University  of  California 


(rl  FT     < 


THE 


MEDICAL  AND  SURGICAL  HISTORY 


OF  THE 


WAR  OF  THE  REBELLION 


PART    III. 


VOLUME    II. 


SURGICAL    HISTORY. 


Prepared,  under  the  direction  of  JOSEPH  K.  BARNES,  Surgeon  General  United  States  Army. 

BY 

GEORGE  A.  OTIS,  SURGEON  UNITED  STATES  ARMY, 

AND 

D.  L.  HUNTINGTON,  SURGEON  UNITED  STATES  ARMY. 


SIEOOHSTID    ISSTJIE. 


WASHINGTON: 

GOVERNMENT    PRINTING    OFFICE. 

1883. 


u 


2-2, 


WAR  DEPARTMENT, 

SURGEON  GENERAL'S  OFFICE, 

WASHINGTON,  D.  0.,  January  2,  1883. 
Brigadier  General  CHARLES  H.  CRANE, 

Surgeon  General,  U.  S.  Army. 
SIR: 

With  the  present  volume,  which  I  have  the  honor  to  submit  to  you,  the  surgical  series 
of  the  Medical  and  Surgical  History  of  the  War  of  the  Rebellion  is  complete. 

The  treatment  of  regional  injuries  of  gunshot  origin  is  continued,  and  those  of  the 
Lower  Extremities  are  taken  up  and  thoroughly  discussed  in  Chapter  X.  Miscellaneous 
Injuries  not  strictly  gunshot  in  character,  but  incident  to  the  military  status,  form  the  sub 
ject  of  Chapter  XI.  Chapter  XII,  on  Wounds  and  Complications,  includes  facts  of  general 
interest  and  of  statistical  value  relative  to  wounds;  to  the  nature,  peculiarities,  and  effects 
of  missiles  and  projectiles;  to  conditions  affecting  the  course  and  results  of  wounds,  with 
especial  reference  to  the  graver  complications  of  secondary  haemorrhage,  erysipelas,  pyaemia, 
gangrene,  and  tetanus;  and,  finally,  a  condensed  summary  of  operations  and  treatment. 
Anaesthetics,  with  reference  to  their  use  in  the  Army,  are  treated  of  in  Chapter  XIII.  A 
brief  historical  sketch  of  the  Medical  Staff,  and  a  description  of  the  Materia  Chirurgica 
will  be  found  in  Chapter  XIV.  The  methods  of  field,  railway,  and  water  transportation 
of  the  wounded  are  detailed  in  the  concluding  Chapter  (XV). 

It  was  attempted,  from  the  inception  of  the  work,  to  give,  in  the  beginning  of  each 
chapter,  the  number  of  cases  to  be  treated  therein.  But,  as  the  work  progressed,  new  cases 
had  to  be  added,  duplicates  had  to  be  eliminated,  or  additional  information  changed  the 
nature  of  a  case,  so  as  to  transfer  it  to  a  group  different  from  the  one  to  which  it  had  been 
originally  assigned.  Thus  the  total  number  of  cases  given  in  the  beginning  of  a  chapter 
was  frequently  found  to  be  incorrect  at  its  close,  and  as  the  preceding  pages  had  been 
stereotyped,  it  was  not  practicable  to  make  the  necessary  corrections.  The  percentages  and 
general  deductions,  however,  were  not  materially  affected  by  these  discrepancies,  which 
have  been  corrected  in  the  summary  of  cases  given  in  Chapter  XII,  in  this  volume. 

In  undertaking  the  completion  of  this  work,  interrupted  by  the  untimely  death  of  its 
distinguished  author,  it  may  be  proper  to  say  that  no  change  in,  or  deviation  from,  the 

m 


PREFATORY. 


original  plan  has  been  attempted;  that,  so  far  as  known,  his  wishes  and  intentions  with 
regard  to  the  arrangement  and  development  of  the  History  have  been  scrupulously  regarded. 
The  work  was  entered  upon,  not  without  serious  misgivings  as  to  the  wisdom  of  the 
choice  of  successor,  and  with  a  full  appreciation  of  the  delicate  nature  of  the  task  and  the 
difficulties  involved  in  its  satisfactory  solution ;  its  prosecution  has  been  a  source  of  pleasure, 
while  the  labor  has  been  materially  lessened  by  the  valuable  assistance  afforded  by  Mr. 
G.  J.  MYERS,  who  has  been  associated  with  the  work  as  colaborer  since  its  inception,  and 
to  whose  faithful  and  assiduous  care  the  reliability  and  accuracy  of  the  History  is  largely 
due.  The  completed  volume  now  awaits  your  approval  and  the  judgment  of  the  profession. 
It  is  hoped  that  its  short-comings  may  not  seriously  impair  or  detract  from  the  beauty  and 
harmony  of  the  masterpiece,  which  must  remain  a  living  monument  to  the  intelligent 
industry,  perseverance,  and  professional  learning  of  the  late  Surgeon  GEORGE  A.  OTIS. 

I  am,  sir, 

Very  respectfully, 

Your  obedient  servant, 

D.  L.  HUMTNGTON, 

Surgeon,  U.  S.  Army. 


IV 


TABLE   OF    CONTENTS 

OF 

PART  III  OF  VOLUME  II 


OF  THK 


MEDICAL  AND  SURGICAL  HISTORY  OF  THE  REBELLION, 


BEING   THE 


THIRD    SURGICAL    VOLUME. 


CHAPTER   X.     WOUNDS   AND   INJURIES   OF  THE   LOWER    EXTREMITIES. 


Page. 

INTRODUCTION 1 

TABLE  I.  Collated  returns,  indicating  the  relative  fre 
quency  of  shot  wounds  of  the  lower  extremity  in 

aggregates  of  wounded  men  who  came  under  treatment  2 

TABLE  II.  Partial  numerical  statement  of  shot  wounds 
of  the  lower  extremities  in  the  field  or  primary  hospitals 
in  various  campaigns  during  the  last  year  of  the  war, 

1864-'C5 3 

SECTION  I.     Flesh  Wounds  of  the  Lower  Extremities . . .  5 

Punctured  and.  Incised  wounds 5 

Bayonet  wounds 5 

Abstracts  of  four  cases 6 

Sabre  wounds 7 

Other  Punctured  and  Incised  wounds 7 

Legations 7 

Abstracts  of  three  cases 7 

Amputations 8 

Abstracts  of  four  cases 8 

Shot  Flesh  wounds 8 

Flesh  wounds  of  the  Lower  Limbs  with  injury  of  the 

Nerves 9 

Abstracts  of  seven  cases 10 

Flesh  wounds  of  the  Lower  Limbs  with  injury  of  the 

Larger  Blood-vessels 13 

Wounds  of  Blood-vessels  treated  without  operation  13 

Abstracts  of  six  cases 13 

Wounds  of  Blood-vessels  treated  by  ligation 16 

Abstract  of  one  case 16 

Wounds  of  Blood-vessels  treated  by  amputation ....  17 

Abstracts  of  two  cases 17 

PLATE  XXVIII.  Gangrene  following  a  shot  lacera 
tion  of  the  Femoral  Artery,  facing 18 

Wounds  of  Blood-vessels   treated   by  ligation   and 

subsequent  amputation 18 

Abstract  of  one  case 18 

Flesh  wounds  of  the  Lower  Limbs  unattended  by 
Primary  injury  of  the  Large  Nerves  and  Blood 
vessels  IS 

Shot  Lacerations 19 

Abstracts  of  five  cases 19 

Lodgement  of  Missiles 21 

Abstracts  of  six  cases 21 

Peri-articular  wounds.  Hij>,  Knee,  and  Ankle 24 

Abstracts  of  twenty-nine  cases 25 

PLATE  LVI.    Dry  Traumatic  Arthritis  of  the  Right 

Hip,  facing 27 


Pet 


SECTION  I.    SHOT  FLK.SII  WOUNDS—  [Continued. 

Complications   of   Shot  Flesh  wounds  of  the 
Lower  Extremities  ............................. 

Pyaemia  ........................................ 

Abstracts  of  three  cases  ....................... 

Hospital  0  ungrene  ................................ 

Abstracts  of  three  cases  ....................... 

Tetanus  ......................................... 

Abstracts  of  three  cases  ....................... 

Erysipelas  ....................................... 

Abstracts  of  two  cases  ........................ 

Haemorrhage  ..................................... 

Abstracts  of  two  cases  ..................... 

Ligations  of  Blood-vessels  of  the  Lower  Limbs 
after  Flesh  wounds  .......................... 

Ligations  of  the  Common  Iliac  Artery  .......... 

Abstract  of  one  case  ......  ................. 

Ligations  of  the  External  Iliac  Artery  .......... 

Abstracts  of  eleven  cases  .................. 

Ligations  of  the  Femoral  Artery  ............... 

Abstracts  of  seven  cases  ................... 

TABLE  III.    Summary  of  one  hundred  and 
twenty  -seven    cases    of  ligations    of   the 
Femoral  Artery  .....   ................... 

Ligations  of  the  Profunda  Artery  .............. 

Abstracts  of  six  cases  ..................... 

Ligations  of  large    branches  of   the   Profunda 
Artery  ..................................... 

Abstracts  of  three  cases  .................. 

Ligations  of  the  Popliteal  Artery  .............. 

TABLE  IV.     Summary  of  seventeen  cases  of 
ligations  of  the  Popliteal  Artery  .......... 

A  bstract  of  one  case  .................. 

Ligations  of  the  Posterior  Tibial  Artery  ........ 

TABLE  V.     Summary  of  seventeen  cases  of 
ligations  of  the  Posterior  Tibial  Artery.  ... 

Ligations  of  the  Anterior  Tibial  Artery  ........ 

Abstracts  of  ten  cases  .................... 

Ligations  of  the  Anterior  and  Posterior  Tibial 
Arteries  .................................... 

Abstracts  of  two  cases  ..................... 

Ligations  of  Veins  ............................ 

Abstract  of  one  case  ..................... 

Amputations  in  the  Lower  Limbs  after  Shot 
Flesh  wounds  ................................... 

Amputations  in  the  Thigh  ......................... 

Abstracts  o(  tivo  cases  ........................ 


32 
32 
32 
33 
33 
35 
36 
37 
37 
37 
i!8 

38 
39 
39 
39 
39 
43 
43 


47 

49 
49 

50 
50 
50 

50 
51 
51 

51 
51 
51 

52 
52 


TABLE    OF    CONTENTS. 


CHAPTER  X.     WOUNDS  AND  INJURIES  OF  THE   LOWER   EXTREMITIES— CONTINUED 


i'age. 
SECTION  I.— FLESH  WOUNDS,  ETC.— [Continued. 

PLATE    XXVII.      Effects  of    Hospital   Grangrene, 

facing 53 

TABLE  VI.   Summary  of  one  hundred  and  thirty- 
one  amputations  in  the  Thigh 54 

Amputations  at  the  Knee 56 

TABLE  VII.     Summary  of  six  cases  of  amputa 
tions  at  the  Knee 50 

Amputations  in  the  Leg 57 

Abstracts  of  two  cases 57 

TABLE  VIII.     Summary  of  sixty-three  amputa 
tions  in  the  Leg 57 

Amputations  of  the  Toes 51) 

Abstract  of  one  case 59 

Tenotomy 59 

Abstracts  of  three  cases 59 

SECTION  II.     Wounds  and  Injuries  of  the  Hip  Joint. .  61 

Shot  fractures  at  the  Hip  Joint 61 

TABLE  IX.     Tabular  statement  of  three  hundred  and 

eighty-six  shot  fractures  of  the  Hip  Joint 65 

Shot  fractures  at  the  Hip  treated  by  conservation  ...  66 

Recoveries 67 

Abstracts  of  twenty-one  cases 67 

PLATE  LVII.    G  unshot  fracture  of  the  Right  Ace- 

tabulum  and  the  Head  of  the  Femur,  facing. . .  68 
PLATE  XXXIII.     Consolidated  gunshot  fracture 

of  the  Femur,  facing 74 

Fatal  cases 77 

Abstracts  of  fifty-two  cases - .  77 

Excision  at  the  Hip  Joint  after  shot  injury 89 

TABLE  X.    Numerical  statement  of  sixty-six  cases 

of  excision  at  the  Hip  Joint  for  shot  injury. ...  89 

Primary  excisions  at  the  Hip  Joint 92 

Abstracts  of  thirty-three  cases 92 

TABLE  XI.     Summary  of  thirty-three  cases.  99 

Intermediary  excisions  at  the  Hip  Joint 101 

Abstracts  of  twenty-two  cases 101 

TABLE  XII.    Summary  of  twenty-two  cases.  Ill 

Secondary  excisions  at  the  Hip  Joint 113 

Abstracts  of  eleven  cases )  1  •) 

TABLE  XIII.    Summary  of  eleven  cases  ...  119 
Excisions  at  the  Hip  Joint  for  shot  injury  in  the 

United  States  service  since  the  war 120 

Abstracts  of  six  cases 120 

Amputations  at  the  Hip  Joint .  .  .  127 

TABLE  XIV.     Numerical  statement  of  sixty-six 

cases  of  amputation  at  the  Hip  Joint 127 

Primary  amputations  at  the  Hip  Joint 131 

Abstracts  of  twenty-five  cases 13L 

TABLE  XV.     Summary  of  twenty-five  cases  138 

Intermediary  amputations  at  the  Hip  Joint J39 

Abstracts  of  twenty-three  cases 139 

TABLE   XVI.     Summary   of  twenty-three 

cases 144 

Secondary  amputations  at  the  Hip  Joint 145 

Abstracts  of  nine  cases 145 

TABLE  XVII.     Summary  of  nine  cases 151 

Ke  amputations  at  the  Hip  Joint !52 

Abstracts  of  nine  cases 152 

TABLE  XVIII.     Summary  of  nine  cases .  ...  159 

SECTION  III.     Injuries  in  the  Shaft  of  the  Femur  .         .  icy 

Shot  contusions  of  the  Shaft  of  the  Femur    . .  169 
TABLE  XIX.     Numerical  statement  of  one  hundred 
and  sixty-two  cases  of  shot  contusions  of  the  Shaft 

of  tins  Femur    170 

Abstracts  of  four  cases 170 

Legations  after  shot  contusions  of  the  Femur 172 

Abstracts  of  eight  cases 172 

Amputations  consequent  on   shot  contusions   of  the 

Femur ....  172 

Abstracts  of  nine  oases 17:) 

Shot  fractures  of  the  Shaft  of  the  Femur  ...  174 
TABLE  XX.     Numerical  statement  of  sixty -five  hun 
dred  and  seventy-six  shot  fractures  of  the  Shaft  of 

the  Femur 175 

VI 


Page. 
SECTION  III.— INJURIES  OF  FEMUK— [Continued. 

Partial  shot  fractures  of  the  Shaft  of  the  Femur 175 

Abstracts  of  two  cases 176 

Shot  fractures  of  the  Shaft  of  the  Femur  treated  by 

conservation 176 

Shot  fractures  of  the  upper  third  of  the  Shaft  of 

the  Femur 177 

Recoveries  (abstracts  of  thirteen  cases) 178 

PLATE  LIX.     Consolidated  gunshot  fractures  of  the 

Femur,  facing 178 

PLATE  LVIII.     Consolidated  gunshot  fractures  of  the 

Femur,  facing 180 

PLATE  LV.  Two  views  of  a  united  shot  fracture  of  the 

Right  Femur  over  eleven  years  after  injury,  facing  182 

Fatal  cases  (abstracts  of  seven  cases) 184 

PLATE  XXV.     Secondary  inflammation  of  the  Knee 

Joint,  facing 184 

Shot  fractures  of  the  middle  third  of  the  Femur 

treated  by  conservation 1 87 

Recoveries  (abstracts  of  eleven  cases) 187 

PLATE  LX.     Consolidated  gunshot  fractures  of 

the  Femur,  facing 188 

PLATE  LXI.     Consolidated  gunshot  fractures  of 

the  Femur,  facing 190 

Fatal  cases  (abstracts  of  five  cases) 191 

PLATE  LXII.     Consolidated  gunshot  fractures  of 

the  Femur,  facing 192 

PLATE  XXIV.     Osteomyelitis  in  a  fractured  Fe 
mur,  facing 194 

Shot  fractures  of  the  lower  third  of  the  Femur 

treated  by  conservation 1 94 

Recoveries  (abstracts  of  eight  cases) 194 

PLATE  LXIII.     Consolidated  gunshot  fractures 

of  the  Femur,  facing 19(> 

Fatal  cases  (abstracts  of  three  cases) 197 

PLATE  LX1V.     Consolidated  gunshot   fractures 

of  the  Femur,  facing 1 98 

Shot  fractures  of  the  Femur,  without  indication 

of  the  seat  of  injury,  treated  by  conservation  I'Jtf 
Pseudarthrosis  after  shot  fractures  of  the  Fe 
mur  1 1:8 

Abstracts  of  two  cases 1 98 

Excisions  in  the  continuity  of  the  Femur  for 

.shot  injury l'J9 

TABLE  XXI.  Numerical  statement  of  one  hundred 
and  seventy-five  excisions  in  the  Shaft  of  the  Fe 
mur  for  shot  injury 2UU 

Primary  excisions  in  the  Shaft  of  the  Femur 2CO 

Recoveries  (abstracts  of  four  cases) 200 

TABLE  XXII.     Summary  of  twenty  cases  of  re 
covery  20:1 

PLATE  XXX.     Obstructed  femoral  vein,  facing..  2U4 

Fatal  cases  (abstracts  of  five  cases) 204 

TABLE  XX1I1.    Summary  of  sixty-five  fatal  cases  200 

Undetermined  cases 207 

TABLE  XXIV.     Summary  of  six  cases  with  un 
known  results ~07 

Intermediary  excisions  in  tlie  Shaft  of  the  Femur  207 
Recoveries  (abstracts  of  two  cases)     .  '-'07 
TABLE   XXV.     Summary   of  nine   cases   of  re 
covery  208 

Fat:.!  i  ;ises  (abstracts  of  three  cases) 209 

TABLE   XXVI.      Summary   of  thirty-nine   fatal 

cases 210 

Secondary  excisions  in  the  Shaft  of  the  Femur  210 

Recoveries  (abstracts  of  two  cases)  210 

Fatal  cases  (abstract  of  one  case) 211 

TABLE  XXVII.     Summary  of  nineteen  cases  212 
Excisions  in  the  Shaft  of  the  Femur  at  an  unknown 

period 212 

TABLE  XXVIII.     Summary  of  seventeen  cases  212 

Amputations  in  the  Shaft  of  the  Femur. .  213 
TABLE   XXIX.     Numerical   statement   of  sixty-two 
hundred  and  twenty-nine  amputations  of  the  Thigh 

for  shot  injury 213 


TABLE    OF    CONTENTS. 


CHAPTER  X.     WOUNDS   AND   INJURIES  OF   THE   LOWER   EXTREMITIES-CONTINUED 


Page 
SECTION  III. — INJURIES  OF  FEMUR — [Continued. 

Primary  amputations  in  the  Shaft  of  the  Femur  ....     214 
Primary  amputations  in   the  upper  third  of  the 

Femur 214 

Successful  cases  (abstracts  of  four  cases) ....     215 

Fatal  cases  (abstracts  of  three  cases) 216 

TABLE  XXX.    Summary  of  five  hundred  and 

thirty-three  cases 

Primary  amputations  in  the  middle  third  of  the 

Femur 223 

Successful  cases  (abstracts  of  five  cases) 223 

PLATE  LXIX.     Tubular  sequestra  from  am 
putations  of  the  Femur,  facing 

Fatal  cases  (abstracts  of  five  cases) 

PLATE  XXXII.    Diseased  stump  of  Femur, 

facing 226 

TABLE  XXXI.   Summary  of  eleven  hun 
dred  and  fifty -seven  cases 227 

PLATE  XXXI.    Gangrene  of  the  Medulla  . .     228 
Primary  amputations  in  the  lower  third  of  the 

Femur 241 

Successful  cases  (abstracts  of  seven  cases) . .     241 
PLATK   LXX.       Involucra  of   the  Femur, 

facing 242 

Fatal  cases  (abstracts  of  two  cases) 244 

TABLE  XXXII.     Summary  of  nineteen  hun 
dred  and  fourteen  cases 245 

Primary  amputations  in  the  Femur  without  in 
dication  of  the  seat  of  incision : 

TABLE  XXXIII.     Summary  of  three   hun 
dred  and  forty-five  cases 268 

Intermediary  amputations  in  the  Shaft  of  the  Femur.     272 
Intermediary  amputations  in  the  upper  third  of 

the  Femur 272 

Successful  cases  (abstracts  of  four  cases) 272 

Fatal  cases  (abstract  of  one  case) 274 

TABLE  XXXIV.     Summary  of  one  hundred  and 

forty-seven  cases 275 

Intermediary  amputations  in  the  middle  third  of  the 

Femur 277 

Successful  cases  (abstracts  of  four  cases) 277 

PLATE  XXVI.     Osteomyelitis  of  Femur,  facing.     278 

Fatal  cases  (abstracts  of  two  cases) 279 

TABLE  XXXV.     Summary  of  four  hundred  and 

seventy-one  cases 280 

PLATE  XLII.    Round  musket  ball  in  the  medul 
lary  cavity  of  the  Femur,  facing 280 

Intermediary  amputations  in  the  lower  third  of  the 

Femur 287 

Successful  cases  (abstracts  of  five  cases) 287 

Fatal  cases  (abstracts  of  five  cases) 289 

PLATE  XLIII.    Results  of  Osteomyelitis,  facing  .     290 
PLATE  XXI.       Gangrene  of  a   Thigh   Stump, 

facing 292 

TABLE  XXXVI.    Summary  of  six  hundred  and 

seventy-six  cases 293 

PLATE  XX.     Femoral  artery  and  Femoral  rein 

after  amputation,  facing 294 

Intermediary  amputations  in  the  Femur  without  in 
dication  of  the  seat  of  incision 303 

TABLE  XXXVII.   Summary  of  twenty-six  cases.     304 
Secondary  amputations  in  the  Shaft  of  the  Femur. . .     304 
Secondary  amputations  in  the  upper  third  of  the  Fe 
mur  304 

Successful  cases  (abstracts  of  four  cases) 304 

Fatal  cases  (abstracts  of  three  cases) 306 

PLATK  LXVI.    Shot  fracture  of  the  middle  third 

of  the  Femur,  facing 306 

TABLE  XXXVIII.     Summary  of  fifty-five  cases.     308 
Secondary  amputations  in  the  middle  third  of  the  Fe 
mur 3C9 

Successful  cases  (abstracts  of  five  cases) 309 

Fatal  cases  (abstracts  of  three  cases) 311 

PLATE  XXIII.     Separation  of  Periosteum  in  Os 
teomyelitis,  facing 312 


Page. 


SECTION  III.— INJURIES  OF  FEMUR— (Continued. 

TABLE  XXXIX.     Summary  of  one  hundred  and 

sixty-eight  cases 313 

PLATE  XLIX.     Medullary  abscesses  of  the  Fe 
mur,  facing 314 

Secondary  amputations  in  the  lower  third  of  the  Femur    316 

Successful  eases  (abstracts  of  four  cases) 316 

PLATE  LXXII.     Involucra  of  bones  of  the  Leg, 

facing 317 

Fatal  cases  (abstracts  of  two  cases) 318 

TABLE  XL.     Summary  of  two  hundred  and  seven 

cases 320 

Secondary  amputations  of  Thigh,  point  of  ablation 

not  specified 323 

Abstract  of  one  fatal  case 323 

TABLE  XLI.     Summary  of  twelve  cases 323 

Amputations  in  the  continuity  of  the  Femur 

of  uncer t  ain  date 324 

Amputations  in  the    upper   third  of  the  Femur  of 

uncertain  date 324 

TABLE  XLII.     Summary  of  thirty-three  cases..     324 
Amputations  in  the  middle  third  of  the   Femur  of 

uncertain  date 324 

TABLE  XLIII.     Summary  of  seventy  cases 325 

Amputations  in  the  lower  third  of  the  Femur  of  un 
certain  date 326 

TABLE  XLIV.      Summary  of  one  hundred  and 

four  cases 326 

Amputations   in  the  Femur  of  uncertain  date,  and 

seat  of  operation 327 

TABLE  XLV.     Summary  of  three  hundred  and 

eleven  cases 327 

Recapitulation 331 

TABLE  XLVI.  Tabular  statement  indicating  the 
seats  of  injury  in  six  thousand  two  hundred  and 

twenty-nine  amputations  in  the  Thigh 332 

TABLE  X  LVII.  Results  of  amputations  of  the  Thigh 
on  the  occasions  named  and  from  the  authorities 

quoted 334 

Concluding  observations  on   shot  injuries  of 

the  Femur 335 

TABLE  XLVIII.  Results  of  shot  fractures  of  the  Fe 
mur  treated  by  conservation  on  the  occasions  named 

and  from  the  authorities  quoted 336 

TABLE  XLIX.  Summary  of  twenty-one  ligations  of 
the  Femoral  artery  in  cases  of  shot  fractures  of  the 

Femur  treated  by  conservation 353 

TABLE  L.     Numerical  statement  of  Union  and 
Confederate  soldiers  treated  by  conservation 

after  shot  fracture  of  the  Femur 355 

Excisions  in  the  Shaft  of  the  Femur 355 

Amputations  in  the  Thigh 355 

PLATE  LXX  III.     Thigh  stumps,  facing 356 

TABLE  LI.  Statement  of  the  ages  of  six  thousand 
two  hundred  and  nine  patients  who  submitted  to 
amputation  of  the  Thigh  for  shot  injury 358 

SECTION  IV.    Wounds  and  Injuries  of  the  Knee  Joint  ..  359 

Punctured  and  incised  wounds 359 

Punctured  wounds  (abstracts  of  ten  cases) 360 

Incised  wounds 361 

Incised  wounds  treated  without  operative  inter 
ference  3<>1 

Abstracts  of  ten  cases 361 

Amputations  in  tho  Thigh  after  incised  wounds. .  362 

Abstracts  of  six  cases 362 

Shot  injuries  of  the  Knee  Joint 363 

Shot  contusions  of  the  Knee  Joint 363 

Treated  by  conservation 364 

Recoveries  (abstracts  of  ten  cases) 364 

Fatal  cases  (abstracts  of  six  cases) 365 

Treated  by  amputation 367 

Shot  fractures  of  the  Knee  Joint 367 

TABLE  LII.    Numerical  statement  of  thirty-three 
hundred  and  fifty-five  cases  of  shot  fractures 

of  tho  bones  of  the  Knee  Joint 3C7 

VII 


TABLE    OF    CONTENTS. 


CHAPTER    X.     WOUNDS  AND   INJURIES   OF   THE    LOWER    EXTREMITIES— CONTINUED. 


Page. 
SECTION  IV. — INJURIES  OF  KNEE  JOINT — [Continued. 

Shot  fractures  of  the  Knee  Joint  treated  by  con 
servation  3(>8 

Recoveries  (abstracts  of  twenty-three  cases).  369 
PLATE  LXVIII.     Results  of  shot  injuries  of 

the  Knee  Joint,  facing1 '.!70 

PLATE  LXVII.     Hall  lodged  in  outer  con- 

dyle  of  Left  Femur  over  15  years,  facing. . .  1(72 

Fatal  oases  '  abstracts  of  fifteen  cases) 380 

Excisions  at  the  Iviiee  Joint  for  shot  injury  . .  384 
TABLE  LIU.     Classified  statement  of  fifty- 
seven  cases  of  excisions  at  the  Knee  Joint 

for  shut  fracture 335 

Primary  excisions  at  the  Knee  Joint 1)86 

Abstracts  of  thirty-two  cases 386 

PLATE  LXV.     Successful  excisions  of  the 

Knee  Joint  after  shut  injury,  facing 386 

Intermediary  excisions  at  the  Knee  Joint  . . .  391 

Abstracts  of  thirteen  cases 391 

Secondary  excisions  at  the  Knee  Joint 394 

Abstracts  of  seven  cases 394 . 

Excisions  at  the  Knee  Joint  of  uncertain  date  397 

Abstracts  of  five  cases 397 

Amputation  at  the  Knee  Joint 397 

TABLE  LIV.    Summary  of  one  hundred  and 
eighty-nine  amputations  at  the  Knee  Joint 

for  shot  fracture 398 

Primary  amputations  at  the  Knee  Joint   ....  398 

Abstracts  of  five  cases 399 

TABLE  LV.     Summary  of  one  hundred 

and  eight  cases 401 

Intermediary  amputations  at  the  Knee  Joint  404 

Abstracts  of  five  cases 404 

TABLE    LVI.     Summary    of   fifty -one 

cases 405 

Secondary  amputations  at  the  Knee  Joint   . .  407 

Abstracts  of  four  cases 407 

TABLE  LVII.     Summary  of  twenty-six 

cases 409 

Amputations  at  the  Knee  Joint  of  uncertain 

date 410 

TABLE  LVIII.     Summary  of  four  cases  410 
Concluding  observations  on  shot  injuries 

of  the  Knee  Joint 411 

TABLE  LIX.     Shot  wounds  of  the  Knee  Joint 
treated  by  conservation  on  the  occasions  named 

and  from  the  authorities  quoted 417 

Excisions  at  the  Knee  Joint  419 

TABLE  LX.    Excisions  at  the  Knee  Joint  for 
shot  injury  on  the  occasions   named  and 

from  the  authorities  quoted 422 

Amputations  at  the  Knee  Joint 423 

SECTION  V.     Wounds  and  Operations  in  the  Leg 427 

Shot  contusions  of  the  bones  of  the  Leg. 427 

Treated  by  conservation  427 

Recoveries  (abstracts  of  six  cases) 427 

PLATE  LXXI.     Tubular  sequestra  and  pieces  of 

necrosed  bone  from  tibia,  facing 428 

Deaths  (abstracts  of  three  cases) 430 

Followed  by  amputation 430 

Abstracts  of  eight  cases  431 

Shot  fractures  of  the  Bones  of  the  Leg 432 

TABLE  LXI.  Descriptive  numerical  statement  of 
the  nature  and  treatment  of  eight  thousand  nine 
hundred  and  eighty-eight  shot  fractures  of  the 

bones  of  the  Log 433 

Shot  fractures  of  the  bones  of  the  Log  treated  by  con 
servation 432 

Shot  fractures  of  the  Tibia  treated  by  conservation  433 

Recoveries  (abstracts  of  nine  cases) 433 

PLATE   LXXIV.      Upper   portion   of   right 

Tibia  sawn  longitudinally,  facing 434 

Deaths  (abstracts  of  three  cases) 436 

Shot  fractures  of   the   Fibula  treated  by  con 
servation  .  437 


SECTION  V.— WOUNDS  OF  LEG— [Continued. 

Recoveries  (abstracts  of  two  cases) 437 

Deaths  (abstract  of  one  case) 437 

Shot  fractures  of  both   bones  treated  by  con 
servation  438 

Recoveries  (abstracts  of  eight  cases) 438 

Deaths  (abstracts  of  three  cases) 441 

Excisions  in  the  continuity  of  the  bones  of  the 

Leg  for  shot  injury 444 

TABLE  LXII.     Numerical    statement  of   three 
hundred   and    eighty-seven    excisions   in    the 

bones  of  the  Leg  for  shot  fracture 445 

Primary  excisions  in  the  bones  of  the  Leg 445 

Abstracts  of  nine  cases 445 

TABLE  LXIII.     Summary  of  two  hundred 

and  fifteen  cases 449 

Intermediary  excisions  in  the  bones  of  the  Leg. .     453 

Abstracts  of  six  cases 453 

TABLE   LX1V.     Summary  of  eighty-seven 

cases 455 

Secondary  excisions  in  the  bones  of  the  Leg. . . .     456 

Abstracts  of  four  cases 456 

TABLE  LXV.     Summary  of  fifty  cases 458 

Excisions  in  the  bones  of  the  Leg  of  uncertain 

date 459 

TABLE  LXVI.    Summary  of  thirty-five  cases    460 
Amputations  in  the  continuity  of  the  Leg  for 

shot  fracture 4liO 

TABLE  LXVII.     Numerical  statement  of  fifty- 
four  hundred  and  fifty-two  amputations  of  the 

Leg  for  shot  injury 461 

Primary  amputations  in  the  continuity  of  the  Leg 

for  shot  injury 46] 

Primary  amputations  in  the  upper  third  of 

the  Leg 461 

Abstracts  of  ten  cases 461 

TABLE  LXVIII.    Summary  of  one  thou 
sand  and  twenty-nine  cases 466 

Primary  amputations  in  the  middle  third  of 

the  Leg 478 

Abstracts  of  eight  cases 478 

PLATE    LXXVI.      Laceration   of   right 

Leg  by  solid  shot,  facing 478 

TABLE  LXIX.     Summary  of  eight  hun 
dred  and  ninety-two  cases 480 

Primary  amputations  in  the  lower  third  of 

the  Leg 491 

Abstracts  of  eight  cases 491 

TABLE  LXX.      Summary  of  nine  hun 
dred  cases 494 

Primary  amputations   in   the  Leg — seat  of 

operation  not  indicated 505 

Successful  cases  (abstracts  of  four  cases)     505 
Fatal  cases  (abstracts  of  two  cases)  ....     506 
TABLE  LXX1.      Summary  of  five  hun 
dred  and  seventy-one  cases 506 

Intermediary  amputations  in  the  continuity  of  the 

Leg  for  shot  injury 512 

Intermediary  amputations  in  the  upper  third 

of  the  Leg 513 

Successful  cases  (abstracts  of  six  cases) .     513 
Fatal  cases  (abstracts  of  three  cases) .  . .     514 
TABLE  LXX1I.     Summary  of  two  hun 
dred  and  ninety-six  cases  515 

Intermediary  amputations  in  the  middle  third 

of  the  Leg 519 

Successful  cases  (abstracts  of  five  cases)     520 
Fatal  cases  (abstracts  of  throe  cases)    . . 
TABLE   LXXIII.      Summary  of   three 

hundred  and  sixty-eight  cases. 

Intermediary  amputations  in  the  lower  third 

of  the  Leg. 508 

Successful  cases  (abstracts  of  six  cases)    528 
Fatal  cases  (abstracts  of  four  cases) ....     529 
TABLE    LXXIV.      Summary  of   three 
hundred  and  thirty-five  cases 531 


VIII 


TABLE    OF    CONTENTS. 


CHAPTER  X.     WOUNDS  AND  INJURIES  OF  THE  LOWER   EXTREMITIES— CoxTrxuED. 


Page. 
SECTION  V.— WOUNDS  OF  LEG— [Continued. 

Intermediary  amputations  in  the  Log — point  of 

operation  not  specified 536 

Abstracts  of  two  examples 536 

TABLE  LXXV.     Summary    of   forty-seven 

cases 536 

Secondary  amputations  in  the  continuity  of  the  Leg 

for  shot  injury 537 

Secondary  amputations  in  the  upper  third  of  the 

Leg 537 

Examples  of  recovery  (abstracts  of  five  cases)    537 

Fatal  cases  (abstracts  of  four  cases) 539 

TABLE  LXXVI.     Summary  of  one  hundred 

and  thirty-three  cases 541 

Secondary  amputations  in   the  middle  third  of 

the  Leg 544 

Recoveries  (abstracts  of  five  cases) 544 

Fatal  cases  (abstracts  of  three  cases) 546 

TABLE  LXXVII.    Summary  of  one  hundred 

and  seventy-four  cases 547 

Secondary  amputations  in  the  lower  third  of  the 

Leg 550 

Recoveries  (abstracts  of  three  cases) 550 

Fatal  cases  (abstracts  of  three  cases) 551 

TABLE  LXXVIII.     Summary  of  one  hun 
dred  and  twenty-one  cases 552 

Secondary  amputations  in   the   Leg — third  not 

indicated 554 

Recoveries  (abstract  of  one  case) 554 

Fatal  cases  (abstract  of  one  case) 554 

TABLE  LXXIX.    Summary  of  sixteen  cases    555 
Amputations  in  the  continuity  of  the  Leg  of  uncer 
tain  date 555 

Amputations  in  the  upper  third  of  the  Leg  of 

uncertain  date 555 

TABLE  LXXX.    Summary  of  fifty-one  cases    555 
Amputations  in  the  middle  third  of  the  Leg  of 

uncertain  date 556 

TABLE  LXXXI.     Summary  of  forty-seven 

cases 556 

Amputations  in  the  lower  third  of  the  Leg  of 

uncertain  date 557 

TABLE    LXXXII.     Summary  of  fifty-one 

cases 557 

Amputations  in  the  Leg  of  uncertain  date  and 

seat  of  operation 558 

TABLE  LXXXIII.     Summary  of  four  hun 
dred  and  twenty-one  cases 558 

Recapitulation 563 

Concluding    observations    on    shot   fractures 

of  the  Bones  of  the  L.eg 563 

TABLE  LXXXIV.     Results  of  shot  fractures  of  the 
bones  of  the  Leg  treated  by  conservation  on  the 
occasions  named  and  from  the  authorities  quoted. .     564 
Excisions  in  the  continuity  of  the  bones  of  the  Leg. .     569 
TABLE  LXXXV.     Results  of  shot  fractures  of 
the  bones  of  the  Leg  treated  by  excision  on  the 
occasions  named  and  from  the  authorities  quoted    570 

Amputations  in  the  Leg 572 

TABLE  LXXXVI.  Summary  of  seven  thousand 
six  hundred  and  thirty-seven  amputations  in  the 
Leg  for  shot  injuries  on  the  occasions  named  and 
from  the  authorities  quoted 573 

SECTION  VI.    Wounds  and  Operations  at  the  Ankle  Joint   577 

Shot  contusions  of  the  Ankle  Joint 577 

Shot  contusions  of   the  bones  of  the  Ankle  Joint 

treated  by  conservation 577 

Abstracts  of  seven  cases 577 

Shot  fractures    of    the    Bones   of  the  Ankle 

Joint 578 

TABLE  LXXXVII.     Summary  of  one  thousand  seven 
hundred  and  eleven  shot  fractures  of  the  Tibio- 

tarsal  Articulation - 578 

Shot  fractures  of  the  bones  of  the  Ankle  Joint  treated 

by  conservation 579 

Abstracts  of  twenty  cases 579 

9* 


Pnj-o. 
SECTION  VI.— WOUNDS  OK  AXKLE  JOINT— [Continued. 

Excisions  at  the  Ankle  Joint  for  shot  ir\jury. ..  585 
TABLE   LXXXVIII.      Numerical    statement   of 
thirty-three  excisions  at  the  Ankle  Joint  for 

shot  injury 535 

Primary  excisions  at  the  Ankle  Joint 5S6 

Abstracts  of  eleven  cases 580 

Intermediary  excisions  at  the  Ankle  Joint 588 

Abstracts  of  eight  cases 588 

Secondary  excisions  at  the  Ankle  Joint 531 

Abstracts  of  nine  cases 501 

Excisions  at  the  Ankle  Joint — time  between  the 

injury  and  operation  unknown 594 

Abstracts  of  five  cases 594 

Amputations  at  the  Ankle  Joint 595 

TABLE  LXXXIX.     Numerical  table  of  one  hun 
dred  and  sixty-one  amputations  at  the  Ankle 

Joint  for  shot  injury 595 

Primary  amputations  at  the  Ankle  Joint 595 

PLATE    LXXV.     Amputations  at  the   Ankle  Joint, 

facing 59R 

Successful  cases  (abstracts  of  eight  cases) . .  596 

Fatal  cases  (abstracts  of  four  cases) 598 

TABLE  XC.     Summary  of  one  hundred  and 

three  cases 599 

Intermediary  amputations  at  the  Ankle  Joint 603 

Successful  cases  (abstracts  of  five  cases) . . .  603 

Fatal  cases  (abstracts  of  two  cases) 604 

TABLE  XCI.     Summary  of  thirty -nine  cases  605 

Secondary  amputations  at  the  Ankle  Joint 006 

Abstracts  of  two  cases 606 

TABLE  XCII.     Summary  of  thirteen  cases.  607 

Amputations  at  the  Ankle  Joint  of  uncertain  date  fi08 

TABLE  XCIII.     Summary  of  six  cases 608 

Concluding  observations  on  shot  injuries  of 

the  Ankle  Joint 608 

Excisions  at  the  Ankle  Joint  for  shot  injury 610 

TABLE  XCIV.     Results  of  excisions  at  the 
Ankle   Joint  on   the  occasions    named  and 

from  the  authorities  quoted 610 

Amputations  at  the  Ankle  Joint 612 

TABLE  XCIV.     Results  of  amputations  at 
the  Ankle  Joint  on  the  occasions  named 

and  from  the  authorities  quoted 614 

SECTION  VII.    Wounds  and  Operations  in  the  Foot err 

Bayonet  wounds  of  the  Bones  of  the  Foot...     617 
Shot  wounds  of  the  Bones  of  the  Foot 617 

Shot  contusions  of  the  bones  of  the  Foot 617 

Abstracts  of  two  cases 617 

Shot  fractures  of  the  bones  of  the  Foot 618 

TABLE  XCV.     Summary  of  five  thousand  eight 
hundred  and  thirty-two  shot  fractures  of  the 

bones  of  the  Foot 618 

Shot  fractures  of  the  bones  of  the  Foot  treated 

by  conservation 618 

Abstracts  of  sixteen  cases 61 !) 

Excisions  in  the  Bones  of  the  Foot 622 

TABLE    XCVI.      Numerical    statement    of 
ninety-seven  cases  of  excisions  in  the  bones 

of  the  Foot 

Primary  excisions  in  the  bones  of  the  Foot. . 

Abstracts  of  seven  cases 

Intermediary  excisions  in  the  bones  of  the 

Foot 624 

Abstracts  of  four  cases 624 

Secondary  excisions  in  the  bones  of  the  Foot    625 

Abstracts  of  two  cases C25 

TABLE  XCVII.     Summary  of  ninety-seven 
cases  of  excisions  in  the  bones  of  the  Foot    626 

Amputations  in  the  Foot 

TABLE   XCV1II.     Numerical   statement   of 
one  thousand  five  htimlrcd  and  eighteen 

cases  of  amputations  in  the  Foot 628 

Primary  amputations  in  the  Foot 628 

Abstracts  of  ten  cases C28 

IX 


TABLE    OF    CONTENTS. 


CHAPTER   X.      WOUNDS  AND  INJURIES  OF  THE   LOWER   EXTREMITIES— CONTINUED. 


Page. 
SECTION  VII.— WOUNDS  OF  FOOT— [Continued. 

TABLE  XCIX.     Summary  of  one  hundred 

and  sixty-one  cases 630 

Intermediary  amputations  in  the  Foot C33 

Abstracts  of  three  cases 633 

TABLE  C.     Summary  of  fifty-two  cases.  633 

Secondary  amputations  in  the  Foot 604 

Abstracts  of  two  cases  . .                        .  634 


Tage. 
SECTION  VII.— WOUNDS  OF  FOOT— [Continued. 

TABLE  CI.    Summary  of  eighteen  cases  635 

Amputations  in  the  Foot  of  uncertain  date. .  635 

Abstract  of  one  case 636 

TABLE  CH.     Summary  of  sixty  cases.  636 

Concluding  observations 637 

Excisions  in  the  bones  of  the  Foot 637 

Amputations  in  the  Foot 639 


CHAPTER    XL      MISCELLANEOUS    INJURIES. 


Page. 

SECTION  I.  TABLE  CIII.  Summary  of  one  hundred  ami  seventy- 
one  thousand  five  hundred  and  sixty-five  miscel 
laneous  injuries 640 

TABLE  CIV.    Summary  of  one  thousand  three  hun 
dred  and  thirty-six  deaths  from  various  causes  ....  641 

Burns  and  scalds 641 

Abstracts  of  four  cases 641 

Contusions  and  sprains 642 

Abstracts  of  six  cases 642 

Concussion  and  compression  of  the  Brain 644 

Dislocations 644 

Abstracts  of  fourteen  cases 644 

Simple  and  compound  fractures 649 

Abstracts  of  fifteen  cases 649 

Punctured,  incised,  and  lacerated  wounds 652 

Abstracts  of  nine  cases 652 

Other  accidents  and  injuries 654 

Abstracts  of  six  cases 654 

SECTION  II.     Operations  for  Miscellaneous  Injuries....  657 

Excisions 657 

TABLE  CV.     Numerical  statement  of  forty-five  cases 
of   excisions  following   miscellaneous   injuries  or 

diseases 657 

Abstracts  of  two  cases 657 

TABLE  CVI.     Summary  of  twenty  cases 658 

Amputations 659 

Amputations  in  the  Upper  Extremities 659 

TABLE  CVII.  Numerical  statement  of  one  hun 
dred  and  ninety -five  cases  of  amputations  in 
the  Upper  Extremities  for  disease  or  for  injury 

not  inflicted  by  weapons  of  war 659 


Page. 
SECTION  II. — OPERATIONS  FOR  MISCEL.  INJURIES — [Continued. 

Abstracts  of  three  cases 660 

TABLE  CVIII.    Summary  of  one  hundred  and 

two  cases (561 

Amputations  in  the  Lower  Extremities 664 

TABLE  CIX.  Table  of  five  hundred  and  eighty- 
three  cases  of  amputations  in  the  Lower  Ex 
tremities  for  disease  or  for  injury  not  inflicted 

by  weapons  of  war 664 

Abstracts  of  four  cases 665 

TABLE  CX.  Summary  of  one  hundred  and  forty- 
nine  amputations  in  the  Thigh  for  miscel 
laneous  injuries  or  diseases 666 

Exarticulations  at  the  Knee  Joint 670 

Abstracts  of  four  cases 670 

Amputations  in  the  Leg 670 

Abstract  of  one  case 671 

TABLE  CXI.    Summary  of  two  hundred  and 

fifty-nine  cases 671 

Amputations  in  the  Foot 677 

TABLE  CXII.     Summary  of  fifty-one  cases  677 

Amputations  of  the  Toes 678 

Abstract  of  one  case 678 

legations 679 

Abstracts  of  ten  cases 680 

Operations  on  the  Eye  or  its  appendages 68 1 

TABLE  CXIII.     Summary  of  seventy-six  cases 681 

Operations  on  the  Mouth  and  its  appendages 684 

Operations  on  the  Air  Passages 684 

Operations  on  the  Chest  and  Abdomen 684 

Operations  on  the  Genito-Urinary  organs 684 


CHAPTER   XII.     WOUNDS  AND   COMPLICATIONS. 


Page. 

TABLE  CXIV.    Frequency  of  sabre  and  bayonet  and  shot 
wounds  on  occasions  named  and  from  authorities  quoted .     685 

Sabre  and  Bayonet  Wounds 686 

TABLE  CXV.  Summary  of  nine  hundred  and  twenty- 
two  sabre  and  bayonet  wounds  recorded  during  the 

American  civil  war,  1861-'65 686 

Shot  Wounds .     687 

TABLE  CXVI.  Tabular  statement  of  the  shot  wounds 
of  the  Head,  Face,  and  Neck  recorded  during  the 

American  civil  war 688 

TABLE  CXVII.  Tabular  statement  of  the  shot  wounds 
of  the  Spine,  Chest,  Abdomen,  Pelvis,  aud  Back  re 
corded  during  the  American  civil  war 689 

TABLE  CXVIII.  Tabular  statement  of  the  shot 
wounds  of  the  Upper  and  Lower  Extremities 

recorded  during  the  American  civil  war 690 

TABLE  CXIX.  Table  indicating  percentage  of  fa 
tality  and  relative  frequency  of  shot  wounds  re 
corded  during  the  War  of  the  Rebellion 691 

TABLE  CXX.  Tabular  statement  of  the  relative  fre 
quency  of  shot  wounds  of  the  different  regions  of 

the  body 693 

Definition  of  shot  injuries 694 

Fire-arms  and  their  projectiles 695 

TABLE  CXXI.     Table  indicating  the  seat  of  the 
injury  and  nature  of  the  projectile  in  the  cases 

of  shot  wounds  reported  during  the  war 696 

Explosive  balls .     701 


Abstracts  of  sixteen  cases 

Effects  of  large  projectiles 

Abstracts  of  five  cases  

Effects  of  missiles  and  projectiles  from  small  arms..  . 

Abstracts  of  two  cases 

PLATE  LXXVlIt.     Distorted  bullets,  facing 

Entrance  and  exit  wounds 

PLATE  XXXIX.    Early  appearance  of  entrance  and  exit 

wounds,  facing 

Effects  of  projectiles  on  muscular  tissue  and  tendons 
Effects  of  missiles  and  projectiles  on  bony  structure 

Abstracts  of  eleven  cases 

PLATE   XL.    Early   appearances   of  entrance   und   exit 

wounds,  facing 

TABLE  CXXII.  Numerical  statement  of  shot  contu 
sions  of  the  bones  of  the  Head,  Trunk,  and  Ex 
tremities  

Simple  fractures  (abstract  of  one  case) 

Partial  fractures  (abstract  of  one  case) 

Penetrations  of  bone  (abstract  of  one  case) 

Perforations  of  bone  (abstracts  of  three  cases)   

Complete  fractures  (abstracts  of  two  cases) 

Effects  of  missiles  and  projectiles  on  nerves 

Abstracts  of  thirty  cases 

PLATE  XXXVIII.     Facial  Paralysis  consequent  on  shot 

injury,  facing 

Effects  of  missiles  and  projectiles  on  Blood-vessels. . . 
Abstracts  of  eleven  cases 


age. 
702 

704 
704 
708 
709 
710 
711 

712 
712 
713 
714 

714 


716 

718 
719 
719 
721 
YOO 

725 
726 

74! 
750 
750 


TABLE    OF    CONTENTS. 


CHAPTER  XII.      WOUNDS  AND   COMPLICATIONS— CONTTCUED. 


Page. 

TABLE  CXXIII.  Summary  of  one  hundred  and 
eighteen  cases  of  complete  division  of  the  larger 
Blood-vessels,  indicating  the  number  of  cases  in 

which  primary  bleeding  occurred 752 

Lodgement  of  missiles  and  projectiles 757 

Primary  symptoms  common  to  gunshot  wounds 759 

Shock  (one  case) 759 

Pain  (abstract  of  one  case) 760 

Primary  haemorrhage 761 

Haemorrhages  and  Legations 762 

Arteries 763 

TABLE  CXXIV.  Summary  of  two  thousand  two  hun 
dred  and  thirty-five  cases  of  arterial  haemorrhages 
of  the  Head,  Neck,  Chest,  Trunk,  and  Upper  and 
Lower  Extremities  in  which  the  bleeding  vessels 

were  indicated  by  name 763 

TABLE  CXXV.  Tabular  statement  of  one  thousand 
one  hundred  and  fifty-five  ligations  for  shot  injuries .  765 

Ligations  of  the  Common  Carotid  artery 766 

Abstracts  of  two  cases 766 

TABLE  CXXVI.  Condensed  summary  of 
eighty-two  cases  of  ligalions  of  the  Com 
mon  Carotid  for  shot  injuries 767 

Ligations  of  the  Internal  Carotid  artery 770 

Ligations  of  the  External  Carotid  artery ...     770 

TABLE  CXXVII.  Condensed  summary  of 
seven  cases  of  ligations  of  the  External 

Carotid  artery  for  shot  injuries 770 

Ligations  of  minor  branches  of  the  External  Ca 
rotid  artery  (abstracts  of  eight  cases) 770 

Ligations  of  the  Temporal  artery 771 

TABLE  CXXVIII.  Condensed  summary  of 
eighteen  cases  of  ligations  of  the  Temporal 

artery  for  shot  injuries 771 

Ligations  of  the  Facial  artery  (one  example) ....     772 

TABLE   CXX1X.      Condensed  summary  of 

eight  ligations  of  the  Facial  artery  for  shot 

injuries 772 

Ligations  of  the  Subclavian  artery  (one  abstract)     772 
TABLE  CXXX.   Condensed  summary  of  fifty- 
one  cases  of  ligations  of  the   Subclavian 

artery  for  shot  injuries 773 

Ligations  of  branches  of  the  Subcliivian  artery. .     774 

Abstracts  of  twelve  cases 774 

Ligations  of  the  Axillary  artery 775 

TABLE  CXXXI.  Condensed  summary  of 
forty-nine  cases  of  ligations  of  the  Axillary 

artery  for  shot  injuries 775 

Ligations  of  brandies  of  the  Axillary  artery. . . .     776 

Abstracts  of  four  cases 77fi 

Ligations  of  the  Circumflex  artery 

TABLE  CXXX1I.  Condensed  summary  of 
eighteen  ligations  of  the  Circumflex  artery 

for  shot  injury 777 

Ligations  of  the  Brachial  artery 777 

TABLE  CXXXIII.  Summary  of  one  hun 
dred  and  seventy  cases  of  ligations  of  the 

Brachial  artery 777 

Ligations  of  branches  of  the  Brachial  artery. . . .     782 

Abstracts  of  eleven  cases 782 

Ligations  of  the  Radial  artery 782 

TABLE  CXXXIV.  Condensed  summary  of 
fifty-nine  ligations  of  the  Radial  artery  for 

shot  injury 783 

Ligations  of  the  Ulnar  nrtery 784 

TABLE  CXXXV.  Condensed  summary  of 
twenty-two  ligations  of  the  Ulnar  artery 

for  shot  injuries 784 

Ligations  of  the  Interosseous  artery  of  Forearm.     785 

Abstracts  of  nine  cases 785 

Ligations  of  arteries  of  the  Hand 785 

TABLE  CXXXVI.  Condensed  summary  of 
twelve  cases  of  ligations  of  arteries  of  the 

Hand 786 

Ligations  of  the  Common  Iliac  artery 780 


Page. 

TABLE  CXXXVII.    Summary  of  five  unsuc 
cessful  cases  of  ligations  of  the  Common 

Iliac  artery 786 

Ligations  of  the  Internal  Iliac  artery 786 

TABLE  CXXXVIII.     Condensed  summary 

of  three  ligations  of  the  Internal  Iliac  artery  787 

Ligations  of  the  Gluteal  artery 787 

TABLE  CXXXIX.    Summary  of  six  ligations 

of  the  Gluteal  artery 787 

Ligations  of  the  Sciatic  artery 787 

Abstracts  of  two  cases 787 

Ligations  of  the  External  Iliac  artery 787 

TABLE  CXL.     Summary  of  twenty -six  liga 
tions  of  the  External  Iliac  artery 788 

Ligations  of  the  Spermatic  artery  (one  abstract)  788 

Ligations  of  the  Femoral  artery 788 

TABLE  CXLI.     Summary  of  three  hundred 
and  seventy-four  ligations  of  the  Femoral 

artery 789 

Ligation  of  the  External  Pudic  artery 798 

Ligation  of  the  Profunda  Femoris 798 

Abstract  of  one  case 798 

TABLE  CXLII.      Summary  of  twenty-two 

cases  of  ligations  of  the  Profunda  Femoris.  798 

Ligations  of  the  Perforating  arteries 799 

Abstracts  of  six  instances 799 

TABLE    CXLIII.         Summary    of  twenty- 
four  ligations  of  muscular  and  other  small 

branches  of  the  Femoral  artery 799 

Ligations  of  the  Popliteal  artery 800 

TABLE  CXLIV.     Summary  of  thirty-six  li 
gations  of  the  Popliteal  artery 800 

Ligations  of  the  Articular  branches  of  the 

Popliteal  artery 801 

Abstracts  of  three  cases 801 

Ligations  of  the  Anterior  Tibial  artery 801 

TABLE  CXLV.     Summary  of  forty-seven  li 
gations  of  the  Anterior  Tibial  artery 802 

Ligations  of  branches  of  the  Anterior  Tibial  ar 
tery 803 

Abstracts  of  three  cases 803 

Ligations  of  the  Posterior  Tibial  artery 803 

TABLE  CXLVI.     Summary  of  forty-eight  li 
gations  of  the  Posterior  Tibial  artery 803 

Ligations  of  Plantar  arteries 805 

Abstracts  of  three  cases 805 

Ligations  of  the  Peroneal  artery 805 

Abstracts  of  four  cases 805 

Remarks  on  haemorrhages  and  ligations 805 

Abstracts  of  five  cases 806 

TABLE  CXLVII.     Table  indicating  the  days  on 

which  the  first  haemorrhage  occurred 805 

Traumatic  aneurism  (abstract  of  one  case) 808 

TABLE   CXLVIII.      Summary   of  seventy-four 

cases  of  Traumatic  aneurism 808 

PLATE  LXXVII.     Traumatic  aneurism 808 

Causes  of  haemorrhage  (abstracts  of  three  cases) ....  809 

Treatment  (abstract  of  four  cases) 810 

TABLE  CXLIX.     Summary  of  two  thousand  two 
hundred  and  thirty-five  cases  of  haemorrhage, 

indicating  mode  of  treatment 810 

Ligations  (abstracts  of  three  cases) 813 

TABLE  CL.     Table  indicating  the  various 

Modes  of  Ligations  and  their  fatality 814 

Veins  (abstracts  of  three  cases) 81G 

TABLE  CLI.     Summary  of  one  hundred  and  six 

cases  of  hncmorrhago  from  veins filfi 

PLATK   LXXIX.      Fig.  1.  The  left  Femoral  vein  after 
death  from  pyaemia.     Fig.  2.  Gangrene  of  Foot  after 

shot  wound  of  Leg,  upper  third,  facing 818 

Tetanus  (abstracts  of  ten  cases) 8)8 

TABLE  CLII.     Summary  of  five  hundred  and  five 

cases  of  tetanus,  indicating  seat  of  injury  and  result.  819 
TABLE  CLIII.     Statement  indicating  the  day  after 

injury  or  amputation  on  which  tetanus  appeared. . .  819 

XI 


TABLE    OF    CONTENTS. 


CHAPTER   XII.      WOUNDS  AND   COMPLICATIONS— CONTINUED. 


Page. 

TABLE  CLIV.      Numerical  statement  of  results   of 
three  hundred   and  fifty-eight  cases  of  tetanus  in 
which  the  duration  of  the  disease  was  reported  . . .     820 
Gangrene  (abstracts  of  nine  cases) 823 

TAUI.E  CLV.  Summary  of  two  thousand  six  hun 
dred  and  forty-two  cases  of  gangrene,  indicating 
the  result  and  frequency 824 

TABLE  CLVI.  Indicating  the  years  in  which  the 
gangrene  occurred 825 

TABLE  CLVII.  Summary  of  cases  of  hospital  gan 
grene,  giving  treatment  and  results 836 

TABLE  CLVIII.  Summary  of  nine  cases  of  hospital 
gangrene,  showing  date  and  grade  of  disease 842 

PLATE  XXIX.     Dry  gangrene  of  the  Feet,  facing  ...     850 

Dry  gangrene  (abstracts  of  seven  cases) 850 

Traumatic  Erysipelas  (abstracts  of  eight  cases) 851 

TABLE  CL1X.  Numerical  statement  of  one  thousand 
and  ninety-seven  cases  of  traumatic  erysipelas  ....  852 

TABLE  CLX.  Numerical  statement  of  one  thousand 
and  ninety-seven  cases  of  traumatic  erysipelas,  in 
dicating  causes  of  death 854 

Pyaemia  (abstracts  of  seven  cases) 857 

TABLE  CLXI.  Summary  of  cases  of  pyaemia,  indi 
cating  location  of  injury  and  result 859 

TABLE  CLXII.  Indicating  day  of  appearance  of 
pyaemia  after  injury  and  after  operation 860 

Condensed  summary  of  forty-eight  pnst-mortem  ex 
aminations  in  cases  of  pyaemia 862 

Concluding  observations  on  Sliot  wounds  ....     860 

Climatic,  hygienic,  aud  moral  influences 867 

Multiple  wounds  (abstracts  of  two  cases) 868 

Conservation,  Excision,  Amputation 869 

TABLE  CLXIII.  Tabular  statement  of  eighty-seven 
thousand  seven  hundred  and  ninety-three  cases  of 
shot  injuries  of  the  Upper  Extremities,  indicating 
seat  of  injury,  mode  of  treatment,  and  final  results.  870  i 


Page. 

TABLE   CLXIV.      Tabular  statement   of  eighty-six 
thousand  four  hundred  and  thirteen  cases  of  shot 
injuries  of  the  Lower  Extremities,  indicating  seat 
of  injury,  mode  of  treatment,  and  final  results    . .     870 
TABLE  CLXV.    Summary  of  sixty  thousand  two  hun 
dred  and  sixty -six.shot  fractures ot 'the  Extremities. 

showing  treatment  and  results 87:i 

Excisions , 874 

TABLE  CLXVI.  Numerical  statement  of  four  thou 
sand  six  hundred  and  fifty-six  excisions  in  the  Ex 
tremities  87f> 

TABLE  CLXVII.  Tabular  statement  of  excis 
ions,  indicating  the  months  in  which  the  opera 
tions  were  performed : 87(1 

Amputations 877 

TABLE  CLXVIII.  Tabular  statement  of  twenty- 
nine  thousand  nine  hundred  and  eightyamputa- 
tions.  indicating  seat  of  operation  and  results. .  877 

TABLE  CLXIX.  Table  indicating  the  rate  of 
mortality  after  amputations  and  excisions  in  the 
Extremities 878 

TABLE  CLXX.  Summary  of  twenty-three  thou 
sand  seven  hundred  and  sixty-two  amputations, 
indicating  the  period  of  the  operation 87'.) 

TABLE  CLXXI.  Summary  of  eighteen  thousand 
seven  hundred  and  eighteen  cases  of  amputa 
tions  in  the  Extremities,  indicating  the  side 
upon  which  the  operation  was  performed 880 

TABLE  CLXXII.  Numerical  statement  of  on* 
hundred  and  seventy-two  cases  of  double  am 
putations  for  shot  injuries 881 

TABLE  CLXXIII.  Condensed  summary  of  one 
hundred  and  seventy-two  double  amputations 
after  shot  injury 881 


CHAPTER  XIII.     AN/ESTHETICS. 


Prolegomena 

Deaths  from  chloroform 

Abstracts  of  thirty  -seven  cases 

Deaths  from  chloroform  and  ether 

Abstracts  of  two  cases 

Deaths  from  ether 894 

Abstracts  of  four  cases  ...  .894 


Page. 

.  887 
.  890 
.  890 
.  894 
.  894 


Page. 


TABLE  CLXXIV.  Statement  of  five  hundred  and  ninety- 
seven  cases  of  the  employment  of  anaesthetics,  showing 
quantities  used,  time  to  induce  anaesthesia,  and  period 
during  which  it  was  maintained R9fi 

TABLE  CLXXV.  Statement  showing  the  frequency  of 
vomiting,  excitement,  and  prostration  in  five  hundred 
and  ninetv-seven  cases  of  anaesthesia  . . .  .  897 


CHAPTER  XIV.     THE  MEDICAL  STAFF  AND   MATERIA  CHIRURGICA. 


Page. 

Prolegomena 899 

An  Act  to  Reorganize  and  Increase  the  Efficiency  of  the 

Medical  Department  of  the  Army 900 

Duties  of  the  Medical  Director  of  a  Corps 903 

Duties  of  the  Medical  Inspector  of  a  Corps 906 

Duties  of  the  Surgeon-in-Chief  of  a  Division 906 

Duties  of  a  Surgeon-in-Chief  of  a  P.rigade 907 

Duties  of  the  Surgeon  in  Charge  of  a  Division  Hospital  . .  908 

Duties  of  the  Mediool  Recorder  of  a  Division  Hospital 909 

Duties  of  the  Attending  Surgeon  of  a  Division  Hospital     .  .  909 


Page. 

Duties  of  the  Operating  Surgeon 909 

Duties  of  the  Regimental  Surgeon 910 

Duties  of  the  Assistant  Regimental  Surgeon                         .  912 
Duties   of  the   Commissary  of  Subsistence   of  a   Division 

Hospital 912 

Duties  of  the  Chief  Ambulance  Officer  of  a  Corps 913 

Duties  of  the  Chief  Ambulance  Officer  of  a  Division 913 

Duties  of  the  Chief  Ambulance  Officer  of  a  Brigade 914 

Matoria  Chirurgica 914 


CHAPTER    XV.     TRANSPORTATION   OF  THE  WOUNDED. 


Page. 

Hand  Litters 923 

Wheel  Litters 926 

Mule  Litters 926 

Cacolets 927 

Ambulance  Corps 931 

Ambulance  Wagons 944 

Railway  Transportation 957 

Water  Transportation 971 

Steamer  City  of  Memphis 974 

TABLE.      Tabular  statement  of  trips  of  Steamer  City  of 


Pnge. 

Steamer  Louisiana  and  R.  C.  Wood   975 

TABLE.     Tabular  statement  of  trips  of  Steamer  Louisiana  976 

TABLE.     Statement  of  trips  of  Steamer  H.  C.  Wood 976 

Steamer  D.  A.  January 977 

TABLE.     Statement  of  trips  of  Steamer  D.  A.  January 979 

Steamer  Empress .  981 

Steamer  .1.  K.  Barnes .  982 

INDICES. 

List  of  Plates I 

List  of  Operators  and  Reporters Ill 


Memphis. . . 

XII 


975  !  Subject-Matter  Index. 


XVTT 


THE 


MEDICAL  AND  SURGICAL  HISTORY 


OF   THE 


WAR  OF  THE  REBELLION  (1861-651 


PART  III,  VOLUME   II. 

BEINO    THE    THIRD    SURGICAL    VOLUME. 


ON  SPECIAL  WOUNQI»«J[URIES—  CONTINUED, 


CHAPTER    X. 


WOUNDS  AND   INJURIES  OP  THE  LOWER  EXTREMITIES. 


In  attempting  to  furnish  a  description,  as  adequate  as  practicable,  of  the  various 
classes  of  injuries  inflicted  by  war- weapons  that  were  reported  during  the  late  war  in 
this  country,  I  have  reviewed  and  analyzed  at  great  length,  in  two  preceding  volumes, 
histories  of  cases  of  wounds  of  the  head,  neck,  trunk,  and  upper  extremities.  It  remains, 
to  complete  this  branch  of  the  subject,  to  discuss,  in  like  manner,  Wounds  of  the  Lower 
Extremities,  a  very  important  group,  comprising  not  only  a  larger  number  of  those  cases 
that  come  under  the  treatment  of  the  military  surgeon  than  any  other  group,  but  a  greater 
proportion  of  cases  demanding  operative  interference  than  is  observed  in  other  regions, 
and  presenting  to  the  field  surgeon,  especially  in  connection  with  lesions  of  the  hip  and 
thigh,  some  of  the  most  difficult  practical  problems  he  has  to  encounter. 

Of  the  253,142  cases  of  wounds  returned  during  the  War  that  have  been  examined 
and  classified  and  entered  on  the  permanent  registers  of  the  Surgeon-General's  Office, 
89,528  are  cases  of  Wounds  of  the  Lower  Extremities.  Of  these,  59,376  are  entered  as 
Plefli  Wounds,  of  which  674  were  punctured  or  incised  wounds,  and  the  rest  shot  wounds. 
The  remaining  30,152  cases  were  all  returned  as  shot  fractures,  and  were  distributed  as 

Ill— 1 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


follows:  Sliot  Fractures  of  the  Femur,  including  fractures  penetrating  the  hip  joint,  7,776; 
Fractures  involving  the  Knee  Joint,  3,557;  Fractures  of  the  Shafts  of  the  Tibia  or  Fibula, 
or- of  both,  10,026;  Fractures  implicating  the  Tarsus,  Metatarsus,  and  Phalanges,  8,793. 
It  must  be  borne  in  mind  that  this  total  of  89,528  cases  of  wounds  of  the  lower  extrem 
ities  represents  only,  those  cases  that  have  been  accurately  determined  and  entered  on  the 
registers,  and  by  no  means  all  the  cases  belonging  to  this  group  that  were  reported  during 
the  War,  and  hence  as  the  work  progresses  the  figures  will  need  to  be  modified.  Besides 
the  253,142  registered  cases,  quite  a  number,  reported  with  insufficient  details  for  class 
ification,  have  been  noted  for  investigation ;  and,  by  searching  the  Pension  Records,  and 
through  Union  and  Confederate  reports  which  continue  to  be  sent  in,  even  at  this  late  date, 
and  by  special  reports  from  surgeons  who  kept  note-books,  and  who,  since  the  publication 
of  the  First  Surgical  Volume,  have  been  led  to  transmit  particulars  of  their  cases,  it  will 
be  possible,  as  each  successive  subject  is  taken  up  for  analysis,  to  sensibly  augment  the 
aggregates  of  each  group.  This  was  observed  in  the  discussion  of  the  Wounds  of  the 
Upper  Extremities.  In  TABLE  XII,  on  page  454  of  the  Second  Surgical  Volume,  but 
84,718  cases  of  such  wounds  are  recorded  as  registered,  but  in  examining  CHAPTER  IX  it 
will  be  found,  as  mentioned  in  the  MEMORANDUM  at  page  III  of  that  Volume,  that  88,741 
oases  are  actually  specified,  the  particulars  of  4,023  additional  cases  having  been  obtained 
through  information  derived  from  various  sources.  Such  additions  may  be  expected  in 
this  Volume  also;  but  they  will  not  invalidate  the  approximate  correctness  of  the  figures 
above  given,  so  far  as  relates  to  the  relative  frequency  of  wounds  of  the  lower  extremities. 
For  such  a  purpose,  the  numbers  89,528  :  253,142  are  ample,  and  the  ratio  is  perhaps 
quite  as  reliable  as  it  could  be  made  by  larger  aggregates. 

The  relative  frequency  of  wounds  of  the  lower  extremities  received  in  battle,  com 
pared  with  the  total  number  that  came  under  treatment,  appears  from  the  above  returns 
to  be  represented  by  a  ratio  of  35.3  per  cent.,  or  a  little  over  one-third.  There  is  good 
reason  to  believe  that  this  is  a  very  near  approximation  to  the  precise  facts.  Note,  for 
example,  its  correspondence  with  returns  from  other  campaigns: 

TABLE  I. 

Collated   Returns,  indicating    the   Relative  Frequency   of  Shot    Wounds  of   the  Lower 
Extremity  in  Aggregates  of  Wounded  Men  who  came  under  Treatment. 


WARS,  CAMPAIGNS,  AND  OTHEH  OCCASIONS. 

AGGREGATE 
WOUNDED. 

WOUNDS  OF 
LOWER  EX 
TREMITY. 

RATIO. 

July  1830  days  in  Paris  and  Lyons  (SERRlEn's  table1)                                   .          .           

784 

« 

185 

Crimean  War  (MATTHEW'S  return')                               .         .                  

7,660 

2,396 

31.2 

Crimean  War  (CHENU's  return3)                                         .                                             

34,  306 

11  873 

34.6 

Italian  War  of  1839  (CHENU's  return4)                             .       .     .                   

19,  672 

7,704 

39.1 

Italian  War  of  1859  (DEMME  8  estimates6)                             .  .                                    

17,  095 

5,  248 

30.  G 

Danish  War  of  1864  (HEINE6)                                         .                                                     

1,  907 

553 

28.9 

24,  788 

7,560 

30.5 

Totals                                                                                                                                                    

106,  212 

35,  519 

33.4 

1  SERULER  (L.),  Traite  des  plaies  d'armes  a  feu,  Paris,  1844,  p.  30.  The  insurgents  fighting  behind  barricades,  the  proportion  of  injuries  of  tho 
lower  extremities  is  less  than  usual.  *  MATTHEW  (T.  P.),  Med.  and  Surg.  Hist,  of  the  Brit.  Army  in  the  years  1854-55-56,  London,  1858,  Vol.  II,  p.  355. 
aCHE.\U  (J.  C.),  Rapport,  etc.,  de  Campagne  d' Orient  en  1854-55-56,  Paris,  1865,  p.  6-27.  "CHENU  (J.  C.j,  Statistique  Med.  Chir.  de  la  Campagne 
d'ltalie  en  185!)  et  1860,  Vol.11,  p.  850.  B  DEMME  (H.),  Studien,  Wiirzburg,  1861,  B.I,  p.  20.  6  HEINK  (C.),  Die Schwsverletzunge.n  der  Untercn  Extrem- 
Uaten,  Berlin,  1866.  I  much  regret  that,  in  regard  to  the  statistics  of  the  Danish  War  of  1864,  I  cannot  refer  to  the  conclusions  of  the  lamented  Gen- 
eralarzt  F,  LcEFFLER,  from  whose  excellent  General- Bcric.ht  iibcr  den  Gcsundheitsdienst  im  Feldzuge  gcgen  Diinemarli  18C4,  Berlin,  1867,  the  statistics 


INTRODUCTION.] 


WOUNDS    OF    THE    LOWER   EXTREMITIES. 


It  will  be  observed,  by  comparing  the  tabular  statement  on  page  434  of  the  Surgical 
Volume  of  Part  II,  that  the  relative  frequency  of  shot  wounds  of  the  lower  extremities 
does,  not  exceed  that  of  wounds  of  the  upper  limbs  to  the  extent  that  might  be  anticipated 
from  the  greater  size  of  the  lower  limbs.  This  is  doubtless  due  to  the  fact  that,  in  all 
fighting  in  entrenched  positions,  the  lower  part  of  the  person  is  partially  screened  from 
injury.  In  the  last  year  of  the  War,  the  field  casualties  of  the  Union  armies  were  reported 
with  much  completeness  and  accuracy,  as  has  been  already  noticed  (supra,  Part  I,  Vol.  II, 
p..  600,  Part  II,  Vol.  II,  pp.  6,  917),  and  over  a  hundred  thousand  cases  of  wounds  were 
recorded  with  careful  discrimination  of  their  nature  and  position.  In  the  engagements 
during  this  period,  the  combatants  had  learned  to  cover  their  positions  with  hastily 
improvised  earthworks;  and  this  may  partly  account  for  the  smaller  ratio  of  wounds  in  the 
lower  limbs  presented  in  these  returns.  Notice,  for  example,  in  the  following  tabular 
statement,  the  very  small  proportion  of  wounds  of  the  lower  limbs  in  the  siege  operations 
before  Mobile.  Another  probable  cause  why  the  proportion  of  wounds  of  limbs  was 
smaller  in  the  field  than  in  the  general  hospital  returns,  is  that  a  large  number  of  rapidly 
mortal  wounds  of  the  head  and  trunk  appear  on  the  field  casualty  lists,  representing 
patients  who  never  reached  the  base  hospitals. 

TABLE  II. 

Partial  Numerical  /Statement  of  Shot  Wounds  of  the  Lower  Extremities  in  the  Field  or 
Primary  Hospitals  in  various  Campaigns  during  the  last  year  of  the  War,  1864-65. 


CAMPAIGNS. 

FLESH   WOUNDS. 

FRACTURES. 

FOOT. 

MISSILE. 

a 
§ 

•- 
O 

•A 

THIGH. 

LEG. 

THIGH. 

LEG. 

Large  projec- 

Small  projec- 
tilei.  musket, 

b 
o 

0  Q 
<  f~ 

£S 

NAPLES  AND  DATES. 

.3 

Ja 

£ 

. 

J3 

J3 

alul  boinb  Irag- 

pistul  I'mlK 
and  small  mis. 

H) 

<; 

*> 

o£ 

CO 

I 

5 
B 

| 

i 

1 

OS 
<o 

a 

munu,  grape, 
ami  canister. 

site,  from 

s 

s 

o 

Q 

o 

Q 

0 

e 

o 

o 

o 

G 

canister. 

H 

Army  of  Potomac,  from  May  4  to  August  31,  1864  .  . 

4,037 

10 

3,843 

6 

812 

104 

938 

21 

2,  209 

1 

978 

10,  828 

38,944 

30.5 

Campaign  to  Atlanta,  from  May  4  to  Sept.  8,  1804  .  . 

3,312 

1C 

2,058 

0 

573 

73 

581 

31 

1,044 

543 

5,  720 

23,308 

32.4 

Geu.G  II.Thomas's  Army,  from  Oct.  25  to  Dec.31,'64. 

376 

450 

81 

106 

1 

93 

74 

1,025 

3,610 

30.6 

Gen.W.  T.  Sherman's  Army  through  Carolinas  in  '05. 

225 

3 

148 

46 

3 

47 

62 

1 

10 

4!)8 

1,  533 

34.4 

From  Fort  Fisher  to  Goldsborough,  N.  0.,  1865  

110 

12-1 

1 

32 

2 

32 

i 

35 

43 

178 

1,075 

31.5 

Siege  of  Mobile,  from  March  26  tu  April  19,  1805 

100 

84 

40 

8 

32 

48 

57 

137 

2,111 

14.4 

Army  of  James,  from  May  4,  1864,  to  April  !>,  1805. 

1,091 

6 

1,850 

390 

°7 

436 

11 

718 

504 

3,  899 

16,  120 

27.8 

Shenandoah  Valley,  from  May  4  to  August  20,  1861. 

253 

205 

fi9 

4 

23 

1 

16 

32 

554 

2,  196 

26.  7 

Shenandoah  Valley,  from  Aug.  21  to  Dec.  30,  1804.  . 

829 

1 

949 

273 

18 

3:20 

5 

403 

226 

2,540 

7,542 

26.6 

Army  of  Potomac,  from  Sept.  1,  1864,  to  Ap'l  9,  1805. 

1,017 

1 

1,  120 

269 

32 

27',' 

10 

555 

170 

2,  581 

10,  407 

31.1 

Aggregates  

11,  356 

39 

10,  903 

13 

2,  545 

271 

2,  787 

81 

5,243 

0 

2,  649 

27,  900 

106,  846 

30.7 

of  wounds  of  the  upper  extremity  in  this  campaign  were  cited  in  the  Second  Surgical  Volume  (Chap.  IX,  p.  434).  This  eminent  surgeon  died  in  1874; 
and  I  have  been  unable  to  procure  the  second  volume  of  his  most  painstaking  and  accurate  treatise :  or  to  learn  that  it  lias  been  published.  Fortunately, 
Dr.  HEINE'S  statistics  cover  the  ground,  if  not  as  thoroughly,  at  least  with  commendable  precision.  '  These  24,788  cases  are  collected  from  the  following 
authors:  McCOKMAC  (W.)  (Notes  and  Recollections  of  an  Ambulance.  Surgeon,  London,  1871,  p.  129;  total  number  of  cases,  610,  lower  extremities,  257); 
BlLUtoni  and  CZEKNY  (Chirurgische  liriefe,  Berlin,  1872,  p.  180 ;— 277— 135);  RUPPKECHT  (MilitardrMiclie  Erfahrungen,  1871,  S.  10 ;— 361— 128); 
MtfHUiAUEU  (Erfa.hru.ngen  aus  dem  Feldzuye,  etc.,  in  BayeriscUes  drtzliches  Intelligenzblatt,  1871,  S.  374;— 1899— 849);  STEINBERG  (Die  Kriegslaz- 
arethe  und  Baracken  von  Berlin,  Berlin,  1871,  S.  140;— 8531— 974);  GOLTDAMMER  (Bcricht  iiber  die  Thatigkeit  des  Keserve-Lazarethes  des  Berliner 
Hulfscereins,  in  Berliner  Klin.  Wochenschr.,  1871;— 639 — 67);  HKYFELDKU  (O.)  (BericM  iiber  meine  Wirksamkeit  am  Rhein,  in  Petersburg  Metl. 
Zeitschrift,  1871 ;— f?26— 81);  Socix  (A.)  (Kriegschirurgische  Erfahrungen,  Leipzig,  1872,  p.  8;— 643— 328);  MUXDY  and  MOSETIG  (Service  Med.  chir. 
de  Vambulance  du  Corps  legislatif,  in  Gaz.  des  Hop.,  1871,  No.  149 ;— 136— 58) ;  BECK  (B.)  (Chir.  der  Sc/iussD.,1872,  S.  160;— 4344— 1787);  FISCHER  (II.) 
(Krieyschir.  Erfahrungen,  Erlangen,  1870,  S.  28;— 875— 356):  KmcHNER  (C.)  (^rtzlicher  Bericht  u.  s.  w.  im  Palast  zu  I'ersailles,  Erlangen,  1872;— 
2099—751);  GUAF  (E.)  (Die  Konigl.  Reservdazare'.he,  :u  Diissetdorf,  1872;— 298— 101);  SCHOu.EK  (Kriegs.  chir.  Skizzen,  Hanuover,  1871  ;— 491— 160); 
GllOS  (F.)  (Notice  sur  I'hopital  cii'il.  ttc.,de  Strasbourg,  in  Gaz.  Med.  de  Strasbourg,  1872,  No.  17;— 140— 55):  BEIITHOLU  (Deutuche  Mil.-ii.r:t  Zeitschrift, 
1872,  B.  I,  S.  429;— 1804— 723);  aud  MOSSAKOWSKY  (l>.)  (Deutsche  Zcitschrift  fiir  Chir.,  1872,  B.  I,  S.  320 ;— 1415— 744), 


4  INJURIES   OF   THE    LOWER   EXTREMITIES.  [CHAP.  x. 

Examining  carefully  several  series  of  a  thousand  each  of  the  89,528  registered  cases 
of  wounds  of  the  lower  extremities,1  including  only  those  in  which  the  seat  of  injury  was 
noted  with  precision,  a  predominance  of  wounds  of  the  left  lower  extremity  is  found  in  the 
following  proportion:  Both  limbs,  3.4  per  cent.;  left  limb,  53.1;  right  limb,  43. 5.2 

A  word  may  be  added  regarding  the  recorded  instances  of  evulsion  of  one  or  other 
of  the  lower  limbs  by  solid  shot,  fragments  of  shell,  torpedoes,  or  other  large  projectiles. 
Of  164  such  instances  93  recovered,  62  or  40  per  cent,  were  fatal,  while  in  9  instances 
the  results  were  not  ascertained.  In  129  of  the  164  cases  it  is  noticed  that  ablations, 
many  of  them  doubtless  resembling  merely  the  paring  and  regularization  of  the  soft  tissues 
with  removal  of  splinters  or  sharp  projections  of  bone,  rather  than  legitimate  amputations, 
were  performed.  Two  of  these,  however,  were  successful  formal  disarticulations  at  the 
ankle  joint,  2  successful  amputations  at  the  knee  joint,  1  a  fatal  exarticulation  at  the  hip. 
Seventy-six,  with  56  recoveries,  14  deaths,  and  6  unknown  terminations,  were  opera 
tions  in  the  continuity  of  the  leg;  forty  cases,  26  successful,  13  fatal,  1  doubtful,  were 
amputations  in  the  thigh.  In  4  cases,  both  legs  were  removed  in  the  continuity  with  2 
recoveries,  1  fatal  and  1  unknown  result.  In  1  fatal  case  the  left  thigh  and  right  leg  were 
simultaneously  removed;  in  1  case  of  recovery  amputation  was  performed  in  the  right 
thigh  and  through  the  left  knee  joint;  in  1  fatal  case  simultaneous  amputation  of  both 
thighs  in  the  continuity  was  practised;  and  in  one  instance  disarticulation  of  the  left  hip 
and  ablation  of  the  right  leg  was  performed,  the  case  terminating  fatally.  In  35  of  the 
aggregate  of  164  cases  there  is  no  record  of  operative  interference.  Of  these,  1  was  a 
fatal  instance  of  evulsion  of  both  limbs  in  the  continuity  of  the  thigh;  in  6  fatal  cases 
both  limbs  were  torn  off  in  the  leg;  in  4  fatal  cases  the  right  or  left  limb  was  torn  off  in 
the  thigh,  and  in  24  the  mutilation  took  place  in  the  continuity  of  the  leg  with  4  recoveries, 
19  deaths,  and  1  with  unknown  result. 

An  additional  proof  that  of  the  shot  wounds  received  in  action  those  inflicted  upon 
the  lower  extremities  ordinarily  constitute  about  one-third  of  the  aggregate,  is  found  in 
the  carefully  prepared  statistical  researches  of  Councillor  G.  Fischer.3 

'The  lamented  L<EFFLER,  one  of  the  soundest  of  modern  Prussian  military  surgeons,  set*  forth  (General-Bericht  iiber  den  Gesundheitsdienst  irn 
Feldzuge  gegen  Danemark,  1864,  Berlin,  1867,  p.  48)  that  of  2,388  Prussians  killed  and  wounded  in  the  Danish  War  of  1804,  about  31  per  cent,  were 
struck  in  the  lower  extremities,  and  remarks  (S.  49):  "The  comparatively  small  proportion  of  wounds  of  the  lower  extremities  mny  appear  strange. 
One  is  accustomed  to  regard  the  preponderance  of  such  injuries  us  considerable.  The  protections  above  referred  to  (trenches,  and,  in  Schleswig,  brush- 
hedges  \ Knicks])  would  undoubtedly  partially  protect  the  lower  limbs.  But  statistics  that  omit  the  killed  are  defective ;  they  give  to  the  shot  wounds 
of  the  extremities  an  undue  preponderance,  because  their  immediate  fatality  is  much  more  limited  than  is  observed  in  wounds  of  the  head  and  trunk." 
Professor  H.  FISCHER  (Lehrbuch  der  Allgemeinen  Kriegschir.,  Erlangen,  1808,  S.  25)  observes  :  "  In  later  wars,  in  which  the  fighting  was  mainly  in  the 
open  field,  the  remarkable  fact  has  almost  uniformly  appeared,  that  among  shot  injuries  those  of  the  lower  extremities  far  exceed  those  of  the  upper  limbs. 
Dr.  MACLEOD'S  statistics  refer  68  per  cent,  of  wounds  in  action  to  wounds  of  the  lower  extremities.  [This  is  an  oversight.  Di\  MACLEOD  (Notes  o?»  fJie 
Surgery  of  the  War  in  the  Crimea,  1858,  p.  414)  gives  the  proportion  of  wounds  of  the  lower  extremities  among  the  men  as  31.7;  among  officers  35.2. 
Professor  FISCHEU  seems  to  have  added  these  ratios  together.]  DJOERUP  reports  the  proportion  of  wounds  of  the  lower  limbs  in  the  Danish  army,  in  the 
war  of  1848-50,  as  40.5  per  cent.  In  Paris  in  1848,  and  in  Italy  in  1859,  the  wounds  of  the  lower  extremities  constituted  a  third,  and  those  of  the  upper 
limbs  nearly  another  third.  When  it  is  considered  that  the  remaining  third  was  made  up  of  cases  of  injuries  of  the  head,  chest,  abdomen,  and  pelvis,  it  is 
apparent  how  enormously  large  is  the  number  in  modern  wars  that  have  to  be  transported  with  the  utmost  care  and  skill.  Hence,  perhaps,  the  most 
difficult  problem  for  the  modern  military  surgeon  is  the  management  of  the  ambulance  trains.  LCEFFLF.R,  it  is  true,  has  said  that  the  preponderance  of 
wounds  of  the  lower  limbs  in  modern  wars  is  seeming  rather  than  real,  and  is  conditioned  on  the  less  proportion  of  immediate  fatality  in  wounds  of  the 
limbs.  This  assumption,  though  assuredly  founded  on  facts,  might  explain  the  conspicuous  fact  that  the  shot  injuries  of  the  limbs  predominate  greatly 
over  those  of  the  bead  and  trunk ;  but  does  not  explain  the  extraordinary  disproportion  between  the  shot  injuries  of  the  upper  and  lower  limbs."  I  may 
remark  that  the  statistics  I  have  examined  do  not  show  any  greater  disparity  in  the  frequency  of  wounds  in  the  upper  and  lower  limbs  than  is  warranted 
by  the  relative  size  and  position  of  the  extremities. 

2  HEINE  (C.)  (Die  Schussvrrletzungen  der  unttren  Extremitaten,  Berlin,  T866,  p.  30)  remarks  that  in  the  Schleswig-Holsteiu  War,  I860,  27  of  the 
562  cases  of  injuries  of  the  lower  extremities  both  limbs  were  injured,  or  a  percentage  of  4.8,  and  FISCHER  (G.)  (Statistic  der  in  dem  Kriege  1870-'71,  d-c., 
vorgekommenen  Verwundungen  und  Todtungen,  Berlin,  1876)  tabulates  780  cases  of  injuries  of  both  limbs  in  a  total  of  20,lfiO  cases  of  injuries  of  the  lower 
extremities,  or  3.8  per  cent. 

3  The  Statistik  der  in  d»m  Kriege  1870-1871  im  Preussischen  Heere,  vorgekommenen  Verwundungen  und  Todtungen  von  G.  FISCHER  comes  to 
hand  as  these  pages  are  going  to  press.     Tabelle  C  (loc.  cit.,  p.  59)  contains  a  recapitulation  of  the  seat  of  injury  in  64,897  cases  (7,735  killed  and  57,100 
wounded).    In  18,905  instances,  or  29. 14  per  cent.,  the  upper  extremity  was  injured,  and  in  20,160,  or  31.  06  per  cent.,  the  lower  extremity  was  involved, 
The  latter  percentage  varies  but  little  from  that  given  on  page  2  (ante  30. 5),  which  was  consolidated  from  a  number  of  publications  by  various  authors 
that  have  appeared  since  the  late  Franco- Prussian  War. 


SKCT.  I.)  FLESH    WOUNDS. 


SECTION  I. 


FLESH   WOUNDS    OF   THE   LOWER   EXTREMITIES. 


The  reader  is  respectfully  referred  to  the  introductory  observations  to  the  first  section 
of  the  Ninth  Chapter,  in  Part  II,  Volume  II,  page  435,  for  many  remarks  on  the  Flesh 
Wounds  of  the  Upper  Extremities,  which  are  equally  applicable  to  the  cases  of  the  cate 
gory  now  to  be  considered.  The  gravity  of  flesh  wounds  in  the  lower  extremities  greatly 
exceeds,  however,  that  of  analogous  injuries  in  the  upper  limbs.  The  dangers  arising  from 
lesions  of  the  great  blood-vessels  and  nerves  of  the  lower  extremities,  from  peri-articular 
wounds,  and  especially  from  deep  seton  wounds  and  lacerations  of  the  massive  muscles 
of  the  thigh,  are  great.  Many  perforations  of  the  thigh  that  are  lightly  regarded  at  the 
outset,  present  ultimately  formidable  complications.  Dr.  H.  Fischer  remarked,1  in  the  late 
Franco-German  War,  that  "many  a  wounded  man  sent  to  the  rear  with  the  diagnosis 
'slight  shot  wound  of  the  thigh,'  succumbed  to  burrowing  of  pus,  detected  too  late  and 
treated  with  too  little  vigor.  We  had  five  such  cases,  and  succeeded  in  all  in  controlling 
this  terrible  complication  by  early  and  deep  incisions,  absolute  rest,  and  disinfecting  band 
ages.  When  the  first  stage  is  neglected,  the  surgeon  loses  the  mastery,  pyaemia  delighting 
to  develop  in  deep  phlegmonous  cavities." 

It  was  impossible,  with  the  clerical  force  available,  to  make  more  than  a  superficial 
examination  of  the  individual  cases  of  the  immense  series  of  nearly  sixty-thousand  flesh 
wounds  of  the  lower  extremities.2  All  that  has  been  attempted  has  been  to  sift  out  dupli 
cated  cases  and  those  that  ultimately  proved  to  be  complicated  by  contusion  of  bone  or  by 
fracture,  and  to  scrutinize  the  series  sufficiently  to  select  instances  illustrating  the  different 
varieties  of  injuries  of  this  group,  to  determine  the  average  distribution  of  the  wounds  in 
the  several  regions  of  the  limb,  and  to  ascertain  approximatively  the  mortality. 

Of  the  series  of  flesh  wounds  of  the  lower  extremities,  six  hundred  and  seventy-four 
were  punctured  or  incised,  and  fifty-eight  thousand  seven  hundred  and  two  were  shot 
wounds. 

PUNCTURED  AND  INCISED  WOUNDS--There  were  reported  six  hundred  and 
seventy-four  cases  of  punctured  or  incised  wounds  of  the  lower  extremities,  including  a 
hundred  and  seventy-six  bayonet  wounds,  twenty-two  sabre  wounds,  and  four  hundred  and 
seventy-six  wounds  from  daggers,  knives,  axes,  or  other  pointed  or  cutting  weapons. 

Bayonet  Wounds.— The  series  of  bayonet  wounds  included  sixty-two  stabs  in  the 
thigh,  with  two  deaths;  seventy-seven  penetrations  of  the  leg,  with  two  deaths;  and  thirty- 

1  FISCHER  (H.),  Kriegschirurg.  Erfahrungen,  for  Metz,  Erlangen,  1872,  S.  164.  Dr.  Fischer,  professor  of  surgery  at  Breslaa,  was  a  volunteer 
Burgeon  in  the  Prussian  army  during  the  campaign  from  Saarbrticken  to  Metz,  August  10  to  October  27,  1870. 

"Of  the  89,528  registered  cases  of  wounds  of  the  lower  extremities,  30,152,  or  33.6  per  cent.,  were  returned  as  fractures,  so  that,  as  in  the  upper 
limbs,  the  wounds  of  the  soft  parts  alone  constitute  very  nearly  two-thirds  of  the  aggregate — 59,376  in  89,528  cases. 


D  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

seven  wounds  of  the  soft  parts  of  the  foot,  with  one  death, — the  series  of  a  hundred  and 
seventy-six  cases  thus  presenting  a  mortality  of  2.8  per  cent.  Several  of  the  cases  present 
particulars  of  interest: 

CASE  1.— Private  P.  Dietrich,  Co.  E,  151st  New  York,  aged  34  years,  was  wounded  at  Spottsylvania,  May  12,  1864, 
and  admitted  to  the  field  hospital  of  the  3d  division,  Sixth  Corps.  Surgeon  R.  Barr,  67th  Pennsylvania,  recorded  :  "A  bayonet 
thrust  through  the  right  leg."  The  patient  was  transferred  to  Douglas  Hospital,  Washington,  subsequently  to  Summit  House, 
and  lastly  to  the  Satterlee  Hospital,  Philadelphia,  whence  he  was  discharged  April  27,  1865,  because  of  "lameness  of  the  right 
leg,  caused  by  chronic  eczema,"  following  a  bayonet  injury.  Examiner  H.  N.  Loomis,  of  Buffalo,  New  York,  May  8,  1855, 
certified :  "A  bayonet  was  thrust  through  the  right  leg  between  the  tibia  and  fibula,  about  six  inches  below  the  knee.  The 
wound  healed;  but  is  followed  by  chronic  eczema,  extending  from  the  knee  to  the  ankle,  much  inflamed,  with  some  ulceration, 
and  producing  so  much  lameness  as  to  unfit  him  for  any  kind  of  labor."  In  August,  1868,  the  pension  examiner  states  that  the 
eczematous  eruption  occupies  about  half  the  space  between  the  knee  and  the  ankle,  and  that  the  limb  is  still  inflamed,  ulcerated, 
and  swollen.  This  pensioner  was  paid  to  March  4,  1870,  since  when  he  has  not  been  heard  from. 

Iii  two  cases  the  femoral  artery  was  reported  severed  by  a  bayonet.  One  of  these  is 
related  by  Surgeon  J.  A.  Lidell,1  U.  S.  V.:  A  soldier  of  the  106th  Pennsylvania  received 
a  thrust  in  the  upper  inner  part  of  the  thigh  from  a  sabre-bayonet,  in  a  picket  skirmish 
near  Fair  Oaks,  in  June,  1862,  and  perished  from  haemorrhage  before  assistance  could 
reach  him.  The  result  of  the  second  case  suggests  the  probability  that  a  minor  branch, 
rather  than  the  main  femoral  trunk,  was  injured  by  the  weapon: 

CASE  2. — Corporal  E.  Hacket,  Co.  A,  1st  Pennsylvania  Chasseurs,  was  accidentally  wounded  near  Camp  Whipple, 
Philadelphia,  in  August,  1863.  Acting  Assistant  Surgeon  L.  D.  Radzinsky  reported:  "While  at  bayonet  exercise  he  received 
a  punctured  wound  of  the  right  femoral  artery,  below  Poupart's  ligament.  The  wound  was  received  a  short  distance  from  the 
camp.  When  brought  to  the  hospital  tent  the  man  was  considerably  exhausted  from  loss  of  blood.  Judging  from  the  clots 
found  in  his  clothes  he  must  have  lost  at  least  twelve  ounces.  The  haemorrhage  was  immediately  controlled  by  manual  pressure 
upon  the  external  iliac  artery,  a  compress  and  spica  bandage  applied,  and  pressure  continued  with  a  tourniquet  for  three  clays, 
at  which  time  the  tourniquet  was  removed,  a  new  dressing  applied,  and  pressure  continued  with  the  spica  bandage.  He  was 
returned  to  duty  five  days  afterwards,  and  has  not  had  any  untoward  symptoms  since."  Hacket  is  not  a  pensioner. 

Surgeon  T.  H.  Squire,  89th  New  York,  reports  a  case  in  which  the  synovial  cavity  of 
the  knee  was  penetrated  by  a  bayonet  without  bad  results,  remarking  that  Dr.  James 
Allen,  of  Marathon,  New  York,  examined  the  recent  wound  and  concurred  in  the  diagnosis: 

CASE  3. — "Private  C.  A.  Ball,  Co.  K,  89th  New  York,  aged  16  years,  in  the  spring  of  1862,  at  Roanoke  Island,  while 
jumping  for  exercise,  accidentally  sprang  against  the  point  of  a  bayonet.  At  a  moment  when  the  joint  was  partially  flexed, 
the  point  of  the  bayonet  penetrated  the  cavity  of  the  knee  joint,  the  wound  being  immediately  above  the  centre  of  the  patella. 
The  patient  was  immediately  received  into  the  regimental  hospital,  and  Assistant  Surgeon  W.  A.  Smith,  89th  New  York, 
enjoined  perfect  rest  in  bed  and  low  diet,  with  cold  applications  to  the  joint.  The  wound  was  from  the  first  regarded  as  a 
dangerous  one.  Some  days  after  the  accident  occurred,  Dr.  Squire  saw  the  case  with  Dr.  Smith.  There  was  then  synovial 
swelling  of  the  joint,  and  other  conclusive  evidences  that  the  joint  had  been  penetrated.  The  boy  was  kept  in  hospital  till  the 
recovery  was  complete,  when  he  again  entered  the  ranks  for  duty.  The  recovery  was  complete,  and  no  bad  effects  followed. 
The  wound  was  not  very  extensive.  The  point  of  the  bayonet  may  have  gone  through  the  synovial  membrane  half  an  inch  or 
so,  and  in  such  a  glancing  direction  as  not  to  injure  the  cartilage  or  bone.  Dr.  Squire  did  not  know  exactly  how  long  the  boy 
was  kept  in  hospital,  but  thought  about  four  weeks."  The  field  registers  show  that  this  Private  Ball  received  a  gunshot  wound 
of  the  right  side  of  the  thorax  at  the  battle  of  Chapin's  Farm,  September  29,  1834,  which  fact  is  corroborated  by  the  examining 
surgeons.  For  this  injury  he  is  a  pensioner,  but  the  Pension  Records  make  no  mention  of  a  bayonet  injury  of  the  knee. 

Of  the  five  fatal  cases  in  this  subdivision  of  bayonet  wounds  in  the  lower  limbs,  three 
succumbed  from  gangrene,  one  from  pyaemia,  and  one  from  primary  haemorrhage.  The 
following  is  one  of  the  cases  complicated  by  gangrene : 

CASE  4. — Private  S.  Dick,  Co.  E,  79th  Indiana,  was  wounded  at  Chickamauga,  September  19,  1863,  and  sent  to  hospital 
No.  13,  Nashville,  October  1st.  Assistant  Surgeon  J.  K.  Bauduy,  U.  S.  V.,  reported :  "  He  was  admitted  with  a  flesh  wound  of 
the  calf  of  the  left  leg,  caused  by  a  bayonet.  The  wound  was  superficial  and  slight,  and  did  well  for  several  days ;  treated 
with  cold-water  dressings.  On  October  20th,  hospital  gangrene  manifested  itself;  the  disease  was  then  prevailing  endemically 
in  the  hospital.  This  patient  was  immediately  transferred  to  the  gangrene  ward,  and  applications  of  pure  bromine  were  made. 
Tincture  of  iron  and  fluid  extract  of  cinchona  were  freely  administered.  Milk-punch  and  beef-tea  were  also  given  at  stated 
intervals.  His  bowels,  which  were  inclined  to  be  costive,  were  kept  open  with  enemeta  of  salt,  molasses,  and  tepid  water. 
The  disease  steadily  progressed,  and  large  sinuses  formed  in  all  directions  in  the  intermuscular  spaces.  One  immense  sinus  ran 

>LIDKLL  (J.  A.),  Bayonet  Wounds,  with  casts,  in  Am.  Med.  Times,  1866,  Vol.  VII,  p.  153. 


SECT.  I.]  PUNCTURED    AND    INCISED    WOUNDS.  7 

along  the  course  of  the  tendo-achilles.  The  sinuses  were  freely  opened  and  injected  with  chlorinated  soda  solution,  and  bromine 
was  thoroughly  applied,  taking  great  care  to  get  it  well  into  the  intermuscular  spaces.  Disinfecting  poultices  were  used  in  the 
removal  of  the  sloughs.  November  4th,  the  gangrene  at  this  date  was  entirely  arrested,  but  symptoms  of  pyaemia  arose.  The 
pulse  became  frequent  and  weak,  ranging  between  140  to  150.  Rigors;  skin  cold  and  clammy;  breathing  oppressed  and 
labored.  Patient  complained  of  pain  in  chest.  The  conjunctiva  assumed  an  icteroid  hue,  and  the  whole  surface  of  the  body 
became  tinged  with  a  pale  yellow  appearance.  The  knee  and  ankle  joints  commenced  to  swell  and  cause  great  pain.  The 
following  treatment  was  then  resorted  to:  Carbonate  of  ammonia  in  large  and  frequent  doses;  stimulants  every  half  hour; 
iron  and  cinchona  continued;  tincture  of  iodine  and  blisters  to  swollen  joints;  surface  of  body  washed  with  whiskey  and 
water.  Patient  continued  to  sink,  and  died  on  the  afternoon  of  November  7,  1863.  Post-mortem :  Lungs  healthy ;  no  metas- 
tatic  foci  could  be  found  in  either  of  them  or  in  the  liver;  but  microscopical  examination  of  the  latter  revealed  a  fatty  infiltra 
tion.  The  liver  was  also  greatly  hypertrophied.  The  heart,  spleen,  pancreas,  bowels,  and  kidneys  were  all  healthy.  There 
was  an  accumulation  of  pus  in  the  left  knee  joint.'' 

Sabre  Wounds. — None  of  the  twenty-two  reported  sabre-cuts  of  the  lower  limbs1  were 
of  a  sufficiently  grave  character  to  prove  fatal.  Seventeen  of  the  patients  returned  to 
duty,  and  five  were  discharged  for  slight  disabilities.  Six  cases  were  flesh  wounds  of  the 
thigh,  ten  of  the  leg,  and  six  of  the  foot.  One  of  the  patients,  Corporal  Rice,  1st  Vermont 
Cavalry,  whose  case  is  recorded  on  page  22  of  the  First  Surgical  Volume,  suffered  also 
from  a  sword-cut  of  the  frontal;  but  he,  with  the  rest,  recovered  without  serious  trouble. 

Other  Punctured  and  Incised  Wounds  — Besides  wounds  caused  by  legitimate 
weapons  of  war,  a  considerable  number  were  reported  as  inflicted  by  daggers,  dirks,  or 
bowie-knives,  arrows,  picks,  and  other  pointed  implements,  and  by  knives,  scythe-blades, 
hatchets,  axes,  and  other  cutting  instruments.  There  were  seventy-two  of  these  serious 
punctured  wounds  of  the  lower  limbs,  and  four  hundred  and  four  cases  of  severe  incised 
wounds.  There  were  eight  deaths  in  this  series  of  four  hundred  and  seventy-six  cases,  a 
mortality-rate  of  1.6  per  cent.,  and  disability  leading  to  discharge  from  service  resulted  in 
a  hundred  and  two  of  the  cases.  Twenty-eight  cases  were  wounds  of  the  thigh,  a  hundred 
and  seventeen  wounds  of  the  leg,  three  hundred  and  thirty-one  wounds  of  the  foot. 

Ligations. — In  four  instances,  at  least,  of  this  series,  ligations  of  arteries  were  practised 
on  account  of  haemorrhage  or  aneurism.  One  of  these,  an  instance  of  aneurismal  varix 
from  puncture  of  the  femoral  artery  and  vein,  by  a  pocket-knife,  has  been  narrated,  with  a 
figure  of  the  specimen,  at  page  336  of  the  Surgical  Volume  of  Part  II.2  The  three  other 
cases  were  ligations  of  the  tibial  arteries: 

CASES  5,  6,  7. — Assistant  Surgeon  J.  C.  G.  Happersett,  U.  S.  A.,  reports  that  Private  T.  J.  Moore,  Co.  B,  82d  Ohio, 
aged  29  years,  received,  July  14,  1865,  a  punctured  wound  near  the  right  ankle.  The  haemorrhage  was  so  uncontrollable  that, 
on  July  22d,  Assistant  Surgeon  H.  M.  Lilly,  U.  S.  V.,  ligated  the  posterior  tibial  artery,  placing  a  single  proximal  ligature. 
July  24th,  unhealthy  gangrene  attacked  parts,  and  bromine  dressings  were  applied.  The  patient  recovered,  and  was  transferred 
to  Jeffersonville  October  19th,  and  to  Post  Hospital,  Louisville,  December  16,  1855. — 6.  Surgeon  C.  A.  Covvgill  reports  that 
Lieutenant  T.  Linder,  Co.  E,  158th  New  York,  aged  30  years,  received,  May  11,  1864,  a  punctured  wound  by  a  sharp  knife  on 
the  inner  side  of  the  right  leg  at  the  juncture  of  the  lower  and  middle  thirds,  dividing  the  posterior  tibial  artery  through  one 
half  its  diameter  and  causing  a  diffused  traumatic  aneurism.  He  was  admitted  into  the  Foster  Hospital,  New  Berne,  May  20th; 
the  cellular  tissue  and  iutermuscular  spaces  were  filled  with  coagula,  which  had  temporarily  arrested  hsemorrhage.  There 
was  great  tension  and  considerable  sloughing  of  the  soft  parts.  May  22d,  Surgeon  C.  A.  Cowgill,  U.  S.  V.,  made  an  incision 
five  inches  long  over  the  wound,  through  the  integuments  down  to  the  posterior  tibial  artery,  and,  ligating  it  above  and  below 
the  wound,  the  coagula  were  removed  and  the  wound  closed  by  adhesive  straps.  A  good  recovery  ensued,  and  the  officer 

returned  to  duty  June  29,   1864. — 7.  Surgeon  G.  A.  Otis,  27th  Massachusetts,  reports  that  Private  C.  D ,  Co.  B,  27th 

Massachusetts,  in  December,  1863,  at  Newport  News,  Virginia,  received  a  severe  wound  in  the  left  leg  from  an  axe,  about  three 
inches  above  the  annular  ligament.  The  tendons  of  the  tibialis  anticus,  the  common  and  proper  extensors,  and  the  anterior 

'In  old  times,  and  in  the  combats  of  the  trained  European  Cavalry,  sabre  cuts  of  the  lower  limbs  were  not  uncommon.  RAVATOX  (Chirurgic 
d'armee.,  17C8,  Chap.  IX,  p.  518)  gives  many  examples,  in  which  not  only  the  soft  parts  but  the  bones  were  hacked  by  sword-cuts.  M  LEOOUEST  also 
(Chirurgie  d'armee,  Seme  ed.,  187;!,  p.  461 )  details  several  such  examples,  and  refers  to  illustrations  in  the  Museum  of  HUTIM  at  the  Hotel  des  Invalides. 
Abstracts  of  interesting  incised  wounds  of  the  lower  limbs  may  be  found  also  in  fiE  DlJA.V  (Obsenmt.  de  Chir.,  1731,  T.  II,  p.  332)  and  in  LA  MO'lTE 
(Traitt  compute  de  Chirurgie,  1771,'T.  Ill,  p.  143  ct  seq.). 

2  First  the  femoral,  then  the  external  iliac,  and  finally  and  fatally  the  common  iliac  were  ligated  by  Dr.  J.  B.  CUTTEU.  The  operator  has  published 
abstracts  of  these  ligations  in  the  Am.  Jour.  Med.  Sci.,  18G4,  Vol.  XLVIII,  p.  36,  Ibid.,  1865.  Vol.  L,  p.  391.  The  pathological  specimen,  showing  the 
communication  between  the  artery  and  vein  and  the  huge  sacculation  of  the  latter,  is  numbered  3507  in  Sect.  I  of  the  Army  Medical  Museum. 


INJURIES   OF   THE    LOWER   EXTREMITIES.  [CHAP.  x. 

tibial  artery  veins  and  nerve  were  divided,  and  the  periosteum.  The  wound  gaped  widely,  and  the  artery  gave  freely  per  saltv.m. 
The  vessel  was  completely  severed.  Ligatures  were  at  once  placed  by  Dr.  Otis  about  the  upper  and  lower  orifices  of  the  arterv, 
and  the  wound  was  united  by  sutures.  Recovery  was  rapid  and  uncomplicated,  and  the  soldier  returned  to  duty. 

Amputations. — In  four  instances,  after  deep  incised  wounds  by  axes,  complications 
arose,  and  recourse  was  had  to  amputation.  Two  were  thigh  amputations: 

CASES  8,  9. — Private  Christian  Webber,  8th  Co.,  New  York  Independent  Volunteers,  received,  September  24,  1863,  a 
severe  wound  from  an  axe,  severing  the  quadriceps  of  the  left  thigh  two  inches  above  the  patella.  He  was  sent  to  Fairfax 
Seminary  Hospital,  September  26th,  and  deep-seated  suppuration  having  appeared,  burrowed,  and  finally  penetrated  the  knee 
joint,  Surgeon  D.  P.  Smith  thereupon  decided  to  amputate  the  limb.  The  operation  was  practised,  October  4th,  at  the  junction  of 
Ihe  lower  and  middle  thirds  of  the  femur.  The  patient  was  transferred,  convalescent,  to  York,  Pennsylvania,  October  30th,  and 
subsequently  discharged.  The  portion  of  the  femur  amputated  has  been  catalogued  in  the  Army  Medical  Museum,1  but  exhibits 
nothing  abnormal. — 9.  Private  T.  H.  Breckridge,  Co.  C,  6th  New  York  Artillery,  received  a  wound  by  an  axe  in  March,  1864, 
and  was  sent  to  Armory  Square  Hospital.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  reported  that  the  wound  involved  the  right  tarsus 
and  metatarsus,  and  presently  became  erysipelatous,  and  that  gangrene  then  supervened.  On  this  account,  on  May  27th,  Dr. 
Bliss  amputated  the  limb,  at  the  junction  of  the  middle  and  lower  thirds  of  the  femur,  by  antero-posterior  flaps  formed  bv 
transfixion.  Recovery  was  satisfactory.  On  December  28,  1864,  he  was  supplied  with  an  artificial  limb  at  Ladies'  Home,  New 
York,  by  Dr.  E.  D.  Hudson,  at  Government  expense.  The  stump  was  then  soundly  healed,  and  "creditable"  in  shape.  This 
soldier  was  discharged  July  12,  1865,  and  pensioned.  His  pension  was  paid  March  4,  1876. 

In  two  instances  the  leg  was  amputated  for  incised  wounds  of  the  ankle  or  foot: 

CASES  10,  11. — Private  M.  Dunham,  Co.  D,  Engineer  Battalion,  aged  23  years,  received  a  severe  incised  wound  of  the 
left  ankle  January  24,  1864.  He  was  sent  to  hospital  at  Alexandria.  Surgeon  E.  Bentley,  U.  S.  V.,  reports  that  long-con 
tinued  suppuration  had  ended  in  necrosis  of  the  tibia-tarsal  articulation,  the  patient  being  of  a  strumous  habit.  Dr.  Bentley 
practised  a  circular  amputation  in  the  lower  third  of  the  leg  May  5,  1864.  Pyaemia  supervened,  and  death  ensued  June  18, 
1864. — 11.  Private  A.  Stacy,  Co.  H,  12th  Kansas,  received  a  severe  wound  of  the  left  leg  by  an  axe  on  March  17,  1864.  He 
was  sent  to  hospital  at  Fort  Leavenvvorth.  In  September,  1864,  the  limb  was  amputated  by  short  anterior  and  long  posterior 
flaps  by  Dr.  Clark.  The  patient  recovered  with  a  good  stump,  and  was  fitted  with  an  artificial  limb  by  B.  Frank  Palmer,  at 
New  York,  June  23,  1866.  He  is  a  pensioner,  and  was  paid  March  4,  1876. 

The  foregoing  instances  comprise  nearly  all  the  seriously  complicated  cases  reported 
of  punctured  and  incised  wounds  of  the  lower  extremities.  There  was  a  case  (Private 
Wherry,  115th  New  York)  where  half  the  small  blade  of  a  pocket-knife  broke  off  against 
the  femur  after  perforating  the  quadriceps  two  inches  above  the  knee  joint;  attempts  at 
extraction  of  the  foreign  body  failed;  the  patient  recovered  with  partial  false  anchylosis 
at  the  knee.  Except  those  noted,  the  examples  of  sloughing  or  consecutive  bleeding  were 
trivial,  and  no  case  of  tetanus  was  observed. 

SHOT  FLESH  WOUNDS.— In  the  vast  series  of  fifty-eight  thousand  seven  hundred 
and  two  cases  of  shot  wounds  of  the  soft  parts  of  the  lower  limbs  placed  on  the  registers, 
it  is  difficult  in  many  cases  to  determine,  from  the  hasty  field  notes  or  brief  hospital  entries, 
the  exact  positions  and  extent  of  the  wounds.  As  nearly  as  can  be  approximated,  how 
ever,  it  would  appear  that  about  twenty-six  thousand  of  these  wounds  were  in  the  thigh, 
about  twenty-one  thousand  in  the  leg,  and  about  ten  thousand  in  the  foot,  a  certain  number 
of  reports  presenting  no  indication  of  the  precise  seat  of  injury. 

These  wounds  were  of  every  grade  of  severity,  from  trivial  skin-scratches  to  huge 
lacerations  by  large  projectiles;  long  furroughed  wounds  with  tortuous  tracks,  deep  seton 
perforations,  superficial  or  deep  penetrations  with  lodgement  of  the  missile,  filling  up  the 
gamut.  In  reviewing  the  great  series,  two  small  groups  especially  claim  attention — the 
wounds  attended  by  lesion  of  the  principal  nerves,  and  those  with  injury  of  the  main 
blood-vessels.  We  shall  consider  these  first',  and  then  typical  examples  of  shot  injuries 
of  the  soft  parts,  selecting  for  illustration  those  cases  remarkable  for  extent  of  lacerations, 
those  in  which  foreign  bodies  were  lodged  in  the  limb,  those  ultimately  complicated  by 
extension  of  inflammation  to  the  joints,  or  by  disease  of  the  arteries,  or  by  gangrene, 
tetanus,  and  other  complications. 

1  See  No.  2004,  Section  I,  p.  3(14,  of  Catalogue  of  the  Surgical  Section  of  the  Army  Medical  Museum,  Washington,  18C6. 


Si-CT.  i.l  SHOT    FLESH    WOUNDS.  9 

Flesh  Wounds  of  the  Lower  Limbs,  with  Injury  of  the  larger  Nerves.— Instances 
in  which  wounds  of  the  larger  nerves  were  sufficiently  distinct  and  uncomplicated  to  be 
returned  under  this  head  were  comparatively  few ;  they  were  less  frequent,  indeed,  than  in 
the  upper  limbs.1  The  relations  of  the  large  nerve  trunks  of  the  lower  extremities  to  the 
blood-vessels,  bones,  and  joints  are  such  that  they  are  more  liable  to  share  in  the  injuries 
of  these  parts  than  in  wounds  mainly  involving  the  muscular  tissues.  Moreover,  it  is 
probable  that  in  many  flesh  wounds,  nervous  branches  of  magnitude  were  implicated  with 
out  manifestation  of  any  very  serious  results,  and  that  such  cases  were  not  returned  as 
injuries  of  nerves.2  Presenting  less  urgency  in  relation  to  immediate  treatment  than  lesions 
of  the  arteries  and  bones,  these  accidents  nevertheless  were  frequently  very  grave,  entail 
ing  a  vast  amount  of  protracted  misery,  and  sometimes  fatal  consequences.  Of  fifty-nine 
cases  referred  to  this  category,  thirty-one  were  reported  as  wounds  of  the  sciatic,  two  of 
tiie  crural,  five  of  the  long  saphenous,  one  of  the  middle  cutaneous,  nine  of  the  popliteal, 
five  of  the  anterior  tibial,  three  of  the  posterior  tibial,  and  three  of  unspecified  large  nerve 
trunks.  Eleven  cases  proved  fatal,  of  which  six  succumbed  from  tetanus.  Amputation 
was  resorted  to  in  four  cases,  briefly  noted  in  succeeding  tables.  Two  amputations  in  the 
thigh  were  successful;  one  through  the  knee  joint,  and  one  in  the  leg  proved  fatal. 

Of  thirty-one  cases  of  wounds  of  the  sciatic  nerve,  twenty-five  recovered,  including 
one  in  which  amputation  in  the  thigh  was  practised,  and  six  were  fatal.  Four  died  of 
tetanus.3  One  succumbed,  long  after  the  injury,  from  secondary  traumatic  coxitis.4 
Erysipelatous  inflammation  with  sloughing,  extending  to  the  hip  joint,  and  resulting  in 
ulceration  of  the  cartilages  and  caries  of  the  head  of  the  femur  and  acetabulum.  The 
fourth  fatal  case5  was  an  example  of  exhaustion  from  protracted  suffering.  Of  the 

1  As  indicated  in  Part  II,  Vol,  II,  p.  461,  there  were  96  cases  distinguished  as  nerve  lesions  of  the  upper  extremities,  contrasted  with  59  instances  in 
the  lower  extremities.     Professor  A.  SOCIN  (Kriegschir.  Erf.,  Leipzig,  187:2,  p.  64)  remarks  a  similar  disproportion  in  the  Franco-German  War.     Relating 
16  cases  of  shot  injuries  of  the  nerves,  he  observes  that:  "  more  than  five-eighths  of  these  concerned  the  upper  extremities." 

2  In   their  treatise  on   Gunshot   Wounds  and  other  Injuries  of  Nerves.     By  S.  WEIR  MITCHELL,  M.  D.,  GEORGE  R.  MOItKHOUSE,  M.  D.,  and 
WILLIAM  W.  KEEN,  M.  D.,  Philadelphia,  1864,  the  authors  detail  (pp.  93,  93)  two  cases  of  shot  injury  of  the  sciatic  nerve :  Private  K.  Grim,  Co.  B, 
121st  Pennsylvania,  who  received  at  Fredericksburg,  December  13,  1863,  a  shot  perforation  of  the  left  thigh,  the  ball  entering  externally  four  inches 
above  the  upper  border  of  the  patella,  and  emerging  on  the  inside  of  the  thigh,  two  inches  lower  down,  slightly  injuring  the  sciatic  nerve.     He  had,  July, 
18G3,  severe  burning  on  the  dorsum  of  the  left  foot,  and  eczema,  with  ulceration  about  the  nails,  complete  paralysis  of  the  flexors  of  the  fo<;t  and  partial 
paralysis  of  the  flexor  communis  and  calf  muscles.     The  other  patient  entered  the  hospital  about  the  same  time,  a  ball  wound  passing  close  to  the  sciatic. 
He  had  complete  loss  of  power  in  the  flexors  of  the  foot,  defective  sensation  on  the  outside  of  the  leg  and  foot,  and  eczema  with  burning  pain.     Both 
patients  were  treated  with  electricity,  with  gradual  gain  of  motion  and  relief  of  pain,  and  were  regarded  as  fair  types  of  partial  wound  or  commotion  of 
a  nerve.     At  page  128,  of  the  same  work,  the  case  of  Private  J.  S.  L.  Scott,  Co.  F,  121st  New  York,  aged  31  years,  is  related:  lie  had  a  shot  wound  of 
the  calf  of  the  right  leg.  at  Chancellorsville,  May  3,  1863.     The  ball  passed  between  the  fibula  and  tibia  about  mid-leg.     Total  less  of  motion  below 
knee,  slightly  tactile  insensibility,  foot  extended  and  powerless.     September,  1863,  rapid  improvement  followed  alternated  cold  and  hot  douches,  with 
faradization,  and  a  splint  to  correct  the  malposition  of  the  foot.     Discharged,  improved,  February  12,  1864.     The  reports  of  Pension  Kxaminers  Maun  and 
Lanning,  of  Manchester,  Ohio,  where  this  pensioner  now  resides,  recapitulate  the  foregoing  facts,  and  describe  the  paralysis  as  in  all  probability  perma 
nent.     The  latest  report  by  Dr.  Lanning,  February  4,  1874,  states  that  "paralysis  of  the  foot  and  toes  is  nearly  complete,"  and  recommends  that  the 
pensioner  be  excused  from  further  biennial  examinations,  as  his  disability  is  considered  irremediable.     This  recommendation  was  opposed,  and  the  pen 
sioner's  condition  was  unchanged  when  he  was  last  paid,  March  4,  1876.     In  Circular  6,  S.  G.  O.,  1864:  On  It'Jlex  Paralysis  resulting  from  shot  wounds, 
the  sumo  authors  narrate  two  examples  of  reflex  paralysis  of  the  upper  extremity  induced  by  shot  flesh  wounds  implicating  the  nerves  of  the  lower 
limbs :  Private  W.  W.  Armlin,  Co.  D,  134th  New  York,  aged  23  years,  was  shot  at  Gettysburg,  July  1,  1863,  the  ball  entering  anteriorly  about  midway 
on  the  inner  part  of  the  right  thigh  and  emerging  outside  and  below  the  tuberosity  of  the  ischinm,  just  above  the  fold  of  the  nates.     The  sciatic  nerve 
was  probably  injured.     There  was  partial  paralysis  of  the  right  leg,  and  reflex  paralysis  of  the  right  arm.     The  latter  speedily  recovered. — Private  D. 
Kent,  Co.  15,  145th  Pennsylvania,  aged  24  years,  was  struck,  at  Gettysburg,  July  2,  1863,  over  the  upper  third  of  the  right  rectus  femoris,  by  a  musket 
ball,  which  passed  through  the  thigh,  emerging  at  the  inner  side  a  little  below  the  fold  of  the  nates.     There  was  loss  of  motion  and  sensation  in  the 
thigh  and  leg,  and  reflex  motor  paralysis  in  the  right  arm.     The  patient  was  discharged  January  20,  1864,  for  tuberculosis.     The  paralysis  had  amended 
under  the  use  of  hot  and  cold  douches,  active  motor,  and  faradization.     In  his  work,  entitled  Gunshot  Wounds  of  the  Nerves  and  their  Consequences, 
Philadelphia,  1872,  Dr.  S.  WEIIJ  MITCHELL  cites  the  case  of  Sergeant  C.  Beatty,  26th  Pennsylvania,  shot  through  the  calf,  at  Chancellorsville,  May 
3,  1863,  who  suffered  intensely  from  causalgia.     The  foot,  a  few  days  after  injury,  was  prickling  and  burning  intensely.     After  a  fortnight  the  prickling 
ceased;  but  the  burning  persisted.     He  recovered  in  about  five  months,  without  treatment.     In  this  valuable  work,  abounding  in  illustrations  of  the 
effects  of  shot  lesions  of  the  nerves  of  the  trunk  and  upper  limbs,  I  find  no  other  example  of  shot  wound  of  the  nerves  of  the  lower  extremities. 

8  Privates  Albro,  27th  Michigan;  Fry,  3d  New  Jersey;  Riley,  10th  New  York;  and  Smith,  46th  New  York. 

4  Case  of  Private  T.  J.  Dame,  Co.  E,  18th  Mississippi,  wounded  at  Antietam,  September  17, 1862.  Died  June  1!),  1863.  See  Spec.  3849,  A.  M.  M., 
Cat.  Surg.  Sect.,  1866,  p.  243. 

6  Case  of  Private  E.  M.  McGregor,  Co.  C,  76*.h  New  York,  shot  through  the  left  sciatic  nerve  September  6,  1863.  The  missile  lodged  and  could 
not  be  detected  during  life.  He  had  motor  paralysis  of  the  leg  muscles,  and  intense  pain  in  the  upper  part  of  the  track  of  the  perineal  and  anterior  tibia, 
and  used  hypodermic  injections  of  morphia.  He  died  February  1,  1863. 

Suim.  Ill— 2 


10  INJUKTES    OF    THE    LOWER   EXTREMITIES.  [CHAP.  X. 

twenty-five  survivors,  one  fully  recovered  and  returned  to  duty,  three  entered  the  Veteran 
Reserve  Corps,  and  twenty-one  were  discharged.  With  few  exceptions,  they  suffered  from 
neuralgia  or  from  partial  motor  paralysis.  One  (Private  Armlin,  134th  New  York)  had 
reflex  paralysis  of  the  arm  on  the  side  corresponding  with  the  injury  to  the  sciatic  nerve.1 
Notes  of  two  of  the  cases  of  persistent  neuralgia  are  appended: 

CASE  12. — Private  W.  T.  Burk,  Co.  F,  151st  New  York,  aged  24  years,  was  wounded  at  Monocacy,  July  9,  1864,  and 
admitted  to  hospital  at  Frederick  the  following  day.  Acting  Assistant  Surgeon  E.  R.  Ould  reported:  "Gunshot  flesh  wound 
of  both  thighs,  perforating  upper  third  and  injuring  the  sciatic  nerve  of  the  right  thigh.  The  patient  is  of  a  nervous  and 
irritable  temperament.  Simple  dressings  were  applied,  and  opiates  given  at  night;  wound  healing.  July  20th,  great  pain 
complained  of  in  the  course  of  the  sciatic  nerve  and  increasing  in  the  region  of  the  foot  and  ankle;  pulse  accelerated,  100  per 
minute;  pain  increasing;  general  appearance  moderately  good ;  appetite  poor.  Applied  pounded  ice  to  foot  and  gave  two 
drachms  of  solution  of  morphia  four  times  a  day.  August  1st,  the  ice  moderated  the  amount  of  pain ;  treatment  continued. 
Patient  slept  half  the  night.  August  12th,  patient  much  improved;  ice  discontinued;  prescribed  morphia,  iron,  and  quinine 
four  times  a  day.  September  1st,  pain  more  severe;  the  wounds  have  entirely  healed ;  treatment  continued.  September  20th, 
walking  about  with  crutches,  but  very  lame;  stimulating  and  anodyne  liniment  used  night  and  morning.  September  25th, 
patient  finds  great  relief  by  keeping  his  hands  wet  with  water;  bowels  regular;  pulse  natural.  October  1st,  but  slight 
improvement;  continued  the  quinine  and  iron  mixture,  also  one  drachm  of  fluid  extract  of  cimicifuga.  October  30th,  still 
walks  lame,  the  leg  being  very  painful  on  motion.  October  31st,  furloughed  this  day;  patient  has  but  little  prospect  of  a  speedy 
recovery."  He  subsequently  returned  to  the  hospital,  aud  was  mustered  out  of  service  May  31,  1865,  and  pensioned.  Examiner 
J.  H.  Helmer,  of  Lockport,  New  York,  February  9,  1863,  certified:  "Ball  entered  right  thigh,  upper  third,  passed  through  in 
front  of  the  bone,  and  through  the  left  thigh  back  of  the  bone,  destroying  the  femoral  nerve.  Left  leg  two  inches  smaller  than 
the  right;  muscles  flabby;  no  voluntary  motion  of  the  left  foot.  He  can  walk,  but  walks  like  a  paralytic."  At  a  subsequent 
examination  it  was  additionally  reported  that  "  the  temperature  of  the  left  leg  and  foot  is  reduced,"  etc.  The  pensioner  was 
paid  June  4,  1876. 

CASE  13. — Private  C.  J.  Keegan,  Co  H,  80th  New  York,  aged  40  years,  was  wounded  at  Gettysburg,  July  1,  1863,  and 
entered  the  York  Hospital  on  July  19th.  Acting  Assistant  Surgeon  G.  Byers  reported:  "Gunshot  flesh  wound  of  right  thigh; 
ball  entered  the  middle  third  below  the  edge  of  the  sartorius  muscle,  passing  upward  and  outward,  made  its  exit  two  inches 
below  and  behind  the  trochanter,  injuring  the  great  sciatic  nerve  in  its  course.  The  wound  closed  kindly;  the  leg  and  foot, 
however,  continued  cedematous,  and  the  man  has  suffered  very  greatly  with  pains  of  a  darting  character.  He  has  at  no  time 
been  able  to  use  the  limb  since  the  receipt  of  the  injury.  Liniment  of  aconite  was  applied  to  the  leg,  and  opiates  were  given 
internally.  May  23, 1864,  the  pain  has  much  diminished  in  intensity  within  the  last  two  months."  The  patient  was  discharged 
from  service  June  28,  1864,  and  pensioned.  Examiner  H.  B.  Day,  of  Utica,  New  York,  certified,  February  16,  1865: 
"The  great  ischiatic nerve  must  have  been  injured,  as  he  has  constant  pain,  numbness,  and  partial  paralysis  of  the  parts  supplied 
by  this  nerve  and  its  branches,  rendering  him  unable  to  stand  for  any  length  of  time,"  etc.  Examiner  I.  Spencer,  of  De  Ruyter, 
certified,  October  19,  1865:  "Permanent  lameness  of  the  thigh.  The  foot  is  also  deformed  by  an  unnatural  action  of  the  muscles 
contracting  the  toes  obliquely,  and  there  is  an  unnatural  fixedness  of  the  arch  of  the  foot,"  etc.  Subsequent  examiners  reported 
substantially  the  same,  and  all  concur  in  their  belief  as  to  the  nerve  injury.  This  pensioner  was  paid  June  4,  1876. 

The  two  patients  wounded  in  the  anterior  crural  nerve,  were  discharged  without 
relief  of  the  persistent  pain  that  followed  their  injuries.  Surgeon  I.  I.  Hayes,  U.  S.  V., 
has  furnished  a  detailed  report  of  one  of  the  cases : 

CASE  14. — Private  W.  H.  Cookson,  Co.  E,  42d  New  York,  aged  23  years,  was  wounded  at  Antietam,  September  17, 
1882,  and  entered  the  Satterlee  Hospital,  Philadelphia,  nine  days  afterwards.  Four  months  after  his  admission  Surgeon  I.  I. 
Hayes,  U.  S.  V.,  reported:  "He  was  wounded  b}-  a  mini6  ball  entering  on  the  outer  side  of  the  right  thigh,  about  midway 
between  the  anterior  superior  spinous  process  of  the  ilium  and  the  trochanter  major,  and,  passing  obliquely  upward,  made  its 
exit  near  the  middle  of  Poupart's  ligament,  wounding,  I  infer,  the  anterior  crural  nerve,  from  the  intense  pain  he  has  suffered 
iff  the  course  of  that  nerve.  The  wound  has  long  since  healed.  The  suffering  experienced  over  the  front  and  side  of  the  thigh, 
parts  supplied  by  the  anterior  crural  nerve,  is  instructive  as  showing  the  effect  of  an  injury  in  the  course  of  a  nerve  manifesting 
itself  in  the  extremities  of  that  nerve.  The  pain  has  not  abated  by  the  use  of  the  most  powerful  anodynes,  and  sleep  is  only 
procured  through  the  influence  of  sulphate  of  morphia.  A  question,  which  is  still  'subjudice,' arises:  Shall  we  excise  that 
portion  of  the  nerve  which  is  wounded,  hoping  thereby  to  relieve  his  almost  intolerable  suffering?"  The  patient  was  discharged 
from  service  February  28,  1863,  and  pensioned.  Drs.  T.  S.  Johnston  and  R.  H.  Hope,  of  Rock  Hill,  S.  C.,  in  certifying  to  the 
results  of  the  wound,  May  9,  1874,  stated  that  "from  this  cause  he  is  now  suffering  witli  neuralgia  and  partial  paralysis  of  the 
extensor  muscles  of  the  thigh."  The  pensioner  was  paid  June  4,  1876. 

Of  the  five  cases  of  wounds  of  the  long  saphenous,  one  resulted  in  complete  recovery, 

1  J.  MASON  WAKREN,  in  an  interesting  article  on  Neuralgic  Affections  following  Injuries  of  Nerves,  in  Am.  Jour.  Me.il.  Sci.,  N.  S.,  18fi4,  Vol. 
XLVII,  p.  316  (which  is  reproduced  in  his  excellent  Surgical  Observations,  Boston,  1867,  p.  465),  details  the  case  of  a  soldier  with  wound  of  the  sciatic 
nerve,  who  was  probably  Private  D.  Callahan,  <!o.  E,  19th  Massachusetts,  aged  2J  years,  whose  history  on  the  registers  of  this  Office  closely  corresponds 
to  the  graphi-  description  given  by  Dr.  Warren,  to  which  the  reader  is  referred.  His  Pension  Report  for  187G  may  be  added  :  There  was  atrophy  of  the 
injured  thigh  and  leg,  with  diminished  temperature  and  grea'ly  diminished  motor  power  in  the  muscles  of  tlie  leg  and  foot. 


SECT.  M  SHOT    FLESH    WOUNDS    IMPLICATING   NERVES.  11 

four  in  more  or  less  paralysis  and  atrophy.1  The  case  of  wound  of  the  middle  cutaneous 
nerve  was  attended  with  severe  neuralgia,  which  yielded  to  blistering  and  other  remedies, 
and  the  patient  returned  to  duty. 

The  series  of  nine  cases  of  wounds  of  the  popliteal  nerve  comprises  a  fatal  case  of 
tetanus.2  The  other  patients  recovered,  and  three  entered  the  Veteran  Reserves,  while 
five  were  discharged,  one  after  recovery  from  amputation  in  the  thigh,  and  one  with 
excruciating  neuralgia. 

The  category  of  five  cases  of  wounds  of  the  anterior  tibial  included  one  death  from 
tetanus.3  The  four  survivors  had  partial  paralysis  of  the  extensor  muscles.  An  instance 
is  detailed : 

CASE  15.— Private  D.  S.  Pierce,  Co.  B,  1st  Michigan,  aged  22  years,  was  wounded  at  Bull  Run,  August  30,  1862,  and 
admitted  to  Ryland  Chapel  Hospital,  Washington,  three  days  afterwards.  Surgeon  J.  A.  Lidell,  U.  S.  V.,  reported:  "The 
patient  was  admitted  to  Stanton  Hospital  from  Eyland  Chapel,  December  5th,  with  wound  in  the  right  leg.  The  bullet  entered 
the  outer  part  of  the  front  of  the  middle  third  of  said  leg,  about  midway  between  the  tibia  and  fibula.  The  bullet  did  not  go 
through  the  limb.  It,  however,  went  in  so  deep  that  it  could  not  be  reached  by  exploration.  The  wound  has  been  healed  since 
the  middle  of  October.  The  missile  has  gravitated  through  between  the  tibia  and  fibula,  and  can  now  be  felt  deeply  seated  in 
the  muscles  of  the  calf.  It  gives  him  no  trouble.  The  anterior  tibial  nerve  was  divided  by  the  bullet,  in  consequence  of  which 
the  muscles  of  the  front  of  the  leg  are  paralyzed.  The  end  of  the  foot  points  downward  from  activity  of  those  on  the  back  of 
the  leg,  and  the  case  resembles  talipes  equinus.  The  patient  walks  haltingly,  but  without  a  cane,  by  the  aid  of  a  high-heeled 
shoe.  He  has  suffered  but  little  pain  since  the  wound  healed,  and  considers  himself  to  be  slowly  improving.  He  was  discharged 
December  16,  1862."  Examiner  D.  Hudson,  of  Lansing,  Michigan,  reported,  May  8, 1863:  "Ball  passed  through  both  peroneal 
muscles,  dividing  the  tibial  nerve  d  *  and  lodging  deep  in  the  soleus  muscle.  Ankle  joint  became  stiff  at  an  obtuse  angle, 
requiring  a  heel  more  than  an  inch  higher  on  the  right  shoe  than  on  the  left  one.  Neuralgic  pain  in  foot  and  ankle  daily  and 
hourly."  Drs.  J.  B.  Hull  and  I.  H.  Bartholomew,  of  the  Lansing  Examining  Board,  certified,  December  7,  1870:  "The  ball 
passed  down,  and  now  lies  under  the  skin  above  the  inner  malleolus.  He  cannot  stand  on  his  leg  but  a  short  time,  and  is  getting 
worse,"  etc.  They  also  stated  that  they  excised  the  ball,  and  reported,  September,  1872:  "The  nerve  is  diseased,  and  he  suffers 
great  pain  through  the  whole  leg;  is  emaciated  and  feeble,  and  growing  worse."  This  pensioner  died  of  "consumption," 
November  22,  1872,  superinduced,  in  the  opinion  of  the  attending  physicians,  by  "the  continually  depressing  effects  of  the  pain 
and  tenderness  of  his  limb." 

The  three  cases  of  wounds  of  the  posterior  tibial  nerve  were  fatal.  Two  involved 
unsuccessful  amputations,  one  at  the  knee  joint  and  one  in  the  leg,  and  the  third  was  fatal 
from  gangrene.4  The  two  amputations  were  practised  after  tetanus  had  supervened:5 

CASE  16. — Corporal  B.  Prather,  Co.  D,  103d  Ohio,  aged  18  years,  was  wounded  at  the  battle  of  Nashville,  December 
15, 1864,  and  Avas  admitted  to  the  Cumberland  Hospital  on  the  following  day.  Surgeon  B.  Clark,  U.  S.  V.,  reported:  "Gun 
shot  wound  of  right  foot,  ball  entering  immediately  under  the  metatarsal  bone  of  the  great  toe  and  burying  itself  in  the  plantar 
fascia.  The  soft  parts  were  remarkably  sensitive  in  the  vicinity  of  the  wound,  showing  a  great  degree  of  muscular  and  nervous 
irritability.  The  foot  was  not  swollen,  the  bones  were  not  fraqtured,  nor  the  tissues  severely  lacerated.  December  26th,  the 
ball  was  removed  by  Acting  Assistant  Surgeon  S.  G.  Ayres;  second  operation,  exsection  of  a  half  inch  of  the  posterior  tibial 
nerve,  behind  the  inner  malleolus,  by  Assistant  Surgeon  W.  B.  Trull,  U.  S.  V.;  third  operation,  amputation  of  the  toe,  with 
removal  of  the  first  metatarsal  bone,  by  Acting  Assistant  Surgeon  L.  E.  Tracy.  The  patient  complained,  on  December  26th, 
saying  that  a  feeling  of  stiffness  had  been  coming  on  for  three  days,  especially  in  the  shoulders,  neck,  and  jaws.  The  latter 
gradually  closed  until  it  was  impossible  to  introduce  food  into  his  mouth.  There  was  a  tetanic  spasm  of  the  muscles  of  deglutition, 
so  that  the  patient  was  dying  from  inability  to  swallow.  Chloroform  alone  seemed  to  afford  temporary  relief  from  his  intense 
sufferings.  Relaxation  of  the  jaws  was  effected  by  division  of  the  nerve,  but  the  spasms  of  the  muscles  immediately  returned. 
At  midnight  of  the  27th,  amputation  at  the  lower  third  of  the  leg  was  performed  by  Acting  Assistant  Surgeon  S.  G.  Ayres,  but 
without  effect.  Large  opiate  injections  were  afterward  given,  and  the  patient  obtained  sleep.  A  copious  warm  perspiration 
breaking  out  upon  the  face  and  the  improved  pulse  were  considered  favorable  symptoms.  Died  December  28,  1864." 

The  three  cases  of  shot  wounds  of   unspecified   nerves  were   probably  examples  of 

1  Cases  of  Lieutenant  A.  Rodman,  2d  Wisconsin,  wounded  in  I860,  and  who  recovered.  Also  of  Private  W.  Lette,  Co.  F.  09th  New  York,  wounded 
at  Bull  Run,  August  29,  1862;  Corporal  A.  McNeal,  Co.  A,  121st  New  York,  wounded  October  19,  1862;  Sergeant  C  E.  Clark,  Co.  H.  32d  Virginia, 
wounded  at  Spottsylvania,  May  12,  1864  ;  and  Private  P.  J.  Vimont,  Co.  C,  7th  Kentucky  Cavalry,  who  were  discharged  for  disability. 

2Caseof  Private  J.  G.  Grissetta,  Co.  D,  2d  Alabama;  wounded  at  Fort  Blakely,  April  9,  1864;  died  April  21st.  It  is  stated  that  the  popliteal 
nerve  was  "dark  and  disorganized." 

3  Private  James  Rollins,  Co.  H,  28th  North  Carolina,  aged  30  years ;  wounded  at  Gettysburg,  July  3,  1863;  tetanus  July  20th  ;  death,  July  22, 1863. 

4  Case  of  Private  G.  Richmoud,  Co.  D,  lllth  New  York,  wounded  at  Bristow  Station,  October  14,  1863,  in  the  upper  third  of  the  left  calf  by  a 
carbine  ball.     He  was  sent  to  the  Third  Division  Hospital  at  Alexandria.     The  wound  was  dilated  by  an  incision.     Gangrene  appeared  and  spread  very 
rapidly,  and  death  took  place  October  23,  1863. 

SCASE  16,  and  the  case  of  Private  J.  Leonard,  Co.  G,  5th  Ohio,  aged  22  years,  wounded  at  Gettysburg,  July  3, 1863 ;  tetanic  symptoms  July  14th. 
amputation  at  knee  joint  July  16th,  and  death  three  hours  after. 


12  INJURIES   OF   THE   LOWER   EXTREMITIES.  [CHAP.  x. 

injuries  of  the  sciatic  in  one  instance,  of  the  anterior  and  posterior  tibials  in  the  others. 
Abstracts  of  two  of  the  cases  are  subjoined;  the  third  case  has  been  published,  and  has 
been  noticed  in  the  foot-note  on  page  9  (case  of  Private  J.  S.  L.  Scott,  121st  New  York). 

CASE  17. — Sergeant  J.  W.  Crane,  Co.  A,  ?9th  New  York,  aged  27  years,  was  wounded  at  Bull  Run,  August  30,  1862, 
and  admitted  to  Judiciary  Square  Hospital,  Washington,  one  Aveek  afterward.  On  May  9, 1863,  he  was  transferred  to  DeCamp 
Hospital,  David's  Island,  whence  Acting  Assistant  Surgeon  J.  W.  Dickie  reported:  "A  ball  passed  through  right  thigh  at  about 
the  junction  of  the  upper  and  middle  thirds.  The  wound  closed  about  the  first  of  March,  and  a  small  abscess  formed,  about 
that  tin\e,  a  little  below  the  wound.  When  the  abscess  healed  a  pain  commenced  in  the  left  hip  joint,  extending  to  the  foot.  This 
pain  was  constant.  No  pain  was  felt  in  the  right  leg  except  when  pressure  was  made  on  the  wound.  The  pain  was  most  severe 
in  the  hip  and  calf  of  the  leg.  It  would  at  times  ascend  and  affect  the  respiratory  muscles,  causing  great  distress  and  difficulty 
in  breathing.  Appetite  poor  when  admitted,  yet  the  patient  is  quite  fleshy.  Had  taken  considerable  quantity  of  morphia,  so 
much  as  to  be  free  from  pain.  May  13th,  had  recurrence  of  pain  and  dyspnoaa,  and  spasm  of  upper  extremities.  Gave  chloro 
form,  twenty  drops,  and  repeated  the  dose  in  fifteen  minutes.  May  17th,  had  another  spasm ;  same  treatment.  Has  slighter 
attacks  more  frequently,  which  are  relieved  by  exposure  to  cold.  May  19th,  had  another  spasm;  two  grains  of  sulphate  of 
morphia  given ;  pain  checked.  May  24th,  another  spasm ;  gave  chloroform  one  drachm,  and  sulphate  of  morphia  one  grain ;  pain 
relieved.  On  the  next  day  cauterization  was  performed  along  the  course  of  the  great  ischiatic  and  peroueal  nerves.  May  28th, 
gave  nine  grains  of  sulphate  of  quinine  and  a  half  grain  of  sulphate  of  morphia,  and  repeated  every  evening.  May  29th, 
had  a  recurrence,  but  not  much  spasm.  June  12th,  the  cauterized  surface  is  healed;  patient  improving  and  has  but  little  pain. 
June  22d,  walked  out,  supporting  himself  by  means  of  canes."  The  patient  was  subsequently  transferred  to  McDougall 
Hospital,  where  he  was  recorded  as  having  been  "returned  to  duty  December  28,  1863."  The  records,  however,  do  not  show 
that  he  resumed  active  duty  in  the  field.  He  was  mustered  out  October  6,  1864,  and  pensioned.  The  Hartford  Examining 
Board  certified,  May  3,  1871:  *  *  "The  muscles  and  skin  are  bound  down  to  the  bone  and  are  much  impaired  in.  action. 
Partial  paralysis  of  both  limbs,  owing  to  the  injury  to  the  nerves."  The  same  Board  reported,  September  15,  1873,  that  "owing 
to  the  injury  to  some  nerve  he  suffers  excruciating  pain  on  slight  exercise  or  change  of  temperature,"  and,  at  a  subsequent 
examination,  they  stated  that  "pain  extends  to  the  spine  and  down  the  other  leg,  and  the  limb  at  such  times  is  drawn  up 
spasmodically ;"  also  that  "  he  is  confined  to  bed  from  one  to  three  months  every  year,"  etc.  The  pensioner  was  paid  June  4,  1876. 

CASE  18. — Private  J.  W.  Young,  Co.  E,  137th  New  York,  aged  27  years,  was  wounded  at  Gettysburg,  July  2,  1863, 
and,  admitted  to  Harewood  Hospital,  Washington,  three  weeks  afterward.  Acting  Assistant  Surgeon  T.  H.  Elliott  reported: 
"Gunshot  wound  of  right  leg.  Ball  entered  through  upper  portion  of  gastrocnemius  muscle  and  emerged  near  the  head  of  the 
fibula.  The  foot,  immediately  after  the  injury,  dropped  to  full  extension ;  all  of  the  muscles  of  the  leg  paralyzed  from  division 
of  nerves;  flexors  of  thigh  contracted,  causing  the  heel  to  be  raised  from  the  floor  three  inches  in  the  erect  posture.  Patient  is 
unable  to  bear  any  weight  on  the  limb.  August  6th,  wound  unhealed ;  paralysis  of  extensor  muscles  complete.  Patient 
discharged  from  service  August  16,  1863."  Examiner  J.  G.  Orton,  of  Binghamton,  New  York,  September  15,  1866,  certified : 
"The  power  of  flexion  of  the  foot  upon  the  leg  is  impossible  in  consequence  of  injury  to  flexor  muscles;  walking  is  performed 
with  much  difficulty  and  not  without  assistance."  On  February  29,  1876,  he  reported :  *  *  "The  power  of  flexion  of  the 
foot  is  entirely  gone.  It  is  at  present  almost  worthless,  the  foot  being  swollen,  and  drags  when  he  walks;  he  cannot  walk 
without  assistance."  The  pensioner  was  paid  March  4,  1876. 

In  addition  to  the  cases  of  reflex  paralysis  cited  from  Dr.  Keen  in  foot-note  2  on 
page  9,  a  report  of  an  instance  of  this  rare  affection  is  given  below.1  Special  reports  of 
operations  on  this  subject  are  infrequent.2 

1  Private  C.  Sullivan,  Co.  K,  69th  New  Y<  rk,  aged  36,  was  wounded  at  Spottsylvania,  May  10,  1864.     From  a  field  hospital  of  the  Second  Corps 
he  passed  to  Douglas  Hospital  at  Washington,  and  thence  to  South  Street  at  Philadelphia,  from  all  of  which  places  "a  shell  wound  of  the  left  leg"  was 
reported.     Assistant  Surgeon  S.  A.  STORHOW,  U.  S.  A.,  in  charge  of  the  Filbert  Street  Hospital,  described  the  injury  as  ''a  shot  wound  of  the  gastro 
cnemius  muscle,  involving  the  posterior  tibial  nerve."     Acting  Assistant  Surgeon  L.  Tosier  reported  the  patient's  admission  to  the  Ladies'  Home  Hospital, 
New  York  City,  November  7th,  and  the  following  history:  "A  shell  wound  of  the  posterior  portion  of  the  leg,  severing  the  lower  portion  of  the  gastro 
cnemius  muscle.     The  wound  has  healed  with  considerable  contraction  of  the  parts,  flexing  the  foot  strongly  and  leaving  the  ankle  joint  exceedingly 
tender  and  painful— almost  immovable.    On  the  morning  of  July  llth  the  patient  awoke  with  almost  complete  paralysis  of  each  forearm  and  hand,  in 
which  condition  they  yet  remain."    The  patient  was  discharged  December  9,  1864,  and  pensioned.     Examiner  E.  Bradley,  of  New  York,  on  February  10, 
1866,  certified  to  atrophy  of  the  wounded  limb  and  an  open  ulcer  occupying  the  lower  and  posterior  surface;  also  to  partial  paralysis  of  the  right  hand. 
The  New  York  Examining  Board  reported,  September  11,  1872:  "A  shell  wound,  etc.,  leaving  a  tender  cicatrix  which  is  constantly  breaking  open. 
Locomotion  is  interfered  with.     The  limb  is  very  tender,  and  it  is  painful  for  him  to  walk.     He  cannot  move  his  right  hand  on  account  of  total  paralysis 
of  it,  nor  close  the  fingers.     He  states  that  both  hands  became  paralyzed  after  he  was  wounded,  and  that  he  recovered  the  use  of  the  left  hand,  but  the 
other  hand  remained  useless.     We  cannot  discover  any  connection  between  the  wound  of  the  leg  and  the  paralysis  of  the  hand.''     Dr.  A.  B.  MOTT,  of 
New  York  City,  who  was  surgeon  in  charge  of  Ladies'  Home  Hospital  at  the  time  of  the  pensioner's  discharge  from  service,   certified,   February  22, 
1873:  'At  the  time  of  his  admission  to  the  hospital  the  patient  had  lost  the  use  of  both  arms,  but  he  recovered  the  use  of  the  left  arm.     As  far  as  my 
memory  serves  me,  it  was  my  opinion  at  that  time  that  the  paralysis  was  due  to  shock  at  the  time  of  receiving  the  wound .''    The  pensioner  was  paid 
June  4,  1877. 

2  On  wounds  of  the  nerves  of  the  lower  extremities  the  reader  can  consult,  in  addition  to  the  works  already  cited,  and  the  researches  of  CllUJK- 
8HANK,  KOXTANA,  J.  F.  MECKEL,  RETZIUS,  TIEDEMAXX,  and  other  experimenters  in  surgical  physiology  on  the  results  of  division  of  the  nerves,  the 
following  authors:  DESCOT,  Diu.  sur  Us  affections  locales  des  nerfs,  Paris,  1822,  No.  21(3;  SWAX  (J.),  A  Treatise  on  Diseases  and  Injuries  of  the  Nerves, 
2d  ed.,  London,  1834  ;  HAMILTON'  (J.),  On  some  effects  resulting  from  Wounds  of  Nerves,  in  Dublin  Jour,  of  Med.  Sci.,  1834,  Vol.  XIII,  p.  38;  WALLER, 
Nouv.  meth.  anat.  pour  V investigation  du  systeme  nerveux,  Bonn,  1852 ;  PHILLU'EAUX  and  VULPIAN,  Recherches  sur  la  regeneration  des  nerfs,  in  Mem. 
de  la  Societe  de  Bioloyie,  1859 ;  DfCHEXXE,  De  electrisation  localisee,  etc.,  2d  ed.,  1860 ;  LOXDE,  Recherches  sur  les  nevralgies,  consecutives  aux  lesions  des 
nerfs,  Paris.  1860,  No.  199;  TlLLAUX  (P.),  Det  Affection*  Chirurgicales  des  Nerfs,  Paris,  1866;  PAULET,  Les  Suites  immediates  et  eloignees  des  lesions 
traumatiques  des  nerfs,  in  Gaz.  Hebdom.  de  Paris,  1868,  T.  V,  p.  283;  FOLLIX  (E.),  Traiti  iUm.  de  path,  ext.,  Paris,  1867,  T.  II.  p.  23& 


SECT.  I.]  SHOT    FLESH    WOUNDS    IMPLICATING    BLOOD-VESSELS.  13 

Flesh  Wounds  of  the  Lower  Limbs  •with  Injury  of  the  larger  Blood-vessels. — As 

indicated  in  my  preliminary  surgical  report  in  Circular  6,  S.  G.  0.,  1865,  p.  38,  shot 
wounds  of  the  larger  arteries  of  the  lower  extremity,  the  femoral,  profunda,  peroneal,  and 
tibials,  uncomplicated  by  fracture  of  the  adjacent  bones,  or  by  extended  disorganization  or 
complete  removal  of  the  limb  by  the  impact  of  large  projectiles,  that  come  under  the  treat 
ment  of  the  military  surgeon,  are  comparatively  infrequent.  It  is  difficult  to  convince 
surgeons  who  have  had  little  field  practice  of  the  rarity  of  this  form  of  accident.1  It  is 
strikingly  illustrated  by  the  fact  that,  in  the  series  of  fifty-eight  thousand  seven  hundred 
and  two  cases  of  shot  flesh  wounds  of  the  lower  extremities  we  are  now  discussing,  only  a 
hundred  and  fifty-six  instances  of  this  particular  lesion,  or  2.6  per  thousand,  were  reported. 
Of  one  hundred  and  fifty-six  cases,  thirty-three  were  treated  without  operative  inter 
ference,  eighty-seven  by  ligation,  twenty-three  by  amputation,  and  eight  by  ligation 
followed  by  amputation.  These  four  groups  will  be  separately  considered. 

Wounds  of  Blood-vessels  treated  without  Operation- — This  group  comprises  eighteen 
cases  of  wounds  of  the  femoral  artery,  in  two  of  which  the  femoral  vein  was  likewise 
implicated.  Of  these  fifteen  terminated  fatally.  There  were  three  fatal  cases  in  which 
the  femoral  vein  alone  was  involved.  There  were  four  cases  of  wounds  of  the  popliteal, 
with  two  recoveries.  Of  two  cases  of  wounds  of  the  posterior  tibial,  one  complicated  by 
wound  of  the  peroneal  was  fatal.  Of  two  cases  of  wounds  of  the  peroneal  one  was  fatal, 
and  the  result  in  the  other  case  cannot  be  ascertained.  Two  cases  of  wounds  of  the 
internal  saphenous  vein  resulted  favorably,  as  did  a  case  of  wound  of  the  dorsalis  pollicis. 
A  case  of  wound  of  an  unspecified  artery  of  the  lower  extremity  had  a  fatal  result. 
Twenty-three  of  the  thirty-three  cases  terminated  fatally,  a  mortality  of  71.8  per  cent.  A 
few  examples  of  these  injuries  will  be  detailed,  commencing  with  a  case  of  occlusion  of  the 
femoral  artery  from  contusion,  and  two  instances  of  direct  lesion  of  that  vessel:2 

CASE  19. — Private  S.  T.  Newell,  Co.  B,  1st  U.  S.  Artillery,  aged  21  years,  was  wounded  at  Gettysburg,  July  2,  1863, 
and  entered  the  Satterlee  Hospital,  Philadelphia,  July  llth.  Acting  Assistant  Surgeon  W.  C.  Dixon  reported:  "The  missile, 
a  piece  of  shell,  struck  the  inner  side  of  the  left  thigh,  middle  third,  producing  a  severe  flesh  wound.  Simple  dressings  were 
applied.  On  the  19th  the  wound  assumed  a  gangrenous  appearance;  a  mixture  of  equal  parts  of  creasote,  alcohol,  and  water 
was  applied.  Under  that  treatment  it  remained  about  the  same  until  JuJy  28th,  when  the  sloughing  commenced  to  spread 
i/ipidly  and  nitric  acid  was  applied.  On  the  29th  the  femoral  artery  was  exposed  at  the  upper  and  lower  edges  of  the  wound, 
ivith  a  large  amount  of  sloughing  tissue  occupying  the  intermediate  space.  Two  days  later  the  slough  was  removed  from 
around  the  artery,  which  was  found  to  have  been  converted  into  a  fibrous  cord  bearing  no  resemblance  to  an  artery.  It  was 
watched  closely  to  guard  against  haemorrhage.  At  2  o'clock  P.  M.  on  August  1st  the  artery  separated,  and  the  proximate  and 
distal  extremities  of  the  vessel  were  found  to  be  perfectly  occluded.  The  wound  healed  rapidly,  and  in  September  the  patient 
was  transferred  to  Fort  Hamilton."  He  was  discharged,  at  Fort  Independence,  December  7,  1863,  and  pensioned.  Examiner  J. 
H.  Crombie,  of  Derry,  N.  H.,  certified,  May  6,  1874:  *  *  "Was  struck  by  a  piece  of  shell,  *  *  making  a  wound  six 
inches  in  length  and  three  in  width,  penetrating  nearly  to  the  bone.  The  limb  is  weakened  very  much.  The  muscular  power 
is  considerably  limited.  He  is  unable  to  walk  or  labor  on  the  limb  for  any  length  of  time  by  reason  of  weakness."  The 
pensioner  was  paid  June  4,  1876. 

'HEINE  (C.)  (Die  SchussverMzungen  der  tinteren  Extremitaten,  Berlin,  1866,  p.  127)  remarks  that:  "The  rarity  with  which  shot  injuries  compli 
cated  by  serious  arterial  haemorrhages  present  themselves  to  surgeons  at  the  stations  for  first  dressings  (erste  Vtrbandplatz)  is  an  experience  that  repeats 
itself  in  every  campaign.  Hence  operative  interference  on  account  of  wounded  blood-vessels  is  seldom  necessary  at  this  stage.  From  the  last  war  [the 
Danish  war  of  1864J  I  cannot  recall  a  single  case  in  which  ligation  or  amputation  was  performed  for  primary  bleeding  at  the  field  ambulance  stations." 
The  first  chapter  of  GUTHRIE's  Commentaries  on  the  Surgery  of  the  Peninsular  War,  that  excellent  vade-mecum  of  the  military  surgeon,  and  the  chap 
ter  on  gunshot  wounds  of  the  extremities  by  MATTHEW,  the  historian  of  the  surgery  of  the  British  army  in  the  Crimea,  have  already  established  the 
doctrine  above  enunciated.  The  misconceptions  which  such  an  authority  as  VALENTINE  MOTT  adopted  in  his  paper  On  Haemorrhage  from  Wounds, — 
a  paper  contributed  to  the  publications  of  the  SANITARY  COMMISSION,— can  only  be  explained  by  his  comparatively  slight  acquaintance  with  the  effects 
of  shot  injuries. 

2  Of  the  remaining  fifteen  cases  of  shot  wounds  of  the  femoral  artery  treated  on  the  expectant  plan,  one  resulted  successfully — case  of  Wammack, 
5th  North  Carolina— and  fourteen  fatally,  viz:  Dinguid,  Griffin's  Battery;  Ledbetter,  9th  Alabama;  Sylvester,  9th  New  Hampshire;  Uiming,  8 1st  Penn 
sylvania;  Corris,  17th  Illinois;  Collins,  Ordnance  Corps;  Blaisdell,  17th  Massachusetts;  Lawrence,  9th  New  York  Cavalry;  Masser,  143d  Pennsyl 
vania;  Craft,  144th  New  York;  Stephen,  147th  New  York;  Geary,  4th  Georgia;  Bailey,  8th  Illinois  Cavalry,  and  Clarendon,  26th  Massachusetts.  In 
the  last  two  cases  the  femoral  vein  was  also  implicated.  It  is  impracticable  to  give  the  details  of  these  cases,  but  the  names  are  mentioned  in  order  that 
students  of  this  special  subject  may  be  enabled  to  refer  to  them  in  the  MS.  records  of  the  Surgeon  General's  Office. 


14  INJURIES   OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

Of  the  cases  of  wounds  of  the  femoral  artery  treated  without  operation,  a  case  of 
recovery  and  a  fatal  case  will  be  detailed : 

CASK  20. — Lieutenant  L.  Hallman,  Co.  D,  51st  Pennsylvania,  aged  04  years,  was  wounded  at  South  Mills,  April  19, 
1862,  and  admitted  to  Hygeia  Hospital,  Fort  Monroe,  h've  days  afterwards.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported: 
"'Gunshot  wound  of  femoral  artery,  a  bullet  traversing  the  middle  of  the  left  thigh,  entering  anteriorly,  and  escaping  on  the 
posterior  aspect  just  opposite.  Pulsation  could  indistinctly  be  felt  in  the  pedal  and  posterior  tibial  arteries.  About  one  week 
after  admission  a  smart  arterial  haemorrhage  came  from  the  anterior  wound.  Compression  by  a  bandage  and  cold  wet  applica 
tions  were  made,  and  the  haemorrhage  was  controlled,  but  returned  the  next  day.  We  proceeded  to  his  room  to  tie  the  femoral ; 
on  consultation,  however,  it  was  decided  to  wait,  and,  if  it  should  bleed  again,  to  operate.  He  continued  doing  well.  Treat 
ment:  Absolute  rest  and  cold  wet  applications,  ice  in  small  portions  being  allowed  to  melt  on  the  bandage  which  surrounded  the 
thigh.  May  20th,  abscess  of  the  skin  appeared,  and  discoloration  of  the  great  toe,  which  eventually  sloughed  to  the  first  pha 
lanx;  temperature  of  the  foot  all  the  while  good.  He  was  sent  to  Philadelphia,  in  June,  quite  well."  Lieutenant  Hallman 
was  transferred  to  the  Veteran  Reserve  Corps  on  March  14,  1854,  and  ultimately  mustered  out  of  service  June  30,  1866,  and 
pensioned.  Examiner  W.  Carson,  of  Norristown,  Pennsylvania,  March  3,  1867,  certified:  "Ball  passed  through  left  thigh,  * 
*  wounding  the  sciatic  nerve;  has  lost  first  joint  of  great  toe,  with  immobility  of  all  the  toes.  Atrophy  of  limb  equal  to  one 
inch  in  circumference;  foot  cold."  Examiner  H.  E.  Goodman,  of  Philadelphia,  certified,  September  18,  1869:  *  *  "Limb 
much  weakened  and  painful  all  the  time."  The  pensioner  died,  of  consumption,  November  24,  1871. 

CASE  21. — Sergeant  H.  Booth,  Co.  E,  7th  Indiana  Cavalry,  aged  24  years,  was  admitted  to  the  Gayoso  Hospital, 
Memphis,  April  18,  1864,  having  been  wounded  on  the  previous  day  by  the  accidental  discharge  of  a  revolver  held  in  the  hands 
of  one  of  his  comrades.  Surgeon  F.  N.  Burke,  U.  S.  V.,  made  the  following  report :  "The  ball  entered  the  left  thigh  directly 
over  the  course  of  the  femoral  vessels,  two  inches  below  Poupart's  ligament,  and  escaped  at  the  crease  of  the  nate  and  median 
line  of  the  left  thigh.  There  was  copious  haemorrhage  at  the  time  the  wound  was  received,  but  it  was  arrested  by  application 
of  the  tourniquet.  As  a  precautionary  measure  it  was  left  on  at  the  time  of  admission,  but  not  tightened.  The  wound  became 
unhealthy  and  had  a  gangrenous  smell  on  the  fourth  day.  Charcoal  cataplasms  were  then  applied,  and  Labarraque's  solution 
used  to  the  wound.  On  the  sixth  day  haemorrhage  again  occurred,  amounting  to  about  six  ounces,  but  pressure  again  arrested 
it.  For  the  twenty-four  hours  preceding  this  the  whole  limb  had  become  swollen  and  ccdematous,  especially  the  upper  portion 
of  the  thigh.  The  patient  had  become  very  much  prostrated  and  his  pulse  quite  weak.  He  was  naturally  of  a  weak  constitu 
tion.  It  was  thought  that  to  tie  the  artery  there  would  result  in  gangrane  of  the  limb,  as  its  vitality  was  evidently  quite  low, 
and,  the  wound  being  unhealthy,  secondary  haemorrhage  from  the  sloughing  of  the  vessel  would  be  imminent.  Amputation 
was  then  thought  of,  but  it  was  obvious  that  the  patient  was  too  much  prostrated  to  hope  for  a  successful  result.  Oozing  of 
blood  occurred  a  couple  of  times  during  the  ensuing  few  days,  but  the  formation  of  a  small  clot  was  sufficient  to  arrest  it.  He 
died  on  April  28,  1864.  The  post-mortem,  examination  discovered  the  femoral  artery  to  have  been  perforated  so  as  to  admit  the 
passage  of  a  duckshot  through  the  wound  about  half  an  inch  below  the  origin  of  the  profunda.  The  femoral  vein  was  found 
to  have  sloughed  for  a  distance  of  about  one  and  a  half  inches,  gangrene  having  extended  along  the  fascia  and  cellular  planes 
from  one  to  one  and  a  half  inches  at  different  parts  along  the  course  of  the  wound.  The  ball  had  passed  between  the  femoral 
vessels  and  the  femur." 

Of  the  four  casss  of  injury  of  the  popliteal  artery,  a  fatal  instance  and  one  that 
eventually  resulted  in  fatal  aneurism  are  selected  for  illustration  :x 

CASE  22. — Private  J.  C.  Mapes,  Co.  K,  103d  Pennsylvania,  aged  22  years,  was  wounded  in  the  left  leg  at  Kinston, 
December  14,  1862,  and  entered  the  Stanley  Hospital,  New  Berne,  six  days  afterwards.  Acting  Assistant  Surgeon  J.  B.  Upham 
reported :  "A  mini6  ball  entered  three  inches  above  the  knee  joint,  on  the  inside,  over  the  track  of  the  femoral  artery,  and 
passing  downward  and  backward  emerged  in  the  popliteal  space  near  the  insertion  of  the  biceps,  lacerating,  in  its  course,  the 
popliteal  artery.  His  condition  at  the  time  of  his  admission  was  one  of  great  mental  and  bodily  depression.  He  was  treated 
by  stimulants,  warm  applications,  and  generous  diet.  Three  days  afterwards,  secondary  haemorrhage  coming  on,  attempt  was 
made  to  ligate  the  femoral  artery  by  dilating  the  wound,  which  failed.  Amputation  was  not  resorted  to  on  account  of  the  con 
dition  of  the  patient.  Gangrene  below  the  point  of  the  injury  came  on  rapidly,  and  the  patient  died  December  29,  1862,  fifteen 
days  after  the  reception  of  the  wound.  The  post-mortem  examination  revealed  the  injury  of  the  artery  already  alluded  to, 
which  extended  for  a  considerable  distance,  the  track  of  the  ball  being  almost  in  a  direct  line  with  the  course  of  the  vessel  itself." 

The  other  case  referred  to  is  a  remarkable  example  of  aneurism  developed  after 
fourteen  years,  as  the  remote  result  probably  of  a  shot  contusion  of  the  popliteal  artery: 

CASE  23. — Private  W.  Young,  Co.  K,  4th  New  York,  aged  19  years,  was  wounded  at  Fredericksburg,  December  13, 
1862,  and  admitted  to  Campbell  Hospital,  Washington,  four  days  afterwards.  Surgeon  J.  H.  Baxter,  U.  S.  V.,  recorded: 
"Gunshot  wound  of  leg;  patient  transferred  to  Baltimore  January  8,  1863  "  Surgeon  L.  Quick,  U.  S.  V.,  reported  that  the 
patient  was  discharged  from  McKim's  Mansion  Hospital,  March  18,  1863,  for  "gunshot  wound  of  left  leg,  ball  entering  near 
the  head  of  the  tibia  and  emerging  through  the  internal  belly  of  the  gastrocnemius  muscle,  producing  lameness."  The  Boston 
Examining  Board  certified,  October  27,  1865 :  "  Has  had  wound  of  leg  below  knee,  *  *  ball  emerging  one  inch  below  and 
behind  the  internal  condyle  of  the  femur,  evidently  passing  across  the  internal  saphenous  vein.  Cicatrices  not  adherent,  but 
there  is  some  loss  of  substance  of  muscle,  and  the  veins  of  the  leg  are  varicose,  probably  in  consequence  of  the  wound.  Mo 
tions  of  joint  good.  He  says  he  has  pain  in  leg  on  walking  or  standing,  and  much  pain  in  popliteal  space  while  sitting."  On 
August  25,  ]']>;!,  this  pensioner  came  under  the  care  of  Dr.  J.  Collins  Warren,  at  the  Massachusetts  General  Hospital,  who 

1  The  other  two  cases  of  shot  wounds  of  the  popliteal  artery  are  those  of  Pogue,  110th  Ohio,  who  recovered  and  was  discharged,  and  of  Thompson, 
120th  New  York,  who  died  sixteen  days  after  the  reception  of  the  injury. 


SECT.  i.J  SHOT    FLESH    WOUNDS    IMPLICATING    BLOOD-VESSELS.  15 

reported  the  further  progress  of  the  case  to  the  Boston  Society  for  Medical  Improvement,  in  the  Boston  Medical  and  Surgical 
Journal,  Vol.  XCV,  No.  18,  as  follows :  "Was  wounded  fourteen  years  ago,  at  the  battle  of  Fredericksburg,  by  a  musket  ball, 
which  entered  the  calf  of  the  left  leg  a  little  to  the  inside,  and  came  out  opposite  the  inner  aspect  of  the  knee  joint.  There 
was  no  unusual  amount  of  haemorrhage  at  the  time,  and  the  wound  healed  well,  but  on  recovery  a  smull  bunch  remained  in 
the  popliteal  space,  growing  larger  at  times,  and  again  almost  wholly  disappearing.  One  year  ago  it  grew  larger  than  before 
and  began  to  pulsate.  It  soon  filled  the  hollow  of  the  knee,  and  during  the  last  two  months  lias  spread  rapidly  on  the  inside 
of  the  thigh.  The  skin  over  the  popliteal  space  is  made  tense  by  an  ill-defined  pulsating  mass,  which  spreads  along  the  course 
of  the  femoral  artery  to  within  eleven  inches  of  the  anterior  superior  spinous  process  of  the  ilium.  The  left  knee  is  nineteen 
inches  in  circumference,  while  the  right  knee  measures  but  thirteen  and  one-fourth  inches.  The  patient  suffers  severely  from 
pain  in  the  calf  and  foot,  which  is  relieved  only  by  frequent  subcutaneous  injections  of  morphine.  A  pound  cannon-ball  applied 
to  the  femoral  diminishes  but  does  not  arrest  pulsation  in  the  vessel.  Heavy  pressure  with  the  hand  arrests  pulsation  entirely. 
August  30th:  The  patient  was  etherized  and  pulsation  in  the  femoral  was  arrested  by  two  hospital  tourniquets  applied,  near 
the  apex  of  Scarpa's  triangle,  alternately  every  fifteen  minutes  for  twelve  hours.  During  this  period  the  patient  was  kept 
profoundly  etherized,  about  a  pound  and  a  half  of  ether  having  been  consumed  for  that  purpose,  with  the  exception  of  a  few 
minutes  during  the  afternoon,  when  some  beef- tea  and  brandy  were  administered.  The  pulse  during  this  time  gradually  rose 
from  the  normal  rate  to  about  120,  but  subsided  somewhat  after  nourishment  had  been  taken.  On  removing  the  tourniquets 
pulsation  had  ceased,  although  on  auscultation  a  slight  murmur  was  heard  beneath  the  tumor.  At  midnight  there  was  no 
return  of  the  pulsation,  but  the  next  morning  a  slight  pulsation  was  observed,  which  gradually  increased  to  its  previous  force. 
September  10th:  Pressure  was  applied  as  before  by  tourniquet  without  ether,  the  patient  preferring  to  bear  the  pain,  and  .was 
continued  for  twenty  hours,  but  had  no  effect  upon  the  pulsations,  which  reappeared  after  it  was  removed.  September  19th  : 
The  patient  was  etherized,  the  sac  laid  open,  the  clots,  which  were  numerous,  everted,  and  the  artery  tied  at  each  end.  It  was 
found  that  the  sac  extended  to  the  point  of  bifurcation  of  the  popliteal  artery.  Two  ligatures  were  therefore  necessary  at  this 
point.  The  patient  rallied  well  from  the  operation,  and  for  the  first  week  the  wound  healed  rapidly.  An  attack  of  erysipelas 
arrested  the  healing  process  and  reduced  the  patient  greatly.  On  October  3d,  haemorrhage  occurred  from  the  upper  end  of  the 
wound  during  the  afternoon,  and  although  digital  pressure  was  immediately  resorted  to  by  an  attendant,  and  in  a  few  minutes 
the  tourniquet  was  applied,  the  patient  sank,  and  died  the  same  evening.  Dr.  Fitz  showed  the  specimen,  which  consisted  of  the 
aorta  from  its  origin,  the  left  femoral,  and  a  portion  of  the  aneurism  in  continuity.  The  fatal  haemorrhage  had  resulted  from 
the  sloughing  of  the  walls  of  the  artery  at  the  upper  end  of  the  aneurismal  sac,  where  the  ligature  had  been  applied.  There 
was  no  alteration  of  the  inner  surface  of  the  femoral  artery,  but  the  fibrous  tissue  was  indurated  around  it,  corresponding  with 
the  region  where  compression  had  been  applied.  The  entire  inner  coat  of  the  thoracic  aorta  was  thickened,  wrinkled,  elevated 
in  patches  of  an  opaque  grayish-white  color,  and  the  canal  was  dilated,  especially  that  of  the  arch.  Just  above  the  cceliac  axis 
these  alterations  ceased  abruptly,  the  interior  of  the  abdominal  aorta  being  smooth  and  yellow,  its  walls  evidently  in  a  normal 
condition.  The  specimen  was  particularly  interesting  from  the  absence  of  changes  at  the  point  of  compression  and  the  presence 
of  chronic  inflammatory  conditions  of  the  thoracic  aorta,  such  as  are  associated  with  the  formation  of  aneurisms  in  a  young 
man  in  whom  a  popliteal  anuerism  had  arisen  directly  or  indirectly  from  a  traumatic  cause." 

Of  five  cases  in  which  large  veins  were  wounded,  three  in  which  the  Jemoral  vein 
was  separately  injured  proved  fatal,  and  two,  in  which  the  internal  or  long  saphenous  was 
believed  to  be  lacerated,  recovered.  One  of  these  is  detailed:1 

CASE  24. — Lieutenant  L.  D.  Martin,  Co.  A,  29th  Illinois,  aged  32  years,  was  wounded  through  the  left  thigh  at  the 
siege  of  Fort  Donelson,  February  15,  1862.  Dr.  Madden,  of  Nashville,  noted  the  following  history  of  the  case,  which  was 
forwarded  by  Surgeon  E.  Swift,  U.  S.  A.,  Medical  Director:  "A  rifle  ball  entered  the  limb  at  a  point  directly  over  the 
eaphenous  opening  and  glanced  around  upon  the  fascia  lata  to  the  outer  aspect  of  the  thigh,  where  it  emerged  one  inch  below 
the  trochanter  major.  There  was  a  copious  flow  of  blood  from  the  wounded  veins  at  the  time  of  the  injury,  but  this  was  readily 
checked  with  lint.  The  patient  was  conveyed  to  the  Academy  Hospital  at  Nashville.  On  the  eighth  day  there  was  a  recur 
rence  of  venous  haemorrhage  from  the  inguinal  wound.  This  was  again  arrested  by  pressure,  and  the  patient  continued  to 
improve  till  the  evening  of  the  5th  of  March,  when  the  bleeding  was  suddenly  renewed  to  such  a  degree  that  the  coats  of  the 
femoral  artery  were  supposed  to  have  yielded.  Surgeon  E.  Swift,  Medical  Director  in  this  city,  having  been  consulted,  he 
directed  that  the  artery  should  not  be  ligated  but  judiciously  compressed,  and  it  was  decided  to  postpone  till  the  next  morning 
any  attempt  to  place  a  ligature  upon  the  vessel.  Pressure  with  the  fingers  upon  the  artery  at  the  point  of  its  emergence  from 
beneath  Poupart's  ligament  was  maintained  during  the  whole  night  by  relays  of  assistants.  Next  morning,  on  intermission  of  the 
pressure,  there  was  no  haemorrhage,  nor  was  there  any  pulsation  distinguished  below  the  wound.  A  compress  was  placed  over 
the  artery,  and  a  bandage  applied  from  the  toes  to  the  groin.  This  was  removed  at  the  expiration  of  twelve  hours,  and  the 
limb  was  wrapped  in  flannels.  Pulsation  below  the  groin  was  not  perceptible  for  several  days.  The  limb,  however,  retained 
its  temperature  and  its  vitality,  and  the  circulation  gradually  became  re-established.  There  was  no  recurrence  of  haemorrhage. 
The  patient  recovered  his  strength  rapidly,  and  returned  to  his  home  April  5,  1862,  at  which  time  he  was  able  to  walk  with  the 
assistance  of  a  cane."  Lieutenant  Martin  resigned  the  service  September  17,  1862,  and  was  pensioned.  Examiner  J.  W. 
Redden,  of  Shawneetown,  Illinois,  March  1,  1864,  certified:  ''The  ball  entered  the  front  of  the  left  thigh  near  the  femoral 
artery,  which  seems  to  have  been  wounded;  there  is  general  derangement  of  the  nerves  affecting  the  joints,  and  muscular 
activity  and  strength  of  the  limb."  Examiner  H.  \V.  McCoy,  of  Golconda,  Illinois,  September  16,  1873,  reported  the  pensioner 
as  having  received  a  "flesh  wound  of  the  left  shoulder"  in  addition  to  the  above  injury,  but  no  mention  is  made  of  this  in  any 

previous  reports.     The  pensioner  was  paid  June  4,  1876  

1  The  three  cases  01  injury  cf  the  femoral  vein  are :  Scullen,  25th  Ohio,  who  died  of  pyaemia  ou  the  16th  day ;  Cambridge,  iMth  New  York,  fatal  on 
the  SKd  day  (for  autopsy  see  Lincoln  Hospital  Case  Book  No.  17);  and  Schumaker,  2d  New  York  Cavalry,  who  died  on  the  eighth  day  after  the  reception 
of  the  injury.  The  i-thcr  case  U  injury  of  the  internal  saphenous  vein  is  that  of  Johnson,  7th  Connecticut,  who  recovered  and  was  discharged. 


16  INJURIES    OF    THE    LOWER    EXTREMITIES.  fCHAp.  x. 

The  result  of  this  series  of  thirty-three  shot  wounds  of  the  larger  arteries  and  veins 
of  the  lower  limb  sufficiently  prove  that  compression,  styptics,  or  a  let-alone  practice 
cannot  be  safely  adopted  in  such  grave  accidents.  The  histories  of  three  fatal  cases  of 
wound  of  the  femoral  vein  corroborates  the  argument  of  Surgeon  S.  W.  Gross,  U.  S.  V., 
in  favor  of  the  ligation  of  wounded  venous  trunks.1  Surgeon  J.  A.  Lidell,  U.  S.  V.,  in 
his  excellent  memoir  on  traumatic  haemorrhage,2  has  cited  two  or  three  other  instances  of 
shot  lesions  of  the  great  vessels  of  the  thigh,  reported  by  Surgeon  W.  Clendenin,  U.  S.  V., 
of  which  I  am  unable  to  find  any  mention  in  the  official  returns.  The  comparative  rarity 
of  profuse  primary  bleeding  from  shot  wounds  of  the  large  blood-vessels  of  the  extremities 
can  hardly  be  seriously  contested.3 

Wounds  of  Blood-vessels  treated  by  Ligation. — Eighty-seven  cases  were  reported  of 
shot  flesh  wounds  of  the  lower  extremities  with  lesions  of  the  larger'blood-vessels,  treated 
by  .primary  or  intermediary  ligation  of  arteries.  Only  twenty-six  of  these  resulted 
favorably,  leaving  the  formidable  mortality-rate  of  70.1  per  cent.  Six  rases  in  which 
the  external  iliac  artery  was  tied  for  wound  of  the  femoral  or  profunda,  or  of  these  vessels 
and  their  accompanying  veins,  were  fatal.  Of  sixty-two  ligations  of  the  femoral  but 
seventeen,  or  27.4  per  cent.,  were  successful.  One  of  two  ligations  of  the  profunda  was 
successful.  In  seven  ligations  of  the  popliteal,  two  patients  survived.  There  were  two 
ligations  of  the  anterior  tibial  with  one  recovery, — five  of  the  posterior  tibial  with  four 
recoveries, — two  of  both  tibials  with  one  recovery, — arid  one  fatal  case  of  ligation  of  the 
peroneal  artery.  All  of  these  cases  will  be  hereafter  enumerated  in  brief  abstracts  or  in 
tabular  form;  but,  as  there  are  many  other  cases  of  delegation  of  the  same  vessels  in  shot 
flesh  wounds  without  primary  arterial  lesion,  it  will  be  most  convenient  to  classify  the 
analogous  cases  further  on,  and  there  will  be  presented  here  only  a  single  abstract  of  a 
remarkable  recovery  after  ligation  of  the  femoral  artery  for  shot  injury:3 

CASE  25. — Assistant  Surgeon  R.  S.  Vickery,  2d  Michigan,  aged  33  years,  was  wounded  at  Petersburg,  July  30,  1864, 
and  admitted  to  the  field  hospital  of  the  3d  division,  Ninth  Corps.  Surgeon  P.  A.  O'Connell,  U.  S.  V.,  reported:  "Gunshot 
wound  of  upper  third  of  left  thigh  by  mini6  ball;  ligation  of  femoral  artery  performed  by  Surgeon  W.  B.  Fox,  8th  Michigan." 
From  the  field  hospital  the  patient  was  moved  to  City  Point,  and  subsequently  to  New  York.  Assistant  Surgeon  J.  E.  Semple, 
U.  S.  V..  reported  his  admission  to  the  Officers'  Hospital,  Bedloe's  Island,  August  25th,  with  "flesh  wound  involving  direct 
injury  to  the  large  artery  of  the  thigh."  In  January  following,  the  invalid  was  transferred  to  Armory  Square  Hospital,  Wash 
ington,  where  he  was  discharged  from  service  March  11,  1865.  Examiner  J.  Nichols,  of  Washington,  certified,  March  24, 
1865 :  "  Gunshot  wound  of  left  thigh,  inner  aspect,  upper  third,  ball  severing  femoral  artery.  Limb  much  atrophied  and  shrunk 
away  almost  to  the  bone;  leg  partially  flexed  upon  the  thigh;  inability  to  extend  it.  Great  danger  of  secondary  haemorrhage 
from  the  artery,  which  requires  a  long  time  for  restoration.  Limb  perfectly  useless;  prognosis  doubtful — may  yet  have  to  be 
amputated."  Dr.  Vickery  was  a  pensioner  until  May  14,  1867,  when  he  was  appointed  Assistant  Surgeon  in  the  regular  army. 

'GROSS  (S.  W.),  Remarks  upon  the  General  Applicability  of  Ligation  as  a  Venous  Hemostatic  Agent,  in  Am.  Jour.  Med.  Sci.,  1867,  Vol.  LIII, 
pp.  17,  305. 

*In  his  paper  on  the  Wounds  of  Blood-vessels,  Traumatic  Hemorrhage,  Traumatic  Aneurism,  and  Traumatic  Gangrene,  in  the  Surgical  Memoirs 
of  the  Sanitary  Commission,  1870,  Vol.  I,  p.  51,  etc.,  Dr.  JOHN  A.  LIDELL  published  several  abstracts,  contributed  by  Surgeon  W.  CLENDENIN,  U.  S.V., 
purporting  to  be  descriptions  of  examples  of  "complete  division  of  arteries  by  gunshot  projectiles.''  Although  these  abstracts  aptly  illustrate  the  subject 
in  hand,  it  has  been  found  impracticable  to  verify  the  cases  on  the  regimental  and  hospital  returns  ;  but  in  the  confusion  of  the  battle-field  it  is  probable 
that  not  a  few  important  surgical  accidents  failed  to  get  recorded  In  the  case  of  James  Brown,  3d  Tennessee  Mounted  Infantry  (loc.  cit.,  p.  51),  it 
appears  that  this  regiment  was  never  in  action,  and  the  patient's  name  is  not  on  the  hospital  registers,  nor  does  it  appear  on  the  death  records.  In 
the  case  of  James  O'Neal  (loc.  cit.,  p.  55),  it  is  left  to  conjecture  whether  the  man  belonged  to  the  10th  Tennessee  Mounted  Infantry  or  to  Wheeler's 
Cavalry.  No  reference  to  such  a  case  is  found  on  the  flies  of  the  War  Department.  In  the  case  of  Sergeant  French,  4th  U.  S.  Cavalry  (loc.  cit.,  p.  56), 
neither  the  date  of  the  injury  nor  the  engagement  in  which  it  was  received  are  given,  and  on  inquiry  of  the  Adjutant  General  it  has  been  ascertained 
that  "there  is  no  record  of  the  enlistment  of  any  soldier  by  the  name  of  French  in  the  4th  U.  S.  Cavalry,  from  1856' to  1865,  inclusive." 

3  BlLLUOTH  (Til.)  (Chirurgische  Brief c,  etc.,  Berlin.  1872,  p.  113)  remarks :  "  Of  the  immediate  results  of  injuries  of  the  larger  blood-vessels,  of 
profuse  haemorrhages  on  the  field  of  battle,  1  have  as  little  to  relate  as  other  surgeons  that  have  served  in  the  field.  None  of  the  colleagues  with  whom 
I  conversed  had  observed  such  bleedings.  Nowhere  did  I  find  a  case  of  primary  ligation  of  a  large  blood-vessel.  It  has  been  asserted  that  injuries  of 
this  kind  prove  fatal  so  rapidly  on  the  battle-field  that  any  assistance  comes  too  late.  There  is  no  valid  proof  of  this  assertion.  *  *  Observations  are 
accumulating  that  arteries,  even  of  the  size  of  the  aorta,  when  perforated  by  some  modern  shot  projectiles,  do  not  invariably  bleed.  In  Carlsruhe,  I  have 
learned  of  a  case  a  priori  incredible,  but  attended  by  u  careful  autopsy,  in  which  a  shot  through  the  aorta  caused  no  bleeding  until  several  days  after  the 
injury;  the  patient  was  therefore  transported  from  Worth  to  Carlsruhe  with  a  hole  in  his  aorta  without  any  bleeding.  I  have,  myself,  seen  three  cases 
of  shot  wounds  of  the  external  iliac  and  femoral  artery  in  which  n-j  bleeding  occurred."  1'roiessor  BILLROTH  then  details  the  cases. 


SECT.  I  ] 


SHOT    FLESH    WOUNDS    IMPLICATING    BLOOD-VESSELS. 


Dr.  F.  H.  Hamilton  states  (Appendix  to  Treatise  on  Military  Surgery  and  Hygiene,  1865,  p.  G40)  th.it  in  this  case  "the 
bleeding  was  arrested  temporarily  by  a  tourniquet,  and  three  hours  afterwards  Surgeon  Fox,  of  the  8th  Michigan,  enlarged  the 
wound  and  tied  the  femoral  loth  above  and  below  the  seat  of  injury." 

No  military  surgeon  now  disputes  the  propriety  of  tying  both  ends  of  a  bleeding 
artery  at  the  wounded  point,1  and  it  is  probable  that  if  the  judicious  practice  of  Surgeon 
Fox  had  been  more  generally  followed,  and  the  precepts  of  Guthrie  better  appreciated,  the 
deplorable  fatality  of  this  series  of  cases  might  have  been  largely  averted. 

Wounds  of  Blood-vessels  treated  by  Amputation.  —  There  were  twenty-eight  cases  in 
which  amputation  was  practised  on  account  of  uncontrollable  bleeding  from  shot  wounds 
of  the  larger  blood-vessels  of  the  lower  extremity,  and  eight  cases  mentioned  in  the  next 
subsection,  in  which  recourse  was  had  to  amputation  after  proximal  ligation  of  main 
arterial  trunks  had  proved  ineffectual.  The  series  of  twenty-eight  cases  includes  twenty- 
six  thigh  amputations  with  only  seven  recoveries,  a  fatal  amputation  at  the  knee,  and  a 
fatal  amputation  in  the  leg.  In  this  series  the  femoral  artery  was  wounded  in  eleven 
instances,  the  profunda  in  one,  the  popliteal  in  nine,  one  of  the  tibials  in  six,  and  the  long 
saphenous  vein  in  one.  All  of  these  cases  are  tabulated  further  on.  Details  of  two  are 
inserted  here:  . 

CASE  26.  —  Corporal  H.  Schatt,  Co.  H,  64th  New  York,  aged  30  years,  was  wounded  at  Hatcher's  Run,  March  25, 
1865,  and  was  admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps,  where  Surgeon  F.  M.  Hammond,  126th  New 
York,  noted  "a  shot  wound  of  the  leg."  On  the  following  day  the  man  was  sent  to  City  Point  and  thence  to  Washington. 
Assistant  Surgeon  H.  Allen,  U.  S.  A.,  reported  his  admission  to  Mount  Pleasant  Hospital  April  2d,  and  contributed  the  follow 
ing  history:  "Gunshot  wound  of  left  lower  extremity,  ball  passing  through  popliteal  space  from  without  inward,  injuring  the 
popliteal  artery.  When  admitted  the  patient's  pulse  was  small,  sharp,  and  fast;  face 
pale  and  tongue  coated.  His  toes  were  of  a  bluish  tint,  and  the  foot  was  covered  with 
bluish  and  yellowish  purple  spots.  The  entire  leg  was  greatly  swollen  and  the  super 
ficial  veins  enlarged;  the  small  veins  of  the  lower  third  of  the  thigh,  on  the  external 
surface,  were  somewhat  discolored,  and  the  integument  was  assuming  a  yellowish  color. 
The  limb  was  amputated  at  the  lower  third  of  the  thigh,  on  the  day  of  admission,  by 
Acting  Assistant  Surgeon  H.  Craft.  The  operation  was  performed  by  the  circular 
method,  very  little  blood  being  lost.  Two  double  ligatures  were  applied  to  the  femoral 
and  four  to  the  branches.  The  anaesthetic  consisted  of  equal  parts  of  aether  and  chloro 

form.     After  the  oper 

ation,  cold-  water  dress 

ings  were  applied,  and 

a    stimulating    course 

FIG.  3.  —  Stump  after  intermediary  amputa- 

adopted.  Thehgaturea   tion  of  thigh.    Spec.  2283. 

came  away  Qn  thg  gjxtlj 

and  seventh  clays.  On  May  10th,  there  were  symptoms  of  the  femur  exfoliating.  The  stump  was  nearly  healed,  when  a 
collection  of  pus  formed  around  the  bone,  and  to  give  exit  to  it  an  incision  was  made  just  above  the  end  of  the  stump.  This 
was  kept  open  by  a  tent  and  the  stump  encouraged  to  heal.  Simple  dressings  were  continued,  and  the  tonic  and  stimulating 
course  was  persevered  in.  The  exfoliating  process  steadily  progressed  up  to  June  19th,  when  a  sequestrum  was  removed 
which  proved  to  be  nine  inches  long  and  was  nearly  a  perfect  shaft,  extending  nearly  or  quite  to  the  trochanter  major.  It 
had  only  been  partially  destroyed  on  its  under  surface,  and  a  new  shaft  of  bone  had  formed  around  it.  The  stimulants  and 
tonics  were  now  increased,  with  nourishing  diet,  and  by  June  30th  the  patient  was  progressing  favorably."  The  sequestrum 
was  forwarded  to  the  Army  Medical  Museum  by  Dr.  Allen,  and  is  represented  in  the  annexed  cut  (FlG.  1).  The  patient  was 
subsequently  transferred  to  Rochester,  and  ultimately  discharged  from  Ira  Harris  Hospital,  Albany,  September  25,  1865. 
Assistant  Surgeon  J.  II.  Armsby,  U.  S.  V.,  contributed  a  cast  of  the  stump  (Cat.  Surg.  Sect.,  1866,  p.  554),  which  shows  the 
inferior  portion  to  be  baggy,  and  a  deep  and  poorly  healed  cicatrix  at  that  point,  caused  by  loss  of  substance  over  the  bone 
(FlG.  2).  Examiner  G.  W.  Cook,  of  Syracuse,  N.  Y.,  July  9,  1873,  certified:  "Tenderness  of  stump  and  slight  covering  over 
end  of  bone.  He  does  not,  nor  can  he,  wear  an  artificial  limb."  The  pensioner  was  paid  June  4,  1876. 

Another  case  of  this  category  is  selected  for  illustration  because  it  affords  quite  a 
typical  example  of  what  is  likely  to  occur  after  a  shot  wound  of  the  popliteal  artery 

1  HK.IXE  (C.)  (Die  Schussverlctzungen  der  unteren  Extremildten,  Berlin,  1866,  p.  133).  speaking  of  shot  flesh  wounds  with  injury  of  the  arteries, 
remarks:  "  The  ligation  of  the  femoral  artery  was  practised  eight  times  [in  the  Danish  War  of  1664]  and  the  external  iliac  was  tied  twice.  In  one  of 
the  latter  cases,  the  femoral  artery  had  been  previously  ligated  ;  but  as  bleeding  recurred,  the  external  iliac  was  tied.  This  is  the  only  case  of  the  ten 
ligations  that  proved  successful.  *  *  The  bleeding  was  primary  in  two  cases  only.  *  *  In  two  other  cases,  no  bleeding  at  all  occurred,  although  tho 
artery  was  completely  severed  in  the  wound  ;  in  the  rest  of  the  cases  the  bleeding  was  secondary,  —  from  the  seventh  to  the  seventeenth  day  after  the 
injury. 

SURG.  Ill—  3 


FIG.  1.—  Cylindrical  sequestrum  from  stump  of  left  femur.   Spec.  171.    J. 


18  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

unless  the  proximal  and  distal  ends  of  the  vessel  are  promptly  secured  by  ligature,  and 
the  formation  of  traumatic  aneurism  in  the  ham  and  consequent  gangrene  of  the  leg 
prevented.  Moreover,  in  this  instance,  the  patient  having  been  brought  to  Washington,  a 
very  conscientious  artist  was  able  to  depict  the  appearance  of  the  gangrenous  limb,  in  a 
water-color  drawing,  which  is  reproduced  with  tolerable  accuracy  in  the  chromolithograph 
opposite : 

CASE  27. — Sergeant  G.  W.  Gardner,  Co.  A.  12th  Illinois  Cavalry,  aged  29  years,  was  wounded  at  Mitchell's  Ford, 
on  the  Rappahannock,  October  11,  1863.     Surgeon  S.  B.  Wylie  Mitchell,  8th  Pennsylvania  Cavalry,  reported  that  he  was 
struck  by  a  conoidal  carbine  ball,  which  entered  four  inches  above  the  right  knee,  passed  through  the  inner  hamstring  muscles 
and  the  adductor  magnus,  outward  and  downward,  and  lodged  under  the  integument  on  the  outer  side  of  the  thigh.     Upon 
extracting  the  ball  through  an  incision  there  was  a  profuse  haemorrhage,  which  ceased  spontaneously.     The  patient  was  sent 
by  railway  ij  Washington,  and  entered  Emory  Hospital  on  October  13th.     Acting  Assistant  Surgeon  J.  Walsh  reported  that 
"he  was  feeble  and  pallid;  no  pulsation  could  be  detected  in  the  tibial  arteries  of  the  injured  limb. 
There  was  loss  of  sensibility  and  slight  discoloration  of  the  skin  of  the  right  foot.     The  leg  was 
packed  in  raw  cotton,  and  the  temperature  was  kept  up  by  bottles  of  hot  water.     Frictions  with  a 
stimulating  liniment  were  occasionally  employed.     After  October  18th,  the  leg  was  daily  immersed 
in  a  bath  of  oxygen  gas.     On  October  25th,  two  bits  of  blue  cloth  and  a  small  piece  of  white  cotton 
cloth  were  extracted  from  the  wound.     The  foot  was  decidedly  gangrenous,  and  gangrene  began 
to  advance  rapidly  up  the  leg."     At  this  time  a  sketch  of  the  appearances  of  the  limb  was  made, 
under  Surgeon  J.  H.  Brinton's  direction,  by  Hospital  Steward  E.  Stauch.     This  drawing  was 
elaborated,  after  the  lamented  death  of  Mr.  Stauch,  by  Hospital  Steward  S^hultze,  and  has  been 
reproduced  by  chromolithography  in  the  plate  opposite  (PLATE  I,  28).     On  October  29th,  Acting 
Assistant  Surgeon  W.  H.  Ensign  amputated  the  limb  at  the  lower  third  of  the  thigh.     On  exam 
ination  of  the  amputated  member  it  was  found  that  the  artery  had  been  completely  divided  by  the 
ball  near  the  point  at  which  it  passes  through  the  opening  in  the  great  adductor.     The  divided 
extremities  of  the  artery  were  occluded  by  dark  grumous  clots.     After  the  operation  the  patient 
was  attacked  by  diarrhoea,  and,  on  December  5,  1863,  the  case  terminated  fatally.     A  wet  prepa 
ration  of  the  lower  half  of  the  right  femur,  with  a  portion  of  the  soft  tissues,  including  the  popliteal 
I  If!.  3.  —  Preparation  of  lower  _  ° 

half  of  the  right  thigh,  showing  artery  and  vein,  was  contributed  to  the  Army  Medical  Museum  by  Acting  Assistant  Surgeon  J. 
arto^laCS.i0i7CO.the  popWeal  AValsh  (Cat.  Surg.  Sect.,  1866,  p.  521),  and  is  represented  in  the  adjacent  wood-cut  (FiG.  3). 

Wounds  of  Blood-vessels  treated  by  Ligation  and  subsequent  Amputation. — Of  the 
eight  instances  in  which  consecutive  amputation  was  had  recourse  to  after  the  failure  of 
proximal  ligation  of  large  arteries  for  primary  bleeding,  six  succeeded  ligation  of  the 
femoral,  one  ligation  of  the  popliteal,  and  one  ligation  of  the  posterior  tibial.  Five  were 
amputations  in  the  thigh,  and  three  of  the  leg.  Only  one  of  the  eight  patients  recovered, 
a  case  of  wound  of  the  popliteal  artery  treated  by  tying  the  femoral  and  subsequently 
amputating  at  middle  thigh.  One  of  the  fatal  cases  is  detailed: 

CASE  28. — Corporal  J.  M.  Harris,  Co.  E,  14th  Iowa,  aged  20  years,  was  wounded  in  the  right  thigh  at  the  battle  of 
Tupelo,  July  15, 1864,  and  entered  the  Adams  Hospital,  Memphis,  five  days  afterwards.  Assistant  Surgeon  J.  M.  Study,  U.  S.V., 
made  the  following  report:  "A  minie"  ball  entered  the  lower  portion  of  the  middle  of  the  thigh  and  passed  beneath  the  bone 
without  fracturing  it.  Aneurism  of  the  femoral  artery  resulted.  On  July  27th,  Surgeon  J.  G.  Keenon,  U.  S.  V.,  probed  the  sac 
with  the  finger,  when  excessive  haemorrhage  ensued,  and,  after  great  difficulty  in  finding  the  ends  of  the  artery,  the  vessel  was 
ligated  above  and  below  the  sac.  Acting  Assistant  Surgeon  S.  S.  Jessup  assisted  at  the  operation.  Sphacelus  of  the  foot  and 
leg  afterward  necessitated  amputation,  which  was  performed,  just  below  the  knee  joint,  by  Acting  Assistant  Surgeon  R.  W. 
Coale.  The  patient  died  of  pyaemia  August  3,  1864." 

Eecurrent  haemorrhage  from  the  lower  end  of  the  wounded  vessel  was  what  com 
monly  necessitated  amputation  in  these  cases. 

Flesh  Wounds  of  the  Lower  Limbs  unattended  by  Primary  Injury  of  the  Large 
Nerves  or  Blood-vessels. — While  in  the  two  hundred  and  fifteen  cases  discussed  in  the 
two  foregoing  subsections,  direct  shot  injury  of  the  larger  blood-vessels  or  nerves  was 
regarded  as  the  paramount  lesion  distinctively  characterizing  them,  there  were  many  other 
instances  in  the  immense  category  of  recorded  shot  flesh  wounds  of  the  lower  extremities 
where  the  nerves  and  vessels  shared  in  the  laceration  of  the  muscular  and  other  soft  parts 
by  large  projectiles,  or  were  indirectly  involved  in  the  morbid  processes  following  penetra- 


XXVIII 


w 


w 


CANCRENE    FOLLOWING   A  SHOT    LACERATION    OF  THE    FEMORAL  ARTERY 


SECT.  I.]  SHOT    LACEEATIONS    OF    THE    SOFT    PARTS.  19 

ting  or  perforating  wounds  by  small  missiles.  These  are  included  in  this  third  subsection 
of  shot  flesh  wounds  of  the  lower  extremities,  a  group  of  fifty-eight  thousand  four  hundred 
and  eighty-seven  reported  cases,  which  (as  stated  on  page  8)  it  is  difficult  to  classify. 
Some  instances  remarkable  for  the  extent  of  laceration  of  the  soft  parts  will  be  cited,  some 
of  lodgement  of  foreign  bodies,  and  some  distinguished  by  the  complications  of  pyaemia, 
tetanus,  gangrene,  erysipelas,  haemorrhage,  secondary  involvement  of  joints,  etc.,  will  be 
adverted  to.  In  a  hundred  cases,  ligation  of  the  larger  arterial  trunks  was  resorted  to,  and 
in  a  hundred  and  sixty-one  recourse  was  had  to  amputation.  It  will  be  recollected  that  in 
the  two  preceding  subsections  ninety-five  examples  of  ligations  and  forty  of  amputations 
have  been  alluded  to,  as  connected  with  primary  injury  of  the  nerves  or  vessels.  All  of 
these  cases  of  ligations  and  amputations  will  be  cited  in  consolidated  tabulations  at  the 
close  of  this  section.  Some  cases  of  shot  wounds  of  the  lower  limbs,  in  which  no  operative 
interference  was  undertaken,  will  now  be  detailed. 

Shot  Lacerations.  —  After  extensive  destruction  of  the  fleshy  parts  of  the  thigh  and 
leg,  reparation  was  usually  slow  and  imperfect,  sometimes  as  much  so  as  in  the  remarkable 
case  of  laceration  of  the  buttocks,  narrated  at  page  430  of  the  Second  Surgical  Volume. 
Practitioners  accustomed  to  regard  mere  flesh  wounds  as  of  little  moment  were  not  always 
happy  in  their  prognoses  of  shot  injuries  of  the  soft  parts  in  the  lower  limbs.1 

CASE  29.  —  Sergeant  J.  W.  White,  Co.  F,  14th  New  Jersey,  aged  24  years,  was  wounded  at  Monocacy,  July  9,  1864, 
and  admitted  to  hospital  at  Frederick  on  the  following  day.  Acting  Assistant  Surgeon  J.  H.  Bartholf  reported  :  "  The  patient 
was  wounded  by  a  cannon  ball,  or,  as  he  says,  by  an  uuexploded  shell,  which  tore  through  the  back  of  his  left  thigh  and  killed 
a  man  close  by  him.  It  produced  a  very  extensive  lacerated  wound,  extending  on  the  back  of  his  thigh  from  near  his  knee  to 
the  fold  of  his  buttock  —  a  huge  flap  hanging  downward  and  a  shorter  one  attached  at  the  upper  end  of  the  wound.  He  was 
admitted  here  the  next  day,  without  then  suffering  from  any  shock.  Free  suppuration  followed,  but  not  any  sloughing,  and 
simple  measures  only  were  required,  viz  :  poultices,  dilute  solution  of  permanganate  of  potash,  balsam  of  peru,  water  dress 
ings,  oakum,  simple  cerate.  It  granulated,  contracted,  and  healed  till,  on  November  25th,  the  raw  surface  was  only  four  inches 
square.  No  loss  of  motion  at  the  knee  joint,  strange  to  say,  resulted  from  this  extensive  involvement  of  the  muscles.  Decem 
ber  22d,  he  is  transferred  to  hospital  at  Beverly  this  day.  The  wound  is  very  nearly  healed,  and  the  patient  in  good  health." 
Subsequently  the  man  was  transferred  to  the  Whitehall  Hospital,  whence  he  was  discharged  June  17,  1865,  and  pensioned. 
The  Trenton  Examining  Board  certified,  September  4,  1873:  "The  muscles  of  the  posterior  portion  of  the  left  thigh  were  very 
badly  lacerated  by  a  fragment  of  a  shell;  all  the  flexor  muscles  were  torn  through  and  a  most  persistent  and  gangrenous  sore 
followed  the  wound,  and  the  cicatrix  is  very  large  and  tender,  the  leg  weakened,  so  that  he  cannot  walk  far  or  stand  long  on 
it."  The  pensioner  was  paid  June  4,  1876. 

Even  in  young  and  healthy  subjects  the  progress  of  repair  was  slow  after  large 
solutions  of  continuity: 

CASE  30.  —  Corporal  A.  W.  McCausland,  Co.  B,  16th  Maine,  aged  18  years,  was  wounded  at  Gettysburg,  July  2,  1863, 
and  admitted  to  the  field  hospital  of  the  First  Corps.  On  August  24th  he  was  transferred  to  Camp  Letterman,  where  he  came 
under  the  care  of  Assistant  Surgeon  W.  F.  Richardson,  C.  S.  A.,  who  recorded:  "A  shell  struck  the  outer  side  of  the  left 
thigh,  inflicting  a  terrible  flesh  wound  eight  inches  long  by  four  in  width,  with  ragged  edges.  When  admitted  the  patient  was 
in  good  health,  the  wound  looking  well  and  filling  up  with  healthy  granulations.  Up  to  date  the  treatment  has  been  cold- 
water  dressings.  Stimulants  are  given  and  simple  cerate  dressings  now  used.  The  patient  improved  rapidly,  and  the  wound 
closed."  In  October  the  man  was  transferred  to  Satterlee  Hospital,  Philadelphia,  and  on  January  10,  1864,  he  was  discharged 
from  service  by  reason  of  "lameness  of  left  leg  resulting  from  the  wound."  Examiner  T.  Hildreth  certified,  September  4,  1873  : 
"  Was  wounded  by  a  shell  in  the  posterior  part  of  the  thigh,  carrying  away  a  very  large  part  of  the  muscles  and  integument, 
resulting  in  a  tender  cicatrix.  He  now  suffers  from  numbness  of  the  limb."  The  pensioner  was  paid  June  4,  1876. 

Sometimes  small  projectiles  produced  extended  lacerations  by  driving  into  the  soft 
parts  coins,2  knives,  or  other  hard  objects  carried  in  the  pockets  of  the  soldiers: 

CASE  31.—  Private  J.  C.  Haggerty,  Co.  I,  124th  New  York,  aged  21  years,  was  wounded  at  Chancellorsville,  May  3, 
1833.  Surgeon  J.  S.  Jamison,  86th  New  York,  noted  a  "  shot  wound  of  the  right  thigh.''  The  patient  passed  from  a  Third 

1  Dr.  C.  HEINE  (Die  Schussrerletzungen  der  unteren  Extremitiiten,  Berlin,  1866,  p.  65)  thinks  that  large  shot  lacerations  of  the  fleshy  parts  of  the 
lower  extremities  are  peculiarly  liable  to  be  followed  by  tetanus  ;  but  I  find  in  the  records  under  discussion  little  to  corroborate  this  view.     1  will  revert 
to  the  subject  in  treating  of  Tetanus. 

2  SOCLN  (A.)  (Kriegschir.  Erf.,  Leipzig,  1872,  p.  16)  gives  a  drawing  of  a  flattened  Langblei  (the  missile  of  the  needle-gun),  together  with  three  bent 
French  copper  sous  pieces  and  two  vest  buttons,  all  of  which  wei  j  extracted  from  the  thigh  of  a  French  soldier  at  the  Swiss  ambulance  at  Lure.     The 
ball  and  the  large  copper  coins  were  detected  and  removed  soon  after  the  reception  cf  the  injury,  but  the  buttons  were  not  extracted  until  three  months 


afterwards. 


20  INJURIES    OF    THE    LOWER,    EXTEEMITIES.  [CHAP.  x. 

Corps  hospital  to  Fairfax  Seminary,  and  thence  to  Satterlee  Hospital,  when  Acting  Assistant  Surgeon  I.  Roberts  reported  the 
case  as  interesting,  inasmuch  as  the  ball  struck  a  silver  coin  in  the  right  pocket  of  the  man's  trousers  and  was  thus  deflected 
from  the  track  of  the  femoral  vessels;  but  passed  through  the  soft  parts,  driving  fragments  of  the  pocket-book  into  the  tissues, 
and  escaping  at  the  gluteal  fold.  The  wound  progressed  favorably  for  a  time,  but,  about  July  20th,  deep  abscesses  formed,  and 
there  was  some  sloughing  at  the  aperture  of  entrance  and  exit.  The  abscesses  were  incised,  and  several  fragments  of  the 
pocket-book  came  away  with  the  pus.  There  was  so  much  constitutional  irritation  that  quiuia  and  stimulants  were  freely 
exhibited.  The  wound  healed  about  the  middle  of  December,  and  the  man  was  transferred  to  the  Veteran  Reserves.  He  was 
quite  lame,  and  the  right  foot  was  much  everted.  He  was  discharged  October  7, 1834,  and  pensioned.  Examiner  J.  Nichols,  of 
Washington,  certified:  "Ball  entered  anterior  aspect  of  upper  third  of  right  thigh,  passing  directly  through,  and  inflicting  a 
frightful  flesh-wound.  Bone  uninjured;  cicatrix  very  deep  and  adherent  to  all  the  soft  parts  below,  nearly  to  the  bone,  render 
ing  free  motion  of  the  limb  impossible,  and,  if  much  used,  very  painful."  Examiner  J.  Gordon,  of  Newburgh,  New  York, 
reported,  February  28,  1876:  *  *  ''There  remains  a  large  umbilicated  cavity,  with  adhesions  of  skin,  fascia,  and  muscles. 
He  suffers  more  particularly  from  distress  in  the  leg,  extending  in  part  to  the  foot,  accompanied,  before  atmospheric  changes, 

with  shooting,  darting  pains,    *     *     so  severe  at  times  as  to  unfit  him  for  manual  labor."    This  pensioner  was  paid  June  4, 1876. 

• 

Extensive  lacerations  of  the  calf  were  very  slow  in  healing,  and  usually  resulted  in 
adherent  cicatrices  with  atrophy  of  the  remaining  muscular  tissues,  greatly  disabling  the 
functions  of  the  leg  and  foot: 

CASE  32. — Sergeant  F.  A.  Ingerson,  Co.  K,  27th  Massachusetts,  was  wounded  at  New  Berne,  March  14,  1862. 
Surgeon  G.  A.  Otis,  27th  Massachusetts,  reported  that  "a  large  fragment  of  shell  striking  the  calf  of  the  left  leg  carried 
away  the  greater  portion  of  the  bellies  of  the  gastrocnemius  and  soleus  muscles.  There  was  inconsiderable  bleeding.  The 
laceration  was  so  very  extensive  that  it  was  difficult  to  coaptate  or  adjust  the  wound,  and  much  of  it  had  to  be  dressed  open." 
The  patient  was  sent  to  Academy  Green  Hospital.  After  the  separation  of  sloughs,  there  remained  a  huge  granulating  sur 
face.  On  April  19th,  the  patient  was  sent  to  a  northern  hospital,  and  discharged  December  19,  1862.  Examiner  A.  Lambert, 
of  Springfield,  reported,  March  11,  1863,  the  wound  "  unhealed  and  discharging  constantly."  The  Boston  Examining  Boai-d 
stated,  March  23,  1870:  "A  fragment  of  shell  engaged  the  left  calf.  During  the  suppurating  process  that  ensued  a  considerable 
portion  of  the  belly  of  the  calf  was  lost.  The  wound  has  not  entirely  closed,  and  the  injured  leg  is  notably  larger  than  the  other." 
In  October,  1875,  Examiner  A.  W.  Nelson,  of  New  London,  reported:  "There  is  a  large  cicatrix  of  left  calf,  with  loss  of  most 
of  the  substance  of  the  gastrocnemius ;  *  *  patient  unable  to  walk  a  long  distance." 

In  a  similar  case,  amputation  was  contemplated;  but  the  patient  ultimately  made  a 
satisfactory  recovery  without  operative  interference: 

CASE  33.— Private  P.  C.  Whidden,  Co.  B,  13th  Massachusetts,  aged  22  years,  was  wounded  at  Antietam,  September  17, 
1862,  and  entered  the  Mason  Hospital,  Boston,  January  22,  1863.  Acting  Assistant  Surgeon  W.  E.  Townsend  noted:  "Shot 
wound  of  left  leg.  Patient  returned  to  duty  November  1,  1863."  The  following  detailed  account  of  his  injury  and  its  result 
was  forwarded  by  the  man  in  July,  1866,  through  Dr.  H.  I.  Bowditch,  of  Boston:  "Was  struck  by  a  piece  of  shell  on  the 
posterior  aspect  of  the  left  leg,  causing  extensive  laceration  and  loss  of  the  soft  tissues,  without  injury  to  the  bone.  The  wound 
extended  from  just  above  the  ankle  joint  about  eight  inches  up  the  back  of  the  leg,  from  which,  within  these  bounds,  the  soft  parts, 
integuments,  tendons,  muscles,  both  arteries,  and  the  posterior  tibial  nerve  were  entirely  carried  away,  exposing  the  bones 
through  nearly  the  whole  length  of  the  wound.  On  the  front  of  the  leg,  corresponding  to  the  middle  of  the  wound,  hut  about 
an  inch  of  sound  skin  was  left.  A  rounded  flap,  about  an  inch  and  a  half  long,  containing  the  lower  portion  of  the  tendo- 
achilles,  wras  torn  up  and  laid  back  over  the  heel.  The  upper  part  of  the  wound  was  ragged  and  contused,  and  the  middle 
portion  cleanly  cut  away.  There  was  but  little  haemorrhage.  He  walked  with  great  difficulty  to  the  rear,  and  was  then  carried 
to  a  house  a  short  distance  from  the  field,  where  a  consultation  as  to  the  propriety  of  amputation  was  held,  six  surgeons  being 
present.  Four  decided  that  amputation  was  necessary  to  preserve  life;  one  assented  to  this  under  existing  circumstances,  but 
thought  that  under  more  favorable  conditions  there  was  a  possibility  of  recovery  without  the  operation ;  the  other  that  amputa 
tion  was  uncalled  for.  The  patient  decided  to  retain  the  limb.  The  wound  was  dressed  with  lint  and  was  not  disturbed  for  five 
days.  On  the  fifth  day,  he  was  carried  in  an  ambulance  a  distance  of  twelve  miles  to  the  hospital  in  Hagerstown.  Upon 
examination  the  wound  was  suppurating  profusely  and  full  of  maggots,  and  it  was  dressed  with  yeast  poultice  and  powdered 
charcoal.  It  was  then  determined  to  amputate,  but  the  operation  was  postponed  for  three  days,  and  nourishing  diet  and  stim 
ulants  were  ordered.  On  the  fourth  day  an  examination  preliminary  to  the  operation  was  made,  when  healthy  granulations 
appeared  along  the  edges  of  the  bones,  and  the  operation  was  abandoned.  The  patient  was  then  carried  to  a  private  house, 
where  he  received  proper  nourishment  and  good  nursing,  and  at  the  end  of  a  month,  no  bleeding  having  at  any  time  occurred, 
went  to  his  home  in  Boston  Granulations  had  been  going  on  rapidly;  the  wound  had  been  filling  up  without  a  sign  of  inflam 
mation,  and  a  pellicle  was  spreading  out  from,  the  sound  skin  all  around  the  borders  of  the  wound.  After  the  journey  the  parts 
became  irritated  and  inflamed,  and  the  process  of  cicatrization  went  on  much  more  slowly.  By  the  first  of  March  following 
the  parts  were  perfectly  healed,  and  the  patient  walked  about  with  the  aid  of  a  cane.  But  the  pellicle  covering  the  surface  being 
excessively  thin  was  easily  abraded,  and  the  newly  formed  tissues  possessing  but  little  vitality,  it  healed  slowly,  new  portions 
being  rubbed  off  before  the  old  were  renewed,  so  that  at  no  time  since  the  wound  was  first  closed  has  it  been  entirely  free  from 
slight  superficial  ulceration.  At  the  present  time  the  gap  is  partially  filled  up  with  cicatricial  tissue,  which  has  undergone  con 
traction,  making  the  wound  appear  much  smaller  than  it  originally  was.  It  is  covered  with  a  thin  layer  of  epithelium  which 
constantly  desquamates.  The  flap  torn  up  and  laid  over  the  heel,  as  referred  to  above,  instead  of  presenting  the  narrow  outline 
of  the  tendo-achilles,  has,  in  healing,  become  a  thick  flabby  mass  beneath  the  cicatrix,  and  after  long  walking  becomes  cedema- 
tous.  The  length  of  the  cicatrix  from  top  to  bottom,  on  each  side  of  the  flap,  is  seven  inches  in  the  median  line;  from  the  top 


SECT.  I.] 


LODGEMENT    OF    MISSILES    IN    SOFT    PARTS. 


21 


of  the  cicntrix  to  the  edge  of  the  flap  five  inches;  across  the  widest  part  at  top  and  bottom,  three  and  a  half  inches;  in  the 
middle,  the  narrowest  part,  three  inches.  Four  inches  and  a  half  above  the  malleoli  the  leg  measures  in  circumference  six  and 
a  half  inches;  the  sound  leg  at  the  corresponding  part,  nine  inches.  The  integument  on  the  front  of  the  leg,  at  its  narrowest 
part,  is  three  and  a  half  inches  in  breadth.  The  muscles  of  the  calf  contract  but  exert  no  influence  over  the  foot,  the  tendons 
being  absent,  and  extension  cannot  be  performed,  but  the  foot  drops  with  its  own  weight.  Owing  to  contraction  of  the  cicatrix 
the  foot  can  be  flexed  to  but  little  less  than  a  right  angle  with  the  leg.  Sensation,  which  was  lost  in  the  external  border  of  the 
foot  and  heel,  has  gradually  returned.  There  is  slight  obstruction  to  the  circulation  from  the  slow  return  of  venous  blood.  The 
patient  walks  Avith  ease,  unaided  by  a  cane,  and  without  the  slightest  perceptible  limp."  The  report  of  the  Adjutant  General 
of  Massachusetts  shows  that  Private  Whidden  was  discharged  from  service,  by  order  of  the  War  Department,  December  11, 
1863.  He  is  not  a  pensioner. 

In  extensive  lacerations  of  the  soft  tissues  of  the  thigh  and  leg  by  shell  fragments,  or 
other  large  projectiles,  it  was  often  difficult  to  make  out  the  exact  extent  of  the  injuries 
inflicted,  and  the  field  returns  of  the  surgeons  who  examined  the  primary  wounds,  and  the 
later  reports  of  the  hospital  surgeons  and  pension  examiners  were  often,  of  necessity, 
wanting  in  precision  regarding  such  lesions.1 

Lodgement  of  Missiles. — A  few  cases  of  lodgement  of  projectiles  or  of  foreign  bodies 
driven  by  them  into  the  soft  parts  of  the  lower  limbs  will  be  cited  :2 

CASE  34. — Private  W.  H.  King,  Co.  E,  17th  Maine,  aged  24  years,  was  wounded  at  Bartlett's  Mill,  November  27,  18C3, 
and  admitted  to  Prince  Street  Hospital,  Alexandria,  one  week  afterwards.  Acting  Assistant  Surgeon  J.  Cass  contributed  the 
specimen  (FlG.  4),  with  the  following  history:  "He  was  wounded  by  a  musket  ball  which  struck  two  pocket  knives,  breaking 
them  and  driving  the  fragments  with  the  ball  into  the  anterior  side  of  the  middle  third  of  the  left  thigh.  A  hundred  fragments 
of  the  knives  and  four  of  the  ball  ware  removed  on  the  field.  Lime-water  dressings  applied  to  the  wound,  and  fifteen  drops 
of  tincture  of  iron  given  before  meals.  On  December  13th,  he  suffered  considerable  pain  in  the  wound,  and  on  the  following 
day  an  incision  was  made  two  and  a  half  inches  from  the  wound,  and  a  jagged  piece  of  ball  an  inch  long  and  three- fourths  of 
an  inch  wide  was  extracted.  IGth,  complained  of  strangury  and  some  pain  in  the  limb.  A  teaspoonful  of  spirits  of  nitre 
given  three  times  a  day.  17th,  was  restless  during  the  night;  sweats  profusely,  and  had  a  chill  this  morning.  Gave  morphia 
and  whiskey,  also  half  an  ounce  of  castor-oil.  Has  had  no  stool  for  forty-eight  hours;  pulse  115 
and  feeble;  tongue  coated ;  very  thirsty ;  some  soreness  in  inguinal  glands.  Prescribed  extract  of 
ginger  and  turpentine  ten  drops  each,  to  be  repeated  in  six  hours  if  it  does  not  operate,  and  gave 
tonics  and  stimulants.  18th,  pulse  100,  tongue  moist  and  coated.  Sweats  all  the  time,  and  vomited 
in  the  night.  Bowels  moved  freely  and  urinates  more  fruely;  appetite  better.  There  is  a 
greater  discharge  of  pus  from  the  wound.  19th,  pulse  115  and  feeble;  vomited  considerable  during 
the  day.  Ordered  two  quinine  pills  to  be  taken  before  meals,  and  an  anodyne  injection  at  bedtime. 
20th,  about  the  same;  had  a  chill  yesterday;  granulations  are  pale  and  flabby.  21st,  pulse  140  and 
very  feeble;  great  prostration ;  had  a  chill  this  morning  and  is  delirious.  Takes  stimulants  every 
hour.  22d,  rested  well,  but  is  more  prostrated  and  shows  tendency  to  coma.  Died  at  4.30  P.  M. 
Autopsy  eighteen  hours  after  death :  On  cutting  through  the  muscles  of  the  thigh,  an  inch  and  a 
half  from  the  surface  and  an  inch  from  the  main  channel  of  the  wound,  a  sliver  of  horn  from  a  knife- 
handle  was  found,  half  an  inch  long  and  one-sixteenth  of  an  inch  wide;  also  a  brass  rivet  one-sixteenth 
of  an  inch  in  diameter  and  one-fourth  of  an  inch  long.  In  another  place  two  pieces  of  horn  from  the 
other  knife-handle,  one  three-eighths  of  an  inch  long  and  one-fourth  wide,  and  the  other  one-eighth 
each  way,  were  found ;  also  a  piece  of  a  blade  one-fourth  of  an  inch  long  and  one-eighth  wide ;  and 
two  pieces  of  brass,  one  being  three-eighths  of  an  inch  long  and  one-sixteenth  wide  at  one  end  and 
tapering  to  a  sharp  point  at  the  other,  and  the  other  piece  measuring  one-eighth  of  an  inch  each  way.  Opposite  the  external 
wound  the  periosteum  was  found  in  places  thickened,  inflamed,  jagged,  discolored,  slightly  ossified,  and  separated  from  the 
bone  for  the  space  of  two  and  a  quarter  inches  longitudinally,  and  one  inch  transversely,  with  some  pus  beneath  it."  Dr.  Cass 

1  CllEXU  (J.  C.)  (Aper<;u,  hist.  stat.  et  din.,  etc.,  pendant  la  guerre  de  1870-71,  T.  I,  p.  283)  observes:  "  U  eclat  de  bombe  ou  dobus  cause  le  plus 
gouvent  de  larges  plates  avec  perl?,  de  substance.     Nous  connaissons  quatre  faits  dans  lesquels  la  partie  antero-interne  des  teguments  de  la  cuisse  fut 
enlevee  d'un  seul  coup  sans  lesion  de  I'artere  femorale;  on  voyait  les  battements  du  vaisseau  an  fond  de  la  plaie."    The  same  surgical  annalist  cites  a 
case,  in  which  disartieulation  at  the  hip  j  jint  was  performed  in  extremis  by  M.  MAUUICK  RAYNAUD  on  a  soldier  of  the  National  Guard,  aged  19,  with 
a  terrible  flesh  wound  of  the  thigh. 

2  Among  interesting  published  cases  of  lodgement  of  shot  projectiles  in  the  thigh  is  that  of  Major  R.  H.  Stephenson,  24th  Massachusetts,  described 
by  the  late  J.  MASON  WARRKX  (Surgical  Observations,  with  Cases  and  Operations,  1867,  p.  546):    A  musket  ball,  entering  the  front  of  the  left  thigh, 
about  two  inches  below  Poupart's  ligament,  was  concealed  somewhere  beneath  the  rectus,  and  eluded  the  researches  of  a  number  of  experienced  surgeons. 
WARREX,  after  ineffectually  searching  for  the  ball  a  month  after  the  injury,  advised  that  the  patient  should  use  (he  limb  with  a  view  that  muscular  action 
would  bring  the  ball  from  its  hiding  place.     This  prevision  was  justified,  and  a  fortnight  afterwards  the  position  of  the  ball  was  recognized,  and  WARREN 
cut  down  and  extracted  it,  and  the  officer  speedily  rejoined  his  regiment.     The  same  writer  has  related  (Boston  Med.  and  Sitrg.  Jour.,  1862,  Vol.  tiXVI, 

p.  473)  the  case  of  Lieutenant  C ,  2d  Massachusetts,  wounded  in  the  retreat  from  Winchester,  a  musket  ball  making  a  long  track  in  the  gastrocnemius, 

and  carrying  before  it,  like  a  glove-finger,  a  patch  of  trousers  and  flannel  underclothing,  making  a  huge  plug,  which  could  only  be  removed  the  following 
day  by  free  incisions.     Dr.  M.  GOLDSMITH,  of  Rutland,  Vermont,  formerly  Surgeon  U.  S.  V.,  has  described  (The  Search  for  Balls  in  old  Gunshot  Wounds, 
in  New  York  Med.  Jour.,  1868,  Vol.  VI,  p.  42G)  the  case  of  a  color-bearer  of  a  Vermont  regiment,  in  which  a  ball  deeply  buried  in  the  thigh  was  reached 
by  dilating  the  sinus  leading  to  it  by  sponge-tents. 


FlG.  4. — Fragments  of  ball 
and  pocket  knife  extracted 
from  thigh.  Spec.  3236. 


INJURIES    OF    THE    LOWER    EXTREMITIES.  fCHAp.  x. 

also  contributed  five  inches  of  the  shaft  of  the  femur  of  the  injured  thigh,  which  constitutes  specimen  1985  of  the  Surgical 
Section  of  the  Army  Medical  Museum.  It  is  sawn  longitudinally,  and  shows  the  shaft  to  be  denser  than  usual  and  apparently 
somewhat  hypertrophied.  (See  Cat.  Surg.  Sect.,  1866,  pp.  258,  617.) 

There  were  several  cases  in  which  large  missiles  buried  in  the  fleshy  parts  escaped 
recognition;  but  none  have  been  observed  in  which  such  concealed  foreign  bodies  equalled 
in  magnitude  the  projectiles  that  have  been  cited  in  some  works  on  military  surgery  as 
embedded  in  the  great  muscles  of  the  lower  limb  :l 

CASE  35. — Lieutenant  L.  Soistman,  Co.  H,  98th  Pennsylvania,  aged  23  years,  was  wounded  at  Salem  Heights,  May  3, 
1863.  Three  days  afterwards  he  entered  the  Campbell  Hospital,  Washington,  where  he  obtained  a  leave  of  absence  on  May  19th. 
On  July  8th,  he  was  admitted  to  the  Officers'  Hospital,  Philadelphia,  where  Acting  Assistant  Surgeon  W.  Cammac  recorded 
the  following  history :  "A  piece  of  shell  entered  the  right  thigh  at  the  most  depending  inner  part  of  the  middle  of  the  upper 
third,  went  under  the  deep  fascia,  and  upward  under  the  femoral  artery  and  buried  itself.  The  missile  appears  not  to  have  been 
noticed  at  first,  as  the  wound  was  sewed  up.  After  going  to  his  home  in  Philadelphia  he  was  attended  by  a  private  physician, 
but  the  missile  remained  still  undiscovered.  On  July  8th,  Acting  Assistant  Surgeon  W.  Hunt  was  called  in,  who  was  struck 
by  the  peculiar  feel,  and  on  introducing  a  probe  immediately  found  the  foreign  body,  and  ordered  the  patient  to  the  hospital  to 
have  it  removed.  On  July  9th,  Dr.  Hunt  enlarged  the  wound,  and,  after  considerable  trouble  from  the  proximity  of  the  large 
vessels,  removed,  with  the  assistance  of  the  forceps,  a  piece  of  shell  weighing  nine  ounces,  which  had  lodged  in  the  thigh  sixty- 
six  days.  Its  presence  had  given  rise  to  no  great  disorganization,  but  he  complained,  he  says,  of  a  weight  in  the  part  during 
the  whole  time.  After  recovery  from  the  effects  of  the  ether,  a  half  grain  of  sulphate  of  morphia  was  given.  Cerate  dressings 
and  light  pressure  were  applied,  and  the  wound  drawn  together  with  adhesive  straps.  The  patient's  general  health  was 
excellent.  He  did  remarkably  well  and  felt  greatly  relieved  by  the  operation.  On  July  13th,  cataplasms  were  ordered,  the 
wound  looking  well  and  suppurating  moderately,  and  the  patient  having  better  appetite  than  any  time  since  wounded.  On 
September  5th  he  was  attacked  with  intermittent  fever,  which  was  checked  after  several  days  by  quinine.  By  October  1st  the 
wound  had  nearly  healed,  but  the  leg  was  still  weak  from  extensive  disorganization  of  the  great  muscles  of  the  thigh.  On 
November  9,  1863,  he  was  returned  to  duty."  This  officer  was  again  wounded,  at  the  battle  of  the  Wilderness,  May  5,  18(54,  in 
the  right  side,  for  which  injury  he  was  treated  in  hospitals  at  Philadelphia  and  Annapolis.  On  August  2,  1864,  he  was  again 
returned  to  duty,  and  on  October  13,  1864,  he  was  mustered  out  of  service.  The  Philadelphia  Examining  Board  certified, 
October  19,  1870:  '  "A  deep  flesh  wound,  which,  in  healing,  caused  a  cicatrix  about  five  inches  long  and  four  inches  wide, 

with  loss  of  portion  of  muscular  tissue,  causing  partial  loss  of  power  in  the  limb  upon  making  much  exertion,"  etc.  The  pen 
sioner  was  paid  March  4,  1876. 

Sometimes  musket  balls  buried  themselves  in  the  muscular  parts  of  the  lower  limbs 
after  ricochetting  from  stony  or  metallic  surfaces: 

CASE  36. — Private  A.  Wegner,  Co.  A,  16th  Michigan,  aged  25  years,  was  wounded  at  Gaines's  Mill,  June  27,  1862. 

Surgeon  P.  B.  Goddard,  U.  S.  V.,  contributed  the  specimen  (FlG.  5),  and  reported:  "He  was  wounded  in  the  right  hip  by 
a  shell  and  ball,  taken  prisoner  June  30th,  and  carried  to  Richmond ;  paroled  July  25th,  and  arrived  at  Sixth 
and  Master  Streets  Hospital,  .Philadelphia,  July  30th.  This  ball  ricochetted  from  a  stone  or  some  hard 
substance,  entered  the  front  of  the  thigh  near  the  femoral  artery,  and  was  cut  out  at  the  glutens  maxim  us 
muscle  four  inches  higher  up  than  the  orifice  of  entrance.  It  did  not  touch  the  bone,  but  carried  in  with  it  a 
long  strip  of  trousers."  The  patient  was  discharged  January  26,  1863,  and  pensioned.  In  the  certificate  of 
disability  Surgeon  Goddard  stated  that  "the  ball  wounded  the  sciatic  nerve."  Examiner  R.  G.  Jennings,  of 
Little  Rock,  certified,  Septembers,  1873:  *  *  "One  ball  entered  the  right  hip  near  the  joint,  glanced, 
and  was  cut  out  from  the  gluteal  muscles.  The  wound  occasionally  discharges  pns.  Suffers  from  frequent 
pain  in  the  joint.  The  leg  remains  weak  and  of  comparatively  little  service  to  him,  as  he  is  unable  to  walk 
or  stan(^  ^ono  uPon  **•"  *n  January,  1876,  the  same  examiner  reported :  "Has  periodical  discharges  of  pus 

moved  from  the  and  spiculffi  of  bone.  The  sensation  of  the  right  leg  is  much  impaired  and  the  motion  impeded  by  partial 
paralysis,"  etc.  The  pensioner  was  paid  June  4,  1876. 

1  HENXEX  (Principles  of  Mil.  Surgery,  3d  ed.,  1829,  p.  79)  has  recorded  several  examples  of  the  lodgement  of  large  projectiles  in  the  thigh.     He 
remarks  that :  '•  Masses  of  very  extraordinary  and  almost  incredible  sizes  are  found.     .     .     I  have  frequently  seen  them,''  he  says,  "  of  one  and  sometimes 

two  pounds  weight."     He  then  cites  the  case  of  Lieutenant  F ,  12th  Regiment,  wounded  at  Scringapatam.     A  cannon  shot  rolled  over  the  banquet 

behind  which  this  officer  was  lying  down,  and  buried  itself  in  the  muscles  of  the  hip.  The  bearers  who  conveyed  him  on  a  dooley  to  the  tent  of  the 
chief  medical  officer,  Dr.  ALEXANDER  ANDERSON,  complained  of  the  difficulty  of  carrying  him  from  the  trenches,  owing  to  the  litter  "having  been 
unusually  heavy  on  one  side."  The  officer  was  moribund  on  his  arrival ;  but,  after  his  death,  Dr.  ANDERSON  cut  out  what  he  told  Dr.  IlEXNEN  was 
"unequivocally  a  thirty-two  pound  shot."  GUTIIRIE  (Treatise  on  Gunshot.  Wounds,  1871,  p.  72)  relates  the  case  of  a  soldier  at  Badiijos,  with  a  large 
piece  of  shell  Ijdgsd  \:\  the  thigh  and  buttock.  HENNEN  says  (loc.  cit.,  p.  79)  that  the  projectile  weighed  eight  pounds.  It  was  removed,  and  the  man 
recovered.  LARREY  (Mem.,  de  Chir.  Mil.,  1812,  T.  Ill,  p.  582)  describes  a  case  in  -which  he  removed  a  ball  -weighing  five  pounds  from  the  thigh  of  a 
soldier.  It  had  caused  him  little  inconvenience,  except  a  feeling  of  weight  in  the  limb.  PAlT.T,Aiu>  (Relation  chir.  du  siege  d'anvers)  mentions  that 
BterilX  told  him  of  a  case  in  which  a  nine-pound  shot  was  embedded  in  the  muscles  of  the  thigh.  Dr.  G.  M.  B.  MACLEOD  (Notes  on  the  Surgery  of  the 
War  in  the  Crimea,  ?th  ed.,  p.  108)  states  that  he  "saw  a  case  at  Scutari,  in  which  a  piece  of  shell  weighing  nearly  three  pounds  was  extracted  from 
the  hip  of  a  man  wounded  at  the  Alma,  which  had  been  overlooked  for  two  months,  and  to  which  but  a  small  opening  led."  He  further  relates  that 
BAUDENS  describes  the  case  of  a  French  soldier  in  the  Crimea,  in  which  a  shell  fragment  weighing  2  kilog.  150  grammes,  or  about  five  and  three-quarters 
pounds  avoirdupois,  buried  itself  in  the  thigh  so  as  to  be  invisible.  I  have  not  found  this  case  in  the  Guerre  de  Crimee  of  BAUDKXS,  or  in  his  letters  of 
that  date  to  the  Gaze.tte  Medicale.  A  surgeon  of  a  Maine  regiment  told  me  of  a  twelve-pound  solid  shot,  that  he  had  extracted  from  the  muscles  of  the 
thigh  of  a  volunteer  soldier  at  Portland,  which  he  should  send  to  the  Museum;  but  the  missile  never  arrived,  nor  could  the  injury  referred  to  be  identified 
on  the  surgical  rpconls. 


.  I.]  LODGEMENT   OF    MISSILES    IN    SOFT   PARTS.  23 

The  small  iron  balls  from  spherical  case-shot,  having  only  a  slight  velocity  at  a  little 
distance  from  the  point  of  explosion,  often  lodged : 

CASE  37.— Private  E.  E.  Middleton,  Co.  C,  12th  Now  Jersey,  aged  24  years,  was  wounded  at  Gettysburg,  July  3,  18G3, 
and  admitted  to  Newton  University  Hospital,  Baltimore,  several  days  afterwards.  Surgeon  C.  W.  Jones,  U.  S.  V.,  reported' 
"The  patient  was  in  good  condition  when  -admitted.  A  ball  entered  near  the  posterior  border  of  the  tibialis  anticus,  a  little 
above  the  middle  third  of  the  left  leg,  and,  passing  downward 'and  backward,  was  removed  July  13th,  from  the  posterior 
portion  of  the  leg  by  a  counter-opening  about  four  inches  below  the  point  of  entrance.  The  missile  on  being  removed  proved 
to  be  a  round  ball  from  a  spherical  case  shot.  The  wound  has  healed  well  and  rapidly,  but  the  contraction  of 
the  muscles  makes  the  man  look  as  if  he  had  talipes  equinus.  However,  the  contraction  is  growing  less  by 
passive  motion,  and  there  is  reason  to  hope  that  he  will  soon  have  perfect  use  of  the  limb.  Simple  dressings 
were  used  all  the  time."  The  missile  was  contributed  to  the  Museum  by  Surgeon  Jones,  and  is  represented 
in  the  cut  (FlG.  6).  On  February  2,  1864,  the  patient  was  transferred  to  Patterson  Park  Hospital,  and  one 
week  afterwards  he  was  returned  to  his  command  for  duty.  On  June  4,  1865,  he  was  mustered  out  of  service. 
In  his  application  for  pension  he  alleged  that  "the  wound  healed,  but  broke  out  afresh  in  the  spring  of  1865,  FlG-  «•  — Iron 
and  discharged  pieces  of  bone."  Examiner  B.  H.  Stratton,  of  Masonville,  N.  J.,  September  4,  1873,  reported  eTfrom°the*WghN 
the  leg  as  being  in  an  ulcerated  condition  from  necrosis  of  bone.  Examiner  F.  Ashurst,  of  Mount  Holly,  Spec-  3199- 
certified,  September  18,  1875:  "The  cicatrices  are  healed,  and  the  pensioner  enjoys  very  good  health."  This  pensioner 

was  paid  June  4,  1876. 

In  the  next  case,  a  musket  ball  had  remained,  innocuously,  for  more  than  two  years, 
encysted  near  the  outer  hamstring  tendons,  and  was  not  removed  until  the  patient  under 
went  amputation  in  the  thigh  on  account  of  a  complicated  fracture  of  the  leg.  The  cyst 
is  of  dense  connective  tissue.1 

CASE  38. — Sergeant  H.  M.  Lambert,  Co.  D,  12th  Illinois  Cavalry,  aged  29  years,  sustained  a  contusion  of  the  right  leg 
by  the  falling  of  his  horse  during  a  charge  on  the  enemy  near  Germanna  Ford,  October  10, 1863.  Three  days  after  the  accident 
he  was  admitted  to  Emory  Hospital,  Washington,  whence  Surgeon  N.'  R.  Moseley,  U.  S.  V.,  contributed  the  specimen  (FlG. 
7),  with  the  following  report:  "Slightly  comminuted  fracture  of  both  bones  of  right  leg  at  middle  third,  followed  by  copious 
discharge  of  sanious  pus.  The  patient  having  become  weak  and  debilitated,  tonics  and  stimulants  were  resorted  to  with  the 
desired  effect.  On  October  25th,  double-flap  amputation  at  the  upper  third  of  the  leg  was  performed  by 
Acting  Assistant  Surgeon  W.  H.  Ensign.  Simple  dressings  and  adhesive  straps  were  used.  The  patient  did 
well,  and  the  stump  had  almost  entirely  healed,  when,  on  November  8th,  haemorrhage  supervened.  Graduated 
compresses  were  resorted  to  without  avail,  and  on  November  10th  the  limb  was  reamputated  at  the  lower  third 
of  the  thigh  by  the  double-flap  method.  The  stump  was  again  well-nigh  healed,  when,  on  November  26th, 
haemorrhage  again  set  in,  and  Dr.  Mott's  tourniquet  was  applied  with  perfect  success.  On  December  10th 
the  tourniquet  was  removed,  and  no  return  of  the  haemorrhage  followed.  By  January  18,  1864,  the  patient 
was  up  and  about  the  ward,  and  doing  well.  The  specimen,  a  conical  ball  enclosed  in  a  sac,  was  removed 
from  the  amputated  leg  at  the  second  operation.  The  patient  had  received  this  ball  in  a  skirmish  with  the  _ 
enemy  in  Kentucky,  in  October,  1861,  and  the  missile  had  remained  in  the  popliteal  space  beneath  the  outer  i  ve  tissue.  S/>.  1879. 
hamstring  tendons,  without  inconvenience,  for  two  years  and  one  month."  The  amputated  tibia  and  fibula,  showing  no  attempt 
at  union,  were  contributed  by  the  operator  (See  Cat.  Surg.  Sect.,  1866,  p.  511),  and  constitute  specimen  1744  of  the  Surgical 
Section  of  the  Army  Medical  Museum.  The  patient  was  subsequently  transferred  to  Judiciary  Square  Hospital,  and  discharged 
from  service  July  30,  1864.  He  is  a  pensioner,  and  was  paid  June  4,  1876. 

There  were  cases  in  which  missiles  gravitated  for  considerable  distances  from  the 
point  at  which  they  at  first  lodged : 

CASE  39. — Private  A.  J.  Dougherty,  Co.  1, 13th  Indiana,  aged  19  years,  was  wounded  in  the  thighs  at  Turkey  Bone  Bridge, 
November  2,  1861.  After  being  treated  for  a  time  at  the  regimental  hospital  he  was  returned  to  his  company  for  duty,  and 
subsequently  he  received  a  furlough  to  visit  his  home  in  Philadelphia.  Acting  Assistant  Surgeon  H.  M.  Bellows  reported  the 
following  history:  "He  was  admitted  to  Broad  and  Cherry  Streets  Hospital,  April  13,  1863,  at  which  time  a  foreign  body  was 
discovered  beneath  the  skin  on  the  front  of  the  right  thigh,  five  inches  above  the  patella,  which  gave  rise  to  considerable  pain 
whenever  the  patient  walked.  On  the  next  day  it  was  removed  by  Surgeon  J.  Neill,  U.  S.  V.,  and  proved  to  be  the  half  of  a 
round  leaden  ball.  He  stated  that  the  missile  entered  the  left  thigh  just  below  and  in  front  of  the  trochanter,  where  the  only 
visible  scar  was  found.  After  the  injury  he  had  some  pain  and  tenderness  on  pressure  over  the  lower  part  of  the  abdomen,  with 
difficult  micturition  for  a  few  days.  On  examination  the  presumption  was  that  the  fragment  must  have  crossed  from  left  to 
right,  either  in  front  or  just  above  the  pubes,  and  thence  gradually  downward  into  the  thigh.  The  wound  healed  by  granula 
tions  and  by  the  5th  of  May  had  completely  cicatrized."  The  missile  was  contributed  to  the  Museum  by  the  operator,  and 
constitutes  specimen  1776  of  the  Surgical  Section.  The  patient  was  subsequently  transferred  to  Indiana,  and  mustered  out  at 
the  expiration  of  his  term  of  service,  June  19,  1864.  He  afterward  again  enlisted,  and  was  finally  discharged  June  21,  1865, 

1  At  the  points  a  a  the  ball  is  uncovered  by  the  cyst ;  but  the  cellular  envelope  was  probably  nicked  by  the  scalpel  in  cutting  out  the  ball.  This 
is  one  of  the  few  good  examples  the  Museum  possesses  of  the  " Kyste.  defmitif"  surrounding  balls  as  defined  by  BAUDEXS  (La  Guerre  de  Crimee,  Seme 
6d.,  1858,  p.  110).  This  " Kyste  primitif,"  which  he  claimed  to  have  "peremptorily  demonstrated"  to  always  invest  balls  embedded  in  the  muscular 
tissues,  even  when  extracted  immediately  after  the  infliction  of  injury,  has  not  been  observed  by  others  (See  MACLEOD,  Kates,  etc.,  op.  cit.,  p.  109),  and 
doubtless  means  nothing  more  than  that  missiles  sometimes  get  an  investment  from  the  intramuscular  areolur  tissue. 


24  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

and  pensioned.  Examiner  E.  A.  Smith,  of  Philadelphia,  August  28,  1865,  certified:  *  *  "Pain  in  right  testicle,  and  left 
leg  feels  perfectly  dead  at  times;  walks  with  difficulty."  The  Philadelphia  Examining  Board  reported,  February,  18,  1874: 
*  *  "Complains  of  pain  in  both  limbs.  Alleges  that  he  has  difficulty  in  passing  water  at  times  from  irritable  condition  01 
bladder,  and  pain  in  the  whole  course  of  the  ball.  Cicatrices  are  without  adhesions  to  the  bone,  and  there  is  no  atrophy  of  the 
limb.  Slight  stiffness  about  the  left  hip  joint."  This  pensioner  was  paid  June  4,  1876. 

As  in  Chapter  XI  the  peculiarities  of  shot  wounds  in  general  will  be  discussed,  it 
would  be  superfluous  here  to  dwell  longer  on  the  particular  instances  of  missiles  lodged  in 
the  fleshy  parts  of  the  lower  limbs.1  While  not  wishing  to  be  rudely  incredulous  in  regard 
to  the  almost  marvellous  accounts  that  some  authors  have  given  of  large  projectiles 
embedded  in  the  soft  parts  of  the  thigh  and  leg,  I  may  say  that  analogous  authenticated 
examples  are  not  to  be  found  in  the  experience  of  the  American  War,  and  that  in  most  of 
the  remarkable  heretofore  recorded  cases  there  is  reason  to  believe  that  they  were  probably 
associated  with  fractures. 

Peri-articular  Wounds. — After  the  shot  wounds  of  the  soft  parts  of  the  lower 
extremity  implicating  the  larger  vessels  and  nerves,  or  producing  great  lacerations,  or 
complicated  by  the  lodgement  of  foreign  bodies,  cases  are  to  be  considered  in  which  mis 
siles,  without  immediately  injuring  the  osseous  articular  surfaces,  so  injure  the  surrounding 
ligaments  and  other  soft  parts,  in  some  instances  even  the  synovial  membrane,  as  to  light 
up  immediate  or  consecutive  inflammation  in  the  capsular  cavity,  or  to  induce,  through 
the  formation  of  cicatricial  bridles  or  by  other  deformities,  a  diminution  or  even  abolition 
of  the  movements  of  the  joint.  These  injuries  have  been  discriminated  by  M.  Legouest 
under  the  title  of  Peri-articular  Wounds?  He  apparently  includes  in  this  group  only 
cases  in  which  the  capsular  cavity  is  not  primarily  opened;  but  I  prefer  to  adhere  to  the 
definition  proposed  in  my  monograph  on  Excision  of  the  Head  of  the  Femur?  and  have  not 
felt  at  liberty  to  exclude  from  this  category  the  rare  instances  in  which  evidence  indicates 
the  probability  of  a  primary  lesion  of  the  synovial  membrane  without  direct  implication 
of  the  bones  of  the  articulation,  and  I  observe  that  Drs.  Beck  and  Fischer  adopt  a  similar 
view-4  After  a  careful  analysis  of  the  reports  of  cases  liable  to  belong  to  this  group,  four 
hundred  and  thirty-seven  have  been  classified  as  instances  of  peri-articular  shot  wounds  of 

1  The  Army  Medical  Museum  is  rich  in  specimens  of  projectiles  extracted  from  the  soft  parts  of  the  lower  limbs.  Besides  those  described  in  the 
text,  there  are  twenty  examples  of  small  missiles  extracted  from  the  soft  parts  of  the  thigh.  These  specimens  are  numbered  176, 
1095,  1368,  2559,  2C54,  2971.  44CO,  4476,  4480,  4501,  4502,  4507,  4520,  4521,  4552,  4553,  4501,  4574,  4624,  4693.  Brief  notes  of  the 
particulars  regarding  these  cases  may  be  found  in  the  Catalogue,  of  the  Surgical  Section  of  1£66,  from  pages  593  to  597.  Two  of 
the  most  remarkable  are  illustrated  in  the  annexed  wood-cuts.  That  represented  in  FIGUKE  8  was  extracted  by  Assistant 
Surgeon  J.  T.  CALHOUN,  U.  S.  A.,  from  the  thigh  of  a  private  cf  the  12Qth  New  York,  at  the  battle  of  the  Wilderness,  May  7, 
18G4,  and  was  regarded  as  an  explosive  ball.  Specimen  4553  (FIG.  9)  was  remarkable  for  having  entered 
the  left  thigh  below  and  in  front  of  the  great  trochanter,  and  having  passed  subcutaneous]}-  around  the 
pubic  region  and  lodged  in  the  right'  high  five  inches  above  the  patella.  The  case  is  that  of  Private  A. 

G.  D ,  13th  Indiana,  wounded  at  Gauley  River,  November  2, 1862 ;  the  ball  was  extracted  by  Surgeon 

JOHN  NEILL,  U.  S.  V.,  April  14,  18G3.  There  are  seven  specimens  of  missiles  extracted  from  the  fleshy 
parts  of  the  leg  in  the  Museum,  viz :  Numbers  1586.  2326,  3199,  4462,  4500,  4514,  4695,  and  two  specimens 
extracted  from  the  soft  parts  of  the  foot,  viz:  1580  and  4523.  All  of  these  specimens  are  described,  with 
notes  of  the  cases  to  which  they  belong,  in  the  27th  Chapter  of  the  Surgical  Catalogue  already  referred 
to.  These  specimens  are  neatly  mounted  on  brass  rods.  Dr.  A.  SCHINZIN'GEH  (Das  Keservilazareth 
Schwetzingen  im  Krie.ge,  1870-71,  Freiburg,  i.  B.,  1873,  p.  37)  relates  that  he  has  a  small  collection  of  q  _ 

Distorted    extracted  bullets  remarkable  for  their  deformation,  and  that  those  extracted  from  German  soldiers  have    ro,ln(^    {,au    extracted 

tht/jh   °^pec   4561  r°m    ^een  mounted  in  silver,  and  on  the  setting  the  name  of  the  wounded  man  and  the  date  of  the  battle    from  thigh.  5p«c.4553. 

engraved,  at  the  thoughtful  suggestion  of  the  princess  of  that  province. 
2LEGOUEST  (L.)  (Traite  de  Chirurgie  d'Armee,  26me  Gd.,  Paris,  1872,  p.  442).     Some  citations  from  his  remarks  on  this  subject  may  be  found  in 

the  Surgical  Volume  of  Part  II  of  this  work,  footnote  1,  p.  503.     His  further  observation  on  this  point  is  worthy  of  consideration,  that  "  when  shot  wounds 

and  notably  even  slight  contused  wounds  are  situated  on  the  side  of  extension  of  joints,  where  they  are  exposed  to  continual  attritions  and  tractions,  they 

readily  inflame  and  sometimes  give  rise  to  circumscribed  abscesses  or  diffused  phlegmous  of  more  or  less  gravity." 

3  OTIS  (G.  A.),  A  Report  on  Excisions  of  the  Ilead  of  the  Femur  for  Gunshot  Injury.     Circular  No.  2,  War  Department,  Surgeon  General's  Office, 

Washington,  D.  C.,  1869,  pp.  63,  90,  92. 

*  BECK  (B.)  (Chirurgie  der  Schussverletzungen,  1872,  p.  609)  details  25  cases,  in  which  the  soft  parts  of  the  knee  joint  were  either  primarily  or 

secondarily  involved.     Four,  or  16.0  per  cent.,  terminated  fatally.    He  also  gives  7  cases  of  flesh  wounds  of  the  ankle  joint;  no  deaths.     FISCHER  (H.) 

(Kriegschir.  Erfahr.,  Ister  Theil,  For  Metz,  Erlangen,  1872,  p.  102)  gives  an  account  of  7  cases  in  which  the  knee  joint  was  injured  without  lesion  of  the 

bony  structure.     Two,  or  28.5  per  cent.,  had  a  fatal  termination. 


SECT.  I.I  FEET-ARTICULAR    WOUNDS.  25 

the  lower  limb,  of  which  forty-nine  are  referred  to  the  hip  joint,  three  hundred  and  fifty- 
one  to  the  knee  joint,  and  thirty-seven  to  the  ankle  joint.  Each  of  these  subdivisions  will 
be  concisely  discussed. 

In  peri-articular  shot  wounds  of  the  Hip  Joint,  the  difficulties  of  diagnosis  are  almost 
insurmountable  in  the  present  state  of  our  knowledge.  In  the  cases  of  recovery,  the  exact 
extent  of  the  lesions  can  only  be  surmised,  and  in  the  fatal  cases  necroscopic  examination 
will  scarcely  determine  with  absolute  precision  whether  the  articular  capsule  was  primarily 
or  secondarily  opened.  Memoranda  of  forty-nine  cases  of  shot  wounds,  which  the  reporters 
believed  to  have  led  to  the  opening  of  the  coxo-femoral  articulation  without  direct  injury 
of  the  bones,  are  found  on  the  registers.  Thirty-five  instances  are  adduced  in  which  it 
was  supposed  that  there  was  primary  lesion  of  the  joint  capsule;  twenty-one  of  them  are 
reported  as  recoveries.  Abstracts  of  seven  of  these  have  been  already  published.1  Of  the 
remaining  fourteen  recoveries,  such  scanty  information  as  can  be  found  in  the  reports  is 
condensed  in  the  appended  abstracts: 

CASES  40-48. — Lieutenant  D.  H.  Miller,  Co.  H,  75th  Ohio,  aged  28  years,  was  wounded  and  captured  at  Gettysburg, 
July  1,  1863.  After  remaining  a  prisoner  for  a  few  days,  he  was  admitted  to  the  Eleventh  Corps  Hospital.  Several  weeks  later 
he  proceeded  to  his  home  in  Logan,  Ohio,  where  he  was  attended  by  Drs.  G.  W.  Pullen  and  J.  Sharp,  who  reported  his  case 
as  follows:  "The  ball  entered  the  posterier  and  inferior  part  of  the  glutei  muscles  of  the  left  hip,  passed  over  the  neck  of  the 
femur,  and  came  out  on  the  inner  side  of  the  trochanter  major.  February  15,  1864,  the  wound  has  closed,  but  the  motions  of 
the  hip  joint  are  diminished  to  a  great  extent,  and  the  leg  is  so  weakened  that  he  is  unable  to  walk  without  the  use  of  crutches." 
The  patient  was  discharged  from  service  January  22,  1864,  Surgeon  A.  M.  Speer,  U.  S.  V.,  certifying  to  "shot  wound  of  hip 
joint  without  fracture."  Examiner  T.  O.  Edwards,  of  Lancaster,  Ohio,  in  February,  1871,  stated  that  "the  wound  had  opened 
and  discharged  a  portion  of  his  blouse,"  etc.  Examiner  W.  C.  Hyde  certified,  September  10,  1873:  "There  is  flattening  of 
muscles  of  the  hip,  the  cavity  of  the  joint  injured  by  the  missile,  and  the  joint  partially  anchylosed."  The  pensioner  was  paid 
March  4,  1877. — Corporal  L.  Bertram,  Co.  A,  6th  Louisiana,  entered  a  Confederate  hospital  at  Richmond  with  "shot  wound  of 
right  hip,  involving  the  joint,"  received  May  4,  1863,  and  was  furloughed  April  15,  1864. — T.  J.  Brandon,  a  member  of  Co.  F, 
14th  Alabama,  was  treated  in  the  Confederate  hospital  at  Farmville  for  "shot  wound  in  the  buttock  with  injury  to  hip  joint," 
and  was  .furloughed  October  22,  1862. — Private  77.  KiniberUn,  Co.  G,  48th  Virginia,  received  a  gunshot  injury  of  the  right  hip 
joint,  producing  lameness,  and  was  furloughed  from  the  Confederate  hospital  at  Farmville. — Private  C.  C.  McMurray,  Co.  H, 
15th  North  Carolina,  was  admitted  to  hospital  No.  24,  Ricbmond,  with  "shot  wound  of  hip  joint,"  and  was  discharged  Septem 
ber  13,  1862. — Private  G.  W.  Williams,  Co.  F.  3d  North  Carolina,  appears  on  a  Confederate  hospital  case-book  as  having 
received  a  "shot  wound  of  the  hip  joint,  May  3.  1833,  the  ball  being  extracted  near  the  knee."  Furloughed. — Private  J.  Hilk, 
Co.  B,  112th  Pennsylvania,  was  wounded  in  June,  1862.  Surgeon  E.  Griswold,  of  the  regiment,  reported,  "an  injury  to  hip 
joint  by  a  pistol  ball.''  The  man  was  discharged  from  service  October  16,  1832.  He  is  not  a  pensioner. — Private  I.  J.  Brown, 
Co.  A,  18th  Infantry,  was  wounded  at  Stone  River,  December  31,  1862.  He  was  treated  at  various  hospitals,  and  lastly  at 
Camp  Thomas,  Ohio.  Acting  Assistant  Surgeon  C.  R.  Reed  reported  that  he  was  discharged  March  17,  1864,  by  reason  of 
"shot  wound  of  left  hip  joint."  He  is  not  a  pensioner. — Private  M.  Ahern,  Co.  E,  183d  Pennsylvania,  aged  24  years,  was 
wounded  at  Spottsylvania,  May  14,  1864.  Surgeon  L.  A.  Edwards,  U.  S.  A.,  reported  his  admission  to  Lovell  Hospital  with 
"shot  wound  of  right  hip  joint."  The  man  was  mustered  out  July  13,  1835,  and  is  not  a  pensioner. 

Spontaneous  luxation  after  traumatic  coxitis  from  shot  injury  of  the  hip  joint  with 
out  fracture,  was  reported  in  three  instances: 

CASES  49-51. — Sergeant  I.  Murdick,  Co.  I,  134th  Pennsylvania,  aged  23  years,  wounded  at  Fredericksburg,  December 
13,  1862.  He  was  admitted  to  Stone  Hospital,  Washington,  December  20th,  with  "gunshot  wound  of  left  thigh."  Assistant 
Surgeon  C.  A.  McCall,  U.  S.  A.,  reported  that  the  man  was  discharged  from  Mount  Pleasant  Hospital,  April  16,  1863,  because  of 
"gunshot  Avound  over  left  trochanter,  passing  in  the  direction  of  the  hip  joint ;  ball  undiscovered  and  interfering  with  the  free  use 
of  the  joint."  Examiner  G.  McCook,  of  Pittsburg,  June  22, 1834,  certified  :  *  *  "Inflammation  and  suppuration  have  ensued 
and  have  progressed  until  the  round  and  capsular  ligaments  of  the  left  hip  joint  have  been  destroyed  and  the  femur  drawn  at 
least  two  inches  above  the  acetabulum.  The  left  leg  is  thrown  across  the  right  at  least  two  inches  or  more  above  the  right  knee, 
resembling  the  position  of  a  dislocated  femur.  The  heel  is  elevated,  and  it  is  with  extreme  difficulty  that  he  can  walk  with  the 
aid  of  crutches.  The  toes  of  the  left  foot  rest  on  the  dorsum  of  the  right."  On  November  22,  1837,  the  pensioner  was  furnished 

1  OTIS  (GEORGE  A.)  (A  Report  on  Excisions  of  the  Head  of  the  Femur  for  Gunshot  Injury.  Circular  No.  2,  War  Department,  S.  G.  O.,  Washington, 
1869,  pp.  90-92):  CASE  166,  Corporal  II.  C.  Boyd,  3Plh  111.;  CASE  169,  Lieut.  C.  Duncan,  18th  Ind.j  CASE  176,  Pt.  G.  W.  Mir.nick,  7th  Md.;  CASK  177, 
Pt  W.  M.  Moore,  3d  Ohio;  CASK  178,  Pt.  W.  N.  Morgan,  9th  Penn'a  Reserves ;  CASE  1«.~>,  I't.  Jacob  Widmann,  97th  Xew  York;  CASE  186,  Pt.  Henry 
Witzleben,  28th  Ohio.  In  all  seven  cases  the  evidence  of  direct  lesion  of  the  articulation  was  inconclusive,  and  the  opinions  of  the  several  surgical 
attendants  were  conflicting  in  each  instance.  Two  cases  (Witzleben,  Morgan)  terminated  in  false  anchylosis.  In  the  latter  the  adhesions  were  forcibly 
and  successfully  broken  up  by  Professor  S.  D.  GROSS.  In  one  case  (Widmann),  after  suppuration  of  the  joint,  the  head  of  the  femur  was  apparently 
luxated.  Professor  B.  von  LANGENBECK  holds  (Ueber  die  Schussutrletzungen  des  Uiiftgtlenks,  in  Archiv  fur  Klin.  Chir.,  B.  XVI,  p.  286)  that,  "the 
most  usual  result  (constanteste  Ausgang)  of  healing  shot  injuries  of  the  hip  joint  is  in  anchylosis. " 
SURG.  Ill— 4 


26  INJUEIES    OF   THE    LOWEE   EXTREMITIES.  [CHAP.  X. 

with  an  apparatus  for  dislocated  hip  joint,  by  Dr.  E.  D.  Hudson,  of  New  York  City.  Examiner  J.  K.  Reinholdt,  February  7, 
1871,  certified:  ''The  downward  momentum  caused  the  ball  to  imbed  itself  securely  in  the  hip  joint.  *  *  Parts  swollen  and 
tender;  wound  discharging;  more  or  less  injury  to  great  sciatic  nerve;  limb  deficient  in  temperature;  more  or  less  constant 
pain;  confined  to  bed  months  at  a  time,"  etc.  This  pensioner  died  May  7,  1874,  of  convulsions  superinduced  by  the  results  of 
his  wound,  his  attending  physician  and  others  stating  that  the  serious  attacks  of  inflammation,  resulting  in  the  formation  of 
abscesses,  proved  a  severe  tax  upon  his  vitality  and  prepared  the  way  for  his  sudden  demise. — Private  R.  Emerick,  Co.  D,  82d 
Pennsylvania,  aged  28  years,  was  wounded  at  Cold  Harbor,  June  1,  1864,  and  admitted  to  hospital  at  Alexandria,  and  subse 
quently  to  Pittsburg.  Surgeon  J.  Bryan,  U.  S.  V.,  reported  that  he  was  transferred  to  the  Veteran  Reserve  Corps,  October  8, 
1864,  by  reason  of  "a  grapeshot  wound,  dislocating  the  right  femur."  Not  a  pensioner. — Lieutenant  F.  Heck,  Co.  I,  74th  Penn 
sylvania,  aged  37  years,  was  wounded  in  the  right  thigh  at  Rappahannock  Ford,  August  22,  18G2,  and  was  discharged  from 
service  October  9,  1863.  In  1874,  the  Examining  Surgeons  report :  "Firm  anchylosis,  with  head  of  femur  thrown  out  of  socket; 
knee  and  ankle  joints  entirely  stiff;  foot  in  an  extended  position,  arid  limb  shortened  two  inches." 

Two  cases  are  reported  as  injuries  of  the  hip  joint  by  large  projectiles: 

CASES  52-53. — Private  J.  Teeters,  Co.  A,  84th  Pennsylvania,  aged  34  years,  was  wounded  at  Bull  Run,  August  30, 1862, 
and  discharged  from  service  March  29,  1863.  Assistant  Surgeon  J.  D.  McClure,  of  the  regiment,  certifying  to  ''an  injury  in 
the  right  hip  joint  by  a  piece  of  shell,  producing  paralysis  of  the  whole  leg."  This  man  was  a  pensioner,  but  has  not  been  heard 
from  since  September  4, 1864. — Private  W.  S.  Gardiner,  Co.  A,  14th  South  Carolina;  injury  to  hip  joint  from  bomb;  furloughed. 

The  entire  subject  of  traumatic  lesions  of  the  hip  joint  is  of  such  importance  that  it 
is  deemed  proper  to  adduce  or  to  refer  to  the  previous  publication  of  all  the  information 
that  can  be  found  on  the  registers,  with  the  warning  that,  in  many  instances,  the  facts  are 
derived  from  reports  suggestive  of  superficial  examination,  and  sometimes  of  diagnoses 
that  must  be  regarded  as  little  more  than  conjectures.1 

Of  the  fourteen  fatal  Cases  in  the  series  of  thirty-five  shot  injuries  believed  to  have 
been  attended  with  primary  lesion  of  the  hip  joint  without  fracture,  the  details  of  all  are 
published  in  Circular  2,  S.  Gr.  0.,  1869,  already  cited.2  In  the  reports  of  many  of  these 
cases  it  is  stated  that  the  character  of  the  lesions  was  verified  by  necroscopic  examination, 
and  in  others  it  may  be  inferred  that  autopsies  were  made,  so  that  the  series  is,  as  a  whole, 
more  reliable  than  the  preceding.3 

Of  the  series  of  forty-nine  cases  of  reported  peri-articular  shot  wounds  of  the  hip 
joint,  fourteen  may  be  classified  as  examples  of  secondary  traumatic  coxitis.4  Seven  were 

1  VON  LANGENBECK  (B.)  (Uber  die  Shussverletzungen  des  Huftgelenks,  in  Archivfur  Klinische  Chirurgie,  Berlin,  1874,  B.  XVI,  p.  280)  remarks: 
"It  may  be  taken  for  granted  that  a  gunshot  injury  of  the  hip  joint  may  heal  under  favorable  circumstances  without  traumatic  coxitis  beginning.    Coxitis 
may  certainly  be  avoided  in  simple  capsule  wounds,  which  are  kept  perfectly  quiet  from  the  commencement,  as  well  as  in  gunshot  injury  of  the  knee 
joint,  as  I  have  seen  the  recovery  of  several  cases  without  any  inflammation  arising.     As,  however,  in  most  cases  (Pott's)  side  splint  was  recommended 
by  the  surgeon  or  adopted  by  the  patient,  and  as  during  the  last  war  not  a  few  of  the  men  were  subjected  to  distant  transport,  and,  injury  of  the  hip  joint 
not  having  been  discovered,  were  allowed  to  go  about,  it  was  difficult  In  such  cases  to  avoid  inflammation.     It  appears  to  me  that  we  must  admit  that  in 
all  those  cases  in  which  coxitis  suddenly  appears  a  considerable  time  after  the  injury,  recovery  is  certain  under  favorable  external  circumstances  without 
any  further  trouble  occurring."     [The  translation  is  the  version  of  JAMES  F.  WEST,  F.  R.  C.  S.] 

2  Circular  No.  2,  S.  G.  O.,  18G9,  op.  cit.,  pp.  90,  91,  9?.     The  names  of  the  patients,  the  duration  of  life  after  injury,  and  the  names  of  the  reporters 
are  noted:  CASE  1C5,  W.  Blair,  survived  injury  23  days ;  extent  of  injury  demonstrated  by  autopsy ;  McKEE,  reporter. — CASE  167,  A.  D.  Bradshaw, 
survived  19  days;  verified  by  autopsy;  BUUXE,  reporter. — CASE  168,  P.  Cornell,  survived  3  days;  WOLFE,  reporter. — CASE  170,  J.  W.  Falconer, 
survived  15  days;  autopsy;  MOROXG,  reporter. — CASE  171,  S.  Finnegan,  survived  1  day;  COLE,  reporter. — CASE  172,  G.  Green,  survived  14  days; 
GRAHAM,  reporter. — CASE  173,  F.  M.  Hate,  survived  102  days;  HATCHITT,  reporter. — CASE  174,  J.  E.  Leedy,  survived  7  days ;  LEAVITT,  reporter. — 
CASE  175,  J.  McMahon,  survived  19  days;  BLISS,  reporter. — CASE  179,  B.  F.  Pittman,  survived  73  days;  JANES,  reporter. — CASE  180,  W.  R.  Reeves, 
survived  16  days;  autopsy;  HARRINGTON,  reporter.— CASE  181,  T.  Smith,  survived  28  days;  autopsy;  VANDERKIEFT,  reporter.— CASE  182,  R.  Taylor, 
survived  4  days;  autopsy;  SEABUOOK,  reporter. — CASE  183,  B.  K.  Wagoner,  survived  265  days;  HATCIUTT,  reporter. — CASE  184,  of  J.  Wells,  was  also 
reported  in  Circular  2  as  belonging  to  this  group;  but  the  carbine  ball  inflicting  the  injury,  much  deformed,  with  large  bone  fragments  embedded  in  it 
(Specimen  2994,  Cat.  Surg.  Sect.,  1866,  p.  603),  has  since  been  discovered,  and  the  case  has  been  transferred  to  the  category  of  shot  fractures  of  the  neck 
of  the  femur.    In  three  cases,  in  which  the  patients  died  within  a  few  days  after  the  infliction  of  the  injury,  it  is  probable  that  there  were  grave  concom 
itant  lesions.    In  those  in  which  they  survived  two  months,  three  months,  and  eight  months,  respectively,  there  were  no  autopsies  held,  and  the  lesions 
were  not  accurately  determined.     In  the  eight  remaining  cases,  the  parents  lived  from  one  to  four  weeks ;  the  mean  was  16  days. 

3BlLLROTH  (TH.)  (Chir.  Briefe,  u.  s.  w.,  Berlin,  1872,  p.  238)  observes:  "I  am  of  opinion,  that  neither  the  direct  injury  of  the  joint  capsule  and 
bone,  nor  the  secondary  necrosis,  can  always  be  early  diagnosticated.  In  cases  resulting  favorably,  the  diagnosis  can  generally  only  be  made  ex  post, 
from  the  total  anchylosis  of  the  hip  joint,  and  in  many  cases  only  after  the  discharging  of  some  necrosed  bone.  .  .  Nevertheless  I  had  not  imagined 
the  diagnosis  to  be  so  difficult ;  I  had  thought  that  there  must  be,  under  all  circumstances,  symptoms  of  acute  coxitis ;  but  I  was  mistaken  therein.  .  . 
But  gradually  we  arrive  at  a  correct  diagnosis  in  the  majority  of  these  cases  from  the  slow  progress  after  the  injury,  the  copious  suppuration,  rapid 
debilitation,  and  speedy  decubitus." 

4  Circular  No.  2,  S.  G.  O.,  1869,  op.  cit.,  pp.  93,  94.  The  cases  of  five  of  the  seven  patients  who  partially  recovered  have  been  enumerated  in  the 
Circular  above  cited:  CASE  190,  of  Capt.  H.  C.  Mason,  20th  Massachusetts,  is  more  extensively  reported  by  J.  MASON  WARREN  in  his  excellent  Surgical 
Observations  with  Cases  and  Operations,  Boston,  1867,  p.  565.  A  fortnight  after  the  accident,  acute  inflammation  of  the  hip  joint  came  on,  and  WARREN 
cut  down  and  removed  the  ball  from  directly  over  the  capsule  of  the  joint.  He  ultimately  recovered  with  stiff  joint.  The  next  case,  No.  191,  A.  McGce, 
will  be  noticed  on  the  next  page.  In  CASE  193,  Private  S.  Schafer,  81st  Ohio,  was  struck  in  the  left  hip  at  Resaca,  May  14,  1864,  and  recovered  with  a 
Stiff  joint,  according  to  Surgeon  W.  THRELKELD,  U.  S.  V.,  and  others.  CASE  196,  Private  W.  A.  Shingledecker,  101st  Pennsylvania,  Gettysburg,  July 


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PERT-ARTICULAR   WOUNDS. 


27 


fatal,  and  seven  resulted  in  recovery.  Abstracts  of  five  of  the  latter  have  been  published 
in  Circular  2,  and  two  others  are  here  noted: 

CASES  54-55.—  Sergeant  J.  A.  Heady,  Co.  B,  15th  Kentucky,  .igcd  22  years,  was  wounded  at  Chickamauga,  September 
20,  1863,  and  was  discharged  from  Camp  Chase  July  18,  18G4.  Surgeon  J.  T.  Carpenter,  U.  S.  V.,  certified  to  "shot  wound 
of  left  hip,  the  ball  entering  three  inches  above  and  posterior  to  the  trochanter  major  and  remaining;  function  of  hip  joint  inter 
fered  with,  and  marching  impossible."  This  man  is  an  applicant  for  pension.  The  Louisville  Examining  Board  reported,  in 
1875,  that  the  missile  was  still  unextracted.  —  Private  E.  D.  Bates,  Co.  B,  24th  New  York  Cavalry,  aged  21  years,  was  wounded 
in  the  left  hip  at  Petersburg,  June  17,  1864,  and  was  treated  at  various  hospitals.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported 
his  discharge  from  Harewood  Hospital,  Washington,  May  5,  1885,  by  reason  of  "shot  wound  resulting  in  necrosis  of  head  of  left 
femur."  The  various  Examining  Surgeons  certify  to  more  or  less  injury  of  the  bone,  also  that  the  missile  remains  in  the  limb. 

Of  the  seven  examples  of  secondary  coxitis  from  shot  wounds  which  recovered,  the 
most  interesting  is  the  one  numbered  191  of  Circular  2,  in  which  the  nature  of  the 
injuries  was  observed  more  than  seven  years  after  reparation  had  taken  place. 

CASE  56.  —  Albert  McGee,  a  negro  refugee,  aged  about  30  years,  is  reported  to  have  been  struck  at  the  first  battle  of  Bull 
Run,  July  21,  1861,  by  a  musket  ball,  which  probably  entered  the  right  hip  at  the  level  of  the  trochanter  major,  and,  passing 
downward  and  forward,  made  its  exit  from  the  inner  surface  of  the  thigh  just  below  the  perineum.  He  made  a  complete 
recovery  with  the  right  lower  limb  shortened  two 
and  a  half  inches.  About  seven  years  subsequently 
McGee  entered  the  Howard  Grove  Hospital,  at  Rich 
mond.  Assistant  Surgeon  J.  H.  Janeway,  U.  S.  A., 
then  stationed  at  Richmond,  learned  from  Dr.  D.  R. 
Brower  that  the  man  came  to  Howard  Grove  Hos 
pital  in  the  latter  part  of  October  from  the  settlement 
of  refugees  at  Hampton,  Virginia,  and  was  then 
suffering  with  Bright's  disease.  Professor  Hunter 
McGuire,  of  Richmond,  and  Dr.  J.  N.  Upshur,  at  the 
time  resident  physician  at  the  Howard  Grove  Hos 
pital,  have  kindly  contributed  their  recollection  of 
the  case.1  An  autopsy  was  made  by  Dr.  J.  N. 
Upshur,  and  the  surgeons  who  examined  the  injury 
of  the  hip  were  of  the  opinion  that  the  head  of  the 
femur  had  been  grooved  by  the  ball  at  its  lower  part. 
The  pathological  specimen2  was  sent  to  the  Army  Medical  Museum,  and  there  a  vertical  section  of  the  epiphyses  and  upper 
portion  of  the  femur  was  made,  and  it  clearly  appeared  that  there  had  never  been  a  fracture  of  the  head,  and  that  the  groove, 
supposed  to  have  been  made  by  the  ball,  was  a  depression  resulting  from  a  former  abscess.  The  appearances  closely  resembled 
those  sometimes  observed  in  cases  of  chronic  rheumatic  arthritis.  They  are  represented  in  the  wood-cut  above  (FlG.  10),  and 
yet  more  satisfactorily  in  the  heliotype  opposite  (PLATE  LVI). 

2,  1863,  after  a  gunshot  wound  disordering  the  functions  of  the  right  hip  joint,  recovered  with  a  stiff  joint,  according  to  the  testimony  of  Examiner  of 
Pensioners  G.  McCOOK.—  CASE  197,  Private  T.  Swartwood,  25th  Ohio,  was  wounded  May  8,  1862,  by  a  musket  ball  which  injured  the  right  hip  joint. 
Pension  Examiner  C.  Hurr  testified  that  the  limb  was  shortened  two  inches  and  all  movements  of  the  articulation  caused  severe  pain. 

»Dr.  HUNTER  MCGUIUE  writes,  Richmond,  Va.,  October  17,  1877  :  "  I  have  received  your  letter  of  the  12th  inst.,  and  am  sorry  to  be  able  to  give 
you  so  little  information  about  the  case  you  speak  of  (CASE  101  of  your  report  on  excisions  at  the  hip  joint).     I  think  I  gave  you  at  different  times  two 
specimens  of  shot  wounds  of  th»  head  of  the  femur.     One  of  these  cases  you  saw  in  the  College  Hospital  here,  before  I  operated.    [Reference  is  made  to 
Specimen  No.  6217,  Surg.  Sect.,  A.  M.  M.,  an  excised  head  an-t  upper  extremity  of  the  right  femur  with  osteomyelitis.]     The  other  is  the  specimen  Dr. 
UPSHUR  speaks  of,  the  one  you  here  refer  to.     My  recollection  of  this  case  is  not  very  distinct,  but  I  am  quite  certain  that  I  looked  upon  it  at  the  time 
as  a  case  of  peri-articular  gunshot  wound  of  the  hip,  and  that  the  changes  about  the  head  and  neck  of  the  femur  were  due  to  the  resulting  coxitis. 
Dr.  D.  R.  Brower  was  in  charge  of  the  Howard  Grove  Hospital  when  this  specimen  was  obtained.     He  was,  afterwards,  superintendent  of  the  Insane 
Asylum  at  Williamsburg,  Virginia,  and  I  think  is  now  in  Chicago  and  holds  some  office  there  under  the  government.     He  may  be  able  to  give  you 
further  information  about  the  case,  but  I  do  not  think  it  probable  that  he  will  remember  anything  about  it."     Dr.  J.  N.  Ul'SllUK  in  a  letter  to  Dr.  HUM 
McGuiUE,  dated  Richmond,  October  16.  1877,  remarks:  "In  compliance  with  your  request,  I  would  state  in  regard  to  the  history  of  the  negro  man  coi 
corning  whom  you  have  received  a  letter  from  the  surgeon  in  charge  of  the  Medical  Muser.m  at  Washington.     He  came  to  Howard  Grove  Hospital, 
then  a  hospital  for  freedmen—  suffering  with  Bright's  disease  of  the  kidneys.     Having  noticed  considerable  shortening  of  the  right  leg,  with  in 
of  the  foot,  I  enquired  if  he  had  had  fracture  of  the  thigh  ;  he  replied  that  he  had  been  in  the  army,  and  was  shot  by  a  Confederate  sharpshooter 
stationed  in  an  apple  tree,  the  ball  passing  just  below  and  through  the  hip  joint.     The  wound  had  healed  perfectly,  and  he  possessed  some  motion  in  the 
joint.     There  was  no  reason  for  surgical  interference  at  that  time.    After  his  death,  which  occurred  a  few  weeks  subsequently,  I  made  a  post-mortem  exam 
ination,  removing  the  head  of  the  femur,  which  I  found  had  been  fractured  within  the  capsule,  and  recovered  with  perfect  bony  union.    As  well  as  I 
remember,  the  bone  bore  plainly  on  its  surface  the  track  of  the  ball.     The  specimen  was  removed  and  given  to  you,  and  sent  by  you  to  the  Medical 
Museum.     I  could  not  obtain  from  the  man.  who  was  an  ignorant  negro,  a  clinical  history  of  the  case." 


pl(j_  10._Cbronic  traumatic  artlrritis  of  the  right  hip  joint  following  a  shot  injury, 
with  secondary  suppurative  transformations  which  ultimately  eventuated  in  recovery. 

pec'  °*    ' 


the  anterior  part  of  the  neck  a  considerable  projection  is  seen,  a  true  exostosis  of  irregular  surface,  perfectly  isolated  by  a  line  of  demarcation  fr< 
rest  of  the  Done.     This  tissue  was  at  that  point  very  red  and  vascular.     On  the  surface  of  the  head  of  the  femur  is  found  a  mult: 
aginous  vegetations,  some  of  which,  narrow  at  their  base,  might  have  ultimately  detached  themselves  and  fallen  as  foreign  be 
cavity.     In  spots  the  diartnrodial  cartilage  is  ossified  abnormally.     On  the  specimen  a  condensation  or  kind  of  concentric  hypa^rophy  of 
femur  is  observed  in  the  section,  while  the  lower  part  of  the  head  of  the  bone  presents,  on  the  contrary,  an  atrophic  rarefaction  of 
therefore,  an  unequally  distributed  process  of  osteo-cartilaginous  new  formation,  of  atrophic  absorption,  and  of  ossification  of  the  norma 


28  INJURIES    OF    THE    LOWEK    EXTREMITIES.  [CHAP.  X. 

Abstracts  of  six  of  the  seven  fatal  cases  of  secondary  arthritis  from  peri-articular  shot 
wounds  of  the  hip  are  published1  in  the  oft-cited  Circular  2.  The  following  is  the  seventh: 

CASE  57. — Private  C.  M.  BlacTcweldcr,  Co.  A,  52d  North  Carolina,  was  wounded  at  Gettysburg,  July  2,  1863,  and 
admitted  to  hospital  at  Chester  about  three  weeks  afterwards.  Surgeon  E.  Swift,  U.  S.  A.,  reported:  ''Gunshot  wound,  followed 
by  a  dissecting  abscess  involving  the  head  of  the  femur  and  its  ligaments.  The  patient  died  of  pyaemia,  September  21,  1863. 
1\\epjst- mortem  showed  inflammation  of  the  arachnoid  membrane  with  serous  effusion,  also  effusion  of  serum  in  the  other  serous 
membranes,  and  twelve  ounces  of  pus  in  the  left  pleura." 

Of  peri-articular  shot  wounds  of  the  Knee  Joint,  three  hundred  and  fifty-one  cases 
were  reported.  It  would  appear  that  of  two  hundred  and  fifty-five  of  these  cases,  accord 
ing  to  the  evidence  available,  the  articular  capsule  of  the  knee  joint  was  directly  involved 
without  fracture,  and  that  in  ninety-six  cases  the  projectiles  did  not  injure  the  joint,  which 
was  opened  by  secondary  traumatic  arthritis.2  Of  the  aggregate  of  the  three  hundred  and 
fifty-one  cases,  ninety-eight  or  27.9  per  cent,  had  a  fatal  termination.  Three  hundred  and 
thirteen  cases  were  treated  without. operative  interference  and  thirty-eight  were  followed 
by  amputation.  The  latter  will  be  enumerated  in  the  tabular  statements  of  amputations 
fallowing  shot  flesh  wounds  of  the  lower  extremities.  Of  the  three  hundred  and  thirteen 
cases  treated  without  operative  interference,  two  hundred  and  forty-four  recovered  and 
sixty-nine  or  22  per  cent,  proved  fatal. 

In  the  following  two  cases  of  recovery  the  joint  appeared  to  be  directly  injured.  The 
patients  recovered  with  considerable  use  of  the  limbs : 

CASE  58. — Private  A.  Parker,  Co.  K,  5th  Maine,  aged  18  years,  was  reported  by  Surgeon  C.  S.  Tripler,  U.  S.  A.,  as 
having  received  a  "bullet  wound  of  the  left  knee"  at  the  battle  of  West  Point,  May  7,  1862.  Surgeon  A.  B.  Mott,  U.  S.  V.,  in 
charge  of  the  Ladies'  Home  Hospital,  New  York  City,  recorded  the  following  description  and  result  of  the  injury:  "A  musket 
ball  entered  the  left  knee  joint  at  the  junction  of  the  tibia  and  fibula,  passed  through  the  joint,  and  emerged  at  the  inner  edge  of 
the  internal  hamstring.  Bleeding  occurred  freely  for  about  forty-five  minutes  and  then  ceased  spontaneously.  The  pain  after 
the  wound  was  very  severe.  On  the  day  following  a  consultation  of  surgeons  was  held,  when  it  was  thought  amputation  would 
bo  necessary;  but  the  operation  was  postponed.  Two  days  after  he  went  to  Fort  Monroe,  where  he  remained  until  May  25th, 
when  he  came  to  this  hospital.  While  at  Fort  Monroe  he  suffered  considerable  pain  for  six  days  after  the  receipt  of  the  injury, 
and  cold-water  dressings  constituted  the  entire  treatment,  with  perfect  quiet  of  the  limb.  When  admitted  here  the  leg  and  foot 
were  badly  swollen;  discharge  slight  and  watery;  orifice  of  exit  closed.  The  external  wound  was  attacked  with  gangrene,  and 
a  deep  slough  came  away.  Charcoal  poultices  were  used,  and  creasote,  and  the  wound  stuffed  with  pulverized  cinchona.  After 
the  slough  came  away  there  was  some  synovitis,  and  tincture  of  iodine  was  applied  for  several  weeks.  The  general  treatment 
was  tonic  and  sustaining ;  porter  and  ale  were  taken  occasionally  but  not  regularly.  September  5th,  wound  has  healed  with  a 
good  cicatrix.  There  is  stiffness  in  the  knee  which  is  gradually  improving.  Treatment :  cold  douche,  passive  motion  and 
careful  uso  of  the  limb.  Patient  has  used  crutches  and  afterwards  a  cane,  but  now  uses  neither.  December  30th,  the  knee  can 
be  flexed  to  but  little  more  than  a  right  angle  and  is  very  straight.  Patient  walks  without  a  limp,  and  there  is  very  little  weak 
ness  in  the  limb.  He  has  been  on  guard  duty  for  more  than  two  months."  This  man  was  assigned  to  the  Veteran  Reserve 
Corps  November  27,  1883.  He  is  not  a  pensioner. 

cit,,  p.  603.  In  many  respects  this  specimen  closely  resembles  that  of  McGee,  which  is  represented  in  FlGUUE  10,  and  in  the  heliotype  print,  PLATE 
LVI,  Med.  and  Surg.  Hist,  of  the  War  of  the  Rebellion,  Part  III,  Vol.  II,  op.  page  27.  In  the  specimen  in  the  Army  Medical  Museum  there  is  more 
extensive  ossification  of  the  cartilage  at  the  rim  of  the  acetabulum,  and  the  neighboring  osseous  surfaces  are  more  densely  studded  with  osteophytes. 
The  atrophic  rarefaction  and  absorption  are  more  pronounced  at  the  inferior  portion  of  the  head,  giving  rise  to  the  appearance  which  was  mistaken  for  a 
groove  made  by  a  ball.  On  such  lesions  consult  further  CAUL  ROKITAXSKY,  Lehrbuch  der  Patliologisclien  Anatotnie,  Dritte  Umgearbeitete  Auflage, 
Wien,  1836,  B.  II,  S.  205. 

1  Circular  No.  2,  S.  G.  O.,  18C9,  op.  cit.,  pp.  92,  94.  The  six  published  cases  are:  CASE  187.  Pt.  J.  Delaney,  51st  New  York,  wounded  at  Antietam, 
Sept.  17,  1862;  matter  burrowed  about  the  left  hip  joint,  and  the  thin  part  of  the  acetabulum  was  perforated.  Dr.  WILLIAM  M.  NOTSOX  reported  his 
case  and  death,  Dec.  24,  18J2. — CASK  198.  Pt.  O.  J.  Dunn,  18th  Mississippi,  was  struck  at  Antietam,  Sept.  17,  1862.  Secondary  involvement  of  the  head 
of  the  left  femur,  from  which  he  died  June  19,  1803.  A  wood-cut  of  the  specimen  is  reproduced  in  the  Circular. — CASE  189.  Pt.  A.  Hall,  1st  Cavalry, 
was  wounded  in  Louisiana,  Sept.  27,  1865,  the  ball  penetrating  ultimately  into  the  hip  joint  of  the  left  side.  Death,  January  12,  1860,  Asst.  Surgeon  A. 
HAUTSUFF,  U.  S.  A.,  having  reported  the  case. — CASE  194.  Serg't  C.  M.  Scovil,  14th  Connecticut,  wounded  May  12,  18IJ4,  received  a  musket  contusion 
of  the  left  hip  joint.  He  died  July  14,  1864,  as  reported  by  Surgeon  T.  R.  SPEXCER,  U.  S.  V. — CASE  195.  Lieut.  J.  G.  Seldon,  2d  Cavalry,  received 
July  3,  1863,  at  Gettysburg,  a  wound  of  the  left  thigh  in  the  vicinity  of  the  hip.  The  hip  joint  became  involved  secondarily.  He  died  Sept.  17,  1863. 
Asst.  Surgeon  R.  F.  WEIR  reported  the  case. — CASE  198.  Serg't  C.  B.  Wheeler,  81st  Indiana,  received  a  shot  wound  of  the  left  hip  joint,  near  Atlanta, 
August  8,  1864.  The  injury  soon  affected  the  articulation,  and  Surgeon  M.  S.  SlIEHMAX,  9th  Indiana,  reports  that  he  had  profuse  suppuration,  and  died 
October  7,  1864. 

2HKINE  (C)  (Die  ScUussverletzungen  der  unleren  Extremitdten,  Berlin,  1866,  p.  58)  observes:  "Shot  wounds  of  the  soft  parts,  in  which,  secondarily, 
suppuration  of  the  .joint  resulted  from  the  breaking  down  of  the  tissues  surrounding  the  shot  channel,  especially  at  the  knee  joint,  were  not  very  rare, 
while  at  the  hip  joint  we  only  observed  a  solitary  but  very  remarkable  case  of  this  kind."  KlRCIIXKR  (C.)  (Aerztlicher  Dericltt  iiber  das  KiJniglich 
Frev'?ische  Feld-Lazareth  im  Palast  zu  Versailles,  Erlangen,  187..',  p.  86)  tabulates  27  injuries  of  the  soft  parts  of  the  knee  joint ;  but  does  not  give  the 
results.  ARNOLD  (J.)  (Anatomische  Beitrdge  zu  der  Lehre  von  den  Scfiussiounden,  Heidelberg,  1873,  pp.  123,  124)  gives  details  of  2  cases  of  shot 
wounds  of  the  knee  joint,  in  which,  at  the  autopsies,  the  bones  of  the  joint  were  found  uninjured. 


SECT.  I.]  PERI-ARTICULAR   WOUNDS.  29 

CASE  59. — Private  G.  Deacon,  Co.  G,  14th  Virginia  Cavalry,  aged  25  years,  was  wounded  at  Boonesboro',  July  8,  1863, 
and  admitted  to  the  Cavalry  Corps  Hospital.  Surgeon  S.  B.  W.  Mitchell,  8th  Pennsylvania  Cavalry,  noted  a  "flesh  wound  at 
the  knee  joint."  One  week  after  the  reception  of  the  injury  the  wounded  man  was  transferred  to  hospital  at  Frederick,  whence 
Acting  Assistant  Surgeon  W.  S.  Adams  reported  the  following  history:  "He  was  wounded  by  a  spent  bull,  which  entered  on 
the  outer  lateral  surface  of  the  right  knee,  passing  inward  and  forward,  striking  the  patella  and  lodging.  The  patient  worked 
the  ball  out  with  his  finger  on  the  field.  By  examination  I  find  no  evidence  of  the  ball  having  entered  the  cavity;  the  joint  can 
be  moved  without  pain,  and  there  is  no  evidence  of  effusion.  Simple  dressings  were  ordered  to  the  wound.  On  July  25th  the 
external  opening  had  closed  and  an  abscess  was  forming  at  the  point  of  lodgement  of  the  ball.  Enlarged  the  external  opening 
so  as  to  communicate  with  the  abscess,  whea  about  a  half  ounce  of  pus  escaped,  but  no  synovial  fluid,  although  there  was 
evidence  of  the  joint  being  involved,  but  perhaps  not  communicating  with  the  opening.  On  the  following  day  the  swelling  of 
the  joint  was  more  extensive  and  fluctuation  well  marked.  Tincture  of  iodine  was  then  ordered  to  be  applied  to  the  joint  twice 
a  day,  and  the  limb  was  placed  in  Smith's  anterior  splint.  On  August  10th  the  wound  had  nearly  healed,  effusion  within  the 
joint  had  almost  entirely  subsided,  and  the  patient  was  comfortable.  By  August  20th  the  wound  was  entirely  healed;  appearance 
of  joint  jiatural.  Considerable  anchylosis  existed,  partly  owing  perhaps  to  deposit  and  partly  to  long  continuance  in  one 
position.  About  a  week  later  the  splint  was  removed,  and  afterwards  passive  motion  was  resorted  to  without  producing  much 
pain  or  tenderness.  On  September  5th  the  patient  was  transferred  to  Baltimore,  having  considerable  and  daily  increasing 
motion  of  the  knee."  He  was  paroled  from  West's  Buildings  Hospital  on  September  25,  1863. 

Then  follow  three  fatal  cases  of  direct  shot  injury  involving  the  cavity  of  the  knee 
without  lesion  of  the  osseous  surfaces: 

CASE  60. — Private  J.  Wagoner,  Co.  F,  116th  Pennsylvania,  aged  23  years,  was  wounded  at  Petersburg,  June  22,  1864, 
and  admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps,  where  Surgeon  D.  II.  Houston,  2d  Delaware,  recorded: 
"Flesh  wound  of  left  thigh  by  a  minid  ball."  Surgeon  G.  L.  Pancoast,  U.  S.  V.,  contributed  the  pathological  specimen  (Cat. 
Sury.  Sect.,  1866,  p.  333,  Spec.  3260)  with  the  following  notes  of  the  case:  "The  patient  entered  Finley  Hospital,  Washington, 
July  1st,  with  shot  wound  through  left  knee  joint.  The  bone  was  not  injured.  He  died  July  17, 1864.  Two  days  before  death 
signs  of  pneumonia  presented  themselves.  An  autopsy  was  made  by  Acting  Assistant  Surgeon  G.  H.  Hopkins,  who  found 
extensive  inflammation  extending  all  around  the  joint  and  its  neighboring  parts.  The  femur  and  tibia  were  denuded  of  cartilage 
around  the  edges.  In  the  cavity  of  the  thorax  there  was  considerable  pleuritic  adhesion,  with  effusion  of  thick  pus,  the  lungs 
themselves  being  very  much  congested  and  hepatized — in  fact,  the  lungs  were  diseased  throughout  their  entire  extent.  There 
was  also  effusion  both  in  the  pleura  and  pericardium."  The  specimen  consists  of  the  bones  of  the  injured  knee  joint. 

CASK  61. — Private  E.  Dolan,  Co.  D,  5th  U.  S.  Cavalry,  aged  21  years,  was  wounded  at  Gaines's  Hill, 
June  27,  1862.  Acting  Assistant  Sui-geon  R  P.  Thomas  contributed  the  pathological  specimen  (Cat.  Sury. 
Sect.,  18G6,  p.  333,  Spec.  227),  with  the  following  description:  "The  patient  was  wounded  by  a  bullet,  which 
entered  on  the  outside  of  the  left  knee  joint  opposite  its  lower  portion,  and  made  its  exit  at  the  inside  of  the 
popliteal  region,  nearly  on  a  horizontal  line  with  the  wound  of  entrance.  He  was  admitted  to  the  Episcopal 
Hospital,  Philadelphia,  July  30th,  and  died  on  September  30,  1862.  During  this  period  he  was  in  a  very  low 
condition,  the  wounds  and  abscesses  in  the  neighborhood  of  the  joint  discharging  profusely  the  greater  part  of 
the  time;  he  also  suffered  from  diarrhoea.  An  autopsy,  performed  a  few  hours  after  death  by  Acting  Assistant 
Surgeon  R.  P.  Thomas,  showed  "loss  of  cartilage,  and  ulceration  of  the  heads  of  the  femur,  tibia,  and  fibula, 
with  extension  of  the  disease  on  the  posterior  aspect  of  the  femur  and  between  the  heads  of  the  tibia  and 
fibula.  There  was  also  ulceration  of  the  posterior  face  of  the  patella  and  abscesses  in  the  soft  parts."  The 
specimen  (FlG.  11)  consists  of  the  bones  of  the  knee.  The  age  of  the  patient  is  perhaps  overstated.  The 

epiphyses,  both  in  the  tibia  and  fibula,  were  not  united,  and  the  real  age  was,  probably,  under  20;  possibly  did     ylf;  n Bones  of 

not  exceed  19  years  of  age.  left  knee.  Sp.227. 

CASE  62. — Private  U.  Conn,  Co.  M,  12th  Pennsylvania  Cavalry,  aged  28  years,  was  wounded  during  a  cavalry  skirmish 
at  Frederick,  July  10,  1864,  and  was  admitted  to  hospital  the  same  day.  Acting  Assistant  Surgeon  J.  II.  Bartholf  reported: 
"He  was  wounded  in  the  right  knee  joint  by  a  pistol  ball.  The  missile  entered  at  the  knver  inner  edge  of  the  patella,  and  I 
removed  it  from  the  joint,  having  put  in  my  finger  between  the  femur  and  tibia  after  enlarging  the  wound  to  feel  the  ball.  There 
was  no  fracture  of  any  bone.  On  consultation,  it  was  determined  to  try  to  save  the  i  mb.  The  joint  was  freely  opened  and  local 
antiphlogistic  treatment  was  employed.  Great  pain  and  swelling,  for  a  few  days  only,  ensued,  with  but  slight  irritative  fever  at 
any  time,  and  the  pulse  for  weeks  ranged  from  85  to  95.  Sometimes  for  a  fortnight  at  a  time  he  had  a  really  good  appetite;  this 
notwithstanding  that  extra  capsular  abscesses  appeared  early  and  continued  throughout  to  discharge  much;  at  other  times  he 
was  in  a  precarious  condition.  He  \vas  placed  on  a  water-bed,  being  thin  in  flesh  on  admission  and  soon  troubled  with  bed-sores. 
About  a  month  before,  his  death  there  was  some  cough.  He  sank  very  gently,  and  died  October  14,  1864.  The  post-mortem 
examination  revealed  the  recovery  from  the  joint  wound  by  obliteration  of  its  cavity  and  bony  anchylosis,  which  was  not  so  firm, 
however,  but  that  accidental  violence  partly  broke  it.  The  crucial  ligaments  were  still  undestroyed.  There  was  one  vast  abscess 
from  the  knee  to  the  groin  encircling  the  femur,  and  another  four  inches  long  from  the  knee  downward — neither  of  them  com 
municating  with  the  joint.  He  had  gray  hepatization  (pneumonic)  of  two-thirds  of  the  middle  lobe  of  the  right  lung,  all  the 
rest  of  the  lungs  being  healthy.  The  heart  was  very  small  and  its  weight  six  ounces.  All  the  other  organs  were  healthy." 

In  the  three  following  cases  the  projectile  did  not  open  or  enter  the  knee  joint,  and 
the  involvement  of  the  articulation  was  secondary  in  its  nature: 

CASE  63. — Private  E.  Williams,  Co.  E,  5th  Michigan  Cavalry,  aged  26  years,  was  wounded  during  the  engagement 
at  Shepherdstown,  August  26,  1864.  Acting  Staff  Surgeon  N.  F.  Graham  reported  his  admission  on  the  day  of  the  injury  to 


30  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  X. 

the  field  hospital  at  Sandy  Hook  with  "shot  wound  of  right  thigh,"  and  his  transfer  to  Frederick  two  days  afterwards. 
Acting  Assistant  Surgeon  J.  C.  Shinier,  from  the  latter  hospital,  made  the  following  report  of  the  case :  "  He  was  wounded 
by  a  fragment  of  a  shell,  which  lodged  in  the  external  muscles  of  the  lower  third  of  the  thigh  in  close  proximity  to  the  bone. 
It  was  extracted  on  the  field  through  the  opening.  Upon  admission  the  patient's  general  condition  was  good.  He  experienced 
no  pain  whatever  from  the  injury.  Suppuration  was  going  on  finely  and  everything  indicated  a  speedy  recovery.  The  wound 
was  thoroughly  examined  with  the  finger  and  a  sinus  found  leading  in  the  direction  of  the  knee,  but  not  into  the  joint.  Sep 
tember  15th,  patient  complains  of  slight  pain  and  tenderness  in  knee.  The  discharge  has  nearly  subsided  and  the  wound  is 
healing.  I  enlarged  the  opening  so  as  to  allow  free  vent  for  the  pus.  Tincture  of  iodine  is  directed  to  be  applied  every  other  day. 
September  25th,  for  the  last  few  days  there  has  been  some  general  derangement  of  the  whole  system ;  appetite  somewhat  impaired ; 
pulse  excited;  bowels  irregular.  The  knee  is  still  painful,  especially  upon  pressure,  and  the  discharge  is  the  same  in  quantity. 
Ordered  fifteen  drops  of  tincture  of  iron  three  times  a  day,  with  a  half  pint  of  milk-punch,  a  poultice  of  flaxseed  meal  to  be 
applied  around  the  joint,  and  the  limb  to  be  kept  at  rest.  September  30th,  no  change  in  the  general  condition.  The  discharge 
of  pus  has  ceased,  but  a  thin  oily  looking  material,  resembling  synovia,  constantly  exudes  from  the  small  opening  that  remains 
at  the  entrance  of  the  wound.  October  10th,  patient  has  been  doing  well  until  to-day;  is  very  restless;  pulse  accelerated  to 
128;  appetite  very  moderate;  complains  of  excruciating  pain  in  the  knee.  The  wound  has  healed  externally.  Tonics,  stimu 
lants,  and  generous  diet  are  continued;  one  pill  of  opium  is  given  four  times  a  day,  and  blisters  are  applied  over  the  joint. 
October  20th,  patient  has  received  considerable  relief  from  the  blisters.  The  blistered  surface  having  healed  on  October 
25th,  I  directed  them  to  be  reapplied  and  the  surface  to  be  kept  excoriated  by  an  ointment  of  Goulard's  cerate  and  powdered 
cantharides.  The  other  treatment  was  continued.  28th,  pulse  113 ;  suffers  but  little  pain  in  knee,  and  feels  quite  encouraged. 
An  opium  pill  is  given  at  bedtime.  30th,  pulse  110;  appetite  improving;  bowels  regular;  tongue  clean;  knee  of  its  original 
size  and  no  pain  on  pressure.  November  10th,  general  health  rapidly  improving;  the  ointment  is  discontinued.  November 
18th,  walks  about  the  ward  with  a  splint  adjusted  to  favor  the  knee  and  keep  it  at  rest;  general  health  excellent.  On  Decem 
ber  1st  the  tonics  and  stimulants  were  discontinued  and  the  splint  removed  from  the  limb ;  the  knee  is  anchylosed,  and  no 
passive  motion  is  made  for  fear  of  exciting  inflammation.  On  December  21st  the  patient  received  a  fall,  the  entire  weight  of 
the  body  resting  for  the  time  on  the  injured  limb.  He  was  directed  to  be  confined  to  bed,  the  limb  to  be  kept  at  rest,  and 
iodine  to  be  applied  over  the  knee;  parts  painful.  December  24th,  doing  well;  no  constitutional  disturbance.  December  29th, 
pain  and  swelling  subsided;  patient  on  crutches  again.  January  10,  1865,  patient  transferred  to  Michigan."  Assistant 
Surgeon  D.  O.  Farrand,  U.  S.  A.,  reported  that  the  man  was  discharged  from  Harper  Hospital,  Detroit,  May  26,  1865,  by 
reason  of  "anchylosis  of  the  knee  joint,  produced  by  the  wound."  Williams  is  a  pensioner,  and  has  been  reported  by  various 
examiners  as  suffering  from  "complete  anchylosis  of  the  right  knee  joint."  He  was  paid  June  4,  1876. 

CASE  64. — Private  T.  G.  Scott,  Co.  13,  54th  North  Carolina,  aged  45  years,  was  wounded  at  Harper's  Farm,  April  6, 1865, 
and  admitted  to  the  field  hospital  of  the  3d  division,  Second  Corps.  Surgeon  O.  Everts,  20th  Indiana,  noted, 
"shot  flesh  wound  of  left  knee."  From  the  field  hospital  the  wounded  man  was  transferred  to  City  Point, 
and  thence,  on  April  22d,  to  the  West's  Buildings  Hospital,  Baltimore.  Acting  Assistant  Surgeon  A.  Kess- 
ler  contributed  the  specimen,  represented  in  the  annexed  wood-cut  (FlG.  12),  with  the  following  descrip 
tion  :  "A  mini6  ball  passed  through  the  left  leg  just  below  the  knee  joint,  implicating  the  joint  but  not  laying 
it  open.  The  leg  became  much  swollen  and  discolored,  and  from  the  openings  flowed  a  quantity  of  what 
appeared  to  be  arterial  blood.  Soon  after  the  patient's  admission  there  appeared  severe  constitutional 
symptoms :  rigors  followed  by  high  and  continued  fever,  delirium,  extreme  nervousness,  much  prostration, 
constant  vomiting,  and  sleeplessness.  Amputation,  which,  at  an  earlier  period,  might  have  saved  his  life, 
was  then  pronounced  impracticable,  and  the  patient  died  with  symptoms  of  pyzemia,  May  4,  1865.  A 
post-mortem  examination  of  the  limb  revealed  the  fact  that  the  tissues  above  and  below  the  joint,  the 
muscles,  fascia,  etc.,  were  a  gangrenous  mass,  and  that  the  greater  portion  of  the  joint  itself  was  divested 

FIG.  12.— Caries  of  left     °f  ^ts  periosteum  and  rapidly  assuming  the  character  of  caries.     Otherwise  the  joint  was  found'to  be  intact, 

knee  joint.    Spec.  4205.     exhibiting  no  fracture." 

CASE  65. — Private  W.  P.  Werden,  Co.  K,  34th  Massachusetts,  aged  20  years,  was  wounded  at  New  Market,  May 
15,  1864.  Surgeon  J.  V.  Z.  Blaney,  U.  S.  V.,  reported  his  injury  as  "a  shot  wound  of  the  knee."  Acting  Assistant 
Surgeon  J.  H.  Bartholf  contributed  the  following  history  from  the  General  Hospital  at  Frederick :  "  The  patient  was  ad 
mitted  here  May  25th,  from  the  post  hospital  at  Martinsbui-g,  with  a  flesh  wound  ol  the  left  leg  near  the  knee,  caused  by  a  mini6 
ball.  The  missile  entered  a  half  inch  below  the  patella,  between  it  and  the  tuberosity  of  the  tibia,  directly  over  the 
quadriceps  extensor  tendon,  and  lodged  superficially  just  under  the  skin,  whence  it  was  extracted  the  same  day.  lie  was 
removed  in  an  ambulance  sixty  miles  to  Martinsburg.  The  joint  soon  became  inflamed  and  swollen,  and  remained  so  until  his 
admission  here.  Water  dressings  had  been  applied.  I  found  the  joint  inflamed  and  very  much  distended,  probably  with 
synovia  or  a  collection  of  pus,  over  the  tendon  of  the  quadriceps.  A  counter-opening  was  made  at  the  lowest  part  of  this,  and 
evaporating  lotions  applied,  on  the  29th  of  May.  On  the  1st  of  June  the  patient  was  somewhat  better.  June  4th,  ice  applied 
to  the  knee.  June  llth,  patient  has  made  very  rapid  and  great  improvement,  so  that  the  synovitis  is  nearly  gone  and  the 
abscess  is  almost  healed;  but  there  is  communication  with  the  knee  joint  from  the  abscess,  a  minute  orifice  having  been  made 
by  ulccration  apparently,  through  which  healthy-looking  synovia  has  been  flowing  in  small  quantities  for  a  couple  of  days. 
There  is  no  constitutional  trouble.  June  12th,  no  more  synovia  comes  out.  June  17th,  patient  is  permitted  to  get  out  of  bed 
and  walk  a  little.  July  4th,  has  gone  on  very  favorably  to  this  time,  walking  with  a  cane.  Is  now  transferred  to  Baltimore." 
After  this  date  the  patient  was  treated  in  hospital  at  Annapolis  until  September  13,  1864,  when  he  was  returned  to  duty.  The 
Adjutant  General  of  Massachusetts  reports  that  the  man  was  mustered  out  June  30,  1865.  He  is  not  a  pensioner. 

Of  thirty-eight  recorded  instances  of  lesions  of  the  knee  joint  without  injury  to  the 


SECT.  i.j  PERI-ARTICULAR    WOUNDS.  31 

articular  surfaces,  followed  by  amputation,  twenty-nine  or  76.3  per  cent,  were  fatal.  Two 
of  the  cases  will  be  detailed,  and  all  will  be  enumerated  in  the  tables  of  amputation  at 
the  end  of  this  section: 

CASE  66. — Lieutenant  J.  A.  Boies,  Co.  H,  13th  Infantry,  aged  22  years,  was  wounded  in  the  assault  on  Vicksburg, 
May  22,  1863.  He  was  admitted  on  a  hospital  transport  and  conveyed  to  Memphis,  whence  he  was  admitted  to  the  Marine 
Hospital  at  Chicago  on  June  8th.  Acting  Assistant  Surgeon  R.  N.  Isham  reported:  "He  was  struck  upon  the  outer  side 
of  the  left  knee  by  a  cannon  shot  from  a  distance  of  about  two  miles.  The  ball  probably  only  glanced  over  the  surface,  for 
there  was  the  merest  trifling  appearance  of  a  redness,  but  no  wound  or  bruise  upon  the  surface.  Amputation  at  the  upper  third 
of  the  thigh  was  performed  on  June  18th,  and  death  resulted  June  28,  18G3,  from  pyaemia.  A  frequent  pulse,  brown  tongue, 
anxious  expression  of  the  face,  and  diarrhoea  indicated  the  existence  of  the  poison  on  admission.  The  strongest  symptom,  that 
of  profuse  discharges  from  the  bowels,  almost  involuntary,  and  of  a  color,  smell,  and  consistency  of  the  discharge  from  the 
stump,  together  with  the  sickening  sweetish  odor  of  the  perspiration  and  chills,  indicated  the  invasion  of  the  disease  in  a  marked 
manner  on  the  night  of  the  18th.  The  treatment  was  by  iron,  quinine,  and  stimulants.  Scrupulous  attention  was  given  to  the 
stump,  removing  all  soiled  dressings  three  times  a  day  and  injecting  the  wound  with  a  solution  of  bromine  and  occasionally 
with  tincture  of  myrrh  and  balsam  pern.  This  pai'tially  succeeded  in  correcting  its  unhealthy  appearance  and  producing  the 
secretion,  for  a  short  time,  of  good-looking  pus.  There  never  was  any  attempt  at  healing  in  th«  wound,  the  edges  of  which 
looked  like  'cut  edges  of  pork.'  The  discharge  from  the  wound  was  of  a  dark-colored  thin  offensive  character.  There  was  no 
sloughing  or  gangrene.  The  system  seemed  to  make  great  efforts  to  eliminate  the  poison,  as  evidenced  by  the  profuse  per 
spiration  and  diarrhoea.  The  blood  seemed  to  part  with  its  serum  easily.  No  clot  was  formed  in  the  stump,  and  late  in  the 
progress  of  the  dis-ease  the  discharge  consisted  of  altered  blood.  The  pulse  during  the  case  was  from  130  to  150.  No  post 
mortem  was  allowed  by  his  friends,  but  the  sudden  invasion  of  pain  in  the  joints,  a  swelling  of  the  knee  and  fluctuation, 
satisfied  me  that  pus  had  formed  in  the  synovial  cavity." 

CASE  67. — Sergeant  G.  A.  Dyer,  Co.  G,  6th  Maine,  aged  21  years,  was  wounded  at  Rappahannock  Station,  November 
7,  1863,  and  was  admitted  to  Armory  Square  Hospital,  Washington,  two  days  afterwards.  Surgeon  D.  W.  Bliss,  U.  S.  V., 
reported:  "A  mini6  ball  entered  four  inches  below  and  in  .line  with  the  trochanter  major  of  the  right  thigh,  took  a  down 
ward  and  inward  course,  and  could  not  be  found  on  admission  to  the  hospital.  On  November  29th, 
the  missile  was  extracted  from  the  popliteal  space;  suppuration  continued  free  and  of  good  char 
acter.  Two  weeks  subsequent  to  the  extraction  of  the  ball  a  bit  of  woolen  cloth  came  from  the 
lower  wound.  December  10th,  patient  was  allowed  to  get  up  and  move  about,  using  crutches. 
December  25th,  knee  joint  became  painful  and  continued  to  swell  from  this  date.  Under  iodine  the 
swelling  subsided  to  a  considerable  extent,  but  the  pain  continued;  suppuration  still  free  and  at 
times  thin  and  poor  in  character.  On  February  1,  1864,  synovial  fluid  was  observed  from  the  upper 
point  in  the  discharge;  pain  in  knee  joint  still  considerable  at  night,  and  leg  enlarged.  On  February 
19th.  the  thigh  was  amputated  above  the  coudyles  by  Hap  operation;  four  arteries  tied;  loss  of  blood 
small ;  patient  in  fair  condition  constitutionally.  On  opening  the  knee  joint  after  the  operation, 
erosion  of  the  cartilages  was  discovered,  and  an  abscess  below  the  knee  joint  communicating  with  it. 
February  22d,  patient  doing  well."  The  specimen  represented  in  the  adjacent  cut  (FlG.  13)  was 
contributed  by  Surgeon  Bliss,  and  consists  of  the  bones  of  the  knee  of  the  amputated  limb,  showing 
a  slight  deposit  of  callus  on  the  posterior  aspect  of  the  shaft,  apparently  due  to  the  irritation  set  up 
by  contact  with  the  ball  in  position.  The  patient  was  discharged  from  service  April  18,  1864,  and 
pensioned,  and  subsequently  furnished  with  an  artificial  limb.  In  his  application  for  commutation, 
dated  1870,  he  described  the  stump  as  being  in  a  sound  condition.  The  pensioner  was  paid  June  4, 
1876.  In  the  cut  only  a  portion  of  the  specimen,  which  consists  of  the  four  bones  entering  into  the  femu'r  studded  with  osteo- 
articulation,  is  represented.  The  amputation  was  done  at  the  middle  of  the  femur,  and  not  through  ^byte|04?er  shot  contusicra- 
the  lower  third  as  represented  in  the  cut. 

Of  peri-articular  shot  wounds  of  the  Ankle  Joint,  thirty-seven  cases  are  indicated  on 
the  records;1  but  the  evidence  in  regard  to  the  precise  nature  of  the  injury  may  be  termed 
unsatisfactory.  In  fifteen  cases,  of  which  one  proved  fatal,  no  operative  interference  was 
deemed  necessary.  In  the  remaining  twenty-two  cases  the  limb  was  amputated  at  the 
leg,  with  fatal  results  in  twelve  instances.  One  case  may  here  be  detailed;  all  the  cases 
of  amputations  of  leg  for  peri-articular  shot  wounds  of  the  ankle  joint  will  be  enumerated 
in  the  tables  of  amputations  following  shot  flesh  wounds  of  the  lower  extremities: 

CASE  68. — Corporal  E.  D.  Goodell,  Co.  D,  25th  Massachusetts,  aged  21  years,  was  wounded  at  Cold  Harbor,  June  3, 
1864.  Surgeon  S.  A.  Richardson,  13th  New  Hampshire,  recorded  his  admission  to  the  Eighteenth  Corps  field  hospital  with 
"shot  wound  of  right  ankle."  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported  the  result  of  the  injury  ao  follows:  "The  patient 
entered  the  Harewood  Hospital,  Washington,  June  10th,  with  shot  wound  of  right  foot  near  os  cak-is,  the  ball  severing  the 

1  The  records  of  shot  flesh  wounds  of  the  ankle  joint  without  injury  to  the  bones  are  very  meagre.  KlRCHNER  (C.)  (Aerztlfcher  Bericht  iiber  dot 
Koniglich  Preussische  FM-Lazareth  im  Palast  zu  Versailles.  Erlangen,  1872,  S.  86)  tabulates  8  cases  of  flesh  wounds  of  the  tibio-tarsal  articulation  but 
gives  no  results.  HELNE  (C.)  (Die  Schussverlelzungen  der  unteren  Extremitdten,  Berlin,  1860,  S.  5)  thinks  it  very  remarkable  that  not  a  single  case  of 
secondary  arthritis  following  "shot  wound  of  the  ankle  joint  without  lesion  to  the  bjiie  "  was  observed. 


32  INJUKIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

tendo-achilles.  On  admission,  he  was  very  weak.  The  parts  were  swollen  and  suppurating  freely,  and  became  subsequently 
gangrenous,  the  tarsal  and  metatarsal  bones  denuded.  An  operation  was  deemed  necessary,  and  performed  on  July  22d  by 
Acting  Assistant  Surgeon  13.  F.  Butcher,  who  amputated  the  leg  at  the  lower  third  by  the  circular  method.  Sulphuric  ether 
was  used.  The  patient  improved  after  the  operation,  and  was  furloughed  August  17th,  the  stump  looking  well."  The  bones 
of  the  amputated  ankle  were  contributed  to  the  Museum  by  the  operator,  and  constitute  specimen  3332  of  the  Surgical  Section. 
In  December  following  the  man  was  admitted  to  Dale  Hospital,  Worcester,  whence  Surgeon  C.  H.  Chamberlain,  U.  S.  V., 
reported  that  the  stump  assumed  a  large  suppurating  surface  with  several  sinuses  leading  to  diseased  bone,  and  that  on  February 
20,  18J5,  lie  removed  a  sequestrum  eight  inches  in  length  by  a  longitudinal  incision.  After  this  the  patient  was  reported  as 
having  made  excellent  progress,  and  the  stump  as  being  nearly  healed  on  March  31st.  He  was  ultimately  discharged  from  the 
Soldiers'  Rest,  at  Boston,  October  31,  1803,  and  pensioned.  The  pensioner  was  paid  March  4,  1877. 

Peri-articular  shot  wounds  of  the  joints  should  be  treated  at  the  outset  by  complete 
immobilization  of  the  articulation,  by  wire-cloth  splints,  or  plaster  bandages,  the  wound 
being  covered  with  simple  dressings  of  thick  compresses  saturated  with  cold  lotions.  The 
complications  are  to  be  cornbatted  as  they  arise. 

Complications  of  Shot  Flesh  Wounds  of  the  Lower  Extremities.— In  the  great  series 
of  58,702  shot  flesh  wounds  of  the  lower  limbs,  besides  the  groups  characterized  by  lesions 
to  the  principal  blood-vessels  and  nerves,  by  extensive  lacerations,  by  lodgement  of  foreign 
bodies  or  extension  of  inflammation  to  the  joints,  there  were  many  examples  of  compli 
cations  of  Pyaemia,  Gangrene,  Tetanus,  Erysipelas,  and  Haemorrhage.  A  certain  number 
of  cases  have  been  classified  in  each  of  these  categories.  The  reader,  however,  must  guard 
against  the  belief  that  this  class  of  cases  is  complete,  for,  as  explained  heretofore,  there 
was  neither  time  nor  clerical  assistance  for  an  exhaustive  search.  The  cases,  however, 
have  been  impartially  selected,  and  the  results  probably  present  a  fair  average. 

Pycemia. — Three  hundred  and  twenty-eight  cases,  of  which  three  hundred  and  twenty, 
or  97.5  percent.,  resulted  fatally,  were  found  recorded.  One  of  the  eight  cases  of  recovery 
will  be  detailed: 

CASE  69. — Private  S.  S.  Chase,  Co.  L,  1st  Maine  Cavalry,  aged  43  years,  was  wounded  at  Stony  Creek,  October  27, 
1864,  and  admitted  to  the  field  hospital  of  the  2d  division,  Cavalry  Corps,  where  Surgeon  F.  LeMoyne,  16th  Pennsylvania 
Cavalry,  noted:  "  Shot  flesh  wound  of  both  legs."  The  patient  was  moved  to  City  Point  on  the  following  day,  and  on  November 
14th  he  was  transferred  to  Washington.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  made  the  following  report:  "He  was  admitted  to 
Armory  Square  Hospital  with  wounds  of  the  right  thigh  and  left  leg.  The  first  ball  entered  the  thigh  posteriorly,  about  the 
junction  of  the  middle  and  upper  thirds,  passing  inward  and  a  little  downward,  and  emerging  on  the  inner  side  of  the  thigh; 
the  second  ball  entered  the  left  leg  on  the  posterior  aspect,  about  the  middle,  and  passed  directly  forward,  emerging  on  the  inner 
side,  one  and  a  half  or  two  inches  from  point  of  entrance.  The  patient  had  an  unhealthy  appearance  and  was  considerably 
emaciated  when  admitted,  the  wounds  discharging  a  very  thin  and  offensive  matter,  not  very  profusely.  On  November  26th, 
pyaemia  became  developed ;  patient  had  several  violent  chills,  which  were  repeated  on  the  following  days,  when  his  wounds 
became  dark  colored  and  dry  and  ceased  to  discharge,  and  he  grew  delirious.  From  this  period  quinine,  iron,  and  chlorate  of 
potassa  were  prescribed,  with  stimulants  and  the  most  nourishing  diet,  together  with  applications  of  creasote,  tannin,  and  solu 
tion  of  chlorate  of  patassa  to  the  wounds,  under  which  treatment  ho  gradually  improved.  At  present  (December  31st)  his 
wounds  are  about  healed  and  he  is  able  to  leave  his  bed,  being  greatly  improved  in  every  respect,  and  convalescent."  The  man 
was  discharged  from  service  March  24,  1805,  because  of  "permanent  contraction  of  the  gastrocnemius  muscle  of  the  left  leg, 
resulting  from  the  wound."  Examiner  J.  O.  Perry,  of  Portland,  Maine,  certified,  April  30,  1868,  that  "both  wounds  are  very 
tender;"  and  that  "the  wound  in  the  leg  so  far  involved  the  nerves  that  the  leg  below  it  and  the  foot  are  quite  numb."  The 
Portland  Examining  Board  reported,  in  ls-73  and  1875,  that  they  find  deep,  and,  on  the  left  leg,  adherent  scars,  with  considerable 
loss  of  tissues  in  both  wounds.  The  pensioner  was  paid  June  4,  1876. 

In  the  greater  proportion  of  the  fatal  cases,  although  the  ratio  of  mortality  was  so 
large,  necroscopic  appearances  were  not  recorded : 

CASE  70.— Sergeant  M.  Armstrong,  Co.  M,  6th  Cavalry,  was  wounded  at  Williamsburg,  May  4,  1862,  and  admitted  to 
the  Hygeia  Hospital,  Fort  Monroe,  five  days  afterwards,  when  Surgeon  R.  B.  Bontecou,  U.  S.  V..  noted  a  "shot  wound  of 
left  thigh."  Acting  Assistant  Surgeon  S.  J.  Radcliffe  contributed  the  following  history,  from  Hospital  No.  1,  Annapolis :  "  The 
ball  entered  the  external  aspect  and  posterior  of  the  upper  third  of  the  thigh,  passing  inward  and  downward,  and  emerged 
about  the  centre  of  the  middle  third.  The  patient  was  in  hospital  at  Fort  Monroe  about  ten  weeks,  when  he  rejoined  his 
regiment.  He  went  through  most  of  the  great  battles  and  skirmishes  until  Gettysburg,  in  July,  1863,  when  he  was  taken 
prisoner  at  Fairfield,  Penn.,  and  went  to  Richmond  via  Staunton,  arriving  there  on  July  20th.  He  was  paroled  and  left 
the  enemy's  lines  on  the  23d,  arrived  at  Annapolis  on  the  24th  and  at  Camp  Parole  on  August  2d,  and  entered  this  hospital 
September  20th.  He  states  that  the  leg  has  not  been  painful  except  in  cloudy  weather,  and  has  not  swelled,  and  that  his  health 


SECT,  i.]  COMPLICATED    SHOT    FLESH    WOUNDS.  33 

lias  been  good.  Prescribed  pills  consisting  of  quinine  one  and  a  half  grains,  and  blue  mass  and  capsicum  one  hnlf  grain  each, 
to  be  given  every  four  hours.  September  25th:  Had  a  chill  yesterday;  tongue  coated;  skin  dry;  pulse  quick;  conjunctiva 
yellow;  countenance  dejected  and  of  painful  expression;  great  lancinating  pain  in  leg;  nervousness;  bowels  irregular. 
Stopped  the  pills  and  gave  quinine  in  solution,  five  grains  every  six  hours.  September  '27th  :  Has  lost  flesh  during  last  week. 
Has  had  continued  fever,  and  the  leg  has  been  swelling  for  two  or  three  days  and  is  very  painful,  the  least  motion  being  painful; 
abscess  forming  between  the  former  orifices  of  the  wound  on  the  posterior  aspect ;  general  condition  unfavorable.  A  large 
flax  seed  poultice  was  applied  to  envelope  the  whole  thigh,  and  the  quinine  was  continued.  Patient  objects  to  taking  stimulants, 
find  takes  but  little.  October  1st,  A.  M.:  The  thigh,  from  the  groin  to  the  knee,  has  continued  to  enlarge  to  this  date,  with 
sharp  throbbing  pain,  sleeplessness,  depressed  nervous  condition,  deafness,  fever  of  a  low  type,  diarrhoea  and  loss  of  appetite; 
patient  quite  hectic,  pulse  quick,  and  cheeks  flushed;  abscess  pointing  at  the  eschar  or  orifice  of  wound  of  exit.  Made  an  in 
cision  from  one  to  five  inches  long,  and  a  full  stream  of  dark,  thin,  offensive  matter  followed,  amounting  to  nearly  two  pints; 
bathed  with  warm  water  and  vinegar,  and  continued  the  stimulants,  beef-tea  and  quinine,  with  an  occasional  dose  of  compound 
mixture  of  catechu.  5  P.  M.:  Patient  feels  better;  pulse  quick  and  feeble;  skin  in  good  condition;  tongue  cleaner;  bowels 
better.  Ordered  spirits  of  mindereri,  one  half  ounce,  to  be  given  alternately  with  the  other  medicine.  October  3d:  Abscess 
still  discharging  very  dark,  thin,  and  fetid  matter;  patient  very  prostrate;  emaciation  very  rapid  and  distinct.  Gave  stimu 
lants  freely  and  often.  October  3,  A.  M.:  Patient  very  feeble,  pale  and  thirsty;  pulse  quick  and  sharp ;  bowels  worse  ;  delirium 
most  of  the  night,  and  nausea 5  abscess  still  discharging;  leg  very  much  swollen  and  highly  sensitive;  sloughing  about  the 
wound.  Applied  charcoal  and  yeast  poultices,  and  gave  tincture  of  chloride  of  iron,  twenty-five  drops,  with  quinine  every  four 
hours.  3  P.  M.:  Pupils  contracted;  stupor;  pulse  120,  feeble,  sharp,  and  quick;  very  sensitive  to  touch;  bowels  more  invol 
untary;  leg  largely  infiltrated,  red  and  swollen,  and  pits  at  the  knee;  very  little  discharge  of  bloody  serum;  patient  sinking. 
Died  at  5.oO  A.  M.  on  October  4,  1883." 

An  example  of  the  series  of  fatal  cases  in  which  autopsies  were  made  is  subjoined. 
This  series  constitutes  seventy-three  of  the  three  hundred  and  twenty  cases. 

CASE  71. — Sergeant  D.  A.  Lent,  Co.  A,  6th  New  York  Heavy  Artillery,  aged  24  years,  was  wounded  at  Cedar  Creek, 
October  19,  18G4.  Surgeon  W.  A.  Barry,  98th  Pennsylvania,  noted  his  admission  to  the  Sheridan  Field  Hospital  with  "shot 
flesh  wound  of  right  leg."  Several  days  after  being  wounded  the  man  was  transferred  to  the  Camdeu  Street  Hospital,  Baltimore, 
and  subsequently  to  Rulison,  Annapolis  Junction,  whence  Acting  Assistant  Surgeon  A.  Marion  reported  the  following  history: 
"The  patient  was  admitted  to  this  hospital  January  4,  1865,  with  a  wound  of  the  right  leg,  middle  third,  a  minic  ball  entering 
on  the  anterior  aspect  one  inch  outside  of  the  tibia,  lodging  between  the  tibialis  anticus,  tibialis  posticus,  and  the  anterior  tibial 
artery.  When  admitted  the  wound  was  completely  healed  up,  but  the  leg  was  much  swollen  and  no  ball  could  be  detected. 
During  the  first  week  after  his  admission  the  patient  had  his  leg  rolled  up  with  a  bandage,  and  the  swelling  completely  disap 
peared.  He  became  able  to  walk  about  until  January  18th,  when  he  again  complained,  and  on  examination  I  found  the  leg 
again  much  swollen,  with  a  dark  spot  located  where  the  wound  first  healed  up.  After  this  fiaxseed  poultices  were  constantly 
applied  until  February  2d,  when,  on  opening  the  wound,  the  ball  was  carefully  removed  from  its  place  of  lodgement.  On  the 
two  days  following  the  operation  the  patient  had  a  severe  fever  and  chills,  with  extreme  pain  and  great  depression.  I  ordered 
eight  grains  of  calomel  with  ten  grains  of  rhubarb  to  be  taken  at  once,  followed  by  a  saline  aperient.  On  the  morning  after  the 
4th,  I  ordered  strong  beef-tea,  with  brandy,  to  be  taken  freely.  This  treatment  was  continued  until  February  7th,  with  some 
saline  draughts,  according  to  the  condition  of  the  bowels.  On  the  morning  of  the  8th,  I  found  the  patient  greatly  depressed  and 
complaining  of  extreme  pain  in  the  joints,  and  on  examining  the  wrists  and  the  left  shoulder  joint  T  discovered  them  to  be  very 
much  swollen,  with  a  peculiar  boggy  feel  to  the  touch.  All  these  symptoms  were  attended  with  rigors,  drowsiness,  yellowness 
of  the  skin,  and  offensive  perspiration,  sometimes  accompanied  with  delirium.  Poultices  were  applied  over  the  joints,  with 
warm  fomentations,  and  opium  was  given  to  relieve  the  pains  every  night.  The  treatment  was  continued,  but  no  amelioration 
whatever  of  the  symptoms  took  place,  the  patient  gradually  sinking  until  the  morning  of  February  15,  1865,  when  he  died. 
At  the  post-mortem,  an  abscess  was  found  in  the  upper  lobe  of  the  right  lung,  about  two  and  a  half  inches  long  and  two  inches  in 
width  and  depth,  filled  with  thick  pus.  Both  lungs  were  much  congested.  The  right  ventricle  of  the  heart  was  filled  with  a 
semi-organized  clot.  Kidneys  about  six  inches  long  and  four  inches  wide;  small  abscesses  were  found  in  the  cortical  portion  of 
each  one.  Pus  was  also  found  in  the  urethra.  Liver,  spleen,  pancreas,  stomach,  and  intestines  normal.  About  one  teaspoouful 
of  thick  fetid  pus  was  found  in  the  right  knee  joint,  and  about  half  as  much  in  the  right  wrist  joint.  There  was  no  pus  in  the 
ankle  joints." 

It  is  to  be  regretted  that  autopsies  were  not  more  generally  practised  in  cases  of  this 
group,  and  that  in  the  exceptional  cases  the  necroscopical  records  were  so  imperfect. 

Hospital  Gangrene. — The  shot  flesh  wounds  of  the  lower  extremity  that  were 
distinguished  by  the  supervention  of  hospital  gangrene1  numbered  two  hundred  and 
eighty-three,  with  one  hundred  and  fifty-eight  deaths,  or  55.8  per  cent.  Details  of  three 
cases  of  recovery  are  appended: 

CASE  72. — Private  W.  J.  Briggs,  Co.  A,  102d  Pennsylvania,  aged  27  years,  was  wounded  at  Chancellorsville,  May 
3,  1863.  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  in  charge  of  the  General  Hospital  at  Pittsburgh,  reported  the  following 

'In  Investigations  upon  the.  Nature,  Causes,  and  Treatment  of  Hospital  Gangrene  as  it  prevailed  in  the  Confederate  Armies.  ]8Gl-186.'i,  by  JosEni 
JONES,  M.  D.,  published  in  the  Surgical  Memoirs  of  the  War  of  the  Rebellion  collected  and.  published  by  the  U.  S.  Sanitary  Commission,  the  author  details 
many  illustrations  of  gangrenous  wounds  resulting  from  shot  wounds  of  the  lower  extremities.     Instances  may  be  found  in  the  San.  Comm.  Memoir, 
Surg.  Vol.  11,  pp.  234,  250,  310,  311,  315,  318,  3.J9,  331,  334,  337,  347,  375,  380,  388,  394,  399,  406,  411,  437. 
SURG.    HI— 5 


34  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

history:  "The  ball  passed  between  the  tibia  and  fibula,  about  the  middle  of  the  leg,  escaping  through  the  calf  opposite  the  point 
of  entrance.  The  patient  was  four  days  at  Falmouth  Hospital,  seven  days  at  Douglas,  Washington,  and  was  then  removed 
to  Sutterlee,  Philadelphia.  Seventeen  days  after  his  admission  to  the  latter  he  was  furloughed  and  came  to  Pittsburgh. 
The  wound  had  healed  at  its  entrance  and  was  still  discharging  at  its  exit,  but  was  considered  fit  to  travel  with.  He  had 
several  slight  chills  before  leaving  Philadelphia,  and  one  of  i\  more  severe  character  after  his  arrival  home,  followed  by  haemor 
rhage  from  the  posterior  wound,  which  was  arrested.  The  next  day  he  came  to  the  hospital.  The  wound  presented  the 
unmistakable  evidence  of  gangrene.  He  was  isolated,  and  nitric  acid  was  freely  applied  to  all  parts.  The  disease  was  found 
very  extensive,  involving  the  greater  part  of  the  calf  of  the  leg.  Poultices  of  charcoal  and  pyroligneous  acid,  etc.,  were  applied. 
The  constitutional  remedies  were  quinia,  muriated  tincture  of  iron,  stimulants,  beef-tea,  etc.  The  disease  was  checked,  and 
the  patient  is  (July  31st)  recovering  rapidly.  The  interest  in  this  case  is  the  distance  the  man  carried  the  contagion,  the 
great  rapidity  and  destructiveness  of  its  attack,  apparently  uninfluenced  by  the  comforts  of  a  good  home  and  the  best  of  food 
and  nursing/'7  The  patient  remained  in  the  hospital  until  September  3,  1864,  when  he  was  mustered  out,  his  term  of  service 
having  expired.  The  Pittsburgh  Examining  Boarxl  certified,  in  1873  and  1875,  that  there  was  wasting  of  the  gastrocnemius 
muscle  from  gangrene,  and  that  the  resulting  adhesions  have  impaired  the  action  of  that  muscle  and  cause  pain  in  the  ankle. 
The  pensioner  was  paid  June  4,  1876.  ' 

CASE  73. — Private  A.  W.  Bretz,  Co.  D,  49th  Ohio,  aged  23  years,  was  wounded  in  the  right  thigh,  at  Murfreesboro', 
December  31,  1862.  Surgeon  J.  R.  McClurg,  U.  S.  V.,  in  charge  of  the  General  Hospital  at  Cleveland,  contributed  the  follow 
ing  history:  ''The  ball  entered  upon  the  outer  and  posterior  aspect  of  the  limb,  passed  through  the  biceps,  semi-membra- 
nosus  and  semi-tendinosus  muscles,  and  out  upon  the  inner  side  of  the  thigh.  The  patient  was  in  Hospital  No.  21,  Nashville, 
about  ten  days,  after  which  he  was  sent  to  the  West-End  Hospital,  Cincinnati,  where  he  remained  over  three  months.  He 
says  his  limb  was  at  one  time  almost  healed,  but  it  soon  manifested  symptoms  for  the  worse,  and  afterward  discharged  consid 
erably  for  several  days.  He  was  forwarded  to  and  ai-rived  at  this  hospital  upon  the  evening  of  the  29th  of  April,  and  on  the 
30th  his  wound  was  examined  and  dressed.  At  this  time  we  found  a  ragged,  foul  ulcer  upon  the  back  part  of  the  limb,  where 
the  ball  entered,  about  one  and  a  half  inches  in  diameter,  surrounded  by  an  erysipelatous — or  a  halo  of  dusky  red — inflamma 
tion,  hard  and  painful  to  the  touch.  The  patient  was  feverish,  restless,  unable  to  sleep;  had  poor  appetite,  and  appeared  much 
prostrated.  He  complained  of  severe  shooting  pain  in  the  limb  and  of  the  disagreeable  odor  of  the  wound.  We  dressed  the 
wound  with  the  creasote  ointment  and  prescribed  a  tonic  treatment.  Some  three  days  afterwards  the  whole  integument  and 
cellular  tissue,  previously  inflamed  and  diseased,  became  one  putrid  mass  and  dropped  out,  leaving  a  large  cavity,  large  enough 
to  admit  the  whole  hand.  The  haemorrhage  at  this  time  was  considerable,  and  was  arrested  at  the  time  by  applying  the  pure 
creasote  to  the  whole  bleeding  cavity,  together  with  compresses,  adhesive  strips,  and  a  roller  from  the  foot  to  the  groin.  Tin; 
haemorrhage  was  by  this  process  arrested,  and  for  two  or  three  days  afterwards  my  assistant  surgeons  reported  the  caso  favor 
ably.  But  I  Avas  again  called  upon  to  visit  the  patient,  who  was  reported  to  be  sinking  very  fast,  and  that  the  wound  was 
bleeding  very  much.  I  found  to  my  surprise  the  whole  bandage  and  bed  saturated  with  blood,  and  the  patient  truly  in  a 
dangerous  condition.  Upon  removing  the  bandages  and  compresses  a  large  mass  of  coagulated  blood  and  dead  tissue  dropped 
out,  having  the  most  intolerable  stench  imaginable.  The  haemorrhage  was  still  very  great,  and  I  was  almost  at  a  loss  to  know 
how-to  stop  it.  The  whole  back  part  of  the  thigh  appeared  to  be  one  bleeding  cavity.  I  introduced  my  hand  into  the  wound 
and  found  I  could  pass  my  fingers  almost  up  to  the  tuber  ischii.  At  the  bottom  of  the  cavity,  entirely  exposed  to  view,  were 
the  belly  of  the  biceps,  the  semi-membranosus  and  semi-tendinosus  muscles.  We  used  cold  water,  which  succeeded  in  a  measure 
to  stop  the  haemorrhage  temporarily.  Immediately  afterward,  or  as  soon  as  the  patient  had  recovered  from  the  shock  produced 
by  the  loss  of  blood,  I  put  him  under  the  influence  of  equal  parts  of  sulphuric  ether  and  chloroform;  then  commencing  imme 
diately  below  the  tuber  ischii  and  cutting  through  the  parts  down  to  the  muscles,  I  brought  the  knife  down  and  out  at  the  upper 
part  of  the  cavity,  turning  the  flaps  outward  and  exposing  the  whole  cavity;  with  a  pledget  of  lint  tied  to  a  probang  I  cauterized 
every  part  of  this  cavity — the  flaps  and  even  the  muscles — with  pure  nitric  acid  until  they  became  perfectly  charred  and  all 
haemorrhage  entirely  ceased.  The  flaps  were  now  brought  together  and  fixed  with  wide  adhesive  strips  around  the  thigh.  A 
compress  saturated  with  a  lotion  of  nitric  acid  was  applied,  and  over  this  a  roller  from  foot  to  groin.  The  patient  was  ordered 
sulphate  of  quinine  one  grain,  and  tincture  of  chloride  of  iron  fifteen  drops,  every  two  hours;  also,  eggnog,  brandy-punch, 
and  essence  of  beef.  From  this  moment  he  began  to  improve  rapidly  and  complained  of  no  more  severe  stinging  pain  in  the 
limb.  Not  the  least  haemorrhage  ensued  afterward,  and  that  most  offensive  fetid  discharge  subsided  at  once.  We  dressed  the 
sore  twice  per  day  afterward,  still  using  a  weak  lotion  of  nitric  acid.  It  has  progressed  and  is  still  (June  1st)  progressing 
most  favorably."  The  patient  was  assigned  to  the  Veteran  Reserve  Corps  December  11,  1863.  There  is  no  record  of  his  ever 
having  applied  for  pension. 

In  addition  to  the  history  of  the  case,  Surgeon  McClurg  submits  the  following  remarks  in  relation  to  the  treatment 
of  gangrene:  "There  is  not  a  doubt  in  my  mind  but  that  the  nitric  acid  is  one  of  the  most,  if  not  the  most,  efficient  remedy 
in  use  for  sloughing  phagedaena  and  hospital  gangrene.  I  am  aware  that  of  late  bromine1  and  its  compounds  are  exciting 
considerable  interest  in  the  medical  profession  as  curative  agents  in  hospital  gangrene,  but  I  must  acknowledge  that  my  expe 
rience  with  these  agents  will  not  allow  me  to  call  them  specific,  and  I  certainly  regard  them  as  secondary  remedies  to  nitric 
acid.  The  acid  is  an  old  and  common  remedy,  and  I  believe  the  reason  it  has  not  often er  proved  its  superiority  over  all  other 
remedies  in  hospital  gangrene  has  been  on  account  of  the  cautious  manner  in  which  it  has  been  used.  This  is  a  serious  disease, 
and  the  remedy  should  be  freely  applied.  In  the  above  case,  I  placed  one  ounce  of  acid  in  a  tumbler,  dipped  my  pledget  of 
lint  in  again  and  again  until  the  whole  diseased  part  was  effectually  cauterized.  All  danger  was  at  once  over,  and  the  disease 
that  moment  arrested." 

1  Among  published  papers  on  the  local  application  of  bromine  in  hospital  gangrene  may  be  mentioned  Bromine  in  Hospital  Gangrene,  by  R.  L. 
8TANFOU1),  M.  D.,  Surgeon  U.  S.  V.,  in  Am.  Med.  Times,  18C3,  Vol.  VII,  p.  24,  and  Remarks  on  Hospital  Gangrene,  by  Surgeon  O.  R.  WEEKS,  U.  S.  V., 
in  Am.  Med.  Times,  1863,  Vol.  VII,  p.  4fi.  GOLDSMITH  (M  ),  A  Report  on  Hospital  Gangrene,  etc.,  Louisville,  1863.  THOMSON  (WM.),  JKeport  of  Cases 
of  Hospital  Gangrene  treated  in  Douglas  Hospital,  Washington,  D.  C.,  in  Am.  Jour.  Med.  Sci.,  18(54,  Vol.  XLVII,  p.  378. 


SECT.  I.]  COMPLICATED    SHOT    FLESH    WOUNDS.  35 

CASE  74. — Private  H.  Barr,  Co.  I,  21st  Iowa,  aged  43  years,  was  wounded  at  the  Black  River  Bridge,  May  17,  18G3, 
and  was  transferred  from  a  field  hospital  to  Memphis,  two  weeks  after  the  injury.  Acting  Assistant  Surgeon  W.  M.  Dorran 
contributed  the  following  history:  "He  received  a  flesh  wound  of  the  right  leg,  the  ball  entering  about  two  inches  below  the 
head  of  the  fibula,  external  aspect,  passing  inward  and  downward  behind  the  bones  of  the  leg,  and  escaping  three  inches  below 
the  head  of  the  tibia,  internal  aspect.  On  June  4th,  he  was  admitted  into  the  Jackson  Hospital,  in  this  city.  The  wounds 
were  then  small,  the  external  one  nearly  healed;  both  wounds  were  suppurating,  and  the  pus  was  'darkish,'  the  patient  stated. 
Either  pus  burrowed  or  a  diffuse  abscess  formed  six  inches  below  the  internal  wound  on  the  calf  of  the  leg,  pointed  and  broke 
there,  discharging  a  considerable  quantity  of  pus.  The  tissues  all  around  this  new  sore  began  to  slough,  and  a  destructive 
process  extended  doAvn  to  within  two  inches  of  the  ankle,  up  to  the  internal  wound,  forward  to  the  spine  of  the  tibia,  and 
backward  to  the  median  line  of  the  muscles  of  the  calf.  A  consultation  was  held  over  the  case,  and  it  was  decided  to  ampu 
tate,  the  patient  states;  but  the  superintendent  of  the  hospitals  happened  to  be  present  and  overruled  the  decision,  arid  had  the 
patient  transferred  to  the  gangrene  section  of  this,  the  Union  Hospital,  on  June  30th.  On  admission,  a  large  portion  of  black 
dead  tissue  surrounded  the  breach  of  the  surface,  which,  when  cut  away  by  the  scissors,  made  the  ulcer  to  be  about  eight  inches 
long  and  four  inches  in  width  at  the  middle  of  the  leg.  The  tibia  was  denuded  of  periosteum  to  the  extent  of  four  inches  in 
its  middle  third.  The  internal  saphenous  vein  was  a  black  cord  for  about  six  inches.  The  gastrocnemius  and  soleus  muscles 
had  sloughed  to  the  median  line,  and  the  fascia  between  these  two  muscles,  and  also  under  the  soleus,  had  sloughed  away 
much  farther  in  extent  than  the  muscles.  After  it  was  cleaned  as  well  as  possible  by  cutting  and  washing,  fuming  nitric  acid 
was  applied,  or  almost  poured  on  the  dead  and  dying  tissues  still  remaining,  and  with  a  piece  of  wood  it  was  worked  into  their 
structure,  and  the  semifluid  slush  or  mud  was  cleaned  away,  as  it  formed,  by  the  application  of  the  acid.  Then  the  whole  leg 
was  enveloped  with  a  poultice  of  charcoal  and  linseed-meal,  covered  by  an  oilcloth,  and  bandaged  from  the  toes  to  the  knee. 
After  the  cauterization,  when  the  patient  was  under  the  influence  of  some  stimulants  and  morphia  given  to  him  during  the 
operation,  he  expressed  himself  as  feeling  better  than  he  had  for  two  weeks  past,  and  the  leg  easier.  July  1st,  Sloughing  by 
acid  not  ready  to  be  removed  yet;  acid  again  applied  where  gangrenous  ulceration  still  proceeded,  also  the  poultice  and  tight 
bandage.  July  4th,  The  patient  rests  well  at  night,  and  his  appetite  is  rather  improved.  He  is  cheerful  and  hopeful,  and  of 
the  opinion  now  that  there  is  a  chance  of  his  leg  being  saved,  whereas  before  he  had  made  up  his  mind  that  it  was  to  be  lost. 
The  slough  by  the  acid  was  removed  to-day,  and  the  sore  is  fresher  in  appearance  anteriorly,  but  posteriorly  the  fascia  is  still 
sloughing.  The  strong  acid  was  again  applied  in  this  region,  causing  the  formation  of  a  mass  to  be  cleaned  away  to  the 
amount  of  two  or  three  ounces.  Lint  saturated  with  a  solution  of  bromine  and  bromide  of  potassium  is  now  introduced  into 
every  crevice  and  sinus  and  over  every  sloughing  part,  and  over  this  a  poultice  and  bandage.  Stimulants  are  given  four  times 
a  day,  also  tonics  of  quinine  and  tincture  of  chloride  of  iron.  July  8th,  By  assiduous  attention  to  ti-eatment,  after  the  manner 
already  described,  the  sore  has  been  brought  to  present  a  fresh  and  rather  healthy  base,  and  some  granulations  are  springing  up 
on  the  anterior  part.  Nitric  acid  has  still  to  be  applied  under  the  muscles  of  the  calf,  and  at  the  lowest  margin  of  the  ulcer 
some  dead  tissue  remains.  July  12th,  The  ulcer  is  quite  clean  and  has  quite  a  healthy  appearance;  granulations  are  springing 
up  very  beautifully,  except  at  the  lower  margin.  The  patient's  general  condition  has  improved.  Resin  cerate  is  used  to  dress 
the  parts  where  granulations  are  springing  up,  but  solution  of  bromine  or  Labarraque's  solution  where  any  unhealthy  appear 
ance  presents  itself.  July  16th,  The  sore  appears  quite  healthy  and  granulating  all  over.  The  muscles  that  were  separated 
from  each  other  by  destruction  of  tissue  between  them  are  beginning  to  grow  together.  The  tibia,  which  was  bare  for  some 
distance,  is  again  being  covered  by  granulations.  The  edges  of  the  ulcer  are  becoming  depressed  and  rather  inverted  instead 
of  being  indurated  and  everted.  The  internal  saphena  vein  has  been  destroyed  for  eight  inches  of  its  length  and  cut  away. 
There  was  no  haemorrhage  at  any  time.  September  1st,  Ulcer  very  much  reduced  in  size.  Nitrate  of  silver  is  used  at  times 
to  depress  exuberant  granulations.  October  1st,  Wound  almost  completely  healed,  and  patient  able  to  walk  about,"  He  was 
discharged  April  6,  1864,  and  pensioned.  Examiner  R.  S.  Lewis,  of  Dubuque,  Iowa,  certified,  June  16,  1864:  "The  right  leg 
has  been  pierced  by  a  ball  about  three  inches  below  the  knee,  *  *  *  followed  by  gangrene  ;  is  still  discharging,  leaving 
the  limb  useless."  This  pensioner  was  last  paid  September  4,  1868,  since  when  he  has  not  been  heard  from. 

The  pathology  and  treatment  of  gangrene  of  the  lower  extremities  will  be  considered 
in  the  chapter  on  the  general  subject.  In  the  lower  limbs  traumatic  gangrene  is  usually 
of  the  humid  variety  and  commonly  progresses  with  great  rapidity. 

Tetanus. — Among  cases  of  shot  wounds  of  the  lower  extremities  not  attended  by 
lesions  of  the  bones,  joints,  great  vessels  or  nerves,1  there  were  one  hundred  and  seventeen 

1  Surgeon  J.  JULIAN  CHISOLM,  C.  S.  A.,  in  his  Manual  of  Military  Surgery  for  the  use  of  Surgeons  in  the  Confederate  States  Army  (Columbia, 
S.  C.,  3d  ed.,  1864,  p.  257),  observes  that  the  results  described  by  LAKKEY  in  his  campaigns  in  Egypt  and  Germany  (Memoires  de  Chir.  Mil.  et  Cam- 
pagnes,  Paris,  1812,  T.  Ill,  p.  280),  in  the  frequent  appearance  of  tetanus  in  wounded  soldiers  upon  exposure  on  battle-fields  to  cold  and  damp  night  air, 
never  followed  the  leaving  of  wounded  soldiers  upon  the  battle-fields  of  the  Confederacy.  Dr.  EDWARD  WAIJUEN.  Surgeon  General  of  the  State  of  North 
Carolina,  declares  (An  Epitome  of  Practical  Surgery  for  Field  and  Hospital,  Richmond,  18(53,  p.  132)  that  "the  experience  of  all  surgeons  establishes  the 
fact  that  changes  of  temperature  are  prolific  sources  of  this  disease;"  and  Professor  SAMUEL  D.  C.UOSS  (A  System  of  Surgery,  etc.,  5th  ed.,  1872,  Vol.  I, 
Chap.  X,  p.  238)  remarks  that  gunshot  wounds  are  peculiarly  liable  to  be  followed  by  tetanus  only  when  the  sufferers  are  neglected,  or  permitted  to  lie 
upon  damp,  cold  ground,  or  in  currents  of  cold  air,  after  an  engagement.  Dr.  CHISOLM  says  (1.  c.,  p.  258)  that  "a  trifling  puncture  or  scratch  is,  at  times, 
sufficient  to  cause  an  attack  ;  and  it  has  been  noticed  by  military  surgeons  that  the  scraping  of  the  skin  by  a  ball,  with  bruising  of  the  nerves,  is  more 
liable  to  this  complication  than  the  more  severe  wounds."  "  Wounds  in  certain  situations/'  Dr.  CHISOLM  adds,  "are  thought  to  favor  its  appearance,  viz : 
injury  to  the  hands,  feet,  joints,  etc."  .  .  "Its  common  period  for  appearing  is  between  the  fifth  and  fifteenth  days."  Professor  Jos.  JONES,  Surgeon 
P.  A.  C.  S.,  in  an  article  on  Traumatic  Tetanus,  in  Confed.  States  Sled,  and  Surg.  Jour.,  1864.  p.  1,  dwells  upon  the  good  effects  of  chloroform  mixture, 
administered  by  the  stomach,  in  shot  flesh  wounds.  The  compilers  of  A  Manual  of  Military  Surgery  prepared  for  the  use  of  the  Confederate  States  Army, 
Richmond,  1863  [Surgeons  A.  TALLEV,  W.  F.  CAMPHELL,  ST.  GEOUOK  PEACHEY,  A.  E.  PETICOLIS,  and  J.  DUNN  are  reported  to  have  constituted  the 
commission  that  prepared  this  work],  in  the  chapter  on  Tetanus,  on  page  9,  refer  to  the  effect  of  draughts  of  cold  air  in  determining  violent  exacerbations 
of  muscular  rigidity. 


36  INJURIES    OF    THE    LOWER    EXTREMITIES.  iCHAP.  x 

cases  of  tetanus  noticed,  with  one  hundred  and  six  deaths,  or  90.5  per  cent.     An  example 
of  one  of  the  eleven  instances  of  recovery  is  appended: 

CASE  75.— Private  G.  C.  Nichol,  Co.  C,  22d  Iowa,  aged  20  years,  was  wounded  at  Vicksburg,  May  22,  18(33.  Surgeon 
T.  F.  Azpell,  U.  S.  V.,  noted  his  admission  to  the  Steamer  E.  C.  Wood,  from  a  field  hospital,  June  4th,  with  "shot  wound  of 
right  thigh."  Assistant  Surgeon  J.  M.  Study,  U.  S.  V.,  reported  the  following  history  from  Union  Hospital,  Memphis,  where 
the  patient  was  admitted  June  8th:  "The  injury  for  which  this  man  was  admitted  was.au  ordinary  llesh  wound,  the  hall 
passing  transversely  from  without  inward,  through  the  posterior  aspect  of  the  right  thigh.  At  the  time  of  his  admission  the 
wound  showed  no  indication  of  having  made  any  progress  toward  reparation,  but  presented  an  extremely  irritable  margin. 
Warm-water  dressing  was  applied,  and  on  the  following  day  there  were  marked  symptoms  of  tetanus,  chiefly  confined  to  the 
jaws,  which,  however,  soon  became  more  general,  and  in  addition  to  the  trismus  there  was  that  frightful  condition  of  the  body 
intermediate  between  opisthotonos  and  pleurothotonos.  Sufficient  quantity  of  chloroform  was  administered  by  inhalation,  to 
produce  complete  anaesthesia,  twice  regularly  in  twenty-four  hours.  Sulphate  of  morphia,  in  half-grain  doses,  was  given  each 
evening  at  bed-time,  and  brandy  ad  libitum.  June  llth,  no  notable  change  in  the  case ;  patient  is  stupid,  and  there  is  an  absence 
of  muscular  rigidity  as  long  as  the  combined  effects  of  the  chloroform  and  morphia  continue.  June  14th,  patient  much  in  the 
same  condition  as  when  last  noted,  excepting  an  extensive  tumefaction  of  the  left  limb,  which  tumefaction,  so  far  as  the  most 
careful  scrutiny  would  show,  is  entirely  idiopathic  in  its  nature.  A  roller  was  applied  to  this  limb  from  the  toes  to  the  groin; 
otherwise  the  treatment  of  the  case  is  the  same.  June  18th,  tetanic  symptoms  subsiding  somewhat;  the  wound  has  changed  in 
appearance  but  little  since  first  noted ;  tumefaction  in  left  leg  still  present.  Chloroform  is  given  less  freely  than  before;  morphia 
continued  the  same,  also  the  brandy.  June  21st,  patient  is  now  able  to  separate  the  jaws  to  the  width  of  half  an  inch;  his 
general  condition  is  improving  rapidly ;  appetite  is  ravenous;  the  bowels  are  regular;  swelling  in  left  leg  disappeared ;  wound 
beginning  to  suppurate.  Morphia,  in  one-third  doses,  is  given  at  bed-time;  brandy,  one  ounce  every  two  hours.  June  28th, 
the  wound  has  been  suppurating  freely,  a  large  amount  of  the  adjacent  tissues  having  sloughed  away.  The  warm-water  dress 
ing,  which  has  been  continued  until  now,  is  stopped,  and  scraped  lint  moistened  with  glycerine  is  applied.  Patient  takes  one 
pint  of  ale  daily.  July  15th,  the  wound  is  quite  healed,  and  the  patient  walks  with  the  aid  of  a  cane.  On  August  19th,  he  was 
f  urloughed."  The  registers  of  the  Union  Hospital  show  that  this  man  returned  from  furlough,  and  was  sent  to  his  regiment  for 
duty  September  30,  1863. 

Two  examples  of  fatal  cases  are  subjoined.  It  has  been  impracticable  to  discover 
any  details  of  autopsies  throwing  any  light  on  the  subject.1  Apparently  there  were  no 
instances  recorded  in  this  group  in  which  microscopical  examinations  of  sections  of  the 
spinal  cord  were  undertaken : 

CASE  76. — Private  P.  Brown,  Co.  A,  169th  New  York,  aged  36  years,  was  wounded  at  Cold  Harbor,  June  3,  1834,  and 
admitted  to  Harewood  Hospital,  Washington,  five  days  afterwards.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported  :  "Shot  flesh 
wound  of  left  leg.  Patient  furloughed  July  29th."  Assistant  Surgeon  M.  F.  Coggswell,  U.  S.  V.,  in  charge  of  the  Albany 
Hospital,  reported  the  following  result  of  the  case:  "The  patient  was  admitted  August  1st,  having  a  large  ulcer,  measuring  six 
by  five  and  a  half  inches,  on  the  calf  of  the  leg,  the  result  of  a  gunshot  wound.  His  general  health  was  very  poor,  and  he  was 
anaemic  and  debilitated.  Gangrene  had  appeared  previous  to  his  admission  to  this  hospital,  and  the  ulcer  was  indolent,  foul, 
and  unhealthy.  Nitrate  of  silver  was  applied  and  solution  of  chlorinate  of  soda,  also  poultices  of  flaxseed-meal  mingled  with 
pulverized  charcoal.  This  treatment  was  followed  in  twenty-four  hours  by  a  healthy  discharge  of  pus  and  a  general  improve 
ment  of  the  ulcer.  Beef-tea,  milk-punch,  and  extra  diet  were  ordered.  On  the  2d  of  August  his  tongue  was  red  and  dry,  his 
appetite  failed,  and  he  manifested  great  uneasiness  and  appeared  to  labor  under  an  impression  of  impending  evil.  That  nijht 
(August  2d)  the  weather,  which  had  been  very  hot  and  dry  for  several  days,  suddenly  became  damp  and  chilly,  and  on  the 
morning  of  August  3d,  at  4  o'clock,  symptoms  of  trismus  appeared,  and  were  followed  in  two  hours  by  a  general  spasm  of  all 
the  voluntary  muscles.  The  rlsus  sardonicus  was  marked,  and  the  patient  was  in  great  distress;  deglutition  was  impossible. 
Beef-essence  and  milk-punch  were  administered  by  enemata,  and  half  a  grain  of  sulphate  of  morphia  was  injected  hypodermic- 
ally  over  the  epigastrium.  The  latter  acted  so  speedily  and  powerfully  that  in  two  hours  all  the  muscles  were  relaxed.  The 
patient's  strength,  however,  was  completely  exhausted,  and  at  8  o'clock  P.  M.  he  expired,  there  being  no  recurrence  of  the 
tetanic  symptoms.  No  general  post-mortem  was  made;  a  local  examination  did  not  reveal  anything.  The  trunk  of  the  posterior 
tibial  nerve  was  intact,  but  its  muscular  and  cutaneous  branches  were  involved." 

CASE  77. — Sergeant  W.  Walters,  Co.  B,  87th  Pennsylvania,  aged  29  years,  was  wounded  at  the  Wilderness,  May  8, 
1864.  Surgeon  N.  R.  Moseley,  U.  S.  V.,  reported  his  admission  to  Emory  Hospital,  Washington,  May  16th,  with  "shot 
wound  of  foot."  Surgeon  J.  II.  Taylor,  U.  S.  V.,  reported  the  following  result  of  the  injury:  "The  patient  was  admitted  to 
Summit  House  Hospital,  Philadelphia,  May  20th,  having  been  wounded  by  a  ball  striking  the  plantar  surface  of  the  left  foot 
at  the  first  interosseous  space,  one  and  a  half  inches  from  the  metatarso-phalangeal  joints,  going  directly  through  on  the  dorsum 
and  producing  a  flesh  wound.  Cold-water  dressings  were  applied.  The  patient  is  of  strumous  diathesis,  having  scars  on  the 
side  of  his  neck,  the  remains  of  scrofulous  abscesses.  May  30th,  at  8  A.  M,  he  was  in  excellent  health;  at  1"2  M.  he  com 
plained  of  stiffness  and  pains  in  the  jaws  and  neck;  great  pain,  referred  to  articulation  of  left  inferior  maxilla  with  temporal 
bone,  together  with  constant  fixed  pains  at  the  epigastrium,  shooting  around  to  the  spine;  jaws  seemingly  tied,  as  the  patient 
expressed;  mouth  gradually  closing;  twitching  of  facial  muscles;  some  difficulty  of  respiration,  but  none  of  deglutition. 

1  CIIISOLM  (J.  Jvi.lAX),  M.  D.,  (in  his  Manual  of  Military  Surgery,  3d  ed.,  Columbia,  18(54,  p.  259)  states:  "That  fruitful  source  of  information, 
pathology,  gives  us  no  instruction  in  this  disease.  An  autopsy  reveals  to  the  eye  nothing  commensurate  with  the  intensity  of  the  symptoms.  A  slight 
congestion  of  the  spinal  cord  and  medulla  oblonguta  is  all  that  can  be  discerned.'1 


SECT.  T.j  COMPLICATED    SHOT    FLESH    WOUNDS.  37 

Treatment:  Bowels  unloaded  by  injections;  brandy  and  quinine  given  in  large  quantities,  milk-punch  and  beef-tea  by  mouth 
and  rectum.  Liquor  of  morphia,  one  half  ounce,  was  given  every  two  hours  for  eight  or  ten  hours,  but  with  no  effect.  Injected 
one  grain  of  sulphate  of  morphia,  dissolved  in  one  drachm  of  water,  hypodermically  just  over  the  temporal  region;  but  even 
this  failed  to  produce  any  narcotic  effect.  Counter-irritation  was  used  at  the  spine  with  chloroform  and  covered  with  oiled  silk, 
but  so  severe  was  the  burning  pain  that  it  soon  had  to  be  discontinued.  On  May  31st,  the  patient  was  attacked  with  severe 
cramps  in  the  abdomen,  the  muscles  here  becoming  hard  and  tense,  the  muscles  of  the  back  rigid  and  prominent;  great  pain, 
referred  to  chest  in  inspiration;  pupils  contracted.  There  was  profuse  perspiration  over  the  entire  body  from  the  commence 
ment  of  the  disease;  pulse  natural.  A  solution  of  sulphate  of  atropia,  one  grain  to  an  ounce  of  water,  was  now  injected,  in 
quantities  of  one  drachm,  a  little  to  the  left  of  the  median  line  of  the  neck  at  first,  and  subsequently  on  each  side  of  the  spine, 
below  the  scapula,  at  intervals  of  one  half,  one,  and  two  hours,  in  all  seven  or  eight  times.  The  pupils  were  now  dilated,  but 
there  was  not  the  slightest  relaxation  of  muscular  spasm;  perspiration  still  profuse.  An  effort  to  rouse  him  from  this  state  with 
cold  douche  had  but  little  effect.  The  spasms  continued  to  increase  in  frequency  and  violence  until  3  A.  M.  on  June  1,  1864, 
when  he  died." 

Extraction  of  foreign  bodies,  removal  of  all  causes  of  irritation  to  the  wound,  avoid 
ing  cold  and  currents  of  air,  were  the  prophylactic  measures  advised.  Anaesthetics  and 
narcotics  were  generally  employed,  but  in  grave  and  confirmed  cases  the  therapeutical 
results  were  most  discouraging. 

Erysipelas. — In  forty-five  cases,  of  which  thirty-four  proved  fatal,  extended  erysipe- 
latous  inflammation  was  the  most  characteristic  feature.  An  example  of  recovery  from 
this  complication  is  detailed: 

CASE  78. — Private  W.  Bowling,  Co.  B,  1st  Maryland  Cavalry,  aged  22  years,  was  wounded  at  Gettysburg,  July  4,  1863, 
and  entered  the  Frederick  Hospital  two  days  afterwards.  Acting  Assistant  Surgeon  W.  S.  Adams  reported :  "  The  patient  was 
wounded  by  a  minie  ball  which  entered  two  inches  above  the  right  patella,  passing  downward,  striking  that  bone  and  glancing, 
and  came  out  at  its  lower  border,  without  causing  fracture  or  involving  the  joint.  The  patient's  general  health  was  good.  Cold- 
water  dressings  were  ordered,  and  rest.  July  20th,  evidence  of  erysipelas  appeared  this  morning;  bowels  constipated;  pulse 
quick.  Ordered  lead  and  opium  wash  to  the  knee  joint,  and  gave  three  compound  rhubarb  pills.  21st,  bowels  open  freely ; 
pulse  less  frequent ;  tongue  furred,  with  red  edges  and  tip;  skin  dry;  loss  of  appetite;  erysipelas  extending  above  and  below 
the  wound.  Applied  tincture  of  iodine  around  the  limb  beyond  the  disease.  23d,  erysipelas  extending  rapidly;  considerable 
gastric  irrita'tion;  pulse  quick  but  feeble.  Ordered  one  pint  of  milk-punch  a  day,  and  three  grains  of  quinine  three  times  a  day. 
24th,  erysipelas  still  extending  and  now  occupying  the  entire  right  leg  and  thigh,  and  the  pelvic  region  down  the  left  thigh  as 
far  as  the  knee;  right  limb  very  cedematous  and  assuming  a  decided  phlegmonous  character.  Evaporating  lotions  of  ether  were 
ordered  to  the  worst  points,  and  the  other  treatment  continued.  30th,  erysipelas  still  extending  up  the  body  and  now  occupies 
the  entire  left  limb.  It  has  subsided  in  its  original  seat,  and  desquamation  has  taken  place.  Numerous  longitudinal  incisions, 
extending  from  the  instep  to  the  toes  of  the  left  foot,  were  made  to  relieve  the  tension.  Stimulants  were  increased  to  one  pint  of 
whiskey  per  day,  and  beef-tea  and  generous  diet  pushed  as  far  as  possible.  August  2d,  general  condition  much  better,  but 
erysipelas  still  continues  on  the  feet  and  ankles,  and  there  is  some  sloughing  of  the  integuments  over  the  metatarsus  of  the  left 
foot  owing  to  the  incisions  not  having  been  made  in  due  time.  August  6th,  condition  still  improving;  erysipelas  has  nearly 
disappeared.  9th.  decidedly  convalescent;  ulcer  of  left  foot  granulating  finely;  appetite  good.  30th,  ulcer  entirely  healed; 
wound  of  knee  nearly  so.  October  13th,  wounds  entirely  healed,  and  patient  this  day  transferred  to  Baltimore."  Surgeon  T. 
H.  Bache,  U.  S.  V.,  reported  that  the  patient  was  paroled  from  West's  Buildings  Hospital  November  12,  1863. 

The  graver  cases  of  erysipelas  complicating  flesh  wounds  were  pernicious  and  contagious  : 

CASE  70. — Private  L.  Brittin,  Co.  M,  1st  Pennsylvania  Cavalry,  aged  35  years,  was  wounded  at  Hanoverton,  May  28, 
1864,  and  admitted  to  the  field  hospital  of  the  3d  division,  Fifth  Corps,  where  Surgeon  L.  W.  Read,  U.  S.  V.,  noted  "a  shot 
wound  of  leg."  From  the  field  hospital  the  patient  passed  to  Washington  and  thence  to  Philadelphia,  entering  the  Summit 
House  June  28th,  and  subsequently  the  Satterlee  Hospital.  Surgeon  I.  I.  Hayes,  U.  S.  V.,  recorded  the  following  history:  "The 
injury  was  caused  by  a  minie'  ball  passing  transversely  and  producing  a  slight  flesh  wound  of  the  upper  third  of  the  right  leg. 
The  wound  healed,  when  it  was  attacked  by  gangrene,  and  after  again  becoming  healthy  the  whole  limb  was  seized  with  erysip 
elas.  On  March  24,  1865,  the  whole  external  lateral  surface  of  the  knee  presented  two  sloughing  wounds,  one  on  a  line  with 
the  head  of  the  tibia,  the  other  just  above  the  tendon  of  the  muscle.  The  whole  limb  was  swollen,  red,  and  painful.  General 
condition  poor,  with  headache,  fever,  dry  tongue,  and  dry  hot  skin.  On  March  26th,  a  large  collection  of  pus,  amounting  to 
about  six  ounces,  was  evacuated  immediately  below  the  patella.  The  patient's  bed  was  moved,  the  old  splint  removed  and  a 
Smith's  anterior  applied.  On  rinsing  the  limb  a  sloughing  wound  involving  nearly  the  whole  popliteal  space  was  found.  On 
the  following  day  the  patient  was  slightly  more  comfortable,  but  there  was  not  much  change  in  his  general  condition.  On  March 
31st,  there  was  no  change  in  the  appearance  of  the  wound,  but  the  patient's  strength  was  evidently  becoming  exhausted.  There 
were  symptoms  of  pyaemia,  and  he  was  delirious  during  the  afternoon,  but  better  toward  evening.  His  pulse  was  120  and  very 
small ;  countenance  sunken,  with  hectic  spots  on  the  cheeks.  He  complained  of  no  pain,  but  was  evidently  partially  unconscious. 
He  died  April  6,  1865." 

Hcemorrhage. — In  addition  to  the  group  of  cases  of  shot  flesh  wounds  of  the  lower 
limbs  with  primary  lesion  of  the  large  blood-vessels,  as  discussed  on  pp.  13,  18,  ante,  one 


38  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

hundred  and  fifty  cases  have  been  noted — and  this  is  probably  an  imperfect  summary— 
of  consecutive  bleeding  from  the  large  vessels,  among  which  were  sixty-four  examples  of 
recovery,  eighty  deaths,  and  six  cases  with  unknown  results,  a  mortality  rate  of  55.5. 
Consecutive  bleeding  was  from  vessels  varying  in  magnitude.1  Tabulations  have  been 
made  showing  the  time  from  the  reception  of  the  injury  to  the  onset  of  the  bleeding,  the 
amount  of  blood  lost,  and  the  treatment,  but  there  is  not  space  to  reproduce  this  analysis. 
Two  illustrative  cases  are  appended: 

CASK  80. — Private  J.  C.  Corliss,  Co.  G,  17th  Illinois,  aged  21  years,  was  wounded  before  Vicksburg,  May  19,  1803,  and 
entered  the  Jackson  Hospital  at  Memphis  eight  days  afterwards.  Acting  Assistant  Surgeon  II.  D.  Garrison  recorded  the  follow 
ing  description  of  the  injury  and  its  result:  ''A  conical  ball  entered  the  left  thigh  anteriorly,  about  five  inches  below  Poupart's 
ligament,  passing  upward  and  slightly  inward  in  its  course.  The  wound  was  examined  at  the  time  by  a  surgr-on,  who  was 
unable  to  extract  the  ball.  When  admitted  to  this  hospital  the  man  was  in  good  health,  and  his  wound  gave  him  but  very  little 
pain.  Water  dressings  were  applied  and  all  went  well  until  about  noon  on  the  28th,  when,  from  some  slight  motion,  copious 
haemorrhage  commenced  suddenly.  The  femoral  artery  was  almost  instantly  compressed  over  the  pubic  arch,  but  not  until  much 
blood  was  lost.  A  consultation  being  called,  it  was  believed  that  the  profunda  femoris  was  probably  severed,  and  that  a  tourni 
quet  with  a  small  roller  for  a  pad  placed  over  the  track  of  the  ball  would  probably  be  sufficient  to  prevent  the  recurrence  of 
haemorrhage  until  nature  had  time  to  permanently  close  the  vessel.  This  plan  was  accordingly  adopted  and  proved  successful 
for  twenty-four  hours,  when — while  Surgeon  E.  M.  Powers,  ?th  Missouri,  in  charge  of  the  hospital,  was  looking  at  the  appliance 
and  congratulating  the  patient  on  his  safety — the  haemorrhage  again  set  in  with  all  its  former  force.  On  consultation  it  was 
then  agreed  to  inject  the  wound  with  solution  of  persulphate  of  iron,  which  was  accordingly  done,  and  the  tourniquet  was 
re-applied.  Xo  further  haemorrhage  occurred  afterwards,  but  in  spite  of  stimulants  freely  administered  the  patient  expired 
fourteen  hours  after  the  last  attack.  The  post-mortem  examination  revealed  the  fact  that  the  femoral  artery  was  opened  about 
an  inch  below  the  origin  of  the  profunda.  The  opening  was  about  the  size  of  a  small  pea  and  seemed  to  have  been  caused  by 
the  sloughing  of  the  coats.  In  this  case  the  pulsation  of  the  tibial  and  popliteal  arteries  demonstrated  that  the  flow  of  blood 
through  the  femoral  was  uninterrupted  and  led  to  the  adoption  of  an  erroneous  diagnosis."  Surgeon  Powers  in  his  report 
stated  that  tin;  loss  of  blood  in  tins  case  amounted  to  four  and  a  half  pints,  also  that  the  bullet  was  extracted  from  its  place  of 
lodgement  after  the  patient's  admission  to  Jackson  Hospital. 

CASK  HI. — Private  A.  Kunkle,  Co.  IJ.  62d  Pennsylvania,  aged  18  years,  was  wounded  at  Gettysburg,  July  2,  1863, 
and  remained  at  a  field  hospital  for  two  weeks,  when  he  was  transferred  to  Baltimore.  Acting  Assistant  Surgeon*  J.  Dickson 
made  the  following  report  from  Jarvis  Hospital:  "  He  was  wounded  through  the  right  thigh,  the  missile  entering  near  the 
tuberosity  of  the  i^chium,  and,  passing  about  fourteen  inches  through  the  deep  muscles,  emerged  outside  of  the  femur  four  inches 
from  the  knee.  lie  stateil  that  he  bled  very  freely  on  the  field,  and  after  being  taken  to  a  neighboring  house  there  was  a  recur 
rence,  lasting  all  night.  Xo  further  haemorrhage  occurred  until  the  patient  was  brought  to  this  hospital.  At  that  time  he  wTas 
very  anaemic  and  feeble.  Generous  diet  and  iron  were  ordered.  On  July  17th,  an  alarming  haemorrhage  occurred  from  both 
wounds,  which  was  arrested  by  compression  and  the  local  application  of  persulphate  of  iron.  Two  days  afterwards  there  was 
another  haemorrhage  as  profuse  as  before,  and  the  same  treatment  was  resorted  to  with  the  same  result.  On  July  28th,  there 
was  a  recurrence  nearly  as  profuse  as  the  last.  Amputation  and  ligatiou  of  the  femoral  artery  was  thought  of;  but  it  was 
concluded  he  would  die  after  either,  and  compression  upon  the  femoral  and  along  the  course  of  the  wound  was  resorted  to.  On 
July  30th,  tbe  patient  was  rallying.  On  August  6th,  another  slight  haemorrhage  came  on,  followed  by  a  discharge  of  sanious 
pus,  the  contents  of  an  aneiirismal  sac.  By  August  29th  the  wounds  had  almost  healed  and  the  patient  quite  built  up  and  walking 
on  crutches,  his  leg  being  considerably  contracted  but  straightening  gradually."  In  October  following  the  patient  was  trans 
ferred  to  the  Sattcrlee  Hospital,  Philadelphia,  and  subsequently  to  Pittsburg,  whence  he  was  returned  to  his  regiment  for  duty 
February  12,  1861.  The  Adjutant  General  of  Pennsylvania  reports  that  the  man  was  mustered  out  with  his  command  July  13, 
1864.  He  is  not  a  pensioner. 

Ligations  of  Blood-vessels  of  the  Lower  Limbs  after  Flesh  Wounds. — At  page  16  it 
will  be  recollected  that  attention  was  called  to  a  considerable  number  of  cases  of  direct 
injury  of  blood-vessels  treated  by  primary  or  consecutive  ligation,  and  that  it  was  promised 
that  further  on  such  examples  would  be  enumerated,  together  with  cases  of  deligation  of 
the  same  vessels  for  flesh  wounds  without  primary  arterial  lesion.  The  series  which  will 
be  here  presented  numbers  one  hundred  and  ninety-five  instances, — one  hundred  and 
ninety-four  ligations  of  arteries  and  one  of  the  saphenous  vein.  It  will  be  noticed,  how 
ever,  that  among  the  hundred  and  ninety-four  cases  of  arterial  ligations  there  were  six 
instances  in  which  the  femoral  vein  was  simultaneously  tied  with  the  artery  it  accompanied. 

'An  analysis  (if  the  series  shows  1  fatal  case  of  bleeding  from  the  external  iliac;  thero  were  23  cases  of  hscmorrhage  from  the  femoral,  with  18  fatal 
results,  3  recoveries,  and  2  unknown.  The  haemorrhages  from  the  profunda,  Circumflex,  and  other  branches  were  111  with  ">  deaths.  There  were  13  coses 
of  secondary  bleeding  from  the  popliteal  with  8  deaths;  6.  of  bleeding  from  the  anterior  tibial  with  1  death,  and  15  of  the  posterior  tibial  with  9  deaths. 
It  is  hardly  necessary  to  follow  out  the  statistics  of  the  smaller  vessels.  There  were  13  cases  of  profuse  venous  hsemorrhage  of  which  10  were  fatal. 
This  includes  -1  cases  (if  bleeding  from  the  femoral  veins,  all  of  which  were  fatal. 


SECT.  j.i  LIGATJONS    AFTER    SHOT    FLESH    WOUNDS.  39 

A  fatal  instance  of  delegation  of  the  common  iliac  artery  is  first  detailed,  constituting 
one  of  the  six  instances  in  which  this  operation  was  practised  during  the  American  civil 
war.  This  operation  now  (1877)  foots  up  sixty-one  cases  with  forty-eight  deaths: 

CASE  82. — Private  J.  Bouer,  Co.  I,  48th  Pennsylvania,  aged  19  years,  was  wounded  at  Tolopotomy  Creek,  May  31,  18G4, 
and  admitted  to  the  field  hospital  of  the  2d  division,  Ninth  Corps.  Surgeon  J.  Harris,  7th  Khodc  Island,  noted,  "shot  flesh 
wound  of  both  thighs  by  a  minie"  ball."  Four  days  after  being  wounded  the  man  entered  Judiciary  Square  Hospital, 
Washington.  Assistant  Surgeon  A.  Ingram,  U.  S.  A.,  corroborated  the  above  description  of  the  injury,  and  reported  the  result 
as  follows:  "Disorganization  of  tissue  from  a  deep  flesh  wound;  haemorrhage  took  place  on  June  10th,  from  the  small  vessels, 
and  was  controlled  by  pressure,  but  recurred  on  June  loth,  when  the  femoral  artery  was  taken  up  at  Scarpa's  triangle.  This 
vessel  was  again  ligated,  on  June  18th,  at  Poupart's  ligament ;  haemorrhage  again  occurred  on  the  morning  of  June  22d,  when 
the  common  iliac  was  ligated.  The  patient  died  during  the  day.1'  The  report  does  not  show  which  of  the  two  limbs  was 
operated  on,  and  diligent  search  has  revealed  no  additional  record  of  the  particulars  of  the  case. 

The  reader  may  compare,  on  page  333  et  seq.  of  Volume  II  of  Part  II,  the  details  and 
comments  on  four  other  examples  of  ligation  of  the  common  iliac  artery  practised  during 
the  War,  two  for  shot  wounds  of  the  pelvis  and  two  on  account  of  aneurisms  arising  from 
punctured  wounds.  Yet  another  instance  of  unsuccessful  ligation  of  the  common  iliac 
artery  for  consecutive  haemorrhage  after  a  shot  wound  of  the  pelvis  has  been  recorded  by 
Medical  Inspector  F.  H.  Hamilton,  U.  S.  A.  The  particulars,  so  far  as  they  can  be 
ascertained,  are  stated  in  the  foot-note.1 

Ligatwns  of  the  External  Iliac  Artery. — In  four  of  these  examples  ligatures  were 
placed  at  first  on  this  trunk,  but  in  the  seven  remaining  cases  after  the  femoral  had  been  tied. 

CASE  83. — Private  G.  W.  Husk,  Co.  F,  1st  Maryland  Cavalry,  aged  47  years,  was  wounded  at  Deep  Bottom,  August 
16;  1884.  Assistant  Surgeon  C.  Wagner,  U.  S.  A.,  reported,2  from  the  hospital  at  Beverly,  New  Jersey:  "Admitted  from  City 
Point  with  a  gunshot  flesh  wound  of  the  upper  third  of  the  right  thigh.  Bleeding  occurred  from  the  femoral  artery  on  Novem 
ber  10th,  fifteen  ounces  of  blood  being  lost.  The  patient  was  feverish,  pulse  130,  appetite  wanting.  Acting  Assistant  Surgeon 
J.  C.  Morton  administered  chloroform  and  ligated  the  external  iliac  artery.  The  patient  died  November  17, 1864,  from  recurrent 
haemorrhage." 

CASE  84. — Private  J.  H.  Gatewood,  Co.  F,  21st  Georgia,  aged  32  years,  wounded  at  Manassas,  August  28, 1862,  Surgeon 
J.  Chambliss,  P.  A.  C.  S.,  reported  :3  "Small  ball  entered  just  behind  the  left  trochanter,  passed  out  below  the  perineum,  entered 
the  right  thigh  opposite,  and  emerged  at  the  external  aspect  at  middle  of  upper  third  of  the  thigh  ;  bleeding  was  profuse  for 
several  minutes.  Aneurism  of  the  femoral  artery;  digital  compression  repeatedly  used  without  avail.  January  31,  1864,  liga 
tion  of  the  external  iliac  artery,  pretty  much  after  Cooper's  method,  by  Surgeon  Jackson  Chambliss,  P.  A.  C.  S.  February  3d, 
erysipelatous  inflammation  subsided.  February  15th,  the  wound  presented  a  healthy  granulated  appearance  and  discharged 
healthy  pus.  He  continued  to  improve  until  February  17,  1864,  when  violent  arterial  haemorrhage  occurred,  from  which  he 
died  in  a  few  minutes." 

1  Professor  FRANK  HASTINGS  HAMILTON,  A.  M.,  M.  D.,  LL.  I).,  in  The  Principles  and  Practice  of  Surgery,  New  York,  1872,  in  treating  of  liga 
tions  of  the  common  iliac,  states,  at  page  232,  that :  "  On  the  15th  of  May,  3804,  after  the  battle  of  the  Wilderness,  1  tied  the  same  vessel  in  the  presence 
of  Dr.  WALSEK  and  my  student  Mr.  HOYN.     The  patient,  John  E.  Preston,  of  the  19th  Pennsylvania  Vols.,  had  been  wounded  by  a  rifle-ball  which  had 
traversed  the  pelvis,  and  the  operation  was  made  to  arrest  a  haemorrhage  which  had  already  nearly  proved  fatal.     He  died  on  the  following  day,  but 
without  a  recurrence  of  the  bleeding.''     In  editing  the  surgical  report  in  Circular  No.  (i,  S.  G.  O.,  1865,  p.  78,  I  cited  from  the  records  but  three  cases  of 
ligation  of  the  common  iliac  practised  during  the  American  civil  war, — the  operation  on  the  left  common  trunk  by  Surgeon  J.  COOPEH  McKEE,  U.  S.  A., 
for  haemorrhage  after  shot  wound  of  the  pelvis  (which  afforded  the  specimen  3464,  Sect.  I,  A.  M.  M.),  and  the  operations  by  Acting  Assistant  Surgeon  K. 
N.  ISHAM  of  Chicago,  and  J.  B.  CUTTER  of  Newark,  for  aneurisms  consequent  on  stabs.     In  the  seventh  chapter  of  Volume  II,  of  Part  II,  of  the  Medical 
and  Surgical  History  of  the  War,  pp.  233-6,  these  three  cases  of  ligation  of  the  common  iliac  artery  were  detailed,  and  a  fourth  operation  of  ligation  of 
this  trunk  for  haemorrhage  following  shot  injury,  in  the  case  of  Colonel  J.  K.  Scott,  19th  Illinois,  was  quoted  from  the  report  of  the  operator,  Professor  D. 
BRAINARD,  in  the  Chicago  Medical  Journal,  1864,  Vol.  XXI,  p.  97,  and  reprinted  in  the  Am.  Jour.  Med.  Sci.,  1864,  Vol.  XL VI I,  p.  065.     The  operation 
of  ligation  of  the  common  iliac  for  haemorrhage  after  shot  flesh  wound  of  the  lower  extremity  reported  above  (CASE  82)  by  Assistant  Surgeon  A.  INGRAM. 
U.  S.  A.,  is  the  fifth,  and  the  case  adduced  by  Professor  F.  H.  HAMILTON  is  the  sixth,  example  of  the  war-series  of  this  important  procedure.    From 
Professor  HAMILTON'S  printed  report  of  the  case  of  Preston  I  was  unable  to  trace  the  injury  upon  the  records,  as  there  is  no  mention  made  of  it  either  in 
the  19th  or  1 19th  Pennsylvania  Volunteers ;  but  after  repeated  diligent  search  the  original  manuscript  entry  of  the  case  was  found  on  the  field  register  of 
the  3d  division  of  the  Sixth  Army  Corps  hospital,  at  the  Baptist  Church,  Fredericksburg,  Virginia.     It  is  there  stated  that  Corporal  John  E.  Preston,  of 
Co.  G.  1 1 9th  Pennsylvania,  was  wounded  at  the  battle  of  the  Wilderness,  receiving  a  "gunshot  injury  of  the  anterior  superior  spinous  process  of  the  left 
ilium.'      The  precise  date  and  extent  of  the  injury  is  not  noticed,  nor  the  disposition  made  of  the  patient ;  but,  in  a  list  of  deaths  in  the  3d  division 
hospital,  Sixth  Corps,  at  the  Baptist  Church,  Fredericksburg,  the  death  of  Corporal  John  E.  Preston,  on  May  14,  1864,  is  recorded.    In  another  part  of 
the  register,  signed  by  Dr.  J.  W.  WALSKR,  is  a  list  of  operations  performed  at  Baptist  Church  Hospital  after  the  battle  of  the  Wilderness,  by  Drs.  HAM 
ILTON  and  BUCK,  which  comprises:  ';  One  ligation  of  the  common  iliac, — death  in  twenty-four  hours."     The  data  are  very  imperfect,  but  the  probabilities 
are.  from  the  documentary  evidence  accessible,  that  Corporal  Preston,  119th  Pennsylvania,  was  struck,  on  May  7th,  at  the  Wilderness,  by  a  musket  ball 
which  fractured  the  anterior  superior  spinous  process  of  the  left  ilium,  and  that  he  was  sent  to  Fredericksburg  by  the  hospital  trains  that  reached  that 
town  on  May  lltli.     Further,  that  uncontrollable  haemorrhage  arose,  and  that  Medical  Inspector  F.  H.  HAMILTON.  U.  S.  A.,  ligated  the  left  common  iliac 
artery  on  May  J3th,  and  that  the  fatal  termination  of  the  case  took  place  twenty-four  hours  afterwards,  May  14,  1864. 

2  See  Report  on  Interesting  Surgical  Operations  performed  at  the  Hospital  at  Beverly,  N.  J.,  by  Assistant  Surgeon  C.  WAGNER,  U.  S.  A.,  1864,  p.  13. 

3  CHAMIJLISS  (J.),  Case  of  Traumatic  femoral  Aneurism — Treated  l>y  Digital  Compression — Ligation  afterwards  of  the  External  Hiac  Artery,  in 
Confed.  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  97. 


40 


INJURIES   OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


CASE  83.  —  Private  J.  R.  Spaulding,1  Co.  F,  112th  New  York,  aged  23  years,  was  wounded  at  Fort  Fisher,  January  15, 
1865.  Assistant  Surgeon  S.  H.  Orton,  U.  S.  A.,  reported,  from  McDougall  Hospital,  New  York  Harbor:  "A  mini6  ball  entered 
the  upper  and  inner  aspect  of  the  left  thigh,  and,  passing  a  little  downward  and  outward,  emerged  near  the  knee,  apparently 
avoiding  the  bone  and  all  important  vessels.  Simple  dressings  were  applied  for  about  three  weeks,  when  the  wound  began  to 
look  unhealthy  and  had  a  tendency  to  slough.  Solution  of  the  permanganate  of  potash  was  freely  used  and  tonics  given.  On 
March  23d,  haemorrhage  occurred  from  the  posterior  wound  and  was  arrested  by  sulphate  of  iron  and  pressure.  On  March  IJlst, 
bleeding  commenced  from  the  anterior  wound.  Dr.  Orton  applied  a  ligature  to  the  external  iliac  artery.  On  April  21st,  the 
haemorrhage  recurred  from  the  anterior  wound,  probably  through  the  collateral  circulation,  which  in  the  meantime  had  become 
established.  The  bleeding  was  successfully  restrained  by  the  application  of  the  horse-shoe  tourniquet,  which  was  kept  con 
stantly  retained  for  the  space  of  two  weeks,  when  it  was  omitted  without  any  subsequent  recurrence  of  the  haemorrhage.  At 
this  time  the  patient  was  greatly  afflicted  with  bed-sores,  which  were  a  source  of  great  annoyance  and  sufficient  to  exhaust  his 
strength.  The  wounds,  however,  were  healing  kindly.  On  May  31st,  the  patient  was  attacked  with  dysentery,  which,  in  his 
enfeebled  condition,  resisted  all  efforts  at  once.  The  patient  continued  to  sink  under  this  complication,  and  died  June  15,  1805, 
five  months  after  the  receipt  of  the  original  injury  and  about  two  and  a  half  months  after  the  operation  of  ligating  the  artery. 
At  the  time  of  his  death  the  wounds  were  nearly  healed." 

The  fourth  case  of  this  group  is  that  of  Private  J.  Langford,  printed  in  full  in  the 
American  Medical  Times,  1863,  Volume  VI,  page  256.  A  somewhat  extended  abstract 
of  this  interesting  case  is  here  appended: 

CASE  88.  —  Private  J.  R.  Lanyford,  Co.  F,  10th  Georgia,  was  wounded  at  Antietam,  September  17,  1862.  Assistant 
Surgeon  R.  F.  Weir,  U.  S.  A.,  reported  from  the  hospital  No.  1,  Frederick,  that  the  patient  entered  that  hospital  October  27th. 
He  had  been  struck  by  a  musket  ball  which  entered  half  an  inch  below  Poupart's  ligament,  below  the  right  groin,  just  over  the 
vessels,  and  made  its  exit  on  a  line  with  the  right  tuber  ischii,  about  two  inches  and  a  half  behind  it.  Profuse  immediate 
haemorrhage  of  arterial  color  produced  syncope,  and  there  was  recurrent  bleeding  when  the  fainting  was  over.  The  patient 
was  confined  to  his  bed  only  about  a  week,  and,  by  September  27th,  both  orifices  had  cicatrized.  When  he  left  his  bed  the  thigh 
was  flexed  on  the  pelvis,  extension  causing  pain.  On  October  27th,  an  examination  revealed  an 
aneurismal  pyriform  tumor  in  the  right  groin,  its  apex  directed  toward  the  scrotum  and  the 
greatest  transverse  diameter  corresponding  with  Poupart's  ligament.  At  the  base  its  diameter 
extended  to  the  vessels  about  four  and  a  half  inches;  at  the  apex,  internal  to  the  vessels,  and 
about  three  inches  external  to  the  vessels.  Starting  from  Poupart's  ligament,  the  tumor  extended 
in  its  outer  portion  three  fingers'  breadth  toward  the  anterior  superior  spine,  and  in  the  iliac  fascia 
it  extended  a  similar  distance.  Near  the  cicatrix  of  the  wound  of  entrance  the  aneurismal  thrill 
was  very  distinct.  The  patient  said  he  perceived  this  thrill  since  he  had  been  able  to  go  about. 
The  prominence  of  the  tumor  was  moderate.  The  limb  was  flexed  on  the  pelvis  at  an  angle  of 
about  45°.  Neuralgic  pains  affected  the  anterior  surface  of  the  thigh  and  bitterly  increased  in  its 
intensity.  Pressure  on  the  aorta  or  external  iliac  completely  arrested  pulsation.  The  pulsation 
of  the  posterior  tibeal  at  the  ankle  was  feeble.  The  patient  was  of  fine  physique,  and  reported 
himself  as  in  excellent  health  prior  to  injury.  By  November  5th  the  tumor  had  rapidly  aug 
mented  in  bulk,  and,  after  consultation,  it  was  determined  to  operate  by  Syme's  method  on  the 
following  day.  The  measures  proposed  contemplated  compression  on  the  right  common  iliac,  an 
incision  through  the  cicatrix  of  the  wound  of  entrance  sufficient  to  introduce  the  left  index,  and 
feel  and  plug  the  original  opening  into  the  artery,  then  to  freely  lay  open  the  sac  and  ligate  the 
vessel  above  and  below  the  point  of  injury.  November  6th,  at  noon,  patient  was  placed  under 
ether.  A  straight  incision  two  inches  long,  starting  from  just  within  the  middle  of  Poupart's 
ligament  and  running  obliquely  downward  along  the  thigh,  was  made.  The  upper  end  of  this 
opening  was  prolonged  by  a  curved  incision  one  and  a  half  inches  long,  running  upward  and 

outward  as  far  as  the  ligature  of  the  external  iliac  artery.     This  incision  was  deepened  through 

„.,„.  ,,•,•*•>•  ,  •  i      •  t       t      •<•          •  •    i         , 

the  superficial  fascia,  and  the  knife  being  then  laid  aside,  the  dissection  was  carried  on  by  means 

of  the  handle  of  the  scalpel  and  the  finger  nails.  The  lymphatic  of  the  saphenous  opening  was 
thus  brought  into  view,  immensely  enlarged,  congested,  and  pushed  upward.  The  aneurismal  tumor  was  found  to  have 
partially  forced  its  way  through  this  opening,  overlapping  its  upper  edge  like  a  femoral  hernia.  Commencing  at  the  inner 
margin  of  this  opening  the  dissection  was  carried  on  without  much  difficulty  to  Poupart's  ligament,  which  was  found  very  tense, 
and  the  artery  could  be  felt  beating  just  beyond.  The  upper  end  of  the  incision  was  then  prolonged  one  inch  toward  the  umbil 
icus,  and  after  dividing  the  tendons  of  the  external  oblique  on  a  director,  the  ligament  was  divided  directly  over  the  artery  by 
blunt-pointed  scissors.  The  sheath  of  the  artery  was  soon  brought  plainly  into  view  and  its  covering  pushed  up  to  one-half 
inch  beyond  the  epigastric  and  circumflex  arteries,  at  which  point  a  ligature  was  placed  around  from  within  outward  by  means 
of  a  Mott's  aneurismal  needle.  The  effect  of  ligation  was  to  arrest  pulsation  in  the  tumor.  The  curved  wound  was  closed  by 
means  of  silver  interrupted  sutures.  One  small  artery,  the  superficial  epigastiic,  required  ligation.  Not  more  than  one  ounce 
of  blood  was  lost  during  the  operation.  The  limb  was  enveloped  in  cotton  batting.  An  anodyne  was  given  after  recovery  from 
the  amcsthetic,  and  repeated  at  midnight.  At  4  o'clock  P.  M.  the  patient  was  quiet;  pulse  120,  temperature  of  sound  limb  93, 
of  limb  operated  upon  95  in  popliteal  space.  November  7th,  patient  passed  a  quiet  night,  though  sleeping  but  little,  and  states 
that  the  neuralgic  pains  have  ceased.  In  a  paper  on  Hospital  Ganyrcnc,  by  Acting  Assistant  Surgeon  A.  North,  printed  in  the 


Fio.  14.  —  Liantion  of  right  ex- 
ternal  iliac  for  shot  injury.  Sj>.  :to80. 


1  The  case  is  briefly  noted  by  Surgeon  J.  A.  LlDF.LF,,  U.  S.  V.,  Gunshot  Wound  of  Thigh,  etc.,  in  Surgical  Memoirs  of  the  \Var  of  the  Rebellion, 
coll.  and  pub.  by  the  U.  S.  San.  Comm.,  1870,  Surgical  Vol.  I.  p.  231. 


SECT.  1. 1  LTGATIONS    AFTER    SHOT    FLESH    WOUNDS.  41 

American  Medical  Times,  1833,  Volume  VI,  p.  257,  the  sequel  of  the  history  is  given:  "The  operation  was  successful,  and  in 
two  weeks  the  wound  was  nearly  healed,  when  it  took  on  an  unhealthy  action,  and  patient  then  complained  of  a  burning  pain 
in  it.  Anticipating  what  was  coming,  he  was  immediately  moved  to  a  stone  building  where  there  had  previously  been  no  gan 
grene;  and  here,  November  21st,  he  came  under  my  care.  He  remained  here  for  four  days  before  the  disease  became  sufficiently 
developed  to  justify  his  removal  to  the  gangrene  tent.  November  25th,  patient  is  very  desponding,  and  is  growing  weaker  day 
by  day ;  has  considerable  headache ;  pulse  120  and  almost  imperceptible ;  tongue  furred,  brown,  tip  and  edges  red  and  dry. 
The  ulcer,  which  is  three  inches  in  width,  extends  from  the  pubes  up  nearly  to  the  anterior  spine  of  the  ilium;  has  an  unhealthy 
and  sloughy  appearance.  Patient  complains  of  a  slight  burning  pain  in  wound,  the  edges  of  which  are  everted,  jagged,  and 
undermined  for  about  two  inches;  the  integument  is  indurated  and  tumefied,  and  extremely  sensitive  to  the  touch  or  the  least 
movement  of  the  limb;  characteristic  odor  not  well  marked.  The  sinuses  extending  under  the  integument  were  freely  laid  open 
and  the  surface  of  the  ulcer  scraped  with  a  spatula,  to  which  the  acid  was  first  applied  with  a  mop,  and  then  worked  in  with  a 
stick  so  as  to  get  it  down  to  the  comparatively  healthy  tissue,  and  was  also  applied  in  a  similar  manner  to  the  tissue  surround 
ing  the  ulcer,  to  destroy,  in  this  way,  both  the  cuticle  and  cutis  vera  and  thus  to  limit  the  extension  of  the  disease.  Superficially 
antiseptic  poultices  were  applied,  and  opiates  given  to  relieve  pain ;  takes  half  an  ounce  of  brandy  and  beef-tea  every  half  hour. 
November  26th,  although  the  pain  following  the  application  of  the  acid  was  so  severe  as  to  cause  slight  convulsions  for  a  time, 
patient  is  feeling  better  to-day;  pulse  108  and  gaining  in  strength.  Fearing  that  the  progress  of  the  disease  has  not  been 
entirely  arrested,  the  acid  was  again  thoroughly  applied.  Takes  stimulants  and  tonics,  with  fifteen  grains  of  tartrate  of  iron 
and  potass  three  times  a  day.  November  28th,  the  black,  charred  slough  has  separated,  revealing  a  healthy,  granulating 
surface  beneath.  The  extreme  sensitiveness  to  the  touch,  together  with  the  induration  and  swelling  of  the  surrounding  parts, 
has  almost  entirely  disappeared;  applied  oakum  saturated  with  acid  wash  to  the  ulcer.  December  5th,  patient  represents 
himself  as  feeling  much  better;  mind  hopeful  and  cheerful ;  appetite  good;  ulcer  is  cicatrizing  rapidly;  continue  stimulants  and 
tonics.  December  15th,  all  unfavorable  symptoms  have  disappeared  and  patient  is  regarded  as  convalescent.  For  two  months 
after  this  date  patient  Avas  up  and  about  the  ward,  when  secondary  haemorrhage,  following  sloughing  of  the  sac,  supervened, 
arid  in  four  days  resulted  fatally,"  March  15,  1863.  Assistant  Surgeon  R.  F.  Weir's  notes  state  that  a  sudden  change  occurred 
on  February  25th,  when,  in  the  evening,  the  patient  had  high  fever;  pulse  140  and  almost  imperceptible.  On  February 
27th,  considerable  pain  over  the  right  tuber  ischii  and  knee  joint.  A  consultation  failed  to  discover  the  cause  of  this  change 
for  the  worse.  On  March  2d,  an  opening  formed  at  the  upper  portion  of  the  cicatrix  and  discharged  twelve  ounces  of  ill- 
conditioned  pus.  The  opening  was  enlarged  and  examined  digitally  and  with  a  probe;  the  cavity  was  syringed  out.  March 
9th,  the  patient's  condition  had  improved  since  the  opening  of  the  sac.  March  13th,  about  the  same,  discharge  increasing  in 
quantity.  It  was  decided  to  make  a  counter  opening  at  the  lower  extremity  of  the  sac,  on  the  inside  of  the  thigh,  and  seven 
ounces  of  fetid  pus  escaped,  which  was  soon  succeeded  by  a  jet  of  arterial  blood.  The  sac  was  laid  freely  open  and  a  compress 
of  sheet-lead  was  held  over  the  sac  by  an  assistant  provided  with  relays  of  assistants.  About  seven  ounces  of  blood  was  lost 
during  the  operation.  On  March  14th,  at  9  o'clock  A.  M.,  pressure  was  removed  and  bleeding  occurred,  five  ounces  being  lost. 
Pressure  was  again  applied.  On  March  15th,  the  patient  was  much  brighter,  and  it  was  decided  to  keep  up  pressure  until 
bleeding  recurred,  and  then  to  enlarge  the  lower  opening,  search  for  the  bleeding  point,  and,  if  it  could  not  be  found,  to  freely 
lay  open  the  sac.  At  7  o'clock  P.  M.,  seven  ounces  of  blood  were  lost.  Chloroform  was  given  and  the  opening  enlarged;  clots 
were  turned  out,  the  entire  cavity  was  exposed,  and  nothing  more  than  a  general  oozing  could  be  found.  The  cavity  was 
thoroughly  cleansed,  and  the  slight  oozing  of  blood  was  stopped  by  cold  water.  The  patient  sank  soon  afterwards,  from  the 
antecedent  haemorrhages  and  the  shock  of  operation.  An  autopsy  was  made  four  hours  after  death  :  "Body  much  emaciated; 
rigor  mortis  well  marked;  right  thigh  flexed  on  pelvis  and  everted.  The  incision,  made  for  the  purpose  of  opening  the  suppu 
rating  cavity  to  arrest  the  haemorrhage  which  occasioned  death,  was  seven  inches  long,  commencing  about  one  and  a  half  inches 
to  the  inner  side  and  on  a  level  with  the  anterior  superior  spinous  process,  and  terminating  on  the  inner  side  of  the  thigh.  The 
thickness  of  the  tissue  divided,  part  of  which  was  cicatricial,  was  about  three  and  a  quarter  inches,  in  which  ran  the  femoral 
vessels.  These  were  found  to  have  been  divided  by  this  incision  but  did  not  otherwise  directly  communicate  with  the  aneur- 
ismal  cavity.  This  cavity  occupied  the  iliac  fossa  of  the  right  side  and  was  situated  between  the  fibres  of  the  iliac  muscles,  and 
had  crowded  the  caput  coli  toward  the  median  line.  It  extended  from  a  level  with  the  fourth  lumbar  vertebra  to  four  and  a 
half  inches  below  Poupart's  ligament.  The  sac  or  abscess  in  the  thigh  was  about  four  inches  in  diameter  and  of  a  size  nearly  to 
contain  a  foetal  head.  It  had  dissected  up  the  tissues  with  the  exception  of  the  tendons,  psoas,  and  iliacus  from  lesser  trochanter, 
and  anterior  and  inner  surfaces  of  the  femur.  Below  this  point,  at  the  bottom  of  the  cavity,  a  track  extended  to  the  inside 
of  the  lesser  trochanter  and  approached  to  within  an  inch  of  the  surface  of  the  tuberosity  of  the  ischium.  Another  track 
extended  in  front  of  the  pubes  toward  the  root  of  the  pubis.  This  extensive  cavity  contained  about  four  ounces  of  coagulum 
mixed  with  blood,  which  gave  to  the  smooth  wall  a  sloughy  appearance.  At  the  inferior,  beneath  the  femoral  artery,  a  small 
quantity  of  fresh  coagulum  was  found  in  the  cellular  tissue,  suggesting  the  idea  that  the  haemorrhage  had  proceeded  from  this 
point,  but  the  vessels  causing  it  could  not  be  found.  An  attempt  had  been  made  to  inject  the  artery,  but  had  failed  for  the  want 
of  proper  instruments.  On  dissection  of  the  abdominal  walls  the  peritoneal  cavity  and  its  contents  were  found  in  a  healthy 
condition.  The  external  iliac  artery  of  the  right  side,  from  its  origin  to  the  point  of  ligation,  had  diminished  to  a  small  cord 
about  one-eighth  of  an  inch  in  diameter,  firm  to  the  touch,  and  of  a  dark  color  from  its  containing  clot.  The  principal  branch 
of  the  external  iliac,  the  epigastric,  and  circumflex  were  found  larger  than  the  corresponding  arteries  of  the  left  side.  The 
sacral  artery  was  also  enlarged.  The  chain  of  lymphatic  ganglia  along  the  inside  of  the  iliac  artery  was  much  enlarged  and 
indurated,  and  the  tissue  in  the  region  of  Poupart's  ligament  had  been  much  altered  and  firmly  matted  together  by  inflamma 
tory  Action.  The  femoral  artery,  as  it  passed  under  the  ligament,  was  nearly  three-fourths  of  an  inch  nearer  the  pubis  than 
usual.  The  femoral  vein  was  in  a  normal  condition.  The  artery  below  the  point  of  ligature  to  the  point  of  division,  in  the 
operation  immediately  preceding  death,  was  about  three  and  one-fourth  inches  in  length.  This  portion  was  laid  open,  together 
with  the  upper  portion  of  the  femoral  artery,  in  order  to  ascertain,  if  possible,  the  locality  of  the  original  injury.  About  one 
and  a  half  inches  below  the  origin  of  the  epigastric  and  its  inner  margin  there  was  a  faint  permanent  discoloration,  which  also 
SURG.  Ill— 6 


42  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

presented  a  slight  linear  appearance;  elsewhere  the  artery  presented  no  peculiar  appearance."     The  specimen  is  represented  in 
the  wood-cut  (FlG.  14),  drawn  from  the  preparation  3986,  Section  I,  A.  M.  M.,  and  presented  by  Dr.  Weir  to  the  Museum. 

In  the  other  seven  cases  of  ligation  of  the  external  iliac  the  femoral  artery  had 
previously  been  ligated.  Successful  results  were  finally  attained  in  two  instances: 

CASES  87-93. — Private  J.  S.  Degolia,  Co.  A,  76th  Pennsylvania,  aged  32  years,  wounded  at  Drury's  Bluff,  May  16, 
1864.  Surgeon  A.  Heger,  U.  S.  A.,  described  the  injury  and  its  result  as  follows:  "The  patient  was  admitted  to  the  Point 
Lookout  Hospital  May  19th,  having  been  wounded  by  a  musket  ball  entering  the  right  hip  at  the  external  and  posterior  aspect, 
passing  across,  over  the  pubes,  to  the  left  thigh,  and  downward  toward  the  knee,  wounding  the  great  vessels  of  the  left  side, 
and  making  its  exit  one  inch  above  the  knee,  on  the  external  surface.  On  May  24th,  the  femoral  artery  was  ligated  above  the 
wound  two  inches  below  Poupart's  ligament.  The  patient  was  much  prostrated  from  the  severity  of  the  wound  and  loss  of 
blood.  Stimulants  were  used,  and  warm  applications  to  the  limb.  Repeated  haemorrhage  required  the  ligation  of  the  external 
iliac  on  May  29th.  The  patient  died,  of  gangrene,  June  1,  1864.  The  first  operation  was  performed  by  Surgeon  A.  Heger, 
U.  S.  A.,  and  the  second  by  Surgeon  J.  H.  Thompson,  U.  S.  V." — Private  W.  S.  Marshall,  Co.  E,  llth  Pennsylvania  Reserves, 
aged  26,  wounded  at  Gaines'  Hill,  June  27,  1862.  Assistant  Surgeon  C.  Wagner,  U.  S.  A.,  reported  that  the  patient  was  admitted 
into  Hammond  Hospital  with  a  "gunshot  wound  of  the  right  thigh  and  false  aneurism  of  the  femoral  artery.  The  aneurism 
measured  six  and  a  quarter  inches  in  its  longest  diameter.  Dr.  \Vagner  ligated  the  femoral  near  Poupart's  ligament.  On 
September  6th,  haemorrhage  to  the  extent  of  forty  ounces  occurred  from  the  femoral  artery.  Dr.  Wagner  then  tied  the  external 
iliac.  The  bleeding  did  not  recur.  The  patient  died  September  16,  1862,  from  exhaustion." — Private  H.  Locke,  Co.  H,  6th 
Vermont,  aged  23  years,  wounded  at  the  Wilderness,  May  5,  1864.  Surgeon  Henry  Janes,  U.  S.  V.,  reported,  from  Sloan 
Hospital,  Montpelier:  "Gunshot  wound,  right  thigh;  ligation  of  femoral  and  iliac  arteries  for  secondary  haemorrhage.  Trans 
ferred  'to  Veteran  Reserve  Corps  December  5,  1864." — Sergeant-Major  L.  C.  Sears,  5th  New  Hampshire,  aged  22  years, 
wounded  at  Fredericksburg,  December  13,  1862.  Surgeon  T.  Antisell,  U.  S.  V.,  reported  from  Harewood  Hospital,  Wash 
ington  :  "A  conical  ball  entered  the  right  thigh  two  inches  below  Poupart's  ligament.  On  the  morning  of  December  19th  there 
was  a  slight  haemorrhage  from  the  wound.  Search  was  made  for  the  ball  without  result.  A  counter  opening  was  made  and  a 
seton  inserted.  He  remained  very  comfortable  until  the  22d  instant,  when  a  severe  haemorrhage  occurred,  which  necessitated 
the  tying  of  the  femoral  in  the  ward,  by  Dr.  Antisell.  On  Sunday,  January  4,  1863,  there  occurred  a  haemorrhage  which  was 
arrested  by  means  of  styptics  and  compression.  Another  haemorrhage  followed  on  the  evening  of  January  7th,  which  could 
not  be  controlled  by  styptics.  Search  was  made  for  the  bleeding  vessel  without  result.  The  patient  lost  much  blood.  On  the 
following  morning,  January  8th,  the  patient  was  again  brought  into  the  operating  room  and  the  wound  was  carefully  explored, 
but  the  bleeding  vessel  was  not  found.  The  operation  of  tying  the  external  iliac  artery  was  then  performed  by  Dr.  Antisell,  in 
the  hope  of  arresting  the  haemorrhage  permanently.  The  operation  was  no  sooner  completed  than  there  was  a  welling  up  of 
blood  from  the  point  from  which  the  previous  haemorrhage  had  proceeded.  Styptics  and  compression  were  applied,  and  the  patient 
was  returned  to  the  barrack.  Stimulants  and  beef-tea  were  freely  given,  and  warmth  was  applied  to  the  extremities  to  restore 
reaction.  He  revived  toward  evening,  and  remained  sensible  and  quite  comfortable  until  the  evening  of  the  10th  instant.  He 
died  January  11,  1863,  from  exhaustion." — Lieutenant  J.  A.  McQuillan,  Co.  I,  38th  Ohio,  aged  25  years,  wounded  near  Atlanta, 
July  29,  1864.  Surgeon  J.  H.  Phillips,  U.  S.  V.,  reported,  from  Hospital  No.  1,  Chattanooga:  "Gunshot  wound  of  right 
thigh.  Haemorrhage  occurred  on  September  20th,  thirty  ounces  of  blood  being  lost.  The  femoral  artery  was  ligated  Sep 
tember  20th,  in  the  wound,  which  was  gangrenous.  On  the  26th.  the  haemorrhage  again  returned,  and  it  being  found 
impossible  to  ligate  it  again  in  the  wound,  the  external  iliac  was  ligated  just  above  Poupart's  ligament,  after  which  the 
haemorrhage  did  not  recur,  but  the  gangrene  continued,  and  the  patient  sank,  and  died  October  2,  1864." — Private  R.  B.  Corn- 
well,  Co.  A,  23d  Ohio,  aged  23  years,  wounded  at  South  Mountain,  September  14,  1862.  Assistant  Surgeon  W.  E.  Waters, 
U.  S.  A.,  reported  from  Caspari  Hospital  that  the  patient  died  November  3,  1862,  of  peritonitis.  Acting  Assistant  Surgeon  L. 
Heard  reported:1  "The  shot  had  entered  some  four  inches  below  Poupart's  ligament,  over  the  track  of  the  femoral  artery.  An 
examination  gave  evidence  that  the  femoral  artery  had  been  wounded  and  that  a  traumatic  aneurism  was  forming.  Water 
dressing  was  applied  till  the  29th,  when  compression  by  means  of  a  horse-shoe  tourniquet  was  made,  and  continued  until  Octo 
ber  4th.  On  October  10th,  Drs.  J.  F.  May  and  Shippen,  assisted  by  Drs.  Hall  and  Seeley,  ligated  the  femoral  artery.  Ligatures 
were  placed  on  the  cardiac  and  distal  sides,  and  the  vessel  was  divided  between  the  two  ligatures.  (Jn  the  sixth  or  seventh 
day  bleeding  occurred,  which  was  soon  arrested  and  a  tourniquent  placed  upon  the  h'mb.  In  about  a  fortnight  after  the  oper 
ation  the  proximal  ligature  came  away  of  itself,  with  knot  and  loop  at  the  end.  On  October  30th,  profuse  secondary  haemor 
rhage  took  place,  which  greatly  reduced  the  strength  of  the  patient.  Dr.  May  ligated  the  external  iliac  artery.  The  patient 
gradually  sank,  and  died  November  3,  1862." — Sergeant  J.  K.  Zeiders,  Co.  I,  53d  Pennsylvania,  aged  19  years,  wounded  near 
Gettysburg,  July  3,  1863.  Acting  Assistant  Surgeon  W.  V.  Keating  reported,  from  Broad  Street  Hospital,  Philadelphia: 
"  Gunshot  flesh  wound  of  the  right  thigh  by  a  conical  ball.  The  wound  sloughed,  and  secondary  haemorrhage  occurred  from  the 
femoral  artery  on  July  28th.  The  haemorrhage  recurring  on  August  4th,  Acting  Assistant  Surgeon  A.  Hewson  ligated  the 
femoral  artery  just  above  Scarpa's  triangle,  and  on  August  llth  again  ligated  the  vessel  higher  up.  The  thigh  became  some 
what  cedematous;  by  October  28th  the  wounds  of  the  previous  ligations  had  nearly  healed  externally.  A  sinus  extended  into 
the  tissues  below,  which  were  found  to  be  in  a  softened  broken-down  condition ;  ligature  separated.  On  October  8th,  Dr. 
Hewson  administered  ether  and  ligated  the  external  iliac  artery  through  a  curved  incision  about  three  inches  long;  about  six 
ounces  of  blood  lost.  October  25th,  slight  haemorrhage  from  point  of  ligature,  and  another  in  the  afternoon,  amounting  in  all  to 
about  six  ounces;  controlled  by  styptics  to  wound  and  oil  of  turpentine  and  veratrnm  viride  internally.  Pulse  130  and  weak." 
The  patient  was  discharged  from  service  May  14,  1864. 


1  HEARD  (L.),  Wound  of  the  Femoral  Artery — Ligation  of  both  Cardiac  and  Distal  Sides  of  Severed  Vessel — Secondary  Hamorrhage — Lirjature 
of  External  Iliac— Peritonitis— Death ;  in  Am.  Med.  Times,  1862,  Vol.  AT,  p.  337;  and  Boston  Wed.  and  Surg.  Jour.,  1862,  Vol.  LXVII,  p.  369. 


SECT.  1. 1 


LIGATIONS    AFTER    SHOT    WOUNDS. 


43 


Professor  John  Ashhurst,  jr.,  has  lately  remarked1  that  a  study  of  the  statistics  of 
the  operations  of  tying  some  of  the  larger  arteries  impresses  the  fact  that  "as  cases  have 
accumulated,  the  percentage  of  mortality  has  greatly  increased."2  This  comment,  however, 
is  less  applicable  to  the  series  of  ligations  of  the  external  iliac  artery.3  In  studying  the 
statistics  the  operations  for  disease  and  for  traumatic  cause  must  be  discriminated.  The 
war  cases  have  a  fatality  more  than  twice  as  great  as  those  in  civil  practice.4 

^Ligation  of  the  Femoral  Artery. — In  a  previous  portion  of  this  section,  commencing 
at  page  16,  reference  is  made  to  sixty-two  ligations  of  the  femoral  artery  for  direct  shot 
injury  of  the  vessel,  with  the  large  mortality  of  72.6  per  cent.  An  interesting  example 
of  a  well-managed  successful  case  is  adduced,  and  the  great  importance  of  ligating  the 
distal  as  well  as  proximal  extremities  of  the  vessel  is  urgently  enjoined.  In  addition  to 
these  sixty-two  cases  there  were  sixty-five  instances  in  which  the  femoral  artery  was  tied 
for  consecutive  bleeding  unattended  by  primary  injury  to  the  vessel.  The  hundred  and 
twenty-seven  examples  are  enumerated  in  the  summary  entitled  TABLE  III.  This  series 
presents  the  same  grave  mortality  as  when  the  cases  of  direct  lesion  of  the  vessels  were 
separately  considered.  References  to  publications  of  detailed  cases  are  given;  a  few 
abstracts  will  be  presented  of  cases  which  furnished  pathological  material  for  the  Museum : 

CASE  94. — Private  B.  Ayres,  Co.  A,  5th  Iowa,  aged  40  years,  was  wounded  at  Vicksburg,  May  19,  1863,  transferred  by 
hospital  steamer  to  Memphis,  and  admitted  into  Gayoso  Hospital  on  the  27th.  On  the  Medical  Descriptive  List  appear  the 
following  notes  by  Acting  Assistant  Surgeon  A.  W.  Nelson :  "A  minie"  ball  entered  the  left  thigh  through  the  centre  of  Scarpa's 
triangle,  passing  to  the  inside  of  the  vein  and  out  at  the  lower  part  of  the  left  nates.  At  the  time 
of  admission  the  wound  was  in  a  very  dirty  and  sloughing  condition  and  the  skin  had  a  dark  tinge. 
There  was  considerable  diarrhoea,  with  free  perspiration ;  he  was  dozing  a  good  deal  of  the  time 
without  any  opiate ;  pulse  100.  Water  dressings  were  applied,  and  he  was  ordered  to  lie  on  the 
abdomen  occasionally  to  allow  the  discharge  to  escape.  Ale  was  given  daily.  He  had  a  severe 
rigor  on  the  evening  of  the  30th,  and  on  the  31st,  at  7  o'clock  p.  M.,  had  haemorrhage  from  the 
anterior  wound,  which  was  checked  by  a  compress.  Fifteen  grains  of  quinine  were  divided  into 
four  powders,  one  powder  to  be  given  every  four  hours.  At  2  o'clock  p.  M.  on  June  1st  the  wound 
was  opened  to  the  sheath  of  the  femoral  vessels  and  a  darning  needle  removed  from  the  sheath; 
there  was  no  haemorrhage,  and  all  compression  was  removed.  The  wound  was  thoroughly  cleansed, 
and  the  patient  removed  to  bed.  About  8  o'clock  P.  M.  blood,  in  large  quantities,  burst  forth  in  a 
jet,  apparently  from  below ;  it  was  quite  dark,  but  the  exact  shade  was  not  observed.  The  femoral 
artery  was  immediately  ligated,  but  with  difficulty  owing  to  the  thickened  and  diseased  condition  of 
the  parts.  There  was  no  haemorrhage  after  ligation,  but  patient  did  not  rally  under  the  use  of 
stimulants,  and  he  died  at  11  o'clock  P.  M.  Chloric  ether  was  used  during  the  operation.  The 
autopsy  disclosed  great  sloughing  in  the  course  of  the  wound.  There  was  a  slough  of  the  femoral 
vein  of  the  size  of  a  three-cent  piece.  The  vein  was  pierced  by  the  large  needle  alluded  to  above, 
two  small  holes  existing  opposite  each  other;  the  artery  was  healthy.  It  was  observed  that  well 
marked  symptoms  of  pyaemia  existed  several  days  before  his  death ;  however,  the  autopsy  was  not  carried  far  enough  to  verify 
this  diagnosis."  The  specimens  (FiG.  15)  consist  of  wet  preparations  of  the  left  femoral  artery  ligated  below  the  origin  of  the 
profunda,  and  of  the  femoral  vein,  showing  the  point  of  perforation  by  the  needle,  which  were  contributed  by  Dr.  Nelson. 

1  Transactions  of  the  International  Medical  Congress  of  Philadelphia,  1877,  p.  572. 

2  Thus  Professor  AsmiuusT  observes  that  when  Dr.  G.  W.  NOURIS  published  liis  classical  paper  in  1847  (Am.  Jour.  Afed.  Sei.,  Vol.  XIJI,  p.  24), 
he  had  collected  sixteen  eases  of  ligation  of  the  common  iliac  artery  with  eight  recoveries  and  eight  deaths,  a  mortality  of  fifty  per  cent.,  while  there 
are  now  recorded  sixty-one  cases  with  only  thirteen  recoveries  and  forty-eight  deaths,  a  mortality  of  seventy-nine  per  cent. 

3Thus  HODGSON  (Treatise  on  Diseases  of  Arteries,  etc.,  1815,  p.  416)  enumerated  twenty-one  instances  of  ligations  of  the  external  iliac  following 
the  first  operation  by  AUEUXETHY,  in  1796,  and  fifteen  of  the  twenty-two  patients  completely  recovered,  or  68.2  per  cent.  In  1875,  Dr.  RABE  collected 
(Deutsche  Zeitschrift  fur  Chir..  Leipzig.  1875,  B.  V,  p.  213)  two  hundred  and  seven  cases  of  ligations  of  the  external  iliac,  of  which  one  hundred  and 
thirty-five  recovered,  or  C5.2  per  cont.,  advancing  the  death  rate  but  3  per  cent.,  though  the  number  of  cases  is  decupled. 

4  Among  American  Surgeons  two  principal  methods  of  ligating  the  external  iliac  artery  are  taught  and  practised.  ABEKXETHY,  who  first  ligated 
this  vessel  on  the  living  subject  in  l"9(i  (TJie.  Medical  and  Physical  Journal,  London,  1802,  Vol.  VII.  p.  97.  and  The  Surgical  and  Physiological  works 
of  JOHN  ABEKXETHY,  London,  ]830,  Vol.  I,  p.  292),  made  a  perpendicular  incision  ''about  three  inches  in  length,  through  the  integuments  of  the 
abdomen  in  the  direction  of  the  artery,  and  thus  laid  bare  the  aponeurosis  of  the  external  oblique  muscle,  which  was  next  divided  from  Poupart's  liga 
ment,  in  the  direction  cf  the  external  wound,  for  the  extent  of  nearly  two  inches.  The  margins  of  the  internal  oblique  and  transversalis  being  thus 
exposed,  the  finger  was  introduced  beneath  them  for  the  protection  of  the  peritonaeum,  and  they  were  divided.  Next,  the  peritonaeum  and  its  contents 
were  pushed  upward  and  inward,  and  the  external  iliac  artery  taken  hold  of  with  the  finger  and  thumb.  It  now  only  remained  to  pass  a  ligature  round 
the  artery  and  tic  it ;  but  this  required  caution  on  account  of  the  contiguity  of  the  vein."  In  his  second  case.  ABERNETHY  made  his  incision  in  a  line  a 
little  external  to  the  artery  to  avoid  the  epigastric.  Both  of  these  operations  failed,  but  ABERXETHY's  third  and  fourth  attempts  were  completely  suc 
cessful.  Sir  ASTLKY  (JOOl'Eu's  operation  is  generally  preferred  as  endangering  the  peritoneum  less,  and  less  weakening  the  abdominal  parietes  so  as  to 
give  a  tendency  to  hernia.  Sir  A.  COOPER  saved  four  of  his  six  patients.  His  method  of  operating  is  described  in  HODGSOX  (op.  cit.,  p.  42),  by  HARRISON 


Fie.  15. — Femoral  artery  and 
vein.  Ligation  of  artery.  Specs. 
2085,  2020. 


44 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  16.— 
Ligation 
of  femoral. 


FIG.  17. -Left 
femoral  artery 
tied  four  and  a 
half  inches  be- 
lowtheprofun- 
da.  Spcc.y.ft-3. 


CASK  U5. — Private  S.  Brown,  Co.  G,  134th  New  York,  aged  16  years,  was  accidentally  wounded  on  August  30,  1862, 
and  entered  the  Mansion  House  Hospital,  Alexandria,  six  days  afterwards.  Assistant  Surgeon  W.  A.  Conover,  U.  S.  V., 
contributed  the  following  report  of  the  injury  :  "  The  ball  entered  the  left  leg  at  the  posterior  middle  third,  penetrated  the  tibialis 
posticus  muscle,  and  was  extracted  at  the  same  opening.  At  first  there  was  free  discharge  of  laudable  pus,  but 
suppuration  increased  rapidly,  and  by  September  26th  infiltration  of  the  tissues  had  nearly  reached  the  popliteal 
space.  Under  a  supporting  treatment  the  patient  seemed  to  gain  rapidly  until  November  14th,  when, 
during  his  sleep,  a  profuse  haemorrhage  occurred  from  the  sloughing  of  the  posterior  tibial  artery  and 
a  great  quantity  of  blood  was  lost  before  it  was  discovered.  His  condition  not  admitting  an  operation, 
the  wound  was  plugged  with  styptics  and  a  bandage  was  applied  from  the  toes  to  the  hip.  This  treat 
ment  controlled  the  haemorrhage  for  eight  days,  stimulants  being  given  freely  in  the  mean  time  in  order 
to  prepare  the  system  for  an  operation,  if  necessary.  On  November  28th  another  attack  of  bleeding 
was  promptly  controlled  by  the  attendant,  and,  upon  consultation,  ligation  of  the  femoral  artery  at  the 
lower  third  was  agreed  upon  as  giving  the  patient  a  chance  for  his  life.  The  operation  was  performed 
with  some  difficulty,  owing  to  the  abnormal  structure  of  a  branch  artery  which  had  to  be  carefully 
avoided.  The  patient  bore  the  operation  very  well  considering  his  condition,  and,  on  the  following  day, 
his  extremities  were  perfectly  warm  and  remained  so,  showing  that  circulation  had  been  re-established. 
The  discharge,  however,  continued  excessive,  and  although  stimulants  and  tonics  Avere  used  very  freely, 
the  patient  sank  steadily,  and  died  of  pyaemia  on  December  7,  1862.  The  autopsy  confirmed  the 
extensive  disorganization  from  infiltration  of  pus,  the  artery  being  in  an  unhealthy  condition  up  to 
within  an  inch  of  the  ligature.  The  tying  of  the  artery  was  a  success,  the  clot  having  been  perfectly 
formed  and  the  circulation  re-established  by  the  profunda,  which  was  sufficiently  enlarged  for  the 
purpose.''  The  ligated  artery  was  contributed  by  Dr.  Conover,  a  wet  preparation  of  which  is  shown 
in  the  cut  (FlG.  16). 

CASE  93. — Private  W.  Colgan,  Co.  C,  2d  Massachusetts  Cavalry,  aged  21  years,  was  wounded  at  Berry- 
ville,  September  14,  1884.  On  the  following  day  he  was  admitted  to  hospital  at  Sandy  Hook,  and  three  days 
afterwards  he  was  transferred  to  Frederick.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  reported :  The  wound  was 
caused  by  a  conoidal  ball,  which  entered  on  the  outer  border  of  the  popliteal  space  of  the  left  limb,  took  a  diagonal 
course  up  behind  the  femur,  and  emerged  on  the  inner  aspect  at  the  lower  portion  of  the  upper  third.  The 
patient  was  very  anaemic  when  admitted,  and  stated  that  he  lost  a  considerable  amount  of  blood  on  the  field. 
Stimulants  and  generous  diet  were  ordered.  On  September  24th  there  was  an  attack  of  haemorrhage  to  the 
amount  of  twelve  ounces,  which  was  checked  by  compression.  On  the  following  day  another  haemorrhage  occurred,  when  the 
femoral  artery  was  ligated  four  and  a  half  inches  below  the  profunda  by  Acting  Assistant  Surgeon  J.  C.  Shimer.  On  the  morn 
ing  of  September  28th  there  was  slight  oozing  of  arterial  blood,  when  the  openings  were  enlarged  and  the  source  of  bleeding 
searched  for  ineffectually.  Recourse  was  had  to  digital  compression.  Death  ensued  at  10  o'clock,  September  23,  1864.  At  the 
post-mortem  (see  the  adjoining  wood-cut,  FlG.  17)  the  femoral  and  profunda  arteries  were  found  to  be  intact.  (See  the  Catalogue 
of  the  Surgical  Section  of  the  Army  Medical  Museum,  I860,  p.  433.) 

CASE  97. — Private  I.  Curler,  Co.  G,  5th  Michigan,  was  wounded  at  Fair  Oaks,  May  31,  1862,  and  admitted  to  Ilygeia 
Hospital,  Fort  Monroe,  four  days  afterwards.     Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported:   "Gunshot  wound  of  femoral 
artery,  the  ball  entering  the  anterior  and  middle  portion  of  the  right  thigh  and  passing  out  opposite  posteriorly,  going  close  to 
the  inside  of  the  femur.     The  temparature  of  the  limb  was  good,  although  the  artery  at  the  ankle  beat  feebly. 
Haemorrhage  from  both  Avounds  occurred  on  June  10th,  and  returned  in  a  few  hours.     An  unsuccessful  attempt 
to  find  the  artery  below  the  wound  was  made,  and  I  tied  the  femoral,  as  I  supposed,  above  the  profunda;  but 
pulsation  being  so  strong  in  the  artery  exposed  below  the  ligature,  further  search  was  made  and  the  profunda 
was  found  unusually  high  up.    This  was  also  tied,  and  no  haemorrhage  returned.    The  foot,  before  the  operation 
warm,  now  became  cold;  but  by  the  aid  of  external  heat  its  temperature  returned  on  the  following  day.     The 
patient  was  a  fine  healthy  looking  young  fellow.     He  was  transferred  to  New  York  by  steamer  on  June  12th." 
Surgeon  S.  W.  Gross,  U.  S.  V.,  contributed  the  specimen  shown  in  the  annexed  cut  (FlG.  18)  and  reported  the 
result  of  the  case  as  follows  :  "The  patient  was  admitted  to  DeCamp  Hospital,  David's  Island,  New  York,  June 
15th,  and  was  placed  under  the  charge  of  Acting  Assistant  Surgeon  W.  K.  Cleveland.     At  the  time  of  his  admis 
sion  the  ligature  had  come  away  but  the  wound  had  not  united.     On  June  17th,  profuse  haemorrhage  occurred 
from  the  profunda  femoris,  around  which  a  ligature  was  cast.     The  patient,  however,  had  lost  so  much  blood 
that  he  succumbed  two  hours  after  the  operation."     The  specimen  (FlG.  18)  consists  of  a  small  section  of  the 
femoral  and  profunda  arteries,  and  shows  the  femoral  blocked  up  with  a  clot  at  the  seat  of  the  ligature,  also  the 
ligature  around  the  profunda,  Avhere  another  clot  was  formed. 
CASE  98. — Private  D.  Rapp,  C<>.  K,  7th  Indiana,  aged  20  years,  was  Avounded  at  Robinson's  Creek,  November  30,  1863. 
He  was  admitted  to  the  field  hospital  of  the  1st  division,  First  Corps,  Avhere  Surgeon  G.  W.  Metcalf,  76th  New  York,  noted: 
"Gunshot  wound  of  left  thigh."     On  December  6th,  the  wounded  man  Avas  transferred  to  Douglas  Hospital,  Washington. 
Three  days  aftenvards  he  was  operated  on  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  Avho  furnished  the  following  detailed 

(Surg.  Anat.  of  the  Arteries,  4th  cd.,  183!),  p.  351),  and  most  of  the  text-books.  Dr.  STEPHEN  SMITH  has  published  a  good  account  of  thirty-two  dcliga- 
tions  of  the  primitive  iliac  artery  (Am.  Jour  Med.  Sci.,  I860,  Vol.  XL,  p.  17).  I  have  mentioned  many  of  the  more  recent  cases  in  a  foot-note  to  Part  II, 
Vol.  II,  p.  333,  of  the  Med.  and  Surg.  Hist,  of  the  War.  But  by  far  the  most  comprehensive  analytical  summary  furnished  is  given  by  Dr.  L.  RAISK.  \Zur 
Unterbindung  der  grosser!  Gffdssstiimme  in  der  Continuitdt  by  Erkran-Kungen  und  Verlet:vngen  dcr  itntcren  Extremitatcrt ,  in  Deutsche  Zeitscliriftflir 
Chir..  Leipzig,  1875,  B.  V,  p.  213).  who  tabulates  207  cases  of  ligationsof  the  external  iliac,  of  which  7:.',  or  34.7  percent.,  proved  fatal.  Of  these  207  cases 
the  author  distinguishes  H4  with  22  deaths  (G4.7  %)  as  war  cases,  and  173  with  50  deaths  (28.0)  as  cases  from  civil  practice.  In  four  of  the  cases  from 
civil  life  the  common  iliac  was  afterwards  ligated  (twice  successfully),  and  in  one  of  the  cases  from  war  practice  the  same  vessel  was  tied  with  temporary 
success.  This  was  Dr.  BRAINARD'8  case,  published  in  the  Chicago  Med.  Jour..  Igfi4,  Vol.  XXI,  p.  97,  which  Dr.  RABE  quotes  from  Professor  GtiRLT'8 
Jahresbericht  for  1864. 


Fio.  18.— Sec 
tion  of  right  fem 
oral  and  profun 
da.  Ligature  on 
the  former  has 
cut  its  way  out. 
Spec.  1004. 


SECT.  I.J  LIGATIONS    AFTER    SHOT    FLESH    WOUNDS.  45 

report  of  the  case:  He  was  a  well  developed  and  very  muscular  man  and  had  been  apparently  in  good  health.  At  the  moment 
of  injury  he  was  retreating,  and  was  struck  by  a  bullet  on  the  posterior  aspect  of  the  left  thigh  a  short  distance  below  the 
gluteal  fold,  which  passed  through  the  limb  to  the  inside  of  the  bone,  divided  both  femoral  artery  and  vein,  and  made  its  exit 
three  and  a  half  inches  below  Poupart's  ligament,  at  the  point  of  election  in  ligating  the  femoral  in  Scarpa's  space.  There  was 
profuse  haemorrhage  at  the  time  of  injury,  and  an  immediate  want  of  sensibility  in  the  leg  and  foot.  When  examined  on  the 
7th  of  December,  the  whole  limb  was  found  warm  and  the  collateral  circulation  had  been  established ;  but  there  was  no  pulsa 
tion  in  either  of  the  tibial  arteries.  At  the  superior  margin  of  the  wound  of  exit  there  was  a  small  tense  swelling,  which 
pulsated  synchronously  with  the  systole  of  the  heart.  An  aneurismal  thrill,  resembling  the  loud  purring  of  a  cat,  was  distinctly 
felt,  extending  along  the  course  of  the  vessels  into  the  pelvis,  but  not  communicating  laterally.  The  little  finger  was  intro 
duced  into  the  wound  at  the  time  of  the  operation,  and  the  pulsation  and  thrill  were  found  to  be  closely  localized  and  confined 
lo  the  divided  ends  of  the  femoral  vessels.  There  was  no  extensive  effusion  of  blood  into  the  tissues  of  the  thi^h,  and  hence 
this  was  not  in  the  strict  surgical  sense  of  the  word  a  traumatic  aneurism.  It  was  concluded  that  the  sac  was  composed  only 
of  the  sheath,  which  had  been  united  by  inflammation  after  the  division  and  retraction  of  its  vessels,  and  had  then  been  some 
what  distended  after  the  heart  had  regained  its  force.  It  was  also  suggested  by  Surgeon  Lidell,  who  kindly  saw  the  case  with 
me,  that  there  was  a  free  communication  between  the  divided  artery  and  vein  in  this  sac  which  permitted  the  arterial  blood  to 
return  freely  by  the  vein,  as  evinced  by  the  pulsation  communicating  with  such  force  backward  toward  the  heart  in  the  line  of 
the  vessels.  It  was  unmistakable  that  there  existed  a  wound  of  the  femoral  artery  sufficient  to  cause  its  obliteration,  that  an 
aneurism  was  being  developed  at  the  divided  proximal  extremity,  and  that  the  proper  surgical  procedure  would  be  to  secure 
the  ends  of  the  vessel  at  the  point  of  the  injury.  It  was  determined  to  emulate  the  example  of  Mr.  Syme,  to  lay  open  boldly 
the  sac  by  a  free  incision  and  search  for  and  secure  the  bleeding  orifices.  It  was  hoped  that  the  profunda  had  escaped  injury 
and  every  precaution  was  to  be  used  to  secure  the  femoral  below  its  origin.  A  small  haemorrhage  on  December  9th  rendered 
immediate  interference  necessary,  and  the  following  operation  was  then  done  with  the  assistance  of  Surgeon 
Lidell  and  the  medical  officers  of  the  hospital.  After  the  patient  had  been  fully  etherized  and  the  femoral  artery 
thoroughly  compressed  on  the  pubes  by  the  thumb  of  a  reliable  assistant,  as  evinced  by  the  loss  of  pulsation  in 
the  tumor,  an  incision  four  inches  in  length  was  made  through  the  skin  and  fasciae,  immediately  over  the  tumor 
and  including  the  gunshot  wound,  in  a  line  parallel  with  the  sartorius.  A  second  incision  was  now  made  into 
the  tumor,  which  was  dilated  instantly  by  the  finger  to  the  siz«  of  the  first.  Distal  haemorrhage  was  anticipated, 
and  it  caused  but  little  surprise  when  a  most  profuse  dark  colored  torrent  poured  out  from  the  incision.  The 
lower  angle  of  the  incision  was  rapidly  searched  in  vain  for  the  source  of  the  haemorrhage,  and  it  was  feared 
that  it  might  come  from  the  dark  softened  depth  of  the  track  of  the  ball.  No  pressure  on  the  artery  had  the 
least  controlling  effect  upon  it.  The  removal  of  the  sponge  was  followed  instantly  by  a  boiling  dark  torrent  of 
venous  blood,  which  so  quickly  filled  the  cavity  as  to  prevent  any  examination.  So  profuse  and  uncontrollable 
was  the  flow  that  visions  of  ligating  the  external  iliac  were  vividly  presented  to  the  mind.  When  the  flow 
was  found  to  arise  from  the  superior  angle  of  the  incision  numerous  and  ineffectual  efforts  -were  made  to  secure 
the  vessel,  but  the  parts  were  so  hardened  by  local  inflammation  that  the  forceps  glided  over  them  as  it  would 
over  a  cartilaginous  surface.  This  point,  from  whence  the  dark  blood  seemed  to  flow,  was  finally  compressed 
by  the  point  of  the  left  index  finger,  and  by  means  of  the  nail  of  the  small  finger  of  the  right  hand  a  vessel  was 
isolated,  a  ligature  passed  around  it  with  an  aneurism  needle,  and  this  haemorrhage,  most  embarrassing  because 
uncontrolled  by  pressure,  was  finally  suppressed.  The  first  ligature  was  applied  at  the  superior  angle  of  the  ,.FIG'  1f9'TLiffa; 
incision  to  the  proximal  extremity  of  the  divided  femoral  vein,  from  which  this  unexpected  and  most  annoying  artery  and  vein, 
hajmorrhage  escaped  by  regurgitation  from  the  saphena.  The  blood  found  its  way  into  the  limb  by  means  of  Spec>> 
arteries  arising  from  the  iliac  above  the  point  compressed,  was  finding  its  Avay  back  by  the  sapheiia,  enlarged  to  compensate  for 
the  occlusion  of  the  femoral,  was  poured  into  the  femoral  a  short  distance  above  its  divided  proximal  extremity,  and  then  regur 
gitated  through  the  stump  of  the  femoral  into  the  superior  angle  of  the  incision.  The  proximal  end  of  the  femoral  artery,  from 
which  a  crimson  tide  escaped  on  relieving  the  pressure  slightly,  was  now  easily  found,  and  this  was  ligated.  The  wound  was 
now  thoroughly  cleansed  of  all  clots  of  blood.  The  femoral  artery  and  vein,  denuded  of  their  sheath  for  a  distance  of  two  inches, 
were  clearly  seen  at  the  bottom  of  the  wound,  their  divided  extremities  having  become  adherent  to  the  neighboring  tissues  during 
the  inflammatory  action  of  the  previous  ten  days.  As  a  precautionary  measure  a  ligature  was  cast  around  the  femoral  artery  at 
the  lower  angle  of  the  wound,  and  some  little  difficulty  was  experienced  in  discriminating  between  the  artery  and  vein,  owing 
to  the  fact  that  from  ten  days'  disuse  the  vein  in  becoming  an  impervious  cord  had  become  similar  in  size,  color,  and  consistency 
to  the  artery.  A  small  orifice  was  observed  in  the  vein  near  its  distal  extremity,  and  from  this  occurred  a  free  black  How  on 
moving  the  limb.  This  was  also  included  in  a  ligature.  The  wound  was  now  closed  by  one  or  two  sutures  and  the  patient 
placed  in  his  bed.  A  brief  recapitulation  may  give  clearness  to  the  above  account.  The  first  vessel  tied  was,  therefore,  the 
proximal  extremity  of  the  femoral  vein  near  the  entrance  of  the  saphena;  the  second,  the  femoral  artery  a  short  distance  below 
the  origin  of  the  profunda,  both  at  the  superior  angle  of  the  incision ;  the  third,  the  femoral  artery  at  the  lower  angle  of  the 
incision  and  two  inches  from  its  distal  extremity;  the  fourth,  the  femoral  vein  near  its  distal  extremity  at  the  centre  of  the 
incision,  and  to  control  a  flow  from  an  incision  through  its  coats,  which  may  have  been  made  accidentally.  The  profunda  had 
not  been  seen,  and  it  was  hoped  that  it  would  suffice  to  keep  up  the  circulation.  No  important  arterial  channels  had  been 
interfered  with  by  the  operation,  and  a  successful  issue  might  be  expected.  The  man  was  stimulated,  took  morphia,  and  his 
leg  was  covered  closely  in  bed  with  blankets  to  preserve  the  animal  warmth.  This  man  had  lost  blood  freely  at  the  time  of  the 
injury;  he  had  been  subjected  to  a  very  long  and  fatiguing  transport  in  ambulances  and  cars  before  reaching  the  hospital,  and 
for  seven  days  his  food  had  not  been  as  good  or  sufficient  as  might  have  been  desired  for  one  about  to  undergo  such  an  operation. 
He  was  pallid  and  haggard  looking,  and  iron,  nutrients,  and  stimulants  were  freely  ordered.  There  was  great  pain  and  restless 
ness  during  the  ensuing  night,  and  large  quantities  of  morphia  were  required  to  procure  sleep.  December  10th,  no  interference 
with  the  circulation;  leg  and  foot  both  warm.  The  whole  limb  is  swollen,  and  bloody  serum  escapes  freely  at  the  point  of 


46  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

the  injury.  December  l^tli,  the  restlessness  has  been  the  most  marked  symptom,  caused  seemingly  by  constant  and  severe'  l-ut 
indescribable  pain  in  the  limb.  The  pnlse  is  120,  the  countenance  pale  and  haggard,  the  tongue  dry  and  coated,  and  the 
general  symptoms  indicate  great  nervous  prostration.  Large  quantities  of  morphia  have  been  found  requisite.  The  whole 
limb  and  foot  are  much  swollen  and  oedematous.  On  the  evening  unmistakable  signs  of  sphacelus  appeared,  the  foot  became 
cold,  and  a  hue  of  purple  discoloration  was  observed  as  high  up  as  the  ankle.  The  neuralgic  pain  and  restlessness  still  con 
tinued.  On  December  13th,  all  the  symptoms  were  worse.  The  discoloration,  the  dark  purple  hue  of  gangrene,  extended 
rapidly  upward,  particularly  on  the  inside  of  the  limb.  The  whole  thigh  became  crepitant,  the  pulse  more  rapid  and  feeble. 
He  became  more  and  more  depressed,  and  finally  died  at  12  o'clock  at  night.  These  final  scenes  all  surgeons  can  imagine.  The 
post-mortem  revealed  nothing  interesting  in  the  great  cavities.  The  whole  thigh  and  leg  were  found  gangrenous  as  far  as  the 
point  of  the  injury.  The  vessels  were  dissected,  spread  upon  a  board,  and  a  most  faithful  picture  was  made  of  them  by  the 
artist  under  Dr.  Brinton's  direction.  Only  the  proximal  extremities  of  the  vessels  were  found  in  the  softened  gangrenous 
mass;  but  they  threw  light  upon  the  history  of  the  case.  The  artery  was  divided  below  the  origin  of  the  profunda,  which  was 
uninjured,  but  not  enlarged,  as  one  would  expect  if  the  whole  force  of  the  circulation  had  been  directed  toward  it  by  the  oblit 
eration  of  the  main  artery.  In  ten  days  the  profunda  should  here  have  been  as  large  as  the  femoral,  if  all  the  blood  brought 
to  the  divided  femoral  had  been  seeking  a  passage  through  its  calibre.  Its  undilated  condition  gives  color  to  the  idea  that  most 
of  the  blood  brought  to  the  divided  femoral  extremity  found  its  way  quickly  back  by  the  divided  femoral  vein  ;  that  the  pressure 
was  thus  relieved,  and  that  the  profunda  received  only  its  usual  supply  of  blood.  That  the  limb  was  nourished  by  a  collateral 
circulation,  arising  above  the  brim  of  the  pelvis,  is  clear  from  the  fact  that  no  pressure  on  the  external  iliac  would  restrain  the 
flow  x»f  blood  from  the  saphena  through  the  femoral  vein.  The  saphena  vein  is  normal,  and  its  relation  with  the  femoral 
indicates  how  easily  the  regurgitating  haemorrhage  was  caused,  as  no  valves  are  there  to  prevent  it.  For  several  days — from 
the  9th  to  the  12th — there  were  no  signs  of  an  interference  with  the  circulation,  but  at  that  time  gangrene  appeared  and  spread 
with  great  rapidity.  This  may  have  been  due  to  the  recent  phlebitis  of  the  profunda  vein,  which  is  now  filled  with  a  pink 
firm  coagulum.  The  irritation  caused  by  the  operation,  or  due  to  the  passage  of  the  ball,  may  have  induced  the 
inflammation  of  this  vein,  now  so  vital  to  the  support  of  the  circulation.  This  seems  to  have  been  a  wound 
of  an  artery,  resulting  in  an  aneurism  the  sac  of  which  was  composed  of  the  re-united  sheaths  and  enlarged 
probably  by  some  dissection  upward,  in  which  a  free  passage  of  blood  took  place  from  the  artery  to  the  vein.  No 
question  as  to  the  propriety  of  the  operation  now  exists  in  my  mind,  since,  as  the  sequel  shows,  no  digital  com 
pression  over  the  femoral  would  have  sufficed  to  prevent  or  control  a  secondary  haemorrhage."  The  two  speci 
mens  were  contributed  by  the  operator,  Dr.  William  Thomson  (see  FlG.  19).  The  case  is  cited  by  Dr.  Lidell.1 
CASE  99. — Lieutenant  R.  W.  Smith,  Co.  I,  5th  Pennsylvania  Reserve  Corps,  was  wounded  at  the  battle 
of  Bull  Run,  Virginia,  August  30,  1862,  in  the  right  thigh.  He  was  conveyed  to  Alexandria  in  a  rough  wagon, 
and  thence  brought  to  Washington,  and  admitted  to  Douglas  Hospital,  September  5,  1862,  with  a  circumscribed 
false  aneurism  of  the  femoral  artery.  The  vessel  was  ligated  in  the  continuity  on  September  7th.  Secondary 
haemorrhage  followed-,  and  the  patient  died  September  8,  1862.  At  the  autopsy  it  was  ascertained  that  the 
haemorrhage  had  been  temporarily  restrained  by  the  direction  of  the  wound  and  coagula  in  the  large  aneurismal 
sac.  Recurrent  haemorrhage  had  led  to  the  fatal  result.  The  preparation  is  well  represented  in  the  accompanying 
wood-cut  (FlG.  20)  reduced  to  one-half. 

CASE  100. — Private  J.  Hiibner,  Co.  K,  5th  Michigan,  aged  29  years,  was  wounded  at  Fair  Oaks,  May 

T^TC    ^0         TTn 

successful  prox-     31,  1862,  and  conveyed  to  New  York  City  one  week  afterwards.     Dr.  F.  T.  foster,  of  the  New  York  (Civil) 

tinal  ligation  of    Hospital,  reported  the  following  history:  "He  was  admitted  on  June  8th,  having  been  wounded  by  a  musket 

the  right  femo-  '  . 

ral    artery   for    ball,  which  entered  the  posterior  fleshy  part  of  the  right  thigh  and  had  not  been  removed.     The  case  presented 

rism^/Snec  509  nothing  peculiar,  and  under  simple  treatment  progressed  well  until  June  27th,  when  there  occurred  from  the 
wound  a  copious  arterial  haemorrhage,  controlled  with  difficulty  by  the  application  of  lint  and  pressure.  On 
the  same  day  he  was  etherized  and  the  wound  opened;  but  the  source  of  the  haemorrhage  was  not  discovered.  The  wound 
was  again  stuffed  with  lint  and  the  limb  bandaged,  after  which  Dr.  T.  M.  Markoe  tied  the  femoral  artery  a  short  distance 
below  the  origin  of  the  profunda.  The  ligature  came  away  on  the  8th  of  July,  and  the  incision  and  the  original  wound  soon 
began  to  close  by  granulation.  On  the  29th  the  ball  could  be  felt  encysted  beneath  the  integument  on  the  anterior  aspect  of  the 
thigh,  but  he  declined  to  have  it  removed.  On  September  3d  he  was  discharged  from  the  hospital  with  the  wound  Entirely 
healed  and  the  limb  in  good  condition."  The  man  was  discharged  from  service,  at  Fort  Hamilton,  New  York  Harbor,  October  1, 
1862,  and  pensioned.  Examiner  H.  F.  Montgomery,  of  Rochester,  New  York,  certified,  February  2,  1863:  "A  ball  entered  the 
right  thigh  in  middle  third,  over  the  femoral  artery,  and  was  not  abstracted.  There  is  a  long  cicatrix  in  this  region,  and 
another  behind,  on  the  inside  of  the  bone.  His  foot  is  benumbed,  and,  on  exercise,  swells  and  is  painful.  He  is  apparently  in 
good  health.  He  has  a  buckshot  in  the  right  leg  below  the  knee."  Examiner  J.  J.  Lutze,  of  East  Saginaw,  Michigan,  reported, 
March  4,  1874:  "Large  tender  cicatrices  on  outer  and  inner  posterior  thigh,  points  of  entrance  and  incision.  Adductor 

brevis  and  longus  muscles  impaired  and  injured."     This  pensioner's  rate  of  compensation  was  reduced  from  five-eighths  to 
one-fourth  on  March  4,  1873,  since  which  date  he  has  not  drawn  any  pension. 

Besides  the  cases  of  ligation  of  the  femoral  artery  above  detailed,  numerous  other 
cases  have  been  narrated  at  length  in  journals  or  elsewhere,  to  which  references  are  given 
further  on.  In  TABLE  III,  the  entire  series  of  thirty-six  recoveries  and  ninety-one  fatal 
cases  are  noted  alphabetically,  and  the  principal  facts  regarding  them  are  soncisely  recorded. 

1  L,IDEU,  (J.  A.).   On  the.  Wounds  of  Blood- Vessels,   Traumatic  Exmorrhage,   Traumatic  Aneurism,  and  Traumatic  Gangrene,  in  Surgical 
Memoirs  of  the  War  of  the  Rebellion,  collected  and  published  by  the  United  States  Sanitary  Commission,  1870,  Vol.  I  (Surgical),  p.  143. 


SECT.  I.] 


LIGATIONS    AFTER,    SHOT    FLESH    WOUNDS. 


47 


TABLE  III. 

Summary  of  One  hundred  and  Twenty-seven  Cases  of  Ligation  of  the  Femoral  Artery  for  Haemorrhage 

from  Shot  Injuries  unattended  by  Fractures. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

I.NJUUT,  OPERATOR,  AND 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

1 

Ambrose.  T.  L.,  Chap 

July  2."), 

Right  thigh  :  htom.;  femoral  lig.; 

25 

Crowdtr,    D.    J.,     Pt., 

Dec.  16, 

Right  thigh;  ligation  of  femoral. 

lain,  12th  New  Hamp 

Aug.  15, 

haam.  from  branch  of  profunda  — 

Stamford's  Bat'ry,  age 

'64,  Jan. 

by  A.  A.  Surg.  D.  D.  Talbot. 

shire,  age  35. 

1864. 

large  branch  tied.     Died  Aug. 

23. 

9,  '65. 

Died  Feb.  3.  1865,  gangrene. 

20,  1864. 

26 

Cummings,  J.  M.,    Pt., 

Dec.  28, 

Shot  wound  right  femoral  artery; 

2 

Archibald,    T.,   Ft.,   G, 

April  2, 

Right  femoral  artery  wounded  and 

D,  49th  Indiana. 

1862. 

vessel  ligated.  Died  Jan.  29,  '63. 

24  tli  Mass.,  age  18. 

12,  '65. 

ligated;    one   end   tied.      Died 

27 

Cummins.  H.,  Pt.,  A,  7th 

May  8, 

Right  thigh  ;  femoral  tied  above 

April  26,  1865.  pyjemia. 

West  Virginia,  age  21. 

25,  '64. 

profunda.    Died  May  29,  1864. 

3 

At  wood.  L.  IX.  Pt..  B, 

Sept.  30, 

Left  thigh,  middle  third;  ligation 

28 

Curler,    L,   P.,   G,    6th 

May  31, 

Right  thigh  ;  fern,  and  profunda 

Ii2d  Mass..  age  31. 

Oct.  31, 

of  femoral,  both  ends  tied.   Died 

Michigan. 

June  10, 

lig.;  haem.  recurred;   profunda 

1864. 

November  9,  1864. 

17-,  '62. 

relig.  Died  June  17,  1862.  Spec. 

4 

"Ayres.  B.,  Pt.,  A,  5th 

May  22, 

Left  thigh;  ha>m.;  wound  opened 

1004,  A.  M.  M 

Iowa,  age  40. 

June  1, 

and  a  darning  needle  removed 

29 

Darling,  S.  G.,  Pt.,   D, 

May  12, 

Fern,  artery  severed:  vessel  lig.; 

1863. 

from  sheath  of  vein  ;  artery  lig 

* 

32d  Maine,  age  19. 

1864, 

May  26th,  thigh  amp.,  by  Surg. 

ated.  Died  June  1,  '63,  pyaemia. 

On  field. 

R.  B.  Bontecou,  U.  S.  V.     Died 

Specs.  2020,  2085,  A.  M.  M. 

May  26,  1864,  hemorrhage. 

5 

Bailey,  J..   Pt.,  I,  55th 

June  18. 

Left  thigh  ;  ligation  of  femoral. 

30 

Delamatev,    M.,   Corp'l. 

May  28. 

Right  thigh  ;  lig.  of  femoral,  by 

Perm.,  age  26. 

Jul.  9,  '64. 

Died  July  10,  1864. 

G,  7th  Michigan  Cav 

July  10, 

A.  Surg.  H.  M.  Sprague,  U.S.A. 

(. 

Banfill.    T.,    Serg't.    C, 

May  12, 

Left  thigh;  femoral  ligated,  by 

alry,  age  20. 

1864. 

July    12th.    thigh    amputated. 

19th  Indiana,  age  20. 

June  12, 

Surg.  T.  R.  Crosby,  U.  S.  V. 

Died  Aug.  7,  1864,  pyaemia. 

1864. 

Died  June  12,  1864,  pyaemia. 

31 

Dier,W.,  Corp'l.  A,  129th 

Dec.  13, 

Left  popliteal  space  ;  femoral  lig. 

7 

Barkeloo.  J.,  Pt..  M,  2d 

July  19, 

Right  popliteal  artery  severed  ; 

Pennsylvania,  age  23. 

'62,  Feb. 

Died  Mar.  4,  1863,  pyaemia. 

Ohio  Cav.,  age  28. 

1863. 

primary  lig.  of  femoral  artery; 

22,  '63. 

amp.  thigh.  Disch'd  Mar.  17.  '65. 

32 

Doyle,  L.,  Pt..   K.   8th 

May  20, 

Right  thigh  :  femoral  and  several 

8 

Bedingfield,  J.  T.,  Capt., 

Mar.  25. 

Both  thighs;  left  femoral  ligated, 

Maine,  age  34. 

June  1, 

branches  ligated  above  and  be 

G.  60th  Georgia,age25. 

April  15, 

by  A.  A.  Surg.  N.  A.  Robbing. 

1864. 

low  wound,  by  Surg.  A.  Heger, 

1865. 

Died  April  25,  1865,  exhaustion. 

U.  S.  A.     June  6th.  thigh  amp. 

9 

Bell,  J.  C.,  Pt.,  E.  34th 

April  6, 

Left  leg,  cutting  post.  tib.  artery; 

Died  June  ti,  1864,  exhaustion. 

Iowa,  age  23. 

17,  '65. 

fern.  lig.  ,  by  Surg.  A  .  McMahon, 

33 

Dunn,  G.  R..  Serg't,  E, 

Mar  16, 

Right    thigh  ;     femoral    ligated. 

U.  S.V.;  amp.  thigh  forrecurrent 

25th  S.Carolina.age20. 

29,'  '64. 

Recovery. 

hsem.  Died  Ap.  23/65,  exhaus'n. 

34 

Edwards,  J.  W.,  Pt.,  B, 

Mar.  26, 

Right  leg  ;  femoral  ligated,  by  A. 

10 

Bills.   C.,    Pt.,    K,   17th 

Aug.  30, 

Wound  of  thigh,  involv.  profunda 

26th  Illinois,  age  18. 

April  20, 

A.  Surg.  H.  B.  Cole.   Recovery. 

New  York,  age  20. 

Sept.  26, 

artery  ;  both  ends  femoral  tied  ; 

1865. 

1862. 

sloughing.     Died  Oct.  4,  1862. 

35 

Edwards,    R.,    Pt.,    G, 

June  25. 

Both    thighs;    femoral    ligated. 

11 

Blake,    G.,   Pt.,    I,    3d 

Aug.  26, 

Shot  wound  of  left  femoral  artery; 

98th  Illinois. 

Jul.  6.  '63. 

Died  July  11,  1863. 

West  Virginia. 

Sept.  9, 

vessel  tied,  by  Surgeon  W.  D. 

36 

Elliott,  E.,  Pt.,  H,  118th 

June  3, 

Right  thigh  ;  femoral  ligated.  by 

1863. 

Stewart,  U.  S.  V.     Furloughed 

Pennsylvania,  age  21. 

13,  '64. 

Asst.  Surg.  H.  Allen,  U.  S.  A. 

Nov.  12,  1863.    Wounds  healed. 

Died  June  21,  1864.  gangrene. 

12 

Brown.  S..  Pt.,  G,  134th 

Aug.  30, 

Left  leg  ;  fern.  lig.  in  lower  third, 

37 

Freeman,  C.  A.,  Serg't, 

April  6, 

Left  thigh  :  femoral  art'y  ligated, 

New  York,  age  16. 

Nov.  28, 

by  Asst.  Surg.  W.  A.  Connor, 

B,  37th  Mass.,  age  22. 

15,  '65. 

by  Surg.  B.  A.,  Vande'rkieft,  U. 

1862. 

U.  S.  V.     Died  Dec.   7,  1862, 

S.V.  Died  April  18,  '65,  anaemia. 

pyaemia.     Spec.  1024,  A.  M.  M. 

38 

Gardner,  R.  T.,  Pt.,  A, 

July  2, 

Both  thighs  ;  left  femoral  ligated. 

Hi 

Brown.    W.,   Serg't,   1st 

Dec.  10, 

Left  thigh  ;  femoral  ligated.    Re 

IstMd.  Battal'n.agelK. 

23.  '63. 

Doing  well  November  30,  1863. 

Maryland  Artillery. 

—  .  '63. 

covered. 

39 

Gillev,    M.,   Pt.,   I.    9th 

May  5, 

Right   thigh,    involving  femoral 

14 

*Check,  M.,   Pt..   I,  6Ist 

July  30, 

Femoral  artery  severed  ;  femoral 

N.  York  State  Militia, 

—  ,  ''64. 

artery  ;  femoral  ligated.     Died 

North  Carolina. 

A  uer.  3, 

artery  ligated,  by  Surg.  D.  F. 

age  37. 

May  27,  1864,  of  pyajmia. 

1864. 

Wright.  P.  A.  C.  S.    Recovered. 

40 

Goodwin,  A.,  Pt.,  B,  2d 

July  2. 

Left  thigh  ;  femoral  ligatedabove 

L5 

Clark,    W.    L.,    Pt..    H, 

April  ], 

Shot  wound  lower  third  right  fem 

New  Hampshire. 

20,  '63. 

and  below.     Died  Aug.  8,  1863. 

25th    North    Carolina, 

10,  '65. 

oral  artery;  artery  tied,  by  A.  A. 

41 

Graham.  J.   A.,  Serg't, 

June  1  , 

Right  thigh;  lurm.;  profundalig.; 

age  20. 

Surg.  J.  Morris.    Died  April  19, 

H,  116th  Penn.,  age  21. 

10,  '64. 

lisem.  recurred:  fern.  lig.     Died 

1865,  gangrene. 

June  13,  1864. 

16 

Claypole,  S..  Pt.,  I),  G2d 

May  30, 

Right  leg;  femoral  lig..  by  Asst. 

42 

Gray,  ,T.,Pt.,D.2d  Penn 

June  1  8, 

Left  thigh  :  femoral  tied  in  con 

Penn.,  age  27. 

June  8, 

Surg.  W.  P.  Norris,  U.S.A.  Died 

sylvania  Heavy  Art'y, 

30,  '64. 

tinuity,  by  Surg.  N.  R.  Mosely, 

1864. 

Aug.  4,  '64,  asthenia  and  pleuro- 

age  17. 

U.  S.  V.     Died  July  12,  1864! 

pneumonia. 

43 

4  Gross,   C.,  Pt.,  K,  6th 

May  30, 

Left  femoral  artery  divided;  liga 

17 

Clelland,  W..  Pt.,  A.  8th 

June  1. 

Left  thigh  ;   one  end  of  femoral 

Pennsylvania  Cavalry, 

31,'  '64. 

tures  placed  above  and   below. 

New  York  Heavy  Art., 

July  24, 

tied.    Died  July  24,  '64,  typhoid 

age  26. 

Died  June  8.  1864.  exhaustion. 

age  18. 

1863. 

fever. 

44 

5Hagan.  J.,  P.,  G,  76th 

July  17, 

Right  thigh  :  fern,  tied  at  proximal 

18 

Clover,  B..  Civilian,  age 

Aug.  23, 

Left  fern,  artery  injured;  aneur 

Pennsylvania. 

23,'  '64. 

extrem.  and  accompanying  vein 

16. 

Sept.  1, 

ism  ;  femoral  tied.     Recovered. 

at  prox.  and  distal  ends  ;  gang. 

1864. 

Died  July  27,  1864. 

19 

Clymer.  J.,  Pt.,  B,  104th 

May  31, 

Left  popliteal  space  :  femoral  lig., 

45 

Hamilton,  E.,  Capt.,  G, 

May  6, 

Right  femoral  vein  and  branch  of 

Pennsylvania. 

June  16, 

by  A.  A.  Surg.  M.  K.  Cleveland. 

15th  New  Jersey,  age 

15,  "'64. 

profunda  divided:  femoral  tied. 

1862. 

Died  June  16,  1862. 

19. 

by  Surg.H.W.Ducachet.U.S.V. 

20 

3Coble..T.A..  Pt.,  F.45tb 

Nov.  27, 

Left   thigh  ;  diffused  trau.  fem'l 

Died  May  16.  1864  ;  exhaustion. 

North  Carolina,  age  20. 

'63,  Jan. 

aneurism;  fern.  lig.  above  and 

46 

Ilarbaugh,  H..  Serg't,  K, 

July  2, 

Left  thigh"  femoral  ligated.  Pis- 

23,  T>4. 

below  ;   femoral  vein  also  tied. 

7th  Wisconsin,  age  22. 

Sept.  13, 

charged  July  21,  1864,  atrophy 

Recovered. 

1863. 

of  thigh  and  leg. 

21 

Colgau,  W.,  Pt.,  C,  2d 

Sept.  14, 

Left  thigh  ;  fern.  lig.  in  continuity, 

47 

Harrington,  W.  J.,  Pt., 

July  5, 

Left  thigh  ;  both  ends  of  femoral 

Mass.  Cavalry,  age  21. 

25,  '64. 

by  A.  A.  Surg.  J.  C.  Shrimer. 

C,  16th  Wisconsin. 

16,  "'64. 

tied,  by  Surg.  G.  F.  French,  U. 

liied  Sept.  28.  '64.  loss  of  blood 

S.  V.  '  Died'  July  20.  1864. 

and  exhaust.  Spec.  3972.  A.M.  M. 

48 

Harris,  J.  M.,  Corp'l,  C; 

July  15, 

Right  fern.  art.  injured  :  aneurism  ; 

22 

Connell.  M.,  Pt.,  K.  2d 

April  7. 

Right  thigh  ;  one  end  of  fern,  tied, 

14th  Iowa,  age  20. 

27,  '64. 

art.  ligated  above  and  below  sac. 

New  York  Heavy  Art., 

June  15, 

by  A.  Surg.  O.  P.  Sweet,  U.S.V. 

by  Surg.  J.  G.  Kcenon,  U.  S.V.; 

age  34. 

1865. 

liied  June  16,  1865,  exhaustion. 

amp.  leg,  by  A.  A.  Surg.  R.W. 

~3 

Coultes,  W.  H.,  Lieut., 

June  1, 

Middle  of  thigh;  both  ends  femoral 

Coale.  Died  Aug.  3,  "64.  pyaemia. 

C,  Gist  New  York. 

18,  '62. 

tied,  by  A.  A.  Surg.  W.  Hunt. 

49 

Harrison,  E..  Serg't,  1', 

May  —  , 

Right  thigh:  ligation  of  femoral. 

Died  June  23,  1862.  shock. 

10th  New  York. 

1864. 

by  Surg.  M.  Rizer,   72d  Penn. 

24 

Coy,    J.    II.,  Serg't,  K, 

Nov.  7, 

Left  thigh;  femoral  lig.,  by  A.  A. 

Died  .May  22.  1864. 

tith  Maine,  age  28. 

24,  '63. 

Surg.  J.C.W.  Keunon  ;  haem.  re 

50 

Hickey,  T..  Pt.,  G,  73d 

Aug.  30, 

Right  thigh  :  common  femoral  tied 

curred  ;  religated.  by  A.  A.  Surg. 

Pennsylvania,  age  53. 

Se.27.!62. 

in  continuity.  Died  Sept.  27,  '62. 

T.  O.  Bannister.  Dec.  1  ;  again 

51 

Horn,   S..   Pt.,   H,   53d 

Mar.  25, 

Left  thigh;  femoral  ligated.  by 

on  Dec.  23,  by  Surg.  D.W.  Bliss. 

North  Carolina,  age  21. 

July  9, 

A.  A.  Surg.    J.  Morris.     Died 

U.  S.  V.     Died  Deo.  23,  1863. 

1865. 

July  14,  1865,  haemorrhage. 

48 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPEUATOIJ,  AND 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOB,  AND 
RESULT. 

52 

Honser.    P.,  Serg't,    H, 

Aug.  16, 

Left   thigh;    femoral  ligated    in 

77 

Moscrip,  W.  8.,  Serg't, 

Aug.  22, 

Left  fem.  artory  injured;  femoral 

76th  Pennsylvania,  age 
26. 

Sept.  10, 
1864. 

continuity,  by  A.  A.  Surg.  J.  II. 
Packard.    Disch'd  May  '^0,  1865, 

78 

K,  l<;th\Vis.,  age3J. 
2O'Keefe,  J.,  Major,  2d 

87,  '64. 

Mar.  51, 

ligated.  Died  Sept.  14,  '64,  haem. 
Right  fem.  art'y  injured;  femoral 

and  pensioned.     Lameness. 

New    York     Cavalry, 

—  ,  '65. 

tied,  and,  haem.  recurring,  vessel 

53 

HUbner,  J.,  Pt.,  K,  5th 

May  31, 

Right  thigh;  femoral  ligated.  by 

age  24. 

religated.    Died  May  31,  1865. 

Michigan,  age  29. 

June  27, 

Dr.  T.  M.  Markce.    Discharged 

79 

Pack.  J.  R.,Pt.,  D,  39th 

April  8, 

Right  fem.  artery  wounded  ;  lig 

1862. 

Oct.  1,  1862:  pensioned. 

North  Carolina,  age  17. 

27,  '65. 

ated,  by  A.  A.  Surg.  H.  B.  Cole. 

54 

Hugging,  W.,  Serg't,  G, 

Mar.  16, 

Right  thigh  ;  hapm.;  profundalig., 

Died  April  27,  1865,  cong.  chill. 

50th  Illinois,  age  25. 

April  3, 

by  A.  A.  Surgeon  II.  Sanders; 

80 

Paden,  W.,  Corp'l,  G, 

May  23, 

Great  laceration  right  thigh  ;  fem. 

5,  '63. 

baem.  recur.;  fern,  tied,  by  A.A. 

10th  Pennsylvania  Re 

June  1, 

tied  in  continuity,  by  Surg.  G. 

Surg.  E.  DeWitt.     Died  April 

serves,  age  22. 

1864. 

L.  Pancoast,  U.S.V.:  leg  gang.; 

8,  1865. 

amp.  leg  by  same  operator.  Died 

55 

Hunt,  J.  L.,  Pt..  G.  57th 

May  5, 

Left  thigh  ;  femoral  ligated  ;  dry 

June  26,  1864,  gangrene. 

New  York,  age  41. 

July  9, 

gangrene  of  toes  ;  Sept.  5th,  amp. 

81 

Palmer,  J.  C.,   Pt.,   G, 

April  2, 

Right  thigh  :  femora)  tied  at  both 

1864. 

toes.     Disch'd  June  6,  1865. 

10th  Conn.,  age  18. 

10,  '65. 

ends.   Uisch'd  July  5,  '65;  pen'd. 

56 

Hurlbut,  G.  Q.,  Pt.,  G, 

May  17, 

Both  thighs:  haem.;  fern.  lig.  in 

82 

3Pasclial.  J.,  Pt..  I,  2d 

Aug.  16, 

Right  thigh;  femoral  ligated,  by 

109th  N.  York,  age  37. 

June  8, 

continuity;  hiem.;  profundalig.; 

N.  Carolina  Cavalry. 

27,  '64. 

Surg.  D.  F.  Wrigat,  P.  A.  C.  S. 

1864. 

hasm.:  vessel   religated.     Died 

Retired  February  '-:2,  1865. 

June  8,  1864. 

83 

Pennsyl,  E.,  Pt.,  H,  93d 

May  31, 

fem.  artery  wounded:  vessel 

57 

Jones,  W.   H.,   Pt.,   C, 

June  9, 

Right  thigh  ;  fern,  tied  in  wound, 

Pennsylvania. 

J  'el  6,  62. 

tied.     Died  J  uly  5,  '62,  py  a?mhi. 

14th  New  York  Heavy 

July  5, 

by  Surg.  II.   Palmer,  U.  S.  V. 

84 

Perry,  i'..  Serg't,D,  16th 

Sept.  3D, 

Right  thigh;  femoral  tied  at  both 

Artillery. 

1864. 

Died   Sept.   25,    1864,    chronic 

Michigan,  age  30. 

Nov.  19, 

ends,  by  A.A.  Surg.G.H.R.  Rob 

diarrhoea. 

1864. 

inson.  Died  Nov.  21.  '64,  exh'n. 

58 

Jones,   IV.   W.,  Ensign, 

Sept.  19, 

thigh,  involving  fern,  artery; 

85 

Peters,   W.   C.,   Pt.,  C, 

July  2, 

Left  thigh  ;  artery  secured.  Died 

Thomas's  Legion,  acre 

Oct.  2, 

ligation  of  femoral  artery.    Died 

6^th  Penn.,  age  19. 

15,  '63. 

July  15,  1863,  haemorrhage. 

2.->. 

1864. 

Oct.  5,  1864,  haemorrhage. 

86 

Pickett,  J.,  Pt.,  F,  8th 

June  20, 

Right  fem.  artery  severed  :  artery 

59 

Judd.  I.  E.,  Lieut.,  K, 

May  25, 

Right  thigh  ;  fern.  art.  tied  at  both 

Illinois  Cavalry,  age  21  . 

20,  '63. 

secured.     Disch'd  June  !>,  '64. 

49th  Mass.,  age  25. 

June  12, 

ends,  by  Med.  Insp.  P.  1'ineo. 

87 

Pope,  P.  P..  Pt.,  M,  67ih 

May  9, 

Right  thigh  ;  fem.  tied  in  continu 

1863. 

U.  S.  A.;  fern,  vein  included  in 

Ohio,  age  22. 

21,  564. 

ity.    Died  May  22,  '64,  exh'n. 

a  ligature.    Died  June  13,  1863. 

88 

Pope,  W.,  Pt.,  I,  2d  N. 

June  3, 

Left  thigh  ;  one  end  <  if  artery  tied. 

CO 

Karlmyer,   F.,    Pt.,   K, 

June  1, 

Right  thigh;  femoral  ligated,  by 

York  Artillery,  age  1!). 

20,  '64. 

Died  June  24,  '04,  hemorrhage. 

48th  New  York,  age  37. 

9,  '64. 

Surgeon   E.   Bentley,  U.  S.  V. 

89 

4Rapp,  D.,  Pt.,  K,  7th 

Nov.  30, 

Left  thigh;  fem.  art.  and  vein  di 

Discharged  May  20,  1865. 

Indiana,  age  20. 

1863. 

vided:  double  lig.  placed  upon 

Cl 

Kimber,  W.,  Pt.,  D,  36th 

Nov.  29, 

Left  thigh  ;  both  ends  of  femoral 

fem.  art  and  vein.  Died  Dec.  13, 

Illinois,  age  33. 

'64,  Jan. 

tied.     Died  January  26,  18.65. 

1863.  Specs.  2249,  2250,  A.  M.  M. 

20,  '65. 

90 

Heed,   J.  P.,  Pt.,   19th 

April  6, 

Right  thigh  ;  fem.  artery  ligated, 

62 

Landon,  L.,  Lieut.,  H, 

Sept.  29, 

Left  thigh  ;  also  fract.  left  radius  : 

Alabama,  age  20. 

May  29, 

by  Surg.  J.  T.  Hudgen,  U.  S.  V. 

tith     Colored    Troops, 

Oct.  9, 

both  ends  of  fern,  tied  in  wound. 

1862. 

Died  June  30,  1862. 

age  20. 

1864. 

Died  Oct.  28,  '64,  pyaemia. 

91 

Ringer,  O.,  Pt.,  C,  60th 

July  6, 

Right  thigh  :  femoral  ligated,  by 

63 

Lang.   W.   M..   Pt.,   C, 

April  2, 

Right  leg  ;  femoral  ligated.    Died 

Ohio,  age  21  . 

Aug.  22, 

A.  A.  Surg.  J.  F.  Holt.    Died 

4()th  New  York,  age  34. 

13,  '65. 

April  16,  1865,  mortification. 

1864. 

Aug.  25.  1864,  haemorrhage. 

64 

Lapp,   C.,   Pt.,    I,    22d 

July  28, 

Left  fem.  art'y  wounded  ;  vessel 

92 

Roberts,    A.  F.,  Pt.,    I, 

May  19, 

Left  popliteal  space  :  fem.  artery 

Wisconsin,  age  21. 

Aug.  11, 

liff..  by  A.A.  Surg.  J.  M.  Brown. 

127th  Illinois,  age  20. 

I'e  5,  '63. 

tied.     Died  June  7,  1863. 

1861. 

Died  Aug.  11,  '64,  haemorrhage. 

93 

Rodgers,   S.  J.,  Pt.,  A, 

June  17, 

Right  thigh.  July  22d,  aneurism  ; 

65 

Layne.   J.   H.,   Pt.,    B, 

April  6, 

Right  thigh  :  fem.  vein  rupt.:  fem. 

2d  Michigan,  age  21. 

Julv  26, 

fem.  tied,  tivo  ligatures,  by  A.A. 

19th  Virginia,  age  18. 

25,  '65. 

lig.  at  middle  portion,  and  vein 

1864. 

Surg.  0.  W.  Peck.     Died  July 

above  and  below  rupt.,  by  A.A. 

3J,  1864,  haemorrhage. 

Surg.  J.  Morris:  haam.  recurred 

94 

Ross,   A.  G.,  Corp'l,  I, 

Oct.  19, 

R't  and  leftthighs:  fern,  wounded 

May  6.  fem.  relig.  abo.  profunda. 

13th  Mississippi,  age  21. 

—  ,  '64. 

and  lig.:  Nov.  8,  amp.  right  leg 

Die'd  May  7,  1865. 

aboveank.    Retired  Mar.  14/65. 

66 

Lei-.  J.  A.,  Pt.,  I,  17th 

July  2, 

Left  leg;  femoral  artery  ligated. 

95 

Howe,  J.  B.,  Pt.,  G,  12th 

May  14, 

Right  thigh  ;  gang.:  fem    artery 

Mississippi,  age  25. 

21,  "'63. 

Transferred   to  prison  at   Fort 

N.  Hampshire,  age  22. 

June  12, 

lig.  in  wound,  both  ends  tied,  by 

Mcllenry,  Md.,  March  2.  1864. 

J864. 

Surg.   A.  Heger,  U.  S.  A.,  anil 

67 

Leline,  G.,  Serg't.  C,  8th 

Nov.  28, 

Right  fem.  art'y  injured;  ligature 

A.A.Surg.  T.  Liebold.  Diseh'd 

Michigan,  age  27. 

Dec.  5, 

applied,  by  A.  A.  Surg.  S.  T. 

June  5,  1865  ;  pensioned. 

1864. 

Williams.     Died  Dec.  5,  1864, 

96 

*  S  W  ,  —  ,  1,  17th 

Sept.  1, 

Right  thigh;  proximal  endof  fem. 

shock  and  haemorrhage. 

New  York. 

12,  '64. 

artery  tied,  by  Surg.  E.  Bat  well, 

68 

'Lenneghan.  P.,  Serg't, 

April  6, 

Right  thigh;  femoral  ligated  in 

14th  Michigan.    Sent  to  rear  ten 

B,  88th  New  York,  age 

20,  '65. 

continuity,  by  Surg.  J.  Aiken, 

weeks  after  injury. 

30. 

71st  Pcnn.   D'isch'd  July  26,  '65  ; 

97 

Sager,  W.,   Serg't,    E, 

April  1, 

Right  thigh  ;  both  ends  of  femoral 

pensioned.     Died  Nov.  —  ,  1875. 

188th  N.  York,  age  19. 

22,  '65. 

tied,  by  Asst.  Surg.W.  F.Norris, 

69 

Lesler,  J.,  Pt.,  K,  148th 

June  6, 

Left  leg;  both  ends  femoral  tied, 

U.S.A.  DiedAp'12;>,  '65,  pyaem. 

New  York,  age  28. 

Julv  28, 

by  A.  A.  Surg.  W.  P.  Moore. 

98 

Sassaman,  L.  II.,  Pt.,  E, 

May  8, 

Right  leg,  wounding  ant.  tibial 

1864. 

Disch'd  January  11,  1865. 

12th    Penn.   Reserves, 

June  4, 

artery;  femoral  tied,  by  A.  A. 

70 

Lund,  E.  T.,  Pt.,  C,  4th 

June  30, 

Left  thigh,  and  fract.  right  knee 

age  24. 

1864. 

Surg.  J.  S.  Cohen.  Disch'd  July 

New   Hampshire,   age 

Aug.  12, 

joint  ;  left  fem.  tied  above  and 

21,  1865;  pensioned. 

20. 

1864. 

below,  by  Asst.  Surg.  W.  Thom 

99 

Sf.if.   J.,    PC,,    H,   llth 

,  July 

thigh;  femoral  ligated.  Died 

son,  U.  S.  A.     Died  Aug.  23, 

Alabama. 

11,  '62. 

July  11,  1862. 

'64,  pyaemia.  Spec.  3592.  A.M.M. 

100 

Sharpe,  A.,  Pt.,  D,  llth 

June  21, 

Both  thighs  :  both  ends  of  

71 

McXally,  J.,  Pt,,  G,  C9th 

June  16, 

Right  thigh;  femoral  tied  in  con 

Pennsylvania. 

21,  '64. 

femoral  tied.    Died  June  26,  '64. 

New  York,  age  24. 

July  4, 

tinuity,  by  A.  A.  Surg.  O.  P. 

101 

Sheaffer,  C.,  Pt.,  D,  1st 

June  5, 

Right  fem.  artery  injured;  vessel 

1864. 

Sweet.     Furloug'd  Nov.  1,  '64. 

New  York  Cavalry. 

July  8, 

secured,  by  Surg.R.F.  Baldwin, 

72 

MoRevnolds,  J.,  Corp'l, 

Aug.  19, 

Both  thighs  ;  femoral  tied,  by  A. 

1864. 

P.A.C.S.   Died  J'y  21,  '64,  gang. 

60th  Ohio  S.  S.,  age  20. 

Sept.  5, 

A.  Surg.  H.  B.  Maben;  haem. 

102 

Sheffer,  G.  W.,  Pt.,  C, 

May  24, 

Left  fem.  artery  severed;  ligated, 

1864. 

recur.  Sept.  llth;  artery  relig., 

5th  U.  S.  Art.,  age  22. 

24,  '64. 

by   Surg.    N.    Hay  ward,    20th 

by  A.  A.   Surg.   E.   Do  Witt. 

Mass.     Disch'd  Jan.  30,  1865. 

Died  Sept.  17,  '64,  haemorrhage. 

103 

Simmons,  T.,Pt.,  F,  97th 

June  18, 

Loft  thigh;    femoral    ligated  in 

73 

Mason,  J.W.,  Pt.,1,  12th 

Aug.  30, 

Right   femoral   artery;    ligature 

New  York,  age  26. 

July  27, 

continuity  and  wound.      Died 

New  York,  age  21. 

—  ,  '62. 

applied.     Died  Sept.  28,  1862. 

1864. 

August  3,  1864,  gangrene. 

74 

Miller,  G.  H.,  Pt.,  F,  3d 

May  18, 

Both  thighs,  dividing  right  pro 

104 

Smith,  H.,  Pt.,  F,  21st 

Oct.  19, 

Both  thighs,  scrotum,  right  fem. 

Iowa,  age  23. 

June  3, 

funda  artery:  right  fem.  ligated. 

Virginia,  age  41. 

Nov.  10, 

artery  severed  ;  vessel  tied,  by 

1863. 

Died  June'lO,  '63,  haemorrhage. 

1864. 

Surg.  W.W.Wilkerson,  C.  S.A. 

Spec.  2086,  A.  M.  M. 

Retired  from  service  Mar.  14/65. 

75 

Mills,   J..    Pt.,    D,   4th 

Jan.  16, 

Left  fem.  artery  wounded-:  liga 

105 

Smith,  J.,  Pt.,  D,  97th 

May  18, 

Both  thighs  ;  haem.  from  circum 

Missouri  Cavalry. 

Feb.  7, 

ture  applied.     Died  February 

Pennsylvania,  age  22. 

June  2, 

flex;  right  femoral  tied.     Died 

1864. 

17.  1864. 

1864. 

June  5.  1864,  haemorrhage. 

76 

Moore,  W.,  Pt.,  G,  5th 

Oct.  19, 

Right  fem.  artery  wounded  ;  lig. 

106 

Smith.    R.   W.,   Lieut., 

Aug.  30, 

Right  thigh  :  fem.  art'y  wouaded  ; 

North  Carolina,  age  27. 

20,  '64. 

applied,  by  Surg.  J.  F.  Pearson, 

G,  5th  Penu.  Reserves, 

Sept.  7, 

lig.  in  contin'y.  Died  Sept.  7,  "62, 

5th  N.  C.     Exch'd  Feb.  16,  '65. 

uge  24. 

1862. 

loss  of  blood.  Spec.  509,  A.M.M. 

1  LIDELL  (J.  A.),  op.  cit.,  p.  262.  2  Ibid.,  p.  233. 

3BLACKMAN  (G.  C.),  On  the  Treatment  of  Inflammation  of  the  Limbs  by  thf.  Compression,  or  Ligature,  of  their  Main  Arterial  Trunk,  in 
Cincinnati  Lancet  and  Observer,  1858,  Vol.  XI,  p.  77,  and  Richmond  Med.  Jour.,  1866,  Vol.  I,  p.  307. 

4  LIDELL  (J.  A.),  On  the  Wounds  of  Blood-vessels,  etc.,  in  Surgical  Memoirs  of  the  War  of  the  Rebellion,  collected  and  published  by  the  U.  S.  San 
itary  Commission,  1870,  Vol.  I,  p.  143.  "BATWELL  (E.),  Surgeon,  14th  Michigan,  in  Med.  and  Surg.  Reporter,  1865,  Vol.  XIII,  p.  50.  Probably 
the  case  of  M.  Shaw,  Pt.,  I,  17th  New  York,  ago  19.  Died  Nov.  16,  1864, 


LIGATIONS    AFTER    SHOT    FLESH    WOUNDS 


49 


No 

NAMK.  Mi  UTAH  Y 

DESCnirTlOX,  AND  AGE. 

DATES. 

INJURY,  OPEUATOU,  AND 
RESULT. 

1 
NO. 

NAME,  MILITARY 
DESCRIPTION,  AT;D  AGH. 

DATKS. 

I.VJUKY,  Ol'EHATOR,  AND 
RESULT. 

107 

Smith,  W.  F.,  Major,  1st 

Oct.  27, 

Hight  thigh  ;  fern.  lig.  above  and 

118 

Wilder.  E.,   Corp'l,   A, 

Aug.  10, 

Left  leg;  haem.  from  post,  tibial 

Delaware. 

27,  '64. 

bclow,vein  also  tied;  amp.  thigh, 

100th  N.  York,  age  19. 

Sept.  21, 

artery  ;  fein.  lied  in  continuity, 

Surg.  A.  N.  Dougherty,  U.S.V. 

1664. 

by  A.  A.  Surg.  J.  C.  Morton. 

Died  Nov.  0,  1804. 

Deserted  March  23,  1805. 

10? 

Sookwcll.  C.  L.,  Pt.,  K, 

Mav  6, 

Right  thigh  :    femoral    secured. 

'nn 

Williams,  C.,  Pt.,  F,  5th 

Sept.  29, 

Laceration  left  thigh  ;  both  ends 

ICth  N.  Jersey,  age  2;!. 

C,  '64. 

Disch'd  June  30,  '05;  pensioned. 

Colored  Troops,  age  23. 

Oct.  15, 

of  fern,  tied  in  wound,  by  A.  A. 

109 

'Spicey,  D.,  Pt.,  C,  5th 

,  July 

Loft  thigh,  also  right  leg;  aneur- 

1804. 

Surg.  O.  Warner;  haemorrhage 

Is'.  Carolina,  age  40. 

8,  '03.' 

ismul  tumor  of  left  fern,  art.;  fern. 

recurred.  Died  October  21,  1804, 

tied,  by  Surg.  E.  B.  Haywood, 

phlebitis. 

C.  S.  A.  Recovered  Jan.  10,  '04. 

120 

Williams,  G.,  Pt.,  E,  9th 

July  9, 

Left  thigh  ;  art'y  tied  below  origin 

110 

Story,   F.,   Pt.,    E,  38th 

July  23, 

Right  thigh  ;  gangrene  ;  both  ends 

N.  York,  Heavy  Art., 

Aug.  3, 

cf  profunda.  by  A.  A.  Surg.  J.C. 

Ohio,  age  22. 

Sep.  9,  64. 

of  fern.  tied.    Died  Sept.  K),  '04. 

age  31. 

1804. 

Shimer.     Died  August  4,  18ti4, 

111 

Sweeney,  .1.  L..  Serg't, 

May  1."), 

Right  fern,  artery  injured  and  lig 

exhaustion. 

D,  12th  Mass.,  age  25. 

30,'  '04. 

Disch'd  from   hospital  Oct.  15, 

121 

Willis,  jr.,  A.,  Pt.,  1,  7th 

Dec,  13, 

Right  femoral  artery  injured  and 

1804  ;  pensioned. 

Rhode  Island,  age  25. 

25,  '62. 

ligated.      Died    Dec.   28,    1862, 

112 

Thorn,  II.  C.,  Pt.,  I.  14th 

July  20, 

Right  thigh;  fein.  ligated;  haem. 

from  previous  lileedin0". 

West  Virginia,  age  19. 

Aug.  7. 

recurred  from  proi'iinda:  thigh 

122 

3  Wilson,  J.,  Pt.,  27th  N. 

May  26. 

Left  thigh:  ball  passed  close  to 

1864. 

amp.,  by  Surg.  J.  B.  Lewis.  U. 

York  Battery,  age  20. 

July  10, 

femoral  vessels  ;  large  aneurism 

S.  V.     Died  Aug.  12,  1804. 

1863. 

of  fern,  artery;  fern,  tied  above 

113 

Tompkins.—  .  substitute, 

July  28, 

Right  leg  and  lett  arm  ;  femoral 

and  below,  by  A.  A.  Surg.  G.  B. 

age  21. 

29,  '03. 

ligated  ;  gang.  Aug.tid,  trismus. 

Hammond.   Duty  July  31.  1803. 

Died  Aug.  4,  1803,  tetanus. 

123 

Winchell.  C.  I).,  Pt.,  K. 

Apr:  12, 

Left  thigh  ;  fein.  lig.  in  continuity, 

114 

Unknown     .    . 

Sept.  17, 

Wound  of  fern,  art.;  proximulcnd 

38th  Wisconsin,  age  19. 

12,  '05. 

by  Surg.  J.  C.  McKee,  U.  S.A. 

22,  '02. 

tied  in  wound.  Died  Sept.  22.  '02. 

Disch'd  July  3,  1805;  pensioned. 

115 

Vearing,    W.,    Pt.,    G, 

May  22. 

Right  thigh  ;   small   aneurism  cf 

124 

Winchester,  I).  W..  Pt., 

May  19, 

Left  thigh:    sloughing  :  femoral 

12th  Missouri,  age  30. 

June  22, 

femoral    artery;    femoral  tied. 

I,  1st  Mass.  H'vy  Ar'y, 

28,  '04. 

tied  in  continuity,  by  Surg.  T.R. 

1863. 

Returned  to  duty  Dec.  10,  1863. 

age  21. 

Crosby,  U.  S.  V.     Duty  Febru 

116 

'Vickery,    R.    S.,  Asst. 

July  30. 

Left  thigh  ;  femoral  tied,  by  Siirg. 

ary  10,  1805. 

Surgeon,  2d  Michigan. 

30,  '04. 

W.  B.  Fox.  8th  Mich.     Diseh'd 

125 

Witham,  A.,  Pt,,  A,  1st 

May  19, 

Left  thigh:  fern,  ligated.  by  A.  A. 

Mar.  14,  'G5  ;  pens'd.    Appointed 

Maine    Heavy   Art'y, 

June  29, 

Surg.  J.  Newcombe.  Died  July 

Asst,  Surg.  U.S.A..  May  14,  67. 

age  20. 

1864. 

2,  1804.  loss  of  blood. 

117 

Wakeham,  J.  E.,  Corp'l, 

Mar.  31  , 

.Left  fern,  artery  involved  ;  lig.  of 

126 

Wood,   W.  R.,   Pt.,   II, 

Dec.  31, 

Right  thigh  ;  femoral  tied.   Duty 

E.  18th  Virginia,  age 

April  10, 

artery  above  profunda,  by  A.  A. 

81st  Indiana. 

'62.  Jan. 

June  22,  1863;  pensioned. 

°7 

1805. 

Surg.  J.  Morris.  Ha?m.  recur'd  ; 

17,  '63. 

relig.  just  below  Poupart's  lig. 

127 

Worley,  S.,  Pt,,  A,  139th 

May  5, 

Right  thigh  ;  fern,  ligated.    Died 

Died  April  28,  '05,  exhaustion. 

Pennsylvania,  age  2J. 

20,  '64. 

June  2,  1804. 

Of  this  series  of  one  hundred  and  twenty-seven  cases  with  ninety-one  deaths,  the 
mortality  rate  of  71.7  per  cent,  of  the  aggregate  scarcely  varies  from  that  of  the  smaller 
series  of  ligations  for  direct  shot  injury  of  the  femoral  adverted  to  on  page  16. 

Ligations  of  the  Profunda  Artery. — Six  instances  were  reported  of  ligation  of  the 
profunda  in  addition  to  the  cases  in  which  that  vessel  was  tied  in  connection  with  ligations 
of  the  femoral.  Brief  abstracts  of  the  two  successful  and  four  fatal  cases  are  subjoined: 

CASES  101-106. — Sergeant  11.  W.  Bcdingfidd,  Co.  G,  COth  Georgia,  age  18  years,  wounded  at  Monocacy,  July  9,  1864; 
admitted  into  hospital  at  Frederick ;  conoidal  ball  passed  through  upper  third  of  left  thigh  and  lodged  near  the  inner  side  of 
right  femur,  wounding  the  right  profunda  artery;  traumatic  aneurism,  sac  five  inches  in  length,  containing  at  least  a  pint  of 
clotted  blood.  August  15th,  Acting  Assistant  Surgeon  J.  H.  Bartholf  laid  open  the  aneurismal  sac.  Bleeding  came  from  the 
profunda  artery;  a  ligature  was  applied  above  and  below  the  wound  of  the  artery  by  an  incision  four  inches  along  the  sartorius 
muscle;  the  patient  was  in  good  condition  though  irritable  and  depressed;  brandy  was  given  every  hour  during  the  day  after 
the  operation;  haemorrhage  did  not  recur.  August  25th,  ligature  came  away;  the  wound  healed,  and  the  patient  was  trans 
ferred  to  Point  Lookout,  October  25th,  for  exchange. — Private  J.  H.  Beun,  Co.  E,  45th  Pennsylvania,  aged  18  years,  wounded 
at  the  Wilderness,  May  6,  1864.  Admitted  into  Campbell  Hospital,  Washington;  shot  wound  of  thigh.  May  28th,  bleeding  to 
amount  of  forty-eight  ounces  from  profunda  artery;  profunda  ligated  at  one  end  in  wound;  haemorrhage  recurred  June  14th, 
and  death  on  the  same  day. — Lieutenant  J.  T.  Lowe,  Co.  D,  12th  New  Jersey,  wounded  at  Bristoe  Station,  October  14,  1863; 
admitted  into  Third  Division  Hospital,  Alexandria;  gunshot  wound  of  left  thigh  by  conoidal  ball;  haemorrhage  to  extent  of 
twenty-four  ounces  from  profunda  artery;  both  ends  of  profunda  femoris  tied  in  the  wound.  Patient  died  October  30,  1863. — 
Corporal  T.  Machelent,  Co.  B.  140th  New  York,  aged  27  years,  wounded  at  the  Wilderness,  May  8,  1864 ;  admitted  into  Mower 
Hospital,  Philadelphia;  missile  entered  middle  of  posterior  surface  of  upper  third  of  right  thigh,  passed  in  a  direct  line  and 
emerged  from  inner  surface;  slight  wound.  July  4th,  haemorrhage  to  the  extent  of  thirty  ounces  from  the  profunda  artery; 
the  proximal  end  of  the  artery  was  ligated  in  the  wound.  Patient  was  discharged  May  31,  1865. — Private  M.  Murphy,  Co.  G, 
5th  Kentucky ;  wounded  at  Mission  Ridge,  November  25,  1863;  admitted  into  hospital  No.  4,  Chattanooga;  contused  shell 
wound  of  left  thigh.  On  January  1,  1864,  gangrene  appeared,  which  was  checked,  but  reappeared  on  the  17th  and  20th,  and 
spread.  On  January  26th,  the  profunda  gave  way  and  was  ligated  by  Surgeon  A.  H.  Stephens,  6th  Ohio.  The  patient  died 
January  27,  1864. — Corporal  T.  Patterson,  Co.  D,  5th  Michigan,  aged  32  years,  wounded  at  the  Wilderness,  May  5,  1864 ; 
admitted  into  the  hospital  at  Chester,  Pennsylvania;  shot  flesh  wound  of  upper  third  of  both  thighs.  On  July  13th,  bleeding 
occurred  from  a  branch  of  the  left  profunda;  one  end  of  the  artery  was  tied  in  the  wound;  haemorrhage  recurred  on  July  16th, 
and  death  ensued  July  20,  1864,  from  pyaemia. 

1  HAYWOOD  (E.  B.),  Aneurism  of  Femoral  Artery  cured  by  Ligature,  in  Confederate  States  Med.  and  Surg.  Jour.,  1804.  Vol.  I,  p.  36. 
•  *  HAMILTON  (F.  H.),  A  Treatise  on  Military  Surgery  and  Hygiene,  1805,  p.  639. 

3  LlDELL  (J.  A.),  On  Gunshot  Wounds  of  Arteries,  Traumatic  Hxmorrhage  and  Traumatic  Aneurism,  in  Am.  Jour.  Mcd.  Sci.,  1864,  Vol.  XIA'H, 
p.  110.  and  San.  Comm.  Mem,.,  Vol.  I,  p.  119. 

SURG.  Ill— 7 


50 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


There  were  also  a  few  examples  of  ligations  of  large  branches  of  the  profunda  involv 
ing  very  difficult  and  troublesome  dissections;  instances  in  which  the  external  circumflex, 
posterior  perforating,  and  anastomotica  arteries  were  tied  are  here  briefly  noted.  In 
several  cases  it  was  impracticable  to  determine  what  particular  branch  was  severed: 

CASE  107. — Private  S.  Michaels,  Co.  E,  9th  Maine,  aged  35  years,  wounded  at  Petersburg,  June  2ii,  1864.  Surgeon  J. 
J.  Craven,  U.  S.  V.,  reported  his  admission  into  the  3d  division  hospital  of  the  Tenth  Corps  with  a  "gunshot  wound  of  both 
thighs."  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported  from  Hampton  Hospital,  Fort  Monroe:  "On  July  30th,  bleeding 
occurred  from  the  descending  branch  of  the  external  circumflex  artery:  six  ounces  of  blood  were  lost.  Assistant  Surgeon  E. 
Curtis,  U.  S.  A.,  applied  ligatures  at  both  ends  of  the  bleeding  vessel  in  the  wound — the  injury  was  about  the  middle  of  the 
thigh.  On  August  4th,  a  haemorrhage  occurred  from  the  femoral  artery  of  the  left  thigh  of  about  one  pint;  it  was  arrested  by 
pressure,  but  the  patient  died  from  exhaustion  a  short  time  after.'' 

CASK  108. — Private  Theodore  B.  Benedict,  Co.  D,  7th  Connecticut,  age  32  years,  wounded  at  Drury's  Bluff,  May  10, 
1864.  Assistant  Surgeon  E.  McClellan  reported  from  Hampton  Hospital,  Fort  Monroe:  "Gunshot  wound  of  right  thigh,  flesh. 
On  June  9th,  haemorrhage  to  the  extent  of  eight  ounces  occurred  from  one  of  the  posterior  perforating  arteries.-  The  bleeding 
vessel  was  ligated  in  the  wound  at  one  end.  The  hemorrhage  did  not  recur."  On  July  25th,  the  patient  was  sent  north.  He 
was  subsequently  treated  in  McDougall  Hospital,  New  York,  and  Knight  Hospital,  New  Haven.  Surgeon  P.  A.  Jewitt,  U.  S.V., 
reported  from  the  latter  hospital  that  the  patient  died  May  3,  1865,  of  pneumonia. 

CASE  109. — Corporal  Thomas  Haglemeyer,  Co.  D,  41st  Ohio,  aged  49  years,  was  wounded  at  Nashville,  December  16, 
1864.  Surgeon  C.  N.  Hoagland,  71st  Ohio,  reported  from  the  3d  division,  Fourth  Corps:  "Gunshot  wound  of  hip;  simple 
dressings."  Surgeon  J.  E.  Herbst,  U.  S.  V.,  reported  that  the  patient  was  admitted  into  hospital  No.  2,  Nashville,  December 
22,  1864,  with  a  "gunshot  wound  of  the  upper  third  of  the  right  thigh.  Wound  gangrenous  from  Scarpa's  triangle  to  the 
popliteal  space.  December  29th,  separation  of  the  slough  caused  haemorrhage  from  the  superior  perforating  and  anastomotica 
arteries — oozing  surface.  The  patient  was  much  exhausted  from  repeated  haemorrhage — blood  deh'brinated.  Acting  Assistant 
Surgeon  S.  Blackwood  applied  proximal  ligatures  to  the  bleeding  arteries  in  the  Avound  and  lint  to  the  ooziug  surface.  Simple 
dressings  were  applied,  and  iron  and  ale  ordered.  The  patient  died  January  15,  1864." 

legations  of  the  Popliteal  Artery. — Of  seventeen  cases  of  ligation  of  the  popliteal 
for  shot  flesh  wounds  of  the  leg,  thirteen  were  fatal,  or  76.5  per  cent.  Five  patients 
succumbed  after  amputation  of  the  thigh  following  ligation  of  the  popliteal.  The  series 
is  enumerated  in  TABLE  IV,  and  a  case  is  detailed: 

TABLE  IV. 

Summary  of  Seventeen  Cases  of  Ligation  of  the  Popliteal  Artery  for  Haemorrhage  from  Shot  Injuries 

unattended  by  Fractures. 


No. 

NAME,  MILITARY 

DESCKLPTIOX,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

1 

Dittos,  W.,  Pt.,  H,  42d 

May  14, 

Right  popliteal  region;  sloughing; 

10 

Smith,  A.  M.,  Serg't,  F, 

May  15, 

Wound  of  popliteal  artery;  art'y 

Illinois,  age  27. 

June  C, 

both  ends  of  popliteal  art'ry  tied 

20th  Maine. 

15,  '64. 

tied.     Died  May  22,  1864. 

1864. 

in  wound,  by  Ass't  Surg.  B.  E. 

11 

Smith,   F.,    Pt.,   B,  1st 

May  23, 

Rt.  and  1'ft  thighs;  ha?m.  from  post. 

Fryer,  U.  S.  A.     Disch'd  Aug. 

Mass.  Heavy  Artillery. 

June  2!), 

tib.;  rt.  post.  tib.  lig.  in  continu 

16,  1865;  pensioned. 

1861. 

ity;  haem.  recurred;  poplit'l  lig. 

2 

Elliot,  J.  E.,  Corp'l,  E, 

April  1, 

In'rside  left  leg;  poplit'l  art.  lig., 

Died  June  29,  1864. 

2d  Pennsylvania  Cav 

29,  '63. 

lower  portion  ;  haem.  recurred  ; 

12 

Smith,  P.  D.,Pt.,  C,  8th 

Mar.  19, 

Right  ankle  ;  gang.;  hami.  from 

alry,  age  24. 

thigh  amp.  May  5th.   Died  from 

Iowa  Cavalry,  age  20. 

Mav  0, 

post.  tib.  art'y;  poplit'l  art  'y  lig. 

shock  two  hours  after  operation. 

1864. 

in  continuity,  by  A.  A.  Surg.  I). 

3 

Fletcher,  J.  M.,  Corp'l, 

June  18, 

Flesh  wound  up.  third  right  leg; 

McLean.  Disch'd  Mar.  21,1865. 

C,  39th  Massachusetts, 

Aug.  14, 

sloughing  ;  both  ends  artery  tied 

13 

Taber,  J.  A.,  Serg't,  E, 

Mar.  31, 

Right  leg  ;    poplit'l  art'y  lig.  in 

age  '-'8. 

1864. 

in  wound,  by  A.  A.  Surg.  J.  M. 

5th  Michigan,  age  2:i. 

April  12, 

contin'ty,  by  Surg.  J.  C.  McKee, 

McGrath.     Died  Aug.  24,  1864, 

1865. 

U.S.A.  Died  April,  18/65,  htem. 

typhoid  fever. 

14 

Vann,   D.,    Pt,,   B,   8th 

June  3, 

Left  poplit'l  art  y  injured;   art'y 

4 

Gray,  W.,  Pt.,  E,  18th 

Dec.  31, 

Near  popliteal  region  ;  both  ends 

New    York    Artillery, 

16,  '64. 

lig.,  by  Surg.   H.  15.  Bontecou, 

Infantry,  age  20. 

'(10,  Jan. 

artery  tied  in  wound.  Died  Jan. 

age  18. 

U.  S.  V.;  haem.  recurred;    new 

12,  '63. 

22,  1863,  gangrene. 

i 

lig.  applied  June  20;  same  day 

5 

Kausche,  G.,Pt.,D,  20th 

Sept.  17, 

Laceration  of  right  poplit'l  space; 

amp.  thigh.   Died  June  22,  1864, 

New  York,  age  35. 

17,  '(«. 

up.  end  art.  tied  in  wound  ;  haem. 

gangrene. 

recurred.     Disch'd  Aug.  13,  '63. 

15 

Walker,  M..  col'd  serv 

June  3, 

Right  poplit'l  art'y  injured:  vessel 

6 

Kraher,   J.  P.,    Pt.,  D, 

June  1, 

Left  thigh  near  knee;  gang.;  one 

ant,  K,  58th  Penn.,  age 

26,  '64. 

tied  above   bleeding  point,  by 

Cth  New  York  Heavy 

July  24, 

end  of  artery   tied  in   wound. 

13. 

Surg.  R.  15.  Bontecou.  U.  S.  V. 

Artillery,  age  35. 

1804. 

Disch'd  Mar.  15,  '65;  pensioned. 

Died  July  3,'64,  diarrhoea.    [See 

7 

Leonard,  J.,  Pt.,  L,  7th 

May  30, 

Left  leg;  art.  tiedbeh.  knee;  hteni. 

CASE  107.] 

New  York  Heavy  Ar 

July  3, 

recur'd;  thigh  amp.  just  above 

16 

'Wick.  J.C.,Pt.,C,  155th 

Mar.  25, 

Both  thighs;  left  poplit'l  art'y  tied 

tillery,  age  21. 

18(i4. 

knee  JulyS.  Died  July  23,  '64. 

Pennsylvania,  ago  22. 

Mav  23, 

above  and  below,  by  Ass't  Surg. 

8 

Lynch,    J.,    Corp'l,    K, 

May  10. 

Left  popliteal  region  ;  lig.  poplit'l, 

1«65. 

A.  Delany,  U.  S.  V.;  June  14, 

14lith  N.  York,  age  34. 

17,  '64. 

by  Ass't  Surg.  C.  A.  McUall,  U. 

amp.  thigh.     Died  June  20,  '65. 

S.  A.  DiedMay  23,  '64.  pyaemia. 

17 

Wild,  C.  B.,  Corp'l,  E, 

Sept.  10, 

Right  thigh  thro'  poplit'l  space; 

9 

SfMen,  B.,  Pt.,   11,  Oth 

July  8, 

Left  post.  tib.  art.  wounded  ;  pop 

114th  New  York. 

Oct.  1, 

lig.  of  poplit'l;  haem.  recurred; 

Virginia  Cav.,  age  23. 

•-'7,  '63. 

liteal  tied,  by  A.  A.  Surg.  W.S. 

1864. 

Oct.  12.  amp.  thigh.     Died  Oct. 

Adams.  DiedAug.2,'63,  pyasin. 

13,  1864,  of  exhaustion. 

1  This  is  probably  the  case  referred  to  by  Prof.  A.  C.  POST,  in  the  Addendum  to  Section  I  of  the  Surg.  Mem.  of  the  War  of  the  Rebellion,  pub.  by 
the.  V.  S.  San.  Comm.,  1870,  Vol.  I,  p.  262. 


SECT.  I.] 


LIGATIONS    AFTER    SHOT    FLESH    WOUNDS. 


51 


CASE  110. — M.  Walker,  a  colored  servant  of  the  58th  Pennsylvania  Volunteers,  aged  13  years,  was  wounded  at  Cold 
Harbor,  June  .3,  1864,  by  a  minie  ball,  which  entered  on  the  inner  side  of  the  lower  third  of  the  right  thigh,  passed  through  the 
popliteal  space,  injuring  the  popliteal  artery,  and  making  its  exit  latterly.  Twelve  days  after  the  reception  of  the  injury  he 
was  admitted  to  Harewood  Hospital,  Washington.  Haemorrhage  to  the  amount  of  from  three  to  five  ounces  took  place  on 
June  25th,  and  was  controlled  by  pressure.  On  the  following  day  haemorrhage  recurred,  and  the  popliteal  artery  was  ligated  by 
Surgeon  II.  13.  Bontecou,  U.  S.  V.,  by  enlarging  the  wound  of  entrance,  the  patient  being  under  the  influence  of  sulphuric 
ether.  The  leg  was  placed  in  Smith's  anterior  splint  with  a  fcnestra  opposite  the  Avound  to  facilitate  dressing,  and  a  supporting 
treatment  was  ordered.  The  patient  exhibited  typhoid  symptoms  with  very  profuse  diarrhoea  until  death,  which  occurred  July 
3,  1864.  An  autopsy  showed  that  the  coats  of  the  artery  had  been  injured  by  the  ball,  causing  sloughing  and  the  subsequent 
haemorrhage.  The  history  was  reported  by  the  operator. 

Legations  of  the  Posterior  Tibial  Artery  separately. — ID  a  series  of  seventeen  liga- 
tions  of  the  posterior  tibial  artery  for  shot  wounds  of  the  soft  parts  of  the  leg  and  foot, 
thirteen  recovered,  or  76.5  per  cent.  Three  patients  submitted  to  consecutive  amputation, 
of  whom  one  died.  The  cases  are  enumerated  in  TABLE  V: 

TABLE  V. 

Summary  of  Seventeen  Cases  of  Ligation  of  the  Posterior  Tibial  Artery  for  Hcemorrhage  from  Shot 

Injuries  unattended  by  Fractures. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

NO. 

NAME,  MILITARY 
DESCKTPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

i 

Ball,   J.  D.,  Corp'l,  A, 

May  12, 

Right  post.  tib.  artery  wounded  ; 

9 

Ingalls,   H.  B.,  Pt.,  L, 

Mar.  31, 

Right  leg;   post.  tib.  artery  lig., 

125th  New  York,  age 

28,  '64. 

artery  tied  in  wound,  by  Ass't 

1st  Maine  Cavalry,  age 

April  9, 

by  Surg.  E.  Griswold,  U.  S.  V. 

24. 

Surg.  A.  Ingram,  U.  S.  A.   Dis 

25. 

1865. 

Diseh'd  Aug.  12,  18(55;  pens'd. 

charged  Dec.  29,  '64  ;  pens'd. 

10 

Maran,   M.,   Pt.,   A,   2d 

Feb.  U, 

Right  lejr;  gang.;  posterior  tibial 

o 

Brown,  W.  H.,  Bugler, 

May  24, 

Left  leg  ;  posterior  tibial  art.  tied. 

New  Jersey  Cavalry, 

27,  '64. 

art.  ligated  on  ulcerated  surface. 

5th  New  Jersey  Batte 

June  10, 

Died  July  7,  1864,  pyaemia. 

age  20. 

by  A.  A.  Surgeon  S.  S.  Jessop. 

ry,  age  23. 

1864. 

Disch'd  Oct.  21,  1865;  pens'd. 

3 

Bi:cker,  J.  F..  Pt.,  B,  1st 

April  6, 

Right  leg  ;  posterior  tibial  artery 

11 

Oaklev,   C.  N.,  Pt.,  A, 

March  8, 

Left  leg  ;  lig.  post.  tib.  and  pero- 

Confederate,  age  01. 

16,  '62. 

tied.     Recovered. 

85th  "New  York,  age  32. 

8,  1865. 

neal  arteries.  Died  Mar.  23,  '(i5. 

4 

Dow,  J.  A..  Pt.,E,  136'th 

June  20, 

Right  posterior  tibial  art.  severed  ; 

12 

Rigbey,  T.,  Pt.,  C,  9th 

June  20, 

Left  leg  ;  post.  tib.  artery  tied  at 

New  York,  age  20. 

20,  '64. 

vessel  tied,   by  Surgeon  I.  N. 

N.  Hampshire,  age  23. 

J'y3/64. 

wound.     Furl'd  Aug.  11,  1864. 

Himes,  73d  Ohio.    Disch'd  June 

13 

'Ritter,  D.  T.,  Corp'l,  P, 

Mar.  25, 

Left  post.  tib.  art.  wounded  ;  both 

13,  1865;  pensioned. 

208th      Pennsylvania, 

April  7, 

ends  of  vessel  ligated,  bv  Surg- 

5 

Emery,  R.,  Pt.,  D,  5th 

May  5, 

Left  leg  ;  gang.;  ends  of  art'y  tied 

age  19. 

1865. 

G.  L.  Pancoast,  U.  S.  V.     Dis 

Vermont,  age  133. 

Aug.  4, 

in  wound,  bv  A.  A.  Surg.  J.  B. 

charged  June  27,  18(i5  ;  pens'd. 

1864. 

Crandall.    Disch'd  Dec.  16,  '64  ; 

14 

Sherdan,  J.,  Pt.,  D,  68th 

July  3, 

Right  leg  ;  posterior  tibial  artery 

6 

Flannagan,  H.  A.,  Ser 

April  7, 

pens'd  ;  Aug.  28,  '6.3,  amp.  leg. 
Left  posterior  tib.  art'y  wounded  ; 

Pennsylvaniag»ge  31. 

25,  V63. 

tied  at  both  ends.     Discharged 
Feb.  6.  1865;  pensioned. 

geant,   H,    16th  Penn. 

May  14, 

vessel  tied  at  its  middle  third. 

15 

Thompson,  S.,   Pt.,    E, 

Sept.  22, 

Right  leg  ;  both  onds  of  posterior 

Cav.,  age  25. 

1865. 

Died  June  13,  1865,  erysipelas. 

4th  N.  Jersey,  age  23. 

Oct.  19, 

tibial  artery  ligated  in  wound, 

7 

Gihnore,  M.,  Pt.,  B,  96th 

Aug.  3, 

Left  leg,  involving  posterior  tib. 

1864. 

by   A.   A.  'Surg.  J.  W.  Kerr. 

Illinois,  age  22. 

3,  *64. 

artery  ;  vessel  tied,  by  Surgeon 

Duty  March  30.  1865. 

S.    II.    Kersev,    36th    Indiana. 

16 

Trowbridge,  D.  A.,  Cor 

July  8, 

Right    leg;      artery    ligated    in 

Disch'd  Jan.  10,  1863;  pens'd. 

poral.   L,   5th    Illinois 

Sept.  23, 

wound.     Disoh'dNov.  17,  1863. 

8 

Hagey,    J.    D..    Pt.,    I, 

April  2, 

Left  posterior  tibial  art.  opened  ; 

Cavalry. 

1863. 

138th      Pennsylvania, 

May  8, 

one  end  of  artery  tied  in  wound, 

17 

Wright,  E.,  Pt.,  F,  119th 

May  5, 

Ball  cutting  right  post,  tibial  art.; 

age  24. 

1865. 

by  A.  A.  Surg.  H.  M.  Bellows; 

Peunsylvania,  age  18. 

23,  '64. 

gang.;  art.   tied  in  wound,  by 

sloughing;  May  10,  amp.  leg,  by 

Surg.  E.Bentley,  U.  S.  V.;  May 

A.  A.  Surg.  H.  A.  Drane.     Dis 

25,  haem.  recur'd  ;  leg  amp.  Died 

charged  July  26,  1865  ;  pens'd. 

May  28,  '64,  asthenia  and  pysem. 

legations  of  the  Anterior  Tibial  Artery. — Of  ten  cases  of  ligation  in  which  the 
anterior  tibial  was  separately  tied,  seven  were  successful,  one  after  consecutive  amputation. 
The  cases  are  here  briefly  noted: 

CASES  111-120. — Captain  C.  C.  Brewster,  Co.  D,  10th  Connecticut,  aged  45  years;  wounded  at  Bermuda  Hundred,  May 
16,  1864;  shot  flesh  wound  of  left  leg.  Admitted  into  Chesapeake  Hospital,  Fort  Monroe,  May  21st.  Bleeding  from'the  anterior 
tibial  artery  to  the  amount  of  eight  ounces  occurred.  The  vessel  was  ligated  in  the  wound  at  the  cardial  end.  Haemorrhage 
did  not  recur.  Discharged  September  19,  1864,  and  pensioned.  Examiner  6.  C.  Jarvis,  of  Hartford,  reported,  August  '24, 
1869:  "The  wound  is  now  an  open,  deep  ulcer;  occasionally  pieces  of  bone  come  out  from  some  part  of  the  sore."  Pensioner 
died  June  17,  1873,  of  phthisis  pulmonalis. — Private  W.  Brommel,  Co.  E,  15th  New  York  Artillery,  aged  30  years;  wounded  at 
Boydton  Plank  Eoad,  March  31,  1865;  shot  wound  of  left  leg,  lower  third.  Admitted  into  Columbian  Hospital,  Washington. 
Haemorrhage  from  anterior  tibial  artery;  vessel  ligated  by  Acting  Assistant  Surgeon  S.  W.  Briggs.  Died  May  2,  1865,  from 
exhaustion  from  loss  of  blood. — Corporal  T.  Condon,  Co.  C,  2d  New  York  Artillery,  aged  21  years;  wounded  at  Deep  Bottom. 
August  16,  1864  ;  shot  flesh  wound  of  the  middle  third  of  the  right  leg ;  the  ball  entered  the  posterior  portion  of  the  leg  and  made 
its  exit  at  a  corresponding  point  anteriorly.  Admitted  into  Satterlee  Hospital,  Philadelphia.  Haemorrhage.  August  26th,  Ligation 
of  anterior  tibial  artery  above  and  below  bleeding  orifice  by  Acting  Assistant  Surgeon  W.  F.  Atlee.  Collateral  circulation 
re-established  in  twenty-four  hours.  Discharged  July  26,  1865,  and  pensioned.  The  New  York  Examining  Board  reported, 
March  4,  1876 :  "  There  is  a  cicatrix  three  and  a  half  inches  in  length  on  anterior  surface  of  right  leg ;  the  ball  emerged  through 

1  The  case  numbered  13  in  TABLE  V  is  detailed  by  Professor  A.  C.  POST  in  the  Surg.  Memoirs  of  the  U.  S.  San.  Comm.,  Surgical  Vol.  I,  p.  862. 


52  TNJUEIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

the  calf.  Both  cicatrices  are  adherent  and  interfere  with  locomotion  and  the  strength  of  the  limb." — Sergeant  M.  C.  Glass,  Co. 
F,  16th  Michigan,  aged  24  years;  wounded  at  Hatcher's  Run,  February  7,  1865;  shot  wound  of  right  anterior  tibial  artery. 
Admitted  into  Jarvis  Hospital,  Baltimore.  Ulceration  and  haemorrhage;  six  ounces  of  blood  lost.  Ligation  of  anterior  tibial  artery 
in  continuity,  February  20,  1865.  Died  February  28,  1865,  of  haemorrhage.— Private  J.  L.  Renshaw,  Co.  H.  191st  Pennsyl 
vania,  aged  28;  wounded  at  Petersburg,  June  24,  1864;  shot  flesh  wound  of  left  leg  by  a  conoidal  ball;  sloughing  and 
haemorrhage  from  anterior  tibial  artery  to  extent  of  eight  ounces.  Ligation  of  artery  above  and  below  wound.  The  patient 
recovered,  and  was  discharged  May  18, 1865. — Private  S.  Riley,  Co.  H,  92d  New  York,  aged  24;  wounded  at  Cold  Harbor,  June 
1,  1864  ;  conoidal  ball  passed  through  the  integument  of  the  left  leg  one  inch  below  the  knee.  June  25th,  sloughing  and  erysip 
elas.  July  8th,  recurrent  haemorrhage  to  the  extent  of  six  ounces  from  the  anterior  tibial  artery.  The  artery  was  tied  in  the 
wound.  The  patient  was  discharged  February  9,  1865,  and  pensioned.  Examiner  H.  O.  Hitchcock,  of  Kalamazoo,  reported, 
June  8,  1867:  ''Ball  passed  below  the  patella  and  under  the  ligament,  The  wound  was  followed  by  gangrene  and  large 
sloughing,  and  now  there  is  an  extensive  cicatrix,  causing  lameness  and  great  weakness  of  the  knee."  Examiner  J.  A.  Brown, 
of  Detroit,  reported,  September  28,  1869  :  "Gunshot  wound  of  left  knee,  the  ball  striking  the  inner  condyle  of  the  tibia  and 
the  patella,  causing  weakness  and  impaired  motion  of  the  knee,  mostly  from  contraction  of  the  cicatrix."  Examiner  D.  F. 
Wooley,  of  Big  Rapids,  reported,  April  1,  1875 :  "Ball  entered  at  upper  and  inner  third  of  the  tibia,  passing  directly  in  front 
and  under  the  patella  and  out,  severing  the  attachment  of  the  lower  end  of  the  patella  and  fracturing  the  upper  end  of  the 
tibia;  resulting  in  loss  of  part  of  upper  portion  of  the  tibia  and  weakening  of  knee  joint  to  a  serious  extent,  with  slight 
adhesions  of  the  muscles ;  on  the  whole  seriously  impeding  locomotion  and  requiring  care  to  maintain  a  standing  position  upon 
it."  The  pensioner  was  paid  March  4.  1876. — Corporal  I.  Sampson,  Co.  F,  1st  Massachusetts  Cavalry,  aged  35,  was  wounded 
during  Sheridan's  raid,  May  11,  1864;  shot  wound  of  right  leg,  middle  third,  outside.  Admitted  into  Hammond  Hospital, 
Point  Lookout.  Gangrenous  sloughing  set  in,  destroying  the  coats  of  the  anterior  tibial  artery.  June  28th,  haemorrhage  to  the 
extent  of  four  ounces  from  the  anterior  tibial  artery.  Both  ends  of  artery  tied  in  the  wound  by  Acting  Assistant  Surgeon  T. 
Liebold.  The  bleeding  did  not  recur.  The  patient  re^vered,  and  was  mustered  out  October  16,  1864.  Examiner  \V.  H.  Page,  of 
Boston,  reported,  April  11,  1865 :  "  Ball  struck  about  the  middle  of  the  left  leg,  fracturing  and  splintering  the  tibia,  a  large  part  of 
which,  at  seat  of  injury,  has  been  removed,  and  there  is  a  deep  cicatrix  three  inches  by  one  and  a  half.  The  whole  leg  is  much 
swollen  and  cedematous,  and  there  is  probably  more  dead  bone  to  be  removed."  The  Boston  Examining  Board  reported,  Decem 
ber  2,  1874  :  "  Ball  entered  middle  third  of  leg  anteriorly  and  passed  directly  through.  The  tibia  was  shattered,  and  necrosis 
has  resulted  therefrom.  The  leg  is  weak  and  the  wound  is  still  open,  an  ulcer  at  the  time  of  examination  existing  the  size  of 
a  five-cent  piece,  surrounded  by  an  areola  four  inches  in  diameter  and  somewhat  eczematous.  His  leg  is  painful  and  weak 
upon  long  standing,  and  this  interferes  with  the  performance  of  manual  labor."  In  September,  1875,  the  Board  reported: 
"Large  adherent  cicatrix,  inflamed  and  very  tender;  anchylosis  of  ankle."  Pensioner  paid  June  4,  1876. — Private  W.  Sauls- 
bury,  Co.  K,  39th  U.  S.  C.  T.,  aged  36;  wounded  at  Petersburg,  July  30,  1864;  flesh  wound  of  lower  third  of  right  leg.  He 
was  admitted  into  Summit  House  Hospital,  Philadelphia.  Secondary  haemorrhage  ;  ligation  of  anterior  tibial  artery  January 
19,  1865.  Amputation  of  right  leg  at  lower  third  by  double-flap  method.  Transferred  to  hospital  at  Beverly,  and  discharged 
May  26,  1865.  He  died  July  16,  1871.— Private  J.  Skiffington,  Co.  I,  2d  New  York  Heavy  Artillery,  aged  28;  wounded  at 
Petersburg,  June  16,  1864;  flesh  wound  of  l^er  third,  right  leg.  Admitted  into  Satterlee  Hospital,  Philadelphia;  wound 
sloughing.  Acting  Assistant  Surgeon  W.  F.  Atlee  ligated  both  ends  of  the  anterior  tibial  artery  in  the  wound,  on  account  of 
haemorrhage,  July  28,  1864.  The  patient  died  August  29,  1864,  of  pyaamia. — Private  L.  Weaver,  Co.  G,  4th  Virginia,  aged  23 ; 
wounded  at  Gettysburg,  July  3,  1863.  Admitted  into  Twelfth  Corps  Hospital.  Shot  flesh  wound  of  both  legs  and  face.  July 
13th,  bleeding  of  eight  ounces  from  the  anterior  tibial  artery,  which  recurred  on  the  14th,  sixteen  ounces  of  blood  being  lost. 
The  anterior  tibial  artery  was  tied  above  and  below  the  point  of  division.  The  patient  was  paroled  November  12,  1863. 

legations  of  the  Anterior  and  Posterior  Tibial  Arteries. — There  were  two  instances 
in  which  the  posterior  and  anterior  tibial  arteries  were  conjointly  tied  for  shot  flesh  wounds: 

CASES  121-122.— Private  J.  Hoar,  Co.  G,  144th  New  York,  aged  22  years,  wounded  at  White  Plains,  July  24,  1863. 
Shot  wound  of  right  foot;  admitted  into  Douglas  Hospital,  Washington;  haemorrhage  to  the  extent  of  six  ounces  occurred 
from  the  metatarsal  artery  on  August  1st.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  ligated  the  anterior  tibial  artery  in  the 
continuity  at  the  instep  and  the  posterior  tibial  behind  the  malleolus.  The  wounds  healed  well,  and  the  patient  was  returned  to 
duty  from  Central  Park  Hospital,  New  York,  April  11,  1834.  He  is  not  a  pensioner. — Private  J.  Kercher,  Co.  D,  7th  Michigan 
Cavalry,  wounded  at  Gettysburg,  July  2,  1863.  Shot  wound  of  right  leg  and  of  anterior  and  posterior  tibia]  arteries ;  admitted 
into  McDougall  Hospital,  New  York  Harbor.  July  29th,  ligation  of  anterior  and  posterior  tibial  arteries.  August  10th, 
haemorrhage,  amounting  to  thirty-two  ounces  of  blood.  Died  August  10,  1863. 

Ligation  of  Veins. — Six  cases  in  which  the  femoral  vein  was  tied  simultaneously  with 
the  artery  are  noted  on  page  38.  Specimens  from  two  of  the  cases  are  shown  in  Figures 
15  and  19.  A  case  of  ligation  of  the  saphenous  vein  is  detailed: 

CASE  123. — Private  A.  Kendig,  Co.  B,  97th  Pennsylvania,  aged  31  years,  wounded  at  Bermuda  Hundred,  May  18,  1864. 
Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported  from  Hampton  Hospital,  Fort  Monroe:  "Gunshot  wound  of  left  thigh, 
inner  surface,  upper  third;  the  ball  entered  near  the  apex  of  Scarpa's  space,  passed  through  the  adductor  longus  muscle,  und 
made  its  exit  over  the  upper  third.  Gracilis  muscle  wounded;  phagedaeua.  On  May  24th,  haemorrhage  to  the  extent  of  xix 
ounces  occurred  from  the  saphenous  vein.  Both  extremities  of  the  vein  were  ligated  in  the  wound.  The  haemorrhage  did  not 
recur,  but  the  patient  sank  and  died  of  exhaustion  June  4,  1864." 

Amputations  following  shot  flesh  wounds  will  next  be  considered. 


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SECT.  1. 1  /    AMPUTATIONS    AFTER    SHOT    FLESH    WOUNDS.  53 

Amputations  in  the  Lower  Limbs  after  Shot  Flesh  Wounds. — Two  hundred  and  one 
cases  were  reported  of  amputations  in  the  lower  extremity  for  shot  wounds  involving  only 
the  soft  parts,  comprising  one  hundred  and  thirty-one  amputations  in  the  thigh,  six 
disarticulations  at  the  knee,  sixty-three  amputations  at  the  leg,  and  one  of  the  toes. 

Amputations  in  the  Thigh. — In  the  hundred  and  thirty-one  cases  of  this  series,  ninety- 
four  or  71.7  per  cent,  were  fatal.  The  cases  are  enumerated  in  TABLE  VI.  Ten  of  the 
operations  were  primary,  with  only  two  recoveries.  '  Fifty-seven  intermediary  operations, 
with  forty-eight  deaths,  gave  a  mortality  rate  of  84.2  per  cent.;  sixty-four  secondary 
operations,  with  thirty-eight  deaths,  had  a  death-rate  of  59.4  per  cent.  The  amputations 
were  necessitated  for  the  most  part  by  complications  of  consecutive  haemorrhage,  gangrene, 
or  secondary  disease  of  the  bone  or  joints,  and  in  some  instances  were  resorted  to  after 
ligations,  removals  of  sequestra,  or  other  interference  had  been  unavailingly  employed : 

CASE  124. — Private  H.  Root,  Co.  B,  104th  New  York,  aged  26  years,  was  wounded  at  Petersburg,  June  22,  1864, 
and  admitted  to  the  field  hospital  of  the  3d  division,  Fifth  Corps.  Surgeon  L.  W.  Read,  U.  S.  V.,  noted,  "buckshot  flesh 
wound  of  right  leg,  slight."  On  June  30th,  the  patient  entered  the  Harewood  Hospital,  Washington,  whence  Surgeon  R.  B. 
Bontecou,  U.  S.  V.,  contributed  the  specimen  (FiG.  21),  with  the  following  brief  history:  "Gunshot  wound  of 
right  leg,  middle  third,  injuring  soft  parts.  On  admission  the  constitutional  state  of  the  patient  was  very  poor; 
condition  of  injured  parts  tolerably  good,  but  wound  very  painful.  The  parts  subsequently  became  gangrenous, 
with  rapid  sloughing  of  soft  parts;  about  one  half  of  the  lower  third,  and  three-fourths  of  the  upper  third,  and 
all  of  the  middle  third  of  the  tibia  exposed  and  denuded  of  periosteum.  The  tibia  became  necrosed  throughout 
its  whole  extent,  and  at  this  time  the  patient  became  jaundiced.  On  October  29th,  about  ten  inches  of  necrosed 
bone  was  extracted  by  Acting  Assistant  Surgeon  D.  I.  Evans.  The  general  condition  of  the  patient  improved 
soon  afterwards,  under  a  supporting  treatment  throughout,  and  was  doing  tolerably  well,  parts  improving, 
when  transferred  to  hospital  at  Elmira,  January  4,  1865."  Two  weeks  after  his  transfer  the  patient  obtained  a 
furlough  and  proceeded  to  his  home  in  Tioga  County,  New  York,  where  his  limb  was  subsequently  amputated 
at  the  middle  third  of  the  thigh.  Dr.  S.  Knapp,  his  attending  physician,  certified  that  "he  found  him  suffering 
from  a  badly  cared  for  and  neglected  wound,"  etc.,  and  that  "on  February  28,  1865,  it  became  necessary  to  ampu 
tate  the  leg,"  which  operation  he  performed,  being  assisted  by  Dr.  E.  Daniels.  About  two  months  afterwards 
the  patient  returned  to  the  hospital,  and  on  July  21,  1885,  he  was  discharged  from  service  and  pensioned.  He 
died  July  25,  1870,  of  consumption,  resulting  from  the  wound  and  its  effects,  more  than  five  years  after  the  ampu 
tation.  The  parts  removed  by  the  amputation  at  mid-thigh  by  Dr.  Knapp  were  not  transmitted  to  the  Museum; 
but  the  large  sequestrum  comprising  the  greater  part  of  the  diaphysis  of  the  tibia  is  represented  in  the  wood-cut  FIG.  21.— Se- 
(FiG.  21),  and,  as  mounted,  is  nine  inches  in  length  (see  Catalogue  of  the  Surgical  Section  of  the  Army  Medical  J^™?],^ 
Muesum,  Washington,  1866,  p.  405).  Isjec.  3601.*' 

In  a  grave  case  of  hospital  gangrene  following  a  shot  wound  at  the  ankle,  the  lamented 
artist,  Hospital  Steward  E.  Stauch,  made  a  colored  drawing  of  the  appearances  after  the 
sloughing  surfaces  had  cleaned  off  under  the  applications  of  fermented  cataplasms.  The 
drawing  is  copied  in  the  chromolithograph  opposite,  PLATE  XXVII. 

CASE  125. — Corporal  C.  H.  Dudley,  llth  Indiana  Battery,  received  at  Chicamauga,  September  20,  1863,  a  wound  of  the 
right  foot,  a  conoidal  ball  entering  the  under  portion  just  below  ankle  joint.  He  was  taken  prisoner,  conveyed  to  Richmond, 
and  on  October  29,  1863,  was  admitted  to  Division  No.  1  hospital,  Annapolis,  from  the  steamer  New  York.  The  wound  had 
sloughed  extensively.  On  October  30th  and  31st  there  was  haemorrhages  from  the  dorsalis  pedal  artery,  Avhich  was  promptly 
arrested  by  the  use  of  styptics.  Soon  after  admission  a  phagedenic  ulcer  made  its  appearance  on  the  posterior  face  of  the  right 
leg,  immediately  below  knee  joint,  and  an  examination,  made  November  19,  1863,  revealed  a  deeply  excavated  sloughing 
wound.  Yeast  poultices  were  applied  to  the  sloughing  tissues,  and  when  the  gangrenous  masses  had  cleaned  off  a  colored 
drawing  was  made  of  the  parts  by  Hospital  Steward  E.  Stauch.  November  23d,  haemorrhage  amounting  to  eight  ounces 
occurred  from  this  wound,  and  was  restrained  by  finger  compression  on  the  femoral  artery;  tourniquet  was  loosely  applied  on 
limb,  and  stimulating  draughts  given.  On  November  24th,  Assistant  Surgeon  W.  S.  Ely,  U.  S.  V.,  who  had  charge  of  the  case,^ 
reports  that  the  "wound  from  which  the  haemorrhage  proceeded  was  thoroughly  examined  and  the  diseased  tissues  found 
more  extensive  than  had  been  supposed ;  the  finger  could  be  passed  beneath  superficial  border  of  ulcer  to  a  considerable  extent, 
and  the  popliteal  artery  was  found  to  be  divided  by  the  extent  of  the  ulcerative  process,  and  the  ligamentous  structures  of  the 
knee  joint  were  found  extensively  destroyed.  Amputation  was  determined  on  as  the  only  rational  treatment.  It  was  imme 
diately  performed,  after  the  circular  method,  directly  above  the  knee  joint,  by  Surgeon  T.  A.  McParlin,  U.  S.  A.,  assisted  by 
Surgeon  B.  A.  Vanderkieft,  U.  S.  V.  Patient  bore  the  operation  well,  and  the  tissues  at  seat  of  amputation  appeared  healthy. 
No  sutures  were  used  to  approximate  the  flaps,  wet  straps  being  the  only  retentive  treatment  employed."  The  case  progressed 
favorably  until  December  2d.  Acting  Assistant  Surgeon  C.  Hayes  kept  the  further  record  of  the  case.  On  December  8,  1863, 
haemorrhage,  amounting  to  eight  ounces,  occurred  from  the  stump.  He  failed  rapidly  after  this,  and  died  December  11,  1863. 
Surgical  Series  of  Drawings,  Nos.  59,  60,  S.  G.  O.,  PLATE  XXVII. 


54 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


TABLE  VI. 

Numerical  Statement  of  One   Hundred  and   Thirty-one  Amputations  in  the  Thigh  for  Shot  Injury 

unattended  by  Fracture. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

1 

Atwood,  H.,  Pt.,  K,  14th 

Sept.  1  9. 

night  fern.  art.  injured  ;  circulat'n 

24 

Chescltine,  W.  C.,   Pt., 

May  27, 

Right  thigh,  severing  fern,  vein  ; 

New  Hampshire. 

23,  '04. 

destroyed;  gang.;  circ.  amp.  at 

C,  1st  Maryland  Cav 

June  4, 

gang.;  circ.  amp.  thigh,  by  Asst. 

low.  third  thigh,  by  A.  Surar.W. 

alry,  age  22. 

1804. 

Surg.  W.   F.   Norris,  U.  S.  A. 

Fritz,  12th  Mo.  Died  Sept.30,'64. 

Died  June  9,  1804,  exhaustion. 

2 

Baker,  J.,  Pt.,  A,  llth 

June  15, 

Sheath  of  right  fern.  art.  wounded  ; 

25 

Christ,   J.,    Corp'l,    M., 

Mar.  25, 

Right  thigh  ;  circ.  amp.  thigh,  by 

Com  ccticut.  age  3-. 

26,  'M. 

haem.  from  branch  of  prnfunda  ; 

198th  Penn.,  age  27. 

April  7, 

A.  A.  Surg.  J.  H.Gillman.  Died 

tlap  amp.  thigh,  by  A.  A.  Surg. 

1805. 

April  25,  1805,  pyaemia. 

J.  S.  Hill.     Died  June  29.  1804. 

20 

Cook,  L.,  Serg't,  C,  26th 

June  18, 

Right  thigh.    Aug.  9,  Ini'in.;  amp. 

3 

Barkeloo.  J.,  Pt.,  M.  2d 

July  19. 

Right  popliteal  artery  severed  ; 

Ohio,  age  25. 

Aug.  10, 

post.  Hap,  mid.  third,  by  A.  A. 

Ohio  Cavalry,  age  28. 

2(i,'  '03. 

tern.  art.  ligatcd:  flapnmp.  thigh 

1804. 

Surg.  E.  H.  Sands.     Died  Aug. 

at  up.  third.  Disch'd  Mar.  17,'05. 

11,  1804. 

4 

Barnum,  C.  F.,  Pt.,  E, 

June  18. 

Left  leg;  amp.bel.  tubcrc.  of  tibia  ; 

27 

Cooper,  T.,  Pt.,  C,  4th 

June  22, 

Left  thigh  and  leg  ;  contraction  of 

167th  Penn.,  age  30. 

Sept,  7, 

haem.;  amp.  thigh,  eirc.,  lo.  third, 

Penn.  Reserves,  age  18. 

'04,  May 

muscles  ;  Dec.  31,  hamstring  teu- 

1804. 

bv  A.  A.  Surg.  J.  Morris.  Died 

3,  '70. 

dons  divided.     Disch'd  June  23, 

Oct.  13,  '04.  A}M!C.  3133,  A.M.  M. 

'65  ;  leg  deform  'd  and  paralyz'd  ; 

5 

Barry,  E.,   Pt.,  A,  S2d 

June  3, 

Left  k-g  ;  flap  amp.  at  mid.  third, 

amp.  above  knee,  by  Surg.  O. 

Perm.,  age  24. 

Aug.  11, 

by  Dr.  J.  Shields.     Discharged 

Pemberton,  F.  R.  C.  S.,  of  Birm 

1804. 

Sept.  2,  1805. 

ingham,  England. 

6 

Blaker.J.  P..Pt.,E,  15th 

Aug.  7, 

Left  leg  ;  gang.;  ant.  post.,  lower 

28 

Curtis,   J.   A.,   Pt.,    D, 

June  27, 

Right  thigh;  gang.:  flaps  of  skin, 

Inl'antrv,  age  18. 

Sept.  l(i, 

third  thigh,  by  A.  A.  Surg.  11. 

101st  Ohio,  age  25. 

Aug.  7, 

cir.  of  muscles,  by  Surg.  S.  E. 

1804. 

\V.  Forrest.  Died  Sept.18,  1804, 

1804. 

Fuller,  U.  S.  V.     Died  Aug.  15, 

exhaustion. 

1804,  pyaemia. 

7 

Brastcd,A.A.,  Serg't,  H, 

June  1, 

Right   knee  joint;    gang.;   joint 

29 

Curtis,  G.,  Pt.,   A,  1st 

Oct  27, 

Shell  contusion  of  right  thigh  and 

%th  New  York,  age  22. 

Nov.  7, 

opened;  circ.,  low.  third  thigh, 

Colored  Troops,  age  23. 

Nov.  19, 

leg  ;  gang.;  amp.  thigh,  by  Asst. 

18C4. 

by  A.    A.    Surg.  A.  J.  Smith. 

1804. 

Surg.  J.  H.  Frantz,   U.  S.  A. 

Died  Nov.  30,  1804,  exhaustion. 

Died  Jan.  13.  1805,  pyaemia. 

8 

Bell,  J.  C..  Pt.,  E,  34tli 

April  0, 

Left  posterior  tibial  artery  cut  by 

30 

Daniclson,   H.   A.,  Pt., 

Dec.  16, 

Left  thigh  ;  gang.:  amp.  thigh,  by 

Iowa,  age  23. 

18,  'b'5. 

ball;  gang.;  haem.;  lig.  of  fern. 

G,  7th  Minnesota,  age 

'64,  Feb. 

A.  A.  Siirg.  S.  W.  Thompson. 

artery;  amp.  at  low.  third  thigh, 

01 

23. 
Dirlinc"    S    G     Pt     D 

11,  '65. 

M1V  l-T 

Disch'd  August  10,  1805. 

Died  April  23,  '05,  exhaustion. 

oJ. 

32d  Maine,  age  19. 

**J    l  —  i 

26,  '04. 

tied  on  field  :  gang.;  thigh  amp. 

9 

Belt.  W.  H.  II..  Pt.,  A. 

Feb.  10, 

Shot  perforation  left  thigh  ;  ery 

by  Surg.  R.  B.  Bontecou.U.S.V. 

10th  Ohio  Cavalry,  age 

April  21, 

sipelas:  (lap  amp.  at  mid.  third, 

Died  May  20,  '04,  haemorrhage. 

21. 

1863. 

by  Surg.  J.  It.  McClurg,  U.S.V. 

32 

Decker,  E.,  Pt.,  H,  81st 

July  22, 

fern.  art.  wounded  ;  primary 

Disch'd  Sept.  2,  1803. 

Ohio. 

1864. 

amputation  of  thigh.  Died  Aug. 

10 

Bishop,  J.,  Pt.,  M,  22d 

Aug.  25. 

Right  leg,  destroying  post,  tibial 

3,1864. 

New   York     Cavalry, 

Sept.  C, 

artery,  vein,  and  nerve;  hrem.: 

23 

Deinlein,  D.,  Pt.,  C.  5th 

May  25, 

Right  popliteal  space,  producing 

age  20. 

18C4. 

thigh  amp.  at  low.  third,  by  A. 

Ohio,  age  43. 

July  10, 

aneurism  :  amp.  thigh,  by  A  .  A. 

A.  Sura:  .  \V.  .T.  Mcllench.   Died 

1864. 

Surg.  O.  D.  Norton.    Died  Aug. 

Sept.  15,  1804,  pyaemia. 

1,  1804,  in  low  typhoid  condition. 

11 

Black.  J.  M..  Corp'l,  D. 

July  20. 

Right  Irsr;  gang.:  llapamp.  thigh, 

34 

Delamater,   M.,   Corp'l, 

May  28, 

Right  thigh;  gang.:  haem.:  July 

35th  Ohio,  age  21. 

Aug.  15, 

low.  third,  by  A.  A.  Surg.  J.  E. 

G,  7th  Mich.  Cavalry, 

July  12, 

10,  femoral  ligatcd  ;  amp.  thigh, 

1804. 

Crowo.  Died  Aug.  18,'04,  exh'n. 

age  20. 

1864. 

by  Asst.  Surg.  II.  M.  Sprague, 

12 

Blaisdell.   II..    Pt.,    II, 

April  20, 

Right  leg  near  knee;  no  fracture; 

U.S.A.  Died  Aug  7.  '04.  py'mia. 

58th  Pennsylvania. 

June  28, 

thigh  amp.  at  middle  third,  by 

35 

Deniker,  D.  H.,  Pt.,  E, 

Sept.  20, 

Right  leg  ;  thigh  amp.  at  lower 

1803. 

Surg.  J.  F.  Galhv-pe.  17th  Mass. 

2d  Maryland,  age  20. 

28,  '04. 

third,  by  A.  A.  Surgeon  M.  M. 

Died  July  !.(),  18u3. 

Townsend.     Died  Sept.  29,  '04. 

13 

Boies,  J.  A..  Lieut.,  II, 

May  22, 

Loft  knee.  by  spent  shot  ;  pyaemia  ; 

30 

Dodge,  W.   M.,  Serg't, 

July  2, 

Right  leg;   gang.;    lupin.;   amp. 

13th  Infantry,  age  22. 

June  18, 

amp.   of  thigh  at  upper  third. 

F,    137th    New   York, 

10,  '03. 

thigh,  by  Surg.  II.  E.  Goodman, 

1803. 

Died  June  28,  1803. 

age  45. 

28th  Penn.     Died  July  13,  '63. 

14 

Brockman,    11.,    Pt.,    I, 

April  0, 

Right  femoral  artery  cut  :  double 

37 

Doyle,   L.,  Pt.,  K,   8th 

May  20, 

Right  thigh  perforated!  June  1, 

Oth  Kentucky. 

June  20, 

(lap  amp.  thigh.     Disch'd  Aug. 

Maine,  age  34. 

June  C, 

haem  :    fern,   ligated  :    recurred  ; 

1802. 

i>,  1803. 

1804. 

amp.  thigh,  by  Asst.  Surer.  W. 

15 

inurl-f.  IF.,  Pt.,  B,  24th 

Sept.  19, 

thigh  :  gangrene  :  thigh  amp. 

II.  Gardner,  u".  S.  A.  Died  June 

Alabama. 

23,  '03. 

Died  Sept  23,  1803. 

0,  1864,  exhaustion. 

16 

Burroughs.    //.    C.,    C, 

April  1, 

Poplit'l  space,  r't  leg  ;  gang.:  circ. 

38 

Drilling,  H.,Pt.,C,  124th 

Oct.  26, 

Right  fern,  vein  and  art'ry  wound 

7th  C.  S.  Cavalry. 

May  15, 

amp.  thigh,  by  Surg.  W.  Hayes, 

New  York,  age  30. 

Nov.  1, 

ed;  haem.;  amp.  thigh,  by  Surg. 

1805. 

U.S.V.    Died'May  17,  '05.  gang. 

1804. 

D.  W.  Bliss,  U.S.Y:    Die'd  Nov. 

17 

Butler,   II.,  Pt.,   TI.   1st 

June  1  . 

Left  le*"1  just  below  poplit'l  space  • 

21,  1804,  pyaemia. 

New    York    Artillery. 

Aug.  5, 

gang  ;  amp.  thigh,  by  A.  A.  Surg. 

3'J 

Dudley,  C.  H.,  Corp'l, 

Sept.  20, 

Right  foot  ;  gang.,  involving  pop 

age  21. 

1804. 

\V.  C.  Way.    Died  'Aug.  0.  '04. 

1  1th  Indiana  Battery. 

Nov.  24, 

liteal  artery;  lurm.:  amp.  thigh, 

18 

Cameron.  .!.,  Serg't,  1C, 

June  20, 

Risfht  thigh  :  ch.  arthritis  ;  double 

1803. 

by  Surg.  T.  A.  MoParlin.U.S.A. 

31st  Maine,  age  '21. 

'04,  July 

flap,  thigh,  by  Ass't  Surg.  H.  E. 

Died  Dec.  11,  '63.  haem..  debility. 

5,  '00.' 

Brown,  U.  S.  A.     Recovery. 

40 

2Dutcher,  J.  H.,  Pt.,  M, 

May  31, 

Left  popliteal  artery  divided  near 

10 

Carroll,  R.  A.,  Pt..   F, 

July  3, 

Right  leg;  doub.  flap  amp.  thigh, 

2d  New  York   Heavy 

June  5, 

end  ;  gang.;  thigh  amp.,  by  Surg. 

3d  Alabama,  age  19. 

Nov.  29, 

by  A.  A.  Surg.  J.    E.  Steele; 

Artillery. 

1864. 

J.  A.  Lidell,  U.  S.V.  Die'd  June 

1803. 

haemorrhage:  fern,  art'ry  li<rated. 

8,  '04.  exhaustion. 

20 

Case.  E.  F.,  Pt..  O,  13th 

Sept.  19, 

Died  Feb.  17,  1804,  pyasmia. 
Left  fern,  artery  severed;  gang.; 

41 

Dyer,  G.  A.,  Serg't,  G, 
6th  Maine,  age  21. 

Nov.  7, 
'03,  Feb. 

Right  thigh  ;  amp.  thigh,  by  Surg. 
D.  W.  Bliss,  U.  S.  V.     Disch'd 

Michigan. 

26,  '03. 

Sept.  24.  amp.  leg  four  inches 

19,  '04. 

April  19,  '04.  Spec.  2047.A.M.M. 

below  knee  ;  20th.  thigh  amp.  at 

42 

Edwards.  C.  S.,  Pt.,  G, 

Dec.  31, 

Left  leg;  amp.  thigh,  by  A.  A. 

upper  third.     Died  Sept.  27,  '03. 

57th  Indiana. 

'02,  May 

Surgeon  J.  B.  Burns.     Disch'd 

21 

Chapmnn.  C.  II..  Serg't, 

Sept.  30, 

Right  thigh:    gang.,  destroying 

26,  '03.' 

Aug.  23,  1863. 

10,   13th   Ne\r    Hamp 

'04,  Apr. 

profundaart'yjhaem.;  circ.  amp. 

43 

Elliot,  J.,  Corp'l,  E,  2d 

April  2, 

Left  leg  ;hsem.:  April  29,  popliteal 

shire,  age  26. 

7,  '05. 

up.  third,  by  Surg.  11.  I.  P.  flood- 

Pennsylvania  Cavalry, 

May  5, 

artery  ligated:  hjpm.  recurred  : 

win.  Died  iive  hours  after  ope'n. 

age  24. 

1863. 

amp.'  thigh.     Died  May  5,  1863, 

22 

Chapmnn.  J.  S..  Pt..  E. 

June  18, 

Left  knee  ;  amp.  post.  flap,  thigh, 

from  shock,  2  hours  after  amp. 

4th  Maine,  age  33. 

July  5, 

by  Surg.  E.  Bentlev,  V.  S.  V. 

44 

Farder,  J.,  Pt..  1st  N. 

June  20, 

Right  thigh  and  left  leg:  amp.  left 

23 

Chawgo.  M.  \V.,  Pt..  II, 
40th  New  York,  age  21. 

18(54. 

May  13, 
17,'  '64. 

Died  July  0,  1804,  exhaustion. 
Right  leg;  gang.;  hsem.:  amp.  at 
low.  third,  by  Asst.  Surg.  C.  A. 

45 

Carolina  Cavalry,  age 
25. 
Feary,   G.  M.,    Pt.,   B, 

Sept.  1, 
1804. 
July  2, 

thitrh,  by  Surg.  II.  L.  W.  Bur- 
ritt,  U.  S.  V.     Died  Sept.  2,  '64. 
Right  thigh,  severing  fern,  artery; 

McCall,  U.  S.  A.     Died  May  19, 

108th  New  York. 

14,  '03. 

hnnm.;  gangrene;  amp.  of  thigh. 

1804,  pyaemia. 

Died  July  24,  1863. 

1  FERRY  (C.),  Report  of  Wounded  treated  in  Field  Hospital  of  llindman's  Division,  etc.,  in  Confederate  States  Med.  and  Surg.  Jour.,  1804,  Vol. 
I,  p.  77.          2Lir>KLT,  (J.  A.),  Wounds  of  the  Arteries,  in  Surg.  Mem.  of  the.  War  of  the  Rebellion,  by  the  U.  S.  Sanitary  Commission,  1870,  Vol.  I,  p.  59. 


SECT.  I.] 


AMPUTATIONS    OF    THE    THIGH    AFTER    SHOT    FLESH    WOUKDS. 


55 


No. 

NAME,  MILITARY 
DESCRIPTION1,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 

RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

46 

Fenton,   C.(   Serg't,   E, 

May  6, 

Left  thigh,  wound'g  profunda  art.; 

72 

Lauch,   H.,   Pt.,   Bras- 

Sept.  19, 

Left  thigh,  severing  fern.  art.  and 

1st  Penn.,  age  25. 

22,  r64. 

frequent  luems.;  amp.  thigh,  by 
Surg.  K.  B.  Bontecou,  U.  S.  V. 

ton's  Artillery,  age  34. 

28,  '64. 

vein;  hiem  :  amp.  thigh,  by  Surg. 
G.  M.  Uurditt,  P.  A.  C.  S.    Died 

Died  May  22,  '64,  exhaustion. 

Sept.  28,  shock  opcr'n  and  gang. 

47 

Foss,  A.  J.,  Pt.,  F,  loth 

April  27, 

Right  leg  ;    gang.;    amp.   thigh. 

73 

Lee,  W.  II.,  Corp'l,  F, 

Feb.  10, 

Right  thigh  ;  exten.  suppu  n,  knee 

N.  Hampshire,  age  '-'I. 

M'y8,'G3. 

Died  May  S,  1863. 

32d    Colored    Troops, 

.Mar.  14, 

joint  inv.;  circ.,  lower  third,  by 

48 

Foust,  J.,  Pt.,  —  ,  North 

Mar.  27, 

Left  knee,  not  in  volv'g.  joint  ;  ex 

age  £6. 

1865. 

Surg.  A.  H.  Thurston,  U.  S.  V. 

Carolina  Artillery,  age 

June  17, 

tensive  suppurat'n  involv'g  joint; 

Died  March  14,  1865,  irritative 

37. 

1865. 

amp.  thigh,  by  A.  A.  Surg.  J.Gil- 

fever,  shock. 

man  ;  hajin.;  artery  lig.;  July  10, 

74 

Leonard,  J.,  Pt.,  L,  7th 

Mav  30, 

Left  leg;  July  3,  haem.;  ligation 

pyaemia.   Died  J'y  25,  '65,  exh'n. 

New  York  H'vy  Art'y, 

July  8, 

of  posterior  tibial  artery;   amp. 

49 

Gardner,  G.  W.,  Serg't, 

Oct.  11, 

Right  fern,  artery  injured;  gang.; 

age  21. 

1864. 

thigh.     Died  July  23,  1864. 

H,   12th   Illinois   Cav 

29,  '03. 

amp.  thigh,  by  A.  A.  Surg.  W. 

75 

Lloyd,  R.,   Pt.,   B,    1st 

Dec.  31, 

Left  thigh  ;  amp.  thigh  at  lower 

alry,  age  29. 

H.  Ensign.     Died  Dec.  5,  1863, 

Kentucky. 

'62,  Ap'l 

third.     Disch'd  Aug.  26,  1863. 

debility.     Spec.  1760,  A.  M.  M. 

4.  '63. 

50 

Goldsborough.     H.    J., 

June  26, 

Left  knee;  ulcerat  ion  of  articular 

76 

Lyon,  II.  J.,  Serg't,  H, 

July  21, 

Left  popliteal  space  ;  gang.;  amp. 

Pt.,  B,  3  1st  Illinois. 

Dec.  1G, 

surface  of  bone  ;  amp.  thigh,  by 

40th  Illinois,  age  24. 

28,  '64. 

of  thigh,  by  Surg.  E.  J.  Buck, 

1863. 

A.  A.  Surg.  J.  D.  Davis.    Died 

18th  Wis.    Disch'd  April  26,  '65. 

April  15,  1H64. 

77 

McCarthy,   D.,   Pt.,   C, 

Aug.  9, 

Right  popliteal  space;  amp.  right 

51 

Gooding,  H.  P.,  Pt.,  H, 

Jan.  30, 

Left  knee;  extensive  suppurat'n, 

2d  Mass.,  age  22. 

Sept.  15, 

thigh,    by   A.   A.   Surg.  T.   B. 

10th  Michigan  Cav'ry. 

Feb.  27, 

joint  disorg'zed;  flap.  low.  third, 

1862. 

Townsend.  Disch'd  June  17,'64. 

1865. 

by  A.  A.  Surg.  T.  \V.  Branch. 

78 

McClure,  R.,  Pt.,  L,  15th 

Jan.  21, 

Right  leg,  severing  ant.  tibial  art. 

Died  March  4.  1865  ;  pyaemia. 

Kansas,  age  18. 

24,  '64. 

and  nerve  ;  mortification  ;  amp. 

53 

Hasey,W.  H.  H.,  Serg't, 

July  1, 

Right  leg;  gang,  and  luetn.:  amp. 

thigh,  by  Surg.A.C.  Van  Duzen, 

E  20th  Maine,  age  23. 

30,  ''64. 

thigh,  by  A.  A.  Surg.  11.  B.  Ma- 

U.  S.  V.   Disch'd  Nov.  14.  '64. 

ben.     Died  Sept.  2y,  '64,  exh'n. 

: 

McMahon,  E.,  Lieut.,  D, 

Aug.  30, 

Left  knee  ;  circ.,  lower  third,  by 

53 

Haskell,  A.  M.,  Corp'l, 

Oct.  19, 

Right  knee  ;  amp.  post,  flap,  June. 

80th  New  York,  age  21. 

'62,  Feb. 

Asst.  Surg.  E.  J.  Marsh,  l/.S.A. 

K,  12th  Maine,  age  23. 

Nov.  15, 

lower  third,  by  A.  A.  Surg.  W. 

7,'63.  Jul. 

Re-amp.,  by  Prof.  W.  Parker. 

1864. 

Kempster.     Nov.  21,  haem.:  lig. 

—  ,  1864. 

Recovery.  'Spec.  1054. 

fern.;  hajm.  27th  and  30th.  Died 

80 

Maher,  L.,  Pt.,  C,  69th 

Sept.  17, 

Right  knee  ;  amp.  post  flap,  up. 

Dec.  1,  1864,  exhaustion. 

New  York. 

Nov.  24, 

third,  by  Surg.  II.  S.  Hewif,  U. 

54 

tfai/nes,  A.,  Major,  29th 

May  —  , 

Right  fern.  art.  injured:  single  flap 

V 

1862. 

S.  V.;  necrosis.     Disch'd  April 

Virginia. 

27.  '64. 

amp.  of  thigh.  Died  May  30,  '64. 

12.  1864.     Spec.  754. 

55 

'Bembery,  A.  J.,  —,  K, 

Sept.  19, 

Lower   portion   popliteal   space; 

81 

Martin,  J.  H.,   Pt.,    E, 

May  12, 

Left  leg.  injuring  saphenous  vein  ; 

4th  Alabama. 

Oct.  1, 

haam.  from  poplit'l  art.;  amp.  just 

100th  Pennsylvania. 

12,  '64. 

gangrene  :  amp.  thigh  at  lower 

18(i3. 

above  knee.  Died  end  third  day. 

third.     Died  May  18,  '64. 

56 

Rickey,  J.,  Pt,,  C,  22d 

July  2, 

Right  leg,  follow'd  by  trau.  aneur. 

82 

Martin,  M.,  Pt,,  H,  1st 

June  24, 

Left  knee  :   circ.,  mid.  third,  by 

Massachusetts,  age  19. 

Aug.  5, 

of  ant.^and  post,  tibial  arteries; 

Artillery,  age  24. 

Aug.  14, 

Surg.  E.  Bentlev,  U.  S.  V.     To 

1863. 

haem.;  gang.;   amp.    thigh,    by 

1864. 

duty  Dec.  9,  18:>4. 

Surg.  C.W.  Jones,  U.S.V.  Died 

83 

3McCreary,  S.C.,  Pt.,F, 

Sept.  1, 

Right  leg.pertbrat'gant.  tib.art'y; 

Aug.  16,  '63.  Spec.  1698,  A.  M.  M. 

100th  Pennsylvania. 

14.  '62. 

amp.  thigh.  Disch'd  Dec.  4,  '62. 

57 

Hogstead,  P.,  Corp'l,  A, 

Feb.  7, 

Left  leg;  amp.  thigh,  by  A.  A. 

84 

Mather,  H.  G.,   Pt.,  H, 

June  17, 

Left  leg;  gang.;  amp.  thigh,  by 

187th  New  York,  age 

26,  '65. 

Surgeon  R.  Westerling.     Died 

90th  Penn.,  age  20. 

July  20, 

A.  A.  Surg.  G.  Badger.     Died 

£}. 

March  8,  1865. 

1864. 

July  20,  1SG4. 

58 

Hopper,  B.,  Pt..  F,  64th 

May  12, 

Left  knee;  destructive  inflamma 

85 

Mathers,  W.  D.,  Pt..  I, 

Oct.  19, 

Left  leg  ;  gang,  and  haem.;  amp. 

New  York,  age  28. 

June  1C. 

tion  in  joint;  amp.  thigh,  by  A. 

Cth  Vermont,  age  28. 

Nov.  13, 

thigh,  by  A.  A.  Surg.  F.  F.  Mur- 

1864. 

A.  Surg.  J.  E.  Dexter.     Died 

ltjG4. 

dock.  Died  Dec.  16.  '64.  pyaemia. 

June  21,  1864,  pyaemia. 

86 

Mej-er,  M.,  Pt.,  L,  15th 

Aug.  18, 

Left  leg:  gang.:  amp.  thigh,  by 

59 

Hubbach,  H.,  Corp'l,  F, 

Ang.  30, 

Left  thigh.     Disoh'd  Nov.  20,  '63. 

New    York    Artillery, 

Oft.  6, 

A.  A.  Surg.  J.  P.  Arthur.  Died 

68th  Xew  York,  age  42. 

'62,  Oct. 

Contract'n  of  flex,  of  thigh,  and 

age  44. 

1864. 

Oct.  7,  '64.  Spec.  3?80,  A.  M.  M. 

6,  '65. 

atrophy:  flap  amp.  thigh  seven 

87 

Miller,  P  ,  Pt.,  A,  64th 

Dec.  16, 

Left  leg:  gang.:  thigh  amp.,  by 

inches  from   body,   by   Dr.  L. 

Ohio,  age  40. 

Jan.  22, 

Surg.    R.  H.   Gilbert.  U.  S.  V. 

Bauer,  of  Brooklyn.  Recovered. 

1865. 

Died  Feb.  9,  '65,  pyaemia. 

CO 

Hyatt,  J.  B.,  Pt.,  E,  7th 

July  9; 

Loft  popliteal  art.  in.i.:  gang.;  amp. 

88 

Monre,    T.,  Pt.,  E,   51st 

Sept.  19, 

Right  knee;  abscess:  ciro,,  lower 

Indiana  Cavalry,   age 

19,  VC4. 

thigh,  by  Surg.  J.  G.  Keeuon, 

Virginia,  age  19. 

Nov.  14, 

third,  by  Surg.  B.  M.  Cromwell, 

18. 

U.S.  V.:  gang,  of  stump  and  loft 

1864. 

C.  S.  A.     Died  Nov.  14,  1864. 

King.  DiedA'ig.  11.  '64,  pya?mia. 

89 

Moss.  B.  F.,  Corp'l,  B, 

July  25, 

Left  leg:  gang.:  amp.  leg,  by  A. 

61 

Jenkins,  W.  II.,  Pt.,  C, 

Oct.  13, 

Right  thigh.   Disch'd.  May  If,  '65, 

101st  Illinois,  age  43. 

Nov.  1  1, 

Surg.  W.H.Trull,  U.S.V.  Nov.9, 

39th  Illinois. 

1864. 

three  large  exost^scs  rem.,  bone 

1864. 

diffused  aneur.  in  poplit'l  region; 

Mav  5, 

scraped  ;  Oot.  21.  rcm.  large  se 

lutms.:  amp.  thigh,  by  Dr.Trull: 

1863. 

questrum:  May  5,  '68.  thigh  amp. 

hiems.  from  and  ligation  i.f  fern. 

at  base  of  troclmnter,  bv  Surg. 

artery.     Disch'd  .lime  25.  '65. 

C.  M.  Clark,  late  3:)th  ill.    Re 

90 

Nichols,   M.   S.,  Pt.,  G, 

Sept.  19, 

Loft   leg:   knee  joint  opened  by 

covered,  Got.  2,  1869. 

91st  Ohio,  age  23. 

Nov.  14, 

uloeration:  amp.  thigh,  by  Asst. 

62 

Johnson,  P.,  Pt.,  E,  2d 

June  27,  !  Right     knee;    sloughing:    amp. 

1864. 

Surg.   N.  F.  Graham,  tf.  S.  V. 

Penn.,  age  27. 

Oct.  19, 

thigh,   bv  A.  A.  Surg.  W.  P. 

Died  Dec.  7,  '64.  pyaemia. 

1864. 

Moon.     Died  Oct.  21,  18G4.             91 

Nobler,  B.,  Pt,,  F,  85th 

June  30.    Right  log  :  sloughing  ;md  h;pm.; 

63 

Johnson,  W.,  Pt.,G,  34st 

June  n. 

Left  gnstrocnemius;  amp.  thigh.  '. 

Illinois,  age  21. 

Aug.  4, 

amp.  thigh  at  lower  third,  by  A. 

Alabama,  age  22. 

J'v  1,  <<)4. 

Died  July  12,  1HG4,  pyaemia. 

1864. 

A.   Surg.   S.  C.   Ayres.      Died 

64 

Jones,  J.  T.,  Pt.,  H,  8th 

Dec.  10, 

Loft  log  ;  gang.;  amp.  thigh.  byA. 

Aug.  14.  '64,  anaemia. 

Wisconsin,  age  21. 

'64,  Feb. 

A.  Surg.  C.  V.  Barnard.    Trans-  1|  92 

4  Nottingham,  G.  M.,  Pt., 

May  1, 

Left  popliteal  region  secondarily 

26,  '65. 

fcr'd  Sept.  20.  '65,  for  musterout. 

I,  56th  Ohio. 

20,  '63. 

involv'g  popliteal  artery:  luem.; 

65 

Keep,  M..   Pt.,  E,  3Gth 

May  19, 

Left  pnpliteal  space;  knee  joint 

amp.  thigh,  by  A.  A.  Surg.  L. 

Massachusetts,  age  23. 

June  4. 

ope'd  by  suppurat'n:  amp.  thigh. 

Dyer.     Died  May  29.  '63. 

1864. 

by  Surg.  D.  P.  Smith,  IT.  S.  V,      93 

opaue,  A.  C.,  Capt,  D, 

Sept,  16, 

Post.  tib.  art.  cut  by  ball  :  incip. 

Died  June  !\  1864,  pyaemia. 

21st  Virginia. 

16,  '62. 

tnort.:  amp.  thigh,  by  If.  T.  Cole- 

66 

Keller,  B.,   Pt..  T,    1st 

Mav  11, 

Right  thigh;  circ.  amp.  of  thigh, 

man,  chief  surg.  Gen.  Stonewall 

Mich.  Cavalry,  age  36. 

Jtilv  2, 

bv  Surgeon  A.  Ileger,  U.  R.  A. 

Jackson's  Corps.     Recovered. 

1864. 

liiod  July  3.  1804.  exhaustion.        94 

Pcrcel,  J.,  Pt.,  —  ,  148th 

Mav  3, 

Thigh  :  aneurism  :  amp.  up.  third. 

67 

Kenvon.  B.  G..  Corp'l, 

Je.16,'64, 

Left  leg:  amp.  thigh,  by  Prof.  A. 

Pennsylvania. 

21,  ''63. 

by  Surg.  C.  S.  Wood.  6<;th  New 

H,  llth  New  Hamp. 

Jnn.3.'67.      II.  Crosby.  Discli'd  Sept.  27,  '6.">. 

York.     Died  May  21.  1863. 

68 

Kintnor,    S.    L.,  Corp'l, 

Julv  12.    R't  thigh  :  amp  ,  f-ure.  J.  L.  Dick-     95 

Pittoe.  R..  Corp'l,  F,  50th 

Dec.  11, 

Popliteal  space,  destroying  popli 

A.  24th  Iowa. 

—,''63. 

ey,  47th  I  ml.    Died  July  16.  '63. 

New  York. 

11,  '62. 

teal  vessels  and  nerves:  ha'in.: 

6!) 

2Kogcl.  C..  Pt.,  D.  1.1th 

May  30, 

Right  leg  ;  gangrene  :  amp.  thiffh, 

amp.  thigh.    Died  Dec.  12,  (12. 

New  York  H'vy  Art'y, 

June  6, 

by  A.  A.  Sur<r.  C.  II.  Osborne.      96 

Ports,  I.  A.,  Pt.,  D,  27th 

Oct.  3, 

Perfor.  riglit  poplit'l  space:  gang.; 

age  39. 

1864. 

Died  June  16   18G4,  pyo?mia. 

Ohio. 

12.  'R2. 

amp.  thigh.   Disch'd  April  7.  '63. 

70 

Lane,  D.,  Pt.,  K,   14th 

June  14, 

Left  knee  :  sloughing  :  amp.  thigh. 

97 

Price,    G.,    Pt.,    C,    2d 

July  2,  2,   Left  foot  and  log  :  gang.:  primary 

Ohio,  age  34. 

Aug.  7, 

by  Asst.  Surgeon  B.  E.  Fryer. 

Delaware. 

1863. 

amp.  thigh,  by  Sure-.  C.S.Wood, 

1864. 

Died  Aug.  U>.  !P64,  pyaemia. 

66th  X.  Y.     Died  July  —  ,  '63. 

71 

Larkin,  T.,  Pt.,  K,  4th 

June  23. 

Left  thigh  and  wrist.   Di'sc'd  Aug. 

98 

Rayser,.I.J..  Pt..  B.  14th 

Oct.  19, 

Right   knee:  joint  opened  by  in- 

Mass.,  age  18. 

'63,  June 

20,  '(!:).     Atrophvand  exo.  pain  ;  ij 

Penn.  Cav.,  age  40. 

Nov.  8, 

flam.:  amp.  post.  flap.  mid.  third, 

15,  '64. 

amp.  at  up.  third  thigh,  bv  Dr. 

1864. 

bv  A.  A.  Surg.  A.  W.  Emory. 

C.  H.  Stedman,  Boston.   Ree'd. 

Died  Nov.  8,  1864. 

1  EVE  (P.  F.),  Casts  of  Secondary  Hemorrhage,  etc.,  in  Sury.  Mem.  of  the  U'ar  of  the  Kebe.Uinn,  U.  S.  San.  Comm.,  1870,  Vol.  I  (Surgical)   p.  210. 
2Lll>ELL  (J.  A.),op.cit.,  p.  61.  3  Ibid.,  p.  57.  4  BuYAN  (J).  Amputation  of  Left  Thigh,  upper  third,  in  Am.  Med.  Times,  Vol.  VII,  p.  5. 

COLEMAN  (R.  T.),  Hems  of  Army  Experience,  in  Virginia  Clinical  Record,  1872,  Vol.  II,  p.  141. 


56 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR.  AND 
RESULT. 

NO. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJUKY,  OPERATOR,  AND 
RESULT. 

9!) 

Uennick,  L.,  Pt.,  I,  26th 
Missouri. 

Sept.  19, 
Dec.  30, 
1862. 

liight  thigh  :  pr  ifuso  suppurat'n  : 
amp.  thigh.     Died  Dec.  31,  '02. 
pyaemia. 

116 

Spencer,  C.,  Capt.,  1,  1st 
Michigan. 

Julv  2, 
Dee'  28, 
1863. 

Right  thigh,  injnr'g  sciatic  nerve  ; 
amp.  thigh,  by  A.  A.  Surg.D.O. 
Farrand.     Disch'd  May  16,  '64. 

100 

Rickard,  .T.  II.,  Ft..  D, 
1st  Alabama  Cavalry. 

Jan.  27, 
Feb.  28, 
1804. 

Right  thiirh  :  ulceration  popliteal 
art.:  basin.  :  thigh  amp.,  by  Surg. 
J.  G.Keenon.l'.s.V.  Died  Feb. 

117 

Stark,  ().  II.,  Scrg't,  H, 
13tli  New  Hampshire, 
age  36. 

Sept.  an, 

'64.  Jan. 
3,  '05. 

Right  leg  ;  sloughing  :  "Dec.  25, 
amp.  leg;  reamp.  in  thigh,  by  A. 
A.  Surg.  II.  H.James;  haem.; 

29.  '64.  exhaustion  from  haem. 

art'y  lig.  Died  Jan.  13,'05,pyaem. 

101 

Uobericlit.    C..    It..    B. 

Julv  18, 

Extcns.  lace,  right  leg.     Disch'd 

118 

Suit/,  S.  A.,  Pt..  B,  1st 

Nov.  30, 

Right  thigh  ;  gang.;  popliteal  art. 

48th  New  York,  age  44. 

'<;:!.  'Mar. 

15.  .'65. 

Autr.  2J,'C4  :  flap  amp.  thigh,  by 
Dr.'L.  Bauer,  c.f  Brooklvn.  Died 

Missouri,  age  25. 

'64,  Feb. 
7,  '65. 

sloughed  ;  amp.  thigh,  bv  Surg. 
B.  B.  Breed.  1'.  S.  V.  Died  Feb. 

Aug.  23.  1871. 

16,  1865,  exhaustion. 

102 

Rolf,  L.  F.,  Pt.,  M,  1st 
Maine  Artillery. 

June  18. 
'l>4.  June 

Left  leg  :  necrosis  ;  thigh  nt  mid. 
third,    by   Dr.   J.    C.    Manson. 

tin 

Taylor.  James.  Pt.,  K. 
7th  New  York  Heavy 

June  16, 
'64.  Jan. 

Left  leg;  thigh  amp.,  by  A.  A. 
Surg.  E.  J.  Farwelt.     Disch'd 

30,  "06. 

Recovery. 

Artillery,  age  22. 

17,  '65. 

July  6,  1865. 

103 

Roork,  E.  P..  Pt.,  F.  3d 

Nov.  27. 

Right  popliteal  nerve  and  artery 

120 

Thorn,  11.  C.,  Pt.,  1,  14th 

July  20, 

Right  thigh  ;  Aug.  7,  haem.;  lig. 

Pennsylvania  Cavalry, 

utrp  <>•> 

Dee.  (i, 

1863. 

severed  ;  thigh  amp.,  bv  Surg. 
K.   Bcntlev.    r.  S.  V.     Disch'd 

West  Virginia,  age  19. 

Aug.  7, 
1864. 

fern.:  amp.  thigh,  by  Surg.  J.  B. 
Lewis,  U  S.V.  Died  Aug.  12,  '64. 

"&e  '  —  • 

June  18,  1864. 

121 

Townsend,    E.,    Pt.,  F, 

June  2, 

Left  knee  ;  joint  ope.  by  ulcerat'n; 

104 

Root,  11.  V..  Pt.,  B.  104th 

June  20. 

Right  leg:  gang.:  necrosis  ;  Oct. 

5th    New   Hampshire, 

31,  '64. 

amp.  post,  flap,  upper  third,  bv 

Xew  York,  age  26. 

'64.  Feb. 

29,  remov.  of  10  inches  neen  sed 

age  35. 

Surg.  E.  Bentley.U.S.V.;  haem"; 

29,  05. 

tibia:  thigh  amp.    Disch'd  Julv 

lig'n.   Died  July  1.  '64,  asthenia. 

21.  '65.     Sj>cc.  3601,  A.  M.  M. 

122 

Trees.  .L,  Corporal,  D, 

June  2, 

Right  knee.    June  20,  haem.;  pop 

105 

Kowe,    G.,  Pt.,  B,   Cist 

July  0, 

Right  knee:  gangrene,  involving 

188th  Penn..  age  21. 

28,  '64. 

liteal  flaps,  mid.  third.    Disch'd 

Georgia,  ago  32. 

Aug.  5, 
1864. 

joint;  thigh  amp.,  by  A.  A.  Surg. 
J.  II.  Coover.    Died  Aug.  7,  '04. 

123 

Vann,  D.,  Pt.,  B,  8th  N. 

June  3, 

Dec.  8,  1864. 
Left  thigh,  injuring  popliteal  art.; 

Spec.  3809.  A.  M.  M. 

York  Artillery,  age  18. 

20,  '64. 

hsem.;    June   J6,  popliteal  lig.; 

IOC 

Royster,  J.  M.,  l>t..  C. 

Julvl. 

Lett  thisrh:  amp.  thigh,  bv  A.  A. 

haem.  recurred  ;  amp.  thigh,  bv 

47th    North    Carolina, 

2(i,  '<;:!. 

Surg.  (1.  M.  Paullin.   Died  July 

. 

A.   A.   Surg.   E.  Vogel.     Died 

age  29. 

20.  1863.     Spec.  3961,  A.  M.  M. 

June  22.  '64,  gangrene. 

107 

'Schatt,  II.,  Corp'l,  II. 

Mar.  25. 

Left  thigh,  dividing  popliteal  art.; 

124 

Waller,  J.  R.,  Corp'l,  A, 

July  30, 

Right  knee:  gang.;  thigh  amp., 

04th  New  York,  age  30. 

April  2. 

amp.  thigh,  bv  A.  A.  Surg.  11. 

19th  Infantry,  age  17. 

Oct.  25, 

by  A.  A.  Surgeon  M.  L.  Herr. 

186-5. 

Craft.     Disch'd  Sept.  26.  18G5. 

1864. 

Died  Nov.  5.  '64.  pyaemia. 

,v/«-<-.«.  171.  228:!.  A.  M.  M. 

125 

Watson,  J.  II..  Pt.,  B, 

June  4, 

Left  knee  ;  joint  ope.  by  suppu'n  ; 

108 

Shugert.  J.  L.,  Corp'l,  B, 

April  1. 

Right  knee:  second,  disease  joint  ; 

ICth  N.  Jersey,  age  36. 

24,  '('A. 

muscular   flaps,  mid.  third,  by 

49tli  Penn..  age  20. 

Mav  20. 

amp.  thigh  at  low.  third,  by  A. 

Surg.  E.Bentley,  U.S.V.    Died 

1865. 

A.  Surg.W.B  Chambers:  liirm.: 

June  28,  1864,  exhaustion. 

May  24.  lig.  femoral.  Died  May 

126 

White,  J.  L.,  Guerilla, 

May  —  , 

Both   legs  perforated;   left  post. 

25.  '65.  exh  n  from  haemorrhage. 

age  38. 

1863, 

tibial  art.  and  nerve  completely 

109 

Shupe,  J.,   Pt..  E,  40th 

Dec.  15, 

Left  leg,  amp.  thigh.     Died  Jan. 

Primary. 

sev'd:  gang.:  amp.  thi.  Recov'd. 

Ohio. 

15,  '64. 

1.  181)5.  gangrene. 

127 

Wick,  J.  C.,Pt.,C,  155th 

Mar.  25, 

Both  thighs:  May  23,  luvm   from 

110 

Simpson.  P..  Pt..  F,  3Cth 

Sept.  00. 

Left  thigh  :    amp.   thigh.     Died 

1'enu.,  age  22. 

June  14. 

left  popliteal  ;  lig'n  ;  amp.  thigh, 

Colored  Troops,  age  23. 

1864. 

(M.  22.  '('4,  exhaustion. 

1865. 

by  A.  Surg.  A.  Delanev.  I*.  S.V. 

111 

Slanker,  J.,  Pt.,  C,  IGQd 

Juno  19. 

Left  thigh,  injuring  poplit'l  art'y; 

Died  June  20.  '65.  exhaustion. 

Ohio  N.  G. 

Julv  2. 

gang.:  amp.  thigh.  bv  A.  A.  Surg. 

128 

Wild,  C.  B..  Corp'l,  E, 

Sept.  19, 

Right    popliteal    space  :    Oct.    1. 

1864. 

W.  11.  Drnry.    Died  July  2,  '64. 

114th  Ne\v  York. 

(Jet.  12, 

haem.  from  popliteal  artery:  iig.; 

12  hours  after  opcr'n,  from  shock. 

1864. 

amp.  thierh.  bv  Asst.  Surg-  B.  A. 

112 

Sloss,   A.,   Pt.,    A,   5th 

Dec.  10, 

Left  knee:  drstruc.  cf  tissue;  amp. 

Fordyce,  160th  N.York.     Died 

Penn..  age  35. 

'(14,  June 

junct.  low.  thirds.  bv  Asst.  Surg. 

Oct.  13.  3864,  exhaustion. 

10,  'ti5. 

J.  11.  Frant/.     Dis.'  Nov.2J,  '65. 

129 

Wing,  J.  W.,Pt.,TI,27th     Mar.  14. 

Right  leg;  gangrene;  amp.  thigh. 

111!    Smith.  J.  A.,  Pt..C,4th 

Mav  14, 

Right  ki;ec;  second,  involv.  ji.int: 

Mass..  age  45. 

April  7, 

by  Surg.  (1.  A.  Otis,  27th  Mass. 

Maryland,  age  18. 

June  9, 

amp.  of  thigh,  by  A.  Surg.  A.  In 

1862. 

liicd  April  17,  1862.  exhaustion. 

1804. 

gram.  I'.  S.  A.  Disc'd  Mar.  23.'65. 

1GO 

Wolf.  J..  Corp'l,  D,  4th 

Oct.  12. 

Left  thigh  :  gang.:  amp.  thigh,  by 

114 

Smith,  W.  F.,  Major,  1st 

Oct.  27, 

R  lit  thigh;  lig.  fern.  art.  and  vein; 

New  York  Cavalry. 

Nov.  26. 

A.  A.  Surgeon  J.  F.  Thompson. 

Delaware. 

27,  '('A. 

amp.th.,l>v  Surg.  A.  N.Dougher 

1803. 

Disch'd  Oct.  11.  1864. 

ty,  r.  S.V.    Died  Nov.  6.  1864. 

131 

Wright.  D.,l't.,A.57th 

Sept.  17, 

Right  thigh  :  gang.;  amp.  thigh. 

115 

Spalding.  J.  K.,  Pt.,  C. 

Aug.  30, 

Left    popliteal     artery   severed; 

New  York,  age  23. 

Dee.  2, 

by  A.  A.  Surg.  A.  V.  Cherbon 

35th  New  York,  age  30. 

Sept.  12. 

amp'n  thigh.     Died  same  day, 

1862. 

nier.     Died  Dec.  20,  '02.  gang. 

1862. 

from  haemorrhage. 

Spec.  688,  A.  M.  M. 

Amputations  at  the  Knee. — But  one  of  the  six  disarticulations  at  the  knee  for  com 
plications  involving;  shot  flesh  wounds  of  the  leg  had  a  favorable  result.     Three  of  the 

1  (    *  O 

operations  were  intermediary,  three  secondary: 

TABLE  VIT. 

Numerical  Statement  of  Six  Disarticulations  at  the  Knee  Joint  for  Complicated  Shot  Injuries  unattended 

by  Fracture. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

x          NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPKRATOR,  AND 
RESULT. 

1 

Cole.  D.  D.,  Corp'l.  A. 
2d  New  York  Cavalry. 

April  7, 
Aug.  1, 

Left  leg  ;  gang.;  amp  at  the  knee 
joint,  patella  retained,  bv  Ass't 

4   i  Huntington.    I..  Pt.,    B, 
92d  New  York,  age  29. 

June  3. 
Aug.  2. 

Left  leg;  slough  'g:  rccur't  liicin.: 
amp.  at  knee  joint,  bv  Surg.  R. 

age  23. 

1865. 

Surg.   G.   M.  Mcfiill,  U.  S.  A. 

1804. 

B.   Bontecou,    U.   S.   V.     Died 

Diseh'd  Nov.  22.  1865. 

Aug.  8.  1864.  exhaustion.   Card 

o 

Dempsey.  M..Pt.,  I.  17th 

Oct.  5, 

Left  leg  :  obliteration  of  fern.  art.. 

I'hot.,  Vol.  Ill,  p.  23. 

\  ermont.  age  18. 

DC.:.  27. 

sloughing,  and  recurrent  haem.; 

5     Leonard.  J..  Pt..  (1.  5th 

Julv  3. 

Right  leg,  injur  g  post.  tib.  nerve  : 

1864. 

amp.  at  knee  joint,  by  Ass't  Sur 

Ohio,  age  22. 

16,  '63. 

tetanus;  amp.  at  knee  joint,  bv 

geon  W.   A.   llarvev,  U.  S.  V. 

Ass't  Surg.  11.  C.  May.  115th  N. 

Died  March  26,  1865. 

Y.     Died  July  16,  '63.  tetanus. 

3 

Grimes.  F.    A.,    I't..  C. 

April  16, 

Right  leg.  injuring  popliteal  art.: 

6     Taggart.   S.  D..  Serg't. 

Feb.  6. 

Left  leg;  ganff.:  recurrent  ha'in.: 

4th  \  ermont,  !ige  2~'. 

22,    62. 

haem.:  amp.  at  knee   joint,    by 

G,  150th  Pennsylvania, 

20,  '65. 

amp.  at  knee  joint,  by  Ass  t  Surg. 

Surg.  R.  B.  Bontecou.  U.  S.  V.: 

i    age  25. 

J.  Vansant.  T'.  S.  A.  Died  Feb 

gang.     Died  April  £8,  1862. 

i 

ruary  20,  1865. 

1  LIIIELI.  (J   A.),  op.cit.,  p.  47. 


SECT.  J.I 


AMPUTATIONS    IN    THE    LEG    FOR    SHOT    FLESH    WOUNDS. 


57 


Amputations  in  the  Leg. — Of  sixty-three  operations  in  this  category  thirty-three 
proved  fatal,  or  52.3  per  cent  Two  primary  cases  were  successful;  of  twenty-four  inter 
mediary  operations,  seventeen,  or  70.8  per  cent.,  proved  fatal;  of  thirty-seven 
secondary  amputations,  sixteen,  or  43.2  per  cent.,  proved  fatal.  The  Museum 
possesses  pathological  specimens  from  some  of  the  cases.  Two  of  the  cases 
are  detailed,  and  all  are  enumerated  in  TABLE  VIII: 

CASE  126. — The  late  Dr.  Bodisco  Williams,  of  Georgetown,  D.  C..  who  served  in  the  Confederate  Army, 
presented  Acting  Assistant  Surgeon  F.  Schafhirt,  of  the  Army  Medical  Museum,  with  the  specimen  figured  below, 

with  the  accompanying  history :  "  Rev.  J.  L ,  a  young  priest  from  New  Orleans,  acting  voluntarily  as  field 

chaplain,  tried  to  persuade  a  company  of  Irish  railway  laborers  to  take  up  arms  to  fight  against  the  Yankees  in 
front  of  Fredericksburg,  December  12,  1862;  but  during  his  speech  a  large  shell  exploded  close  in  front  of  the 
group  and  killed  three  and  wounded  eight,  including  the  priest,  who  received  a  small  skin  wound  over  the 

inner  surface  of  the  left  tibia,  about  five  inches  above  the  tarsal  articulation.     Rev.  L did  not  take  much 

notice  of  the  wound  until  the  leg  was  in  full  inflammation  up  to  the  knee.     He  had  returned  to  Lynchburg, 

where  he  applied  bread  and  milk  poultices  for  several  weeks,  but  afterwards  he  sent  for  a  physician,  who 

exerted  all  his  knowledge  to  ?avc  the  leg.     But  nothing  would  avail,  and  caries  of  the  bone  having  supervened, 

gangrene  at  last  reminded  the  attendant  of  amputation,  which  was  performed  by  Dr.  Pearson,  of  Virginia,  who 

took  the  leg  off  one  inch  below  the  tuberosity  of  the  tibia,  August  25,  1863.     But  even  this  remedy  did  not 

improve  the  physical  health  of  the  patient;  and  his  soul  left  Lynchburg,  September  2,  1863,  for  that  great  and 

blissful  haven,  it  may  be  hoped,  which  he  had  promised  to  those  Irishmen  in  front  of  Fredericksburg."     The 

specimen    represented  in    the   adjacent  wood-cut  (FlG.  22)  presents  great  erosion,  as   though   from   caustic     jncj,e8  of  shaft 

applications  made  to  arrest  the  progress  of  gangrene,  and  there  are  neighboring  evidences  of  extensive  periosteal     °^  !1|C  left  tibia, 

thickening  with  osseous  exudations  and  deposits.     See  Cat.  Sunj.  Sect.,  Army  Medical  Museum,  1863,  p.  394.          ded.    Spec.  858. 

CASK  127. — Private  G.  Brown,  Co.  C,  97th  Pennsylvania,  aged  18  years,  was  wounded  at  Petersburg,  June  17,  1864, 
and  was  admitted  to  hospital  at  Fort  Monroe  two  days  afterwards.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported : 
"Gunshot  wound  of  right  foot,  flesh."  From  Fort  Monroe  the  wounded  man  was  transferred  to  Knight  Hospital,  New  Haven. 
where  amputation  was  performed  but  not  recorded.  Subsequently  the  patient  was  transferred  to 
McDougall  Hospital,  and  lastly,  on  January  19,  1865,  to  Central  Park,  New  York  City,  whence 
Surgeon  B.  A.  Clements,  U.  S.  A.,  reported:  "Gunshot  wound  of  right  foot;  a  minie  ball  passed 
through  the  metatarsus,  entering  on  the  dorsiun  of  the  foot.  Mortification  supervened  and  the 
condition  of  the  injured  parts  became  very  bad;  constitutional  condition  of  patient  feeble;  loss  of 
appetite  ;  unable  to  sleep  from  pain  in  wound.  On  July  llth,  amputation  (apparently  circular)  of  the 
leg  just  above  the  ankle  joint  was  performed  at  the  Knight  Hospital,  New  Haven,  by  Acting  Assistant 
Surgeon  C.  Lindsley.  Two  ligatures  were  applied,  and  ether  was  used  as  the  anaesthetic.  Healing 
progressed  well  for  three  Aveeks,  when  the  stump  sloughed,  which  was  arrested  in  four  or  five  days." 
The  specimen  represented  in  the  annexed  wood-cut  (FlG.  23)  was  contributed  by  Acting  Assistant 
Surgeon  S.  Teats,  who  performed  re-amputation  on  April  1G,  1865,  on  account  of  "  a  sloughing  ulcer 
and  a  cold  and  blue  condition  of  the  stump."  The  stump  healed  at  the  end  of  five  weeks  after  the 
last  operation,  and  the  patient  was  supplied  with  an  artificial  leg  about  two  months  afterwards.  He- 
was  discharged  from  service  August  17,  1835,  and  pensioned.  In  his  application  for  commutation,  Spec'  43~9' 
dated  1875,  the  pensioner  described  the  stump  as  being  in  good  condition.  He  was  paid  his  pension  June  4,  1876. 


FIG.  23.— Two  and  a  half 
inches  of  stump  of  right  leg. 


TABLE  VIII. 

Summary  of  Sirtij-three  Cases  of  Amputations  of  the  Ley  for  Complicated  Shot  Injuries  unattended  by 

Fracture. 


No. 

NAME.  MILITARY 
DESCKIPTIOX,  AXD  AGE. 

DATES. 

INJURY,  OPEUATOU.  AXD 
RESULT. 

:co. 

NAME,  MILITARY 
DESCRIPTION,  AXD  A'GE. 

DATES. 

INJURY,  OPEUATOH.  ASH 
RESULT. 

1 

Addington,  .T.,Serg't,  A, 

Juno  20. 

Right  ankle  :  gangrene:  amputa 

G 

Batherie.  N.  T..  Corp'l. 

June  6, 

Left  leg;  gang.;  amp.  leg.  by  A. 

84th  Indiana,  ago  25.       Julv  2J. 

tion  leg.  by  Surg  U.  51.  S.  Jack 

A,  15th  Mass.,  age  34. 

24.  '64. 

A.  Surgeon  M.  F.  Price:  haMn. 

18G4. 

son,  I'.  S.V.  Died  Sept.  2.  1864. 

Died  June  30.  '64.  asthenia  from 

pyaemia. 

wound,  and  diarrhoea. 

2 

Ainswerth.W.H.,.Serg't.      May  6, 

Right   leg  ;  amp.   leg.    by  Surg. 

7     Becker.   II..  Pt..  F,  50th 

May  <). 

Right  leg:  sloughing:  amp.  leg. 

K.  4::d  Now  York,  age    Juno  2.), 

W.  1).  Stewart.  11.  S.V.  Disch  d 

Penn..  asre  23. 

Aug.  10, 

by  A.  A.  Surgeon  (4.  E.  (ialen. 

2  -'. 

1864. 

Nov.  3.  1865. 

1864. 

Disch'd  May  22.  1865. 

:! 

Alexander.  E.  J..  Corp'l,    June  1  4. 

Right    leg;  aaip.    of   leg.     Died 

t!     Bell.  J.,  Corp'l.  C,,  (ii'th 

Dec.  13, 

Left  leg  ;  sloughing;  harm.:  amp. 

B.  11  Oth  Now  York. 

—  .  '(S3. 

July  2,  1863. 

Penn.,  age  40. 

'62.  Mar. 

leg.  by  A.  A.  Surg.   F.  II.  (let- 

4 

Barnum.  C.  F.,  I't..  E,    June  18. 

Left  leg  .-  amp.  leg,  bv  A.  A.  Surg. 

in,  •<;:». 

chell.  "  Disch  'il  Dec.  14.  U63. 

187th  Pcnn..  age  30.       j  Aug.  2~! 

J.  P.'  Arthur:   hsein.;  Sept.   7, 

9     Biokley.  II..   Serg't.   F, 

May  14, 

Left;  slough  :  amp.  leg,  by  A.  A. 

186  J. 

amp.  thigh.    Died  Oct.  13.  18G4. 

!     lOtli  New  Jersey,  age 

Aug.  13. 

Surg.  G.  W.Webb  :  ha>;n.   I  >i<-d 

S/Kie.313,!,  A.  M.  M. 

21. 

1864. 

Aug.  23.'64.  Spec.  3665.  A.M.  51. 

5 

Ban-on,  C.,  Pt.,  D,  14th    May  12. 

Left  f.)ot  :  gang.:  amp.  leg.  by  A. 

10     Bloomer.  A.  S.,  Pt.,  G, 

May  15, 

Right  foot  ;  gang.;  amp.  leg.  by 

Connecticut,  age  43. 

Sept.  10, 
1864. 

A.  Surgeon  S.  Smith.     Disch  d 
Juno  18.  186."). 

5Jth  Ohio,  age  20. 

July  21. 

1864. 

Ass't  Surg.  J.  A.  Freeman.  I'. 
S.  V.     Disch'd  Feb.  10.  1865. 

Sr-KG.  Ill— H 


58 


INJURIES    OF    THE   LOWER    EXTREMITIES. 


[CHAP. 


:;o 

NAME,  MILITARY 
DESCRIPTION*,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATOR,  AND 
RESULT. 

n 

Drown,  G.,  Pt.,  C,  97th 

June  17, 

Right  fool;  gang.;  amp.  just  aboye 

39 

Mangan,  J..  Pt.,  F,  82d 

Julv  20, 

Left  leg;  amp.  leg,  by  Surg.  H. 

Penn.,  ago  18. 

Julv  11, 

ankle,  by  A.  A  Surg.  Lindsley; 

Ohio,  age  C8. 

22,'  '64. 

K.   Spooner,  61st  Ohio;  haem.; 

'64,'Ap'l 

sloughing;  ream  p.  leg.   Disch'd 

lig.  ot  anterior  tibial  artery  Aug. 

16,  '65. 

Aug.  )8,  '65.  Spec.  4329,  A.  M.M. 

15,  '64.     Disch'd  May  23,  '65. 

12 

Burke,   M.,    Serg't,    C, 

June  3, 

Right  leg;  sloughing;  amp.  leg, 

39 

Mendenhall,  J.,  Pt.,  B, 

May  20. 

Right  leg;  sloughing;  amp.  leg, 

lC5th  N.  York,  age  51. 

Aug.  2G, 

by  A.  A.  Surgeon  M.  Lampen. 

!)7th  Penn.,  age  30. 

Julv  22. 

by  A.  A.  Surgeon  A.  D.  Hall. 

186-1. 

Died  Aug.  27,  1864,  pyaemia. 

1864. 

Died  July  29,  18G4,  pyaemia. 

13 

Burley.    M.  D.,  Pt..  G, 

May  6, 

Right  leg;   amp.  log,  by  A.  A. 

40 

Moser,   C.,   Pt.,  K,   5th 

June  18, 

Left  ankle  and  thigh  ;  gang.;  amp. 

45th  Penn.,  age  17. 

Sept.  13, 

Surg.  1J.  Wilson,  gang.;  hoem. 

Michigan,  age  43. 

July  19, 

leg,  by  A.  A.  Surg.  F.D  \Veisse. 

1864. 

Diseh'd  Jan.  2-'.  18i>5. 

18~64. 

Died  July  26,  1864,  pyaemia. 

14 

nunis.  T.,  Pt.,  D,  8th  N. 

June  17, 

Right  leg;  amp.  leg.    Discharged 

41 

Moss,  B.  F..  Corp'l,  B, 

July  25, 

Left  leg;  gang.;  amp.  leg,  by  A. 

Vcrk  II.  Art'ry.  age  34. 

17,  '64. 

June  20.  1865. 

101st  Illinois,  age  43. 

Aug.  2-1, 

Surg.  W.  B.  Trull,  U.  S.V.;  dif 

15 

Case,  E.  F.,  Pt.,  G,  13th 

Sept.  19. 

Left  thigh,  sevc'g  fern,  art.;  gang.; 

1864. 

fused  aneurism  ;  haem.;  Nov.  11, 

Michigan. 

24,  '63. 

amp  below  knee;  gang,  extend 

amp.  thigh  ;  haem.;  Dec.  15,  lig. 

ing;  Sept.  26,  amp.  at  up.  third 

fem.    Disch'd  June  25.  1865. 

thigh.   Died  Sept.  i.7,  '63,  gang. 

43 

Mott,  J.,  Pt.,  E,   105th 

June  26, 

Left  log;  slough,  ant.  tibial;  haem.; 

16 

Cous:ns.    J.  A.,   Corp'l, 

May  19, 

Left  foot;  slougliing  and  erysipe- 

Illinois,  age  37. 

July  26, 

amp.  leg,  by  Ass't  Surg.  B.  E. 

I.  1st  Maine  H'vy  Art., 

June  16, 

lous  :  flap  amp.  at  up.  third,  by 

1864. 

Fryer.  U.  S.  A.;  July  27,  trans 

ago  24. 

1864. 

Dr.   McConnor.     Diseh'd  July 

fusion.     Died  Aug.  5,  '64,  haem. 

10.  1865. 

43 

Paden,    W.,  Corp'l,    G, 

May  23, 

Right  thigh;  May  29,  31,  haem.; 

17 

Cross,  G.  P.,  Pt..  P,  1st 

^ine  l(i, 

Right  leg:  gang.;  haem.:  amp.  leg, 

ll.th    Peun.   Reserves, 

June  —  , 

June  1,  femoral  tied;  amp.  leg, 

Mass.  Heavy  Artillery. 

Aug.  18, 

by  Surg.  E.  Bentley,  U.  S.  V.: 

age  22. 

1864. 

by  Surg.  G.  L.  Pancoast,  U.S  V. 

age  19. 

1864. 

two  ounces  of  blood  injected  into 

- 

Died  June  26,  1864.  gangrene. 

veins.     Diseh'd  June  9,  '65. 

44 

Parmenter,    J.   D.,   Pt., 

April  fi, 

Left  foot  ;  gangrene  and  necrosis  ; 

18 

Dixon,  J.  #.,Pt.,F,  24th 

Mar.  23, 

Right  leg;   gang.;  amp.  leg.  by 

G,  67th  Penn.,  age  16. 

June  21, 

amp.  leg,  by  Surg.  R.  B.  Bonte- 

N.  Carolina,  age  24. 

April  12, 

A.  A.  Surg.  J.  P.  Arthur.  Died 

1865. 

cou,  U.S.V.'Disch'd  Nov.  23,  '65. 

1863. 

May  4,  1865.  exhaustion. 

45 

Prather,  B.,  Corp'l,   D, 

Dec.  15, 

Right  foot  :  exc'nhalf  in.  post.  tib. 

19 

Downey,  J.,  Pt.,  F,  29th 

May  15, 

Left   leg;   caries;   amp.  leg,   by 

103d  Ohio,  age  18. 

27,  '64. 

nerve  ;  Dec.  26,  amp.  great  toe  ; 

Penn.",  age  30. 

July  13. 

Ass't  Surg.  II.  T.  Legler.U.S.V. 

amp.  leg,  by  A.  A.  Surg.  S.  G. 

18,i4. 

Diseh'd  Sept   1,  1864. 

Ay  res.  Died  Dec.  29,  '64,  tetanus. 

20 

Emery,  R.,  Pt.,  D.  5th 

M'y5,'64. 

Loft  leg;  gang-.;  ha?m.;   Aug.  4, 

4G 

Reed,  J..  Corp'l,  F,  101st 

June,  '62. 

Shot  flesh  w'nd  of  ank.  joint  ;  circ. 

Vermont,  age  33. 

Aug.  23, 

1834,  post,  tibial  lig'n.    Diseh'd 

New  York. 

Interme 

amp.  at  junct.  of  low.  third  leg, 

13(55. 

Dec.  16,  '64  ;  leg  amp. 

diary. 

by  Ass't  Surg.  P.  S.  Connor,  U. 

21 

Gilbert,  G.  H.,  Lieut.,  B, 

Nov.  8, 

Both  feet  contused  by  spent  ball  ; 

S.  A.     Died  July  29,  1862. 

122d  New  York. 

Dec.  7, 

gang,  left  foot  ;  amp.  left  leg.  by 

47 

Ross,   A.    G.,  Corp'l,  I, 

Oct.  19, 

Right  fem.  art.  injured;  also  w'd 

1863. 

Surg.  II.  W.  Ducaohet,  U.  S.V. 

13th  Mississippi,  age  21. 

Nov.  8, 

of  left  thigh:  gang.;  lig.  of  fem.; 

Diseh'd  May  23,  1864. 

1864. 

amp.  right  leg  three  ins.  above 

22 

Gooch,    A.    B.,  Pt.,    F, 

May  9, 

Left  ankle;  caries  inv.  ank.  joint; 

ankle.    Retired  March  14,  1865. 

12th  Ohio,  age  21. 

Nov.  19, 

flap  amp.  mid.  third,  by  Surg. 

48 

Saulsbury,  W.,  Pt.,  K, 

July  30, 

Right  leg;  sloughing;  hasm.ant. 

1864. 

N.  Gay.  U.  S.  V.     Disch'd  Feb. 

Stlth   Colored    Troops, 

1864. 

tibial  art.;  art.  lig.  in  w'nd  ;  ha?m. 

33.  1865. 

age  36. 

Jan.  19, 

recur'd;  art.  relig.:  amp.  log,  by 

23 

Goodell.  E    D.,  Corp'l, 

June  3, 

Right  foot  ;  gangrene  ;  amp.  leg, 

1865. 

A.  A.  Surg.  O.  Shittler.    Disch'd 

D,  25th  Massachusetts, 

July  22. 

by  A.  A.  Surg.  B.  F.  Butcher. 

May  26.  '65.    Died  July  16,  '71. 

age  21  . 

1864. 

Disch'd  Oct.  31,  '65.    Spec.  333J, 

49 

Smith,  \V.,  Pt,.  D,  17th 

May  12, 

Right  ankle  joint  ;  suppurative  in- 

A.M.  M. 

Infantry,  age  22. 

July  8, 

flam'n,  caries;  amp.  leg,  by  A. 

24 

Goodrich,    J.,    Pt.,    G. 

May  9, 

Both  ankles  ;  gang.;  amp.  right 

1864. 

Surg  A.  Ingram,  U.  S.A.    Died 

1-JSth  N.  York,  age  40. 

June  5, 

leg.  by  Ass't  Surg.H.C.  Roberts. 

July  20,  '64.  Spec.  2865,  A.  M.  M. 

1864. 

U.  S.V.  Died  June  5,  "64.  exh'n. 

53 

Stark,  O.  H.,  Serg't,  II, 

Sept.  29, 

Right  ;  slough.;  amp.  leg.  by  A.  A. 

23 

Green,  J.  A.,  Serg't.  E, 

June  7, 

Left  foot;  circ.amp.  up.  third  leg, 

l"th  New  Hampshire, 

Dec.  25, 

Surg.H.IT  James;  sloug'g;  Jan. 

2d  Connecticut  Art'ry, 

28,  '64. 

by  A.  A.  Surg.  1'.  Wilson.  Died 

age  36. 

1864. 

3.  1865,  amp.  thigh;  haem.;  lig. 

age  23. 

July  7,  1864,  pyaemia. 

Died  Jan.  13,  '65,  pyaemia. 

2fi 

Gutting,  A.,  Pt.,  D,  llth 

Oct.  2, 

Right  leg  ;  amp.  leg,  by  Surg.  J. 

51 

Stebbius.  E.,  Serg't,  L, 

Sept.  6, 

Left  leg;  haem.;  amp.  leg.     Dis 

Mich.  Cavalry,  age  26. 

Nov.  9, 

B.   Murphy.  C.  S.  A.'    Diseh'd 

3d  New  York  Cavalry, 

Oct.  12, 

charged  June  15,  1863. 

1864. 

Sept.  14,  1865. 

ago  26. 

1862. 

27 

Hagey,   J.    D.,   Pt.,  I, 

April  2, 

Left  leg;   artery  opened;  hoem. 

5J 

Stultz,   G.,     Serg't,    K, 

June  16, 

Left  leg;  gang,  and  necrosis:  amp. 

138th  Penn.,  age  24. 

May  19, 

from  post,  tibial  artery;  art.  tied; 

5th  New  Jersey,  age  26. 

'64,  Jan. 

leg.  by  Surg.  E.  Bcntlev.U.S.V. 

1865. 

amp.  leg,  by  A.  A.  Surg.  IT.  A. 

9,  '65. 

Left  hospital  April  18,  '1865. 

Drane.     Disch'd  July  26,  '65. 

53 

Sullivan,  D.,  Pt.,  F,  1st 

Dec.  13, 

Left  foot  ;  extensive  inflammat'n  ; 

28 

Harris,  J.  M.,  Corp'l,  C, 

July  15, 

Right  thigh;  aneurism;  sphacelus: 

Penn.  Rifles,  age  23. 

29,  '62. 

amp.  leg,  by  A.  A.  Surg.  C.  II. 

14th  Iowa,  age  20. 

27,  '64 

ati'mal  sac  probed;  exces.  hiem  ; 

Bowen.     Discharged. 

fern,  tied;   amp.  leg,  by  A.  A. 

54 

Tawncy,  A.,Pt.,  D,  74th 

Sept.  19, 

Left  leg;  haem.;  amp.  leg,  by  Surg. 

Surg.  R.  W.  Coale.    Died  Aug. 

Indiana,  age  38. 

Nov.  29, 

G.  Grant,  U.  S.  V.;  gang.    Died 

3,  1864,  pyaemia. 

1863. 

Dec.  6,  1863,  gangrene. 

29 

Hays,  A.,  Corp'l.  F,  3d 

June  18, 

Right  foot  ;  slough  'g  ulcer  :  amp. 

55 

Tewksbury.  D.,  Pt.,  F, 

July  2, 

Left  leg.;   gang.;  amp.   leg,   bv 

Delaware,  age  29. 

Aug.  10, 

leg,  by  A.  A.  Surgeon  W.  W. 

73d  Ohio,  age  22. 

'63,  Ap'l 

Surg.  A.  M.  Speer,  U.S.V.  Died 

1864. 

Sharplev.     Disch'd  Mayl8,'65. 

8,  '64. 

May  8,  1864,  pyaemia. 

Spec.  3668.  A.  M.  M. 

56 

Thompson,  J.  A.,  Corp'l, 

Aug.  3, 

Left  leg  ;  gang.;  amp  leg.  by  A. 

30 

James,  A.,  Pt.  1,  2d  Ten 

Dec.  17, 

Left  ankle;  ball  removed:  gang.; 

K,  10th   Indiana,   age 

Sept,  3, 

A.  Surg.  A.  L.  Rice;  haem.  from 

nessee  Cavalry,  age  20. 

'64,  Feb. 

circ.  amp.  lower  third  leg.  bv 

27. 

1864. 

popliteal    artery;    artery    tied. 

4,  '65. 

Ass't  Surg.  W.  B.  Trull,  U.  S.V. 

Died  Oct.  4,  1864. 

* 

Died  May  16,  1865. 

57 

Thornton,  R.  M.,  Serg't, 

July  30, 

Left  leg;  haem.;  amp.  leg.  by  A. 

31 

Kane,   H.,  Pt.,  A,  24th 

Sept.  19, 

Left  leg  ;  gangrene  :  amp.  leg.  by 

K,  4th  Rhode  Island, 

Sept.  28, 

Surgeon  S.  A.  Orton.  V.  S.  A. 

Iowa,  age  25. 

Deo.  30, 

A.A.Surg.J.W.H.Baker.  Dis 

age  26. 

1864. 

Disch'd  January  28,  1865. 

18G4. 

charged  May  29,  1865. 

58 

Tillotson,  C.  A.,  Pt.,  E, 

Oct.  5, 

Right  ankle  ;  slough  'g  ar.dliaem.; 

32 

'Knoble,  H.,Pt.,D,  149th 

Nov.  27, 

Both  thighs,  ball   impinging  on 

39th  Iowa,  age  32. 

Dec.  25, 

ant.  post,  flap  amp.  at  mid.  third, 

New  York,  age  27. 

Dec.  14, 

sheath  of  left  fem.  artery;  gang.; 

1864. 

by  Ass't  Surg.  B.  E.  Fryer,  U. 

1863. 

amp.  left  thigh.     Died'  Jan.  14, 

S.  A.  Died  Jan.  6,  '65,  pyremia. 

'64.  pyaemia.  Spec.  2114,  A.M.M. 

59 

Tryan,   N.,  Pt.,  E,  4th 

May  5, 

Left  foot  ;  gang.;  amp.  leg,  by  A. 

33 

Kuentzler,    J.,    Pt.,   II, 

June  18, 

Right  leg  :  sloughing:  amp.  leg, 

Ohio,  age  26. 

July  3, 

A.  Surg.  A.  McLetchie.     Died 

56th  Penn.,  age  24. 

Julv  2.3. 

by  A.  A.  Surg.  E.  K.  Tell.  Died 

1864. 

Aug.  10,  1864,  asthenia. 

1864. 

Aug.  G,  1864,  pyaemia. 

GO 

Wares,   D.,  Corp'l,  22d 

May  5, 

Right  leg  ;  amp.  leg.  by  Surg.  D. 

34 

Leasure,  J..  Pt.,  F.  62d 

May  12, 

Left  leg:  haem.:  amp.  leg,  by  A. 

Massachusetts,  age  31. 

20,  '64. 

W.  Bliss,  U.  S.  V.     Discharged 

Penn.,  age  23. 

June  2, 

A.  Surg.  John  Priestley.     Died 

October  23,  1864. 

1864. 

June  15,  '64,  haem.  and  pyaemia. 

61 

Williams,    G.,    Pt.,    II, 

Sept.  27, 

Left  leg  ;  haem.;  amp.  log,  by  A. 

33 

L  J  ,    Chaplain 

Dec.  11, 

Left  leg;  gang.:  amp.  leg.  by  Dr. 

29th   Colored    Troops, 

Oct.  22, 

A.   Surgeon   J.    II.    Buchanan. 

(field). 

'62,  Aug. 

Pearson.     Died   Sept.   2,   1863. 

age  37. 

1864. 

Died  Oct.  23,  "64,  exhaustion. 

25,  '63 

Spec.  858.  A.  M.  M. 

62 

Wolf,  C.,  Corp'l,  D,  5th 

Dec.  16, 

Left  leg,  also  wound  of  right  leg  ; 

36 

McCnrley,    H.,    Pt.,  D, 

June  21, 

Right   ankle:    gang.;  circ.  amp. 

Minnesota,  age  31. 

'64,  Jan. 

amp.  left  leg.  bv  A.  A.  Surg.  L. 

J  st  Maine,  age  18. 

July  23. 

mid.  third,  by  A.  A.  Surg.  G.  E. 

5,  '65. 

E.  Tracy.     Died  Jan.  19,  1863, 

1864. 

Brickett.     Died  Aug.  28,  1864, 

gangrene. 

pyaemia. 

63 

Wright,  E.,Pt.,F,  119th 

Mav  5, 

Right  leg,  cutting  post,  tibial  art.; 

37 

Maguire,  E.,  Pt..   I,  8th 

Sept.  29. 

Right  leg:    gang.;  uleeration  of 

Penn.,  age  18. 

25,  '64. 

gang.;  haem.;  May  2:.',  lig.:  haern. 

Conn.,  age  26. 

1864. 

ante,  tibial  art.;  amp.  leg,  by  A. 

recur'd;  amp.  leg,  by  Surg.  F. 

Mar.  22, 

A.  Surg.  W.  B.  Casey.  Disch'd 

Bentley,  U.  S.  V.    Died  May28, 

1863. 

Nov.  28,  1863. 

1864,  asthenia  and  pyaemia. 

1  LlDELL  (J.  A.).  Wounds  of  the  Arteries,  in  Surg.  Mem.  of  the  War  of  the  Rebellion,  coll.  and  pub.  by  the  U.  S.  San.  Comm.,  1870,  Vol.  I,  pp.  27,  551. 


SECT.  I.]  DEFORMITIES   AFTER    SHOT    FLESH    WOUNDS.  59 

Amputations  of  the  Toes. — There  was  a  single  example  of  amputation  of  the  great 
and  second  toes  for  gangrene  following  ligation  of  the  femoral  artery  for  a  shot  wound  of 
the  thigh.  (CASE  55  of  TABLE  III,  p.  48.) 

CASE  128. — Private  J.  L.  Hunt,  Co.  G,  57th  New  York,  aged  42  years,  was  wounded  at  the  Wilderness,  May  5,  18G4. 
Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  reported  his  admission  to  Lincoln  Hospital,  Washington,  May  26th,  with  "gunshot 
wound  of  left  thigh."  Two  weeks  afterwards  the  patient  was  transferred  to  Camden  Street  Hospital,  Baltimore,  and  on 
October  23d  he  entered  Mower  Hospital,  Philadelphia,  where  Acting  Assistant  Surgeon  F.  W.  Saunders  recorded  the 
following:  "A  minie  ball  entered  the  thigh  at  the  inner  side,  upper  third,  and,  passing  backward  and  outward  behind  the 
femur,  emerged  just  below  the  tuberosity  of  the  ischium.  Deficient  circulation  from  ligature  or  otherwise  of  the  great  trunks 
occasioned  mortification  in  the  foot,  rendering  necessary  the  amputation,  previous  to  admission,  on  September  5th,  of  the  first 
and  second  toes  at  the  second  joints."  The  patient  was  subsequently  transferred  to  McDougall  Hospital,  New  York  Harbor, 
whence  he  was  discharged  June  5,  18G5,  Assistant  Surgeon  S.  H.  Orton,  U.  S.  A.,  certifying,  "  the  wound  has  been  gangrenous ; 
extensive  cicatrix  remaining,  causing  great  contraction  of  muscles;  little  use  of  leg."  On  June  1,  1866,  the  pensioner  was 
supplied  with  a  supporting  and  extensor  apparatus  by  Dr.  E.  D.  Hudson,  of  New  York,  \vlio  in  his  statement  reports  the 
ligation  as  having  been  performed  on  "July  9."  The  New  York  City  Examining  Board  certified,  December  8.  1875:  "There 
is  a  cicatrix  five  inches  by  four  on  inner  side  of  left  thigh,  middle  third,  which  is  adherent  and  radiated.  The  femoral 
artery  has  been  cut  and  tied.  There  is  great  loss  of  muscular  substance.  The  great  and  second  toes  have  sloughed  away ; 
foot  poorly  nourished.  Has  to  wear  an  artificial  appliance  to  enable  him  to  walk.  There  is  considerable  atrophy  of  muscles 
of  the  limb.  The  disability  is  equal  to  the  loss  of  the  limb."  The  pensioner  was  paid  March  4,  1876. 

Tcnotomy. — There  were  five  examples  of  tenotomy  for  the  relief  of  deformities  result 
ing  from  shot  wounds  of  the  lower  extremities.  The  case  of  Sergeant  Louis  Morell  (CASE 
243,  Med.  and  Surg.  Hist,  of  the  War,  Part  II,  Vol.  II,  Chap.  VI,  p.  80,  and  PLATE  V, 
Fig.  I)  has  been  detailed.  In  the  case  of  Private  H.  B.  Franklin,  Co.  E,  52d  Indiana, 
aged  21,  Surgeon  A.  Hammer,  U.  S.  V.,  divided  the  tendo  Achillis  at  the  Marine  Hospital, 
St.  Louis,  November  5,  1864,  and  relieved  talipes  of  several  months'  standing.  He  was 
returned  to  duty  January  24,  1865. 

CASE  129. — Private  J.  H.  Armidon,  Co.  I,  49th  New  York,  aged  19  years,  was  admitted  to  Satterlee  Hospital,  Phil 
adelphia,  June  21,  1863.  Acting  Assistant  Surgeon  M.  J.  Perry  reported:  "The  patient  was  received  from  hospital  at 
Washington,  suffering  from  diarrhoea.  He  had  previously  received  a  gunshot  wound  of  the  leg  at  the  battle  of  Antietam.  Leg 
bent  almost  on  to  thigh.  The  hamstring  tendons  were  cut  by  Acting  Assistant  Surgeon  T.  G.  Morton,  formerly  in  charge  of 
the  ward.  October  30th,  leg  much  straighter;  is  obliged  to  walk  with  crutches.  November  20th,  is  able  to  walk  about 
with  a  cane;  leg  still  a  little  bent.  December  13th,  wound  nearly  healed;  general  health  good.  January  1,  1834,  patient 
returned  to  duty,  cured."  Several  weeks  afterwards  the  man  entered  Augur  Hospital,  whence  he  was  discharged  for  disability, 
February  10,  1864,  Surgeon  S.  B.  Hunt,  U.  S.  V.,  certifying  to  "Shell  wound  of  popliteal  space  of  right  leg,  received  at 
Chancellorsville,  May  3,  1863,  causing  permanent  lameness;  still  discharging."  The  Washington  hospital  records  show  that 
Armidon  was  "admitted  to  Lincoln  Hospital  on  February  27,  1833,  with  intermittent  fever,"  and  that  he  "deserted  June  20, 
1863,"  but  no  note  was  made  of  the  wound.  He  is  not  a  pensioner. 

CASE  130. — Private  T.  Caswell,  Co.  C,  6th  New  Hampshire,  aged  30  years,  was  wounded  in  the  right  leg,  at  Bull 
Run,  August  29,  1852.  He  was  admitted  to  the  Georgetown  College  Hospital,  subsequently  transferred  to  Satterlee,  Philadel 
phia,  and  lastly  to  Lovell,  Portsmouth  Grove.  Assistant  Surgeon  W.  F.  Cormick,  U.  S.  A.,  in  charge  of  the  latter,  reported : 
"Wound  healed  with  severe  contraction  of  the  tendo-achilles,  resulting  from  extensive  and  repeated  sloughing.  On  October 
5,  1863,  tenotomy  was  pel-formed,  by  dividing  the  tendo-achilles,  by  Acting  Assistant  Surgeon  J.  W.  Gushing.  The  wound 
caused  by  the  operation  healed  by  November  23th,  and  the  splints,  etc.,  were  removed,  the  foot  and  ankle  resuming  their  former 
positions  and  functions.  On  December  15th  the  patient  was  able  to  walk  without  crutch  or  cane.  He  was  discharged  from 
service  December  30,  1833."  Examiner  W.  G.  Perry,  of  Exeter,  N.  H.,  February  17,  1864,  certified:  "Ball  entered  the  out 
side  about  midway  between  the  knee  and  ankle  joints,  passing  directly  across  the  leg.  *  *  There  is  contraction  of  the  tendo- 
achilles,  which  has  been  partially  relieved  by  division,  but  he  cannot  bring  his  heel  entirely  down.  Standing  causes  pain."  In 
October,  1889,  he  reported  that  contraction  in  the  use  of  the  leg  had  produced  irritation  of  the  eschar,  resulting  in  ulceration. 
Examiner  E.  B.  Hammond  stated,  September  11,  1875:  "The  foot  is  reduced  in  size,  the  leg  is  weak,  etc."  The  pensioner 
was  paid  June  4,  1876. 

The  fifth  case  in  which  tenotomy  was  practised  has  been  already  noted  as  27  of  TABLE 
VI,  on  page  54,  amputation  being  resorted  to  twelve  years  after  the  reception  of  the  injury 
on  account  of  the  uselessness  of  the  limb. 

CASE  131.— Private  T.  Cooper,  Co.  C,  4th  Pennsylvania  Reserves,  aged  18  years,  was  wounded  near  White  Sulphur 
Springs,  June  22,  1864.  He  was  admitted  to  the  Post  Hospital  at  Beverly,  and,  on  August  8th,  transferred  to  the  Grafton 
Hospital.  Surgeon  S.  N.  Sherman  reported:  "Gunshot  wound  of  left  thigh;  ball  entered  two  inches  above  knee,  on  outer  side, 
exit  near  tuberosity  of  the  ischium;  also  flesh  wound  of  middle  of  leg.  December  31st,  leg  flexed  at  nearly  right  angle  to  the 
thigh,  caused  principally  by  contraction  of  the  semhnembranosus  and  semiteudiuosus ;  motion  of  knee  joint  perfect;  consid- 


60  INJURIES    OF    THE   LOWER    EXTREMITIES.  [CHAP.  x. 

erable  talipes  varus,  though  without  anchylosis.  Subcutaneous  division  of  the  hamstring  tendons  performed  by  Surgeon  S.  N. 
Sherman,  U.  S.  V.;  chloroform  used.  Patient  reacted  promptly,  being  in  good  health,  though  of  rather  delicate  constitution. 
After  division  of  the  tendons  the  leg  was  forcibly  extended  and  secured  to  a  straight  splint,  extending  from  nates  to  heel. 
Twenty-four  hours  after  operation  patient  rested  quite  easy  and  entirely  free  from  pain."  The  patient  was  furloughed  on  April 
11,  1865,  and  admitted  to  the  Emory  Hospital,  Washington,  several  weeks  afterwards.  On  June  23,  1865.  he  was  discharged 
by  reason  of  "paralysis  and  deformity  of  the  left  leg  caused  by  the  wound,"  and  pensioned.  The  man  subsequently  removed 
to  Birmingham,  England,  where,  in  December,  1870,  he  was  seen  by  Mr.  J.  B.  Gould,  the  U.  S.  Consul,  who  described  his 
condition  as  follows:  ''His  left  leg  and  foot  are  withered,  the  foot  icy  cold  and  curled  up  like  a  bird's  claw,  and  the  leg  with 
ered  and  dead  to  the  hip  joint,"  etc.  About  this  time  the  pensioner  was  also  examined  by  Surgeon  Jos.  Morris,  M.  R.  C.  S., 
who  certified :  "I  find  him  suffering  from  the  effects  of  a  gunshot  wound  of  the  left  thigh.  The  sciatic  nerve  has  been  injured, 
and  the  entire  limb  rendered  permanently  and  entirely  useless.  He  suffers  great  pain  in  the  injured  limb,"  etc.  This  certificate 
was  corroborated  by  Surgeon  Jordan,  F.  R.  C.  S.,  and  Professor  of  Surgery  at  Queen's  College,  at  a  subsequent  examination 
on  March  4,  1871 .  Surgeon  Oliver  Pemberton,  F.  R.  C.  S.,  in  charge  of  the  General  Hospital  at  Birmingham,  certified,  on 
June  6,  1876:  "On  the  third  day  of  May,  1876,  I  amputated  the  left  leg  of  Thomas  Cooper  above  the  knee,  the  said  limb 
having  become  useless  on  account  of  a  gunshot  wound,"  etc.  The  pensioner  was  paid  June  4,  1876. 

A  case  of  shot  injury  of  the  foot  in  a  distinguished  general  officer  may  conclude  the 
illustrations  selected  for  this  section: 

CASE  132. — Major-General  J.  Hooker,  U.  S.  V.,  was  wounded  at  the  battle  of  Antietam,  September  17, 1862.  The  injury 
was  reported  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  as  follows:  "  He  was  wounded  in  the  right  foot  by  a  mini6  ball  while 
leading  his  command,  being  on  horseback  at  the  time,  and  standing  in  the  stirrups  with  his  weight  thrown  on  his  right  foot, 
which  was  turned  outward.  The  ball  struck  the  inner  side  of  the  foot  inferiorly  to  the  middle  of  the  scaphoid  bone,  passing 
between  the  first  and  second  layers  of  the  plantar  muscles,  almost  transversely  across  the  plantar  portion  of  the  foot,  and  emerg 
ing  inferiorly  to  the  anterior  border  of  the  cuboid  bone.  The  bones  of  the  foot  were  uninjured.  On  the  morning  of  September 
18th,  I  was  sent  by  the  Medical  Director  of  the  Army  of  the  Potomac  to  attend  General  Hooker,  '  then  lying  in  a  farm 

house  near  the  battle-field.  Warm-water  dressings  had  been  applied  previous  to  my  visit.  There  was  no  constitutional 
disturbance,  but  the  foot  was  hot  and  inflamed.  By  means  of  a  syringe  I  thoroughly  washed  out  the  wound  with  warm  water, 
and  finding  it  most  agreeable  to  the  patient,  substituted  cold-  for  warm-water  dressings.  The  next  day  I  found  the  patient  very 
comfortable;  the  appearance  of  the  foot  had  greatly  improved  and  the  inflammatory  symptoms  had  disappeared.  I  then  ordered 
a  lotion  of  plumbi  instead  of  cold-water  dressings  as  being  more  likely  to  allay  any  irritation  that  might  arise  in  the  parts. 
Before  the  General  left  that  evening,  for  Washington,  I  advised  him  to  resume  the  use  of  tepid  water  as  soon  as  all  tendency  to 
active  inflammation  should  cease.  On  October  25th,  I  heard  that  tetanic  symptoms  had  manifested  themselves,  but  received  a 
letter  from  the  General  a  few  days  afterwards  stating  to  the  contrary.  On  November  25th  the  General,  who  had  returned  to 
duty  in  the  field,  requested  me  to  look  at  his  wound,  which  still  troubled  him  somewhat.  I  found  the  newly  formed  cicatrices 
somewhat  tumefied;  they  were  painful  on  pressure,  and  the  General  was  still  unable  to  mount  hia  horse  unaided,  though  he 
persisted  in  being  on  active  duty.  On  November  30th,  I  found  there  had  been  a  steady  improvement,  and,  although  the  step 
had  not  its  former  elasticity,  the  wound  had  left  no  serious  inconvenience  behind."  General  Hooker  remained  in  active  service 
until  the  close  of  the  war,  and  was  ultimately  retired  October  15,  1868. 

Wounds  of  the  soft  parts  of  the  lower  extremities,  though  constituting  the  largest 
group  of  injuries  received  in  action,  have  seldom  been  much  commented  on  by  authors.1 

'In  addition  to  the  bibliographical  references  cited  in  previous  pages  of  this  section  the  following  may  be  consulted  with  interest:  PAKE  (A.) 
( (EuvreS  completes,  ed.  MALGAIGNE,  Paris,  1840.  T.  II,  Chap.  XXXVII,  p.  110)  remarks :  "  Les  plaies  faites  au  dedans  des  Cuisses  sont  souvent  cause  de 
mort  subite,  quand  clles  penetrent  en  la  grosse  veine  Saphene,  on  grosse  artere.  et  aux  nerfs  qui  les  accompagnent :  ce  que  j  ay  veu  souvent  advenir" 
.  .  and  "Mais  quand  elles  penetrent  profondement,  souvent  advient  grands  accidens.  comme  inflammation,  aposteme, et  pourriture  anx  membranes  qui 
couvrent  les  muscles,  qui  causeutquerulcerejette  une  tres-grandequantitede  matiere.  defacon  quele  malade  meurt  en  atrophie,  et  tout  desseicheV'  .  .  . 
RAVATON  (Chir.  d'armee,  on  Traite  des  plaies  d'armes  a  feu,  Paris,  1768,  p.  321  et  seq.)  dwells  on  the  importance  of  flesh  wounds  of  the  lower  extrem 
ities,  and  cites  many  and  exceedingly  interesting  examples  of  extensive  lacerations,  lodgement  of  missiles  and  other  foreign  substances.  He  details  six 
cases  of  shot  flesh  wounds  of  the  thigh  (06s.  81,  83,  84,  85,  86,  87),  an  instance  (Obs.  90)  of  shot  wound  of  the  knee,  the  missile  opening  the  joint  without 
lesion  (sans  toucher)  of  bone,  and  four  cases  of  shot  flesh  wounds  in  the  leg  {Obs.  91.  93,  94,  95),  one  of  which  (Obs.  94)  was  followed  by  amputation  of  the 
leg.  .  .  .  LE  UUAN  (H.  F.)  (Obs.  de  Cliir.,  Paris,  1731,  T.  I,  p.  347)  records  a  case  of  shot  flesh  wound  of  the  thigh  followed  by  repeated  hasmorrhages. 
.  .  .  WILLIAMSON  (G.)  (Military  Surgery,  London,  1863,  p.  133),  in  a  subsection  on  Simple  Flesh  Contusions  and  Wounds  of  the  Lower  Extremities,  records 
130  cases  of  this  kind  from  the  mutiny  in  India,  1857-58  ;  117  were  slight.  13  severe.  Of  the  130  cases,  90  were  returned  to  duty,  15  to  modified  duty,  and 
25  were  invalided.  .  .  .  THOMPSON  (JOHN)  (Report  of  Obs.,  etc.,  after  the  Rattle  of  Waterloo,  Edinburg,  1816,  p.  125)  refers  to  several  cases  of  extensive 
lacerations  of  the  soft  parts  by  large  missiles.  .  .  .  NEALE(JOHX)  (Chirurgical  Institute,  London,  1805,  p.  247  et  seq.).  .  .  .  GORDON  (C.  A.)  (Lessons  on 
Hygiene  and  Surgery,  London,  1873,  pp.  152,  153)  cites  several  examples  of  flesh  wounds  of  the  thigh,  and  on  page  157  gives  three  cases  of  recovery  after 
periarticular  wounds  of  the  knee  joint.  .  .  .  KLEIJS  (E.)  (Beitrdf/e  zur  Path.  Anatom.it  der  Schiisswunden,  Leipzig,  1872,  pp.  42,  58)  cites  six  obductions 
in  cases  of  shot  flesh  wounds  of  the  lower  extremities — 3  of  the  thigh  and  3  of  the  leg.  .  .  .  CHENU  (J.  C.)  (Aper<;u  hist.  slat,  et  din.  pendant  la  guerre 
de  1870-71,  Paris,  1874,  T.  T,  p.  278)  very  briefly  adverts  to  two  cases  of  flesh  wounds  of  the  thigh,  one  of  the  leg  and  a  penetrating  flesh  wound  of  the 
knee  joint,  followed  by  traumatic  arthritis.  .  .  .  FISCHEU  (H.)  (Kriegschir.  Erf..  1»72,  p.  1C4)  says :  "  The  wounds  of  the  soft  parts  of  the  leg,  as  a  rule, 
progressed  very  favorably.  .  .  Much  worse  proved  the  wounds  of  the  soft  parts  of  the  foot.  Nearly  always  circumscribed  or  diffuse  plilogmonous 
abscesses  developed  necessitating  repeated  incisions.  .  .  .  MACCOHMAC  (W.)  (Notes  and  Jtecollections  of  an  Ambulance  Surgeon,  London,  1871.  p.  129) 
tabulates  63  cases  of  wounds  of  the  soft  parts  of  the  thigh  without  fracture,  with  6  deaths,  and3(i  cases  of  wounds  of  the  soft  parts  of  the  leg,  with  1  death. 
.  .  .  LOcKK  (ALDEKT)  (Kriegschir.  Fragen  und  liemerlc..  Bern,  1871,  pp.  6-9)  details  six  cases  of  shot  flesh  wounds  of  the  lower  extremities  compli 
cated  by  secondary  bleeding,  among  them  three  cases  of  ligation  of  the  crural  artery,  and  remarks:  "In  recent  injuries  we  yet  ligate  now  and  then 
successfully  the  crural  artery,  but  we  will  more  and  more  come  to  the  conclusion  rather  to  tie  the  external  iliac  than  the  crural  artery."  .  .  .  ScnfJu.EU 
(M.)  Kriegschir.  Skizzen,  Hannover,  1671,  p.  18)  tabulates  13(i  cases  of  shot  flesh  wounds  of  the  lower  extremities.  All  recovered.  .  .  .  SCHINZINT.EU 
(A.)  (Das  Reserve- Lazareth  Schwetzingen,  Freiburg  i.  Br.,  1873,  p.  68)  notes  the  gravity  of  shot  wounds  of  the  soft  parts  of  the  thigh  after  the  battle  of 
Weissenburg. 


SKCT.  n.j  WOUNDS    AND    INJURIES    OF    THE    HIP    JOINT.  61 


SECTION  II. 


WOUNDS  AND  INJURIES  OF  THE  HIP  JOINT. 


In  the  important  class  of  injuries  of  the  joints,  those  of  the  hip  joint  are  preeminently 
hazardous  to  life,  obscure  in  diagnosis,  and  difficult  in  treatment.  In  the  Surgical  History 
of  the  War  of  the  Rebellion,  a  comprehensive  and  systematic  classification  of  this  group 
of  wounds  and  injuries  should  include  the  contusions  and  sprains  and  dislocations  and 
simple  fractures  at  the  articulation,  shot  wounds  involving  the  tendinous  and  ligamentous 
structures  about  the  joint,  or  laying  open  the  capsule,  and  shot  fractures  implicating  the 
•acetabulun>  or  head,  neck,  and  trochanters  of  the  femur,  examples  of  secondary  coxitis 
from  extension  of  inflammation,  or  septic  infection  from  injuries  of  the  upper  part  of  the 
shaft,  and  lastly,  cases  in  which  operative  interference  at  the  hip  is  imperative  from  the 
extension  of  lesions  of  the  upper  part  of  the  shaft  to  the  articulation.  Yet,  in  this  Section, 
it  is  proposed  to  treat  mainly  of  shot  fractures  involving  the  hip  joint,1  and  of  operations 
at  the  hip  following  shot  injuries,  except  in  a  single  instance.2  There  appear  on  the  records 
notes  of  about  thirty-five  examples  of  luxations  at  the  hip,  fifteen  simple  fractures  believed 
to  implicate  the  hip  joint,  and  forty-four  cases  returned  as  contusions  or  sprains  at  the 
hip;  but  these  cases  will  be  referred  to  in  subsequent  chapters  of  this  volume,  as  more  in 
accordance  with  the  classification  heretofore  adopted.  Examples  of  coxitis  from  periartic- 
ular  wounds,  in  which  the  primary  lesions  were  believed  to  be  confined  to  the  membranous 
or  ligamentous  or  other  adjacent  soft  tissues,  were  discussed  in  the  last  Section,  and  of 
instances  of  secondary  coxitis  from  extension  of  lesions  of  the  shaft  we  shall  find  many  in 
the  following  Section  on  shot  fractures  of  the  shaft  of  the  femur. 

In  the  preceding  Section  (pp.  26,  28)  all  pains  has  been  taken  to  collect  the  obser 
vations  that  were  recorded  of  periarticular  shot  wounds  at  the  hip,  and  details  are  referred 
to  of  all  the  facts  that  could  be  collected  of  forty-nine  cases  that  were  reported.  Professor 
H.  H.  Smith3  and  other  systematic  authors  believe  that  shot  wounds  of  the  hip  joint, 
unattended  by  injury  of  the  bone,  are  very  rare;  but  there  seems  to  be  a  growing  convic 
tion  among  military  surgeons  that,  owing  to  the  extreme  difficulties  of  diagnosis,  many 
such  cases  may  escape  observation,  or  be  misinterpreted  until  late  in  their  progress.  The 
early  recognition  of  the  precise  extent  of  wounds  of  the  hip  joint  is  of  the  utmost  practical 

'JOHN  HEXXEX,  in  his  classical  treatise,  remarks:  "The  injuries  occasioned  by  balls  lodging  near  or  about  the  joint  of  the  hip  are  among  the 


most  serious  of  military  s 
some  of  these  cases  the  c 
balls  lodged  in  almost  e 

discovery  of  their  situat'u 


rgery.  The  fever,  the  profuse  discharges,  the  tedious  exfoliations,  all  tend  to  sink  the  patient,  and  are  but  too  often  fatal.  In 
urse  of  the  ball  is  so  obscure,  and  its  place  of  lodgement  so  uncertain,  that  it  can  only  be  detected  after  death.  I  have  seen 
cry  part  of  the  trochanters,  neck,  and  head  of  the  bone,  and  yet  the  most  accurate  examination  during  life  did  not  lead  to  a 
n." — Principles  of  Military  Surgery,  2d  ed.,  Edinburgh,  IS'-JO,  p.  155. 


2  Among  the  coxo-femoral  disarticulations  one  example  will  be  cited  where  the  operation  was  a  re-amputation  following  an  amputation  in  the 
continuity  of  the  thigh  fora  bayonet  stab  in  the  knee  joint,  the  only  case  to  be  adverted  to  not  connected  with  shot  wounds. 

3  Professor  H.  II.  SMITH  (J'rinc.  and  Pract.  of  Surgery,  1863,  Vol.  I,  p.  52(i)  remarks  that  "wounds  of  the  hip  joint,  uncomplicated  by  injuries  of 
the  bone,  arc  seldom  seen.    The  joint  lies  quite  deep,  and  is  protected  by  the  shelving  outward  of  the  ilium  and  by  the  prominence  of  the  great  trochanter. 
An  injury  reaching  it  is  almost  necessarily  associated  with  some  fracture  of  the  bones.1' 


62 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


importance,  and  demands  a  careful  and  prompt  examination  to  determine  whether  conserv 
ative  measures  are  admissible  or  if  operative  interference  is  advisable.  Yet  here  the 
greatest  obstacles  present  themselves.  It  must  still  be  admitted,  and  cannot  be  too  much 
impressed  on  the  minds  of  surgeons,  that  far  greater  attention  and  care  and  trouble  are 
requisite  in  these  than  in  the  injuries  of  other  joints.  Until  comparatively  recent  years 
shot  injuries  of  the  hip  were  regarded  as  almost  inevitably  hopeless,  and  military  surgeons 
enquired  into  them  but  little;1  but  now  it  is  agreed  that  recoveries  may  be  obtained  in  this 
group  of  cases,  either  under  conservative  measures  or  by  operative  interference,  and  the 

1  In  the  section  on  the  surgical  literature  of  shot  wounds  of  the  hip  joint  with  which  Professor  B.  von  LAXGEXBECK  prefaces  his  essay  Ueber  die 
Schussverletzungen  des  Huftgelenks,  read  before  the  second  session  of  the  German  Surgical  Congress,  April  19, 1873,  and  printed  in  the  Archiv,  B.  XVI, 
S.  264,  the  learned  professor  observes  that  in  ancient  military  surgical  literature  we  find  wounds  of  this  joint  seldom  mentioned.  This  is  emphatically 
true.  Not  only  in  SCHENCKIUS,  of  Graeffenburg,  who  laboriously  summarized  the  labors  of  his  predecessors  in  chronicling  rare  cases,  in  PLATER,  in 
FABRICIUS  HILDANUS,  in  the  monumental  BOXETUS,  and  in  other  collectors  of  curious  pathological  observations,  one  searches  in  vain  for  instances  of 
wounds  of  the  hip;  but  we  scan  the  writings  of  the  early  teachers  who  treated  specially  of  shot  injuries  with  as  little  success.  MAGGIUS,  FERKIUS, 
ROTA,  and  the  excellent  BOTALLUS,  Vioo,  FELIX  WUUTZ,  HIEROXYMUS  of  Braunsweig,  GERSDORF,  and  even  the  so-called  father  of  modern  army 
surgery,  AMiiROlSE  PARE,  are  silent  on  this  subject.  At  last,  toward  the  end  of  the  seventeenth  century,  we  find  a  detailed  example  of  recovery  from  a 
shot  wound  of  the  hip.  MATTHIAS  GOTTFRIED  PURMAXX  (Funfftzig  Sander-  und  Wunderbahre  Schusswundcn  Curen,  Frankfurt,  1721,  Obs.  XLIII,  p. 
324)  relates  the  case  of  Pt.  S.  Kirsky,  of  the  regiment  Gotz,  wounded  at  the  siege  of  Stettin,  1677,  in  the  right  hip  by  a  falconet  ball,  injuring  ilium  and 
upper  portion  of  femur.  Recovery  in  twenty  weeks,  with  complete  anchylosis  of  hip.  In  the  writings  of  English  surgeons  of  the  time,  in  GALE,  WlSE- 
MAA",  BROWX,  and  RAXBY  ;  among  the  Germans  who  were  then  eminent  for  treating  of  shot  wounds,  HEISTER,  THEUEX,  and  SCHMUCKER;  and  of  French 
authors  who  refer  particularly  to  shot  wounds  of  the  joints,  like  LEDUAX,  GAREXGEOT,  and  FAUDACQ,  we  look  in 
vain  for  instances  of  shot  injuries  implicating  the  hip.  MORAXD  and  RAVATOX,  it  is  true,  in  the  middle  of  the  eight 
eenth  century,  advocated  coxo-femoral  amputation  for  shot  fractures  high  up  in  the  femur,  but  do  not  allude  to  any 
fractures  at  or  above  the  trochanters.  BILGUER,  who  cites  ( Chirurgische  Wahrnehmungen,  Berlin,  1763,  p.  398  et  seq.) 
117  cases  of  shot  injuries  of  the  lower  extremities  during  the  years  1756-02,  among  them  cases  of  wounds  of  knee  and 
ankle  joints,  gives  not  a  single  instance  of  a  shot  injury  of  the  hip  joint.  JEAN  MEHEE  (Traite  des  plaics  d'armes 
A  feu,  Paris,  An.  VIII — 1800),  who  systematically  divides  the  wounds  of  the  joints  into  three  classes,  those  of  the 
lower  joints  (ankle  and  wrist),  middle  joints  (knee  and  elbow),  and  upper  joints  (hip  and  shoulder),  and  who  cites 
numerous  examples,  only  gives  examples  of  wounds  of  the  shoulder  joint  in  the  last-named  class,  and  entirely  omits 
wounxls  of  the  hip  joint.  The  next  definite  instance  of  shot  injury  of  the  hip  joint  found  in  surgical  annals  is  remark 
able  on  several  accounts.  The  case  is  recorded  by  Dr.  JAMES  JOIIXSTOXE,  of 
Worcester,  in  the  London  Medical  Journal,  1786,  Vol.  VIII,  pp.  135-140.  Dr. 
JOHXSTOXE  took  pains  to  have  prepared  a  drawing  the  size  of  nature,  representing 
the  exfoliated  fragment  of  the  head  of  the  femur,  which  is  accurately  copied  in  the 
annexed  wood-cut,  FIGURE  24.  The  case  was  attended  by  Mr.  JOSEPH  BRAX- 
DISH,  a  "  deserving  surgeon  and  apothecary,  at  Alcester,"  and  has  been  sometimes 
cited  as  an  early  example  of  excision  at  the  hip  for  shot  injury.  Mr.  BRAXDISH 
treated  a  lad  aged  12,  who  had  accidentally  shot  himself  December  23,  1783.  The 
contents  of  the  gun  "passed  into  the  upper  part  of  the  thigh,  adjoining  to  the 
middle  of  the  groin,  and  came  out  about  the  middle  of  the  glutaeus  maximus." 
Several  successive  abscesses  were  formed,  and  several  exfoliations  came  away; 
one,  in  particular,  which  appeared  to  be  a  considerable  portion  of  the  head  of  the 
thigh  bone  with  a  shot  sticking  in  it.  Much  as  Baron  LAHREY  has  to  say  of  oper 
ations  at  the  hip  joint,  he  only  once  describes  a  case  of  shot  fracture  involving 
the  hip.  It  appears  in  the  Clinique  Chirurgicale  (1836,  T.  V,  p.  242):  A  young 

officer  of  the  9th  demi-brigade  of  Infantry  of  the  army  of  Egypt,  at  the  siege  of 

FIG.  24. — Carious  fragment  of  ,   ,     ,  ...    ,  .  ,     .     ,    .. 

the  head  of  the  femur:    1.  Outer    Alexandria,  was  wounded  at  the  outer  and  upper  part  of  the  leit  thigh,  the  ball 

urface  of  exfoliation ;   2,   same    embedding  itself  in  the  neck  of  the  femur.     The  officer  recovered  with  anchylosis 

presence  of  the  missile  was  not  recognized  until  after  the  death 

ixelles,  twenty  years  after  the  injury.  The  specimen  was  LEG*OUEST  l" 
presented  to  Baron  LARREY  by  Dr.  SEUTIN,  and  ultimately  was  deposited  in  the 
Museum  at  Val-de-grace.  Professor  LEGOUEST  had  a  drawing  made  of  it,  which  is  copied  in  the  adjacent  wood-cut  (FlG.  25).  The  chief  British 
surgical  authorities  in  the  great  Napoleonic  wars,  HEXXEX,  GUTHRIE,  and  BALLIXGALL,  cite'  no  cases  of  shot  wounds  of  the  hip.  HEXXEN,  in  his 
classical  Observations,  dwells  (3d  ed.,  1829,  p.  158)  on  the  extreme  difficulties  of  detecting  the  course  of  balls  lodged  in  this  region.  "I  have  seen,"  he 
remarks,  "  balls  lodged  in  almost  every  part  of  the  trochanters,  neck  and  head  of  the  bone,  and  yet  the  most  accurate  examination  during  life  did  not 
lead  to  a  discovery  of  their  situation."  Dr.  JOHN  THOMSON  (in  his  Report  of  Observations  made  in  the  British  Military  Hospitals  in  Belgium  after  the 
Battle  of  Waterloo,  1816,  p.  123)  refers  to  a  case  of  wound  of  the  hip  joint,  in  which  the  ball  lodged;  paralysis  was  produced,  and  great  swelling  of  the 
foot  and  leg  supervened ;  and  to  another  case,  in  which  the  head  and  neck  of  the  thigh  bone  together  with  the  acetabulum  were,  at  the  autopsy,  found  in 
a  diseased  state ;  and  to  one  or  two  other  cases  which  seem  to  have  progressed  favorably  but  were  not  followed  up  to  the  final  issue ;  and  to  other  instances 
where  the  ball,  without  penetrating  the  capsule  of  the  joint  had  injured  the  parts  around  it,  inducing  abscesses  in  the  joint  and  ulceration  of  the  articular 
cartilages,  with  softening  and  absorption  of  the  head  and  neck  of  the  femur.  Writers  on  more  recent  wars  have  cited  but  few  cases  and  very  few  of  recovery. 
M^XIEUU  (P.)  (/,' Hotel- TJieude  Paris  en  Juilletet  Aout,  1830,  Paris,  1830,  p.  16)  gives  the  case  of  M.  Firer,  aged  23,  shot  fracture  of  head  of  femur.  Death 
August  30,  1830.  JOBERT  (A.  J.)  (Plaies  d'armes  a  feu,  Paris,  1833,  p.  247)  cites  two  cases  of  recovery  after  shot  wounds  of  the  hip  joint  received  in  the 
Paris  Revolution  of  1830.  BAUDEXS  (M.  L.)  (Clinique  des  Plaies,  etc.,  Paris,  1836,  p.  445)  relates  a  fatal  case,  in  which  the  ball  had  perforated  the  head  of 
the  femur,  in  Algiers,  November  15,1835,  and  adds:  " Had  I  remained  at  the  Algiers  Hospital  I  should  have  practised  disarticulation  or  resection." 
ALCOCK  (J.)  (06s.  on  Injuries  of  the  Joints,  in  Med.-Chir.  Transact.,  1840,  Vol.  XXIII,  p.  261)  tabulates  four  cases  of  shot  wounds  of  the  hip ;  but  in  two 
only  the  joint  was  primarily  involved;  both  were  fatal.  MACLEOr  (G.  H.  B.)  (Notes  on  the  Surgery  of  the  War  in  the  Crimea,  London,  1858,  p.  309) 
relates  the  case  of  A.  McPhail,  aged  33,  wounded  at  Dubba,  March  24,  1843,  by  a  matchlock  ball,  which  entered  anteriorly  above  the  great  trochanter  of 
the  right  limb.  The  wound  in  the  skin  cicatrized;  but  the  patient  died  of  tetanus,  May  9,  1843.  The  ball  was  found  embedded  in  the  head  of  the 
femur,  having  fractured  the  brim  of  the  acetabulum.  The  specimen  is  preserved  in  the  Fort  Pitt  Museum,  and  numbered  2604.  IIYRTL  (J.)  (Handbuch 
der  topog.  Anatomie,  Wien,  1865,  p.  534)  relates  the  case  of  a  member  of  the  national  guard,  wounded  in  1848 ;  the  neck  of  the  femur  was  fractured ;  the 


Bunauu  01  UA.KUIUIIOII  ;    «,    BUIIIO  ouiuuuuuijg  iweu  tu  uua 

bone,  showing cancellous  surface  of  the  hip.    The  presen 

with  (A)  lead  shot  sticking  in  it. 

[After  JOHXSTONE,  op.  cit.}  of  the  Patient'  at  Brus 


FIG.  25.— Musket  ball  lodged  in 
the  neck  of  the  left  femur.    [After 


SECT.  II.]  WOUNDS    AND    INJURIES    OF    THE    HIP    JOINT.  63 

credit  of  surgery,  and  still  more  the  interests  of  humanity,  imperatively  require  that  the 
most  favorable  periods  and  conditions  of  treatment  should  be  diligently  sought.  Drs.  H. 
H.  Smith,1  H.  Fischer,2  E.  Klebs,3  B.  Langenbeck,  and  other  modern  writers  on  military 
surgery,  have  dwelt  on  the  inaccessibility  of  the  parts  to  exploration  through  the  long 
narrow  shot  tracks  produced  by  missiles  of  comparatively  small  calibre,  on  the  frequent 
absence  of  shortening  or  displacement,  or  escape  of  synovia,  or  indeed  with  scarcely  any 
serious  disturbance  of  the  functions  of  the  joint,  until  the  inflammatory  and  infiltration 

patient  recovered.  STROMEYER  (L.)  (Maximen,  u.  s.  w.,  Hannover,  3855,  p.  756)  tabulates  five  cases  of  shot  fractures  of  the  neck  of  the  femur 
from  the  Danish  War,  1848-1850;  all  were  fatal.  Two  of  these  five  cases  are  detailed  by  Dr.  H.  SCHWARTZ  (Beitrage  zur  Lehre  von  den  Schuss. 
wunden,  Schleswig,  1854,  p.  143).  J.  J.  COLE  (Military  Surgery,  etc.,  London,  1852,  p.  13C)  cites  a  case  of  fracture  of  the  neck  of  the  feuiur  during  the 
war  in  India,  1848-49,  but  the  result  is  not  recorded.  BERTHERAND  (A.)  (Campagnes  de  Kabylie,  Paris,  1862,  p.  301)  relates  the  case  of  Mohammed 
ben  Achtned,  shot  in  the  right  hip  joint  at  Icheriden,  June  25,  1857;  death,  August  31st.  MATTHEW  (T.  P.)  (lied,  and  Surg.  Hist,  of  Brit.  Army, 
London,  1858,  Vol.  II,  p.  351)  refers  to  three  cases  of  wounds  of  the  hip  joint  in  the  Crimean  War,  which  proved  fatal  in  a  few  hours.  CHEXU 
(J.  C.)  (Rapport  au  Conseil  de.  Santt  des  Armees  de  Campagne  d' Orient,  Paris,  1865,  p.  372)  tabulates  30  cases  of  shot  wound  of  the  hip  joint,  of 
which  two  recovered.  The  same  author  (in  Rapport,  etc.,  de  Campagne  d'ltalie,  Paris,  1809,  T.  II,  p.  690)  groups  26  cases  of  shot  wounds  of  the  coxo- 
femoral  region,  of  which  1C  recovered,  but  it  is  not  even  indicated  whether  the  wounds  were  fractures  or  simple  flesh  wounds.  DEMME  (H.)  (Mil.  Chir. 
Studien,  Wilrzburg,  1861,  p.  252)  details  two  cases  of  recovery  after  shot  fractures  of  the  bones  of  the  hip  joint.  HEINE  (C.)  (Die  Schussverletzungen 
der  Unteren  Extremitaten,  Berlin,  1866,  p.  365)  records  four  cases  of  shot  wounds  of  the  hip  joint  from  the  Schleswig-Holstein  War  of  1864  ;  all  proved 
fatal.  STROMEYER  (L.)  (Erfahrungen  iibcr  Schusswunden  im  Jahre  1866,  Hannover,  1867,  p.  8)  tabulates  four  fatal  shot  fractures  of  the  hip  joint 
treated  at  Langensalza.  LAXGEXBECK  (B.  v.)  (Ober  die  Schussverletzungen  der  EiiftgeUnke,  in  Arch,  fur  Klin.  Chir.,  1874,  B.  XVI,  p.  270)  relates  the 
case  of  Major  J.  Preuss,  wounded  in  the  hip  joint  at  MUnchengratz,  June  28,  1806.  The  patient  died  September  13,  1867  ;  and  another  fatal  case  of  a 
soldier  wounded  in  1864.  In  the  latter  instance,  the  autopsy  showed  that  the  ball  had  entered  the  outer  point  of  the  left  trochanter  major  and  passed 
through  the  neck  of  the  femur  in  its  length  into  the  acetabulum.  BRUCE  (A.)  (Observations  in  the  Military  Hospitals  of  Dresden,  London,  1866,  p.  24) 
describes  the  case  of  a  Prussian  wounded  at  Sadowa,  July  3,  1866,  which  terminated  fatally.  BlEFEL  (R.)  (Im  Reserve- Lazareth,  in  LANGEXBECK'8 
Arcliiv,  B.  XI,  p.  441-2)  treated  a  case  of  shot  fracture  of  the  hip  joint  at  Landeshut,  in  1866,  which  proved  fatal  on  the  171h  day.  In  the  Archiv  fur 
Klinische  Chirurgie,  Berlin,  1874,  B.  XVI,  p.  309,  B.  v.  LAXGEXBECK  tabulates  25  cases  of  recovery  and  63  fatal  cases  after  shot  wounds  of  the  hip 
joint,  during  the  Franco-Prussiau  War,  1870,  collected  from  various  sources.  Among  the  cases  of  recovery  he  cites  the  case  of  R.  Rousseau  (CASE  12, 
p.  313),  observed  by  Dr.  SCHIXZIXGER,  although  the  latter  (Das  Reservdazareth  Schwetzingen,  Freiburg,  i.  Br.  1873,  p,  56)  distinctly  states  "hip  joint 
intact"  (Huftgelenk  intact);  also  the  case  of  Schaefer  (CASE  19,  p.  315),  observed  by  SOCIN  (Kriegschir.  Erf.,  Leipzig,  1872,  p.  135),  who  remarks 
that  the  patient  died,  on  the  188th  day,  of  exhaustion.  Of  the  ten  cases  treated  by  himself,  Professor  LANGENBECK  had  the  satisfaction  of  recording  eight 
recoveries.  Stabsarzt  DEDONGEU,  of  the  Hallway  Battalion  (Beitrage  zur  den  Schussfracturen  des  BiiftgeUnks  unter  besondercr  Berilcksichtiyung  der 
Erfahrungen  aus  dem  Fcldzuge  1870-71,  und  Benutzung  der  Acten  des  Koniglichen  Kriegsministeriums,  in  Deutsche  Militairarztliche  Zeitsclirift,  1874, 
B.  Ill,  p.  314),  in  his  statistics  describes  66  cases  of  shot  wounds  of  the  hip  joint,  of  which  13  recovered.  All  but  15  of  these  cases  are  contained  in  von 
LAXGEXBECK'S  enumeration.  Of  the  15  cases  not  contained  therein  (CASES  5,  6.  7,  8,  31,  32,  33,  37  [Recovery],  38  [Recovery!,  49,  50,  51,  54  [Recovery], 
50,  58),  12  were  fatal  while  only  3  recovered.  Besides  the  cases  collected  by  Professor  von  LANGENBECK  and  Dr.  DEININGER  I  have  found  the  following 
from  the  Franco-Prussian  War  of  1870-71,  not  contained  in  the  tables  of  either.  Assistant  Surgeon  EVERS,  Saxon  train  battalion  No.  12  (Gelenkwunden 
und  ihr  Ausgang,  in  Deutsche  mil-u.rztl.  Zeitcshrift,  1874,  B.  Ill,  p.  381),  gives  the  case  of  Frode,  wounded  August  29,  1870;  ball  penetrated  the  right  hip 
joint ;  patient  recovered  but  is  totally  disabled.  LOSSEN  (H.)  (Kriegschir.  Erf.  etc.,  in  Deutsche  Zeitschrift  fur  Chir.,  1873,  B.  II,  p.  64),  case  of  Th. 
Margaillon,  22d  French  Infantry,  shot  wound  of  neck  and  trochanter  of  left  femur,  August  18,  1870;  died  September  4,  1870.  MAYER  (L.)  (Kriegschir. 
Mitth.,  etc.,  in  Deutsche  Zeitschrift  fur  Chir.,  1873,  B.  Ill,  p.  47),  case  of  Sommerfeld,  3d  Prussian  Jaegers,  shot  fracture  of  head  and  neck  of  fernur ; 
fatal.  The  cases  referred  to  in  this  note  give  a  total  of  173  cases  with  38  recoveries,  134  deaths  (a  fatality  of  77.9  per  cent.),  and  one  result  unknown. 

1  SMITH  (H.  H.)  (The,  Principles  and  Practice  of  Surgery,  1863,  Vol.  I,  p.  526)  says:  "  The  diagnosis  is  difficult,  as  the  joint  lies  so  very  deep  as 
to  be  almost  beyond  the  reach  of  the  finger.     There  may  be  neither  shortening  of  the  limb  nor  eversion,  and  at  first  the  patient  may  be  able  to  move  the 
limb  without  very  much  pain." 

2  Professor  H.  FISCHER,  of  Breslau,  in  his  Kriegschirurgische  Erfahrungen  Vor  3tetz  (Erlangen,  1872,  p.  201),  remarks  on  the  difficulties  encoun 
tered  in  diagnosticating  wounds  of  the  hip  joint:  "  The  deep  position  of  the  hip  joint,  strongly  protected  by  thick  layers  of  muscles ;  the  generally  long 
wound-canal,  the  termination  of  which  is  so  difficult  to  determine ;  the  absence  of  all  severe  disturbance  of  the  functions  of  the  joint,  and  the  very  trivial 
subjective  complaints  of  the  patient,  render  it  often  impossible  to  determine  precisely  the  lesion  soon  after  the  injury.     All  authorities,  from  LARKEY  and 
GUTHRIE  to  contemporary  surgeons,  agree  in  this.     LEGOUEST  relates  (Chirurgie  d'Armee,  2e  6d.,  1872,  p.  449)  that  a  zouave,  who,  at  the  Alma,  received 
a  shot  in  the  hip,  traversing  from  the  groin  to  the  buttock,  and  completely  fracturing  the  upper  rim  of  the  cotyloid  cavity,  yet  still  walked  about  for  ten 
days,  escaping  all  our  explorations,"  and  adds  that  this  apparent  innocuity  or  benignity  led  into  error  our  young  surgeous  and  the  patients  themselves ;  the 
foimer  not  daring  to  propose,  and  the  latter  utterly  rejecting,  the  sole  means  of  averting  the  almost  inevitably-fatal  termination.     "In  the  case  of  our 
patient  Emmerich,''  Dr.  FISCHER  continues,  "the  ball  had  lodged  in  the  shattered  head  in  the  hip  joint.     He  moved  about  for  some  time  after  the  injury 
and  even  from  one  bed  to  another  a  short  time  before  his  death,  from  syncope.     The  wounded  man,  Henkel,  also  reported  that  he  had  walked  a  consid 
erable  time  on  his  injured  limb.     This  remarkable  insensibility  in  the  hip  joint  immediately  after  shot  injury,  if  one  reflects  on  the  ordinary  painfulness 
at  the  head  of  the  femur  in  coxitis,  appears  to  be  explained  only  by  the  supposition  of  a  contusion-paralysis,  or  direct  severing  of  the  sensory  nerves  of 
the  hip  joint.     In  the  course  of  time  a  view  of  the  injury  generally  becomes  clearer  and  the  diagnosis  easier.     In  Henkel's  case,  the  characteristic  pains 
at  the  knee  joint  set  in,  and  the  local  pains  at  the  hip  joint  were  also  present;  but  with  other  patients  these  highly  important  diagnostic  symptoms 
remained  entirely  absent.     In  Henkel's  case  the  head  of  the  femur  was  intact  and  its  sensibility  therefore  undisturbed.     Profuse  suppuration,  early  septic 
infe«tion  and  prostration,  and  the  necessity  of  making  counter  openings,  always  led  us,  unfortunately  too  late,  to  the  diagnosis.     But  here  the  question 
may  be  asked  of  what  use  is  an  accurate  diagnosis  if  no  help  can  be  rendered  when  attained.     It  is  for  this  reason  that  I  deplore  the  difticulty,  nay, 
impossibility,  of  the  same  so  much,  because  I  believe  that  primary  excision  at  the  hip  would  be  the  best  method  of  treatment  for  shot  fractures  at  the  hip, 
no  matter  ho\v  difficult  the  operation  might  be.     All  later  operative  interference  is  frustrated  by  the  exhaustion  and  septic  infection  <:f  the  patients,  by 
extensive  and  profuse  suppuration,  and  by  phlegmonous  and  gangrenous  processes  in  deep  tissues  about  the  pelvis.'1 

3  Kl.EBS  (E.)  (Beitrdge  zur  Pathologischm  Anatomie  der  Schusswunden.  Leipzig,  1872,  p.  29)  observes:  "The  shot  injuries  of  the  hip  joint  that  1 
uad  occasion  to  observe  had  this  in  common,  that  they  proved  fatal  at  a  comparatively  early  date,  viz:  at  from  thirteen  to  twenty-four  days;  and  also 
.hat  even  in  the  more  protracted  cases  no  vestige  of  a  healing  process  was  apparent.'"    And,  on  page  34,  he  adds:  "As  you  may  surely  depend  upon  the 
fact,  that  in  all  cases  where  the  ball  does  not  perpendicularly  strike  the  spongy  substance  of  the  neck  considerable  fracture,  generally  into  the  joint, 
exists,  and  that  these  fissures,  even  after  four  weeks,  show  no  inclination  towards  reparation  ;  but  that  they  offer  the  most  favorable  conditions  for  infec 
tion,  namely  thrombus  of  the  veins ;  a  cure  without  operation,  according  to  my  judgment,  is  absolutely  not  to  be  expected,  and  the  dictum  of  the  American 
Circular  No.  6,  1865,  S.  61,  in  which,  on  account  of  the  absolute  incurability  of  these  fractures  '  when  abandoned  to  the  resources  of  nature,'  the  excisiou 
of  the  head  of  the  femur  was  recommended,  has  again  been  sadly  confirmed  by  the  experience  of  this  war." 


64  "  INJUEIES   OF   THE    LOWER    EXTREMITIES.  [CHAP.  x. 

period  arrived.  The  dictum  of  Hennen,  cited  at  the  outset  of  this  Section,1  that  the  diffi 
culties  of  early  precise  diagnosis  in  shot  injuries  of  the  hip  joint  are  sometimes  insuperable, 
is  corroborated  by  Dr.  F.  H.  Hamilton2  in  reviewing  the  surgical  experiences  of  the 
American  civil  war,  and  by  Drs.  Billroth3and  Deininger4  in  recording  their  personal  observa 
tions  and  the  contemporaneous  surgical  literature  of  the  Franco-German  War  of  1870-71. 

The  evidence  regarding  shot  injuries  of  the  hip  joint  presented  in  the  annals  of  the 
protracted  American  civil  war  is  numerically  very  imposing;,  yet  attempts  to  analyze  it 
with  a  view  to  learn  the  principles  that  should  govern  the  treatment  of  these  grave  injuries 
are  beset  with  difficulties.  The  abstracts  of  the  individual  cases  are  for  the  most  part 
wanting  in  precision,  still  the  material  must  be  classified  and  consolidated  as  systematically 
as  practicable,  and  permitted  by  the  character  of  the  reports. 

In  the  preliminary  surgical  report  made  by  me  in  1865,  in  Circular  6,  8.  G.  O.,5  at 
page  31,  ninety-seven  cases  of  shot  fractures  involving  the  hip  joint  were  tabulated,  and 
some  of  the  more  remarkable  cases  were  detailed  and  several  were  illustrated  by  drawings. 
In  1867,  in  a  monograph  on  amputations  at  the  hip  joint,6  fifty-three  examples  of  that 
operation  practised  during  the  civil  war  in  America  were  described,  and  seven  cases  were 
narrated  that  resulted  favorably  under  conservative  measures,  although  it  was  alleged, 
though  not  absolutely  demonstrated,  that  the  shot  lesions  described  involved  the  articulation 
at  the  hip.  In  1869,  in  a  report  of  excisions  of  the  head  of  the  femur  for  shot  injury.7  I 
detailed  sixty-three  instances  of  this  operation  performed  during  the  American  civil  war, 
with  minutes  of  a  number  of  doubtful  or  not  well  authenticated  cases;  and  narrated  the 
facts  collected  respecting  two  hundred  and  seventy-four  examples  of  shot  wounds  believed 
to  implicate  the  hip  joint  and  treated  either  by  extracting  fragments  or  by  strictly 
expectant  measures.  In  1871,  in  a  report  on  surgical  cases  treated  in  the  army  of  the 
United  States  from  1865  to  1871,8  the  histories  of  four  examples  of  shot  fractures  mvolv- 

1  HEXXEN  (JOHN)  (Principles  of  Military  Surgery,  2d  ed.,  1820,  p.  155,  cited  in  foot-note  1,  p.  61,  ante.).  He  asserts  emphatically:  "  In  some  of 
these  cases  the  course  of  the  ball  is  so  obscure,  and  its  place  of  lodgement  so  uncertain,  that  it  can  only  be  detected  after  death.  I  have  seen  balls  lodged 
in  almost  every  part  of  the  trochanters,  neck,  and  head  of  the  bone,  and  yet  the  most  accurate  examination  during  Hie  did  not  lead  to  a  discovery  of  their 
situation." 

*  Professor  FliANK  H.  HAMILTOX  (Princ.  and  Pract.  of  Surgery,  1872,  p.  407),  while  regarding  the  results  of  excisions  at  the  hip  as  favorable  in 
comparison  with  those  obtained  in  amputations  at  the  hip  joint,  and  possibly  when  compared  with  the  results  of  the  expectant  plan,  concludes:  "I  see, 
in  the  probable  inaccuracy  of  diagnosis,  in  both  classes  of  cases  many  sources  of  error.  Indeed,  in  my  opinion,  the  surgeon  is  still  justifiable  in  exercis 
ing  a  considerable  amount  of  discretion  as  to  the  course  to  be  pursued.  If,  for  example,  he  has  reasons  to  believe  that  the  comminution  is  not  extensive, 
and  the  patient  is  in  a  favorable  condition  as  to  health ;  if  he  is  neither  very  fat  nor  very  muscular ;  if  the  limb  can  be  kept  at  rest  and  moderate  extension 
continuously  applied,  1  believe  an  attempt  may  be  properly  made  to  save  the  limb  without  excision." 

3BlLl.ROTH  (Tit.)  (Chirurgische  Brief e  aus  den  Kriegx-Lazarethen,  u.  s.  w.,  Berlin,  1872,  S.238).  In  the  foot-note  No.  3,  on  page  20,  of  the  preceding 
Section,  some  of  Professor  l!lU,ROTH's  emphatic  declarations  on  the  occasional  impossibility  of  diagnosticating  direct  shot  injury  of  the  capsule  or  bones 
of  the  hip  joint  have  been  cited.  The  length  of  the  shot  canals  and  the  great  variety  of  direction  in  shot  perforations  of  the  muscular  masses  about  the 
coxo-femoral  articulation,  greatly  modified  by  the  changing  postures  of  the  soldier,  are  great  obstacles  to  satisfactory  explorations,  and,  owing  to  the 
form  of  the  pelvic  bones  and  ligaments,  the  course  of  the  missile  is  very  liable  to  be  deflected.  The  index  finger  is  generally  too  short  to  reach  the 
projectile  or  fracture,  and  a  sound  or  catheter  is  but  a  poor  substitute.  Moreover,  the  surgeon  is  puzzled  by  the  absence  of  symptoms  he  has  been  taught 
were  pathognomonic.  In  none  of  the  cases  examined  by  BILLUOTH  and  C/ERNY  was  found  the  displacement  and  peculiarity  of  position  usually  ascribed 
to  fractures  implicating  the  hip;  and  the  characteristic  intense  pain  in  the  hip  and  knee,  aggravated  on  motion,  was  missing  in  many  instances.  Space 
forbids  further  citations,  but  the  reader  may  profitably  consult  the  comments  of  the  Viennese  professor  on  this  difficult  subject. 

4  DEIXIXGEIC  (lieitrdge  zu  (Jen  Scliusffracturen  des  Huftgelenks,  u.  s.  w.,  in  Deutsche  MiL-drztl.  Zeitschrift,  1874,  Jahrg.  Ill,  p.  237):  ''The  diffi 
culty  of  diagnosing  a  hip  joint  fracture  in  its  first  stages  is  very  great,  and  frequently  it  can  only  be  ascertained  in  the  subsequent  course  whether  the  joint 
is  really  injured,  and,  sometimes,  the  fracture  is  not  ascertained  until  after  death.     For  instance,  in  the  preparation  exhibited  by  TKENIIELKNHUUG  in  the 
Second  Congress  of  the  Deutsche  Gesellschuft  fur  Chirurgie,  the  Langblei  ball  had  comminuted  the  head  and  neck  of  the  left  femur  and  lodged  among 
the  fragments  of  the  head  of  the  bone;  a  slight  fissure  existed  in  the  acetabulum.     The  patient  died  in  consequence  of  purulent  infiltration;  during  life  it 
was  not  possible  to  determine  with  certainty  an  injury  of  the  joint.    The  fragments  had  been  held  together  by  the  periosteum,  and  a  dislocation  was  not 
indicated.    Even  walking  on  the  injured  limb  is  no  proof  that  the  hip  joint  has  not  been  fractured."     Dr.  DEINLXCKU  (I.  c.,  pp.  238  and  245)  refers  to  12 
cases  in  which  the  injured  limbs  could  be  used  for  some  time  after  the  injury,  although  the  autopsy  subsequently  proved  fracture  of  the  joint. 

5  Surgical  Report  of  "  Reports  on  the  Extent  and  Nature  of  the  Materials  available  for  the  Vre.pa.ra.tion  of  a  Medical  and  Surgical  History  of  the 
Rebellion.''   Printed  at  Philadelphia,  1865.    CIRCULAR  No.  6,  War  Department,  Surgeon  General's  Oflice,  Washington,  November  1,  18fi5,  4to,  pp.  88. 

"  A  Report  on  Amputations  at  the  Hip  Joint  in  Military  Surgery.  CIRCULAR  No.  7,  War  Department.  Surgeon  General's  Oflice,  July  1,  1867, 
4to,  pp.  88,  PLATES  9. 

''A  Report  on  Excisions  of  the  Bead  of  the  Femur  for  Gunshot  Injury.  CIRCULAR  No.  2,  War  Department,  Surgeon  General's  Office,  Wash 
ington,  January  2,  1869,  4to,  pp.  142. 

*A  Report  of  Surgical  Cntes  treated  in  the.  Army  of  the  United  States  from  1865  to  1871.  CIRCULAR  No.  3,  War  Department,  Surgeon  General's 
Office,  Washington,  August,  1871,  4to,  pp.  296. 


SECT.  II.J 


WOUNDS    AND    INJURIES    OF    THE    HIP    JOINT. 


65 


ing  the  hip  joint  were  detailed,  one  resulting  fatally  under  expectant  measures,  and  three 
treated  by  formal  excision,  of  which  two  recovered  and  one  had  a  fatal  result. 

Three  hundred  and  eighty-six  cases  of  shot  fracture  directly  involving  the  articular 
sill-faces  at  the  hip  are  found  recorded  in  the  returns  of  the  Union  and  Confederate  armies. 
Though  the  reports  are,  in  many  instances,  very  imperfect,  they  permit  an  approximate 
analysis  of  the  cases  in  TABLE  IX  following,  according  to  the  particular  portion  of  the 
articulation  injured,  and  also  with  reference  to  the  treatment  of  the  cases,  either  by  rest 
and  suitable  position,  with  splints  and  extension  and  other  expectant  measures,  or  by 
freely  incising  the  joint  and  removing,  if  necessary,  fragments  of  bone,  projectiles,  or  other 
foreign  bodies,  cases  numbering  three  hundred  and  four,1  and  grouped  as  treated  by 
conservation;  and  then  follow  two  groups  treated  by  formal  operative  interference,  a  series 
of  fifty-five  cases  of  excisions  at  the  hip,  and  a  series  of  twenty-seven  cases  of  amputations 
at  the  hip. 

TABLE  IX. 

Tabular  Statement  of  Three  Hundred  and  Eighty-six  Shot  Fractures  of  the  Hip  Joint. 


PARTS  INJURED. 

CO 
M 

00 

< 
O 

TREATED  BY  CONSER 
VATION. 

FOLLOWED  BY  EXCIS 
ION  AT  HIP  JOINT. 

FOLLOWED  BY  AMPU 
TATION  AT  HIP  JOINT. 

Cases. 

Recov. 

Died. 

Cases. 

Recov. 

Died. 

Cases. 

Recov. 

Died. 

Acetabulum  without  fracture  of  the  Femur  

11 

:!5 

19 
3 

0 

4 
34 
23 
5 
9 
1 
108 
35 
37 
2 
11 
o 

5 
40 

11 
33 

14 

0 

1 

3 

34 

12 

1 
1 

10 
32 
14 
o 

1 
3 
23 

11 

2 
4 
1 
1 
1 

o 

Aoetabulum,  Head,  and  Nock  of  Femur  

4 

1 
I 

1 

1 

1 

Acetabulum,  Head,  Neck,  and  Trochanter  Major  of  Femur  
Acetabulum   Head,  Neck,  and  Shaft  of  Femur  

A  cetabulum  and  Neck  of  Femur  

11 
1 

Head  and  Neck  of  Femur  

10 
o 

1 

9 
o 

1 
10 
9 
9 

1 
3 

1 

1 
3 
1 

Head,  Neck,  and  Trochanter  Major  of  Femur  

6 

6 

o 

1 

10 
10 
9 

96 
16 
27 
o 

8 
2 

a 

0 

70 
14 
25 

0 

9 
1 

8 
1 

Neck  and  both  Trochanters  of  Fern  ur  .   . 

1 

1? 

Neck  and  Trochanter  Major  of  Femur 

Nock  and  Trochanter  Minor  of  Femur  

1 

7 

1 

1 

o 

1? 

1 

Trochanter  Major,  involving  the  Hip  Joint.  - 

5 

5 

37 

10 

27 

1 

1 

2 

386 

304 

55 

249 

55 

0 

53 

07 

2? 

25 

In  discussing  the  two  series  of  excisions  and  of  amputations  at  the  hip,  eleven  instances 
must  be  added  to  the  first,  and  thirty-nine  to  the  second,  in  which  the  operations  were 
practised  for  shot  fractures  of  the  shaft  of  the  femur  that  did  not  primarily  implicate  the 
hip,  or  for  injuries  of -the  knee  joint,  thus  giving  a  total  of  four  hundred  and  thirty-six 

1  In  Circular  No.  2,  S.  G.  O.,  1869,  from  pages  65  to  106,  two  hundred  and  seventy-four  abstracts  of  shot  wounds  at  the  hip  joint  were  recorded  as 
treated  on  the  expectant  or  conservative  plan,  with  forty-nine  recoveries.  Of  these,  forty-seven,  with  fifteen  recoveries,  are  omitted  from  TABLE  IX.  Of 
this  category  of  forty-seven,  22,  with  7  recoveries  (CASES  165-186,  inclusive,  of  Circular  2,  pp.  90-92),  and  12  cases,  with  2  recoveries  (CASES  187-198, 
inclusive,  of  Circular  2,  pp.  92-94),  are  discarded,  the  former  as  uncomplicated  by  fracture,  and  the  latter  as  examples  of  secondary  traumatic  arthritis. 
These  thirty-four  cases  have  already  been  referred  to  in  SECTION"  I,  at  page  26,  ante.,  under  the  head  of  Peri-articular  Wounds.  Twelve  cases,  with  two 
recoveries  (CASES  216-227,  inclusive,  of  Circular  2,  pp.  96-98),  are  postponed  for  consideration  in  SKCTION  HI,  as  instances  of  fractures  of  the  trochan- 
terio  region,  in  which  the  hip  joint  became  secondarily  involved.  One  case  of  recovery  (CASE  224,  Circular  2,  p.  100)  has  been  transferred  to  a  future 
chapter,  later  information  having  proved  that  the  injury  was  not  inflicted  by  shot.  On  the  other  hand  there  were  added  to  the  cases  summed  up  in  Circu 
lar  2,  66  cases,  with  18  recoveries,  since  discovered  and  not  heretofore  published;  4  cases,  withl  recovery,  already  published  in  the  Second  Surgical 
Volume  (CASES  859,  p.  295,  920,  p.  317,  922,  p.  318,  and  935,  p.  324);  5  cases,  with  1  recovery,  referred  to  in  Circular  2,  but  not  included  in  the  enumerated 
list  (CASES  of  Swanson,  Greenwood,  p.  113,  Scott,  p.  114,  and  CASES  of  Drs.  AVENT  and  BRUNS,  p.  57);  1  case  of  recovery  (CASE  of  Sweeney,  noted  in 
Circular  7,  S.  G.  O.,  1867,  p.  73);  and  1  fatal  case  (Circular  2,  p.  92,  CASE  184),  reported  in  Circular  2  as  a  case  in  which  the  hip  joint  was  involved  but 
uncomplicated  by  fracture.  The  specimen,  since  received  (Specimen  2994,  A.  M.  M.),  conclusively  proves  the  fracture. 
SUKG.  Ill— 9 


66  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

cases  to  be  considered  in  the  three  following  subsections.  If  the  conclusions  deducible 
from  these  numerous  examples  are  in  many  respects  unsatisfactory,  it  may  be  borne  in 
mind  that  the  surgical  experiences  of  the  Six  Weeks'  Prusso- Austrian  War  of  1866,  of  the 
Franco-German  War  of  1870-71,  and  of  the  Russo-Turkish  War  of  1876-77,  have  not 
so  far  proved  more  fruitful  in  results  tending  to  solve  the  difficulties  that  beset  the  subject. 

SHOT  FRACTURES  AT  THE  HIP  TREATED  BY  CONSERVATION.-Three 

hundred  and  four  cases  in  which  shot  wounds  at  the  hip  were  believed  to  have  been 
attended  with  fracture  of  the  articular  surfaces  were  treated  on  the  expectant  plan,1  or 
with  such  incisions  and  removals  of  fragments  or  foreign  bodies  as  was  consistent  with  a 
true  conservative  treatment. 

Five  modern  writers  on  military  surgery,2  the  late  Dr.  H.  Demme,  of  Berne,  Professor 

1  Professor  B.  VON  LANGEXBECK,  in  seeking  for  examples  of  recoveries  after  shot  wounds  of  the  hip  joint  ( Ueber  die  Schussverletzungen  des  Iliift- 
gf.lenks,  in  Archiv  fur  Klin.  C7i.tr.,  1874,  B.  XVI,  p.  265)  finds  none  recorded  prior  to  recent  wars,  "apart  from  a  case  communicated  by  HEXNEX,  in  his 
classical  work  (Observations  on  Some  Important  Points  of  Military  Surgery,  Edinburgh,  1818,  p.  17',!),  and  several  eases  mentioned  by  THOMSON 
(Report  of  Observations  made  in  the  British  Military  Hospitals  in  Belgium,  Edinburgh,  1810,  p.  123)  of  hip  joint  wounds  which  seemed  to  have  pro 
gressed  favorably,  but  were  not  followed  up  to  the  final  issue  ;"  but  it  can  hardly  have  escaped  Professor  LAXGENISECK'S  notice,  in  HEXNEX's  account  of 
his  CASE  XXVII,  of  Spontaneous  Luxation  of  the  Hip  Joint,  that  HEXXEX  says:  "  Whether  the  luxation  in  this  case  was  produced  from  a  primary 
injury  of  the  bone,  or  of  the  cartilages,  and  sebaceous  glands  of  the  joints,  or  from  a  secondary  scrofulous  affection,  it  is  impossible  to  say  with  certainty," 
and  by  no  means  cites  this  instance  of  the  mounted  officer,  wounded  July  22,  1812,  as  an  instance  of  recovery  from  shot  wounds  of  the  hip  joint.  In  a 
later  portion  of  his  work,  Dr.  JOHN  THOMSON  (Report  of  Observations  *  *  after  Waterloo,  Edinburgh,  1816,  p.  275)  observes:  "The  proportion  of 
cures  which  has  been  obtained  from  amputation  at  the  hip  joint  is,  I  believe,  much  greater  than  of  cures  from  gunshot  fractures  of  the  head  or  neck  of  the 
thigh  bone.  Indeed,  of  recoveries  from  these  injuries  I  know  of  none  which  have  been  recorded.  Those  who,  for  a  time,  seem  to  do  well,  in  the  end  sink 
under  the  hectic  which  supervenes.  This  has  been  the  fate,  I  believe,  of  the  two  cases  which  I  have  mentioned  in  the  account  of  injuries  of  the  hip  joint  as 
having  put  on  a  favorable  appearance."  With  such  examples,  the  propriety  of  caution  in  admitting  recoveries  after  shot  wounds  at  the  hip  as  incontestable 
is  apparent.  Dr.  RICHARD  M.  HODGES  ( The  Excision  of  Joints,  Boston,  1861,  p.  94)  observed :  "  The  extent  of  injury,  and  the  condition  of  the  parts  after 
a  gunshot  wound  of  the  hip  joint,  are  as  notoriously  difficult  to  determine  as  the  cases  are  certain  to  terminate  fatally.  Even  when  the  upper  part  of  the 
femur  has  been  shot  through,  shortening,  rotation  outwards,  and  crepitus  are  not  always  present,  and  sometimes  a  very  considerable  power  of  flexion  and 
extension  remains."  After  citing  GUTHUIE's  famous  picture  (Commentaries,  etc.,  6th  London  ed.,  185.5,  p.  77)  of  "a  man  lying  with  a  small  hole  cither 
before  or  behind  in  the  thigh, — with  no  bleeding,  no  pain,  nothing  but  an  inability  to  move  the  limb,  to  stand  upon  if, — and  think  that  he  must  inevitably 
die  in  a  few  weeks,  worn  out  by  the  continued  pain  and  suffering  attendant  on  the  repeated  formation  of  matter  burrowing  in  every  direction,  unless  his 
thigh  be  amputated  at  the  hip  joint,  or  he  be  relieved  by  the  operation  of  excision,  which,  I  insist  upon  it,  ought  first  to  be  performed,"  Dr.  HODGES 
declared  that:  "  By  following  an  expectant  course  and  trusting  to  the  resources  of  nature,  an  almost  invariable  mortality  will  ensue.  A  case  occurring 
at  the  battle  of  Solferiuo,  diagnosticated  as  fracture  of  the  neck  of  the  femur,  and  another  seen  at  Nantes,  in  1830,  by  M.  BOINET,  are  the  only  recoveries 
I  am  aware  of  which  have  followed  gunshot  wounds  of  the  hip  joint."  Dr.  HODGES  refers  to  the  two  exceptional  recoveries  after  Solferino  and  Nantes 
in  L'  Union  Medicale.  28  Juin,  1860.  The  discussion  of  the  Sociite  de  Chirurgie  here  given,  from  p.  605  of  L'  Union  Medicale,  is,  in  that  journal,  errone 
ously  attributed  to  May  30,  1860.  The  discussion  was  on  June  6,  1860,  and  is  correctly  reported  in  the  Bulletin  de  la  Societe  de  Chirurgie  de  Paris,  1861, 
ome  s(ir  _  T.  it  p.  32f>.  The  Solferino  case  refers  to  a  soldier,  wounded  June  24,  1859,  and  presented  before  the  Societe  de  Chirurgie  June  6,  1860,  by  M. 
LEGOUEST.  This  soldier,  after  receiving  shot  wounds  of  the  left  shoulder  and  of  the  neck  of  the  left  femur,  the  latter  ball  entering  anteriorly  and  passing 
out  through  the  sciatic  notch,  entered  the  hospital  at  Cremona.  Numerous  and  largo  splinters  were  extracted.  The  neck  of  the  femur  perfectly  consoli 
dated,  with  three  centimetres  shortening.  M.  BOIXET  mentioned  "a  man  wounded  at  Nantes,  in  1830,  by  a  shot  fracture  of  the  neck  of  the  femur  with 
grave  complications,  now  perfectly  cured,  and  able  to  take  long  walks  notwithstanding  the  anchylosis  that  had  followed  the  accident."  (See  Circular  2, 
S.  G.  O.,  1869.  p.  65.)  Professor  RICHARD  VOLKMAXX  (Die  Resectionen  der  GelenJce,  in  UsSammlung  Klinischer  Vortrdge,  Leipzig,  1873,  No.  51,  p.  301), 
speaking  of  the  American  statistics  of  excision  and  exarticulation  at  the  hip  for  shot  injury,  declares  that  they  "demonstrate  that  after  both  operations  only 
exceptionally  a  patient  survives;  but  that  also,  under  a  purely  conservative  treatment,  the  result  is  invariably  none  better,  on  the  contrary,  rather  still 
somewhat  worse.  The  wounded  with  shot  fractures  of  the  hip  joint  about  nearly  all  perish.  This  is  also  the  experiences  which  we,  who  participated  in  the 
two  last  great  wars,  the  Austro-Prussian  and  Franco-German,  alas,  could  only  confirm.  I  myself  saw  only  fifteen  instances  of  this  injury.  Three  timrs 
I  performed  resection,  twice  after  the  battles  of  Beaumont  and  Sedan,  once  in  Dijon.  All  three  patients  died ;  two,  as  I  believe,  chiefly  from  the  con 
sequences  of  a  coexisting  decubitus ;  in  a  third  an  extensive  comminution  of  the  pelvis  was  found  at  the  resection ;  but  the  remaining,  about  twelve  cases 
treated  conservatively,  also  perished.  Among  them  also  one  in  which  the  head  of  the  femur,  separated  by  the  ball  and  sp'it  in  two  halves,  was  extracted 
by  an  incision  opening  the  joint.  Only  one  patient  I  see  still  now  and  then,  who,  at  Toul.  received  an  undoubted  intracapsular  shot  fracture  of  the  nock 
of  the  femur,  but  which  had  not  been  diagnosticated,  and  who  recovered,  after  exfoliation  of  several  pieces  of  bone  with  relatively  little  shortening,  and 
with  anchylosis  of  the  joint."  LOHMEYEIt  (C.  F.)  (Die  Schusswunden  und  Hire  Behandlung,  Gottingeu,  1859,  S.  198)  remarks:  "An  operation  for  tho 
simplification  of  the  wound,  in  cases  where  the  acetabulum  has  been  crushed,  is  naturally  out  of  the  question  ;  but,  in  cases  of  comminution  of  the  head  or 
neck  of  the  femur  with  injury  of  the  capsule,  one  is  called  upon  to  operate,  as  such  injuries,  without  artificial  help,  uniformly  prove  fatal  after  the  patients 
have  undergone  terrible  suffering."  LOFFLKR  (F.)  (Grundsiitze  und  Regeln  fiir  die  Behandlung  der  Schusswunden  im  Kriege,  Berlin,  1859,  Erste 
Abthciliing,  p.  66), speaking  of  shot  injuries  of  the  hip  joint,  remarks:  "  The  conservative  treatment  of  this  injury,  according  to  the  experience  hitherto 
acquired,  gives  no  prospect  of  saving  life.  Even  if  pyaemia  does  not  supervene,  death  ensues  sooner  or  later  from  exhaustion  following  endless  suppuration." 
With  such  testimony  as  the  foregoing,  together  with  that  of  Drs.  H.  FISCHER  and  E.  KLEBS,  in  the  foot-note  to  page  63,  ante,  we  are  indisposed  to  concur 
in  the  declaration  of  Dr.  SAMTEL  W.  Glioss  (Military  Surgery,  in  Am.  Jour.  Med.  Sci.,  1867,  Vol.  LIV,  p.  447)  that  "those  surgeons  who  pointedly 
condemn  all  efforts  to  save  the  limb  after  gunshot  fracture  of  the  surgical  or  anatomical  neck  of  the  thigh  bone,  exercise,  in  our  judgment,  but  little 
discrimination,  when  they  declare,  as  does  the  surgical  historian  of  tho  late  American  War,  that  'experience  has  demonstrated  the  uniform  fatality  of 
gunshot  fractures  of  the  head  or  neck  of  the  femur  when  abandoned  to  the  resources  of  nature. ' ''  and  that  "no  statement  can  be  farther  from  the  trutli." 
The  compiler  of  the  surgical  report  in  Circular  No.  6,  S.  (i.  O..  1S6.">,  might  have  said  "alum*!  uniform  fatality,"  but  his  statement,  if  lacking  qualifica 
tion,  was  assuredly  not  widely  apart  from  the  truth. 

ZDEMMK  (H.),  Spec.  Chir.  der  Schusswunden,  \VUrzburg,  1864.  S.  348.  Pn:o<;oi-T  (X.),  <lrund:uge  der  Allg.  Krieyschir.,  Leipzig,  1864,  p.  814. 
GROSS  (S.  W.),  Military  Surgery,  in  Am.  Jour.  Med.  Sci.,  1867,  Vol.  LIV,  p.  447.  Sl'lU.MAXX,  Elude  Anal,  et  Crit.  d'un  Rapport  sur  la  Resection  de  la 
Te.te.du  Femur,  Paris.  1870,  Extrait  du  Rcc.  de  Mem.  de  Med.  de  Chir.  i;t  do  Fharm.  Mil..  3"":  s6r.,  T.  XXVIII,  1870,  p.  48.  LANGENBECK  (B.  vox), 
Ueber  die  Schussverletzungen  des  Huftgelenkf.  in  his  Archives  fur  Klin.  Chir..  Berlin,  1874,  B.  XVI.  p.  ~'63.  and  translated  as  Surgical  Obs.  on  Gun-shot 
Wounds  of  the  Hip-Joint,  by  JAMES  F.  WEST,  F.  R.  C.  S.,  in  Birmingham  Med.  Review,  Vol.  V,  1876,  pp.  29,  88,  167. 


SECT,  ii.j  SHOT    FRACTURES    AT    THE    HIP    TREATED    BY    CONSERVATION.  71 

Hospital  on  May  10,  1862.  A  conoidal  musket  ball  had  entered  the  right  groin,  passed  slightly  downward,  traversed  the  line 
of  union  between  thigh  and  trunk,  fractured  the  neck  of  the  femur  in  its  transit,  and  emerged  posteriorly  at  the  fold  of  the  but 
tock.  On  flexing  or  rotating  the  thigh  crepitus  was  plainly  distinguished.  His  limb  was  suspended  by  Smith's  anterior  splint, 
and  this  treatment  was  continued  for  two  months.  The  case  progressed  without  a  single  untoward  symptom,  and  in  the  middle 
of  July,  1862,  consolidation  of  the  fracture  was  sufficiently  firm  to  permit  the  patient's  removal  to  the  house  of  a  friend.  The 
limb  was  shortened  one  and  a  half  inches.  In  October  Captain  Bugh  was  able  to  move  about  on  crutches,  and  the  wounds  were 
entirely  healed.  About  this  time  he  took  a  journey  to  Washington,  and  was  promoted  to  a  lieutenant  colonelcy  in  the  32d  Wis 
consin  and  placed  on  recruiting  service.  He  served  until  April  25,  1863.  His  recovery  was  so  rapid  and  uninterrupted  that  he 
reluctantly  assented  to  the  opinion  of  his  surgeon,  Dr.  Edmund  G.  Waters,  that  he  would  be  incapable  of  active  duty  in  the 
field.  A  letter  was  received  from  Lieutenant  Colonel  Bugh,  dated  June  12,  1867,  more  than  five  years  subsequent  to  his  injury, 
in  which  he  stated  that  he  had  partial  anchylosis  of  the  hip  joint  and  was  unable  to  perform  any  labor  in  a  stooping  posture. 
Otherwise  his  condition  was  satisfactory,  though  he  was  more  readily  fatigued  and  debilitated  than  before  he  was  wounded.  He 
suffered  no  inconvenience  from  the  slight  shortening  of  the  femur.  His  death  occurred  eight  years  afterwards,  on  August  19, 
1875,  of  phthisis  pulmonalis.  Examining  Surgeon  N.  M.  Dodson,  of  Berlin,  Wisconsin,  informed  this  office  on  December  13, 
1878,  that  "  no  post-mortem  was  had  in  the  case  of  Captain  Bugh.  The  wound  healed  in  1866,  and  the  limb  remained  sound 
afterwards.  Bugh  tilled  the  position  of  postmaster,  was  much  upon  his  feet,  and  residing  for  some  years  three-quarters  of  a  mile 
from  the  post  office,  he  walked  to  and  fro  three  times  a  day  with  very  little  inconvenience,  using  only  a  cane.  The  joint  was 
firmly  anchylosed.  He  suffered  from  pain  of  a  neuralgic  character  in  the  whole  limb,  and  at  night  frequently  with  cramps  in  leg 
and  foot." 

CASE  138. — Private  J.  T.  Elliott,  Co.  H,  22d  Georgia,  of  Sorrell's  Brigade,  aged  24  years,  received,  at  the  engagement  at 
Deep  Bottom,  Virginia,  August  16,  1864,  a  gunshot  fracture  of  the  neck  of  the  left  femur.  He  was  conveyed  to  Richmond  and 
admitted  to  the  Jackson  Hospital.  He  recovered  with  three  inches  shortening  of  the  limb,  and  being  permanently  disabled  and 
totally  disqualified  for  any  military  duty,  he  was  retired  from  the  Confederate  States  service  on  February  17,  1865.  The  case 
is  reported  by  Surgeons  A.  J.  Semmes,  Thomas  F.  Maury,  and  W.  D.  Hoyt,  members  of  the  medical  examining  board  of  the 
Jackson  Confederate  Hospital,  at  Richmond,  Virginia,  in  February,  1865. 

CASE  139. — Private  Charles  Miller,  Co.  A,  9th  Illinois,  aged  26  years,  was  wounded  at  the  battle  of  Shiloh,  Tennessee, 
April  6,  1862,  apparently  by  a  small  rifle  ball  entering  at  a  point  midway  between  the  left  trochanter  major  and  the  tuberosity 
of  the  ischium  and  fracturing  the  neck  of  the  left  femur.  He  was  conveyed  to  the  general  hospital  at  Savannah,  and  a  month 
afterward  was  transferred  by  steamer  to  Quincy,  Illinois,  and  admitted  to  hospital  on  May  7th.  An  unsuccessful  search  for  the 
missile  was  made,  and  Buck's  apparatus  was  applied.  The  bone  united  and  the  wound  healed.  He  was  discharged  from  service 
on  October  14,  1862,  having  limited  motion  at  the  hip  joint.  The  case  is  reported  by  Surgeon  R.  Niccolls,  U.  S.  V.  On  April 
7,  1864,  Dr.  John  C.  Hupp,  Pension  Examining  Surgeon  at  Wheeling,  West  Virginia,  stated  that  the  limb  was  shortened  by 
about  two  inches,  a  partial  luxation  of  the  head  of  the  femur  upward  apparently  having  been  produced.  Any  movement  of  the 
thigh  created  severe  pain.  The  cicatrices  were  firm  and  there  were  no  fistulous  orifices.  In  December,  1870,  Examining  Surgeon 
C.  Griswold,  of  Fulton,  Illinois,  reported  :  "  The  ball  entered  posteriorly  through  the  glutei  muscles,  and  fracturing  the  femur  near 
the  socket,  resulted  in  partially  stiffened  joints  both  at  hip  and  knee  of  left  leg.  The  hip  joint  will  admit  of  only  a  little  forward 
motion  and  rotation  outward.  The  knee  joint  allows  only  partial  flexion,  and  cannot  be  crossed  over  the  right  leg  in  a  sitting 
posture.  The  leg  is  shortened  about  one-quarter  of  an  inch.  He  cannot  walk  without  limping."  In  August,  1873,  Examiner  P. 
J.  Farnsworth,  of  Clinton,  Iowa,  stated  :  "  The  bullet  remained  in  for  four  years,  and  was  found  under  the  superficial  fasciae  three 
inches  below  the  wound.  Motion  of  hip  joint  impaired.  Contraction  of  abductor  muscles,  causing  stiffening  and  retraction  of 
knee  joint.  Constant  neuralgic  pain  of  thigh  and  leg,  and  considerable  atrophy  of  muscles.  Thigh  two  inches  less  in  circum 
ference  than  right  at  upper  third.  The  original  disability  has  increased."  On  May  1,  1878,  the  Davenport,  Iowa,  Examining 
Board  reported :  "There  is  shortening  of  the  thigh  to  the  extent  of  three-quarters  of  an  inch,  whence  it  is  inferred  that  fracture 
of  the  upper  portion  of  the  acetabulum,  or  neck  of  femur,  occurred;  there  is  partial  anchylosis  of  the  knee  joint.  The  patient 
walks  with  a  cane  with  considerable  impairment  of  motion." 

CASE  140. — Private  T.  L.  Lomax,  Co.  K,  30th  Virginia,  wounded  at  Antietam,  September  17,  1862,  and  admitted  to  hospital 
No.  5,  Frederick,  on  October  20th.  Dr.  A.  V.  Cherbonnier  communicated,  in  June,  1869,  that  "it  was  supposed,  when  Lomax 
was  admitted  to  hospital,  he  was  merely  suffering  with  a  fracture  of  the  thigh,  high  up,  with  no  accurate  knowledge  of  the 
extent.  He  was  removed  to  a  private  residence,  and  after  removal  his  limb  was  explored  and  a  full  knowledge  and  extent  of 
the  injury  was  ascertained.  The  injury  was  found  to  be  serious,  involving  the  upper  portion,  the  trochanter,  and,  if  I  remember 
correctly,  the  neck.  In  the  presence  and  with  the  assistance  of  Surgeon  H.  S.  Hewit,  U.  S.  V.,  and  Assistant  Surgeon  J.  H. 
Bill,  U.  S.  A.,  I  removed  all  the  fragments  of  bone,  and  with  the  gouging  forceps  removed  a  considerable  portion  of  dead  and 
rough  bone.  The  operation  was  repeated  a  couple  of  weeks  after.  The  whole  of  the  trochauter  major  was  removed,  going  deep 
into  the  shaft,  and  leaving,  if  I  remember  correctly,  but  a  shell  of  bone.  When  I  left  Frederick  I  had  the  satisfaction  of  seeing 
young  Lomax  on  crutches.  I  cannot,  with  no  notes,  do  justice  to  what  I  consider  a  most  interesting  case,"  etc.  Surgeon  Hewit, 
in  a  note  dated  July  26,  1869,  stated:  "It  was  a  case  of  comminution  of  the  hip.  Three  secondary  operations  by  gouging  were 
performed  by  myself,  in  which  nearly  all  the  head,  neck,  and  trochanteric  portion  of  the  femur  were  removed.  He  subsequently 
made  a  good  recovery."  Dr.  G.  Johnson,  of  Frederick,  subsequently,  on  October  21,  1869,  furnished  the  following  details  of 
the  case:  "  Mr.  Lomax  was  wounded  in  the  left  hip.  The  ball  struck  the  femur,  shattering  it  by  his  account,  but  producing  no 
solution  of  the  continuity.  He  remained  in  the  temporary  hospital  near  the  battle-field  for  weeks,  was  then  brought  to  Frederick, 
and  on  October  31st  was  transferred  to  a  private  residence  and  came  under  my  charge.  His  strength  at  this  time  was  gradually 
succumbing  to  profuse  suppuration  and  pain,  and  although  he  rallied  somewhat  at  first  by  the  change  of  circumstances  and 
improved  hygiene,  it  soon  became  apparent  that  surgical  interference  was  demanded  to  arrest  the  downward  tendency.  Until 
this  time  his  only  treatment  had  been  the  abstraction  of  detached  pieces  of  bone,  detergent  washes  to  the  wound,  and  anodynes 
and  tonics.  Carious  bone  in  considerable  extent  being  evident  to  the  probe,  it  was  determined  to  attempt  its  removal,  and  on 


72  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

November  15th  Drs.  Hewit  and  Charbonnier  operated  for  that  purpose,  under  chloroform.  A  large  quantity  of  diseased  bone 
was  removed  from  the  outer  part  of  the  upper  third  of  the  femur.  There  was  but  trifling  haemorrhage,  but  ranch  depression  and 
irritability  of  stomach  succeeded  the  operation,  yielding,  however,  in  a  few  days,  to  stimulants  and  effervescing  draughts.  For 
a  fortnight  the  patient  steadily  improved  under  nourishing  diet  and  tonics.  He  then  again  began  to  deteriorate  under  increasing 
suppuration,  and  On  December  15th  it  was  determined  to  again  operate  for  the  removal  of  diseased  bone.  This  was  accordingly 
done  on  that  day  by  Dr.  Hewit,  the  patient  being  under  chloroform.  The  great  trochanter  and  about  two-thirds  in  circumference 
of  the  shaft  of  the  femur  were  removed  for  several  inches.  The  depression  consequent  was  not  so  great  as  before,  but  on 
December  17th  congestion  of  the  right  lung  occurred,  with  expectoration  of  a  quantity  of  typhoid  pneumonic  sputa.  I  painted 
the  chest  thoroughly  with  iodine  tincture,  and  gave  hydrochlorate  of  ammonia,  with  milk  punch  and  animal  soup.  No  consolidation 
of  the  lung  occurred,  and  after  a  few  days  his  chest  gave  no  further  trouble.  I  will  not  weary  you  with  a  detailed  account  of 
his  symptoms  and  treatment  during  the  four  months  ensuing.  There  was  at  no  time  any  inflammation  of  the  hip  joint.  Erysip 
elas  twice  gave  much  trouble,  as  also  the  usual  disposition  in  such  cases  to  form  purulent  sinuses.  On  January  23,  1863,  I 
noted  hard  and  excessive  swelling  of  the  limb,  with  grave  constitutional  disturbance  attributed  to  lymphatic  inflammation,  and 
after  this  subsided  much  oedematous  infiltration.  Pieces  of  carious  bone  became  from  time  to  time  detached,  and  were  removed 
as  soon  as  detected;  the  feeble  circulation  was  supported  by  careful  bandaging;  the  wound  was  kept  thoroughly  clean  and  his 
hygiene  perfect.  He  took  exercise  in  the  open  air  in  carriage  and  on  crutches  as  soon  as  strength  permitted,  and  in  May  was 
quite  convalescent.  June  8th,  he  left  Frederick  for  exchange,  still  on  crutches  and  wound  discharging  slightly,  but  looking 
healthy — almost  robust.  A  year  after,  he  wrote  that  he  was  perfectly  well  and  walked  comfortably  with  a  cane.  In  mentally 
reviewing  this  case  some  points  of  interest  occur  to  me :  As  to  the  cause  of  so  extensive  a  caries — this  was  a  true  bone  ulcer. 
The  several  operations  did  not  consist  of  merely  removing  sequestra  or  detached  portions  of  dead  bone,  but  in  paring  and  pinching 
off  the  diseased  bone  from  that  which  was  still  sound.  The  ulceration  was  progressive.  The  second  operation  was  more  extensive 
than  the  first  and  at  a  month's  interval.  These  facts  are  consistent  with  the  theory  (suggested,  I  think,  by  Dr.  Hewit)  that  the 
caries  depended  upon  osteitis,  and  this  probably  caused  by  the  peculiar  velocity  with  which  the  minie  ball  strikes.  The  amount 
of  callus  effused  after  the  final  operation  was  immense,  fully  equalling  the  new  bone  of  a  prolonged  case  of  necrosis,  and  soon 
allaying  the  fear  at  first  felt  of  fracture  of  the  continuity  of  the  bone  through  muscular  action  or  otherwise.  As  regards  the 
statistical  value  of  the  case  it  ended  well ;  but  after  an  illness  in  which  his  life  was  in  extreme  jeopardy  several  times,  and  under 
circumstances  rarely  attainable  in  private  practice,  and  I  should  think  impossible  in  military  life.  The  patient  had  full  advantage 
of  every  circumstance  that  affection  could  prompt  and  pecuniary  means  procure.  He  was  in  the  prime  of  life  and  entirely  free 
from  constitutional  taint.  He  was  free  from  depressing  influences  of  every  kind,  while  in  his  medical  and  surgical  treatment  I 
had  the  counsel  and  assistance  of  scientific  and  thoroughly  experienced  men.  Among  them,  both  he  and  I  are  under  lasting 
obligations  to  Dr.  Hewit,  to  whose  operative  skill,  no  less  than  to  his  humanity  in  permitting  his  removal  from  hospital,  is  due 
whatever  credit  may  pertain  to  the  issue  of  the  case."  The  bone  removed  at  the  two  operations  referred  to  consists  of  a  number 
of  fragments,  and  was  subsequently  contributed  to  the  Museum  by  Dr.  Johnson,  and  constitutes  Spec.  5652  of  the  Surgical  Section. 

CASE  141. — Private  M.  M.  Phillips,  Co.  F,  42d  Mississippi,  aged  23  years,  was  wounded  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  3,  1863,  by  a  musket  ball,  which  entered  the  posterior  and  outer  aspect  of  the  left  buttock,  fractured  the 
neck  of  the  femur,  and  emerged  in  the  left  groin.  He  was  captured  and  removed  to  the  hospital  for  Confederates,  and  was 
treated  by  the  expectant  plan.  On  July  22d  he  was  transferred  by  rail  to  the  De  Camp  Hospital,  in  New  York  Harbor.  The 
wounds  of  entrance  and  exit  had  healed.  He  was  able  to  walk  by  the  aid  of  a  crutch  or  cane  and  suffered  no  pain.  The  limb 
was  shortened  one  and  three-quarter  inches.  By  flexing  and  rotating  the  limb  true  osseous  crepitus  was  obtained.  There  was 
no  inversion  or  eversion.  The  patient,  much  against  his  will,  was  placed  upon  a  fracture-bed,  where  extension  was  produced 
for  six  weeks  by  a  twelve-pound  weight  acting  over  a  pulley.  He  was  then  permitted  to  rise  and  directed  to  use  passive  motion 
and  friction.  On  September  20,  1863,  he  was  paroled,  being  able  to  walk  without  assistance  of  any  kind.  The  limb  was  short 
ened  one  and  a  quarter  inches.  The  case  is  reported  by  Acting  Assistant  Surgeon  George  Edwards. 

Iii  the  next  case,  as  in  the  case  of  Private  Charles  Miller  (CASE  139,  page  71),  partial 
anchylosis  of  the  knee  joint  had  supervened  many  years  after  the  injury: 

CASE  142. — Private  James  Vanderbeck,  Co.  F,  145th  New  York,  aged  21  years,  was  wounded  at  the  battle  of  Chancellors- 
ville,  May  3, 1863,  by  a  conoidal  musket  ball,  which  entered  the  left  thigh  above  and  behind  the  trochanter  major,  passed  forward 
and  inward,  fractured  the  neck  of  the  femur,  and  made  its  exit  at  the  groin.  He  was  made  a  prisoner  and  remained  in  the  hands 
of  the  enemy  eleven  days.  He  was  then  exchanged  and  conveyed  to  the  Twelfth  Corps  Hospital,  at  Aquia  Creek.  The  injured 
limb  was  simply  placed  in  a  comfortable  position  without  any  attempt  at  extension.  On  June  14th  the  patient  was  removed  on 
a  hospital  transport  to  Alexandria  and  placed  in  the  First  Division  Hospital.  He  was  in  good  condition.  The  suppuration  was 
comparatively  slight,  and  no  bone  splinters  were  found  loose  and  none  had  come  away.  Three  days  subsequently  he  was  trans 
ferred  to  Philadelphia,  and  thence,  on  October  12th,  to  New  York,  where  he  was  admitted  to  the  Ladies'  Home  Hospital.  The 
wounds  were  closed  at  this  date.  The  patient  was  discharged  from  the  hospital  and  from  the  service  of  the  United  States  on 
November  19,  1863.  On  that  date  he  walked  with  crutches.  His  limb  was  shortened  two  inches,  with  eversion.  He  was  allowed 
a  pension.  On  August  2,  1866,  Dr.  E.  Bradley,  Examining  Surgeon  of  the  Pension  Bureau,  reported  that  Vanderbeck's  general 
health  was  good,  but  that  there  was  much  lameness.  The  fracture  was  firmly  consolidated.  Commissioner  C.  C.  Cox  reports 
that  Vanderbeck  received  his  pension  at  the  agency  in  New  York  City  on  March  4,  1868,  and  that  his  disability  was  then  rated 
by  the  examining  surgeon  as  total.  On  September  9,  1873,  Examining  Surgeon  T.  F.  Smith,  of  New  York  City,  states:  "Ball 
entered  left  nates  and  emerged  beneath  left  popliteal  ligament,  fracturing  the  femur;  there  is  union  with  deformity  and  three  inches 
shortening."  On  September  7, 1875,  the  New  York  Examining  Board,  Surgeons  T.  F.  Smith,  J.  F.  Ferguson,  and  M.  K.  Hogan, 
report  "that  the  knee  is  anchylosed  and  the  patient  is  obliged  to  wear  a  sole  on  his  shoe  three  inches  thick,  and  to  walk  with  a 
cane ;  the  leg  is  useless  for  purposes  of  labor." 


SECT.  II.]  SHOT    FRACTURES    AT    THE    HIP    TREATED    BY    CONSERVATION.    •  73 

CASE  143. — Private  T.  C.  Garvin,  Co.  H,  94th  New  York,  aged  43  years,  was  wounded  at  Hatcher's  Run,  February  7, 
1865,  and  admitted  to  the  field  hospital  of  the  3d  division,  Fifth  Corps.  Surgeon  D.  C.  Chamberlain,  94th  New  York,  noted : 
"Gunshot  wound  of  genitals."  Four  days  after  the  reception  of  the  injury  the  man  was  admitted  to  the  Newton  University 
Hospital,  Baltimore,  whence  Surgeon  R.  W.  Pease,  U.  S.  V.,  reported:  "  Gunshot  wound  of  penis  and  right  testicle,  ball  emerging 
from  right  gluteal  region,  fracturing  the  femur."  In  a  case  book  it  is  recorded  that  Buck's  apparatus  and  counter- extension 
were  used,  also  that  there  was  free  suppuration  from  the  wound,  and  that  evidence  of  union  of  the  bone  set  in  about  March  10th. 
Assistant  Surgeon  D.  C.  Peters,  U.  S.  A.,  reported  that  the  patient  was  admitted  to  Jarvis  Hospital  May  23d,  and  described  the 
injury  as  follows:  "Gunshot wound  of  penis,  right  testicle,  and  fracture  of  femur  involving  the  neck.  Urine  escapes  through 
the  lower  opening  of  the  penis.  He  had  some  union  of  limb,  with  about  three  inches  shortening."  The  patient  was  discharged 
from  service  June  11,  1865,  and  pensioned.  Examiner  G.  \V.  Cook,  of  Syracuse,  New  York,  certified,  April  25,  1866:  "Bullet 
struck  the  glans  penis,  passing  downward  and  backward  through  the  urethra,  producing  hypospadia,  through  which  the  urine 
is  voided,  thence  into  the  right  testicle,  which  is  destroyed,  thence  into  the  right  thigh,  fracturing  the  same."  The  pensioner  died 
January  3,  1869.  Dr.  A.  Welch,  his  attending  physician,  certified  that  "to  the  time  of  his  death  Garvin  was  laboring  under 
severe  pain  and  difficulty  from  a  wound  which  he  received  in  the  hip  of  the  right  side,  passing  through  the  joint  and  through 
the  testicle,  destroying  the  hip  joint,  and  producing  shortening  of  the  limb,  and  an  open  wound  from  which  pus  and  portions  of 
the  joint,  consisting  of  splinters  of  bone,  were  discharged  to  the  time  of  his  death." 

CASE  144. — Corporal  Daniel  Bachler,  Co.  G,  82d  Illinois,  aged  23  years,  was  wounded  in  the  battle  of  Chancellorsville, 
Virginia,  May  2, 1863,  by  a  round  ball,  which,  entering  just  above  the  right  trochanter  major,  fractured  the  neck  of  the  femur,  and 
emerged  beneath  Poupart's  ligament  about  two  inches  from  the  symphysis  pubis.  He  stated  that  he  lay  thirteen  days  on  the 
plank  road  unattended.  He  was  admitted  May  15th  to  the  field  hospital  of  the  3d  division,  Eleventh  Corps,  and  was  transferred 
thence,  by  steamer,  to  Alexandria,  and  admitted  May  25th  into  the  First  Division  Hospital.  The  patient  had  been  informed 
that  the  wound  involved  the  soft  parts  only;  cold-water  dressings  had  been  applied.  The  limb  was  shortened  about  three  inches. 
A  fracture  through  the  neck  was  discovered.  Partial  union  had  taken  place.  There  was  little  suppuration  and  the  pus  was 
healthy ;  the  parts  were  but  little  swollen.  Smith's  anterior  splint  was  applied  and  moderate  extension  made  by  weight  and  pulley. 
He  was  furloughed  on  July  14th  for  sixty  days,  and  went  to  Chicago,  Illinois.  On  September  10th  Bachler  was  received  into  the 
City  General  Hospital  in  Chicago.  A  gunshot  wound  of  the  right  hip  joint  was  recorded.  He  was  transferred  to  the  2d  bat 
talion  of  the  Veteran  Reserve  Corps  on  August  7,  1864.  The  case  is  reported  by  Surgeon  Norman  S.  Barnes,  U.  S.  V.  The 
patient  was  discharged  on  July  15,  1865.  The  Chicago  Examining  Board,  Drs.  Wm.  C.  Lyman,  E.  D.  F.  Roler,  and  F.  A. 
Emmons,  report  on  September  10, 1873 :  "  The  pensioner  was  shot  through  the  hip  close  to  the  joint;  there  was  loss  of  some  small 
pieces  of  bone,  and  half  an  inch  shortening  of  the  limb."  On  April  3,  1878,  the  Board  state:  "There  is  partial  loss  of  flexion 
and  of  power  of  leg,  with  neuralgic  pains;  the  neuralgia  is  increasing." 

CASE  145. — Private  James  McCabe,  Co.  A,  12th  Massachusetts,  was  wounded  on  September  17,  1862,  at  the  battle  of 
Antietam,  by  a  musket  ball,  which  entered  just  below  the  right  groin  and  made  its  exit  at  the  buttock,  fracturing  the  neck  of  the 
femur  in  its  passage.  He  was  conveyed  to  hospital  No.  5,  at  Frederick,  Mai-yland,  and  was  treated  with  the  limb  in  an  extended 
position.  On  November  9th  he  was  transferred  to  Frederick  Hospital  No.  1.  In  December  a  large  metastatic  abscess  formed  about 
the  right  shoulder,  which  was  laid  open  by  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  a  large  quantity  of  pus  escaping.  After  the 
healing  of  the  abscess  there  was  much  Aveakness  of  the  muscles  of  the  acromial  and  humeral  region,  and  the  patient  could  not 
raise  his  hand  above  his  chin.  On  June  16th  he  was  sent  in  good  condition  to  the  Jarvis  Hospital  at  Baltimore,  and  thence  to 
Point  Lookout  Hospital,  where  he  remained  until  July  25,  1864,  when,  the  wound  being  healed,  he  was  discharged.  He  was 
mustered  out  of  service  August  5,  1864.  On  June  10,  1887,  he  was  examined  at  the  office  of  Surgeon  General  Dale,  of  Massa 
chusetts.  The  fracture  was  firmly  consolidated.  There  was  but  a  slight  limp  in  walking.  His  general  health  was  excellent. 
He  received  a  pension  and  was  employed  in  the  Soldiers'  Messenger  Corps.  He  experienced  no  pain,  except  on  change  of 
weather  or  when  his  walk  was  extended  beyond  two  miles.  He  considered  his  injury  but  a  slight  disability  in  his  business, 
since  he  had  free  passes  on  all  the  lines  of  horse  cars  in  Boston. 

CASE  146. — Sergeant  Edward  G-.  Gilliam,  Co.  C,  llth  Virginia,  aged  24  years,  was  wounded  in  the  engagement  at  Drury's 
Bluff,  Virginia,  May  16,  1864,  by  a  rifle  ball,  which,  entering  the  upper  portion  of  the  right  thigh  in  front,  fractured  the  neck  of 
the  femur,  and  lodged.  He  was  conveyed  the  same  day  to  Richmond  and  admitted  into  Chimborazo  Hospital.  There  was  ever- 
sion  of  the  limb,  but  no  shortening.  On  placing  the  finger  upon  the  seat  of  fracture  and  rotating  the  thigh  it  was  observed  that 
the  trochanter  major  moved  with  the  shaft.  There  appeared  to  be  but  little  comminution,  and  there  was  no  escape  of  synovial 
fluid.  The  parts  were  but  little  tumefied.  The  limb  was  comfortably  adjusted  on  pillows.  The  patient  complained  of  severe 
pain  in  the  thigh,  especially  along  its  inner  aspect,  and  had  frequent  twitchings  of  the  muscles.  The  pulse  was  80,  the  tongue 
clean,  the  appetite  poor.  Half  an  ounce  of  whiskey  was  directed  every  fourth  hour,  and  a  nourishing  diet,  with  one-third  of  a 
grain  of  morphine  given  at  bedtime.  During  the  latter  part  of  May  there  was  severe  local  pain,  with  rapid  emaciation,  and  a 
bed-sore  formed  over  the  sacrum.  On  June  15th  the  limb  was  swung  in  a  Smith's  anterior  splint.  The  patient's  appetite  soon 
began  to  improve,  the  pulse  about  96.  On  June  27th  he  yet  suffered  severe  pain  in  the  hip  and  along  the  inner  part  of  the 
thigh.  On  July  1st  synovial  fluid  in  large  amount  issued  from  the  wound,  after  which  the  pain  subsided.  His  appetite  continued 
to  improve,  and  he  now  slept  well  at  night.  One  or  two  small  spiculae  of  bone  were  eliminated  in  the  discharges.  On  July  10th 
he  was  stronger  and  had  no  pain  ;  the  bed-sore  was  healing;  the  discharge  from  the  wound  was  small  in  quantity,  and  the  oedema 
was  disappearing.  For  several  days,  about  July  20th,  lie  suffered  pain  at  the  knee,  and  the  splint  was  removed.  On  July  30th 
the  bed-sore  was  healed  and  his  health  was  greatly  improved;  but  any  movement  of  the  hip  joint  continued  to  create  severe  pain. 
By  August  10th  he  had  become  stout  and  fleshy  and  could  suffer  the  limb  to  be  moved,  and  August  22d  it  could  be  moved  freely 
without  producing  pain.  At  this  date  a  small  spicula  of  bone  was  removed.  There  was  only  a  slight  discharge  from  the  wound. 
On  September  5th  he  was  able  to  raise  the  limb  a  short  distance  from  the  bed,  and  September  14th  he  sat  up  in  a  chair.  There 
was  limited  motion  of  the  hip  joint.  He  was  furloughed  for  sixty  days  on  September  20, 1864.  The  case  is  reported  by  Surgeon 
E.  M.  Seabrook,  C.  S.  A. 
SURG.  Ill— 10 


74  INJURIES    OF    THE    LOWER   EXTREMITIES.  [CHAP.  x. 

CASE  147. — Surgeon  B.  W.  Avent  reports  that  au  officer  received  a  gunshot  fracture  of  the  ueck  of  the  femur;  two  fingers 
at  entrance  and  exit  fully  explored  the  wound;  date  of  injury  unknown.  The  wound  was  dilated  at  entrance  and  spiculse  was 
removed  with  saw  and  forceps.  He  lingered  for  months,  but  finally  recovered  with  a  limb  four  inches  short,  but  able  to  walk 
with  the  assistance  of  a  cane. 

CASE  148. — Private  R.  Yerger,  Co.  I,  llth  Pennsylvania,  aged  31  years,  was  wounded  at  Antietam,  September  17,  1862, 
and  entered  the  Broad  and  Cherry  Streets  Hospital,  Philadelphia,  on  December  12th.  Surgeon  J.  Neill,  U.  S.  V.,  reported: 
"He  was  admitted  to  this  hospital  with  an  undetected  fracture  of  the  neck  of  the  right  femur.  A  minie  ball  entered  on  the  front 
of  the  thigh  on  a  vertical  line  with  the  anterior  superior  spinous  process  of  the  ilium  and  four  inches  below  it,  and,  passing 
obliquely  upward  and  backward,  was  cut  out  on  a  line  with  and  about  two  inches  below  the  posterior  superior  spinous  process 
by  the  surgeon  of  the  regiment  on  the  field.  At  the  time  of  his  admission  the  wound  had  entirely  healed,  but  the  patient  was 
unable  to  bear  weight  on  the  limb  without  pain.  The  tissues  over  and  above  the  trochanter  were  flattened,  and  the  fold  in  t&<i 
buttock  was  absent.  Rotation  was  imperfect,  and  when  an  attempt  was  made  to  bear  weight  on  the  limb  distinct  crepitus  could 
be  felt  in  the  neck  of  the  bone,  and  he  complained  of  pain  at  that  point.  Measurement  from  the  xiphoid  cartilage  revealed  two 
and  a  half  inches  shortening  of  the  injured  side,  and  from  the  anterior  superior  spinous  process  of  the  ilium  it  was  three-fourths 
of  an  inch.  The  fracture  appeared  to  be  impacted,  and  the  whole  of  the  right  innominate  bone  was  considerably  elevated  above 
its  normal  position.  The  posterior  superior  spinous  process  of  that  side  was  also  more  prominent  than  that  on  the  other  side, 
giving  the  idea  that  the  sacro-iliac  symphysis  had  been  injured  and  in  that  way  accounting  for  the  marked  amount  of  shortening 
by  measurement  from  the  xiphoid  cartilage.  He  stated  that  when  shot  he  fell,  the  right  hip  striking  the  ground,  and  any  attempt 
to  move  the  limb  gave  rise  to  severe  pain  in  the  hip  joint;  also  that  the  surgeon  told  him  it  was  only  a  flesh  wound  and  would 
soon  be  well.  He  remained  in  a  field  hospital  for  nine  days,  when  he  was  removed  to  Chambersburg  and  treated  for  nine  weeks, 
during  which  time  he  was  allowed  to  get  up  to  go  to  stool.  The  wound  healed  about  two  weeks  before  admission  to  this  hospital. 
No  fragments  of  bone  were  removed;  crepitis  is  not  so  distinct,  and  his  general  condition  is  good.  The  amount  of  shortening 
from  the  anterior  superior  spinous  process  has  increased  from  three-fourths  to  a  full  inch  since  admission."  The  patient  was  dis 
charged  from  service  April  27,  1863,  and  pensioned.  Examiner  J.  J.  McCormick,  of  Irwin  Station,  Pennsylvania,  certified, 
September  5,  1873:  "Ball  entered  right  thigh  in  front  of  trochanter  major  and  came  out  one  inch  from  lower  end  of  sacrum, 
fracturing  the  neck  of  the  femur.  The  limb  is  two  and  one-half  inches  shorter  than  the  other;  strength  so  much  impaired  that  he 
cannot  walk  without  a  cane.  Muscles  of  limb  are  atrophied."  In  an  examination  for  increase  of  pension,  in  April,  1880, 
Examiner  McCormick  reports:  "There  is  great  impairment,  of  the  strength  and  usefulness  of  the  limb.  The  pensioner  cannot 
work  at  all,  nor  can  he  set  on  a  chair  except  a  little  on  the  left  hip.  The  injury  is  nearly  equivalent  to  the  loss  of  the  limb." 

In  five  instances  of  recovery  after  alleged  shot  fracture  of  the  hip  joint  the  "neck 
and  trochanters"  or  "the  neck  and  shaft"  of  the  femur  were  reported  to  have  been  frac 
tured.  Three  of  the  cases1  are  here  given  in  detail: 

CASE  149. — C.  F.  Beyland,  Q.  M.  D.,  aged  26  years,  was  wounded  December  8,  1861,  by  a  conoidal  musket  ball,  which 
fractured  the  great  trochanter  and  neck  of  the  right  femur.  Excision  was  proposed  and  refused.  The  fracture  was  treated  by 
Hagedorn's  apparatus.  After  protracted  and  profuse  suppuration  the  patient  recovered  with  a  limb  shortened  two  inches.  In 
July,  1863,  he  had  dispensed  with  crutches  and  walked  quite  well.  Assistant  Surgeon  C.  K.  Winne,  U.  S.  A.,  reported  the  case. 

CASE  150. — Corporal  Luke  English,  Co.  E,  2d  Wisconsin,  aged  21  years,  was  wounded  at  the  battle  of  Gettysburg,  Penn 
sylvania,  July  1, 1863,  by  a  conoidal  musket  ball,  which  entered  at  a  point  between  the  left  trochanter  major  and  the  tuberosity  of 
the  ischium,  emerging  near  the  anus,  penetrated  the  right  thigh  and  fractured  its  trochanters,  and  lodged.  He  was  admitted  the 
next  day  into  the  Seminary  Hospital  at  Gettysburg.  Search  for  the  missile  was  unsuccessful.  Two  fragments  of  bone  were 
extracted.  Cold-water  dressings  were  applied.  On  July  17th  he  was  transferred  by  railroad  to  York  Hospital.  Early  in 
August  the  average  discharge  of  pus  was  about  four  ounces.  The  wound  of  entrance  had  nearly  closed.  On  November  4th  he 
could  walk  a  little,  the  wound,  however,  discharged  considerably.  He  was  discharged  from  the  service  of  the  United  States  on 
June  23,  1864.  Surgeon  Henry  Palmer,  U.  S.  V.,  reports  the  case.  His  attorney,  John  Hancock,  of  Oshkosh.  Wisconsin, 
reports  that  English  died  in  1867. 

CASE  151. — Private  Philip  Sweeney,  Co.  C,  3d  New  York,  was  wounded  in  the  affair  at  Big  Bethel,  June  10,  1861,  by  a 
conoidal  musket  ball,  which  shattered  the  trochanters  of  the  right  femur.  He  was  admitted  to  Hygeia  Hospital,  Fort  Monroe, 
on  June  13th,  and  was  treated  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  by  moderate  extension  and  dilatation  of  the  wound  by 
sponge  tents  in  order  to  facilitate  the  extraction  of  primary  sequestrse,  of  which  many  were  removed.  Suppuration  and  exfolia 
tion  persisted  until  March,  1862.  In  April  there  were  two  severe  attacks  of  erysipelas,  involving  the  entire  limb,  which  greatly 
reduced  the  patient,  but  he  quickly  rallied,  and  in  May  was  able  to  run  a  race  on  crutches  with  his  wounded  companions.  He 
was  transferred  to  Albany  in  June,  1862;  but  his  name  does  not  appear  upon  the  hospital  reports  until  March,  1863.  when  he 
was  admitted  to  the  Ladies'  Home,  in  New  York  City,  where  a  number  of  necrosed  fragments  were  removed.  On  May  25, 1863, 

1  The  remaining  two  cases  were:  1.  Serg't  P.  Casserleigh,  A,  38th  Illinois;  Chickamauga,  Sept.  19,  1863:  eonoidal  ball  entered  behind  the  right 
great  trochanter,  passed  inward  and  forward,  fractured  the  apophysis,  and,  it  was  believed,  injured  the  anterior  crural  nerve.  It  was  considered  possible, 
though  not  probable,  that  the  joint  was  injured.  He  was  discharged  July  11,  1863.  Examiner  T.  S.  HEXING,  of  Springfield,  reported,  in  May,  1865, 
that  a  ball  entered  the  right  hip  a  little  posterior  to  the  great  trochanter,  passed  into  the  hip  and  remained  concealed  in  the  tissues ;  limb  one  and  a  half 
inches  shortened ;  motion  and  power  of  joint  destroyed ;  and  in  November,  1866,  that  "  the  ball  fractured  the  head  and  neck  of  the  femur."  The  Springfield 
Examining  Board  reported,  in  August,  1874:  "Thelimbisanchylosed  in  a  semiflexed  position  and  shortened  four  inches  (Circ.%,  p.  94,  CASE  201). — 2.  Pt.  T. 
Purcell,  F,  96th  Pennsylvania,  aged  22;  Chancellorsville,  May  3,  1863;  a  conoidal  ball  was  stated  to  have  produced  a  fracture  of  left  femur  in  upper 
third,  extending  into  hip  joint.  From  a  field  hospital  of  the  Sixth  Corps  he  was  transferred  to  Armory  Square  Hospital,  Washington,  and  subsequently 
to  Cuyler  Hospital,  Gerrnantown,  Pennsylvania.  No  mention  was  made  at  either  of  the  latter  hospitals  of  the  involvement  of  the  hip  joint.  At  Mower 
Hospital,  Philadelphia,  the  injury  was  noted  as  a  "gunshot  wound  of  upper  third  of  left  thigh  with  loss  of  four  inches  of  bone."  He  was  discharged 
July  8,  1865.  Examiner  J.  T.  CARPENTER,  of  Pottsville,  reported,  in  September,  1873 :  "  Entrance  of  wound  about  four  inches  below  anterior  superior 
spinous  process  of  ilium,  upper  third  of  femur  shattered ;  five  inches  shortening;  no  power;  wasting  of  limb."  (Circ.  2,  p.  95,  CASE  211.) 


.H-  Surg.  UieU.uf'  the  War  oT  the  Rebellion,  Part  ill  Vol.11. 


PLATE    XXXIII.  CONSOLIDATED    GUNSHOT    FRACTURE  OF   THE    FEMUR 
Case  of  Private  Pltilip  Sweeny,  3r<?  X*wYork  Volunlrers  . 


SECT.  II!  SHOT    FRACTURES    AT    THE    HIP    TREATED    BY    CONSERVATION.  75 

he  was  discharged,  being  able  to  walk  without  a  crutch  and  the  limb  being  but  slightly  shortened.  He  soon  afterwards  engaged 
himself  as  a  laborer  at  an  iron  foundry  in  Troy,  New  York,  where  he  has  since  worked  without  intermission.  On  July  20,  186G. 
he  was  examined  by  Brevet-Colonel  R.  B.  Bontecou,  who  found  him  in  perfect  health,  the  injured  limb  a  trifle  shortened,  and 
the  knee  rather  stiff,  owing  to  the  destruction  of  connective  tissue  about  the  extensor  muscles  of  the  thigh  during  the  suppura 
tion  following  the  erysipelatous  attacks,  and,  doubtless,  the  formation  of  adhesions.  The  knee  joint  was  in  good  condition  and 
had  sufficient  motion  to  allow  a  firm,  good  gait.  In  a  letter  dated  November  23,  1868,  Dr.  Bontecou  states  that  Sweeney  is  at 
work  at  Troy  in  a  spike  factory,  and  was  able  to  sit  at  and  run  a  machine.  His  knee  was  stiff  from  agglutination  of  the  sheath 
of  the  extensor  muscles  of  the  thigh,  otherwise  the  limb  was  useful.  The  Albany  Examining  Board,  Drs.  W.  Craig,  R.  B.  Bon 
tecou,  and  C.  H.  Porter,  record,  in  September,  1873:  "  Gunshot  wound  through  the  trochanters,  fracturing  the  femur  at  the  neck, 
leaving  adhesions  of  all  the  muscles  of  the  thigh  from  deep-seated  sloughing,  the  result  of  erysipelas,  making  knee  joint  stiff  in 
the  extended  posture."  In  September,  1875,  Examining  Surgeon  R.  B.  Bontecou  certified  that  "adhesions  have  rendered  the 
knee  immovable  and  the  limb  comparatively  useless." 

The  parts  injured  were  not  particularly  specified  in  ten  instances  of  recovery  after 
alleged  shot  fracture  of  the  hip  joint.  Two  are  here  detailed,  and  eight  are  briefly  recorded 
in  the  foot-note.1 

CASE  152. — "Private  William  C.  Watson,  Co.  A,  4th  Michigan,  was  struck  in  the  left  hip,  at  the  battle  of  Malvern  Hill, 
Virginia,  July  1,  1862,  by  a  conoidal  musket  ball.  A  fracture  through  the  trochanteric  region,  with  fissures  probably  extending 
to  the  joint,  was  reported.  He  was  conveyed  to  Philadelphia  and  admitted  into  the  Episcopal  Hospital  July  30th,  transferred 
to  Master  Street  Hospital  on  March  18th,  and  to  South  Street  Hospital  May  llth.  The  patient  stated  that  for  weeks  his  life 
was  despaired  of  in  consequence  of  the  excessive  suppuration  which  took  place.  Abscesses  formed  in  the  upper  third  of  the 
thigh.  Spiculae  of  bone  escaped  at  intervals  for  months  from  the  wound  and  through  the  incisions  made  for  the  evacuation  of 
the  abscesses.  On  January  1,  1864,  suppuration  had  nearly  ceased.  The  limb  was  shortened  several  inches  and  there  was  much 
deformity.  On  March  24th  he  was  admitted  into  Christian  Street  Hospital,  where  he  was  discharged  from  service  May  5,  1864. 
He  received  a  pension  in  September,  1868,  and  his  disability  was  rated  as  total  and  permanent."  Surgeon  Paul  B.  Goddard, 
U.  S.  V.,  reports  the  case. 

CASE  153. — Private  Samuel  Hensel,  Co.  H,  114th  Pennsylvania,  aged  31  years,  was  wounded  at  the  battle  of  Chancellors- 
ville,  Virginia,  May  3,  1863,  by  a  musket  ball,  which  entered  the  central  portion  of  the  left  buttock.  The  soldier  was  conveyed 
by  steamer  to  Washington,  where,  on  May  8th,  he  was  received  into  Armory  Square  Hospital.  The  wound  was  probed  daily  in 
search  of  the  missile,  which,  at  the  end  of  two  weeks,  presented  itself  at  the  point  of  entrance  and  was  extracted  by  the  patient. 
He  states  that  it  was  a  round  ball,  but  was  flattened  on  one  side,  and  had,  in  this  surface,  a  clean  cut  filled  with  osseous  matter. 
The  treatment  consisted  of  rest,  position,  and  the  application  of  cold-water  dressings.  On  June  16th  the  patient  was  transferred 
to  McKim's  Mansion  Hospital,  in  Baltimore.  About  the  middle  of  July  the  nurse,  while  dressing  the  wound,  discovered  in  it  a 
foreign  substance,  Avhich,  upon  removal,  proved  to  be  a  portion  of  the  haversack.  The  patient  was  soon  afterwards  transferred 
to  Mower  Hospital,  Philadelphia,  Early  in  September  a  spicula  of  bone,  nearly  two  inches  in  length  by  one  in  width  in  its 

1  Cases  of:  Corp'l  J.  J.  Atkenson,  B,  1st  Tennessee ;  wounded  at  Murfreesboro' ;  he  was  examined  at  Lauderdale,  Mississippi,  by  Surgeons  J.  T. 
KEXXEDY,  D.  W.  WHIMPER,  and  H.  YAKDELL,  P.  A.  C.  S.,  who  certified  that  he  was  suffering  from  a  shot  wound  of  left  hip,  fracturing  bone,  and  wound  of  left 
hand,  loss  of  use  of  two  fingers;  shortening  and  deformity  of  leg;  retired  to  Confederate  Invalid  Corps  (Circ.  2,  p.  98,  CASE  228). — 2.  Sergeant  Albert  G. 
Beebe,  A,  85th  Illinois,  received,  in  the  engagement  near  Perryville,  Kentucky,  October  8, 1862,  a  gunshot  wound  of  the  right  hip,  which  was  believed  to 
involve  a  fracture  of  the  joint.  He  was  conveyed  to  hospital  No.  7,  in  Perryville.  He  was  discharged  from  service  on  February  15, 1863.  His  disability 
was  rated  as  total.  He  is  a  pensioner.  Examiner  P.  I,.  DlFFEXBECHER.  of  Havana,  Illinois,  reported,  May  29, 1876 :  "  Wound  of  right  leg ;  ball  entered 
on  the  anterior  aspect  about  three  and  a  half  inches  below  the  groin,  passed  posteriorly  and  wounded  trochanter  major,  superior  aspect.  Exit  just 
posterior  to  the  thigh  joint;  bones  and  muscles  destroyed;  also  large  cicatrix  at  point  of  ingress.  Hip  joint  and  leg  affected  by  rheumatism  aggra 
vated  by  fatigue  and  exposure."  The  case  is  reported  by  Assistant  Surgeon  H.  S.  WOLFE,  81st  Indiana.— 3.  Pt.  D.  J.  C.  Campbell,  E.  3d  Virginia, 
aged  36 ;  Payne's  Farm,  November  27,  1863 ;  shot  wound  left  hip,  ball  entering  near  the  trochanter  major  and  lodging  in  the  bone  in  the  vicinity  of  the 
hip  joint;  retired  from  service,  unfitted  for  any  duty  (Circ.  2,  p.  98,  CASE  229). — 4.  Corp'l  H.  Koch,  F,  7th  Missouri,  aged  26;  Chickamauga,  September 
20,  1863;  conoidal  ball  splintered  left  femur  above  the  shaft;  discharged  May  16,  1864.  The  St.  Louis  Examining  Board  reported,  June  3,  1874:  "Ball 
struck  left  thigh  near  trochanter  major,  shattering  the  bone"  (Circ.  2,  p.  100,  CASE  245). — 5.  Pt.  A.  C.  Woodall,  G,  55th  Pennsylvania,  aged  17 ;  Drury's 
Bluff,  May  16, 1864 ;  fracture  left  hip,  involving  the  articulation  ;  mustered  out  June  8, 1865,  and  pensioned  ( Circ.  2,  p.  101,  CASE  254).— 6.  Corp'l  T.  Gal 
lagher,  F,  165th  New  York,  aged  30;  Port  Hudson,  May  27,  1863;  canister  ball  entered  two  and  a  half  inches  below  great  trochanter,  passed  backward 
and  upward,  and  lodged  three  inches  from  place  of  entrance ;  projectile  and  several  fragments  of  bone  removed :  discharged  December  19,  1863,  and  pen 
sioned.  The  New  York  Examining  Board  reported  in  October,  1872:  ''Ball  struck  outer  aspect  upper  third  left  hip,  fracturing  or  splintering  the  femur, 
and  leaving  two  well-marked  cicatrices;  interferes  with  locomotion"  (Circ.  2,  p.  103,  CASE  261).— 7.  Pt.  R.  F.  Carter,  B,  20th  North  Carolina,  aged  21 
years,  was  wounded  at  Gettysburg.  July  1,  1863.  His  injury  is  entered  on  the  register  of  the  Gettysburg  field  hospital  as  a  "gunshot  wound  of  thigh  and 
hip,  with  compound  comminuted  fracture  of  hip  joint."  On  September  4th  the  patient  was  admitted  to  Camp  Letterman,  where  Surgeon  H.  JAXES,  V. 
S.  V.,  recorded :  "  A  minie  ball  entered  outer  side  of  upper  third  of  left  thigh,  lodging  in  the  left  groin  and  fracturing  the  femur  in  its  course.  When 
admitted  the  general  health  of  the  patient  was  good;  leg  a  little  swollen.  On  September  12th  a  small  piece  of  bone  was  removed.  October  10th,  wound 
discharging  freely,  and  fracture  united  with  firm  callus  thrown  out.  November  8th.  improving  slowly.  Patient  can  bear  about  one-tenth  of  the  weight 
of  his  body  on  the  limb.  November  10th,  transferred  convalescent."  Surgeon  A.  CHAPEL,  U.  S.  V.,  reported  that  the  man  was  admitted  to  West's  Build 
ings  Hospital,  Baltimore,  with  "gunshot  wound  of  left  hip,"  and  that  he  was  paroled  November  12,  1863. — 8.  Pt.  H.  Marlatt,  G,  12th  Illinois  Cavalry, 
aged  19  years,  was  wounded  at  Upperville,  June  21,  1863.  He  was  admitted  to  a  Cavalry  field  hospital,  where  Surgeon  J.  B.  W.  MITCHELL,  8th  Penn- 
sylvania  Cavalry,  noted  :  "Wound  of  left  thigh  by  a  pistol  ball."  Surgeon  J.  A.  LIDELL,  U.  S.  V.,  recorded  his  admission  to  Stanton  Hospital,  Wash 
ington.  June  23d,  with  "wound  of  thigh,"  and  his  "return  to  duty  on  November  25,  1863."  It  is  believed,  however,  that  the  man  did  not  return  to  active 
field  service,  but  was  discharged  from  the  hospital  only  to  accompany  his  command  when  changing  station  from  the  Army  of  the  Potomac  to  the  Western 
armies.  He  was  subsequently  admitted  to  Camp  Gamble,  whence  he  was  transferred  to  the  Lawson  Hospital,  St.  Louis,  on  February  15, 1864.  Surgeon 
C.  T.  ALEXANDER,  U.  S.  A.,  reported:  "Gunshot  wound  of  left  thigh  two  inches  below  Poupart's  ligament;  ball  passing  downward,  inward,  and 
lodging.  Wound  healed  when  admitted.  General  condition  good ;  uses  crutches.  Patient  discharged  from  service  February  27,  1864."  Examiner  C. 
HAY,  of  Warsaw,  Illinois,  certified,  December  20,  1865:  "A  pistol  ball  entered  the  anterior  upper  third  of  the  thigh,  ranging  towards  the  hip  joint.  The 
joint  was  in  all  probability  injured,  as  he  has  not  been  able  to  move  the  limb  upward  since  the  casualty.  The  ball  was  lodged  in  or  near  the  hip  joint, 
upon  the  thigh  bone,  and  still  rests  there.  The  bones  composing  the  hip  joint  are  now  carious.  The  urinary  organs  are  much  deranged  iu  their  functions." 


76  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  x. 

central  portion,  was  extracted  from  the  wound.  Flaxseed  poultices  were  applied.  Subsequently  ten  other  pieces,  varying  in 
size  from  one-fourth  to  one  inch  in  length,  were  eliminated.  The  wound  soon  closed  and  the  patient  was  able  to  get  about  on 
crutches.  On  September  24th  he  was  transferred  to  McClellan  Hospital,  Philadelphia,  where,  on  May  13,  1864,  he  was  dis 
charged  from  service  "because  of  a  compound  fracture  of  the  left  thigh,  upper  third,  incapacitating  him  for  duty."  Pension 
Examining  Surgeon  H.  L.  Hodge,  of  Philadelphia,  reported,  May  26, 1864  :  "On  account  of  a  gunshot  fracture,  probably  of  the 
os  innominatum  (left),  there  is  a  luxation  of  the  head  of  the  femur,  which  destroys  the  usefulness  of  the  whole  limb."  On 
November  1,  I860,  an  apparatus  was  fitted  to  the  disabled  limb  by  Gemrig,  of  Philadelphia.  Examining  Surgeon  James  Cum- 
miskey  reported,  April  6,  1867  :  "Was  wounded  by  a  ball  entering  the  left  buttock  and  lodging  for  a  time  in  the  left  groin,  frac 
turing  the  head  of  the  femur  badly,  and  resulting  in  shortening  of  the  limb  about  three  and  a  half  inches  and  much  wasting  and 
feebleness  of  the  limb.  He  is  obliged  to  wear  constantly  an  iron  instrument  to  support  the  limb  in  walking.  He  suifers  much 
pain  at  night."  In  a  communication  to  this  office  dated  Philadelphia,  February  13,  1868,  Mr.  Hensel  states  that  he  is  unable  to 
walk  without  the  use  of  the  apparatus  and  a  cane,  but  by  the  aid  of  these  he  can  walk  from  a  half  to  three-quarters  of  a  mile, 
being  obliged,  however,  to  rest  for  two  or  three  minutes  once  or  twice  by  the  way  on  account  of  pain  and  weakness  in  the  limb. 
The  Philadelphia  Examining  Board,  Drs.  H.  E.  Goodman,  T.  C.  Rich,  and  James  Collins,  reported,  September  4,  1875:  "Has 
had  a  ball  enter  the  left  buttock,  which  was  extracted  from  the  wound  of  entrance.  Has  lost  bone  from  head  of  femur,  and  the 
limb  is  nearly  three  and  a  half  inches  shortened.  He  has  to  wear  a  support  with  a  high  heel  and  sole  shoe.  Motion  of  hip  joint 
limited  to  one-eighth  degree.  Spine  curved  from  short  limb." 

Details  of  twenty-one  of  the  reported  cases  of  recovery  after  alleged  shot  fractures  of 
the  hip  joint  have  been  cited  in  the  preceding  pages,  and  the  remaining  thirty-four  cases 
have  been  briefly  alluded  to  in  the  foot-notes.  The  hip  joint  was  undoubtedly  involved  in 
three  of  the  fifty-five  cases,  viz:  CASE  134,  of  Lieutenant  Colonel  H.  0.  Strong,  38th  New 
York  Volunteers;  CASE  140,  of  Private  T.  L.  Lomax,  30th  Virginia;  and  CASE  143,  of 
Private  T.  C.  Garvin,  94th  New  York  Volunteers.  The  latter  died  four  years  after  the 
injury,  but  the  opportunity  was  not  improved  of  ascertaining  unequivocally  the  precise 
nature  of  the  injury  to  the  articulation.  Twelve  cases1  were  probably  examples  of  fractures 
of  the  trochanteric  region  or  base  of  the  neck  of  the  femur,  without  the  capsule.  In 
thirteen  cases  the  evidence  is,  to  say  the  least,  contradictory  as  to  the  seat  of  injury.2  In 
five  cases  the  evidence  adduced  is  compatible  with  the  supposition  that  the  fractures  were 
extracapsular.3  In  five  other  cases  it  is  not  proven  that  the  articulation  was  directly 
injured.4  The  case  of  Private  A.  C.  Woodall  (Note  1,  page  75)  seems  to  have  been  a 
periarticular  injury  only.  In  the  case  of  Private  J.  W.  Galyean,  10th  Indiana  Volunteers 
(Note  1,  page  70),  the  Pension  Examining  Surgeon,  years  after  the  injury,  diagnosticated 
an  injury  to  the  joint.  In  the  case  of  Private  J.  Hughes,  1st  Alabama  Cavalry,  the  evi 
dence  consists  of  an  affidavit  of  an  unknown  surgeon  before  an  "Association  for  the  relief 
of  maimed  soldiers."  In  thirteen  cases5  the  evidence  is  entirely  insufficient  to  prove  that 
the  injuries  were  intracapsular  shot  fractures  of  the  joint.  In  the  case  of  Private  W.  C. 
Watson  (CASE  152,  page  75),  4th  Michigan  Volunteers,  there  remains  room  for  argument, 
but  the  weight  of  evidence  is  adverse  to  the  supposition  that  the  hip  was  implicated. 

Of  the  fifty-five  cases  of  alleged  recoveries  after  shot  fractures  of  the  hip  joint  treated 
without  operative  interference,  eighteen  were  Confederate  and  thirty-seven  Union  soldiers. 
In  the  cases  of  the  Confederate  soldiers  no  information  subsequent  to  the  close  of  the  war 
could  be  obtained.  Of  the  thirty-seven  Union  soldiers  four  had  died  previous  to  1880, 
one  had  not  been  heard  from  since  1866,  and  thirty-two  were  pensioners. 

"Cases  of:  Pt.  Philip  Sweeney  (CASE  151,  p.  74.  ante);  Pt.  Charles  Miller  (CASE  139,  p.  71);  Pt.  M.  M.  Phillips  (CASE  141,  p.  72);  Pt.  James 
Vanderbeck  (CASE  142,  p.  72);  Pt.  J.  Doody  (Note.  1,  p.  70);  Corp'l  D.  Bachler  (CASE  144,  p.  73);  Serg't  E.  G.  Gilliam  (CASE  146,  p.  73);  Pt.  J.  W  right 
(CASE  13'),  p.  69);  Corp.  L,.  English  (CASE  150,  p.  74);  Serg't  A.  G.  Beebe  (Note  1,  p.  75);  Corp.  T.  Gallagher  (Note  1,  p.  75);  Pt.  S.  Hensel  (CASE  153,  p.  75). 

2Casesof:  Pt.  J.  Kivel,  Pt.  W.  Swank,  and  Pt,  O.  Wilson  (Note  1,  p.  69);  Pt.  J.  W.  Britton,  Pt.  A.  G.  Cotton,  Pt.  F.  Kimball,  Pt.  R.  P. 
McCutchen,  Lieut.  C.  P.  Stoneroad,  Pt.  D.  Strickler,  and  Pt.  J.  Weber  (Note  1,  p.  70);  Serg't  P.  Casserleigh  and  Pt.  T.  Purcell  (Note.  1,  p.  74);  and  of 
Pt.  H.  Marlatt  (Note  1,  p.  75). 

3  Cases  of:  Capt.  W.  A.  Hugh  (CASE  137,  p.  70);  Pt.  J.  T.  Elliott  (CASE  138,  p.  71);  Surgeon  B.  W.  Avent's  case  of  an  unknown  officer  (CASE  147, 
p.  74);  Pt.  R.  Yerger  (CASE  148,  p.  74) ;  and  C.  F.  Beyland  (CASE  149,  p.  74). 

4  Cases  of:  Pt.  J.  McCabe  (CASE  145,  p.  73);  Pt.  S.  T.  Hook,  Pt.  W.  Miles,  and  Pt.  T.  Winans  (Note  1,  p.  70);  and  Corp'l  H.  Koch  (Note  1,  p.  75). 
BCases  of:  Pt.  J.  L.  Harvey  (CASE  133,  p.  G7,  ante);  Pt.  G.  A.  Crymes,  Serg't  F.  M.  Hunter,  Colonel  L.  S.  Slaughter,  Pt.  I.  S.  Smith,  Pt.  R 

Finkle,  and  Pt.  C.  Wilson  (Note  1,  p.  69);  Serg't  J.  M.  Adams  (CASE  136,  p.  69);  Pt,  W.  V.  Trail  and  Pt.   W.  B.  Reynolds  (Note  1,  p.  70);  Corp'l  J.  J 
Atkenson,  Pt.  D.  J.  C.  Campbell,  and  Pt.  R.  F.  Carter  (Note  1,  p.  75). 


WOUNDS    AND    INJURIES   OF    THE    HIP    JOINT. 


77 


Shot  Fractures  at  the  Hip  Joint  unsuccessfully  treated  by  Conservation. — Two  hun 
dred  and  forty-nine  fatal  cases  of  shot  fractures  of  the  bones  of  the  hip  joint  treated  by 
conservation  were  found  on  the  various  reports  and  hospital  registers.  In  ten  instances 
the  aeetabulum  was  recorded  to  have  been  fractured: 

CASE  154. — Private  G.  W.  Gentle,  Co.  E,  5th  Ohio,  was  wounded  at  Antietam,  September  17,  1862,  and  admitted  to 
hospital  No.  3,  Frederick,  October  1st.  Assistant  Surgeon  J.  H.  Bill,  U.  S.  A.,  reported:  "The  ball  entered  to  the  outside  of 
the  right  pyramidalis  muscle,  passed  outward  and  downward  in  front  of  the  femur,  and  emerged  at  a  spot  in  the  integument 
corresponding  to  the  insertion  of  the  gluteus  maximus.  Nothing  happened  in  this  case,  and  no  injury 
of  a  grave  character  was  suspected.  On  the  23d  of  October,  however,  a  haemorrhage  from  both 
wounds  took  place.  It  was  dark  in  color  and  readily  checked  by  a  tampon.  Accordingly  no  action 
was  taken,  and,  on  the  25th,  it  recurred.  It  was  now  found  that  the  thigh  and  hip  were  much 
swollen,  an  abscess  present,  seated  in  the  track  of  the  wound,  and  haemorrhage  evidently  due  to  the 
ulceration  of  some  vessel.  In  consultation  with  Surgeon  PI.  S.  Hewit,  U.  S.  V.,  ligation  of  the 
external  iliac  was  determined  on.  The  man,  however,  refused  the  operation,  and  as  the  haemorrhage* 
externally  had  ceased,  it  was  considered  proper  to  wait.  On  October  27th,  the  hemorrhage  returned 
and  the  man  wanted  the  artery  tied.  He  was  nearly  moribund,  and  the  case  otherwise  being  unprom 
ising  still,  the  operation  was  undertaken  by  an  incision  parallel  to  but  outside  of  the  epigastric 
artery.  The  external  iliac  was  found  and  tied  without  any  difficulty.  Previous  to  tying  the  ligature 
it  was  intended  to  lay  open  the  abscess  and  search  for  the  bleeding  vessel,  knowing  that  the  circu 
lation  could  be  controlled.  But  at  this  stage  of  the  operation  the  shock  to  the  patient  was  so  severe 
that  it  was  necessary  to  finish  all  operative  interference  as  soon  as  possible.  The  patient  survived 
the  operation  only  twenty-four  hours.  The  autopsy  showed  the  external  iliac  tied  a  quarter  of  an 
inch  below  the  internal  iliac,  and  the  vein  and  peritoneum  uninjured.  A  syringe  was  introduced  into 
the  femoral  artery  below  the  origin  of  the  profunda  and  water  thrown  upward,  but  the  bleeding  os  innominatunfand'healf  <'.f 
vessel  was  not  discovered,  notwithstanding  a  careful  dissection  and  prolonged  search.'  The  syringe  £mur75ofter  Shot  contllsi"n- 
was  now  introduced  into  the  internal  iliac  and  the  water  thrown  downward,  but  with  no  better  result. 

Failing  thus  to  discover  an  ulcerated  vessel  on  the  cadaver,  what  likelihood  would  there  have  been  of  a  successful  seai-ch  for 
the  bleeding  point  on  the  living  patient?  The  operation  performed  was  unquestionably  the  proper  one,  as  it  checked  the  hsenior- 
rhage,  and  was  the  only  feasible  method  of  doing  this."  The  specimen  represented  in  FIG.  26  was  contributed  by  Assistant 
Surgeon  J.  H.  Bill,  and  consists  of  "the  right  os  innominatum  and  head  of  the  femur.  The  joint  was  opened  and  the  ischium 
at  the  lower  border  of  the  aeetabulum  contused  by  a  musket  ball  which  escaped  through  the  glutaeus  maximus.  The  articular 
surfaces  are  eroded,  but  the  implication  of  the  joint  was  not  suspected  during  life." — (Cat.  Surg.  Sect.,  A.  M.  M.,  1866,  p.  235.) 

The  remaining  nine  cases  of  fatal  shot  fracture  of  the  aeetabulum  have  been  detailed; 
seven  in  Circular  Wo.  2,1  and  two  in  the  Second  Surgical  Volume?     The  ten  patients 
belonging  to  this  group  survived  the  injury  10, 11,  28,  31,  31,  32, 
41,  46,  85,  and  160  days  respectively,  and  in  two  instances  frag 
ments  of  bone  were  removed.3     Autopsies  verifying  the  injury  to 

the  hip  joint  were  made  and  recorded  in  nine 

of  the  ten  cases,  and  in  seven  instances  the 

specimens  are  preserved  in  the  Army  Medical 

Museum.  Specimen  1285  (FiG.  27)  is  from  the 

case  of  Private  Joseph  D ,  Co.  E,  129th 

Pennsylvania,    aged     20    (Circular    No.    2, 

S.  G-.  0.,  1869,  p.  90,  CASE  161).     A  conoidal 

ball  had  chipped  the  upper  edge  of  the  coty- 
Fio.27.-i5.mes  of  left  hip  joint   loidcavitv,  causing  slight  exfoliation.     The     FIG.  28.-canous  bones  of  ie»  hip 

ith  conoidal  ball.     Spec.  1285.         .  ,       -    .,          .  Jomt'    *"'  694' 

head  ot  the  temur  and  the  aeetabulum  were 
deprived  of  periosteum.     The  injury  to  the  bone  was  very  trivial.     The  patient  survived 
the  injury  thirty-one  days.     Specimen  694  (FiG.  28)  is  from  the  case  of  Private  C.  H. 

1  Circular  No.  Z,  p.  88  :  CASE  150,  Pt.  Wm.  P.  F ,  121st  New  York,  Spec.  3525,  A.  51.  M.  CASE  160,  p.  89,  Pt.  J.  Brandon,  119th  New  York, 

Spec.  1843.  CASE  161,  p.  90,  Pt.  J.  Donegan,  129th  Pennsylvania,  Spec.  1085.  CASE  162,  p.  90,  Pt.  T.  McGowan,  121st  New  York.  (See  Boston  Med. 

and  Surg.  Jour.  1863,  Vol.  68,  p.  439.)  CASE  163,  p.  90,  Pt.  C.  H.  Roberts,  1st  New  Jersey,  Spec.  694.  CASE  164,  p.  90,  Pt.  Wm.  H  W ,  G,  4th 

New  York.  CASE  2o7,  p.  102,  Capt.  S.  J.  Alexander,  B,  9th  New  Hampshire. 

*Med.  and  Surg.  History  of  the  War  of  the  Rebellion,  Part  II,  Vol.  II,  p.  317:  CASE  920,  Pt.  L.  M.  B ,  I,  1st  Massachusetts,  Spec.  116;  CASK 

922,  p.  318,  Serg't  T.  A ,  C,  119th  New  York,  Spec.  1183. 

3OASE  of  J.  Brandon,  F,  119th  New  York,  Circular  2,  p.  89,  and  CASE  of  Capt.  S.  J.  Alexander,  B,  9th  New  Hampshire,  Circular  2,  p.  102. 


with 


78 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Roberts,  Co.  C,  1st  New  Jersey  Volunteers,  aged  19  (Circular  No.  2,  p.  90,  CASE  163). 
The  point  of  impact  of  the  missile  appears  to  have  been  at  the  lowest  margin  of  the 
acetabulum,  where  a  square  inch  of  the  ischium  is  necrosed  and  nearly  separated. 

The  acetabulum  and  head  of  femur  were  recorded  as  having  been  fractured  in  thirty- 
two  of  the  two  hundred  and  forty-nine  fatal  cases  of  shot  fractures  of  the  hip  joint.  Autop 
sies  are  recorded  in  twenty  instances,  and  in  thirteen  cases  the 
specimens  are  preserved  in  the  Army  Medical  Museum.  /Specimen 
1908  (FiG.  29)  is  from  the  case  of  Private  Joseph  W-  -,  K,  6th 
Maryland,  aged  45  (Circular  2,  p.  89,  CASE  154).  Death  occurred 
in  thirteen  days.  The  lower  margin  of  the  acetabulum  was 
chipped  by  the  ball,  which  lodged  in  the  summit  of 
the  head  of  the  right  femur,  splitting  it  perpendic 
ularly.  Specimen  1248  (FiG.  30)  is  from  the  case 
of  Corporal  G.  Greenwood,  D,  13th  Massachusetts 


. 

FIG.  29.  —  Bones  of  right  hipjomt.  Ball 


(Circular  2,  p.  113). 
injury  thirteen  days. 


The  patient  survived  the 
The  ball  had  shattered  the 


FIG.   30.  — Shattered 
head  of  the  left  femur. 


impacted  in  head  of  femur, 


1908. 


of  the  left  femur  and  lodged  in  the  pelvis.    Spec- 
Twenty-five  of  the  cases  have  been  published  in  detail  in  Circular  No.  2,1  and  seven  will 
here  be  recorded: 

CASE  155. — Lieutenant  C.  F.  Bailey,  Co.  D,  6th  Vermont,  aged  40  years,  was  wounded  at  Lee's  Mills,  April  16,  1862. 
Surgeon  J.  B.  Brown,  U.  S.  A.,  described  the  injury  as  a  "wound  of  the  groin."  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported : 
"He  was  admitted  into  the  Hygeia  Hospital,  Fort  Monroe,  on  April  22d,  having  been  wounded  by  a  round  ball,  which  entered 
the  left  groin,  passing  between  the  femoral  artery  and  anterior  crural  nerve,  then  entering  the  ramus  of  pubis  and  acetabulum, 
furrowing  deeply  the  head  of  the  femur,  and  passing  through  the  acetabulum  into  the  pelvis  and  resting  by  the  left  side  of  the 
rectum,  about  four  inches  above  its  termination.  On  admission,  he  was  suffering  much  pain  when  the  limb  was  moved.  Wet 
applications  and  soothing  treatment,  with  perfect  rest,  made  him  for  some  days  comfortable.  Fever  of  a  low  form  occurred, 
and  a  yellow  condition  of  the  skin  followed,  with  delirium,  and  death  on  May  1,  1862." 

CASE  156. — Private  H.  U.  Cady,  Co.  K,  207th  Pennsylvania,  was  wounded  at  Peters 
burg,  April  2,  1865,  by  a  conoidal  ball.  He  was  carried  to  the  field  hospital  of  the  Ninth 
Corps,  and  remained  there  until  April  5th,  when  he  was  taken  on  board  the  hospital  steamer 
State  of  Maine.  He  died  April  6th,  during  the  trip  to  Alexandria,  and  was  buried  from 
the  Third  Division  Hospital.  Surgeon  E.  Bentley,  U.  S.  V.,  who  presented  the  injured 
upper  extremity  of  the  left  femur,  with  portions  of  the  ilium  and  ischium,  to  the  Museum, 
furnishes  the  following  description  of  the  specimen,  No.  3205,  A.  M.  M.,  represented  in  the 
adjoining  wood-cut  (FiG.  31):  "The  bullet  entered  one  inch  above  the  symphisis  and  to 
the  left  of  the  median  line,  shattered  the  ramus  of  the  pubes,  left  the  obturator  vessels 
untouched,  passed  through  the  acetabulum,  grooving  the  head  of  the  femur,  and  lodged 
in  the  loose  tissue  beyond.  The  ramus  of  the  ischium  appears  to  have  been  fractured  by 
Spec.  3205.  indirect  violence.  The  bony  fragments  in  the  track  of  the  ball  are  thoroughly  necrosed." 
CASE  157. — Private  W.  Hobbs,  Co.  C,  22d  Indiana,  was  wounded  at  Mission  Ridge,  November  25,  1863,  and  entered  the 
General  Field  Hospital  at  Chattanooga,  December  4th.  Acting  Assistant  Surgeon  C.  E.  Ball  reported:  "He  was  wounded  by 
a  minie  ball  in  the  right  inguinal  region  just  above  Poupart's  ligament,  the  missile  passing  downward,  toward  and  into  the 
thigh  apparently.  The  patient  has  double  pneumonia.  The  bullet  was  in  the  wound,  and  the  surgeons  could  not  find  it.  The 
wound  granulated  well.  Patient  was  in  a  recumbent  position  from  the  first.  December  30th,  has  pneumonic  symptoms  still; 
wound  granulating  finely.  Gangrene  appeared  in  the  wound  January  3d.  Bromine  was  applied  and  scissors  used,  also  stim 
ulants  on  poultice.  Most  of  the  wound  granulated  healthily  again,  but  in  spite  of  stimulants  and  iron,  carefully  given,  the 
patient  died  January  23,  1864."  Acting  Assistant  Surgeon  G.  E.  Stubbs  contributed  the  specimen  (Cat.  Sury.  Sect.,  1866, 
p.  240,  Spec.  2103),  with  the  following  account  of  the  autopsy:  "A  sloughing  wound,  circular  in  form,  and  five  and  a  half  inches 

1  Circular  No.  2,  1869:  CASE  40,  p.  70,  Corp'l  Wm.  Francks,  G,  24th  Iowa  (Boston  Med.  and  Surg.  Jour.,  1865,  Vol.  72,  p.  29),  Spec.  3793.     CASK 
1.23,  p.  85.  Corp'l  II.  Achlcy,  G,  2d  New  York  H.  A.     CASE  125,  p.  85,  Pt,  J.  H.  Brown,  A,  19th  Mass.     CASE  126,  p.  85,  Pt.  C.  H.  Calhoun,  H,  7th  North 

Carolina.     CASE  127,  p.  85,  Pt.  J.  H.  Carlon,  D,  184th  Pennsylvania.     CASE  128,  p.  85,  Pt.  G.  II.  C ,  F,  59th  Mass.,  Spec.  3582.     CASE  131,  p.  86,  Pt.  //. 

De  Coux,  Depeak's  Confederate  Battery.    CASE  133,  p.  86,  Pt,  J.  S.  Fabus,  1, 169th  New  York.    CASE  134,  p.  86,  Pt.  David  F ,  G,  lllth  New  York,  Spec. 

1616.    CASE  135,  p.  86,  Sergeant  S.  Carver,  K,  89th  Indiana.    CASE  136,  p.  86,  Pt.  F.  Geyser,  F,  1st  Minnesota.    CASE  138,  p.  86,  Serg't  W.  N.  Hinds,  D,  IS'.'d 

New  York.     CASE  141,  p.  87,  Pt.  W.  D.  Little,  G,  100th  Indiana.     CASE  144,  p.  87,  Pt.  Royal  S.  N ,  A,  26th  Mass.,  Spec.  3726.    CASE  146,  p.  88,  Pt.  C. 

Robinson,  C,  2d  District  Columbia,    CASE  147,  p.  88.  Pt.  C.  R ,  49th  New  York,  Spec.  1247.     CASK  148,  p.  88,  Pt.  Z.  S ,  K,  2d  Ohio  Cavalry,  Spec.  3904. 

CASE  149,  p.  88,  Pt.  H.  II.  Sturdivant,  A,  179th  New  York.    CASK  157,  p.  89,  Corp'l  J.  P.  White,  II,  115th  Illinois.    CASK  151,  p.  89,  Pt.  Joseph  W ,  K,  Gth 

Maryland,  Spec.  1908.    CASE  155,  p.  89,  Pt.  J.  Wiley,  A,  155th  Now  York.    CASE  156,  p.  89,  Pt.  J.  B.  Wilson,  E,  20th  Mass.    CASE  157,  p.  89,  Pt.  L.  Winslow, 
A,  67th  Ohio.    CASE  239,  p.  100,  Pt.  D.  A.  Brewer,  E,  37th  Kentucky.    CASE  275a,  p.  113,  Corporal  G.  Greenwood,  D,  13th  Mass.,  Spec.  1248. 


FIG.  31. -Grooved  head  of  left  femur,  with 
portion  of  ilium  and  ischium. 


SECT.  II.]  WOUNDS    AND    INJURIES    OF    THE    HIP    JOINT.  79 

in  diameter,  occupies  the  right  inguinal  region.  The  ball  entered  two  inches  from  the  anterior  superior  spinous  process  of  the 
ilium,  descended  behind  the  caecum,  one  and  a  half  inches  from  the  ramns  of  the  pubis,  passing  through  the  bone  and  laying 
open  the  acetabulum,  and  fractured  the  tuberosity  of  the  ischium,  where  it  lodged.  The  head  of  the  femur  is  denuded.  The 
left  lower  extremity  is  much  larger  than  the  right  and  pits  under  the  finger.  The  femoral  glands  are  enlarged  and  prominent; 
the  tissues  about  them  infiltrated  with  serum.  The  right  femoral  vein  is  filled  with  a  thrombus  more  or  less  attached  to  its  wall, 
which  may  be  detached  without  impairing  the  integrity  of  the  lining  of  the  vein.  This  thrombus  consists  in  the  main  of  greyish 
granular  matter  with  portions  of  black  coagulum,  and  extends  to  the  junction  of  the  iliac  veins.  A  similar  thrombus  is  found  in 
the  left  iliac  and  femoral  veins."1  The  specimen  consists  of  the  bones  of  the  right  hip  joint.  Much  of  the  head  of  the  femur  is 
eroded,  but  a  small  circular  portion  of  sound  bone  remains  on  the  anterior  aspect,  surrounded  by  diseased  tissue. 

CASE  158. — Sergeant  M.  B.  Pendley,  Co.  E,  6th  North  Carolina,  aged  36  years,  was  wounded  at  Gettysburg,  July  1, 
1863.  He  remained  at  a  field  hospital  until  August  7th,  when  he  was  admitted  to  Camp  Lettermau.  Acting  Assistant  Surgeon 
D.  R.  Good  reported:  "Gunshot  wound  of  right  hip  joint.  A  minie"  ball  passed  through  his  pocket  book,  and  entered  the  right 
iliac  region  one  and  a  half  inches  inside  of  the  anterior  superior  spinous  process  of  the  ilium,  passed  directly  in  the  region  of 
the  joint  and  remained.  The  patient's  general  health  has  been  very  good,  though  he  has  suffered  constant  and  severe  pain  from 
the  injury  and  cannot  endure  the  least  motion  of  the  limb.  There  has  been  comparatively  very  little  inflammation  and  swelling 
of  the  surrounding  parts.  Simple  dressings  were  applied  and  generous  diet  given.  August  loth,  for  some  time  the  limb  has 
been  flexed  and  drawn  over  and  in  front  of  the  other  leg.  Administered  chloroform  and  straightened  the  limb,  and  applied 
splint  to  keep  the  leg  at  rest.  22d,  patient  is  comfortable  so  long  as  his  limb  is  not  moved,  and  is  doing  well.  The  general 
treatment  is  continued.  27th,  general  health  not  so  good;  limb  more  swollen.  Administered  tonics  and  some  stimulants. 
30th,  has  slight  diarrhoea;  opiates  prescribed.  September  4th,  diarrhoea  continues;  ordered  opiates  and  astringents.  10th, 
considerably  better ;  treatment  continued,  with  tonics  and  stimulants.  12th,  diarrhoea  still  troublesome  at  times;  his  strength 
foiling  considerably.  16th,  greatly  prostrated;  evidence  of  pyaemia.  17th,  gangrene  in  the  parts  about  the  wound.  Died 
September  17,  1863,  at  10  o'clock  P.  M.  Post-mortem :  The  ball  had  passed  directly  into  the  joint, 
slightly  fracturing  the  head  of  the  femur,  and  was  buried  in  the  acetabulum.  The  cavity  was  filled 
up  with  bone,  and  a  large  quantity  of  pus  was  found  to  have  accumulated  in  and  about  the  joint." 
The  os  innominatum  and  the  upper  portion  of  the  femur  were  forwarded  to  the  Museum  by  Acting 
Assistant  Surgeon  E.  P.  Townsend.  The  specimen  shows  a  fracture  extending  through  the  acetabu- 
Inm  at  the  point  of  impact,  which  is  necrosed,  nearly  the  entire  remainder  of  the  articular  surface 
being  carious.  A  large  portion  of  the  head  of  the  femur  has  been  absorbed.  Slight  osseous  deposits 
exist  on  the  outer  margin  of  the  acetabulum. — (Cat.  Surg.  Sect.  1866,  p.  242,  Spec.  1942.) 

CASE  159. — Corporal  G.  W.  Stepps,  Co.  C.  20th  North  Carolina,  aged  20  years,  was  wounded 
at  Spottsylvania,  May  12,  1864,  and  entered  Lincoln  Hospital,  Washington,  on  May  22d.  Assistant 
Surgeon  J.  C.  McKee,  U.  S.  A.,  reported:  ''Gunshot  wound  of  right  groin,  a  minie"  ball  entering  half 
an  inch  below  and  exterior  to  the  middle  of  Poupart's  ligament,  fracturing  the  head  of  the  femur 
and  the  acetabulum,  and  escaping  at  the  middle  of  the  right  nates.  Death  occurred  on  June  10, 
1864."  A  portion  of  the  os  innominatum,  represented  in  the  wood-cut  (FlG.  32),  was  contributed 

by  Acting  Assistant  Surgeon  H.  M.  Dean.— (Cat.  Surg.  Sect.,  1866,  p.  236,  Spec.  2488.) 

Fir..  32. — Portion  of  right  m- 
CASE  160. — Private  G.  S.  Turner,  Co.  I,  19th  Maine,  aged  18  years,  Avas  wounded  at  Gettys-     nomiuatum,  with  fracture  of 

burg,  July  3,  1863.     He  remained  at  the  field  hospital  of  the  2d  division,  Second  Corps,  until  July    ^l°fi 
14th,  when  he  was  transferred  to  the  Jarvis  Hospital  at  Baltimore.     Assistant  Surgeon  D.  C.  Peters, 

U.  S.  A.,  reported:  "Gunshot  wound  of  left  hip  joint.  The  anterior  wound  was  about  the  middle,  and  above  Poupart's 
ligament;  the  posterior  near  the  tuberosity  of  the  ischium.  Blood  oozed  almost  continuously  from  the  wound  in  front,  and 
twice  alarming  haemorrhages  occurred.  He  had  a  bad  and  colliquative  diarrhoea,  and  was  nearly  pulseless  when  admitted.  No 
reaction  came  on  such  as  would  warrant  so  formidable  an  operation  as  tying  the  common  iliac.  Constant  pressure  by  com 
presses  was  made.  Death  occurred  on  July  19,  1863.  The  post-mortem  revealed  an  immense  traumatic  aneurism  and  abscess 
about  the  hip  joint.  The  femoral  artery  was  lacerated  and  a  mass  of  decomposed  tissue.  The  musket  ball  struck  the  acetabu- 
lunf  and  the  head  of  the  femur,  gouging  them,  and  subsequent  disorganization  denuded  them  of  periosteum.  The  structures 
around  were  in  an  advanced  state  of  decomposition,  and  it  is  a  wonder  the  patient  lived  so  long  as  he  did." 

CASE  161. — Private  H.  West,  Co.  A,  3d  North  Carolina,  aged  20  years,  was  wounded  at  Antietam,  September  17,  1862, 
and  admitted  to  the  hospital  at  Locust  Springs,  November  22d,  where  Surgeon  T.  H.  Squire,  89th  New  York,  recorded:  "The 
patient  came  to  this  hospital  from  Sharpsburg.  He  was  wounded  by  a  musket  ball,  which  entered  the  right  gluteal  region 
midway  between  the  summit  of  the  trochanter  and  the  crest  of  the  ilium  and  lodged  in  some  unknown  part  of  the  body.  There 
is  a  general  fullness,  and  some  hai'dness  and  redness  in  the  groin  and  region  of  Poupart's  ligament,  and  possibly  the  ball  may 
be  in  that  neighborhood.  The  patient's  general  health  is  tolerable."  On  January  19th  he  was  transferred  to  the  Smoketown 
Hospital,  and,  on  May  llth,  to  hospital  No.  1,  at  Frederick.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  reported  that  he  died, 
July  6,  1863,  of  •'gunshot  wound  of  hip,  involving  the  joint."  Acting  Assistant  Surgeon  G.  M.  Paulin  contributed  the  os 
innominatum  and  the  head  of  the  femur  of  this  case  to  the  Museum.  The  specimen  shows  that  a  round  bullet  entered  obliquely 
from  the  right  front,  fractured  the  superior  portion  of  the  head  of  the  femur,  perforated  the  acetabulum,  and  lodged  in  the  body 
of  the  ilium  without  derangement  to  its  own  form.  One  half  of  the  head  of  the  femur  has  been  absorbed;  the  anterior  superior 
third  of  the  acetabulum  is  carious  and  partially  detached;  near  the  fundus  of  the  acetabulum  ulceratiou  has  perforated  the  bone, 
and  the  bullet  communicates  with  the  head  of  the  femur  by  a  carious  channel.  The  missile  is  encircled  with  a  wall  of  new- 
bone  thrown  out  from  the  irritation  of  its  presence;  there  is  also  considerable  deposit  of  callus  on  the  ilio-pubic  region,  which 
caused,  during  life,  a  prominence  in  the  region  of  Poupart's  ligament.  The  dorsum  ilii  and  the  posterior  surface  of  the  body  of 
the  ischium  show  evidence  of  periosteal  inflammation. — (Cat.  Sury.  Sect.,  1866,  p.  242,  Spec.  3865.) 

'LlDELL  (J.  A.),  in  Memoirs  of  U.  S.  Sanitary  Commission,  New  York,  1870,  Surgical  Vol.  I,  p.  551,  describes  the  thrombosis  with  pyaemia. 


80  INJUEIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

In  twenty  of  the  two  hundred  and  forty-nine  cases  with  fatal  terminations  after  shot 
fractures  of  the  hip  joint,  the  acetabulum  with  the  head  and  neck  or  trochanters  and  shaft 
were  injured.  Post-mortem  examinations  are  recorded  in  seventeen  instances,  and  the 
Army  Medical  Museum  possesses  eight  specimens  belonging  to  cases  of  this  group.  Fifteen 
of  the  cases  have  been  detailed  in  Circular  No.  2;1  five  will  here  be  given  in  full: 

CASE  162. — Private  E.  Snyder,  Co.  K,  13th  Illinois,  was  wounded  at  Ringgold,  November  27,  1863,  and  admitted  to  the 
general  field  hospital  at  Chattanooga  on  the  following  day,  where  Surgeon  J.  Perkins,  U.  S.  V.,  recorded:  "Gunshot  wound 
of  left  hip."  Two  weeks  afterwards  the  patient  was  transferred  to  Nashville,  where  he  was  admitted  to  hospital  No.  19. 

Surgeon  W.  Foye,  U.  S.  V.,  described  the  case  as  follows:  "Admitted  December  15th,  with 
gunshot  fracture  of  left  femur;  the  ball,  which  proved  to  be  a  large  mini<§,  entered  about  one 
and  a  half  inches  to  the  left  and  below  the  anterior  superior  spinous  process  of  the  ilium  and 
had  not  emerged.  The  wound  was  quite  small,  and  discharging  a  small  quantity  of  pus  of  a 
somewhat  serous  character ;  pulse  weak,  about  90,  and  feverish.  Simple  dressings,  supporting 
diet,  and  tonics  were  ordered.  The  following  day  the  discharge  was  of  a  fair  character  and  the 
patient  feeling  better.  As  the  ball  had  been  searched  for  twice  without  success,  it  was  deemed 
best  not  to  disturb  the  parts  unless  rendered  necessary.  On  December  18th  the  discharge  was 
very  profuse,  amounting  to  nearly  a  quart  of  sanious  and  watery  matter  of  very  fetid  odor. 
The  wound  was  laid  open  and  probed;  the  path  of  the  ball  was  apparently  along  the  inner 
side  of  the  femur,  yet  that  was  not  sufficiently  large  for  so  profuse  a  discharge;  but  no  other 
path  or  sac  was  found,  though  the  neck  of  the  femur  was  ascertained  to  be  much  comminuted. 
He  seemed  more  feverish  during  the  day,  and  had  some  dyspnoea  and  cough ;  pulse  100.  Treat- 
Fio.  33.— Bones  of  the  left  hip  ment  continued.  On  December  19th  the  patient  was  evidently  failing ;  pulse  110,  and  weak ; 
junction  wfth  the  "neck. S  Spec^ZlTA.  discharge  more  profuse  and  of  the  same  character.  On  the  20th  the  symptoms  were  all  aggra 
vated.  He  died  on  December  21,  1863.  The  autopsy  showed  that  the  ball  had  entered  at  the 

point  above  described  and  struck  the  neck  of  the  femur,  completely  severing  it  and  partially  dividing  the  head,  comminuting 
the  lower  part  of  the  acetabulum  and  passing  through  the  ilium,  and  lay  about  an  inch  within  the  cavity  of  the  pelvis.  It  was 
surrounded  by  coagula,  but  had  done  no  injury  to  the  intestines.  A  smaller  track  was  made  along  the  inner  side  of  the  femur. 
No  piece  of  ball  was  found  in  this  path.  Intestines  normal ;  liver  and  spleen  considerably  enlarged  and  friable.  The  right  lobe 
of  the  lungs  Avas  inflamed  but  not  hepatized.  There  were  no  abscesses  in  any  of  these  organs.  The  heart  and  other  organs 
were  in  good  condition."  The  bones  of  the  injured  hip  joint  were  contributed  to  the  Museum  by  Surgeon  Foye.  (Cat.  Sury. 
Sect.,  1865,  p.  242,  Spec.  2174.)  The  specimen  (FlG.  33)  shows  the  borders  of  the  bony  wound  to  be  necrosed. 

CASE  163. — Private  A.  Kibble,  Co.  C,  81st  New  York,  aged  26  years,  was  struck  in  the  right  hip  by  a  cannon  ball 
during  the  engagement  near  Petersburg,  May  19,  1864.  He  was  admitted  to  the  General  Hospital  at  Fort  Monroe,  where  he 
died  May  25,  1864.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported:  "Both  the  os  innominatum  and  the  femur  were  frac 
tured  and  much  comminuted,  all  the  bones  entering  into  the  formation  of  the  joint  being  literally  crushed  by  a  solid  shot." 

CASE  164. — Private  C.  Cook,  Co.  F,  18th  Illinois,  aged  41  years,  is  reported  by  Surgeon  J.  Simons,  U.  S.  A.,  as  having 
died  of  "gunshot  wound,"  at  the  General  Hospital  at  Cairo,  December  4,  1861.  In  a  report  of  surgical  cases  transmitted  in 
April,  1873,  by  Dr.  J.  H.  Brinton,  late  Surgeon  U.  S.  V.,  the  injury  is  described  as  follows:  "Cook  was  shot  while  drunk,  by 
a  guard,  on  December  1st,  at  6  o'clock  p.  M.,  at  a  distance  of  thirty  yards.  The  missile,  a  Maynard  rifle  ball,  entered  in  left 
side  on  a  line  with  the  crest  of  the  ilium,  passed  outward  and  downward,  and  emerged  at  the  posterior  part  of  the  left  buttock. 
I  saw  him  shortly  after  the  injury  in  a  state  of  collapse  from  the  shock,  pulse  132,  feeble  and  thready;  skin  cold,  white  and 
waxy;  cold  sweat  on  forehead;  constant  venous  dribbling  from  both  openings.  December  2d,  no  discharge  from  his  bowels 
since  being  shot ;  passes  his  urine;  is  in  a  very  prostrate  condition;  has  reacted  but  very  little.  Stimulants  have  been  freely 
given.  A  few  spiculse  were  extracted  from  near  the  exit  orifice.  December  3d,  patient  failing  fast;  pulse  feeble  and  not  to  be 
counted;  urine  scanty;  pulse  imperceptible;  skin  hot  and  dry;  urine  voided  involuntarily;  bowels  have  not  been  moved.  Died 
at  9  o'clock  A.  M.,  on  December  4th.  Post-mortem  two  hours  after  death  :  Tissues  around  wound  o£,  entrance  dissected  up  all 
around  for  an  inch.  Ball  had  passed  obliquely  outward  and  downward,  grazing  the  anterior  lip  of  acetabulum,  passing  through 
head  of  femur,  splintering  it  and  the  neck,  and  destroying  the  posterior  lip  of  the  acetabulum.  The  extravasation  of  blood  had 
passed  down  from  wound  of  entrance,  along  and  superficial  to  tendon  of  external  oblique  muscle  as  far  as  the  external  ring, 
then  up  the  inguinal  canal  through  the  internal  ring,  and  was  collected  in  a  clot  of  three  or  four  drachms  around  the  internal 
ring.  Both  rings  were  enlarged;  a  hernia  came  down  after  injury,  which  was  reduced;  no  wound  of  the  peritoneum.  The 
tissues  were  loosened  around  the  wound  of  entrance  in  a  circumference  of  one  and  a  half  inches."  In  addition  to  this  case  Dr. 
Brinton  makes  the  following  remarks:  "This  loosening  of  tissues  around  the  entrance  wound  of  a  conoidal  ball  I  have  since 
observed  in  hundreds  of  cases.  It  is  undoubtedly  peculiar.  Usually  the  point  of  a  finger  passed  through  the  wound  can  be 
hooked  under  the  skin  and  swept  around  without  encountering  resistance  suflicient  to  impede  its  motion.  The  earlier  the  wound 
is  examined  the  more  perfectly  will  this  phenomenon  be  observed,  as  clots,  etc.,  afterwards  block  up  the  disintegrated  zone." 

1  Circular  No.  2, 1869 :  CASE  80,  p.  77,  Pt.  Wm.  O.  M ,  C,  24th  Iowa,  Spec.  3792.     CASE  124,  p.  85,  Pt.  F.  Baker,  I,  3d  Vermont.     CASE  129,  p.  80, 

Pt.  D.  Combe,  K,  209th  Penn.    CASE  130,  p.  86,  Pt,  Ch.  Cushion,  179th  New  York.    CASE  132,  p.  86,  Pt.  S.  N.  E ,  G,  40th  Indiana,  Spec.  3390.    CASE  137, 

p.  86,  Corp'l  J.  T.  Glancy,  F,  2d  Rhode  Island.    CASE  139,  p.  86,  Pt.  D.  M.  Johnson,  1, 13th  Alabama.    CASE  140,  p.  86,  Pt.  George  L ,  D,  5th  Louisiana, 

Spec.  3946.    CASE  142,  p.  87,  Pt.  L.  L.  Lowe,  E,  101st  Ohio.    CASE  143,  p.  87,  Pt.  Peter  M ,  A,  28th  Mass.,  Spec.  4227.    CASE  145,  p.  87,  Serg't  Charles  G. 

P ,  G,  13th  Penn.,  Spec.  3632.    CASE  151,  p.  88,  Pt.  G.  F.  Tilton,  E,  1st  Mass.  Cav.    CASE  153,  p.  89,  Serg't  William  Whitney,  K,  147th  New  York.   CASE 

158,  p.  89,  Pt.  A.  Wormack,  G,  48th  North  Carolina.    CASE  159,  p.  89,  Corp'l  M.  F.  Yoder,  G,  51st  Ohio. 


SECT.  II.l 


WOUNDS    AND    INJURIES    OF    THE    HIP    JOINT. 


81 


FIG.  34.— Bones  of  the  left  hip 
joint.     Spec.  1659. 


CASE  165. — Private  M.  C.  Lcsncur,  Co.  C,  3d  Georgia,  was  wounded  at  Liberty  Gap,  June  25,  1863,  and  admitted  to 
hospital  at  Murfreesboro'  two  days  afterwards.  Assistant  Surgeon  W.  P.  McCullogh,  78th  Pennsylvania,  recorded:  "Gunshot 
wound  of  right  thigh,  ball  entering  trochanter  and  passing  inward  and  backward.  The  missile  was  traced  through  the 
trochanter  but  could  not  be  found."  The  treatment  is  noted  as  having  consisted  of  water  dressings,  morphia,  stimulants,  and 
tonics,  and,  in  the  latter  stage,  astringents  were  given  to  control  the  diarrhoea.  On  July  8th,  the  wound  was  suppurating  freely 
and  the  leg  was  bandaged.  On  August  1st,  an  incision  was  made  anil  some  spicula?  of  bone  removed, 
a  discharge  of  pus  to  the  amount  of  eight  ounces  taking  place.  On  August  9th  the  patient  was 
slowly  sinking,  and,  on  the  16th,  he  was  failing  rapidly.  He  died  August  19,  1863.  An  autopsy 
was  held  eight  hours  after  death,  and  is  recorded  as  follows:  "The  ball  entered  the  trochanter 
major,  passing  through  it  and  entering  the  capsule  of  the  joint,  carrying  away  a  portion  of  the 
head  of  the  ftmur  and  ligament um  teres,  and  posterior  portion  of  acetabulum,  and  was  found 
lodging  in  the  lower  attachment  of  the  latissimus  dorsi.  A  large  abscess  was  found  in  the  locality 
of  the  iliacus  internus  and  psoas  muscle,  the  cartilage  and  bone  of  the  joint  much  absorbed,  and 
the  cancellated  structure  infiltrated  with  sanious  pus." 

CASE  166. — Private  M.  J.  H.  Perkins,  Co.  K,  6th  Maine,  aged  21  years,  was  wounded  at 
Chancellorsville,  May  3,  1833.  He  was  admitted  to  Judiciary  Square  Hospital,  Washington,  May 
7th,  and  transferred  to  McDougall  Hospital,  Fort  Schuyler,  New  York  Harbor,  one  month  after 
wards.  Assistant  Surgeon  R.  Bartholow,  U.  S.  A.,  contributed  the  specimen  (Cat.  Surg.  Sect,, 
1866,  p.  235,  Spec.  1659),  represented  in  the  adjacent  wood-cut  (FlG.  34),  with  the  following  descrip 
tion:  "A  minic  ball  entered  the  left  hip,  striking  the  neck  of  the  femur  within  the  capsule,  passing 
through  the  obturator  foramen  and  between  the  rectum  and  urethra  without  injuring  either,  and 
escaped  behind  the  ramus  of  the  right  ischium.  Inflammation  of  the  prostate  gland,  and  priapism 
set  in.  The  patient  died  June  13,  1863."  The  specimen  consists  of  the  bones  of  the  hip  joint,  the 
articular  surfaces  being  entirely  eroded. 

Of  the  two  hundred  and  forty-nine  fatal  cases  of  shot  fractures  of  the  hip  joint, 
twenty-three  were  limited  to  the  head  of  the  femur  alone.  In  ten  instances  autopsies 
were  performed,  and  six  specimens  are  preserved 
in  the  Army  Medical  Museum.  Two  are  represented 
in  the  adjoining  wood-cuts.  /Specimen  1968  (FiG.  35) 
was  obtained  from  Corporal  J.  E.  G ,  Co.  I,  2d 

South  Carolina,  aged  22  years, 

wounded  at  Gettysburg,  July 

2,   1863.     The   head   of   the 

femur  was  slightly  fractured; 

the  acetabulum  became  cari 
ous,  and  the  patient  died  from 

exhaustion  on  Oct.  12,  1863, 

one   hundred    and   two   days 

after  the  injury  (Circular  2, 

TIG.  35.— Bones  of  the  right  hip  joint.  ' 

Head  of  femur  nearly  absorbed.    Spec,     page   71,    CASE   42).      /Specimen 

2198  (FiG.  36)  shows  the  bone 
of  the  left  hip  joint.  The  head  of  the  femur  is  carious  and  the  articular  surface  has  been 
roughened  by  ulceration.  The  history  of  the  case  from  which  the  specimen  was  obtained 
is  given  in  detail  in  Circular  No.  2,  page  82,  CASE  104.  Besides  the  specimen  cases  here 
referred  to,  fifteen  have  been  detailed  in  Circular  No.  2.2  The  histories  of  the  remaining 
six  cases  will  here  be  recorded: 

CASE  167.— Private  I.  Conduri,  Co.  D,  1st  Michigan  Cavalry,  aged  22  years,  was  shot  in  the  right  thigh  while  on  scout 
near  Cnlpepcr,  April  24,  1864.     He  was  admitted  to  the  Third  Division  Hospital,  Alexandria,  whence  Surgeon  E.  Bentley, 

1  MOSES  (J.),  Surgical  Notes,  etc.,  in  Am.  Jour.  lied.  Sci.,  1864,  Vol.  XLVII,  p.  337. 

2  Circular  No.  2, 1869 :  CASE  9,  p.  66,  Pt.  C.  Benjamin,  1 18th  Pennsylvania.     CASE  1 4,  p.  67,  Pt.  F.  Bowman,  F,  1st  U.  S.  Sharpshooters.     CASE  25, 

p.  69,  Pt.  J.  A.  Deyo,  B,  20th  Indiana,      CASE  53,  p.  73,  Pt.  J.  Harrigan,  K,  36th  Mass.     CASE  57,  p.  73,  Pt.  Robt.  N.  II ,  D,  1st  New  Jersey  Cav.,  Spec. 

3636.  CASE  70,  p.  76,  Pt.  J.  Lawler,  B,  12th  New  York  Cav.    CASE  74,  p.  76,  Pt  Chas.  II.  M ,  G,  L'd  Maryland,  Spec.  3U23.   CASE  85,  p.  78,  Pt.  Tohn  M , 

1, 61st  New  York,  Spec.  1602.     CASE  101,  p.  82,  Pt.  H.  Sault,  1, 5th  New  York.    CASE  1C8,  p.  83,  Pt.  J.  Spangler,  A,  38th  Ohio.   CASE  111,  p.  83,  Sergeant  H. 
Stulter,  D,  Slid  Pennsylvania.     CASE  113,  p.  83,  Pt.  Peter  L.  Swank,  I,  38th  Ohio.     CASK  115,  p.  83,  Serg't  V.  Tidball,  H,  122d  Ohio.    CASE  246,  p.  100,  Pt. 
F.  Kreegor,  B,  18th  Georgia.     CASE  251,  p.  101,  Pt  S.  Sellers,  1, 168th  Ohio. 

SURG.  Ill— 11 


FiG.  36. — Bones  of  the  left  hip  joint  with  carious  head  of 
femur.     Spec.  2198. 


82  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

U.  S.  V.,  reported:  "The  treatment  consisted  of  water  dressings,  tonics,  stimulants,  and  extra  diet.  The  patient  died  June  11, 
1864.  The  post-mortem  showed  that  the  ball  entered  the  thigh  at  its  middle  third,  on  its  anterior  aspect,  passed  upward  and 
entirely  through  the  articulation  of  the  hip  joint,  and  lodged  in  the  body  of  the  sacrum." 

CASE  168.— Sergeant  M.  D.  Ensor,  Co.  C,  20th  North  Carolina,  aged  '26  years,  was  wounded  and  captured  at  Winchester, 
September  19,  1864.  On  the  following  day  he  was  admitted  to  the  Prisoners  Hospital,  where  Assistant  Surgeon  II.  B.  Noble, 
2d  Ohio  Cavalry,  recorded:  "Gunshot  compound  comminuted  fracture  of  upper  third  of  right  femur;  Desault's  long  splint? 
applied  and  simple  dressings."  Surgeon  A.  Chapel,  U.  S.  V.,  reported  the  man's  admission  to  West's  Buildings  Hospital, 
Baltimore,  January  19,  1865,  from  Winchester,  with  "gunshot  wound,  the  ball  entering  near  the  trochanter  of  the  tfiigh  bone, 
producing  fracture."  On  May  9th  the  prisoner  was  transferred  to  Fort  McHenry.  Surgeon  W.  Hays,  U.  S.  V.,  in  charge  of 
the  Post  Hospital  at  the  latter  place,  reported  that  the  man  "died  from  exhaustion,  resulting  from  excessive  suppuration  caused 
by  gunshot  fracture  of  head  of  femur,  June  3,  1865." 

CASE  169. — Private  A.  Farm,  Co.  C,  18th  Tennessee,  was  wounded  at  Stone's  River,  December  31,  1862,  and  admitted 
to  hospital  No.  4,  Nashville,  January  27th.  Acting  Assistant  Surgeon  F.  L.  Tower  reported:  "Gunshot  fracture  of  head  of  left 
femur  and  wound  of  abdomen.  Death  on  January  31,  1863." 

CASE  170. — Private  S.  Irwin,  Co.  C,  10th  Massachusetts,  aged  25  years,  was  wounded  at  the  Po  River,  May  12,  1864. 
Surgeon  S.  F.  Chapin,  139th  Pennsylvania,  noted  his  admission  to  the  field  hospital  of  the  2d 
division,  Sixth  Corps,  with  "gunshot  wound  of  left  thigh."  On  May  24th  the  wounded  man  was 
admitted  to  Prince  Street  Hospital,  Alexandria,  whence  Acting  Assistant  Surgeon  J.  Cass  con 
tributed  the  specimen  (Cat.  Surg.  Sect.,  1866,  p.  234,  Spec.  2374)  and  the  following  report:  "The 
patient  suffered  considerable  pain,  had  chills,  was  very  uneasy  and  anxious,  had  no  appetite,  hic 
cough,  and  great  prostration,  and  died  May  28,  1864.  At  the  autopsy  the  left  groin  was  found 
considerably  discolored,  and,  on  examination,  it  was  discovered  that  the  wound  commenced  just 
below  the  middle  of  Poupart's  ligament,  extending  doAvmvard  and  inward,  and  terminating  at  the 
ischium,  which  was  fractured.  The  ball  was  found  near  that  bone,  between  it  and  the  head  of  the 
femur,  which  was  also  fractured.  The  ligaments  of  the  hip  joint,  the  soft  parts  in  the  groin,  and 

the  upper  part  of  the  thigh  were  gangrenous."     The  specimen  (FlG.  37)  consists  of  a  portion  of  the 
FIG.  37. — Portion  of  left  ischi-      .   ,,    .     ,  .  .,        ,.  .-,      ,.  rrl  ,.    ,  ,.  ,.  ,,      ,        ,     „    , 

urn  and  upper  part  of  femur.     'e™  ischmm  and  tiie  upper  extremity  01  the  lemur.     Inere  is  a  partial  fracture  of  the  head  ot  the 

Spec.  2374.  femur  at  its  articular  border  and  of  the  ischium  by  a,  battered  round  bull,  which  is  attached. 

CASE  171. — Lieutenant  J.  Snyder,  Co.  K,  83d  Ohio,  aged  33  years,  was  wounded  at  Fort  Blakely,  April  9,  1865,  and 
admitted  to  the  St.  Louis  Hospital,  New  Orleans,  five  days  afterwards.  Surgeon  A.  McMahon,  U.  S.  V.,  reported:  ''Gunshot 
wound  of  right  thigh  and  nates,  fracturing  the  ischium  and  the  femur  at  its  neck.  Death  resulted  from  peritonitis  following 
inflammation  of  the  pelvic  fascia." 

CASK  172. — Private  A.  Underbill,  Co.  C,  10th  New  York,  was  wounded  at  the  Wilderness,  May  6,  1864,  and  admitted 
to  the  field  hospital  of  the  2d  division,  Second  Corps.  Surgeon  J.  F.  Dyer,  19th  Massachusetts,  reported:  "Gunshot  fracture 
of  head  of  femur."  The  wounded  man  was  conveyed  to  Fredericksburg,  where  he  died  May  15,  1864. 

In  seventeen  of  the  fatal  cases  after  shot  fracture  of  the  hip  joint  treated  by  conserva 
tion  the  head  and  neck,  or  head,  neck,  and  trochanters  of  the  femur  were  injured.  Full 
details  of  fifteen  of  the  cases,  with  illustrations  of  eight  specimens,  have  been  given  in 
Circular  2.1  Meager  details  of  two  cases  will  here  be  added : 

CASE  173. — Private  H.  P,eters,  Co.  D,  18th  U.  S.  Infantry,  was  wounded  at  Chickamauga,  September  19,  1863.  He 
was  admitted  to  hospital  at  Chattanooga  ten  days  after  the  injury.  Surgeon  J.  S.  Woods,  99th  Ohio,  reported:  "Fracture  of 
head  and  neck  of  right  femur.  Patient  in  bad  condition;  several  pieces  of  bone  were  removed."  The  man  died  October  11, 
1863.  On  the  list  of  casualties  at  the  battle  of  Chickamauga,  furnished  by  Surgeon  G.  Perin,  U.  S.  A.,  Medical  Director  of  the 
Army  of  the  Cumberland,  the  injury  in  this  case  is  reported  as  a  "  wound  of  privates  and  right  side." 

CASE  174. — Private  F.  Benda,  Co.  F,  26th  Wisconsin,  aged  19  years,  was  wounded  at  Gettysburg,  July  1,  1863,  and 
admitted  to  the  field  hospital  of  the  2d  division,  Eleventh  Corps,  where  Surgeon  W.  II.  Thorn,  U.  S.  V.,  recorded:  "Gunshot 
wound  of  left  hip ;  ball  extracted."  On  August  6th  the  patient  entered  Camp  Letterman  Hospital,  where  Surgeon  H.  Janes, 
U.  S.  V.,  recorded:  "The  patient  suffers  from  a  compound  comminuted  fracture  of  femur.  The  ball  entered  from  the  outside 
of  the  hip,  crushing  the  bone  from  the  trochanter  major  upward,  then  passing  obliquely  upward  entered  the  pelvis  near  the 
sacrum.  No  history  of  this  case  could  be  procured  previous  to  his  admission  to  this  hospital.  August  12th,  the  patient  suffers 
from  diarrhoea  and  hectic  fever  and  is  sinking  rapidly.  He  died  from  exhaustion,  August  20,  1863.  Treatment:  Exhibition 
of  tonics,  stimulants,  and  anodynes." 

1  Circular  2,  1869:  CASE  6,  p.  66,  Pt.  J.  Barnes,  B,  52d  Indiana.     CASE  8,  p.  56,  Pt.  Anthony  B ,  C,  12th  Illinois,  Spec.  46G.     CASK  10,  p.  66, 

Pt.  Charles  R.  B ,  E,  16th  Maine,  Spec.  598.     CASE  17,  p.  67,  Pt.  W.  C ,  159th  New  York,  Spec.  1291.     CASE  21,  p.  68,  Pt,  D.  Curran,  A,  5th 

Kentucky.     CASE  45,  p.  72,  Major  John  J.  G- -,  G,  47th  Pennsylvania,  Spec.  3789.    CASE  52,  p.  73,  Corporal  Benjamin  H ,  C,  9th  West  Virginia, 

Spec.  4267.     CASE  76,  p.  77,  Corporal  Donald  McD ,  E,  12th  New  York  Cav.,  Spec.  2170.      CASE  89,  p.  79,  Serg't  8.  W.  N ,  E,  15th  Now  Jersey, 

Spec.  1253.     CASE  91,  p.  80,  Captain  Samuel  Oakley,  77th  New  York.     CASK  102,  p.  82,  Pt.  C.  Saunders,  C,  Cth  Louisiana  Cavalry.     CASE  106,  p.  82, 

Pt.  G.  IT.  S ,  H,  2d  North  Carolina,  Spec..  1967.     CASE  118,  p.  84,  Pt.  H.  A.  Walker,  E,  2d  New  Hampshire.     CASE  275,  p.  113,  Pt,  A.  Swanson,  II, 

3d  Michigan.  In  the  case  reported  by  Dr.  J.  DlCKSOX  BltUXS  (Circ.  2,  S.  G.  O.,  1869,  p.  57),  a  first  attempt  to  remedy  the  injury  by  an  operation  was 
suspended,  as  the  haemorrhage  was  very  great.  Some  ten  days  or  two  weeks  after,  an  excision  of  the  head  of  the  femur  was  attempted,  as  an  examination 
had  shown  that  the  neck  was  extensively  split.  After  the  primary  incisjons  had  been  made,  and  several  fragments  of  the  neck  had  been  removed,  the 
operation  was  discontinued,  as  it  became  apparent  that  death  was  inevitable. 


SECT.  II.] 


WOUNDS    AND    INJURIES    OF    THE    HIP    JOINT. 


83 


Seventy  instances  are  recorded,  among  the  two  hundred  and  forty-nine  fatal  cases  of 
shot  fractures  of  the  hip  joint  treated  by  conservation,  in  which  the  neck  of  the  femur  was 
stated  to  have  been  fractured.  Fifty-six  of  the  cases  have 
been  recorded  in  Circular  2;1  fourteen  will  be  recorded 
here.  Autopsies  were  made  in  twenty-one  of  the  cases, 
and  eleven  specimens  are  preserved  in  the  Army  Medical 
Museum.  A  specimen  belonging  to  this  group,  represented 
in  the  adjoining  wood-cut  (FiG.  38),  was  received  without 
history.  It  consists  of  the  upper  fourth  of  the  femur,  with 
a  fragment  of  a  round  ball  embedded  in  the  neck  within  the 
capsule.  There  is  no  evidence  of  chronic  articular  disease. 

FIG. 38.-Shot  fracture     m,  •  f    '        Ml  C    '     •  1,  FIG.  39.-Shot  fracture 

of  neck  _0f  left  femur.    The  specimen  is  a  tair  illustration  ol  injury  to   bone   by    sfe°ei661     g 

round  balls  at  low  velocities.     A  similar  specimen  is  rep 
resented  in  FIG.  39,  showing  a  round  ball  embedded  in  the  neck  of  the  femur  near  the 
trochanter  major,  fracturing  the  neck  within  the  capsule.     The  history  of  this  case  has 
been  detailed  in  Circular  No.  2,  p.  81,  CASE  98. 

CASE  175. — Private  J.  Boaz,  Co.  A,  1st  Confederate  States  Cavalry,  was  wounded  at  Stone's  River,  December  31,  1862. 
He  was  admitted  into  No.  19  Hospital,  Nashville,  January  20,  1863.  Surgeon  J.  Shrady,  2d  East  Tennessee,  noted:  "Gun 
shot  compound  fracture  of  the  neck  of  the  right  femur."  Ho  died  February  4,  1863. 

CASK  170. — Private  J.  W.  Connor,  Co.  D,  81st  Pennsylvania,  was  wounded  at  Fredericks- 
burg,  December  13, 1862.  Surgeon  J.  E.  McDonald,  79th  New  York,  recorded  his  entrance  into 
the  field  hospital  of  the  1st  division,  Ninth  Corps,  with  "Gunshot  wound  of  left  thigh."  Surgeon 
J.  A.  Lidell,  U.  S.  V.,  contributed  the  specimen  represented  in  the  adjoining  wood-cut  (FiG. 
40)  (Cat.  Surri.  Sect.,  1866,  p.  243,  Spec.  622),  and  reported  the  following  history:  "Admitted 
to  Stanton  Hospital,  Washington,  December  26th,  with  gunshot,  fracture  of  left  thigh  in  upper 
third;  ball  not  extracted.  The  injured  limb  was  a  good  deal  swelled;  pus  flowing  from  the 
wound.  Exploration  did  not  discover  the  ball;  thigh  found  fractured  high  up;  amount  of 
displacement  small.  The  case  did  pretty  well  till  December  31st,  when  symptoms  of  pyaemia 
showed  themselves.  He  grew  rapidly  worse,  and  died  January  2,  1863.  The  necropsy  showed 
inflammation  of  the  femoral  vein,  pus  in  the  femoral  and  iliac  veins,  a  comminuted  fracture  in 
the  neighborhood  of  the  trochanters,  and  the  ball  firmly  impacted  in  the  ischium.''  The  specimen 
consists  of  the  bones  of  the  hip  joint  with  a.  portion  of  the  ligaments,  the  head  of  the  femur  being  FK,  4o._Bones  of  the  left  hip 

dislocated.     The  track  of  the  ball  is  necrosed,  but  a  small  quantity  of  callus  has  been  thrown    .i»int  with  dislocation  of  head  of 

.  .  „  femur.     Spec.  622. 

out  on  ilie  anterior  surface  of  the  femur. 

CASE  177. — Private  A.  E.  Davis,  Co.  E,  1st  Maine  Cavalry,  aged  22  years,  was  wounded  during  the  Richmond  raid, 
March  2,  1864,  and  admitted  to  the  General  Hospital  at  Fort  Monroe  five  days  afterwards.  Assistant  Surgeon  E.  McClellan, 
U.  S.  A.,  reported:  "Gunshot  wound  of  right  hip.  The  patient  was  admitted  in  good  condition;  wound  healthy.  Pyaemia 
was  developed  on  March  12th,  and  death  occurred  within  twenty-four  hours.  The  autopsy  discovered  that  the  ball  had  pierced 
the  neck  of  the  femur.  There  were  symptoms  of  inflammation  of  the  femoral  vein ;  six  ounces  of  dark  bloody  fluid  in  left 

1  Circular  2,  S.  G.  O.,  1869:  CASE  1,  p.  65,  Pt.  A.  Baker,  5th  Maine  Battery.     CASE  3,  p.  65,  Pt.  J.  Balines,  C,  26th  Wisconsin.     CASE  4,  p.  60,  Pt.  W. 

Bancho,  II,  3d  New  Hampshire.     CASE  5,  Corp'l  M.  Barden,  K,  10th  Mass.     CASE  12,  p.  67,  Serg't  (i.  Bond,  A,  137th  Illinois.     CASE  18,  p.  68,  Pt.  1'.  C . 

G,  24th  Alabama  (sec  also  Confed.  States  Med.  Jour.,  Vol.  I,  p.  76).  CASE  19,  p.  68,  Pt.  J.  Connelly,  C, 1st  Louisiana  (Colored)  Cavalry.  CASE  23,  p.  68,  Pt. 
It.  Damback,  1, 17th  Ohio.  CASE  26,  p.  69,  Pt.  J.  Dice,  43d  Missouri.  CASE  27,  p.  69,  Pt.  C.  <  1.  Dodson,  C,  13th  West  Virginia.  CASE  29,  p.  69,  Pt.  E.  II. 
Dimklebcrg,  F,  11  th  Infantry.  CASE  30,  p.  69,  Pt.  N.  II.  Eisenhower,  F,  103d  Ohio.  CASE  33,  p.  70,  Pt.  D.  Elmer,  M,  14th  New  York  H.  A.  CASE  35,  p.  70, 
Pt.  A.  E.  Fields,  B,  6th  Maine,  Spec.  2932.  CASE  36,  p.  70,  Pt.  S.  Fleig,  E,  45th  New  York.  CASE  38,  p.  70,  Pt.  J.  Foreman,  E,  5th  Alabama.  CASE  4J,  p. 

71,  Pt.  S.  F ,  E,  lllth  New  York,  Spec.  14G2.    CASE  44,  p.  71,  Pt.  J.  G ,  B,  New  Hampshire  II.  A.,  Spec.  3540.     CASE  47,  p.  72,  Pt.  B.  F.  Green,  E, 

125th  New  York.  CASE  48,  p.  72,  Pt.  T.  Green,  L,  12th  Tennessee  Cav.  CASE  50,  p.  72,  Pt.  D.  Haley,  15,  57th  Mass.  CASE  54,  p.  73,  Pt.  L.  P.  Harvey,  B, 
,11th  Now  Hampshire.  CASE  58,  p.  74,  Pt.  W.  linger,  D,  7th  Virginia.  CASE  62,  p.  74,  Pt.  P.  C.  Johnson,  H,  15th  Ohio.  CASE  65,  p.  74,  Pt.  U.  A.  Kimble. 
G,  3d  Minnesota.  CASE  72,  p.  76,  Corp'l  J.  G.  Mallory,  C,  31st  Indiana.  CASE  75,  p.  76,  Pt.  J.  Matthews,  A,  llth'  Louisiana  (Colored).  CASE  77,  p.  77,  E. 
McGce,  Secret  Service.  CASE  78,  p.  77,  Lieut.  T.  H.  McKiuley,  B,  29th  U.  S.  C.  T.  CASE  81,  p.  77,  Pt.  J.  W.  Moore,  II,  Oth  Penn.  Cav.  CASE  82,  p.  78,  Pt. 

J.  M ,  F,  63d  New  York,  Spec.  782.     CASE  83,  p.  78,  Pt.  J.  R.  Merrill,  D,  184th  Penn.     CASE  84,  p.  78,  Pt.  P.  M ,  H,  1st  Virginia,  Spec.  33.     CASE  86, 

p.  79,  Pt.  J.  B.  Mullen,  G,  13th  Indiana.    CASE  95,  p.  81,  Pt.  J.  L.  Riley,  1, 21st  Mississippi.    CASE  98,  p.  81,  Pt.  L.  11 ,  F,  48th  New  York,  Spec.  1661.   CASE 

100,  p.  81,  Serg't  F.  Sailyards,  A,  70th  Ohio.     CASE  107,  p.  82,  Corp'l  H.  F.  Smith,  B,  1st  Wisconsin.     CASE  109,  p.  83,  Corp'l  J.  A.  Staunton,  II,  1st  Florida. 

CASE  110,  p.  83,  Pt.  J.  Stewart,  B,  26th  Ohio.     CASE  112,  p.  83,  Pt.  J.  S ,  B,  43d  Ohio,  Spec.  465.     CASE  117,  p.  84,  Pt.  J.  Wagoner,  F,  81st  Illinois.    CASE 

1 19,  p.  81,  Pt.  I.  W.  Winans,  C,  3d  Wisconsin.  CASE  120,  p.  84,  Corp'l  G.  W.  Wright,  Blonnf  s  Virginia  Battery.  CASE  1 21,  p.  84,  Pt.  U*  /'.  Ycargin,  E, 
22d  Georgia.  CASE  212,  p.  96,  Pt.  S.  Randall,  G,  118th  New  York.  CASE  236,  p.  99,  Serg't  S.  R.  Arrison,  A,  118th  Illinois.  CASE  240,  p.  100,  Pt.  J.  T.  Cmie, 
7th  Virginia  (see  Am.  Mcd.  Times,  1864,  Vol.  VIII,  p.  13).  CASE  241,  p.  100,  Pt.  W.  A.  Dibble,  C,  106th  Pcnn.  CASE  249,  Pt.  B.  Page,  I,  51st  North  Carolii 

CASE  255,  p.  102,  Corp'l  G.  W.  W ,  Virginia  Battery.     CASE  259,  p.  102,  Pt.  H.  T.  Elam,  A,  llth  Virginia,  Spec.  9.    CASE  268,  p.  104,  Pt.  E.  Longyear,  D, 

72d  Penn.  CASE  269,  p.  104,  Pt.  L.  N.  P.  Rodenbough,  D,  55th  Illinois.  CASE  271,  p.  105,  Pt.  L.  Schmidt,  H,  8th  Kansas.  CASE  276,  p.  114,  Serg't  E.  Scott, 
A,  1st  New  Jersey  Cavalry,  Spec.  3520. 


84  INJURIES    OF   THE    LOWER   EXTREMITIES.  [CHAP.  x. 

thorax,  with  an  oily  fluid  floating  on  it;  two  ounces  of  light  colored  bloody  fluid  in  pericardium;  an  oily  substance  collected  on 
the  blood  from  all  parts  of  the  body.     Liver  engorged  and  soft.     No  formation  of  pus  discovered." 

CASE  178. — Private  G.  W.  Fierstine,  Co.  K,  93d  Pennsylvania,  was  wounded  at  Fair  Oaks,  June  1,  1862,  and  admitted 
to  the  Fifth  and  Buttomvood  Streets  Hospital,  Philadelphia,  six  days  afterwards.  Acting  Assistant  Surgeon  A.  C.  Bournonville 
reported:  "Fracture  of  neck -of  femur,  tuberosity  of  ischium  shot  off  and  pelvic  bones  shattered;  no  wound  of  bladder  or 
rectum.  Prognosis  fatal.  Patient  was  most  comfortable  by  having  the  limb  elevated  and  supported  by  pillows.  He  died  June 
12,  1862." 

CASE  179. — Private  J.  M.  Hayse,  Co.  K,  14th  Kansas  Cavalry,  was  accidentally  wounded  May  19,  1864,  and  admitted 
to  hospital  at  Fort  Smith.  Surgeon  C.  E.  Swasey,  U.  S.  V.,  reported:  "Gunshot  wound  of  left  thigh  into  abdomen,  with 
fracture  of  neck  of  femur.  Death  resulted,  from  perforation  of  the  bowels,  on  May  20,  1864." 

CASE  180. — Private  F.  M.  Hayes,  Co.  A,  211th  Pennsylvania,  aged  21  years,  was  wounded  at  Fort  Steadman,  March 
25,  1865.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Ninth  Corps,  where  Surgeon  M.  F.  Bowes,  211th  Pennsyl 
vania,  recorded:  "Wound  of  right  hip  by  conoidal  ball."  Two  days  afterwards  the  man  was  moved  to  the  Depot  Hospital  at 
City  Point,  and  ten  days  later  he  was  conveyed  on  a  hospital  steamer  to  Alexandria,  Avhere  he  entered  the  Third  Division 
Hospital.  Surgeon  E.  Bentley,  U.  S.  V.,  reported:  "Gunshot  fracture  of  right  hip.  Light  cold-water  dressings  and  a  bandage 
were  applied  over  the  thigh  to  facilitate  the  discharge  of  pus  from  the  wound.  The  limb  was  retained  in  position  by  means 
of  an  inclined  plane,  with  slight  extension  and  counter-extension.  Alcoholic  stimulants  and  nourishing  diet  were  freely  admin 
istered.  He  died  April  14,  1865.  Autopsy  thirteen  hours  after  death:  Tissues  of  thigh  very  much  disorganized  by  the  extent 
of  suppuration,  involving  the  entire  limb.  The  femur  was  fractured  at  the  neck.  The  ball  had  passed  under  the  pubis  and  was 
found  in  the  pelvis,  external  to  the  peritoneum." 

CASE  181. — Private  C.  Hambrecht,  Co.  E,  4th  New  Jersey,  was  wounded  at  South  Mountain,  September  14,  1862,  and 
admitted  to  the  field  hospital  at  Burkettsville.  Assistant  Surgeon  H.  A.  DuBois,  U.  S.  A.,  reported:  "Gunshot  wound  through 
os  pubis  and  neck  of  femur.  Secondary  haemorrhage  occurred  on  October  18th.  A  ligature  was  applied  to  the  external  iliac 
and  the  femoral  arteries.  But  little  blood  was  lost,  the  surgeon  being  in  the  ward  at  the  time  the  haemorrhage  commenced. 
The  operation  was  difficult,  it  being  necessary  in  order  to  stop  the  hemorrhage  to  compress  the  artery  on  each  side  and  close  to 
the  wound,  which  was  directly  below  Poupart's  ligament.  The  patient  rallied  after  the  operation  and  was  able  to  read  a  letter, 
but  died  six  hours  after." 

CASE  182. — Private  W.  J.  Little,  Co.  I,  57th  Pennsylvania,  aged  22  years,  was  wounded 
at  the  Wilderness,  May  5,  18G4,  and  admitted  to  the  field  hospital  of  the  3d  division,  Second 
Corps.  Surgeon  O.  Lvarts,  20th  Indiana,  noted:  "Gunshot  wound  of  left  hip."  Surgeon 
D.  W.  Bliss,  U.  S.  V.,  forwarded  the  specimen  (Cat.  Surg.  Sect.,  1866,  p.  241,  Spec.  2398) 
and  reported:  "The  patient  entered  Armory  Square  Hospital,  Washington,  May  28th.  He 
was  wounded  by  a  conoidal  ball,  which  entered  the  right  gluteal  region  on  a  line  with  the 
coccyx,  two  inches  above  the  anus,  passing  under  the  fascia  in  a  direct  line  and  through  the 
ramus  of  the  ischium,  comminuting  the  left  femur  at  its  neck,  and  making  its  exit  over  the 
great  trochanter.  Powerful  stimulants  were  given  but  with  no  effect.  The  patient  died  from 
the  effects  of  the  injury,  May  30,  1864."  The  specimen  shown  in  the  wood-cut  (FlG.  41) 
FIG.  41.— Hones  of  left  hip  joint,  consists  of  the  bones  of  the  left  hip  joint,  and  shows  the  head  of  the  femur,  with  the  exception 
Neck  of  femur  shattered.  Spec.  2398.  of  a  slight  fissure  on  its  articular  surface,  to  be  uninjured. 

CASE  183. — Private  J.  McAlpine,  Co.  C,  7th  Illinois,  was  wounded  at  Allatoona,  October,  5,  1864.  Surgeon  J.  R. 
Zearing,  57th  Illinois,  reported  his  admission  to  the  field  hospital  of  the  4th  division,  Fifteenth  Corps,  with  "gunshot  fracture 
of  neck  of  femur,"  and  his  death  on  October  8,  1864. 

CASE  184. — Musician  F.  McNeil,  Co.  B,  17th  Illinois,  was  wounded  at  Shiloh,  April  6,  1862,  and  admitted  to  hospital 
at  Quincy  twelve  days  afterwards.  Surgeon  R.  Niccolls,  U.  S.  V.,  reported:  "Compound  comminuted  fracture  of  right  femuu 
at  the  neck  and  transverse  fracture  of  left  femur  at  the  middle  third.  Dr.  Buck's  weight  and  pulley  were  employed.  Death 
took  place  on  April  27, 1862.  At  the  post-mortem  a  mini6  ball,  split  longitudinally,  was  removed  from  the  neck  of  the  femur." 

CASE  185. — Private  U.  T.  Palmer,  Co.  I,  1st  Maine,  aged  33  years,  was  wounded  at  Cedar  Creek,  October  19,  1864,  and 
admitted  to  the  field  hospital  of  the  2d  division,  Sixth  Corps.  Surgeon  S.  F.  Chapin,  139th  Pennsylvania,  noted  :  "Gunshot 
fracture  of  left  thigh."  On  October  27th  the  wounded  man  was  admitted  to  Camden  Street  Hospital,  Baltimore,  whence 
Surgeon  Z.  E.  Bliss,  U.  S.  V.,  reported  as  follows:  "Gunshot  wound  of  left  gluteal  region,  with  fracture  of  neck  of  femur. 
Smith's  anterior  splints  were  applied,  and  quinine  and  carbonate  of  ammonia,  etc.,  were  resorted  to,  but  unsuccessfully.  The 
patient  died  of  pyaemia,  November  3,  1864.  At  the  post-mortem  pus  was  found  in  the  synovial  cavities  near  the  hip  joint." 

CASE  186. — Sergeant  W.  Peabody,  Co.  C,  10th  Vermont,  aged  22  years,  was  wounded  at  Monocacy,  July  9,  1864,  and 
admitted  to  hospital  at  Frederick  the  following  day.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  reported:  "Gunshot  fracture 
of  neck  of  left  femur  and  flesh  wound  of  thigh  and  scrotum.  Ball  removed  July  llth.  Tonics,  opiates,  and  stimulants 
administered;  Buck's  extension  apparatus  applied.  Death,  from  exhaustion,  July  23,  1864." 

CASE  187. — Private  J.  H.  Smith,  Co.  H,  12th  South  Carolina,  appears  on  a  report  from  the  Confederate  Hospital  al 
Charlottesville  as  having  died  June  1,  1864,  of  "gunshot  wound  of  left  thigh;  missile  found  in  neck  of  femur." 

CASE  188. — Captain  R.  Ward,  Co.  B,  33d  Alabama,  was  wounded  at  Perry ville,  October  8,  1862.  On  a  report  of  "  Sick 
and  Wounded  Confederates  left  behind  after  the  battle,"  signed  by  Surgeon  C.  Longenbecker,  13th  Louisiana  Regiment,  C.  S.  A., 
his  injury  is  described  as  a  "gunshot  fracture  of  left  thigh  through  neck  of  femur  into  the  joint  and  os  ischii,  ball  in  pelvis," 
and  his  death  is  stated  to  have  occurred  on  October  27,  1862 . 


SECT.  II.] 


WOUNDS    AND    INJURIES    OF   THE    HIP    JOINT. 


85 


FIG.  42.-Comminuted  frac 
ture  of  upper  third  of  left  fe 
mur,  with  fissure  extending 
into  the  neck.  Spec.  49:30. 


FIG.  43. — Upper  portion  of  left  femur, 
with  fragments  of  bone  removed  after 
shot  fracture  of  the  neck.  Specs.  3143 
and  67. 


Of  the  two  hundred  and  forty-nine  fatal  shot  wounds  of  the  hip  joint  treated  by  conser 
vation  fifty  were  instances  of  shot  injuries  of  the  neck  and  trochanters,  or  neck,  trochanters 
and  shaft  of  femur.  Autopsies  were  performed  in  thirty-two  instances,  and  twenty-five 
specimens  are  deposited  in  the  Army  Medical  Museum.  All  of  the  cases  have  been 
reported  in  Circular  No.  2,1  and  only  a  few  of  those  in  which  interesting  specimens  are 
preserved  will  be  here  briefly  noticed. 

CASE  189.— Private  C.  H.  Elliott,  Co.  D,  61st  Pennsylvania,  was  wounded  at  the  battle  of  Fair  Oaks,  May  31,  1862,  by 
several  musket  balls.  One  entered  near  the  right  acromion  process  and  emerged  at  the  insertion  of  the  deltoid  muscle ;  another 
at  the  gluteal  fold;  a  third  passed  through  the  tipper  part  of  the  thigh;  a  finger  was  also  shot  away. 
He  was  conveyed  to  Portsmouth,  and  on  June  5th  was  admitted  into  the  Balfour  General  Hospital. 
A  fracture  of  the  head  of  the  humerus  was  recognized,  and,  on  June 
14th,  Assistant  Surgeon  Sheldon,  U.  S.  A.,  excised  the  head  and 
about  three  inches  of  the  shaft  (see  Second  Surgical  Volume,  p.  586, 
CASE  23).  Abscesses  formed  in  the  left  thigh.  Pyaemia  super 
vened,  and  the  patient  died  on  June  17,  1862.  At  the  autopsy  the 
upper  third  of  the  femur  was  found  to  be  shattered.  There  was  a 

collection  of  pus  near  the  wound  in  the  hip.     Assistant  Surgeon  II.     f!v    V'^     )  \j   ( 
L.  Sheldon,  U.  S.  A.,  reports  the  case.     The  specimen,  4930,  repre 
sented  in  FlG.  42,  was  contributed  by  Assistant  Surgeon  W.  Thorn- 
son,  U.  S.  A..— (Circular  No.  2,  p.  69,  CASE  31.) 

CASE  190.— Private  Philo  Wilbur,  Co.  1, 185th  New  York,  aged 

19  years,  was  wounded  in  action  at  the  Southside  Railroad,  Virginia, 

March  25,  1865.     A  conoidal  ball  entered  over  the  left  trochanter 

major,  produced  a  comminuted  fracture  of  the  process,  and  emerged 

at  the  lower  and  inner  border  of  the  left  buttock.     He  was  taken  to 

City  Point  and  Washington  and  admitted,  on  April  2d,  into  the 
Mount  Pleasant  Hospital.  On  April  7th  there  was  febrile  action  and  anorexia.  On  April  9th,  Assistant  Surgeon  H.  Allen, 
U.  S.  A.,  removed  several  detached  fragments  of  bone.  Irritative  fever  and  anorexia  continued.  On  April  14th  he  had  a  rigor; 
pyffimia  appeared,  with  vomiting  and  diarrhoea.  On  April  18th  secondary  haemorrhage  of  from  six  to  eight  ounces  occurred 
from  branches  of  the  external  circumflex,  and  was  arrested  by  compression  of  the  femoral.  He  died  April  20,  1865.  The 
history,  with  the  specimens  3143  and  67  (FlG.  43),  were  contributed  by  Assistant  Surgeon  H.  Allen,  U.  S.  A. — (Circular  No.  2, 
p.  106,  CASE  274.) 

CASE  191. — "Alfred  G.  R ,  Adjutant  134th  Pennsylvania,  aged  24  years,  was  wounded  in  the  upper  part  of  the  left 

femur  by  a  round  ball,  which  partially  fractured  the  trochanter  major,  at  the  battle  of  Fredericksburg,  December  13,  1862.  The 
wound  received  no  attention  for  some  days,  and  was  then  dressed  with  side  splints  firmly  bound  by  a  roller,  a  plug  of  lint  being 
tightly  inserted  in  the  wound.  On  the  20th  of  December  he  was  admitted  to  E  Street  Infirmary,  Washington.  He  stated  that 
for  some  days  he  had  experienced  occasional  twitchings  in  the  limb,  and  had  taken  large  doses  of  opium.  The  wound  was  a 
little  behind  the  trochanter  major.  Upon  removing  the  plug  of  lint  about  half  a  pint  of  blood  and  pus  was  discharged.  There 
was  no  crepitus  upon  rotation,  nor  shortening.  Owing  to  his  weakened  condition,  no  extended  search  was  made  for  the  missile. 
Simple  dressings  were  applied,  and  half  grain  doses  of  sulphate  of  morphia  were  given.  For  the  two  succeeding  days  he 
seemed  to  improve.  The  twitchings  of  the  limb  occurred  every  few  minutes,  with  occasional  intermissions  of  a  few  hours.  On 
the  23d  the  spasms  became  more  violent  and  frequent,  and  it  was  deemed  advisable  to  extract  the  missile.  He  was  etherized, 
and  the  wound  was  enlarged  two  inches  downward  and  backward.  A  gum  catheter  was  made  to  follow  the  course  of  the 
missile  behind  and  beneath  the  neck  of  the  femur  to  the  body  of  the  pubis,  where  the  ball  was  found  in  the  scrotum  near  the 
spermatic  cord.  A  flattened  round  musket  ball  was  extracted  through  an  incision  at  the  base  of  the  scrotum.  A  portion  of  it  had 

1  Circular  No.  2,  1869 :  CASE  15,  p.  67,  Pt.  T.  B ,  14th  North  Carolina,  Spec.  548.     CASE  20,  p.  68,  Pt.  J.  C ,*I,  10th  New  Jersey,  Spec.  3806. 

CASK  22,  p.  08,  Pt.  J.  C ,  C,  5th  New  York  Cav.,  Spec.  3189.     CASE  24,  p.  68,  Pt.  M.  D ,  H,  14th  New  York  H.  A.,  Spec.  3261.     CASE  28,  p.  69,  Pt.  A. 

D— ,  B,  43d  New  York,  Spec.  3797.     CASE  31,  p.  69,  Pt.  C.  H.  E ,  D,  61st  Penn.,  Spec.  4930.    CASE  34,  p.  70,  Pt.  J.  F ,  H,  1st  Mass.  Cav.,  Spec.  2704. 

CASE  46,  p.  72,  Pt.  F.  G ,  1st  Louisiana,  Spec.  1300.     CASK  49,  p.  72,  Pt.  G.  H ,  D,  26th  Michigan,  Spec.  2839.    CASE  51,  p.  72,  Serg't  W.  D.  H ,  A, 

6th  Iowa,  -Spec.  3488.     CASE  55,  p.  73,  Pt.  W.  Herold,  B,  6th  Alabama.     CASE  56,  p.  73,  Musician  J.  B.  H ,  A,  41st  Ohio,  Spec.  2178.    CASE  61,  p.  74,  Pt. 

H.  J ,  F,  14th  K.  York,  Spec..  2309.    CASE  64,  p.  74,  Pt,  M.  K ,  D,  65th  N.  York,  Spec.  3419.     CASE  66,  p.  74,  Pt,  A.  J.  K ,  E,  8th  Florida,  Spec.  1932. 

CASE  67,  p.  75,  Pt.  L.  P.  L, ,  K,  91st  Penn.,  Spec.  1343.     Case  68,  p.  75,  Pt.  J.  Laner,  F,  39th  N.  Jersey.    CASE  69,  p.  75,  Capt  J.  M.  L ,  1, 20th  Indiana, 

Spec.  565.     CASE  71,  p.  76,  J.  McCarthy,  E,  76th  New  York.     CASE  73,  p.  76,  Capt.  H.  D.  M ,  K,  79th  Illinois,  Spec.  1747  (Am.  Jour.  Med.  Sci.,  1864,  Vol. 

XLVII,  p.  337).     CASE  88,  p.  79,  Pt.  T.  M ,  C,  14th  Maine,  Spec.  1728.     CASE  90,  p.  79,  Serg't  W.  Norton,  1, 5th  Wisconsin  ( V.  S.  Sanitary  Commission 

Memoirs,  Vol.  I,  p.  5^6).     CASE  92,  p.  80,  Pt.  W.  O ,  K,  2d  U.  S.  Cav.,  Spec.  2528.    CASE  94,  p.  80,  Adj't  A.  G.  R ,  134th  Penn.,  Spec.  545.    CASE  96,  p. 

81,  Pt.  J.  R ,  C,  69th  New  York,  Spec.  86.    CASE  99,  p.  81,  Pt.  T.  R ,  K,  210th  Penn.,  Spec.  4168.    CASE  103,  p.  82,  Capt.  E.  F.  S ,  K,  1st  New  York 

Cav.,  Spec.  4213.   CASE  114,  p.  83,  Corp'l  J.  M.  Thompson,  B,  29th  Mass.     CASK  122,  p.  84,  Serg't  D.  Y ,  H,  106th  New  York,  Spec.  3931.    CASE  199,  p.  94, 

Serg't  J.  H.  Bridwell,  B,  87th  Illinois  Mounted  Infantry.  CASE  200,  p.  94,  Pt,  W.  Campbell,  A,  23d  Missouri.  CASE  203,  p.  95,  Serg't  W.  G.  Davis,  H,  19th 
Ohio.  CASE  205,  p.  95,  Pt.  C.  Falk,  E,  26th  New  York.  CASE  206,  p.  95,  Pt.  W.  T.  Fostner,  F,  28th  Virginia.  CASE  207,  p.  95,  Pt.  H.  B.  Gardner,  F,  38th 
Illinois.  C.V8E  208,  Pt.  M.  Haehl,  A,  3Jd  Indiana.  CASE  209,  p.  95,  Capt.  J.  D.  Irwin,  C,  124th  Ohio.  CASE  213,  p.  96,  Pt.  J.  Scheets,  T,  lllth  Ohio.  CASE 
214,  p.  'Hi,  Pt.  D.  Schamill,  H,  50th  Penn.  CASE  215,  p.  96,  Corp'l  G.  Williams,  D,  llth  Missouri.  CASE  242,  p.  100,  Corp'l  M.  J.  Fitzharris,  E,  42d  N.  York. 
CASH  258,  Pt.  F.  Beck,  F,  115th  Penn.  CASE  263,  p.  103,  Pt.  T.  Hay  ward,  F,  5th  Penn.,  Spec.  592.  CASE  265,  p.  104,  Corp'l  W.  Hermka,  D,  1st  Maryland 
Cav.  CASK  2fi6,  p.  104,  Pt.  J.  Leehart,  C,  16th  Mississippi.  CASE  270,  p.  104,  Capt.  H.  A.  Sand,  10"d  New  York.  CASE  273,  p.  105,  J.  T.  Tindell,  K,  18th 
Mississippi  Cav.  (Confed.  States  Med.  and  Sitrff.  Jour.,  January,  1865).  CASE  274,  p.  106,  Pt.  P.  Wilbur,  1, 185th  New  York,  Spec.  3143.  Second  Surgical 
Volume :  CASE  859,  p.  295,  Serg't  W.  Spendlovn,  E,  1st  New  York  Cav.,  and  CASE  935,  p.  324,  Serg't  C.  Moulton,  D,  2d  Maryland. 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  x. 


FIG.  44.  —  Fracture 


FIG.  45.— Fissure  of 
right  femur,  caused  by 
a  conoidal  ball  lodging 
in  the  neck .  Svec.  393 1 . 


been  chipped  off.  The  patient  rested  well  that  night,  but  on  the  following  day  the  spasms  were  increased  in  intensity,  commencing 
in  the  injured  limb  and  extending  over  the  body.  Cloths  saturated  with  chloroform  and  olive  oil  were  applied  to  the  limb,  and  an 
antispasmodic  and  anodyne  mixture  was  prescribed.  He  rested  quietly  until  the  following  morning,  when  clonic  spasms  returned 
and  persistently  increased.  The  patient's  countenance  became  pinched,  wan,  and  haggard,  and  expressive  of  fright.  There 
was  no  pain  nor  trismus,  and  he  partook  freely  of  nouishment.  At  times  there  was  complete  opisthotonos.  On  December  25th 
he  took  four  dozen  pills  of  assafrctida  of  four  grains  each,  and  one  half  ounce  of  fluid  extract  of  Cannabis  Indica  in  divided 
doses,  without  any  benefit.  Sulphate  of  morphia  in  doses  of  one  grain  was  then  prescribed,  to  be  administered  every  two 
hours,  and  a  poultice  of  powdered  opium  and  cinchona  applied  to  the  wound,  but,  as  before,  without  apparent  benefit.  The 
mind,  up  to  this  time,  continued  clear  and  undisturbed,  his  pulse  moderately  full  and  strong,  ranging  at  about  100.  He  now 
became  drowsy,  and  at  times  lay  in  a  semi-comatose  condition.  His  pulse  ran  up  to  150.  Respiration  was  free,  but  at  times 
hurried,  from  25  to  28  per  minute.  The  skin  became  bathed  in  sweat,  which  exhaled  a  peculiar  pungent  odor.  The  bowels 
were  regular;  the  urine  was  scantily  secreted  and  high  colored,  though  voided  without  difficulty.  The 
discharge  from  the  wound  was  thin,  bloody,  and  offensive.  On  December  27th  opisthotonos  recurred, 
and  was  temporarily  relieved  by  the  application  of  chloroform  to  the  entire  extent  of 
the  spine.  Subsequently,  violent  epileptifonn  convulsions  set  in,  and  death  resulted 
from  exhaustion,  on  December  28,  1862."  The  pathological  specimen  is  figured  in 
the  Avood-cut  (FlG.  44).  and  shows  a  fracture  of  the  great  trochanter  of  the  left  femur 
and  a  piece  of  a  leaden  ball  embedded  in  the  neck.  The  specinien  and  history  were  con 
tributed  by  Surgeon  C.  L.  Allen,  IT.  S.  V.— (Circular  2,  S.  G.  O.,  1869,  p.80.  CASE  94.) 

CASE  192. — "Sergeant  David  Y ,  Co.  H,  106th  New  York,  aged  29  years,  Avas 

Avounded  at  the  battle  of  Monocacy  Junction,  July  9,  1864,  by  a  conoidal  musket  ball, 
Avhich  entered  tAvo  inches  posterior  to  and  one  inch  above  the  right  trochanter  major, 
passed  forward  and  imvard,  and  lodged  in  the  neck  of  the  femur  at  its  middle  portion. 

of  trochanter  and  nock     He  Avas  admitted  to  General  Hospital  at  Frederick,  Maryland,  on  the  same  day,  and 

of  the  left  femur  by  a       ,  ,    ,.  .        ,.          ..    .  .      ,.  _   .          .         .      '  * 

round  musket  ball.  A     the  wound  did  well  until  the  12th  of  July,  when  it  assumed  an  unhealthy  appearance. 

trag-meutof  lead  isim-     ^  careful  examination  Avas  made  with  the  finger  and  by  the  probe,  and  the  integu- 
pacted    in   the    neck.  _  ...  .  .  , 

Spec.  545.  ments  and  fascia  were  divided,  giA'ingf'ree  exit  to  sanious  and  fetid  pus.     Large  quan 

tities  of  stimulants  and  beef  tea  Avere  given.     On  July  19th  symptoms  of  pyremia  made 

their  appearance,  such  as  rigors  folloAved  by  profuse  perspiration  and  acceleration  of  the  pulse  and  respiration,  dryness  of  the 
tongue,  and  anorexia.  Another  examination  of  the  wound  Avas  made,  and  the  ball  Avas  found  embedded  in  the  femur,  but,  OAving 
to  the  patient's  condition,  its  removal  was  deemed  inadvisable.  On  July  20th  another  rigor  occurred,  and  gradual  aggravation 
of  all  the  symptoms  folloAved.  He  died  at  3  o'clock  P.  M.,  July  22,  1864."  The  pathological  specimen  and  history  (FlG.  45) 
Avere  contributed  to  the  Army  Medical  Museum  by  Assistant  Surgeon  R.  F.  Weir,  IT.  S.  A. — (Circular  2,  p.  84,  CASE  122.) 

CASE  193. — "Captain  James  M.  L ,  Co.  I,  20th  Indiana,  Avas  tAvice  Avounded  in  an  engagement  in  front  of  Richmond, 

on  June  27,  1862.  The  first  wound  Avas  through  the  lumbar  muscles,  and,  while  lying  on  the  field,  he  Avas  again  struck  by  a 
conoidal  musket  ball,  Avhich  entered  on  the  outer  side  of  the  left  thigh  a  little  beloAV  the  great  trochanter, 
and,  passing  upAvard  and  inward,  lodged.  He  Avas  conveyed  to  Washington,  and  on  June  29th  was 
admitted  to  the  Columbia  College  Hospital.  A  finger  could  be  readily  passed  into  the  perforation  of 
the  femur,  but  the  ball  could  not  be  reached.  There  Avas  no  shortening  or  eversion  of  the  limb,  interfering 
with  the  motion  of  the  joint.  Three  formal  attempts  to  ascertain  the  position  of  the  ball  and  accomplish 
its  removal  were  unsuccessfully  made.  The  patient  died  from  exhaustion,  August  19,  1862."  The  speci 
men  is  represented  in  the  adjoining  Avood-cut  (FlG.  46).  It  shoAvs  the  upper  portion  of  the  left  femur 
perforated  betAveen  the  trochanters  on  the  posterior  surface.  The  track  of  the  ball  is  carious.  The 
great  trochanter  has  been  split  off,  but  is  reunited  by  callus.  The  space  betAveen  the  trochanters  is 
bridged  over  by  a  displaced  fragment  of  bone,  attached  in  its  neAV  position  by  slight  osseous  deposits. 
The  missile  Avas  found  resting  against  the  capsular  ligament.  Assistant  Surgeon  W.  M.  Notson,  U.  S.  A., 

FIG.  46. —  Perforation     wno  ^tended  and  reported  the  case,  is  confident  that  the  ball  Avas  external  to  the  joint;  but  as  the 
of  the  neck  of  left  femur 
byaconoidal  musket  ball,     grooving  of  the  neck  extends  upAvard  nearly  to  the  articular  surface  of  the  fenrtir,  it  is  hardly  possible 

that  the  .joint  escaped.— ( Circular  2,  p.  75,  CASE  69.) 

In  twenty-seven  of  the  two  hundred  and  forty-nine  shot  fractures  of  the  hip  joint  with 
fatal  terminations  the  parts  of  the  joint  involved  were  not  indicated.  The  details  in  the 
cases  are  very  meagre,  and  no  autopsies  were  made.  Fifteen  have  been  recorded  in  Circular 
No.  2;1  such  information  as  was  obtainable  of  the  remaining  twelve  will  here  be  given: 

CASE  194. — Private  J.  Cilley,  Co.  E,  19th  Maine,  aged  22  years,  was  Avounded  at  Petersburg,  June  22,  1864,  by  a  conoidal 
ball.  He  Avas  taken  to  the  field  hospital  of  the  2d  division,  Second  Corps,  Avhere  Surgeon  J.  F.  Dyer,  19th  Massachusetts, 
noted :  "Shot  fracture  of  the  left  hip  joint."  On  July  1,  1864,  he  Avas  admitted  into  the  Carver  Hospital,  Washington,  and  he 
died  August  30,  1864.  Surgeon  O.  A.  Judson,  U.  S.  V.,  reports  cause  of  death  :  "Exhaustion  folloAving  shot  fracture  left  ilium." 


SECT.  II.]  WOUNDS    AND    INJURIES    OF    THE    HIP   JOINT!  87 

CASE  195. — Private  J.  Farrel],  Co.  ]},  I4tli  U.  S  Infantry,  aged  35  yours,  was  wounded  at  Spottsylvania,  May  12, 1804, 
and  admitted  to  the  field  hospital  of  the  2d  division.  Fifth  Corps.  Surgeon  W.  K.  DeWitt,  jr.,  recorded:  ''Gunshot  wound  of 
left  thigh;  severe.''  On  May  18th  the  wounded  man  was  received  into  Douglas  Hospital,  Washington.  Assistant  Surgeon  W. 
Thomson,  U.  S.  A.,  reported  :  "Gunshot  wound  of  left  hip;  fracture  of  pelvis  and  femur.  Haemorrhage  to  the  amount  of  two 
ounces  occurred  from  a  muscular  branch  on  May  28th.  and  ceased  spontaneously.  The  patient  died  of  asthenia  May  28,  18G4. 

CASE  196". — Colonel  C.  Knoderer,  167th  Pennsylvania,  was  wounded  at  Suffolk,  January  30,  18G3.  Surgeon  D.  M. 
Marshall,  of  the  regiment,  reported:  "Wound  of  left  hip  produced  by  a  piece  of  shell,  completely  shattering  the  hip  joint  and 
causing  immediate  prostration.  Stimulants  were  given  internally,  and  cold  applications,  combined  with  styptics,  were  used. 
Death  occurred  on  February  15,  1863." 

CASE  197. — Corporal  E.  W.  Mulford,  Co  ,  E,  74th  Illinois,  was  wounded  at  Chattanooga,  November  25,  1863,  by  a 
conoidal  ball,  which  fractured  the  right  hip.  He  died  December  10,  1863,  in  the  2d  division,  Fourth  Corps,  field  hospital. 
Surgeon  F.  W.  Lytli,  36th  Illinois,  records  the  case. 

CASE  198.— Private  M.  Murphy,  Co.  D,  8th  New  York  Heavy  Artillery,  was  wounded  at  Cold  Harbor,  June  3,  1864, 
by  a  conoidal  ball.  He  was  taken  to  the  field  hospital  of  the  2d  division,  Second  Corps,  where  Surgeon  J.  F.  Dyer,  19th 
Massachusetts,  records  :  "Shot  fracture  of  the  right  hip  joint  and  wound  of  both  shoulders."  He  died  June  6,  1864.  The  cause 
of  death  is  given  on  the  burial  records  as  "shot  wound  of  bowels." 

CASE  199. — Private  A.  Olds,  Co.  F,  8th  New  York  Heavy  Artillery,  was  wounded  at  Cold  Harbor,  June  3,  1864,  and 
admitted  to  the  field  hospital  of  the  2d  division,  Second  Corps.  Surgeon  J.  F.  Dyer,  19th  Massachusetts,  reported:  "Gunshot 
fracture  of  left  hip  joint.  Died  June  5,  1864." 

CASE  200. — Private  C.  Pease,  Co.  C,  4th  Michigan,  was  wounded  in  the  left  hip  at  Gettysburg,  July  2,  1863.  He  was 
treated  at  a  Fifth  Corps  field  hospital  until  July  24th,  when  he  was  admitted  to  Camp  Letterman.  Surgeon  H.  Janes,  U.  S.  V., 
reported  that  the  man  "died  August  7,  1863,  of  gunshot  fracture  of  left  hip  joint." 

CASE  201. — Private  H.  Stratton,  Co.  B,  99th  Pennsylvania,  was  wounded  at  Gettysburg,  July  2,  1863,  by  a  conoidal 
ball,  lie  was  taken  to  the  field  hospital  of  the  1st  division,  Third  Corps,  where  Surgeon  G.  W.  Lyman  noted:  "Gunshot 
compound  comminuted  fracture  of  the  right  thigh  implicating  the  hip  joint."  He  died  July  4,  1863. 

CASE  202. — Private  J.  J.  Stumple,  Co.  A,  7th  West  Arirginia,  was  wounded  at  Cold  Harbor,  June  3,  1864,  by  a  conoidal 
bull.  lie  was  taken  to  the  field  hospital  of  the  2d  division,  Second  Corps,  where  Surgeon  J.  F.  Dyer,  19th  Massachusetts, 
noted:  "Shot  fracture  of  the  right  hip."  He  was  admitted  into  the  Second  Division  Hospital,  Alexandria,  June  7th,  where 
Surgeon  T.  R.  Spencer,  U.  S.  V.,  records  "shot  wound,  right  thigh."  He  died  June  25,  1864. 

CASE  203. — Private  T.  O.  Tucker,  Co.  D,  (51st  Pennsylvania,  aged  39  years,  was  wounded  at  Spottsylvania,  May  15, 
18G4,  by  a  shell.  He  was  taken  to  the  field  hospital  of  the  2d  division,  Sixth  Corps,  where  Surgeon  S.  J.  Allen,  4th  Vermont, 
noted:  "Wound  of  the  right  groin."  On  May  2H,  1864,  he  was  admitted  into  the  Second  Division  Hospital  at  Alexandria.  He 
died  the  following  day.  Surgeon  T.  R.  Spencer,  U.  S.  V.,  reported  the  cause  of  death  "shot  wound  of  the  right  hip  joint." 

CASE  204. — Private  J.  Volkommer,  Co.  C,  46th  New  York,  aged  19  years,  was  wounded  at  Petersburg,  July  30,  1864, 
and  admitted  to  the  field  hospital  of  the  3d  division,  Ninth  Corps.  Surgeon  P.  A.  O'Conuell,  U.  S.  V.,  reported:  "Gunshot 
wound  of  left  hip;  ball  entered  one  and  a  half  inches  from  the  trochanter  major,  wounding  the  capsular  joint."  Three  days 
after  the  reception  of  the  injury  the  wounded  man  was  transferred  to  the  Depot  Hospital  at  City  Point,  whence  he  was  sent  to 
De  Camp  Hospital,  David's  Island,  New  York  Harbor,  August  7th.  Assistant  Surgeon  W.  Webster,  U.  S.  A.,  in  charge  of  the 
latter,  reported  that  the  patient  died  November  19,  1884,  of  "gunshot  wound  of  left  hip,  with  fracture  of  femur.''' 

CASE  205: — Private  S.  Waisner,  Co.  E,  28th  North  Carolina,  was  wTounded  and  captured  at  Gettysburg,  July  3,  1863, 
and  entered  Camp  Letterman  on  July  23d.  Surgeon  H.  Janes,  U.  S.  V.,  reported :  "Gunshot  fracture  of  right  hip  joint. 
Death  on  August  18,  18G3." 

Of  the  series  of  two  hundred  and  forty-nine  cases  of  shot  fractures  of  the  hip  joint 
unsuccessfully  treated  by  conservation,  fifty-two 'have  been  detailed  in  the  preceding  pages 
and  one  hundred  and  ninety-seven  cases  have  been  briefly  noted,  the  details  of  the  cases 
having  been  cited  in  Circular  No.  '2. 

O 

In  one  hundred  and  eighty-four  cases  the  injuries  were  caused  by  small,  and  in  fifteen 
cases  by  large  projectiles,  while  in  fifty  instances  the  nature  of  the  missile  was  not  indi 
cated.  Fragments  of  bone  were  removed  in  twenty-one  of  the  two  hundred  and  forty- 
nine  fatal  cases  of  shot  fracture  of  the  hip  joint  treated  by  conservation.  Pya?rnia  was 
indicated  in  thirty-eight  instances,  gangrene  in  thirteen,  tetanus  in  one  case,  erysipelas  in 
one  case,  peritonitis  in  five  cases,  and  secondary  haemorrhage  in  fourteen  cases.  In  one 
instance  (CASK  of  John  McCarthy,  Co.  E,  76th  New  York,  Circular  No.  2,  p.  76,  CASE  71, 
and  foot-note  1,  p.  85)  the  femoral  artery  was  tied,  and  in  two  instances  (CASES  ot:  Cor 
poral  J.  F.  Smith,  Co.  B,  1st  Wisconsin,  Circular  No.  2,  p.  82,  and  107,  of  Private  C. 
Hambrecht,  Co.  E,  4th  New  Jersey,  CASE  181,  p.  84,  ante]  the  external  iliac  artery  was 


88  SHOT    INJURIES    OF    THE    LOWER    EXTREMITIES.  ICHAP.  x. 

ligated.  In  four  instances  the  missile  penetrated  the  abdomen ;  in  nine  cases  the  pelvic 
cavity  was  pierced,  but  apparently  without  injury  to  the  viscera.  In  fifteen  cases  a  shot 
fracture  of  either  the  ilium,  ischium,  or  os  pubis  was  reported;  in  two  instances  the  blad 
der  was  involved,1  and  in  twenty-two  cases  the  injury  to  the  hip  joint  was  complicated  by 
various  other  injuries  of  less  gravity.  Eleven  patients  died  on  the  day  of  the  reception 
of  the  injury;  fifty-three  survived  the  injury  from  one  to  ten  days;  seventy,  from  eleven 
to  twenty  days;  thirty-two,  from  twenty-one  to  thirty  days;  twenty-one,  from  thirty-one 
to  forty-days;  the  remaining  sixty-two  patients  lived  from  forty-one  to  two  hundred  and 
sixty-three  days,  and  one  patient  lingered  for  nearly  two  years  and  a  half.2  In  eighty- 
three  instances  it  was  reported  that  the  missile  had  lodged,  in  nineteen  of  which  it  was 
stated  to  have  been  extracted. 

In  seventy-eight  of  the  two  hundred  and  forty-nine  fatal  cases  of  shot  fracture  of  the 
hip  joint  treated  by  conservation,  the  specimens  indicating  the  bony  lesion  at  the  hip  are 
preserved  in  the  Army  Medical  Museum.  Illustrations  of  forty  of  these  seventy-eight 
specimens  were  given  in  Circular  No.  2,  pp.  66-114,  and  twenty-one  have  been  repre 
sented  by  wood-cuts  in  the  preceding  pages. 

In  tabular  statement  IX,  on  page  65,  ante,  the  total  number  of  alleged  shot  fractures 
at  the  hip  joint  treated  by  the  conservative  expectant  mode  was  given  as  three  hundred 
and  four,  of  which  fifty-five  were  reported  to  have  recovered;  but,  from  an  analysis  of  the 
cases,  it  becomes  clearly  evident  that  it  would  be  impossible  to  arrive  at  just  conclusions 
regarding  the  mortality  of  injuries  of  this  nature  from  the  total  number  of  cases  tabulated. 
It  has  already  been  stated  on  pp.  76,  77,  ante,  that  in  fourteen  of  the  fifty-five  cases  of 
recovery  after  alleged  shot  fractures  at  the  hip  joint  the  evidence  is  contradictory,  or 
adverse  to  the  supposition  that  the  hip  was  implicated;  that  in  nineteen  instances  the 
evidence  is  vague  and  insufficient,  and  that  in  two  cases  the  testimony  consists  solely  of  the 
statements  of  examining  surgeons  based  upon  examinations  made  long  after  the  injury  had 
healed.  Deducting  these  thirty-five  cases,  there  remain  two  hundred  and  sixty-nine  cases 
with  twenty  recoveries,  giving  a  mortality  of  92.5  per  cent.  But  it  was  further  stated  on 
pages  76  and  77,  ante,  that  in  twelve  instances  the  evidence  is  compatible  with  the  sup 
position  that  the  fractures  were  probably  in  the  trochanteric  region,  and  that  in  five 
instances  the  fractures  were  extracapsular.  Eliminating  these  seventeen  cases,  there 
remain  only  two  hundred  and  fifty-two  cases  with  three  recoveries,  or  a  mortality  rate  of 
98.8  per  cent.  Of  the  three  patients  that  recovered  after  undoubted  intracapsular  shot 
fracture  of  the  hip  joint,  one,  Private  T.  0.  Garvin,  Co.  H,  94th  New  York  (CASE  143, 
ante),  died  nearly  four  years  after  the  reception  of  the  injury,  from  which  pus  and  portions 
of  the  joint,  consisting  of  splinters  of  bone,  were  discharged  to  the  time  of  his  death.  In 
the  case  of  T.  L.  Lomax  (CASE  140,  ante],  in  which  it  remains  a  disputed  point  whether  it 
should  be  regarded  as  an  example  of  treatment  by  excision  or  by  conservation,  it  was 
impracticable  to  ascertain  whether  the  patient  is  still  living.  The  third  patient,  Colonel 
J.  C.  Strong  (CASE  134,  ante),  was  in  tolerably  good  health  in  December,  1878. 

From  the  evidence  recorded  on  the  registers  of  this  Office  in  the  alleged  examples  of 
recovery  after  shot  fractures  of  the  hip  joint  treated  by  temporization,  I  must  continue  to 
share  the  unfavorable  impression  of  the  results  in  this  class  of  injuries  of  Guthrie,  and 

1  The  details  of  these  cases  have  been  published  with  Injuries  of  the  Parts  Contained  in  the  Pelvis,  Section  II,  Chapter  VII,  Second  Surgical  Volume, 

viz:  Sergeant  T.  A ,  Co.  C,  119th  New  York,  CASK  922,  p.  318;  see  also  Note  2,  p.  77,  ante;  and  Sergeant  W.  Spendlove,  Co.  E,  1st  New  York 

Cavalry,  CASE  859,  p.  295,  and  Note  1,  p.  85,  ante. 

'Case  of  Private  Louis  Schmidt,  8th  Kansas,  wounded  at  Chickamauga,  Sept.  19,  1863,  died  Jan.  3,  18GG.     Circular  Xo.  0,  18(19,  CASE  271,  p.  105. 


SI:CT.  ri.) 


EXCISION    AT    THE    HIP    FOR   SHOT    INJURY. 


89 


many  of  the  older  as  well  as  more  modern  writers  on  military  surgery,  and  can  only 
reiterate  the  conclusion  that  I  have  already  expressed  in  Circular  No.  6,  at  page  61,  and 
in  Circular  No.  2,  at  page  117,  that  shot  injuries  of  the  hip  joint,  when  abandoned  to  the 
resources  of  nature,  prove  almost  uniformly  fatal.1 

With  regard  to  the  twenty-five  cases  of  recovery  after  shot  injuries  of  the  hip  joint 
under  conservative  treatment  in  the  Franco-German  War,  1870-71,  tabulated  by  Professor 
von  Langenbeck,  and  alluded  to  on  page  67,  ante,  it  may  be  hoped,  in  the  interest  of  sur 
gical  science,  that  the  future  histories  of  these  patients  will  be  noted,  and  that  when  death 
ensues  it  may  be  found  practicable  to  have  the  extent  of  the  injury  to  the  hip.  joint  pre 
cisely  ascertained  by  post-mortem  examination.  The  difficulties  of  such  a  task  are  apparent 
and  have  hitherto  proved  insurmountable.  In  five  of  the  fifty-five  cases  of  recovery  after 
alleged  shot  fracture  at  the  hip  joint  cited  from  the  American  civil  war,  the  patients  have 
since  died;  but  so  far  the  opportunity  to  verify  the  diagnosis  by  an  autopsy  has  not  been 
improved. 

EXCISION  AT  THE  HIP  AFTER  SHOT  INJURY.— A  large  addition  to  our 
statistical  information  on  this  subject  was  afforded  by  the  experience  of  the  American  civil 
war  as  indicated  by  the  accompanying  tabular  statement: 

TABLE  X. 
Numerical  Statement  of  Sixty-six  Cases  of  Excision  at  the  Hip  Joint  for  Shot  Injury. 


CASES. 

PEK  CENT. 

Recovery. 

Fatal. 

Total. 

MOUTALITV. 

1 

3-2 

33 

96  9 

2 

20 

oo 

00  9 

3 

8 

11 

72  7 

6 

60 

66 

00  9 

"Twelve  cases  of  excision  of  the  head  of  the  femur  for  gunshot  injury  are  all  that 
are  recorded  in  print,  prior  to  1861,"  is  correctly  asserted  at  page  17  of  the  report  from 
this  Office2  published  in  1869;  but  it  is  now  known3  that  in  the  Italian  Campaign  of  1859 
Dr.  J.  Neudorfer  excised  at  the  hip  for  shot  injury  four  times,  at  least,  which  gives  a  total 

1  In  note  1,  of  page  62,  ante,  it  was  attempted  to  give,  in  chronological  order,  the  earliest  references  to  cases  of  shot  wounds  of  the  hip  in  military 
surgical  literature,  and  the  first  case  adverted  to  was  that  of  Private  S.  Kirsky,  in  1677,  related  by  PUUMAXX  (M.  G.)  (Funfftzig  Sonder-und  WumJcr- 
bahre  Scliuxswunden  Citren,  Frankfurt,  1721,  Obs.  XLI1I,  p.  324).  After  page  62  had  gone  to  press,  the  following  case,  cited  by  Dr.  JOSEPH  SCHMIDT 
(Speculum  Chirurgicum  oder  Spiegel  der  Artzney,  Augspurg,  1656,  p.  144),  which  antedates  the  case  of  PURMAXX  by  33  years,  came  to  the  editor's 
notice  :  ''In  the  month  of  May,  1634,  while  the  here-stationed  Swedish  regiment  was  being  mustered  in  the  castle-yard,  a  sergeant,  whose  quarters  were 
with  Mr.  Peter  Rehlinger,  was  accidentally  shot  tftrough  the  hip.  He  was  conveyed  in  a  trough  to  his  quarters.  I  was  called  upon  to  see  the  case,  but 
found  that  there  was  great  difficulty  in  the  way  of  bandaging  and  that  the  thigh  was  greatly  swollen,  the  wound  of  entrance  being  as  large  as  a  hen-egg. 
On  probing  the  wound  I  readily  discovered  the  bare  bone,  with  every  indication  that  the  shaft  must  have  been  split.  Great  haemorrhage  bad  also  taken 
place ;  his  system  was  in  a  bad  condition,  unfavorable  for  a  cure.  The  symptoms  hourly  grew  more  aggravated  and  became  so  severe  as  to  terminate  his 
life  on  the  sixth  day.  After  his  death,  I  endeavored  to  obtain  the  consent  of  the  officers  to  let  him  be  opened,  which  was  readily  granted.  When  I  did 
open  him  I  discovered  that  the  upper  part  of  the  femur,  the  head  which  enters  the  hip  bone,  was  comminuted,  as  if  it  had  been  done  with  a  hammer  upon 
an  anvil.  There  was  also  a  long  fissure  in  the  shaft  running  down  towards  the  knee ;  the  great  trunk  of  the  artery  was  torn,  and  the  condition  of  the  soft 
parts,  inwardly  near  the  bone,  was  so  offensive  that  I  can  hardly  describe  it.  It  was  no  wonder  that  he  lost  his  life  from  so  severe  an  injury.  Should  he 
have  recovered  he  would  have  done  so  with  a  bad  walk."  An  instance  from  the  Turco-Russian  War  of  1877,  is  related  by  KADE  (E.)  (Das  tempordre 
Kriegslazareth  der  Anstalten  der  Kaiserin  Maria  im  Kloslcr  Marialiimmclfalirt  by  Sistowa,  in  St.  Petersburger  Medicinische  Wochenschrift,  1877,  No. 
45,  p.  383):  A  soldier,  on  August  31,  1877,  received  a  shot  wound  of  the  right  coxo-femoral  joint  without  separation  of  continuity  of  bone.  The  ball 
lodged  with  its  point  in  the  neck  of  the  femur.  On  September  12th,  the  wound  was  enlarged  and  the  missile  extracted.  The  patient  died  September 
17th,  of  septicaemia  following  suppuration  of  the  joint. 

'Oxis  (G.  A.),  A  Report  on  Excisions  of  the  Head  of  the  Femur  for  Gunshot  Injuries.  Circular  No.  2,  War  Department,  Surgeon  General's 
Office,  January  G,  1869,  4to,  pp.  141. 

3LOXGMOUE  (T.J,  Gunshot  Wounds,  in  T.  HOLMES's  System  of  Surgery,  2d  ed.,  London.  1870,  Vol.  II,  p.  230. 
SURG.    111-12 


90  INJURIES   OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

of  sixteen  examples  of  this  operation  iu  military  surgery  prior  to  our  war.  Of  these, 
a  primary  excision  by  Mr.  T.  0.  O'Leary,  in  the  Crimea,  in  1855,  was  successful.  The 
patient  died  ten  years  afterwards  of  phthisis.  A  secondary  excision,  by  Dr.  Neudorfer,  in 
1859,  was  followed  by  amputation  at  the  hip,  which  the  patient  happily  survived.  In  the 
foot-note1  instances  of  excision  at  the  hip  for  shot  injury  are  enumerated,  in  addition  to 
those  practised  in  the  United  States  service. 

At  the  date  of  the  publication  of  Circular  No.  2,  S.  Gr.  0.,  January,  1869,  the  records 
of  this  Office  contained  sixty-three,  as  was  then  believed,  authenticated  cases  of  excision 
of  the  head,  or  of  the  head  and  neck,  or  head  and  neck  and  portion  of  the  shaft  of  the 

'1.  OPPENHEIM  (F.  W.)  (Die.  Extirpation  des  Sclienkelkopffs  atis  <ltr  Gelenkhohle,  in  Ze.itsclirift  fur  die  gesammte  Medicin,  Hamburg,  ]83(i, 
B.  I,  S.  137);  a  Russian  chasseur  wounded  May  5,  1829,  at  the  battle  of  Eski-Arna-Utlar;  fracture  of  neck  of  left  femur  and  rim  of  aeetabuhim. 
Primary  excision  May  5,  1829 ;  death  from  plague  May  23,  1829. — 2.  SF.UTIK  (Resection  de  la  partie  snperieitre  du  femur,  in  Bulletin  General  de  Tltfr- 
apeulique,  Paris,  1833,  T.  IV,  p.  371);  Private  Lisieux,  25th  Infantry:  fracture  of  neck,  trochanters,  and  upper  fourth  of  right  femur.  Primary  excision 
December  8,  1832;  death  on  the  fourth  day,  from  gangrene.—:!.  C.  TEXTOll  (K.vui,  TEXTOU,  Der  Zweite  Fall  row  Aussaf/ting  des  Schenl-elknpfes  mit 
volkommenem  Erfolg,  Wurzburg,  1858,  S.  15,  No.  12);  Kaspar  Artes,  aged  44  ;  caries  of  head  of  right  femur  consequent  upon  gunshot  fracture.  Secondary 
operation  on  November  8,  1847;  death  on  November  18,  1847. — 4.  Dr.  H.  SCHWARTZ  (Beitriigc  zur  Lehrc  von  den  Scliusswunden,  Schleswig,  1854, 

p.  142);  O ,  Danish  soldier;  shot  fracture  of  trochanters  of  left  femur.     Intermediary  excision  May  13,  1849;   death,  May  20.  ISO.— 5.  Dr.  G.  Ross 

(Deutsche  Klinik,  1850,  B.  II,  p.  451);  Karl  Engelking,  aged  23,  received,  at  Fredericia,  May  8,  1848,  a  shot  fracture  of  the  left  trochanter.  Secondary 
excision,  June  10,  1850;  death,  June  13,  1850. — G.  Professor  BAUM  (LOHMEYKU,  Die  Xchusswunden ,  1859,  p.  !!>£);  a  subaltern  officer ;  shot  comminu 
tion  of  neck  of  femur.  Primary  excision  in  1854  ;  death  in  twenty-two  hours.— 7.  G.  E.  BLEXKIXS  (G.  H.  B.  MACLEOD,  J\'otcs  on  the  Surgery,  etc.. 
London,  1858,  p.  341,  and  G.  J.  GUTHIUE,  Commentaries,  London,  1855,  p.  621);  Private  C.  Monsterey,  3d  Batt.  Grenadier  Guards;  shell  fracture  of  neck 
and  trochanters  of  right  femur.  Primary  excision  in  June,  1855;  death  in  five  weeks.— 8.  G.  H.  B.  MACLEOD  (!\~otes  on  the  Surgery  nf  the  War  in  tltr. 
Crimea,  1858,  p.  338);  Private  Couch,  of  the  Rifle  Brigade;  fracture  of  the  neck  of  left  femur,  June  18,  1855.  Intermediary  excision  July  5 ;  death  fiv.m 
cholera  July  10,  1855.— 9.  Surgeon  J.  CREHAU  (G.  J.  GUTHKIE,  Commentaries,  6th  ed.,  London,  1855,  p.  622);  Private  W.  Smith,  1st  Royals;  grenade 
fracture  of  trochanter  and  neck  of  left  femur.  Primary  excision  August  6,  1855;  died  August  21,  1855.— 10.  T.  C.  O 'LEAKY  (T.  P.  MATTHEW.  Medical 
and  Surgical  History,  etc.,  during  the  War  against  Russia,  1854-'55-"56,  London,  1858,  Vol.  II,  p.  378);  Private  T.  McKevena,  68th  Regiment:  shell 
fracture  of  trochanter  and  neck  of  left  femur.  Primary  excision  August  20,  1855;  recovery.— 11.  Dr.  GEORGE  HYPE  (MATTHEW.  7.  c..  Vol.  II.  p.  378;; 
Corporal  B.  Sheehan,  41st  Regiment ;  grapeshot  comminution  of  trochanter  and  neck  of  femur.  Primary  excision  Septembers,  1855;  death  September 
14,  1855. — 12.  Dr.  COOSIBE  (MACLEOD,  loc.  cit.,  p.  344);  British  artillery  soldier;  shot  fracture  of  neck  of  feinnr.  Intermediary  excision  in  1855;  death  in 
a  fortnight. — 13-19.  J.  NEl'DORFER  (Das  EndresnUat  der  Geknkresectionen,  in  Wiener  Med.  Presse,  1871,  B.  XII,  p.  407)  remarks  :  •'  I  have  performed 
the  hip  joint  resection  for  shot  wounds  seven  times;  six  died  from  the  eighth  to  the  eleventh  day,  and  the  seventh  I  exarticulated  at  the  hip  after  a  few- 
days  on  account  of  purulent  infiltration  of  the  excised  joint.  The  patient  recoj^red  after  the  exarticulation,  and  lives  here  in  Vienna."  J.  Schranz,  7th 
Jaeger  Bat.,  wounded  at  Palestro,  May  30,  1859.  Excision  at  left  hip  joint  November  27th.  Purulent  infiltration  followed,  and.  on  December  1,  1859, 
amputation  at  the  hip  joint  was  performed  by  Professor  NEUDORFER.  The  patient  recovered,  and  lived  in  Vienna  in  1868.  During  the  Schleswig- 
Holstein  War,  1864,  Dr.  NEUDORFEU  twice  excised  the  hip  joint,  on  Austrian  soldiers,  for  shot  fracture  of  the  upper  extremity  of  the  femur.  Inter 
mediary  operations.  Both  cases  proved  fatal  (C.  HEINE,  Die  SchussverUtzungen,  etc.,  1866,  p.  369).  Of  the  remaining  four  operations  by  NEUHORFKR 
I  have  been  unable  to  find  any  details. — 20.  A  successful  secondary  excision  of  the  hip  joint  for  shot  wound  received  in  the  Austro-Prussiaii  War,  18(i6, 
was  performed  by  Dr.  WAGNER  in  Konigsberg.  NEUDORFER  (Handbuch  der  Kriegschir.,  Leipzig,  1872,  Zweite  Halfte,  Ahth.  2,  p.  1458)  states  that 
he  saw  the  patient  in  November,  1866,  at  Gorlitz,  when  his  recovery  was  yet  doubtful,  but  that  in  1872  the  patient  was  living  a,t  Graz,  entirely  recovered. 
He  could  walk  without  a  cane,  and  could  ascend  and  descend  stairs.— ','1-23.  B.  von  LAXGEXBECK  (Uber  die  Schussfracturen  der  Geleuke.  18C8.  p.  16); 
Kucharsky,  aged  18.  fracture  of  left  trochanter,  March  22,  1863.  Secondary  excision  July,  1863;  death  in  fourteen  days.  Austrian  soldier,  wounded 
July  3,  1866;  shot  fracture  of  the  neck  of  the  right  femur.  Intermediary  resection  August  5,  1866:  death  August  12,  1866.  Emil  Bauer,  ICth  Saxon 
Infantry,  wounded  June  29,  1866;  shot  fracture  of  the  neck  of  right  femur.  Secondary  excision  August  20th;  death  in  September,  1866. — 24.  Dr. 
SCHOXBORX  (B.  v.  LAXGKXBECK,  loc.  cit.,  p.  16);  Maxim  Glutschak.  aged  24;  wounded  July  3,  1866,  fracture  of  head  of  the  right  femur.  Secondary 

resection  August  22,  1866;  recovery.— 25.  B.  BECK  (Kriegschir.  Erf.,  1867,  p.  351);  A.  F.  S ,  Wiirtemberg  drummer,  wounded  July  24,  18(>6:  shot 

fracture  of  neck  of  femur  and  trochanter  major.  Intermediary  resection  August  5th;  died  August  7,  1866.— 26.  L.  STUOMEYEK  (Erfakrungen  iiber 
Sc.husswunden,  1867,  S.  52);  a  debilitated  subject;  intracapsular  shot  fracture  of  the  neck  of  the  femur.  Intermediary  resection  in  1866;  death  in  two 
days.— Stabsarzt  Dr.  DEIXIXGER,  of  the  Railway  Battalion  (Beitrdge  zu  den  Schussfracturen  des  Hiiftgelenks  unter  besonderer  Berucksichtigimg  der 
Erfahrungen  aus  dem  Fcldzuge  1870-71,  und  Benutzung  der  Acten  des  Koniglichen  Kriegsministeriiims,  in  Deutsche  Mil.-arM.  Zeitschnft,  1874. 
Jahrgang  III,  pp.  237-335),  gives  a  tabular  statement  of  forty-five  cases  of  resection  of  the  head  of  the  femur  for  shot  injury,  from  the  Franco- 1'russian 
War,  1870-71.  The  cases  are:  1  primary  case  fatal,  26  intermediary  cases  (all  fatal),  and  17  secondary  (with  5  recoveries  and  12  deaths),  and  I  case 
in  which  the  time  of  operation  was  not  recorded.  Brief  details  are  given  :  27.  A.  Stephan,  3d  Pioneer  Bat.;  shot  fracture  of  neck  and  tn-clmnter 
major  of  left  femur,  September  20,  1870;  excision  same  day,  by  Dr.  B.  BECK;  died  September  29,  1870.— 28.  Piurko,  22d  Infantry;  shot  fracture  of 
trochanter  and  neck  of  right  femur,  September  23,  1870;  excision  October  25,  1870,  by  SzMULA  ;  recovered,  with  useless  limb.— 29.  A  soldier  wounded 
at  Orleans;  comminution  of  head  of  femur;  intermediary  excision,  by  Dr.  METZLER;  died  4  days  after  operation.— 30.  J.  B.  Mtiller.  85th  French 
Line;  shot  fracture  of  head  of  right  femur  and  rim  of  acetabulum  at  Beaune  la  Rolande,  November  28,  1870;  excision,  by  Dr.  RtirPEL,  December 
2d;  died  December  7,  1870.— 31.  Corporal  Heinartz,  75th  Prussian,  wounded  at  Orleans,  December  9,  1870;  ball  fractured  acetabulum  and  opened  joint; 
excision,  December  14th,  by  Dr.  LAXGEXBECK;  died  of  septicaemia,  December  20,  1870.— 32.  A.  Eichner,  2d  Prussian  Lancers;  shot  fracture  <  f  head 
of  right  femur,  Orleans,  December  4, 1870;  excision,  by  Dr.  LAXGEXBECK,  December  12th ;  died  December  18,  1870.— 33.  J.  Schone,  wounded  at  Weissen- 
berg,  August  4,  1870.  splintering  trochanter  and  head  of  femur;  excision,  by  Dr.  C'ZERNY,  August  13th;  died  August  16,  1870.— 34.  M.  Echteibruch, 
Corporal,  78th  Infantry ;  shot  fracture  of  left  femur  below  the  greater  trochanter,  August  16,  1870;  excision,  by  Dr.  Mfn.LER,  August  26th  ;  died  Sept.  7, 
1870.— 35.  J.  Pakowsky,  14th  Inf.,  wounded  Decembers,  1870,  in  left  hip  joint;  excision,  December  14th,  by  Dr.  NEWHAUS;  died  December  20,  1870.— 
!) ;.  J.  Unterherg.  Oldenberg  Infantry  No.  91  ;  shot  fracture  of  left  trochanter,  August  16,  1870;  excision,  August  27th,  by  Dr.  A.  EWAI.D;  died  Sept.  9, 
1870.— 37.  J.  Wiedener,  52d  Infantry,  shot  wound  in  right  hip  joint,  August  16,  1870;  excision,  by  Dr.  TRENPELEXBEUG,  August  28th :  died  September 
2(  1870.— 38.  F.  Kopzinsky,  5th  Artillery,  shot  fracture  of  left  hip  joint,  Sept.  19,  1870;  excision,  October  2d,  by  Dr.  WEGXER  ;  died  October  28,  1870.— 
3!».  J.  Busse,  24th  Infantry,  shot  fracture  of  the  left  femur,  August  16,  1870;  excision  of  hip  joint,  August  29th,  by  Dr.  MARCU8E;  died  Sept.  7,  1870.— 
40.  F.  Patzwald,  9th  Infantry,  shot  wound  of  left  hip  joint,  December  2,  1870;  excision,  by  Dr.  BRA8CH,  December  16th ;  died  December  21,  1870. — 41. 
V.  Vaillant,  42<1  French  Line,  shot  fracture  head  of  left  femur,  September  30,  1870 ;  excision,  October  14th,  by  Dr.  GRAXDIES ;  died  October  17,  1870.— 
42.  A.  Dettki,  41st  Infantry,  shot  comminution  of  neck  of  left  femur,  August  31,  1870;  excision,  by  Dr.  SACHS,  Sept.  15th;  died  October  11,  1870. — 43.  P. 
Congacz,  French  Guards  No.  3,  shot  fracture  of  head  of  left  femur.  August  18,  1870;  excised,  by  Dr.  LAXGEXBECK,  September  1st ;  died  Sept.  2,  1870.— 
44.  C.  C.  Petit,  French  Infantry  No.  67,  comminution  of  left  hip  joint,  August  16,  1870;  excision,  by  Dr.  LAXGEXBECK,  September  1st;  died  September 


SECT.  ILJ  EXCISION    AT    THE    HIP    FOB,   SHOT    INJURY.  91 

femur,  for  shot  injury.  It  has' since  been  ascertained  that  in  one  of  these  cases  the  head 
of  the  femur  was  not  removed;1  but  records  of  four  additional  cases2  have  since  been 
obtained  and  added  to  the  list  of  this  operation,  making  a  total  of  sixty-six  cases  of 
excision  at  the  hip  joint  done  for  shot  injuries  received  during  the  American  civil  war. 
As  indicated  in  TABLE  IX,  at  page  65,  ante,  fifty-five  of  these  operations  were  performed 
for  shot  injuries  of  the  hip  joint,  while  in  eleven  instances  the  excision  was  practised  for 
fracture  of  the  shaft  of  the  femur  that  did  not  primarily  implicate  the  hip. 

4,  1870. — 45.  C.  Pacot,  50th  French  Infantry,  shot  fracture  of  neck  of  right  femur,  Weissenburg,  August  4,  1870;  excision,  by  Dr.  BlLl.KOTH,  Aug.  20th; 
died  August  20,  1870.— 46.  W.  Liesegang,  24th  Infantry,  shot  fracture  of  neck  of  left  femur,  Vionville,  August  16,  1870;  excision,  September  L'd,  by  Dr. 
GAEIIPE;  died  September  3,  1870. — 47.  E.  W.  Hoffman,  of  the  Prussian  Guards,  shot  fracture  of  hip  joint,  St.  Privat,  August  18,  L870;  excision,  by  Dr. 
LiJCKE,  September  5th;  died  September  13,  1870.— 48.  A.  Weinert,  Corporal,  10th  Dragoons,  wounded  in  trochanter  major,  August  14,  1870;  excision, 
by  Dr.  FISCHER,  September  1st;  died  September  13,  1870. — 49.  B.  Payant,  32d  French  Infantry,  shot  fracture  of  upper  third  of  right  femur,  August  16, 
1870 ;  excision,  September  4th,  by  Dr.  NEUHAUS ;  died  September  8.  1870. — 50.  A.  Piasecki,  5th  Infantry,  comminution  of  neck  of  left  femur,  September 
9,  1870;  excision,  by  Dr.  WAGNEK,  September  29th  ;  died  October  11,  1870. — 51.  P.  Perrot,  13th  French  Infantry,  comminution  of  right  femur  into  joint, 
Gravelotte.  August  8,  1870;  excision,  by  Dr.  P.USCH,  September  12th ;  died  September  23,  1870.— 52.  J.  Pitzer,  83d  Infantry,  comminution  of  trochanter 
major  and  neck  of  left  femur,  Worth,  August  C,  1870;  excision,  by  Dr.  I'AGEXSTECHEH,  September  1st;  died  September  10,  1870.— 53.  Sergeant-major 

B ,  3d  French  Infantry,  shot  fracture  of  trochanter  and  neck  of  right  femur,  Worth,  August  6,  1870;  excision,  by  Dr.  BECK,  at  the  end  of  August ; 

died  in  the  latter  part  of  September.— 54.  C.  Schmock,  of  the  Guard  Sharpshooters,  shot  wound  in  left  hip  joint,  St.  Privat,  August  18, 1870;  excised,  by 

Dr.  BEXSBERG,  September  14th  ;  died  September  19,  1870. — 55.  P ,  61st  Infantry,  comminution  of  neck  of  left  femur,  January  21,  1871 ;  excision,  by 

Dr.  VOLKMANN,  February  20th;  died  February  22,  1871.— 56.  J.  Blanche*,  French  Garde  Mobilier,  shot  fracture  of  head  of  left  femur,  November  28. 1870 ; 
excision,  by  Dr.  HEIXEMANN,  December  29th ;  died  January  12,  1871.— 57.  E.  Paschke,  58th  Infantry,  comminution  of  neck  and  trochanter  of  right 
femur,  October  2,  1870;  excision,  by  Dr.  BORETIUS,  November  Oth ;  died  November  16,  1870.— 58.  A.  Schoblock,  7th  Wiirtemberg  Infantry,  shot  frac 
ture  of  femur  high  up,  Champigny,  December  2,  1870 ;  excision,  by  Dr.  HUETER,  January  (i,  1871  ;  died  January  13, 1871.— 59.  Bartsch.  2d  Guards,  shot 
fracture  below  trochanter,  with  fissuring  of  neck  of  left  femur,  August  4,  1870;  excision,  September  13th,  by  Dr.  SCHILLBACH ;  died  in  a  few  hours.— 
60.  D.  Blennemann,  7th  Infantry,  shot  wound  of  hip  joint,  Gravelotte,  August  18,  1870  ;  excision,  about  six  weeks  later,  by  Dr.  WINDSCHEIDT  ;  recovery, 
with  good  use  of  limb  and  one  and  a  half  inch  shortening. — 61.  E.  Geier,  9th  Infantry,  shot  through  left  hip  joint,  Worth,  August  G,  1870;  excision,  by 
Dr.  BiLLUOTH,  September  28th ;  died  October  27,  1870. — 62.  Sciiaal,  10th  French  Infantry,  shot  wound  in  right  hip,  August  16,  1870;  excision,  by  Dr. 
JOSErHSON,  October  24th;  death  October  25,  1870.— 63.  F.  John.  8th  Infantry,  shot  wound  of  right  hip,  fracture  of  acetabulum,  Saarbriicken,  August 

6.  1870 ;  excision,  by  Dr.  HUI'EDEX,  November  4,  1870;  recovery,  with  moderately  free  use  of  limb  and  one  inch  shortening. — 64.  B ,  2d  Zouaves,  shot 

fracture  of  upper  third  of  femur,  Worth,  August  6, 1870 ;  excision  six  mouths  after  injury,  by  Dr.  WELKKR  ;  recovery.— 65.  French  soldier,  shot  fracture 
of  hip  joint  September  30,  1870;  secondary  excision  ;  recovery,  with  comparatively  good  use  of  limb.— 66.  J.  Pieper,  21st  Infantry,  shot  wound  of  left  hip; 
secondary  excision  of  head  of  femur,  February  19,  1871,  by  Dr.  JACOHY;  died  Feb.  23, 1871.— 67.  G.  Rossmanieck,  4th  Infantry,  shot  in  left  hip  in  August, 

1870;  secondary  excision  of  hip  joint;  died  Sept.  7,  1870.— 68.  P ,  17th  Infantry,  shot  wound  of  right  hip  joint ;  secondary  excision  of  joint;  died.— CD. 

Unknown  soldier ;  secondary  excision,  by  Dr.  BATTLEHXKK ;  fatal.— 70.  Unknown  soldier ;  shot  fracture  of  neck  of  femur ;  secondary  excision,  three  months 
after  injury,  by  Dr.  HKPI'NER ;  death  in  two  weeks.— 71.  Unknown  soldier,  shot  fracture  of  neck  and  trochanter  ;  resection  three  and  a  half  months  after 
injury ;  died  a  week  afterwards.  In  a  tabular  statement  of  cases  of  resection  of  the  hip  joint  performed  during  the  same  period,  arid  collected  by  Professor 
B.  v.  LANGENBECK  (fiber  die  Schussverletzimgen  des  Hiifigelenkg,  in  Archiv  fur  Klinisclie  Chirurgie,  Berlin,  1874,  B.  XVI,  p.  263),  I  find  7  cases 
(2  intermediary  fatal  cases,  CASES  Nos.  2,  5,  pp.  329,  330,)—!  secondary  fatal  (CASE  No.  14,  p.  334)— and  4  fatal  cases,  period  of  operation  not  stated 
(CASES  12,  20,  21,  and  27,  pp.  333,  335,  336),  not  contained  in  Dr.  DElNIXGER's  tables.  They  are:  72.  Lieut.  Roma,  9th  French  Infantry,  shot  frac 
ture  of  left  hip  joint,  August  18,  1870;  excision,  by  Dr.  LAXGEXBECK,  August  31st;  died  September  4,  1870.— 73.  Petit,  67th  French  Infantry,  shot 
fracture  of  right  hip  joint,  Mars  la  Tour,  August  16,  1870 ;  excision,  August  30th,  by  Dr.  LANGEXBECK  ;  died  December  10, 1870.— 74.  Unknown  soldier, 
shot  fracture  of  hip  joint;  excision,  by  Dr.  BlLLROTll;  died  24  hours  after  operation.— 75.  Unknown  soldier,  shot  fracture  of  pelvis;  secondary  involve 
ment  of  hip  joint ;  secondary  excision  of  head  and  neck,  by  Dr.  KUSTEK  ;  death  eight  days  after  the  operation. — 76,  77.  Unknown  soldiers ;  excisions,  by 
Dr.  VOLKMAXN ;  fatal.— 78.  Unknown  soldier ;  excision  of  head  of  femur,  by  Dt.  GRAF ;  fatal.— 79.  Another  intermediary  case  of  excision  of  head  of  femur 
for  shot  injury  during  the  late  Franco-Prussian  War,  1870-71,  not  reported  by  either  Dr.  DEININGER  or  Professor  B.  v.  LANGEXBECK,  is  reported  by  Dr. 
GEORGE  FISCHER  (Dorf  Floing  und  Schloss  Versailles,  in  Deutsche  Zeitschrift  fur  Chirurgie,  Leipzig,  1872,  B.  I,  S.  227);  unknown,  fracture  of  head 
of  left  femur.  September  30,  1870 ;  wound  of  exit  and  entrance  on  a  level  with  the  trochanter  major.  October  20th,  resection;  October  28th,  death  from 
pyffimia.  An  operation  ascribed  to  Dr.  LUTTER,  in  Lancet,  1870,  Vol.  II,  p.  452,  is  identical  with  the  case  described  by  Dr.  H.  FISCHER  (Kriegschir. 
Erf.  vor  Mdz,  Erlangen,  1872,  p.  200),  and  included  in  cases  collected  by  Drs.  DEIXIXGER  and  v.  LANGENBECK  (No.  48,  ante). — 80-97.  CHEXU  (J.  C.) 
(Apery u  hist.  stat.  et  din.,  etc.,  pendant  la  guerre  de  1870-71 ,  Paris,  1874,  T.  I,  p.  493)  tabulates  eighteen  cases  of  excisions  of  the  hip  joint  for  shot  frac 
tures,  in  the  Franco-Prussian  War,  1870-71,  with  three  recoveries.  The  same  author  (loc.  cit.,  T.  II,  pp.  1-150)  records,  by  name,  the  cases  of  recovery 
after  amputations,  disarticulations,  and  excisions ;  but,  after  a  careful  search,  I  have  been  able  to  find  only  one  of  the  (3)  successful  cases  of  excisions  at 
the  hip  joint  among  them.  The  case  is  detailed  on  p.  85:  "  Lande  (P.  F.),  born  June  6,  1849,  at  Valognes  (Manche),  109th  line.  Fracture  of  head  of 
femur  for  shot  wound.  Resection  of  heitd  of  femur.1'  The  case  is  duplicated  and  again  appears,  on  p.  86,  as  Laude,  giving  same  details  in  every  res'peet. 
I  find  no  record  of  the  two  other  cases.  There  is  nothing  to  indicate  whether  the  cases  are  primary,  intermediary,  or  secondary  operations.  The  cases 
reported  by  Dr.  DUBUEIL  (Gaz.  mid.  de  Paris,  1871,  T.  XVI,  p.  314)  and  Dr.  ARXAUD  (GRELLOIS,  Hist.  med.  de  blocus  de  Metz,  1872,  pp.  351-353)  are 
undoubtedly  included  in  CHENU's  (loc.  cit.,  p.  493)  statistics.— 98.  ROBERTSON  (J.  B.)  (Resection  at  the  Hip  joint— Removal  of  the  Head  with  Four  Inches 
of  the  Femur— Tetanus— Cure  by  Physostigma,  in  Pacific  Med.  and  Surg.  Jour.,  1878,  Vol.  XX,  p.  500),  excised,  on  April  8,  1876,  the  head  and  four 
inches  of  the  shaft  of  the  femur  in  the  case  of  George  Miller,  aged  45,  who  had  suffered  for  over  a  year  from  a  sinus,  evidently  resulting  from  a  rifle  shot 
received  two  years  previously.  The  wound  healed  by  first  intention.  Tetanus,  which  supervened  about  three  weeks  after  the  operation,  was  successfully 
treated  with  physostigma.  In  February,  1878,  Miller  was  "well  and  able  to  ride  on  horseback  and  herd  cattle  in  the  mountains." — 99.  Dr.  UunttUCK 
(Sf  AUXOI:I:I,  Rapport  sur  le  mouvement  de  lambulance  A'o.  5  du  Croissant  Rouge  a  Orchanie,  du  17  Octobre  au  8  Norembre  1877,  in  Le  Progres  Medical, 
1878,  No.  1,  p.  6)  excised,  on  October  21,  1876,  the  head  of  the  left  femur  in  the  case  of  Mehemet-Osman,  for  shot  wound  received  in  the  Turro-Russiaii 
War;  secondary  operation  ;  pneumonia;  death.  Summing  up  the  cases  of  resection  of  the  hip  joint  referred  to  in  this  note  we  have  a  total  of  99  oases 
with  86  deaths,  a  fatality  of  86.8  per  cent.  Of  these  99  cases  8  were  primary  operations  with  7  deaths  (87.5  per  cent.);  37  were  intermediary,  all  fatal; 
27  were  secondary  with  18  deaths  (66.6  per  cent.);  and  in  27  instances  with  24  deaths  the  time  of  operation  was  not  specified. 

1  The  case  of  Lieutenant  Dwight  Beebe,  3d  New  York,  cited  in  Circular  2,  at  page  32.  Information  received  since  the  publication  of  the  case 
proves  it  to  be  an  example  of  removal  of  three  and  a  half  inches  of  the  upper  portion  of  the  femur  just  without  the  capsule.  The  case  will  be  detailed 
with  excisions  in  the  continuity  of  the  femur  in  the  third  section  of  this  chapter. 

'CASKS  of:  1.  Private  J.  W.  Epton.  Co.  I,  5th  South  Carolina,  referred  to  in  Circular  2,  at  p.  120,  but  not  included  in  the  tabular  statements  on 
pp.  59  and  137;  2.  Private  C.  Raines,  Co.  E,  25th  North  Carolina;  3.  Private  G.  W.  Tilliston,  1st  Ohio  Light  Artillery;  and  4.  Private  T.  W.  Pease, 
Co.  H,  19th  Indiana. 


92  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  X. 

Primary  Excisions. — Of  thirty-three  well  authenticated  primary  excisions  at  the  hip 
practised  during  the  War,  twenty  were  performed  upon  Union  and  thirteen  upon  Confed 
erate  soldiers.  The  only  successful  result  was  in  the  case  of  Private  Cannon,  a  young 
soldier  of  a  Georgia  regiment,  on  whom  Dr.  J.  J.  Dement,  of  Huntsville,  Alabama, 
operated.  The  particulars  of  the  case  were  communicated  by  Dr.  Claude  H.  Mastin,  of 
Mobile,  formerly  Inspector  of  Hospitals  in  the  Confederate  service,  and  by  Dr.  J.  B. 
Duggan,  of  Toombsborough : 

CASE  208. — Private  Cannon,  Co.  A,  49th  Georgia,  aged  24  years,  was  wounded  at  the  battle  of  the  Wilderness,  May  5, 
1864,  by  a  conoidal  musket  ball,  which  struck  an  inch  below  the  left  trochanter  major,  extensively  comminuting  the  femur  and 
lodging  in  the  adductor  muscles.  The  Confederate  line  being  forced  back,  the  wounded  man  lay  on  the  ground  all  night  until 
the  early  morning,  when  the  Confederates  recovered  their  wounded.  In  Cannon's  case,  the  consultation  at  the  field  infirmary  by 
Surgeons  J.  J.  Dement,  Holt,  J.  J.  Wynne,  and  F.  P.  Henderson,  it  was  determined  to  enlarge  the  wound  and  remove  the 
detached  fragments  of  bone.  Accordingly,  the  patient  having  been  chloroformed,  Surgeon  Dement  made  an  incision  two  inches 
upward  from  the  entrance  wound,  and  extending  from  the  wound  downward  four  inches.  On  ascertaining  the  condition  of  the 
parts,  it  was  decided  to  exarticulate  the  head  of  the  femur.  This  was  readily  accomplished,  and  then  the  neck  and  upper  extremity 
of  the  shaft  were  removed.  The  fragments  of  the  upper  extremity  of  the  femur,  when  put  together,  measured  four  and  a  half 
inches.  The  haemorrhage  during  the  operation  was  trivial.  All  the  medical  gentlemen  present,  remarked  upon  the  slight  degree 
of  shock  induced  by  the  operation.  The  limb  and  body  were  confined  by  roller  bandage  to  a  straight  splint  extending  from  the 
axilla  to  the  foot.  A  full  dose  of  sulphate  of  morphia  was  then  administered.  In  a  few  hours  the  patient  was  placed  in  an 
ambulance  wagon  and  conveyed  to  Orange  Court  House,  twenty-five  miles  distant,  and  thence  by  rail  to  Staunton,  about 
seventy  miles  farther,  where  the  after  treatment  was  conducted  at  the  general  hospital.  Little  can  be  learned  of  the  after  treat 
ment,  save  that  the  patient  was  supplied  with  rich  diet,  a"  liberal  allowance  of  wine,  and  that  no  untoward  complication  occurred 
except  the  formation  of  abscesses  attendant  on  an  exfoliation  of  a  ring  of  bone  from  the  upper  end  of  the  shaft.  When  this  was 
eliminated,  the  wound  rapidly  healed.  At  the  end  of  nine  months  the  cicatrix  was  firm.  The  limb  was  shortened  three  inches, 
and  was  useless  for  purposes  of  locomotion.  The  patient  was  in  fine  health,  and  moved  about  on  crutches.  He  went  to  his 
home,  in  Toombsborough,  Georgia,  in  February,  1835,  and  earned  a  livelihood  by  his  trade  of  shoemaking.  He  enjoyed  good 
health  until  November  12,  1865,  when  he  had  an  attack  of  diphtheria  which  terminated  fatally  on  November  23,  1865. 

The  thirty-two  unsuccessful  primary  excisions  at  the  hip  may  be  arranged  in  three 
categories.  The  first  comprises  thirteen  instances  where  the  circumstances  were  favorable, 
the  patients  of  mature  and  robust  organization,  the  lesions  of  bone  limited  to  the  upper 
extremity  of  the  femur,  the  important  vessels  and  nerves  intact;  the  injuries  to  the  soft 
parts  were  not  excessive;  there  were  no  complications  of  wounds  in  other  regions,  and  the 
patients  were  not  subjected  to  hazardous  removals;  yet  all  thirteen  succumbed  within  two 
or  three  days,  or  in  one  case  as  late  as  the  fourth  day,  from  the  conjoined  shock  of  the 
injury  and  the  operation. 

CASE  207. — Captain  Frederick  M.  Barber,  Co.  H,  16th  Connecticut,  aged  32  years,  was  wounded  at  Antietam,  Septem 
ber  17,  1862,  by,  a  musket  ball,  which  entered  behind  the  right  trochanter  major  and  shattered  the  trochanters  and  neck  of 
femur.  He  was  conveyed  to  the  field  hospital  of  the  3d  division  of  the  Ninth  Corps.  His  general  health  was  good,  and  there 
was  but  little  shock.  There  was  no  swelling  of  the  soft  parts;  the  fracture  was  accessible  to  exploration,  and  appeared  limited 
to  the  epiphysis.  The  case  was  one  in  which  excision  seemed  peculiarly  applicable,  and,  after  a  consultation  of  several  surgeons 
of  the  division,  that  operation  was  decided  upon.  On  the  morning  of  September  18th,  the  patient  being  anaesthetised  by  chlo 
roform,  Surgeon  Melancthon  Storrs,  8th  Connecticut,  made  a  straight  incision  four  inches  long,  passing  through  the  wound  of 
entrance.  The  comminuted  fragments  of  the  neck  and  trochanter  were  extracted,  the  round  ligament  divided,  the  head  of  the 
femur  removed,  and  the  fractured  upper  extremity  of  the  shaft  was  sawn  off  by  the  chain  saw.  The  edges  of  the  wound  were 
then  approximated  by  adhesive  straps,  and  simple  dressings  were  applied.  Little  blood  was  lost,  and  the  patient  rallied 
promptly  from  the  operation,  and  appeared  quite  comfortable  during  the  day.  Surgical  fever  soon  set  in,  however;  the  patient 
sank  rapidly  under  the  constitutional  irritation,  and  died  on  September  20,  1862. 

CASE  208. — Sergeant  Edwin  T.  Brown,  Co.  C,  21st  Massachusetts,  aged  about  30  years,  was  wounded  in  front  of  Peters 
burg,  on  July  23,  1864,  by  a  ragged  fragment  of  a  mortar  bomb,  which  struck  the  left  thigh  over  the  trochanter  major  and 
comminuted  the  upper  extremity  of  the  femur.  The  wounded  man  was  immediately  conveyed  to  the  hospital  of  the  1st  division 
of  the  Ninth  Corps.  Surgeon  Whitman  V.  White,  57th  Massachusetts,  and  Surgeon  James  Oliver,  21st  Massachusetts,  saw 
the  patient  a  short  time  after  his  admission  to  the  hospital.  He  was  a  strong,  healthy  man,  five  feet  ten  inches  in  height, 
weighing  about  one  hundred  and  sixty  pounds,  with  a  constitution  of  iron,  and  was  in  perfect  health  when  injured.  The  soft 
parts  about  the  seat  of  injury  were  lacerated  and  torn,  and  the  upper  extremity  of  the  femur,  to  an  extent  of  five  inches,  was 
crushed  to  fragments.  No  important  arteries  or  nerves  were  wounded.  Excision  of  the  fractured  bone  was  decided  upon.  On 
the  afternoon  of  the  day  on  which  the  injury  was  received  chloroform  was  administered,  and  Dr.  White  made  a  longitudinal 
incision  and  removed  the  shattered  fragments.  The  ligamentum  teres  was  divided  and  the  head  of  the  bone  turned  out.  The 
broken  extremity  of  the  shaft  of  the  femur  was  evened  off  with  a  chain  saw.  The  patient  reacted  promptly  from  the  shock  of 


SECT.  II.]  EXCISION   AT   THE   HIP   AFTER    SHOT    INJURY.  93 

the  operation.  The  limb  was  placed  in  proper  position,  and  stimulants  were  freely  used.  Dr.  Oliver  states  that  he  saw  the 
man  several  times  on  the  following  day,  who  was  in  excellent  spirits,  and  talked  and  laughed,  and  did  not  complain  of  any 
pain.  On  the  26th  his  appetite  failed  and  he  began  to  sink.  He  died  July  27,  1864. 

CASE  209. — Private  Charles  Beard,  12th  Mississippi,  was  wounded  and  made  a  prisoner  in  the  engagement  on  the 
Weldon  Railroad,  August  23,  1864.  With  nearly  two  hundred  other  Wounded  Confederates  he  was  received  at  the  field 
hospital  of  the  1st  division  of  the  Fifth  Corps  at  Reams's  Station,  where  it  was  found  that  a  conoidal  musket  ball  had 
entered  the  front  of  the  right  thigh  a  little  to  the  outside  of  the  course  of  the  great  vessels,  and  had  comminuted  the  neck  of  the 
femur  and  fractured  the  head,  and  lodged  in  the  acetabulum,  of  which  the  lower  portion  of  the  rim  was  broken  oif.  A  few 
hours  after  the  reception  of  the  wound  the  patient  was  placed  under  the  influence  of  chloroform,  and, 
after  a  thorough  examination,  it  was  deemed  expedient  to  excise  the  upper  extremity  of  the  femur. 
The  operation  was  performed  by  Surgeon  A.  A.  White,  8th  Maryland.  An  incision,  commencing  a  little 
below  the  anterior  superior  spine  of  the  ilium,  was  carried  downwards  below  and  behind  the  prominence 
of  the  trochanter  major.  From  the  lower  extremity  of  the  h'rst,  another  incision,  Dr.  McGill  states,  was 
carried  backwards.  The  muscular  attachments  were  then  dissected  aside,  and  the  chain  saw  was  passed 
around  the  bone,  which  was  divided  just  above  the  lesser  trochauter.  The  head  of  the  femur  was  then 
readily  exarticulated,  and  the  ball  and  splintered  fragments  were  removed.  The  wound  was  then  approx-  FIG  47^Sh  tf 
imated  by  sutures  and  adhesive  strips,  and  the  limb  was  suspended  by  Smith's  anterior  splint.  The  of  bead  of  right  femur, 
patient  reacted  favorably;  but  very  soon  after  the  operation  there  was  a  marked  rigor,  and  on  the  follow-  *~pe°' 
ing  day  there  was  extreme  irritability  of  stomach  and  retention  of  urine.  The  case  terminated  fatally  on  August  25,  1864,  two 
days  after  the  reception  of  the  injury.  At  the  autopsy,  it  was  found  that  the  fracture  of  the  acetabulum  did  not  communicate 
with  the  interior  of  the  pelvis;  but  the  articular  surfac^vas  intensely  injected;  its  cavity  was  filled  with  offensive  sanious  pus. 
The  sawn  extremity  of  the  femur  was  black.  One  report  states  that  the  patient's  appearance  was  of  one  who  had  undergone 
great  privations  and  was  not  in  a  favorable  condition  to  undergo  any  severe  operation.  The  excised  portions  of  bone,  repre 
sented  in  the  accompanying  wood-cut  (FlG.  47),  were  sent  to  the  Army  Medical  Museum  without  a  memorandum ;  but  were 
ultimately  identified,  and  numbered  1410  in  the  Surgical  Section. 

CASE  210. — Private  Bartholomew  Dempsey,  Battery  I,  4th  Artillery,  was  wounded  February  25,  1864,  at  Buzzard's 
Roost,  Georgia,  by  a  piece  of  shell,  which  passed  through  the  upper  portion  of  the  right  thigh,  crushing  the  trochanter  and  neck 
of  the  femur,  and  producing  fissures  which  extended  to  the  head  of  the  bone.  The  wounded  man  was  taken  to  a  private  house 
in  the  neighborhood,  at  a  place  called  "Big  Spring,"  or  in  another  report  "Burke's  Spring,"  a  place  ten  miles  northwest  of 
Dalton,  where,  shortly  after  the  reception  of  the  injury,  it  was  decided,  on  the  recommendation  of  Surgeon  S.  G.  Menzies,  1st 
Kentucky,  that  excision  should  be  performed.  Chloroform  having  been  administered,  Surgeon  Nathan  W.  Abbott,  86th  Illinois, 
made  an  incision  five  inches  in  length,  commencing  two  inches  above  the  trochanter  major.  After  dissecting  aside  the  muscular 
attachments  and  removing  many  fragments  of  the  neck  and  trochanteric  portions  of  the  femur,  the  shaft  of  the  bone  was 
smoothly  divided  by  the  chain  saw  at  a  point  an  inch  or  a  little  more  below  the  lesser  trochanter.  Then,  with  a  straight 
bistoury,  the  capsular  and  round  ligaments  were  divided,  and  the  fractured  head  of  the  femur  was  exarticulated.  The  wound 
was  then  approximated  by  sutures  and  adhesive  strips.  The  patient  rallied  satisfactorily  from  the  shock  of  the  injury  and 
operation,  and  his  condition  was  encouraging  on  the  following  morning,  when  the  Union  forces  retired,  sending  all  the  wounded 
who  could  be  moved  to  the  hospitals  at  Chattanooga.  Private  Dempsey  alone  was  left  at  Big  Spring.  On  the  evening  of 
February  26th  Surgeon  Menzies  sent  Assistant  Surgeon  P.  F.  Ravenot,  7Cth  Illinois,  with  a  cavalry  escort  from  General  Cruft's 
camp,  to  Big  Spring,  a  distance  of  five  miles,  to  learn  of  Private  Dempsey's  condition,  and,  if  possible,  to  bring  him  off.  The 
escort  was  dispersed  and  Dr.  Ravenot  was  captured.  The  fate  of  Dempsey  could  not  be  definitely  ascertained.  He  is  dropped 
from  the  rolls  of  his  company  as  "  missing  in  action  at  Buzzard  Roost  Gap."  Dr.  Abbott  afterwards  heard,  indirectly,  that 
Dempsey  survived  the  operation  four  or  five  weeks;  but  was  not  satisfied  that  this  information  was  reliable.  That  the  case  had 
a  fatal  termination  there  can  be  no  doubt.  The  excised  portions  of  bone  were  preserved  by  Dr.  Barnes,  of  Centralia,  Illinois, 
who  was  present  at  the  operation.  A  statement  has  been  received  from  Brevet-Major  E.  B.  Atwood,  16th  Infantry,  that  he  had 
learned  from  parties  who  attended  Private  Dempsey  after  he  was  wounded  that  he  died  on  February  28,  1864,  at  the  house  of  a 
Mr.  Rogers,  ten  miles  northwest  of  Dalton,  Georgia. 

CASE  211. — Private  T.  J.  Holson,  Co.  H,  32d  Tennessee,  aged  23  years,  was  wounded  at  Kenesaw  Mountain,  June  '24, 
1864,  by  a  conoidal  musket  ball,  which  struck  the  femur  and  comminuted  the  neck  and  trochanters.  The  fracture  extended 
within  the  capsular  ligament.  The  shock  was  very  great.  The  patient  was  seen  by  Surgeon  J.  F.  Grant,  P.  A.  C.  S.,  who 
found  that  amputation  was  not  practicable  except  at  the  hip  joint,  and  deemed  it  expedient  to  undertake  the  operation  of  excision, 
as  giving,  in  his  judgment,  the  best  chance  for  recovery.  The  army  was  then  retreating,  and  if  the  patient  was  removed  to  the 
rear  it  was  doubtful  if  surgical  relief  could  be  had.  Accordingly,  about  twelve  hours  after  the  reception  of  the  injury,  the  patient 
being  placed  under  the  influence  of  chloroform,  Dr.  Grant  proceeded  to  operate,  by  making  a  linear  incision  ten  inches  long  on 
the  outside  of  the  thigh  over  the  trochauters.  The  articulation  was  exposed,  the  capsular  ligament  divided,  and  the  head  of 
the  bone  enucleated.  The  shattered  fragments  were  then  removed,  and  the  shaft  of  the  femur  was  divided  by  a  straight  saw 
just  below  the  trochanter.  The  loss  of  blood  was  slight.  Immediately  after  the  completion  of  the  operation  the  patient  was 
placed  upon  a  box-car  and  transported  forty,  miles  over  a  very  rough  road  to  the  rear.  Reaction  was  never  complete,  though 
the  patient  lingered  three  days,  and  died  on  June  S7,  1864. 

CASE  212. — Lieutenant  John  A.  McGuire,  Co.  I,  148th  Pennsylvania,  was  wounded  on  May  12,  1864,  at  Spottsylvania, 
by  a  musket  ball,  which  smashed  the  trochanters  and  neck  of  the  right  femur.  He  was  carried  to  the  hospital  of  the  3d  division 
of  the  Ninth  Corps,  where,  after  an  exploration  of  the  wound  under  chloroform  and  a  consultation  of  the  senior  surgeons  of  the 
division,  it  was  determined  to  excise  the  injured  bone.  The  head,  neck,  and  trochanters  were  accordingly  removed  through  a 
longitudinal  incision  by  Surgeon  George  W.  Snow,  35th  Massachusetts.  The  patient  died  on  May  15,  1864. 


94  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

CASE  213. — Private  O'EourJce,  18th  Mississippi,  aged  24  years,  healthy  and  of  flue  constitution,  was  wounded  at  the 
Wilderness,  May  6,  1864,  by  a  musket  ball,  which  entered  the  right  thigh  a  little  behind  the  trochanter,  shattered  the  neck  of 
the  femur,  and  lodged.  There  was  little  injury  to  the  soft  parts,  and  the  important  vessels  and  nerves  were  unharmed.  He 
was  taken  to  a  field  hospital,  and  his  injury  was  examined  under  chloroform,  by  Surgeon  J.  T.  Gilmore,  Chief  Surgeon,  1st 
division,  Longstreet's  Corps.  The  limb  was  everted  and  shortened,  the  fracture  appeared  to  be  confined  to  the  epiphysis,  and 
there  was  no  bleeding.  Believing  that  removal  of  the  injured  bone  offered  the  best  chance  of  preserving  life,  Surgeon  Gilmore 
proceeded  to  excise  the  head  and  neck  of  the  femur.  A  curvilinear  incision  four  or  five  inches  long,  with  its  convexity  back 
ward,  was  carried  downward  from  a  point  a  little  above  and  behind  the  trochanter,  and  was  made  to  pass  through  the  entrance 
wound.  The  muscles  inserted  in  the  trochanter  were  then  divided,  the  head  was  readily  disarticulated,  and  the  femur  was  then 
smoothly  divided  through  the  trochanters  by  a  chain  saw.  The  operation  was  accomplished  with  the  loss  of  but  little  blood. 
Yet  the  patient  did  not  react,  but  gradually  sank,  and  died  May  9,  1864. 

CASE  214.— Private  Thomas  G.  Pease,  Co.  B,  117th  New  York,  was  wounded  October  28,  1864,  near  Fair  Oaks  Station. 
The  trochanters  and  neck  of  the  right  femur  were  shattered  by  a  musket  ball,  which  lodged  against  the  head  in  the  cotyloid 
cavity.  The  soft  parts  were  not  injured  badly,  and  it  was  determined  by  surgeons  on  duty  at  the  field  hospital  of  the  Tenth 
Corps  that  excision  of  the  upper  extremity  of  the  femur  was  expedient.  The  operation  was  performed,  a  few  hours  after  the 
reception  of  the  injury,  by  Surgeon  N.  Y.  Leet,  76th  Pennsylvania.  The  patient  died  on  October  29,  1864. 

CASE  215. — Sergeant  James  M.  Tolman,  Co.  H,  18th  Wisconsin,  aged  30  years,  was  wounded  May  14,  1863,  near  Jack 
son,  Mississippi,  by  a  conoidal  ,musket  ball,  which  comminuted  the  head  and  neck  of  the  left  femur,  lodging,  and  producing 
fissures  which  extended  about  two  inches  below  the  lesser  trochanter.  The  important  nerves  and  vessels  of  the  region  and  the 
walls  of  the  pelvis  had  escaped  injury.  The  patient  was  a  somewhat  cachectic  subject,  debilitated  by  malarial  disorders.  It  was 
deemed  that  the  gravity  of  the  injuries  of  the  upper  extremity  of  the  femur  rendered  operative  interference  imperative.  About 
twenty-four  hours  after  the  reception  of  the  injury,  the  patient  was  placed  under  the  influence  of  chloroform,  and  Surgeon  Henry 
.  S.  Hewit,  U.  S.  V.,  exarticulated  the  head  of  the  femur.  The  incision  commenced  a  little  above  and  anterior  to  the  trochanter 
major  and  extended  downward  in  a  curved  direction  with  the  convexity  backward,  and  passed  through  the  wound  of  entrance. 
The  splintered  fragments  of  the  head  and  neck  and  the  ball  were  removed,  and  then  the  fissured  upper  extremity  of  the  shaft 
was  sawn  two  and  a  half  inches  below  the  lesser  trochanter.  The  operation  was  well  borne,  and  the  patient  was  removed  the 
same  day  to  a  hospital  in  the  city  of  Jackson,  where  he  was  supplied  with  every  comfort  and  provided  with  the  most  careful 
attendance.  He  did  apparently  well  until  the  third  day,  when  he  began  to  sink,  the  wound  from  this  time  forward  exhaling  a 
faint  cadaveric  odor.  He  died  four  days  after  the  operation,  May  19,  1863. 

CASE  216. — An  unknown  private  soldier  of  the  Fifth  Corps,  Army  of  the  Potomac,  was  wounded  in  the  engagement  at 
Laurel  Hill,  near  Spottsylvania  Court  House,  on  May  10,  1864,  by  a  musket  ball,  which  fractured  the  trochanteric  portion  of 
the  left  femur.  He  was  conveyed  to  the  field  hospital  of  the  Fifth  Corps,  at  Cassin's,  on  the  Block  House  road.  He  was  placed 
under  the  influence  of  chloroform,  and  the  head,  neck,  and  trochanters  of  the  left  femur  were  excised.  Assistant  Surgeon  J.  S. 
Billings,  U.  S.  A.,  saw  him  on  the  following  morning,  when  he  appeared  to  be  in  a  comfortable  condition.  Dr.  Billings  recollects 
that  he  was  a  young  and  healthy  looking  man.  The  attendants  mentioned  the  character  of  the  operaticn  and  the  name  of  the 
operator,  but  Dr.  Billings  cannot  recall  these  particulars.  On  revisiting  the  hospital  three  days  subsequently,  Dr.  Billir.gs 
learned  that  the  patient  had  died  on  that  morning,  May  13,  1864. 

CASE  217. — An  unknown  soldier  of  the  Eighteenth  Corps  was  wounded,  in  the  assault  on  the  enemy's  intrenched  lines 
at  Cold  Harbor,  June  3, 1864,  by  a  fragment  of  shell,  which  completely  comminuted  the  trochanter  and  neck  of  the  right  femur. 
Shortly  after  the  reception  of  the  injury  he  was  conveyed  to  the  field  hospital  of  the  Eighteenth  Corps,  and  immediately  anaes 
thetized  and  examined.  Excision  of  the  head,  neck,  and  trochanters  of  the  right  femur  was  then  practised.  Assistant  Surgeon 
Billings,  U.  S.  A.,  saw.  the  patient  soon  after  the  operation,  and  observed  that  he  had  rallied  encouragingly,  and  was  in  a  com 
paratively  comfortable  condition.  On  June  7th  the  wounded  of  the  Eighteenth  Corps  were  placed  in  wagons  and  sent  to  the 
rear.  Dr.  Billings  visited  the  hospital  with  a  view  of  preventing  the  removal  of  this  patient,  but  was  informed  by  the  director 
of  transportation  that  the  man  had  died  the  previous  night,  June  6,  1834. 

CASE  218. — A  Confederate  private  soldier  was  wounded  at  the  battle  of  Fredericksburg,  December  13,  1862,  by  a  frag 
ment  of  shell,  which  struck  the  trochanter  of  the  right  femur  and  fractured  it  and  the  neck  of  the  bone,  and  lacerated  the  soft 
parts,  but  without  injuring  any  of  the  important  vessels  or  nerves.  He  was  conveyed  to  a  field  infirmary,  where,  a  few  hours 
after  the  reception  of  the  wound,  he  was  placed  under  the  influence  of  chloroform,  and  Surgeon  Hunter  McGuire,  Medical 
Director  of  Jackson's  Corps,  having  ascertained  the  extent  of  the  injury,  decided  that  although  the  lesions  of  the  soft  parts 
rendered  the  case  an  unpromising  one,  yet  excision  was  the  only  1'esource  that  offered  any  hope,  and  proceeded  to  excise  the 
head,  neck,  and  trochanters,  dividing  the  shaft  just  below  the  trochanter  minor  with  a  chain  saw.  The  wound  was  left  open; 
the  limb  placed  in  a  comfortable  position  by  means  of  pillows,  without  splints,  and  the  patient  was  treated  at  the  temporary 
hospital  at  which  the  operation  was  performed.  Notwithstanding  the  most  careful  attention  to  the  after-treatment,  he  succumbed 
two  or  three  days  after  the  operation. 

CASE  219. — A  Confederate  soldier  of  Kershaw's  South  Carolina  Brigade  was  wounded  at  the  battle  of  Chancellorsville, 
May  3,  1863,  by  a  musket  ball  which  shattered  the  neck  of  the  femur.  It  having  been  decided,  after  an  examination  of  the 
wound  under  chloroform,  that  the  case  was  a  favorable  one  for  the  operation  of  excision,  the  important  nerves  and  vessels  being 
intact,  and  the  injury  limited  mainly  to  the  neck  of  the  bone,  the  operation  was  performed  by  Surgeon  James,  Kith  South 
Carolina,  on  the  day  after  the  reception  of  the  wound.  The  patient  died  May  6,  1863. 

In  a  second  category  are  placed  nine  cases  of  primary  excision  at  the  hip  which 
resemble  each  other  in  that  in  each  the  operations  were  fairly  indicated  and  offered  favor- 


SECT.  ii. |  EXCISION    AT   THE    HIP   AFTER   SHOT    INJURY.  05 

able  prospects  of  success.  The  patients,  for  the  most  part,  were  robust  soldiers,  and  the 
lesions  were  limited  to  shot  fracture  of  the  upper  extremity  of  the  femur.  All  made  a 
struggle  for  existence,  several  lived  three  or  four  weeks  and  one  for  sixty  days,  and  the 
fatal  results  were  due,  in  several  instances,  to  the  imperative  military  exigencies  that 
necessitated  the  removal  and  inopportune  and  disastrous  transportation  of  the  patients. 

CASE  220. — Private  Robert  Cole,  Co.  B,  29th  Connecticut  (colored  troops),  was  wounded  near  Fair  Oaks,  October  27, 
1864,  by  a  musket  ball,  which  shattered  the  upper  extremity  of  the  right  femur  without  injury  to  any  important  vessels  or 
nerves.  He  was  conveyed  to  the  hospital  of  the  Tenth  Corps,  where  the  wound  was  explored,  and  it  was  decided  to  excise  th« 
head,  neck,  and  trochanters  of  the  femur.  The  operation  was  performed  by  Surgeon  C.  M.  Clark,  39th  Illinois,  a  few  hours 
after  the  reception  of  the  injury,  by  a  longitudinal  incision  over  the  trochanter  major,  and  division  of  the  superior  portion  of  the 
shaft  by  a  chain  saw.  Dressings  to  secure  the  immobility  of  the  limb  were  applied,  and  the  patient  was  removed  to  the  base 
hospital  of  the  Army  of  the  James,  at  Point  of  Rocks,  where  he  was  received  on  October  26th,  and  died  on  October  29,  1864. 

CASE  221. — Private  John  Coon,  Co.  C,  60th  Indiana,  aged  20  years,  a  robust  man,  was  wounded  at  Arkansas  Post,  Jan 
uary  11,  1883,  by  a  conoidal  musket  ball,  which  entered  the  right  buttock  and  passed  forward  and  outward,  striking  the  femur 
on  the  inter-trochanteric  line  and  comminuting  the  neck  and  upper  pai't  of  the  shaft  of  the  bone.  A  few  hours  after  the  recep 
tion  of  the  injury  the  patient  was  conveyed  to  a  hospital  steamer,  and  a  consultation  was  held,  at  which  it  was  determined  to 
excise  the  injured  portions  of  bone.  The  loss  of  blood  which  had  taken  place  and  the  patient's  exposure  to  inclement  weather 
were  regarded  as  very  unfavorable  circumstances,  but  it  was  considered  that  on  the  whole  an  excision  was  the  best  thing  to  be 
done.  An  ounce  of  brandy  and  other  restoratives  were  administered,  and  half  an  hour  subsequently  the  wounded  man  was 
placed  under  the  influence  of  chloroform,  and  Surgeon  Milton  T.  Carey,  48th  Ohio,  made  a  semi-circular  incision,  beginning  two 
inches  above  the  prominence  of  the  great  trochanter  downward  in  the  direction  of  the  shaft  of  the  femur.  The  muscular 
attachments  were  then  divided,  and  the  capsular  ligament  freely  incised.  Some  difficulty  was  then  experienced  in  dividing  the 
ligameiitum  teres;  but  this  was  finally  accomplished,  and  the  head  of  the  femur  removed.  The  extent  of  splintering  having 
been  determined,  the  shaft  was  sawn  below  the  trochanter  minor  by  means  of  a  chain  saw.  The  edges  of  the  wound  were  then 
brought  together,  and  a  retentive  apparatus  was  applied.  After  the  operation  the  patient  seemed  much  prostrated,  but  he 
rallied  after  a  few  hours,  and  was  conveyed  on  the  hospital  transport  D.  A.  January  to  Memphis,  Tennessee,  and  placed  in  the 
military  general  hospital  at  that  place,  where  he  died  ten  days  subsequently,  January  21,  1863. 

CASE  222.  — Private  J.  W.  Epton,  Co.  I,  5th  South  Carolina,  was  wounded  at  Deep  Bottom,  August  16,  1864,  and  was 
conveyed  to  the  third  division  of  the  Jackson  Hospital  at  Richmond.  Surgeon  J.  G.  Cabell,  in  charge,  entered  on  the  hospital 
register,  page  214:  "A  minie"  ball  penetrated  the  right  hip  joint,  on  account  of  which  a  primary  resection  of  the  head  and  neck 
,  of  the  femur  was  practised.  The  patient  sank,  and  died  September  2.  1864." 

CASE  223. — Private  Timothy  Greely,  Co.  C,  74th  New  York,  aged  20  years,  was  wounded  October  5,  1861,  by  a  round 
musket  ball,  which  entered  near  the  fold  of  the  left  natis,  struck  the  left  femur  at  the  digital  fossa,  splintered  the  neck  into  the 
articulation,  and  made  its  exit  outside  the  vessels  anteriorly.  He  was  conveyed  to  the  E  street  Infirmary,  Washington,  on  the 
same  day.  A  stream  of  blood  and  another  of  clear  and  pellucid  synovia  issued  from  the  wound  of  exit.  There  was  but  little 
constitutional  irritation,  the  pulse  was  but  slightly  depressed,  and  the  patient  congratulated  himself  on  having  escaped  with 
what  he  regarded  as  a  slight  injury.  On  the  morning  of  October  6th  Assistant  Surgeon  John  W.  S.  Gouley,  U.  S.  A.,  assisted 
by  Surgeon  C.  H.  Laub,  U.  S.  A.,  Assistant  Surgeon  C.  B.  White,  U.  S.  A.,  Surgeon  T.  Sim,  and  Assistant  Surgeon  H.  E. 
Brown,  proceeded  to  operate.  Insensibility  having  been  induced  by  chloroform,  Dr.  Gouley  made  an  incision  seven  inches  long, 
commencing  above  and  behind  the  trochanter  major  and  continued  downward  in  the  axis  of  the  limb.  The  neck  of  the  bone 
was  found  to  be  badly  shattered,  but  the  fracture  did  not  extend  to  the  shaft.  A  section  through  the  great  trochanter  and  base 
of  the  neck  was  made  with  the  chain  saw.  The  head  of  the  bone  was  then  disarticulated  and  removed,  and  the  fragments  of 
the  neck  were  extracted.  There  was  very  little  loss  of  blood.  The  wound  having  been  approximated  and  dressed  simply,  the 
patient  was  put  to  bed,  and  the  limb  was  kept  in  position  by  pads  and  cushions.  Surgical  fever  set  in  soon  after  the  operation ; 
pyaemia  was  developed,  and  the  patient  gradually  sank,  and  died  on  October  12,  1861.  His  friends  would  not  permit  an 
autopsy.  The  pathological  specimen  and  Dr.  Gouley's  notes  of  the  case  were  destroyed  in  the  conflagration  which  shortly 
afterwards  consumed  the  Infirmary. 

CASE  224. — Sergeant  Samuel  Grimshaw,  Co.  H,  6th  New  York  Cavalry,  aged  31  years,  was  wounded  at  Cedar  Creek, 
October  19,  1864,  by  a  fragment  of  shell,  which,  after  lacerating  the  scrotum,  entered  at  the  upper  inner  part  of  the  left  thigh 
near  the  femoral  artery,  making  a  wound  one  and  a  half  inches  in  length,  and  passing  upward  and  backward,  shattered  the 
head  and  neck  of  the  femur  and  produced  fissures  extending  four  and  a  half  inches  in  the  shaft,  and  lodged  in  the  acetabulurn. 
The  shock  to  the  nervous  system  was  great.  The  patient  was  desponding,  and  he  complained  of  severe  pain.  He  was  con 
veyed  to  a  field  hospital,  and  two  hours  after  the  reception  of  the  injury  he  was  placed  under  chloroform,  and  Surgeon  A.  P. 
Clark,  6th  New  York  Cavalry,  made  a  straight  incision  seven  inches  in  length  over  the  trochanter  major,  and  excised  the  head 
and  four  and  a  half  inches  of  the  shaft  of  the  femur.  The  wound  was  then  dressed,  and  the  limb  was  supported  by  pasteboard 
splints.  On  the  following  day  no  bad  symptoms  were  observed.  Beef  essence  and  stimulants  were  freely  given,  and  afterwards 
sulphate  of  morphia  was  administered.  He  was  removed  to  the  Sheridan  Field  Hospital  at  Winchester  on  October  20th,  and 
there  died  on  November  5,  1864. 

CASE  225. — Private  B.  C.  Johnston,  Co.  B,  56th  North  Carolina,  Ransom's  Brigade,  was  wounded  on  the  night  of  the 
17th  of  June,  1864,  in  front  of  Petersburg,  by  a  conoidal  ball  probably,  in  the  right  thigh.  The  ball  entered  on  the  inner  aspect 
of  the  limb  and  passed  obliquely  upward  and  outward,  producing  a  comminuted  fracture  of  the  neck  of  the  femur  and  driving 
the  fragments  of  bone  into  the  surrounding  tissues.  The  shaft  of  the  bone  was  not  shattered,  and,  as  the  man  was  very  much 


96  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

worn  and  exhausted,  as  most  of  the  Confederate  troops  were  at  that  time,  it  was  considered  advisable  to  perform  resection  of 
the  head  and  neck  of  the  femur,  as  offering  a  better  chance  of  recovery  than  amputation.  The  operation  was  performed  on 
June  18th,  twelve  hours  after  the  reception  of  the  wound,  and  the  bone  was  sawn  through  the  trochanters.  He  bore  the  opera 
tion  well,  and,  although  weak,  was  hopeful.  He  was  sent  to  the  Fair  Grounds  Hospital,  from  which  he  was  removed  in  a  few 
days,  placed  in  a  tent,  and  attended  by  Surgeon  Ladd,  56th  North  Carolina,  and  Dr.  C.  J.  O'Hagan.  He  survived  the  operation 
two  months,  and  succumbed  at  last  to  suppuration,  caused  by  the  want  of  proper  food  and  stimulants,  and  the  general  prevalence 
of  pyaemic  infection,  which  at  that  period  intervened  in  nearly  all  the  surgical  cases  in  the  neighborhood  of  that  hospital.  To 
this  account  Dr.  J.  D.  Jackson  adds:  "I  recollect  very  distinctly  of  being  present  at  the  operation  of  Dr.  Ladd,  being  then  of 
the  same  division  with  him,  but  not  of  the  same  brigade.  It  was  on  the  18th  or  19th  of  June,  1864,  that  it  was  done,  the  place 
being  an  unfinished  brick  church  in  the  centre  of  Petersburg,  which  we  were  then  occupying  as  an  hospital.  There  were  also 
present  some  four  or  five  other  surgeons,  among  whom  I  recollect  Surgeon  C.  J.  O'Hagan,  Dr.  Wilson,  of  Virginia,  then  the 
senior  Surgeon  of  Kansom's  Brigade,  Dr.  Luckie,  of  the  same  brigade,  and,  if  I  mistake  not,  Dr.  R.  L.  Brodie,  then  Medical 
Director  of  General  Beauregard's  army,  was  among  the  number.  The  man  operated  upon  was  of  Dr.  Ladd's  own  regiment; 
his  age,  and  any  other  personal  peculiarities,  I  have  forgotten,  though  I  think  he  was  young  and  comparatively  robust.  The 
wound  had  apparently  been  done  by  a  musket  ball,  and  the  range  of  the  wound  was,  I  think,  from  the  inner  and  upper  aspect 
of  the  thigh,  and  nearly  transversely  through,  ranging  slightly  upward,  the  aperture  of  exit  being  over  the  trochantcr  major. 
If  I  recollect  aright,  the  trochanter  was  torn  off  and  most  of  the  neck  of  the  femur  shattered  to  fragments,  the  shaft  of  the  femur 
being  entirely  separated  from  the  head.  Chloroform  was  given,  and  Dr.  Ladd  operated  by  making  a  slightly  curvilinear  incision 
over  the  acetabulum  and  trochanter — the  aperature  of  the  wound  being  in  its  line — cut  down  upon  the  head  of  the  femur,  exartic 
ulated  and  removed  it,  and  cut  off  a  sharp  fragment  of  the  remaining  end  of  the  femur.  The  difficulty  of  performing  the  opera 
tion  seemed  to  be  small.  The  haemorrhage  was  trifling.  I  do  not  recollect  that  I  saw  the  patient  again,  he  being  sent  off  to  the 
General  Hospital  at  what  was  then  known  as  the  "Fair  Grounds  Hospital,"  situated  in  the  suburbs  of  Petersburg.  But  I 
further  remember  distinctly  of  hearing  Dr.  Ladd,  Dr.  O'Hagan,  and  probably  others  of  Ransom's  Brigade  speaking  of  his 
death,  which  was  on  the  sixtieth  day  after  the  operation,  and  which  all  agreed  at  the  time  in  ascribing  to  want  of  good  food  in 
proper  quantity.  Owing  to  the  scarcity  of  our  supplies,  and  the  immense  number  of  wounded  men  then  crowding  the  city  in 
consequence  of  the  battles  fought  in  front  of  Petersburg  on  the  17th,  18th,  and  19th  of  June,  food  really  proper  for  wounded  men 
was  not  obtained,  and  anything  like  delicacies  were  out  of  the  question." 

CASE  226. — Private  Edward  A.  McDonald,  Co.  F,  149th  Pennsylvania,  aged  31  years,  a  robust,  athletic  man,  was 
wounded  on  August  20,  1864,  on  the  Weldon  Railroad.  A  conoidal  musket  ball  entered  the  upper  anterior  part  of  the  right 
thigh  and  lodged  in  the  head  of  the  femur,  after  splintering  its  neck.  He  was  carried  to  the  hospital  of  the  1st  division  of  the 
Fifth  Corps,  and  placed  under  the  influence  of  chloroform  a  few  hours  after  the  reception  of  the  injury,  and  Surgeon  F.  C. 
Reamer,  143d  Pennsylvania,  assisted  by  Surgeon  Thomas,  119th  Pennsylvania,  and  others,  proceeded  with  the  operation.  A 
V-shaped  incision,  arranged  to  traverse  the  entrance  wound,  exposed  the  muscular  attachments  of  the  neck  and  trochanter. 
These  being  divided,  with  the  capsular  and  round  ligaments,  the  head  of  the  femur  was  exarticulated.  Fragments  of  the  neck 
were  extracted,  and  then  the  femur  was  sawn  through  the  trochanteric  ridge  by  the  chain  saw.  The  wound  was  then  partly 
closed  by  sutures  and  adhesive  plasters,  a  pledget  of  lint  being  inserted  at  the  lower  end,  and  the  limb  was  bandaged  and 
suspended  by  a  Smith's  anterior  splint.  Little  loss  of  blood  had  been  incurred,  and  the  patient  reacted  and  his  condition 
appeared  hopeful.  Two  days  afterwards  it  was  deemed  necessary  to  remove  the  severely  wounded  from  the  advanced  position 
of  the  Fifth  Corps,  and  McDonald  was  sent  in  an  ambulance  wagon  several  miles,  over  a  rough  road,  to  the  railroad  to  the 
hospital  at  City  Point.  There  he  remained  three  days,  and  was  placed  on  a  hospital  transport  and  sent  to  Philadelphia,  entering 
Broad  and  Cherry  Streets  Hospital  August  27th.  The  injured  limb  was  extended  by  means  of  a  weight  and  pulley,  concentrated 
nourishment  and  stimulants  were  administered,  with  quinia  and  opium.  August  31st,  symptoms  of  pyaamia  were  noted  and  the 
complication  made  rapid  progress.  Death  took  place  September  4,  1864.  At  the  autopsy  large  metastatic  foci  were  observed 
in  both  lungs. 

CASE  227. — Private  Charles  Morrison,  Co.  C,  185th  New  York,  was  wounded  on  the  Quaker  Road,  south  of  Petersburg, 
on  March  29,  1865.  A  conoidal  musket  ball  struck  the  outside  of  the  left  thigh,  fractured  the  trochanter,  and  separated  the 
neck  from  the  shaft.  In  less  than  two  hours  after  the  reception  of  the  injury  he  was  placed  on  the  operating  table  at  the  field 
hospital  of  the  1st  division  of  the  Fifth  Corps,  and  his  wound  was  examined  while  he  was  under  the  influence  of  chloroform. 
He  was  a  robust  man,  in  the  best  health.  In  the  judgment  of  the  operating  staff,  the  case  was  a  very  favorable  one  for  the 
operation  of  excision.  Surgeon  William  Fuller,  1st  Michigan,  was  requested  to  perform  the  operation,  and  proceeded  with  it 
without  delay.  He  entered  his  knife  an  inch  above  the  great  trochanter  and  made  an  incision  three  and  a  half  inches  in  length, 
divided  the  muscular  attachments,  and  readily  exarticulated  the  head  of  the  femur.  A  fissure  was  found  to  extend  downwards 
half  an  inch  below  the  trochanter  minor.  The  shaft  was  divided  by  a  chain  saw  at  this  point.  The  ball  could  not  be  found, 
but,  from  the  direction  of  its  track,  it  was  the  opinion  of  the  operator  and  his  colleagues  that  it  had  entered  the  pelvis  through 
the  obturator  foramen.  There  was  scarcely  any  hemorrhage  during  the  operation,  no  artery  requiring  ligation  or  torsion.  A 
tent  was  introduced  into  the  wound,  which  was  then  approximated  by  two  sutures  and  covered  by  a  compress  dipped  in  cold 
water.  A  full  dose  of  morphia  was  then  administered,  and  the  patient  was  made  as  comfortable  as  possible  in  a  bed  in  a  hospital 
tent.  In  the  middle  of  the  night  Surgeon  Fuller  returned  to  the  hospital  to  visit  his  patient,  but  found  that  he  had  been  removed 
to  City  Point,  in  compliance  with  orders  from  a  superior  authority.  Dr.  Fuller  was  subsequently  informed  by  Surgeon  Joseph 
Thomas,  118th  Pennsylvania,  that  the  man  died  on  the  way  to  the  base  hospital,  about  twelve  hours  after  the  operation.  There 
was  some  haemorrhage  a  few  hours  after  the  operation,  but  it  was  not  considerable.  The  report  of  the  patient's  death  was 
premature.  The  records  of  the  City  Point  Hospital  show  that  he  was  received  there,  and  survived  until  April  26,  1865. 

CASE  228. — A  Confederate  private  soldier  of  Ewell's  Corps  was  wounded  at  the  battle  of  the  Wilderness,  May  5,  18b'4, 
by  a  colloidal  musket  ball,  which  broke  the  neck  of  the  left  femur  into  several  fragments  and  lodged  in  the  bone  at  the  junction 


SECT.  ii.J  EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY.  97 

of  the  head  and  neck.  A  few  hours  after  receiving  his  wound  he  was  placed  under  the  influence  of  chloroform  at  a  field  hospital, 
and  was  examined  by  Surgeon  Hunter  McGuire,  the  Medical  Director  of  the  Corps,  who  decided  that  the  case  was  well  adapted 
for  the  operation  of  excision  of  the  head  of  the  femur,  and  proceeded  to  remove,  through  a  longitudinal  incision,  the  head  and 
shattered  fragments  of  the  neck,  and  to  smooth  off  with  a  saw  the  jagged  upper  extremity  of  the  shaft.  The  operation  was 
accomplished  with  but  trilling  haemorrhage.  It  is  Dr.  McGuire's  impression,  but,  owing  to  the  loss  of  his  notes  he  cannot  state 
positively,  that  in  the  subsequent  rapid  movements  of  the  army  it  was  necessary  to  send  the  patient  to  the  rear,  and  besides  the 
disadvantages  of  removal,  he  failed  to  receive  such  nourishment  and  careful  treatment  as  his  case  demanded.  He  died  of 
pyaemia,  May  22,  1864.  As  in  the  majority  of  the  primary  field  excisions  the  shattered  epiphysis  removed  was  not  preserved. 

Ten  fatal  cases  of  primary  excision  at  the  hip  are  placed  in  a  third  category.  These 
ten  might  almost  be  set  aside  in  estimating  the  value  of  the  operation,  inasmuch  as  the 
interference  would  hardly  have  been  undertaken,  had  the  extent  of  the  lesion  been  fully 
ascertained.  Four  of  the  cases  were  complicated  by  penetration  of  the  pelvic  cavity, 
inducing  hopeless  peritonitis;  four  were  prostrated  from  excessive  loss  of  blood;  in  two 
instances  extensive  longitudinal  splintering  of  the  shaft  of  the  femur  forbade  the  anticipa 
tion  of  a  favorable  result. 

CASE  229. — Private  J.  T.  Goode,  Co.  K,  6th  Virginia,  aged  21  years,  was  wounded  before  Petersburg,  July  31,  1864,  by 
a  conoidal  musket  ball,  which  fractured  the  upper  extremity  of  the  left  femur.  A  few  hours  after  the  reception  of  the  injury 
he  was  anaesthetized  by  a  mixture  of  chloroform  and  ether,  and  the  wound  being  explored  excision  was  decided  upon.  Surgeon 
G.  S.  West,  C.  S.  A.,  proceeded  to  perform  the  operation,  assisted  by  Dr.  W.  L.  Baylor  and  others.  Upon  making  a  linear 
incision  in  the  axis  of  the  limb  and  exposing  the  fracture,  it  was  found  that  it  extended  longitudinally  much  lower  on  the  shaft 
than  was  anticipated.  Dr.  Baylor  reports  that  one  of  the  surgeons  present  thinks  that  fully  one-third  of  the  femur  was  excised. 
The  patient  never  fairly  rallied  from  the  shock  of  the  operation,  but  he  lingered  until  August  2,  1864,  when  he  died.  Dr.  Baylor 
adds  that  the  circumstances  were  very  unfavorable,  the  patient  being  fully  nourished  and  nosocomial  gangrene  at  the  time 
pervading  the  surgical  wards. 

CASE  230. — Private  John  McCullo.h,  aged  35  years,  a  recruit  at  the  depot  for  volunteers  at  Camp  Dennison,  Ohio,  was 
wounded  on  August  30,  1881,  by  the  accidental  discharge  of  a  musket.  The  ball,  taking  effect  at  the  distance  of  a  few  yards 
only,  severely  shattered  the  upper  part  of  iL*  femur  and  lacerated  the  soft  parts  extensively.  The  patient  was  conveyed  to  St. 
John's  Hospital,  in  Cincinnati,  and  on  arrivii^  \\as  greatly  depressed  by  loss  of  blood.  Professor  George  C.  Blackman  deter 
mined  that  removal  of  the  shattered  bone  offered  the  best  resource  for  the  preservation  of  life,  and,  the  patient  having  been 
rendered  iusensible  by  chloroform,  excision  of  the  head,  neck,  and  trochanters  was  practised  without  delay,  through  a  vertical 
incision  on  the  exterior  of  the  thigh.  The  patJent  died  August  30,  1861,  four  hours  after  the  completion  of 
the  operation.  This  was  the  first  excision  at  the  hip  for  shot  injury  in  this  country. 

CASE  231. — Private  G.  W.  Mayo,  Co.  B,  25th  Battalion  Virginia  Reserves,  was  wounded  at  the  affair 
between  Yellow  Tavern  and  the  outer  defences  of  Richmond,  Virginia,  May  12,  1864,  by  a  conoidal  musket 
ball,  at  short  range,  which  entered  the  right  buttock  and  passed  forward  and  outward  through  the  thigh, 
striking  the  femur  between  the  trochanters,  and  producing  very  extensive  splintering  of  the  neck  and  shaft. 
He  was  admitted  to  the  Receiving  and  Wayside  Hospital,  at  Richmond,  early  the  next  day,  and  his  wound 
being  examined  under  chloroform,  Surgeon  Charles  Bell  Gibson,  C.  S.  A.,  determined  to  proceed  at  once  with 
the  operation  of  excision  of  the  head  and  upper  extremity  of  the  femur.  The  injured  bone  being  exposed  by 
a  long  straight  incision,  the  muscular  and  ligamentous  attachments  were  divided,  and  the  head  of  the  femur 
was  disarticulated.  Numerous  detached  fragments  were  then  removed,  and  the  shaft  of  the  femur  was  sawn 
at  a  point  five  or  six  inches  below  the  trochanter  minor.  The  operation  was  rapidly  accomplished,  but  the 
shock,  added  to  the  depression  already  existing  from  the  injury,  was  such  that  the  patient  did  not  react.  He  FiG.48.-Shot  com- 
died  at  9  o'clock  A.  M.  on  May  15,  1864,  about  forty-five  hours  after  the  operation.  The  pathological  speci-  "nd^rochan^o'f 
men  was  preserved,  and  has  lately  been  contributed  to  the  Army  Medical  Museum  by  Dr.  W.  F.  Richardson,  left  femur.  Spec. 
It  is  represented  in  the  annexed  wood-cut  (FlG.  48). 

CASE  232. — At  the  assault  on  Knoxville,  Tennessee,  on  November  16,  1863,  a  soldier  of  a  Michigan  cavalry  regiment 
was  wounded  and  made  a  prisoner.  He  was  a  man  about  eighteen  years  of  age,  five  feet  eight  inches  in  height,  with  light  hair 
and  blue  eyes,  and  was  in  robust  health  when  he  received  the  injury.  A  mini6  ball  entering  about  the  centre  of  the  nates, 
passed  forward,  shattering  the  head  and  upper  part  of  the  neck  of  the  femur,  but  did  not  injure  the  acetabulum.  No  hemor 
rhage  of  importance  followed  the  wound.  It  was  considered  that  the  case  demanded  excision  of  the  head  of  the  femur,  and  the 
operation  was  performed  on  the  day  of  the  reception  of  the  injury  by  Surgeon  J.  S.  D.  Cullen,  P.  A.  C.  S.  "The  operator 
made  his  incision  posteriorly,  directly  through  the  thickest  part  of  the  gluteal  muscles,  on  a  line  parallel  with  the  os  femoris, 
instead  of  laterally.  In  making  his  incision,  which,  at  the  least  calculation,  was  ten  inches  in  length,  he  cut  the  gluteal  artery 
near  its  point  of  exit  from  the  pelvis."  The  artery  was  ligated  finally,  though  not  until  there  had  been  much  loss  of  blood. 
The  head  and  neck  of  the  femur  were  then  excised.  "When  the  siege  was  abandoned,"  another  report  states,  "General  Long- 
street  retired  to  Russellville,  and  this  patient  was  left  behind.  I  am  positive  that  he  could  not  have  recovered,  for  the  suppura 
tion  that  followed  the  operation  was  immense,  and  he  was  suffering  from  hectic  fever  when  I  last  saw  him,  some  six  days  after 
the  operation."  There  can  be  but  little  doubt  that  the  patient  referred  to  in  this  account  was  Private  Isaac  Melcar,  Co.  A,  8th 
Michigan  Cavalry,  aged  18  years,  who  was  found  abandoned  on  the  retirement  of  the  Confederate  army  from  Knoxville,  and 

SURG.   Ill— 13 


98  INJUEIES   OF   THE    LOWER   EXTREMITIES.  [CHAP.  * 

was  taken  to  hospital  No.  2,  in  that  city,  and  entered  as  a  case  of  ''gunshot  fracture  of  left  hip."  No  other  Michigan  cavalry 
soldier  is  reported  at  the  perfod  referred  to  with  this  or  any  similar  wound.  This  man  died  on  December  2, 1863.  The  register 
of  the  Knoxville  Hospital  gives  no  particulars  of  the  case. 

CASE  233. — Private  J.  J.  Phillips,  Co.  G,  61st  Virginia,  was  wounded  on  the  second  day  of  the 
battle  of  the  Wilderness,  May  6,  1864,  by  a  conoidal  musket  ball,  which  entered  at  the  posterior  upper 
portion  of  the  left  thigh,  fractured  the  femur,  and  lodged.  He  was  immediately  conveyed  to  Richmond 
by  rail,  and  was  admitted  to  the  Receiving  and  Wayside  Hospital  on  May  7th.  The  wound  was  at  ouce 
thoroughly  explored  under  chloroform,  and  excision  of  the  shattered  bone  was  decided  on.  Surgeon 
Charles  Bell  Gibson,  C.  S.  A.,  performed  the  operation.  A  long  vertical  incision  over  the  trochanter  major 
exposed  the  injured  bone.  It  was  found  that  the  ball  had  produced  extensive  longitudinal  splintering 
and  had  itself  split,  a  small  fragment  lodging  in  the  medullary  canal,  while  a  larger  portion  had  buried 
itself  in  the  gluteal  muscles  about  two  inches  from  the  point  of  impact  upon  the  bone.  The  muscles 
inserted  into  the  trochanter  having  been  divided,  the  head  of  the  femur  was  exarticulated,  and  the  upper 
extremity  of  the  shaft  was  smoothed  off  with  a  saw.  The  operation  was  accomplished  without  much 
hemorrhage,  and  the  patient  rallied  promptly  from  the  shock.  He  had  an  anodyne,  and  passed  a  good 
night,  and,  on  the  following  day,  May  8th,  he  appeared  to  be  doing  well.  On  the  9th,  however,  there 
was  much  constitutional  irritation,  and  on  the  morning  of  the  10th  it  was  apparent  that  the  man  was  sink- 
FIG.  49.— Fissuringof  ing.  He  died  at  4  o'clock  A.  M.,  May  11,  1864.  The  pathological  preparation  was  contributed  by  Dr. 
righlrfeeimirr!m^«c°5499e  Richardson  to  the  Army  Medical  Museum,  and  is  a  fine  illustration  of  the  characteristic  longitudinal 
fissuring  produced  in  the  femur  by  conoidal  balls.  It  is  represented  in  the  adjoining  wood-cut  (FiG.  49). 

In  a  letter  dated  Chicago,  September  18,  1869,  Dr.  C.  M.  Clark,  late  Surgeon  89th 
Illinois  Volunteers,  reports  the  following  case  of  excision  at  the  hip: 

CASE  234. — "  Private  C.  Raines,  Co.  E,  25th  North  Carolina,  was  wounded  June  2,  1864,  by  a  conoidal  ball,  which 
entered  the  right  thigh  at  the  upper  and  outer  third,  near  the  great  trochanter,  passing  obliquely  downward  and  inward,  and 
making  its  exit  near  the  junction  of  the  middle  with  the  upper  third  of  the  femur.  This  man  was  not  seen  until  eight  hours 
after  the  wound  was  received,  being  among  the  last  to  be  brought  from  the  field.  When  he  reached  the  operating  table  he  was 
almost  exsanguinated  and  pulseless,  having  lost  a  large  amount  of  blood.  After  free  administration  of  milk  punch  and  beef  tea, 
with  comfortable  rest  for  two  hours'  time,  he  was  placed  on  the  operating  table  at  7  o'clock  P.  M.,  and  the  following  operation 
performed:  Chloroform  was  given  (which  added  greatly  to  the  stimulation  of  the  system— pulse  80  and  full),  and  a  longitudinal 
incision  made  from  the  great  trochanter  down  to  the  extent  of  six  inches.  The  femur  was  found  to  be  extensively  comminuted, 
and  some  sixteen  fragments  were  removed,  leaving  the  periosteum  behind.  There  was  diffused  ecchymosis  with  clots  through 
out  the  extent  of  the  fracture.  The  lower  fragment  was  turned  out  and  smoothly  sawn  off,  and  then  attention  paid  to  the  upper 
portion,  which  Avas  found  comminuted  within  the  capsule  to  such  a  degree  as  warranted  the  removal  of  the  head  of  the  bone, 
which  was  done  by  extending  the  incision  upward  one  inch,  opening  the  capsular  ligament,  turning  head  of  bone  out  and 
dividing  the  ligamentum  teres.  The  parts  were  then  thoroughly  cleansed  and  brought  together  with  eight  interrupted  sutures. 
Applied  strip  of  lint  to  the  wound,  wet  with  solution  of  tannic  acid  and  collodion,  then  bandaged  with  spica  turns  about  hip  and 
splint,  etc.  He  rallied  well  from  the  operation  and  passed  a  comfortable  night  at  the  hospital.  In  the  morning  he  was  taken, 
per  hospital  transport,  to  the  Chesapeake  Hospital,  and  I  have  no  knowledge  of  the  case  sinc^e  that  time,  but  presume  the  records 
of  that  hospital  will  furnish  the  result.  The  bone  removed  below  the  trochanter  major  measured  three  and  a  half  inches."  This 
case  has  been  identified  as  that  of  "  U.  C.  Eaines,  a  rebel  prisoner,"  aged  23  years,  who  was  reported  by  Assistant  Surgeon  E. 
McClellan,  U.  S.  A.,  as  having  been  admitted  to  hospital  at  Fort  Monroe,  June  4,  1864,  with  "shell  wound  of  right  side  and 
abdomen,"  and  as  having  died  the  same  day  of  "exhaustion." 

CASE  235. — Captain  Thomas  R.  Robeson,  2d  Massachusetts,  aged  24  years,  an  athletic  man,  was  wounded  July  3,  1863, 
at  Gettysburg,  his  regiment  having  become  warmly  engaged  under  a  musketry  fire  at  short  range.  A  rifled  musket  ball  struck 
him  over  the  right  trochanter  major,  shattering  the  neck  and  head  of  the  femur,  and,  as  was  subsequently  ascertained,  fractured 
the  pelvis  and  penetrated  its  cavity.  He  was  carried  a  short  distance  to  the  rear,  where  the  stretcher-bearers  became  exhausted 
and  laid  him  down.  Sergeant  Francis  O'Doherty,  of  his  regiment,  coming  shortly  afterwards  wounded  to  the  rear,  impressed 
some  stragglers  and  had  the  wounded  man  conveyed  to  a  field  station  of  medical  officers  of  the  Twelfth  Corps.  In  the  after 
noon  he  was  brought  into  the  Twelfth  Corps  hospital,  and  was  examined  by  Surgeon  John  McNulty,  U.  S.  V.  The  sufferings 
of  the  patient  were  intense,  and  he  urgently  demanded  some  operative  interference  for  his  relief.  Although  the  prospect  was 
very  discouraging,  it  was  decided  to  comply  with  his  request.  An  exploration  of  the  wound  indicated  that  there  was  some 
injury  of  the  pelvic  wall.  The  patient  was  placed  under  the  influence  of  chloroform  very  soon  after  his  admission  to  the  hospital, 
and  a  few  hours  subsequent  to  the  reception  of  the  injury  Dr.  McNulty  made  an  incision  over  the  trochanter  major  six  inches 
long,  passing  through  the  wound  of  entrance  and  continued  downward  in  the  axis  of  the  limb,  turned  out  the  shattered  superior 
extremity  of  the  femur  and  sawed  the  bone  just  below  the  trochanters.  The  fragments  of  the  head  and  neck  were  then  removed. 
There  was  more  bleeding  in  this  than  in  Dr.  McNulty's  other  operations  of  excision  of  the  head  of  the  femur,  yet  the  haemor 
rhage  could  not  be  called  profuse.  The  patient  survived  the  operation  fourteen  hours.  During  this  interval  he  appeared  to  be 
unconscious. 

CASE  236. — It  has  not  been  possible  to  learn  the  name  and  military  description  of  the  subject  of  this  operation.  He  was 
a  private  soldier  of  the  First  Corps,  and  a  Frenchman,  for  the  operator  recalls  the  broken  English  in  which  he  begged  for  the 
operation,  and  expressed  his  relief  and  thanks  after  it  was  performed.  He  had  a  terrible  comminution  of  the  upper  extremity 
of  the  left  femur,  inflicted  by  a  fragment  of  shell  at  the  battle  of  Antietam,  September  17,  1862.  Surgeon  John  McNulty,  U.  S.  V., 
excised  the  head  and  neck  of  the  femur,  five  hours  after  the  reception  of  the  injury,  through  a  vertical  incision  six  inches  long, 


SECT.  II.  | 


EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY. 


99 


under  chloroform.  As  in  two  other  operations  performed  by  Dr.  McNulty,  it  was  found  that  the  lesions  extended  into  the  pelvis. 
Consequently  there  could  be  little  or  no  hope  of  a  successful  result.  This  patient  survived  the  operation  only  ten  hours. 

CASE  237. — Private  —  — ,  of  the  First  Corps,  was  wounded  at  the  second  battle  of  Bull  Run,  August  30,  1862, 

by  a  conoidal  musket  ball,  which  entered  the  left  hip  below  and  in  front  of  the  trochanters,  and  fractured  the  femur  at  the  junc 
tion  of  the  head  and  neck.  He  was  conveyed  to  the  hospital  of  General  King's  division  of  the  First  Corps  in  the  brick  house 
which  had  been  occupied  as  the  rebel  headquarters  at  the  first  battle  of  Bull  Run.  The  prostration  from  shock  was  great,  yet 
it  was  thought  that  exarticulation  of  the  femur  was  the  only  resource,  and  that  excision  would  be  less  hazardous  than  amputa 
tion.  Accordingly,  fifteen  hours  after  the  reception  of  the  injury,  Surgeon  John  McNulty,  U.  S.  V.,  proceeded  to  excise  the 
head  and  neck  of  the  left  femur  through  a  vertical  incision  on  the  exterior  of  the  limb  about  six  inches  in  length,  the  patient  being 
under  chloroform.  On  dividing  the  round  ligament  to  enucleate  the  head  of  the  bone,  it  was  discovered  that  the  ball  had  pene 
trated  the  pelvic  cavity  through  the  lower  portion  of  the  acetabulum.  The  femur  was  sawn  through  at  the  junction  of  the  shaft 
and  neck  by  a  narrow-bladed  saw.  After  the  removal  of  the  shattered  fragments  of  bone,  the  patient  suffered  much  less  pain. 
There  were  no  symptoms  of  peritonseal  inflammation  at  the  date  of  the  operation,  but  they  were  subsequently  developed.  The 
patient  died  August  31,  1862. 

CASE  238. — Private  —  — ,  was  wounded  on  August  28,  1862,  in  the  engagement  between  General  Rufus  King's 

division  of  the  First  Corps  and  the  advance  of  General  Jackson's  column  on  the  Washington  turnpike,  near  Gainesville.  A 
couoidal  musket  ball  had  splintered  the  neck  and  trochanters  of  the  left  femur,  and  was  supposed  to  have 
lodged  about  the  acetabulum,  though  the  operator  discovered  in  the  sequel  that  it  had  penetrated  into  the 
cavity  of  the  pelvis.  The  symptoms  of  shock  were  very  grave  and  the  prognosis  very  unfavorable  ;  but 
the  chief  medical  officer  of  the  division,  Surgeon  Peter  Pineo,  U.  S.  V.,  determined  to  remove  the  upper 
extremity  of  the  femur.  The  upper  fourth  of  the  femur  was  excised  a  few  hours  after  the  reception  of  the 
injury.  The  excision  was  done  under  chloroform,  with  little  apparent  loss  of  blood,  through  a  vertical 
incision  on  the  outside  of  the  limb.  The  femur  was  sawn  about  two  inches  below  the  lesser  trochauter. 
It  was  now  discovered  that  the  ball  had  passed  through  the  innominatum,  and  that  internal  haemorrhage 
was  going  on.  During  the  night  of  August  28th  General  King's  division  was  driven  back  to  Manassas, 
and  this  patient  with  other  wounded  fell  into  the  hands  of  the  enemy.  It  is  probable  that  he  survived 
but  a  very  short  time.  Dr.  Pineo  secured  the  specimen,  and  it  is  preserved  in  the  Surgical  Section  of  the 
Army  Medical  Museum  as  No.  71.  It  is  figured  at  page  233  of  the  Catalogue  of  the  Surgical  Section,  and 
another  view  is  given  in  the  accompanying  wood-cut  (FlG.  50).  The  trochanter  major  is  separated  into 
five  fragments,  and  a  long  oblique  fissure  produces  a  complete  solution  of  continuity  in  the  shaft  of  the 
femur.— (Circ.  6,  S.  G.  O.,  1865,  p.  62,  CASE  5,  and  Circ.  2,  S.  G.  O.,  1869,  pp.  21,  132.) 

The  successful  primary  excision  at  the  hip  and  thirty-two  unsuccessful  operations  will 
now  be  concisely  tabulated  in  alphabetical  order  for  convenience  of  comparison  and  reference: 

TABLE  XI. 
Summary  of  Thirty-three  Cases  of  Primary  Excision  at  the  Hip  after  Shot  Injury. 


FIG.  50.— Perforation 
of  trochanter  and  fissur- 
ing  of  the  shaft  of  left 
femur.  Spec.  71. 


NO. 

NAME,  AGE,  AND  MILITAKY 
DESCRIPTION. 

DATE 

OF 
INJUKY. 

NATLUE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AXD  REMARKS. 

1 

Cannon,     —,   Pt.,    A,    49th 

May  5, 

Conoidal  ball  comminuted  left 

May  6, 

Head.  neck,  and  upper  extrem 

Recovered,  February.  1865,  short 

Georgia,  age  24. 

1864. 

femur  one  inch  below  trochan 

1864. 

ity  of  shaft,  through  incision 

ening  three  inches  ;  limb  useless 

ter  major  and  lodged. 

in  wound  six  inches  long,  by 

for  locomotion.     Died  Novem 

Surg.  J.  J.  Dement,  P.A.C.S. 

ber  23,  1865,  diphtheria.     Circ. 

2 

Barber,  F.M.,  Capt.,H,  16th 

Sept.  17, 

Shot  shattering  trochanters  and 

Sept.  18. 

Head,  neck,   trochanters,  and 

No.  2,  pp.  26,  133. 
Surgical  fever.    Died  September 

Connecticut,  age  32. 

1862. 

neck  of  right  femur. 

1862. 

tract,  upper  extremity,  thro' 

20,  1862.     Circ.  2,  pp.  22,  133. 

straight  incision  four  ins.  long, 

by  Surg.  M.  Storrs.  8th  Conn. 

3 

Beard,  C.,  Pt.,  12th  Missis 

Aug.  23, 

Conoidal  ball   fractured  head 

Aug.  23, 

Head  and  femur,  just  above 

Died  Aug.  25,  1864.     Spec.  1410, 

sippi. 

1804. 

and  neck  of  right  femur  and 

18o4. 

lesser  troch.,  thro'  angular  in 

A.  M.  M.     Circ.  2,  pp.  31,  134, 

lodged  in  acetabulum. 

cision,  by  Surg.  A.  A.  White, 

and  Circ.  6,  p.  70. 

8th  Maryland. 

4 

Brown,  E.  T.,  Sergeant,  C, 

July  23, 

Fragment  of  bomb   fractured 

July  23, 

Head  and  broken  extremity  of 

Died  July  27,  1864.    Circ.  2,  pp. 

21st  Massachusetts,  age  :!0. 

1864. 

\ipper  extremity  of  left  femur, 

1864. 

shaft,    thro'   longitudinal  in 

30,  134. 

five  inches. 

cision,  by  Surg.  W.V.White, 

57th  Massachusetts. 

5 

Cole,  R.,  Pt.,  B,  29th  Con 

Oct.  27, 

Musket  ball  shattering  upper 

Oct.  27, 

Head,   neck,  troohanters,  and 

Died  October  29,  1864.     Circ.  2, 

necticut. 

1864. 

extremity  of  right  femur. 

1864. 

portion  of  shaft  by  longitudinal 

pp.  33,  134. 

incision  over  troch.  major,  by 

Surg.  C.  M.  Clark,  39th  111. 

6 

Coon,  J.,  Pt.,  C,  60th  Indiana, 

Jan.  11, 

Conoidal  ball  comminut'g  neck 

Jan.  11, 

Head  and  shaft  below  troch. 

Died  January  21,  1863.     Circ.  2, 

age  20. 

1863. 

and  upper  part  of  shaft  of 

1863. 

minor,  through  semi  -circular 

pp.  23,  133. 

right  femur. 

incis'n.  by  Surg.  M.  T.  Carey, 

48th  Ohio. 

7 

1  Dempsey,  B.,  Pt.,  Battery 

Feb.  25, 

Fragment    of   shell    crushing 

Feb.  25, 

Head,  neck,  and  shaft  au  inch 

Died  February  28,  1864.     Circ.  2, 

I,  4th  Artillery. 

1864. 

trochanters  and  neck  of  right 

1864. 

below  trochanter  minor,  thro' 

pp.  25,  133. 

femur. 

longitudinal  incis.  five  ins.,  by 

Surg.  N.  W.  Abbott,  80th  III 

8 

Epton,  J.  W.,  Pt.,  I,  5th  S. 

Aug.  16, 

Conoidal  musket  ball  wound  of 

Prim'ry. 

Head  and  neck  of  right  femur. 

Died  September  2,  1864.     Circ. 

Carolina. 

1864. 

right  hip. 

2,  p.  120. 

9 

Goode,    J.    T.,   Pt.,    K,   6th 

July  31, 

Conoidal   ball   fracture  upper 

July  31, 

Head.neck.and  nearly  one-third 

Died  August  2,  18G4,  from  shock 

Virginia,  age  21. 

1864. 

extremity  of  left  femur. 

1864. 

of  shaft,  thro'  linear  incision, 

of  operation.   Circ.  2,  pp.  30,  134  . 

by  Surg.  G.  S.  West,  C.  S.A., 

and  others. 

1  AliliOTT  (N.  W.;,  Cases  of  Resection,  in  Chicago  Medical  Examiner,  1864,  Vol.  V,  p.  612. 


100 


INJURIES   OF    THE    LOWEE    EXTREMITIES. 


[CIIAV.  X. 


NO. 

NAME,  AGE,  AND  MILITARY 
DEBCKIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

10 

1  Greely,  T.,  Pt.,  C,  74th  New 

Oct.  5, 

Round  ball  splintering  neck  of 

Oct.  6, 

Head  and  fragments  of  neck, 

Surgical  fever,   pyaemia.     Died 

York,  age  20. 

1861. 

left  femur  into  articulation. 

1861. 

through  incision  seven  inches 

Oct.  12,  1861.    Circ.  6,  p.  62,  and 

long.sect.  thro'  troch.  inaj.  and 

Circ.  2,  pp.  21,  132. 

base  of  neck,  by  Ass't  Surg. 

J.  W.  S.  Gouley,  U.  S.  A., 

and  others. 

11 

Grimshaw,  S.,  .Sergeant,  H. 

Oct.  19, 

Fragm'nt  of  shell  shat'ing  head 

Oct.  19, 

Head  and  four  and  a  half  ins. 

Died  November  5,  1864.    Circ.  2, 

6th  N.  Y.  Cavalry,  age  31. 

1864. 

and  neck  of  left  femur,  fissures 

1864. 

of  shaft,  through  straight  in 

pp.  32,  134. 

extending  four  and  a  half  ins. 

cision  seven  inches  long,  by 

in  shaft,  lodged  in  acetabul'm. 

Surg.  A.  P.  Clark,  6th  New 

York  Cavalry. 

12 

*Bobson,  T.J.,  Pt.,  H,  32d 

June  24, 

Conoidal  ball  fract.  neck  and 

June  24, 

Head  and  shaft  just  below  tro 

Reaction  never  complete.     Died 

Tennessee,  ago  23. 

18G4. 

trochanters  of  femur,  extend- 

1864. 

chanters,  through   linear  in 

June  27,  1864.     Circ,  2,  pp.  30, 

into  capsular  ligament. 

cision  ten    inches    long,   by 

134. 

Surg.  J.F.  Grant,  P.  A.C  S. 

13 

Johnston,  11.  C.,.Pt.,  B,  56th 

June  17, 

Conoidal    ball   severing   head 

June  17, 

Head  and  fragments,  through 

Died  August  16,  1864,  from  ex 

North  Carolina,  age  26. 

1864. 

and  portion  trochanter  major, 

1864. 

curvilinear  incision  five  ins. 

haustion,  probably  the  result  of 

right  femur. 

long,  roughened  projection  of 
shaft  cut  off,  by  Surg.  C.  H. 

caries  and  ill-judged  diet.   Circ. 
2,  pp.  29,  134.  EVE  (I.  c.,  p.  263)  . 

Ladd,  56th  N.  C. 

14 

McCulloch,  J.,  Recruit,  age 

Aug.  30, 

Shot  shattering  upper  part  of 

Aug.  30, 

Head,  neck,  and  trochanters, 

Died  August  30,  1861,  four  hours 

35. 

1861. 

femur. 

1861. 

through  vertical  incision,  bv 

after  operation.      Circ.  2,    pp. 

Prof.  G.  C.  Blackman. 

20,  132. 

15 

McDonald,   E.   A.,   Pt.,  F, 

Aug.  20, 

Conoidal  ball  splintered  neck 

Aug.  20, 

Head,  fragments  of  neck,  and 

Died  September  4,  1864,  of  pyae 

149th  Pennsylvania,  age  31. 

1664. 

and  lodged  in  head  of  right 

1864. 

shaft,  thro'  trochanteric  ridge, 

mia.     Circ.  6,  p.  70,  and  Circ. 

femur. 

V-incision,  by   Surg.   F.  C. 

2,  pp.  30,  134. 

Reamer,  143d  Penn. 

16 

McGuire,   J.   A.,    Lieut.,  I, 

May  12, 

Musket  ball  smashed  trochant 

MavlS, 

Head,   neck,  and  trochanters. 

Died  May  15,  1864.     Circ.  2,  pp. 

148th  Pennsylvania. 

1864. 

ers  and  neck  of  right  femur. 

1664. 

thro"  longitudinal  incision,  by 

28,  134. 

Surg.  G.W.  Snow,  35th  Mass. 

17 

Mayo,   G.   W.,  Pt.,  B,  25th 

May  12, 

Conoidal  ball  fractured  neck 

Mav  13. 

Head  and  shaft,  five  inches  be 

Died  May  15,  1864,  from  shock. 

Virginia  Reserves. 

1864. 

and  shaft  of  right  femur. 

1864. 

low  troch.     minor,     through 

Spec.  5498,  A.  M.  M.     Circ.  2, 

straight  incision,  by  Surg.  C. 

pp.  28  134. 

B.  Gibson,  P.  A.  C.  S. 

18 

Melcar,  I.,  Pt.,  A,  8th  Mich 

Nov  16, 

Conoidal   ball  shattered  head 

Nov.  16, 

Head  and  neck,  thro'  incision 

Died  December  2,  1863.    Circ.  2, 

igan  Cavalry,  age  18. 

1863. 

and  upper  part  neck  of  left 

1863. 

ten  inches  long,  by  Surg.  J. 

pp.  25,  133.     EVE  (I.  c.,  p.  257). 

femur. 

S.  D.  Cullen,  C.  S.  A. 

19 

Morrison,   C.,  Pt.,   C,  185th 

Mar.  29, 

Conoidal  ball  separated  neck 

Mar.  29, 

Head  and  shaft,  half  inch  be 

Haemorrhage.      Died  April  26, 

New  York,  age  21. 

1863. 

from  shaft  of  left  femur  and 

1865. 

low  trochanter  minor,   thro' 

1865,  irritation  and  profuse  sup 

track  trochanter  major,  and 

longitudinal  incis'n,  by  Surg. 

puration.     Circ.  2,  pp.  33,  134. 

probably  lodged  in  pelvis. 

W.  Fuller,  1st  Mich. 

20 

O'Rourke,  —,  Pt.,  18th  Mis 

May  6, 

Musket  ball  shattered  neck  of 

Mav  6, 

Head,  neck,  and  shaft,  through 

Did  not  react.   Died  May  9,  1864. 

sissippi,  age  24. 

1864. 

right  femur  and  lodged. 

1864. 

trochanters,  curvilinear  incis. 

Circ.  2,  pp.  27,  133,  and  EVE 

four  inches  long,  by  Surg.  J. 

(I.  c.,  p.  257). 

T.  Gilmore,  C.  S.  A. 

21 

Pease,  T.  G.,  Pt.,  B,  117th 

Oct.  28, 

Musket  ball  shattered  trochant 

Oct.  28, 

Upper  extremity  of  femur,  bv 

Died  Oct.  29,  1864.     Circ.  2,  pp. 

New  York. 

1864. 

ers  and  neck  of  right  femur 

1864. 

Surg.  N.  Y.  Leet,  76th  Penn. 

32,  134. 

and  lodged  in  cotyloid  cavity. 

22 

Phillips,  J.  J.,  Pt.,  G,  61st 

May  6, 

Conoidal  ball,  extensive  longi 

May  7, 

Head  and  up.  extremity,  thro' 

Died  May  11.  1864.     ftpec.  5499, 

Virginia. 

1864. 

tudinal  splintering  of  shaft  of 

1864. 

long  vertical  incis'n,  by  Surg. 

A.  M.  M.     Circ.  2,  pp.  27,  133. 

right  femur. 

C.  B.  Gibson,  C.  S.  A. 

23 

Raines,   C.,  Pt.,  E,  25th  N. 

June  2, 

Conoidal  ball,  extensive  com 

June  2, 

Head,  neck,  trochanter  major, 

Died  June  4,  1864,  exhaustion. 

-» 

Carolina,  age  23.           • 

1864. 

minution  of  shaft  and  upper 

1864. 

and  three  and  a  half  ins.  of 

portion  of  right  femur  within 

shaft,  thro'  longitudinal  incis 

the  capsule. 

ion  six  inches  long,  by  Surg. 

1.  M.  Clark,  39th  111. 

24 

Robeson,   T.   R.,   Capt.,  2d 

July  3, 

Conoidal  ball  shattered  head 

July  3, 

Head,  neck,  and  shaft  just  be 

Didnotrally.   Died  July  3,  1863. 

Massachusetts,  age  24. 

1863. 

and  neck  of  right  femur,  frac 

1863. 

low  trochanters,  thro'  incis'n 

Circ.  2,  pp.  25,  133. 

tured   the  pelvis,  and  pene 

six  inches  long,  by  Surg.  J. 

trated  its  cavity. 

McNulty,  U.  S.  V. 

25 

Talman.  J.  M.,  Sergeant,  H, 

May  14, 

Conoidal  ball  comminuted  head 

May  15, 

Head,  neck,  and  shaft,  two  and 

Died  May  19.  1863.     Circ.  6,  p. 

18th  Wisconsin,  age  30. 

1863. 

and  neck  of  left  femur,  and 

1863. 

a  half   inches    below  lesser 

66,  and  Circ.  2,  pp.  24,  133. 

lodged  in  neck  ;  fissures  ex 

trochanter,   curved    incision, 

tending  down  shaft. 

by   Surgeon    H.    S.   Hewit, 

U.  S.  V. 

26 

Unknown,     Pt.,    1st    Army 

Sept.  17, 

Fragment  of  shell  comminut'g 

Sept.  17, 

Head  and  neck,  thro'  vertical 

Survived  the  operation  ten  hours. 

Corps  (a  Frenchman). 

1862. 

upper  extremity  of  left  femur, 

1862. 

incision  six  inches  long,  by 

Circ.  2,  pp.  22,  133. 

lesions  extending  into  pelvis. 

Surg.  J.  McNulty,  U.  S.  V. 

27 

Unknown,  Pt.,   First  Army 

Aug.  30, 

Conoidal  ball  fractured  the  left 

Aug.  30, 

Head  and  shaft,  at  junct'n  with 

Died  August  31,  1862,  from  shock 

Corps. 

1863. 

femur  at  junction  of  head  and 

1862. 

neck,  vertical  incision  six  ins. 

of  injury  and  operation.     Circ. 

neck,  pen.  pelvic  cavity. 

long,  by  Surg.  J.  McNulty, 

2,  pp.  22,  132. 

U.  S.  V. 

28 

Unknown,  Pt.,  General   R. 

Aug.  28, 

Conoidal  ball  splintering  neck 

Aug.  28, 

Head  and  shaft,  about  two  ins. 

Patient  fell  into  the  hands  of  the 

King's  division,  First  Army 

1862. 

and  trochanters  of  left  femur, 

1862. 

below  trochanter  minor,  vert 

enemy,  probably  survived  but 

Corps. 

and  pen.  pelvic  cavity. 

ical  incision,  by  Surgeon  P. 

a  short  time.     Spec.  71,  A.M  .  M. 

Pineo,  U.  S.  V. 

Phot.  Ser.,  Vol.  1,  p.  13,  S.  G.  O. 

Circ.  6,  p.  62;  Circ.  2,  pp.  21,  132. 

29 

Unknown,   Pt.,  Fifth  Army 

May  10, 

Musket  ball  fracturing  trochan- 

May  10, 

Head,  neck,  and  trochanters.  .  . 

Died  May  13,  1864.     Circ.  2,  pp. 

Corps. 

1864. 

teric  portion  of  left  femur. 

1864. 

28,  133. 

30. 

Unknown,    Pt.,    Eighteenth 

June  3, 

Fragment  of  shell  comminuted 

June  3, 

Head,  neck,  and  trochanters.  .  . 

Died  June  6,  1864.      Circ.  2,  pp. 

Army  Corps. 

1864. 

trochanter  major  and  neck  of 

1864. 

29,  134. 

right  femur. 

31 

Unknown,  Pt.,  C.  S.  A  

Dec.  13, 

Fragment  of  shell    fractured 

Dec.  13, 

Head.  neck,  and  trochanters,  by 

Died    two  or  three    days  after 

1862. 

trochanter  major  and  neck  of 

1802. 

Surg.  II.  McGuire,  P.A.  C.  S. 

operation,  from  shock.    Circ.  2, 

right  femur. 

pp.  23,  133. 

32 

Unknown,  Pt.,  Swell's  Corps. 

May  5, 

Conoidal  ball  fractured  neck  of 

Mav  5, 

Head  and  shat'd  fragments  of 

Died  May  22,  1864,  pyipmia.  Circ. 

1864. 

left  femur,  lodging. 

1864. 

neck  and  shaft,  longitudinal 

2,  pp.  26,  133. 

incis'n,  bvSurg.  II.  McGuire, 

P.  A.  C.  S. 

33 

Unknown,    Pt.,     Kershaw's 

May  3, 

Musket  ball  shattered  neck  of 

May  4. 

Head  and  neck,  by  Surgeon 

Died  May  6,  1863.     Circ.  2.  pp. 

S.  C.  Brigade. 

1863. 

femur. 

1863. 

James,  16th  South  Carolina. 

24,  133,  and  EVE  (I.  c.,  p.  2o7). 

'CALHOUN  (J.  T.),  Army  Correspondence,  in  Med.  and  Surg.  Reporter,  1862,  Vol.  VIII,  p.  76. 

2  EVE  (P.  F.),  Contribution  to  the  History  of  the  Hip  Joint  Operations,  etc..  rn  Trans,  of  Am.  Med.  Ass.,  1867.  Vol.  XVIII,  p.  261. 


SECT.  II.J 


EXCISION    AT    THE    HIP    AFTEK    SHOT    Ii\TTURY. 


101 


Of  the  thirty-three  primary  excisions  at  the  hip  seventeen  were  on  the  right  side, 
thirteen  on  the  left,  and  in  three  cases  the  side  of  the  injury  was  not  indicated.  In 
twenty-two  instances  the  straight,  vertical  longitudinal  or  linear  incision,  as  variously 
termed  by  the  different  operators,  was  employed;  in  four  instances  the  curvilinear;  in  one 
the  V-shaped,  and,  in  six  cases  the  mode  of  incision  was  not  indicated.  In  five  instances 
the  missile,  either  whole  or  in  part,  was  excised  with  the  injured  bone. 

Intermediary  Excisions. — Of  twenty-two  excisions  classified  as  intermediary,  two 
resulted  successfully,  a  mortality  rate  of  90.9.  Sixteen*  of  the  operations  were  practised 
on  Union  and  six  on  Confederate  soldiers.  The  shortest  interval  between  the  dates  of 
reception  of  injury  and  operation  was  two  days,  the  longest  twenty-eight,  the  average 
interval  being  about  thirteen  days.  Details  of  the  two  successful  intermediary  excisions 
will  be  first  noticed : 

CASE  239. — Lieutenant  James  M.  Jarrett,  Co.  C,  15th  North  Carolina,  a  spare  man;  28  years  of  age,  of  medium  size, 
of  fair  complexion,  of  temperate  habits,  and  good  general  health,  was  wounded  at  the  affair  at  Bristow  Station,  Virginia, 
October  14, 1863,  by  a  conoidal  musket  ball,  which  entered  in  front  and  a  little  to  the  outside  of  the  median  line  of  the  left  thigh, 
two  inches  below  Poupart's  ligament,  shattered  the  femur,  and  made  its  exit  posteriorly  at  the  outer  part  of  the  limb,  the  wound 
of  exit  being  on  a  rather  higher  level  than  that  of  entrance.  The  fracture  was  dressed 
with  a  straight  splint,  and  the  wounded  officer  was  placed  in  an  ambulance  wagon  and 
transported  over  rough  roads  to  Richmond,  a  distance  of  one  hundred  and  sixty  miles. 
On  October  20th,  he.  was  admitted  to  hospital  No.  4,  at  Richmond,  in  an  exhausted 
state,  and  was  placed  in  charge  of  Surgeon  James  B.  Read,  P.  A.  C.  S.  He  complained 
of  extreme  pain  upon  any  movement  of  the  limb,  and  was  unwilling  to  submit  to  an 
examination  of  the  injury  unless  insensibility  was  induced.  Chloroform  having  been 
administered,  the  splints  and  soiled  bandages  were  removed,  and  the  limb  was  placed 
in  an  easy  position  on  pillows.  Water  dressings  were  applied  to  the  wounds,  and  an 
opiate  was  administered.  For  the  next  three  weeks,  the  progress  of  the  case  was  very 

unfavorable.     The  wound  of  exit  discharged  copiously  unwhole 
some  thin  pus,  mixed  with  blood  and  bubbles  of  fetid  gas  and 

small  bits  of  dead  bone.     The  pulse  was  quick  and  small,  the 

tongue  red  and  dry.     There  was  a  tendency  to  diarrhoea,  and 

night  sweats  frequently  recurred.     On   November  9th,  as   the 

patient  was  steadily  growing  worse,  a"  consultation  was  asked 

for,  and  Surgeons  C.  B.  Gibson  and  M.  Michel  saw  the  case  with 

Dr.  Read.     It  was  decided  that  the  circumstances  called  for 

operative  interference,  and  that  an  excision  of  the  head  of  the 

femur  offered  the  best  prospect  of  recovery.     On  November  9th 

the  patient  was  anaesthetized,  and  then  placed  on  his  right  side 

on  the  operating  table.     A  straight  incision  was  commenced  two 

inches  below  the  posterior  or  exit  wound,  and  was  carried  through 

this  to  the  great  trochanter,  and  thence  upward  for  two  inches 

further,  thus  making  a  wound  about  seven  inches  in  length.     This 

incision  being  earned  down  to  the  bone,  the  upper  end  of  the  shaft 

of  the  femur  was  examined  and  was  found  to  be  jagged  and 

pointed,  thin  layers  of  bone  about  three  inches  long  being  broken 
off  from  its  anterior  aspect.  The  lower  fragment  was  projected  through  the  incision  by  adducting  the  limb  and  pushing  the 
knee  upward,  and  it  was  sawn  about  two  inches  below  its  upper  sharp  extremity.  The  trochanteric  portion  of  the  femur  was 
then  sought  for,  and  was  found  drawn  upward  by  the  psoas  and  iliacus  internus.  Its  extremity  was  seized  by  the  lion  forceps 
and  drawn  downward,  and  the  attachments  of  these  muscles  to  the  lesser  trochanter  were  divided.  To  luxate  the  head  of  the 
femur  so  as  to  admit  of  the  division  of  the  round  ligament  was  a  work  of  great  difficulty.  It  was  finally  accomplished,  partially 
by  twisting  the  neck  of  the  bone,  and  the  head  was  exarticulated.  The  appearance  of  the  principal  portion  of  this  excised 
bone  is  shown  in  the  annexed  wood-cut  (FiG.  51).  Several  large  detached  fragments  and  splinters  were  then  extracted,  and 
other  closely  attached  bits  of  bone  were  enucleated  by  the  finger-nail.  The  wound  was  cleansed  and  then  closed  by  sutures  and 
adhesive  strips.  Dry  dressings  were  applied,  and  the  thigh  was  fixed  by  a  large  straight  splint.  The  patient  was  ordered  two 
grains  of  opium  and  a  drachm  and  a  quarter  of  brandy  every  two  hours.  At  bed-time  the  patient  was  quite  comfortable,  and 
could  shift  his  position  slightly  without  pain;  his  pulse  was  120.  On  the  following  day,  anodynes  were  given  at  greater  inter 
vals.  On  November  llth,  they  were  omitted,  except  at  bed-time,  and  nutritious  diet  was  ordered.  The  next  day  the  sutures 
were  removed ;  the  wound  began  to  discharge  laudable  pus  in  small  quantity.  The  case  progressed  without  any  untoward 
complication.  On  December  9th  the  wound  was  healed,  except  at  two  points,  connected  by  sinuses  leading  to  the  cotyloid 
cavity  and  the  upper  end  of  the  shaft.  The  patient  had  gained  flesh  and  strength;  his  pulse  was  full  and  strong  at  76;  his 


FIG.  51.  —  Shattered 
upper  portion  of  the  left 
femur.  [From  a  wood 
cut  after  READ.] 


FIG.  52. — Appearance  of  limb  seven  months 
after  operation.     [From  a  photograph.] 


102 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X 


appotito  and  digestion  were  natural;  he  slept  well,  was  cheerful,  and  did  not  complain  of  pain.  The  limb  was  shortened  five 
inches.  The  daily  discharge  of  pus  was  less  than  half  an  ounce.  Two  weeks  subsequently  the  wound  was  entirely  united;  the 
cicatrix  was  firm ;  the  patient  could  move  about  his  bed  without  inconvenience ;  there  was  no  pain  on  pressure  about  the  muscles 
of  the  injured  part.  The  patient  was  now  removed  to  his  home  in  North  Carolina,  and  was  soon  able  to  move  about  on  crutches. 
In  September,  1864,  ten  months  after  the  operation,  he  reported  that  he  was  able  to  bear  considerable  weight  on  the  limb,  and 
that  he  had  discarded  his  crutches  and  walked  about  in  a  high-heeled  boot  with  the  aid  of  a  cane.  The  appearance  of  the 
patient,  seven  months  after  the  operation,  is  exhibited  in  the  wood-cut  on  the  preceding  page  (FlG.  52).  copied  from  a  photo 
graph  presented  to  the  compiler  by  Assistant  Surgeon  Latimer,  C.  S.  A. 

CASE  240. — Private  Hugh  Wright,  Co.  G,  87th  New  York,  aged  28  years,  a  robust,  healthy  man,  was  wounded  on  May 
5,  1864,  at  the  battle  of  the  Wilderness,  by  a  conoidal  musket  ball,  which  entered  the  right  thigh  an  inch  within  the  track  of 
the  femoral  vessels  and  two  inches  below  Poupar^'s  ligament,  passed  backward  and  outward,  shattering  the  neck  and  trochanters 
of  the  femur,  and,  having  been  greatly  flattened  and  distorted  by  the  impact,  it  lodged  amid  the  fragments  of  bone.  The  precise 

direction  of  the  fracture  is  indicated  in  the  accompanying  wood-cut  (FlG.  54). 1  He  stated 
that  after  being  wounded,  he  was  carried  to  the  rear  by  a  number  of  his  companions,  and, 
in  the  evening,  was  taken  to  the  field  hospital  of  the  2d  division  of  the  Second  Corps. 
Here  he  remained  for  three  days.  He  was  then  sent  in  an  ambulance  wagon  to  Fredericks- 
burg,  and  placed  in  a  temporary  hospital.  He  stated  that  his  wound  was  repeatedly 
examined  by  different  surgeons,  but  that  no  treatment  was  instituted  beyond  the  applica 
tion  of  a  compress  dipped  in  cold  water  to  the  wound.  He  was  transferred,  after  a  fort 
night,  on  a  hospital  steamer,  to  Washington,  and  on  May  25th  he  was  admitted  to  Stanton 
Hospital,  then  under  the  charge  of  Surgeon  B.  B.  Wilson,  U.  S.  V.  He  was  placed  in  Ward 
6,  under  the  care  of  Acting  Assistant  Surgeon  J.  B.  Garland,  who  communicated  a  special 
report  of  the  case.  The  injured  limb  was  swollen,  everted,  and  shortened.  Pus  had 
accumulated  in  the  tissues  about  the  hip.  Notwithstanding  the  gravity  of  the  injury,  the 
patient's  constitutional  condition  is  said  to  have  been  hopeful.  On  exploring  the  wound 
with  the  finger,  the  patient  "being  under  the  influence  of  chloroform,  detached  fragments  of 
bone  could  be  felt.  On  consultation  with  Acting  Assistant  Surgeon  George  A.  Mursick,2 
an  operation  was  decided  upon,  for  the  purpose  of  removing  these  loose  fragments,  and 
the  missile,  if  it  could  be  found.  On  May  2?th,  the  patient  was  rendered  insensible  by 
sulphuric  ether,  and  Dr.  Mursick,  assisted  by  Dr.  Garland  and 
others,  made  a  straight  incision,  commencing  above  and  behind  the 
trochanter  major  and  carried  downward  in  the  axis  of  the  thigh. 
It  was  not  in  contemplation,  at  the  beginning  of  the  operation,  Dr. 
Garland  states,  to  exarticulate  the  head  of  the  femur;  but  when  the 
muscular  attachments  were  divided,  and  the  full  extent  of  the  frac 
ture  was  revealed,  and  the  joint  was  found  distended  with  pus,  it 
was  at  once  determined  to  make  a  formal  excision.  The  fragments 
of  the  neck  were  extracted  piecemeal.  The  ball  was  found  lying 
behind  the  neck,  and  was  exti-acted.  The  capsular  ligament  being 
freely  incised,  a  bistoury  was  inserted  into  the  cotyloid  cavity  and 
the  round  ligament  was  severed,  and  the  head  of  the  femur  was 
removed  without  difficulty.  The  jagged  upper  extremity  of  the 
shaft  of  the  femur  was  then  turned  out  of  the  wound  by  carrying  the  limb  over  the  opposite  knee,  and  was  smoothed  off  by  a 
chain  saw.  There  was  but  trifling  haemorrhage,  and  no  ligatures  were  required.  The  wound  was  carefully  cleansed,  dressed 
with  dry  lint,  and  left  to  heal  by  granulation.  To  keep  the  limb  in  position,  long  sand  bags  were  laid  on  either  side  of  it,  and 
moderate  extension  was  made  by  means  of  a  weight  attached  to  the  leg  and  suspended  from  the  foot  of  the  bed.  At  night  he 
took  a  grain  of  sulphate  of  morphia  in  a  draught.  The  operation  seemed  to  depress  him  very  much,  and  reaction  was  slow. 
He  passed  a  restless  night,  manifesting  much  nervous  excitement.  In  the  morning  his  pulse  was  feeble  and  frequent;  his 
tongue  dry  and  furred.  He  was  ordered  an  ounce  of  brandy  every  three  hours,  a  grain  of  opium  every  four  hours,  and  as  much 
beef  tea  and  concentrated  nourishment  as  he  could  take.  On  May  29th  his  general  condition  had  much  improved;  the  pulse 
was  less  frequent  and  stronger.  There  was  free  suppuration.  The  wound  was  dressed  with  a  weak  solution  of  permanganate 
of  potassa.  On  June  1st  he  continued  to  improve,  the  wound  looked  well,  and  the  character  of  the  suppuration  was  good. 
The  amount  of  brandy  was  reduced  to  four  ounces  daily.  On  August  1st  he  was  still  doing  well.  The  wound  was  filled  up 
with  granulations  from  the  bottom,  with  the  exception  of  a  sinus  leading  to  the  bone.  It  continued  to  suppurate  quite  freely, 
and  some  small  pieces  of  dead  bone  had  come  away  with  the  discharges.  He  had  gained  in  flesh,  and  his  health  and  spirits 
were  good.  On  August  22d,  he  attempted,  for  the  first  time,  to  sit  up  in  bed,  but,  owing  to  the  rigidity  of  the  parts  and  the 
agglutination  of  the  muscles,  the  pain  caused  by  the  sitting  posture  was  so  severe  that  he  was  compelled  to  lie  down  again. 
Cold  evaporating  lotions  were  applied  to  the  thigh.  On  August  23d  the  upper  part  of  the  thigh  swelled  and  was  painful,  and 
the  discharge  was  increased  in  quantity.  On  August  27th  the  swelling  of  the  thigh  had  increased,  the  discharge  from  the 
wound  was  very  free,  thin,  and  flaky,  and  the  surrounding  surface  was  glazed  and  doughy  to  the  touch.  The  wound  of  entrance 
had  re-opened  and  discharged  thin  pus.  An  abscess  formed  on  the  inner  side  of  the  thigh,  and  about  four  ounces  of  thin  flaky 

1  An  anterior  view  of  this  specimen  is  printed  in  the  surgical  report  in  Circular  Xo.  G,  S.  G.  O.,  1865,  p.  74,  and  in  the  Catalogue  of  the  Surgica 
Section  of  the  Arm;/  Metl.  Museum,  1866.  p.  24G. 

2MUUSICK  (G.  A.),  A  successful  Case  of  Excision  of  the  Head  of  the  Femur  for  Gunshot  Fracture,  in  New  York  Med.  Jour.,  1865,  Vol.  I,  p.  424. 
See  also  Circular  Xo.  G,  S.  G.  O.,  1865,  p.  68,  Circular  Xo.  2,  S.  G.  O.,  18G9,  pp.  41,  135,  Photographic  Series,  A.  M.  M.,  Vol.  IV,  p.  38. 


FIG.  53. — Appearance  of  limb  two  years 
and  five  months  after  operation.  [From  a 
photograph.] 


FlG.  54. — Shot  commi 
nution  of  neck  and  tro 
chanters  of  right  femur. 
Spec.  3375. 


SECT,  ii.]  EXCISION    AT    THE    HIP    FOR    SHOT    INJURY.  103 

pus  was  discharged.  The  patient  was  restless.  He  was  ordered  twenty  drops  of  the  tincture  of  the  sesquichloride  of  iron 
every  six  hours,  with  stimulants  and  nutritious  diet.  On  September  1st  the  swelling  and  inflammation  of  the  thigh  continued. 
He  complained  of  nausea  and  want  of  appetite.  An  abscess  formed  on  the  outer  side  of  the  thigh.  On  September  5th  the 
abscess  was  incised,  and  a  large  quantity  of  thin,  flaky,  and  offensive  pus  was  evacuated.  He  had  an  irritable  stomach,  and 
Hoffman's  anodyne  was  administered.  On  September  Gth  the  edges  of  the  incision  in  the  abscess  were  beginning  to  slough,  and 
nitric  acid  was  freely  applied.  On  September  9th  he  had  diarrhoea;  ten  grains  of  subnitrate  of  bismuth  and  a  grain  of  opium 
were  given  every  six  hours.  On  September  13th  the  diarrhoea  had  nearly  ceased.  The  patient's  general  condition  had  improved, 
and  the  wound  looked  well,  though  the  suppuration  was  still  copious,  and  had  improved  in  quality.  On  September  25th  a  large 
ring-shaped  exfoliation  from  the  upper  end  of  the  femur  was  removed  through  the  wound  of  operation.  On  September  26th 
another  exfoliation  was  removed.  On  October  Gth,  1864,  Private  Wright  was  discharged  from  the  military  service  on  account 
of  the  expiration  of  his  enlistment.  On  October  7th  the  swelling  of  the  thigh  had  subsided;  the  discharge  from  the  wounds 
had  much  diminished  in  quantity,  and  presented  the  appearance  of  laudable  pus;  the  diarrhoea  had  ceased,  and  his  general 
condition  was  much  improved,  he  being  able  to  sit  up  in  bed.  On  October  30th.  a  sinus  communicating  with  necrosed  bone 
opened  on  the  outside  of  the  thigh.  In  the  latter  part  of  December,  another  abscess  formed  on  the  outer  side  of  the  thigh. 
When  this  was  opened  the  swelling  and  inflammation  subsided.  He  continued  to  do  well  until  February  6,  1865,  when  another 
abscess  formed  in  the  lower  third  of  the  thigh,  on  the  outer  side.  This  was  incised  and  the  pus  evacuated.  Several  pieces  of 
dead  bone  came  away  with  the  discharges  from  the  wound  of  operation.  About  the  middle  of  March,  1865,  he  was  able  to  get 
out  of  bed,  and  to  walk  about  the  ward  on  crutches.  Soon  after,  in  getting  out  of  bed,  "he  let  his  leg  fall  and  hurt  it."  This 
accident  was  followed  by  inflammation  and  swelling  of  the  thigh,  and  an  abscess  in  the  lower  third  of  it,  on  the  inner  side. 
This  was  incised,  and  a  small  quantity  of  pus  was  evacuated.  He  was  now  attacked  with  erysipelas,  which  extended  from  the 
knee  to  the  hip.  This  was  combated  with  tonics  and  stimulants,  such  as  iron  and  quinine,  and  rapidly  disappeared.  From  this 
time  he  did  well,  taking  daily  exercise  about  the  hospital  on  crutches.  On  April  17th,  he  was  transferred  to  the  Ward  Hospital, 
at  Newark,  New  Jersey.  His  general  health  was  tolerably  good.  He  could  not  bear  much  weight  on  his  limb,  and  inflamma 
tion  and  abscesses  followed  any  unusual  exertion.  He  remained  at  this  hospital  until  May  6,  1865,  when  it  was  reported  that 
he  "eloped."  As  a  discharged  soldier,  he  was  no  longer  under  military  authority,  and  was  at  liberty  to  go.  For  many  months, 
though  diligent  inquiries  were  made,  he  could  not  be  traced;  but,  in  July,  1866,  Surgeon  General  L.  W.  Oakley,  of  New  Jersey, 
transmitted  a  letter  from  Dr.  W.  Pierson,  of  Orange,  New  Jersey,  which  stated  that  Wright  had  entered  the  almshouse  at  that 
place  in  June,  1865,  and  had  remained  there  until  the  following  spring,  under  Dr.  Pierson's  professional  care.  At  first,  the 
mutilated  limb  had  been  enormously  swollen  from  oedema,  and  there  was  an  ichorous  discharge  from  a  sinus  near  the  hip  joint. 
With  careful  bandaging,  tile  oedema  gradually  disappeared.  In  the  spring  of  1866,  Wright  left  the  almshouse,  and  engaged 
himself  as  a  laborer  on  a  farm.  He  wore,  Dr.  Pierson  reported,  a  cork-soled  shoe  of  his  own  manufacture.  The  limb  was 
shortened  precisely  five  inches.  The  circumference  of  the  injured  thigh  at  the  highest  part  was  one  inch  less  than  that  of  its 
fellow.  He  walked  well  without  crutch  or  cane,  bearing  his  full  weight  on  the  mutilated  limb.  There  was  quite  free  motion  at 
the  hip,  but  little  at  the  knee.  There  were  no  open  iistules,  and  no  tenderness  about  any  of  the  cicatrices.  Dr.  Stephen  Wickes, 
of  Orange,  reported,  in  the  summer  of  1866,  that  Wright  was  in  good  health,  though  somewhat  intemperate;  that  he  worked 
daily  at  light  tasks,  and  was  even  able  to  mow  grass.  He  commonly  walked  with  a  cane.  According  to  the  measurement 
of  Dr.  Wickes,  the  limb  was  shortened  four  and  tln-ee-quarter  inches.  About  this  period,  Dr.  Mursick,  the  operator  in  the 
case,  discovered  his  former  patient,  and  examined  him.  He  found  the  resected  end  of  the  femur  firmly  attached  to  the  pelvis 
by  ligamentous  tissue  an  inch  and  a  half  long.  The  agglutination  of  the  muscular  sheaths  had  nearly  disappeared.  The  limb 
was  quite  under  control.  The  man  could  Hex  and  extend  it  slightly,  and  adduct  to  a  limited  extent;  the  power  of  rotating  and 
abducting  was  lost.  Motion  at  the  knee  was  quite  restricted,  on  account  of  the  thickening  and  consolidation  of  the  surrounding 
tissues  resulting  from  inflammation.  He  stated  that  latterly  the  improvement  in  his  limb  had  been  very  decided;  that  when  he 
first  commenced  to  walk,  the  limb  felt  like  a  weight  attached  to  the  body;  this  sensation  had  entirely  disappeared.  January 
15,  1837,  Hugh  Wright  was  found  duly  established  at  his  residence  in  North  Orange,  Essex,  New  Jersey,  receiving  a  pension 
dating  from  October,  1864,  the  date  of  his  injury.  The  Pension  Examiner,  Dr.  A.  W.  Woodhull,  of  Newark,  reported  "that 
at  that  date  there  was  about  six  inches  shortening,  with  no  power  of  flexion  or  extension  at  the  hip  and  the  power  of  rotation 
to  a  very  limited  degree.  All  motion  of  the  injured  limb  for  progression  was  imparted  by  lateral  swing  of  the  body  itself.  I 
may  add  that  the  knee  joint  of  the  injured  limb  is  stiffened."  On  October  19,  1867,  Dr.  Mursick  again  examined  Wright,  and 
took  him  to  New  York,  and  had  his  photograph  taken.  The  negative  is  preserved  at  the  Army  Medical  Museum,  and  is  No. 
183  of  the  Surgical  Series  of  Photographs,  a  reduced  copy  of  the  lower  limbs  as  shown,  in  the  photograph,  is  presented  in  the 
wood-cut  (FlG.  53).  At  this  period,  Wright  reported  that  his  limb  had  given  him  no  trouble  since  the  sinuses  healed,  in  May/ 
1865,  and  that  it  sufficed  for  all  purposes  of  locomotion.  He  stood  on  it  very  firmly,  and  could  move  it  in  any  direction  with 
an  easy,  swinging  motion.  He  had  been  engaged  for  a  year  and  a  half  as  a  farm  hand,  and  was  employed  at  that  time  as  a 
wood-chopper.  He  had  for  a  short  time  earned  larger  wages  as  a  hod  bearer,  and  had  climbed  high  ladders  with  a  heavy  hod 
of  bricks  on  his  shoulders ;  but  he  found  this  avocation  too  fatiguing.  His  general  health  and  physical  condition  were  good. 
The  knee  joint  continued  quite  stiff.  It  could  be  flexed  to  about  quarter,  perhaps,  of  the  normal  extent.  When  he  walked, 
the  rounded  upper  extremity  of  the  femur  played  up  and  down  on  the  dorsum  of  the  ilium  over  a  space  of  an  inch  and  a  half. 
In  November,  1888,  Dr.  Mursick  again  examined  Wright,  and  reported  on  his  condition.  The  utility  of  his  limb  had  augmented 
during  the  twelve  months  that  had  elapsed  since  the  last  examination.  The  attachment  of  the  femur  to  the  pelvis  was  strong; 
the  cicatrices  were  firm  and  healthy.  All  the  movements  of  the  thigh  were  performed  with  almost  as  much  facility  as  in  the 
normal  state;  rotation,  even,  as  well  as  flexion,  extension,  adduction,  and  abduction.  His  general  health  was  good.  On  August 
3,  1872,  Wright's  pension  was  increased  to  $18  per  month  on  account  of  increasing  disability  and  because  additional  legislation 
permitted  larger  payment  to  the  more  gravely  mutilated.  In  September,  1873,  Pension  Examiner  A.  W.  Woodhull  reported  the 
local  disability  unchanged,  and,  on  October  26,  1874,  the  sudden  death  of  the  pensioner,  Hugh  Wright,  from  supposed  cardiac 
disease  was  reported.  Unfortunately  no  autopsy  was  made  and  the  valuable  opportunity  of  examining  the  relations  of  the 
resected  joint  was  unimproved. 


104  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

In  the  twenty  unsuccessful  intermediary  excisions  the  average  duration  of  life  after 
operation  was  twelve  and  a  half  days.  One  patient  (CASE  248)  survived  seventy-five  days, 
and  apparently  succumbed  to  climatic  influences  rather  than  to  the  effects  of  the  injury  and 
operation;  another  (CASE  251)  died  at  the  end  of  three  weeks  with  colliquative  diarrhoea 
and  malarial  complications.  Four  cases  where  the  lesions  seemed  to  indicate  the  operation, 
made  little  or  no  recuperative  effort,  and  form  the  first  category.  The  first  was  a  solitary 
instance  of  fracture  by  a  shell  fragment: 

CASE  241. — Private  Cornelius  Callaghan,  Co.  G,  2d  Delaware,  was  wounded  in  the  left  hip  by  a  fragment  of  shell,  at 
the  battle  of  Antietam,  September  17,  1862.  On  September  19th,  he  was  admitted  to  hospital  No.  3,  at  Frederick,  Maryland". 
He  was  placed  under  the  influence  of  chloroform,  and  an  examination  of  the  wound  was  made  by  Assistant  Surgeons  Bill  and 
Colton,  U.  S.  A.  The  wound  being  enlarged  sufficiently  to  admit  of  free  exploration,  the  trochanteric  region  of  the  femur  was 
found  to  be  badly  comminuted,  the  great  trochanter  entirely  detached  and  drawn  backward  by  the  action  of  the  glutens,  while 
fissures  extended  up  the  neck  within  the  capsular  ligament.  No  fissures  extended  below  the  trochanter  minor.  The  patient's 
general  condition  was  good,  and  all  the  circumstances  being  favorable  to  such  an  attempt,  it  was  determined,  in  a  consultation 
of  the  medical  staff,  and  with  the  approval  of  Medical  Inspector  Coolidge  and  Surgeon  Milhau,  U.  S.  A.,  that  the  injured 
portions  of  bone  should  be  excised.  On  September  29th,  Assistant  Surgeon  J.  H.  Bill  made  an  incision 
from  the  wound  three  inches  downward  in  the  course  of  the  shaft,  and  another  three  inches  long  curving 
upward  and  inward  from  the  wound  to  a  point  a  little  below  the  anterior  superior  spinous  process  of  the 
ilium.  The  muscular  attachments  being  dissected  aside,  a  chain  saw  was  passed  around  the  shaft  of  the 
femur  and  made  to  divide  it  just  below  the  trochanter  minor.  The  head  of  the  bone  was  then  disarticu 
lated.  The  edges  of  the  wound  were  united  by  six  sutures,  and  adhesive  plasters  and  water  dressings 
were  applied.  The  limb  was  kept  in  position  by  pillows,  without  the  use  of  splints.  A  full  dose  of  morphia 
was  given,  and  light  but  nourishing  food  was  directed.  On  the  following  day  the  patient  was  quite  com- 

FiG.55.— Neck  and  tro-     fortable.     His  pulse,  which  was  100  before  the  operation,  now  beat  120.     He  was  ordered  a  diet  of  beef 
chanters  of  right  femur 
shattered  by  a  fragment    tea,  eggs,  and  oysters,  with  a  small  amount  of  wine.     At  midnight  he  was  sleeping  quietly.     On  October 

Spec  840  Sec  I  A^oi'     1st  ^ie  was  st^  cheerful.     His  pulse  was  very  compressible  at  120,  and  he  was  sweating  profusely.     The 
thigh  was  swollen  and  painful.     A  draught  of  aromatic  sulphuric  acid  with  a  little  quiuia  was  added  to  his 

prescriptions,  and  the  allowance  of  wine  was  increased.  The  prognosis  was  now  very  unfavorable.  On  October  2d  the  sweating 
was  checked,  but  diarrhoea  had  supervened.  The  pulse  was  still  softer  and  more  frequent,  and  suppuration  had  commenced. 
At  midnight  the  patient  was  attacked  with  vomiting  and  hiccough.  On  October  3d  the  vomiting  persisted,  and  the  sweating 
was  renewed.  This  state  continued  through  the  day  and  night,  the  patient  sinking  gradually.  He  died  at  3  o'clock  P.  M.  of 
October  4,  1832.  The  pathological  preparation  is  deposited  in  the  Army  Medical  Museum,  and  is  numbered  840  of  the  Surgical 
Section.  An  anterior  view  of  it  is  presented  at  page  247  of  the  Catalogue  of  the  Surgical  Section,  and  a  posterior  view  in  the 
accompanying  wood-cut  (FiG.  55). 

CASE  242. — Private  D.  M.  Noe,  Co.  C,  4Gth  Ohio,  aged  22  years,  was  wounded  at  the  battle  of  Shiloh,  Tennessee,  April 
6,  1852,  by  a  conoidal  musket  ball,  which  shattered  the  neck  of  the  left  femur.  The  patient  was  placed  on  board  the  hospital 
transport  steamer  Lancaster,  under  the  charge  of  Surgeon  George  C.  Blackman,  U.  S.  V.  On  April  16, 1862,  chloroform  having 
been  administered,  Dr.  Blackman  made  a  longitudinal  incision  four  inches  in  length  over  the  trochanter,  and  excised  the  head, 
neck,  and  trochanters,  together  with  three  inches  of  the  shaft  of  the  femur,  the  diaphysis  being  divided  by  a  common  amputa 
ting  saw.  The  patient  reacted  well  after  the  operation,  and  for  five  days  the  symploms  progressed  favorably.  Pyasmia  was 
subsequently  developed,  and  death  ensued  on  April  24,  1862,  eight  days  after  the  operation. 

CASE  243. — Private  Marsella  Smith,  Co.  F,  38th  Virginia,  a  robust  middle-aged  man,  was  wounded  near  Spottsylvania, 
early  in  the  morning  of  May  10,  18G4,  by  a  conoidal  musket  ball,  which  entered  at  the  upper  posterior  part  of  the  left  thigh, 
passed  through  the  perinscum  without  injuring  the  urethra,  and  through  the  soft  parts  of  the  right  hip.     He  was  sent  to  Rich 
mond  by  rail,  and  was  admitted  to  hospital  No.  9,  otherwise  known  as  the  Receiving  and  Wayside  Hospital, 
on  the  following  morning.     On  May  12th  he  was  placed  under  chloroform  and  the  wound  was  thoroughly 
explored.     The  limb  was  everted  and  shortened  and  swollen;  there  was  crepitus  on  rotation.     The  fracture 
appeared  to  be  limited  to  the  great  trochanter  and  neck.     It  was  supposed  that  the  urethra  was  divided;  but 
this  was  afterwards  proved  not  to  be  the  case.     Surgeon  Charles  Bell  Gibson,  C.  S.  A.,  decided  to  excise 
the  injured  bone,  and  the  operation  was  performed  forty-eight  hours  after  the  reception  of  the  injury,  the 
head,  neck,  and  two  inches  of  the  shaft  being  removed.     It  is  stated  that  the  effects  of  the  chloroform  were 
unfavorable.     On  the  following  day  "patient  commenced  sinking  at  an  early  hour,  and  continued  growing 
FIG.  53.— Oblique     more  and  more  feeble  until  3  o'clock  P  M.,  when  death  ended  his  sufferings,"  May  13,  18G4.     The  excised 
upper^irTion'of'sMft     portion  of  the  femur  was  preserved  by  Dr.  Richardson,  and  has  been  presented  by  him  to  the  Army  Medical 

of  left  femur.  Speg.  Museum.  It  is  represented  in  the  accompanying  drawing  (FiG.  5G),  and  shows  that  the  injury  to  the  bone 
5500.  Sect.  I,  A.M.M.  ,  .  .,  ,  .  •  •  . 

was  altogether  external  to  the  hip  joint. 

CASE  244. — A  soldier  of  General  Buell's  army  was  wounded  in  a  picket  skirmish,  about  seven  miles  from  Nashville,  in 
March,  1832,  by  a  conoidal  musket  ball,  which  shattered  the  neck  and  trochanters  of  the  femur.  He  was  immediately  conveyed 
to  Nashville,  and  placed  in  the  College  Hospital,  under  the  care  of  Surgeon  A.  H.  Thnrston,  U.  S.  V.  Surgeon  M.  Goldsmith, 
U.  S.  V.,  saw  him  in  two  days  after  the  reception  of  the  injury,  and  deemed  the  case  peculiarly  well  adapted  for  the  operation 
of  excision.  The  surgeon  in  charge  concurring  in  this  opinion,  the  patient  was  anesthetized,  and  Dr.  Thurston  proceeded  to 
excise  the  head  and  splintered  upper  extremity  of  the  femur,  through  a  long  straight  incision.  The  operation  was  accom- 


SECT.  n.j 


EXCISION    AT    THE    HFP    AFTER    SHOT    INJURY. 


105 


plished  with  but  little  haemorrhage,  and  although  the  patient  was  much  prostrated  by  the  shock  of  the  injury  and  of  the  opera 
tion,  he  reacted  and  was  in  a  comfortable  condition  for  several  days.  But  surgical  fever  and  suppuration  soon  set  in,  and  he 
gradually  sank,  and  died  one  week  after  the  operation.  There  can  be  little  doubt  that  the  subject  of  this  operation  was  Corporal 
Henry  F.  Smith,  Co.  B,  1st  Wisconsin,  who,  according  to  the  records  of  the  Nashville  Hospital,  was  admitted  for  a  gunshot 
wound  of  the  hip,  and  was  the  only  patient  who  died  from  wounds  in  Dr.  Thurston's  wards,  at  the  period  referred  to.1 
Corporal  Smith  died  on  March  15,  1832.  The  operation  was  probably  done  on  March  10th.2 

In  the  second  category  of  intermediary  excisions  are  grouped  eight  cases  well  adapted 
from  the   local  lesions  for  the  operation  in  which   all  the  patients  made  a  struggle  for 
.recovery,  and  two  survived  respectively  five  and  eleven  weeks: 

CASE  245. — Private  T.  C.  Christopher,  Co.  D,  18th  South  Carolina,  aged  21  years,  a  robust  man,  was  wounded  at 
Williamsburg,  Virginia,  May  5,  1832,  by  a  conoidal  musket  ball,  which  entered  about  two  inches  below  and  behind  the  left 
trochanter  major,  and  passed  forward,  upward,  and  inward.  He  was  stooping  at  the  time  he  received  the  injury.  He  was  made 
prisoner,  and  sent  to  York  River,  and  thence  on  a  hospital  steamer  to  Washington,  and  placed  in  Cliffburne  Hospital,  May  17th. 
His  pulse  was  100,  and  he  complained  of  severe  pain  in  the  hip  and  knee.  The  tissues 
about  the  hip  were  much  swollen ;  the  limb  was  everted,  and  shortened  one  and  a  half 
inches.  The  opening  made  by  the  bullet  was  very  small,  and  discharged  a  thin  sanious 
pus.  There  was  no  orifice  of  exit.  The  patient  was  etherized,  and  careful  exploration 
of  the  wound  revealed  a  fracture  of  the  inner  portion  of  the  neck  and  probably  of  the 
head  of  the  femur.  It  was  decided  that  excision  should  be  performed,  and  the  patient 
was  placed  upon  a  soothing  and  supporting  regimen  preparatory  to  the  operation.  May 
20th,  Assistant  Surgeon  J.  S.  Billings,  U.  S.  A.,  made  a  curvilinear  incision,  four  inches 
in  length,  one  inch  behind  the  great  trochanter,  that  revealed  the  condition  of  the  parts. 
Fragments  of  the  inner  extremity  of  the  neck  were  removed  piecemeal.  The  head  was 
then  removed  from  the  cotyloid  cavity,  except  a  small  fragment  which  was  extracted 
from  an  iutermuscular  space.  The  ball  was  now  discovered  lying  in  the  obturator 
externus  muscle,  and  extracted.  Little  blood  was  lost,  and  reaction  took  place.  Water 
dressing  was  applied,  and  a  grain  of  sulphate  of  morphia  administered.  Eversion  of 
the  foot  was  corrected  by  fastening  the  limb  by  straps  of  adhesive  plaster  to  an  upright 
piece  of  wood  screwed  to  the  foot  of  the  bedstead,  and,  the  latter  being  raised,  adequate 
extension  and  counter-extension  were  secured.  On  May  21st,  the  patient  reported  a 
comfortable  night,  but  now  had  a  very  irritable  stomach,  with  frequent  vomiting.  His 
skin  was  cool  and  clammy ;  his  pulse  small  and  feeble  at  115.  He  was  ordered  aromatic 
spirits  of  ammonia  in  small  doses,  brand}',  egg-nog,  and  beef  essence,  with  sinapisms  to 

the  epigastrium.  On  May  23d,  the  irritability  of  the  stomach  had  subsided.  The  j,-.IG  57 —Transverse  shot  fracture  of  the 
patient  was  weaker;  stimulants  and  concentrated  nourishment  were  given.  On  May  anatomical  neck  of  the  left  femur,  with  caries. 
24th,  the  patient  rapidly  grew  weaker.  Capillary  haemorrhage  took  place  from  the 

surfaces  of  the  incision,  but  was  readily  checked  by  the  application  of  a  solution  of  persulphate  of  iron.  Enemata  of  beef 
essence  and  brandy  were  administered,  and  these  articles  also  by  the  mouth.  The  patient  sank  rapidly,  and  died  May  24th, 
five  days  after  the  operation.  At  the  autopsy,  twelve  hours  after  death,  the  soft  parts  about  the  seat  of  injury  were  found  dark 
in  color  and  softened.  The  acetabulum  was  eroded.  A  clot  of  blood  of  three  ounces  was  found  between  the  peritoneum  and 
iliacus  externus  muscle.  The  innominatum  and  superior  portion  of  the  femur  were  removed,  and,  together  with  the  excised 
fragments,  forwai'ded  to  the  Army  Medical  Museum,  and  numbered  19  of  the  Surgical  Section,  having  been  mounted  among  its 
earliest  specimens,  and  it  is  represented  in  the  wood-cut  (FlG.  57). — (Circ.  6,  S.  G.  O.,  1865,  p.  62,  and  Circ.  2,  S.  G.  O.,  1869, 
pp.  35,  135.) 

CASE  24G. — Private  T.  E.  Foulke,  Co.  D,  2d  Alabama,  aged  17  years,  was  wounded  and  captured  at  Fort  Blakely, 
Alabama,  April  9,  18G5.  A  conoidal  musket  ball  entered  posteriorly  at  the  middle  third  of  the  left  thigh,  fractured  the  upper 
third  of  the  femur,  including  the  trochanters  and  neck,  and  was  removed  from  above  the  anterior  supei'ior  spinous  process  of  the 
left  ilium.  The  patient  was  then  transferred  to  New  Orleans,  and,  on  April  15th,  he  was  admitted  to  the  St.  Louis  Hospital. 
On  admission  he  was  very  much  exhausted  by  profuse  suppuration,  the  soft  parts  about  the  hip-joint  being  filled  with  unhealthy 
pus.  On  April  27th  Surgeon  A.  McMahon,  U.  S  V.,  excised  the  head,  neck,  trochanters,  and  two  inches  of  the  shaft  of  the 
left  femur,  the  patient  being  under  the  influence  of  chloroform.  He  was  placed  on  nourishing  diet,  with  two  bottles  of  porter 
daily,  eggs,  beef  tea,  and  everything  he  desired.  On  May  2f>th  he  was  transferred  to  the  Marine  Hospital  at  New  Orleans.  He 
was  then  doing  well;  but  he  gradually  failed,  and  died  June  5,  1835,  of  exhaustion,  thirty-nine  days  after  the  operation. 

CASE  247. — Private  Charles  E.  Marston,  Co.  F,  1st  Massachusetts,  aged  19  years,  a  pale  and  delicate  boy,  was  wounded 
at  the  second  battle  of  Bull  Run,  August  30,  1832.  He  was  admitted  to  the  College  Hospital,  Georgetown,  D.  C.,  on  Septem 
ber  Gth,  having  laid  on  the  battle-field  several  days,  and  then  moved  in  an  ambulance  wagon  thirty  miles  over  very  rough  roads. 
An  examination  revealed  a  large  bullet  wound  an  inch  anterior  to  and  on  a  line  with  the  right  trochanter  major,  with  great 
comminution  of  the  head  and  neck  of  the  femur.  The  limb  was  shortened,  and  the  foot  was  everted.  The  circumference  of  the 

1  The  above  account  has  been  submitted  to  Dr.  M.  GOLDSMITH,  who  states  that  ho  thinks  that  the  identification  of  the  case  is  complete.     Surgeon 
TnunsTOX  died  during  the  war. 

2  The  report  of  the  Adjutant  General  of  Wisconsin  for  18C5,  p.  33,  states  that  on  March  8,  18G2,  five  companies  of  the  1st  Wisconsin  Volunteers  were 
sent  out  beyond  Nashville  on  picket  duty.     They  were  attacked  by  a  cavalry  force,  and  Private  Willett  Greenly  was  killed—"  the  first  Union  soldier 
killed  in  Tennessee" — while  Corporal  H.  F.  Smith  and  one  other  were  wounded,  and  were  sent  to  Nashville. 

SURG.   Ill— 14 


106 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  58. — Shot  commi- 


limb  exceeded  that  of  its  fellow  by  half.  The  pulse  was  11-2,  and  of  moderate  volume.  The  tongue  was  rather  dry.  The 
patient  suffered  little  pain.  The  general  condition  was  not  promising,  and  yet  not  very  bad.  Excision  of  the  fractured  bone 
was  decided  upon,  and,  on  the  27th  of  September,  Assistant  Surgeon  B.  A.  Clements,  U.  S.  A.,  assisted  by  Assistant  Surgeon 
Charles  H.  Alden,  U.  S.  A.,  and  the  surgical  staff  of  the  hospital,  proceeded  to  perform  the  operation.  Chloroform  was 
administered,  and  a  slightly  curved  incision  five  inches  in  length  was  made  on  the  outside  of  the  thigh,  the  shot  hole  in  the 
middle  of  the  incision,  and  the  trochanters  and  neck  were  thus  exposed.  The  neck  was  crushed  into  about  forty  fragments, 
which  were  extracted.  The  head  was  also  much  broken,  and  the  round  ligament  was  absorbed  or  destroyed,  so  that  exarticula- 
tion  was  easy.  The  roughened  portion  of  the  neck,  at  its  attachment  with  the  trochantcr,  was  sawn  off  with  a  small  chain  saw. 
The  missile,  a  conoidal  musket  ball,  was  found  on  the  inner  side  of  the  thigh  at  the  bottom  of  a  large 
cavity,  and  was  removed  with  difficulty.  After  thoroughly  syringing  the  wound  and  removing  the  pow 
dered  bone,  the  wound  was  closed  by  silver  sutures,  except  at  the  bullet  hole,  and  sand  bags  were  placed' 
to  keep  the  limb  in  position.  Slight  extension  was  made  by  a  weight  to  the  foot.  The  patient  expressed 
himself  as  relieved  by  the  operation,  and  he  slept  well  that  night.  On  the  following  day  his  pulse  had 
risen  to  128,  and  the  discharge  from  the  wound  was  very  copious,  thin,  and  brown.  On  September  29th, 
his  pulse  was  still  quick  and  feeble,  and  his  tongue  dry,  and,  though  he  took  nourishment  well,  and  was 
free  from  distress,  he  gradually  sank.  He  died  on  September  30,  1862,  at  half  past  8  o'clock  A.  M.,  three 
days  after  the  operation.  At  the  autopsy,  on  October  1st,  made  by  Acting  Assistant  Surgeon  G.  K.  Smith, 
the  wound  made  by  the  operation  was  found  to  be  filled  with  very  offensive  pus.  The  upper  end  of  the 
shaft  of  the  femur  was  found  to  be  diseased  on  its  posterior  surface  near  the  trochanter  minor,  and  the 
nation  of  head  ami  neck  periosteum  was  loosened  from  the  bone  for  some  distance  above  and  below  this  point.  The  fracture  of  the 
ischium,  which  was  noticed  at  the  operation,  extended  obliquely  upward  and  backward  from  the  lower 

border  of  the  acetabulum,  terminating  in  the  sciatic  notch,  about  an  inch  and  a  quarter  above  the  spine  of  the  ischium.  The 
lower  half  of  the  acetabulum  had  been  broken  into  several  fragments,  which  were  held  in  position  by  the  cotyloid  ligament.  The 
excised  portions  of  the  femur  were  forwarded  to  the  Army  Medical  Museum,  and  are  numbered  328  in  the  Surgical  Section. 
They  are  represented  in  the  adjoining  wood-cut  (FlG.  58). 

CASE  248. — Private  John  Miller,  Co.  E,  lG2d  New  York,  aged  about  38  years,  a  robust,  phlegmatic  German,  in  good  health, 
was  wounded  on  June  14,  1833,  in  the  assault  on  Port  Hudson,  Louisiana,  by  a  conoidal  musket  ball,  which  passed  through 
the  upper  portion  of  the  thigh,  breaking  the  neck  of  the  left  femur  transversely,  and  splitting  it  longitudinally,  but  without 
great  comminution.  The  pelvis  was  uninjured,  and  there  was  no  serious  damage  to  the  soft  tissues.  The  patient  was  conveyed 
to  New  Orleans  on  a  hospital  transport,  and  was  placed  in  the  St.  Louis  Hospital,  on  June  16th.  It  was  determined  that 
excision  of  the  injured  bone  was  advisable,  and  the  officer  in  charge  of  the  hospital,  Surgeon  F.  Bacon,  U.  S.  V.,  being  confined 
to  his  bed  by  illness,  the  operation  was  performed  on  July  8th,  by  Assistant  Surgeon  George  W.  A  very,  9th  Connecticut.  The 
head,  neck,  and  great  trochanter  were  removed  in  the  usual  way,  through  a  single  straight  incision  of  moderate  extent  over  the 
trochanter  and  in  a  line  with  the  axis  of  the  femur.  There  was  an  immaterial  loss  of  blood.  The  state  of  the  tissues  involved 
and  the  constitutional  condition  of  the  patient  were  as  good  as  might  be.  Dr.  Bacon  remarked  that  the  operation  was  well  and 
rapidly  performed.  The  patient  rallied  from  it  promptly,  and  afterwards  received  the  most  assiduous  care.  His  progress  was 
very  favorable  until  the  early  part  of  September.  The  wound  had  nearly  healed,  and  Surgeon  Bacon  and  his  assistants  were 
very  hopeful  of  the  patient's  recovery.  But  in  September  the  weather  became  most  oppressively  hot,  and  the  patient  steadily 
declined.  The  wound  assumed  a  bad  appearance,  discharging  copiously,  and  despite  sustaining  measures,  the  patient  sank  and 
died  from  exhaustion  on  September  21,  1832,  seventy-five  days  after  the  operation.  Dr.  Bacon  examined  the  fragments  of  bone 
removed,  and  found  the  periosteum  adherent  throughout  the  larger  pieces. 

CASE  249. — Private  Henry  Phillips,  Co.  I,  146th  New  York,  a  robust  man,  aged  34  years,  was  wounded  at  the  South 
Side  Railroad,  near  Petersburg,  on  April  1,  1835,  by  a  conoidal  musket  ball,  which  entered  the  left  thigh  and  lodged  against  the 
anterior  surface  of  the  neck  of  the  femur.  The  patient  was  conveyed  to  the  field  hospital  of  the  2d  division  of  the  Fifth  Corps, 
and  thence  by  ambulance  and  rail  to  City  Point,  where  he  arrived  on  April  4th,  and  was  transferred  by  steamer  to  Washington, 

and,  on  April  6th,  was  admitted  into  Douglas  Hospital.  He  was  much  exhausted  and  had 
considerable  fever,  though  in  frequency  the  pulse  and  respiration  were  nearly  normal.  The 
wound  was  painful,  and  the  beginning  of  its  grave  constitutional  aspect  was  becoming  man 
ifest.  There  was  no  shortening  or  deformity  of  the  limb.  At  a  preliminary  exploration  the 
ball  was  found  impacted  near  the  anatomical  neck,  and  was  extracted.  The  limited  nature 
of  the  fracture  was  also  ascertained,  and  excision  was  decided  on.  On  April  8th  the  patient 
was  placed  under  the  influence  of  ether,  and  Assistant  Surgeon  William  F.  Norris,  U.  S.  A., 
excised  the  head,  neck,  and  trochanter  major  through  a  curved  incision  six  or  seven  inches 
in  length  with  its  convexity  forward.  About  twelve  or  sixteen  ounces  of  blood  were  lost 
during  the  operation.  One  small  artery  required  a  ligature.  The  ball  had  crushed  in  the 
laminated  structure  of  the  anterior  face  of  the  neck,  and  from  this  cup-shnped  cavity  a  small  fissure  ran  up  the  articular  surfr.ee 
and  a  deep  fissure  nearly  around  the  neck;  but  the  separation  between  the  head  and  neck  was  incomplete.  During  the  opera 
tion  this  fracture  was  converted  into  a  complete  one  in  rotating  the  bone  to  facilitate  the  exarticulation.  The  operation  concluded, 
the  limb  was  supported  by  pillows,  and  the  patient  was  ordered  beef  tea  and  milk  punch  every  three  hours,  and  a  full  dose  of 
opium  at  midnight.  He  had  another  dose  of  laudanum  at  four  o'clock  the  next  morning.  On  the  9th,  10th,  and  llth.  there 
was  little  pain,  and  anodynes  were  not  required,  but  concentrated  nourishment  and  stimulants  were  assiduously  administered. 
It  was  thought  the  nurse  exceeded  his  instructions  in  the  amount  of  whiskey  given,  for  on  April  12th,  the  patient  had  hiccough 
and  nausea,  and  his  breath  was  redolent  of  alcoholic  fumes.  He  was  now  transferred  to  the  immediate  charge  of  Acting  Assistant 
Surgeon  C.  Carvallo.  A  laxative  enema  was  administered,  and,  when  the  bowels  were  unloaded,  a  sinapism  at  the  epigastrium, 
and  small  doses  of  creasote  allayed  the  irritability  of  stomach.  On  April  13th  the  stomach  was  quiet,  pulse  120,  rather  weak, 


FIG.  59.— Fracture  of  head  and  neck 
of  left  femur  by  a  conoidal  musket  ball. 
Spec.  3235,  Sect.  I,  A.  51.  M.  * 


SECT.  II.  1 


EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY. 


107 


and  there  was  profuse  perspiration.  The  patient  was  ordered  a  cupful  of  beef  tea  every  two  hours,  one  of  milk  punch  every 
four  hours,  milk  toast  and  soft  boiled  eggs  at  breakfast  and  dinner.  No  change  the  next  day.  On  the  14th  the  wound 
looked  well.  Some  shreds  of  disorganized  connective  tissue  were  removed  by  the  dressing  forceps.  There  was  some  pain  and 
difficulty  in  micturition.  Small  doses  of  tincture  of  the  sesquichloride  of  iron  were  directed  thrice  daily,  and  chicken  broth  was 
added  to  his  dietary.  No  entry  of  importance  appears  on  the  16th.  On  the  17th  the  pulse  was  120,  respiration  32.  Slight  pain 
on  right  side,  and  signs  of  pleurisy  on  auscultation.  There  was  an  erythematous  blush  about  the  wound,  and,  in  the  evening, 
there  was  diarrhoea,  which  was  cheated  by  pills  of  opium  and  nitrate  of  silver.  On  the  18th  the  pleurisy  was  worse,  the 
breathing  more  rapid,  and  there  was  retention  of  urine,  so  that  it  was  necessary  after  this  to  use  a  catheter.  April  19th  tin- 
countenance  was  sunken,  and  the  wound  was  flabby.  There  was  a  sore  on  the  sacrum.  The  patient  was  moved  to  a  Crosby 
Invalid  Bed.  He  had  a  draught  containing  ammonia  and  sugar,  and  a  blister  on  his  side.  April  20th  the  nurse  reported  a  chill 
during  the  night.  The  breathing  was  labored.  There  were  sordes  on  the  teeth.  At  the  next  morning  visit  the  patient  was 
very  low.  He  died  before  noon,  April  21,  1865,  eleven  days  after  the  operation.  The  autopsy  revealed  dry  pleurisy  on  either 
side;  lungs  healthy,  somewhat  congested  posteriorly;  heart  and  liver  not  abnormal.  A  large  sub-peritoneal  abscess  in  the 
course  of  psoas  and  internal  iliac  muscles,  which  appeared  to  originate  in  the  obturator  foreamen  and  ascend  along  the  left  iliac 
fossa,  denuding  the  bone  of  its  periosteum.  No  evidences  of  pyaemia  were  found,  though  it  was  strongly  suspected  after  the 
occurrence  of  the  chill  on  April  20th.  The  pathological  specimen,  contributed  by  the  operator  to  the  Army  Medical  Museum,  is 
represented  at  pnge  24G  of  the  Catalogue  of  the  Surgical  Section  of  18o6,  and  by  the  Avood-cut  (FlG.  59). 

CASE  250. — Captain  John  Phelan,  Co.  A,  73d  New  York,  aged  22  years,  received  a  compound  comminuted  fracture  of 
the  neck  and  upper  extremity  of  the  left  femur  at  the  battle  of  Spottsylvania  Court  House,  on  May  14,  1864.  On  May  16th,  he 
was  admitted  to  Mount  Pleasant  Hospital.  Washington.  The  rapid  and  incessant  influx  of  wounded  was  such  that  the  attention 
of  the  overworked  hospital  staff  was  not  especially  drawn  to  his  case  for  some  time  after  his  admission,  and  the  delay  in 
minutely  examining  the  case  was  extended  by  the  uncomplaining  fortitude  of  the  sufferer,  who  expressed  his  wish  that  the  more 
serious  cases  should  first  be  attended  to,  and  declared  that  his  own  sufferings  were  comparatively  slight.  When,  however, 
Acting  Assistant  Surgeon  Mulford,  the  ward  surgeon,  proceeded,  on  June  3d,  to  adapt  apparatus  to  what  he  supposed  to  be  an 
ordinary  gunshot  fracture  of  the  upper  third  of  the  thigh,  he  was  led  to  apprehend  that  the  injury  extended  to  the  coxo-femoral 
articulation,  and  requested  the  opinion  of  the  surgeon  in  charge  of  the  hospital,  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A.,  as  to 
the  diagnosis  and  treatment.  Dr.  McCall  immediately  visited  the  patient,  and  found  him  to  be  a  large,  muscular,  finely  formed 
man,  whose  previous  health  had  been  excellent.  When  lying  quietly  in  bed,  he  suffered  but  little.  His  appetite  was  good ;  and 
his  strength,  so  far,  had  diminished  but  little.  Altogether,  his  general  condition  was  extraordinarily  good,  in  view  of  the  gravity 
of  the  injury  he  had  sustained.  The  ball  had  entered  in  front,  just  over  the  point  at  which  the  profunda  is  given  off  from  the 
left  femoral  artery.  The  aperture  of  entrance  was  small  and  characteristic  as  an  entrance  wound  of  a  conoidal  musket  ball. 
The  missile  had  passed  toward  the  great  trochanter  and  shattered  it.  Further,  its  course  could  not  be  ascertained  »t  the  time. 
Any  movement  of  the  limb  caused  extreme  pain.  Though  the  femur  was  much  comminuted,  Dr.  McCall  was  not  positive  that 
the  hip  joint  was  implicated,  and,  with  a  view  to  a  full  exploration  of  the  injury,  he  directed  Dr.  Mulford  to  make  a  longitudinal 
incision  three  inches  in  length  over  the  trochanter,  to  explore  the  parts  thoroughly,  and  to  ascertain  by  digital  examination  the 
condition  of  the  articulation.  If  it  was  uninjured,  Dr.  Mulford  was  instructed  to  extract  detached  fragments  of  bone  and  foreign 
matters,  to  close  the  upper  part  of  the  wound,  and  to  avail  of  the 
lower  portion  for  drainage.  In  the  afternoon  the  patient  was  ether 
ized,  and  the  exploratory  incision  was  made,  and  it 
was  found  that  the  fracture  extended  to  the  head  of 
the  femur.  It  was  then  decided  to  excise  the  head. 
The  patient  was  again  rendered  insensible  by  the 
inhalation  of  sulphuric  ether,  and  Dr.  McCall 
extended  Dr.  Multbrd's  incision  upward  an  inch 
or  more,  and  then  made  an  oblique  incision  across 
its  upper  extremity,  as  represented  in  the  accom 
panying  figure  (FlG.  61).  The  two  flaps  thus 
marked  out  were  reflected,  and  the  joint  was  read 
ily  exposed,  the  round  ligament  divided,  and  the 
head  of  the  femur  exarticulated.  The  acetabulum 
was  carefully  examined  and  found  to  be  uninjured. 
Seven  large  and  numerous  small  fragments  of  the 
neck  and  trochanter  major  were  then  removed,  a  task  requiring  much  time  and  patience,  many  fragments  being  driven  into  the 
gluteal  muscles,  or  deeply  retracted  by  the  muscles  attached  to  the  great  trochanter.  The  fractured  upper  extremity  of  the 
femur  was  then  brought  out  at  the  wound,  by  adducting  and  pushing  upward  the  knee  of  the  injured  limb,  and  all  diseased 
tissue  was  removed.  The  periosteum  was  in  a  healthy  condition  quite  up  to  the  end  of  the  bone.  The  wound  was  now 
thoroughly  washed  out,  and  approximated  by  three  stitches,  and  by  adhesive  strips.  A  grain  of  sulphate  of  morphia  was 
administered,  and  the  patient  was  put  to  bed.  The  operation  lasted  three-quarters  of  an  hour.  Dr.  McCall  thinks  that  the  ball 
was  removed  during  the  operation;  but  is  not  positive  on  this  point.  The  hospital  report,  which  is  quoted  at  page  69  of  Circular 
No.  6,  S.  G.  O.,  1865,  states  that  the  patient's  pulse  was  quick  and  irritable  at  the  time  of  the  operation,  that  he  had  a  furred 
tongue  and  diarrhoea,  and  was  reduced  by  suppuration.  But  Dr.  McCall  (letter  of  February  11,  1868)  thinks  that  this  report 
exaggerates  the  gravity  of  the  constitutional  symptoms,  and  is  quite  sure  that  the  general  condition  was  favorable.  The  patient 
rallied  well  from  the  operation.  For  two  days  the  wound  was  dressed  with  lint.  Suppuration  then  commencing,  the  limb  was 
placed  in  Fergusson's  apparatus  for  excision  of  the  head  of  the  femur,  the  counter-extension  straps  being  left  off.  The  wound 
was  freely  syringed  with  cold  water  containing  a  little  permanganate  of  potassa.  A  nourishing  diet  was  ordered,  with  tonics 


FIG.  CO.— Excised 
head  and  fragments 
of  neck  of  left  femur. 
,Sp<?c.2G18. 


FIG.   61. — Direction  of  the  incisions  in   case  of  excision  of  the 
head  of  the  femur.     [From  a  drawing  by  Dr.  MCCALL.] 


108  INJURIES    OF    THE    LOWER    EXTREMITIES.  fCHAP.  X. 

and  stimulants.  For  a  week  or  ten  days  subsequently,  the  case  progressed  favorably.  Suppuration  was  moderate  in  amount, 
and  of  a  healthy  character.  About  the  middle  of  June,  the  weather  became  intensely  hot.  The  atmosphere  of  the  wards,  in 
which  nearly  every  bed  was  occupied  by  a  patient  with  suppurating  wounds,  became  intensely  oppressive.  About  this  time, 
the  patient  began  to  grow  worse.  The  cheerful  resolution  and  hopefulness  he  had  hitherto  evinced,  gave  way.  Diarrhoea 
supervened,  and  he  lost  strength  rapidly.  The  fatal  event  was  thought  to  have  been  delayed  by  the  plan  which  was  pursued 
of  daily  removing  the  patient  in  his  bed  at  nine  in  the  morning  to  a  spot  beneath  the  shade  trees  near  the  hospital,  where  he  had 
pure  air  and  escaped  the  distressing  scenes  of  the  ward;  he  remained  each  day  until  five  in  the  afternoon.  He  died  on  June 21, 
1834.  The  portion  of  bone  excised  was  forwarded  at  the  time  of  the  operation  to  the  Army  Medical  Museum.  The  preparation 
is  No.  2618  of  the  Surgical  Series.  It  is  represented  in  the  adjacent  wood-cut  (FlG.  60). 

CASE  251. — A  private  soldier  of  General  Pope's  Army  of  Virginia,  was  admitted  on  September  2,  1862,  to  the  Cliffburne 
Hospital  at  Washington,  D.  C.,  with  a  gunshot  fracture  of  the  neck  of  the  left  femur,  received  at  the  second  Bull  Run  battle,  on 
August  29,  18G2.  A  conoidal  musket  ball  had  entered  the  left  hip  directly  over  the  trochanter  major  and  embedded  itself  in  the 
neck  of  the  femur.  The  trochanter  major  and  the  neck  of  the  femur  were  split  and  comminuted,  but  the  head  was  uninjured. 
The  patient  had  suffered  greatly  from  the  journey  from  the  battle-field  to  the  hospital,  and  was  prostrated  by  diarrhoea  and 
malarial  complications.  The  tissues  about  the  hip  joint  were  but  slightly  swollen,  and  the  wound  discharged  healthy  pus.  It 
was  decided  that  excision  was  the  most  hopeful  resource,  and  on  September  4, 18G2,  Assistant  Surgeon  John  S.  Billings,!!.  S.  Av 
proceeded  to  operate.  Chloroform  was  administered,  and  a  straight  incision  was  made  over  the  trochanter  major,  and  the  head 
and  fragments  of  the  neck  were  removed.  The  shaft  of  the  femur  was  then  divided  by  a  chain  saw  at  the  level  of  the  trochanter 
minor.  The  patient  reacted  well  from  the  operation.  He  was  placed  on  a  fracture  bed,  and  extension  by  means  of  a  weight 
was  made  on  the  injured  limb.  The  diarrhoea  increased  in  severity  despite  all  treatment,  and  the  patient  succumbed,  exhausted, 
on  September  24,  1862,  twenty  days  after  the  operation. 

CASE  252. — "Private  Michael  Welsh,  Co.  II,  10th  Kentucky,  aged  40  years,  was  struck  by  a  conoidal  ball  in  the  region 
of  the  left  great  trochanter,  at  the  battle  of  Chickamauga,  September  20,  1863,  and  at  once  conveyed  to  a  field  hospital,  which 
soon  after  fell  into  the  hands  of  the  enemy.  Ten  days  subsequently,  he  was  brought  to  Chattanooga;  and  during  the  period  of 
his  captivity  the  only  nourishment  that  he  received  was  a  small  portion  of  corn-meal  gruel  daily.  Having  lost  his  blankets,  he 
also  suffered  much  from  cold,  and  had  contracted  a  rather  severe  bronchial  inflammation.  On  the  1st  of  October,  he  was 
admitted  into  the  general  field  hospital  of  the  Fourteenth  Corps,  when  a  conoidal  musket  ball  was  removed  from 
among  a  mass  of  small  fragments  of  the  neck  of  the  femur,  the  ball  having  entered  just  anteriorly  to  the  great 
trochanter.  Two  days  subsequently,  Surgeon  F.  H.  Gross,  U.  S.  V.,  carried  a  curvilinear  incision,  with  its  con 
vexity  presenting  forwaid,  and  including  the  opening  made  by  the  ball,  from  above  downward,  and  excised  the 

head  of  the  femur  along  with  the  attached  greater  portion  of  the  lower  surface  of  the  neck  of  the  bone.     Many 
FIG.  G~.— Shct  .  .    .  .   . 

fracture  of  neck     fragments  were  removed  with  the  forceps;  but  as  the  trochanters  were  not  involved  m  the  injury,  the  remaining 

s^  ecC344^mUr'  snai'P  portions  of  the  neck  were  trimmed  off  close  to  the  inter-trochanteric  lines,  which  completed  the  procedure. 
No  ligatures  were  required.  The  man  bore  the  operation  well,  and  the  limb  was  placed  in  a  comfortable  position. 
From  the  date  of  the  operation  up  to  October  20th,  the  man  did  very  well,  in  spite  of  his  enfeebled  condition  and  bronchial 
trouble,  when  the  discharge  from  the  wound  became  sanions.  On  the  same  night  he  had  a  chill  and  was  delirious,  and  the 
pulse  was  very  feeble  and  frequent.  On  the  25th  of  October  his  condition  is  thus  described  :  Pulse  125  and  very  feeble;  tongue 
dry  and  red ;  had  a  natural  alvine  evacuation.  At  9  o'clock  A.  M.  haemorrhage  recurred  from  the  wound,  which  was  arrested  by 
injecting  a  solution  of  sulphate  of  iron.  Stimulants  freely  administered,  but  the  man  grew  more  and  more  feeble,  and  expired 
at  2  o'clock  p.  M.  No  post-mortem  examination  was  held,  but  death  was  evidently  due  to  pyaemia.  The  specimen  shows  that 
about  one-fifth  of  the  head  at  its  upper  aspect  has  been  shot  away,  together  with  the  entire  upper  surface  of  the  neck,  about 
one-half  of  the  anterior  and  posterior  surfaces  and  the  lower  border  of  the  neck  remaining."  The  pathological  specimen,  illus 
trated  by  the  accompanying  wood-cut  (FlG.  62),  was  forwarded  to  the  Army  Medical  Museum,  June  3,  1868,  by  the  operator. 

The  third  category  of  intermediary  excisions  includes  eight  cases  in  which  the  con 
ditions  revealed  on  exploration  offered  little  prospect  of  success.  '  All  of  the  patients  were 
subjected  to  rough  transportation.  The  first  case  was  complicated  with  shot  perforation  of 
the  elbow,  the  second  was  a  man  of  sixty  in  poor  health,  the  third  a  lad,  rudely  exposed 
in  a  wagon  without  springs;  two  others  had  wounds  penetrating  the  pelvic  cavity,  and,  in 
one  of  these  cases,  a  splinter  of  the  left  innominate  bone  opened  the  internal  iliac  vein,  and 
led  to  uncontrollable  haemorrhage,  while,  in  the  other,  hyperacute  peritonitis  supervened. 

CASE  253.— Private  G.  W.  Brantley,  Co.  C,  2d  Alabama,  aged  18  years,  was  wounded  and  taken  prisoner  at  Fort 
Blakely,  Alabama,  April  9,  1865.  A  conoidal  musket  ball  had  passed  through  the  left  groin,  fractured  the  neck  of  the  femur, 
and  emerged  posteriorly  at  the  apex  of  the  left  buttock.  lie  also  received  a  gunshot  fracture  of  the  external  condyle  of  the 
right  humerus.  He  was  conveyed  to  New  Orleans,  and,  on  April  15th,  he  was  admitted  to  the  St.  Louis  Hospital.  The  thigh, 
groin,  and  surrounding  parts  were  infiltrated  with  unhealthy  pus,  and  the  patient  was  very  much  exhausted.  On  April  28th, 
the  patient  was  anesthetized  by  chloroform,  and  Surgeon  A.  McMahon,  U.  S.  V.,  proceeded  to  excise  the  head,  neck,  and 
trochanters  of  the  left  femur.  No  arteries  required  ligation.  The  patient  did  not  rally  very  well.  Stimulants  were  freely 
administered;  but  the  patient  sank,  and  died  on  May  2,  1865,  of  capillary  hremorrhage.  The  condition  of  the  patient  did  not 
admit  of  any  operation  on  the  elbow  joint. 

CASE  254. — Private  Peter  Boyle,  Co.  D,  59th  Massachusetts,  aged  60  years,  was  wounded  at  Petersburg,  July  30,  1864. 
A  conoidal  musket  ball  entered  the  left  hip  and  passed  antero-posteriorly  through  the  soft  parts  and  surgical  neck  of  the  femur, 


SECT.  II.  | 


EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY. 


109 


FIG.  H3. — Siiot  per 
foration  of  neck  of  loft 
femur.  Spec.  3593. 


and  fractured  the  trochanter  major.     His  entry  at  the  base  hospital  at  City  Point  and  transfer  to  Washington  are  recorded  on 

August  1st.     He  was  conveyed  to  Washington  on  an  hospital  steamer,  and  on  August  3d  was  admitted  to  Douglas  Hospital. 

His  constitutional  condition,  on  admission,  was  poor      The  wound,  however,  had  an  healthy  aspect,  and  a  thorough  exploration 

showed  that  the  injury  to  the  soft  tissues  involved  no  important  part,  and  that  the  fracture  at  the  junction  of 

the  neck  and  trochanter  major  was  not  accompanied  by  much  longitudinal  splintering  in  either  direction. 

Assistant  Surgeon  William  Thomson,  U.  S.  A.,  decided  that  an  excision  of  the  injured  bone  was  expedient, 

and  that  the  operation  should  be  done  as  soon  as  the  patient  had  rallied  from  the  fatigue  and  irritability 

induced  by  his  long  journey.     On  August  5th,  ether  having  been  administered,  Assistant  Surgeon  Thomson 

proceeded  to  excise  the  head,  neck,  and  trochanters  of  the  left  femur,  through  a  straight  incision  of  sufficient 

length  made  over  the  trochanter  major.     The  rotator  muscles  and  the  tendons  of  the  psoas  and  iliacus  being 

divided,  the  round  ligament  was  readily  cut  and  the  head  exarticulated.     The  section  of  the  shaft  was  made 

by  a  chain  saw  at  the  level  of  the  trochanter  minor.     The  operation  was  rapidly  accomplished,  and  there 

was  no  haemorrhage  of  moment.     The  wound  was  dressed  with  an  antiseptic  solution  of  one  drop  of  creasote 

to  each  ounce  of  water  on  charpie,  and  the  limb  was  supported  by  a  sand  bag  on  either  side.     The  patient 

reacted  well  after  the  operation;  but  at  night  there  was  profuse  sweating  and  some  nausea.     On  the  following  morning  he  ate  a 

good  breakfast.     He  still  had  a  cool,  sweating  skin,  and  his  pulse  was  at  128.     He  gradually  sank,  and  died  from  exhaustion  on 

August  7,  1834.     The  pathological  preparation,  presented  by  Dr.  Thomson  to  the  Army  Medical  Museum,  is  figured  by  the 

accompanying  wood-cut  (FlG.  63). 

CASE  255. — Private  Charles  C.  Cleaver,  Co.  C,  2d  Infantry,  aged  18  years,  was  wounded  at  the  battle  of  Spottsylvania, 
on  May  12,  18G4,  by  a  conoidal  musket  ball,  which  fractured  the  neck  and  trochanters  of  the  right  femur.     He  was  transferred  to 
Fredericksburg  and  thence  to  Belle  Plain  in  a  wagon,  and  thence  on  a  steam  hospital  transport  to  Washington.     On  May  18th 
he  arrived  at  Washington,  and  was  admitted  to  Judiciary  Square  Hospital.     The  soft  parts  of  the  upper  and 
outer  part  of  the  thigh  were  extensively  lacerated,  and  pus  of  an  ill-conditioned  character  was  burrowing 
in  every  direction  around  the  wound.     The  patient's  condition  was  unfavorable;  but  it  was  decided  that 
excision  of  the  fractured  portion  of  the  femur  afforded  the  only  prospect  of  relief.     Accordingly,  on  the 
19th,  Assistant  Surgeon  Alexander  Ingram,  U.  S.  A.,  proceeded  to  make  a  curved  incision  six  inches  in 
length,  through  which  the  head,  neck,  and  four  and  a  quarter  inches  of  the  shaft  of  the  femur  were  removed. 
Carpie  soaked  with  permanganate  of  potash  was  applied  to  the  wound,  and  tonics  and  stimulants  were 
freely  given.     Pyaemia  supervened,  and  the  patient  died  on  May  23,  1864,  four  days  after  the  operation. 
The  pathological  specimen,  figured  in  the  accompanying  wood-cut  (FlG.  64),  is  in  the  Surgical  Section  of 
the  Army  Medical  Museum. 

CASE  256. — Private  Alexander  Ewing,  Co.  A,  140th  Pennsylvania,  aged  30  years,  was  wounded  at 
the  battle  of  Spottsylvania,  on  May  12,  1864,  by  a  conoidal  musket  ball,  which  comminuted  the  upper  part 
of  the  left  femur.  He  was  taken  to  the  hospital  of  the  1st  division  of  the  Second  Corps,  and  on  the  follow 
ing  day  was  sent  to  the  rear  in  a  wagon.  Arriving  at  Belle  Plain  after  a  three-days'  journey  over  rough 
roads,  he  was  conveyed  on  an  hospital  steamer  to  Washington,  and,  on  May  18th,  he  was  admitted  to 
Judiciary  Square  Hospital.  There  was  considerable  inflammation  and  swelling  of  the  soft  parts,  and  the  patient  was  in  poor 
health.  On  the  following  day  he  was  anaesthetized,  and  Acting  Assistant  Surgeon  J.  F.  Thompson  made  an  incision  five  inches 
in  length  over  the  great  trochanter,  including  in  it  the  wound  of  entrance.  The  muscular  attachments  being  divided,  it  was 
found  that  the  neck  was  splintered,  that  fissures  extended  within  the  capsule,  that  the  great  trochanter  was  separated  from  the 
shaft,  and  the  upper  part  of  the  shaft  much  comminuted.  The  head  and  fragments  of  the  neck  and  trochanters  were  removed, 
and  the  shaft  was  sawn  just  below  the  trochanter  minor.  Ice  was  applied  to  the  wound,  and  stimulants  were  freely  administered. 
The  wound  assumed  an  unhealthy  action,  and  the  patient  gradually  sank  and  died  from  exhaustion  on  May  24.  1864,  five  days 

after  the  operation.     The  pathological  specimen  was  not  received  at  the  Army  Medical  Museum. 

•> 

CASE  257. — Corporal  Henry  C.  Sennett,  Co.  F,  122d  New  York,  aged  27  years,  was  wounded  in  front  of  Petersburg, 
March  27,  1835,  by  a  conoidal  musket  ball,  which  entered  midway  between  the  anterior  superior  spinous  process  of  the  ilium 
and  the  trochanter  major,  and  lodged  in  the  head  of  the  left  femur.  The  patient  was  removed  to  Washington,  and,  on  April  2d, 
was  admitted  to  Mount  Pleasant  Hospital.  He  was  feverish  and  fretful,  and  his  tongue  was  furred;  but 
the  wound  had  a  healthy  aspect,  and  there  was  but  little  swelling  or  deformity  of  the  limb.  But  explo 
ration  with  the  finger  proved  that  the  ball  had  penetrated  the  hip  joint.  On  April  4th  the  patient  being 
anaesthetized  by  an  equal  mixture  of  chloroform  arid  ether,  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  made 
a  T-shaped  incision,  four  inches  by  six  inches,  over  the  trochanter  major,  and  excised  the  head  and  neck 
of  the  femur.  The  head  was  fractured  into  three  pieces,  and  the  ball  was  embedded  in  it.  Violent 
hiccough  came  on  immediately  after  the  operation  and  continued  through  the  night,  but  was  finally 
arrested  by  the  persistent  use  of  antispasmodics.  On  April  5th  and  6th  there  was  great  tympanitis,  the 
bowels  being  obstinately  constipated.  An  enema  of  castor  oil  was  administered  without  effect,  and  in 
two  hours  another  of  molasses  and  water  and  salt,  which  induced  a  slight  evacuation.  Singultus  again 
recurred.  On  April  7th  the  bowels  moved  freely.  A  chill  occurred,  lasting  half  an  hour.  There  was 
great  abdominal  tenderness  on  pressure,  and  other  well  marked  symptoms  of  peritonitis.  On  the  8th 
the  hiccough  continued;  the  abdomen  became  greatly  distended;  the  countenance  became  pinched  and 
ghastly,  and  the  patient  died  at  ten  at  night.  At  the  autopsy,  made  twelve  hours  after  death,  the  lungs 
were  found  healthy;  the  liver  greatly  hypertrophied;  the  lower  fifth  of  the  ilium  inflamed  and  injected. 
The  tissues  surrounding  the  hip  joint  were  in  a  sloughing  condition,  and  were  infiltrated  with  fetid  pus,  which  had  burrowed 
several  inches  under  the  gluteal  muscles  and  two  inches  below  the  trochanter  minor.  The  acetabulum  was  denuded  and  slightly 


FIG.  64.— Shot  frac 
ture  of  the  neck  and 
trochunter  of  right  fe 
mur.  Spec.  2819. 


FIG.  C5. — Upperextrem- 
ity  of  the  left  femur,  from 
vrhirh  the  head,  with  a 
conoidal  ball  in  it,  has 
boon  excised. — Spec.  103. 


no 


INJUEIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


fractured  at  its  upper  and  posterior  border.  Two  inches  of  the  upper  extremity  of  the  shaft  of  the  femur  was  denuded  of  peri 
osteum.  The  specimen  was  presented  by  Dr.  Allen  to  the  Army  Medical  Museum,  and  is  represented  in  the  adjoining  wood 
cut  (FlG.  05).  The  innominate  bone  was  not  removed ;  but  the  upper  fourth  of  the  femur  was  sawn  oft'  after  death,  and  mounted 
with  the  excised  head  to  show  how  completely  the  injury  to  the  femur  was  limited  to  the  epiphysis.  Had  it  not  been  for  the 
fracture  of  the  pelvis,  it  would  have  been  difficult  to  have  found  a  case  better  adapted  for  the  operation  of  primary  excision. 

CASE  258. — Private  F.  Machlin,1  llth  Pennsylvania,  a  robust  man,  was  wounded  at  the  second  battle  of  Bull  Run, 
August  30,  1862.  He  laid  on  the  field  several  days,  and  was  then  transported  thirty  miles  in  a  wagon  to  the  Warehouse  Hos 
pital,  Georgetown,  D.  C.,  where  he  was  received  on  September  8th.  A  musket  ball  had  entered  the  right  buttock  and  emerged 
an  inch  and  a  half  below  and  within  the  anterior  superior  spinous  process  of  the  ilium.  The  limb  was  shortened,  and  the  foot  was 
everted ;  any  movement  gave  excessive  pain.  A  thorough  examination  was  made  under  the  influence  of  chloroform,  and  showed 
that  the  neck  of  the  bone  was  comminuted  and  the  shaft  uninjured.  The  case  was  considered  to  be  a  particularly  favorable  one 
far  the  operation  of  excision  of  the  broken  fragments,  and  the  general  condition  of  the  patient  was  such  as  to  oft'er  some  hopes 
of  its  success,  and  it  was  determined  to  do  the  operation  on  the  following  day.  But  the  surgeon  in  charge  of  the  hospital  was 
confined  to  his  bed  by  illness,  and  was  unable  to  see  the  patient  for  five  days.  On  September  13th  the  general  condition  of  the 
latter  was  less  favorable.  His  pulse  was  130,  quick  and  weak,  and  his  tongue  was  dry.  He  was  placed  under  very  careful 
nursing,  and  beef  essence,  brandy,  eggs,  and  milk,  and  other  concentrated  nourishment  and  stimulants  were  administered  ad 
libitum.  By  September  20th  this  treatment  had  produced  slight  improvement,  and  though  he  was  still  in  a  very  unfavorable 
condition  for  an  operation,  it  was  determined,  on  consultation,  that  an  excision  might  afford  the  patient  relief  from 
the  constant  pain  he  suffered,  and  that  it  could  not  greatly  depress  him.  At  noon  on  September  20th,  accordingly 
Assistant  Surgeon  B.  A.  Clements,  U.  S.  A.,  assisted  by  Dr.  George  K.  Smith,  of  Brooklyn,  and  the  surgical  staff 
of  the  hospital,  performed  the  operation.  An  incision  five  inches  in  length  was  made  from  a  point  two  inches 
behind  and  an  inch  below  the  anterior  superior  process  of  the  ilium,  downward  over  the  prominence  of  the 
trochanter  major.  The  incision  exposed  the  parts  freely,  and  the  muscular  insertions  being  divided,  and  several 
gmall  loose  fragments  of  bone  removed,  the  irregular  broken  extremity  of  the  shaft,  at  its  junction  with  the  neck 
and  the  tip  of  the  great  trochanter,  were  excised  by  a  chain  saw.  The  remnant  of  the  capsular  ligament  and  the 
round  ligament  were  now  cut,  the  joint  being  opened  from  belojv  and  in  front  with  a  probe-pointed  bistoury. 
A  blade  of  a  long  bullet  forceps  was  then  introduced  as  a  lever  and  the  head  was  disarticulated  by  gently  prying  it  out  of  the 
cotyloid  cavity.  These  steps  in  the  operation  were  facilitated  by  rotating  the  trochanter  outward,  and  by  lifting  the  extensor 
muscles  by  a  metallic  retractor.  A  small  vessel  was  tied  at  the  upper  end  and  another  at  the  lower  end  of  the  wound.  The 
wound  was  well  washed  out  by  means  of  a  syringe  and  a  few  stitches  were  applied,  the  middle  portion  of  the  wound  being  left 
open.  The  limb  was  suspended  in  a  Smith's  anterior  wire  splint.  The  patient  appeared  to  rally  from  the  operation  satisfactorily. 
At  9  o'clock  P.  M.  he  was  free  from  pain ;  his  pulse  was  136,  and  the  skin  was  cool  and  natural.  He  had  slept  tranquilly.  On 
the  following  day,  September  21st,  his  pulse  was  120  and  very  feeble.  The  discharge  from  the  wound  was  dark  and  thin,  and 
copious.  His  countenance  was  placid,  the  pinched,  distressed  expression  it  had  worn  having  disappeared.  But  in  the  afternoon 
he  sank  rapidly,  and  died  in  the  evening,  thirty-six  hours  after  the  operation,  September  21,  1862.  The  specimen  is  No.  329 
of  the  Surgical  Section  of  the  Army  Medical  Museum,  and  is  represented  in  the  accompanying  wood-cut  (FlG.  66). — (Circular  6, 
S.  G.  O.,  1865,  p.  64;  Circular  2,  S.  G.  O.,  1869,  pp.  37,  135.) 

CASE  259. — Lieutenant  D.  N.  Patterson,  46th  Virginia,  aged  31  years,  was  wounded  at  an  engagement  on  the  Boydton 
Plank  Road,  near  Petersburg,  March  29,  1865,  and  was  captured  and  sent  to  City  Point,  and  immediately  conveyed  on  an 
hospital  transport  to  Washington,  and  placed  in  Armory  Square  Hospital  on  April  2d.  On  examination,  it  was  found  that  a 
conoidal  ball  had  entered  the  left  thigh  behind  the  trochanter  major,  and  had  passed  inward  and  forward,  fracturing  the  trochan 
ter,  neck,  and  head  of  the  femur,  and  the  anterior  border  of  the  acetabulum.  On  the  day  after  the  patient's  admission,  five  days 

subsequent  to  the  reception  of  the  injury,  Surgeon  D.  W.  Bliss,  U.  S.  V.,  in  charge 
of  the  hospital,  decided  that  the  case  was  one  in  which  excision  of  the  upper  extrem 
ity  of  the  femur  was  applicable.  The  wounded  man  was  anxious  thai  an  operation 
should  be  performed,  and  his  general  condition  was  very  satisfactory.  On  April  3d 
he  was  placed  under  the  influence  of  chloroform,  and  Surgeon  Bliss  exposed  the 
fractured  bone  by  a  curvilinear  incision  with  its  convexity  forward.  The  shattered 
fragments  of  the  neck  were  extracted,  the  rent  in  the  capsular  ligament  was  enlarged 
and  the  round  ligament  was  divided,  and  the  head  of  the  femur  was  exarticulated. 
It  was  found  that  the  ball  had  not  only  comminuted  the  head,  neck,  and  great 
trochanter,  but  that  fissures  extended  down  the  shaft  of  the  femur.  The  bone  was 
divided  by  the  chain  saw  two  inches  below  the  trochanter  minor.  The  deep  wound 
was  now  washed  out,  and  small  fragments  of  bone  were  removed,  and  search  was 
made  for  the  ball.  It  was  finally  detected  by  means  of  a  N<§laton  probe  deeply 
buried  in  the  obturator  muscle  near  the  posterior  margin  of  the  obturator  foramen. 
The  operation  was  accomplished  with  little  loss  of  blood,  and  the  patient  reacted 
satisfactorily.  The  wound  was  lightly  dressed,  sufficient  outlet  for  discharges  being 
left,  and  the  limb  was  extended  and  supported  by  pillows.  Careful  nursing  was 
provided,  and  such  stimulants  and  concentrated  nourishment  as  seemed  best  adapted  to  the  patient's  condition.  For  three  days 
he  progressed  very  satisfactorily.  Notwithstanding  the  extensive  lesions  of  the  pelvis,  which  were  not  detected  until  after 
death,  there  was  no  indication  of  peritonitis  or  disturbance  of  the  urinary  organs.  On  April  7th,  however,  profuse  haemorrhage 


Flii.  67. — Extensive  fractures  of  the  shaft,  tro- 
rhunters,  head,  and  nock  of  the  left  femur,  and  of 
the  os  innominatum.  Spec.  4048. 


'BATES  (S.  P.)  (History  of  Pennsylvania  Volunteers,  1861-5,  Harrisburg,  1869,  Vol.  I,  p.  30)  records  the  name  of  this  patient  as  Philip  Mechling, 
Co.  I,  Uth  Pennsylvania  Volunteers. 


SECT.  II. 


EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY. 


Ill 


took  place,  which  could  not  be  controlled,  and  the  patient  died  on  the  morning  of  that  day.  At  the  autopsy  it  was  found  that 
the  bleeding  had  proceeded  from  the  internal  iliac  vein,  gradually  worn  away  by  a  sharp  bit  of  bone  forced  inward  by  the  ball. 
The  pathological  specimen,  represented  in  the  adjoining  wood-cut  (FlG.  67),  is  also  figured  at  page  240  of  the  Catalogue  of  the 
Surgical  Section  of  the  Army  Medical  Museum,  where  another  view  is  given. 

CASE  260. — "I  have  the  honor  to  report,"  writes  Dr.  Hooton,  "that  I  did  not  take  charge  of  hospital  21  until  March  10, 
18o'3,  and  did  not  treat  the  case  referred  to.  I  was  somewhat  conversant  with  its  history,  however,  and  will  give  it  to  you  as  I 
received  it  from  Surgeon  Sennet,  94th  Ohio,  whom  I  relieved.  The  wound  was  received  at  the  battle  of  Stone  River  or 
Muifreesboro',  the  last  of  December,  1862,  or  January  1,  1863.  Resection  of  the  upper  part  of  the  shaft,  including  the  shattered 
trochanters,  was  performed  on  the  field.  The  head  of  the  bone  was  left  in  the  cotyloid  cavity.  A  few  days  subsequently  the 
patient  was  sent  by  rail  to  Nashville,  a  distance  of  twenty  miles.  Notwithstanding  the  fatigue  of  the  long  journey,  his  general 
condition  was  very  satisfactory,  and  the  wound  looked  well.  Part  of  the  incision  healed;  but  there  was  a  profuse  discharge 
from  the  lower  part,  and  gradually  this  discharge  became  thin  and  ichorous.  About  January  21st  it  was  determined  to  reopen 
the  wound.  It  was  found  that  the  head  of  the  bone  was  carious  throughout  its  whole  extent.  It  was  therefore  removed  After 
this  operation,  which  was  accomplished  without  haemorrhage  or  other  untoward  circumstance,  the  limb  swelled  very  much, 
irritative  fever  set  in,  and  the  patient  died  exhausted  in  a  few  days."  [The  records  of  the  hospital  identify  this  patient  as 
Sergeant  Dallas  W.  Hade,  Co.  H,  101st  Ohio,  wounded  at  Stone  River,  December  31,  1862;  died  January  31,  1863.] 

Of  the  twenty-two  intermediary  excisions  at  the  hip,  four  were  on  the  right  side, 
sixteen  on  the  left;  in  two  cases  the  side  of  the  injury  was  not  reported.  A  straight 
longitudinal  incision  was  made  in  nine  instances,  a  curvilinear  in  seven,  a  crucial  in  one,  a 
T-shaped  in  one,  and  in  four  operations  the  mode  of  incision  was  not  stated.  In  five 
instances  the  missile  was  removed  at  the  time  of  the  operation.  Twenty  excisions  were 
performed  by  Union  surgeons  and  two  by  Confederate  surgeons.  Pathological  specimens 
illustrating  thirteen  of  the  excisions  are  preserved  in  the  Army  Medical  Museum,  with 
photographs  of  the  two  survivors  of  intermediary  excisions  at  the  hip. 

TABLE  XII. 
Summary  of  Twenty-two  Cases  of  Intermediary  Excision  at  the  Hip  Joint  for  Shot  Injury. 


NO. 

NAMK,  AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

lJarret,    J.  M.,   Lieut.,   C, 

Oct.  14, 

Left  femur  shattered  at  upper 

Nov.  9, 

Excis'nof  head,  neck,  trochant 

September,  1864.     Recovered. 

15th  North  Carolina,  age  28. 

1863. 

third  by  a  conoidal  ball. 

1863. 

ers,  and  a  port'n  of  shaft  of  left 

femur;  several  largedetached 

fragments  and  spiculse  rem'd, 

by  Surgeon  J.  B.  Read,  P.  A. 

C.   S.;    chloroform  ;   straight 

incision  seven  inches  long. 

2 

2  Wright,  H.,  Pt.,  O,  8th  N. 

May  5,    Conoidal    ball    shattered    the  1  May  27, 

Head,  neck,  and  both  trochant 

Disch'd  October  C,  1864.  and  pen 

Jersey,  age  28. 

1864.         neck  and  trochanters  of  right  ,    1664. 

ers  of  right  femur  removed 

sioned.     Spec.  3375,   A.  M.  M. 

femur  and  lodged,  greatly  flat 
tened  and  distorted,  amid  the 

thro'  straight  incision  ;  missile 
extracted  ;  jagged  upper  ex 

Sept.  4,  1673,  "Six  and  a  half 
inches  shortening."     Pensioner 

fragments  of  bones. 

tremity  of  shaft   turned  out 

died  October  26,  1874,  of  heart 

and  smoothed  off,  by  Ass't 

disease. 

Surg.  G.  A.  Mursick,  U.  S.V. 

3 

Boyle,  P.,  Pt.,  D,  59th  Mas 

July  30, 

Conoidal  ball  perforated  surgi 

Aug.  5, 

Head,  neck,  and  shaft  of  left 

Died  August  7,  1864,  from  ex 

sachusetts,  age  60. 

1864. 

cal  neck  of  the  left  femur  and 

1864. 

femur  at  level  of  troch  minor, 

haustion.     Spec.  ;'593,  A.  M.  M. 

fractured  trochanter  major. 

excised  through  straight  in 

Circ.  6,   S.  G.  O.,  1865,  p.  70. 

cision,  by  Ass  t  Surgeon  W. 

Circ.  2,  S.  G.  O..  1869,  pp.  45, 

Thomson,  U.  S.  A.;  ether. 

136. 

4 

Brantley,  G.  W.,  Pt.,  C,  2d 

April  9, 

Conoidal  ball  fractured  neck  of  April  28, 

Head,  neck,  and  trochanters  of 

Died  May  2,  1865,  of  capillary 

Alabama,  age  18. 

I860. 

left  femur  ;  also  fract.  of  extl. 

1865. 

femur  excised,  by  Snrg.  A. 

haemorrhage.    Circ.  6.  S.  G.  O.. 

condyle  hum. 

M.  McMahon,  U.  S.  V. 

18G5,  p.  74.     Circ.  2,  S.  G.  O., 

1869,  pp.  47,  13C. 

r> 

Callaghan,   C.,    Pt.,    G.   2d 

Sept.  17. 

Comminut'n  of  left  trochanteric 

Sept.  29, 

Head,  neck,  and  portion  of  shaft 

Died  October  4,  1862.     Spec.  840, 

Delaware. 

1862. 

region,  fissures  extending  up 

1862. 

of  left  femur  excised,  by  Ass't 

A.  M.  M.    Circ.  6.  S.  G.  O.,18t!5. 

neck  of  femur,  by  a  fragment  ' 

Surgeon  J.  H.  Bill.  U.'S.  A.; 

p.  C4.     Circ.  2,  S.  G.  O.,  1SG9. 

of  shell. 

curved  incision  :  shaft  divided 

pp.  37,  135. 

just  below  trochanter  minor. 

6 

Christopher,    T.    C.,  Pt.,  D, 

Mav  5, 

Conoidal   ball  fractured  head 

Mav  20, 

Shattered  fragments   of  head 

Died  May  24,  1862.      Spec.   19, 

18th   South   Carolina,   age 

18fJ2. 

and  neck  of  left  femur  and 

1862. 

and  neck  of  left  femur  remo'd 

A.  M.  M.  Circ.  6,  S.  G.  O.,  1865. 

21. 

lodged  in  obturator  externus 

through  a  curvilinear  incision 

p.  62.     Circ.  2,  S.  G.  O.,  1869, 

i     muscle. 

four  inches  long,  by  Assistant 

pp  35,  135. 

Surg.  J.  S.  Billings,  U.  S.  A. 

7 

Cleaver.    C.  C..   Pt.,   C,  2d 

Mav  12, 

Neck  and  trochanters  of  right 

Mav  19. 

Head,    neck,   and  four  and  a 

Died  May  23,  1864,  of  pyaemia. 

Infantry,  age  18. 

1864. 

femur  fractured  by  a  conoidal 

1864. 

quarter  inches  of  shaft  of  right 

Spec.  2819,  A.  M.  M.     Circ.  6, 

ball. 

femur  removed  thro'  a  curved 

S.  G.  O.,  1865,  p.  66.     Circ.  2, 

incision,  by  Ass't  Surgeon  A. 

S.  G.  O.,  1869,  pp.  43,  135. 

Jngram,  U.  S.  A. 

1  RKAD  (J.  B.),  Resections  of  the  Hip  Joint,  in  Confederate  States  Medical  and  Surgical  Jour.,  1864,  Vol.  I,  p.  5.  Phot.  Ser..  A.  M.  M.,  Vol.  I,  p.  41 . 
Circular  No.  0,  S.  G.  O.,  1865,  p.  66.  Circular  No.  2,  S.  G.  O.,  1869,  pp.  39,  135.  EVE  (P.  F.),  A  Contribution  to  the  History  of  the  Hip  Joint  Opera 
tions,  etc.,  in  Trans,  of  the,  Am.  Med.  Association,  1867,  Vol.  XVIII,  p.  256. 

2MuusiCK  (G.  A.),  A  Successful  Case  of  Excision  of  the  Head  of  tlie  Femur  for  Gunshot  Fracture,  in  New  York  Med.  Jour.,  1865,  Vol.  I,  p.  424. 
Circular  No.  6,  S.  G.  O.,  1865,  p.  68.  Circular  No.  2,  S.  G.  O.,  1869,  pp.  41,  135.  Surgical  Photograph  Series,  A.  M.  M.,  Vol.  IV,  p.  38. 


112 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

8 

Ewing,    A.,    Pt.,    A,    140th 

Mav  12, 

Conoidal  ball  splintered  neck, 

May  19, 

Removal  of  the  head  and  i'rug- 

Died  May  24,  1864,  from  exhaus 

Pennsylvania,  age  30. 

1864. 

separated  the  great  trochanter 

1864. 

ments  of  the  neck  and  tro- 

tion.     Circ.  6,  S.  G.  O.,  1865,  p. 

from  shaft,  and  comminuted 

chantors  through  an  incision 

68.     Circ.  2,  S.  G.  O.,  1869,  pp. 

upper  part  of  the  left  femur. 

five  inches  long,   by  A.    A. 

43,  135. 

The  fissure  extended  within 

Surgeon  J.  F.  Thompson. 

the  capsule. 

9 

Fovlke,    T.  E..    Pt..    1),   2d 

April  9, 

Neck,  trochanters,  and  upper 

April  27, 

Excision   of   the  head,   neck, 

Died  June  5,  1865,  from  exhaus 

Alabama,  age  17. 

1865. 

third  of  left  femur  fractured 

1865. 

trochanters,  and  two  inches  of 

tion.     Circ.  6,  S.  G.  O..  1865,  p. 

by  a    conoidal    ball,   which 

the  shaft  of  femur,  by  Surg. 

74.     Circ.  2,  S.  G.  O.,  1869,  pp. 

lodged  above  the  ant.  sup. 

A.  M.  McMahon,  U.  S.  V. 

47,  136. 

spinous    process  of  the  left 

ilium.     Missile  removed. 

10 

Hade,  D.  W.,  Sergeant,  H, 

Dec.  31, 

Shot  fracture  of  the  trochanters 

Jan.  21, 

On  reopening  the   wound  the 

Died  January  31  ,  1863.  from  ex 

101st  Ohio. 

1862. 

of  femur;  resection  of  the 

1863. 

head  of  the  femur  was  found 

haustion.   Circ.  2,  S.  G.  O.,  1869, 

upper  part  of  the  shaft  and  the 

carious  throughout  its  entire 

pp.  38,  135. 

shattered  trochanters  on  the 

extent;  it  was  therefore  re 

field;    head  of   bone  left  in 

moved,  by  Surg.  E.  Sennet, 

cotyloid  cavity. 

94th  Ohio. 

11 

Marston,  C.  E.,   Pt.,   F,   1st 

Aug.  30. 

Neck  of  right  femur  crushed, 

Sept.  27, 

Fragments  of  neck  removed, 

Died  Sept.  30,  1862.     Spec.  328, 

Massachusetts,  age  19. 

1862. 

and  the  head  of  the  bone  com 

1862. 

head  of  bone  exartieulated, 

A.M.M.   Circ.  6,  S.G.  O.,  1865, 

minuted  by  a  conoidal  ball, 

the  roughened  portion  of  the 

p.  64.     Circ.  2,  S.  G.  O.,  1869, 

which  lodged  in  the  inner  side 

neck  at  its  attachment  with 

pp.  36,  135. 

of  the  thigh. 

the  trochanter  sawn  off  with  a 

small  chain  saw.  and  the  mis 

sile  removed  with  difficulty  at 

the  bottom  of  a  large  cavity; 

slightly  curved  incision,  by 

Ass't  Surgs.  B.  A.  Clements 

and  C.  H.  Alden,  U.S.A. 

12 

Machlin,    F.,    Pt.,    I,    llth 

Aug.  30, 

Comminution  of  neck  of  right 

Sept.  20, 

Loose  fragm'ts  removed,  irreg 

Died  Sept.  21,  1862.     Spec.  329, 

Pennsylvania. 

1862. 

femur  by  a  musket  ball  ;  fis 

1862. 

ular  broken  extremity  of  shaft 

A  .  M.  M.  Circ.  6,  S.G.  O.,  1865, 

sure  extending  into  the  head 

excised,  and  head  of  bone  dis 

p.  64.     Circ.  2,  S.  G.  O.,  1869, 

of  the  bone. 

articulated  ;  incis'n  five  inches 

pp.  37,  135. 

long;  Ass't  Surg.  B.  A.  Clem 

ents,  U.  S.  A.,  assisted  by  Dr. 

G.  K.  Smith,  of  Brooklyn. 

13 

Miller,   J.,    Pt.,  E,  162d  N. 

June  14, 

Conoidal  ball  perforated  upper 

July  8, 

Ass't  Surg.  G.  W.  A  very,  9th 

Died  Sept.  21,  1863,  from  exhaus 

York,  age  38. 

1863. 

portion  of  left  thigh,  breaking 

1863. 

Conn.,  excised  the  head,  neck, 

tion.     Circ.  2,  S.  G.  O.,  1869, 

the  neckoffemurtransversely 

and  great  trochanter  through 

pp.  38,  135. 

and  splittingit  longitudinally. 

a  single  straight  incision. 

but  without  great  comminutV 

: 

Noe,  D.  M.,  Pt.,  C,  46th  Ohio, 

April  6, 

Neck  of  left  femur  shattered 

April  16, 

Excision  of  the  head,  neck,  and 

Died  April  24,  1862,  of  pyaemia. 

age  22. 

1862. 

by  a  conoidal  ball. 

1862. 

trochanters,  and  three  inches 

Circ.  2,  S.  G.  O.,  1869,  pp.  34, 

of  the  shaft  of  femur  ;  incision 

135. 

four  inches  long,  by  Surg.  G. 

C.  Blackman,  U.  S.  V. 

15 

Patterson,     D.    N.,    Lieut., 

Mar.  29. 

Conoidal  ball  fractured  the  tro 

April  3, 

Shattered  fragm'ts  of  the  neck 

Died  April  7,  1865,  from  haemor 

46th  Virginia,  age  31. 

1863. 

chanter  major,  neck,  and  head 

1865. 

extracted,  head  of  femur  ex- 

rhage.     Spec.   4048,  A.  M.  M. 

of  the  left  temur,  and  anterior 

articulated,  and  shaft  divided 

Circ.  6,  S.  G.  O.,  1865,  p.  72. 

border    of   the  acetabulum  ; 

two  inches  below  the  trochan 

Circ.  2,  S.  G.  O.,  1869,  pp.  45, 

fissures  extended  down  shaft. 

ter  minor,  through  curvilinear 

136. 

Missile  lodged. 

incision;  missile  removed,  by 

Surg.  D.  W.  Bliss,  U.  S.  V. 

Died.Tune21,  1864,  from  diarrhoea. 

16 

Phelan,   J.,    Capt.,    A,   73d 

May  14, 

Left  trochanter  major  shattered 

June  3, 

Head  of  femur  exartieulated 

Spec.  2618,  A.  M.  M.     Circ.  6, 

^6w  York  sisfo  22. 

1864 

and  neck  of  lemur  fractured 

1864. 

and  the  fragments  of  the  neck 

S.  G.  O.,  1865,  p.  68.     Circ.  2, 

to  the  head  by  a  conoidal  ball, 

and  trochanter  major  rcmov'd, 

S.  G.  O.,  1869,  pp.  44,  136. 

which  lodged  ;  many  fragm'ts 

thro'  crural  incision,  by  Ass't 

driven  into  gluteal  muscle. 

Surg.  C.  A.  McCall,  U.  S.  A. 

17 

Phillips,    H.,    Pt.,    I,    146th 

April!, 

Conoidal  ball  crushed  in  the 

April  8, 

Head,    neck,    and    trochanter 

Died  April  21,   1865.     Autopsy: 

New  York,  age  34. 

1865. 

laminated  structure  of  the  an 

1865. 

major    removed    through    a 

Pleurisy  on  either  side  ;  large 

terior  surface  of  neck  of  left 

curved  incision  six  or  seven 

subperiosteal  abscesses.     Spec. 

femur,  where  it  lodged.    Mis 

inches  long,  by  Ass't  Surg. 

3235,  A.M.M.   Circ.  6,  S.  U.O., 

sile  extracted. 

W.  F.  Norris,  U.  S.  A. 

1865,  p.  72.     Circ.  2,  S.  G.  O., 

1869,  pp.  47,  136. 

18 

Sennett.  H.  C.,    Corp'l.    F, 

Mar.  27, 

Left  acetabulum  fract'd  slight 

April  4, 

Head  and  neck  excised   thro' 

Died  April   8,    1865,   from  peri 

122d  New  York,  age  27. 

18(i5. 

ly  at  its  up.  and  post,  border 

1865. 

a  T-shaped  incision,  by  Ass't 

tonitis.    Spec.   153,   A.  M.   M. 

by  a  conoidal  ball,  which  also 

Surgeon  H.  Allen,  U.  S.  A. 

Circ.  6,  S.  G.  O.,  1865,  p.  72. 

fractured  the  head  of  the  bone 

Circ.  2,  S.  G.  O.,  1869,  pp.  46, 

and  lodged  in  the  same. 

136. 

19 

Smith,     M.,    Pt.,     F,     38th 

May  10, 

Conoidal    ball    fractured    the 

May  12, 

Head,  neck,  and  two  inches  of 

Died  May  13,  1864.     Spec.  5500, 

Virginia. 

1864. 

upper  portion  of  the  shaft  of 

1864. 

the  shaft  of  femur  excised,  by 

A.  M.  M.   Circ.  2,  S.  G.  O.,  1869, 

left  femur,  passed  throt-gh  the 

Surg.  C.  B.  Gibson,  C.  S.  A. 

pp.  43,  135. 

perinaDum    without    injuring 

the  urethra,  and  through  the 

20 

Unknown  soldier  of  General 

Mar.  —  , 

soft  parts  of  the  right  hip. 
Neck  and  trochanters  of  

Two 

Head  and  splintered  upper  ex 

Died  one  week  afteroperat'n.from 

Buell's  Army.     [Probably 
Corporal  II.  F.  Smith,  12th 

1862. 

femur  shattered  by  a  conoidal 
ball. 

days 
after  in 

tremity  of  femur  remov'd  thro' 
a  long  straight  incision,  by 

surgical  fever  and  suppuration. 
Circ.  6,S.G.O.,  1865,  p.62.  Circ. 

Wisconsin.  | 

jury. 

Surg.  A.  H.  Thurston.U.  8.V. 

2,  S.  G.  O.,  1869,  pp.  34,  135. 

21 

Unknown  soldier,  private  of 

Aug.  29. 

Conoidal  ball  split  and  commi 

Sept.  4, 

Head  and  fragments  of  neck  of 

Died  Sept.  24,  1862,  from  exhaus 

Gen'l  Pope's  Army. 

1862. 

nuted  the  left  trochanter  ma 

1862. 

the  femur  removed:  the  shaft 

tion.     Circ.  6,  S.  G.  O.,  1865,  p. 

jor  and  neck  of  the  femur  and 

of  femur  was  then  divided  at 

64.     Circ.  2,  S.  G.  O.,  1869,  pp. 

lodged  in  the  latter. 

the  level  of  trochanter  minor. 

36,  135. 

straight  incision,  by  Assistant 

Surg.  J.  S.  Billings,  U.  S.  A. 

Couoidal    ball    fractured    the 

Oct.  3, 

Head  of  femur  excised,  together 

Died  October  25,    1863.      Spec. 

22 

'Welsh,    M.,    Pt.,    H.    10th 

Sept.  20, 

neck  and  head  of  left  femur 

1863. 

with  the  attached  greater  por 

5442,  A.  M.  M. 

Kentucky,  age  40. 

1863. 

and  lodged.     Oct.   1st,   ball 

tion  of  the  lower  surface  of 

removed. 

the  neck  of  the  bone,  fragments 

removed  and  remaining  sharp 

portions  of  neck  trimmed  off; 

Surg.  F.  H.  Gross,  U.  S.  V. 

1  GROSS  (S.  W.),  Head  of  the  Thigh  Bone  removed  by  Excision  on  account  of  Gunshot  Injury,  in  Am.  Jimr.  Med.  Sci.,  1868,  Vol.  LV,  p.  410. 
OTIS  (G.  A.),  Observations  on  some  Recent  Contributions  to  the  Statistics  of  Excisions  and  Amputations  at  the  Hip  for  Injury,  in  Am.  Jour.  Med.  Sci., 
1868,  Vol.  LVI,  p.  130.  Circular  No.  2,  S.  G.  O.,  1869,  pp.  39,  135. 


SECT.  II.] 


EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY. 


113 


Secondary  Excisions. — There  were  reported  eleven  secondary  excisions  at  the  hip 
practised  on  nine  Union  and  two  Confederate  soldiers,  resulting  in  three  recoveries  and 
eight  deaths,  a  mortality  rate  of  72.7  per  cent.1  The  shortest  interval  between  the  recep 
tion  of  the  injury  and  the  operation  was  thirty-one  days,  and  the  longest  eight  years' and 
four  months.  Two  of  the  survivors  of  secondary  excision  at  the  hip  are  still  pensioners  in 
comparatively  good  health,  at  a  period  remote  from  the  date  of  operation. 

CASE  261. — Private  Joseph  Brown,  Co.  I,  3d  Michigan,  aged  33  years,  was  wounded  at  the  second  battle  of  Bull  Run, 
August  29,  1832,  by  a  musket  ball,  which  passed  through  the  left  thigh,  fracturing  the  femur  just  below  the  trochanter  minor. 
He  laid  on  the  battle  field  three  days,  and  was  then  removed  to  Centreville.  On  September  11,  18G2,  he  was  admitted  to 
Fairfax  Seminary  Hospital,  near  Alexandria.  The  limb  was  kept  in  position  by  appropriate  apparatus;  but  suppuration  was 
profuse,  and,  on  two  occasions,  fragments  of  bone  were  removed  from  the  wound.  Early  in  March,  1833,  there  was  great 
swelling  of  the  thigh,  the  discharge  became  scanty  and  fetid,  and  pus  burrowed  amid  the  muscles.  On  March  iilst,  an  explo 
ratory  incision  was  made  from  three  inches  above  to  five  inches  below  the  prominence  of  the  great  trochanter.  The  neck  and 
upper  extremity  of  the  shaft  of  the  femur  were  found  to  be  extensively  diseased,  and  excision  was  decided  on.  Surgeon  D.  P. 
Smith,  U.  S.  V.,  performed  the  operation.  Difficulty  was  experienced  in  separating  the  mus 
cular  attachments  from  the  trochanters,  on  account  of  the  foliaceous  masses  of  callus  that  had 
been  thrown  out.  When  this  dissection  was  accomplished,  many  necrosed  fragments  were 
extracted,  and  the  periosteum  and  new  bone  were  separated  by  the  handle  of  the  scalpel  and 
preserved  as  far  as  practicable.  The  shaft  of  the  femur  was  then  divided  by  powerful  cutting 
bone  forceps,  about  six  inches  below  the  tip  of  the  great  trochanter.  A  screw  was  driven  into 
the  mass  of  callus,  below  the  trochanters,  to  be  used  as  a  lever  in  disarticulating  the  head,  but 
it  would  not  hold,  and  the  bone  was  seized  with  large  forceps  and  rotated,  so  as  to  facilitate 
the  division  of  the  capsular  and  round  ligaments.  The  head,  neck,  and  trochanters,  and  the 
masses  of  callus  adhering  to  the  trochanters,  were  then  removed.  The  operation  was  accom 
plished  with  but  very  trifling  haemorrhage,  yet  great  prostration  followed,  and  the  patient 
rallied  slowly.  As  the  anesthesia  passed  off,  he  had  much  nausea  and  vomiting.  As  soon  as 
this  subsided,  he  was  given  a  very  full  allowance  of  concentrated  nourishment,  such  as  strong 
beef-tea,  eggs,  milk,  etc,  with  half  an  ounce  of  brandy  every  two  hours.  The  wound  was  par 
tially  closed;  the  limb  was  supported  on  pillows  until  the  third  day,  when  it  was  dressed  in  a 
Smith's  anterior  splint.  About  forty-eight  hours  after  the  operation,  an  erysipelatous  blush 

pervaded  the  limb,  and  the  constitutional  symptoms  assumed  a  typhoid 

character.     A  female  catheter  was  passed  through  the  middle  of  the 

wound  and  another  at  its  lower  extremity,  through  which  much  offensive 

decomposed   serum   and    grumous    blood    escaped.     The   wound   was 

thoroughly  washed  out  through  the  catheters  with  warm  water  impreg 
nated  with  chlorinated  soda.     On  the  fifth  day  there  was  a  rigor,  and 

hemorrhage  to  the  extent  of  six  ounces.     As  the  anterior  splint  did  not 

permit  convenient  access  to  the  limb,  it  was  removed,  and  the  leg  and 

thigh  were  suspended  in  a  canvas  hammock,  the  leg  being  horizontal 

and  the  thigh  in  an  almost  vertical  position.     A  piece  of  soft  toweling 

extending  from  the  perineum  to  the  popliteal  space,  and,  connected  by 

cords  with  an  upright  post  at  the  head  of  the  bed,  supported  the  muscles 
on  the  sides  and  under  surface  of  the  thigh.  The  wound  freely  discharged  synovia,  bloody  serum,  and  thin  pus,  until  the  seventh 
day,  when  healthy  suppuration  was  fairly  established.  During  April,  1863,  the  patient's  progress  was  satisfactory.  He  was 
supplied  with  very  nutritious  diet,  with  porter,  and  cod-liver  oil.  He  took  for  a  time  as  much  as  a  half  a  pint  of  oil  daily. 
During  May,  the  case  continued  to  progress  favorably.  It  was  necessary  to  keep  a  tube  in  the  wound  until  June  1st.  Pre 
viously,  whenever  it  was  removed  pus  would  accumulate  and  burrow.  A  mesh  of  suture  wire  was  finally  substituted  for  the 
tube.  This  was  retained  until  June  20th,  when  the  patient  began  to  get  about  on  crutches.  In  the  latter  part  of  July  the  wounds 
closed.  In  August,  Brown  was  reported  as  "well,"  and  on  August  23,  1803,  he  was  discharged  from  the  hospital  and  from 
the  military  service  of  the  United  States.  On  March  21, 1834,  he  wrote  from  his  home  in  Coopersville,  Michigan,  that  his  health 
was  good;  that  he  could  get  about  and  attend  to  home  business ;  could  saw  and  split  a  little  wood  for  fuel,  though  his  knee  was 
stiff  and  his  leg  painful.  On  the  whole,  there  had  been  steady  improvement.  In  September,  1835,  he  again  wrote,  and  stated 
that  his  general  health  was  good;  that  he  had  some  control  over  the  movements  of  the  thigh,  being  able,  when  standing  on  the 
right  foot,  to  swing  the  left  backward  and  forward,  and  to  adduct  the  thigh  enough  to  carry  the  injured  limb  across  the  other. 
He  could  bear  some  weight  on  the  limb,  and  use  but  one  crutch,  with  a  stirrup  for  the  foot.  There  had  been  no  fistulous  orifices 
since  March  1834,  and  there  was  no  soreness  about  the  cicatrices.  In  November,  1835,  in  accordance  with  a  request  from  the 
Surgeon  General's  Office,  Mr.  Brown  had  a  photograph  (FlG.  69)  taken  to  represent  the  amount  of  deformity  in  his  limb.  This 
picture  is  numbered  110  in  the  Photograph  Series  of  the  Army  Medical  Museum.  It  is  carefully  copied  in  the  accompanying 
wood-cut.  The  excised  bone  is  preserved  at  the  Museum,  and  is  numbered  1192.  Section  I.  It  is  represented  in  the  adjacent 
wood-cut  (FlG.  68).  On  February  12,  1868,  he  wrote  to  the  compiler  of  this  report :  ''  I  take  pleasure  in  informing  you  that  my 

1  Besides  the  nine  cases  recorded  in  the  Report  on  Excisions  of  the  He.ad  of  the  Femur  for  Gunxhot  Injury,  S.  G.  O.,  1869,  a  successful  example  has 
been  reported  by  Dr.  E.  STKULINQ,  of  Cleveland,  Ohio,  and  another  successful  operation  was  performed  in  1871,  by  Dr.  J.  K.  BlGELOW  of  Indianapolis. 
SURG.   Ill— 15 


Fia.  68.— Head,  neck, 
and  trochanters  of  left 
femur,  with  foliaceous 
callus.  Spec.  11S2. 


FIG.  CO.— Appearance  of  limb  three 
years  after  the  operation.  [From  a 
photograph.] 


114  INJURIES    OF    THE    LOWER    EXTREMITIES.  ICHAP.  x. 

limb  is  in  as  good  condition  as  when  I  last  wrote  you ;  but  think  there  is  no  improvement,  except  that  it  is  not  as  tender.  There 
have  been  no  abscesses,  nor  any  pain  in  the  limb,  excepting  slight  pains  about  the  knee,  just  before  storms  About  two  years 
ago,  I  slipped  and  fell  upon  the  ice,  injuring  the  limb  severely  about  the  knee,  and  was  thereby  confined  to  the  house  for  about, 
three  weeks.  In  March  last  I  had  a  severe  attack  of  ague.  The  limb  swelled  quite  badly  at  this  time,  and  was  much  inflamed  for 
about  ten  days.  I  applied  cold  water  and  a  bandage  to  reduce  the  swelling.  I  had  to  keep  it  bandaged  about  two  weeks  after 
the  inflammation  was  removed.  Since  that  time  the  limb  has  given  me  no  more  trouble  than  usual.  Since  I  was  discharged  ] 
cannot  see  that  there  is  any  lengthening  of  the  limb.  I  have  to  use  a  crutch  and  cane  all  the  time  when  moving  about,  and  I 
think  I  shall  always  have  to  do  this.  The  injured  limb  has  wasted  away  somewhat  since  I  last  wrote.  The  circumference  of 
the  well  limb  at  the  upper  extremity  is  22  inches,  and  the  injured  liinb  measures  at  the  same  place  19^-  inches.  The  knee  of  the 
well  limb  measures  around  the  centre  of  the  knee-pan  154-  inches;  the  injured  limb  measures  at  the  same  place  17  inches.  The 
above  measurements  were  made  in  the  evening;  I  think  that  in  the  morning  the  measurements  of  the  injured  limb  would  be 
less.  The  knee  still  remains  quite  stiff,  and  gives  me  about  all  the  pain  there  is  anywhere  in  the  limb.  I  have  been  troubled 
during  cold  weather  by  coldness  of  the  outer  side  of  the  leg,  and  I  have  to  warm  it  by  the  fire  before  going  to  bed  nearly  every 
night  when  I  have  been  out."  On  November  19,  1863,  another  letter  was  received  from  Mr.  Brown,  from  which  the  following 
extract  is  made:  "I  take  pleasure  in  informing  you  that  my  limb  is  in  as  good  condition  as  it  has  been  at  any  time  since  it  was 
entirely  healed,  and,  if  anything,  in  better  condition.  It  does  not  pain  me  about  the  knee  as  much  as  it  did  one  year  ago.  It 
does  not  have  any  spell  of  swelling  at  the  knee  as  it  did  for  the  first  two  years  after  my  discharge,  and  there  is  less  soreness 
about  the  limb  than  there  was  even  one  year  ago.  I  can  get  around  without  hurting  it  as  much  as  formerly.  I  can  bear  some 
weight  upon  it.  I  have  walked  across  a  room  without  the  aid  of  crutch  or  cane,  by  stepping  very  quick  with  the  well  limb; 
but  it  is  more  like  hopping  than  walking.  There  have  been  no  abscesses  in  the  limb.  I  think  that  it  is  gradually  improving,  and 
hope  that  I  may  yet  see  the  day  that  I  can  go  without  a  crutch.  My  general  health  is  good.  I  have  not  been  sick  a  day  for  a 
year  and  a  half,  and  then  only  a  few  days  with  ague.  My  weight  now  is  167£  pounds.  Before  I  entered  the  army  my  weight 
was  never  quite  up  to  those  figures,  but  within  a  few  pounds  of  it.  I  have  been  postmaster  at  this  oifice  over  a  year,  and  have 
attended  to  all  the  business  of  the  office  almost  entirely  without  assistance,  and  it  gives  me  pretty  good  exercise."  On  Septem 
ber  6,  1875,  the  date  of  his  last  examination  for  pension,  the  Grand  Rapids  Examining  Board  stated:  "There  is  now  a  false 
joint  with  shortening  of  the  limb."  Since  then  this  pensioner  has  been  exempted  from  further  surgical  examinations.  He  was 
paid  September  4,  1877,  remaining  in  comparatively  good  health  more  than  fourteen  years  after  the  operation. 

The  next  successful  secondary  excision  at  the  hip  after  shot  injury  was  not  identified 
at  the  Surgeon  General's  Office  until  after  the  publication  of  Circular  2,  in  1869. 

CASE  262. — G.  W.  Tilliston,  Co.  D,  1st  Ohio  Artillery,  aged  44  years,  was  wounded  at  Laurel  Hill,  July  7,  18(31,  by  a 
rifle  ball,  which  entered  the  right  groin,  passing  backward  through  the  neck  of  the  femur  and  lodging  in  the  large  muscles  of 
the  buttock.  Two  weeks  after  the  reception  of  the  injury  he  was  mustered  out  by  reason  of  expiration  of  service,  and  subse 
quently  he  was  admitted  on  the  Pension  Rolls.  Dr.  E.  Sterling,  of  Cleveland,  who  was  the  regimental  surgeon  and  treated  the 
wounded  man  in  the  field,  subsequently  certified  toxthe  nature  of  the  injury  and  reported  the  following:  "Extraction  of  the 
ball  was  impossible.  The  wound  was  dressed,  and  within  a  few  days  the  patient  was  removed  to  his  home  in  Cleveland.  On 
or  about  the  20th  of  September  following  it  became  necessary  to  remove  that  portion  of  the  bone  traversed  by 
the  ball,  and  I  performed  the  operation  of  excision  at  the  hip  joint."  Examiner  J.  Laisy,  of  Cleveland,  on 
July  17,  1867,  certified  to  resection  of  the  head  and  part  of  the  neck  of  the  femur,  and  stated:  "A  fistulous 
opening  has  formed  six  inches  below  the  anterior  superior  spinous  process  of  the  ilium,  which  is  keeping  up 
a  constant  and  profuse  discharge  of  purulent  matter.  The  right  leg,  in  consequence  of  the  operation,  is  short- 
70.— Shat-  ene(l  about  three  inches.  He  is  unable  to  bear  any  weight  on  the  injured  limb,  and  obliged  to  walk  on  crutches." 
tered  head  of  right  Two  years  later,  in  August,  1869,  the  excised  head  of  the  femur,  represented  in  the  wood-cut  (FiG.  70),  was 
transmitted  to  the  Museum  by  the  operator,  who  deplored  the  loss  of  the  other  portion  of  the  resected  bone,  and 
described  the  case  as  being  attended  with  "perfect  recovery  and  a  good  limb,  the  pensioner  being  able  to  go  up  and  down  stairs 
with  ease." '  Dr.  N.  M.  Jones,  attending  physician  of  the  pensioner,  certified  that  he  died  September  6,  1871,  and  added  that  a 
post-mortem  examination,  held  by  himself,  revealed  ''extensive  necrosis  of  the  upper  third  of  the  femur  *  *  *  and  of  the 
ilium,  having  entirely  destroyed  the  acetabulum  and  penetrated  the  pelvis."  He  also  stated  that  he  found  an  enormous  abscess 
covering  the  entire  right  ilium  and  sacrum. 

The  third  successful  secondary  excision  at  the  hip  was  practised,  in  1871,  for  ostitis 
and  coxitis,  eight  years  arid  four  months  subsequent  to  the  reception  of  the  shot  injury. 

CASE  283. — Private  T.  W.  Pease,  Co.  H,  19th  Indiana,  aged  26  years,  was  wounded  at  Gettysburg,  July  1,  1883,  by  a 
conical  musket  ball,  which  entered  the  anterior  aspect  of  the  right  thigh  three  inches  below  Poupart's  ligament,  passed  back 
ward  and  outward,  and  lodged  just  behind  the  trochanter  major,  having  fractured  the  upper  third  of  the  femur  and  passed 
through  the  trochanter.  The  wounded  man  remained  for  several  months  at  a  Corps  hospital  at  Gettysburg,  where  merely  a 
"shot  wound  of  right  thigh"  was  noted,  but  no  progress  of  the  case  recorded.  According  to  his  statement,  the  missile  was 
extracted  by  incision  three  days  after  the  injury,  and  on  July  9th,  while  under  the  influence  of  ether,  nearly  three  inches  of  bone 
was  removed  in  fragments.  Extension  and  counter-extension  were  applied,  but  the  latter  caused  so  much  pain  that  it  was  discon- 

1  Professor  H.  CULBERTSOX,  M.  D.  (Excision  of  the  Larger  Joints  of  the  Extremities,  Prize  Essay,  Trans.  Am.  Med.  Assoc.,  Vol.  XXVII,  Supple 
ment,  107G,  pp.  5  and  50),  reports  this  operation  as  practised  "August  20,  1861,"  which  would  make  it  the  first  excision  at  the  hip  after  shot  injury 
performed  in  the  United  States,  the  primary  excision  practised  by  Professor  BLACKMAN,  on  Private  J.  McCulloch  (CASE  230,  p.  97,  ante)  having  been 
done  August  30, 1861.  Dr.  E.  STERLING  in  his  letter  transmitting  the  specimen  (3590)  also  asserts  that  his  excision  of  the  head  of  the  femur  in  Tilliston's 
case  was  the  first  during  the  war.  Pension  Examiner  LAIST  also  states  that  the  patient  was  wounded  July  7,  1861,  and  that  resection  was  performed  six 
weeks  afterwards  j  but,  in  his  official  report  to  the  Pension  Office,  Dr.  STERLING  states  that  the  operation  was  performed  "  on  or  about  the  20th  of  September." 


SECT.  II.] 


EXCISION    AT    THE    HIP   AFTER    SHOT    INJURY. 


115 


tinued  at  the  end  of  twenty-four  hours.  Smith's  anterior  splints  were  applied  on  July  20th,  and  cold-water  dressings  were  used. 
The  patient  also  stated  that  the  limb  was  swollen  and  painful,  the  discharge  of  pus  profuse,  and  his  general  health  bad.  For 
the  first  two  weeks  he  suffered  from  constipation,  after  which,  having  taken  a  laxative,  diarrhoea  set  in  and  troubled  him,  with 
short  intermissions,  for  about  three  months.  The  records  of  Camp  Letterman  Hospital  show  that  the  patient  was  admitted  there 
on  September  5th,  also  that  Acting  Assistant  Surgeon  E.  A.  Koerper  took  charge  of  the  case  on  October  8th,  who  opened  a  large 
abscess  on  the  inner  side  of  the  thigh  on  November  3d,  and  removed  the  splints  several  days  afterwards,  the  fracture  having 
become  united  and  the  patient's  health  improved.  The  subsequent  progress  of  the  case  was  recorded  by  Acting  Assistant  Surgeon 
H.  L.  Smyscr,  at  the  York  Hospital,  where  the  patient  was  transferred  on  November  14th.  The  wound  of  entrance  aud  exit 
at  that  time  had  closed,  but  there  was  still  discharge  from  an  opening  on  the  middle  and  external  part  of  the  thigh,  and  the 
limb  was  swollen  and  curved  outward,  with  three  inches  shortening.  After  this  a  steady  improvement  followed  until  January 
12,  186'4,  when  the  patient  was  seized  with  a  chill,  followed  by  fever,  and  a  deep  seated  abscess  began  to  form  on  the  anterior 
part  of  the  thigh,  which  was  opened  four  days  afterwards.  Abscesses  continued  to  form  at  intervals  and  suppuration  was  more 
or  less  constant,  causing  the  cicatrices  of  the  wound  to  be  reopened.  On  February  29th,  symptoms  of  tetanus  appeared,  being 
exhibited  by  stiffness  of  the  muscles  of  the  neck  and  inability  of  the  patient  to  open  his  mouth  more  than  half  an  inch.  This 
attack  was  subdued,  by  the  administration  of  pills  of  camphor  aud  opium,  after  several  days'  duration,  and  during  the  succeed 
ing  night  and  morning  it  was  followed  by  an  almost  constant  hiccough,  after  which  another  attack  of  diarrhoea  came  on.  In 
April  following  the  wound  had  again  healed,  and  the  patient  had  so  far  amended  as  not  to  require  any  more  medicine.  On  July 
3d,  he  was  able  to  walk  about  on  crutches  for  the  first  time.  His  term  of  service  having  expired,  he  was  mustered  out  August 
8,  1834,  and  pensioned.  Examiner  G.  W.  Clippinger,  of  Indianapolis,  certified,  October  17,  1833: 
*  *  *  "Almost  total  anchylosis  of  knee  joint,  with  foot  turned  inward  at  the  toes;  extensive 
necrosis  of  entire  shaft  of  bone,  with  discharge  at  three  points.  *  '  Discharge  offensive  and 

exhaustive.  Is  feeble  and  emaciated,  has  frequent  night  sweats,  aud  requires  constant  aid  and 
attendance."  Dr.  A.  L.  Lowell,  of  the  Pension  Office,  who  made  a  special  examination  of  the  pen 
sioner  on  July  20,  1838,  reported  the  following:  *  *  *  "The  wound  is  still  discharging  from 
its  anterior  opening  and  the  process  of  exfoliation  is  still  progressive.  The  coxofemoral  articulation 
is  firmly  fixed  and  immovable.  *  *  *  The  subject  travels  with  the  assistance  of  crutches.  His 
general  health  is  good."  Dr.  J.  K.  Bigelow,  attending  physician  of  the  pensioner  aud  late  Surgeon 
of  the  8th  Indiana,  reported  that  he,  being  aided  by  Surgeon  J.  S.  Bobbs,  "on  September  2,  1888, 
removed  ten  and  a  half  inches  of  the  necrosed  shaft  of  the  femur,  said  necrosed  bone  having  kept 
up  a  constant  and  exhaustive  discharge  from  three  or  four  large  sinuses  at  various  places  along  the 
inner  and  posterior  part  of  the  thigh,"  etc.  The  Indianapolis  Examining  Board  certified,  February 
8,  1870:  "The  pensioner  is  very  obnoxious  to  erysipelas,  which  frequently  causes  largo  inguinal  and 
popliteal  abscesses,"  etc.  Two  years  afterwards  the  same  Board  reported  that  "the  operation  for 
removal  of  necrosed  bone  two  years  ago,  apparently  resulted  in  good  recovery.  '  *  One  year 
after  said  operation  erysipelas  of  the  limb,  with  ulceration,  etc,,  again  ensued,  and  on  October  20, 
1871,  he  was  again  attacked  with  large  abscesses,  and  several  sinuses  made  their  appearance.  Upon 
careful  examination  it  was  found  that  the  new  bone  was  necrosed  and 
necessitated  coxo-femoral  exsection,  which  was  performed  on  the  8th  of 
November,  1871.  There  is  ten  inches  shortening.  He  requires  the  con 
stant  attention  of  a  nurse,"  etc.  In  a  report  recapitulating  the  history 
of  this  case,  transmitted  by  Dr.  Bigelow,  in  September,  1877,  he  describes 
the  operation  of  exsection  as  follows:  "While  under  the  influence  of 
chloroform,  an  incision  was  made  from  the  middle  of  the  dorsum  of  the 
right  ilium  down  the  outer  aspect  of  the  thigh  to  within  two  inches  of 
the  knee  joint.  The  femur  was  exposed  and  divided  five  inches  below 
the  trochanter  with  Hey's  saw,  and  on  account  of  the  extensive  perfora 
tions  of  the  muscles  surrounding  the  bone  by  osteophytes  (FlG.  71)  the 
cpiphysis  was  with  difficulty  and  considerable  haemorrhage,  enucleated 
and  unjointed  from  the  acetabulum.  It  was  found  to  consist  of  a  very 
large  dead  involucrum,  filled  in  all  its  aspects  with  sharp  projecting  spiculsB.  A  portion  of  the  leaden  ball  was  found  embedded 
in  the  cancellous  structure  near  the  trochanter.  The  wound  healed  kindly,  and  was  entirely  closed  in  twenty-eight  days.  In 
three  mouths  a  cartilaginous  union  had  taken  place,  and  now — in  September,  1877 — with  the  assistance  of  a  'six-inch  lift'  on 
the  right  boot  the  man  can  walk  quite  well  with  a  cane,  having  nearly  a  perfect  arthrodial  joint  at  the  hip,  and  being  able  to 
attend  to  the  ordinary  duties  of  a  Deputy  United  States  Marshal."  In  1873,  in  visiting  the  Surgeon  General's  Office,  Dr.  J.  K. 
Bigelow  contributed  a  photograph  of  the  excised  epiphysis,  which  is  copied  in  the  wood-cut  (FlG.  71).  In  1877,  Dr.  Bigelow 
contributed  to  the  Museum  another  photograph  representing  the  cicatrix  and  appearance  of  the  injured  limb,  which  is  copied  in 
the  right  hand  wood-cut  (FlG.  72).  This  pensioner  was  paid  September  4,  1877. 

The  number  of  patients  who  servive  shot  injuries  involving  the  hip  joint  until  the 
secondary  period  without  operative  interference  is  small ;  but  such  cases  may  be  regarded 
in  reference  to  their  ability  to  sustain  excisions  as  becoming  analogous  to  the  subjects  of 
excisions  at  the  hip  for  pathological  causes.  Now  we  learn  from  the  experience  of  civil 
practitioners  that  excisions  at  the  hip  for  disease  have  a  mortality  rate  in  children  aver 
aging  perhaps  below  45  per  cent.,  yet  in  adults  of  the  military  age  rising  to  an  average 


FlG.  71. — Shot  fracture  of  tro 
chanter  major  of  right  femur. 
[From  a  photograph  furnished 
by  Dr.  BIGELOW.] 


FlG.  72. — Appearance  of  the 
limb  six  years  after  the  opera 
tion.  [From  a  photograph.] 


116  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

of  over  60  per  cent.  It  is  found  on  examination,  that,  as  might  be  anticipated,  the  second 
ary  excisions  at  the  hip  for  traumatic  cause  attain  a  mortality  rate  approximating  that  of 
excisions  for  disease  in  adults  of  about  the  same  age.  The  three  survivors  of  secondary 
excisions  at  the  hip  after  shot  injury  were  robust  mature  men  of  26,  34,  and  44  years  of 
age.  In  the  eight  unsuccessful  cases  the  ages  varied  from  18  to  43  years.  In  seven  of 
the  eight  unsuccessful  operations  the  patients  succumbed  in  from  one  to  eight 'days  from 
the  dates  of  operation,  a  mean  of  a,  little  over  four  days,  while  the  eighth  lived  over  a 
hundred  clays  after  the  operation,  and  succumbed  apparently  to  unfavorable  climatic  influ 
ences  and  only  in  part  to  traumatic  causes. 

CASE  264. — Private  Hugh  Frain,  Co.  G,  31st  Massachusetts,  aged  22  years,  was  wounded  February  1,  1865,  by  a 
conoidal  musket  ball,  which  entered  the  anterior  surface  of  the  middle  third  of  the  left  thigh,  ranging  upward,  and  making  its 
exit  above  the  left  glutens,  fracturing  the  neck  of  the  femur  in  its  course.  He  was  on  horseback,  his  regiment  serving  at  the 
time  as  mounted  infantry.  He  was  treated  in  the  regimental  hospital  for  several  days,  and  then,  on  February  loth,  he  was 
admitted  to  the  St.  Louis  Hospital,  at  New  Orleans.  When  admitted,  he  stated  that  the  surgeon  of  his  regiment  had  given  him 
chloroform,  and  examined  the  wound,  and  that  the  bone  was  not  touched.  He  had  walked  upon  the  limb,  and  there  was  then 
no  evidence  of  fracture.  His  general  health  became  poor.  He;  had  night  sweats.  His  tongue  was  clean  and  moist,  and  his 
appetite  was  good.  The  whole  thigh  gradually  became  dissected  with  pus  of  an  unhealthy  character.  Abscesses  discharged 
through  fistulous  openings  in  the  groin.  The  limb  was  inverted  and  shortened,  and  was  drawn  over  to  the  right.  It  was 
decided  that  an  excision  of  the  head  of  the  femur  was  expedient.  On  March  24th,  Surgeon  A.  McMahon,  U.  S.  V.,  proceeded 
to  perform  the  operation.  An  incision  four  inches  in  length  was  made  over  the  great  troclianter,  the  soft  parU  were  dissected 
up,  and  the  femur  was  divided  by  the  chain  saw  just  below  the  trochantur  minor.  The  ligamentum  teres  was  softened,  and  the 
head  of  the  femur  was  removed  without  difficulty.  The  wound  was  filled  with  lint,  and  the  patient  was  ordered  porter,  chicken 
broth,  eggs,  stimulants,  and  everything  necessary  to  sustain  the  drain  upon  his  system.  He  felt  easier  for  a  few  days  after  the 
operation,  but  he  gradually  sank,  becoming  very  much  emaciated,  and  died  March  30,  1885,  six  days  after  the  operation.  The 
ball  had  injured  the  neck  of  the  femur,  and  the  subsequent  caries  had  caused  the  destruction  of  the  head  and  the  disorganization 
of  the  surrounding  tissues. 

CASE  235. — Private  Edward  Hunt,  Co.  D,  71st  Pennsylvania,  aged  24  years,  was  wounded  at  the  battle  of  Antietam, 
September  17,  186J,  by  a  conoidal  musket  ball,  which  entered  about  two  and  a  half  inches  above  the  troclianter  major,  and 
grazing  the  neck  of  the  right  femur,  passed  out  at  the  nates.  Shortening  and  eversion  were  not  present,  and  it  was  thought 
that  there  was  not  a  complete  fracture.  After  the  battle,  he  was  removed  to  a  barn  near  the  battle-field,  where  he  was  treated 
with  cold-water  dressings  for  eleven  days.  He  was  then  removed  to  the  City  Hotel  at  Frederick, 
Maryland,  and  the  cold  applications  were  continued  up  to  November  19th.  During  this  period  the 
wound  was  discharging  healthy  pus  profusely.  As  pus  was  burrowing  in  the  muscles,  a  seton  was 
run  through  the  wound  and  six  inches  down  the  thigh.  On  November  19th,  he  was  removed  to  Jail 
Street  Hospital,  and  about  the  last  of  December  he  wras  transferred  to  the  U.  S.  Hotel  Hospital,  and 
thence,  on  January  20,  1833,  to  hospital  No.  5,  at  Frederick,  Maryland.  On  January  31st,  an 
abscess  formed  on  the  anterior  internal  aspect  of  the  thigh,  which  was  opened,  and  discharged  nearly 
a  quart  of  laudable  pus  in  twenty-four  hours.  On  February  2d,  the  opening  on  the  posterior  aspect 
of  the  thigh  was  enlarged  and  the  wound  syringed  out  with  warm  water.  Erysipelas  attacked  the 
wound,  but  it  was  not  of  an  intense  character,  and  by  February  10th,  it  had  subsided,  and  the  patient 
was  in  good  condition  comparatively.  On  February  23d,  he  had  become  more  emaciated  and  had 
night  sweats,  but  his  strength  continued  good.  On  exploring  for  the  ball  with  the  finger,  in  the 
opening  on  the  inner  side  of  the  thigh,  a  round,  smooth  surface  was  felt,  which  was  thought  at  first 

FIG.  73.— Caries  of  the  ace-     to  be  a  piece  of  a  conoidal  ball,  but  was  ascertained  to  be  the  head  of  the  femur  just  outside  of  the 
tabulum,  neck,  and  trochanters  ,,      .  .  „    ,       ,  .      .   .  i      -i    i  i     A      •  *      i.    o  TT 

of  the  right  femur,  following     acetabulum.     Excision  of  the  hip  joint  was  now  decided  upon,  and  Assistant  burgeon  Henry  A. 

»n  ex^0i»n  f°l  shot  {'racture-     Dubois,  U.  S.  A.,  operated,  the  patient  being  under  chloroform,  by  enlarging  the  opening  on  the 
inner  side  of  the  thigh,  cutting  the  capsular  ligament,  and  removing  the  head  of  the  femur.     The 

neck  was  divided  by  the  lion-jawed  cutting  forceps.  A  small  quantity  of  pus  was  found  behind  the  head  of  the  bone.  But 
very  little  blood  was  lost  during  the  operation,  and  the  patient  rallied  partially,  but  he  never  fully  recovered  from  the  shock, 
and  died  February  25,  1853,  two  days  after  the  operation.  At  the  autopsy  the  neck  of  the  femur  was  found  rounded  off,  and 
formed  a  false  centre  of  motion  on  the  inner  side  of  the  acetabulum.  The  rounded  extremity  of  the  neck  and  the  acetabulum 
were  carious.  The  cut  (FlG.  73)  imperfectly  represents  the  specimen,  which  was  sent  to  the  Army  Medical  Museum. 

CASE  266. — Ensign  W.  J.  Henry,  21st  Mississippi,  aged  22  years,  was  wounded  near  Petersburg,  on  June  21,  1864,  by 
a  conoidal  musket  ball,  which  entered  the  upper  third  of  the  left  thigh  anteriorly  and  made  its  exit  at  the  opposite  side  of  the 
limb,  having  badly  comminuted  the  femur,  without  injuring  the  principal  vessels  or  nerves.  The  wounded  man  was  conveyed 
to  Richmond,  and  was  admitted  to  hospital  No.  4,  on  June  28th.  The  injured  limb  was  suspended  by  Smith's  anterior  splint, 
th'e  wound  was  dressed  with  water  dressings,  a  nourishing  diet  was  ordered,  with  an  opiate  at  bed-time.  Under  this  treatment 
the  case  progressed  satisfactorily  until  August  2d,  when  the  copious  suppuration  and  wasting  of  the  patient  excited  so  much 
anxiety  that  a  consultation  was  held,  at  which  Surgeons  C.  B.  Gibson,  M.  Michel,  and  J.  B.  Read  assisted.  After  a  careful 
exploration  of  the  injury  under  chloroform,  it  was  decided  that  an  excision  of  the  upper  extremity  of  the  femur  was  expedient, 
and  the  operation  was  at  once  performed  by  Surgeon  J.  B.  Read,  P.  A.  C.  S.  An  incision  seven  inches  in  length  was  made, 


SECT.  H.J  EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY.  117 

commencing  above  the  troclmnter  and  carried  downward  in  the  axis  of  the  thigh.  The  joint  was  opened  and  the  head  of  the 
bone  exarticulated.  The  shaft  was  sawn  below  the  trochanter  minor,  about  six  inches  of  the  bone  being  removed.  The  wound 
being  thoroughly  cleansed,  was  approximated  and  kept  in  position  by  sutures  and  adhesive  strips.  A  long  straight  splint  was 
then  applied  on  the  outside  of  the  limb.  An  ounce  of  brandy  and  thirty  drops  of  tincture  of  opium  was  ordered  to  be  admin 
istered  every  hour  until  reaction  should  be  fully  established.  August  3d,  the  patient  had  reacted  and  had  passed  a  comfortable 
night.  The  pulse  was  at*  136;  there  was  no  pain,  except  in  the  left  knee,  which  was  swollen,  but  without  increased  heat  or 
redness.  The  appetite  was  poor  but  improving.  A  nourishing  diet  was  directed,  and  half  an  ounce  of  brandy  every  two  hours 
with  a  grain  of  opium  every  three  hours.  4th,  the  patient  had  rested  well,  had  a  good  appetite,  the  tongue  was  clean,  the  skin 
moist,  the  bowels  had  been  moved  naturally,  the  pulse  was  at  129,  the  countenance  was  cheerful.  The  treatment  was  continued 
with  the  addition  of  porter  thrice  daily.  5th,  the  pulse  was  stronger  at  120,  the  countenance  was  cheerful  ;  the  treatment  was 
continued.  6th,  the  patient  was  reported  to  have  passed  a  bad  night.  He  complained  of  acute  pain  in  his  left  knee  and  in  the 
right  side  of  his  chest.  The  pulse  was  135  and  weak.  Incipient  pneumonia  was  detected  in  the  right  lung.  He  had  vomited 
the  porter,  and  it  was  discontinued;  the  brandy  and  opium  were  continued  as  before.  The  wound  was  suppurating  profusely. 
The  sutures  were  clipped,  and  the  wound  was  kept  together  by  adhesive  strips.  The  bowels  were  constipated.  An  enema  of 
warm  soap  and  water  was  administered,  which  procured  a  normal  dejection  in  a  few  hours.  Sinapisms  were  applied  to  the  chest. 
7th,  he  had  rested  tolerably  well,  but  breathed  badly.  He  was  sweating  profusely,  and  complained  of  much  pain  in  the  chest. 
The  pulse  was  at  140,  and  was  very  weak.  He  was  ordered  an  ounce  of  brandy  every  hour  and  a  grain  of  opium  ever}'  four 
hours.  8th,  he  was  reported  as  having  passed  a  very  restless  night.  He  was  too  weak  to  expectorate;  the  pulse  was  very 
feeble  at  148.  He  was  evidently  sinking.  He  died  at  3  o'clock  P.  M.,  August  8,  1834,  six  days  after  the  operation,  and  forty- 
nine  days  from  the  reception  of  the  injury.  The  report  gives  no  account  of  the  post-mortem  appearances. 

CASE  267. — Private  John  W.  Nelling,  Co.  K,  1st  Massachusetts,  aged  23  years,  was  wounded  on  June  30,  1862,  at  the 
engagement  at  White  Oak  Swamp,  by  a  musket  ball,  which  entered  his  right  groin,  passed  horizontally  backward,  comminuted 
the  neck  of  the  femur,  and  emerged  posteriorly.  He  was  abandoned  with  other  wounded  in  the  retreat  of  General  McClellan's 
army.  Being  made  a  prisoner,  he  was  confined  in  Richmond  for  three  weeks,  and  was  then  released  and  sent  by  water  to 
Baltimore,  where  he  was  admitted  to  the  National  Hospital,  on  July  25th,  in  a  very  depressed  condition.  There  was  copious 
suppuration,  and  through  the  large  orifices  of  entrance  and  exit  it  was  easy  to  explore  the  extent  of  the  injury  to  the  bone,  and 
to  determine  that  the  comminution  was  limited  to  the  epiphysis.  It  was  deemed  advisable  to  excise  the  shattered  extremity  of 
the  bone  as  soon  as  the  patient  could  acquire,  by  a  tonic  treatment,  strength  to  undergo  such  an  operation.  In  a  few  weeks  his 
general  condition  was  much  improved,  though  he  was  still  anaemic  and  feeble.  On  August  21st,  Assistant  Surgeon  Roberts 
Bartholow,  U.  S.  A.,  in  charge  of  the  hospital,  proceeded  to  perform  the  operation.  The  patient  being  placed  under  chloroform, 
Dr.  Bartholow  made  a  vertical  incision,  commencing  a  little  above  and  behind  the  great  trochauter,  continued  downward  into 
the  axis  of  the  limb  four  inches,  and  carried  it  down  to  the  bone.  The  head  of  the  femur  was  found  to  be  entirely  separated 
from  the  neck,  and  was  retained  in  the  acetabulum  only  by  the  round  ligament. 
This  was  divided,  and  the  head  was  removed.  Several  necrosed  fragments  were 
then  extracted,  and  the  jagged  extremity  of  the  neck  was  smoothed  by  an  osteo- 
tome.  But  little  blood  was  lost  in  the  operation,  and  the  patient  rallied  promptly 
from  the  effects  of  the  anaesthetic.  After  he  was  put  to  bed,  the  limb  was 
suspended  by  Smith's  anterior  splint,  and  the  patient's  condition  was  rendered 
comparatively  comfortable.  The  case  progressed  favorably  and  without  an 

untoward  symptom  till  the  afternoon  of  August  25th,  when  a  sudden  and  very 

FIG.  74.— Head  and  fragments  of  the  neck  of  right 
profuse  gush  of  dark  blood  from  the  wound  of  incision  and  the  entrance  bullet    femur,  excised  for  gunshot  fracture.    Spec.  400,  Sect. 

wound  took  place,  and  the  patient  expired  before  the  haemorrhage  could  be  con-     *"  •**  M'  JI-    * 

trolled.  At  the  post-mortem  examination,  the  soft  parts  in  the  vicinity  of  the  wound  were  found  to  be  in  a  softened  and  semi- 
gangrenous  condition.  The  end  of  the  excised  neck  was  denuded  of  periosteum  and  was  necrosed.  The  external  iliac  and 
femoral  arteries  were  traced  some  distance  above  and  below  Poupart's  ligament,  and  were  found  to  be  in  a  normal  condition. 
The  femoral  vein  was  softened,  and  near  the  track  of  the  ball  appeared  to  be  broken  down  so  as  not  to  be  distinguished  from  the 
surrounding  tissues.  A  quantity  of  dark  fluid  blood  was  found  under  the  integuments.  The  excised  head  and  neck  were 
deposited  in  the  Army  Medical  Museum  by  the  operator,  and  are  represented  in  the  cut  (FlG.  74). 

CASE  268.— Private  Joseph  Roth,  Co.  B,  188th  New  York,  aged  25  years,  a  large  robust  man,  was  wounded  in  the 
engagement  at  Hatcher's  Run,  near  Petersburg,  on  February  6,  1865,  by  a  round  musket  ball,  which  entered  a  little  below 
Poupart's  ligament,  an  inch  external  to  the  course  of  the  vessels,  and  lodged  in  the  neighborhood  of  the  hip  joint.  He  was 
received  at  the  field  hospital  of  the  1st  division  of  the  Fifth  Corps,  and  thence  conveyed  to  the  base  hospital  at  City  Point,  and, 
as  there  was  no  pain  or  deformity,  the  case  was  regarded  and  treated  as  a  flesh  wound,  and  a  week  subsequently  the  patient 
was  sent  in  the  hospital  transport  steamer  State  of  Maine  to  the  General  Hospital  at  Point  Lookout;  After  a  short  time,  Roth 
began  to  complain  of  great  pain  in  the  knee  and  leg  of  the  wounded  limb,  which  aroused  suspicion  that  the  hip  joint  was  impli 
cated.  The  symptoms  becoming  aggravated,  and  pointing  clearly  to  some  injury  of  the  joint,  Surgeon  John  Vansant,  U.  S.  A., 
in  charge  of  the  hospital,  determined  to  make  an  exploratory  incision,  and  to  ascertain  the  true  condition  of  things.  The  patient 
being  anaesthetized  by  a  mixture  of  chlorofonn  and  ether  on  March  9th,  an  incision  was  made,  commencing  at  the  wound  of 
entrance,  and  continued  downward  three  inches  or  more.  The  ball  was  now  found  impacted  in  the  head  of  the  femur,  the 
anterior  part  of  Avhich  was  shattered,  while  the  posterior  two-thirds  of  the  head  was  intact.  The  muscular  attachments  being 
divided,  and  the  capsular  ligament  freely  opened,  the  round  ligament  was  severed,  and  the  head  was  exarticulated.  A  chain  saw 
was  then  passed  around  the  neck,  which  was  divided  near  to  the  head,  and  the  latter,  with  the  ball  inserted  in  it,  was  removed. 
Some  sharp  projecting  portions  of  the  neck  were  smoothed  off  with  bone  forceps.  There  was  very  little  haemorrhage.  The 
wound  was  drawn  together  and  treated  by  water  dressings,  and  the  limb  was  kept  in  suitable  position  by  pads  and  pillows. 
The  patient  seemed  to  do  well  for  several  weeks,  but  gradually  became  feeble  and  emaciated,  losing  all  appetite.  There  was 


118  INJURIES    OF    THE    LOWER    EXTREMITIES.  fCIlAP.  X. 

but  a  slight  discharge.  In  May,  the  patient  became  quite  yellow,  and  apparently  suffered  from  malarial  complications.  In  spite 
of  a  careful  tonic  and  sustaining  regimen,  and  the  bracing,  wholesome  salt  air  of  Point  Lookout,  he  gradually  declined,  and 
died  June  17,  1885.  The  pathological  specimen  was  not  forwarded  to  the  Museum,  and  no  account  of  an  autopsy  was  rendered, 
an  annoying  omission,  since  it  would  have  been  interesting  to  have  learned  what  reparative  action  had  taken  place  during  the 
three  months  after  the  operation  which  this  patient  survived. 

CASE  269. — Private  Alfred  Toney,  Co.  A,  16th  North  Carolina,  aged  43  years,  a  farmer  by  profession,  was  wounded 
June  30, 1863,  and  admitted  to  hospital  No.  4,  Richmond,  on  the  same  day.  A  conoidal  musket  ball  had  entered  the  left  buttock 
and  lodged.  No  particular  attention  was  called  to  this  case  for  some  time.  The  patient  seemed  to  be  doing  well.  On  August 
llth,  however,  he  complained  of  great  pain  in  the  knee  and  ankle;  the  slightest  touch  caused  great  anguish.  The  foot  was 
oedematous.  Chloroform  was  administered,  and  digital  examination  of  the  wound  was  made.  The  finger  could  pass  but  half 
an  inch  into  the  wound  until  the  limb  was  carried  forward ;  it  then  could  be  passed  into  the  cotyloid  cavity,  and  the  ball  was  found 
in  the  acetabulum.  The  round  ligament  was  severed  and  the  head  of  the  femur  was  ascertained  to  be  slightly  fractured  and 
deprived  of  its  cartilage.  Excision  of  the  head  of  the  femur  was  decided  upon,  and  on  August  12th,  Surgeon  James  B.  Head, 
P.  A.  C.  S.,  proceeded  to  operate.  The  patient  was  laid  on  his  face,  and  his  buttocks  were  brought  to  the  edge  of  the  table.  A 
straight  incision  was  commenced  two  inches  below  the  anterior  superior  crest  of  the  ilium  and  carried  downward  to  one  inch 
below  the  trochanter  major.  The  muscles  were  then  separated,  and  the  joint  exposed.  The  head  was  then  dislocated  by  forcibly 
bringing  the  leg  under  the  table.  The  soft  parts  were  protected  by  a  spatula  and  the  head  was  sawn  off.  The  ball  was  removed 
from  the  cotyloid  cavity,  which  was  found  to  be  broken  across  and  the  cartilage  loosened.  The  wound  was  then  closed  by 
sutures  and  the  patient  was  removed  to  his  bed.  He  suffered  no  pain,  and  in  twenty-four  hours  the  swelling  had  subsided.  His 
general  condition  was  very  feeble,  and  he  was  freely  stimulated  during  the  after-treatment.  He  died  August  19,  1833,  eight 
days  after  the  operation,  exhausted  by  hectic  fever.  There  is  no  account  of  any  abdominal  disturbance  or  pyaemia  symptoms 
resulting  from  the  fracture  of  the  acetabulum. 

CASE  270. — Private  Henry  Woodworth,  Co.  A,  4th  Vermont,  aged  18  years,  was  wounded  at  the  battle  of  Spottsylvania 
Court  House,  on  May  11,  1864,  by  a  conoidal  musket  ball,  which  entered  the  left  thigh,  just  below  the  trochanter  major,  passed 
inward  and  forward,  grooving  the  femur  anteriorly  at  the  level  of  the  lesser  trochanter,  and  lodging  under  the  sartorius  muscle. 
The  patient  was  conveyed  to  the  field  hospital  of  the  2d  division  of  the  Sixth  Corps,  where  the  ball  was 
removed  through  an  incision  at  the  edge  of  the  sartorius.  A  week  subsequently,  he  was  placed  on  one  of 
the  trains  for  the  Rappahannock,  and  was  transferred  from  Fredericksburg  to  Washington,  where,  on  May 
25th,  he  was  admitted  to  Harewood  Hospital.  His  condition  on  admission  was  very  unpromising;  his  pulse 
was  quick  and  feeble;  he  was  anaemic,  and  without  appetite.  He  was  placed  upon  a  tonic  regimen,  but  he 
did  not  improve.  The  wound  discharged  profusely;  there  was  much  pain  in  the  joint,  pain  aggravated  by 
the  slightest  movement,  and  pus  had  burrowed  in  every  direction  about  the  articulation.  Surgeon  R.  B. 
Bontecou,  U.  S.  V.,  in  charge  of  Harewood  Hospital,  decided  that  an  excision  of  the  head  of  the  femur 
per  extremity  of  loft  offered  the  only  possible  chance  of  saving  life,  and,  on  July  1st,  the  patient  having  been  anaesthetized  by 

lemur  with  a  conoidal  sulphuric  ether,  Dr.  Bontecou  proceeded  to  peiform  the  operation.  A  curved  incision,  with  its  concavity 
ball.  &pec.  MW.  J  *  . 

forward,  embracing  the  trochanter,  readily  exposed  the  joint.     The  muscular  attachments  were  divided,  and 

the  head  was  easily  disarticulated,  the  joint  being  disorganized  and  the  round  ligament  destroyed.  The  continuity  of  the 
bone  being  uninterrupted,  the  upper  extremity  was  readily  turned  out  and  sawn  just  below  the  point  of  impact  of  the  ball.  On 
examination  of  the  portion  of  bone  removed,  it  was  found  that  much  of  the  head  had  been  absorbed,  and  that  the  remainder 
was  carious.  The  specimen  is  represented  in  the  accompanying  wood-cut  (FlG.  75).  The  neck  and  trochanters  are  covered 
with  traces  of  the  effects  of  periostitis.  The  cotyloid  cavity  was  ulcerated.  The  wound  was  drawn  together  by  adhesive  strips, 
and  the  limb  was  dressed  in  a  fracture  apparatus  with  moderate  extension.  Every  means  of  supporting  the  patient's  strength 
was  adopted,  but  he  did  not  rally  from  the  operation,  and,  sinking  gradually,  expired  on  July  2,  1864. 

CASE  271. — Private  John  Zaborowski,  Co.  II,  7th  Connecticut,  aged  33  years,  was  wounded  at  the  engagement  at  Deep 
Bottom,  Virginia,  August  16,  1884,  by  a  conoidal  musket  ball,  which  entered  just  below  the  right  trochanter  major,  and  passing 
upward  and  inward,  fractured  the  neck  and  slightly  injared  the  head  of  the  femur.  The  patient  was  conveyed  to  the  field 
hospital  of  the  Tenth  Corps,  where  his  wound  was  dressed,  and  he  was  then  sent  to  City  Point  and  transferred  to  the  hospital 
transport  steamer  De  Molay,  and  conveyed  to  the  U.  S.  Hospital,  at  Beverly,  New  Jersey,  where  he  was  admitted  on  August 
22d".  His  condition  at  this  period  is  not  described,  and  it  is  not  stated  whether  the  ball' had  been 
extracted.  From  the  subsequent  history,  it  would  appear  that  there  was  profuse  suppuration  about  the 
joint,  since  a  free  transverse  incision  was  practised  to  give  free  escape  to  the  discharge.  On  September 
27th  it  was  determined  to  excise  the  head  of  the  femur.  The  patient  had  greatly  lost  in  flesh  and  strength 
since  his  admission,  and  seemed  to  be  rapidly  failing  from  the  exhaustive  suppuration;  extensive  slough 
ing  of  the  soft  parts  had  supervened,  and,  upon  the  whole,  the  case  was  unfavorable  and  unpromising. 
Chloroform  having  been  administered,  and  the  patient  being  placed  on  his  sound  side,  Assistant  Surgeon 
C.  Wagner,  U.  S.  A.,  made  an  incision  four  and  a  half  inches  in  length,  extending  from  just  below  the 
FIG.  ?6.-Heail  of  ri"-M  anterior  superior  spinous  process  of  the  ilium  toward  the  tuberosity  of  the  ischium,  crossing  the  trans- 
femur  excised  lor  caries  fol-  verse  incision  previously  made  over  the  trochanter  major  to  permit  free  exit  of  pus.  The  thigh  was 
lowing  a  gunshot  fracture.  . 

Spec.  b7i6,  Sect.  I, A. M.  M.     flexed  and  rotated  inward,  the  tendons  of  the  muscles  were  divided,  and  a  chain  saw  was  passed  under 

^  and  between  the  head  of  the  femur  and  the  trochanter  major,  and  the  bone  was  sawn  through  the  neck, 
the  soft  parts  being  protected  by  spatulas.  About  one  inch  of  the  trochanter  major  was  found  to  be  necrosed,  and  was  removed 
by  a  small  saw.  No  blood  was  lost  during  the  operation.  The  patient  sank  rapidly,  and  died  September  28,  1834,  of  exhaus 
tion.  A.  post-mortem  examination  revealed  nothing  of  note,  except  slight  caries  of  the  acetabulum.  The  carious  head  of  the 
femur  was  sent  to  the  Army  Medical  Museum,  and  is  represented  in  the  adjacent  wood-cut  (FlG.  76).  The  fragments  of  the 
neck  and  the  necrosed  trochanter  major  were  lost. 


SECT.  IL) 


EXCISION    AT    THE    HIP    AFTER    SHOT    INJURY. 


119 


Of  the  eleven  secondary  excisions  at  the  hip  five  were  on  the  right  and  six  on  the 
left  side.     The  pathological  specimens  were  preserved  in  six  instances. 

TABLE  XIII. 
Summary  of  Eleven  Cases  of  Secondary  Excision  of  tlic  Head  of  the  Femur  for  Shot  Injury. 


No. 

NAME,  AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY 

NATURE  OF  I::JI:RY. 

DATE 

OK 

OPERA 
TION. 

OrF.RATio:;  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

1  Brown,  J.,  Pt.,  I,  3d  Mich 

Aug.  29 

Musket  ball  perforated  the  loft 

Mar.  01. 

Necrosed  fragments  extracted  ; 

Disch'd  Aug.  23,  1863,  and  pen 

igan,  age  38. 

1862. 

thigh,   fracturing  femur  just 

1863. 

shaft  of  lemur  divided  six  ins. 

sioned.     Appointed  postmaster 

below  the  trochanter  miner. 

below  tip  oftroch.  minor.  The 

in  1867,  at  Coopersville,  Mich. 

head,  neck,  and  trochanters, 
and  the  masses  of  callus  ad 

Able  to  attend  almost  entirely 
without  assistance  to  the  busi 

- 

hering  to  the  trochanters  were 

ness  of  the  office.    Paid  pen 

then  removed,  straight  incis. 

sion  March  4,  1876.     Spec.  1192, 

eight  ins.  long,  by  Surgeon 

A.M.M.  Pliot.  Ser.  110.A.M.M. 

D.  P.  Smith,  U.  S.  V. 

2 

Tilliston,  G.  W.,  Pt.,  D,  1st 

July  7, 

Rifle  ball  enter'd  the  right  groin. 

Sept.  CO, 

Head   and   neck  of  femur  ex 

(Disch'd  July  21,  1861.)     July, 

Ohio  Light  Artillery,  age 
44. 

1861. 

passed    backward,    fractured 
the  head  and  neck  of  femur. 

1861. 

cised,  by  Dr.  E.  Sterling. 

1867,  fistulousopeningdischarg- 
ing  purulent  matter.    Three  ins. 

and  lodged  in  large  muscles 

shortening.  Pens  ner  died  Sept. 

of  buttock. 

6,  1871,  of  as'henia.     Autopsy. 

Spec,  f.590,  A.  M.  M. 

3 

Pease,  T.  W..  Pt.,  H,  19th 

July  1, 

Conoidal  ball  fractured  upper 

Nov.  8. 

Fomur  divided  five  ins.  below 

Portions  of  fomur  had  been  pre 

Indiana,  age  26. 

1863. 

third  of  right  femur,  passed 

1871. 

the  trochauter  and  unjointcd 

viously  removed.     Patient  had 

thro'  trochanter  and  lodged 

from  acetabulum,  by  Dr.  J. 

been  disoh'd  Aug.  8,  1864.    In 

behind  trochanter  major,  fol 
lowed  by  chronic  ostitis  and 

K.  Bigelow,  late  Surgeon  8lh 
Indiana. 

Sept.,  18^,  the  pensioner  had 
"nearly  a  perfect  art  hrodial  joint 

coxitis. 

at  hip.  and  was  able  to  attend  to 

the  ordinary  duties  of  a  deputy 

marshal.' 

4 

Frain,  H.,  Pt.,  G,  31st  Mas 

Feb.  1, 

Left  thigh  perforated  by  a  co 

Mar.  24, 

The  femur  was  divided  by  the 

Died  March  30,  1865.     Circ.  6, 

sachusetts,  age  22. 

1865. 

noidal  ball  ;  the  neck  of  the 

1865. 

chain  saw  just  below  the  tro 

S.  G.  O.,  1865,  p.  72.     Circ.  2, 

femur  was  fractured. 

chanter  minor;   the  head  of 

S.  G.  O.,  1869,  pp.  54,  137. 

the  femur  was  removed  with 

out  difficulty;    Surg.  A.   M. 

McMahon,  U.  S.  V.    Incision 

four  ins.  long. 

5 

Henry,  W.  J.,  Ensign,  21st 

Tune  21, 

Comminuted  shot  fracture  of 

Aug.  2, 

Head  of  femur  exarticulated, 

Died  August  8.  1864.    Circ.  2,  S. 

Mississippi,  age  22. 

1864. 

upper  third  of  left  femer  by  a 

1864. 

shaft  sawn  below  trochanter 

G.  O.,  1869,  pp.  52,  137. 

conoidal  musket  ball. 

minor,  six  inches  of  bone  re 

moved,  by  Surg.  J.  B.  Read, 

C.  S.A.  Incis.  seven  ins.  long. 

6 

Hunt,  E.,  Pt.,  D,  71st  Penn 

Sept.  17, 

Conoidal  ball  grazed  the  neck 

Feb.  23, 

Opening  on  inner  side  of  thigh 

Died  Feb.  25,  1863.    Spec.  3907, 

sylvania,  age  24. 

1862. 

of  the  right  femur  und  passed 

1863. 

enlarged,  neck  of  the  femur 

A.  M.  M.   Circ.  6,  S.  G.  O.,  1865, 

out  at  the  nates. 

divided  with   lion-jawed  for 

p.  66.     Circ.  2,  1869,  S.  G.  O., 

ceps   and  head  of  bone  re 

pp.  49.  137. 

moved,  by  Ass't  Surg.  II.  A. 

DuBois,  U.  S.  A. 

7 

Netting,  J.  W.,  Pt.,  K,  1st 

June  30, 

Musket  ball  comminuted  neck 

Aug.  21, 

Head  of  bone  removed,  several 

Died  August  25.  1862,  of  hemor 

Massachusetts,  age  25. 

1862. 

of  right  femur;  head  of  bone 

1&J2. 

fragments  extracted,  and  the 

rhage.  Spec.  400,  A.  M.  M.  Circ. 

entirely  separated. 

jagged  extremity  of  the  neck 

6,  S.  G.  O..  1865,  p.  62.    Circ.  2, 

• 

smoothed  by   an  osteotome. 

S.  G.  O.,  1869,  pp.  48,  137. 

by  Ass't  Surg.  R.  Bartholow, 

U.  S.  A.,  thro'  vertical  incis 

8 

Roth,  J.,  Pt.,   B,  188th  N. 

Feb.  6, 

Anterior  part  of  head  of  left 

Mar.  9, 

The  neck  of    the  femur  was 

Died  June  17,  1865.     Circ.  6,  S. 

York,  age  25. 

1865. 

femur  shattered  by  a  round 

186"). 

divided  near  the  head  of  the 

G.  O.,  1865,  p.  74.     Circ.  2,  S. 

ball,  which  lodged  in  same. 

bone  by  a  ch  ain  saw;  the  head 

G.  O.,  1869,  pp.  53,  137. 

of  the  bone  with  the  ball  in 

serted    was    then    removed, 

straight  incision,  by  Assistant 

Surg.  J.  Vansunt.U.  S.  A. 

9 

2  Toney,  A.,  Pt,,  A,   16th  N. 

Tune  30, 

Head  of  the  left  femur  slightly 

Aug.  12, 

Head  of  femur  sawn  off  and 

Died  August  19,   1863,  from  ex 

Carolina,  age  43. 

18b3. 

fractured  by  a  conoidal  bail 

1863. 

the  ball  removed  from   the 

haustion,  of  hectic  fever. 

that  lodged  in  acetabulum. 

cotvloid  cavity,  by  Surg.  J. 

B.  head,  P.  A,  C.  S.;  straight 

incision. 

10 

Woodworth,  H.,  Pt.,  A,  4th 

May  1  1  , 

A   conoidal   ball  grooved  the 

July  1, 

Head  of   femur  disarticulated 

Died  July  2,  1864.    Spec.  "049, 

Vermont,  age  18. 

1864. 

left  femur  anteriorly  at  the 

1864. 

arid  upper  extremity  of  bone 

A.  M.  M.  Circ.  6,  S.  G.  O.,  1865, 

level  of  the  lesser  trochanter 

rca  dily  turned  out  and  sawn 

p.  70.     Circ.  2,  S.  G.  O.,  1869, 

and  lodged  underthe  sartorius 

just  below  the  point  of  impact 

pp.  52,  137. 

muscle  and  was  removed. 

of  the  ball,  by  Surg.  R.   B. 

Bmtecou,  U.  S.  V.;   carved 

incision. 

11 

'Zaborowski,  J.,  Pt.,  H,  7th 

Vug.  16. 

Conoidal    ball    fractured    the 

Sept.  27. 

Chain   saw  passed  under  and 

Died  September  28.  1864,  from 

Connecticut,  age  33. 

1864. 

neck  and  slightly  injured  the 

1864. 

between  the   head  cf  femur 

exhaustion.  Spec.  3716,  A.  M.M. 

head  of  the  right  femur. 

and  trochanter  majcr  and  the 

bun  o  sawn  through  the  neck; 

an   inch  of  trochanter  major, 

found  to  be  necrosed,  removed 

by  small  saw,  by  Ass't  Surg. 

C.  Wagner,  U.  S.  A.;  crucial 

incision. 

'SMITH  (D.  P.),  Gunshot  Wounds  of  the  Great  Trochanter,  in  Am.  Med.  Times,  18G3,  Vol.  VII.  p.  12.  Circular  No.  6,  S.  G.  O..  1865,  p.  65. 
Circular  No.  2,  S.  G.  O.,  1869,  pp.  50,  137. 

2 READ  (J.  B.),  Resections  of  the  Hip  Joint,  in  Confederate  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  6.  Evu  (P.  F.).  A  Contribution  to  the 
History  of  tlie  Hip  Joint  Operations  performed  during  the  late  Civil  War,  in  Transactions  of  the  American  Medical  Association,  Vol.  XVill.  p.  256. 
Circular  No.  2,  S.  G.  O.,  1869,  pp.  51,  137. 

3  WAGNER  (C.),  Report  of  Interesting  Surgical  Operations  performed  at  the  U.  S.  Gen.  Hasp.,  Beverly,  N.  J.,  1864,  pp.  14,  15.  Circular  No.  6, 
ST  G.  O.,  18C5,  p.  70.  Circular  No.  2,  S.  G.  O.,  1869,  pp.  53,  137. 


120 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Since  the  termination  of  the  civil  war  the  operation  of  excision  at  the  hip  for  shot 
injury  has  been  practised  five  times  in  the  service  of  the  United  States  Army  and  once 
in  the  service  of  the  United  States  Navy,  and  this  aggregate  of  six  excisions1  gives  the 

1  Four  of  the  operations  are  described  at  length  in  A  Report  of  Surgical  Cases  treated  in  the  Army  of  the  United  States  from  1865  to  1871,  Circular 
No.  3,  War  Department,  Surgeon  General's  Office,  Washington,  1871,  pp.  228-234,  and  the  facts  regarding  them  will  be  here  briefly  recorded,  two  of  the 
cases  are  hitherto  unpublished,  and  will  be  narrated  more  in  detail.  Two  of  the  excisions  were  primary,  one  intermediary,  and  three  secondary  opera 
tions.  The  first  case  was  that  of  Private  Hubert  Erne,  Co.  D,  4th  Infantry,  aged  48  years,  wounded  December  2,  1869,  while  acting  as  one  of  a  corpo 
ral's  guard  of  the  mail  wagon  from  Fort  Laramie  to  Fort  Fetterman,  in  an  attack  by  a  band  of  Indians.  He  was  struck  in  the  left  buttock  by  a  round 
carbine  ball  (cal.  45,  weight  225  grains),  and  fell  to  the  ground.  Ills  comrades  placed  him  in  a  wagon  and  drove  rapidly  to  Laramie,  over  a  very  rough 
road ;  he  was  struck  at  two  in  the  afternoon  and  was  placed  in  bed  in  the  hospital  at  half-past  seven,  much  exhausted,  having  driven  thirty -two  miles  in 
five  and  a  half  hours.  He  had  lost  blood  copiously.  His  extremities  were  cold,  pulse  almost  imperceptible,  and  his  countenance  was  pallid  and  covered 
with  clammy  sweat.  The  left  lower  limb  showed  shortening  with  eversion,  the  thigh  arched  with  an  anterior  convexity.  The  entrance  wound  was  an 
inch  and  a  half  behind  the  trochanter  major  on  a  slightly  higher  plane  ;  the  exit  aperture  was  near  the  centre  of  the  groin  just  below  Poupart's  ligament, 
directly  over  the  axis  of  the  femoral  artery.  The  diagnosis  of  Assistant  Surgeon  P.  MEACIIA&I,  post  surgeon,  was  that  there  was  fracture  of  the  shaft, 
neck,  and  trochanters  of  the  left  femur.  As  he  had  not  rallied  from  the  shock,  it  was  thought  best  to  defer  surgical  interference  until  morning,  and 
the  limb  was  placed  in  a  comfortable  position,  and  the  patient  allowed  half  an  ounce  of  brandy  every  half  hour,  while  external  applications  of  heat  were 
made  by  hot  blankets,  heated  sad-irons,  and  bottles  of  hot  water.  At  midnight  the  patient  had  fairly  reacted ;  but  complained  of  great  pain  in  the 
middle  of  the  injured  thigh.  He  was  ordered  a  fourth  of  a  grain  of  morphia  to  be  repeated  in  two  hours  if  needed.  At  7.30  A.  si.,  December  3d,  the 
patient  was  comfortable  ;  pulse  at  90.  No  appetite  and  little  sleep  during  the  night.  Temperature  in  axilla  99°  F.  Cold-water  dressings  to  wound  were 
applied,  milk  punch  given  freely,  and  an  eighth  of  a  grain  of  sulphate  of  morphia  every  two  hours.  At  1  P.  si.  Dr.  MEACHAM,  assisted  by  Assistant 
Surgeon  J.  B.  GlKARP,  U.  S.  A.,  placed  the  patient  under  chloroform  and  thoroughly  explored  the  injury,  after  enlarging  the  entrance  wound  to  admit 
the  finger  to  ascertain  the  extent  of  shattering  of  the  neck,  trochanters,  and  shaft.  No  important  vessels  or  nerves  were  involved.  The  patient  was 
an  old  soldier;  he  had  been  a  hard  drinker;  during  the  civil  war  had  been  more  than  once  wounded,  having  on  one  occasion  suffered  a  shot  fracture  of 
the  lower  jaw.  After  careful  consideration  of  the  Iccal  and  constitutional  conditions  it  was  determined  that  excision  of  the  upper  extremity  of  the  femur 
would  afford  the  patient  the  best  chance  of  life.  Dr.  MEACHAM  made  a  curvilinear  incision  seven  inches  in  length, 
beginning  an  inch  and  a  half  above  the  trochanter  major,  traversing  the  entrance  wound  and  extending  downward  in 
the  axis  of  the  shaft.  Exposing  the  bone  by  rapid  division  of  the  muscular  attachments,  the  fragments  of  the  shaft 
were  first  removed  and  the  pointed  upper  extremity  of  the  shaft  was  then  divided  by  the  chain  saw;  then,  with 
some  difficulty,  the  head  of  the  bone  was  exarticulated,  and  the  operation  completed.  The  exploratory  incisions, 
consultation,  and  final  excision  occupied  nearly  an  hour.  Little  blood  was  lost,  and  the  patient  promptly  rallied,  with 
little  sign  of  shock.  The  upper  part  of  the  incision  was  united  by  sutures  and  adhesive  strips.  The  man  was  put  to 
bed  with  the  injured  limb  extended,  and  a  weight  of  four  pounds  attached  by  Buck's  method.  The  wound  had  cold- 
water  dressings,  and  the  patient  had  an  ounce  Of  brandy  every  hour  when  awake,  and  a  quarter  of  a  grain  of  sulphate 
of  morphia  every  two  hours.  December  4th,  the  patient  had  passed  a  good  night,  and  had  a  full  pulse  at  90.  During 
the  day  he  had  nutritious  diet,  a  half  ounce  of  brandy  hourly  if  awake,  and  two  grains  of  quinia  and  an  eighth  of  a 
grain  of  sulphate  of  morphia  every  four  hours.  Excised  fragments  of  bone  were  cleaned  and  sent  to  the  Army 
Medical  Museum  and  preserved  as  Specimen  5658,  of  the  Surgical  Section,  which  are  represented  one-fourth  the  size 
of  nature  (FIG.  78).  On  December  5th,  in  the  early  morning, 
there  was  little  change  in  the  constitutional  symptoms.  The 
patient  had  slept  four  hours  during  the  night.  He  was  troubled 
with  hiccough.  He  had  partaken  freely  of  freshly  prepared 
essence  of  beef.  At  the  surgeon's  morning  visit,  at  half  past 
seven,  twenty-grain  doses  of  bromide  of  potassium  were  substi 
tuted  for  the  morphia,  and  the  other  treatment  and  diet  were 
continued,  with  the  addition  of  canned  oyster  soup.  At  the 
evening  visit,  at  nine,  the  hiccough  had  nearly  ceased,  the 
wound  had  begun  to  suppurate,  the  pulse  was  100,  the  tongue 
was  moist,  and  the  thirst  diminished.  The  dose  of  bromide  of 
potassium  was  reduced  one-half;  the  other  treatment  was  con 
tinued.  On  the  morning  of  December  6th  he  was  found  to  have 
passed  a  restless  night,  annoyed  by  hiccough  when  awake.  He 
complained  of  the  extension,  and  the  weight  attached  to  his 
«**  «  «"».n..hod  one-halt  Whiskey  was  substituted  for  the 
left  hip.  [From  a  photograph.]  brandy  which  he  disliked,  and  a  tincture  of  sesquichloride  of  gpec  5(553  A.  M.  M. 

iron  was  given  in  twenty -drop  doses,  with  two  grains  of  sul 
phate  of  quinia  every  four  hours.  One-fourth  of  a  grain  of  sulphate  of  morphia  was  ordered  to  be  given  when  the  pain  demanded  it.  The  patient 
was  removed  to  a  water-bed.  On  December  7th  the  patient  was  more  comfortable  and  had  slept  well.  He  was  annoyed  by  flatulence,  the  bowels  not 
having  moved  since  the  reception  of  the  injury.  He  was  ordered  a  tablespoonful  of  castor  oil  and  twenty  drops  of  turpentine,  and  an  enema  of  soap 
and  water.  The  suppuration  from  the  wound  was  quite  copious.  On  the  following  day  it  was  practicable  to  omit  the  anodyne,  and  the  patient  had  a  free 
evacuation  of  the  bowels,  with  great  relief.  Tlio  patient  was  allowed  a  small  piece  of  beef-steak  for  his  breakfast,  and  chicken  for  dinner.  The  discharge 
from  the  wound  was  profuse,  and  the  integument  over  the  hips  and  nates  was  somewhat  abraded  from  heat  and  moisture.  The  weight  attached  to  the 
foot  was  removed  altogether.  The  patient  was  transferred  from  the  water-bed  to  a  mattress,  in  the  middle  of  which  was  a  movable  portion  corresponding 
with  the  pelvic  region.  This  arrangement  greatly  facilitated  the  application  of  dressings  and  the  use  of  a  bed-pan.  The  patient  was  ordered  three 
ounces  of  beef  essence  thrice  daily  and  as  much  mill;  as  he  should  relish.  On  the  9th,  he  was  found  to  have  slept  well  without  taking  an  anodyne.  The 
suppuration  was  profuse.  The  pulse  was  at  100.  The  appetite  was  abundant.  Hiccough  was  again  quite  troublesome.  The  bowels  had  not  been 
moved  since  the  7th,  and  an  enema  of  castile  soap  and  warm  water  was  ordered  to  be  given  daily,  unless  there  should  be  an  alvine  evacuation  before 
nine  in  the  morning.  During  the  next  fortnight  there  were  no  symptoms  of  especial  interest.  The  wound  continued  to  suppurate,  but  less  copiously,  and 
was  rapidly  filling  up  with  granulations.  On  December  2Cd  the  patient  passed  a  very  restless  night.  The  surface  was  hot,  and  the  pulse  at  100;  the 
appetite  was  gone;  the  abdomen  was  tympanitic.  On  December  2:id,  he  had  several  dejections,  and  had  slept  soundly  during  the  previous  night,  and 
was  in  every  respect  much  better.  On  January  1,  1870,  his  bowels  were  again  obstinately  constipated.  Cicatrization  of  the  wound  was  rapidly  g"ing 
on.  Citrate  of  iron  and  quinine  was  substituted  for  the  sesquichloride  of  iron.  Laxative  enemata  were  required  daily,  and  whiskey  was  still  given.  The 
obstinate  hiccough  ceased  about  the  middle  of  January,  at  which  date  the  pulse  had  fallen  to  an  average  of  90,  and  the  wound  had  far  advanced  toward 
healing.  For  the  next  six  weeks  there  was  very  little  change  in  the  daily  record.  The  patient's  convalescence  progressed  favorably,  and  by  February 
28th  the  wound  was  open  at  two  points  only.  Constipation  was  still  a  troublesome  complication ;  the  patient  being  annoyed  by  injections  he  was  ordered 
to  take  a  three-grain  compound  cathartic  pill  nightly.  By  the  end  of  March  the  patient  was  able  to  sit  up.  There  were  still  two  fistulous  sinuses  leading 


SECT.  II.  | 


EXCISION    AT    THE    HIP    FOR    SHOT    INJURY. 


121 


gratifying  result  of  four  recoveries.  Adding  to  the  sixty-six  cases  of  excision  at  the  hip 
for  shot  injury  performed  during  the  War  of  the  Rebellion  the  ninety-nine  cases  referred 
to  in  Note  1  on  page  90  ante,  and  the  six  cases  detailed  in  Note  1  commencing  on  page 

toward  the  cotyloid  cavity.  About  an  ounce  of  pus  was  discharged  daily.  The  limb  was  about  five  inches  shorter  than  the  other.  On  April  10th  the 
patient  got  on  crutches,  but  could  not  walk  far  without  fatigue.  For  the  next  twenty  days  he  seemed  disinclined  to  exert  himself  but  was  taken  out 
every  day  in  a  wheeled  litter.  One  of  the  sinuses  had  closed.  By  July  8th  the  patient  had  gained  in  flesh  and  strength,  and  the  purulent  discharge  hud 
diminished  to  a  few  drops  daily.  The  limb  was  swollen  considerably  and  there  was  an  erysipelatous  blush  extending  below  the  knee.  At  this  date  Dr. 
MEACHAJI  was  ordered  to  Omaha,  and  the  patient  passed  into  the  hands  of  Acting  Assistant  Surgeon  L.  S.  TESSON,  who,  on  July  20th,  wrote  to  Dr. 
MEACIIAM  that  quite  a  large  abscess  formed  in  the  muscles  of  the  thigh.  On  August  9th,  Dr.  TESSON  again  wrote  that  it  had  been  necessary  twice  t<> 
make  incisions  to  evacuate  abscesses  in  the  thigh.  Again,  on  March  9,  1871,  Acting  Assistant  Surgeon  A.  J.  HOGG  writes  that  the  man  is  entirely  well, 
the  cicatrix  being  perfectly  sound;  but  the  man  persisted  in  lying  in  bed.  On  April  1,  1871,  Dr.  MEACIIAM  reports  that  he  had  succeeded  in  getting  his 
patient  again  under  his  personal  observation,  previous  to  which  he  had  borne  transportation  in  an  ambulance  for  ninety  miles,  and  appeared  in  better 
spirits  at  the  end  of  the  journey  than  when  he  set  out.  The  wound  had  entirely  healed,  leaving  a  firm  and  sound  cicatrix  three  inches  in  length.  The 
patient  was  able  to  walk  comfortably  on  crutches  and  had  slight  control  over  the  limb,  which  admitted  of  a  to-and-fro  motion,  with  rotation  inward.  The 
upper  end  of  the  femur  rested  on  the  dorsum  of  the  ilium,  about  one  inch  above  the  acetabulutn,  and  was  movable  in  that  position.  There  was  six  and  a 
half  inches  shortening.  The  patient  was  somewhat  hypochondriacal,  being  greatly  troubled  with  indigestion  and  irregular  bowels.  A  photograph  of 
the  patient,  taken  at  Omaha,  March  30,  1871,  is  copied  in  the  wood-cut  (FIG.  77).  Private  Hubert  Erne  was  discharged  from  service  May  18,  1871, 
and  by  an  order  dated  A.  G  O.,  June  9,  1871,  was  sent  to  the  Soldier's  Home,  near  Washington.  In  answer  to  an  enquiry  from  this  Office,  Surgeon  C. 
H.  LAUI;  reported  :  ''Hubert  Erne,  late  of  the  4th  Infantry,  was  received  in  hospital  at  Soldier's  Home  on  July  16,  1871,  in  a  very  emaciated  and  feeble 
condition,  the  result  of  chronic  diarrhrea.  Having  during  his  residence  here  exhibited  symptoms  of  partial  insanity,  and  having  no  facilities  for  the 
proper  care  of  such  cases,  he  was  transferred  to  the  Government  Insane  Asylum,  near  Washington,  August  20,  1871,  at  which  place  it  is  reported  that  he 
died  a  short  time  after  his  admission."  Then  Dr.  C.  H.  NICHOLS,  Superintendent  of  the  Government  Hospital  for  the  Insane,  reported  that  the  patient  "  was 
admitted  August  19,  1871,  to  be  treated  for  acute  insanity,  and  that  he  died  Nov.  7,  1871,  from  exhaustion,  of  acute  mania.  No  autopsy  was  made  in  the 
case.'1  Another  primary  excision  at  the  hip  for  shot  fracture  of  the  upper  extremit.y  of  the  femur  was  practised  at  Fort  Concho,  Texas,  in  1874,  by 
Assistant  Surgeon  W.  F.  BUCHANAN,  U.  S.  A.  The  fracture  was  attended  with  very  extensive  longitudinal  splintering,  and  it  would  appear  that  such 
conditions  involve  incisions  of  such  perilous  magnitude  as  to  afford  the  slightest  prospects  of  success  even  under  the  most  favorable  attendant  circum 
stances.  The  abstract  of  this  case  has  not,  at  this  date,  (June  1,  1878),  been  published  in  print. — Sergeant  T.  Duncan,  Co.  K,  25th  Infantry  (Colored), 
aged  27,  was  shot  in  the  left  hip  while  a  prisoner  and  attempting  to  escape  from  his  guard  at  Fort  Concho,  Texas,  on  the  morning  of  November 
24,  1874.  On  receiving  the  injury,  which  was  produced  by  a  conical  rifle  ball  at  a  distance  of  about  sixty  yards,  he  fell  to  the  ground,  when  he  was 
placed  on  a  wheeled  litter  and  was  conveyed  to  the  Post  Hospital.  At  9.20  A.  M.  an  ounce  of  brandy  with  half  a  grain  of  morphia  was  administered. 
An  examination  externally  exhibited  a  wound  of  entrance  in  the  gluteal  region,  on  a  line  with  the  lower  border  of  the  great  trochanter,  and  about  mid 
way  between  the  trochanter  and  the  tuberosity  of  the  ischium ;  the  wound  of  exit  existed  in  the 
anterior  part  of  the  thigh,  same  side,  about  an  inch  and  a  half  below  Poupart's  ligament  and  one 
inch  external  to  the  femoral  vessels.  The  mobility,  crepitus,  probing,  etc.,  proved  that  the  upper 
part  of  the  shaft  of  the  femur  had  been  shattered ;  a  compound  comminuted  fracture,  doubtless 
extending  within  the  capsule.  Venous  haemorrhage  was  taking  place  from  the  wound  in  the  gluteal 
region,  and  great  pain  was  felt  in  touching  the  great  trochanter  and  in  the  knee.  There  was  also 
great  nervousness,  and  quick  and  feeble  pulse.  He  was  placed  on  his  right  side,  the  injured  leg 
supported,  the  body  bolstered,  and  the  haemorrhage  controlled  by  pledgets  of  lint  saturated  with  a 
solution  of  persulphate  of  iron.  Cold-water  dressing  was  applied,  a  tin  warmer  filled  with  hot 
water  applied  to  the  feet,  and  a  quarter  of  a  grain  of  sulphate  of  morphia  together  with  an  ounce  of 
brandy  was  given  every  two  or  three  hours.  On  the  following  day,  at  11.30  A.  Ji.,  the  patient  was 
quite  nervous,  suffering  great  pain,  and  only  relieved  by  the  full  effects  of  the  anodyne,  having 
slept  little  during  the  night  and  eaten  nothing  but  a  little  beef  essence ;  pulse  120  and  small ;  tem 
perature  normal.  It  was  decided  that  resection  offered  him  the  only  chance  to  survive.  He  was 
therefore  placed  on  the  operating  table  and  brought  under  the  influence  of  the  anaesthetic,  consist 
ing  of  one  part  of  chloroform  and  two  of  ether,  when  a  longitudinal  incision  about  eight  inches  in 
length  was  made,  commencing  just  above  the  trochanter  and  extending  in  the  axis  of  the  head  and 
neck  of  the  bone,  and  the  soft  parts  were  dissected  away.  The  upper  end  of  the  shaft  being  found 
much  shattered  and  the  fracture  extending  within  the  neck,  the  head  of  the  bone  was  exurticulated 
and  the  fractured  extremity  removed  with  the  chain  saw.  About  five  inches  of  the  shaft,  with  the 
head  and  neck,  were  exsected.  No  arteries  were  cut,  and  but  one  small  vein  was  ligated.  All  the 

p        ~() si    *t       i     fragments  of  bone,  about  forty,  were  removed,  the  parts  washed  out  and  a  weak  solution  of  per- 

upper  extremity  of  the    manganate  of  potassa  applied,  the  sides  of  the  wound  being  united  with  interrupted  sutures  sup- 
left  femur.     Spec.  6313.    ported  by  adhesive  straps.     The  patient  was  then  placed  in  bed,  position  maintained  by  sand  bags,     of  the  same  specimen. 

and  cold-water  dressings  instituted.     As   soon  as  he  had  recovered  consciousness,  brandy  and 

morphia  were  given  and  repeated  frequently.  Warmth  was  applied  to  the  feet.  The  patient  was  of  great  muscular  development,  and  the  incision 
required  to  be  lengthened  an  inch  or  so  to  allow  of  necessary  retraction.  His  pulse  was  about  the  same  as  before  the  operation,  rather  full.  Although 
relieved  of  the  pain  he  had  suffered  previous  to  the  operation,  he  continued  restless,  constantly  trying  to  change  his  position,  groaning,  etc.,  and  died  on 
the  morning  of  November  26th,  about  fourteen  hours  after  the  operation."  The  excised  portion  of  the  fractured  femur,  represented  in  the  wood-cuts 
(FIGS.  79,  80),  with  the  history,  was  contributed  to  the  Museum  by  the  operator,  Assistant  Surgeon  W.  F.  BUCHANAN,  U.  S.  A.  Of  the  excisions  at  the 
hip  after  shot  injury,  practised  since  the  close  of  the  civil  war  in  the  United  States  Army,  one  was  an  intermediary  operation  performed  by  Surgeon 
GLOVE::  PEUIN,  U.  S.  A.,  at  Newport  Barracks,  Kentucky,  in  August,  18G7  :  CASE. — Private  Francis  Ahearn,  aged  30  years,  U.  S.  General  Service,  was 
wounded  at  Newport  Barracks,  Louisville,  on  July  31,  1867.  He  was  a  prisoner  in  the  guard-house,  and  was  shot  by  a  sentinel  while  attempting  to 
escape.  The  ball  entered  behind  and  below  the  prominence  of  the  right  trochanter  major  and  passed  inward  and  upward,  emerging  on  the  anterior 
part  of  the  thigh,  two  inches  below  Poupart's  ligament,  a  little  to  the  outside  of  the  course  of  the  femoral  artery,  having  shattered  the  upper  part  of  the 
femur,  the  fissures  extending  within  the  joint.  The  wounded  man  was  immediately  taken  to  the  Post  Hospital,  and  was  examined  by  Colonel  PEUtX, 
the  surgeon  in  charge.  The  patient  had  been  an  habitual  drunkard  for  years  and  had  mania  apotu  when  shot.  The  shock  of  the  injury  was  so  great 
that  an  operation  was  not  considered  advisable.  It  was  determined  to  adopt  a  supporting  treatment,  and  to  endeavor  to  build  up  the  general  health, 
with  a  view  of  operating  at  the  first  favorable  moment  when  a  good  result  could  be  reasonably  anticipated.  On  August  26,  1867,  the  patient  was  in  a 
better  condition  than  at  any  time  subsequent  to  the  reception  of  the  injury.  The  pulse  was  at  90 :  there  had  been  troublesome  diarrhoea,  but  it  was  some 
what  abated;  the  injured  limb  was  much  wasted,  except  at  the  upper  part  of  the  thigh,  where  it  was  greatly  swollen ;  the  discharge  from  the  wound 
was  very  copious,  and  there  was  extreme  pain  on  the  slightest  movement.  There  were  abscesses  about  the  joint  communicating  with  its  cavity. 
Excision  having  been  decided  upon,  Surgeon  PEBIN,  assisted  by  Assistant  Surgeon  T.  E.  WlLCOX,  U.  S.  A.,  proceeded  with  the  operation.  The 
patient  being  rendered  insensible  by  a  mixture  of  chloroform  and  ether,  the  entrance  wound  was  enlarged  by  a  straight  incision  downward  and  three 
SURG.  Ill— 16 


FIG.  80. — Posterior  view 


122 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


120,  wo  have  a  total  of  one  hundred  and  seventy-one  instances  of  excision  at  the  hip  for 
shot  injury,  of  which  one  hundred  and  forty-eight,  or  86.5  per  cent,  proved  fatal.  Forty- 
three  _of  the  operations  were  primary,  with  forty  deaths,  or  93  per  cent.;  sixty  were  inter- 
inches  in  length.  The  head  of  the  bone  was  disarticulated,  and  the  shaft  was  sawn  several  inches  below  the  lesser  trochanter.  The  wound  was  then 
cleansed  and  approximated.  Scarcely  any  haemorrhage  took  place,  no  ligatures  being  required.  On  recovering  from  the  anaesthetic,  the  patient  com 
plained  of  great  pain  and  nausea.  Brandy  was  administered,  and  half  a  grain  of  sulphate  of  morphia  ;  but  there  was  such  irritability  of  stomach  that 
everything  was  rejected.  A  quarter  of  a  grain  of  sulphate  of  morphia  was  then  administered  hypodermically,  and  this  relieved  the  pain.  But  there  was 
no  decided  reaction,  and,  sinking  gradually,  the  patient  died  from  the  shock  of  the  operation 
twenty  hours  after  its  completion.  No  autopsy  was  made.  The  shattered  excised  bones  were 
sent  to  the  Army  Medical  Museum,  and  are  represented  in  the  adjoining  wood-cuts  (Fics.  81 ,  80). 
Many  of  the  fragments  were  carious.  Of  the  six  cases  of  excision  at  the  hip  joint  practised  on 
account  of  shot  injury  in  the  United  States  since  the  civil  war,  three  were  successful  secondary 
operations.  Two  occurred  in  the  United  States  Army  and  one  in  the  United  States  Navy.  The 
first  of  the  operations  was  performed  by  Assistant  Surgeon  J.  R.  GIBSON',  in  August,  1868.  Tlio 
patient  recovered  with  a  very  satisfactory  control  of  the  functions  of  the  articulation  and  limb. 
A  detailed  report  of  the  case  was  published  in  Circular  No.  2,  S.  G.  O.,  1869,  pp.  117-120,  and 
in  Circular  No.  3.  S.  G.  O.,  1871,  p.  228,  an  account  of  the  pensioner's  progress  was  given,  with 
a  lithograph  plate  showing  the  appearance  of  the  injured  limb  three  years  subsequent  to  the 
operation.  The  following  is  the  condensed  abstract  of  the  case  as  published  in  Circular  No.  3: 
"  Private  Charles  F.  Read,  Co.  I,  37th  Infantry,  while  in  a  stooping  posture,  and  distant  about 
one  hundred  feet,  was  shot  by  a  sentinel  at  Missouri  Bottom,  New  Mexico,  on  June  C,  18G8. 
The  ball  struck  about  the  middle  of  the  posterior  aspect  of  the  left-  thigh,  causing  an  injury  to 
the  bone,  the  nature  of  which  is  shown  in  the  accompanying  wood-cut  (Vic,.  84),  illustrating 
the  specimen  contributed  to  the  Army  Medical  Museum  by  the  operator,  Assistant  Surgeon  J. 


FIG.  81.— Shattered  upper    R  GIBSON,  U.  S.  A.     The  case  being  fully  detailed  in  Circular  No.  2,  S.  G.  ().,  18G9,  page        Fin.  80. 
?xeised  for  caries  following    ^^'  reference  will  only  be  made  to  the  more  salient  points,  and  to  information  received  since    °f  *ne  sam 


—Posterior  view 
me  specimen. 


shot  fracture.  Spec.  5489. 


the  publication  of  that  report.     After  weeks  of  temporization,  during  which  the  patient,  a  young 
man  in  the  prime  of  life,  had  become  much  exhausted  from  numerous  and  futile  searches  after  the  missile,  from  bedsores, 

profuse  suppuration,  an  irritable  diarrhoea,  and  pain  so  intense  as  to  require  the  administration  of  an  anaesthetic  previous  to  dressing  the  wound,  the 
choice  lay  between  a  lingering  death  or  excision  of  the  head  of  the  femur,  or  the  more  fearful  and  precarious  alternative  of  amputation  at  the  joint.  On 
August  14th  the  patient  expressed  willingness  to  submit  to  any  operation  that  would  afford  relief,  when  he  was  anaesthetized  for  the  purpose  of  again 
freel}-  examining  the  parts,  and  performing  such  operation  as  should  be  considered  necessary.  Upon  explorations  of 
the  wound  with  the  probe  and  finger,  the  ball  was  discovered  in  the  head  of  the  femur,  a  T-shaped  incision  was 
made  over  the  joint,  the  head  of  the  bone  was  turned  out  of  the  acetabulum,  and  was  sawn  through  the  neck,  just 
within  the  greater  trochanter.  The  incisions  were  closed  with  metf.llio  sutures,  and  the  limb  was  temporarily 
placed  between  splints,  with  a  pillow  under  the  knee.  A  Smith's  anterior  splint  not  being  on  hand,  nor  the  material 
procurable  for  making  one,  a  long  external  splint,  made  in  two  parts,  and  connected  by  iron  braces,  was  devised  and 
put  in  course  of  construction.  The  after  treatment  consisted  in  oarbolized  dressings  to  the  wound,  the  administra 
tion  of  antiperiodics  to  control  a  fever  of  a  remittent  type  (at  one  time  supposed  to  be  the  precursor  of  erysipelas 
or  pyaemia),  and  a  plain  nutritious  diet.  Notwithstanding  frequent  displacement  of  the  limb  from  occasional  attacks 
of  diarrhoaa,  and  the  absence  of  a  proper  apparatus  to  secure  immobility,  the  performance  of  this  formidable  opera 
tion  seemed  to  have  imparted  a  new  tenure  of  life.  By  November  20th  the  patient  was  able  to  walk  about  the 
hospital,  and  the  further  progress  of  the  case  was  as  rapid  as  it  was  favorable.  On  May  10,  1SG9,  this  soldier  was 
discharged  the  service  and  pensioned  for  total  and  permanent  disability,  the  injured  member  being  shortened  one 
inch  and  three-quarters.  He  came  across  the  plains  by  the  next  train,  and,  in  September,  18G9,  reported  at  the 
Surgeon  General's  Office,  where  a  photograph  was  taken.  At  that  time  the  patient's  general  health  was  excellent  ; 
the  cicatrix  was  perfectly  firm  and  sound,  and  the  strength  of  the  ligamcntous  attachments  and  the  amount  of 
control  over  the  movements  of  the  limb  were  very  remarkable.  He  could  bear  much  weight  on  the  limb.  He  was 
supplied  with  a  prothetic  apparatus  and  advised  not  to  use  it  straightway,  but  to  continue  exercising  the  limb 
continuously  for  some  months,  thereby  increasing  the  strength  of  the  muscles  and  ligamentons  attachments,  and  the 
freedom  of  the  newly-formed  joint.  The  next  week  Read  went  to  New  York,  where  the  pro 
posed  apparatus  was  ingeniously  applied  by  Dr.  E.  D.  HUDSON'.  In  the  summer  of  1870,  it  WHS 
reported  that  this  man  could  walk  very  comfortably  with  a  cane  either  with  or  without  appa 
ratus.  The  appearance  of  the  patient  is  shown  in  the  accompanying  wood-cut  (FIG.  83.)  In 
June  1871,  three  years  after  the  operation,  the  man  was  in  very  good  health,  and  could  walk 
almost  as  well  as  ever."  He  was  last  paid  on  September  4,  1877.  The  next  secondary  operation 
was  performed  by  Surgeon  W.  E.  TAYLOR,  U.  S.  Navy.  A  report  of  the  case  was  published  FIG.  84.  -Excised 
in  Circular  No.  3,  S.  G.  O.,  1871,  p.  232:  Charles  B.  Scott,  a  seaman  of  the  U.  S.  Navy,  aged  head  of  left  femur 
the  limb  34>  °f  fa'r  general  health,  was  wounded  in  an  attack  on  a  piratical  vessel  in  Tecapan  River,  west  ^Jlgj-ctJj^iV  <O 
coast  of  Mexico,  June  17,  1870,  by  a  rifle  ball,  fired  at  a  distance  of  about  eighty  yards.  He  5575. 
was  conveyed  a  distance  of  seventy  miles  to  the  U.  S.  ship  Mohican,  on  board  of  which  lie  was 

treated  for  several  days,  and  finally  transferred  on  July  12th  to  the  Naval  Hospital,  Mare  Island,  California.  The  wound  of  entrance  was  small,  and 
situated  a  little  below  and  about  two  inches  posterior  to  the  top  of  the  left  great  trochanter.  He  rested  entirely  on  the  right  side,  with  the  Injured  limb 
partially  flexed  and  resting  on  the  sound  one,  the  whole  limb  being  inverted  and  shortened  about  one  inch.  Cold-water  dressings  had  been  applied  to  the 
wound  and  anodynes  administered  when  required.  His  general  condition  was  decidedly  below  par.  The  least  movement  in  the  injured  joint  caused  severe 
pain  ;  he  did  not  sleep  well,  and  his  appetite  was  poor.  Full  diet,  with  milk  and  an  anodyne  at  night,  were  ordered.  .On  July  14th  an  examination  of 
the  wound  was  made.  No  anaesthetic  was  used,  and  the  result  was  unsatisfactory.  However,  appearances  led  to  the  belief  that  the  neck  and  probably 
the  head  of  the  femur  were  fractured;  the  ball  could  not  be  felt.  The  joint  was  not  swollen  but  was  very  sensitive,  and  there  was  a  scanty  sanious 
and  fetid  discharge  from  the  wound.  On  July  25th  the  patient  was  chloroformed,  and  Surgeon  \V.  E.  TAYLOR,  U.  S.  Navy,  made  a  single  straight 
incision,  seven  or  eight  inches  long,  and  found  the  neck  and  head  extensively  comminuted;  he  then  sawed  off  the  bone  just  below  the  trochanter  minor, 
and  removed  the  fragments,  some  twelve  or  fourteen  in  number,  as  also  the  ball,  which  seemed  to  have  struck  the  neck  obliquely,  breaking  it  into  three 
pieces,  and  then  passed  into  the  head,  shattering  it  into  nearly  a  dozen  pieces.  Very  little  blood  was  lost,  two  small  arteries  only  requiring  to  be  secured. 
After  syringing  the  wound  with  a  weak  solution  of  permanganate  of  potash,  it  was  partially  approximated  by  four  sutures,  and  the  limb  was  placed  in 
an  ordinary  fracture  box,  and  dressed  with  oakum.  The  operation  was  well  borne,  and  reaction  prompt.  Stimulants,  with  nutritious  diet,  were  ordered, 
and  rigid  cleanliness  was  enforced.  On  the  27th  the  patient  began  to  suffer  from  decubitus.  On  the  evening  of  the  29th  he  became  delirious  ;  pulse  130 


J,IIG  §3  _  Appearanc 
fifteen  months  after  the  operation. 


SECT.  II.] 


EXCISION    AT    THE    HIP    FOR    SHOT    INJURY. 


123 


mediary,  with  fifty-eight  deaths,  or  96.6  per  cent.;  forty-one,  with  twenty-six  deaths,  or 
63.4  per  cent.,  were  secondary;  and,  in  twenty-seven  instances,  with  twenty-four  deaths, 

and  irritable.  Hydrate  of  chloral  being  substituted  for  morphia,  he  went  to  sleep  in  a  few  minutes,  and  next  morning  awoke  refrethed  and  feeling  better 
than  at  any  time  since  the  accident.  The  pulse  fell  to  100.  On  the  31st,  the  sutures  were  removed.  The  good  effect  of  the  chloral  was  very  marked, 
but,  by  August  Cth,  it  seemed  to  have  lost  some  of  its  effect ;  whereupon  morphia  was  combined  with  the  usual  dose, 
and  he  slept  well.  The  discharge  from  the  wound  was  small  in  quantity  and  laudable.  On  August  8th,  some  exten 
sion  of  the  limb  was  made,  but  was  badly  borne.  By  the  14th,  the  patient  was  doing  well  in  every  respect.  On  the 
21st,  all  dressings  being  removed  from  the  limb,  it  was  thoroughly  bated  and  rubbed,  after  which  it  was  replaced  in  the 
fracture  box,  when  extension  and  counter-extension  were  made  by  means  of  the  ordinary  perineal  band  and  screw. 
This  was  discontinued  on  the  2Gth,  owing  to  enlargement  of  the  inguinal  glands  and  the  general  malaise  and  discom 
fort  experienced  by  the  patient.  On  the  30th,  the  use  of  anodynes  was  discontinued,  as  he  could  sleep  without  them. 
September  1st,  found  the  patient  improving,  the  discharge  from  the  wound  being  moderate,  with  an  entire  absence  of 
inguinal  trouble,  bedsores,  and  excoriations.  Slight  passive  motion  was  commenced  in  the  limb,  and  it  was  allowed 
to  rest  lightly  on  a  pillow  for  several  hours.  On  the  7th,  he  was  able,  for  the  first  time,  with  assistance,  to  leave  his  bed. 
After  this  he  continued  to  sit  up  several  hours  daily,  and,  gaining  in  flesh,  was  able,  by  the  18th,  to  walk  on  crutches. 
He  continued  to  take  daily  a  moderate  amount  of  out-door  exercise,  the  limb  meanwhile  being  supported  and  steadied 
by  means  of  a  wire  splint,  and  his  general  condition  became  excellent.  On  December  27th,  he  went  by  steamer  to 
San  Francisco,  a  distance  of  fifty  miles,  and  returned  in  the  evening,  having  borne  the  journey  well.  On  January  20, 
1871,  a  prothetic  apparatus  was  adjusted  to  the  limb,  which,  at  the  beginning,  proved  highly  useful.  On  February  1st, 
the  patient  was  transferred  to  the  new  Naval  Hospital.  At  this  time  his  general  health  was  excellent.  The  left  buttock 
was  somewhat  flattened,  and  there  was  a  small  opening  about  the  centre  of  the  line  of  incision,  which  discharged  a 

small  quantity  of  pus;  the  limb  was  about  three  and  a  half  inches 
shorter  than  its  fellow,  the  knee  being  quite  stiff  and  foot  everted 
(FIG.  8(>)-  The  patient  had  gained  about  thirty  pounds  since  the 
operation  of  excision,  and  there  was  a  probability  of  his  being  able  to 
walk  quite  well  without  the  aid  of  crutches.  Scott  was  discharged 
April  18, 1871,  at  Mare  Island,  California,  and  pensioned.  Drs.  R.  V. 
WAI.SII  and  J.  S.  GUNNING,  of  Enniskillen,  Ireland,  certified,  Sep 
tember  4.  1875:  "There  is  a  fistulary  opening  connected  with  the 


-_  ,     .  ,         ...  bone.     The  leg  is  greatly  wasted,  being  one-third  the  size  of  the  sound 

FIG.  80. — Anterior  and  posterior  views  of  the 
>per  extremity  of  the  left  femur.     Spec.  5884.      leS-       Dr.  JOHN  ST.  Cl,AIR  GUNNING  certified,  October,  17,  1877: 


upper 


FIG.  86. — Appearance  of  limb 

"Charles  B.  Scott,  who  died  at  Omagh,  Tyrone' County,  Ireland,  on  seven  months  after  °Peration- 
the  1st  day  of  July,  1877,  was  under  my  professional  care,  and  his  death  was  caused  by  chronic  cystitis,  the  result  of  a  very  extensive  and  severe  injury 
to  his  hip  joint."  The  specimen  5884  is  preserved  in  the  Museum  and  shown  in  the  accompanying  wood-cut  (FIG.  85).  The  third  of  the  secondary 
operations  of  excision  at  the  hip  joint  for  shot  injury  was  practised  at  Fort  Fetterman,  Wyoming  Territory,  in  September,  1877,  by  Assistant  Surgeon 
JOHN  V.  K.  HOFF,  U.  S.  A.,  who  has  furnished  a  detailed  report  of  the  case,  from  which  a  condensed  abstract  is  made:  Sergeant  William  J.  Linn,  Co. 
M,  4th  Cavalry,  aged  22  years,  was  wounded  in  a  fight  with  Cheyenne  Indians  during  the  Powder  River  Expedition,  November  25,  1876.  The  bullet 
(probably  conoidal,  calibre  .50  inch,  weighing  412  grains)  entered  the  right  groin  three 
inches  below  and  slightly  internal  to  the  anterior  superior  spinous  process  of  ilium  and  two 
and  three-fourth  inches  external  to  the  symphysis  pubis,  passed  obliquely  backward  through 
the  hip  joint,  fractured  the  neck  of  the  femur,  notched  the  posterior  segment  of  the  rim  of 
the  acetabulum,  and  emerged  at  a  point  about  one  inch  posterior  and  exterior  to  the  notch 
in  the  acetabulum.  The  wound  was  received  while  the  soldier  was  resting  on  his  right  knee 
and  left  foot  in  the  act  of  discharging  his  carbine.  The  patient  was  immediately  earned  to 
the  rear  and  a  plaster  of  Paris  badge  applied.  He  was  moved  on  a  travois  over  an  almost 
impassable  country,  during  weather  so  cold  that  mercury  froze,  and  reached  Supply  Camp 
on  the  third  day.  Here  the  plaster  bandage  was  reapplied  and  the  patient  was  placed  in  an 
ambulance  and  carried  to  Cantonment  Reno,  reaching  the  latter  place  after  a  five  days'  jour 
ney  over  a  country  where  roads  are  unknown,  in  weather  of  the  utmost  severity,  and  under 
circumstances  of  hardship  which  skillful  care  and  unremitting  attention  could  but  little 
alleviate.  A  week  after  his  arrival  at  Reno,  the  plaster  bandage  was  removed,  the  limb  was 
elevated,  and  the  wounds  of  entrance  and  exit,  which  were  discharging  pus  freely,  were 
treated  with  simple  dressings.  The  wound  of  entrance  closed  in  four  weeks,  and,  though 
the  wound  of  exit  was  still  discharging,  an  immense  abscess  formed  in  and  about  the  joint, 
which  pointed  in  anterior  cicatrix,  finally  opened  spontaneously,  and  remained  so  for  several 
months.  A  light  extending  weight  was  used  fur  a  short  time,  no  medicine  given  except 
morphia  occasionally  fur  pain  and  physic  for  constipation.  On  March  24,  1877,  the  patient 
was  transferred  to  the  post  hospital  at  Fort  Fetterman.  The  journey  was  accomplished  in 
five  days  on  a  stretcher  slung  in  an  arm}'  wagon.  When  admitted  he  was  very  emaciated, 
pale  and  pain-worn,  and  weighed  about  100  pounds,  having  lost  80  pounds  since  the  recep 
tion  of  the  injury.  Two  suppurating  sinuses  led  into  the  articulation  and  there  was  fibrous 
anchylosis  of  both  hip  and  knee  joints.  The  patient  had  not  moved  from  a  recumbent  ._£ 
position  since  he  received  the  injury,  and  could  not  even  be  raised  upon  a  bed-pan  without 
great  pain.  Tonics  anda  generous  diet  wereordered,  the  wounds  were  dressed  with  carbolic 
acid  solution.  The  bowels  were  freely  opened  and  kept  regular.  When  the  patient  had  fairly 
recovered  from  the  exhausting  effects  of  the  journey  a  side  splint  was  applied  which  enabled 
him  to  be  moved  without  pain.  Notwithstanding  the  most  careful  attention  the  patient 

Y\r,    ffj \pncarance  of    gradually  failed,  and  grew  so  feeble  and  complained  so  much  of  pain  that  it  seemed  but  a 

limb  ten  months  after  oper-     question  of  weeks  between  an  operation  or  death.     On  September  28th,  Assistant  Surgeon 
ation.     Side  view.  j    y    R    HOFF,   U.  S.  A.,  excised  the  hip  joint  after  SEDII.LOTT'S  method.     A  circular 

incision  was  made  to  include  the  great  trochanter  and  opening  into  the  joint,  the  capsular  ligament  was  severed,  the  head  of  the  femur  was  thrown 
out  and  removed  by  the  chain  saw  at  a  point  just  below  great  trochanter.  The  head  of  the  femur  (proper),  which  had  been  severed  by  the  bullet  at  its 
neck,  was  found  lying  loosely  in  the  acetabulum  partially  absorbed,  and  was  easily  removed  by  forceps.  Ether  was  used;  insensibility  induced  in 
seventeen  minutes  and  maintained  one  hour  and  ten  minutes;  reaction  was  rapid  and  satisfactory.  Antiseptic  dressings  were  used.  A  double  splint  to 
fit  both  legs,  made  of  light  iron,  reaching  to  the  waist  and  there  secured  by  a  belt,  was  applied.  This  proved  most  useful  in  enabling  the  patient  to  be 
moved  with  comparative  ease,  and,  at  the  same  time,  keeping  the  wounded  parts  measurably  immovable.  Extension  was  applied  by  means  of  tin  plates 


FIG.    88. — Anterior    view  of 
the  s;une. 


124  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

or  88.8  per  cent.,  the  period  of  the  operation  was  not  stated.  Grouping  the  one  hundred  and 
seventy-one  cases  of  excision  at  the  hip,  according  to  the  time  or  the  occasions  on  which 
the  injuries  were  received,  we  find  that  of  sixteen  operations  performed  before  the  American 
war,  1860-65,  one  proved  successful,  and  that  in  a  second  the  patient  survived  after  con 
secutive  amputation;  that  four  fatal  operations  were  performed  during  the  insurrection  in 
Poland,  1863,  and  the  campaign  in  Schleswig-Holstein,  1864;  that  six  excisions  at  the 
hip  with  two  successes  were  performed  during  the  Austro-Prussian  War  of  1866;  that  of 
seventy-one  operations  done  in  the  Franco-Prussian  AVar  of  1870-71,  eight  were  success 
ful;  that  once,  at  least,  excision  at  the  hip  was  unsuccessfully  performed  during  the  Russo- 
Turkish  War,  1876-77,  and  that  in  one  instance  the  hip  joint  was  successfully  excised  for 
shot  injury  in  1876,  in  California;  that  of  the  sixty-six  cases  of  excisions  at  the  hip  per 
formed  for  shot  injury  received  during  the  American  civil  war,  six  proved  successful;  and 
that  finally,  of  the  six  cases  performed  in  the  service  of  the  United  States  since  the  close 
of  the  American  war  in  1865  to  the  present  time  (1879),  four  were  attended  with  success. 
Of  the  six  survivors  of  excision  at  the  hip  performed  on  patients  wounded  during  the 
American  civil  war,  two  only  were  living  in  the  early  part  of  1879:  Brown,  of  Grand 
Rapids,  Michigan  (CASE  261,  ante),  and  Pease,  of  Indianapolis,  Indiana,  (CASE  263,  ante); 
both  were  examples  of  recovery  from  secondary  excision.  Brown  can  bear  his  weight 
upon  the  injured  limb,  can  walk  across  a  room  without  the  aid  of  crutches  or  cane,  but 
ordinarily  uses  a  support.  Pease,  with  the  assistance  of  a  "six-inch  lift,"  can  walk  quite 
well  with  a  cane.  Tilliston,  the  third  survivor  of  secondary  excision,  lived  until  Septem 
ber  6,  1871,  ten  years  after  the  operation.  He  was  unable  to  bear  any  weight  on  his 
limb,  and  was  obliged  to  wear  crutches.  He  succumbed  to  most  extensive  necrosis  of  the 
pelvic  bones  and  femur,  with  huge  recurring  abscesses.  In  the  case  of  Cannon,  the  sur 
vivor  of  primary  excision  (CASE  206,  ante),  the  limb  was  useless  for  purposes  of  locomo 
tion.  He  died  of  diphtheria,  in  1865,  eighteen  months  after  the  injury  and  operation. 
Of  the  two  survivors  of  intermediary  excision,  Lieutenant  /.  M.  Jarrett  (CASE  239,  ante) 
went  to  his  home  in  North  Carolina,  and  was  reported  as  doing  well  in  September,  1864, 
ten  months  after  the  operation;  walking  about  with  a  high-heeled  boot  and  the  aid  of  a 
cane.  Persevering  attempts  to  obtain  further  information  regarding  the  ulterior  history  of 

three  inches  wide  by  twelve  inches  long1,  secured  to  the  log  by  adhesive  straps  and  connected  through  eyes,  at  their  extremities,  by  elastic  tubing,  to  a 
twenty-one  pound  weight,  playing  over  a  pulley.     The  tubing  passed  through  a  piece  of  board  twelve  inches  long,  secured  below  the  foot  piece,  thereby 
preventing  pressure  on  the  malle<;li.     This  arrangement  answered  the  purposes  of  extension  admirably,  while  counter-extension  was  effected  by  elevating 
the  foot  of  the  bed.     The  patient's  convalescence  was  very  tedious.     lie  suffered  from 
bed-sores  and  almost  continuous  pain,  requiring  the  constant  administration  of  opiates  nnd 
anodynes;  but  gradually  improved,  and,  on  December  9th,  Dr.  llOFF  notes:  "From  this 
date  there  was  scarcely  an  'untoward  symptom.     Convalescence  progressed  slowly  but 
surely;  stiirncss  of  the  muscles  disappeared  entirely  about  the  15th  instant.     Tympanitis 
lasted  three  days.     Spasm  persisted,  but  with  greatly  reduced  violence,  nearly  two  weeks 
after  the  extension-weight  was  removed,  December  27th.     The  patient  had  daily  exercise, 

FIG.  88a.— Excised  upper  ex-    and,  on  Januarv  10,  1878,  took  his  first  walk  in  the  open  air.     The  discharge  grew  less  in       vir  £M,      T3.,ct,  ,.,«• 

tremi tv of riffht  femur-  anterior  '   •  """• — *  OBtenot  \  ie\\  01 

view      Spec  C787  amount,  and,  on  January  15th,  the  dressings  were  entirely  removed.     February  17th,  the    the  same. 

partial  anchylosis  of  the  right  knee  joint  not  having  been  fully  overcome  by  passive  motion 

and  mechanical  appliance,  ether  was  administered  and  the  adhesions  thoroughly  broken  up.  There  was  partial  bony  anchylosis,  the  patella  at  portion  of 
superior  external  border  was  firmly  joined  to  femur,  and  in  the  breaking  down  suffered  fracture.  The  limb  was  placed  in  a  straight  splint,  and  on  the 
third  day  passive  motion  was  instituted.  March  18,  1878,  the  patient  was  ordered  to  join  his  regiment.  The  false  joint  at  the  hip  had  all  the  motions  of 
its  predecessor  in  a  somewhat  limited  degree,  and,  though  capable  of  sustaining  the  patient's  weight  while  walking,  was  not  yet  equal  to  any  great  exer 
tion,  but  daily  gained  in  strength.  In  other  respects  the  patient's  health  was  in  admirable  condition.  Apparent  shortening  of  the  limb  one  inch.  The 
resected  upper  extremity  of  the  femur  was  contributed  to  the  Army  Medical  Museum  by  the  operator,  and  is  numbered  0787  of  the  Surgical  Section.  It 
is  shown  in  the  wood-cuts  (FIGS.  88a,  8S&).  In  a  letter  to  Dr.  HOFF,  dated  Fort  Clark,  Texas,  April  3C,  1878,  Sergeant  Linn  writes :  "  Dear  Sir:  I  write 
to  you  according  to  promise  to  let  you  know  how  1  am  getting  along.  I  am  feeling  just  as  well  as  ever  I  did.  My  leg  is  improving  in  size  and  strength, 
but  the  hip  joint  is  just  about  the  same  as  when  I  left  you.  1  weigh  one  hundred  and  fifty  pounds  now  and  am  still  improving."  On  July  10,  1878, 
Surgeon  JOHN'  MoOKE,  U.  S.  A.,  Medical  Director  Department  of  Texas,  forwarded  to  the  Surgeon  General  two  photographs  showing  the  appearance 
of  the  limb  ten  months  after  the  operation.  They  are  copied  in  the  wood-cuts  (Fir;s.  87,  88)  on  the  preceding  page.  In  a  letter  from  Fort  Clark,  Texas, 
October,  1 878,  Linn  states  that  he  "  don't  use  a  crutch  at  all,  and  only  uses  a  cane  when  he  goes  to  walk  a  long  distance." 


SECT,  n.]  EXCISION    AT   THE   HIP    FOR   SHOT   INJURY.  125 

this  officer  were  unavailing.  The  second  survivor  of  the  intermediary  operation,  Hugh 
Wright  (CASE  240,  ante),  excised  May  27,  1864,  walked  well  without  crutch  or  cane, 
bearing  his  full  weight  on  the  mutilated  limb.  He  lived  until  October  26,  1874;  his 
death  was  ascribed  to  cardiac  trouble. 

Of  the  six  patients  submitted  to  excision  at  the  hip  in  the  United  States  Army  and 
Navy  since  1865,  four  recovered.  Assistant  Surgeon  F.  Meacham's  primary  case  of  Erne, 
4th  Infantry,  aged  48  (Note  1,  p.  120,  ante),  operated  on  December  3,  1869,  lived  until 
November,  1871.  The  patient  walked  comfortably  on  crutches  and  had  slight  control  of 
his  limb.  Recovering  thoroughly  from  the  coxo-femoral  lesions,  he  became  a  great  sufferer 
from  chronic  diarrhoea,  and,  at  last,  was  attacked  with  acute  mania.  The  other  three  cases 
were  examples  of  successful  secondary  excision.  In  the  case  of  Charles  F.  Read,  37th 
Infantry  (Note  to  p.  122,  ante),  wounded  June  6,  1868,  and  successfully  excised  by  Assist 
ant  Surgeon  J.  R.  Gibson,  August  14,  1868,  the  result  was  exceptionally  gratifying.  In 
a  letter  from  his  home  at  Thornton's  Ferry,  New  Hampshire,  dated  July  1,  1878,  nearly 
ten  years  after  the  operation,  Read  was  able  to  write  that  he  thought  he  had  a  very  good 
leg  under  the  circumstances,  and  used  no  artificial  appliance.  His  crutches  he  had  laid 
aside  since  1871,  relying  altogether  on  his  cane,  with  which  he  "could  get  along  very 
handily."  He  adds  a  minute  account  of  the  condition  of  the  injured  limb,  showing  indis 
putably  an  extraordinary  restoration  of  the  functions  of  the  articulation.  "I  can  use  it 
so  well,"  says  Read,  "that  some  think  me  falsifying  when  I  tell  them  that  the  head  of  the 
bone  is  lost."  In  the  secondary  case  of  the  seaman,  Charles  B.  Scott,  wounded  June  17, 
1870,  on  whom  Surgeon  W.  E.  Taylor,  U.  S.  N.,  successfully  excised  the  head  of  the  femur, 
July  25,  1870,  there  was  temporary  relief.  The  patient  regained  comparative  health  and 
flesh,  and  partial  use  of  the  limb,  exchanging  his  crutches  for  a  cane;  but  necrosis  invaded 
the  articulation,  and  the  patient  succumbed  July  1,  1877,  while  on  a  visit  to  his  friends 
in  Tyrone  County,  Ireland.  In  the  case  of  Sergeant  W.  J.  Linn,  4th  Cavalry,  wounded 
November  25, 1876,  who  underwent  excision  at  the  right  hip  by  Assistant  Surgeon  J.  V.  R. 
Hoff,  U.  S.  A.,  September  28,  1877;  a  year  after  the  operation  the  patient's  health  was 
in  admirable  condition,  and  there  was  every  prospect  that  the  mutilated  limb  would  regain 
as  great  a  measure  of  utility  as  can  be  hoped  for,  under  such  circumstances.  In  October, 
1878,  he  had  discarded  the  crutch,  and  only  used  a  cane  when  he  walked  long  distances. 

Of  the  sixty-six  excisions  at  the  hip  performed  during  the  American  civil  war,  forty- 
five  were  practised  on  Union  and  twenty-one  on  Confederate  soldiers.  Of  the  forty-five 
Union  soldiers,  four  recovered,  a  mortality  rate  of  91.1  per  cent.;  of  the  twenty-one 
Confederates,  two  recovered,  a  fatality  of  90.5  per  cent. 

The  side  on  which  the  excision  was  practised  was  recorded  in  sixty-one  of  the  sixty- 
six  cases,  twenty-six  being  on  the  right  and  thirty-five  on  the  left  side.  Three  of  the 
former,  or  88.4  per  cent.,  and  also  three  of  the  latter,  or  91.4  per  cent.,  proved  fatal. 

Six  operations,  viz:  one  primary,  four  intermediary,  and  one  secondary,  performed 
on  patients  under  the  age  of  20  years,  terminated  fatally;  twenty  excisions,  viz:  nine 
primary,  six  intermediary,  and  five  secondary,  on  patients,  between  20  and  29  years, 
inclusive,  presented  three  recoveries,  one  after  a  primary,  and  two  after  intermediary 
operations;  of  thirteen  operations  on  men  between  30  and  39,  six  were  primary,  four 
intermediary,  and  three,  with  two  recoveries,  were  secondary;  four  excisions  were  per 
formed  on  patients  over  40  years,  two  being  fatal  intermediary,  and  two,  with  one  recovery, 


126  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

secondary  operations.  In  twenty-three  of  the  sixty-six  excisions  the  ages  of  the  patients 
were  not  ascertained. 

According  to  the  statistical  arrangement  of  the  cases  of  excision  at  the  hip  for  shot 
wounds  in  the  American  civil  war,  as  given  in  TABLE. X,  p.  89,  ante,  the  mortality  of  the 
primary  operations  was  96.9  per  cent.,  that  of  the  intermediary  90.9  per  cent.,  while 
the  fatality  of  the  secondary  operations  was  only  72.7  per  cent.  The  results  of  the  six 
e'xcisions  at  the  hip  in  the  American  Army  and  Navy  since  the  civil  war  gave  a  mortality 
of  50.0  per  cent,  for  the  primary  operations,  of  100.0  per  cent,  for  the  intermediary,  while 
the  three  secondary  operations  were  all  successful.  Of  the  ninety-nine  other  cases  of 
excision  at  the  hip  after  shot  injury,  cited  in  Note  1,  page  90,  ante,  of  primary  cases,  87.5 
per  cent,  proved  fatal;  of  the  intermediary  all  perished,  while,  of  the  secondary,  only  66.6 
per  cent,  had  a  fatal  termination.  Aggregating  all  cases  of  excision  at  the  hip  for  shot 
injury  in  which  the  results  have  been  ascertained,  we  have  a  mortality  rate  of  93.0  per 
cent,  for  the  primary,  of  96.6  per  cent,  for  the  intermediary,  and  of  63.4  per  cent,  for  the 
secondary  operations.  This  result  confirms  what  we  have  already  stated  on  page  610  of 
the  Second  Surgical  Volume,  that  the  "excisions  and  amputations  practised  during  the 
intermediary  or  inflammatory  stage  are  by  far  the  most  dangerous,  and  should  never  be 
performed  except  as  compulsory  operations."  The  ratio  of  mortality  in  the  secondary  or 
ulterior  operations  is  considerably  less  than  that  in  the  primary  operations.  But  this  fact 
should  not  lead  to  the  conclusion  that  the  primary  operation  is  to  be  avoided.  The  dis 
astrous  results  attending  cases  of  indubitable  shot  fracture  at  the  hip  treated  by  tempor- 
ization,  as  pointed  out  on  page  88,  ante,  must  induce  the  surgeon  to  desist  from  such  an 
experiment,  and  to  excise  primarily  rather1  than  submit  the  patient  to  the  danger  of  the 
inflammatory  period.2 

In  nine3  of  the  sixty-six  cases  of  excision  of  the  head  of  the  femur  performed  for 
shot  injuries  received  during  the  American  civil  war,  the  acetabulum  was  involved,  and, 
although  these  nine  cases  terminated  fatally,  the  successful  operations  of  Assistant  Surgeon 
J.  V.  R.  Hoff,  U.  S.  A.,  in  the  case  of  Linn  (Note  on  page  123,  ante],  and  of  Drs.  Schon- 

1  Dr.  JOHN*  AsilHUUSl',  jr.  (Princ.  and  Pract.  of  Surgery,  1671,  p.  165),  declares  that:  "Gunshot  injuries  of  the  hip  joint  are  universally  regarded 
as  among  the  gravest  injuries  met  with  in  military  practice,"  and,  after  reviewing  the  statistical  and  other  evidence  on  the  comparative  advantages  of 
expectant  treatment,  excision,  and  amputation,  asserts  that :  "  From  these  facts  the  conclusion  is  fairly  drawn,  that  in  any  case  of  gunshot  injury  of  the  hip 
joint,  primary  excision  should  be  preferred  to  any  other  mode  of  treatment,  and  this  simply  to  increase  the  chance  of  life,  without  reference  to  the  utility 
of  the  preserved  limb.  Of  course  there  may  be  such  extensive  destruction  of  parts  as  to  put  excision  out  of  the  question,  and  in  such  cases  the  surgeon 
must  still  have  recourse  to  what  HEXXEX  calls  the  '  tremendous  alternative '  of  hip  joint  amputation,  an  operation  which  may  also  be  required  secondarily, 
after  an  unsuccessful  attempt  to  save  the  limb."  Dr.  WILLIAM  THOMSON,  formerly  Brevet  Major  and  Assistant  Surgeon,  U.  S.  A.,  who,  as  Acting  Med 
ical  Inspector  of  the  Army  of  the  Potomac  and  Surgeon-in-charge  of  Douglas  Hospital,  Washington,  had  excellent  opportunities  to  investigate  the  subject 
of  shot  fractures  at  the  hip  joint,  wrote  to  the  compiler  in  1868 :  *  *  ''  From  a  study  of  these  cases,  and  others  similar  in  character,  it  would  appear  that 
the  fatal  terminations,  under  expectant  treatment,  are  due  to  the  following  causes :  the  joint  becomes  inflamed  primarily  or  secondarily ;  the  capsule  becomes 
distended  by  the  products  i.f  inflammation,  gives  way,  and  the  contents  escape  into  the  neighboring  parts,  and  give  rise  to  those  extensive  dissecting 
abscesses  which  are  found  at  the  autopsies,  and  which  account  so  entirely  for  the  fatal  results.  If  these  views  should  be  accepted,  a  full  and  free  incision 
into  the  joint,  at  an  early  period,  would  be  the  proper  surgical  procedure,  and  this  is  accomplished  by  its  excision.  The  removal  of  the  head  of  the  bone 
severs,  to  that  extent,  the  connection  between  the  body  and  the  lower  extremity,  prevents  that  constant  disturbance  at  the  joint  that  follows  every  motion 
of  the  body,  and  thus  places  the  seat  of  injury  at  comparative  rest.  The  division  of  the  bone  through  its  cancellated  structure  may  increase  the  risk  of 
osteomyelitis  with  its  purulent  infection,  and  experience  may  yet  demonstrate  that  a  full  and  free  incision  alone,  in  the  primary  stage,  may  be  the  best 
resource  of  surgery." — (Circular  No.  2,  S.  G.  O.,  1869,  p.  114.) 

2LOSSEN'  (I.)  (Kritgschir.  Erf.  aus  Mannheim,  Heidelberg  und  Carlsruhe,  in  Deutsche  Zeitschr.  fur  Chir.,  1873,  B.  II,  p.  64)  cites  a  fatal  case  of 
shot  fracture  of  the  neck  of  the  femur  and  great  trochauter,  and  remarks  :  "A  primary  resection  of  the  joint,  with  removal  or  gouging  of  the  trochanter 
major,  might  in  this  case  have  offered  a  chance  for  recovery.  But  it  was  probably  difficult  to  ascertain  immediately  after  the  injury  how  far  the  joint  was 
involved.  -A  secondary  excision,  from  the  general  appearances  (post-mortem)  cited,  gave  very  little  prospect  of  success."  FisCHEll  (II.)  (Kriegschirur- 
gische  Erfahrungen,  Erlangen,  1872,  p.  201)  remarks  of  shot  fractures  of  the  hip  joint:  "  AH  well-timed  operative  interference  miscarries  on  account  of 
the  difficulty  of  the  diagm>sis.  .  .  I  lament  this  difficulty  and  impossibility  of  exact  diagnosis,  because  I  believe  that  the  best  mode  of  treatment  of* 
shot  fractures  of  the  hip  joint  is  the  primary  resection  of  the  joint',  however  difficult  the  execution  of  the  operation  might  be." 

3  CASE  209,  p.  93,  Private  Charles  Beard,  10th  Miss.;  CASE  224,  p.  95,  Sergeant  S.  Grimshaw ;  CASE  235,  p.  98,  Captain  T.  R.  Robeson ;  CASK 
236,  p.  98,  Unknown  private  of  the  First  Army  Corps ;  CASE  237,  p.  99,  Unknown ;  CASE  247,  p.  105,  Private  C.  E.  Marston,  1st  Massachusetts ;  CASH 
257,  p.  109,  Corporal  H.  C.  Sennett,  122d  New  York  :  CASE  259,  p.  110,  Lieutenant  D.  N.  Patterson,  46th  Virginia;  CASE  269,  p.  118,  Private  A.  Toney, 
16th  North  Carolina. 


SECT.  U.| 


AMPUTATIONS    AT    THE    HIP    JOINT. 


127 


born1  arid  Hupeden,2  prove  conclusively  that  an  injury  of  the  margin  of  the  acetabulum 
does  not  preclude  the  operation  of  excision  at  the  hip. 

When  we  consider  the  evidence  adduced  in  the  foregoing  pages,  and  especially  the 
fact  that  of  one  hundred  and  seventy-one  patients  on  whom  excision  at  the  hip  for  shot 
injury  is  known  to  have  been  performed  to  the  present  date,  twenty-three  survived  the 
operation,  although  in  one  instance  the  excision  was  followed  by  amputation  at  the  hip 
(Neudorfer's  case  of  Schranz,  Note  1,  on  page  90,  ante),  and  that  the  remaining  twenty- 
two  survivors  had  more  or  less  use  of  the  injured  limbs,  it  must  be  admitted  that  the  results 
of  this  operation,  so  far,  have  been  encouraging,  in  an  almost  hopeless  class  of  cases. 

AMPUTATIONS  AT  THE  HIP  JOINT.-In  1867,  in  a  monograph  on  amputa 
tions  at  the  hip  joint,3  it  was  stated  that  "fifty-three  authenticated  instances  of  amputations 
at  the  hip  joint,  performed  on  account  of  injuries  inflicted  by  weapons  or  of  lesions  con 
secutive  thereto,"  had  occurred  during  the  American  civil  war.  Since  that  time,  data  of 
thirteen  additional  cases  of  this  operation  have  been  obtained,  making,  at  the  present  time, 
a  total  of  sixty-six  cases  of  coxo-femoral  amputations  to  be  considered  here: 

TABLE  XIV. 
Numerical  Statement  of  Sixty-Six  Cases  of  Amputation  at  the  Hip  Joint. 


AMPUTATIONS. 

TOTAL  CASES. 

RECOVERIES. 

DEATHS. 

RATIO  OF 

MORTALITY. 

Primary  

"5 

3 

00 

88  0 

Intermediary  

*3 

23 

100  0 

Secondary  

9 

0 

77  7 

Reampututions  

9 

6 

3 

33.  3 

Aggregate  

66 

11 

55 

83  3 

I  have  continued  to  divide  these  sixty-six  operations  into  primary,  intermediary, 
secondary,  and  reamputations,  according  to  the  plan  adopted  in  the  monograph  of  1867, 
and  the  relative  percentage  of  fatality  of  the  secondary  operations  and  of  reamputations 
confirm  me  in  the  opinion  expressed  at  that  time,  that  the  reamputations  "should  be  sep 
arated  into  a  distinct  class,  because  they  are  quite  numerous  and  widely  differ  in  ttie  risk 
attendant  upon  them  from  other  secondary  operations."  Of  nine  cases  of  reamputations 
at  the  hip  three  only,  or  33.3  per  cent.,  were  fatal;  of  nine  secondary  operations  six,  or 
77.7  per  cent.,  terminated  in  death.  The  subjects  of  the  twenty-three  intermediary 
exarticulations  at  the  hip  all  perished,  and  of  twenty-five  primary  amputations  probably 
three  were  successful. 

As  indicated  in  TABLE  IX,  page  65,  an$e,  in  twenty-seven  of  the  sixty-six  exarticu 
lations  the  injury  directly  involved  the  hip  joint.  In  thirty-two  instances,  the  operations 
followed  shot  fractures  which  did  riot  extend  beyond  the  diaphysis  of  the  femur.  In  two 
of  this  scries  and  in  seven  examples  in  which  the  primary  lesion  implicated  the  knee  joint, 
amputations  in  the  continuity  of  the  thigh  had  preceded  the  exarticulations  at  the  hip. 

1  See  L AXGFABECK  (B.  von),  Ucber  die  Schussfracturen  der  Geknlce  und  Hire  Behandlung,  Berlin,  1868,  p.  16,  and  CASE  2-1  of  Note  1,  on  page  00,  ante. 

2  See  DEINIXGKR,  Beitrdge  zu  den  Scliustfracturen  des  HiJftgeknks  untcr  besonderer  BeriicksicJitigung  der  Erfahrungen  aits  dent  Fcldzuge  1870-71 
und  Benutzung  der  Acten  des  Koniglichen  Kriegsministeriums,  in  Deutsche  Militairdrztlichc  Zcitschrift,  1874,  B,  III,  p.  300,  CASE  No.  37;  and  CASE 
No.  63,  in  Note  on  page  91,  ante. 

3 OTIS  (G.  A.),  A  Report  on  Amputations  at  the  Hip  Joint  in  Military  Surgery,  Circular  No.  7,  War  Department,  Surgeon  General's  Office,  July 
1,  1867,  Washington,  p.  20. 


128  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

In  the  subjoined  foot-note1  an  endeavor  is  made  to  compile  a  correct  record,  in  chrono 
logical  order,  of  the  published  authentic  examples  of  amputation  at  the  hip  joint  in  military 

'LARREY  (D.  J.)  (Men.  de  Chir.  mi!,  et  Camp.,  Paris,  1812,  T.  II,  p.  180),  A  soldier  of  the  French  army  of  the  Rhine,  in  1793.     Primary  operation; 
died  within  a  week. — 2.  WEXDELSTADT  (Reminiscen:en,  in  IIUFELAXD's  Neues  Journal  tier  Practischen  Arzneykunde,  Berlin,  1811,  B.  XXVI,  StUok 

11,  p.  110)  relates:  "I  have  seen  and  examined  an  Englishman,  who  served  as  a  sailor  in  the  British  Navy,  and  who  had  lost  at  the  bloody  battle  of 
Aboukir,  August  1,  1798,  the  thigh  from  a  cannon  ball,  and  who  had  undergone  the  amputation  of  the  probably  splintered  stump  out  of  the  acetabulum, 
and  who  survived  the  operation  many  years." — 3.  LARREY  (D.  .T.)  (Rel.  chir.  de.  I'Armee.  d' Orient,  Paris,  1803.  p.  329),  Bonhomme,  officer  of  the  16th 
Demi-Brigade,  Army  of  Egypt,  1799.     Primary  exarticulation  at  right  hip;  died  of  the  plague  on  the  eighth  day. — 4.  LARKEY  (D.  J.)  (Rel.cliir.  de 
I'Armee  d' Orient,  1803,  p.  332),  Drummer  of  2d  Light  Demi-Brigade,  Army  of  Egypt,  in  1799,  aged  20.    Primary  amputation  at  right  hip;  died  in  a  few 
days. — 5.  LARREY  (D.  J.)  (Mem.  de  Cliir.,  etc.,  1812,  T.  Ill,  p.  350),  A  French  soldier  at  Wagram,  July  6,  1809.     Primary  operation;  died  in  three 
hours.— 6.  LAUUEY  (D.  J.)  (Mim.  de  Chir.,  etc.,  T.  Ill,  p.  351),  A  French  soldier  at  Wagram,  July  6,  1809.     Primary  operation ;  died  within  twenty-four 
hours. — 7.  BROWXRIGG  (GUTHUIE's  Commentaries,  6th  ed.,  1855,  p.  62),  A  soldier  at  Elvas,  1811.     Secondary  operation  ;  died  in  eight  days.— 8.  L.vUREY 
(D.  J.)  (Hem.  de  Chir.,  etc.,  1817,  T.  IV,  p.  26),  A  Russian  soldier,  in  1812.     Primary  amputation  at  left  hip ;  died  on  the  twenty-ninth  day  from  dysen 
tery.— 9.  LARREY  (D.  J.)  (Mem.  de  Chir.,  etc.,  1817,  T.  IV,  p.  50),  Lieutenant  of  Dragoons,  Borodino,  September  7,  1812.     Primary;  alive  and  well  at 
Orcha  three  months  after. — 10.  BROWXRIGG  (AVEHILL  (C.)  (A  Short  Treatise  on  Operative  Surgery,  London,  1825,  p.  217),  Private  13th  British  Light 
Dragoons,  December  29,  1811.    Secondary  operation  December  12, 1812;  recovery. — 11.  BROWXRIGG  (A VERILL,  loc.  cit.),  Particulars  not  recorded  ;  fatal. — 

12.  G  UTHIUE  (G.  J.)  ( Treatise  on  Gunshot  Wounds,  1827,  p.  332),  Private  Mason,  23d  British  Infantry,  in  1 812.     Secondary  re-amputation  ;  death  in  seven 
hours. — 13.  COOPER  (SAMUEL)  (Diet.  Pract.  Surg.,  8th  London  ed.,  1861,  Vol.  I,  p.  116),  A  British  soldier  at  Oudenbosch,  in  Holland,  in  1814.     Inter 
mediary  operation;  died  in  a  few  minutes.— 14.  COLK  (Or.  J.  GUTHRIE,  loc.  cit.,  p.  351),  A  soldier  at  Bergen-op-Zoom,  1814.     Secondary  operation;  died 
in  twenty  hours.— 15.  EMERY  (GUTHRIG,  loc.  cit.,  p.  334),  Sebastian  de  1' Amour,  Corp.  Chass.  Britt.,  Spain,  August,  1813.     Secondary  operation  July 
21,  1814;  death  in  thirty  days. — 16.  GUTHRIE  (G.  J.)  (A  Treatise  on  Gunshot  Wounds,  London,  1827,  p.  342),  Duguet,  45th  French  Regiment,  aged  25, 
Waterloo,  June  18,   1815.    Intermediary  operation  July  7th;  recovered.    Dugnet  died  in  1840  (GUYOX,  Stat.  da  amputations  pratiqutes  a  I'Armee 
d'Afrique,  etc.,  pendant  les  anndes  1837,  1838,  et  1839,  in  Gaz.  Med.  de  Paris,  1841,  T.  IX,  p.  106).— 17.  Mr.  BUCKE  (J.  THOMSON,  06s.  after  the  Battle  of 

Waterloo,  Edinb.,  1816,  p.  270),  A  British  soldier,  Waterloo,  1815.  Secondary  operation ;  died  in  eight  days.— 18.  B.  BRODIE  (G.  J.  GUTHKIE,  On  Gunshot 
Wounds  of  the  Extremities,  London,  1815,  p.  116)  operated,  in  1814,  unsuccessfully  in  a  case  of  accidental  shot  wound.— 19.  QUARRIER  (D.)  (Med.  Chir. 
Trans.,  1820,  Vol.  VIII,  p.  3),  Seaman  T.  Sullivan,  Algiers,  1816.  Primary  operation  ;  death  in  fifteen  minutes.— 20.  KRIMEU  (Exarticulution  de» 

Oberschenkels  aus  dem  Huftgelenke,  in  Journal  der  Chirurgie,  von  C.  F.  von  Gli.VEFE  und  Ph.  v.  WALTHKR,  Berlin,  1828,  B.  XII,  p.  121),  J.  S.  C , 

aged  38,  Waterloo,  1815.  Exarticulated  in  1822;  died  on  the  tenth  day.— 21.  Er.  Sl'ER  (ROUX  (J.),  Desarticulation  de  la  cuisse  d'apres  des  observations 
rec.  a  Saint  Mandrier,  Paris,  1860,  p.  4),  A  galley  prisoner  at  Toulon,  in  1825;  fatal.— 22.  DlEFFEXUACH  (J.  F.)  (Mag.  fur  die.  gesammte  Heilkunde,  B. 
XXIV,  II,  S.  335),  A  Baron,  aged  22.  Secondary  operation  in  1826 ;  died  in  ten  hours.— 23.  Dr.  BRYCE  (Glasgow  Med.  Jour.,  1831,  p.  262),  Soldier,  aged 
23,  at  the  siege  of  Athens,  May,  1827.  Recovery  in  six  weeks.— 24.  ROUX  (P.  J.)  (Gaz.  des  Hop.,  1830,  p.  392),  A  Swiss  subaltern,  in  1830.  Primary 
operation;  died  the  same  day.— 25.  CLOT  BEY  (Gaz.  des  Bop.,  1830,  T.  IV,  p.  96),  All  Homer,  an  Arab,  aged  26.  Secondary  operation  in  1830;  died 
November  17,  1830.— 26.  SED1LI.OT  (C.)  (Ann.  de  la  Chir.  Fran?,  et  Et.,  1841,  T.  II,  p.  27!>),  A  Russian  prisoner;  Poland,  1831.  Primary;  died  soon 
after  the  operation.— 27.  The  elder  DEMME  (VERDAT,  These  inaug.,  Berne,  1846,  and  A.  LtfNJNG,  Vber  die  Blutung  bei  der  Exarticulation  des  Ober- 
schenkels,  Zurich,  1877,  p.  69),  Polish  solder,  in  1831.  Intermediary  operation ;  death  in  thirteen  days.— £8.  Surgeon  ARXOU)  (A.LUXIXG,  loc.  cit.,  p.  69, 
and  VERDAT,  These  inaug.,  Berne,  1846),  Russian  soldier  in  Polish  War,  1831.  Ligation  of  common  iliac  by  Dr.  DEMME.  Intermediary  exarticulathm 
at  hip;  death  on  the  third  day.— CD.  Dr.  FRAXCKE  (A.  LUXIXG,  loc.  cit.,  p.  69,  and  FRAXCKE,  Diss.,  Leipzig,  1835),  Russian  soldier,  A.  Pasgezuk,  aged  22, 
Warsaw,  Sept.  7,  1831.  Operation  Sept.  22,  1831 ;  death  in  two  days.— 30.  The  elder  DEMME  (A.  LUXIXG,  loc.  cit.,  p.  68,  and  VEUDAT,  These  inaug.,  Berne, 
1846),  Polish  soldier,  in  1831.  Intermediary  operation;  death  from  gangrene  on  fifth  day.— 31.  LF.TULLE  (H.  LAUREY,  Hist.  chir.  du  siege  de  la  Cit. 
d'Anvers,  1803,  p.  307),  A  French  cannonier  of  the  llth  regiment  of  Artillery.  Siege  of  Antwerp,  1832.  Primary  operation  December  13th ;  died  Decem 
ber  22,  1832.— "32,  33.  During  the  campaign  in  Syria,  in  1832,  two  exarticulations  at  the  hip  were  performed,  one  by  VOX  WELZ,  the  other  by  CliRUUlilM. 
Both  were  fatal  (M.  JAEGER  in  Dr.  W.  WALTHEK'S  Handwiirterbuch  der  Gesammten  Chirurgie,  Leipzig,  1836,  B.  I,  p.  409).— 34,  35.  ALCOCK  (R.) 
(Notes  on  the  Sled.  Hist,  and  Stat.  of  the  British  Legion  in  Spain,  London,  1838,  p.  78)  relates  that  he  was  informed  by  Dr.  BEI.MUXT  that  an  accom 
plished  Spanish  surgeon  had  twice  amputated  at  the  hip  joint  during  the  Peninsular  War  of  1835— once  with  success.— 36.  HUT1X  (F.)  (Rec.  de  Mem.  de 

Med.  de.  Chir.,  etc.,  I"  s6rie,  T.  XLIV,  p.  219),  M ,  a  soldier  of  the  1st  Light  Battalion,  Constantine,  1836.     Primary  amputation  ;  Manec's  method  ; 

died  December  13,  1836  —37.  HUTIX  (F.)  (Rec.  de  Mem.  de  Med.  de  Chir.,  etc.,  T.  XLIV,  p.  220),  L ,  2d  Regiment  of  Engineers,  Constantine,  1836. 

Primary  operation  ;  died  December  4,  1836.— 38.  BAUDEXS  (L.)  (Clin.  des  plaies  d'armes  a  feu,  Paris,  1836,  p.  517),  C .  a  soldier  in  the  Dattalion 

d'Afrique,  24  years  old,  Algiers,  1836.  Intermediary  operation;  recovered,  and  was  an  inmate  of  the  Hotel  des  Invalides  in  1840  (SEDILI.OT.  Amp.  coxo- 
fenwrale,  in  Rec.  de  Mem.  de  Med.,  1840,  T.  49,  p.  276).— 39^1.  From  the  tabular  statement  of  Dr.  GUYOX  (Statistique  des  amputations  pratiques  d 
Varmee  d'Afrique,  etc.,  pendant  les  annees,  1837,  1838,  et  1839,  in  Gaz.  Med.,  1841,  T.  IX,  p.  105)  it  appears  that  no  exarticulations  at  the  hip  were  per- 
formed  during  these  years ;  but  Dr.  GUYOX  states  (loc.  cit.,  p.  106)  that  three  unsuccessful  amputations  at  the  hip  were  performed  in  1841. — 42.  BAUDEXS 

(L.)  (Rec.  de  Mem.  de  Med.  de  Chir.,  etc.,  1853,  2«"  s6r.,  T.  X,  p.  130),  X ,  a  soldier  of  the  18th  Light  Infantry,  Paris.  1848.    Primary  operation; 

death  on  the  second  day.— 43.  VlDAL  (AUG.)  (Traite  de  Path.  ext.  et  de  Med.  op.,  5«"  ed.,  Paris,  1861,  T.  V,  p.  731),  A  French  student  of  medicine, 
insurrection  in  Paris  in  1848.  Secondary  exarticulation ;  fatal.— 44-46.  During  the  same  revolution  RlCHET  (M.  E.  HERVIEUX,  Compte  rendu  des  blessCs 
recvs  a  I'ambulance  des  Tuileries,  in  Gaz.  Med.  de  Paris,  1848,  p.  712)  performed  a  primary  operation  which  proved  fatal ;  and  P.  GUEliSAXT  and  ROBERT 
(L.  LEGOUEST,  TraiU  de  Chir.  d'Armfe,  1863,  p.  700)  had  each  an  unsuccessful  intermediary  operation.— 47.  RESTELLI  (F.  BAROFF1O,  Delle  Ferite  d'arma 
da  fuoco,  Torino,  1862,  p.  284)  performed  a  successful  exarticulation  in  1848,  after  the  insurrection  in  Lombardy. — 48.  TliEZZI  (GRITTI  ROCCO,  Delle 
Fratture  del  Femore  par  arma  da  fuoco,  Milano,  1866,  p.  80)  operated  unsuccessfully  on  an  insurgent  at  Milan  in  March,  1848. — 49.  C.  TEXTOU  (G.  B. 
GUEXTHER,  Die  Blutigen  Operationen,  Leipzig,  1859,  Abschmitt  VIII,  p.  180),  Exarticulation  for  shot  fracture  of  the  neck  of  the  femur  in  a  patient  aged 
32,  in  1848;  death  from  pytBmia.— 50.  TEXTOU,  the  younger  (GDxTHEli,  loc.  cit.,  p.  180),  performed  an  intermediary  operation  in  1848;  death  on  the 
fourth  day.— 51.  ROUX  (R  J.)  (Des  plaies  d'armes  a  Jeu,  Communications  fa ites,  etc.,  par  BAUDEXS,  ROUX,  etc.,  Paris,  1849,  p.  38,  and  Gaz.  des  Hop., 
1848,  p.  513)  had,  in  June,  1848,  a  secondary  fatal  operation.— 52.  LlXHAUT  (W.)  (A.  LUXIXG,  loc.  cit,  p.  75,  and  ESCHE,  Diss.  inaug.,  Wtlraburg, 
1863,  p.  11),  in  1848,  in  a  case  of  shot  comminution  of  the  trochanter,  ligated  the  femoral,  and  afterwards  exarticulatcd  at  the  hip.  The  patient  died 
shortly  after  the  operation.— 53-59.  During  the  Schlesxvig-Holstein  War,  1848-50.  seven  exarticulations  at  the  hip  were  made.  Prof.  B.  von  LANGEXI'.ECK 
(Vber  die  Schussfracturen  der  Gdenke,  Berlin,  1868,  p.  19)  performed  four  of  the  sevon  operations:  J.  Seibold,  drummer  in  Tann's  corps,  aged  18, 
wounded  at  Hoptrup,  June  7,  1848;  operation  June  8th;  patient  hale  and  hearty  in  18.56.  Anders  Nielson,  2d  Danish  Jaegers,  aged  2fi,  Schleswig,  April 
23,  1848;  operation  April  24th ;  death  May  21st.  Niels  Andersen,  4th  Danish  Infantry,  Schleswig,  April  23,  1848;  operation  May  14th ;  death  May  20, 
1848.  Danish  soldier,  wounded  at  Ban,  April  9,  1848 ;  operation  June  20th  ;  death  June  21,  1848.  The  other  three  operations  of  this  campaign  proved 
fatal;  no  further  data  are  noted  (L.  STROMEYER,  Maximem,  1861,  p.  53',').— 60.  LEXTE  (F.  D.)  (Transactions  Am.  Med.  Association,  1848,  Vol.  IV.  p. 
316),  J.  Dalzell,  aged  23.  Astor  Place  Riots,  New  York,  1849.  Primary  operation;  died  May  12,  1849.— 61-63.  In  the  War  in  the  Punjaub,  1848-4!), 
three  primary  operations  were  performed.  Dr.  McRAE  (Indian  Annals  of  Med.  Sci.,  1857,  p.  663)  states  that  the  patients  died— one  in  six,  one  in  twelve, 
and  one  in  thirty-six  hours,  from  shock.— 64.  BKCK  (B.)  (Die  Schusswunden,  Heidelberg,  1850,  p.  315),  Soldier  of  the  2d  Baden  Infantry,  wounded  June 
29,  1849,  in  battle,  at  the  Murg.  Secondary  operation:  death  six  days  after  operation.— 65.  FAYRER  (J.)  (Clinical  Surgery  in  India,  London,  1866,  p. 
630),  Moung  Schwe-Mo,  a  Burraan,  aged  30.  Rangoon,  Bengal,  February  15,  1853.  Primary  amputation  at  left  hip  February  16th  ;  deatli  March  17, 
1853.— fi6.  Dr.  BEATSON  (ttAXKIXG's  Abstract,  1855,  No.  21,  p.  182),  Thomas  Lisbey,  aged  61.  Conductor  in  the  Ordnance  Department,  Doimabevv, 
March  19,  1853.  Exarticulation  of  left  hip  March  25th;  died  March  25,  1853.— 67-110.  Of  the  forty-four  exarticulations  at  the  hip  performed  during  the 


SECT.  ii. j  AMPUTATIONS    AT    THE    HTP    JOINT.  129 

surgery  apart  from  the  sixty-six  cases  that  pertain  to  the  "American  civil  war.  This  cate 
gory  comprises  one  hundred  and  eighty-four  cases,  of  which  the  results  are  ascertained  in 

Crimean  War,  two  were  done  in  the  Sardinian  army,  eight  by  Professor  N.  PlUOGOFF  (Grundziige  der  Allgtmeinen  Kriegsch.,  Leipzig,  1864,  p.  1137),  in 
the  Russian  army,  fourteen  in  the  British  army  (MATTHEW,  loc.  cit.,  p.  374),  and  twenty  in  the  French  army  (J.  C.  CHEXU,  Rapport  med.  chir.  de  Camp, 
d' Orient,  18G5,  p.  C58).  PORTA  states  that  the  two  cases  in  the  Piedmontese  army  were  fatal.  Of  PlROGOFF'B  eight  cases  two  survived  five  days  and 
the  others  perished  within  two  or  three  days.  The  operations  in  the  English  army  were  all  primary  and  resulted  fatally.  The  results  of  the  operations 
in  the  French  army  were  equally  unfortunate ;  all  the  patients  died.  Of  twenty-two  of  the  forty-four  cases  it  is  only  recorded  that  they  had  a  fatal 
termination.  The  particulars  of  the  other  twenty-two  will  here  be  cited:  ALEXAXDER  (T.)  (GUTHKIF.'s  Comment.,  6th  ed.,  p.  C-'O)  disarticulated  at  the 
hip,  in  the  case  of  Peter  Cleary,  23d  Fusileers,  for  gunshot  fracture  of  femur,  Alma,  Sept.  20,  1854.  Operation  Sept.  21st ;  patient  died  on  the  passage  to 
Scutari.  ALEXANDER  (T.)  (G.  J.  GUTHUIE,  Commentaries,  6th  ed.,  1855,  p.  620),  A  Russian  prisoner,  Alma,  Sept.  20,  1854.  Primary  operation  Sept. 
22d,  died  Oct.  22,  1854.  ALEXANDER  (T.)  (G.  J.  GUTHUIE,  loc.  cit.,  p.  620),  Peter  Sullivan,  33d  British  Infantry,  Alma,  Sept.  20,  1854.  Primary  opera 
tion  Sept.  21st;  died  Oct.  11,  1854.  McKEXZIE  (R.)  (MACLEOD,  Notes  on  Surgery  in  the  Crimea,  London,  1858,  p.  369),  Soldier,  Alma,  Sept.  20,  1854. 
Primary  operation ;  died.  Assistant  Surgeon  W'YATT  (T.  P.  MATTHEW,  Med.  and  Surg.  Hist,  of  the  British  Army  in  the  Crimea,  London,  1858,  Vol.  I, 
p.  Ill),  An  offleerof  the  Coldstream  Guards,  Inkermann,  Nov.  5, 1854.  Primary  operation ;  died  immediately  after  the  operation.  MOU.MEU  (in  CllENU's 
Rapp.  med.  chir.  sur.  la  Camp,  d' Orient,  18C5,  p.  6CO),  Garassimoff,  a  Russian  prisoner,  Alma,  Sept.  20,  1854.  Intermediate  operation  Sept.  27th ;  died 
Sept.  29,  1854,  two  days  after  the  operation.  LEGOUEST  (L.)  (M6m.  de  la  Soc.  de  Chir.,  1863,  T.  V,  p.  157),  Ignatius  Wolokenski,  5th  Russian  Infantry, 
aged  30,  Alma,  Sept.  20,  1854.  intermediary  amputation  at  left  hip  October  3d;  died  Feb.  9,  1855.  MOUNIEK  (CHENU,  loc.  cit.,  p.  660),  Chiffttzoff,  a 
Russian  prisoner,  Inkermann,  Nov.  5,  1854.  Intermediary  operation  November  5th;  died  December  2,  1854,  one  week  after  the  operation.  PAUI.ET 
(CHENU,  loc.  cit.,  p.  661),  Soldier.  Primary  operation  in  1855;  died  one  hour  after  the  operation.  LUSTREMAN  (CHENU,  loc.  cit.,  p.  661),  Soldier. 
Primary  operation  in  1855 ;  died  five  hours  after  the  operation.  THOMAS  (CHENU,  loc.  cit.,  p.  661),  Soldier,  gunshot  fracture  of  the  femur,  1853.  Primary 
operation  ;  died  five  hours  after  the  operation.  THOMAS  (CHENU,  loc.  cit.,  p.  661),  Soldier,  1855.  Primary  operation  ;  died  eleven  hours  after  operation. 
PEKRIN  (CllEXU,  loc.  cit.,  p.  660),  A  private  of  the  32d  French  Infantry.  Fracture  of  left  femur  July  5,  1855.  Primary  operation  a  few  hours  after 
injury;  died  in  one  or  two  days.  FRANKLYN  (T.  P.  MATTHEW,  lac.  cit.,  Vol.  I,  p.  377),  A  private  of  the  77th  British  Infantry,  Sevastopol,  August,  1855. 
Primary  operation ;  died  twenty-two  hours  after  the  operation,  from  exhaustion.  DUNI.OP  (T.  P.  MATTHEW,  loc.  cit.,  Vol.  I,  p.  403),  A  soldier  of  the 
88th  Regiment  Connaught  Rangers.  Primary  operation ;  died  soon  after  the  operation,  in  November,  1855.  Surgeon-Major  TROUSDELL  (R.  DUUITT, 
Surgeon's  Vade  Mecum,  1865,  9th  ed.,  p.  160),  A  private  of  the  50th  British  Regiment,  Sevastopol,  1855.  Primary  operation  ;  died  the  day  after  the 
operation.  MOCNIER  (CHENU,  loc.  cit.,  p.  6(iO),  Pietrow,  a  Russian  prisoner.  Inkermann,  Nov.  5,  1855.  Secondary  operation  Dec.  19th;  died  Dec.  29, 
1854.  LARIVIEUE  (CHENU,  loc.  cit.,  p.  660),  Kerigla,  a  Russian  prisoner,  Traktir  Bridge,  Aug.  16,  1855.  Intermediary  operation  Aug.  2od;  died  August 
23,  1865,  during  the  operation.  MAUGEIl  (CHENU,  loc.  cit.,  p.  661),  A  Russian  prisoner,  Traktir  Bridge,  Aug.  16,  1865.  Intermediary  operation;  died 
soon  after  the  operation.  SALLERON  (Mem.  de  Med.,  de  C'hir.  et  de  Phar.  Mil.,  2me  s6r.,  T.  XXI,  p.  317),  A  soldier,  Sevastopol,  1855.  Intermediary 
operation  (?);  died  twenty  hours  after  the  operation.  SALLERON  (Mem.  de  Med.,  de  Chir.  et  de  Phar.  Mil.,  2rae  s6r.,  T.  XXI,  p.  317),  A  soldier,  Sevasto 
pol,  1855.  Intermediary  operation  (?);  died  sixty  hours  after  the  operation.  Chief  Surgeon  MARROIN,  of  the  French  Navy  (J.  ROUX,  Desarticulation  de 
la  cuisse,  Paris,  I860,  p.  4),  disarticulated,  in  the  case  of  a  soldier  of  the  Crimean  army,  for  fracture  of  the  greater  trochanter.  The  patient  died  shortly 
after  the  operation. — 11 1-112.  Professor  J.  F.  HEYFELUER,  chief  surgeon  of  the  Russian  army  in  Finland,  in  1855  (Die  Verwundungen  und  Openitionen 
in  Folge  des  Bombardements  von  Sveaborg  vom  9-11  Aug.,  in  Deutsche  Klinik,  1855,  B.  7,  pp.  530-532)  exarticulated  twice  at  the  hip.  A  Finnish  soldier, 
wounded  at  Sveaborg,  August,  1855;  primary  amputation  at  left  hip ;  died  in  two  hours.  Stanislaus  Maletzki,  8th  Finnish  Bat.,  shot  fracture  of  neck  of 
left  femur,  Sv§aborg,  Aug.  9-11,  1855;  primary  operation;  patient  died  in  less  than  an  hour. — 113-115.  BERTHERAND  (Camp,  de  Kabijlie,  Paris,  1862, 

pp.  145,  238,  and  280)  gives  three  examples  of  disarticulation  at  the  hip:  A ,  60th  Line,  wounded  June  20,  1854 ;  fracture  of  neck  of  femur,  disartic- 

ulation,  by  Dr.  GlLGENCRANTZ,  July  14,  1854  ;  death  on  the  same  day,  before  recovering  from  the  effects  of  the  chloroform.  C ,  90th  Line,  shot  frac 
ture  of  neck  of  femur,  Algiers,  May  24,  1857 ;  secondary  disarticulation  ;  died  on  the  day  of  the  operation.  W ,  2d  Legion  etrangere,  shot  fracture  of 

neck  of  right  femur;  disarticulation  by  Dr.  TABOUHET;  fatal.— 116.  BERTHERAND  (A.)  (Camp,  d'ltalie,  de  1859,  Paris,  1860,  p.  37),  An  Austrian  soldier, 
a  prisoner  after  the  battle  of  Palestro,  June  4,  1859.  Intermediary  operation  ;  died  three  hours  after  the  operation. — 117.  ARLAUD  (J.  C.  CHEXU,  Camp, 
d'ltalie  en  1859  et  1860,  T.  II,  p.  697),  Louis  Legallo,  Fusileer,  84th  French  Regiment,  age  25,  Montebello,  Kay  20,  1859.  Secondary  exarticulation  at 
right  hip;  recovered. — 118.  ISNARD  (J.  C.  CHENU,  loc.  cit.,  p.  694),  Captain  Deshayes,  73d  Regiment,  Solferino,  June  24,  1859.  Secondary  exarticula 
tion  at  left  hip;  recovery.— 119.  Roux  (JULES)  (CHENU,  Camp,  d'ltalie,  en  1859  et  1860,  T.  II,  p.  697),  Lieutenant  Joseph  Vitarel,  65th  French  Infantry, 
aged  24,  Magenta,  June  4,  1850.  Secondary  amputation  at  left  hip;  recovered. — 120.  NEUDORFKR  (J.)  (Handbuch  der  Kriegschir.,  1872,  B.  II,  Abth.  II, 
S.  1468),  Johann  Schranz,  7th  Jaeger.  Neck  of  femur.  Palestro,  May  30,  1859.  November  27th,  excision  at  left  hip  joint.  December  1st,  amputation 
at  hip  joint.  NEUDORFER  saw  the  patient  in  1868. — 121.  NEUDORFER  (J.)  (toe.  cit.,  p.  1467),  Jurko  Katsch,  of  Inf.  regiment  E.  H.  Stephan,  Solferino, 
June  24,  1859.  Right  trochanter.  Operation,  August  8th,  seventy-six  days  after  the  injury;  died  August  25,  1859. — 12;!.  NEUDORFER  (J.)  (toe.  cit.,  p. 
1468),  Walland  Waskaneder,  Co.  13,  of  Baron  Rossbach's  Regiment,  Solferino,  June  24,  1859.  Fracture  of  upper  third  of  femur.  Disarticulation  Dec. 
31st  (one  hundred  and  ninety  days  after  injury);  died  four  months  later. — 123.  SCOTTT(G.  B.)  (GRITTI  ROCCO,  Frat.  del  fern,  per  arma  dafuoco,  Milano, 
1866,  p.  80),  An  Italian  soldier.  Gunshot  fracture  of  femur,  Solferino,  June  24,  1859.  Intermediary  exarticulation  in  July,  at  Ospitale  San  Francesco, 
Brescia;  died. — 124.  TASSAXI  (GRITTI  ROCCO,  loc.  cit.,  p.  80),  An  Italian  soldier.  Shot  fracture  of  femur,  Solferino,  June  24,  1859.  Intermediary  ampu 
tation  at  hip  at  Ospitale  Maggiore,  Milan,  July,  1859;  died. — 125.  GlIERINI  (GRITTI  ROCCO,  loc.  cit.,  p.  80),  An  Italian  soldier.  Gunshot  fracture  of  the 
femur,  Solferino,  June  24,  1859.  Disarticulation  about  July  26th,  at  Ospitale  San  Filippo,  Brescia;  died. — 126.  JOHNSON  (T.  D.)  (Amputation at  the  Hip 
Joint,  Recovery,  in  Pacific  Med.  and  Surg.  Jour.,  N.  S.,  Vol.  II,  1808-69,  p.  305),  A  man  of  San  Juan,  Monterey  Co.,  received  a  shot  from  a  Colt's  revol 
ver,  in  July,  1862;  ball  shattered  the  entire  shaft  of  femur.  Dr.  JOHNSON  exarticulated  two  days  after  the  injury.  The  patient  recovered,  and  was  still 
living,  in  1868,  at  the  New  Almaden  mine,  in  Santa  Clara  County. — 127.  VlLLAGRAX  (J.  M.  B.  de)  (Observacion  de  una  herida  de  arma  defuego  situada 
en  el  muslo  izquierdo  complicada  con  fractura  comminutiva  del  femur:  desarticulacion  coxa-femoral  a  los  180  dias,  y  muerte  del  enfernw  a  los  259,  in 
Gaceta  Medica  de  Mexico,  1865,  Vol.  I,  p.  164),  Roman  Medina,  age  26,  shot  Nov.  2,  1863,  in  the  left  thigh,  and  admitted  to  hospital  at  San  Pablo,  Nov.  8, 
1863.  Disarticulated  May  11,  1864 ;  death  July  29,  1864.— 128-129.  LANGENBECK  (B.  von)  (Schussfracturen  der  Gelenke,  Berlin,  1868,  p.  20),  Danish 
soldier,  wounded  at  Alseu,  June  29,  1864 ;  disarticulation  July  1st;  died  July  8,  1864,  of  septicaemia;  and  Danish  soldier,  wounded  at  Alsen,  June  29, 
1864  :  disarticulated  at  right  hip  June  30th;  death  July  5,  1864.— 130-131.  LAXGENBECK  (B.  von)  (Die  Schussfracturen  der  Gelenke,  Berlin,  1868,  p.  21), 
Austrian  soldier,  wounded  at  Koenigsgratz,  July  3,  1866;  exarticulated  at  left  hip  July  10th;  death  July  14,  1866,  of  septicajmia.  Austrian  soldier, 
wounded  at  Koenigsgratz,  July  3,  1866 ;  amputation  at  right  hip  July  17th  ;  death  July  24,  1866.— 132.  LlNHART  (W.)  (BECK.  B.,  Kriegschir.  Erf.,  1867, 
p.  340)  performed  secondary  disarticulation  at  the  hip  in  1866,  at  Wlirzburg,  for  comminution  of  upper  part  of  femur.  Patient  died  a  few  hours  after  the 
operation. — 133.  FISCHER  (K.)  (MilitairdrMiche,  Skizzen,  Arau,  1867,  p.  78)  mentions  a  case  in  which  disarticulation  at  the  hip  was  performed  unsuc 
cessfully  for  hsemorrhage,  in  the  Austro- Prussian  campaign  of  1866. — 134.  HEYFELDER  (J.)  (Gaz.  med.  de  Paris,  1867,  p.  541)  states  that  an  unsuccessful 
disarticulation  at  the  hip  was  performed  at  the  hospital  at  Nedelischt,  in  charge  of  Dr.  WILDE,  after  the  battle  of  Koenigsgratz,  July  3,  1866. — 135. 
MAXNEL  (OTTO)  (Kriegschirurgische  Beobachtungen  im  Cadetenhaus  Kriegslazareth  zu  Dresden,  in  Allgemeine  Wiener  Med.  Zeitung,  1867.  Jahrg,  XII, 

p.  403),  Musquetier  B ,  1st  Thiiringian  Infantry,  No.  31,  wounded  July  3,  1866,  near  Hradeck,  in  the  left  femur.     Exarticulation  October  4,  1866,  by 

Stabsarzt  Dr.  KUHXE ;  died  October  8,  1866.— 136.  Dr.  J.  HEYFELUER  ( Gaz.  Med.  de  Paris,  1867,  p.  540)  reports  that  a  second  amputation  at  the  hip 
was  performed  at  the  hospital  at  Hradeck,  in  1866,  which  proved  fatal  in  about  forty-eight  hours.— 137.  FAYRER  (J.)  (Gunshot  Wound;  Amputation  at 

the  Hip  Joint,  in  Edinburgh  Med.  Journal,  1868,  Vol.  XHI,  II,  p.  793),  Lieutenant  H ,  shot  accidentally,  on  the  Island  of  Ceylon,  Sept.  12,  1867,  over 

the  left  tuber  ischii,  ball  lodged ;  fracture  of  neck  of  femur  not  detected.  Exarticulation  at  left  hip  Sept.  25th ;  died  three  hours  after  the  operation. — 
138.  ASHHURST  (JOHN,  jr.)  ( Case  of  Amputation  at  the  Hip  Joint  for  Gunshot  Fracture  of  the  Head  and  Neck  of  the  Femur,  in  Am.  Jour.  Med.  Sci.,  1869, 

SURG.  Ill— 17 


130  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

one  hundred  and  eighty-three,  presenting  sixteen  recoveries.  We  thus  arrive  at  an  aggre 
gate  of  two  hundred  and  fifty  cases  of  exarticulation  at  the  hip  as  the  present  status  of 
this  grave  mutilation  in  military  surgery,  with  twenty-seven  recoveries,  two  hundred  and 
twenty-two  deaths,  and  one  example  with  unknown  result,  or  a  mortality  rate  of  89.1  per 
cent.  We  will  next  notice  the  details  of  the  sixty-six  cases  of  hip  joint  amputations  of 
the  American  civil  war  as  classified  in  TABLE  XIV. 

Vol.  LVII,  p.  94),  E.  B ,  Irish  woman,  aged  23,  shot  in  the  right  hip,  in  Aug.,  1867,  at  Tacony,  Pennsylvania.     Exarticulation  on  Jan.  14, 1868;  death 

in  three  hours. — 139.  CAROTHER8  (A.  E.)  (Amputation  at  the  Hip  Joint,  in  Am.  Jour.  lied.  Sci.,  1873,  Vol.  LXV,  p.  92),  Juan  Blanco,  aged  14 ;  Saltillo, 
Mexico,  Dec.  5,  1871.  Intermediary  operation  Dec.  15th;  recovery.— At  least  forty-four  exarticulations  at  the  hip  were  performed  during  the  Franco- 
Prussian  War,  1870-71. — 140.  Dr.  RtiPFEL  (DEININGER,  Bcitrage  zu  den  Schussfracturen  des  Hiiftgelenks,  etc.,  in  Deut.  Mil.-drztl.  Zeitschr,  1874,  B.  Ill, 
p.  304),  Cbr.  Lucia.  3d  Brandenburg  Field  Art.,  shell  laceration,  received  at  Artenay,  Dec.  3, 1870.  Exarticulation  at  right  hip  Dec.  4th :  died  shortly  after 
the  operation,  Dec.  4,1870. — 141-143.  Generalarzt  Dr.BUBCH  (Zweiter  Congress  der  Deutsch.  Gesellschaftfur  Chir.,  in  Berlin  Klin.  Wochenschrift,  1873,  B.  X, 
p.  273,  and  DEINIXGER,  Inc.  cit.,  p.  306)  performed  three  exarticulations  at  the  hip :  Aug.  Hensel,  2d  Pomm.  Grenadier  Reg't ;  fracture  of  right  femur,  Metz, 
Oct.  14,  1870;  operation  Oct.  15th  ;  death  immediately  after  operation.  No  particulars  of  the  other  two  unsuccessful  cases  are  recorded. — 144-147.  MAC- 
CORHAC  (W.)  (Notesand  Recollections  of  an  Ambulance  Surgeon,  etc.,  London,  1871,  pp.  78,  79),  Guerieri,  4th  Marines,  wounded  at  Sedan,  Sept.  1,  1870. 
Left  tibia  and  upper  part  of  left  femur  smashed.  Admitted  to  Asfeld  hospital  Sept.  10th ;  operation  Sept.  18th ;  death  shortly  after  the  operation.  Liprencle. 
wound  of  back  part  of  left  thigh  by  explosion  of  shell.  Admitted  to  Asfeld  hospital  Sept.  10th  ;  operation  Sept.  15th;  death  in  six  days.  Dr.  MACCOHMAC 
(toe.  cit.,  p.  80)  states  that  Mr.  BLEwnr  disarticulated  the  hip  at  Balan,  "but  with  no  better  result  than  our  two  cases,"  and.  on  page  123,  enumerates  among 
the  operations  at  the  field  hospital  at  Floing,  under  Generalstabsarzt  STROMEYER,  another  hip  joint  exarticulation  with  unknown  result.  Dr.  DEIXINOER 
also  refers  to  two  exarticulations  by  Dr.  FRANK,  and  cites  MACCORMAC  as  authority.  The  latter  (loc.cit.,  p.  46),  however,  only  states  that  "he  (Dr.  FRANK) 
afterwards  told  me  there  were  two  cases  where  operations  should  have  been  performed  at  the  hip  joint,  but  this  had  to  be  left undone  for  want  of  assistance/' 
148.  Ober-Stabs-arzt  NEUBER  (DEIXLNGER,  loc.  cit.,  p.  308)  exarticulated  in  the  case  of  August  Schmidt,  70th  French  Line ;  shot  fracture  of  femur,  Aug. 
18,  1870 ;  died  Sept.  7,  1870.— 149.  Ober-Stabs-arzt  Dr.  LlPPEL  (DEININGER,  toe.  cit.,  p.  308),  at  the  8th  field  hospital  of  the  Tenth  Army  Corps,  at  Pont 
d  Mousson,  exarticulated  for  gangrene  in  the  case  of  Louis  Lecoque,  shot  in  the  soft  parts  of  the  leg;  death  four  hours  after  the  operation. — 150.  Dr.  KOCH 
(DE1NINGER,  loc.  cit.,  p.  308),  at  the  hospital  at  Maizery,  Private  Andreas  Wilczynski,  44th  Infantry,  shot  fracture  of  the  right  femur  immediately 
below  the  trochanter,  August  31,  1870.  Exarticulation  October  23,  1870;  died  of  dysentery  October  31,  1870. — 151.  Dr.  SACHS  (DEININGER,  loc.  cit..  p. 
306),  at  the  9th  field  hospital  of  the  First  Army  Corps,  at  Les  Etanges,  case  of  J.  Nikelski,  private,  12th  Co.,  43d  Infantry;  shot  fracture  of  right  femur  : 
ball  lodged.  Metz,  Aug.  14,  1870.  Exarticulation  Sept.  20,  1870;  death,  from  pyaemia,  Sept.  25,  1870.— 152.  Dr.  BRAMSII,  at  the  hospital  at  Neudorf 
(DEIXIXGER,  loc.  cit.,  p.  306),  disarticulated  in  the  case  of  Private  H.  Malton,  66th  French  line,  shot  in  the  left  femur  August  6,  1870.  Operation  Sept. 
7th ;  death  on  day  of  operation.— 153.  Generalarzt  Dr.  WAGNER  (DEININGER,  loc.  cit.,  p.  30C),  at  the  8th  field  hospital,  First  Army  Corps,  at  Gras,  Private 
M.  Buddrus,  Co.  2,  East  Prus.  Gren.,  No.  1;  shot  fracture  of  right  femur  near  trochanter  major,  with  extensive  injury  of  the  soft  parts,  received  at  Met/ 
Sept.  1,  1870.  Exarticulation  Sept.  17th ;  died  upon  the  operating  table. — 154.  Assistant  Surgeon  TRENDELEXBERG  (DEININGER,  loc.  cit.,  p.  306),  of  the 
8th  field  hospital,  Third  Army  Corps,  at  Vionville,  case  of  Adolpb  Marschall,  private,  52d  Infantry.  Shot  fracture  of  left  knee  joint  August  16,  1870; 
extensive  suppuration.  Exarticulation  August  28,  1870;  death  on  the  same  day.— 155.  Dr.  METZLER  (DEININGER,  loc.  cit.,  p.  30C),  at  the  Hessian  field 
hospital  No.  1,  Anoux  la  Grange,  exarticulated  at  the  hip  in  the  case  of  L.  Nouveau,  73d  French  line,  wounded  August  18,  1870.  Operation  Aug.  19th  : 
death  two  hours  after  operation. — 156.  Dr.  RAYNAUD  (GILLETTE,  Remarques  sur  les  blessurespar  armcs  A  feu  observces  pendant  la  siege  de  Metz  (1870),  e.t 
cclui  de  Paris  (1871),  in  Arch.  gen.  de  Med.,  1872,  T.  XX,  p.  571,  and  CH.  PlLLET,  De  la  suppression  de  la  compression  digitale  preliminaire,  etc.,  Paris, 
1873,  p.  64)  exarticulated  at  the  left  hip  in  a  young  garde  nationale,  aged  19;  death  in  a  few  hours.— 157.  Dr.  WlESEMES  (B.  BECK,  Chir.  der  Schussverlet- 

zungen,  Freiburg,  1872,  p.  855),  W ,  67th  Infantry,  wounded  before  Paris,  December  21, 1870,  by  ashell,  fracturing  femur  to  neck.   Primary  operation  ; 

death  in  twenty-four  hours.— 158.  HUETER  (Berlin,  Klin.  Wochenschrift,  1873,  p.  250)  operated  on  a  French  soldier  for  extensive  fracture  of  femur.  The 
patient  died  suddenly  on  the  following  day  from  venous  ha?morrhage. — 159,  160.  BCEHME  ( Verhandl.  der  mil.-drztl.  Gesellschaft  zu  Orleans  1870-71,  in 
Deut.  Mil.-arztl.  Zeitschrift,  1872,  B,  I,  p.  66),  Fracture  of  femur  just  below  trochanter,  arterial  bleeding ;  ligation  of  femoral ;  secondary  haemorrhage ; 
exarticulation ;  died  during  the  operation.  Another  case  proved  fatal  in  a  few  days. — 161.  OTT  ( Kriegschir.  Mittheil.  aus  dem  Reserve  Laz.  Ludwigsburg, 
1871,  p.  52),  Harles,  a  French  soldier,  wounded  at  Vionville,  Aug.  16.  1870,  in  right  femur  close  to  trochanter.  Exarticulation  Sept.  24,  1870;  death  a 
few  hours  after  the  operation.— 162.  SIMON  (G.)  ( Verhandl.  des  Zweiten  Congress  der  Deut.  Gesellshaft  fur  Chir..  in  Berl.  Klin.  Wochenschr.,  1873,  B.  X, 
p.  261),  French  officer;  fracture  of  femur — osteomyelitis.  Secondary  exarticulation ;  fatal  in  three  days. — 163-167.  RUPPRECHT  (L.)  (Mil.  drztl.  Erf., 
f.lc.,  im  Jahre  1870-71,  WUrzbnrg,  1871,  p.  75)  states  that  four  unsuccessful  exarticulations  at  the  hip — three  primary,  one  intermediary — were  performed 
at  the  Bavarian  field  hospital  No.  8,  during  September  and  October,  1870,  and  that  a  later  operation  at  Verne1  res  also  resulted  fatally. — 108.  MUNDY 
(Rapport  sur  I'ambulance  de  I'ancien  corps  legislat.  du  19  Sept.,  1870,  an  31  Janv.,  1871)  exarticulated  on  December  2,  1870,  in  the  case  of  Deschamp,  2d 
Zouaves,  for  shot  fracture  of  the  right  femur  with  injury  of  the  large  veins  and  of  the  hip  joint;  fatal. — 169.  Dr.  J.  ARNOLD  (Anat.  Beitrage  -it  rlrn 
Schusswunden,  Heidelberg,  1873,  p.  97)  gives  the  case  of  H.  Moulin,  wounded  at  Worth,  August  6,  1870 ;  shot  wound  of  right  femur,  with  fissure ;  osteo 
myelitis  and  necrosis  extending  to  neck  of  femur.  Exarticulation  at  the  hip ;  death  Sept.  22,  1870. — 170.  Dr.  JCESSEL  (SfJDILLOT,  Du  traitement  drs 
fractures  des  membres,  etc.,  in  Archives  gen.  de  mid.,  1871,  VI"  serie,  T.  17,p.421)  performed  a  secondary  fatal  exarticulation  at  the  hip.— 171-183.  Cn.^M 
(J.  C.)  (Apergu  hist.  stat.  et  din.,  etc., pendant  la  guerre  de  1870-71,  Paris,  1874,  T.  I,  p.  493)  tabulates  twenty-three  exarticulations  at  the  hip  performed 
on  French  soldiers.  Some  details  of  ten  of  these  cases  have  just  been  noticed;  of  the  remaining  thirteen  cases  it  is  only  recorded  that  all  the  patients 
perished.— 184.  MORTON  (T.  G.)  (The  Cincinnati  Lancet  and  Clinic,  Cincinnati,  Jan.  4,  1879,  N.  S.,  Vol.  II,  p.  9),  Dominico  Ludovcss,  aged  24,  wounded 
at  Sedan,  September  1,  1870;  amputation  of  thigh;  admitted  to  Pennsylvania  Hospital  Nov.  24,  1878;  reamputation  at  hip  December  14,  1878.  In  a  letter 
dated  February  19,  1879,  Dr.  MORTON  reports  that  the  "patient  is  up  and  about,  and  would  be  discharged,  but  he  has  no  home  to  go  to."  Of  the  184 
rases  of  exarticulation  at  the  hip  here  cited,  one  (STROMEYER's  case,  reported  by  MACCOKMAC)  must  be  set  aside,  since  its  result  was  unknown.  Of  the 
remaining  183  cases,  16  recovered  and  167  proved  fatal,  a  mortality  of  91.2  per  cent.  Of  the  53  primary  operations,  50,  or  94.3  per  cent.,  were  fatal.  The 
three  recoveries  were:  LARREY'S  sub-lieutenant  of  dragoons,  wounded  September  7,  1812,  and  seen  at  Orcha  three  months  afterwards;  LAXGENBECK'S 
operation  on  J.  Siebold,  June  8, 1848 ;  T.  D.  JOHXSOX'S  operation  on  the  California  miner,  July,  1862.  Of  the  32  intermediary  cases,  29,  or  90.fi  per  cent.. 
were  fatal.  The  three  successful  instances  were:  G.  J.  GUTHRIE's  Waterloo  case  of  Duguet,  in  1815;  L.  BAUDEXS's  Algerian  case  in  1836;  and 
CAROTHEU'S  case  of  the  Mexican  lad,  in  December,  1871.  Of  the  31  secondary  operations,  26,  or  83.8  per  cent.,  had  a  fatal  termination.  The  five  success 
ful  cases  were :  BROWNRIGG'S  British  dragoon,  wounded  at  Merida,  December,  1811,  and  amputated  in  1812,  who  was  living,  long  afterwards,  at  Spalding, 
in  Lincolnshire.  England;  ArtLAUD's  case  of  the  fusileer,  in  the  Italian  War  of  1859;  ISXARB'8  case  of  the  officer  wounded  at  Solferino;  Dr.  JULES 
Koux'8  case  of  the  Magenta  soldier,  in  1859;  and  NEUDORFER'S  case  of  the  soldier  wounded  at  Palestro,  May  30.  1859,  who  underwent  secondary 
excision  and  amputation  in  December  following.  Of  two  re-amputations  at  the  hip  (CASES  12  and  184),  T.  G.  MORTON'S  operation,  in  1878,  on  a  French 
soldier  wounded  in  1870,  had  a  successful  issue.  Of  the  66  exarticulations  in  which  the  period  of  operation  was  unknown,  4  recovered,  giving  a  mortality 
of  93.8  per  cent.  The  operators  in  the  four  successful  cases  were :  The  unknown  operator,  who,  in  1798,  operated  on  the  English  sailor  who  was  examined 
by  Dr.  WENDELSTADT ;  Dr.  CHARLES  BRYCE,  in  the  case  of  the  British  soldier  wounded  at  Athens,  in  1827;  the  Spanish  surgeon  reported  by  Dr. 
BELMUNT  to  Mr.  ALCOCK,  who  successfully  disarticulated  in  1835;  and  RESTELLI,  in  the  Italian  revolution  in  1848.  Of  the  16  successful  operations,  5 
were  performed  by  French  surgeons,  4  probably  by  English,  3  by  American,  2  by  German,  1  by  an  Italian,  and  1  by  a  Spanish  surgeon. 


SECT.  II.) 


PRIMARY    AMPUTATIONS    AT    THE    HIP    JOINT. 


131 


Primary  Operations. — Of  twenty-five  well  authenticated  primary  amputations  at  the 
hip  joint  practised  during  the  American  civil  war,  one  was  completely  successful.  The 
pensioner,  Kelly,  whose  left  lower  limb  Surgeon  Edward  Shippen  disarticulated  more  than 
fifteen  years  ago,  still  survives  in  comfortable  health.  A  brief  review  of  the  case  will  be 
given,  with  references  to  a  few  of  the  numerous  accounts  of  it  that  have  been  published:1 

CASE.272. — Private  James  E.  Kelly,  Co.  B,  5Gth  Pennsylvania,  aged  28  years,  was  wounded,  about  9  o'clock  of  the 
morning  of  April  29,  18G3,  in  a  skirmish  of  the  1st  division,  First  Corps,  on  the  Rappahannock,  nearly  opposite  the  "Pratte 
House,"  below  Fredericksburg.  A  conoidal  musket  ball,  fired  from  a  distance  of  about  three  hundred  yards,  shattered  his 
left  femur.  A  consultation  of  the  senior  surgeons  of  brigades  decided  that  exarticulation  of  the  femur  was  expedient,  and  the 
operation  was  performed,  at  four  in  the  afternoon,  at  the 
"  Fitzhugh  House,"  by  Surgeon  Edward  Shippen,  U.  S.  V., 
surgeon-in-chief  of  the  1st  division.  The  single  flap  method 
was  adopted,  and  the  amputation  was  accomplished  with 
slight  loss  of  blood.  The  patient  was  at  first  placed  in  a 
hospital  tent,  and  was  transferred,  May  22d,  to  the  Corps 
Hospital,  progressing  favorably.  By  May  28th,  all  the  liga 
tures  had  been  removed.  On  June  15,  1863,  the  patient  was 
captured  by  the  enemy,  and  was  removed  to  the  Libby  Prison, 
in  Richmond.  Up  to  this  date  there  had  been  no  bad  symp 
toms.  On  July  14th,  Kelly  was  exchanged,  and  was  sent  to 
the  Annapolis  U.  S.  A.  General  Hospital.  On  his  admission 
he  was  much  exhausted  by  profuse  diarrhoea.  The  internal 
portion  of  the  wound  had  united,  but  the  external  portion 
was  gangrenous.  Applications  of  bromine  were  made  to  the 
sloughing  surface  without  amelioration.  A  chlorinated  soda 
lotion  was  substituted,  and  in  the  latter  part  of  July  there 
was  a  healthy  granulating  surface.  On  December  23,  1863, 
the  wound  had  entirely  healed,  and  Kelly  visited  Washing 
ton,  and  obtained  an  honorable  discharge  from  service,  and  a 
pension.  Kelly  then  went  to  his  home,  near  Black  Lick  P.  O.. 
Indiana  County,  Pennsylvania.  A  letter,  dated  January  12, 
18155,  was  received  from  him  at  this  Office,  and  represented 
him  as  in  excellent  health  and  spirits  at  that  time.  In  the 
spring  of  1863,  Kelly  went  to  New  York  and  had  an  artificial 
limb  adapted  by  Dr.  E.  D.  Hudson.  At  that  time  a  photo 
graph  was  taken  representing  the  appearance  of  the  cicatrix 
and  of  the  prothetic  appliance.  A  reduced  copy  of  this  pic 
ture  is  presented  in  the  accompanying  wood-cut  (FlG.  89). 
Front  and  posterior  views  of  the  upper  half  of  the  shattered 
exarticulated  femur  are  introduced  among  the  accessories  in 
the  picture.  In  a  pamphlet  on  Mechanical  Surgery,  New 
York,  1878,  page  31,  Dr.  E.  D.  Hudson  prints  an  excellent 

wood-cut  displaying  the  appearance  of  the  cicatrix  and  the  artificial  stump.  By  this  simple  and  excellent  expedient  of  a  padded 
gutta-percha  artificial  stump  secured  to  the  pelvis  by  a  broad  chamois-lined  canvas  band,  Dr.  Hudson  succeeded  in  applying 
satisfactorily  and  comfortably  the  ordinary  artificial  limb  for  thigh  amputations,  not  only  in  Kelly's  case  but  in  the  case  of  Pt. 
George  W.  Lemon,  Co.  C,  6th  Maryland.  The  specimen  of  the  fractured  exarticulated  femur  is  preserved  at  the  Army  Medical 
Museum,  as  No.  1148  of  the  Surgical  Section.  Kelly's  disability  was  rated,  March  4,  1874,  as  total.  His  pension  of  $24.00 
monthly,  was  paid  in  March,  1878,  and  he  was  then  in  tolerably  good  health,  nearly  fifteen  years  after  his  terrible  mutilation. 
He  remains  an  irrefragable  demonstration  of  a  successful  primary  amputation  at  the  hip  after  shot  injury.  There  was  nothing 
additional  recorded  at  the  Pension  Office  at  the  above  date. 

Although  in  the  next  two  instances  of  primary  amputation  at  the  hip  it  was  found 
impracticable  to  trace  the  ulterior  histories  of  the  patients,  it  is  known  that  Surgeon  W.  M. 
Gompton's  patient,  Hobinson,  aged  35,  was  alive  and  well  six  months  after  the  exarticula 
tion,  and  that  Private  Williamson,  the  subject  of  Dr.  J.  T.  Gilmore's  operation,  reached 
his  home  in  Mississippi,  after  two  months,  with  his  stump  fairly  cicatrized. 

"HAMILTON"  (F.  II.),  A  Treatise  on  Mil.  Surg.,  1865,  p.  482.  SORREL  (F.),  Gunshot  Wounds— Army  of  Northern  Virginia,  in  Confcd.  States 
Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  153.  BUTCHER  (R.  G.),  On  amputations  at  the  hip  joint,  in  Dublin  Quar.  Jour,  of  Med.  Sci.,  18C6.  No.  LXXXIV, 
p.  301.  LKGOUEST  (M.  L.),  Le  Service  de  Sante  des  Armies  Americaines,  etc.,  in  Annales  D' Hygiene  Publique,  18fi6,  Deuxieme  s6rie,  T.  XXVI,  p.  270. 
Circular  No.  6,  S.  G.  O.,  ISGj,  p.  48.  Circular  No.  7,  S.  G.  O.,  1867,  pp.  26,  58.  LOxrxG  (A.),  Ueber  die  Blutung  bei  der  Exarticulation  des  Ober- 
schenkds,  Zurich,  1877,  p.  93.  HUDSON  (E.  D.),  Mechanical  Surgery:  Prothetic  Appliances  and  Apparatus.  New  York,  1878,  p.  31. 


FIG.  89. — Appearance 
photograph.) 


»f  stump  five   years  after  the  operation.     [From  a 


132  INJUEIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

CASE  273. — Private  Robinson,  of  a  Louisiana  Regiment,  aged  35  years,  was  wounded  at  Battery  Pemberton,  at  the  con 
fluence  of  the  Tallahatchie  and  Yalabusha  Rivers,  on  March  13,  1863,  by  a  fragment  of  a  twenty-four  pounder  shell,  fired  from 
one  of  the  United  States  gunboats  attacking  the  work.  Surgeon  William  M.  Compton,  2d  Texas,  was  standirg  near  the 
wounded  man  when  he  fell,  and  ran  to  his  assistance.  Hastily  exposing  the  wound,  Dr.  Compton  found  that  the  immense 
projectile,  consisting  of  nearly  half  of  an  elongated  shell,  had  buried  itself  in  the  upper  part  of  the  left  thigh,  smashing  the 
trochanters  and  neck  of  the  femur  and  wounding  the  femoral  artery.  An  assistant  compressed  the  artery  at  the  crural  arch, 
while  the  necessary  preparations  for  an  amputation  were  made  on  the  spot.  Chloroform  was  administered,  and  then  Dr.  Comp 
ton  made  an  irregular  circular  incision  through  the  integuments  just  above  the  margin  of  the  huge  lacerated  wound,  dissected 
up  and  retracted  the  skin,  trimmed  away  the  lacerated  muscles  and  divided  those  that  were  intact,  and  exarticulated  the  head  of 
the  femur,  making,  as  Dr.  Compton  described  it,  an  awkward  circular  amputation.  The  arteries  were  now  rapidly  secured  and 
the  wound  dressed.  Strange  to  say,  the  patient  reacted  with  scarcely  a  symptom  of  shock.  When  the  influence  of  the  anaesthetic 
passed  away,  he  was  cheerful  and  even  jocular.  He  was  moved  to  a  field  hospital,  and  was  treated  under  Dr.  Compton's 
immediate  supervision  until  March  17th.  The  febrile  reaction  was  very  slight;  the  appetite  never  failed;  the  wound  had  as 
healthy  an  appearance  as  could  be  desired.  On  the  fifth  day,  the  patient  was  sent  on  a  steamer  to  the  large  general  hospital  at 
Yazoo  City.  The  surgeon  in  charge  of  that  hospital,  Dr.  J.  M.  Greene,  writes  that  the  case  presented  a  most  extraordinary 
example  of  union  by  the  first  intention  throughout  almost  the  entire  extent  of  the  vast  wound.  The  patient  left  the  hospital  on 
April  20,  1863,  in  fine  health  and  excellent  spirits.  Dr.  Greene  received  direct  intelligence  from  him  near  the  close  of  the 
ensuing  September,  more  than  six  months  subsequent  to  the  operation,  and  he  then  reported  himself  in  good  condition.' 

CASE  274. — Private  Williamson,  13th  Mississippi,  was  wounded  at  an  advanced  picket  station  near  Seven  Pines,  on  June 
4,  1862.  A  conoidal  musket  ball  entered  the  posterior  part  of  the  right  thigh  about  two  inches  below  the  trochauter  major,  and, 
passing  forward  and  downward,  made  its  exit  at  the  middle  third  of  the  thigh  in  front,  having  badly  shattered  the  femur  in  its 
course.  The  wounded  man  was  carried  to  the  field  hospital  in  charge  of  Surgeon  J.  T.  Gilmore,  C.  S.  A.,  in  a  church  building 
on  the  road  to  Richmond,  and  there  placed  under  the  influence  of  chloroform  about  two  hours  after  the  reception  of  the  injury. 
After  an  exploration  of  the  wound,  it  was  decided  that  amputation  should  be  performed.  Dr.  Gilmore  began  the  operation  with 
the  belief  that  the  comminution  of  the  femur  was  mainly  below  the  entrance  wound,  and  that  by  making  a  long  anterior  flap  the 
bone  might  be  sawn  at  least  through  the  trochauters;  but  when  the  anterior  flap  was  reflected  and  the  fracture  exposed,  it  was 
found  that  fissures  extended  upward  into  the  neck  quite  within  the  capsular  ligament,  and  that  disarticulation  must  be  resorted 
to.  A  ligature  was  first  placed  upon  the  femoral  artery,  and  the  incisions  were  then  extended  upward,  the  joint  opened,  the 
round  ligament  divided,  and  a  short  posterior  flap  formed  by  cutting  downward  and  outward.  Assistants  compressed  the 
bleeding  orifices  of  the  arteries,  which  were  then  rapidly  picked  up  and  tied.  The  amount  of  blood  lost  was  small.  The  wound 
was  dressed,  and  the  patient  was  comfortably  in  bed  within  three  hours  after  the  reception  of  the  injury.  He  was  put  upon  a 
very  nutritious  regimen,  a  messenger  being  sent  daily  to  Richmond  for  eggs,  milk,  and  other  delicacies  which  could  not  be 
procured  in  camp.  Dr.  Gilmore  attended  him  for  two  weeks,  during  which  suppuration  was  not  excessive,  and  the  healing  of 
the  wound  progressed  favorably.  He  was  then  placed  under  the  charge  of  Acting  Assistant  Surgeon  Spinks.  Early  in  July, 
he  was  carried  to  Richmond  upon  a  hand-litter  to  a  private  house,  at  which  he  received  every  attention.  In  the  middle  of  July, 
six  weeks  subsequent  to  the  amputation,  the  wound  had  entirely  healed,  and  he  was  allowed  to  start  for  his  home  in  Mississippi. 
Dr.  Gilmore  learned  that  he  arrived  there  in  safety;  but  no  intelligence  was  subsequently  received  from  him. 

Of  twenty-two  primary  coxo-femoral  amputations  that  resulted  fatally  soon  after 
operation,  the  following  series  of  thirteen  cases  is  composed  of  instances  in  which  the 
wounds  were  inflicted  by  cannon  shot,  shell  fragments,  or  other  large  projectiles: 

CASE  275. — Private  Jacob  Barger,  Co.  B,  26th  Pennsylvania,  aged  22  years,  of  robust  constitution  and  sanguine  temper 
ament,  was  wounded  on  the  morning  of  May  18,  1864,  in  the  attack  of  Birney's  division  of  the  Second  Corps  upon  the  intrench- 
ments  before  Spottsylvania  Court  House.  He  was  struck  by  a  fragment  of  shell,  which  shattered  the  femur  from  a  little  above 
the  trochanter  minor  for  nine  inches  downward,  and  tore  and  mangled  the  soft  parts  on  the  anterior  and  lateral  aspects  of  the 

1  "Mississippi  State  Lunatic  Asylum.  Jackson,  Mississippi,  January  1,  1878.  MY  DEAR  DOCTOR:  I  herewith  enclose  a  letter  from  Dr.  GREENE, 
of  Aberdeen,  Mississippi,  the  surgeon  who  treated  the  case  of  amputation  at  the  hip  joint  in  the  Yazoo  City  hospital.  To  explain  to  you  what  may  appear 
to  be  my  want  of  attention  in  keeping  the  track  of  so  interesting  a  case,  I  will  remind  you  that  the  operation  was  performed  in  the  field.  The  patient 
was  at  once  conveyed  to  a  steamboat,  and  as  soon  as  it  was  full  of  sick  and  wounded  (a  few  days)  the  boat  was  sent  to  Yazoo  City.  Soon  after  the  date 
of  the  operation,  I  was  ordered  to  Vicksburg,  where  I  remained  until  after  the  surrender  of  that  citj',  and  for  a  long  time  was  shut  up  by  the  siege  from 
all  communication  with  the  outside  world.  The  fall  of  Vicksburg,  in  July,  was  succeeded  by  the  rapid  evacuation  of  Yazoo  City,  and  it  was  nearly  a 
year  before  I  met  Dr.  GREEXE,  in  Alabama,  who  informed  me  of  the  recovery  of  my  patient.  I  had  not  heard  of  him  after  the  departure  of  the  steam 
boat  from  Fort  Pemberton,  and  did  not  know  that  he  had  fallen  into  the  hands  of  Dr.  GREEXE  until  the  doctor  informed  me  himself.  I  lost  my  note-book 
and  other  papers  at  Vicksburg  and  have  never  had  any  means  of  tracing  the  patient.  I  will  say,  however,  for  Dr.  J.  M.  GREENE,  that  he  stands  at  the 
head  of  hW  profession  in  Mississippi,  and  is  in  every  respect  a  highly  esteemed  Christian  gentleman,  and  his  word  in  any  statement  of  fact  where  he  is 
known  is  received  as  solid  truth.  Very  respectfully,  your  obedient  servant,  (signed)  Wsi.  M.  COMPTON."  "Aberdeen,  Mississippi,  December  29,  1877. 
DEAR  DOCTOR:  At  the  request  of  Dr.  WM.  M.  COMPTON,  of  Jackson,  Mississippi,  I  again  write  to  you  in  regard  to  the  hip  joint  amputation  which  he 
performed  at  Fort  Pemberton,  in  1863.  I  greatly  regret  my  inability  to  furnish  any  facts  in  addition  to  those  contained  in  a  letter  which  I  wrote  to  you  in 
1867.  I  oelieve  I  therein  told  you  that  the  subject  of  the  amputation  was  received  by  me  in  hospital  at  Yazoo  City,  Mississippi,  in  a  few  days  after  the 
operation.  So  skilfully  were  the  flaps  made  and  so  perfect  was  the  coaptation  throughout  the  vast  extent  of  cut  surface,  that  the  fibrinous  agglutination 
followed  at  once,  and  resulted  in  union  by  first  intention  in  all  parts  except  the  tracks  of  ligatures  and  sutures.  I  am  positive  in  my  recollection  that 
within  six  weeks  from  the  time  of  the  operation  the  patient  was  dismissed  from  the  hospital  with  the  stump  healed.  Information  of  him  reached  me  some 
months — I  believe  about  five — afterwards,  which  I  then  regarded  as  entirely  authentic.  It  was  probably  in  the  form  of  an  application  for  '  Certificate  of 
Disability'  upon  which  to  be  'retired'  or  'discharged'  from  service.  At  any  rate,  I  am  certain  that  it  thoroughly  satisfied  me  of  the  life  and  well-doing 
of  the  patient.  It  is  to  be  deplored  that  in  a  matter  of  so  much  interest  to  the  profession,  complete  documentary  evidence  cannot  be  obtained ;  but  yet  I 
feel  assured,  from  my  point  of  view,  that  the  cause  of  surgical  history  can  sustain  no  detriment  from  placing  Dr.  COMPTON's  case  In  the  same  catalogue 
as  that  of  Dr.  SHIPPEN.  Very  sincerely,  your  obedient  servant,  (signed)  J.  M.  GREENE." 


SECT.  II.]  PRIMARY    AMPUTATION    AT    THE    HIP    JOINT.  133 

thigh,  leaving  uninjured  a  V-shaped  portion  of  integument  and  subjacent  tissue  on  the  antero-internal  femoral  region,  seven 
inches  wide  at  the  base  and  ten  inches  in  vertical  length.  He  was  carried  to  a  field  hospital  of  the  Second  Corps  and  examined 
about  two  hours  after  the  injury.  There  was  no  apparent  shock,  and  there  had  been  very  little  hemorrhage.  The  pulse  was 
full  and  calm,  and  the  surface  of  the  body  was  of  a  natural  temperature.  The  senior  surgeons  of  the  division  concurred  in  the 
opinion  that  this  was  one  of  the  few  cases  of  extensive  gunshot  injury  of  the  femur  in  which  a  successful 
result  might  reasonably  be  anticipated  from  an  amputation  at  the  hip  joint.  The  patient  was  desirous  that 
an  operation  should  be  practised.  He  was  of  a  hopeful,  buoyant  nature,  and  was  sanguine  of  a  favorable 
issue.  Amputation  having  been  decided  upon,  chloroform  was  administered  by  Surgeon  John  Wiley,  6th 
New  Jersey,  a  medical  officer  of  great  experience  and  caution  in  this  duty.  Only  two  drachms  of  the  anaes 
thetic  was  used,  given  from  a  napkin,  with  great  regard  to  a  due  admixture  of  atmospheric  air.  Surgeon 
C.  C.  Jewett,  16th  Massachusetts,  performed  the  amputation  by  making  a  single  antero-internal  flap. 
Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.,  and  others  present  on  the  occasion,  have  described  the  admirable 
dexterity  and  skill  manifested  in  the  operative  procedure.  The  disarticulation  was  completed  in  less  than 
forty  seconds.  Surgeon  C.  K.  Irwine,  72d  New  York,  compressed  the  crural  artery  at  the  groin  ;  Surgeon 
F.  Prentice,  73d  New  York,  grasped  the  flap  and  secured  the  cut  end  of  the  femoral;  Surgeon  James  Ashe, 
70th  New  York,  had  charge  of  the  limb;  Surgeon  Everts,  20th  Indiana,  Surgeon  E.  A.  Winston,  1st  Massa 
chusetts,  and  Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.,  also  aided  in  the  operation.  The  flap,  the  form 
and  location  of  which  were  determined  by  the  wound,  was  made  by  cutting  from  without  inward.  Imme 
diately  after  the  head  of  the  bone  was  freed  from  the  acetabulum  a  spasmodic  catch  was  heard  in  the  patient's 
respiration,  and  an  assistant  exclaimed :  "Stop  the  chloroform  !"  Surgeon  Wiley  promptly  responded  :  "He 
is  not  taking  any."  The  next  instant  an  assistant  at  the  wrist  reported  that  the  pulse  was  failing.  The 
arteries  were  now  rapidly  secured.  The  loss  of  blood  was  estimated  not  to  exceed  a  single  ounce.  But  the 
patient  was  insensible,  the  respiration  labored,  the  pulse  very  slow  and  feeble.  The  usual  restoratives  were 
employed  without  effect.  The  patient  did  not  rally;  he  lingered  for  about  two  hours,  and  died  a  little  after 
noon,  May  18,  1864.  In  consequence  of  an  advance  of  Rhodes's  Division  of  Swell's  Corps  the  field  hospital  plGf  gy Commi- 

was  hastily  broken  up.     Surgeon  Jewett  was  under  the  impression  that  the  specimen  was  lost.     This,     nation  Of  femur  by  a 

J  ,  '     shell.     Spec.  3080. 

however,  was  not  the  case.     Some  one  fastened  a  label  with  the  names  of  the  patient  and  operator  to  the 

mangled  limb,  and  it  was  forwarded,  with  other  pathological  specimens,  from  Spottsylvania  to  the  Army  Medical  Museum,  where 
it  arrived  safely,  and  furnished  the  preparation  represented  in  the  adjoining  wood-cut  (FlG.  90). ' 

CASE  276. — On  March  9,  1862,  in  the  engagement  between  the  U.  S.  frigate  Congress  and  the  rebel  iron-clad  Merrimac, 
Private  J.  Bushmil,  99th  New  York,  or  Union  Coast  Guard,  detailed  as  a  seaman  on  the  Congress,  was  wounded  by  a  piece  of 
shell,  which  tore  away  the  muscles  on  the  outer  side  of  the  left  thigh  so  as  to  expose  the  bone,  and  comminuted  the  neck  and 
trochanters  of  the  femur.  He  was  immediately  conveyed  to  the  military  post  hospital  at  Newport  News,  Virginia,  which  was 
distant  but  a  few  hundred  yards  from  the  anchorage  of  the  Congress,  and  restoratives  and  stimulants  were  administered.  Eight 
hours  after  the  injury,  reaction  having  taken  place  to  a  considerable  degree,  the  patient  was  placed  under  the  influence  of  chlo 
roform  by  Surgeon  R.  K.  Browne,  U.  S.  V.,  and  Surgeon  Leroy  McLean,  2d  New  York,  amputated  at  the  hip  joint  by  the 
lateral  double-flap  method  of  Larrey.  His  principal  assistants  were  Dr.  Everts,  Dr.  R.  K.  Browne,  and  Surgeon  J.  Curtis, 
U.  S.  V.  The  operation  was  rapidly  accomplished,  with  the  loss  of  but  little  blood.  Six  arteries  required  ligature.  The  patient 
did  not  rally  from  the  shock  of  the  operation,  and  died  in  less  than  two  hours  after  its  completion.2 

The  details  of  the  next  primary  amputation  at  the  hip  (CASE  277),  communicated  by 
Dr.  F.  J.  Bancroft,  of  Denver,  Colorado,  have  not  been  heretofore  published  :3 

CASE  277. — "Captain  Ralph  Carlton,  Co.  I,  3d  New  Hampshire,  received  a  severe  wound  in  the  left  hip  and  thigh  from  a 
cannon  ball  or  a  fragment  of  a  shell  at  the  battle  of  Secession ville,  on  James's  Island,  June  16,  1862.  The  trochanters  were 
fractured  and  the  femur  was  shattered  and  laid  bare  for  several  inches  below.  The  gluteus  maximus  muscle  was  severed  from 
its  insertion,  and  the  biceps  and  semi-membranosus  were  torn  asunder.  Amputation  at  the  hip  joint  was  performed  about  two 
hours  after  the  reception  of  the  injury  by  some  surgeon  whose  name  I  have  forgotten,  assisted  by  myself.  The  anterior  flap  was 
made  by  transfixion  and  carried  well  down  the  limb.  The  posterior  one  was  short  and  made  by  paring  the  torn  ends  of  muscles 
and  the  skin.  The  patient  did  not  rally,  and  died  about  two  hours  thereafter,  although  he  possessed,  apparently,  a  strong  will 
and  a  good  constitution,  and  was  suffering  but  moderately  from  shock  at  the  time  of  the  operation.  When  told  of  the  dangers 

1  The  abstract  of  this  case  is  compiled  from  a  full  report  by  Surgeon  C.  C.  JEWETT,  16th  Massachusetts,  of  Holliston,  and  from  communications  by 
Assistant  Surgeon  J.  C.  CALHOUN,  Surgeon  II.  F.  I/Y6TE1S,  U.  S.  V.,  Assistant  Surgeon  J.  D.  STEWART,  74th  New  York,  Major  SAMUEL  BKECK,  A.  A.  G. 
See  Catalogue  of  Surg.  Sect,  of  A.  M.  M.  of  1806,  p.  234,  Spec.  3080  of  SECT.  I.     See  Circular  7,  S.  G.  O.,  18G7,  pp.  30  and  59,  and  LtelNG  (A.),  Vber 
die  Blutung  bei  der  Exarticulation  des  Obcrsclienkels,  Zurich,  1877,  CASE  324,  p.  96. 

2  The  imperfect  abstract  of  CASE  27C  is  com  piled- from  letters  from  Surgeon  G.  C.  HARLAN,  llth  Pennsylvania  Cavalry,  Surgeon  R.  B.  BOXTKCOU, 
U.  S.  V.,  Dr.  llUFUS  KING  BROWNE,  and  Dr.  LEROY  MCLEAN,  2d  New  York.     See  Circular  7,  S.  G.  O.,  1867,  pp.  24  and  57,  and  L,t)NING  (A.),  Vbtr 
die  Blutung  bei  der  Exarticulation  des  Obcrschenkels,  Zurich,  1877,  p.  90,  CASE  281. 

3  The  particulars  of  this  case  were  first  communicated  to  the  Surgeon  General's  Office  by  Dr.  F.  J.  BANCROFT,  of  Denver,  Colorado,  formerly 
Surgeon  of  the  3d  Pennsylvania  Artillery,  November  26, 1875.     Captain  CARLTON'S  regimental  surgeon,  Dr.  A.  A.  MOULTON,  3d  New  Hampshire,  wrote 
to  the  Surgeon  General's  Office  from  Tilton,  New  Hampshire,  December  9,  1875,  that  he  "did  not  see  Captain  CARLTON,  but  heard  that  his  limb  was 
amputated  at  or  near  the  hip  joint."    A  search  at  the  Pension  Office  corroborates  the  dates  of  the  injury  as  reported  by  Dr.  BANCROFT.     On  June  16th, 
the  3d  New  Hampshire  was  in  a  brigade  comprising  the  97th  Pennsylvania,  7th  Connecticut,  and  3d  Rhode  Island  Artillery.    Enquiries  regarding  the 
case  were  addressed  to  Surgeon  J.  R.  EVERHART,  97th  Pennsylvania,  to  Assistant  Surgeon  H.  P.  PORTER,  7th  Connecticut,  and  Surgeon  H.  G.  STICKNET, 
3d  Rhode  Island  Artillery,  medical  officers  of  the  brigade  of  General  I.  I.  STEPHENS,  and  also  to  Surgeon  E.  L.  DIBBLE,  6th  Connecticut,  and  Surgeon 
P.  A.  O'CONNELL,  28th  Massachusetts,  New  England  medical  officers  who  were  present  at  the  engagement  on  James  Island,  on  June  16,  1862;  but  no 
further  information  could  bo  elicited  from  any  surgeon  present  at  this  operation  in  addition  to  the  details  recorded  by  Dr.  F.  J.  BANCROFT,  formerly 
surgeon  3d  Pennsylvania  Artillery. 


134  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

attending  and  following  the  amputation,  I  well  remember  how  earnestly  and  energetically  he  said :  'I  desire  it.  I  must  live.  I 
will  live.  I  have  a  wife  and  five  children  to  provide  for.'  Yet  in  two  short  hours  all  earthly  ties  were  severed."  Surgeon  A. 
A.  Moulton,  3d  New  Hampshire,  reported  that  Captain  Carlton  died  on  June  16,  1862,  of  "gunshot  wound,"  and  in  the  military 
history  of  the  regiment,  published  by  the  Adjutant  General  of  the  State  in  1866,  he  is  mentioned  as  "a  gallant  and  promising 
officer,"  who  during  said  engagement  "  was  hit  in  both  legs  by  a  solid  shot,  and  died  the  same  day." 

CASE  278. — Private  Cooper,  of  an  Alabama  Regiment,  aged  20  years,  was  wounded  at  the  siege  of  Vicksburg,  on  May 
22,  1863,  by  a  fragment  of  shell,  which  inflicted  a  terrible  laceration  of  the  upper  exterior  part  of  the  right  thigh,  comminuted 
the  upper  third  of  the  femur,  and  fractured  the  tuberosity  of  the  ischium.  There  was  profuse  haemorrhage.  Surgeon  W.  M. 
Compton,  2d  Texas,  decided  to  operate,  because  the  wounded  man  most  earnestly  begged  that  an  attempt  should  be  made  by 
amputation  to  save  his  life.  A  few  hours  after  the  reception  of  the  injury  he  was  placed  under  chloroform,  and  amputation  at 
the  right  hip  joint  was  rapidly  performed  by  making  a  large  anterior  flap  and  dividing  the  soft  parts  posteriorly  by  a  circular 
sweep  of  the  knife.  The  stump  was  dressed  and  the  patient  actively  stimulated,  but  he  never  rallied  from  the  shock  of  the 
operation,  and  died  in  less  than  an  hour  after  its  accomplishment.1 

CASE  279. — Private  Isaac  C.  Fulton,  Co.  I,  4th  New  York  Heavy  Artillery,  was  wounded,  on  October  1,  1864,  in  the 
trenches  before  Petersburg,  by  a  fragment  of  shell,  which  shattered  the  upper  extremity  of  his  left  femur  and  lacerated  the  soft 
tissues  on  the  outside  of  the  thigh,  without,  however,  implicating  any  important  vessels  or  nerves.  He  was  immediately  carried 
to  the  Second  Corps  field  hospital,  under  the  charge  of  Surgeon  F.  F.  Burmeister,  69th  Pennsylvania,  and  a  consultation  was 
held,  at  which  it  was  determined  that  an  amputation  at  the  hip  joint  was  the  only  resource  that  could  possibly  preserve  life. 
The  wounded  man  was,  therefore,  immediately  placed  under  the  influence  of  chloroform,  and  Surgeon  J.  W.  Wishart,  140th 
Pennsylvania,  did  the  operation.  The  ordinary  method  by  antero-posterior  flaps  formed  by  transfixion  was  employed.  The 
operation  was  rapidly  performed  and  but  a  trifling  quantity  of  blood  was  lost.  The  patient  survived  the  shock  of  the  injury 
and  operation  but  a  few  hours,  and  died  at  City  Point,  October  1,  1864. 

CASE  280. — Private  Richard  Gordon,  Co.  H,  7th  Rhode  Island,  a  stout  and  apparently  healthy  man,  aged  28  years,  was 
wounded  May  18,  1864,  in  one  of  the  assaults  on  the  lines  at  Spottsylvania,  and  was  carried  on  a  stretcher,  two  or  three  miles 
to  the  rear,  to  a  field  hospital  of  the  Ninth  Corps.  A  fragment  of  shell  had  completely  shattered  the  left  thigh,  leaving  the 
lower  part  of  the  limb  attached  to  the  upper  by  shreds  of  integument  and  muscles  only.  There  had  been  but  slight  primary 
haemorrhage.  He  was  conscious  and  his  pulse  was  perceptible;  but  he  was  in  extreme  collapse.  A  consultation  was  held,  at 
which  the  Surgeon-in-chief  of  the  division,  Surgeon  P.  A.  O'Connell,  Surgeon  James  Harris,  7th  Rhode  Island,  and  others, 
assisted,  and  it  was  determined  to  give  the  man  the  chance  of  an  operation  rather  than  to  allow  him  to  die  without  an  effort  to 
save  him,  and  Dr.  J.  M.  Carnochan,  who  had  volunteered  his  services  at  the  hospital,  was  selected  to  operate.  Chloroform  was 
carefully  administered  by  Surgeon  Harris,  and  Dr.  Carnochan,  as  a  preliminary  step,  tied  the  femoral  artery  three-quarters  of 
an  inch  below  Poupart's  ligament,  and  then  proceeded  to  amputate  at  the  hip  joint  by  a  modification  of  the  oblique  method  of 
Guthrie.  A  vertical  incision  three  inches  long,  commencing  an  inch  above  the  great  trochanter,  was  made,  the  soft  parts  being 
divided  down  to  the  bone.  From  the  lower  third  of  this  incision,  two  oblique  incisions,  one  before  and  one  behind,  were  made 
to  diverge  and  then  to  reunite  about  two  and  a  half  inches  below  the  level  of  the  ischiatic  tuberosity.  The  head  of  the  femur 
was  then  disarticulated,  and  the  knife  being  earned  to  the  inner  side  of  the  neck  the  operation  was  finished  by  dividing  the  soft 
parts  on  that  side  by  a  single  sweep  of  the  instrument.  The  operation,  including  the  ligation  of  the  femoral,  was  completed  in 
two  minutes.  The  patient  recovered  kindly  from  the  influence  of  the  anaesthetic.  He  was  placed  in  a  shelter  tent  and  took  a 
dose  of  opium.  He  died  ten  hours  after  the  operation,  no  reaction  having  taken  place.2 

CASE  281. — Brevet  Lieutenant-Colonel  J.  H.  Janeway,  Assistant  Surgeon,  U.  S.  A.,  learned  that  Dr.  Hunter  McGuire, 
Surgeon-in-chief  of  Swell's  Division,  performed  a  primary  amputation  at  the  hip  after  the  engagement  at  Ball's  Bluff,  October 
21,  1861,  upon  a  Union  prisoner  of  war,  with  a  frightful  injury  of  the  upper  part  of  the  femur,  caused  by  a  large  projectile,  and 
that  the  patient  succumbed  to  the  combined  shock  of  the  injury  and  operation  soon  after  the  completion  of  the  latter. 

CASE  282. — A  lieutenant  in  an  Arkansas  Regiment  in  Cabell's  Brigade,  aged  28  years,  was  wounded  at  the  attack  on 
Corinth,  Mississippi,  October  3,  1862.  A  solid  cannon  ball  struck  the  right  hip  and  made  a  formidable  wound,  tearing  up  the 
soft  parts  of  the  buttock  and  shattering  the  upper  extremity  of  the  femur.  The  trochanters  and  about  five  inches  of  the  shaft  of 
the  femur  were  comminuted;  the  head  of  the  femur  was  exposed  and  was  split  across.  It  was  decided  that  amputation  at  the 
hip  presented  the  only  possible  surgical  resource,  and  the  operation  was  undertaken,  two  hours  after  the  injury,  by  Surgeon  W. 
M.  Compton,  2d  Texas.  The  operation  consisted  in  paring  into  shape  the  lacerated  soft  parts  at  the  posterior  part  of  the  thigh, 
completing  the  disarticulation  already  partly  effected  by  the  projectile,  and  forming  a  large  and  long  antero-internal  flap.  The 
patient  was  under  the  influence  of  chloroform.  There  was  but  little  hemorrhage.  The  flap  covered  the  immense  wound  and 
was  adjusted  with  tolerable  accuracy  to  meet  the  incision  at  the  gluteal  region.  The  combined  shock  of  the  injury  and  operation 
was  very  great,  and  the  patient  reacted  slowly  and  with  difficulty.  But  he  rallied  finally,  and  progressed  very  favorably  for 
several  days.  The  inflammation  was  not  intense,  appetite  returned,  and  strong  hopes  of  the  patient's  recovery  were  entertained. 
But,  on  the  seventh  day,  erysipelas  invaded  the  stump  and  extended  rapidly,  in  spite  of  the  use  of  tincture  of  iron  and  such  other 
treatment  as  it  was  thought  proper  to  institute.  The  case  terminated  fatally  on  October  12,  1862.3 

CASE  283. — A  private  in  General  A.  S.  Johnston's  army  was  wounded  on  the  morning  of  Sunday,  April  7,  1862,  at  the 
battle  of  Shiloh,  by  a  fragment  of  shell,  which  shattered  the  upper  extremity  of  the  left  femur.  The  comminution  extended  to 
the  neck  and  head  of  the  bone,  and  .the  soft  parts  at  the  upper  third  of  the  thigh  were  torn  into  shreds.  Notwithstanding  the 

1  EVE  (P.  F.),  A  Contribution  to  the  History  of  Hip  Joint  Operations  performed  during  the  late  civil  war,  in  Transactions  of  the  Am.  Med.  Ass'n, 
1867,  Vol.  XVIII,  pp.  255,  263.  Circular  No.  7,  S.  G.  O.,  1867,  pp.  27,  58. 

2 HAMILTON  (F.  H.),  A  Treatise  on  Mil.  Surgery,  1865,  pp.  485,  637.     Circular  No.  6,  S.  G.  O.,  ISti.j,  p.  50.     Circ.  Xo.  7,  S.  G.  O.  1S67,  pp.  30,  5U. 

3E\'E  (P.  F.),  A  Contribution  to  the  History  of  the  Hip  Joint  Operations  performed,  etc.,  in  Transactions  of  the  Am.  Med.  Ass'n,  1867,  Vol.  XV1I1 
pp.  255,  262.  Circular  No.  7.  8.  G.  O..  1867.  pp.  25,  58. 


SECT.  n. |  PRIMARY    AMPUTATIONS    AT    THE    HIP    JOINT.  135 

terrible  nature  of  the  injury  the  patient  reacted,  and  it  was  thought,  in  the  evening,  that  his  condition  justified  amputation.  At 
seven  in  the  evening  disarticulation  at  the  hip  joint  was  performed  by  Dr.  D.  W.  Yandell,  Medical  Director.  The  operation  was 
well  borne;  but  about  three  hours  after  its  completion  symptoms  of  exhaustion  were  manifested,  and  the  case  terminated  fatally 
seven  hours  after  the  operation,  at  two  o'clock  of  the  morning  of  April  8,  1862.1 

CASE  284. — A  private  of  the  3d  Missouri  Regiment  was  wounded  at  the  siege  of  Vicksburg,  in  June,  1863,  by  a  large 
fragment  of  shell.  The  projectile  produced  a  frightful  laceration  of  the  tissues  on  the  inner  and  posterior  parts  of  the  right  thigh, 
completely  divided  the  femoral  artery,  and  comminuted  the  femur  through  an  extent  of  eight  or  nine  inches.  A  surgeon  in  the 
trenches  put  a  ligature  on  the  femoral  artery,  d"nd  the  wounded  man  was  conveyed  to  the  City  Hospital  and  was  plied  with 
cordials.  The  sufferer  had  but  recently  recovered  from  an  attack  of  illness ;  the  primary  haemorrhage  had  been  copious,  and 
reaction  was  very  imperfect.  A  consultation  of  surgeons  decided  that  amputation  at  the  hip  joint  should  be  practised,  and  the 
wounded  man  expressed  a  desire  to  have  the  benefit  of  this  forlorn  chance.  Surgeon  B.  D.  Lay  undertook  the  operation  with 
great  reluctance,  fearing  that  the  patient  might  die  under  the  knife,  he  was  so  very  feeble.  Stimulants  were  freely  administered 
and  morphia;  but  it  was  decided  that  the  operation  should  be  done  without  anaesthetics.  The  nature  of  the  wound  determined 
the  direction  of  the  incisions.  There  was  a  rent  in  the  soft  parts  laying  bare  the  tuberosity  of  the  ischium,  and  another  extend 
ing  nearly  to  Poupart's  ligament,  in  which  the  ligated  femoral  artery  was  hanging.  Dr.  Lay  commenced  the  operation,  in  the 
presence  of  Surgeons  Britts,  McDowell',  Nidelet,  and  others,  by  making  a  clean  circular  cut  through  the  inner  and  posterior  parts 
of  the  thigh,  dividing  all  the  soft  parts  down  to  the  articulation ;  a  semilunar  flap  was  then  obtained  from  the  outer  and  anterior 
part  by  cutting  from  without  inward;  the  head  of  the  femur  was  then  disarticulated.  Eight  ligatures  were  required.  The  flap 
fitted  well.  The  operation,  which  occupied  about  twenty  minutes,  was  wall  supported,  and  the  patient  said  that  he  felt  more 
comfortable  after  than  before  it.  However,  reaction  was  never  fully  established.  Dr.  Nidelet  relates  that  the  patient  died  upon 
the  table  within  an  hour  and  a  half  after  the  completion  of  the  dressing.  Dr.  Lay's  recollection  is  that  he  survived  the  opera 
tion  some  fourteen  or  sixteen  hours.3 

CASE  285. — A  private  of  the  27th  Tennessee  Regiment  was  wounded  at  Jonesboro',  Georgia,  August  31,  1864,  by  a 
cannon  shot,  which  frightfully  lacerated  the  soft  parts  on  the  upper  and  outer  part  of  the  thigh  and  shattered  the  femur,  the 
splintering  extending  quite  to  the  neck  of  the  bone.  Six  hours  after  the  injury,  Surgeon  J.  R.  Buist,  1st  Tennessee,  of  Cheat- 
ham's  Division,  removed  the  limb  at  the  hip  joint  by  the  antero-posterior  flap  method  by  transfixion.  The  patient  was  rendered 
insensible  by  chloroform.  He  rallied  promptly  from  the  anaesthetic  and  from  the  shock  of  the  operation.  Cold-water  dressings 
were  applied  to  the  stump,  and  stimulants  and  concentrated  nourishment  were  administered.  After  about  eight  hours  the  patient 
began  to  sink,  and  he  died  thirty-six  hours  after  the  operation,  September  2,  1864.3  In  a  letter,  dated  Nashville,  Tennessee, 
March  25,  1867,  Dr.  Buist  states:  "I  am  sorry  to  say  that  the  exsected  head  of  the  femur  was  not  preserved,  nor  a  photographic 
drawing  taken." 

CASE  286. — Private  William  Waters,  Co.  K,  123d  New  York,  was  wounded  at  Resaca,  Georgia,  on  May  15,  1864,  by  a 
large  fragment  of  shell,  which  completely  carried  away  his  left  thigh  and  fractured  both  the  tibia  and  fibula  of  the  right  leg. 
He  was  carried  to  a  field  hospital  of  the  Twentieth  Corps,  and  as  soon  as  he  had  partially  rallied  from  the  shock  of  his  frightful 
injuries  chloroform  was  administered,  and  Surgeon  J.  W.  Brock,  66th  Ohio,  amputated  at  the  left  hip  joint:  and  then  removed 
the  right  leg  at  the  place  of  election.  The  patient  survived  the  double  operation  but  a  short  period.  The  exact  length  of  time 
is  not  stated;  but  he  died  in  the  afternoon  of  the  day  on  which  he  was  wounded,  May  15,  1864.4 

CASE  287. — Private  Elisha  Waylancl,  Co.  E,  34th  Iowa,  had  his  right  thigh  almost  completely  torn  off  at  the  hip  joint, 
at  the  siege  of  Vicksbnrg,  July  3,  1863,  by  an  unexploded  shrapnel  shell.  He  was  hurriedly  conveyed  to  a  field  hospital,  but 
bled  very  profusely  during  the  short  transit,  and  is  represented  as  almost  exsanguineous  upon  reaching  the  hospital.  His  regi 
mental  surgeon,  Charles  W.  Davis,  34th  Iowa,  having  mastered  the  haemorrhage,  had  the  patient  placed  under  chloroform,  ligated 
the  femoral  artery,  divided  the  lacerated  soft  parts  which  still  connected  the  mutilated  limb  with  the  trunk,  and  then  formed  a 
single  large  anterior  flap,  and  exarticulated  the  femur.  The  patient  survived  the  operation  two  hours,  and  died  July  3,  1863.5 

In  five  of  the  foregoing  examples  (CASES  273,  280,  284,  286,  287)  and  in  CASE  289, 
to  be  cited  presently,  primary  disarticulation  at  the  hip  appeared  to  be  of  absolute  urgency, 
since  the  graver  injuries  of -the  femur  were,  in  each  case,  conjoined  with  lesions  of  the 
femoral  artery. 

1  The  particulars  of  this  case  were  communicated  to  the  Surgeon  General  by  Professor  P.  F.  EVE  in  a  letter  dated  Nashville,  March  5,  1867.     See 
also  EVE  (P.  F.),  foe.  cit.,  p.  253,  and  Circular  No.  7,  S.  G.  O.,  1867,  pp.  24  and  57  ;  LttxiXG  (A.),  op.  tit.,  p.  90. 

2  The  abstract  of  this  case  was  compiled  from  data  furnished  by  the  operator,  Dr.  BENJAMIN  D.  LAY,  in  charge  of  the  City  Hospital,  at  Vicksburg, 
during  the  siege,  in  a  letter  to  the  editor,  dated  Paducah,  July  26,  1867.    Dr.  LAY,  who  reluctantly  undertook  the  operation,  closes  his  account  with  the 
following  remark :  "I  saw  nothing  in  it  to  diminish  the  horror  with  which  I  approach  such  cases,  of  which  I  have  had  the  misfortune  to  have  three.     I 
have  been  present  at  three  others.     All  were  fatal."    See  Circular  No.  7,  S.  G.  O.,  1867,  pp.  27,  58 ;  EVE  (P.  P.),  toe.  cit.,  pp.  253.  258;  LttxiXG  (A.), 
op.  cit.,  p.  94. 

3  The  facts  in  this  case  were  furnished  by  Professor  PAUL  F.  EVE,  from  a  carefully  written  account  by  the  operator,  Surgeon  J.  K.  BUIST,  1st  Ten 
nessee.     See  Circular  No.  7,  S.  G.  O.,  1867,  pp.  31,  59;  EVE  (P.  P.),  toe.  cit.,  pp.  253,  258;  LOxrxo  (A.),  op.  cit.,  97. 

4  The  abstract  of  this  case  was  made  from  field  returns  signed  by  Surgeon  G.  E.  COOPER,  TJ.  S.  A.,  Medical  Director,  Surgeon  A.  L.  Cox,  If.  S.V., 
and  Surgeon  A.  BALL,  5th  Ohio.     See  Cireular  No.  6,  S.  G.  ()..  1865,  p.  50 ;   Circular  No.  7,  S.  G.  O.,  1867,  pp.  29,  58 ;  L»X»G  (A.),  op.  cit.,  p.  96. 

8  This  abstract  was  compiled  from  notes  of  the  case  on  the  Monthly  Report  of  Sick  and  Wounded  of  the  34th  Iowa,  for  July,  1863.  In  a  letter 
to  the  editor,  dated  Indianola,  Iowa,  June  1,  1869,  the  operator,  Dr.  C.  W.  DAVIS,  writes:  "In  reply  to  yours  of  May  1st,  I  will  say,  after  examining 
my  Army  surgical  notes,  I  notice  the  case  of  E.  M.  Wayland,  Co.  E,  34th  Iowa  Volunteers.  Disarticulation  of  hip  joint,  on  the  right  side.  The  femur 
was  fractured  at  upper  third;  also  laceration  of  the  tissues,  muscles,  and  vessels  of  the  posterior  part  of  the  leg  ns  far  upas  the  insertion  of  the  glutens 
marimus.  I  performed  the  amputation  by  the  single  anterior  flap  operation,  ligating  the  artery  before  disarticulating  the  head  of  the  femur.  The 
operation  was  neat  and  made  a  perfect  stump,  but  the  patient  lived  only  forty-seven  hours."  See  Circular  No.  2,  S.  G.  O.,  1869,  p.  108. 


136 


INJUEIES    OF    THE    LOWER    EXTREMITIES. 


ICHAP.  x. 


PIG.  91. — Shot  fracture 
through  the  trochanters 
of  the  left  femur.  [From 
a  drawing  by  Surgeon  H. 
Z.  GILL,  U.  S.  V.] 


The  following  nine  fatal  cases  of  primary  amputations  at  the  hip  were  for  wounds 
inflicted  by  small  projectiles.  In  one  instance  (CASE  294),  the  patient  survived  the  opera 
tion  at  least  eleven  days;  in  another  (CASE  293),  the  patient  had  rallied  so  far  that  it  was 
considered  safe  to  move  him,  but  he  succumbed  on  the  road,  forty-eight  hours  after  the 
operation.  The  remaining  seven  patients  died  within  a  few  hours. 

CASE  288. — Private  James  A.  Ailing,  Co.  D,  3d  Wisconsin,  was  wounded  on  March,  16,  1865,  at 
tlie  battle  of  Averysboro',  North  Carolina,  by  a  conoidal  musket  ball,  which  entered  the  upper  part  of 
the  left  thigh  in  front,  and  produced  a  comminuted  fracture  of  the  femur  through  the  trochanters,  with 
longitudinal  splintering  extending  a  short  distance  down  the  shaft  and  upward  within  the  capsular  liga 
ment.  The  wounded  man  was  conveyed  to  a  field  hospital  of  the  Twentieth  Corps.  Chloroform  was 
administered  and  the  wound  was  thoroughly  explored,  and  it  was  determined  to  amputate  at  the  hip 
joint,  because  it  was  imperative  to  move  the  wounded  on  the  following  day  over  rough  roads,  and  either 
an  excision  of  the  head  of  the  femur,  or  an  attempt  at  conservation  of  the  limb,  offered,  under  the 
circumstances,  less  chance  of  a  favorable  result  than  the  removal  of  the  limb.  Five  hours  after  the 
reception  of  the  injury,  Surgeon  H.  Z.  Gill,  U.  S.  V.,  amputated  by  double  flap.  The  patient  reacted 
well  after  the  operation,  but  the  amendment  was  of  brief  duration.  He  died  seven  hours  after  the  com 
pletion  of  the  amputation,  March  17,  1865.  A  drawing  of  the  shattered  extremity  of  the  femur,  contrib 
uted  by  the  operator,  is  presented  in  the  adjacent  wood-cut  (FiG.  91).' 
CASE  289. — Corporal  Wad  Brookins,  Co.  C,  49th  U.  S.  Colored  Troops,2  was  accidentally  shot,  in  the  regimental  camp, 
near  Transylvania  Landing,  Louisiana,  on  September  3,  1863.  He  was  struck  in  the  upper  third  of  the  left  thigh,  at  close 
range,  by  a  musket  ball,  which  divided  the  femoral  artery  and  badly  comminuted  the  thigh  bone.  Assistance  was  immediately 
rendered,  and  the  copious  hasmorrhage  was  controlled  by  compression.  Prompt  preparations  having  been  made,  the  thigh  was 
amputated  at  the  hip  by  Surgeon  Sylvester  Lanning,  49th  U.  S.  C.  T.  The  patient  died  from  the  haemorrhage  and  shock,  four 
hours  after  the  completion  of  the  operation,  September  3,  1863. 

CASE  290. — Private  J.  M.  Brown,  Co.  H,  63d  Indiana,  was  wounded  on  June  16, 1864,  in  the  attack  of  the  Twenty-third 
Corps  upon  the  earthworks  at  Lost  Mountain,  near  Marietta,  Georgia.  A  conoidal  musket  ball  struck  his  right  thigh  and  shat 
tered  the  upper  extremity  of  the  femur,  fissures  extending  through  the  trochanter  major.  He  was  conveyed  to  the  field  hospital 
of  the  Twenty-third  Corps,  and  on  June  17th,  about  fourteen  hours  after  the  reception  of  the  injury,  he  was  placed  under  the 
influence  of  chloroform,  and  after  a  careful  examination  of  the  injury,  it  was  decided  to  amputate  at  the  hip  joint.  The  oper 
ation  was  performed  by  Surgeon  Edward  Shippen,  U.  S.  V.  The  operative  method  was  similar  to  that  adopted  by  Dr.  Shippen 
in  his  successful  operation  (CASE  272).  Comparatively  little  blood  was  lost,  but  the  patient  succumbed 
to  the  shock  of  the  operation  and  died  upon  the  operating  table  very  soon  after  the  completion  of  the 
disarticulation.3 

CASE  291. — Seaman  George  Cook,  aged  21  years,  an  Englishman,  was  wounded  on  February  1, 
1834,  in  an  engagement  of  a  gunboat  with  a  battery  supported  by  sharpshooters,  at  Smithfield,  Virginia. 
A  rifle  ball  grazed  his  right  thigh,  passed  through  both  testicles  and  entered  the  left  thigh,  fractured  the 
femur,  and  passed  out  at  the  posterior  and  outer  portion  of  the  limb.  The  wounded  man  was  taken  to 
the  Naval  Hospital,  at  Portsmouth,  Virginia,  not  many  miles  distant,  and  Surgeons  Solomon  Sharp,  A. 
C.  Gorgas,  John  Paul  Quinn,  and  Assistant  Surgeon  G.  S.  Franklin,  U.  S.  N.,  held  a  consultation,  at 
which  it  was  decided  that  the  femur  was  extensively  shattered,  and  that  an  amputation  at  the  hip  joint 
presented  the  only  chance  of  saving  the  patient's  life.  On  the  morning  of  February  2d,  the  patient  was 
placed  under  the  influence  of  chloroform,  the  femoral  artery  was  compressed  at  the  groin,  and  Surgeon 
Gorgas,  assisted  by  his  colleagues,  proceeded  to  remove  the  limb.  The  operation  was  performed  by 
transfixing  and  forming  an  anterior  flap,  disarticulating,  and  then  making  a  posterior  flap  by  cutting 
from  within  outward.  Very  little  blood  was  lost;  yet  the  patient  never  reacted,  but  succumbed  about 
two  hours  after  the  completion  of  the  operation.  The  shattered  femur  was  forwarded  by  Surgeon 
Gorgas  to  the  Army  Medical  Museum.  It  is  represented  in  the  adjacent  wood-cut  (FiG.  92).  It  is  a 
very  strong  and  compact  bone.  The  ball  has  separated  five  large  fragments,  and  has  produced  fissures 
extending  from  above  the  level  of  the  trochanter  minor  a  little  over  four  inches  down  the  shaft.4 

CASE  292. — "  Private  John  W.  Dadds,  Co.  B,  4th  Maryland,  was  wounded  on  the  morning  of  May  12,  1864,  at  the  battle 
of  Spottsylvania,  by  two  musket  balls,  one  of  which  shattered  his  left  tibia  and  fibula,  while  the  other  passed  through  the  left 

1  The  notes  in  this  case  were  furnished  by  the  operator,  Surgeon  H.  Z.  GILL,  U.  S.  V.     See  Circular  No.  7,  S.  G.  O.,  1867,  pp.  31,  59 ;  LOxiXG  (A), 
Ober  die  Slutung  bei  dcr  Exarticulation  des  ObersclienJcels,  etc.,  Zttrich,  1877,  S.  102. 

2  The  regiment  was  styled  at  the  period  "  llth  Louisiana  Regiment  of  African  Descent."    Its  designation  was  changed,  March  11,  1864.  to  "49th 
United  States  Colored  Troops."    The  case  was  reported  on  the  Monthly  Report  of  Sick  and  Wounded  of  the  llth  Louisiana  Regiment  of  African  Descent, 
signed  by  the  operator,  Surgeon  SYLVESTER  LANSING.   See  Circular  No.  2,  S.  G.  O.,  1869,  p.  108 ;  Lt)ND»r.  (A.),  op.  cit.,  p.  93. 

3  A  Report  of  Surgical  Operations  during  the  Atlanta  Campaign  in  1864,  collected  by  Surgeon  A.  M.  WILDER,  TJ.  8.  V.,  furnished  the  data  in  this 
case.     This  is  one  of  the  two  fatal  cases  referred  to  by  Dr.  EDWARD  SHIPPEN,  the  operator,  in  connection  with  an  account  of  his  successful  amputation  at 
the  hip  (CASE  270,  ante.),  published  in  Professor  FRAKK  H.  HAMILTON'S  Treatise  on  Military  Surgery,  New  York,  18G5,  p.  485.     A  special  report  from 
Dr.  Smri'EX,  dated  January  13,  1866,  contains  no  further  particulars.     See  Circular  No.  6,  S.  G.  O.,  1865,  p.  50;  Circular  No.  7,  S.  G.  O.,  1867,  pp.  31, 
59;  LtJxrso  (A.),  op.  cit.,  p.  97. 

4  An  account  of  this  case  was  forwarded  to  the  Surgeon  General's  Office  by  the  operator,  Surgeon  ALHEKT  C.  GORGA8,  U.  S.  N.,  together  with 
the  pathological  preparation.    See  Circular  No.  6,  S.  G.  O,,  1865,  p.  50 ;  Circular  No.  7,  S.  G.  O.,  1867,  pp.  28,  58 ;   Catalogue  of  the  Surg.  Sect,  of  the 
Army  Medical  Museum,  18C6,  p.  233;  LINING  (A.),  op.  cit.,  p.  96. 


FIG.  92. — Comminution 
of  femur  by  a  rifle  ball. 
Spec.  2273. 


SECT,  n.]  PRIMARY   AMPUTATIONS    AT   THE    HIP   JOINT.  137 

thigh,  comminuting  the  femur  at  the  trochanters.  He  was  carried  to  the  field  hospital  of  the  2d  division  of  the  Fifth  Corps, 
where  a  consultation  was  held  by  the  senior  surgeons  present.  After  a  careful  exploration,  under  chloroform,  it  was  determined 
that  the  thigh  wound  involved  the  hip  joint.  It  was  decided  that  an  excision  of  the  head  of  the  femur,  or  a  resort  to  expectant 
treatment,  were  alike  forbidden  by  the  grave  compound  fracture  of  both  bones  of  the  leg,  which  complicated  the  thigh  fracture, 
and  that  there  was  no  alternative  but  coxo-femoral  amputation.  Accordingly,  stimulants  were  administered,  and  every  means 
were  employed  to  bring  about  reaction,  and,  three  hours  after  the  reception  of  the  injury,  Surgeon  Enos  G.  Chase,  104th  New 
York,  proceeded  to  remove  the  limb.  He  performed  the  double-flap  operation,  sometimes  described  as  Bdclard's,  transfixing  the 
thigh  and  forming  a  large  flap  in  front,  disarticulating  and  then  cutting  from  within  outward  to  make  a  posterior  flap.  The 
vessels  were  then  rapidly  secured.  The  patient  survived  the  operation  twelve  hours."1 

CASE  293. — Private  James  Martin,  Co.  I,  146th  New  York,  aged  20  years,  was  wounded  on  July  13,  1863,  in  one  of  the 
reconnoissances  of  General  Lee's  position  near  Williamsport.  He  was  carried  to  the  rear  and  placed  in  a  barn  by  the  roadside 
not  far  from  Williamsport.  On  the  following  morning  a  consultation  was  held  in  the  case,  at  which  Assistant  Surgeons  Howard, 
C.  Wagner,  and  Colton,  U.  S.  A.,  and  Drs.  Stearns,  Lord,  Dean,  and  others  assisted.  It  was  found  that  a  couoidal  musket  ball 
had  passed  through  the  upper  part  of  the  left  thigh  from  before  backward,  and  had  struck  the  femur  a 
little  below  the  great  trochanter  and  produced  a  comminuted  fracture.  It  was  believed  that  the  fracture 
extended  into  the  coxo-femoral  articulation,  and  it  was  decided  that  no  operative  procedure  could  be 
advantageously  practised  except  an  amputation  at  the  hip  joint.  Dr.  Howard  was  invited  to  operate. 
Chloroform  having  been  administered,  he  removed  the  limb  by  a  double-flap  operation.  He  describes  the 
operation  as  performed  by  "entering  the  knife  about  four  or  five  inches  below  the  anterior  superior  spinous 
process  of  the  ilium,  and  causing  it  to  emerge  by  transfixion  an  inch  and  a  half  to  the  inside  of  the  course 
of  the  femoral  vessels.  The  operation  was  completed  in  the  ordinary  manner  of  flap  amputations.  By 
transfixing  at  the  points  described,  the  mouths  of  the  divided  vessels  were  so  near  the  margin  of  the 
anterior  flap  as  to  be  readily  seized  immediately  after  division,  and  by  the  external  obliquity  of  the  plane 
of  incision  drainage  of  pus  was  facilitated  more  than  by  the  ordinary  horizontal  antero-posterior  flaps." 

It  appears  that  the  disarticulation  Avas  rapidly  accomplished,  and  that  very  little  blood  was  lost.     The  shock       FIG.  93. -Comminuted 
.      .  .  x    i        i  iv   j        *      ii.   A  •*  -j       j       f    ^  T--  ,r>        8hot  fracture  of  femur, 

was  great,  but  the  patient  is  reported  to  have  rallied  so  far  that  it  was  considered  sate  to  move  him.     On     gp^.  1379. 

July  16,  1863,  he  died  on  the  road  to  Sharpsburg,  about  forty-eight  hours  subsequent  to  the  operation. 

An  examination  of  the  specimen  from  this  case,  which  was  forwarded  by  Assistant  Surgeon  Howard  to  the  Army  Medical 
Museum,  and  is  represented  in  the  wood-cut  (FlG.  93),  justified  the  opinion  formed  before  the  operation,  that  an  excision  of  the 
head  of  the  femur  was  impracticable  ;  for  besides  the  comminution  about  the  lesser  trochanter  and  the  fissures  towards  the  neck, 
fissures  ran  down  the  shaft  of  the  bone  for  a  long  distance.2 

CASE  294. — A  private  soldier  of  Major  Douglass's  Cavalry  was  accidentally  wounded  by  a  comrade  near  Lavergne, 
Tennessee,  on  October  19,  1862.  The  injury  was  inflicted  by  a  round  ball,  with  buckshot,  fired  from  a  fowling-piece,  the  muzzle 
being  within  a  few  inches  of  the  person  of  the  man  who  was  wounded.  The  charge  passed  directly  through  the  thigh  just 
below  the  trochanters,  comminuted  the  femur,  and  extensively  lacerated  the  soft  parts.  The  operation  was  performed  eight  hours 
after  the  reception  of  the  injury.  Chloroform  was  administei-ed  until  anaesthesia  was  complete.  Then  an  assistant  controlled 
the  femoral  at  the  groin,  and  the  operator,  Dr.  J.  F.  Grant,  P.  A.  C.  S.,  entered  the  point  of  a  knife  twelve  inches  long  an  inch 
below  the  anterior  superior  spinous  process  of  the  ilium  and  transfixed,  according  to  Lisfranc's  method,  on  the  outer  side  of  the 
femur,  bringing  the  point  out  near  the  tuberosity  of  the  ischium,  and  cutting  an  external  and  posterior  flap  five  inches  long.  The 
gluteal  and  sciatic  arteries  were  then  tied;  then  an  antero-internal  flap  was  cut  and  the  head  of  the  bone  was  disarticulated. 
He  was  taken  to  the  neighboring  house  of  a  widowed  lady  on  the  Murfreesboro'  pike,  between  Lavergne  and  Nashville.  Here 
he  was  seen  by  Dr.  Grant  on  October  22d,  and  seemed  in  every  respect  to  be  doing  well.  On  this  day  that  locality  was  occupied 
by  United  States  troops  and  Dr.  Grant  did  not  see  his  patient  again.  He  received  a  message  from  him  on  October  30th,  but  no 
subsequent  information.  It  is  altogether  probable,  therefore,  that  the  patient  died.3 

CASE  295. — A  private  of  the  18th  Mississippi  Regiment,  of  Barksdale's  Brigade,  a  robust  man,  under  thirty  years  of  age, 
received  a  shot  fracture  of  the  upper  extremity  of  the  left  femur,  at  Malvern  Hill,  July  1,  1862.  The  injury  was  probably 
caused  by  a  conoidal  musket  ball,  and  there  was  great  splintering  of  bone,  extending  to  the  neck.  Eai'ly  on  the  morning  of 
July  2d  the  patient  inhaled  chloroform,  and  amputation  at  the  hip  joint  was  performed  by  Surgeon  J.  T.  Gilmore,  P.  A.  C.  S., 
by  forming  anterior  and  posterior  flaps  by  transfixion.  There  was  no  reaction,  and  the  patient  died  from  the  shock  of  the 
operation  an  hour  or  two  after  its  completion.4 

CASE  298. — A  private  of  the  21st  Mississippi  Regiment,  a  young  healthy  man,  was  wounded  at  Malvern  Hill,  July  1, 
1862,  by  a  conoidal  musket  ball,  which  fractured  the  left  femur  through  the  trochanters  and  neck.  Twelve  hours  after  the 
reception  of  the  injury  he  underwent  amputation  at  the  hip  joint.  The  operation  was  performed  under  chloroform,  by  Surgeon 
J.  T.  Gilmore,  by  the  antero-posterior  flap  method,  the  flaps  being  formed  by  transfixion.  The  patient  only  partially  reacted 
after  the  operation,  and,  though  he  lingered  until  the  morning  of  July  4th,  he  died  apparently  from  the  shock  of  the  operation.5 

1  At  the  date  of  the  publication  of  Circular  No.  7,  in  18C7,  various  reports  regarding  this  case  led  to  the  belief  that  the  head  of  the  femur  had  been 
excised.     A  report  of  the  case,  by  Surgeon  EXOS  G.  CHASE,  104th  New  York,  the  operator,  was  finally  discovered  in  time  for  publication  in  Circular 
No.  2,  18C9,  at  page  107;  LINING  (A.),  op.  cil.,  p.  96. 

2  Assistant  Surgeon  BENJAMIN  HOWAUD,  U.  S.  A.,  the  operator,  and  Surgeon  T.  M.  FLANDRAU,  146th  New  York,  communicated  the  facts  in  this 
case.     See  Circ.  No.  G,  S.  G.  O.,  1865,  p.  50 ;   Circ.  No.  7,  S.  G.  O.,  1867,  pp.  28,  58 ;   Cat.  Surg.  Sect.  A.  M.  M.,  18C6,  p.  '-'33 ;  LlJNING  (A.),  op.  cit.,  p.  94. 

3  The  abstract  of  this  case  was  compiled  from  data  furnished  by  Professor  PAUL  F.  EVE.     See  Circular  No.  7,  S.  G.  O.,  1867,  pp.  25,  28;  EVE 
(P.  F.),  Joe.  cit.,  pp.  234,  260;  LuNING  (A.),  loc.  cit.,  p.  91. 

"EVE  (P.  F.),  Joe.  cit.,  pp.  254,  259;  Circular  No.  7,  S.  G.  O.,  1865,  pp.  25,  57;  LterNG  (A.),  op.  cit.,  p.  91. 

8SOUUEL  (F.),  Confed.  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  155;  EVE  (P.  P.),  loc.  cit.,  p.  254;   Circular  No.  7,  S.  G.  O.,  1867,  pp.  25,  58; 
LOxiXG  (A.),  op.  cit.,  p.  91. 

SURG.  Ill— 18. 


138 


INJURIES    OF    THK   .LOWER    EXTREMITIES. 


[CHAP.  X. 


TABLE  XV. 
Summary  of  Twenty-five  Cases  of  Primary  Amputation  at  the  Hip  Joint. 


NO. 

NAME,  AGE,  AXD  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Kelly,   J.   E.,  Pt,  B,   56th 

April  29, 

Conoidal  ball  fractured  upper 

April  29, 

Single  anterior  flap,  by  Surg. 

Gangrene,    diarrhoea.      Disch'd 

Pennsylvania,  age  28. 

1863. 

extremity  of  left  femur. 

1863. 

E.  Shippen,  U.  S.  V. 

December  23,  1  863.    Spec.  1148. 

2 

Robinson,  Pt.,  Louisiana  reg 

Mar.  13, 

Frag.of  24'-pounder  shell  crush 

Mar.  13, 

Antero-internal  flap  amputat'n, 

Healed  by  first  intent'n  ;  left  hos 

iment,  age  35. 

1863. 

ing  trochanters  and  neck  of 

1863. 

by  Surg.  W.  M.  Compton,  2d 

pital  April  20,  '63,  in  fine  health. 

left  femur  and  wounding  fem 

Texas. 

EVE  (P.F.).  ?oe.ci/..pp.254,  262. 

oral  artery. 

Circ.  7,  S.  G.O.,  1867,  pp.  26,  58. 

3 

Williamson,  Pt.,  13tb  Mis 

June  4, 

Conoidal  ball  fract.  right  femur, 

June  4. 

Long  anterior  and  short  poste 

Six  weeks  after  operation  wound 

sissippi,  age  20. 

1862. 

fissures  extending  into  neck 

1862. 

rior  flaps,  by  Surg.  J.  T.  Gil- 

healed  and  patient  allowed  to 

quite  within  capsular  ligam't. 

more,  C.  S.  A. 

leave  hospital.     EVE  (P.   F.), 

loc.  cit.,  pp.  254,  259.     Circ.  7, 

S.  G.  0.,  1867,  pp.  24,  57. 

4 

Ailing,    J.  A.,    Pt.,    D,   3d 

Mar.  16, 

Conoidal  ball  fract'd  left  femur 

Mar.  16, 

Double  flap,   by  Surg.  H.  7,. 

Died,  March  17,  18t>5,  seven  hours 

Wisconsin. 

1865. 

thro'  troch's,  with  longitud'l 

1865. 

Gill,  U.  S.  V. 

after  operation.     Circ.  7,  S.  G. 

splintcr'gextend'g  down  shaft 
and  upw'd  within  capsul.  lig. 

O.,  1867,  pp.  31,  59. 

5 

Barger,    J.,    Pt.,     B,     26th 

May  18, 

Fragment  of  shell  shattering 

May  18, 

Single  antero-interual  flap,  by 

Died,  May  18,  1864,  two  hours 

Pennsylvania,  age  22. 

1864. 

right  femur  from  just  above 

1864. 

Surg.  C.  C.  Jewett,  16th  Mass. 

after  operation.  iSpcc.3080.  Circ. 

tro.  minornine  ins.  downward. 

7,  S.  G.  O..  1867,  pp.  30,  5!). 

li 

Brookins,  W.,  Corp'l,  C,  49th 

Sept.  3, 

Musket  ball  eomminut'g  upper 

Sept,  3, 

Amputation,  by  Surg.  S.  Lan- 

Died,  Sept.  3,  1863,  from  hemor 

Colored  Troops. 

1863. 

third  left  thigh  and  dividing 

1863. 

ing,  49th  Colored  Troops. 

rhage  and  shock,   four    hours 

femoral  artery. 

after  operation.     Circ.  2,  S.  G. 

O.,  1869,  p.  109. 

7 

Brown,   J.  M.,  Pt,,  H,   63d 

June  16. 

Conoidal  ball  shattered  upper 

June  17, 

Single  anterior  flap,  by  Surg 

Died  June  17,    1864;   shock   of 

Indiana. 

1864. 

extremity  right  femur,fissures 

1864. 

E.  Shippen,  U.  S.  V. 

operation.     Circ.  6,  S.  G.   O., 

extending  through  trochauter 

1865,  p.  50.     Circ.  7,  S.  G.  O., 

major. 

1867,  pp.  31,  59. 

8 

Bushmil.  J..  Pt.,  99th  New- 

Mar.  9, 

Piece  of  shell  comminuted  neck 

Mar.  9, 

Lateral  double  flap,  method  of 

Did  not  rally;   died  two  hours 

York  (detailed  as  a  seaman 

1862. 

and  trochanters  of  left  femur. 

1862. 

Baron  Larrey,  the  elder,  by 

after  operation.     Circ.  7,  S.  G. 

on  U.  S.  frigate  Congress). 

Surg.  L.  McLean,  2d  N.  Y. 

O.,  1867,  pp.  24,  57. 

9 

Carlton.   R.,   Captain,  1,  3d 

June  16. 

Large    missile    fractured    tro 

June  16. 

Anterior  posterior  flap,   by  a 

Did   not   rally  ;   died.  June   16, 

New  Hampshire. 

1862. 

chanters  and  shattered  left  fe 

1862. 

New  England  surgeon;  assist 

1862,  less  than  two  hours  after 

mur  for  several  inches  below. 

ed  by  Ass't  Surg.  F.  J.  Ban 

operation. 

croft,  76th  Penn. 

10 

Cook,  G.,  seaman,  age  21  ... 

Feb.  1, 

Rifle  ball  fractured  left  femur, 

Feb  2, 

Anterior  posterior  flap.bv  Surg 

Never  reacted  :  died  two  hours 

1864. 

wounded  both  testes  and  right 

1864. 

A.  C.  Gorgas,  U.  S.  N. 

after  operat'n.  Spec.  2273.   Circ. 

thigh. 

6,  S.  G.  O.,  18G5,  p.  50.     Circ. 

7,  S.  G.  O.,  1867,  pp.  28.  58. 

11 

Cooper,  ,  Pt.,  Alabama 

May  22. 

Fragment  of  shell  comminuted 

Mav  22, 

Large  anterior  flap,  by  Surg. 

Never  rallied  ;  died  in  less  than 

regiment,  age  20. 

1863. 

upper  third  right  femur,  frac 

1863. 

W.  M.  Compton,  2d  Texas. 

an  hour. 

turing  tuberosity  of  ischium. 

13 

Dadds,  J.  W.,  Pt.,    15,   4th 

May  12. 

Musket  ball  comminuting  left 

May  12, 

Double  flap,  Beclard's  method, 

Died,  May  12,  1864,  twelve  hours 

Maryland. 

1864. 

femur  at  trochanters,  involv. 

1864. 

by  Surg.  E.  G.  Chase,  104th 

after  operation.     Circ.  2,  S.  G. 

hip  joint  (also  fract.  left  leg). 

New  York. 

O.,  1869,  p.  107. 

13 

Fulton,  I.  C.,  Pt.,  I.  4th  New 

Oct.  1. 

Fragment  of  shell  shattered  up 

Oct.  1, 

Anterior  post,  flaps,  by  Surg. 

Died,  Oct.  1,  1864,  from  shock, 

York  Heavy  Artillery. 

1864. 

per  extremity  of  left  femur. 

1864. 

J.  W.  Wishart,  140th  Penn. 

in  a  few  hours.     Circ.  2,  S.  G. 

O.,  1869,  p.  108. 

1-1 

Gordon,     R.,    Pt.,     H,   7th 

May  18, 

Fragment  of  shell  completely 

May  18, 

Method  of  Guthrie,  by  Dr.  J. 

No  reaction  ;  died  ten  hours  after 

Rhode  Island,  age  28. 

1864. 

shattered  left  femur. 

1864. 

M.  Carnochan  :   femoral  tied 

operation. 

before  amputation. 

15 

Martin,  J.,  Pt.,  1,  146th  New 

July  13, 

Conoidal  ball  comminu'd  frac 

July  14, 

Double  flap,  by  Ass't  Surgeon 

Shock  great  ;  rallied  somewhat. 

York,  age  20. 

1863. 

ture  of  left  femur  a  little  below 

1863. 

B.  Howard,  U.  S.  A. 

Died  July  16,  1863.     Spec.  1379. 

trochanter  major. 

Circ.  6,   S.  G.  O..  1865,  p.  50. 

Circ.  7,  S.  G.  O.,  1867,  pp.  28,  £8. 

Hi 

Unknown,     Union      soldier, 

Oct.  21, 

Large  missile  fractured  upper 

Oct.  21, 

Amputation,    by   Surgeon   H. 

Died  soon  after  operation  ;  com 

taken  prisoner. 

1861. 

part  of  femur. 

1861. 

McGuire,  C.  S".  A. 

bined  shook  of  injury  and  oper'n. 

Circ.  2,  S.  G.  O.,  1869,  p.  108. 

17 

Unknown,  Lieut..   Arkansas 

Oct.  3, 

Cannon    ball  wound   of   right 

Oct.  3, 

Soft  parts  of  post,  part  of  thigh 

Rallied  ;  favorable  progress  :  Oct. 

regiment,  age  28. 

1862. 

hip,  five  inches  of  the  shaft  of 

1862. 

pared  into  shape,  large  and 

10th.  erysipelas  extended  rapid 

femur  comminuted,  head  split 

long  antero-internal  flap,  by 

ly.    'Died  October  12,  1862. 

and  exposed. 

Surg  W.M.Compton,  2d  Tex. 

18 

Unknown,   Pt.,  Maj.   Doug 

Oct.  19. 

Round    ball  and   buck    com 

Oct.  19, 

External  posterior  flap,  antero- 

Oct.  22d,  doing  well  ;  last  heard 

lass's  Cavalry. 

1862 

minuted    femur    just    below 

1862. 

internal  flap,  by  Surg.  J.  F. 

from  Oct.  30th  ;  probably  died. 

trochanters. 

Grant,  P.  A.  C.'S. 

EVE  (P.  F.),  loc.  cit.,  pp.  254, 

260.     Circ.  7,  S.  G.  O.,  1867,  pp. 

25.  58. 

19 

Unknown,  Pt.,   Gen.   A.    S. 

April?, 

Frag,  shell  shatt'd  up.  extrem 

April  7, 

Amputation,  by  Surg.  D.  W. 

Died,  from  cxhaust'n,  seven  h'rs 

Johnston's  army. 

1862. 

ity  left  femur,  com.  extended 

1862. 

Yandell,  C.  S.  A. 

after  operation.    EVE  (P.  F.), 

to  head  and  neck  of  bone. 

loc.  cit  .  p.  253.     Circ.  7,  S.  G. 

O.,  1867,  pp.  24,  57. 

20 

Unknown,    Pt.,    18th   Miss., 

July  1, 

Conoidal  ball  fractured  upper 

July  2, 

Anterior  and  posterior  flaps,  by 

Died,  an  hour  or  two  after  oper 

Barksdale's    brigade,    age 

1862. 

extremity  of  left  femur,  splint 

1862. 

Surg.  J.  T.  Gilmore,  C.  S.  A. 

ation,  from  shock  of  operation. 

under  30. 

ering  extending  to  neck. 

EVE  (P.   F.),   loc.  cit..  p.  254. 

Circ.  7,  S.  G.  O.,  1  867,  pp.  25,  57. 

21 

Unknown,  Pt.,  21st  Miss.... 

July  1, 

Conoidal  ball  fract'd  left  fumur 

July  1, 

Anterior  posterior  flap,  by  Sur 

Died,  July  4,   1862,  apparently 

1862. 

through  trochanters  and  neck. 

1862. 

geon  J.  T.  Gilmore,  C.  S.  A. 

from  shock  of  operation. 

oo 

Unknown,  Pt..  3d  Missouri. 

June  —  , 

Large  frag,  of  shell  comminu 

Day  of 

Semi-lunar  flap  from  outer  and 

Reaction  never  completely  estab 

1863. 

ting  right    femur   extent  of 

injury. 

anterior  part,  by  Surg.  B.  D. 

lished  ;   died  samo   dav.     EVE 

eight  inches;   femoral  artery 

Lay,  P.  A.  C.  S. 

(P.  F.),  loc.  cit.,   pp.  253,  261. 

divided. 

Circ.  7,  S.  G.  O.,  18<i7.  pp.  27,  58 

•„•:; 

Unknown,  Pt..  27th  Tenn  

Aug.  31, 

Cannon  shot  shat'd  right  femur, 

Aug.  31, 

Antero-posterior  flaps,  by  Surg. 

Rallied  promptly  ;  died.  Sept.  2, 

1864. 

splintering  extending  to  neck. 

1864. 

J.  R.  Buist,  1st  Tennessee. 

1864,  thirty-six  hours  after  oper 

ation.     EVE  (P.  F.),  Inc.  cit.  ,  pi>. 

253,  258.    Circ.  7.  S.  G.  O.,  1  867, 

pp.  31.  59. 

24 

Waters,   W.,    Pt.,    K,    123d 

May  15, 

Large  fragment  of  shell  carried 

MaylS, 

Amputation  of  the  left  hip  and 

Died  May  15,  1864.     Circ.  6.  S. 

New  York. 

1864. 

away  left   thigh,    fracturing 

1864. 

right  leg.  by  Surgeon  J.  W. 

G.  O.,  1865,  p.  50.      Circ.  7,  S. 

right  leg. 

Brock,  66th'Ohio. 

G.  O.,  1867,  pp.  29,  58. 

25 

Wayland,  E.,    Pt.,   E,  34th 

July  3, 

Unexploded  shrapnel  shell  al 

July  3, 

Single  large  anterior  flap,  by 

Died  two  hours  after  operation. 

Iowa. 

1863. 

most  completely  tearing  off 

1863. 

Surgeon  C.  W.   Davis,  34th 

Circ.  2,  S.  G.  O.,  1869,  p.  108. 

right  thigh  at  hip  joint. 

Iowa. 

SECT.  II.] 


INTERMEDIARY    AMPUTATIONS    AT    THE    HIP    JOINT. 


139 


Intermediary  Amputations. — Twenty-three  instances  of  amputations  at  the  hip  joint 
during  the  inflammatory  period  after  shot  injury  are  included  in  this  category,,  and  refer 
to  cases  of  fifteen  Union  and  eight  Confederate  soldiers,  each  case  having  a  fatal  result. 
Brief  details  of  the  cases  are  given  in  alphabetical  order,  with  foot-note  references  to  the 
sources  of  information.1 

CASE  297. — Private  James  Garden,  of  the  army  of  Major  General  Rosecrans,  was  wounded  at  the  battle  of  Chickamauga, 
in  the  second  day's  fight,  September  20,  1863,  by  a  fragment  of  shell,  which  caused  great  laceration  of  the  soft  parts  at  the  upper 
part  of  the  thigh,  with  comminuted  fracture  of  the  femur.  He  was  left  upon  the  field  and  was  made  a  prisoner.  On  the  even 
ing  of  September  21st,  Surgeon  R.  P.  Bateman,  C.  S.  A.,  amputated  his  thigh  at  the  hip  joint.  The  patient 
died  on  September  27,  1863,  six  days  after  the  operation.2 

CASE  298. — Sergeant  Lewis  Carroll,  Co.  H,  1st  Delaware,  aged  23  years,  was  wounded  on  October  22, 
1864,  near  the  Weldou  Railroad.3  A  conoidal  musket  ball  entered  the  right  thigh  in  front,  and,  striking  the 
femur  at  the  junction  of  the  upper  thirds,  produced  a  remarkable  longitudinal  splintering  of  the  bone,  extending 
from  an  inch  below  the  lesser  trochanter  downward  for  ten  inches,  together  with  several  oblique  fissures.  The 
wounded  man  was  conveyed  in  an  ambulance  to  one  of  the  field  hospitals  of  the  Fifth  Corps,  where  the  ball  was 
extracted  and  the  sharp  extremity  of  the  upper  fragment  of  the  femur  was  sawn  off.  Tie  fractured  limb  was 
then  dressed,  and  the  patient  sent  to  City  Point,  and  thence  on  a  hospital  steamer  to  Alexandria,  where  he  was 
admitted  to  the  Third  Division  Hospital  on  November  2d.  The  thigh  was  swollen  to  three  times  the  size  of  its 
fellow.  An  incision  six  inches  long  on  the  outer  side  presented  inflamed  everted  edges,  between  which  fasciculi 
of  muscles  protruded.  There  was  much  febrile  irritation,  but  the  patient's  strength  was  maintained  to  a  remark 
able  degree.  On  November  llth,  there  was  quite  free  haemorrhage  from  a  small  artery,  and  the  patient  was 
etherized  and  the  vessel  secured,  and  afterward  a  thorough  exploration  of  the  wound  was  made.  The  very 
extensive  longitudinal  splintering  was  recognized ;  the  bone  was  found  denuded  in  several  places;  the  soft  tissues 
of  the  thigh  were  infiltrated  with  pus  of  a  very  offensive  character.  In  view  of  this  condition  of  things,  it  was 
determined  to  remove  the  limb  at  the  hip  joint.  The  patient  was  placed  under  the  influence  of  chloroform,  and 
the  operation  was  performed  by  Surgeon  Edwin  Bentley,  U.  S.  V.  An  external  flap  was  made  by  cutting  from 
without  inward;  then  the  head  of  the  femur  was  disarticulated,  and  au  internal  flap  was  cut  from  within  out 
ward.  The  loss  of  blood  was  slight  and  the  patient  reacted  promptly.  The  progress  of  the  case  for  two  or 
three  days  after  the  operation  was  very  favorable.  Then  a  chill  occurred,  followed  by  a  cold  clammy  sweat. 
The  wound  looked  badly  and  the  discharge  was  unhealthy ;  the  stump  was  kept  covered  with  yeast  poultices. 
Beef  essence,  stimulants,  and  anodynes  were  administered.  Six  days  after  the  operation  there  was  yellowness 
of  the  surface  and  of  the  conjunctival  membranes;  then  delirium  and  coma,  and  death  on  November  19th,  eight 
days  from  the  date  of  the  operation.  At  the  autopsy,  pus  was  found  in  the  external  iliac  vein,  metastatic  foci  in 
the  lungs,  and  a  gangrenous  abscess  in  the  enlarged  spleen.  The  preparation  of  the  femur  was  sent  to  the  Army 
Medical  Museum,  and  is  figured  in  the  adjacent  wood-cut  (FlG.  94). 

CASE  299. — Private  John  Chamberlain,  of  one  of  the  United  States  regiments  engaged  at  the  battle  of  Chickamauga, 
was  wounded  on  September  20,  1863.  A  conoidal  musket  ball  passed  through  the  upper  part  of  the  thigh  and  produced  great 
comminution  of  the  upper  extremity  of  the  femur,  the  fissures  extending  to  the  neck  of  the  bone.  The  wounded  man  was  left 
upon  the  field  when  the  United  States  forces  were  driven  back  and  fell  into  the  hands  of  the  enemy.  On  September  21st  lie 
underwent  amputation  at  the  hip  joint,  the  operation  being  performed  by  Surgeon  R.  P.  Bateman,  P.  A.  C.  S.  The  man 
survived  the  operation  thirty-six  hours,  and  died  September  23,  1863.4 

CASE  300. — Private  Levi  Eckley,  Co.  A,  67jh  Ohio,  was  wounded  May  20,  1864,  in  the  assault  upon  the  entrenchments 
near  Bermuda  Hundred.  A  conoidal  musket  ball  passed  through  the  left  thigh,  shattering  the  upper  extremity  of  the  femur 
and  wounding  the  sciatic  nerve.  The  patient  was  conveyed  on  a  hospital  transport  to  Fort  Monroe,  and  was  admitted  to 
Chesapeake  Hospital  on  May  22d.  A  consultation  was  held,  at  which  it  was  decided  that  amputation  at  the  hip  joint  presented 
the  only  chance  of  preserving  life.  The  patient's  condition  was  unfavorable;  he  was  greatly  prostrated.  On  May  24th  the 
operation  was  performed  by  Assistant  Surgeon  H.  C.  Roberts,  U.  S.  V.,  by  forming  antero-posterior  flaps  by  transfixion.  The 
femoral  artery  was  compressed  at  the  groin  by  Surgeon  D.  G.  Rush,  101st  Pennsylvania,  and  Acting  Assistant  Surgeons  Bayles, 
Frick,  and  others  aided  in  the  operation.  The  haemorrhage  was  excessive.  Though  the  patient  reacted  fairly,  and  partook 
of  nutritious  food  and  stimulants,  he  died  from  exhaustion  four  days  after  the  operation,  May  24,  1864. 5 

1  Of  the  twenty-three  intermediary  coxo-feraoral  amputations,  details  of  eighteen  were  published  in  A  Report  on  Amputations  at  the  Hip  Joint  in 
Military  Surr/fry,  War  Department,  S.  G.  O..  July  1,  18G7,  pp.  30-39  and  pp.  Cl-62,  four  were  noted  on  pages  107-8,  of  A  Report  on  Excisions  of  Hie 
Head  of  the  Femur  for  Gunshot  Injury,  Circular  No.  2,  War  Department,  S.  G.  O.,  1869,  and  one  (CASE  308,  p.  141,  ultra,  of  Martin,  a  soldier  of  the 
20th  Confederate  Arkansas  regiment)  was  communicated  personally  by  Dr.  WILLIAM  BLACKWELL  WKLCI1,  of  Boonsboro',  Arkansas,  who  served  three 
and  a  half  years  in  the  Confederate  service.  Eleven  of  the  operations  were  practised  by  Confederate  surgeons, — seven  upon  their  own  men  and  four  upon 
prisoners. — twelve  of  the  operations  were  by  Union  surgeons,  upon  eleven  Union  and  one  of  the  Confederate  wounded. 

2EVE(P.  F.),  A  Contribution  to  the  History  of  the  Rip  Joint  Operations  performed  during  the  late  Civil  War,  in  Trans.  Am.  Med.  Assoc.,  18C7, 
Vol.  XVIII,  p.  255.  Circular  No.  7,  S.  G.  O.,  18G7,  pp.  36,  C2. 

3See  Circ.  No.  6,  S.  G.  O.,  1805,  p.  50,  CASE  18,  and  Circ.  7,  S.  G.  O.,  1867,  CASE  XXXVI,  pp.  38  and  62,  and  Cat.  of  Surg.  Sect.,  of  1866,  p.  247. 

4  This  case  was  communicated  to  Dr.  P.  F.  EVE  (loc.  cit.  p.  255)  by  Dr.  R.  P.  BATKMAX,  of  Memphis,  Tennessee.  A  request  for  further  details  of 
the  case,  from  the  Surgeon  General's  Office,  of  May,  1867,  received  no  response. 

5 The  data  in  this  case  are  noted  in  Circular  6,  S.  G.  O.,  1865,  p.  50,  CASE  XII,  and  in  Circular  7,  S.  G.  O.,  1867,  at  pp.  37  and  62,  with  additional 
details  from  letters  by  Assistant  Surgeon  E.  McCLELLAN",  U.  S.  A.,  and  Acting  Assistant  Surgeon  G.  BAYLES. 


Fir..  94. -Right 
fern,  fissured  by 
a  musket  ball. 
Spec.  1020. 


140  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

CASE  301. — Private  Sullivan  Gaines,  Co.  M,  2d  Michigan  Cavalry,  was  wounded  on  January  31,  1864,  near  Knoxville, 
Tennessee,  by  a  conoidal  musket  ball,  which  shattered  the  neck  and  head  of  the  right  femur.  On  the  following  day  the  patient 
was  admitted  to  hospital  No.  4,  at  Knoxville.  He  was  greatly  prostrated,  and  his  constitutional  condition  was  considered 
unfavorable.  On  February  3d,  Surgeon  Edward  Shippen,  U.  S.  V.,  amputated  at  the  hip  joint  in  the  presence  of  Surgeon 
Henry  S.  Hewit,  U.  S.  V.,  and  others.  The  patient  being  placed  under  the  influence  of  chloroform,  a  long  double-edged  knife 
was  introduced  about  an  inch  above  the  trochanter  major ;  the  point  was  first  directed  inward  and  slightly  upward  so  as  to 
divide  the  capsule  freely,*and  was  then  depressed  and  brought  out  near  the  tuberosity  of  the  ischium ;  a  large  antero-internal 
flap  was  then  formed,  an  assistant  having  passed  his  hands  into  the  incision  and  compressed  the  femoral  artery  in  the  flap  before 
it  was  cut.  The  flap  was  now  raised,  and  the  heel  of  the  knife  was  placed  at  the  inner  angle  of  the  wound,  and  a  straight 
incision  was  made  connecting  this  point  with  that  at  which  the  knife  first  entered,  and  dividing  the  tissues  on  the  back  of  the 
thigh  down  the  bone.  Disarticulation  was  then  effected.  The  patient  never  rallied  from  the  shock  of  the  operation.  He  died 
in  about  one  hour.1 

CASE  302. — Frank  G ;  a  private  in  a  Texan  regiment,  was  wounded  at  the  battle  of  Gettysburg,  in  the  left  thigh, 

by  a  grapeshot,  which  entered  two  inches  below  the  trochanter  major,  shattered  the  bone  up  into  the  neck,  and  lacerated  the  soft 
parts  terribly  between  the  place  of  entrance  and  the  knee.  He  remained  on  the  battle-field  from  the  2d  until  the  4th  day  of  July, 
with  very  little  attention,  until  he  was  brought  to  the  hospital  of  the  Fifth  Corps.  After  a  consultation  with  a  number  of 
surgeons,  and  the  conclusion  being  in  favor  of  amputation  at  the  hip,  the  patient  was  placed  upon  the  table,  and,  when  fully 
under  the  influence  of  chloroform,  Surgeon  B.  Rohrer,2  10th  Pennsylvania  Reserves,  performed  the  antero-posterior  operation, 
assisted  by  Dr.  Joseph  A.  Philips,  and  Henry  Grimm,  Surgeon  12th  Pennsylvania  Reserves.  Surgeon  Philips  controlled  the 
femoral  artery,  and  not  over  three  ounces  of  blood  were  lost.  Death  followed  in  thirty-six  hours. 

CASE  303. — Private  Henry  H.  Hale,  Co.  G,  14th  Illinois,  aged  21  years,  was  wounded  at  the  battle  of  Shiloh,  April  6, 
1862.  A  fragment  of  shell  shattered  the  upper  portion  of  his  left  femur  so  that  fissures  extended  to  the  neck  and  far  down  the 
shaft.  The  soft  parts  on  the  outer  aspect  of  the  thigh  were  extensively  lacerated  and  contused;  the  femoral  vessels  and  nerves 
were  uninjured.  On  April  9th  he  was  placed  on  the  hospital  transport  steamer  Crescent  City  to  be  conveyed  to  St.  Louis.  On 
April  12th,  Surgeon  D.  P.  Smith,  U.  S.  V.,  assisted  by  Surgeons  Thomas  W.  Fry  and  H.  P.  Stearns,  U.  S.  V.,  and  Assistant 
Surgeon  M.  C.  Tolman,  2d  Minnesota,  performed  amputation  at  the  hip  joint.  The  patient  being  made  insensible  by  chloroform, 
a  long  anterior  flap  was  made  by  transfixion.  Surgeon  Stearns,  following  the  knife  with  his  fingers,  compressed  the  vessels  in 
the  flap  and  completely  controlled  the  haemorrhage.  The  head  of  the  femur  was  rapidly  disarticulated  and  the  soft  parts  poste 
riorly  were  divided  by  a  straight  incision.  On  April  14th  the  hospital  transport  steamer  arrived  at  St.  Louis,  and  the  wounded 
were  transferred  to  hospitals  in  that  city.  Shortly  after  Bale's  admission  to  hospital  his  stump  began  to  look  badly,  the  vast 
wound  suppurated  profusely,  gangrene  supervened,  and  he  sank  and  died  on  April  20,  1862.3 

CASE  304. — Private  C.  Hamilton,  Co.  H,  3d  U.  S.  C.  T.,  while  employed  as  a  stretcher  bearer,  in  carrying  a  wounded 
man  from  the  field,  during  the  assault  on  Port  Hudson,  Louisiana,  June  14,  1863,  was  struck  by  a  musket  ball,  which  passed 
through  the  upper  part  of  his  left  thigh.  The  missile  entered  behind,  near  the  gluteal  fold,  and,  having  fractured  the  upper  part 
of  the  femur  badly,  passed  out  in  front  in  close  proximity  to  the  track  of  the  femoral  artery.  He  was  taken  to  his  regimental 
hospital.  The  limb  was  shortened  and  rotated  inward,  and  great  swelling  and  inflammatory  mischief  speedily  supervened.  It 
was  ascertained  that  fragments  of  bone  were  detached  and  driven  into  the  soft  tissues,  and  there  was  excessive  pain  in  the  limb. 
It  was  resolved  to  make  an  exploratory  incision  and  to  remove  the  displaced  splinters.  Chloroform  was  administered  for  this 
purpose,  and  the  patient  was  then  removed  to  an  operating  table.  While  being  moved  from  his  bed  to  the  table  arterial  hemor 
rhage  of  an  alarming  character  took  place,  and  was  so  copious  as  to  threaten  a  speedy  dissolution.  The  bleeding  was  controlled 
by  digital  compression  of  the  femoral  at  the  crural  arch,  and  a  hasty  consultation  was  held  by  Surgeon  E.  P.  Gray,  3d  U.  S.  C.  T., 
Surgeon  Pierce,  U.  S.  C.  T.,  and  Assistant  Surgeon  George  P.  Percival,  3d  U.  S.  C.  T.,  and  it  was  determined  that  amputation 
at  the  hip  joint  afforded  the  only  chance  of  preserving  the  man's  life.  The  operation  was  immediately  performed  by  Surgeon 
Gray,  assisted  by  his  colleagues.  He  disarticulated  the  thigh  by  the  antero-posterior  flap  method,  the  operation  being  quickly 
accomplished  without  much  haemorrhage.  Although  the  patient  was  reduced  by  the  irritation  and  pain  caused  by  his  wound, 
and  prostrated  by  the  sudden  profuse  haemorrhage,  his  constitution  was  robust,  and  he  bore  the  operation  remarkably  well. 
The  wound  being  approximated  by  sutures  and  adhesive  strips,  he  was  put  to  bed  and  carefully  nourished  and  watched.  He 
expressed  great  gratitude  for  the  operation,  declaring  that  it  had  entirely  relieved  him  of  his  excessive  suffering.  He  rallied 
and  appeared,  for  forty-eight  hours  after  the  operation,  to  be  in  a  very  hopeful  condition.  Then  the  vital  powers  seemed  to  flag. 
He  sank  gradually,  and  died  from  exhaustion,  June  29,  1863,  four  days  after  the  operation.1* 

CASE  305. — Private  Jackson,  of  Colonel  Tappan's  Brigade,  aged  21  years,  was  wounded  at  the  battle  of  Belmont,  Mis 
souri,  November  7,  1861,  and  was  conveyed  on  a  steamer  to  Memphis  and  admitted  to  the  Marine  Hospital.  He  had  a  badly 
comminuted  fracture  of  the  upper  extremity  of  the  femur.  On  November  15th,  Dr.  Richard  Potts  proceeded  to  amputate  at  the 
hip  joint  by  antero-posterior  flap  method.  The  patient  succumbed  promptly  to  the  shock  of  the  operation;  dying,  indeed,  befoi'e 
its  completion,  according  to  Dr.  Mastin,  or,  according  to  Dr.  Saunders,  ten  hours  after  its  completion.6 

>  HAMILTON  (F.  H.),  Treatise  on  Mil.  Surgery,  1865,  p.  485.      Circular  No.  6,  S.  G.  O.,  1865,  p.  50.      Circular  No.  7,  S.  G.  O.,  1867,  pp.  37,  G2. 

2ROHRER  (B.),  Original  Communications,  in  Am&r.  Jour.  Med.  Sci.,  1869,  Vol.  LVII,  N.  S.,  p.  085.     Circular  No.  2,  S.  G.  O.,  1869,  p.  108. 

3 SMITH  (D.  P.),  Experiences  in  the  Practice  of  Mil.  Surg.,  in  Am.  Med.  Times,  1862,  Vol.  IV,  p.  332,  Circular  No.  6,  S.  G.  O.,  1865,  p.  50. 
Circular  No.  7,  S.  G.  O.,  1867,  pp.  34,  61. 

4  The  details  of  the  coxo-femoral  amputation  by  Surgeon  E.  P.  GRAY,  3d  U.  S.  C.  T.,  were  not  received  in  season  for  publication  in  Circular  7, 
S.  G.  O.,  1867,  but  were  printed  in  Circular  2,  S.  G.  O.,  1869,  p.  109.  See  also  LtiNING  (A.),  (Jber  die  Blutung  bei  der  Exarticulation  des  Oberschenkels 
und  deren  Vermcidung,  Zurich,  1877,  CASE  301,  p.  93. 

6 The  facts  in  this  case  were  furnished  by  Dr.  CLAUDE  H.  MASTIN  and  Dr.  D.  D.  SAUNDERS,  of  Memphis.  See  Professor  P.  F.  EVE'S  Contribution 
to  the  History  of  the  Hip  Joint  Operation  performed  during  the  late.  Civil  War,  in  Trans.  Am.  Med.  Assoc.,  1867,  Vol.  XV1H,  pp.  255  and  264,  and 
Circular  7,  S.  G.  O.,  1867,  pp.  33  and  61,  and  LttMNG  (A.),  Vber  die  Blutung  bei  der  Exarticulation  des  Oberschenkels,  Zurich,  1877,  p.  89,  CABK  272. 


SECT.  If.J  INTERMEDIARY    AMPUTATIONS    AT    THE    HIP    JOINT.  14] 

CASE  306. — Private  P.  Johnson,  Co.  C,  2d  Delaware,  was  wounded  at  the  battle  of  Fredericksburg,  December  14,  1862 
by  a  conoidal  musket  ball,  which  entered  the  upper  part  of  the  right  thigh  in  front  and  passed  out  at  the  nates,  haviii"-  in  its 
course  divided  the  femoral  artery  and  perforated  the  great  trochanter.  Except  that  the  primary  liEemor- 
rhage  was  slight,  little  is  known  of  the  early  history  of  the  case.  On  December  25th  the  wounded  man 
was  conveyed  to  Washington  and  placed  in  the  Douglas  Hospital.  On  admission,  nearly  the  entire 
injured  limb  was  gangrenous,  and  it  was  believed  that  the  fracture  extended  into  the  hip  joint.  Surgeon 
P.  Pineo,  U.  S.  V.,  decided  to  amputate  at  the  hip  joint,  "with  no  hope  of  a  favorable  result,  but  to 
mitigate  patient's  distress  in  the  last  moments  of  life."  On  December  27th,  anaesthesia  being  induced  by 
ether,  the  operation  was  performed.  The  patient  survived  it  only  a  few  hours.  The  pathological  speci 
men  was  sent  to  the  Army  Medical  Museum.  It  presents  an  oblique  shot  perforation  through  the  great 
trochanter,  with  radiating  fissures  which  separate  the  trochanter  and  neck  in  four  large  fragments  and 
run  obliquely  down  the  shaft.  Traces  of  the  results  of  periostitis  are  visible  along  the  outer  aspect  of 
the  shaft.1 

CASE  307. — Private  Charles  Lackey,  Co.  E,  7th  Wisconsin,  aged  30  years,  was  struck,  at  Spott- 
sylvania,  May  12,  1864,  by  a  conoidal  musket  ball,  which  entered  in  front  at  the  upper  part  of  the  right 
thigh  and  produced  a  comminuted  fracture  of  the  femur  through  the  trochanters,  and  extending  down 
ward  nearly  half  the  length  of  the  shaft  of  the  bone,  and  then  lodged  in  the  muscles  at  the  posterior 
part  of  the  thigh.  After  a  fatiguing  journey  to  Belle  Plain,  to  which  most  of  the  wounded  from  Spott-  FIG.  95.— Shot  perfora- 
sylvania  were  unavoidably  subjected,  Lackey  was  conveyed  on  a  hospital  steamer  to  Washington,  and  1'^  '*  trochanter  of  right 
was  received  at  Judiciary  Square  Hospital  on  May  18th.  The  wounded  limb  was  much  swollen.  The 

sharp  extremity  of  the  lower  fragment  of  the  femur  had  lacerated  the  muscles,  and  there  was  profuse  suppuration  with  burrow 
ing  of  pus  throughout  the  thigh.  The  fracture  was  believed  to  extend  into  the  joint.  The  patient  earnestly  demanded  that  an 
operation  should  be  performed  for  his  relief.  His  condition  was  unpromising,  for  he  was  suffering  from  surgical  fever  of  an 
intense  character.  A  consultation  of  surgeons  decided,  however,  that,  without  operative  interference,  the  case  would  prove 
inevitably  and  speedily  fatal ;  and  as  the  extensive  fracture  of  the  shaft  of  the  femur  and  the  purulent  infiltration  of  the  thigh 
precluded  excision,  amputation  at  the  hip  joint  was  determined  on.  On  May  21st  anaesthesia  was  induced  by  sulphuric  ether, 
and  Assistant  Surgeon  Alexander  Ingram,  U.  S.  A.,  performed  ihe  operation  by  the  antero-posterior  ttap  method.  After  the 
operation  the  patient  reacted  but  partially.  After  removal  to  the  ward  he  was  plied  with  beef-tea  and  stimulants  and  restora 
tives  ;  but  he  continued  to  sink,  and  died  on  the  following  day,  May  22,  1864,  twenty  hours  after  the  operation.2 

The  details  of  the  next  intermediary  amputation  at  the  hip  (CASE  308)  were  person 
ally  communicated  to  the  Surgeon  General's  Office  by  the  operator,  Dr.  W.  B.  Welch,  of 
Boonsboro',  Arkansas,  on  June  10,  1875,  arid  have  not  been  heretofore  published:3 

CASE  308. — Private  Martin,  of  the  26th  (Brooks's)  Arkansas  Regiment,  aged  25  years,  was  wounded  at  Prairie  Grove, 
December  7,  1862,  by  a  cannon  shot,  which  shattered  his  left  thigh  so  dreadfully  as  to  leave  the  limb  attached  to  the  trunk  only 
by  the  soft  parts  on  the  anterior  aspect.  His  case  had  been  regarded  as  hopeless,  but  after  the  surgeons  had  finished  all  the 
other  operations  he  was  observed  to  have  rallied  somewhat,  though  greatly  exsanguined  and  prostrated.  Wkh  the  assistance 
of  Drs.  Duvall  and  Keller,  Surgeon  W.  B.  Welch,  P.  A.  C.  S.,  of  Gunter's  Arkansas  Regiment,  performed  exarticulation, 
making  a  large  anterior  flap.  The  operation  was  performed  twenty -four  hours  after  the  injury,  and  the  patient  survived  four 
days,  when  he  succumbed  from  exhaustion. 

CASE  309. — Private  Joseph  Minott,  Co.  A,  4th  Vermont,  was  wounded  early  on  June  23,  1864.  Minott  had  his  right 
femur  fractured  in  the  upper  portion  of  the  shaft  by  a  conoidal  musket  ball,  and  lay  where  he  fell,  beyond  the  reach  of  succor. 
On  the  morning  of  the  third  day,  June  25th,  having  been  without  food  or  drink  for  forty-eight  hours,  he  crawled  into  our  lines, 
a  distance  of  over  half  a  mile.  He  was  carried  to  the  field  hospital  of  the  2d  division  of  the  Sixth  Corps,  greatly  exhausted. 
After  he  had  received  nourishment  and  cordials  his  injuries  were  examined,  and  it  was  found  that,  besides  the  extensive  com 
minution  of  the  femur,  rapidly  spreading  gangrene  had  supervened.  In  front,  mortification  already  extended  to  within  a  few 
inches  of  Poupart's  ligament.  A  consultation  of  the  surgeons  of  the  division  decided  that  coxo-femoral  amputation  offered  the 
only  chance  of  recovery,  and  that  the  operation  could  not  be  delayed.  On  the  afternoon  of  June  25th,  therefore,  the  patient 
was  rendered  insensible  by  chloroform,  and  the  amputation  was  performed  by  Surgeon  D.  A.  Goodwin.  But  little  blood  was 
lost,  yet  the  patient  soon  began  to  sink,  and  expired  on  June  25,  1864.4 

1  See  Circular  6,  S.  G.  O.,  1 865,  p.  50.  CASE  10 ;  Catalogue  of  the  Surg.  Sect,  of  the  Army  Medical  Museum,  4to,  I860,  p.  248 ;  Circular  7,  S.  G.  O., 
1867,  pp.  35  and  62. 

2  The  abstract  of  this  case  is  compiled  from  register  and  Report  of  Surgical  Operations  of  the  Judiciary  Square  Hospital,  Washington.     The  case 
is  noted  at  p.  50  of  Circular  6,  S.  G.  O.,  1865,  as  CASE  11.     The  age  is  correctly  stated  at  "19"  years,  while  in  Circular  No.  7,  S.  G.  O,  1867,  pp.  37,  62, 
by  a  clerical  inadvertence  the  age  is  given  at  "30"  years.     See  also  LiJXIXG  (A.),  Ueber  die  Blutung  bci  der  Exarticulation  des  Oberschenkcls,  Zurich, 
1877,  Fall  328,  S.  97. 

3  After  the  publication  of  Circular  7,  S.  G.  O.  (A  Report  on  Amputations  at  the  Hip  Joint  in  Military  Surgery,  Washington,  1807,  4to,  p.  88). 
Dr.  JAMES  M.  KELLKK,  of  Kentucky,  Vice  President  of  the  American  Medical  Association,  in  1874,  informed  the  compiler  of  that  report  that  of  several 
excisions  or  amputations  at  the  hip  that  he  had  observed  during  his  service  in  the  Confederate  Army,  one  was  a  coxo-femoral  amputation  practised  by 
Dr.  WELCH,  after  the  battle  of  Prairie  Grove,  December  7,  1862;  and  that  he'had  notes  of  this  and  of  several  other  amputations  and  excisions  at  the  hip, 
which  "in  the  conflagration  caused  by  the  explosion  in  the  ordnance  depot,  at  Alobile,  Alabama,  just  after  the  surrender  (April  9,  18.15),  with  notes  on 
field  and  hospital  Surgery,  were  destroyed."    In  the  absence  of  any  particulars,  it  was  impossible  to  classify  this  case  of  amputation  at  the  hip;  but 
years  subsequently,  June  10,  1876,  Dr.  WILLIAM  BLACKWELL  WELCH  called  at  the  Army  Medical  Museum  with  Colonel  THOMAS  MOXTICUE  GUNTEK, 
M.  C.  of  the  IVth  Arkansas  district,  and  formerly  colonel  of  the  13th  Arkansas  regiment,  and  furnished  the  details  of  the  case  above  cited. 

4  Surgeon  S.  J.  ALLEN,  4th  Vermont,  and  the  operator.  Surgeon  DAVID  M.  GOODWIN,  reported  this  case.     See  Circular  No.  7,  S.  G.  O.,  1867,  pp. 
38,  62,  and  LtiNlNG  (A.)  (op.  cit.,  Zurich,  1877,  p.  97,  CASE  330). 


142 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


(CHAP.  X. 


CASE  310.— Private  Peter  Pausbeck,  Co.  K,  43d  Illinois,  was  admitted  on  April  20,  1862,  from  the  battle-field  of  Shiloh, 
to  hospital  No.  2,  at  Evansville.  He  had  been  wounded  on  April  7th,  probably  by  a  conoidal  musket  ball.  The  projectile  bad 
entered  the  front  of  the  left  thigh,  about  an  inch  below  the  level  of  the  trochanter  major,  and  ranging  a  little  upward  had 
emerged  from  the  gluteal  region  opposite.  The  upper  portion  of  the  femur  was  crushed  and  the  injury  to  the  soft  parts  was 
most  extensive.  A  consultation  was  held  on  April  21st,  and  the  opinion  that  amputation  at  the  hip  afforded  the  only  possible 
chance  of  preserving  life  was  unanimous.  Dr.  DeI3ruler  operated,  assisted  by  Dr.  T.  N.  Myers  and  others.  The  loss  of 
blood  was  very  trifling.  After  the  completion  of  the  operation,  the  pulse,  which  had  been  carefully  watched,  was  observed  to 
fail  rapidly.  Unavailing  attempts  were  made  to  give  brandy  and  other  restoratives.  In  a  few  moments  the 
man  was  dead.  There  was  no  reason  to  believe  that  the  use  of  chloroform  had  any  connection  with  the  fatal 
result,  which  was  apparently  due  solely  to  the  shock  of  the  operation.  Such  was  the  opinion  of  the  eminent 
professor  of  surgery  of  Jefferson  College,  Dr.  S.  D.  Gross,  who  happened  to  visit  the  hospital  half  an  hour 
after  the  operation.  Professor  Gross  expressed  his  approbation  of  the  course  that  had  been  adopted,  since, 
although  it  had  resulted  unfortunately,  it  afforded  the  only  hope  of  saving  the  patient's  life.1 

CASE  311. — Private  George  M.  Spencer,  Co.  B,  2d  New  York  Mounted  Kifles,  aged  17  years,  was 
wounded  on  March  31,  1865,  at  Dinwiddie  Court  House,  Virginia,  by  a  conoidal  musket  ball,  which  entered 
the  right  gluteal  region,  and  striking  the  great  trochanter,  produced  a  fracture  through  the  trochanters,  with 
very  remarkable  longitudinal  splintering,  extending  nine  inches  down  the  shaft  (FlG.  96).  The  projectile  then 
lodged.  The  wounded  man  was  sent  to  City  Point,  and  thence  by  steamer  to  Washington,  and  entered 
Judiciary  Square  Hospital  on  April  4th.  There  was  already  a  good  deal  of  inflammatory  swelling  and  sup 
puration,  but  the  constitutional  condition  was  encouraging.  Upon  examination  of  the  wound,  it  was  thought 
that  the  fracture  did  not  extend  below  the  trochanter  and  that  the  joint  was  probably  involved,  and  it  was 
determined  to  excise  the  head  of  the  femur.  The  patient  having  stated  that  he  wras  anxious  to  avail  of  the 
benefit  of  any  operation  that  was  deemed  necessary,  he  was  placed  under  the  influence  of  chloroform  on  April 
12th,  and  Surgeon  Elisha  Griswold,  U.  S.  V.,  proceeded  to  disarticulate  the  head  of  the  femur  through  a  long 
vertical  incision  on  the  outside  of  the  thigh,  and  to  remove  the  head  with  an  obliquely  fractured  fragment  of 
the  shaft  attached  to  it.  The  splintering  of  the  shaft  was  now  discovered,  and  after  a  hasty  consultation  with 
the  surgical  staff  it  was  decided  that  amputation  at  the  hip  joint  was  the  only  procedure  which  afforded  the 
patient  any  prospect  of  recovery.  This  operation  was  rapidly  executed  by  Surgeon  Griswold,  aided  by  Acting 
tudinai fissuring^of  Assistant  Surgeons  Hill,  McCalla,  Colton,  and  Ahern,  by  the  double-flap  method.  There  was  but  little  haemor- 
right  femur.  Spec,  rhage;  but  the  shock  of  the  operation  was  too  great.  The  usual  means  to  promote  reaction  were  diligently 

employed,  but  the  patient  never  rallied,  and  survived  the  operation  less  than  an  hour.2 

CASE  312. — A  private  of  Co.  C,  54th  Massachusetts,  a  colored  man,  was  wounded  and  made  a  prisoner  in  the  assault  on 
Morris  Island  on  July  11,  1863.  A  fragment  of  a  shell  from  Fort  Wagner  struck  the  upper  and  outer  part  of  his  right  thigh, 
and  fractured  the  neck  and  head  of  the  femur  and  the  rim  of  the  acetabulum,  and  extensively  lacerated  the  soft  parts  in  its  exit 
through  the  posterior  part  of  the  thigh.  The  patient  was  conveyed  to  Charleston  on  the  afternoon  of  July  12th,  and  was  placed 
in  a  hospital  hastily  prepared  for  the  reception  of  wounded  colored  prisoners.  The  contract  surgeon  in 
charge  of  the  hospital  reports  that  the  patient's  condition,  in  view  of  the  terrible  wound  he  had  suffered, 
was  remarkably  good,  and  that  the  symptoms  of  shock  were  unusually  slight.  On  July  13th,  the  third 
day  after  the  reception  of  the  injury,  Surgeon  R.  A.  Kinloch,  P.  A.  C.  S.,  saw  the  case,  and  amputated  at 
the  hip  joint  by  Manec's  method.  The  knife  being  entered  midway  between  the  anterior  superior  spinous 
process  of  the  ilium  and  the  great  trochanter,  and  carried  downward  and  inward  until  its  point  emerged 
just  in  front  of  the  ischium,  was  made  to  form  a  large  antero-internal  flap;  the  soft  parts  on  the  outer  and 
posterior  part  of  the  thigh  were  then  divided  by  a  semicircular  incision  from  without  inward,  and  the 
head  of  the  femur  was  then  disarticulated.  The  patient  bore  the  operation  well,  but  a  few  hours  subse 
quently  there  was  extreme  depression,  and  the  case  terminated  fatally  on  the  following  morning,  July 
14th,  twenty  hours  after  the  operation.3 

CASE  313. — A  private  soldier  of  an  Ohio  regiment,  aged  35  years,  was  wounded  at  the  battle  of 
Shiloh,  April  6,  1862,  by  a  fragment  of  shell,  which  extensively  comminuted  the  shaft,  trochanters,  and 
neck  of  the  right  femur,  as  illustrated  in  the  accompanying  wood-cut  (FlG.  97).  The  patient  was  left  on 
the  battle-field  during  the  tempestuous  night  of  April  6th,  and  until  late  on  the  following  day.  He  was 
then  removed  to  a  temporary  hospital,  and  thence  to  the  steamer  Lancaster,  to  be  transported  to  Cincin 
nati.  On  April  16th,  it  was  decided  to  remove  the  limb,  and  the  patient  being  rendered  insensible  by 
chloroform,  amputation  at  the  hip  joint  was  performed  by  Surgeon  G.  C.  Blackman,  U.  S.  V.,  by  the 
antero-posterior  flap.  On  April  18th,  the  patient  was  transferred  to  St.  John's  Hospital,  Cincinnati,  and  Dr.  C.  D.  Palmer 
reported  that  the  flaps  began  to  slough.  Death  ensued  on  April  22,  1862.4 


FK;.  07.— Comminuted 
shot  fracture  of  femur. 
From  a  drawing  furnish 
ed  by  Dr.  BLACKMAX. 


1  Dr.  J.  P.  DEBRULEU,  of  Evansville,  Indiana,  communicated  the  particulars  of  this  case.     See  Circular  No.  7,  S.  G.  O.,  1867,  pp.  34  and  61,  and 
LO.NING  (A.),  (jber  die  Blutung  bei  der  Exarticulation  des  Oberschenkelt,  Zurich,  1877,  S.  91,  F.  290. 

2  This  case  was  first  published  in  Circular  No.  C,  1865,  p.  50,  CASE  21,  from  the  Judiciary  Square  Hospital  Surgical  Report  for  the  second  quarter 
of  1865.     See  Catalogue  of  the  £irgical  Section  of  the  Army  Medical  Museum,  4to,  1866,  p.  248,  and  Circular  No.  7,  S.  G.  O.,  1867,  pp.  39  and  62,  with 
reference  to  the  report  of  a  board  of  inquiry  in  the  case,  convened  April  13,  1865,  consisting  of  Surgeon  O.  A.  .TUDSOX,  U.  S.  V.,  Assistant  Surgeon  \V. 
THOMSON,  U.  S.  A.,  and  Assistant  Surgeon  W.  F.  NORKI8,  U.  S.  A.     See  also  LtixiNG  (A.)  (loc.  cit.,  Zurich,  1877,  p.  102,  CASE  366). 

3The  particulars  of  this  case  were  communicated  to  the  Surgeon  General's  Office  by  Professor  R.  A.  KlNLOCK,  of  Charleston.  See  EVE  (P.  F.) 
(loc.  cit.,  Vol.  XVIII,  p.  255,  CASE  17,  and  Circular  No.  7,  S.  G.  O.,  1867,  pp.  36  and  62,  and  LttxiXG  (A.),  op.  cit.,  Zurich,  1877,  p.  94,  CASE  307. 

4Br,ACKMAX  (G.  C.),  Amputation  at  the  Hip  joint,  in  Cincinnati  Jour,  of  Medicine,  1866,  Vol.  I,  p.  101.  Circular  No.  6,  S.  G.  O.,  1865,  p.  50. 
Circular  No.  7,  S.  G.  O.,  1867,  pp.  34,  61.  L,tfNINC.  (A.),  tfler  die  Blutung  bei  der  Exarticulation  des  Oberschenlcels,  Zurich,  1877,  p.  91,  CASE  289. 


SECT.  ii. j  INTERMEDIARY    AMPUTATIONS    AT    THE    HIP    JOINT.  143 

CASE  314. — A  private  soldier  of  the  U.  S.  Army  was  wounded  at  the  first  battle  of  Bull  Run,  July  21, 1861,  by  a  musket 
ball,  which  fractured  the  lower  third  of  right  femur.  He  fell  into  the  hands  of  the  enemy,  and,  on  the  following  day,  was  con 
veyed  in  an  army  wagon  to  Manassas  Junction,  and  thence  by  rail  to  Richmond,  where  he  was  admitted  to  the  Alms  Ho;is<- 
Hospital.  One  week  after  the  reception  of  the  injury  there  was  extensive  purulent  infiltration  in  the  muscles  of  the  thigh  and 
incipient  gangrene  of  the  leg.  Under  these  circumstances  Drs.  St.  George  Peachy  and  Charles  Bell  Gibson  decided  to  amputate 
at  the  hip  joint.  On  July  29th  the  operation  was  performed  by  Dr.  Peachy,  in  the  presence  of  Drs.  Gibson,  A.  E.  Peticolas, 
Richardson,  and  others.  A  preliminary  ligature  was  placed  upon  the  femoral  artery  at  the  beginning  of  the  operation,  which 
was  probably  done  according  to  Larrey's  method.  The  patient  is  believed  to  have  survived  the  operation  two  or  three  days.1 

CASE  315. — A  private  of  General  Bragg's  army,  whose  name  and  military  description  are  not  recorded,  a  large  man, 
six  feet  high,  of  fair  complexion,  about  26  years  of  age,  was  wounded  on  December  28,  1852,  in  a  skirmish  prior  to  the  battle 
of  Murfreesboro'.  A  conoidal  musket  ball  produced  a  fracture  of  the  trochanter  major  and  neck  of  the  femur,  with  fissures 
extending  within  the  capsular  ligament.  The  wounded  man  was  placed  in  a  field  hospital,  and  his  injured  limb  was  supported 
in  a  proper  position ;  but  the  local  inflammation  and  constitutional  disturbance  that  ensued  were  intense,  and,  on  January  5, 1863, 
it  was  determined  to  amputate  at  the  hip  joint.  The  patient  being  placed  under  chloroform,  the  operation  was  performed  by  the 
antero-posterior  flap  method  by  Assistant  Surgeon  A.  C.  Crymes,  39th  Alabama.  On  being  removed  to  his  bed  the  patient 
manifested  extreme  prostration,  and  stimulants  were  freely  administered.  After  a  few  hours  he  was  able  to  take  nutriment  in  a 
concentrated  form,  and  a  supporting  and  stimulating  treatment  was  perseveringly  pursued.  In  a  very  few  hours  after  the  oper 
ation,  however,  the  stump  evinced  a  tendency  to  unhealthy  action,  and  the  patient  sank  into  an  adynamic  condition,  and  died  on 
the  morning  of  January  8th,  three  days  after  the  operation.- 

CASE  316. — A  private  of  Colonel  Dockeray's  Arkansas  Regiment  of  Cabell's  Brigade  was  wounded  at  the  battle  of  Corinth, 
Mississippi,  October  3,  1862,  by  a  conoidal  musket  ball,  which  shattered  the  neck  of  the  right  femur.  He  was  conveyed  to  a 
hospital  at  luka,  where,  on  November  3d,  his  thigh  was  amputated  at  the  hip  joint  by  his  regimental  surgeon,  Dr.  R.  A.  Felton. 
The  patient  died  upon  the  table  before  the  dressing  of  the  stump  was  completed.  The  operation  was  done  under  chloroform, 
and  it  was  the  general  impression  of  the  surgeons  present  that  the  anaesthetic  was  administered  too  freely.3 

CASE  317. — Besides  the  instance  of  primary  coxo-femoral  amputation  for  shot  injury  by  Dr.  B.  D.  Lay,  P.  A.  C.  S., 
detailed  as  CASE  284,  p.  135,  ante,  were  two  intermediary  amputations  at  the  hip  joint  for  comminution  of  the  upper  portion 
of  the  femur  by  conoidal  musket  balls,  performed  by  the  same  surgeon.  One  of  them,  here  to  be  noted,  was  that  of  a  Confed 
erate  private  soldier,  who  suffered  a  shot  fracture  of  the  femur,  in  Mississippi,  early  in  1863,  prior  to  the  siege  of  Vicksburg. 
Comminution  of  the  femur  extended  high  up  through  the  trochanteric  region,  and  amputation  at  the  hip  was  practised  two  days 
after  the  injury.  The  patient  sank  under  the  shock  of  the  injury  and  operation  a  few  hours  after  the  latter,3  although  the  oper 
ation  was  completed  rapidly  and  vvith  slight  loss  of  blood.  Dr.  Lay  observed  that  "nothing  in  this  case  served  to  diminish 
the  terror  with  which  I  approach  such  cases."4 

CASE  318. — A  private  Confederate  soldier,  whose  name  and  military  description  are  not  identified,  received  a  shot  com 
minution  of  the  femur  in  one  of  the  engagements  in  Mississippi,  in  the  early  part  of  1863,  prior  to  the  siege  of  Vicksburg.  A 
day  or  two  after  the  injury,  amputation  at  the  hip  was  performed  by  Dr.  B.  D.  Lay,  P.  A.  C.  S.  Although  the  amputation  was 
rapidly  accomplished,  with  little  loss  of  blood,  the  patient  sank  and  died  a  few  hours  after  the  operation.  The  detailed  memo 
randa  of  this  and  the  preceding  case  were  unfortunately  lost.5 

CASE  319.— Private  J.  H.  Wolf,  Co.  D,  4th  Virginia,  had  his  femur  fractured  at  the  battle  of  Bull  Run,  July  21,  1861, 
by  a  musket  ball,  which  traversed  the  upper  part  of  the  thigh  in  an  antero-posterior  direction,  and  striking  the  femur  four  inches 
below  the  trochanlers,  shattered  it  quite  up  to  the  neck.  The  patient  was  removed  to  Charlottesville,  and  was  received  in  the 
general  hospital  at  that  place  on  July  24th.  The  fracture  was  treated  by  Smith's  anterior  suspensory  splint,  and  this  mode  of 
dressing  proved  very  serviceable  for  a  time.  The  inflammatory  phenomena  did  not  abate,  however,  and  after  four  weeks  it  was 
decided  that  removal  of  the  limb  at  the  coxo-femoral  articulation  alone  afforded  a  hope  of  preserving  the  patient's  life.  On 
August  21st  the  operation  was  performed  by  Brigadier  General  Edward  Warren,  Surgeon  General  of  North  Carolina,  and  was 
rapidly  executed  by  the  double  flap  method,  with  inconsiderable  haemorrhage.  On  the  following  day  there  was  slight  haemor 
rhage.  Death  from  exhaustion  ensued  on  August  23,  1801,  thirty  hours  after  the  operation.  The  constitutional  condition  of 
the  patient  was  unfavorable,  and  he  was  suffering  from  colliquative  diarrhoea.6 

1  The  particulars  of  this  case  were  supplied  by  Professor  T.  G.  RlCHARDSOX,  of  New  Orleans,  who  was  present  at  the  operation.  See  also  Circular 
Vo.  7,  S.  G.  O.,  1867,  CASE  XX,  pp.  33,  61,  and  LfJNlXG  (A.),  ffber  die  Slutung,  u.  s.  w.,  Zurich,  1877,  p.  89,  CASE  270. 

2Details  of  this  case  were  communicated  to  the  Surgeon  General's  Office  by  the  operator,  Assistant  Surgeon  A.  C.  CRYMES,  39th  Alabama,  and 
by  Professor  R.  A.  Klxr.OGH,  of  Charleston,  South  Carolina.  The  case  has  been  published  in  Professor  P.  F.  EVE'S  contribution  (op.  cit.,  Trans.  Am. 
Med.  Assoc.,  1807,  Vol.  XVIII,  p.  255,  CASE  20).  See  also  Circ.  7,  S.  G.  O.,  1667,  pp.  35,  62,  and  LiJNING  (A.),  loc.  cit.,  Zttrich,  1877,  p.  92,  CASE  293). 

3This  case  was  first  published  by  Professor  P.  F.  EVE  (Transact.  Am.  Med.  Assoc.,  1867,  Vol.  XVIII,  pp.  253,  261).  Further  particulars  of  the  case 
were  communicated  by  Surgeon  JAMES  D.  WALLACE,  1st  Missouri.  The  operator,  Surgeon  R.  A.  FELTOX,  died  in  1863.  See  Circular  No.  7,  S.G.O., 
1867,  pp.  35,  62.  See  also  Dr.  AUGUST  LUNING  (op.  cit.,  Zurich,  1877,  S.  92,  CASE  291). 

4  Dr.  B.  D.  LAV,  of  Paducah,  Kentucky,  in  a  letter  of  July  26,  1867,  to  the  Surgeon  General's  Office,  refers  to  this  case,  and  Dr.  L.  D.  NIDELKT,  of 
Mobile,  Alabama,  in  letters  of  April  21  and  May  4,  1867,  mentions  having  assisted  at  the  operation. 

5  In  a  letter  to  the  Surgeon  General's  Office,  dated  Paducah,  Kentucky,  July  25,  1867,  Dr.  B.  1).  LAY  regrets  his  inability  to  furnish  more  details 
respecting  this  and  the  preceding  case  of  intermediary  amputation  at  the  hip  joint,  and  states  that  he  had  kept  copious  notes  of  all  of  his  cases  of  ampu- 
i.-itions  practised  during  the  war,  and  that  these  notes,  with  records  and  instruments  of  the  Vicksburg  hospitals  and  its  branches,  were  given  in  charge  to 
Surgeon  J.  II.  BOUCHER,  of  Major-General  J.  B.  McPllERSOX's  corps ;  and,  if  the  registers  were  preserved,  they  would  give  the  desired  information.    It 
was  ascertained  that  Dr.  J.  H.  BOUCHER,  formerly  Surgeon  13th  Iowa,  afterwards  Surgeon  U.  S.  V.,  and  Medical  Director  of  the  Seventeenth  Corps, 
resided  in  Iowa  City  after  the  war,  and  died  in  April,  1874.     His  son,  Dr.  F.  H.  BOUCHEU,  of  Clarksville,  Iowa,  July  15,  1878,  made  a  careful  examina 
lion  in  his  father's  library  for  papers  and  notes  pertaining  to  the  surgery  of  the  war  without  finding  any  trace  of  the  memoranda  referred  to  by  Dr.  B.  D.  LAY. 

'•EVE  (P.  F.),  loc.  cit.,  p.  254.  Circular  No.  7,  S.  G.  O.,  1867.  pp.  33,  61.  FAUNTLKROY  (A.  II.),  Hip  Joint  Amputations,  in  Richmond  Med. 
Joitr..  1866,  Vol.  I,  p.  11.  LINING  (A.),  fiber  die  Blutung  bei  der  Erarticulation  des  Obcrscliexkels,  ZUrich,  1877,  p.  89,  CASK  271. 


144 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Of  the  twenty -three  intermediary  amputations  at  the  hip  joint,  ten  were  on  the  right 
side,  six  on  the  left;  in  seven  cases  the  side  of  injury  was  not  stated.  The  Museum 
possesses  pathological  specimens  from  three  of  the  twenty-three  cases. 

TABLE  XVI. 
Summary  of  Twenty-three  Cases  of  Intermediary  Amputation  at  the  Hip  Joint. 


NO. 

NAME,  AGE,  AND  MILITARY 
DESCRIPTION. 

DATK 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Garden,  J.,  Pt.,  Gen.  Rosen- 

Sept.  20, 

Fragment  of  shell  comminuted 

Sept.  21, 

Amputation,  by  Surg.  R.  P. 

Died  September  27,  1863. 

crans's  army. 

1863. 

femur,  ex.  lac.  of  soft  parts. 

1863. 

Bateman,  P.  A.  C.  S. 

2 

Carroll,  L.,  Sergeant,  H,  1st 
Delaware,  age  23. 

Oct.  22, 
1864. 

Conoidal  ball,  r't  femur  splint 
ered,  extending  ten  ins.;  ball 

Nov.  11, 
1864. 

External  flap  made  by  cutting 
from  without  inward,  internal 

Progress  favorable  forthree  days; 
Nov.  17th,  pya3mic  symptoms. 

ext.;  sharp  upper  extremity 

flap  by  cutting  from  within 

Died  Nov.  19,   1864,   pyasmia. 

of  femur  sawn  off;    Nov.  2, 

outward,  by  Surg.  E.  Bent- 

Autopsy.    Spec.  1020.     Circ.  G, 

lurm.,  lig.  small  artery. 

ley,  U.  S.  V. 

S.  G.  O.,  1  865,  p.  50.    Circ.  7,  S. 

G.  O.,  1867,  pp.  38,  62. 

3 

Chamberlain,  J.,  Pt.,  U.  S. 

Army. 

Sept,  20, 
1863. 

Conoidal  ball,  great  com.  upper 
extremity  of  femur,  fissures 

Sept.  21, 
1863. 

Amputation,    by  Surg.  R.  P. 
Bateman,  P.  A.  C.  S. 

Died  thirty-six  hours  after  oper'n. 
EVE  (P.  F.),  loc.  cit.,   p.  255. 

extending  to  neck. 

Circ.  7,  S.  G.  O..1PG7,  pp.  36,  62. 

4 

Eckley,    L.,    Pt.,    A,    67th 

May  20, 

Conoidal  ball  shattering  upper 

May  24, 

Antero-posterior  flap,  by  Ass't 

Reacted  fairly.     Died,  May  28, 

Ohio,  age  33. 

1864. 

extremity  of  left  femur  and 

1864. 

Surg.  H.  C.  Roberts,  U.  S.  V., 

1864,  from  exhaustion.    Circ.  6, 

wounded  sciatic  nerve. 

and  others. 

S.  G.  O.,  1865,  p.  50.     Circ.  7, 

S.  G.  O.,  1867,  pp.  37,  62. 

5 

Gaines,  S.,  Pt.,  M,  2d  Mich 

Jan.  31, 

Conoidal  ball  shattered  head 

Feb.  3, 

Large  antero-internal  flap,  by 

Never  rallied.      Died  one  hour 

igan  Cavalry. 

1864. 

and  neck  of  right  femur. 

1864. 

Surg.  E.  Shippen,  U.  S.  V. 

after  operation,  from  shock. 

£. 

C                F       Pt       Tcvac 

July  2 

C*  rinpslint  sliatt'rino*  Ipft  f'pmnr 

July  4, 

Antero-postGrior  flup  by  Surff. 

Died  thirty-six  hours  after  oper 

regiment. 

1863.  ' 

at  trochanter  major  up  into 

1863.  ' 

B.  Rohrer,  10th  Penn.  Res., 

ation. 

the  neck. 

and  others. 

7 

Hale,    H.  H.,  Pt.,  G,    14th 

April  6, 

Frag,  of  shell  shattered  upper 

April  12, 

Long  anterior  flap,  bv  Surg. 

Reaction   fair;  April  14th,  gan 

Illinois,  age  21. 

1862. 

portion  of  the  left  femur,  soft 

1862. 

D.  P.  Smith,  U.  S.V.,  and 

grene.     Died  April  20,  1862. 

parts  ex.  lacerated. 

others. 

8 

Hamilton,   C.,    Pt.,    H,    3d 

June  14, 

Musket  ball  fract.  upper  part 

June  25, 

Antero-posterior  flap,  by  Surg. 

Sank  gradually,  and  died,  June 

Colored  Troops. 

1863. 

of  left  femur  —  great  swelling, 

1863. 

E.  P.  Gray,  3d  Col'd  Troops, 

29,  1863,  from  exhaustion.  Circ. 

inflammation,  and  pain  —  co 

and  others. 

2,  S.  G.  O.,  1869,  p.  109. 

pious  hasm.,  digital  pressure. 

9 

Jackson,  —,  Pt,  Col.  Tap- 

Nov.  7, 

Shot  comminuted  fracture  of 

Nov.  15, 

Antero-posterior  flap,  by  Surg. 

Succumbed  to  shock  of  opera 

pan's  brigade,  age  21. 

1861. 

upper  extremity  of  femur. 

1861. 

E.  Potts,  P.  A.  C.  S. 

tion.   EVE  (P.  F.),  loc.  cit.,  pp. 

255,  264.    Circ.  7,  S.  G.  O.,  18G7, 

pp.  33,  61. 

10 

Johnson,  P.,  Pt.,  C,  2d  Del 

Dec.  14, 

Conoidal  ball  perforating  right 

Dec.  27, 

Amputation,   by  Surgeon    P. 

Died  a  few  hours  after  operation. 

aware. 

1862. 

great    trochanter  ;    gangrene 

1862. 

Pineo,  U.  S.  V. 

Spec.  710.  Circ.  6,  S.G.O.,1865, 

entire  limb. 

p.  50.     Circ.  7,  S.  G.  O.,  1867, 

pp.  35,  62. 

11 

Lackey,  C.,  Pt.,  E,  7th  Wis 
consin,  age  30. 

May  12, 
1864. 

Conoidal  ball  frac.  right  femur, 
thro'  trochanters,  nearly  half 

May  21, 
1864. 

Antero-posterior  flap,  by  Ass't 
Surg.  A.  Ingram,  U.  S.  A. 

But  partial  reacti'n.  Died  twenty- 
fourhoursafteroperation.  Circ. 

1 

length  of  shaft  ;  surgical  fev. 

6,  S.  G.  O.,  1865,  p.  50.     Circ. 
7,  S.  G.  O.,  1867,  pp.  37,  62. 

12 

Martin,  —,  Pt.,  26th  Arkan 

Dec.  7, 

Cannon  shot  shattering  the  left 

Dec.  8, 

Large  anterior  flap,  by  Surg. 

Rallied  somewhat.     Died,  Dec. 

sas,  age  25. 

1862. 

thigh. 

1862. 

W.  B.  Welch,  of  Col.  Gun- 

12,  1862,  from  exhaustion. 

ther's  Arkansas  regiment. 

13 

Minott,  J.,  Pt.,  A,  4th  Ver 

June  23, 

Conoidal  ball  fract.  upper  por 

June  25, 

Short  anterior,  long  posterior 

Rallied,  but  soon  began  to  fail; 

mont,  age  20. 

1864. 

tion  shaft  right  femur;  gan 

1864. 

flap,  by  Surg.  D.M.  Goodwin, 

died  two  hours  after  operation. 

grene,  mortification. 

3d  Vermont. 

Circ.  7,  S.  G.  O.,  1867,  pp.  38,  62. 

14 

Pausbeck,  P.,    Pt.,   K,    43d 

April  7, 

Conoidal  ball  crushing  upper 

April  21, 

External  and  internal  flap,  after 

Died,  a  few  moments  after  oper 

Illinois. 

1862. 

portion  left  femur,  extensive 

1862. 

Lisfranc's  method,  by  A.  A. 

ation,  from  shock.     Circ.  7,  S. 

injury  of  soft  parts. 

Surg.  J.  P.  Do  Bruler. 

G.  O.,  1867,  pp.  34,  61. 

15 

Spencer,  G.  M.,  Pt.,  B,  2d 

Mar.  31, 

Conoidal  ball  fract.  thro'  right 

April  12, 

Incision  for   excision,   double 

Died  in  less  than  an  hour.    Spec. 

New  York  Mounted  Rifles, 

18G5. 

trochan's,  splintering  extend 

1865. 

flap  amp.,  by  Surg.  E.  Gris- 

4237.      Circ.  6,  S.  G.  O.,  18G5, 

age  17. 

ing  nine  ins.;  lodged. 

wold,  U.  S.  V.,  and  others. 

p.  50.      Circ.  7,  S.  G.  O.,  1867, 

pp.  39,  62. 

16 

Unknown,  Pt.,  C,  54th  Mas 

July  11, 

Fragment  of  shell  fract.  neck 

July  13, 

Manec's  method,  large  antero- 

Died  twenty-four  hours  after  op 

sachusetts. 

1863. 

and  head  of  right  femur  and 

1863. 

internal  flap,  by  Surg.  R.  A. 

eration.     EVE  (P.  F.),  loc.  cit., 

rim  of  acetabulum. 

Kinloch,  P.  A.  C.  S. 

p.  255.     Circ.  7,  S.  G.  O.,  1867, 

pp.  36,  62. 

17 

Unknown,    Pt.,    Ohio    regi 

April  6, 

Frag,    of    shell    comminuted 

April  16, 

Antero-posterior  flap,  by  Surg. 

Rallied  satisfactorily:  April  18th, 

ment,  age  35. 

1862. 

shaft,  trochanters,  and  neck 

1862. 

G.  C.  Blackman,  U.  S.  V. 

flaps  sloughed  badly;  pyaemic 

of  right  femur. 

symptoms.    Died  April  22,  1862. 

18 

Unknown,  Pt.,  U.  S.  Army. 

July  21, 
1861. 

Musket  ball  fract.  lower  third 
right  femur  ;  ex.  pur.  infiltra 

July  29, 
1861. 

Probably  by  Larrey's  method, 
by  Surg.  St.  G.  Peachy,  P. 

Survived  oper'n  two  or  three  days. 
EVE  (P.   F.),  toe.  cit.,  p.  253. 

tion  ;  incipient  gang,  of  leg. 

A.  C.  S. 

Circ.  7,  S.  G.O.,  1867,  pp.  33,  61  . 

19 

Unknown,  Pt.,  Gen.  Bragg's 

Dec.  28, 

Conoidal  ball  fract.  troch.  maj. 

Jan.  5, 

Antero-posterior  flap,  by  Ass't 

In  a  few  hours  stump  evinced  a 

army,  age  26. 

1862. 

and  neck  of  femur,   fissures 
extending  into  capsular  lig. 

1863. 

Surgeon  A.  C.  Crymes,  39th 
Alabama.- 

tendency  to  unhealthy  action, 
and  patient  sank  into  adynamic 

condition;   died  Jan.   8,   1863. 

EVE  (P.F.).toc.  cit.,  -p.  255.  Circ. 

7,  S.  G.  O.,  1867,  pp.  35,  62. 

20 

Unknown,   Pt.,   Col.   Dock- 
eray's  Arkansas  regiment. 

Oct  3, 
1862. 

Conoidal  ball  shattering  neck 
of  right  femur. 

Nov.  3, 
1862. 

Amputation,  by   Surg.  R.  A. 
Felton,   of  Col.   Dockeray's 

Died  before  dressing  of  stump 
•was  completed.     EVE  (P.  F.), 

regiment. 

loc.  cit.,  pp.  253,  261.     Circ.  7, 

S.  G.  O.,  1867,  pp.  35,  62. 

21 

Unknown,   Confederate  sol 

1863. 

Shot  fracture  of  the  femur.  .  . 

1863. 

Amputation,  by  Surg.  B.  D. 

Died.      Circ.  2,  S.  G.  O.,  1869, 

dier. 

Lay,  P.  A.  C.  S. 

p.  108.  LUXING  (A.),  Exart.  des 

OberscJienk.,  Zurich,  1877,  S.  99, 

CASE  340. 

22 

Unknown,   Confederate  sol 

1863. 

Shot  fracture  of  the  femur.  .  .  . 

1863. 

Amputation,  by  Surg.  B.  D. 

Died.     Circ.  2.   S.  G.  O.,  1869, 

dier. 

Lay,  P.  A.  C.  S. 

p.  108.    LUNING,  op.  cit.,  S.  99, 

CASE  341. 

23 

Wolf,    J.    H.,   Pt.,    D,  4th 

July  21 

Musket  ball  shatt'g  femur  from 

Aug.  21, 

Double  flap,  by  Surg.  E.  War 

Died  Aug.  23,  1861,  from  exhaus 

Virginia. 

1861. 

four  ins.  below  troch's  quite 

1861. 

ren,  C.  S.  A. 

tion. 

up  to  neck  ;  colliquative  diarr. 

SECT.  II.) 


SECONDARY    AMPUTATIONS    AT    THE    HIP   JOINT. 


145 


Secondary  Amputations. — Of  nine  instances  of  secondary  amputations  at  the  hip 
joint,  eight  were  practised  on  Union  soldiers  and  one  on  a  Confederate  soldier,  resulting  in 
two  recoveries  and  seven  deaths,  a  mortality  rate  of  77.7  per  cent.  The  shortest  interval 
between  the  reception  of  the  injury  and  the  operation  was  forty-three  days;  the  longest, 
two  years  nine  months  and  twenty-one  days.  Six  of  the  operations  were  performed  on  the 
right  side  and  three  on  the  left.  Of  the  two  survivors  of  secondary  amputation  at  the  hip, 
one  is  a  pensioner  in  comfortable  health  at  a  period  nearly  fifteen  years  after  the  operation. 

CASE  320  — Private  George  W.  Lemon,  Co.  C,  Cth  Maryland,  aged  30  years,  bad  liis  left  femur  fractured,  at  the  junction 
of  the  middle  and  upper  thirds,  by  a  conoidal  musket  ball,  at  the  battle  of  the  Wilderness,  May  5,  1864.  He  was  left  in  a 
shelter  tent  on  the  field  and  fell  into  the  hands  of  the  enemy.  On  May  13th  he  was  recaptured,  and  was  sent  to  Fredericksburg, 
and  thence  to  Alexandria,  where  he  was  received  at  the  Third  Division  Hospital  on  June  14th.  When  admitted  he  had 
diarrhoea  and  was  greatly  emaciated.  There  was  a  bed-sore,  four  inches  in  diameter,  over  the  sacrum,  and  smaller  sores  over 
the  prominences  on  the  spine  and  scapulae.  The  lower  end  of  the  upper  fragment  of  the  femur  protruded  from  the  wound,  from 
which  there  was  a  profuse  offensive  ash-colored  discharge.  To  check  the  diarrhoea,  to  administer  suitable  nourishment,  and  to 

take  pressure  from  the  bed-sores  by  supporting  the  body  on 

air  cushions,  were   the  first  matters   attended   to.     Then 

moderate  extension  was  applied  to  the  injured  limb,  and  a 

tolerably  good  position  was  maintained  by  means  of  pillows 

and  cushions.     In  three  weeks  the  bed-sores  were  healed. 

and  there  was  a  slight  improvement  in  the  general  constitu 
tional  condition.  Extension  of  the  limb  causing  pain,  it 

was  discontinued.     For  the  next  ten  or  twelve  months  the 

patient  clung  to  life  by  the  slenderest  thread.     Detached 

fragments  of  bone  frequently  gave   rise  to  inflammatory 

swelling,  abscesses  in  the  thigh,  and  profuse  suppuration. 

Yet  the  appetite  and  digestion  continued  to  be  good,  and  the 

great  drain  upon  the  system  was  supported  unusually  well. 

In  May,   1865,  it  was  found  that  the  fracture  was  quite 

firmly  consolidated.     The  patient  now  occasionally  sat  up 

in  a  chair,  but  every  attempt  of  the  sort  was  followed  by 

acute  inflammation  of  the  thigh,  with  increased  suppura 
tion.  It  was  now  decided  that  the  patient  must  ultimately 

sink  under  the  profuse  suppuration,  and  that  an  operation 

should  be  performed  as  soon  as  it  was  opportune,  and  that 

every  effort  should  be  made  to  put  the  patient  in  a  condition 

to   support  this   shock.     On   October   12,    1865,    Surgeon 

Edwin  Bentley,  U.  S.  V.,  proceeded  to  ainputate  at  the  hip 

joint.     Chloroform  was   administered ;    the   external   iliac 

artery  was  compressed  at  the  pubis ;  anterior  and  posterior 

semilunar  flaps  were  formed  by  transfixion,  and  the  femur 

was  disarticulated.     The  haemorrhage  was  inconsiderable, 

and  the  patient  reacted  soon  and  satisfactoriljr.     From  the 

day  of  the  operation  he  steadily  improved,  with  scarcely 

On  November  15th,  Dr.  Bentley  reported  that  the  ligatures  had  all  come  away,  and  that  the  wound 
In  December  the  stump  was  healed,  and  the  patient  began  to  get  about  on  crutches.  The  fracture  of 
the  exarticulated  femur  was  found  to  be  imperfectly  but  quite  firmly  united,  with  great  antero-posterior  angular  deformity  and 
shortening.  The  bone  was  sent  to  the  Army  Medical  Museum,  where  it  is  preserved  as  Specimen  4386.  A  posterior  view  of  it 
is  given  by  the  annexed  left  hand  wood-cut  (FlG.  98).  On  January  31,  1866,  a  photograph  of  the  man  was  taken,  from  which 
the  right  hand  wood-cut  (FlG.  99)  is  copied.  Lemon  was  then  transferred  to  the  Harewood  Hospital,  at  Washington.  He  was 
then  quite  well,  and  able  to  go  where  he  chose  on  crutches.  The  cicatrix  was  firm  and  healthy.  On  February  3,  1866,  he  was 
discharged  from  the  hospital,  and  from  the  service  of  the  United  States,  at  his  own  request.  He  went  to  his  home  at  Bird  Hill, 
Carroll  county,  Marj-land,  and  resumed  his  trade  of  shoemaking.  He  was  granted  a  pension  of  fifteen  dollars  a  mouth.  On 
April  23,  1867,  a  letter  was  received  from  him  in  which  he  stated  that  bis  health  was  excellent ;  that  he  weighed  ninety-nine 
and  a  half  pounds,  an  increase  of  twelve  and  a  half  pounds  from  the  date  at  which  he  left  the  hospital ;  and  that  be  had  been 
able  to  walk  to  the  village  of  Westminster,  a  distance  of  seven  miles,  without  fatigue.  In  a  letter  dated  Westminster,  Maryland, 
July  31,  1870,  he  states  "that  the  artificial  limb  is  not  now  or  ever  has  been  of  the  least  service  to  me.  *  *  I  have  tried  to 
wear  it;  but  it  only  serves  to  irritate  the  stump,  and  makes  it  so  raw  and  sore  that  I  cannot  bear  it  to  touch  anything  for  days 
afterwards."  The  pensioner  was  paid  June  4,  1878.1 

1  This  secondary  amputation  at  the  hip  is  noted  on  page  52  of  Circular  No.  6,  S.  G.  O.,  1865,  in  a  foot-note.    In  the  Catalogue  of  the  Surgical 
Section  of  the  Army  Medical  Museum,  of  1866,  p.  248,  there  is  a  brief  memorandum  of  the  facts  of  the  case,  with  a  wood-cut  of  the  fractured  femur, 
contributed  to  the  Museum  by  the  operator,  Surgeon  EbWIX  I5ENTLEY,  U.  S.  V.     A  detailed  account  of  the  case,  compiled  from  the  reports  of  the  Third 
Division  Hospital,  Alexandria,  and  Harewood  Hospital,  Washington,  is  printed  in  Circular  No.  7,  S,  G.  O.,  1867,  p.  42. 
SURG.   Ill— 19 


FIG.  98.  —  Consolidated 
gunshot  fracture  of  the  left 
femur.  Spec.  43£6. 

an  untoward  symptom, 
was  granulating  kindly. 


FlG.  99. — Appearance  of  cicatrix  after  secondary 
coxo-femoral  amputation.     [From  a  photograph.] 


146 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


The  subject  of  the  second  successful  secondary  amputation  at  the  hip  was  in  good 
health  four  and  a  half  years  subsequent  to  the  operation,  but  has  not  replied  to  letters  of 
inquiry  of  a  later  date. 

CASE  321. — Private  Woodford  W.  Lonymour,  a  rebel  soldier,  aged  25  years,  a  robust,  healthy  111:111,  was  wounded  at  a 
skirmish  at  Cynthiana,  Kentucky,  on  June  11,  1864.  A  ball  from  a  Belgian  rifle,  at  short  range,  passed  through  his  right  thigh, 
shattering  the  shaft  of  the  femur.  There  was  profuse  haemorrhage  and  the  shock  was  alarming.  He  remained  almost  insensible 
for  three  or  four  days,  and  for  a  fortnight  there  was  extreme  prostration.  He  was  placed  in  a  rebel  field  hospital,  and  the  injured 
limb  was  put  in  a  fracture  box,  with  which  was  connected  a  crutch  piece  extending  to  the  axilla.  On  the  evening  of  the  recep 
tion  of  the  wound  numerous  detached  bony  splinters,  a  handful  almost,  were  extracted.  For  six  weeks  extension  and  counter- 
extension  were  maintained,  but  so  much  suffering  arose  from  this  treatment  that  it  was  discontinued,  and  the  limb  was  simply 

supported  in  a  comfortable  position.  The  patient  was  confined  to 
his  bed  for  eight  and  a  half  months.  In  the  middle  of  March, 
1865,  he  was  removed  to  Florence,  Kentucky,  seven  miles  from 
Cincinnati,  and  Dr.  George  C.  Blackman,  professor  of  surgery  in 
the  Medical  College  of  Ohio,  was  consulted  in  the  case.  There 
was  a  profuse  discharge  of  offensive  pus,  and  the  patient's  strength 
seemed  to  be  failing  under  the  protracted  irritation  and  spoliation. 
There  had  been  frequent  recurrences  of  abscesses  in  the  thigh, 
attended  with  excessive  pain  and  swelling,  and  followed  by  the 
elimination  of  fragments  of  necrosed  bone.  Ever  since  the  recep 
tion  of  his  injury  the  patient  had  taken  morphia  very  freely. 
Evidently  there  Avere  still  loose  sequestra  and  diseased  bone  with 
which  sinuses  communicated,  and  Dr.  Blackman  proposed  to 
remove  these  sources  of  irritation.  On  April  23d  the  patient  con 
sented  to  an  operation,  and  a  number  of  necrosed  fragments  were 
extracted,  with  much  relief  to  the  local  irritation  and  benefit  to  the 
general  health.  During  the  autumn,  however,  evidences  of  exten 
sive  destructive  inflammation  of  the  shaft  of  the  femur  became 
unmistakable,  and  in  December  a  second  operation  for  the  removal 
of  fragments  wras  performed  without  advantage.  The  discharge 
became  more  offensive  and  sanious,  and  the  strength  of  the  patient 
rapidly  gave  way.  In  January,  1866,  his  condition  became  almost 
hopeless,  and  the  removal  of  the  diseased  limb  was  determined  on. 
The  operation  was  performed  on  January  18th.  Ether  was  admin 
istered,  and  the  lower  extremities  were  kept  elevated  for  a  few 
minutes  before  the  incisions  were  made.  Then  the  right  femoral 
was  compressed  at  the  groin,  and  the  disarticulation  was  rapidly 
effected  by  Lacauchie's  method.1  A  circular  cut  through  the  skin 
was  made  at  the  junction  of  the  upper  third  of  the  thigh ;  then  the 
integuments  were  retracted  and  the  muscles  were  divided  circularly  down  to  the  bone.  A  vertical  incision  was  now  made  on 
the  outer  side  of  the  limb,  commencing  a  little  above  the  trochanter  and  joining  the  first  incision.  The  head  of  the  bone  was 
then  exarticulated.  There  was  but  little  haemorrhage,  and  the  patient  rallied  from  the  operation  remarkably  well.  The  follow 
ing  day  he  suffered  greatly  from  nausea,  which  he  ascribed  to  the  use  of  the  ether.  This  distressing  complication  soon  subsided, 
however,  and  thenceforward  there  was  no  unpleasant  symptom,  and  the  patient  progressed  rapidly  toward  recovery  (FlG.  100). 
In  February,  1867,  Longmoor  reported  himself  to  Dr.  Blackman  as  in  excellent  health,  and  as  having  recently  married.  In  the 
latter  part  of  June,  1867,  seventeen  months  after  the  operation,  Dr.  Blackman  again  saw  him,  and  found  that  his  general  health 
was  good,  and  that  his  stump  was  sound,  though  subject  to  occasional  attacks  of  neuralgia  of  extreme  severity.  He  was 
accustomed,  in  these  attacks,  to  alleviate  his  suffering  by  taking  large  doses  of  morphia.  An  examination  of  the  limb  after  its 
removal  showed  that  the  entire  shaft  of  the  femur  had  been  affected  by  osteomyelitis.  The  specimen,  with  its  delicately  encased 
sequestra  and  fragile  deposits  of  new  bone,  was  destroyed  by  an  unskilful  preparer.  On  July  21,  1870,  a  letter  of  inquiry  was 
addressed  by  the  reporter  to  Mr.  Longmoor,  then  at  Cynthiana,  Kentucky,  which  elicited  the  following  response:  "In  answer  to 
your  inquiry, '  have  you  suffered  much  from  neuralgic  pains,'  I  answer  there  existed,  for  a  long  time,  contractions  of  the  muscles, 
in  the  centre  of  the  stump,  attended  with  considerable  pain  and  tenderness ;  the  interval  between  those  contractions  of  the 
muscles  and  the  pain  is  much  lengthened.  I  now  suffer  comparatively  little,  and  my  general  health  is  much  improved."2 

In  the  seven  fatal  cases  of  secondary  amputations  at  the  hip  joint  the  injuries  were 
inflicted  by  small  projectiles.  One  patient  survived  the  operation  nearly  four  months; 
one,  twenty-three  days;  one,  eleven  days;  one,  three  days;  and  three,  one  day  or  less. 

'M.  A.  E.  LACAUCHIE,  chirurgien  principal,  and  chief  medical  officer  of  the  French  army  of  occupation  in  Rome,  gives  a  description,  with  illus 
trations,  of  his  procedure  for  amputating  at  the  hip  joint,  in  the  Gazette  Medicale  de  Paris,  Nos.  19,  20,  25,  and  26,  1850. 

2  The  particulars  of  this  case  of  secondary  amputation  nt  the  hip  joint  were  contributed  to  the  Surgeon  General's  Office  by  the  operator,  Professor 
GKOKGE  C.  BLACKMAN,  of  the  Medical  College  of  Ohio,  in  a  letter  dated  February  26,  1867.  The  operation  had  been  briefly  noted  in  the  Cincinnati 
Jour,  of  lied.,  1866,  Vol.  I,  p.  101,  and  was  more  fully  detailed  in  the  Report  on  Amputations  at  the  Hip  Joint,  Circular  No.  7,  S.  G.  0.,  1867,  p.  43,  with 
a  ohroinolithographic  sketch  of  the  patient  five  months  after  recovery,  from  a  drawing  transmitted  by  Dr.  BLACKMAN. 


PIG.  100. — Cicatrix  five  mouths  after  secondary  amputation  at  the  hip. 
[From  a  drawing  by  Prof.  BLACKMAN.] 


SECT.  II.] 


SECONDARY    AMPUTATIONS    AT    THE    HIP    JOINT. 


147 


FIG.  101.— Gunshot  frac 
ture  of  the  femur.    Spec. 

2288. 


CASK  322. — Private  Daniel  H.  Bowman,  Co.  C,  110th  Pennsylvania,  aged  24  years,  was  wounded  on  July  27,  1864,  at 
Deep  Bottom,  on  the  left  bank  of  James  River.  A  conoidal  musket  bull  entered  at  the  upper  posterior  part  of  the  right  thigh, 
comminuted  the  femur  from  the  trochanters  downward  for  several  inches  and  lodged.  The  wounded  man  was  transported  to 
Washington  on  a  hospital  steamer,  and  was  received  at  Lincoln  Hospital  on  July  '.30th.  The  injured  limb  was  shortened  two  and 
a  half  inches;  the  soft  parts  were  badly  lacerated.  On  August  7th  the  position  of  the  ball  at  the  anterior  part  of  the  thi"h  was 
detected.  An  incision  was  made  and  the  ball  and  several  detached  fragments  of  bone  were  removed.  On  August  17th  the 
wound  looked  badly,  and  there  was  slight  sloughing.  For  the  next  few  weeks  the  patient  lost  ground 
steadily.  There  was  profuse  suppuration,  with  great  constitutional  irritation.  There  appeared  to  be  no 
attempt  at  union  at  the  seat  of  the  fracture.  The  patient  had  become  much  emaciated,  and  his  powers 
of  resistance  were  failing  daily.  After  due  consultation  it  was  determined  to  amputate  at  the  hip  joint. 
On  September  15th  the  operation  was  performed  by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.  The  patient 
was  rendered  insensible  by  sulphuric  ether.  The  method  by  antero-posterior  flaps  formed  by  transfixion 
was  adopted.  The  amputation  was  rapidly  completed  and  very  little  blood  was  lost.  The  patient  did 
not  rally,  but  died  one  hour  after  the  operation,  September  15,  1884.  At  the  autopsy,  the  lungs  were 
found  to  be  attached  to  the  thoracic  walls  by  firm  fibrinous  adhesions.  In  the  upper  lobe  of  the  right 
lung  there  were  two  small  isolated  abscesses.  Otherwise  the  lungs  were  normal.  The  right  weighed 
13  and  the  left  11  ounces.  The  abdominal  viscera  were  normal,  save  that  the  liver  and  kidneys  were 
unusually  small,  the  former  weighing  44-J  and  the  latter  9£  ounces.  At  the  seat  of  the  fracture  of  the 
femur  (FlG.  101)  there  was  no  attempt  at  repair;  the  fragments  were  carious:  a  large  one,  consisting 
of  nearly  half  of  the  cylinder  of  the  shaft,  was  four  inches  long  and  was  quite  detached.  Fissures  pene 
trated  the  trochanters  and  extended  posteriorly  half-way  up  the  neck  of  the  bone. 

CASE  323. — Sergeant  Hiram  H.  Davis,  Co.  B,  IfiGth  New  York,  aged  26  years,  was  wounded  at 
the  battle  of  Opequan,  Virginia,  on  September  19, 1864,  by  a  conoidal  musket  ball,  which  passed  through 
the  fleshy  part  of  the  left  thigh,  and,  entering  the  other  thigh,  fractured  the  upper  third  of  the  right 
femur.  He  was  sent  by  his  regimental  surgeon,  Dr.  G.  C.  Smith,  to  the  Sheridan  Field  Hospital,  near 
Winchester,  where  the  fracture  was  adjusted  upon  a  double  inclined  plane.  Thence  he  was  transferred,  on  March  6,  1865, 
to  the  General  Hospital  at  Frederick,  Maryland,  which  reports  the  flesh  wound  in  the  left  thigh  healed,  great  deformity  and 
shortening  of  the  fractured  limb,  and  copious  suppuration  from  fislulous  sinuses  communicating  with  necrosed  bone.  On  April 
25th  he  was  transferred,  in  a  somewhat  improved  condition,  to  the  Cuyler 
General  Hospital  at  Germantown,  Pennsylvania,  where  no  special  alteration 
in  his  symptoms  or  treatment  is  noted.  On  May  10th  he  was  moved  from 
Cuyler  to  Mower  Hospital,  and  thence,  on  October  18th,  to  the  Post  Hospital 
at  Philadelphia.'  The  register  of  the  Post  Hospital  states  that  the  fracture 
of  the  femur  was  consolidated  at  the  date  of  his  admission,  and  that  he  was 
discharged  from  service  on  November  8,  1885.  In  the  spring  of  1866  Davis 
was  received  at  the  Episcopal  (civil)  Hospital  in  Philadelphia.  The  appear 
ance  of  the  injured  limb  at  the  date  of  his  admission 

is  indicated  in  the  accompanying  wood-cut  (FlG.  103). 

The  right  lower  extremity  was  shortened  six  and  a 

half  inches;    there  was  false  anchylosis  of  the  knee 

and  ankle  joints  on  this  side;  extensive  cicatrices  on 

the  thigh  indicated  the  location  of  former  sloughing; 

there  were  five  fistulous  canals  communicating  with 

diseased  bone;  apparently  the  entire  upper  portion  of 

the  femur  was  necrosed.     On  May  5,  1886,  Dr.  Wil 
liam  S.  Forbes,  surgeon  to  the  hospital,  amputated 

the  limb  at  the  hip  joint.     Ether  was  employed  as  an 

anaesthetic,  but  it  did  not  act  satisfactorily.    The  vessels 

were  controlled  by  the  abdominal  aortic  compressor. 

An  anterior  flap  was  made  by  cutting  from  without 

inward,  the  integument  being  dissected  up  to  form  the 

longer  portion  of  the  flap.     Then  the  femoral  artery 

was  tied ;  and  then  the  bone  was  disarticulated  and  the 

posterior  flap  was  completed.     The  haemorrhage  was 

estimated  at  less  than  eight  ounces.    The  patient  rallied 

bravely  from  the  shock  of  the  operation.     Forty-eight 

hours  after  the  operation  the  pulse  fell,  and  for  about 

five  hours  there  was  great  depression.     This  was  fol 
lowed  by  a  febrile  reaction,  accompanied  by  an  erysip- 

elatous  blush,  which,  commencing  at  the  outer  angle 
of  the  wound,  gradually  involved  its  entire  extent.  After  this  the  patient  sank  rapidly,  and  expired  sixty-four  hours  after  the 
operation,  May  8,  1886.  On  examining  the  injured  femur  (FlG.  102)  it  was  found  to  be  imperfectly  united  by  fragile  masses 
of  callus,  which  enclosed  large  fragments  of  dead  or  diseased  bone.1 

1  MouTON  (T.  G.),  On  Amp.  Hip  Joint,  with  the  Hist,  of  the  Cases,  in  A  m.  Jour.  Med.  Sci.,  1866,  Vol.  L1I,  p.  36  (  Circ.  No.  7,  S.  G.  O.,  1667,  pp.  46,  64. 


FIG.  102.— Partial  union 
of  gunshot  fracture  of  the 
femur.  [  From  a  photo 
graph  by  RHOADS.J 


FIG.  103.—  Gunshot  fracture  of  the  right  femur  with 
great  shortening  and  deformity.  [From  a  photograph  by 
NEWELL.] 


148  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

CASE  324. — Corporal  Frederick  Kelb,  Co.  G,  7th  New  York,  was  wounded  at  Fredcricksburg,  Virginia,  December 
14,  1862,  by  a  conoidal  musket  ball,  which  fractured  the  right  femur  at  the  junction  of  the  upper  and  middle  thirds.  After 
remaining  for  a  fortnight  in  the  field  hospital  of  the  1st  division  of  the  Second  Corps  he  was  conveyed  to  Washington  and  placed, 
on  December  Ciith,  in  the  Patent  Office  Hospital,  where  the  injured  limb  was  placed  in  a  fracture  box  and  the  wound  was 
dressed  with  oakum.  The  case  progressed  favorably,  and,  on  April  2,  1863,  the  patient  was  transferred  to  Judiciary  Square 
Hospital,  and,  on  May  9th,  was  sent  to  De  Camp  Hospital,  at  David's  Island,  New  York.  Acting  Assistant  Surgeon  John  C. 
DuBois  reported:  "The  ball  entered  about  one  inch  below  the  fold  of  the  right  natis,  and,  passing  outward,  shattered  the 
femur  at  its  middle,  and  lodged  in  the  anterior  part  of  the  thigh.  The  ball  was  extracted  two  days  afterwards.  On  January  1, 
1863,  six  pieces  of  bone  were  removed.  The  limb  was  placed  on  a  double  inclined  plane  and  cold  water  applied.  Six  weeks 
after,  the  long  straight  external  and  short  internal  splints  of  pasteboard  were  applied.  This  was  removed  in  a  few  weeks  and 
merely  the  short  internal  pasteboard  splint  retained.  On  April  2d  and  8th,  pieces  of  bone  came  away.  The  splint  was  then 
removed,  and  the  limb  suffered  to  lie  on  a  hair  mattress.  May  6th,  several  pieces  of  bone  removed.  May  12th,  firm  union  has 
taken  place,  with  great  deformity.  External  angular  curvature,  with  about  4f  inches  shortening,  as  near  as  can  be  measured. 
His  whole  limb  is  everted,  and  he  is  unable  to  raise  it.  His  general  condition  is  much  reduced.  As  union  is  firm  no  treatment 
can  be  adopted  to  relieve  the  deformity.  July  10th,  a  few  more  pieces  of  bone  have  been  removed.  The  probe  reveals  rough 
bone,  not  loose.  Internal  wound  closed;  sinus  injected  with  dilute  tincture  of  iodine.  General  health  pretty  good."  On 
July  10th  he  was  removed  to  McDougall  Hospital,  at  Fort  Schuyler;  and  on  January  19,  1864,  he  was  readmitted  to  De  Camp 
Hospital.  On  June  8,  1834,  he  was  discharged  from  the  service  of  the  United  States.  There  was  evidence  of  disease  of  the 
femur.  On  June  7,  1865,  Kelb  was  admitted  to  St.  Luke's  Hospital,  in  New  York  City.  There  had  been  a  series  of  recur 
ring  abscesses  in  the  thigh,  and  it  was  believed  that  nearly  the  entire  femur  was  necrosed.  It  was  determined  to  amputate 
at  the  hip  joint,  and,  on  June  7th,  the  patient  being  anesthetized  by  sulphuric  ether  and  the  aorta  being  compressed  by 
Signoroni's  clamp  tourniquet,  the  amputation  was  performed  by  the  attending  surgeon,  Dr.  R.  F.  Weir,  by  the  method 
recommended  by  Dr.  Van  Buren,  an  anterior  flap  being  formed  by  transfixion  and  a  posterior  one  by  section  from  without 
inward.  The  haemorrhage  was  slight  and  the  shock  .was  moderate.  The  case  at  first  progressed  very  favorably.  Three 
weeks  after  the  operation  the  healing  of  the  stump  was  far  advanced  and  the  patient  was  able  to  leave  his  bed.  After  this  he 
began  to  lose  ground  very  gradually.  He  died  on  October  4,  1865,  nearly  four  months  after  the  operation.  At  the  autopsy, 
the  pelvis  of  the  right  kidney  was  found  to  be  blocked  up  with  numerous  calculi;  there  was  an  abscess  in  the  left  kidney,  and 
there  was  tuberculosis  of  both  lungs  at  an  advanced  stage.  The  stump  was  still  open  and  the  horizontal  portion  of  the  os  pubis 
was  necrosed.  A  section  of  the  exarticulated  femur  presented  the  characteristic  lesions  of  chronic  osteomyelitis.1 

CASE  325. — Private  James  McGeehen,  Co.  K,  107th  Pennsylvania,  aged  48  years,  was  wounded  at  the  battle  of  Gettys 
burg,  on  July  1,  1863,  by  a  conoidal  musket  ball,  which  entered  at  the  inner  aspect  of  the  middle  of  the  right  thigh  and 
traversed  the  entire  thickness  of  the  limb,  badly  comminuting  the  shaft  of  the  femur  in  its  progress.  He  lay  upon  the  field  for 
about  five  hours  and  lost  a  good  deal  of  blood,  although  none  of  the  larger  vessels  appeared  to  have  been  wounded.  He  was 
then  conveyed  to  a  temporary  field  hospital,  and  his  wounds  were  dressed.  On  July  6th  he  was  removed  to  the  Seminary 
Hospital  at  Gettysburg,  where  he  remained  until  September  4th,  at  which  date  there  was  profuse  suppuration  and  some  slough 
ing  at  the  wound  of  entrance,  and  it  was  deemed  expedient  to  put  the  patient  under  canvas  in  the  Camp  Letterman  Hospital. 
On  October  llth  he  was  moved  to  the  Town  Hall  Hospital  at  Chambersburg.  Here  he  was  able  to  move  about  on  crutches,  but 
the  injured  limb  was  greatly  enlarged  and  deformed,  and  numerous  fistulous  openings  successively  formed,  through  which  pus 
was  freely  discharged  and  bits  of  necrosed  bone  were  occasionally  eliminated.  On  April  23,  1864,  by  order  of  the  Medical 
Director  at  Harrisburg,  he  was  discharged  from  the  military  service  of  the  United  States  on  account  of  "permanent  lameness 
resulting  from  gunshot  fracture  of  the  right  femur."  Nearly  two  years  subsequently,  April  9,  1866,  McGeehen  entered  the 
Pennsylvania  Hospital  at  Philadelphia.  His  general  condition  was  satisfactory;  his  spirits  were  excellent;  a  careful  examina 
tion  failed  to  detect  organic  disease  of  any  viscus.  His  injured  thigh  remained  greatly  deformed  and  enlarged;  the  original 
wounds  had  long  since  closed,  but  there  were  numerous  fistulous  sinuses,  discharging  on  an  average  a  gill  of  pus  daily,  and,  at 
intervals,  scales  or  nodules  of  necrosed  bone;  three  tracks  seemed  to  ascend  to  within  an  inch  and  a  half  of  the  trochanter  major. 
It  was  thought  probable  that  above  this  point  the  femur  was  healthy.  After  a  careful  consultation,  it  was  determined  to  remove 
the  limb  at  the  hip  joint.  The  patient  was  placed  upon  tonic  treatment,  with  nourishing  diet;  his  bowels  were  also  carefully 
regulated.  He  complained  of  nothing  except  his  cough,  arising  from  a  slight  bronchitis,  which,  however,  gave  him  very  little 
trouble.  On  April  21,  1866,  Dr.  D.  H.  Agnew,  Surgeon  to  the  Pennsylvania  Hospital,  removed  the  limb.  The  abdominal 
tourniquet  was  employed,  and  by  this  means  the  circulation  of  the  abdominal  aorta  was  completely  controlled.  The  method 
of  operating  was  by  antero-posterior  skin  flaps,  with  circular  division  of  the  muscles.  The  femoral  artery  was  ligated  after 
the  anterior  flap  was  dissected  up.  The  femoral  vein  was  not  included  in  the  ligature.  Twenty-one  of  the  smaller  arteries 
required  deligation.  The  disarticulation  was  accomplished  in  a  minute  and  a  half.  Pressure  was  maintained  by  the  abdominal 
tourniquet  for  twenty-seven  minutes  while  the  minor  vessels  were  secured.  The  hemorrhage  during  the  entire  operation 
did  not  exceed  three  ounces,  scarcely  more  than  an  ounce  and  a  half  of  which  was  arterial  blood.  Ether  alone  was  employed 
in  inducing  anesthesia,  and  about  three  ounces  sufficed,  as  he  inhaled  it  without  effort  and  soon  came  under  its  influence. 
The  stump  was  packed  with  lint.  The  leg,  when  drained  entirely  of  blood,  weighed  twenty-two  pounds,  the  entire  weight  of 
the  body  at  that  time  being  about  one  hundred  and  forty-five  pounds.  Immediately  after  his  removal  to  the  ward  an  enema 
of  half  a  drachm  of  tincture  of  opium  was  administered,  and  this  was  repeated  at  eight  in  the  evening,  when  the  stump  was 
closed  by  lead  sutures  and  dressed  with  cerato.  On  the  following  day  the  patient  had  entirely  reacted  from  the  slight  amount 
of  shock  following  the  operation.  Pulse,  which,  under  agitation  from  the  approaching  operation,  had  been  averaging  from 
100  to  115,  had  fallen  to  98;  respiration  20;  skin  moist  and  pleasantly  warm.  No  stimulus;  moderate  diet,  and  a  drachm 


1  LlDELL  (J.  A.),  On  the  Secondary  traumatic  Lesions  of  bone,  etc.,  in  U.  S.  San.  Cam.  Hem.,  1870,  Surgical,  Vol.  I,  p.  438.  W.  H.  VAN  BUKEN, 
Transactions  of  New  York  Academy  of  Medicine,  Vol.  I,  1851-57,  p.  123,  and  Contributions  to  J'ractical  Surgery,  Philadelphia,  1865,  p.  9.  M.  A. 
GUERIN  (Medecint,  Oplraloire,  p.  220)  has  suggested  the  same  plan.  See  also  Circular  7,  S.  G.  O.,  1867,  pp.  41,  64. 


SECT,  n.j 


SECONDARY    AMPUTATIONS    AT   THE    HIP   JOINT. 


149 


of  laudanum  by  enema.  On  April  23d  he  was  more  comfortable.  Had  passed  a  quiet  night;  had  a  good  appetite.  A  con 
siderable  part  of  the  stump  had  united  by  first  intention,  and  there  was  only  a  little  greasy,  watery  discharge  from  the 
inner  angle.  Dry  dressing  continued.  On  April  24th  he  was  doing  well.  Discharge  thin  and  small,  and  flaps  were  rapidly 
uniting.  He  was  ordered  four  ounces  of  whiskey  daily,  and  half  an  ounce  of  Basham's  mixture.  Dry  dressing  continued. 
April  25th,  no  unpleasant  symptom  save  a  rather  frequent  bronchitic  cough.  The  flaps  are  united  at  the  middle  of  the  stump; 
the  discharge  comes  from  the  angles,  and  it  is  evidently  due  to  the  breaking  down  of  the  subcutaneous  fat.  Laudanum 
enemata  were  now  given  twice  daily;  warm-water  dressings  were  substituted  for  the  dry  applications.  April  26th,  he  ate 
and  slept  well,  but  was  troubled  by  his  cough,  which  was  severe,  accompanied  by  tenacious  mucous  sputa.  The  opiate 
enemata  were  suspended,  and  from  two  to  four  drachms  of  solution  of  sulphate  of  morphine  were  given  every  night;  durin*' 
the  day,  a  sedative  expectorant  mixture  every  three  hours.  The  stimulus  was  not  increased.  April  27th  and  28th,  steady 
improvement ;  cough  less  troublesome,  discharge  more  purulent  and  increased  in  quantity ;  warm-water  dressing  still  applied. 
April  29th,  discharge  purulent  and  quite  abundant,  amounting,  probably,  to  three  or  four  ounces  daily. 
April  30th,  much  the  same,  excepting  that  the  cough  was  again  more  troublesome.  The  union  of  the  flaps 
was  daily  becoming  more  secure,  and  the  discharge  now  consisted  of  laudable  pus.  Four  ligatures  came 
away.  May  1st,  seemed  brighter  and  better  than  any  day  heretofore;  ate  heartily;  stump  looked  perfectly 
healthy,  discharge  moderate;  two  more  ligatures  came  away.  May  2d,  condition  excellent;  the  stump  was 
rapidly  healing;  the  skin  remained  as  soft  and  healthy  as  on  the  day  of  operation.  Most  of  the  stitches 
had  been  cut  away.  The  pulsation  of  tho  external  iliac  artery,  which  for  several  days  was  very  marked,  had 
diminished  greatly,  and  seemed  as  though  propagated  through  a  firm  clot.  He  had  been  troubled  consid 
erably  with  cough  for  two  days.  At  midnight,  in  the  absence  of  the  watchman,  haemorrhage  occurred,  and 
on  the  return  of  the  latter  the  patient  was  found  dead.  Upon  removing  the  dressing  it  was  seen  that  a 
secondary  haemorrhage  had  taken  place.  Most  of  the  blood  was  retained  either  in  the  stump  or  inside  the 
dressing;  the  little  that  had  escaped  had  flowed  from  the  inner  angle  of  the  stump  back  under  the  body. 
The  haemorrhage  was  found  to  have  proceeded  from  the  femoral  artery.  The  most  powerful  restorative 
measures  were  employed  for  a  long  time,  but  without  producing  the  slightest  effect.  Upon  dissecting  the 
stump,  the  union  was  found  to  be  complete  over  one-half  of  the  entire  surface  of  the  flaps,  whilst  the  deeper 
portions  of  the  stump  were  covered  with  healthy  granulations.  The  femoral  vein,  which  was  not  ligated, 
was  entirely  occluded;  the  femoral  artery  was  patulous,  its  inner  coat  projecting  somewhat  beyond  the 
other  two;  the  inner  coat  of  the  artery  was  deeply  stained  and  roughened  for  at  least  one  and  a  quarter 
inches  above  the  extremity;  higher  up  it  appeared  perfectly  healthy;  the  ligature  which  had  secured  the 
vessel  was  still  attached  to  a  shred  of  the  outer  fibrous  coat.  It  had  evidently  very  recently  cut  its  way 
through,  and  still  retained  in  its  loop  the  end  of  the  vessel  which  had  sloughed  off.  Lying  immediately 
in  front  of  the  femoral  vessels,  embedded  in  a  recent  clot,  was  found  the  plug  which  had  been  driven  out  of 
the  artery.  This  was  a  firm,  flesh-colored  clot,  of  the  calibre  of  the  vessel,  and  long  enough  to  reach  up  to 
the  origin^  of  the  deep  epigastric  and  circumflex  iliac  arteries.  No  positive  testimony  could  be  obtained 
that  the  patient  had  suffered  from  one  of  his  violent  spells  of  coughing  immediately  before  the  accident,  as 
all  in  the  ward  were  asleep  excepting  the  watchman;  but  all  the  appearances  render  it  highly  probable 
that  directly  after  the  ligature  of  the  femoral  became  detached  the  violent  succussion  of  the  diaphragm 
incident  to  a  paroxysm  of  coughing  had  expelled  the  clot  from  that  vessel.  All  the  other  vessels  appeared 
completely  obliterated.  Only  the  thoracic  and  abdominal  cavities  were  examined.  The  lungs  were  large  and  free  from  pleuritic 
adhesions.  They  were  somewhat  emphysematous,  and  showed  a  large  amount  of  pigniP'.t  over  their  surface.  The  anterior 
portions  were  anaemic,  but  posteriorly  there  was  marked  congestion  of  the  lower  lobes.  The  heart  was  quite  flabby  and  moder 
ately  dilated.  There  was  no  valvular  disease  or  apparent  insufficiency,  but  microscopic  examination  showed  advanced  fatty 
degeneration  of  the  muscular  fibres.  The  liver  was  also  very  soft  and  fatty.  Kidneys  anaemic  and  pale.  Other  viscera 
healthy.  The  large  vessels  and  heart  contained  very  little  blood.  There  was  a  small  collection  of  unhealthy  purulcjnt  matter 
in  the  manubrium  of  the  sternum.  The  limb,  upon  dissection,  showed  very  great  disease  of  all  the  soft  parts  between  the 
trochanters  of  the  femur  and  the  knee  joint.  The  muscles  had  undergone  fatty  degeneration ;  their  sheaths  were  very  much 
hypertrophied  and  of  almost  cartilaginous  density.  Toward  the  bone  there  was  a  thick  layer  of  tenacious  colloid  bone  carti 
lage,  apparently  resulting  from  periosteal  disease.  Through  the  dense  and  morbid  mass  fistulous  tracks  radiated  in  every 
direction,  many  of  them  containing  small  spiculae  of  bone.  The  bone  itself  was  diseased  from  the  condyles  to  within  one  and 
a  half  inches  of  the  lesser  trochanter.  The  shaft  had  been  fractured  obliquely,  with  considerable  comminution,  and  union  had 
taken  place  by  formation  of  a  very  large  amount  of  dense  bony  structure,  which  projected  in  spurs  and  ridges  in  all  directions. 
The  original  track  of  the  ball  was  marked  by  a  deep  groove,  and  one  or  two  small  fragments  of  lead  were  found  embedded  in 
the  bone.  There  was  a  large  anfractuous  cavity,  bridged  over  in  places  by  newly  formed  bone,  which  still  contained  several 
quite  large  sequestra.  There  was  incipient  periosteal  disease  along  the  linea  aspera  up  to  the  trochanters.  A  section  of  the  bone 
showed  that  if  osteo-myelitis  had  existed  it  had  not  extended  within  several  inches  of  the  trochanters.1 

In  the  four  foregoing  fatal  secondary  amputations,  one  succumbed  to  the  shock  of 
operation  in  an  hour;  another  died  on  the  third  day  with  surgical  fever  and  erysipelas;  a 
third  in  seventeen  weeks  with  phthisis  and  lithiasis,  the  stump  nearly  healed ;  and  a  fourth 

'An  account  of  this  case  was  published  by  Dr.  THOMAS  G.  MOUTOX,  in  The  American  Journal  of  Medical  Sciences,  1866,  Vol.  LII,  p.  33  (Com 
pound  Comminuted  Fracture  of  Right  Femur,  from  Wound  by  Minie  Ball.  Amputation  at  Hip  Joint  after  Thirty-four  Months,  by  Dr.  D.  II.  AGNEW, 
Death  from  Secondary  Hxmorrhage  on  the  Twelfth  Day),  from  notes  carefully  and  admirably  drawn  up  by  Dr.  WILLIAM  PKFPEI:,  the  resident  surgeon 
at  the  Pennsylvania  Hospital,  under  whose  immediate  care  the  patient  was.  See  also  List  of  the  More  Important  Specimens  added  to  the  Pathological 
Museum  of  the  Pennsylvania  Hospital  during  the  year  1867,  by  WILLIAM  PEPPER,  M.  D.,  Curator,  in  Penn'a  Hospital  Reports,  Vol.  I,  18C8,  p.  399. 


FIG.  104.— Consoli 
dated  shot  fracture  of 
femur,  with  secondary 
lesions.  [From  a  pho 
tograph  by  WlLLAUD.] 


150  INJURIES   OF   THE    LOWER    EXTREMITIES.  [CHAP.  x. 

perished  on  the  eleventh  day,  from  giving  way  of  the  femoral  at  the  point  of  ligation.  In 
two  of  the  following  cases  the  patients  sank  from  shock  in  a  little  over  twenty-four  hours. 
In  the  third  case,  secondary  haemorrhage  was  restrained  by  ligating  the  external  iliac  on 
the  eleventh  day,  but  bleeding  recurred  fatally  on  the  twenty-third  day. 

CASE  326. — Antonio  Mutieres,  a  Mexican,  aged  30  years,  employed  by  the  depot  quartermaster  at  Fort  Union,  New 
Mexico,  was  wounded,  in  an  altercation  with  another  Mexican,  on  May  10,  1867,  by  a  conoidal  pistol  ball,  which  entered  two 
inches  below  the  anterior  superior  spiuous  process  of  the  left  ilium,  and  passed  downward  and  lodged  in  the  neck  of  the  left 
femur  at  its  junction  with  the  head.  He  was  admitted  to  the  Post  Hospital  at  Fort  Union  on  May  llth,  when  Assistant  Surgeon 
DuBois,  Post  Surgeon,  enlarged  the  wound  and  extracted  the  ball  and  wadding  with  a  pair  of  Tiemamvs  bullet  forceps.  After 
the  removal  of  the  ball  the  finger  could  be  passed  half  an  inch  or  more  into  the  substance  of  the  cervix,  in  which  the  ball  had 
been  embedded.  The  patient  suffered  but  little  pain,  but  he  gradually  lost  flesh  and  strength  from  the  surgical  fever  and  sup 
puration.  On  June  14th  he  began  to  have  severe  pain,  running  up  the  side  of  the  trunk  and  downward  to  the  knee.  Tins 
became  more  continuous  and  distressing  on  the  succeeding  day.  Surgeon  J.  C.  McKee,  U.  S.  A.,  saw  the  patient  in  consulta 
tion,  at  this  date,  and  advised  that  amputation  should  be  performed  in  preference  to  an  excision.  At  noon,  on  June  22d, 
Assistant  Surgeon  DuBois  operated,  assisted  by  Dr.  Short,  of  Los  Vegas,  and  Dr.  Simpson,  of  Moro.  A  rude  clamp  abdominal 
compressor  had  been  made  at  the  post  under  the  direction  of  Dr.  DuBois,  and  this  instrument,  applied  a  little  above  and  to 
the  left  of  the  umbilicus,  effectually  controlled  the  aorta.  A  long  anterior  and  short  posterior  flap  were  made.  The  disarticu- 
lation  was  completed  in  fifteen  seconds.  Eighteen  arteries  were  ligated.  The  soft  parts  were  much  diseased,  and  there  was  a 
large  amount  of  venous  haemorrhage.  The  anaesthetic  employed  was  a  mixture  of  equal  parts  of  chloroform  and  ether.  The 
patient  breathed  well  notwithstanding  the  compression  of  the  abdomen.  The  flaps  were  left  open,  a  cerate  cloth  being  inter 
posed.  In  the  evening  the  patient  was  free  from  pain  and  had  slept  a  little;  but  he  had  not  reacted  satisfactorily,  and  talked  and 
laughed  excitedly.  His  pulse  was  at  160  and  feeble.  It  was  fuller  and  less  frequent  immediately  after  the  operation.  Milk 
punch  had  been  given  in  small  quantities  every  fifteen  minutes.  Hypodermic  injections  of  tincture  of  opium  in  doses  of  from 
ten  to  thirty  drops,  repeated  every  twenty  minutes  or  at  longer  intervals,  were  now  administered.  This  remedy  appeared  to 
bring  the  pulse  up,  and  to  act  as  a  stimulant  and  not  as  a  narcotic — a  therapeutic  result  observed  by  Dr.  DuBois  in  other  cases 
of  shock.  The  patient  died  June  23,  1867.  At  the  autopsy,  the  acetabulum  was  found  to  be  extensively  diseased.1 

CASE  327. — Private  Michael  O'Neil,2  Co.  E,  58th  Massachusetts,  aged  19  years,  was  wounded  at  the  battle  of  Cold  Harbor, 
June  3,  1884,  by  a  conoidal  musket  ball,  which  entered  the  upper  anterior  part  of  the  right  thigh,  and  passed  backward  and 
slightly  upwai-d  through  the  limb,  comminuting  the  upper  extremity  of  the  femur.  The  fissures  extended  about  three  inches 
down  the  shaft,  and  through  the  trochanters  halfway  up  the  neck.  The  wounded  man  was  sent  in 
an  ambulance  to  the  White  House,  on  the  York  River,  and  thence  by  a  hospital  steamer  to  Alex 
andria,  where  he  was  received  at  the  Third  Division  Hospital  on  June  7th.  On  admission  his  limb 
was  much  swollen,  yet  there  was  but  little  pain,  and  this  was  not  increased  by  moving  the  limb. 
His  general  condition  was  satisfactory,  though  he  reported  that  he  was  subject  to  attacks  of  inter 
mittent  fever.  His  limb  was  arranged  in  a  straight  position,  supported  by  cushions  and  pillows ; 
evaporating  lotions  were  applied  to  the  wound,  and  a  nutritious  diet  was  ordered.  On  June  10th, 
several  fragments  of  bone  were  extracted.  On  June  12th  the  patient  had  a  chill,  and  was  ordered  to 
take  four  grains  of  sulphate  of  quinia  every  four  hours.  The  injured  limb  was  now  suspended  by 
means  of  Smith's  anterior  splint.  On  June  24th  there  was  another  chill.  The  wound  was  now  sup 
purating  freely,  and  the  limb  was  very  sensitive  when  handled.  On  June  31st  there  was  a  slight 
chill.  From  this  date  to  August  1st  there  was  little  change  in  the  symptoms.  It  was  now  decided 
that  there  was  little  hope  of  consolidation  of  the  fracture.  The  suppuration  was  profuse,  and  it  was 
believed  that  the  patient  would  inevitably  succumb  ultimately  to  the  constitutional  irritation  and  the 
drain  upon  the  system.  It  was  determined,  therefore,  that  amputation  should  be  performed,  and  the 
FIG.  10.3.— Gunshot  fracture  character  of  the  fracture  admitted  only  of  amputation  at  the  hip  joint.  On  August  10th,  the  patient 

°.f  Jke  upper  extremity  of  the  was  anaesthetised  bv  sulphuric  ether,  and  amputation  at  the  hip  joint  was  performed  by  the  lateral 
right  lemur,  spec.  jU9b.  '  '  l  r  J 

flap  method  by  Surgeon  Edwin  Bentley,  U.  S.  V.  There  was  but  little  haemorrhage,  and  the  oper 
ation  was  borne  well.  The  patient  had  an  anodyne,  and  was  freely  stimulated.  For  forty-eight  hours  after  the  operation  there 
was  some  febrile  excitement,  with  complete  anorexia.  The  fever  then  subsided  and  the  appetite  returned.  The  wound  looked 
well,  and  the  amount  of  suppuration  was  trifling.  The  case  progressed  very  favorably  until  August  20th,  when  secondary 
haemorrhage  supervened  from  ulceration  of  the  femoral  near  the  ligature.  About  six  ounces  of  blood  were  lost.  A  ligature  was 
promptly  placed  upon  the  external  iliac  just  above  Poupart's  ligament.  After  the  operation  the  patient  was  very  weak  and 
faint,  and  stimulants  were  freely  administered.  On  August  22d  there  was  an  excess  of  febrile  excitement,  but  this  abated  on 
the  following  day  and  the  appetite  again  became  moderately  good.  On  August  28th  there  was  nausea  and  vomiting,  which 
persisted  for  forty-eight  hours.  The  wound  at  this  time  had  assumed  a  very  unhealthy  appearance,  and  the  patient  had  become 
much  emaciated.  On  the  night  of  September  1st  there  was  delirium.  The  case  terminated  fatally  on  the  morning  of  September 
3d,  twenty-three  days  after  the  operation.  At  the  autopsy  the  viscera  was  found  to  be  healthy,  except  that  there  was  an  old 
cicatrix  with  cretaceous  deposit  at  the  apex  of  the  left  lung.  The  lips  of  the  wound  were  united  in  nearly  their  entire  extent. 
There  was  a  large  accumulation  of  pus  within  the  flap,  bathing  the  acetabulum  and  the  gaping  mouth  of  the  femoral  artery. 
The  wound  left  by  the  incision  above  Poupart's  ligament,  through  which  the  external  iliac  was  tied,  communicated  with  an 
abscess  between  the  iliacus  oxternus  muscle  and  the  iliac  fascia,  filled  witli  pus.  The  ligature  on  the  external  iliac  was  found  to  be 

1  See  DuBois  (II.  A.),  A  Case  of  Amputation  at  the  Hip  Joint  for  Gunshot  Wound  of  the  Head  of  the  Femur,  in  The  Medical  Record,  18C8,  Vol. 
II,  p.  266 ;   Circular  No.  7,  S.  G.  O.,  1867,  p.  40;  Circular  No.  3,  S.  G.  O.,  1871,  p.  214. 

2  The  abstract  of  this  case  was  compiled  from  a  report  by  the  operator,  Surgeon  E.  BEXTLEY,  U.  S.  V.    See  Circular  No.  7,  S.  G.  O.,  1867,  p.  39. 


SECT.  II.] 


SECONDARY    AMPUTATIONS    AT    THE    HIP    JOINT. 


151 


placed  about  half  an  inch  below  the  origin  of  the  epigastric;  the  circumflex  iliac  was  given  off  a  little  below  the  epigastric. 
There  was  a  firm  conical  plug  in  the  external  iliac,  ending  at  the  origin  of  the  epigastric.  Through  this  plug  ran  a  canal 
communicating  with  the  mouth  of  the  circumflexa  ilii;  this  canal  was  closed  by  a  clot  colored  by  included 
red  corpuscles  and  of  more  recent  formation  than  the  plugging  clot.  Ulceration  of  the  external  iliac  just 
above  the  ligature  had  commenced.  The  femoral  vein  was  collapsed  and  contracted;  the  external  iliac  vein 
was  distended  by  a  dirty  fluid,  which,  when  placed  under  the  microscope,  was  found  to  abound  in  pus 
globules.  Higher  up,  the  contents  of  the  vein  consisted  of  a  granular  detritus.  The  branches  of  the  external 
iliac  vein  was  blocked  up  by  dense  coagula.  The  deep-seated  abdominal  lymphatic  glands  were  enlarged  and 
deeply  injected.  An  examination  of  the  fractured  femur  showed  that  it  was  shattered,  with  much  loss  of  sub 
stance,  just  below  the  trochanters.  The  fissures  ran  up  with  the  capsule,  and  the  fractured  extremities  of  the 
bone  were  carious  and  had  lost  tissue  by  absorption. 

CASE  328. — Private  John  Williams,  Co.  F,  13th  Ohio  Cavalry,  aged  44  years,  was  wounded  at  Peebles' 
Farm,  near  Petersburg,  September  30,  1864,  by  a  conoidal  musket  ball,  which  passed  through  the  left  thigh 
and  contused  or  partially  fractured  the  femur.  He  was  conveyed  in  an  ambulance  to  the  field  hospital  of  the 
first  division  of  the  Ninth  Corps,  and  his  wounds  were  dressed,  and  he  was  then  sent  by  rail  to  City  Point, 
and  thence  to  the  North  in  a  hospital  transport  steamer.  On  October  7th  he  was  received  at  the  General 
Hospital  at  Beverly,  New  Jersey.  For  over  three  months  the  case  progressed  very  favorably  under  the 
simplest  treatment;  but  early  in  February  abscesses  formed  in  the  thigh,  and  when  they  were  incised  they 
discharged  copiously  an  offensive  pus.  About  the  same  time  the  patient  was  attacked  by  an  obstinate  diarrhoea. 
On  February  17,  1865,  an  exploratory  incision  was  made,  and  a  careful  examination  with  the  finger  and  the 
probe  indicated  that  the  femur  was  necrosed  as  high  as  the  trochanters.  It  was  then  considered  that  amputa 
tion  at  the  hip  joint  presented  the  only  chance  for  preserving  life.  The  operation  was  performed  by  Assistant 
Surgeon  Clinton  Wagner,  U.  S.  A.  The  patient  inhaled  chloroform;  anterior  and  posterior  semilunar  flaps 
were  made  by  transfixion;  the  femoral  artery  was  tied  as  soon  as  divided;  disarticulation  was  then  effected, 
and  the  operation  completed  by  securing  the  minor  vessels.  Very  little  blood  was  lost.  The  patient  reacted 
satisfactorily,  but  sank  and  died,  apparently  from  shock,  twenty-nine  hours  after  the  operation.  An  autopsy 
revealed  a  healthy  condition  of  the  viscera  and  no  lesion  worthy  of  special  mention.  The  femur  displayed  an 
interesting  example  of  necrosis  of  the  entire  diaphysis.  It  is  numbered  Specimen  84  in  the  collection  of  the 
Army  Medical  Museum,  and  is  represented  in  the  adjacent  wood-cut,  FlG.  106. 


FIG.  106.-Necrosis 
of  the  femur  follow 
ing  gunshot  injury. 
Spec.  84. 


TABLE  XVII. 
Summary  of  Nine  Cases  of  Secondary  Amputation  at  the  Hip  Joint. 


No. 

NAME,  AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Lemon,  G.  W.,  Pt.,  C.,  6th 

May  5, 

Conoidal  ball  fract.  left  femur, 

Oct.  12, 

Anterior  and  post'r  semilunar 

Steady  imp.     Dec.,  1865,  stump 

Maryland,  age  30. 

1864. 

junct.  upper  thirds  ;  bedsores  ; 

1865. 

flap,  by  Surgeon  E.  Bentley, 

healed.     Disch'd  Feb.  3,  1866. 

abscesses.    May,   lt-65,   pro 

U.  S.  V. 

Specs.  4386,  4167,  51)40.     Pliot. 

fuse  suppuration,  bone  firmly 

£er.  136,  137.    Circ.  6,  S.  G.  O., 

consolidated. 

1865,  p.  52.      Circ.  7,  S.  G.  O., 

1867,  pp.  42,  64. 

2 

Longmoor,  W.  W.,  Pt.,  age 

June  11. 

Conoidal  ball  shattering  shaft 

Jan.  18, 

Lacanchie'g  method  ;   circular 

Rapid  recovery.     1870,   general 

25. 

1864. 

right  femur  ;  abscesses  ;  nee. 

1866. 

cut  thro'  skin,  integ.  retracted, 

health  good.  BLACKMA\(G.C.), 

bone  rem'd  ;  protracted  irrita 

muscles  div.  circularly  down 

Amputations  at  Hip  Joint,  in 

tion  and  exhaustive  suppu 

to  bone  ;  vertical  incision  on 

Cincinnati  Jour,  of  Jled.,  1866, 

ration. 

outer  side,   by  Prof.   G.  C. 

Vol.  I,  p.  101.     Circ.  7,  1867, 

Blackman. 

pp.  43,  64. 

;j 

Bowman,  D.  H.,  Pt.,  C,  110th 

July  27, 

Conoidal  ball  com.  right  femur 

Sept.  15, 

Antero-posterior  flaps,  by  Ass't 

Did  not  rally.     Died  one  hour  af 

Pennsylvania,  age  24. 

1864. 

from  trochanters  down  several 

1864. 

Surgeon  J.C.McKee,  U.S.A. 

ter  operation.   Spec.  2288.  Circ. 

inches.     Aug.  17th,  ball  and 

6,  S.  G.  O.,  1865,  p.  50.     Circ. 

fragm'ts  bone  extracted  ;  pro 

7,  S.  G.  O.,  1867,  pp.  41.  64. 

fuse  suppuration  ;  no  union. 

4 

Davis,  H.  H.,  Sergeant,  B, 

Sept,  19, 

Conoidal  ball  fract.  upper  third 

May  5, 

Anterior  posterior  flap,  by  Dr. 

Rallied  well.     Died  May  8,  1866, 

100th  New  York,  age  26. 

1864. 

rightfemur.  Mar.,  '65,  healed 

1866. 

W.  S.  Forbes,  Civil  Hospital, 

sixty-four  hours  after  operation. 

with  great  deformity.  '66,  dis 

Philadelphia. 

Circ.  7,  S.G.O.,  1867,  pp.46,  64. 

eased  bone;  fistulous  canals. 

5 

Kelb,    F.,  Corporal,   G,  7th 

Dec.  14, 

Conoidal  ball  fract.  right  femur, 

June  7, 

Anterior  flap  by  transfix'n,  pos 

July  1st,  able  to  leave  bed  ;  after 

New  York. 

1862. 

junct.  up.  thirds.     J  une  8.  '64. 

1865. 

terior  flap  by  sect'n  from  with 

this  failed,  and  died  Oct.  4,  1865. 

fracture  consolidated.    June, 

out,  in,  by  Dr.  R.  F.  Weir,  St. 

Circ.  6,  S.  G.  O.,  1865,  p.  52. 

1865,  abscesses,  necrosis. 

Luke's  Hosp.,  N.  York  City. 

Circ.  7,  S.  G.  O.,  1867,  pp.  41.  64. 

6 

McGeehen,  J.,  Pt.,  K,  107th 

July  1, 

Conoidal  ball  badly  comminu 

April  21, 

Anterior  post'r  skin  flap,  circ. 

April  23d,  heal'g  by  first  intent'n. 

Pennsylvania,  age  48. 

1863. 

ting  right  femur.  Oct.  11,  '65, 

1866. 

division  of  muscles,  by  Dr. 

26th,  bronchial  cough  trouble 

able  to  move  on  crutches  — 

D.  H.  Agnew,  Pennsylvania 

some.     May  2d,  hcem.  from  fem 

li  mb  deformed,  bone  n  ecros'd. 

Hospital. 

oral  artery;  died.    Circ.  7,  1867, 

April,  '66,  numerous  fistulous 

pp.  44,  64. 

openings  discharging. 

7 

Mutieres,  A.,  Mexican,  team 

Mav  11, 

Revolver  ball  ent'g  left  thigh. 

June  22, 

Long  anterior,  short  posterior 

Died  June  23,  1867.    Circ.  7.  1867, 

ster  in  Quartermaster's  De 

1867. 

lodging  in  neck  of  femur;  ball 

1867. 

flap,  by  Ass't  Surgeon  H.  A. 

pp.  46,  64.     Circ.  3,  S.  G.  O., 

partment,  age  33. 

removed  —  lost  strength  daily. 

Dubois,  U.  S.  A. 

1871,  p.  214. 

8 

ONeil,  M.,  Pt.,  E,  58th  Mas 

June  3, 

Conoidal  ball  comminuting  up. 

Aug.  10. 

Lateral   flap,    by   Surgeon  E. 

Ulce,ration  of  femoral.    Aug.  20, 

sachusetts,  age  19. 

1864. 

extremity  right  femur.    June 

1864. 

Bentley,  U.  8.  V. 

hasm.,  lig.  of  ext.  iliac.     Died 

10,  fragments  extract'd.  Aug. 

Sept.  3,  1864.  Spec.  3098.  Circ. 

1st,  profuse  suppuration. 

6,  S.  G.  O.,  1865,  p.  50.     Circ. 

7,  S.  G.  O.,  1807,  pp.  39,  64. 

S> 

Williams,   J.,    Pt.,    F,   13th 

Sept.  30, 

Conoidal  ball  thro'  left  thigh, 

Feb.  17, 

Anterior  and    posterior  semi- 

Died,  twenty-nine  h'rs  after,  from 

Ohio  Cavalry,  age  44. 

1864. 

partially  fract  'g  or  contusing 

1865. 

lunar  flaps,  by  Ass't  Surgeon 

shock  of  operation.    Spec.  84. 

femur.    Feb,  '65,  exam,  found 

C.  Warner,  U.  S.  A. 

Circ.  6,  S.  G.  O  ,  1865,  p.  50. 

femur  necrosed  to  trochanters. 

Circ.  7,  S.G.O.,  1867,  pp.  41,  64. 

152 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Reamputations  at  the  Hip  Joint. — The  category  of  exarticulations  at  the  hip  for 
diseased  conditions  succeeding  previous  amputations  in  the  continuity  of  the  thigh,  per 
taining  to  the  surgery  of  the  late  civil  war,  includes  nine  examples  with  only  three  deaths.1 

CASE  329. — Private  \V.  Cotter,  Co.  E,  9th  New  Hampshire,  aged  27  years,  was  wounded  at  Petersburg,  July  30,  18C4. 
Surgeon  J.  Harris,  7th  Rhode  Island,  recorded  his  admission  to  the  field  hospital  of  the  2d  division,  Ninth  Corps,  and  noted: 
"Fracture  of  thigh,  lower  third;  amputation  of  thigh  at  middle  third."  From  the  field  hospital  the  patient  was  transferred  to 
City  Point,  and  thence  to  Washington,  August  3d.  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A.,  contributed  the  pathological 
specimen,  shown  in  the  wood-cut  (FlG.  107),  with  the  following  history  by  Acting  Assistant  Surgeon  H.  Gibbons:  "The  patient 
was  admitted  to  Douglas  Hospital  with  primary  amputation  of  right  thigh,  lower  part  of  middle  third.  The 
operator  had  made  a  long  posterior  skin  flap,  which  was  turned  up  over  the  muscles  and  bone,  and  attached  to 
the  integument  anteriorly  by  means  of  several  sutures.  When  first  seen  the  stump  was  greatly  swollen,  partly 
from  a  retention  of  pus  by  the  bag-like  flap.  A  couple  of  sutures  were  removed  and  the  pus  evacuated.  On 
August  4th,  an  incision  was  made  in  the  dependant  portion  to  admit  of  free  drainage,  and  poultices  were  ordered. 
Appetite  and  sleep  were  not  greatly  disturbed,  and  there  was  not  as  much  irritative  fever  as  in  most  similar  cases. 
Ordered  stimulants,  tonics,  and  generous  diet.  August  13th,  swelling  much  reduced  ;  constitutional  irritation  less. 
Ligature  of  femoral  artery  separated.  The  poultices  were  alternated  with  flannel  dressings  till  September  1st, 
when  wet  cloths  were  substituted.  Flaps  mostly  united;  appetite  poor;  sleep  disturbed;  stump  painful.  Ordered 
morphia  at  bed-time.  September  13th,  patient  sits  up  and  walks  about  with  some  assistance. 
Stopped  the  stimulant.  September  28th,  stump  doing  well;  swelling  gone;  dead  bone  felt 
with  the  probe  Had  an  attack  of  diarrhoea,  which  lasted  but  a  few  days.  The  irritability 
of  the  stomach  was  a  source  of  continual  complaint  for  two  or  three  months.  The  various 
stomachics  relieved  but  temporarily ;  nevertheless  there  was  marked  improvement,  especially 
during  November,  the  patient  being  about  on  his  crutches  daily.  November  29th,  divided 
the  cicatrix  (but  a  small  fistulous  opening  was  still  remaining)  and  removed  a  sequestrum 
nearly  six  inches  long.  It  was  attended  with  some  difficulty,  yet  not  as  much  as  was  expe 
rienced  in  similar  cases.  The  sequestrum  consists  of  the  entire  bone  at  the  lower  extremity, 
but  tapers  to  two  or  three  points  at  the  other;  the  circumference  is  complete  for  three  inches. 
In  its  centre,  surrounding  the  medulla,  was  found  a  beautiful  transparent  flake  of  new  bone. 
The  femur  contained,  as  in  like  cases,  a  large  amount  of  new  bone.  July  16,  1865,  the  cavity 
left  in  the  stump  has  never  entirely  closed,  but  continues  to  discharge,  and  refuses  to  heal, 
though  various  stimulating  injections  have  been  resorted  to.  It  is  over  three  inches  deep. 
The  patient  is  in  a  promising  state  of  health."  On  November  2d,  the  patient  was  transferred 
$rife125£erniir'  to  the  Harewood  Hospital.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported  that  he  was  doing 
well  on  December  31st,  but  that  there  was  still  a  "fistulous  discharge  from  the  stump."  At 

the  closing  of  the  Harewood  Hospital,  on  May  1,  1866,  the  patient  was  transferred  to  the  Washington  Post  Hospital,  where  the 
specimen  represented  in  the  adjacent  cut  (FlG.  108)  was  removed.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  who  performed 
the  operation,  reported  as  follows:  "Two  sinuses  lead  to  the  interior  of  new  bone,  which  have  failed  to  close  since  the  date 
of  the  first  operation.  On  June  6,  1866,  resection  of  four  inches  of  femur  from  the  end  of  the  stump,  after  previously  made 
incisions  into  the  soft  parts,  was  performed.  Ether  was  used,  and  the  incisions  were  united  by  silver  sutures.  June  30th, 
wound  has  healed  kindly,  two-thirds  by  first  intention,  leaving  a  sinus  on  the  under  surface  of  the  stump  still  discharging. 
September  30th,  although  mostly  healed  the  stump  is  still  indurated.  Two  sinuses,  evidently  leading  to  necrosed  fragments  of 
femur,  are  still  open  and  keep  up  an  offensive  discharge.  Small  intercellular  abscesses  form  occasionally.  Patient  in  good 
condition."  He  was  discharged  from  service  October  15,  186f>,  and  pensioned.  In  the  following  year  he  was  reported  as 
having  been  treated  for  a  time  at  the  Bellevue  Hospital,  New  York  City,  where  Drs.  H.  B.  Sands  and  F.  H.  Hamilton  are 
said  to  have  removed  several  pieces  of  necrosed  bone.  On  October  5,  1871,  the  pensioner  entered  the  Providence  Hospital 

1  Amputation  at  the  hip,  after  previous  amputation  in  the  continuity  <,f  the  thigh,  was  first  performed  by  G.  J.  (IL'TMRIE,  in  1812,  in  the  case  of 
Private  Mason,  23d  Infantry,  or  Welsh  Fusiliers,  wounded  at  Ciudad  Rodrigo.  GUTHRIE,  On  Gunshot  Wounds  of  the  Extremities,  London,  1815,  8vo, 
p.  141.  Of  the  nine  cases  pertaining  to  the  American  civil  war,  the  earliest,  May  21,  1864,  was  practised  by  Dr.  A.  B.  MOTT,  on  the  stump  of  a  prior 
amputation  for  bayonet  stab  of  the  knee.  On  September  21,  18C4,  Dr.  Guunox  BUCK  and  Dr.  F.  HASSENBUUG  disarticulated  at  the  hip  unsuccessfully, 
after  prior  amputations  for  shot  fracture.  In  1865,  Dr.  J.  H.  PACKARD  had  the  first  successful  reamputetion  at  the  hip  after  previous  amputation  in  the 
thigh  for  shot  fracture,  and  Dr.  A.  M.  FAUXTLEROY  successfully  reamputatcd,  under  similar  conditions,  on  March  llth.  In  1806,  the  successful  reampu- 
tation  at  the  hip  by  Dr.  T.  G.  MOUTOX,  and  a  like  operation,  with  fatal  result,  by  Dr.  J.  B.  WniTCOMB,  were  practised.  In  1870,  and  in  1871,  Dr.  G.  A. 
OTIS  and  Dr.  N.  S.  LINCOLN  performed  successful  reamputations  at  the  hip,  after  prior  amputations  of  the  thigh,  for  shot  fracture.  Professor  J.  FAYUER 
(Clin.  and  Path.  Obs.  in  India,  London,  1873,  pp.  84,  489),  in  1867,  unsuccessfully  reamputated  at  the  hip  after  prior  thigh  amputation  for  an  incised 
wound  of  knee.  Besides  these  eleven  reamputations  at  the  hip,  the  records  of  civil  surgery  afford  .it  least  twenty-one  examples,  viz:  five  following 
amputations  forbad  fractures  of  the  femur— J.  SYME'S,  in  1848  (The  Medical  Times,  London,  1849,  Vol.  XIX,  p.  252);  J.  Roux's,  in  1859  (Gaz.hebd.,  1860, 
pp.  292,  297),  recoveries ;  J.  F.  HEYFELT)ER's,  in  1801  (Deutsche  Klinik,  1862,  S.  275),  fatal ;  J.  FAYREK'S,  in  1864,  recovery ;  und  J.  FAYHEIl's,  in  1805, 
fatal  (Clin.  and  Path.  Obs.  in  India,  1873,  p.  489).  There  were  eight  exarticulations  following  prior  amputations  for  ostitis  or  ill-defined  lesions,  viz: 
A.  COOPER'S,  in  1824  (Lond.  Lancet,  1824,  Vol.  II,  p.  96);  BRADIIURY'S,  in  1851  (Host.  Med.  and  Surg.  Jour.,  1852,  Vol.  LXVI  p.  349);  B.  BECK'S,  in 
1854  (Deutsche  Klinik,  1856,  No.  47);  ROSER'S,  in  1857  (THIEME's  Diss.,  Leipzig,  1867,  p.  9),  successful:  and  TEXTOK'S,  in  1851  (EscuE'S  Diss.,  Wiirz- 
burg,  1863);  CHEUUS'S,  in  1853  (THIEME's  Diss.,  Leipzig,  1807,  p.  8);  HEYFELUEIl's,  in  1854  (THIEME's  Diss.,  Leipzig.  1867,  p.  8);  and  HANCOCK'S,  in  1860 
(Lond.  Lancet,  1860,  Vol.  I,  p.  319).  Eight  exarticulations  followed  prior  amputations  for  malignant  growths,  viz :  MAYO's,  in  1835  (COSTELLO's  Cyclop., 
1841,  Vol.  I,  p.  182);  BOISSEAU'S,  in  1841  (METZ's  Diss.,  Wurzburg,  1841,  p.  17);  W.  8.  COXE's,  in  1844  (Mem.  on  Amp.  at  the  Hip  Joint,  London,  1845); 
VAN  BUREN'S,  in  1850  (Contrib.  to  Pract.  Surg.,  1865,  p.  10);  GROS  CLARK'S,  in  1866  (Lond.  Lancet,  1867,  Vol.  I,  p.  11),  successful;  and  CHELIUS's,  in 
1845  (BituCH,  Die  Diagnose  der  bosartigen  Geschwulste,  Mainz,  1847,  p.  3);  VOLKMANN'S,  in  1868  (Deutsche  Klinik,  1868,  p.  338);  and  J.  LISTER'S,  in 
1872  (REYUHli.  in  LAXGENliECK's  Archiv,  B.  XVII,  p.  516),  fatal  cases. 


FIG.  108.— Resected 
extremity  of  the  right 
femur  from  a  case  of 
osteomyelitis.  Spec. 
4954.  i 


SECT.  IT.) 


REAMPUTATION    AT   THE    HIP    JOINT. 


153 


at  Washington,  with  the  stump  still  in  a  diseased  condition;  and  ten  days  afterwards  Dr.  N.  S.  Lincoln  exarticulated  the  remain 
ing  part  of  the  femur,  consisting  of  the  head,  neck,  and  trochanteric  portions,  which  was  also  contributed  to  the  Museum,  and 
is  represented  in  the  annexed  cut  (FlG.  109).  The  femoral  vessels  were  respected,  go  that  the  disarticulation  might  be  said  to 
have  resembled  an  excision  or  enucleation  rather  than  a  reamputation.  The  patient  was  able  to  be  about  in  a  short  time;  and 
on  April  22, 1872,  he  visited  the  Army  Medical  Museum, 
and  a  photograph  was  made  of  the  stump,  which  is 
copied  in  the  adjoining  wood-cut  (FlG.  110).  The  pen 
sioner  subsequently  entered  the  Na 
tional  Military  Asylum  at  Hampton, 

Elizabeth  City  County,  Va.,  where 

Examiner  C.   McDermout  certified 

the  following:   "The  right  leg  has 

been   amputated   at   the   hip  joint. 

This  was  the  third  amputation  per 
formed  on  the  limb.    Since  the  last 

operation  he  has  been  troubled  with 

abscesses  in  and  about  the  cicatiix, 

which  have   not  healed,  though   a 

year  has  almost  elapsed  since  the 

disarticulation  was  made.     It  is  my 

belief  that  the  tissues  of  the  wounded 

limb  have  been  diseased  and  never 

free  from   ulceration  since  he  was 

wounded.     His  general  health  hiss 

been  considerably  impaired  by  the 

constant  irritation  and  drain  upon 

his  svstem."     This   pensioner  died 
FIG.   109.— Exartic 
ulated  head  and  tro-    at    Queenstown,    Ireland,    January 

21,   1874,  while  on  furlough   from 
the  Asylum. 


chanters  of  i-igli  t  femur 
after  osteomyelitis. 
Spec.  5346.  "  $ 


FIG.  110. — Cicatrix  six  months  after  cox< 
tion.    [Prom  a  photograph.] 


femoral  disarticulation  and  reumputa- 


CASE  330. — Private  Julius  Fabry,  Co.  K,  4th  Artillery,  aged  38  years,  was  wounded  at  Deep  Bottom,  Virginia,  August 
16,  1864.  Surgeon  B.  Gesner,  10th  New  York,  reported  :  "Severe  shot  wound  of  left  knee  joint;  amputation  at  lower  third  of 
femur.  Sent  to  general  hospital  at  City  Point, 
Virginia,  August  17th."  He  was  admitted, 
on  August  20th.  into  Satterlee  Hospital,  Phil 
adelphia,  from  City  Point.  Surgeon  I.  I. 
Hayes,  U.  S.  V.,  reported:  "Gunshot wound 
of  left  leg  by  round  ball,  which  embedded 
itself  in  knee  joint;  also  conical  ball,  which 
was  extracted  high  up  on  outer  side  of  left 
thigh.  August  17,  1864,  circular  amputation 
of  lower  third  of  left  thigh.  Improving  slow 
ly;  simple  dressings,  tonics,  and  stimulants." 
On  an  unsigned  case  book  of  Ward  3,  of  Sat 
terlee  Hospital,  the  progress  and  treatment  of 
the  case  are  recorded  as  follows:  "Stump 
looks  well ;  patient  somewhat  weak  but  doing 
well.  August  26th,  suppurates  very  freely. 
August  28th,  conical  ball  extracted  from  outer 
side  of  thigh  two  inches  below  great  trochan- 
ter.  Patient  states  that  he  saw  one  other  ball 
extracted  from  the  wound.  September  1st, 
doing  well;  suffers  from  a  bedsore  contracted 
before  he  came  here.  States  that  he  lost  much 
blood  during  the  amputation,  which  accounts 
for  his  weak  and  anaemic  condition.  Septem 
ber  9th,  doing  well.  21st,  improving  slowly. 

FIG.  ill.— Left  femur,    November  8th,  transferred  to  Ward  A."     The 
from  a  case  of  reampu-  c  .,  ,.         i  ,, 

tation  for  osteomyelitis    progress  of  the  case  is  continued  on  another 
following  shot    injury.    case  })QO^>  also   unsigned:   "December  2d. 

Bone  ex- 


Spec.  5C14,  A.  M.  M. 


FIG.  112. — Cioatrix  twelve  months  after  coxo-femoral  disarticulation 
and  reamputation.     [From  a  photograph-l 


wound  still  discharging  copiously, 
posed  about  one-eighth  of  an  inch ;  general  health  middling,  appetite  good,  bowels  regular.  Some  difficulty  with  his  urinary 
apparatus;  detected  pus  in  nrine.  January  9,  1855,  morphia  ceases  to  have  any  effect  except  to  constipate.  Remains  much 
the  same,  better  and  worse,  alternately,  every  ten  or  twelve  days.  February  4th,  made  an  incision  on  external  side  of  stump 
some  two  inches  in  length,  just  cutting  the  fascia,  and  removed  a  small  piece  of  woolen.  The  muscles  were  not  affected  by  the 
SURG.  Ill— 20 


154 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CtTAP.  X. 


superficial  sinus."  On  May  22,  1863,  this  soldier  was  sent  to  regimental  headquarters  at  Fort  Washington,  whence  he  was 
discharged  from  service  January  1,  13 33,  on  surgeon's  certificate  of  disability,  signed  by  Surgeon  John  H.  Bayne,  U.  S.  V.  In 
October,  1885,  the  patient  received  an  artificial  limb  but  could  not  use  it  without  discomfort.  Fabiy  was  admitted  into  the 
Soldiers'  Home  January  31,  1836.  The  remnant  of  the  femur  was  affected  by  osteomyelitis,  and  Surgeon  C.  H.  Laub,  U.  S.  A., 
had  frequent  occasion  to  have  the  stump  poulticed  and  abscesses  opened.  October  27,  1838,  Assistant  Surgeon  J.  S.  Billings, 
U.  S.  A.,  made  an  exploratory  and  palliative  operation,  cutting  down  on  the  outer  aspect  of  the  thick  involucrum  a  little  below 
the  trochanter  major,  trephining  over  one  of  the  cloaca?,  and  discovering  a  sequestrum  consisting  of  the  shaft  of  the  femur. 
Fabry  was  pensioned,  and  remained  at  the  Soldiers'  Home  for  the  next  three  years,  suffering  acutely,  at  times,  from  suppuration 
in  the  stump,  and  again  enjoying  intervals  of  comparative  comfort,  The  general  health  did  not  give  way  materially  under  the 
protracted  suppuration.  The  patient  was  exempt  from  albuminuria,  and  the  viscera  generally  were  in  a  normal  condition.  The 
nervous  system  seemed  shattered,  a  result  ascribed  to  the  inordinate  doses  of  narcotics  which  the  patient  consumed.  On  May 
15,  1870,  Assistant  Surgeon  George  A.  Otis,  U.  S.  A.,  exarticulated  at  the  hip  and  removed  the  stump.  The  single  anterior  flap 
procedure  was  used,  only  the  flap  was  cut  from  without  inward,  because  the  great  masses  of  foliaceous  callus  enveloping  the 
upper  third  of  the  femur  precluded  transfixion.  The  accompanying  wood-cut  (FlG.  Ill)  will  indicate  the  extent  of  these 
osseous  formations.  Fabry  had  a  rather  rapid  convalescence,  being  about  on  crutches  in  twenty-one  days,  and  soon  afterwards 
able  to  ride  about  the  grounds  at  the  Soldiers'  Home.  A  photograph  of  the  patient,  made  at  the  Army  Medical  Museum  a  year 
after  the  operation,  is  copied  in  the  Avood-cut,  FlG  112.  On  May  15,  1878,  eight  years  after  the  operation,  Fabry  has  had  no 
trouble  with  his  stump.  He  has  never  been  willing  to  attempt  the  expedient  of  an  artificial  limb.1 

The  next  case  is  exceptional  inasmuch  as  the  amputation  and  reamputation  followed 
a  bayonet  stab  in  the  knee  instead  of  shot  injury. 

CASE  331. — Private  Lewis  Francis,  Co.  I,  14th  New  York  Militia,  aged  42  years,  was  wounded  July  21,  18G1,  at  the  first 
battle  of  Bull  Run,  by  a  bayonet  thrust,  which  opened  the  right  knee  joint.     He  received  not  less  than  fourteen  other  stabs  in 

different  parts  of  the  body,  none  of  them  implicating  the  great  cavities.  He  was 
taken  prisoner,  and  conveyed  to  Richmond  and  placed  in  hospital.  One  of  his 
wounds  involved  the  left  testis,  which  was  removed  on  July  24th.  On  October 
28,  1861,  his  right  thigh  was  amputated  at  the  middle,  on  account  of  disease  of 
the  knee  with  abscesses  in  the  thigh.  The  double-flap  method  was  employed. 
The  stump  became  inflamed  and  the  femur  protruded.  An  inch  of  the  bone  was 
resected  and  the  flaps  were  again  brought  together.  In  the  spring  of  1882  the- 
patient  was  exchanged  and  sent  to  Fort  Monroe.  Thence  he  was  transferred  to  a 
Washington  hospital,  and  thence,  in  March,  1862,  to  his  home  in  Brooklyn. 
There  was  necrosis  of  the  femur,  and  in  May,  1862,  its  extremity  was  again 
resected  by  a  civil  surgeon.  On  October  28,  1833,  Francis  was  admitted  to  the 
Ladies'  Home  Hospital,  New  York.  Necrosis  had  apparently  involved  the  remain 
ing  portion  of  the  femur.  On  May  21,  1864,  Surgeon  A.  B.  Mott,  U.  S.  V.,  laid 
open  the  flaps  and  exarticulated  the  bone.  The  patient  recovered  rapidly  and  had 
a  sound  stump.  He  was  discharged  August  12,  1864.  On  October  1,  1865,  a 
photograph,  from  which  the  accompanying  wood-cut  (FlG.  113)  was  taken,  was 
forwarded  by  Surgeon  A.  B.  Mott  to  the  Army  Medical  Museum.  Dr.  Mott 
reported  that  the  pathological  specimen  of  the  exarticulated  femur  was  stolen  from 
his  hospital.  For  some  months  after  his  discharge  Francis  enjoyed  good  health  ; 
but  then  the  cicatrix  became  unhealthy,  pus  was  discharged  through  several 
sinuses,  and  there  was  bleeding  from  the  slightest  irritation.  In  March,  1837,  a 
messenger  was  sent  to  his  residence,  54  Hamilton  Street,  Brooklyn,  and  found  him 
in  very  poor  health.  He  had  been  unable  to  leave  the  house  since  November,  1866. 
On  April  12, 1887,  he  was  visited  by  Dr.  E.  D.  Hudson,  who  reported  him  as  then 
confined  to  his  bed.  There  was  a  large  ulcer  at  the  upper  outer  angle  of  the 
cicatrix,  which  communicated  with  extensive  sinuses;  there  was  a  fistula-in-ano 
also.  The  pus  from  the  different  fistulous  orifices  was  thin,  oily,  and  ichorous. 
There  could  be  little  doubt  that  there  was  disease  of  some  portion  of  the  innomi- 
natum.  The  patient  was  much  emaciated,  and  had  a  cough  with  muco-purulent 
expectoration.  His  pulse,  however,  was  not  frequent,  and  he  had  a  good  appetite. 
In  May,  1887,  it  was  reported  that  his  general  condition  had  somewhat  improved. 
In  March,  1838,  Pension  Examiner  J.  C.  Burdick,  of  Brooklyn,  reported  that  this  pensioner  was  ''  permanently  helpless  and 
required  the  constant  aid  of  a  nurse."  On  May  30,  1874  (Decoration  Day),  and  the  day  prior,  at  a  preparatory  parade  of  the 
veterans  of  his  regiment,  he  was  particularly  active.  The  day  after  this  unusual  exercise,  May  31,  1874,  he  died  suddenly  while 
at  table.2  This  statement  from  the  Brooklyn  Union,  June  1,  1874,  is  corroborated  by  the  records  of  the  Pension  Bureau. 


FlG  113. — Cicatrix  sixteen  months  after  a  reampu 
tation  at  the  right  hip,  succeeding-  amputation  for  a 
bayonet  stab  through  the  knee. 


SECT.  II.J 


REAMPUTATION    AT    THE    HIP    JOINT. 


155 


FIG.  114.  — Shot 
perforation  of  right 
tibia.  Spec.  3709. 


CASE  332. — Private  Eben  E.  Smith,  Co.  A,  llth  Maine,  aired  19  years,  was  wounded  August  16,  18C4,  at  Deep  Bottom. 
A  musket  ball  passed  through  the  right  leg  from  within  outward,  fiacturing  the  head  of  the  tibia.  The  wounded  man  was 
conveyed  to  a  field  hospital  of  the  Tenth  Corps,  where  it  was  determined  that  an  attempt  should  be  made  to  preserve  the  limb. 
Constant  cold  applications  were  made  to  the  wounds.  After  a  few  days,  the  patient  was  sent  to  the  North 
on  a  hospital  steamer,  and,  on  August  22d,  he  was  received  at  the  hospital  at  Beverly,  New  Jersey.  On 
admission  he  suffered  but  little  pain,  though  the  knee  joint  was  considerably  swollen.  On  September  14th 
secondary  haemorrhage  occurred,  and  it  was  deemed  advisable  to  remove  the  limb.  The  amputation  was 
performed  by  Acting  Assistant  Surgeon  J.  C.  Morton,  at  the  lower  third  of  the  thigh,  by  the  circular  method, 
the  patient  being  anaesthetised  by  chloroform.  On  examining  the  seat  of  the  injury,  it  was  found  that  a  fissure 
ran  through  the  external  tuberosity  of  the  tibia  and  the  external  articular  surface,  and  that  the  bone  was 
carious  in  the  vicinity  of  the  fracture.  The  specimen  was 
forwarded  to  the  Army  Medical  Museum  by  Assistant 
Surgeon  C.  Wagner,  U.  S.  A.,  and  is  represented  in  the 
wood-cut  (FlG.  114).  The  case  progressed  favorably  until 
October  17th,  when  there  was  haemorrhage  from  the  stump 
to  the  amount  of  twelve  ounces.  The  stump  was  in  a 
sloughing  condition,  and  it  was  therefore  determined  to  tie 
the  femoral  artery  in  Scarpa's  space,  which  was  done  by 
Dr.  Morton.  The  ligature  came  away  on  November  1st. 
The  wound  remained  in  an  unhealthy  condition,  with  a  copious  fetid  suppu 
ration,  and  the  necrosed  extremity  of  the  femur  protruded  from  the  upper 
angle  of  the  wound.  On  November  5th,  the  soft  parts  were  retracted,  and 
four  inches  of  the  shaft  of  the  femur  were  resected  by  the  chain  saw.  After 
this  the  stump  became  much  swollen,  frequent  abscesses  formed,  and  it  was 
finally  decided  that  necrosis  involved  the  femur 
quite  up  to  the  trochanters.  This  conclusion  was 
verified  by  an  exploratory  incision  made  on  Janu 
ary  19,  1865,  when  it  was  determined  to  proceed  at 
once  to  amputate  at  the  coxo-femoral  articulation. 
The  operation  was  performed  by  Acting  Assistant 
Surgeon  John  H.  Packard.  The  patient  being 
already  under  the  influence  of  chloroform,  the  fem 
oral  artery  was  exposed  and  tied  just  below  Pou- 
part's  ligament.  Anterior  and  posterior  flaps  were 
then  formed  and  disarticulation  effected.  Some 
difficulty  was  experienced  in  securing  an  artery 
supposed  to  be  the  comes  nervi  ischiadici;  but  the 
quantity  of  blood  lost  in  the  operation  was  not  con 
sidered  large.  There  was  extreme  depression  after 
the  operation,  and  the  patient  was  kept  on  the  am 
putating  table  for  two  or  three  days,  lest  an  attempt 

at  removal  should  prove  fatal.  Large  quantities  of  stimulants  and  concentrated  food  were  adminis 
tered,  and  artificial  warmth  was  applied  to  the  surface  of  the  body.  Eight  days  after  the  operation 
haemorrhage  to  the  extent  of  six  ounces  occurred,  and  a  ligature  was  placed  upon  the  external  iliac 
artery  by  Dr.  J.  C.  Morton.  The  ligature  separated  on  February  17th.  On  the  19th. there  was  pro 
fuse  bleeding  from  the  point  of  ligation,  which  was  controlled  by  pressure.  Direct  compression  was 
maintained  for  fourteen  days.  After  this  the  patient  rapidly  improved,  and  by  the  end  of  March 
he  was  quite  well.  On  April  12th,  Smith  was  transferred  to  the  White  Hall  Hospital,  near  Bristol, 
Pennsylvania.  On  May  27,  18b'5,  Assistant  Surgeon  W.  H.  Forward,  U.  S.  A.,  reported  his  discharge 
from  service  with  a  sound  stump  and  robust  health.  After  his  discharge  Smith  went  to  his  home  at 
Eastbrook.  Maine,  and  was  granted  a  pension.  On  February  27,  1867,  he  wrote  to  this  office  that  his 
general  health  was  excellent,  but  that  the  cicatrix  of  his  stump  was  painful.  In  May,  1867,  he  was  admitted  to  the  eastern 
branch  of  the  U.  S.  Military  Asylum  for  disabled  volunteer  soldiers,  at  Togus  Springs,  near  Augusta,  Maine.  On  May  12th, 
the  surgeon  of  the  asylum,  Dr.  B.  B.  Breed,  wrote  that  he  "was  apparently  in  perfect  health,  and  complained  only  of  conges 
tion  of  the  stump  after  standing  for  some  time."  In  July,  1887,  Dr.  Breed  forwarded  photographic  prints  representing  the 
condition  of  the  cicatrix  two  and  a  half  years  after  the  amputation  at  the  hip,  from  one  of  which  the  adjoining  photograph  (FlG. 
115),  is  copied.  An  attempt  was  proposed  to  adapt  an  artificial  limb  to  the  stump.  The  exarticulated  portion  of  the  femur  was 
forwarded  to  the  Army  Medical  Museum  by  Assistant  Surgeon  C.  Wagner,  U.  S.  A.  It  is  represented  in  the  adjacent  wood-cut 
(FlG.  116),  and  shows  a  fragile  involucrum  and  sequestrum  about  to  separate  extending  quite  to  the  epiphysis.  Pension  Exam 
ining  Surgeon  P.  H.  Harding,  of  Ellsworth,  Maine,  reports,  in  1837,  that  the  pensioner's  health  has  become  poor,  and  that  he  is 
unable  to  do  any  manual  labor.  On  December  4,  1874,  Dr.  G.  Parcher,  of  Ellsworth,  certifies  "that,  in  consequence  of  the 
extensive  and  tender  cicatrix,  the  pensioner  cannot  sit  to  work  at  any  trade  or  to  write,  and  as  he  cannot  wear  an  artificial  limb, 
he  can  perform  no  labor  in  an  erect  position."  June  4,  1878,  this  pensioner  alleged  no  further  disability.1 

1  WAGXEU  (C.),  Report  of  interesting  Surgical  Cases,  p.  15.  MOUTON  (T.  G.),  Amp.  Hip  Joint  in  Philadelphia,  etc.,  in  Am.  Jour.  Med.  Sci.,  1866, 
Vol.  LII,  p.  32.  PACKARD  (J.  H.),  On  Amputation  at  the  Hip  Joint,  in  New  York  Jour.  Med.,  1865,  Vol.  II,  p.  161.  Circular  No.  6,  S.  G.  O.,  1865,  pp. 
49,  50.  Circular  No.  7,  S.  G.  0.,  1867,  pp.  49,  65. 


FIG.  115. — Appearance  <;f  cicatrix  two  and  a  half  years 
after  coxo-femoral  exarticulation.     [From  a  photograph.] 


FIG.  116.— The  upper  half 
of  right  femur,  disarticulated 
five  months  after  amputation 
in  lower  third.  Spec.  81. 


156 


INJURIES   OF   THE    LOWER    EXTREMITIES. 


ICHAP.  X. 


Fir,.  117.-Shot  com 
minution  of  lower  half 
of  left  femur.  Spec. 
3734,  A.  M.  M.  J 


CASE  333. — Sergeant  E.  D.  Ulmer,  Co.  G,  15th  New  Jersey,  aged  21  years,  was  wounded  at  Cedar  Creek,  October  19, 
18(54,  by  a  musket  ball,  which  entered  the  inner  face  of  the  left  thigh,  fractured  the  bone,  and  lodged  under  the  skin  on  the  outer 
side  of  the  limb.  The  femur  was  badly  comminuted,  fissures  extending  into  the  knee  joint  and  upward  for  seven  inches  (FlG. 
117).  The  ball  was  extracted  at  a  field  hospital  of  the  Sixth  Corps,  and  it  was  determined  to  attempt  to 
save  the  limb.  The  wounded  man  was  conveyed  to  Baltimore,  to  Jarvis  Hospital,  on  October  '2411).  Intense 
arthritis  supervened,  with  deep  dissecting  abscesses  in  the  thigh.  On  November  14th  haemorrhage  to  the 
extent  of  twenty-five  ounces  took  place  from  both  orifices,  which  were  in  a  sloughing  condition.  The  patient 
was  put  under  ether,  and  amputation  at  the  middle  of  the  thigh  was  performed  by  Acting  Assistant  Surgeon 
Edmund  G.  Waters.  The  patient  rallied  promptly  after  the  operation,  and  in  a  few  weeks  was  able  to  get 
about  on  crutches.  Yet  the  stump  continued  painful,  and  the  extremity  of  the  femur  was  found 
to  be  necrosed.  In  March,  1865,  it  was  found  that  a  cylindrical  sequestrum  was  loose.  This  was 
removed,  on  March  8th,  by  Acting  Assistant  Surgeon  B.  B.  Miles,  with  forceps  (FlG.  118).  On 
May  29,  1865,  he  was  discharged.  On  the  following  day  he  started  for  Philadelphia,  and, 
unfortunately,  on  the  journey  he  fell  with  violence  upon  the  stump.  After  this  there  was  increased 
suppuration,  with  deep-seated  pain  in  the  stump.  On  the  22d  of  January,  1836,  fifteen  months 
•  after  the  original  injury,  while  dressing  the  part  as  usual,  a  haemorrhage  occurred  from  one  of  the 
fistulous  openings  at  the  end  of  the  stump,  amounting,  according  to  his  statement,  to  at  least  a 
pint.  On  account  of  this  haemorrhage,  he  was  admitted  into  the  Pennsylvania  Hospital.  The 
history  of  the  case  and  the  appearances  of  the  stump  clearly  indicated  the  existence  of  osteo 
myelitis,  with  necrosis  of  the  neck,  and  probably  nlceration  of  the  head  of  the  bone.  The  risk 
of  recurrence  of  dangerous  haemorrhage,  and  the  extensive  disease  of  the  femur,  obviously 
demanded  operative  treatment.  On  February  17,  1835,  in  the  hospital  amphitheater,  the  patient 
being  etherised,  an  exploratory  operation  was  made  by  Dr.  Thomas  G.  Morton,  the  attending  surgeon,  and  amputation  was 
decided  upon  by  him  in  consultation  with  Drs.  W.  Hunt  and  D.  H.  Agnew.  The  abdominal  tourniquet,  used  the  first  time  in 
this  country  by  Professor  Joseph  Pancoast,  June,  1860,  was  applied,  and  antero-posterior  integumentary  flaps  were  dissected 
up;  the  femoral  artery  was  then  tied,  the  muscles  cut  circularly,  and  the  head  of  the  bone  was  disarticulated.  The  aorta  was  so 

completely  controlled  by  the  abdominal  tourniquet  that  no 
arterial  jet  was  observed  during  the  operation.  About  six 
teen  ligatures  were  applied.  The  flaps  were  approximated 
with  adhesive  plaster,  no  sutures  being  deemed  necessary. 
The  dressings  consisted  of  lint  soaked  in  pure  laudanum. 
The  patient  reacted  well ;  under  vigorous  stimulating  treat 
ment  and  the  local  application  of  permanganate  of  potash 
he  rapidly  recovered.  He  left  the  hospital  March  27,  1866, 
for  his  home  in  Philadelphia.  The 
exarticulated  portion  of  the  femur 
presented  a  characteristic  example  of 
necrosis  following  osteomyelitis.  A 
long  loose  sequestrum  was  found  en 
cased  in  a  new  deposit  of  porous  bone, 
and  was  not  limited  to  the  diaphysis, 
but  extended  quite  into  the  neck,  and 
then  projected  through  the  ulcerated 
capsular  ligament.  The  head  of  the 
femur  was  ulcerated.  The  acetabu- 
lum  was  healthy.  On  May  10, 1866, 
the  patient  was  able  to  get  about 
on  crutches.  On  the  20th,  he  left  for 
New  Jersey  to  fill  a  situation  as  tele 
graph  operator.  On  July  24,  1866, 
he  sent  a  letter  to  this  office  from 
Milford,  New  Jersey,  announcing 
that  his  health  was  excellent,  and  a 


FlG.  120.— Kxarticnlated 

few   weeks  subsequently  he  corrob-  necrosed  upper  portion  of 
.         .  .       femur.  [From  a  photograph 

orated   this  statement   by  transmit-  by  WILLAUD.] 

On 


FIG.  ll!i. — Cicatrix  five  months  after  reamputation  at  the  left  hip  by  Dr.  T. 
G.  MOHTO.V.     I  From  a  photograph.] 

ting  his  photograph  (FlG.  119). 

October  27,  1868,  he  was  supplied  with  an  artificial  limb  by  Clement,  of  Philadelphia.  On  June  28,  1867,  Mr.  Ulmer  wrote  to 
this  office  that  he  had  never  had  a  day's  illness  since  the  hip  joint  amputation  was  performed,  and  had  never  been  in  better  health 
than  then.  He  was  stouter  than  ever  before,  weighing  one  hundred  and  seventy-five  pounds,  or  twenty-five  more  than  his 
average  weight  when  he  had  both  lower  extremities.  His  stump  was  firm  and  solid  and  gave  him  no  pain  or  inconvenience. 
He  considered  his  artificial  limb  an  excellent  one,  but  found  it  inconvenient  at  his  work,  which  required  him  to  sit  all  day  on  a 
high  stool.  In  a  letter  addressed  to  the  Surgeon  General's  Office  from  the  publishing  house,  1630  Wellington  Street,  Philadel 
phia,  October  15,  1878,  Mr.  Ulmer  reported  his  health  as  most  excellent,  his  weight  at  173  pounds,  or  25  pounds  more  than 
before  exarticulation.  He  had  an  artificial  limb  from  Clement,  but  had  to  abandon  it.1 

'MORTON  (T.  G.),  loc.  cit.,  Vol.  LII,  p.  26.    UDELL  (J.  A.),  On  Secondary  Traumatic  Lesion  of  Bone,  etc.,  in  U.  S.  San.  Com.  Memoirs,  1870, 
Surg.  Vol.  I,  p.  440.     Circular  No.  7,  S.  G.  O.,  18G7,  pp.  51,  05. 


SECT.  II.] 


REAMPUTATIONS   AT   THE    HIP   JOINT. 


157 


CASE  334. — Private  E.  A.  Viclc,  Co.  E,  43d  North  Carolina,  aged  37  years,  received  a  shot  wound  of  the  knee  joint,  at 
Cedar  Creek,  October  19, 1864,  and  underwent  primary  amputation  at  the  lower  third  of  the  right  thigh.  On  December  19th,  he 
was  sent  to  the  hospital  at  Staunton.  On  January  1,  1835,  the  stump  had  almost  cicatrized,  but  there  were  apertures  through 
which  pus  issued.  On  February  15,  1865,  an  exploration  with  a  silver  probe  revealed  bone  denuded  of  periosteum  and  roughened. 
Another  aperture  lyd  to  a  somewhat  superficial  fistulous  track  of  six  or  eight  inches.  It  was  determined  to  open  the  face  of  the 
stump,  with  a  view  to  the  removal  of  the  diseased  bone.  The  operation  was  performed  on  March  11,  1865,  by  the  surgeon  in 
charge  of  the  hospital.  Dr.  A.  M.  Fauntleroy,  assisted  by  Drs.  T.  W.  Glocker 
and  R.  K.  Carter.  Chloroform  was  administered.  A  transverse  incision 
was  then  made  over  the  face  of  the  stump.  At  the  exposed  extremity  of  the 
femur  was  a  redundant  mass  of  new  bone,  which  was  sawn  off.  It  was  then 
found  that  the  carious  shaft  of  the  bone  was  encircled  by  a  soft  porous  osseous 
deposit.  About  six  inches  of  this  formation  was  stript  off  by  the  gouge,  yet 

the  limits  of  morbid  action  had  not  been  reached.     An  incision 

on  the  outer  side  of  the  thigh,  between  the  vastus  externus  and 

biceps,  was  extended  upward  to  a  point  between  the  great  tro- 

chanter  and  the  anterior  iliac  spine,  and  revealed  the  fact  that 

the  entire  femur  was  diseased.  It  was  now  decided  to  disartic 
ulate  at  the  hip  joint.  The  femoral  artery  was  compressed  upon 

the  pubic  bone  and  anterior  and  posterior  flaps  were  formed,  the 

arteries  being  secured  as  they  were  cut.     The  loss  of  blood  was 

trifling.     The  flaps  were  brought  together  by  silver  sutures,  and 

the  stump  was  dressed  with  dry  lint.     As  soon  as  consciousness 

was  restored  the  patient  was  freely  stimulated,  and  warmth  was 

applied  to  the  surface  of  the  body;  the  patient  rallied  in  a  few 

hours.  At  bed-time  the  pulse  beat  120.  On  the  following  morn 
ing  the  patient  was  doing  well.  Pulse  still  the  same  in  quick 
ness  and  frequency.  On  March  13th,  his  condition  was  satisfac- 

tory;  his  appetite  was  remarkably  good ;  he  ate  soft-boiled  eggs 

and  drank  largely  of  rich  milk.    Suppuration  having  commenced, 

cold  water  was  directed  to  be  constantly  applied  to  the  stump  to 

lessen  the  secretion  of  pus.     He  was  ordered  twenty  drops  of 

the  tincture  of  the  sesquichloride  of  iron  thrice  daily,  and  ten 

grains  of  Dover's  powder  at  bed  time.     Suppuration  amounted 

to  half  a  pint  during  the  day.     On  March  '20,  1865,  he  was  still 

doing  well.     Suppuration  was  diminished  in  quantity  and  was 

laudable. 
•JLEUOY.J  .  .  . 

support  the  flaps  and  maintain  them  in  apposition.     Ihe  patient  s 

bowels  had  been  regular  since  the  operation.  His  tongue  had  at  no  time  been  furred.  The  stump  was  doing  well.  The 
discharge  had  abated  to  three  or  four  ounces.  March  28th,  the  progress  of  the  patient  was  highly  favorable.  March  29th,  the 
patient's  condition  was  comfortable  and  favorable;  his  appetite  continued  good.  The  stump  along  the  lower  surface  seemed  to 
have  united  firmly;  on  the  side,  granulations  were  healthy;  the  pus  discharged  was  laudable.  On  April  24th  the  face  of  the 
stump  had  entirely  healed.  There  was  still  a  granulating  sore  at  the  outer  angle.  On  July  18,  1865,  the  patient  started  for 
his  home,  near  Tarborough,  in  Edgecomb,  North  Carolina.  He  was  in  excellent  health,  and  walked  about  on  crutches  with 
facility.  A  year  subsequently  he  was  in  Lyuchburg,  Virginia.  Since  that  date  no  intelligence  has  been-  received  from  him, 
and  it  is  not  known  whether  he  still  survives.1  Dr.  A.  M.  Fauntleroy,  the  operator,  courteously  transmitted  to  the  Surgeon 
General's  Office  a  photograph  of  the  diseased  exarticulated  femur,  which  is  copied  in  the  wood-cut  (FiG.  121),  and  the  photograph 
of  the  patient  and  of  his  stump  sixteen  months  after  the  operation,  July,  1866,  which  is  represented  in  the  wood-cut,  FiG.  122.  • 
CASE  335. — Henry  Campbell,  aged  23  years,  received,  in  March,  1863,  at  New  Orleans,  a  pistol  shot  in  the  left  knee. 
Primary  amputation  at  the  junction  of  the  middle  and  lower  thirds  of  the  thigh  was  performed  by  Acting  Assistant  Surgeon 
Avery.  Osteomyelitis  supervened  and  resulted  in  necrosis.  After  a  few  months  the  patient  was  removed  to  his  home  in  Con 
necticut.  In  October,  1864,  eighteen  months  subsequent  to  the  injury,  he  was  visited  by  Dr.  Bauer,  of  New  York,  who  laid 
open  the  cicatrix,  crowded  with  fistulous  openings,  and  removed  a  cylindrical  sequestrum  five  inches  in  length.  For  a  few 
months  after  the  removal  of  this  sequestrum  the  health  of  the  patient  improved,  and  hope  was  entertained  of  his  recovery  without 
further  operative  interference;  but  persistent  pain  and  constitutional  disturbance  then  recurred  with  augmented  intensity.  The 
lower  part  of  the  stump  was  riddled  with  sinuses  and  the  tissues  were  much  indurated.  The  probe  detected  dead  bone,  or 
morbid  bone  formation,  in  every  direction.  In  October,  1856,  the  medical  attendants  resolved  that  an  operation  should  be 
performed  for  the  radical  removal  of  the  diseased  bone.  It  was  hoped  that  it  would  be  only  necessary  to  remove  a  portion  of 
the  shaft  of  the  femur.  On  October  22d,  the  patient  was  placed  under  the  influence  of  chloroform,  and  Dr.  James  B.  Whitcomb, 
assisted  by  Dr.  Charles  Bliss,  of  Willimantic,  and  others,  proceeded  with  the  operation.  An  exploratory  incision  was  made 
on  the  outside  of  the  thigh,  extending  quite  up  to  the  trochanter.  On  exposing  the  new  osseous  formation  at  the  end  of  the 
stump  it  was  found  to  be  more  than  twice  the  normal  diameter  of  the  shaft  of  the  femur,  rough,  porous,  and  fragile.  The 
immensely  thickened  periosteum  was  studded  with  plates  and  spines  of  new  bone,  and  in  many  cases  there  were  foliaceous 
masses  of  callus  unconnected  with  the  shaft.  Toward  the  upper  extremity  of  the  femur  the  periosteum  appeared  less  diseased, 

1  FAUNTI.KKOY  (A.  M.),  Hip  Joint  Amputations,  in  Richmond  Medical  Journal,  18C6,  Vol.  I,  p.  7.  EVE  (P.  F.),  Contribution  to  the  Hip  Joint 
operations  performed,  etc.,  in  Trans.  Am.  Med.  Ass'n,  1867,  Vol.  XVIII,  p.  254.  Circular  No.  7,  S.  G.  O.,  1867,  pp.  50,  65.  LON1XG  (A.),  loc.  tit.,  p.  10a 
CASK  368. 


FIG.  122. — Cicatrix  sixteen  months  after  reamputatiou 
futures  were  removed,  and  adhesive  strips  used  to  at  the  right  hip.    [From  a  photograph.) 


158  INJURIES    OF    THE    LOWER    EXTREMITIES.  ICHAP.  x. 

but  the  bone  was  found  to  be  softened  and  disorganized  quite  up  to  the  great  trochanter.  It  was  therefore  decided  to  amputate 
at  the  hip  joint.  Ether  was  administered.  Pressure  with  the  thumb  on  the  femoral  artery  served  to  control  the  haemorrhage. 
A  large  antero-internal  flap  was  formed  and  disarticulation  effected.  There  was  very  little  loss  of  blood,  but  the  patient  was 
greatly  prostrated  by  the  shock  of  the  operation,  which,  from  the  beginning  of  the  exploration  to  the  completion  of  the  ampu 
tation,  lasted  fifty  minutes.  The  free  administration  of  ammonia  and  brandy  brought  about  reaction;  but  it  was  temporary,  and 
the  case  terminated  fatally,  five  hours  after  the  operation,  October  22,  I860.1 

CASE  336. — Private  Lewis  Larry,  Co.  A,  1st  New  Orleans  Regiment,  aged  23  years,  was  shot  through  the  left  knee  by 
a  sentry,  July  18,  1864,  while  attempting  to  avoid  arrest.  He  was  carried  to  the  University  Hospital.  It  was  found  that  the 
condyles  of  the  femur  were  badly  comminuted.  Synovial  fluid  was  dribbling  from  the  wound,  with  little 
haemorrhage.  Amputation  at  mid-thigh  was  promptly  performed,  under  chloroform,  by  double  flaps.  The 
patient  did  well  for  about  three  weeks,  when  he  was  attacked  with  persistent  diarrhoea.  Erysipelas  now 
attacked  the  stump.  Sloughing  phagedaena  of  the  flaps  ensued,  and  purulent  sinuses  extended  upward 
along  the  femur,  the  necrosed  extremity  of  which  protruded  from  the  stump.  Amputation  at  the  hip  joint 
was  performed  by  Acting  Assistant  Surgeon  F.  Hassenburg,  on  September  21,  1864.  The  patient  was 
under  the  influence  of  chloroform.  The  artery  was  controlled  at  the  groin,  an  anterior  flap  was  formed  by 
transfixion,  the  capsule  divided  and  disarticulation  effected,  and  a  posterior  flap  cut  from  within  outward. 
The  haemorrhage  was  inconsiderable,  and  the  patient  promptly  rallied  from  the  shock  of  the  operation. 
For  a  few  days  his  appetite  and  general  health  improved;  then  the  wound  assumed  an  unhealthy  aspect, 
and  finally  sloughed.  Symptoms  of  pyaemic  infection  set  in,  and  death  ensued  on  September  30,  1864. 
On  dissecting  the  removed  portion  of  the  thigh  it  was  found  riddled  with  abscesses.  The  periosteum  was 
enormously  thickened  and  contained  flaky  ossific  deposits.  The  shaft  of  the  femur  was  necrosed  up  to  the 
trochanters,  the  dead  bone  being  included  in  a  redundant  friable  involucrum.  The  preparation  was 
forwarded  to  the  Army  Medical  Museum  by  Surgeon  Samuel  Kneeland,  U.  S.  V.2 
FIG.  123.— Diseased  CASE  337. — Charles  H.  Hawkins,  a  second  lieutenant  in  Co.  C,  4th  New  York  Cavalry,  aged  23 

ifcase  of^oxo-'femoral  years>  was  wounded  in  a  reconnoissance  near  Strasburg,  Virginia,  on  the  night  of  June  1,  1882.  A  conoidal 
disarticulation.  Spec,  ball,  from  a  Colt's  cavalry  pistol,  entered  the  posterior  surface  of  the  right  thigh,  and,  passing  downward 
and  forward,  fractured  the  femur  at  the  lower  part  of  the  middle  third,  and  lodged  under  the  skin  about 
five  inches  above  the  knee.  The  wounded  man  layout  all  night  in  the  rain,  and  in  the  sun  next  day  until  three  in  the  afternoon, 
when  he  was  brought  into  camp  and  had  tho  ball  removed  by  his  regimental  surgeon.  He  was  then  conveyed  in  an  ambulance 
to  a  hospital  in  Strasburg,  where  his  limb  was  dressed  with  a  straight  splint,  moderate  extension  and  counter-extension  being 
maintained.  After  ten  days  he  was  carried  on  a  stretcher  to  a  private  house,  where  he  remained  seventeen  days.  Two  frag 
ments  of  bone  were  extracted  during  this  period.  He  was  next  transferred  to  a  tent  hospital,  five  miles  distant,  near  Middletown, 
and  after  a  sojourn  of  nine  days  was  again  transferred  to  a  hospital  at  Winchester.  The  splints  were  removed  and  the  limb  was 
bandaged.  On  July  19th  he  was  conveyed  to  Baltimore,  and  admitted  to  the  Camden  Street  Hospital  on  July  20th.  His  con 
dition  was  very  unpromising;  there  was  much  irritative  fever,  a  copious  suppuration,  and  partial  union  of  the  fracture,  with 
three  inches  shortening  and  much  angular  deformity.  No  ap^iratus  was  applied;  but  the  limb  was  maintained  in  an  easy 
position  by  pillows,  and  attention  was  mainly  directed  to  improving  the  condition  by  wholesome  diet.  Two  months  subse 
quently  the  patient  had  gained  ground,  and  an  operation  to  remove  the  diseased  bone  and  to  break  up  the  faulty  union  of  the 
fragments  was  determined  on.  On  October  1st,  the  posterior  orifice  was  enlarged,  a  number  of  denuded  fragments  of  bone  were 
removed  by  forceps,  and  the  deformed  callus  was  chiseled  and  gouged  away.  Temporary  improvement  ensued.  The  limb  was 
put  in  a  proper  position  and  the  wound  was  daily-syringed  out  by  iodine  injections.  After  a  time,  however,  it  became  manifest 
that  the  broken  extremities  of  the  femur  were  still  diseased.  On  April  5,  1863,  the  patient  was  transferred  to  the  Ladies'  Home 
Hospital,  New  York  City,  where  he  was  received  on  April  8th,  greatly  reduced  in  strength.  The  wounds  discharged  profusely, 
and  he  complained  of  much  pain.  On  April  29th,  Surgeon  A.  B.  Mott,  U.  S.  V.,  amputated  the  limb  at  mid-thigh.  Evidence 
that  the  femur  was  diseased  above  the  point  at  which  it  was  sawn  soon  became  apparent,  and,  after  a  protracted  effort  to  induce 
healthy  action,  the  flaps  were  freely  laid  open  and  the  femur  was  resected,  four  inches  of  the  shaft  being  removed.  After  this  the 
patient  was  put  upon  a  full  diet,  with  an  allowance  of  brandy  and  of  porter  daily.  The  stump  still  failed  to  assume  a  healthy 
action,  but  became  much  enlarged,  undergoing  apparently  a  fatty  degeneration.  On  April  4,  1864,  Lieutenant  Hawkins  was 
mustered  out  of  the  military  service,  and  was  transferred  to  St.  Luke's  civil  hospital,  and  came  under  the  care  of  Dr.  Gurdon 
Buck.  The  patient  was  anaemic,  his  appetite  capricious;  he  was  compelled  to  keep  his  bed  continually  on  account  of  the  pain 
he  suffered  when  the  stump  was  in  a  dependent  position.  For  over  five  months  every  means  were  used  to  bring  the  patient  up 
to  a  condition  in  which  an  operation  for  the  removal  of  the  diseased  femur  stump  might  be  safely  undertaken.  On  September 
21st,  he  was  placed  under  the  influence  of  sulphuric  ether,  and  Dr.  Buck  proceeded  to  disarticulate.  It  was  found  necessary  to 
bisect  the  stump,  uncovering  the  neck  of  the  bone  on  the  inner  as  well  as  the  outer  aspect,  by  an  incision  which  commenced 
above  the  great  trochauter  and  ran  around  the  extremity  of  the  bone  to  near  the  tuberosity  of  the  ischium.  During  the  opera 
tion  the  administration  of  ether  was  suspended  on  account  of  the  extreme  feebleness  of  the  circulation,  and  brandy  was  ft-eely 
given,  and  warm  applications  were  made  to  the  trunk.  The  loss  of  blood  was  not  great,  but  every  possible  means  had  to  be 
called  into  requisition  to  bring  about  a  partial  reaction  after  the  operation,  so  great  was  the  prostration  and  so  feeble  the 
recuperative  powers.  After  twenty-four  hours  of  great  apparent  suffering,  the  patient  died  in  a  syncope,  September  22,  1864. 
The  portion  of  the  femur  removed  consisted  of  the  head,  neck,  and  trochanters,  with  four  inches  of  the  shaft.  The  head  and 
neck  were  much  softened  and  the  shaft  was  atrophied  and  fatty.3 

1  Circular  No.  7,  S.  G.  O.,  1867,  pp.  52,  65. 

2  Circular  No.  6,  S.  G.  O.,  1866,  p.  50.     Circular  No.  7,  S.  G.  O.,  1867,  pp.  48,  65. 

3\VATEKS  (E.  G.),  Shot  Fractures  of  the  thigh,  in  Am.  JUed.  Times,  1863,  Vol.  VI,  p.  185.     HAMILTON  (F.  H.),  Amp.  in  Shot  Fractures  of  the 
femur,  in  Am.  Aled.  Timtt,  1864,  Vol.  VIII,  p.  1.     Circular  No.  (i,  S.  G.  O.,  1865,  p.  50.     Circular  No.  7,  S.  G.  O.,  1867,  pp.  47,  65. 


SECT.  II.] 


EEAMPUTATIONS   AT   THE    HIP   JOINT. 

TABLE  XVIII. 
Summary  of  Nine  Cases  of  Reamputation  at  the  Hip  Joint. 


159 


NO. 

NAME,  AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATUUE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Cotter,  W.,  Pt.,  E,  9th  New 
Hampshire,  age  27. 

July  30, 
1864. 

Musket  ball  fract.  lower  third 
right  femur;  prim.  amp.  thigh, 
mid.  third.  Nov.  29,  '64,  seq. 

Oct.  15, 
1871. 

Reamp.  thro'  extend'g  incision 
of  later  operation  upward  suf 
ficiently  to  allow  ready  exar- 

April,  1872,  w'd  cicatriz'd  firmly. 
1873,  abscesses  unhealed  ;  con 
stant  irritation.  Died  Jan.  21,  '74. 

rem.;  osteomyelitis.  June,'66, 

ticulation  of  head,  neck,  and 

Specs.  252,  4954,  5946.     Photos. 

exc.  four  inches  end  of  stump. 

trochanteric  portion  of  femur, 

61,  ISO,  324.     OTJS  (G.  A.),  in 

Subsequent  operation   rem'd 

by  Dr.  N.  S.  Lincoln,  Wash 

Boston  lied,  and  Surg.  Jour., 

dead  bone. 

ington,  D.  C. 

Feb.  7.  '78.  Vol.  XCVIII.  p.  166, 

and  Circular  3,  S.  G.  O.,  Wash 

ington,  1871,  p.  283. 

o 

Fabry,  J.,  Pt.,  Battery  K,  4th 

Aug.  16, 

Shrapnel  shot  wound  left  knee 

Mav  15, 

Long  semi-lunar  flap;  incision 

Reaction  prompt.  Mayl6th,w'nd 

Artillery,  age  38. 

1864. 

joint  ;  prim.  amp.  lower  third 

1870. 

from  point  on   tuberosity  of 

united  nearly  f  full  extent  by 

thigh.     Aug.  28,  ball  and  pc. 

ischium  to  point  midway  be 

first  intention.     June  5th,  about 

of  fuse  ext.;  necro.;  abscesses 

tween  ant.  sup.  spin,  process 

on  crutches.  July  13th,  complete 

opened.     1866,  discharge  pro 

of  ilium  and  troch.  major,  by 

ly  cicatrized.    Specs.  5684,  5685, 

fuse  ;  exfol.  fistulous  open'gs. 

Ass't  Surg.  G.A.  Otis,  U.S.A. 

5687,  5(599,  5702.     Photos.  274, 

Oct.  i!7th,  dead  bone  removed. 

275,  276. 

1867  to  1870,  abscesses  cont'd 

to  form  and  dead  bone  to  exfo. 

3 

Francis,  L.,  Pt.,  1,  14th  New- 

Jul\-21, 

Bayonet  thrust  opening  right 

Mav  21, 

Antero-posterior  flap  reampu- 

Rapid  recovery;    stump   sound. 

York  State  Militia,  age  42. 

1861. 

knee  joint  (14  other  bayonet 

1864. 

tation  at  hip  joint,  bv  Surg. 

1867,  confined  to  bed  ;  copiously 

stabs);   gangrene;   extensive 

A.  B.  Mott,  U.  S.  V.'  (Bone 

discharging  ulcer,  fistula  in  ano. 

abscess  on  thigh.     Oct.  28th, 

found    extensively    diseased 

1870.  about  on  crutches,  stump 

amp.  mid.  third  thigh.  Nov.  -, 

close  up  to  head.) 

apparentlv  healed.     Died,  May 

femur  protruded;    exsected. 

30,  1874,  suddenly. 

May,  1862,  necrosed  end  of 

femur  exsected. 

4 

Smith,  E.   E.,   Pt.,   A,  llth 

Aug.  Ifi, 

Musket  ball  fract.  head  of  right 

Jan.  19, 

Anterior    and    posterior    flap 

Extreme  depression.  Jan.  27,  '65, 

Maine,  age  19. 

1864. 

tibia.    Sept.  14th,  haem.;  amp. 

1865. 

amputation  at  hip   joint,  by 

ha?m.;  lig.  external  iliac  artery. 

low.  third  thigh.     Sept.  17th, 

A.  A.  Surg.  J.  H.  Packard. 

Feb.  19th,  hsem.;  compression. 

haem.;  lig.  fern.  Nov.  5th,  ne 

(Femur  found  necrosed  up  to 

Disch'd  May  27,    1865,   sound 

crosis  ;  four  ins.  end  of  femur 

trochanters.) 

stump.  Specs.  81,  3709.  Photos. 

resected  ;  frequent  abscesses. 

29,  174,  203. 

5 

Ulmer,    E.    D.,    Serg't,   G, 

Oct.  19, 

Conoidal  ball  com'nuted  fract. 

Feb.  17, 

Anterior    and     posterior    flap 

Rapid  recovery.     Left   hospital 

15th  New  Jersey,  age  21. 

1864. 

left  femur,  fissures  extending 

1866. 

amputation  at  hip  joint,  by 

March  27,  1866.    1877,  continues 

into  kneej  t  and  upw'd  seven 

Dr.  T.  G.  Morton,  Penn.  Hos 

in  good  health  ;  stump  in  healthy 

inches;  ball  ext.     Nov.  14th, 

pital.    (Bone  diseased  as  high 

condition.    Specs.  107,  3734. 

haem.;  amp.  mid.  third.  Mar., 

as  neck.) 

'65,  seq.  removed.    Jan.,  '66, 

haem.  from  endofstump;  osteo 

myelitis. 

6 

Vick,  R.  A.,  Pt.,  E,  43d  N. 

Oct.  19, 

Shot  wound  right  knee  joint; 

Mar.  11, 

Anterior    and     posterior    flap 

April  24,   1865,   stump  entirely 

Carolina,  age  37. 

1864. 

prim.  amp.  lower  third  thigh. 

1865. 

amputation,  by  Surg.  A.  M. 

healed.     Last  heard  from  July, 

Jan.  ]  ,  '65,  almost  cicatrized. 

Fauntlerov,  C.  S.  A.  .assisted 

1866,  in  excellent  health. 

Feb.  15th.  increased  disch'rge 

by  Drs.  T.  W.  Glocker  and 

of  pus.    Exploration  revealed 

R.  K.  Carter. 

entire  femur  diseased. 

7 

Campbell,  H.,  Sutler's  Cl'k, 

Mar.  —  , 

Pistol  shot  in  left  knee:  prim. 

Oct.  22, 

Large  anterior  internal  flap,  by 

Died  October  22,  1866,  five  hours 

age  23. 

1863. 

amp.  junct.  low.  thirds  thigh  ; 

1866. 

Dr.  J.  B.  Whitcomb.     (New 

after  operation. 

osteomyelitis  ;  necrosis.   Oct., 

osseous  formation  at  end   of 

1864,   seq.   removed;    stump 

stump  was  twice  the  diameter 

riddled  with  sinuses. 

of  shaft  of  femur  :  bone  soft 

and  diseased  up  to  troch.) 

8 

Hawkins,  C.  H.,  Lieut.,  C, 

June  1, 

Conoidal  pistol  ball  fract.  mid. 

Sept.  21, 

Tissues  of  stump  indurated  and 

Only  partial  reaction.  Died  Sep 

4th    New    York    Cavalry, 

]862. 

third  right  femur;  ballextr'd. 

1864. 

inelastic;  stump  bisected  by 

tember  22,  1864,  in  a  syncope. 

age  23. 

July  20th,  bone  partially  uni 

an  incision  commencing  above 

after  twenty-four  hours  of  great 

ted.     Oct.  1st,  fragments  and 

great  troch.,  running  around 

apparent  suffering. 

calloused  bone  removed.  Apr. 

end  of  bone  to  near  tuberosity 

29,  '63,  amp.  mid.  third  ;  exc. 

of   ischium  :  antero-posterior 

four  inches  of  femur. 

flap,  by  Dr.  G.  Buck. 

9 

Larry,  I,.,  Pt.,  A,  1st  New 

July  17, 

Shot  wound  left  knee  comminu 

Sept.  21, 

Anterior  flap  formed  by  trans 

Rallied  promptly;  wound  became 

Orleans,  age  23. 

1864. 

ting  condyles  of  femur;  prim. 

1864. 

fixion,  posterior  flap  cut  from 

unhealthy  and  sloughed.    Died 

• 

amp.  mid.  third  thigh  ;  erysip. 

within  outward,    by   A.   A. 

Sept.  30,  1864  ;  pyaemia.    The 

attack'd  stump,flapsslough'd, 

Surg.  F.  Hassenburg. 

shaft  of  femur  was  necrosed  up 

necrosed  end  bone  protruded. 

to  trochanters.    Spec.  3738. 

These  nine  cases  of  reamputation  at  the  hip  comprise  only  three  deaths,  giving  the  low 
mortality  rate  of  33.3  per  cent.  In  three  instances  the  exarticulation  had  been  preceded 
by  amputation  in  the  lower  third  of  the  thigh,  and,  in  six  cases,  the  disarticulation  was 
subsequent  to  amputation  in  the  middle  third  of  the  thigh.  In  two  of  the  cases  the  prior 
amputation  was  done  on  account  of  shot  fracture  of  the  shaft  of  the  femur,  in  six  for  shot 
fractures  involving  the  knee  joint,  and,  in  one,  for  a  bayonet  stab  of  the  knee.  In  six 
instances  extraction  of  sequestra  or  resection  of  the  necrosed  extremity  of  the  femur  had 
been  practised  in  the  interval  between  the  amputation  in  the  continuity  and  the  disarticula 
tion.  In  the  three  fatal  cases  the  prior  amputation  had  been  primary  in  two  instances; 
secondary  in  the  third  case.  One  patient  survived  the  shock  of  the  operation  only  a  few 
hours;  another  died  in  a  syncope  after  twenty-four  hours  of  great  apparent  suffering,  and 


160  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

the  third  succumbed  to  pyaemia  eight  days  after  the  exarticulation.  Of  the  six  patients 
who  survived  the  operation,  three,  J.  Fabry  (CASE  330),  E.  E.  Smith  (CASE  332),  and  E. 
D.  Ulmer  (CASE  333),  were  living  in  August.  1879.  Of  the  Confederate  soldier,  Vick 
(CASE  334),  no  information  has  been  received  since  1866,  and  it  is  not  known  whether  he 
still  lives.  Two  survivors  of  the  operation  have  since  died:  Cotter  (CASE  329),  in  1874, 
two  years  and  three  months  after  the  operation;  Francis  (CASE  331),  in  1874,  over  ten 
years  after  the  exarticulation. 

The  nine  cases  cited  in  TABLE  XVIII,  and  the  operations  performed  by  G.  J.  Guthrie,1 
in  1812,  and  by  T.  G.  Morton,8  in  1878,  are,  it  seems,  the  only  recorded  examples  of 
reamputations  at  the  hip  in  military  surgery.  From  the  records  of  the  surgery  of  civil 
life  twenty-five  cases  may  be  collected,  making  a  total  of  thirty-six3  exarticulations  at  the 
hip  after  previous  amputations  in  the  thigh,  with  fourteen  deaths,  a  mortality  of  38.8  per 
cent.  Of  the  eleven  cases  in  military  surgery,  four,  or  36.3  per  cent.,  proved  fatal,  while, 
of  the  twenty-five  operations  in  civil  practice,  ten,  or  40.0  per  cent.,  had  a  fatal  termination. 

Summing  up  the  sixty-six  cases  of  amputation  at  the  hip  detailed  in  the  preceding 
pages,  it  will  be  seen  that  twenty-five  were  primary,  twenty-three  intermediary,  nine 
secondary,  and  nine  were  reamputations.  In  each  of  the  twenty-five  primary  cases  the 
amputation  was  performed  within  twenty  hours  of  the  infliction  of  the  injury,  the  average 
interval  between -the  reception  of  the  wound  and  the  operation  being  about  four  hours. 
Sixteen  died  within  twelve  hours,  one  survived  thirty-six  hours,  two  about  forty-eight  hours, 
and  one  lingered  eight  days;  in  two  instances  the  period  between  the  operation  and  death 
could  not  be  ascertained;  the  average  period  of  death  being  about  twenty  hours.  Of  the 
three  survivors  after  primary  amputation  at  the  hip,  one  was  in  comfortable  health  over 
fifteen  years  after  the  operation;  the  other  two  patients  were  heard  from  two  and  six 
months,  respectively,  after  the  date  of  the  operation,  but  the  hope  expressed  in  Circular  No. 
7,  at  page  23,  that  the  subsequent  histories  of  these  men  might  be  traced  has  not  been 
attained;  and  there  might  be  some  question  regarding  the  justness  of  citing  these  cases  as 
well  authenticated  instances  of  recovery.  In  TABLE  XIV,  on  page  127,  ante,  these  cases 
have  been  classed  among  the  recoveries,  thus  arriving  at  a  fatality  of  88.0  per  cent. 
Should  they  be  excluded,  the  fatality  of  the  primary  amputations  at  the  hip  during  the 
war  of  the  rebellion  would  be  95.6  per  cent.  The  femoral  vessels  were  torn  in  six  of  the 
primary  amputations,  to  wit:  Compton's  case  (273)  of  Robinson;  Carnochan's  case  (280) 
of  Gordon;  Lay's  case  (284)  of  a  private  of  the  3d  Missouri,  in  which  the  femoral  artery 
was  ligated  prior  to  amputation;  Brock's  case  (286)  of  Waters,  in  which  the  opposite  leg 
was  also  amputated  at  the  point  of  election;  Davis's  case  (287) of  Wayland,  and  Lanning's 
case  (289)  of  Brookins. 

The  twenty-three  intermediary  exarticulations  at  the  hip  had  fatal  results.  The  inter 
val  between  the  reception  of  the  injury  and  the  date  of  the  operation  varied  from  twenty- 
four  hours  to  thirty  days,  the  mean  length  being  a  little  over  nine  days.  Only  two  survived 

1  See  CASE  12  in  Note  1  on  page  128, 'ante.  *  See  CASE  184  in  Note  on  page  130. 

3In  note  1  on  page  152,  ante,  reference  was  made  to  32  instances  of  exarticulation  at  the  hip  after  previous  amputation  in  the  continuity  of  the 
thigh.  The  prior  operations  had  been  performed  in  9  instances  for  shot  injury,  in  2  for  punctured  and  incised  wounds,  in  5  for  bad  fractures  of  the  femur, 
in  8  for  ostitis  or  ill  denned  lesions,  and  in  8  for  malignant  growths.  Particulars  of  4  additional  instances  have  since  been  ascertained,  viz :  three  exartic 
ulations  at  the  hip  after  amputations  in  the  thigh  for  ill  defined  lesions:  E.  S.  O'GRADY,  in  1874  (Dublin  Journal  of  Med.  Sciences,  1876,  Vol.  LXI,  p. 
78);  T.  G.  MORTOX,  in  1877  (Cincinnati  Lancet  and  Clinic,  1879,  Vol.  II,  N.  S.,  p.  9,  and  letter  of  Dr.  T.  G.  MORTON  to  the  editor,  dated  February  19, 
1879);  D.  BECK,  in  1878  (Archiv  fur  Klin.  Chir.,  Berlin,  1879,  B.  XXITI,  p.  654);  and  a  reamputation  at  the  hip  by  T.  G.  MORTON,  in  1878  :  Boasso 
Dominico  (notDominico  Ludovess,  as  indicated  in  CASE  184  in  note  on  p.  130,  ante),  aged  24;  wounded  in  the  right  thigh,  by  a  cannon  ball,  at  Sedan,  ip 
1870;  amputation  in  middle  third;  reamputation  at  hip,  December  14,  1878.  Recovery  (Cincinnati  Lancet  and  Clinic.  1879,  Vol.  II,  N.  S.,  p.  9,  and  Dr. 
T.  G.  MOKTON'8  letters  to  the  editor,  dated  February  19,  March  18,  and  May  28,  1879).  Of  the  36  reamputations  at  the  hip,  14  had  a  fatal  termination, 
•  a  mortality  of  38.8  per  cent. 


SECT,  n.1  AMPUTATIONS   AT   THE   HIP   JOINT.  161 

the  amputation  eight  days;  nine  died  within  the  first  twenty-four  hours,  four  on  the  second 
day,  one  on  the  third,  three  on  the  fourth,  two  on  the  sixth,  and  in  two,  the  date  of  death 
could  not  be  ascertained;  the  average  duration  of  life  after  the  operation  in  the  inter 
mediary  series  was  only  about  thirty-five  hours.  In  four  instances  gangrene,  and,  in  two, 
pyaBmia,  supervened.  In  one  case  (Surgeon  P.  Pineo'g  case  of  Private  P.  Johnson,  CASE 
306,  p.  141,  ante)  it  is  stated  that  the  femoral  artery  was  divided  by  the  missile,  and  in 
one  (Surgeon  E.  Bentley's  case  of  L.  Carroll,  CASE  298,  p.  139,  ante)  the  amputation  had 
been  preceded  by  a  primary  partial  excision  in  the  shaft  of  the  femur. 

Of  the  nine  secondary  amputations  at  the  hip,  two  resulted  successfully.  George  W. 
Lemon  (CASE  320,  p.  145,  ante)  enjoyed  good  health  in  1879,  nearly  fifteen  years  after  the 
operation.  In  the  case  of  the  Confederate  soldier  W.  W.  Longmoor  (CASE  321,  p.  146, 
ante),  the  following  additional  information  was  received  shortly  after  the  case  had  been 
sent  to  press: 

CASE  321,  p.  146  (continued) :  Mr.  Longmoor,  who,  at  the  present  writing,  is  clerk  of  the  court  at  Cynthiana,  Kentucky, 
writes,  under  date  of  April  2,  1879 :  "  I  have  had  two  abscesses  form  in  my  stump,  *  *  the  first  one  was  very  severe  indeed, 
and  kept  me  confined  to  my  bed  for  several  weeks,  and  discharged  copiously  for  about  one  week  of  that  time.  The  next  and 
last  abscess  was  not  near  so  severe,  and  did  not  confine  me  to  my  bed  for  more  than  about  two  weeks.  The  discharge  was  not 
near  so  great,  and  the  pain  accompanying  the  formation  not  near  so  severe.  I  have  a  constant  pain  in  my  stump ;  an  uneasy, 
restless  sort  of  a  pain  that  never  ceases  but  is  always  with  me — at  times  much  worse  than  others,  and  often  taking  the  form  of 
neuralgia,  especially  before  or  during  damp  or  falling  weather.  I  suffer  a  great  deal  from  neuralgia — acute,  very  acute,  lasting 
generally  four  or  five  days;  sometimes  compelling  me  to  leave  my  office,  at  which  times  I  usually  resort  to  heavy  doses  of  quinine. 
I  use  morphine  every  day.  I  take  about  one-fourth  of  a  grain  three  times  a  day — have  been  doing  this  ever  since  I  was  wounded. 
During  these  times  my  stump  becomes  very  sore,  and  hurts  me  when  I  walk.  I  have  never  been  able  to  wear  an  artificial  limb, 
in  fact  have  never  tried,  knowing  its  utter  impossibility,  for  I  could  not  bear  the  weight  of  the  limb  much  less  the  pressure  on 
the  stump." 

Of  the  seven  fatal  cases  after  secondary  amputation  at  the  hip,  one  patient  died  from 
phthisis  and  lithiasis,  one  from  secondary  haemorrhage  and  phlebitis,  one  from  the  giving 
away  of  the  femoral  artery  at  the  point  of  ligation,  one  from  surgical  fever  and  erysipe- 
latous  inflammation  of  the  stump,  and  three  from  the  shock  of  the  operation.  The  shortest 
interval  between  the  operation  and  the  date  of  death  was  one  hour,  the  longest  one  hun 
dred  and  nineteen  days,  the  average  duration  of  life  being  a  little  above  twenty-two  days. 
The  average  interval  between  the  date  of  injury  and  the  date  of  operation  was  about  four 
hundred  and  twenty-nine  days,  the  shortest  interval  being  forty-three  days,  the  longest  two 
years,  nine  months  and  twenty-one  days. 

The  sixty-six  exarticulations  at  the  hip  were  practised  in  forty-five  instances  with 
seven  recoveries  on  Union  soldiers,  in  twenty  instances  with  four  recoveries  on  Confederate 
soldiers,  and,  in  a  fatal  instance,  on  a  citizen  employs'.  In  twenty-nine  instances  with  six 
recoveries,  the  right  limb  was  removed;  in  twenty-eight  with  five  recoveries,  the  left;  and, 
in  nine,  the  side  was  not  stated.  Chloroform  was  the  anaesthetic  administered  in  thirty- 
eight  of  the  sixty-six  cases,  ether  in  ten,  chloroform  and  ether  in  three.  In  one  instance 
(Dr.  B.  D.  Lay's  CASE  284,  p.  135,  ante),  stimulants  and  morphia  only  were  given,  and 
in  fourteen  instances  this  point  is  not  mentioned.  Considering  the  ages  of  the  patients  we 
find  that  three  operations,  performed  on  patients  under  twenty,  were  fatal;  that  of  thirteen 
operations  performed  on  patients  between  the  ages  of  twenty  and  twenty-four  inclusive, 
three  were  successful ;  of  ten  between  the  ages  of  twenty-five  and  twenty-nine  inclusive, 
two  had  a  successful  issue;  of  seven  between  the  ages  of  thirty  and  forty,  four  recovered; 
and  of  four  above  forty,  two  had  a  successful  termination.  In  twenty-nine  instances  the 
age  of  the  patient  was  not  recorded. 

Fragments  or  splinters  of  bone  were  removed  prior  to  the  exarticulation  at  the  hip 

SURG.   Ill— 21 


162  INJURIES    OF    THE    LOWER   EXTREMITIES.  [CHAP.  x. 

joint  in  the  cases  of  W.  W.  Longmoor  (CASE  321,  p.  146,  ante)  and  of  M.  O'Neil  (CASE 
327,  p.  150,  ante).  The  ball  and  detached  fragments  of  bone  were  extracted  in  Bowman's 
case  (CASE  322,  p.  147,  ante),  and  the  ball,  with  some  wadding,  in  the  case  of  Antonio 
Mutieres  (CASE  326,  p.  150,  ante). 

Of  the  different  modes  of  amputating  at  the  hip  joint,  the  operation  by  the  antero- 
posterior  flap  method  was  most  commonly  selected.  It  was  used  in  twenty-nine  of  the 
sixty-six  cases  of  exarticulation  at  the  hip  described  in  the  preceding  pages,  and  in  five  of 
the  eleven  cases  of  recovery,  viz:  in  Dr.  E.  Bentley's  case  of  Lemon  (p.  145,  ante);  in 
Dr.  A.  B.  Mott's  case  of  Francis  (p.  154,  ante);  in  Dr.  J.  H.  Packard's  case  of  E.  E.  Smith 
(p.  155,  ante);  in  Dr.  T.  Gr.  Morton's  case  of  Ulmer  (p.  156,  ante);  and  in  Dr.  A.  M. 
Fauntleroy's  case  of  VicJc  (p.  157,  ante).  The  single  flap  method  was  successfully  employed 
in  three  instances:  by  Dr.  Shippen  in  the  primary  case  of  Kelly  (p.  131,  ante),  by  Dr.  J. 
T.  'Gilmore  in  the  case  of  Williamson  (p.  132,  ante),  and  by  Dr.  G.  A.  Otis  in  the  case  of 
Fabry  (p.  153,  ante),  and  unsuccessfully  in  twelve  cases.  Drs.  William  M.  Compton  and 
Gr.  C.  Blackman  adapted,  with  success,  the  circular  method  in  the  cases  of  Robinson  (CASE 
273,  p.  132,  ante)  and  Longmoor  (CASE  321,  p.  146,  ante).  Larrey's  method  of  amputa 
ting  at  the  hip  by  two  lateral  flaps  was  preferred  in  eight  instances;  the  oval  was  employed 
only  once,  in  Dr.  J.  M.  Carnochan's  case  of  Gordon  (CASE  280,  p.  134,  ante).  In  Dr.  N. 
8.  Lincoln's  successful  operation  at  the  hip,  in  the  case  of  Cotter  (CASE  329,  p.  152,  ante), 
the  disarticulation  resembled  an  excision  or  enucleation  rather  than  a  reamputation.  The 
mode  of  operation  is  not  indicated  in  ten  instances. 

Prothetic  apparatus,  that  might  in  some  measure  compensate  the  survivors  after  hip 
joint  amputation  for  the  loss  of  the  limb,  and  relieve  them  of  the  necessity  of  continually 
using  crutches,  have  been  devised  by  Charriere,  Foullioy,1  and  others.  In  1867,  Dr.  E.  D. 
Hudson  devised  a  lined  and  padded  gutta-percha  bonnet  conforming  to  the  entire  ilio-lumbar 
parts,  and  some  eight  inches  in  length,  firmly  strapped  to  the  pelvis  by  a  broad  chamois- 
lined  canvas  band.  To  this  artificial  stump  an  ordinary  apparatus  for  thigh  stumps  could 
be  fitted.  This  simple  apparatus,  which  is  fully  described  by  Dr.  E.  D.  Hudson  in  his  pam 
phlet:  Mechanical  Surgery,  New  York,  1878,  p.  29,  was  tried  by  Kelly  and  Lemon;  but, 
although  great  hopes  were  entertained  that  it  would  answer  the  purpose  for  which  ii  was 
designed,  it  seems  that  this,  as  well  as  similar  appliances,  have  now  been  discarded  as  use 
less,  even  by  those  survivors  who,  at  the  first,  were  favorably  impressed  with  their  utility. 
Mr.  Ulmer,  who  wrote  to  this  Office  in  June,  1867,  that  he  considered  his  "artificial  limb 
an  excellent  one,"  in  a  letter  dated  October  15,  1878,  states  that  after  several  attempts  to 
wear  the  artificial  limb  he  had  to  abandon  it,  "as  it  gave  intense  pain;  the  weight  of  the 
body  pressing  the  top  of  the  limb  too  severely  against  the  pelvic  bone.  Another  objection 
is  the  absence  of  motive  power  in  the  stump  to  propel  the  limb.  As  this  has  to  be  given 
by  a  swinging  motion  of  the  body,  the  effort  is  too  fatiguing."  James  E.  Kelly,  under 
date  of  July  30,  1870,  writes:  "The  leg  I  got  from  Dr.  Hudson  is  of  no  benefit  to  mo 
whatever,  nor  ever  will  be.  I  tried  it  sufficiently  to  know  that  I  cannot  wear  it."  Lemon 
advises  this  Office  on  July  31,  1870,  that:  "The  artificial  limb  is  not  now  nor  ever  has 
been  of  the  least  service  to  me."  Longmoor  has  never  tried  an  artificial  limb  as  he  "knew 
it  would  be  useless."  Fabry  never  attempted  to  wear  one,  and  there  is  no  record  that 

1  See  GAUJOT  (G.)  et  SriLLMAXN  (E.),  Arsenal  de  la  Chirurgie  contemporaine,  Paris,  1872,  T.  II,  p.  15!J,  M.  DEUOUT  (Appareils  destines  aux 
ampules  qui  ont  subi  la  disarticulation  de  la  cuisse,  in  Bulletin  General  de  Thfrapeutique  Med.  et  Chir.,  Paris,  1862,  T.  62,  p.  283)  relates  that  Cauzeret, 
a  soldier  of  the  Light  Infantry,  on  whom  BAUDEXS  successfully  performed  intermediary  amputation  at  the  hip,  in  Africa,  in  1836  (CASE  38,  Note  1,  p. 
128,  ante),  wore  the  apparatus  of  Foullioy  for  11  years,  from  March,  1837,  to  October,  1848. 


SECT.  II.] 


AMPUTATIONS    AT    THE    HIP    JOINT. 


163 


FIG.  125.— Anteriorview 


Cotter,  Williamson,  Robinson,  Vick,  or  Francis  essayed  a  trial.  In  the  case  of  E.  E.  Smith 
the  cicatrix  remained  too  tender  to  allow  the  wearing  of  an  artificial  limb. 

While  the  preceding  pages  were  in  press,  a  report  of  an  unsuccessful  primary  ampu 
tation1  at  the  hip  by  Assistant  Surgeon  Edward  B.  Moseley,  U.  S.  A.,  was  received  from 
Fort  Robinson,  Nebraska.  This,  with  three  additional  cases  given  in  the  foot-note,2 
increases  the  total  number  of  exarticulations  at  the  hip  to  two  hundred  and  fifty-four, 

1  "Private  Bernard  Kelley,  Co.  E,  3d  Cavalry,  aged  39,  while  in  the  field  in  pursuit  of  Cheyenne  Indians,  on  January  11,  1879,  was  struck  by  a 
carbine  ball  (said  to  have  been  an  accidental  shot  from  one  of  his  own  company),  which  entered  at  a  point  just  over  the  centre  of  the  sacrum,  half  an 
inch  to  the  left  of  the  median  line,  passed  downward  and  outward  through  the  gluteal  muscles,  and  struck  the  left  femur  just  between  the  two  trochan- 
ters,  fractured  it,  and  escaped  from  the  front  of  the  thigh  about  two  inches  above  its  middle,  and  an  inch  to  the  outside  of  the  median  line.     He  was 
brought  to  the  post  hospital  at  Fort  Kobinson  the  same  day,  and  was  found  to  be  suffering  from  a  high  degree  of  shock ;  he  was  pale,  cold,  and  weak 

from  haemorrhage,  which  had  occurred  at  intervals  since  the  receipt  of  the  wound.  He  was  given 
one  grain  of  morphia,  and  hot  water  was  placed  to  his  feet,  and  small  quantities  of  beef  essence  given 
at  frequent  intervals.  During  the  night  he  reacted  a  little  from  shock,  but  complained  greatly  of 
pain  in  the  wound  and  of  weakness.  The  thigh  was  supported  in  a  comfortable  position  by  pillows, 
and  wet  compresses  were  kept  over  the  wounds.  About  one  p.  m.,  a  brisk  haemorrhage  commenced 
from  the  posterior  wound,  which,  on  examination,  was  found  to  be  of  such  a  serious  nature  as  to 
require  immediate  interference  to  save  the  man's  life.  He  was  immediately  placed  under  the 
influence  of  chloroform,  and  the  posterior  wound  was  freely  enlarged,  with  the  idea  that  the  haemor 
rhage  came  from  the  sciatic  artery.  This  was  found  not  to  be  the  case,  however,  the  blood  flowing 
from  the  deeper  portion  of  the  wound,  and  probably  originating  from  the  branches  of  the  profunda 
femoris.  This  opening  allowing  of  a  free  introduction  of  the  finger,  the  wound  was  thoroughly 
explored,  and  the  femur  was  found  to  be  hopelessly  comminuted.  The  bleeding  still  continuing,  it 
was  decided  to  amputate  the  limb  at  the  hip  joint,  which  was  done  at  once  by  Assistant  Surgeon  E. 
B.  Moseley,  U.  S.  A.,  assisted  by  Acting  Assistant  Surgeon  C.  V.  Petteys.  The  femoral  artery 
was  compressed  against  the  brim  of  the  pelvis  by  Dr.  Petteys,  and  the  limb  was  removed  by  trans 
fixion  from  without,  joining  the  incision  made  previously  to  explore  for  the  seat  of  haemorrhage  to 
that  forming  the  anterior  flap,  which  was  rather  long,  and  forming  the  posterior  flap  from  the  muscles 
on  the  back  of  the  thigh.  About  four  ounces  of  blood  were  lost,  as  well  as*could  be  judged,  mostly 
from  a  general  oozing  from  the  surface  of  the  flaps.  The  neck  of  the  bone  was  seized  by  forceps 
and  the  head  was  removed  from  the  acetabulum  with  some  difficulty,  owing  to  the  short  leverage 
obtained.  The  vessels  were  tied  with  silk  ligatures  and  the  flaps  brought  together  with  silver  wire. 

minution  of  upper  por-    ^ne  Patient  was  then  covered  with  blankets  and  bottles  of  warm  water  placed  about  him,  and,  as 
tion  of  left  femur.  Spec,    soon  as  possible  after  he  reacted  from  the  chloroform,  he  was  given  teaspoonful  doses  of  brandy  and 

'"•  water.     He  had  taken  the  anaesthetic  well  and  seemed  to  come  out  of  it  in  good  condition,  recognized  those  about  him,  asked  i  f 

his  leg  was  off,  and  complained  of  pain,  etc.;  his  pulse  gradually  improved  in  strength  and  decreased  in  rapidity.  While  in  this  improving  condition, 
and  before  he  could  be  stopped  by  the  attendants,  he  suddenly  raised  his  head  and  shoulders  quite  high  and  looked  down  at  where  his  leg  had  been,  then 
instantly  fell  back ;  the  eyes  rolled  up,  respiration  became  irregular,  and  he  was  dead  inside  of  three  minutes.  Death  occurred  about  two  hours  after  the 
completion  of  the  operation."  The  specimen  of  the  fractured  femur  was  forwarded  to  the  Army  Medical  Museum,  with  the  foregoing  report,  by  the  operator, 
Assistant  Surgeon  E.  B.  Moseley,  and  is  numbered  6914  of  the  Surgical  Section.  Two  views  of  the  specimen  are  shown  in  the  wood-cuts  (FIGS.  124,  125). 

2  To  the  examples  of  amputations  at  the  hip  joint  for  shot  injury  cited  in  Note  1  on  page  128,  ante,  should  be  added  the  following:  185.  A  primary 
operation  performed  by  Assistant  Surgeon  J.  M.  STEIXER,  U.  S.  A.    Private  Hall,  Co.  K,  14th  U.  S.  Infantry,  was  struck,  at  the  battle  of  Chapultepec, 
September  12,  1847,  by  a  round  shot,  just  below  the  trochanter  major  of  the  left  thigh.     The  femur  was  fractured  and  the  soft  parts  lacerated  for  some 
inches.     The  patient  survived  only  until  evening.     The  case  is  reported  by  the  operator,  Dr.  J.  M.  STEIXER,  in  the  Medical  Examiner  and  Record  of 
Medical  Science,  Philadelphia,  1849,  N.  S.,  Vol.  V,  p.  15. — 186.  Another  primary  operation  to  be  added  to  the  examples  of  exarticulation  at  the  hip,  in 
Note  1,  p.  128,  ante,  is  cited  by  M.  CHEXU  from  a  report  of  Dr.  DE  POTOR  (Stat.  Mid.-Chir.  de  la  Camp,  d'ltalie,  en  1859  et  I860,  Paris,  1869,  T.  II,  p. 
693).     On  June  25th,  1859,  an  Austrian,  wounded  at  Solferino  the  night  before,  was  brought  to  the  Cavalry  Hospital.     The  neck  of  the  femur  and  the 
cotyloid  cavity  were  comminuted.     Coxo-femoral  exarticulation  was  performed  by  Dr.  EHRMAXX.     The  patient  survived  only  two  hours. — 187.  A  third 
primary  operation  to  be  added  was  performed  by  Dr.  W.  A.  EAST,  of  San  Antonio,  Texas.    A  negro,  aged  25,  received,  in  the  latter  part  of  1864,  in 
Lavaca  County,  Texas,  a  shot  wound  at  the  outer  and  upper  margin  of  the  trochanter  major.     The  head  of  the  femur  was  comminuted.    About  ten 
hours  after  the  injury  Dr.  EAST  exarticulated  at  the  hip  by  LARUEY'S  method.     He  recovered,  and  was  last  heard  from  in  the  winter  of  1865-66,  through 
Dr.  DOUGLASS  (W.  A.  EAST,  Gunshot  Wound — Fracture  of  the  Head  of  the  Os  Femoris — Amputation  at  the  Hip  Joint — Recovery,  in  Southern  Jour, 
of  Medical  Science,  18(56,  Vol.  I,  p.  232).   It  will  be  noticed  that  I  have  omitted  from  the  list  of  examples  of  amputations  at  the  hip  joint  for  shot  injury 
in  Note  1,  p.  128,  ante,  several  cases  heretofore  referred  to  by  writers  on  this  subject  as  authenticated  instances  of  this  exarticulation.     I  believe,  with 
Dr.  A.  LtJ'NIN'G  (Ueber  die  Blutung  bei  der  Exarticulation  des  Oberschenkels  und  deren  Vermeidung,  Zurich,  1877,  p.  56),  that  the  three  cases  ascribed 
to  A.  BLAXDIX,  of  which  two  are  reported  to  have  been  successful,  and  the  successful  case  of  PERUET.  are  apochryphal.    Mr.  PH.  F.  BLAXDIX,  who 
cites  the  successful  cases  of  amputation  at  the  hip  in  his  article  Amputation,  in  Diet,  de  Mf.d.  et  de  Chir.  Prat.,  Paris,  1829,  T.  II,  p.  280,  does  not  men 
tion  these  cases,  and  they  are,  as  far  as  I  have  been  able  to  ascertain,  first  mentioned  by  VELPEAU  (Nouv.  £lem.  de  Medecine  Op'ratoire,  Paris,  1832,  T. 
I,  p.  514);  but  the  latter  author,  who,  in  the  second  edition  of  his  Nouv.  JZlem.  de  Med.  Opi'rat.,  Paris,  1839,  T.  II,  p.  539,  attempts  to  cite  the  authorities 
for  his  statements,  omits  to  state  the  sources  from  which  the  BLAXDIX  and  PERRET  cases  are  derived.     MALGA1GXE,  in  the  discussions  of  the  National 
Academy  of  Medicine  at  Paris,  on  August  8,  1848  (Bull,  de  VAcad.  Nat.  de  Med.,  Paris,  1847-48,  T.  XIII,  p.  1278),  refers  to  "a  very  remarkable  thesis" 
on  amputations  by  "ALEXAXDRE  BLAXDIX,  aide-major  "  to  LARREY.    In  his  Rfjlexions  sur  plusieurs  points  de  Chirurgie,  read  to  the  first  class  of  the 
Imperial  Institute  on  March  6,  1815,  and  an  extract  of  which  is  published  in  Jour,  de  Med.  de  Chir.  et  de  Pltar.  Mil.,  Paris,  1815,  T.  I,  p.  132,  LARREY 
states  that  "  Mr.  MlLLEXGEX,  Surgeon  in  Chief  of  the  British  Armies  in  Spain,  assured  him  that  he  had  made,  with  success,  according  to  his  method  [of 
M.  LARREY],  two  amputations"  at  the  hip.    I  have  omitted  these  cases,  as  it  is  probable  that  Mr.  J.  G.  V.  MlLLIXGEX,  who  was  Chief  Surgeon  of  the 
British  Armies  in  Spain  and  Portugal,  in  1811  and  1812,  had  reference  to  the  cases  of  BROWXR1GG.     It  would,  to  say  the  least,  appear  strange  that  British 
writers  on  military  surgery,  who  cite  BROWXRlGG's  and  GUTHRIE's  cases  of  amputation  at  the  hip,  should  have  failed  to  record  the  cases  ascribed  to 
MILLIXGEX,  who,  as  late  as  1830,  was  chief  surgeon  of  the  British  Armies.    M.  VELPEAU  (Noun.  £lem.  de  Med.  Operat.,  Paris,  1839,  T.  II,  p.  540) 
refers  to  a  successful  exarticulation  at  the  hip  by  AVEDE.MEYER,  and  LEGOUEST  in  his  paper  De  la  disarticulation  coxo-fimorale  au  point  de  vue  de  la 
chir.  oVarmle,  in  Rec.  de  Mim.  de,  Mid.  de  Chir.  et  de  Phar.  Mil.,  Paris,  1855,  2°"'  ser.,  T.  XV,  p.  224,  and  Trait&  de  Chirurgie  d'Armce,  Paris,  1863,  pp. 
669,  670,  ascribes  two  fatal  cases  of  amputation  at  the  hip  to  the  same  operator.     VELPEAU  gives  as  his  authority  the  Bulletin  de  Ferussac,  T.  II,  p.  1G5  ; 
LKGOUEST,  the  same  Bulletin,  T.  Ill,  p.  161.     In  the  second  volume  of  the  Bulletin  des  Sciences  M&licales,  Paris,  1824,  "public  sous  la  direction  dt.  M. 
It  Baron  de  FKRUSSAC,"  on  p.  161,  Obs.  Ill,  reference  has  been  made  to  a  case  of  amputation  at  the  hip  cited  from  an  nrtirlo  by  Dr.  Wl'DKMr.YEU.  Amputa- 


' 


164  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  x. 

with  twenty-eight  recoveries,  two  hundred  and  twenty-five  deaths,  and  one  instance  in 
which  the  result  was  not  ascertained,  giving  the  slightly  modified  mortality  rate  of  88.9 
per  cent.,  instead  of  89.1,  as  indicated  on  page  130,  ante.  Of  these  two  hundred  and 
fifty -four  cases  there  were  eighty-two  primary,1  with  seventy-five  deaths,  or  91 .4  per  cent, 
fatality;  fifty-five  intermediary,  with  fifty-two  deaths  (94.5  per  cent.);  forty  secondary,  with 
thirty-three  deaths  (82.5  per  cent.);  eleven  reamputations,  with  four  deaths  (36.3  per  cent.); 
and  sixty-six  cases  with  sixty-one  deaths,  and  one  unknown  result  (93.8  per  cent.)  in  which 
the  time  of  the  operation  was  not  ascertained.  According  to  these  statistics  it  would  seem 
that  intermediary  operations  offer  the  least  chance  of  recovery,  that  the  results  of  primary 
operations  are  more  favorable;  that  secondary  exarticulations  give  one  recovery  in  twelve 
cases,  and  that  of  the  instances  of  reamputation  one  in  about  three  proves  successful ;  and 
I  can,  therefore,  only  reiterate  what  I  have  already  stated  on  page  78  of  Circular  No.  7, 
that  the  statistics  "tend  to  show  that  unless  the  nature  of  the  injury  is  such  that  the  ope 
ration  can  be  delayed  until  the  secondary  period,  it  is  better  that  it  should  be  done  at  once,"2 
although  it  would  appear  that  the  dire  results  of  amputations"  at  the  hip,3  performed  for 
shot  injury  during  the  Schleswig-Holstein  War  of  1864,  the  Austro-Prussian  War  of  1866, 
and  the  Franco-Prussian  War  of  1870-71,  have  had  a  tendency  to  raise  doubts  regarding 
the  expediency  of  especially  the  primary  exarticulation  at  the  hip.4 

tion  nahe  am  Hiiftgelenke,  wegen  Osteosteatoma,  etc.,  in  Mag.  fur  die  gesammte  Heilkunde,  B.  XIII,  Berlin,  1823.  The  article  will  be  found  at  page  45  of 
the  Magazin,  and  it  is  there  stated  that  the  amputation  was  performed  in  May,  1821,  the  width  of  a  hand  below  the  hip  joint  ("eine  Handbreit  unter  dem 
Huftgelenke").  The  patient,  a  soldier  named  Kloppner,  recovered.  I  have  vainly  searched  Baron  FEKUSSAC's  Bulletin  for  the  fatal  cases  cited  by  M. 
LEGOUEST.  The  case  of  fatal  secondary  exarticulation  at  the  hip  by  Dr.  JOHN  WEIGHT,  of  Illinois,  in  the  case  of  Private  J.  W.  Spradling,  Co.  A,  33d 
Illinois,  detailed  by  the  operator  in  The  Cincinnati  Lancet  and  Observer,  Vol.  XI,  No.  5,  p.  257,  May,  1808,  and  reported  also  in  Circular  No.  2,  War 
Department,  S.  G.  O.,  Washington,  1869,  p.  109,  and  mentioned  by  LOxiNG,  loc.  cit.,  p.  108,  No.  397,  I  have  omitted  from  the  secondary  coxo-femoral 
amputations  for  shot  injury.  The  records  of  this  Office  show  that  the  original  shell  wound  in  the  right  side,  received  at  Black  River,  May  17,  1863, 
healed,  leaving  a  large  cicatrix ;  that  a  bedsore  formed  on  the  left  hip,  and  that  the  left  femur  became  diseased  and  was  exarticulated  on  February  20, 
1867.  It  is  apparent  that  the  original  wound  had  only  a  remote  connection  with  the  disease  for  which  the  operation  was  performed.  Dr.  WRIGHT  after 
wards  reported  to  the  Pension  Office  that  "soon  after  the  amputation  Spradling  was  taken  with  diarrhoea  and  that  dropsy  followed,  which  continued  off 
and  on  until  the  date  of  his  death,  September  28,  1872." 

1  LARREY's  successful  instance  of  amputation  at  the  hip  in  the  case  of  the  lieutenant  of  dragoons  wounded  at  Borodino,  September  7,  1812,  has 
been  cited  by  M.  LEGOUEST  (De.  la  dfsarticulation  coxo-femorale,  in  Rec.  de  Mem.  de  Med.  de  Chir.  et  de  Phar.  Mil.,  1855,  2ms  s6r.,  T.  XV,  p.  234,  and 
Traite  de  Chir.  d'Armee,  Paris,  1863,  p.  699)  as  an  instance  of  successful  intermediary  exarticulation  at  the  hip.  This  was  undoubtedly  a  primary 
operation,  and  I  have  classed  it  as  such.  M.  LARREY  (Mem.  de  Chir.  Mil.  et  Camp.,  Paris,  1817,  T.  IV,  p.  51)  details  the  case  and  remarks  of  the  oper 
ation  :  " Que  j'entrepris,  quoique  sur  le  champ  de  bataille,  avec  d'autant  plus  de  confiance  qu'il  la  demandait  instamment." 

2 Professor  B.  v.  LAXGEXBECK,  in  his  article:  Ueber  die  Schussverletzungen  des  Huftgelenlts,  in  Archiv  fur  Klinische  Chirurgie,  Berlin,  1874,  B. 
XVI,  p.  299  (republished  in  his  Chirurgische  Beobachtungen  aus  dem  Kriege,  Berlin,  1874),  remarks :  "As  heretofore,  I  am  still  quite  convinced  that  dis- 
articulation  of  the  thigh  ought  not  to  disappear  from  military  surgery,  and  that  if  we  do  not  regard  all  very  severe  shot  fractures  of  the  hip  joint  and 
thigh  from  the  beginning  as  lost,  in  all  these  cases  primary  exarticulation  ought  to  be  performed  if  possible  during  the  first  12-24  hours.  In  this  connec 
tion  I  can  only  repeat  what  I  have  said  in  1868,  and  what' I  may  again  emphasize,  that  the  only  two  primary  exarticulations  that  I  performed  in  the 
Schleswig  War,  1848,  recovered,  and  that  one  of  the  patients  operated  upon  is  still  alive."  I  cannot  omit  here  to  call  attention  to  the  translation  of  Pro 
fessor  B.  v.  LANGENBECK'S  article  by  Dr.  JAMES  F.  WEST,  F.  R.  C.  S.  The  translation  is  published  in  The  Birmingham  Medical  Review,  Vol.  V,  1876, 
pp.  29,  88,  and  166.  At  page  100,  Professor  LAXGEXBECK  is  made  to  say:  "The  results  of  the  American  War,  with  its  great  numbers,  have  been  suf 
ficient  for  settlement  of  the  question  of  disarticulation  of  the  thigh.  We  must  regard  it  as  an  operation  which,  at  the  least,  ought  to  be  excluded  from 
military  practice,  and  one  that  ought  at  the  most  to  be  thought  of  in  the  light  of  reamputation."  From  this  Prof.  LAXGEXBECK  would  appear  to  be  in 
favor  of  excluding  exarticulation  at  the  hip  from  the  field  of  military  surgery.  Nothing  could  be  more  erroneous.  What  Prof.  LANGEXBECK  (Archiv 
fur  Klin.  Chir.,  1874,  B.  XVI,  pp.  298,  299)  really  says  is :  "  The  results  of  the  American  War,  with  its  great  numbers,  have  become  decisive  as  regards 
the  value  of  hip  joint  exarticulation.  It  has  been  designated  as  an  operation  which  it  would  be  best  to  exclude  from  military  practice,  and  which  should 
at  the  most  be  thought  of  in  the  light  of  reamputation,"  and  further  on  he  continues  with  the  remark  cited  in  the  beginning  of  this  note. 

3  The  two  exarticulations  at  the  hip  for  shot  injury  performed  during  the  Schleswig-Holstein  campaign  of  1864,  and  the  seven  operations  performed 
during  the  Austro-Frussian  War  of  1866,  proved  fatal.  Of  the  forty-four  cases  of  amputation  at  the  hip  performed  for  shot  injury  received  during  the 
Franco- Prussian  War,  1870-71,  cited  in  note  on  page  130,  ante,  the  only  successful  one,  as  far  as  I  have  been  able  to  ascertain,  was  the  case  of  reamputa 
tion  at  the  right  hip  performed  by  Professor  T.  G.  MORTOX,  of  Philadelphia,  on  a  soldier  named  Boasso  Dominico  (not  Dominico  Ludovess,  as  first 
erroneously  communicated  in  note  on  page  130,  ante),  whose  thigh  had  been  amputated  after  the  battle  of  Sedan,  September  1,  1870. 

"HOLMES  (T.)  (.4  Treatise  on  Surgery,  its  Principles  and  Practice,  Philadelphia,  1876,  p.  344):  "  The  following  are,  I  believe,  the  main  maxims 
of  practice  in  gunshot  injuries  of  the  extremities.  .  .  II  (p.  345).  In  the  lower  extremity  gunshot  fractures  involving  the  hip  joint  or  the  upper  third  of 
the  femur  are  usually  fatal,  however" treated.  Primary  amputation  is  so  fatal  in  these  cases  that  it  is  almost  abandoned.  Several  cases  have  recovered 
under  strictly  conservative  treatment;  a  few  cases  of  successful  excision  are  on  record ;  and  secondary  amputation  has  been  decidedly  more  successful  than 
primary.  The  surgeon  must  use  his  own  discretion  in  each  case,  but  all  surgeens  nowadays  have  a  well  founded  horror  of  primary  amputation  at  the  hip, 
believing  that  the  operation  is  almost  necessarily  fatal,  while  the  injury  is  not  so."  BECK  (B.)  (Chir.  der  Schussverletzungen,  Freiburg,  1872,  p.  852)  remarks  : 
"Exarticulation  at  the  hip  .  .  is  only  to  be  performed,  as  a  primary  operation,  in  cases  of  extensive  comminution  of  the  bones  with  laceration  of  the 
soft  parts,  especially  of  the  large  vessels,  and  where  amputation  high  up  is  not  possible.  In  injuries  which  involve  the  femur  in  its  continuity  close  to  the 
joint,  conservative  expectant  treatment  should  be  employed,  and  operative  interference  should  only  be  had  in  the  further  course,  as  it  is  known  that  the 
secondary  operation  is  more  readily  tolerated.  I  have  not  yet  seen  in  the  various  campaigns  at  the  places  of  first  dressing  a  case  really  adapted  to  primary 
exarticulation;  either  expectation  was  yet  admissible,  or  resection  or  high  amputation  could  be  performed ;  or  the  lesions  were  of  such  a  nature  that  there 
was  no  prospect  of  a  cure.  The  wounded  of  the  last  category  I  left  to  their  fate  as  incurable,  ligating  only  the  larger  vessels." 


SECT.  ii. |  AMPUTATIONS    AT    THE    HIP    JOINT.  165 

Generalarzt  B.  Beck1  proposes  "to  let  secondary  exarticulation  at  the  hip  be  preceded 
by  resection,"  and  considers  this  procedure  as  not  unworthy  of  the  consideration  of  his 
colleagues.  During  the  Franco-Prussian  War,  1870-71,  he  had  selected  a  patient2  for  this 
mode  of  treatment,  and  had  excised  the  hip  and  intended  to  remove  the  limb  fourteen  days 
later;  but  he  was  compelled  to  leave  the  patient,  who  died  about  a  month  after  the  excision. 
Professor  J.  Neudorfer,3  in  the  case  of  an  Austrian  soldier,  Johann  Schranz,  during  the 
Italian  War  of  1859,  resected,  on  November  27.  1859,  the  head  of  the  femur  for  shot 
injury  received  at  Palestro,  May  30,  1859,  and,  on  December  1st,  removed  the  limb  at  the 
hip.  The  patient  recovered.  This  seems  to  be  the  only  case  of  this  kind  on  record  in 
military  surgery.  In  civil  surgery  six  instances4  may  be  cited  in  which  the  exarticulation 
at  the  hip  had  been  preceded  by  excision  at  the  hip  joint.  Five  of  the  six  cases  had  a 
successful  issue,  giving  the  favorable  result  of  a  mortality  of  16.66  per  cent. 

The  evidence  set  forth  in  the  preceding  pages  in  regard  to  the  three  plans  of  treat 
ment  of  gunshot  injuries  of  the  hip  joint  received  during  the  American  civil  war  shows 
that  of  the  cases  of  undoubted  intracapsular  shot  fracture  of  the  hip  treated  by  conserva 
tion,  98.8  per  cent,  had  a  fatal  termination;  that  in  sixty-six  cases  treated  by  excision5 

'BECK  (B.),  Chirurgie  der  Schussverletzungen,  Freiburg,  1872,  p.  855. 

2 BECK  (B.)  (loc.  cit.,  p.  854)  remarks:  "In  another  case  I  had  performed  resection,  and  intended  to  disarticulate  14  days  later;  but  I  had  to  leave 
the  patient,  who  reacted  well,  and  he  died  of  pyaemia  afterwards,  because  my  plan  was  not  follo\^d,  to  wit:  to  let,  at  the  proper  time,  when  it  became 
evident  that  recovery  could  not  be  achieved  in  this  manner,  the  resection  be  followed  by  exarticulation."  The  patient  he  had  selected  for  this  manner  of 

operation  was  Sergeant  Major  B ,  of  the  3d  French  Infantry  (see  BECK,  loc.  cit.,  p.  894,  and  note  on  page  91,  ante,  CASE  53),  who  had  survived  a  shot 

fracture  of  the  neck  and  trochanter  of  the  femur  at  Worth.  August  6,  1870.  In  the  latter  part  of  August  the  head  and  neck  and  more  than  one-third  of 
the  shaft  of  the  femur  were  excised.  But  Dr.  BECK  was  sent  away  before  the  time  for  the  removal  of  the  limb  had  arrived.  Professor  BECK  continues : 
•'In  another  case,  which,  to  my  sorrow,  I  also  had  to  leave  before  the  proper  time  for  the  operation,  there  was  an  extreme  oblique  and  longitudinal  frac 
ture  extending  into  the  capsule,  with  considerable  infiltration  of  the  soft  parts.  When  I  left  Dijon  I  had  ordered  that,  as  soon  as  the  swelling  would  some 
what  go  down,  the  limb  should  be  amputated  high  up,  and  that  subsequently  the  remaining  bone  should  be  extirpated,  provided  acute  septicaemia  should 
not  supervene.  Several  days  after  my  departure  the  latter  complication  appeared;  energetic  interference  was  not  attempted,  and  only  the  projecting  end 
of  bone  fragment  was  resected.  The  patient  died  shortly  afterwards." 

3NEUDORFER  (J.),  Uandbuch  der  Kriegschir.,  1872,  B.  II,  Abth.  II,  S.  14C8,  and  notes  on  pp.  90  (CASE  13)  and  129  (CASE  120),  ante. 

*HRYFKLDER  (J.  P.)  (Ueber  Resectionen  und  Amputationen,  Breslau  utid  Bonn,  1854,  p.  155)  resected  the  hip  joint  on  January  11,  1848,  in  a  tailor, 
Carl  Eckstein,  aged  20,  for  caries  of  the  joint,  and  exarticulated  the  limb  on  May  20, 1851.  The  patient  died  in  two  hours. — 2.  T.  CAKR  JACKSOX  (Trans 
actions  of  the  Path.  Society  of  London,  London,  1872,  Vol.  XXIII,  p.  191),  for  disease  of  the  hip  joint,  excised,  in  1871,  the  head  of  the  femur  in  a  young 
man  aged  19,  and,  in  1872,  successfully  removed  the  limb. — 3.  Dr.  TEALE  (Medical  Times  and  Gazette,  July  26,  1872,  Vol.  II,  p.  93)  excised,  on  Decem 
ber  28,  1871,  the  head  of  the  femur  for  hip  disease,  in  a  boy  aged  10,  and,  on  July  18,  1872,  the  limb  was  successfully  removed  at  the  hip. — 4.  In  a  girl, 
aged  7,  suffering  from  hip  disease,  Mr.  HANCOCK  performed  excision  of  the  head  of  the  femur  in  the  early  part  of  1871,  and,  on  November  2,  1872,  ampu 
tation  at  the  hip  was  performed  by  Dr.  RICHARD  BARWELL.  The  girl  recovered  (London  Lancet,  April  5,  1873,  Vol.  I,  p.  105). — 5.  Dr.  RUSHTOX 
PARKEU  (London  Lancet,  1875,  Vol.  II,  p.  099),  on  a  boy,  aged  6,  with  inflammation  of  the  hip  joint,  excised  the  head  of  the  femur  on  July  31,  1874,  and 

amputated  at  the  hip,  November  21,  1874.  The  boy  survived.— 6.  Professor  Sl'EXCE  (London  Lancet,  1875,  Vol.  II,  p.  549),  ThomasH ,  aged  20;  hip 

disease;  excision  at  the  hip  October  29,  1864.  Amputation  April  13,  1875,  by  Prof.  Sl'EXCE;  the  patient  recovered. 

*Besides  the  works  referred  to  on  pages  89  to  120,  ante,  by  ABBOTT,  AT.COCK,  AsimuRST,  CHEXU,  CALHOUX,  CULBERTSOX,  DEINIXGER,  Du- 

BREUIL,  EVE,  H.  FISCIIEH,  G.  FISCHER,  GUTIIKIE,  GRELI.OIS,  GROSS,  HEINE,  HODGES,  KADE,  LAXGEXliECK,  LOHMEYER,  LOXGMORE,  LOSSEN,  MAT 
THEW,  MACLEOD,  Muxx,  MAUXOURI,  MURSICK,  XKUDOKFER,  OTIS,  OITEXHEIM,  OITEXHEIMER,  PAILLARD,  READ,  ROBERTSOX,  SEUTIX,  SCHWARTZ, 
D.  P.  SMITH,  STKOMEVER,  K.  TEXTOI:,  and  C.  WAGXER,  the  following  may  be  consulted  on  excision  at  the  hip  joint:  ADAMS  (Z.  B.),  Excisions  of 
Joints  for  Traumatic  Cause,  in  Boston  Med.  and  Surg.  Jour.,  18C7,  Vol.  7G,  p.  229;  BALLARUE  (D.  P.),  Beitrage  zur  Statistik  der  Huftgelenks  Resec 
tion,  Leipzig,  1808.  BECK  (B.),  Zur  Statistik  der  Amputationen  und  Resectionen,  in  LAXGEXBECK's  Arch,  fur  Klin.  Cliir.,  B.  V,  pp.  245,256,  and  Kriegs 
chir.  Erfahrungen  u-ahrend  des  Feldzuges,  18CO,  in  Suddeutschland,  pp.  206,  351,  and  Die  Schusswunden,  Heidelberg,  1850,  p.  332.  BEKAltD  (A.), 
Resection  de  I'articulation  coxo-femorale,  in  Diet,  de  M^d.  en  30,  1837,  T.  XV,  p.  82.  BlLLROTH  (TH.),  Ueber  die  Resectionen,  in  Deutsche  Klinik.  B.  V, 
p.  220.  BLAXD1X  (P.  P.),  Article  Resection,  in  Diet,  de  Med.  et  de  Cliir.  prat.,  Paris,  1835,  T.  XIV,  p.  266.  BOXIXO  (E.),  De  la  n'section  de  la  tete  du 
femur,  in  Annal.  de  la  Cliir.  Fran?  et  Etrang.,  Paris,  1844,  T.  X,  p.  385.  BOWMAX  (WM.),  Resection  of  the  Hip  Joint,  in  Medical  Times  and  Gazette, 
London,  1800,  Vol.  II,  p.  210.  BRYK  (A.),  Beitrage  zu  den  Resectionen,  in  LAXGEXllECK'S  Archiv  filr  Klin.  Chir.,  1873,  B.  XV,  p.  273.  ClIAMTIOX 
(L.),  Traite  de  la  Resection,  etc.,  These,  Paris,  1815.  ClIKEVER  (D.  W.),  Two  successful  cases  of  Excision  of  the  Head  of  the  Femur,  in  Boston  Med. 
and  Surg.  Jour.,  Vol.  LXXV1I,  p.  281.  COOTE  (H.),  Remarks  on  the  operation  of  Resection  of  the  Head  of  the  Femur,  in  British  Medical  Journal 
January  2,  1858,  p.  2.  DlltCKS  (C.  J.  M.),  Diss.  inaug.  de  resectione  capitis  femoris,  Wirceb,  1846.  DECAISXE,  Des  moyens  d'eviter  les  amputations  et 
les  resections  osseuses,  Bruxelles,  1855.  EULEXBURG  (ALBERT),  Beitrage  zur  Statistik  und  Wiirdigung  der  Huftgelenkresection,  in  Archiv  filr  Klin. 
Chir.,  I860,  B.  VII,  p.  701.  FOCK  (C.),  Bemerkungen  und  Erfahrungen  ueber  die  Resection  im  Hiiftgelenk,  in  Archiv  fur  Klin.  Chir.,  Berlin,  1861,  B.  I, 
p.  172.  GERDY  (J.  V.),  De  la  resection  des  extremites  articulaires  des  os,  Paris,  1839,  p.  157.  GOOD  (R.  R.),  De  la  resection  de  V articulation  coxo-fem- 
oralepour  carie,  Paris,  1809.  GOOD  (R.  R.),  Comparative  Mortality  after  resection  of  the  hip  joint  in  France  and  in  England,  in  Med.  Times  and  Gaz., 
London,  1809,  Vol.  I,  p.  355.  GOSSELIX,  Resection  de  la  hanche,  in  Bull,  de  VAcad.  de  Med.,  Oct.  15,  1861.  GURLT,  Resection  im  Hiiftgelenk,  in  LAX 
OEXBECK'S  Archiv,  1867,  B.  VIII,  p.  903.  HAXCOCK  (H.),  On  Excision  of  the  Hip  Joint,  Lancet,  1857,  Vol.  II,  p.  84.  HKYFF.LDER  (J.  P.),  Ueber 
Resectionen  und  Amputalionen,  Breslau,  1854,  p.  154.  IlEYFELDER  (O.),  Lehrbuch  der  Resectionen,  Wien,  1863.  HUETKU  (C.),  Die  Resectionen,  in 
LAXGEXBECK's  Archiv,  B.  VIII,  p.  94.  JACOBSEX  (L.),  Om  Resektion  of  Hofteleddet  i  Tilfdlde  of  caries  og  suppuration,  Kbhvn,  1874.  JAEGER  (M.), 
Operatio  resectionis  conspeclu  chronologico  adumbrata,  Erlangen,  1832.  JAEGER,  Article  Decapitatio,  in  J.  N.  RUST'S  Handbuch  der  Chirurgie,  1831. 
B.  V,  p.  626.  KlXLOCH  (R.  A.),  A  case  of  Excision  of  the  Hip  Joint  for  morbus  coxarius,  with  Remarks  upon  the  Propriety  of  such  an  Operation,  and 
a  Summary  Account  of  the  recorded  Cases  up  to  the  present  Time,  in  Charleston  Med.  Jour,  and  Rev.,  1857,  Vol.  XII,  p.  307.  KRETSCHMAU  (G.  A.),  Ueber 
BuftgeUnkresection,  Jena,  1867.  LARGIII  (B.),  Resection  de  tete  et  du  col  du  femur,  in  Gaz.  Med.  de  Paris,  1857,  T.  XII,  p.  8.  LE  FORT  (LEOX),  De  la 
resection  de  la  hanche  dans  les  cos  de  coxalgie  et  de  plaies  par  armes  d.  feu,  in  Mtm.  de  VAcad.  Imp.  de  Med.,  1861,  T.  XXV,  p.  445.  LEISRINK  (H.), 


166  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

the  fatality  was  90.9  per  cent.,  and  that  in  sixty-six  cases  treated  by  exarticulation1  it  was 
83.3  per  cent.;  but  from  these  results  it  should  not  be  concluded  that  operative  interference 
was  always  indicated,  and  that  amputation  was  preferable  to  excision.  On  page  121,  of 
Circular  No.  2,  I  have  already  pointed  out  that  the  question  as  to  the  most  eligible  treat 
ment  of  shot  injuries  of  the  hip  joint  is  not  susceptible  of  a  purely  arithmetical  solution, 
and  that  the  variety  of  the  conditions  under  which  the  patients  are  placed,  the  diversity 
in  the  extent  of  their  injuries,  and  the  inevitable  imperfection  of  all  surgical  records  forbid 
any  such  rigorous  comparison.  Not  less  than  nine2  of  the  sixty-six  cases  of  excision  at 
the  hip  were  complicated  with  such  lesions  of  the  pelvic  walls  and  viscera  as  made  any 

Zur  Statistik  der  Huftgelenk  Resection,  in  Archiv  fur  Klin.  Chir.,  Berlin,  1870,  B.  XII,  p.  134.  LEPOLD  (F.),  Ueber  die  Resection  des  HuftgeJenkes, 
Inaug.  Diss.,  Wttrzburg,  1834.  LOCKE  (A.),  Beitrdge  zur  Lehrevon  den  Resectionen,  in  Archiv  fur  Klin.  Chir.,  Berlin,  1862,  B.  Ill,  p.  291.  LYON 
(IRVIXG  W.),  Excision  of  the.  Knee  and  Hip  Joints,  in  Am.  Jour.  tied.  Sci.,  1865,  K.  S.,  Vol.  XLIX,  p.  49.  MOHNS  (J.),  Beitrdge  zu  den  Resectionen 
der  Knochen,  Jena,  1866.  PAGENSTECHER,  Zur  Resection  des  Hiiftgelenkes,  in  LANGENBECK's  Archiv,  1862,  B.  II,  pp.  312-315.  PERCY  et  LAURENT, 
Article  Resection,  in  Dictionnaire  des  Sciences  Mtdicales,  Paris,  1820,  T.  XLVII,  p.  553.  RlEU  (F.),  Die  Resectionen  der  Knochen,  Nuremberg,  1860,  p. 
385.  ROUX  (P.  J.),  De  la  resection  ou  de  retrenchment  de portions  d'os  malades,  Paris,  1862,  p.  49.  SAUNDERS  (D.  D.),  Excision  or  Resection  of  the  Bones 
and  Joints  of  the  Lower  Extremity,  in  Memphis  Med.  Monthly,  April,  1866,  Vol.  I,  p.  77.  SAYUE  (L.  A.),  Exsection  of  the  Head  of  the  Femur  and 
Removal  of  the  Upper  Rim  of  the  Acetdbulum  for  morlus  coxarius,  with  perfect  recovery,  in  New  York  Jour,  of  Med.,  1855,  Vol.  XIV,  p.  70.  SCHEDE 
(M-),  De  resectione  articulationis  coxse,  Halis  Saxonum,  1866.  SCHILLBACH  (L.),  Beitrdge  zu  den  Resectionen  der  Knochen,  Jena,  1861.  SEDILLOT  (C.), 
De  la  resection  coxo-fSmorale,  in  Gaz.  Mid.  de  Paris,  1866,  T.  XXI,  p.  691.  SENFTLEBEN  (H.),  Beobachtungen  und  Bemerkungen  ueber  die  Indikationen, 
den  Heilungsprocess  und  die  Nachbehandlung  der  Resectionen  grcesserer  Gelenlce,  in  LANGENBECK'S  Archiv'filr  Klin.  Chir.,  Berlin,  1862,  B.  Ill,  p.  112. 
SlEBERT  (L.),  Statistik  der  Resectionen,  etc.,  Jena,  1868.  STARK  (W.),  Beitrage  zu  der  Statistik  und  den  Endresultaten  der  Gelenkresectionen,  in  Bei 
trage  zur  Operativen  Chirurgie,  von  Dr.  V.  CZERNY,  Stuttgart,  1878,  p.  183.  STEVENS  (G.  F.),  On  Excisions  in  Cases  of  Gunshot  Wounds,  in  Trans. 
Med.  Society  of  New  York,  1866,  p.  132.  SWINBURNE  (J.),  Exsection  of  the  Hip  Joint,  and  Conservative  Surgery,  in  Med.  and  Surg.  Reporter,  1861, 
Vol.  VII,  p.  198,  and  Vol.  IX,  1863,  p.  377.  SYME  tf  AMES),  Treatise  on  the  Excision  of  Diseased  Joints,  Edinburgh,  1831,  p.  125.  SZYMANOWSKY 
(J.),  Ueber  die  Resection  des  Hilftgelenkes,  in  LANGENBECK's  Archiv,  1865,  B.  VI,  p.  787.  TALLICHET,  Dissert,  de  resecto  femore  ex  articulo,  Haloe, 
18C8.  TEXTOK  (CAJETAN),  Ueber  die  Wiedererzeugung  der  Knochen  nach  Resectionen,  WUrzburg,  1842.  TOSTIVINT  (A.  L.  M.),  Sur  les  resections  coxo- 
fi'morales  dans  les  cas  de  coxalgie,  These,  Paris,  18C8.  WAGNEH  (A.),  Ueber  den  Heilungsprocess  nach  Resection  und  Extirpation  der  Knochen,  Berlin, 
1853,  p.  14.  WAGNEH,  Article  Decapitatio  ossium,  in  EncyclopddiscJies  Worterbuch  der  Med.  Wissenschaften,  von  W.  H.  BUSCH,  Berlin,  1833,  B.  IX, 
p.  188.  WlNNE  (C.  K.),  Statistical  Inquiry  as  to  the  Expediency  of  Excision  of  the  Head  of  the  Femur,  in  Am.  Jour.  Med.  Sci.,  18C1,  Vol.  XLII,  p.  26. 
1  The  literature  of  amputation  at  the  hip  joint  is  copious.  In  the  foot-notes  on  pages  127  to  159  I  have  referred  to  the  various  sources  of  information 
on  this  subject  by  AixocK,  AsuHUKST,  AVERILL,  BAUDEN8,  BECK,  BERTHERAND,  CHENU,  COSTELLO,  W.  S.  Cox,  DEININGER,  GUTHRIK,  J.  F.  HEY- 
FELDER,  D.  J.  LARREY,  H.  LARREY,  LANGENBECK,  LEGOUKST,  MACCORMAC,  MACLEOD,  MATTHEW,  MORTON,  KEUDORFER,  OTIS,  J.  Roux,  P.  J. 
ROUX,  STUOMK.YER,  C.  TEXTOK,  J.  THOMSON,  and  others.  To  these  may  be  added:  ARMAND  (A.),  Histoire  medico-chirurgicale  de  la  guerre  de 
Crimie  d'apres  les  travaux  des  medecins  militaires,  Paris,  1858,  p.  19.  BAKBET,  in  Prix  de  I'Acad.  roy.  de  Chir.,  Paris,  1819,  T.  IV,  p.  45,  relates  the 
operation  by  LA  CROIX,  and  defends  the  exarticulation  at  the  hip.  BECK  (B.),  Zur  Auslosuvg  des  Femur  im  Huftgelenk,  in  Archiv  fur  Klin.  Chir., 
Berlin,  1679,  B.  XXIII,  p.  654.  CARPIO  (L.  H.),  Una  observation  de  desarticulacion  coxo-femoral,  in  Gaceta  Mddica  de  Mexico,  1865,  T.  I.  p.  346. 
DENECHAUD,  Observation  sur  Vextirpation  de  la  cuisse,  in  Rec.  de  Mem.  de  Med.,  Paris,  1820,  T.  VIII,  p.  190.  DOLIGNON,  Amputation  de  la  cuisse  dans 
Varticle,  in  Jour,  de  M(d,  Chir.,  Paris,  1786,  T.  LXVI,  p.  69.  FLAJANI  (GlUSEPPO),  Osservazione  pratiche  sopra  I'amputazione  digli  articoli,  etc., 
Roma.  1791.  GOURAUD  (V.  O.),  Demonstrations  des  principals  operations  de  Chir.,  Tours,  1815,  p.  85.  GURLT  (E.),  Ampulationen,  Exarticulaiionen, 
Resectionen,  in  Jahresbericht  ueber  die  Leistungen  und  Forlschritle  in  der  Gcsammten  Medicin,  Berlin,  1868,  B.  II,  Abth.  2,  S.  411.  HAWERKAMP  (A.), 
Ein  Fall  von  Exarticulatio  femoris.  Inaug.  Diss.,  Berlin,  1678.  HEDENUS  (A.  G.),  Cvmmentatio  chirurgica  de  femore  in  cavitate  cotyloidea  ampu- 
tando,  Lipsiaj,  1823.  IlENOT,  Mem.  sur  la  desarticulation  coxo-femorale,  in  Mem.  de  I'Acad.  Nat.  de.  M<.d.,  Paris,  1852,  T.  XVI,  p.  213.  HEYFELDER 
(O.),  Exarticulation  des  Hiiftgelcnks.  Bemerkungcn  zu  NKUDORFER's  Kriegschirurgie,  in  Deutsche  Klinik,  1873,  B.  XXV,  p.  167.  JENTY  (C.  N.) 
Methodo  de  hacer  la  amputacion  del  muslopor  su  articulacion  con  el  hueso  innominado,  etc.,  Madrid,  1766.  JUBIOT,  Observations  sur  Vamputation  dans 
I'article  coxo-fcmoral,  Montpellier,  1840.  KERR  (WILLIAM),  An  account  of  the  Operation  of  Amputating  the  Thigh  at  the  Upper  Exarticulation,  in 
Medical  and  Philosophical  Commentaries,  London,  1779,  Vol.  VI,  p.  337.  KEliST,  Heelkundige  Mengelingen,  Utrecht,  1836,  p.  186.  KREMER  (H.  S.  W.  L.), 
Ueber  Exarticulation  im  Huftgelenk,  Marburg,  1857.  KROENER  (C.  A.),  De  exarticulalione  femoris  et  cruris  quxdam,  Stuttgartiae,  1837.  L'ALUETTE 
(PET.),  An  femur  in  cavitate  cotyloidea  aliquando  amputandum,  Paris,  1748,  in  HALLKR'S  Disput.  chirurg.,  Lausannae,  1756,  T.  V,  p.  265.  LAND  (A.  L.), 
Over  the  exarticulalio  ossis  femoris,  in  BOERHAVE,  Tijdschrift,  Amsterdam,  1841,  Jaarg.  Ill,  p.  2G5.  LlSFRANC  (J.),  Memoire  sur  un  nouveau  procede 
operatoire  pour  pratiquer  I  amputation  dans  V articulation  coxo-femorale,  in  Archives  Generales  de  Med.,  1823,  T.  II,  p.  161.  METZ  (H.),  Ueber  die 
Losing  des  Oberschenkels  aus  dem  Huftgdenke,  WUrzburg,  1841.  MOKAND  (S.  F.),  Sur  Vamputation  de  la  cuisse  dans  son  articulation  avec  I'os  de  la 
hanche,  in  his  Opuscules  de  Chir.,  Paris,  1768,  T.  I,  p.  176.  MULDER,  Overzigt  von  de  voornamste  gevallen,  welke  in  het  heelen  vroekundig  akademisch 
Ziekenhuis  to  Griiningen,  etc.,  zijn  waargenommen,  door  MULDER,  Amsterdam,  1814,  p.  144.  NEVEKMANN,  Vie  Exarticulation  des  Oberschenkels  in 
geschichtlicher  Hinsicht  dargestellt,  in  Journal  der  Chirurgie  und  Augenheilkunde\on  C.  F.  v.  GRAEFE  und  Ph.  WALTHER,  Berlin,  1839,  p.  95.  POHTA 
(L.),  Delia  disarticolazione  del  Cotile,  Milano,  1860.  PUTHOD,  Sur  Vamputation  de  la  cuisse  dans  so-n  articulation,  in  MORAND'S  Opusc.  de  Chir.,  Paris, 
1768,  T.  I,  p.  199.  RAUSCH  (J.  J.),  Ueber  die  Amputation  grosser  Glieder  nach  Schusswunden,  Leipzig,  1807.  ROBUCHON  (L.),  Observations  et  statis- 
tiquespour  servir  a  Ihistoire  des  amputations,  Paris,  1872,  p.  61.  SABATIER  (R.  B.),  De  la  Medecine  Operatoire,  Paris,  1824,  T.  IV,  p.  542.  SAUVAN, 
Diss.de  extirpatione  femoris,  Vilnas,  1823.  SCHNEIDER  (AUGUST),  Ueber  die  Exarticulation  des  Oberschenkels  im  Huftgelenk,  Inaug.  Diss.,  Landau, 
1848.  SMITH  (STEPHEN),  Statistics  of  the  Operation  of  Amputation  at  the  Hip  Joint,  in  New  York  Jour,  of  Med.,  1852,  Vol.  IX,  p.  184.  SoLGER,  Veber 
die  Amputation  im  Hi'iftge lenke,  WUrzburg,  1854.  S'iEMMERMANN  (W.),  Ueber  die  Exarticulation  des  Oberschenkels,  Jena,  1866.  UNCER,  An  femur 
aliquando  et  quo  methodo  e  cavilate  cotyloidea  sit  amputandum?  Halae,  1793.  Vo'LCKERS  (C.),  Beitragezur  Statistik  der  Amputalionen  und  Resectionen, 
in  Archiv  fur  Klinische  Chirurgie,  Berlin,  1863,  B.  IV,  p.  574.  VOELKNER  (LOUIS),  Ueber  die  Exarticulation  de.s  Oberschenkels  im  Huftyeie.nl-,  Halle, 
1868.  VOIJ1ER,  Sur  Vamputation  de  la  cuisse  dans  son  articulation,  in  MORAND'S  Opuscules  de  Chir.,  Paris,  1768,  T.  I,  p.  189.  VOLKMANN  (RICHARD), 
Ueber  die  Anwendung  des  ESMARCH's  schen  blutersparenden  Verfahrens  by  Exarticulationen  des  Hilftgelenkes,  in  Centralblatt  fur  Chirurgie,  May  2, 
1874,  Xo.  5,  p.  C5.  WACHTER  (G.  H.),  Diss.  chir.de articulis  extirpandis,  etc.,  Groningae,  1810.  WAGNER,  Ueber  die  Exarticulation  des  Oberschenkels 
aus  dem  Huftgelenke,  in  Magazin  fur  die  Gesammte  Heilkunde,  von  J.  N.  RUST,  Berlin,  1823,  B.  XV,  p.  261.  WlNNINGHOFF  De  exarticulatione 
femoris,  Gryphias,  1843.  ZANDERS,  Ablosung  der  Glieder  in  den  Gelenken,  DUsseldorf,  1831. 

2 See  CASE  209,  p.  93,  of  Pt.  C.  Beard,  12th  Miss.;  CASE  227,  p.  96,  of  Pt.  C.  Morrison,  185th  N.  Y.;  CASE  235,  p.  98,  of  Capt.  T.  R.  Robeson,  2d 
Mass.;  CASE  23G,  p.  98,  of  an  unknown  private  soldier  of  the  First  Corps;  CASE  238,  p.  99,  of  an  unknown  soldier;  CASE  247,  p.  105,  of  Pt.  C.  E.  Mars- 
ton,  1st  Mass.;  CASE  257,  p.  109,  of  Corp'l  H.  C.  Sennett,  122d  N.  Y.;  CASE  259,  p.  110,  of  Lieut.  D.  If.  Patterson,  46th  Va.;  and  CASE  209,  p.  118,  of 
Pt.  A.  Toney,  16th  N.  C. 


SECT.  IT.]  WOUNDS    AND    INJURIP;S    OF    THE    HIP    JOINT.  167 

operative  interference  useless;  among  the  sixty-six  coxo-fernoral  amputations  probably  all 
successful  cases  have  been  recorded,  while  some  fatal  cases  may  remain  unpublished;  and  in 
the  three  hundred  and  four  cases  treated  by  conservation,  the  correctness  of  the  diagnosis 
may  be  questioned  in  many  instances.  The  character  of  the  injury  must  determine  the 
choice  of  treatment;  but  the  general  rules  regarding  shot  wounds  of  the  hip  joint1  laid  down 
in  Circular  2  are  uncontro verted:  that  "expectant  treatment  is  to  be  condemned  in  all 
cases  in  which  the  diagnosis  of  direct  injury  to  the  articulation2  can  be  clearly  established;" 
that  "primary  excisions  of  the  head  or  upper  extremity  of  the  femur  should  be  performed 
in  all  uncomplicated  cases  of  shot  fracture  of  the  head  or  neck;"  that  "intermediary  excisions 
are  indicated  in  similar  cases  where  the  diagnosis  is  not  made  out  till  late;"  that  "secondary 
excisions  are  demanded  by  caries  of  the  head  of  the  femur  or  secondary  involvement  of  the 
joint;"  that  amputation  should  be  performed:-  "1.  When  the  thigh  is  torn  off,  or  the  upper 
extremity  of  the  femur  comminuted  with  great  laceration  of  the  soft  parts,  in  such  prox 
imity  to  the  trunk  that  amputation  in  the  continuity  is  impracticable.  2.  When  a  fracture 
of  the  head,  neck,  or  trochanters  of  the  femur  is  complicated  with  a  wound  of  the  femoral 
vessels.  3.  When  a  gunshot  fracture  involving  the  hip  joint  is  complicated  by  a  severe 
compound  fracture  of  the  limb  lower  down,  or  by  a  wound  of  the  knee  joint." 

'A  number  of  authors  especially  on  excision  or  exarticulation  at  the  hip  have  already  been  cited,  but  many  additional  facts  in  regard  to  injuries 
of  the  hip  joint  may  be  derived  from  the  works  of:  BALLIXGALL  (Sir  GEORGE),  Outlines  of  Military  Surgery,  London,  5th  ed.,  1855,  p.  397.  BARWELL 
(RICHARD),  A  Treatise  on- Diseases  of  the  Joints,  London,  1865.  BELL  (JOSEPH),  A  Manual  of  the  Operations  of  Surgery,  London,  1866',  p.  111. 
Br.EXKIXS  (G.  E.),  Article  Gunshot  Wounds,  in  COOPER'S  Dictionary  of  Practical  Surgery,  London,  8th  ed.,  1861,  Vol.  I,  p.  838.  BRINTON  (J.  H.), 
Consolidated  Statement  of  Gunsliot  Wounds,  Circular  No.  9,  S.  G.  O.,  Washington,  July  1,  1863,  p.  12.  BlUOT  (M.),  Bistoire  de  VEtat  et  des  Progres 
de  la  Chirurgie  Militaire  en  France  pendant  les  Guerres  de  la  Revolution,  Besan9on,  1817,  p.  177.  CHAUSSIER,  Pr&is  d experiences  sur  I' amputation 
des  extremites  articulaires  des  os  longs,  in  Hem.  de  la  Soc.  Mid.  d' Emulation,  an  VIII,  T.  Ill,  p.  399.  CHELIUS  (J.  M.),  System  of  Surgery,  translated 
from  the  German  by  J.  P.  SOUTH,  Philadelphia,  1847,  Vol.  III.  CHISOLM  (J.  JULIAN),  A  Manual  of  Military  Surgery  for  the  use  of  Surgeons  in  the 
Confederate  States  Army,  3d  ed.,  Columbia,  S.  C.,  1864.  CORTKSE,  Guida  teorica  pratica  del  medico  militare  in  campana  Torino,  1862,  Vol.  I,  p.  209, 
uud  Vol.  II,  p.  308.  COUL60N  (W.),  On  Disease  of  the  Hip  Joint,  London,  1867.  EMMERT  (CARL),  Lehrbuch  der  Chirurgie,  Stuttgart,  1867,  B.  IV. 
KRICHSEX  (JOHN),  The  Science  and  Art  of  Surgery,  London,  1872.  FERGU68ON  (Sir  WM.),  A  System  of  Practical  Surgery,  London,  4th  ed.,  1867 ;  and 
Clinical  Lecture  on  Hip  Disease,  in  London  Lancet,  1849,  Vol.  I,  p.  359.  FISCHER  (H.),  VerUtzungen  durch  Kriegswaffen,  in  v.  PlTHA  and  BlLLROTH's 
Handbuch,  1865,  B.  I,  Abth.  II,  S.  483,  496.  GAXT  (F.  J.),  The  Science  and  Practice  of  Surgery,  London,  1878.  GHERLXI  (A.),  Vade  Mecum  per  le 
Ferite  d'Arma  da  Fuoco,  Milano,  1866;  aud  Relazione  chirurgica  dell  'Ospedale  militare  provisorio  di  S.  Filippo,  in  Annali  Universali  di  Medicina, 
Milano,  1860,  Vol.  CLXXIII,  p.  450.  HOLMES  (T.),  Report  on  Surgery,  in  Biennial  Retrospect  of  Medicine  and  Surgery  for  1867,  pp.  225,  326;  A  Trea 
tise  on  Surgery,  its  Principles  and  Practice,  Philadelphia,  1876.  HUETER  (C.),  Klinik  der  Gelenk  Krankheiten  mil  Einschluss  der  Ortopadie,  Leipzig, 
1870-71,  p.  596.  KOCH  (W.),  Notizen  uber  Schussverletzungen,  in  LANGEXBECK's  Archio  fur  Klin.  Chir.,  1872,  B.  XIII,  p.  510.  MALGAIGXE  (J.  T.), 
Manuel  de  Medecine  Operatoire,  sept,  ed.,  Paris,  1861,  p.  250.  METZLER,  Verhandlungen  der  Mil.  arztl.  Gesellschaft  zu  Orleans,  1870-71,  in  Mil.  Arztl. 
Zeitschrift,  1872,  B.  I,  p.  63.  MILLER  (JAMES),  A  System  of  Surgery,  Edinburgh,  1864.  MOXTFALCOX,  Memoire  sur  VEtat  Actutl  de  Chirurgie,  Paris, 
1816,  p.  J03.  MOTT  (V.),  VELPEAU's  New  Elements  of  Operative  Surgery,  New  York,  1847,  Vol.  II,  pp.  779,  845.  OCHWADT  (A.),  Kriegschirurgiscle 
Erfahrungen,  Berlin,  18G5,  S.  53.  OLLIER  (L.),  Traiti  experimental  et  clinique  de  la  Regeneration  des  Os,  Paris,  1867,  p.  165.  OTIS  (G.  A.),  Observa 
tions  on  some  Recent  Contributions  to  the  Statistics  of  Excisions  and  Amputations  at  the  Hip  for  Injury,  in  Am.  Jour.  Med.  Sci.,  1868,  Vol.  LVI,  p.  128. 
PAGET  and  STANLEY,  Catalogue  of  the  Pathological  Specimens  contained  in  the  Museum  of  the  Royal  College  of  Surgeons  of  England,  London,  1847, 
Vol.  II,  p.  230.  PAXCOAST  (J.),  A  Treatise  on  Operative  Surgery,  Philadelphia,  1846,  2d  ed.,  p.  129.  PASSAVANT  (G.),  Bemerkungen  aus  dem  Gebiete 
der  Kriegscliirurgie,  in  Berliner  Klinische  WocJienschrift,  Berlin,  1871,  Jahrg.  VIII,  p.  115.  PAUL  (H.  J.),  Die  Conservative  Chirurgie  der  Glieder, 
Breslau,  1859,  S.  38,  193.  PlRUIK  (WILLIAM),  The  Principles  and  Practice  of  Surgery,  London,  1860.  PlTHA  (F.),  Krankheiten  der  Extremitaten, 
Krlangen,  1868,  S.  203.  M.  ROCHOUX,  Communications  sur  les  platjes  d'armes  afeufaites  a  V Academic,  in  Bull,  de  VAcad.  de  Med.,  1848,  T.  XIV,  p. 
127.  Rossi  (P.),  Elemens  de  Medecine  Operatoire,  Turin,  1806,  T.  II,  p.  224.  SANTESSON  (CHARLES),  Om  Hoflleden  och  Ledbrosken  uti  anatomiskt, 
pathologiskt,  och  chirurgiskt  hanseende,  je.mte  en  Kritish  Ofversigt  ofver  nagra.  bland  Injlammationlarens  vigtigaste,  Stockholm,  1849,  and  Dublin 
Journal  of  Medical  Sciences,  1861,  Vol.  XI,  p.  432.  SEDILLOT  (C.),  Traite  de  Medicine  Operatoire,  Paris,  1865,  T.  I,  p.  515,  and  De  I'evidement  sous 
periosti  des  Os,  Paris,  1867,  p.  165,  and  Compte  Rendu  de  VAcad.  des  Sciences,  seance  du  15  Oct.,  1866.  SIMON  (GUSTAV),  Mittheilungtn  aus  der  Chir- 
urgischen  Klinik,  Prag,  1868,  S.  98.  SKEY  (F.  C.),  Operative  Surgery,  Philadelphia,  1851,  p.  374.  SMITH  (G.  K.),  The  Insertion  of  the  Capsular  Lig 
ament  of  the  Hip  Joint  and  its  relation  to  intra-capsular  fractures  of  the  Neck  of  the  Femur,  in  Med.  and  Surg.  Reporter,  Vol.  VII,  p.  244,  et  seq. 
SMITH  (STEPHEN),  Handbook  of  Surgical  Operations,  New  York,  3d  ed.,  1862,  p.  221.  SOLLY  (S.),  Clinical  Lectures  on  Injuries  and  Diseases  of  the 
Joints,  delivered  at  St.  Thomas's  Hospital,  in  London  Lancet,  1852,  Vol.  II,  pp.  121,  144.  SYME  (JAMES),  The  Principles  of  Surgery,  edited  by  Dr. 
MACLEAN,  Philadelphia,  1866,  p.  C94.  SZYMAXOWSKI  (JULIUS),  Additamenta  ad  Ossium  Resectionem,  Dorpati  Livonorum,  1856.  TEXTOU  (CAJETAX), 
Grundzuge  zur  Lf.hr  der  Chirurgischen  Operaliimen,  Wtirzbu«g,  1835.  S.  310,  348.  VELPEAU  (A.  L.  M.),  Nouveau  Elements  de  Medecine  Opiraloire, 
Paris,  1833,  T.  I,  p.  582.  VERMAXDOIS,  Sur  le  traitement  de  quelques  maladies  chirurgicales  de  I' articulation  du  femur  avec  Vos  innomine,  in  Journal 
de  Medicine,  Chirurgie,  Pharmacie,  etc.,  1786,  T.  LXVI,  p.  51.  VOGEL  (A.  F.),  Observationes  quasdam  chirurgicas  defendit,  Kiliae,  1771.  WAKREX 
(EDWARD),  An  Epitome  of  Practical  Surgery,  Richmond,  1863.  WHITE  (C.),  Cases  in  Surgery,  in  Philosophical  Transactions,  Vol.  HX  for  the  year 
1769,  London,  1770,  p.  45.  WILLIAMSON"  (G.),  Military  Surgery,  London,  1863.  WOODHULL  (A.  A.),  Catalogue  of  the  Surgical  Section  of  the  U.  S. 
Army  Med.  Museum,  Washington,  1866,  p.  234.  ZANG  (C.  B.),  Darstellung  blutiger  heilklinstlerischer  Operationen,  Wien,  1821,  Theil  4,  pp.  287,  300. 

2 Professor  II.  II.  SMITH  (Princ.  and  Pract.  of  Surgery,  1863,  Vol.  I,  p.  526)  pronounces  "compound  fractures  involving  the  hip  joint  are  exceed 
ingly  dangerous.  If  left  alone  death  usually  results."  .  .  "  Some  few  cases  of  recovery  have  resulted  after  injuries  in  this  locality,  but  in  them  the 
fracture  may  not  have  entered  the  joint,  and  these  few  exceptions  to  the  general  fatal  result  certainly  offers  no  encouragement  for  their  repetition.  LOr- 
FLEK  (F.),  Grundsdtze  und  Regeln  fur  die  Behandlung  der  Schusswunden  im  Kriege,  Berlin,  1859,  Erste  Abtheilung,  p.  66),  speaking  of  shot  injuries 
of  the  hip  joint,  remarks:  "The  conservative  treatment  of  this  injury,  according  to  the  experience  hitherto  acquired,  gives  no  prospect  of  saving  life. 
Even  if  pyaemia  does  not  oupervene,  death  ensues  sooner  or  later  from  exhaustion  following  endless  suppuration." 


168  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

The  preceding  portions  of  this  Section  were  already  in  print  when  Professor  E.  Gurlt's1 
excellent  and  elaborate  work  on  resections  of  joints  was  received.  On  page  1261  he 
enumerates  one  hundred  and  thirty-seven  cases  of  excision2  at  the  hip,  of  which  the  results 
were  ascertained  in  one  hundred  and  thirty-six  instances,  with  sixteen  recoveries,  a  mor 
tality  rate  of  88.23  per  cent.;  and  "on  page  1319  he  states  that,  considering  the  severity  of 
wounds  of  the  hip  joint  and  the  great  mortality  that  has  hitherto  followed  them,  this  result 
must  be  regarded  as  favorable. 

'GuilLT  (E.),  Die  Gelenk-Resectionen  nach  Schussverletzungen.  Ihre  Geschichle,  Statistik,  End-Resultate,  Berlin,  1879,  pp.  1333.  Professor  GURLT 
cites  the  following  additional  cases  ot  excision  at  the  hip  for  shot  injury  not  hitherto  published:  Dr.  BRYK  (GURLT,  loc.  cit.,  p.  63)  excised  the  head  of 
the  right  femur  in  the  case  of  Nagy  Lajos,  age  27,  wounded  at  Buda,  May  21,  1849;  excision  May  24  ;  death  June  2,  1849.  Dr.  ABEL  (GUHLT,  loc.  cit., 
p.  317),  Pt.  J.  Poulsen,  20th  Danish  Infantry;  Dtippel,  April  18,  1864;  neck  of  right  femur;  intermediary  excision  May  4;  death  May  4,  1864.  Dr. 
HAHN  (GURLT,  loc.  cit.,  p.  317),  P.  Rasmussen,  5th  Danish  Infantry,  age  25;  Alsen,  June  29,  1864,  in  left  trochanters;  resection  July  4,  death  July  6, 
1864.  BURCHARDT  (GuilLT,  loc.  cit.,  p.  483),  F.  Haberditz,  Austrian  Infantry,  age 42;  Koeniggratz,  July  3,  1866,  through  left  hip;  resection  August  6; 
fatal.  BUSCH  (GURLT,  Inc.  cit.,  p.  395),  N.  Breidt,  Gth  Rhenish  Infantry,  Koeniggratz,  July  3,  1866,  right  hip;  excision  July  20;  death  July  21,  186'6. 
BUSCH  (GURLT,  loc.  cit.,  p.  483),  F.  Harlitschek,  Austrian  Infantry,  age  74;  Koeniggratz,  July  3,  1866;  right  trochanter  major;  excision  August  9;  death 
August  13,  1866;  pyaemia.  KLOPSCH  (GURLT,  loc.  cit.,  p.  484),  N.  N.  Oest,  Austrian  Infantry,  Koeniggratz,  July  3,  1866,  left  hip;  excision  July  7; 
death  July  9,  1866.  C.  REYHER  (GURLT,  loc.  cit.,  p.  1159),  W.  Jowanowitsch,  age  45;  Russo-Turkish  War,  August  24,  1876;  excision  Sept.  8;  death 
Sept.  12,  1876.  On  p.  1154  Dr.  GURLT  tabulates  2  additional  cases  of  excision  at  the  hip  during  the  Russo-Turkish  War,  1876-1878,  but  gives  no  details. 
*The  operation  of  excision  at  the  hip  was  first  proposed  in  1769,  by  CHARLES  WHITE,  F.  R.  S.,  Surgeon  to  the  Manchester  Infirmary,  at  the  con 
clusion  of  an  account  of  a  successful  excision  of  the  head  of  the  humerus  performed  by  him  April  14,  1768.  The  paper  is  recorded  in  the  Philosophical 
Transactions  for  1769,  Vol.  LIX,  p.  45,  and  is  republished  the  following  year  in  CHARLES  WHITE'S  Cases  in  Surgery.  1770,  p.  76.  Prior  to  this  a  surgeon 
had,  in  1730,  according  to  J.  D.  SCHLICHTfNG  (Obsercationis  variee  medico-chirurgicx,  in  Philosophical  Transactions,  Ldndon,  1744,  Vol.  XLII,  for  the 
years  1742  and  1743,  p.  274),  extracted  the  carious  head  of  the  femur  in  a  girl,  aged  14,  by  dilating  a  fistulous  opening  over  the  hip.  The  girl  recovered 
in  six  weeks.  Similar  instances  in  which  the  diseased  head  of  the  femur  was  spontaneously  eliminated  or  was  extracted  were  reported  by  A.  F.  VOGEL 
(Observationes  quasdam  chirurgicas  defendit,  Kiliae,  1771),  in  1771;  T.  KIRKLAND  (Thoughts  on  Amputations,  etc.,  London,  1780),  in  1780;  HOFMANM 
(Vom  Schaarbocke,  Munster,  1782),  in  1782  ;  OlILE  (SCHMIDT'S  Jahrbucher,  1834,  B.  II,  S.  116),  in  1815  or  1816;  SCHMALZ  (cited  by  HEDENU8  (A.  G.). 
Commentatio  chirurgica  de  femore  in  cavitate  cotyloidea  amputando,  Lipsias,  1823,  p.  65),  in  1817.  In  the  meantime  experiments  had  been  made  in 
excising  the  joints  of  animals  by  VERMANDOIS  (Jour,  de  mid.  cliir.  et  phar.,  Janv,-Mar.,  1786,  T.  LXVI,  p.  73),  in  1785;  G.  L.  KOELEU  (Experimenta 
circa  regenerationem  ossium,  Gottingen,  1786,  experiments  14,  15,  16,  pp.  84-98),  in  1786 ;  CHAUSSIER  (Magazin  Encycloped.,  56me  annee,  T.  VI,  No.  24), 
in  1801 ;  F.  ROSSI  (Elem.  de  Mcd.  Operat.,  Turin,  1806,  T.  II,  p.  224),  in  1806;  and  G.  H.  WACHTER  (Dissertatio  Chirurgica  de  Articulis  Exlirpandis, 
Groningen,  1810,  pp.  91-94),  in  1810;  but  the  first  excision  of  the  head  of  the  femur  upon  the  living  human  subject  was  performed  by  Mr.  ANTHONY 
WHITE,  of  Westminster  Hospital,  London,  in  April,  1821.  The  date  of  this  operation  has  been  variously  stated.  O.  HEYFELDER  (Lehrbuch  der  Resec- 
tionen,  Wien,  1H63,  p.  78)  gives  the  date  as  1815,  and,  on  page  88,  as  1818,  and  refers  to  an  article  by  LIONEL  J.  BEALE,  in  the  London  Medical  Gazette, 
1832,  Vol.  IX,  p.  853 ;  but  Mr.  BEALE  gives  no  date  for  the  operation.  In  COOPER'S  Dictionary  of  Practical  Surgery,  1872,  Vol.  II,  p.  151,  it  is  also  stated 
that  the  operation  was  performed  in  1818,  and  Mr.  FERGUSSON  speaks  of  the  operation  as  done  in  1818  in  his  paper  in  the  Medico-  Chirurgical  Transactions, 
1845,  Vol.  X,  p.  578,  and  in  his  System  of  Practical  Surgery,  1870,  5th  ed.,  p.  407.  FOCK  (C.),  (Bemerkungen  und  Erfahrungen  iiber  die  Resection  im 
Huftgelenk,  in  Arclnv  fur  Klinische  Chirurgie,  Berlin,  1861,  B.  I,  S.  172)  and  GOOD  (R.  R.),  (De  la  resection  de  I' articulation  coxo-femorale  pour  carie, 
Paris,  1869)  correctly  state  that  the  operation  was  performed  in  1821.  HODGES  (R.  M.).  (The  Excision  of  Joints,  Boston,  1861,  p.  91)  and  CULlJERTSON 
(II.),  (Excision  of  the.  Larger  Joints  of  the  Extremities ;  Prize  Essay,  in  Transactions  of  the  American  Medical  Association,  1876,  Supplement  to  Vol. 
XXVII,  p.  40)  give  1822,  and  LEPOLD  (F.),  (Ueber  die  Resection  des  Hiiftgelenkes,  Inaugural  Th§sis,  WUrzburg,  1834,  p.  15)  1824,  as  the  year  of  the 
operation.  However,  in  Mr.  FERGUSSON's  Lecture  on  Hip  Disease,  at  King's  College  Hospital,  reported  in  the  Lancet,  April  7,  1849,  at  page  361 ,  is  quoted 
Mr.  ANTHONY  WHITE'S  own  account  of  the  operation  on  the  boy  John  West,  a  twin  :  "In  April,  1821,  we  met,  and  the  boy  being 
placed  on  a  table,  I  proceeded,"  etc.,  etc.,  with  the  operation.  This  would  seem  to  be  conclusive  as  to  the  date  of  the  operation. 
Mr.  ANTHONY  WHITE'S  account  states  further  on  in  the  same  page  (361)  that  this  boy,  five  years  after  the  operation,  became 
phthisical,  and  died  of  diseased  lungs  in  the  Westminster  Hospital.  The  pathological  specimen  was  presented  by  Mr.  A.  WHITE 
to  the  Museum  of  the  Royal  College  of  Surgeons,  and  numbered  941,  and  is  described  at  page  230  of  Vol.  II.  1847,  of  the  quarto 
catalogue.  The  patient  was  a  boy,  14  years  old,  who  had  suffered  from  hip  disease  following  a  fall  received  at  the  age  of  nine. 
The  head  and  neck  of  the  femur  were  excised.  The  wound  healed  quickly  and  quite  a  useful  joint  was  obtained.  The  second 
excision  at  the  hip  was  performed  in  1828,  by  Mr.  HEWSON,  of  Dublin.  The  date  of  IlEWSON's  operation  is  given  as  1823  by 
BONING  (E.),  (De  la  resection  de  la  tele  du  femur,  in  Annales  de  la  Chirurgie  Fran^aisc  et  tUtrangere,  1844,  T.  X,  p.  391) ;  HODGES 
(R.  M.),  (loc.  cit.,  p.  91) ;  SAYUE  (L.  A.),  (Exseclion  of  the  Head  of  the  Femur  and  Removal  of  the  Upper  Rim  of  the,  Acetabulum 
for  Morbus  Coxarius,  with  perfect  recovery,  in  the  New  York  Journal  of  Medicine,  1855,  Vol.  XIV,  p.  81);  LE  FORT  (LEON),  (La 
resection  de  la  hanche,  etc.,  Paris,  I860),  and  others ;  but  the  correct  date  of  the  operation  seems  to  be  1828,  as  given  by  LEPOLD 
(F.),  (ffeber  die  Resection  des  H:iftgelenkes,  Inaugural  thesis,  Wurzburg,  1834);  OPPENIIEIM  (F.  W.),  (Die  Extirpation  des 
Schenkelkopfes  aus  der  Gelenkltohle,  in  Zeitsclirift  fiir  die  gesammte  Medicin,  1836,  B.I,  S.  137);  FOCK  (C.),  (Bemerkungen  und 
Erfahrungc.n  iiber  die  Resection  im  Iliiftgelenk,  in  Archiv  filr  Klinische  Chirurgie,  Berlin.  1861,  B.  I,  S.  172);  OTIS  (G.  A.)  (loc. 
cit.,  p.  10);  GOOD  (R.  R.),  (De  la  rezection  de  I'articulation  coxo-femorale  pour  carie,  Paris,  1869).  HAKGRAVS  (WILLIAM),  (A 
System  of  Operative  Surgery,  Dublin,  1831,  p.  514)  states  that  the  operation  was  performed  "a  short  time  since."  The  third 
FIG.  126.  —  Head,  excision  of  the  head  of  the  femur,  and  the  first  example  of  the  performance  of  the  operation  for  shot  injury,  was  done  by  Dr. 
neck.andpart  of  shaft  Ol'PENHEUI  of  Hamburg,  in  1829.  Professor  LONGMORE,  iu  his  article  on  Gunshot  Wounds  of  the  Lower  Extremity,  in  the  second 
RIB'S  successful  in-  edition  of  A  System  of  Surgery,  of  Mr.  T.  HOLMES,  New  York,  1870,  Vol.  II,  p.  230.  remarks :  "  It  is  a  curious  fact,  in  a  historical 
termediary  amputa-  point  of  view,  that  Sir  CHAULES  BELL  proposed  excision  of  the  upper  fragments  in  1818  [1815?]  at  Brussels,  in  the  case  of  Fran9ois 
tion  at  the  hip,  in  the  <je  QaVj  wno  had  been  W0unded  nineteen  days  before  at  Waterloo,  and  on  whom  Mr.  GUTIIUIE  successfully  practised  amputation 
guet.  Spec  2929  in  at  the  hip  joint  the  next  day  instead.  The  reasons  for  his  advice  are  preserved  in  some  manuscript  notes  made  about  the  time  of 
Army  Med.  Museum  the  occurrence,  in  a  diary  presented  to  the  Army  Medical  School  by  Lady  Bell,  his  widow.  The  chief  points  are  the  following: 
at  Netley.  I  After  i  jjy  proposal  is  to  extract  the  head  of  the  bone,  and  do  no  more.  Mr.  GUTHRIE'S  proposal  is  to  amputate  the  thigh  at  the  hip 
joint.  If  the  bone  be  taken  out,  there  is  a  great  cavity  and  suppuration  certainly;  but  by  this  means  the  shock  and  violence  will 

be  saved.  I  fear  the  shock  of  so  great  an  injury,  especially  as  now  the  wound  cannot  be  cut  off  (alluding  to  its  extent  and  sloughing  condition),  and  its 
injury  must  be  superadded  to  that  of  the  incisions.  The  man  will  readily  allow  of  my  proposal,  but  not  of  G.'s.  However,  next  day  he  said  he  would 
consent.  In  the  meantime  I  was  forced  home  by  business,'  etc.  The  separated  head  and  neck  of  the  femur  in  GUTHRIE'S  case  is  preserved  in  the  Museum  of 
the  Army  Medical  Department  at  Netley,  and,  both  from  its  intrinsic  interest  and  because  it  almost  exactly  corresponds  with  the  fragment  in  the  Crimean 
case  in  which  resection  was  successfully  performed,  a  drawing  of  it  is  appended."  A  reduced  copy  of  this  drawing  is  reproduced  iu  the  wood-cut  (FlO.  126). 


8ECT.UI.J  INJURIES    OF    THE    SHAFT    OF    THE    FEMUE.  1.69 


SECTION  III. 


INJURIES   OF   THE  SHAFT   OF   THE   FEMUR. 


In  this  Section  will  be  considered  only  injuries  of  the  shaft  of  the  femur  unattended 
by  primary  injury  of  the  hip  or  knee  joints,  and  inflicted  by  weapons  of  war.  Simple  and 
compound  fractures  produced  by  other  causes  are  reserved  for  consideration  in  Chapter  XII 
of  this  volume.  No  sword  or  bayonet  injuries  of  the  femur  are  recorded  on  the  registers 
of  this  Office,  and  it  is,  therefore,  only  necessary  to  consider  the  shot  injuries  of  and  the 
operations  performed  in  the  continuity  of  the  femur.  There  are  recorded  6,738  shot  inju 
ries  of  the  femur.  Of  these,  3,620  were  treated  by  the  expectant  conservative  mode;  11 
were  followed  by  excision  at  the  hip;  29  by  exarticulation  of  the  hip  joint;  1  by  excision 
in  the  shaft  and  subsequent  disarticulation  at  the  hip;  6  by  excision  in  the  shaft  and  sub 
sequent  amputation  of  the  thigh;  168  by  excision  in  the  shaft;  2  by  amputation  of  the 
thigh  and  subsequent  exarticulation  at  the  hip,1  and  2,901  by  amputation  of  the  thigh. 
The  total  number  of  amputations  of  the  thigh  to  be  recorded  in  this  Section  will  be  6,238, 
the  discrepancies  in  numbers  being  due  to  the  many  examples  of  amputation  through  the 
thigh  in  which  the  operation  was  performed  for  shot  lesions  of  the  knee  joint  or  leg.  The 
shot  injuries  of  the  femur  were  accompanied  by  flesh  wounds  of  the  upper  or  lower  extrem 
ities,  of  the  back,  and  of  the  chest.  Some  were  attended  by  fracture  of  the  pelvic  bones, 
of  the  bones  of  the  leg,  and  of  the  upper  extremities;  and,  in  a  few  instances,  by  pene 
trating  wounds  of  the  chest  or  abdomen.  These  instances  will  be  alluded  to  in  the  various- 
subdivisions  of  this  Section;  « 

At  page  666  of  the  Second  Surgical  Volume  the  number  of  shot  injuries  of  the  shaft 
of  the  humerus  is  stated  as  8,245,  and,  on  page  697  of  the  same  volume,  the  number  of 
amputations  in  the  arm  recorded  is  5,456.  Comparing  these  figures  with,  the  injuries  and 
amputations  of  the  thigh,  it  will  be  seen  that  while  the  shot  fractures  of  the  humerus  exceed 
the  shot  injuries  of  the  shaft  of  the  femur  by  1,407,  the  amputations  in  the  thigh  are  in 
excess  of  the  amputations  in  the  humerus  by  782.  The  latter  fact  is,  perhaps,  to  be  attrib 
uted  to  the  perilous  nature  of  shot  injuries  of  the  knee  joint.  Of  the  6,738  cases  of  shot 
injuries  of  the  femur,  162  were  shot  contusions  and  6,576  were  shot  fractures. 

SHOT  CONTUSIONS  OF  THE  SHAFT  OF  THE  FEMUR.— In  treating  of 
shot  injuries  of  the  shaft  of  the  humerus  in  the  Second  Surgical  Volume,  at  pages  667  and 
817,  only  twenty-two  instances  of  contusion  of  the  humerus  could  be  cited.  The  examples 
of  shot  contusion  of  the  femur  are  not  rare,  one  hundred  and  sixty-two  instances  of  this 
class  being  found  on  the  registers  of  this  Office:  fifty  in  the  upper,  thirty  in  the  middle, 
and  forty-two  in  the  lower  third;  while  in  forty  instances  the  precise  seat  of  the  injury 
was  not  stated.  Amputation  in  the  thigh  became  necessary  in  nine  instances,  with  seven 

1  The  cases  of  excisions  and  exarticulations  at  the  hip  for  shot  injuries  of  the  shaft  of  the  femur  have  already  been  considered  in  the  preceding 
section  of  this  Chapter.  For  the  11  instances  followed  by  excision  at  the  hip  see  CASES  206,  208,  216,  220,  229,  233,  239,  243,  261,  263,  266,  ante.  The  29 
cases  followed  by  exarticulation  at  the  hip  are:  CASES  272,  275,  277,  278,  280,  284,  285,  286,  289,  290,  291,  293,  294,  295,  297,  299,  303,  305,  308,  309,  311, 
314,  319,  320,  321,  323,  324,  325,  328,  ante.  In  CASE  298  excision  in  the  shaft  was  followed  by  amputation  at  the  hip,  and  in  CASES  329  and  337  exarticu 
lation  at  the  hip  joint  had  been  preceded  by  amputation  of  the  thigh. 

SUUG.  Ill— 22 


170 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


fatal  results,  a  mortality  of  77.7  per  cent.,  while  of  the  remaining  one  hundred  and  fifty- 
three  cases  treated  without  operative  interference,  thirty-five,  or  22.8  per  cent.,  proved  fatal: 

TABLE  XIX. 
Numerical  Statement  of  One  Hundred  and  Sixty-two  Cases  of  Shot  Contusion  of  the  Shaft  of  the  Femur. 


POINT  OF  CONTUSION. 

AGGREGATE. 

TREATED  BY  CONSERVATION. 

TUEATHB  BY  AMPUTATION  OF 
THE  THIGH. 

£ 

a 
O 

Recovered. 

•a 

0) 

s 

Ratio  of 
Mortality. 

'£ 
a 
0 

Recovered. 

£ 
'& 

Ratio  of 
Mortality. 

50 
30 
42 
40 

49 

*,O 

36 
40 

33 

32 
30 

1C 
5 
4 
10 

32.  G 
17.8 
11.1 
25.0 

1 
o 

G 

1 
1 

5 

100. 
50. 
83.3 

Middle  Third  of  Femur 

1 
1 

Total  

1G2 

153 

118 

35 

22.  8 

9 

o 

7 

77.7 

i 

It  is  probable  that  in  many  cases  in  which  the  periosteum  or  the  external  layer  of  the 
femur  was  only  slightly  bruised  the  injury  to  the  bone  remained  unnoticed,  and  that  the 
wound,  treated  as  a  simple  flesh  wound,  healed  without  complication;  but  generally,  after 
a  few  weeks'  suppuration,  the  surface  of  the  bone  became  roughened  and  sometimes  slight 
exfoliation  followed: 

CASE  338.—  Private  H.  H.  Coombs,  Co.  D,  6th  Maine,  aged  22  years,  was  wounded  at  Fredericksburg,  May  3,  1863, 
and  entered  Douglas  Hospital,  Washington,  five  days  afterwards.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  reported:  "He 
was  struck  by  a  bullet  on  the  outer  side  of  the  right  thigh.  The  missile  was  extracted  from  below  the  crest  of  the  ilium  on  May 
14th,  the  operation  demanding  a  very  extensive  incision,  which  was  kept  freely  open  to  permit  the  discharge  to  escape.  The 
femur  had  been  denuded  of  its  periosteum  for  several  inches,  the  ball  evidently  having  been  deflected  upward  after  impinging 
upon  that  bone.  This  man  recovered,  and  was  transferred  to  Lovell  Hospital,  Portsmouth  Grove,  July  3d."  The  patient  sub 
sequently  entered  Cony  Hospital,  Augusta,  Maine,  whence  he  was  returned  to  duty  October  24,  1864.  On  June  28,  1865,  he 
was  mustered  out  of  service,  and  subsequently  he  was  admitted  on  the  Pension  Roll.  The  Bangor  Examining  Board,  October 
4,  1873,  certified  to  the  injury,  and  adds:  "The  scar  is  three  inches  long,  and  deep,  permitting  the  finger  to  pass  through  the 
fascia  and  feel  roughened  bone.  Slight  lameness  results."  Examiner  C.  Fuller,  of  Lincoln,  Maine,  reported,  October  20,  1877 : 
"  The  cicatrix  is  now  so  depressed  that  the  little  finger  can  be  laid  in  it,  and  the  bone  below  is  a  little  hollowed,  the  parts  around 
being  very  tender  on  pressure.  A  disagreeable  pricking  sensation  is  also  produced  there  on  percussion  at  the  bottom  of  the 
heel."  The  pensioner  was  paid  December  4,  1878.  The  extracted  missile,  a  conical  ball,  was  contributed  to  the  Museum  by 
Assistant  Surgeon  W.  Thomson,  and  constitutes  Specimen  4277  of  the  Surgical  Section. 

In  two  cases  of  shot  contusions  of  the  middle  third,  and  in  ten  of  the  lower  third  of 
the  femur,  anchylosis  or  stiffening  of  the  knee  joint  resulted.  One  example1  will  be  cited: 

CASE  339. — Private  W.  A.  Currier,  Co.  B,  22d  Massachusetts,  aged  33  years,  was  wounded  at  Fredericksburg,  December 
13,  1862,  and  admitted  into  Harewood  Hospital,  Washington,  four  days  afterwards.  Surgeon  T.  Antisell,  U.  S.  V.;  recorded  the 
following  history:  "A  minie"  ball  entered  the  outer  side  of  the  right  thigh  at  the  middle  third,  striking  against  the  femur.  The 
missile  was  extracted  on  December  18th,  being  found  to  have  moulded  itself  to  the  cylindrical  form  of  the  shaft  of  the  bone. 
The  patient's  general  health  was  good.  Simple  dressings  were  applied  to  the  wound.  On  February  11,  1863,  the  bone  was 
found  to  be  re-covered  with  periosteum  excepting  a  very  small  portion,  and  the  wound  was  allowed  to  close.  On  February  20th 
it  had  healed ;  but,  on  this  day,  erysipelas  set  in,  spreading  rapidly,  and  invading  the  whole  leg  and  the  body  to  the  umbilicus. 
The  leg  swelled  enormously  and  vesicated  over  a  large  portion  of  its  surface,  the  cellular  tissues  being  distended  with  serum. 
Punctures  being  made,  several  quarts  of  serum  were  discharged.  By  April  22d  the  patient  had  recovered,  though  he  was  still 
debilitated,  and  there  was  yet  some  enlargement.  He  was  discharged  from  service  May  9, 1863,  by  reason  of  an  oodematous  and 
stiffened  condition  of  the  wounded  leg."  Examiner  A.  L.  Monroe,  of  Medway,  Massachusetts,  certified,  January  12,  1864  : 
"The  knee  cannot  be  flexed  perfectly;  the  leg  is  swollen,  and  the  fascia  of  the  thigh  seems  to  have  been  destroyed  by  the  ery- 
sipelatous  inflammation.  The  limb  will  improve,  but  it  will  never  be  perfectly  restored."  The  Boston  Examining  Board,  in 
1873,  certified  to  "  varicose  condition  of  the  veins  of  the  thigh  and  leg,  phlebit.s,  etc."  Pensioner  was  paid  March  4,  1879. 

1  Partial  or  complete  anchylosis  of  the  knee  joint  following  shot  contusion  of  the  femur  were  noted  also  in  the  cases  of:  Pt.  D.  Brown,  E,  8th  Mary 
land.  Pt.  S.  Clark,  B,  14th  Infantry,  anchylosis  of  knee,  necrosis,  exfoliation.  Pt.  H.  B.  Baker,  A,  IGth  Maine ;  in  this  instance  there  was  almost  complete 
anchylosis  at  the  hip  and  knee.  Corporal  J.  C.  Noteman,  D,  8th  Wisconsin,  partial  anchylosis  and  paralysis.  Pt.  R.  B.  Pierce,  F,  7th  Wisconsin.  Pt.  H. 
Schocker,  B,  12th  Ohio  Cavalry.  Lieutenant  A.  D.  Detweiler,  C,  116th  Pennsylvania.  Pt.  J.  D.  Page,  K,  57th  Illinois.  Pt.  E.  J.  Russell,  G,  10th 
Regiment  Veteran  Reserves,  partial  anchylosis  of  knee  joint,  and  false  anchylosis  of  ankle  joint.  Pt.  F.  De  Braymaii,  E.  53d  Pennsylvania.  Pt.  J.  W. 
Bowlinger,  M,  4th  Cavalry. 


SECT.  111. 


SHOT    CONTUSIONS    OF    THE    SHAFT    OF    THE    FEMUR. 


171 


FIG.  127.— Shot  con 
tusion  of  left  femur. 
Spec.  4341. 


Of  the  grave  complications  after  shot  contusions  of  the  shaft  of  the  femur,  pyaemia 
was  the  most  frequent;  it  supervened  in  eighteen  instances,  of  which  sixteen  proved  fatal. 
There  were  thirteen  cases  in  which  serious  secondary  haemorrhage  followed. 
Two  of  the  patients  recovered,  eleven  died.  Three  cases  of  recovery  from 
gangrene,  and  three  fatal  cases  were  reported: 

CASE  340. — Private  J.  White,  Co.  A,  4th  New  Jersey,  aged  19  years,  was  wounded  before  Peters 
burg,  April  2,  1865,  and  admitted  to  the  field  hospital  of  the  1st  division,  Sixth  Corps,  where  Surgeon  R. 
Sharpe,  15th  New  Jersey,  recorded :  "Shot  wound  of  left  thigh."  On  the  following  day  he  was  conveyed  to 
the  Depot  Hospital  at  City  Point,  and  one  week  afterwards  he  was  transferred  to  Washington.  Surgeon  R. 
B.  Bontecou,  U.  S.  V.,  who  removed  the  missile  from  the  patient's  limb,  made  the  following  report:  "He 
was  admitted  to  Harewood  Hospital  April  12th  with  a  wound  of  the  upper  third  of  the  thigh,  the  ball  enter 
ing  posteriorly,  passing  upward  and  inward,  impinging  against  the  femur  and  denuding  it  of  a  small  portion 
of  its  periosteum,  and  lodging  beneath  the  vastus  externus  muscle.  On  April  17th,  the  ball  was  extracted 
by  incision,  the  patient  being  under  the  influence  of  chloroform.  The  condition  of  the  injured  parts  and  the 
constitutional  state  of  the  patient  at  the  time  of  the  operation  were  poor.  He  was  suffering  from  diarrhoea 
and  his  progress  was  unfavorable.  On  April  19th,  pysemic  symptoms  were  developed.  The  treatment 
consisted  of  alteratives,  and  was  supporting  throughout.  The  patient  gradually  sank,  and  died  April  27, 
1865."  The  upper  third  of  the  injured  femur  was  contributed  to  the  Museum  by  Surgeon  Bontecou,  and  is 
represented  in  the  adjacent  wood-cut  (FlG.  127). 

In  the  following  fatal  instance  of  shot  contusion  of  the  shaft  of  the  femur,  gangrenous 
osteomyelitis1  was  found  at  the  autopsy : 

CASE  341. — Private  J.  Kagrice,  Co.  F,  198th  Pennsylvania,  aged  30  years,  was  wounded  during  the 
engagement  at  White  Oak  Road,  March  31,  1865.  Surgeon  W.  R.  DeWitt,  U.  S.  V.,  recorded  his  admission  to 
the  field  hospital  of  the  1st  division,  Fifth  Corps,  with  "shot  wound  of  left  thigh,"  and  his  transfer  to  City  Point 
on  the  following  day.  Several  days  afterwards  the  wounded  man  was  transferred  to  Douglas  Hospital,  Wash 
ington,  whence  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A.,  contributed  the  specimen  (Cat.  Surg.  Sect.,  1866,  p. 
258,  Spec.  4201),  with  the  following  history:  "The  injury  was  a  severe  gunshot  contusion  of  the  left  femur  at 
its  middle  third.  The  patient  was  in  good  health  and  spirits  at  the  time  of  his  admission  and  doing  well.  The 
wound  was  carefully  examined,  but  the  ball  could  not  be  traced.  On  April  23d,  a  large  abscess  was  opened  on 
the  anterior  aspect  of  the  thigh  near  the  ti'ochanter.  On  the  29th,  another  similar  incision  was  required  in  order 
to  give  free  exit  to  pus.  The  patient,  however,  continued  pretty  well  until  May  5th,  when  he  had  a  chill.  This 
ream-red  on  May  7th  and  8th,  and  on  the  9th,  12th,  13th,  and  14th,  he  had  two  chills  a  day.  The  thigh  became 
painful,  the  discharge  thin  and  fetid.  On  May  16th,  the  patient  became  delirious,  had  another  chill,  and  his 
tongue  became  swollen  and  inflamed.  He  died  on  the  following  day.  At  the  autopsy  no  pleurisy  or  effusion 
was  found  in  either  thoracic  cavity.  The  lungs,  liver,  spleen,  kidneys,  and  brain  were  carefully  examined  for 
pysemic  abscesses,  but  appeared  healthy.  On  examining  the  femur  it  was  found  that  the  ball  had  struck  it  at 
its  middle  third,  contused  the  bone  without  fracturing,  and,  being  deflected  from  its  course,  had  lodged  in  the 
hollow  above  the  acetabulum.  The  hip  joint  was  healthy  and  uninjured.  A  longitudinal  section  was  made  of 
the  femur,  which  exhibited  well  marked  gangrenous  osteomyelitis,  the  medulla  being  of  a  dirty  greenish  color, 
dry,  pulverulent,  and  excessively  fetid.  The  interspaces  between  the  cancelli  contained  a  dark  greenish  liquid, 
a  quantity  of  which  escaped  in  sawing  the  bone,  and  was  also  extremely  offensive.  The  bone  where  the  missile 
had  struck  had  become  necrosed  and  nearly  separated,  and  around  this  partial  exfoliation  a  ring  of  new  bone 
had  formed.  A  portion  of  the  injured  femur  is  illustrated  in  the  adjacent  wood-cut  (FlG.  128). 

Besides  the  specimens  referred  to  in  the  preceding  two  cases  the  Army  Medical  Museum 
possesses  nine  representations  of  shot  contusions  of  the  shaft  of  the  femur,2  and  several 
missiles  flattened  by  impact  with  the  bone.3 

1  Dr.  J.  A.  LlDELL  in  his  excellent  paper  on  Contusion  and  Contused  Wounds  of  Bone,  with  an  Account  of  Thirteen  Cases,  in  Am.  Jour.  Med.  Set.. 
1865,  Vol.  L,  p.  17,  gives  the  following  as  the  principal  pathological  effects  of  contusions  of  bone:  1.  Ecchymosis  of  the  osseous  tissue;  2.  Ecchymosis 
of  the  medullary  tissue ;  3.  Osteom yelitis  of  a  simple  character;  4.  Necrotic  osteitis ;  5.  Suppurative  osteomyelitis ;  and  C.  Gangrenous  osteomyelitis. 

2 Specimen  291  ( Cat.  Surg.  Sect.  A.  M.  M.,  I860,  p.  259):  The  upper  third  of  the  right  femur,  necrosed  one  inch  below  the  trochanter  minor ;  the 
adjacent  bone  is  honeycombed  by  suppuration.  Spec.  759  (Cat.,  p.  334),  showing  exfoliation  and  some  periosteal  thickening  in  the  lowest  third  of  the  right 
femur.  Spec.  1671  (Cat.,  p.  25!l):  Section  of  right  femur,  showing  an  exfoliation  about  to  separate,  and  some  necrosed  action.  Spec.  2675  (Cat.,  p.  259): 
Contusion  at  the  inner  surface  of  the  middle  third  of  the  right  f<?mur;  the  bone  is  necrosed  and  greatly  roughened  by  suppuration.  Spec.  3106  (Cat.,  p. 
253):  Portion  of  shaft  of  middle  third  of  left  femur  contused  by  a  ball,  which  split  and  escaped  in  two  pieces;  the  bone  is  necrosed  where  struck  by  the 
ball ;  an  abscess  was  found  in  the  medullary  canal  corresponding  with  this  spot.  Spec.  3873  (Cat.,  p.  258):  A  section  of  the  upper  third  of  the  left  femur 
contused  by  shot;  there  is  a  slight  degree  of  caries  with  widespread  periosteal  disturbance.  Spec.  G716:  Part  of  the  left  femur  slightly  contused.  The 
specimen  is  sawn  longitudinally,  exhibiting  diseased  action  of  the  bone.  Spec.  2437  (Cat.,  p.  283):  The  lowest  third  of  the  left  femur  amputated  for 
contusion  above  the  inner  condyle,  where  it  is  locally  carious.  Spec.  1985  (Cat.,  p.  258),  see  CASE  34,  p.  21,  ante. 

3  Specimen  4277  (Cat.  Surg.  Sect.  A.  M.  M.,  I860,  p.  609)  has  been  alluded  to  in  CASE  340.  Spec.  2726  (Cat.,  p.  598):  A  spherical  ball,  with  a  small 

concave  impression  caused  by  contact  with  the  shaft  of  the  femur,  in  the  case  of  J.  C ,  Co.  I,  1st  Ohio  Artillery.  Spec.  3009  (Cat.,  p.  604):  A  conoidal 

riflo  ball  from  which  a  smooth  slice  has  been  removed  on  one  side;  case  of  T.  McO ,  1st  Vermont  Cavalry. 


FlG.  128.— Shot 
contusion  of  left 
femur.5pec.420). 


172  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

Ligations  after  Shot  Contusions  of  the  Femur. — At  page  47  were  tabulated,  it  will 
be  remembered,  one  hundred  and  twenty-seven  cases  of  ligation  of  the  femoral  artery  for 
shot  flesh  wounds  of  the  thigh,  with  ninety-one  deaths,  a  mortality  rate  of  71.7  per  cent. 
To  this  series  of  operations  must  be  added  seven  instances  of  ligations  of  the  femoral 
following  shot  contusions  of  the  femur,  the  patients  perishing  in  every  instance: 

CASES  342-348. — Private  G.  Coleman,  Co.  F,  94th  New  York,  aged  19  years ;  wounded  August  29,  1862 ;  slight  injury 
of  upper  third  of  femur.  December,  1862,  ligation  of  femoral  artery  on  account  of  secondary  hemorrhage;  pysemia.  Died 

December  3,  1862. — Sergeant  G ,  16th  Illinois ;  mini6  ball  passed  through  left  thigh  about  three  and  a  half  inches  above  the 

knee  joint,  grazing  the  femur;  admitted  into  the  hospital  of  the  2d  division,  Fourteenth  Corps.  Surgeon  E.  Batwell,1  14th 
Michigan,  reported  that  on  the  eleventh  day  considerable  haemorrhage  occurred,  eight  or  ten  ounces  of  blood  being  lost.  The 
tourniquet  was  loosely  applied.  The  bleeding  recurred  on  the  twelfth  and  thirteenth  days,  when  Dr.  Batwell  cut  down  and  tied 
the  main  vessel  in  the  middle  stage  of  its  course.  He  seemed  comfortable  for  about  thirty-six  hours;  but  notwithstanding  all 
the  efforts  used  to  keep  up  the  temperature  of  the  leg  and  to  nourish  and  support  his  system,  he  gradually  sank  into  a  comatose 
condition,  and  died  on  the  eighteenth  day  after  the  reception  of  the  injury. — Private  A.  Kitzing,  Co.  H,  57th  New  York,  aged  40 
years;  wounded  at  Fredericksburg,  December  13, 1862,  a  musket  ball  passing  through  the  left  popliteal  space.  December  20th, 
violent  haemorrhage  from  inner  orifice  of  wound.  Surgeon  J.  P.  Prince,2  36th  Massachusetts,  immediately  placed  a  ligature  on 
the  femoral  at  the  angle  formed  by  the  sartorius  and  adductor  magmis  muscles,  which  entirely  controlled  the  haemorrhage. 
The  bleeding  recurred  and  continued  to  increase,  notwithstanding  the  use  of  styptics  and  pressure,  and,  on  December  23d,  the 
left  thigh  was  amputated  at  the  upper  part  of  the  lower  third.  Pyaemia  developed,  and  the  patient  died  January  12, 1863.  The 
specimen  of  the  injured  knee  was  forwarded  to  the  Army  Medical  Museum  by  the  operator,  Dr.  Prince,  and  is  numbered  535  of 
the  Surgical  Section.  The  femur  has  been  grazed  above  the  condyle  and  the  popliteal  artery  cut  across  by  a  bullet  (Cat.  Surg. 
Sect.,  A.  M.  M.,  1866,  p.  457).— Private  J.  Eoberts,  Co.  A,  9th  West  Virginia,  aged  31  years;  wounded  at  Winchester,  July  20, 
1864;  shot  wound  of  left  thigh,  denuding  upper  third  of  femur  of  its  periosteum;  missile  lodged,  and  was  extracted  July  27th; 
haemorrhage  set  in  on  July  29th,  and  Surgeon  J.  B.  Lewis,  U.  S.  V.,  ligated  the  femoral  artery.  Typhoid  symptoms  supervened, 
and  the  patient  died  August  24,  1864. — Private  J.  Scott,  Co.  D,  69th  New  York,  aged  30  years;  \vounded  at  Petersburg,  July 
24,  1864;  ball  entered  upper  part  of  left  thigh,  striking  the  femur  and  denuding  it  of  its  periosteum  for  two  inches.  August  4th, 
haemorrhage  to  the  extent  of  one  pint;  limb  bandaged  from  distal  extremity  and  wound  plugged  with  lint  saturated  Avith  per 
sulphate  of  iron.  Bleeding  recurred  on  the  next  day,  and  Acting  Assistant  Surgeon  11.  M.  Dean  ligated  the  femoral  artery  in 
Scarpa's  space,  about  three  inches  below  Poupart's  ligament.  The  case  progressed  favorably  until  August  20th,  when  he  had  a 
slight  chill  followed  by  profuse  perspiration.  He  died  August  21,  1864,  of  pysemia.  The  pathological  specimens  in  the  case, 
consisting  of  the  femoral  artery,  the  contused  portion  of  the  shaft  of  the  femur,  and  the  femoral  vein,  were  forwarded  to  the  Army 
Medical  Museum,  and  are  numbered  3105,  3106,  and  3118,  respectively,  of  the  Surgical  Section.  They  were  contributed  by  the 
operator,  Dr.  Dean. — Sergeant  S.  Van  Wie,  Co.  B,  62d  Ohio,  aged  25  years,  was  admitted  into  the  hospital  at  Beverly,  New 
Jersey,  August  21,  1864,  with  a  shot  wound  of  the  left  thigh,  injuring  the  bone,  received  at  Deep  Bottom,  August  16,  18{54. 
Parts  in  sloughing  condition.  September  28th,  secondary  haemorrhage  to  extent  of  eight  ounces.  Acting  Assistant  Surgeon  J. 
C.  Morton  ligated  the  femoral  artery.  Patient  died  September  29,  1864,  from  exhaustion. — Private  A.  Young,  Co.  F,  1st  Mis 
souri  Cavalry,  was  wounded  at  Cape  Girardeau,  April  26,  1863.  He  was  admitted  into  the  post  hospital  at  Cape  Girardeau,  and 
Surgeon  H.  A.  Martin,  U.  S.  V.,  reported  that  a  minie  ball  entered  the  lower  third  of  left  thigh,  struck  the  femur  without  frac 
turing  it,  and  lodged  in  the  perineum.  The  ball  was  removed,  in  a  flattened  state,  May  8th.  Profuse  haemorrhage  occurred  on 
May  llth.  The  femoral  artery  was  ligated  above  and  below  the  seat  of  injury  on  May  17th.  The  haemorrhage  did  not  recur, 
but  the  patient  sank,  and  died  May  20,  1863. 

One  fatal  instance  of  ligation  of  the  profunda  for  secondary  haemorrhage  following 
shot  contusion  of  the  shaft  of  the  femur  is  found  recorded  on  the  registers  of  the  Office: 

CASK  349. — Corporal  James  Sturgis,  Co.  G,  85th  Pennsylvania,  received  at  Deep  Bottom,  Virginia,  August  Hi,  1864,  a 
shot  wound  of  the  left  thigh,  the  missile  injuring  the  femur.  He  was  admitted  into  the  hospital  at  Beverly,  New  Jersey,  August 
21st.  The  parts  began  to  slough;  haemorrhage  to  the  amount  of  sixteen  ounces  occurred,  and,  on  November  1st,  the  profunda 
was  ligated  in  the  continuity  by  Acting  Assistant  Surgeon  J.  C.  Morton.  Haemorrhage  recurred  from  the  point  of  ligation,  and 
death  ensued  November  6,  1864. 

Adding  to  this  the  six  cases  of  ligation  of  the  profunda  for  haemorrhage  following  shot 
flesh  wounds  of  the  thigh,  recorded  on  page  49,  ante,  we  have  seven  instances  of  this 
operation  with  five  deaths,  in  shot  injuries  of  the  thigh  without  fracture  of  the  fernur. 

Amputations  consequent  on  Shot  Contusions  of  the  Shaft  of  the  Femur. — In  nine 
instances  of  shot  contusions  of  the  shaft  of  the  femur  amputation  of  the  thigh  was  per 
formed.  Four  were  intermediary,. five  secondary  operations;  the  former  proved  fatal;  of 

1  BATWELL  (E.),  Notes  of  Army  Practice — Ligation  of  the  Femoral  Artery  for  Secondary  Hnsmorrhage,  in  Med.  and  Surg.  Rep.,  1865,  Vol.  XII, 
p.  254,  and  LlDELL  (J.  A.),  United  States  Sanitary  Commission  Memoirs,  New  York,  1870,  Surgical  Volume  I,  p.  186. 

2PRL\CE  (J.  P.)  (Surgical  Cases — Wound  in  the  Popliteal  Space — Secondary  Hamorrhage — Amputation  in  Boston  Mcd.  and  Sury.  Jour.,  1863, 
Vol.  LXVIII,  p.  70)  gives  a  detailed  account  of  the  case. 


SECT.  III.] 


SHOT    CONTUSIONS    OF    THE    SHAFT    OF    THE    FEMUR. 


173 


ti 


the  latter,  two  recovered.  The  seat  of  contusion  was  in  the  upper  third  in  one  instance,  in 
the  middle  in  two,  and  in  the  lower  in  six  instances ;  while  four  amputations,  with  one 
recovery,  were  practised  in  the  upper  third;  one,  fatal  in  the  middle  third;  and  four,  with 
one  successful  issue,  in  the  lower  third.  The  cases  will  be  briefly  detailed : 

CASES  350-358.— Private  H.  F.  Rugg,  Co.  H,  2d  New  York  Heavy  Artillery;  wounded  at  Cold  Harbor,  June  3,  1864 ; 
a  mini6  ball  passed  through  the  middle  third  of  the  right  thigh,  injuring  the  bone  and  causing  necrosis.  Circular  amputation  of 
the  thigh  at  the  upper  third  was  successfully  performed  at  Blairsville,  Pennsylvania,  on  January  24,  1866,  by  Drs.  St.  Clair 
and  T.  M.  Laney.  The  pensioner  was  paid  in  1878. — Lieutenant  W.  D.  Templin,  Co.  D,  32d  Iowa,  aged 
26  years;  wounded  at  Bayou  de  Glaze,  Louisiana,  May  1?-,  1864;  missile  entered  two  inches  above  knee 
internally  and  posteriorly  and  passed  downward  and  outward,  slightly  grazing  the  femur.  On  July  22d, 
Surgeon  E.  Powell,  72d  Illinois,  amputated  the  left  thigh  at  the  lower  third.  The>  patient  recovered  and  was 
discharged  March  30,  1865,  with  a  sound  stump. — Private  7?.  L.  Donald,  Co.  B,  27th  North  Carolina,  wounded 
at  Anfietatn,  September  17,  1862,  through  the  middle  of  the  left  thigh,  and  admitted  to  the  hospital  at  Ches 
ter,  Pennsylvania,  October  2d.  Necrosis  and  hectic  supervening,  and  death  being  imminent,  amputation  at 
the  junction  of  the  middle  and  upper  thirds  of  the  thigh  was  performed  by  Dr.  J.  Ashhurst,  jr.,1  by  circular 
incision,  November  6,  1862.  The  patient,  with  great  difficulty,  rallied  from  the  shock  of  the  operation;  but 
subsequently  sank  suddenly,  and  died  seven  hours  afterwards.  Dr.  Ashhurst  contributed  the  specimen  of 
the  injured  femur  to  the  Army  Medical  Museum.  It  is  numbered  863  of  the  Surgical  Section,  and  consists 
of  "five  inches  of  the  shaft  of  the  left  femur,  showing  local  necrosis  after  contusion  by  a  conoidal  ball  in  the 
upper  third.  A  moderate  deposit  of  callus  has  occurred  adjacent  to  the  seat  of  injury.  The  specimen  is  an 
interesting  illustration  of  serious  injury  without  complete  fracture."  (FlG.  129.)  (Cat.  Surg.  Sect.,  A.  M.  M., 
1866,  p.  288.) — Private  B.  A.  Elmore,  Co.  B,  6th  Michigan  Cavalry,  aged  18  years,  received,  near  Old 
Church,  Virginia.  May  28,  1864,  a  shot  wound  of  the  left  knee  joint.  "A  conical  ball  entered  the  joint  from 
the  front,  and  passing  backward  and  upward,  impinged  against  the  inferior  epiphysis  of  the  femur,  glanced, 
and  passing  upward,  lodged  high  among  the  muscles  of  the  thigh,  deep.  Knee  and  thigh  considerably 
swelled.  Track  of  bullet  emphysematous,  filled  with  thin,  dirty  looking,  offensive  pus.  The  emphysema  and 
suppuration  extended  as  high  up  as  the  junction  of  the  middle  and  superior  thirds  of  the  thigh.  June  5th, 
thigh  amputated  high  up  in  the  upper  third  by  the  double  flap  method.  The  bullet  dropped  out  while  cutting 
the  posterior  flap.  There  was  but  trifling  loss  of  blood  during  the  operation,  and  the  patient  reacted  promptly. 
June  6th,  feverish  and  restless,  pulse  rapid.  June  10th,  pyaemia  developed.  Died  June  17,  1864."  The 
operator,  Surgeon  John  A.  Lidell,  U.  S.  V.,  contributed  the  portion  of  the  femur  removed,  together  with  the 
history  of  the  case,  to  the  Army  Medical  Museum.  The  specimen  is  numbered  2437  of  the  Surgical  Section,  and  consists  of  the 
"  lowest  third  of  the  left  femur.  It  is  contused  above  the  inner  condyle,  where  it  is  locally  carious.  The  specimen  is  sawn  open 
longitudinally,  exhibiting  diseased  action  to  the  center  of  the  bone."  (Cat.  Sury.  Sect.,  A.  M.  M.,  1866,  p.  283.) — Captain  G. 
Grecheneck,  Co.  A,  72d  New  York,  received,  at  Williamsburg,  Virginia,  May  4,  1862,  a  gunshot  wound  of  the  right  popliteal 
space.  Surgeon  R.  B.  Boritecou  reported  that  a  minie  ball  transfixed  the  thigh  between  the  hamstrings  and 
condyles  of  the  femur,  grooving  that  bone  slightly  at  the  attachments  of  the  gastrocnemius  muscles  and 
injuring  the  artery  and  nerve.  The  foot  became  gangrenous,  and  amputation  in  the  lower  third  of  the  thigh, 
by  circular  operation,  was  done.  Gangrene  attacked  the  stump  on  the  15th,  and  he  died  May  16,  1862. — 
Private  Lafayette  Hoyan,  Co.  G,  14th  Tennessee,  was  admitted  into  Lincoln  Hospital,  Washington,  Decem 
ber  23,  1862,  with  a  gunshot  wound  of  the  right  knee.  Amputation  at  the  lower  third  of  the  thigh  was  per 
formed  on  the  day  of  admission.  The  patient  died  January  1,  1863,  from  haemorrhage.  Assistant  Surgeon 
G.  M.  McGill,  U.  S.  A.,  forwarded  the  pathological  preparation  (Specimen  1891,  Section  I)  to  the  Army 
Medical  Museum.  It  consists  of  "a  ligamentous  preparation  of  the  bones  of  the  right  knee,  except  the 
patella,  amputated  in  the  lowest  fourth,  apparently  for  a  contusion  just  above  and  behind  the  outer  condyle." 
( Cat.  Sury  Sect.,  A.  M.  M.,  1866,  p.  338.)— Private  J.  L.  Hudson,  Co.  1, 59th  Illinois,  aged  18  years,  received, 
at  Nashville,  December  15,  1864,  a  shot  wound  of  the  right  thigh  just  above  the  knee  joint,  the  ball  grazing 
the  femur  and  denuding  it  of  its  periosteum.  The  wound  progressed  favorably  until  December  30th,  when 
the  structures  of  the  joint  became  implicated.  An  abscess  made  its  appearance  just  below  the  patella.  The 
patient  became  much  debilitated.  On  January  25, 1865,  Acting  Assistant  Surgeon  F.  B.  Nossinger  ampu 
tated  the  right  thigh  at  the  middle  third  by  the  circular  method.  Great  prostration  followed.  Irritative 
fever  ensued,  and  the  patient  died  February  1, 1865. — The  case  of  Private  A.  Kitzing,  Co.  H,  57th  New  York; 
wounded  at  Fredericksburg,  December  13,  1862,  whose  thigh  was  amputated  on  account  of  recurrent  bleed 
ing  after  ligation  of  the  femoral  artery,  has  been  alluded  to  on  page  172,  ante,  CASE  344. — Private  M.  Shay, 
Co.  B,  61st  New  York,  aged  20  years,  received,  at  Antietam,  September  17,  1862,  a  shot  wound  of  the  anterior  aspect  of  the 
right  thigh  ;  the  femur  was  bruised ;  ball  lodged.  October  20th,  ball  found  lying  against  the  femur,  at  upper  third,  and  removed. 
The  discharge  became  profuse  and  offensive  and  the  patient  failed  daily.  November  15th,  flap  amputation  of  right  thigh  at  the 
upper  third  by  Surgeon  H.  S.  Hewit,  U.  S.  V.  The  patient  died  November  24,  1862.  Dr.  Hewit  contributed  the  specimen 
shown  in  the  wood-cut  (FlG.  130).  There  is  "a  large  portion  of  necrosed  bone  nearly  detached,  with  very  little  callus."  He 
also  forwarded  the  preparation  of  the  right  femoral  artery  to  the  Museum.  It  is  numbered  853  of  the  Surgical  Section. 

1  Dr.  ASHIIURST,  in  a  published  account  of  this  case  (Surgical  Cases,  Illustrating  some  Practical  Faints,  in  Am.  Jour.  Med.  Sci.,  1863,  Vol.  XI/V, 
p.  343),  states  that:  "  The  wound,  which  appeared  to  be  simply  a  flesh  wound,  did  well,  and  was  nearly  healed,  when,  from  some  then  unknown  cause 
the  track  reopened,  and  by  the  probe  and  little  finger  dead  bone  was  detected  about  the  middle  of  the  left  femur."  - 


FIG.  129.— Shot 
contusion  of  shaft 
of  left  femur.  Spec. 
863. 


FlG.  130. — Necrosis 
of  the  right  femur. 
Spec.  109(>. 


INJURIES    OF    THE    LOWER    EXTREMITIES.  |CHAP.  x. 

The  left  thigh  was  amputated  in  three,  the  right  in  six  instances;  of  the  latter,  two 
recovered.  The  modes  of  operation  selected  were:  The  circular  amputation  five  times,  the 
flap  operation  twice;  in  two  instances  the  manner  of  operation  was  not  indicated.  Seven 
amputations  were  practised  on  Union,  two  on  Confederate  soldiers. 

Comparing  the  results  of  cases  of  shot  contusion  in  the  shaft  of  the  femur  with  the 
results  of  analogous  cases  in  the  shaft  of  the  humerus,  we  find  that  of  one  hundred  and 
sixty-two  contusions  in  the  femur  forty-two,  or  25.9  per  cent.,  proved  fatal,  while  of  twenty- 
two  patients  with  contusion  of  the  humerus  only  four,  or  18.1  per  cent.,  succumbed,  and 
that  while  in  not  a  single  instance  of  contusion  of  the  humerus  operative  interference  was 
deemed  necessary,  nine  amputations  of  the  thigh  were  practised  for  complications  following 
shot  contusions  of  the  femur.1  The  serious  consequences  ascribed  to  injuries  of  this  nature 
by  Dr.  Lidell  have  been  alluded  to  on  page  171,  ante.  Professor  L.  Stromeyer,  Dr.  H. 
Gibbons,  Professor  A.  Liicke,  M-  Jobert  (de  Lamballe),  Dr.  C.  Heine,  and  Dr.  J.  Arnold2 
have  noted  the  complications  accompanying  shot  contusions  of  the  femur;  but  only  a  few 
writers  on  military  surgery  have  cited  instances  of  such  injuries.3 

SHOT  FRACTURES  OF  THE  SHAFT  OF  THE  FEMUR. — Shot  fractures  of  the 
shaft  of  the  femur  were  considered  as  almost  universally  fatal  by  the  older  writers  on 
military  surgery,  and  amputation  of  the  thigh  was  regarded  by  many  as  the  only  means 
of  saving  the  patient's  life.4  But  the  many  successful  attempts  at  preservation  of  the  limb 
in  cases  of  shot  fracture  of  the  femur  within  the  last  twenty  years  leave  no  doubt  as  to  the 
value  of  the  conservative  treatment  of  such  fractures.5  Six  thousand  five  hundred  and 

1  SCHWARTZ  (H.)  (Beitrage  zur  Lehre  von  den  Schusswunden,  Schlesswig,  1854,  p.  147),  in  a  very  interesting  chapter,  carefully  notes  the  frequently 
serious  consequences  following  shot  contusions  of  the  femur,  and  remarks  that:  "Notwithstanding  the  most  careful  treatment,  the  attempts  at  conserva 
tion  not  rarely  necessitate  consecutive  amputation  as  a  last  means  of  saving  the  life  of  the  patient."  A.  J.  JOBERT  (de  LAMBALLE)  (Plaies  d'armes  a 
feu,  Paris,  1833,  p.  255)  refers  to  contusions  with  denudation  of  the  femur,  and  cites  a  case  in  which  he  amputated  the  thigh  unsuccessfully. 

2STROMEYER  (L.),  Ueberdiebei  Schusswunden  varlcommenden  Knochen  verlelzungen,  Freiburg,  1870,  p.  3.  GIBBONS  (H.),  Contused  Wounds  of 
Bone,  in  the  Pacific  Med.  and  Surg.  Jour,  and  Press,  San  Francisco,  1866,  Vol.  VIII,  p.  284.  LtiCKE  (A.)  (Kriegscliirurgisclte  Aphorismen  aus  dem 
Zweiten  Schleswig  Holsteinschen  Kriege  im  Jahre  1864,  Berlin,  1865,  p.  67)  remarks  that  contusions  of  the  femur  by  musket  balls  are  very  severe  injuries, 
frequently  misapprehended,  and  followed  by  ostitis,  osteomyelitis,  and  even  osteophlebitis,  ar.cl  cites  three  cases  of  which  one  proved  fatal.  JOBERT 
(A.  J.  de  LAMBALLE),  Contusion  des  os,  in  L' Union  Medicate,,  Paris,  1865,  T.  XXV,  pp.  263.  337.  HEIXE  (C.),  Die  Schussverletzungen  der  unteren 
Extremitaten,  Berlin,  I860',  p.  164,  etc.  ARNOLD  (J.)  (Analomiiche  Beitrage  zu  der  Lehre  von  den  Schusswunden,  Heidelberg,  1873)  describes  the  path 
ological  changes  following  contusions  of  the  femur  as  observed  in  his  autopsies  of  six  cases  of  this  injury. 

3LARREY  (H.)  (Hist.  Chir.  du  siege  de  la  Citadelle  d'Anvers,  Paris,  1833,  p.  202,  etc.)  cites  three  successful  instances  of  shot  contusion  of  the 
femur,  and  adds:  "Les  resultats  cons6cutifs  de  cette  blessure,  constates  &  1'hopital,  ont  e~t6  raflh6rence  dela  principale  cicatrice,  1'atrophie  et  1'ankylose 
du  genou."  CHENU  (J.  C.)  (Rapport,  etc.,  pendant  la  Campagne  d'Orienl  en  1854,  1855,  1856,  Paris,  1865,  p.  374)  tabulates  146  cases  of  shot  contusion 
of  the  femur  with  22  deaths,  a  mortality  of  15.0  per  cent.  MATTHEW  (T.  P.)  (Med.  and  Surg.  Hist,  of  the  British  Army,  etc.,  London,  1858,  p.  355) 
tabulates  43  cases  of  shot  contusions  and  partial  fractures  of  the  lower  extremities,  but  it  is  impossible  to  eliminate  from  his  tabulations  the  number  of 
shot  contusions  of  the  femur.  CHEXU  (J.  C.)  (Stat.  Med.  Chir.  de  la  Camp,  d' Italic  en  1859  et  I860,  Paris,  1869,  p.  715)  groups  103  shot  contusions  of  the 
femur  with  13  deaths.  SCHIXZINGER  (A.)  (Das  Reserve-Lazareth  Schwetzingen  im  Kriege  1870  und  1871,  Freiburg,  1873,  p.  69)  observed  10  cases  of  shot 
contusion  of  the  femur.  One  of  the  cases  proved  fatal  from  pysemia,  another  succumbed  to  ansemia  following  arterial  bleeding.  SCIlULLER  (MAX.) 
(Kriegschirurgische  Skizzen  aus  dem  Deutsch-Franzosischen  Kriege,  1870-71,  Hannover,  1871,  p.  66)  cites  2  cases  of  shot  contusion  of  the  femur,  one  in 
the  middle,  the  other  in  the  lower  third ;  both  recovered.  BECK  (B.)  (Chir.  der  Schussverletzungen,  Freiburg,  1872,  p.  677)  reports  15  cases  of  shot  con 
tusions  of  the  femur  in  the  Bavarian  (XII)  Corps  during  the  Franco-Prussian  War,  1870-71,  of  which  3,  or  20  per  cent.,  proved  fatal,  and  remarks:  "  That 
the  shot  contusions,  although  entirely  innocuous  looking  in  the  beginning,  are  apt,  in  the  progress  of  the  case,  to  prove  dangerous,  and  to  convince  the 
surgeon  how  careful  ho  must  be  not  to  overlook  the  sneaking  initiatory  processes  of  inflammation  of  the  periosteum  and  the  interior  of  the  bone." 

4  RAVATOX  (Chirurgie  d'Armee  ou  Traite  des  Plaies  d'armes  a  feu,  etc.,  Paris,  1768,  p.  323):  Les  coups  de  feu  qui  fra^ssent  1'os  de  la  cuisse  dans 
son  cntier,  sont  si  facheux  quo  j'ai  vu  pgrir  tous  ceux  qui  1'ont  eu  fracture."  SCHMUCKER  (J.  L.)  (  Vermischte  Chir.  Schriften,  Berlin  und  Stettin,  1785, 
p.  42):  "  If  the  fracture  is  in  the  lower  part  of  the  bone,  the  danger  is  relatively  a  great  deal  less,  as  the  muscles  are  not  very  powerful  here,  and,  in  such  a 
fracture,  amputation  should  not  be  at  once  performed,  but  all  other  means  should  first  be  tried;  and  very  frequently  T  have  happily  cured  fractures  of  this 
kind;  but  if  the  femur  is  fractured  and  splintered  in  the  middle  or  above  the  middle,  I  never  wait  for  complications,  but  perform  the  operation  before 
they  occur,  and  several  times  I  have  cured  patients  where  the  operation  has  been  done  soon."  BAUDENS  (L.)  (Clinique  des  plaies  d'armes  a  feu,  Paris. 
1836,  p.  460)  remarks:  "  Toute  fracture  de  cet  os  [femur]  par  coup  de  feu  exige  1'amputation  immediate,"  and,  on  page  461,  adds,  that  of  25  cases  with 
fracture  of  the  femur  treated  by  expectation,  only  two  recovered  with  deformed  limbs,  incapable  of  fulfilling  their  functions.  MACLEOD  (Notes  on  the 
Surgery  of  the  War  in  the  Crimea,  London,  1858,  p.  296)  advises  primary  amputation  in  fractures  of  the  middle  and  lower  thirds  of  the  femur ;  but 
where  the  fracture  is  in  the  upper  third  of  the  bone  he  concludes  "  that  slight  as  the  chance  of  saving  life  is  in  any  case,  it  is  still  our  part  to  attempt  con 
solidation  in  preference  to  amputation."  LARREY  (D.  J.)  (Mem.  de  Chir.  Mil.  et  Camp.,  Paris,  1812,  T.  II,  p.  503)  refers  to  a  case  of  simple  shot  fracture 
of  the  femur  without  notable  lesion  of  the  soft  parts  for  which  amputation  had  been  performed  on  the  40th  day,  and  remarks :  "Jo  no  ddsapprouve  point 
cette  operation  ;  car  mon  exp6rience  m'a  appris  quo  toutes  les  plaies  avec  fracture  de  la  cuisse  sont  tres-faehouses,  et  exigent  toutes  en  g6n6ral  1'amputa 
tion  qu'on  no  peut  pas  toujours  pratiquer  dans  les  premiers  momens,  et  c'est  un  des  cas  ou  ello  pout  etro  faite  consdcutivement." 

SHEINE  (C.)  (Die  Schussverletzungen  der  unteren  Extremitaten,  Berlin,  1866,  p.  234)  declares :  "  To-day  it  must  be  accepted  as  an  axiom  that  in 
all  cases  of  shot  fractures  of  the  femur  by  small  projectiles,  uncomplicated  by  injury  of  the  femoral  artery  or  by  opening  of  the  knee  joint,  the  conserva 
tive  treatment  should  by  all  means  be  tried." 


SECT.  III.] 


PARTIAL  SHOT  FRACTURES  OF  THE  SHAFT  OF  THE  FEMUR. 


175 


seventy-six  shot  fractures  of  the  diaphysis  of  the  femur  were  found  on  the  returns,  furnish 
ing  examples  of  every  variety  of  partial  fracture,  of  comminution  of  bone,  of  longitudinal 
fissuring,  of  oblique  or  transverse  fracture,  and  of  detachment  of  large  fragments.  Of 
these  six  thousand  five  hundred  and  seventy-six  shot  fractures  of  the  femur  three  thousand 
four  hundred  and  sixty-seven  were  treated  by  conservation,  and  three  thousand  one  hun 
dred  and  nine  were  followed  by  excision  either  in  the  shaft  of  the  femur  or  at  the  hip  joint, 
or  by  amputation  of  the  thigh  or  exarticulation  at  the  hip. 

TABLE  XX. 

Numerical  Statement  of  Sixty-jive  Hundred  and  Seventy-six  Shot  Fractures  of  the  Shaft  of  the  femur 
unattended  by  Primary  Injury  of  the  Hip  or  Knee  Joint. 


TREATMENT. 

FRACT.  IN  UPPER  THIRD. 

FRACT.  IN  MIDDLE  THIRD. 

FRACT.  IN  LOWER  THIRD. 

POINT  OF  FRACTURE 
UNSPECIFIED. 

1 

o 

Recovered. 

•a 

<u 

ft 

Undeter 
mined. 

Ratio  of 
Mortality. 

3 

a 

o 

Recovered. 

•d 
5 

Undeter 
mined.  ' 

Ratio  of 
Mortality. 

1 

Recovered. 

•a 

V> 

S 

Undeter 
mined. 

Ratio  of 
Mortality. 

3 
1 
o 

Recovered. 

•3 
5 

5 

Undeter 
mined. 

Ratio  of 
Mortality. 

1,254 
11 
25 
73 

1 
1 

669 
4 
2 
25 

572 

7 
23 
47 

1 
1 

13 
1 

46.0 
63.6 
92.0 
65.2 

100.0 

100.0 
73.3 

855 

500 

342 

13 

40.6 

620 

375 

232 

13 

38.2 

738 

145 

538 

55 

78.7 

Excision  at  the  Hip  Joint.  . 
Amputation  at  the  Hip  Joint. 
Excision  in  Shaft  of  Femur 
Excision  in  Shaft  of  Femur 
and  Amp.  at  Hip  

3 

56 

1 
17 

2 
38 

1 

66.6 
69.1 

1 
16 

1 

100.0 

4 

10 

o 

71.4 

23 

3 

16 

4 

84.2 

Excision  in  Shaft  of  Femur 
and  Amp.  in  Thigh  

3 

355 

o 

1 
156 

1 

2 
195 

1 

4 

66.6 
55.5 

50.0 

2 
1,120 

1 
606 

1 
496 

50.0 

92 

24 

66 

2 

18 

45.0 

1,325 

461 

801 

63 

63.4 

Amputation  in  Thigh  and 
Consec.  Amp.  at  Hip  

986 

33 

1,457 

724 

717 

16 

49.7 

1,274 

676 

580 

18 

46.1 

1,759 

740 

42.8 

2,086 

609 

1,355 

122 

68.9 

It  was  found  impracticable  to  eliminate  from  the  large  number  of  cases  aggregated  in 
TABLE  XX  the  instances  of  partial  shot  fractures  of  the  shaft  of  the  femur,  as  frequently 
the  diagnosis  was  too  vague  to  allow  a  distinction  to  be  made  between  a  complete  fracture 
or  a  partial  fracture.  The  Army  Medical  Museum  possesses  eighteen1  specimens  of  partial 

1  Specimen  126  (Cat.  Surg.  Sect.  Army  Med.  Museum,  1866,  p.  260),  the  upper  part  of  the  left  femur,  the  great  trochanter  being  carried  away  by  ;i 

grape  shot.    Spec.  134  (Cat.,  page  260),  upper  half  of  left  femur  with  a  section  of  the  shaft  just  below  the  great  trochanter  gouged  out:  Pt.  A.  B , 

Co.  Gr,  152d  New  York,  aged  34 ;  wounded  June  10,  1864 ;  died,  of  asthenia,  August  29,  1864.    Spec.  1594  (Cat.,  p.  261),  the  upper  portion  of  the  left 

femur,  with  the  great  trochanter  badly  grooved  by  a  musket  ball :  Corporal  J.  M ,  E,  39th  Massachusetts,  aged  19 ;  wounded  at  Petersburg,  April  1, 

1865;  died,  exhausted  after  pleuro-pneumonia,  August  17,  1865.     Spec.  2132  (Cat.,  p.  259),  the  upper  fourth  of  the  right  femur,  the  great  trochanter  being 

partly  fractured.     Spe.c.  2197  (Cat.,  p.  258),  the  right  femur  chipped  and  contused  on  anterior  and  inner  face:  Pt.  G.  S ,  Co.  E,  88th  Illinois,  aged  27; 

wounded  at  Mission  Ridge,  November  27,  1863;  died,  from  exhaustion,  February  18,  1864.    Spec.  2995  (Cat.,  p.  260),  the  upper  third  of  the  left  femur 

partially  fractured  at  the  level  of  the  trochanter  minor:  Pt.  E.  P ,  Co.  A,  38th  Mass.,  aged  19;  wounded  at  Port  Hudson,  June  14th;  died,  from 

exhaustion,  July  27,  1863.     Spec.  3433  (Cat.,  p.  259),  the  upper  third  of  the  left  femur  contused  and  partially  fractured :  Pt.  W.  V ,  Co.  F,  12th  Penn. 

Cavalry,  aged  20 ;  wounded  at  Winchester,  July  24th ;  died,  of  typhoid  fever,  September  29,  1864.     Spec.  3956  (Cat.,  p.  261),  the  shaft  of  the  left  femur 

sawn  longitudinally,  showing  an  oblique  partial  fracture  by  a  conoidal  ball,  which  chipped  the  shaft  in  its  outer  border:  Serg't  J.  O'B ,  Co.  F,  42d 

New  York,  aged  30;  wounded  at  Antietam,  September  17,  1862;  died,  from  pyaemia,  February  17,  1863.     Spec.  140  (Cat.,  p.  260),  the  lowest  third  of  the 

left  femur  grooved  two  inches  above  the  condyles :  Serg't  H.  D ,  Co.  E,  2d  X.  Y.  S.  M.;  wounded  at  Bull  Run,  August  30th ;  died  October  10,  1862. 

Spec.  916  (Cat.,  p.  260).  the  lower  half  of  the  left  femur,  penetrated  in  the  lowest  third,  with  a  slight  osseous  deposit  on  the  neighboring  portion  of  the 

shaft:  Serg't  L.  B ,  Co.  A,  7th  Wisconsin;  wounded  at  South  Mountain,  September  14th;  died  December  29,  1862.     Spec.  1104  (Cat.,  p.  259),  tho 

lower  half  of  the  left  femur  severely  contused  in  the  lowest  third,  with  an  oblique  fissure  around  the  bone.     Spec.  1757  (Cat.,  p.  261),  the  lowest  third 

of  the  right  femur  obliquely  perforated  above  the  external  condyle:  Pt.  M.  K ,4th  Ohio  Cavalry;  wounded  July  10th;  ligation  of  popliteal  and 

femoral  arteries  on  account  of  recurrent  haemorrhage ;  died,  from  exhaustion,  August  14, 1863.     Spec.  1788  ( Cat.,  p.  260),  the  lower  half  of  the  right  femur 

partially  split,  with  a  longitudinal  fragment  nearly  detached:  Pt.  O.  B.  N ,  Co.  K,  3d  Michigan  Cavalry;  wounded  near  Jackson,  July  15th;  died 

October  2,  1863,  of  pyaemia.     Spec.  1924  (Cat.,  p.  260),  the  lowest  third  of  the  left  femur  grooved  on  the  outer  aspect  from  before  backward:  Pt.  S.  T. 

C. ,  Co.  E,  17th  Kentucky;  wounded  at  Chickamauga,  September  19th;  died  November  5.  1863.     Spec.  2370  (Cat.,  p.  261),  the  lower  half  of  the  right 

femur  chipped  by  a  bullet  on  the  outer  side;  part  of  the  injury  repaired  by  a  deposit  of  callus :  Pt.  A.  R ,  Co.  A,  2d  Penn.  Cavalry;  wounded  at  Mine 

Run,  November  29,  1863;  taken  prisoner,  paroled,  and  admitted  into  hospital,  Baltimore,  April  18,  1864 ;  died,  May  22,  1864,  of  pyaemia.  Spec.  4271 
(Cat.,  p.  261),  the  lowest  third  of  the  left  femur,  showing  partial  fracture  of  the  laminated  portion  of  the  shaft  just  above  the  condyles,  with  a  longitudinal 
fissure  upward:  Corp'l  J.  E.  T) ,  Co.  O-,  r?4th  Massachusetts:  wounded  at  Newmarket.  May  15th:  died,  with  typhoid  symptoms,  June  5,  1864. 


176 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X 


PIG.  131.— Partial  shot 
fracture  of  right  femur. 
Spec.  3339. 


shot  fractures  of  the  shaft  of  the  femur.  Two  instances  will  here  be  cited,  and  then  the 
shot  fractures  of  the  femur  treated  by  expectation,  according  to  the  seat  of  the  injury  in 
the  upper,  middle,  and  lower  thirds,  will  be  considered. 

CASE  359. — Private  O.  C.  Higgins,  Co.  D,  31st  Maine,  aged  24  years,  was  wounded  before  Peters 
burg,  June  23,  1864.  Surgeon  J.  Harris,  7th  Khode  Island,  reported  bis  admission  into  tbe  field  hospital 
of  the  2d  division,  Ninth  Corps,  with  a  "shot  wound  of  thigh  caused  by  a  musket  ball."  From  the  field 
hospital  the  wounded  man  passed  to  the  Depot  Hospital  at  City  Point,  and  thence,  on  July  3d,  to  the  Third 
Division  Hospital  at  Alexandria.  Surgeon  E.  Bentley,  U.  S.  V.,  in  charge  of  the  latter,  reported  the  fol 
lowing  description  of  the  injury  and  its  result :  "A  conical  explosive  ball  entered  the  external  aspect  of  the 
middle  third  of  the  right  thigh  anteriorly,  and,  exploding,  scattered  fragments  of  lead  through  the  thigh 
and  partially  fractured  the  femur,  not,  however,  preventing  the  patient  from  using  his  leg  at  will.  Water 
dressings  were  applied.  When  admitted  the  patient  was  not  in  good  condition,  having  been  suffering  from 
diarrhoea  for  some'  time,  for  which  astringents  were  given.  On  July  Cth,  he  was  somewhat  improved. 
The  cold-water  dressings  were  changed  to  warm.  By  July  10th  the  diarrhoeal  discharges  had  ceased,  but 
the  wound  was  very  much  inflamed.  On  July  15th,  a  slight  discharge  of  dark  and  unhealthy  pus  set  in, 
and  flaxseed  poultices  were  applied.  Tonics  and  stimulants  were  administered.  On  July  21st,  the  patient 
felt  better,  and  his  treatment  was  continued.  Two  days  later  there  were  dark  and  unhealthy  discharges 
from  the  wound,  but  the  patient  looked  bright  and  his  tongue  was  cleaning.  Death  occurred  suddenly  at 
4  A.  M.,  011  July  24,  1864,  the  patient  having  been  given  water  to  drink  about  an  hour  previously  by  the 
nurse,  and  no  signs  of  rapid  exhaustion  being  then  apparent.  The  post-mortem  examination,  made  nine 
hours  after  death,  showed  the  thigh  filled  with  fragments  of  the  bullet,  and  a  partial  fracture  of  the  femur; 
there  was  profuse  suppuration  above  and  around  the  bone,  and  great  emaciation.  The  viscera  were  found 
to  be  perfectly  healthy."  The  upper  two-thirds  of  the  injured  femur  were  contributed  to  the  Army  Med 
ical  Museum  by  Dr.  Bentley,  and  are  represented  in  the  wood-cut  (FlG.  131).  The  specimen  shows  the  existence  of  local 
necrosis,  with  trivial  osseous  deposit  near  by,  and  the  traces  of  profuse  suppuration  following  the  fragments  of  lead  are  seen 
in  the  roughening  of  the  shaft. 

In  another  instance  of  partial  shot  fracture  of  the  shaft  of  the  femur,  the  ball,  at  the 
autopsy,  was  found  lodged  in  the  medullary  cavity : 

CASE  360. — Corporal  J.  Higgins,  Co.  A,  159th  New  York,  aged  19  years,  was  wounded  at  Irish  Bend,  April  14,  1863. 
Surgeon  T.  B.  Reed,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  4th  division,  Nineteenth  Corps,  with  a  "shot 
wound  of  leg."  Assistant  Surgeon  P.  S.  Conner,  U.  S.  A.,  contributed  the  pathological  specimen  represented  in  the  annexed 
wood-cuts  (FlGS.  132,  133),  with  the  following  history:  "The  patient  entered  University  Hospital,  New  Orleans,  April  17,  1863. 
Upon  examination  he  was  found  to  have  a  wound  just  below  and  external  to  the  head 
of  the  left  fibula,  the  track  of  the  ball  being  upward  and  inward.  The  missile  had 
not  been  extracted  nor  could  it  be  detected.  There  being  no  evidence  of  fracture,  the 
case  was  regarded  as  a  simple  flesh  wound  and  treated  accordingly.  On  the  seventh 
day  after  admission  haemorrhage  supervened,  but  upon  cutting  down  tlii'ough  the 
popliteal  space  no  bleeding  vessel  could  be  detected,  and  no  further  h;emorrhage 
occurred.  On  passing  the  finger  along  the  track  of  the  wound  the  superior  margin  of 
a  cavity  was  felt,  which  appeared  to  be  a  portion  of  the  femur  partially  split  off  and 
thrown  backward.  There  being  no  displacement  or  other  evidence  of  fracture  extend 
ing  entirely  across  the  shaft,  and  the  man  being  unable  to  give  any  account  of  his 
position  at  the  time  of  receiving  the  injury,  it  was  concluded  that  the  ball  had  lodged 
in  the  femur.  Though  much  prostrated  by  the  loss  of  blood  the  patient  was  rallied 
by  careful  nursing.  As  a  precautionary  measure  the  limb  was  placed  in  an  anterior 
splint  after  a  few  days,  from  which  time  the  case  progressed  quite  favorably  until  May 
15th,  when  rigors  came  on  and  the  patient  failed  rapidly.  He  died  on  May  18,  1863, 

thirty-five  days  after  being  wounded.  At  the  post-mortem  examination  no  inflammation  of  the  knee  joint  was 
discovered,  but  little  pus  at  the  seat  of  the  injury,  and  no  abscesses  in  the  lungs  or  liver.  An  inspection  of  the  specimen  indicates 
that  the  leg  must  have  been  strongly  flexed  on  the  thigh  at  the  time  the  man  was  shot."  The  specimen  shows  longitudinal 
fractures  on  the  anterior  surface  of  the  bone,  with  some  periosteal  thickening,  and  the  ball  lodged  in  the  medullary  canal. 

SHOT  FRACTURES  OF  THE  SHAFT  OF  THE  FEMUR  TREATED  BY 
CONSERVATION. — The  shot  fractures  of  the  shaft  of  the  femur  treated  by  conserva 
tion  numbered  three  thousand  four  hundred  and  sixty-seven.  The  result  of  the  injury 
could  not  be  ascertained  in  ninety-four  instances.  Sixteen  hundred  and  eighty-nine  patients 
recovered,  and  sixteen  hundred  and  eighty-four,  or  49.9  per  cent.,  died.  The  injury  was  on 
the  right  side  in  fourteen  hundred  and  thirty-one  instances,  with  a  mortality  rate  of  47.0 
per  cent.;  on  the  left  in  sixteen  hundred  and  five,  of  which  47.1  per  cent,  died;  in  four 
hundred  and  thirty-one  cases  the  side  of  the  injury  was  not  specified.  The  seat  of  fracture 


FIG.  132.  — Lowest 
third  of  right  femur, 
with  ball  in  medullary 
canal.  Spec.  1296. 


FIG.    133.  —  Anteric 
view  of  Spec.  129G. 


SECT,  ni.1  SHOT   FRACTURES   OF   THE   UPPER   THIRD    OF   THE    FEMUR.  177 

was  in  the  upper  third  in  twelve  hundred  and  fifty-four  instances;  in  the  middle  third,  in 
eight  hundred  and  fifty-five;  in  the  lower  third,  in  six  hundred  and  twenty  cases;  and  in 
seven  hundred  and  thirty-eight  instances  the  precise  seat  of  fracture  was  not  stated. 

Shot  Fractures  of  the  Upper  Third  of  the  Femur  treated  by  Conservation. — Very 
few  instances  of  recovery  after  shot  fractures  in  the  upper  third  of  the  femur  treated  by 
expectation  seem  to  have  been  reported  by  the  older  authors  on  military  surgery,  and  I 
have  been  unable  to  find  more  than  eight  examples  of  recovery  after  this  class  of  injury 
prior  to  the  beginning  of  the  present  century.  In  the  subjoined  foot-note1  an  attempt  is 
made  to  collect  the  instances  of  recovery  after  fractures  in  the  upper  third  of  the  femur,  to 
show  that  in  later  years  these  cases  have  been  by  no  means  as  rare  as  has  generally  been 
believed,  and,  indeed,  the  results  obtained  in  the  American  Civil  War,  and,  subsequently, 

1  The  earliest  instance  of  shot  fracture  of  the  upper  third  of  the  femur  that  I  have  been  able  to  trace  is  a  case  reported  by  Dr.  JOSEPH  SCHMIDT. 
In  his  Speculum  Chirurgicum  oder  Spiegel  der  Artzney,  Augspurg,  1656,  p.  144.  J.  von  Meda,  of  Captain  Newmann's  company,  received  a  shot  fracture 
of  the  upper  third  of  the  femur,  August  31,  1648,  at  Meramingen.  He  recovered  and  was  able  to  go  about  on  crutches.  PUBMAJfX  (M.  G.)  (Funfftzig 
Sonder-und  Wunderbahre  Schusswunden  Curen,  Franckfurt,  1721 )  reports  three  cases  of  recovery  after  shot  fracture  of  the  upper  third  of  the  femur,  viz : 
The  case  of  a  soldier  wounded  at  Ttlrckshansen,  in  November,  1671  (Obs.  I,  p.  32);  the  case  of  Corp'l  C.  Endte,  wounded  before  Stettin  in  1677  (Obs. 
XVIII,  p.  213),  and.  the  case  of  M.  Leschke,  wounded  before  Wolgarth  in  October,  1675  (Obs.  XXXIII,  p.  250).  BKLLOSTE  (Le  Chirurgien  d'Hopital, 
3d  ed.,  Paris,  1716,  p.  206)  relates  the  case  of  Sergeant  LeGrand,  who  received,  in  1686,  a  shot  fracture  of  the  upper  portion  of  the  right  femur,  and,  after 
copious  suppurations  with  exfoliations,  recovered.  The  ball  and  a  fragment  of  the  femur  were  extracted  eighteen  months  after  the  injury.  RAVATOX 
(Chirurgie  d'  Armie,  Paris,  1768,  p.  338)  relates  that  at  the  battle  of  Dettingen,  July  5,  1743,  a  lieutenant  of  cavalry  received  a  shot  fracture  of  the  right 
lesser  trochanter.  On  the  55th  day  five  pieces  of  bone  came  away,  and  the  wound  cicatrized  without  further  accident.  MOSCATI  (Hem.  de  VAcad.  de 
Clrir.,  Paris,  1768,  T.  IV,  p.  625)  relates  the  case  of  a  soldier  of  35,  who,  at  the  battle  of  Crevelt,  June  23,  1758,  received  a  shot  fracture  just  below  the 
trochanters  of  the  right  femur.  He  recovered,  and  was  sent  to  the  Invalides,  at  Paris,  where  he  died  April  13,  1764.  Two  copperplates  well  represent 
the  fracture  united  by  large  masses  of  callus.  DE8AULT  (Jour,  de  Chirurgie,  Paris,  1792,  T.  Ill,  p.  104)  reports  the  case  of  Louis  Waymet,  shot  in  Paris, 
Feb.  28,  1791.  The  ball  passed  through  both  thighs  and  fractured  the  left  femur  in  the  upper  third.  The  patient  recovered  and  walked  well.  FEXECH 
(E.)  (Obs.  recueillics  a  I' Armie  d'Espagne  sur  les  plaits  d'armes  a  feu  aux  txtrimitls,  Paris,  Thesis,  1813,  p.  10)  cites  the  case  of  Lieut.  Larque,  70th 
regiment,  wounded  near  the  right  great  trochanter,  at  Busaco,  Portugal,  September  27,  1810,  and  recovered.  LEGOUEST  (De  la  Desarticulation  Coxo- 

fimorale,  in  Mem.  de  la  Soc.  de  Chir.  de  Paris,  1863,  T.  V,  p.  166):  M.  X was  shot  in  the  left  trochanter  in  1812.     He  recovered  with  four  or  five 

inches  shortening,  and  was  piesented  by  H.  LARKEY,  in  1854,  to  the  surgical  clinic  of  Val  de  Grace.  FOKGET  (Bull.de  la  Soc.  de  Chir.  de  Paris  pendant 
1853-56,  p.  230)  reports  that  a  captain  at  Waterloo,  in  1815,  received  a  shot  fracture  of  the  femur  near  the  trochanter.  Pieces  of  bone  continued  to  come 
away,  and  suppuration  and  fistul«B  yet  existed  in  1852.  HEXXEN  (J.)  (Principles  of  Military  Surgery,  London,  1829,  p.  131)  states  that  a  French  prisoner 
was  brought  to  Brussels  after  the  battle  of  Waterloo,  June,  1815,  whose  right  femur  had  been  struck  by  three  musket  balls,  splintering  the  bone  from  the 
middle  of  the  upper  third  to  within  two  inches  of  the  condyles ;  enormous  suppuration  followed,  and  extensive  incisions  were  made  to  extract  bones  and 
halls,  and  the  patient  recovered.  Four  cases  of  recovery  after  shot  fractures  in  the  upper  thirds  of  the  femur,  received  in  the  Paris  revolution  in  1830,  are 
reported  by  A.  J.  JOBEKT  (DE  LAMBALLE)  (Plaies  d'armes  a  feu,  Paris,  1833,  pp.  262,  264).  LAUUEY  (H.)  (Relation  chirurg.  dts  evenemens  de  Juillet, 

1830,  Paris,  1831,  pp.  1P2,  106)  relates  two  instances  of  recovery  after  shot  fracture  of  the  upper  third  of  the  femur:  Cases  of  M.  de  Saint  C.,  and  H , 

7th  regiment.  AUXAL  (Mem.  sur  quelques  peculiarity  desplaies  par  armes  a  feu,  in  Jour.  Held,  de  Mid.  et  de  Chir.  prat.,  Paris,  1831,  p.  36)  reports  two 
cases.  A  member  of  the  National  Guard  of  Lyon  recovered  after  a  shot  fracture  of  the  neck  of  the  femur,  in  1831  (GEXSOUL,  Note  sur  lei  blesses  recus 
a  V Hotel- Dieu  de  Lyon,  pendant  Its  troubles  de  1831,  in  Gaz.  Sled,  de  Paris,  1833,  No.  43,  p.  300).  LAUUEY  (H.)  (Hist.  chir.  du  siege  de  la  Citad.  d'Anvers, 
Paris,  1833,  p.  21fi)  cites  four  cases  of  shot  fractures  of  the  upper  portion  of  the  femur  treated  successfully  during  the  siege  of  Antwerp,  in  1832.  LEGOUEST 
(loc.  cit.,  p.  167)  gives  the  successful  case  of  Tanguel  of  the  2d  light  infantry,  wounded  in  the  right  trochanter,  at  Cherchell,  in  January,  1841.  The 
same  author  states  that  SEDILLOT  successfully  treated  a  shot  fracture  of  the  right  trochanter  in  a  lieutenant  of  artillery,  wounded  in  a  duel  in  1843. 
According  to  HUGUIEU  (Bulletin  de  la  Soc.  de  Chir.  de  Paris  pendant  1855-56,  Paris,  1856,  p.  230),  Dr.  GEUDY  successfully  treated  a  shot  fracture  of  the 
trochanter  in  1848.  (This  is  probably  the  case  of  Guiton,  alluded  to  in  Gaz.  des  H6p.,  1848,  p.  98.)  BAUDEXS  (Des  plaies  d'armes  a  feu — Communica 
tions  faites,  etc.,  Paris,  1849,  p.  231)  cites  a  case  of  shot  fracture  of  the  upper  third  of  the  femur  in  1848 ;  the  patient  recovered.  AMUSSAT  (Des  Plaies 
d'armes  a  feu — Communications,  etc.,  Paris,  1849,  p.  55,  refers  to  a  case  of  recovery.  During  the  discussion  on  disarticulation  at  the  hip  at  the  meetings 
of  the  Surgical  Society  of  Paris  (Bulletin  de  la  Soc.  de  Chir.  de  Paris,  1855-56,  pp.  230-234),  on  October  24  and  October  31,  1855,  GlliALDES,  ROBEUT, 
and  DEXOXVILLJERS  gave  details  of  three  cases  of  recovery  after  shot  fractures  of  the  upper  third  of  the  femur.  SCHWARTZ  (H.)  (Beitrage  zur  LeJtre 
von  den  Schusswunden,  Schleswig,  1854,  pp.  154  and  167)  cites  two  cases:  J.  G ,  wounded  at  Altendorf,  April  21,  1848,  fracture  of  the  great  tro 
chanter  ;  fragments  of  bone  removed ;  recovery.  C.  B ,  of  the  Berlin  volunteers ;  fracture  of  trochanter  minor ;  recovery  in  four  months.  HUT1X 

(Recherches  sur  le  resultat  des  fractures  de  la  moitie  superieure  de  la  cuisse,  in  Rec.  de  Mem.  de  Mid.  de  Cliir.  et  de  Phar.  Mil.,  1854,  2me  s6rie,  T.  XIV, 
p.  2(i3)  found  among  the  inmates  of  the  Hotel  des  Invalides  at  Paris,  from  1847  to  1853,  seventeen  patients  who  had  recovered  from  shot  fractures  of  the 
upper  third  of  the  femur.  MATTHEW  (loc.  cit.,  Vol.  II,  pp.  361,  362)  relates  two  cases  of  recovery  after  shot  fracture  of  the  upper  third  of  the  femur:  An 
officer  of  the  17th  regiment,  wounded  September  8,  1855,  by  a  rifle  ball,  which  fractured  the  trochanter  major  of  the  left  femur.  On  November  llth,  the 
bone  had  united,  and  there  was  only  slight  shortening  of  the  limb.  J.  Fitzball,  62d  regiment,  received,  September  8,  1855,  a  shot  fracture  of  the  femur  at 
the  junction  of  upper  and  middle  thirds.  He  recovered,  with  11  inches  shortening.  LOXGMOUE  (T.)  (HOLMES's  System  of  Surgery,  2d  ed.,  1870,  Vol.  II, 

p.  225)  details  the  case  of  Lieut.  D.  M ,  19th  regiment,  who  received  a  shot  fracture  of  the  left  femur  on  September  9,  1855.    On  February  22d,  the 

union  of  bone  was  firm.  In  1856,  "the  stiffness  of  joints  gradually  disappeared,  and  the  patient  was  enabled  to  return  to  duty.''  Among  the  282  pen 
sioners  after  injuries  of  the  thigh,  recorded  by  name  by  M.  CHEXU  in  his  Rapport,  etc.,  pendant  la  Campagne  d'Orient  en  1854,  1855,  1856,  Paris,  1865, 
pp.  375-397,  37  cases  of  recovery  are  found  after  shot  fracture  of  the  upper  third  of  the  femur.  From  the  same  campaign,  L.  BAUDEXS  (La  Guerre  de 
Crimee,  Paris,  1858,  pp.  3:iO,  331,  336)  reports  a  case  of  recovery  after  shot  fracture  of  the  upper  third  of  the  femur  among  the  French  troops,  not  recorded 
by  CHEXU :  J.  Albaric,  80th  line,  upper  third  of  right  femur,  Sept.  8,  1855 ;  and  two  cases  of  recoveries  among  the  Russian  prisoners :  Jusef  Testanief, 
left  femur,  just  below  the  trochanter  major,  and  S.  Zarepa,  fracture  of  right  femur  at  the  trochanter  major.  WlLUAMSOX  (G.)  (Military  Suryery,  Lon 
don,  1863,  pp.  141,  142)  records  six  cases  of  recovery  after  shot  fracture  of  the  upper  third  of  the  femur:  Private  P.  Carty,  64th  regiment,  wounded  at 
Lucknow  in  1857.  Private  J.  Ashworth,  53d  regiment,  wounded  November  1,  1857;  July  14,  1858,  wounds  healed.  Private  J.  Hewitt,  52d  regiment, 
wounded  July  12,  18.77;  wounds  healed  July  20,  1858  ;  and  Private  E.  Collins,  75th  regiment,  wounded  at  Delhi,  June  8,  1857;  September  6,  1858,  sent 
to  modified  duty;  and  cases  of  Williams  and  Curtis,  on  p.  151.  In  the  Italian  War  of  1859,  H.  DEMME  (Militar-Chir.  Studien,  WUrzburg,  1864,  B.  II, 
p.  365)  tabulates  43  cases  of  shot  fractures  of  the  upper  (bird  of  the  femur  treated  conservatively  among  the  Austrian  troops,  of  which  18  recovered, 
giving  a  fatality  of  58.1  per  cent.  Among  the  French  wounded  in  the  same  campaign,  named  by  ClLEXU  (Stat,  med.  chir,  de  la  Campagne  d'Jtalie  en 
SURG.  Ill— 23 


178  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

in  the  Franco-Prussian  War,  1870-71,  have  been  highly  encouraging,.1    From  the  statistics 

O          •/  <— >          CJ1 

in  TABLE  XX,  ante,  it  will  be  seen  that  of  twelve  hundred  and  fifty-four  cases  of  shot 
fracture  of  the  upper  third  of  the  femur  treated  by  expectation,  six  hundred  and  sixty-nine 
recovered,  and  five  hundred  and  seventy-two  proved  fatal;  while  in  thirteen  instances  the 
result  could  not  be  ascertained,  giving  a  mortality  of  only  46.0  per  cent. 

Recoveries  after  Shot  Fractures  of  the  Upper  Third  of  the  Femur  treated  by  Con 
servation. — Of  the  six  hundred  and  sixty-nine  cases  of  this  group,  two  hundred  and  ninety- 
eight  were  on  the  right,  and  three  hundred  and  thirty-four  on  the  left  side ;  in  thirty-seven 
instances  the  side  was  not  specified.  Five  hundred  and  fifty-one  patients  were  Union,  and 
one  hundred  and  eighteen  were  Confederate  soldiers. 

CASE  361.— Private  W.  Eigney,  Co.  G,  21st  New  York  Cavalry,  aged  18  years,  was  shot  near  Bladensburg,  May  27, 
1865.  Surgeon  B.  B.  Wilson,  U.  S.  V.,  reported  his  admission  to  Stanton  Hospital,  Washington,  May  29th,  with  "shot  wound 
of  right  nates  and  right  thigh,  fracturing  the  femur,  received  while  running  the  guard."  The  method  of  treatment,  however, 
was  not  stated.  On  September  13th  the  patient  was  transferred  to  Harewood  Hospital,  whence  Surgeon  E.  B.  Bontecou,  U.  S.  V., 
described  his  condition  as  follows  :  "  He  was  admitted  convalescing  from  a  fracture  of  the  upper  third  of  the  femur,  caused  by  a 
revolver  ball,  the  injured  bone  having  firmly  united  with  two  inches  shortening  and  very  slight  deformity.  His  constitutional 
condition  was  good,  and  he  was  able  to  go  about  on  crutches  and  had  good  prospects  of  a  useful  limb."  One  month  afterwards 
the  man  was  transferred  to  De  Camp  Hospital,  David's  Island,  New  York,  and  on  June  26,  1866,  he  was  discharged  from 
service  and  pensioned.  Examiner  W.  G.  Davis,  of  Lyons,  New  York,  certified,  July  1,  1872:  "Pistol  shot  wound  of  right 
thigh,  the  ball  entering  posteriorly  and  fracturing  the  femur  just  below  the  trochanter  major.  There  is  considerable  deformity 
and  two  and  a  half  inches  shortening.  Pieces  of  bone  discharged.  Has  pain  in  the  limb  in  damp  weather.  Cannot  rotate  the 
thigh  or  flex  it  upon  the  pelvis,  and  has  pain  in  it  if  he  works,  stands  long,  or  lifts  heavy  loads."  No  material  changes  were 


1859  et  1860,  Paris,  1809,  T.  II,  p.  715,  etc.),  50  cases  of  recovery  are  found  after  shot  fracture  of  the  upper  third  of  the  femur  treated  by  conservation. 
ROUX  (J.)  (D.'sarticulation  de  la  cuisse,  Paris,  1860)  cites  9  cases  of  recovery  after  shot  fracture  of  the  upper  third  of  the  femur  in  the  Italian  campaign 
of  1859-60,  not  contained  in  CHENU'S  list,  viz:  Barka-ben-Brahim,  3d  Turks;  G.  Barbet,  100th  line;  B.  Girel,  65th  line;  J.  Hyvan,  1st  Zouaves;  J. 
Labastoule,  15th  line;  P.  Mignucci,  1st  Zouaves;  J.  Pamary,  85th  line:  F.  Rousselot,  5th  Battalion;  C.  Rossignol,  6th  line.  GHEUIXI  (A.)  (Relazione 
chlrurgica  dell'  Ospedale  m.llita.re  provisorio  di  S.  Filippo,  in  Annali  Universali  di  Medicina,  Milano,  I860,  pp.  459,  460)  tabulates  9  cases.  Mot 'AT 
(The  New  Zealand  War  of  1863-64-65,  in  Stat.  San.  and  Med.  Reports  for  the  year  1865,  London,  1867,  Vol.  VII,  pp.  502-3)  tabulates  2  cases  of  recovery. 

HKINE  (C.)  (Die  SchussverUtzungen  der  Unteren  Extremitdten,  Berlin,  1866,  p.  251):  J ,  shot  fracture  of  upper  portion  of  right  femur,  April  18,  1804  ; 

recovered,  with  1|  inches  shortening.  From  the  Austro-Prussian  campaign  of  1866,  B.  BECK  (Kriegschirurgisclie  Erfahrungen,  1867,  p.  294)  reports  4 
cases ;  STKOMEVEi:  (L.)  (Erfahrungen  iiber  Schusswunden  im  Jahre  1866,  Hannover,  1867,  p.  53)  3  cases;  R.  BlEFEL  (LANGENHECK's  Archiv,  1869,  B. 
XI,  p.  445)  1  case;  and  MA  AS  (Kriegschirurgisclie  Beitrage,  Breslau,  1870,  p.  40)  3  instances  of  recovery  after  shot  fracture  of  the  upper  third  of  the 
femur.  GlUTTI  (R.)  (Nunvi  document!  infavore  della  euro,  conservativa,  etc..  in  Annali  Universali  di  Medicina,  Milano,  1868,  Vol.  CCV,  p.  518,  et.  se.q.) 
gives  details  of  10  successful  cases  of  fracture  of  the  upper  third  of  the  femur.  From  various  sources  it  has  been  possible  to  collect  264  instances  of 
recovery  after  shot  fractures  of  the  upper  third  of  the  femur,  received  during  the  Franco-German  War  of  1870-71.  Of  these  cases  were  reported  among 
the  German  forces:  By  B.  BKCK  (Chirurgie  der  Schussverletzungen,  Freiburg,  1872,  p.  694),  28  cases;  by  W.  KOCH  (Notizen  iiber  Schussverletzungen,  in 
LANGENBECK'S  Archiv,  1872,  B.  XIII,  p.  474,  etc.),  5;  by  A.  SOCIN  (Kriegschir.  Erfahr.,  Leipzig,  1872,  p.  134),  6;  by  G.  FlSCHEK  ( Dorf  Floing  und 
Schloss  Versailles,  in  Deutsche  Zeitsch.  fur  Chir.,  Leipzig,  1872,  B.  I,  pp.  185  and  224,  etc.),  8;  by  OTT  (Wiirtemburg.  Med.  Correspondenz-Blatt,  1871, 
p.  169),  5;  by  H.  FlSCHEtt  (Kriegschir.  Erfahr.,  Erlangen,  1872,  p.  171,  etc.),  4;  by  CZERXY  (Bericht  iiber  die  im  College  Stanislaus  in  Weissenburg 
behandelten  verwundeten,  in  Wiener  Medizinische  Wochenschrift,  1870,  No.  57,  p.  1373),  3 ;  by  A.  SCHINZINGER  (Das  Reserve- Lazareth  Schwetzingen, 
Freiburg,  1873,  pp.  70,  71),  3;  by  H.  LOSSES  (Kriegschir.  Erf.,  in  Deutsche  Zeitschrift  fiir  Chir.,  1873,  B.  II,  p.  112),  2;  by  TH.  BlLLKOTH  (Chir. 
Brief t,  Berlin,  1872,  p.  228),  2;  by  KUCHLER  (Memorabilien,  1871,  B.  XVI,  p.  141),  2;  by  GUAF  (E.)  (Die  Koniglichen  Reserve-Lazarethe  zu  Dilsseldorf 
wahrend  des  Krieges  1870-71,  Elberfeld,  1872,  p.  62),  2;  and  by  C.  KlKCHXEU  (Aerztlicher  Bericht  iiber  das  K.  P.  Feldlazareth  im  1'alast  zu  Versailles, 
Erlangen,  1872,  p.  56),  by  GUTEKUNST  (Zeitschrift fiir  Wundarzte  und  Geburtshulfe,  1870-71,  p.  146),  by  GOLIUAMMEK  (Berliner  Klinische  Wochen- 
schrifl,  1871,  B.  VIII,  p.  150),  by  STALL  (Bericht  aus  dem  K.  Wiirttembergischen  4  Feldhospital,  in  Deutsche  Mil.  Zeitschrift,  1874,  B.  Ill,  p.  197),  1  each ; 
a  total  of  74  cases  among  the  German  troops.  Of  the  cases  of  recovery  after  shot  fracture  of  the  upper  third  of  the  femur  among  the  French  troops  in 
3870-71:  SEUILLOT  (Fractures  des  membres  par  armes  de  guerre,  in  Arch.  Gen.  de  Med.,  1871,  6m<!  s6r.,  T.  XVII,  p.  423,  etc.)  reports  10  cases;  A.  W. 
ROALDES  (Des  fractures  compliquees  de  la  cuisse,  Paris,  1871,  pp.  43,  44,  46),  4;  A.  CHIPAULT  (Fractures  par  armes  a  feu,  Paris,  1872,  pp.  4,  7,  19,  et 
seq.),  3;  andWM.  MACCOUMAC  (Notes  and  Recollections  of  an  Ambulance  Surgeon,  London,  1871,  pp.  120,  129),  4;  CHHISTIAN  (J.)  (Relation  sur  tcs 
plaies  de  guerre,  in  Gaz.  Mi'd.  de  Strassbourg,  1872,  p.  283),  4 ;  FELTZ  et  GEOLLEMUND  (Rel.  Clin.  sur  les  Ambulances  de  Hagenait,  in  Gaz.  Med.  de 
Strassbourg,  1871,  No.  11,  p.  133),  5;  JOESSELL  (Ambulance  du  Petit  Quartier  a  Haguenau,  in  Gaz.  MM.  de  Strassbourg,  1871,  p.  8),  li;  MOYKIEU  (E.) 
(Ambulance  de  la  Rue  Saint  Lazare,  in  Gaz.  des  Hop.,  1871,  Vol.  XLIV,  p.  445),  1;  PAX  AS  (F.)  (Mem.  sur  le  traitement  des  blessures,  in  Gaz.  Hebd.  de 
Med.  et  de  Chir.,  1872,  T.  IX,  p.  391),  2 ;  VASLIN  (L.)  (Etude  sur  les  plaies  par  armes  a  feu,  Paris,  1872,  pp.  114,  120,  etc.),  3 ;  and  among  the  pensioners 
enumerated  by  M.  CIIEKU  (Apercu  hist.  stat.  et  din.,  etc.,  des  armies  pendant  la  guerre  de  1870-71,  Paris,  1874,  p.  153,  et  seq.),  150  cases  are  found. 
Five  of  these  are  included  in  the  reports  of  SEUILLOT  (1),  CHIPAULT  (2),  ROALUE6  (1),  MACCOUMAC  (1),  ante,  leaving  151  additional  cases.  To  these 
should  be  added  9  cases  of  French  pensioners  reported  by  MOSSAKOWSKY  (Stat.  Bericht  ueber  1514  Franzosische  Invaliden,  in  Deutsche  Zeitschrift  fiir 
Chir.,  1872,  B.  I,  p.  342,  et  seq.),  not  contained  in  CHEXU  ;  and  4  cases  of  German  invalids,  detailed  by  BEKTHOLD  (Deutsche  Militair-arztl.  Zeitschrift, 
1872,  B.  I,  p.  522).  One  case  is  reported  by  G.  TILING  (Bericht  ueber  die  124  im  Serbisch-Tiirkischen  Kriege  (1876),  etc.,  behandelten  Schussverletzungen^ 
Dorpat,  1877,  p.  66).  The  489  cases  of  recovery  of  shot  fractures  in  the  upper  third  of  the  femur  under  conservative  treatment,  here  referred  to,  must 
convince  the  reader  that  recoveries  under  such  circumstances  are  not  as  infrequent  as  the  older  writers  on  military  surgery  contended. 

'BKCK  (B.)  (Chir.  der  Schussverletzungen,  Freiburg,  1872,  p.  694,  etc.)  details  37  cases  of  shot  fractures  of  the  lemur  in  the  upper  third,  of 
which  28  recovered  and  9  proved  fatal,  and  remarks:  "Unfortunately,  I  have  not  been  able  to  give  an  entirely  precise  account  regarding  the  proportion  of 
the  seat  of  the  fractures  in  the  various  parts  of  the  femur,  and  the  corresponding  mortality,  as  frequently  the  seat  of  the  fracture  was  not  clearly  designated. 
But  I  can  say  this  much,  that  I  had  reason  to  be  very  well  satisfied  with  the  results  of  the  fractures  in  the  upper  third,  providing  the  lesion  was  not  too 
extensive  and  severe.  The  fractures  in  the  middle  third  at  the  junction  with  the  upper  always  made  the  most  unfavorable  impression  upon  me,  on 
account  of  the  frequent  injuries  and  lesions  of  the  bloodvessels,  which,  through  frequent  and  even  profuse  bleedings,  etc.,  easily  lead  to  fatal  results,  aud 
which  should,  therefore,  be  carefully  investigated  at  the  place  of  first  dressing,  and,  if  necessary,  at  once  subjected  to  the  proper  operation." 


Med  and  Surg.  Hist  of  the  Wai-  of  the  Rebellion .  Part  HI   Vol  Jl.ChapX 


Ward    phot 


J.Bien    lith. 


PLATE       LIX.- CONSOLIDATED    GUNSHOT  FRACTURES   OF  THE  FEMUR 


Fig.  I.  Case  of  Private  W.  Rigney 

21  ».*  "N"ew  Tork  Cavalrv. 


Fis.  2  Case  of  Corporal  T.  Crasslev 
69  ^  Nev\-York. 


SECT.  III.] 


SHOT  FRACTURES  OF  UPPER  THIRD  OF  FEMUR. 


179 


reported  at  subsequent  examinations.  The  pensioner  was  paid  June  4.  1879.  Photographs  taken  at  the  Harewood  Hospital  in 
October,  1865,  were  contributed  by  Surgeon  Bontecou.  (Photo's  of  Suryical  Cases,  Vol.  8,  No.  4,  Card  Photo's,  Vol.  3,  p.  32.) 
A  copy,  taken  at  the  Army  Medical  Museum  (Photo.  Series,  No.  Ill),  is  represented  in  FIG.  1  of  PLATE  LIX,  oppl  p.  178. 

CASE  362. — Captain  D.  Lewis,  Co.  G,  8th  Ohio,  aged  26  years,  was  wounded  at  the  Wilderness,  May  6,  1864,  by  a  mini6 
ball,  which  entered  the  external  part  of  the  left  thigh  about  the  junction  of  the  upper  and  middle  third,  fractured  the  femur,  and 
made  its  exit  at  the  left  buttock  two  inches  from  the  anus.  He  was  conveyed  to  Fredericksburg  and  treated  with  a  double  inclined 
plane  for  three  weeks.  On  May  26th  he  was  removed  to  a  private  dwelling  in  Washington,  where  he  was  attended  by  Acting 
Assistant  Surgeon  G.  K.  Smith,  who  applied  Buck's  method  of  treatment.  There  was  but  little  suppuration  or  constitutional 
disturbance,  and  by  July  9th  the  fracture  had  so  far  united  as  to  permit  the  patient  to  walk  on  crutches.  On  July  13,  1864, 
Captain  Lewis  was  mustered  out  by  reason  of  expiration  of  service,  and  pensioned.  In  October  following  his  wound  had  entirely 
healed,  and  soon  afterwards  he  was  able  to  walk  on  the  injured  limb.  Subsequently  he  was  for  some  years  an  employ6  in  the 
Treasury  Department.  On  August  22,  1865,  his  photograph  was  taken  at  the  Army  Medical  Museum  (Photo.  Series  of  Surgical 
Cases,  No.  91,  A.  M.  M.),  at  which  time  he  was  in  excellent  health,  and  the  injured  limb  showed  no  other  deformity  than  one  and 
a  half  inches  shortening.  The  St.  Louis  Examining  Board,  in  September,  1874,  certified  to  "occasional  lameness  and  soreness." 
The  pensioner  was  paid  March  4,  1879.  His  photograph  is  represented  in  FlG.  1  of  PLATE  LVIII,  opp.  p.  180. 

CASE  363. — Private  John  Durkin,  Co.  G,  llth  Infantry,  aged  30  }rears,  was  wounded  at  Gettysburg,  July  2,  1863,  by  a 
conoidal  ball,  which  entered  the  outer  side  of  the  upper  third  of  the  left  thigh,  and,  passing  obliquely  inward  and  downward, 
produced  a  comminuted  fracture  of  the  femur.  On  the  3d  he  was  admitted  to  the  Seminary  Hospital  at  Gettysburg,  where,  on 
the  8th,  Assistant  Surgeon  W.  R.  Ramsey,  IT.  S.  A.,  made  an  incision  three 
inches  in  length  a  short  distance  below  and  opposite  the  point  of  entrance,  and 
extracted  the  ball.  On  the  31st  he  was  transferred  to  the  Camp  Letterman 
Hospital,  where,  so  far  as  recorded,  expectant  treatment  only  was  used.  At 
this  hospital  a  surgeon,  who  took  charge  of  the  case  on  August  19th,  "found 
the  limb  lying  in  bed,  without  either  splints  or  bandage;  wounds  discharging 
freely;  considerable  shortening  of  leg;  ordered  junk  bags,  placed  Barton's 
handkerchief  to  foot,  and  made  extension  and  counter-extension."  On  the 
next  day  the  leg  was  reported  the  same  length  as  the  right  one.  On  Septem 
ber  10th  there  was  very  little  suppuration,  and  the  bones  were  uniting;  but, 
on  the  30th,  the  discharge  still  continued,  and  the  patient  was  reported 
"sinking."  On  November  8th,  he  was  transferred  to  the  Newton  University 
Hospital  at  Baltimore,  where,  on  December  2d,  Acting  Assistant  Surgeon  W. 
S.  Smiill  made  an  incision,  three  inches  in  length,  down  to  the  injured  part, 
and  removed  a  small  fragment  of  bone.  On  February  19,  1864,  the  wound 
was  still  suppurating  freely,  and  presented  indications  of  the  presence  of 
necrosed  bone.  The  limb  was  shortened  four  inches.  The  patient  was  fur- 
loughed  on  June  30,  1864,  and  at  its  expiration  was  admitted  to  the  post 
hospital  at  Fort  Independence,  Boston  Harbor,  the  recruiting  depot  of  the  llth 
Infantry,  where  he  was  discharged  the  service  April  30,  1865,  for  disability 
arising  from  gunshot  fracture  and  "excision  of  four  inches  of  the  upper  third 
of  the  femur,  performed  previous  to  admittance."  The  wound  was  still  sup 
purating,  and  there  was  partial  anchylosis  of  knee.  Prior  to  his  admission  to 
the  latter  hospital  there  is  no  mention  of  an  excision.  The  patient  became  an 
inmate  of  Old  Soldiers'  Home ;  and  on  August  3,  1868,  he  visited  the  Army 
Medical  Museum  and  had  his  photograph  (FlG.  134)  taken.  He  states  that 
Dr.  Smull  excised  four  inches  of  the  shaft  of  femur  at  Newton  University 
Hospital  in  December,  1863;  that,  at  the  time  of  the  operation,  there  was  profuse  suppuration  from  the  wound  and  abscesses  in 
the  thigh,  and  that  Smith's  anterior  splint  was  used.  At  the  date  of  his  visit  to  the  Museum  open  fistulous  sinuses  remained.  The 
patient's  statement  at  Fort  Independence  undoubtedly  led  to  the  above  diagnosis ;  and,  from  the  treatment  pursued  prior  to  his 
admission  to  Newton  University  Hospital,  coupled  with  the  report  of  the  operation  made  the  same  month,  it  is  most  plausible  to 
believe  that  the  great  shortening  is  not  to  be  attributed  to  excision.  The  Boston  Examining  Board  in  September,  1873,  reported 
the  wound  of  entrance  to  be  still  discharging.  The  pensioner  was  paid  March  4,  1874,  since  when  he  has  not  been  heard  from. 

CASE  364. — Private  A.  F.  Dinsmore,  Co.  E,  3d  Michigan,  aged  19  years,  was  wounded  at  Fair  Oaks,  May  31,  1862, 
and  admitted  to  Hygeia  Hospital,  Fort  Monroe,  four  days  afterwards.  On  June  12th  the  wounded  man  was  transferred  on 
board  of  the  Hospital  Steamer  Fulton  and  conveyed  to  New  York.  Surgeon  J.  Simons,  U.  S.  A.,  reported  that  he  was  admitted 
to  De  Camp  Hospital,  David's  Island,  June  15th,  and  discharged  from  service  April  9,  1863,  by  reason  of  "shot  fracture  of  left 
thigh."  Several  months  afterwards  the  man  entered  the  Veteran  Reserve  Corps,  and  after  serving  in  that  organization  for  three 
years  he  was  mustered  out  and  pensioned.  Subsequently  the  pensioner  received  employment  as  clerk  in  the  General  Land 
Office,  and  in  December,  1866,  he  visited  the  Army  Medical  Museum,  where  his  photograph  was  taken  (Photo.  Series  of 
Surgical  Cases,  No.  157,  A.  M.  M.).  At  that  time  he  was  in  good  health,  though  the  missile,  a  musket  ball,  which  fractured  the 
femur  at  the  upper  third,  was  still  lodged  in  the  limb.  The  bone  was  firmly  united,  union  having  occurred,  according  to  his 
statement,  about,  seven  months  after  the  injury,  and  his  treatment  having  been  by  moderate  extension  and  counter-extension. 
He  also  stated  that  numerous  detached  fragments  were  removed.  Examiner  J.  B.  Bascom  certified,  September  4,  1873 :  "Gun 
shot  fracture  of  left  femur.  The  ball  remains  in  the  hip.  A  fistulous  opening  finally  healed,  but  occasionally  breaks  out  again. 
There  is  a  large  indurated  cicatrix  over  the  trochanter  major  and  several  smaller  ones,  caused  by  the  opening  of  abscesses," 
The  pensioner  was  paid  June  4,  1879.  A  copy  of  the  photograph  is  shown  in  FlG.  2  of  PLATE  LVIII,  opp.  p.  180. 


FIG.  134. — Result  of  shot  fracture  in  the  upper  third  of 
the  femur.     [From  a  photograph.] 


180 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


CASE  365. — Private  H.  A.  Wiggins,  Co.  K,  37th  Massachusetts,  age  24  years,  was  wounded  in  the  left  thigh,  at  the 
Wilderness,  May  5,  1864.  Three  weeks  afterwards  he  was  admitted  to  hospital  in  Alexandria,  whence  Surgeon  E.  Bentley, 
U.  S.  V.,  reported  the  injury  as  a  "shot  fracture  of  the  upper  third  of  the  femur,  caused  by  a  musket  ball."  In  April,  1865, 
the  patient  was  transferred  to  Dale  Hospital,  Worcester,  and  subsequently  to  DeCamp  Hospital,  David's  Island,  where  he  was 
ultimately  discharged  September  21,  1865,  Assistant  Surgeon  W.  Webster,  tJ.  S.  A.,  certifying  to  "angular  union  of  the  frac 
tured  bone,  with  five  inches  shortening;  wasting  and  powerlessness  of  the  limb,  and  anchylosis  of  the  knee  joint.  Wound  not 
healed."  One  month  after  leaving  the  service  the  man  was  supplied  with  an  apparatus  for  the  injured  limb  by  Dr.  E.  D. 
Hudson,  of  New  York  City.  In  a  communication,  received  during  July,  1866,  and  corroborated  by  a  statement  by  Dr.  W.  J. 
Sawin,  late  Surgeon  2d  Vermont,  the  pensioner  related  the  following  in  regard  to  his  case:  "The  ball  and  eight  pieces  of  bone 
were  removed  from  my  leg  on  the  field,  and  a  second  operation  was  performed  at  the  Fredericksburg  hospital,  where  Surgeon 
Sawin  extracted  four  pieces  of  bone."  He  also  alleged  that  a  third  operation  was  performed  while  he  was  an  inmate  of  the 
Alexandria  hospital,  and  that  he  had  recently  removed  a  fragment  of  bone  himself,  making  altogether  some  fifty-five  pieces 
that  were  removed  from  the  limb.  Three  fistulous  openings  were  described  as  existing  in  the  injured  thigh.  The  pensioner 
further  represented  himself  as  having  been  able  for  two 
months  to  move  about  with  the  aid  of  a  cane  and  without 
crutches,  and  added  that  since  he  was  wounded  his  weight 
had  become  reduced  from  one  hundred  and  seventy-four 
pounds  to  one  hundred  and  twenty-nine,  and  was  steadily 
decreasing.  Examiner  E.  Barton,  of  Orange,  Massachu 
setts,  certified,  January  2,  1867  :  "There  is  an  open  ulcer 
near  the  hip,  from  which  fragments  of  bone  are  frequently 
discharged ;  the  knee  joint  is  nearly  perfectly  anchylosed, 
and  from  the  loss  of  bone  the  limb  is  five  and  a  half  inches 
shorter  than  the  other.  The  foot  is  distorted,  and  he  does 
oot.know  when  it  is  cold.  With  the  aid  of  an  apparatus  he 
walks  very  comfortably."  No  new  facts  were  reported  at 
subsequent  examinations.  The  pensioner  Avas  paid  March 
4,  1879.  His  card  photograph,  taken  at  his  home  in  July, 
1866,  was  contributed  (Card  Photos.,  A.  M.  M.,  Vol.  II, 
p.  21),  an  enlarged  copy  of  which,  taken  at  the  Army  Med 
ical  Museum  (Surg.  Phot.  Scries,  No.  152),  is  represented 
in  the  wood-cut  (FiG.  135). 

CASE  366.— Private  I.  Wetzel,  Co.  I,  184th  Penn 
sylvania,  aged  21  years,  was  wounded  in  the  left  thigh 
during  the  siege  of  Petersburg,  October  3,  1864.  He  was 
admitted  to  a  field  hospital  of  the  Second  Corps,  and  trans 
ferred  to  Armory  Square,  Washington,  five  days  afterwards. 
In  July,  1835,  Acting  Assistant  Surgeon  H.  A.  Bobbins 
reported  the  following  description  of  the  injury  and  its  re 
sult  :  "A  conical  ball  entered  the  anterior  aspect  of  the  limb 
one  inch  below  Poupart's  ligament,  passed  backward,  frac 
turing  the  femur  near  the  trochanters,  and  made  its  exit  at 
the  apex  of  the  left  nates.  The  limb  was  treated  in  Hod- 
gen's  splint  without  extension.  The  bone  is  now  united 
with  three  and  a  quarter  inches  shortening ;  the  foot  is  everted  and  the  limb  slightly  turned  outward.  Incomplete  anchylosis 
of  the  knee  joint  exists,  and  there  is  still  a  discharge  of  healthy  pus  amounting  to  about  one  ounce  daily.  The  patient  is  not 
yet  able  to  use  crutches,  but  from  present  appearances  he  soon  will  be."  The  patient  was  discharged  from  service  on  August 
21,  1885,  and  pensioned.  Various  Pension  Examiners,  at  successive  dates,  certified  to  "shortening  of  the  limb  and  partial 
anchylosis  of  the  knee;"  and  in  March,  1877,  Dr.  J.  Y.  Shindell  reported  as  follows:  "I  find  the  left  knee  joint  quite  stiff,  also 
evidences  of  occasional  abscesses  in  the  muscular  portions  of  the  leg.  He  says  that  about  once  a  year  matter  does  form,  and 
that  he  continually  wears  bandages  around  the  thigh  as  a  support."  In  September,  1877,  the  Examiner  stated:  "The 
pensioner's  general  physical  condition  is  not  good.  He  is  now  confined  to  his  bed,  and  has  been  for  the  last  two  weeks,  on 
account  of  his  wound,  which  is  again  suppurating.  *  *  '  But  the  greatest  trouble  now  seems  to  be  in  the  hip  joint  and  its 
neighborhood.  On  probing  the  opening  a  little  above  the  joint  the  body  of  the  ilium  seems  to  be  of  a  honey-combed  nature, 
diseased,  and,  no  doubt,  the  cause  of  these  frequent  attacks  of  suppuration  which  occur  every  three  or  four  months.  ' 
His  leg  trouble  will  very  likely  cause  death  some  time."  The  pensioner  was  paid  March  4,  1879.  The  wood-cut  (FiG.  13G) 
represents  a  photograph  taken  at  the  Army  Medical  Museum  on  July  6,  1865.  (Sure/.  Phot  Series,  No.  67,  A.  M.  M.) 

In  the  next  case  perfect  consolidation  of  the  ends  of  the  fractured  femur  took  place  in 
less  than. five  weeks.  The  patient  recovered  with  a  strong,  sound  limb,  and,  in  1879,  while 
engaged  in  active  business,  has  walked  six  miles  without  difficulty,  limping  but  little. 

CASE  367. — Lieutenant  J.  S.  Lowery,  Co.  D,  146th  New  York,  aged  21  years,  was  wounded  at  Bethesda  Church,  June 
3,  1864.  Surgeon  W.  E.  DeWitt,  jr.,  U.  S.  V.,  recorded  his  admission  to  a  Fifth  Corps  field  hospital,  with  a  "severe  wound  of 
the  right  thigh  caused  by  a  mini6  ball."  Surgeon  D.  W.  Bliss,  U.  S.  V.,  reported  that  the  patient  entered  Armory  Square  Hos- 


FlG.  135. — Result  of  shot  frac 
ture  of  upper  third  of  left  femur. 
I  From  a  photograph.] 


FIG.  13". — Result  of  shot  fracture  of  upper 
third  of  left  femur.     [From  a  photograph.] 


MiHl.aml  Simj.  Ilist  of  Uu-  War  oi"  the  Rebellion  .  Part  III ,  Yol.H,Chap.X. 


\Vanl   phot 


PLATE      LVIII.- CONSOLIDATED    GUNSHOT   FRACTURES   OF  THE  FEMUR 


Fi-j  1. Case  of  Captain   l).l.«»\vis 


l;rj  1'  Case  i)l'  Private  A.K  Dinsmore 
3  •?   Mic  Ki^an  . 


SECT,  m.j 


SHOT  FRACTURES  OF  UPPER  THIRD  OF  FEMUR. 


181 


pital,  Washington,  June  7th,  and  described  his  injury  as  a  "shot  fracture  of  the  upper  third  of  the  femur,"  but  gave  no  account 
of  any  treatment  but  that  of  simple  dressings.  Dr.  T.  M.  Flandrau,  late  Surgeon  146th  New  York,  who  attended  Lieutenant 
Lowery  at  the  field  hospital,  gives  the  following  details:  The  patient  was  wounded  by  a  rifle  ball  while  on  picket  duty.  The 
missile  entered  at  the  middle  of  the  thigh,  toward  its  inner  aspect,  and  was  cut  out  on  the  field  by  Assistant  Surgeon  G.  H. 
Fossard,  146th  New  York,  above  the  trochanter.  The  femur  was  fractured  in  its  upper  third.  The  patient  was  brought  six 
miles  on  a  stretcher  to  the  field  hospital  of  the  2d  division,  Fifth  Corps,  where  I  determined  not  to  amputate,  and  supported  the 
limb  on  folded  blankets,  so  that  it  was  very  comfortable.  He  was  then  carried  by  some  men  belonging  to  the  Quartermaster's 
Department  fifteen  miles  further  to  the  White  House,  and  placed  on  a  steamboat  and  sent  to  Washington.  He  was  left  on  his 
stretcher  while  on  board  of  the  transport  and  was  not  removed  from  it  until  placed  on  a  bed  in  Armory  Square  Hospital,  four 
days  after  receiving  the  injury.  At  the  latter  place,  Acting  Assistant  Surgeon  T.  O.  Bannister  had  immediate  charge  of  the 
case.  According  to  the  patient's  statement  the  limb  was  placed  in  a  box,  little  extension  being  used  and  no  counter-extension. 
Three  or  four  small  pieces  of  bone  Avere  discharged  within  a  short  time,  and  another  small  piece  was  cut  since  from  under  the 
skin.  An  abscess  was  opened  on,  the  outer  side  of  the  thigh,  the  scar  of  which  is  conspicuous  in  the  photograph.  When  the 
patient  left  the  hospital  he  used  crutches,  the  wound  having  closed  in  four  or  five  weeks  and  the  bone  united  firmly.  He  con 
tinued  to  use  his  crutches  until  the  following  April.  The  limb  is  shortened  two  and  five-eighths  inches;  the  thigh  cannot  be  fully 
flexed  on  the  pelvis,  but  the  limb  is  strong,  sound,  and  freely  movable,  with  the  afore-mentioned  exception.  When  wearing  a 
boot  slightly  thickened  in  the  sole  he  limps  but  little.  Lately  he  has  walked  six  miles  without  difficulty,  and  is  actively 
engaged  in  business."  In  a  previous  communication  Dr.  Flandrau  stated  that  the  very  expeditious  recovery  of  the  patient  was, 
no  doubt,  to  be  attributed  in  a  large  measure  to  his  good  fortune  of  having  unusually  comfortable  transportation.  Lieutenant 
Lowery  became  a  pensioner  from  the  date  of  his  discharge  from  service,  January  13,  1865.  Various  surgeons  have  examined 
liim  at  regular  intervals,  and  certified  to  lameness,  etc.,  as  resulting  from  the  injury,  up  to  April,  1872,  since  when  he  has  been 
exempted  from  further  examinations,  owing  to  the  permanent  character  of  his  disabilities.  He  was  paid  June  4, 1879.  A  photo 
graph  of  the  patient  was  prepared  under  the  direction  of  Dr.  Flandrau,  who  contributed  it  to  the  Army  Medical  Museum.  It 
is  numbered  265  of  the  Surgical  Photographic  Series. 

In  the  following  instance  a  rifle  ball  fractured  the  upper  third  of  the  left  femur,  and 
passing  through  the  right  thigh  chipped  off  a  piece  of  the  upper  third  of  the  right  femur; 
a  second  ball  shattered  the  head  of  the  left  fibula;  a  third  ball  caused  a  flesh  wound  of  the 
leg;  and  a  fourth  missile  struck  over  the  sacrum: 

CASE  368. — Sergeant  W.  Shakespeare,  Co.  K,  2d  Michigan,  aged  18  years,  was  wounded  in  both  lower  limbs  at  Jackson, 
July  11,  1863.  He  was  treated  at  a  field  hospital  of  the  Ninth  Corps  for  several  weeks,  and  was  then  transferred  by  steamer 
to  Cincinnati,  where,  on  August  12th,  he  entered  Washington  Park  Hospital.  On  June  1,  1864,  the  patient  was  discharged 
from  service  and  pensioned.  Examiner  H.  O.  Hitchcock,  of  Kalamazoo,  Michigan,  in  March,  1866, 
furnished  the  following  description  of  the  case:  "Shakespeare  was  struck  by  a  minie"  ball,  which, 
after  passing  through  the  upper  third  of  the  left  thigh  and  fracturing  the  femur,  entered  the  right 
thigh  and  either  fractured  the  right  femur  or  perhaps  chipped  off  a  piece  of  bone,  making  its  exit 
on  the  outer  side  of  that  limb.  A  minie  ball  about  the  same  time  shattered  the  head  of  the  left  fibula, 
and  another  ball  produced  a  flesh  wound  of  the  leg ;  and  while  lying  on  the  field  he  was  severely 
wounded  by  some  missile  over  the  sacrum.  From  this  last  injury  he  suffered  long  and  severely. 
Before  being  taken  from  the  field  several  corps  surgeons  advised  amputation  of  the  left  thigh,  which 
operation  was  opposed  by  Surgeon  E.  J.  Bonine  of  the  regiment,  on  the  ground  that  it  would  not 
add  to  the  chances  of  recovery.  When  the  patient  reached  Cincinnati,  union  of  the  fragments  had 
taken  place,  with  about  seven  inches  shortening,  the  fragments  crossing  each  other  at  a  considerable 
angle  and  one  of  them  protruding  from  the  wound.  Acting  Assistant  Surgeon  A.  D.  Norton,  on 
August  14th,  broke  up  the  temporary  union  of  the  parts  of  the  left  femur  and  extended  the  limb. 
Three  months  later,  when  the  case  was  examined  by  several  surgeons,  the  parts  were  still  ununited. 
At  present  there  is  complete  union  of  bone,  the  right  leg  being  one  and  one-fourth  inches  shortened, 
and  the  left  leg  one  and  three-fourths  inches  shorter  than  the  right.  The  left  femur  is  a  little 
straighter  than  normal;  the  left  leg  can  be  flexed  upon  the  thigh  to  an  angle  of  about  30°;  the  foot 
is  contracted,  rather  stiff,  and  sometimes  painful.  He  suffers  considerably  from  neuralgia,  is  not 
as  robust  as  formerly,  and  walks  with  the  aid  of  a  cane,  his  gait  being  rather  slow  and  halting." 
Several  years  afterwards  the  same  Examiner  reported  that  the  wound  in  the  left  thigh  frequently 
opened  and  discharged  pieces  of  bone  and  bits  of  lead.  Drs.  E.  J.  Bonine  and  H.  A.  Clelland,  late 
Surgeon  and  Assistant  Surgeon  of  the  2d  Michigan,  both  testify  to  the  injury  of  both  femurs,  as  well 
to  the  fact  of  amputation  having  been  advised  or  ordered  to  be  performed  at  the  field  hospital,  and 
that  the  operation  was  refused  or  deferred.  The  former  in  his  report  on  October  4,  1874,  states: 
"The  present  condition  of  the  pensioner,  as  I  find  by  critical  examination,  is  as  follows:  'An  open, 
suppurating,  and  discharging  wound  in  the  superior  third  of  the  left  thigh,'  the  bone,  having  been  crushed,  lapping  in  the  heal 
ing,  so  as  to  shorten  the  leg  from  two  to  three  inches.  Bone  denuded;  partial  anchylosis  of  knee,"  etc.  Examiner  Hitchcock, 
at  subsequent  dates,  lastly  in  December,  1877,  added  that  "there  is  a  sinus  leading  down  to  diseased  bone  in  the  left  Aigh,  which 
is  open  and  discharging  more  or  less  nearly  all  the  time.  The  left  knee  is  nearly  anchylosed  and  is  swollen ;  the  foot  is  tender 
and  the  toes  are  stiffened  in  a  deformed  position,"  etc.  The  pensioner  was  paid  June  4,  1879.  Pension  Examiner  O.  H. 
Hitchcock  presented  to  the  Army  Medical  Museum  a  card  photograph  of  the  patient  (Vol.  I,  p.  2,  Card  Photographs').  A  copy 
is  represented  in  the  wood-cut  (FlG.  137). 


/ 


3 


FIG.  137.— Shot  fractures  of 
the  tipper  thirds  of  both  femurs. 
[Froip  a  photograph. 1 


182 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Forty-six  of  the  five  hundred  and  fifty-one  Union  soldiers  who  recovered  after  shot 
fracture  in  the  upper  third  of  the  femur  died  during  the  fourteen  years  that  have  passed 
since  the  close  of  the  American  civil  war,  a  fatality  of  less  than  0.6  per  cent,  a  year.  In 
the  following  two  instances  the  patients  survived  the  injuries  eleven  and  ten  and  a  half 
years,  respectively: 

CASE  369. — Corporal  T.  Crassley,  Co.  E,  69th  New  York,  aged  34  years,  was  wounded  at  Fort  Steadman,  March  25, 
1865,  and  admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps,  where  Surgeon  F.  M.  Hammond,  126th  New  York, 
noted:  "Shot  wound  of  hip  by  mini6  ball."  Assistant  Surgeon  C.  A.  Leale,  U.  S.  V.,  reported  that  the  wounded  man  was 
admitted  to  Armory  Square  Hospital,  Washington,  April  1st,  and  discharged  from  service  July  25,  1865,  by  reason  of  "shot 
fracture  of  upper  third  of  right  femur,  resulting  in  one  inch  shortening."  The  Albany  Examining  Board,  consisting  of  Drs. 
R.  B.  Bontecou,  W.  H.  Craig,  and  C.  H.  Porter,  certified,  September  11,  1873:  "The  ball  entered  near  the  right  trochanter, 
injuring  the  bone  seriously.  Numerous  portions  of  bone  were  removed.  The  missile  passed  deeply  through  the  muscular 
tissue  and  escaped  near  the  inner  border  of  the  right  nates.  The  limb  is  greatly  weakened,  and  occasionally  ulcers  appear  near 
the  entrance  wound,  owing  to  necrosed  bone."  The  pensioner  died  at  the  National  Military  Asylum  at  Dayton,  Ohio,  January 
8,  1876.  The  immediate  cause  of  his  death  has  not  been  ascertained.  A  photograph,  taken  at  the  Army  Medical  Museum  in 
July,  1865  (Surg.  Phot.  Series,  No.  76),  is  copied  in  FIG  2  of  PLATE  LIX,  opp.  p.  178. 

CASE  370. — Private  M.  Murthra,  Co.  H,  159th  New  York,  aged  18  years,  was  wounded  in  the  right  thigh,  at  Irish  Bend, 
April  13,  1863,  and  admitted  to  the  Marine  Hospital,  New  Orleans,  four  days  afterwards.  Surgeon  J.  Bockee,  U.  S.  V., 

described  the  injury  as  a  "compound  fracture  of  the  femur  at  or  near  the  trochanter,"  and 
reported  that  the  patient  was  assigned  to  the  Veteran  Reserve  Corps  March  9,  1864.  Surgeon 
G.  Sutton,  U.  S.  V.,  recorded  his  entrance  into  Augur  Hospital,  Alexandria,  with  "chronic 
ulcer,"  and  his  transfer  to  Sickels  Hospital  several  days  afterwards.  On  May  31,  1865,  the 
man  was  discharged  from  service,  Surgeon  E.  Bentley,  U.  S.  V.,  certifying  to  "great  deformity 
resulting  from  the  fracture."  Examiner  C.  Rowland,  of  Brooklyn,  reported,  July  28,  1865:  * 
"Many  pieces  of  bone  have  been  extracted  from  a  large  abscess  still  existing.  The 
leg  is  three  inches  shorter  than  the  other  and"  quite  lame.  He  is  obliged  to  walk  with  a  crutch," 
etc.  The  pensioner  subsequently  entered  the  National  Military  Asylum  at  Augusta,  whence 
Surgeon  J.  O.  Webster  contributed  his  photograph  in  August,  1869,  with  the  following  recapit 
ulation  of  his  case:  "The  wound  was  caused  by  a  minie"  ball,  which  entered  the  anterior  aspect 
of  the  thigh  in  the  upper  third,  emerging  posteriorly,  nearly  opposite,  and  lodging  in  the  pants. 
On  admission  to  the  hospital  the  lirnb  was  treated  by  sand  bags,  and  by  manual  extension  once 
a  day.  The  femur  united  in  bad  shape,  and  another  Surgeon  coming  in  charge,  it  was  rebroken 
and  a  straight  splint  applied.  He  was  able  to  bear  his  weight  on  the  leg  eight  months  after  the 
injury.  The  wounds  have  never  healed,  and  the  thigh  now  discharges  in  four  places.  Several 
splinters  of  bone  have  come  away.  He  can  walk  comfortably  with  a  cane."  The  Augusta 
Examining  Board  certified,  August  6,  1873:  *  *  *  "The  parts  being  thickly  invested  by 
muscles,  masses  of  new  bone  have  been  thrown  out  around  the  fragments  from  the  surrounding 
inflamed  tissues.  Owing  to  the  nature  of  the  fracture,  it  being  greatly  comminuted,  proper 
apposition  could  not  be  maintained.  Masses  of  new  bone  were  deposited  as  supports  and  the 
splinters  enveloped  with  provisional  callus,  producing  an  enlargement  of  the  limb  at  the  point 
of  the  fracture.  We  are  of  the  opinion  that  superficial  exfoliation  is  going  on  in  some  part  of 
the  bone  on  account  of  the  nature  and  quantity  of  the  discharges,  the  limb  having  to  be  dressed 
several  times  during  the  day.  The  pensioner  has,  at  short  intervals,  profuse  haemorrhage  from 
the  posterior  opening  near  the  ischium.  These  bleedings  are  no  doubt  produced  by  sharp 

spiculse  of  bone  cutting  small  arteries."     The  pensioner  died  December  26,  1873.     A  copy  of 
FlO.  1.T8. — Result  of  shot  fracture     ,  .       ,  n         ,  ,  ,r    ,.     ,  ,,  ,  c,          -ni    *    a     •      -KT     oo<--\    •  *   j 

of  femur.    [From  a  photograph.]         his  photograph,  taken  at  the  Army  Medical  Museum  (Surg.  Phot.  Series,  No.  236),  is  represented 

in  the  wood-cut  (FlG.  138). 

In  the  next  case  the  patient  died  from  extensive  inflammation  and  suppuration  of  the 
injured  limb,  caused  by  a  fall,  eleven  and  a  half  years  after  the  injury: 

CASE  371. — Lieutenant  E.  L.  Postley,1  Co.  D,  176th  New  York,  aged  39  years,  was  wounded  at  Winchester,  September 
19,  1864.  Surgeon  E.  S.  Hoffman,  90th  New  York,  reported  his  admission  to  the  field  hospital  of  the  2d  division,  Nineteenth 
Corps,  with*  "severe  wound  of  the  thigh,  caused  by  a  minie  ball."  On  September  23d  the  patient  was  moved  to  the  Depot 
Hospital  at  Winchester,  where  Surgeon  L.  P.  Wagner,  114th  New  York,  recorded  the  following  description  of  the  injury:  "The 
missile  entered  the  right  thigh  at  the  upper  third,  one  and  a  half  inches  below  Poupart's  ligament,  passed  through  the  limb 
outside  the  femoral  vessels,  and  emerged  one  and  a  quarter  inches  below  the  trochanter  major,  fracturing  and  comminuting  the 
femur.  The  limb  was  kept  in  a  splint  for  ten  days,  after  which  some  extension  was  made,  and  subsequently  a  sort  of  a  Desault 
splint  was  applied  for  five  weeks.  No  bad  symptoms  occurred.  The  wound  discharged  very  freely.  Not  much  bone  came  out, 
but  some  w  Js  removed  at  the  time  of  the  injury.  By  November  27th  there  was  firm  union  of  bone,  with  two  and  a  half  inches 
shortening  and  some  outward  curvature  at  the  seat  of  the  fracture,  and  the  patient  was  able  to  throw  his  leg  up."  On  December 

1  The  case  of  Lieutenant  Postley  is  noticed  by  Assistant  Surgeon  JOHX  HOMANS,  jr.,  in  his  article :   Cases  of  Gunshot  Fractures  of  the  Thigh  and 
Wound*  of  the  Cites!,  showing  tlie,  Ke.sults  of  Conservative  Surgery  in  the  Former,  in  Boston  Med.  and  Surg.  Journal,  18G5,  Vol.  72,  p.  11. 


Med.fi-  Sin--.  Hirft.of  11  ic  War  of  the  h'ebrllioii  1'nrt  HI, Vol.11. 


Ward    phot 


PLATE   LV.  _  TWO   VIEWS    OF   A   UNITED    SHOT   FRACTURE  OF   THE  UPPER 
EXTREMITY  OF   THE  RIGHT  FEMUR  OVER  II  YEARS  AFTER   INJURY. 

Casf    of  Lipulc>imii(    K.L.  Po.sllev.   I7(i  M.'  N««\\- York. 
-Spec    (ir)9(j.  Surj»*a-Hl  Section  A.M.M. 


SECT.  III.] 


SHOT  FRACTURES  OF  UPPER  THIRD  OF  FEMUR. 


183 


9th  lie  was  transferred  to  Camden  Street  Hospital,  Baltimore,  and  in  the  following  month  he  obtained  a  leave  of  absence  and 
proceeded  to  his  home.  He  was  ultimately  mustered  out  April  13,  1865,  and  pensioned.  Examiner  J.  Neil,  of  New  York  City, 
certified,  April  24,  1867:  "The  thigh  is  shortened  about  four  inches;  the  limb  is  crooked  and  feeble;  he  requires  the  aid  of  a 
crutch."  The  pensioner  subsequently  entered  the  National  Military  Asylum  at  Hampton,  whence  Surgeon  W.  M.  Wright 
reported  him,  in  1873,  as  being  iu  good  general  health,  his  wound  as  well  healed,  and  the  fractured  bone  united,  with  five  inches 
shortening,  also  that  stiffness  of  the  knee  joint  resulted  from  extensive  adhesions  of  the  muscles  of  the  thigh.  Two  years  after 
wards  spiculac  were  reported  to  have  been  removed  from  the  wound,  and,  on  March  6,  1876,  Dr.  Wright  communicated  that  the 
pensioner  had  died  on  the  previous  day,  stating  that  "he  was  able  to  walk  well  without  the  aid  of  a  crutch  or  cane,"  and  that 
"  two  weeks  ago  he  fell,  while  intoxicated,  upon  his  disabled  thigh,  which  resulted  in  extensive  inflammation  and  suppuration,  from 
which  he  died."  The  greater  part  of  the  injured  femur,  comprising  the  two  upper  thirds,  was  contributed  to  the  Museum  by  Dr. 
Wright,  and  constitutes  Specimen  6596  of  the  Surgical  Section.  Illustrations  of  the  hone  are  shown  in  PLATE  LV,  opp.  p.  182. 
CASE  372. — Corporal  E.  Worthen,  Co.  B,  2d  Vermont,  aged  25  years,  was  wounded  in  the  right  thigh,  at  the  Wilderness, 
May  5,  1864,  and  admitted  to  hospital  in  Alexandria  three  weeks  afterwards.  Surgeon  E.  Bentley,  U.  S.  V.,  described  the 
wound  as  a  "shot  fracture  of  the  upper  third  of  the  femur,"  but  the  progress  of  the  case  was  not  recorded.  On  March  17, 1865, 
the  patient  was  transferred  to  Sloan  Hospital,  Montpelier,  whence  Surgeon  H.  Janes,  U.  S.  V.,  contributed  the  following  history: 
"The  wound  was  caused  by  a  minie"  ball,  which  entered  the  thigh  in  front,  passed  directly  through  and  emerged  posteriorly,  at 
the  lower  border  of  the  glutei  muscles,  comminuting  the  femur  for  about  three  inches.  From  the  field  the  wounded  man  was 
taken  to  the  hospital  of  the  2d  division,  Sixth  Corps,  at  Fredericksburg,  and  thence  by  boat  to  Alexandria,  where  the  limb  was 
first  adjusted,  and  kept  in  position  by  sand  bags  without  extension.  He  stated  that  no  other  apparatus  was  ever  used.  Sub 
sequently  he  had  typhoid  fever  and  erysipelas.  The  first  fragment  of  bone  was  removed  in  July.  1864,  and  since  that  time  about 
fifty  pieces  have  come  away.  When  admitted  to  Sloan  Hospital  the  wound  was  still  slightly  discharging,  but  the  patient  was 
able  to  go  about  on  crutches.  About  three  months  afterwards  the  bone  had  become  so  firmly  united  that  he  could  walk  a  short 
distance  without  crutch  or  cane.  When  discharged  from  service,  .June  23,  1865,  the  patient 
was  in  good  general  health,  and  able  to  walk  a  considerable  distance  on  smooth  ground 

without  crutch  or  cane,  the  injured  limb  being  shortened  two 

and  a  half  inches  and  considerably  deformed.    There  was  also 

necrosed  bone  remaining,  and  the  wound  still  slightly  dis 
charging."  Examining  Surgeon  C.  L.Allen,  of  Rutland,  Vt., 

reported,  September  24,  1866:  "The  right  limb  is  now  three 

inches  shorter  than  the  left.     An  opening  (the   wound   of 

entrance)  still  exists  in  front  of  the  trochanter,  into  which  a 

probe  passes  about  four  inches ;  another  opening  posteriorly 

(the  wound  of  exit)  allows  the  probe  to  pass  in  about  three 

inches.     A  third  opening  exists  near  the  middle  of  the  inside 

of  the  thigli,  having  been  made  by  the  Surgeon  for  the  dis 
charge  of  the  burrowing  pus."  The  same  examiner  subse 
quently  certified  that  he. was  called  on  to  visit  the  pensioner 

on  October  23,  1870,  and  found  him  "suffering  from  pyaemia, 

resulting  from  the  wound  breaking  out  anew,  from  the  effects 

of  which  he  died  October  25,  1870."     A  card  photograph  of 

the  patient,  taken  at  the  Sloan  Hospital,  was  contributed  by 

Surgeon  Janes  (Card  Photos.,  A.  M.  M.,  Vol.  II,  p.  22),  an 

enlarged  copy  of  which,  taken  at  the  Army  Medical  Museum 

(Surf/.  Phot.  Series,  No.  129),  is  shown  in  wood-cut  (FlG.  139). 
CASE  373. — Private  G.  Ruoss,  Co.  G,  7th  New  York, 

aged  27  years,  was  wounded  near  Petersburg,  March  31,  1865, 

and  admitted  to  the  field  hospital  of  the  1st  division,  Second 

Corps,  where  Surgeon  F.  M.  Hammond,  126th  New  York, 

noted :  "  Shot  fracture  of  right  thigh."     On  the  day  following 

the  injury  the  wounded  man  was  sent  to  the  Depot  Hospital 

at  City  Point,  and  several  days  afterwards  he  was  conveyed 

to  Washington,  where  he  entered  Campbell  Hospital,  and 

subsequently  Stanton   Hospital.     Surgeon  R.  B.  Bontecou, 


FIG.  130.— Kesultofa  shot  wound 
of  upper  third  of  femur.  [From  a 
photograph.] 


FlG.  140. — Shot  fracture  of  upper  third 
of  right  femur.     [From  a  photograph.] 


U.  S.  V.,  reported  his  admission  to  Harewood  Hospital  September  12th,  and  his  condition  as  follows:  "The  patient  was  suffer 
ing  from  great  deformity  of  the  right  limb,  the  result  of  a  shot  wound  of  the  upper  third  of  the  thigh,  fracturing  the  femur. 
When  admitted  he  had  so  far  recovered  as  to  be  able  to  sit  up,  and  his  constitutional  state  was  tolerably  good.  The  fractured 
parts  had  firmly  united  but  with  great  deformity;  the  wound  of  entrance  had  healed,  but  there  were  still  some  discharges  from 
sinuses  in  the  thigh,  and  small  fragments  of  necrosed  bones  were  daily  removed.  The  prospects  of  usefulness  of  the  limb  are 
unfavorable;  otherwise  the  patient  is  doing  tolerably  well."  At  the  closing  of  Hanwood  Hospital,  May  1, 1866,  the  patient  was 
transferred  to  the  Post  Hospital  at  Washington,  where  he  was  operated  on  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  who 
described  the  injury  and  operation  as  follows :  "The  wound  was  caused  by  a  minie"  ball,  which  entered  on  the  anterior  and  outer 
aspect  of  the  thigh  about  three  inches  below  the  great  trochanter,  passed  inward  and  a  little  downward,  comminuting  portions 
of  the  upper  and  middle  thirds  of  the  femur,  and  escaped  posteriorly  near  the  middle  of  the  gluteal  fold.  On  June  8th,  the 
patient  was  etherized  and  a  triangular  incision,  three  by  three  and  a  half  inches,  was  made  on  the  upper  and  outer  side  of  the 
thigh,  and  several  pieces  of  bone  were  removed.  On  September  30th  the  wound  had  almost  healed.  Three  sinuses,  evidently 


184 


INJURIES    OF   THE    LOWER   EXTREMITIES. 


[CHAP.  X. 


leading  to  necrosed  bone,  however,  still  existed,  two  of  which  were  located  on  the  upper  and  one  on  the  lower  surface.  The 
patient's  health  was  not  very  good,  having  suffered  from  several  attacks  of  diarrhoea,  and  a  severe  attack  of  erysipelas  which 
commenced  near  the  wound  and  soon  spread  over  the  entire  surface  of  the  leg  and  foot.  On  December  31st,  the  sinuses  were 
still  open  and  discharging,  and  there  was  great  deformity,  with  about  five  inches  shortening,  and  almost  complete  anchylosis  of 
the  knee  joint."  Assistant  Surgeon  J.  Brooke,  U.  S.  A.,  who  took  charge  of  the  patient  in  November,  1807,  reported  the 
termination  of  the  case:  "I  found  the  limb  in  much  the  same  condition  as  described  by  Dr.  Thomson,  except  that  a  collection 
of  pus,  which  had  formed  on  the  inner  aspect  of  the  thigh  just  above  the  knee,  had  been  opened  and  a  sinus  found  to  connect 
with  the  seat  of  the  fracture.  This  sinus,  as  well  as  those  already  described  by  Dr.  Thomson,  remained  open,  and  the  patient 
continued  extremely  feeble,  became  greatly  emaciated,  and  suffered  much  from  diarrhoea  and  frequent  attacks  of  almost  total 
loss  of  appetite.  These  symptoms  continued  until  his  death,  which  occurred  on  June  27,  1868.  At  the  autopsy  the  liver  was 
found  to  be  enormously  enlarged,  weighing  ten  pounds  and  ten  ounces,  and  the  right  lung  contained  a  small  mass  of  calcareous 
matter."  The  injured  femur,  with  the  os  innominatum  and  patella  attached,  and  portions  of  the  tibia  and  fibula  were  contributed 
to  the  Museum  by  Dr.  Brooke,  and  constitute  specimen  5450  of  the  Surgical  Section.  The  femur  is  imperfectly  united,  with  great 
displacement  and  a  deposit  of  foliaceous  callus,  and  shows  that  extensive  periostitis  has  taken  place,  and  the  patella  and  upper 
portions  of  tibia  and  fibula  also  show  similar  pathological  changes.  The  photograph  represented  in  the  wood-cut  (FlG.  140) 
was  obtained  at  the  Harewood  Hospital,  and  contributed  by  Surgeon  Bontecou.  Other  photographs  of  the  patient,  taken  at  the 
same  hospital  and  at  the  Army  Medical  Museum,  are  represented  by  No.  40,  Vol.  8,  of  Photo's  of  Surgical  Cases,  S.  G.  O.;  Card 
Photo's,  Vol.  2,  p.  21,  and  Vol.  3,  p.  27,  and  Surgical  Photograph  Series,  Nos.  139,  178,  179,  and  292. 

Fatal  Cases  of  Shot  Fractures  of  the  Upper  Third  of  the  Femur  treated  by  Conser 
vation. — Of  the  twelve  hundred  and  fifty-four  cases  of  shot  fractures  of  the  upper  third  of 
the  femur  tabulated  in  TABLE  XX,  on  page  175,  ante,  five  hundred  and  seventy-two  proved 
fatal.  Four  hundred  and  eighty  were  Union  and  ninety-two  Confederate  soldiers.  The 
side  on  which  the  injury  was  received  was  noted  in  four  hundred  and  eighty-one  instances, 
the  right  side  being  involved  in  two  hundred  and  nineteen,  the  left,  in  two  hundred  and 
sixty-two  cases.  A  few  fatal  examples  will  be  cited: 

CASE  374. — Private  J.  Northrnp,  Co.  K,  77th  New  York,  aged  21  years,  was  wounded  before  Yorktown,  April  29, 1862, 
and  entered  the  Douglas  Hospital,  Washington,  May  15th.  Assistant  Surgeon  W.  Webster,  U.  S.  A.,  forwarded  the  specimen 
(FlG.  141),  and  recorded  ihe  following  history:  "The  wound  was  caused  by  a  conoidal  ball,  which  entered  on  the  outer  side  of 
the  lower  portion  of  the  upper  third  of  the  left  thigh,  and  was  extracted  through  the  glutens  maximus  muscle  on  a  level  with 
and  two  inches  from  the  anus,  same  side.  The  missile  produced  a  compound  fracture  of  the  femur  at  the  upper  third  and 
shortened  the  limb  to  the  extent  of  two  inches.  On  admission,  the  patient,  who  was  of  robust  and  healthy  appearance,  had 
considerable  fever  and  constipation  of  the  bowels.  There  was  extensive  swelling  of  the  integuments,  and  he  was  suffering  acute 
pain.  Vedder's  long  splint  was  applied,  and  extension  from  the  ankle  and  counter-extension  by  a  perineal  band  was  made. 
By  these  means  the  limb  was  lengthened  one  inch  and  retained  in  that  position.  The  acute  pain  rendered  any  further  extension 
impracticable.  The  patient  was  ordered  to  take  one-half  ounce  of  castor  oil,  and  sulphate  of  morphia  at  night  to  relieve  the 
pain.  May  18th,  the  wound  has  been  dressed  with  poultices  of  flaxseed  meal ;  the  swelling  has  some 
what  subsided  and  there  is  no  fever.  The  pain  continues,  and  to  relieve  it  and 
promote  sleep  a  mixture  of  two  drachms  of  elixir  of  opium  and  one  ounce  of 
camphor  water  is  given  in  two  doses  every  evening.  June  2d,  the  discharge 
has  ceased  and  the  external  wound  is  nearly  closed.  There  are  some  signs  of 
union  and  of  the  deposition  of  abundant  provisional  callus.  June  10th,  the 
splint  was  removed;  the  shortening  of  the  limb  now  amounts  to  three  inches. 
June  16th,  the  patient  was  this  morning  attacked  with  chills  and  the  initiatory 
symptoms  of  fever,  a  frequent  and  very  weak  pulse  and  red  tongue,  also  great 
tenderness  in  the  epigastric  region,  with  frequent  vomiting.  The  above  symp 
toms  continued  without  intermission  until  terminated  in  death,  at  11  o'clock 
P.  M.,  on  June  18,  1862.  The  autopsy,  ten  hours  after  death,  confirmed  the 
previous  diagnosis  of  acute  gastro-enteritis.  The  coats  of  the  stomach  were 
found  to  be  intensely  congested,  with  disorganization  of  the  mucous  membrane, 
which  appeared  to  be  greatest  about  the  greater  curvature  of  the  stomach. 
The  fracture  was  found  firmly  consolidated,  with  abundant  deposition  of  pro 
visional  callus."  The  specimen  consists  of  the  upper  half  of  the  fractured  femur, 
showing  partial  union  at  right  angles  and  the  shaft  roughened  by  the  action  of 

pus,  also  callus  somewhat  copiously  thrown  out  and  entangling  the  fragments,      FIG.  142.— Shot  frac- 
,          .    .  ture  of  left  femur.  Callus 

but  the  inner  surfaces  being  carious.  without  union.  Spec.  1810. 

CASE  375.— Private  F.  Smith,  Co.  C,  121st  New  York,  was  wounded  at 
Fredericksburg,  May  3,  1863.  Surgeon  E.  F.  Taylor,  1st  New  Jersey,  noted  his  admission  to  the  field  hospital  of  the  1st  division, 
Sixth  Corps,  with  "shot  wound  of  thigh,"  and  his  transfer  to  general  hospital  June  13th.  Surgeon  A.  Heger,  U.  S.  A.,  con 
tributed  the  specimen,  shown  in  the  adjoining  wood-cut  (FlG.  142),  with  the  following  description  of  the  case:  "The  patient  was 
wounded  by  a  round  ball,  causing  fracture  of  the  left  femur  at  the  upper  third.  He  was  admitted  to  hospital  at  Point  Lookout, 
June  14th,  very  much  reduced,  abscesses  and  sinuses  extending  through  the  whole  thigh  from  the  pelvis  to  the  knee.  He 


Fm.  141.— Left  femur  shat 
tered  below  trochanters.  Spec. 
27. 


.-•(.»!' t!i<'  Wiir.TfthrKohpflii.il.    I'nrl  III A'oi  II .C'hnji  X 


PLATE    XXV.        SECONDARY     INFLAMMATION     OF    THE    KNEE    JOINT 
I'nsr  «»r  IM  AVillinin  /iliox.  F.  2 '.»'!.'  .\c\v"l'<  u  ]< 


SECT.  III.] 


SHOT    FRACTURES   OF    UPPER   THIRD    OF    FEMUR. 


185 


seemed  to  gain  a  little  strength,  but  died  July  11,  1803,  from  exhaustion."  Tie  specimen  consists  of  a  portion  of  the  femur 
with  the  missile  attached.  The  bone  was  shattered  below  the  trochanters  and  shows  considerable  effusion  of  callus,  but  no  union 
seems  to  have  occurred. 

CASK  376. — Private  M.  Sullivan,  Co.  K,  6th  Louisiana,  aged  30  years,  was  wounded  at  Antietam,  September  17,  1862, 
and  admitted  to  hospital  at  Frederick  two  weeks  afterwards.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  recorded  the  following 
history:  "The  patient  was  wounded  by  five  balls.  The  first  entered  about  one  and  a  half  inches  above  and  a  little  inside  of  the 
left  patella,  and,  passing  through,  fractured  and  comminuted  the  femur,  and  emerged  on  the  outside  about  three  and  a  half  inches 
above  the  knee  joint.  The  second  ball  entered  the  left  thigh  near  the  junction  with  the  perinaeum,  merely  making  a  flesh  wound. 
The  third  entered  about  three  and  a  half  inches  below  and  a  little  posterior  to  the  trochanters  of  the  right  thigh,  fracturing  the 
femur,  and,  going  directly  through,  emerged  at  the  junction  of  the  thigh  with  the  perinseum.  The  fourth  missile  produced  a  flesh 
wound,  entering  just  over  the  junction  of  the  dorsal  and  lumbar  vertebra,  and  was  not  found;  and 
the  fifth  grazed  the  left  thigh  posteriorly  at  the  junction  of  the  upper  and  middle  thirds.  After 
the  battle  he  was  carried  to  the  White  House  Hospital,  where  his  limbs  were  placed  in  long  board 
splints,  and  in  that  condition  he  was  sent  to  the  Seminary  Hospital  at 
Frederick,  where  the  splints  were  removed  and  Buck's  apparatus  was 
substituted,  with  two  bricks  on  each  leg  for  extension.  No  bone  was 
extracted.  Two  abscesses  formed,  one  near  the  right  knee,  which  was 
opened  and  discharged  copious  quantities  of  bloody  pus.  The  wounds 
in  the  right  thigh  also  discharged  considerable  quantities  of  curdy  mat 
ter.  The  second  abscess  was  opened  near  the  first  and  the  discharge  was 
similar  in  character.  While  in  the  Seminary  the  patient's  treatment  con 
sisted  of  tonics  and  stimulants.  On  January  15,  1863,  when  admitted  to 
hospital  No.  1,  both  limbs  were  very  much  swollen,  and  tight  bandages 
were  ordered  to  be  applied.  On  the  17th  an  abscess  made  its  appearance 
on  the  posterior  part  of  the  right  thigh  just,  below  the  buttock,  and  the 
ball,  which  had  entered  the  back  and  could  not  be  discovered  at  first,  was 
taken  out  with  two  pieces  of  bone,  one  being  about  two  inches  long  and  one 
and  a  half  inches  wide,  and  the  other  a  small  fragment.  23d,  the  limbs 
PJG  143 —United  shot  frao-  are  S'OW^J  improving  and  are  considerably  reduced  in  size,  the  left  leg  FIG.  144.— United  shot  fracture 

ture  of  lowest  third  of  left  measuring  thirty-three  inches  and  the  right  one  thirty-two  and  a  half  f  "p?Rflri third  °f  right  femun 
femur.  Spec.  3882.  *  .  .  Spec.  3881. 

inches;  general  health  tolerable;  treatment  consisting  of  iron  and  quinine, 

with  generous  diet.  28th,  opened  an  abscess  on  left  side  of  left  knee;  abscess  under  right  thigh  gradually  healing.  30th,  a 
bloody  sanious  pus  is  being  discharged  from  the  abscess  in  the  left  knee,  and  the  burrowing  includes  a  space  of  about  eight  inches 
square.  Introduced  a  tent  into  the  opening  of  both  abscesses.  The  patient's  bowels  being  rather  costive,  three  compound 
cathartic  pills  were  given.  February  1st,  abscesses  looking  well  and  gradually  filling  up  with  healthy  granulations;  patient 
slowly  improving.  9th,  general  condition  not  so  good;  has  some  hectic  fever  at  night,  also  diarrhoea.  Abscesses  healing  and 
limbs  appear  to  be  doing  well.  17th.  slowly  improving;  appetite  better.  Discovered  a  sinus  leading  from  the  external  wound 
of  the  left  thigh  posteriorly,  at  the  bottom  of  which  there  is  some  necrosed  bone.  21st,  abscess  on  knee  cicatrized;  small 
abscess  making  its  appearance  on  the  anterior  aspect  of  the  upper  third  of  left  thigh;  discharge  from  sinus  increased;  wound 
on  right  thigh  discharging  considerable  healthy  pus.  Patient  had  a  chill  this  morning.  His  bowels  being  constipated,  castor 
oil  was  prescribed.  March  3d,  improving.  Abscess  on  under  surface  of  tipper  third  of  right  thigh  is  closing  up,  but  a  portion 
of  the  necrosed  femur  is  yet  felt  by  the  probe.  The  left  thigh  is  discharging  healthy  pus,  and  from  its  external  wound  an 
abscess  opened  extending  about  two  inches,  from  which  there  is  now  protruding  a  large  portion  of  necrosed  bone,  which  will 
be  removed  by  exsection  as  soon  as  the  patient's  health  will  permit.  13th,  general  health  improving;  sinus  discharging  as 
usual.  Wound  in  posterior  aspect  of  thigh  probed  and  found  to  be  very  extensive;  necrosed  bone  apparently  covered  by 
healthy  granulations.  April  5th,  patient  rapidly  improving;  has  an  excellent  appetite;  bowels  regular.  Wounds  on  posterior 
aspect  of  right  thigh  entirely  closed  and  the  other  wounds  doing  well.  15th,  patient  has  had  a  severe  attack  of  erysipelas  in 
his  left  leg,  also  a  high  fever  aiid  attacks  of  vomiting;  leg  much  inflamed  and  greatly  swollen.  It  was  painted  with  tincture 
of  iodine  and  lead  and  opium  wash  was  applied.  Stimulants  were  also  ordered.  20th,  considerable  swelling  of  the  knee  joint. 
Urine  was  drawn  off,  he  being  unable  to  pass  it.  22d,  patient  much  worse.  An  incision  was  made  near  the  right  knee  joint  and 
a  large  quantity  of  pus  discharged.  The  urine  was  again  drawn  oif.  Death  occurred  April  22, 1863.  Post-mortem,  examination 
five  hours  after  death  :  On  opening  the  chest  pleuritic  adhesions  were  found  on  both  sides;  lungs  healthy  and  partially  covered 
with  seropurulent  lymph;  liver  highly  congested  and  fatty  and  weighing  fourteen  ounces;  kidneys  weighing  eight  ounces,  of 
light  color,  and  external  surface  mottled;  heart  healthy  and  weighing  eight  ounces."  The  pathological  specimens  represented  hi 
the  wood-cuts  were  contributed  to  the  Museum  by  Acting  Assistant  Surgeon  G.  M.  Paullin.  FlGUKE  144  shows  the  right  femur 
united  with  two  inches  shortening  after  fracture  in  the  tipper  third,  a  large  fragment  being  bound  fast,  a  small  sequestrum  nearly 
loose,  the  ends  well  rounded,  and  the  lower  extremity  diseased  as  far  as  the  condyles.  The  other  specimen  (FlG.  143)  consists 
of  the  lower  third  of  the  left  femur;  showing  a  fracture  firmly  united  by  profuse  bone  deposits,  with  lateral  deformity  and  two 
and  a  half  inches  shortening,  the  lower  fragment  forming  an  angle  with  the  shaft  of  about  fifteen  degrees  forward. 

CASE  377.— Private  William  Ziliox,  Co.  F,  29th  New  York,  aged  31  years,  was  wounded  at  Chancellorsville,  May  3, 
1863.  He  was  standing  erect  and  in  the  act  of  firing.  The  missile,  a  conoidal  ball,  entered  the  outer  and  middle  portion  of  the 
left  thigh,  passed  upward,  fractured  the  femur,  and  lodged  in  the  surrounding  muscles.  He  was  left  on  the  battle-field  and  fell 
into  the  hands  of  the  enemy,  and  received  no  treatment  until  his  return  within  our  lines,  May  15,  1863.  He  was  then  admitted 
into  the  field  hospital  of  the  Eleventh  Corps,  at  Brook's  Station,  where  his  leg  was  dressed  in  splints.  On  June  14th,  he  was 
admitted  into  the  Lincoln  Hospital,  Washington.  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  reports :  "  When  admitted  his  affected 
SuttG.  Ill— 24 


186 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


thirdof  left  femur. 
Spec.  17G1. 


Fit;.  ]4(i. — Shot  fracture 
of  right  femur  below  tro- 
chanters.  Spec.  2.'i3. 


limb  looked  as  though  no  extension  had  been  employed.  The  ball  had  not  been  extracted,  there  Avas  no  union,  and  there  was 
four  and  a  half  inches  shortening.  Acting  Assistant  Surgeon  D.  Weisel,  under  whose  care  the  patient  was  placed,  removed  the 
splints  and  applied  the  anterior  splint.  This  treatment  was  continued  until  June  20th,  when,  suppuration  becoming  so  great, 
fear  was  entertained  of  pus  burrowing  toward  the  hip  joint,  and  it  was  discontinued,  and  sand  bag  supports  and  extension, 
produced  by  a  bag  of  stones  suspended  by  a  rope  run  through  a  pulley  and  attached  to  the  base  of  the  foot,  substituted.  The 
case  progressed  favorably.  August  1st,  small  abscesses  appeared  near  the  knee,  not,  however,  troublesome.  There  was  little 
burrowing  of  pus.  August  7th,  Dr.  Weisel  opened  a  small  abscess  on  the  posterior  portion  of  the  thigh  immediately  behind  the 
seat  of  fracture.  August  26th,  several  spiculae  of  bone  were  extracted  through  this  opening,  together  with  the 
bullet,  which  was  flattened  and  contorted  to  a  very  irregular  form.  Early  in  September,  the  pus  was  observed 
extending  down  the  inner  side  of  the  thigh  and  opening  two  inches  above  the  internal 
condyle  of  the  femur.  -By  pressure  pus  could,  at  any  time,  be  made  to  pass  out  of  this 
opening,  it,  no  doubt,  communicating  with  the  injury  above.  The  constitutional  symp 
toms  were  still  favorable.  October  1st,  effusion  in  the  knee  joint  of  the  corresponding 
side  was  first  noticed;  the  skin  over  the  joint  had  an  erysipelatous  hue,  and  the  joint 
was  swollen.  It  was  at  first  thought  that  the  opening  on  the  inside  of  the  thigh  com 
municated  with  the  joint,  and  that  pyarthrosis  was  caused  thereby;  but  it  was  afterwards 
thought  to  be  a  case  of  suppurative  arthritis  and  in  no  direct  way  connected  witli  the 
pus-producing  surface  about  the  seat  of -fracture.  From  the  first  appearance  of  this 
complication  the  patient  sank  rapidly,  the  tongue  became  dry  and  brown,  the  stomach 
rejected  all  aliment;  hiccough  was  a  constant  and  distressing  symptom.  Severe  pain 
was  experienced  in  the  limb.  These  signs  of  constitutional  exhaustion  continued  with 
out  relief  until  the  day  of  his  death,  October  6,  1863."  The  secondary  inflammation  of 
the  knee  joint  is  shown  in  PLATE  XXV,  opposite  p.  184.  The  fractured  femur,  show 
ing  fractures  in  the  upper  third,  large  deposits  of  callus,  but  without  union,  is  Spec.  17(il 
of  the  Surgical  Section,  A.  M.  M.  (FlG.  145.) 

CASE  378.— Private  W.  Eeed,  Co.  II,  83d  Pennsylvania,  aged  29  years,  was 
wounded  and  captured  at  Gaines's  Mills,  June  27,  1862.  He  remained  in  the  hands  of 
the  enemy  for  a  month,  when  he  was  paroled  and  conveyed  to  Philadelphia.  Acting 
fracture  of  upper  Assistant  Surgeon  II.  P.  Thomas,  in  charge  of  the  Episcopal  Church  Hospital,  recorded 
the  following  description  of  the  wound  and  its  result:  "The  ball  entered  the  outer  side 
of  the  right  thigh  about  five  inches  below  the  anterior  superior  spinous  process  of  the 
ilium,  fractured  the  femur,  and  made  its  exit  on  a  horizontal  line  with  the  point  of  entrance  and  five  inches  from  it.  The  man 
entered  this  hospital  on  July  30th  in  a  miserable  condition.  The  thigh  was  much  shortened,  and  an  opening  formed  in  the 
buttock  wiChin  four  inches  of  the  wound  of  exit,  discharging  very  freely  and  resulting  from  the  passage  of  a  piece  of  bone.  The 
patient  was  also  suffering  from  diarrhoea  and  a  diphtheritic  exudation  in  the  mouth  and  fauces.  He  was  taking  stimulants  and 
chlorate  of  potassa.  Death  resulted  on  September  26,  1862,  from  pysemia  and  exhaustion.  The  post-mortem  showed  no  metas- 
tatic  abscess.  The  femur  was  found  to  be  extensively  fractured  high  up  and  to  consist  mainly  of  two  fragments,  around  the 
free  ends  of  which  and  adherent  to  them  were  several  other  pieces  of  large  size.  The  specimen,  represented  in  the  cut  (FlG.  146), 
was  contributed  by  Acting  Assistant  Surgeon  A.  C.  Bournonville,  and  shows  considerable  deposit  of  callus  imprisoning  the  larger 
fragments  and  affording  partial  union. 

CASE  379. — Private  E.  Vehorn,  Co.  F,  13th  South  Carolina,  was  wounded  at  Gettysburg,  July  3,  1863,  and  was  treated  in 
hospital  at  Chester.  Acting  Assistant  Surgeon  B.  Brinton  contributed  the  specimen,  shown  in  the  annexed  cut  (FlG.  147),  and 
described  the  injury  as  a  "shot  wound  of  the  right  hip,  fracturing  the  femur  near  its  neck.  Patient  died  of  exhaustion  October 
13, 1883."  The  specimen  consists  of  the  upper  portion  of  the  femur,  showing  oblique  fracture  through 
the  lesser  trochanter,  with  a  moderate  deposit  of  callus,  but  without  union. 

CASE  380.— Private  T.  Manley,  Co.  A,  63d  New  York,  aged  26  years, 
was  wounded  at  Gettysburg,  July  2,  1863,  and  admitted  to  Camp  Letterman 
one  month  afterwards.  Acting  Assistant  Surgeon  R.  S.  L.  Walsh  described 
the  injury  as  a  "compound  fracture  of  the  upper  third  of  the  right  femur,"  and 
reported:  "There  is  no  history  of  the  case  previous  to  admission.  The  gen 
eral  health  of  the  patient  is  good ;  the  wound  discharging  profusely.  Tonics 
and  stimulants  were  given,  and  the  limb  treated  by  the  double-inclined  plane. 
The  patient  did  tolerably  well  for  some  days,  but  his  general  condition  became 
worse  about  August  31st."  Acting  Assistant  Surgeon  J.  Newcombe,  into 
whose  hands  the  case  passed  on  September  4th,  reported  the  following  termina 
tion  :  "  On  taking  charge  of  the  patient  he  was  sinking  rapidly.  The  fracture 

FIG.  147.— Shot  fracture  was  disunited  and  the  limb  was  shortened  about  five  inches.  The  patient  was  ^  ]4g  _shot  fr!icturc  of 
of  left  femur  through  a]so  troubled  with  profuse  night  sweats  and  had  a  large  bed-sore  on  his  back,  rurht  femur  below  troelwn- 
lesser  trochanter.  Callus  ,-,,.,-,  ,,  tors  C'-illim  without  union 

without  union.  Spec.2070.     He  died  September  8,  1863,  of  exhaustion.     At  the  post-mortem  examination  the    ™_  1935. 

fractured  ends  were  found  overlapping  each  other,  the  lower  being,  as  usual, 

drawn  upward  and  inward  by  the  adductor  muscles,  while  the  upper  was  carried  forward  by  the  psoas  and  iliacus  and  outward 
by  the  external  rotators.  The  fracture  ran  obliquely  upward  and  inward,  and  considerable  callus  had  been  thrown  out  on  the 
inner  side  only.  A  false  joint  had  formed  between  the  fragments,  the  lower  playing  in  a  rude  socket  formed  by  the  upper,  and 
both  being  covered  by  a  dense,  smooth,  glistening,  and  apparently  fibrous  membrane."  The  pathological  specimen  (FlG.  148) 
consists  of  the  upper  portion  of  the  injured  femur,  and  was  contributed  by  Acting  Assistant  Surgeon  E.  P.  Townseim. 


SECT.  III.l 


SHOT  FRACTUEES  OF  THE  MIDDLE  THIRD  OF  FEMUR. 


187 


Shot  Fractures  of  the  Middle  Third  of  the  Femur  treated  by  Conservation.— Ei  Mi  t 

G 

hundred  and  fifty-five  cases  of  shot  fracture  of  the  middle  third  of  the  femur  treated  with 
out  operation  were  collected  from  the  registers  in  this  Office.  In  thirteen  instances  the 
result  could  not  be  ascertained;  five  hundred  patients  recovered  and  three  hundred  and 
forty-two  died,  a  mortality  of  40.6  per  cent. 

Cases  of  Recovery  after  Shot  Fractures  of  the  Middle  Third  of  the  Femur  treated 
by  Conservation. — The  five  hundred  cases  of  recovery  after  shot  fracture  of  the  middle 
third  of  the  femur  included  four  hundred  and  twenty-one  Union,  and  seventy-nine  Confed 
erate  soldiers.  In  two  hundred  and  eight  cases  the  injury  was  on  the  right,  and  in  two 
hundred  and  sixty-seven  on  the  left  side: 

CASE  381. — Private  J.  H.  Green,  Co.  E,  14th  New  York  Heavy  Artillery,  aged  46  years,  was  wounded  at  Bethesda 
Church,  June  2,  1864,  and  admitted  to  the  field  hospital  of  the  1st  division,  Ninth  Corps,  where  Surgeon  M.  K.  Hogan,  U.  S.  V., 
recorded:  ''Gunshot  fracture  of  right  thigh."  Two  days  afterwards  the  wounded  man  was  moved  to  the  Depot  Hospital  of  the 
Ninth  Corps,  and  on  June  14th  he  reached  Washington.  Acting  Assistant  Surgeon  H.  A.  Robbins  reported:  "He  was  admitted 
to  Armory  Square  Hospital,  having  been  wounded  by  a  conoidal  ball,  which  entered  the  anterior  aspect  of  the  right  thigh  at  a 
point  above  the  junction  of  the  middle  and  lower  thirds,  producing  comminuted  fracture,  and  made  its  exit  at  a  point  on  the 
posterior  surface  opposite  to  that  of  entrance.  The  limb  was  treated  in  Hodgen's  splint  without  extension.  During  the  month 
of  March,  186"),  several  spiculoe  of  bone  were  removed,  varying  in  size,  the  longest  being  two  and  a  half  inches  in  length.  These 
were  extracted  without  enlarging  the  opening.  The  patient  came  under  my  care  June  1,  1865.  The  bone  is  now  united  with 
five  and  a  half  inches  shortening.  The  femur  is  bowed  out  and  the  foot  is  considerably  inverted.  The  knee  joint  is  considerably 
stiffened,  so  that  it  can  only  be  flexed  to  an  angle  of  about  twenty  degrees.  About  one  ounce  of  healthy  pus  is  now  discharged 
during  twenty-four  hours.  The  patient's  health  is  very  good."  On  July  6th  he  was  brought  to  the  Army  Medical  Museum, 
when  the  photograph,  shown,  in  the  cut  (FlG.  149),  was  taken.  On  the  following  day  he  was  transferred  to  the  Ira  Harris 

Hospital  at  Albany,  whence  Assistant  Surgeon  J.  H.  Armsby,    ' 

U.  S.  V.,  contributed  a  cast  of  the  injured  limb  (Cat.  Surg. 

Sect..  1866,  p  535,  Spec.  1356).     The  patient  was  discharged 

from  service  October  3, 1863,  and  pensioned.     Examiner  S.  L 

Parmelee,  of  Gouverneur,  New  York,  certified,  September  4, 

1873:  "The  ball  entered  five  inches  above  the  knee,  anteriorly, 

fracturing  the  femur,  and  splitting,  with  two  points  of  emer 
gence,  on  the  posterior  aspect  of  the  thigh.  Result :  Stiff  knee ; 

femur  curved  outward  at  an  angle  of  twenty  degrees,"  etc.     At 

a  subsequent  examination  substantially  the  same  was  reported. 

The  pensioner  was  paid  March  4,  1879. 

CASE  382.— Private  W.  D.  Gilbert,  Co.  C,  6th  Vermont, 
aged  CO  years,  was  wounded  in  the  right  thigh  at  the  Wilder 
ness,  May  5,  1864.  Three  weeks  afterwards  he  arrived  at 
Alexandria  and  entered  the  Mansion  House  Hospital,  whence 
Surgeon  C.  Page,  U.  S.  A.,  reported  the  injury  as  a  "shot 
fracture  of  the  middle  third  of  the  femur."  Subsequently  the 
patient  was  transferred  to  Sickels  Hospital,  and  lastly  to  Sloan, 
Montpelier.  Surgeon  II.  Janes,  U.  S.  V.,  in  charge  of  the  latter 
hospital,  contributed  the  following  history:  "The  patient,  a 
man  of  strong  constitution,  was  wounded  by  a  minie  ball,  which 
passed  through  the  thigh  at  the  junction  of  the  middle  and 
lower  thirds,  comminuting  the  femur  for  several  inches.  The 
day  after  the  injury  he  was  sent  by  ambulance  to  Fredericks- 
burg,  no  retentive  apparatus  having  been  applied,  and  two 
weeks  later  he  was  moved  by  cars  and  boat  to  Alexandria,  the 
limb  being  kept  in  a  fracture-box  during  the  trip.  At  Alex 
andria,  it  was  put  upon  an  anterior  splint  and  extension  was 
made  by  brick  and  pulley.  In  June  several  pieces  of  bone  ^ 
were  removed.  Suppuration  was  profuse,  and  about  August 


FIG.  150.— Shot  fracture  of  middle  third 
1st  Ins  appetite  failed  and  he  became  so  much  debilitated  that    of  right  femur.    [From  a  photograph.] 


I'l  ;.  140.— S|1(,t  fracture  of  mid 
dle  third  of  right  femur.  [From 
a  photograph.] 

his  life  was  despaired  of.     After  this  he  gradually  but  slowly 

improved,  though  not  without  occasional  relapses.  On  January  1,  1865,  the  splint  was  removed  and  the  patient  allowed  to  sit  at 
the  bedside,  and  no  retentive  apparatus  was  used  for  more  than  two  or  three  days  after  that  time.  About  the  last  of  January 
he  could  walk  about  the  ward  on  crutches,  though  unable  to  bear  any  weight  upon  the  limb.  On  March  17th  the  patient  was 
transferred  to  this  hospital,  during  which  journey  the  limb  became  considerably  inflamed,  resulting  in  his  confinement  to  bed 
for  three  days.  On  May  29th  the  limb,  having  again  become  inflamed  and  discharging  vory  offensive  pus,  was  freely  opened  for 


188  INJURIES   OF   THE    LOWER    EXTREMITIES.  [CHAP.  X. 

about  four  inches,  and  several  large  pieces  of  necrosed  bone,  one  of  which  measured  one  by  three  inches,  were  removed.  The 
cavity  in  the  callus,  which  contained  these  fragments,  was  found  to  be  large  and  seemed  to  extend  quite  or  nearly  to  the  can 
cellated  structure  of  the  condyles.  After  the  operation  suppuration  became  healthy  and  the  wound  mended  rapidly  for  four 
weeks,  when  the  improvement  became  checked.  On  September  7th,  the  limb  was  again-laid  open  freely  and  a  small  piece  of 
bone  was  removed,  after  which  there  was  no  further  interruption  in  the  progress  of  the  patient  up  to  October  12,  1865,  when  he 
was  discharged  from  service.  At  this  time  the  wound  still  suppurated  to  the  amount  of  two  ounces  per  day,  and  a  considerable 
cavity  existed  between  the  ends  of  the  bone,  but  no  necrosis  could  be  detected  by  the  probe.  The  limb  was  shortened  three 
inches,  and  there  was  ligamentous  anchylosis  of  the  knee  joint,  permitting  the  patient  to  move  it  about  ten  degrees.  He  was  in 
general  good  health,  able  to  bear  half  his  weight  on  the  injured  leg  for  a  short  time,  and  seemed  to  have  a  fair  prospect  of  obtain 
ing  a  useful  limb.  There  had  been  no  haemorrhage,  gangrene,  or  diarrhoea  since  the  injury,  and  his  appetite  had  been  good 
nearly  all  the  time,  having  taken  nutritious  food  freely  and  stimulants  moderately."  Examiner  W.  McCollom,  of  Woodstock, 
Vermont,  November  14,  1866,  certified  to  the  injury,  and  stated:  "The  bone  has  united  with  three  inches  shortening.  Exfolia 
tions  are  thrown  off  occasionally,  and  the  wound  in  the  soft  tissues  has  not  entirely  healed.  He  is  totally  disabled  from  performing 
manual  labor  at  present."  Examiner  O.  W.  Sherwin  stated,  September  4,  1873:  "There  is  considerable  loss  of  tissue,  and  the 
knee  is  permanently  flexed  so  as  to  keep  the  heel  two  inches  from  the  floor,"  and,  in  September,  1877,  he  reported  the  following : 
"During  the  present  year  a  large  abscess  formed  at  the  seat  of  the  injury,  Avith  exfoliation  of  bone.  I  attended  him  during  two 
months  of  confinement  in  bed  from  the  aforesaid  cause."  A  card  photograph  of  the  patient,  taken  at  the  Sloan  Hospital,  was 
contributed  by  Surgeon  Janes  (Card  Photos,  A.  M.  M.,  Vol.  2,  p.  22),  an  enlarged  copy  of  which,  taken  at  the  Army  Medical 
Museum  (Surg.  Phot.  Series,  No.  130).  is  represented  in  the  cut  (FlG.  150).  The  pensioner  was  paid  March  4,  1879. 

CASE  383. — Lieutenant  J.  Buckley,  Regimental  Quartermaster  of  the  140th  New  York,  aged  22  years,  was  wounded  at 
Spottsylvania,  May  8,  1864,  by  a  mini6  ball,  which  fractured  the  right  thigh  at  the  middle  third.  From  the  field  he  was,  on 
May  12th,  admitted  to  hospital  at  Alexandria,  and  five  days  afterwards  he  was  transferred  to  the  Seminary  Hospital,  George 
town.  Surgeon  II.  W.  Ducachet,  U.  S.  V.,  in  charge  of  the  latter,  reported  the  character  of  the  injury  and  that  the  patient 
remained  under  treatment  until  November  12th,  when  he  obtained  a  leave  of  absence  and  departed  for  his  home.  On  January 
13,  1865,  Lieutenant  Buckley  was  mustered  out  of  service  and  pensioned.  Dr.  T.  M.  Flandrau,  formerly  Surgeon  146th  New 
York,  who  saw  this  officer  at  the  time  of  the  injury,  and  also  after  he  left  the  service,  communicated  his  observations  in  March, 
1870,  as  follows :  "I  decided  to  save  the  limb,  and,  aided  by  Surgeon  H.  C.  Dean,  140th  New  York,  dressed  it  in  Smith's  anterior 
splint,  suspending  it  from  the  bows  of  an  army  wagon,  in  which,  with  his  servant  steadying  the  foot,  he  was  carried  to  Belle 
Plain.  When  he  reached  the  Georgetown  Hospital  the  thigh  was  found  shortened  five  inches.  During  the  second,  third,  and 
fourth  months  after  the  injury  he  was  treated  by  an  extension  weight  of  sixteen  pounds,  a  counter-extending  band,  and  lateral 
sand  bags.  On  August  20th  he  had  three  profuse  haemorrhages,  jeopardizing  his  life,  which  were  controlled  without  operation. 
He  used  crutches  when  leaving  the  hospital,  but  threw  them  aside  five  months  afterwards.  He  has  since  been  employed  as  a 
bookkeeper.  There  is  two  and  a  half  inches  shortening,  and  the  knee  is  somewhat  stiffened.  A  fistulous  opening  still  exists  on 
the  back  of  the  thigh  and  discharges  a  little.  The  limb  is  very  useful,  and  the  limp  is  not  conspicuous."  The  Utica  Examining 
Board  reported,  January  3, 1872:  *  *  *  "There  has  been  extensive  exfoliation  of  bone,  leaving  several  deep  cicatrices,  and 
there  is  still  an  open  sinus  extending  to  the  bone  and  attended  with  bloody  sanious  discharge,  indicating  that  there  is  still  disease 
of  the  bone,"  etc.  Examiner  C.  B.  Coventry,  September  6,  1873,  certified  to  several  pieces  of  bone  having  been  removed,  some 
of  them  since  the  previous  examination.  The  pensioner  was  paid  March  4,  1879.  FIG.  1  of  PLATE  LX,  opp.,  is  a  representa 
tion  of  a  photograph  of  the  pensioner,  taken  in  Rome,  New  York,  March,  1870,  which  was  contributed  by  Dr.  Flaudrau,  and 
copied  at  the  Army  Medical  Museum.  (Sury.  Phot.  Scries,  No.  266,  A.  M.  M.) 

CASE  384. — Private  J.  Hamilton,  Co.  I,  1st  Delaware,  aged  19  years,  was  accidentally  shot,  while  on  picket  duty  at 
Camp  Hamilton,  November  24,  1831.  On  the  following  day  he  was  admitted  to  Hygeia  Hospital,  Fort  Monroe,  whence  Surgeon 
R.  B.  Bontecou,  U.  S.  V.,  reported  :  "  Gunshot  fracture  of  right  thigh,  above  the  middle,  by  a  conical  ball.  The  bone,  though 
considerably  comminuted,  finally  united  at  the  expiration  of  five  Aveeks;  suppuration  and  exfoliation  kept  up  Avith  occasional 
intermission  until  June,  1862.  The  Avounds  Avere,  at  times,  dilated  Avith  sponge  tents  to  keep  them  free.  Constant  slight  exten 
sion  Avas  used,  and  some  portions  of  bone  Avere  removed  from  time  to  time.  On  June  14, 1862,  the  patient  Avas  discharged  from 
service,  and  sent  home  with  limb  pound  and  shortened  not  more  than  an  inch."  Examiner  D.  W.  Maull,  of  Wilmington,  Del- 
aAvare,  certified  to  "shot  fracture  of  the  femur  and  shortening  of  the  limb,  Avith  pain  and  occasional  suppuration."  A  Pension 
Examining  Board  reported,  in  September,  1877:  "An  inch  shortening;  deep  cicatrices;  one  of  the  Avounds  has  been  suppurating 
within  six  Aveeks,  when  a  piece  of  dead  bone  came  out."  The  pensioner  Avas  paid  June  4,  1879.  Photographs  of  the  patient 
Avere  furnished  by  Surgeon  Bontecou  (Photos,  of  Surgical  Cases,  Vol.  8,  No.  54,  and  Card  Photos.,  Vol.  2,  p.  21,  and  Vol.  3,  p- 
22),  an  enlarged  copy  of  Avhich  (Surj.  Phot.  Series,  No.  119)  is  represented  in  FIG.  2  of  PIATE  LX,  opp. 

CASE  385. — Sergeant  A.  Ryder,  Co.  B,  121st  New  York,  aged  22  years,  Avas  wounded  before  Petersburg,  April  2,  1865, 
and  admitted  to  the  field  hospital  of  the  1st  division,  Sixth  Corps,  Avhere  Surgeon  R.  Sharpe,  15th  New  Jersey,  noted:  "Shot 
fracture  of  left  thigh;  splints  applied."  On  the  day  following  the  injury  the  wounded  man  Avas  sent  to  the  Depot  Hospital  at 
City  Point,  and,  on  April  12th,  he  Avas  transferred  to  Armory  Square  Hospital,  Washington,  Avhence  Acting  Assistant  Surgeon 
G.  K.  Smith  reported  the  folloAving  history:  "The  Avound  Avas  caused  by  a  conoidal  ball,  Avhich  struck  the  femur  about  six 
inches  above  the  patella,  fracturing  the  shaft  of  the  bone  and  lodging.  But  slight  constitutional  disturbance  took  place,  and 
the  quantity  of  discharge  from  the  AVOUIH!  Avas  Arery  moderate.  The  position  of  the  ball  could  not  be  ascertained.  The  patient 
Avas  treated  on  Dr.  Gurdon  Buck's  plan.  TAVO  weeks  after  his  admission,  the  injured  limb  Avas  found  to  be  shortened  one  and 
one-quarter  inches.  By  June  9th  the  Avound  had  healed,  but  bony  union  Avas  still  incomplete  and  extension  by  Aveights  Avas 
continued*  On  July  8th  the  femur  Avas  found  to  be  firmly  consolidated,  and  the  patient  Avas  allowed  to  go  about  on  crutches. 
He  was  mustered  out  of  service  August  2,  1865,  his  general  health  being  good  and  his  injured  leg  shortened  less  than  an  inch." 
Examiner  J.  C.  Tibbets,  of  WarsaAV,  NCAV  York,  certified,  October  14,  1872 :  "  The  ball  passed  through  the  rectus  muscle, 
fractured  the  bone,  and  lodged  in  the  posterior  pan  of  the  thigh  among  the  muscles,  where  it  still  remains.  The  muscles  in  the 


M.M!  ami   Surv    Hist  of  the  War  of  ihe  Kebolhoii.  Part  Ifl,  Vol.lU'haj)  X 


PLATE    LX- CONSOLIDATED    Gil  NSHOT  FRACTUR  ES   OF  THE  FEMUR 


.Case  of  Lieuieuanl  J.BiicJdev 
I/K)  A  New  York  . 


Fig. 2. Case  of  Private  J. Hamilton 


SECT,  in.] 


SHOT   FRACTURES   OF   THE   MIDDLE   THIRD    OF    FEMUR. 


189 


back  of  the  leg  and  thigh  are  contracted,  so  that  walking  or  even  much  resting  on  the  limb  causes  spasms  (cramps),  etc."  The 
pensioner  was  paid  March  4,  1879.  His  photograph,  taken  at  the  Army  Medical  Museum  on  July  25,  1865  (Surg.  Phot. 
Series,  No.  72),  is  represented  in  FlG.  1  of  PLATE  LXI. 

CASE  386. — Private  J.  Friederick,  Co.  F,  127th  New  York,  aged  19  years,  was  wounded  in  the  right  thigh  at  Honey 
Hill,  November  30,  1864.  Assistant  Surgeon  J.  F.  Huber,  U.  S.  V.,  reported  his  admission  to  hospital  at  Hilton  Head,  on  the 
day  following  the  injury,  with  "compound  fracture  of  femur,  treated  with  splints,"  and  his  transfer  to  Washington,  May  7,  1865, 
but  gave  no  account  of  the  progress  of  the  case.  The  following  notes  were  furnished 
by  Acting  Assistant  Surgeon  G.  K.  Smith,  from  Armory  Square  Hospital,  and  by 
Assistant  Surgeon  W.  Webster,  U.  S.  A.,  in  charge  of  DeCamp  Hospital,  David's 
Island,  New  York.  The  wound  was  caused  by  a  round  ball,  which  entered  the 
inner  side  of  the  thigh  at  its  middle  third,  passing  obliquely  outward  and  forward, 
fracturing  the  femur  and  lodging.  An  attempt  to  stand  on  the  limb  after  receiving 
the  injury  caused  the  thigh  to  bend  to  an  obtuse  angle  at  the  seat  of  the  fracture. 
The  wounded  man  was  placed  on  a  shelter  tent  and  conveyed  to  a  steamboat,  about 
eight  miles  distant,  no  examination  of  the  wound  having  been  made  and  no  local 
support  having  been  applied  to  the  broken  bone.  During  the  night  following  the 
injury  the  ball  was  removed  through  an  incision  on  the  external  aspect  of  the  thigh. 
Cold-water  applications  were  used,  and  a  partial  support  was  given  by  an  arrange 
ment  of  blankets  around  the  parts.  On  arriving  at  the  Hilton  Head  Hospital  a 
surgical  examination  was  made  under  chloroform,  but  with  no  operative  result,  the 
limb  being  exceedingly  tumefied.  Smith's  anterior  suspensory  apparatus  was  then 
applied,  and  the  topical  applications  of  cold  water  were  continued.  This  treatment 
was  kept  up  until  January  7th,  when  side  splints,  extending  below  the  foot,  were 
substituted,  and  the  limb  was  maintained  in  a  straight  position.  This  apparatus 
was  continued  for  nearly  two  months,  and  during  this  stage  of  the  treatment  the 
swelling.greatly  subsided,  and  about  a  half  dozen  pieces  of  bone  were  removed  by  the 
attending  surgeon  at  various  intervals.  The  largest  of  these  is  represented  to  have 
been  about  three  inches  long,  one-half  inch  wide,  and  one-eighth  inch  thick.  An 
abscess  also  opened,  spontaneously,  about  two  inches  below  Poupart's  ligament. 
In  the  latter  part  of  March  the  side  splints  gave  way  to  a  fracture-box,  the  cold- 
water  dressings  being  still  persevered  in.  On  May  1st  all  local  supports  by  means 
of  splints  were  cast  aside,  bandages  and  pillows  being  sufficient  from  that  period  in 
consequence  of  the  advanced  stage  of  bony  consolidation.  On  May  10th,  when  the 
patient  was  admitted  to  Armory  Square  Hospital,  the  fractured  femur  had  firmly 
united,  with  seven  inches  shortening,  a  marked  deformity  by  an  outward  curvature 
of  the  thigh,  and  very  limited  motion  of  the  knee  joint.  There  was  still  a  slight  dis 
charge,  and  the  extremity  of  the  upper  fragment  lapping  by  the  lower  fragment 
presented  itself  on  the  outer  aspect  of  the  limb,  close  to  the  external  condyle,  at  which  point  the  skin  was  ulcerated  through, 
exposing  the  end  of  the  bone.  By  June  1st  the  patient's  recovery  was  so  far  advanced  as  to  enable  him  to  walk  about  the  ward 
with  the  aid  of  crutches.  About  the  last  of  June,  however,  he  was  compelled  to  resume  his  bed  in  consequence  of  the  appear 
ance  of  an  abscess  on  the  outer  side  of  the  thigh,  which  was  opened  and  gave  exit  to  about  eight  ounces  of  sanious  and  offensive 
pus.  Up  to  this  time  the  purulent  discharges  from  the  wound  had  been  moderate  in  quantity  and  healthy  in  character.  On  July 
5th,  however,  the  several  openings  were  attacked  by  gangrene,  which  rapidly  extended  up  the  thigh  and  destroyed  the  skin  and 
superficial  and  deep  fascia  nearly  the  whole  length  of  its  external  surface.  This  disease  was,  at  length,  arrested  by  the  appli 
cation  of  bromine,  and  by  August  15th  the  wound  had  become  filled  with  granulations,  and  cicatrization  was  progressive.  On 
August  17th  the  patient  was  transferred  to  Douglas  Hospital,  where  a  subsequent  exploration  of  the  limb  resulted  in  the  removal 
of  six  small  sequestra  from  the  external  wound.  Simple  dressings  were  now  used,  and  no  further  operative  interference  was 
required  in  the  case  until  after  the  arrival  of  the  patient  at  DeCamp  Hospital,  where  he  was  transferred  on  October  23d.  At 
this  date  he  was  strong  enough  to  walk  from  the  steamboat  landing  to  his  ward  on  crutches,  and  his  general  health  was  excellent. 
There  were  three  apertures,  two  on  the  external  and  one  on  the  posterior  surface  of  the  thigh,  from  which  pus  of  a  healthy 
appearance  found  exit  in  small  quantities.  An  examination  of  the  wound  by  means  of  a  probe  revealed  secondary  splinters,  but 
not  sufficiently  approachable  to  warrant  an  attempt  at  their  removal.  The  amount  of  new  osseous  deposit  was  considerable,  but 
unfortunately  the  sequestra  were  found  so  intimately  embedded  in  it  as  to  cause  their  removal  to  be  attended  with  great  difficulty 
and  even  impossibility,  and  involving  the  sacrifice  of  so  much  new  growth  as  to  endanger  the  limb.  On  February  25, 1866,  how 
ever,  the  further  removal  of  necrotic  pieces  was  induced  by  constitutional  symptoms,  which  manifested  themselves  and  indicated 
local  irritation.  Portions  of  the  involucrnm  were  removed  by  the  trephine  and  chisel,  where  necessary  for  the  purpose,  and  small 
masses  of  dead  bone  were  extracted  from  each  of  the  orifices.  One  of  the  pieces,  deeply  situated,  measured  about  two  inches 
in  length.  As  a  seeming  consequence  of  the  operation  the  unfavorable  constitutional  symptoms  entirely  disappeared,  and  the 
condition  of  the  patient  and  his  wounds  became  highly  satisfactory."  In  June  following  he  was  supplied  with  an  apparatus  for 
the  injured  limb  by  E.  D.  Hudson,  of  New  York  City,  and  four  months  later  he  left  for  his  home,  having  been  discharged  from 
service  November  25, 1865,  but  re-admitted  to  the  hospital  one  month  afterwards.  The  Examining  Board  of  Augusta,  Maine, 
certified,  in  May,  1873,  and  in  December,  1876:  "The  leg  is  withered  and  badly  deformed,  and  there  are  discharging  ulcers 
all  the  time.  He  can  perform  no  manual  labor  of  any  kind,  and  is  confined  to  his  bed  a  large  part  of  the  time.  The  leg,  from 
knee  to  foot,  is  nothing  but  skin  and  bone."  The  pensioner  was  paid  June  4,  1879.  The  wood-cut  (FlG.  151)  represents  a 
photograph  of  the  patient,  taken  August  15,  1865.  (Photo's  of  Suryical  Cases,  Vol.  9,  p.  16,  and  Surg.  Phot.  Series,  No.  90.) 


FIG.  151.— Shot  fracture  of  middle  third  of  right 
femur.     [From  a  photograph.] 


190  INJUKIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

Card  photographs,  taken  at  a  subsequent  date  at   the  DeCamp  Hospital,  were   contributed  by  Assistant  Surgeon  Webster. 
(Card  Photo's,  Vol.  2,  p.  22,  A.  M.  M.) 

CASE  387. — Private  T.  Miller,  Co.  G,  116th  Pennsylvania,  aged  18  years,  was  wounded  at  the  Wilderness,  May  5,  1864, 
and  admitted  to  Armory  Square  Hospital,  Washington,  three  weeks  afterwards.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  described  the 
injury  as  a  "fracture  of  the  upper  third  of  the  left  femur,  caused  by  a  mini6  ball,"  but  the  progress  of  the  case,  further  than  an 
attack  of  pleuro-pneumonia,  in  March,  1865,  was  not  reported.  On  August  15,  1865,  the  patient  was  transferred  to  Harewood 
Hospital,  whence  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported  the  following  history :  "  When  admitted  he  was  convalescent  from 
a  wound  of  the  thigh,  the  missile  entering  and  fracturing  the  femur  at  the  junction  of  the  upper  and  middle  thirds,  passing 
through  and  coming  out  on  the  inner  side,  near  the  tuberosity  of  the  ischium.  According  to  the  patient's  statement  his  constitu 
tional  condition  at  the  time  of  the  injury  was  very  good,  although  the  wound  was  very  painful.  Severe  haemorrhage  followed 
the  injury,  with  great  tumefaction  of  the  whole  limb.  The  fracture  box  was  used  and  counter-extension,  and  the  treatment  was 
suppoi-ting  throughout.  The  patient  had  so  far  recovered  as  to  be  able  to  be  about  on  crutches.  The  thigh  had  shortened 
about  two  inches  and  three-fourths;  but  otherwise  the  man  was  in  good  condition  and  in  a  fair  way  of  having  a  useful  limb." 
Two  weeks  afterwards  he  was  transferred  to  Mower  Hospital,  and  subsequently  to  the  Post  Hospital  at  Philadelphia,  and  in 
October  he  was  finally  sent  to  Harrisburg  to  be  mustered  out,  his  term  of  service  having  expired  July  14,  1805.  An  apparatus 
for  the  injured  limb  was  furnished  on  December  6,  1865,  by  J.  M.  Gemrig,  of  Philadelphia.  Dr.  J.  A.  McArthur,  Surgeon  of 
the  Soldiers'  Home,  Philadelphia.  October  17,  1866,  certified  to  anchylosis  of  the  knee  joint  as  resulting  from  the  injury,  and 
described  the  wound  as  still  open  and  requiring  treatment.  The  Philadelphia  Examining  Board  reported  "almost  complete 
anchylosis  of  the  knee,"  in  September,  1873,  and  two  years  afterwards  the  same  Board  stated:  "The  femur  is  curved  antero- 
posteriorly — concavity  forward.  There  are  several  scars  on  the  front  of  the  thigh,  where  spicula3  were  removed,  and  the 
muscular  structure  of  the  thigh  is  much  wasted.  He  alleges  constant  pain  in  walking."  The  pensioner  was  paid  June  4, 1871). 
A  photograph  of  the  patient,  taken  at  the  Harewood  Hospital  in  October,  1865,  was  contributed  by  Surgeon  Bontecou,  and 
copied  at  the  Army  Medical  Museum.  (Photos,  of  Surgical  Cases,  Vol.  8,  No.  142,  and  Surg.  Phot.  Scries,  No.  114,  A.  M.  M.) 
A  representation  is  shown  in  FIG.  2  of  PLATE  LXI,  opp. 

CASE  388. — Private  H.  Shatter,  Co.  D,  7th  Wisconsin,  aged  30  years,  was  wounded  at  Gravelly  Run,  March  31,  1865, 
and  admitted  to  the  field  hospital  of  the  3d  division,  Fifth  Corps,  where  Surgeon  A.  S.  Coe,  147th  New  York,  recorded:  "Frac 
ture  of  middle  third  of  right  thigh  by  a  minie"  ball."  On  the  second  day  after  the  injury  the  wounded  man  was  moved  to  the 
Depot  Hospital  at.  City  Point,  and  several  days  later  he  was  sent  to  Washington.  Acting  Assistant  Surgeon  G.  K.  Smith 
reported  the  following  history:  "The  patient  was  admitted  to  Armory  Square  Hospital  April  5th.  The  missile  had  entered  the 
external  portion  of  the  thigh,  producing  fracture  and  lodging.  On  April  19th,  a  small  opening  ulcerated  through  the  skin  on 
the  inner  side  of  the  thigh,  about  two  inches  below  the  perinaeum,  through  which  the  ball  was  removed  by  the  forceps.  Tin1 
limb  was  bandaged  in  its  whole  length  and  laid  upon  a  mattress,  being  supported  by  sand  bags  and  extended  by  weight  and 
pulley.  On  July  5th  the  patient  was  able  to  ride  about  the  ward  in  an  invalid  chair,  and  a  few  days  later  he  walked  on  crutches. 
By  July  16th  the  bone  had  firmly  united,  with  only  one  inch  shortening,  though  there  was  still  a  slight  discharge  from  the 
wound.  The  patient's  general  health  was  remarkably  good."  He  was  subsequently  transferred  to  Harvey  Hospital,  Madison, 
and  ultimately  discharged  from  Camp  Randall  November  15,  1865,  Acting  Assistant  Surgeon  A.  W.  Greenleaf  certifying  to 
"shortening  and  total  loss  of  power  and  strength  of  the  limb."  Examiner  A.  J.  Ward,  of  Madison,  Wisconsin,  on  September  8, 
1873,  reported  over  three  inches  shortening  of  the  limb  and  anchylosis  of  the  knee  joint;  and  two  years  later  he  stated  that  the 
pensioner  "will  never  be  any  better."  The  pensioner  was  paid  March  4,  1879.  FlG.  2  of  PLATE  LXII,  opp.  p.  192,  is  a  copy 
of  a  photograph  of  the  patient,  taken  at  the  Army  Medical  Museum  on  July  16,  1865.  (Sury.  Phot.  Scries.  No.  71,  A.  M.  M. ) 

CASE  389. — Private  H.  E.  Gumberts,  Co.  E,  136th  Indiana,  aged  18  years,  was  shot  in  the  left  thigh,  at  Camp  Carrington, 
May  13,  18J4.  Acting  Assistant  Surgeon  J.  M.  Kitchen  reported  his  admission  to  hospital  at  Indianapolis  on  the  day  of  the 
injury,  and  described  the  wound  as  a  "fracture  of  the  femur,  caused  by  a  musket  ball."  The  patient  was  discharged  by  reason 
of  expiration  of  service  September  2,  1834,  and  subsequently  he  was  placed  on  the  Pension  Rolls.  In  January,  18l>6,  Dr. 
Kitchen  communicated  that  he  received  a  letter  from  the  man  stating  that  he  could  "run  and  jump  as  well  as  ever,"  and  repre 
senting  "the  injured  limb,  with  the  exception  of  a  little  shortening,  just  as  good  and  useful  as  the  other."  Examiner  H.  M. 
Harvey,  of  Evansville,  Indiana,  certified,  August  12,  1871:  "The  ball  entered  the  thigh  about  midway  between  the  knee  and 
hip  joints,  on  its  outer  aspect,  passed  inward,  backward,  and  slightly  downward,  fracturing  the  shaft  of  the  femur  in  its  course, 
and  emerging  on  the  inner  side  of  the  limb.  There  is  a  large  amount  of  callus  around  the  seat  of  the  fracture,  and  the  limb  is 
shortened  about  one  and  one-quarter  inches.  He  complains  of  pain  in  the  knee  joint,  and  cannot  completely  flex  the  leg  upon 
the  thigh."  At  a  subsequent  examination  the  pain  in  the  knee  was  reported  to  be  increasing.  The  pensioner  was  paid  June  4, 
1879.  His  photograph  was  obtained  in  July,  1866,  and  contributed  by  Dr.  Kitchen  to  the  Museum,  where  it  was  copied. 
(Surg.  Phot.  Series,  No.  153,  A.  M.  M.)  A  representation  of  it  appears  in  FIG.  1  of  PLATE  LXII,  opp.  p.  192. 

Of  the  four  hundred  and  twenty-one  Union  soldiers  discharged  the  service  on  account 
of  shot  fracture  of  the  middle  third  of  femur,  thirty-three  have  died  in  the  course  of  four 
teen  years  since  the  close  of  the  war,  and  one  committed  suicide.  In  the  following  two 
instances  the  patients  died  nine  and  twelve  years  after  the  reception  of  the  injury: 

CASE  390. — Captain  R.  T.  Shillinglaw,  Co.  I,  79th  New  York,  aged  32  years,  was  wounded  in  the  left  thigh,  both 
upper  extremities,  and  the  right  temple,  at  Bull  Run,  July  21,  1861.  The  injury  of  the  thigh  was  caused  by  a  conoidal  ball, 
which  fractured  the  femur  obliquely  at  the  middle  third.  He  was  made  a  prisoner  and  conveyed  to  Richmond,  where  the  frac 
ture  was  treated  at  the  Alms  House  Hospital,  by  a  Desault  splint  for  one  week,  and  by  Smith's  anterior  splint  for  twelve  weeks 
subsequently.  Slight  suppuration  continued  for  nearly  a  year  after  the  injury,  with  occasional  elimination  of  bits  of  necrosed 


Mnl  and  Sunj    Hisl  of  the  War  of  lh«-  Kebt'lliou  .  l';u-t  HI    Vol.11. Chap.X. 


PLATE     LXI.-  CONSOLIDATED    GU  NSHOT   FRACTURES   OF  TH  E   FEMU  R 


'I'-'   1    ('use  of  Scr«M'iUit    A  RvdfM- 
!'J1  -.'    N'^vFYork 


l'iv  1'    Case  of   Private    '!'  Mill.-r 
1  l(i  ll>   l\>nn  s  vlviiii;  .'i 


SECT.  III.] 


SHOT  FRACTURES  OF  MIDDLE  THIRD  OF  FEMUR. 


191 


FIG.  152. — Shot  fracture  <  f  middle  third 
of  left  femur.     [From  a  photograph.] 


bone.  Having  been  exchanged  on  December  31, 1861,  he  proceeded  to  his  home  in  New  York  City,  where  he  was  treated,  for  a 
time,  by  his  family  physician.  Some  months  afterwards  he  returned  to  the  field,  and  served  as  Acting  Aid-de-Camp  to  General 
Wilcox  until  January  20,  1863,  when  he  resigned  the  service.  In  August  following,  Captain  Shillingluw  was  commissioned 
in  the  Veteran  Reserve  Corps,  in  which  organization  he  remained  until  August  2,  1865, 
when  he  was  finally  mustered  out  and  pensioned.  After  leaving  the  service  he  took  up  his 
residence  in  Washington  City,  and  obtained  employment  in  the  U.  S.  Treasury  Department. 
The  photograph,  represented  in  the  annexed  cut  (FlG.  152),  was  obtained  in  June,  1866, 
when  he  visited  the  Army  Medical  Museum.  At  that  time  the  injured  limb  was  shortened 
nearly  three  inches,  but  he  could  walk  briskly  and  without  a  limp.  He  used  no  cane  and 
experienced  little  or  no  inconvenience  from  his  wounds.  Examiner  J.  Phillips  certified, 
February  6,  1869t  "Gunshot  wound  of  left  thigh,  left  arm,  right  hand  and  arm,  and  right 
temple.  Compound  comminuted  fracture  of  thigh  bone.  The  bone  has  united  crookedly, 
and  is  about  three  inches  shorter  than  its  fellow;  the  muscles  are  attenuated,  and  the  nerves 
of  the  limb  so  affected  that  he  is  constantly  suffering.  Gunshot  wound  of  left  elbow  joint; 
ball  lodged  near  the  joint,  which  is  now  so  weakened  as  to  be  unserviceable  for  labor. 
Flesh  wound  of  right  hand  from  piece  of  shell.  The  right  arm  was  pierced  by  a  piece  of 
shell,  scraping  the  bone.  This  wound  impairs  the  usefulness  of  the  limb.  A  ball  struck  the 
right  parietal  bone.  He  suffers  but  little  from  this  wound."  This  pensioner  died  April  14, 
1870,  of  consumption,  superinduced  by  an  attack  of  pleuro-pneumonia  and  gunshot  wounds. 
CASE  391. — Private  J.  Moran,  Co.  K,  25th  Ohio,  aged  22  years,  was  wounded  "at  Bull 
Run,  August  30, 1862,  and  admitted  to  hospital  at  Alexandria  four  days  afterwards.  Surgeon 
E.  Bentley,  U.  S.  V.,  reported :  "A  ball  entered  on  the  anterior  side  of  the  left  thigh,  at  the 
top  of  the  middle  third,  passed  though  the  limb,  fracturing  the  bone,  and  emerged  on  the 
inner  side  of  the  thigh,  at  the  bottom  of  the  middle  third.  The  patient  was  treated  by  rest 
and  position,  and  the  bone  united  with  considerable  shortening.  He  was  discharged  from 
hospital  January  30,  1863."  The  man  subsequently  joined  the  Veteran  Reserve  Corps,  and 
was  ultimately  discharged  from  service  March  28,  1865,  and  pensioned.  Examiner  S.  S. 
Thorn,  of  Toledo,  Ohio,  October  3,  1865,  certified  to  the  "shot  fracture  of  the  femur,  fol 
lowed  by  three  and  a  half  inches  shortening,  anchylosis  of  knee,  and  impaired  power  of 
limb;"  also  to  "the  wound  being  still  open  and  exfoliating  bone."  Examiner  S.  M.  Smith, 
of  Columbus,  one  year  later  reported  the  injured  femur  as  affected  with  necrosis,  and  Exam 
iner  T.  A.  Reamy,  of  Cincinnati,  in  September,  1873,  describes  the  "muscles  firmly  adherent  to  the  bone  at  the  point  of  the 
injury,  an  open  sinus  communicating  with  the  bone  anteriorly,  and  great  angular  deformity  at  the  union  of  the  fractured  bone." 
The  attending  physician  of  the  pensioner  certified  that  he  died  November  11,  1874,  of  debility  superinduced  by  necrosis  of  the 
injured  femur,  which  was  attended  by  continued  exfoliation  and  suppuration. 

fatal  Cases  of  Shot  Fractures  of  the  Middle  Third  of  the  Femur  treated  by  Con 
servation. — Three  hundred  and  forty-two  cases  of  shot  fracture  of  the  middle  third  of  the 
femur  treated  by  conservation  had  fatal  terminations.  Eighty-six  were  Confederate  and 
two  hundred  and  seventy-four  Union  soldiers: 

CASE  392. — Private  J.  Shimrock,  Co.  A,  55th  Ohio,  aged  20  years,  was  wounded  at  Chancellorsville,  May  3,  1863. 
Surgeon  G.  Suckley,  U.  S.  V.,  reported  that  he  was  left  in  the  hands  of  the  enemy,  and  described  his  injury  as  "a  shot  fracture 
of  the  femur."  Twelve  days  after  being  wounded  the  man  was  paroled  and  admitted  to  the  Eleventh  Corps  field  hospital  at 
Brook's  Station,  and  one  month  later  he  was  transferred  to  the  Stan  ton  Hospital  at  Washington.  Surgeon  J.  A.  Lidell,  U.  S.  V., 
contributed  the  specimen  (FlG.  153)  and  made  the  following  report  of  the  case:  "Examination  at  the  time  of  admission  showed 
that  the  right  femur  was  broken  near  the  junction  of  the  lower  with  the  middle  third,  and  that  union  had  not  yet  taken  place. 
There  was  a  copious  discharge  of  thin  pus  from  the  wound  of  the  soft  parts.  The  fracture  had  been  treated  in  a  simple  straight 
fracture-box,  and  the  limb  was  still  in  it  when  the  patient  was  brought  to  this  hospital.  He  stated  that  the  bullet  had  not  yet 
been  extracted  from  the  wound.  He  was  pale,  thin,  and  weak,  with  a  frequent  pulse.  His  tongue  was  smooth,  dry,  and  red, 
and  he  complained  of  diai'rhcea,  but  said  this  was  an  old  affair,  and  that  he  had  also  had  chills  and  fever  some  time  back.  The 
prognosis  was  very  unfavorable.  The  broken  limb  was  placed  in  Hodgen's  splint;  pills  of  camphor  and  opium  were  given  to 
control  the  diarrhoea,  and  the  system  was  supported  with  a  nourishing  diet,  using  eggs,  milk,  beef  tea,  farina,  etc.,  together  with 
milk-punch.  Juno  18th,  diarrhoea  checked;  tongue  continues  red  and  smooth;  has  considerable  irritability  of  the  stomach. 
The  pills  were  suspended,  but  the  supporting  treatment  continued.  22d,  secondary  haemorrhage  from  the  wound,  to  the  extent 
of  about  three  ounces,  occurred  this  morning;  there  was  also  slight  bleeding  yesterday,  some  branch  of  the  profunda  being  the 
probable  source.  Two  drachms  of  solution  of  persulphate  of  iron  was  injected  into  the  bottom  of  the  wound  through  a  catheter, 
and  the  haemorrhage  did  not  again  occur.  24th,  complained  of  pain  in  the  thigh,  was  restless,  and  had  some  diarrhoea.  Gave 
one-grain  opium  pills  every  four  hours  until  the  26th,  when  the  diarrhoea  was  again  checked.  Suppuration  continued  profuse; 
tongue  smooth  and  red.  July  2d,  patient  appeared  to  be  slowly  failing.  Fluctuation  having  been  detected  above  the  internal 
condyle  of  the  femur,  an  incision  was  made  and  about  two  ounces  of  pus  evacuated.  Two  grains  of  quinine  was  prescribed 
three  times  a  day,  and  six  ounces  of  whiskey  daily  was  substituted  in  place  of  the  milk-punch,  which,  the  patient  thought,  did 
not  agree  with  him.  8th,  patient  began  to  exhibit  night  sweats,  with  increase  of  pallor  and  anaemia;  suppuration  profuse, 
unhealthy  and  fetid ;  necrosed  bone  at  the  bottom  of  the  wound  firmly  impacted.  18th,  had  a  chill,  followed  by  a  hot  and  sweat 
ing  stage.  Administered  ten  grains  of  quinine  three  times  a  day:  chills  did  not  return  for  four  days.  20th,  patient  very  pale 


192 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  153. — Fracture 
of  right  femur  at  junc 
tion  of  middle  and  low 
er  thirds.  Spec.  1536. 


and  feeble,  with  smooth  red  tongue;  in  addition  to  quinine  he  takes  muriated  tincture  of  iron,  and  porter  two  pints  daily,  with 
nourishing  diet.  21st,  diarrhoea  returned  and  was  checked  by  pills  of  opium.  22d  and  23d,  chills  occurring  at  irregular  inter 
vals,  associated  with  hot  flushes  and  profuse  perspiration.  25th,  some  unhealthy  fetid  pus  was  evacuated 
from  the  inner  side  of  the  thigh  by  incision.  27th,  had  pysemic  rigors  and  sweats  again ;  is  much  emaciated 
and  very  pale;  pulse  120  and  feeble;  tongue  glazed  and  of  bright  red  color.  29th,  continuance  of  pysemic 
rigors  and  sweats,  the  perspiration  being  very  profuse;  left  leg  and  thigh  cedematous  and  blue  colored, 
the  superficial  veins  looking  like  dark  blue  knotted  cords;  all  of  which  denotes  obstruction  of  the  left 
iliac  and  femoral  veins.  The  patient  continued  to  sink,  and  died  of  exhaustion  on  July  31,  1863.  Post 
mortem  twenty  hours  after  death:  Fracture  of  right  thigh  firmly  united;  necrosed  bone  closely  surrounded 
by  involucrum ;  muscles  of  right  thigh  extensively  infiltrated  with  pus.  The  missile,  a  conical  and  much 
flattened  bullet,  was  found  at  the  lower  and  inner  side  of  the  thigh.  The  femoral  artery  opposite  the  seat 
of  the  injury  contained  an  oval-shaped  clot  of  blood  (embolus)  which  completely  occluded  it;  no  other 
abnormity  of  the  artery  was  noticed.  On  examination  of  the  left  thigh  a  metastatic  abscess  was  found  in 
the  popliteal  space  containing  about  an  ounce  of  pus,  and  the  external  iliac  and  femoral  veins  were  dis 
covered  to  be  distended  with  coagulated  blood.  The  femoral  and  iliac  veins  of  the  injured  limb  appeared 
to  be  normal.  The  liver  was  somewhat  enlarged,  nutmegged  and  fatty;  kidneys  beginning  to  be  granular; 
spleen  enlarged,  softened,  and  reddish  brown  in  color;  lungs  containing  some  frothy  serum,  otherwise 
natural ;  left  ventricle  of  heart  containing  some  coagulated  blood."  The  specimen  consists  of  the  lower 
half  of  the  injured  femur  with  a  battered  piece  of  lead  attached,  and  exhibits  a  fragment  four  inches  long 
by  one  and  a  half  w;ide,  which  preserved  the  vitality  of  its  periosteal  surface.  The  effusions  from  this 
fragment  connect,  as  a  bridge,  the  broken  shaft;  its  internal  surface  is  carious.  Besides  this,  other  and 
smaller  fragments  are  entangled  in  the  newly  formed  bone,  some  of  which  are  necrosed  and  some  serve  as 
bonds.  A  wet  preparation  of  portions  of  the  common  and  external  iliac  and  femoral  arteries  of  the  right 
side,  showing  an  embolus  in  the  latter  near  the  seat  of  the  fracture  of  the  thigh,  was  also  contributed  by 
Surgeon  Lidell,1  and  constitutes  Specimen  3454  of  the  Surgical  Section  of  the  Army  Medical  Museum. 

CASK  303. — Corporal  W.  Ford,  Co.  B,  1st  Colored  Regiment,  aged  20  years,  received  a  shot  wound  at  Petersburg,  June 
1"),  1885,  and  was  conveyed  to  Baltimore  twelve  days  afterwards.  Surgeon  L.  W.  Read,  U.  S.  V.,  reported  his  admission  to 
McKim's  Mansion  Hospital  with  "shot  fracture  of  left  thigh."  On  July  25th,  the  patient  was  transferred  to  Hick's  Hospital, 
whence  Assistant  Surgeon  G.  M.  McGill,  U.  S.  A.,  forwarded  the  specimen,  shown  in  the  annexed  cut  (FiG.  154),  with  the  fol 
lowing  account  of  the  case:  "The  patient  suffered  with  a  wound  of  the  left  thigh. 
The  ball  had  entered  the  posterior  part  of  the  outer  aspect  of  the  middle  third,  pass 
ing  inward,  forward,  and  slightly  upward,  and  lodged.  It  was  sought  for  several 
times  but  could  never  be  detected.  A  large  detached  piece  of  necrosed  bone  was 
taken  out  of  the  opening  of  entrance  during  the  month  of  September,  1865.  The 
patient  complained  of  continual  pain,  aggravated  by  pressure  in  both  lumbar 
regions,  in  which  regions  there  was  extended  flatness  on  percussion.  He  continued 
very  weak,  had  several  attacks  of  erysipelas,  and  finally  sank,  after  a  severe  attack, 
on  February  20,  1866.  The  injured  thigh  was  greatly  swollen,  its  skin  shiny  and 
somewhat  tuberculated  about  the  sinuses  and  slow-healing  incisions.  The  diagnosis 
of  fatty  degeneration  (interstitial  formation  and  proper)  was  made  for  the  left  thigh 
and  leg  and  inferred  for  the  great  organs.  Ford  was  a  long  time  dying :  For  seventy 
hours  or  more  his  death  was  expected  from  hour  to  hour.  Before  death  the  surface 
of  his  body,  in  appearance,  was  waxen.  The  left  leg  and  foot  were  gangrenous. 
There  was  a  tumor  (result  of  periosteal  action)  of  the  diaphysis  of  the  left  femur. 
The  ball  (much  flattened)  was  found  beneath  the  sartorius  muscle  and  vessels  in  the 
middle  third  of  the  thigh.  There  was  pus  in  the  left  knee  joint,  in  the  left  hip  joint, 
and  in  the  superficial  fascia  of  the  left  leg.  No  disease  of  the  vessels  was  observed." 
The  specimen  consists  of  the  left  femur,  obliquely  fractured  in  the  middle  third  and 
partly  consolidated  by  an  excessive  deposit  of  new  bone  on  the  posterior  surface,  the 
adjacent  surfaces  being  carious,  with  a  necrosed  fragment  remaining  at  the  upper 
portion. 

CASE  394. — Private  C.  Hill,  Co.  K,  7th  Michigan,  was  wounded  at  Antietam, 
September  17,  1862.  Surgeon  G.  Chaddock,  7th  Michigan,  reported  his  admission 
to  the  Stone  House  Hospital,  near  the  battle-field,  with  "shot  wound  of  the  thigh." 
Surgeon  B.  A.  Vanderkieft,  U.  S.  V.,  forwarded  the  specimen,  shown  in  the  wood-cut 
(FiG.  155),  with  the  following  history:  "The  patient  was  wounded  by  a  musket  ball,  which  passed  through  the  middle  third  of 
the  right  thigh,  fracturing  the  femur.  He  came  under  my  care  six  weeks  after  the  injury,  there  being  no  previous  history 
other  than  his  statement  that  a  small  piece  of  bone  was  extracted  a  few  days  after  the  reception  of  the  wound.  On  account  of 
the  normal  appearance  and  length  of  the  leg,  the  slight  suppuration,  the  absence  of  other  fragments  and  of  any  crepitation 
whatever,  I  diagnosed  an  incomplete  compound  fracture  of  the  thigh,  such  as  is  often  the  result  of  an  injury  by  a  spherical  ball 
received  at  short  distance.  (Patient  stated  that  he  distinctly  saw  the  man  who  shot  at  him.)  His  general  condition  was  very 
satisfactory.  The  fractured  limb  presented  two  fistular  openings,  one  on  the  inner  and  the  other  on  the  outer  side  of  the  thigh 
at  the  middle  third,  and  discharging  but  little  pus.  There  was  no  shortness  whatever,  and  if  there  had  been  a  complete 

'Dr.  LIDELL,  in  an  article  on  Thrombosis  and  Embolism,  in  the  American  Journal  of  Medical  Sciences,  1872,  Vol.  LXIV,  N.  S.,  p.  343,  gives  a 
minute  account  of  this  important  case. 


FIG.  154. —  Oblique  fracture 
of  left  femur  in  middle  third. 
Spec.  255. 


FIG.  155. — Left 
femur  fractured  in 
middle  third. 
Spec.  1043. 


M.'d  aiul  Sin-.'    Ilisl   of  the  WHi-oI'llieKrbellion.  Part  III    Vol.  II,  C  hap  X. 


PLATE     LXII  -CONSOLIDATED    GUNSHOT  FRACTURES   OF  THE  FEMUR 


Fi»  1  Case  of  Private  H.K  r.HM.h.M-ts 
l:-5t)1h  Indiana. 


Fi-j  1'   Case  of  Wivatr   H.Shetter 
/  *.h  Wisconsin . 


SECT   in.]  SHOT    FEACTUEES    OF    MIDDLE   TRIED    OF    FEMUE.  193 

division  of  the  bone  consolidation  had  already  followed.  The  limb  was  placed  between  two  sand  bags,  acting  as  splints,  and 
a  plain  dressing  was  applied.  A  very  nourishing  diet  was  prescribed.  By  the  17th  of  December  the  patient  was  doing  very 
well;  the  inner  fistular  opening  was  closed,  while  the  one  on  the  outside  was  still  of  the  same  dimension,  but  discharging  an 
ichorons  pus  mixed  with  small  pieces  of  bone  in  the  form  of  sand,  such  as  is  often  noticed  in  caries  of  the  long  bones.  On  Jan 
uary  9,  1863.  notwithstanding  the  continuation  of  the  discharge  of  the  aforementioned  character,  the  patient  felt  well  enough  to 
sit  up  a  short  time  in  an  arm-chair,  but,  on  returning  to  his  bed,  he  accidentally  fell  down,  and,  owing  to  the  fragility  of  the 
injured  parts,  he  fractured  the  same  precisely  at  the  corresponding  point  of  the  passage  of  the  ball.  Notwithstanding  the  most 
careful  attendance  no  consolidation  could  be  obtained,  the  whole  femur  seeming  to  be  in  a  state  of  molecular  disorganization, 
and  having  lost  its  normal  firmness  even  as  in  rachites.  The  discharge  of  ichorous  pus  increased  daily,  and  the  patient  died  of 
exhaustion  on  March  19,  1853,  no  signs  of  pyaemia  having  been  noticed.  The  use  of  phosphate  of  lime  against  the  existing 
osteomalacia  did  not  afford  the  slightest  relief.  According  to  the  patient's  statement,  there  was  no  constitutional  predisposition." 
The  specimen  consists  of  the  injured  femur,  and  shows  the  formation  of  an  immense  sequestrum  in  the  lower  half  and  disease 
of  the  lower  two-thirds  of  the  shaft. 

CASE  395. — Sergeant  T.  Bechtold.  Co.  C,  93d  Pennsylvania,  aged  34  years,  was  wounded  at  Fair  Oaks,  June  1,  1862, 
and  entered  Hygeia  Hospital  at  Fort  Monroe  nine  days  afterwards.  Surgeon  R.  B.  Bontecon,  U.  S.  V.,  reported:  "He  received 
a  shot  while  in  line  of  battle,  the  ball  entering  the  anterior  and  middle  third  of  the  right  thigh,  and  making  its  exit  nearly 
opposite  on  the  posterior  portion  of  the  limb;  and  while  on  the  ground  he  was  hit  again  by  a  conical  ball,  which  entered  the 
back  below  the  inferior  angle  of  the  scapula  and  was  cut  out  in  the  axilla.  On  June  12th,  secondary  haemorrhage  from  the 
wound  in  the  axilla  set  in,  which  continued  from  time  to  time  for  four  days,  when  it  was  finally  controlled  by 
pressure  and  plugging.  The  thigh  was  swung  up  in  Smith's  anterior  splint,  and  imperfect  union  took  place 
under  unfavorable  circumstances,  the  patient  being  very  much  emaciated  and  suffering  from  bedsores  and 
diarrhoea.  He  was  sent  to  his  home  in  August,  1832,  and  I  learned  that  he  subsequently  died  from  the  exhaust 
ing  suppuration,  which,  from  the  first,  kept  up  from  the  thigh  wound.  Sequestra  were  removed  whenever 
discovered,  and  the  fascia  of  the  thigh  relieved  to  prevent  burrowing."  The  patient  died  at  Lebanon,  Penn 
sylvania,  on  September  24,  18(i2,  whence  the  specimen  represented  in  the  wood-cut  (FlG.  13b')  was  con 
tributed  by  Dr.  B.  F.  Schenk.  The  specimen  embraces  a  portion  of  the  fractured  femur,  and  shows  a 
remarkable  instance  of  reparative  effort.  The  fragments  are  thoroughly  involved  with  callus,  and  a  large 
sequestrum  is  nearly  detached.  There  is  also  an  accidental  post-mortem  fracture  of  the  specimen  one  inch 
below  its  superior  border. 

CASE  396. — Private  Tobias  Bever,  Co.  C,  57th  North  Carolina,  aged  30  years,  was  wounded  and  taken 
prisoner  at  Eappahannock  Station,  Virginia,  November  7, 1863.  Surgeon  John  A.  Lidell,  U.  S.  V.,  reported : 
"The  bullet  entered  the  left  limb  one  and  a  half  inches  to  the  inner  side  of  the  inner  margin  of  the  patella, 
passed  upward  and  outward,  fractured  the  femur  five  or  six  inches  above  the  knee  joint  and  lodged;  its  locality 
could  not  be  ascertained.  He  was  admitted  into  Stanton  Hospital  November  9th,  his  general  condition  being 
favorable.  The  synovia!  pouches  were  apparently  unopened.  The  limb  was  placed  in  Hodgen's  splint  and  a  of 
moderate  amount  of  extension  applied ;  the  wound  was  kept  wet  with  cold  water.  Some  synovial  effusion  into  tured  in  middle  third, 
the  cavity  of  the  joint  occurred  on  November  21st,  but  no  other  untoward  symptoms  were  present.  November  ^ec' 
30th,  doing  well,  wound  healing,  but  little  effusion  in  the  knee  joint ;  general  health  good ;  bullet  still  unextracted.  December  1st, 
the  external  wound  is  healed ;  there  is  a  hard  substance,  feeling  like  a  portion  of  bone,  or  perhaps  the  ball,  to  be  felt  in  the  outer 
and  back  part  of  the  thigh  at  a  point  corresponding  with  the  fracture.  December  25th,  femur  united  and  quite  strong.  The 
ball  still  remained  in  the  limb,  and  its  location  was  not  surely  known.  On  January  1,  1864,  the  extension  was  discontinued. 
He  could  move  the  limb  very  well;  the  amount  of  shortening  was  two  inches,  which  was  occasioned  by  overlapping  at  the  seat 
of  fracture.  His  general  health  was  excellent,  and  he  was  out  of  bed  almost  every  day,  and  appeared  to  be  doing  well  until 
February  1,  1864,  when  the  wounded  thigh  had  become  swollen  (not  circumscribed)  and  painful.  Ordered  to  stay  in  bed  for 
the  purpose  of  resting  the  limb  and  to  apply  a  lotion  of  lead  and  opium.  The  tumefaction  of  the  thigh  partially  subsided  on 
February  14th,  but  the  lymphatic  glands  of  the  groin  had  become  swollen,  painful,  and  tender.  March  2d,  the  swelling  about 
the  track  of  the  bullet  has  increased  and  is  very  painful.  Fluctuation  is  also  detected.  The  cicatrix  of  the  wound  is  tense  and 
puffy  ;  incised  it  and  evacuated  about  two  ounces  of  laudable  pus.  March  3d,  the  pain  has  ceased  and  the  swelling  has  partially 
subsided.  The  discharge  from  the  wound  is  thin,  straw  colored,  and  flaky.  Directed  the  tincture  of  iron  to  be  continued,  with 
the  addition  of  six  ounces  of  whiskey  daily.  On  March  20th,  the  swelling  and  soreness  of  the  thigh  had  again  increased.  The 
discharge  continued  free.  There  was  also  diffuse  redness  of  the  skin,  extending  from  the  wound  up  the  inner  side  of  the  thigh. 
He  was  pale,  anaemic,  and  felt  very  weak.  Stimulants  were  directed  to  be  continued,  with  such  articles  of  diet  as  he  could  take. 
It  was  now  apparent  that  he  would  not  recover  without  amputation  of  the  thigh,  but  we  were  compelled  to  await  the  subsidence 
of  the  diffuse  inflammation  of  the  soft  parts  in  order  to  perform  that  operation  with  any  hope  of  success.  March  22d,  the 
discharge  continues  copious.  It  is  thin  and  there  is  some  blood  mixed  with  it.  He  is  somewhat  emaciated  and  slowly  failing 
in  strength.  March  24th,  copious  haemorrhage  from  the  wound,  apparently  parenchymatous  in  character,  occurred  this  morning, 
and  about  half  a  pint  of  blood  was  lost  before  it  could  be  controlled.  Injected  about  two  ounces  of  solution  of  persulphate  oi 
iron  through  a  catheter  carried  deep  into  the  wound,  after  which  there  was  no  more  external  haemorrhage.  The  loss  of  blood 
reduced  him  very  much.  He  gradually  sank,  and  died  on  the  morning  of  March  27,  1864.  At  the  autopsy,  in  dissection,  great 
oedema  of  the  areolar  tissue  of  the  thigh  was  found.  There  was  a  large  cavity  beneath  the  fascia  lata  and  surrounding  the  seat 
of  fracture.  It  extended  from  the  synovial  pouches  of  the  knee  joint  up  to  the  trochanter  major.  It  was  lined  with  a  moderate 
amount  of  plastic  exudation.  It  contained  about  a  quart  of  dark  colored  blood  mixed  with  some  pus.  At  the  bottom  of  it,  and 
toward  the  inner  side  of  the  femur,  a  minie"  ball  was  discovered.  A  piece  had  been  split  off  from  the  side  of  it  which  could  not 
be  found.  The  medulla  of  the  femur  above  the  fracture  was  found  to  be  bright  red  in  color  and  soft  in  consistence.  It  presented 
the  appearance  described  by  Virchow  as  the  'red  inflammatory  marrow'  (osteomyelitis).  The  fracture  was  firmly  but  irregu- 
SURG.  Ill— 25 


194 


LNJUIUES    OF    THE    LOWEK    EXTREMITIES. 


IciiAr.  x. 


larly  united.  Examination  of  the  specimen  showed  that  the  bullet  passed  upward  and  outward  from  the  orifice  of  entrance  at 
the  inner  side  of  the  knee,  but  without  opening  the  joint  cavity,  and  impinged  against  the  femur  about  three  and  a  half  inches 
above  the  extremity  of  the  condyles,  fracturing  the  bone  very  obliquely  with  comminution,  so  obliquely,  indeed,  that  while  the 
line  of  fracture  commences  about  three  and  a  half  inches  above  the  extremity  of  the  condyles,  as  already  stated,  it  terminates 
about  seven  inches  above  the  extremities  of  the  femoral  condyles,  so  that  the  lower  fragment  of  the  broken  femur  is,  in  all,  about 
seven  inches  long.  The  fragments  of  comminution  had  all  united  with  more  or  less  irregularity  of  position,  but  portions  of  some 
of  them  appeared  likely  to  exfoliate.  The  two  principal  fragments  had  united  at  something  of  an  angle  opening  forward  and  a 
little  inward,  so  that  the  femur  bowed  backward  and  somewhat  outward  on  that  account.  The  marrow  at  the  place  of  exam 
ination,  a  few  inches  above  the  fracture,  was  bright  red  in  color,  and  presented  a  striking  resemblance  to  newly  formed  gran 
ulations.  A  few  spots  appeared  to  be  undergoing  the  process  of  conversion  into  bone."  The  pathological  preparation,  Specimen 
2167,  was  contributed  to  the  Army  Medical  Museum  by  Dr.  Lidell.  A  colored  drawing  of  the  specimen,  prepared  by  Hospital 
Steward  E.  Stanch,  U.  S.  A.,  is  copied  in  the  chromo-lithograph  (PLATE  XXIV)  opposite. 

Shot  Fractures  of  the  Lower  Third  of  the  Femur  treated  by  Conservation. — Six 

hundred  and  twenty  cases  of  shot  fractures  of  the  lower  third  of  the  femur  were  treated 
without  operative  interference.  Instances  of  shot  fracture  of  the  lower  third  of  the  femur, 
in  which  the  knee  joint  was  primarily  involved,  are  not  included  in  this  series;  they  will 
be  considered  in  Section  IV  of  this  Chapter,  with  injuries  of  the  knee  joint.  Three  hun 
dred  and  seventy-five  of  the  six  hundred  and  twenty  patients  recovered;  two  hundred  and 
thirty-two  died,  and  in  thirteen  instances  the  result  remained  undetermined,  giving  a  ratio 
of  mortality  of  38.2  per  cent.  Five  hundred  and  two  were  Union,  and  one  hundred  and 
eighteen  were  Confederate  soldiers,  and  the  proportion  of  deaths  among  the  former  was 
38.7,  among  the  latter  36.0  per  cent. 

Successful  Cases  of  Shot  Fractures  of  the  Lower  Third  of  the  Femur  treated  by  Con 
servation. — Three  hundred  and  four  of  the  three  hundred  and  seventy-five  survivers  of  shot 
fracture  of  the  femur  in  the  lower  third  were  Union  soldiers,  and  an  account  of  the  pension 
record  has  been  obtained  in  two, hundred  and  thirty-nine  instances: 

CASE  397. — Private  C.  H.  Schellenger,  Co.  C,  9th  New  York  Heavy  Artillery,  aged 
35  years,  was  wounded  at  Petersburg,  April  2,  1865,  and  admitted  to  the  field  hospital  of 
the  2d  division,  Sixth  Corps,  where  Surgeon  W.  A.  Childs,  10th  Vermont,  recorded : 
"  Shot  fracture  of  right  femur;  splints  applied."  Surgeon  E.  Griswold,  U.  S.  V.,  reported 
the  patient's  entrance  into  Judiciary  Square  Hospital  April  12th,  and  the  fracture  as  being 
located  at  the  "middle  third"  of  the  bone.  He  also  stated  that  the  treatment  at  first  con 
sisted  of  simple  dressings,  and  afterwards  splints  and  sand  bags  were  used,  and  that  "the 
progress  of  the  case  was  favorable  throughout,  the  wound  being  nearly  healed  about  the 
middle  of  June,  with  one  and  a  half  inches  shortening  of  the  limb."  The  patient  was 
discharged  from  service  June  22,  1865,  and  pensioned.  Examiner  E.  Hall,  of  Auburn, 
New  York,  certified,  November  25,  1865,  to  "  shot  wound  through  right  thigh  above  the 
knee,  breaking  the  femur  obliquely,  the  ball  coming  out  on  the  inside  of  the  leg  near  the 
scrotum.  Limb  shortened  and  knee  quite  stiff  from  thickened  cartilage."  The  Syracuse 
Examining  Board  reported,  April  5,  1876:  *  *  *  "The  limb,  he  alleges,  is  lame, 
weak,  and  subject  to  spasms  upon  fatigue."  The  pensioner  was  paid  June  4,  1879.  His 
photograph,  taken  at  the  Army  Medical  Museum  in  June,  1865  (Sury.  Phot.  Scries,  A.  M.  M., 
No.  45),  is  represented  in  the  wood-cut  (FiG.  157). 

In  the  following  instance  the  patient  recovered  with  such 
excellent  use  of  the  limb  that  the  Pension  Examining  Board 
recommended,  in  1876,  that  the  pensioner's  name  be  dropped 
from  the  Rolls,  as  the  disability  had  ceased  and  the  injured  limb 
was  as  well  nourished  as  the  other: 

CASE  398.— Private  J.  Durst,  Co.  D,  69th  New  York,  aged  21  years,  was  wounded 
at  Hatcher's  Run,  March  25,  1865.  On  the  following  day  he  was  admitted  to  the  Depot 

FIG.  157.— Result  of  shot  fracture  of  lower     Hospital  of  the  Second  Corps,  at  City  Point,  and,  on  March  30th,  he  reached  Washington, 
lird  of  riprht  femur.     [From  a  photograph.]  .      .         ,  n    T-    a     vu 

where  he  entered  Armory  Square  Hospital.  Acting  Assistant  Surgeon  G.  K.  Smith  con 
tributed  the  following  history  :  "A  minie"  ball  entered  the  anterior  aspect  of  the  right  thigh  at  the  junction  of  the  middle  and  lower 
thirds,  passing  backward  and  fracturing  the  femur,  and  made  its  exit  opposite  the  wound  of  entrance.  The  injury  produced  very 
little  constitutional  disturbance,  and  the  discharge  from  the  wound  did  not  exceed  two  drachms  in  twenty-four  hours  at  any  time. 
The  limb  was  treated  in  Hodgen's  splint,  without  extension,  until  April  14th,  when  it  was  placed  on  a  mattress  with  a  sand  bag 


third  < 


PLATE    XXIV.       OSTEOMYELITIS    IN    A    FRACTURED    FEMUR. 


'iisc   (i  I'  I 'I   Tnliiiis  I  Ic-MVt  •!•.('.  i~i ,  i:'N«  :-lli  ( 'lire!  in. 


SECT.  III.]  SHOT    FRACTURES    OF    LOWER   THIRD    OF    FEMUR.  195 

on  each  side  to  keep  it  in  position,  and  extension  was  applied  by  Buck's  method.  On  June  9th  the  extension  was  removed  and 
the  bone  was  found  to  be  firmly  united,  with  one  and  one-fourth  inches  shortening.  The  patient  was  now  walking  on  crutches. 
The  anterior  wound  had  healed  for  about  a  week,  but  the  posterior  wound  was  still  discharging  very  slightly.  By  June  23d  he 
had  good  movement  of  the  knee  and  could  bend  the  leg  to  a  right  angle  with  the  direction  of  the  thigh.  The  discharge  from 
the  wound  at  this  time  did  not  amount  to  over  one  drachm  in  a  week.  No  fragments  of  bone  were  ever  removed,  and  the  limb 
healed  almost  as  kindly  as  a  simple  fracture,  showing  no  deformity  except  the  shortening."  The  patient  was  subsequently  trans 
ferred  to  DeCamp  Hospital,  David's  Island,  New  York,  and,  on  August  19,  1865,  he  Avas  discharged  and  pensioned.  Examiner 
W.  M.  Chamberlain,  on  August  22,  18G6,  certified  to  a  "  well  united  fracture  of  the  right  femur,  with  only  one  inch  shortening, 
and  some  lameness  and  debility  of  the  limb."  Substantially  the  same  was  reported  at  subsequent  examinations  until  January 
19.  1876,  when  the  New  York  Board  certified  to  the  injured  thigh  being  as  well  nourished  as  the  other,  and  to  the  disability  as 
having  ceased,  in  accordance  with  which  the  pensioner  was  dropped  from  the  Pension  Rolls.  A  photograph  of  the  patient,  taken 
at  the  Army  Medical  Museum  in  June,  1865  (Surg.  Phot.  Series,  No.  46,  A.  M.  M.),  is  represented  in  PLATE  LXIII,  opp.  p.  196. 

CASE  399. — Private  E.  P.  Allen,  Co.  D,  12th  Infantry,  aged  19  years,  was  wounded  at  Gettysburg,  July  2,  1863,  and 
admitted  to  the  field  hospital  of  the  2d  division,  Fifth  Corps.  The  injury  was  caused  by  a  minie"  ball,  which 
lodged  in  the  anterior  portion  of  the  lower  third  of  the  left  thigh,  and  was  removed  on  the  following  day  by 
Assistant  Surgeon  E.  DeW.  Brenneman,  U.  S.  A.  The  missile  was  contributed  to  the  Museum  by  the  oper 
ator  and  is  represented  in  the  annexed  wood-cut  (FlG.  158).  It  consists  of  a  couoidal  ball  beaten  into  nearly 
a  triangular  pyramid  with  very  sharp  edges.  From  the  field  hospital  the  patient  was,  on  July  25th,  transfer 
red  to  the  Cotton  Factory  Hospital  at  Harrisburg,  whence  Acting  Assistant  Surgeon  W.  S.  Woods  reported 
that  he  was  discharged  from  service  December  21,  1863,  by  reason  of  "compound  fracture  of  left  thigh." 
Examiner  C.  Hard,  of  Ottawa,  Illinois,  certified,  May  1,  1869:  "There  is  a  compound  comminuted  fracture 
of  the  lower  third  of  the  left  femur.  The  bones  have  united,  with  three  inches  shortening,  leaving  great  and 
incurable  deformity,  and  there  is  partial  anchylosis  of  the  knee  joint,  making  him  permanently  lame."  In  FIG.  1 58.— Batter- 
September,  1873,  the  same  Examiner  stated  that  "the  heel  is  drawn  up,  the  fo»t  turned  out,  and  the  limb  moved  from  thigh, 
atrophied  from  foot  to  body."  The  pensioner  was  paid  June  4,  1879.  <$Pec-  3028- 

CASE  400. — Private  M.  Burns,  Co.  B,  28th  Massachusetts,  aged  22  years,  was  wounded  at  Hatcher's  Run,  March  25, 1865. 
Surgeon  F.  M.  Hammond,  126th  New  York,  noted  his  entrance  into  the  field  hospital  of  the  1st  division,  Second  Corps,  with 
"shot  wound  of  left  thigh."  The  wounded  man  reached  Washington  April  3d,  and  was  admitted  to  the  Armory  Square 
Hospital,  whence  Acting  Assistant  Surgeon  G.  K.  Smith  reported  the  following  history:  "The  missile,  a  mim'6  ball,  entered  the 
anterior  portion  of  the  thigh  at  the  junction  of  the  middle  and  lower  thirds,  and,  passing  horizontally  backward,  fractured  the 
femur  and  made  its  exit  posteriorly.  The  constitutional  disturbance  resulting  from  the  injury  was  very  slight,  the  discharge  of 
pus  from  the  wound  amounting  to  only  about  half  an  ounce  in  twenty-four  hours.  The  limb  was  shortened  two  inches.  It  was 
placed  on  a  mattrass,  between  two  sand  bags,  and  extension  was  applied  with  a  sixteen  pound  weight.  Muriated  tincture  of 
iron  was  ordered;  but  no  stimulants  were  given.  By  April  loth,  the  discharge  amounted  to  only  one  drachm  daily,  and  the  limb 
was  shortened  only  one  and  a  quarter  inches.  On  May  llth,  believing  the  fragments  to  be  firmly  united,  I  allowed  the  extension 
to  be  removed  and  the  patient  to  ride  on  the  invalid  chair,  and,  on  measuring  the  limb,  I  found  that  it  was  still  shortened  three- 
quarters  of  an  inch.  I  reapplied  the  weight ;  but  this  contraction  could  not  be  overcome  by  any  amount  of  extension  that  the 
patient  could  bear.  He  was  now  kept  in  bed  until  June  9th,  at  which  time  the  fragments  had  firmly  united  and  he  commenced 
walking  on  crutches.  No  fragments  of  bone  were  ever  removed  from  the  limb."  The  patient  was  transferred  to  the  Readville 
Hospital  July  5th,  and  subsequently  to  Dale  Hospital,  Worcester,  where  he  was  discharged  and  pensioned  August  28,  1865, 
Surgeon  C.  N.  Chamberlain,  U.  S.  V.,  certifying  to  "fracture  of  femur,  with  moderate  deformity  and  shortening  and  slight 
contraction  of  the  flexors  of  the  thigh."  The  pensioner  enlisted  in  the  43d  Infantry  on  August  21,  1867,  and  was  again 
discharged  June  10,  1869.  Examiner  I.  F.  Galloupe,  of  Lynn,  Massachusetts,  certified,  in  1869:  "A  musket  ball  passed  through 
the  left  thigh,  fracturing  the  femur.  The  wound  is  healed  and  the  bone  appears  to  be  sound.  The  limb  is  shortened  and  he 
walks  slow  and  with  difficulty,"  etc.  In  June,  1874,  the  same  Examiner  reported :  "  In  walking  he  does  not  touch  the  heel,  but 
rests  on  the  forward  part  of  the  foot,  thus  making  locomotion  slow  and  fatiguing.  The  limb  is  painful  when  much  used  and  in 
cold  weather.  The  femur  is  enlarged  and  the  foot  is  swollen."  The  pensioner  was  paid  June  4,  1879.  FlG.  2  of  PLATE 
LXIII,  opp.  p.  196,  represents  a  copy  of  a  photograph  of  the  patient  taken  at  the  Army  Medical  Museum  on  June  25,  1865 
(Surg.  Phot.  Series,  No.  47,  A.  M.  M.). 

CASE  401. — Corporal  L.  Tenney,  Co.  F,  82d  New  York,  aged  20  years,  received  a  comminuted  fracture  of  the  lower 
third  of  the  right  femur,  at  Gettysburg,  July  2, 1863.  The  following  history  of  the  case  and  its  result  was  obtained  from  reports 
of  Surgeon  Z.  E.  Bliss,  U.  S.  V.,  in  charge  of  Camden  Street  Hospital,  Baltimore,  and  Assistant  Surgeon  W.  Webster,  U.  S.  A., 
in  charge  of  DeCamp  Hospital,  David's  Island,  New  York  Harbor:  "The  ball,  believed  to  be  cylindro-conoidal,  struck  the 
anterior  surface  of  the  bone  external  to  the  median  line,  and  passed  directly  backward  through  the  posterior  surface  of  the  thigh. 
The  patient  stated  that  the  limb  bent  beneath  him,  at  the  point  of  the  fracture,  directly  the  injury  was  received.  Soon  afterwards 
he  was  borne  from  the  field  on  a  blanket,  and  was  deposited  temporarily  in  a  neighboring  barn.  The  following  day  he  was 
removed  in  an  ambulance  about  the  distance  of  a  mile  to  a  temporary  hospital.  There  he  first  received  professional  attendance, 
and  was  placed  under  the  influence  of  chloroform  preparatory  to  amputation  of  the  thigh.  The  examination,  however,  to  which 
he  was  submitted,  appears  to  have  decided  the  attending  surgeon  in  favor  of  endeavors  to  preserve  the  limb.  A  rough  fracture- 
box  was  accordingly  adopted,  in  which  the  limb  remained  subjected  to  cold-water  dressings  for  six  days,  when  the  disclosure  to 
the  surgeon  of  three  inches  contraction  of  the  femur  induced  him  to  substitute  a  double-inclined  plane.  The  patient  alleged  that 
by  this  new  apparatus  the  limb  was  restored  to  its  normal  length.  About  three  weeks  after  the  reception  of  the  injury  the  double- 
inclined  plane  gave  place  to  Smith's  wire  splint,  which  was  employed  during  a  space  of  five  weeks.  In  the  mean  time  the  patient 
was  transferred  to  the  Corps  Hospital  at  Gettysburg,  where  he  remained  until  October  21st.  The  fracture  appears  to  have  been 


196  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

thought  sufficiently  consolidated  on  August  20th  to  warrant  the  removal  of  all  mechanical  support  from  the  limb  on  that  date. 
Tennev  stated  that  the  limb  was  at  that  time  of  primitive  length,  and  that  ho  could  raise  the  heel  from  the  bed  by  the  unaided 
muscular  power  of  the  leg.  The  posterior  aperture  gave  constant  exit  to  pus  of  a  healthy  character  throughout  the  treatment. 
The  perpendicular  direction  of  the  wound,  in  the  recumbent  posture  of  the  patient,  is  believed  to  have  had  a  beneficial  influence 
in  this  instance,  as  it  has  in  several  other  successful  cases  whose  treatment  has  come  under  observation,  in  protecting  the  patient 
from  accumulations  of  pus  and  securing  an  otherwise  happy  result.  It  will  be  observed  that  the  fracture  of  the  femur  suffered  by 
this  patient  was  one  of  those  typically  favorable  cases  described  by  Stromeyer,  where  the  femur  is  struck  by  the  bullet  on  the 
outer  side,  remote  from  the  great  vessels,  and  the  limb  traversed  in  an  antero-posterior  direction,  affording  free  escape  to  the 
secretion  of  the  wound  during  treatment.  About  the  middle  of  October  the  patient  was  able  to  move  about  on  crutches,  and  on 
the  20th  of  that  month  he  was  removed  from  Gettysburg  to  Baltimore.  On  January  1,  1834,  he  walked  a  distance  of  three 
miles  without  the  aid  of  cane  or  crutch.  One  week  afterwards  an  exploration  of  the  wounds  discovered  small  necrosed  portions 
of  the  shaft,  which  were  removed  by  Surgeon  Bliss,  under  chloroform,  by  making  an  incision  two  and  a  half  inches  in  length 
anteriorly,  and  another  internally  three  and  a  half  inches  long.  On  April  '25111  the  patient  was  transferred  U>  DeCamp  Hospital, 
nt  which  time  he  was  able  to  walk  about  freely  without  cane  or  crutch.  The  osseous  case  of  new  bone  which  surrounded  the 
fracture  was  very  large,  and  an  operation  performed  by  Acting  Assistant  Surgeon  E.  DeWitt,  on  February  18,  18('4,  for  the 
further  removal  of  necrosed  bone,  necessitated  the  penetration  of  the  involucrum  by  the  trephine  to  a  depth  of  two  inches  and  a 
half.  Nine  spiculas  of  old  bone  were  removed  during  the  operation,  the  largest  of  which  was  one  inch  long,  a  half  inch  wide, 
and  one-fourth  of  an  inch  in  thickness.  About  three  weeks  afterwards  a  thin  fragment  of  sequestrum,  two  inches  long  and  a 
half  inch  wide,  was  removed  by  the  same  channel.  The  patient  received  his  discharge  from  service  October  1,  18(54,  after  which 
he  was  employed  for  nearly  two  years,  in  the  capacity  of  a  wardmaster,  at  DeCamp  Hospital.  At  the  date  of  the  report,  March 
5,  I860,  he  was  one  of  the  most  accomplished  and  indefatigable  skaters  at  the  hospital,  and  suffered  no  inconvenience  from  the 
injured  limb,  although  the  two  wounds  had  not  yet  permanently  cicatrized."  Examining  Surgeon  T.  F.  Smith,  of  New  York 
City,  September  17,  1873,  certified  to  the  injury,  and  stated:  "There  are  eight  adherent  cicatrices,  with  great  loss  of  bone  and 
muscular  substance;  movements  of  knee  joint  limited  one-half,"  etc.  The  New  York  City  Examining  Board,  two  years  later, 
reported  that  "the  bone  united  with  great  thickening,"  etc.;  also  that  "the  cicatrices  on  the  anterior, . outer,  and  posterior 
surfaces  of  the  limb  are  attached  to  the  bone  and  at  times  take  on  ulceration."  Substantially  the  same  was  reported  at  an 
examination  in  September,  1878.  The  pensioner  was  paid  June  4,  1879. 

CASE  402. — Private  E.  Hanlon,  Co.  C,  5th  Cavalry,  aged  21  years,  was  wounded  at  Beverly  Ford,  June  9,  1863.  On 
the  following  day  he  was  admitted  to  Lincoln  Hospital,  Washington,  subsequently  to  Judiciary  Square,  and  lastly  to  Carlisle 
Barracks,  whence  he  was  discharged  May  16,  1864,  and  pensioned.  Acting  Assistant  Surgeon  G.  K.  Smith  contributed  the 
following  history:  "He  was  wounded  by  a  mini6  ball,  which  entered  the  external  aspect  of  the  left  thigh  near  its  middle,  com 
minuting  the  greater  portion  of  the  middle  third  of  the  femur,  and  splitting  the  lower  third  longitudinally  nearly  down  to  the 
knee  joint.  The  missile  lodged  and  could  not  be  found.  Ether  was  administered  and  the  wound  enlarged,  and  seventeen 
fragments  of  bone,  comprising  three  inches  of  the  continuity  of  the  shaft,  were  removed.  On  June  23d,  an  abscess  opened  on 
the  inner  aspect  of  the  thigh,  near  the  perinaeum,  through  which  the  ball  was  extracted.  The  limb  was  bandaged  in  its  whole 
length,  placed  on  a  mattrass,  and  kept  in  position  by  a  sand  bag  on  either  side.  Owing  to  the  loss  of  bone  no  extension  was 
resorted  to  until  October  1st,  at  which  time  the  patient  was  able  to  roll  his  injured  limb  on  the  mattrass,  the  fragments  having 
united,  though  the  callus  had  not  yet  become  firm  and  hard.  I  then  applied  a  ten  pound  weight,  suspended  by  a  cord  and 
pulley,  and  succeeded  in  reducing  the  shortening  one-half  inch.  This  amount  of  extension  was  continued  until  I  left  Lincoln 
Hospital,  on  November  8tli,  but  was  removed  soon  afterwards.  On  December  16th,  while  moving  about  on  crutches,  the  patient 
fell  and  rcfractured  the  bone.  The  surgeon  in  charge  then  applied  a  long  splint  to  the  posterior  aspect  of  the  limb,  retaining  it 
in  that  position  and  preventing  any  motion  of  the  knee  joint  until  the  fragments  had  reunited.  The  wound  healed  in  the  begin 
ning  of  March,  1864,  but  broke  open  again  in  the  middle  of  June,  and  continued  to  discharge  slightly  until  March,  1865,  during 
which  time,  however,  the  man  was  able  to  walk  about  and  to  serve  as  a  watchman  at  the  Government  Repair  Shops  in  Washing- 
ton.  On  June  20th,  1865,  the  limb  appeared  perfectly  sound,  and  at  this  period  the  man  could  walk  all  day  without  feeling  tired, 
though  there  was  fibrous  anchylosis  of  the  knee  joint."  Various  pension  examiners  have  certified  at  different  dates  to  "anchy 
losis  of  the  knee  and  about  three  inches  shortening  of  the  limb."  The  pensioner  was  paid  June  4,  1879.  PLATE  LXIV,  FIG.  1, 
opp.  p.  198,  represents  his  photograph,  taken  at  the  Army  Medical  Museum  in  June,  1885. — (Surg.  Phot.  Scries,  No.  55,  A.  M.  M.) 

CASE  403. — Private  J.  O'Conner,  Co.  F,  16th  Michigan,  aged  16  years,  was  wounded  at  Cold  Harbor,  June  2,  1864. 
He  reached  the  Fifth  Corps  Hospital  at  White  House  three  days  after  the  injury,  and  was  thence  conveyed  to  Washington, 
where  he  entered  the  Armory  Square  Hospital  June  10th.  Acting  Assistant  Surgeon  G.  K.  Smith  made  the  following  report  of 
the  case :  "A  mini6  ball  entered  the  external  aspect  of  the  left  thigh  three  inches  above  the  patella,  and,  passing  obliquely 
inward  and  upward,  fractured  the  shaft  of  the  femur  through  the  upper  end  of  the  lower  third,  making  its  exit  posteriorly.  The 
patient  was  treated  by  Acting  Assistant  Surgeon  T.  O.  Banister.  Hodgeu's  splint  was  used,  and  no  extension  was  applied  other 
than  the  tying  of  the  foot  to  the  foot-board  with  a  bandage.  During  the  treatment  eight  small  fragments  of  bone  were  removed. 
On  December  27th  the  patient,  though  his  wound  had  not  entirely  healed,  was  transferred  to  the  Veteran  Keserve  Corps  and 
placed  on  guard  duty ;  but  being  unable  to  perform  it,  he  was  readmitted  to  the  hospital  for  treatment  several  weeks  afterwards. 
He  came  under  my  care  on  June  22,  1865,  at  which  time  he  was  in  good  health,  but  slightly  lame  and  able  to  walk  without  a 
cane.  There  was  still  a  slight  discharge  of  sero-pimilent  fluid  from  the  wound.  The  limb  was  shortened  one  and  one-fourth 
inches,  and,  at  the  seat  of  the  fracture,  it  was  a  little  larger  than  normal  but  not  otherwise  deformed.  On  July  18,  18(55,  the 
patient  was  mustered  out  of  service,  with  his  wound  still  open."  Examiner  W.  G.  \Vilkinson,  of  Farwell,  Michigan,  May  K!, 
1876.  certified  to  the  wound,  and  stated:  "The  fracture  lias  been  followed  by  necrosis  of  bone,  several  pieces  having  been 
removed  during  the  year  1875..  The  sciatic  nerve  was  injured,  and  the  veins  are  in  a  varicose  condition.  The  wound  has 
continued  open."  The  pensioner  was  paid  June  4,  1879.  His  photograph,  taken  at  the  Army  Medical  Museum  in  June,  1865 
(Svr:/.  I'lot,  Srrirs,  No.  49.  A.  M.  M.),  is  copied  in  PLATE  LXIV,  FIG.  2,  opp.  p.  198. 


M.-d  .uul  Sun;    Hist  oftht-  War  of  th«- Rebellion.  Part  HI.  Vol.H.l'hap  X. 


PLATE      LXIII    -  CONSOLIDATED    GU  NSHOT   FRACTUR  ES   OF  TH  E   FEMUR 


Private  ,1  .Durst 
Xt,NV  York. 


1'VJ  -    (  asr  of  Private  M.Kuriif 
'J8  *.h  Massachusetts 


SECT.  III.J 


SHOT  FRACTURES  OF  LOWER  THIRD  OF  FEMUR. 


The  records  of  the  Pension  Office  show  that,  of  the  three  hundred  and  four  Union 
soldiers  who  recovered  after  shot  fracture  of  the  lower  third  of  the  femur  under  conserva 
tive  treatment,  twenty-five  have  died  since  the  termination  of  the  War.  In  the  following 
instance  the  patient  survived  the  injury  fourteen  and  a  half  years: 

CASE  404. — Assistant  Surgeon  T.  S.  Stanway,  102d  Illinois,  aged  33  years,  was  wounded  during  a  fight  with  Guerrillas, 
between  Lavergne  and  Nashville,  December  '21,  1833,  a  pistol  ball  entering  the  left  thigh  about  four  inches  above  the  knee  joint, 
passing  downward  and  out  about  two  inches  above  the  knee,  fracturing  the  feinur  in  two  places.  The  limb  was  treated  with 
simple  dressings  and  kept  upon  a  double-inclined  plane.  About  two  weeks  after  the  injury  an  abscess  formed,  which  was  evac 
uated  through  the  lower  wound.  The  wound  healed  rapidly,  without  loss  of  bone,  and  union  took  place  between  the  fractured 
ends.  About  two  months  after  the  reception  of  the  wound  the  patient  obtained  a  leave  of  absence  and  went  to  his  home,  and  on 
April  29,  1864,  he  returned  to  his  regiment  with  a  good  limb  of  proper  length.  Soon  afterwards  he  started  with  his  command 
on  the  Atlanta  campaign.  In  the  course  of  six  weeks,  however, — owing  to  the  want  of  sufficient  nutrition, — scurvy  set  in,  and 
the  newly  formed  callus  was  gradually  absorbed.  Although  keeping  the  limb  supported  by  starch  bandages,  he  became  almost 
unable  to  step  upon  it,  in  consequence  of  which  he  resigned  August  13,  1834.  Some  months  after  reaching  his  home  partial 
union  again  took  place,  but  the  limb  remained  shortened  to  the  extent  of  three  inches.  Dr.  Stanway  became  a  pensioner,  and 
was  examined  on  April  17,  18G5,  by  Examiner  J.  A.  Young,  of  Moumouth,  Illinois,  who  described  his  condition  as  follows: 
"  There  is  displacement  of  the  upper  portion  of  the  femur  downward  and  outward,  with  consequent  shortening  of  nearly  two 
inches.  At  present  he  suffers  from  pain,  particularly  during  locomotion,  owing  to  the  slipping  of  the  tendon  of  the  vastus 
externus  over  the  projecting  end  of  the  femur."  The  San  Francisco  Examining  Board,  in  September,  1873,  reported  "an 
apparent  movement  in  the  bone  at  the  point  of  the  fracture,"  and  several  years  later,  "  slight  overlapping  of  the  extremities, 
occasioning  deformity,  also  lameness,"  etc.,  was  alleged.  The  pensioner  died  at  Los  Angelos,  California,  prior  to  May,  1878. 

Fatal  Instances  of  Shot  Fracture  of  the  Lower  Third  of  the  Femur  treated  by  Con 
servation, — Two  hundred  and  thirty-two  such  cases  are  reported: 

CASE  405. — Sergeant  Sewell  T.  Douglas,  Co.  G,  1st  Maine  Heavy  Artillery,  aged  28  years,  was  wounded  ut  the  battle 
of  Spottsylvania,  May  19,  1804,  and  was  admitted  to  Emoiy  Hospital,  at  Washington,  May  22,  1834. 
A  musket  ball  entering  posteriorly,  had  fractured  the  lower  third  of  the  left  femur  and  lodged  in  the 
medullary  cavity.  The  injured  limb  was  placed  on  a  double-inclined  plane  and 
moderate  extension  was  used.  Internally,  stimulants  and  tonics  were  employed. 
In  August,  1834,  the  patient  suffered  from  severe  diarrhoea.  There  was  a  copious 
ill-conditioned  discharge  from  the  wound.  The  patient  died  September  26, 1864,  from 
exhaustion,  and,  at  the  autopsy,  a  deposition  of  callus  was  found  at  the  seat  of  in 
jury,  enclosing  several  necrosed  splinters  and  a  battered  musket-ball.  The  speci 
men  (FiG.  159)  was  contributed  to  the  Army  Medical  Museum  by  Acting  Assistant 
Surgeon  J.  M.  Downs. 

CASK  403. — Private  E.  A.  Dickerson,  Co.  C,  5th  New  Hampshire,  was  wounded 
in  the  right  thigh,  at  Fair  Oaks,  June  1,  1862,  and  was  admitted  to  the  Fifth  and 
Buttomvood  Streets  Hospital,  Philadelphia,  ten  days  afterwards.  Acting  Assistant 
Surgeon  A.  C.  Bournonville  reported  the  nature  of  the  injury  and  its  result  as  follows : 
"A  compound  comminuted  fracture  of  the  femur  at  the  junction  of  the  middle  and 
lower  thirds.  At  date  of  admission  the  wound  was  suppurating  freely,  with  no  effort 
at  repair,  though  the  patient  was  doing  well.  The  treatment  was  by  weights  and 
sand  bags.  Death  occurred  on  September  5,  1862."  The  specimen  represented  in 
the  cut  (FiG.  160)  consists  of  a  portion  of  the  femur,  obliquely  fractured  in  the  lower 
third,  showing  considerable  but  irregular  effusion  of  callus  without  union,  and  the 
formation  of  a  sequestrum  in  the  upper  fragment.  It  was  contributed  by  Acting 
Assistant  Surgeon  W.  Hunt. 

CASE  407. — Private  O.  Rales,  Co.  F,  61st  Georgia,  aged  34  years,  was  wounded  at  Monocacy,  July  9,  1884,  and  entered 
the  General  Hospital,  at  Frederick,  three  days  afterwards.  Acting  Assistant  Surgeon  T.  E.  Mitchell  contributed  the  pathological 
specimen  (Ca<.  Sury.  Sect.,  183G,  p.  468,  Spec.  3934)  and  the  following  history:  "The  patient  was  admitted  into  this  hospital 
with  gunshot  fracture  of  the  left  femur,  lower  third.  He  came  under  my  care  on  August  29th,  Smith's  anterior  splints  having 
been  applied  to  the  injured  limb.  He  complained  very  much  of  pain  in  his  leg,  which  was  swollen  and  discharging  freely  from 
the  wound.  His  appetite  was  good,  but  his  appearance  was  quite  anaemic.  I  prescribed  tincture  of  iron  and  quinine,  with  milk 
punch  three  times  a  day.  On  September  10th,  I  removed  the  splint  and  substituted  Buck's  apparatus  with  sand  bags  to  the 
outside  of  the  leg.  Under  this  treatment  his  condition  remained  much  the  same  as  when  I  first  saw  him.  By  October  1st,  sup 
puration  was  still  continuous,  and  the  patient  was  very  much  reduced  in  strength.  On  November  1st,  his  appetite  was  better 
and  his  general  condition  slightly  improved,  though  as  yet  there  was  no  union  of  bones.  On  November  12th,  I  made  counter- 
openings  into  the  thigh  and  found  sinuses  extending  nearly  to  the  hip.  On  November  19th  haemorrhage,  amounting  to  about 
four  pints,  took  place  from  the  femoral  artery,  from  the  effects  of  which  he  died.  The  post-mortem  examination  proved  that 
non-union  of  the  bones  was  due  to  a  small  spicula  of  loose  bone  between  the  broken  ends  of  the  femur.  The  haemorrhage  was 
the  result  of  sloughing  of  the  femoral  artery,  which,  in  all  probability,  was  wounded  in  making  the  counter-opening."  The 
specimen  consists  of  a  wet  preparation  of  portion  of  the  femoral  and  popliteal  arteries,  injected  with  wax,  and  shows  the 
accidental  wound  of  the  vessel,  enlarged  by  nlceration.  from  which  the  secondary  haemorrhage  occurred. 


FIG.  159.— Partially 
consolidated  gunshot 
fracture  of  left  femur. 
Spec.  32G7. 


FIG.  160.  — Oblique 
fracture  of  lower  third  of 
right  femur.  Spec.  240. 


198  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

Shot  Fractures  of  the  Femur  without  Indication  of  the  Seat  of  Injury  treated  by 
Conservation. — Besides  the  shot  fractures  in  the  upper,  middle,  and  lower  thirds  of  the 
femur  treated  by  conservation,  considered  in  the  preceding  pages,  there  were  seven  hundred 
and  thirty-eight  cases  in  which  the  precise  seat  of  injury  was  not  indicated.  In  fifty-five 
of  these  cases  the  result  as  to  fatality  is  undetermined.  Of  the  six  hundred  and  eighty-three 
determined  cases,  five  hundred  and  thirty-eight  died  principally  in  the  field  hospitals  a  few 
days  after  the  reception  of  the  injury,  giving  the  large  death  rate  of  78.7  per  cent.  The 
histories  of  these  cases  are  brief,  and  give  little  information  beyond  the  mere  fact  that  the 
femur  had  been  fractured;  it  is,  therefore,  not  considered  necessary  to  detail  examples  of 
this  group.  In  two  hundred  and  eighty-three  cases  the  right  femur  was  involved;  in  two 
hundred  and  eighty-two,  the  left;  and  in  one  hundred  and  seventy-three  the  side  was  not 
specified.  Six  hundred  and  two  of  the  patients  were  Union  and  one  hundred  and  thirty- 
six  were  Confederate  soldiers. 

Pseudarthrosis  after  shot  fractures  of  the  femur  was  not  frequent.  Sixteen  instances 
are  reported  among  the  three  thousand  four  hundred  and  sixty-seven  shot  fractures  of  the 
femur  treated  by  expectant  measures.  In  seven  cases  the  fracture  was  in  the  upper  third, 
in  three  in  the  middle  third,  and  in  six  in  the  lower  third.  Two  examples1  will  be  cited: 

CASK  408. — Corporal  E.  G.  Abbott,  4th  Indiana  Battery,  aged  21  years,  was  wounded  at  Stone  River,  December  31, 
1862.  He  remained  at  a  field  hospital  of  the  Fourteenth  Corps  for  nine  days,  when  he  was  conveyed  to  Murfreesboro'.  Two 
months  later  he  was  transferred  to  hospital  at  Nashville,  and  subsequently  to  Louisville,  at  all  of  which  places  his  injury  was 
recorded  as  a  "shot  wound  of  left  thigh."  On  April  14,  1863,  the  patient  was  discharged  from  Camp  Chase,  Acting  Assistant 
Surgeon  J.  S.  Bailey  certifying  to  "Shot  fracture  of  left  femur,  resulting  in  nearly  two  inches  shortening."  In  January, 
1871,  Dr.  A.  L.  Lowell,  Special  Examiner  of  the  Pension  Office,  who  saw  the  man  several  years  previously,  furnished  the  fol 
lowing  description  of  the  injury  and  its  result,  which  he  obtained  partly  from  his  own  observations  and  partly  from  a  personal 
communication  of  Examiner  L.  T.  Ballou,  of  Newark,  Ohio  :  "Aconoidal  ball  struck  the  left  thigh  anteriorly,  about  four'inches 
below  the  great  trochanter,  and,  fracturing  the  femur,  passed  backward  and  made  its  exit  about  one  inch  below  the  gluteal  fold. 
He  states  that  neither  splints  nor  extension  were  ever  applied  to  the  limb.  About  September  1,  1863,  the  external  wound  had 
healed,  but  there  was  still  some  tenderness  about  the  seat  of  the  fracture,  and  as  he  further  improved  and  began  to  use  the  limb 
with  less  care,  he  observed  that  it  would  rotate.  At  present  he  is  able  to  shorten  the  distance  between  the  knee  and  trochanter 
six  inches  by  a  sudden  swinging  and  extending  motion  of  the  limb,  which  appears  to  throw  the  lower  fragment  to  one  side  and 
is  followed  by  voluntary  contraction  of  the  muscles.  While  in  this  position  he  is  able  to  support  his  weight  (140  pounds)  on 
the  limb,  and  he  can  then  extend  the  same  again  to  its  former  position  by  a  little  shaking,  or,  as  he  describes  it,  by  a  'wiggle,' 
the  thigh  in  either  attitude  being  firm  and  inflexible.  He  can  evert  the  left  foot  so  as  to  place  its  heel  to  the  toes  of  the  right  foot, 
thus  placing  the  outer  margin  of  the  left  foot  in  apposition  with  the  inner  margin  of  its  fellow.  These  malpositions  are  com 
pleted  without  eversion  of  the  trochanter.  The  lower  part  of  the  shaft  of  the  femur  appears  to  slide  up  on  the  anterior  and 
internal  surface  of  the  upper  fragment.  The  upper  and  middle  thirds  of  the  injured  thigh  exceed  the  corresponding  portions  of 
its  fellow  one  inch  in  circumference.  This  increased  size  is  doubtless  due  to  a  large  ensheathing  callus  which  surrounds  the 
lower  portion  of  the  upper  third  of  the  femur,  and  which  is  distinctly  perceptible  by  digital  compression.  Sometimes,  though 
only  with  great  care,  the  man  is  able  to  walk  well,  his  gait  showing  only  a  slight  irregularity  of  step.  The  limb  is  often  pain- 

1  The  remaining  14  instances  of  pseudarthrosis  in  the  femur  after  fracture  treated  by  conservation  are :  1.  Pt.  J.  Kissee,  1st  Arkansas  Cavalry, 
aged  29 ;  fracture  of  upper  third  of  right  femur ;  Arkansas  River,  May  16, 18G4 ;  discharged  March  20,  1865 ;  recovery,  with  1 J  inches  shortening  and  a  false 
joint. — 2.  Pt.  Joseph  Patterson,  G,  40th  Indiana,  aged  20;  shell  fracture  of  upper  third  of  left  femur;  Stone  River,  Tennessee,  December  31,  1862;  dis 
charged  April  21, 1863;  there  is  3  inches  shortening,  and  the  ligamentous  union  or  false  joint  renders  locomotion  uncertain. — 3.  Pt.  Franklin  Rosenbery, 
A,  148th  Pennsylvania,  aged  30;  shot  fracture  of  upper  third  of  right  femur;  Spottsylvania,  May  12,  1864;  discharged  May  15,  1865;  1  inch  shortening: 
there  is  cartilaginous  union — the  limb  can  be  rotated  on  the  thigh,  and  the  foot  is  entirely  reversed. — 4.  Pt.  H.  Meyers,  B,  157th  New  York,  aged  30 ;  shot 
fracture  of  upper  third  of  left  femur;  Gettysburg,  July  1,  1863;  discharged  December  3,  1863;  shortening  about  2J  inches,  with  false  joint  at  point  of 
fracture. — 5.  Lieut.  B.  Button,  B,  76th  New  York,  aged  46;  shot  fracture  of  upper  third  of  left  femur;  Gettysburg,  July  1,  1863  ;  discharged  November 
9,  1863;  nearly  3  inches  shortening  and  false  joint. — 6.  Corp'l  Franklin  Cusick,  H,  108th  New  York,  aged  21 ;  shot  fracture  of  upper  third  of  right  femur; 
Wilderness,  May  5,  1864 ;  discharged  March  31 ,  1865 ;  shortening  of  1 J  inches,  leaving  a  false  joint  with  eversion  of  toes. — 7.  Pt.  J.  F.  Hutchinson,  B,  7th 
Maine,  aged  24  ;  shot  fracture  of  right  femur  at  middle  third;  Wilderness,  May  5,  1864;  discharged  July  7,  1865;  false  joint  and  2  inches  shortening. — 
8.  Pt.  P.  S.  Chase,  I,  2d  Vermont,  aged  20 ;  shot  fracture  left  thigh,  middle  third ;  Wilderness,  May  5,  1864 ;  discharged  May  16,  1865 ;  false  joint  and  . 
shortening  of  the  thigh  2  inches. — 9.  1't.  J.  L.  Hanna,  D,  95th  Pennsylvania,  aged  42;  compound  fracture  of  left  femur  at  middle;  West  Point,  Virginia, 
May  10,  1862;  discharged  August  29,  1862;  false  joint  at  point  of  fracture,  and  3J  inches  shortening;  muscles  atrophied.— 10.  Pt.  I,.  Paul,  C,  12th  Wis 
consin,  aged  24;  shot  fracture  of  lower  third  of  femur;  Kenesaw  Mountain,  June  15,  1864;  discharged  September  1,  1865;  false  joint  and  2  inches 
shortening ;  varicose  veins  covering  all  the  leg  and  lower  thigh. — 11.  Pt.  L.  D.  Boyd,  K,  85th  Pennsylvania,  aged  24 ;  shot  fracture  left  thigh  just  atwve 
the  condyles ;  Ware  Bottom  Church,  May  20,  1864;  discharged  November  22,  1864;  artificial  joint  and  about  3  inches  shortening. — 12.  Corp'l  E.  II. 
Morrison,  F,  35th  Illinois,  aged  20 ;  shot  fracture  right  thigh  about  2J  inches  above  knee  joint ;  Chickamauga,  September  19,  1863  ;  discharged  January 
19,  1864 ;  false  joint  and  about  2J  inches  shortening. — 13.  Pt.  H.  P.  Mayer,  A,  1st  West  Virginia,  aged  22;  shot  fracture  left  femur,  lower  third;  New 
Market,  May  15,  1864 ;  discharged  October  10,  1864 ;  weak  cartilaginous  union ;  can  bring  the  bottom  of  his  foot  against  his  face. — 14.  Pt.  B.  Whiting, 
C,  9th  New  York  Heavy  Artillery,  aged  27;  shot  fracture  right  femur  about  4  inches  above  knee;  Cold  Harbor,  June  3,  1864;  false  joint  above  knee; 
limb  shortened  about  three  inches. 


M.-.1  ,m«l  Sin-j    Hist  <.r  the  War  of  the  Keb.'ll ion  Tart  HI    Vol.11, Chap  X. 


Ward    phot 


PLATE     LXIV- CONSOLIDATED    GU  NSHOT  FRACTURES   OF  THE  FEMUR 


1.  I'usc  of  IVivHte  H.Haiiloti 
"I'h   I'.S.  Cuvalrv. 


Fis.  2.  Case  of  Pi-i\"ate  J. O'Connor 
16  ^  Miclxioan 


,UN"  r?-U3ITY 


SECT.  m.J  EXCISIONS    IN    THE    CONTINUITY    OF   THE    FEMUR.  199 

ful,  and  frequently  he  is  obliged  to  suspend  his  occupation  as  a  laborer.  During  the  winter  of  1869  he  could  not  walk  without 
pain,  and  was  unable  to  put  on  his  boot."  Subsequent  examiners  report  no  changes  in  the  condition  of  the  limb.  The  pensioner 
was  paid  June  4,  1877. 

CASE  409. — Private  E.  Gilroy,  Co.  F,  6th  Vermont,  aged  22  years,  was  wounded  and  captured  at  Savage  Station,  June 
29,  1862.  After  remaining  in  the  hands  of  the  enemy  for  one  month,  he  was  exchanged  and  conveyed  to  Philadelphia.  Acting 
Assistant  Surgeon  J.  Neill,  in  charge  of  Broad  and  Cherry  Streets  Hospital,  reported  the  following  description  of  the  injury: 
"A  musket  ball  entered  the  right  thigh  anteriorly,  three  inches  above  the  knee  joint,  passed  backward  and  fractured  the  femur, 
and  was  removed  by  a  surgeon  on  the  field.  The  wounded  man  was  admitted  to  this  hospital  on  July  30th,  at  which  time  there 
was  considerable  swelling  and  inflammation  of  the  thigh,  also  slight  sloughing  of  the  edges  of  the  wound,  which  discharged 
healthy  pus.  The  foot  was  everted  and  there  was  two  inches  shortening  of  the  limb.  The  patient's  health  was  good.  A  stim 
ulating  poultice  was  applied  to  the  part  and  the  limb  kept  in  a  Dessault  apparatus,  with  side-extension  and  counter-extension, 
for  six  weeks.  At  the  end  of  this  time  the  wounds  had  healed,  but  there  was  very  little,  if  any,  union  at  the  seat  of  the  frac 
ture.  Two  moulded  splints  of  binder's  board,  with  bandage,  were  then  applied  to  the  thigh,  and  Dessault's  apparatus  continued." 
Subsequently,  on  November  18th,  "union  of  bone,  with  one  inch  shortening  and  fair  indication  of  a  good  cure,"  was  noted  in 
the  case;  but  at  the  date  of  the  patient's  discharge  from  service,  February  23,  1863,  the  fracture  was  reported  as  remaining 
uuunited.  Examiner  T.  B.  Nichols,  of  Plattsburgh,  New  York,  reported  April  15,  1838:  "The  leg  is  five  inches  shorter  than 
its  fellow  and  swings  loosely,  except  when  he  lets  his  weight  down  upon  it.  In  this  position  it  supports  him,  but  in  no  other  is 
it  of  any  use."  In  September,  1873,  the  same  examiner  described  the  injured  limb  as  being  shortened  six  inches,  and  stated  that 
the  man  "  can  lift  his  right  foot  with  his  hand  up  against  his  breast."  The  pensioner  was  paid  June  4,  1879. 

Comments  on  the  various  complications  of  shot  fractures  of  the  femur  treated  by  con 
servation — pyeemia,  tetanus,  gangrene,  erysipelas,  and  haemorrhage — and  on  the  different 
modes  of  treatment,  will  be  reserved  for  the  concluding  pages  of  this  section  of  Chapter  X. 

EXCISIONS  IN  THE  CONTINUITY  OF  THE  FEMUR  FOR  SHOT  INJURY. 

The  results  of  excisions  in  the  continuity  of  the  femur  performed  during  the  American 
civil  war  have  been  discouraging,  and  justify  the  disfavor  with  which  this  operation  is 
regarded  among  American1  as  well  as  European2  surgeons.  One  hundred  and  seventy-five 
cases  have  been  reported.3  In  eight  instances  the  terminations  could  not  be  ascertained. 

1  HAMILTON  (F.  II.)  (A  Treatise  on  Military  Surgery  and  Hygiene,  New  York,  1865,  p.  517)  remarks  that  he  has  never  seen  a  case  of  shot  fracture 
of  the  femur  that  would  justify  excision.  "  The  great  depth  of  the  bone  and  the  attachment  of  the  muscles  to  almost  every  point  of  the  surface  of  the 
bone  are,  perhaps,  the  chief  circumstances  which  render  these  operations  so  unsuccessful."  GllOSS  (S.  W.)  (Military  Surgery,  in  Am.  Jour.  Med.  Sci., 
18G7,  Vol.  LIV,  p.  478):  "  Resection  of  the  femur  in  its  continuity  has  proved  to  be  a  more  fatal  procedure  than  amputation  at  the  hip,  and  should,  there 
fore,  not  be  repeated."  AsHHUliST  (JOHX,  jr.,)  (The  Principles  and  Practice  of  Surgery,  Philadelphia,  1878,  p.  167)  asserts  that  "excision  in  the  con- 
tinuity  of  the  femur  is  a  bad  operation  and  should  be  definitely  rejected  from  military  practice." 

8 SCHWARTZ  (H.)  (Beitrage  zur  Lehre  von  den  Schusswunden,  etc.,  Schleswig,  1854,  p.  106):  "The  resection  of  the  splintered  ends  of  the  fracture 
for  the  purpose  of  converting  the  comminuted  fracture  into  a  simple  fracture,  as  well  as  any  resection  in  the  continuity,  is  to  be  rejected  in  the  femur." 
DKMSIE  (II.)  (Militar-Chirurgische  Studien,  etc.,  WRrzburg,  1861,  B.  II,  p.  283):  "The  facts  hitherto  known  justify  the  total  rejection  of  resection  in  the 
continuity  of  the  femur,  even  more  so  than  the  resection  in  the  shaft  of  the  humerus."  NEUUORFER  (J.)  (Handbuch  der  Kriegschirurgie,  etc.,  Leipzig, 
187:3,  B.  II,  Zweite  Hiilfte,  p.  1521):  "  Even  as  an  advocate  of  resection  in  the  continuity  of  bone,  one  cannot  defend  resection  in  the  continuity  of  the 
femur,  as,  in  this  bone,  the  indication  for  the  resection  is  relatively  rarely  found,  and  as  the  risks  attending  its  execution  are  very  great.  It  is  possible 
that  a  resection  in  the  continuity  for  total  caries  of  the  injured  bone  at  the  point  of  fracture  may  prove  successful;  but,  as  yet,  no  such  cases  have  been 
observed.  It  is  also  probable  that,  even  in  the  most  favorable  case  of  recovery  after  resection  for  caries,  the  resected  ends  of  bone  would  not  unite,  and 
that  psendarthrosis  would  be  the  result  of  the  resection." 

'Instances  of  excision  in  the  shaft  of  the  femur  for  shot  fracture  are  not  frequent  in  military  surgery:  1.  ROSS  (G.)  (Militairdrztliches  aus  dem 
Ersten  Schlesivigschen  Feldzuge  im  Sommer,  1848,  Altona,  1850,  p.  54)  excised  H-  inches  of  the  shaft  of  the  left  femur  in  a  Prussian  soldier,  wounded  at 
Dflppel,  June  5,  1848;  death  from  gangrene. — 2.  SCHWARTZ  (H.)  (Beitrage  zur  Lehre  von  den  Schusswunden,  Schleswig,  1854,  p.  167)  relates  the  case  of 
a  Danish  volunteer,  wounded  at  Holding,  April  23,  1849;  fracture  at  junction  of  upper  and  middle  thirds  of  the  right  femur;  excision  April  26;  death 
April  28,  1849. — 3.  STROMEYEIJ  (L.)  (Maximen,  etc.,  Hannover,  1855,  p.  757)  tabulates  a  third  fatal  instance  of  excision  in  the  shaft  of  the  femur  from  the 
Schleswig-Holstein  War,  1848-50.— 4-14.  CHEXU  (J.  C.)  (Stat.  Med.  Chir.  de  la  Camp,  d'ltalic  en  1859 et  1860,  Paris,  1869,  T.  II,  p.  763)  tabulates  6  cases 
of  excisions  in  the  shaft  of  the  femur,  with  5  deaths,  and,  on  page  7(i2,  gives  an  extract  from  a  report  of  Dr.  BlMA,  of  the  Sardinian  army,  who  states 
that  of  5  excisions  in  the  shaft  of  the  femur  by  the  subperiosteal  method,  performed  at  the  hospital  at  Vercelli,  4  proved  fatal :  A.  Paschit,  Regiment 
Archduke  Leopold,  admitted  into  hospital  May  31,  1859;  shot  comminution  of  femur;  excision  June  5,  after  extraction  of  missile;  sent  to  Verona,  Aug. 
4,  1859;  able  to  walk  with  the  aid  of  a  cane.  E.  Rigovich,  Regiment  Archduke  Leopold,  admitted  into  hospital  May  31,  1859;  shot  comminution  of 
lower  third  of  femur;  excision  June  18  ;  death  September  13,  1859.  E.  Opodopic,  Regiment  Archduke  Leopold,  admitted  May  31,  1859 ;  comminuted 
fracture  lower  third  of  femur;  excision  of  three  centimeters  of  bone  June  22;  death  July  6,  1859.  L.  Gerbitz,  Austrian,  admitted  into  hospital  May  31, 
1859;  comminuted  fracture  lower  third  of  femur;  excision  June  23;  death  July  23,  1859.  M.  Goldschmitt,  Regiment  Wimpfen,  admitted  May  31 ;  com 
minuted  fracture  middle  third  of  femur;  excision  June  4;  death  July  17,  1859. — 15-16.  HEIXE  (B.)  (Die  Schus$oerletzungen  der  CTnteren  Extremitaten, 
Berlin,  1866,  p.  293)  reports  that  in  the  Schleswig-Holstein  War  of  18G4,  excision  in  the  shaft  of  the  femur  was  only  performed  twice  by  Dr.  NEUuOtiFEU ; 
the  result  is  not  indicated. — 17.  LOT/IJECK.  (Zur  Resection  des  Trochanter  major,  in  Aerttliches  Intelligent  Ulatt,  MUnehen,  1870,  B.  XVII,  p.  438)  cites 

the  case  of  Sergeant  W.  S ,  9th  Infantry;  fracture  of  left  trochanter  major,  July  4,  1866;  excision  of  trochanter  in  September;  death  November  9, 

1866.— 18-21.  BECK  (B.)  (Chirurgie  der  Schussverletzungen  Freiburg,  1872,  p.  912)  tabulates  4  cases  of  excision  of  the  shaft  of  the  femur  in  the  Austro- 
Prussian  War  of  1866 ;  only  one  patient  survived  —22-37.  CHEXU  (J.  C.)  (Apercu  Hist.  Stat.  et  Clin.,  etc.,  pendant  la  guerre  de  1870-71,  Paris,  1874,  p. 
493)  tabulates  16  cases  of  excision  of  the  shaft  of  the  femur,  with  14  deaths,  from  the  Franco-Prussian  War,  1870-71 ;  four  cases  reported  by  FELTZ  and 
GEOI.I.KMUND,  and  two  by  UOALDES,  seem  not  to  be  included  in  M.  CHEXU'S  Statistics.— 38-41.  FELTZ  et  GUOLLEHUXD  (Relation  Chir.  sur  les  Ambu 
lances  de  Haguenau,  in  Gaz.  MCd.  at  Strasbourg,  1871,  No.  11,  pp.  131-134)  relate  4  cases:  J.  Debat,  47th  Line,  aged  22,  fracture  of  upper  third  of  left 
femur,  in  August,  1870 ;  secondary  excision  September  26 ;  death  October  2,  1870.  Beschia  Mohammed,  3d  Tirailleurs ;  fracture  of  middle  third  of  right 
femur;  excision  September  26;  death  October  2, 1870.  Thomas  Ferray,  aged  20,  1st  Algerian  Tirailleurs;  shot  fracture  of  middle  third  of  femur,  prior 
to  August  8,  1870;  excision  August  28;  recovery.  E.  Plichon,  3d  Zouaves,  aged  22;  fracture  of  middle  third  of  right  femur,  prior  to  August  9,  1870; 


200 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X 


Fifty-one  cases  had  a  successful,  and  one  hundred  and   sixteen  a  fatal  issue,   giving  a 
mortality  of  69.4  per  cent. 

TABLE  XXI. 
Numerical  Statement  of  One  Hundred  and  Seventy-five  Excisions  in  the  Shaft  of  Femur  for  Shot  Injury. 


OPERATIONS. 

CASES. 

EXCISION  Df  THE 

UPPER  THIKD. 

EXCISION  IS  THE 
MIDDLE  THIRD. 

EXCISION  IN  THE 
LOWER  THIRD. 

PART  EXCISED  NOT 
SPECIFIED. 

Recovered. 

•a 
1 

Undeterm'd. 

°£ 
.2*3 
~t 
--  o 

Ks 

Recovered. 

•d 

9 

s 

Undeterm'd. 

Ratio  of 
Mortality. 

Recovered. 

•a 

fi 

Undeterm'd. 

Ratio  of 
Mortality. 

Recovered. 

•d 

s 

Undeterm'd. 

Ratio  of 
Mortality. 

Recovered. 

•o 
o 

3 

Undeterm'd. 

•s£ 

.£'•3 

«! 

20 
9 

15 

7 

65 
39 
3 

9 

6 

1 
1 

76.4 
81.2 
16.6 
56.2 

13 
1 
9 

2 

30 
17 
1 
1 

1 

69.7 
94.4 
10.0 
33.3 

6 
6 
4 
2 

21 
14 
2 

3 

1 

77.7 
70.0 
33.3 
60.0 

2 
2 

1 

4 
5 

2 

100.0 
71.4 

1 

10 
3 

3 

90.9 
100.0 
00.0 
60.0 

00.0 
66.6 

1 

2 

2 

3 

51 

116 

8 

69.4 

25 

49 

1 

66.2 

18 

40 

1 

68.9 

5 

11 

2 

68.7 

3 

16 

4 

84.2 

Primary  Excisions  in  the  Shaft  of  the  Femur. — Ninety-one,  or  more  than  one-half 
of  the  total  number  of  cases  of  excision  in  the  shaft  of  the  femur,  belong  to  the  primary 
group.  In  six  instances  the  result  remains  undetermined;  twenty  proved  successful,  and 
sixty-five  were  fatal,  giving  a  mortality  rate  of  76.4  per  cent. 

Cases  of  Recovery  after  Primary  Excision  in  the  /Shaft  of  the  Femur. — Of  the  twenty 
patients  who  survived  this  operation,  four  were  Confederate  and  sixteen  were  Union  soldiers. 
The  point  of  excision  was  in  the  upper  third  in  twelve  instances,  in  the  upper  and  middle 
thirds  in  one,  in  the  middle  third  in  five,  in  the  middle  and  lower  thirds  in  one,  and  in  one 
instance  the  point  of  excision  was  not  indicated.  Thirteen  of  the  sixteen  Union 
soldiers  were  pensioned  and  were  living  in  1879.  In  the  following  case  four 
inches  of  the  upper  and  middle  thirds  of  the  shaft  of  the  femur  were  excised:1 

CASE  410. — Lieutenant  W.  M.  Tirtlot,  Co.  F,  105th  Illinois,  aged  24  years,  was  wounded  at  Resaca,  May  15, 
1834,  by  a  shell,  which  fractured  the  right  femur.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Twen 
tieth  Corps,  where  excision  was  performed  but  not  recorded.  On  June  22d  he  was  transferred  to  hospital  No.  2, 
Chattanooga,  and  several  days  afterwards  to  the  Officers'  Hospital  at  Nashville.  Surgeon  J.  E.  Herbst,  U.  S.  V., 
in  charge  of  the  latter,  reported:  "Shot  fracture  of  femur,  middle  third.  Primary  excision  of  about  four  inches 
of  the  shaft  at  the  middle  third  w'as  performed  on  the  field  by  Surgeon  A.  W.  Reagan,  70th  Indiana.  The  limb 
was  treated  in  straight  splints,  and  simple  dressings  were  applied.  Tonics  and  a  generous  diet  were  prescribed." 
The  patient  went  on  leave  of  absence  July  21st,  and  on  November  28,  18G4,  he  was  mustered  out  and  pensioned, 
inches  <>f  right  The  excised  portion  of  the  femur  was  contributed  by  Surgeon  G.  W.  McMillin,  5th  Tennessee,  and  is  represented 
fornobiique(frSaecl  in  the  cut  (FiG.  1G1).  Examiner  A.  Steele,  of  Oberlin,  Ohio,  certified,  March  21,  1867 :  "Part  of  the  femur  is 
ture.  £/>«:.2l5!>.  gone  an(i  the  leg  is  short  in  proportion.  There  is  exostosis  of  the  femur,  and  suppuration  is  nearly  constant;  also 
anchylosis  of  what  is  left  of  the  knee  joint;  unimpaired  health,"  etc.  Examiner  A.  II.  Steele,  of  Olympia,  W.  T.,  certified, 
October  4,  1873:  *  *  "There  is  lateral  motion  of  the  knee  joint,  caused  by  the  proximity  of  the  injury  destroying  the  lateral 

secondary  excision  October  25 ;  recovery. — 42-43.  ROALDE8  (A.  W.)(Des  fractures  compliquees  de  la  cuisse  par  armes  de  guerre,  Paris,  1871,  p.  58,  etc.) 
details  2  cases  of  excision  in  the  shaft  of  the  femur :  Ch.  Huart,  Adjutant  193d  Batt.  Nat.  Guards,  aged  32 ;  fracture  of  right  femur  at  union  of  upper  and 
middle  thirds,  May  21,  1871 ;  excision  June  2 ;  death  January  15,  1871.  A.  Cavarr6,  Lieutenant  of  Marines ;  shot  fracture  of  upper  third  of  right  femur, 
May  21,  1871 ;  excision  June  10;  recovery. — 44-46.  SOCIN  (A.)  (Kriegschirurgische  Erfahrungen,  Leipzig,  1872,  pp.  135,  13(5)  cites  3  cases  of  excision  in 
the  shaft  of  (he  femur:  A.  Leonhardt,  shot  fracture  of  left  femur  at  juncture  of  middle  and  upper  thirds,  Gravelotte,  August  18,  1870;  excision  of  7  centi 
meters  of  lower  fragment ;  recovery.  A.  Leroy,  shot  fracture  of  right  femur  near  trochanter,  at  Noisseville,  August  31,  1870 ;  excision  September  24  ; 
death  September  27,  1870.  A.  Primault,  shot  fracture  of  middle  third  of  right  femur.  Worth,  August  6,  1870;  excision  October  26;  recovery,  with  12 
centimeters  shortening. — 47.  FISCHER  (G.)  (Dorf  Floing  und  Schloss  Versailles,  in  Deutsche  Zeitschrift  fiir  Ciiirurgie,  Leipzig,  1872,  B.  I,  p.  187)  tabu 
lates  a  fatal  instance  of  secondary  excision  in  the  shaft  of  the  femur. — 48-50.  BECK  (B.)  (Chir.  der  Schussverletzungen,  Freiburg.  1672,  p.  900)  reports  3 
cases  of  excision  of  shaft  of  the  femur  in  the  14th  Corps  during  the  Franco-Prussian  War,  1870-71.  One  recovered,  one  died;  the  result  in  the  third 
instance  is  not  recorded.— 51.  TRITTON  (W.  P.)  (Excision  of  a  Large  Portion  of  the  Femur  after  Gunshot  Wound,  in  The  Lancet,  London,  1879,  Vol.  I, 
p.  117)  resected  the  shaft  of  the  femur  on  an  Arab  of  the  Turkish  army,  in  December,  1877.  The  patient  recovered,  with  1J  inches  shortening.of  the  limb. 
Of  the  51  cases  here  cited,  the  results  could  not  be  ascertained  in  3  instances;  12  patients  recovered,  and  36  died,  a  mortality  rate  of  75.0  per  cent. 

1  The  extent  of  bone  excised  in  the  remaining  cases  was :  One  inch  in  2  cases;  two  inches  in  1 ;  two  and  a  half  inches  in  1 ;  three  inches  in  2 ;  three 
and  a  half  inches  in  2;  foar  inches  in  1 ;  four  and  n  half  inches  in  3;  five  inches  in  1  ;  six  and  a  half  inches  in  1 ;  trochanter  major  or  a  portion  thereof  in 
3;  and  in  2  cases  (his  point  was  not  defined. 


SECT.  III.] 


EXCISIONS    IN    THE    CONTINUITY    01-'    THE    FEMUR. 


201 


ligaments.  There  are  also  extensive  cicatrices  which  are  tender  and  painful.  The  limb  at  this  time  is  more  of  an  impediment 
than  an  advantage.''  The  pensioner  was  paid  March  4,  1879.  In  January,  1870,  he  was  furnished  with  an  apparatus  for  his 
injured  limb  by  the  firm  of  Marsh  &  Corliss,  of  Cincinnati. 

CASE  411. — Lieutenant  Dwight  Beebe,1  Adjutant  3d  New  York  Veteran  Vols.,  was  wounded  on  October  27,  1884,  while 
in  command  of  a  skirmish  line  on  the  Darbytown  Road,  near  Richmond.  He  was,  on  the  same  day,  admitted  into  the  Flying 
Hospital  of  the  Tenth  Corps,  near  Chapin's  Farm.  Dr.  C.  M.  Clark,  late  Surgeon  39th  Illinois,  under  date  of  September  17, 
1839,  gives  the  following  description  of  the  case:  "The  wound  was  made  with  a  conoidal  ball,  which  entered  the  right  thigh, 
outer  surface,  at  the  junction  of  middle  with  upper  third,  passing  upward  and  inward,  and  making  its  exit  at  the  upper  and  inner 
angle  of  Scarpa's  triangle,  slightly  abrading  the  scrotum  in  its  passage.  On  examination  of  the 
wound  I  found  an  extensive  comminution  of  the  femur,  and  removed  sixteen  (10)  fragments  before 
the  operation  was  decided  upon.  *  *  I  made  a  longitudinal  incision  from  the  great  trochanter 
down,  to  the  extent  of  five  inches,  and  took  away  the  upper  fragment  with  a  chain  saw  at  its  junc 
tion  with  the  capsule  (the  bone  above  being  sound).  I  then  removed  all  the  spiculse  attaching  to 
the  periosteum  (which  was  preserved)  and  muscle,  cleansing  the  wound  thoroughly ;  then  turned 
out  the  lower  portion  and  removed  it  smoothly  with  the  common  amputating  saw.  Dr.  N.  Y.  Leet 
assisted  me  in  the  operation."  On  October  28th,  Lieutenant  Beebe  was  taken  to  the  landing  near 
Deep  Bottom,  and  placed  on  board  a  hospital  transport  and  conveyed  to  Fortress  Monroe,  and 
admitted  into  the  Chesapeake  Hospital  on  the  evening  of  November  1st.  He  was  placed  upon  a 
fracture  bed  and  received  the  best  attention.  There  was  a  profuse  discharge  and  the  patient  soon 
became  exhausted.  The  upper  extremity  of  the  lower  fragment  necrosed,  and  a  ring  of  bone 
seven-eighths  of  an  inch  in  length  exfoliated.  This  occurred  in  the  middle  of  January,  1865. 
After  the  dead  bone  was  eliminated,  Lieutenant  Beebe  rallied.  On  May  17,  1865,  he  was  able  to 
be  moved  comfortably,  and  obtained  a  leave  of  absence  and  went  to  his  home  in  New  York.  He 
returned  to  the  hospital  July  9th,  and,  in  September,  1835,  again  went  to  the  north  with  his  regi 
ment  to  be  mustered  out  at  the  expiration  of  its  term  of  service  (  Circular  2,  p.  33).  In  a  letter  dated 
Havana,  October  27, 1888,  Mr.  Beebe  says:  "I  continued  to  improve  until  I  was  able  to  get  around 
with  a  cane  and  supposed  I  was  as  well  as  I  would  ever  be,  until  August,  1837,  when  my  wound 
broke  out  and  discharged  terribly  for  about  three  weeks.  The  medical  men  here  thought  it  was 
brought  on  by  irritation,  being  on  it  too  much.  Now,  Avith  the  exception  of  the  limb  being  quite 
weak,  it  only  troubles  me  in  damp  weather,  when  it  has  a  dull  heavy  ache.  It  has  all  healed. 
The  flesh  on  the  outside  of  the  thigh  is  quite  numb.  My  knee  is  stiff.  My  general  health  is  not 
good,  and  my  physician  cautions  me  to  be  very  careful  of  myself.  The  limb  measures  3-J-  inches 
short.  Resection,  2J  inches ;  necrosis  of  the  bone,  &  inch."  Pension  Surgeon  G.  D  Baley,  of 
Havana,  N.  Y.,  examined  Lieutenant  Beebe  in  November,  1867,  and  reported :  "Right  leg  is  three 
inches  shorter  and  three  inches  smaller  in  circumference  than  the  other.  There  is  anchylosis  of 
the  knee  joint.  The  patient  has  repeatedly  been  confined  to  his  room  six  weeks  at  a  time.  The 
wound  is  now  discharging,  the  limb  is  weak  and  painful.  He  is  constantly  liable  to  fall  in  walk 
ing."  In  a  letter  to  the  editor,  dated  April  30,  1869,  Dr.  Baley  describes  the  portion  of  the  femur 
shown  to  him  by  Lieutenant  Beebe's  father,  the  upper  division  of  the  bone  being  "just  below  the 
greater  trochanter  obliquely  downward  from  the  outer  side  of  the  bone,  to  the  middle  of  the  lesser 
trochanter  on  the  inner  side ;  the  lower  division  being  a  transverse  cut  embracing  1J  or  1-J-  inches 

of  the  upper  section  of  the  bone.  I  think  the  head  of  the  bone  could  not  have  been  removed,  as  there  is  now,  and  was  at  the 
time  of  my  first  examination,  the  full  development  of  the  greater  trochanter  and  neck  of  the  femur.  There  is  at  this  time  great 
tenderness  and  pain  both  above  and  below  the  section  of  excision,  with  frequent 'suppurations.  There  is  also  evidence  of  a  los? 
of  portion  of  bone  two  or  three  inches  below  the  lower  section  of  the  operation."  Pension  Surgeon  F.  J.  Bancroft,  of  Denver, 
Colorado,  reported,  in  September,  1875:  "Ball  entered  anterior  portion  of  thigh,  fracturing  upper  third,  and  made  its  exit  near 
the  anus.  Resection  of  two  inches  of  the  upper  third  of  the  femur  was  performed,  causing  shortening  of  three  inches.  The 
muscles  are  softer  and  smaller  in  this  limb."  Since  that  time  the  pensioner  has  been  exempted  from  biennial  examination,  his 
disability  being  considered  permanent.  A  copy  of  the  photograph,  furnished  by  the  patient  (Contributed  Photographs,  Vol.  XII, 
p.  17),  is  represented  in  FlG.  162.  He  was  paid  March  4,  1879. 

1  The  case  of  Lieutenant  D.  Beebe,  Adjutant  3d  New  York,  has  been  cited  on  page  32  of  Circular  2,  War  Department,  S.  G.  O.,  1869,  ns  an 
example  of  excision  of  the  head  of  the  femur.  It  had  been  stated  by  Lieutenant  Beebe,  in  a  communication  to  the  editor,  dated  Havana,  N.  Y.,  Novem 
ber  2,  1868,  shortly  before  the  publication  of  Circular  2,  that  "  the  head  of  the  bone  was  not  taken  out."  A  letter  of  inquiry  was  thereupon  addressed  to 
Dr.  N.  Y.  LKET,  late  Surgeon  7Gth  Pennsylvania,  who  had  been  officially  reported  as  the  operator  on  the  register  of  the  Tenth  Corps  field  hospital, 
requesting  information  in  the  case  of  Lieutenant  Beebe,  and,  in  an  answer  dated  Scranton,  Tenn.,  March  9,  1869,  Dr.  LEET  stated  that  "  about  four  inches 
of  the  femur,  including  the  head,  was  removed,"  and,  in  a  second  communication,  dated  April  20,  1869,  Dr.  LEET  asserted  that  "the  style  of  the  operation 
was  first  a  longitudinal  incision,  cutting  directly  in  the  direction  the  ball  took  until  I  opened  the  capsule,  thus  exposing  the  head  of  the  bone ;  by  carry 
ing  the  limb  over  the  opposite  thigh  and  pushing  the  limb  upward  I  removed  the  head  of  the  bone  by  sawing  through  the  trochanter  with  a  chain  saw." 
These  positive  assertions  of  Dr.  LEET  led  the  editor  to  accept,  in  such  a  matter  of  anatomical  detail,  the  statement  of  the  surgeon  rather  than  the  impres 
sion  of  the  patient.  However,  in  September,  1869,  after  the  publication  of  Circular  2,  a  letter  dated  Chicago,  September  17,  18G9,  was  received  from 
Dr.  CHARLES  M.  CLAHK,  late  Surgeon  39th  Illinois.  In  this  communication  Dr.  CLARK  gave  the  account  of  Lieutenant  Beebe's  case  as  detailed  in  CASE 
411,  above,  and  added  that  Dr.  N.  Y.  LEET  assisted  him  in  the  operation.  Immediately  upon  receipt  of  this  communication,  on  September  20,  186:',  a 
copy  of  Dr.  CLAKK'S  letter  was  forwarded  to  Dr.  N.  Y.  LEKT,  at  Scranton,  for  comment  on  the  issue  as  to  matter  of  fact  between  Dr.  CLARK  and  himself; 
but  no  answer  was  ever  received.  In  the  meantime  a  letter  had  been  sent  by  the  editor  to  Dr.  G.  D.  BALEY,  Pension  Examining  Surgeon,  of  Havana, 
where  Mr.  Beebe  then  resided,  asking  whether,  in  his  opinion,  the  head  of  the  fern  ur  in  the  case  of  Lieut.  Beebe  had  been  removed.  Dr.  BALEY'S  answer, 
dated  April  30th,  is  included  in  the  history  (CASE  411),  and  corresponds  with  the  statements  of  Dr.  CLAKK  in  regard  to  the  extent  of  the  operation.  A  letter 
from  Lieut.  Beebe,  dated  September  25,  1869,  corroborated  Dr.  CLARK'S  statement,  and  gave  a  description  of  the  excised  portion  of  the  femur,  then  in  the 
possession  of  his  father.  In  addition  to  these  facts,  a  letter  was  received  from  Dr.  D.  II.  BUOWEU,  late  Assistant  Surgeon  U.  S.  V.,  dated  Chicago,  Becenv 

Suno.  Ill— 26 


FIG.  11)2.— Hesult  of  excision 
in  the  upper  third  of  the  femur. 
[From  a  photograph.] 


202 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


In  the  next  case  six  and  one-half  inches  of  the  shaft  of  the  femur,  from  the  great 
trochanter  downwards,  were  excised.  By  means  of  a  prothetic  apparatus  and  with  the 
aid  of  a  small  cane  the  patient  is  enabled  to  make  good  use  of  his  limb,  although  it  is 
shortened  six  and  one-half  inches: 

CASE  412. — Private  J.  W.  Joslin,  Co.  I,  7th  New  York  Heavy  Artillery,  aged  20  years,  received  a  shot  fracture  of  the 
right  thigh  at  Cold  Harbor,  June  3,  1864.  He  was  captured,  and  while  in  the  hands  of  the  enemy  underwent  the  operation  of 
excision  of  the  femur.  After  being  a  prisoner  for  more  than  two  months  he  was  paroled  and  conveyed  by  steamer  to  hospital 

at  Annapolis,  where  Surgeon  B.  A.  Vanderkieft,  U.  S.  V.,  recorded  his  admission,  August 
28th,  with  "shot  wound  of  right  femur."  On  November  28th  the  patient  was  transferred  to 
Jarvis  Hospital,  Baltimore,  whence  Assistant  Surgeon  D.  C.  Peters,  U.  S.  A.,  reported  that 
"the  parts  were  nearly  healed  on  admission,  and  entirely  so  on  December  31st,  when  the 
patient  was  furloughed,  at  which  time  the  limb  was  shortened  six  inches  and  could  be  swung 
backward  and  forward,  but  could  not  be  exercised  in  lateral  or  rotary  motion."  One  mouth 
afterwards  the  man  entered  Dale  Hospital  at  Worcester,  whence  Surgeon  C.  N.  Chamberlain, 
U.  S.  V.,  reported  his  condition  as  follows:  "  He  is  in  perfect  health;  the  parts  ai'e  free  from 
tenderness,  and  the  limb  is  movable  in  every  direction  and  perfectly  under  the  control  of  the 
muscles.  The  upper  end  of  the  femur  is  enlarged,  apparently  by  new  osseous  growth,  to 
almost  twice  its  normal  diameter,  and  it  has  a  good  false  joint."  On  August  '29th  the  patient 
was  finally  transferred  to  DeCamp  Hospital,  David's  Island,  whence  Assistant  Surgeon  W. 
Webster,  U.  S.  A.,  contributed  the  following  history:  "The  wound  was  inflicted  by  a  minid 
ball,  which  entered  the  gluteal  region  about  four  inches  external  to  the  os  coccygis,  passed 
downward,  and  struck  the  femur  a  little  below  the  trochanter  major,  producing  a  compound 
comminuted  fracture  of  the  upper  half  of  the  shaft  of  the  bone.  Excision  of  six  and  a  half 
inches  of  the  femur,  extending  downward  from  a  point  immediately  below  the  great  trochanter, 
was  performed  by  a  surgeon  of  the  Confederate  army.  This  operation  was  done  fifty-four 
hours  after  the  injury,  by  a  linear  incision  seven  and  a  half  inches  long  in  the  axis  of  the  limb, 
beginning  from  a  point  opposite  the  superior  portion  of  the  trochauter  major,  and  on  the  same 
day  the  patient  was  transferred  thirteen  miles  in  an  ambulance  to  Richmond,  where  he  was 
placed  in  hospital  No.  21.  He  stated  that  he  was  in  a  very  weak  and  exhausted  condition 
when  he  reached  Richmond.  His  limb  was  then  placed  in  a  fracture-box,  and  whiskey  was 
administered  twice  daily,  his  diet  consisting  of  corn  and  wheat  bread  and  inferior  soup. 
Extensive  sloughing  of  the  soft  parts  of  the  thigh  occurred  in  the  third  week.  On  October 
26,  1865,  the  patient  was  discharged  from  service,  at  which  time  a  careful  examination  of  the 
injured  thigh  revealed  union  of  the  trochanter  major  with  the  upper  extremity  of  the  lower 
fragment  of  the  resected  femur.  There  was  also  extensive  deposit  of  new  bone,  and  the  degree 
of  shortening  amounted  to  six  and  a  half  inches.  He  could  bear  his  entire  weight  upon  the 
injured  limb  without  producing  any  apparent  yielding  of  the  united  bone.  The  flexion  of  the 
thigh  was  natural,  and  when  it  was  rotated  the  trochanter  major  performed  its  entire  and 
natural  circuit.  The  thigh  and  leg  were  very  much  atrophied,  but  the  knee  joint  Hexed  freely, 
and  the  cicatrix,  though  extensive  on  account  of  the  sloughing  of  the  parts,  was  firm  and 
healthy.  The  gastrocnemius  and  extensor  muscles  of  the  foot  were  rigidly  contracted,  and 
the  foot  was  extended  to  its  utmost  capacity."  One  week  before  receiving  his  discharge  the 
patient  was  furnished  by  Dr.  E.  D.  Hudson,  of  New  York  City,  with  a  prothetic  apparatus,1  consisting  of  a  case  of  raw  hides, 
laced  upon  the  thigh  and  leg,  and  terminating  in  an  artificial  foot  with  ginglymoid  articulations  at  the  ankle  and  toes.  15y  means 
of  this  appliance  he  was  enabled  to  walk  with  ease,  requiring  only  the  aid  of  a  light  cane.  In  a  communication  from  the  pensioner 
in  March,  1868,  he  stated  that  "the  apparatus  works  very  well,"  considering  the  condition  of  the  limb,  and  added  that  he  had 
not  had  any  abscesses  about  the  hip  or  any  part  of  the  injured  leg.  Various  examining  surgeons  at  successive  dates  certified  to 
the  injury  and  operation  resulting  in  shortening,  etc.,  and  the  San  Francisco  Board  added,  in  1877:  "The  result  is  good,  and 

ber  24,1877,  in  which  the  following  occurs:  "CASE  XXX,  of  the  same  Circular,  in  my  opinion,  is  not  correctly  reported.  I  treated  Lieut.  Beebe  from  his 
admission  into  the  Chesapeake  Hospital  until  he  was  considered  well  enough  to  be  sent  north.  This  case,  in  my  judgment,  wus  not  of  the  magnitude  the 
report  represents  it.  The  fractured  portions  of  the  femur  were  removed,  and  the  ends  of  the  bone  smoothed  off;  the  head  of  the  femur  was  not  removed 
from  the  cotyloid  cavity.  In  this  opinion,  I  am  pleased  to  say,  I  am  sustained  by  Surgeon  D.  G.  RUSH  of  this  city,  who  was  one  of  the  staff  of  the 
Chesapeake  Hospital  at  the  time  the  patient  was  under  my  treatment,  and  who  repeatedly  saw  the  case  with  me.  He  recollects  distinctly  to  have  felt, 
at  the  time  the  man  was  admitted,  the  head  of  the  femur  in  its  proper  position.  Surgeon  CLARK,  of  the  39th  Illinois  regiment,  told  me,  a  year  or  two 
afterwards,  that  he  performed  the  operation,  and  described  it  just  as  I  have  done  above."  From  a  careful  examination  of  all  the  correspondence  and 
records  on  file  in  this  Office,  it  is  evident  that  the  head  of  the  femur  was  not  removed  from  the  cotyloid  cavity,  that  an  excision  in  the  upper  third  of  the 
shaft  of  the  femur  was  performed  by  Dr.  C.  M.  CLARK,  and  not  by  Dr.  N.  Y.  LEET,  and  that  the  account  of  the  injury  and  of  the  operation  as  published 
on  page  32  of  Circular  2,  on  the  authority  of  Dr.  N.  Y.  LEET,  is  erroneous.  On  July  17,  1879,  another  letter  was  addressed  to  Dr.  N.  Y.  LEET,  asking 
him  whether  he  would  deny  the  correctness  of  the  account  of  the  case  as  furnished  by  Dr.  C.  M.  CLARK  and  the  pensioner,  Jlr.  D.  Becbo.  To  this,  as 
well  as  to  a  prior  letter  of  similar  tenor,  no  answer  has  been  received  at  the  date  of  this  writing  (September  8,  1879).  This  case  has  been  published  as  an 
excision  of  the  hip  joint  by  Dr.  H.  CuLliERTSON  (Excision  of  the  Larger  Joints  of  the  Extremities,  Philadelphia,  1870,  p.  G4),  and  as  a  resection  of  the 
hip  joint  by  Professor  E.  GUKLT  (Dfe  Gelenlc-Iiesectionen  nach  Schussverletzungen,  Berlin,  1879,  p.  203),  and  it  is  to  be  regretted  that  the  erroneous  version 
of  the  operation  has  misled  these  reliable  authorities  on  excisions. 

1  The  apparatus  is  figured  on  page  33  of  E.  D.  HUDSON'S  Mechanical  Surgery,  Prothe.tic  Appliances  and  Apparatus  for  Amputations,  Resections, 
Vnunited  Fractures,  Diseases  of  Joints,  Deformities,  Curvatures  of  Spine  and  Paralysis,  New  York,  1878. 


FIG.  103. — Result  of  primary  excision 
in  the  shaft  of  the  femur.  [From  a 
photograph.] 


SECT.  III.] 


EXCISIONS    IN    THE    CONTINUITY    OF   THE    FEMUR. 


203 


the  leg,  by  the  use  of  a  mechanical  apparatus,  is  of  use  to  the  man."  The  pensioner  was  paid  March  4,  1879.  Photographs 
of  the  patient,  taken  in  1865,  and  showing  his  appearance  without  and  with  the  apparatus,  were  contributed  by  Dr.  Webster 
(Contr.  Photo's,  A.  M.  M.,  Vols.  9  and  10,  pp.  31,  32,  and  33)  and  copied  at  the  Army  Medical  Museum  (Sim/.  Phot.  Series,  Nos. 
lOo  and  107).  The  former  is  represented  in  the  wood-cut  (FlG.  163). 

CASE  413. — Captain  S.  V.  Shipman,  Co.  E,  1st  Wisconsin  Cavalry,  aged  38  years,  was  wounded  in  the  right  thigh 
during  the  engagement  at  Whitewater  River,  April  24,  1883.  Two  days  after  the  reception  of  the  injury  he  was  admitted  to  the 
Post  Hospital  at  Cape  Girardeau,  whence  Surgeon  W.  McClellan,  1st  Nebraska,  reported  the  wound  as  "a  fracture  of  the  femur, 
caused  by  gunshot,  for  which  primary  resection  of  three  and  a  half  inches  at  the  upper  third  was  performed,  the  ends  of  the 
bone  being  clipped  off.  Patient  left  the  hospital  on  leave  of  absence  July  17th."  Captain  Shipman  was  subsequently  promoted 
to  Major,  and  ultimately  mustered  out  as  Brevet  Colonel  on  July  19,  1803.  In  his  application  for  pension  he  alleged  that  the 
ball  was  not  found  nor  removed  from  his  thigh  until  eight  months  after  the  reception  of  the  wound.  Examiner  A.  J.  Ward,  of 
Madison,  Wisconsin,  October  23,  1836,  certified  to  the  injury  and  operation  resulting  in  contraction  of  the  leg  and  stiffness  of 
the  knee,  and  added:  "The  pensioner  has  had  an  abscess  form  three  different  times;  the  last  time  it  laid  him  on  his  back  some 
six  weeks.  It  may  recur  any  time,  as  there  is  evidently  diseased  bone  in  the  femur."  Dr.  H.  A.  Martin,  late  Surgeon,  U.  S.  V., 
in  a  letter,  dated  Boston,  April  24,  1889,  makes  reference  to  this  case  as  follows:  "When  I  was  stationed  at  Cape  Girardeau  a 
most  interesting  case,  that  of  Captain  Shipman,  was  under  my  care  to  a  perfect  successful  issue.  He  lost  nearly  four  inches  of 
the  whole  shaft  of  the  femur,  including  portion  of  the  trochanters,  and  is  now  living,  with  a  limb  shortened  some  two  and  a 
half  inches."  This  pensioner  was  paid  June  4,  1879. 

TABLE  XXII. 
Summary  of  Twenty  Cases  of  Recovery  after  Primary  Excision  of  the  Shaft  of  the  Femur  for  Shot  Injury. 


NO. 

NAMB,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATION,  AND 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AOE. 

DATES. 

INJURY,  OPERATION,  AND 
RESULT. 

( 

I 

Beebe,  D.,  Adjutant,  3d 

Oct.  27. 

Right  ;  three  and  a  half  ins.  from 

10 

Hayes,  W.  J.,   Pt.,   L, 

June  11, 

Right  ;  five  ins.  middle  third,  by 

New  York,  age  25. 

27,  '64. 

junct.  with  caps,  to  level  of  troc. 

16th    Penn.    Cavalry, 

11,  '64. 

Surg.  F.  Le  Moyne,  16th  Penn. 

minor,    by  Surg.  C.  M.  Clark, 

age  18. 

Cav.;  necrosis.  Disch'd  June  20, 

39th  111.     Mustered  out   Sept., 

1865;   pensioned;   three  inches 

1865.     Surg.  Phot.  210  ;  pens'd. 

shortening  ;  fistulous  opening. 

o 

Brewer,  J.  W.,  Pt,,   C, 

Aug.  14, 

Right;  four  and  a  half  ins.,  inclu 

11 

Joslyn,  J.   W.,    Pt..   I, 

June  3. 

Right  ;  six  and  a  half  ins.  from 

4th  Tenn.  Car.,  age  40. 

14,  'ti4. 

ding  great  trochanter,  by  Surg. 

7th  New  York  Heavy 

5,  '64. 

great  troch.  downward,  by  Conf. 

—  Sevenson,  4th  Tenn.  Cav'y. 

Artillery,  age  20. 

surg.     Disch'd  Oct.  26,  1865; 

Released  June  1  6,  '65  ;  two  and 

pens'd;   seven  ins.   shortening. 

a  half  ins.shortn'g.     Circular  %, 

Surg.  Phot.  Ser.,  Nos.  106,  107. 

1869,  p.  58. 

Circ.  6,  1865,  p.  68. 

3 

1  Button,  F.H.,  Musician, 

July  6, 

Lett  ;   four  ins.    upper  third,  by 

12 

Keyser,  M.,  Pt.,  E,  9th 

June  17, 

Left;  one  inch  middle  third,  by 

I,  14th  Mich.,  age  18. 

G,  'M. 

Surg.   E.   Batwell,   14th  Mich. 

Kansas  Cav.,  age  40. 

20,  '63. 

A.  A.   Surg.  J.  Tliorne.    Also 

Disch'd   May  5,  1865;  pens'd; 

exc.  r't  radius.     Disch'd  March 

ligamentous  union  ;  three  inches 

1,  1864  ;  compl.  union  ;  two  ins. 

shortening. 

shortening  ;  not  pensioned. 

4 

2  B  ,  S.,7th  Kentucky 

April  6, 

;  two  and  a  half  inches  from 

13 

McLaughlin,  G.  H..  Lt., 

July  2, 

Left.     Duty  Oct.  9,  1864  ;  retired 

Mounted  Inf  '  y,  age  —  . 

(i,  '62. 

upper  third,  by  Surgeon  S.  F. 

11,  2d  Infantry,  age  —  . 

3,  '63. 

Dec.  31,  1870. 

Clardy,  C.  S.  A.    Recovered; 

14 

3Reynolds,  J.  C.,  Pt.,  E, 

May  5, 

Left  ;  portion  of  trochanter  major. 

ends  of  bone  united  well  ;  limb 

5tb  N.  Jersey,  age  24. 

8,  '62. 

Disch'd  Aug.  18,  '64  ;  not  pens'd. 

of  great  use. 

]5 

Shanley,  J.,  Pt.,  A,  76th 

May  24, 

Left  ;  portion  of  trochanter  major. 

5 

Cnlhonn,   W.  F.,  Sorg't, 

Mar.  25, 

Right  ;  mid.  third,  by  Surg.  G.  U. 

New  York,  age  24. 

26,"'G4. 

Duty  Nov.  15,  1864  ;  pensioned  ; 

F,  5th  Virginia,  age  25. 

25,  '05. 

Sullivan.  39th  N.  J.  Erysipelas. 

hip  joint  stiffened  ;  necrosis. 

Released  June  11,  18G5. 

16 

*  Shelley,  J.  H.,  Pt.,  L, 

June  10, 

Four  and  a  half  ins.  middle  third, 

G 

Conner,  S.,  Colonel,  19th 

May  C, 

Right  ;  two  ins.,  fragment,  middle 

3d  Kentucky  Cavalry, 

10,  '64. 

by  Surg.  S.  F.  Clardy,  C.  S.  A. 

Maine,  age  25. 

G,  'G4. 

third,  by  Surg.  J.  F.  Dyer,  19th 

age  15. 

Disch'd  Dec.,  1864  ;  union  com 

Mass.;  June,  liaems.;  Sept.,  bone 

plete;  four  and  a  half  ins.  short'g. 

extracted.    Disch'd  April  7,  '66, 

17 

Shipman.   S.  V.,  Capt., 

April  24, 

Right  ;  three  and  a  half  ins.  upper 

as   Brig.   General  ;    pensioned  ; 

E,  1st  Wisconsin  Cav., 

24,  '63. 

third  and  portion  of  troch.  maj. 

0 

anchylosis   of    knee  joint  ;    leg 

age  38. 

Promoted  Maj.  Disch'd  July  19, 

entirely  useless. 

1865;  pensioned  ;  two  and  a  half 

7 

Gebhardt,  J.,Pt.,B,  149th 

July  2, 

Left  ;  about  two  ins.  up.  third,  by 

ins.  shortening  ;  anch.  knee. 

New  York,  age  22. 

3,  1863. 

Surg.  J.  V.  Kendall.  149th  N.  Y. 

18 

Shock,   A.,   Pt,,  A,  4th 

Mar.  11,    Right  ;  four  and  a  half  ins.,  frag- 

Disch'd  March  1,  1865;  pens'd; 

Penn.  Reserves.age  23. 

12,   '62. 

ments,  up.  third,  by  Ass  t  Surg. 

shortening,  ulcerntion,  and  de 

J.  S.  Billings,  U.  S.  A.    Disch  d 

formity.   C'ont.  Phot.  Series,  Vol. 

Oct.  10,  62  ;  pensioned  ;  five  ins. 

4,  No.  '8. 

short'g.     Med.  and  Surg.  Hist., 

8 

IIurris.B.F.,  Lieut.-Col., 

Nov.  7, 

Left;  three  ins.,  neck,  trochanter, 

Pt.  II,  Vol.  II,  p.  367. 

Gth  Maine,  age  33. 

7,  '63. 

upper  third.     Discharged  July 

19 

Thibaut,  F.  W.,  Capt.,  A, 

Dec.  13, 

Left  ;  trochanter  major,  by  Surg. 

19,  18G4  ;   pensioned  ;  shortened 

7th  New  York,  age  28. 

13,  '62. 

C.  Gray,  7th  N.  Y.     Also  amp. 

three  inches. 

left  ring  finger.     Disch'd  May 

9 

Hartman,    L.,    Pt.,    E, 

June  1, 

Right;  three  ins.,  upper  third,  by 

8,  1863  ;   pensioned. 

24th  Mich.,  age  16. 

1,  '64. 

Surg.  J.  II.  Beech,  24th  Mich'.; 

20 

Tirtlot,  W.  M.,  Lieut., 

May  15, 

Right  ;  four  ins.  middle  third,  by 

gang.     Disch'd  Aug.  23,  18G5; 

F,  105th  111.,  age  24. 

15,'  '64. 

Surg.  A.  W.  Reagan,  70th  Ind. 

pens'd;  four  ins.  shortening. 

Disch'd  Nov.  28,  1864  ;  pens'd  ; 

limban  impediment.  Spec.  2159. 

The  injuries  are  reported  to  have  been  inflicted  by  shell  fragments  in  two  instances, 
by  a  fuse  plug  in  one,  and  by  small  projectiles  in  seventeen  cases.  Sixteen  of  the  twenty 
operations  were  performed  by  Union  and  four  by  Confederate  surgeons. 

1  BATWELL  (E.),  Notes  on  Bisection,  in  Med.  and  Surg.  Reporter,  1865,  Vol.  XII,  p.  221. 

2  THOMPSON  (J.  W.),  Resection  of  the  Long  Bones,  in  Med.  Record,  1868-9,  Vol.  Ill,  Case  VI,  p.  29. 
3PllAY  (O.  M.),  Reports  of  Hospitals,  in  Am.  Med.  Times,  18,'i3,  Vol.  V,  Case  IX,  p.  77. 

4MAUGIIS  (G.  M.  B.),  Conservative  Treatment  of  Compound  Comminuted  Fractures  of  the  Femur,  in  Confederate  States  Med.  and  Surg.  Jour., 
1865,  Vol.  II,  Case  8,  p.  8.  THOMPSON  (J.  W.),  Cases  of  Resections,  etc.,  in  Nashville  Med.  Jour.,  1868,  N.  S.,  Vol.  I,  p.  340.  THOMPSON  (J.  W.),  Resec 
tion  of  the  Long  Bones,  in  Med.  Record,  1868-9,  Vol.  Ill,  Case  I,  p.  28. 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP  x. 


Fatal  Cases  of  Primary  Excision  in  the  Shaft  of  the  Femur. — Of  the  sixty-five  cases 
of  this  group,  the  operation  was  performed  on  Union  soldiers  in  fifty-three  and  on  Confed 
erate  soldiers  in  twelve  instances.  The  right  femur  was  involved  in  thirty,  the  left  in 
twenty-six  cases;  in  nine  the  side  of  the  injury  was  not  indicated. 

CASE  414. — Private  A.  A.  Shaw,  Co.  C,  9th  Missouri  State  Militia  Cavalry,  was  accidentally  wounded  in  the  left  thigh 
by  a  conical  ball,  April  1,  1863.  He  was  admitted  to  the  general  hospital  at  Eolla,  and  operated  on  by  Surgeon  II.  Culbertson, 
U.  S.  V.,  who  described  the  case  as  follows:  "A  compound  comminuted  fracture  of  the  femur  at  the  lower  third,  the  bone  being 
broken  into  small  fragments,  and  small  spiculae  being  thrown  over  the  internal  surface  of  the  wound;  orifice  of  exit  two  and  a 
half  inches  in  diameter,  and  located  on  inner  side  of  thigh.  The  vasti,  biceps,  semi-membranosis,  and  tendinosis,  rectus, 
and  adductors  (below)  were  lacerated  as  high  as  the  middle  third  and  down  to  the  knee  joint,  which  was  not  involved.  The 
large  vessels  were  uninjured.  The  patient  was  vomiting,  being  cold  and  prostrated ;  pulse  140.  Under  these  circumstances  I 
determined,  on  consultation,  to  stimulate  and  anaesthetize,  then  remove  all  loose  portions  of  bone  and  resect  the  ends  of  the  femur 
as  far  as  they  were  denuded  of  periosteum,  amputation  being  precluded  by  the  great  prostration.  In  three  hours,  the  pulse  having 
become  somewhat  fuller  and  slower  and  the  general  surface  warmer,  I  performed  the  resection.  Under  the  influence  of  chloroform 
the  patient's  pulse  grew  stronger,  and  after  the  operation  he  seemed  better.  He  recovered  from  the  effects  of  the  anaesthetic  in 
due  time,  but  never  rallied  fully  from  the  shock  of  the  injury,  and  his  system  gradually  failed,  though  supported  by  full  doses  of 
morphia  and  brandy.  He  died  eighteen  hours  after  the  reception  of  the  injury,  being  conscious  of  his  approaching  end." 

CASE  415. — Private  Jonathan  Wallace,  Co.  F,  21st  Georgia,  aged  33  years,  was  wounded  by  a  conoidal  ball,  in  the 
charge  on  Fort  Steadman,  March  25,  1835.  The  missile  entered  on  the  external  surface  of  the  left  thigh  at  the  lower  portion 
of  the  middle  third,  passed  obliquely  upward  and  inward,  fractured  the  femur  through  the  middle  third,  and  emerged  on  the 
internal  surface  an  inch  above  the  wound  of  entrance.  He  was  taken  to  the  field  hospital  of  the  2d  division,  Ninth  Corps,  where 
Surgeon  G.  W.  Snow,  35th  Massachusetts,  reports  that  "resection  at  the  middle  third  of  the  femur  was  performed  by  .Surgeon 
G.  R.  Sullivan,  39th  New  Jersey,  and  anterior  splints  applied."  On  April  10th,  he  was  admitted  into  the  Armory  Square 
Hospital,  Washington.  Acting  Assistant  Surgeon  George  K.  Smith  reports  "that  the  injured  limb  was  shortened  one  inch; 

extension  was  applied  (Buck's  method)  with  a  weight  of  eleven  pounds,  after  which  there 
was  no  shortening.  Patient  did  remarkably  well  until  June  8th,  when  he  was  attacked  with 
diarrhoea,  which  was  arrested  at  the  end  of  three  days.  On  June  23d,  the  bone  appeared 
to  be  firmly  united  with  half  an  inch  shortening,  and,  on  July  2d,  extension  was  removed, 
and  the  patient  rode  about  the  ward  in  an  invalid  chair.  July  28th,  it  was 
discovered  that  the  limb  had  shortened  two  and  one-fourth  inches;  exten 
sion  was  reapplied  with  a  weight  of  sixteen  pounds,  and,  on  August  5th,  it 
measured  three-fourths  of  an  inch  shorter  than  its  fellow.  On  August  15th, 
a  photograph  of  the  patient  was  taken  [No.  92  of  the  Surgical  Plioto- 
<jrap\  Series  of  the  Army  Medical  Museum,  a  reduced  copy  of  which  is 
represented  in  the  wood-cut,  FlG.  164].  On  August  17th,  the  wound 
had  nearly  healed,  his  condition  was  remarkably  good,  and  the  bone  had 
apparently  united."  On  this  date  he  was  transferred  to  the  Douglas  Hos 
pital,  Washington,  to  the  care  of  Assistant  Surgeon  W.  F.  Norris.  U.  S.  A., 
who  reports:  "The  wound  was  still  open  and  discharging  a  small  quantity 
of  matter,  but  there  was  firm  union  of  the  broken  femur,  and  the  patient 
could  without  assistance  raise  his  leg  from  the  bed.  His  general  health 
seemed  to  be  improving,  and  he  daily  rode  about  the  ward  in  a  wheeled 
chair,  the  limb  being  supported  in  an  extended  position.  August  26th* 
several  small  loose  fragments  of  bone  were  removed.  August  28th,  had  a 
severe  chill ;  on  the  29th,  had  an  attack  of  erysipelas  in  the  thigh,  and,  on 
the  following  day,  a  loose  piece  of  necrosed  bone,  one  and  a  half  inches  in 
length,  was  removed.  On  September  2d,  erysipelas  had  spread  down  to 
ankle  joint,  llth,  erysipelas  had  disappeared;  another  small  sequestrum 
was  removed  from  the  posterior  wound.  16th,  had  two  chills,  diarrhoea! 
passages,  and  vomiting.  21st,  he  steadily  grew  weaker;  the  wound  had 
almost  ceased  to  discharge.  There  was  slight  icterus;  the  countenance 
was  pinched  and  anxious  and  the  breathing  labored.  22d,  he  had  pain  in 

Fio.  1G4.— Appearance  five  months  chest  and  abdomen,  and  was  unable  to  pass  his  urine.  These  symptoms  united  six  months  ;if- 
after  excision  in  middle  third  of  femur,  continued  until  the  evening  of  the  23d,  when  death  ensued  from  pysernia.  ter  shot  injury.  Spec. 
[Irom  a  photograph.]  i.J.j4. 

At  the  autopsy,  fifteen  hours  after  death,  the  brain  appeared  healthy;  but 

there  was  a  large  amount  of  serous  subarachnoid  effusion.  Both  lungs  were  adherent  and  thickly  studded  with  pyremic  patches, 
most  of  which  were  dark  colored  and  hardened,  a  few  only  having  softened,  and  containing  pus.  There  was  considerable  serous 
effusion  in  the  left  plenral  sac.  The  spleen  was  enlarged  but  not  softened;  the  other  thoracic  and  abdominal  viscera  appeared 
healthy.  The  fractured  femur  [which  is  represented  in  the  adjoining  wood-cut,  FlG.  165]  was  removed  and  sawn  longitudinally; 
above  the  fracture  the  marrow  and  interspaces  between  the  cancelli  presented  a  reddish  chocolate  hue,  below,  it  appeared  red 
dened  and  inflamed;  it  had  not,  in  either  locality,  any  gangrenous  odor.  The  femoral  vein  [represented  in  PLATE  XXX, 
opposite]  was  found  to  contain  old  and  partially  disintegrated  blood  clots,  and  in  some  portions  also  a  quantity  of  healthy  look 
ing  creamy  pus;  its  walls  were  much  thickened.  It  continued  to  present  the  same  appearance  up  to  about  two  inches  below  its 


1C5.— Ends   of 
fractured   left    femur 


\ 


PLATF    XXX.     OBSTRUCTED      FEMORAL     VEIN 


SECT.  III.] 


EXCISIONS    IN    THE    CONTINUITY    OF    THE    FEMUR. 


205 


junction  with  the  internal  iliac  vein ;  here  the  clots  ceased,  and  the  coats  of  the  vein,  although  of  reddish  hue,  did  not  appear  much 
thickened.  The  pus  was  carefully  examined  Avith  the  microscope  and  presented  its  usual  round  corpuscles,  which  under  the  appli 
cation  of  acetic  acid  exhibited  distinctly  their  characteristic  double  and  triple  nuclei.  The  femoral  artery  appeared  to  be  healthy." 
CASE  416. — Private  W.  J.  Beck,  Co.  D,  2d  Pennsylvania  Heavy  Artillery,  aged  18  years,  was  wounded  at  Petersburg, 
June  18,  1864.  Surgeon  M.  K.  Hogan,  U.  S.  V.,  recorded  his  admission  to  the  field  hospital  of  the  1st  division,  Ninth  Corps, 
with  "shot  wound  of  left  thigh."  Surgeon  N.  R.  Moseley,  U.  S.  V.,  reported  the  following:  "The  patient  was  admitted  to 
Emory  Hospital,  Washington,  June  24th,  with  fracture  of  the  middle  of  the  upper  third  of  the  left  femur,  caused 
by  a  minie"  ball,  and  resulting  in  resection,  which  operation  was  performed  on  the  field  on 
June  19th.  The  treatment  consisted  of  cold-water  dressings,  and  stimulants  and  nutritious 
diet.  Death  occurred  July  8,  1864."  The  upper  third  of  the  injured  fernur  was  contributed 
to  the  Museum  by  Acting  Assistant  Surgeon  W.  H.  Ensign,  and  is  represented  in  the  cut 
(FlG.  167).  The  specimen  shows  no  bony  deposit,  and  the  shaft  is  stripped  of  periosteum 
for  some  distance  below  the  seat  of  the  injury. 

CASE  417. — Private  J.  Fearing,  Co.  G,  21st  Massachusetts,  aged  23  years,  received 
a  gunshot  fracture  of  the  right  thigh  at  Cold  Harbor,  June  3,  1834.  He  was  admitted  to 
the  field  hospital  of  the  1st  division,  Ninth  Corps,  where  the  operation  of  resection  was  per 
formed  but  not  recorded,  and  several  days  afterwards  he  was  conveyed  to  Washington. 
Acting  Assistant  Surgeon  P.  O.  Williams  described  the  injury  and  its  result,  as  follows: 
"The  patient  was  admitted  to  Emoiy  Hospital,  June  7th,  with  compound  comminuted  frac 
ture  of  the  femur  at  the  upper  third,  caused  by  a  minie"  ball,  which  entered  anterior  to  the 
femoral  artery,  passed  backward  and  outward,  and  emerged  on  the  opposite  side.  Two  and 
a  half  inches  of  the  bone  had  been  excised  the  day  after  the  injury,  through  an  incision  four 
inches  in  length.  The  general  treatment  consisted  of  tonics,  stimulants,  astringents,  and 
FIG.  166.— Upper  por-  generous  diet.  Pulley  extension,  sand  bags,  and  bandages  were  applied  to  the  limb  and 
in^lxc^i'on^'So^^T  c°1^-watc'r  dressings  to  the  wound.  Small  spiculse  of  bone  and  a  small  piece  of  lead  about 

the  size  of  a  pea  were  removed  on  June  30th.  The  patient  died  August  3,  1834,  of  exhaus-  Spec-  * 
tion  resulting  from  the  excessive  discharge  of  the  wound  and  from  severe  diarrhoea,  which  had  troubled  him  the  last  two  weeks. 
The  post-mortem  revealed  necrosis  of  both  excised  extremities,  extending  from  one  to  one  and  a  half  inches.  There  was  abundant 
deposit  of  osseous  matter  on  the  upper  portion,  but  upon  the  lower  part  only  a  little  was  found  on  the  posterior  aspect."  The 
upper  half  of  the  injured  femur  was  contributed  by  Surgeon  N.  R.  Moseley,  U.  S.  V.,  and  is  shown  in  the  cut  (FlG.  166). 

In  the  following  case  severe   hemorrhage  occurred  on   the  twentieth  day  after  the 
injury,  and  amputation  in  the  upper  third  of  the  thigh  was  performed: 

CASE  418. — Corporal  J.  W.  Soule,  Co.  D,  6th  Michigan  Cavalry,  aged  27  years,  was  wounded  in  the  right  thigh  at 
Boonesboro',  July  8, 1863.  Surgeon  S.  B.  W.  Mitchell,  8th  Pennsylvania  Cavalry,  recorded  his  admission  to  the  Cavalry  Corps 
field  hospital,  and  noted  that  a  resection  was  performed.  On  July  21st  the  wounded  man  was  transferred  to  the  Frederick 
Hospital,  whence  Acting  Assistant  Surgeon  J.  H.  Bartholf  contributed  the  specimen  (FlG.  168),  with  the 
following  history:  "The  wound  was  caused  by  a  rifle  ball,  which  entered  below  the  nates  and  fractured 
the  femur  at  the  lower  part  of  the  upper  third.  A  portion  of  the  bone  was  removed  on  the  evening 
following  the  injury,  and  sand  bags  were  kept  to  the  sides  of  the  limb  until  the  day  before  the  patient 
was  removed  to  this  hospital,  when  a  long  outer  splint  was  applied.  On  admission  the  limb  was  in  very 
good  condition  and  shortened  only  one  and  three-quarter  inches.  On  July  23d  the  long  splint  had  become 
displaced  and  was  doing  harm,  when  I  removed  it  and  substituted  Buck's  extension  (pulley,  weight,  and 
sand  bags).  On  the  following  day  the  patient  felt  comfortable  and  the  Avound  looked  well;  the  short 
ening  now  amounted  to  two  and  three-quarter  inches.  On  the  next  day  the  extension  was  increased  by 
additional  weight.  A  moderate  flow  of  haemorrhage  from  the  wound  took  place  on  July  25th,  which 
could  not  be  controlled  by  pressure  on  the  common  femoral  artery,  and  did  not  cease  until  after  five 
minutes'  continuance,  of  the  pressure.  The  amount  of  blood  lost  was  estimated  at  six  ounces.  Explora 
tion  showed  the  sawn  end  of  the  upper  fragment  to  be  denuded  a  finger's  breadth;  but  the  upper  end  of 
the  lower  fragment  could  not  be  felt  nor  reached.  On  the  28th  a  collection  of  pus  was  detected,  by 
examination  with  the  finger,  in  a  cavity  at  the  inner  side  of  the  upper  fragment,  and  at  8.30  P.  M.  of  this 
day  another  haemorrhage,  uncontrollable  by  pressure  on  the  femoral  artery,  to  the  amount  of  eight 
ounces  took  place.  Stimulants  and  opiates  were  then  given  to  procure  sleep  and  time  in  order  to  enable 
the  patient  to  recover,  in  part  at  least,  from  the  effects  of  the  haemorrhage  and  undergo  an  operation,  for 
which,  with  a  view  of  having  the  further  advantage  of  daylight,  the  following  morning  was  determined 
upon.  At  4  o'clock  A.  M.  the  next  day  there  was  another  hemorrhage,  estimated  at  six  ounces,  and 
when  the  patient  had  pretty  well  recovered,  amputation  was  performed  by  transfixion  through  the  site 
of  the  wound,  making  antero-posterior  flaps.  The  patient  did  not  rally  well.  He  died  two  hours  after 
the  operation.  At  the  post-nuirteni  examination,  the  thoracic  and  abdominal  organs  were  found  to  be 
healthy.  The  hemorrhages  were  discovered  to  have  occurred  from  a  large  orifice  plainly  to  be  seen  in 
the  upper  end  of  the  lower  portion  of  the  severed  sciatic  artery,  the  ball  having  evidently  found  the  vessel  lying  in  its  course 
and  disrupted  it.  The  blood  not  coming  from  any  branch  of  the  femoral  explains  the  non-control  of  the  flow  by  pressure 
thereon,  as  was  believed  at  the  time.  The  bleeding  and  stopping  was  probably  due  to  the  closing  of  the  orifice  by  the  end  of  the 
bone,  and  to  its  shifting,  and  perhaps  to  other  causes.  The  two  sawn  ends  of  the'  bone  were  necrosed  for  the  space  of  one- 
quarter  inch  to  an  inch,  beyond  which  a  good  amount  of  callus  was  thrown  out." 


FIG.  168.— Upper  halfcif 
rig-lit  femur.  Spec.  3S.T4. 


206 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


TABLE  XXIII. 
Summary  of  Sixty-jive  Fatal  Cases  after  Primary  Excision  of  the  Shaft  of  the  Femur  for  Shot  Injury. 


xo. 

NAME,  MILITARY 
DESCRIPTION',  AND  AGE. 

DATES. 

INJURY,  OPERATION,  AND 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATION,  ANL> 
RESULT. 
l 

1 

Austin,  M.  G.,  Pt..  D, 

July  2, 

Right  ;  up.  third  ;  Sept.  26,  bony 

34 

Mcllhany,    P.,  Pt.,    C, 

May  5, 

Left  ;  three  inches  mid.  third,  by 

21st  Virginia,  age  24. 

3,  '63. 

union,   with    lateral  curvature. 

88th  New  York. 

5,  '64. 

Surg.  W.  O'Meagher,  69th  N. 

Died  Dec.  2,  1863,  of  wounds. 

York.    Died  May  5.  1864. 

o 

Ball,    C.  H.,  Capt.,  K, 

Mav  7, 

Left.     Died  May  14,  1864. 

35 

Meeks,  W.  A.,  Pt.,  F, 

Sept.  19, 

Right;  upper  third,  by  Surg.  H. 

6th  Va.  Cav.,  age  20. 

9,  '64. 

125th  Ohio. 

19,  '63. 

McHenry,   125th    Ohio.      Died 

3 

Becht,   J.,   Pt.,    15.   7th 

Mar.  31, 

Right  ;  mid.  third,  by  Surg.  R.  K. 

Nov.  3,  1863,  exhaustion. 

Maryland,  age  38. 

31,  '65. 

Robinson,    7th   Md.;   April   12, 

36 

Mehwaldt,    H.,   Pt.,   B, 

June  18, 

Right;  six  inches  mid.  third,  by 

amp.  up.  third.    Died  April  12, 

8th  New  York  Heavy 

18,  '64. 

Surg.  N.  Hayward,  20th  Mass. 

1865,  shock. 

Artillery. 

Died  June  21,  1864. 

4 

Beck.  W.  J.,  Pt.,  D,  2(1 

June  19, 

Left;  upper  third;  no  attempt  at 

37 

Messenger,    I.,    Pt,,   F, 

A  ug.  6, 

Right;  three  inches  upper  third, 

Peun.    Heavy   Art'ry, 

iy,  '64. 

union.    Died  July  8,  1864.    Au 

1  12th  Illinois,  age  25. 

6,  Y04. 

by  Surg.  C.  S.  Frink,  U.  S.  V. 

age  If. 

topsy.     Spec.  2816. 

Died,  Sept  2,  1864,  of  wounds. 

5 

Hittle,  M.,  Pt.,  K,  3(itli 

fe.  18/64, 

Right  :  mid.  third,  by  Surg.  S.  11. 

38 

Milkie,  W.,  Pt.,  D,  26th 

July  20, 

Left.     Died  August  7,  1864. 

Wisconsin. 

Primary. 

Plumb.  59th  N.  Y.     Died   June 

Wisconsin. 

SO,  '64. 

21,  1864. 

31) 

Mock,   A.,  Pt.,  K,  55th 

Mar.  30, 

Left  ;  four  inches  mid.  third,  by 

o 

lions,  D.  ir.,  Pt.,K,<;-lth 

Feb.  6, 

Right  ;  three  inches  upper  third. 

Pennsylvania. 

30,  '05. 

Surg.  C.  M.  Clark,  3!>th  Illinois. 

Georgia,  ago  20. 

7,  '65. 

Died  February  9,  1865. 

Died  March  31,  1805. 

7 

Brown,  J.  10.,  Corp'I,  !•', 

July  2, 

Middlethird.   Died  July  11,  1863. 

40 

Moore,  H.,  Pt.,  H,  36th 

Nov.  27, 

Left  ;  lower  third,  by  Surg.  J.  C. 

80th  New  York. 

2,  '63. 

Alabama. 

28,  '63. 

Morgan,  29th  Mo.  (gang,  of  foot, 

8 

Brozier,    N.   P.,   Pt.,    I, 

June  27, 

Right  ;  neck,  by  Surg.  S.  H.  Ker 

amp.  foot).     Died  Dec.  6,  1803. 

101st  Ohio,  age  27. 

27,  '64. 

sey,  3(ith  Ind.    Died  July  6,  '64. 

41 

Personius,    S.  W.,   Pt., 

May  6, 

Left  ;  upper  third.     Died  May  20, 

!) 

Burch,  ().,  Pt..  G.  llltli 

April  2, 

Left;  three   ins.  mid.  and  upper 

G,  109thN.  Y.,  age  21. 

6,  '64. 

J804. 

New  Vork,  age  17. 

5,  '65. 

thirds,  by  Act.  Staff  Surg.W.  J. 

42 

Peterson,  C.  M.,  Pt.,  I, 

June  27, 

Right:  four  ins.  lower  third,  by 

]?urr,  U.  S.  A.;  sloughing.   Died 

6th  Iowa. 

27,  '64. 

S  urea.  W.  Graham,  40th  111.,  and 

July  18,  '65,  exhaustion.  Autop. 

W.  Lomax,  12th  Ind.  Died  July 

10 

Burt,  E.  K.,  Pt.,  C,  8th 

June  17, 

Right  ;  four  ins.  lower  third,  by 

20.  1864. 

Xew  York  Heavy  Art. 

17,  '64. 

Surg.  N.  Hayward,  20th  Mass. 

43 

Phinney,  J.  A.,  Corp'I, 

April  2, 

Right;  upper  third,  by  Surg.  J. 

Died  June  20,  18(i4. 

B,  31st  Maine,  age  22. 

2,  '65. 

A.  Hayes,  1  1  th  New  Hampshire. 

11 

Carroll,  L.,  Serg't,  II,  1st 

Oof.  22, 

Right;  mid.  third:  Nov.  11,  haein.; 

Died  April  16,  1865. 

Delaware,  age  22. 

22,  '64. 

lig.;  amp.  hip.  joint.    Died  Nov. 

44 

Potter,  R.  E.,  Serg't,  II, 

Mav  12, 

Right;  two  ins.  middle  third,  by 

r.>.'64;  proem.  Spec.  1020.  Circ. 

1st  N.  York  Dragoons, 

12,'  '64. 

Surg.  B.  T.  Kneeland,  1st  N.  Y. 

6,  '65,  p.  50.    Circ.  7,  '67,  pp.  38, 

age  26. 

Drag's.  Died  J  une  1  8,  '64  ;  p  viem. 

62.     See  CASE  298,  p.  139,  ante. 

45 

Pugh,  J.  M.,  Corp'I,  F, 

Sept.  1, 

Upper  third.  Died  Sept.  14/1864. 

12 

Chirk,  K.,   Pt.,   15,   55th 

Mav  17, 

Left,     Died  May  20,  1862. 

38th  Ohio. 

1,  '64. 

Illinois. 

18,"  '62. 

* 

40 

Ramage,  E.,  Pt.,  I,  15th 

June  25, 

Left  ;   three  inches.     Died  June 

13 

Conner,    S.   L.,   Pt.,  10, 

July  1, 

Right  ;  middle  third.     Died  July 

Ohio. 

25,  '03. 

28,  1863.     Spec.  1752. 

8~>d  Ohio. 

1,  '(53. 

16,  1863. 

47 

Ruokel,  D.,  Pt.,  I,  14th 

June  16, 

Right:  upper  third,  by  Surff.  C. 

14 

Cox.  R.,  Serg't,  L,  1st  S. 

June  30, 

—  ;  up.  third;  bones  of  pelvis 

Ohio. 

16,  '64 

N.  Fowler,    105th  Ohio.    Died 

Carolina  Sliarpshoot'rs. 

J'y3,'62. 

also  fractured.  Died  July  11,  '62. 

June  27,  1804. 

15 

Dawson,  J.,  Pt..  G.  48th 

Aug.  Hi, 

August    18th,    gangrene.     Died 

48 

Shaw,  A.  A.,  Pt,,  C,  9th 

April  1, 

Left;    lower  third,   by  Surg.  H. 

New  York,  age3J. 

16,  '64. 

August  19,  1864. 

Missouri  S.  M.  Cav. 

1,  '63. 

Culbertson,  U.  S.V.    Died  April 

10 

Daniel,  It.,  Pt.,  I-1,   1  3th 

Oct.  19. 

Left  ;  six  inches  upper  and  middle 

2,  1863.    Autopsy. 

West  Virginia,  age  37. 

19,  '64. 

thirds.  Died  Nov.  7,  '64  ;  pysem. 

49 

Small,  E.,  Pt.,  E,  69th 

Sept.  17, 

Left,     Died  October  2,  1862. 

Autopsy. 

Xew  York. 

17,  '62. 

17 

Delinger,    C.,    Pt.,    D, 

Mar.  25, 

Left;  upper  third.     Died  March 

50 

Smith,  C.,  Serg't,  K,  3d 

May  21. 

Right:  middle  third.     Died  May 

200th  Pennsylvania. 

25.  '65. 

29,  1865. 

Ohio  Cavalry. 

21,  ''63. 

25.  1863. 

18 

Engle,   J.,   Government 

Mar.  16, 

Right  ;  middle  third,  by  Surg.  B. 

51 

Soule,  J.  W.,  'Corp'I,  D, 

July  8, 

Right;  upper  third;  ha?ms.:  2!)th, 

employe,  age  19. 

18,  '64. 

Woodward,  22d  111.    Died  Mar. 

Oth  Mich.  Cav.,  age  27. 

8,  '63. 

amputat'n  up.  third.    Died  July 

24,  1864. 

29,  1863,  of  haem.     Spec.  3854. 

1'J 

10  vans,   J.,   Pt.,  I,   57th 

June  15, 

Right  :  upper  third,  by  Surg.  E. 

53 

Sullivan,  J.,  Pt.,  F,  57th 

Mav  27, 

Left;  middle  third.      Died  June 

Indiana. 

15,  '64. 

15.  Glick,  40th  Ind.     Died  June 

Indiana. 

27,'  '64. 

17,  1864,  of  wounds. 

29,  1864. 

53 

Thomas.  R.  M.,  Serg't, 

Mar.  10, 

Left  ;  four  inches,  by  Surg.  G.  W. 

20 

Fearing,  J.,  Pt.,  G,  21st 

June  3, 

Right  ;  two  and  a  half  ins.  upper 

10,  129th  Ind.,  age  28. 

10,  '65. 

Carr.   129th  Ind.     Died   March 

Mass.,  age  2:5. 

4,  '61. 

third:  June  31,  spic.  removed; 

20,  1805,  exhaustion. 

nee.  Died  Aug.  3,  '64.  S)w!c.  2947. 

54 

2  ,  Lieut.,  118th 

Sept.  17, 

Fourinches  middle  third.  by  Surg. 

21 

Foster,  F.,  Serg't,  K,  1st 

April  2, 

Left;  middle  third.     Died  May  5, 

or  115th  Penu.,  age  30. 

17,  '62. 

H.  W.  Rivers,  4th  Rhode  Island. 

New  York  Dragoons. 

2,  '65. 

1865. 

Died  Sept.  19.  1862. 

22 

<;il!is,  G.,  Serg't,  (;,(ilst 

June  2, 

Upper  and  middle  thirds.     Died 

55 

Vining,    M.   R.,   Lieut., 

May  12. 

Right  ;    four  inches  upper  third, 

Georgia,  ago  24. 

2,  '64. 

Juno  10,  1864 

A,  7th  Maine. 

12,'  '04. 

by  Surg.   F.   M.  Eveleth,    7th 

23 

Harris,    L.    W.,    Pt.,    I, 

Aug.  8, 

Middle  third,  by  Ass't  Surg.  W. 

Maine.     Died  May  19,  1864. 

84th  Indiana. 

8,  '64. 

H.  Matchett,  40th  Ohio.     Died 

50 

Wallace,  J.,  Pt.,  C,  21st 

Mar.  25, 

Left:  mid.  third,  by  Surg.  G.  R. 

Sept.  5,  1864. 

Georgia,  age  37. 

25,  '65. 

Sullivan,  39th  N.  J.:  Aug.  20th 

24 

Hill,  J.  M.,  Pt.,  C,  llth 

May  24, 

Right  ;  three  ins.   middle   third. 

and  Sept.  11,  rem.  frags.     Died 

Alabama,  age  21. 

24,  '64. 

Died  June  9,  1864. 

Sept.  23,  1865  ;  pyaemia.     Spec. 

25 

Holmes,  J.,  Lieutenant, 

June  17, 

Right:  upper  third,  by  Surg.  E. 

1354.    Photo.  Series,  No.  92. 

E,  40th  Indiana. 

17,  '64. 

B.  Glick,  40th  Ind.     Died  June 

57 

Washburne,   E.    A.   B., 

April  6, 

Right:  upper  third.     Died  April 

25.  1864. 

Pt.,  D,  10th  New  York 

6,  '65. 

19,  1865,  exhaustion  from  harmi. 

26 

Hood,    S.,   Pt.,    D,    mh 

Dec.  10, 

Eight  ins.  from  lesser  trochanter 

Cavalry,  age  23. 

South  Carolina. 

10,  '64. 

down.     Died  Dec.  11,  1864. 

5S 

White,  J.,  Lieut.,  G,  1st 

May  12, 

Right  ;   troch.   minor,   and   frag. 

27 

Hyatt,   J.,   Pt.,  F,  57th 

Mav  27, 

Left:  middle  third,  by  Surg.  E. 

Penn.  Reserves,  age  30. 

12,  '64. 

upper  third,   by   Surg.   I/.  W. 

Indiana. 

27,  '64. 

B.  Glick,  40th  Ind.    'Died  June 

Reed,  U.  S.  V.     Died  May  18, 

24,  1864. 

1664  ;  pyaemia. 

28 

Lambert,   J.  S.,  Pt.,  I, 

Sept.  14, 

Left;  entire  middle  third,  by  A. 

59 

Williams,  P.  I.,  Lieut., 

June  21, 

Upper  third,  by  Surgs.  C.  Carle, 

30th  Wisconsin,  age  30. 

14,  '64. 

A.  Surg.  A.  Kelly.    Died  Sept. 

E,  76th  Illinois. 

21,  '03. 

41st  111.,  and  B.  F.  Stephenson, 

14.  1864,  shock. 

14th  111.    Died  in  three-quarters 

29 

Lediuell,  J.,  Pt.,  B,  52d 

July  14, 

Right  ;  three  inches  up.  third,  in 

of  an  hour. 

North  Carolina. 

—  ,  '63. 

cluding  troc.  maj.,  by  Surg.  R. 

60 

Williams,  B.,Pt.,C,  76th 

April  9, 

Left.    Died  April  12,  1805. 

W.  Pease,  U.  S.  V.     Died  on  the 

Colored  Troops. 

9,  '65. 

eighth  day.     Spec..  1476. 

61 

Wishmire,  C.  E.,  Pt.,  A, 

July  3, 

Left:  by  Surg.W.  H.  Twiford. 

30 

Lewis.  W.   II.,    Pt.,    F, 

June  18, 

Left;  middle  third,  by  Surg.  N. 

27th  Indiana,  age  33. 

5,  '63. 

27th  Ind.;  12th,  htem.  Died  July 

1  1th  New  Jersey. 

18,  '64. 

Hayward,  20th  Mass.  Died  June 

15,  1803. 

24/1864. 

62 

Wolf,  M.  B.,  Serg't,  E, 

Nov.  24, 

Right  :  three  inches.     Died  Dec. 

31 

'  Lihbv,  J.  C.,  Serg't,  I, 

Dec.  13, 

Left;   middle  third.     Died  Jan. 

llth  Ohio. 

25,  '63. 

9.  1803. 

17th  'Maine. 

13,  '62. 

2,  1863. 

63 

Wool.  C.,   Pt.,   M,   Oth 

June  11, 

Right  ;  upper  third.     Died  June 

32 

Matthews.  J.  S..  Pt.,  B, 

May  25, 

Right  :  upper  third.    Died  May 

New  York  Cavalry. 

11,  '04. 

13,  1864. 

3d  Iowa  Cavalry. 

25,  '63. 

30.  1863. 

64 

Wrir/ht,   H.  A.,   Lieut., 

July  30, 

Right  ;  upper  and  middle  thirds. 

33 

Mayer,    J.    15.,    Pt.,    C, 

Sept.  3, 

Middle  third,  by  Ass't  Surg.  W. 

G,  Oth  Virginia,  age  23. 

An.1,'64. 

Died  Aug.  5,  1864. 

9th  Indiana. 

3,  '64. 

H.  Matchett,  40th  Ohio.     Died 

65 

Yancey,  T.  IT.,  Serg't.  B, 

Oct.  7, 

Left  :  four    inches    upper  third. 

Sept,  3,  1864,  of  wounds. 

48th  Alabama,  age  33. 

7,  '64. 

Died  Oct.  25,  1864. 

'O'MEAOHER  (TV.),  Casualties  of  the  Battle  of  FredericTesburg,  in  Am.  Med.  Times,  1803,  Vol.  VI,  p.  179. 
2 Supposed  to  be  Lieutenant  R.  M.  Johnston,  Adjutant  125th  Pennsylvania. 


SECT.  III.  | 


EXCISIONS    IN    THE    SHAFT    OF   THE    FEMUR. 


207 


In  ten  of  the  sixty-five  fatal  cases  of  primary  excision1  in  the  shaft  of  the  femur  the 
point  of  resection  was  not  indicated;  in  twenty-five  instances  the  excision  was  in  the  upper 
third;  in  five,  in  the  upper  and  middle  thirds;  in  twenty-one,  in  the  middle  third,  and  in 
four,  in  the  lower  third. 

Undetermined  Cases  of  Primary  JUxcision  in  the  Shaft  of  the  Femur. — There  are  six 
cases  of  this  group;  the  data  are  very  meagre,  and  in  five  of  the  six  cases  not  even  the 
names  of  the  patients  are  recorded: 

TABLE  XXIV. 
Summary  of  Six  Cases  of  Primary  Excision  in  the  Shaft  of  the  Femur  with  Unknown  Results. 


No. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPKKATOES, 
RESULT. 

NO. 

NAME,  MILITAUY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Gosa,  J.  A.,  1't..  K,  3!!th 

Nov.  27, 

Right  ;  lower  third.     Surg.  J.  C. 

4 

Unknown. 

July  3, 

Left  ;  middle  third  ;  nine  inches. 

Alabama. 

28,  '63. 

Morgan,  29th  Mo. 

3,  '63. 

Spec.  1552. 

2 

Unknown. 

May  6, 

Left  ;  five  and  a  half  inches  ex 

5 

Unknown. 

May—, 

Left  ;  six  und  a  half  inches  lower 

(i,  r(i4. 

cised.     Spec.  2671. 

—  ,  '64. 

third.     Spec.  2410. 

3 

Unknown. 

May  (i, 

Left;   eight  and  a  half  inches. 

6 

Unknown. 

May  3, 

L't;  seven  and  a  half  ins.  Surg.  J. 

6',  '64. 

Spec.  2644. 

3,  '63. 

Y.  Cantwell,  82dOhio.and  A.  A. 

Surg.  A.  D.  Kibbee.   Spec.  1374. 

Intermediary  Excisions  in  the  Shaft  of  the  Femur. — This  category  comprises  forty- 
eight  cases,  with 'nine  recoveries  and  thirty-nine  deaths,  a  fatality  of  81.2  per  cent. 

Recoveries  after  Intermediary  Excision  in  the  Femur. — Two  examples  are  detailed : 

CASE  419. —  Private  J.  B.  Kendall,  Co.  K,  5th  Wisconsin,  aged  34  years,  was  wounded  in  the  right  thigh  during  the 
assault  on  the  heights  of  Fredericksburg,  May  3,  1863,  and  entered  Campbell  Hospital,  Washington,  five  days  afterwards. 
Surgeon  A.  F.  Sheldon,  U.  S.  V.,  reported  his  discharge  from  service  May  3,  1864,  by  reason  of  "shot  fracture  of  right  femur," 
and  at  an  examination  on  July  2,  1886,  Surgeon  J.  H.  Baxter, 
U.  S.  Ar.,  described  the  man  as  "  suffering  from  the  effects  of  an 
excision  of  nearly  five  inches  of  the  femur.'1  On  November  6, 
1887,  the  pensioner,  who  then  held  the  appointment  of  clerk  in 
the  Quartermaster  General's  Office,  visited  the  Army  Medical 
Museum,  when  the  photograph,  represented  in  the  annexed  cut 
(FiG.  169),  was  taken.  The  following  information  in  regard  to 
his  case  was  elicited  from  his  statements:  "He  was  wounded  by 
a  musket  ball,  which  split  upon  the  shaft  of  the  femur,  a  portion 
of  the  missile  lodging  in  tbe  cylinder  of  the  bone  and  a  portion 
traversing  the  thigh  and  making  its  exit  posteriorly.  He  was 
conveyed  on  a  stretcher  to  a  house  in  Fredericksburg,  and  on 
the  following  morning  to  the  Sixth  Corps  Hospital  on  Falmouth 
Heights.  On  May  10th,  he  was  sent  on  the  cars  to  Aquia  Creek, 
and  thence  on  a  hospital  transport  to  Washington.  The  injured 
limb  was  suspended  by  Smith's  anterior  splint.  There  was 
intense  irritative  fever,  with  copious  suppuration.  On  May  21st, 
Acting  Assistant  Surgeon  F.  W.  Kelly  made  a  long  incision  on 
the  posterior  aspect  of  the  thigh,  removed  a  fragment  of  ball 
and  numerous  detached  pieces  of  bone,  and  turned  out  and 
sawed  off  the  sharp  extremities  of  the  fractured  shaft.  The 
limb  was  then  supported  in  a  wooden  trough  by  cushions.  The 
surgical  fever  and  suppuration  gradually  abated,  and  ultimately 
firm  union  took  place  and  the  wound  healed.  Abscesses  formed 
several  times  after  his  discharge  from  hospital,  and  bits  of 
necrosed  bone  were  eliminated.  The  sinuses  did  not  close 
definitely  until  August,  1868."  At  the  time  of  his  visit  to  the 
Museum  the  cicatrices  were  in  a  sound  condition,  and  the  frac 
ture  appeared  firmly  consolidated,  having  resulted  in  two  and  a 
half  inches  shortening  of  the  limb  and  false  anchylosis  of  the 
knee.  His  general  health  was  excellent,  and,  notwithstanding 
the  stiffness  of  his  knee,  he  walked  briskly  with  only  a  slight  limp, 
injury  tliis  pensioner  has  been  exempted  from  examinations. 


FIG.  169. — Result  of  intermediary  excision  of  the  shaft  of  the  femur. 
[From  a  photograph.] 


Owing  to  the  permanent  character  of  the  results  of  the 
The  pensioner  was  paid  December  4,  1878. 


1  The  portion  of  bone  excised  amounted  to  eight  inches  in  one  instance  (CASE  No.  26  of  TABLE  XXIII)  ;  to  six  inches  in  two  (CASES  l(i  nnd  36  of 
TAHLR  XXIII) ;  to  four  inches  in  eight ;  to  three  inches  in  eight;  to  two  and  one-half  and  to  two  inches  in  one  each;  and  in  forty-four  cases  the  length  of 
bone  excised  was  not  precisely  stated.  The  fractures  were  caused,  in  62  instauues,  by  small  projectiles,  twice  by  shell  fragments,  and  once  by  a  grapeshot. 


208 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


CASE  420. — Private  L.  M.  Baker,  Co.  B,  2d  Wisconsin,  aged  29  years,  was  wounded  at  Gettysburg,  June  1,  18f>3,  and 
admitted  to  the  field  hospital  of  the  1st  division,  First  Corps.  Surgeon  G.  M.  Ramsey,  95th  New  York,  recorded:  '•Gunshot 

fracture  of  right  thigh.  July  (>th,  resection."  On  September  5th,  the  patient  was  trans 
ferred  to  Camp  Letterman,  and  subsequently  to  the  General  Hospital  at  York.  A  photo 
graph,  represented  in  the  annexed  cut  (FlG.  170),  was  received  from  Surgeon  H.  Palmer, 
U.  S.  V.,  with  the  following  description  of  the  case :  "A  conical  leaden  ball  entered  the 
anterior  aspect  of  the  right  thigh  six  inches  below  the  middle  of  Poupart's  ligament,  thence 
passing  backward  and  slightly  upward,  making  its  exit  at  the  posterior  aspect,  an  inch 
above  the  point  of  entrance,  fracturing  the  femur.  Two  hours  after  the  reception  of  the 
injury  he  was  taken  to  a  field  hospital,  and,  he  states,  on  the  3d  of  July  he  was  placed 
under  the  influence  of  chloroform  and  fragments  of  bone  to  the  extent  of  two  inches  of  shaft 
were  removed  by  cutting  down  upon  them  at  the  seat  of  the  fracture.  Water  dressings 
were  used  for  the  first  two  weeks,  when  Smith's  anterior  splint  was  applied — the  limb 
suppurating  profusely,  and  the  man's  vital  power  being  a  good  deal  depressed.  There  was 
a  constant  tendency  to  sloughing  in  the  posterior  wound,  rendering  the  frequent  application 
of  caustic  necessary.  The  splint  was  removed  on  the  15th  of  November,  partial  bony 
union  having  taken  place,  suppuration  still  continuing  and  spiculse  of  bone  being  discharged 
from  time  to  time ;  patient,  who  was  upon  tonics  and  nutritious  diet,  gradually  improving. 
On  the  13th  of  January  the  posterior  wound  assumed  a  sloughing  condition,  which  spread 
with  rapidity,  and  was  attended  with  considerable  constitutional  disturbance.  It  was 
checked  by  the  free  use  of  bromine,  the  patient  being  at  the  same  time  upon  iron  and  quinia. 
Since  that  time  the  patient  has  continued  slowly  but  steadily  to  improve.  April  14th,  the 
wounds  have  closed;  the  man  is  in  excellent  health  and  able  to  walk  about  on  crutches, 
amount  of  shortening  being  two  and  a  half  inches.  On  June  30,  1864,  he  was  discharged 
from  service,  although  still  using  crutches,  able  to  bear  considerable  weight  upon  the 
injured  limb."  Examiner  C.  D.  Cameron,  of  LaCrosse,  Wisconsin,  reported,  December 
23,  1865:  "Shot  wound  of  right  thigh,  shattering  the  bone.  Some  four  inches  of  the  femur 
were  removed.  Limb  much  crooked  and  greatly  atrophied;  is  five  inches  shorter  than  the 
other.  Wound  not  yet  healed."  Examiner  W.  D.  Flinn,  of  Eedwood  Falls,  Minnesota, 
September  26,  1873,  certified  to  "resection  of  about  three  inches  of  bone,"  and  stated  "the 
wound  has  been  open  and  running  during  the  last  two  and  a  half  years."  The  pensioner 
was  paid  June  4,  1879. 

One  of  the  nine  survivors  after  intermediary  excision  in  the  shaft  of  the  femur  was  a 
Confederate  soldier,  and  eight  were  Union  soldiers.  Of  the  latter,  one  died  nearly  a  year 
after  the  operation,  six  are  pensioners  in  1879,  and  one  has  not  been  heard  from  since  1870. 
The  point  of  excision  was  in  the  upper  third  of  the  femur  in  one  instance;  in  the  middle 
third  in  five;  in  the  middle  and  lower  in  one;  and  in  the  lower  third  in  two  cases. 

TABLE  XXV. 

Summary  of  Nine   Cases  of  Recovery  after  Intermediary  Excision  of  the  Shaft  of  the  Femur  for 

Shot  Injury. 


FIG.  170. — Result  of  intermediary  ex 
cision  in  the  shaft  of  the  femur.  [From 
a  photograph.J 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

IXJUEY,  OPEHATION,  AMD 
ilKSULT. 

NO 

NAME,  MILITAUY 
DKSCRIPTION,  AND  AGE. 

DATES. 

IXJUUY,  OPERATION,  AND 
RESULT. 

1 

Anderson,  L.  C.,  Pt.,  A, 

Nov.  11, 

Left;  three  ins.  upper  third,  by 

6 

McFarland,  R.,  Pt.,  K, 

July  3, 

Right  ;  two  and  a  half  ins  middle 

7th    Kansas    Cavalry, 

20,  '61. 

A.  A.  Surg.  J.  Thome  ;  erysip 

22d  N.Carolina,  age  19. 

23,  '63. 

third,  by  A.  A.  Snrg.  J.  L.Whit- 

age  19. 

elas.     Disch'd  March  1,   1864  ; 

aker.     Sept.  23,  leg  paralyzed 

pens'd  ;  four  ins.  shortening;  an 

and  two  ins.  shorten  g.     Kxch'd 

chylosis  knee  joint. 

April  25,  1864. 

2 

Baker,  L.  M.,  Pt.,  B,  Sd 

Wisconsin,  age  29. 

July  1, 
6,  fo. 

Right;  two  inches  middle  third  ; 
two  and  a  half  ins.  short  g  ;  Oct. 

7 

Morrison,  II.  A.,  Pt.,  A, 
1st  Maine  Heavy  Art., 

May  19, 
23,"  '64. 

Right;  two  and  a  half  ins.,  and 
iragm'ts  amount'g  to  three  ins. 

14.  partial  union.    Uisch'd  June 

age  20. 

more,  middle  third,  by  Surg.  N. 

30,  1864  ;  pens'd;  Sept.,  73,  w'd 

R.  Mosely,  U.  S.  V.     Mustered 

has  been  open  two  years.    Surg. 

out  June  6,  186~>;   pens'd;   nut 

I'hot.  Scries,  Vol.  4,  1865. 

heard  from  since  March,  1070. 

3 

Hall,  8.  C.,  Pt.,  F,  3d 

Nov.  8, 

Right  ;  three  and  n  half  ins.  up. 

Spec.  23:i3. 

Indiana  Cav.,  age  18. 

15.  '03. 

third,  by  Surg.  T.  R.  Crosby,  U. 

8 

Whitesell,  J.,  Pt.,E,  61st 

Aug.  29, 

Left:  four  and  a  half  ins.  low.  and 

S.  V.     April  13,  1864,  amp",  up 

Ohio,  age  2o. 

Sept.  8, 

middle   thirds,  by  Surg.  15.  I?. 

per  third.    Disch'd  July  8,  1804  ; 

1H6_2. 

Breed,  U.  S.V.  Disch'd  Jan.  17, 

pensioned  ;  stump  healed. 

1863;  pens'd.  Died  Aug.  1  .',  '03. 

4 

Hazelrigg,   W.  G.,  Pt., 

April  6, 

Left  ;  lower  third.     Disch'd  Jan. 

Spec.  1!)9. 

A,  19th  Inf  'ry,  age  31. 

—  ,  '62. 

14,  18G3;  pens'd  ;  three  and  a  half 

9 

Wilson,   J.    E.,   Pt.,  F, 

May  3, 

Right;  fragments,  four  ins.  mid. 

ins.  short  'g;  pieces  of  bone  dis'd; 

13th  N.  Jersey,  age  37. 

17,  '63. 

third,  by  Surg.  W.  II.  Twiford, 

anch.  knee  joint. 

27th  Ind.     Disch'd  April  8,  '64  ; 

5 

Kendall,   J.  B.,   Serg't, 

May  3, 

Right  ;  three  ins.  low  third,  by  A. 

pens'd  ;  four  and  a  half  inclies 

K,  5th  Wisconsin,  age 

21,  YC3. 

A.  Surg.  F.  W.  Kelly.     Firmly 

short'g;  anchy.  of  knee  joint. 

34. 

united.     Disch'd  May  3,   1864  ; 

Spec.  1277. 

pens'd  ;  '67.  slight  limp;  two  and 

a  half  ins.  short'g  ;  false  anchy. 

of  knee  joint.     Surg.  Phot.  187. 

SECT.  III.] 


EXCISIONS    IN    THE    SHAFT    OF    THE    FEMUR. 


209 


FIG.  171. — Section  of  rig-lit  femur 
fractured  in  lowest   third.     Spec. 


The  injuries  were  inflicted  by  a  grape  shot  in  one  case,  by  a  slug  in  one,  and  by  small 
missiles  in  seven  instances.  The  length  of  the  excised  portion  of  the  femur  varied  from 
two  to  five  and  one-half  inches. 

Fatal  Cases  of  Intermediary  Excision  in  the  Shaft  of  the  Femur. — A  few  illustra 
tions,  showing  the  nature  and  extent  of  the  intermediary  excisions  practised,  will  precede 
the  tabular  statement  of  the  thirty-nine  fatal  cases: 

CASK  421. — Private  T.  Fitzgerald,  Co.  C,  38th  New  York,  aged  27  years,  was  wounded  at  Chancellorsville,  May  2, 1863, 
and  treated  at  a  field  hospital  until  June  15th,  when  he  was  conveyed  to  Washington.  Assistant  Surgeon  G.  A.  Mursick,  U.  S.  V., 
reported:  "The  patient  was  admitted  to  Stanton  Hospital  with  compound  fracture  of  the  lower  third  of  tho  right  femur.  Resec 
tion  of  a  portion  of  the  bone  was  performed  on  May  19th,  before  admission  to  this  hospital.  The  wound  suppurated  profusely, 
and  his  condition  was  unfavorable.  Water  dressings  were  used, 
and  Hodgen's  splint  was  applied  to  the  limb.  Six  ounces  of  whis 
key  were  administered  daily.  There  was  no  attempt  at  union  of 
the  bone  and  no  abatement  of  the  discharge.  By  July  2d  the 
patient  had  become  pale,  anaemic,  and  emaciated,  when  muriated 
tincture  of  iron  was  prescribed  in  doses  of  twenty  drops  three  times 
a  day.  The  patient  was  also  troubled  with  anorexia,  and  on  July 
5th  diarrhoea  came  on,  for  which  astringents,  consisting  of  opium 
and  tannin,  and  subsequently  tincture  of  catechu  and  opium,  were 
administered.  Death  occurred  on  July  10, 1863."  A  section  of  the 
injured  femur  was  contributed  by  Surgeon  J.  A.  Lidell,  U.  S.  V., 
and  is  shown  in  the  wood-cut  (FlG.  171).  The  specimen  exhibits 
considerable  deposit  of  callus,  imprisoning  the  necrosed  fragments 
but  not  uniting  the  extremities. 

CASE  422.— Corporal  J.  White,  Co.  F,  12th  Infantry,  aged 
16  years,  was  wounded  in  the  thigh  at  Gaines's  Mills,  June  27, 
1862.  Assistant  Surgeon  H.  S.  Schell,  U.  S.  A.,  reported  that  the 
femur  was  fractured  and  that  the  wounded  man  was  captured  by 
the  enemy.  After  remaining  a  prisoner  for  three  weeks  he  was 
exchanged  and  conveyed  to  Baltimore.  Acting  Assistant  Surgeon 
E.  G.  Waters  reported  the  following  history:  "The  patient  was  admitted  to  Camden  Street  Hospital,  July  21st,  with  the  left 
femur  badly  shattered  at  the  upper  third.  No  apparatus  had  been  applied.  On  July  26th,  he  was  placed  under  the  influence 
of  chloroform,  and  an  incision  over  the  seat  of  injury,  six  inches  in  extent  and  exposing  the  bone,  was  made  and  the  broken 
and  unattached  fragments  removed,  after  which  the  ends  of  the  upper  and  lower  extremities  were  sawn  off,  leaving  a  hiatus  of 
some  four  inches.  The  wound  was  then  closed  by  stitches  and  adhesive  strips,  and  the  patient  was  put  upon  a  supporting  treat 
ment.  There  was  considerable  loss  of  blood  during  the  operation,  which  was  performed  by  Assistant  Surgeon  R.  Bartholow, 
U.  S.  A.  On  August  5th,  the  limb  was  placed  in  the  anterior  splint.  At  this  time  the  discharge  had  improved  in  appearance 
and  diminished  in  quantity,  and  the  external  wound  looked  healthy  and  was  closing  rapidly;  the  patient  also  maintained  his 
strength  and  cheerfulness,  and  but  for  a  troublesome  bedsore  over  the  sacrum  he  was  almost  free  from  pain.  On  August  8th, 
typhoid  symptoms  came  on,  the  pulse  being  quick  and  irritable;  the  tongue  dry,  cracked,  and  covered  with  brown  epithelium; 
appetite  good  but  thirst  insatiable.  Wine,  quinine,  iron,  and  concentrated  nourishment  were  now 
administered  liberally.  The  wound  was  nearly  closed  and  presented  a  healthy  appearance  as  well 
as  the  discharge.  On  August  14th,  colliquative  diarrhoea  came  on,  from  which  the  patient  sank 
and  died,  having  survived  the  operation  nineteen  days.  At  the  post-mortem  examination  both 
extremities  of  the  resected  portion  of  the  femur  were  found  denuded  of  periosteum  and  extensively 
necrosed.  There  had  been  no  attempt  at  union,  nor  was  any  callus  found  in  the  surrounding 
tissues.  The  soft  parts  were  gangrenous  and  intolerably  offensive."  The  specimen,  shown  in 
the  wood-cut  (FlG.  172),  was  contributed  by  the  operator,  and  consists  of  a  portion  of  the  shaft 
of  the  injured  femur,  embracing  two  sections  an  inch  and  a  half  and  three  inches  long  respectively, 
and  an  irregular  portion  two  inches  by  three  in  its  greater  lengths.  The  latter  is  composed  of 
fragments  united  by  new  bone.  The  larger  section  is  obliquely  fractured  at  one  end,  with  thick 
ened  periosteum,  and  the  smaller  shows  a  ring  of  necrosis  at  one  extremity. 

GASP:  423. — Sergeant  M.  Smith,  Co.  I,  73d  Pennsylvania,  was  wounded  in  the  left  thigh  at 
Chancellorsville,  May,  3, 1863.  The  injury  involved  a  fracture  of  the  femur  at  the  trochanter  major. 
The  wounded  man  reached  the  Eleventh  Corps  hospital  at  Brook's  Station  on  May  15th,  and  on  the  following  day  five  inches  of 
the  bone,  commencing  just  below  the  neck,  was  resected  by  Surgeon  R.  Thomain,  29th  New  York.  The  patient  died  June  8, 
1883.  The  excised  bone  is  represented  in  the  wood-cuts  (FlGS.  173, 174),  and  was  contributed,  with  the  history,  by  the  operator. 

The  excision  was  practised  in  the  upper  third  in  fifteen  instances;  at  the  junction  of 
middle  and  upper  thirds  in  two;  in  the  middle  third  in  fourteen;  in  the  lower  third  in  five 
instances.  In  three  cases  the  point  of  excision  was  not  indicated. 

SURG.  Ill— 27 


FIG.  172. — Two  sections  and  an 
irregular  portion  of  shaft  of  femur. 
Spec.  394. 


FIG.  173.-E*- 
cisedfive  inches 
ofshaftofleftfe- 
mur.  Posterior 
view.5pec.1539. 


FIG.  174.-Ante- 
rior  view  of  the 
same  specimen. 


210 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


TABLE  XXVI. 
Summary  of  Thirty-nine  Fatal  Cases  of  Intermediary  Excision  of  the  Shaft  of  the  Femur  for  Shot  Injury. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

IXJUHY,  OPERATION,  AND 
RESULT. 

NO. 

NAME,  MILITAUY 
DESCRIPTION,  AND  AGE 

DATES. 

IXJUUY,  OPERATION,  AM> 
RESULT. 

1 

Atkinson,  H.  L.,  Pt.,  II, 

Sept.  30, 

Kight  ;  great  trochanter  and  one 

22 

Horrigan,   D.,    Pt.,    K, 

Mav  5, 

Left;  four  ins.  up.  third,  by  Surg. 

2d  Maryland,  age  32. 

Oct.  30, 

inch  of  shaft.     Died  Oct.  25,  '65  ; 

28th  Mass.,  age  32. 

30,  ''64. 

A.  F.  SheJdon,  U.  S.  V.     Died 

1864. 

traumatic  erysipelas. 

Sept.  2,  1864,  of  wounds. 

0 

Baker,  J.    P.,   Pt..    D, 

May  3, 

Right;  two  ins.,  and  loose  spiculae. 

23 

Huntley,  H.  S.,  Pt.,  I, 

May  5, 

Left;  lower  third,  by  Surg.  1.'.  B. 

147th  Pcun.,  age  2'J. 

18,  SG3. 

June  10,  diarrhoea.     Died  Aug. 

37th  New  York. 

17,  '62. 

Bontecou,  U.  S.  V.     Died  May 

10,  1863. 

22,  1862  ;  pyaemia. 

3 

Biddle,  A.,  Pt.,  E,  6th 

May  5, 

Left  ;  mid.  third,  by  Surg.  R.  B. 

24 

Lemberger,F..Pt.,  1,  33d 

July  4, 

Right  ;  nineteen  fnigm.  and  sharp 

New  Jersey. 

14,  '6-'. 

Bontecou,  U.  S.  V.     Died  May 

Iowa,  age  23. 

17,  ''63. 

ends,  four  ins.  in  all,  lower  third. 

2.3,  1862,  of  pyaemia. 

by  Snrg.  I.  Moses.  U.S.  V.   1  >i<><t 

4 

Brewer,  J..  Pt.,  K,  130th 

Aug.  6, 

Right;  three  ins.  upper  third,  by 

July  26,  1863,  of  inflammatory 

Indiana,  age  18. 

Sept.  1, 

Surg.   F.  Meacham,  U.  S.   V. 

fever.     Spec.  2084. 

1864. 

Died  Nov.  18,  18G4. 

25 

Martin,    F.,    Serg't,   F, 

May  8, 

Left;  middle  third,  by  Surg.  A. 

5 

Brown,   E.   W.,  Lieut., 

May  5, 

Kight  ;  three  ins.  upper  third,  by 

155th  Penn.,  age  22. 

June  1, 

F.  Sheldon,  U.  S.  V.;  gangrene. 

C,  37th  New  York. 

16,  ''62. 

Surg.  R.  B.  Bontecou,  U.  S.  V. 

1864. 

Died  June  7,  1864;  exhaustion. 

Died  May  23,  1862;  pyasmia. 

26 

May,  A.  S.,  Pt.,  E,  8th 

April  9, 

Right  ;  three  ins.  up.  third.    Died 

6 

Burden,  H.,  Pt.,  6th  8. 

May  5, 

Left  ;  by  Surg.  R.  B.  Bontecou, 

Iowa,  age  26. 

May  5, 

May  6,  1864. 

Carolina,  age  18. 

17,  '62. 

U.S.V.  Died  May  20.  '62;  pyaem. 

1864. 

7 

Burroughs.    J.,   Serg't, 

Sept.  li>, 

Right;  four  ins.  low.  third;  amp. 

27 

McCormick,  R.,  Serg't, 

Sept.  20, 

Left  ;  frag,  and  ends,  three  and  a 

IJ,  3d  Kentucky. 

28,  'G3. 

mid.  third.     Died  Oct.  10,  1863. 

C,  2d  Missouri,  age  24. 

Oct.  1«, 

half  ins.,  mid.  third,  by  Surg.  J. 

8 

Collar,  C.,  Pt.,  P,  45th 

Feb.  14, 

Right  ;  mid.  third,  by  Surg.  G.  S. 

1863. 

Moses,  U.  S.  V.    Nov.  3,  arterial 

Illinois,  age  20.- 

Mar.  1-!, 

Kemble,  U.  S.  V.     May  1,  amp. 

ham.  DiedNov.  11,  1863,  of  py 

1864. 

thigh,  upper  third.     Died  May 

aemia.     Autopsy.     Spec.  2131. 

9,  '64.  shock. 

28 

p 

Interme 

Ri^ht  ;  low.  third  V>v  Sur°°.  B   A, 

9 

Connover,  J.  C.,  Corp'l, 

May  25, 

Left  ;  four  ins.  up.  third,  by  Ass't 

' 

diary, 

Vanderkieft,102dN.Y.   Died  in 

E,  27th  Illinois,  age  21. 

June  18, 

Surg.  Ci.  W.  Burke,  46th  Penn. 

18G2. 

three  weeks  ;  pyasmia.  Spec.  1  1  . 

18G4. 

Died  June  21,  1864;  pneumonia. 

29 

Parker,    T.,   Pt.,  I,  5th 

May  5, 

Right;  three  ins.  mid.  third,  by 

10 

Cramer,  J.,  Pt.,  E,  55th 

Mav  5, 

Five  ins.  mid.  third,  by  Surg.  R. 

New  Jersey,  age  20. 

15,  '62. 

Surg.  R.  B.  Bontecou,  U.  S.  V. 

New  York. 

14,  'G2. 

B.    Bontecou,   U.  S.  V.    Died 

Large  bed-sores.     Died  July  2. 

May  17,  1862. 

1862;  diarrhoea. 

11 

Dickenson,  C.,  Corporal, 

Sept.  20, 

Right  ;  four  inches  middle  third, 

30 

Paton,   T.,   Pt.,   E,  72d 

Mav  7, 

Left;  up.  port,  protruding  femur, 

G,  88th  Indiana. 

—  ,  '63. 

by  Surg.  I.  Moses,  U.S.V.  Died 

New  York. 

17,  '62. 

bv  Surg.  R.  B.  Bontecou,U.S.Y. 

Oct.  5.  18G3.    Spec.  2145. 

Died  May  20,  1862.  of  pyaemia. 

12 

Dillon,  W.,  Pt.,  A,  10th 

June  3, 

Kight  ;  six  ins.  up.  third,  by  Surg. 

31 

Polser,  J.  P.,  Pt.,  B,  15th 

Oct.  4, 

Left  ;  upper  third.    Died  Oct.  -~7, 

New  York,  age  23. 

13,  '64. 

A.  F.  Sheldon,   U.  S.  V.     Died 

Iowa. 

25,  '62. 

1862. 

June  13,  1864,  shock. 

32 

Redwood.  W.,   Pt,,    A', 

May  5, 

Left  ;  five  ins.  mid.  third,  by  Surg. 

13 

Eisele,   R.,   Pt.,   E,  6th 

May  5, 

Left;  four  ins.  middle  third,  by 

5th  Michigan. 

16,  '62. 

R.  B.  Bontecou.     Died  Mav  11', 

New  Jersey. 

17,  '62. 

Surg.  R.  B.  Bontecou,  U.  S.  V. 

1862. 

Died  May  20,  1862  ;  pyaemia. 

33 

Rose,   S.  L.,  Serg  t,  D, 

Sept.  20. 

Right;  ends  and  frag.,  two  and  a 

14 

Fitzgerald,    P.,    Pt.,    I, 

May  2, 

Right;  low.  third.   July  5,  diarrh. 

113th  Ohio. 

Oct.  17, 

half  ins.  in  all,  middle  third,  by 

38th  New  York,  age  27. 

19,  'G3. 

Died  July  10,  1863,  suppuration 

1863. 

Sqrg.  L  Moses,  U.  S.  V.     Died 

and  diarrhoea.     Spec.  1522. 

Oct  20,  1863.    Spec.  2130. 

15 

Friend,  J.,  Pt.,  H,  7th 

July  4, 

Right  ;  mid.  third,  by  A.  A.  Surg. 

34 

Sayre,  A.,  Pt.,  E,  12th 

Dec.  11, 

Left;  troch.   major.     Died  Janu 

Missouri,  age  27. 

13,  '63. 

A.  Sterling.    Died  July  17,  1863; 

Ohio. 

2G,  '63. 

ary  23,  1804;  pyaemia. 

haemorrhage.     Spec.  2091. 

35 

Smith,  I.  M.,  Serg't,  I, 

May  3, 

Right;  five  ins.  up.  third,  includ'g 

16' 

Goddard,  W.,  ,  B, 

June  24, 

Middle  third;    erysipelas.     Died 

73d  Pennsylvania. 

16,  ''63. 

troc.  major,  by  Surg.  11.  Tho- 

Caswell's  Georgia  S.  S. 

J'yl,'63. 

August  24,  1863. 

maine,   29th  New  York.     Died 

17 

Hall,  J.  W.,  Pt.,  I,  92d 

Dec.  14, 

Left  ;  three  and  a  half  ins.  up.  t'd, 

June  8,  '63;  anaemia.  Spec.  1539. 

New  York. 

29,  '62. 

by  Surg.  C.  A.  Cowgill,  U.  S.  V. 

36 

Stevens,  H.,  Pt.,  I,  59th 

May  6, 

Right;  three  ins.  upper  third,  by 

Died  Jan.  22,  1863.     Autopsy. 

Mass.,  age  16. 

June  3, 

Surg.  R.  B.  Bontecou,  U.  S.  V. 

Spec.  1328. 

1864. 

Died  June  5,    '64;  exhaustion. 

18 

Hall,  S.  M.,  Pt,,  E,  7th 

June  3, 

Left  ;  five  ins.  up.  third,  by  Surg. 

Spec.  3034. 

New  York,  age  29. 

13,  '64. 

A.  F.  Sheldon,  U.  S.  V.     Died 

37 

Taylor,   C.   H.,  Pt.,  E, 

Feb.  20, 

Right;  mid.  third,  five  ins.,  by 

June  17,  1864,  exhaustion. 

3d  Artillery,  age  20. 

Mar.  6, 

Ass't  Surgeon  W.  R.  Ramsay, 

19 

Hamlin,    J.    L.,    Corp'l, 

Dec.  16, 

Left  ;  two  and  a  half  ins.  upper 

1864. 

U.  S.  A.,  and  others.  Died  April 

<  r,  7th  Minnesota,  age 

23,  '64. 

third,  by  A.  A.  Surg.  S.  Black- 

2,    1864  ;  exhaustion  from  con 

21. 

wood.    Died  Dec.  24,  '64  ;  shock 

tinued  haemorrhage. 

of  operation. 

38 

White,  J.,  Corp'l,  F,  12th 

June  27, 

Left  ;  three  ins.  up.  third,  by  Ass't 

20 

Harper,   C.   D.,  Pt.,  F, 

Mav  5, 

Left  ;  four  ins.  mid.  th'd,  by  Surg. 

Infantry. 

July  26, 

Surg.  R.  Bartholow,   U.  S.  A. 

5th  Michigan. 

14,  ''62. 

R.  B.  Bontecou,  U.  S.  V.     Died 

1862. 

Died  Aug.  14,  1862.     Autopsy  ; 

May  17,  18<>2  ;  pyaemic  hsemor. 

gangrene.     Spec.  394. 

from  wounded  veins  of  thigh. 

39 

Young,    W.,    Serg't,  C, 

Dec.  16, 

Left  ;  thre*e  and  a  half  ins.  upper 

21 

Heller,    J.    P.,   Pt.,   F, 

Mav  3, 

Right  ;  three  ins.     Died  May  25, 

5th  Minnesota,  age  28. 

23,  '64. 

third,  by  A.  A.  Surg.  S.  Black- 

147th  Pennsylvania. 

19,  '63. 

18G3,  tetanus.     Spec.  1272. 

wood.     Died  Dec.  31,  1864. 

Three  of  these  thirty-nine  soldiers  belonged  to  the  Confederate  and  thirty-six  to  the 
Union  army.  The  right  femur  was  injured  in  nineteen,  the  left  in  eighteen  of  the  thirty- 
seven  cases  in  which  this  point  was  recorded. 

Secondary  Excisions  in  the  Shaft  of  the  Femur. — Nineteen  examples  were  reported 
in  this  category.  Fifteen  patients  recovered,  three  died,  and  the  result  in  one  instance 
remains  undetermined. 

Recoveries  after  Secondary  Excision  in  the  Shaft  of  the  Femur. — Two  examples  of 
the  fifteen  cases  of  this  group  will  be  given  in  detail : 

CASE  424. — Private  J.  Reid,  Co.  G,  162d  New  York,  aged  35  years,  was  wounded  in  the  right  thigh,  at  Springfield 
Lauding,  June,  1863.  Assistant  Surgeon  J.  Romans,  jr.,  U.  S.  A.,  recorded  his  admission  to  St.  James  Hospital,  New  Orleans, 
July  3d,  and  described  the  injury  as  follows:  "The  patient  had  sustained  a  compound  fracture  of  the  right  femur  a  few  days 
previous  to  entering  the  hospital,  having  been  wounded  by  a  bullet,  which  entered  the  anterior  face  of  the  limb  about  four  and 
a  half  inches  below  Poiipurt's  ligament,  and  emerged  about  four  inches  below  the  great  trochanter,  having  passed  just  outside 


SECT.  1II.J  EXCISIONS    IN    THE    SHAFT    OF    THE    FEMUR.  211 

the  femoral  artery  and  shattered  the  bone  in  its  passage.  On  admission  the  thigh  was  but  slightly  swollen ;  the  shortening 
amounted  to  about  an  inch  and  a  half.  I  determined  to  make  an  effort  to  save  the  limb,  for  experience  had  taught  me  how 
much  conservative  surgery  can  accomplish  in  gunshot  fractures  of  the  thiglu  A  Smith's  anterior  splint  was  applied,  but,  proving 
uncomfortable,  it  was  removed  and  the  limb  was  placed  on  a  double-inclined  plane.  The  orifice  of  entrance  healed,  and  pus, 
which  began  to  be  discharged  quite  freely,  flowed  out  through  the  lower  opening.  On  July  29th  the  patient's  condition  was 
favorable  for  an  operation,  and  I  determined  to  remove  all  the  necrosed  bone  possible,  and,  if  necessary,  to  resect  a  portion  of 
the  shaft  of  the  femur.  The  patient  was  placed  under  the  influence  of  chloroform,  and  an  incision  two  and  a  half  inches  long 
was  made  from  either  side  of  the  orifice  of  exit  in  the  direction  of  the  long  axis  of  the  limb.  Several  pieces  of  necrosed  bone 
were  then  removed,  and  the  end  of  each  fragment  of  the  fractured  femur  was  turned  out  and  sawn  off  with  a  chain  saw  beyond 
the  point  where  the  bone  was  bare.  The  periosteum  along  the  course  of  linea  aspera  was  carefully  preserved  and  peeled  off  from 
the  bone,  or  rather  the  bone  was  gently  torn  away  from  the  periosteum.  About  three  inches  of  the  femur  were  thus  resected. 
No  untoward  symptom  followed  for  more  than  two  months,  and,  in  October,  the  limb  could  be  raised  by  the  heel,  union  being 
quite  firm.  About  this  time  he  was  attacked  with  erysipelas,  which  seemed  to  be  caused  by  the  whitewashing  of  the  ward  in 
which  he  lay;  but  the  attack  was  slight  and  soon  passed  off.  In  November  he  could  walk  about  on  crutches  and  bend  his  knee 
slightly.  I  noticed  that  union  took  place  first  and  mainly  along  the  inner  side  of  the  bone ;  and  as  the  periosteum  here  was 
preserved  entire,  there  was  not  so  much  shortening  as  would  otherwise  have  resulted,  it  being  only  three  and  a  half  inches.  On 
December  12,  1863,  the  patient  was  discharged  from  service  and  left  for  New  York.  How  useful  a  limb  he  will  have  cannot  yet 
be  determined,  but  amputation  would  have  killed  him."  The  New  York  City  Examining  Board,  at  different  dates,  certified  to 
the  injury,  and  to  union  with  deformity,  and  from  four  and  a  half  inches  to  five  inches  shortening  as  resulting  therefrom,  together 
with  complete  anchylosis  of  the  knee  joint.  The  pensioner  is  also  reported  as  wearing  an  artificial  appliance  attached  to  his 
shoe.  The  pensioner  was  paid  Match  4,  1879. 

CASE  425. — Private  J.  F.  Williams,  Co.  H,  26th  Pennsylvania,  aged  25  years,  was  wounded  in  the  right  shoulder  and 
right  thigh,  at  Gettysburg,  July  2,  1833.  He  entered  a  field  hospital  of  the  Third  Corps,  and  was  removed  to  Camp  Letter-man 
one  month  afterwards.  Surgeon  H.  Janes,  U.  S.  V.,  noted  the  injury  as  "a  compound  fracture  of  the  right  femur  at  the  upper 
third,  caused  by  a  miuie  ball,"  and  recorded  the  following  result:  "On  September  8th,  the  upper  extremity  of  the  lower  frag 
ment  was  found  to  be  protruding  and  to  be  denuded,  and  four  days  later  the  patient  was  placed  upon  the  operating  table  and 
about  two  inches  of  the  lower  fragment  were  carefully  excised  by  Acting  Assistant  Surgeon  H.  Leaman.  The  limb  was  then 
placed  in*  an  anterior  splint.  Small  pieces  of  bone  were  discharged  from  time  to  time  and  steady  improvement  followed.  By 
November  9th,  partial  union  had  taken  place,  and  several  days  afterwards  the  patient  was  transferred  to  York  Hospital."  Surgeon 
H.  Palmer,  U.  S.  V.,  in  charge  of  the  latter,  on  February  15,  1864,  made  the  following  note  of  the  condition  of  the  limb:  "At 
this  time  there  is  complete  bony  union  of  the  fracture.  There  is,  however,  some  dead  bone  at  the  upper  fourth  of  the  thigh,  still 
causing  rather  free  discharge  of  pus  by  three  openings.  The  thigh  is  shortened  about  four  and  a  half  inches,  its  circumference 
increased  four  inches,  and  the  limb  bent  outward.  The  patient's  general  health  is  excellent  and  his  constitutional  condition 
good."  The  patient  was  ultimately  transferred  to  Mower  Hospital,  Philadelphia,  July  25,  1865,  and  one  month  later  he  was 
discharged  and  pensioned.  Examiner  E.  A.  Smith,  of  Philadelphia,  on  August  28,  1865,  certified  to  "total  loss  of  use  of  right 
arm  and  right  leg  from  wound  of  shoulder  and  thigh,  to  fracture  of  femur  and  eight  inches  shortening,"  and  to  "one  hundred 
and  twenty-nine  pieces  of  bone  having  been  removed,"  and  added  that  the  pensioner  "has  a  cough  and  is  a  sad  wreck."  The 
pensioner  was  paid  March  4,  1866,  since  when  he  has  not  been  heard  from. 

The  excision  was  practised  in  the  upper  third  in  nine  instances,  in  the  middle  third  in 
four,  and  in  the  lower  third  in  two.  In  four  cases  portions  of  the  trochanter  major  and  of 
the  shaft  of  the  femur  were  excised;  in  the  remaining  eleven  cases  the  excised  portion  of 
the  femur  varied  in  length  from  two  to  six  inches. 

Fatal  Cases  of  /Secondary  JSxcision  in  the  Shaft  of  the  Femur. — The  three  operations 
of  this  group  were  practised  on  Union  soldiers.  In  one  instance  the  right  femur,  and  in 

two  the  left  femur  had  been  fractured. 

• 

CASE  426. — Private  J.  McElroy,  Co.  E,  35th  Iowa,  aged  38  years,  was  wounded  in  the  right  thigh,  at  Lake  Chicot, 
June  6,  1864,  and  underwent  the  operation  of  resection  of  the  femur  at  Gayosa  Hospital,  Memphis.  Surgeon  F.  N.  Burke, 
U.  S.  V.,  who  performed  the  operation,  made  the  following  report  of  the  case:  "The  patient  was  admitted  twelve  days  after  the 
injury,  which  was  caused  by  a  mini6  ball  striking  the  anterior  surface  of  the  middle  third  of  the  thigh,  fracturing  the  femur,  and 
lodging  in  the  limb.  The  leg  was  placed  in  a  double-inclined  concave  splint.  The  wound  healed  readily  without  suppuration, 
and  in  two  months  the  patient  was  able  to  walk  on  crutches,  the  fragments — though  not  in  a  straight  position — having  united 
partly  by  cartilage  and  partly  by  ligament.  His  constitutional  state  was  very  good,  he  being  fat  and  healthy.  The  patient  was 
to  have  been  sent  to  his  home  on  furlough,  but  on  October  25th,  having  been  allowed  to  go  out  on  the  street,  he  became  intox 
icated,  and,  by  a  fall,  refractured  the  femur  at  the  place  of  union.  On  the  following  day  he  was  placed  under  the  influence  of 
chloroform,  and  three  inches  of  bone  was  excised  through  an  incision  five  inches  in  length,  an  opening  one  inch  long  being  made 
on  the  posterior  surface  of  the  thigh  for  drainage.  Bilious  diarrhoea  set  in  five  days  after  the  operation  and  continued  for  two 
weeks.  Death  resulted  from  pya3mia,  November  23, 1864,  several  violent  chills  having  occurred  five  or  six  days  before  and  much 
prostration  during  two  weeks.  Large  quantities  of  stimulants,  together  with  quinine  and  iron,  and  nourishing  diet  w«re 
administered,  and  solution  of  chlorinate  of  soda  was  applied  to  the  wound.  The  post-mortem  examination  revealed  a  large 
abscess  extending  from  the  wound  to  the  hip  joint  and  containing  laudable  pus  in  considerable  quantity.  There  was  no  sign  of 
any  reparative  process  in  the  ends  of  the  bone,  and  no  pus  was  found  in  the  lungs,  liver,  or  spleen." 


212 


INJURIES    OF    THE    LOWER   EXTREMITIES. 


[CHAP.  X. 


TABLE  XXVII. 
Summary  of  Nineteen  Cases  of  Secondary  Excision  in  the  Shaft  of  the  Femur  for  Shot  Injury. 

[Recoveries,! — 15;  Deaths,  16 — 18;  Result  undetermined,  19.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJUUY,  OPERATION,  AND 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

INJURY,  OPERATION,  AND 
RESULT. 

1 

Allen,  J.  W.,  Pt.,  B,  22d 

Oct.  8, 

Left  ;  three  ins.  lower  third,  by 

11 

O'Riley,  P.,  Pt.,  H,  69th 

Sept.  17, 

Left:  carious  and  necrosed  tro- 

Indiana,  age  28. 

Dec.  1, 

Surg.  J.  G.  Hatehitt,  U.  S.  V. 

New  York. 

Oct.  22, 

chanter  major  and  shaft.    Dis 

180-2. 

Anaemia.  Disch'it  Feb.  13,  1863; 

1862. 

charged  Mar.  10,  1863  ;  not  pen 

]>ens'd  ;  six  inches  shortening. 

sioned. 

o 

Curtin,  D.,  Pt.,  G,  47lh 

Feb.  20, 

Left  ;  four  in.  mid.  third.    Disch'd 

12 

"Reid,  J.,  Pt.,  G,  162d 

June  8, 

Right  ;  necrosis  ;  three  ins.  upper 

New  York,  age  25. 

July  15, 

June  5,  1865;  peus'd;  lig.  union 

New  York,  age  35. 

July  20, 

third,  by  Ass't  Surg.  J.  Homans, 

1864. 

only  ;    knee  joint    anchylosed  ; 

1863. 

jr.,  U.S.A.;  Oct.,  "63,  union  firm  ; 

shortening  over  seven  inches. 

erysip.     Disch'd  Dec.  12,  1863; 

3 

Dennell,  W.  I.,   Serg't, 

July  20, 

Left;  troch.  maj.  and  two  inches 

pensd;   union  with  deformity; 

E,  73d  Penn.,  age  23. 

Aug.  23, 

necrosed  shaft,  by  A.  A.  Surg. 

anchylosis  knee  joint. 

18G4. 

M.  L.  Herr.  Duty  Jan.  10,  1865; 

13 

Thomas,  W.  C.,  Pt.,  F, 

May  2, 

Right:  July  11,  rein,  seq.;  ex.  of 

not  pensioned. 

55th  Ohio,  age  17. 

Sept.  11, 

four  ins.  up.  third.  Disch'd  June 

4 

Duggan,  T..  Corp'l,  M, 

Dec.  18, 

Right  ;    lower  third  :    gangrene. 

1863. 

27,  1864;  pens'd;  great  deform. 

llth   Illinois  Cavalry, 

'(52.  Aug. 

Disch'd  April  7,  '65;  pensioned. 

and  short'g.     Spe.c.  1686. 

age  19. 

23,  'C3. 

July  5.  1866,  amputation,  junct. 

14 

Watts,    S.,    Serg't,    K, 

May  14, 

Right  ;  two  ins  low.  thirds.  Dis'd 

lower  and  middle  thirds. 

33d  Ohio,  age  21. 

1864. 

June  6,  '65;  pens'd;  shortening 

5 

Frazee.  H.  W.,  Pt..  L, 

A  pi  7,  '65, 

Left;  two   ins.  upper  thirds,  by 

six  ins.,  leg  useless. 

2d   New   York  Heavy 

April  —  , 

Dr.    Hutchinson;    ends    wired. 

15 

Williams,  J.  F.,  I't.,  II, 



Right  ;   two  inches   upper  third, 

Artillery,  age  29. 

1866. 

Dis'd  Jan.  10.  '66,  befo.  operat'n  ; 

26th  Penn.,  age  25. 

July  2. 

by  A.  A.  Surgeon  H.  Leaman. 

pcns'd  ;  no  union,  limb  no  use. 

Sept.  12, 

Nov.,  '63,  partial  union.     Must. 

(i 

Hrayson.  C.,  Pt.,  F,  16th 

Sept.  17, 

R't;  necro.:  portion  of  troch.  maj. 

1863. 

out  Aug.  26,  '65;  pens'd;  eight 

Mississippi. 

Dec.  22, 

and  shaft,  by  A.  A.  Surg.  A.  V. 

inches  shortening. 

1862. 

Cherbonnier.  Duty  April  27,  '63. 

Chase,  J.  A.,  Pt.,  B,  12th 

Dec.  J  3, 

Left  ;  fragm'ts  and  sharp  points, 

7 

Haggerty,    D.,    Pt.,   L, 

Oct.  12. 

Left  :  necrosis  troch.;  exc.  discas'd 

16 

Mass.,  age  36. 

1862, 

two  ins.  in  all,  by  A.  A.  Surg. 

1st  New  Jersey  Cav., 

1863, 

portion,  by  A.  A.  Surg.  J.  H. 

Jan.  13, 

R.  Reyburn.     Jan.  ]8,  19,  haem 

age  2:i. 



Thompson.     Must,  out  Sept.  22, 

1863. 

orrhage  from  external  circum 

1864  ;  applied  for  pension  Dec., 

flex  artery.     Died  Jan.  19,  1863. 

1864,  not  heard  from  since. 

Spec.  1021. 

8 

ITosay.   J.,    Pt.,    B,   9th 

July  4, 

Left  ;  three  ins.  mid.  third,  by  A. 

17 

2McElroy,   J.,    Pt..    E, 

June  6, 

Right  ;  bone  united  ;  refract,  by 

Missouri. 

'63,  Mar. 

A.  Surg.  A.  Sterling.     Prison, 

35th  Iowa,  age  38. 

Oct.  26, 

fall;  three  ius.  mid.  third,  Surg. 

8,  '64. 

Nov.  4,  1864. 

1864. 

F.  N.  Burke.  U.  S.  V.    Died  Nov. 

n 

Houghton.D.  F.,  Corp'l, 

Dec.  13, 

Left  ;  caries  :  six  ins.  up.  third,  by 

23,  1864,  pyamiia.     Autopsy. 

E,  Kith  Maine,  age  21. 

'62,  Aug. 

Surg.  C.  Alexander,  16th  Maine. 

18 

3Unknown,  Pt.,  —  New 

June  27, 

Left;  five  and  a  quarter  inches 

6,.  '63. 

Disch'd  May  15,  1863,  pens'd; 

Jersey,  age  22. 

Aug.  10, 

mid.  third.  ~8  pieces,  by  !>r.  — 

shorten'g  six  ins.,  stiff,  open. 

1862. 

Merritt.     Died  Aug.  10,  1862. 

10 

Millhousp  J.,  Serff't   Iv 

Sept.  20 

T  pft  •    two  nrirl  '\  linlt'ins    mifldle 

1!) 

Unknown               . 



.    Excis'n  of  trair't  ami  small 

7:id  Illinois,  age  31. 

Dec.  —  ,' 

"third.     Disch'd  April  30,  1865; 

1862. 

portion  of  shaft  partly  necrosed. 

1863. 

pens'd  ;  bone  carious,  very  lame. 

Result  unknown.     Spec.  396. 

Excisions  in  the  Shaft  of  the  Femur  at  an  Unknown  Period  after  Shot  Injury. — 

The  seventeen  cases  of  this  group  are  enumerated  in  the  following  table: 

TABLE  XXVIII. 
Seventeen  Cases  of  Excision  in  the  Shaft  of  the  Femur  after  Shot  Injury;  time  of  Operation  not  known. 


[Recoveries,  1 — 7;  Deaths,  8 — 16;  Result  unknown,  17.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Grauaz,   F.,  Pt.,  D,  1st 

Dec.  13, 

Left  ;  two  ins.  mid.  third.     Dis'd 

8 

Baker,  R.,  Lieut.,  A,  9th 

Nov.  25, 

Left;  three  ins.  and  small  frag 

Penn.  Rifles,  age  38. 

'62,  . 

Aug.  20,  1863;  subsequently  en 

Mississippi,  age  —  . 

'63,  . 

ments   middle  third;  diarrhoea. 

listed  in  V.  R.  C.     Dis'd  June  4, 

Died  Jan.  2,  '64  ;  pyasm.    Autop. 

'65.  and  pens'd:  union  complete. 

9 

Bartholomew,  G.,  Pt.,  E, 

May  8, 

Right  :  fractured  parts  mid.  third, 

Not  heard  from  since  Mar.  4,  '68. 

8th  Missouri,  age  —  . 

'62,  . 

by  Surg.  I).  W.  Hartshorne,  U. 

2 

Hiatt,    H.   H.,    Pt.,    B, 

Aug.  31, 

Right  ;  three  ins.    Disch'd  Oct.  20, 

S.  V.     Died  May  20,  1862. 

19th  Indiana,  age  19. 

'62,  . 

'63;  pens'd.    Atrophy;  three  ins. 

10 

Bowman,  W.  H.,  Pt.,  I, 

Jfov.  24, 

Left  ;  lower  third,  ends  sawn  off; 

short'g  ;  auchy.  of  knee  and  hip 

78th  Illinois,  age  —  . 

'63,  . 

pyicmia.     Died  Dec.  22,  1863. 

joints.     Died  Mar.  21,  '71  ;  gen 

11 

Furgerson,    N.,    Pt.,   G, 

Nov.  23, 

Right  ;  low.  third,  ends  sawn  otf. 

eral  debility  and  prostration. 

6th  Indiana,  age  —  . 

'63,  . 

Died  Jan.  18,  1864;  exhaustion. 

3 

Holbrook,  S.,  Pt.,  1st  N. 

Dec.  13, 

Right;  up.  third.  Disch'd  Dec.  17, 

Autopsy. 

H.  Battery,  age  22. 

'6° 

'63;  pens'd:  bone  discharging: 

12 

McHarper,  P.,  l>t.,   H, 

Left.     Died  June  6,  1864. 

can  do  light  work. 

12th  Miss.,  age  —  . 

4 

Murphy.  E.  A.,  Serg't, 

Mar.  31, 

Left;  two  ins.  middle  third  ;  ball 

13 

iMaines,  R.,  I't.,  F,  70th 

May  5, 

Loft.    Died  May  31,  1862. 

C,  2d  New  York  Mt'd 

'65,  . 

extracted.     Disch'd  Oct.  11,  '65; 

New  York,  age  30. 

'62,  . 

Rifles,  age  23. 

pens'd;  short'g  three  and  a  half 

14 

Thompson,  J.  S.,  Pt.,  H, 

Nov.  24, 

Right;  middle  third,  rough  ends 

ins.;  anchy.  knee  joint  ;  necrosis. 

llth  Tenn.,  age  —  . 

'63,  . 

sawn  off.    Jan.  14,  1864,  haein. 

5 

Nelson,  J.,  Pt.,  H,  51st 

Sept.  3, 

Right  ;  two  ins.  one  side  of  upper 

from  profunda  art'y.    Died  Jan. 

Ohio,  age  21. 

'64,  . 

third;  gang.,  car,  necro.    Uis'h 

19,  1874.     Autopsy. 

July  29,  '65;  pens'd:  bone  dis 

15 

Woolf,  T.,  Pt.,  A,  125th 

Sept.  17, 

Left.     Died  Jan.  25,  1863. 

eased;  one  and  a  half  ins.short'g; 

Pennsylvania,  age  —  . 

'go  

anchy.  of  knee  joint. 

16 

Yocum,   J.   P.,    I't.,    A, 

Nov.  24, 

Left;  upper  third,  ends  sawn  off. 

6 

Shannon,  A.  J.,  Pt.,  F,    April  20, 

Left.     Retired  February  9,  ]865; 

89th  Illinois,  age  —  . 

'63,  . 

Dec.  19,  pyaemia.    Died  Dec.  20, 

35th  N.  C.,  age  33.           '64,  . 

limb  entirely  useless. 

1863.     Autopsy. 

7 

Woolton.  A..  Pt.   A    15th    Aug.  28  '  T?*^*-  ir\n-«*.*Vi;»./-i      !?«+;»•«/}  Ton 

17 

Debuck    J    Pt.   C   29th 

Alabama,  age  26.             '62,  . 

4,1865;  shortening  2J  inches. 

Tennessee,  age  —  . 

Je.  1,'64. 

chanter  major.  Result  unknown. 

1  HOMANS  (J.,  jr.),  Resection  of  Three  Inches  of  the  Upper  Third  of  Femur,  in  Am.  Med.  Times,  1864,  Vol.  VIII,  p.  65. 

2DORRAN(W.  M.),   Tivo  Cases  of  Gunshot  Fract.  of  Upper  Third  of  Femur,  Treated  Conservatively,  in  Med.  Record,  1866-67,  Vol.  I,  Case  II.  p.  467- 

3MEKRITT  (— ).  Compound  C'lmminntfd  Fracture  nf  Frinitr—Emrdimi.  in  .\ni.  Mol.  Times,  1863,  Vol.  VI,  p.  247. 

4PRAY  (O.  M.),  Reports  of  Hospitals,  in  Am.  Med.  Times.  li?62,  Vol.  V,  Case  III,  p.  76. 


SECT.  III.] 


AMPUTATIONS    IN    THE    SHAFT    OF    THE    FEMUR. 


213 


The  seventeen  cases  in  which  the  time  between  the  reception  of  the  injury  and  the 
operation  could  not  be  ascertained  comprise  eleven  Union  and  six  Confederate  soldiers. 
In  eleven  instances  the  length  of  the  excised  portion  of  the  femur  wa.s  not  indicated;  in 
three  instances  two  inches,  and  in  three,  three  inches  of  bone  were  removed. 

Summing  up  the  one  hundred  and  seventy-five  cases  of  excision  in  the  shaft  of  the 
femur,  it  will  be  seen  that  the  operations  were  performed  in  the  upper  third  in  seventy-six 
instances,  including  nine  cases  in  which  the  operation  extended  into  the  middle  third  of  the 
femur.  Of  these  seventy-six  cases  twenty-five  recovered,  forty-nine  proved  fatal,  and  in 
two  the  result  remained  undetermined,  a  mortality  of  66.2  per  cent.  Of  the  fifty-nine 
excisions  in  the  middle  third  of  the  femur,  the  final  issue  could  not  be  ascertained  in  one 
case;  eighteen  were  followed  by  recovery,  and  forty  by  death,  a  death  rate  of  68.9  per 
cent.  The  seventeen  operations  in  the  lower  third  include  five  recoveries,  eleven  deaths, 
and  one  undetermined  result,  a  fatality  of  68.7  per  cent.  The  twenty-three  operations  with 
undefined  seat  of  fracture  include  sixteen  deaths,  three  recoveries,  and  four  undetermined 
cases,  a  mortality  of  84.2  per  cent.  In  six  of  the  one  hundred  and  seventy-five  cases  of 
excision  in  the  shaft  of  the  femur  recourse  was  had  to  subsequent  amputation  of  the  thigh, 
and  in  one,  to  exarticulation  at  the  hip.1  Further  observations  on  excisions  in  the  shaft 
of  the  femur  will  be  reserved  for  the  concluding  remarks  of  this  section. 

AMPUTATIONS  IN  THE  SHAFT  OF  THE  FEMUR.— On  page  169,  ante,  the 
total  number  of  cases  of  amputations  of  the  thigh  to  be  considered  in  this  section  was 
stated  as  6.238.  Of  these,  9  were  performed  for  shot  contusions  of  the  femur,  2,900  on 
account  of  shot  fractures  of  the  shaft  of  the  femur,  and  3,329  for  immediate  or  remote 
results  of  shot  fractures  of  the  knee  joint,  leg,  ankle  joint,  or  foot.  The  nine  operations 
for  complications  following  shot  contusions  of  the  shaft  of  the  femur  have  been  detailed 
at  page  173,  and  there  remain  to  be  noticed  6,229  cases  as  indicated  in  the  following  table:2 

TABLE  XXIX. 
Numerical  Statement  of  Sixty-two  Hundred  and  Twenty-nine  Amputations  of  the  Thigh  for  Shot  Injury. 


OPKUATIOXS. 

TOTAL. 

UFPEK  THIUD. 

MIDDLE  THIRD. 

LOWER  THIRD. 

SEAT  UNRECORDED. 

o> 

s 

o 

Recovered. 

-a 

D 

s 

Undetermined. 

Ratio  of  Mor 
tality. 

Recovered. 

•3 
o 

5 

Undetermined. 

Ratio  of  Mor 
tality. 

Recovered. 

•d 

5 

Undetermined. 

Ratio  of  Mor 
tality. 

Recovered. 

i 

3 

Undetermined. 

Ratio  of  Mor 
tality. 

Recovered. 

•d 
o 

3 

Undetermined. 

o 
Sx 

jl 

K 

3,949 
1,320 
442 

1,958 
479 
239 

1,943 
841 
203 

48 

49.8 
63.7 
45.9 

260 
50 

•^o 

268 
97 

°T 

5 

50.7 
66.0 
45.4 

686 
205 
102 

463 
266 
fifi 

8 

40.3 
56.4 
39.2 

46.0 

973 
217 
107 

37 

927 
459 
100 

61 

14 
6 

48.7 
67.9 
48.3 

62.2 

39 

7 

80 

285 
19 

212 

21 
19 

87.9 
73.0 
100.0 

72.6 

Intermediary  

Time  between  injury  and 
operation  not  stated   

518 

163 

323 

32 

66.4 

12 

63.6 

34 

29 

7 

6,229 

2,839 

3,310 

80 

53.8 

352 

411 

5 

53.8 

1,027 

824 

15 

44.5 

1,334 

1,547 

20 

53.6 

126 

528 

40 

80.7 

1  The  oases  of 
XXIII,  p.  2()<>);  Cori 
Indiana  Cavalry,  rec 
Collar,  F,  4.r,th  Illino 


xcision  in  the  shaft  of  the  femur  followed  by  amputation  of  the  thigh  are :  Private  J.  Becht,  B,  7th  Maryland,  fatal  (CASE  3,  TAISLE 
.nil  J.  W.  Soule,  D,  6th  Michigan  Cavalry,  fatal  (CASE  418,  p.  205,  and  CASE 51,  TA1U.E  XXIII,  p.  206);  Private  S.  C.  Hall,  P,  3d 
>very  (CASE  3,  TAHLK  XXV,  p.  208);  Sergeant  J.  Burroughs,  B,  3d  Kentucky,  fatal  (CASE  7,  TABLE  XXVI,  p.  210);  Private  C. 
s,  fatal  (CASE  8,  TAUI.E  XXVI,  p.  210);  and  Corp'l  T.  Duggan,  M,  llth  Illinois  Cavalry,  recovery  (CASE 4,  TAULE  XXVII,  p.  212). 


In  the  case  of  I,.  Carroll,  H,  1st  Delaware  (CASE  298,  p.  139,  and  CASE  11,  in  TAULE  XXIII,  p.  206),  the  excision  in  the  shaft  of  the  femur  was  followed 
by  an  unsuccessful  exarticulation  at  the  hip. 

2  Adding  to  the  6,229  cases  recorded  in  this  Table  the  9  cases  of  amputation  in  the  thigh  following  shot  contusions  of  the  femur,  the  2  operations 
cited  at  page  8,  ante,  for  complications  following  deep  incised  wounds,  and  the  131  amputations  tabulated  at  page  54,  ante,  following  shot  flesh  wounds 
of  the  lower  extremity,  we  have  a  total  of  6,371  recorded  cases  of  amputation  of  the  thigh  performed  for  injuries  Inflicted  by  weapons  of  war  in  the 
American  civil  war. 


214  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

As  indicated  in  the  Table,  the  result  as  to  fatality  remained  undetermined  in  only 
eighty  of  the  six  thousand  two  hundred  and  twenty-nine  cases;  twenty-eight  hundred  and 
thirty-nine  were  followed  by  recovery,  and  three  thousand  three  hundred  and  ten  by  death, 
a  mortality  of  53.8  per  cent.  This  exceeds  the  fatality  in  cases  of  shot  fractures  of  the 
femur  treated  by  conservation  (49.9  per  cent.,  see  page  176,  ante)  by  3.9  per  cent.,  while 
it  is  15.6  per  cent,  less  than  the  ratio  of  deaths  after  excisions  in  the  shaft  of  the  femur 
(69.4  per  cent.,  see  page  200,  ante).  It  will  also  be  observed  that  of  the  amputations  in 
which  the  time  between  the  injury  and  the  operation  could  be  definitely  ascertained,  the 
primary  are  by  far  the  most  numerous.  The  sixty-two  hundred  and  twenty-nine  amputa 
tions  were  performed  on  sixty-two  hundred  and  nine  patients,  twenty  being  double  opera 
tions.  In  three  cases  both  thighs  were  removed  at  the  middle  thirds;  ten  ablations  of 
both  thighs  were  performed  in  the  lower  thirds;  in  one  case  the  point  of  amputation  in  tlie 
right  thigh  was  not  stated,  while  the  left  thigh  was  amputated  in  the  lower  third,  and  in 
six  instances  of  amputation  of  both  thighs  the  thirds  were  not  indicated.1  In  fourteen  of 
the  twenty  double  thigh  amputations  both  operations  were  primary;  in  two,  both  inter 
mediary;  in  one,  the  operation  in  the  right  thigh  was  a  primary,  and  in  the  left  thigh  an 
intermediary;  in  one,  the  amputation  in  the  right  thigh  was  a  primary,  and  in  the  left  thigh 
a  secondary;  and  in  two  instances  the  periods  of  the  operations  were  not  recorded.  In 
twelve  cases  the  ablation  in  the  thigh  was  accompanied  by  an  amputation  of  the  opposite 
limb,  viz:  in  three,  by  amputations  at  the  knee  joint;  in  eight,  by  amputations  in  the  leg; 
and  in  one,  by  an  amputation  at  the  ankle  joint.2 

PRIMARY  AMPUTATIONS  IN  THE  SHAFT  OF  THE  FEMUR  FOR  SHOT 
INJURY. — According  to  the  plan  indicated  on  p.  697  of  the  /Second  Surgical  Volume,  the 
cases  in  which  the  operation  was  practised  within  forty-eight  hours  subsequent  to  the 
reception  of  the  injury  have  been  classified  as  primary  amputations.  Three  thousand 
nine  hundred  and  forty-nine  of  the  six  thousand  two  hundred  and  twenty-nine  amputations 
in  the  shaft  of  the  femur  belong  to  this  group.  In  forty-eight  instances  the  results  were 
not  ascertained;  nineteen  hundred  and  fifty-eight  were  successful,  and  nineteen  hundred 
and  forty-three  were  fatal,  a  mortality  of  49.8  per  cent. 

Primary  Amputations  in  the  Upper  Third  of  the  Femur. — -Five  hundred  and  thirty- 
three  of  the  thirty-nine  hundred  and  forty-nine  primary  amputations  in  the  shaft  of  the 

'The  throe  instances  in  which  both  thighs  were  removed  in  the  middle  thirds  are:  Sergeant  T.  Doud,  2d  Michigan,  primary  operations,  fatal: 
Corporal  J.  W.  Woodworth.  II,  llth  Michigan,  primary  operations,  fatal;  Private  S.  Bagley,  B,  5th  New  Hampshire,  right,  primary,  left,  secondary 
operation,  fatal  (Spec.  4232,  A.  M.  M.).  Tlie  ten  instances  of  ablations  of  both  thighs  in  tin;  lower  thirds  are:  Corporal  M.  Dunn,  II,  40th  Pennsyl 
vania,  primary  operations,  recovery  (Spec.  3193,  A.  M.  M.);  Private  E.  G.  Rush,  21st  Georgia,  primary  operations,  recovery  (see  Surg.  Phot.  Scries,  Nos. 
132,  133,  and  Cont'd  Photo's,  Vol.  :j.  p.  36,  and  Spec.  3998,  A.  M.  M.):  Private  S.  Allen,  G,  59th  Massachusetts,  primary  operations,  fatal:  Private  U.  S. 
Michael,  A,  105th  Pennsylvania,  primary  operations,  fatal;  Private  D.  Nicholson,  II,  23d  Massachusetts,  primary  operations,  fatal  (Spec.  2966,  A.M.  M.); 
Sergeant  E.  C.  Rabbit,  15,  10th  Missouri,  primary  operations,  fatal;  Private  J.  Stewart,  D,  77th  New  York,  primary  operations,  fatal ;  Lieutenant  J. 
Whelpley,  D,  1st  Maine,  primary  operations,  fatal;  Private  D.  Wallace,  I,  5th  Artillery,  intermediary  operations,  fatal  (Specs.  1383.  1384,  A.  M.  M.); 
Pt.  J.  Moore,  E,  46th  Pennsylvania,  intermediary  operations,  fatal.  In  the  fatal  case  of  Private  W.  F.  Mills,  E,  8th  New  York  Heavy  Artillery,  the  point 
of  the  primary  amputation  in  the  right  thigh  was  not  recorded,  the  operation  in  the  lower  third  of  the  left  thigh  was  an  intermediary.  The  six  instances 
in  which  the  points  of  ablation  were  not  stated  are:  Pt.  S.  Goodwell,  G,  29th  Illinois,  primary  operations,  fatal ;  Pt.  If.  Kenncr,  4th  Virginia,  primary 
operations,  fatal;  Pt.  C.  Myer,  F,  3()th  Missouri,  primary  operations,  fatal;  Pt.  H.  Tieman,  0,  119th  New  York,  primary  operations,  fatal;  Pt.  ./.  A. 
Parker,  L,  Cobb's  Legion  Cavalry,  time  of  operations  not  stated,  recovery;  Pt.  G.  Nune.nger,  A,  58th  Virginia,  time  of  operations  not  stated,  fatal. 

2 The  three  cases  of  amputation  of  the  thigh  and  of  exarticulation  at  the  knee  of  the  opposite  limb  are :  Corporal  C.  N.  Lapham,  K,  1st  Vermont 
Cavalry,  amputation  of  right  thigh  in  middle  third  and  of  loft  leg  at  the  knee  joint,  primary  operations,  recovery  (see  Surf/.  Photo's  Scries,  Nos.  154.  155); 
Private  J.  Barker,  I,  58th  Massachusetts,  amputation  of  right  thigh  in  lower  third  and  of  left  leg  at  knee  joint,  primary  operations,  fatal;  Private  II. 
Smith,  I,  14th  New  Jersey,  amputation  of  right  thigh  in  lower  third  and  of  left  leg  at  the  knee  joint,  primary  operations,  fatal.  Tho  eight  cases  of 
amputations  in  the  thigh  and  ablations  of  the  opposite  leg  are:  Private  S.  Banks,  C,  43d  Colored  Troops,  primary  amputations  in  middle  third  of  right 
thigh  and  lower  third  of  left  leg,  fatal;  Private  L.  Johnson,  B,  1st  Tennessee,  primary  amputations  of  left  thigh  in  lower,  and  right  log  in  upper  third, 
fatal;  Private  L.  O.  Lamphere,  G,  21st  Connecticut,  Sergeant  P.  Bradley,  C,  16th  Michigan,  and  Private  J.  K.  Lewis.  II,  53d  Georgia,,  primary  amputa 
tions  in  left  thighs  in  lower  thirds  and  of  right  legs  in  lower  thirds,  fatal ;  Sergeant  J.  Foss,  C,  59th  New  York,  primary  amputations  of  thigh  and  leg, 
thirds  unknown  ;  II.  Housley,  F,  33d  Wisconsin,  amputation  of  right  thigh  in  lower  third  and  of  left  leg  in  upper  third,  intermediary  operations,  recov 
ery;  Private  H.  Brown,  K,  2'Jd  Colored  Troops,  primary  amputation  of  right  leg  in  upper  third,  and  secondary  amputation  of  left  thigh  in  lower  third, 
recovery ;  Lieut.  A.  Birmingham,  A,  69th  New  York,  primary  amputation  of  right  thigh  in  lower  third  and  of  left  foot  at  ankle  joint,  fatal. 


SECT,  in.]  PRIMARY    AMPUTATIONS    IN    THE    SHAFT    OF    THE    FEMUR.  215 

femur  were  practised  in  the  upper  third  of  the  thigh.  The  result  was  determined  in  all 
but  five  cases.  Two  hundred  and  sixty  patients  recovered  after  the  operation,  and  two 
hundred  and  sixty-eight,  or  50.7  per  cent.,  died.  The  right  thigh  was  amputated  in  two 
hundred  and  forty-nine,  and  the  left  in  two  hundred  and  thirty  of  the  four  hundred  and 
seventy-nine  instances  in  which  this  point  was  recorded.  A  few  successful  and  fatal  exam 
ples  will  be  detailed,  and  all  cases  of  primary  amputation  in  the  upper  third  of  the  thigh 
will  be  enumerated  in  TABLE  XXX. 

Successful  Cases  of  Primary  Amputations  in  the  Upper  Third  of  the  Thigh. — The 
two  hundred  and  sixty  operations  of  this  category  were  performed  on  two  hundred  Union 
and  on  sixty  Confederate  soldiers.  It  was  impracticable  to  ascertain  the  subsequent  his 
tories  of  the  Confederate  soldiers.  Of  the  Union  soldiers,  one  officer  was  retired  and  one 
hundred  and  ninety-nine  men  were  pensioned,  and  it  appears  from  the  records  of  the  Pen 
sion  Office  that  one  hundred  and  ninety-three  of  the  survivors  after  primary  amputation 
in  the  upper  third  of  the  femur  were  living  in  September,  1879.  One  had  died  from 
chronic  diarrhoea,  two  from  consumption,  the  result  of  the  injury  and  the  operation,  and  in 
four  cases  the  cause  of  death  was  not  reported: 

CASE  427. — Lieutenant-Colonel  R.  Avery,  102d  New  York,  aged  24  years,  received  a  shot  fracture  of  the  upper  third  of 
the  right  thigh,  at  Lookout  Mountain,  November  24,  1863.  He  entered  the  field  hospital  of  the  2d  division,  Twelfth  Corps, 
where  the  injured  limb  was  amputated  by  Surgeon  C.  H.  Lord,  102d  New  York,  who  reported  as  follows :  "This  case  of  ampu 
tation  at  the  upper  third  of  the  thigh  is  of  interest  from  the  fact  that  the  patient  had  recently  returned  to  duty  from  hospital, 
where  he  had  been  since  receiving  a  severe  wound  of  the  face  and  neck  at  Chancellorsville,  May  3,  1863.  His  general  health 
was  poor,  yet  he  underwent  the  operation  well,  and  at  the  date  of  this  report,  December  2d,  he  is  getting  along  finely.  The 
flap  has  closed  completely  for  nearly  two  inches  anteriorly,  and  every  indication  points  to  a  speedy  recovery.  Dry  dressings 
have  been  used  entirely."  TJie  patient  was  subsequently  transferred  to  hospital  at  Bridgeport,  and  afterwards  to  Nashville, 
whence  he  proceeded  to  his  home  on  leave  of  absence.  Lastly  he  entered  the  Annapolis  Hospital,  and  on  June  27,  1864,  he 
was  discharged  from  service.  In  the  following  year  he  was  re-appointed  as  an  officer  of  the  Veteran  Reserve  Corps,  and  on 
December  31,  1870,  he  was  retired  from  active  service.  In  a  communication  from  Dr.  H.  E.  Goodman,  late  surgeon  U.  S.  V., 
the  amputation  was  described  as  having  been  performed  "at  the  great  trochanter."  During  January,  1866,  Colonel  Avery,  who 
was  then  serving  on  duty  at  the  office  of  the  Commissary  General  of  Prisoners,  visited  the  Army  Medical  Museum,  being  quite 
well  and  in  good  health,  and  the  stump,  though  aft'ected  with  neuralgia,  having  been  healed  for  more  than  a  year  previous.  This 
officer's  name  appears  on  the  retired  list  in  1879. 

CASE  428. — Private  T.  E.  Gay,  Co.  H,  9th  Ohio  Cavalry,  aged  19  years,  was  shot  in  the  left  thigh  while  on  guard  duty, 
at  Cypress  Creek,  April  22,  1864.  The  nature  of  the  injury  was  reported  by  Surgeon  C.  M.  Finch,  of  the  regiment,  as  follows : 
"  The  wound  was  the  result  of  an  accident,  the  missile,  a  carbine  ball,  entering  the  knee  joint  at  the  external  condyle,  passing 
upward  and  comminuting  the  femur  to  the  upper  third,  at  which  point  the  limb  was  amputated.  From  present  indications  (eight 
days  after  the  accident)  the  man  will  recover."  One  month  after  the  reception  of  the  injury  the  patient  was  transferred  to 
hospital  at  Nashville,  subsequently  to  Louisville,  and  lastly  to  Camp  Dennison.  Surgeon  C.  McDermont,  U.  S.  V.,  in  charge  of 
the  latter  hospital,  reported  that  "the  patient  was  admitted  June  21st  in  good  general  health,  but  in  his  transfer  he  sustained  a 
severe  contusion  of  the  stump  by  a  fall.  On  the  following  day  the  stump  presented  a  gangrenous  appearance,  which  was  checked 
by  the  application  of  a  solution  of  bromine.  Subsequently  dressing  of  basilicon  ointment  was  applied,  under  which  it  rapidly 
improved  and  threw  out  healthy  granulations."  The  patient  was  furnished  with  an  artificial  limb,  seven  months  after  the  recep 
tion  of  the  injury,  by  the  firm  of  Douglas  Ely,  and  on  November  17,  1864,  he  was  discharged  from  service  and  pensioned.  In 
his  application  for  commutation,  in  1870,  the  pensioner  mentions  that  Assistant  Surgeon  John  C.  Thorpe,  9th  Ohio  Cavalry, 
performed  the  amputation.  Examiner  J.  W.  Long,  of  Bryan,  Ohio,  May  7,  1873,  certified  to  "amputation  of  left  leg  four  inches 
below  the  upper  point  of  the  trochanter  major;  muscles  very  much  atrophied,  the  bone  being  covered  by  nothing  but  the  skin 
and  fascia  up  to  the  trochanter.  He  has  no  power  in  the  stump,  etc."  The  pensioner  was  paid  September  4,  1879. 

CASE  429. — Private  J.  H.  Judd,  Co.  C,  86th  New  York,  aged  18  years,  was  wounded  in  the  right  thigh,  before  Petersburg, 
September  11,  1864.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Second  Corps,  whence  Surgeon  J.  S.  Jameson, 
86th  New  York,  described  the  injury  as  "a  compound  fracture  of  the  femur  at  the  middle  third,  caused  by  a  musket  ball,"  and 
reported  that  he  "amputated  the  limb  at  the  upper  third."  The  patient  was  subsequently  transferred  to  City  Point,  and  three 
weeks  after  the  date  of  the  operation  he  was  moved  to  hospital  at  Alexandria,  whence  Surgeon  E.  Bentley,  U.  S.  V.,  described 
(In-  amputation  as  an  "antero-posterior  flap  operation."  The  patient  was  ultimately  transferred  to  Judiciary  Square  Hospital, 
Washington,  and  discharged  from  service  January  13,  1865,  and  pensioned.  Previous  to  leaving  the  hospital  he  was  supplied 
with  an  artificial  limb  by  the  Jewett  Patent  Leg  Company,  of  Washington,  D.  C.  In  his  application  for  commutation,  dated  1870, 
the  pensioner  represented  the  stump  as  being  in  a  sound  condition,  but  reported  the  artificial  leg  as  having  be<Mi  unsatisfactory. 
Examiner  F.  R.  Wagner,  of  Addison,  N.  Y.,  April  15,  1874,  certified  to  "  amputation  about  two  inches  below  the  trochanter 
minor,  leaving  the  stump  so  short  that  an  artificial  limb  cannot  be  worn."  The  pensioner  was  paid  June  4,  1879.  The  specimen, 
No.  410,  Army  Medical  Museum,  consists  of  the  middle  third  of  the  shaft  of  the  injured  femur.  It  was  contributed  by  the  operator. 


216  INJURIES    OF    THE    LOWER    EXTREMITIES.  ICHAP.  x. 

CASE  430. — Private  A.  Tarcott,  Co.  H,  94th  New  York,  aged  18  years,  was  wounded  at  Fredericksburg,  December  13, 
1862,  and  admitted  to  the  field  hospital  of  the  '2d  division.  First  Corps.     Surgeon  C.  J.  Nordquist,  83d  New  York,  noted:  "Gun 
shot  wound;  right  leg  amputated  ahove  knee/'     Two  weeks  after  the  injury  the  wounded  man  was  conveyed  to  Washington, 
where  he  entered  Trinity  Church  and  subsequently  Judiciary  Square  Hospital.     On  June  11,  1803,  he  was 
transferred  to  Central  Park  Hospital,  New  York  City,  whence  Acting  Assistant  Surgeon  G.  F.  Shrady 
contributed  to  the  Army  Medical  Museum  a  cast  of  the  stump  (Spec,  1:573),  taken  nine  months  after  the 
amputation,  with  the  following  history:  "According  to  the  patient's  account  the  lower  portion  of  his 
right  thigh  was  almost  completely  carried  away  by  a  grapeshot,  and  a  great  deal  of  haemorrhage  fol 
lowed  the  injury.     Amputation  at  the  upper  third  by  the  long  posterior  tlap  was  performed,  on  the  day 
following  the  injury,  by  Surgeon  G.  W.  Avery,  94th  New  York.     There  was  an  attack  of  gangrene  of  the 
stump  in  the  latter  part  of  April,  and  the  patient  has  suffered  from  necrosis  of  the  femur.     When  admitted 
FIG.  175.— Stamp  of  right   to  this  hospital  the  stump  was  entirely  healed."     Two  months  later  the  patient  was  furnished  with  an 
putation.    Spec.  1373.    '        artificial  limb  by  E.  D.  Hudson,  of  New  York  City,  and  on  Novemter  15,  1863,  he  was  discharged  from 
service  and  pensioned.     Examiner  C.  M.  Johnson,  of  Watertown,  New  York,  certified,  May  7,  1873: 

"The  stump  is  only  three  inches  in  length,  tender  and  painful;  the  extremity  of  the  femur  being  covered  only  by  integument. 
He  uses  an  artificial  limb  occasionally  only."     The  pensioner  was  paid  September  4,  1879. 

Fatal  Cases  of  Primary  Amputation  in  the  Upper  Third  of  the  Thigh. — There  were 
two  hundred  and  sixty-eight  cases  of  this  group.  Two  hundred  and  thirty  patients  were 
Union  and  thirty-eight  were  Confederate  soldiers.  Gangrene  supervened  in  eight,  pyaemia 
in -thirty,  and  tetanus  in  four  instances.  In  the  following  case  the  femur  was  fractured  in 
its  upper  third: 

CASE  431. — Private  W.  H.  Croyle,  Co.  H,  55th  Pennsylvania,  aged  21  years,  was  wounded  at  Petersburg,  June  16, 1864, 
and  was  admitted  to  hospital  at  Fort  Monroe  four  days  afterwards.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported: 
"Gunshot  fracture  of  right  femur,  upper  third.  Amputation  was  performed  in  the  field  on  the  day  of  the  injury,  chloroform 
being  used."  On  August  27th,  the  patient  was  transferred  to  DeCamp  Hospital,  David's  Island,  New  York  Harbor,  whence 
Assistant  Surgeon  W.  Webster,  U.  S.  A.,  reported  that  the  stump  was  still  unhealed,  and  that  the  patient  was  a  sufferer  from 
chronic  diarrhoea,  from  the  effects  of  which  he  died  September  7,  1864. 

In  the  next  two  cases  primary  amputation  in  the  upper  third  of.  the  femur  was  per 
formed  for  fractures  in  the  middle  third: 

CASE  432.— Private  M.  H.  Bartlett,  Co.  D,  4th  Vermont,  aged  19  years,  was  wounded  at  Funkstown,  July  10,  1863,  and 
entered  the  General  Hospital  at  Frederick  two  days  afterwards.  Acting  Assistant  Surgeon  C.  M.  Martin  reported  the  injury  and 
its  result  as  follows  :  "A  minie"  ball  entered  the  outer  side  of  the  left  thigh  about  the  middle  third  and  passed  directly  through, 
breaking  the  bone.  Amputation  in  the  upper  third  was  performed  on  the  field  by  the  circular  method.  When  admitted  to  this 
hospital  there  was  partial  union  of  the  flaps,  and  granulation  was  progressing.  Cold-water  dressings  were  used.  The  patient 
was  in  good  spirits  and  seemed  to  be  doing  finely  until  July  29th,  when  I  saw  a  change  for  the  worse,  his  pulse  being  low  and 
quick.  I  then  ordered  pills  of  iron  and  quinine  to  be  given  three  times  a  day,  also  full  diet.  Two  days  afterwards  he  had  a 
slight  chill  and  appeared  rather  weaker,  the  stump  not  looking  healthy  and  the  granulations  very  pale  and  flabby.  Ten  drops 
of  nitric  acid  diluted  in  an  ounce  of  water  was  then  ordered  to  be  applied  once  a  day,  and  the  pills  were  continued,  with  one 
ounce  of  whiskey  every  three  hours.  On  the  next  day  the  patient  was  gradually  sinking,  and  on  August  2d,  he  had  a  severe 
chill  in  the  morning.  Death  supervened  at  9.30  A.  M.  on  August  3,  1863.  At  the  post-mortem  examination,  three  hours  after, 
the  lungs,  heart,  spleen,  and  kidneys  were  found  to  be  healthy,  but  the  liver  was  highly  congested.  On  removing  the  remaining 
portion  of  the  femur  considerable  callus  was  discovered  to  have  been  thrown  out,  and  in  dissecting  the  muscles  I  found  two 
circumscribed  abscesses,  each  containing  about  half  an  ounce  of  pus."  The  upper  portion  of  the  femur  was  contributed  to  the 
Museum  by  Dr.  Martin,  and  is  numbered  3887  of  the  Surgical  Section. 

CASE  433. — Private  F.  Ward,  Co.  G,  45th  Colored  Infantry,  was  accidentally  shot  in  the  left  thigh,  near  Fort  Harrison, 
February  7,  1865.  The  nature  of  the  injury  and  its  result  were  recorded  by  Dr.  N.  Folsom,  Regimental  Surgeon,  as  follows : 
"A  conical  musket  ball,  fired  at  a  distance  of  about  three  hundred  yards,  entered  the  outer  aspect  of  the  limb  about  the  middle, 
fractured  the  femur,  and,  splitting  in  two,  passed  out  on  the  inner  aspect  lower  down.  There  were  two  orifices  of  exit,  and 
two  more  pieces  of  the  ball  were  found  in  the  wound.  The  man  was  admitted  to  hospital  within  six  hours  after  the  injury.  The 
loss  of  blood  was  estimated  at  a  pint  and  a  half,  and  the  boije  was  found  extensively  comminuted,  there  being  twenty-six  frag 
ments.  Amputation  by  the  circular  method,  at  the  junction  of  the  upper  and  middle  thirds  of  the  bone,  was  performed  under 
ether,  three  ligatures  being  applied  and  six  sutures.  Stimulants  were  freely  exhibited,  with  beef  tea,  through  the  night.  The 
case  progressed  well  until  forty-eight  hours  after  the  operation,  when  the  patient  was  suddenly  attacked  with  violent  pain  in  the 
stump,  and,  the  dressing  being  removed,  adhesion  was  found  to  be  quite  extensive.  The  sutures  were  then  removed  and  a  finger 
gently  introduced  at  the  middle  of  the  wound  for  one  and  a  half  inches,  and  relief  was  afforded  by  giving  one-fourth  of  a  grain 
of  morphia.  Wet  lint  covered  with  oiled  silk  was  now  applied,  and  the  adhesions  gradually  gave  way  during  the  week  follow 
ing.  Granulations  appeared  over  about  one-third  of  the  surface,  but  were  pale  and  inactive.  The  patient  took  tincture  of 
chloride  of  iron,  fifteen  drops  three  times  a  day,  and  good  diet  and  stimulants.  Poultices  were  applied  after  the  fourth  day,  but 
suppuration  was  at  no  time  profuse.  Considerable  pain  and  tenderness  of  the  other  leg  was  also  complained  of.  The  pulse 
gradually  rose  from  100  to  130,  and  fell  in  strength.  After  the  seventh  day  the  patient's  tongue  became  dry  and  brownish.  He 
died  on  the  twelfth  day,  February  19,  1865." 


SECT.  III.) 


PRIMARY    AMPUTATION    OP    THIGH    IN    UPPER   THIRD. 

TABLE  XXX. 


Condensed  Summary  of  Five  Hundred  and  Thirty-three  Cases  of  Primary  Amputations  in  the  Upper 

Third  of  the  Femur  for  Shot  Fractures. 


[Recovery,  1-260;  Death,  261-528;  Kesult  unknown,  529-533.1 


NO. 

NAME,  MILITARY 
DESCRIPTION',  AND  AGK. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

'No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATES. 

OPERATIONS,  OPERATORS. 
RESULT. 

1 

Abey,   J.,  Corporal,  B, 

Oct.  19, 

Left  ;  circular;  Surg.  R.  Barr,  67th 

41 

Cozad,    II.   J.,    Pt.,    A. 

June  2, 

Right  ;  Surgs.  G.  S.  Walker  and 

67th  Penn  .  age  20. 

20,  '64. 

Penn.     Disch'd  May  8.  1865. 

6th  Missouri. 

2,  '61. 

W.  F.  McChesnev,  6th  Missouri. 

o 

Allen,  \V.  G.,  Capt.,  F, 

Mar.  20, 

Right  ;  Surg.  A.  Sabine.  76th  Ohio. 

Disch'd  June  16,  1862. 

20th  Iowa,  age  Ii8. 

20,  '65. 

Mustered  out  June  6,  1865. 

42 

Congdon,    J.,     Pt.,     II, 

June  2!. 

Left  ;  circular:  Surg.  A.  K.Fifield, 

3 

Amos,  1\  .l/..Pt.,D,  45th 

July  7, 

Lett.     Prison,  December  4,  1864. 

30th  Ohio,  age  21. 

24,  '64. 

29th  Ohio.  Disch'd  July  19,  '65. 

North  Carolina,  age  27. 

7,  '64. 

43 

Crawford.  G.  W.,  Lieut., 

July  14, 

Flap.     Discharged  Feb.  17,  1864. 

4 

Atchinson,  J.  N.,  Pt.,  F. 

Aug.  27, 

Right  ;  circular;  Aug.  31st,  haem., 

F.  6th  Michigan  Cav. 

14,  '63. 

2d  New  Jersey,  age  28. 

27,  '62. 

lig.  femoral.  Disch'd  June  3,  '63. 

44 

Cribb,  D.  W.  i".,  Pt.,  F, 

May  12, 

Left;  Surg.  Gelks,  26th  Georgia. 

5 

Atwater.   T.  J.,  Pt.,  C, 

Nov.  18, 

Left;  flap;  Confederate  surgeon. 

23th  Georgia. 

13,  '64. 

Recovery. 

112th  Illinois. 

19,  '63. 

Disch'd  Feb.  17,  1864. 

1  45 

Criss,  S.  G..  Pt.,  A,  7th 

May  24, 

Right;  flap;  Surg.  D.  W.  Maull. 

6 

Avery,  II..  Lt.Col.,  102d 

Nov.  24, 

Right;   flap;    Surg.  C.  II.  Lord. 

West  Virginia,  age  19. 

24,  '64. 

1st  Del.     Disch'd  May  27,  1865. 

New  York. 

25,  '63. 

102d  N  .  Y.   Disch'd  J  une  27,  '64. 

46 

Crowley,  D..  Pt.,  F,  25th 

Sept.  17, 

Right.     Discharged. 

7 

Babcock,  J.  P.,  Pt.,  D, 

May  14, 

Right:    circular.     Disch'd   Ma}' 

New  York,  age  35. 

17,  '62. 

18th  Ohio,  age  24. 

14.'  '64. 

20,  1865. 

47 

Cue,    E.,    Pt.,    F,    97th 

Sept.  17, 

Right  ;  flap.  Disch'd  May  15,  '63. 

8 

Barker,   D.,   Serg't,    K, 

April  18, 

Left;  flap.  Disch'd  June  29,  1863. 

New  York. 

18,  '62. 

10th  Illinois  Cavalry. 

18,  '03. 

48 

Curtis,  E.  I).,  Serg't,  I, 

July  2, 

Right  ;    flap.     Disch'd  February 

9 

Barnes,  S.,  Pt.,  B,  12th 

Oct.  3, 

Right.     Disch'd  April  6,  1863. 

1st  Penn.  Res.,  age  25. 

3,  '63. 

3,  1864. 

Illinois. 

5,  '62. 

49 

Dart,  E.  S.,  Pt.,  G,  Sth 

June  16, 

Left.     Discharged  Oct  18.  1862. 

10 

Barrett,   G.  W.,  Serg't, 

Aug.  9, 

Right  ;  circular.    Disch'd  Oct.  27, 

Michigan. 

17,  '62. 

1,  7th  Ohio. 

11,  '62. 

1862. 

50 

Davis,    S.   M.,   Pt.,    A, 

July  1, 

Left;    Surg.   Mitchell,  C.  S.  A. 

11 

Barton,  G.,    Lieut.,    D, 

Dec.  13, 

Right;  circular.  Disch'd  April  16, 

24th  Georgia. 

1,  '64. 

Recovered. 

81st  Pennsylvania. 

13.  '62. 

1863. 

51 

Dailey,  P.,  Pt.,  G,  140th 

May  5, 

Right;  flap;  Confederate  surgeon. 

12 

Bassett,     \V.,     Pt.,     A, 

Sept.  17, 

Left  ;  flap.    Disch'd  Dec.  1,  1862. 

New  York,  age  29. 

6,  '64. 

Disch'd  June  11,  1865. 

lllth  Pennsylvania. 

17,  '62. 

52 

Dana,  D.  Z.,  Pt..  B,  60th 

June  15, 

Right  ;  circ.;  Surg.  H.  P..  Whiton, 

13 

Bauer,  A.,Serg't,A,102d 

June  27, 

Left;  circ.;  Surg.  A.  K.  Fifleld, 

New  York,  ago  35. 

15,  '64. 

60th  N.  Y*.     Disch'd  Jiar.  7.  '65. 

New  York,  age  21. 

27,  '64. 

29th  Ohio.    Disch'd  Nov.  22,  '64. 

'  53 

Dean,  U.  H.,  Pt.,  Pro 

July  18, 

Surgeon  Gleeves,  C.  S.  A.     Re 

Spec.  2:i28. 

vost  Guard. 

20,'  '63. 

covered. 

14 

Bedell.  11.  E.,  Lieut.,  D, 

Sept.  13, 

Left  ;  Surg.  C.  B.  Park,  llth  Ver 

54 

Dell,   F.,   Pt.,    F,   70th 

'May  1, 

Right;  Ass't  Surg.  J.  Ash.  70th 

llth  Vermont. 

13,  '64. 

mont.     Disch'd  Feb.  20,  1865. 

New  York,  age  21. 

2,  '62. 

N.  York.     Disch'd  Oct.  13.  '62. 

15 

Beaver,   J.  A..  Colonel, 

Aug.  25, 

Right  ;  circ.;  Surg.  J.  W.Wishart, 

55 

Delcher,   P.,  Pt.,  K,  3d 

May  16. 

Left;  flap;  Confederate  surgeon. 

148th  Pennsylvania. 

26,  'Ii4. 

140th  Penn.  Disch'd  Dec.  22,'64. 

N.  Y.  Cavalry,  age  42. 

16,'  '64. 

Disch'd  March  8.  1865 

16 

Bell,  J.,  Serg't,  D,  150th 

Mar.  19, 

Right  ;   flap  ;    Skey's  operation  ; 

56 

Dermock,  T..  Pt.,  B,  7th 

Oct.  8, 

Left;  flap  :  Surg.  G.C.  Jarvis,  7th 

New  York,  age  28. 

19,  '65. 

Surg.  C.  M.  Campbell.  150th  N. 

Conn.,  age  27. 

8,  '63. 

Conn.     Disch'd  Dec.  24.  1863. 

York.     Disch'd  Oct.  1  3,  1865. 

57 

Donohue,  J.S.,Capt.,  A, 

May  6, 

Left  ;  circ.;  Surg.  VV.  B.  Fox,  8th 

17 

Benedrum,  C.  W.,  Pt..  G, 

July  1, 

Left.     Recovered. 

8th  Michigan,  age  27. 

7,  '64. 

Mich.     Disch'd  ^ept.  28.  18.i4. 

17th  Virginia  Cavalry. 

1,  '63. 

58" 

Downs.  T.,  Pt.,  F.  88th 

Sept.  17, 

Right  ;  Surg.  F.  Reynolds,  88th 

18 

Benninghoff,  F.,  Corp'l, 

Nov.  22, 

Right  ;  flap  ;  Surg.  A.  Sabine,  76th 

New  York,  age  38. 

17,  '62. 

N.  Y.     Sept.  29th,  ham.,  fern. 

B,  1st  Mich.  Artillery, 

22,  '64. 

Ohio.     Disch'd  June  18,  1865. 

tied.     Disch'd  March  13,  1803. 

age  28. 

59 

1  Duncan.  M.  I  ,  Serg't, 

Oct.  26, 

Right:  eiro.  ;  Surgs.  Coleman  and 

19 

liine,  J.,  Pt.,  J,  Stuart 

May  2, 

Right  ;  Surg.  Randolph,  C.  S.  A. 

G,  21st  Virginia. 

27,  '63. 

Fleming,  C.S.  A.  Fur.  Jan.  11.  '64. 

Horse  Art'y.  age  43. 

2,  '63. 

Furloughed  June  11,  1863. 

60 

Dunlap,   I.    N.,    Pt.,   I, 

Feb.  15. 

Left  ;  flap  ;  Surg.  C.  Goodbrake, 

20 

Birt.  W.  T..  Corp'l,  D, 

May  22, 

Left;  circular;   Surg.  11.  7j.  Gill, 

17th  Illinois. 

15,  '62. 

20th  111.     Disch'd  .Mar.  2?,  1862. 

47tli  IWnois. 

22,  '63. 

U.  S.  V.  Disch'd  Sept.  23,  1863. 

61 

Dunham,  C.  R.,  Pt  .  II, 

June  3. 

Riffht  ;   circ.;  Surg.  A.  A.  White, 

Died  October,  1863;  diarrhoea. 

1st  Maryland,  age  30. 

3,  '64. 

8th  Md.     Disch'd  Mar.  30.  1865. 

21 

Boden,  E.  G.,  Pt.,  A,  1st 

May  5, 

Right;  circular.    Disch'd  August 

62 

Emmitt.    J..   Serg't,   C, 

July  30, 

Left  ;  Surg.  C.  H.  Ladd,  C.  S.  A. 

Vermont,  age  19. 

5,  '64. 

30,  1865. 

56th  North  Carolina. 

30,  '64. 

Recovery. 

22 

Brannagan,  \Vr.,  Pt.,  II, 

Julys, 

Left  ;  flap.     Veteran  Res.  Corps 

63 

Eveland,  J.,  Pt.,  E,  7th 

Oct.  4, 

Right.     Jan.  15,  1863,  loose  skin 

70th  New  York,  age  21  . 

4,  '63. 

Dec.  31,  1863. 

Illinois. 

4,  '62. 

cut  off.     Discharged. 

23 

Brown,  A.  P.,  Serg't,  K, 

June  18, 

Right;  flap;  Surgs.  W.P.  Pierce, 

64 

Frrguson.  S  ,Pt.,  D,  14th 

Sept.  17, 

Left;  Surg.  Tracy.  C.  S.  A.    Re 

7-lth  Illinois,  age  2(i. 

18,  '64. 

88th  111.,  and  11.  E.  Hasse.  24th 

N.  Carolina,  age  28. 

18,  'C2. 

tired  March  1(5.  1865. 

Wis.     Disch'd  Oct.  28.  1864. 

65 

Finn.  T.    Lilut.,  D,  7th 

J  une  3, 

Left;  circ.;  Surg.  D.  W.  Maull. 

24 

Brown,  C.  E.,  Lt.  Col., 

July  22, 

Left  ;  flap  ;  Surg.  A.  B.  Monohan, 

West  Virginia,  age  21. 

3,  '64. 

1st  Del.     Disch'd  Dec.  19,  1864. 

63d  Ohio,  age  30. 

23,'  '64. 

63d  Ohio.    Disch'd  July  8.  18'>5. 

66 

Fisher,    II.   J.,    Pt.,    K, 

Mar.  16. 

Left;  flap:  Surg.  W.  Hamilton, 

25 

Bruck,  T.,  Capt.,  F,  Sth 

June  8, 

Left  :  Drs.  Allen,  Davis,  'and  Her 

102d  Illinois,  age  24. 

16,  '6."). 

102d  111.    Disch'd  June  14,  1865. 

New  York. 

10,  '62. 

ald.  C.  S.  A.    M.  O.  Apr.  2:!,  'ii.3. 

67 

Fisher,  J.  A.,  Serg't,  E, 

Aug.  9, 

Right:  Surg.  Waddell,  C.  S.  A. 

26 

Bryant,  E.  A.,  Musician, 

July  30, 

Right  ;  circular.    Disch'd  Oct.  18, 

52d  Virginia. 

10.  '62. 

Disch'd  Oct.  7,  186,'. 

C,  4thN.Hamp..age24. 

30,'  '64. 

1864. 

68 

2Fischer.  F.,  Lieut.,  K, 

May  19, 

Right  ;    circular.      Disch'd   Deo. 

27 

Butler.  G.,  Pt.,  31st  Mis 

July  20. 

Right  ;  circular.  To  Provost  Mar 

47th  Ohio,  age  26. 

20,'  '63. 

15,  1863. 

sissippi,  age  2d. 

20,'  '64. 

shal  Dec.  1,  1864. 

69 

Fisher,  J.,  Lieut..  K,  17th 

Oct.  28, 

Left;    Surg.    Fountain.   2d    Ala. 

28 

Bull,    H.,    Pt..    K,    7th 

Nov.  28, 

Right:  circ.;  Surg.  G.  W.  New, 

Indiana,  age  24. 

28,  '64. 

Cav.     Disch'd  May  15,  1865. 

Indiana,  age  24. 

28,  '63. 

7th  Ind.     Disch'd  April  1.1864. 

70 

Fitzgerald,  P.,rt.,  A,  7th 

June  18, 

Left  :  circular.     Disch'd  May  25, 

29 

Campbell,  J.,  Pt..  T,.  2d 

Sept.  29, 

Right;  flap.  Disch'd  July  10.  '65. 

Wisconsin,  age  18. 

18,  '64. 

1865. 

Penn.  Art'y,  ago  24. 

30,  '64. 

71 

Fit:Uufjh,     H.,     Lieut., 

Antcro-interual   large  and  small 

30 

Capstran,    A.,     Pt.,    H, 

May  13, 

Left  ;  circular.     Disch'd  October 

Purcell's  Battery. 

post,  flap  at  neck  of  fern.;  Surgs. 

98th  New  York,  age  18. 

13,  '64. 

18,  1864. 

G.  R.C.Toddand  Taney.  C.S.A. 

31 

Carroll,  J.,  Pt.,  11.  25th 

June  1, 

Right.     Disch'd   June  23,    1863. 

Recov'd.     Died  two  years  later. 

New  York,  age  19. 

2,  '6J. 

Spec.  2400. 

72 

Flemming,   D.,  Pt.,  D, 

Nov.  30, 

Right  ;  ant  post.  flap.  To  Provost 

32 

Carpenter,   I.,    Pt.,    II, 

Dec.  18, 

Right;    circular.      Disch'd   Oct. 

Sth  C.  S..  age  27. 

30,  '64. 

Marshal  March  7.  18;i5. 

10  Jd  New  York,  age  19. 

18,  '64. 

5,  1865. 

73 

Foote,  F.  W.,  Lieut..  I, 

May  10, 

Left;  flap:  Surg  Met  !uire,C.S.A. 

33 

Carter,    W.    W.,  Pt..  I, 

April  2. 

Right  ;  circular.  To  Provost  Mar 

121st  N.  York,  age  22. 

11,  ''64. 

Disch'd  Sept.  27.  1864. 

2d  Tenn.  Cav.,  age  26. 

2,  'Go. 

shal  May  6,  1865. 

74 

Foster,  R.,  Corporal,  B, 

April  5, 

Left;   circular.     Disch'd  August 

34 

Carter.  A.  L.,   Pt.,    A, 

Juno  27, 

Amp.  by  Surg.  Evans,  C.  S.  A. 

16th  Penn.,  age  24. 

5,  '65. 

21,  1865. 

5()th  Virginia. 

27,  '62. 

Recovery. 

75 

Fox,  J.,  Pt..  K,  1st  Cav 

Aug.  10, 

Right;   ant.    post,  flap:    Confod. 

35 

Cashine.  ./.  //.,  Pt.,  K, 

April  3, 

Left.     Released  July  10,  18G5. 

alry,  age  20. 

10,  '64. 

surgeon.     Disch'd  July  6,  1865. 

Sth  N.  Carolina,  age  30. 

4.  '65. 

Spec.  3224. 

36 

Cassell.  R.,  Pt.,  E,  29th 

April  2, 

Right:    circular.      Disch'd  July 

76 

French,  S.  S.,Pt.,  I,  Sth 

June  17, 

"Right;  flap.  Disch'd  July  26,  '65. 

Col'd  Troops,  age  38. 

2,  '6,1. 

11.  1865. 

N.  Hampshire,  age  18. 

17.  '64. 

37 

Clarke,  II.  G.,  Corp'l,  A, 

July  2, 

Right:  circ.;    Surg.  O.  Munson, 

77 

Fry,  W.,  Serg't,  K,  123d 

April  2, 

Left;  circ.;  Surg.  H.  C.  Leven- 

lllth  N.  York,  age  22. 

3,  '63. 

108th  N.  Y.  Disch'd  Oct.  15,  '63. 

Ohio,  age  26. 

2,  '65. 

sacler.  Sth  Me."  Recovery. 

38 

Cook,  D.,  Pt.,  F,  118th 

Dec.  29, 

Right;    circ.     Disch'd   June   23, 

78 

Gay,  T.  E.,  Pt.,  II,  9th 

April  22, 

Left;  flap;  As't  Surg.  J.C.  Thorpe, 

Ohio,  age  21. 

29,  '63. 

1865. 

Ohio  Cavalry,  age  19. 

22.  '64. 

9th  Ohio.    Disch'd  Nov.  18.  '64. 

39 

Cookson,  R.  B.,  Pt.,  B, 

Aug.  5, 

Left  :  flap  ;  Surg.  E.  Adams.  14th 

79 

Gilbert.  R.  r.,'Serg't.  D, 

July  2, 

Riffht  ;  circ.:  Asst.  Surg.  Ramseur, 

14th  Maine,  age  18. 

5,  %2. 

Maine.     Disch'd  Sept.  26.  1862. 

18th  Georgia,  age  31. 

0,  *l>3. 

C.  S.  A.    Exch'd  Nov.  12.  1863. 

40 

Cowger.  G.  M.,  Serg't, 

May  14, 

Left;  circular.     Disch'd  Nov.  23, 

80 

Golden,   J.,   Pt,,    B,  2d 

July  21, 

Left;  Asst.  Surg.  C.  J.  Wilson, 

E,  17th  Iowa. 

15,  '63. 

1863. 

U.  S.  Cavalry. 

21,  '63. 

U.  S.  A.    Disch'd  Mar,  16,  1864. 

1  DAVIS  ( W.  A.),  Case  of  Tetanus— Recovery,  in  Confed.  States  Med.  and  Surg.  Journal,  1864,  Vol.  I,  No.  1,  p.  8. 
2BRYAN  (J.),  Cases  of  Amputations  from  the  Armies  of  the  Southwest,  in  Am.  Med.  Times,  1863,  Vol.  7,  p.  288. 

SURG.  Ill— 28 


218 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

81  !  Goodman,  J.  E.,  Serg't. 

Nov.  27, 

Left;  circ.;  Surg.  H.E.  Goodman, 

123 

Jones,   O.,  Pt.,  C,  27th 

May  15, 

Left  ;  flap  ;  Surg.  W.  II.  Rice.  81st 

D,  147th  Perm.,  age  21. 

27,  '03. 

28th  t'enn.  Disch'd  Sept.  19,  '04. 

Mass.,  age  19. 

15,  '64. 

N.  Y.  Disch'd  July  10,  1805. 

82 

Goodwin,  W.H.,Pt.,B, 

Aug.  0, 

Left:  flap.    Disch'd  February  19, 

124 

Jones,  S.  P.,  Serg't,  D, 

Dec.  13, 

Right:    flap;    Confed.    surgeon. 

yth  Missouri  S.  M.  Cav. 

0,  "OJ. 

1803. 

121st  Pennsylvania. 

15,  '02. 

Disch'd  Dec.  3.  1803. 

83  |  Grim,  F.  M.,  Pt.,F,  140th 

June  18. 

Left  ;  Surg.  J.  W.  Wishart,  140th 

125 

Judd,  J.  H.,  Pt.,  C,  86th 

Sept.  11, 

Right  ;  ant.  post,  flap  ;  Surg.  J.  S. 

Pennsylvania,  age  18. 

19,  '04. 

Penn.     Disch'd  May  10,  1805. 

New  York,  age  18. 

11,  '64. 

Jamison,  8*ith  N.  York.  Disch'd 

84 

Grims,  W.,  Pt.,  1,  49th 

May  31, 

Right;  circ.     To  prison   Oct.  1, 

Jan.  13,  18.J5.     Spec.  4110. 

Virginia,  age  17. 

Jo.  1,'04. 

1804. 

126 

Kelly,  T.  A.,  Pt..  E,  57th 

July  20, 

Left:  ant.  post,  flap;  gang.     To 

85 

Hall,  J.  D.,  Pt.,  K,  1st 

Oct.  27, 

Left  ;  flap.     Disch'd  June  22,  "05. 

Alabama,  age  19. 

22,  '04. 

prison  Aug.  21.  1805. 

Delaware,  age  18. 

28.  '04. 

127 

Kesslcr,  M.,  Pt.,  A,  87th 

Oct.  17, 

Left;  flap.'  Disch'd  July  1,1865. 

8G 

Hall,  J.  W.,  Serg't,  H, 

July  i), 

Right;  circular.    Disch'd  June  7, 

Penn.,  age  46. 

19,  '64. 

(ith  Kentucky,  age  24. 

9,  '04. 

18G5. 

128 

Key,  J.  J.,  Pt.,  E,  8th 

July  1, 

Right.     Retired  Feb.  7,  1805. 

87 

Hall,  A.,  Serg't,  li,  15Cd 

Aug.  14, 

Left;  flap;  Confederate  surgeon. 

South  Carolina,  age  23. 

3,  '03. 

New  York,  age  26. 

!.->;  '04. 

Diseh'd  June  23,  1805. 

129 

Kilbonrn,  G.  L.,  Serg't, 

July  2, 

Left;    Surg.  11.  B.  Whiton.  G"th 

88 

Hainos.  E.,  Pt.,   I,   8th 

May  0, 

Right  ;  ciro.;  Surg.  C.  Bowers,  Oth 

C,  137th  N.  Y.,  age  25. 

3.  '63. 

N.  Y.     Disch'd  July  19,  1864. 

Penn.  Reserves,  age  23. 

0,  '04. 

Penn.  Res.  Disch'd  Jan  18,  '05. 

130 

Kilncr.  T.  A..  Corp'l.  E, 

Aug.  30, 

Left:  (lap;  Asst.Surg.J.  D.Gatch, 

8!) 

Ilainliak.  D.  F..  Major, 

Mar.  31, 

Right  ;  flap.     Mustered  out  Sept. 

Kith  Indiana,  age  3;!. 

30,  '62. 

16th  Ind.     Disch'd  Oct.  24,  '02. 

4t!iN.  Y.H.A.,  age22. 

31,  '05. 

20.  1805. 

131 

Kiser,  G.,  Serg't,  G,  95th 

Aug.  30, 

Right;    circ.:    Surg.    II.  Z.  Gill, 

90  j  BamM,  S.  /).,  1't..  K,  1st 

Nov.  30, 

Right  :  ant.  post,  flap  :  Asst.  Surg. 

Ohio. 

31,  •(>•>. 

S)5th  Ohio.  Disch'd  Aug.  20.  '03. 

Mississippi,  age  31. 

Dec.  1, 

W.    E.    Whitehcad,    U.  S.  A. 

132 

Klein,  D.,  Pt.,  C,  64th 

July  22, 

Left;  ant.  post.  flap;  Asst.  Surg. 

'    1804. 

Provost  Marshal,  May  0,  1805. 

Illinois,  age  20. 

22,'  '04. 

II.  A.  Mix.  04th  111.    lltem.;  lig. 

91 

llankins.  D.  W.,  Corp'l, 

June  1, 

Right;  double  flap;  Surg.  J.  S. 

Disch'd  Feb.  6,  1866. 

E,    14th   New  Jersey, 

2,  '04. 

Martin.  14th  N.Jersey.  Disch'd 

133 

Knapp,  L.,Pt.,  B.  lllth 

May  18, 

Left;  flap;  Surg.  W.  S.  Cooper, 

age  24. 

Jan.  23,  1805. 

New  York,  age  21. 

18,'  '61. 

1-^Sth  N.  Y.    Disch'd  Oct.  5.  '05. 

92 

Harrison,  S.,Pt.,A,149tb 

May  25, 

Left;  circ.;  Surg.  J.  V.  Kendall, 

131 

Knapp,  D.  E.,Pt.,K.05th 

July  IS), 

Left:  circ.;  Surg.  C.  S.  Frink,  U. 

New  York,  age  25. 

20.'  '04. 

149th  N.  York.     Reamputation. 

Illinois,  age  21. 

19.  '04. 

S.  V.  Mustered  out  July  12,  '05. 

Disch'd  July  15,  1805. 

135 

Langston.  6.  M.,  Serg't, 

July  2, 

Right  ;  flap.     Exchanged  March 

93 

Harrington,  H.,  Pt..  B, 

June  19, 

Right;  flap;  Surg.  J.  Chapman 

I,  3dS.('arolina.age37. 

3,  '03. 

17.  1804. 

123d  New  York,  age  20. 

20,  '64. 

]-^3dN.  York.     Disch'd  Oct.  4, 

130 

Lawrence,    J.,    Pt.,    B, 

July  30. 

Right  ;  flap.  Disch'd  April  24,  '65. 

1805.     Spec.  580. 

37  th  Wisconsin. 

30,  '04. 

94 

Hartford.  W.  H.,  Serg't, 

June  2, 

Right  ;    circ.;    Confed.    surgeon. 

137 

Leich.  J.,  Serg't,  A,  27th 

Sept.  27, 

Right;  Surg.  Walker,  C.  S.  A. 

A,  5th  N.  York,  age  28. 

3,  '04. 

Disch'd  Aug.  7,  1805. 

North  Carolina. 

£8,  '03. 

Pvocovered. 

95 

Harvey,  E.  II.,  Pt.,  A, 

May  28, 

Right:  ant.  post,  flap;  Surg.  S.     138 

Lewis.  W.  W.,  Pt.,  K, 

June  10, 

Right  ;  flap  ;  Confederate  surgeon. 

7th  Mich.  Cav.,  age  111. 

28,'  '04. 

R.  \Vooster,  1st  Michigan  Cav. 

95th  Ohio. 

11.  '04. 

Discharged. 

Disch'd  Dec.  25,  1804.                     131) 

Liudslcy,  D.,Pt.,  C,  29th 

May  8, 

Right  ;  Surg.  A.  K.  Fifield,  29th 

96 

Ilassler,  J.  A.,  Pt.,   II, 

Feb.  6, 

Right;  circ.;  Surg.  F  .H.LeMoyne,  ' 

Ohio,  age  22. 

8,  '04. 

Ohio.     Disch'd  Jan.  9,  1805. 

IGtb  I'enn.Cav..  age  23. 

7,  '05. 

10th  Penn.  Cav.   Dis.Aug.  G!'G5.   !  140 

Lock,  J.,    Serg't,    I,   2d 

Sept.  —  , 

Right.    Furloughed  April  13,  '64. 

97 

I  hives.  J.  E.,  Lt.  Col., 

April  30. 

Left.     Mustered  out  June  30,  '05. 

North  Carolina. 

—  ,  '02. 

!     12th  Kansas. 

30,  '04. 

141 

Loftis,  W.  J.,  Pt.,  K,  5th 

May  27, 

Left  ;  ant.  post,  flap  :  Surgeon  J. 

98    Hays,  Jl.  F.,  1't  .  F,   3d 

Sept.  17, 

Left;  Surg.  Mayo,  C.  S.  A.   Fur- 

Tenn.,  age  22. 

27,  '04. 

Sympson,    24th    Ky.     Disch'd 

\  irginia. 

17,  'u'2. 

loughcd  Oct.  30,  18G3. 

May  0,  1805. 

99 

II;;flen,    Jr.  J..    Pt.,    (.', 

June  14, 

Right;  Surg.  Love,  C.  S.  A.    Re 

142 

Lowe,  W.,  Pt.,  F,   9th 

Oct.  18, 

Right;  circ.;  Surg.  R.  R.  Clarke. 

Sill  Louisiana. 

15,  '03. 

tired  Oct.  22.  1834. 

Maryland,  age  17. 

18,  '03. 

31th  Mass.  M.  0.  Feb.  2.  '04. 

100 

Henry,  J-,  Pt.,  A,  57th 

May  5, 

Right  :  circ.;  Surg.D.Kelsey,  G4Hi 

143 

Lumphrcy,    O.,    Serg't 

April  0, 

Left  ;  Surg.  T.  S.  Gardner,  17th 

New  York. 

0,  '04. 

N.  Y.     Disch'd  Jan.  18,  1865. 

Major,  1st  N.  Y.  Cav. 

0,  '05. 

Penn.  Cav.  Disch'd  July  24,  '05. 

101 

Henry,    P..   Pt..    G,   2d 

Oct.  8, 

Right  ;  flap;  Surg.  C.  Spinzig.  2d  ,:  144 

Maass,  L.,  P.,  F,  1st  In 

July  13, 

Right  ;  flap  :  Surg.  G.  P.  Ilex,  33d 

Missouri. 

8,  '02. 

Missouri.     Disch'd  Jan.  3,  1853.  j 

diana  Batterj-. 

13,  '03. 

Illinois.     Disch'd  Dec.  10,  1803. 

102 

Hill,  R.  8.,  Capt..  B,  2d 

April  10. 

Right.    Mustered  out  July  22,  '05.   1  145 

Mahouev,    J..    Pt.,    A, 

Indiana  Cavalry. 

10.  '05. 

llth  New  York  Cav., 

15,  '04. 

Gray,  llth  N.  Y.  Cav.    Diseh'd 

103 

Hill,  A.  F.,   Serg't,   D, 

Sept.  17, 

Left;  flap.    Diseh'd  June  21,  '63. 

age  21. 

March  30,  1805. 

8th  Pennsylvania. 

17,  '62. 

140 

Manning,  G.M.,  Lieut., 

Nov.  29, 

—  ;  Surg.  Shine,  C.  S.  A.  Fur 

104 

Himes,  A.,  Pt.,  D,  7th 

June  3, 

Right;    ant.    p--st.    flap:    Surgs. 

(',  Phillips  s  Legion. 

29,  '63. 

loughed  Oct.  15,  1804. 

New  York  Heavy  Art., 

5,  '04. 

Peel  and  Snelly,  C.  S.  A.     Dis 

147 

Martin,  C.  A.,  Serg't,  F, 

July  20, 

Right  ;  ant.  post.  flap.     Disch'd 

age  25. 

charged  Jan.  2:1,  1SG5. 

2!'th  Penn.,  age  27. 

21,  '04. 

July  2,  1805. 

105 

Hor/.in.  F.,  Sergeant,  B, 

June  1, 

Left;  circ;  Surg.  C.  B.  Gibson, 

148 

Mattock,  J.  M.,  Pt.,  A.  1st 

Aug.  27, 

—  ;  Surgs.  Mitchell  and  Ford, 

Huger's  I.atterv. 

1,  04. 

C.  S.  A.    Recovery. 

Arkansas  Battery. 

27,  '03. 

C.  S.  A.     Recovered. 

10G 

Ilolbert.  J.,  Pt.,  'E,  20th 

Mar.  25, 

Left  ;  flap.     Disch'd  Aug.  2,  1805.     149 

McCabe,J.2*.,$eig*t,  F, 

Oct.  11, 

Right;  Surg.  Shackleford.C.S.A. 

Indiana,  age  43. 

25,  '05. 

2d  Virg'a  Cav.,  age  20. 

11,  '03. 

Retired  Feb.  28,  1805. 

107 

Holman,  II.,  Pt.,  A,  25th 

June  25, 

Left  :  flap.    Diseh'd  June  20,  '05.  '  150 

McClaiu,  J.  S.,  Pt.,  K, 

Deo.  31, 

Left  ;  flap  ;  Surg.  L.  Manker,  79th 

Mass.,  age  35. 

20.  '04. 

79th  Indiana. 

31,  '02. 

Ind.     Disch'd  March  G,  18G3. 

108 

'Hood  J.  B.,  Lt.  Gen'l, 

Sept.  IS), 

Professor  J.   G.   Richardson,   of;   151 

McCtmkey,  S.  /.,  Pt.,  G, 

Sept.  20, 

—  ;  Surg.  Hall.     Recovered. 

0.  S.'  A. 

lit,  '03. 

New  Orleans.     Recovery. 

37th  Tennessee. 

21,  '03. 

109 

Howard,  N.  J.,  Pt.,  II, 

June  3, 

Circular.     Furloughed. 

152 

McCord.   C.   P.,  Corp'l, 

May  17, 

Left;  Surg.  W.   II.  White,    22d 

48th  Alabama,  age  33. 

4,  '04. 

K,  23d  Iowa. 

17.'  '03. 

Iowa.     Disch'd  Aug.  20,  1803. 

no 

Hoyer,  15.,  Pt  ,  G.  107th 

Sept.  17, 

Right;  flap;  Snrg.  J.  F.  Hutchin- 

153 

McCurlcy,  J.,  Pt,  B,  1st 

Aug.  29, 

Right.     Disch'd  Oct.  29,  1862. 

Penn.,  age  18. 

19,  '02. 

son,  10?th  Penn.     Disch'd  July 

Pennsylvania  Art'y. 

2.),  '02. 

13,  1803. 

154 

McDan'iels,    S.,   Pt.;  D, 

April  11, 

Left:  flap;  Surg.  C.  L.  Wilson, 

111 

Huder,    A.   L.,  Pt.,  H, 

July  2, 

Left.     Exchanged  Sept.  25,  1803. 

75th  Ohio. 

13,  '02. 

75th  Ohio.     Disch'd  June  2,  '02. 

llth  Georgia,  age  20. 

3,  '03. 

155 

McFarland,  R.  W.,  Cor 

May  25, 

Left;  circular.     Disch'd  May  20, 

112 

Uur/hes,  G.  W.,  Pt.,   B, 

Mar.  20, 

Right;   Surg.    Swann,   C.   S.   A. 

poral  ,  C  .  3d  \V  i  s  .  ,  age  23  . 

20,'  '04. 

1805. 

(ith  Georgia. 

20,  '04. 

Recovery. 

156 

McKce,    S.   T.,   1't.,   E, 

Mar.  31. 

Left:  circular.     Disch'd  .lime  14. 

113 

Huston,  W.  G.,  Pt.,  K, 

May  13, 

Right  ;  periosteum  flap  ;  Surg.  J. 

4th  Penn.  Cav.,  age  2'). 

Ap.  1,'05. 

1805. 

8th  Indiana. 

23,  '03. 

K.  Bigclow.  8th  Ind.     Disch'd 

157 

McLaughlin,  M.,  1't.,  A. 

Mar.  10, 

Left:  circular.     Disch'd   Oct.   3, 

October  8,  1803. 

2Jth  Conn.,  age  34. 

10,  '05. 

1805. 

114 

Hutcltinxon,  K.  B.,  Pt., 
D,  7th  South  Carolina. 

Sept.  17, 
18,  '62. 

Right  ;  Surg.  T.  II.  Squire,  89th 
N.  Y.   Nov.  21th,  b;me  removed. 

158 

McMahon,  I).,  Capt.,  D, 
8Uth  New  York. 

July  1, 
3.  '03. 

Left;  flap.     Disch'd  June  23,  '64. 

femoral  opened,   lig.     Provost 

159 

McNulty.    C.,    Pt..    A, 

Sept.  17, 

Right  ;  flap  ;  Surg.  B.  A.  Yander- 

Marshal,  April  27,  1863. 

2!>th  Massachusetts. 

18,  '02. 

kcift,U.S.V.  Diseh'd  Mnr.23,  '63. 

115 

Hyatt,  K.  F.,  Pt.,  C,  3d 

Sept.  17, 

Left;  sloughing:  gangrene.    Dis 

160 

Milling,  K.  K  .  Pt.,  O. 

Sept.  20, 

Right  ;  Surgeon  Walker,  C.  S.  A. 

i     Arkansas,  ago  18. 

19,  '02. 

charged  Nov.  24,  1802. 

3d  S.Carolina  Battcrv. 

21,  '03. 

Recovered. 

116 

Ireland,  A.,  Pt.,  B,  9th 

Oct.  27, 

Right;  Surg.C.M.  Clark,  39th  111. 

16) 

Moore.  J.  II.,  Corp'l,  K, 

Aug.  25, 

Right;  circular;  Surgeon  J.  W. 

Maine,  age  18. 

27,  '04. 

Disch'd  June  12,  1805. 

2d   New  York  Heavy 

20.  '04. 

Wishart.  140th  Penn.     Disch'd 

117    Inmn,  1.  M.,  1't.,  G.  45th 

Oct.  19, 

Right.     To  Prov.  Marshal  April   i 

Artillery,  age  20. 

March  22.  1805. 

North  Carolina,  age  21. 

19,  '04.        171805.                                               I"-' 

Moore,  I1.,  Pt.,  E,  26th 

Sept.  10, 

Left  ;  nnt.  post,  flap:  Surg.  J.  G. 

118 

Irving,   D.,  Pt.,   H,  8th 

Nov.  27, 

Right;  circular.    Exchanged  and 

Mass.,  age  32. 

19,  '04. 

Bradt.  20th  Mass.    Disch'd  Oct. 

Louisiana,  age  20.             27,  '03. 

retired  February.  1805. 

3:i,  '05.     Died  Dec.  5,  1809. 

119 

Jackson.  J.,   Serg't,  A       May  •>, 

Left:  circular.     Disch'd  June  7,     103 

Mosher,   D.  II.,  Pt.,  I?. 

May  G, 

Right;    Surg.    \V.    B.    Fox,   8th 

00th  Illinois,  ugc  30 

10,  '04.       1805. 

8th  Mich.,  age  24 

8,  '04. 

Michigan.     Disch'd  Jan.  24,  '65. 

1120 

Jarrett,  I..  Serg't,  A.  1st 

Alar.  31,    Left:  circular;  Surg.  W.  W.  L.     104 

Murphy,   E.,   Lieut.,  A, 

Sept.  19. 

Left:  skin  flap:   Asst.    Surg.  J. 

New  .Jersey  Cavalry, 

Ap.  1,'05.     Phillips,    1st  New  Jersey  Cav.  '• 

5th  Cavalry,  age  20. 

20,  '04. 

\f.  Williams.  U.  ,S.  A.    Retired 

age  18. 

Disch'd  July  5,  18G5. 

April  25,  1805. 

21    Jessup,    J.,    Lieut.,    B,    Juno  18,    Right.    Mustered  out  Aug.  7,  'G4.  ,105 

Myers,  S..  Pt.,  C.  183d 

May  2, 

Lett  ;  circular;  Surg.  D.  II.  Hous 

187th  Pennsylvania. 

18.  '04. 

Pennsylvania,  age  18. 

2,  ''04. 

ton,  2d  Del.  Disch'd  June  8,  '05. 

122 

Jones,  D.  M.,  Corp'l,  I. 

April  2,  !  Right:  flap;  Surg.  J.  S.  Taylor,  i  100 

Nealis.'.T.  P.,  Serg't,  E, 

July  3, 

Left.     Recovered. 

199th  Penn.,  age  25. 

2,  '05.         23d  111.     Must,  out  June  24.  '05.  '•', 

23d  Virginia  Cavalry. 

5,  '03. 

.           :                   i                                                                ;> 

1                                                                1 

'SMITH  (STEPHEN),  Analyses  of  439  amp.  -in  the  contiguity  nj  the  lower  extremity,  in  Memoirs  of  the  U.  i>.  £an.  Com.,  187],  Surg.  II,  p.  04. 


SECT.  III.] 


PRIMARY    AMPUTATION"    OF    THIGH    IN    UPPER    THIRD. 


219 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

107 

Nelson,   J.,   Lieut.,    K, 

Feb.  26, 

Right  ;  ant.  post,  flap  ;  Surg.  J. 

307 

Space,  J.  D.,  Pt.,  1,  15th 

Aug.  17, 

RigTit;  circ.:  Surg.  J.  W.  Miller, 

18th  Penn'a  Cavalry, 

26,  '63. 

J.  Marks,  18th  I'enn.  Cavalry. 

New  Jersey,  age  21. 

18,  '64. 

C.  S.  A.     Disced  June  24.  '65. 

age  42. 

Discharged. 

208 

Springer,  J.  M.,  Corp'l, 

April  6, 

Right  ;   flap.     Disch'd   July    10, 

168 

Nnthrnann,  A.,  Pt.,  D, 

May  fi, 

Left:  ciro.;  Surg.  G.   L.  Potter, 

B,  40th  Illinois. 

8,  '62. 

1863. 

39th  Now  York,  age  40. 

8,  '64. 

145th  Peun.  Disch'd  Dec.  9,  '64. 

309 

Stackhouse,  P.  J.,  Pt.,C, 

July  2. 

Left;    ant.    post.    flap.     Disch'd 

169 

O'Brien,  E.,  Pt.,  A,  63d 

May  18, 

Right;  circ.;  Surg.  P.  B.  Hubon, 

3d  Penn.  Res.,  age  34. 

4,  '63. 

.  May  3,  1864. 

New  York,  age  24. 

18,  '64. 

28th  Mass.    Disch'd  April  9,  '66. 

210 

Steinberger,  W.,  Pt.,  A, 

May  1, 

Left  ;»flap.     Recovered  ;  disch'd. 

170 

O'Connell,    T.,    Pt.,   H, 

July  2, 

Left;  circular.     Disch'd  June  15, 

23d  Indiana. 

1,  '63. 

124th  N.  York,  age  24. 

4,  '63. 

1865.     Died  June  9,  1872. 

211 

Stiensberger,  M.,  Pt.,  H, 

Mar.  31, 

Left  ;  flap.    Disch'd  June  9,  1865. 

171 

Olive,  J.  W.  A.,  Corp'l, 

Mav  6, 

Right  ;  Surgeon  Brown.  C.  S.  A. 

Uth  Penn.,  age  30. 

31,  '65. 

H.  3d  Arkansas. 

6,  '64. 

Recovered. 

212 

Stoddard,  A.,Pt.,G,  4th 

Sept.  1  , 

Left:  flap;    Surg.   S.   A.  Green, 

175 

Park,  W.  B.,  Corp'l,  E, 

July  11, 

Left  [injuring  popliteal  artery)  ; 

N.  Hampshire,  age  33. 

1,  '63. 

24th  Mass.  Disch'd  June  1  6,  '64. 

3d  Michigan,  age  20. 

11.  '63. 

circ.';  Surgeon  E.  J.  Bonine,  3d 

Spec.  4306. 

Mich.     Disch'd  April  9,  1864. 

213 

Stoughton,  W.  L.,  Col., 

July  4. 

Right;  Surg.  W.  N.  Elliott,  llth 

173 

Payne,  I.  A.,  Pt.,  K,  1st 

Oct.  27, 

Left  ;    lateral   flap  ;    Confederate 

llth  Michigan. 

4,  '64. 

Mich.     Disch'd  Sept.  30,  1864. 

Colored  Troops,  ago  18. 

28,  '64. 

surgeon.    Disch'd  July  12,  1865. 

214 

Stocks,  G.  W.,  Pt.,  I.  3d 

July  12, 

Left  ;  flap.     Disch'd  Oct.  1,  1863. 

174 

Peach,  G.  S.,  Serg  t,  B, 

April  11, 

Right;  circ.:  Surg.  S.  A.  Green, 

Iowa. 

12,  '63. 

24th  Mass.,  age  29. 

11,  '63. 

24th  Mass.  Disch'd  May  10,  1864. 

215 

Streeter,  H.  R.,  Pt..  A, 

Aug.  9, 

Right  :  flap  ;  Surg.  II.  R.  Payne, 

175 

Perkins,  L.  A.,  Corp'l, 

Sept.  19, 

Right;  circ.:  Surg.  Buvard.C.S.A. 

85th  Illinois,  age  28. 

9,  '64. 

10th  Ills.     Disch'd  Nov.  7,  J865 

D.lSth  Virgim'a.age  19. 

19.  '64. 

Provost  Marshal,  April,  1.  1865. 

316 

Strickland,   N.,    Pt.,   C, 

Jan.  15. 

Right:  circ.:  Surg.  J.W.Mitchell, 

176 

Peterson,  W.,  Pt.,  K,  3d 

June  3, 

Right;  double  flap:  Surg.  D.  M. 

203d  Penn..  age  20. 

15,  '65. 

4th  C.  T.     Mar.  8th,  reamp. 

Vermont,  age  30. 

3.  '64. 

Goodwin,  3dVi.  Dis.  June6,'65. 

217 

Stuekev,  J.  S.,  Capt..  D, 

Sept.  19, 

Right.     Surg.  C.  E.  Cady.  138th 

177 

Phillips.  W.  IX,  Serg't, 

April  2, 

Left  ;  ant.  post,  oval  flap  ;  Confed. 

138th  "Penn..  age  30. 

20,  '64. 

Penn.     Disch'd  Feb.  8,"'65. 

I,  10th  N.  York  Heavy 

2,  '65. 

surgeon.     Necr.  bone  removed. 

218 

Sweet,    L.,    Corp'l.    C, 

Mar.  19, 

Left;  flap:  Confederate  surgeon. 

Artillery,  age  28. 

Disch'd  Oct.  17,  1865. 

88th  Indiana,  age  :i3. 

20,  '65. 

Disch'd  Oct.  4,  1865. 

178 

Pinknev,  J.  H.,  Pt.,  C, 

Sept.  29, 

Right  ;  flap.    Disch'd  Dec.  20,  '65. 

219 

Taggart,  J.  X.,   Pt.,  G, 

Aug.  26, 

Left  :  ant.  post,  flap  ;  Surg.  AV.  B. 

4th  Old  Troops,  age  33. 

29,  '64. 

1st  West  Virginia  L.A., 

26,  '63. 

Wynne.     14th   I'enn.    Cavalry. 

179 

Pluss,  W.,   Pt.,   E,  23d 

Mav  14, 

Left;  circ.;  Surg.  D.L.Heath,  23d 

age  33. 

Disch'd  June  14.  1864. 

Michigan,  age  39. 

14,  '64. 

Mich.     Disch'd  July  18,  1865. 

220 

Tanner,  J.,  Pt.,  C,  38th 

Sept.  1, 

Left  ;  circular.     Disch'd  June  3, 

180 

Powell.  F.,  Pt..  A,   10th 

Aug.  29, 

Left:  Surg.  Tanncy,  C.S.A.  Re 

New  York. 

1,  '62. 

1863. 

Louisiana. 

30,  '62. 

tired  Oct.  22,  1864'. 

221 

Tarcott.  A.,  Pt.,  A,  94th 

Dec.  13, 

Right  ;  long  post,  flap  ;  Surg.  G. 

181 

Purcell,  J.,  Pt.,  A,  20th 

Mar.  16, 

Left  :  ant.  post,  skin  flap  ;  Surg. 

New  York,  age  18. 

14,  '62. 

VV.  Avery,  94th  N.  Y.    Disch'd 

Connecticut,  age  23. 

16,  '65. 

J.  W.  Terry,  20th  Conn.     M.  O. 

Nov.12,  1863.  Spec.  1373. 

June  13,  1865. 

233 

Taylor.  M.  C..  Pt..  G,  4th 

June  19, 

Right.    Furloughed  Nov.  3,  1863. 

183 

Pullien,  R.,  Pt.,  E,  47th 

July  3, 

Right.     Exch'd  Oct.  26,  1863. 

North  Carolina  Cav. 

20,  '63. 

Nofth  Carolina. 

3,  '63. 

223 

Terry,    J..    Pt.,   B,   7:3d 

July  3, 

Left  ;  flap.    Disch'd  Nov.  29,  '64. 

183 

Pyle,   A.  J.,  Corp'l,  V, 

April  30, 

Right.'  Disch'd   Sept.  33,  1863. 

Ohi'o,  age  23. 

4,  '63. 

51st  Indiana,  age  25. 

1863. 

Died  Jan.  11,  1867. 

224 

Thompson,   W.,    Signal 

Nov.  7, 

Right  :  flap;  Surg.  J.  T.  Kitchen, 

184 

Quinu,  P.,  Serg't,  E,  1st 

April  7, 

Right  ;    circular.     Disch'd   June 

Quartermaster,  U.S.N. 

7,  '61. 

U.  S.  N.     Disch'd  July  22,  '62. 

Louisiana  Cavalry. 

7,  '64. 

10,  1864. 

Died  Sept.  12,  1872. 

185 

Redmond,  M..  Serg't,  F, 

Sept.  17, 

Right;  circ.:  Surg.  G.  B.  Cogs 

225 

Thresher,  A.,  Pt.,  I,  66th 

June  28, 

Left  ;  flap  ;   Surg.  E.  Guilick.  9th 

63d  New  York. 

18,  '62. 

well,  29th  Mass.     Disch'd  May 

Illinois. 

28,  '64. 

Ills.     Disch'd  Aug.  1,  1865. 

20,  1863. 

236 

Tucker,  R.,  Pt.,  K,  19th 

July  22, 

Left  ;  flap.     Recovery. 

180 

Rennells,  A.  L.,  Corp'!, 

May  12, 

Right;  flap:  Surg.  W.  D.  Hum 

Arkansas,  age  21. 

22,  '64. 

K,  149th  Pennsylvania. 

13,  '64. 

phrey,    149th    Penn.      Disch'd 

237 

2  Tucker,   J.,  Serg't,  G, 

May  9. 

Right;   flap.     May  14th,  reamp. 

July  18,  1865. 

4th  Tenn.  Cav.,  age  40. 

9,  '64. 

Furloughed. 

187 

Richmond,  J.  L.,  Pt.,  G, 

June  27, 

Right.  Retired  from  service  Sept. 

238 

Uhl,  G.,  Serg't,  K,  20th 

Mar.  25, 

Left  ;  flap.     Disch'd  July  6,  1865. 

6th  South  Carolina. 

1864. 

6,  1864. 

Indiana,  age  22. 

25,  '65. 

188 

Riley,  J.  H.,  Corp'l,  K. 

Sept.  1, 

Left  ;  lat.  flap  :  Surg.W.  M.  Gray. 

239 

Vangorden,  J.  S.,Pt.,C, 

June  (i, 

Left.     Disch'd  Sept.  4,  1862. 

78th  Illinois,  age  31. 

1,  '64. 

60th  Ills.  Gang.  Dis.  Feb.  8.  '65. 

14th  Infantry. 

7,  '62. 

189 

Rohne,   A.  AV.,  Pt.,  K, 

June  13, 

Right  :  flap.    Disch'd  Oct.  26,  '6J. 

330 

Vaughan,  J.  F.,  Lieut., 

June  1, 

Left;  Surg.  G.  W.  New,  7th  Ind. 

123d  Ohio. 

13,  '63. 

K,  7th  Indiana,  age  32. 

1,  '64. 

Disch'd  Sept.  20,  1864. 

H>0 

Rogers,  E.,  Pt.,  C,  103d 

Oct.  3, 

Right.     Disch'd  March  13,  1863. 

331 

Vebber.  II.  II..  Serg't.  D, 

April  2, 

Right:  circ.:  Surg.  O.  S.   Cope- 

Pennsylvania. 

3,  '63. 

10th  N.  Y.  Art.,  age  33. 

4,  '65. 

land,  10th  New  York  Artillery. 

191 

Royal,  J.  B.,  l>t.,  F,  59th 

July  3. 

:  Surg.  Harris,  C.  S.  A.     Pa 

Disch'd  Oct.  5.  1865. 

Georgia. 

3.  '63. 

roled  Oct.  32,  1863. 

333 

Vechan,  C.,  Pt.,  D.  12th 

May  10, 

Right:    circ.;    Stirg.    A.    Satter- 

193 

Sandi'urd,  G.  P..  Comis'y 

April  6, 

Right  ;  ant.  pest.  flap.  Recovery. 

New  Jersey,  age  24. 

11,  '64. 

thwaite,  Uth  N.  Jersey.  Disch'd 

Serg't,  F,  2d  West  Vir 

6,  '65. 

Mustered  out  June  30,  1863. 

July  18,  1865. 

ginia  Car.,  age  24. 

233 

Vinzant,   J.,  Serg't,  A, 

Dec.  4, 

Right:  ant.  post.  flap.     Paroled 

193 

Schenkelberger.  J.,  Lt., 

Aug.  29, 

Left:  circ.  inside,  flap  externally; 

1st  Florida,  age  26. 

6.  '64. 

July  15.  18ti5. 

I,  1st  New  York  Arfy. 

29,  '62. 

A.  A.  Surg.  J.  B.  Greene.     Dfs- 

234 

Wait,  A.,  Corp'l,  D,127th 

July  28, 

Left;  flap:  Surg.A.C.  Messenger. 

charged  Dec.  17,  1863. 

Illinois,  age  31. 

28,  '64. 

57th  Ohio.  Disch'd  Mar.  33,  65. 

194 

Schleier.  M.,  Pt.,  B,  3d 

Aug.  14, 

Right;  circular.      Disch'd   Aug. 

235 

Walker,    G.,  Serg't,  K, 

June  26, 

Right  ;  Surgeon  Spence,  C.  S.  A. 

Iowa,  age  29. 

14,  '64. 

15.  1865. 

40th  Virginia. 

27,  '62. 

Recovered. 

195 

Schneider.    E.,    Pt.,   II, 

Sept.  19, 

Left  ;  flap.     Disch'd  Feb.  24,  '64. 

236 

Wallace,  S.  F.,  Pt.,  D, 

April  9, 

Left  ;  flap.     Disch'd  June  35,  '65. 

5th  Artillery. 

21,  '63. 

178th  N.  York,  age  18. 

9,  '64. 

1870,  stump  tender. 

196 

Schwartz,  P.  J't.F,  46th 

July  30, 

Right  ;  double  flap  ;  Surg.  W.  B. 

237 

Wakefield,   S.,    Pt,,    K, 

May  18, 

Left  ;  flap  ;   Surg.  J.  W.  Green, 

New  York,  age  20. 

30,  '64. 

Fox.  8th  Mich.    Dis.  Apr.  3,  '65. 

95th  Illinois. 

19,  '63. 

95th  111.    Disch'd  Aug.  11.  '63. 

197 

Shea.    A.,    Pt..  C,  Pur- 

June  18. 

Right:  circ.;  Surg.  J.  S.  O'Don- 

238 

Warren.  G.  W.,  Pt.,  B, 

June  25, 

Left;  flap;    Surg.  M.  Gunn.  5th 

uell  s  Legion,  age  ~0. 

18,  '64. 

nell.  Puniell  Legion.     Disch'd 

20th  Indiana. 

26,  '62. 

Mich.     Disch'd  Aug.  21.  '62. 

Oct.  28,  1864. 

239 

Waters,  P.,  Pt.,  C,  4th 

Sept.  29, 

Left.     Disch'd  April  10,  1865. 

198 

Sheldon.  D.  D.,  Serg't. 

May  23, 

Left:  circular.     Disch'd  Nov.  11, 

Col'd  Troops,  age  45. 

30,  '64. 

B,  14th  Missouri. 

23,  'G~>. 

1862. 

•,'-!:> 

Wathins.  J.  £>..  Serg't. 

Dec.  17, 

Left;    Surg.    Warren,   C.   S.   A. 

199 

Simmers,     P..     Pt.,     A, 

June  3, 

Right  ;    flap  ;    Confed.    surgeon. 

I,  52d  North  Carolina. 

17,  '62. 

Recovered. 

140th  N.  York,  age  41. 

2,  '64. 

Disch'd  Aug.  11.  1865. 

341 

Watkins,  L.  D.,  Pt,,  E, 

June  18, 

Left.    Disch'd  Dec.  20,  '64.   Spec. 

200 

1  Simpson,   W.,  Courier, 

Sept.  —  . 

Left  ;  ant.  post,   flap  ;   Surg.  E. 

55th  Penn..  age  21. 

20,  '64. 

4325. 

Iowa,  age  24. 

Batwell,   14th   Mich.     Disch'd. 

242 

Webb,  J.  M.,  Lieut.,  D, 

April  6, 

Left:  flap;  Surg.  N.  A.  Ilersom. 

Not  a  pensioner. 

17th  Maine,  age  29. 

(i.  '65. 

17th  Maine.     M.  out  June  4,  '63. 

201 

Sluder,   A.    L..   Pt.,   II. 

July  3, 

Left.     Exchanged  Sept.  25.  1864. 

243 

Wedeking.  J.  11..  Pt.,  A, 

July  16, 

Right:  ant.  post,  flap;  Surg.  II. 

llth  Georgia,  age  20. 

3,  '63. 

114th  Illinois,  age  20. 

16,  '63. 

'/,.  Gill.  U.  S.  V.     Disch'd  May 

203 

Small.   G.    \V..    Pt..    K, 

June  3, 

Right:  circular.    Disch'd  August 

244 

20.  1864. 

2ist  I'enn.  Cav.,agel9. 

3,  '64. 

2   1865. 

3  Weeks,  J.  D.,  Pt.,  G. 

Nov.  14, 

Left  ;  oblique  flap  ;  Surg.  S.  W. 

203 

Smith.  K.  A.Pt.,  A,  48th 

June  30, 

Right;  cir.    Escaped  August  18, 

3d  Col'd  Troops,  ago  20. 

14,  '63. 

Gross.  U.  S.  Y.    Also  amp.  arm. 

Mississippi,  age  49.         l.J'vl,  '62. 

1863. 

245 

Dis.  July  2ii.  '65,  and  pensioned. 

304 

.Smith,    .1.,     Ft.,    B.    2d 

Mar.  16, 

Right  ;  ant.  post.   flap.     Disch'd 

Welch,  W.,  Pt..  D,  33d 

May  8, 

Left;  circ.:  Confederate  surgeon. 

Massachusetts,  age  29. 

1  (i,  '65. 

Sept.  12,  1865. 

246 

New  Jersey,  ago  19. 

!»,  '64. 

Disch'd  Aug.  20,  1865. 

205 

Smith.  S.  D.,  Pt.,  C,  7th 

July  18, 

Left:  circ.:    Con.  surg.     Disch'd 

Welsh,  J.,   Pt..  A.  4th 

Aug.  16, 

Right.     Disch'd  Feb.  9,  1865. 

N.  Hampshire,  age  30. 

20,  '63. 

April  13,  1864.     Spec.  1856. 

247 

Penn.  Cav..  age  37. 

16,  '64. 

200 

Snyder,  W.  E..  Pt.,   F, 

May  22, 

Lett.     Disch'd  Sept.  4,  1863. 

Westmoreland,  M  .   Pt., 

July  23, 

;  Surg.  J.  Scmple,  C.  S.  A. 

7th  Kentucky. 

22,'  '63. 

B,  Nelson's  Battery.       '  20,  '64.    j     Recovered. 

1  B.vnVKLL  (E.),  Successful  Amputation  at  the  Hip  Joint,  in  Med.  and  Surrj.  Reporter.  1865,  Vol.  XIII,  p.  188. 

2O'KKKFE  (I).  C.),  Surgical   Cases  of  Interest  treated  at  Institute  Hospital,  Atlanta.  Ga.,  May  and  June,  1864,  in  Confederate  States  Med.  and 
Surg.  Jour..  1865,  Vol.  IT,  p.  25. 

3GUOSS  (S.  W.),  Synchronous  Amputation  of  the.  Left  Thiylt  at  its  Upper  Third  and  of  the  Left  Arm,  in  Am.  Mat.  Times,  1864.  Vol.  VIII.  p.  122. 


220 


INJURIES  OF  THE  LOWER  EXTREMITIES. 


[CHAP.  X. 


Xo. 

NAME,  MILITAKY 
DESCRIPTION,  AND  AGE. 

DATES. 

Ol'EKATIONS,   OPKRATOliS, 

RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

248 

Wiatt,  T.,  Pt.,  A,  24th* 

June  1, 

Right;  flap.     Disch'd  March  22, 

295 

Breunan,  P.,Pt.E,  169th 

Jan.  16, 

Right;  ant.  post,  flap;  Surg.  L. 

Kentucky,  age  32. 

1,  '64. 

1865. 

New  York,  age  23. 

16,  '65. 

Barney,  6th  Col'd  Troops.  Died 

249 

Wiggins,  \V.  W.,  Corp'l, 

Mav  12. 

Right:  flap:  Surg.  C.  R.  Crane, 

Feb.  2",  1865;  exhaustion. 

E,  5ih  Wis.,  ago  34. 

12,  '64. 

5th  Wis.     Mustered  out  1864. 

296 

Briggs,  J.,  Pt.,  C,  79th 

May  25, 

Right.     Died  June  11,  1864. 

250 

Wilbur,    D.,   Serg't,  K, 

Get.  27, 

Right;    ant.  post,  flap;    Confed. 

Ohio. 

25,  '64. 

1st  Maine  II.  A.,  age  37. 

v.9,  '64. 

surgeon.     Mustered  out  1865. 

297 

Brine.  J.  M.,  Pt.,  F,  27th 

July  30. 

Right;   Surg.    W.    B.    Fox,   8th 

251 

Willey,  K.,  Pt,,  E,  40tti 

April  6, 

Left  ;  circ.    Disch'd  Aug.  4,  1862. 

Michigan. 

30,  '64. 

Michigan.     Died  July  30,  1864. 

Illinois. 

8,  '62. 

298 

Brooks,    M.,   Serg't,  4-1, 

July  3, 

Right,     Died  July  18,  1863. 

252 

Wilkinson,  U.T.,  Lieut., 

Nov.  27, 

Right;  circular.     Trans.  Dec.  3, 

J6th  North  Carolina. 

3,  '63. 

0,  22d  Virginia,  age  25. 

28,  '03. 

1863. 

299 

Browney,    W.,    Pt.,    G, 

July  3, 

Left.     Died  July  13,  1863. 

253 

Winn,    J.   J.,    Quarter 

April  22, 

Left  ;  Surg.  J.Y.  Taylor,  U.  S.  N. 

73d  New  York. 

3,  '63. 

master  U.  S.  S.  Oneida, 

22,  '62. 

Also  amp.  left  arm.     Disch'd 

300 

Brown,  I.,  Pt.,  I,  142d 

May  5, 

Left.     Died  May  7,  1864. 

age  33. 

Nov.  17,  1862. 

Pennsylvania. 

5,  '64. 

254 

Wise,  G.  C.,  Pt.,  B,  14th 

May  6, 

Left.    Surg.  Huger,  C.  S.  A.    Re 

301 

Brown,  J.,  Pt,  K,  102d 

May  27, 

Right;  flap;  Surg.  C.   II.    Lord, 

South  Carolina,  age  20. 

6,  '64. 

tired  from  service  Feb.  11,  1865. 

Neir  York,  age  27. 

27,  '64. 

102d  N.  Y.     Died  Feb.  18.  1865. 

255 

Wolf,    A.,    Pt.,   I,  38th 

April  2, 

Left  ;  flap  :  also  amp.  finger  right 

302 

Brown,    J.   P.,  Pt,,   A, 

June  1, 

Left;  double  flap.     Died  June  9, 

Wisconsin. 

2,  '65. 

hand.     Disch'd  Sept.  6.  1865. 

15th  South  Carolina. 

1,  '64. 

1864. 

256 

Wormwood,  C.,  Pt.,  13, 

June  4, 

Right.      Disch'd.  Spec.  1464. 

303 

Brown,  J.    W.,    Pt.,   F, 

May  18, 

Right  ;  Surg.  M.  Rizer,  72d  Penn. 

97th  New  York,  age  19. 

4.  '64. 

152d  New  York. 

18,  '64. 

Died  May  18,  1864. 

257 

Worthy,  (J.  W.,  Pt.,  H, 

June  22, 

Right  ;  circ.  Furloughed  August 

304 

Brown,   M.   A.,   Pt.,  II, 

May  16, 

Flap.     Died  May  22,  1864. 

15th  S.  Carolina.age21. 

22,  '64. 

16,  1864. 

25th  S.Carolina,  age  18. 

16,  '64. 

258 

Yeagle,  J.,  Pt.,  C,  lllth 

Mav  25, 

Left;  flap:  Surg.  G.  P.  Oliver, 

305 

Buch,   J.,    Pt.,  H,  27th 

June  21, 

Left:    Surg.    N.   Gay,   U.  S.  V. 

Penn.,  age  25. 

25,'  '64. 

lllth  Penn.  Disch'd  Feb.  8,  '65. 

Iowa. 

21,  '63. 

Died  June  22.  1863. 

259 

Yerwood,  T.  L.,  Pt.,  11, 

Aug.  9, 

;  Surg.  Beckie.     Recovered. 

306 

Burks,  J.  U.,  Pt.,  F,  9th 

June  24, 

Died  June  26,  1864. 

19th  Georgia. 

10,  '62. 

Alabama. 

24,  '64. 

200 

York,  D.  P.,  Pt  ,  B,  12th 

Sept.  19, 

Left  :  circ.;  Surg.  II.  Fearn,  175th 

307 

Burns,   A.,  Pt.,  F,  66th 

Sept,  17, 

Surg.  C.  S.  Wood,  66th  N.  York. 

Maine,  age  30. 

20,  '64. 

N.  York.     Disch'd  Dec.  3'J.  '64. 

New  York. 

17,  '62. 

Died  Sept.  25,  1862. 

261 

Able,    P.,  Pt.,  A,  49th 

May  30, 

Left:  ant.  post.  flap.     Died  July 

308 

Butler,  A.  K.,  Corp'l,  F, 

Mar.  19, 

Right  ;  circular.    Died  March  27, 

Virginia. 

31,  '64. 

1,  1864;  pyaemia. 

1st  Michigan  Cavalry. 

20,  '62. 

1862  ;  pvirmia. 

262 

Aikens,  II.  N.  G.,  Serg't, 

June  10, 

Right;  Asst.  Surg.  J.  S.  French. 

309 

Caesar,  H.,  Captain,  A, 

May  1, 

Right;   Surg.  C.  S.  Wood,  66th 

B,  109th  N.  Y.,  age  21. 

10,  '64. 

109th  N.  York.    Irritative  fever. 

52d  New  York. 

1,  '63. 

N.  York.     Died  May  10,  1863. 

Died  Sept.  17,  '64  ;   exhaustion. 

310 

Cairns,  J.  W.,  Pt.,  G,  5th 

Mav  9, 

Surg.  C.  Bowers,  6th  Penn.    Died 

263 

Albert,  H.  C..  Corp'l,  A, 

July  27, 

Right;  flap.    Died  Aug.  19,  1864; 

Penn.  Reserves. 

9,  '64. 

May  10,  1864. 

1st  Cavalry,  age  21. 

27,  '64. 

exhaustion. 

311 

Callahan,  J.,  Pt  ,  I,  1st 

Aug.  10, 

Died'  August,  1804. 

264 

Allison,  J.  J.,  Serg't,  15. 

.Iunel9, 

Right.     Died  July  30,  1864. 

Ne^v  York  Dragoons. 

10.  '64. 

39th  Mass.,  age  40. 

19,  '64. 

312 

Carne,  W.W.,  Serg't,  H, 

Sept.  19. 

Left;  flap  :  Surg.  J.  G.  itradt.  26th 

265 

Anderson,  11.,  L!eut.,  I, 

Mav  21, 

Flap;  Surg.  J.  C.  Morgan,  29th 

26th  Massachusetts. 

20,  '64. 

Mass.  Died  Nov.30,'64.  Sp.3796. 

31st  Iowa. 

21,'  '63. 

Missouri.     Died  May  22,  1863. 

313 

Camp.  E.  L.,  Serg't,  G, 

June  —  , 

Left;    Surg.   J.   T.   Woods,  9!'th 

266 

Anderson,  S.  P.,  Pt..  D, 

Sept.  20. 

Right.     Died  Sept.  29,  1862. 

84th  Illinois. 

-,  '64; 

Ohio.     Died  June  21,  1864. 

118th  Pennsylvania. 

20,  '62. 

314 

Campbell,  M.,    Pt.,    C, 

July  2, 

Left.     Died  August  1,  1863. 

267 

Angle,  T.,  Pt,,  D,  100th 

Dec.  16, 

Left;  circ.;  Surg.  J.  R.  Ludlow, 

llth  Penn.  Reserves. 

2,  '63. 

Colored  Troops,  age  21  . 

17,  '64. 

U.S.V.  Died  Dec.  30,  '64  ;  exh'n. 

315 

Campbell,  J.,  Pt.,  K,  6th 

May  15, 

Right.     Died  May  18,  1864. 

268 

Arms,  A.  I.,  Pt.,  H,  71st 

July  2. 

Also  amp.  arm.    Died  July  3,  '63. 

Vermont. 

15,  '64. 

New  York. 

2.  ?63. 

316 

Carpenter,  C.,  Pt.,  L.  1st 

April  30, 

Right  ;  Surg.  E.  Shippen,  U.S.V. 

269 

Armstrong,   J..    Pt.,  I), 

July  18, 

Left;  circ.;  Surg.   T.  F.  Oakes, 

New  York  Artillery. 

30,  '63. 

Died  May  2.  1863. 

14th  New  York  H.  Art. 

18,'  '64. 

56th  Mass.     Died  July  21.  1864. 

317 

Carson,    T.   D.,   Pt.,  C, 

May  3, 

Surg.C.  S.\Vood,  66th  N.Y.  Died 

270 

Armstrong,    .T.,    Pt.,   A, 

June  25. 

Right.     Died  July  6,  1862. 

4th  Ohio. 

3,  '63. 

May  3,  1863. 

2<1  Rhode  Island. 

25,  '62. 

318 

Chambers.    W.,    Pt.,   I, 

May  5, 

Right.     Died  May  7,  1864. 

271 

Armstrong,  S.  H.,    Pt., 

Deo.  16. 

Right,     Died  January  1,  1865.     • 

4th  New  Jersey. 

5,  '64. 

A.  13th  C.  T.,  age  24. 

17,  '64. 

319 

Chisler,   J.,    Pt..    I,  8th 

May  6, 

Left;  Surg.  C.  Bowers,  6th  Penn. 

272 

A  shcrwood,  J..Pt,,  G,7tli 

June  16. 

Left  ;  ant.  post.  flap.     Died  June 

Penn.,  age  19. 

6,  '64. 

Reserves.       Died  May  13,  1864. 

N.  Y.  II.  Arfy,age30. 

16,  '64. 

28.  1864;  exhaustion. 

320 

Churchill,  A.W.,  Corp'l, 

Oct.  19, 

Right  ;  flap.     Died  Nov.  8.  1864  ; 

273 

Aylesworth,  E.  G^,  Pt., 

July  2, 

Right,     Died  July  10,  1863. 

G,  7th  Mich.  Cavalry, 

19,  '64. 

exhaustion  ;  anemia. 

G,  147th  New  York. 

3,  '63. 

age  33. 

274 

Babcock,  W.,  Lt.  Col., 

Sept.  19, 

Left  :  ant.  post.  flap.     Died  Oct. 

321 

Clapp,  S.  C.  B.,  Lieut., 

May  12, 

Right  ;  Surg.  J.W.  Wishart,  140th 

75th  New  York. 

19,  '64. 

5,  1864  ;  pyaemia. 

H,  125th  N.  Y.,  age  22. 

12,  '64. 

Penn.     Died  June  5,  1864. 

275 

liailcy,  W.,  Pt.,  D,  31st 

May  16, 

Left;  flap.     Died  June  14,  1864. 

322 

Clarke,  A.,  Pt.,  A,  69th 

Primary. 

Right.     Died  November  7,  1862. 

N.  Carolina,  age  23. 

16,  '64. 

Indiana. 

276 

Bailey.  J.,  Pt.,  E,  35th 

Nov.  30, 

L^ft;  ant.  post.  flap.     Died  Jan. 

323 

Coffing,  J.  C.,  Lieut.,  K, 

Dec.  14, 

Right  ;   Surg.  F.  G.  Snelling,  U. 

Alabama,  ago  29. 

De.  1.  '64. 

~8.  1865;  exhaustion. 

10th  Connecticut. 

14,  '6,'. 

S.  V.     Died  Dec.  25.  '62  :  exh'n. 

277 

Ball,   C.  A.,  Corp'l,  D, 

Sept.  19, 

Right:  ant.  post.  Hap:  pyaemic. 

324 

Collier.    P..    Pt.,   K,  3d 

May  1, 

Right,     Died  May  3,  1863. 

14th  N.  Hamp.,age45. 

19,  '64. 

Died  Oct.  25,  1864. 

Missouri  Cavalry. 

1,  '63. 

278 

Barr.   S.,   Serg't,   B,  3d 

Oct.  22, 

Left:  oval  flap.     Died  Nov.  28, 

325 

Combs,   A.   J.,    Pt.,   II, 

Dec.  4, 

Flap;    A.  A.  Surg.  W.   Appley. 

Iowa  Cavalry,  age  23. 

22,  '64. 

18.'!4:  irritative  fever. 

39th  Georgia,  age  27. 

4,  '64. 

Died  Dec.  5.  '64  ;  haemorrhage. 

279 

Jiarnes,  It.  G.,  Sergeant 

July  3, 

Right.     Died  July,  1863. 

326 

Condon,  S.,  Pt.,  I,  87th 

June  25. 

Right:  July  7th.     Died  Sept.  2, 

Major,  52d  N.  Carolina. 

3,  '6:i. 

New  York,  age  18. 

27,  '62.' 

1862;  pyaemia. 

280 

Bart'lett,  M.  II.,  Pt.,  D, 

July  10, 

Left;  circ.     Died  August  3,  '63; 

327 

Conlin,  W.,  Pt.,  H,  140th 

July  3, 

Left.     Died  July  15,  1863. 

4th  Vermont,  age  19. 

10,  '63. 

exhaustion.     Spec.  3887. 

Pennsylvania. 

3.  '63. 

281 

Barrett,  A..   Pt.,  II,  4th 

Oct.  4, 

Left  :  double  flap:  Asst,  Surg.  J. 

328 

Connor,   S.    A.,  Pt.,   G, 

Oct.  13, 

Right.   Died  Nov.  7,  '64  ;  tetanus. 

Indiana  Cavalry. 

5,  '63. 

K.  Link,  21st  III.  Died  Oct.  7,  '63. 

62d  Ohio,  age  21. 

13,  '64 

282 

Realty,  C.  L.,  Capt..  A, 

Aug.  14, 

Died  August  15,  1864. 

329 

Connor,  P.,  Pt.,  D,  53d 

June  1, 

Right  ;  June  26th.  reamp.     Died 

Palmetto  S.  S. 

14.  '64. 

Pennsylvania. 

1,  '62. 

July  8,  1862;  exhaustion. 

283 

Hell.  J.  C.,  Pt.,  A,  13th 

July  28, 

Circ.:  Ast.  Surg.  W.F.Richardson, 

330 

Constine.  L.,  Pt.,C,  143d 

May  11, 

Circ.;    Surg.  W.  T.  Humphrey, 

South  Carolina. 

28,  '64. 

C.S.A.  Died  July  30,  '64;  exh'n. 

Pennsylvania. 

13,"'63. 

149th  Penn.     Died  May  18,  '63. 

284 

Bennett,  L.,  Pt.,  D,  141st 

July  3, 

Died  July  10,  1863. 

331 

Coqitillet,  L,  Pt.,  G.  8th 

Dec.  1, 

Right  :  circ.;  A.  Surg.  T.W.  Stull, 

Pennsylvania. 

3,  fe. 

111.  Cavalry,  age  21. 

2,  '63. 

8th  111.  Cav.   Died  Jan.  17,  1864. 

285 

Bennett.   J.    W..  Major, 

Sept.  27, 

Left.     Died  November  15,  1864. 

Spec.  1893. 

10th  Missouri  Cavalry. 

27,  '64. 

332 

Cowman,  J.,  Pt.,  C,  81st 

Sept.  3, 

Left;  Surg.  J.  Pogue,  66th  111 

286 

Berguist,  (',..  1't.,  C.  95th 

June  17, 

Left  :  atit.  post.  flap.     Died  Aug. 

Ohio. 

3,  '64. 

Died  Sept.  10,  1864;  pvasmia. 

New  York,  age  33. 

17,  '64. 

4,  1864  ;  pyaemia. 

333 

Coxe,   L.  T.,   Serg't,  D, 

Sept.  29, 

Left.    Died  October  23,  1864. 

287 

Biltz.  G.  C.,  Serg't,  E, 

Mav  14, 

Right.     Died  May  24,  1864. 

25th  South  Carolina. 

29,  '64. 

108th  Ohio. 

14,'  '64. 

334 

Crane,  J.,  Pt.,  K,   100th 

Sept.  4, 

Right  :  Surg.M.S.Kittingor.lOOth 

288 

Bishop,  M.  G.,  Serg't,  E, 

July  20. 

Right.     Died  July  28,  1864. 

New  York. 

4,  '64. 

New  York.    Died  Sept.  5,  1864. 

5th  Connecticut. 

20."  '64. 

335 

Crawton,W.,Pt.,  II,  63d 

Sept.  17, 

Died  September  22,  1862. 

289 

Bollonbaugh.  J..  Pt.,  E, 

June  28, 

Right.     Died  July  28,  1864. 

New  York. 

17,  '62. 

93d  Ohio. 

28,  '64. 

336 

Croyle,  W.  II.,  Pt.,  11, 

June  16, 

Right.    Died  Sept.  6,  '64  ;  chronic 

290 

Bowers,  .1.  C.,  Capt.,  D, 

Juno  2, 

Right;  Surg.  J.  L.  Brinton,  8th 

55th  Penn.,  age  21. 

16,  '64. 

diarrhcea. 

184th  Penn..  age  2J. 

2,  '64. 

Ohio.    Died  July  18,  '64  :  exh'n. 

3.')? 

Danner,  S.,  Pt.,  I,  lllth 

Mav  14. 

Right  :  Surg.   A.  C.  Messenger, 

291 

Boi/cf.S..  Serg't,  K,  30th 

Nov.  8, 

Left;    Surg.   11.   F.    Lyster,  5th 

Illinois. 

14,'  '64. 

57th  Ohio.     Died  June  7.  1864. 

North  Carolina. 

8,  '63. 

Mich.  Cav.     Died  Nov.  11,  '63. 

338 

Davill,  J.,  Pt.,  U,  10th 

May  14, 

Left.     Died  May  18,  1863. 

292 

P.oyd.  J..  Color  Scrg't. 

July  2, 

Left.     Died. 

Missouri. 

14,'  '63. 

2d  Delaware. 

2,  '63. 

339 

Davis,  E.,   Pt.,  C,  18th 

Dec.  15. 

Left  ;  ant.  post,  flap;  A.  A.  Surg. 

21(3 

Bragg.    J.,   Pt,,   I,    4Qd 

Sept.  17, 

Left.     Died  October  3,  1862. 

Ohio,  age  35. 

16,  '64. 

M.  L.  Herr.     Died  Dec.  27,  '64  ; 

New  York. 

17.  '62. 

pyaemia. 

294 

Brandt,    C.,  Pt.,  A,  1st 

July  3, 

Right.     Died  July  21  ,  1863. 

340 

Delancy,  J.,  Pt.,  C,  101st 

May  25, 

Right;  ex.  and  int.  lateral  flaps. 

Minnesota. 

3,  '63. 

Illinois,  age  25. 

26,  '64. 

Died  June  20,  1864  ;  pyaemia. 

SECT.  III. 


PEIMARY    AMPUTATION    OF    THIGH    IN    UPPER   THIRD. 


221 


No. 

NAME,  MILITARY 
DESCRIPTION,  AXI)  Ar.E. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DAT  KB. 

OPERATIONS,  OPERATORS, 
RESULT. 

341 

Diefenbangh,  J.,  It.,  H, 

May  8, 

Right.     Died  July  2,  1864  ;  gan 

387 

Hughes,  ff.,  Serg't,  Mil 

July  22, 

Left  ;  gang.;  circular.    Died  July 

•J3d  Ohio. 

6,  '64. 

grene. 

ler's  Mississippi  Cav. 

24,  '64. 

24,1864. 

342 

Dingman,    A.,    I't.,    F, 

June  3, 

Left;  Surg.  W.  B.  Fox,  8th  Mich. 

388 

Hyde,  W.  J.,  Pt.,  C,  19th 

Dec.  17, 

Left;  flap;  gangrene.    Died  Nov. 

27th  Michigan. 

3,  '64. 

Died  June  3,  1864. 

Louisiana,  age  24. 

18,  '64. 

20,  1865  ;  typh.  fever. 

343 

Dixon,  J..   I't.,    F,  32d 

May  15, 

Right.     Died  May  25,  1864. 

389 

Hydrick,   L.,  Serg't,  I, 

Aug.  14, 

Left.     Died'August  16,  1864. 

Alabama. 

15,  '64. 

66th  New  York. 

14,  '64. 

344 

Doiz,  J.  C.,  It.,  B,  19th 

July  22, 

Right.    Died  August  4,  1864. 

390 

Jackson,  J.,  Corp'l,  K, 

June  18, 

Left.     Died  July  23,  1864;   ex 

Infantry. 

L'2,  '64. 

llth  Conn.,  age  36. 

18,  '64. 

haustion. 

345 

Donaldson,   S..   It.,   C, 

June  7, 

Right.     Died  June  9,  1864. 

391 

2  James,  J.  L.,  Corp'l,  C, 

May  1, 

Right;  double  flap.     Died   Mav 

ll'SJth  Pennsylvania. 

7,  '64. 

18th  Indiana. 

1  .  "C3. 

27,  1863. 

340 

Douglass.  A.'j.,  I't..  B, 

Aug.  25, 

Left;  do.  flap;  A.Surg.C.W.Stin- 

392 

Jennings,  J.,  Pt.,  1,  14th 

Aug.  25, 

Left;  ant.  post,  dovib.  flap;  Surg 

14th  W.  Ya  ,  ago  25. 

C7,  '64. 

son,  23d  111.     Died  Aug.  27,  '64. 

Conn.,  age  17 

27,  '64. 

Hunt,  C.S.A.  Died  Sept.  -Jli,'(i4. 

347 

Doyle,  T.,  Oorp'l,  I,  4th 

July  2, 

Right.     Died  July  6,  1863. 

393 

Jessop.    N.,   Corp'l,    K, 

Aug.  18. 

Right:  <-ii-(!.  Aug.  31st,  pyu'iuia. 

Maine. 

3,  '63. 

97th  N.  York,  age  30. 

19,  '64. 

Died  Sept.  5,  1864;  pyaemia. 

348 

Dudley,  J.,  Pt.,  C,  34th 

Mar.  31, 

Left;  flap;  Surg.  T.  H.  Squire, 

394 

Johnson,  J.  W.  C.,  It., 

June  18, 

Died  July  1,  1864. 

Massachusetts. 

31.  '65. 

8!>th  New  Y'ork.     Died. 

B,  187th  Penn. 

18,  '64. 

349 

Dudley,  W.,  I't.,  E,  64th 

July  2, 

Left;  haemorrhage.     Died  July 

395 

Jonex,  D.  C.,  It.,  H,43d 

Mav  16, 

Flap.     Died  May  19,  1864. 

New  York. 

2.  '63. 

23,  1863. 

Alabama,  age  25. 

16,'  '64. 

350 

Dunham,  W.  H..  It.,  K, 

Oct.  19, 

Right  ;  circ.     Died  Oct.  28,  1864  ; 

396 

Jones.  H.,  Pt,,  F,  36th 

June  15, 

Left  ;  flap.     Died  August  20,  '64  : 

114th  New  York. 

19,  '64. 

pyaemia. 

Col'd  Troeps,  age  33. 

35.  '64. 

haemorrhage. 

351 

Dunn,  <).,  Corp'l,  F,  66th 

Sept.  17, 

Surg.  C.  S.  Wood,  66th  N,  Y'ork. 

397 

Jones,   J.    W.,    It.,    A. 

Dec.  13, 

Died  December  20,  1*62. 

New  Y'ork,  age  26. 

17,  '62. 

Died  October  25,  1862. 

122d  Pennsylvania. 

13,  '62. 

302 

Durnan.  L.,  Corp'l,   G, 

Mar.  19, 

Left.     Died  April  14,  1865. 

398 

Jones.  O.  H.,  Serg't,  D, 

June  2, 

Left  ;  flap.     Died  June  —  ,  1864  ; 

121st  Ohio,  age  21. 

20,  65. 

14'Jth  New  Y'ork. 

3,  '64. 

absorption. 

303 

Eddy,  J.  C..  It.,  F,  22d 

Dec.  13. 

Died  December  20,  1862. 

399 

Kelty,  T.,  Pt.,  K,  100th 

July  30, 

Left;   flap;    Surg.  T.  F.  Oakes. 

(  'onnerticut. 

13,  '62. 

Pennsylvania. 

30,  '64. 

56th  Mass.     Died  July  31,  1864. 

354 

Edward,  W.,  It.,  I,  49th 

June  26, 

Left.    Died  June  26,  1864. 

4CO 

Kenison,  A.,  It.,  E,  12th 

Sept.  19, 

Right  :  circ.:  pvscmic  sym.    Died 

Ohio. 

26,  '64. 

Maine. 

ilt,  '64. 

October  16,  1864. 

355 

Edwards,     C.,    It.,    K, 

Mav  25, 

Left.     Died  June  2,  1864. 

401 

Kennedy,  C.,  Pt.,  F,  71st 

Mav  18, 

Right  .-  Surg.  G.  L.  Potter,  145th 

J4Uth  New  Y'ork. 

25.  '64. 

Penn..  age  27. 

18,  '64. 

Penn.  Died  June  4,  '64;  pyaemia. 

35(i 

1  Elder,  W.  B.,Serg't,  B, 

Dec.  14, 

Right;  circ.     Died  Jan.  8,.  1863; 

402 

Kensler,  P.,  Pt.,  G,  47th 

July  28, 

Left;  flap:    Act.  Staff  Surg.  C. 

91st  Ponu. 

14,  '62. 

tetanus. 

Ohio,  age  36. 

29,  '64. 

15.  Richards,  U.S.A.  Died  July 

357 

Erwin,  W.  B.,  It.,  C,  5th 

May  14, 

Left.     Died  May  16,  1864. 

31,  1864. 

Tennessee. 

14,  '64. 

403 

Kerr,  S.  M.,  Pt.,  C.  6th 

Dec.  16, 

Right:  ant.  post.  flap.    Died  Jan. 

358 

Evans.  E.  S.,  Pt.,  1,  87th 

June  15. 

Left.     Died  June  26,  1864. 

Tenn.  Cav.,  age  20. 

16,  '64. 

10,  '65;  typhoid  pneumonia. 

Indiana. 

15,  '64. 

404 

Kief,    J.,    It.,    B,    66th 

Dec.  16, 

Left  :  Surg  C.  S.  Wood,  6>ith  N. 

35'J 

Evans,    H.,    Serg't,    E, 

Mav  5, 

Right.     Died  May  6,  1864. 

New  York. 

16,  '62. 

York.     Died  Dec.  19,  1862. 

12th  Massachusetts. 

5.  '64. 

405 

King,  T.  II.,  Corp'l,  C, 

Oct.  19, 

Circular.     Died;  tetanus. 

360 

Fortna,    H.  A.,  It.,  D, 

Mar.  19, 

Left.    Died  May  4,  1865  ;  exhaus 

12th  N.  C.,  age  19. 

19,  '64. 

16th  Illinois,  age  20. 

19,  '65. 

tion. 

406 

Kirkpatrick.  E.,  Pt.,  A, 

Dec.  16, 

Left:  ant.  post,  flap:  Surg  11.  11. 

361 

French,  J.,  Pt.,  C,  53d 

June  27, 

Right;    Surg.  A.  C.   Messenger, 

16th  Ohio,  age  31. 

16,  '64. 

Breed,  U.  S.  V.     Died  Deo.  17, 

Ohio. 

27,  '64. 

57th  Ohio.    Died  July  1,  1864. 

1864  :  exhaustion. 

362 

French,  D.,  Pt.,  F,  81st 

May  16, 

Left.     Died  June  8,  1864. 

407 

Knox,  S.,  Pt.,   C,   28th 

July  20, 

Left.     Died  August  22,  1864. 

•Ohio. 

16,'  "64. 

Pennsylvania. 

20,"  '64. 

363 

Gaston,  T.,  Pt.,  E,  8Pth 

June  1, 

Died  June  3,  1864. 

408 

Lackey,  J.,  Pt.,  C,  21st 

May  5, 

Right  ;  Surg.  P.  E.  Hubon,  28th 

Illinois. 

1,  '64. 

Mass.,  age  39. 

6,  '64. 

Massachusetts.      Died  June  1, 

364 

Geary,  C.  M.,  Corp'l,  M, 

April  7, 

Right.     Died  April  15,  1865. 

18(i4  ;  pyaemia. 

1st  Maine  Cav.,  age  23. 

7,  '65. 

409 

Lake,  C.,   Pt.,  A,  102d 

Sept.  17, 

Right.    Died  September  29,  1862. 

305 

Gillsen,  A.,  I't.,   F,  7th 

Feb.  21, 

Asst.  Surg.  B.  Norris,  U.  S.  A. 

New  York. 

17,  '62. 

Infantry. 

22,  '62. 

Died  Feb.  22,  1862. 

410 

Lamson,  W.  H.,  Pt.,  C, 

May  9, 

Right  :  skin  flap  ;  circular.    Died 

366 

Gilbert,  'W.,  It.,  D,  23d 

July—, 

Left.     Died  August  15,  1863. 

6th  Maine,  age  23. 

9,  '64. 

J  une  (i,  18(54. 

South  Carolina. 

—,"'63. 

411 

Langelle,  L..  It.,  H,7th 

June  17, 

Circular;    pyaemia.     Died   July 

367 

Girrior,     IF.,     I't..     K, 

April  2, 

Died  April,  1865. 

Missouri. 

17,  '63. 

7,  1863. 

Dawsou's  Artillery. 

2,  '65. 

412 

Laughner,    A.,    Pt.,   F, 

Nov.  12, 

Right;  oval   flap;    Surg.   J.  W. 

368 

Glqver,   W.,  It.,  A,  16th 

De.31,'62, 

Right.     Died  January  7,  1863. 

18th  Penn.  Cavalry. 

12,  '64. 

Smith,  2d  Ohio  Cavalry.     Died 

or  25th  La.,  age  21. 

Jan.  1,  '63. 

Dec.  22,  1864  ;  pyaemia. 

369 

Good,   F.,   It.,    15,   llth 

May  12, 

>•  Right.     Died  June  19,  1864. 

413 

Leary,    T.,   Pt.,    I,   5th 

Feb.  21, 

Asst.  Surg.   B.  Norris,  U.  S.  A. 

New  Ilatnp..  age  19. 

12,  '64. 

Infantry. 

22,  '62. 

Died  Feb.  22,  1862. 

370 

Grice,S.M.,  I't.,  A,  27th 

June  15, 

Right  ;  ant.  post,  flap;  Asst.  Surg. 

414 

Leech,  j..  It.,   A,   82d 

Sept.  21, 

Right.     Died  Oct.  S,  '64  ;  shock. 

South  Carolina. 

17,  '64. 

W.  F.  Richardson.C.S.A.  Died 

Penn.,  age  42. 

21,  '64. 

Juno  18,  1864;  exhaustion. 

415 

Leonard,  S.  H.,  Pt.,  A, 

Sept.  19, 

Right,    Died  September  24,  1864. 

371 

Griffin,   T.,   I't.,   15,   6th 

July  27, 

Right  ;  circ.;  Surg.  C.  E.  Swezey, 

3d  Massachusetts. 

19,  '64. 

Kansas  Cavalrv. 

27,  '64. 

U.S.V.  Died  July  29/64  ;  shock. 

416 

Linerman,    H.,    Pt,   G, 

July  28, 

Left  ;  circ,;  Act.  Staff  Surg.  C.  B. 

37:2 

Groat,  P.,  It.,  11,   14th 

Mav  18, 

Right  ;  flap.     Died  June  14,  '64  ; 

37th  Ohio,  age  33. 

28,  '64. 

Richards.  Died  Aug.  4,  1864. 

Iowa,  ago  25. 

18,"  '04. 

typho-malarial  fever. 

417 

Long.  F.  M.,  Major,  45th 

July  12, 

Right.    Died  July  12,  1863. 

373 

Gusler,  W.,  Pt..  F,  60th 

Sept.  1, 

Left.    Died  September  3,  1864. 

Illinois. 

12,  '63. 

Illinois. 

1,  '61. 

418 

Long,  R.,  Serg't,  H,  24th 

June  16, 

Left  ;  circ.    Died  July  23,  1864. 

374 

Guilford,  II.,  Corp'l,  F, 

Dec.  13, 

Left.     Died  December  15,  1862. 

N.  Carolina,  age  23. 

16,  '64. 

Spec.  1685. 

Kith  Maine. 

13,  '62. 

419 

Lothian,    J.,   Capt.,    C, 

June  16, 

Left  ;  lat.  flap  ;  Surg.  J.  W.  Wis- 

370 

Iladdike,  L.,  Serg't,  I, 

Aug.  13, 

Left  ;  Surg.  A.  Van  Devere,  66th 

24th  Mich.,  age  27. 

16,  '64. 

hart,   140th   Penn.     Died  July 

60th  New  York. 

13.  '64. 

N.  Y'.     Died  August,  1864. 

12,  1864. 

376 

Hall,  .}.  C.,  It..  A,  20th 

Sept.  30, 

Right.  Oct.  llth,  diarrhoea.  Died 

420 

Luderking,    R.,   Corp'l, 

Nov.  29, 

Right;  Surg.  G.  B.  Cogswell,  29th 

Maine,  ago  37. 

Oct.  1,  '64. 

Oct.  21,  1864. 

A,  2d  Michigan. 

29,  '63. 

Mass.    Died  Dec.  3,  1863. 

377 

Ilannan,   J.  H.,  Serg't, 

May  18, 

Left.    Died  June  6,  1864  ;  irrita 

421 

Lynch,   W.  M.,   Serg't, 

June  3, 

Right;  Surg.  J.  A.  Spencer,  69th 

K,  9th  Maine,  age  21. 

18,  '64. 

tive  fever. 

A,  69th  New  Y'ork. 

3,  '64. 

New  Y'ork.     Died  June  8,  1864. 

378 

Hartland,  A.,  Corp'l,  A, 

June  —  , 

Left;  circ.:  Surg.  J.  Wilson.  99th 

422 

Mace,  W.  H.,  Corp'l,  D, 

July  22, 

Left.     Died  July  23,  1864. 

S)9th  New  York. 

—  ,  '63. 

N.  Y'.     Died  June  24,  1863. 

3-d  Maine. 

22,"  '64. 

379 

Homphill,     D.,    It.,    E, 

July  2, 

Right;    July  20th,  gang.     Died 

423 

Maders,  W.  C..  Pt.,  G, 

Mav  8, 

Right.     Died  June  3,  1664  ;  py 

72d  I'enn.,  age  26. 

4,  '63. 

Aug.  20,  1863;  pyaemia. 

83d  New  Y'ork,  age  30. 

9,  '64. 

aemia. 

380 

Hensey,  J.  if.,  It.,  H, 

Aug.  31, 

Left  ;  Surg.  A.C.  Messenger,  57th 

424 

Mahan,  M.,  It.,  A,  12th 

Dec.  13. 

Left  ;  flap.     Died  Dec.  —  ,  1862. 

50th  Illinois. 

31.  '64. 

Ohio.     Died  Sept.  6,  18(54. 

Massachusetts. 

13.  '62. 

381 

Hewitt,  L.   T.,   I't.,  M, 

Muv  14, 

Left.  Died  May  22,  1864  ;  exhaus 

425 

Marsh,  J.,  2d  Lieut.,  I, 

July  1, 

Right.     Died  July  4,  1863. 

(ith  Peiin.  Cavalry. 

14,"  '64. 

tion. 

29th  Ohio. 

1,  '63. 

382 

Hills,    W.,    Pt.,    D,    2d 

Nov.  24, 

Left;  Surg.  G.  B.Cogswell,  20th 

426 

Martin,  A.  B..  Capt.,  H, 

Mav  5, 

Left.     Died  May  5,  1864. 

Michigan. 

24,  '63. 

Mass.     Died  Dec.  22,  1863. 

6th  Maryland. 

5,  '64. 

383 

Hoffman,  A.,  It.,  I,  57th 

Jan.  11, 

Right;    Surg.  M.  F.  Carey,  48th 

427 

Mason,  A'.  J.,  Capt.,  H, 

Dec.  13, 

Left.   Died  Jan.  12,  '64  ;  pyaemia. 

Ohio. 

11,  '63. 

Ohio.     Died  Jan.  13,  1863. 

145th  Penn.,  age  30. 

13,  '62. 

384 

Holmes,  J.,  It.,  II,  9th 

May  5, 

Right.     Died  May  8,  1864. 

428 

Mathias.  L.,  It..  C,  107th 

Mar.  16, 

Left;  flap.     Died  May  6,  1865. 

Massachusetts. 

5,  '64. 

New  York,  age  38. 

16,  '65. 

385 

Howard,  G.  J.,  Serg't, 

Mar  25, 

Left.     Died  April  2,  1865. 

429 

May,  J.,  Corp  1,  H,  6th 

Mav  14, 

Died  May  14,  1864. 

G,  5th  Vermont. 

25,  '65. 

Wisconsin. 

14,'  '64. 

386 

Howard.  W.,  It  ,  K,55th 

July  3, 

Left.     Died  July  22,  1863. 

430 

Mayo,   J.,  It.,   C,   44th 

Oct.  2. 

Right;  Surg.  A.  A.  White,  8th 

North  Carolina. 

3,  ''63. 

North  Carolina. 

2,  '64. 

Md.     Died  Oct.  4,  1864. 

1  BUTLER  (W.  If.),  Kcmarl.-s  on  tetanus,  with  histories  of  nine  cases,  in  Am.  Med.  Times.  1P63,  Vol.  7,  p.  108 

*  BRYAN  (J.),  Sixteen  cases  of  Amputation  treated  in  hospital  at  Grand  Gulf,  Jtiss.,  in  Am.  Jlcd.  Times,  1863,  Vol. 


90-7 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OrEK.vnoxs,  OPEKATOISS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

431 

McDonald,    1'.,    1't.,  K, 

Sept.  19, 

Right  ;    circular.     Died   October 

474 

Rider,   J.,    Pt.,    A,    8th 

Sept.  19, 

Left  ;  circ.    Died  October  22,  "63  ; 

f-th  Kansas,  age  30. 

20,  '63. 

12,  J  863;  haemorrhage. 

Kansas,  age  37. 

20,  '63. 

pyaemia. 

432 

McDonald.    II..    Corp'l, 

Sept.  1, 

Right  ;  ant.  post.  flap.   Died  Nov. 

475 

Riley,  J.,  Pt.,    B,   llth 

Mar.  29, 

Left.     Died  April  1,  1865. 

15,  98th  Ohio,  age  3'.). 

1,  '64. 

24,  1864  ;  exhaustion. 

New  Jersey. 

29,  '65. 

433 

McFarland,  G.,  Pt.,  B, 

Dec.  13, 

Died  December  12,  1862;  shock 

476 

Riley,    O.,  "Pt.,    M,   2d 

Sept.  13, 

Right.    Died  September  33,  186.'  . 

13th  Indiana. 

12,  '62. 

and  haemorrhage. 

New  York. 

13/63. 

434 

McGany,  J.  E.,  1't.,  I?, 

June  16, 

Right:  ant.  post,  flap;  Surer.  D. 

477 

Rinker,  G.  W.,   Pt.,   B, 

July  27, 

Right  :  circ.;  Surg.  C.  E.  Swezev, 

105th  IJenn.,  age  21. 

16,  '64. 

S.  Hays,  110th  Penn.  Died'  J  uly 

6th  Kansas  Cavalry. 

28,  '64. 

U.8.V.  Died  July  29.'04  ;  shook. 

17,  1864. 

476 

Rupert,  J.  F.,  Corp'l,  K, 

May  12, 

Died  May  13,  1864". 

435 

McMorris,    M.,    Pt.;   B, 

May  5, 

Left.    Died  May  30,  '64  ;  pyaemia. 

2-lth  Michigan. 

12/64. 

124th  N.  Y.,  age  18. 

5,  '64. 

479 

Ryan.  T.,  Pt.,  E,  127th 

June  27, 

Right  ;    Surg.  A.  C.  Messenger, 

436 

Mead,  J.  P.,  Pt.,  I,  llth 

July  21, 

Died  July  23,  1861  ;  under  opera 

Illinois,  age  23. 

27,  '64. 

57th  Ohio.    Died  Aug.  9,  1864. 

Massachusetts. 

23,  '61. 

tion. 

480 

Salmoud,  K.,  Pt.,G,74th 

July  22, 

Left.    Died  July  30,  1864. 

437 

Miller,    W.,    Corp'l,    B, 

June  27, 

Right.     Died  July  6,  1864. 

Ohio. 

22,'  '64. 

85th  Indiana. 

27,  '64. 

481 

Sanderson,  J.  K.,  Pt.,  F. 

May  5, 

Right  ;   Surg.  G.  T.  Stevens,  77th 

438 

Montgomery,  J.  P.,  Pt., 

Aug.  21, 

Left;  ant.  post,  flap;  Surg.  J.  W. 

37th  Massachusetts. 

5,  '64. 

N.  V.    Died  May  12,  '05  ;  gang. 

B,  10th  Inia'ry,  age  18. 

21,  '64. 

Anawalt,  llth  Penn.  Died  Sept. 

482 

Schmidt,  F.,Pt.,D.118th 

Sept.  20, 

Left.    Died  September,  1802. 

10,  1864  ;  pyaemia. 

Pennsylvania. 

—  ,  '62. 

439 

Moore,  J.  N.,  Pt.,  F,  5th 

May  14. 

Left.     Died  May  17,  1864. 

483 

Schrafenberger,  P.,  Pt., 

Sept.  19, 

Right.    Died  October  13,  186:!. 

Tennessee,  age  40. 

14,  '64. 

A,  9th  Ohio. 

19,  '63. 

440 

Morgan,  G.  C.,   Serg't, 

July  —  , 

Asst.  Surg.  R.  L.  Von  Haiiingen, 

484 

Seaman,    H.  J.,  Pt.,  E, 

Nov.  27, 

Left;  Surg.  S.  C.  Phimmer,  13th 

D.  48th  Illinois. 

—  ,  '63. 

53d  Ohio.     Died  July  18,  1863. 

13th  Illinois. 

27,  '63. 

111.    Died  Nov.  27,  1803. 

441 

Mulligan.  T.  H.,  Pt.,  A, 

July  2, 

Left.    Died  July  14,  '64  ;  tetanus. 

485 

Seevers,  R.  D.,  Pt.,  K, 

July  25, 

Right  ;   lat.  flup.      Died  October 

14th  Infantrv,  age  30. 

4,  '63. 

36th  Ohio,  age  43. 

25,  '64. 

20,  1864  ;  exhaustion. 

442 

Murray,  M.,  Pt.,  I,  149th 

July  20, 

Left;   circ.;   Surg.   C.   H.   Lord. 

486 

Sharp,    I).,   1't.,   A,  7th 

Sept.  14, 

Died  September  15,  1862. 

New  York. 

20,  '64. 

102d  New  York.    Died  July  21, 

Penn.  Reserves. 

15/62. 

1864  ;  haemorrhage. 

487 

Shepard,  H.  B.,  Pt.,  F, 

May  5, 

Right  ;  circ.    Died  June  12,  1804  ; 

443 

Myers.  S.  C.,  Corp'l,  F, 

July  2, 

Left.     Died  July  28,  1863  ;  haem 

95th  New  York,  age  21  . 

6,  '*64. 

pyaemia. 

70th  N.  Y.,  age  24. 

3,  'ti3. 

orrhage. 

488 

Sherman,   E.,  Corporal, 

July  28, 

Right  ;  flap.    Died  July  29,  1804. 

444 

A'elms.    W.  F.,   Pt.,  B, 

July  3, 

Right.     Died  July  9,  1863. 

Young's  Bat'ry,  age  43. 

28,  '64. 

5th  Texas. 

3,  '63. 

489 

Sherman,  M.,Pt.,G,  28th 

Sept.  17, 

Left.     Died  October  5,  1  802. 

445 

Noonan,  C.,  —  ,  F,  18th 

Sept.  14, 

Amp.;  sloughing.     Died  August 

Pennsylvania. 

17,  '62. 

New  York. 

15,  '62. 

8,  1863. 

490 

Shields!  T.,  Pt.,  H,  99th 

July  3, 

Right.    Died  July  5,  1863. 

440 

Nye,  G.  W.,  Serg't,  H, 

Aug.  30, 

Right.     Died  September  5,  1862. 

Pennsylvania. 

3,  '63. 

3d  Maine. 

30,  'C2. 

491 

Shrine^J.  T..Pt.,G,83d 

May  27, 

Died  June  10,  1862. 

447 

O'Hagan.  M.  P.,  Serg't, 

Aug.  12, 

Left  ;  Surg.  E.  Bentley,  U.  S.  V. 

Pennsylvania. 

27,''02. 

C.  ItithN.  York  Heavy 

12,  '65. 

Died  August  23,  1865;  haemor- 

492 

Slaine,  P.  S.,  Pt..H,  10th 

Feb.  8, 

Died  February  10,  1862. 

Artillery,  ago  22. 

rhage. 

Connecticut. 

8,  '62. 

448 

Ormsby,  U.,  Pt.,  G,  64th 

July  2, 

Right.     Died  July  16,  1863. 

493 

Smith,  J.,  Serg't,  K,  7th 

June  2, 

Left.     Died  August  22,  1864  ;  ex 

New  York. 

2,  '63. 

Connecticut,  age  29. 

2,  '64. 

haustion. 

449 

Osborn,    L.,   Pt.,  G,  3d 

May  17, 

Right;    circ.     May  22d,  haemor 

494 

Smith,  J.  W.,  Serg't,  H, 

April  6, 

Right.  Died  May  2,  '05;  pya?mia. 

New  York  Cav.,  age  27. 

18,  '64. 

rhage.     Died  May  27,  18(14. 

48th  N.  C.,  age  2"-.'. 

7,  '65. 

400 

Page,  J.  L.,  Corp'l,  H, 

Sept.  17, 

Right;  Surg.  C.  S".  Wood,  (Kith 

495 

Smith,  N.,  Pt.,  A,  39th 

April  2, 

Right;  circ.:  Surg.  C.  M.  Ciark, 

00th  N.  York,  age  33. 

17,  '62. 

N.  Y.     Died  October  10,  1862. 

Illinois. 

2,  '65. 

39th  111.    Died  April  4,  1H05. 

401 

Partridge,  P.  S-.  Pt.,  D, 

June  3, 

Circ.:  Surg.  Taley.     Died  June 

496    Smith,  T.,  Pt.,  34th  Cl'd 

Dec.  9, 

Left.     Died  December  23,  1  £64. 

26th  Mississippi. 

5,  '04. 

10,  1864. 

Troops.                                 9,  "64. 

452 

Parker,  W.  S.,  Pt,,  C,  1st 

May3, 

Right.     Died  May  3,  1863. 

497 

Soper,    J.,  Pt.,   C,   16th 

Dec.  13, 

Left.    Died  December  26,  1862. 

U.  S.  Sharpshooters. 

3,  '63. 

Maine. 

13,  '62. 

153 

Parker,  M.,  Pt.,  A,  5th 

Oct.  19, 

Right,     Died  October  21,  1864. 

4i»8 

Sperioer,  G.  E.,  Pt.,  A, 

Nov.  27, 

Left.    Died  December  21,  1803. 

Vermont. 

20,  '64. 

7th  Ohio. 

27,  '63. 

454 

Paul.W.,  —  .  C,  7th  Wis 

July  1, 

Circ.     Died  July  6,  1863. 

499 

Stiene.S.  P.,Pt.,K,  100th 

May  12, 

Right  ;  Surg.  T.  F.  Oakes,  50th 

consin. 

1,  '63. 

Penn.,  age  22. 

12,'  '64. 

Mass.    Died  May  30.  1864. 

455 

Pwkins,  J.  W..  Pt.,  F, 

June  5, 

Left  ;  Asst.  Surg.  J.  T.  Wharton, 

500 

Stood,   M.,  Pt.,  C,  14th 

Mar.  19, 

Left.     Died  March  21,  1865. 

(itli  West  Virginia. 

5,  '63. 

6th  W.Virginia  Cav.,  and  others. 

Michigan. 

21,  '65. 

Died  June  5,  18C3. 

501 

Strong,  L..  Serg't,  A.  9th 

Sept.  13, 

Right.     Died  September  16,  '04  ; 

450 

Perrin,  W.,  Pt.,  T,  158th 

April  2, 

Right:   Asst.  Surg.  C.  G.  Allen, 

N.  York  Cav.,  age  23. 

13,  '63. 

pyaemia. 

New  York,  age  26. 

2,  '(i5. 

34th  Mass.    Died  April  13,  '65  ; 

502 

Stuart,   S.,   Pt.,   F,  31st 

July  30. 

Right:  circ.;  Surg.  F.  M.  Weld, 

pyaemia. 

Colored  Troops. 

30/64. 

27th  C.  T.    Died  Aug.  —  ,  1804. 

457 

Pettigrew,  A.  J.,  Pt..  C, 

July  2, 

Right.     Died  July  13,  1863. 

503 

Sulfrise,  C.  A.,  Pt.,  6th 

Aug.  6, 

Left;  Surg.  A.  M.  Wilder,  U.S.V. 

11  th  Penn.  Reserves. 

3,  '63. 

Tenn..  age  20. 

6,  '64. 

Died  Sept.  3,  1864. 

458 

Potter,  W.,  Pt.,  B,  29th 

May  8, 

Left;  circ.;  Surg.  A.  K.  Fifield. 

504 

Sullivan,  D.,  Pt.,  B,  63d 

Deo.  13, 

Left.    Died  January  3,  1863. 

Ohio,  age  22. 

8,  '64. 

29th  Ohio.     Died  July  6,  1864  ; 

New  York. 

13,  '62. 

diarrho?a. 

505 

Slimmer,  G.,  Corp'l,  K. 

May  12, 

Left.    Died  May  14,  1864. 

459 

Poust,  W.t  Pt.,  K,  51st 

Aug.  19, 

Right;  circ.     Died  Sept.  10,  '64  ; 

20th  Michigan. 

12,'  '64. 

Penn.,  age  29. 

19,  '64. 

erysipelas. 

506 

Thomas.   A.,  Pt.,  C,  2d 

Feb.  5, 

Left;  circ.:  Surg.J.G.F.Uolston, 

460 

Pratt,  E.  C.,  Lieut.,  G. 

Sept.  29, 

Right.  Died  Dec.  15,  '64;  pyaemia. 

Tennessee  C.  T. 

6,  '04. 

U.  S.  V.    Died  Feb.  29.  1864. 

6th  Cl'd  Troops,  age  24. 

29,  '64. 

507 

Van  Buren,  M.,  Pt.,  II, 

June  28, 

Left.    Died  July  6,  1864. 

461 

Preston,    Y.  P.,  Pt.,  C, 

May  15. 

Died  June  8,  1864. 

59th  Ohio. 

28,  '64. 

42d  Alabama. 

15,  '64. 

508 

Waffle,  W.,  Pt.,  F,  14th 

July  11, 

Right;  flap;  Surg.  T.  F.  Oakes, 

462 

Preston,  J.  W..  I't.,  F, 

June  18, 

Right;  circ.;  Surg.  J.  W.  Brook, 

New  York  H'vy  Art., 

11/64. 

50th  Mass.    Died  Sept.  26,  1864  ; 

147th  Penn.,  age  29. 

19,  '64. 

(Kith  Ohio.    Died  Aug.  29,  1864  ; 

nee  30. 

pyaemia. 

diarrhoea. 

509 

Ward,  F.,   Pt.,  G,  45th 

Feb.  7, 

Lei't  :  circ.;  Surg.  N.  Falsom,  45th 

4(i3 

Prescott,  C.,  Pt.,  G,  51st 

June  2. 

Left.     Died  June  4,  1864. 

Colored  Troops. 

7    '65. 

Cl'd  Troops.    Died  Feb.  19,  '05. 

Pennsylvania. 

2,  '64. 

510 

Walters,   J.   R.,  Pt.,  I. 

July  3, 

Left.    Died. 

464 

Purdy,    H.,    Pt.,   C,  2d 

July  1, 

Right.  Died  September  11,  1863; 

52d  North  Carolina. 

3,  '03. 

Penn.  Battery,  age  33. 

1,  fe. 

pyaemia. 

511 

Warren,  J.  11.,   Pt.,  D, 

May  15, 

Died  May,  1864. 

465 

llanner,  W.,  Pt.,  F,  3d 

Mar.  19, 

Right.     Died  March  25,  1865. 

42d  Georgia. 

15/64. 

Florida. 

19,  '65. 

512 

Watson,  G.  M.,  Pt.,  D. 

May  J4, 

Right  :  gangrene.     Died  May  22, 

466 

Kalhlone     L.,    Pt.,    C, 

Dec.  J, 

Left  ;  circ.     Died  Dec.  2,  1864. 

63d  Indiana. 

14/64. 

1864. 

25th  N.  C  ,  age  20. 

1,  '64. 

513 

Wciler..T.,  Corp'l,  K,40th 

May  24, 

Right.    Died  May  31,  1864  ;  haem 

467 

Reaghton.  W  ,    I:t.,   G, 

Mar.  25, 

Right.     Died  March  25,  1865. 

New  York,  age  SO. 

24,  '64. 

orrhage. 

67th  Pennsylvania. 

25,  '65. 

514 

Wheeler.A.  R..  Corp'l,  I, 

June  16, 

Left.     Died  July  20,  1864, 

468 

Reed,  J.  M.',  Serg't,  B, 

May  12, 

Left.     Died  May  12,  1864. 

9th  N.  Hamp.,  age  21. 

16/64. 

24th  Michigan. 

12,  '64. 

515 

Whipple,  R.  G.,  Corp'l, 

Aug.  19, 

Left  ;  flap.     Died  August  25,  '64  ; 

469 

Reynolds,  J.,  Pt.,  C,  1st 

April  5. 

Left.     Died  April  5,  1862;  shock. 

K,  2'lth  Mich.,  age  41. 

20,  '64. 

haemorrhage. 

Rhode  Island  Artil  ry. 

5,  '62. 

516 

White,  P.,  Pt.,  A,  35th 

June  ](), 

Left;   Surg.  H.  G.  Averdiok,  35th 

470 

Rice,  A.,  Pt.,  G,  lllth 

June  19, 

Left  ;  circ.:  Surg.  J.  W.  Wishart, 

Indiana,  age  27. 

]()/64. 

Ind.     Died  July  12,  1*64. 

New  York,  age  21. 

19,  '64. 

140th  Penn.     Died  June  29,  "64  ; 

517 

White,W.,Pt.,I,  3d  Wis 

Mar.  16, 

Lett:    Asst.  Surg.  G.  W.  Burke, 

exhaustion. 

consin. 

](),  '65. 

46th  Penn.     Died  March  17.  '65. 

471 

Rice,  J.  C.,  Brig.  Geivl 

May  10, 

Died  May  10,  1864. 

518 

Whitehead,    F.,    Pt.,  I, 

May  12, 

Died  May,  J  864. 

U.  S.  V.,  5th  A.  C. 

10,  '64. 

97th  New  York. 

12,  '64. 

472 

Richardson.  A.  C.,  Serg't, 

July  30, 

Right:  flap;  Surg.  T.  F.  Oakes, 

519 

Whitney,  G.  P.,  Pt.,  II, 

May  5, 

Left  ;  Surg.  D.  W.  Maull,  1st  Del 

A,  59th  Mass. 

30,  '64. 

56th  Mass.    Died  July  30,  1864. 

6th  Vermont. 

5,  '64. 

aware.    Died. 

473 

Richardson.   T..   Pt.,  II, 

Mar.  16, 

Right  :  cire.:  Surg.  C.'  M.  Clark, 

520 

Wicks,  A.,  Pt.,  G,  14th 

May  10, 

Right;  Surg.  G.W.  McCune,  14th 

llth  West  Virginia. 

16,  '64. 

39th  111.     Died  March  18,  1864  ; 

Indiana. 

K>,  '64. 

Ind.    Died  May  12,  1864. 

shock  and  exh'n.     Spec.  5656. 

SECT.  III.J 


PRIMARY    AMPUTATIONS    OF    THIGH    IN    MIDDLE    THIRD. 


223 


No. 

NAME,  MILITARY 
DESCKUTIOX,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

521 
522 

523 

Wiley,  J.,Corp'l,  K,  40th 
New  York. 
Willey,  H.,  Pt.,  E,  46th 
New  York,  age  28. 

Williams,  E.,  I't.  ,E.  80th 

May  24, 
25,  '64. 
June  17, 
17,  '04. 

Oct.  8, 

8  '6° 

Right;  Surg.  H.  F.  Lyster,  5tb 
Mich.    Died  May  31,  1664. 
Left;  eirc.;  Surg.  W.  C.  Shnrlock, 
61st  Pcnn.     Died  July  12,  1864  ; 
pyeinia. 
Died  October  10,  1862. 

527 
528 
529 
530 

Winsket,  A.,  Pt.,G,  123d 
Indiana. 
Wright.  J.  If.,  Lieut.,  D, 
5th  Virginia. 
Craifi,  J.  C.,  Pt.,  E,  44th 
Mississippi,  age  28. 
Frayer  T  J   I't    I  4(lth 

June  16, 
10,  '64. 
Mar.  25, 
25,  '65. 
July  28, 
S8,  '64. 

Right  ;  Surg.  A.  M.  Wilder,  U.  S. 
V.    Died  June  23,  1864  ;  shock. 
Left.     Died  March  27,  1865. 

Right  ;  ant.  post.  flap. 

524 
525 
520 

Williams,  .1.  15..  I't.,   A, 
14th  N.  Y.  II.  Art'y. 
Williams,  W.  II.,  Serg't, 
D,  l"th  Mississippi. 
Wilson,  J.,  I't.,  15,  5th 

Aug.  5, 
5,  '04. 
July  3, 
3,  '03. 
July  2, 
4  '03 

Right  ;  flap  :  Surg.  T.  F.  Oakes, 
50th  Mass.    Died  Aug.  0,  1804. 
Right.     Died. 

Right:    flap.     July  15th,  haem.,  ! 
\\"  fern     Died  July  °!5  lSf>") 

531 
532 
•533 

Virginia. 
Hawkins,  G.  W.,  Lieut., 
TI,  30th  Mississippi. 
Ilennesy,     W.,    Citizen, 
Confederate. 
Whitney  F.    Pt    A  44th 

2,  '64. 
Aug.  31, 
—  ,  '64. 
July  —  , 
—,''63. 
May  19 

Left:  also  wound  right  ;  Surg.  A. 
Sabino,  76th  Ohio. 
Surg.  C.  H.  Richards,  30th  Ohio. 

Georgia. 

—  ,  '64. 

In  two  hundred  and  five  of  the  five  hundred  and  thirty-three  cases  enumerated  in 
the  foregoing  table  the  precise  seat  of  fracture  in  the  femur  was  not  indicated.  In  the 
remaining  three  hundred  and  twenty-eight  cases  the  fracture  was  in  the  upper  third  of  the 
femur  in  sixty-six,  in  the  middle  third  in  one  hundred  and  seventy,  in  the  lower  third  in 
fifty,  at  the  knee  joint  in  thirty-seven,  and  in  the  leg  in  five  instances. 

Primary  Amputations  in  the  Middle  Third  of  the  Femur. — There  were  eleven  hun 
dred  and  fifty-seven  of  these  operations.  The  results  were  ascertained  in  eleven  hundred 
and  forty-nine  cases;  six  hundred  and  eighty-six  were  successful,  and  four  hundred  and 
sixty-three  proved  fatal,  a  mortality  of  40.3  per  cent.  The  operations  were  on  the  right  side 
in  five  hundred  and  forty-four,  and  on  the  left  in  five  hundred  and  thirty-four  instances;  in 
seventy-nine  cases  the  side  was  not  specified. 

Recoveries  after  Primary  Amputation  in  the  Middle  Third  of  the  Femur. — The  six 
hundred  and  eighty-six  operations  of  this  group  were  performed  on  one  hundred  and  forty- 
five  Confederate  and  five  hundred  and  forty-one  Union  soldiers.  Of  the  latter,  two  have 
become  insane,  one  was  retired,  and  five  hundred  and  thirty-seven  were  pensioned;  in  one 
instance  no  application  for  pension  seems  to  have  been  made. 

CASE  434. — Private  J.  Kells,  Co.  I,  113th  Ohio,  aged  44  years,  was  wounded  at  Jonesboro',  September  1,  1864.  He 
was  admitted  to  the  field  hospital  of  the  2d  division,  Fourteenth  Corps,  whence  Surgeon  W.  C.  Daniels,  U.  S.  V.,  reported: 
"Shot  fracture  of  right  thigh  at  middle  third  by  a  mini6  ball ;  limb  amputated."  From  the  field  hospital  the  patient  passed  to 
Chattanooga,  thence  to  Cumberland,  Nashville,  and  afterwards  to  Brown,  Louisville,  from  which  hospitals  his  case  was  described 
as  an  "antero-posterior  flap  amputation  of  the  thigh  at  the  middle  third."  He  was  discharged  from  service  at  Camp  Dennison 
March  21, 1865,  and  supplied  with  a  Palmer  artificial  leg  four  months  afterwards.  He  became  a  pensioner,  and  has  been  paid  as 
such  June  4,  1879.  In  his  application  for  commutation  he  represented  the  stump  as  "healed  and  sound,"  and  stated  that 
Surgeon  T.  B.  Williams,  121st  Ohio,  performed  the  amputation. 

In  the  following  instance  a  large  sequestrum  was  removed  from  the  stump  of  the 
femur  three  months  after  the  amputation: 

CASE  435. — Private  J.  McMahon,  Co.  I,  6th  New  York  Cavalry,  aged  23  years,  was. wounded  in  the  left  leg,  at  Todd's 
Tavern,  May  7,  1864.  He  was  admitted  to  a  field  hospital  of  the  Cavalry  Corps,  where  amputation  was  performed  but  not 
recorded,  and  five  days  afterwards  he  was  transferred  to  Washington.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  made  the 
following  report  of  the  case:  "The  wound  was  caused  by  a  musket  ball,  which  caused  a  fracture  of  the  femur  extending  into 
knee  joint,  for  which  amputation  was  performed  at  the  middle  third,  by  the  circular  method,  within  an  hour,  chloroform  being 
used.  He  was  admitted  to  Douglas  Hospital  May  12th,  at  which  time  a  large  slough  existed  on  the  anterior  flap,  which  soon 
separated,  exposing  the  end  of  the  bone.  There  was  no  vigorous  effort  at  repair,  the  granulations  being  pale  and  flabby.  The 
patient's  general  condition  was  unfavorable;  he  was  much  depressed  and  very  pallid,  and  had  a  severe  diarrhoea.  On  June 
20th,  the  cellular  tissue  of  the  stump  again  began  to  slough,  and,  on  the  22d,  it  was  found  requisite  to  apply  pure  bromine.  On 
the  23d  most  of  the  sloughs  separated,  and,  by  the  next  day,  the  stump  was  clean  and  the  granulations  more  florid  and  healthy. 
One  inch  and  a  half  of  the  end  of  the  femur  was  in  a  state  of  necrosis  and  protruding.  On  August  llth,  a  sequestrum,  nine 
inches  in  length,  was  removed  by  extraction,  leaving  a  deep  cavity  in  the  stump,  which  was  bounded  externally  by  a  large  and 
firm  cylinder  of  new  bone.  The  patient's  improvement  was  then  rapid,  and,  by  November  1st,  he  was  considered  convalescent. 
This  man  had  remained  for  weeks  MS  ]»:>!<>  :••<  denth  and  so  feeble  as  to  be  unable  to  lift  his  head  from  his  pillow.  He  seemed 
daily  on  the  verge  of  the  chill  of  pyujmi.i,  and  his  case  was  recognized  and  pointed  out  as  one  of  osteomyelitis  of  the  femur,  from 
which — if  death  did  not  result— a  long  exfoliation  would  be  removed."  On  May  18,  1865,  the  patient  was  discharged  from 


224 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


service,  and  several  weeks  after  he  was  furnished  with  an  artificial  limb  by  the  firm  of  A.  A.  Marks,  of  New  York  City.  In  his 
application  for  commutation,  dated  1870,  the  pensioner  stated  that  the  amputation  was  performed  by  Assistant  Surgeon  S.  C. 
Sanger,  6th  New  York  Cavalry,  also  that  the  stump  was  in  a  healthy  condition.  The  pensioner  was  paid  June  4,  1879.  The 
sequestrum  (Spec.  4281)  was  contributed  to  the  Museum  by  Dr.  Thomson,  and  is  shown,  reduced  in  size  one-third,  in  FlG.  4  of 
PLATE  LXIX,  opposite. 

Amputation  of  the  right  thigh  in  the  middle  third  and  of  the  left  leg  at  the  knee  joint 
was  successfully  performed  in  the  following  instance: 

CASE  436. — Corporal  C.  N.  Lapham,  Co.  K,  1st  Vermont  Cavalry,  aged  23  years,  was  wounded  during  the  engagement 
near  Boonsboro',  July  8, 1833,  by  a  cannon  ball,  which  carried  away  botli  logs.  He  was  conveyed  to  the  field  hospital  at  Boons- 
boro',  where  both  limbs  were  amputated  two  days  after  the  receipt  of  the  injury. 
Four  months  after  the  operation  the  patient  was  deemed  well  enough  to  be  allowed 
to  go  to  his  home,  where  he  remained  until  the  following  year.  On  May  31,  1834, 
he  was  furnished  with  artificial  limbs  by  Dr.  E.  D.  Hudson,  of  New  York  City, 
who  contributed  the  photographs  represented  in  the  annexed  cuts  (FiGS.  176,  177) 
and  the  following  description  of  the  operation:  "The  right  thigh  was  amputated 
at  the  middle  third,  by  the  antero-posterior  flap  method,  on  account  of  great  com 
minution  of  the  leg  involving  the  knee  joint;  the  stump  is  healed  and  in  a  favor 
able  condition.  The  left  leg  was  disarticulated  at  the  knee  joint.  This  operation 

was  also  performed  by  antero- 
posterior  flaps,  and  the  stump 
is  healed  and  in  good  condi 
tion,  though  the  supporting 
cicatrix  at  the  base  is  not  good. 
The  condyles  of  the  femur,  us 
a  base,  form  the  most  useful. 
reliable,  and  comfortable  sup 
port,  and  constitute  his  chief 
dependence,  and  the  benefits 
of  disarticulation,  when  com 
pared  with  amputations  of  the 
thigh,  are  shown  to  be  incal 
culable."  The  patient  was  dis 
charged  from  Baxter  Hospital, 
at  Burlington,  Vermont,  Aug. 
25, 1864,  and  pensioned.  Five 
months  later,  when  a  student 
at  the  Collegiate  Institute  in 
Poughkeepsie,  N  Y.,  he  wrote 
to  Dr.  Hudson  that  "he  could 
walk  with  ease  on  level  ground, 
get  up  and  down  stairs  readily, 

and  was  getting  along  much  better  than  he  anticipated  in  so  short  a  time."  Some  time  afterwards  he  obtained  an  appointment 
as  clerk  in  the  U.  S.  Treasury  Department  at  Washington,  in  which  occupation  he  is  still  employed.  His  pension  was  paid 
September  4,  1879.  In  his  application  for  commutation  he  reported  that  Surgeon  L.  P.  Woods,  5th  New  York  Cavdry,  was 
the  operator  who  amputated  his  limbs. 

In  thirteen  instances  re-amputation  of  the  thigh  became  necessary,  and  in  fourteen 
cases  the  protruding  ends  of  the  femur  were  removed.  In  the  following,  four  inches  of  the 
extremity  of  the  bone  were  exsected  nearly  seven  months  after  the  amputation. 

CASE  437. — Private  J.  Wearing,  Co.  L,  2d  Pennsylvania  Heavy  Artillery,  aged  20  years,  was  wounded  at  Petersburg, 
June  17,  1864,  and  admitted  to  the  field  hospital  of  the  1st  division,  Ninth  Corps,  where  Surgeon  M.  K.  Hogan,  U.  S.  V., 
recorded:  "Wound  of  left  knee  joint ;  amputation  at  junction  of  middle  and  lower  third  of  thigh."  One  week  after  the  recep 
tion  of  the  injury  the  man  was  transferred  to  Finley  Hospital,  Washington,  and  in  October  following  he  entered  Broad  and 
Cherry  Streets  Hospital,  Philadelphia,  whence  Acting  Assistant  Surgeon  T.  C.  Brainerd  made  the  following  report:  "At  the  date 
of  admission  the  femur  protruded  about  one-fourth  of  an  inch,  and  the  stump  was  healed  to  within  one  inch  of  the  bone.  The 
patient  being  anaemic,  iron  and  quinine  were  administered.  Simple  dressings  were  applied  to  the  stump.  By  November  15th 
his  general  health  had  improved  and  the  line  of  separation  was  forming  around  the  protruding  portion  of  the  bone.  On  Decem 
ber  1st,  the  ulcer  upon  the  stump  presented  a  sloughing  tendency,  but  again  cleaned  up.  On  January  6, 1835,  about  four  inches 
of  the  extremity  of  the  femur  was  exsected  by  cutting  down  upon  it  from  the  outer  anterior  surface  of  the  stump  and  sawing 
through  the  bone  with  a  chain  saw.  The  bone  removed  was  necrosed  and  surrounded  by  a  large  amount  of  reparative  material. 
A  small  artery  spouted  from  the  medullary  canal  of  the  bone,  the  haemorrhage  from  which  was  promptly  controlled  by  pressing 
a  piece  of  soft  wax  into  the  canal.  Three  ligatures  were  applied  and  ether  was  used  The  operation  was  performed  by  Acting 
Assistant  Surgeon  H.  M.  Bellows.  The  patient  reacted  promptly.  Simple  dressings  were  continued  to  the  stump.  Two  days 


FIG.  176.— Araputati 
of  left  leg  at  knee  joint 


i  of  right  thigh  at  middle  third  and 
[From  a  photograph.] 


Fio.  177. — Appearance  of  patient  with  artificial 
gs.     [From  a  photograph.) 


Med.»Suro.  Hist,  of  the  War  of  the  Rebellion,  Part  HI.Vol  II. 


Ward    phot 


T  .Sinclair  ttttm  litli 


PLATE    LXIX.  _TUBULAR    SEQUESTRA    FROM    AMPUTATIONS    OF   THE  FEMUR. 

L   Spec.  l&Vi3._2   Spec  14-1. ._«  Spec-,.  aiOO.   .4  Spco.  4281. 

SiLTgica.1    Section,  Aj-mv  Medical   Museum. 


^^  A  ^-^ 

<^>  o  ••     '•{••;        ^ 

'UNTV^USITy!] 


SECT.  III.] 


.  PRIMARY    AMPUTATIONS    OF    THIGH    IN    MIDDLP^    THIRD. 


225 


.FIG- 

of  right  femur. 
sPec-  412(X 


later  fin  attack  of  erysipelas  supervened,  extending  as  for  up  as  the  groin,  but  yielding  to  treatment,  and  by  January  15th  it  had 
entirely  disappeared  and  the  general  condition  had  much  improved.  One  mouth  later  cicatrization  was  almost  complete,  and  the 
patient  was  walking  about  with  the  aid  of  crutches."  In  April  he  was  transferred  to  South  Street  Hospital,  and  subsequently  to 
Chester,  where  he  was  discharged  from  service  July  26,  1865,  and  pensioned.  Some  weeks  afterwards  the  man  was  supplied 
with  an  artificial  leg,  manufactured  by  K.  Clements.  In  his  application  for  commutation,  dated  1870.  he  represented  the  stump 
as  being  in  a  sound  and  healthy  condition.  The  pensioner  was  paid  June  4,  1879.  The  sequestrum  (Spec.  4196)  removed  from 
the  stump  was  contributed  to  the  Museum  by  the  operator,  and  is  represented  in  FlG.  3  of  PLATE  LXX,  opposite  p.  242. 

Thirteen  of  the  pensioners  have  died  since  the  date  of  their  discharge  from 
the  service;  one  from  lung  disease,  three  of  debility,  and  nine  of  causes  not 
stated  : 

CASE  438.  —  Corporal  J.  Bidlingmaier,  Co.  II,  73d  New  York,  aged  46  years,  was  wounded  before  Peters 
burg,  September  11,  1864.  Surgeon  O.  Everts,  20th  Indiana,  noted  his  admission  to  the  field  hospital  of  the 
3d  division,  Second  Corps,  with  "shot  fracture  of  thigh,  followed  by  amputation."  From  the  field  the  wounded 
man  was  transferred  to  the  depot  hospital  at  City  Point,  and  thence,  on  October  8th,  to  Washington.  Assistant 
Surgeon  J.  C.  McKee,  U.  S.  A.,  reported  his  entrance  into  Lincoln  Hospital,  with  "antero-posterior  flap  ampu 
tation  of  the  right  thigh  at  the  middle  third,"  also  that  he  was  furloughed  December  9th.  The  patient  subse 
quently  entered  Judiciary  Square  Hospital,  and  on  May  6,  1865,  he  was  discharged  from  service,  having  been 
previously  supplied  with  an  artificial  limb  by  the  Jewett  Patent  Leg  Co.,  of  Washington,  D.  C.  He  was  a 
pensioner  until  June  16,  1871,  when  he  died  of  marasmus,  his  attending  physiciau  certifying  that  "it  was  evi 
dent  that  some  portion  of  the  splintered  bone  remained  in  the  stump,  as  abscesses  frequently  formed  thereon 
and  copious  discharges  ensued;"  also  that  the  disease,  as  a  consequence,  first  became  apparent  about  the  first 
of  April,  1871.  The  amputated  portion  of  the  femur,  represented  in  the  wood-cut  (FlG.  178),  was  contributed 
by  Surgeon  D.  S.  Hays,  110th  Pennsylvania,  who  performed  the  operation.  The  specimen  shows  that  the  shaft 
was  badly  comminuted  by  a  conoidal  ball,  which  flattened,  in  a  mushroom  shape,  against  the  anterior  surface 
in  the  lowest  third. 

fatal  Cases  of  Primary  Amputation  in  the  Middle  Third  of  the  Thigh.  —  The  four 
hundred  and  sixty-three  operations  of  this  group  were  performed  on  four  hundred  and 
sixty-one  patients;  in  two  instances  both  thighs  having  been  primarily  removed  at  the 
middle  third.  Sixty-seven  were  Confederate  and  three  hundred  and  ninety-four  were 
Union  soldiers: 

CASE  439.  —  Private  G.  Cox,  Co.  K,  1st  North  Carolina  Cavalry,  aged  27  years,  was  wounded  at  Brandy  ^Station,  June  9, 
1863.  He  was  admitted  to  a  field  hospital  of  the  Fifth  Corps,  whence  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  reported  the 
following  history:  "The  patient  was  a  man  of  usual  good  health  but  had  the  bloated  appearance  of  a  habitual 
drinker.  He  was  shot  in  the  right  thigh,  and  was  brought  to  Kelly's  Ford,  a  distance  of  about  three  miles,  in 
an  ambulance.  On  examination  I  found  a  wound  of  entrance  on  the  outer  side  of  the  thigh,  a  little  above  its 
middle,  but  there  was  no  wound  of  exit.  The  wound  of  entrance  was  very  small,  as  if  made  by  a  pistol 
ball.  The  femur  was  badly  shattered.  The  patient  complained  of  having  lost  a  good  deal  of  blood  on  his 
way  to  Kelly's  Ford.  I  immediately  proceeded  to  amputate  near  the  upper  third  by  the  circular  mode.  The 
patient  suffered  considerably  from  shock,  but  rallied  comfortably,  and  was  transported  eight  miles  the  next 
morning  in  an  ambulance,  and  thence  by  cars  to  Alexandria.  On  examination  of  the  amputated  leg  the 
femur  was  found  to  be  shattered  more  than  six  and  a  half  inches,  but  not  comminuted  as  finely  as  often  hap 
pens  in  fractures  by  a  mini6  rifle  ball,  this  fracture  being  more  vitreous  in  appearance  and  furnishing  but 
one  small  fragment,  all  the  others  being  large  ones.  The  ball  had  entered  the  outer  side  of  the  thigh,  passed 
behind  and  partially  around  the  femur,  entering  at  its  inner  aspect,  and  lodging  in  the  medullary  canal.  The 
interesting  point  in  the  case  is  the  relation  of  the  extensiveness  of  the  fracture  to  the  weight  and  the  dimin 
ished  velocity  of  the  ball;  that  the  bone  should  have  been  so  extensively  shattered  by  a  pistol  ball,  which, 
when  subsequently  weighed,  did  not  exceed  five  scruples  and  six  grains,  and  that  the  mischief  was  all  done, 
too,  after  the  ball  had  been  so  much  deflected  from  its  original  course."  Surgeon  T.  R.  Spencer,  U.  S.  V., 
reported  the  patient's  admission  to  Prince  Street  Hospital,  and  the  result  of  the  case  as  follows:  "On  June 
19th  and  23d,  haemorrhage  occurred  from  the  external  circumflex  artery,  for  which  compression  and  cold 
applications  were  made.  The  loss  of  blood  amounted  to  six  ounces.  The  patient  looked  anaemic,  and  there 
was  considerable  sloughing  of  the  stump.  Death  followed  on  June  24,  1863."  The  amputated  portion  of 
the  femur  was  contributed  to  the  Museum  by  the  operator,  and  is  numbered  1233,  Surg.  Section  (FlG.  179). 

CASE  440.  —  Sergeant  John  Sproul,  Co.  C,  40th  New  York,  aged  24  years,  received  at  Kelly's  Ford, 
November  7,  1883,  a  conoidal  musket  ball  wound,  causing  a  compound  fracture  of  the  left  femur  just  above 

the  knee.     He  was  taken  to  the  field  hospital  of  the  1st  division,  Third  Corps,  Surgeon  J.  W.  Lyman,  U.  S.  V.,  »>">  <>{  ">'<ldl,e  thi,n'  l'f 

'  right  femur.  3pec.  1233. 
in  charge,  and  amputation  of  the  thigh  in  the  middle  third,  anterior  and  posterior  flap  method,  was  performed 

by  Surgeon  A.  Campbell,  40th  New  York,  on  the  day  of  injury.  He  was  conveyed  to  Washington,  and  admitted  into  the 
Douglas  Hospital  on  November  9th.  His  attending  medical  officer,  Assistant  Surgeon  W.  F.  Norri*,  U.  S.  A.,  reports,  Novem 
ber  16th:  It  was  found  impossible  to  support  the  heavy  posterior  muscular  flap;  the  sutures  sloughed  out,  and  there  was 
a  great  gaping  surface  discharging  profusely,  but  normal  in  appearance.  The  patient  was  very  pallid.  The  stump  was 
SUKG.  Ill—  29 


FlO.  179. — Comininu- 


226  INJURIES    OF    THE    LOWER    EXTREMITIES.  .  [CHAP.  x. 

thoroughly  supported  l>y  adhesive  straps,  and  the  best  nutrients,  with  stimulants,  were  administered.  24th,  there  was  slight 
tenderness  along  the  femoral  artery  and  slight  enlargement  of  the  inguinal  glands.  There  was  no  vigorous  effort  at  repair  in 
the  stump,  which  remained  pale  and  flabby,  and  his  general  condition  became  worse  daily.  December  4th,  there  were  well- 
marked  chills  with  fever  in  the  evening,  pulse  120  and  feeble,  respiration  hurried,  sweating,  and  nausea.  These  symptoms 
became  hourly  worse ;  his  pulse  became  countless,  his  respiration  sighing  and  very  rapid,  his  face  pinched  and  anxious; 
occasional  vomits  of  a  green  bilous  matter:  he  finally  died,  on  December  7th,  at  4  o'clock  P.  M.,  of  pyaemia.  Autopsy  sixteen 
hours  after  death.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  records:  "The  most  careful  examination  failed  to  find  a  trace  of 
inflammation  or  coagulation  in  the  blood-vessels.  The  soft  tissues  of  the  stump  were  perfectly  normal.  There  were  found  in 
the  thoracic  cavity  the  usual  traces  of  pya'inia.  The  lungs  anteriorly  were  pale,  posteriorly  they  were  both  coated  over  the 
lower  lobes  with  recent  yellow  and  soft  ill-looking  lymph.  There  was  no  considerable  effusion  or  adhesions;  no  traces  of  a 
frank  pleuritis,  but  of  a  local  asthenic  inflammation  were  found.  Both  lungs  were  congested,  hardened,  and  dark  in  color 
posteriorly,  and  in  the  left  there  were  several  small  yellowish-white  spaces,  apparently  abscesses.  :  The  other  organs, 

except  the  cerebro-spinal,  were  examined  and  found  normal  except  the  spleen,  which  was  slightly  hardened  and  congested.  No 
trace  of  embolia  was  found  in  the  lungs,  nor  was  death  caused  by  the  secondary  changes  there  produced.  The  destruction  of 
pulmonary  tissue  had  not  progressed  sufficiently.  There  must  have  been  the  absorption,  by  the  veins  most  probably,  from  this 
medullary  and  cancellated  portion  of  the  femur,  of  a  material  soluble  in  the  fluids  of  the  blood,  and  produced,  in  the  cadaveric 
changes  that  took  place  in  the  organic  matter — dead,  but  confined  in  this  cancellated  bone.  This  caused  the  fatal  toxicomiia 
which  overpowers  the  nervous  system,  and  may  have  also  caused  those  local  changes  found  in  the  posterior  portions  of  both 
lungs.  It  seems  strongly  probable  that.it  is  due  to  blood  poisoning,  introduced  by  the  veins,  since  all  cases  of  pyaemia  exhibit 
pathological  changes  in  the  lungs,  where  the  venous  blood  becomes  distributed  to  thin  delicate  structures  before  being  depurated 
by  exposure  to  the  atmosphere.  The  case  was  about  to  be  relinquished  as  incomprehensible,  when  it  was  proposed  by  Dr. 
Norris  to  saw  the  femur  from  its  head  to  its  extremity  longitudinally,  and  thus  expose  its  medullary  canal.  A  small  quantity 
of  apparently  healthy  pus  had  been  found  between  the  periosteum  and  the  shaft  two  inches  from  the  sawn  end,  and  there  were 
a  few  osteophytes  clinging  to  the  bone  at  that  point.  When,  however,  the  bone  had  been  separated  in  its  long  diameter,  its 
medullary  canal  presented  the  traces  of  pathological  action.  This  canal  and  the  cancellated  structure  extending  past  the 
trochanters  to  a  point  half  way  through  the  head  were  found  filled  with  a  yellowish -green  substance,  intolerably  fetid,  and 
resembling,  more  than  anything  else,  the  debris  of  hospital  gangrene.''  The  bone  was  sent  at  once  to  the  Museum  and  portrayed 
in  colors.  No  pus  was  found  in  this  bone,  and,  under  the  microscope,  nothing  but  debris.  The  connective  tissue  seemed  to 
have  perished  en  masse.  In  PI,ATK  XXXII,  opposite,  the  diseased  stump  of  the  femur  is  represented,  and  PLATE  XXXI,  opp. 
j).  228,  exhibits  the  gangrenous  condition  of  the  medullary  canal. 

CASE  441. — Private  William  Crawford.  Co.  B,  2d  Pennsylvania  Cavalry,  aged  40  years,  had  his  right  leg  shattered  near 
the  knee  by  a  fragment  of  shell,  at  the  battle  of  Spottsylvania,  May  12,  1864.  The  soft  parts  were  much  torn,  and  the  popliteal 
artery  was  divided.  Amputation  was  immediately  performed  near  the  middle  of  the  thigh  by  Surgeon  Charles  Bower,  (5th 
Pennsylvania  Reserves.  The  patient  was  sent  to  Washington,  and  admitted,  on  July  Kith,  to  Lincoln  Hospital.  He  was  in 
an  exhausted  condition  and  had  no  appetite.  He  utterly  refused  to  take  bark  or  stimulants  of  any  description.  The  tongue 
and  fauces  were  covered  with  aphthto.  There  was  diarrhoea,  from  which,  in  a  chronic  form,  the  patient  had  long  suffered.  He 
died  on  July  27.  1834.  There  was  extreme  emaciation.  At  the  autopsy  but  slight  lesions  were  found  in  the  viscera,  except  the 
great  intestine,  which  was  studded  with  ulcers.  The  necrosed  extremity  of  the  femur  slightly  protruded  from  the  wound.  This 
was  the  end  of  a  very  large,  loose  sequestrum,  invested  by  a  fragile  involucrum.  The  specimen  in  the  Army  Medical  Museum, 
No.  2890,  Surtfical  Section,  consists  of  the  stump  of  the  right  femur,  with  a  very  large  sequestrum  in  process  of  separation  and 
a  partial  involucrum  formed. 

The  histories  of  the  two  cases  of  primary  amputations  of  both  thighs  iu  the  middle 
third  are  very  brief.  The  patients  died  on  the  day  following  the  operations: 

CASE  442. — Sergeant  Theodore  Doud,  Co.  C,  2d  Michigan,  received,  at  Petersburg,  July  W,  18(54.  a  shell  wotinfl  of  both 
thighs.  He  was  carried  to  the  field  hospital  of  the  'M  division,  Ninth  Corps,  where,  on  the  same  day,  Surgeon  W.  B.  Fox,  8th 
Michigan,  amputated  both  thighs  at  the  middle  third.  Death  resulted  July  31,  1864.  The  case  is  recorded  by  Surgeon  P.  A. 
O'Connell,  U.  S.  V. 

CASK  44:5. — Corporal  John  W.  Woodworth.  Co.  H,  llth  Infantry,  was  wounded  at  Rappahannock  Station,  November 
7.  1863,  a  shell  fracturing  both  femurs  at  the  middle  third.  He  was  taken  to  the  field  hospital  of  the  Fifth  Corps,  and  both 
thighs  were  amputated  in  the  middle  third.  lie  died  the  next  day,  November  8,  1863.  The  case  is  reported  by  Assistant 
Surgeon  E.  DeW.  Breneman,  17.  S.  A. 

Pyaemia  was  observed  in  seventy-six,  gangrene  in  eighteen,  tetanus  in  seven  <>t  the 
four  hundred  and  sixty-three  fatal  primary  amputations  in  the  middle  third  of  the  thigh, 
and  in  forty-four  instances  haemorrhages  occurred  subsequent  to  the  operations.  In  three 
cases  the  amputation  in  the  thigh  was  accompanied  by  operations  in  the  upper  extremities, 
and  in  one  instance  the  opposite  limb  was  amputated  in  the  leg.1 


1  In  tlie  case  of  Private  W.  .T.  Rand,  K,  45th  Massachusetts  (TAHI.K  XXXI,  p.  -~>39.  No.  1,018,  and  Second  Surgical  Volume..  TADLK  XUV,  1>-  o:i4, 
No.  87),  the  left  arm  was  removed  at  the  shoulder  joint ;  the  left  arm  was  amputated  in  the  lower  third  in  the  ease  of  Private  H.  Jackson.  E,  4th  Colored 
Troops  (T.AHLE  XXXI,  p.  237.  No.  904,  and  Second  Surgical  Volume,  TAHLK  LXXII1.  p.  747.  No.  40):  three  inches  of  the  right  radius  were  excised  in 
the  case  of  Sergeant  .1.  Uolnnson,  II,  48th  Illinois  (TAIU.K  XXXI,  p.  2:19,  No.  1.033.  and  Secmid  Surgical  Volume,  TAlir.K  CXXVII,  ]>.  95:2.  No.  51).  Thf 
left  leg  was  amputated  in  the  lower  third  in  the  case  of  Private  S.  Banks,  C,  43d  Colored  Troops  (TABLE  XXXI,  p.  230,  No.  706'). 


DISEASED    STUMP    OF     FEMUR 


SECT,  in.]  PRIMARY    AMPUTATION    OF    THIGH    IN    MIDDLE    THIRD. 

TABLE  XXXT. 

Condensed  Nummary  of  Eleven  Hundred  and  Fifty-seven  Caws  of  Primary  Amputations  in  the  Middle 

Third  of  the  Femur  for  Shot  Fracture. 

[Recoveries,  1— 68:;;   Deaths.  687—1,149;  Results  unknown.  1.150—1,157.) 


NAMK,  MILITARY 

Ol-EUATlONS,   Ol'EUATOllS, 

NAMK,  MILITARY 

OI'KKATIOXS.  OL'KK.VKJUS. 

No. 

DKsuui'Tiox,  AXD  AGE. 

U  Allot. 

RESULT. 

Xo. 

DESCUUTIOX,  AXD  AGE. 

D.MT.S. 

RESULT. 

1 

Adams,    C.    B.,  Pt.,  G, 

Sept.  19, 

Right  :  circ.  A.  Surg.  J.  Homans, 

39 

Bentley,  A.  C.,  Pt.,  D. 

May  23, 

Left;  flap.    Disch'd  June  30,  '64. 

116th  X.  York,  age  37. 

20,  '64. 

jr.,  U.S.A.      Dis.  Aug.  25,  '65. 

93d  New  York,  age  27. 

23,'  '64. 

0 

Adams    J.    Pt.    H    27th 

Mar.  13 

Ri°"ht  •  flap.    Disch  d  Aug.  2  '62. 

40 

Br.ntlfij,   G.,  Pt.,  B,  8th 

.1  ii  IIP  27 

Ohio.' 

13,   '62.' 

Louisiana. 

28,  '62.  ' 

3 

Alexander,    J.,   Pt..    A, 

May  4, 

Right.   Surg.W.G.  Xugent,  126th 

41 

Bentley,  W.  G.,  Major, 

June  21, 

Left  ;  circ.    Surg.  W.  H.  Rulison. 

129th  Peun.,  age  25. 

4,  '63. 

Penn.    Disch'd  Mar.  16,  1864. 

9th  N.  Y.  Cav.,  age'  28. 

21,  '64. 

9th  N.  Y.  Cav.    Disc.  Oct.  5.  'l>5 

4 

Alexander,   J  ,    Pt,,   P, 

Sept.  20, 

Left;  flap.    Mar.  15,  '65,  removed 

42 

Berran.    B.,    Serg't,   K, 

May  27, 

Left  ;  circ.     Discharged  Oct.  26, 

22d  C.  T.,  age  34. 

21,  '64. 

necro'd  bone.     Dis.  Mar.  20,  '65. 

160th  New  York. 

27,  '63. 

1863. 

5 

Allaback,  E.  W..  Pt.,A, 

May  24, 

Left  ;  flap.     Surg.  W.  S.  Woods, 

43 

Best.  W.  J.,  Ord'y  Sea 

June  27, 

Left;  Surg.  X.  Pinkney,  U.  S.  N. 

52d  Pennsylvania. 

24,  ''62. 

52d  Penn.    Disch'd  Aug.  1,  1862. 

man.  U.  S.  S.  Pawnee. 

28,  '61. 

Discharged. 

6 

Allen,  F.  A.,  Pt.,  I,  8th 

June  3, 

Left  ;    flap.     Subseq.  operations. 

44 

Biebel.  A.,   Pt.,   L,  9th 

Nov.  2,i, 

Left  ;  ant.  post.  flap.    Surg.  C.  H. 

X.  Y.  Cavalry,  age  29. 

3,  '64. 

Disch'd  July  13,1865. 

X.  York  Cav.,  age  23. 

27,  '64. 

Andrus,  176th  N.  York.   Pisch'd 

7 

Allen,  G.  W.,  Serg't,  A, 

Oct.  19, 

Right;  circ.    Surg.  D.  F.  Leavitt, 

Oct.  2  1,1865. 

3d  Mass.  Cav.,  age  27. 

20,  '64. 

3d  Mass.  Cav.    Dis.  May  31,  '65. 

45 

Bidlingmayer,  J.,  Corp'l, 

Sept,  11, 

Right  ;    ant.  post.  flap.      Surg.  P. 

S 

Allen,  ,S'.,  Pt.,  11,23d  X. 

July  1, 

Left  ;  circular.    Exchanged  Nov. 

H,  73d  N.  York,  age  46. 

11,  '64. 

S.  Hays,  110th  Penn.     Pisch'd 

Carolina,  age  25. 

3,  '63. 

12,  1863. 

May  6,  1865.    Spec.  4120. 

9 

Allroth,  W.,  Pt.,  K,  46th 

July  30, 

Left;  flap.     Surg.  A.  F.  Whelan, 

46 

Bishop,  F.,  Pt.,  H,  65th 

Dec.  13, 

Right;  flap.    Pisch'd  Oct.  21/64. 

New  York,  age  30. 

30,  '64. 

1st  Mich.  S.  S.  Dis.  Sept.  11,'65. 

Indiana,  age  21. 

14,  '63. 

10 

Altenberger,  J.,  Pt.,  F, 

May  19, 

Left.     Surg.  S.  P.  Bonner,  47th 

47 

Bishop,  I,  Pt.,  K,  lllth 

May  14, 

Left;  flap;  one  and  one-half  inch 

37th  Ohio. 

19,  '63. 

Ohio.      Subsequent    operation. 

Ohio,  age  24. 

14,  '64. 

boneremo'd.  Ris'd  Aug.  29,  '65. 

Disch'd  Sept.  8,  1863. 

48 

Bissell,  J.  B..  Sergeant- 

Sept.  4, 

Right;  ant.  post.  flap.     Surg.  A. 

11 

Ammermau,  R.  W..  Pt., 

May  12, 

Right;  circ.    June  24th,  removed 

Major,  26th  Iowa. 

4,  '64. 

T.  Hudson,  26th  Iowa.     Pisch'd 

B,  148th  Penn.,  age  22. 

13,  '64. 

three  ins.  femur.     Disch'd  May 

Jan.  6,  1865. 

30,  1865.    Spec.  2698. 

49 

Bivens,    T.   E.,  Pt.,   C, 

May  28, 

Right;  flap.     Reg'l  Surg.  C.  S. 

12 

Andrews,  P.,  Pt.,  I,  62d 
Penn.,  age  18. 

May  6, 
6,  '64. 

Left  ;  ant,  post.  flap.    Discharged 
July  26,  1865. 

50 

Bissell's  Engin'r  Reg't. 
Blair,  J.,  Serg't,  A,  lOoth 

28,  '62. 
Oct.  2, 

Shelton.    Pisch'd  July  29,  1865. 
Left;  cire.  8urg.D-8.Hays,  110th 

13 

Andrews,  W.  A.,  Pt.,  E, 

Nov.  30, 

Right  ;  lateral  flap.     Exchanged 

Penn.,  age  26. 

2,  '64. 

Penn.     Pisch'd  Jan.   11,    1866. 

3d  C.  S.  Inf.,  age  27. 

Pec.1,'64. 

March  7,  1S65. 

Pied  Nov.  8,  1869.    Spec.  4125. 

14 

Arts,  J.,   Capt.,   K,   2d 

June  25, 

Left.     Discharged  Nov.  10,  1862. 

51 

Blake,  W.,  Pt..  K,  18th 

July  3, 

Left.     Sept.  4th,  extol,  removed. 

Xevv  York. 

25,  '62. 

Mississippi,  age  18. 

3,  '63. 

Exchanged  Nov.  12,  1863. 

15 

Aschman,  R.,  Capt.,  A, 

Aug.  15, 

Right.     Surg.  H.  F.  Lyster,  5th 

52 

Boatwrigltt,  It.  S.,  Pt., 

Jyll,'63. 

Left  ;  circ.  July  17th.  end  of  bone 

1st  Sharpshooters. 

15,  '64. 

Mich.    Disch'd  Aug.  19,  1864. 

I,  21st  South  Carolina. 

Primary. 

removed.   Exch'd  July  23,  1863. 

16 

Austin,  W.  F.,Capt.,  K, 

April  7, 

Right.     Dr.   W.  W.  Goldsmith, 

53 

Brake,  G.,  Pt.,  D,  15th 

June  18, 

Left  ;  double  flap.    Ass't  Surg.  J. 

9th  Kentucky. 

8,  '62. 

Louisville.   Disch'd  Apr.  19,  '62. 

West  Virginia,  age  41. 

18,  '64. 

J.  Johnson,   15th  W.  Virginia. 

17 

Azdcll,  J.,  Pt.,  C,  104th 

May  27, 

Left;  circ.    Surg.  F.  H.  Rodgers, 

Pisch'd  Oct.  19,  1864. 

Ohio,  age  29. 

27,  '64. 

104th  Ohio.     Dis.  June  13,  1865. 

54 

Brandon    S   S.,  Pt.    C 

June  2, 

18 

Bachman,   C.,    Pt.,    P. 

Mar.  29. 

Left  :  flap.    Discharged  June  27, 

27th  S.  Carolina.age  19. 

2,  '64. 

Oct.  18,  1864. 

198th  Penn..  age  28. 

29,  '65. 

1865. 

55 

Brannon,  L.,  Pt.,  D,  10th 

Oct.  8, 

Left  ;  flap.    Surg.  C.  S.  Museroft, 

19 

Bagley,   T.  K.,   Pt.,   H, 

May  14, 

Tfppovprpd 

Ohio. 

10,  '62. 

10th  Ohio.     Pisch'd  Feb.  15,  '63. 

24th  South  Carolina. 

14,  '63.' 

56 

Breen,   M.,  Pt.,   E,  9th 

June  3, 

Right  ;  double  skin  flap.    Pisch'd 

20 

Bailey,  J.  C.,  Pt,,  P,  4th 

Dec.  13, 

Left;  flap.   Disch'd  April  22,  '63. 

Mass.,  age  40. 

5,  '64. 

Oct.  18,  1864. 

Ohio. 

14  '62. 

57 

1  Brett    C     Pt     B    llth 

21 

Ball,   L.,  Serg't,   F,  3d 

Sept.  ?!», 

Right  ;  flap.    One  inch  fern,  rem'd. 

Alabama. 

28,  '62.  ' 

July  15,  1862. 

Kentucky,  age  24. 

21,  '63. 

Disch'd  March  22,1864. 

58 

Brickham,    L,    Pt,,    K, 

April  3, 

R't;  ant.poet.flap.  Surg.  E.  Pow 

22 

Barnett,  R.,  Pt.,  P,  1st 

Oct.  14, 

Left:  ant,  post.  flap.     Surg.  A.  P. 

14th  Wisconsin,  age  46. 

3,  '65. 

ell,  72d  111.    Pisch'd  Oct.  20,  '65. 

N.  Y.    Pragoons,   age 

15,  '64. 

Clark,  6th  N.  Y.  Cav.    Disch'd 

59 

Briggs.  W.  D.,  Pt.,  A, 

Sept.  29, 

Left  ;  circ.   Surg.  P.  McFall,  142d 

25. 

Oct.  30,  1865. 

147th  N.  York,  age  29. 

29,  '64. 

N.  Y.    Pisch'd  Sept.  11,  1865. 

23 

Barnes.  J.  W.,  Pt.,   C, 

Jan.  28, 

Left;  flap.    Surg.  T.  H.  Kearney, 

60 

Brobst,   J.,    Serg't.    A, 

April  9, 

Left;    ant.    post.  flap.     Surg.   J. 

llth  Tennessee  Cav. 

28,  '64. 

45th  Ohio.    Disch'd  Mar.  28,  '65. 

107th  Ohio,  age  22. 

10,  '65. 

Knauss,   107th    Ohio.     Pisch'd 

24 

Barnes,   W.,    Serg't,   I, 

Aug.  3d, 

Left.    Disch'd  April  23,  1863. 

Sept.  6,  1865. 

13th  Mass.,  age  38. 

31,  '62. 

61 

Brock,   M.    V.,   Pt.,    C, 

July  2, 

Right.     Surgeon  Craft,  C.  S.  A. 

25 

Barnhart,  T.  P.,  Pt.,  F, 

Mar.  16, 

Right;   circular.     Disch'd   Aug. 

48th  Mississippi. 

3,  '63. 

Recovered. 

3d  Wisconsin,  age  19. 

16,  '65. 

22,  1865. 

62 

Brown,  C.,   Pt.,   F,  8th 

July  28, 

Right  ;  flap.   Surg.  J.  K.  Bigelow, 

26 

Barraham,   ./.    11.,  Pt., 

Aug.  16, 

Right  ;  circular.     Retired  March 

Indiana,  age  23. 

28,  '64. 

8th  Ind.     Pisch'd  Nov.  29,  1864, 

H,  2d  North  Carolina. 

16,  '64. 

17,  1865. 

63 

Brown,  D.  W.,  Pt.,  A, 

Feb.  13, 

Left.    Pisch'd  July  31,  1862. 

27 

Barrett,  S.,  Pt..  K,  69th 

Mar.  19, 

Left  ;  flap.    Confederate  surgeon. 

25th  Indiana. 

13,  '62. 

Ohio,  age  17. 

20,  '65. 

Disch'd  Oct.  14,  1865. 

64 

Brown,  G.  M.,   Pt.,  A, 

June  15, 

Left;  circ.     Surg.  J.  S.  Reeves, 

28 

Bartlett,    \V.  F.,  Capt., 

April  25, 

Left  ;  circ.     Surg.  N.  Hay  ward, 

31st  Illinois,  age  22. 

15,  '64. 

78th  Ohio.     Disch'd  Feb.  2,  '65. 

I.  20th  Mass.,  age  21. 

25,  '62. 

20th  Mass.    Disch'd  July,  1866. 

65 

Bruce,    W.   D.,   Pt.,  C, 

Aug.  28, 

Right.    Surg.W.  Grimes,  C.  S.  A. 

29 

Bartling.  H..  Pt.,  L,  9th 

June  12, 

Left  ;  lat.  flap.    Surg.  A.  Nash,  9th 

13th  Virginia. 

29,  '62. 

Recovered. 

Mich.  Cavalry,  age  22. 

12,  '64. 

Mich.  Cav.  Disch'.  May  12,  1865. 

66 

Bruce,   V.   W.,   Pt.,  A, 

Nov.  16, 

Right;    circ.      Confed.  surgeon. 

30 

Barton,  M.,  Pt,,  E,  72d 

May  9, 

Right    Surg.  D.  B.  Rice,  102d  111. 

17th  Mich.,  age  20. 

17,  '63. 

Disch'd  April  4,  1864. 

Indiana. 

10,  '63. 

Disch'd  Sept.  15,  1863. 

67 

Bryant,   W.  W.,  Pt.,  G, 

May  31, 

Left.    Surgeon  Wright,  C.  S.  A. 

31 

Batch,  P.,  1't.,  K.  99th 

June  20, 

Right;  ant.  post.  flap.      Surg.  J. 

1st  Tennessee. 

Je.l,  '62. 

Recovered. 

Ohio,  age  21. 

20,  '64. 

T.  Woods,  99th  Ohio.     Disch'd 

68 

Buckles,   A.  J.,  Lieut,, 

Mar.  25, 

Right  :  flaps.     Surg.  D.  S.  Hays. 

Nov.  22,  1865. 

E,  20th  Ind..  age  18. 

25  '65. 

110th  Peun.  Disch'd  May  16,  '65. 

32 

Becht,    A..  Pt.,  E,   52d 

June  1, 

Left.    Disch'd  Dec.  25,  1862. 

69 

Bullcnr,   A.  C.,'  Pt.,  F, 

Sept.  14. 

Left.      Disch'd  Nov.  19,  1862. 

New  York. 

3,  '62. 

18th  New  York. 

15,  '62. 

33 

Beck,  (1.  H.,  Corp'l.  I, 

May  5, 

Left  ;  circ.     Ass't   Surg.   W.  F. 

70 

Bullock,  W.   S.,  Pt.,  G, 

Oct.  27, 

Right  ;  circ.    Surg.  T.  H.  Squire. 

llth  Penn.,  age  18. 

6,  '64. 

Osboni,    llth    Penn.       Disch'd 

89th  New  York. 

28,  '64. 

8»th  N.Y.    Disch'd  April  20,  '65. 

June  1,  1865. 

July,  '65,  necro.  bone  remo'd. 

34 

Becker,    C.,    Corp'l,   B, 

Mar.  8, 

Right  ;  circ.     Surg.  C.  Coot,  12th 

71 

Burbank.  J.  H.,  Pt,,  F, 

May  3, 

Right  ;  flap.       Disch'd   Feb.  25, 

12th  Missouri. 

8,  '62. 

Missouri.    Discharged. 

)0th  Massachusetts. 

3,  '63. 

1864. 

35 

Keck  with,  D.G.,  Pt.,  K, 

Dec.  13, 

Left.     Surg.    J.   Ebcrsole.    19th 

72 

Burcliett,  J.  IV..  Pt..  K, 

July  3, 

Left.     Exchanged  Nov.  12,  1863. 

23d  New  York. 

13,  '62. 

Ind.     Disch'd  April  10,  1863. 

8th  Virginia,  age  21. 

3,  '63. 

36 

Beckwith  W.(r.  Ser"*'t 

April  8 

Iltii'l'    ]l   F    Ser°"'t   K 

Sept.  17, 

Surg    Lindsay    0    S   A 

B,  5th  Alichigan  Cav., 

8,  '65.' 

5th  Mich.    June  26th,  nee.  bone 

' 

48th  North  Carolina. 

18,  '62.' 

age  31. 

rem.    Dis.  Sept.  1,  '65.  flp.  4239. 

74 

Kiirkf.tt,  F.  H.,  Pt..  D, 

July  2, 

Right.     Surgeon  Pierce,  C.  S.  A. 

37 

Bell,  L,  Serg't,  15,  81st 

July  2, 

Right;  flap.     Pisch'd  March  10, 

2d  S.  Carolina,  age  24. 

4,  '63. 

Furloughed  Dec.  4,  18(i3. 

Penn.,  age  20. 

3,  to. 

1864. 

75 

•^Burnett.  J.  B.,  Pt.,  1st 

Sept.  17, 

Left;  circular.    Recovered. 

38 

Bellis,  R.,  Serg't,  D,  1st 

July  2, 

Right  ;  circ.     Ass't   Surg.  J.  A. 

S.  Carolina,  age  31. 

18,  '62. 

Maryland  P.  H.  B. 

4,  '63. 

Freeman,  13th  X.  Jersey.  Pise. 

76 

Burton.   J.   O.,   Pt.,    B, 

Feb.  13, 

Right  ;    flap.     Disch'd   June   17, 

Jan.  31,  1864. 

48th  Illinois. 

13,  '62. 

1862. 

1  SMITH  (E.  H.),  Cases  of  Fracture  of  Femur,  in  Confed.  States  Me.d.  and  Surg.  Jour.,  1864,  Vol.  I,  j>.  24. 

ZFISHKU  (G.  J.),  Cases  of  Amp.  after  the  Battle  of  Antietam,  Sept.  17,  1862,  in  Am.  Jour,  of  Med.  Sci.,  1863,  Vol.  XLV,  p.  -17. 


228 


INJURIES    OF    THE    LOWER   EXTREMITIES. 


ICHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AXD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

77 

Butler,  A.C.,Pt.,  D,  llth 

Aug.  14, 

Right  ;  circ.     Ass't  Surg.  W.  W. 

120 

Cosby,  A.  W.,  Corp'l,  E, 

May  5. 

Left.    Surg.  Young.     Recovered. 

Maine,  age  20. 

14,  '64. 

Royal,    llth    Maine.     Disch'd 

4th  Georgia. 

5,  '64. 

Sept.  20,  1865. 

121 

Costa,  D.,  Pt.,  K,  6th  C. 

Sept.  29, 

Right;   ant.  post.  flap.     Disch'd 

78 

Butler,  W.  H.,  Serg't,  C, 

Sept.  29, 

Right  ;  circ.     Ass't  Surg.  J.  W. 

Troops,  age  19. 

29,  '64. 

June  20,  1865. 

6th  C.  Troops,  age  24. 

29,  '64. 

Mitchell,  4tL   Colored   Troops. 

122 

Cotter,  W.,  Pt.,  E,  9th  N. 

July  30, 

Right;  long  post,  flap  ;  rem.  dead 

Disch'd  May  29,  1865. 

Hampshire,  age  27. 

30,  '64. 

bone.  Oct.  15,  1871,  amp.  hip  j't. 

79 

Bnzzell,  S.  P.,  Corp'l,  B, 

Aug.  13, 

Right:  circ.     Surg.  W.  B.  Fox, 

Specs.  252,  4954,  5946.  Died  Jan. 

38th  Wisconsin,  nge  24. 

13,  '64. 

8th  Mich.     Discf  d  Feb.  25,  '65. 

21,  1874. 

80 

Catltlell.   G.  R.,  Pt.,  K, 

Sept.  19, 

Left.    Surg.  Hill,  3d  N.Carolina. 

123 

Covey,   W.  G.,  Pt.,  B, 

Feb.  14, 

Right  ;  ant.  post,  skin  flap.    Surg. 

43d  N.  Carolina,  age  20. 

19,  '64. 

Exchanged  April  3,  I8!i5. 

27th  Missouri,  age  24. 

14,  '65. 

B.  N.  Bond,  27th  Mo.     Disch'd 

81 

Cammett,  W.  B.,  Pt.,  A, 

June  14, 

Right  ;  eirc.  Surg.C.  Abbott,  26th 

July  15,  1865. 

26th  Maine. 

14/63. 

Maine.    Disch'd  Aug.  29,  1863. 

124 

Coyne,   P.,  Pt.,  B,  69th 

Sept.  17, 

Right  ;  aut.  post.  flap.    Surg.  J.H. 

82 

Cannon,  J.,  Pt.,  D,  7th 

July  18, 

Left  :  flap.  Surg.  R.  II.  Robinson, 

New  York. 

17,  '62. 

Taylor.  U.  S.  V.     Disch'd  May 

Maryland,  age  24. 

18/04. 

7th  Md.    Disch'd  June  5,  1865. 

15/1863. 

83 

Cappers,  A.,  Pt.,  A,  4th 

May  27, 

Right  ;  circ.    Disch'd  Feb.  19,  :64. 

125 

COT,  J.  W.  M.,  Corp'l,  A, 

May  17, 

Right.    Snrg.  Wilson,  4th    Miss. 

Wisconsin. 

27,  '63. 

61st  Tennessee. 

18/63. 

Recovered. 

84 

Capper,  11.  M.,  Serg't,G, 

Mar.  M, 

Right  ;  flap.    Disch'd  July  1,  '62. 

126 

Cram,  W.  H.,  Pt.,  K,  9th 

May  12, 

By  Surg.  J.  S.  Ross,    llth   New 

10th  <  'onnecticut. 

14,  '62. 

New  Hampshire. 

12/64. 

Hauii>sliire. 

85 

'Carlisle,  M.,  Lieut.,  G, 

Sept.  19, 

Right.   Recovered. 

127 

Cramer,  A.,  Serg't,    B, 

Mar.  16, 

Left;  circular.    Disch'd  Aug.  23, 

19th  South  Carolina. 

19,  '63. 

55th  Ohio,  age  37. 

16/65. 

1865. 

86 

Carpenter,  H.  II.,  Pt.,  D, 

May  15, 

Left,    Ass't  Surg.  B.  L.  Hovey, 

128 

Creager,  W.  H.,  Pt.,  B, 

June  27, 

Left  ;  circ.    Surer.  T.  B.  Williams, 

136th  N.  Y.,  age  27. 

16,  '64. 

146th  N.Y.  Disch'd  June  13,  '65. 

121st  Ohio,  age  17. 

28,  '64. 

121st  Ohio.     Dis.  June  21  ,  1865. 

87 

Carpenter,    J.   M.,   Pt,, 

Sept.  19, 

Left  ;  circ.  Surg.  W.  S.  Love  and 

129 

Crist,  (F.J/.,Pt..2dRock- 

April  2, 

Left  :    lat.  flap.     Released  June 

Carpenter's  Bat'y,  age 

19,  '64. 

II.  McGuire,  C.  S.  A.    Exch'd 

bridge(Va.)Bat.,age!9. 

3,  '65. 

29,  1865. 

17. 

April  1,  1865. 

130 

Crommett,   C.,   Pt.,    K, 

Nov.  18, 

Left  ;  flap.  Confed.  Surg.  Disch'd 

88 

Carr,    P.,    Pt.,    F,    73d 

June  27, 

Left;  circular.    Discharged  Aug. 

112th  Illinois. 

19,  '63. 

Feb.  16,  1864. 

Penn.,  age  18. 

27,  '64. 

2,  1865. 

131 

Crow,  W.  T.,  Serg't,  I. 

Nov.  30, 

Right;    circ.      Provost   Marshal 

89 

Carroll,  J.,  Pt.,  B,  1st  N. 

June  2, 

Right.     Surg.  W.  W.  L.  Phillips, 

35th  Mississippi,  age  25. 

30,  '64. 

March  7,  1865. 

Jersey  Cavalry. 

2,  '62. 

1st  N.  J.  Cav.    Dis.  Sept.  27,  '62. 

132 

Growl,  J.,  Pt.,  F,  100th 

July  30, 

Left;  cire.    Surg.  W.  V.  White, 

90 

Carroll,   S.  F.,  Pt.,  D, 

Sept.  23, 

Right  ;    flap.      Trans,     to  prison 

Penn.,  age  18. 

30,  '64. 

57th  Mass.  Disch'd  Feb.  25,  '65. 

1st  N.  Carolina  Cav. 

23,  '63. 

December  7,  1863. 

133 

Crye,  J.  D.,  Pt.,  D,  34th 

May  16, 

Left;  flap.    Disch'd  Sept.  21/64. 

91 

Carrow,  J.  T.,  Corp'l,  F, 

June  16, 

Left  ;  ant.  post.  flap.     Surg.  D.  S. 

Indiana,  age  22. 

16,  '63. 

4th  Delaware,  age  33. 

16,  '64. 

Hopkins,  4th  Delaware.    Disc'd 

134 

Curran,  J.W.,  Pt.,G,  5th 

April  6, 

Left  ;  ant.  post.  flap.    Ass't  Surg. 

May  31,  1865. 

Wisconsin,  age  24. 

8,  '65. 

W.W.Allen,  5th  Wis.  July  Kith, 

92 

Carson,  A.,  Pt.,  H,  42d 

Dec.  33, 

Left.    Confed.  surgeon.     Disch'd 

prot.  exfol.  rem.     Disch'd  Nov. 

Pennsylvania, 

15,  '62. 

March  4,  1863. 

30,  1865.    Spec.  547. 

93 

Carter,  C.  C.,  Pt.,  H,  9th 

July  19, 

Right  ;  out.  post.  flap.     Surg.  T. 

135 

Curtis,  R.D.,Pt.,K,  18th 

June  5, 

Right  ;   lat.  flap.     Surg.  L.  Hoi- 

Kentucky,  age  35. 

19,  '64. 

R.  W.  Jeffray,  19th  Ky.     Mus 

Conn.,  age  40. 

5,  '64. 

brook,  18th  Conn.    Disch'd  June 

tered  out  Dec.  7,  1864. 

27,  1865. 

94 

Gartner,  C.,  Pt.,  A,  30th 

Sept.  19, 

Right  ;  circ.     Released  June  28, 

136 

Dalton,    J.,    Serg't,    G, 

Oct.  19, 

Left  ;  ant.  post.  flap.     Surg.  J.  R. 

Virginia,  age  22. 

1!),  '64. 

1865. 

151st  N.  York,  age  33. 

20,  '64. 

Cotes,  151st  N.Y.     Disch'd  Jan. 

95 

Carver,  J.,  Pt.,  E,  18th 

July  17, 

Left  ;  flap.     Dr.  Pendleton,  C.  S. 

23,  1865. 

Kentucky. 

17,  '62. 

A.   Recovered. 

137 

Dangler,  J.  H.,  Pt.,  B, 

Sept.  22, 

Right  ;  oval  skin  flap.   Ass't  Surg. 

96 

Casey,  J.,'  Pt.,  C,  100th 

April  2, 

Right  ;  circ.    Surg.  N.  M.  Carter, 

1st  N.  Y.  Cav.,  age  26. 

22,  '64. 

P.  Gardner,   1st  Vermont   Cav. 

New  York,  age  19. 

2,  '65. 

100th  N.  Y.  Disch'd  Nov.  20,  '65. 

Disch'd  March  16,  1865. 

97 

Case}',    P.,    Pt.,  II,   1st 

July  10, 

Right  ;  flaps  of  skin  ;  circ.  of  mus. 

138 

Danner,  J.,  Pt.,  A,  39th 

May  6, 

Left  ;  ant.  post.flap.  Confed.  Surg. 

Cavalry,  age  21. 

10,  '63. 

Hiem.   July  26th,  femoral  ligat. 

New  York,  age  33. 

8,  '64. 

Disch'd  June  26,  1865. 

Disch'd  Dec.  9,  1863. 

139 

Davis,  E.  J.,  Serg't,  G, 

Aug.  25, 

Right  ;    circ.     Furloughed   Nov. 

98 

Casselberry,  G.,  Serg't, 

Oct.  27, 

Left  ;  bilateral  flap.  Disch'd  July 

Cobb's  Georgia  Leg'n, 

25,  '64. 

24,  1864. 

K,  51st  I'enn.,  age  23. 

27,  '64. 

27,  I8o5.     Sub.  operation. 

age  25. 

99 

Cltranif,  W.  W.,  Lieut., 

July  4, 

Right;  haem.;  femoral  lig.    Fur- 

140 

Davis,   B.,  Pt,,  I,  17th 

Oct.  19, 

Left  ;  doub.  lat.  flap.     Surg.  Pat 

]!,  30th  Arkansas. 

4,  '63. 

loughed  Oct.  15,  1864. 

Mississippi,  age  30. 

19,  '64. 

terson,  C.  S.  A.     To  prison  Mar. 

100 

Cheeseboro,    J.,    Pt,,  I, 

May  15, 

Right  ;  circ.    Surg.  C.  J.  Bellows, 

9,  1865.  Nov.,  '65,  seq.  remov'd. 

13!ith  N.  York,  age  20. 

15,  '64. 

7th  Ohio.     Disch'd  Juno  19,  '65. 

141 

Davis,  J.,  Pt.,  B,  88th  N. 

Sept.  17, 

Right  ;  flap.    Surg.  F.  Reynolds, 

101 

Clark,  E.  W.,  Pt.,  F,  5th 

June  16, 

Left  ;  flap.    Disch'd  Feb.  7,  1865. 

York. 

18,  '62. 

88th  N.  Y.    Disch'd  Nov.  18,  '62. 

"  Michigan,  age  31. 

17,  '64. 

142 

Day,  R.  M.,  Pt.,  B,  54th 

July  16, 

Right;  circ.    A.  Surg.  L.  D.  Rail- 

102 

Clark,  G.W.,  Pt.,E,  12th 
N.  Hampshire,  age  25. 

May  9, 
9,  '64. 

Right;  flap.  Surg.A.C.  Benedict, 
II.  S.V.  (also  amp.  right  forearm.) 

Mass.  C.  T.,  age  22. 

16,  '64. 

zinsky,  54th  Mass.  Aug,6,  ream- 
putatV    Disch'd  March  29,  '65. 

Disch'd  J  une  2,  1865. 

143 

Debaugh,  A.,Pt.,A,  123d 

April  6, 

Right;  flap.     Surg.  T.  II.  Squire, 

103 

Clark,  J.,  Pt.,  H,8thN. 

June  14, 

Lett.    Discharged  Aug.  24,  1863. 

Ohio,  age  28. 

7,  '65. 

89th  N.  Y.     Discharged. 

Hampshire. 

14,  '63. 

144 

Deloe,W.  W.,  Corp'l,  H, 

Mar.  31, 

Right;  circ.    Surg.  C.  M.  Clark, 

104 

dart;,  R.  F.,  Pt.,  B,  49tb 

March, 

To  Provost  Marshal  May  10,  '65. 

15th  West  Va.,  age  23. 

31,  '65. 

39th  111.    Disch'd  April  16,  1866. 

North  Carolina, 

1865. 

145 

Demers,  E.,  Corp'l,  D, 

July  3, 

Left;  lat.  flap.  Surg.W.S.Cooper, 

105 

Clineo,  N.,  Pt.,  H,  28th 

Aug.  16, 

Left  ;  circ.    Surg.  28th  North  Car 

125th  N.  York,  age  21. 

4,  '63. 

125th  N.  Y.    Disch'd  June  7,  '64. 

North  Carolina. 

16,  '64. 

olina.    Recovered. 

146 

Dennison,  J.  M.,  Corp'l, 

Sept.  19, 

Right  ;   ant.  post.  flap.      Disch'd 

106 

Clowes,  J.,  Seaman  U. 

Jan.  15, 

Left.    Surg.J.  McClellan.U.S.N.; 

K,  126th  Ohio,  age  27. 

19,  '64. 

Jan.  17,  1865. 

S.  Navy. 

15,  '65. 

nee.  bone  rem.    Dis'd  Feb.  7,'65. 

147 

Dercourt,  A.,  Pt,,  F,  32d 

May  8, 

Right.    Disch'd  Oct.  25,  1862. 

107 

Cli/burn,  B.  R.,  Major, 

Oct.  19, 

Left:  circ.   Surg.  Gilmore.C.S.A. 

New  York. 

8,  '62: 

2d  S.  Carolina,  age  22. 

19,  '64. 

Sent  to  prison  Jan.  10,  1865. 

148 

Detweiler,    C.,    Pt.,   B, 

May  12, 

Right  ;  ant.  post.  flap.   Surg.  T.F. 

108 

Cockburn,  W.,  Serg't,  H, 

Dec.  28, 

Left;  flap.   Jan.  7th,  femoral  lig.; 

100th  Penn.,  age  37. 

12,  '64. 

Oakes,  56th  Mass.     Discharged 

2d  N.  Jersey  Cavalry, 

29,  '64. 

religated  18th  and  23d.    May  li, 

Jan.  13,  1865. 

age  38. 

1865,  recovered. 

149 

Devlin,  J.,  Pt.,  1,  91st  N. 

Mar.  31, 

Left  ;  Teale's  method  ;  also  amp. 

109 

Coffett,  J.  B.,  Pt.,  B,  7th 

May  23, 

Left.    Surg.  West.    Retired  Mar. 

York,  age  22. 

31,  '65. 

thumb  and  mid.  finger.    Disch'd 

Virginia  Cav.,  ago  20. 

23,  '62. 

8,  1865. 

Sept.  30,  '65.    Phot.  Ser.,  Vol.  8, 

110 

Coleman,  M.  J.,  Pt.,  D, 

Oct.  14, 

Left  ;  circular.     Disch'd  May  9, 

No.  45.     Card  Pt.,  Vol.  1,  p.  25. 

14  '63 

1865 

?Dew  J.  H.  Pt.    A  24th 

Sept.  19 

Sent  to  hospit'il  Oct  31 

111 

Collins,  W.  T!,  Corp'l,A, 

Aug.  23, 

Left,     Surg.  J.  P.  Prince,  36th 

Alabama. 

21,  '63.  ' 

1863. 

2d  Sharpshooters. 

23,  '62. 

Mass.    Disch'd  Feb.  23,  1863. 

151 

DeWolf,  H.,  Pt.,  D,  7th 

May  31, 

Right.     Surg.  G.  Chaddock,  7th 

112 

Coombs,  F.  M.,  Pt.,  B, 

Aug.  25, 

Right:  circ.    Surg.  A.  C.  Messen 

Michigan,  age  17. 

Je  1,  '62. 

Mich.  Rem.  of  sequest.  Disch'd. 

6th  Missouri,  age  23. 

25,  '64. 

ger,  57th  O.   Disch'd  July  5,  '65. 

152 

Dilks,  J.,  Pt.,  D,  25th  N. 

Dec.  13, 

Left;  flap.    Surg.  J.  Riley,  25th 

113 

Council,  Q.,  Pt,.  4th  Me. 

Sept.  29, 

Left  ;  ant.  post.  flap.  Disch'd  Jan. 

Jersey. 

13,  '62. 

New  Jersey.   Recovered. 

Battery,  age  30. 

Oct.  1/64. 

20,  1865. 

153 

Dillon,  J.  J.,  Pt.,  B,  16th 

Mar.  20, 

Right;    flap.     Surgeon  C.  S.  A. 

114 

Connor,    H.,   Capt.,    H, 

Mar,  31, 

Right  ;  circ.     Surg.  J.  Thomas, 

Illinois. 

20,  '65. 

Mustered  out  July  8,  1865. 

118th  Penn.,  age  28. 

31  ,  '65. 

1  !  8th  Penn.  Disch'd  Oct.  28,  '65. 

154 

Dixon,  L.,  Pt.,  H,  17th 

July  1, 

Right;  circ.    Confed.  surg.   Aug. 

115 

Coogan,  T.,  Pt.,  F,  5th 

Sept.  20, 

.  A.  Surg.  Roberts,  5th  Texas. 

Connecticut,  age  19. 

2,  '63. 

28th  and  Sept.  3d,  spiculas  rem. 

Texas. 

21,  '63. 

Disch'd  Oct.  16,  1863. 

Disch'd  Oct.  10,  1864. 

116 

Coolidge,N.,  Pt.,  K,  46th 

July  7, 

Right  ;  flap.    Surg.  Allen,  C.S.  A. 

155 

Dollar,  G.,  Col'd  Team 

March, 

Right.    Doing  well. 

Illinois,  age  21. 

7,  '64. 

Disch'd  Oct.  5,  1864. 

ster. 

1865. 

117 

Conk,  J.  /•'.,  Pt.,  H,  4th 

Oct.  11, 

Right;  flap.    Transferred  to  hos 

156 

Dormyer,  J.,  Pt.,  G,  93d 

Oct.  19, 

Left  ;  ant.  post,  skin  flaps  ;  circ. 

Virginia  Cav.,  age  34. 

13,  '63. 

pital  April  10,  18(i4. 

Pennsylvania,  age  29. 

20,  '64. 

sect,  of  mus.  Disch.  April  1,  "65. 

,118 

Cook,  J.,  Corp  1,  F,  6th 
New  York. 

May  7, 
8,  '62. 

Left.   Surg.  F.  II.  Hamilton,  U.S. 
V.     Disch'd  July  1,  186J. 

157 

Douglas,  A.  C.,  Serg't, 
G,  97th  N.York,  age  20. 

May  10, 

10,  '64. 

Left;  flap.  Surg.W.B  Chambers, 
97th  N.  Y.    Disch'd  Dec.  13,  '64. 

119 

Cooper,  H.J.Pt.,F,  71st 

May  12, 

Right,     Surg.  J.  M.  Rizer,  72d 

158 

Downs,    D.,    Serg't,    B, 

Nov.  29, 

Left  ;  circ.   Provost  Marshal  May 

Peun.,  age  23. 

12,  '64. 

Penn.     Disch'd  July  27,  1865. 

35th  Alabama,  age  24.  :De.  1,  '64. 

20,  1865. 

1  TERRY  (C.),  Report  of  wounded,  Army  of  Tennessee,  after  the  battle  of  Cliickamauga,  in  Confed.  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  76. 
1  TKHRY  (C.),  op.  tit.,  p.  76. 


GANGRENE   OF  THE    MEDULLA. 


SECT.  III. 


PRIMARY    AMPUTATION    OF    THIGH    IN    MIDDLE    THIRD. 


229 


No. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION  AND  AGE. 

DATES. 

OPERATIONS,  OPEIIATOUS, 
RESULT. 

159 

Downs,  T.  J.,  Ft.,  B,  21st 

May  3, 

Left;  circ.     Surg.  N.  Hay  ward, 

200 

French,  S.,  Pt.,  D,  16th 

Aug.  16, 

Left;  circ.;  bone  removed.    Dis 

Mississippi. 

3,  63. 

20th  Mass.    Kern,  three  ins.  fern. 

Penn.  Cav.,  age  23. 

16,  '64. 

charged  July  18,  1865 

Exchanged  April  11,  1864. 

201 

French,  W.,  Corp'l,  D, 

Aug.  16, 

Left  ;    lateral  flap.     Discharged 

ICO 

Doyle,    J.,    Pt.,    B,    1st 

Aug.  3, 

Left  ;  flap.    Veteran  Res.  Corps. 

17th  Penn.  Cav.  .age  17. 

16,  '64. 

Jan.  17,  1866. 

202 

Fristoe   It   U    Captain 

July  14 

161 

>V  isconsin  cavalry. 
Drain,  W.  L.,  Ft.,  I,  5tli 

3,  62. 
June  2, 

Left  ;  flap.     Surg.  C.  S.  A.    Feb. 

8th  Kentucky  Cavalry. 

14,  '64.' 

New  York,  age  19. 

2,  '64. 

16,  1865,  sequest.  rem.     Disch'd 

203 

Fultz,   II.,    Pt.,  K,  23d 

Nov.  25, 

Left  ;  flap.    A.  A.  Surg.  R.Wirth. 

June  9,  1865.    Spec.  113. 

Kentucky,  age  34. 

26,  '63 

Discharged  June  22,  1864. 

162 

Drach,  W.  S,,Pt.,F,7th 

Mav  8, 

Right  ;  double  flap.    Dr.  Dungan, 

204 

Fuller,   J.,    Pt.   G.,   3d 

May  14, 

Right;  flap.      Surg.   A.   Sabino, 

Man-laud,  age  22. 

9,  "64. 

C.  S.  A.    Diseh'd  July  21,  1865. 

5Iissouri,  age  28. 

14,  '64. 

76th  Ohio.     Disch'd  Slar.  8,  '65. 

-I  (?•} 

Nov.  30 

205 

Gable,  J.,  Pt.,  B,  155th 

June  18 

Ri^lit  ;  ant.  post.  flap.     Sur<f.  A, 

lOo 

B,  3uth  Term.,  age  20. 

De.  1,  '64. 

Marshal  May  4,  1865. 

Pennsylvania,  age  19. 

20,  '64.' 

E.  Reed,  155th  Penn.      Disch'd 

164 

Duchenes,  J.,  Pt.,C,  71st 

July  2, 

Left  •  flap.     Surg.  J.  51.  5Ierrow, 

Aug.  7,  1865. 

New  York,  age  26. 

3,  '63. 

2dN.  II.    Disch'd  June  14,  1864. 

206 

Gahl,.jr.,W.,Pt.,  K,57th 

Oct.  4, 

Right  ;  flap.     Recovered. 

165 

Duff,  L.  B.,  Lieut.-Col., 

June  18, 

Right.    Discharged  Oct.  25,  1864. 

Illinois. 

4,  '62. 

105th  Pennsylvania. 

18,  '64. 

207 

Gallagher,  T.,  Serg't,  F, 

June  14, 

Left.     Surgeon  Davis.     Retired 

16C 

DulTuny,  A.  D.,  Pt.,  C, 

April  16, 

Right  ;  flap.    Surg.  C.  M.  Chand 

7th  Louisiana,  age  30. 

15,  '63. 

February  13,  1865. 

6th  Vermont,  age  44. 

18,  '62. 

ler,  6th  Yt.    Disch'd  July  1,  '62. 

2C8 

2  Gardner,  H.,  ('apt.,  I, 

Nov.  24, 

Right  ;  (lap.    Surg.  A.  W.  Ileise, 

167 

Dugal,  }j.,  Sergeant,  F, 

Mav  5, 

Left  ;  ant.  post.  doub.flap.  Confed. 

100th  Illinois,  age  23. 

25,  '63. 

100th  111.     Ila-m.;  lig.  cf  fem'l 

14.ith  N.  Y.,  age  26. 

6,  '64. 

surg.    Disch'd  March  22,  1865. 

art'ry.     Disch'd  Aug.  18,  1864. 

]68 

Dugan,  P.,  Pt.,  G,  169th 

Sept.  29, 

L't  ;  circ.  Surg.  J.Knowlson,  169th 

209 

Gardner,  C.  II.,  Pt.,  C, 

June  18, 

Left  ;  circ.     Confed.  surg.     Dis. 

New  York,  age  25. 

29,  '64. 

N.Y.  Dis.Nov.3,'65.  Nov.25.'65, 

16th  Mass.,  age  34. 

18,  '62. 

July  11,  1863.     S]*c.  '-'itf. 

reamp.,Surg.  Thorn,  Troy,N.Y. 

210 

GarrM,  W.,  Pt.,  I,  15th 

July  18, 

Right;  Hap;  slough.;  gangrene. 

169 

Duncan,  L.  S.,  Serg't,  I, 

Aug.  14, 

Left  ;  circ.  Provost  Marshal  Nov. 

Mississippi,  age  18. 

19,'  '64. 

Recovery. 

4th  Tenn.  Cav.,  age2ti. 

14,  '64. 

16,  1864. 

211 

Gathers,  L.,Pt.,H,  155th 

Feb.  6, 

Left  ;  flap.    Disch'd  Slay  29,  '65. 

170 

Dunlap,L.I.,Pt.,F,119th 

April  2, 

Left  ;  circ.    Surg.  P.  Leidy,  119th 

Penn.,  age  30. 

6,  '65. 

Penn.,  age  22. 

2,  '65. 

Penn.    Disch'd  June  17,  1865. 

2J2 

Gay,  I.  D.,    Serg't,  F, 

Aug.  6, 

Left;  «irc.     Surg.  E.    Batwell, 

171 

Dunn,  J.,  Pt.,  I,  2d  New 

Aug.  14, 

Right  ;  circ.    Disch'd  June  9,  '65. 

91st  Indiana,  age  28. 

7,  '64. 

14th  Slich.  Disch'd  June  20.  'Co. 

York  II.  A.,  age  30. 

15,  '64. 

213 

Gear,  N.  II.,  Pt.,  D,  2d 

June  1, 

Left;  doiib.  flap.  Surg.ll.  Plumb, 

172 

Duron,  L.  M.,  Pt.,  C,  7th 

Oct.  8, 

Left  :  circ.    Furloughed  June  16, 

Connecticut. 

2,  '64. 

2d  Conn.     Disch'd  June  3,  '64. 

Arkansas,  age  21. 

8,  '62. 

1863. 

July  7th,  re-amputation. 

173 

Eaton,  G.  1,.,  Pt.,  F,  16th 

April  24, 

Left  ;  cire.  Ass't  Surg.  J.  B.Whit- 

214 

Geissler.  J.,  Pt.,  B,  49th 

July  12, 

Right  ;  ant.  post.  Hap.     Surg.  G. 

Conn.,  age  28. 

24,  '63. 

comb,  16th  Conn.    Disch'd. 

New  York,  age  49. 

12,  '64. 

T.  Stevens.  77th  X.  Y.    Disch'd 

174 

Eck,  11.,  Serg't,  F,  14th 

Dec.  13, 

Left.    Surg.  White.    Furloughed 

June  23,  1865.     Card  Phot. 

Louisiana. 

13,  '62. 

Jan.  26,  1864. 

215 

Gelsleichter,  C.,  Corp'l, 

July  30, 

Left  ;   double  flap.     Surg.  A.  F. 

175 

Englebrecht,  H.,  Pt.,  E, 

April  7, 

Lett.    Disch'd  August  4,  1862. 

C,  Kith  Ohio  Cavalry, 

30,"  '64. 

Whelan,  1st  Mich.  S.  S.     Sept. 

2d  Kentucky. 

8,  '62. 

age  32. 

7,  bone  rem.   Disch'd  JuneJ','65. 

176 

Erenburg,  A.,  Lieut.,  1st 

Sept.  17, 

Left.  Surg.H.E.  Smith,  27th  Mich. 

216 

Gibson.  G.,  Pt.,  C.  63d 

June  1, 

Right.     Disch'd  July  21,  1862. 

Ky.  Light  Artillery. 

17,  '62. 

Dis.  May  15,'65.  Subs,  rem.bone. 

Pennsylvania. 

1,  '62. 

177 

Evans,  E.  M.,  Corp'l,  D, 

Oct.  19, 

Right  ;  circ.    A.Surg.J.M.Cowen, 

217 

Giese,  E.  F.,  Pt.,  D,  82d 

July  1, 

Left:  flap.     Surg.  W.  C,  Stein' 

28th  Iowa,  age  19. 

20,  '64. 

77th  111.    Disch'd  June  21,  1865. 

Illinois,  age  20. 

1,  *63. 

58th  N.  Y.    Sub.  oper.    Disch'd 

178 

Everson,  F.,  Pt.,  E,  1st 

Aug.  24, 

Right  ;  circ.    Insanity.   Washing 

March  14,  1864. 

Wisconsin,  age  40. 

24,  '64. 

ton,  Oct.  20,  1864. 

218 

Gibson,  IT.  B.,  Pt..  D, 

July  3, 

Left;  circ.     Transferred  for  ex 

17'J 

Ewald,  11.,  Pt.,F,43dN. 

Mav  3, 

Right  ;  flap.     Surg.  M.  Case,  43d 

2d  S.  Carolina,  age  23. 

4,  1863. 

change  Sept.  10,  1863. 

York,  age  18. 

5,  '63. 

N.  Y.    Disch'd  Sept.  16,  1863. 

219 

Gildersleeve,  A.,  Lands 

Jan.  15, 

Left  ;  also  amp.  r't  thumb  and  in 

180 

Fairgricves,  G.,  Pt.,  H, 

June  1, 

Right  ;  circ.     Surg.  J.  S.  Martin, 

man,    U.    S.    Steamer 

16,  '65. 

dex  finger.     Re-amp.     Disch'd 

15th  X.  Jersey,  age  23. 

2,  '64. 

14th  N.  J.  Disch'd  June  30,  '65. 

Montgomery. 

July  (i,  1867. 

181 

Farmer,  M..  Pt.,  K,  10th 

June  3, 

Left;  circ.     Surg.  11.  N.  Small, 

220 

Gill,  J.  W.,  Serg't,  A, 

April  2, 

Left;  flap.  Surg.  E.  1C.  Foreman, 

N.  Hampshire,  age  24. 

3,  '64. 

10th  N.  II.    Disch'd  June  14,'65. 

6th  Maryland,  age  27. 

2,  '65. 

6th  Sid.     Disch'd  July  21,  '65. 

182 

Faulkner,  I.,  Pt.,  B,  (ith 

Aug.  25, 

Right;  circ.     A.  A.  Surg.  J.  F. 

221 

Godley,  L.M.,  Serg't,  E, 

51  ay  22. 

Left  ;  flap.     Discharged  Sept.  4, 

Missouri  Cav.,  age  25. 

27,  '64. 

Musgrove.  Disch'd  Mar.  16,'65. 

22d  Iowa. 

23,  '63. 

18(i3. 

183 

Feerer,   D.   A.,   Pt.,   A, 

Mav  27, 

Left  ;  flap.     Disuh'd  Dec.  28,  '64. 

222 

Gooch,  J.    1).,    Pt.,   B, 

Mav  5, 

Left  :  circ.  Surg.  Slater,  15th  Va. 

7'.)th  Ohio,  age  22. 

27,'  '64. 

15th  Virginia. 

5,  '64. 

Furlonghcd  May  25.  1864. 

184 

Fickel,   S.  W.,  Pt.,    B, 

Aug.  26, 

Right  ;  circ.    Surg.  J.  S.  Reeves, 

223 

Good,    P.,   Pt.,    B,  33d 

June  22, 

Left  ;    flap.     Dis'ch'd   April  14, 

78th  Ohio,  age  17. 

26,  '64. 

78th  Ohio.    Dec.  4th,  re-amp,  by 

Indiana,  age  19. 

23,  '64. 

1865. 

Surg.  G.  Grant,  U.  S.  V.     Dis 

224 

Gould,  T.  M..  Serg't,  E, 

July  20, 

Right;   circ.;   gang.;   bone  exc. 

charged  July  24,  1865. 

29th  Alabama,  ago  29. 

21,  '64. 

Recovery. 

1S5 

Fitzgerald,    C.,   Pt,    G, 

Jan.  7, 

Left.     Ass't  Surg.  F.  J.  Foster, 

225 

Goulding.  J.  F.,  Serg't, 

July  2, 

Right  ;  tta'p.    Surg.  N.  Hayward, 

lOlith  Illinois,  age  25. 

7,  '65. 

13th  111.  Cav.    Dis.  Aug.  31,  '65. 

C,  20th  Massachusetts, 

3,  '63. 

2Uth  Slass.    Aug.  30,  spicu.  ext. 

186 

Finn,    J.,    Pt.,     B,    llth 

Oct.  1, 

Right.     Surg.  T.  M.   F  landrail, 

age  29. 

•Sept.  23,  nee.  bone  ext.    Disch'd 

Infantry,  age  28. 

1,  '64. 

146th  N.  Y.    Duty  Mar.  17,  '65. 

Jan.  28,  1864. 

187 

Fisher,   H.,  Pt.,  E,  14th 

July  5, 

Right  ;  long.  ant.  flap.    Insanity. 

226 

3  Gowans,  J.,  Pt.,  A,  38th 

Dec.  13, 

L«-ft  ;  lat.  flap.    Ass't  Surg.  R.  A. 

N.  York  II.  A.,  age  36. 

5,  '64. 

Insane  asylum  Mar  3,  1865. 

New  York. 

15,  '62. 

Everett,  5th  Mich.    Discharged 

188 

Fisher,   L.,  Corporal,  F, 

June  3, 

Rijjht.    circ.     Discharged  May 

April  27,  1863. 

184th  Penn..  age  18. 

3,  '64. 

30,  1865. 

227 

Grant,   P.,  Pt.,  E,  48th 

June  27, 

Left;  circ.     Surg.W.R.D.B'.nck- 

189 

Fisher,  T.,  Corp'l,  15,  4th 

June  14, 

Right  ;    flap.     Discharged  5Iay 

Pennsylvania,  age  17. 

27,  '64. 

wood,  48th  Pa.    Dis.  Jan.  1  3,'6J. 

Colored  Troops,  age  1  8. 

15,  '64. 

20,  1865. 

228 

Grant,  11.,  Pt.,  F,  165th 

July  23, 

Left  ;  circ.     Discharged  Feb.  10, 

190 

Fordice.   J.  11.,   Pt.,  B, 

Sept.  11, 

Left;    circ.     A.  A.  Surg.  W.  H. 

New  York,  age  21. 

25,  '64. 

1865. 

3:>th  Illinois. 

11,  '63. 

Finn.     Disch'd  June  20,  1864. 

229 

"Gray,    W.  A.,  Pt.,    K, 

Sept.  19, 

Right.     Discharged  Oct.  9,  1863. 

191 

Folger,  I.  H.,  Lieut.,  II, 

June  3, 

Right.     Surg.  32d  Me.     Subseq. 

24th  Alabama. 

19,  '63. 

58th  Mass.,  age  21. 

3,  '64. 

operat'n.     Disch'd  Deo.  17,  '64. 

230 

Gra>j,  W.  11.,  Pt.,  F,  33d 

Slay  23, 

Left.     Ass't  Surg.  J.  A.  Vigal, 

Dead  bone  removed. 

North  Carolina. 

24,  '64. 

33d  N.  Carolina.     Recovered. 

192 

Follard,  J.,  Pt.,  A,  21st 

Nov.  30, 

Left  ;  circular.    Provost  Marshal 

231 

Green.  D.,  Serg't.  G,  4th 

June  li), 

Left;  ant.  post.  Hap:   remo.  necr. 

Tennessee,  age  18. 

De.  1,'64. 

March  18,  1865. 

Delaware,  age  26. 

19,  '64. 

bone.    Disch'd  June  23,  1865. 

193 

Forney,  K.,  Pt.,  H,  48th 

Sept.  17, 

Right  :    flap.      Discharged   Jan. 

232 

Green,  J.  D.,  Pt.,  E,  7th 

Mav  5, 

Left  ;  flap.    Surg.  Smith,  C.  S.A. 

Penn.,  age  24. 

18.  '64. 

13.  1864. 

51aryland,  age  22. 

6,  '64. 

Disch'd  Aug.  18,  1865. 

194 

Forrest.    J.   J.,  Pt.,   K, 

Sept.  1, 

Right  :  flap.    Surg.  D.  S.  Young. 

233 

Green,    T.   G..    Pt.,    G, 

July  1, 

Left;  flap;  necr.  bone  removed. 

21st  Ohio,  age  24. 

1,  '64. 

21st  Ohio.    Disfh'd  June  21,  '65. 

36th  New  York. 

2.  ''62. 

Disch'd  July  15.  '6:5.    Spec.  1  15. 

195 

'Forrester,    P.,   Pt.,    G, 

Dec.  13, 

Left  :  ant.  post.  flap.     Surg.  \V. 

234 

Green,    W.  II.,   Pt.,  K, 

S~ept.  4, 

Right.    Released  April  1,  1865. 

99th  Pennsj-lvania. 

13,  '62. 

O'Meagher,   69th  N.  Y.     Sub. 
rem.  of  bone.     Dis.  Nov.  26.  '63. 

235 

2d  S.  Carolina,  age  32. 
Griffin,   H.   SI.,    Pt.,    D, 

4,  '64. 
July  6, 

Left  ;  circ.    Surg.E.  Hat  well,  14th 

196 

Fountain,  N.,Pt.,B,  18th 

Oct.  5, 

Right:  circ.     Surg.  E.  J.  Buck, 

14th  Michigan,  age  20. 

6,  '64. 

Slich.    Discharged  July  If,  '65. 

Wisconsin,  age  17. 

5,  '64. 

18th  Wis.    Disch'd  May  18,'65. 

236 

Grogan,   A.,   Lieut.,  G, 

June  29, 

Left  ;  ant.  post.  flap.    Surg.  !•'.  L. 

197 

Fonts,    S.,    Pt.,    G,   2d 

Feb.  15, 

Left  ;  flap.     Discharged. 

6th  Conn.,  age  21. 

29,  '64. 

Dibble.  6th  Conn.     Discharged 

Iowa,  age  23. 

16,  '62. 

Nov.  26,  1864. 

198 

Fralick,  \V.  A.,   Pt.  M, 

April  2, 

Left  ;  circ.    Confederate  surgeon. 

237 

Groover,  P.  II.,  Pt.,  I, 

Oct.  20, 

Right.    Surgeon  Burton.   Recov 

IDthN.Y.  H.  A.,  age  19. 

2,  '65. 

Disch'd  Sept.  22,  1865. 

48th  Alabama. 

20,  '63. 

ered. 

199 

Frazer,  P.,  Lieut.,  C,  4th 

July  30, 

Right  ;  flap;  haem.  Disch'd  April 

238 

Gross,  J.,  Corp'l,  E,  82d 

Slay  25, 

Right  :   circular.     Disch'd  Feb. 

Colored  Troops,  age  40. 

30,"'64. 

22,  1865. 

Illinois,  age  24. 

26,  '64. 

12,  1865. 

'O'MEAGHKK  (W.),  Casualties  at  the  Battle  of  Fredericksburg.  in  Am.  Med.  Time.s,  1863,  Vol.  VI,  p.  179. 

2LIHELL  (J.  A.),  On  the  Surgical  Treatment  of  Traumatic  Hemorrhage,  etc.,  in  Surg.  Mem.  of  the  War  of  the  Rebellion,  collected  and  published 
by  the  U.  S.  Sanitary  Commission,  1870,  Vol.  I,  p.  225. 

3O'SIKAGUEU  (W.),  Casualties,  etc.,  op.  cit.,  p.  179,  and  Surg.  Mem.  of  the  War  of  the  Rebellion,  Coll.  and  pub.  by  the  U.  S.  San.  Comm.,  1871, 
Vol.  IL  p.  20.  *  TERUY  (C.),  toe.  cit.,  p.  76. 


IN.IUKIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME.  MII.ITAUV 

DESCUH'TIOX,  AND  AcK. 

DATES. 

(  UT.UATIONS.  Ol'EKATOKS, 
RESULT. 

No. 

! 

NAME,  MILITARY 
DEscnii'Tiox.  AND  ACK. 

DATES. 

Ol'KKATlONS,  (  H'EKATOIiS. 

RESULT. 

239 

(j'rorex.    J.   li..    Pt..   K, 

July  1, 

Left.    Recovered. 

280 

Hunt,  M.,  Serg't.  I),  3d 

June  3, 

Left;  double  flap.     Surg.   D.  M. 

13th  North  Carolina. 

2,  '63. 

Vermont,  age  25. 

3,  '04. 

Goodwin,  3d  Vermont.    Disch'd 

240 

Guy   II.  W.,  Pt.,  F,  14th 

July  1, 

Right;  ant.  post.  flap.     Surg.  G. 

May  17,  1865. 

N.  York  S.  M.,  age  30. 

2,  ;63. 

M.  Ramsey,  !'5th  N.Y.    Disch'd 

281 

Hyndman.  J.  A.,  Pt.,  G, 

Feb.  23, 

Left;  cire.     Surg.  D.V.  Runnels 

March  30,  1864.     Spec.  4368. 

5th  Ohio  Cavalry. 

23,   03. 

and  Ass't  Surg.  G.  Sprague,  5th 

24) 

Gayer.  F.,  Capi.   D,  83d 

Mav  6, 

Right:    circ.     Confed.    surgeon. 

Ohio  Cav.  Disch'd  June  3,  "04. 

Now  York,  age  36. 

7,  '64. 

Mustered  out. 

282 

Iburg,    F..    Pt.,    E,    2d 

Oct.  8, 

Left;  flap.     Disch'd  Oct.  3,  1863. 

242 

Hall,  A.  A.,  Pt.,  E,  fith 

Oct.  11, 

Right;  circ.    Surg.B.G.  Streeter, 

Missouri. 

8,  '02. 

N.  York  C'av.,  age  20. 

11,  'C3. 

4fh  N.  Y.  Cav.     Disch'd  Aug. 

283 

Imhoff.  F.,  Pt.,D,2d  N. 

July  3, 

Left;    flap.     Disch'd  March    15. 

23,  1804.    Spec.  4307. 

Jersey,  age  32. 

4,  '03. 

1804. 

243 

HalloweU,    W.    G.,  Pt., 

Oct.  14, 

Left.    Furloughcd  Dec.  18,  1863. 

284 

Inman"  W.,   I't.,  D,  4th 

May  5, 

Left;  flap.    Surg.  J.  D.  Osborne, 

A,  27th  North  Carolina. 

15.  '63. 

New  Jersey. 

5,  '04. 

4th  N.  J.    Disch'd  Nov.  21,  '64. 

fyAI 

Sept.  10 

C                             -p.,   ,.  „      f<      ^       A 

285 

Inman,  P.,  Pt.,  A,  95th 

June  '^'7 

Left;  flap.     Surg.  G.  W.   East 

nfl1* 

Hamilton.  *f.  R-,  Lieut., 
E,  10th  Florida. 

10,  '64.' 

Recovered. 

Illinois,  age  20. 

•27,  '64.' 

man,  Kith  Wis.     Sub.  amputa 

245 

Hammell,  D.  F.,  Serg't, 

Oct.  19, 

Right;  flap.    Snrg.G.T.  Stevens, 

tions.     Disch'd  June  17,  1805. 

E,  132dN.  Y.,  age  34 

19,  '64. 

77th  N.  Y.    Disch'd  May  30,'65. 

280 

Irvine,    T.,    Pt.,    I,    1st 

Mav  31, 

Left  ;  cire.    Confederate  surgeon. 

246 

Hammers,  G.,  Capt.,  D, 

July  21, 

Left:  circ.    Surg.  J.  W.  Lawton, 

Pennsylvania,  ago  27. 

J'ne'l,'64. 

Disch'd  May  12,  1865. 

'-7th  Kentucky,  age  :i4. 

21,'  '64. 

U.  S.  V.    M.  o.  March  29,  1865. 

287 

Jackson,  A..  Pt.,  E,  75th 

Aug.  19, 

Right  ;  circ.  "(also  w'd  left  knee). 

247 

Hanna,  O.,  Pt,,  B,  47th 

Mar.  21, 

Right  ;  circ.    Surg.  J.  II.  Hutchin- 

Ohio,  ago  18. 

19,  '03. 

Surg.  C.  L.  Wilson,  75th  Ohio. 

Ohio,  age  26. 

21,  '65. 

son,  15th  Mich.     Disch'd  June 

Disch'd  Jan.  20,  1865. 

17,  1865. 

288 

James,  J.,  Pt..  H.,  19th 

July  2, 

Right;  flap.      Disch'd  Nov.  12, 

24  1- 

Hannah,   A.,  Pt.,  I.  1st 

Aug.  12, 

Right:  flap.     Surg.  H.  II.  Lang- 

Maine,  age  29. 

3,  '03. 

1804. 

Mich.  Art'y,  age  18. 

12,  '64. 

don,  7t)th  Ohio.    Disch'd  Oct.  3, 

289 

James,  S.E.,Pt.,G.  :!0th 

Oct.  21. 

Right  ;  flap.     Surg.  A.  T.  Hud 

1865. 

Iowa. 

21,  '03. 

son,  20th  la.     Disc.  Feb.  27,'t4. 

249 

Hauerwas,    L  ,    Pt.,  C, 

May  15, 

Left;  circ.    Confederate  surgeon. 

290 

Jarrell,  A.,  Corp'l.  I,  1st 

April  7, 

Left  ;  circ.  A.  Surg.  E.  P.  Roche, 

18th  Connecticut. 

16,  '64. 

Disch'd  May  12,  1865. 

Delaware,  age  23. 

8,  '65. 

35th  Mass.    Disch'd  Oct.  18,  '65. 

550 

Harford,   T.  J.,  Pt.,  D, 

April  8. 

Right;  circ.     Ass't  Surg.  W.  F. 

291 

Jarvis,  I.,Pt.,K,  lOthN. 

May  31, 

Left  ;  circ.   Surg.  O.  R.  Freeman. 

161st  N.  York,  age  21. 

9,  '64. 

Sigler,  13Cth  III.     Sub.  opera'n. 

Jersey,  age  30. 

31,  ''64. 

10th  N.  J.    Disch'd  Dec.  15,  '64. 

Disch'd  March  8,  1865. 

.M,.) 

Jay,   I.,     Pt.,    14th    In 

June  10, 

Right;  ant.  post.   flap.     Confed. 

231 

Harvey,  H.G..  Capt.,E, 

June  12, 

Right;  circ.     Surg.  G.  L.  Potter, 

diana  Battery,  age  28. 

11,  '64. 

surgeon.     Disch'd  July  8,  1865. 

145th  Pennsylvania. 

12,  '64. 

145th  Penn.    Disch.  Dec,  19/64. 

293 

Jean  R.  M.,  Pt.,  G,  3d 

July  8, 

Left.     Surgeon  Brown.     Recov 

252 

Haskins,     D.',    Pt..    1st 

Sept.  29, 

Left;  double  flap.     Ass't  Surg. 

Arkansas. 

8,  '64. 

ered. 

Virginiai  Artillery. 

29,  '64. 

W.  F.  Richardson,  C.  S.  A.  Fur- 

294 

Jennings,  J.  W..  Serg't, 

Jan.  17, 

Left.      Surgeon   Bozeman.     Re 

loughed  Nov.  10,  1864. 

B,  Hampton's  Legion. 

18,  '64. 

covered. 

253 

Held,  P.,   Pt.,   C.,   40th 

Mav  23. 

Right;  ant.  post.  flaps.   Nov.  18th, 

295 

Jerger,  S.,Capt.,  K,  27th 

Mav  3. 

Right;   circ.     Discharged   Aug. 

New  York,  age  21. 

23,"  '64. 

bone  rem.    Disch'd  Mar.  8,  1805. 

Indiana,  age  40. 

3.  '63. 

19.  1863. 

254 

Honne,    li.,   Lieut.,    II, 

Mar.  8, 

Left.     Surg.  C.  Cook,  12th  Mo. 

290 

Jess,  T.,  Pt..   F,   125th 

Aug.  5, 

Left  :  flap.    Surg.  M.  AV.  Hooton, 

12th  Missouri,  age  40. 

8,  '62. 

Disch'd  Jan.  27,  1863  ;  re-amps. 

Illinois,  age  25. 

5,  T64. 

80th  111.     Disch'd  Feb.  22,  '65. 

255 

Herald,  J.,    Pt.,    J,    1st 

Aug.  29, 

Right.     Surg.  J.  \V.  Tunniclitfe, 

297 

Johnson,  V,  W.,  Serg't, 

June  21, 

Right.     Surg.  A.   Hard,  8th  111. 

Michigan. 

29,  '62. 

1st  Mich.     Disch'd  Feb.  20,  '63. 

O,  3d  Indiana  Cavalry. 

21,  '03. 

Cavalry.     Diseh'd  Feb.  11.  '64. 

25G 

Hill,  J.,  Pt.,  B,  79th  N. 

Oct.  10, 

Left;  circ.     Surg.  G.  13.  Coggs- 

298 

Johnson,  W.  W.,  Corp'l, 

Julv  1  , 

Right:  ant.  post.  flap.     Disch'd 

York,  age  :)6. 

11,  '63. 

well,  2!)th   Mass.     Discharged 

E,  143d  Penn.,  age  31. 

2,  '03. 

Jan.  20,  1864. 

June  4,  1864.    Spec.  4377. 

299 

Jolin.-<ton,  J.  L.,  Corp'l, 

July  22, 

Right  :    circ.     Sept.  5th,   gang.. 

257 

Hill.  T.  M..  Pt.,  I,  14th 

Julv  3, 

Left.     Surg.  L.  V.  Hurt,  C.  S.  A. 

G,  19th  Ala.,  age  20. 

22,'  '64. 

slough.     Trans'd  Sept.  22,  '64. 

South  Carolina. 

4,  '63. 

Paroled  Sept.  23,  1803. 

300 

Johnston,  G.  S.,  Pt,,  H, 

May  22, 

Left.     Surgeon    Hunt,   C.  S.  A. 

258 

Hitler,  S.  J..  Pt.,  E,  3d 

Oct.  19, 

Right  ;  circ.     Surg.  Evans,  C.  S. 

27th  North  Carolina. 

22,  '63. 

Recovered. 

South  Carolina,  age  23. 

19,  '64. 

A.     Pro.  Marshal  April  1,  1865. 

301 

Johnston.     R.,    Pt.,    D, 

July  20, 

Right.   Disch'd  June  7,  '65.  Died 

259 

Hodges,  S.,  Pt.,  F,  82d 

May  25, 

Left  ;   flap  ;    gangrene  ;    re-amp. 

70th  Indiana. 

20,'  '64. 

March  15.  1809;  pytemia. 

Ohio,  age  20. 

26,  '64.    I      .Tune  Kith.     niseh'd  .Time  5.  '65. 

302 

Jones  J     seaman  II.  S. 

Jan.  15 

Left.     Disch'd  August  4,  1805. 

260 

Holbrook,   C.,    Pt.,    II, 

May  12. 

Left  ;  double  flap.    Confed.  surg. 

Navy. 

16,  '65. 

lOUth  N.  York,  age  21. 

14,''04. 

Disch'd  Nov.  25,  1865. 

303 

Jones,  E.  E.,  Corp'l,  F, 

Jan.  15. 

Left;  circ.     Ass't  Surgeon  F.  B. 

201 

Holloit'dit  J    -I     Pt     F 

1  17th  N   York   afre  20 

15   '65 

15th  South  Carolina. 

1,  '64.' 

7,1864. 

Diseh'd  Oct.  14.  1865. 

2(52 

Holloway,  F.,  Corp'l,  F, 

June  1, 

Right  :  doub.  flap.    Confed.  surg. 

304 

Jordan.   A.,  Pt.,  C,  12th 

Oct.  19. 

Left  :  circ.     Discharged  June  12, 

3Gth  Wisconsin,  age  20. 

1,  '64. 

Disch'd  May  27,  1865. 

Maine,  age  21. 

19,  '04. 

1865. 

2G3 

Holmes,  P.,  Pt..  D.  8th 

June  3, 

Right  ;  circ.     Ass't  Surg.  W.  R. 

305 

Joyce,   E.,    Pt.,    A,    1st 

Mav  27, 

Left  ;  ant    post.  flap.     Surg.  M. 

Maine,  age  20. 

3,  "64. 

Benson,  8th  Maine.   Discharged 

Artillery,  age  27. 

27,"  '63. 

Benedict,  75th  N.  Y.     Disch'd 

May  3,  1805. 

March  30,  '04.    'Spec.  2670. 

264 

'Holmes,  W.  F.,  Pt.,  G, 

May  9, 

Left;    flap;   three-fourths  of  an 

306 

Knrn,  W..  Pt.,  G,  118th 

July  20, 

Left  ;  ant.  post.  flap.    Surg.  C.  D. 

4th  Tcnn.  C'av.,  age  24. 

9,  '64. 

inch  ot  bone  remo.    Recovered. 

Ohio,  age  24. 

20,'  '64. 

Moore,  13th  Ky.    Disch'd  April 

265 

Hopwood,  A.  S..  Corp'l, 

June  28, 

Left;  Surg.  R.  R.  Taylor.  U.S.V. 

14.  1805. 

B,  7th  Ky.  C'av.,  age  27. 

28,  '63. 

Disch'd  June  8,  1804. 

307 

Karstens.  H.,  Corp'l,  K, 

Sept.  19, 

Right  :  flap.     Surg.  J.  G.  F.  Hol- 

266 

Ilorton,   \V.  H.,  Pt.,  B, 

July  2, 

Right  ;    removal    of   protruding 

16th  Iowa. 

19,  '02. 

ston,  U.S.V.  Disch'd  Ap'18,  '63. 

8th  Alabama  age  19. 

2,  '03. 

b:inc.    Exchanged. 

:  ;i  •- 

Kearney,  J.,   Serg't,   I, 

July  2, 

Right;  circ.  Surg.  G.W.Metcalf. 

267 

Houghton.  C.  H.,  Capt., 

Mar.  25, 

Right;  circ.     Surg.  W.   Ingalls, 

76th  New  York,  age  30. 

2,  '03. 

76thN.Y.   Also  amp.  r'tthumb. 

L,  14th  New  York  II. 

25,  '65. 

5'Jth   Mass.     Disch'd  Aug.  26, 

Disch'd.Iulyli,  1864.  Spec.  4300. 

Artillery,  age  23. 

1865.     Spec.  4001. 

309 

Heeler.   D.   N.,   Pt.,    C, 

Feb.  15, 

Right;    circ.'    Diseh'd   Oct.    11. 

268 

House,    M.,    Serg't,    F, 

Feb.  1, 

Left;  flap.    Surg.  A.  Sabine,  76th 

8th  Illinois. 

16,  '02. 

1802. 

9th  Iowa,  age  21. 

1,  '65. 

Ohio.     Diseh'd  June  6,  1865. 

310 

Keller,    G.    W.,    Pt.,  I, 

Aug.  28, 

Left:  flap.     Surg.   J.   McNulty. 

269 

Howard,   R.  C.,  Pt..  F, 

Sept.  27, 

Right  :   circ.     Confed.    surgeon. 

19th  Indiana. 

29,  '62. 

U.  S.  V.     Disch'd  Dec.  23,  '62. 

5th  Penn.  C'av..  age  22. 

27,  '04. 

Disch'd  July  18,  1805. 

311 

Hells,  J.,  Pt.,  I,   113th 

Sept.  1, 

Right:  ant.  post.  flap.     Surg.  T. 

270 

Howard.  \V.  H.,  Pt.,  K, 

Aug.  19, 

Right:  circ.  Disch'd  N'ov.25,'65. 

Ohio,  age  44. 

1,  '64. 

B.Williams.rjlstOhio.  Disch'd 

14th  New  York  II.  A., 

20,  '64. 

Died  Nov.  27,  '08.     Spec.  391. 

March  21,  1865. 

age  18. 

312 

Kelly,   J.,    Pt.,    G,    2d 

Mav  31, 

Lett;  flap.     A.  A.  Surgeon  J.  II. 

271     Howe,  F.M.,Pt..  C,30th 

Aug.  18, 

Left;  circ.     Surg.  W.  B.   Fox, 

Artillery,  age  21. 

31,"  '64. 

Thompson.     Julv  31,  seq.  rem. 

Michigan,  age  23. 

18,  '64. 

8th  Mich.     Disch'd  July  26,  '65. 

Disch'd  Mar.  10,  '05.  Spec.  2920. 

272 

Hw.-Jf.tt,  H.  M.,  Pt.,  A, 

May  6. 

Left.     Surgs.  Hancock  and  Trip- 

313 

Kelly,    M..    Pt.,  A,    1st 

Aug.  16. 

Left  ;  bilateral  flap.    Discharged 

7th  Louisiana. 

7,  '62. 

lett.     Disch'd  July  14.  18C2. 

Vermont  Battery. 

16,  '63. 

Dec.  10,  1803. 

273 

Hoyner.  J.,  Pt.,  A.  153d 

Oct.  1!', 

Left:  circ.     Surg.   N.  L.  Snow, 

314 

Kelscy.   E.    E.,  Pt.,   B, 

Dec.  13, 

Left.     Diseh'd  March  13,  1864. 

New  York,  age  30. 

20,  '64. 

153d  N.  Y.    Disch'd  Jan.  9,  '65. 

04th'  New  York. 

14,  '62. 

274 

Hulbard,  W.  Jtf.,  Pt.,  A, 

July  2, 

Left.      Surgeon  White.  C.  S.  A. 

315 

Kennedy,  J.,  Serg't,  A, 

Dec,  15, 

Left;  circ.     Surg.  J.  W.  Green, 

1st  Louisiana,  age  26. 

2,  '63. 

Exchanged  March  3,  1864. 

95th  Illinois,  age  28. 

15,  '04. 

95th  111.     Disch'd  June  8,  1805. 

275 

Huck,  J.,    Pt.,    A,   72d 

Avig.  27. 

Left.    Disch'd  April  7,  '63.    Died 

316 

Kennedy,  1'.  R..  Pt.,  C, 

Oct.  14, 

Left;  circular.     Furloug'd  Feb 

New  York,  age  34. 

27,  '62. 

Sept.  8,  1865. 

27th  N.  C..  age  21. 

15.  '03. 

ruary  13,  1804. 

27t  ; 

Hudson,   G.  H.,  Pt.,  L, 

Sept.  23, 

Left  :  circ.     Surg.  W.  S.  Love, 

317 

Killen,  A.,  Pt.,  K,  14th 

Sept.  19, 

Left  ;  'ant.   post.   flap.      Disch'd 

5th  Virginia,  age  38. 

2:!,  '04. 

C.  S.  A.    Released  June  28,  '65. 

Ohio,  age  31. 

21,  '63. 

July,  17,  1805. 

277 

Huffman,  A.,  Corp'l,  C, 

Dec.  3J. 

Left;  flap.     Surg.  B.  F.  Miller, 

318 

Killian,  M.,  Pt  .  I,  79th 

Julv  20. 

Right:   hit.   flap.     Disch'd    July 

2d  Ohio. 

'62,  Jan. 

2d  Ohio.     Disch'd  April  9,  '63. 

Penn.,  age  20. 

21,  ''64. 

13,  1805. 

1,  '63. 

319 

King,    A.,    Pt..    II.    7th 

Aug.  24, 

Right:  flap.     Ass't  Surg.  C..  R. 

-.'.- 

Hughes,   P.  F.,   Serg't, 

Mav  18, 

Left  :  circ.     Surg.  W.  S.  Cooper, 

Michigan  Cavalry. 

25,  '04. 

Richards,  7th  Mich.  Cav.  Disch. 

C,    125th    New   York, 

18,'  '64. 

125th  N.   Y.     Nee.    bone   rem. 

320 

'•'Kirly,    W.    T.,    Pt  ,   —  ,     Sept.  19, 

—  .    Bono  protruded;  reampu- 

age  22. 

Disch'd  Aug.  29.'65.  Spec.  3^76. 

50th  Alabama. 

19.  '03. 

tation. 

279 

Hunt.  J.,  Pt.,  K,  151st 

June  1, 

Right  ;  double  flap.    Discharged 

321 

Kirby,   \V.   II..    Pt.,   A, 

July  1, 

Left;  flap.    Disch'd  May  6,  1804. 

New  York. 

2,  '64. 

Dec.  26,  1864. 

7th  N.  Jersey,  age  24. 

2,  to. 

. 

I 

'O'KEEFE  (D.  C.),  Surgical  Casi-s  of  Interest,  treated  tit  Institute  Hospital,  . 
'urg.  Jour..  1865,  Vol.  II,  p.  25.  2TERUY  (C.).  Joe.  cit.,  p.  70. 


SECT.  III. | 


PRIMARY    AMPUTATION    OF    THIGH    IN    MIDDLE    THIRD. 


No 

XAMK,  MILITARY 
DESCIIU'TIOX,  AND  AfJK 

Ol'KKA  TIOX8,  OPERATORS, 
RESULT. 

NO 

II 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

.,.,.                      Ol'KKATIOXS.    OlT.KATOIJS 

RKMI.I. 

322 

Kline,   K.,   1't..   E,   51st 

June  3.     Uight:  flap:  necrosis.     Mustered     365 

Lucas,  W.  V.,  Sersr't,  I, 

May  1, 

Right  ;  flap.     Disch'd    Aug.   27. 

Penn  .  age  1!>.                       3,  'ti4.         out  Jan.  25,  1866.                                           8th  Indiana.' 

1,  '63. 

18G3. 

323 

Kin  tli  H.    <'.   II-    Serg't,     Dec.  16,     Right;    circ.      Provost   Marshal     366     Lusty,  H,   Pt..  E.    15th 

July  2, 

Left.     Surg.  S.   H.  Plumb.  8_'d 

K,  8th  Ark  .  age  22.           17,  '64.        Juno  24,  1865. 

Massachusetts,  age  18. 

2,  '63. 

X.  V.     Disch'd  Jan.  12,  Ib64. 

324 

Kottinger.  .1.  F..  Pt..  B.     Dec.  31.     Left  ;  Hap.     Ass't  Surgeon  J.  F. 

367 

Luttmann,    J.,    Pt.,   K, 

Jan.  15, 

Right  ;  circ.     Disch'd  May  7,  '(;.">. 

16th  Infantry,  nge  30.      '62.  Jan.       Woods.  K.  S.  A.    Disch'd  July 

203d  Penn.,  age  34. 

15,  '65. 

1.  '113.         15,  1863. 

368    Li/onx.   W.,  Pt.,  Wheat's 

July  21, 

Left.     Surg.  Love.      Recovered. 

323 

Konklcman.   F..   Pt..  C.      Oct.  8,      Right  ;  flap.     Disch'd   July    lit, 

Battery. 

21,  '61. 

I 

149th  Penn.,  age  19.           8.  '64.          1«64. 

369    Maybt.'W.,   Pt..   C,   63d 

May  16, 

.     Recovered. 

I  326 

Kohlnian.    II.,     Pt..    F,     Pec.  13.     U't;  circ.;  also  amp.  three  fingers 

Tennessee,  age  51. 

Hi,'  '64. 

47th  Ohio,  age  37.               14,  '(i4. 

r  t  hand.     Surg.   I.  X.  Barnes. 

370    Madden.   T..  Corp'l,   A, 

May  27, 

Left:  circ.     Surg.  X.  W.  Leigh- 

lliith  111.    Disch'd  Sept.  20,  '65. 

173d  New  York. 

29,'  '63. 

ton,  173d  X.  Y.     Disch'd  Sept. 

327 

Kountz.  J  .  musician,  G.     Nov.  25. 

Lett  :  ant.  post.  flap.     Surg  C.  P. 

12,  1863. 

37th  Ohio,  age  20.              25,  '63.        Brent.  54th  Ohio.     Discharged 

371 

Maguire,  D.,  Serg't.  B, 

June  26, 

Left  ;  circ.   Dr.  Swinburne.    Dis 

April  29.  1864. 

2d  Penn.,  age  24. 

28,  '62. 

charged  Mar.  3,  '(M.     Spr.r.  170. 

328 

Kramer,  C.,  Pt.,  E,  191st     Mar.  31.     Lelt:  oval  skin   Hap:  circ.  sect. 

372 

Magill.  D.  B..  Capt.,  A, 

Jan.  15, 

Left.     Surg.  J.  W.  Mitchell.  4th 

Penn..  age  20.                    31,  '(15.        of  muse.     Disch'd  June  16,  '65. 

117th  X.  York,  age  26. 

15,  '65. 

C.  T.     Diseh'd  June  8,  1865. 

329 

Kranz.C..  Corp'l.  B.  15th    Aug.  18.  i  Left  :    circ.      Disch'dSept.]-,'.      373 

Maher,  P.,  Lieut.,  F,  63d 

June  22. 

Left.     Discharged  June  12,  1865. 

X.  Y.  II.  A.,  age  27.           19.  '<M.    '     1865. 

New  York,  age  42. 

22.  '64. 

Not  pensioned. 

330 

Kreig,   P.,   Pt  ,  C.    40th     Aug   21,  :  Left  ;  amp.  left  arm.     Surg.  W.     374 

Main,  F.  F..  Pt..  F,  100th 

July  18. 

Left;  ciro.  Confcd.Surg.  Slough 

New  York,  age  28.             21.  '64.        15.  Fox.  8th  Michigan.    Di.-ch'd 

New  York,  age  19. 

19,'  '63. 

ing;  necr.     liisch'd  July  30.V1. 

April  27,  1865. 

.S'jwc.  4298. 

:«i 

Landolt.  W.  H.,  Serg't.     April  (i.     Left:  circ.     Disch'd  July  13,  '65. 

375     Mansfield.    C..     Pt.,     E, 

May  12, 

Right  ;  flap.     Disch'd  March  24. 

A,  5th  Wis..  age  29.'       '.     6,  '65. 

145th  Penn.,  age  30. 

13.'  '64. 

1865. 

332    Langshold.    A..    1't..   I!.     May  12.     Left  :  Hap.     Pisch'd  Aug.  8,  '63. 

376 

Manson,    S.  B.,  Pt.,   F, 

July  24, 

Right:  flap.     Surg.  C.  L.  Traf- 

i     8th  Illinois.                           12,  '(13. 

3-(d  Maine,  age  24. 

24,'  '64. 

ton,  32d  Maine.     Disoh'd  May 

333      T.:im>     .F      M.      Sor"'t.    E       Oof    °7         TJi.rht-     fl:m        TkicoliM     .Tiili-    9C 

6   1865. 

Kith  Penn.  Cav.,oge41. 

28,  '64.        1865.' 

377 

Mapes,  W.  E.,  Capt.,  II, 

Aug.  14, 

Right;  flap.  Disch'd  Dec.  19.  '6-1. 

SIM 

Langan,  J..    Pt..    B,   2d     June  18.    Right:  ant.  post.  Hap.     Surg.  S. 

124th  X.  York,  age  21. 

14.  '64. 

Michigan,  age  22. 

18.    64. 

S.  French.  20th  Mich.     Gang. 

378 

Marine,    S.   A.,   Pt  ,  G, 

July  21, 

Right  ;  Hap.    Surg.  M.W.  Thom 

Disch'd  Sept.  11,  1865. 

loth  Iowa,  age  21. 

21  .''64. 

as,  13th  Iowa.     Dis.  April  5/65. 

335 

Lanning.  A.,  Serg't.  F,  !  Dec.  15. 

Left;  circ.:  gang.:  necr.    Disch'd 

379 

Marr,  A.  C.,   Serg't,  E, 

Sept.  19, 

Right:  flap.  Surg.T.  A.  Ilclwi-r, 

9:kl  Indiana,  age  27.       j    !"•,  '64. 

Xov.  16,  1865. 

14th  X.  Jersey,  age  25. 

19.  "64. 

87th  Penn.   Disch'd  July  ,".  '(.">. 

336 

Lapham.   C.  X..  Corp'l.      July  8. 

Right:    ant.    post.    flap.     (  Left  : 

380 

Marsh.    A.,    Serg't,    B, 

May  12, 

Right:  flap.     Surg.  J.  W.  Wis 

K,   1st  Vermont   Cav.,      10,  "'63. 

knee  joint.)  Surg.  A.  Wood,  1st 

64th  X.  York,  age  32. 

12,'  '64. 

hart,   140th  Penn.     Feb.,  1865, 

nye  23. 

Mass'.  Cav.    Disc'd  Aug.  25.  '64. 

necrosed    hone    pulled    awav. 

337 

Lanystone,  B.  F..  Pt..  C.     Nov.  30, 

Left  ;  bilateral  flap.     Prov.  Mar 

Disch'd  Feb.  24,  J865. 

5th  Arkansas,  age  19.      Do.  1,  '64. 

shal  March  27,  1865. 

381 

Marsh.  T.  J.,  Pt..   I.  2d 

June  18, 

Rig-lit  ;  ant.  post.  flap.     Proves! 

338 

Larkin.   A.   1?..    1't..    I),      Oct.  21. 

Right  ;  lat.  flap.     Surgeon  G.  L. 

Missouri,  a<?e  19. 

19,  '64. 

Marshal  Oct.  21,  1864. 

30th  Iowa,  age  24. 

21.  '63. 

Carhart,   31st   Iowa.      Pisch'd 

382 

Martin,    D.    D.,    Pt.,  C, 

Sept,  15, 

Right  ;  flap.     Discharged  1863. 

Feb.  4.  1864. 

12th  Maine,  age  45. 

15,  '62. 

339 

Lawrence,  J.  K.,  Pt..  D.     May  12. 

Left  ;  circ.     Pisch'd  June  16/65. 

383 

Martin,    J..    Corp'l,    F, 

June  22, 

Right  :  flap.     Surg.  J.  Chapman, 

93d  New  York,  ago  33.  i    13,'  '64. 

123d  X.  York,  atre  25. 

22,  '64. 

123d  X.  Y.  Disch'd  July  19,  '65. 

340 

Laurie,    C.,    Pt.,    F,    2d     June  4, 

—  :  double  flap:  gang.     Fur- 

384     Martin,  J.,  Pt.,  D,  106th 

Sept.  19, 

Left:  flap.     Sursr.  T.  A/Helwig, 

Vermont. 

4.  '64. 

loughed. 

Xew  York,  age  20. 

19,  '64. 

87th  Penn.    Disch'd  Mar.  31/05. 

341 

Learey.  J.,  Pt..  M,   10th 

Mar.  31, 

Left  :    ant.    post.    flap.      Disch'd 

385 

Martin.  S..  Pt.'.  H,  64th 

July  22, 

Left:  flap.    Disch'd  Feb.  28,  '65. 

N.  Y'ork  Cav..  age  22. 

A)>.  1/65. 

July  20,  1865. 

Illinois,  age  22. 

22,"  '64. 

342 

Leach.  E.  B.,  Corp'l.  K, 

Sept.  19. 

Right  ;  ant.  post.  flap.     Surg.  J. 

386 

Martin,  W.  J.,  Corp'l,  I, 

July  20, 

Right:  ant.  post.  flap.     Surg.  J. 

2:>th  Mass.,  age  33. 

20.  '64. 

G.  Bradt.  2,'.th  Mass.     Pisch'd 

14th  W.  Va.,  age  33. 

21,  "'64. 

H.  Manown,  14th  W.  Va.    July 

Oct.  29,  1864. 

27.  '65,  necrosed  bone  removed. 

343 

L?.?,  r.  ,r.,  PI.,  i,  38th 

Aug.  25. 

Right.  Surgeon  Wilbur.  C.  S.  A. 

Pisch'd  April  16.  1666. 

Virginia,  a^o  32. 

26.  'M.        Retired  March  13.  1865. 

387 

Mason,  G.,  Pt.,  K,   13th 

Sept.  30, 

Right  ;  circ.    Prison  Jan.  27,  '65. 

344 

L:-::,  Z.   J'.,  Pt.,  C,  23d 

Sept.  20.    Right.    Surgeon  Plummer.    Re- 

Virginia  Cav..  age  24. 

Oct.  1/64. 

Tennessee. 

20.  '63. 

covered. 

388 

MeAnany,  P.,  Pt.,  Bat'y 

April  12, 

Right:  ant.   flap.     Pisch'd   from 

315 

Le  Flure.  11.,  Serg't,  (1, 

July  17,     Uight;  circ.     Pisch'd  Aug.   29, 

A,  1st  Art'ry,  age  28. 

12,  '63. 

hospital  Jan.  29,  1864. 

2d  Kansas  Col  'd.                 17.  '63.        1804. 

389 

McCann.  F.,  Pt..  B,  10th 

Aug  17, 

Right:    circ.     (  'unfed.    Surgeon. 

340 

Loggett,  W.   F.,   Pt..  F.     July  29.     Left  :  Hap.    Surg.  A    I!.  Stewart, 

Xew  Jersey,  age  22. 

18r'64. 

Pisch'd  March  17,  1R65. 

1st  Ala.  •Cav.,  age  2  i. 

3J.  '03. 

1st  Ala.  Cav.    Pise.  July  5.  '64. 

390 

McCarthy,  F.,  Corp'l,  G, 

April  30. 

Right.     Disch'd   Aug.   14.    1863. 

347 

Lelar,  \V.  P..  Corp'l,  II.     Dec.  13. 

Right.     Pisch'd  May  4,  1863. 

1st  Wis.  Cav.,  age  27. 

3:),  '63. 

Died  Feb.  10,  1864. 

9Jth  Pennsylvania. 

14.  '62. 

391 

MoClaskev.  J.  R..  Serg't, 

July  6, 

Left  :  ant.  post.  flap.    Surg.  M.W. 

:;l- 

Lemmon.   J..   Corp  1,  P.      May  17. 

Right:  flap.     Surg.  G.  P.  Rex. 

A,  13th  Iowa,  age  33. 

7,  '64. 

Thomas.    131h  Iowa.     Diseh'd 

33d  Illinois.                           17."  '63. 

'   33d  III.     (Jang.     Pisch'd  Xov. 

Aug.  23,  1865. 

- 

4.  1863. 

392 

McClintock,  J.  II..  Pt.. 

Oct.  19. 

Left  :  ant,  post.  Hap.  Surg.  F.  A. 

349 

Lennon.  W.,  Pt.,  A,  8tli      Oct.  25.     Lett:  circ.     Pisch'd  May  26,  '64. 

A,  87th  Penn.,  age  18. 

19,  '64. 

llelwig,  87th  Penn.   Discharged 

.Michigan  Cav.,  a-,'o  17.  ;    25.  '63. 

April  ']().  1865. 

350 

Leonard.  <>.  H..  Pt..  1!,      Julv4.     Right  :  ant.  post.  flap.     Surg.  C. 

393 

McCord.  P..Pt  .(!,  149th 

July  3. 

Left  :  circ.     Surg.  J.  V.  Kendall. 

21st  Indiana,  ago  22.      !     4,  '64.         J.  Walton.   21st   Ky.     Pisch'd 

Xe\v  York,  age  24. 

3.  '63. 

149th  X.  V.     May  26th,  rein,  of 

June  20.  1865. 

bone.     Pisch'd  March  3,   1865. 

351 

Levitt,  J..  Serg't.  C.  35th    June  18. 

Left;  circ.     Surg.  S  P.  Ilawley, 

Spen.  2756. 

Illinois,  age  31. 

19,  '(14. 

35th  111.     Disch'd  Feb.  24.  '65.     394 

McDonald.  II..  Corp'l.  F, 

Oct.  16. 

Left:  ant.  post.  flap.  Confederate 

352 

Lewis,   M..   Pt..   K.  7th 

July  3, 

Right.     Pisch'd  June  3,  1864. 

61st  C.  Troops,  age  24. 

17.  '61. 

Surg.     Disch'd  July  29.  1865. 

Mich.  Cav..  age  18.             4.  'C.i. 

395 

McFarling.    J.,    Pt..   1), 

June  22, 

Left  :'  flap.     Disch'd  May  31.  '65. 

353 

Liesy,  J..   Pt..    P..    17th     May  14,     Right:    circ.     Disch'd    Feb.    18. 

154th  X.  Y.,  age  20. 

2.',  '64. 

Ohio,  ago  36.                       15.  '64.        18(15.                                                  396 

Me.Gary,  W..  Pt.,  D,  1st     July  12. 

Lett:    circ.     Surg.   Clark.     Dis 

354    Lillev.  S.  O..  I't..  L.  1st 

May  19. 

Right  :   flap.     Disch'd  April  26. 

Xew  jersey,  age  29. 

13.  '63. 

charged  Oct.  5,  1863. 

Maine  H.  A.,  age  2  .). 

21.  ''64. 

1865. 

397 

-Mcllniro,   P.,  Corp'l,  E, 

July  3.      RiirM  :  circ.    Surg.  X.  Havward. 

355    Lincoln,    E  .    Serg't,    I, 

April  6. 

Left;  flap.     Surg.  II.  Wardnor, 

20th  Mass.,  age  32. 

5,   63.         20th  Mass.  Disch'd  May  14,  ')M. 

12th  Illinois.                          7,   l>2. 

U.  S.  V.     Disch'd  May  29.  1862. 

398 

Mcfiill.  L  .  Pt.,   1!.  97th     Aug.  16. 

Right:  circ.     Surg.  J.   R.  F.ver- 

356 

Litultaii.  \V..  Pt.,  I.  18th      May  2. 

Right  :  circ.    Surg.  Lane.  (lang. 

Penn..  age  16.                        16,  '64. 

liart,  97th  Penn.      Pisch'd  Jan. 

.North  Carolina.                    3.  'ii3. 

FiirhmgluMWuly  28.  1863. 

17.  1866.     SIM.  2399. 

357    Listinau.   J.,    dipt.,    II, 

Feb.  (i, 

Right  ;  circ.     Surg    J.  Thomas. 

399     Mcliaulley.  W..    Pt..   P.      Aug.  23,     R't  :  doub  Hap.   Snrir.  R  W.  Ila/- 

185th  Now  York. 

6.  '65. 

118th  Penn.  Disch'd  May  29/65. 

2d  W.  Va.,  a  ire  27.              23.  '62.         lctt.2d  W.Va.   Dis.  April  27/63. 

358    Little.   J.,    Pt.,    B,  27th 

Aug.  28, 

Left.    Surg.  Gibson.    Recovered.      400    Metlindloy.   B.'.    Pt..   C.      May  16.     Hiyht  :   Hap.     Sursr.  B.  F.  Steven 

Virginia 

28,  '62. 

22d  Kentucky.                     17.  '63.        son.  22d  Ky.    Dis.  Sept.  10.  '63. 

359    L'lfton,   It.    /•'..    Pt.,   P. 

Sept.  20, 

Left.     Surg.  Grant.     Recovered. 

401     MoGomiglo.    C.,    Corp'l,      Oct.  19,     Ki;rht  :  ciiv  :    femoral    rel'uratod. 

DM  Tennessee. 

21.  '63. 

C.  35th  Ohio,  age  24.         20.  '64.         Diseh'd  March  31.  1865. 

360    Logan.  W.    A.,    Corii'l.  ,    Sept.  1, 

Right:  flap.      Surg.  X.  G.  Sher 

402    Mcr.rew.  X.   1!.,   Pt.,  F.     Sept.  13.     Left  :  flap.     Diseh'd  June  17.  '63. 

D,  110th  III..  age  30.           1.  'Ii4. 

man.  9th  Ind.  Disc'd  Feb.  1/65.                 34th  Ohio.                              13,  '62. 

Died  0<-t.  27.  1864  :  shock. 

3i;i     L'ltf.,   G.   \V..  Sorg't,  H, 

July  3, 

Right.     Surgeon  Pierce,  C.S.  A.     403    McKay,  R..  Pt.,  F,  28th     May  18.     Left:  circ.     Disch'd  April  26,  '65. 

7th  South  Carolina. 

3,  '63. 

Recovered.                                                 i     Mass..  age  18.                       18!  '64. 

362    Lovely,  C.,  Pt.,  F,  llth 

June  1. 

Right:    double  flap;   also  amp.     404    McKinney,  J.,  Serg't,  A,     June  24.     Riirlit  :  circ.     Disch'd-  March  9, 

Vermont,  ajje  38. 

1,  '64. 

left  arm.     Disch'd  Feb.  6.  1865. 

15th  Ohio.                             24.  '63.         18ii4. 

303    Loveridge,    C.,    Pt.,    1!, 

May  27, 

Left;  flap:  gang.     Disch'd  Jan.     405    McMahon.  .)..  Pt..  I.  6th      Mav  7.      Left  ;  circ.     A.  Rrirg.  R.  C.  ftang- 

1st  U.  S.  S.  S. 

27,'  '62. 

29,  1863. 

New  York  Cav.  .auo  •_>:;.        7.  '64.          cr.  6th  N.  Y.  Cav.     AllfT.  18th, 

364    Lowenstein,M.,Lieut.,D,    Mar.  31, 

Right  :  circ.     Surg.  A.  A.  White, 

remo  .8  ins.  seq.     Disch'd  May 

15thN.Y.  II.A.,age21.      31,  '65. 

8th  Md.     Disch'd  Oct.  20.  1865. 

:        18,    1865.       .ST/wr.  4281. 

:                                                                 1 

232 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


"Vn 

NAME,  MILITARY 

OPEUATIO.NS.  OPERATORS, 

Vn 

NAME,  MILITARY 

DATES 

OPERATION'S,  OPERATORS, 

JNO. 

DESCRIPTION,  AND  AGE. 

RESULT. 

11  <j. 

DESCRIPTION,  AND  AGE. 

RESULT. 

JOG 

McMann,  S.,  Corp'l,  C, 

May  11, 

Right  ;  flap.    Snrg.  J.  J.  Comfort, 

448 

Nugent.   T.,   Lieut.,  II, 

July  3, 

Left  ;  flap.   Surg.  W.  II.  Twiford, 

1st  Peuu.  Rifles,  age  35. 

11,  '64. 

1st  Penn.  Rifles.     Disch'dAug. 

27th  Indiana,  age  26. 

3,  '03. 

27th,  lud.   Disch'd  May  25,  1804. 

7,  1805.     Spec.  221. 

449 

Nurse,    H.    H.,    Pt.,    II, 

Mar.  16, 

Left;  ant.  post.  flap.  Surg.  A.  Wil 

407 

McMillan,  J  .,  Serg't,  G, 

July  2, 

Right  :  eirc.     Surg  J.  H.  Beach, 

80th  Illinois,  age  21. 

17,  '65. 

son,  113th  O.    Dis.  June  25,  '65. 

24th  Michigan,  age  22. 

4,  '63. 

24th  Mich.  Disch  'dNov.  30,  '03. 

450 

O'Brien.  J.  D.,  Capt.,  A, 

Sept.  17, 

Right  ;  circ.     Surg.  J.  M.  Farley, 

408 

McMillan,  W.  VF.,Corp'l, 

July3, 

Left  ;  flap.    Exchanged. 

24th  New  York. 

17,  '02. 

84th  N.  Y.     Disch'd  Dec.  22,  '62. 

0,  12th  Ala.,  age2U. 

3,  fU3. 

451 

O'Connor,  C.,  Pt.,  G,  8th 

May  7, 

Right  ;  circ.    Surg.  M.  Storrs,  8th 

409 

McMullan,    A..   Pt.,   15, 

July  1, 

Right;  circ.:  July  17th,  flap  amp. 

Connecticut. 

7,  r64. 

Conn.     Disch'd  Oct.  4,  1804. 

3(ith  New  York,  age  23. 

2,  '02. 

up.  third.    Disch'dJuly  3,  1803. 

452 

Ohlinger,  F.,  Pt.,  D,  13th 

June  18, 

Left;  flap.     Disch'd  June  10,  '05. 

Spec.  1392. 

West  Virginia,  age  18. 

18,  '64. 

410 

McNair,   G.,  Corp'l,  C, 

Oct.  19, 

Left  ;  flap.     Disch'd  Oct.  5,  1865. 

453 

O'Kaue,   D.,  Corp  1,  A, 

May  15, 

Right;  circ.     Surg.  J.  A.  Wolf, 

6th  N.Y.  H.  A.,  age  19. 

HI,  '04. 

29th  Penn..  age  22. 

15,  '64. 

29tli  Penn.    Diseh  d  July  4,  '65. 

411 

'JtfuA'eaf,   J.,    Lieut.,  C, 

Sept.  J  7, 

Right;  circ.  Surg.  G.G.Crawford, 

454 

Oliver,  C.  E.  M.,  It.,  F, 

Mar.  31, 

Right;  fire.    Surg.-C.  II.  I.evan- 

luth  Georgia,  age  34. 

17,  '02. 

C.  S.  A.     Retired  Nov.  11,  '63 

123d  Ohio,  age  20. 

31,  '65. 

saler,  8th  Me.    Disc.  Aug.  30,  '65. 

412 

McNey,  J.,  Pt.,  B,  loth 

May  10, 

Right;  flap.  Disch'd  Sept.  2,  '65. 

455 

Oliver,  G.  W.,    Pt.,   H, 

June  19, 

Right;  circ.     Surg.  J.  W.  Brook, 

New  Jersey. 

10,'  '64. 

7th  Ohio,  age  36. 

19,  '64. 

Goth  Ohio.    Gangrene.    Disch'd 

413 

McNulty,    \'.,    Pt.,    7th 

Mar.  27, 

Right;  ant.  post.  flap.     Disch'd 

May  12,  1865. 

Mass.  Bat'ry,  age  24. 

27,  'G5. 

June  3,  1805. 

456 

O'Neal,  R.  H.,   Pt.,   K, 

July  3, 

Right;  circ.     Disch'd  March  14, 

414 

McOmber,  M.  J.,  Pt.,  H, 

July  2, 

Right  ;  flap.  Surg.  C.  Bowers,6th 

29th  Penn.,  age  21. 

3,  '63. 

1804. 

6th  Penn.  Res.  Corps, 

4,  '03. 

Peun.  Res.  Disch'd  May  30,  '64. 

457 

Orbetou,  J.  H.,  It.,  K, 

May  20, 

Right;  double  skin  flap.    Disch'd 

age  18. 

9th  Maine,  age  33. 

20,''64. 

Jan.  6,  1805. 

415 

McVeau,  D.  C.,  Capt.,E, 

Sept,  19, 

Left.   Surg.  L.  I.  Dixon,  1st  Wis., 

458 

Osborn,  V.  B.,  Pt.,  A,2d 

Jan.  17, 

Right;    flap.     Surg.  J.  P.  Root, 

1st  Wisconsin. 

20,  '03. 

Capt.,  V.  R.  C.   Res.  May  9,  '64. 

Kansas  Cav.,  age  26. 

19,  '65. 

2d  Kan.  Cav.  Disch.  May  8,  '05. 

416 

Means,    P.    B.,    Pt.,   K, 

July  3, 

Left.     Exchanged  Nov.   12,  '63. 

459 

Owens,  J.  M.,  Lieut.,  H, 

Dec.  13, 

Right;  circ.     Surg.  T.  Jones,  8th 

48th  Alabama,  age  18. 

3,  '03. 

8th  Penn.  Reserves. 

15,  '62. 

Penn.  Res.  Disch'd  April  4,  '63. 

417 

Melion,  J.,  Pt.,  G,  55th 

June  27, 

Right,     Ass't  Surg.  J.  J.  Smith. 

460 

Oxley,  J.  H.,  Pt.,  K,  86th 

Jan.  1, 

Right  ;  flap.  Disch'd  Mar.  7,  1865. 

Illinois. 

27,  '04. 

Disch'd  March  1,  1805. 

Indiana. 

2,  '03. 

418 

Mellinger,    It.,   Pt.,   B, 

June  18, 

Left.     Disch'd  April  4,  1865. 

461 

Page,  J.  C.,  Pt.,  E,  112th 

Jan.  15, 

Left:  ant.  post.  flap.    A.  Surg.  F. 

55th  Penn.,  age  28. 

19,  '04. 

New  York,  age  25. 

16,  '65. 

B.  Kimball,  3d  N.  II.     Disch'd 

419 

Mercer,  J.  Q.,  Capt.,  E, 

June  10, 

Right;  flap.     Surg.  H.  E.  Good 

June  27,  1865. 

147th  Penn.,  age  25. 

16,  '04. 

man,  U.  S.  V.     Two  sub.  oper. 

462 

Palmer,  W.  H.,  Lieut., 

Mar.  21, 

Right  ;  circ.     Surg.  F.  M.  Rose, 

Disch'd  Feb.  2,  1865. 

G,  53d  Illinois. 

21,  '05. 

43d  Ohio.     Disch  d  June  22,  '65. 

420 

Mess,    F.,   Pt.,   B,   llth 

April  1, 

Left;  bilateral  flap.    Disch'dJuly 

463 

Parks,  G.  W.,  It.,  I,  7th 

Aug.  10, 

Right  :  flap.    Surg.  Raydon,  C.  S. 

New  Jersey,  age  47. 

1,  '05. 

21.  1865. 

Missouri  Cavalry. 

17,  '62. 

A.    Boneremov.  subs.    Disch'd 

421 

Messmer,  A.",  Pt.,  B,  7th 

Aug.  15, 

Right  ;  oir.  Surg.  J.  W.  Wishart, 

Nov.  8,  1862. 

N.  York  H.  A.,  age  33. 

15,  '04. 

140th  Penn.  Disch'd  Dec.  10,  '04. 

464 

Paul,  J.  S.,  Corp'l,   H, 

Oct.  21, 

Right.    Surg.  A.  B.  Crosby,  U.  S. 

422 

Miller,  D.  C.,  Pt.,  F,  G3d 

Sept.  20, 

Left.     Surg.   McDonough.     Re 

71st  Pennsylvania. 

22,  '01. 

V.     Disch'd,  186J. 

Tennessee. 

21,  '03. 

covered. 

465 

Parr,    J.,    It.,    D,    100th 

Mar.  25, 

Right;  circ.  Disch'dJuly  16,  '65. 

423 

Miller,  G.,  Pt.,  E,  15th 

Aug.  7, 

Leit  ;   ant.  post.  flap.     V.  R.  C. 

Penn.,  age  24. 

25,  '65. 

Infantrv,  age  19. 

8,  V04. 

June  1,  1865. 

466 

Parry,  D.  D.,  Pt.,  F,  3d 

Oct.  8, 

Left;  lateral  flap.     Surg.  G.  D. 

424 

Miller,  J.  K.,  Pt.,  D,  1st 

May  18, 

Left  ;  ant.  post,  flap.    Surg.  S.W. 

Ohio. 

9,  '02. 

Beebe.     Disch'd  March  21,  '63. 

Conn.  H.  Art.,  age  32. 

18,  '64. 

Skinner,  1st  Conn.  II.  A.    Dis 

467 

Parsell,  L.  D.,  Corp'l,  A, 

Aug.  18, 

Right;    flap.    Confed.    Surgeon. 

charged  May  6,  1805. 

5th  New  York,  age  30. 

19,  '64. 

Disch'd  March  8,  1865. 

425 

Miller,  J.  P.,  It.,  I,  12th 

May  6, 

Left  ;   oval  flap.     Surg.  Gaskill, 

408 

Patterson,  S.  N.,  Corp'l, 

Aug.  28, 

.     Surgeon  Grimes,  C.  S.  A. 

New  Jersey,  age  24. 

7/64. 

C.  S.  A.    Disch'd  April  28,  '65. 

A,  52d  Virginia. 

29,  '62. 

Recovered. 

426 

Miner,  R.  F.,  Pt.,  F,  3()th 

Aug.  27, 

Right  ;  flap.    Surg.  O.  Hoyt,  30th 

469 

Faxon,  G.  H.,  It.  E,  4th 

June  11, 

Right  ;  flap.      Disch'd  July  -1,  '65. 

Wisconsin,  age  29. 

28,  '64. 

Wis.  Exfol.  removed.    Disch'd 

Penn.  Cav..  age  22. 

11,  '64. 

April  5,  1805. 

470 

Peeden.  J.   M,   It.,    H, 

Oct.  22, 

Right  ;  circ.      Confed.   Surgeon. 

427 

Moody,  D.  M.,  Pt.,  C,  3d 

July  1, 

Left;  flap.    Confederate  Surgeon. 

16th  Georgia,  age  23. 

22.  '64. 

Prison  Feb.  18,  1865. 

Maine,  age  3<i. 

3,  '03. 

Disch'd  Nov.  28,  1863. 

471 

Perkins,   H.   C.,  It.,  B, 

Aug.  0, 

Right:  flap.     Surg.  A.  C.  Miller, 

428 

Moore,  S.  E.,  Serg't,  L, 

Aug.  28, 

Left.     Surg.  T.  A.  Evans,  P.  A. 

141h  Kentucky. 

6,  703. 

14th  Ky.     Disch'd  Dec.  31,  '03. 

1st  S.  C.  Rifles. 

28,  '62. 

C.  S.     Disch'd  Oct.  25,  186->. 

472 

Perkins,   G.  R.,  It..  C, 

Mar.  31, 

Right;  circ.    Act.  Staff  Surg.  G. 

429 

Moran,  I  K.,  Pt.,D,  14th 

May  16, 

Left.     Surg.   Doughty.     Furl'd 

1st  Maine  Cav.,  age  18. 

31,  '05. 

W.  Colby.   Disch'd  Aug.  24,  '05. 

Virginia. 

10,  '04. 

June  25,  1864. 

473 

Perry.   J.,   Pt.,    C,   74th 

July  2, 

Right;  flap.     A.  Surg.  J.T.  Cul- 

430 

Morgan,  H.  O.,  Captain, 

May  5, 

Left  ;  circ.     Surg.  L.  W.  Oakley, 

New  York,  age  2i>. 

3,  r03. 

houn,  U.  S.  A.    Dis.  July  19,  '04. 

12th  Infantry. 

0,  r04. 

2d  N.  J.     Retired  Feb.  17,  1808. 

474 

Phelps,  R.  S.,  Pt.,  B,  1st 

May  14, 

Left.     Recovered. 

431 

Morgan,  J.,  Pt.,  K,  145th 

Oct.  12. 

Left  ;  doub.  ant.  post.  flap.    Surg. 

Georgia  Cavalry. 

16,"'G4. 

New  York. 

12,  '03. 

R.  K.  Tuthill,  14Sth  N.  Y.    Dis. 

475 

Phillips,  Z.  D.,  'it.,  H, 

May  5, 

Right.     Surg.   Moft'at,   C.   S.  A. 

Feb.  23,  '04.     Spe.c.  4317. 

49th  Va.,  age  21. 

5,  '04. 

Retired  Feb.  11,  1865. 

432 

Morgan,  J.  M.,  Pt.,  Orr's 

July  28, 

Left;  double  flap.     Reg't  Surg. 

470 

Pickering,  A.  II.,  It.,  F, 

June  10, 

Right  ;  flap.     Disch'd  Jan.  2,  '65. 

S.  C.  Rifles. 

28,'  '04. 

Transfd  Sept  16,  1804. 

1st  Mass.  Art.,  age  29. 

17.  '04. 

433 

Morse,  J.  \V.,Pt.,F,  14th 

Sept.  I'.i, 

Left  ;  ant.  post,  flap:  one  inch  of 

477 

PiMiford,  R.   T.,  Rich 

April  2, 

Right.     Camp    Parole  June  17, 

N.  Hampshire,  age  20. 

21,  '04. 

femur  rem.     Dis.  June  15,  '05. 

ard's  Miss.  Bat'n,age  29. 

2,  '05. 

1865. 

434 

Moses.  M.  J.,  Corp'l,  E, 

May  !), 

Left:  ant,  post.  flap.     Surg.  W. 

478 

Pfemons.  Z.  T.,  .   E, 

Nov.  27, 

Left.     Surg.  J.  Dwinelle,    106th 

81st  New  York,  age  28. 

9,  '04. 

H.  Rice,  81st  N.   Y.     Disch'd 

60th  Georgia. 

28,  '63. 

Penn.     Prison   April    11,  1864. 

Sept.  14,  18ii4. 

Spec.  1886. 

435 

Mowatt,  D.,  Pt.,  C,  100th 

Aug.  16, 

Left  ;  flap  ;  spic.  remo'd.    Disch'd 

479 

Pollard,    A.,    Serg't,    C, 

July  20, 

Right;  circular.     Recovery. 

Xew  York,  age  2(5. 

17,  '04. 

Jan.  18,  18!i5. 

38th  Tennessee. 

20,  '04. 

436 

Mulrenen,    P.,    Pt.,   H, 

July  13, 

Right.     Disch'd    Dec.   26,    1863. 

480 

Porter,    li.    C.,    It.,   A, 

May  10, 

Left  ;  circular.   Confed.  Surgeon. 

30th  Mass.,  age  43. 

H,  '63. 

Died  Sept.  5,  1808:  debility. 

9th  Virginia,  age  31. 

10.  '(.'4. 

Retired  Nov.  4,  1864. 

437 

Murphy,  D.,  1't.,  A,  17th 

May  13, 

Left:  circ.    Surg.  .  I.  F.Galloupe, 

481 

Porter,  J.  A.,  Serg't,  B, 

Oct.  28, 

Left;  circ.  Surg.  N.  Y.  Lcct,  76th 

Mass.,  age  28. 

13,'  '03. 

17th  Mass.  Disch'd  Mar.  5,  1804. 

76th  Penn.,  age  27. 

29,  '64. 

Penn.     Disch'd  Aug.  12,   1865. 

438 

Murphy,  E.    (P.,  Serg't 

Aug.  10, 

Right.     Surgeon  Pope.     Recov 

482 

Powell,    R.   H.,   It.,  E, 

Mar.  31, 

Right;  flap:  sequ.  rem'd.  Disch'd 

Major,  48th  Georgia. 

10,  '04. 

ered. 

7th  Wisconsin,  age  33. 

31,  '65. 

Nov.  28,  '05.     Spec.  3015. 

439 

Murphy,  11.  A.,  Pt.,  E, 

July  2, 

Right.     Surg.   Taney,  C.  S.  A. 

'483 

Powell.  J.,  It,,  K,  143d 

Mar.  19, 

Left  ;  skin  flap.    Surg.  II.  Z.  Gill, 

14th  Louisiana. 

2,  '63. 

Gangrene.    Exch'd  Mar.  3,  '04. 

New  York,  age  20. 

19,  '65. 

U.  S.  V.     Disch'd  Oct.  21,  '65. 

440 

Myers,    A.   A.,    Pt..    B, 

Dec.  15, 

Left;  circ.     Disch'd  July  G,  '05. 

484 

Powell,  W.,  It.,  K,  66th 

Sept.  17, 

Left;  circ.     Disch'd  Dec.  4,  1802. 

51st  Indiana,  age  31. 

15,  '04. 

Ohio. 

17,  '02. 

441 

Myrick,  N.    W.,  Pt.,  A, 

Aug.  18, 

Right  ;  circ.     Surg.  T.  F.  Oakes, 

485 

Powers,  P.,  It.,  B,  25th 

Sept.  12, 

Right;    flap.      Surg.   Buchanan, 

27th  Georgia,  age  27. 

1'.),  '04. 

50th  Mass.    Prison  Mar.  23,  '65. 

Missouri. 

13,  '01. 

C.  S.  A.     Discharged. 

442 

Nelson,  E.  H.,  Pt.,  E,  8th 

Sept.  4, 

Left;    flap.      A.    Surg.    G.   W. 

486 

Price,   T.,    Pt.,    G,    5th 

May  27, 

Right;  ant.  post,  flap  (wound  left 

Vermont. 

5,  '62. 

A  very,  9th  Conn.    Disch'd  Feb. 

Artillery,  age  26. 

27,  '04. 

knee).     Disch'd   Sept.  21,  1864. 

20,  1803. 

487 

Prosser,  G.,  It.,  G,  27th 

July  30, 

Right;  flap.      Disch'd   May  29, 

443 

Newland,  1.  1.,  Serg't,  B, 

Sept.  19, 

Left  ;  ant.  post.  flap.     Surg.  W. 

Indiana,  age  18. 

30,  '04. 

1865. 

34th  Ohio,  age  28. 

20,  '64. 

S.  Newton,  '.'1st  Ohio.     Disch'd 

488 

Quance,   A.,  Pt.,  B,  1st 

July  15, 

Left  ;  flap.    Subs.  oper.    Disch'd 

April  6,  1805. 

Michigan,  age  16. 

15,  '64. 

Jan.  20,  1805. 

444 

Newton,  J.  A.,  Pt.,   F, 

July  1, 

Left.     Surg.  A.  F.  .Miller,  C.S.A. 

489 

Rae,  A.   31.,  It.,  11,  2d 

Aug.  18, 

Left.     To  prison  Feb.  10.  1865. 

34th    North    Carolina, 

2,  '03. 

Necro.  bone  removed.     Exch'd 

Miss.,  age  26. 

19,  '64. 

age  19. 

March  4,  1864. 

490 

Ralph,  W.  R.,  Pt.,  I,  8th 

July  2, 

Left;  flap.     Disch'd  May  30,  '64. 

445 

Nicholson,  J.,  Pt.,  C,  4th 

May  19, 

Left:   flap.     Disch'd  August   14, 

New  Jersey,  age  35. 

2,  '63. 

West  Virginia,  age  25. 

20,  '63. 

1803. 

491 

Reed,  C.,  It.,  F,  4th  W. 

May  19, 

Left  ;  circ.    Surgs.  J.  R.  Philson, 

446 

Nixon,  J.,  1't.,  F,    18th 

Dec.  30, 

Right  ;  flap.     Surg.  G.  D.Beebe, 

Virginia. 

20,  '63. 

4th  W.  Va.,  and  S.  P.  lionner, 

Ohio. 

30,  '62. 

U.  S.  V.    Disch'd  April  2.i.  '03. 

47th  Ohio.     Disch'd  Sept.  1,  '03. 

447 

Norris,  H.,  Pt.,  F,  7th  S. 

Aug.  21. 

Left.     To  prison  Feb.  10,  18'i5. 

4<>2 

Rieder,  C.,  Pt.,   C,   41st 

Nov.  23, 

Right.      Surg.    Wood.     Disch'd 

Carolina  Bat'r}-,  age  44. 

—  .  '04. 

Ohio,  age  19. 

21  '63. 

April  25,  1864. 

1  FISHER  (*j,.  J.),  toe.  cit.,  p.  47. 


SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    TN    MIDDLE   THIRD. 


233 


No. 

* 
NAME,  MILITAKY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

493 

Reifsnyder,  R.  L.,  Pt., 

Mar.  29, 

Left  :   flap  ;   gangrene.     Disch'd 

534 

Schad,  C.  H.,  Pt.,  M,  1st 

May  1, 

Right;  circ.     Ass't   Surg.   J.   S. 

G,  198th  Penn.,  age  30. 

29,  '65. 

July  20,  1865. 

New  York  Art.,  age  19. 

I,  '63. 

Billings,  U.  S.  A.     Discharged 

494 

Reinhart,  J.,  Serg't,  13th 

Aug.  29, 

Right.     Disch'd  March  14,  1863. 

April  15,  .-364.     Spec.  2361. 

New  York  Dattery. 

29,  '62. 

535 

Scharf,  A.,  Pt.,  I,  1st  N. 

April  8, 

Left.  Surg.  W.W.L.  Phillips,  1st 

495 

Repperger,  J..  (Jorp'l,  C, 

June  9, 

Right.    Surg.  E.  Bentley.U.S.V. 

Jersey  Cav.,  age  30. 

8,  '64. 

N.  J.  Cav.     Dis.  July  20,  1865. 

10th  N.  Y.  Art.,  age  38. 

9,  '63. 

Disch'd  April,  1864. 

536 

Scheifely,  J.,  Pt.,  D,  3d 

Dec.  13, 

Right.     Confed.   Surgeon.     Dis 

496 

Reynolds.  J.,  Pt.,  C,  33d 

Mav  14, 

R't  ;  unt.  post.  Hap.   Surg.  J.  Ben 

Pennsylvania. 

15,  '6J. 

charged  June  2J,  1863. 

Slass.,  age  18. 

14,'  '64. 

nett,  19th  Mich.  Dis.  Feb.27,'65. 

537 

Scofield,  E.  D.,  Pt,  F, 

Sept.  28, 

Right;  ant.  post.  flap.     Surg.  II. 

497 

Reynolds,  J.,  Pt.,  B,  13th 

May  3, 

R't;  ant.  post.  flap.    Surg.J.J.lI. 

40th  N.  York,  age  26. 

28,  '64. 

K.  Lyster,  5th  Mich.     Disch'd 

New  Jersey. 

5,  '63 

Lord,  13th  N.J.   Dis.  Oct.  19,  '63. 

May  18,  1865. 

498 

Rexford,  S.,  Pt.,  I,  45th 

June  2, 

Left;  flap.     Disch'd  July  12,  '65. 

538 

Schroeder,  F.,  Pt.,  B,  7th 

May  5, 

Left  ;  double  flap.     Disch'd  July 

Penn.,  age  20. 

2.  '64. 

New  York,  age  21. 

5,  *62. 

8,  1863.     Spec.  3708,  A.  M.  M. 

499 

Rhodes,    C.,    Pt.,     llth 

Sept.  19, 

Left  :  flap.  Surg.  L.  J.  Ham,  48th 

539 

Schweighauser,   S..  Pt., 

March  8, 

Right.    Disch'd  August  28,  1862. 

Ohio  Battery. 

21,  '62. 

Ind.     Disch'd  Mar.  23,  1853. 

1st  Bat'ry  Me.  Art'ry. 

8,  '62. 

500 

Rice,    D.,    Pt..    C,    79th 

Mar.  19, 

Left  ;  bilat.  flaps.     Surgeon  J.  F. 

540 

Scott,    E.,    Pt.,    E,    4th 

Oct.  9, 

Left  ;  circ.     Surg.  Thomas.     To 

Penn.,  age  23. 

20,  '65. 

Reeve,  21st  Wis.   Disch'd  June 

Virginia,  age  28. 

10,  '64. 

Prison  Feb.  16,  1865. 

15,  1865. 

541 

Scott,  P.  U.,  Pt..  A,  13th 

Sept.  19, 

Right;  ciro.  Surg.W.  S.  Grimes, 

501 

Rice,  G.  W.,  Pt.,  I,  4th 

May  5, 

Left  ;  ant.  post.  flap.    Surg.  G.  T. 

Virginia,  age  25. 

19,  '64. 

C.  S.  A.    To  Prison  Jan.  5,  1865. 

Vermont,  age  17. 

6,  '64. 

Stevens,  77th   N.   Y.     Disch'd 

542 

Secor,  J.,  Serg't,  E.  142d 

May  1, 

Right  ;  circ.     A.  Surg.  J.  S.  Bill 

Feb.  23,  1865. 

New  York,  age  23. 

1   fa. 

ings,  U.S.A.  Dis.  Sept.  9,  1863. 

502 

Rice,  J.,    Pt.,  G,  207th 

Mar.  25, 

Right;  ant.  post.  flap.     Surg.W. 

543 

Seiferman,    B.,    Pt.,   B, 

May  28, 

Right.    Surg.  M.  K.  Taylor,  26th 

Penn.,  age  23. 

25,  '65. 

G.  Hunter,  21  1th  Penn.  Disch'd 

26th  Illinois. 

28,  '62 

111.     Disch  d  Oct.  16,  1862. 

Sept.  23,  1865.     Spec.  4008. 

544 

Selbe,   S.,  Pt,    D,   18th 

June  27, 

.     Recovered. 

503 

Richard,    L.  P.,  Serg't, 

April  2, 

Left;  circ.     Disch'd  Sept.  3,  '65. 

Virginia. 

29,  'C2. 

H,  7th  X.  Y.,  age4j. 

2,  '65. 

545 

Shaffer,    F.   H.,  Pt  ,  F, 

Mav  1, 

Right  ;  flap.  Ass't  Surg.  B.  How 

504 

Richards,  W.  T.,  Pt.,  I, 

Mar.  25, 

Right;  ant.  post.  flap.     Surg.  T. 

2d  Infantry,  age  38. 

1,  *63. 

ard,  U.  S.  A.     Jan.  2d,  reamp.; 

12th  Ala.,  age  28. 

25,  '65. 

F.  Oakes.  56th  Mass.     Recov'd 

gang     Disch'd  Sept.  6,    1864. 

Nov.  2,  18u5.     Spec.  4000. 

Died  Feb.  1,  '73. 

505 

Richmond,  J.,    Pt.,    7th 

Sept.  14, 

Right  ;  ant.  post.  flap.     Disch'd 

546 

Shafer,  S.  J.,  Pt.,  E,  66th 

June  9, 

Left  ;  circ.    Surg.  Tener,  C.  S.  A. 

Mass.  Bat'ry,  age  24. 

14,  '64. 

Feb.  25,  1865. 

Ohio. 

11,  '62. 

Disch'd  Dec.  22,  1862. 

506 

Rider,  G.,   Pt.,  H,  llth 

Oct.  9, 

Left  ;  ant.  post.  flap.    Surg.  H.  F. 

547 

Shanley,  3t.,Pt  ,B,  164th 

May  18, 

Left.     Disch'd  August  29,  1865. 

Mass.,  age  29. 

10,  '64. 

Lyster,  5th  Mich.  Diseli  d  Sept. 

New  York,  age  27. 

18,  '64. 

29,  '65.     Died  May  3,  1871.     • 

548 

Shari,G.,Pt.,L,2dMich. 

Nov.  5, 

Left:  ant.  post.  flap.     A.  Surg. 

507 

Riley,  G.   W.,    Pt.,   D, 

May  31, 

Left;  flap     Surg.  j.  Pogue,  66th 

Cavalry,  age  22. 

6,  '64. 

W.  F.  Green,  2d  Mich.  Cavalry. 

6Gth  Illinois. 

31,  '64. 

111.     Disch'd  JuiieS,  1860. 

Disch'd  Sept.  18,  1865. 

508 

Rilev,  P.,  Pt.,  M,  3d  R. 

Sept.  11, 

Right;  flap.     Surg.  S.  W.  Gross, 

549 

Shaw.  J.  S.,  Serg't,   B, 

July!, 

Right  ;  circ.  Nee.  bone  rem.  Sept. 

I.  Art.,  age  29. 

11,  '63. 

U.  S.  V.     Necr'd  bane  removed. 

5th  Alabama,  age  30. 

2,  '63. 

14th.     Exch'd  Dec.  1,  1863. 

Disch'd  June  24,  '63.  Spec.  4320. 

550 

Shaw,   W.   K.,    Pt,,   A, 

May  3, 

Right  ;  ant.  post.  flap.  Surg.  W. 

509 

Roach,   P.,   Pt.,    C,    2d 

June  11, 

Left;    flap.     Ass't  Surg.  J.  W. 

5th  Connecticut. 

4,  '63. 

C.  Bennett,  5th  Conn.     Disch'd 

Cavalry,  age  23. 

11,  '61. 

Williams,  U.  S.  A.     Recov'd. 

Nov.  16,  18J3.     Spec.  1838. 

510 

Roberts,  E.   G..  Pt-.,   C, 

Nov.  30, 

Left  ;  circular.     Provost  Marshal 

551 

Shawgo,  G.,Pt,  A,  121st 

April  1, 

Right;  circ.    Surg.  T.A.Ramsey, 

1st  Georgia,  age  21. 

De.  1,'64. 

Feb.  24,  1865. 

Penn.,  age  21. 

1,  '65. 

121st  Penn.     Hsem.     April  7th, 

511 

Roberts,  C.    W.,    Adj't, 

July  2, 

Left  ;  flap.     Disch'd  Dec.  16,  '63. 

lig.  prof.     Disch'd  June  17,  '65. 

17th  Maine. 

3,  '63. 

552 

Shay,    L.,   Pt.,   K,  21st 

Dec.  17, 

R't  ;  circ.  flap.    Surg.  J.T.  Reeve, 

512 

Roberts,  J.,  Pt.,  F,  Gist 

Dec.  13, 

Left.     Surg.    Sly.     Furlouglied 

Michigan,  ago  20. 

17,  '64. 

21st  Wis.     Disch'd  June  8,  '65. 

Georgia. 

15,  'G2. 

Oct.  31,  1864. 

553 

Shearm,   St.,   Lieut.,  I, 

April  6, 

Right;    flap.     Released  June  9, 

513 

Robinson,  D.,  Corp'l,  A, 

Mar.  20, 

Right  ;  double  flap.    Surg.  A.  B. 

12th  N.  C.,  age  25. 

7,  '65. 

1865. 

25th  Indiana,  age  21. 

20,  '65. 

Monahan,   63d    Ohio.     Disch'd 

554 

Shelley,  A.,  Pt,  H,  52d 

May  12. 

Right  ;  double  flap.     Discharged 

Oct.  17,  1865. 

New  York,  age  21. 

12,  '64. 

Dec.  26,  1864. 

514 

Robinson,    R.,    Pt.,    C, 

Nov.  26, 

Left  ;  circ.     Prot.  bone  rem.  Feb. 

555 

Shelley,   J.  M.,  Pt.,   H, 

Aug.  9, 

Right.     Recovered. 

29th  Penn.,  age  39. 

27,  '63. 

7.  '64.     Disch'd  July  5,  1864. 

48th  Virginia. 

9,  ?62. 

515 

Rodgers,  E.,  Pt.,  C,  103d 

Sept.  3, 

Right.    Disch'd  March  14,  1863. 

556 

Sheppard,  G.,  Seaman, 

April,  '63. 

Lett.     Discharged. 

Pennsylvania. 

3,  '62. 

Gunboat  Prairie. 

Primary. 

516 

Rodgers,   E.  J.,  Pt.,  F, 
12th  Alabama,  age  48. 

July  1, 
1    f63. 

Left.    Confed.  Surgeon.    Exch'd 
Sept.  25,  1863. 

557 

Sheppard,  J.  M.,  Capt  , 
K,  21st  Conn.,  age  23. 

May  16, 
16,  '64. 

Left;  circ.     Surg.  J.  II.  Lee,  21st 
Conn.     Disch'd  Sept.  14,  1864. 

517 

Rogers,   A.,   Pt.,  B,  1st 

July  2, 

Left.     Disch'd  Nov.  14,  1864. 

558 

Sherman,  E.  M.,  Serg't, 

Sept.  19, 

Right;  double  flap.    Surg.  C.  B. 

New  York,  age  17. 

2,  '63. 

C,  llth  Vt,  age  18. 

19,  '64. 

Park,  llth  Vt,    Dis.  June  28,  '05. 

518 

Rollins,  J.  W.,  Pt.,  H, 

Sept.  1, 

Right;   circular.     Disch'd   May 

559 

Sherrill,  if.  O.,  Serg't, 

May  9, 

Right;  circ.     Surg.  Strong.     To 

31st  Indiana,  age  19. 

1,  '64. 

18,  1865. 

A,  12th  N.  C.,  age  22. 

10,  '64. 

Prison  Oct.  26,  1864. 

519 

Rone}',    II.,    Sergt,   E, 

Dec.  13, 

Left;  circ.     Act.   Staff  Surg.  C. 

560 

Shiftier,  J.,  Pt.,  G,  55th 

Sept,  29, 

Right  ;  flap.    Disch'd  June  1,  '65. 

30th  Ohio,  age  30. 

13,  '64. 

B.  Richards.  U.  S.  V.     Disch'd 

Penn.,  age  19. 

29,  '64. 

July  6,  1865. 

5G1 

Shindler,  G.  F.,  Pt,  E, 

Sept.  17, 

Right.     Surg.  J.  F.  Hutchinson, 

520 

Rose,    II.,   1't.,    F,    13th 

Mar.  19, 

Left;    ant.   post.   flap.     Confed. 

107th  Penn. 

19,  '62. 

107th  Penn.    Dis.  Nov.  25,  '62. 

Mich.,  age  35 

19,  '65. 

Surgeon.     Disch'd  June  30,  '65. 

562 

Shultz,  J.  L.,  Pt.,  H,  5th 

Mar.  25, 

Right;  flap.     Disch'd  July  25, 

52] 

Roth,  J.  II.,  Pt.,H,  205th 

April  2, 

Left  ;  flap.     Disch'd  July  6,  '65. 

Penn  ,  age  27. 

25,  '65. 

18(15. 

Penn.,  age  22. 

2,  '05. 

563 

Simms,  W.,  Pt.,  A,   1st 

Mav  8, 

Right,    Surg.  Coleman.    Recov 

i)—^- 

Rouse,  G.  A.,  Serg't,  F, 

Sept.  30, 

Left  ;  flap.    Disch'd  Sept.  13,  '65. 

Virginia  Battery. 

10,  62. 

ered. 

8th  Conn.,  age  22. 

30,  '64. 

564 

Singleton,    G.    W.,   Pt, 

Oct.  7, 

Left.     To  prison  April  13,  1865. 

523 

Rove.    P..    Pt.,    B,   4th 

July  1, 

Left.     Disch'd  Nov.  9,  1863. 

Palmetto  S.  S.,  age  22. 

7,  '64. 

Artillery. 

1,  '63. 

565 

Sippcy,  W.,  Pt.,  C,  1st 

Feb.  20, 

Right  ;  flap.     Surg.  H.  C.  Merry- 

524 

'Rtidd,    X.,   Pt.,   E,  32d 

Sept.  17, 

Right  :    circ.     Furloughed  Nov. 

Colored  Troops. 

20,  '65. 

weather,   5th   C.    T.      Disch'd 

Virginia,  age  28. 

18,  '62. 

2,  1864. 

July  14,  1865. 

525 

Rutherford,  J.,   Pt.,  E, 

Jan.  30, 

.    Surg.  White.    Recovered. 

566 

Sisco,  F.  A.,  Pt.,  I,  23d 

Nov.  25, 

Right  ;  ciro.:  gangrene.    Disch'd 

50th  Virginia. 

33,  '63. 

Michigan,  age  18. 

26,  '64. 

June  21,  1865. 

52G 

Runyon,  J.   M.,  Pt.,  11, 

Sept.  17, 

Right  ;  circ.    Surg.  J.  P.  Colgan, 

567 

Slater.   I.,  Pt.,  D,  75th 

Oct.  9, 

Left  ;  flap.   Surg.  G.  W.  Phillips, 

59th  New  York,  age  16. 

17,  '62. 

59th  N.  Y.     Sequestr.  extract. 

Illinois. 

9,  '62. 

75th  111.     Disch'd  Dec.  5,  '62. 

Disch'd  May  4,  '63.     Spec.  104  1. 

568 

^Slaughter,  W.  B.,  Pt., 

Sept.  19, 

-  —  -.     Removal  of  six  inches  of 

527 

Samples,  J.  B.,  Pt.,  E, 

Feb.  20, 

.    Recovered. 

D,  18th  Tenn.,  age  20. 

19,  '63. 

necrosed  bone.     Recovered. 

19th  Georgia. 

20,  '64. 

569 

Smith,    C.   S.,    Pt.,    K, 

May  10, 

Left;    circ.      Confed.    Surgeon. 

528 

Samlford,  W.  H.,Pt.,  H, 

Mar.  16, 

Left;    ciro.     Ass't  Surg.  G.   M. 

119th  Penn.,  age  20. 

11,  '64. 

Disch'd  June  16,  1865. 

19th  Mich.,  age  20. 

16,  '65. 

Trowbridge,   19th    Mich.     Dis 

570 

Smith,  G.,  Pt.,  C,  28th 

May  8, 

R't  ;  circ.   Surg.  H.  E  Goodman, 

charged  June  30.  1865. 

Penn.,  age  27. 

8,   64. 

28th   Penn.     Discharged  June 

529 

Saner,    G..     Serg't,    G, 

June  1, 

Right;  ant.  post,  flap,-  gangrene1. 

16,  1865. 

169th  N.  Y.,  age  37. 

1,  '64. 

Disch'd  March  20,  1865. 

571 

Smith,  H.  G.,  Serg't.  A, 

Oct.  9, 

Right  :  flap.     Surg.  C.  M.  Clark, 

530 

Sausser,   P.,   Corp'l,  A, 

Mar.  25. 

Left;  ant.  post.  flap.     Surg.  W. 

33th  Illinois,  age  24. 

9,  '63. 

39th  111.     Disch'd  June  22,  '64. 

2L)8th  Penn.,  age  24. 

25,  '65. 

O.  McDonald,  U.  S.  V,    Disch'd 

572 

Smith,  J.,   Pt.,   D,    6th 

June  18, 

Left;    ant.    post.    flap.     Disch'd 

July  10,  '65.     Spec.  4133. 

Penn.  Res.,  age  29. 

18.  '64. 

June  19,  1865. 

531 

Savage.  W.  B.,  Pt.,  F, 

July  20, 

Left  ;  ant  post.  flap.     Surg.  J.  B. 

573 

Smith.  J.  J..  Corp'l,  H, 

April  11, 

Left  ;  flap.   Surg.J.  II.  Thompson, 

91st  Ohio,  age  33. 

21,  '64. 

Warwick.  9lst  Ohio.      Disch'd 

5th  Pennsylvania. 

11,  '63. 

139th  N.Y.   Disch'd  May  30,  '63. 

Nov.  7,  1865. 

574 

Smith.  S.  D.,  Serg't,  D, 

July  20, 

Left  ;  flap.  Surg.  J.  A.  Wolf,  2!'th 

532 

Sawyer,   T.  J.,  Pt.,  E. 

June  20, 

Left;  circ.     Surg.   C.  M.  Clark, 

29th  Penn.,  age  24. 

20,  '64. 

Penn.  Gangrene.  Disch'd  July 

7th  New  Hampshire. 

21,  '63. 

33th  111.     Disoh'd  Oct.  33,  '63. 

10,  1865. 

533 

Sax,  J.,  Pt.,  D,  3d  New 

May  16, 

Right  ;  ant    post.  flap.     Disch'd 

575 

Smith,  W.,  Corp'l,  B,  1st 

,'64, 

Left     Retired  Dec.  7,  1864. 

York,  age  2:3. 

17,  '64. 

Dec.  10,  1364. 

Georgia  S.  S.,  age  22. 

Primary. 

'FISHEU  (G  J.),  loc.  cit. 
ttuiiu.  111—30 


2O'KEEFE  (D.  C.),  loc.  cit.,  p.  25. 


234 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  ANU  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITAHY 
DESCRIPTION,  AND  AOE. 

DATES. 

^ 
OPERATIONS,  OPE.JATORS, 
RESULT. 

57(i 

Smock.  J.  W..  Corp'l,  I", 

June  18. 

Left  :  lat.  flap.     Surg.  J.   Eber- 

R20 

Thomson,  H.  H.,  Lieut., 

Sept.  16, 

Left.      Exchanged  Nov.  21,  '62. 

19tH  Ind.,  age  23. 

18.  '64. 

so!e,    19th   Ind.     Sequest.   and 

K,  Palmetto  S.S.,age22. 

16,  '62. 

frag,  remov'd.    Dis.  Nov.  9.  '65. 

621 

Thorpe,  R.,  Pt.,  B,  10th 

Sept.  19. 

L't  ;  flap.  Stirg.  J.  G.  F.  Hoist.  .n. 

577 

Sneden,    1?.  C.,    Pt.,   I. 

June  22, 

Right;  flap.    Surg.  J.  W.  Tunne- 

Missouri. 

19,  '62. 

U.  S.  V.     Diseh'd  April  4.  1H63. 

1st  Michigan. 

22,  '62. 

clifte.  1st  Mich.     Discharged. 

622 

Tixld,    J.,    It.,    M,    6th 

July  1, 

Right.      Surg.    Hays.   C.   S.    A. 

578 

Snyder,  J..   l>t.,    T,    3<1 

Jan.  11, 

Left  :  flap.     Surg.  W.  Dickinson. 

Alabama,  age  35. 

2,  '63. 

Paroled  Sept.  25,  J8G3. 

Missouri  Cavalry. 

13,  '63. 

U.  S.  V.     Diseh'd  July  19,  '63. 

623 

Treadu'ell.  1)^,  Serg't,  F, 

Dec.  15, 

Right:    ant.    post.    flap.     A.    A. 

579 

Snyder,  W.  S..  It..    15, 

Sept.  17. 

Right  ;  circ.     Diseh'd   Nov.   29, 

33d  Mississippi,  age  29. 

16,  '64. 

Surgeon  S.  C.  Avers.     Provost 

28th  Pennsylvania. 

19,  '62. 

1862. 

Marshal  March  27,  1865. 

580 

Solon,  II..    Bugler.    H, 

June  12, 

Left;    flap:    gangrene.     Diseh'd 

624 

Tracy,  C.  H..  Serg't,  A, 

April  2, 

Right  :  flap.     Surg.  E.  .M.  White. 

1st  Mich.  Cav.,  age  19. 

12,  '64.        Jan.  7.  1865. 

37th  Mass..  age  32. 

2.  '65. 

37th  Mass.     Recovered. 

581 

Sjiangler,  H.  D.,  Pt.,  A, 

Dec.  ,'64,     .  Paroled  Jan.  16,  1865. 

625 

Troi/den,  S.   W.,  Serg't. 

July  1, 

Right.     Surg.  Me  Aden,  C.  S.  A. 

54th  Virginia,  age  33. 

Primary. 

M]  22d  X.  Carolina. 

2,  f63. 

Paroled  Oct.  22.  1863. 

582 

Spellman,  J.,  Pt.,  10.  Bth 

June  27,    Left.     Disch'd  July  13,  1863. 

626 

True,  R.  M.,  It..  B,  2d 

June  2."), 

Left.     Diseh'd  April  1,  1863. 

Massachusetts. 

28,  '62. 

New  Hampshire. 

25,  '62. 

58:5 

Spencer,  W.  H.,  Capt., 

June  30. 

Right  ;  flap.     Diseh'd  December 

627 

Tryon,  M.  M.,Pt.,  I.  14th 

June  1. 

Left:  cire.:    gangrene.     Diseh'd 

G,  Gist  New  York. 

J'y-2,'62. 

21,  1862. 

N.  Y.  H.  A.,  age  26. 

2,  '64. 

Oct.  12.  1865. 

'584 

Si'ittler.  W..  Corp'l,  A. 

July  27, 

Left.     Surg.  D.  S.  Hayes,  1  10th 

6:28 

Tuck,    W.   H..    Pt.,   E. 

Sept.  19. 

Left:  flap.     Surg.  W.  A.  Barry, 

ilOth  I'enn.,  age  21. 

27,"  '64. 

I'enn.     Diseh'd  Jan.  28.  1865. 

38th  Mass.,  age  29. 

20,  '64. 

98th  Penn.    Diseh'd  July  26,  '65. 

585 

Stahlschmidt,  10.,  Serg't, 

Mar.  31, 

Left:  circular.     Diseh'd  July  20, 

C29 

Tunney,  P.,  It.,  E.  24th 

July  2. 

Right:    ant.  post.  flap.    'Diseh'd 

H,  15th  New  York  H. 

31,  '65. 

1865. 

Mich.,  age  23. 

3.  '63. 

Dee.  20.  1863. 

A.,  age  32. 

630 

Tupper,  F.  W.,  Adj'tlst 

Dec.  9. 

Right:  <irc.     Sursr.  F.  M.  Rose, 

586 

Starr,  G.  II..  Pt.,  E.  llth 

May  15. 

Left  :  ant.  post.  flap.   A.  Surg.  D. 

Alabama  Cav.,  age  25. 

9,  '64. 

43d  Ohio.     Duty  Mar.  22,  1865. 

Conn.,  age  40. 

15,  '64. 

Satterlee,  llth  Conn.     Diseh'd 

631 

Turner,  W.  H.,  It.,  G, 

July  1, 

Left.     Exchanged  Nov.  12,  '63. 

June  23,  18G5. 

26th  N.  C'.,  age  35. 

2.  '63. 

587 

Stebbins.  B.   I'..  Corp'l, 

Feb.  6, 

Left;  ant.  post.  flap.     Surg.  F. 

632 

Updyke,  C.,  It..  B,  2d 

June  7. 

Right  :   cire.     Surg.  .T.  C.  Howe, 

C,  16th  Pa.Cav.,age21. 

(i.  '65. 

LeMoyne,  16th  Penn.  Cavalry. 

N.  Y.  H.  A.,  age  39. 

7,  '64. 

2d  N.  Y.  11.  A.    Dis.  Nov.  7,  '65. 

Disch'd  May  31,  1865. 

633 

Vanalstine,  G.  P.,  Serg't, 

June  3. 

Right;  circ.     Surg.  G.  L.  Potter. 

588 

Stelzer.  C..  Pt  ,  K.  37th 

May  19, 

L't:  circ.    A.Surg.C.B.  Richards, 

E,  7thN.Y.Art..age34. 

4.  '64. 

145th  Penn.     Dis.  Mar.  4,  1865. 

Ohio. 

19,  '63. 

30th  Ohio.  Diseh'd  Aug.  24,  '63. 

634 

Van  Blareom.  L.,  Capt., 

May  8. 

Left:    flap.      Confed.    Surgeon. 

589 

Stevens,  C.  I).,  Pt.,  H, 

May  18. 

Right:  flap.    Surg.  (i.  L.  Potter, 

C,  15th  N.  J.,  age  29. 

9,  '64. 

Disch'd  Dec.  19,  1*64. 

126th  N.  York,  age  26. 

18,  '64. 

145th  Penn.     Dis   June  12,  '65. 

635 

Van  Houten,  S.  C..  Pt., 

Aug.  25, 

Right  :  cire.    Surg.  Hunt,  C.S.A. 

590 

Stevens,  J.  C..   Pt.,  A. 

Mar.  16. 

R't  ;  flap.   A.  Surg.  <  '..  W.  Burke. 

E,  4th  New  York  H.  A., 

27,  '64. 

Rem.  of  segues.  July  13.  1805. 

13th  N.  Jersey,  age  29. 

16,  '65. 

4Gth  Penn.    Diseh'd  May'-*,  '65. 

age  32. 

Disch'd  Oct.  14,  '(15.  Spec.  1429. 

591 

^Stevenson,    H.    C.,  Pt., 

June  27, 

:  circ.  Surg.  J.Mc/.  Gaston, 

636 

Viles,  W.  S.,  Pt.,  D,  74th 

July  23, 

Left;  flap.     A.  Surg.  J.  T.  Cal- 

K,  Palmetto  S.  S. 

27,  '62. 

C.  S.  A.     Furl'd  Sept.  4,  '62. 

New  York. 

23,'  '63. 

houn.U.S.A.  Dis'd  Dee.31,  '63. 

592 

Stewart,  T.,  Pt.,  I,  110th 

May  2"), 

Left;  flap.     A.  Surg.  H.  Bauer, 

637     Wade,  D.  F..  Corp'l,  D, 

Aug.  30, 

Right:  circ.    Surg.  D.W.Voyles, 

C.  Troops,  age  22. 

25,  '65. 

97th  C.  T.    Diseh'd  June  x'8,'65. 

66th  Indiana. 

31,  '62. 

66th  Ind.     Disch'd  Nov.  18.  '62. 

:,••:: 

Stierten,  C.,  Pt.,  A,  7th 

Mar.  8, 

Right:    circ.      A.    Surg.    B.    F. 

638 

Wadsworth,  C.P.,Corp'l, 

June  21, 

Right  :  ant.  post.  flap.     Surg.  C. 

New  York. 

8,  '62. 

Staehly,  7th  N.  Y.    Recovered. 

B,  16th  Maine,  age  25. 

21,  '64. 

Alexander,  IGth    Me.     Disch'd 

594 

Stiles,  J.,  Pt.,  1$,  1st  N. 

April  30, 

Right;  cire.    Diseh'd  July  4,  '65. 

June  9,  1  865. 

595 

.lersey  Cav.,  age  19. 
Stoll.  J.  E,,  Pt.,  K,  1st 

30,  '64. 
Mar.  31. 

Aug.  10,  necrosed  bone  remo'd. 
Right.     Diseh'd  July  12,  1865. 

639 

Wadsworth,  D.  G.,  It., 
C,  198th  Penn.,  age  23. 

Mar.  29, 
29,  '65. 

R't  :  ant.  post.  flap.     Surg.  T.  M. 
Flandreau,  146th  N.Y.  Diseh'd 

N.  J.  Cav  ,  age  26. 

A  p.  1,  '65. 

Feb.  21,  1866. 

:/<>; 

Stroud.  K..  Pt.,  H,  8th 

July  2. 

Right.      Provost   Marshal  Sept. 

640 

Wagner,  C.,  Corp'!,  G, 

Mar.  31  , 

Right;    ant.  post.  flap.     Disch'd 

Alabama,  age  27. 

3,  rG3. 

1,  1863. 

!!th  N.  Y.  Cav.,  age  20. 

Ap.  1,'G5. 

July  24,  1865. 

597 

^Stuart,   A.    J.,    Lieut. 

May  19, 

Left.     Recovered. 

641 

Walker,   G.  W.,  1-t.,  G, 

May  9, 

Right;  circ.     To   prison  Oct.  5, 

Hcskin's  Miss.  Bat'ry, 

19,  'Ii4.   i 

8th  La.,  age  36. 

10,  '64. 

1864. 

age  25. 

642 

Walker,   J.  A.,  It.,   C, 

July  2, 

.    Surg.  Brown.    Recovered. 

598 

Sturgis,  W.  (i.,   1't.,  B,      June  2, 

Right  ;  flap.     Surg.  W.  W.  Root, 

3d  Arkansas. 

2,  '63. 

75th  New  York.               j     2,  '63. 

75th  N.  Y.     Diseh'd  Sept.  2,  '63. 

643 

Walsh,  J.,    It.,    II,    1st 

June  17, 

Right:  flap.     Surg.  A.  F.  Whe- 

599 

Sullivan,A.O.L,,  Corp'l, 

May  5, 

Left.    Surg.  S.  R.  Sayers.  C.S.A. 

Mich.  S.  S.,  age  30. 

17,  '64. 

lan,    1st  Mich.    S.    S.     Disch'd 

G,  4th  Virginia.               ;     5,  '64. 

Recovered. 

Oct.  24,  1864. 

000 

Sullivan,  J.,  It.,  F.  22d     June  16, 
Col'd  Troops  a""e21.     :   18   '64 

Left;   ant.   post.   flap.      Diseh'd 
No  v  22  1  864 

644 

Walter,    D.  P.,   It.,   C, 
33d  N   C    age  1*) 

May  3, 
4   '63. 

Left;  circ*   A.  Surg.  J.  A.  Vigel. 

Sullivan,  W.,   Pt!,  15th     Juno  18, 

Left  ;  flap.    Surg.  G.  W.  Metealf, 

645 

Warrell.  W.,  Pt..  1  1,  60th 

Se'pt.'i, 

Left;  flap.     Surg.  W.  M.  Gray, 

New  York  Independent      1'J,  '(i4. 

76th  N.  Y.     Diseh'd  Jan.  31,  '65. 

Illinois,  age  17. 

2,  '64. 

60th  111.     Disch'd  July  31,  '65 

Battery,  age;  22. 

1   646 

Waters,  J.  A.,  Serg't.  C, 

April  2, 

Right  :  ant.  post,  skin  flap.    Surg. 

6ii2 

Sutler,   F.,  Pt.,  10,  12th  |  Aug.  29, 

Left.     Diseh'd  August  1.  1863.      | 

15th  N.  C.,  age  24. 

2,  '65. 

H.  Churchill,  8th  N.  Y.  II.  A. 

Penn.,  age  35.                 1   30,  '62. 

]! 

Released  June  14.  1865. 

G03 

Swan,  G.  B.,  Pt.,  B,21st  |  June  2."), 

Right;  ant.  posterior  (oval)  flap.  II  647 

Weakly.  R.,  Lieut.,  G, 

June  2, 

.     Surg.  McMillan,  C.  S.  A. 

Conn.,  age  18.                      •„'.">,  'Ii4. 

Diseh'd  June  11,  1865. 

42d  Tennessee. 

2.  '64. 

Recovered. 

G04 

Swayer,  11.,  Pt..  B,  93d 

May  (i, 

Right  ;  flap.    Diseh'd  Oct.  25,  '64.   |  648 

Wearing,  J..  Serg't,  A, 

June  17, 

Left;  circ.      Jan.  G,   1865,  resec. 

Penn..  age  20. 

8,  '64. 

\ 

2d  I'enn.  H.  A.,  age  20. 

19,  '64. 

of  extr.  of  femur.    Disch'd  Julv 

605 

Sweeney,  J.,  Pt.,  I.  24th 

Aug.  14, 

Right  ;    cire.     Diseh'd   May   11.    ' 

26,  1865.     Spec.  4196. 

Mass..  ago  22. 

14,  '64. 

1865.                                                  649 

Weatherli/.  J.  M  .  It..  I. 

Dec.  11, 

Right.     Furhmghed  Feb.  17,  '63. 

60fi 

Sweetser.  L.  ('.,  Lieut., 

June  2, 

Left.     Surg.   C.  M.  Clark.  39th 

13th  Miss.,  age  20. 

11,  '62. 

B,  39th  Illinois,  age  26. 

2,  '64. 

Illinois.     Diseh'd  Nov.  7,  1865. 

650 

Wc.ber,  A.,  Corp'l,  I,  7th 

June  14, 

Left.     Surg.  Davis.     Recovered. 

607 

Switzer,  I).  M..  Pt.,  A, 

April  6, 

Right.    Dr.  A.  Judkins.    Diseh'd 

Louisiana. 

15,  '63. 

IGth  Iowa,  age  33. 

G,  '62. 

July  16,  1862.                                  !   651 

Weekwith,    E.,    It.,  K, 

Sept.  17, 

Right;  circ.    Disch'd  June  2,  '65. 

608 

Tanner,  L.  H.,  Corp'l.  B, 

May  12, 

Right;  flap.      Diseh'd   Dec.   29, 

3d  Maryland,  age  39. 

19,  '63. 

3d  Michigan,  age  23. 

13,"  '63. 

1864.                                                  652 

Weeks,   N.,  It,,  B.  10th 

April  2, 

Right;    flap.     Confed.    Surgeon. 

609 

Talbot,  A.,  Pt.,  A,  14th 

Mar.  2, 

Left;    ant.   post.   flap.      Disch'd   : 

N.  Y.  Art'y,  age  26. 

2,  '65. 

Diseh'd  Oct.  21,  '65.     Sper.  .774. 

N.  Y.  H.  A.,  age  22. 

2,  '65. 

Nov.  27,  1865.                                   '  653     Weeman.  W.  H.  H.,  It., 

Oct.  19, 

Left  :  circ.     Surg.  C.  II.  Andrus, 

610 

Talbott,  G.  B.,  It.,  D, 

July  9, 

Left;  circ.  Surg.  L.  Slusser,  69th  I]              1st  Me.  Bat'ry,  age  28. 

19,  '64. 

176th  N.  Y.   Disch'd  Aug.  2,  '65. 

38th  Indiana,  age  24. 

9,  '64. 

Ohio.     Duty  Nov.  17,  1864. 

654 

Welch,    T.,   It,,    B,   9th 

May  3, 

Left.     Disch'd  Jan.  20,  1865. 

611 

Terrell.  J.   it..    Pt.,    B,     Aug.  16, 

Left;  circ.     Surg.  9th  Va.  Cav. 

Alabama,  age  24. 

3,  '63. 

9th  Virginia.                        16.  '64. 

Trans.  Aug.  30.  1864. 

655 

Wells,   F.,   It.,    1,    99th 

Oct.  27, 

Right:    circ.     Confed.   Surgeon. 

612 

Terhuno,  N.  D.  F.,  It., 

July  3, 

R't;  circ.     Surg.W.  H.Twiford, 

Penn.,  age  32. 

28,  '64. 

Diseh'd  Sept.  9,  1865. 

(1.  27th  Ind..  age  19. 

4,  :63. 

27th  Ind.     Disch'd  May  30,  '64. 

656 

Wenhoner,  W.,  Pt.,  II, 

Mar.  31, 

Left;    ant.   post.   flap.      Disch'd 

6i:i 

Tbacker,  B.  F.,  Sg't,  K, 

Aug.  21, 

Right:  flap.     Ass't  Surg.  J.  M. 

15th  N.  Y.H.A.,age22. 

31,  '65. 

Julv  27,  1865. 

61st  C.  Troops,  age21. 

23,  '64. 

Study,  V.  S.  V.     Discharged.        657 

West,  B.  F.,  It.,  A,  59th 

Dec.  31, 

Right;  flap.  Disch'd  April  5.  '63. 

614 

Theban,   T.  A.,  Serg't, 

June  18, 

Left  ;  circ.     Surg.  H.  C.  Tomp- 

Ohio. 

31,  '62. 

H,  4th  N.  York  Art'y, 

18,  '64. 

kius,  4th  N.  Y.  H.  A.     Diseh'd     658 

Whaley,  E.  A.,  Capt.,  C, 

April  1, 

liight.     Mustered  out  August  4. 

age  25. 

May  31.  1865. 

6th  Wisconsin,  age  28. 

1,  '65. 

1865. 

615 

Thoina,    J..   It..  I.  26th 

Dec.  13.    Left;  flap.     Disch  d  Mar.  14  ,'63.     659 

Whitcomb.    J.,    It..    K.     .May  31, 

Left.     Disch'd    Sept.    12,    1862. 

New  York.                          14,  '62. 

llth  Maine,  age  26.          Je.  2,  '62. 

June  15,  '65,  reamp.  upper  third 

016 

Thonia,  1'.,  It..  D.  10th    Sept.  19, 

Left  :  flap.     Diseh'd  April  8,  '63. 

by  Dr.  J.  Benson. 

Missouri. 

19.  '62.                                                                    >  660 

White,  W.  M.,  Pt.,  D,     July  2, 

Left;  ant.  post.   flap.     Surg.   A. 

617    Thomas,  J..  Pt.,  A.  14th 

Aug.  7,     Right;  flap.    Surg.  O.  W.  Snow, 

11  1th  N.  Y.,  age  24.            3,  T>3. 

Satterthwaite,   12th   N.  Jersey. 

N.  V.  II.  A.,  age  20. 

7,  '64.         3:ith  Mass.   Diseh'd  Feb.  27,  '65. 

Diseh'd  Nov.  3,  '64.    Sprc.  1417. 

618    Thomas,  J.,  It.,  I,  33d 

Mar.  19, 

Left:  flap.     Diseh'd  June  24.  '65.      661 

Wliitehead,   J.  M.,  It., 

July  25, 

Left.      Surg.    Boatwright.       Re 

Ohio,  age  47. 

20,  '65.         Died  Sept.  1.  1866. 

H,  15th  Alabama. 

25.  '6u. 

covered. 

GI9 

Thomas.  W.,  Serg't,  B, 

May  5. 

Left;  flap.     Diseh'd  Jan.  17,  '65.      GC2 

Weir,  T.  I'..  Pt.,  B,  5th 

Sept.  19, 

Left.    Surg.  Griggs.    Recovered,  i 

99th  I'enn.,  age  24.              G,  '64. 

Georgia.                                  19.  '63. 

SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    MIDDLE    THIRD. 


235 


No. 

NAME,  MILITARY 
DESCRIPTION.  AND  AGE. 

BATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME.  MILITARY 
DESCRIPTION-,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

063 

Wight,  G.    L.,    I't.,  K, 

J  «  in?  22, 

Left  ;   ant.  post.   flap.     Surg.  J. 

704 

Baker,  E.  S..  Corp'l,  <;, 

April  9. 

Left;  sloughing;  femoral;  ha-iii.; 

24th  Mich.,  age  21. 

22,  '64. 

H.  Beach,  24th  Mich.     Bisch'd 

1st  Maine  Cav.,  uge  2>>. 

9,  '65. 

ant.  ]Mist.  skin  flap:  circ.  sect.  <.f 

July  13,  1865. 

muscles;  up.  third.     Died  July 

G64 

Wilbur,   J.,    Serg't,   D, 

Aug.  29. 

Left  ;  flap.     Disch'd  June  9,  '65. 

18,  1805. 

17th  Penn.,  age  40. 

29,  '04. 

Spec.  1514. 

705 

Ball,   C.  E.,  It..  F,  53d 

June  14, 

Right;   haem.;    ligation   femoral. 

065 

Wiley,   G.   (>.,    I't.,   1), 

Sept.  19, 

Right.     Disch'd  March  8,  1865. 

Mass.,  age  20. 

14,  '63. 

Died  June  29,  1803. 

34tli  Mass.,  age  20. 

20,  '64. 

706 

Banks,   S.,   It.,   C,   43d 

July  30, 

Right:  amp.  left  leg.     Surg.  D. 

666 

Wilkinson,  G.  U.,  It.,  K, 

June  18, 

Left  ;  double  hit.  flap.     Surg.  G. 

Colored  Troops. 

30,'  '04. 

Mackav,  29th  C.  T.     Died  July 

147th  X.  Y.,  age  3.1. 

18,  '64. 

W.  Xew,  7th  Iml.    Disch'd  Sept. 

31,  1804. 

14,  1864. 

707 

Ban-on.    J.,    Pt.,   C,  Oth 

Mar.  31, 

Right;  hit.  flap.     A.  A.  Surg.  S. 

667 

JPYHtfuson,  5.  C'.,  It.,  A, 

Nov.  30. 

Right:  circular.   Provost  Marshal 

Illinois  Cav.,  age  42. 

Ap.  1.'04. 

S.  Jessup.     Died  April  2,  1864  : 

9th  Tennessee,  age  21. 

De.  1,'04. 

March  5,  1805. 

exhaustion. 

668 

Williams,  B.  F.,  Serg't. 

June  20, 

Left  ;  flap.     Surg.  J.  X.  Beach. 

7.18 

Beils,    W.    H.,    It.,    D, 

June  1, 

Left.     Died  June  0,  18<!4. 

K,  40th  Ohio,  age  23. 

20,  '64. 

40th  Ohio.    Ilasm.;  fern,  ligateil. 

14th  New  Jersey. 

1,  '64. 

Disch'd  May  29,  1865. 

709 

Berry,  J.  R.,  Corp'l,  E, 

July  12, 

Right.     Died  November  12,  '03. 

669 

Williams,  E.,  Coal  Hea 

Jan.  15, 

Right.     Disch'd  June  15.  1865. 

41st  Illinois. 

12,'  '63. 

ver,   U.  S.  S.  Tristain 

15,  '65. 

710 

Bcntley,  E.,  Lieut.,  14th 

June  2. 

Right.     Died  June  4,  1864. 

Shandy,  age  33. 

New  York  Artillery. 

2,  '64. 

070 

Williams,  U..  Pt.,  H,  6th 

Sept.  28. 

Left  ;  flap.     Disch'd  May  1  6,  '65. 

711 

Berry,  J.,  Corp'l,  F,  10th 

Sept.  19, 

Left;  circ.  Oct.  25,  pyaem.  chills. 

Col'd  Troops,  age  22. 

28,  '64. 

West  Virginia,  age  20. 

20,  '64. 

Died  Nov.  14,  '64  :  typh.  fever. 

671 

Williams,  K.,    it.,    A, 

May  12, 

•.    Surgeon  Henderson.    Re 

712 

Bidwell,  I).  M.,   Serg't. 

June  3, 

Right.     Died  July  13,  1804. 

14th  Georgia. 

12,"  '64. 

covered. 

20th  Mich.,  age  21. 

3,  '64. 

072 

Wills,    H.,    Lieut.,    G, 

June  14. 

Right.  Surg.  A.  II.  Van  Xorstrand, 

713 

Bigham,  J.,  It.,  H,  17th 

June  25, 

Right;  flap.     Died  July  21,  '03: 

173d  New  York. 

14,  '03. 

4th  \Vis.  Resigned  Aug.  17,  '63. 

Indiana. 

26,  '63. 

pyaemia. 

673 

Wills,  J.  SI.,  Pt.,  I,  21st 

May  3, 

Left.     Disch'd  Aug.  20,  1863. 

714 

Billings,   S.,    Serg't,   C, 

Julyl, 

Left.     Died  July  1,  1803. 

New  Jersey,  age  15. 

3,  '63. 

19th  Maine. 

1,  fe. 

674 

Wilson.  A.,  Pt.,  G.  48th 

April  1. 

Left:  ant.  post,   skin   flap;  circ. 

715 

Rills,  W.  J.,  Pt.,  G,  32d 

Muv  13, 

Rifcht:    circ.     A.    Surg.    AV.    F. 

Col'd  Troops,  age  20. 

3,  '05. 

sect,  of  muso.    Surg.  A.  P.  Bart- 

Tennessee,  age  35. 

13,"  '64. 

Smith,  28th  Penn.    Gang.   Aug. 

lett,  33d  Mo.    Dis.  July  22,  '65. 

14th,  lig.  fern.    Died  Sept.  24), 

675 

Wilson,  A.  L.,  Serg't,  K, 

Dec.  16, 

Left;  circ.     Surg.  C.  J.  Walton, 

'64  ;  acute  diarrhoea. 

84th  Indiana,  age  23. 

16,  '64. 

21st  Ky.     Disch'd  Juno  10,  '65. 

716 

Binson,  J.,  Pt.,  G,  26th 

May  5, 

Right:  circ.  Surg.  J.W.AVisliart, 

676 

Wilson,    E.   J.,    Pt.,    15, 

July  6, 

Right:  circ.    Surg.  J.  Boone,  1st 

North  Carolina. 

5,  '64. 

140th  Penn.     Died. 

21st  N.  Y.  Cav.,  age  32. 

6,  '04. 

Md.  P.  U.  B.     Dis.  Dec.  0.  '64. 

717 

Bixler,   G.  W.,   It.,   H, 

April  0, 

Left;  lateral  flap:  haemorrhage. 

677 

Wilson.   H.   T.,  Pt,,   G, 

Sept.  IS), 

Left;  lateral  flap.     Surg.  1st  W. 

82d  Penn..  age  33. 

7,  '05. 

Died  April  15,  1865. 

10th  West  Va.,  age  40. 

19,  '04. 

Va.     Disch'd  Jan.  17.  1865. 

718 

Blystonc,    W.,    Pt.,    G, 

June  18, 

Died  June  25.  1864. 

678 

Wilson,   Ij.,   Corp  1,    E, 

Sept.  1, 

Right:  circ.    Disch'd  June  9,  '65. 

63d  Pennsylvania. 

18,  '04. 

17th  N.  Y..  age  20. 

2,  '04. 

719 

Bone,  J.,  It.,    E,  147th 

June  18, 

Died  June  18,  1804. 

079 

Wine,  J.,  Pt.,  C,  9th  In 

Dec.  17, 

Left  ;  ant.  post.  flap.    A.  Surg.  J. 

Xew  York. 

18,  '04. 

diana  Cav.,  age  44. 

17,  '04. 

R.  Culbertson,   10th  Ind.  Cav. 

720 

Bouton,   J.    H.,  It.,  H, 

Sept.  29, 

Left;  flap.  Oct.  3d,  haemorrhage. 

Disch'd  May  15,  1865. 

4th  C  I'd  Troops,  age  25. 

29,  '04. 

Died  Oct.  3,  1804;  shock. 

680 

Winkler,  J.,  Pt.,  D.  77th 

Oct.  19, 

Left;  double  flap.     Surg.  G.  T. 

721 

Bowlby,  P.,  It.,  11,  27th 

Nov.  25, 

Right.    Dec.5th,guigrene.    Died 

Xew  York,  age  33. 

19,  '64. 

Stevens,  77th  X.  York.    Disch'd 

111.,  age  25. 

20,  '63. 

December  25,  1863 

Aug.  11,  1805.     Spec.  3513. 

722 

Boyle,  J.  E.,  Corp'l,  E, 

June  2, 

Left.  Died  June  19,  '04;  py;emia. 

681 

Winston.  D.  S.,  Pt.,  F, 

Sept.  29, 

Right:  flap.  Confed.  Surg.    Mar. 

81st  New  York,  age  19. 

2,  '04. 

117th  X.  York,  age  23. 

29,  '64. 

10,  '65,  seq.  remov'd.  Sept.  26th, 

723 

Bradley,  J.,  It.,  D,  164th 

June  3, 

Left;  circ.  Diarrhoea.  Died  Aug. 

rcamp,  A.  Surg.  J.  H.  Armsby, 

New  York,  age  37. 

3,  '04. 

20,  1864. 

U.  S.  V.     Spec.  3226. 

724 

Brannon,  T.  D.,  Serg't. 

May  14, 

.     Surg.  G.  II.  Bane,  115th 

682 

Wion,  J.  W.,  It.,  F,  3d 

Aug.  9, 

Right.     Disch'd  Dec.  26,  1862. 

F,  115th  Illinois. 

14,'  '04. 

111.     Died  May  21,  1864. 

Wisconsin. 

11,  '62. 

725 

Brestler,  J.\V.,Corp'l,A, 

June  27. 

Right.     Died  July  3,  1864. 

683 

Wood.  E.R..  Pt,,  B,  18th 

June  18. 

Right.     Surg.  L.  Holbrook,  18th 

26th  Ohio,  age  24. 

27,  '04. 

Connecticut,  age  30. 

18,  '64. 

Conn.    July  29th,  flap  reamp.; 

726 

Brewer,    W.  L..  Serg't, 

July  1. 

Right.    Died   August  10,   1863: 

up.  third.     Disch'd  May  4.  '05. 

K,  51st  Georgia. 

1,  '63. 

exhaustion. 

084 

Wood,  J.  E..  Pt.,  £,  Nel 

Sept.  19, 

Left.    Surg.  G.  W.Simple'.C.S.  A. 

727 

Brittaln,    F.   M.,   It.,  I, 

June  15, 

Left  ;  ant.  post.  flap.     Surg.  W. 

son's  Batterv,  age  21. 

19,  '64. 

Provost  Marshal  April  1,  1805. 

66th  Ohio,  age  21. 

15,  '04. 

R.  Longshore,  147th  Penn.  Died 

685 

Wright,    II.  J.,    Pt.,  C, 

June  17, 

Right  :  flap.    Surg.  S.  S.  French. 

Nov.  20,  '04  :  chronic  diarrhoea. 

2d  Michigan,  age  21. 

18,  '04. 

20ih  Mich.    Disch'd  Oct.  19,  '05. 

728 

Brown,  A.,  Pt.,  D,   60th 

June  27, 

Left  ;  circ.     Surg.  11.  B.  AVhiton, 

686 

Young,  J.,  Pt.,  I.  120th 

May  5. 

Left:  ant.  post.   flap.     Surg.  E. 

Xew  York,  age  25. 

27,  '04. 

00th  N.  Y.     Died  Sept.  21,  '04  ; 

New  York,  age  18. 

0,  '04. 

L.  Welling,  llth  N.  J.     Feb.  7, 

diarrhoea. 

'65,  seq.  rern.     Dis.  Sept.  5,  '05. 

729 

Brown.  J.  W..  Capt.,  I, 

Aug.  25, 

Right  ;  circ.     Died  Oct.  5,  1864. 

687 

Abbott,    J.,    Serg't,    A, 

Aug.  31, 

Left.     Died  September  14,  1864. 

47th  X.  C.,  age  3li. 

25,  '04. 

31st  Iowa. 

31,  '04. 

730 

Jirongli.  J.  R.,  Capt.,  F, 

Aug.  31, 

Left.  Surg.  A.  C.  Messenger,  57th 

688 

Adams,   H.  T,.,    It..   K, 

Oct.  ID, 

Right  :   oval  ;   sloughing.      Died 

27th  Mississippi. 

31,  '04. 

Ohio.     Died  Sept.  1.  1804. 

18th  Penn.  Cavalry. 

19.  '64. 

Nov.  16,  1804:  pyaemia. 

731 

Brown,    \V.   C.,    Sera't, 

May  11, 

Right;  flap.     Ass't  Surg.  A.  G. 

689 

Adams,  J.,  It.,  I,  12th 

May  12, 

:  cire.    Surg.  J.  W.  Wishart, 

G,  51st  X.  Y.,  age  21. 

11,  '64. 

Sprague,  7th  R.  I.     May  21st, 

New  Jersey. 

12,"  '04. 

14()th  Penn.     Died  Dec.  23.  '04. 

ha-in.;  lig.     Died  July  11,  1804. 

090 

Aherns,  I).,  "it.,  B,  3  1st 

April  2, 

Right.     Surg.  W.  O.  McDonald, 

732 

Brown,  W.,  It.,  A,  14th 

July  9, 

Right:  circ.     A.  A.  Surg.  G.  M. 

Maine,  ago  2J. 

4,  '05. 

U.  S.  V.     Died  April  11,  1805; 

New  Jersey. 

11,  '04. 

Paullin.     Died  July   12,  1804; 

pyaemia.     Spec.  4160. 

exhaustion.     Spec.  ii857. 

691 

Aikin,  H.  H.,  dipt.,  D, 

July  :iO. 

Left  ;  circ.  Surg.  D.  Muckay,  29th 

733 

Bruce,   A.,   Pt.,  H,  91st 

July  20, 

Left:  ant.  post.  flap.    Died  Aug. 

2'.)th  Colored  Troops. 

Au.'l,  '64. 

C.  T.     Died  August  2,  1804. 

Ohio,  age  20. 

20,'  '64. 

14,  18ii4  :  diarrhoea. 

092 

A-kam,  R.  J.,  It.,  I,  145th 

July  :!, 

Died  July  24,  1803. 

734 

Buckingham.  M..  Color 

July  1, 

Right.     Died  July  5,  1803. 

Pennsylvania. 

3,  '"03. 

Serg't"  C,  104th  X.  Y. 

1,  '63. 

693 

Alpen,  'R.,  It.,   F.  20th 

June  1, 

Left.     Died  June  14,  1864  ;  hasm- 

735 

Burneson.    W.,    It.,    D, 

June  10. 

Left  ;  ant.  post.  flap.     Died  July 

Massachusetts. 

1,  '04. 

•  orrhage. 

147th  Penn.,  age  21. 

17,  '04. 

19,  1804:  exhaustion. 

694 

Ambler.  W.  II.,  Pt.,  G, 

May  It!, 

Right  :  anterior  post.  flap.     Died 

736 

Burns,  M.,  It.,  C.  140th 

July  2, 

Left.     Died  August  4,  1863. 

2d  Vermont,  age  21. 

18."  '64. 

June  9,  1864:  exhaustion. 

X.  Y..  age  20. 

4,  '03. 

695 

AmstPiid,  G.,  Serg't,  15, 

May  2, 

Lett.    Died  May  15,  '63;  anaemia. 

737 

Burson,  J.  J.,  It.,  D,  85th 

July  2i», 

Left.     Died  August  20,  1804. 

73d  Pennsylvania. 

2,  '63. 

Indiana. 

20,'  '64. 

696 

Andf.rsnn.  S.  W..  It.,  K, 

July  20, 

Left  ;  circ.    Died  August  10.  '04. 

738 

Burt.   J.    T.,  Pt.,  D,  Sy- 

Dec.  13, 

Right.     Surgeon  E.  Hutchinson. 

37th  Mississippi. 

20,"  '64. 

mon's  Ga.  Res.,  age  18. 

14,  '64. 

137th  New  York.     Died  March 

697 

Ankany,  L.,  It.,  D,  33th 

Oct.  19, 

Right  ;  circ.     Died  Nov.  27.  '04  ; 

2,  181)5;  pya'inia.     Autopsy. 

Ohio,  age  23. 

20,  '04. 

pyaemia. 

739 

Butler,    S.,    Pt.,    C,   3d 

June  27. 

Right  :  circ.'    Died  July  2ii.  1862.. 

698 

Arnold,   J.,    It.,   K,   3d 

June  3, 

Right.     Died  June  23,  1804. 

Xew  Jersey. 

28,  '02: 

Vermont,  age  15. 

3,  '64. 

740 

Butler,  W.,  'it.,  H,  98th 

June  2  I, 

Died  June  22,  1804. 

6!)9 

Askenette,    P..    It.,    II, 

July  21, 

Left.     Surg.  H.  McKennan,  17th 

Illinois. 

21,  '04. 

12th  Wisconsin. 

21,  ''04. 

AVis.     Died  July  23,  1864. 

741 

Campbell,  II.,  Camp  fol 

Mar.  —  , 

Left.     A.  A.  Surg.  G.  W.  A  very, 

700 

Ataway.  S.,  It.,  G.  1st 

July  3, 

Right;  slough  "g,  bone  protrud'g. 

lower,  age  23. 

—  .  '03. 

Osteo-myelitis  :    seq.  removed. 

S.  Carolina,  age  10. 

3,  '63. 

Died  Aug.  10,  '63;  diarrhoea. 

Oct.  22,  "'00,  amputa.  hip  joint. 

701 

Atwell.O.M.,  Pt.,I,2(ith 

Dec.  13, 

Left;    flap.     Jan.  5,  1863,  ha>m. 

Died  Oct.  23,  18;i;'>. 

New  York,  age  21. 

14.  '62. 

Died  Jan.  9,  1863. 

742 

Campburn,    J..     It..    F, 

Oct.  27, 

Right;  bi-Uitoral  flap:  diarrhoea. 

70-2 

Barber,    A.    J.,    Lieut., 

July  2, 

Left.  Died  July  28,  '03;  pyaemia. 

51st  Penn.,  age  23. 

27.  '64. 

Died  Nov.  23,  '04:  exhaustion. 

llth  Infantry,  age  30. 

4,  '63. 

743 

iCantrM,  F.  M.,  It.,  —  , 

Sept.  17, 

Right:   flap.     Died  Sept.  25,  '62: 

703 

Baguley,  S./Pt.,  B,  5th 

April  7, 

R't  ;  circ.     Surg.W.  O'Meagher. 

1st  S.  Carolina,  age  3:). 

18,  "02. 

pyaemia. 

N.  Hampshire,  age  21. 

8,  '05. 

G9th  N.  Y.     June  rid,  nmp.  left 

744 

Carabine.  D.  W.,  It.,  G, 

Dec.  10, 

Right;  circ.  A.  A.  Surg.  A.  Rolls. 

thigh.     Died  July  10,  1805  ;  ex 

Myrick's  Miss.  Battal 

10,  '04. 

Died  Dec.  22,  '04  ;  irrita.  fever. 

haustion.     Spec.  4332. 

ion,  age  21. 

"FlSHHR  (G.  J.),  Casex  af  Amputations,  in  Am.  Jour.  Med.  Sci.,  1803,  A'ol.  15.  p.  17. 


236 


INJURIES   OF   THE    LOWER   EXTREMITIES. 


(CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

745 

Cardeman,  W.,   Pt,  A, 

Jan.  15, 

Left  ;  circ.    A.  Surg.  H.  C.  Mer- 

786 

Culliden,  D.,  Pt.,  I,  83d 

May  5, 

Left;  ant.  post,  flap;   bed-sores. 

203d  Penn.,  age  24. 

15,  '65. 

riweather.  5th  C.  T.    Died  Jan. 

Pennsylvania. 

6,  '64. 

Died  June  16,  '64;  exhaustion. 

29,  1865  ;  pyaemia. 

787 

Culver.'H.,  Pt..  E,  2d  11. 

June  18, 

Left  ;  circ.   Dec.  17,  reamp.   Died 

746 

Carpenter,  L.  B.,  Pt.,  H, 

Oct.  19, 

Right.  Ass't  Surg.  J.Homans,  jr., 

S.  S.  S.,  age  30. 

19,  '64. 

Jan.  10,  '65;  gangrene. 

90th  X.  York,  age  25. 

20,  '64. 

U.S.A.    Haem.  from  wound  in 

788 

Cumber,   J.    G  ,    Pt.,    I, 

May  15, 

Right;  circ.     Surg.  II.  E.  Good 

arm;  lig.     Died  Nov.  14,  1864. 

38th  Ala.,  age  30. 

15,  '64. 

man,  U.  S.  V.     Died  July  14, 

747 

3arver,   E.,   Corp'l,   H, 

May  5, 

Right  :  ant.  post.  flap.    Died  June 

1864;  exhaustion. 

7th  Wisconsin. 

6,  r64. 

16,  1864  ;  exhaustion. 

769 

Cummings,  I.  S.,  Pt.,  F, 

Aug.  6, 

Right.     Surg.  A.  M.  Wilder,  U. 

748 

Case,  C.  F.,  Adj't,  36th 

Nov.  30, 

Right;  circ.     A.  A.  Surg.  J.  II. 

100th  Ohio,  age  20. 

6,  '64. 

S.  V.  Died  Sept.  5,  '64  ;  typhoid 

Illinois,  age  27. 

)ec.l,'64. 

Green.  Died  Dec.  18,  '64:  pyaem. 

fever. 

749 

Casey,  1\  J.,  Lieut.,  E, 

Xug.  21, 

Left.    Died  October  16.  1864. 

790 

Curry,  J.  H.,  Serg't,  D, 

May  5, 

Right.     Surg.   W.   O.  Meagher, 

16th  Mississippi,  ape  36. 

—,'64. 

116th  Penn.,  ago  23. 

5,  '64. 

69th  N.  Y.     Died  May  30,  1864. 

750 

Chamberlain,  (Jr.,  Pt.,  D, 

May  12, 

Left.     Surgs.  A.  F.  Whelan,  1st 

791 

Curtin,  F.,  Pt.,  A,  28th 

June  3, 

Left;  circ.     Surg.  1".  E.  Hnbon, 

8th  Michigan. 

12,  '64. 

Mich.  S.  S.,  and  W.C.  Shurloek, 

Mass.,  age  26. 

3,  '64. 

28th  Mass.      Diarrhoea;   haem. 

51st  Penn.    Died  May,  1864. 

Died  July  1,  1864. 

751 

Chapman,   W.,   Pt.,  G, 

Sept.  1, 

;  by  Surg.  G.  W.  Beach,  141st 

792 

Curtis,  R.,  Lieut.,  D,  3d 

May  6, 

Died  May  19,  1864. 

21st  Ohio. 

1,  '64. 

N.  York.     Died  Sept.  11,  1864. 

New  Jersey. 

6,  '64. 

752 

Chase,  A.,  —  ,  I,  4th  N. 

Julv  30, 

Right;  circ.    Surg.G.P.Greeley, 

793 

Dafrimont,  L.,  Pt.,   G, 

July  28, 

Right.     Died  Aug.  31,  1864. 

Hampshire,  age  35. 

30,  ''64. 

4th  N.H.    Died  Aug.  23,  1864  ; 
exhaustion. 

794 

17th  Alabama. 
Dail,  J.  H.,  Pt.,  K,  79th 

29,  '64. 
Mar.  19, 

Right.     Died  March  29,  1865. 

753 

Cherry,  S.,  Pt.,  A,  34th 

Aug.  6, 

Left.    Died  August  25,  1864. 

Ohio. 

19,  '65. 

Illinois. 

6,  ?64. 

795 

Dangler,  D.  F.,  Pt.,   E, 

June  18, 

Right.     Died  July  20,  1864  ;  ex 

754 

Chestnut,  J.,  Pt.,  A,  80th 

May  14, 

Right.     Died  July  16,  1864. 

55th  Penn.,  age  20. 

18,  '64. 

haustion. 

Indiana,  nge  22. 

14,  '64' 

796 

Davis,   G.,    Pt.,    B,    2d 

Oct.  6, 

Died  October  17,  1864  ;  pyaemia. 

755 

Childs,  G.  W.,   Pt.,  D, 

May  24, 

Right;  diarrhoea.    Died  June  11, 

Artillery. 

6,  '64. 

56th  Mass.,  age  27. 

24,  '64. 

1834;  asthenia. 

797 

Davis,    W.  H.,   Pt.,   A, 

June  23, 

Right  ;  circ.     Surg.  J.  W.  Wis- 

756 

Clark,  J.,  Pt,,  H,  7th  N. 

June  16, 

Right  ;  circ.     Surg.  P.  E.  Hubon, 

38th  N.  C.,  age  21. 

23,  '64. 

hart,  140th  Penn.     Died  August 

York  H.  A.,  age  24. 

17,  '64. 

28th  Mass.    June  27,  haem.;  lig. 

16,  1864. 

profunda.     Died  Oct.  9,  '64  ;  ex 

798 

Davidson,  R.  C.,  Serg't, 

July  30, 

Left;  circ.     Surg.  G.  W.  Snow, 

haustion. 

C,  35th  Mass. 

30,  '64. 

35th  Mass.     Died  Aug.  19,  1864. 

757 

Clapp,   E.,   Pt.,    H,  7th 

June  2, 

Right.     Died  June  10,  1864. 

799 

Dawson,  G.  S.,  Capt.,  F, 

June  16, 

Left.    Dr.  A.  Garcelon.    Necro. 

Conn.,  age  47. 

2,  '64. 

2d  N.  Y.  H.  A.,  age  26. 

17,  '64. 

Died  Dec.  6,  '64.    Sp.  1427,  2828. 

75rf 

Dlapper,   F.,    Serg't,   I, 

April  23, 

Right.    Died  April  1-3,  1864. 

800 

Delaney,  D.,  Pt.,  B,  1st 

Dec.  2, 

Left  ;  ant.  post,  flap;  ciro.  sect,  of 

2d  N.  York  Vet,  Cav. 

23,  '64. 

Md.  Cav.,  age  29. 

4,  '64. 

muscles.     Surg.  J.  B.  Lewis,  U. 

759 

Clough,  J.,  Pt.,  B,  109th 

Oct.  20, 

Left.     Died  November  10,  1862. 

S.  V.   Died  Jan.  5,  '65;  pyaomia. 

Illinois. 

20,  '62. 

Autopsy. 

760 

Coffin,    P.,  Pt.,  B,   19th 

July  3, 

Died  July  9,  1863. 

801 

Dennerhorn.  G.  B.,  S'gt, 

June  1, 

Left.    Died  June  9,  1864. 

Maine. 

3,  '63. 

A,  119th  Penn. 

1,  '64. 

761 

Cor/gins,   V.  M.,  Pt.,  I, 

,  May 

Right.     Died  May  22,  1864. 

802 

Devon,  J.,  Pt.,  F,  26th 

July  2, 

Left.     Died  July  10,  1863. 

13th  South  Carolina. 

22,  '64. 

Pennsylvania. 

2,  r63. 

762 

Colby,  J.  S.,  Corp'l,  I, 

May  19, 

Right  ;  ant.  post.  flap.   Died  June 

803 

Dillon,    N.,    Corp'l,    K, 

Deo.  15, 

Right  ;  circ.    A.  Surg.  R.  J.  Hill, 

27th  Michigan. 

19,  '64. 

21,  1864;  exhaustion. 

80th  111.,  age  21. 

15,  '64. 

45th  111.  Died  Dec.  17,  '64  ;  haem. 

763 

Cole,  A.  E.,  Pt.,  0,  142d 

Jan.  15 

Right  ;  circ.  Surg.  J.W.  Mitchell, 

804 

Dinley,   J.,   Pt,,  E,  73d 

Oct.  29, 

Died  November  14,  1  863. 

New  York,  age  17. 

15,  '65. 

4th  C.T.  Died  Feb.  4,'65;  exh'n. 

Ohio. 

29,  '63. 

764 

Cole,  S.  R.,  Pt.,  K,  9th 

April  2, 

Right.    Died  April  16,  1865. 

805 

Dolan,   J,,    Pt.,   I,   74th 

Sept.  1, 

Right;   circ.;   nee.   femur;  prot. 

N.  Y.  H.  A.,  age  48. 

2,  '65. 

Ohio,  age  26. 

2,  '64. 

remov'd;  gang.     Died  Nov.  21, 

765 

Collier,  H.,  Pt.,  I,  12th 

Dec.  16, 

Right  ;  circ.   A.  Surg.  J.  A.  Free 

QHft) 

1864;  exhaustion. 

Penn.  Cavalry,  age  20. 

17,  '64. 

man,  U.  S.  V.  Died  Dec.  27,'64  ; 

V/Of 

1)71 

Doud,  T.,  Serg't,  C,  2d 

July  30, 

Both.     Surg.    W.    B.    Fox,   8th 

exh.  and  pneumonia.  Sprc.  375.'. 

suo 

Michigan. 

30,  '64. 

Mifth.     F.iod  July  31,  18:i4. 

76J 

Conklin,  C.,  Pt.,  I.,  6th 

April  29, 

Right.     Surg.  J.  Ebersole,  19th 

80S 

Dougal,    F.  L.,    Pt.,  H, 

April  24, 

Right.    Died  April  25,  '63;  shock. 

Wisconsin. 

30,  '63. 

Ind.  DiedMav9,'63.  Spec.  1120. 

loth  Connecticut. 

25,  '63. 

767 

Connell,  J.,  Pt.,  F,  146th 

Mar.  31, 

Left;  ant.  post.'flap.   Surg.  T.  M. 

809 

Downey,  J.,  Corp'l,   B, 

April  1, 

Right    ant.  posterior  flap.     Died 

New  York,  age  21. 

31,  '65. 

Flandrau,  146th  N.  Y.;    gang. 

2d  Iowa  Cav.,  a^e  21. 

1,  '65. 

April  26,  1865;  pyuemia. 

Died  May  27.'65  ;  phleb.  and  exh. 

810 

Dwyer,  W.,  Pt.,  E,  27th 

April  —  , 

Left;     congestive    chill.      Died 

768 

Cook,  C.  C.,  Lieut.,  C, 

June  —  , 

Left.     Died  October  6,  1864. 

Mass.,  age  1!). 

—  ,  '63. 

April  27,  1863. 

77th  Pennsylvania. 

—  ,  '64. 

811 

Eaton,  G.  W.,  Teamster, 

May  17, 

R't;  circ.   A.  Surg.  J.  M.  Palmer, 

769 

Cook,   F.   S.,    Serg't,  I, 

May  10, 

;  ant.  post.  flap.    Surg.  C.  B. 

H,  17th  Mass.,  age  36. 

17,  '64. 

80th  N.Y.     Died  May  18,  '64. 

53d  Virginia. 

12,'  '64. 

Gibson.C.S.A.  Died  May  14,'64. 

812 

Eckhart,  G.  W.,  Corp'l, 

Sept.  19, 

Right  ;    circ.      Surg.    P.    Leidy, 

770 

Coon,  11.,  jr.,  Corp'l,  H, 

Nov.  24, 

Died  November  25,  1863. 

B,  49th  Pennsylvania. 

19,  '64. 

119th  Penn.     Died  Oct.  6,  1864  ; 

149th  New  York. 

24,  '63. 

peritonitis. 

771 

Courtnav,  J.  C.,  Pt.,  H, 

Julv  22, 

Right.  Surg.  H.  McKennan,  17th 

813 

Eddy,   G.,   Pt.,   E,    7th 

Aug.  30, 

Right.     Sept.  8,  13,  haem.;  lig.  of 

30th  Illinois,  age  18. 

22,  '64. 

Wis.     Died  Aug.  12,  1864. 

Wisconsin,  age  24. 

30,  '62. 

femoral.     Died  Sept.  13,  1862; 

772 

Courtney,  C.,Pt.,F,  89th 

Sept,  17, 

Left,   Died  Sept.  26,  '62  ;  tetanus. 

exhaustion. 

New  York,  age  20. 

19,  '62. 

814 

Elder,   M.,    Lieut.,  llth 

July  2, 

Left.  Jply  2!),  pyaemia  dev.  Died 

773 

Cox,   G.,  It.,  K,   1st  N. 

June  9, 

Right  ;  circ.  Ass't  Surg.  B.  How 

Infantry,  age  28. 

4,  '63. 

July  2.3,  '63  ;  pyicmia. 

Carolina,  age  27. 

9,  '64. 

ard,  U.  S.  A.  Died  June  24,  '64. 

815 

Enos,   E  .,   Pt.,    H,  10th 

May  10, 

R't.    Surg.  B.  Robrer,  10th  Penn. 

Spec.  1233. 

Penn.  Res.,  age  28. 

10,  '64. 

Res.  Died  May  19,  '64.  Sp.2442. 

774 

Cox,  J.,  Pt.,  C,  9th  New 

Oct.  19, 

Left.    Died  October,  1864. 

816 

Evarts,    E.,    Serg't,    C, 

Oct.  27, 

Right.    Nov.  14,  sym.  of  pyiemia. 

York  Heavy  Artillery. 

19,  '64. 

8th  N.  Y.  H.  A.,  age  26. 

28,  '64. 

Died  Nov.  18,  18ii4. 

775 

Cox,  W.  F.,  Pt,,  D,  91st 

Aug.  6, 

Right;  Surg.  C.  D.,  Moore,  13th 

817 

Fakee,  N.,  Pt.,  C,  6th  N. 

May  19, 

Right;  flap.     Died  Oct.  2,  1864; 

Indiana. 

6,  ?64. 

Ky.     Died  Sept.  2,  1864. 

Y.  H.  A. 

19,  '64. 

typhoid  pneumonia. 

776 

Coyle,   J.,   Pt.,  D,  15th 

Mar.  31, 

Left.    Died  May  24,  1865. 

818 

Farrer,   J.  W.,   Pt.,  E, 

June  9, 

Left.   Surg.  A.  Hard,  8th  111.  Cav. 

New  York  Cavalry. 

31,  '65. 

8th  111.  Cav.,  age  27. 

9,  '63. 

Died  June  18,  '63.  Aato./S/J.  1224. 

777 

Cramer,  D.,  Pt.,  E,  149th 

May  8, 

Left.     Died  J  une  3,  '64  ;  pyaemia. 

819 

Ferguson,  C.  F.,  Serg't, 

July  2, 

Left.   July  8,  huam.     Died  Sept. 

Penn.,  age  25. 

8,  '64. 

I,  1st  Mass.,  age  25. 

2,  '63. 

11,  1863. 

778 

Crawford,  W.,  Pt.,  B,  2d 

May  12, 

Right,  Surg.  C.  Bower,  6th  Penn. 

820 

Ferguson,    D.,    Pt.,    G, 

June  23, 

Left.  Surg.  T.  L.  Magee,  51st  111. 

Penn.  Reserves,  age  40. 

12,  '64. 

Res.     Died  July  27,  '64  ;  chron. 

125th  Ohio. 

23,  '64. 

Died  June  26,  1864. 

diarrhoea.  Autopsy.  Photo.  Ser. 

821 

Ferguson,    J.,    Pt.,    K, 

Dec.  13, 

Right.     Died  Dec.  14,  1862. 

164.    Spec.  2890. 

51st  Pennsylvania. 

13,  '62. 

779 

Crawford,  W.  S.,  Pt.,  D, 

Dec.  15, 

Left  :  lat.  flap.    A.  A.  Surg.  J.  E. 

822 

Fillingim,    A.,    Pt.,    E, 

Dec.  16, 

Right;  circ.     Ass't  Surg.  W.  B. 

18th  Ohio,  age  23. 

16,  '64. 

Link.     Died  Dec.  29,  1864. 

37th  Miss.,  age  23. 

16,  '64. 

Trull,  U.  S.  V.     Died  Dec.  25, 

780 

Crosby,   A.,    Serg't,   C, 

July  1, 

Left.    Died  July  12,  1863. 

1864  ;  irritative  fever. 

lOth'Maine. 

2,  '63. 

823 

Fisher,  D.,  Pt.,  K,  102d 

July  20, 

Right.    Died  August  30,  1864. 

781 

Cross,    W.   H.,    Pt.,   G, 

July  2, 

Right.     Died  July  13,  1863. 

New  York. 

20,  '64. 

61st  New  York. 

2,  '63. 

824 

Fisher,    S.,    Corp'l,    C, 

May  9, 

Right  ;  circ.    Died  May  30,  1  864  ; 

782 

Crowthers,  J.,  Serg't,  E, 

May  16 

Right  ;  circ.     Died  June  8,  1864  ; 

90th  Penn.,  age  27. 

10,  ''64. 

pyaemia. 

81st  New  York,  age  26 

18,  '64. 

pyaemia. 

825 

Flamburg,   M.,    Pt.,   G, 

Oct.  —  , 

.    Surg.  J.  E.  Pom  fret,  7th  N. 

783 

Crowley,  J.,  Corp'l,  A, 

April  2 

Right;  circ.     Surg.  J.  C.  How, 

52d  New  York. 

—  ,  '64. 

Y.  II.  A.    Died  Oct.  17,  1864. 

7th  New  York,  age  25 

2,  '65. 

2d  N.  Y.  Artillery.     Died  May 

-.'' 

Flynn,  J.  F.,  Pt.,  E,  1st 

April  6, 

Right;  circ.      Died  June  2,  1865; 

7,  '65;  pyae.  Autop.  Spec.  1487. 

Maine  Cav.,  age  26. 

6,  '65. 

exhaustion.    Autopsy. 

784 

Cruser,  P.  C.,  Serg't,  A 

Oct.  19, 

Left  ;  lat.  skin  flap  ;  circ.  section 

827 

Ford,    W.,    Pt.,    B,  7th 

July  1, 

Left;  slough'g;  (also  w'nd  right 

6th  New  York  Heavy 

21,  '64. 

muscles.     Surg.  C.  H.  Andrus, 

Louisiana,  age  23. 

1,  '63. 

thish.)  Died  Aug.  2  ),  '63;  haem. 

Artillery,  age  20. 

176th  N.  Y.     Died  Oct.  27,  '64; 

828 

Frank,  E.  H.,  Lieut.,  A, 

Aug.  12, 

Right.    Surg.  A.  T.  Hudson,  26th 

pyaemia. 

26th  Iowa. 

12,  '64. 

Iowa.    Died  Aug.  14,  1864. 

785 

Crumpton,  F.  A.,  Pt.,  I, 

Jan.  17, 

Left  ;  circ.     Died  Jan.  30,  1864. 

829 

Franklin,  G.  W.,  Pt.,  K, 

Julv  —  , 

Left.    Died  August  10,  1863. 

4th  Indiana  Cavalry. 

18,  '64. 

50th  Georgia. 

—  ,  '63. 

SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    MIDDLE    THIRD. 


237 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

830 

Free,   A.,   Pt.,   K,  26th 

May  15, 

Left.   Died  May,  1864. 

874 

Henderson,  J.,    Pt.,    F, 

July  2, 

Right.     Died  July  8,  '63;  wound,  j 

Pennsylvania. 

16,  '64. 

2d  New  Hampshire. 

2,  r63. 

831 

Frost,  A.,  Pt.,  A,  187th 

June  18, 

Right.     Died  Sept.  12,  1864. 

875 

Hendricks,  F.  E.,  Major, 

Mar.  31, 

Right.     Surg.  P.  E.  Hubi.n,  28th 

Penn  ,  ago  19. 

20,  '64. 

4th  New  York  H.  A. 

31,  '65. 

Mass.     Died  April  1,  1865. 

832 

Funt,   J  .,   Pt.,    H,  75th 

June  24, 

Right.   Surg.  C.  J.  Walton,  21st 

876 

Bengen,  B.,  Pt.,  A,  2d 

Nov.  3, 

Right.     Died  Nov.  14,  1863. 

Illinois. 

24,  '64. 

Ky.     Died  July  15,  1864. 

Louisiana. 

3,  '63. 

833 

Caddie,    S.  W.,  Pt.,  K, 

May  15, 

Left.    Died  May  21,  1864. 

877 

Henry.  J.,  Pt.,  B,  103d 

Nov.  25, 

—  .     Died  December  20,  186;;. 

5th  Kentucky. 

15,  '64. 

Illinois. 

25,  '63. 

834 

Gallagher,    P..    Pt.,    B, 

Oct.  3, 

Right  ;  circ.      Died  Oct.  4,  1864. 

878 

Henwright,  T.,    Pt.,  E, 

Sept.  30. 

.     Died  Oct.  4,  '64  ;  exhaus 

157th  Pennsylvania. 

3,  '64. 

117th  N.  Y.,  age  28. 

—  ,  '64. 

tion  from  suppuration. 

835 

Gardner,  J.,  Pt.,  D,  15th 

Oct.  19, 

Left  ;  slough'g  ;  protruding  bone 

879 

Herndon,   T.  11.,  Pt..  C. 

Nov.  27, 

Left.     Surg.  J.  Dwinelle.  106th 

New  York,  age  28. 

19,  '64. 

excised.     Died  Feb.  4,  1865. 

60th  Georgia. 

£8,  '63. 

Penn.     Died  December  3,  1863. 

836 

Gardner,  J.,Pt.,  K,  27th 

July  3, 

Left.     Ass't  Surg.  G.  V.  Woolen, 

Spec.  1885. 

Indiana. 

3,  'G3. 

27th  Ind.     Died  JnlyCS,  1863. 

880 

Hersha,    C.,    Serg't,    F, 

Mar.  19, 

Right  ;  circ.    Surg.  G.  F.  French, 

837 

Gay,   J.,    Pt.,    A,    35th 

Aug.  18, 

Left  ;  cir.;  sloughing.    Died  Sept. 

25th  Iowa,  age  21. 

20,  '65. 

U.  S.  V.     April  14,  iKfm.j   iTg. 

Massachusetts,  age  36. 

19,  '64. 

29,  1864  ;  pyaemia. 

Died  April  15.  1865 

838 

Geiser,  15.,   Pt.,  G,  32d 

June  4, 

.     Died  June  13,  1864. 

881 

Hess,   A.,    Pt.,  H,    10th 

June  1, 

Left,     Died  June  18,  1  864. 

Indiana. 

4,  '64. 

New  Jersey. 

1,  '64. 

839 

Cetchell.   G.  O.,  Capt., 

May  5, 

Right  ;  muscular  flap.     Surg.  T. 

882 

Hess,  J.,  Pt.,  I,  83d  N. 

May  12, 

Left;  circ.;  protrud.  bone  romo'd. 

E,  3d  Maine,  age  28. 

5,  '64. 

Hildreth,  3d  Maine.     Died  May 

York,  age  19. 

12,  '64. 

Died  Slav  24,  '64:  exhaustion. 

30,  18G4  ;  pyaemia.    Autopsy. 

883 

Heacock,  N.,  Serg't,  E, 

Sept.  19, 

Left.     Die'dOct.  4,  1864  ;  exhaus 

840 

Getchell,  II.  D.,  Pt.,  C, 

Sept.  17, 

Left.    Died  October  14,  1862. 

119th  Pen-,. 

19,  '64. 

tion. 

15th  Mass..  age  19. 

17,  '62. 

884 

Hickman,     I,..    Pt.,    1st 

Sept.  29, 

Right;  circ.;  (also  other  wounds.) 

841 

Gersingrr,  J.  H.,  Pt.,  H, 

July  3, 

Right.     Surg.  G.  P.  Oliver,  lllth 

Virginia  Artillery. 

29,  '64. 

Ass't  Slug.  W.  F.  Richardson, 

1st  North  Carolina. 

4,  '63. 

Penn.     Died  July  28,  1863. 

C.  S.  A.     Died  Oct.  23,  1864. 

842 

Gibbs,    L..   Pt.,   G,  5th 

July  3, 

Right  ;  slough  extending  nearly 

885 

Higgins,  A  .  \V.,  Pt.,  E, 

June  17, 

Lef"  ;  lat.  flap.     Surg.  J.  W.  Wis- 

Mich.  Cav.,  age  33. 

4,  '63. 

to  groin.     Died  Sept.,  18,  1863; 

lllth  N.  York,  age  27. 

18,  '64. 

hart,    140th  Penn.     Died  July 

diarrhoea. 

11,  1864  ;  pyaemia. 

843 

Gilbert,  J.  H.,  Serg't,  K, 

April  1, 

Left  ;  ant.  post.  flap.     Died  April 

886 

Hinchcliff   .'!.  H.,  Pt.,  E, 

Feb.  6, 

Left;  flap.     Died  Feb.  17,  1865; 

2d  N.  Y.  Cav..  age  34. 

1,  '65. 

27.  1865;  pyaemia. 

210th  P(  i;i.,  age  39. 

6,  '65. 

exhaustion. 

844 

Gilbert,  P.,  Pt.,  D,  83d 

June  18, 

Left,    Died  June  28,  1864. 

887 

Hitchcocl  ,    H.,   Corp'l, 

May  5, 

Right  ;  circ.  Surg.  J.W.Wishart, 

Pennsylvania. 

18,  '64. 

G,  39th  New  York. 

5,   64. 

140th  Penn.     Died  May  6,  '64. 

845 

Gilmore,  J.A.,Maj.  ,48th 

May  31, 

Right  ;  flap.     Died  June  9,  1864  ; 

888 

Hoffman.     F.,    Private, 

July  20, 

Right  ;  cire.    Surg.  J.V.Kendall, 

Penn.,  age  30. 

31,  '64. 

exhaustion. 

Knapp'-  Penn.  Bat  ry. 

20,  '64. 

149th  N.  Y.    Died  Aug.  11,  '64. 

846 

Gleuson,   0.  A.,  Corp'l, 

Sept.  19, 

Left;  circ.    Died  Oct.  12,  1864; 

889 

Hoffman    J.  W.,  Pt.,  B, 

Oct.  19, 

Left.     Died  Oct.  25,  'G4  ;  tetanus. 

L,  3d  Mass.  Cavalry. 

19,  '64. 

pyasmia. 

57th  N.  Carolina. 

19,  '64. 

847 

Godfrey,  VV.  M.,  Pt.,  F, 

Nov.  7, 

.  Surg.  E.  C.  Franklin,U.S.V. 

890 

Holley.   C.,  Pt.,   H,  2d 

June  18, 

Right.     Surg.  S.  S.  French,  20th 

7th  Iowa. 

9.  '61. 

Died  Nov.  19,  18G1  ;  tetanus. 

Michigan. 

18,  'G4. 

Mich.     Died  June  18,  1864. 

848 

Goldtbwaite,  J.,  Capt., 

Mar.  25, 

Right.     Died  April  17,  1865. 

891 

Howard,  F.  H.,  Pt.,  B, 

Jan.  30, 

Right.   Died  Feb.  1,'63;  asthenia. 

A,  1st  Maine. 

25,  '65. 

6th  M;;ss. 

30,  '63. 

849 

Goodsell,  G.  B.,  Serg't, 

May  14, 

Left.     Died  May  20,  1864. 

892 

Howard,    J.    S.,    Capt., 

Mar.  31, 

Left.     Died  April  21,  1865. 

D,  103d  Ohio. 

14,  '64. 

G,  8th  Penn.  Cavalry. 

31,  '65. 

850 

Gordon,  P.,  Pt.,  E,  7th 

June  —  , 

Left.     Died  June  7,  1863. 

893 

Bowel,  J.  C.,  Lt.,  C,  55th 

July  20, 

—  .     Died  July  30,  1864. 

Missouri. 

—  ,  '63. 

Alabama. 

20,  '64. 

851 

Gotwaltz,     A.,    Pt.,    A, 

Sept.  19, 

Left;  flap.     Died  Oct.  11,  1864; 

894 

Hiibbard,  J.  D.,  Corp'l, 

Dec.  15, 

Left.    Died  Jan.  22,  '63;  pyaemia. 

138th  Pennsylvania. 

19,  '64. 

exhaustion. 

G,  8th  Florida,  age  32. 

15,  '62. 

Autopsy. 

852 

Gould,  E.  S  ,  Corp'l,  I, 

July  3. 

Right.     Died  August  7,  1863. 

895 

Hubbell,  G.  P.,  Corp'l, 

May  14, 

.     Died  May  17,  1864. 

2Jd  .Mass.,  age  19. 

3,  '63. 

C,  24th  Michigan. 

14,'  '64. 

853 

Goxvers,   J.    A.,  Pt.,  B, 

May  12, 

Right;  circ.;  seq.  removed.  Died 

896 

Hudnot,  M.  B.,  Pt.,  D, 

June  16, 

Left,     Surg.   S.   II.  Plumb,  82d 

14th  X.  Y.  H.A.,age23. 

13/V4. 

Sept.  18,  1864  ;  asthenia. 

8th  New  York  H.  A. 

1G,  '64. 

N.  Y.    Died  June  17,  1864. 

854 

Graves,  J.,  Pt..  D,  lllth 

July  28, 

Right.     Surg.  H.  C.  Messenger, 

897 

Hugh,  E.,  Pt.,  H,  59th 

June  16, 

Right  ;  ciro.     Surg.  G.  L.  Potter, 

Illinois. 

28,  '64. 

56th  Ohio.     Died  Aug.  1,  1864  ; 

New  York,  age  22. 

17,  '64. 

145th  Penn.     Died  June  30,  '64. 

wound. 

898 

Hulce,  C.,  Corp'l,  H,  2d 

June  18, 

Right.     Surg.  S.  S.  French,  20th 

855 

Gray,  T.  W.,  Corp'l,  F, 

Sept.  19, 

Left.     Died  Oct.  29.  1863;  haem. 

Michigan. 

18,  '64. 

Mich.     Died  June  18,  1864. 

58th  Indiana. 

19,  '63. 

and  pyaemia. 

899 

Humel,    H.   J.,  Pt..    G, 

Mav5, 

Left.     Died  June  5,  '64  ;  exhaus 

85(5 

Green,  J.,  Serg't.D,  88th 

Dec.  13, 

Right  ;  slough  ;  rein,  protr.  bone. 

155th  Penn.,  age  23. 

5,  r64. 

tion. 

New  York. 

13,  '62. 

Died  Feb.  23,  18G3.    Spec.  655. 

900 

Husted,  W  ,  Pt.,  I,  142d 

Oct.  27, 

Right.  Surg.  A.  M.  Clark,  U.S.V. 

857 

Grissel.   J.,  Pt.,   B,  8th 

Dec.  16, 

Loft  ;  ant.  post.  flap.    A.  A.  Surg. 

New  York,  age  18. 

27,  '64. 

Died  Nov.  15,  '64;  pyaemia. 

Kansas,  age  21. 

17,  '64. 

R.  McMilley;  shock.  Died  Dec. 

901 

Hutchinson,  W.  W.,  Pt., 

June  —  , 

Left.     Died  July  28,  1864. 

18,  1864  ;  exhaustion. 

F,  18th  Infantry. 

—  ,  '64. 

858 

Grow,  L.,  F.,  Lieut.,  K, 

July  22, 

Right.     Died  July  26,  1864. 

902 

Hutzel,G.  F.,  Pt.,E,  5th 

April  2, 

Right  ;  circ.     Died  May  4,  1865  ; 

25th  Wisconsin. 

24,  '64. 

Wisconsin,  age  33. 

2,  '65. 

pyaemia. 

859 

Haines,    J.,   Pt.,   I,   7th 

May  11, 

Right;  circ.     Surg.  J.  Ebersole, 

903 

Jackson,  E.,  Adj't.  82d 

Juno  1, 

Left.     Surg.   S.  H.  Plumb.  82d 

Indiana,  age  29. 

11,  '64. 

19th  Ind.     Died  May  29,  1864. 

New  York. 

1,  '64. 

New  York.    Died  June  7,  '64. 

Spec.  2408. 

904 

Jackson.  H.,  Pt.,  E,  4th 

Sept.  20, 

Left:   (alsoamp.  arm.)  Died  Oct. 

SCO 

Hance.   W..   Corp'l,   D, 
137th  N.  Y.,  age  18. 

Oct.  29, 
29,  '63. 

Left.     Surg.  J.  V.  Kendall,  149th 
N.  Y.     Died  Oct.  29.  18G3. 

905 

Colored  Troops,  age  23. 
Jackson,  W.  ,  Serg  t,  C, 

20,  '64. 
May  26, 

11,  '64  ;  exhaustion. 
Left;   cire.    Died  June  8,  1864; 

8G1 

Hancock,  G.,  Pt.,  A,  21st 

Sept.  19, 

Right  ;  flap.     Died  Oct.  4,  1  864  ; 

23d  Kentucky,  ago  41. 

27,  '64. 

exhaustion. 

Virginia. 

19,  '64. 

pyaemia. 

906 

Jeffries,   A.  S.,   Pt.,   I, 

April  7, 

Left.    Died  July  9,  1865  ;  exhaus 

800 

Hancock,  J.,Pt.,  E,  179th 

June  18, 

Left.     Died  June  19,  1864. 

17th  S.  Carolina,nge  23. 

7,  '65. 

tion. 

New  York. 

18,  '64. 

907 

Johnson,  F.  B.,  Pt.,  C, 

Dec.  13, 

Right.     Dec.  25,  lig.  fern.     Died 

8(J3 

Hansard.  W.,  Capt.,  K, 

Dec.  16, 

Right;  ant.  post.  flap.     Died  Jan. 

16th  Maine,  age  23. 

14,  '6->. 

Dec.  25,  '62;  exhaustion. 

4ibt    )hio,  age  22. 

16,  '64. 

7,  1865. 

908 

Johnson,    I  ,  Corp'l,  K, 

July  1, 

Left.     Oct.  10,  haem.    Died  Oct. 

804 

Harck.    M.,    Corp'l,    C, 

May  14, 

Left.    Died  May,  1864. 

1st  Ohio  Art'ry,  age  21. 

3,  '63. 

•19,  '63  ;  asthenia. 

C.id  Indiana. 

14,  '64. 

909 

Jones,A.,  Corp'l,  K,  15th 

May  10, 

.   Died  Juno  17,  '64  ;  pyaemia. 

8G5 

Hardy,  E.,  Pt.,  F,  36th 

July  30. 

Left;  flap.  Ass't  Surg.  Th.  Wild. 

Mass.,  age  21. 

10,''64. 

C.  T.,  age  23. 

30,"  "64. 

36th  C.  T.     Died  Aug.  29,  '64; 

910 

Jones,  W.  H.,  Pt.,  H,  1st 

May  19, 

Right.     Died  June  19.  1864  ;  py 

pyaemia. 

Maryland,  age  36. 

19,  '64. 

aemia.     Autopsy. 

8(iC 

Hartinan,    E..    Pt.,    A, 

Oct.  19, 

Lei't.     Surg.   S.  H.  Plumb,   82d 

911 

Kane,  D.,Pt.,  H,  1st  New 

June  3, 

Left  ;  circ.;  slough'g.   Died  Sept. 

59th  Xew  York. 

19,  '64. 

N.  Y.     Died  Oct.  19,  1864. 

Jersey,  ago  19. 

4,  '64. 

10,  1804. 

8G7 

Hartson.  P..  Pt.,  I,  GOth 

June  1C, 

Right  :  flap.  Surg.  H.  B.  Whiton, 

912 

Keeling,  L.   T.,  Pt,,  D, 

May  27, 

Died  June  3,  1864  ;  wounds. 

New  York,  age  25. 

16,  '64. 

GOth  N.   Y.    Gangrene.      Died 

17th  Kentucky. 

27,  '64. 

Aug.  16,  '64  ;  chronic  diarrhoea. 

913 

Keller,    H.  H.,    Pt..  B, 

May  5, 

Right.     May  20,  haem.:  28th,  re 

8G8 

Hatch,  W.  1!..  Col..  4th 

Dec.  13, 

Left.     Died  December,  1862. 

7th  Mich.  Cav.,  age  34. 

6,  '64. 

curred  ;  ligation.    Died  Juno  25, 

New  Jersey. 

13.  '62. 

1864  :  pva?mia. 

8G9 

1  Hawksworth.  T.,  Muj., 

Doc.  14, 

Left.    Died  Jan.  6,  1863  ;  tetanus. 

914 

Kennard,  P.,  Pt.,A,  16th 

May  14, 

—  .    Died  May  14,  1864. 

1 

(iSth  Pennsylvania. 

14,  '62. 

.Spec.  112. 

Kentucky. 

14,'  '64. 

870 

Ilealcy,  T.,  Pt.,  E,  157th 

July  1, 

Left.    Died  July  15,  1863. 

915 

Kerner,  C",  Pt.,  D,  26th 

Mar.  19, 

Right.     Died  April  21,  1865. 

New  York. 

1,  '63. 

Wisconsin,  age  17. 

19,  '65. 

87] 

Ilealy,  J.,   Pt..  E,  64th 

April  7, 

Left.     Died  June  8,  1865. 

916 

Kessler.   J  ,    Serg't,    A, 

Nov.  25, 

Left  ;  gang.;  sym.  of  ichoraemia.  i 

Now  York. 

8,  '65. 

44th  Illinois,  age  26 

27,  '63. 

Died  Dec.  31,  1863. 

i:'72 

Ilolston.  J.,  Pt.,  II,  49th 

Sept.  19, 

Left  ;  circ.     Died  Sept.  29,  1864  ; 

917 

Kidd.W.,  Serg't,  C,  14th 

June  16, 

Right  ;  anterior  post.  flap.     Died 

Pennsylvania. 

19,  '64. 

exhaustion  and  debility. 

N.  Y.  H.  A.,  age  33. 

17,  '64. 

July  7,  18G4. 

^-.., 

Ilcmpletnan,  N.,  Pt.,  G, 

Jul^Si, 

Left  ;  circ.    Surg.  R.  Morris,  103d 

918 

Kiddoo,  A.,  Pt.,  K,  102d 

July  20, 

Right.    Died  November  2G,  1&64. 

Midi  Ohio. 

22,  '64. 

111.     Died  Aug.  18,  1864. 

Illinois. 

20,  '64. 

1  O  MKAGIIER  ( W.),  Casualties  at  the  Battle  of  Freclericksburg,  in  American  Medical  Times,  1863,  Vol.  VI,  p.  179. 


•rill';    LOWER    EXTRKMITIKS. 


ICHAP.  x. 


NO. 

NAMK.  MII.ITAKY                             OI-KKATIONS,  OIMCHATOKS,       j  v 
DESCRIPTION,  AND  .\(.K.    '                               RKSULT. 

NAMK.  MILITARY 
DESCRIPTION.  AND  AUK.    u 

OPERATIONS,    OPERATORS, 
RESl'LT. 

919 

Kilboume,  K.  A.,  Pt  ,  H,     May  18. 

Right  :  ant.  post.  Hap.     Surg.  T. 

956 

Maxsei/.  J.    W.,  Pt.,   A.      July  3. 

Left  :  slough.  Aug.  5.  bone  rem'd. 

4.">th  Penn.,  age  19.            18,'  '64. 

S  Christ,  45th  Penn.   Died  June 

14th  X.  C  .  age  22.              3,  '63. 

Died  Sept.  2,  1863;  pyaemia. 

15.  1864;  exhaustion. 

957 

2  Mail,   IT.  /•'.,  Serg't,  C,    Sept.  19, 

Right.     Died  Oct.  16,  1863;  py 

920 

Kincaiil.    J.  it.,   ('apt.,      July  3, 

Left.     Died  Aug.  21,  1863. 

10th  South  Carolina.          19.  '63. 

aemia. 

G.  5-d  X.  Carolina.        :  —  ,  '63. 

958 

McCollum.    J.,    Pt.,    E.     May  14, 

—  .     Died  May  14.  1804. 

921 

Kirkpatrick.  J.,  Pt.,  G,    June  18, 

Left;    circ.    flap;    gang.      Died 

16th  Kentucky. 

14.  '64. 

4th  X.  Y.  II.  A.,  ago  21.  !    18,  '64. 

Sept.  20,  1864. 

959 

McCoiiaughy,  S.  B.,  Pt., 

May  19, 

Lett.     Surg.    J.   15.   Potter,    30th 

922 

Kline.   M.,  Pt..  H,  2;  3d  i  Jan.  15, 

Right;  circ.    A.  Snrg.  F.  B.  Kim-  ' 

C,  116th  Illinois. 

19,  '63. 

Ohio.     Died  May  20.  1863. 

Penn.,  age  20.                  |    15,  '65. 

ball,  3d  N.  H.     Died  Feb.   9, 

960 

McCullough,  J.  H.,  Ser 

May  14. 

Left.     Died  May  27,  1863. 

1865;  exhaustion.    Autopsy. 

geant,  K,  17th  Iowa. 

14.'  '63. 

923 

Knight,   T.,  Pt..    F,  7th     !>,•,•.  13. 

Right.     Died  December  15.  1862.     961 

McElrov.   S.,   Serg't.   I, 

Oct.  1, 

Left.      Died    October  25,    1864; 

Rhode  Island. 

13,  '62. 

7th  R.'  Island,  ago  33. 

1,  '64. 

pyaemia. 

924 

Knight.  W.,Pt.,  (1.  147th 

Aug.  18. 

Left.     Surg.  A.  S.  Coe.  147th  N. 

962 

3MeEvov,    J.,    Pt.,    II. 

Dec.  14, 

Right  :  ant.  post.  flap.     Surg.  T. 

New  York. 

18,  '64. 

Y.     Died  Aug.  21,  1864. 

99th  Penn. 

15,  '62. 

Hildreth.    3d   Me.     Died    Dec. 

925 

Krani,    T.,    Pt.,    D,  8th 

July  20, 

Left  ;  flap.   Surg.  AY.  B.  Fox,  8th 

29.  1862. 

Michigan,  age  20. 

21,  ''64. 

Mich.     Aug.  18,  reamp.     Died 

963 

McGowan,  W.,  Pt..  D, 

Feb.  6. 

Left.     March  27,  haemor.     Died 

Sept.  1,  '64:  pyaemia.    Autopsy. 

97th  N.  Y..  age  25. 

6,  '65. 

March  28.  1865. 

92i  ; 

Lackey,  M.,  Pt.,  K^Gth 

July  10, 

R't  :  circ.  July  21,  luem.:  lig.  fern. 

904 

McGill,  R.,  Pt.,  A,  12th 

May  27, 

Left.  Surg.  A.  C.Robertson,  159th 

Vermont,  age  18. 

10,'  '63. 

Died  Oct.  22,  1863;  exhaustion. 

Maine,  age  44. 

27.'  '63. 

X.  Y.     Died  June  6,  1863. 

Spec.  3880. 

965 

Mclllhaney,    R.,  Pt..   I, 

July  28, 

Right.     Died  July  29,  1864;  ex 

92? 

Lamb,  H.,   1't.,  H,  31st 

May  26, 

Left  ;  flap.     Surg.  A.  T.  Hudson, 

29th  Pennsylvania. 

28,'  '64. 

haustion. 

Iowa. 

26.'  '64. 

26th  Iowa.    Died  June  6,  1864. 

966 

Melligan.    D..      Pt.,    I, 

June  14, 

Left  ;  haemorrhage.     Died    Aug. 

928 

Lambert,  X  ,  Pt.,  II,  32d 

Feb.  6, 

Right.     Died  March  4,  1865:  py 

110th  New  York. 

14,  '63. 

18.  1863. 

Muss.,  age  34. 

6,  60. 

aemia.    Autopsy. 

967 

Meranvillc,  R.E.,Corp'l. 

Aug.  29, 

.     Sept.  5  and  6,  haem.;  7,  lig. 

929 

Lamphere,    ('  ,     Pt.,    G, 

Sept.  29, 

Left;  circ.     Surg.  T.  H.  Squire, 

F,  2d  New  York  Cav. 

30,  '62. 

femur  :    8,  haemorrhage.      Died 

8th  Conneotieiit. 

29,  '64. 

89th  N.  Y.    Died  Sept.  30,  1864.   ! 

Sept.  12,  ]«62. 

9:5!) 

Lani])inan,    A.,    Pt  ,    B, 

July  18, 

Right.     Died  July  26,  1864.           ;  968 

Miller,  F..   Pt.,  E.  66th 

Dec.  13, 

Right.     Surg.  C.  S.  Wood.  66th 

frtli  X.Y.II.Art,,agc24. 

—,"'64. 

New  York. 

15,  '62. 

N.  Y.     Died  Dec.  20.  1862. 

931 

Lanier,  J'..  Pt.,  C,  17th 

July  30, 

Right:  eire.;   sloughing.       Died   ,969 

Miller,  J.,  1't..  H.  134th 

June  27, 

—  .     Surg.  H.  B.  Whiton.  00th 

S.  Carolina,  age  33. 

—,''64. 

Aug.  17,  1864. 

New  York. 

27,  '64. 

New  York.     Died  June  28,  '64. 

932 

Larkin,   W.   H.,  Pt.,  li, 

Sept.  19, 

Right:  oval.    Surg.  .  I.  W.  Smith,     970 

Miller,    A..    Pt.,    K.    2d 

May  3, 

Left;   circ.     May   8.    sloughing; 

22d  New  York  Cav. 

19,  '64. 

2d  Ohio  Cav.    Died  Oct.  30,  '64  ; 

Virginia,  age  33. 

5.  '63. 

haem.  from  bowels.     Died  May 

pyaemia. 

9,  1863. 

933 

'Larry,   L.,   Pt  ,   A,  1st 

July  17, 

Left  :  double  flaps.     A.  A.  Surg.     971 

Milliner,  W.,  Pt.,  Goss's 

July  4. 

Right;  nee.  bone  remo'd.     Died 

New  Orleans,  age  23. 

17,"'64. 

F.  Hassenburg.     Erysip.  Sept. 

Arkansas  Reg't.age  30. 

5.  '63. 

Sept.  7,  1863.     Spec.  2088. 

21,  amp.  hip  joint.     Died  Sept.     972 

Mink.    M.,  Pt.,  E,  28th 

Oct.  19, 

Left;    flap;   sloughing:  bone  re 

30,  '64  :  pvnemia.ctc.  Spec.  3738. 

Iowa,  age  21  . 

19,  '64. 

moved  ;    haemorrh.     Died  Dec. 

934 

Lawyer,  F.  T.,  Pt.,   A, 

May  5, 

Left.    Died  May  10,  1864. 

7.  1864:  pyaemia. 

6th  Maryland. 

5,  '64. 

973 

*Minslett,  J.  C..  Pt..  —  , 

Sept.  19, 

.      Died  Sept.  30,  1863;  ex 

935 

Ledbetter,  J.  W..  Pt.,  H, 

May  12, 

Right;  circ.     Surg.  A.  H.  Hoff. 

39th  Alabama, 

19.  '63. 

haustion. 

131st  Illinois,  age  28. 

12,"'63. 

U.  S.V.     Died  May  27,    1863; 

974 

Mitchell.  F.  A.,  Corp'I, 

July  3. 

Risrht.     Surg.  H.  F.  Lyster.  5th 

exhaustion. 

I,  17th  Maine. 

4,  '63. 

Mich.    Died  July  29,  '63;  exh'n. 

930 

Leddy,   J.,  Pt.,   G,  4th 

Sept.  30, 

Left.    Died  Oct.  18,  '64;  pyaemia.  |  975 

Mitchell,  J..  Pt.,  L,  6th 

Oct.  19, 

Right;  lat.  skin  flap;   circ.  sect. 

Rhode  Island,  age  21. 

30,  '64. 

Autopsy. 

N.  York  Heavy  Art'y, 

21,  '64. 

muscles.    Surg.  C.  H.  Andrews. 

937 

Lesher,   J.  M.,    Pt.,    G, 

July  20, 

Left  ;  flap.    Surg.W.  Lomax,  12th 

age  25. 

176th  N.Y.    Died  Nov.  3,  1864  ; 

12th  Indiana. 

20.  '64. 

Ind.    Died  Oct.  2,  1864. 

pyaemia.     Autopsy 

938 

Leonard,  J.,  Serg't,  D, 

June  18, 

Right.    Died  Aug.  11,  '64;  exh'n. 

976 

Mohner,  J.,  Pt.,  F,  15th 

Dec.  16, 

Left;  circ.     Surg.  T.  L.  Magee, 

55th  Penn.,  age  27. 

18,  '64. 

Missouri,  age  24. 

16,  '64. 

51st  Ills.     Died  Dec.  23,  1804; 

939 

Lindsay,    W.,    Pt.,    A, 

June  18, 

Right.    Died  June  28,  18C4. 

irritative  fever. 

llth  New  Jersey. 

18,  '64. 

977 

Montgomery,  J..  Corp'!, 

Oct.  5, 

Right.  Ass't  Surg.  J.J.Whitney, 

940 

Lintz,  11.,  Pt.,  K,   10th 

April  2, 

Right.    Died  April  22,  '65  ;  typh. 

C,  93d  Illinois. 

5,  '64. 

18th  Wis.     Died  June  22,  180"5. 

N.  Y.  II.  Art'v,  age  20. 

2,  '65. 

fever. 

978  |  Moon.  J.  L..  Pt.,  E,  44th 

Oct.  3, 

Right.     Died  Oct.  6,  1864. 

941 

Littlffidd,  if.  C.,  Pt,,  15, 

May  I"), 

Right.     Ass't  Surg.  H.  K.  Good 

!     North  Carolina. 

3,  '64. 

43d  Georgia. 

15,'  '64. 

man,  U.  S.  V.   Died  May  21,  '64. 

919    -"'Moral],  J.,    Pt.,   I.    6th 

Jan.  1, 

Right.     Surg.  P.  C.  Pease.  Gth  X. 

942 

Loetze,   H.,  Pt.,  G,  9th 

l>ec.  14, 

Right  ;  circ.    Surg.G.  A.Otis,  27th 

New  York. 

3,  '62. 

York.     Died  Jan.  3,  '62;    never 

New  Jersey,  age  56. 

14,  '62. 

rallied. 

Died  Jan.  31,  '63;  haem.  Autop. 

980 

Morear,  J  ,  Pt.,  1st  Mas 

Oct.  19. 

Right.     Died  Oct.  21,  1864. 

943 

Long,    F  ,    Pt.,   E,  14th 

June  2, 

—  ;  flap;  sloughing.   Died  June 

sachusetts  Batter}-. 

19,  '64. 

N.  Y.  II.  A.,  age  20. 

4,  '64. 

14,  1864  ;  exhaustion. 

981 

Morgan,   J.    D.,   Serg't, 

Mar.  25, 

Right.     Died  March  26.  1803. 

944 

Long,   II.,  Pt.,  K,  148th 

July  —  , 

Left.      Died  July  21,  1863. 

F,  22d  Wisconsin. 

25.  '63. 

Pennsylvania. 

—,"'63. 

982 

Morse,    A.   A.,    Pt.,    D, 

Oct.  19, 

Left;  circ.     A.  Surg.   15.  A.  For- 

945 

Lord,  U.,  Pt..  1,  1st  Me. 

May  —  , 

Left.     Surg.  J.  W.  Lyman,  57th 

114th  N.  York,  age  25. 

20,  '04. 

dyce.  160th  N.  Y.     Died  Nov. 

Heavy  Artillery. 

—  ,"'64. 

Penn.  Died  May.  '64.  Spec.  3225. 

13,  1864:  exhaust  '«.     Autopsy. 

946     l.nvrll,  J.  D..  1't.,  I,  54th 

July  2',>. 

Left.    Surg.  A.C.  Messenger,  57th 

983 

Murphy,  P.,  Pt.,15,  lllth 

Oct.  28, 

L't;  circ.;  (alsofract.  cran.)   Died 

Ohio. 

23,'  '64. 

Ohio.     Died  An?.  3,  1864. 

Penn.,  age  22. 

30,  '63. 

April  30.  '04.     Ant.    Spec.  2139. 

947 

Low,  S.,  Corp'l,  F,  17th 

Aug.  25, 

Right;  circ.   A.  Surg.  J.  D.  Wil- 

984 

Mushiltz.    W.,    Pt.,    A, 

May  6, 

.    June  16.  nee.  bone  remo'd. 

Penn.  Cav.,  age  23. 

25,~:G4. 

lard,   1st   Md.  P.  H.  15.     Died 

llth  Penn. 

6,  '64. 

Died  June  24.  '64;  exhaustion. 

Oct.  9,  1864. 

Spec.  2720. 

948 

Lowery,  J.,  Pt.,  15,  10th 

Aug.  ii, 

R't  ;  circ.  Surg.  II.  N.  Small,  10th 

985 

Nash,  K.  J.,  Pt.,  G,  9th 

July—, 

Right;  haemorrhage.     Died  Aug. 

N.  Hampshire,  age  24. 

6,  r64. 

N.  II.     Died  Oct.  4,  '64;  pytrm. 

Virginia. 

—  ,'  '63. 

16,  1863. 

949 

Lowrey,   J.,   Lieut.,   C, 

May  14, 

—  .     Died  May  15.  1864. 

986 

New,  F.,  Pt.,  E,  7th  N. 

Dec.  13, 

.      Surg.  C.  S.   Wood,  With 

Kith  Kentucky. 

14,  '64. 

York. 

15,  '62. 

N.  Y.     Died  Dee.  23,  1802. 

950 

Ludwig.  E.,  Pt.,  F,  Gth 

Oct.  19, 

Right.     Died  Nov.  23,  1864. 

987 

Newton.  J.  II.,   Pt..  B, 

July  20. 

Right.     Died  Aug.  12,  1864. 

Maryland. 

19,  '64. 

70th  Indiana. 

20,'  '64. 

951 

Lynch,  J..   Pt.,  I,  89th 

July  9, 

Right;  lat.  skin  flaps;  circ.  sect. 

988 

Nicholas,  M.  15.,  Serg't, 

Oet   19, 

Left;  circ.     Died  Nov.  27,  1864; 

Penn.,  age  40. 

11,  ''64. 

mus.    A.  A.Sur"-.  J.  H.  Bartholf. 

I,  24th  Iowa. 

19.  '64. 

pyaemia. 

Died  Feb.  14,  '65:  soft,  of  brain. 

989 

Notestine,  W.  F..  Capt., 

Dec.  15, 

Left;  circ.  A..  V.  Surg.  ,1.11.  Green. 

Autopsy.     Spec,.  1369. 

E,  llth  Mo.,  age  22. 

15.  '64. 

Died  Feb.  12,  1865;  exhaustion. 

952    Mniiii.   I).,  Pt.,  D,  39th 

July  4, 

Left.    May  14.  1865.  reamputat'n. 

990    Nunemacher,   I..  Pt..  C. 

April  6, 

Left;  flap;  diarr.    Died  April  29, 

Ohio,  age  29. 

4,  '64. 

Died  May  SO,  1865;  pyicmia. 

8th  Penn.  Cav.,  age  40. 

6.  '65. 

1805;  pya'inia.     Autopsy. 

9:,::    Martin.    I-'..  Pt.,  H,   llth 

Nov.  10. 

Left.     Surg.  O.  J.  Evans,  40th  N. 

991    Oberly,   F.   A.,  Pt.,   D, 

July  24, 

Right.    Surg.  G.  S.  Palme'r.  U.  S. 

New  Jersey. 

10,  '64. 

Y.    Died  Dec.  3/64.  Spec.  4117. 

10th  N.  York,  age  23. 

24,"'G4. 

V.  Died  July  31,  '64;  exhaust'n. 

9.VJ    Martin,    M.   C..   Pt.,  G, 

Sept.  19, 

Left  :  circ.  Surgs.  Duval  and  Wil 

992    O'Brien.  T.,  Pt.,  G,  69th 

Sept.  17, 

.     Sept.  26,  bone  protruding 

RW  North  Carolina. 

19,  '64. 

kinson.  C.  S.  A.     Died  Sept.  26. 

New  York. 

17,  '62. 

remo'd  ;  tetan.    Died  Oct.  3.  '62. 

1864  ;  pass,  haemorrhage. 

993  ;  O'Connell,  \V.,   Pt.,  D, 

Mar.  10, 

Left;  circ,     Died  Mar.  17,  1805; 

955    Marshall,     K.,     Ft..    G, 

May  28, 

Right  ;  ant.  post.  flap.     Surg.  A. 

25th  Mass.,  ago  19. 

11,  '65. 

exhaustion. 

147th  N.  Y.,  age  23. 

28,  '64. 

S.  Coe,  147th  N.  Y.     Died  June 

994 

O'Donnell,  C.,  Pt.,  A,  2d 

May  19. 

Left;  circ.     Died  June  28,  1864  ; 

18,  18G4  ,  pytemia. 

N.  York  Art'y,  age  19. 

19,'  '64. 

pyaemia. 

1  Circular  No.  6,  S.  G.  O.,  1865,  p.  50,  CASE  10.     Circular  No.  7,  S.  G.  O.,  1867,  pp.  48,  65. 

2  TEIJUY  (C.),  Report  of  Wounded  treated  in  Field  Hospital  of  Hindman's  Divis.,  Army  of  Tennessee.,  after  the  battle  of  Chickamauga,  in  Con  fed. 
States  .Weil,  and  Surg.  Jour.,  1864.  Yol.  I,  p.  70. 

3O'MEA<;HER  (W.),  Casualties  at  the  Battle  of  Fredericksburg,  in  Am.  Med.  Times,  1863,  Vol.  VI,  p.  179. 

•"TKltnv  (C.).  Confederate  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  76. 

5 LYNCH  (E.).  Santa  Rosa  Isle,  Health,  of  the  Gth  JV.  Y.  Vols.,  in  American  Medical  Times,  Vol.  IV  p.  196. 


SECT.  III. 


PRIMARY    AMPUTATION    OF    THIGH    IN    MIDDLE    THIRD. 


No. 

NAME,  MIMTAKY 

DE.srim'TIO.N,  ANH  A(!K. 

DATES. 

(  H'KKATIOXR,   OrEKATOKti, 

RESULT. 

NO 

NAMK,  MIUTAKY 
DKS<  inmox.  AXI>  AGE. 

OrKllATlOXS,   Ol'KKATOIih. 

KKsri.T. 

935 

'O'Harn,  J.,  Pt..C.  12th 

Dec.  14, 

Lett  ;   ant.   post.   flap.     Surg.  J. 

1034   Robiiiett,  J.  A..  Pt.,  (',. 

Julv  2, 

Left.     Died  Julv  22.  1803. 

1'fiiii.  lies.   ii(i"o  40. 

15,  '02. 

Howe    1st  X.  Y.     Jan.  1    3  '63 

5!!th  Xorth  Cnrolinji. 

3,  '03. 

lisem.     Died  Jan.  4,  "63:  exh'n. 

1035   Rogers,   L.  A.,  ('apt.,  D, 

June  2,  :  Left.     Died  Julv  10.  1804. 

996 

Pnlmerton,  J.  P.,  I't..  E, 

June  18, 

Right.    Surg.  O.W.  Metealf.  76th 

9Mh  Xew  York,  age  36. 

2,  '64.     \ 

7(ith  Now  Yi.rk. 

18.  '64. 

N.  Y.     Died  June.  1864. 

1036 

Kogers.XV.  JL.Corp  l.A. 

Julv  22,  '  Left;  circ.     Act.  Staff  Surg.  C. 

Mav  10 

Right  ;  circ.    Died  May  J9,  1864  ; 

110th  Illinois,  age  35. 

22,  '64.         B.    Richards.    1".    S.   A.     Died 

24th  M  ifli.,  aire  '-'3. 

10,  '(54. 

exhaustion. 

>     Sept.  20,  1804. 

il'JS   l'<trl;tr,    J.  L.,   1't.,   G, 

Oct.  19, 

Left.     Died  Xovember  8,  1864. 

1037 

Rowe,  J.  B.,  Corp'l,  I, 

May  10.     Right.     Surg.  J.  S.  Rose,  llth  N. 

12th  Georgia. 

20,  '64. 

llth  New  Hampshire. 

10,  '04.  ,    H.  Died  May  19,  1864;  wounds. 

ll'.i'.i    Parker,  S.  K.,  Serg't,  G, 

Mar.  30, 

Left.     Died  March  31,  186").             1038  ,  Royxtcr,   T  ,  Pt.,  Prices 

Oct.  22,    :  haemorrhage.  Died  Oct.  L'7, 

147th  New  York. 

30,  '65. 

Artillery. 

22,  '63. 

1803. 

10(10    /',//•.«,»>•,   .Y.  It..  Corp'!, 

Oct.  3, 

Left.     Died  October  24.  1864. 

1039  Rannells.  A.  ./.,  Pt.,  D, 

Aug.  19,     Uiglit  ;  circ.    Surg.  W.  V.  White. 

I,  44th  N.  Carolina. 

3,  "64. 

27th  Georgia. 

19,  '04.         57th  Mass.     Died  Aug.  22,  1864. 

KX)1    Fcarsall,  K.   11.,  Pt.,  E, 

June  5, 

Left  :  circ.     Surg.  J.  \V.  Wishart, 

1040  Russell,  A.R.,  Serg't,  E, 

Oct.  17,1   Right:   oval.      Asst.   Surir.   K.  P.. 

2d  N.  Y.  H.  A.,  ago  17. 

5.  '04. 

140th  Penn.    Died  June  30,  '64  ; 

2d  Massachusetts. 

19,  '04. 

Nims,  1st  Vt.  Cav.   Died  Oct.  19, 

pyaemia. 

1804:  tetanus. 

1002 

Peiffer.M.,  Corp'l.  V,  83d 

Mav  8. 

Left  ;  flap.     Died  Oct.  28.  1864. 

1041    Sanders.    L.   C.,    Pt.,   K. 

June  10, 

Left  ;  cire.    Surg.  J.  W.  Wishart, 

Penn.,  age,  37. 

8,  '64. 

2d  X.  Y.  II.  A.,  age  21. 

17,  '04. 

140th  Penn.     Died  July  10,  '64. 

1003 

l'en<Jrrffrant,N.  t'.,  Sgt., 

July  20, 

Left.     Died  August  5,  1804. 

1042   Savers,.!.  \V..  Corp'l,  C, 

April  29, 

Left.    Died  May  5,  1865;  exhaus 

E,  55th  Alabama. 

20,'  '64. 

8th  X.  Y.  Cav.,  age  24. 

30.  '65. 

tion. 

1004 

Perigo,  li.  T  ,  Corp'1,  A, 

Mav  3,      .     Ass't    Sur<r.    11.    Howard, 

1043  Scurry,  J.,    Pt.,    I!.    1st 

Aug.  14, 

Right.     Died  August  21,  1804. 

140th  New  York. 

3,  '63. 

U.  S.  A.     Died  May  3,  1863. 

Minn.,  age  35. 

14,  '64. 

1005 

Perry,  J.  K..  Pt.,A,44th 

Oct.  14, 

—  ;  flap.     Died  Oct.  28,  1863. 

1044   Seudder.    L,    C.,  Pt.,   I, 

June  22, 

Right.      Died  July  15,  1864. 

North  Carolina,  age  31. 

15,  '63. 

33d  Indiana. 

22,  '64. 

100(5 

Pierce,  T.  G.,jr.,  Pt  ,  D, 

July  31, 

Right;   cire.:    gang.     Died  Nov. 

1045,  Scarlet,  G.,  Pt.,  1),  llth 

Aug.  24, 

Left  ;  eirc.    Died  August  25,  '64  ; 

Kith  Iowa,  age  24. 

31,  ''04. 

6,  1864;  exhaustion. 

Colored  Troops.                 25,  '64. 

haemorrhage. 

100? 

I'M*,  C.  C.,  Pt.,  K,  1st 

April  9. 

Right.  Surg.  W.  1).  Murray.  101st 

1040   Scott.  A..  Corp'l,  I.  121st  |  June  27, 

Right.     Died  June  28,  1864. 

Alabama. 

9,  '65. 

N.  Y.     Died  April  9,  1805. 

Ohio. 

27,  :64. 

1008  Plankington,  J..  Pt.,  K. 

June  18, 

Left:  flap.     Aug.  6.  luem.    Died 

1047    Seaburn.  A..  I't.  .G.  97th 

July  30, 

Left  ;  ant.  post.  flap.    Surg.  D.W. 

2d  Penn.  Art'y,  age24. 

18,  '64. 

Aug.  6.  1804  :  exhaustion. 

Pennsylvania. 

30,'  '64. 

Maull,  1st  Del.:  aneur.:  lig.  ex. 

KNi'.i    Pollard.   A.,   Pt.,  ('.  4lh 

June  15, 

Right:  (also  w'ndlcft  knee  joint  ;) 

iliac.   Died  Oct.  9,  '64.    Sp.  3282. 

Colored  Troops.age  19. 

—  ,  '64. 

ant.  pest.  flap.     Died  Julv  21, 

1048'  Sergeant.  \V.  II..  Pt..  G. 

June  17, 

Right  :  flap.     Surg.  S.  S.  French. 

IS'M:  exhaustion. 

24th  Xew  York,  age  28. 

18.  '64. 

20th  Mich.     Died  June  26,  1864. 

1010   Ponle.  C.  '!'..  1't.,  G.  'tli     Dec.  Hi.     Left  ;  ant.  post.  flap.     A.  A.  Surg. 

1049 

Shortsleeve.  G..  Pt..  E, 

May  12, 

Left.   A.  Surg.M.Uizer.  72(1  Penn. 

Illinois  Cav.,  age  35.          17.  '64.        T.    Morrison:    py;eiuia.      Died 

15th  Mass..  age  20. 

12,  '64. 

Died  June  5,  '64  :  pyaemia. 

Dec.  30.  1864. 

10501  Sheppard.  G.,  Pt.,  C',  1st 

Sept.  —  , 

Right;  hsem.    Oct.  20,  reamputa- 

1011    Poole,  J.C.,  l't.,C,  145th  !  May  !•?, 

Left.     Surg.   P.  E.  Hubon.  28th 

Illinois  Cavalry. 

—  ,  '61. 

tion.     Died  Oct.  20,  1861. 

Pennsylvania.                    12,  '(>4. 

Mass.     Died  .Mav  2.1.  1864.             1051   'Shilling,    H.    IK..  Pt., 

Sept.  19, 

—  .     Died  September  28,  1863; 

1012 

Potter.  F.  W.,  Corp'l.  C', 

Mav  13,    .     Surg.  L.  W.  P.liss,  51st  N.  !              A,  19th  Alabama. 

19,  '03. 

exhaustion.    . 

7th  Khode  Island.               13,  -'i4. 

Y.     Died  .May  18.  1864. 

1052  Silliman,  W.,  Col.,  20th 

Dec.  9, 

Right.     Died  December  17,  1864. 

1013 

Prentiss,  W.  S..  Pt.,  A. 

April  2. 

Right;  pyaemia.     Died  June  23, 

Colored  Troops. 

9,  '04. 

2d  Maryland,  age  2(i. 

2.  '65. 

1865. 

1053  Skillman,    F.,     Pt.,    E, 

Sept,  19, 

Right;  eirc.  Surnr.  L.  P.  Wagner, 

1014 

Preston    A.  A.,   1't..  C, 

June  2. 

Right.     Died  June  7,  18G4. 

114th  New  York. 

19.  '04. 

H4thN.Y.  DiedOct.7,'64;  pyse. 

2d  X.  Y.  Mt'd  Killes. 

2.  '64. 

1054   Skinner,  J.,  Pt..  F,  140th 

Mav  12, 

Right  :  ant.  post.  flap.    Died  May 

1015 

Proctor.    K.,    Serg't.  11,     Oct.  19,     Right  ;  cire.  A.  Surg.  J.  Ilomans, 

Xew  York,  age  34. 

12,"  "64. 

31,  1864;  pyaemia.     Autopsy. 

9(>th  N.  Y.,  age  :i5.             20,  '64. 

li.  S.  A.    Died  Nov.  8.'04  :  ha?m. 

1055  ^Skipper,  A.  li.,  Pt..  A, 

Sept.  19, 

:  haemorrhage.     Died   Nov. 

ion; 

Quarlrs.   T.   !>.,   I't.,  H,     June  19, 

Right:  Hap:  (uls:>  fracture  left.) 

ICth  South  Carolina. 

19,  '03. 

2,  1863. 

53d  Virginia,  age  32.          19,  '64. 

Died  August  L',  1864. 

1056  Slater,    B..  Pt.,   B.  72d 

July  23, 

Right.    A.  Surg.  J.  T.  Calhoun. 

1017 

Quinn,  J.,  Pt.,  11.  7th  X.    June  18. 

Right.     Surg.  G.  L.  Potter.  145th 

Xew  York,  age  22. 

23,"  '03. 

II.  S.  A.      Died  Julv  3),   18.14. 

York  Art'y.  age  25. 

19,  "64. 

Penn.    Died  Dec.  18,  '04  :  cxh'n. 

Spec.  1513. 

1018  '•'Kami,   W.".l.."  1't..    K. 

Dec.  14. 

Right;    (also  amputa.  left  arm  at  j  1057  Smiley.  J..  Pt.,  B,  10th 

May  10, 

Left.  Surg.  H.  Rohrer.  10th  Penn. 

45th  Mas*.   a(re  25. 

14,  '62. 

shoul.  ioint.l      Snnr.   1.    F.   Gal-                   Penn.  Reserves. 

10,"  '04. 

Res.     Died  Mav  11.  1864. 

loupe,  17th  Mass.    Died  Jan.  24.     1058   Smith,   D..   Pt.,  G,   6th 

May  12, 

Left.     Surg.  W.'B.  Lyons,  llth 

1863:  pviemia.                                               Penn.  Reserves. 

12,'  '64. 

Penn.  Res.    Died  May  12.  1804 

101  it  Randolph.   \V..    1't..    C. 

April  6. 

—  ;  slough.:  exposed  end  bone    1059!  Smith,  F.  W.,  Pt.,  C,  2d 

May  25. 

;  circ.:  severe  diarrh.     Died 

25th  lii'liaiia. 

6,  '62. 

removed.      Died  April  9,  1862.                 S.  C.  Rifles,  age  16. 

25,''64. 

June  20,  18<»4. 

ID-JO   Ranger.    K.   .]..    I't..    11. 

Feb.  7, 

Left:    circ.  flap.     Died  Feb.  24,    1060  Smith,    H.   M.,    1't.,   G, 

April  6, 

Right;  lat.  (lap  :  femur  prot.  one 

24th  Mich.,  age  2(i. 

7,   '65. 

1865;  pyamiia. 

82d  Penn.,  age  28. 

6,  '65. 

inch.     Died  May  7.  '65:  pyaetn. 

1021!  Kavuio.i(l.\V.  1)..  l't..l).     Mav  1-,'. 

Right;    eirc.;    sloughing.      Died 

1061 

Smith,  J.  J.,  Pt.,  F,  llth 

Oct.  19. 

Left;  circ.:  hieiu  :  lig.  perforating 

5:'id  X.  V.,  ago  28.               12,'  '04. 

June  21,  1864;  pya'inia. 

West  Virginia,  age  20. 

20,  '64. 

artery.   Died  Nov.  9.  '04;  pyaem 

1022   Redman.    U.,  Corp'l,  I.     May  14. 

—  .      Surg.   D.   L.   Heath.   23d    1062 

•Snowbridge,  A.,  Pt.,  G, 

Dec.  14, 

Right-'  flap.    Surg.  J.W.  Lvman. 

2'kl  Michigan,                  i    14.'  '(i4. 

Mich.    Died  July  18,  18:i4. 

99th  Pennsylvania. 

15,  '62. 

U.  S.  V.     Died  Jan.  0,'G3  ;  effect 

1(,V'3  Reed.  \V.  H..  I't.,  11.  8th     (tct.  I'.l. 

Kight  :  oval  flaps.'  Oct.  24,  hasm.: 

of  amputation. 

Vermont,  age  31.                 21,  'ii4. 

lig.  fern.;  29th.  hami.   Died  Nov. 

1063 

Solomon.  H.,  Pt.,  B,  12th 

May  14, 

Right.     Surg.  G.  L.  Carhart.  31st 

21.  '04  :  peritonitis  and  pyaemia.  || 

Missouri. 

14,  '64. 

Iowa.     Died  Mav  17.  1864. 

1024   R:'iii«trr.    Ji.  .I/..  I't..  1».      June  1, 

Right:  circ.     Died  June  15,  1864.  ,1064   Spear,  J..  Serg't.  E,  6th 

June  1, 

Left;  circ.     Died  July  17,  1864. 

51st  N'.  ('..  aire  U-.                1.  ''14. 

Maryland,  age  32. 

2,  '64. 

10.15  .R>-yii<,l,h.    »'..   1't.,   42d  '   .July]. 

.    Died  July  19.  1803.               j  1065  Spear.    J.    W.,    Pt.,    D, 

May  14, 

Left;  diarrhoea.    Died  July  6,  '64. 

Mississippi.                          :i.  '(i3. 

27th  Mass..  age  39. 

14,'  '04. 

1020   Rich.   T.    H..  I't.,  I..  8th     Nov.   Id, 

Right.     Surg.    A.   Churchill,  8th    1066   Sproul,  J..Serg't,C,  40th 

Nov.  7, 

Left  :  double  ant.  post.  flap.  Surar. 

N    Y    11     \     a"-e  27.          10  '64. 

N.  Y.  H.  A.     Died  Dec.  20,  '64; 

New  York,  age  24. 

7,  '63. 

A.  Campbell,  40th  N.  Y.     Died 

pytemin. 

Dec.  7,  1863:  pyatmia.  Autopsy. 

1(1-7    Richard.son.A.C..  I't.  .15.     Dee.    13, 

—  ;  flap.     Died  Jan.  29,  1863;   '1067  Sprowl.    J.   K..   I't.,    B, 

Sept.  19, 

Left.     Died  Sept.  23,  1863. 

1211th  Penn.,  age  30.            13,  '62. 

haemorrhage. 

58th  Indiana. 

20.  '63. 

1028  Ricketts,  I...  I't..  A.  123d    June  2'..     Right  :  ciiv."   Stiffr.  C.  \V.  Me  Mil- 

1068 

Steele.  J.,  I't.,  I.   100th 

Dec.  15, 

Left;    flap.     A.   A.  Surg.   J.  S. 

Indiana,  a-,'!-  2.J.                  27.  '(14.        Ian,  1st  E.  Tenn."  Died  Aug.  29, 

Col'd  Troops,  age  22. 

10,  '04. 

Giltner.     Died  Jan.  14.  1865. 

1864  ;  pytemia. 

1009 

Stines,    H.,    Corp'l.    D, 

June  17. 

Left  :  ant.  post.  flap.     Died  July 

102!)   liilev.  1!..  ('oh  1.  Vr.tli  ,    Mav  2. 

Right.     Died   May  3.   1863;   ex 

97th  New  York,  age  28. 

18,  '04. 

18.  1804:  exhaustion.   Autopsy. 

(  >hio. 

3.  '63. 

haustion. 

1070 

Stokes,    S..    Pt.,   F.    1st 

Mav  21, 

Right;  erysipelas.     Died.  June  1. 

103:)   liilev.   .I..  Drummer.  C,      Julv  3. 

Left;  flap.     Died  July  29,  1863; 

Mo.  S.  M.  Cavalry. 

22,'  '64. 

1804;  tetanus. 

Hj'th  N.  Y..  age  17.           5,  '63. 

diarrhoea  and  typhoid  fever. 

1071 

Stonecyphe.  S.,  Pt.,  G.     Deo.  13, 

Right.     Surg.  C.  S.  Wood.  (iOth 

1031    Risley.   S..   1't..  H.  4-!th  !    Mayo, 

Right.      Died  June  1,  1804;  ex 

131st  Pennsylvania.            15,  '02. 

N.  Y.     Died  Jan.  2.  1863. 

Now  York,  ago  27.             5.  '04. 

haustion.                                              1072  Stnwers,    .V.  "C.,  Lieut..     Aug.  20, 

Right.     Surg.  A.  A.  White,  8th 

1032  3  Roach.  S..  I't..  C.  99th     Dee.  14,      Right  :  ant.  post.  flap.     Surg.  A. 

K,  6th  Georgia. 

20,  '64. 

Mil.     Died  Sept.  17.  1804. 

Pennsylvania.                    15,  '02.        J.  Ilerr.  (i8th  Penn.     Died  Jan. 

1073  Strong,  \V.  U..  Pt..  121st      Mav  s. 

Left;  flap.     Surg.  J.  A.  Ramsey. 

13.  1803;  pya-mia.                                         Penn.,  age  20.                      10,  '64.        121st  Penn.     Died  May  24.  '64  : 

1033   Robinson,  J.,  Serg't,  II.     Mav  —  . 

Right;  flap:  (also  exe.  forearm  )                                                                                   exhaustion. 

48th  Illinois                              '  '64 

^urc    \  Co"lin    lwth  111      l^icd    1071    Stncf'ff    tf    C                      June  1  "J  '  Ri~ht      Died  Fulv  1't   lfi'J4 

June  1,  1864.                                                   ago  l'8.                                   15.  '(i4. 

1  O'MK.Vi.HKi:  (\V.).  lac.  <:..:t..  in  American  Medical  Times,  Vol.  VI.  p.  179. 

"GAl.l.orrE  (1.  !•'.),  Army  .Medii-al  InteUi-jriirr,  in  2iost.  Med.  and  Surg.  Jou,:,  1803.  Vol.  08.  p.  205. 

:'<)'MKA<.III-:K  (\V.),  Casualties  at  the  Rattle  of  Frfdrrii-ktbnnj.  in  Am.  Med.  Times,  18ti3,  Vol.  VI,  p.  179. 

JTi:;;i:v  (('.).  l<»-.rit.,  p.  7C..                                                       "TICKKY  ((.'.).  lot-,  cit..  p.  7(i. 

'•O'MEAUllKK  (W.),  Casualties  at  the  Battle  of  Frulericksbunj.  in  American  Medical  Times,  1863,  Vol.  VI,  p.  179.        » 

240 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITAUY 
DESCRIPTION',  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITAUY         riATwa 
DESCRIPTION,  AND  AGE. 

OPERATIONS,  OPERATORS, 
RESULT. 

1075 

Stulls,  H.,   Pt.,  A,  6th 

Feb.  6, 

Left;  circ.  flap.     Died  Feb.  19, 

1117 

Washington.  G.,  Pt.,  A,     April  1, 

.     Surg.  II.  Osborne,  51st  C. 

Wisconsin,  age  22. 

6,  '65. 

1865  ;  pyaemia. 

48th  Colored  Troops. 

1,  '65. 

Troops.     Died  April  3,  1865. 

1076 

Sullivan,  P.,  Pt.,  F,  42d 

Sept.  17, 

Right.     Died  Sept,  29,  1862. 

1118 

Waters,  J.,  Pt,,  B,  26th 

May  12, 

Right  ;  circ.  Surg.  J.W.Wishart, 

New  York. 

17,  '62. 

Michigan,  age  44. 

12,  '64. 

140th  Penn.     Died  June  26,  '64. 

1077 

Summers,  H.,  Serg't,  M, 

Sept,  19, 

;  circ.  Surg.  Sutton.  C.  S.  A. 

1119 

Webb,  J.,  Pt..  G..  llth 

Mar.  31, 

Right.     Surg.  C.  M.  Clarke.  39th 

21st  N.  C.,  age  30. 

19,  '64. 

Died  Nov.  4,  1864  :  pviemia. 

West  Virginia. 

31,  '65. 

Illinois.     Died  April  10,  1865. 

1078 

Swarman,  J.,Pt.,G,  13th 

Sept.  19, 

Right.     Died  Sept.  27,  1864. 

1J20 

Webb,  J.  D.,  Corp'l,  D, 

Oct.  19, 

Left;  ant.  post,  flap.     Surg.  H. 

Connecticut. 

19,  '64. 

5th  Alabama,  age  26. 

20,  '64. 

McGuire,  C.  S.  A.     Necrosed. 

1079 

Tarbell,  C.  F.,Corp'l,  D, 

May  27, 

Left.     Died  May  27,  1863  ;  effect 

Died  Feb.  26,  1865.    Autopsy. 

21st  Maine,  age  19. 

27,  '63. 

of  chloroform. 

1121 

Weddle.    S.,   Serg't,  L, 

July  4, 

Right  ;  double  flap.     Surg.  W.  R. 

1080 

Tate,  H.  A.,  Pt.,  D,  llth 

July  3, 

Right.     Died  August  25,  1863. 

1st  Md.  P.  H.  B.  Cav., 

6,  '64. 

Wray,   1st  Md.  P.  H.   I!.  Cav. 

N.  Carolina,  age  31  . 

3,  '63. 

age  35. 

Died  July  6,  1864. 

1081 

Taylor,  J.,  Serg't,  K,  2d 

Oct.  21, 

Right;  oval  flap.  Anaemic.    Died 

1122 

Wcdman,  L.  Pt.,  A,  7th 

June  16, 

.     Surg.    A.  M.  Dougherty. 

Colorado  Cav.,  age  33. 

21,  '64. 

December    1,    1864;    irritative 

New  York  Artillery. 

16,  '64. 

U.  S.  V.     Died  June  23.  1864. 

fever. 

1123 

Weeks,  A.  M.,   Pt.,  E, 

June  2, 

Right.     Died  July  9,  1864. 

1080 

Terrell,  L.  B.,  Pt.,  A, 

May  14, 

Left.     Died  June  25,  1864. 

3d  N.  Hamp.,  age  21. 

2,  '64. 

2M  Michigan. 

14,  '64. 

1124 

Weeks,  W.  II.,  Pt.,  E, 

Aug.  15, 

Left.     Died  Sept.  10,  1864;   ex 

1083 

Terry,  J.  It.,  Pt.,  K,  47th 

Aug.  20, 

;  flap;  gang.     Died  August 

10th  Conn.,  age  36. 

15,  '64. 

haustion. 

Virginia,  age  42. 

20,  '64. 

27,  18G4. 

1125 

Wcndt.  C.,  Pt.,  E,  153d 

Oct.  19, 

Right;  oval;  sloughing;   h:em.; 

1084 

Thomas,  F.  G.,  Pt.,  D, 

Oct.  19, 

.    Died  October  22,  1864. 

New  York. 

20,  '64. 

fem.  secured.   Died  Nov.  5,  '64. 

8th  Vermont,  age  20. 

19,  '64. 

1126 

West,  S.  P.,  Corp'l,  K, 

Mav  12, 

Right.     Surg.  J.'  S.   Ross,   llth 

1085 

Thomasxen,  J.  H.,  Pt.,D, 

May  16, 

Left  ;  circ.     Died  June  21,  1864  ; 

llth  N.  Hampshire. 

12,  '64. 

N.  H.     Died  May  19,  1864. 

24th  Virginia,  age  24. 

16,  '64. 

pneumonia. 

1127 

Wheelock,  O.  R.,  Serg't, 

Aug.  30, 

Left.     Died  Sept.  9,  1862. 

1086 

Thompson,  A.,   Pt.,  D, 

Oct.  19, 

Right.    Died  Oct.  21,  1864;  ex 

K,  8th  Michigan. 

30,  '62. 

81  h  Vermont,  age  22. 

21,  '64. 

haustion. 

1128 

White,   C.   S.,    Pt.,   G, 

Dec.  13, 

Left  ;  bone  protruded.    Died  Jan. 

1087 

Thompson,  W.,  Pt.,  A, 

Sept.  30, 

Left.     A.  Surg.  J.  E.  Beattv,  2d 

142d  Penn.,  age  25. 

13,  '62. 

19,  1863.     Autopsy.     Spec.  986. 

3d  Maryland. 

30,  '64. 

Maryland.     Died  Sept.  30,  '64. 

1129 

'  White,   J.    W..   —  ,    F, 

May  18, 

:  circ.     June  12,  one  and  a 

1088 

Thompson,    W.  H.,  Pt., 

Nov.  30, 

Right  ;    anterior    posterior    flap  ; 

39th  Georgia,  age  40. 

18,  '64. 

half  ins.  sawn  off.     Died  June 

K,  15th  Tenn.,  age  29. 

De.  1,  '64. 

gangrene.     Died  Dec.  26,  1864  ; 

29.  1864  ;  irritative  fever. 

exhaustion. 

1130 

Whipple,  E.,  Pt,,  B.  2d 

Mar.  27, 

Left  ;  gang.     Died  April  5,  1865; 

1089 

Thurston,  I.,  Corp'l,  H, 

Dec.  29, 

Right,    Died  January  22,  1863. 

Rhode  Island,  age  32. 

27,  '65. 

pyaemia. 

54th  Indiana. 

29,  '62. 

1131 

2  Wick,   F.,   Pt.,  D,   1st 

Dec.  13, 

Right  ;  circular  flap  :    gangrene. 

1090 

Titus,  L.  G.,  .Serg't,  E, 

Dec.  13, 

Left.    Died  January  7,  1863  ;  py 

N.  Y.  Art.,  age  32. 

13,  '62. 

Died  March  21,  1863;  gangrene. 

51st  Pennsylvania. 

13,  '62. 

aemia. 

Spec.  1000. 

1091 

Todd,  R.  L.,  Pt,,   llth 

July  3, 

Right.    Died  July  10,  1863. 

1132 

Wildhack,  C.  W.,  Pt.,H, 

June  14, 

Left;  circ.    Nov.  11,  bone  rem'd; 

North  Carolina. 

3,  '63. 

1st  La.,  age  27. 

15,  '63. 

abscesses.     Died  Jan.  31,  1864  ; 

1092 

TrauUvine,   J.,   Pt.,   A, 

Aug.  19, 

Right.    Died  September21,  1864. 

exhaustion. 

ir>thN.Y.H.A.,age37. 

20,  '64. 

Il33 

Wilkinson,  A.  J.,  Pt.,  G, 

June  17, 

Left.   Surg.  J.  Ebersole,  19th  Ind. 

1093 

Tressler,  S..  Artificer,  K, 

Aug.  18, 

Right.     Died  September  4,  1864  ; 

7th  Wisconsin,  age  20. 

17,  '64. 

Died  July  7,  1864. 

2d  Penn.  H.  A.,  age  28. 

18,  '64. 

pyaemia. 

1134 

Willman,  II..  Serg't,  F, 

July  1, 

Left.     Died  July  10,  1863. 

1094 

Trester,  W.  B.,  Pt.,  K, 

May  18, 

Right  ;    flap  ;    sloughing.      Died 

154th  New  York. 

2,  '63. 

5','d  Indiana,  age  31. 

18,  '64. 

September  23,  180'4. 

1135 

Wilson,  J.,  Lieut,  Col., 

May  5, 

Right.  Surg.J.Ebersole,19th  Ind. 

1)'.I5   Tnif.    W.     S.,    Ft.,    D, 

Oct.  19, 

Right.     Died  October  22,  1864  ; 

43d  New  York. 

5,  '64. 

Died  May  6,  1864.    Spec.  2315. 

:J!>th  Maine. 

19,  '64. 

shock. 

1136 

Wilson,  C.,  Pt.,  K,  llth 

Mar.  31, 

Left  ;  bilateral  flaps.     Died  May 

1096  Tuft,  .1.   1).,  Serg't,  E, 

June  19, 

Right.     Died  July  22,  1864. 

Mass..  age  25. 

Ap.  1,'Co. 

17,  1865  ;  exhaustion. 

."Ih  Slur  viand,  age  26. 

19,  '64. 

1137 

Winship,  N.  W.,  Pt.,  K, 

July  2, 

.     Died  July  —  ,  1863. 

105.7   Tr.rncr.  S..  1't.,  B,  106th 

Sept.  19, 

Left  ;  circ.     Died  Oct.  15,  1864  ; 

86th  New  York. 

2,  '63. 

New  York,  age  40. 

19,  '64. 

peritonitis. 

1138 

Wipfelder,    F.,    Pt.,    C, 

June  1, 

Right.  June  9,  haemorrh'ge;  liga- 

1098 

Turhill,  D.  I..,  Serg't,  T. 

May  30, 

Left;  circ.     Surg.  G.  L.  Potter, 

52d  New  York. 

2,  '62. 

tion  femoral  artery.    Died  June 

7th  N.Y.  H.  A.,  age  38. 

31,  '64. 

14oth   Penn.;    pyaemia.      Died 

17,  1862. 

July  9,  1864. 

1139 

Wolf.   D.,  Pt.,    A,   23d 

June  18, 

Right.    Died  June  28,  1863. 

1099 

Ulum,   J.,  Pt.,  H,    102d 

July  20, 

Right.     Hsem.  from  femoral  art. 

Indiana. 

18,  '63. 

New  York. 

20,  '64. 

arrested  before  death,  but  never 

1140 

Wood,  L.,  Pt.,  B,  65th 

June  15, 

Right.    Surg.  J.  F.  Kimbly,  lltb 

reacted.     Died  July  21,  1864. 

Illinois. 

15,  '64. 

Kentucky.     Died  July  30,  1864. 

1100 

Van  Anken,  J.L.,  Corp'l, 

May  12, 

.     Died  May  12,  1864. 

1141 

Woodward,  J.,   Pt.,  C. 

Dec.  16, 

Left;  ant,  post.  flap.     Died  Jan. 

K,  56th  Penn. 

18,  '64. 

09th  Illinois,  age  40. 

16,  '64. 

9,  1865:  irritative  fever. 

1101 

Vanausdale,  W.  B..  Cor 

Jan.  13, 

Left;  flap.     Surg.  G.  C.  Jarvis, 

1142 

Woodward,  W.,  Pt.,  C, 

Nov.  30, 

Right;  circ.     Died  Dec.  27,  1863  ; 

poral,  C,   203d  Penn., 

13,  '65. 

7th  Conn.     Died  Feb.  10,  1865  ; 

67th  New  York,  age  31. 

De.l,  '63. 

pya?mia.     Autopsy. 

age  24. 

pyaemia  and  exhaustion. 

1  1  Ar- 

i 

1102 

Vanderburgh.  II.  .Corp'l, 

July  20, 

Right;  middle  third.     Died  July 

1  I4». 

1144 

>Woodworth,  J.  W..  Cor- 

Nov.  7, 

Both.     Died  November  8,  1863. 

B,  129th  Illinois. 

20/64. 

26,  1864. 

'  poral,  11,11th  Infantry. 

7,  '63. 

1103 

Van  Pelt,  D.,  Corp'l,  G, 

June  10, 

Right;  flap.     Died  July  3,  1864. 

8th  Iowa,  age  22. 

10.  '64. 

1145 

Wottington,  B.,  Corp'l, 

May  15, 

Left;    flap.     Asst.   Surg.  H.   G. 

1104 

Vincent,   T.  H  ,  Pt.,  H, 

Nov.  7, 

.     Died  November  19,  1861. 

13th  Colored  H.  A. 

15,  '65. 

Keefer,    li.   S.  V.,   and  others. 

7th  Iowa. 

7,  '61. 

Died  Mav  21  ,  1865. 

1105 

Volner,  E.,  Serg't,  13th 

July  20, 

Left.     Died  September  15,  1864. 

1146 

Wright,  A..  Pt,,  C,  5th 

May  5, 

Right.     Died  Aug.  17,  1864;  en 

New  York  Ballery. 

20,  'C4. 

N.  Y.  Cav.,  age  18. 

5,  r64. 

teric  fever.    Spec.  3084. 

1106 

Walker,  W.,  Pt.,  B,  81st 

Aug.  31, 

Left.     A.  Surg.  S.  W.  Marshall, 

1147 

Wynn,J.  J.,  Pt.,  E,  20th 

Dec.  16, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Indiana. 

31,  '64. 

84th  Illinois.   Died  Sept.  10,  '64. 

Alabama,  age  25. 

17,  '64. 

D.  D.  Talbot,  Died  Dec.  23,'64  ; 

1107 

Walker,  J.  W.,  Serg't. 

Mav  6, 

Left  ;   circ.     Died  June  4,  1864  ; 

exhaustion. 

G,  105th  Penn.,  age  25. 

6,  '64. 

pyaemia. 

1148 

Tount,  E.,  Pt.,  A,  23d 

Sept.  19, 

Right;    circular.      Surg.   J.    W. 

1108 

Wall,  G..   Pt.,   H,  26th 

Dec.  13, 

Left.     Died  Jan.   23,    1863;   ex 

Virginia. 

19,  '64. 

Lawson,  C.S.A.     Died  Oct.  10, 

New  York,  age  18. 

14,  '62. 

haustion.     Autopsy.    Spec.  973. 

1864  ;  pyaemia. 

1109 

Walsh,    E.,    Lieut  ,   B, 

May  12, 

Right;  circular;   typhoid  fever  ; 

1149 

York,  H.  C.,  Pt.,  A,  4th 

May  5, 

Left;  double  flap;  gang,  extend'g 

52d  New  York,  age  33. 

12,  '64. 

diarrhoea.     Died  June  13,  1864. 

Vermont,  age  44. 

5,  '64. 

to  body  ;  four  inches  femur  ex 

1110  Walton,  W.  H.,  Pt.,  B, 

June  18, 

Right.     Died  July  21,  1864  ;  ex 

posed.     Died  June  7,  1864 

3d  New  Damp.,  age  23. 

18.  '64. 

haustion. 

1150 

Colladay,  C.  W.,  Pt.,  D, 

July  2, 

Right. 

1111 

Ware,  11.  S.,  Pt..H,38th 

Mav  5, 

Right.    October  9,  removed  three 

Grey's  Reserves. 

-,  '63. 

New  York,  age  23. 

5,  '62. 

inches    necrosed    bone.      Died 

1151 

Cousin,  N.  A.,  Pt.,  F,  5th 

Sept.  29, 

Right.     A  prisoner,  not  on  Pen 

October  12,    1862;    exhaustion. 

Col'd  Troops,  aged  24. 

—  ,  '64. 

sion  List. 

Spec.  1007. 

1152 

Hart,  W.,  Sergt,  G,  6th 

May  19, 

1112 

Warner,  C.  F.,  Pt,,  G, 

Sept.  19, 

Right  ;  flap.     Died  Sept.  23,  '64  ; 

New  York  Il'vy  Art'y. 

—  ,  '64. 

2d  Connecticut. 

19,  '64. 

exhaustion. 

1153 

Kirby.J.  7'.,  Pt.,  E,58th 

Sept.  1, 

Right.     Surg.  A.  C.  Messenger, 

1113    Warner.   SI.,    Pt.,    13th 

July  2. 

Right.     Died. 

Alabama. 

1,  '64. 

57th  Ohio. 

Mississippi. 

3,  '63. 

1154 

Laureford,  G.  H.,  Pt.,  I, 

May  5, 

.  Surg.  J.  W.  Wishart,  140th 

1114   Warner.  M.,  Pt..  II.  70th 

Aug.  12, 

.     Died  August  27,  1864. 

8th  Georgia. 

-,  '64. 

Pennsylvania. 

Indiana. 

12,  '64. 

1155 

Pierson,  J.,  in.,  G,  26th 

Mav  5, 

Right.  "  Surg.    J.   W.   Wishart, 

,1115  Warren.  G.  W.,  Pt.,  E, 

May  26, 

Right.      Surg.    A.   Goslin,   48th 

North  Carolina. 

-,  '64. 

140th  Pennsylvania. 

100th  Indiana. 

26,  '64. 

111.     Died  June  9,  1864. 

1156 

Royan,  J.,  Pt.,  G,  10th 

Sept.  1,     Left  ;  circ.     Surg.  J.  R.  Zearing, 

1116  Washington,  I).,  Pt..  A. 

Oct.  28. 

Left.  Surg.  C.M.  Clarke,  39th  111. 

Tennessee. 

1,  '64.         57thlll.  Leftinhosp.  Sept.5,'64. 

29th  Conn.,  ago  21. 

28,  '64. 

Died  Dec.   11,   1864;  irritative 

1157 

Walker,   S.  T.,  Pt.,  F, 

May  15, 

Left;  and  wound  of  right  thigh. 

fever. 

12th  North  Carolina. 

—  ,  '64. 

'O'KEEFE  (D.  C.),  Surgical  Cases  of  interest,  treated  at  Institute  Hospital,  Atlanta,  Ga.,  May  and  June,  1864,  in  Confed.  States  lied,  and  Surrj. 
Jour.,  1865,  Vol. a,  p.  25. 

2  THOMSON  (W.),  Rejprtof Cases of  Hasp.  Gangrene  treated  in  Douglas  Hospital,  Washington,  D.C.,  in  Am.  Jour.  Med.  Sci.,  1864,  Vol.  XLVII,  p.  382 


SECT.  III.] 


PRIMARY    AMPUTATIONS    OF    THIGH    IN    LOWER    THIRD. 


241 


The  seat  of  injury  in  these  eleven  hundred  and  fifty-seven  primary  amputations  in 
the  middle  third  of  the  thigh  is  reported  to  have  been  in  the  middle  third  of  the  femur  in 
ninety-eight,  in  the  lower  third  in  three  hundred  and  fifty-eight,  in  the  femur  without  indi 
cation  of  the  third  in  two  hundred  and  ninety,  in  the  knee  joint  in  three  hundred  and  fifty- 
three,  and  in  the  leg  in  fifty-eight  instances. 

Primary  Amputations  in  the  Lower  Third  of  the  Femur. — Of  nineteen  hundred  and 
fourteen  primary  amputations  in  the  lower  third  of  the  femur  the  result  could  not  be  ascer 
tained  in  fourteen  instances.  Nine  hundred  and  seventy-three  operations  were  successful, 
and  nine  hundred  and  twenty-seven  were  fatal,  a  mortality  of  48.7  per  cent.  In  one  hun 
dred  and  fifty-eight  instances  the  limb  implicated  was  not  indicated ;  in  eight  hundred  and 
forty-five  the  right,  and  in  nine  hundred  and  eleven  the  left  thigh  was  amputated. 

Recoveries  after  Primary  Amputations  in  the  Lower  Third  of  the  Femur. — The  nine 
hundred  and  seventy-three  operations  of  this  group  were  performed  on  nine  hundred  and 
seventy-one  patients,  the  discrepancy  in  numbers  being  due  to  the  fact  that  double  ampu 
tations  were  performed  in  two  instances.  Two  hundred  and  twenty-nine  were  Confederate, 
and  seven  hundred  and  forty-two  were  Union  soldiers.  Of  the  latter,  seven  hundred  and 
thirty-four  were  pensioned,  and  four  retired;  the  names  of  the  remaining  four  patients  are 
not  borne  on  the  rolls  of  the  Pension  Office. 

CASK  444. — Corporal  J.  A.  Crawford,  Co.  K,  6th  Wisconsin,  aged  24  years,  was  wounded  through  the  knee  joint,  at 
Gettysburg,  July  1,  1853.  He  was  admitted  to  the  Seminary  Hospital,  whence  Acting  Assistant  Surgeon  W.  M.  Welch  made 
the  following  report:  "The  limb  was  amputated  at  the  lower  third  of  the  thigh  on  the  day  following  the  injury. 
The  patient,  came  under  my  care  on  August  15th,  at  which  time  the  stump  was  granulating  slowly  and  there  was  a 
free  discharge  of  healthy  pus;  but  the  flaps  had  sloughed,  leaving  the  end  of  the  femur  bare.  A  roller  bandage 
was  applied  to  prevent  retraction  of  the  muscles,  and  warm-water  dressings  with  disinfectants  were  used,  iron  and 
stimulants  being  given  internally.  The  patient's  general  health  was  disturbed,  though  his  appetite  was  tolerably 
fair.  He  improved  gradually,  and  was  transferred  to  Camp  Letterman  on  September  2d."  Assistant  Surgeon  H. 
C:  May,  145th  New  York,  continued  the  history  as  follows:  "The  patient  came  under  my  charge  on  October  12th, 
being  very  feeble  and  troubled  with  profuse  and  obstinate  diarrhoea,  having  no  appetite,  and  suffering  from  hectic 
fever  and  much  pain,  also  an  abscess  along  the  course  of  the  lower  end  of  the  bone.  The  stump  was 
conical  shaped,  with  the  end  of  the  femur  exposed,  and  the  granulations  were  pale  and  flabby. 
Astringents  and  tonics  were  administered.  On  October  30th,  the  diarrhoea  was  almost  controlled, 
but  great  pain  and  irritation  was  felt  about  the  stump,  and,  chloroform  having  been  given,  a  seques- 

FIG  180 trum  four  and  a  half  inches  long,  and  consisting  of  a  complete  section  of  the  lower  end  of  the  bone, 

Tubular  se-     was  removed  by  forcible  traction.     The  surfaces  of  the  bone  were  found  to  be  very  rough  and  sur- 
moved"from     rounded  with  a  wall  of  callus.     The  patient  did  well  after  the  operation;  the  abscesses  ceased  to 

stump  of  the     discharge,  and  the  cavity  in  the  stump  filled  with  healthy  granulations.     By  November  6th,  he  had 
right  femur.  ,   *  , 

Spec.  ii)7i.  regained  a  good  appetite,  the  diarrhoea  was  entirely  checked,  and  his  general  appearance  and  con 
dition  were  rapidly  improving."  On  the  next  day  the  patient  was  transferred  to  Newton  University 
Hospital,  Baltimore,  where  the  following  described  operation  was  performed  on  February  2,  1864,  by  Surgeon  C.  W.  Jones, 
U.  S.  V.,  in  charge:  "The  end  of  the  femur  being  necrosed,  an  incision  six  inches  in  length  was  made  on  the  anterior  aspect  of 
the  thigh  and  four  inches  of  bone  removed.  Thirty-six  hours  afterwards  haemorrhage  to  the  amount  of  four  ounces  occurred, 
when  the  sutures  were  removed  and  a  large  clot  of  blood  was  taken  out,  after  which  the  bleeding  ceased.  After  this  the  patient's 
constitutional  condition  continued  to  improve  and  the  flaps  approximated.  By  March  24th,  the  stump  had  entirely  healed  with 
a  good  cushion."  The  patient  was  discharged  from  service  May  3,  1864,  and  pensioned.  He  was  paid  June  4,  1879.  The 
sequestrum  was  contributed  to  the  Museum  by  Acting  Assistant  Surgeon  E.  A.  Koerper,  and  is  represented  in  FIGURE  180, 
and  an  involucrum  of  new  bone,  removed  at  the  last  operation,  is  shown  in  FIGURE  181. 

CASE  445. — Private  J.  Miller,  Co.  C,  18th  Kentucky,  aged  38  years,  received  a  gunshot  injury  of  the  left  lower  extrem 
ity,  at  Richmond,  August  30,  1832.  Acting  Assistant  Surgeon  J.  B.  Smith  furnished  the  following  history:  "The  wound  was 
in  the  left  knee  and  thigh,  and  amputation  was  performed  on  the  field  at  the  lower  third  of  the  femur.  The  patient  was  admitted 
to  Washington  Park  Hospital  October  15th.  At  the  time  of  his  admission  he  presented  evidences)  of  severe  constitutional  suffer 
ing,  his  skin  being  pale  and  yellow,  accompanied  by  general  emaciation,  night  sweats,  and  constant  diarrhoea.  The  stump 
showed  two  or  three  small  openings,  and  there  was  free  discharge  of  sero- purulent,  fluid.  Exposed  bone  could  be  distinctly 
felt  with  the  probe.  Astringent  medicine  was  given  until  the  faecal  discharges  became  natural.  Warm-water  dressings  were 
used  to  the  stump  and  the  flaps  supported  with  adhesive  plaster,  the  wound  being  syringed  every  morning  with  a  weak  solution 
of  chloride  of  soda.  By  December  1st,  the  patient  was  doing  well,  having  good  appetite  and  gaining  flesh  and  strength  rapidly, 
and  all  the  constitutional  trouble  being  removed.  The  end  of  the  bone  gradually  became  more  exposed.  On  January  13,  1863, 
the  patient  being  considered  in  a  suitable  condition  for  an  operation,  and  having  been  placed  under  the  influence  of  chloroform, 
SURG.  Ill— 31 


FIG.  181.-Invo- 
lucrum,  4  inches 
in  length,  from 
stump  of  right  fe 
mur.  Spec.  2153. 


242  INJURIES    OF    THE    LOWEE    EXTREMITIES.  [CHAP.  X. 

Acting  Assistant  Surgeon  O.  D.  Norton  cut  down  to  the  bone  about  four  inches  above  its  exposed  end,  dividing  all  the  tissues, 
and  carrying  the  knife  downward  to  the  opening  at  the  end  of  the  stump.  The  bone,  after  being  dissected  from  the  tissues,  was 
then  separated  by  a  saw  about  three  inches  above  the  projecting  extremity,  the  forceps  being  used  for  the  removal  of  the  spongy 
bone  above  the  point  of  the  division.  Some  trouble  was  experienced  from  haemorrhage,  necessitating  the  ligating  of  two  or 
three  small  vessels.  Water  dressings  were  applied.  By  February  10th,  the  wound  had  healed  and  the  patient  was  apparently 
doing  well.  On  February  20th,  he  had  a  chill,  followed  by  fever  and  by  pain  about  the  stump,  when  a  small  incision  was  made 
and  about  half  an  ounce  of  healthy  pus  discharged.  From  this  time  there  was  a  gradually  lessening  quantity  of  pus  until  April 
20th,  when  the  wound  had  healed,  and  the  patient,  to  all  appearances,  was  well,  being  able  to  walk  about  the  ward,  and  all  his 
constitutional  symptoms  having  disappeared."  The  patient  was  discharged  April  30, 1864,  and  pensioned.  He  was  paid  March 
4,  1879.  The  tubular  sequestrum,  three  inches  long  and  surrounded  by  a  cylindrical  involucrum  of  spongy  bone,  was  contributed 
by  Dr.  Smith,  and  constitutes  Spec.  1094  of  the  Surgical  Section,  A.  M.  M.  It  is  represented  in  FIG.  2  of  PLATE  LXX,  opposite. 

In  the  following  two  instances  of  amputation  in  the  lower  third  of  the  thigh,  the 
officers  continued  in  active  service  until  the  close  of  the  war: 

CASE  446. — Major-General  D.  E.  Sickles,  U.  S.  V.,  while  in  command  of  the  Third  Corps,  at  Gettysburg,  was  wounded, 
on  the  evening  of  July  2,  1863,  by  a  twelve-pounder  solid  shot,  which  shattered  his  right  leg.  He  dismounted  unassisted,  and 
aid  arriving  promptly,  he  was  removed  to  a  sheltered  ravine  a  short  distance  to  the  rear,  where  the  limb  was  amputated  low 
down  in  the  thigh  by  Surgeon  T.  Sim,  U.  S.  V.,  Medical  Director  of  the  Corps.  The  patient  was  then  sent  farther  to  the  rear, 
and,  on  the  following  day,  he  was  transferred  to  Washington.  The  stump  healed  with  great  rapidity.  Two  weeks  after  the 
injury  the  patient  was  able  to  ride  about  in  a  carriage,  and  early  in  September  he  was  well  enough  to  again  mount  a  horse,  the 
stump  being  completely  cicatrized.  The  bones  of  the  amputated  leg  (Spec.  1335)  were  contributed  to  the  Museum  by  the  patient, 
and  the  history  of  the  case  was  obtained  from  the  operator.  General  Sickles  subsequently  for  several  years  held  command  in 
South  Carolina  and  the  Department  of  the  South,  but  has  been  retired  from  active  service  since  April  14,  1869.1 

CASE  447. — Major-General  It.  S.  Ewell,  while  commanding  a  division  of  General  Jackson's  Corps  of  the  Confederate 
Army,  was  wounded  in  the  left  knee  during  the  night  of  the  engagement  at  Manassas,  August  28,  1862.  Dr.  Hunter  McGuire, 
Surgeon  and  Medical  Director  of  the  Corps,  who  amputated  the  wounded  limb,  published  an  account  of  the  case  as  follows  : 3 
"  He  was  kneeling  on  the  ground  and  looking  under  some  pine  bushes  to  get  a  better  view  of  the  field,  when  he  was  hit  upon 
the  left  patella,  nearly  in  the  centre  of  it,  and  his  leg  being  flexed,  the  ball  passed  downward,  striking  the  head  of  the  tibia  and 
splitting  it  into  several  fragments.  The  bullet  finally  lodged  in  the  muscles  of  the  calf  of  the  leg.  He  sent  for  me  at  once,  but 
the  messenger  failed  to  find  me,  and  I  did  not  know  he  was  hurt  until  General  Jackson  sent  his  aid-de-camp  to  tell  me.  He 
was  still  laboring  under  the  severe  shock  of  the  injury  when  I  found  him,  although  several  hours  had  elapsed.  In  all  gunshot 
wounds  of  the  knee  the  shock  of  injury  is  severe,  but  it  was  especially  great  in  this  instance.  The  General's  health,  naturally 
not  very  good,  was  unusually  bad  at  this  time.  He  had  also  lost  a  great  deal  of  sleep,  and  the  night  he  was  hurt  was  compelled 
to  drink  a  large  quantity  of  strong  tea  to  keep  awake.  *  *  He  was  so  much  exhausted  when  he  was  shot  that  his  surgeons 
thought  at  one  time  he  would  die  from  the  shock  of  the  injury.  When  he  had  sufficiently  recovered  from  this,  Tadvised  him  to 
submit  to  amputation;  but  he  consented  to  it  very  reluctantly,  partly  because  some  surgeon  had  assured  him  that  his  wound 
was  not  dangerous,  but  one  from  which  he  would  soon  recover.  I  amputated  the  thigh  just  above  the  knee,  performing  the 
operation  as  rapidly  and  with  as  little  loss  of  blood  as  I  could.  About  ten  days  after  the  amputation,  to  escape  capture,  he  was 
carried  on  a  litter  by  some  soldiers  near  fifty  miles.  The  motion  on  the  litter  caused  the  bone  to  protrude,  and  in  consequence 
of  this  and  his  bad  health  the  wound  sloughed.  After  much  suffering  and  the  loss  of  an  inch  of  bone,  he  got  well  enough  to  go 
about,  when  one  day  he  was  so  unlucky  as  to  let  his  crutches  slip  from  under  him,  and  falling  upon  an  icy  pavement,  he  re-opened 
the  wound  and  knocked  off  another  piece  of  bone.  After  some  months  he  was  well  enough  to  go  back  to  the  field  again,  where 
he  performed  some  very  active  service,  but  from  the  shape  of  his  stump,  and  an  ill-contrived  wooden  leg  he  wore,  he  was  fre 
quently  troubled  with  abrasions  of  the  skin,  small  abscesses,  and  so  on.  He  now  (1866)  uses  a  suitable  artificial  limb,  and  with 
the  assistance  of  a  cane  gets  along  right  well,  being  no  longer  liable  to  affections  of  the  stump." 

As  already  stated,  amputation  in  the  lower  thirds  of  both  thighs  was  twice  success 
fully  performed.  One  of  the  survivors  died  in  1877,  over  thirteen  years  after  the  operation 

CASE  448. — Corporal  M.  Dunn,  Co.  H,  46th  Pennsylvania,  aged  21  years,  was  wounded  at  Dallas,  May  25,  1864. 
Surgeon  W.  C.  Bennett,  U.  S.  V.,  recorded  his  admission  to  the  field  hospital  of  the  1st  division,  Twentieth  Corps,  and  noted: 
"Canister-shot  fracture  of  both  legs,  followed  by  excision  of  the  head  of  the  left  fibula  and  amputation  of  the  right  thigh. 
Vessels  of  left  leg  destroyed  and  mortification  ensuing,  necessitating  amputation  of  left  thigh."  Three  weeks  after  being  wounded 
the  patient  was  removed  to  hospital  at  Chattanooga,  where  the  stumps  assumed  a  gangrenous  appearance,  which  yielded  to  the 
application  of  bromine.  One  month  later  the  patient  was  transferred  to  hospital  No.  14,  at  Nashville,  whence  he  was  furloughed 
and  proceeded  to  his  home.  He  subsequently  entered  the  Post  Hospital  at  Elmira,  and  lastly,  on  April  24, 1835,  he  was  admitted 
to  Central  Park  Hospital,  New  York  City.  Surgeon  J.  J.  Milhau,  U.  S.  A.,  in  charge  of  the  latter,  reported  the  following  history: 
"The  missile  passed  through  both  legs  just  below  the  knee  joints.  The  right  thigh  was  amputated  by  the  flap  method,  just 
above  the  knee  joint,  eighteen  hours  after  the  injury,  and  circular  amputation  of  the  left  thigh  was  performed  forty  hours  after 
the  reception  of  the  wound.  In  August,  1864,  the  right  thigh  had  to  be  re-amputated  at  the  middle  third,  which  operation  was 
performed  by  the  circular  method,  at  the  patient's  home,  by  Dr.  Robison,  of  Wellsville,  New  York.  The  stump  of  the  right 
thigh  closed  completely  about  December  1,  1864,  but  that  of  the  left  never  entirely  healed,  and  was  still  discharging  from  three 

1  Circular  No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  1865,  p.  38. 

2McGuiUE  (HUNTKE),  Clinical  Remarks  on  Gunstiot  Wounds  of  Joints,  etc.,  in  Richmond  MedicalJournal,  1866,  Vol.  I.  p.  262.  Prof.  P.  F.  EVE, 
in  a  communication  published  in  the  V.  S.  Sanitary  Commission  Memoirs,  New  York,  1871,  Surgical  Volume  II,  p.  64,  states  that  "Lieutenant-General 
Ewell  survives  an  amputation  through  the  upper  third  of  the  thigh." 


Hint,  of  the  War  of  the  Kebellion.  Vol.  II.  I'jiH  111 


AV'ard    phot . 


T.  Sinclair  »  #011  Uth 


PLATE    LXX INVOLUCRA     OF  THE   FEMUR 


Fig.  I  ..Case  of  Pi .  W  Vannatta,  4  Pennsylvania   Cav    Tig.  2._Ca^e  of  PtJlliller,    18  Kentucky. 

Spec.   2602   SUP^.  Sect  A.M.M.  Spec.    1094   Surg.  Sect.A.M.M 

KiS   »_  Case  of  Ft,  J.  Wearing.  2  Pennsylvania  Art Fig  l_Case  of  Ft  L.C  Griffin,  8  North  Carolina. 

Spec    4106  Sm-g    Sect.  A.M. M*.  Spec.  3141    Surg.  Sect.. A.M.M. 


SECT.  111.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWEK    THIRD. 


243 


openings  at  the  time  of  the  patient's  admission.  On  April  30th,  chloroform  was  administered,  and  several  pieces  of  necrosed 
bone  were  removed  with  the  forceps  by  Acting  Assistant  Surgeon  S.  Teats,  who  made  an  incision  some  three  inches  in  length  on 
tlie  face  of  the  stump.  The  sequestrum  being  enclosed  by  a  very  thick  involucrum,  it  was  found  necessary  to  remove  a  portion 
of  the  end  of  this  with  the  gnawing  forceps  before  the  sequestrum  could  be  extracted."  The  patient  was  discharged  from  service 
August  17, 1835,  and  pensioned,  having  been  previously  supplied  with  artificial  limbs  by  the  firm  of  A.  A.  Marks,  of  New  York. 
The  removed  necrosed  fragments  were  contributed  to  the  Museum  by  the  operator,  and  constitute  Specimen  3193  of  the  Surgical 
Section.  The  pensioner  died  October  23,  1877.  The  cause  of  his  death  is  alleged  to  have  been  the  diseased  condition  of  the 
stump  of  the  left  thigh. 

In  the  second  successful  case  of  primary  amputation  of  both  thighs  in  the  lower  thirds 
the  patient  was  a  Confederate  soldier: 

CASE  449. — Private  C.  G.  Rusk,  Co.  C,  21st  Georgia,  aged  22  years,  was  wounded  and  captured  during  the  assault  on 
Fort  Steadmnn,  March  25,  1865.  He  was  conveyed  to  the  Ninth  Corps  field  hos 
pital,  whence  Assistant  Surgeon  S.  Adams,  U.  S.  A.,  contributed  the  pathological 
specimen  (Cat.  Sarg.  Sect.,  1886,  p.  321,  Spec.  3998),  with  the  following  history: 
"The  injury  consisted  of  a  shell  wound  of  the  right  leg  below  the  knee  joint,  tear 
ing  open  the  joint,  passing  across  and  smashing  the  patella  of  the  left  leg.  Sur 
geon  L.  W.  Bliss,  51st  New  York,  amputated  both  thighs  at  the  lower  third  on  the 

day  of  the  injury.  By  April  1st  the 
patient's  general  condition  was  excel 
lent,  his  appetite  and  pulse  good,  and 
his  tongue  clean."  The  specimen  con 
sists  of  the  amputated  lower  extremity 
of  the  left  femur,  with  fragments  of  the 
patella.  From  the  field  hospital  the  pa 
tient  was  sent  to  City  Point,  and  thence 
to  Washington,  where  he  was  admitted 
to  Armory  Square,  and  subsequently 
to  Lincoln  Hospital.  Surgeon  J.  C. 
McKee,  U.  S.  A.,  in  charge  of  the  lat 
ter,  contributed  the  photographs,  repre 
sented  in  the  annexed  wood-cuts  (FiGS. 
182,  183),  and  described  the  amputation 
as  a  flap  operation.  The  patient  was 
released  and  discharged  from  hospital 
Aug.  2,  1865.  Subsequently  he  entered 
and  was  treated  for  a  time  at  St.  Luke's 
Hospital,  New  York  City,  where,  on 
February  28,  1866,  he  was  provided  by 
Dr.  E.  D.  Hudson  with  artificial  limbs, 
by  means  of  which  he  was  enabled  to 
walk,  requiring  the  assistance  of  two 
canes  only. 

Twenty-seven  of  the  seven  hundred  and  forty-two  Union  soldiers  who  survived  ampu 
tation  in  the  middle  third  of  the  femur  have  died  during  the  fourteen  years  since  the  close 
of  the  war.  One  case  (CASE  of  Dunn)  has  already  been  detailed ;  in  the  following 
instance  the  patient  survived  the  operation  over  fourteen  years  and  died  of  phthisis : 

CASE  450. — Private  C.  Briof,  Co.  C,  39th  New  York,  aged  26  years,  was  wounded  in  the 
left  knee,  at  Bristoe  Station,  October  14,  1863.  He  was  conveyed  to  Alexandria  on  the  follow 
ing  day,  and  admitted  to  the  First  Division  Hospital,  whence  Acting  Assistant  Surgeon  C.  W. 
Koechling  transmitted  the  pathological  specimen  (FlG.  185),  with  the  following  history :  "The 
wound  was  caused  by  a  mini6  ball  entering  the  external  aspect  of  the  knee,  passing  through  the 
joint,  and  lodging.  The  missile  was  extracted  from  the  internal  aspect  of  the  leg,  on  tho  field, 
by  the  regimental  surgeon,  and  the  limb  was  amputated  at  the  lower  third  of  the  thigh,  by  the 
circular  method,  on  October  16th,  by  Acting  Assistant  Surgeon  N.  Barnes.  The  patient  came 
under  my  care  on  October  26th,  at  which  time  the  bone  protruded  from  the  stump  over  an  inch. 
For  this  gentle  attraction  of  the  integuments  was  made  by  adhesive  strips  and  kept  up  for  a 
week,  when,  the  patient  suffering  too  much  pain,  it  was  continued  no  longer,  and  a  roller  was  FlG  185._ 

applied  from  above  downward  and  kept  on  until  the  bone  was  nearly  covered.     The  patient     Sequestrum 
.  .     .        from    stump 

improved  every  day,  there  being  but  very  little  discharge,  but  occasionally  very  severe  pain  in     Ofl«-ft  femur. 

the  stump.     On  February  8,  1864,  the  accompanying  sequestrum  was  removed.     On  February     SP60-  -^ 
20th,  the  patient  was  seized  with 'tetanic  pains,  which,  though  relieved  by  the  free  administration  of  opium,  recurred  every 
other  day  for  a  month.     After  that  period  the  patient  did  well,  and  was  able  to  take  exercise  on  crutches,  the  stump  having 
healed.     On  May  9th,  the  patient  left  the  hospital  on  furlough."     He  subsequently  passed  through  different  hospitals,  and  lastly 


FIG.  182. — Amputation  of  both  thighs  at  lower 
thirds.     [From  a  photograph.] 


FIG.   183.— Artificial  limbs    applied  in   case  of 
double  amputation.     [From  a  photograph.] 


FIG.  184.  —  Upper 
parts  of  bones  of  left 
leg;  tuberosity  of  tibia 
split  off  obliquely.— 
Spec.  2344. 


244 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


entered  De  Camp,  David's  Island,  New  York  Harbor.  On  September  19,  1865,  the  man  was  discharged  from  service  and  pen 
sioned.  The  upper  portion  of  the  bones  of  the  leg  of  the  amputated  limb  were  forwarded  to  the  Museum  by  the  operator,  and 
are  represented  in  FIGURE  184,  and  a  cast  of  the  stump  was  contributed  by  Acting  Assistant  Surgeon  G.  F.  Shrady.  (Cat.  Surg. 
Sect.,  1866,  p.  548,  Spec.  1787.)  The  New  York  City  Examining  Board  certified,  March  11,  1874:  "The  pensioner  is  unable  to 
wear  an  artificial  limb  in  consequence  of  excessive  tenderness  of  the  stump,  rendering  him  unable  to  stand  the  pressure  upon  it. 
He  has  tried  one  several  times,  but  it  was  so  painful  that  he  could  not  wear  it  more  than  a  few  hom-s."  This  pensioner  died 
November  12,  1877,  of  phthisis  pulmonalis. 

Fatal  Cases  of  Primary  Amputation  in  the  Lower  Third  of  Femur. — Six  of  the  nine 
hundred  and  twenty-seven  cases  of  this  group  were  instances  of  double  amputations;  the 
operations  were,  therefore,  performed  on  nine  hundred  and  twenty-one  patients.  Seven 
hundred  and  ninety  were  Union,  and  one  hundred  and  thirty-one  were  Confederate  soldiers. 
In  the  following  case  both  thighs1  were  amputated  in  the  lower  third  on  the  day  of  the 
injury,  the  patient  surviving  the  operations  eighteen  days: 

CASE  451. — Private  D.  Nicholson,  Co.  H,  22d  Massachusetts,  aged  23  years,  was  wounded  in  both  thighs,  at  Spottsyl- 
vania,  May  10,  1854.  He  was  admitted  to  the  field  hospital  of  the  1st  division,  Fifth  Corps,  where  Surgeon  J.  Thomas,  118th 

Pennsylvania,  amputated  both  limbs.  Surgeon 
R.  B.  Bontecou,  U.  S.  V.,  reported  the  following 
termination  of  the  case:  "The  patient  entered 
Harewood  Hospital,  Washington,  May  25th. 
He  had  undergone  amputation  of  both  thighs  at 
the  lower  third  the  same  day  he  received  the 
wound,  the  operations  being  performed  by  the 
antero-posterior  flap  method.  When  admitted  he 
was  in  a  very  weak  condition,  the  stumps  being 
unhealthy  and  showing  a  tendency  to  slough. 
A  supporting  treatment  was  administered.  Pro 
gress,  however,  continued  unfavorable.  Death 
occurred  from  exhaustion  May  28,  1864."  The 
amputated  portions  of  the  femurs  were  contrib 
uted  to  the  Museum  by  the  operator,  and  consti 
tute  Specimen  2966  of  the  Surgical  Section  (FlGS. 
186,  187),  showing  the  right  femur  to  be  trans 
versely  perforated, with  comminution,  two  inches 
above  the  condyle,  by  a  bullet  which  passed  on,  badly  grooving  the  left  femur  on  the  anterior  face  at  the  same  level  and  producing 
a  severe  oblique  fracture. 

CASE  452. — Private  J.  O.  Blackburn,  Co.  E,  138th  Pennsylvania,  aged  35  years,  was  wounded  at  Monocacy  Junction, 
July  9,  1864,  and  admitted  to  hospital  at  Frederick  on  the  following  day.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  reported 
the  following  history:  "The  injury  was  caused  by  a  fragment  of  a  shell,  which  struck  the  inner  side  of  the  left  knee,  lacerated 
the  soft  parts,  and  comminuted  the  joint.  On  the  day  after  his  admission  the  patient  was  etherized,  and  the  thigh  was  removed 
at  the  lower  third,  by  Acting  Assistant  Surgeon  W.  S.  Adams.  The  integuments  in  this  case  being  in  bad  condition  on  the  inner 
side,  a  circular  incision  was  made  to  extend  half  around  the  limb,  a  long  lateral  flap  on  the  outer  side  and  a  circular  incision 
through  the  muscles,  and  the  parts  united  by  sutures  and  adhesive  straps.  The  patient's  condition  at  the  time  of  the  operation 
was  very  poor.  July  13th,  patient  irritable;  pulse  120;  appetite  rather  poor;  no  effort  at  union  by  first  intention.  16th,  some 
evidence  of  sloughing  of  the  flap.  Ordered  yeast  poultices,  also  tartrate  of  potassa  and  iron  in  doses  of  twenty  grains  three 
times  a  day,  and  continued  the  stimulants  and  generous  diet.  20th,  line  of  demarcation  well  marked.  22d,  slough  being 
detached  at  several  points;  clipped  it  off  with  scissors  down  to  the  bleeding  surface  and  thoroughly  applied  oakum  saturated 
with  a  strong  solution  of  permanganate  of  potassa,  covering  the  whole  with  oiled  silk.  25th,  slough  came  away  nicely,  leaving 
a  clean  healthy  surface.  August  1st,  patient  doing  tolerably  well;  granulations  somewhat  abundant  but  pale  and  flabby.  Has 
obstinate  diarrhoea,  and  is  taking  opiates  and  astringents  in  addition  to  other  treatment.  10th,  diarrhoea  partially  checked; 
appetite  very  poor;  sloughing  has  recommenced,  and  permanganate  of  potassa  is  reapplied.  15th,  sloughing  about  ceased. 
There  is  but  little  discharge,  and  the  end  of  the  stump  is  dry  and  refuses  to  granulate.  Applied  yeast  poultice  and  continued  the 
other  treatment.  21st,  patient  quite  despondent  and  evidently  failing  rapidly;  pulse  140  and  scarcely  perceptible.  Increased 
the  stimulants.  28th,  sloughing  still  continues  and  patient  sinking.  31st,  had  a  haemorrhage  from  femoral  artery  to  amount  of 
eight  ounces;  controlled  by  tourniquet.  Haemorrhage  occurred  again  on  the  following  morning  and  was  arrested  by  the  tourni 
quet,  the  patient  not  being  in  condition  to  undergo  ligation.  He  died  at  7  o'clock  P.  M.,  on  September  1,  1864.  At  the  autopsy, 
eight  hours  after  death,  the  body  was  found  to  be  much  emaciated  and  the  muscles  remarkably  loose  and  flabby.  On  examin 
ing  the  stump  to  the  head  of  the  bone  and  removing  the  femoral  artery  and  vein,  the  end  of  the  artery  was  found  to  be  pervious 
from  the  breaking  down  of  the  clot,  and  the  vein  much  thickened  and  indurated."  The  amputated  extremity  of  the  femur,  showing 
the  inner  condyle  to  be  superficially  fractured  (Spec.  3832),  and  four  and  a  half  inches  of  the  stump  of  the  bone,  being  superficially 
necrosed  (Spec.  3488),  together  with  the  femoral  artery  (Spec.  3980),  were  contributed  to  the  Army  Med.  Museum  by  the  operator. 

>The  remaining  five  fatal  cases  of  amputation  of  both  thighs  in  the  lower  third  of  the  femur  are:  Pt.  S.  Allen,  G,  59th  Mass.  (No.  984,  TAULK 
XXXII,  p.  257);  Pt.  R.  S.  Michael,  A,  105th  Penn.  (No.  1551,  TABLE  XXXII,  p.  263);  Serg't  E.  C.  Rabbit,  B,  10th  Missouri  (No.  1C52,  TABLE  XXXII, 
p.  264);  Pt.  J.  Stewart,  D,  77th  New  York  (No.  1769,  TABLE  XXXII,  p.  265);  and  Lieut.  J.  Whelpley,  D,  1st  Maine  (No.  1862,  TABLE  XXXII,  p.  267). 


FIG.  186.— Anterior  view  of  lower  third  of 
each  femur.     Spec.  2966. 


FIG.  187. — Posterior  view  of  lower  third  of 
each  femur.     Spec.  2966. 


SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER    THIRD. 

TABLE"  XXXII. 


245 


Summary  of  Nineteen  Hundred  and  Fourteen  Cases  of  Primary  Amputations  in  the  Lower  Third  of  the 

Femur  for  Shot  Fracture. 


Recoveries,  1—973 ;  Deaths,  974— 1900;  Result  unknown,  1901— 1914. 


Xo. 

NAME,  MIUTAUY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Abbott,  O.  A.,  Serg't,  A, 

Oct.  27, 

Left;  circ.    fiurg.  F.  A.  Dudley, 

38 

Ballentine,  H.J.,  Lieut., 

Nov.  29, 

Left  ;  circ.     Prov.  Marshal  June 

14th  Conn.,  age  24. 

28,  '64. 

14th  Conn.     Disch'd  June  !>,'65. 

B,  42d  Tenn.,  age  29. 

De.  1,'64. 

5,  1865. 

2 

Adair,  U.,  Serg't,  F,  7th 

Feb.  21, 

Right;  circ.     A.  Surg.  B.  Norris, 

39 

Bangs,  L.  G.,  Adj't.  19th 

Nov.  24, 

Right  ;  circ.     Surg.  F.  H.  Gross, 

Infantry. 

22,  '62. 

U.  S.  A.     Disch'd  July  13,  '62; 

Illinois,  age  27. 

24,  '63. 

U.  S.  V.    Erysipelas.    Mustered 

subsequent  operation. 

out  July  9,  1864. 

3 

Adams,  E.   H.,   Pt.,  C, 

June  8, 

Left;    flap.     Surg.   A.  H.   Hoff, 

40 

Bappert,  M.,  Pt.,  G,  47th 

Aug.  3, 

Left  ;  flap.     Surg.  S.  P.  Bonner. 

12th  Iowa. 

8,  '63. 

U.  S.  V.     Disch'd  Sept.  22,  '63. 

Ohio,  age  18. 

3,  764. 

47th  Ohio.    Aug.  18,  oper.   May 

4 

Aderhold,    E.,    Pt,,   E, 

Oct.  14. 

Left.     Disch'd  May  2,  '64.    Died 

30,  '65,  nee.  bone  rem'd.  Disch'd 

6th  Penn.  Reserves. 

14,  '63 

Jan.  22,  1869. 

Aug.  9,  1865. 

5 

Agren,   A.,   Pt..   C,  7th 

Mar.  27, 

Right  ;  circ.  Surg.  A.  T.  Bartlett, 

41 

Barclay,  T.,  Pt.,  K,  14th 

Nov.  -27, 

.     Surg.  —  White.    Recov 

Minnesota. 

27,  '65. 

3.JdMo.     Dischd  June  14,  1865. 

Louisiana. 

28,  '63. 

ery. 

6 

A  Idensen,  J.  J.  ,  Serg't,  K, 

Nov.  30, 

Right  ;  anterior  post.  flap.     Surg. 

42 

Barker,  H.,  Pt.,  H,  31st 

Oct.  19, 

;  circular.    Dr.  G.  L.  Miller. 

4(ith  Miss.,  age  32. 

De.  1,  '64. 

McCormack,  C.  S.  A.     Provost 

Virginia. 

20,  '64. 

Transferred. 

Marshal  March  7,  1865. 

43 

Barnes,  J.  E.,  Serg't,  A, 

June  21, 

Left  ;  ant.  post.  flap.     Surg.  G.  T. 

7 

Aldrich,B.,Pt.,  A,  155th 

July  9, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

77th  New  York,  age  37. 

21,  '64. 

Stevens.   77th   N.   Y.     Disch'd 

New  York. 

11,  '64. 

W.  S.  Adams.     Disch'd.    Spec. 

Oct.  26,  18(i4. 

3938. 

44 

1  Barrett,  M.,  Corp'l,  E, 

Sept.  19, 

.    Amputation.    Transferred 

8 

Alexander,    G..  Pt.,   A, 

May  3, 

Right  ;  flap.    Recovery  with  good 

19th  Alabama. 

19,  '63. 

to  hospital  Oct.  3.  1863. 

4th  Virginia,  age  39. 

4,  '63. 

stump. 

45 

Bartle.  W.,    Serg't,    H, 

Nov.  17, 

Left  ;  circ.     Surg.  O.  I.  Owens, 

9 

Allen.  J.,  Corp'l,  I,  22d 

Sept   19, 

Right  :  flap.     Surg.  T.  L.  Magee, 

86th  New  York,  age  25. 

17,  '64. 

40th  N.  Y.     Disch'd  June  6,  '65. 

Illinois,  age  23. 

21,  '63. 

51st  111.     Disch'd  Feb.  27,  1864. 

Spec.  4129. 

10 

Allen,  J.  G.,  Pt..  A,  77th 

June  21, 

Left  ;  ant.  post.  flap.     Surg.  G. 

46 

Bastian,  J.,  Pt.,  A,  31st 

June  27, 

Right  ;   circ.      Surg.  J.  Reeves, 

New  York,  age  39. 

21,  '64. 

T.Stevens,  77th  N.Y.     Disch'd 

Illinois. 

27.  '64. 

7Sth  Ohio.     M.  out  Mav  31.  '65. 

Sept.  9.  1864. 

47 

Bauer,  J.,  Pt.,  F,  100th 

July  22. 

Left  :  ant.  flap.     Surg.  M.  S.  Kit- 

11 

Allen,  R.,Serg't,  A,59th 

Dec.  15, 

Right  ;  circ.     Disch'd  July  1,  '65. 

New  York. 

22,  '63. 

tinger.  100th  N.  York.     Disch'd 

Illinois,  age  34. 

15,  '64. 

May  3,  1864. 

12 

Ammerman,  G.,  Corp'l, 

May  6, 

Left;  ant.   post.  flap.     Surg.   C. 

48 

Baughinan,   C.,  Pt.,   B, 

Nov.  22, 

Right  ;  ant.  pest.  flap.     Surg.  A. 

C,  tith  Penn.  Reserves, 

6,  '64. 

Bowers,  6th  Penn.  Res.   Disch'd 

1st  Mich.  Art.,  age  26. 

22,  '64. 

T.  Hudson.  26th  Iowa.    Disch'd 

age  26. 

May  30,  1865. 

June  3,  1865. 

13 

Anderson,  J.,  Pt.,  I,  21st 

Jan.  2, 

Left;   flap.     Disch'd    March   13, 

49 

Beall,   T..  Pt.,  C,  39th 

Oct.  5, 

Left.     Surg.  J.  R.  Zearing,  57th 

Ohio. 

2,  '63. 

1863. 

Iowa,  age  28. 

7,  '64. 

Illinois.     Disch'd  July  8,   1865. 

14 

Anderson,  J..  Pt.,  I,  21st 

June  22, 

Left  ;  flap.     Surg.  C.  J.  Walton, 

50 

Bean,  C.  H.,  Pt..  E,  llth 

July  21. 

Left;  flap.     Surg.  N.  F.   Blunt, 

Kentucky. 

22,  '64. 

21st  Ky.     Must,  out  Jan.  23,  '65. 

Maine,  age  19. 

21,  '64. 

llth  Me.     Disch'd  June  10,  '65. 

15 

Andrews,  A,  C.,  Pt.,  H, 

Feb.  6, 

Right;    flap.     June   10,   reamp. 

51 

Beightal,  J.,  Pt.,  C,  93d 

Mar  25, 

Right  ;  flap  ;  erysipelas.    Disch'd 

32(1  Mass.,  age  21. 

6,  '65. 

two  and  a  half  ins.     A.  A.  Surg. 

Penn.,  age  39. 

25,  '65. 

July  12,  1865." 

E.  B.  Lyon.   Disch'd  Oct.  20,'65. 

52 

Beisse,    N.,    Bugler,  A, 

Oct.  8, 

Left  ;  circ.     Surg.  C.  S.  Muscroft, 

1C 

Angle,   II.,   Pt.,   F,  5th 

May  5, 

Left  ;  circ.     Disch'd  May  30,  '64. 

1st  Michigan  Battery. 

10,  '62. 

10th  Ohio.     Disch'd  June  7,  '63. 

Wisconsin,  age  31. 

5,  '64. 

53 

Bell,  G.  W.,  Pt.,  H,  39th 

July  22, 

Right  ;  flap.    Surg.  J.  R.  Zearing, 

17 

Anthony,  A,,  Lieut.,  E, 

T\l    V     f  '       nn*o  '^1 

Mar.  25, 

C)~    '/;K 

Left  ;  circ.  A.  Surg.  E.  P.  Roche, 

KA 

Ohio,  age  26. 

ftfllJ     T    ff     Pt      V     1  'itVi 

22,  '64. 
Aug.  16 

57th  111.    Disced  June  17,  '65. 
I  eft*  circ      Sure                     15th 

18 

O.Al  A>  .   \_i,,   tlgC  o.L. 

Anthony,  II.  G.,  Pt..  C, 

£3,     U*J. 

Sept.  19, 

o5th  Mass.  Ixcleased  July  10,  65. 
Left  ;  circ.    Surg.  E.  Phillips,  6th 

O4 

/>(.((,  «/  .  J/-,  £v»|  Ju,    I..HI1 

Alabama. 

16.  '64.' 

Ala.  Diarr.  Trans.  Aug.  31,  '64. 

6th  Vermont,  ago  24. 

19,  '64. 

Vt.     Disch'd  June  26,  1865. 

55 

Bellew,   B.,  Pt,,   I,  4th 

July  25, 

Right;  circ.     Surg.  D.  A.  Cham 

19 

Anthony,  R.  H.,  Pt.,  D, 

July  1, 

Left.    Surg.  —  McGuire,  C.  S.  A: 

Delaware,  age  45. 

25,  '64. 

berlain.  94th  N.  York.     Disch'd 

1st  Tennessee. 

2,  '63. 

Exch'd  March  17,  1864. 

July  13,  1865. 

20 

Armsberg,  G.,Pt,,  L,  62d 

July  3, 

Left.     Dec.   21,  exfol.  removed. 

56 

Bergeoin,   P.  P.,  Serg't, 

Aug.  29, 

Right  ;  flap  ;  abscesses.     V.  R.  C. 

Penn.,  age  18. 

3,  fe. 

Disch'd  Oct.  1'J,  '64.    Spec.  2156. 

11,  3d  Mich.,  age  21. 

29,  '62. 

June,  1863. 

21 

Armstrong,   A.  T.,  Pt., 

Mav  12, 

Right  ;  double  lat.  flap.     Surg.  J. 

57 

Berry,  W.  T.,  Pt.,  Pur- 

July  1, 

Left.     Recovery. 

H,  31st  Maine,  age  24. 

14,'  '64. 

S.  Ross,   llth  N.  11.     Disch'd 

cell  s  Battery. 

1,  '62. 

Nov.  16,  1864. 

58 

Bcaverson,   D.,   Pt.,  H, 

July  10, 

Left;  circ.     Disch'd  July  11,  '65. 

20 

Ash,  J.,  Pt.,  G,  25th  S. 

May  16, 

Left  ;  circ.     Furloughed  July  —  , 

187th  Penn.,  age  23. 

10,"  '64. 

Carolina,  age  30. 

16,  '64. 

1864. 

59 

Bickel,  J.  P.,  Corp'l,  G, 

Sept.  20, 

.     Surg.  —  Sawers,  C.  S.  A. 

2J 

Ash  by.  D.  C.,  Lieut.,  H, 

Deo.  15, 

Right.   Vermale's  method.    Asst. 

20th  Virginia  Cavalry. 

20,  '64. 

Recovery. 

80th  Indiana,  age  24. 

17,  '64. 

Surg.  W.  B.  Trull,   U.   S.  V. 

60 

Billington,  S.  A.,  Pt.,  C, 

Oct.  27, 

Left  :  flap.    Surg.  X.  Y.  Leit,  76th 

Mustered  out  May  15,  1865. 

Llth  Maine,  age  26. 

27,  '64. 

Penn.     Disch'd  June  12,  1865. 

24 

Ashburn,  J.  C.,  Coro'l, 

Oct.  19, 

Left  ;  circ.     Disch'd  June  5,  '65. 

61 

Billingsley,  J.  B.,  Pt..  I, 

May  16, 

;  circ.  Surg.  Hilliard,  C.S.A. 

B.  14thW.Va..age25. 

20,  '64. 

43d  Alabama,  age  21. 

16,  '64. 

Recovery. 

25 

Atkins,  C.  S.,  Serg't,  D, 

July  27, 

Right  ;  flap.  Surg.  C.  E.  Swasey, 

62 

Bish,  A.,  Pt.,  G,  155th 

Oct.  27, 

Left:  circ'.     Union  by  first  inten 

6th  Kans.  Cav.,  age  22. 

27,  '64. 

U.  S.  V.     Aug.  2,  hasm.;  artery 

Penn.,  age  25. 

28,  '64. 

tion.    Disch'd  March  17,  1865. 

sec'd..  M.  out,    1870,  bad  stump. 

63 

Bishop,  J.  H.,  Serg't.  F, 

Aug.  30, 

Left  :  flap.    A.  Surg.  J.  D.  Gatch, 

26 

Atwell.  W.P.,  Lieut.,  G, 

July  30, 

Right.     Disch'd    Nov.  25,    1865 

18th  Kentucky. 

30.  '62. 

16th  Indiana.     Discharged. 

37th  Wis.,  age  19. 

30,"  '64. 

1871,  not  in  good  condition. 

64 

Bishop,  II.,  Pt",  A,  88th 

Dec.  13, 

Left  ;  flap  :  gang.  May  1  .  seq.  rem. 

27 

Auker,    II.,    Serg't,  C, 

May  25, 

Left.     Surg.  H.  E.  Goodman,  U. 

Penn.,  age  20. 

13,  '62. 

Disch'd  Dec.  17.  '63.  Spec.  1264. 

28th  Penn.,  age  24. 

25,"  '64. 

S.  V.     Mustered  out  July,  1865. 

65 

Black.  W.  R.,  Serg't,  G, 

April  6, 

Right;  ant.  post.  flap.     A.  Surg. 

28 

Ayrcs.  D.  C.,  Pt.,  1,  102d 

Mav  5, 

Left;  circ.     Disch'd  Mar.'lS,  '65. 

67th  Perm.,  age  22. 

7,  '65. 

T.  F.  Corson.  67th  Penn.     Dis 

Penn.,  age  '-'6. 

5,  '64. 

charged  July  7,  18G5. 

29 

Bacon.   G.   F.,    Pt.,    A, 

Mar.  31, 

Left  ;  flap.     Disch'd  July  25,  '65. 

66 

Blanchard,  C.  H.,Pt.,F, 

Oct.  19, 

Right;    circ.     Confed.  Surgeon. 

20th  Maine,  age  18. 

31,  '65. 

34th  Mass.,  age  23. 

19,  '64. 

Disch'd  Jan.  9,  1865. 

30 

Bailey,  W.   F.,   Pt.,  A, 

A  ug.  29, 

Right  ;  circular.     Discharged. 

67 

Blanchard,  W.,  Pt.,  B, 

Oct.  19, 

Left  ;  flap.     Disch'd  July  4,  1865. 

2d  U.  S.  Sharpshooters. 

30.  '62. 

90th  N.  York,  age  22. 

19,  '64. 

31 

Bakeoven,  G.  A.,  Pt.,  F, 

Nov.  27, 

Left  ;  flap.     Surg.  M.  Rizer,  72d 

68 

Blackburn.  L.    G.,  Pt., 

Oct.  4, 

Recovery. 

72d  Pennsylvania. 

28,  '63. 

Penn.     Mustered  out  Aug.  24, 

D,  3d  Missouri. 

4.  '62. 

1864.     Spec.  1883. 

69 

Bliven,  C.  J.,  Pt.,  K,  4th 

July  30, 

Left:  circ.     A.  Surg.  R.  Millar, 

32 

Bal;er,    H.    C.,    Pt.,    F, 

June  27. 

Right.     Surg.  Gibbon,  C.  S.  A. 

Rhode  Island,  age  21. 

30,"  '64. 

4th  R.  I.  Sub.  operat's.  Disch'd 

4t?th  North  Carolina. 

27,  '62. 

Retired. 

Jan.  23,  1865. 

33 

Baker,   J.    D..    Pt.,    H, 

Nov.  24, 

Left  ;  circ.  Surg.  M.  W.  Robbins, 

70 

Blossom,  W.  E.,  Pt..  G, 

Deo.  5, 

Left  ;  bilat.  oval  flap.     Surg.  N. 

4th  Iowa,  age  28. 

24,  '6:i. 

4th  Iowa.  Disch'd  July  27,  1864. 

184th  N.  York,  age  34. 

G,  '64. 

R.  Barnes,  184th  N.  Y.     Disch'd 

34 

Baker.  J.  W.,  Lie.ut.,  A, 

Dec.  13, 

Left.     Disch'd  February  1,  1863. 

June  15.  1865. 

14th  Indiana. 

13,  '62. 

71 

Boardman,   T.,   Pt.,    A, 

June  27, 

Right.     Surg.  E.  Bentlcy,U.  S.V. 

35 

Baker.  S.,  Pt.,  K,  IGth 

Oct.  7, 

Right  :  flap.     Oct.  12,  bone  cut 

2-d  Massachusetts. 

28,  '62. 

Two  sub.  op.     Dis'd  May  2,  '64. 

N.  Y.  H.  A.,  age  18. 

7,  '64. 

shorter.     Disch'd  Oct.  3,  1865. 

72 

Bolton,   G.    W.,  Pt.,   D, 

Sept.  20, 

Left.    To  Provost  Marshal  March 

Spec.  2382. 

44th  Ala.,  age  39. 

—  ,  '63. 

16,  1864. 

36 

Baldwin,  C.,  Corp'l,  H, 
58th  Penn.,  age  32. 

June  1, 
1,  '64. 

Left  ;  ant.  post.  flap.    Surg.  H.  C. 
Christy.  58th  Pa.     Disch'd  Feb. 

73 

Boland,  J.  C.,  Lieut.,  E, 
60th  New  York,  age  32. 

May  9, 
9,  '64. 

Left:  ant.  post.  flap.     Surg.  W. 
B.  Fox.  8th  Mich.    Disch'd  Nov. 

4,  18<>5. 

27,  1864. 

37 

Baldwin,  P.  B.,  Serg't, 

June  17, 

—  .     Surg.  —  Cook,  47th  Ala 

74 

Bonnell,  W.  D.,  Pt.,  G, 

Aug.  14, 

Left;  flap.     Confed.  Surg.     Neo. 

D,  48th  Alabama. 

17,  '64. 

bama.     Recovered. 

152d  N.  York,  age  23. 

14,  '64. 

Disch'd  May  9,  1865. 

1  TERKY  (C.),  Report  of  Wounded  treated  in  Field  Hospital  of  llindman's  Division,  e 


246 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

75 

Boothman,M.M.,Pt.,H, 

Sept.  1, 

Right  ;  flap.     Surg.  G.  E.  Sloat, 

113 

Bush,  W.,  Pt.,  C,  99th 

June  18, 

Left  ;  flap.     Disch'd  Nov.  15,  '64. 

38th  Ohio,  age  18. 

2,  '61. 

14th  Ohio.     Disch'd  June  5,  '65. 

Penn.,  age  41. 

19,  '64. 

76 

Boostr,  L.  B.,  Pt.,  F,  2d 

July  2, 

Left.     Recovery. 

114 

Butler,  J.   M.,   Pt.,    D, 

May  ]  6, 

Right  ;  circ.    A.  Surg.  J.  O.  Skin 

S.  Carolina,  ago  25. 

3,  '63. 

5th  Iowa. 

16,  '63. 

ner,  10th  la.,  and  W".  II.  Darrow. 

77 

Boring1,    \V.,   Corp'l,   I, 

Feb.  15, 

Right.     Disch'd  July  17,  1862. 

5th  Iowa.   Gang.;  nee.   Disch'd 

7th  Illinois. 

15,  '62. 

Oct.  23,  '63 

78 

Boss,  J.  M.,  Pt.,  A,  3d 

July  28, 

Right  :  circ.;  gang.    Aug  12.  circ. 

115 

Callahan,  T.,  Pt.,  I,  9th 

Aug.  30, 

.     May  15,  '63.  reamp.  upper 

South  Carolina. 

t:8,"'64. 

reamp.     Prison  Jan.  27.  1865. 

Georgia. 

30,  '62. 

third.     Surg.  S.  E.  Ilabcrsham, 

79 

Bourns,  W.  H.,  Pt.,  G, 

Dec.  5, 

Right;  ant.  post.  flap.     Surg.W. 

P.A.C.S.     Disch'd  Oct.  12.  '63. 

1st  Mich.  S.  S.,  age  21. 

5,  '64. 

C.  Shurlock,  51st  Penn.  Disch'd 

116 

Campbell,  D.,    Pt.,    F, 

Aug.  30, 

Right  ;    flap.     Disch'd    Dec.   22, 

July  18.  1865. 

71st  Indiana. 

30,  '62. 

1862.     Died  Feb.  4,  1864. 

80 

Bowers,  A..  Pt.,  H,  32d 

Feb.  14, 

Left:  circ.     Surg.  A.  H.  Brund- 

117 

Campbell,  J.  M.,  Pt.,  C, 

July  2, 

Left;    flap.     Disch'd  August  26, 

Ohio. 

—  ,  '64. 

age,  32d  Ohio.    Not  a  pensioner. 

25th  Ohio,  age  34. 

2,  '63. 

1864. 

81 

Bond,  E.,   Pt.,  I,    69th 

Aug.  30, 

Left;  flap.     Disch'd  April  2,  '63. 

118 

Cameron,    R.,    Pt.,    A, 

April  P, 

Left;  flap.     Surg.  C.  M.  Clark, 

Indiana. 

31,  '02. 

Died  April  6,  1868,  of  amp.  and 

62d  Ohio. 

9,  '65. 

39th  111.     Disch'd  Sept.  27,  '65. 

chronic  diarrhoea. 

119 

Cardwell,  J.  E.,  Pt,,  C, 

Aug.  6, 

Left  ;  circ.  Surg.  S.  K.  Crawford, 

82 

Bonde,  J.  C.,  Capt.,  H, 

May  3, 

Right  ;   ant.  post.  flap.     Retired 

123d  Indiana,  age  32. 

7.  '64. 

50th  Ohio.     Disch'd  May  23,  '65. 

27th  Virginia,  age  28. 

3,  '63. 

March  11,  1864. 

120 

Carl,  J.  E.,  Pt.,  A,  20th 

June  18, 

Right;  ant.  post,  skin  flap;  circ. 

83 

Bowers,  J.,  Pt.,  I,  69th 

Sept.  17, 

Right.  Surg.  S.  N.  Sherman,  34th 

Michigan,  age  2i. 

18,  '64. 

of  muscles.    Surg.  S.  S.  French, 

Pennsylvania. 

19,  '62. 

N.  Y.     Disch'd  May  1  5,  1863. 

20th  Mich.    Disch'd  Nov.  10/64. 

84 

Bradley,  J.  H.,  Pt.,  H, 

June  1, 

Left;  flap.    Surg.  J.  A.  Ramsay, 

121 

Carl,   W.,   Pt.,  G,   14th 

Aug,  18, 

Left  ;  ant.  post.  flap.     Surg.  A.  A. 

121st  Penn.,  age  26. 

2,  '64. 

121st  Penn.     Sept.  27,  ant.  post, 

Infantry,  age  44. 

18,  '64. 

White,  8th  Md.     Gang.     Duty 

flap  amp..  A.  A.  Surg.  T.  T. 

February  18,  1865. 

Maury.     Disch'd  June  23,  ]  865. 

122 

Carlyle,    T.,   —  .   D.  2d 

Aug.  14, 

Left  ;  ant.  post,  flap.     Surg.  J.  W. 

85 

Bradford,  P.,  Pt.,  F,  1st 

June  17, 

Right;  flap.      Disch'd  Dec.   15, 

N.'Y.  H.  A.,  age  49. 

15,  '64. 

Buckman,  5th  X.  II.      Disch'd 

Maine  H.  A.,  age  21. 

17,  '64. 

1864. 

May  21),  1865. 

86 

Brady,  J.,   Pt.,   C,  71st 

May  30. 

Left;  flap.     Surg.  M.  Rizer,  72d 

123 

Carroll,  J.,  Pt.,  D,  10th 

May  3, 

Right.     Surg.   White,   14th   La. 

Penn.,  age  21. 

30,'  '64. 

Penn.     Disch'd  Nov.  28,  1864. 

Louisiana. 

4,  '63. 

Recovery. 

87 

Branoski,  J.  N.,  Pt.,  G, 

Julv  4. 

Loft.     Surg.  W.   M.  Nash,   61st 

124 

Carson,  D.,  Pt.,  I,  86th 

May  10, 

Left  ;  flap'.     Disch'd  Nov.  2,  '64. 

61st  Virginia. 

4,  '63. 

Virginia.     Furl'd  Jan.  9,  1864. 

New  York,  age  26. 

11,  '64. 

88 

Breene,  I).,  Pt.,  F,  97th 

June  18. 

Right;    ant.  post.  flap.     Disch'd 

125 

Carter,   J.    W.,   Pt.,  C, 

June  27. 

Right;  flap.     Disch'd  Nov.  7,  '04. 

New  York,  age  19. 

19.  '64. 

May  17,  1865. 

85th  Illinois,  age  24. 

27,  '64. 

89 

Bridges,  B.  P.,  Pt.,  C, 

Oct.  5, 

Right  ;  flap.     Disch'd  March  30, 

126 

Carter,  J.   It.,  Pt,,   A, 

July  1, 

Left.    Surg.  Warren.    Recovery. 

25th  Indiana 

(5,  '62. 

1S03. 

26th  North  Carolina. 

3,  ''(>:!. 

90 

1  Brings,  W.  11..  Serg't 

Sept.  17, 

Left:  circular.    Confed.  Surgeon. 

127 

Cawlhorne,  C.  F.,  Pt,  E, 

Nov.  30, 

Right;   ant.  post.  flap.     Provost 

Major,  loth  Va.,  age  30. 

17,  '62. 

Furloughed  Dec.  28,  1864. 

15th  Texas,  age  39. 

De.1,'64. 

Marshal  April  6,  1865. 

91 

Brink,  J.,Pt.,C,  2d  Penn. 

Juno  10, 

Left;    ant.   post.   flap.      Disch'd 

128 

Cavanaugh,   J.,   Lieut., 

May  5, 

Left;  flap.     Surg.  G.  T.  Stevens, 

Art'y,  age  48. 

10,  '64. 

Dec.  4,  1865. 

B,  43d  N.  Y.,  age  25. 

5.  '64. 

77th  N.  Y.     Disch'd  Nov.  4,  '64. 

92 

Briody,  P.,   Pt.,  B,  4th 

June  18, 

Left;  ant.  post.  flap.     Surg.   H. 

li'.i 

Clialkley,  G.  R.,  Lieut., 

July  3, 

Right;  circ.     Surg.  —  Doughty, 

New  York  H.  Art'ry, 

18,  '64. 

C.  Tompkins,  4th  N.  Y.  H.  A. 

B,  14th  Va.,  age  29. 

4,  '63. 

C.  S.  A.     Retired  Mar.  15.  '65. 

age  25. 

Disch'd  Jan.  31,  1865. 

130 

Chamberlain,  A.  H.,  Pt., 

Aug.  30, 

Right:  circ.     Surg.  J.  C.  Wilson, 

93 

Briot,  C.,  Pt..  C,  39th  X. 

Oct.  14, 

Right;  circ.     A.  A.  Surg.  N.  S. 

K,  8th  Mich.,  age  23. 

30,  '62. 

8fh  Mich.    Disch'd  Nov.  29,  '62. 

York,  age  26. 

16,  '63. 

Barnes.     Bone  rcm'd.     Disch'd 

131 

Champlain,  W.  H.,  Pt., 

May  3, 

Right  ;  flap.    Surg.  J.  V.  Kendall, 

Sept.  20,  1865.     Died  Nov.  12, 

E,  149th  N.  Y.,  age  29. 

3,  '63. 

149th  N.  Y.  Disch'd  July  21.  '63. 

'77  ;  phthisis  pulm.  Specs.  1787, 

133 

Chapman,  S.  S.,  Pt.,  E, 

May  14, 

Left.   Mustered  out  Sept.  30,  '64. 

2344,  3027. 

27th  Mass.,  age  34. 

14,  '64. 

94 

Bristoff,  G.,  Corp'l,   A, 

July  17, 

Right;  double  flap.     Surg.  J.  D. 

133 

Cheeseman,  R.  C..  Capt,, 

April  2, 

Right  ;  flap.     Surg.  L.  W.  Bliss, 

2d  New  York  Mounted 

17,  '64. 

Mitchell,  31st  Maine.     Disch'd 

A,  45th  Penn.,  age  25. 

2,  '65. 

51st  N.  Y.     M.  out  July  17,  '65. 

Kifles,  age  28. 

April  4.  1865. 

134 

Cherington,  D.  W.,  Bu 

Sept.  22, 

Right;  oval  skin  flap.     Surg.  P. 

95 

Bronson,  A.  B.,  Corp'l, 

April  2, 

Left;  circ.;  (amp.  finger.)     Surg. 

gler,  H,  2d  West  Va. 

22,  '64. 

Gardner,  1st  West  Va.  Cavalry. 

K,  38th  Wis.,  age  23. 

2,  '65. 

W.  E.  Johnson,  lOSrth  X.  York. 

Cavalry,  age  30. 

Disch'd  March  29.  1865. 

Disch'd  June  22,  1865. 

135 

Chesebo'rough.O.  B..Pt,, 

May  15, 

Right;  flap.  Surg.  A.  W.  Reagan, 

96 

Brookfield,  R.,  Capt.,  C, 

May  8, 

Left.     Nov.  3.  rem'd  nccro.  end. 

A,  105th  111.,  age  21. 

15,  '64. 

70th  Ind.     Disch'd  Feb.  24,  '65. 

5th  N.  C..  age  19. 

10,  ''64. 

Released  May  30,  1865. 

L36 

Choselc.y,  S.  E.,  Serg't, 

Oct.  7, 

Left.     Prison  May  4,  1865. 

97 

Brooks,  J..  Pt.,  F,  151st 

July  9, 

Left;  circ.   A.A.Surg.A.R.Gray. 

B,  4th  Texas,  age  30. 

7,  '64. 

New  York,  age  18. 

10,  ''64. 

Disch'd  Nov.  27,  '64.  Spec.  4034. 

137 

3Claridi/,  J.  B.,  Pt.,  C, 

Sept.  19, 

Left.     Recovery. 

98 

Brotherton,    H.    /.,   Pt.. 

Mar.  31, 

Right.     Sent  to  Military  Prison 

24th  Alabama. 

19,  '63. 

I,  49th  N.  C.,  age  35. 

31,  '65. 

May  30,  1865. 

138 

Clark,  A.D.,Pt.,C,  134th 

July  1, 

Right;  flap.    Dec.,  '63,  seq.  rem'd. 

99 

Brower.   C.  A.,  Pt.,  D, 

June  3, 

Left;   circ.;    gangrene.     Disch'd 

Xew  York,  age  20. 

3.  '63. 

Disch'd  Feb.  18,  1865. 

14th  N.  Jersey,  age  18. 

3,  '64. 

June  1.  186.-). 

139 

Clark,  D.,  Serg't,  H,  61st 

Mar.  27, 

Right  ;    flap.     Confed.  Surgeon. 

100 

Brown,   C.,   Pt.,    I,    1st 

Dec.  13. 

Left  :  circ.     Discharged  Feb.  28, 

Pennsylvania. 

27,  '65. 

Mustered  out  Juno  28,  1865. 

Artillery,  age  21. 

13,  '62. 

1863. 

140 

Clarke,  '  J.   L.,   Pt.,   H, 

Sept.  17, 

Right.     Surg.  H.  Taylor,  U.S.V. 

101 

Brown,  E.,  Pt.,  K,  89th 

Oct.  27, 

Right  :  circ.     Surg.  'I'.  H.  Squire, 

57th  New  York. 

18.  '62. 

Disch'd  Jan.  13,  1863. 

New  York,  age  35. 

27.  '64. 

89th  N.  Y.    I  )isch'd  Nov.  30,'65. 

141 

Clarno,  W.,  Pt.,  C,   3d 

June  16, 

Right;  circ.     Surg.  J  W.  Brock, 

L02 

Brown,   G.  W.,  Pt..    L, 

July  22, 

—  .     Surg.  Hawkins,  C.  S.  A. 

Wisconsin,  age  22. 

16,  '64. 

66th  O.     Disch'd  July  26,  '65. 

10th  South  Carolina. 

23,'  '64. 

Recovery. 

142 

Clements,  G.  A.  H.,Lt., 

Aug.  16, 

Right;  circ.;  protrusion.   Disch'd 

103 

Brown,  J.,  Pt.,  G,  17th 

June  17, 

Right;    flap.     Disuh'd   May  27, 

D,  1st  Md.  Cav.,  age  22. 

16,  '64. 

March  16,  1865. 

Vermont,  age  17. 

17,  '64. 

1865. 

143 

Cline,  J.  H.,  Pt.,  K.  4th 

Dec.  13, 

Right  ;  cire.  Disch'd  Aug.  22,  '63. 

104 

Brown,  J.  W.,   Pt..    K, 

June  20, 

Left  ;  ant.  post.  flap.     Surg.  C.  J. 

New  York. 

14,  '62. 

21st  Kentucky,  age  30. 

20,  '64. 

Walton.  21st  Ky.     Discharged 

144 

Clouts,  A.,  Pt.,  F,  32d 

Mar.  21, 

Left  ;  lateral  flap.     Disch'd  June 

March  29,  1865. 

Missouri,  age  20. 

21,  '65. 

26,  1865. 

105 

Brown,   T.    C.,   Pt..    I). 

June  30. 

—  .  Surgg.  Niblet  and  Harrison. 

145 

Cobb,  S.  W.,  Pt,,  E,  20th 

May  29, 

Right  ;  circ.     Surg.  C.  B.  Gibson, 

24th  Virginia. 

J'ly  V62. 

Disch'd  Sept.  24,  1862. 

Georgia,  age  39. 

30,  '64. 

C.  S.  A. 

106 

Brown.  W.  J..   Pt.,   I>, 

Nov.  3, 

Right  ;  ant.  post.  flap.     Surg.  J. 

146 

Coder,   P.    M.,   Pt.,   A, 

May  16, 

Right  ;  flap.     Disch'd   April  17, 

19th  Maine,  age  18. 

4,  '64. 

T.  Myers,  59th  N.  Y.     Disch'd 

28th  Iowa. 

17,  '63. 

1865. 

August  7,  1865. 

147 

Coldwell,  M.  B.,  Corp'l, 

Sept.  14, 

Left;  gangrene;  nee.  p'n  of  shaft 

107 

Brown,   W.    W.,  Serg't, 

Sept.  19, 

Right  ;  flap.  Surg.  Lowe,  C.  S.  A. 

D.  1st  Ga.  Leg.,  age  24. 

15,  '62. 

rem'd.     Retired  Feb.  24.  1865. 

A,  22d  Virginia,  age  36. 

19,  '64. 

Transferred  Jan.  8,  1865. 

148 

<Cole,  J.  W.,  —  ,  G,  28th 

June  27, 

Left  ;  circ.     Furloughed  July  19, 

108 

Browne,  T.  W.,  Pt.,  C, 

Aug.  29, 

Left.     Discharged  Oct.  21.  1862. 

North  Carolina. 

28,  '62. 

1862. 

24th  New  York. 

2!),  '62. 

149 

Cole,  W.,  Corp'l,  H,  6th 

May  18, 

Right;  circ.      Furloughed  July 

109 

2  Bryant,  W.  R.,  Pt.,  —  . 

Sept.  17, 

Left  ;  flap.     Recovered. 

Mass.  Cav.,  age  23. 

20,"  '64. 

10,  1864;  healed. 

18th  Mississippi. 

18,  'C:. 

150 

Coleman,  J.,  Pt,,  A,  14th 

Aug.  5, 

Right.     Disch'd   Sept.  22,  1862. 

110 

Buchanan.  J.  S.,  Pt.,  K, 

Aug.  21, 

Left  ;  iat.  flap.     Surg.  G.W.  Met- 

Maine. 

5,  '62. 

Died  Jan.  12,  1864  ;  gastritis. 

13thS.  C.,  age  22. 

22   '64. 

calf.  76th   N.  Y.    "Prison   Dec. 

151 

Collins,  A.,  Pt.,  E,  36th 

Sept.  29, 

Left.     Surg.  J.  W.  Mitchell.  4th 

30,  1864. 

Col'd  Troops,  age  51. 

29,  '64. 

C.  T.     Disch'd  June  1,  1865. 

111 

Buck,  J  ,  Pt..  A,  3d  N. 

June  4, 

Right  ;  circ.    Disch'd  May  25,  '65. 

152 

Collins,  C.,   Pt.,   D,   3d 

June  18. 

Left;  flap.     Mustered  out  June 

Hampshire,  age  25. 

4,  '64. 

Delaware,  age  23. 

18,  '64. 

6,  1865. 

112 

Bugbee,    S.,   Corp'!,  E, 

Oct.  27, 

Right  :  ant  post.  flap.     Surg.  F. 

153 

Collins,  J.   W.,  Pt.,  F, 

July  20. 

Right;    circ.;    gang.;   sloughing. 

14th  Conn.,  age  24. 

28,  '64. 

A.  Dudley.  14th  Conn.     Hsem.; 

12th  La.,  age  23. 

20,  '64. 

Recovery  Sept.  22,  1864. 

lig.  art.    'Disch'd  Aug.  23.  '65. 

154 

Collins,    S.    A.,  Pt.,  K, 

April  1, 

Right;  (hip.     Surg.  W.  11.  True, 

Dec.,  1865,  reamp.  upper  third. 

20th  Maine. 

2,  '65. 

20th  Maine.    Disch'd  ,  1865. 

'FISHER  (G.  J.),  Fifty-seven  Cases  of  Amp.  after  battle  of  Antietam,  in  Amer.  Jour.  Med.  Sci.,  1863,  Vol.  45,  p.  47. 
3 FISHER  (G.  J.),  loc.  dt..  p.  47.  3  TERRY  (C.).  loc.  cit.,  p.  76. 

4  SMITH  (E.  II.),  Report  of  cases  of  compound  comminuted  fracture  of  fejnur,  Chimborazo  Ilnsp.,  T/iird  Div.,  in  Confed.  States  Med.  and  Suryical 
Journal,  1864,  Vol.  1,  p.  24. 


SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER    THIRD. 


247 


NO. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION  AND  AGE. 

DATES. 

OPERATIONS,  OPEKATOHS, 
RESULT. 

155 

Comstock,  H.,  Pt.,  12th 

Sept.  2, 

Left;  flap.    Disch'd  Oct.  16,  '63. 

195 

Davenport,  J.  M.,  Cap't, 

Sept.  1, 

Right;  flap.  Surg.G.E.Sloat,14th 

Wisconsin  Battery. 

2,  '62. 

G,  10th  Kentucky. 

2,  '04. 

Ohio.    Mustered  out  Dec.  0,  '64. 

156 

Connell,  M.,  Pt,,  E,  2d 

Aug.  3, 

Left;  circ.   Surg.  G.  A.  Otis.  27th 

190 

Davis,  A.  A.,  Pt.,  K.Cth 

Mar.  31, 

Right  ;  long  ant.  flap.      Surg.  J. 

Penn.  Art'y.  age  36. 

4,  ?64. 

Mass.     Disch'd  Mar.  21,  1865. 

Wisconsin,  age  32. 

31,  '65. 

C.  Hall,  Cth  Wis.   April  4,  haem.; 

157 

Conner,  J.,  Pt.,  A,  47th 

July  1, 

Left.    Surg.  J.  S.  Bruce,  C.  S.  A. 

lig.  femor'l.    Aug.  18,  dead  bone 

Virginia,  age  28. 

1,  '63. 

Retired  Nov.  29,  1864. 

rem'd.    Disch'd  Sept.  14,  1865. 

158 

Connor,  J.,  Pt.,  G,  llth 

Sept,  13, 

Left.  Surg.  J.  B.  Whitcomb,  llth 

197 

Davis,  D.  D.,  Corp'l,  C, 

Nov.  24, 

Left;  circ.     Confed.  surg.    Mar., 

Conn.,  age  21. 

13,  '62. 

Conn.     Disch'd  Nov.  25,  1805. 

2d  Mich.,  age  26. 

24,  '63. 

'64,  nee.   June  1.  gang.    11,  nee. 

159 

Conway,  P.,Pt.,  K,  139th 

Sept.  29, 

Left;  circ.     Disch'd  July  31,  '65. 

bone  rem'd.  Disch'd  Aug.  3/64. 

New  York,  age  29. 

30.  '64. 

1870,  stump  tender. 

160 

Coons,    G.   W.,  Pt.,  H. 

Aug.  29, 

Left  ;  circ.    Surg.  J.  Y.  Cantwell. 

198 

Davis,  G.  S.,Pt.,A,185th 

Mar.  31, 

Right  ;  ant.  pest.  flap.     Surg.  C. 

82d  Ohio. 

30,  '62. 

82d  Ohio.     Disch'd  Oct.  25,  '02. 

New  York,  age  33. 

April  1, 

W.  Crary,  185th  N.  Y.    Disch'd 

161 

Cooper,  J.  P.,  Serg't,  G, 

Aug.  21, 

Right  ;  circ.     Surg.  T.  F.  Oakos, 

1865. 

July  20,  1805. 

7th  S.  Carolina,  age  19. 

21,  '64. 

50th  Mass.     Prison  Mar.  1,  1865. 

199 

Davis,   J.,   Pt,,   F,  61st 

Aug.  21, 

Left;  flap.    Surg.  G.T.Stevens, 

162 

Cooper,  S.,  Pt.,  A,  17th 

Oct.  19, 

Right  ;  circ.     Surg.  Patterson.  C. 

Penn.,  age  40. 

21,  '64. 

77th  N.  Y.  Disch'd  June  16,  '65. 

Mississippi,  age  34. 

19,  '64. 

S.  A.    Prison  May  9,  1865. 

200 

Davis,  M.,   Pt.,  E,  15th 

July  5, 

Right  ;  lat.  flap.  Surg.W.lI.  Gib- 

163 

Cooper.    \V.  K.,  Pt,  E, 

Oct.  19, 

Right;  flap.     Retired  March  18, 

Iowa,  age  19. 

5,  '64. 

bon,  15th  Iowa.    Sept.  10,  gang. 

21st  Miss.,  age  20. 

20,  '64. 

1865. 

Disch'd  May  26,  1805. 

164 

Copeland,  D.  B.,  Pt.,  G, 

June  4, 

Right;  ant.  post,  flap.     Dec.  6, 

201 

Day,  A.,  Pt..  H,  31st  C. 

Sept.  15, 

Right;  circ,    Jan.  7/65,  nee.  bone 

2d  New  Hamp.,  age  25. 

5,  '64. 

nee.  bone  rein'd.     Disch'd  May 

Troops,  age  20. 

15,  '04. 

rem'd.    Disch'd  June  10,  1865. 

31,  1865. 

202 

Day,  I.,  Pt.,  A.  5th  C. 

Sept.  29, 

Left;  bi-lat.  flap.     Confed.  surg. 

165 

Corbett,  C.  A.,  Pt.,  B, 

June  6, 

Right  ;  ant.  post.  flap.     Surg.  J. 

Troops,  age  24. 

Oct.  1/04. 

Disch'd  Aug.  31,  1865. 

8th  Wisconsin,  age  23. 

7.  '64. 

E.   Murta,   8th  Wis.      Disch'd 

203 

Dan,    J^-.   Pt.,   A,  10th 

Aug.  28, 

Left.   Surgeon  Walls.  Recovery. 

Nov.  22,  1865. 

Virginia. 

29,  '62. 

106 

Cortes,  L.  G.,  Ptlf  G,  7th 

July  3, 

Left.  Surg.  Davis,  C.  S.  A.   Dec. 

204 

Dean,  D.  W.,  Pt.,  1st  la. 

Aug.  31, 

Left  ;  flap.     A.  Surg.  D.  Haider- 

Louisiana,  age  21. 

3,  '63. 

15,  nee.  bone  ext.    Exch'd  Mar. 

Battery,  age  17. 

31,  '64. 

man,  46th  O.     Dis.  May  9,  '65. 

4,  1864. 

205 

Dean,  J.  M.,  Pt.,  K,  3d 

Sept  22, 

Left;  flap:  bone  prot.    'Dec.  30, 

167 

Costello,  T.,  Corp'l,  E, 

June  10, 

Right;  (also  forearm.)     Confed. 

West  Va.,  age  22. 

22,  '64. 

rem.  of  bone.  Disc'd  May  30/65. 

108 

93d  Indiana. 
Coughlin,M.,Pt.,H,  94th 

12,  '64. 
June  3, 

surg.     M.  out  August  10,  1805. 
Right.    Disch'd  January  25,  1865. 

206 

Deichley,  S.,  Pt.,  I,  53d 
Penn.,  age  19. 

Mar.  31, 
31,  '65. 

Left  ;  bi-lat,  skin  flaps.    Surg.  W. 
Vasburgh,  lllth  N.  Y.     Disch'd 

New  York,  age  19. 

3,  '64. 

August  2,  1865. 

169 

Covington,  W.  J.,  Pt.,  E, 

June  22, 

Right  ;  ant,  post.  flap.    Surg.G.L. 

207 

DMinger,  P.,—  I,  llth 

May  5, 

.     Surgeon  Wilson,  C.  S.  A. 

18th  N.  C.,  age  26. 

22,  '64. 

Potter,  145th  Penn.     Released 

North  Carolina. 

5,  '64. 

Recovery. 

July  13,  1865. 

208 

Delmer,  P.,  Pt.,  F,  17th 

July  28, 

L't  ;  lat.  flap.  Surg.H.McKennan, 

170 

Cox,  R.  N.,  Pt.,  D,  41st 

July  12, 

Right  ;  circ.    Diseh'd  Oct.  9,  '63. 

Wis.,  age  26. 

29,  '04. 

17th  Wis.     V.  R.  C.  April  1/65. 

Illinois. 

13,  '63. 

209 

Demond,G.,Pt.,K,  145th 

Dec.  13, 

Left,    Disch'd  Feb.  26,  1863. 

171 

Craig,  J.  B.,  Pt.,  E,  15th 

Aug.  12, 

Left;  circ.;  gangrene.    Recovery 

Penn.,  age  32. 

13,  '62. 

Texas,  age  25. 

12,  '64. 

Sept.  22,  1864. 

210 

Dempsey,  T.,  Corp'l,  A> 

May  3, 

Right  ;   flap.     Disch'd  April  19, 

172 

Crawford,  J.  A.,  Pt.,  K, 

July  1, 

Right  ;  ant.  post.  flap.   S  urg.  H  .  C  . 

2d  Vermont. 

3,  63. 

1864. 

Oth  Wisconsin,  age  24. 

2,  '63. 

May,  5th  N.Y.  Oct.  30,  seq.  rem. 

211 

Deptitch,  W.,  Pt.,  E,  3d 

Dec.  17, 

Right  ;  flap.    Surg.  A.  A.  Stocker, 

Feb.  2,  '04,  nee.bo.rem.  3d,  hasm. 

Massachusetts. 

17,  '62. 

3d  Mass.    Mustered  out. 

Dis.  May  3/64.  Specs.W'il,  2153. 

212 

Dewitt,  G.  M.,  Corp'l,  H, 

Feb.  6, 

Left  ;  flap.    Surg.A.S.  Coe,  147th 

173 

Creamer,  D.,  Pt.,  C,  9th 

Aug.  23, 

Right  ;  cire.     Surg.  J.  Owens,  U. 

147th  N.  York,  age  26. 

6,  '65 

N.  Y.    Disch'd  June  22,  1865. 

Maryland,  age  19. 

23,  '63. 

S.  V.    M.  out  Feb.  23,  '64.  Died 

213 

Dickerson,  P.  B.,  Lt.,  H, 

Dec.  15. 

Left  ;  circ.  Surg.F.W.Lytle,  36th 

June  28,  1870. 

13th  C.  Troops,  age  32. 

15,  '64. 

Illinois.    Furfd  Feb.  7,  1865. 

174 

Crew,  M.,  Pt.,  E,  156th 

Mar.  22, 

Left;  circ.     A.  A.  Surg.  L.  W. 

214 

Dickinson,  I.,  Pt.,H,  53d 

July  22, 

Right  ;  circ.    Confed.  surg.    Dis. 

Illinois,  age  22. 

22,  '65. 

Beckwith.     Mustered  out. 

Indiana,  age  19. 

23,  '64. 

June  26,  '65.    Reamp.  Sept.  ,'06. 

175 

Cronkite,  J.  W.,  Major, 

April  6, 

Left.    Mustered  out  June  25,  '65. 

215 

Digbij,  C.  T.,  Pt.,  D,  19th 

Aug.  9, 

Left.     Surg.  R.  Battey,  C.  S.  A. 

121st  N.  Y.,  age  24. 

6,  '65. 

Georgia. 

10.^02. 

Recovery. 

170 

Crosby,  A.  C.,  Corp'l,  I, 

Nov.  29, 

Right;  ant.  post.  flap.    March  26, 

210 

Dignian,  E  ,  Pt.,  B,  5th 

Mav  16. 

Left  :  circ.     Surg.  L.  D.  Harlow, 

5th  Ga.,  age  30. 

De.  1/63. 

'64,  reamp.  middle  third.     Pro. 

Confederate,  age  25. 

16,'  '04. 

U.  S.V.     Pro.  Mar.  June  16/65. 

Marshal  Dec.  1,  1804. 

217 

Dittman,  J.  H.,  Lieut.G, 

Aug.  16, 

Left  ;  flap.     Surg.  R.  A.  Dodson, 

177 

Cross,  L.  M.,  Pt.,  E,  58th 

Sept.  29, 

Left;  circ.     Disch'd  March  29, 

1st  Md.  Cav.,  age  21. 

16,  '04. 

IstMd.Cav.  Disch'd  Jan.  12/65. 

Penn.,  age  23. 

30,  '04. 

1865. 

218 

Dnnthil,  S.  J.,  Pt.,  B,  2d 

July  1, 

Left.     Surgs.  Salmon  and  Page. 

178 

Cross,  S.  F.,  Pt.,  D,  llth 

June  6, 

Left;  circ.    Surg.  L.  H.  Baker, 

South  Carolina. 

1.  '02 

Recovery. 

Missouri,  age  33. 

6,  '64. 

24th  Mo.    M.  out  July  13,  1864. 

219 

Dole,  R.  D.,  Corp'l,  II, 

Sept.  1, 

Right;  ant.  post.  flap.     Surg.  J. 

179 

Ci-ouse,  J.  L.,  Serg't,  C, 

Oct.  19, 

Prison  February  10,  1865. 

38th  Ohio,  age  25. 

2,  '64. 

Haller,  38th  O.   Dis.  May  26/65. 

31st  Georgia. 

19,  '64. 

220 

Dooley,  W.,  Pt.,  Wash 

Dec.  7, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

180 

Crowell,  B.,  Pt.,  I,  20th 

May  10, 

Right  ;  flap.    Surg.  H.  F.  Lyster, 

ington  Art'y,  age  29. 

8,  '64. 

J.  R.  Owens.     Provost  Marshal 

Mass.,  age  24. 

10,  '64. 

5th  Michigan.    Dis.  Mar.  27,  "05. 

March  1,  1805. 

181 

Crowell,  S.,  Pt.,  I,  93d 

June  23, 

Right;  circ.    Teal's  method.    A. 

221 

Doore,  C.  F.,  Pt.,  K,  31st 

April?, 

Left;  circ.    Surg.  —  Hays.  Frag. 

Ohio,  age  19. 

24,  '64. 

Surg.  J.  M.  Weaver,  93d  Ohio. 

Maine,  age  16. 

3,  '65. 

bone  rem'd.     Dis'd  July  18/05. 

Disch'd  May  16,  1865. 

222 

Doran,    M.,    Lieut.,  C, 

Mar.  19, 

Left  :  circ.  Surg.  E.  Bat  well.  14th 

182 

Crowley,  R.,  Serg't,  C, 

April  2, 

Right;  bi-lateral  flaps.     Surg.  J. 

14th  Mich.,  age  28. 

19,  '65. 

Mich.    Disch'd  Oct.  17,  1805. 

23d  Illinois,  age  27. 

2,  '65. 

S.  Tavlor,  23d  111.    Disch'd  Oct. 

223 

Dougherty,  J.  H..  Capt., 

Nov.  12, 

Left  ;  ant.  post.  flap.     Sloughing. 

26,  1865. 

B,llthVa.Cav.,age25. 

12,  '64. 

Exchanged  Feb.  16,  1805. 

183 

Crown,  G.,   Pt.,  H,   2d 

Sept.  19, 

Left  ;  circ.     A.  Surg.  J.  J.  Meigs, 

224 

Douglas,  G.  W.,  Lieut., 

Aug.  6, 

Left.    Surg.  A.  M.Wildcr,  U.S.V. 

Vermont,  age  19. 

19,  '64. 

llth  Vt.    Disch'd  June  6,  1865. 

G,  8th  Tennessee. 

6,   64. 

Mustered  out  June  30,  1805. 

184 

Ciillen,  D.  C.,  Serg't,  E, 

July  22, 

Right;  flap.      Surg.  A.  H.  Brun- 

225 

Douglass,  J.  A.,  Pt.,  D, 

June  18, 

Right  ;  circ.     To  Regiment  Feb. 

32d  Ohio,  age  30. 

23,  '64. 

dage,  32d  Ohio.  Erysip.    Disch. 

llth  Infantry,  age  23. 

19,  '64. 

18,  1865. 

March  30,  1865. 

226 

Downei/.  W.  C.,  Pt.,  11, 

May  16, 

;  circ.     Furloughed  August 

185 

Curtin,  T.,  Pt.,  G,  147th 

Jan.  15, 

Right;  double  flap.     Surg.  F.  B. 

43d  Ala.,  age  32. 

16,  '64. 

23,  1861. 

New  York,  age  29. 

16,  '65. 

Kimball,  3d  N.  H.     Nee.  bone 

227 

Doyle.  J.,  Pt.,  F,  Phil- 

Nov.  29, 

Right.     Surg.  .1.  S.  Ross,  llth  N. 

rem'd.  Dis.Oct.21/65.  5pec.3U4. 

lips's  Legion. 

29,  '63. 

11.    Sent  to  Confederate  lines. 

186 

Curtis,   A.  A..  Capt.,  I, 

July  20, 

Flap.    Surg.  B.  L.  Hovev,  136th 

228 

Downing,  ./.,Pt.,  K,  55th 

Nov.  30, 

Left  ;    ant.  post.  flap.      Provost 

136th  N.  Y.,  age  22. 

20,  '64. 

N.  Y.    Disch'd  Jan.  14,  1865. 

Alabama,  age  25. 

De.  1,  '64. 

Marshal  March  17,  1865. 

187 

Cuthbert.  T.,  Serg't,  G, 

Oct.  27, 

Left  ;  ant.  post.  flap.    Surg.  F.  A. 

229 

Drane,  K.,  Pt.,  G,  52d 

Dec.  13, 

Right.    Doing  well. 

8th  New  York  Heavy 

28,  '64. 

Dudley,   14th  Conn.     Nov.  19, 

Virginia,  age  23. 

13,  '62. 

Artillery,  age  44. 

gangrene.  22,  haBm.;lig.  femor'l. 

230 

Driver,   J..   Pt.,   H,   3d 

May  25, 

Right  ;   circ.     Disch'd  June  22, 

Disch'd  July  18,  1805. 

Wis.,  age  18. 

25,  '64. 

1855. 

188 

Daley,  E.,  Pt.,  K,  158th 

Sept.  28, 

Right.     Disch'd  June  24,  1865. 

231 

Drumm,  G.  W..  Pt.,  I, 

Aug.  29, 

Left.     Surg.  J.  Y.  Cantwell,  82d 

New  York,  age  18. 

28.  '64. 

82d  Ohio. 

30,  '62 

Ohio.    Disch'd  Feb.  23,  1863. 

189 

Damarce,  M.,  Corp'l,  A, 

Mar.  20, 

Right  ;  ant.  post,  skin  flap.    Surg. 

232 

Druse,  E.  H.,  Corp'l,  A, 

Dec.  10, 

Left  ;  ant.  post.  flap.     Surg.  V.  B. 

25th  Iowa,  age  23. 

20,  '65. 

A.  T.  Hudson,  26th  Iowa.     Dis. 

5th  Minnesota,  age  20. 

17,  '64. 

Kennedy,  5th    Minn.      Disch'd 

July  23,  1805. 

June  5,  1805. 

190 

Danforth,  H.  J.,  Corp'l, 

May  18, 

Right  ;  circ.;  bone  prot.    May  26, 

233 

Duell,  C.  N.,  Pt.,  H,  9th 

Oct.  19, 

Right  ;  (lap.    Disch'd  June  9,  '65. 

A,  8th  N.Y.  Art.,  age  18. 

19,  '64. 

haem.;  lig.  fern.  Dis.Aug.  11/65. 

N.  Y.  II.  A.,  age  35. 

19,  '04. 

191 

Daniels.  II.,  Pt.,  D,  1st 

June  14, 

Right  ;  flap.    Disch'd  Sept.  4,  '64. 

234 

Dugan,  W.   C.,   Serg't, 

May  25, 

Left  ;  flap.    Disch'd  Jan.  2,  '05. 

Louisiana,  ago  23. 

16,  '63. 

Spec.  4361. 

F,  63d  Ohio,  age  20. 

25,"  '64. 

192 

Dantz.   W.  \V.,  Pt.,   F, 

Aug.  25, 

Right  :    circ.      Confed.  surgeon. 

235 

Duncan,  J.    H.,  Serg't, 

Oct.  10, 

Left  ;  ant.  post.  flap.     Surg.  J.  P. 

36th  Wis.,  age  18. 

27,  '64. 

Disch'd  Jan.  6,  1866. 

B,  7Cth  New  York. 

10,  '03. 

Prince.  30th  Mass.    Discharged. 

193 

Dare,   II.  C.,  Serg't,  C, 

Mav  1, 

Left.     Disch'd  July  16,  1863. 

230 

Dunlap,  W.,  Pt..  I,  9th 

July  30, 

Right  ;  lat.  flap.    Nov.  9th.  gang.; 

50th  Ohio. 

3,  "63. 

New  York,  age  24. 

30,  '64. 

liiPm.    22,  lig.:  erysip.     Disch'd 

194 

Davage,  J.,  Pt.,  B,  4th 

June  15, 

Right  •  circ.    Surg.J.  W.Mitchell. 

MaylS.  '65.   1870,  stump  slou'g. 

Col'd  Troops,  age  22. 

15,  '64. 

4th  C.  T.    Necrosed  ;  six  ins.  of 

237 

Dunn,  A.,  Pt.,   A,  53d 

Aug.  30, 

Right  :  eirc.     Surg.  S.  P.  Homier, 

shaft  rem'd.    Disc'd  May  20/65. 

Ohio,  age  21. 

30,  '64. 

47th  O.      Disch'd  Mav  3,  1865. 

248 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


TCn 

NAME.  MILITARY 

OPERATIONS,  OPERATORS, 

No 

NAME,  MILITARY 

1  *  \  i  i  ^ 

OPERATIONS,  OPERATORS, 

INU. 

DESCRIPTION,  AND  AOE. 

RESULT. 

DESCRIPTION,  AND  AGE 

RESULT. 

238 

Dunn,  J.  W.,  Pt.,  K,  3d 

June  9, 

Right.     Disch'd  February  9,  '64. 

278 

Fisher,  E.  D.,  Pt.,  A,  — 

De.30,'62 

Left.     To  Camp  Morton   March 

OOQ 

Wisconsin. 

9,  '63. 

Louisiana,  age  19. 

Jan.  1,  '63 

22,  1803. 

f,>i\'i 

OA  ("U 

Dunn,  M.,Corp'l,  H,  46th 

May  25, 

Both  ;  oirc.;  (li'd  of  r't  fib.  exc.  on 

279 

Fisher,  N.,  It.,  H,  37th 

Nov.  25, 

Right  ;  circ.     Surg.   A.  Weiden- 

-4U) 

Penn.,  age  21. 

2(i"  27, 

25th;)  gang.    Aug.,  '04,  reainp. 

Ohio,  age  27. 

25,  '63. 

bach,  37th  Ohio.    Disch'd  Oct.  1, 

I«64. 

right  mid.  third.    May,  '05,  nee. 

1804.     Spec.  3210. 

bone  rem'd  from  left.     Disch'd 

280 

Fitzherbert,  A.,  Pt.,  E, 

April  9, 

Right:  ant.  post.  flap.     Surg.  H. 

Aug.  17,  '05.      Died  Oct.  23,  '77. 

llth  Maine,  age  20. 

9,  '65. 

C.  Levensaler,  8th  Me.   Disch'd 

Spec.  3193. 

June  20,  1805. 

241 

Dyer,  J.,  Pt.,  V,  89th  N. 

June  4, 

Left  ;  circ.    Disch'd  June  26,  '05. 

281 

Fitzpatrick,    J.,  Pt,  F, 

April  2, 

Left.     Mustered  out  July  28,  '65. 

York,  age  20. 

5,  '04. 

8th  N.  Jersey,  age  23. 

2,  '65. 

242 

East,  T.J.,Serg't,  1.  13th 

Aug.  19, 

Right;  circ.     A.  Surg.  A.  E.  Ar 

282 

Fleming,  J.,  Pt.,  D,  2d 

Nov.  8, 

Left  ;  flap.   Disch'd  July  4,  '05. 

Alabama,  age  22. 

111.  '64. 

nold,  C.S.A.  Trans.  Nov.  29,"04. 

Artillery,  age  21. 

8,  '63. 

243 

Eastwood,  J.  S.,  Pt.,  H, 

July  21. 

Left  ;  doub.flap.  Surg.  W.Lomax, 

283 

Flood,  W.,    Pt.,    C,  1st 

Mar.  1, 

Right  ;  skin  flap  ;  ciro.  muscles. 

48th  Illinois,  age  19. 

21.  '04. 

12th  Ind.     Disch'd  July  2,  1805. 

Md.  P.  H.  B.,  age  20. 

2,  '64. 

A.  A.  Surg.  W.  S.  Adams.    Dis. 

244 

Edge,  IF.  /,.,  Pt.,  G,  10th 

De.31,'62 

Left;  circ.    Furl'd  June  16,  '63. 

May  27,  '04.     Died  Dec.  C,  teta. 

S.  Carolina,  age  23. 

Jan.  1,'63. 

and  expos  after  reamp.  <Sp.3930. 

245 

Edmonds,  J.  J..  Pt.,  D, 

June  19, 

Left  ;  circ.   Surg.  D.  A.  Chamber 

284 

Fogerty,  M.  J.,  Pt.,  F, 

Aug.  Id. 

Right;  flap.  A.Surg.P.Goddard, 

90th  Penn.,  age  38. 

19,  '64. 

lain,  94th  N.  Y.     Sub.  operat'n. 

12th  Infantry. 

19,  '04. 

U.S.A.    Disch'd  March  9,  1865. 

Dis.  Sept.  21,  't)4.    '70,bad  stump. 

285 

Fogg,  H.  M.,  Pt.,  E,  1st 

Oct.  19, 

Left  ;  gang.;  ant.  post.  flap.    Surg-. 

246 

Edwards,  #.,  Pt.,  C,  20th 

July  9, 

Right.     Surg.  —  Bissell,  C.  S.  A. 

Maine,  age  22. 

20,  '04. 

G.T.Stevens,  77th  N.Y.    Gang.; 

North  Carolina,  age  19. 

9,  "04. 

Exch'd  Sept.  21,  1804.    Retired 

slough'g.    Disch'd  June  8,  '65. 

Jan.  17.  1805. 

286 

Foote,  M.  J.,  Capt.,  B, 

June  17, 

Right.    Surg.  J.  Ash,  70th  N.  Y. 

247 

Edwards,G.,  Pt.,  F,  30th 

July  30, 

Right  ;   flap.     Surg.  G.  J.  Potts, 

70th  N.  York,  age  28. 

17,  '64. 

Furloughed  Sept.  16,  1864. 

C.  Troops,  age  21. 

30,"  '04. 

23d  C.  T.    Feb.,  1805.  nee.  bone 

287 

Ford,  C.,  Pt.,  C,  106th 

Sept.  17, 

Right.    Surg.S.  N.Sherman,  34th 

rem'd.    Disch'd  July  26,  1865. 

Pennsylvania. 

17,  '62. 

N.  Y.    D»ch'd  Jan.  10,  1863. 

248 

Ehle,  J.  N.,  Pt.,  D,  2d 

Sept.  14, 

Left  ;  flap.    Disch'd  Mar.  5,  1863. 

288 

Ford,  J.  A.,  Pt.,  H,  38th 

April  2, 

Right  ;  circ.     Surg.  W.  B.  Fox, 

Wisconsin. 

15,  '02. 

Wisconsin,  age  30. 

2,  '65. 

8th  Mich.    DischU  June  1,  1865. 

249 

Ehle,   W.,  Pt.,  A,  14th 

July  1, 

Right  ;  flap.    Discharged. 

289 

Foreman,  A.,Pt..D,  150th 

July  1, 

Left  ;  ant.  post.  flap.    Oct.  11,  bone 

New  York. 

2,  fe. 

Pennsylvania,  age  21. 

1,  '63. 

prot.  rem.     Disch'd  Dec.  14,  '04. 

250 

Eidson,  J.    W.,  T/ient., 

Sept.  20, 

Right.     Surg.  —  Carlisle.      Re 

Spec.  2397. 

G,  7th  South  Carolina. 

20,  '63. 

covery. 

290 

Fox,    J.,   Pt.,    D,    16th 

May  17, 

Right:  ant.  post,  skin  flap;  circ. 

251 

Elam,  R.  S.,  Corp'l,  E. 

July  2, 

Right.    Sept.  23,  nee.  bone  rem'd. 

Michigan,  age  24. 

18,  '65. 

sect.  mus.    Disch'd  Aug.  5,  '05. 

23d  Va.  Bat'ry,  age  32. 

2.  '03. 

Provost  Marshal  Oct.  13,  1653. 

291 

Franks,  J.W.,Pt.,E,  6th 

Aug.  28, 

Left  ;  doub.  flap.    Surg.  O.  Hoyt, 

252 

Elfwing,   N.  A.,  Major, 

Feb.  21, 

Right  ;  circ.    Surg.  A.  D.  I'almer, 

Iowa  Cavalry. 

30,  '04. 

30th  Wis.    Disch'd  Mar.  30,  '05. 

48th  N.  Y.,  age  33.  ' 

21,  '65. 

9th  Me.    M.  out  Sept.  12,  1805. 

292 

Franklin,  D.  M.,  Pt.,  A, 

July  20, 

Left.     Sent  to  Prison  Oct.  31,  '04. 

253 

Elliott,  J.  J.,  Pt.,  L,  1st 

Aug.  25, 

Right  ;    flap.      Confed.    surgeon. 

30th  Georgia. 

20,  '04. 

Maine  Cav.,  age  20. 

26,  '64. 

Disch'd  June  30,  18f'5. 

293 

Frazer,  J.K.,Pt.,  B,  44th 

Sept.  19, 

.    Surgs.  Jackson  and  Ganna- 

254 

Ellen,  H.,  Pt.,  C,  3d  Mo., 

May  28, 

Left  ;  flap.     Surg.  G.  L.  Carhart, 

Tennessee. 

19,  '03. 

way.    Recovery. 

age  27. 

28,  '64. 

31st  Iowa.  Disch'd  Sept.  27/04. 

294 

Frazier,  J.  B.,  Corp'l,  F, 

Dec.  13, 

Left.    Disch'd  June  6,  1863. 

255 

Ellis,  F.,  Pt.,  B,  21st  Me. 

May  27, 

Left  ;  circ.    Surg.  G.  E.  Brickett, 

26th  New  York. 

14,  '6-3. 

28.  '63. 

21st  Maine.    M.  out  Aug.  25.  '03. 

295 

Freeman,  A.  B.,  Pt.,  E, 

Aug.  30, 

Left,     A.  Surg.  W.  B.  Witt,  69th 

256 

Ellis,  R.,  Pt.,  C,  81st  In 

June  23, 

Right  :  flap.    Surg.  C.  J.  Walton, 

G9th  Indiana. 

30,  '02. 

Ind.    Disch'd  March  20,  1863. 

diana,  age  21. 

23,  '64. 

21st  Ky.    Disch'd  May  22,  1865. 

296 

Freeman,  A.  J.,  Pt.,  C, 

May  7, 

Left;  flap.     Disch'd  May  10,  '65. 

257 

Ellsner.  C.,  Pt.,  B,  20th 

May  5, 

Left  ;  ant.  posterior  flap.    Disch'd 

115th  N.  Y.,  age  19. 

7,  '64. 

Mass.,  age  25. 

6,  '64. 

June  9,  186"). 

297 

Freeman,  P.,Pt.,D,139th 

Sept.  19, 

Left  ;  ant.  post.  flap.    Surg.  W.  A. 

258 

Ell  wood,  J.,   It.,  I,   2d 

Mar.  5, 

Left  ;  flap.  Surg.  G.  B.  Cogswell, 

Penn.,  age  46. 

20,  '64. 

Barry,  9Sth  Penn.  Disch'd  June 

Mich.,  age  28. 

5,  '61. 

29th  Mass.    Disch'd  Sept.  5,  '64. 

8,  1805. 

259 

Erabrce,  H.  A.,  Pt.,  C, 

July  18, 

Left  ;  flap.    Confed.  surg.  Disc'd 

298 

Fnshan,  N.,  Pt.,  E,  21st 

May  6, 

Right.     Asst.  Surg.  G.  H.  Peets, 

5th  N.Y.  H.  A.,  age  23. 

19,  '64. 

June  3,  1805. 

Mississippi. 

7,  r64. 

21st  Miss.     Recovery. 

260 

Emerson,  S.,  Corp'l,  C, 

July  24. 

Left  ;   flap.     Surg.  H.  C.  Leven- 

299 

Fuller,  C.  A.,  Lieut.,  C, 

July  2, 

Left.   Surg.C.S.  Woods.OOth  N.Y. 

8th  Maine,  age  44. 

20,  '64. 

saler,  8th  Me.    J  uly  18,  '65,  scq. 

Olst  New  York. 

3,  '63. 

(H'dhum.exc.)  Dis.  Dec.15,'63. 

seven  ins.  long  rem'd.     Disch'd 

300 

Fulke,  C.,  Pt.,  H,  llth 

Dec.  13, 

Left,    Disch'd  Oct.  24,  1863. 

October  11,  1805. 

Penn.  Reserves. 

14,  '6-2. 

261 

Eschbach,H..Pt.,I.118th 

June  22, 

Left  ;  bi-lat.  flap.     Surg.  W.  Hoi- 

301 

Gallagher,    H.,  Pt.,   K, 

May  5, 

Left;  circ.     Surg.  G.  L.  Potter, 

Penn.,  ago  48. 

22,  '64. 

brook,  18th  Mass.    Exfoliation. 

99th  Penn.,  age  22. 

6/64. 

145th  Penn.  M.  out  July  1,  1805. 

Disch'd  June  30,  1805. 

Nee.  stump.    Died  Nov.  20,  '69; 

262 

Estle,J.L.P.,Pt.,H,27th 

Mar.  13, 

Right  :  flap.    Surg.  W.  R.  Thrall, 

consumption. 

Ohio. 

13,  '62. 

27th  O.    Disch'd  Aug.  20,  1802. 

302 

Galusha,  C.,  Pt.,  D,  17th 

Dec.  13, 

Right.     Disch'd  June   15,    1863. 

263 

Estes,  B.  F.,  Pt.,  F,  10th 

Sept.  1, 

Left;  circ.     A.  Surg.  R.  W.  Var- 

Infantry. 

13,  '62. 

1870,  stump  discharging. 

Kentucky,  age  24. 

3,  '04. 

ney,  31st  O.     Duty  Nov.  29,  '64. 

303 

Galvin,  I.,  Pt.,  D,  14th 

July  6, 

Left;  circ.    Surg.E.Batwell,  14th 

264 

Evans,  J.  B.,  Pt.,D,24th 

April  9, 

Riglit  ;  flap.    Disch'd  June  5,  '65. 

Michigan,  age  20. 

6,  '64, 

Mich.  Gang.;  exf.  Disch'd  June 

Ind.,  age  26. 

9,  '05. 

19,  1865. 

265 

Ecerhi.  A.  F.,  Pt.,A,10th 

Aug.  28. 

Left.    Surg.  —  Walls.  Recovery. 

304 

Garnett.  W.  H.,  Pt.,  B, 

Oct.  28. 

Right.    Mustered  out  Oct.  24,  '05. 

Virginia. 

28,  '62. 

2Jth  Conn.,  age  21. 

28,  '04. 

266 

lEwM.  R.S.,t,\eut.-Gen- 

Aug.  30, 

Left.    Surg.  H.  McGuire,  C.  S.  A. 

305 

Garrahan,  W.,  Pt.,  7th 

June  3, 

Right  ;  circ.    Surg.  P.  E.  Hubon, 

eral. 

30,  '62. 

Returned  to  active  service. 

N.  Y.  H.  A.,  age  28. 

3,  '04. 

28th  Mass.    Sept.  30,  seq.  rem'd. 

267 

'Fabry,  J.,  Pt.,  K,  4th 

Aug.  16, 

Left  ;  circ.    Surg.  G.  W.  Jackson, 

Disch'd  July  0,  1865. 

Artillery,  age  38. 

17,  '64. 

53d  Penn.  Ext'.il.;  abscess.  May 

300 

Garvey,  J.,  Pt.,  E,  99th 

April  0, 

Right  :  circ.     Surg.  H.  F.  Lyster, 

15,  '70,  amp.  hip  j  t.    Specs.  5084, 

Penn.,  age  34. 

0,  '65. 

5th  Mich.    Disch'd  June  20  '65. 

5(585,  5087,  5H99,  5703. 

307 

Gatchell,  A.  A.,  Pt.,  A, 

Oct.  5, 

Left  ;  circ.    Surg.W.  L.  Leonard, 

268 

Fagan.  J.  B.,  Lt.-Col., 

July  3 

Left.     July  31,  rem.  of  nee.  bone. 

39th  Iowa,  age  26. 

0,  '64. 

7th  111.    Disch  il  Dec.  10,  1864. 

15th  Ala.,  age  29. 

3,  '63. 

Exch'd  and  furloughed. 

308 

Gates,  G.  W.,  Corp'l,  I, 

May  5, 

Right  :  circ.    Surg.  J.  A.  Straith, 

21  ' 

Fagar,  W.,  Pt.,  B,  59th 

Aug.  14, 

Left;  flap.    Disch'd  Nov.  7,  1804. 

140th  N.  Y.,  age  30. 

6,  '64. 

C.  S.  A.    Gang.;  car.  bone  rem. 

New  York,  age  19. 

15,  '64. 

Dis.  Aug.  2,  '65.    '70,  bad  stump. 

270 

Farlev,  C.  J.,  Capt.,  B, 

Sept.  19, 

R't:  circ.    Surg.  L.  P.  Woods,  5th 

309 

Geer,  I.  S.,  Carft.,  C,  3d 

May  6, 

Right  ;  circ.    Confed.  surg.    Mus 

.5th  N.  Y.  Cay.,  age  42. 

20,  '64. 

N.  Y.  Cav.   Disch'd  Jan.  11,  '05. 

Michigan,  age  30. 

6,  '04. 

tered  out  Sept.  21,  J804. 

271 

Fasnacht,  W.  E.,  Pt.,  G, 

May  25, 

Left  ;  circular.    Recovery. 

310 

Gentry,  T.,  Pt.,  F,  27th 

Sept.  17 

Left  ;  flap.    Disch'd  Nov.  29,  '02. 

147th  Penn.,  age  20. 

20,"  '64. 

Indiana. 

19,  '62. 

272 

Fawlks,  N.  G.,  Pt.,  D, 

April  12, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

311 

Gerke,  H.,  Lieut.,  I,  52d 

June  3, 

Right.    Surg.  J.  C.  Rappold,  52d 

13th    Tenn.    Cavalry. 

13,  '64. 

C.  Fitch.    Erysipelas.    Disch  d 

New  York. 

3,  '62. 

N.Y.     Bone  prot.:  subs,  opera. 

age  45. 

October  20,  1864. 

Disch'd  May  23,  1805. 

273 

Fay,  J.  S.,  Pt.,  F,  13th 

April  30, 

Right  ;  circ.;  (amp.  f.  arm.)  Surg. 

312 

Gerald,  G.F..PI.,  E,  19th 

June  27, 

—  .    Surg.  Chancellor,  19th  Va. 

Massachusetts. 

30,  '63. 

A.W.Whitney,  Kith  Mass.    Dis 

Virginia. 

28,  '02. 

Recovery. 

charged  Sept.  19,  1803. 

313 

Gerrish,  W.,  Pt.,  H,  20th 

June  3, 

Left;  double  ant.  flap.     Disch'd 

274 

Ferguson,  D.,  Lieut.,  A, 

Jan.  11, 

Left.    Surg.G.  S.Walker,  6th  Mo. 

Maine,  age  28. 

4,  '04. 

Jan.  14,  1805. 

113th  Illinois,  age  27. 

11,  '63. 

Bone  prot.;  haems.;  lig.  femoral. 

314 

Gibbs,  G.  A.,  Pt.,  D,  18th 

June  23, 

—  .    Surg.  Griffin,  C.  S.  A.    Re 

Disch'd  Sept.  3,  1803. 

Mississippi. 

23,  '04. 

covery. 

275 

Field,   A.,  Corporal,  C, 

June  22, 

Left:  flap.  Surg.  A.  Wilson,  113th 

315 

Gibbs,  W.  S.  S.,  Pt.,  A, 

May  12, 

Right  ;  circ.    Retired  Mar.  2,  '05. 

113th  Ohio,  age  29. 

22,  '04. 

Ohio.    Disch'd  Aug.  17,  1804. 

12th  Miss.,  age  22. 

12,  '04. 

276 

Finke,  F.,  Corp  1,  F,  10th 

Mar.  21, 

Right  ;  flap.   Surg.A.B.Monohan. 

316 

Gifford,J.O..Pt.,  B,  26th 

Nov.  30, 

Left.    Disch'd  June  15,  1864. 

Illinois,  age  26. 

21.  '65. 

63d  Ohio.    Disch'd  June  27,  '05. 

Michigan,  age  20. 

30,  '03. 

277 

Finnegan,  T.,  Pt.,  F,  72d 

July  23, 

R't  ;  lat.  flap.    Surg.C.K.  Irwine, 

317 

Gilchrist,  D.  R.,  Pt.,  H, 

May  5, 

Left  :  flap.     Surg.  G.  T.  Stevens, 

New  York,  age  45. 

24,  '03. 

72d  N.  Y.    June.  '(M,  nee.  bone 

3d  Vermont,  age  22. 

5,  '64. 

77th  N.Y.  July  1,  nee.  bone  rem. 

extracted.    Disch'd  July  2,  '64. 

Disch'd  Aug.  12,  '65.   Spec.  2814. 

ns  m.).  Shot  Wounds  of  Joints,  in  Richmond  ifed.  Jour..  IPfifi.  Vol.  I.  p.  262. 
*Ons  (G.  A.),  Mem.  of  a  Cast  of  Re-amp,  at  the  nip,  in  Am.  Jour.  ,Mf<l.  Sci'i,  1871,  Vol.  LXI,  N.  S.,  p.  141,  Circular  No.  3,  p.  215,  S.  G.  O.,  1371. 


SECT.  III. | 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER   THIRD. 


249 


No. 

NAME,  MILITABT 
DESCRIPTION,  AND  AOE. 

DATICS. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

318 

Gill,  C.,  Corp'l,  F,  105th 

Oct.  27, 

Right;  circ.     Surg.  —  Smith,  C. 

360 

Harder,  T.  J.,  Capt.,  H, 

Nov.  16, 

Right.  Surg.  —  Gilmore,  C.  8.  A. 

Penn.,  ago  22. 

29.  '64. 

S.  A.    Disch'd  June  28,  1865. 

9th  Georgia. 

16,  '63. 

Recovery. 

319 

Glass,  J.,  Corp'l,  G,  48th 

June  27, 

Left.    Recovery. 

361 

Harding,  J.,  Pt.,  A,  86th 

Nov.  25, 

Left  ;  flap.    Surg.  W.  J.  Burgess, 

Mississippi. 

27,  '64. 

Indiana,  age  28. 

26,  '63. 

17th  Ky.   Disch'd  Nov.  12,  '64. 

320 

Gomf.r,  A.  J'.,  Lieut.,  F, 

July  3, 

Left  ;  circ.    Surg.  Mayo,  C.  S.  A. 

362 

Harding,  U.,  Ft.,  I,  13th 

Dec.  17, 

Left  ;  flap.    A.  A.  Surg.  J.  S.  Gilt- 

3d  Virginia,  age  27. 

3,  '03. 

Provost  Marshal  Oct.  15,  1863. 

Col'd  Troops,  age  22. 

17,  '64. 

ner.    Disoh'd  Oct.  12,  1865. 

321 

Goodex,  L.,  Pt.,  E,  29tU 

Mav  15, 

Left:  flap.  A.  Surg.  W.  F.  Smith, 

363 

Hardy,  A.  T.,  Pt.,A,  8th 

May  16, 

Left;    double   flap.     Duty  Dec. 

Penn.,  age  22. 

15,"64. 

28th  Penn.    Abscess  :  bone  prot. 

Maine,  age  25. 

16,'  '04. 

14,  1864. 

Disch'd  July  4,  1865. 

364 

Hare,  S.  P.,  Lieut.,  D, 

May  27, 

Right;  circ.    A.  Surg.W.H.  Park, 

322 

Gorman,  IF.  H.,  Pt.,—  , 

June  15, 

.    Surg.  Hunter.    Recovery. 

49th  Ohio,  age  23. 

27,"  '64. 

4'.ltli  O.    Disch'd  Oct.  25,  1864. 

1st  Maryland  Battery. 

15,  '63. 

365 

Harley,  U.,Corp'J,  I,  73d 

Nov.  25, 

Left.     Discharged  May  30,  1864. 

323 

Gorman,  'T.  J.,  Pt.,  —  , 

April  8, 

Left  ;  flap.    Surg.  J.  F.  Hess,  96th 

Penn.,  age  30. 

25,  '03. 

Died  Sept.  14,  1869. 

83d  Ohio,  age  21. 

10,  '64. 

Ohio.    Disch'd  Aug.  30,  18ii4. 

366 

Harold,  W.O.,  Serg't,  B, 

Nov.  30, 

Left  ;  ant.  posterior  flap.   Provost 

324 

Gould,  11.  P.,  Serg't,  G, 

Aug.  6, 

Right  ;  circ.    Surg.W.H.  Mullins, 

57th  Alabama,  age  25. 

De.  1/04. 

Marshal  March  1,  1865. 

12th  Kentucky,  ago  24. 

6,  764. 

12th  Ky.    Disch'd  July  14,  '65. 

367 

Harper,  W.,  Pt.,  B,  llth 

Jan.  24, 

—  .    Surg.  —  Tripler,  C.  S.  A. 

325 

Gould,    J.,    Pt.,    H,   2d 

July], 

Left;  circ.:  nee.  hone  discharged. 

Virginia. 

25,  '64. 

Recovered. 

Col'd  Troops,  age  40. 

1,  '64. 

Disch'd  July  27,  1865. 

368 

Harris,  II.  D.,  Pt.,  D,  7th 

July  18, 

Right;  flap.    Surg.  W.W.  Brown, 

326 

Graeter,  C.,  Pt.,  K,  7th 

Sept,  17, 

Left;  circ.    Disch'd  Dec.  18,  '62. 

New  Hampshire. 

19,  '63. 

7th  N.  H.    Disch'd  Mar.  4,  1864. 

Ohio. 

17,  '62. 

369 

Harris,  W.  C.,  Pt,,  A,  3d 

Oct.  19, 

Left;  circ.  Surg.J.M.G.McGuire, 

327 

Graham,  M.  J.,  Lieut.,  F, 

Sept.  17, 

Right  ;  circ.     Surg.  G.  H.  Hum 

Alabama. 

20,  '64. 

C.  S.  A.   Prov.  Mar.  April  8/65. 

9th  New  York,  age  25. 

17,  '62. 

phreys,  9th  N.  Y.     M.  out  May 

370 

Harrison,  W.  H.,  Pt.,  E, 

April  2, 

Left;  circ.     Surg.  J.  H.  Kimball, 

20,  'o"3.     Spec.  1436. 

39th  N.  Jersey,  age  32. 

3,  '05. 

31  st  Mo.    Disclf  d  Aug.  18,  1865. 

328 

Grant,  G.,  Pt.,  K,  101st 

April  8. 

Left  ;  ant.  post.  flap.     Surg.  J.  F. 

371 

Hart,  D.  F.,  Pt.,  C,  55th 

Dec.  13, 

Left.     Surg.  —  Spence,  C.  S.  A. 

New  York,  age  18. 

10,  '64. 

Hess,  96th  O.    July  21,  '65,  nee. 

Virginia,  age  21. 

13,  '62. 

Retired  April  1,  1865. 

bone  rem.    Disch'd  Aug.  10,'Oj. 

372 

Harding,  E.,  Pt.,  K,  93d 

Sept.  19, 

Right  ;  double  flap.    Subs,  opera. 

329 

Greene,  C.  T.,  Capt.  and 

Nov.  27, 

Right;  flap.     Surgs.  J.  L.  Dunn, 

Penn.,  age  19. 

19,  '64. 

Disch'd  March  23,  1866. 

A.  A.  General,  U.  S.V., 

27,  -G3. 

109th  Penn..  and  J.  A.  Wolfe,29th 

373 

Hartman,  J.,  Pt.,  A,  37th 

June  19, 

Left  :  flap.    Surg.  W.  B.  Fox,  8th 

age  22. 

Penn.    M.  out  Sept.  19,  1865. 

Wisconsin,  age  16. 

20,  '64. 

Mich.    June  27,  ha?m.;  lig.  fern. 

330 

Green,  J.,   Pt.,  B,  34th 

Sept.  17, 

Right  ;  flap  ;  two  ins.  bone  rem'd  ; 

D-sch'd  Aug.  14,  1865. 

New  York,  age  24. 

19,  '62. 

slough.    Disoh'd  Mar.  10,  1863. 

374 

Hartler,  J.,  Pt.,  E,  50th 

Mav  12, 

Left  ;  circ.;  gangrene  ;  bone  prot. 

331 

Green,   J..   Pt.,    B,   6th 

July  3, 

Right  ;  circ.    A.  Snrg.  U.  F  Weir, 

Penu.,  age  20. 

13,'  '64. 

Disch'd  Aug.  19,  1865. 

Penn.  Cavalry. 

5,  '63. 

U.  S.  A.     Disch'd  Sept.  1,  1863. 

375 

Haste.y,  N.B.,Pt.,  E,  20th 

May  6, 

Left.    Surgeon  —  Secan,  C.  S.  A. 

Spec.  3897. 

Georgia. 

6.  '64. 

Recovery. 

333 

Green,  P.,  Pt.,F,  3dVt., 

May  5, 

Left  ;    ant.  post.  flap.     Surg.  E. 

376 

Hatch,  M.  T.,  Serg't,  B, 

Oct.  19, 

Right;  ant.  post.  flap.     Surg.  E. 

age  33. 

7,  '64. 

Phillips,  6th  Vt.     Disch'd  May 

3d  Vermont,  age  25. 

19,  '64. 

Phillips,  6th  Vermont.    Siough- 

31,  1865. 

ing.     Disch'd  July  25,  1805. 

333 

Greenleaf,  R.,   Seaman, 

April  22, 

Right.-  Surg  —  Vreeland,U.S.N. 

377 

Haverfield,G.A.,  Serg't, 

Sept.  21, 

Right;  gangrenous.    Discharged 

U.  S.  S.  Iroquois. 

22,  '62. 

Discharged. 

H,  120th  Ohio,  age  24. 

22,  '64. 

May  22,  1865. 

334 

Greenlief,  II.,  Corp'l,  G, 

Dec.  17, 

Left;  flap.    Surg.  I.  F.  Galloupe, 

378 

Hayes,  J.,  Serg't,  A,  5th 

Sept.  19, 

Right  ;  circ.    Surg.  Hicks.C.S.A. 

17th  Mass.,  age  25. 

17,  '62. 

17th  Mass.    Disch'd  May  31,  '63. 

North  Carolina. 

19,  '64. 

Released  April  1,  1865. 

335 

Greer,  J.  S.,  Pt.,  I,  43d 

May  14, 

Left;    circ.     Surg.  F.   M.  Rose, 

379 

Hayes,T.,  Pt.,  E,25thN. 

Feb.  14, 

Left.    Paroled  May  11,  1865. 

Ohio,  age  28. 

14,  '64. 

43d  Ohio.     Disch'd  July  29,  '65. 

Carolina,  age  28. 

14,  '65. 

1870,  stump  discharging. 

380 

Haynes,  G.,  Pt.,  B,  26th 

Aug.  3, 

Right  ;  circ.     Surg.  J.  II.  Hutchi 

336 

Greer,   T.  I.,  Lieut.,  B, 

Mar.  29, 

Left;  circ.     Released  June  9,  '65. 

Illinois. 

3,  P64. 

son,  15th  Mich.     Disch'd  Aug. 

18th  S.  C..  age  22. 

29,  '65. 

28,  1864.     Feb.  28,  1865,  flap  re- 

337 

Griffin,   J.,  Pt.,   B,   9th 

Oct.  27, 

Left;  circ.    Surg.  A.  M.  Clark.  U. 

amp,  middle  third. 

Maine,  age  27. 

27,  '64. 

S.V.  Gang.    Disch.  Jan.  30,  '66. 

381 

Headley,  A.,  Pt.,  C,  2d 

May  5, 

Left  ;  flap.    Sept.  15,  necro.  bone 

338 

Griffin,  J.  J.,  Pt.,  I,  50th 

July  2, 

Left;  flap;  haem.  recurrent.  Ex 

Rhode  Island,  age  25. 

6,  *64. 

rerao.    Disch'd  May  4,  1865. 

Georgia,  age  27. 

3,  '63. 

changed  Nov.  12,  1863. 

382 

'Heckert,P.,Pt,F,120th 

July  10, 

Left  ;  flap.     Disch'd  Oct.  7,  1863. 

339 

Grimes,  S.  R.,  Corp'l.  C, 

Oct.  7, 

Left.   Recovery  Feb.  28,  1865. 

Ohio. 

10,  '63. 

47th  Alabama,  age  21. 

8,  '64. 

383 

Hearing,  J.,  Lieut.,  G, 

April  29, 

Left  ;  flap.    Disch'd  Dec.  23,  '63. 

340 

Grim,  D.  D.,  Pt.,  D,  1st 

Mav  7, 

Left.    Discharged  July  22,  1864. 

58th  Ohio. 

29,  '03. 

Cavalry,  age  23. 

7,  '64. 

384 

Heath,  P.,  Pt.,  A,  9th  N. 

June  11, 

Left  ;  flap.    Duty  Sept.  1,  1804. 

341 

Gronoble,  I.    I  ,  Pt.,  I, 

May  10, 

Left;  cire.    Surg.W.C.  Byington, 

York  Cavalry. 

11,  '64. 

148th  Penn.,  age  18. 

11,  '61. 

183d  Penn.    Disch'd  June  8,  '65. 

385 

Hebing,G.A.,  Pt.,I,23d 

May  17, 

Left  ;  circ.    gurg.  J.  C.  Ross,  94th 

342 

Grouse,  B.,  Pt.,  B,  13th 

April  14, 

Right;  flap.    Disch'd  Oct.  10,  '63. 

Iowa. 

17,  '63. 

111.    Disch'd  Aug.  17,  1803. 

Conn.,  age  25. 

14,  '63. 

386 

Hoizeman,II.,Pt.,D,77th 

May  14, 

Right;  flap.    .Surg.  S.  11.  Kersey, 

343 

Grower,  J.(F..Pt.,E,29th 

Nov.  30, 

Left  ;  circ.  Provost  Marshal  Mar. 

Penn.,  ago  19. 

14,"  '64. 

3'uth  Ind.     Disch'd  Mar.  28,  '05. 

Georgia,  age  20. 

De.  1,  '64. 

1,  1865. 

387 

Helen,G.F.,Pt.,B,  114th 

July  2, 

Right  ;  flap.     Healed  by  first  in 

344 

Guenther,  H.,Pt,G,65th 

Nov.  26, 

Right  ;  circ.    Surg.  —  Dunn,  58th 

Penn.,  age  18. 

3,  '03. 

tention.    Disch'd  April  12,  '64. 

Illinois,  age  2). 

26,  '64. 

N.  C.    Disch'd  July  31,  1865. 

388 

Hcllings,  J.,  Pt.,  H,  5th 

April  2, 

Right;   flap.     Disch'd  July   19, 

345 

Habcrkern,  J.,  Pt.,  I,  7th 

Feb.  6, 

Right;  circ.   June  1,  reamp.  flap, 

Penn.  Cav.,  age  22. 

2,  '65. 

1805. 

Wisconsin,  age  21. 

7,  '65. 

mid.  third.    Disch'd  Nov.  1  ,  '65. 

389 

Henderson,  A.,   Pt.,  E, 

Aug.  14, 

Left  ;  circ.    Disch'd  April  20,  '65. 

346 

Hagemver,   A.,    Pt.,  C, 
ISthN.Y.H.A.,  age  30. 

Mar.  31, 
31,  '65. 

Right  ;  flap.    Surg.  A.  A.  White. 
8th  Md.    Disch'd  Sept.  20.  '65. 

390 

8oth  N.  York,  age  22. 
Henry,  M.,  Pt.,  I,  69th 

14,  '04. 
Nov.  25, 

Left  ;  lat.  flap.     Surg.  L.  Slusser, 

347 

Baii;  R.  A.,  Pt.,  E,  5th 

May  29, 

Left  ;  lat.  flap.    Surg.C.  B.Gibson, 

Ohio,  age  19. 

20,  '03. 

09th  Ohio.    Nee.  bone  removed. 

S.  Carolina,  age  3.J. 

30,  '64. 

C.  S.  A.    Recovered. 

Disch'd  Feb.  6,  1865. 

348 

Halfpenny,    J.,    Pt.,  H, 

Aug.  20, 

Left  ;  flap.  Confed.  surg.  Disch'd 

391 

Hensel,  C.  W.,  Pt.,  D, 

May  14, 

Right  ;  flap.    Disch'd  Jan.  13/05. 

90th  Penn.,  age  18. 

20,  '64. 

Sept.  8,  1865. 

66th  Indiana,  age  20. 

14,"  '61. 

349 

Hall,  J.W.,  Capt.,  K,  4th 

June  11, 

Lett;  flap.     Surg.  B.  G.  Streeter, 

392 

Henslcy,  E.,  Corp'l,    I, 

Oct.  2, 

Right  ;  circ.    Surg.  J.G.  Hatchitt, 

N.  Y.  Cavalry,  age  23. 

12,  '64. 

4th  N.  Y.  C.    M.  out  July  17,  '65. 

39th  Kentucky,  age  18. 

2,  '64. 

U.  S.  V.    Disch'd  June  20,  1805. 

350 

Hall,  M.  Y.,  Pt.,  A,  31st 

May  5, 

Left.     Surg.  Atkinson,  C.  S.  A. 

393 

Herrin,  T.  J.,Pt.,  F,  10th 

April  6, 

Left;  flap.    Released  June  14/05. 

Virginia. 

5,  ''64. 

Retired  Dec.  14,  1864. 

Georgia,  age  21. 

6,  '65. 

351 

Hall,  W.,Pt.,H,  4th  W. 

May  19, 

Right  ;  flap.     Surg.  E.  D.  Kittoe, 

394 

Herron,  E.  11.,  Capt.,  D, 

May  27, 

Right.     Disch'd  Nov.  20,  1863. 

Virginia. 

19,"  '63. 

U.  S.  V.    Dtech'd  Mar.  4,  1864. 

4th  Wisconsin,  age  24. 

27,  '63. 

352 

Hamilton,  J.  F.,  Pt.,  G, 

Oct.  13, 

Right;  flap.    Surg.C.  M.  Clark, 

395 

Hickey,  C.  M.,  Pt.,  H,  7th 

July  1, 

Left.     Surg.  —  Davis,  C.  S.  A. 

39th  Illinois,  ago  21. 

13,  '61. 

39th  111.     Reamp.  upper  third. 

Louisiana. 

1,  '63. 

Recovery. 

Disch'd  June  5,  1865. 

396 

Hickey,  N.,  Serg't,C,7th 

Oct.  12, 

Lett  ;  circ.    Surg.  J.  E.  Pomfret, 

353 

Hammer,  L.,  Pt.,  C,  47th 

Mav  22, 

Right  ;  flap.    Surg.  S.  P.  Bonner, 

N.  Y.  H.  A.,  age  23. 

12,  '64. 

7th  New  York  Heavy  Artillery. 

Ohio. 

22,'  '03. 

47th  Ohio.    Disch'd  Oct.  6,  1803. 

Disch'd  Aug.  15,  1805. 

354 

Hampel,   A.,  Corp'l,  E, 

Alar.  16, 

Right;    ant.  post,  flap  (Skey's). 

397 

Hill,  J.,  Corp'l,  B,  123d 

July  28, 

Right  ;  flap.    Surg.  A.  M.  Wilder, 

355 

82d  Illinois,  age  28. 
Hampton,   T.  E.,  Pt.,  I, 

16,  '65. 
July  1, 

Disch'd  Sept.  7,  1865. 
Right.    Surg.  L.V.  Huot,  C.  S.  A. 

398 

Indiana,  age  27. 
Hill,  J.  W.,  Pt.,  I,  10th 

28,  '64. 
Oct.  28, 

U.  S.  V.    Disch'd  June  24,  1805. 
Right.    Disch'd  Jan.  15,  1805. 

14th  South  Carolina. 

2,  '63. 

Paroled  Sept.  5,  1863. 

Alabama,  age  23. 

29,  '04. 

35fi 

Hamrick,A.,  Pt.,  E,  45th 

Nov.  30, 

Right  ;   ant.  post.  flap.     Provost 

399 

2  Killer,  W.  P.,  Pt.,  A, 

July  27, 

Left.    Teale's  op.;   ant.  post.  flap. 

Tenn.,  age  25. 

De.  1,'64 

Marshal  March  21,  1865. 

2d  N.  Y.  II.  A.,  age  41. 

27,  '04. 

Surg.J.W.Wishart,  140th  Penn. 

357 

Hancock,  J.  W.,  Pt.,  H, 

Jan.  17, 

Left;  flap.     Surg.  H.  Brown,  1st 

Disch'd  April  3,  1865. 

1st  Kentucky  Cavalry. 

18,  '65. 

Ky.  Cav.    Disch'd  Aug.  1,  1865. 

400 

Bines,  J.  D.  E.,  Pt.,  II, 

May  6, 

Right.  Surg.  —  Hudson,  C.  S.  A. 

358 

Hancock,  W.  L.,  Pt.,  D, 

42d  Miss.,  age  25. 

July  1, 
2,  '63. 

Right;  flaps  sloughed.     July  24, 
reamp.  middle  third.     Paroled 

401 

4th  Alabama. 
Hinson,  T.,  Pt.,  G,  39th 

6,  '64. 

April  7, 

Recovery. 
Right;  flap.  Disch'd  Sept.  25/03. 

Sept.  5,  1863. 

Indiana. 

8,  '62. 

359 

Hardendorf,  A.,  Pt.,  D, 

Aug.  29, 

Left;  circ.    Disch'd  Jan.  13,  1863. 

402 

Hinson,  W.  H.,  Pt.,  H, 

Sept.  19, 

Right;  circ.     Surg.  Bissell,  28th 

6th  N.  York  Cavalry. 

29,  '62. 

25th  N.  C.,  age  37. 

19,  '64. 

N.  C.    Prisou  Jan.  5,  1865. 

1 

'BUY  AN  (J.),  Cases  of  Amputations  from  the  Armies  of  the  Southwest,  in  Am.  Me.d.  Times,  1803,  Vol.  7,  p.  288,  Case  XXXI. 
'O'MEAGHER  (W.),  Surgical  Cases  from  Field  Hospitals,  in  lied,  and  Surg.  Rep.,  1865,  Vol.  XII,  p.  253. 

SL-HG.  Ill— 32 


250 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 

DESCIIIPTIOX,  AMI  AC.K. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

403 

Hitt,  JT.  L.,  Pt.,  F,  3d 

South  Carolina. 

July  1, 
1,  '62. 

Right.    Surg.  —  Sammond,  C.  S. 
A.     Disced  October  14,  1862. 

448 

Keegan,  J.,  Corp'l,   D, 
58th  Pennsylvania. 

Sept.  30, 
30,  '64. 

Left;  flap.    Duty.    Jan.  29,  1866, 
mustered  out. 

404 

Hedging,  I.  M.,  Pt.,  D, 

July  1, 

Left;  flap.    Exchanged  Nov.  12, 

449 

Keep,  D.   S.,  Corp'l,  I, 

Mav  5, 

Left  ;  circ.     Discharged  Sept.  27, 

34th  N.  C.,  age  30. 

1,   63. 

1863. 

142d  Penn.,  age  25. 

5,  r64. 

1864. 

405 

Hoffman,  P.,  Corp'l,  B, 

Julv2, 

Left  ;  circular.    Surg.  —  Purcell. 

450 

Keller,    C.,    Pt.,  B,  43d 

April  6, 

Left:  reamp.  upper  third:  necro. 

40C 

107th  Ohio,  age  21. 
Hoge,    tr.  F.,  Pt.,  Kirk- 

2,  '63. 
June  3, 

Disch'd  July  30,  1864. 
—  .     Surg.  —  Capers,  C.  S.  A. 

451 

Illinois,  age  19. 
Keller,  S.  P.,  Corp'l,  E, 

8,  '62. 
Aug.  18, 

bone  rem'd.     Disch'd  Mar.  9,  63. 
Right;  ant.  post.  flap.  Surg.A.A. 

Patrick's  Battery. 

3,  '64. 

Hecovery. 

1st  Maryland,  age  23. 

19,  '64. 

White,  8th  Md.  Bis.  May  14,  '65. 

407 

Hollingshead,  A.,Pt.,  K, 
2d  West  Virginia. 

June  8, 
9,  '62. 

Left  ;  flap.     Surg.  R.  W.  Hazlett, 
2d  W.  Va.   Disch'd  Aug.  22,  '62. 

452 

Kelley,  E.,Corp'l,C,25th 
Indiana,  age  26. 

Mar.  21, 
21,  '65. 

Right;  ant.  post.  flap.  Surg.  A.  B. 
Monohnn,  63d   Ohio.      Disch'd 

408 

Holt,  A.,  Pt.,  G,  12th  X. 

Mav  2, 

Left;circ.  Surg.  —  Hicks,C.S.A. 

July  9,  1865. 

Carolina,  age  20. 

2,  '63. 

Furl'd  Oct.  4,  1864. 

453 

Kelley,  J.,  Pt..  H,  60th 

Nov.  3, 

Right.     Disch'd  March  10,  1864. 

409 

Hopkins,  O.,  Pt.,  K,  7th 

June  1. 

Right.     Surg.  A.  N.  Dougherty, 

Indiana,  age  39. 

3,  '63. 

Michigan. 

1,  '62. 

U.S.V.     Disch'd  March  5,  1863. 

454 

Kelley,  J.R.,Pt.,  B,14th 

Mav  23, 

Right.    Surg.  —  Henderson,  14th 

410 

Hopkins,  W..Pt.,C,lllth 
Penn.,  age  21. 

July  3, 
4,  '63. 

Left.     Surg.  G.  P.  Oliver,  lllth 
Penn.    Discharged. 

455 

Georgia. 
Kelly,  T.  J.,  Pt.,  D,  49th 

24,  ''64. 
Mav  4, 

Georgia.     Recovery. 
Left  ;  long  ant.,  short  post.   flap. 

411 

Homer,  G.  W.,  Pt.,  G, 

Mav  14, 

Right  :  double  flap.  Vet.  Reserve 

New  York,  age  19, 

5,  '63. 

Disch'd  Aug.  23/64.  '67,  reamp. 

17th  Ohio,  age  22. 

14,'  '64. 

Corps  Jan.  14,  1865. 

456 

Kelly,  T.,  Pt.,  G,  183d 

June  3, 

Right  :  flap.    Surg.  P.  E.  Hubon, 

412 

Horton,  W.  M.,  Serg't, 

June  3, 

Left  ;  circ.    Disch'd  Jan.  19,  1865. 

I'enn.,  age  35. 

3,  '64. 

?8th  Mass.     Disch'd  Mar.  2,  '65. 

B,  8lst  X.  Y.,  age  34. 

5,  '64. 

Spec.  2934. 

413 

Howard,  H.  11.,  Pt.,  G, 

Sept.  19, 

Left;  circ.;  necrosis.    Discharged 

457 

Kelly,  V.  B.,  Corp'l,  B, 

May  10, 

Right  ;  flap.     Surg.  F.  M.  Wafer, 

114th  N.  Y.,  age  23. 

19,  '64. 

Mav  20,  1865. 

108th  N.  York,  ago  22. 

12,  '64. 

108th  N.  Y.  Duty  Sept.  19,  1864. 

414 

Howard,  T.  M.  b.,Pt.,L, 

June  18, 

Right  ;  flap.    Duty  Oct.  26,  1865. 

458 

Kelly,  W.,  It.,  I,  100th 

Nov.  23, 

Left  ;  lat.  flap.    Surg.  B.  N.  Bond. 

1st  Me.  H.  Art.,  age  20. 

19.  '64. 

Indiana,  age  26. 

23,  '64. 

27th  Mo.    Disch'd  June  9,  186.5. 

415 

Howald.  C  ,  Corp  1,  K, 

Sept.  3, 

Right;  flap.     Surg.  C.  H.  Mills, 

459 

Kemp,   R.,   1't.,  K,  6th 

May  30, 

Right;  flap.    Disch'd  Sept.  21/64. 

10th  Mich.,  age  21. 

3,  '64. 

125th  111.    Mustered  out,  1865. 

N.  Y.  H.  A.,  age  33. 

31,  '64. 

III 

Howe,  11.  P.,  Pt  ,0.120th 

July  30, 

Right  ;    ant.  post.  flap.     Disch'd 

460 

Kennedy,  J.,  Pt.,  G,42d 

May  12, 

Right  ;  circ.     Surg.  S.  H.  Plumb, 

New  York,  age  23. 

30,  '64. 

Jan.  7,  1865. 

New  York,  age  42. 

12,''64. 

82d  N.  Y.      Seq.  rem.     Disch'd 

417 

Efowland,  J.,  ,  B,  1st 

Sept.  14, 

—  ;  flaps  sloughed;  bone  prot. 

Oct.  5,  1865. 

Georgia. 

14,  '62. 

rem'd  ;  small  arts.  tied.  Recov. 

461 

Kennedy,  J.,Pt.,B,  110th 

Aug.  16, 

Right;  flap.      Surg.  D.  S.  Hays, 

418 

HoyJe,B.M.,  Pt.,  F,  34th 

June  27, 

Left.    Surg.  Ross.     Retired  Feb. 

Pennsylvania,  age  20. 

16,  '64. 

110th  Penn.    M.  out  Jan.  17/66. 

North  Carolina. 

29,  '62. 

23,  1865. 

462 

Kennedy,  J.,Pt.,C,  157th 

June  19, 

Right;  flap.  A.Surg.N.R.Barnea, 

ll'> 

Huffman,  J..  Corp'l,  M, 

July  28, 

Left;  circ.     Disch'd  May  20,  '65. 

Pennsylvania,  age  19. 

19,  '64. 

76th  N.  Y.     Disch'd  June  30/65. 

1st  Pcnn.  Cav  ,  age  28. 

28,  '64. 

Stump  unsound  in  1870. 

1870,  not  healed. 

420 

Hughes,  E.,  Pt.,  1,  53th 

Sept.  29, 

Right  ;  flap.     Surg.  —  Mitchell, 

463 

Kennison,  A  ,Pt.,A,19th 

July  2, 

Right;  flap.      Disch'd   Sept.   19, 

Penn.,  age  22. 

30,  '64. 

C.S.A.    Nec.;rem.  seq.  Disch'd 

Maine,  ago  39. 

2.  r63. 

1863. 

Feb.  28,  1866. 

464 

Keough,  P.,  Pt.,  C,  <33d 

Mav  13, 

Left;  circ.   Surg.N.Gay,  U.  S.V. 

421 

Hume,  J.,Lient..F.  140th 

Mav  5, 

Left,    Disch'd  Oct.  12,  1864. 

New  Jersey,  age  24. 

14,  '64. 

Gang.    Deo.  2,  reamp.,  circ.,  mid. 

New  York,  age  31. 

5,  '64. 

A.  Surg.  J.  T.  Calhoun,  U.  S.  A. 

422 

Humphries.   11..   Pt.,   I. 

Nov.  29, 

Left  ;  circ.    Provost  Marshal  May 

Disch'd  Aug.  20,  '65. 

45th  Alabama,  age  31. 

29,  '64. 

6.  1865. 

465 

Kimball,  W.  H.,  Lieut., 

Aug.  4, 

Right.     Surg.  S.  P.  Bonner,  47th 

423 

1  Humphrey,  W.  H.,  Lt., 

April  2, 

Right;  flap.    Surg.  C.B.  Park,  jr., 

D,  47th  Ohio,  ago  21. 

4,  ?64. 

Ohio.    Disch'd  Nov.  1,  1864. 

G,  4th  Vermont,  age  2.'). 

2,  '65. 

UthVt.    Pysemia.   Disc'd  Aug. 

166 

Kimberly,  E.  P.,  It.,  C, 

Sept.  19, 

Left;  circ.    A.  Surg.W.  G.  Bryant, 

3,  1865. 

10th  Vermont,  ago  20. 

21,  '64. 

122d  Ohio.    Disch'd  June  12/65. 

424 

Hunt,  C.  E.,  Lieut  ,  r. 

Mav  9, 

Left  :  flap.    Surg.W.  J.  Burr,  426. 

467 

Kincaid,  W.  11.,  Capt.,  I, 

Aug.  16, 

Left;  flap.     Surg.  S.  Smith.  93d 

59th  N.  York,  age  21  i. 

10,  "64. 

N.  Y.    Disch'd  Sept.  3'J,  1864. 

93d  New  York. 

1C,  '64. 

N.  Y.     Disch'd  Nov.  23,  1864. 

425 

Hunter,    B.  F.,  Pt.,   1C, 

July  7, 

Right  ;  (also  wound  of  right  arm.) 

468 

King,  J.,  Pt.,  D,  124th 

Dec.  16, 

Right;  circ.:  gang.    Disch'd  May 

19th  Georgia,  age  23. 

7,  '64. 

Retired  January  13,  1865 

Ohio,  age  18. 

16,  '64. 

16,  '65.     1870,  stump  unhealthy. 

426 

Hunter,C.,Corp'l,G.25th 

Aug.  10, 

Right  :  circ.     Surg.  F.  M.  Rose, 

469 

Kino,  J-  J;  I3*-,  D,  60th 

Aug.  21). 

Right.    Surg.  —  Walls,  C.  S.   A. 

Indiana,  age  21. 

12,  '64. 

43d  Ohio.     Hiem.;  gang.;  necr. 

Alabama. 

29.  '64. 

Recovery. 

bone  ext'd,  1865.    Disch'd  Dec. 

470 

Kingsbury,    A.,    It.,   I, 

Sept.  29, 

Right  ;   circ.     Surg.  D.  McFalls. 

3.  '65.  '70,  stump  open.  Sp.  4247. 

117th  N.  York,  age  20. 

21),  '64. 

142d  N.  Y.    Disoh'd  Aug.  15/65. 

427 

Huiton,  H.,Serg't,  B,62d 

Sept.  19, 

R't;  circ.    Surg.  —  Love,  C.S.A. 

471 

Kircher,  H.,   Capt.,    E, 

Nov.  27, 

Left  ;  flap  ;  (also  amp.  right  arm.) 

Virginia,  age  20. 

19,  '64. 

Sloughing.     Prison  Feb.  16,'65. 

12th  Missouri. 

27,  '63. 

Surg.  J.  Spiegelhalter,  12th  Mo. 

428 

Ingralium,  F.,  Pt.,  E,  1st 

Aug.  23, 

Loft;  flap.     Surg.  \V.  1!.  Rczner, 

Mustered  out  Nov.  14  1864. 

Maine  Cav  ,  age  2  *. 

23,  'C4. 

(ith  O.  Cav.  Disch'd  June  24,  '65. 

472 

Kirkham,  A.  W.,  It.,  A, 

Feb.  20, 

Left  ;  flap.    Confederate  surgeon. 

429 

Irby,  A.  V.,  Pt.,  I),  44th 

Sept.  17, 

Right.     Furloughed  Nov.  21,  '64. 

115th  N.  Y.,  age  32. 

20.  '64. 

Disch'd  May  20,  1865. 

Virginia. 

17,  '(12. 

473 

Kirkman,  D.,  Serg't,  K, 

Mav  4, 

Right.     Surg.  —  White,  C.  S.  A. 

430 

Ivers,   J.,    Pt.,  K,   10th 

Mav  16, 

Left  ;  flap.    Disch'd  Aug.  14,  '63. 

10th  Louisiana. 

4,  '63. 

Furl'd  July  3,  1863. 

Iowa. 

17,'  '63. 

474 

Kirkwood,  B.  F.,  Corp'l, 

Aug.  18, 

Left  ;  lat,  flap.     Surg.  R.  H.  Rob 

431 

Jackson,  J.,  Pt.,  A,  22d 

Sept.  29, 

Right;  circ.  Disch'd  April  10,  '65. 

H,  7th  Md.,  age  23. 

111,  '64. 

inson,  7th   Md.     Disch'd   April 

Cl'd  Troops,  ago  2.5. 

30,  '64. 

10,  1865. 

432 

Jacobs,  J.,  Pt.,  K,  1st  Mo. 

Sept.  2, 

.   Surg.  A.  H.  Ramsie.C.S.  A. 

475 

Kishbauch,  A.,    Pt.,  I. 

May  12, 

Left  ;  (Tealc's  rectangular  meth.) 

2,  '64. 

Recovery. 

143d  I'enn.,  age  21. 

12,  '64. 

Slough'g  ;  end  of  bone  removed. 

433 

Janney,  J.,  Pt.,  B,  14th 

July  1, 

Left;  circ.     Disch'd  April  12/64. 

Mustered  out  Doc.  28.  1865. 

New  York. 

2,  '63. 

476 

Kittlein,  J.,   It.,  D,  8th 

May  5, 

Left  ;    ant.   post.   flap.      Confed. 

434 

Jan-is,  K.,  It.,  E,  3d  N. 

Mav  13, 

Left;  double  flap.  Feb.2J,  rearnp. 

Maryland,  age  21. 

7,  fo. 

surgeon.     Disch'd  June  2,  1865. 

Hampshire,  age  19. 

15,'  '64. 

nee.  bone.    Disch'd  Oct.  26,  '65. 

477 

Klett,  J.,  Pt.,  F,  5th  N. 

Aug.  2.-, 

Left  ;  circ.  A.  Surg.  T.  C.  Smith, 

435 

Jenkins,  E.,  Pt.,  K,  125th 

July  19, 

Right  ;   ant.  post.  flap.     Disch'd 

YorkH'vyArt.,age3G. 

27,  '64. 

116th  Ohio.  Oct.,  reamp.    Disch. 

Illinois,  age  19. 

19,'  '64. 

Sept.  9,  1865. 

July  7,  1865. 

436 

Johnson,   L.  D.,   Pt.,  F, 

Aug.  14, 

Right  :  circ.    Prov.  Marshal  Nov. 

478 

Klinegger,  F.,  Pt.,  I,  41st 

Dec.  1.5, 

Right;  circ.    Disch'd  June  5,  '65. 

9th  Tenn.  Cav.,  age  44. 

14,  '64. 

16,  1864. 

Ohio,  age  33. 

15,  '64. 

437 

Johnson,  S.,  Pt.,  D,  23d 

Mar.  14. 

Left;  circ.     Surg.  G.  Derby,  23d 

479 

Klinger,  C  ,  It.,  E,  33(1 

Aug.  5, 

Right  ;  flap  ;  gang.    Disch'd,  1865. 

Massachusetts. 

14.  '62. 

Mass.     Discharged. 

Ohio,  age  19. 

5,  V64. 

438 

Johnston,  T.,  Pt.,  H,  8th 

June  3, 

Right;  flap.    Surg.  M.  Rizer,  72d 

480 

Knight,  A.  J.,  Corp'l,  C. 

April  2, 

Left  ;  ant.  post.  flap.     Discharged 

New  York,  age  24. 

4,  '64. 

Penn.     Disch'd  'May  31,  1865. 

37th  Mass.,  ago  26. 

2,  '65. 

Sept.  4,  1865. 

439 

Jones,  D.  M.,Lieut.-Col., 

July  2, 

Left;    circ.     Surg.  D.   S.   Hays. 

481 

Knir/ht,    D.    E.,    It.,   12, 

Mar.  —  , 

Right.    1'rovost  Marshal  May  10, 

110th  Pennsylvania. 

2.  '63. 

110th  Penn.     Disch'd  Oct.  9,  '63. 

17th  South  Carolina. 

—  ,  '65. 

1865. 

440 

Jones,  E.  W.,  Serg't.  H, 

Mar.  22, 

Right;    flap.     Surg.    A.  Sabinc, 

482 

Knight,    E.  O.,    It.,  K, 

Mav  5, 

Left;  eiro.     Surg.  W.   B.  Cham 

26th  Illinois,  age  26. 

22,  '6.5. 

7iith  Ohio.    Disch'd  June  18/65. 

97th  New  York,  age  18. 

6,  '64. 

bers.  !>7th  X.  Y.   Dis.  July  12,  '65. 

441 

Joss,  J.  C.,  Lieut.,  G,  2d 

Mav  6, 

Left.     Surgeon  E.  J.  Boninc,  2d 

483 

Knight,  F.W.,  It.,  E,  9th 

July  27, 

Left;  circ.     Surg.  A.  D.  Palmer, 

Michigan,  age  23. 

6,  '64. 

Mich.     Disch'd  Sept.  26,  1864. 

Maine,  age  24. 

27,'  '64. 

9th  Me.    M.  out  Oct.  4,  1865. 

442 

Judge,  T..  Serg't,  H,  62d 

Oct.  19, 

Left  ;  ant.  post.  flap.    Discharged 

484 

Knight,  W.  A.,  It.,  H, 

Sept,  17. 

Right  ;  don.  flap.   Surg.  M.  Storrs, 

New  York,  age  32. 

l!t.  '64. 

April  10,  1865. 

4th  R.  Island,  age  25. 

17,  '62. 

8th  Conn.    Disch'd  Nov.  7,  1863. 

443 

Kahl,  M.,  Pt.,  A,  37th  O. 

Mar.  21, 

Left  ;  bi-lateral  flaps.   Surg.  F.  N. 

485 

Krausc,   J.,   It.,  B,  7th 

Mar.  31, 

Right;  flap.    Disch'd  July  12,  '65. 

age  37. 

22,  '65. 

Barnes,!  16th  111.  Dis.Oct.21/65 

Wisconsin,  age  35. 

Ap.  1  '6.5. 

444 

Kane,  J.  J.,  Lieut.,  H, 

July  2, 

Left.     Surg.  Whitlield,  C.  S.  A. 

486 

Kresgie,  F.,  1't.,  I,  81st 

Aug.  16, 

Left  ;  flap.    Surg.  J.  H.  Buckman, 

fith  Ala.,  age  24. 

2.  '63. 

Provost  Marshal  March  17,  '64. 

Penn.,  age  24. 

16,  '64. 

5th  N.  II.    Disch'd  April  13.  '65. 

445 

Kaufman,  W.  H.,  Pt.,  A, 

Dec.  31, 

Left.     Disch'd  Sept.  18,  1863. 

487 

Krctzler,  A.,  Corp'l,  D, 

June  14, 

Right  ;  ant.  rcct.  flap  ;   (amp.  fore 

9th  Penn.  Cav.,  age  20. 

31.  '62. 

162d  New  York. 

14,  '63. 

arm.)  Surg.  W.I?.  Eager,  jr.,162d 

446 

Kaylor,  A.,  Corp'l,  I,  2d 

Mar.  31, 

Right;  circ.     Mustered  out  June 

N.  Y.    Disch'd  August  29,  1863. 

Ohio  Cav.,  age  25, 

Ap.  1,'6.5. 

6,  18'i.5. 

Died  July  8/7(1:  phthisis  pulmo. 

447 

Kean,  J.,  Pt.,  K,  42d  N. 

Mav  12, 

Left  ;  flap.    Surg.  W.  J.  Burr.  42d 

488 

Kuble,  J.  U.,  Ft.,  K,2d 

Aug.  28, 

Right.     Disch'd  October  18,  '62. 

York,  age  30. 

12,'  '64. 

N.  Y.     Disch'd  Feb.  16,  1865. 

Wisconsin. 

30,  '62. 

'LIDELL  (J.  A.)  On  I'yxmia,  in  U.  S.  San.  Con.  Mem.,  1870,  Surg.  Vol.  1,  Sect.  Third,  p.  535,  Case  XII. 


SECT.  III. 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER    THIRD. 


251 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

489 

Kugan,  M.,  Pt.,  K,  145th 

Aug  16, 

Right;  circ.     Surg.  G.  L.  Potter, 

531 

Maddox,  J,  Qorp'l,   K, 

July  2, 

Left.   Surg.  —  Strickland.C.S.A. 

Penn.,  age  21. 

16,  '64. 

145th  Penn.     M.  out  Oct.  30,  '65. 

5th  Louisiana. 

2,  '63. 

Paroled  Sept.  5,  1863. 

490 

Kurtner,  C.,  Pt.,  A,  31st 

Sept.  IS), 

.     Provost  Marshal  Dec.  17, 

532 

Magee,    J.,   Pt.,  G,   2d 

May  5, 

Right  ;  flap.    Surg.  G.  W.  Carr,  2d 

Virginia  Battery. 

19,  '('A. 

1864. 

Rhode  Island. 

5,  '64. 

R.  Island.    M.  out  Oct.  16,  1864. 

491 

Kyle,  U.,  Pt.,  D,  6th  N. 

July  1, 

Right  ;    flap.     Provost    Marshal 

1870,  stump  discharging. 

Carolina,  age  40. 

2,  '63. 

Oct.  15,  1863. 

533 

Maher,  J.,    Pt.,   F,  4th 

Dec.  14, 

Right;  circ.    A.  Surg.A.  M.Clark, 

492 

Lake,  E.,Pt.,D,8th  Penn. 

Oct.  28, 

Right:  flap.    Surg.  W.  L.  Baylor, 

Infantry,  age  27. 

14,  '62. 

U.  S.  V.    Gang.;  erysip.;  renio. 

Cavalry,  age  19. 

30,  '(54. 

C.  S.  A.    Disch'd  Aug.  29,  1865. 

exfol.    Disch'd  July  8,  1863. 

493 

Lamarsna,  J.  J.,  Pt.,  D, 

June  19, 

Left;  flap.    Surg.A.C.  Messenger, 

534 

Maire.  C.  L.,  Corp'l,  K, 

June  15, 

Left;   flap.     Surg.  J.   L.   Dunn. 

127th  Illinois,  age  18. 

19,  '64. 

57th   Ohio.     Disch'd  March  18, 

109th  Penn.,  age  37. 

16,  '64. 

109th  Penn.  Disch'd  June27,'65. 

1865. 

535 

Malbry,   P.   S.,  Pt.,  K, 

May  30, 

Right  ;  lat.  flap.    Surg.  C.  B.  Gib 

494 

Lambert.  G.,  Pt.,  H,  53d 

Oct.  5, 

Left.    Discharged  April  7,  1863. 

3d  Alabama. 

J'nel,'64 

son,  C.  S  A.     Transferred  June 

Indiana. 

5,  '62. 

3,  1864. 

495 

Lambson,  J.  F.,  Pt.,  A, 

Mar  14, 

Left  ;  flap.   Surg.  B.  N.  Bond,  27th 

530 

Mallort/.  D.   C.,  Serg't, 

Nov.  27, 

Right.     Surg.  —Holt,  C.  S.  A. 

4th  Iowa,  age  26. 

15,"  '64. 

Mo.     Disch'd  Oct.  7,  ]  865. 

F,  4tli  Virginia. 

28,  '63. 

Furloughed  Jan.  19.  1864. 

496 

Land,J.,¥t.,B,lWhQB. 

May  24, 

Right;  circular.   Recovery. 

537 

Manning,  A.  F.,  Pt.,  D, 

June  3, 

Right;    flap.     Disch'd  Sept.  30. 

24,  '64. 

50th  New  York. 

3,  '63. 

1863. 

497 

Landis,  T.  J.,  Corp'l,  D, 

Nov.  30, 

Left  ;  ant.  post.  flap.     Prov.  Mar 

538 

Manning,  G.  W.,  Pt.,  A, 

April  13, 

Right.     Surg.  —  Lewis,  C.  S.  A. 

2d  Arkansas,  age  25. 

De.  1,'64. 

shal  March  7,  1865. 

15th  Virginia. 

13,  '63. 

Furloughed  June  24,  1863. 

498 

Lansperger,  C.,  Pt.,  F, 

Mav  6, 

Left  ;  circ.    Confed.  surg.    Ulcer- 

539 

Marlow,  J.,   Pt..  I,   7th 

May  16, 

Right.     Surg.  W.  Berry,  7th  Ky. 

llth  Penn.,  age  34. 

6,  '64. 

ation.    Disch'd  March:.*],  1865. 

Kentucky. 

16,  '63. 

Disch'd  Sept.  21,  1863. 

499 

Lapoint,  V.,  Pt.,  A.  81st 

June  3, 

Right  :  ant.  post,  flap  ;  nee.  seq. 

540 

Marsh,  D.   W.,  Pt.,  H, 

June  29, 

R't  ;  circ.    Surg.  C.  M.  Campbell, 

New  York,  age  35. 

3,  '64. 

rem'd.     Disch'd  June  16,  1865. 

150th  N.  York,  age  21. 

29,  '64. 

150th  N.  Y.     Mar..  '65,  seq.  rem. 

Specs.  2373,  3765. 

Disch'd  Sept.  11,  '65.    Spec.  476. 

500 

Larke,  W..  Pt.,  E,  9th 

Sept.  30, 

Left;  .circ.    Disch'd  April  20,  '63. 

541 

Marshall,  C.,  Pt.,E,llth 

July  3, 

Left.     Provost  Marshal  Sept.  25, 

Wisconsin. 

30,  '62. 

Virginia,  age  22. 

3,  '63. 

1863. 

501 

Laton,  J.  M.,  Serg't,  A, 

June  14, 

Left  ;  circ.     Discharged  June  17, 

542 

Martin,  H.,  Pt,,H,  8th  N. 

Mar.  31, 

Left  ;  cire.     Surg.  II.  F.  Lyster, 

8th  New  Hampshire. 

14,  '63. 

1864. 

Jersey,  age  23. 

Ap.  1,  '65 

5th  Mich.    Disch'd  Sept.  8J865. 

502 

Lavr.rtjne,  A..  )'t..  Aus 

Mar.  28, 

Right;  circ.    Dr.  Miller.    June  8, 

543 

Mashan,  R.  W.,  Pt.,  K, 

May  27, 

Left  :  flap.     Surg.  J.  V.  Kendall. 

tin's  Battery,  age  22. 

28,  '65. 

dise.  bone  rem'd.    Aug.,  '65.  left 

149th  N.  Y.,  age  22. 

27,  '64. 

149th  N.Y.   Disch.  June  13,  '65. 

hospital.    Spec.  482. 

544 

Masters,  N  ,  Pt.,  D,  8th 

June  13, 

Right  ;  circ.     Disch'd  March  25, 

503 

Lawrence.  C.,  Corp'l,  E, 

June  10, 

L't;circ.;  (amp.  forearm.)     Surg. 

N.  Y.  Cavalry,  age  26. 

13,  '64. 

1865. 

9<)th  New  York. 

10,  '63. 

E.  S.  Hoffman,  90th  N.  Y.    Sub. 

545 

Mattox,  Al.F.,Vt.,  H,13th 

Sept.  19, 

Left  ;  circ.     Prov.  Marshal  April 

operations.    Disch'd  Nov.  21,  '63. 

Virginia,  age  34. 

19,  '64. 

1,  1865. 

504 

Lawrence,  J.  A..  Corp'l, 

June  21, 

Left  ;  ant.  post.  flap.    Surg.  G.  T. 

546 

Maynard,  M.,  Pt.,D,36th 

July  20, 

Left  ;  circ.    Disch'd  Feb.  4,  '65. 

A,  77th  N.  Y..  age  21. 

21,  '64. 

Stevens,  77th  N.  Y.    M.  out. 

Mass.,  age  20. 

20,  '64. 

505 

Lawrence,  F.  J.,  Pt.,  B, 

Sept.  19, 

Left;  circ.     Surg.  C.  H.  Andrus, 

547 

McSride,  W.  H.,  Pt.,  B, 

Mar.  25, 

Right  ;  circ.    Surg.W.  G.  Hunter, 

159th  N.  Y.,  age  17. 

20,  '64. 

176th  N.V.    HaBin.    July,  1865, 

44th  Virginia,  nge  30. 

25,  '65. 

211th  Penn.     Provost  Marshal 

seq.  rem'd.    Disch'd  Mar.  3,  '66. 

July  20,  1865.   Spec.  3996. 

50.; 

Lawrence,  W.  E..  Lieut.. 

Oct.  14. 

Left.     Surgeon  —  Butt,  C.  S.  A. 

548 

McBride,  P.,  Pt.,  D,  1st 

Sept.  1, 

Left;  sloughing.     Disch'd  April 

F,  32<l  N.  Carolina. 

14,  '63. 

Furl'd  February  5,  1865. 

New  York,  age  23. 

1,  '62. 

4,1863. 

507 

Laxton,  J.  L..  Serg't,  F, 

June  1, 

Left.     Surg.  —  Walker,  C.  S.  A. 

549 

McCaffrey,   P.,    Pt.,   C, 

Sept.  14, 

Right;  ant.post.flap.  Surg.  H.  F. 

3d  North  Carolina. 

1,  '64. 

Retired  Feb.  1,  1865. 

5th  N.  Jersey,  age  29. 

14,  '64. 

Lyster,  5th  Mich.    Disch  d  Apr. 

508 

Leach.  M.,  Pt.,  C,  50th 

Mar.  21, 

Loft  ;  ant.  post,  skin  flap.    Disch'd 

37,  1865.    Spec.  4112. 

Illinois,  age  21. 

21,  '65. 

June  30,  1865. 

550 

McCaleb,  B.,  Pt.,  D,  1st 

Sept.  22, 

Right  ;  ant.  post,  flap  ;  bone  prot.; 

509 

Lee.  T.,  Pt.,  K,  45th  Ala.. 

Nov.  29, 

Right  ;  circ.    Surg.  —  Ringgold, 

Tenn.  Cav.,  age  25. 

23,  '64. 

gang.     Disch'd  Nov.  23,  1865. 

age  30. 

30,  '64. 

C.  S.  A.    Pro.  Mar.  April  2,  '65. 

551 

McCann,   A.  J.,   Serg't, 

June  17, 

Right  ;  circ.    Surg.  N.  Hay  ward, 

510 

Lennard,  J.  M.,  Pt.,  C, 

Sept.  21, 

.     Surg.  —  Burton,  C.  S.  A. 

K,  36th  Wis  ,  age  23. 

17,  '64. 

20th  Mass.    Disch'd  Sept."  27,  '64. 

3d  Georgia  Cavalrv. 

23,  '63. 

Recovery. 

552 

McCann,  D.,  Pt.,  D,40th 

Nov.  27, 

Left:  ant.post.flap    Discharged 

511 

Lewin,   J.,    Pt.,   D,"7th 

June  3, 

Right.    Surg.  G.  T.  Stevens,  77th 

New  York,  age  39. 

28,  '63. 

Nov.  8,  1864. 

Maine,  age  34. 

4,  '64. 

N.Y.  Gang.;  fetn.  prot.   Disch'd 

553 

McCann,   H.,  Serg't,  A, 

April  2, 

Left:  flap.    Surg.C.C.McGlaugh- 

Oct.  17.  '64.    Re-amp,  flap,  mid. 

95th  Penn.,  age  21. 

2,  '65. 

lin,  95th  Penn.    Disch'd  —  ,  1865. 

third,  Oct.  21,  1865. 

554 

McCarthy,   B.,   Pt.,   K, 

June  16, 

Left  ;  circ.    Surg.  D.W.Maull,  1st 

512 

Loyson,  J.,  Pt.,  D,  20th 

Dec.  13, 

Right.    Surg.  J.  Dwinelle,  106th 

170th  N.  Y.,  age  28. 

17,  '64. 

Del.    May,  '65,  seq.  rem.    Disch. 

Mass..  age  19. 

13,  '62. 

Penn.    Disch'd  June  6,  1863. 

Oct.  19,  '65.     Died  April  5,  '70. 

513 

Lichstein,  L.,  Lieut.,  F, 

June  18, 

Right.     Surg.  W.  A.  Barry,  !)8th 

Spec.  1581. 

98th  Penn.,  ago  28. 

18,  '64. 

Penn.     Duty  Nov.  15,  1865. 

555 

McCarthy,    J.,   Pt.,   D, 

June  1, 

Right  ;  circ.    Dec.  30,  dead  bone 

514 

Lilley.  M.  A.,  .Serg't,  H, 

Aug.  3, 

Right  ;  flap.  "A.  Surg.  D.  Haider- 

13>Jth  N.  Y.,  age  21. 

2,  '64. 

remo'd.    Disch'd  May  22,  1865. 

4(ith  Ohio,  age  26. 

3,  ?64. 

man,   46th   Ohio.      Erysipelas. 

556 

McCarthy,  W.,  Pt.,   B, 

Oct.  11, 

Left.    Disch'd  May  29,  1865. 

Disch'd  Juno  9,  1865. 

27th  Michigan. 

11,  '63. 

515 

Lindloy,  F.  \V.,  Pt.,  K, 

June  19, 

Left;  flap.    Surg.  J.  H.  Rodgers, 

557 

McCaughey,  T.  M.,  Pt., 

May  17, 

Left.     Surg.  \V.  P.  Pierce,  88th 

103d  Ohio,  age  25. 

21,  '64. 

104th  Ohio.     HsBin.;  gangrene. 

D,  74th  111.,  age  18. 

18,"'64. 

111.    Disch'd  May  18,  '65;  never 

Disch'd  June  30,  1865. 

healed.    Died  Ja'n.  20,  1867. 

516 

Linrtslcv,  M.W.,  Pt.,  G, 

April  2, 

Left  ;  flap.     Disch'd  Oct.  29,  '65. 

558 

McClellan.W.R.,  Serg't, 

Mar.  25, 

Left;    circ.  flap.      Surg.   W.   G. 

1st  N.V.  Drag.,  age  21. 

2,  '65. 

A,  209th  Penn.,  age  27. 

25,  '65. 

Hunter,  211th    Penn.     Disch'd 

517 

Lintlinrst,  C.  W.,  Corp'l, 

Aug.  30, 

Right.  Disch'd  Oct.  10,  '62.  Died 

July  28,  1865.     Spec.  4029. 

I,  1st  Penn.  Reserves. 

30,  '62. 

May  8,  1670:  consumption  and 

559 

McClcskey,   Pt.,  U.  S. 

March  8, 

Left.    Disch'd  Aug.  21,  '62.    Died 

general  debility  from  injury. 

Marines,  age  28. 

8,  '62. 

January  14,  1863. 

518 

Little.  W.  M.,  Corp'l,  I, 

Feb.  10, 

.    Surg.  —  Momenier.C.S.A. 

560 

McColloch,  W.  M.,  Pt,, 

June  25, 

Left  ;  flap.    Confederate  surgeon. 

8th  Louisiana. 

11,  '64. 

Recovery. 

K,  20th  Indiana. 

26.  '62. 

Disch'd  August  8,  1862. 

519 

Long.  D.  B.,  Pt.,  E,  75th 

Get.  8, 

Left.     Disch'd  Dec.  9,  '62.'   Sub. 

561 

MeConnell,  A.  F.,Corp'l, 

Mar.  16, 

Right  :  double  flap.     Surg.  T.  B. 

Illinois. 

9,  '62. 

operation  1870. 

K,  121st  Ohio,  age  24. 

16,  '65. 

Williams,  121st  Ohio.     Disch'd 

520 

Loomis,  D.,  Pt.,  I,  38th 

Sept.  1, 

Right  ;  flap.    Surg.  C.  N.  Fowler, 

June  16,  1865. 

Ohio,  age  18. 

2   '64. 

105th  Ohio.     M.  out  May  17,  '65. 

562 

MeConnell,  J.,  Capt.,  F, 

Mar.  25, 

Left  ;  circ.    A.  Surg.  E.  M.  Smy- 

521 

Losie.  J.  M.,  Capt.,   A, 

May  25, 

Right  ;  flap.    Surg.  J.  Chapman, 

4th  Georgia,  age  22. 

26,  '65. 

ser,  48th  Penn.     Released  June 

107th  N.  York,  ago  34. 

26,  '64 

123d  N.  Y.     Diseh'd  Jan.  31,  '65. 

14,  1865.    Spec.  3993. 

522 

Lovvrcy,  A.,Pt.,G,  104th 

Sept.  11, 

Left  ;  circ.     Surg.  K.  G.  Thomas, 

563 

MeConnell,  J.  J.,  Serg't, 

Oct.  11, 

Right  ;  ant.  post.  flap.     Surg.  E. 

Ohio." 

11,  '62. 

104th  Ohio.  Disch'd  Sept.28,'62. 

G,3dInd.Cav.,age25. 

12,  '63. 

W.  H.  Beck,  3d  Ind.  Cavalry. 

523 

Lozier,  T.  H.,  Pt.,  P.,  2d 

June  11, 

Right  ;  circ.    Surg.  W.  M.  Weid- 

Disch'd  Sept.  5,  1864. 

Penn.  Cav.,  age  18. 

11,  '64. 

man,  2d  Penn.  Cav'y.     Disch'd 

564 

McCord,  T.N.,  Pt.,  For 

Aug.  21, 

Left;  ant.  post.  flap.     A.  Surg. 

March  2,  1865. 

est's  Cavalry,  age  28. 

22,  '64. 

J.  C.  G.  Happersett,  U.  S.  A. 

524 

Ludaka,  A.,  Pt.,  L,  102d 

Sept.  19, 

L't  ;  flap.  A.  Surg.  J.  Romans,  jr., 

Retired  March  16,  1865. 

Penn.,  ago  26. 

19,  '64. 

U.  S.  A.     Disch'd  Aug.  21,  '65. 

565 

McCready,  J.  A.,  Serg't, 

Sept.  20, 

Right:    eirc.      Confed.    surgeon. 

52."> 

Luhinan,     E.,    Seaman, 

Mar.  15, 

Left  ;  flap.     Disch'd  Dec.  14.  '63. 

E,  12th  Ala.,  age  29. 

20,  '64. 

Prison  Jan.  5,  1665. 

II.  S.  Navy,  age  28. 

15,  '63. 

Died  June  12,  '69  ;  consuinpt'n. 

566 

McCutcheon,  G.  B.,  Pt., 

Sept.  30, 

Left  ;  post.  flap;  (also  w'd  of  head, 

52'i 

Lumiitgan.    /'.,    Serg't, 

Sept.  20, 

Left.     Surg.  —  Vaughn,  C.  S.  A. 

E.  6th  South  Carolina. 

Oct.  2,  '64. 

arm,  and  foot.)     A.  Surg.  S.  P. 

A,  5th  C.  S. 

20,  '63. 

Recover}-. 

Brcckinridge.C.S.A.  Recovery. 

527 

Lupton,   J.  W.,   Pt.,   C, 

July!', 

Left:  circ.     A.  Surg.  R.  F.  Weir, 

Spec.  5515. 

14th  N.  Jersey,  age  21. 

10,  "'64. 

IT.  S.  A.     Disch'd  April  3,  1865. 

567 

McDonald,  D.,  Serg't,  A, 

July  21, 

Right  :  flap.     Surg.  G.  M.  Beaks, 

Specs.  2306,  3924. 

101st  New  York,age24. 

21,"  '64. 

141st  N.  Y.    Dec.  10,  gangrene. 

528 

Liiscombe,  F.  E.,  Pt.,  E, 

May  19, 

Left;  circ.     Disch'd  Mar.  29,  '64. 

Disch'd  Sept.  20,  1865. 

17th  Wis.,  age  21. 

20,"  '63. 

568 

McDonald,  J.,Pt.,D,  4th 

April  2, 

Left  ;  circ.     Surg.  H.  Plumb,  2d 

529 

Lynch,  J.,  Serg't,  1,  17th. 

Sept.  20, 

Right.    Surg.  W.  H.  Gentry,  17th 

New  Jersey,  age  23. 

2,  '65. 

Conn.  Heavy  Artillery.  Disch'd 

Tennessee. 

20,  '63. 

Tenn.     Recovery. 

Sept.  11,  1865. 

530 

Madden.  J.  .ST.,  Capt.,D, 

Nov.  30, 

Left  ;  circular.     Provost  Marshal 

569 

McDonald,    P.,    Pt.,  F, 

Sept.  19, 

Left.     Surg.  —  Smith,  C.  S.  A. 

32d  Miss.,  age  34. 

De.1,'64. 

March  1,  1865. 

54th  Tenn.,  age  25. 

19,  '63. 

Transfd  June  16,  1865. 

252 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITAUV 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  Ol'EKATOKS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

570 

McDowell,C..Pt.,I,117th 

July  4, 

night;  ant.  post,  flap      Surg.  H. 

613 

Moore,  P.,  Pt.,  E,  1st  Vt. 

June  1  , 

Left;  double  flap.     Surg.  C.  B. 

New  York,  ajre  til. 

4.  '04. 

W.  Carpenter,  117thNcw  York. 

H.  Art.,  age  19. 

2,  '64. 

Park,  1st  Vermont  H.  A.;  necro. 

Disch'd  Jan.  1;>,  1866.    Spec.  390. 

Disch'd  August  11,  1865. 

571 

McElroy,  R.  P.,  Pt.,  A, 

June  18, 

Left;  eirc.    Surg.lI.C.Tompkins, 

614 

Moore,  H.  P.,  Pt.,  C,  20th 

April  9, 

Right  ;  circ.   Disch'd  April  11,  '66. 

4th  N.  Y.  H.  A.,  n  ffe  33. 

18,  '64. 

4th  N.Y.H.A.  Dis.  Nov.  21,  '64. 

Penn.  Cav.,  age  19. 

9,  '65. 

57:.' 

McFarland,  J.  7/.,Capt., 

May  16, 

.     Surg.  —  Taylor,  C.  S.  A. 

615 

Morton.H.,  Serg't,  D,23d 

Nov.  3, 

Left  ;  flap.     Surg.  .T.  S.  McGrew, 

G,  1st  Missouri. 

17,"  '63. 

Recovery. 

Wis.,  age  25. 

4,  '63. 

83d  Ohio.     Disch'd  Mar.  10,  '64. 

573 

Mcdaha,  W.  H.,  Pt.,  A, 

July  3, 

Right.     .Surg.  —  Strath.  C.  S.  A. 

616 

'Morse,  S.  L.,Pt.,E,  24th 

May  16, 

Right  ;    double   flap  ;    gangrene. 

iM  Virginia. 

3,  '63. 

Exchanged  March  3,  18154. 

Iowa. 

16,  '63. 

Disch'd  Sept.  15,  1863. 

574 

McGuire.T.,  Pt.,  D,21st 

June  21, 

Plight  ;  flap.    A.  Surg.  J.  L.  Rcat, 

617 

Moss,  E.,Pt.,F.7th  Col'd 

Oct.  30, 

Right;  flap.    Recovered. 

Illinois,  age  22. 

21,  '64. 

21st  111.  Disch'd  Feb.  27,  1S65. 

Artillery,  age  23. 

30,  '64. 

575 

Mclntirc,  H.,  Pt.,  C,  12th 

Mar.  28, 

Left  ;  ant.  post.  flap.    Surg.  S.  II. 

618 

Mothersb'augh,  S.,Pt.,B, 

Oct.  27, 

Right  ;  ant.  post.  flap.     Disch'd 

New  Jersey,  age  21. 

29,  '65. 

Plumb,  8~'d  X.  Y.    Disclrd  June 

91st  Penn.,  age  35. 

27,  '64. 

July  13,  1865. 

6,  1865. 

619 

Muller,  G.,  Pt.,  A,  40th 

July  2, 

Right  ;  antero-rectangular.     Dis. 

576 

McKinney,  J.  F.,  Pt.,  F, 

Dec.  16, 

Right  :   ant.  post.   flap.     Provost 

Now  York,  age  32. 

4,  r63. 

Feb.  20,  1864.    Spec.  1478. 

44th  Miss.,  age  26. 

16,  '64. 

Marshal  March  27,  1865. 

(120 

Murphy,  D.,  It.,  D,  20th 

Dec.  13, 

Left.     Surg.  J.  Dwindle,  106th 

577 

Mo.Kinstrcy,  K.,  Pt.,  C, 

June  25, 

Right.     Surg.  T.   Sim.  U.  S.  V. 

Mass.,  age  23. 

13,  '62. 

Penn.     Disch'd  Sept.,  1863. 

70th  New  York. 

25,  '62. 

Disch'd  Sept.  29,  1862. 

621 

Murphy,  J.  D.,  Serg't,  F, 

Nov.  30, 

Left  ;  circ.    A.  Surg.A.  I.Gustine, 

578 

McMahon,  II.  P.,  Pt.,  L, 

June  16, 

Left;  circ.    Disch'd  Nov.  14,  '64. 

42d  Tenn.,  age  18. 

De.  1,'G4. 

48th  Tenn.  Pro.  Mar.  May  6.'65. 

1st  Mass.  Artillery. 

17.  '04. 

622 

Murphy,  P.,  Corp'l,   II, 

May  12, 

Left  ;  flap.  Surg.  A.  S.  Coe,  147th 

579 

McMahon,  M.,It.,B,15th 

July  3, 

Right  ;  ant.  post.   flap.     Disch'd 

147t"n"N.  York,  age  22. 

12,  '64. 

N.Y.    Disch'd  Sept.  9,  1«i5. 

Infantry,  age  19. 

4,  '04. 

Aug.  29,  1WJ5. 

623 

Murray,  R.  W.,  It.,  F, 

May  6, 

Right.    Surg.  R.  M.  Terrill,  P.  A. 

580 

McMahon,  P.,  Pt.,  G,  32<1 

Mar.  22, 

Left  ;  flap.  Surg.  A.  B.  Monohan, 

4th  Texas. 

6,  ''64. 

C.  S.    Recovery. 

Wis.,  age  27. 

22,  '65. 

63d  Ohio.     M.  out  June  20,  '60; 

624 

Murray,  M.,  Pt.,  A,  4th 

June  2, 

Left  ;  flap.    Surg'.A.  S.  Coe,  147th 

not  healed  1870. 

Delaware,  age  19. 

3,  '64. 

N.  Y.    Disch'd  Mav  16,  1865. 

581 

Me  Mann,  J.,  Pt.,  F,  48th 

July  2, 

Left.    Exch'd  Sept.  25,  'G3,  and 

625 

Murray,  R,  Corp'l,  D,  2d 

Sept.  30. 

Left  ;  double  flap.  "  Surg.  R.  T. 

Alabama,  age  18. 

3,  '63. 

furloughed. 

N.  York  M.  R.,  age  18. 

30,  '64. 

Paine,  ir..  2d  N.  Y.  M.  R.    Gang. 

582 

McManus,  J.,  Serg't,  G, 

May  16, 

Right;  flap.    Disch'd  Nov.  6,  '63. 

Disch'd  June  15,  1865. 

69th  Indiana. 

16,"  '63. 

G2C 

Myers,  C.,  Pt.,  1st  Conn., 

April  5, 

Right  ;  circ.      Surg.  E.  Bentley, 

583 

McMillan,  C.,  Corp'l,  F, 

May  19, 

Left.     Disch'd  Sept.  2',',  1863. 

age  32. 

6,  '65. 

U.  S.  V.    Disch'd  July  10,  1865. 

4th  West  Virginia. 

20,  '63. 

627 

Naragon,  A.  C.,  Pt.,  F, 

Sept.  19, 

Left;oirc.  flap.   Confed.  surgeon. 

584 

McRea,  P.,  Pt.,  H,  153d 

Sept.  19. 

Right  ;  circ.     Surg.  X.  L.  Snow, 

19th  Ohio,  age  24. 

21,  '63. 

Disch'd  Sept.  25,  1864. 

New  York,  ago  24. 

19,  '64. 

153d  N.  Y.   Disch'd  June  14,'C5. 

628 

Naughton,  E.,  Pt.,  F,  3d 

Aug.  25, 

Left  i  nnt.  post.  flap.    Surg.W.W. 

585 

Meaker,  W.,  Pt.,  G,  5th 

June  16, 

Left:  circ.     Surg.  H.  F.  Lyster, 

N.  Jersey  Cav.,  age  21. 

25,  '64. 

Bowlby,  3d  N.  J  .  Cav.    Disch  'd 

Michigan,  age  19. 

17,  'C4. 

5th  Mich.     Disch'd  Nov.  9,  '(i5. 

Oct.  2G,  '65.     April  20,  '68,  flap 

Spec.  3318. 

reamp.  mid.  third.      Spec.  2443. 

580 

Mettz,  T.,  Corp'l,  C,  5th 

Oct.  19, 

Left  ;    ant.  post.  flap.     Surg.  — 

629 

Neat,  W.,  It.,  1,  28th  111. 

Oct.  4. 

Right;   circular.     Rcamputation. 

Alabama,  age  31. 

19,  'C4. 

Mushett,  5th  Ala.     Prison  Feb. 

4,  '(12. 

Disch'd  April  17,  1863. 

10,  1865. 

630 

Neidhart,  J.,  Lieut.,  D, 

Mar.  30, 

Right.     Surg.  C.  M.  Clark,  39th 

587 

Meidam,  S.,  Pt.,  E,  5th 

April  2, 

Left  ;  Hap.    Disch'd  Sept.  1,  18(15. 

10th  Conn.,  age  24. 

30,  '65. 

Illinois.     M.  out  Sept.  2,  1865. 

Wis.,  age  17. 

2,  'C5. 

631 

Newell,  A.,  It.,  F,  14th 

June  14. 

Left;  circ.;  flap.  Surg.G.E.Sloat, 

588 

Meinhart,  P.,  Pt.,  D,  6th 

May  4, 

Right  .     Surg.  W.  A.  Robertson, 

Ohio,  age  17. 

14,  '64. 

14th  Ohio.    Disch'd  June21,'G5. 

Louisiana. 

5,  '63 

6th  La.     Recovery. 

632 

Newell,  T.  L.,Pt.,F,  llth 

May  8, 

Left;  circ.     Disch'd  July  21,  '65. 

589 

Meis,  W.,  Pt.,  E,  9th  N. 

May  6, 

Right;    flap.     Disch'd   Feb.    12, 

Penn.,  age  19. 

10,  ''64. 

Jersey,  age  :50. 

6,   04. 

18G5. 

633 

Newton,  J.  M.,  Serg't,  D, 

Oct.  3, 

Left  ;  flap.     Disch'd  May  13,  '65. 

590 

Meissner,  D.  F.,  Pt.,  K, 

July  K1, 

Left  ;  flap.    Disch'd  Nov.  2,  1864. 

12th  Illinois. 

5,  '62. 

34th  N.  Jersey,  age  19. 

12,  'M. 

634 

Nice,  W.  T.,  Pt.,  B,  1st 

Dec.  13, 

Right.    Disch'd  June  3,  1863. 

591 

Merrick,  G.  W.,  Major, 

June  18, 

Right;    circ.     Disch'd   Sept.  30, 

Penn.  Artillery. 

13,  '62. 

187th  Penn.,  age  26! 

18,  '64. 

1864. 

635 

Nichols,  H.,  It.,"  K,  138th 

June  2, 

Right;  circ.;  bpne  prot.    Sept.  27, 

592 

Merrill,  C.,  It.,  K,  4th 

An?.  27, 

Right  ;  flap.     Surg.  S.  A.  Green, 

Penn.,  age  20. 

2,  '64. 

reamp.;  ant.  post,  flap,   middle 

New  Hampshire. 

27,  '(13. 

24th  Mass.    Disch'd  Nov.  25,  '63. 

third.     Disch'd  April  19,  1865. 

593 

Mersheimer,  G.,  Pt.,  D, 

June  10, 

Right;   flap.     Surg.  J.  L.  Dunn, 

636 

Nickason,  A.,  Serg't,  I, 

Sept.  19, 

Left;  circ.     A.  Surg.  B.  Fordycc, 

109th  Penn..  age  22. 

16,  '64. 

109th  Penn.    Disch'd  Aug.  2,'Go. 

73th  New  York,  age  35. 

19,  '64. 

1  6()th  N.Y.    Disch'd  May  25,'  '65. 

594 

Messer.  S.L.,Pt..  E,  20th 

Mar.  31, 

Left;  flap;   erysip.     Discharged 

637 

Nickle,   J.,    Serg't,    H, 

Dec.  9, 

Right  ;  ant.post.flap.    Surg.  J.W. 

Maine,  age  33. 

31,  '65. 

August  17,  1865. 

14Cth  Penn.,  age  24. 

10,  '64. 

Wishart,  140th  Penn.     Disch'd 

595 

Milan,  J.  K.,  Lieut.,  F, 

June  11, 

Right.    Surg.  —  Mitchell,  C.S.A. 

May  19,  1865. 

17th  Arkansas. 

11.  '63. 

Furloughed  Oct.  9,  1864. 

638 

Nigh,  J.,  Serg't,  C,  35th 

Sept.  1  9, 

Right  ;  flap.    Surg.  S.  B.  Hawley, 

59G 

Miles,  J.,Pt.,  F,53dlnd., 

Nov.  24, 

Right;  circ.    Disch'd  June  26,  '65. 

Illinois,  age  33. 

19,  '63. 

35th  Illinois.    M.  out  July,  1864. 

age  23. 

24,  'C4. 

639 

Norman,   W.  B.,  Pt.,  D, 

Sept.  3. 

Right  :  circ.  Surg.  —  Barr.C.S.  A. 

597 

Miller,  C.,  Pt.,   E,  43d 

May  5, 

Left  :  flap.    Disch'd  Dec.  24,  1864. 

13th  Miss  ,  age  25. 

4,  '64. 

Prison  Nov.  19,  1864. 

New  York,  age  'JO. 

6,  r64. 

640 

Norris,  J.  A.,  Capt.,  C, 

July  2(1, 

Right.    Surg.T.B.Williams,121st 

598 

Miller,  C.  A.,  Pt.,  G,  20th 

April  27, 

Left  :  circ.  Surg.O.  Peabody,  23d 

98th  Ohio. 

20,"  '64. 

Ohio.    Disch'd  Oct.  3,  1864. 

Wisconsin,  age  27. 

27,  'Go. 

Iowa.    Gang.    Dis.  Aug.  5,  'G5. 

641 

Obier,  J.,  It.,  E,  1st  Del 

Dec.  J3, 

Right.   Surg.D.W.Maull,  1st  Del. 

599 

Millf.r,F.  M.,  It.,  Nelson 

July  18, 

.     Surg.  —  Love,  C.  S.  A. 

aware,  age  27. 

14,  '62. 

Dec.  28,  reamp.  mid.  third.     A. 

Battenr. 

18,  '64. 

Recovery. 

A.  Surg.  II.  Stone.    Nee.    May  7, 

600 

Miller,  J.,  Corp'l,  F,  2d 

Aug.  11, 

Right  ;  (lap.  A.A.Surg.Maxwell. 

'64,  reamp.  up.  third.  A.  A.  Surg. 

Artillery,  age  33. 

11,  'G4. 

Fort  Mcllenry  July  2,  1805. 

U.  J.  Lewis.     Disch.  Dec.  3,  '64. 

601 

Miller,  J.,  It.,  K,  118th 

Sept.  30, 

Left  ;  circ.    Mar.  29.'<>5,  bonerem. 

642 

O'Brien,  P.,  Pt.,  G,  34th 

June  18, 

Left  ;  flap  ;   sloughing.      Disch'd 

Penn.,  age  30. 

Oct.  1,  '64. 

Disch'd  Sept.9,  1865.  Spec.  4349. 

Mass.,  age  27. 

18,  '64. 

February  4,  1865. 

602 

Miller,  J.,  Corp'l,  15,  73d 

Mar.  19, 

Right;  circ.    Disch'd  August  22, 

643 

O'  Bryan,  P.,  It.,  F,  7th 

Sept.  17, 

Left.    Disch'd  June  29,  '63.    Died 

Ohio,  age  25. 

19,  '65. 

1865. 

'Maine,  age  35. 

—  ,  '62. 

July  9,  'G6  ;  effects  of  amp. 

603 

Miller,  J.,    Pt.,  C,   18th 

Aug.  30, 

Left  :  flap;  bone  exp.  rem.  Disch. 

644 

Oliver,   J.,    It.,    L,  72d 

Sept.  17, 

Right.     Surg.  S.  G.  Lane,  5th  Pa. 

Kentucky,  age  '.58. 

30,  '62. 

April  23,  186-1.    Spec.  1094. 

Pennsylvania. 

18,  '62. 

Res.    Disch'd  Dec.  1  ,  1862. 

61   ! 

Millis,  H.'C.,  Lieut.,  B, 

Oct.  14, 

Left.     Surgeon  —  Butts,  C.  S.  A. 

645 

Oliver,    J.,    Pt.,    A,    2d 

Oct.  8, 

Left;  flap.    Surg.C.  L.Henderson, 

45th  North  Carolina. 

14,  '63. 

Recovery. 

Michigan  Cavalry. 

8,  '62. 

2d  Mich.  Cav.    Dis.  Dec.  17,  'G2. 

605 

Mills,  S.  S.,  .Serg't,  15,7th 

Dec.  16, 

Right;  circ.    Surg.  V.P.Kennedy, 

646 

Ordway,  A.,  It.,  L,  1st 

June  22, 

Left  ;  circ.     Mustered  out. 

Minnesota,  age  39. 

17,  '64. 

5th  Minn.    Disch'd  Mar.  28,  '65. 

Maine  Cavalry. 

23,  '64. 

606 

Minnich,  A.,  Serg't,  K, 

Mar.  25, 

Right  ;  ant.  post.  flap.     Surg.  W. 

647 

Osborne,  J.,  Pt.,  G,  132d 

May  3, 

Left  ;  circ.    Disch'd  Nov.  7,  1863. 

200th  Penn.,  age  24. 

27,  '65. 

().  McDonald,  U.  S.  V.     Disch'd 

Pennsylvania. 

3,  '63. 

July  19,  1865.   Spec.  4134. 

648 

Oflin,  J.  0.,  Pt.,  A,  2d 

Sept.  20, 

Left.    Surgeon  —  Holt,  C.  S.  A. 

607 

Minshew,  J.,  Pt.,  G,  50th 

July  2, 

Left  ;   nee.  bone  rem'd.     IVovost 

Tennessee. 

20,  '63. 

Recovery. 

Georgia,  age  29. 

3,  fa. 

Marshal  Sept.  28,  1863. 

649 

Otle.w,  J.  n.,  Pt.,  A,  43d 

Oct.  19, 

Left.     Pro.  Marshal  April  1  ,  1865. 

608 

Mitchell.  S.  J.,  Corp'l,  A, 

May  29, 

Right  ;    ant.    post.   flap.     Prison 

N.  C.,  age  26. 

19,  '64. 

58th  Virginia,  ago  32. 

30,  '64. 

Oct.  1,  1864. 

650 

Ott,  C.  A.,  Pt.,  B,  155th 

June  18, 

Left;  circ.     Surg.  J.  A.  E.  Reed, 

609 

Moffitt,    S.,    Lieut.-Col., 

Oct.  27, 

Left;  circ.     A.  Surg.  W.  Wood 

Penn.,  age  19. 

19,  'G4. 

155th  Penn.  Gangrene.    Disch'd 

9Gth  X.  Y.,  age  28. 

28,  '64. 

ward,  39th  III.,  and  Surg.  T.  H. 

May  25,  1865. 

Squire,  89th  N.  Y.     Must.  out. 

651 

Palmer,  II.  II.,  Corp'l,  B, 

July  3, 

Right;  circular.  Confed.  surgeon. 

010 

Molegnn,  L.  G.,  Pt.,  H, 

Oct.  19, 

Left  ;  lat.  flap.     Dis.  Sept.  8,  '65. 

2d  Ohio  Cavalry. 

3,  '63. 

Discharged. 

32d  Mass.,  age  24. 

19,  '64. 

Died  Oct.  22,  '69  ;  anaemia  and 

652 

Park,  G.  A.,  It.,'  A,  81st 

Aug.  25, 

Left  ;  flap.     Surg.  W.  C.  Jacobs, 

pain  resulting  from  amputation. 

Ohio,  age  29. 

25,  '(14. 

81st  Ohio.    Disch'd  May  5,  1865. 

611 

Monroe,  E.,  Pt.,  H,  59th 

Dec.  15, 

Right  ;  circ.     M.  out  May  27,  '65. 

653 

Park,  S.  W.,  Colonel,  2d 

May  3, 

Right.    Surg.H.  McLane,2d  N.Y. 

Illinois,  age  24. 

15,  '64. 

New  York,  age  3(i. 

3,  '63. 

Mustered  out  May  26,  1863. 

612 

Moore,  A.  M.,  Pt.,  Wash 

April  2, 

Right.    Released  June  21,  1865. 

654 

Parker,  M.,  It.,  H,  1st 

May  16, 

Left  ;  circ.    Surg.  C.  E.  Swasey, 

ington  Bat.,  age  18. 

2,  '65. 

Arkansas,  age  20. 

17,  '64. 

U.  S.  V.     Disch'd  July  19,  1865. 

1  BRYAN  (J),  foe  cit.,  p.  287. 


SECT.  HI.J 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER   THIRD. 


'253 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AKD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AM>  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

655 

Parker,  M.  F.,Pt..E,  19th 

May  15, 

Left  :  flap.    Surg.  J.  Bennett,  19th 

695 

Reagan,  W.  B.  L.,  Lieut., 

July  24, 

Right.     Surg.  —  Love,  P.A.C.S. 

Michigan,  age  25. 

16,  '64. 

Mich.    Disch'd  Oct.  16,  1864. 

16th  Tenn.  Bat.,age  25. 

24,  '64. 

For  exch.  Nov.  22,  1864. 

656 

Parker,   W.,   J't.,  I,    1st 

June  16, 

Right  ;  circ.    Disch'd  Feb.  27,  '65. 

696 

Rector,  C.  J.,  Lieut.,  C, 

Mar.  29, 

Left;  double   flap.     Surg.  P.  L. 

Mass.  II.  Art'y,  nee  27. 

18,  '64. 

185th  N.  York,  age  21. 

29,  '65. 

Sonnick,  187th  N.  Y.    Must,  out 

657 

Parker,   W.  F.,   Pt.,  F, 

Oct.  21, 

Left  ;  circ.  Surg.R.  J.  Mohr,  10th 

May  29.  1865. 

10th  Iowa,  age  21. 

21,  '64. 

Iowa.    Disch'd  Aug.  21,  1865. 

697 

Reed,  G.  P.,  Sergeant,  I, 

June  11, 

Left  ;  circ.     Skirg.  J.  H.  Rodgers. 

658 

Parquette,  H.,  Pt.,  1,  1st 

Sept.  14, 

Right.    (Teale's  method.)    Surg. 

104th  Ohio,  age  32. 

11,  '64. 

104th  Ohio.    Disch'd  Oct.  25/64. 

N.  H.  H.  Art'y,  age  21. 

14,  '64. 

R.  B.  Bontecou,  U.S.V.    Gang.; 

698 

Reeves,  J.  J.,  Pt.,  F,  1st 

June  18, 

Left;  flap.    Disch'd  Dec.  3,  1864. 

haem.  Dis.Oct.  1.'65.  Spec.  3244. 

Maine  H.  A.,  age  27. 

19.  '64. 

659 

Parquetti,  J.,  Pt.,  B,  1st 

July  29, 

Left  ;  circ.    A.  Surg.  H.  E.  Brown, 

699 

Regner,  M.,  Pt.,  E,  6th 

Feb.  6, 

Left;  circ.     Disch'd  Aug.  21,  '65. 

California  Cavalry. 

30,  '65. 

U.  S.  A.    Disch'd  June  25,  1866. 

Wisconsin,  age  25. 

7,  '65. 

Spec.  4383. 

700 

Reitzel,  U  J.,  Pt.,A,12th 

July  20, 

.     Surg.  —  Hinkle,  C.  S.  A. 

660 

Parsons,  \V.  D.,  Pt.,   15, 

April  2, 

Right  ;  circ.   Surg.  C.  B.  Park,  jr., 

North  Carolina. 

20,  '64. 

Recovery. 

2d  Vermont,  age  18. 

2,  '65. 

llth  Vt.     Disch'd  Aug.  11,  '65. 

701 

Renner,  A.,  Pt.,  K,  26th 

May  14, 

Left  :  flap."    Surg.  A.  Sabine,  76th 

661 

Patterson,  W.  H.,  Lieut., 

Aug.  2, 

;  ant.  post.  flap.     A.  Surg. 

Iowa,  age  16. 

14,'  '64. 

Ohio.     Sept.,  1864.  bone  exfol. 

0,  37th  Virginia. 

2,  ?64. 

Anderson,  C.  S.  A.     Prov.  Mars. 

Jan.,  186.">.  reamp.;  double  flap. 

Nov.  1,  1864. 

middle  third.     A.  A.  Surg.  J.  M. 

662 

Payne,  L.  D.,  Serg't,  D, 

Mar.  25, 

Left.     A.  Surg.  E.  P.  Roche,  35th 

Adler.     Disch'd  May  26.  1865. 

44th  Virginia,  age  22. 

25,  '65. 

Mass.    Released  June  14,  1865. 

702 

Reynolds,  E.  B.,  Pt.,  3d 

Mar.  7, 

Right.   Sing.  B.  J.  Newland,22d 

Spec.  4015. 

Iowa  Battery,  age  18. 

8,  '62. 

Ind.     Disch'd  July  6,  1863. 

663 

Peak.  R.,   Pt.,   E,   66th 

Aug.  4, 

Left  ;  ant.  post.  flap.      Surg.  J. 

703 

Rice,  A.V.,  Colonel,  57th 

June  27, 

Right  :  rirc.    Surg.  A.  C.  Messen 

Illinois,  age  19. 

4,  764. 

Pogue,  66th  111.     Erysip.     Feb. 

Ohio,  age  27. 

27,  '64. 

ger,  57th  Ohio.   Recovery.  Pro 

21,  '65,  reamp.  mid.  third;  circ. 

moted.    Mustered  out. 

flap.    A.  A.  Surg.  S.W.  Thomp 

704 

Rice,  A.  D.,  Pt.,  B,  38th 

April  3, 

Left  ;  circ.    Surg  W.C.  Shurlock, 

son.    Mustered  out  July  19,  '65. 

Wisconsin,  age  17. 

3,  '65. 

51st  Peun.    Disch'd  Aug.  12/05. 

664 

Perkins,  G.,  Pt.,  A,  64th 

Mar.  25, 

Left  ;  ant.  post.  flap.    Surg.  M.  H. 

705 

Rice,  E.,  Pf.,  F,    113th 

June  22, 

R't:  flap.     Surg.A.  Wilson.  113th 

New  York,  age  22. 

25,  '65. 

Ravmond,  26th  Mich.     Exfol. 

Ohio,  age  25. 

23,  '64. 

Ohio.    Disch'd  May  3.  1865. 

Disch'd  Nov.  17,  1865. 

706 

Rice,    L.,    Pt.,    K,   16th 

Sept.  30, 

Left  ;  flap.    Disch'd  Mar.  21,  1865. 

66S 

Perkins,   H.  E.,  Serg't, 

Mar.  29, 

Left  ;  flap.    Surg.  C.  Winne,  77th 

Michigan,  affe  22. 

30,  '64. 

C,  7th  Vt.,  age  22. 

29,  '65. 

Illinois.    Disch'd  Nov.  25,  18fi5. 

707 

nice,    W.    H.,  Captain, 

Oct.  3, 

Left.     Surg.  —  Daily,  C.  S.  A. 

666 

Perrin,  W.  8.,  Lieut.,  C, 

Aug.  25, 

Right  :  circ.    Disch'd  Feb.  4,  '65. 

Rice's  Battery. 

3,  '61. 

Recovery. 

1st  R.I.  Art'y,  age  24. 

26,  '64. 

Lied  August  13,  1876. 

708 

Richards,  R.,  Pt.,C,  51st 

Aug.  17, 

Right.     Prison  Nov.  19,  1864. 

667 

Peters,  J.,  Pt.,  K,  203d 

Jan.  15, 

Right  :  circ.  '  Surg.  L.  Barnes,  6th 

Virginia,  age  27. 

18,  '64. 

Penn.,  age  30. 

15,  '65. 

Col'd  Troops.  Bone  prot.  Disc'd 

709 

Ricker,  J.  W.,  Lieut.,  I, 

May  27, 

Right  :  flap.     Surg.  Y.  G.  Kurd, 

July  18,  1865. 

48th  Massachusetts. 

27.  '63. 

48th  Mass.     M.  out  Sept.  3,  '63. 

6G8 

Philo,  E.  R.,  Pt.,  I,  1st 

Aug.  15, 

Left  ;  ant.  post.  flap.    Discharged 

710 

Rider,    J.,    Pt.,  D,  98th 

Sept.  19, 

Right.     Diseh'd  May  2,  1864. 

Sharpshooters,  age  24. 

15,  '64. 

March  2,  1865. 

Illinois. 

19,  '63. 

669 

Picquel,  L.  A.,  Pt.,  A, 

May  28, 

.     Surg.  —  Brown,  C.  S.  A. 

711 

Rider,  J.  F.,  Pt.,  A,  4th 

May  3, 

Right;    ant.   post.  flap.     Furl'd 

63d  Georgia. 

30,  '64. 

Recovery. 

Virginia,  age  37. 

5,  '63. 

June  14,  1863.     Recovered  with 

670 

Pierce.  C.  L.,  Lieut.,  K, 

April  1, 

Right  ;  flap.  Surgs.R.Curran,  9th 

« 

good  stump. 

9th  N.  Y.  Cav.,  age  23. 

1,  '65. 

N.  Y.  Cav.,  and  A.  P.  Clark,  6th 

712 

Ried,  L.  W.,  Adj.,  25th 

Oct.  8, 

.    Surg.  —  Fleming,  C.  S.  A. 

N.  Y.  Cav.    M.  out  Sept.  25,  '65. 

Virginia  Cavalry. 

9,  '64. 

Recovery. 

671 

Pierce,  T.  D.,  Pt.,  A,  8th 

Nov.  28, 

Left  ;  circ.     Surg.  J.  Sparks,  8th 

713 

Riggs,  H.,   Pt.,  F,  27th 

Oct.  4, 

Right  ;  circ.     Disch'd  Apr.  8,  '63. 

Teun.,  age  37. 

28,  '64. 

Tenn.    Disch'd  March  18,  1865. 

Ohio. 

(i,  '62. 

C72 

Pine,  J.  A.,  Pt.,  I,  168th 

June  11, 

Right  ;    ant.  post.  flap.     Dr.  Mc- 

714 

Rigsbey,  N.  L.,  Pt.,  A, 

June  20, 

Right  ;  circ.     Surg.  J.  Ebersole, 

Ohio,  age  18. 

11,  '64. 

Neese.    Disch'd  Oct.  18,  1864. 

19th  Indiana,  age  20. 

20,  '64. 

19th  Ind.     Disch'd  Nov.  14,  '64. 

673 

Pinson,  J.  V.,  Pt.,  K,  31st 

April  6, 

Left.    Disch'd  October  7,  1862. 

715 

Riley,    H.,  Pt.,  F,  13th 

Dec.  29, 

R't.   Surg.  E.O.F.  Roller,55th  111. 

Indiana. 

6,  '62. 

Infantry,  age  30. 

29,  '62. 

Gang.  Feb./64.  seq.rem.  Disch. 

.;:•! 

Plunkett,  C.,  Pt.,  B.  4th 

July  15, 

Left  ;   ant.  post.  flap.     A.  Surg. 

Nov.  19,  '64.     Died  Oct.  10,  '68. 

Rhode  Island,  age  27. 

15,  '64. 

R.  Millar,  4th  R.  I.    M.  out  Oct. 

Spec.  2676. 

15,  1864. 

716 

Rind,    E.,    Pt.,    B,    5th 

June  25, 

Left.     Surg.  —  Carder,  C.  S.  A. 

675 

Pool,  D.  E.,  Pt.,  D,  5"d 

July  14, 

Left;  circ.    Surg.  Hinkley.  Two 

Tennessee. 

25,  '64. 

Recovery. 

Illinois. 

16,'  '63. 

subs.  oper.     Disch'd  Oct.  10/63. 

717 

Ritchey,  D.,  Pt.,  K,  208th 

Mar.  25, 

Left;  ant.  post.  flap.    A.  Surg.  W. 

676 

Pope,    W.,  Pt.,  K,  10th 

May  3, 

Left.     Surg.  —  Taylor,  C.  S.  A. 

Penn.,  age  25. 

25,  '65. 

Carroll,  U.S.V.  Disch'd  June  28, 

Alabama. 

4,  '63. 

Furloughed  July  3,  1863. 

1865.     Died  May  14,  1872  ;  lung 

677 

P»ulson,  \V.  S.,  Corp'l, 

Oct.  8, 

Right  ;  flap.  Surg.  S.  Marks,  10th 

disease.     Spec.  4132. 

F,  !)8th  Ohio. 

10,  '02. 

\Vis.    Disch'd  Feb.  15,  1863. 

718 

Roacli,  J.  F.,  Lieut.,  E, 

Sept.  19, 

Right  ;  circ.    Surg.  —  Singlet,  C. 

673 

1  Powell,  J.  W.,  Pt.,  A, 

Sept.  19 

.     Recovery. 

45th  N.  C.,  age  20. 

19,  '64. 

S.  A.     Prison  Nov.  19,  1864. 

19th  Alabama. 

19,  '63. 

719 

Roberts,  C..  Pt.,  H,  45th 

June  27, 

Right  :  ant.  post.  flap.    Surg.  F.  H. 

679 

Powell,  S.,  Corp'l,  F,  21st 

Aug.  11, 

Left;  flap.     Surg.  D.  S.  Young, 

Ohio,  age  23. 

27,  '64. 

Kearney,  45th  Ohio.  Gnng.  :  end 

Ohio,  age  20. 

11,  '64. 

21st  Ohio.     Gang.;  necro.  bone 

of  bone  exp.  Disch'd  June  27/65. 

rem.     Disch'd  June  5,  1865. 

720 

Roberts,   O.   D.,  Serg't, 

Sept.  30, 

Left  ;  circ.     Disch'd  July  18.  '65. 

680 

Powers,  D.,  Pt.,  E,  35th 

Jan.  2, 

Left.     Surg.  C.  J.  Walton,  21st 

H,  118th  Penn. 

30,  '64. 

Indiana. 

3,  '63. 

Ky.     Mustered  out  Mar.  27/63. 

721 

Roberts,  W.  W.,  Corp'l, 

Oct.  12, 

Left  ;  circ.    A.  Surg.  T.  W.  Stull, 

681 

Price,  E.,  Pt.,  B,  35th 

Nov.  29, 

Left.     Recovery. 

A,  8th  Illinois  Cavalry. 

12,  '63. 

8th  111.  Cav.  Disch'd  Apr.27/64. 

Virginia  Cavalry. 

30,  '63. 

722 

Robertson,  J.,  Pt.,  I,  18th 

May  8, 

.     Surg.—  Griffin,  18th  Miss. 

682 

Prince,  S.  W.,  Pt.,I,  24th 

Nov.  30, 

L't  ;  lat.  flap.  Surg.  McKinley,  C. 

Mississippi. 

8,  '64. 

Recovery. 

683 

South  Carolina,  age  17. 
Printy,   T.,  Pt,,  G,  20th 

De.  1,'64. 
June  25, 

S.  A.  Gang.  Pro.Mar.May  3U/65. 
Right;  doub.  flap.    Cenfed.  sttrg. 

723 

Robinett,  M.  P..  Pt.,  E, 
65th  Ohio,  age  20. 

Nov.  29, 
30,  '64. 

Right  ;  flap.  Confed.  surg.  Disch. 
Sept.  6,  1865. 

Indiana,  age  33. 

26,  '62. 

Disch'd  July  8,  '63.     Spec.  367. 

724 

Robinson,  J.  ft.,  Serg't. 

Mar.  25, 

Right  ;  circ.    Surg.  W.  L.  Ba  ,-l<;r. 

684 

Prior,   W.,    l>t.,  H,   72d 

Sept.  17, 

Right  :  flap.    Surg.  B.  A.Vander- 

B,  18th  South  Carolina. 

25,  '65. 

C.  S.  A.    Prov.  Mar.  May  10/65. 

Pennsylvania. 

18,  '62. 

kieft,  U.  S.  V.     Dis.  Jan.  11,  '63. 

725 

Rodgers,  T.  J.,  Pt.,  E, 

July  22, 

Right  :  flap.     Surg.  S.  P.  Bonner, 

685 

Quinn,  '.T.,  Pt.,   G,  21st 

Oct.  27, 

Left  :  flap.    Disch'd  Oct.  17,  1865. 

47th  Ohio,  age  20. 

22,  '64. 

*47th  Ohio.    Disch'd  June  30/6.3. 

Penn.  Cav.,  age  22. 

27,  '64. 

726 

Rogers.  C.  B.,  Corp'l,  T, 

Nov.  27, 

Right.     Surg.  —  Taylor.  C.  S.  A. 

686 

Quinn,  M.,  Pt.,  B,  55th 

June  27. 

Left.     Disch'd  Feb.  13,  1863. 

Cobb's  Legion  Cav. 

27,  '63. 

Furloughed  Jan.  26,  1864. 

New  York. 

27,  '62. 

727 

Rogers,  G.,    Pt.,   C,   2d 

July  11, 

Left  ;  circ.    Disch'd  June  6,  1864. 

687 

Quinn,  M.,  Pt.,  A,  14tb 

Aug.  28, 

Left.     Surg.  —  White,  C.  S.  A. 

Michigan,  age  24. 

11,"  '63. 

Louisiana. 

28,  '62. 

Gang.;  abscess,  fistulas.  .Recov. 

728 

Rose,  E.  E.,  Pt.,  F,  47th 

Mar.  27, 

Left  ;  flap.     Surg.  J.  L.  Dicken, 

688 

Raburdy,  J.,  Pt,,  K,  12th 

Sept.  17, 

Left.     Surg.  J.  McL.  Hayward, 

Indiana,  age  34. 

27,  '65. 

47th  Ind.     Disch'd  July  26,  '65. 

Massachusetts. 

17,  '62. 

12th  Mass.     Disch'd  Dec.  1,  '62, 

729 

Rose,  F.,  Pt.,  D,  57th  X. 

Oct.  14, 

Right  ;  circ.;  (amp.  arm.)    Surg. 

689 

Ragan,  J.,    Pt.,    B,  4th 

Oct.  27, 

R't.    Con.  surg.  Kebel.  Mar.  3/65. 

York,  age  20. 

15,  '63. 

W.  W.  Potter.  57th  N.  Y.    Seq. 

Mass.  Cav.,  age  19. 

27,  '64. 

reamp.;  circ.    A.  A.  Surg.  F.  H. 

rem.  Dis.  Oct.  3/64.    Spec.  3104. 

Getchell.    Disch'd  July  27,  '65. 

730 

Rose,  H.  A.,  Pt.,  F,  Kith 

July  30, 

Left  :  ant.  post.  flap.     Subs.  oper. 

690 

Raley,  C.  S.,  Pt.,  G,  60th 

Mar.  5, 

.     Provost  Marshal  May  10, 

N.  Y.  Cavalry,  age  16. 

30,  '64. 

Disch'd  Feb.  7,  1863. 

Georgia. 

5,  '65. 

1865. 

731 

Ross,    H.,    Pt.,   A,   16th 

May  21, 

Left  ;  flap.     Surg.  J.  Pomerene, 

691 

Ramsey,  W.  R.,  Serg't, 

May  6, 

Left  ;  flap.  Confed.  surg.  Disch'd 

Iowa. 

21  ,"'63. 

42d  Ohio.     Disch'd  Aug.  28/63. 

F,  150th  Penn. 

8,  1)4. 

June  3,  1865. 

732 

Ross,  W.  E.  W..  Lieut. 

July  30, 

Left;  circ.     Surg.  J.  P.   Prince, 

692 

Rausher,  H.,  Pt.,  D,  25th 

Sept.  1, 

Left  ;  ant.  post,  skin  flap  ;  gang. 

Col.,  31st  Col'd  Troops. 

30,"  '64. 

36th  Mass.     M.  out  Mar.  11,  '65. 

Iowa,  age  24. 

2,  '64. 

Nit.  acid.    Disch'd  Sept.  12,  '65. 

733 

Roth,   J.,    Pt.,    B,    12th 

May  14, 

Left  ;  flap.     Surg.  A.  T.  Hudson, 

6'J3 

Raynor,  L.  II.,  Pt.,  F.lst 

June  4, 

R't  ;  lat.  flap.     Surg.  C.  B.  Park, 

Missouri,  age  23. 

14,''64. 

26th  Iowa.    Gang.    Discharged 

Vermont,  age  21. 

4,  '64. 

jr.,  1st  Vt.  H.  A.  Gang.    Disch'd 

April  18,  1865. 

Feb  21,  '65.     1870,  stump  bad. 

734 

Rourke,   J.,   Pt.,   I,   1st 

Jan.  30, 

Left;  flap.    A.  A.  Surer.  J.  Brady. 

694 

Reason,  W.,  Pt.,  H,  2d 

Sept.  14, 

Right  ;   skin  flaps  ;  circ.  muscle. 

Louisiana  Cav.,  age  25. 

31,  '65. 

Disch'd  Oct.  19,  1865. 

Cavalry,  age  22. 

15,  '64. 

A.  A.  Surg.  W.  B.  McCausland. 

735 

Royal,  H.  S.,  Serg  t,  A, 

May  3, 

;  circ.     Surg.  —  Bridges,  C. 

Duty  Apr.  2/65.  Sps.  3914,  1574. 

30th  N.  C.,  age  26. 

3,  '63. 

S.  A.    Furl'd  June  23,  1863. 

'TERRY  (C.),  loc.  cit.,  p. 76. 


254 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITAUY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATOKS, 
RESULT. 

736 

Runyon,  J.  A.,  Lieut.,  A, 

June  14; 

Right  ;  circ.     Disch'd  Nov.  5,  '64. 

779 

Bible;/,  J>.  H.,  Pt.,E,  18th 

May  6, 

—  .    Surg.  —  Griifin,  18th  Miss. 

74th  Indiana,  age  18. 

14,  '64. 

Mississippi. 

6,  '04. 

Recovery. 

'V*?  i 

780 

Sickles,    D.    E.,  Major 

July  2, 

Right.     Surg.  T.  Sim,  U.  S.  V. 

/.)/( 

- 

Rush,  C.  G.,  Pt.,  C,  21st 

Mar.  25, 

Both  ;  ant.  post.  flap.  Surg.  L.W. 

General,  U.  S.  V. 

2,  '03. 

Recovery.   Spec.  1335. 

/OOJ 

Georgia,  ago  22. 

25,  '65. 

Bliss,  51st  N.  Y.  Released  Aug. 

781 

Sieben,  J.,  Serg't,  D,  4th 

Sept.  17, 

Right.     Discharged  Feb.  9,  1803. 

2.  1865.     Spec.  3998. 

New  York. 

19,  '62. 

739 

Rust,  C.  W.,  Serg't,  C, 

Dec.  15, 

Right  ;  circ.     Surg.  H.  B.  Tuttle, 

782 

Sinks,  J.  F.,  Q.  M.  S'g't, 

June  22, 

Left  ;  circ.    Surg.  II.  K.  Spooner, 

8th  Kansas,  age  22. 

15,  '64. 

8yth  111.    Disch'd  June  14,  1865. 

61st  Ohio,  age  22. 

22,  '64. 

61st  Ohio.    Erysip.    Discharged 

740 

Ryan,  J,  A.,  Lieut.,  L, 

May  3, 

Right  :  ant.  post.  Hap.     Surg.  J. 

March  31,  1865. 

5th  Virginia. 

3,  '63. 

W.  Walls,  P.  A.  C.  S.     Retired 

783 

Simmons,  P.,  Pt.,  I,  60th 

Aug.  18, 

Left;  flap.     Disch'd  Feb.  7,  1865. 

Feb.  16,  1864. 

Ohio,  age  46. 

18,  '64. 

741 

Ryan,  T.,  Pt.,  G,  90th 

Nov.  25, 

Left  ;  flap.   Surg.  H.  Strong,  90th 

784 

Sisco,   M.,  Pt.,  D,   llth 

Oct.  19, 

Right;  flap.    Disch'd  May  27,'05. 

Illinois,  age  28. 

27,  '63. 

Illinois.     Disch'd  March  19,  '65. 

Vermont,  ago  19. 

20,  '64. 

742 

Saeger,   D.   L.,   Pt.,  A, 

Sept.  2, 

Right  ;  flap.     Surg.  B.  M.  Failer, 

785 

Sivert,  C.  W.,  Pt.,  I,  2d 

Aug.  23, 

Right.   Surg.R.W.Hazlett,2d  W. 

19th  Ohio,  age  24. 

3,  '64. 

llithOhio.    Gang.   Disch'd  May 

West  Virginia. 

23,  '62. 

Va.     Disch'd  Feb.  2,  '03.    Died 

16,  1865. 

April  7,  1870;  consumption. 

743 

Sage,   W.,   Pt.,   E,   42d 
Ohio. 

Mav  1, 
1,  '63. 

Left  ;  flap.     Surg.  J.  Pomercne, 
42d  Ohio.     Disch'd  July  23,  '03. 

786 

Skellie,    E.,   Corp'l,    D, 
112th  New  York. 

Sept.  29, 
29,  '64. 

R't;  circ.     Surg.C.  E.Washburn, 
112th  N.  Y.     Dis.  June  24,  1865. 

744 

Saila,  A.,  Corp'l,  I,  65th 

June  18, 

Left;    flap:    gangrene.     Disch'd 

787 

Skidmore,  G.,  Pt.,  I,  53d 

June  27, 

Left  :  ant.  post.  flap.    Surg.  A.  C. 

Ohio,  age  24. 

19,  '64. 

Aug.  17,  1865. 

Ohio,  age  3:). 

27,  '64. 

Messenger,  57th  Ohio.     Disch'd 

745 

Saladal,  L.,  Pt.,  E,  !!th 

July  30, 

Left;  anterior  post.  flap.     Disch'd 

Jan.  3,  1865. 

N.  Hampshire,  age  23. 

30,  '64. 

March  29,  1866. 

788 

Slack,  0.  F.,  Pt.,  E,  Pur- 

June  3, 

Right  ;  flap.    Surg.  J.  O'Donncll, 

746 

Sanborn,  S.  F.,  Pt.,  E, 

Sept.  1, 

Right  ;  circular.    Surg.  S.  Marks, 

nell  Md.  Leg.,  age  20. 

3,  '64. 

Purnell   Legion.     Disch'd  Oct. 

21st  Wisconsin,  age  24. 

0,  '64. 

10th  Wis.     M.  out  May  25,  1865. 

1C,  1864. 

747 

Sanford.  J.  R.,  (.'apt.,  B, 

May  8, 

Right  ;  circ.     Surg.  J.  Kelly.  33d 

789 

Slater,  AV.  IL.  Capt.,  G, 

Dec.  13, 

Right.     A.  Surg.  W.  E.  Mattison, 

aid  N.  Jersey,  ago  40. 

9,  '64. 

N.  J.     Disch'd  Sept.  12,  1864. 

I 

15th  New  Jersey. 

13,  '62. 

3d  N.  J.    Disch'd  April  22,  1865. 

748 

Santo,   C.,  Pt.,   V,  60th 

July  1, 

Left;  ant.  post,  flap:  gang.:  nee. 

790 

Slaughter,  J.  L.,  'l't.,  E, 

Sept.  29, 

Lett:  circ.   A.Surg.G.G.Odiorne, 

New  York,  age  20. 

2,  '63. 

seq.  rem.     Disch'd  Sept.  20,  '('A. 

4th  C'd  Troops,  age  18. 

29,  '64. 

4th  Col'd  Troops.     Gang.     Dis. 

749 

Santry,  J.,  Pt.,  I,  14th 

Oct.  19, 

Left  :  circ.  Surg.W.W.  Root,75th 

March  27,  1865. 

N.  Hampshire,  age  20. 

21,  'C4. 

N.Y.  Boneprot.  Dis.  June  (>,  '65. 

791 

Smathers,  H.,  Pt.,  E,  53d 

June  23, 

Left;  flap.     A.  Staff  Surg.  C.  B. 

750 

Sounders.  B.,  Serg't,  I, 

May  —  , 

Right.     Surg.  J.  J.  Knott,  P.  A. 

Ohio,  age  23. 

23,  '64. 

Richards,  U.S.A.    Diseh  d  June 

53d  Georgia,  age  28. 

—  ,  '64. 

C.  S.    Recovery. 

17,  1865. 

751 

Sawyer,   J.   H.,   Q.   M. 

May  31, 

Left;  double  flap.     Surg.   J.  P. 

792 

Smith,    E.,    Pt.,   B,   4th 

Sept.  29, 

Right;  lat.  flap.    A.  Surg.M.  Phil 

Sufg't,  36th  Mass. 

Je.  1,  '63. 

Prince,  36th  Mass.    Disch'd  Jan. 

Col'd  Troops,  age  18. 

29,  '64. 

lips,  22d  Col'd  Troops.    Disch'd 

19,  1804. 

July  19,  1865. 

752 

i  Sawyer,  W.  C.,  Capt., 

Mar.  14, 

Left;  cire.     Surg.  G.  Derby,  23d 

793 

Smith,  G.,  rt.,  A,  14th 

Octl, 

Right  ;  flap.    Surg.  F.  A.  Dudley, 

H,  23d  Mass. 

14,  '02. 

Mass.     Disch'd  Nov.  17.  1802. 

Conn.,  age  19. 

1,  '64. 

14th  Conn.    Disch'd  June  10,  '05. 

753 

Saxon,  W.  T.,  Serg't,  E, 

Mav  3, 

Right.     Surg.  —  Todd,  C.  S.  A. 

794 

Smith,  H.,  Pt.,  A,  149th 

June  1, 

Left;  ant.  post.skin  flap;  circ.sc.ct. 

51st  Georgia,  age  21. 

3,  '03. 

Gang.;  bone  prot.    Retired  Dee. 

Penn.,  uge  25. 

1,  '64. 

muscles.    Disch'd  Dec.  8,  18(J4. 

22,  1864. 

795 

Smith,  H.C.,Pt.,  A,  10th 

April  2, 

Left  ;  long  ant.  flap.    Surg.  T.  H. 

754 

Scales,  J.  S.,  Pt.,  H,  43d 

Sept.  14, 

—  .     Surg.  —  Luckie,  C.  S.  A. 

Conn.,  age  25. 

2,  '05. 

Squire,  89th  N.Y.    Disch'd  July 

Alabama. 

14,  '64. 

Recovery. 

31,  1865. 

755 

Schriner,  L.,  Pt.,  K,  81st 

Sept.  17, 

Left.    Surg.  G.  B.  Cogs  we!  1,  29th 

796 

Smith,  J.,  Serg't,  E,  61st 

April  7, 

R't;  circ.   Surg.  W.  13.  Hartman, 

Penn.,  age  18. 

1!),  '02. 

Mass.    Dis.  Dec.  27,'(i2.   V.  R.  C. 

New  York,  age  23. 

8,  '65. 

110th  Penn.     Dis.  July  20,  1805. 

756 

Schwartz,  F.,  Pt.,  B,  1st 

Aug.  21, 

Ripht;  ant.  post,  flap  ;  gangrene. 

797 

Smith,  J.,  Pt.,  D,  6th  N. 

June  3, 

Left  ;  flap.    Disch'd  Aiig.  2,  18'J5. 

Maryland,  age  49. 

22,  '04. 

Mustered  c.ut  Dec.  24.  1864. 

Hampshire,  age  27. 

4,  '64. 

757 

Scott,  J.,  Serg't.A,  126th 

Oct.  19, 

Left:  lat.  flap.     Disch'd  May  20, 

798 

Smith,  J.,  Corp'l,  F,  3d 

May  2, 

Right;  flap.    Disch'd  Sept.  29,  '63. 

Ohio,  age  27. 

19,  '04. 

1805. 

Artillery. 

2,  '63. 

758 

Scram,  J.,  Pt.,  D,  134th 

Dec.  19, 

Right;   flap.     Surg.  J.  L.  Dunn, 

799 

Smith,  J.A.,Pt.,  E.llSth 

May  7, 

Left  ;  flap.  Confed.  surg.  Disch'd 

New  York,  age  31. 

19,  '64. 

109th  Pcun.     Dis.  Aug.  18,  '05. 

New  York,  age  21. 

8,  '64. 

July  20,  1865. 

759 

Sebastian,  J.  M.,  Serg't, 

May  16, 

Right  ;  flap.  Surgs  J.  Pomeryne, 

800 

Smith,  J.  G.,  Pt.,  13,  61st 

Mnr  25, 

Right;  circular.    Recovery. 

A,  7th  Kentucky. 

16,  '63. 

42d  Ohio,  and  W.  Berry,  7th  Ky. 

Alabama,  age  42. 

25,  '65. 

Disch'd  Sept.  1,  1863. 

801 

Smith,  J.  O.,  Pt.,  H,  62d 

July  6, 

Right;  circ.    Excli'd  Nov.  12,'63. 

7(50 

Serey,   J.,  Pt.,  K,  17th 

July  1, 

Left  ;  circ.  Confed.  surg.   Disch'd 

Virginia,  age  40. 

6,  '03. 

Conn.,  age  17. 

1,  '63. 

May  14,  1864. 

802 

Smith,  J.  R.,  Serg't,  E, 

Mar.  31, 

Right  :  circ.    Surg  .  P.  E.  Ilubon, 

701 

Shackley,P.H.M.,Corp., 

June  18, 

Right  ;  circ.;  slough  'g  :  bone  prot. 

53d  Penn..  age  34. 

Ap.l.'fiS. 

28th  Mass.    Disch'd  July  14,  '65. 

B,  32d'Maine,  age  1!'. 

18,  '64. 

Mustered  out  Dec.  12,  1804. 

803 

Smith,  N.  B.,  Pt.,II,  !!8th 

July  20, 

Left;  flap.     Disch'd  Jan.'  2,  1865. 

762 

Shaeffield,  W.  J.,  Pt.,  H, 

June  18, 

Right.     Retired  March  15,  1865. 

Ohio,  age  If. 

23,  '64. 

19th  Georgia,  age  22. 

18,  '64. 

804 

Smith,  S.,  Corp'l,  K,  22d 

Sept.  29, 

Right  ;  lateral  flap.    Disch'd  June 

763 

Shafer,  E.,  Pt.,  K,  23d 

May  15, 

Right;  circ.:  gangrene.     Disch'd 

Col'd  Troops,  age  22. 

29,  '64. 

13,  1865. 

Michigan,  age  21. 

15,"  '64. 

June  7,  1865. 

805 

Smith,  S.  II.,  Pt.,  B,  24th 

June  30, 

—  .     Surg.   —  Neblitt,  C.  S.  A. 

; 

Shaffer,  J.,Corp'l,C,  61st 

April  7, 

Left  ;  circ.     Disch'd  Nov.  6,  1865. 

Virginia. 

J'yl,'62. 

Recovery. 

New  York,  age  26. 

7,  'Co. 

-0,: 

Smith,  T.  N.,  Pt.,  B,  43d 

Oct.  19, 

Right;  ant.  post.  flap.    Surg.G.T. 

760 

Shaffer,   M.  V.,  Pt.,  G, 

May  6, 

Rifrht  ;  flap.     Surg.  W.  Watson, 

New  York,  age  30. 

20,  '04. 

Stevens,  77th  N.Y.    Discharged 

105th  Penn.,  age  25. 

8,  '64. 

105th  I'enn.     Dis.  June  17.  '05. 

January  20,  1805. 

766 

Shaffer,  T.,  Pt.,  F,  138th 

Sept.  21, 

Left.     Disch'd  June  12,  1865. 

807 

Smith,  W.  E.,  Capt.,  E, 

June  25, 

—  .    Surg.  WML  Philpost,  C.  S. 

Penn.,  age  26. 

22,  '64. 

4th  Georgia. 

25,  '62. 

A.     Recovery. 

767 

Shane,  J.  B.,  Lieut.,  D, 

Aug.  6, 

Left.     Surg.  J.  H.  Rodgers,  104th 

--- 

Smith,  W.  U.,  Serg't,  C, 

Mar.  25, 

Right  ;  circ.    Surg.VV.  L.  Baylor, 

16th  Ky.,  age  23. 

7,  '64. 

Ohio.    M.  out  July  15,  1865. 

17th  South  Carolina. 

25,  '65. 

C.S.A.    Released  May  10,  1865. 

768 

Shannon,  W.  M.,  Pt.,  G, 

June  18, 

Right;  circ.    Confed.  surg.  Exfol. 

809 

Smock,  G.W.,  Corp'l,  A, 

April  29, 

Right  ;   circ.    Surg.  R.  B.  Brown, 

14th  W.Va.,  age  23. 

18,  '64. 

rem.    Dis.  June  2.  '65.    Spec.  108. 

14th  New  York  S.  M., 

30,  '63. 

31st  N.  J.    Disch'd  June  15,  '64. 

769 

Shattuck,  W.  W.,  Pt.,  C, 
7th  Michigan. 

May  31, 

Je.2,'62. 

Left;  circ.     Disch'd  July  18,  '62. 

810 

age  18. 
Smed,  J.  R.,  Serg't,  K, 

July  22, 

Spec.  1144. 
Right.  Surg.  —Hawkins,  C.S.A. 

770 

Shelly,  J.,  Pt.,  D,  46th 

July  20, 

Left  \  tint.  post.  flup.    Disc'd.  tJune 

10th  S.  C.   ajro  23. 

2  .,''64. 

Retired  Feb.  24  1865. 

Penn.,  age  24. 

21,  ''64. 

10,1865. 

811 

Snoddy,  VV.,  Pt.,D,46th 

D~ec.  9. 

Ri^ht  ;  flap.    Surg.  II.  7..  Gill,  U. 

771 

Shelly,  W.  H.,  Pt.,  I,  5th 

Mav  5, 

Left;  flap.  A.Surg.  ILC.Grover, 

Penn.,  age  49. 

11,  '64. 

S.  V.    Disch'd  June  19,  1865. 

Michigan,  age  26. 

6,  !64. 

20th  Ind.     Uiseh'd  May  6,  1865. 

812 

Snowble,  J.  F.,Serg't,TI, 

July  23, 

Right  ;  circ.     Surg.  C.  K.  Irwine. 

772 

Shepardson,  C.,  Corp'l, 

Sept.  19, 

Right  :  flap.    A.  Surg.  J.Homang, 

72d  New  York,  age  31. 

24,  ''63. 

72d  N.  V.    Bono  exfol.    Disch'd 

G,  1  14th  New  York. 

19,  '64. 

jr.,  U.  S.  A.    Disch'd  June  8,  '05. 

July  27,  1604. 

773 

Sherwood.  H.,  Serg't,  C, 

June  20. 

Right  :   flap.     Surg.  W.  H.  Gib 

813 

Snyder,  J.  O.,  Lieut.,  B, 

Dec.  13, 

Left;  flap.    Surg.  C.  Bower,  6th 

4th  Michigan. 

22,  '64. 

bon,  15th  Iowa.    Recovery. 

7th  Penn.  Reserves. 

13,  '62. 

Pa.  Res.  •  Disch'd  April  1,  1803. 

774 

Shields,  R.,  Pt.,  K,  12th 

Mar.  21, 

Right  ;  circ.,  with  lat.  flaps.  "Surg. 

814 

Snyder,  VV.    P.,  Pt.,  H, 

Nov.  27, 

Right;  flap.    Surg.  J.  E.  Pomfret, 

Wis.  Bat'ry,  age  20. 

21,  '65. 

A.  T.  Hudson,  26th  Iowa.     Dis 

7th  N.Y.  H.  A.,age22. 

27,  '64. 

7th  New  York  Heavy  Artillery. 

charged  Sept.  1,  1865. 

Disch'd  June  6,  1R65. 

775 

Shoop,  S.,  Pt.,  F,  200th 

Mar.  25, 

Right  ;  long  ant.  short  post.  flap. 

815 

Solan.   T.,  Pt.,  K,  10th 

July  30, 

Left  ;  circ.    Disch'd  Oct.  26,  1865. 

Penn.,  age  23. 

27,  '65. 

Surg.  W.  O.  McDonald,  U.  S.  V. 

N.  Hamp.,  age  30. 

30,  "'64. 

776 

Short,S.A.,Ser,~'t,A,73d 

July  20, 

Disch'd  July  5,  '65.    Spec.  41  30. 
Right  :  flap.    Sursr.  W.  P.  1'eiroe, 

816 

Song.  P.,  Pt.,  H,  47th  N. 
York,  age  24. 

Aug.  10, 
18,  '64. 

Left  ;  flap.  Confed.  surg.  Disch'd 
Oct.  26,'64.    1870,  stump  always 

Illinois,  age  26. 

21,  '64. 

88th  111.     Slough'g:  hsem.;  lig. 

sore. 

777 

Shrieve,  A.  T.,  Pt..  A, 

June  1. 

Disch'd  Jan.  18,  1605. 
Left  :  ant.  post.  flap.     Surg.  f!.  T. 

817 

Soper,  I,  Pt.,  B,  4th  Wis 
consin. 

May  27, 
27,"'03. 

Left  :  flap.     Surg.W.U.  Bronncll, 
12th  Conn.    Disch'd  July  14,  '63. 

778 

6th  Maryland,  age  22. 
Shrum,  j",  I't..  H,  139th 

2,  '64. 
Sept.  19, 

Simpers.lith  Md.  Dis.May  14,  '05. 
Left:  lat.  flap.  Surer.  W.A.Barrv, 

818 

Southworth,  J.  E.,  S'g't. 
C,  1st  U.S.S.S.,  age  20. 

Nov.  7, 
7,  '03. 

Right.    Discharged  June  28,  1864. 

Penn.,  nyc  1!'. 

19,  '04. 

98th  Penn.    Disch'd  Mar.  20  '65. 

819 

Spalding,  L.  G.,  Pt.,  B, 

Nov.  7, 

Left.     Disch'd  March  28,  1864. 

__„ 

Died  Aug.  10,  1870. 

4th  Vt.,  age  29. 

7,  '63. 

1  DERBY  (G.),  Army  Med.  Intelligence,  in  Boston  Med.  and  Surg.  Jour.,  18G2,  Vol.  CO,  p.  193.     OTIS  (G.  A.),ibid^  p.  239. 


SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER    THIRD. 


255 


NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

Ttfrt 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

NO. 

DESCRIPTION,  AND  AGE. 

DATES. 

RESULT. 

IX  U. 

DESCRIPTION,  AND  AGE. 

DATKS. 

RESULT. 

820 

Specht,  J.,  Tt.,  A,  49th 

Mar.  25, 

Left;    flap;  gangrene;    necrosis. 

858 

Terry,  W.,  Pt.,  G,  8th 

Oct.  7, 

Left;  circ.     A.  Surg.  —  Johnson, 

New  York,  ago  45. 

26,  '65. 

Disch'd  Sept.  18/65.   Spec.  4174. 

New  Jersey,  age  19. 

7,  '64. 

C.  S.  A.     April  14,  '65,  reamp. 

821 

Spinnings,    T.,    Pt.,    F, 

Julv  2, 

Right  ;  circ.     A.  A.  Surg.  W.  S. 

mid.  third.    Disch'd  June28,'65. 

137th  N.  York,  age  19. 

3,  '63. 

AVoods.    Gang.;  necro.    Nov.  7, 

859 

Thair,  J.,  Pt.,  E,  22d  Ky. 

Mav  22, 

Left.  Surg.  B.  F.  Stevenson,  22d 

reamp.  up.  third.    Diseh'd  Sept. 

22."  T3. 

Ky.    Disch'd  Aug.  1,  1863. 

14,  1864.    Spec.  4185. 

860 

Thompson,  H.,  Pt.,  A,  2d 

Sept.  20, 

.    Surg.  —  Bates,  C.  S.  A. 

822 

*Spivey,  W.  W.,  1't.,  K, 

Sept.  19, 

.    Recovery. 

Tennessee. 

20,  '63. 

Recovery. 

27th  Alabama. 

19,  '63. 

861 

Thompson,  II.,  Pt.,G,7th 

May  5, 

Right  ;  ant.  post.  flap.    Mustered 

823 

Sprinkle,    S.   M.,  Pt.,  I, 

Julv  30, 

Left;   flap.     Surg.  J.  C.  Denise, 

Indiana,  age  23. 

5,  '64  . 

out  Sept.  20,  1864. 

39th  Ohio,  age  23. 

30,'  '64. 

27th  Ohio.     Disch'd  Dec.  2,  '65; 

862 

Thompson,  M.,  Serg't,  D, 

Mar.  19, 

L't  ;  do  u.  flap.    Surg.D.S.  Young, 

sub.  amputations. 

88th  Indiana,  age  24. 

19,  '65. 

21st  Ohio.     Disch'd  Oct.  17,  '65. 

824 

Squires,  C.  W.,  Ft.,  B, 

April  20, 

Left  ;  circ.     Surg.  N.  Mayer,  16th 

863 

Thompson,  J.  R.,  Pt.,  C, 

Nov.  25, 

Left  ;  flap.    Disch'd  Dec.  1,  1864. 

16th  Connecticut. 

20,  '64. 

Conn.    Disch'd  April  17,  1865. 

40th  Indiana,  age  20. 

27,  '63. 

825 

Staples,   R.  C.,   Pt.,  F, 

Oct.  4, 

Right  ;  flap.    Surg.  R.  L.  Metcalf, 

864 

Thompson,  J.  A.,  Serg't, 

May  9, 

Left;  circ.     Surg.  S.  S.  French, 

7th  Illinois. 

4,  '62. 

7th  111.     Disch'd  Nov.  26,  1862. 

G,  79tb  N.  Y.,  age  42. 

10,  V64. 

20th  Mich.    Nee.  bone  removed. 

826 

Stark,  A.  E.,  Serg't,  II, 

Oct.  19, 

Left;  double  lat.  flap.     Surg.  J. 

Disch'd  Aug.  15,'64.  Spec.  2968. 

49th  Virginia,  age  28. 

20,  '64. 

M.  G.  McGuire,  C.  S.  A.     Ex 

865 

Thompson,  S.  J.,  Serg't, 

Nov.  25, 

Left  ;  flap.    A.  A.  Surg.  R.  W'irth. 

changed  Feb.  16,  1865. 

B,  79th  Ind.,  age  22. 

26,  '63. 

Gang.;  necro.     Dec.  4,  reamp.; 

827 

Stark,  J.  T.,   Serg't,  I, 

Mav  28, 

Left  ;  ant.  post.  flap.     Surg.'C.  D. 

circ.    Disch'd  Aug.  25.  1864. 

13th  Ky,,  age  25. 

28,"  '64. 

Moore,  13th  Ky.     Disc-.li  d  June 

866 

Thanason,  T.  B.,  Pt.,  E, 

Sept.  3, 

Lett;  double  flap.     Surg.  —  Pat 

10,  1865. 

17th  Miss.,  age  27. 

3,  '64. 

terson,  C.  S.  A.     For  exchange 

828 

Starr,  A.  T.,Pt.,  F,  106th 

June  16, 

Left;  circ.     Surg.  H.A.Martin, 

Nov.  22,  1864. 

Penn.,  age  23. 

16,  '64. 

U.  S.  V.    Disoh'd  Jan.  17,  '65. 

867 

Thornton,  R.,  Pt.,  1,  29th 

Oct.  27, 

Left  ;  flap.    Surg.  N.  Y.  Leit,  76th 

829 

Staton,  G.  D.,Vt.,V,  48th 

Aug.  16, 

Right;    circ.      Disch'd  Jan.   15, 

Conn.,  age  18. 

27,  '64. 

Penn.     Disch'd  Aug.  16,  1865. 

Alabama,  age  28. 

17,  '64. 

1865. 

868 

Tliurmer,  J.   W.,  Capt., 

Dec.  11, 

Right.    Surgs.  Hill  and  Franklin, 

830 

Steel,  B.,  Serg't,  C,  9th 

Aug.  14, 

Left.     Surg.  W.  S.  Cooper,  125th 

D,  13th  Mississippi. 

11,  '62. 

C.  S.  A.    Retired  Oct.  29,  Ic64. 

Georgia,  age  22. 

14,  '€4. 

N.  Y.     Prison  Oct.  26,  1864. 

869 

Tomlin,  J.,  Pt.,  A,  21st 

Dec.  8, 

Left;    bi  -lateral    flap.      Provost 

831 

Stephens,  A.  F.,  Pt.,  H, 

Nov.  25. 

Left  ;  flap.     Surg.  J.  H.  Rodgers, 

Tenn.,  age  19. 

8,  '64. 

Marshal  May  6,  1865. 

65th  Illinois,  age  19. 

26,  '64. 

104th  Ohio.   Disch'd  June  13,  '65. 

870 

Tompkins,  S.  C.,  Serg't, 

May  2, 

Left;    ant.  post,  flap.     Surg.  C. 

832 

Stephens,  G.,  Pt.,  C,  1st 

Julv  28, 

Left;  ant.  post.  flap.   A.  A.  Surg. 

F,  159th  New  York. 

3,  '63. 

Robertson.  159th  N.  Y.    Disch'd 

Cavalry,  age  35. 

28,'  '64. 

C.  Rogers.     Disch'd  March  8, 

Aug.  1,  1863. 

1865.     Operation  Jan.,  1866. 

871 

Torrance,  R.  A.,  Pt.,  H, 

Dec.  26, 

Left.     Surg  —  Holmes,  C.  S.  A. 

833 

Stephens,  S.  B.,  Pt.,  G, 

Oct.  7, 

Right.    Surg.  J.  S.  Jackson,  C. 

8th  Texas  Cavalry. 

26,  '6:!. 

Recovery. 

8th  Georgia. 

7,  '64. 

S.  A.    Recovery. 

872 

Tower,  D.W.,  Lieut.,  B, 

May  16. 

Left  :  flap.    Surg.  J.  II.  Ealy.l7th 

834 

Stephenson,   R.,  Pt.,  B, 

June  23, 

Left:  flap.   Surg."D.MacKav,29th 

17th  Iowa. 

'16,  '63. 

Iowa.     Pieces  of  bone  removed. 

19th  C.  Troops,  age  19. 

23,  '64. 

C.  T.     Disch'd  April  17.  1865. 

Mustered  out  May  5,  1865. 

835 

Stevenson.    G,    Pt.,   A, 

June  18, 

Right;  flap.    Surg.  G.  AY.  New, 

873 

Townsend.A.,  Lieut.,  G, 

Aug.  7, 

Left:  circ.    Surg.  L.  SHisser,  6Cth 

7th  Indiana,  age  23. 

18,  '64. 

7th  Ind.    Gang.    Dis.  Oct.  5,  '64. 

18th  Infantry,  age  20. 

7,  T64. 

Ohio.    Retired  Dec.,  1864. 

836 

Stickles.  J.  R.,  Pt.,  M,  2<1 

June  11, 

Left  :  flap;  gang.     July  11,  flap, 

874 

Tramell,  J.  F.,Pt.,  L,  6th 

Julv  1, 

Left.     Provost  Marshal  Sept.  1  0, 

Mich.  Cav.,  age  18. 

11,  '64. 

middle  third.     A.  Surg.  R.  Rae, 

Alabama,  age  21. 

1,  '63. 

1863. 

1st  N.  Y.  Drag.   Dis.  Mar.  10/65. 

875 

Treadivay,  J.  A.,  Pt.,  H, 

Julv  2. 

Left.     Paroled  Sept.  25,  1863. 

837 

Sticknev,  J.  G.,  Serg't, 

Aug.  21, 

Left  ;  ant.  post.  flap.     Surg.  K. 

43d  N.  Carolina. 

2,  '63. 

D,  Cth'Vt.,  age  24. 

21,  '64. 

Phillips,  6th  Vt.    Exfol.;  gang. 

876 

Trexler,  AY.  G.,  Pt.,  B, 

Mav  31, 

Left:  flap:   prot.  bone  removed. 

Disch'd  Oct.  12,  1865. 

93d  Pennsylvania. 

Je.  2,  '62. 

Disch'd  Julv  5.  1862. 

838 

Slinzon,  A.,  Pt.,  1,  38th 

April  2, 

Right.     Trans'd  for  release  June 

877 

Trow.  AY..  Pt.,  A,  8th  N. 

June  3, 

Left  :  flap.  A."Surg.C.II.Pegg.8th 

N.  Carolina,  age  20. 

2,  '65. 

21,  1865. 

York  Art'y,  age  26. 

3,  '64. 

N.  Y.  H.  A.     Haem.;   nee.  bone 

839 

St.  Martz,  W.,  Serg't,  F, 

Dec.  15, 

Right  ;  ant.  post.  flap.     A.  Surg. 

removed.    Disch'd  Sept.  20/65. 

59th  Illinois,  age  26. 

16,  '64. 

H.  P.  Jennings,  51st  O.     Gang. 

878 

Truckev,  G.  F.,  Pt.,  A. 

June  17, 

Right  :  circ.     Surg.  C.  N.  Cham 

Disch'd  June  26,  1865. 

7th  AA'is.,  age  19. 

18,  '64. 

berlain,  U.  S.  Ar.     Disch'd  Oct. 

840 

Stone,   D.,    Pt.,    C,   C3d 

Aug.  29, 

Left.     Discharged  Jan.  13,  1863. 

17,  1864. 

Pennsylvania. 

29,  '62. 

879 

Truesdell,  J.  AY..  Pt.,  L, 

July  18, 

Right;   circ.      Disch'd   Sept.  14, 

841 

Strong,  R.  M.,  Lt.-Col., 

Oct.  27, 

Left;  ant.  post.  flap.     A.  Surg. 

54th  Penn  ,  age  21. 

19.  '64. 

1864. 

19th  YYis.,  age  34. 

29,  '64. 

—  Gibbs,  C.  S.  A.     Discharged 

880 

Tryon,  J.  L.,  Serg't.  H. 

June  11, 

Right  :  flap.    Surg.  E.G.  Streeter, 

April  11,  1865. 

9th  New  York,  age  33. 

11,  '64. 

4th  N.  Y.  Cav.    Dis.  Apr.  28/65. 

842 

Stubblefield,  W.  H.,  Pt,, 

June  1, 

Left;  circ.  June  15,  medulla  prot. 

881 

TumUin,  S.  H.,  Pt.,  H, 

Mav  2, 

Left.    Recovery. 

C,  2d'S.  C.,  age  19. 

3,  '64. 

from  bone.  Released  June  14,  '65. 

22d  N.  Carolina. 

4,  '63. 

843 

Sturgis.  AY.   H.,  Pt,,  K, 

Mav  18, 

Right:  flap.     Surg.  A.  D.  Palmer, 

882 

Turnbull,  J.  M.,  Lieut., 

May  26, 

Left  ;  flap.     Surg.  AV.  P.  Peirce, 

9th  Maine,  age  25. 

18,"  '64. 

9th  Me.     M.  out  Sept.  27.  1864. 

C,  36th  Illinois. 

27,  '64. 

88th  111.    Resigned  Nov.  4,  1864. 

844 

Sturman,  J.  A.,  1't..  A, 

Aupf.  3 

Left  •  eirc.  flaps.    Exfol.    Disch'd 

883 

Turner,  C.II.,Pt.,  B,38th 

Dec.  13, 

Right.  Confed.surg.  Gang.;  haem. 

3d  Ind.  Cav.,  age  19. 

4,  '62. 

April  22,  1863. 

New  York,  age  24. 

15,  '62. 

Mar.  1/63,  amp.  up.  third  ;  haem. 

845 

Suggs,  It.  R.,  Pt'.,  M,  8th 

Julv  1, 

Left.     Transferred  Sept.  28,  '63. 

Disch'd  Sept.  9,  1863. 

S.  C.,  age  22. 

3,  %3. 

884 

Turner,  P.  L.,  Pt,,A,23d 

Oct.  11, 

.    Furloughed  Feb.  6,  1864. 

846 

Button,  J.  M.,  Lieut.,  E, 

Mav  10, 

Left  ;  circ.     Surg.  J.  \V.  Wishart, 

N.  Carolina,  age  19. 

12.  '63. 

148th  Penn.,  age  22. 

11,'  '64. 

140th  Penn.     Dis.  Nov.  2,  1864. 

885 

Underwood,  C.,  Serg't, 

Sept.  30, 

Left.     Discharged  July  12,  1865. 

Nov.  13,  '64.  reamp.  up.  third. 

D,  36th  Mass.,  age  27. 

Oct.  1,'64. 

1865.  dis.  bone  removed.     Died 

'70,  stump  not  healthy.  Sp.2280. 

April  30,  1867. 

847 

Swartz,  J.,  Pt.,  K,  3d  N. 

June  1, 

Right  ;   ant.  post.  flap.     Disch'd 

886 

Underwood,  J.,   Pt.,  F, 

Dec.  15, 

Right  ;  ant.  post.  flap.      Disch'd 

Jersey  Cav.,  age  20. 

1,  '64. 

April  26,  1865. 

41st  Ohio,  age  23. 

16,  '64. 

May  11,  1865. 

848 

Swayne,  W.,  Col.,  43d 

Feb.  2, 

Right  ;  flap.      Surg.  F.  M.  Rose. 

887 

Usher,  J.,  Pt.,  D,  107th 

May  25, 

Left  ;  ant.  post.  flap.    Surg  .  AY.  C. 

Ohio,  age  30. 

2,  '65. 

43d  Ohio.    Haem.;  lig.  small  art. 

New  York,  age  26. 

27,  '64. 

Bennett.U.S.V.    Dis.June6/65. 

Retired. 

888 

Utter,  AY.,    Pt.,    K,  8th 

July  19, 

Right  ;  semi-circ.  integ.tlaps  ;  circ. 

849 

Sweezey,  I.  T.,  Serg't,  I, 

Dec.  13, 

Left  ;  flap.     Surg.  H.  Z.  Gill,  U- 

Iowa,  age  21. 

20,  '63. 

cutmus.    Surg.H.Z.Gill.U.S.V. 

150th  N.  York,  age  19. 

15,  '64. 

S.V.  (Alsoamp.lertsec'dfing'r.) 

Exfol.    Disch'd  Oct.  21,  1863. 

Disch'd  July  19,  1865. 

889 

Van  Lear.  A.  G.  L.,  Pt., 

Mav  3, 

Right;  circ.     May  15,  haem.;  lig. 

850 

Swisher,  J.,  Corp'l,  B, 

Aug.  7, 

Left:  circ.    A.  Surg.  J.  C.  Simon- 

K,  5th  Virginia. 

3,  '63. 

femoral.    Recovery. 

81st  Ohio,  age  22. 

7,  '64. 

son,66th  Ind.  Disch'd  May,  9,  '65. 

890 

*  Vick,  R.  A.,  Pt.,  E,  43d 

Oct.  19, 

Right  :  necr.    Mar.  11,  '65,  reamp. 

851 

Sykes,  O.,  Pt.,  C,  123d 

Sept.  19, 

Left  ;  circ.     Disch'd  June  3,  1865. 

N.  Carolina,  age  37. 

19,  '64. 

hip  joint.     Recovery. 

Ohio,  age  17. 

2!),  '64. 

891 

Vickery,D.L.,Pt.,  I,40th 

Nov.  25, 

Left  ;  circ.    Disch'd  May  20,  1864. 

852 

Tatom,  R.   P.,   Pt.,    C, 

Aug.  19, 

Left,     Surg.  —  Matthews.C.S.A. 

Indiana,  age  23. 

27,  '63. 

19th  Georgia. 

19,  '64. 

Recovery. 

892 

AValbridge,  H.C.,  Pt.,  E, 

June  16, 

Left;  flap.     Surg.  G.  L.  Potter, 

853 

Taylor,  F.  I..  Pt.,E,  17th 

April  2, 

Left;   circ.     Surg.  L.  AY.  Bliss, 

145th  Penn.,  age  18. 

17,  '64. 

145th  Penn.   Disch'd  June  8.  '65. 

Vermont,  age  22. 

2,  '65. 

51st  N.  Y.    Bone  prot.    Disch'd 

893 

AVager.   M.  H.,  Pt.,  G. 

Mar.  31, 

Ri.Sht  :  circ.     Surg.  T.  H.  Squire, 

November  4,  1865. 

123d  Ohio,  age  39. 

31.  '65. 

89th  N.  Y.     Recovery. 

854 

Taylor,  J.  H.,  Lieut.,  F, 

June  19, 

.     Surg.  —  Cooper,  C.  S.  A. 

894 

Walker,    G.    R.,  Pt,  E, 

Julv  4, 

Left;  flap.    A.A.Surg.C.G.Page. 

Kith  South  Carolina. 

19,  '64. 

Recovery. 

7th  AVest  Virginia. 

5,  '62. 

Disch'd  Oct.  23,  1862. 

855 

Taylor,  J.,  Pt.,  A,  19th 

June  22, 

Right:  flap.     Surg.  J.   Bennett, 

895 

AValker,  H.,  Pt.,  K,  6th 

April  16, 

Right.     Surg.  H.  Janes,  3d  A't. 

Michigan,  age  19. 

22,  '64. 

19th  Mich.  Disch'd  Sept.  13.  '65. 

Vermont. 

18,  '62. 

Disch'd  August  22.  1864. 

85G 

Temple,  J.  B.,  Pt.,A,8th 

June  22, 

Left  ;  ant   post.  flap.    Surg.  M.  F. 

896 

AValker,   S.,   Serg't,   F, 

May  3, 

Right;  ant  post.  flap.     A.  Surg. 

N.  York  Art'y,  age  57. 

22,  '64. 

Regan.  164th  N.  Y.     Seq.  rem. 

155th  Penn.,  age  29. 

3,  '63. 

D.  D.  Swift,  126th  Penn.    Lieut. 

Disch'd  Aug.  25.  1865. 

V.  R.  C.March  11,  1864. 

857 

Tennis,  S.,  Pt.,  F,  24th 

Dec.  28, 

Right;  haem.     Disch'd  July  15, 

897 

3  Wallace,  D.  P.,  Pt.,  K, 

July  12, 

R't  ;  circ.    Surg.  J.  Potnerene,42d 

Missouri,  age  28. 

28,  '62. 

1863. 

42d  Ohio. 

12,  '63. 

Ohio.    Disch'd  Oct.  7,  1863. 

"TERRY  (C.),  loc.  cit.,  p.  7(5. 

"FAUNTLEROY  (A.  M.),  Wp  Joint  Amp.-Rec.,  in  Richmond  iM,  Jour.,  1866,  Vol.  I,  p.  7.     Circular  No.  7,  S.  G.  O.,  1867,  pp.  50,  65,  etc. 

3BUYAN  (J.),  loc.  cit..  Arol.  7,  p.  288. 


256 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

898 

Wallace,  R.  T.,  Pt.,  A, 

Oct.  22, 

Left  ;  ant.  post.  flap.     Surg.  R.  B 

942 

Wilkinson,  J:W.,Pt.,  A, 

June  19, 

Right  ;  ant.  posterior  flaps.    Surg. 

76th  Penn.,  age  33. 

24,  '62. 

Bontecou,  U.  S.V.    Disch'd  Jan. 

187th  Penn.,  age  40. 

20,  '64. 

W.  F.  Humphrey,  149th  Penn. 

8,  1864.     Specs.  2031,  3018. 

Disch'd  Jan.  19,  J865. 

899 

Walsh,  R.  L.,  Pt.,  E,  8th 

M&y  10, 

Left.    Surg.  J.  L.  Brenton,  8th  O. 

943 

Wilkinson,  S.  F.,  Pt.,  D, 

Mar.  16, 

Right  ;  circ.     Surg.  C.  M.  Camp 

Ohio,  age  24. 

10,  '64. 

Disch'd  Oct.  i3,  1864. 

150th  N.  York,  age  40. 

16,  '65. 

bell,  150th  N.Y.     Disch'd  June 

900 

Wanzer,J.,Pt.,G,  137th 

Oct.  2'J, 

R't  :  ant.  flap.  Surg.  G.  P.  Oliver, 

17,  1865. 

New  York. 

30,  '63. 

lllth  Penn.    Disch'd  Mar.  1,'64. 

944 

Wilson,  A.,  Corp'l,  H,  6th 

Get  15, 

Right  ;  circ.     Surgs.  A.  P.  Clark, 

901 

Ward,  F.  B.,  Corp'l,  F, 

July  2, 

Right  ;  flap  ;  erysipelas.    Disch'd 

New  York  Cavalry. 

15,  '63. 

6th  N.  Y.  Cav.,  and  W.  H.  Ruli- 

20th  Maine,  age  22. 

3,  '63. 

Nov.  28,  1864. 

son,  9th  N.  Y.  Cav.    Discharged 

902 

Ward,    T.    W..   Pt.,  E, 

May  30, 

Right  ;  dou.  flap.    Surg.  —  Dixon, 

April  26,  1864. 

14th  Alabama. 

30,"'64. 

C.  S.  A.     Involucnim  removed. 

945 

Wilson,  E.  E.,  Pt.,   H, 

July  2, 

Right  ;  flap.    Surg.  II.  F.  Lyster, 

Disch'd  July  17,  1865. 

110th  Penn  ,  age  20. 

4,  '63. 

5th  Mich.     Disch'd  Aug.  7,  '64. 

903 

Wardell.  S.,  Corp'l,  A, 

June  2, 

Left  ;  circ.     Disch'd  June  23,  '65. 

946 

\Vilson,  G.,  Pt.,  I,  95th 

Aug.  30, 

Left  ;  circ.    Surg.  II.  Z.  Gill,  95th 

14thN.Y.H.A.,age23. 

3,  '64. 

Ohio. 

31,  '62. 

Ohio.    Disch'd  Nov.  28,  1862. 

904 

Watkins,  J.  R..  Pt.,  G, 

July  12, 

Left  ;  lateral  flap.   Prison  Oct.  14, 

947 

Wilson,  H.,  Pt.,  I,  45th 

Oct.  7, 

Right;  bi-lat.flap.    Confed.  surg. 

43d  N.  C.,  age  37. 

12,  '64. 

1864. 

Missouri,  age  19. 

7,  '64. 

Disch'd  Jan.  31,  1865. 

905 

Watson,  G.  W.,  Lieut., 

May  5, 

Right  ;  circ.    Disch'd  Nov.  14,  '65. 

948 

Wilson,  P.  P.,  Lieut.,  H, 

June  22, 

Right  ;  (also  wound  of  left  leg.) 

H,  90th  Penn.,  age  35. 

7,  f64. 

5th  Connecticut. 

23,  '64. 

Surg.  J.  Chapman,  123d  N.Y. 

906 

Watson,   M.  F.,  Lieut., 

July  2, 

Right  ;  circ.  A.  Surg.  B.  Howard, 

Disch'd  Dec.  22,  '64  ;  sub.  oper. 

I,  5th  Artillery. 

3,  '63. 

1!.  S.  A.    Promoted.    Spec.  1382. 

949 

Wilson,  R.,  Pt.,  E,  49th 

Dec.  29, 

Right  ;  flap.     Disch'd  March  16, 

907 

Webb,  W.  E.,  Serg't,K, 

Aug.  6, 

Left;  circ.    Surg.G.A.Collamorc. 

Indiana. 

29,  '62. 

'63.     1670,  stump  sore. 

100th  Ohio,  age  22. 

7,  '64. 

100th  O.  Gang.  Dis.  Mar.  27,  '65. 

950 

Wilson,  S.,  Pt.,  F,  C5th 

Nov.  30, 

Left;  lat.  flap.     Provost  Marshal 

908 

Wciler,  G.  S.,   Pt.,  G, 

Nov.  29, 

Right  ;    circ.     Confederate  surg. 

Georgia,  age  26. 

De.1,'64. 

March  2,  1865. 

0:,th  Illinois,  age  29. 

29,  '64. 

Disch'd  June  5,  1865. 

951 

Wilson,   W.,  Pt.,  I,  1st 

June  25 

Left;  circ.     Disch'd  Sept.  29,  '62. 

;iO!) 

Wells,  D.,Corp'l.E,  121st 

Oct.  19, 

Right;   circ.     Disch'd  June   12, 

Massachusetts. 

25,  '62. 

New  York,  age  28. 

20,  '64. 

1865. 

93S 

Winder,  J.,  Pt.,  E,  43d 

Oct.  19, 

Left  ;  long  ant.  flap  ;  sloughing. 

910 

Wells,  G.,  Serg't,  K,  7th 

Sept.  19, 

Left  ;  circ.  Surg.  —  Davis,C.S.A. 

New  York,  age  39. 

20,  '64. 

Disch'd  July  10.  1865. 

Louisiana,  age  21. 

lit,  '64. 

Provost  .Marshal  Feb.  11,  1865. 

953 

Wing,  A.  O.,  Pt.,  F,  1st 

June  18, 

Left;  circ.     Discharged  1865. 

911 

Welsh,  J.,  Ft.,   H,  6th 

June  23, 

Left;  circ  ;    nee.  bone  removed. 

Maine  Art'y,  age  27. 

19,  '64. 

Kentucky,  age  26. 

23,  '64. 

Disch'd  April  10,  1865. 

954 

Winstead,  W.  D.,  Pt.,  H, 

July  1, 

Right.     Surg.  —  Murphy,  C.S.  A. 

912 

Welton.   F.  G.,  Pt.,  B, 

May  29, 

Right;  circ.    Surg.  Z.  1*.  Hanson, 

16th  North  Carolina. 

1,  '63. 

Exchanged  March  17,  1864. 

42d  Illinois,  age  21. 

29,  '64. 

4:.'d  111.     Disch'd  Mar.  20,  1865. 

955 

Woodle,  R.,  Pt.,  F,  21st 

June  16, 

.     Surg.  —  Mullcr,  C.  S.  A. 

913 

Werle,  M.,Pt.,K,66th  N. 

June  16, 

Loft  :  ant.  post.  flap.    Surg.  G.  L. 

South  Carolina. 

16,  '64. 

Recovery. 

York,  age  2:'. 

16,  '64. 

Potter,  145th  Penn.    Discharged 

956 

Wood,  L,  Corp'l,  G,  94th 

May  14, 

Left  ;  flap.    Disch'd  Dec.  2,  1864. 

June  24,  1865. 

Ohio,  age  22. 

14,  '64. 

914 

Worth,  W.,  Pt.,  E,  7th 

April  7, 

L't  ;  dou.  flap.  Surg.  W.Vasburgh, 

957 

Woods,  W.,  Pt.,  G,  32d 

JJuy  7, 

Right  ;  (also  wound  of  left  leg.) 

New  York,  age  32. 

7,  '65. 

lllth  N.  \.    Dis.  Aug.  18,  1865. 

New  York. 

7,  !62. 

Disch'd  Sept.  15,  1862. 

915 

Westbrook,  J.  IF.,  Lieut., 

Nov.  30, 

Left  :  circ.     Pro.   Marshal   Feb. 

958 

Woolbough,  J.  R.,Pt.,I, 

Oct.  1, 

Left  ;  flap.  Surg.J.Thomas,  118th 

B.  4th  Miss.,  age  23. 

Dec.  1,  '64. 

6,  1865. 

118th  Penn.,  age  33. 

1,  '64. 

Penn.  Nee.  bone  rem'd.  Disch'd 

91  G 

Wetlcr,  IL.Licut.,  II,8th 

Aug.  28, 

Uight.    Surg.  L.W.  Read,  1st  Pa. 

July  25,  1865. 

Penn.  Res.,  age  20. 

28,  '62. 

Reserves.    Disch'd  Sept.  29,'62. 

959 

Workman,  A.J.,  Pt.,  I, 

May  16, 

Right  ;   circ.     Retired  February 

917 

Whealan,  J..I't.,D,  123d 

Dec.  15, 

Left  ;  flap.     Surg.  O.  Ferris,  123d 

29th  Virginia,  age  20. 

16,'  '64. 

22,  1865. 

Ohio,  age  23. 

16,  '63. 

Ohio.    Disch'd  .May  23,  1864. 

960 

Wright,  A.,  Pt  ,  I,  68th 

April  9, 

Left  ;    circ.  skin  flap  ;  circ.  sect. 

918 

Wliff.ley,  1'..  Pt.,  K,  61st 

Sept.  30, 

Right.    Prison  April  14.  1865. 

Colored  Troops,age  24. 

10,  '65. 

muscles.    A.  Surg.  B.  F.  Lyford, 

N.  (  'ar.)lina,  age  23. 

30,  '64. 

68th  0.  T.    Disch'd  June  10,  '65. 

'' 

White.  A.  J..l't.,H,  155th 

June  22, 

Left;  flap;  erysip.;  gang.;  bone 

961 

Wright.  J.  C.,  Serg't,  C, 

Oct.  3, 

Left;  flap.  Confed.  surg.  Disch'd 

Pennsylvania,  age  19. 

'22,  '64. 

remov'd.   Disch'd  Nov.  10,  1864. 

58th  Illinois. 

4,  '62. 

April  10,  1803. 

'. 

White,  G.C.,Pt.,F.144th 

Nov.  30, 

Right;  ant.  post.  flap.     A.  Surg. 

962 

Wylie,  R.,  Pt.,  D,  23d 

July], 

Right.    Surg.  —  Neil!,  Dickenson 

New  York,  age  40. 

De.2,'64. 

C.  T.  Reber,  U.  S.  V.     Disch  d 

Penn.  Militia. 

2,  '63. 

College.    M.  out  Aug.  4,  "63. 

Aug.  11,1865. 

963 

Wyse,  C.  F.,  Pt.,  F,  69th 

Sept.  17, 

Left  ;  circ.    Disch'd  Mar.  30,  '63. 

921 

White,  J.,  Corp'l,  E,  6th 

May  27, 

Left.     Surg.  C.  W.  McMillan,  1st 

New  Y'ork. 

19,  '62. 

Tennessee,  age  28. 

27,  '64. 

Tenn.    Disch'd  May  9,  1865. 

964 

YTale,  T.,  Corp'l,  H,  23d 

Jan.  11, 

Right  ;  flap.     Surg.  J.  B.  Sparks, 

922 

White,,/.  M.,Pt.,A,  55th 

June  27, 

Right;  circ.    A.  Surg.  J.T.  Smith, 

Wisconsin. 

11,  '63. 

]9th  Kentucky.    Discli'd  March 

Illinois. 

27,  '64. 

;5th  111.     Disch'd  June  6,  1865. 

7,  1863. 

923 

WhitfJ'.  P.,  Pt.,  A,  20th 

July  1, 

Left.     Surg.  —  Bisscll,  C.  S.  A. 

965 

Yatton,  G.  W.,  Pt.,  D, 

April  2, 

Right  ;  flap.     Surg.  O.  S.  Cope- 

N.  Carolina,  age  21. 

2,  '63. 

Exchanged. 

10th  N.Y.  Heavy  Art., 

2,  '65. 

land,  10th  N.  Y.  Art'y.    Discli'd 

924 

Whitlock,  R.,Pt.,G,  llth 

Sept.  13, 

Left.    Disch'd  Dec.  31,  '62.     Died 

age  23. 

Oct.  3,  1865. 

Connecticut. 

13.  '62. 

of  apoplexy  Dec.  16,  1864. 

966 

Yeager,  B.,  Pt.,  A,  9th 

May  6, 

Left  ;  circ.;  bone  rem'd.     Discli'd 

925 

Whitner,  P.  W.,  Pt.,  A, 

Julyl 

Left.    Exchanged  Nov.  12,  1863. 

New  Jersey,  age  21. 

6,  r64. 

Feb.  25,  1865.    Spec.  2972. 

12th  N.  C.,  age  24. 

1,  '63. 

967 

Yeiser,  J.,   Pt.,  F,  lOtb. 

Nov.  25. 

Right;  circ.     Surg.  R.  J.  Mohr, 

926 

Whitney,  J.  F.,  Corp'l, 

Mar.  16, 

Left;  circ.    Surg.A.  Wilson,  113th 

Iowa. 

25,  '63. 

10th  Iowa.    Discli'd  Nov.  23,  '64. 

C,  14th  Mich.,  age  21. 

16,  '65. 

Ohio.    Disch'd  June  25,  1865. 

968 

Yemmans,  F.,Pt.,  B,  8th 

Nov.  25, 

Left.  Confed.  surg.    Gang.    Mar. 

927 

Whitney,  W.  E.,  Pt.,  I, 

Dec   13, 

Left:  circ.  flap.    Surg.  J.  Avcry, 

Mich.  Cavalry,  age  32. 

25,  '64. 

26,  '65,  reamp.;  circ.;  mid.  third. 

21st  Mich.,  age  53. 

13,  '64. 

21st  Mich.    Disch'd  June  16,  '65. 

Dr.   S.    L.  Norris,    Saugatuck. 

'•:- 

\Vhittingham,  A.  .Serg't, 

Sept.  17, 

Left.    Disch'd  December  31,  '62. 

Disch'd  June  10,1865. 

E.  28th  Penn. 

17,  '62. 

969 

Young,  A.  L.,  Corp'l,  F, 

July  20, 

Left  ;  flap.    DiscU'd  July  28,  '65. 

929 

Wicks,   B.,  Pt.,  A,  89th 

Sept.  17, 

Left;  flap.     Surg.  T.  H.  Squire, 

46th  Penn.,  age  24. 

21,  '64. 

N.  Y.,  nge  20. 

19,  '62. 

89th  N.  Y.    Disch'd  Feb.  2.!,  '63. 

970 

Young,  G.,  Serg't.G,  8th 

June  17, 

Left  ;  circ.     Surg.W.  B.  Fox,  8th 

130 

Wifff/x,  J.  £T.,Pt.,  1,  16th 

April  7, 

Left;  circ.   Released  June  14,  '65. 

Michigan,  ago  23. 

17,  '64. 

Mich.  Gang.  Disch.  June  9,  '65. 

N.  Carolina,  age  23. 

7,  '65. 

971 

Young,  L.,  Corp'l,  F,81st 

July  22, 

Right  ;  flap.   Surg.  W.  C.  Jacobs, 

931 

Wir/inton.  J.  T.,  Pt.,  K, 

Sept.  1, 

Left  ;  circ.    Surg.  —  Wilson,  28th 

Ohio,  age  22. 

22,  '64. 

81st  Ohio.     Disch'd  Feb.  17,  V5 

28th  Tennessee,  age  18. 

1,  '64. 

Teun.     Pro.  Mar.  Nov.  16,  1864. 

972 

Zahnizer,  M.  B.,  Pt.,  B, 

May  12, 

Right;  circ.;  gangrene.     Discli'd 

932 

Wiley.  W.  A.,  Colonel, 

Nov.  25. 

Left.    Discli'd  June  7.  1864.    Maj. 

140th  Penn.,  age  21. 

12,"'64. 

July  4,  1865. 

41st  Ohio. 

25,  '63. 

V.  R.C.April  19,1865. 

973 

Zimmerman,  II.,  Pt.,  E, 

Aug.  24, 

Left;  flap.  Surg.  .T.A.C'oiningtcn, 

933 

Williams,  B.,  Pt.,  E,  6th 

Feb.  11, 

Left  ;  circ.    A.  Surg.  11  C.  Merry- 

llth  Indiana,  age  18. 

24,  '64. 

1  1th  Ind.      Discli'd  Mar.  20.  '65 

Colored  Troops. 

11,  '65. 

weather.   5th   Colored    Troops. 

974 

Abrams,  L.,  P1..D,  158th 

April  2, 

R't  ;  flap.   Surg.I  LC.  Lovensalcr, 

Disch'd  July  25,  1865. 

New  York,  age  30. 

2,  '65. 

8th  Me.     Died  June  5,  '65;  irri 

934 

Williams,  E.  C.,  Pt.,  D, 

Mar.  16, 

Kip-lit;  circ.     (Skey's  operation.) 

tative  fever. 

3d  Wis.,  age  23. 

16,  '65. 

D.sch'd  Sept.  1,  1865. 

975 

Aiken,  W.,  Pt.,  G,  105th 

May  2, 

Right.    Died  June  9,  1663. 

935 

Williams,  E.  S.,  Pt.,  H, 

July  1, 

Right  ;  circ.     Disch'd  December 

Pennsylvania. 

2,  '63. 

2d  Wis.,  age  23. 

2,  '63. 

1,  1863. 

976 

Albert,  G.,  Pt.,  A,  27th 

July  30, 

Left;  circ.    Surg.W.C.  Shurlnek, 

9C6 

Williams,  G.  J.,  Corp'l, 

May], 

Left  ;  flap.     Surg.  J.  Pomerene, 

Michigan,  age  30. 

30,  '64. 

51st  Penn.     Died  Aug.  27,  '64  ; 

B,  42d  Ohio. 

1,  ''63. 

42d  Ohio.    Disch'd  Oct.  29,  1  863. 

exhaustion. 

937 

Williams,  J.,  Pt.,  C,  1st 

Feb.  22, 

Left;  ant.  post.  flap.     Surg.  A.  J. 

977 

Alderson,  B.,Pt.,E,  lllth 

July  22, 

Left.    Surg.  A.  C.  Messenger,  57th 

Infantry,  age  28. 

22,  '65. 

H.  Buzzell,  3d  N.  H.     Discli'd 

Illinois. 

22,  '64. 

Ohio.    Died  Aug.  14,  1864. 

Sept.  22,  186;,. 

978 

Aldinger,  C.,  Pt.,  E,  7th 

Dec.  13, 

Right.      Surg.  C.  S.  Wood,  66th 

938 

Williams,  T.  II.,  Corp'l, 

July  3, 

Left;   double  flap.     Surg.  J.  A. 

New  York. 

13,  '62. 

N.  Y.     Died  Dec.  28,  1862. 

E,  13th  New  Jersey. 

3,  '63. 

Freeman.  13th   N.  J.      Discli'd 

979 

Alexander,  A.  C.,  Pt.,  H, 

Dec.  13, 

Right;  (also  other  wounds;)  flap. 

Nov.  7,  '63.    Died  May  16.  '70. 

64l  h  Ohio,  age  20. 

13,  '64. 

Surgeon  J.  II.  Hutchison,  15th 

939 

Williamson,.!.  J.,  Lieut., 

June  3, 

Right  ;  circ.  Surg.  J.W.Wishart, 

Mich.     Died  Dec.  13,  1864. 

B,  2d  New  York  Art'y, 

3,  '64. 

140th  Penn.    Nee.  bone  remov'd. 

980 

Alexander,  N.  A.,  Pt.,A, 

Sept.  19, 

Left.    Surg.  J.G.F.  Holston,  U.S. 

age  30. 

Disch'd  Fob  25.  1865. 

5th.Iowa,  age  23. 

19,  '62. 

V.    Died  Sept.  29,  1862. 

940 

Wilkersnn.  W.  U.,  Lieut., 

May  10, 

.     Surg.  —  Graves,  44th  Va. 

981 

Allen,  D.,  Serg't,  G,  4th 

May  5, 

Left  ;  flap.     Died  June  0,  1864. 

G,  44th  Virginia. 

11,  '64. 

Recovery. 

Maine,  age  21. 

5,  '64. 

941 

Wilkins.J.,C'rp'l,L,14th 

Aug.  19. 

Ri.fflit  :  circ.     Surg.W.  V.  White. 

982 

Alien,   G.,   Pt,   H,  12th 

June  5, 

Right.     Surg.   J.   Spvcgelhalter, 

N.  Y.  H.  A.,  age  33. 

20,  '64. 

57th  Mass.    Disch'd  May  30,'05.  I 

Missouri. 

5,  '63. 

12th  Mo.     Died  June  25,  1863. 

SECT.  III.J 


PRIMARY   AMPUTATION    OF    THIGH    IN    LOWER    THIRD. 


257 


No-. 

NAMK.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

IlESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

983 

Allen,  E.S.,Serg't,D,3d 

July  2, 

Left.    Died  Aug.  7,  1863;  ha?m. 

1021.' 

Bebout,  L.,S'gt,D,140th 

June  3. 

Left  ;  circ.     Surg.  J.  W.  Wishart, 

Maine,  age  3ti. 

3,  '63. 

Fenn.,  age  32. 

3,  '64. 

140th  Penn.     Died  Oct.  8,  '64  ; 

984? 

Allen,  S.,  1't.,  G,   59th 

June  i7, 

Both.     Died  June  27,  1864. 

disease  of  stomach. 

!i8r,J 

Mass.,  age  19. 

17,  '64. 

1030 

Bechtell,  D.  R.,  Ft.,  B, 

June  18, 

Right.     Died  July  16,  1864. 

986 

Almon.  H'.  J.,  Ft.,  F,  5th 

May  8, 

Left  ;  circ.;  slough.;  baem.  recur 

21st  Penn.,  age  23. 

18,  "64. 

North  Carolina. 

8,  '64. 

rent.     Died  May  24,'(i4  ;  exh'u. 

1031 

Bechtolt,  F.,  Ft.,  G,  54th 

July  3, 

Left.     A.  Surg.  C.  B.  Richards, 

987 

Alpen,   H.,    Ft.,  F,  20th 

May  :iO, 

Left.     Died  June  14,  1864. 

Ohio. 

3,  '64. 

30th  Ohio.     Died  Aug.  :.8.  '64. 

Massachusetts. 

—,''64. 

1032 

Beck,  C.,  Ft.,    D,   29th 

July  28, 

Left;  circ.     Surg.  A.-K.  1  ifield, 

988 

Alsop,  Vv'.,  Ft.,  F,  33d 

June  25, 

Right.     Surg.   J.    Bennett,    ICth 

Ohio. 

28,  '64. 

2Cth  Ohio.     Died  Sept.  16,  '64. 

Indiana. 

25,  '64. 

Hiich.     Died  July  3,  1864. 

1033 

Beck,  G.  W.,  Pt.,  C,  21st 

June  —  , 

Left.     Surg.  A.  L.  Cox,  U.  S.  V. 

989 

Alva,  J.,  Corp'l,  F,  13th 

Oct.  1, 

Right.     Died  Nov.  5,  1864  ;  chr. 

Illinois. 

—  ,  '64. 

Died  June  24,  1864. 

Ohio  Cav.,  age  21. 

1,  '64. 

diarrhoea  and  wounds. 

103-1 

Bcckman,  W.  W.,  Serg't, 

June  16, 

Right  :  circular.     Died  June  25, 

990 

Anderson,  J.  B.,  Ft.,  II, 

June  20, 

Lett.     Surg    C.  J.  Walton,  21st 

D,  27th  S.  C.,  age  33. 

16,  '64. 

1864  ;  pyaemia. 

81st  Indiana,  age  33. 

20,  'ti4. 

Ky.     Died  July  1,  1864. 

1035 

Beckwith,  C.  J.,  Ft.,  C, 

June  14. 

Right.     Died  June  26,  1863. 

991 

Anderson,  .J.  8.,  1't.,  A, 

July  18, 

Right.    Died  August  11,  1864. 

26th  Connecticut. 

14,  '63. 

123d  Ohio,  age  22. 

—  ,'  '64. 

1036 

Becker,  J.  J.,Pt.,K,89th 

June  27. 

Left.     Died  July  22,  1864. 

992 

A  nder.ton,  J.  H.,  Corp'l, 

Nov.  29, 

Left.    Surg.  A.  M.Wilder.U.S.V. 

Ohio. 

27,  '64. 

11,  59th  Georgia. 

2!>,  '63. 

Died  December  12,  1863. 

1037 

Belcher,  F.,  Ft.,  B,  49th 

May  27, 

Right.     Died  June  10,  '63:  diph 

993 

Andrews,  J.,  Pt.,  D,  llth 

Sept.  1  9, 

Right  ;  circ.     Died  Sept.  28,  '64  ; 

Mass.,  age  20. 

27,  '63. 

theria. 

Vermont. 

19.  '64. 

gen'l  depress'n  ol'nerv  s  system. 

1038 

Bell,  H.,Pt.,I,  36thCol'd 

Sept.  29, 

.     Died  October  15,  1864. 

994 

Andrews,  J.,  Capt.,  D, 

May  27, 

;  flap.    Surg.  W.  R.  March, 

Troops. 

29,  '64. 

66th  Illinois. 

27,'  '64. 

2d  Iowa.    IliBin.    Died  June  2:!, 

1039 

Bell,  R.  H.,  Capt,,  F,  7th 

Way  7, 

Left  ;  ha^m.;  lig.  femoral.     Died 

1864;  pyaemia. 

N.  Y.  H.  A.,  age  37. 

-,  f64. 

June  24,  1864;  exhaustion. 

995 

Anglen,   T.  R.,  Pt.,  D, 

July  3, 

.     Died  October  8,  1863;  chr. 

1040 

Benedict,  A.,  Serg't,  A, 

May  14, 

Left.    Died  May  20,  1864. 

38th  Virginia. 

3,  '63. 

diarrhoea. 

104th  Illinois. 

14,  '64. 

996 

Antonio,  J.,  Ft.,  A,  llth 

June  6, 

Right  :  ant.  post.  flap.   Died  June 

1041 

Bennett,  T.,  Ft.,F,  199th 

April  9, 

Left:  circ.     Surg.  G.  DeLandre, 

Conn.,  age  31. 

6,  '64. 

14,  1864  ;  exhaustion. 

Pennsylvania. 

9,  '65. 

158th  N.  Y.     Died  May  29,  '65. 

997 

Argo,  J    E.,  —,  H,  1st 

Sept.  14, 

.  Injured  end  of  stump,  caus 

1042 

Benton,'G.M.,  Lieut.,  B, 

Oct.  19. 

Right.    Confed.  surg.    Died  Nov. 

Georgia. 

15,  '62. 

ing  slough.    Died  Oct.  16,  1862. 

12th  Conn. 

19,  '64. 

4,  1864;  general  depression. 

998 

Armond,  F.,  Ft.,  D,  1st 

May  18, 

Right.     Died  May  30,  1864  ;  py- 

1043 

Berry,  E.  P.,  Capt.,  E, 

July  2, 

Left.     July  8,  haem.     Died  same 

Delaware,  age  39. 

18,  '64. 

aeuila. 

Sth'N.  Jersey,  age  24. 

3,  '63. 

day. 

999 

Armstrong,  F.,.Serg't.A, 

June  3, 

Left:  flap:  ha?m.;  lig.;  haem.  rec'd. 

1044 

Betts,  J.  S.,  Pt.,  F,  40th 

Nov.  26. 

Left  :  ant.  post.  flap.     Surg.  H. 

58th  Mass.,  age  30. 

3.  '64. 

Died  July  18,  1864;  exhaustion. 

New  York,  age  22. 

26,  '63. 

F.  Lyster,  5th  Mich.    Died  Dec. 

1000 

Armstrong,  J..  Serg't,  M, 

June  18, 

Right;  ciro.     Died  July  11,'64  ; 

17,  1863;  pyaemia. 

21st  Fenn.  Cav.,  age  28. 

18,  '64. 

pyasmia. 

1045 

Bibbs,  W.  J.,  Pt.,  G,  32d 

May  15, 

Right  ;  circ.     Ass't  Surg.  W.  F. 

1001 

Armstrong,  S.,  1't.,  G,  2d 

June  18, 

Left.     Died  June  29,  1864. 

Tenn.,  age  35. 

16,  '64. 

Smith,  28th  Penn.     Gang.;  lig. 

Mich.,  age  45. 

18,  '64. 

femoral  on  face  of  stump.     Died 

P  OS 

ATmstronn   T.  H.  Pt.  D 

Aug.  18, 

7th  S.  Carolina  Cav. 

'l9,  '64.' 

S°C.Cav.    Died  Oct.  9,  1864. 

1046 

Biddle,   G.    C.,  Ft.,  C, 

April  2, 

Right  :  ant.  post.  flap.     Surg.  W. 

1003 

Arnich,  M.,  Ft.,  K,  2COth 

Mar.  25, 

.    Died  March  29,  1865. 

205th  Fenn.,  age  25. 

3,  '65. 

O.  McDonald,  U.  S.  V.     Died 

Pennsylvania. 

25,  '65. 

April  25,'65;  pyaem.  Spec.  4159. 

1004 

Atwoori,  H.  W.,  Corp'l, 

May  27, 

Right.     Surg.   J.   W.   Hastings, 

1047 

Biddle,  H.,  Corporal,  C, 

Oct.  27, 

Right.     Died  January  28,  1865. 

C,  105th  Illinois. 

27,'  '64. 

33d  Mass.     Died  June  4,  1864. 

148th  Pennsylvania. 

27,  '64. 

1005 

Austin,  11.  K.  N.,  Serg't, 

June  1, 

Left;  circ.  -Died  June  30,  1864; 

1048 

Bigalow,  C.,  Pt.,  E,  17th 

May  5, 

Left;    flap;    gastric    irritability. 

E,9thN.Y.H.A.,age35. 

3,  '64. 

pyaemia. 

Infantry,  age  16. 

-,  '64. 

Died  May  30,  1864. 

i006 

Bailey,  H.,  Corp'l,  13,39th 

May  20, 

Right.    Died  June  11,  '64  ;  pyaem. 

1049 

Birmingham.  A.  .Lieut., 

Dec.  13, 

Right;  (amputa.  left  ankle  joint.) 

Illinois,  age  27. 

20,  '64. 

A,  69th  New  York. 

13,  '62. 

Died  December  17,  18(12. 

1007 

Buines,  J.  A.,  Pt.,G,  55th 

July  22, 

Left:  flap.    Act.  Staff  Surg.C.B. 

1050 

Bishop,  L.,  Sergeant,  C, 

July  1, 

Left.    Died  July  31,  1863. 

Illinois,  age  25. 

23,  '64. 

Richards,  U.  S.  A.     Died  July 

154th  New  York. 

t,  *63. 

25,  1864. 

1051 

Bitter,  L.,  Ft..  B,  180tb 

Dec.  7, 

Right.     Ass't  Surg.  J.  W.  Reed, 

1008 

Baker,  C.,  Ft.,  12th  Wis 

Oct.  5, 

Left.     A.   Surg.  J.  J.  Whitney, 

Ohio. 

7,  '64. 

115th  Ohio.    Died  Dec.  9,  1864. 

consin  Battery. 

5,  '64. 

18th  Wis.     Died  Oct.  15,  1864. 

1052 

Blackburn,   J.,    Pt.,  E, 

July  9, 

Left;  circ.     A.  A.  Surg.  W.  S. 

1009 

Bamberker,  J.,'Pt.,  F,  2d 

Sept.  19, 

Left.     Died  October  25,  1863. 

138th  Penn.,  age  35. 

11,  '64. 

Adams.  Haem.  recurrent.    Died 

Missouri. 

19,  '63. 

Sept.  1,  1864  :  ha?m.  and  exh'n. 

1010 

Banks,  E.  M.,Pt.,H,  IGth 

Dec.  13, 

Left.     Died  December  16,  1862. 

Specs.  3882,  3848,  3980. 

Maine. 

13,  62. 

1053 

Blackwell.  E.,Pt.,F,13th 

Dec.  15, 

Right;  flap.     A.  A.  Surg.  J.  S. 

1011 

Banning,  L.,  Ft.,  A,122d 

Sept.  19, 

Left.     Died  October  12,  1864  ;  ex 

Colored  Troops,  age  24. 

16,  '64. 

Giltner.     Died  Dec.  27,  1864. 

New  York. 

19,  '64. 

haustion. 

1054 

Blauchard.W.,  Captain, 

Nov.  27, 

Left.     Surg.  S.  C.  Plummer,  13th 

L012 

Barbour,  S.V.,  Ft.,  E.  9th 

Oct.  19, 

Left  ;  ant.  post.  flap.    Surg.  G.  T. 

K,  13th  Illinois. 

27,  '63. 

111.     Died  Dec.  4,  1863. 

N.  Y.  H.  Art'ry,  age  28. 

20,  '64. 

Stevens,  77th  N.  Y.   Haem.  fatal 

1055 

Blaney,  J.  W.,  Ft.,  E, 

Dec.  13, 

.     Died  December  —  ,  1862. 

before  discovery,  Oct.  27,  1864. 

7th  West  Virginia. 

13,  '62. 

1013 

Barclay,  W.  II.,  Lieut., 

June  3, 

Right  ;  circ.     Surg.  G.  L.  Potter, 

1056 

Blett,  D.,  Lieut.,  F,  1st 

May  8, 

Right  ;  circ.  Surg.  J.  J.  Comfort, 

K,  7th  N.  Y.,  age  23. 

5,  '64. 

]45th  Penn.     Oozing  of  blood; 

Fenn.  Rifles,  age  35. 

9,  '64. 

1st  Penn.  Rifles.     Died  June  30, 

diair.     Died  July  6,  64  ;  exh'n. 

1864;  pyaemia. 

1014 

Barker,  J.,  Ft.,  I,  58th 

June  17, 

Right  ;  (amputa.  left  knee  joint.) 

1057 

Bodley,  E.,  Pt.,  B,  39th 

Sept.  19, 

Left;  flap.  Surg.A.M.McMahon, 

Mass.,  age  42. 

17,  '64. 

Died  June  28,  1864. 

Indiana,  age  28. 

19,  '63. 

64th  Ohio.     Sept.  28,  '63,  haem.; 

1015 

Barnes,  C.,  Pt.,  D,  40th 

May  5, 

Right  ;  haem.    June  17,  lig.  fein. 

lig.  fem.,  fatal  six  hours  after. 

New  York,  age  21. 

6,  '64. 

Died  June  19,  1864. 

1058 

Bohrer,    T.,    Serg't,    I, 

April  13. 

—  .     Died  April  14,  1863. 

1016 

Barnes,  H.,  Pt.,  II,  14th 

Sept.  17, 

Right.     Died  October  7,  1862. 

159th  New  York. 

13,  '63. 

Indiana. 

17,  '62. 

1059 

Bond,  R.,   Ft.,  A,  24th 

Aug.  14, 

Left;  circ.     A.   A.   Surg.   S.   J. 

1017 

Barnes,  J.  M.,  Corp'l,  A, 

Aug.  6, 

Right  :  circ.     Surg.  C.  S.  Frink, 

Mass.,  age  28. 

16,  '64. 

Holley.    Died  Sept.  2,  64  ;  irri 

12th  Kentucky,  age  31. 

6,  '64. 

U.S.V.  Died  Nov.  14,  '64  ;  exh'n. 

tative  fever. 

1018 

Barnes,  «.  W-,  Pt.,  H, 

July  .'), 

Right.     Died  August  2,  1863. 

1060 

Bonhauui,   A.,    Pt.,    F, 

June  18, 

Right.    Died  Aug.  7,  '64  ;  exh'n. 

140th  Penn. 

3,  fe. 

143d  Penn.,  age  43. 

18.  '64. 

1019 

Barnett,  P.,    Ft.,  F,  3d 

June  18, 

Left.     Surg.  C.  N.  Chamberlain, 

1061 

Bonneberg,   J.,   Ft.,  E, 

Dec.  29, 

.     Died  January  14,  1863. 

Delaware. 

18,  '64. 

U.  S.  V.     Died  July  1,  1964. 

12th  Missouri. 

29,  '62. 

1020 

Barringer,    F.,    Ft.,    E, 

June  16, 

Right;    lat.   flap.     Surg.   J.  W. 

1062 

Bonyea,R.,Pt.,F.  118th 

June  3, 

Left  :  circ.;  haem.     Died  July  8, 

140th  Penn.,  age  18. 

18,  '64. 

Wishart,  140th  Fenn.  Died  July 

New  York,  age  33. 

3,  '64. 

1864;  pyaemia.     Spec.  2930. 

15,  1864. 

1063 

Boughton,  J.  It.,  Corp'l, 

Sept.  19, 

Right  ;  flap.     Died  Oct.  20,  1864  ; 

1021 

Bartlett,  M.,  Ft.,  G,  10th 

Sept.  17, 

Right.     Died  November  6,  1862. 

E,  2d  Conn.  H.  Art'ry. 

19,  '«4. 

exhaustion. 

Maine. 

17,  '62. 

1064 

Boutwell,  R.  T.,  Ft.,  B, 

May  12, 

Left.     Died  May  12,  1864. 

1022 

Bass,  W.  L.,  Ft.,  K,  6th 

May  16, 

—  ;  flap.     Died  July  30,  1864. 

4th  Vermont. 

12,  '64. 

Georgia. 

17,'  '64. 

1065 

Bowman,  H.  M.,  Ft.,  II, 

Nov.  3, 

Left,     Surg.  J.  S.  McGrew,  83d 

1023 

Battee,  P.,  Sergeant,  B, 

Sept.  1, 

Left.     Died  September  4,  1864. 

60th  Ind..  age  21. 

3,  '63. 

Ohio.     Died  Feb.  1,  1864. 

76th  Ohio. 

1,  '64. 

1066 

Boyd,  W.  A.,Maj.,  84th 

May  7, 

Left.     Ass't  Surg.  H.  Kirby.  84th 

1024 

Battles,  T.,  Pt.,  —  ,  3Gth 

Nov.  25, 

Right  ;  flap.  Surg.A.Sabine,  76th 

Indiana,  age  37. 

7,  '64. 

Ind.     Died  July  11.  1864. 

Alabama. 

25,  '63. 

Ohio.     Died  Nov.  26,  1863. 

1067 

Boyle,   M.,    Pt.,    D,   1st 

Dec.  13. 

Right.     Died  Dec.  31,  1862  ;  py 

1025 

Beach,  J.  T.,  Adj't,  5th 

May  4, 

;  pneumonia  ;  pyaemia.  Died 

Delaware. 

13,  '62. 

aemia  and  tetanus. 

Louisiana. 

5.  V63. 

May  28,  1863. 

1068 

Boyles,    T.   R.,  Ft.,  D, 

June  18, 

Right.     Died  June  19,  1864. 

1026 

Beard,  H.,  Ft.,  F,  46th 

July  20, 

Left;  (also  w'nd  of  face.)     Died 

187th  Pennsylvania. 

18,  '64. 

Pennsylvania. 

20,  '64. 

October  17,  18C4. 

1069 

Bradford,  J.  M.,  Ft.,  B, 

Feb.  6, 

Left.     Died  February  17,  1865. 

1027 

Beaty,  "S.,  Pt.,  B,  30th 

June  16, 

Left  ;  double  flap.    A  .  Surg.  C.  B. 

Kith  Michigan. 

6,  '65. 

Ohio,  age  44. 

16,  '64. 

Richards,  30th  Ohio.  Died  June 

1070 

Bradford.  W.  II.,  Ft.,  A, 

June  17, 

Left  :  circ.    Surg.  W.  B.  Fox,  8th 

16,  '64  ;  shock  and  loss  of  blood. 

38th  Wisconsin,  age  26. 

17,  '64. 

Mich.     Died  June  25,  1864. 

1028 

Bebout,    B.,  Corp'l,  D, 

July  2, 

.     Died  August  9,  1863. 

1071 

Bradley,   P.,  Serg  t,  C, 

Aug.  21, 

Left;  (also  amp.  right  leg.)    Died 

140th  Penn. 

-,  '63. 

16th  Michigan. 

21,  '64. 

Sept.  16,  1864. 

SURG.  111—33 


258 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


KO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATES. 

(  M'EUATIOXS,  Ol'KKATOUS, 
RESULT. 

No. 

NAME,  MILITAKV 
DESCIiU'TION,  ANP  AGE. 

DATES. 

OPERATION'S,  Ol'EUATOUS, 
RESULT. 

1072 

Brand,   A.',   Serg't,   K, 
21st  8.  C.,  age  30. 

May  10, 
18,  '64. 

Left;  flap;  slough  'g  bone  exp'd. 
Died  June  1,  1864. 

1115 

Campbell,  B.,Pt.,  A,  81st 
Ohio. 

Aug.  25, 
25,  '64. 

Left.     Surg.  J.  Pogue,  66th  111. 
Died  Oct.  19,  1864. 

1073 

Brandnhaw,  H.  If.,  Pt., 

July  3, 

Died. 

1116 

Campbell,  S.  G.,  1't.,  F, 

May  31, 

Lel't  ;  circ.  June  20.  haem  ;  21,  lig. 

G,  7th  Tennessee. 

3,  ''63. 

58th  Virginia,  age  31. 

Je.  1,'64. 

Died  June  23,  '64  ;  pyaemia. 

1074 

Brause,  A.  D.,  Pt.,   II, 

Sept.  19. 

Uight  ;  circ.;  pvii'inic  symptoms. 

1117 

Camphor,  L.,  Pt.,  G,4th 

Sept.  29, 

.    Died  October  27,  1864. 

49th  Peun.,  age  20. 

19,  '64. 

Died  Nov.  19,"  1864.                          I 

Colored  Troops. 

29,  '64. 

1075 

Bremer,  E.,  Pt.,  A,  3i)th 

Feb.  C, 

Left  ;  flap.     Surg.  A.  N.  Dough 

1118 

Capen,  S.  L.,Pt.,B.207th 

April  2, 

Right.     Died  April  14,  1865. 

New  York,  age  29. 

8,  G4. 

erty,  II.  S.  V.     Stump  diseased. 

Penn.,  age  22. 

2,  '65. 

Died  June  1,  '64.     Spec.  2043. 

1119 

Carey,  O.,  Pt.,  E,  86th 

May  24, 

Left:    diarrhoea.     Died   June  2, 

107(i 

Brewer.  J.  S.,  Corp'l,  A, 

Oet.  19, 

—  .     Died  November  8,  1804. 

Xew  York,  age  21. 

24,  '64. 

1864  ;  pyaemia. 

20th  .South  Carolina. 

19,  'M. 

1120 

Carlin,   J.,   Pt.,  C,  41st 

Nov.  25, 

Left.     Died  December  9,  1803. 

1077 

lirickley.  P.,  Pt.,  B,  (itli 

Mav  14, 

Uight.     Surg.  D.  L.  Heath,  23d 

Ohio. 

25,  '63. 

Tennessee. 

14/64. 

Mich.     Died  July  28.  1864. 

1121 

Carlton,   R.  B.,  Pt.,   F, 

Mav  5, 

Right  ;  ant.  post.  flap.    Died  May 

1076 

Brigys,  31.    IK.,  Pt.,  C, 

Lel't.     Died  July  19,  1862. 

3d  Vermont,  age  22. 

C,  '64. 

20,  1864  ;  pyaemia. 

24th  Virginia. 

1122 

Carmer,  D.,  Corp  1,   L, 

Aug.  19, 

Left.     Surg.'  T.  F.  Oakcs.  56th 

1079 

Brihm,  J.,  Recruit,  age 

Aug.  26, 

Right  :  circ.     Surg.  G.  L.  Sutton, 

14th  N.Y.H.A.,  agu!9. 

19,  '64. 

Mass.     Died  Sept.  13,  1864. 

38. 

26,  '64. 

I).  S.  V.    Gangrene.    Died  Oct. 

1123 

Carnahan,  J.  A.,  Pt.,  K, 

Sept.  1, 

Left.     Died  Oct.  4,  1864  ;  chronic 

8.  1864. 

10th  Michigan. 

1,  '64. 

diarrhoea. 

1080 

Broomeling.  T.,  Pt.,  C, 

July  9, 

Lett;  circ.    A.A.Surg.G.M.Paul- 

1124 

Carney,  J..  Pt.,  F,  155th 

June  3, 

Right  :  lateral  flap.     Died  June 

106th  N.  York,  age  24. 

10,  ''64. 

lin.    Gangrene.     Died  August 

Xew  York,  age  35. 

3,  '64. 

13,  1864. 

11.  1861;  diphtheria. 

1125 

Carpenter,  J.  M.,  Pt.,  C, 

July  20, 

Left.    Died  July  21,  1864. 

1081 

Brown,  W.  II.  II.,  Lt. 

July  20, 

Uight.     Died  .Septembers,  1804. 

33d  Indiana. 

20/04. 

Col.,  61st  Ohio. 

—,''64. 

1126 

Carroll.  J.,  Pt.,  A,  20th 

Dec.  13, 

Right.     Died  January  1  5,  1863  ; 

1082 

Brown,  H.  Z.,  Pt.,  F.  1st 

.June  18, 

.     Died  June  20,  1864. 

Massachusetts. 

13,  '62. 

pyaemia. 

Mass.  H.  A.,  age  29. 

18,  '64. 

1127 

Carroll,  W.,  Pt.,  H,66th 

May  28, 

.     Surg.  W.  F.  Cady,   12th 

1083 

Brown,  J.  F.,  Lieut.,  F, 

Mav  12, 

Right  ;  flap  :  erj  sipelatous.    Died 

Illinois. 

28,  '64. 

111.     Died  June  15/64  ;  pyannia. 

147th  N.  Y..  nge  29. 

12,'  '64. 

J  uly  14/64  ;  exh'n.    Spec.  3573. 

1128 

Carter,  C.S.,Pt.,D,  50th 

Mav  12, 

Right.     Mav  20,  ha;m.;  lig.  fern. 

1C84 

Brown,  J.  \V.,   1't.,  K, 

July  3, 

Right.     Died  July  —  ,  1863. 

Penn..  age  22. 

—  ,  '64. 

Died  June'  3,  1804. 

3d  Michigan. 

3,  '63. 

1129 

Casey.  T.,  Serg't-Major, 

Sept.  19, 

Left.  Died  Oct.  4,  1863;  pyaemia. 

1085 

Brown,  O.  S.,  Serg't,  F, 

July  3, 

—  -.     Died  July  29,  1863. 

51st  Illinois. 

21,  '63. 

145th  Pennsylvania. 

3,  '63. 

1130 

Cassidy,  M.,  Pt.,C,90th 

June  14, 

Left.     A.  A.  Surg.  —  Kendall, 

1086 

Bryant,  D.,  Pt.,  C,  19th     Sept.  17, 

Right.     Died  October  8,  1862. 

Xew  York. 

—  ,  '63. 

U.  S.  N.    Died  June  22.  1863. 

Massachusetts. 

17,  '62. 

1131 

Causei/,  B.  F.,  Pt.,    F, 

Nov.  29, 

Left  :  lateral  flap.    Died  March  8, 

1087 

Bryant,   J.    C.,  Pt..   B, 

April  0, 

Left  ;  flap.     Died  April  28,  1865  ; 

30th  'Georgia,  age  21. 

30,  '64. 

1865;  exhaustion. 

18th  Georgia,  age  29. 

7,  '65. 

exhaustion. 

1132 

Cave,   R..    Pt.,    F,  8th 

Aug.  !, 

L't  ;  circ.  A.  A.  Surg.  C.  Carvallo. 

1088 

Buchanan,  A,  Corp'l,  K, 

May  12, 

Left;  long  ant.  flap.     Surg.  J.  F. 

Illinois  Cav..  age  29. 

3,  '63. 

Died  Aug.  20.  1863.    Spec.  1077. 

19th  Mass..  age  28. 

13,  '64. 

Dyer.19th.Mass.  DiedJe.  2,  '64. 

1133 

Certain,  W.  R.,  Pt.,  II, 

June  1, 

.  Surg.  C.  B.  Gibson,  C.  S.  A. 

1080 

Bump,  J.,  Pt.,  M,  8th  X. 

June  3, 

Right  ;  circ.    Surg.  S.  H.  Plumb, 

47th  North  Carolina. 

I,  '64. 

Died  June  12,  1804  ;  exhaustion. 

York  Art'y,  age  18. 

3,  '64. 

8Jd  N.  Y.     Died  July  7,  1864  ; 

1134 

Chancellor.    II.    C.,   jr., 

July  3. 

Left.     Died  Aug.  5,  1863. 

pyaemia. 

Lieut  ,  B,  150th  I'enn. 

3,  '63. 

1090 

Bunting,   J.  M.,  Pt.,  B, 

Nov.  29, 

Left.     Surg.  X.  A.  Hursam,  17th 

1135 

Chandler.  W.  S.  J.,  Pt., 

July  3, 

Right.     Died  July  9,  1863. 

9l>th  Pennsylvania. 

29,  '64. 

Me.  Died  Dec.  5,  '64.  .Spec.  4119. 

A,  1st  Maryland. 

4,  '63. 

1091 

Burbank,  W.  II.,  Lieut., 

June  —  , 

Right.     Died  June  10,  1864. 

1136 

Cheever,W.!Pt.,A,  30th 

Oct.  19, 

Right  ;  ant.  post  flap.   Died  Xov. 

58th  Alassachusotts. 

—  ,  '64. 

Mass..  ago  28. 

21,  '64. 

24,  1864  ;  pyaemia. 

1092 

Burdy,  T.,  Pt.,  K,  71st 

June  29, 

Right  ;  ulcer,  dead  bone  exp'd. 

1137 

Churchill,  W.H.,  Serg't, 

Oct.  27, 

Right  ;  circ.     Died  Xov.  7,  1864  ; 

Pennsylvania. 

2!',  '62. 

Nov.  29,  reamp.  six  ins.  higher. 

H,  2d  U.  S.  S.  S. 

—  ,  '64. 

wounds. 

A.    A.    Surg.   R.    P.    Thomas. 

1138 

Clark.  G.H.,  Serg't,  I,  2d 

June  5, 

Left:  ant.  post.  flap.     Surg.  G. 

Died  Dec.  12,  1862;  pyaemia. 

N.Y.  H.Art'ry,  age  32. 

6,  '64. 

L.  Potter,  145th  I'enn.  Typhoid 

1093 

Biirfell,  L.,Pt.,L>,  118th 

May  14, 

Right.     Died  July  30,  1864. 

fever.    Died  July  20.  1864. 

Ohio. 

14,'  '64. 

1139 

Clark,   G.    F.,    Pt.,    A, 

May  15, 

Right.     Surg.  C.  11.  Lord,  102d 

1094 

Burghart,  C.  H.,  Lieut., 

April  2, 

Left  :  flap.     Surg.  G.  B.  Parker, 

149th  Xew  York. 

15,  '64. 

Xew  York.     Died  May  23,  '04. 

K,  4th  New  York  Il'vy 

2,  '65. 

U.  S.  V.     Died  April  17,  1865; 

1140 

Clark,   J..   Pt.,   A,   83d 

April  9, 

Right  ;  flap.     Died  May  4,  1805  ; 

Artillery,  age  20. 

result  of  wound. 

Ohio,  age  18. 

9,  '65. 

pvasmia. 

109:. 

Biirgin,    f.  if.,    Serg't, 

Oet.  19, 

—  ;  circ.;  bone  exposed.     Died 

1141 

Clark,  J.,  Pt.,  13th  Xew 

July  20, 

Left.     Died  August  22,  18<i4. 

H.'oth  Ala.,  nge  24. 

19,  '64. 

November  28,  1864;  pyaemia. 

York  Battery. 

20,''64. 

1090 

Hurley,  W..  Pt.,  K,  7:id 

Oct.  28, 

Lei't  ;  circular;  gangrene.     Died 

1142 

Clark,  J.,  Pt.,  —  ,  38th 

July  3, 

.     Died. 

Ohio,  age  40. 

30,  '63. 

November  1,  1863. 

North  Carolina. 

3,  '63. 

1097 

Burke,   V.,   It.,    H,    1st 

June  17, 

Left;  flap.     A.  A.  Surg.  W.  S. 

1143 

Clark.  J.  L.,  Serg't,  G, 

May  28, 

Right;  doll,  skin  flap;  sloughed. 

Mich.,  age  30. 

19.  '64. 

Forbes.    Died  July  25,  '64  ;  pyae. 

5th  S.  C.  Cav.,  age  27. 

29,'  '64. 

Died  June  18.  18fi4  ;  pyaemia. 

"-- 

Burmastcr,   J.,    Pt.,    1), 

Sept.  19, 

Right.     Died  October  8,  1863. 

1144 

Clark.  S.  F.,  Serg\  D, 

Deo.  13, 

;  flap.     Died  December  30, 

88th  Illinois. 

19,  '63. 

1st  Massachusetts. 

13,  '62. 

1802. 

1099 

Bums,   P..   Pt.,    C,   5th 

Aug.  20, 

—  .     Died  August  25,  1864. 

1145 

Clark,  W.  D.,  Pt.,  A,  3d 

Mav  8, 

Right  ;  femur,  protrud.  and  cxfol. 

New  York. 

20,  '64. 

Xew  Jersey,  ago  26. 

8,  '64. 

Died  Juno  25,  '04  ;  pyaemia. 

1100 

Burns,  P.,  Pt.,  E,  15th 

Aug.  10, 

Right.     Died  August  17,  1864. 

1146 

Cleaveland,  J.F.,Pt.,G, 

Dec.  13, 

Left;  flap.     Dec.  30,  litcm.;  fern. 

Infantry. 

—  ,  '64. 

16th  Maine,  ago  25. 

14,  '62. 

ligated.     Died   Dec.   31,    18(i2; 

1101 

Burns,   K.,    Pt.,  A,  23d 

April  2, 

Right  ;  flap.     Surg.  J.  S.  Taylor, 

exhaustion. 

Illinois. 

2,  '65. 

23d  Illinois.     Died  April  4"  '65. 

1147 

dough,    J.    E.,  Pt..   B, 

April  1, 

Left  ;  oval  ant.  post.  flap.     Surg. 

1102 

Burr,  T  ,  PL,  K,  112th 

June  3, 

Right.     Died  June  20,  1864. 

llth  Mass.,  age  50. 

2,  '65. 

II.  F.  Lyster,  5th  Mich.    Diarr.. 

New  York,  age  33. 

3,  '64. 

phlebitis,    slough.     Died   April 

1103 

Bush,  J.,  Corp'l,  F,  90th 

June  14, 

Right.  Surg.  E.  S.  Hoffman.  90th 

23,  1865;  exhaustion. 

New  York. 

14,  '63. 

N.  Y.     Died  June  24,  1863. 

1148 

Cobaugh,  J.,  Pt.,  A,  10th 

Mav  6, 

Right.      Surg.    B.   Rohrer,    10th 

1104 

Buslinell.    O..     I't.,    A, 

Juno  4, 

Right.     Died  June  14,  1864. 

Penn.  Reserves. 

6,  '64. 

Penn.  Res/  Died  May  19,  1864. 

101st  Illinois. 

4.  '64. 

1149 

Coffee,   J.,  Pt.,  E,  69th 

Sept.  17, 

Right;  circ.     A.  A.  Surg.  A.  V. 

1105 

Butcher,   J.,    Serg't,  F, 

June  17, 

Left;  oval  flap.    Surg.  W.B.  Fox, 

Xew  York. 

17,  '62. 

Cherbonm'er.    Prot.  fern,  rem'd; 

37th  Wis.,  age  45. 

17,  '64. 

8th  Mich.     Died  June  25,  1864. 

necrosed.     Died  Jan.  28,  18(i3. 

1106 

Butler,  L.,  Pt..  B,  181st 

Dec.  7, 

Right;  circ.  A.  Surg.  J.W.  Reed, 

1150 

Cogswell,  W.  H.,  Lieut., 

Sept.  19, 

Left;  circular.     Died  October  7, 

Ohio,  age  43. 

7,  '64. 

1  15th  Ohio.     Died  Dec.  9,  1864  ; 

B,  2d  Connecticut. 

19,  '64. 

1804  ;  exhaustion. 

exhaustion. 

1151 

Cole.  C.,   Pt.,  II,  124th 

Mar.  10, 

Right;  circ.     Died  April  19,  '65. 

1107 

Butler,  J.  N.,  Pt.,  C,  1st 

Dec.  —  , 

Left.     Died  January  5,  1865. 

Indiana,  age  20. 

10,  '65. 

Georgia,  age  41. 

—  '64, 

1152 

Cole,  W.,  Corp'l,  G,  5th 

July  2, 

Left;    haemorrhage.     Died   July 

11C8 

Byers,  J.  II.,  Pt.,  G,  35th 

May  14, 

Right,     Surg.   J.   B.   Rice,   72d 

Michigan. 

2,  '63. 

13,  1803. 

Iowa. 

14,'  '63. 

Ohio.     Died. 

1153 

Cone,   C.   C.,  Lieut.,  1, 

Sept.  29, 

Left.     Died    October    22,    1864  ; 

1109 

Byrne,   W.,   Corp'l,   F, 

Mav  9, 

Left  ;  colliquative  diarrh.     Died 

SthCol'dTr'ps,  age  21. 

29,  '64. 

exhaustion. 

(iOth  Ohio,  age  19. 

9,  '64. 

May  22.  1864. 

1154 

Sept.  17, 

Right.    Died  October  10,  1862. 

1110 

Cahill,  J..  Ft.,  K,  170th 

Mav  24, 

Left  ;  phlcg.  ervsip.     Died  July 

Pennsylvania. 

17,  '02. 

Xew  York,  age  43. 

—  ,  '64. 

3,  1864. 

1155 

Connor.'  D.  C.,  Pt.,   C, 

Dee.  16, 

Left:  flap.     A.  Surg.  It.  J.  Hill 

1111 

Cathoun.  C.  H.,  Lieut., 

Mav  3, 

Right  ;  ant.  post.  flap.     Died  May 

9()th  Ohio,  age  21. 

1C,  '64. 

45th  Ohio.     Died  Jan.  11.  1865. 

F.  5th  Va..  age  21. 

4,  '63. 

8.  1863;  hemorrhage. 

1J56 

Converse.  I).  B.,  Pt.,  G, 

June  4, 

Left.   A.  Surg.  G.  M.  Trowbridge, 

1112 

Caiman,  E  F..!Scrg't,  E, 

Aug.  25, 

R't  ;  circ.     A.  Surg.  T.  C.  Smith, 

129th  Illinois. 

4,  '64. 

19th  Mich.     Died  Sept.  4,  1804. 

5th  N.  Y.  H.  A.,  age  -J9.      '_'7.~  '('A. 

110th  Ohio.     Died  Sept.  1,  1864. 

1157 

Conway.  R.,  Pt.,  F,  30th 

Jan.  11, 

Right.     Died  February  1H,  1803. 

1113 

'Cameron.  D.  II..  ljt.,  C,     Mar.  14 

Right  ;  circ.    Surg.  G.  Derby,  23d 

Iowa,  age  18. 

11,  '63. 

4th  Rhode  Island. 

14,  '62. 

Mass.     April  5,  haein.;  lig.  fern. 

1158 

Cook,  J.  B.,  Lieut.,  H, 

May  5, 

Right.     Died  June  1,  1864,. 

Died  April  6,  1862  ;  exhaustion. 

148th  Penn.,  age  24. 

5,  '64. 

1114 

Campbell,  A.,  Lieut..  II.     Nov.  27, 

—  ;  circ.     Surg.  J.  C.  Morgan, 

1159 

C'*>k.  W.  />.,  Lieut.,  F, 

Jan.  15, 

Left.     Died  April  29,  1865. 

32d  Alabama.                    27.  '(i3. 

29th  Missouri.     Died. 

21st  S.  C.,  age  36. 

15,  '65. 

1  THOMPSON  (J.  H.),  Wounded  at  the  Battle  of  New  Berne,  in  Am.  Jted.  Times,  1862,  Vol.  5,  p.  6. 


SECT.  III.  | 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER    THIRD. 


259 


No. 

NAME,  MILITARY 
DESCRIPTION,  AXI>  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGK. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1160 

Coons,  II.,  Pt.,  K,  100th 

Sept.  9, 

Right.     Surg.   M.  S.   Kittenger, 

1205 

Dice,  .T.,  Pt.,  A,  149th 

May  25, 

Right.     Died  May  27,  1864. 

New  York,  uge  42. 

9,  '<i4. 

100th  N.  Y.     Died  Jan.  25,  '65; 

New  York. 

25,'  '04. 

enteritis,  etc. 

1206 

Dick,  J.,  Pt.,  K,  7th  N. 

Dec.  13, 

—  .     Died  December  20,  1862. 

lib] 

Cooper.   1)  ,  Pt.,  D,  5ih 

June  5, 

Right:    sloughing.      Died    July 

York. 

13,  "62. 

New  York  Anillery. 

5,  '04. 

26,  1864. 

1207 

Dickensheet,  D.,  Pt.,  B, 

Dee.  7, 

Right;  circ.     Surg.  I'.  Harvey, 

1162 

Cope,  W.  M..  Serg't,  I, 

July  20, 

Left.    Died  August  5,  1864. 

71st  Illinois,  age  26. 

8,  '62. 

lyth    Iowa.     Sloughing:   haem. 

33d  Mississippi. 

20,  '64. 

Died  Dec.  22,  186.';  exhaustion. 

1163 

Oppernall,  C.,   Pt.,    B, 

June  14, 

Left.     Died  June  29,  1863. 

1208 

Dickcrson,  C.,  Corp'l,  C, 

April  1. 

Right.     Surg.  T.  H.  Squire.  89th 

75th  New  York. 

14,  '63. 

48th  N.  C.,  age  29. 

1,  '65.  ' 

N.  Y.     Died  May  7.  '65:  exh'n. 

1164 

Corkeran.  W.  J  ,  Pt.,  F, 

Right.     Died  April  29,  1865. 

1209 

Dietrich,  J.,  Pt.,  H,  llth 

Dec.  13, 

Right  ;  flap.    Died  Dec.  13,  1862. 

56th  Virginia. 

Pennsylvania. 

13,  '62. 

1165 

Corn.   J.,    Pt,,   K,   88th 

July  3, 

Right.     Died  July  9,  1863. 

1210 

Dingman,  A.  W.,  Pt.,  D, 

Mar.  30, 

Left:  ant.  post.  flap.     Surg.  J.  C. 

Pennsylvania. 

3,  '63. 

91st  N.  Y.,  age  23. 

31,  '65. 

Hall,  6th  Wis.     Died  April  17, 

1166 

Corpiue.  F.,  Pt.,  H,  llth 

Mar.  31, 

Right  ;  flap.     Died  April  6,  1  865  ; 

1865;  exhaustion. 

Penn.  Cav.,  age  64. 

31,  '65. 

exhaustion. 

1211 

Dix,  L  /.,   Pt.,  D,  4th 

May  3, 

Right;  ant.  post,  flap;  slough'g. 

1167 

Cosgruve,  J.  W.,  Serg't, 

Aug.  19, 

Right;  circ.    Died  Sept.  1,  1864; 

Virginia. 

5,  '63. 

Died  May  7,  1863. 

A.  56th  Mass.,  age  21. 

20,  '64. 

exhaustion. 

1212 

Dodge,  H  N.,  Corp'l,  G, 

May  5, 

.     Surg.  G.  T.  Stevens,  77th 

1168 

Costello,  C.,  Pt.,  P,  28th 

Sept.  17, 

Right.    Died  Sept.  23,  1862. 

10th  Massachusetts. 

5,  '64. 

N.Y.     Died  May  22,  1864. 

Pennsylvania. 

17,  T2. 

1213 

Doman,  I  ,  Pt.,  C,  198th 

Mar.  29, 

Left;  circ.;  erysip.     Died  April 

1169 

Comngton,  J.  A.,  Serg't, 

Mar.  —  , 

Right.     Died  July  3,  1865. 

Penn.,  age  16. 

29,  '65. 

19.  1865;  pyaemia. 

G,  23d  South  Carolina. 

—  ,  '65. 

1214 

Dormoy,  G.,  Pt.,  K,  75th 

June  27, 

Right,     Surg.  T.  M.  Cook,  101st 

1170 

Craig.  J.,  Pt.,  A,  119th 

Mav  5, 

Left  ;  flap  ;  slough'g.     Died  May 

Illinois. 

27,  '64. 

Ohio.    Died  June  30,  10C4. 

Pennsylvania. 

5,  '64. 

26.  1864. 

1215 

Dougherty,  J.,   Pt.,    D, 

Mav  12, 

.     Surg.W.  C.  Shurliick,  51st 

1171 

Cramer,  H.,  Pt.,  I,  21st 

Mar.  19, 

Right,     Died  April  4,  1865. 

9th  N.  Hampshire. 

12,  ''64. 

Penn.     Died  May  18,  1864. 

Michigan. 

19,  '65. 

1216 

Douglass,  E.,  Pt.,  K,  9th 

Mav  12, 

.     Surg.  J.  S.'Ross,  llth  N. 

1172 

Cress,  H.,Corp'l,  K,  95th 

Mav  6, 

Right;  ant.  post,  flap;  abscesses; 

N.  Hampshire. 

12/64. 

Hampshire.     Died  May  17,  T>4. 

Penn.,  age  25. 

7,  '64. 

diarrhcea.     Died  July  8,  1864. 

1217 

Douglass,  D.,  Pt.,  E,  9th 

June  1, 

Left  ;  circ.;  gangrene.   Died  July 

1173 

Crews.  M.  A.,  Pt.,  F,  2d 

June  1, 

Right  ;  ha?m.;  lig.  femoral.    Died 

N.  Y.  H.  Art.,  age  40. 

3,  '64. 

31,  1864  ;  pyaemia. 

South  Carolina,  age  36. 

3,  '64. 

Oct.  25.  1864  ;  tuberculosis. 

1218 

Draper,  L  T.,  Pt.,  E,  3d 

June  17, 

Left;  flap.     July  9,  11,  12,  haem. 

1174 

Crisler.  W.  R.,Corp'l,  C, 

Mar.  16, 

Right.  (Skey's  operation.)  Surg. 

Delaware,  age  37. 

19,  'C4. 

Died  July  12,  1864. 

107th  New  York. 

16,  '65. 

J.  Chapman,  123d  N.  Y.    Died 

1219 

Dudley,  J.A.,Vt.,E,  58th 

Sept.  19, 

Left  ;  circ.;  flap  opened,  stump  ex 

March  17,  1865. 

Virginia. 

19,  '64. 

posed.    Died  Oct.  23,  '64  :  diarr. 

1175 

Cronan,  T..  Pt.,  C,  149th 

May  25, 

Right.    Died  June  8,  1864. 

1220 

Dudley,  A.,  Pt.,  C,  15th 

Aug.  7, 

Right.    Died  September  5,  1864. 

New  York. 

—  ,  '64. 

Infantry. 

7,  '64. 

1176 

Cronin,  U..  Pt.,  F,  59th 

Dec.  13, 

Left.     Died  January  18,  1863. 

1221 

Dueniscli,  T.,  Pt.,  F,37th 

May  17, 

Left  ;  gangrenous.    Died  May  30, 

New  York. 

13,  '62. 

Ohio. 

17,  '62. 

1862. 

1177 

Crow,  T.,  Pt.,   B,   86th 

Sept.  19, 

Left.    Died  October  29,  1863. 

1222 

Duncan,  W.  H.,  Pt.,  A, 

June  1, 

Right;  gangrene.    Died  June  11, 

Indiana. 

19,  '63. 

87th  New  York. 

1,  '62. 

1862. 

1178 

Crulip,  W.   B.,   Pt.,   F, 

June  3, 

Left  ;  circ.     Died  July  10,  1864  ; 

1223 

Dunn,  A.,  Pt.,H,  1st  Mis 

April  4, 

Left.    A.  Surg.W.  W.  Bailey,  1st 

53d  Penn..  age  18. 

4,  '64. 

pyaemia.    Spec.  3165. 

souri  Cavalry. 

4,  '64. 

Mo.  Cav.    Died  April  5,  1864. 

1179 

Cummings.G.  P.,  Serg't, 

June  18, 

Right;  post,  flap;  pyaemia.   Died 

1224 

Dupple,  S,  Pt.,  K,  142d 

May  12, 

Right;  circ.    July  18,.  19,  haem. 

K,  1st  Mass  Art.  .age  26. 

18,  '64. 

Sept.  9,  1864. 

Penn.,  age  20. 

13,  '64. 

Died  July  21  ;  hoem.  Spec.  2885. 

1180 

Cunningham,  J3.,  Pt.,H, 

Jan.  27, 

Right  :  circ.    Surg.  C.  W.  McMil 

1225 

Durant,  C.,  Pt.,  D,  32d 

Feb.  6, 

Right.    Died  February  12,  1865. 

5th  Texas. 

28,  '64. 

lan.  1st  E.  Tenn.    Died  Feb.  18, 

Mass..  age  35. 

8,  '65. 

1864;  exhaustion. 

1226 

Dwire.W.  J.,  Pt.,G,  55th 

May  15, 

Right  ;  (also  wound  of  left  thigh 

1181 

Cunningham,  S.,  Pt.,  D, 

Dec.  4, 

Right  :  circ.     Surg.  H.  B.  John 

Ohio. 

15,  '64. 

and  testes.)    Removal  of  testes. 

13th  Indiana  Cavalry, 

5,  '64. 

son.  115th  O.     Recurrent  haem.; 

Died  May  30,  1864. 

age  29. 

lig.  fem'l.     Died  Jan.  26,  1865. 

1227 

Dwyre,  J.,  Pt.,  K,  176th 

Sept.  19, 

Right.     Died  Sept,  23,  1864. 

1182 

Cunningham.  H.  L.,  Cor 

Mav  16, 

Right.     Surg.   J.   Bennett,    19th 

New  York. 

19,  '64. 

poral,  G,  22d  Wis. 

16/64. 

Mich.     Died  June  26,  1864. 

1228 

Dykeman,W.,  Pt,,  B,5th 

May  11, 

Left;  circ.  Snrg.  H.  F.  Lyster,5th 

1183 

Cuppernull,  C.  E.,  Pt., 

June  18, 

Left;  ant.  post.  flap.     Died  Aug. 

Michigan,  age  45. 

12,  '64. 

Mich.  Died  July  15,'64';pneum. 

K,  6th  Wis.,  age  29. 

19,  '64. 

13,  1864  ;  gang.,  exhaustion. 

1229 

Eagan,  J.,  Pt.,  E,  10th 

June  17, 

Left.    Surg.  D.W.  Maull,  1st  Del. 

1184 

Curaeh.  C.,  Pt.,  D,  10th 

Oct.  8, 

Left.     Died  November  4,  1862. 

New  York. 

17,  '64. 

Died  July  6,  1864. 

Ohio.  ' 

8,  '62. 

1230 

Eaton,  J.,  Pt.,  G,  16th 

June  17, 

Left.     Died  July  8,  1864. 

1185 

Daggett.C.  H.,Corp'l,  B. 

June  19, 

Left  ;  ant.  post.  mus.  flap  ;  gang. 

Maine,  age  27. 

17,  '64. 

1st  Me.  II.  Art.,  age  18. 

19,  '64. 

Died  June  30,  1864  ;  severity  of 

1231 

Eaton,  L.,  Pt.,  1,  17th  In 

June  21, 

Right.  Surg.  B.  N.Bond,27th  Mo. 

wound,  etc. 

diana,  age  18. 

21,  '64. 

Died  July  16,  1864  ;  haem. 

1186 

Dailev,  B.  H..  Pt.,  A, 

Dec.  15, 

Left;  lat.  flap.     A.  A.  Surg.  M. 

1232 

Eddie,  J..Pt..K,3d  Mich 

May  5, 

Left;   circ.     Died  June  2,  1864; 

18th'  Ohio,  age  21. 

15,  '64. 

L.Herr.  Gang.  Died  Jan.  8,  '65. 

igan,  age  23. 

5,  '64. 

pyaemia 

1187 

Dallsby,   J.   O.,   Pt.,  I, 

June  27, 

Right.    Died  J  une  30,  1864. 

1233 

Edwards.G.,  Pt.,  H,  21st 

July  30, 

Right;  flap.     Surg.  N.  Y.  Leet, 

22d  Indiana. 

27,  '64. 

Connecticut,  age  20. 

30,  '64. 

76th  Penn.    Died  Sept.  4,  1864. 

1188 

Daly,  J.  M..  Pt.,  H,  40th 

Nov.  25, 

Left  ;  circ.;  gangrene.    Died  Dec. 

1234 

Egan,  J.,  Pt.,  G,  2d  N.Y. 

Sept.  17, 

Right.    Surg.  S.  N.  Sherman,34th 

Indiana,  age  22. 

27,  '63. 

7,  1863. 

State  Militia,  age  1  8. 

17,  '62. 

N.  Y.     Died  Sept.  25,  1862. 

1189 

Danforth,    M.,    Pt.,    A, 

Sept.  13, 

Left.    Died  September  20,  1864. 

1235 

Eiznor,  J.,  Pt.,  F,  120th 

Mar.  25, 

Right,     Died  April  22,  1865. 

116th  Ohio,  age  18. 

13,  '64. 

New  York. 

25,  '65. 

1190 

Darnels,  B.  F.,  Corp'l,  B, 

July  28, 

Left.     Died  August  3,  1864. 

1236 

Elam,  S.  A.,  Pt.,  A,  33d 

Mar.  30, 

Left;  flap.     Surg.  L.  Dyer,  81st 

4th  Louisiana. 

28,  '64. 

Wisconsin,  age  26. 

30,  '65. 

111.     Died  June  6,  1865  ;  chronic 

1191 

Darrow,    J..   Corp'l,   I, 

Nov.  10, 

.     Surg.  D.   W.   Maull,   1st 

diarrhosa  and  erysipelas. 

59th  New  York. 

10,  '64. 

Del      Died  Nov.  12,  1864. 

1237 

Elkin,  C.  R.,  Pt.,  E,  22d 

Mav  24, 

Right  ;circ.:  missile  lodged  in  left 

1192 

Daum,   L..    Pt.,  G,  5th 

Aug.  20, 

.     Died  August  23,  1864. 

Georgia,  age  22. 

24  ,''64. 

knee.    Died  June  19,  '64;  pyaem. 

New  York. 

20,  '64. 

1238 

Ellingwood,  H.,  Pt.,  K, 

Sept.1, 

Left.     Died  September  24,  1864. 

1193 

Davis,  A.,  Pt.,  D,  44th 

May  5, 

Right,     Died  June  1,  1864. 

79th  Indiana. 

1,  '64. 

New  York,  age  23. 

5,  '64. 

1239 

Ellisou,R.,Corp'l,E,86th 

Oct.  16, 

Left.  Surg.H.F.Lyster.Sth  Mich. 

1194 

Davis,  H.  J.,  Lieut.,  K, 

Mav  22, 

Right  ;  circ.     Ass't  Surg.  H.  M. 

New  York. 

16,  '64. 

Died  Oct.  25,  '64.     Spec.  4116. 

30th  Ohio,  age  22. 

24  ,"'63. 

Sprague,  U.  S.  A.     Died  June 

1240 

Emerson,  H.,  Pt.,  I,  88th 

Nov.  30, 

Left;  circ.     A.  A.  Surg.  J.C.Tay 

5,  1863.     .Spec.  1623. 

Illinois,  age  34. 

De.1,'64. 

lor.   Gang.    Died  Dec.  13,  1864; 

1195 

Davis,  J.  P.,  Pt.,  C,27th 

May  14, 

Left  ;  diarrhoea.     Died  June  19, 

irritative  fever. 

Mass.,  age  34. 

14,'  '64. 

1864  ;  exhaustion. 

1241 

EnbanJc,  J.  G.,  Pt.,  A, 

June  3, 

;  lat.  flaps.    Surg.—  Black, 

1196 

Dawley,  E.,  Pt.,K,  19th 

June  25, 

Left.     Died  July  11,  1864. 

51st  Alabama. 

3,  '64. 

C.S.A.    Died  June  5,'64;  exh'n. 

Michigan. 

25.  '64. 

1242 

Estel,  A.,  Corp'l,  F,  10th 

June  24, 

Left;  circ.     Died  July  22,  1864  ; 

1197 

Day,  C.  C.,  Pt.,  A,  19th 

May  13, 

Left  ;  flap  ;  recurrent  hsem.   Died 

N.  Y.  Cav.,  age  21. 

24,  '64. 

pyaemia. 

Wisconsin,  age  29. 

13,'  '64. 

June  16,  1864. 

1243 

Etters,  B.  J.,  Pt.,  G,  51st 

May  9, 

Right  ;  circ.    Died  May  30,  1864  ; 

1198 

Vaii,  S.  M.,  Pt..  I,  4th 

May  3, 

Left  ;  circ.     Died  June  9,  1863. 

Penn.,  age  18. 

9,  '64. 

exhaustion. 

Virginia,  age  18. 

4,  ;63. 

1244 

Faber,  ,1.  C.,  Serg't,  G, 

April  1, 

Left.    Died  May  17,  1865  ;  pyaem. 

1199 

Dean,  W.,  Pt.,  D,  10th 

Sept.  19, 

Left.     Died  September  30,  1862. 

210th  Penn.,  age  28. 

2,  '65. 

Missouri. 

19,  '62. 

1245 

Faehndrich,   J.,  Ft.,  C, 

Dec.  13, 

Left.     Supposed    to  have    died. 

1200 

Dempsey  .  C.,  Pt.,  G,  32d 

May  12, 

Left  ;   circ.     Died  June  7,  1864  ; 

52d  New  York. 

—  ,  '62. 

Spec.  1362. 

Mass.,  age  38. 

12,  '64. 

pyaemia. 

1246 

Fales,  A.,  Pt,,  F,  9th  N. 

July  9, 

Right;  circ.     A.  A.  Surg.  J.  C. 

1201 

Derocher.  G..  Pt,  I,  1st 

Mav  12, 

Right  ;  flap  ;   femur  prot.     Died 

Y.  H.  A.,  age  20. 

10,  ''64. 

Shimer.    Gangrene.    Died  July 

Maine,  age  23. 

12,'  '64. 

February  20.  1865. 

13.  1864. 

1202 

Det  wyler,  G.,  Pt.,  D.  7th 

June  22, 

Right  ;  flap.    Died  August  1,  '64. 

1247 

Fales,  J.A.,  Corp'l,  K,  3d 

Aug.  21, 

Left.     Died  September  21,  1864. 

New  Jersey,  age  19. 

22,  '64. 

Vermont,  age  45. 

21,  '64. 

1203 

Devlin,  A.,  Pt.,  H,  20th 

June  1, 

;  bone  prot.;  removal  of  bone. 

1248 

Farrellv,B.,Pt.,K,  100th 

May-17, 

Left.    Died  July  21,  1864  ;  exh'n. 

1204 

Massachusetts. 
Dewey,  E.E.,  Pt..  F,  1st 

1,  '62. 
June  1, 

Died  June  18,  1862;  pyaemia. 
Right  :  circ.;  gang.     Died   Aug. 

1249 

New  York,  age  37. 
Faust,  P.  L.,  Pt.,  A,  79th 

17,  '64. 
Aug.  10, 

Left  ;  haem.;  fern,  art'y  lig'd.  Died 

Vermont,  age  31. 

1,  '64. 

7,  1864  ;  pyaniia. 

Penu.,  age  26. 

10,  '64. 

October  2.  1864. 
1 

260 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


|  CHAP.  X. 


NAME,  MILITARY 

OPERATIONS,   OPERATORS, 

Vr* 

NAME,  MILITAUY 

DATES. 

OPERATIONS,  OPERATORS, 

NO. 

DEscuirnox,  AND  AGE. 

DATES. 

RESULT. 

1>U. 

DESCRIPTION,  AND  AGE. 

RESULT. 

1250 

Fenruson.  W..  Corp'l,  D, 

Oct.  7, 

Left.     Died  December  9,  1864; 

1295 

Goodson,  A.  A.,  Pt.,  K, 

Sept.  19, 

;  circ.;  haem.  Oct.  20,  reamp. 

1st  Artillery  age  20. 

7,  '64. 

pyaemia. 

22d  N.  C.,  age  25. 

19,  '64. 

at  mid.  Died  Oct.  27,  "64;  pya?m. 

1251i  Ferrer,  II  ,  It.,  1>,  96th 

Nov.  3, 

Left  :  (also  wound  of  right  knee.) 

1296 

Gordon,  J.,    It.,  C,  1st 

Feb.  3, 

Right.    Surg.  A.  B.  Monohan,  63d 

Ohio,  age  21 

3,  '63. 

Died  Nov.  18,  1863. 

Michigan  Artillery. 

3.  '65. 

Ohio.    Died  Feb.  10,  1865. 

1252  Feller,  11.,  It.,  C,  9th  111. 

Dec.  17, 

Lett:    circ.     A.  A.  Surg.  11.  G. 

1297 

Gould,  J.  P.,  Col.,  59th 

July  30, 

Left  :  circ.    Surg.W.lngalls,  59th 

Cavalry,  age  30. 

17,  '64. 

Ludlow.     Died  March  13,  1865. 

Massachusetts. 

30,"'64. 

Mass.    Died  Aug.  22,  1864. 

1253  Fimiughty.    M.,    Serg't, 

July  2, 

Right;  flap:  biem.  from  femoral. 

1298 

Gradi/,  F.,  It.,  1),  8th  N. 

Feb.  12, 

Left.     Surg.C.A.Cowgill,  U.S.V. 

G,  10th  luf  v,  age  'M. 

3,  '63. 

Died  July  7,  1863;  exhaustion. 

C.  Battalion. 

14,  '63. 

Died  Feb.  15,  1863. 

1254  Fisher,   N.,  it.,   F,  22d 

Sept.  29, 

Right.    Died  October  30,  1864. 

1299 

Graves,  E  .,  Serg't,  F,37th 

May  5, 

.     Surg.  (',.  T.  Stevens,  77th 

Col'd  Troops,  age  2.'}. 

2'.t,  '64. 

Massachusetts. 

5,  '64. 

New  York.     Died  May  26,  1  864. 

1255  Fitch,   M..   It.,  A,  14th 

Mar.  25, 

Left  ;  circ.;  (also  wounds  of  left 

1300 

Gray,  K.  F.,  Pt.,  G,  26th 

May  13, 

Left;  flap.    Surg.W.  Loinax,12th 

New  York  H'vy  Art'y. 

25,  '05. 

shoulder  and  thoracic  parietes.) 

Illinois. 

13,  '64. 

Ind.    Died  July  5,  1864. 

Died  May  2,  1865. 

1301 

Gray,  H.  M.,  Serg't,  E, 

Dec.  7, 

Right  ;  ant.  post.  flap.     A.  Surg. 

1256 

Flax.    S.,    Pt.,   C,  90th 

July  3, 

Lefr.  Surg.C.  J.Walton,  21st  Ky. 

37th  Uinois,  age  30. 

9,  '62. 

M.  A.  Mosher,  20th  Wis.     Died 

Ohio. 

4,  '64. 

Died  Sept.  4,  1864. 

Dec.  17,  1862:  haemorrhage. 

1257  Flftcher,G.W.,Corp'\,K, 

May  18, 

Left.     Died    August   30,    1864  ; 

1302 

Green,  E.  B.,  It.,  H,55th 

May  15, 

Right.    Died  June  20,  1864. 

3d  Arizona  Cav..  age  32. 

18,  '64. 

gangrene. 

Ohio. 

15,  '64. 

1258,  Flood,  P.,   It.,  II,  28th 

May  12, 

.     Surg.   P.  E.  Hubon,  28th 

1303 

Green,  H.  W.,  Serg't,  D, 

July  20, 

Right.    Died  October  25,  1864. 

Massachusetts. 

12,  '64. 

Mass.     Died  May  16,  1864. 

31st  Miss. 

20,  '64. 

1259  Ford,  E.  T.,  It.,  C,  121st 

Sept.  19, 

Right  ;  flap.     Died  Oct.  8,  1664  ; 

i:;i)4 

Green,  J.,Pt.,  B,  IstR.  I. 

July  3, 

Right.     Surg.  G.  Chaddock,  7th 

New  V'ork. 

19,  '64. 

exhaustion. 

Artillery. 

3,  '63. 

Mich.     Died  July  16,  1863. 

1260  Forston,  W.,  Pt.,  F,  53d 

Oct.  5, 

.    Died  October  9,  1862. 

L305 

Green,T.W.,lt.,F,151st 

July  9, 

R't;circ.  A.  A.  Surg.  J.C.  Shimer. 

Indiana. 

5,  '62. 

New  York,  age  26. 

11,  %4. 

Died  Aug.  4,  1864.     Spec.  3935. 

i2<;i 

Fortuey,  H.,  Pt.,  F,  12th 

J  une  5, 

Left.     Died  June  12,  1864. 

1306 

Greenlee,  A.  F.,  Pt.,  F, 

July  3, 

.     Died  August  3,  1863. 

West  Virginia. 

5,  '64. 

140th  Pennsylvania. 

3,  '63. 

1262  Foster,  J.,~  It.,   K,    82d 

Aug  7, 

Left     Surg.  C.  S.  Arthur,  75th 

1307 

Griffith,  J.,  it.,  K,  5th 

Dec.  20, 

Left.    Died  December  24,  1863. 

Indiana,  age  20. 

7,  '64. 

Ind.  Died  Feb.17,  1865:  pneum. 

Connecticut. 

20,  '63. 

1263 

Fredcnburgb.W  ,Pt.,  D, 

Sept.  17, 

Right.     Died  November  —  ,1862. 

1308 

Griffith,  B.,    Corp'l,   G, 

Dec.  31, 

—  .     Died  February  6,  1863. 

lllth  1'enn. 

17,  '62. 

18th  Ohio. 

31,  '62. 

1264 

Fredericks,   D.,   Pt.,  G, 

Sept.  30, 

Left.    Died  Oct.  27,  1864  ;  pyaem. 

1309 

Guillery,    A.,     Pt,,    A, 

Left.     Died  May  23,  1863. 

5.*th  Penn.,  age  42. 

30,  '64. 

Miles's  Legion. 

1265 

French,  G.  W.,  Pt.,  C, 

July  20, 

Right  ;  lateral  flap.    Surg.  M.  W. 

1310 

Gwytiti,  J.,  Pt.,  I,  70th 

Aug.  28, 

Right  ;  circ.  Surg.  R.  Morris,103d 

13th  Iowa,  age  26. 

21,  '64. 

Thomas,  13th  Iowa.    Died  Nov. 

Ohio. 

28,  '64. 

Illinois.     Died  Oct.  3,  1864. 

24,  1864  ;  exhaustion. 

1311 

Hackathorn,  ./.,  Pt.,  F, 

May  12, 

Left;  ant.  post.  flap.     Died  June 

1266 

Frost.  W.  H.,  Pt.,  A,  32d 

Feb.  3. 

Left.     Surg.  A.  B.  Monohan,  63d 

126th  Ohio,  age  21. 

14,  '64. 

9,  1864  ;  exhaustion. 

Wisconsin. 

3,  '65. 

Ohio.   Died  Feb.  25,  '65;  pyaem. 

1312 

Hagan,  L,  II,  Vt,  K,2:id 

July  1, 

Left.     Died  September  18,  1863  , 

1-J67  Fullerton,  A.  1?.,  Pt.,  A, 

Mar.  25, 

Left.    Died  April  4,  '65;  pyaemia. 

North  Carolina,  age  18. 

2,  '63. 

diarrhoea. 

1st  Vt.  H.  Art.,  age  26. 

25,  '65. 

1313 

Haines,  J.,  Pt.,  E,  50th 

June  7, 

Right;  circ.     Surg.  S.  S.  French, 

1268 

Garl,  W.  0.,  Pt.,  G,  3(ith 

April  4, 

Right.    Surg.  S.H.Sawyers,  36th 

Penn.,  age  19. 

8,  '64. 

20th  Mich.    Died  June  26,  1864  ; 

Iowa. 

4,  '64. 

Iowa.     Died  April  7,  1864. 

exhaustion. 

1269  Garland,  M.  H.,  Pt.,  D, 

June  4, 

Left.     A.  Surg.  L.  W.  Kennedy, 

1314 

Haines,  J.  C.,  Pt.,  B,  52d 

July  22, 

Left.     Died  July  30,  1864. 

l:lth  i\e\v  Jersey. 

4,  '64. 

123d  N.York.    Died  J  une  24,'64. 

Ohio. 

22,  '64. 

1270  Ganiish,  J.,  Pt.,  F,  8th 

June  3, 

Left  ;  circ.    Surg.  W.  B.  Fox,  8th 

1315 

Hall,  J.  W.,  Pt.,  G,  4th 

May  13, 

Left  :  long  ant.  flap.     Died  July 

Michigan,  age  46. 

3,  '64. 

Mich.     Died  June  30,  1864. 

Michigan,  age  24. 

13,  '64. 

6,  1864  ;  exhaustion. 

1271 

Gay,  J.  C.,  Pt.,  A,  7th 

June  1, 

Right.    Surg.  G.  T.  Stevens,  77th 

1316 

Ham,  J.  C.,  Pt.,  B,  87th 

Oct.  19, 

Left  :  ant.  post.  flap.    Oct.  28,  fern. 

Maine,  age  37. 

1,  '64. 

N.  Y.    Gang.    Died  Dec.  26,  '64. 

Penn.,  age  24. 

20,  '64. 

artery  lig.     Died  Oct.  28,  1864  ; 

1272 

Gear,  W.,  It.,  E,  14th 

Oct.  5, 

.     Died  October  7,  1862. 

hanmorrhage. 

Illinois. 

5,  '62. 

1317 

Hamrick,  A.,  Corp'l,  H, 

May  11, 

Left;  ant.  post.  flap.     Died  June 

1273 

Gentry,    W.  H.,  Pt.,  G, 

Mar.  25, 

Left.    Surg.  L.W.Bliss,  51st  N.  Y. 

28th  N.  C.,  age  23. 

11,  '64. 

13,  1864  ;  exhaustion. 

44th  Virginia. 

C5,  '65. 

Died  April  5,  '65.     Spec.  4020. 

1318 

Hanes,  E.,  Pt.,  K,  7th  N. 

June  8, 

Right  ;  circ.     Surg.  G.  L.  Potter, 

1274 

George,  A.  1.,  It.,  C,  4th 

Mar.  29, 

Left  ;  flap.  Surg.  W.  G.  Keir,  91st 

Y.  H.  A.,  age  20. 

8,  '64. 

145th  Penn.     Died  July  10,  '64  ; 

I'enn.  Cav.,  age  29. 

29,  '60. 

I'enn.    Died  Apr.  29,'65;  pysem. 

pyasmia. 

1275 

Gerard,  C.,  It.,  K,  35th 

Aug.  19, 

Left  ;  circ.    Surg.T.F.Oakes,  56th 

1319 

Hankins,  G.  S.,  Pt.,  B, 

July  4, 

Left:  (also  w'nd  of  wrist.)    Died 

Massachusetts. 

19,  '64. 

Mass.    Died  Aug.  30,  1864. 

142d  N.  York,  age  20. 

4,   64. 

July  15,  1864  :  exhaustion. 

1276 

Geringer,  J.  H.,  Pt,,  H, 

July  —  , 

Left.     Died  July  28,  1863. 

1320 

Hardy,  A.,  Pt.,  C,  140th 

June  16, 

Right,    Died  July  7,  1864. 

1st  North  Carolina. 

—  ,  '63. 

New  York,  age  33. 

16,  '64. 

1277 

Gerry.  W.H.,Pt.,H,  7th 

May  5, 

Right,     Died  May  22,  1862;  py 

1321 

Hardy.G.  E.,  It.,  1,  13th 

Sept.  30, 

Right.    Died  Oct.  15,1864  ;  morti 

Muss.,  age  30. 

5,  '62. 

aemia. 

N.  Hampshire,  age  31. 

Oct.1,'64. 

fication  following  amputation. 

1278 

Gibbons,  P.,  It.,  E,  150th 

Oct.  27, 

Right  :  flap.     Died  Jan.  5,  1865  ; 

1322 

Harlatid,   I).  G.,  Corp'l, 

Dec.  31, 

.     Died  January  3.  1863. 

I'eun.,  age  21). 

28,  '64. 

pyaemia. 

B,  84th  Illinois. 

31,  '62. 

1279 

Gilibs.  A..  It.,  I,  6th  C'd 

Sept.  29, 

Left.    Died  March  12,  '65;  pneu 

1323 

Harle,  B.  B.,  Serg't,  E, 

Sept.  30, 

Left.    Surg.  F.L.Ainsworth.U.S. 

Troops,  age  22. 

29,  '64. 

monia  and  amputation. 

158th  N.  York,  age  24. 

30,  '64. 

V.  Died  Nov.  16,  '64  ;  irrita.  fev. 

1280 

Gibney,  T.,  It.,  A,  69th 

Sept.  17, 

Right.     Died  Dec.  22,  1862. 

1324 

Harper,  J.  L.,  Pt.,  C,  63d 

Feb.  18, 

Right.    Died  Feb.  28,  1865. 

New  York. 

17,  '62. 

Indiana, 

18,  '65. 

1281 

Gibson,  J.  M.,  Corp'l,  A, 

Nov.  25, 

Right.    Died  Jan.  11,  '64  ;  pyaem. 

1325 

Harrington,  T.,  Serg't,  A, 

May  18, 

Left  :  circ.    A.  Surg.C.  II.  Andrus, 

'M  Kentucky,  age  :J4. 

27,  '63. 

6th  Mass.  Cav.,  age  29. 

20,  '64. 

128th  N.  Y.    Died  July  14,1865; 

1282 

Giddings,  J.  A.,  It.,  G, 

-May  3, 

Right  ;  circ.     Died  June  9.  1863  ; 

chronic  di;irrhu?a. 

t!d  Wisconsin,  age  17 

3,  '63. 

pyaemia.    Specs.  124  1  ,  1  242. 

1326 

Harrington,  W.,  It.,  B, 

June  14, 

Right.     Surg.E.  S.  Hoffman.HOth 

12?3 

Gillespie,  B.  F.,  It.,  G, 

July  28, 

Right;  circ.     Act.  Staff  Surg.  C. 

90th  New  York. 

14,  '63. 

New  York.     Died  Sept.  2,  1963. 

30th  Ohio,  age  32. 

28,  '64. 

15.  Richards,  U.S.  A.    Died  Aug. 

1327 

Harris,  H.  B.,  Serg't,  G, 

July  20, 

Right.     Died  July  27,  1864. 

It,  1864  ;  empyema. 

4(ith  Pennsylvania. 

—  ,  '64. 

1284 

Gillespie,  J.  D.,  Serg't, 

April  6, 

Right  ;  circ.;  luem.;  diarrh.    Died 

1328 

Harris.J.  Z,.,Pt.,  F,  56th 

July  3, 

Left.     Died  July  16,  1863. 

K,  4Uth  Penn.,  age  21. 

7,  '65. 

May  12,  1865;  exhaustion. 

Virginia. 

3,  '63. 

1285 

Gi'ley,C.U.,  It.,  K,  60th 

Dec.  13, 

Left.    Died  December  18,  1862. 

1329 

Ilarrison,  F.,  Pt.,  M,  1st 

Dec.  24, 

.    Died  December  31,  1862. 

Georgia. 

13,  '62. 

Texas  Legion. 

25,  '62. 

1236 

Gillmore,  R.,  Pt.,  F,  91st 

Mar.  31, 

Right  ;  ant.  post,  flaps.  Died  May 

1330 

Harry,  L.,  Pt.,  I,  147th 

Dec.  19, 

Right.     Died  Dec.  20,  1864. 

New  York,  age  20. 

31,  '65. 

25.  1865;  exhaustion. 

Penn.,  age  23. 

19,  '64. 

1287 

Gilrnan,  W.,  Corp'l,  K, 

July  2, 

Left.    Died  July  28/63  ;  pyaemia. 

1331 

Hartman,  C.,  Pt.,  I,  1st 

July  13, 

Right.    A.  Surg.  J.  T.  Myers.  91st 

32d  Mass.,  age  31. 

3,  '63. 

Louisiana. 

13,  '63. 

New  York.     Died  July  13,  '63. 

1288 

Gilt,  J.A.,Corp'l.G,l  30th 

Dec.  16,    Left;  (Vermale's  method.)  Ass't 

1332 

Haskell,  C.,  Pt.,  F,  2d 

Mar.  10, 

Left;  circ.     Died  Mar.  30,  1865; 

Indiana,  age  33. 

16,  '64. 

Surg.W.  B.Trull.U.  S.V.    Died 

Mass.  Art'y,  age  22. 

11,  '65. 

shock  of  wound  and  operation. 

Jan.  2,  1865;  typhoid  fever. 

1333 

Haskill,  C.,  It.,  F,  82d 

July], 

Right.     Died  July  —  ,  1863. 

1289 

Ginither,  J.   A.,  Pt  ,  B, 

May  10, 

Right.    Died  Juue4,'64;  pyaemia. 

Ohio. 

1,  '63. 

49th  Pcnr..,  age  22. 

12,  '64.    , 

1334 

Hawk,  C.,  Pt.,  H,  210th 

Mar.  31, 

Right  :  ant.  post,  flap  :  (also  flesh 

1290 

Glasgow,  A.   /.,  Pt.,  H, 

July  2,   i  Right.     Died  October  18,  1863. 

Penn.,  age  26. 

31,  '65. 

w'nd  r't  thigh.)  Died  May  9,'65. 

21st  N.  C.,  age  26. 

3,  V>3. 

1335 

Hawks,    E.,    Corp'l,  G, 

May  12, 

Right:  flap.     Died  June  8,  1864. 

1291 

Gleason,  T.  E.,Corp'l,  D, 

July  22, 

Left.     Surg.  W.  R.  Marsh,  2d  la. 

115th  Penn.,  ago  37. 

12,'  '64. 

,S>cc.  4547. 

6lith  Illinois. 

22,  '64. 

Died  Nov.  2,  1864  ;  wounds. 

1336 

Hays,  G.  W.,  Corp'l,  K, 

June  17, 

Left  :  circ.:  (and  cxc'n  right  knee 

1292 

Gliddeu,  G.,  Pt.,  K,  40th 
Mass.,  age  2.J. 

May  15, 
15/64. 

Left.    Died  June  13,  1864  ;  exh'n. 

2d  Michigan,  age  19. 

17,  '64. 

joint.)     Died  July  2,  '64;  exh'n. 
Spec.  3046. 

1293 

Goff,  C,,  Pt.,  G,  22d  Va. 

Sept.  19, 

—  ;  circ.  Died  October  t,  1864  ; 

1337 

Heistand.  B.,Pt.,E,  llth 

Dec.  15, 

Left  ;  circ.     Died  Jan.  7,  1865. 

19,  '64. 

pvamia. 

Missouri,  age  17. 

16.  '64. 

1234 

'GV»*:,P..Corp'l,O,26th 

May  15, 

Right;  flap.     Died  June  27,  '64  ; 

1338 

Henderson,  N.W.,Pt.,E, 

Sept.  19, 

Right  :  circ.;  (and  excis'n  of  ulna.) 

Tennessee,  age  22. 

15,  '64. 

asthenia. 

123d  Ohio,  age  16. 

20,  '64. 

Died  Nov.  4,  1864  ;  pyaemia. 

'O'KKEFE  (D.  C.),  Surgical  Canes  of  Interest,  treated  at  Institute  Hospital,  Atlanta,  Ga.,  May  and  June,  1864,  in  Confederate  Stales  Aled.  and 
Surg.  Jour.,  1665,  Vol.  II,  p.  29. 


SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER   THIRD. 


261 


No. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1339 

Hendricks,  M.,Corp'l,  C, 

June  17, 

Left  :  don.  flap.    Surg.  A.  R.  Coe, 

1381 

Huett,  L.  A.,  Pt.,  E,  51st 

Dec.  30, 

—  .    Died  February  27,  1863. 

4th  Delaware,  age  40. 

19,  '64. 

147th  N.  Y.     Died  July  2,  1864. 

Indiana. 

30,  '62. 

1340 

Henry,  W.,  Pt.,  1,  30tb 

May  7, 

.    Surg.C.  J.Walton,21stKy. 

1382 

liuff.W.  F.,  Pt.,G,  119th 

May  5, 

L't  ;  circ.  Surg.P.Leidy,  119th  Pa. 

Indiana, 

7,  '64. 

Died  June  26.  1804. 

Penn.,  age  22.  . 

6/64. 

Died  June  6,  1804;  pyaemia. 

1341 

Herman,  I.,  Pt.,  B,  27th 

May  12, 

Right  ;  circ.     Died  June  3,  1864. 

1383 

Humphreys.C.J.,  Corp'l, 

June  3, 

Right.    Surg.J.H.  Lee,21st  Conn. 

Michigan,  age  19. 

12,"'64. 

H,  81st  N.  Y.,  age  25. 

3,  '64. 

Died  Aug.  17,  1H64  ;  diarrhoea. 

1342 

Herron,  G.  S.,  Pt.,  F,7th 

Aug.  19, 

Right  ;  circ.    Surg.  J.  F.  Hutchin 

1384 

Humphries,  J.,  Pt.,   B, 

July  21, 

R't.    Surg.  J.  \V.  Lawton,  U.S.V. 

S.  Carolina,  age  21. 

20,  '64. 

son,  107th  Penn.    Died  Sept.  18, 

50th  Ohio,  age  47. 

21,  ''64. 

Gang.     Died  August  24,  1864. 

1864;  pyaemia.    Spec.  4155. 

1385 

Hunker,  J.  C.,  Pt.,  D,  2d 

July  17, 

R't;  circ.  A.  Surg.  E.  M.  Smyser, 

1343 

Hickman,  R.,  Corp'l,  E, 

Oct.  17, 

Left  ;  ant.  pos*.  flap.  Confed.  surg. 

N.Y.  Mt'd  Rift.,  age  30. 

1V64. 

48th  Penn.    Died  Aug.  29,  1864  ; 

1st  Del.  Cav.,  age  23. 

18,  '64. 

Died  Feb.  27,  '65  :  typhoid  pneu 

pyaemia. 

monia  and  chronic  diarrhoea. 

1386 

Hunnewell,   J.,  Pt.,  H, 

June  25, 

Left;  flap.     Died  July  21,  1864; 

1344 

Hicks,  J.,  Pt.,  D,  56th  N. 

Mar.  25. 

Right;  flap.     Surg.  T.  F.  Oakes, 

3lst  Maine,  age  30. 

25,  '64. 

exhaustion. 

Carolina,  age  20. 

25,  '65. 

50th  Mass.    Died  April  15,  1805. 

1387 

Hunter,  J.,  Serg't,  B,57th 

July  3, 

Left.     Died  July  22,  1863. 

Spec.  3995. 

Pennsylvania. 

3,  'ti3. 

1345 

Hicks,  J.W.,  Pt.,  A,  37th 

May  31, 

Left.     Died  June  13,  1864. 

1388 

Hurley,  J.,  Pt.,  B,  8th 

May  5, 

Left.    Died  June  5,  1864. 

Indiana. 

31,  '64. 

Maryland,  age  33. 

5,  f04. 

1346 

Higgins,  J.,  Pt.,  I,  6th 

July  9, 

;   circ.     Surg.  C.  H.  Todd, 

1389 

Hutchinson,  G.,  Pt.,  K, 

July  21, 

Right.     Died  July  29,  1864. 

Louisiana. 

11,  ''64. 

C.  S.  A.    Died  July  25,  1864. 

luth  Iowa, 

21/64. 

1347 

Hitrgins,  N.,  Pt.,  M,  1st 

June  21, 

Right.     Died  October  2,  1864. 

1390 

Hutchinson,  R.  D..Pt..G, 

April  9, 

Right  ;  circ.     Died  April  24,  '65; 

Me.  H.'  A.,  age  44. 

22,  '64. 

89th  Indiana,  age  21. 

9,  '65. 

haemorrhage. 

1348 

Highland,  W.,    Pt.,   E, 

Nov.  25, 

Right.    Died  December  26,  1863. 

1391 

Hyctt,  C.  P.,  Capt.,  6th 

Aug.  21, 

Left.    Died  Sept  22,  1864. 

41st  Ohio. 

25,  '63. 

Miss.,  age  25. 

21,  '64. 

1349 

H  igley,  A  .,  Serg't,  E,  68th 

July  21, 

Left.     Surg.  E.  M.  Rogers,  12th 

1392 

Ingraham,  G.,Pt.,K,15th 

July  3, 

Right.     Died  August  3,  1863. 

Ohio. 

21,  '64. 

Wis.     Died  July  25,  1864. 

Alabama,  age  22. 

3,  '63. 

1350 

Hildreth,  N.,  Corp'l,  B, 

Feb.  7, 

Left.     Surg.  C.  N.  Chamberlain, 

1393 

Jackson,  E.  D.,  Pt.,  G, 

Nov.  25, 

Right  ;  semi-circ.  skin  flaps  :  circ. 

94th  N.  York,  age  21. 

8,  '65. 

U.  S.  V.     Died  Mar.  4,  '65  ;  py 

llth  New  York,  age  24. 

26,  '64. 

incis'u  muscles.     A.  A.  Surg.  J. 

aemia.     Specs.  1504,  1595. 

F.  Musgrove.     Died  Mar.  6,  '05  ; 

1351 

Hill,  D.  S.,Lieut.,G,  10th 

Sept.  19, 

Left.     Died  October  26,  1864. 

consumption. 

Vermont. 

19,  '64. 

1394 

Jackson,  G.  W.,  Pt.,  H, 

Sept.  14. 

.     Died  Oct.  17,  1862  ;  exh'n. 

1352 

Hill,    E.,  Pt.,  C,    114th 

May  22, 

Right.     Died   August  14,  1863; 

16th  Georgia, 

15,  '62. 

Illinois. 

22,  '63. 

gangrene  and  chronic  diarrhoea. 

1395 

Jackson,  P.,  Pt.,  E,  31st 

Oct.  28, 

Left;  (also  wound  right  thigh.) 

1353 

Hill,  H.  W.,  Pt.,  A,  24th 

June  18, 

Right;  (also  flesh  w'nd  left  thigh.) 

Colored  Troops. 

28,  '64. 

Surg.  E.  Jackson,  30th  Colored 

New  York  Cavalry. 

18,  '64. 

Surg.  W.B.Fox,8th  Mich.    Died 
at  Andersonville,  Nov.  8,  1864. 

1396 

Jackson,  W.  H.,  Pt.,  E, 

Dec.  13, 

Troops.     Died  Nov.  20,  1864. 
Left  ;  (also  wound  of  right  knee.) 

1354 

Hill,W.,  Pt.,  A,  32d  Col 

Dec.  7, 

Right.    Died  December  16,  1864  ; 

1st  Penn.  Rifles. 

13,  '62. 

Died  December  14,  1862. 

ored  Troops,  age  21. 

7,  '64. 

pyaemia. 

1397 

Jackson,  W.,Pt.,G,  107th 

May  25, 

R't  ;  circ.    A.  Surg.  L.W.  Kenne 

1355 

Hillman,  J.,  Pt.,  C,  31st 

June  14, 

Left.    Died  July  8  1863. 

New  York. 

25,  '64. 

dy,  123d  N.  Y.    Died  June  4,  '04. 

Massachusetts. 

14,  '63. 

1398 

Jacobs,  J.,  Serg't,  G,  90th 

June  14, 

.    Surg.  W.  Y.  Provost,  159th 

1356 

Hiukley,  A.  P.,  Corp'l, 

June  18, 

Left.    Died  Aug.  1,  '64  ;  pyaemia 

New  York. 

14,  '63. 

N.  Y.     Died  June  23,  1803. 

C,  1st  Me.  H.A.,age  19. 

18/64. 

and  osteomyelitis.    Spec.  2918. 

1399 

Jacquith,  A.  J.,  Capt.,  I, 

June  16, 

Right  :  flap.     Died  July  U  ,  1864  ; 

1357 

Hinton,  A.  B.,  Serg't,  H, 

Sept,  29, 

Right.     Died  October  21,  1864  ; 

1st  Me.  H.  A.,  age  32. 

18,  '64. 

prostration. 

4th  C.  Troops,  age  26. 

29,  '64. 

exhaustion. 

1400 

Johns,  J.  A.,  Pt.,  G,  5th 

Sept.  17, 

Left;  haem.:  femoral  artery  lig'd. 

1358 

Hipp,  A.,  Pt.,    F,   15th 

June  26, 

Left    Died  July  16,  1864. 

Florida, 

17,  '62. 

Died  October  5,  1862. 

Missouri. 

—  ,  '64. 

1401 

Johnson,  A.  A.,  Pt.,  F, 

May  25, 

Right.     Surg.  P.  II.  Flood,  107th 

1359 

Hockley,  E.  J.,Serg't.B, 

Dec.  13, 

Right  ;  flap.     Died  Dec.  —  .  1862. 

107th  New  York. 

25,  '64. 

N.  Y.     Died  June  1,  1804. 

12th  Mass.,  age  23. 

13,  '62. 

1402 

Johnson,  C.  L.,Pt.,B,  1st 

Aug.  6, 

Left;  (also  amp.  right  leg.)   Died 

L;  

Holden,  G.   W.,  Pt.,  1, 

July  20, 

Left.    Died  August  16,  1864. 

Tennessee. 

6,  '64. 

August  21,  1864. 

33d  Indiana. 

20,  '64. 

1403 

Johnson.  P.C.,  Corp'l,  C, 

April  1, 

Right  :  circ.     Surg.  C.  M.  Clark, 

1361 

Holden,  £T.,Pt.,  I,  42d  N. 

May  19, 

Left  ;  circ.;  gangrene.  Died  July 

48th  N.  Carolina. 

1,  '65. 

39th  111.     Died  April  3,  1865. 

Carolina. 

19,  '64. 

29,  1864. 

1404 

Johnson,  S.,  Pt.,C,  110th 

May  5, 

.     Died  May  11,  1864. 

1362 

Holman,  J.,  Pt.,  F,  llth 

Dec.  16, 

Right  ;  circ.     Died  Feb.  6,  1865. 

Pennsylvania. 

6,  '64. 

Missouri,  age  22. 

17.  '64. 

1405 

Johnston,  T.,  Pt.,  I,  42d 

July  3, 

Left.    Died  Aug.  14,  '64  ;  pyaem. 

1363 

Holmes.  D.  H.,Pt.,D,7th 

May  12, 

Left  ;  ant.  post,  flap.    Surg.  F.  M. 

Mississippi. 

3,  '63. 

Mlinp  ifrp  *)rl 

12  ''64. 

Everleth,  7th  Me.     Died  June 

1406 

Jones,  A.  A.,  —  ,  K,  7th 

;  circular.    Died. 

'    ° 

2.  1864  ;  exhaustion. 

North  Carolina. 

1364 

Holmes,  G.  E.,  Serg't,  I, 

May  12, 

Left.    Surg.W.  J.  Burr,  42d  N.Y. 

1407 

Jones,  J.  0.,  Pt.,  I,  llth 

July  3, 

Right.     Died  July  15,  1863. 

19th  Maine,  age  21. 

12,  '64. 

Died  June  1  5/64  ;  .  pyaemia. 

Virginia. 

3,  '63. 

1305 

Romans,  S.C.,Pt.,E,  91st 

Oct.  27, 

Left.     Died  November  6,  1864. 

1408 

Jones,  M.,  Pt.,  K,  16th 

Dec.  13, 

Left;  flap.    Died  Jan.  16,  1863; 

Pennsylvania. 

27,  '04. 

Maine,  age  24. 

13,  '62. 

pyaemia. 

1366 

Hoogland,  E.,  Pt.,  A,  2d 

June  17 

Right  ;  circ.;  (also  w'nd  left  leg.) 

1409 

Jones,  S.  W.,  Pt.,  B,  1st 

May  19, 

Left:  flap;  (alsofract.  of  forearm.) 

N.Y.  Mt'd  Rifl.,  age  19. 

17,  '64. 

Died  July  5,  1864  ;  pyaemia. 

Mass.  H.  A.,  age  29. 

19,"  '64. 

Died  of  haem.  from  radial  artery 

1367 

Hoover,  J.,  Pt.,  K,  55th 

June  19, 

Right.     Died  J  une  22,"  1864. 

June  1,  1804.     Spec.  2202. 

Ohio. 

19,  '04. 

1410 

Jones,  W.,  Pt.,  B,   23d 

July  30, 

Right:  flap.   Died  August  19/64  : 

1368 

Hopper,  W.,  Serg't,  A, 

May  3, 

Left.   Died  May  5,  1863. 

Colored  Troops. 

31,  '64. 

pyaemia. 

40th  Pennsylvania. 

3,  ''63. 

1411 

Jones,  W.  A.,  Pt.,  A,  6th 

Nov.  24, 

Right.     Surg.  R.  L.  Von  Harlin- 

1369 

Horth,  M.F.>t.,DJ79th 

July  10, 

Right  ;  circ.     Surg.  G.  W.  Snow, 

Iowa. 

25,  '63. 

gen,  70th  Ohio.     Died  Dec.  24, 

New  York. 

10,  '64. 

35th  Mass.     Died  Sept.  6,  1864  ; 

1803  ;  pneumonia. 

chronic  diarrhoea. 

1412 

Justin,  J.  H.,  Corp'l,  E, 

—  ,  '62. 

Left.    Died  November  2,  1862. 

1370 

Horton,  A.,  Pt.,  B,  48th 

June  3, 

Right  ;   lat.  flap.     June  16,  fem'l 

57th  Illinois. 

New  York,  age  19. 

3,  '04. 

ligated  on  face  of  stump.     Died 

1413 

Justis,   E.,   Pt.,  A,  90th 

June  27, 

Right.    Died  August  3,  1864. 

June  23,  1864:  exhaustion. 

Ohio,  age  29. 

28,  '64. 

1371 

Horton,  I.,  Pt.,  G,  150th 

July  —  , 

Right.     Died  August  10,  1864. 

1414 

Kaser,  J.,Serg't,B,  107th 

Jjme  21, 

Right.      Died   August  5.   1864; 

New  York. 

—  ,  '64. 

Penn.,  age  24. 

21,  '6-1. 

gangrene  and  exhaustion. 

1372 

Houck,   \V.  F.,  Pt.,  D, 

June  21, 

Left.  Surg.T.M.Cook,  101st  Ohio. 

1415 

Karr,  M.,  Pt.,II,  1st  New 

May  7, 

Left:  circ.     Surg.  1$.  G.  Streeter, 

138th  Illinois,  age  26. 

21,  '64. 

Died  June  23,  1864. 

York  Dragoons,  age  21. 

7,  64. 

4th  N.Y.Cav.    Died  May  27/64  ; 

1373 

Hough.  A.,Serg't,H,  15th 

Nov.  25, 

Left  :  circ.;  gangrene.    Died  Jan. 

pyaemia. 

Indiana,  age  31. 

27,  '63. 

6.  1804. 

1416 

Keating,  P.,  Pt.,F,  Phil. 

Dec.  13, 

—  '-.    Died  March  6,  '63;  slough 

1374 

Houston,  «l.\V.,Serg't,C, 
7th  111.  Cav.,  age  23. 

Dec.  15. 
17,  '04. 

Left  ;  circ.    A.  A.  Surg.  J.  N.  Van 
Meter.   Died  Dec,  31,  '04  ;  irrita. 

1417 

Legion. 
Keaton,  J.M.,Pt..D,19th 

13,  '62. 
May  12, 

ing  of  stump. 
Left  :  hK>in.:  lig.  of  fern,  artery. 

fever  andcolliquative  diarrhoea. 

Indiana,  age  24. 

12."  '64. 

Died  June  12,  1804. 

1375 

Howard,  F.  II.,Lieut.,F, 

June  1, 

Left:  circ.      Surg.  G.  L.  Potter. 

1418 

Keese.W.,  Corp'l.  G,74th 

July  23, 

Left  ;  lupin.:  lig.  of  fern,  artery. 

2d  N.  Y.  Art'y,  age  25. 

1,  '04. 

145th  Ptmn.     Died  Aug.  17,'04. 

New  York,  age  31. 

24,  "03. 

Died  .May  8,  1804. 

Spec.  1397. 

1419 

Keilliolz.D.  P.,Corp'l,K, 

May,'64, 

.     Died  May  10,  1864. 

1370 

Howe,  II.  A.,  Corp'l,  I, 

June  19, 

Left.     Surg.  G.  ttr.  Metcalf,  76th 

6oth  New  York. 

Primary. 

!)5th  Now  York,  age  40. 

19,  '64. 

New  York.     Died  July  25,  1864. 

1420 

Kelly,  D.  F.,  Pt.,  C,  67th 

June  8, 

Left.     Died  June  19,  1864. 

1377 

Hubbard,  W.,  Serg't,  A, 

Oct.  19, 

Right.    Died  October  21,  1864. 

New  York,  a.?e  25. 

8,  '64. 

12th  Connecticut. 

19,  '64. 

1421 

Kelly,  T.,Pt.,'G,  51st  N. 

May  12, 

Right.     Snirg.  J.  S.  Ross,  1  1  th  N. 

1378 

Hudson,    F.,   Serg't,  B, 

Mar.  7, 

Lett  ;  flap.     A.  Surg.  E.  F.  Hen- 

York,  age  34. 

12,'  '64. 

Hampshire.    Died  May  29,  '64; 

13-!d  N.  York,  age  24. 

9,  '65. 

dricks,  15th  Conn.     Died  March 

pyaemia. 

23,  1805;  haemorrhage. 

1422 

Kelly,  W.  B  ,  Pt.,F,  39th 

Aug.  18, 

.     Died  August  18,  1864. 

1379 

Hudson,  H.,  Pt..  I),  7th 

May  5, 

Right.     Died  May  31,  1864. 

Mass.,  nge  23. 

18,  '04. 

Mass.,  age  25. 

-,  '64. 

1423 

Kelly,  W.  11.,  Pt.,  A,  7th 

May  12, 

Left  ;  ant.  post.  flap.    Died  July 

1380 

Hudson,  T.  F.,Pt.,\,  4th 
Louisiana,  age  23. 

Dec.  10, 
17,  '64. 

Right;  ant.  post.  flap.    A.  A.  Surg. 
R.  L.  McCture.     Died  Dec.  24, 

1424 

Maine,  age  43. 
Kemp,  I.  M.,  Pt.,  L,  2d 

12,  '64. 
June  17, 

9,  1804. 
Left.     Died  July  6,  1864. 

IP.'il  :  px'i.iKntion. 

N.Y.  ?.!t'dKifl.,  ago  21. 

—  ,  '01. 

262 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MIMTAKY 
DESCRIPTION,  AM>  AGE. 

DATES. 

Ol'ERATiONS,  OPERATORS, 
.    RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS.  Ol'EHATOKS, 
RESULT. 

142: 

Kf.nnaman.    W,.  1't.,  G. 

Mav  12, 

Left;  ant.  post.  flap.     Died  June 

1466 

Lesley,  J.,  Pt.,  A,  HCth 

June  27, 

Left.    Surg.  A.  C.  Messenger,  57th 

12th  Alabama,  age  32. 

12,'  '64. 

14,1864;  exhaustion. 

Illinois. 

27,  '64. 

Ohio.    Died  Sept.  20,  1864. 

1426 

Kent,  1'.  A.,  1't.,  B,  14th 

Nov.  25, 

Left  ;  circ.     Died  Dec.  5,  1863. 

1467 

Letner.D.,  Lieut.,  B,  30th 

Mav  22, 

Right  ;  circ.     Ass't  Surg.  11.  M. 

Mississippi. 

25,  '63. 

Iowa. 

24,  '63. 

Sprague,  TT.  S.  A.    Gang.    Died 

1427 

Kerr.T.,Pt.,L,83dNew 

Mav  10, 

Left.     Died  May  23,  1864. 

May  29,  1863.    Spec.  1621. 

York,  age  2li. 

10,  '64. 

14C8 

Lewis,  J.,Pt..K,  8th  Vt., 

Oct.  19, 

Right  ;  flap  :  erysip.:  gang.    Died 

1408 

Kester,  F.  M..  Pt.,  I,  71st 

Dec.  16. 

Left;  lat.  flap.    A.A.  Surg.  M.  L. 

age  18. 

21,  '64. 

Nov.  11,  1864  '  exhaustion. 

Ohio,  age  22. 

17,  '64. 

JIoiT.    Died  Dec.  29,'64;  pya?m. 

1469 

Lewis,  J.  It,  Pt.,  H,  53d 

July,  '63, 

Left;  (also  right  leg  at  point  of 

HOQ 

Kiclcr   M    L    It.  15  Gth 

Primary. 

«± 

1'enn.  lies.,  age  33. 

10,  '64.' 

Penn'.  Res.     Died  June  26,  1864  ; 

b    '.'0 

A.  C.  S.    Died  July  10,  1863. 

pyaemia. 

1470 

Lewis,  J.W.,Pt.,D,14Cth 

June  7, 

Right:  circ.   Surg.  jiW.Wishurt, 

1430 

Kimball,  D.  C.,  Pt.,  B, 

July  2, 

Left.     Died   July  6,  1863;  trau 

Penn.,  age  18. 

7,  '64, 

140th  Penn.    Died  June  11,1864. 

4th  Midi.,  age  21. 

3,  '63. 

matic  tetanus. 

1471 

Lienthardt,  E..  Serg't,  K. 

June  23, 

Right  ;    double-  lat.  flap.      Died 

1431 

Kimborly,  D.,  1't.,  E,  7th 

June  2, 

Left.     Died  July  5,  1864  ;  irrita 

52d  New  York,  age  42. 

23.  '64. 

August  14,  1864. 

Connecticut,  age  27. 

2,  '64. 

tive  fever. 

1472 

Lilly,  A.,  Pt.,  A,  85th  In 

May  25, 

Left.     Died  July  2,  1864. 

1432 

King,  P.,  Pt.,  E,  97th  N. 

June  18, 

Left.     Surg.  J.  \\.  Ana  wait,  llth 

diana. 

—  ,  '64. 

York,  age  33. 

19,  '64. 

Pa.  DiedOct.19,'64.    Spec.4145. 

1473 

Linaweaver,  C.,  Corp'l. 

Oct.  12, 

Right.     Died  October  16,  1864; 

14:i3 

Kinsey,   W.  S.,  Private, 

June  17, 

Left;  circ.     Died  July  12,  1864  ; 

K,  5<th  Illinois. 

12,  '64. 

haemorrhage. 

Hlounfs  Ya.  Battery. 

17,  '64. 

jaundice. 

1474 

Lindsay,  J.,  Pt.,  A,  134th 

Dec.  13, 

Right.     Died  January  15,  1863. 

1434 

Kinsley,   .1.,  Corp'l,   1C, 

Sept.  30, 

Right.    Died  Oct.  17,'C4  ;  exhaus 

Pennsylvania. 

13,  '62. 

58th  Penti.,  age  27. 

30,  '64. 

tion  and  diarrhoea. 

1475 

Lindsey,  S.,  Pt.,  A,  73d 

Mar.  19, 

Right  ;  (also  fract.  left  leg.)   Died 

143.1 

Kirk,    E.,    Pt.,  A,  98th 

June  27, 

Left.    Died  August  5,  1864. 

Ohio,  age  22. 

19,  '65. 

April  30,  1865;  exhaustion. 

Ohio. 

27,  '64. 

1476 

Link,  G.,  Pt.,  F,  9th  La., 

Julv  9, 

Left;  circ.    Died  July  10,  1864. 

1436 

Kirkendall,D.,Pt.,B,73d 

May  25, 

Right.    Died  July  7,  1864. 

age  27. 

10,  '64. 

Ohio. 

25,  '64. 

1477 

Liston,  W.,  Pt.,  D,  21st 

Sept.  19, 

Left.     Died  October  8,  1863. 

1437 

Klinkhart,    C.,    Pt.,    B, 

June  16, 

:  circ.     Surg.  J.  V.  Kendall. 

Illinois. 

19,  '63. 

149th  N.  York,  age  25. 

16,  '64. 

149th  N.  Y.    Died  July  11,  1864  ; 

1478 

Lock,  J.  L.,  Pt.,  I,  59th 

Dec.  15, 

Left  ;  ant.  post.  flap.     Died  Jan. 

pyaemia. 

Illinois,  age  23. 

16,  '64. 

31,  1865. 

14:58 

Knight,  A.   B.,  Pt.,  B, 

May  11, 

Right  ;  circ.    Surg.  H.  F.  Lyster, 

1479 

Locy,  M.,  1't.,  A,  13Sth 

Dec.  13, 

Left.     Died  December  13,  1862. 

86th  New  York. 

11,  '64. 

5th  Mich.     Died  May  20,  1864  ; 

Pennsylvania. 

13,  '62. 

exhaustion. 

1480 

Long,   T.,   Pt.,  B,    56th 

My  18.  '64, 

Right.     Died  May  20,  1864. 

1439 

Knoll,   J.,  Pt.,  C,   26th 

May  10, 

.    Surg.  J.  W.Wishart,  140th 

Massachusetts. 

Primary. 

Michigan. 

10,  '64. 

Penn.     Died  May  12,  1864. 

1481 

Lonymei/er,  J.,  1't.,  Capt. 

Oct.  13, 

Right.     Died  October  21,  1863. 

1440 

Krir.n,  L>.,Capt.,  15,139th 

Sept.  21, 

Right.    Surg.  S.  F.  Chapin,  139th 

Brown's  Co.,(.')  age  18. 

15,  '63. 

Pennsylvania,  age  50. 

2->,  '64. 

Penn.     Oct.  15.  one  inch  of  bone 

1482 

Loss,  J.  E.,  Pt.,  1,  184th 

Oct.  1, 

Left;  ant.  post.  flap.     Surgeon  G. 

rem'd.  Died  Nov.  25,  '64  ;  exh'n. 

Penn.,  age  28. 

2,  '64. 

Chaddock,  7th  Michigan.    Died 

1441 

Kunkle,  D.,  Pt.,  E.  5?tli 

Oct.  2, 

Left.     Surg.  O.  Evertj,  20th  Ind. 

Nov.  23,  1864. 

1'euu.,  age  19. 

2,  '64. 

Nov.  26,  ant.  post.flap.mid.third. 

1483 

Loucks,  D.,  Pt.,  C,  106th 

Oct.  19, 

Right  ;  circ.    Died  Nov.  16,  1£64  ; 

A.  A.  Surg.  J.  H.  Packard.  Died 

New  York,  age  17. 

19,  '64. 

typhoid  fever. 

Dec.  16.'64  ;  exhaustion.    Specs. 

1484 

Louison,  W.,  Pt.,  G,  81st 

Sept.  17, 

Left.     Died. 

3715,  4122. 

Pennsylvania. 

17,  -62. 

1442 

Kunkle,  J.,  Pt.,  E,  148th 

Julv  3, 

Left.    Surg.C.  S.Wood,66th  N.Y. 

1  i-:. 

Love,  T.W.,  Pt.,  D,  74th 

June,  '64, 

Right,    Died  July  12,  1864. 

Pennsylvania. 

3,  '63. 

Died  July?24,  1863. 

Illinois. 

Primary. 

1443 

Ladd,  C.,  Serg't,  E,  25th 

Julv  1, 

Right.    Died  J  uly  14,  1863. 

M-.; 

Love,  W.,  Pt.,  G,  16th 

Mav  12, 

Right.     Died  May  26,  1864;  py 

Ohio. 

1.  '63 

Maine,  age  19. 

12,"  '64. 

aemia. 

1444 

Lamb,  T.,  Citizen. 

Primary, 

;    double  flap.     Surg.  E.  C. 

1487 

Lovctt,  G.  G.,  Lieut.,  G, 

May  6, 

Left.    Died  May  31/64  ;  pyaemia. 

1862. 

Franklin,  U.S.V.    Died  —  ,  1862. 

119th  Penn.,  age  22. 

8,  '64. 

144.1 

Lampliere.  L.  O.,  Pt.,  G, 

June  30, 

Left  ;    (also  amp.  of  right   leg.) 

1488 

Lowe,   J.,  Pt.,  B,   54th 

April  2, 

Left,      Surg.  R.  R.  Clark,  34th 

21st  Connecticut. 

30,  '64. 

Died  July  22,  186]  ;  tetanus. 

Pennsylvania. 

2,  '65. 

Mass.    Died  May  6,  1865. 

1440 

Lane.  A.  11.,  Pt.,D,  104th 

Aug.  7. 

Right.     Sept.  21,  circ.  re-amp,  at 

1489 

Lowery,  W.  J.,  Pt.,  D, 

Mar.  25, 

Right.      Surg.  M.  II.  Raymond, 

Illinois,  age  26. 

7,  ?64. 

middle  third.    Died  Oct.  4,  1864. 

64th  New  York,  age  18. 

25,  '65. 

26th  Mich.    Died  June  14,  1865; 

1447 

Lane,   J.,    Pt  ,  A,   37th 

June  17, 

Left.     Surg.W.B.  Fox,  8th  Mich. 

exhaustion  and  diarrhoea. 

Wisconsin,  age  25. 

•18,  '64. 

Died  July  7,  1864. 

1490 

LowtJirop,  J.,  —  ,  K,  43d 

Julv  12, 

Left,     Surg.  G.  T.  Stevens,  77th 

1448 

Lanicr.  W.  B.,  Capt.,  H, 

Mav  15. 

Right;  lat.  flap.  Died  May  19,  '64. 

North  Carolina,  age  23. 

13,"  '64. 

N.Y.    Gang.   Died  July  13,  '64. 

(ilst  North  Carolina. 

15.'  '64 

1491 

Lunn,  J.,  Pt.,  D,  5th  N. 

July  17, 

Right  ;    ant.  post.  flap.      Confed. 

! 

Lankow,  !•'.,  Pt.,  E,  26th 

May  25, 

Right.     Died  June  4,  1864. 

York  H'vy  Artiller}-. 

17,"  '64. 

surg.    Died  Dec.  13,'64  ;  exh'n. 

Wisconsin. 

25.'  '64. 

1492 

Lunt,  C.  W.,  Serg't.,  F, 

May  10, 

Right.     Died  May  12,  1864. 

1450 

Laury,  J.,   1't.,  B,  56th 

Mav  8, 

—  .     Died  May  9,  1864. 

22d  Massachusetts. 

10,  '64. 

Pennsylvania. 

8,  "64. 

493 

2Lurchin,  R.  W.,  Pt.,  F, 

May  3, 

Right  ;  circ.     Died  June  1  ,  1863  ; 

1451 

Lawrence,  D.W.,  Pt.,  C, 

Sept.  17, 

Right.     Died  September  —  ,  '62. 

6th  Maine,  age  28. 

3,  63. 

pyaemia. 

7th  Michigan. 

17,  '62. 

1494 

Lyle,  W.  II.,  Pt.,  I,  llth 

Julv  3, 

—  .     Died  August  1,  1863. 

! 

Lawrence,  T.  J.,  Pt.,  B, 

Mav  27, 

Right.     Died  June  30,  1863. 

Mississippi. 

3,  '63. 

8th  X.  Hampshire. 

27,"  '63. 

1495 

Lynch,  H.  fr.,Pt.,F,13th 

Julv  9, 

;  circ.     Surg.  C.  II.  Todd,  C. 

1453 

Lawson,  E.,  Pt.,  V,  30th 

Dec.  16, 

Rifflit  •  fint.  post,  flfip.   A.A.Suny. 

GoorirujL 

11,  "'64. 

S.A.  Died  Aug.  12,'64.  .Sp.3824. 

Alabama,  age  22. 

18,  '64. 

H.  L.'McClure.    Died  Feb.  9,  '65. 

1496 

Lynch,  J.  A.,  Serg't,  B, 

May  14, 

—  .     Died  ^la'y  17,  1864. 

1454 

Laydon,  D.,  Pt.,  G,  54th 

Dec.  28, 

Left.     Died  February  24,  18G3  ; 

24th  Michigan. 

14,  '64. 

Indiana. 

28.  '62. 

pyaemia. 

1497 

Lyons,  J.  N.,  1't.,  I,  42d 

Dec.  29, 

Right.     Died  January  3,  1863. 

Leather,  E.,  Pt.,  B,  55th 

Mar.  16, 

Right  ;  circ.    Died  April  23,  1865  ; 

Ohio. 

29,  '62. 

Ohio,  age  43. 

16,  '65. 

fatty  degeneration  of  the  heart. 

1498 

Mackey,  J.,  Pt.,  B,  9th 

June,  '64, 

Right.     Surg.  J.  N.  Beach,  40th 

1456 

Lee,  D.,  Pt.,G,57th  Mas 

Aug.  19, 

Left;   circ.     Surg.  F.  F.  Oakes, 

Indiana. 

Primary. 

Ohio.    Died  July  4,  1864. 

sachusetts,  age  30. 

20,  '64. 

56th  Mass.    Died  Sept.  27,  1864  ; 

1499 

Maddock,  C.  II.,  Pt  ,  F, 

Oct.  1, 

Left;  (also  exc.  of  metacarpus.) 

pyaemia. 

1st  Maine,  age  22. 

1,  '64. 

Surg.  J.  S.  Jemison,  8(ith  N.  Y. 

1457 

Lee,  F.  G.,  Pt.,  B,  120th 

Mar.  9, 

Right  :  ant.  post.  flap.    Died  Mar. 

Died  <  )ct.27,'64  ;  exh'n.  ftp.  4  121. 

Indiana,  age  20. 

10.  '65. 

Ifi,  1865;  exhaustion. 

1500 

Maguire,  C.  F.,  Pt.,  F, 

June  17, 

Left.     Died  June  23,  1864. 

1458 

Lee,  J.   H.,  Pt.,  I,  29th 

July  4, 

Ri"ht.     Died  July  31  1863. 

14tli  Xcw  Vork  Art'v 

17   '64. 

Iowa. 

4,  '63. 

1501 

Malone,  J.,  Pt.,E,  9th  N. 

Dec.  13, 

.     Died  January  1,  1863. 

1459 

Leech,  C.,  Pt.,  A,    63d 

Oct.  3, 

Right.     Died  October  4,  1862. 

York  State  Militia. 

13,  '62. 

Ohio. 

4,  '62. 

1502 

Mann,  E.,  Pt.,  C,  52d  O., 

Mar.  21, 

Left.    Died  May  1,  1865;  typhoid 

14(30 

Lefller,  J.,  Pt.,  D,  82d 

Juno  18, 

Right.     Died  August  10,  1864; 

age  22. 

21,  '65. 

fever. 

Olno,  aw  21. 

18,  '64. 

pyaemia. 

1503 

Mann,  J.  L,  Pt.,  B,  26th 

June  7, 

Right;  circular.     Died  Aug.  19, 

1461    Lpgott.    A.    S.,    1't.,    I). 

Jan.  1, 

Left.     Died  January  2,  1863. 

Michigan,  age  24. 

7,  '64. 

1864. 

'.'HI  Kentucky. 

1,  '63. 

1504 

Markliam,    \V.   D.,  Pt., 

July  3, 

.     Died  July  16,  1863. 

1462 

Leghtback,  II.  .Pt.,  E,  2d 

May  5, 

Right  ;  ciro.    Died  July  23,  1864  ; 

—  ,  47th  N.  Carolina. 

3,  '63. 

1403 

Now  Jersey,  age  21. 
lLence.  R.,  it.,  —  ,  18th 

6,  '64. 
Sopt.  17, 

diarrhoea. 
—  :  circ.     Confcd.  surg.     Died 

1505 

Marshall,  G.  W.,  Pt.,  D, 
64th  New  York. 

July,  '63, 
Primary. 

.     Died  July  16,  1863. 

.Mississippi,  age  35. 

17.  '62. 

Sept.  21,  1862;  pyaemia. 

1506 

Marshal!,  L.,  Pt.,  F,  27th 

Mar.  14, 

Right.     Died  March  14,  1862. 

1464 

Leonard,  ,f.  II  .  Pt.,E,9th 

Oct.  19, 

Right.     Died  October  28,  1864. 

Mass  ,  age  24. 

14.  '62. 

N.  Y.  H'vy  Artillery. 

20,  'u'4. 

1507 

Marshbrun,  S.  IT.,  Ma.j., 

Oot.  19, 

Right  :  (also  wound  through  left 

Leonard,    J.    1).,    I't.,   I, 

July  4, 

Left.     Died  July  8,  1864. 

53d  Georgia. 

19.  '64. 

knee.)  Surg.J.J.KnottJ'.A.C.S. 

1st  Michigan  Artillery.      4,  '(J4. 

1 

Died  Nov.  18,  1864. 

1  FI8HEK  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations  in  the  Hospitals  mar  Sharpsbury,  Md..  after  the  battle  of  Antictam,  Sept.  17,  1862, 
in  Am.  Jour.  Med.  Sci.,  1863,  Vol.  XLV,  p.  47. 

2LIUEI.L  (J.  A.),  Suppurative  Osteomyelitis  (acute)  following  Primary  Amputation  of  the  Right  Thigh,  in  Surgical  Memoirs  of  the  War  of  the 
Rebellion,  Collected  and  Published  by  the  U.  S.  Sanitary  Commission,  Surgical  Volume  I,  p.  350.  Ibid.  On  Thrombosis  and  embolism,  in  Am.  Jour. 
Med.  Sci.,  1872.  New  Series.  Vol.  LXIV,  p.  353. 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER    THIRD. 


263 


NO. 

NAME,  MILITARY 
DESCIUI'TIOX,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE., 

DATES. 

OPEHATIOX.S,  OPERATORS, 
RESULT. 

1508 

Martin,  R.,  Corp'l,  F,  93d 

May  5, 

—  .     Died  May  7,  1864. 

1553 

Miller,  B.,  Pt.,  B,  185th 

Mar.  25, 

Right.    Died  May  22,  1865. 

New  York. 

6,  ''64. 

New  York. 

25,  '65. 

1509 

Martin,  A.  J.,  Pt,  F,  82d 

July  2'), 

Right.    Died  September  5,  1864. 

1554 

Miller,   J.,  Pt.,  F,  88th 

May  10, 

Right;  flap.    Died  May  33,  1864. 

Ohio. 

20,  '64. 

Penn.,  age  39. 

10,  '64. 

1510 

Mason,  D.,   Pt.,  K,  32d 

Mar.  21, 

Right.    Surg.  A.  B.  Monohan,63d 

1555 

Miller,  J.,  It.,  G,  6th  In 

May  14, 

Right.     Died  May  28,  18C4. 

Wisconsin. 

21,  '65. 

Ohio.     Died  March  29,  1865. 

diana. 

14,'  '64. 

1511 

Mason,  H.W.,Pt.,B,24th 

Nov.  30, 

Right  ;  circ.    Surg.  J.  R.  Ludlow, 

1556 

Miller,  J.,  Pt.,E,  57th  N. 

April  6, 

Right  ;  flap.     Died  May  6,  1865  ; 

Wisconsin,  age  21. 

Dec.1,'64. 

U.S.V.  DiedDec.23,'64;  pyaem. 

Carolina. 

(i,  '65. 

exhaustion. 

1512 

Massie,  J.  W.,  J  t.,G,19th 

July  2, 

Left.     Died. 

1557 

Milter,  J.  E.,  Pt.,  II,  33d 

May  3, 

;  circular  ;  sloughing.    Died 

Virginia. 

3,  '63. 

Virginia,  age  22. 

5,  '63. 

May  14,  1863. 

1513 

Matthews,  B.,  —  ,  H,  16th 

Sept.  14, 

.    Died  Sept.  28,  '62  ;  exhaus 

1558 

Miller,  S.  K.,  Serg't,  K, 

Sept.  19, 

Left;  circ.     Died  Dec.  20,  1864; 

Georgia. 

15,  '62. 

tion. 

2d  Ohio  Cav.,  age  23. 

19,  'C4. 

pyaemia. 

1514 

Matthews,  W.,  Corp'l,  B, 

Jan.  2, 

Right.     Surg.  C.  J.  Walton,  21st 

1559 

Miller,  W.  S.,  Pt.,  K,  8th 

Aug.  28, 

Right.     Died  October  32,  3864; 

78th  Pennsylvania. 

4,  '63. 

Ky.     Died  Jan.  16,  1863. 

Indiana  Cavalry. 

28,  '64. 

remittent  fever. 

1515 

May,  P.,l't.,A,  5th  Mich. 

May  5, 

.     Died  May  19,  1864. 

1560 

Mills,  A.  B.,  Pt.,'E,  16th 

July  3, 

Right.     Died  October  7,  1863. 

6,  '64. 

Maine,  age  19. 

3,  r63. 

1516 

Mazerva,  G.,  Pt.,  A,  86th 

May  5, 

Left.     Died  May  7,  1864. 

1561 

Minoque,  J.,  Pt.,  G,  12th 

May  12, 

Left  ;  flap.    A.  Surg.  P.Adolphus, 

New  York. 

6,  %4. 

Infantry,  age  24. 

12,  '64. 

U.S.A.  Died  June  21,  '64;  exh'n. 

1517 

Mcliride.J.  A.,  Pt.,  —  , 

Oct.  27, 

;  cire.    Surg.  J.  T.  Kelbv,  C. 

1562 

Mitchell,  G.,  Pt,,  D,  2d 

June  19, 

Left;  circ.     Died  July  12,  3864; 

7th  C.  S.  Cav.,  age  26. 

27,  '64. 

S.  A.    Died  Oct.  28,  1864. 

Maryland,  age  42. 

19,  '64. 

pyaemia. 

1518 

McBride.  M.  C.,  Lieut., 

July  9, 

:  circ.     Surg.  C.  H.  Todd,  C. 

1563 

Mitchell,  J.,  Citizen  em- 

Oct.  10, 

Left;  ant.  post.  flap.    A.  A.  Surg. 

G,  9th  Louisiana. 

9,  '"64. 

S.  A.    Died  July  22,  1864. 

ploy6,  age  25. 

.  10,  '64. 

M.  H.  Hend.     Died  Oct.  15,  '64  ; 

1519 

McCandless.W.W.,  Pt., 

Dec.  31, 

Right.     Died. 

double  pneumonia. 

H,  84th  Illinois. 

31,  '62. 

1564 

Mitchell,  B.  J.,  Lieut.,  B, 

Oct.  19, 

Right.    Died  Nov.  12,  '64;  second 

1520 

McCarthy,  D.,Pt..B,39th 

Sept.  19, 

—  .     Died  Oct.  8,  1863. 

1st  Maine. 

19,  '64. 

ary  haemorrhage. 

Indiana. 

19,  '63. 

1565 

Monroe,  M.,  Pt.,E,  109th 

June  17, 

Left.     Died  June  27,  3865. 

1521 

McCarthy,  J.,  Pt.,  Car 

Sept.  19, 

:  circ.    Surg.  G.  W.  Burdett, 

New  York,  age  28. 

17,  '64. 

penter's  Battery. 

20,  '64. 

C.S.A.    Died  Sept.21,'64  ;  shock. 

156C 

Moody,  J.,  Pt.,  H,  17th 

April  2, 

Right.     A.  Surg.E.  P.Roche,35th 

1522 

McCartney,  J.,  Corp'l,  H, 

June  18, 

;  flap.     Died  Feb.  11,  1865, 

Vermont,  age  45. 

2,  '65. 

Mass.    Died  April  24,  1  865. 

149th  Penn.,  age  24. 

38.  '64. 

while  on  furlough. 

1567 

Moore,  J.  T.,  Pt,,  G,  45th 

July  12, 

Left  ;  circ.    A.  Surg.  J.C.  McKee, 

1523 

McClarence,  F.,  It.,  F, 

July  3, 

Left.      Surg.  N.  Hayward,  20th 

North  Carolina,  age  20. 

14,'  '64. 

U.  S.  A.     Died  August  9,  1864. 

20th  Massachusetts. 

3,  '63. 

Mass.    Died  July  20,  1863. 

Spec.  2856. 

1524 

McComb,  J.,  Captain,  D, 

June  3, 

Left,  Surg.A.Satterthwaite,  12th 

1568 

Moore,  L.  M.,  Lieut.,  —  , 

July  3, 

Left.     Died  August  2,  18C3. 

12th  N.  Jersey,  age  25. 

3,  '64. 

N.  J.     Died  July  2,  1864. 

17th  Mississippi. 

3,  '63. 

1525 

McCometrm,A.  J.,  Pt.,  F, 

July  20, 

Left.     Died  July  29,  1864. 

1569 

Moore,  W.  B.,Pt.,E,  llth 

May  25, 

Right;  circ.:  (also  w'd  left  thigh.) 

55th  Alabama. 

20,'  '64. 

N.  Hampshire,  age  34. 

26,''64. 

Surg.  J.S.Ross,llth  N.H.    Died 

1526 

McC'ormick,  N.,  Corp'l, 

June  17, 

.     Surg.  D.  S.  Hopkins,  4th 

June  24,  1864  ;  pyaemia. 

E,  4th  Delaware. 

17,  '64. 

Delaware.    Died  June  22,  1864. 

1570 

Moran,  H.,  Pt.,  K,  155th 

June  3, 

Left.     Died  June  18,  3864. 

1527 

McCulIougb,S.E.,Corp., 

May  22. 

R't:  circ.    A.Surg.H.M.Sprague. 

New  York,  age  25. 

-,  'fi4. 

A,  47th  Illinois. 

24,  '63. 

U.S.A.  Died  J'yl2.'63.  ^.1622. 

1571 

Morey,  D.  D.,  Serg't,  C, 

May  20, 

Left.    Died  July  22,  3  864  ;  opera 

1528 

McCullough,  W.,  Pt.,  D, 
llth  Pennsylvania. 

May  5, 
5,  '64. 

Right.     Died  May  16,  1864. 

1572 

9th  Maine,  age  28. 
Morill,  D.  H.,  Corp'l,  C, 

30,  '64. 
May  18, 

tion  and  chronic  diarrhoea. 
Left.     Surg.  J.  S.  Ross,  llth  N. 

1529 

McCurdy,T.,Pt.,H,  38th 

Aug.  31, 

Right.     Died  Sept.  3,  1864. 

31st  Maine,  age  22. 

38,  '64. 

Hampshire.    Died  Mav  20,  1864. 

Indiana. 

3ir'64. 

1573 

Morris,  J.,  Pt.,  F,  39th 

June  1, 

Left.    Died  July  8,  1864. 

1530 

McDill,  K.,  Pt.,  I,  81st 

Mar.  19, 

Left  ;  circ.     Surg.  W.  C.  Jacobs, 

Illinois,  age  40. 

2,  '64. 

Ohio,  age  25. 

19,  '65. 

81st  O.    Died  May  7,  '65;  diphth. 

1574 

Morris,  W.  C.,  Pt.,  E,  4th 

May  19, 

Right;  flap.     June  1,  basm.:  lig. 

1531 

McDonald,  H  ..Corp'l,  D, 

June  19, 

Left.     Died  August  2,  1864. 

Alabama,  age  24. 

19,  '64. 

femoral.  Died  June  2,'64  ;  hsem. 

35th  Ohio. 

19,  '64. 

1575 

Morris,  W.,  —  ,  C,  44th 

July  2, 

Left.    Died  July  22,  '63  ;  pyaemia. 

1532 

McDonald,    P.,    Pt.,    P., 

May  18, 

Right.    Surg.  M.  Rizer,72d  Penn. 

New  York,  age  30. 

3.  '63. 

170th  New  York. 

18,'  '64. 

Died  May  18,  1864. 

1576 

Morrison,  J.  H.,  Pt.,  B, 

Dec.  13, 

.    Died  December  16,  1862. 

1533 

McDougal,  A.  L.,  Col.. 
123d  New  York. 

June  4, 
4,  '64. 

Right.    A.  Surg.  L.W.  Kennedy, 
12:!d  N.  Y.     Died  June  23,  '64. 

1577 

19th  Massachusetts. 
Morse,  W.  E.,  Pt.,  B,  2d 

13,  '62. 
Dec.  13, 

Left.     Died  December  18,  3862. 

1534 

McFadrlen,  J.  L.,  Tt.,  C, 

June  23, 

Right  ;  ant.  post.  flap.   Surg.  J.H. 

New  Hainpshire. 

13,  '62. 

34th  N.  C.,  age  18. 

23,  '64. 

Buckman,  5th  New  Hampshire. 

1578 

Morse,  R.,  Pt,,  C,  100th 

Aug.  6, 

Right  ;  circ.     Surg.  C.  S.  Frink, 

Died  July  22,  1864. 

Ohio,  age  20. 

6,  Y64. 

U.S.V.    Died  Nov.  22,  1864. 

1535 

McFarJand,  .7..4.,Ccrp'l, 
E,  18th  Tennessee. 

Myl5.'64. 
Primary. 

.     Died  May  27,  1864. 

1579 

Morton,  B.  T.,  Pt.,  H,  2d 

Ohio  Cav.,  age  24. 

June  18, 
20,  '64. 

Right;  circ.   Surg.J.II.Wliitford, 
36th  O.    Hasm.  Died  July  2,  '64. 

1536 

MeGarvey,  M.,  Corp'l,  C, 

June  2, 

Left.     Died  Dec.  3,  1864. 

1580 

Morton,  D.  H.,  Pt.,   D, 

May  23. 

Right;  short  ant.  and  long  post. 

4th  Infantry. 

2,  '64. 

149th  Penn.,  age  20. 

24,'  '64. 

flaps.     Surg.  W.  F.  Humphrey, 

1537 

McUenty,  E.",Pt.,  E.  68th 

July3, 

Left.     Died  July  23,  18C3. 

149th  Penn.    Died  June  6,  1864  : 

Pennsylvania. 

3,  fe. 

pyaemia.     Spec.  2795. 

1538 

McUrat'h,  J  ,  Pt.,  E,  88th 

June  16, 

Left.   A.  Surg.  J.S.  Smith,U.S.A. 

1581 

Morton,  J.   IF.,  Pt.,   E, 

July  3, 

—  —.    Died  July  23,  1863. 

New  York,  age  3ii. 

17,  '64. 

Died  June  29,  '64.     Spec.  3766. 

18th  Virginia. 

3,  '63. 

1539 

McGraw,  11.,  Lieut.,  K, 

July  1. 

.     Died  July  8,  1863. 

1582 

Morton,  P.,  Pt.,  I,   83d 

May  10, 

Right  ;  circ.     Died  May  20,  1864  ; 

140th  New  York. 

3,  '63. 

Penn.,  age  35. 

10,  '64. 

ha?morrhage. 

1540 

McKonzie,  A.,  Corp'l,  M, 

June  3, 

Right;  ant.  post.flap.   Snrg.G.W. 

1583 

Mullen,  W.  W.,  Pt.,  D, 

June  4, 

Right.     Died  June  38,  1864. 

8th  N.  Y.  H.  A.,  age  21. 

4,  '64. 

McCune,  14th  Ind.     Died  July 

57th  Indiana. 

4,  '64. 

11,1864. 

1584 

Mullen,  C..  Serg't,  M., 

April  7, 

Left.     Died  May  18,  1865;  amp. 

1541 

McKnight,  L.  \P.,  Pt.,  C, 
2d  Tenn.  Cav.,  age  22. 

Mar.  25, 

27,  '64. 

Right  ;  flap.    Surg.  H.  P.  Stearns. 
U.  S.  V.     Died  April  16,  1864. 

1585 

7th  Penn.  Cavalry. 
Murphy.  P.,  Pt..  D,  28th 

7,  '65. 
June  15. 

and  pneumonia. 
.     Died  June  17,  1864. 

1542 

McLeod,  J.,  Pt.,  F,  16th 

May  27, 

Right.     Died  June  11,  1864. 

Pennsylvania. 

15,  '64. 

Infantry. 

27,"  '64. 

1586 

Myers,  'R.    P.,   Pt.,    K, 

July  3, 

Left.  Surg.  H.  M.  McAbee,  4th  O. 

1543 

McNew.'C.,  Pt.,  E,  34th 

Jan.  11, 

Right.     Died  February  17,  1863  ; 

lllth  New  York. 

3,  '63. 

Died  August  31,  1863. 

Iowa,  ago  25. 

11,  '63. 

wound. 

1587 

Nash,  J.  A.,  Pt.,  H,  1st 

June  21, 

Right  ;  ant.  post.  flap.    Died  June 

1544 

'McXutt,'J.,  Lieut.,  —  , 

Sept.  37, 

—  ;  flap.     Died  Sept.  19,  1862; 

Mass.  II.  A.,  age  19. 

21,  '64. 

30,  1864;  exhaustion. 

17th  Miss.,  age  26. 

18,  '62. 

shock  and  exhaustion. 

1588 

Nason,  S.  H.,  Pt.,  F,  1st 

June  18, 

Left  ;  ant.  post.  flap.     Surg.  H.  F. 

1545 

Melane,.  K.  B.,  Pt.,  L,  1st 

Oct.9,'63 

—  .     Died  October  27,  1863. 

Maine  H.  A.,  age  28. 

18,  '64. 

Lyster,  5th  Mich.    Died  July  4, 

Tenn.  Cavalry. 

Primary. 

18'(i4  ;  pyaemia. 

154C 

Menich,  J.,  Pt.,  F,  10th 

May  (i, 

Left.     Died  May  28,  1864. 

1589 

Nanss,  J.,   Pt.,  C,    82d 

July  20, 

Right.    Died  October  19,  1864. 

New  Jersey. 

6,  '64. 

Ohio,  age  24. 

20,  '64. 

1547 

Meniott,  E.,  Pt.,  D,  6th 

May  3, 

Left  ;  flap.    S  urg.  F.  G.  Porter.  U. 

1590 

Neal,  F.,  Pt.,  M,  21st  Pa. 

June  18, 

Right.     Died  June  19,  1864. 

Mo.  S.  M.  Cav.,  age  23. 

4,  '65. 

S.V.    Lig.  fern.     Died  May  29, 
1865;  exhaustion. 

1591 

Cavalry. 
Neal,  L.,Corp'l,  I,2dKy. 

18,  '64. 
Dec.  15, 

.     Died  December  17,  1861  ; 

154E 

Menzie,  J.  R.,  Pt.,  I,  9th 

Oct.  19, 

Right.     Died  October  —  ,  1864. 

Cavalry. 

17,  '61. 

shock. 

N.  Y.  H'vy  Artillery. 

19,  '64. 

1592 

Neilson,  G.,  Corp'l,  Tar- 

Dec.  16, 

Right  ;  circ.    Died  Jan.  14,  1865. 

154C 

Messinger,  W.,  Pt.,  A,  3d 
Vermont. 

June  7, 
7,  '64. 

Right.     Died  June  8,  1864. 

1593 

rant's  Battery. 
Nelson,  0.,  Pt.,  F,  40th 

16,  '64. 
July  20. 

Left.     Died  July  26,  1864. 

155( 

Meyer,  J.,  Pt.,  K,  2d  N. 

April  7, 

Right  ;  circ.     Surg.  P.  E.  Hubon, 

Mississippi. 

20,'  '64. 

Y.  H.  A.,  age  23. 

8,  '65. 

28th  Mass.    Died  May  25,  1865  ; 

1594 

Nelson,  R.,  Pt.,  E,  26th 

De-.  13, 

.  ;  circ.    Died  Doc.  15,  1862. 

pyaemia. 

Pennsylvania. 

13,  '62. 

1551 

)  Michael,  R.  S.,  Pt.,  A, 

July  3, 

Right  and  left.    Died  July  16,  '63. 

1595 

^Newman,  W.  G.,  Pt.,  II, 

Aug.  9, 

;  flap.    Died  Sept.  27,  1862. 

155x 

)     105th  Pennsyvania. 

3,  '63. 

58th  Virginia,  age  34. 

10,   62. 

'FISHER,  (G.  J.),  Amp.  after  Battle  of  Antietam,  in  Am.  Jour.  Med.  Sci.,  1863,  Vol.  XLV,  p.  47. 

2CHALMERS  (H.  S.),  Keport  of  Three  Cases  illustrating  the  Correlation  existing  between  Erysipelas,  Diphtheria  (and  Hospital  Gangrene?),  In 
Confed.  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  86. 


264 


INJURIES    OK    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


XO. 

NAME,  MILITAUV 
DESCRIPTION,  AXI>  ACE. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

xo. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1596 

Newton.  W.,  Capt.,  E,2d 

Mar.  31, 

Left.     Died  April  8,  1865. 

1641 

Post,  J.  K.,  Pt.,  B,  112th 

June  1, 

Right;  circ.    Died  June  21,  1864  ; 

Ohio  Cavalry. 

31,  '65. 

New  York,  age  21  . 

3,  '64. 

exhaustion. 

1597 

Nicholas,   I.,  Corp'l,  G, 

Oct.  28, 

Right.  Died  Nov.  28,  1864  ;  irrita 

1642 

Potter,  W.M.,Pt.,E,  84th 

May  3, 

Left.    Died  May  20,  1863. 

7th  C.  Troops,  age  21. 

28,  '64. 

tive  fever. 

Pennsylvania. 

3,  '63. 

1598 

Nichols,  D.,  1't.,  1C,  31st 

May  12, 

.     Surg.  P.  O'M.  Edson,  17th 

1643 

Pratt,  A.,  Pt.,  D,   34th 

Sept.  19, 

.     Died  September  20,  1864, 

Maine. 

12,'  '64. 

Yt.     Died  May  22,  1864. 

Massachusetts. 

20,  '64. 

on  operating  table. 

1599 

(Nicholson,  D.,Pt.,H,2,'d 

May  10, 

Both  thighs;  ant.  post.  flap.    Surg. 

1644 

Price,   J.,    Pt.,  C,    78th 

Sept  28, 

Right  ;  lat.  flap.   Died  Oct.  18,  '64  ; 

1600 

5    Mass.,  ago  23. 

10,  '04. 

.J.  Thomas,  llbth  Penn.     Died 

Penn.,  age  53. 

28,  '64. 

surgical  pneumonia. 

May  28,  '64  ;  exh'n.    Spec.  2966. 

1645 

Priest,  J.,  Corp'l,  D,129th 

July  20, 

Right.    Died  August  24,  1864. 

1001 

Nickerson,  J.,  Pt.,  D,  3d 

Nov.  10, 

Right!  ant.  post.  flap.  Surg.S.W. 

Illinois. 

20,  '64. 

R.I.  Artillery,  age  38. 

10,  '(i3. 

Gross,  U.  S.  V.     Died  Nov.  20, 

1646 

Pritehett,  J.  L.,  Pt  ,  A, 

April  9, 

Right;  circ.     Died  April  30,'64. 

1863;  erysipelas. 

87th  Illinois. 

9,  '64. 

1602 

Nolton,A.W.,  Pt.,F,93d 

May  12, 

Left  ;  circ.     Died  June  4,  1864  ; 

1647 

Pryor,  W.,  Pt,  F,  21st 

Dec.  12, 

—  .   Died  December  18,  1862. 

New  York,  age  22. 

14,  '61. 

pysemia. 

Mississippi. 

12,  '62. 

1603 

Norton,  M.,  Pt.,  I,  117th 

May  13, 

Right.     Died  May  28,  1864. 

1648 

Pulley,  D.  W.,  Pt.,  E, 

Dec.  15, 

Right  ;  lat.  flap.     A.  A.  Surg.  L. 

New  York. 

13,'  '64. 

60th  Illinois,  age  20. 

16,  '64. 

Sinclair.  Erys.    Died  Feb.  4,  '65. 

1604 

Nunamaker,  \V.,  Pt.,  A, 

Aug.  5, 

•Right.     Surg.  J.  N.  McCandless, 

1649 

Pune,  D.  S.,  Pt.,  A,  79th 

July  20, 

Left.    Died  A  ugust  4,  1864. 

77th  Pennsylvania. 

r>,  vi. 

77th  Penn.    Died  Aug.  15,  1864. 

Ohio. 

20,  '64. 

1605 

O'Connor,P.,Pt.,B,147th 

May  2.1, 

Left  :  ant.  post.  flap.     Died  June 

1650 

Putnam,  C.,  Corp'l,  E, 

Mar.  31, 

Left  ;  circ.     Died  J  une  22,  1865  ; 

New  York,  age  3:). 

26,  '64. 

14,  1864  :  pyaemia. 

64th  New  York,  age  27. 

31.  '65. 

pyaemia.    Spec.  4238. 

1606 

Ogden.T.W.,  Pt.,F,94th 

Oct.  19, 

Right.     Died  October  29,  1864. 

1651 

Quinn,  F.,  Pt.,  K,  147th 

July  30, 

Right;  circ.     A.  A.  Surg.  S.  J. 

New  York,  age  16. 

19,  '64. 

New  York,  age  40. 

Au.  1,'64. 

Ilolley.    Died  August  2,  1664. 

1607 

Osgood.G.  H.,  Serg't.,  K, 

June  27, 

Right.     Died  July  25,1864. 

1652 

^Rabbit,  E.  C.,  Serg't,  B, 

Nov.  24, 

Both.  Surg.  E.  J.  Buck,  18th  VVis. 

lllth  Pennsylvania. 

27,  '64. 

1653 

i    10th  Missouri. 

25,  '63. 

Died  Dec.  26,  1863. 

1608 

Otley,  J.   K.,  Adj't,  32d 

Mar.  25, 

Left.     Surg.  J.  T.  Kilby,  C.  S.  A. 

North  Carolina. 

25,  '65. 

Died  April  25,  1665. 

1654 

iRainwater,J.  G.,  Pt.,  —  , 

Sept.  17, 

Left  ;  circ.;  (hasm.  fr.  ant.  tib.  art.; 

1609 

Owen,  E.  F.,  Pt.,  B,  29th 

Dec.  17, 

Right  ;  circ.     Died  Feb.  5,  1865  ; 

18th  Miss.,  age  28. 

19,  '62. 

gang.)    Died  Sept.  22,  '62;  pyae. 

Penn.,  age  4?. 

17,  '64. 

exhaustion. 

1655 

Rapp,   J.,    Pt.,    C,  llth 

June  19, 

Right.    Died  July  13,  1864. 

1610 

Owens.  B.  E.,  Pt.,  C,  30th 

Mar.  '65, 

Right.     Died  May  10,  1865. 

Conn.,  age  31. 

19,  '64. 

Yirginia. 

Primary. 

1656 

*Rate,  J.  B.,  Pt.,  —  ,  45th 

Sept.  17, 

Left  ;  circ.    Confederate  surgeon. 

1611 

Page.  B.  M.,  Pt.,  1,  126th 

May  12, 

Left  ;  circ.    Died  May  26,  1864. 

Virginia,  age  23. 

17,  '62. 

Died  Sept.  30,  1862;  pyaemia. 

Ohio,  age  21. 

12,  '64. 

1657 

Rayburn,  S.  Y.,  Serg't, 

July  3, 

Left  :  circ.    Surg.W.  H.  Twitord, 

161',> 

Paine,  B.,  Musician,  E, 

Dec.  15, 

Right  ;  ant.  post.  flap.    Died  Dec. 

D,  27th  Indiana. 

3,  '63. 

27th  Indiana.    Died  Aug.  1,'63. 

1st  Alabama,  age  22. 

15,  '64. 

24,  1864. 

1658 

Reardon,  J.,  Pt.,  D,  52d 

June  27, 

Left.     Died  July  4,  1864. 

16l:i 

Patterson,  J.,  Corp'l,  K, 

Oct.  18, 

Left.    Died  Jan.  20,  1864  ;  chronic 

Ohio. 

27,  '64. 

10th  Missouri,  age  22. 

18.  '63. 

dyspepsia  and  diarrhoea. 

1659 

Ream,  C.,  Pt.,  I,  26th  N. 

Dec.  13, 

Right.     Died  January  6,  1863; 

1614 

Parker,  L.  II.,  .Serg't,  D, 

July  2, 

.  Died  July  24,  1863  ;  haemor 

York,  age  60. 

14,  '62. 

pyaemia. 

1-Jth  X.  II.,  age  26. 

3,  '63. 

rhage. 

1660 

Reeolder.G.,  Pt.,  A,  79th 

June  16, 

Left;  circ.     Died  July  24,  1864  ; 

1615 

Parncll,  E.,  Pt.,  A,  lllth 

July  2, 

Right.     Surg.  H.  M.  Me  A  bee,  4th 

Penn.,  age  18. 

16,  '64. 

pyaemia. 

New  York. 

3,  '63. 

Ohio.     Died  July  13,  1863. 

Kim 

Reddick,  G.  H.,  Serg't, 

July  2, 

Left.     Died  July  6,  1863. 

1616 

Parsons,  W.,  Serg't,  K, 

May  5, 

Right.     Died  July  3,  1864. 

F,  20th  Indiana. 

2,  '63. 

124th  X.  York,  age  20. 

6,  '64. 

1662 

Reece,   E.,  Pt.,    I,   36th 

May  15, 

Left.    Asst.  Surg.  C.  11.  Burbeck, 

1617 

Pas^hall,  A.  O.,  Pt.,  G, 

Mar.  10, 

Right;  ant.  post.  flap.    Died  Mar 

Alabama. 

15,  '64. 

60th  N.  Y.    Died  May  17,  leG4. 

124th  Indiana,  age  23. 

10,  '65. 

16,1865;  exhaustion. 

1663 

Reed,  J.,  Pt.,C,  15th  Va., 

June  18, 

Left.     Confed.  surgeon.     Nov.  1, 

1618 

Patten,  H.  L.,  Maj.,  20th 

Aug.  16, 

Lett;  anterior  post.   Hap.     Surg. 

age  26. 

20,  '64. 

fern.  lig.     Nov.  8,  re-amp,  at  up. 

Mass.,  age  28. 

17,  '64. 

N.  Haywarcl,  20th  Mass.     Died 

third.  Surg.G.  S.  Palmer,  U.S.V. 

Sept.  10,  1864  ;  pyasmia. 

Ha?m.   Died  Nov.  14/64  ;  exh'n. 

161!) 

Paul,  J.,  .Serg't,  B,  152d 

May  30, 

Left  ;  flap.     Surg.  M.  Rizer,  72d 

1664 

Reed,   J.,  Pt.,  G,  123d 

May  15, 

Right.     Died  July  10,  1864. 

New  York,  age  24. 

31,  '64. 

Penn.   Died  June  30/64:  pyacin. 

Ohio. 

1.1,  '64. 

1620 

Perk,  VV.  H.,  Pt.,  I,  1st 

July  3, 

Right:  haein.;  ligat'n.    Died  July 

1665 

Reedy.C.  T.,  Pt.,G,40<h 

June  20, 

Right.     Surg.  J.  N.  Beach,  40th 

Minnesota. 

5,  '63. 

21,1863. 

Ohio. 

20,  '64. 

Ohio.    Died  July  19,  '64  ;  pyaem. 

1621 

Peclen,J..Corp'l,A,  140th 

May  8, 

:  circ.     Surg.  .T.  W.Wishart, 

1666 

Reeves,  A.,  Pt.,  C,  36th 

Nov.  23, 

Right.     Died  December  18/1863. 

Pennsylvania. 

8,  '64. 

140th  Penn.    Died  May  1.1,1864. 

Ohio. 

23,  '63. 

1622 

Pel  key,'  J.,  Pt.,   II,    2d 

Nov.  25, 

.     Died  Nov.  '28,  1863. 

1667 

Reeves,   W.  J.,  Pt.,  C, 

May  14, 

Loft.    Died  Aug.  3,  1863  ;  chronic 

Minnesota. 

25,  '63. 

10th  Missouri. 

14,  '63. 

diarrhoea. 

1023 

Perkins,  M.,  Pt.,  D,  18th 

Dec.  12, 

Left  :  (also  wound  of  right  side 

1668 

Reidman,  G.,  Pt.,  I.  15th 

Sept.  17, 

Left.    Died  September  30,  1862. 

Massachusetts. 

13,  '62. 

and  lung.)  Died  Dec.  20,  1862. 

Massachusetts,  age  44. 

17,  '62. 

1624 

Perry,   II.  11.,  Corp'l,  K, 

Mar.  25. 

Right  ;  ant.  post.  flap.  Died  April 

1669 

Remele.  D.,  Pt.,  E,  10!)th 

May  6, 

Left:  circ.     Died  Aug.  8,  1864; 

">7th  .Mass.,  age  20. 

25,  '65. 

9,  186."';  apoplexy. 

New  York,  age  19. 

-,  '64. 

diarrhoea. 

162-1 

Peters,  K.,  Pt.,  C,  29th 

Oct.  27, 

Left.     Surg.  A.  C.  Barlow,  62d 

1670 

Renerson.W.  It.,  Pt.,  E, 

June  16, 

Left  :  ant.  post.  flap.     Died  A  ug. 

Conn.     (Col'd.) 

27,  '64. 

Ohio.     Died  Nov.  17,  1864. 

1st  Maine,  age  27. 

16,  '64. 

9,  1864. 

1626 

Peterson,  O.  C.,  Pt.,  A, 

Dec.  16, 

Left;  eirc.    Surg.  V.  B.  Kennedy, 

1671 

Reynolds,  W.  T.,  Pt.,  A, 

April  5, 

Right  ;  circ.    Died  April  30,  1865. 

T>th  Minnesota,  age  ."]. 

16.  '64. 

5th  Minn.    Died  Jan.  13,  1865. 

4t'h  Delaware. 

5,  '6.1. 

1627 

Peterson,    I'.    15.,  Adj't, 

Sept.  17, 

Left.     Died  October  13,  1862. 

1672 

Rhea,  J.  M.,  Pt.,  I,  8th 

June  20, 

Right;   circ.     Surg.   II.   /,.  Gill, 

78th  Xcw  York. 

17,  '62. 

Iowa. 

20,  '63. 

9.1th  Ohio.     Died  July  25,  1863. 

1628 

Petersnn.  O.,  Pt.,O,  39th 

Nov.  30, 

Left  ;  lat.  flap.    Died  May  18,  '65; 

1673 

Richards,  A.  J.,  Pt.,  K, 

May  30, 

Left;  circ.     Died  June'  20,  1864; 

Norlh  Carolina,  age  2.1. 

De.  1,'64. 

exhaustion. 

9th  N.  11.,  age  25. 

3:),  '64. 

exhaustion. 

162!) 

Phelps,  II.  E.,  Corp'l,  K, 

May  27, 

Right.     Died  August  9,  186:!. 

1674 

Richardson,  W.  A.,  Pt., 

Nov.  25, 

Right  ;  circ.  A.  Surg.W.  S.  Lam 

4:Jth  Massachusetts. 

27,'  '63. 

G,  6th  Iowa. 

2.1,  '63. 

bert.  6th  Iowa.    Died  December 

1630 

Phelps.    C.   B.,  Pt.,  H, 

May  15, 

Left;  circ.     Died  June  11,  1864. 

24,  1863;  pneumonia. 

38th  Virginia. 

16,'  '64. 

1675 

Riley,  P.,  Pt.,G,42d  Mas 

Aug.  27, 

Left.     Died  October  4,  1864  ;  py 

1631 

Phipps,  J.,  Pt.,  A,  187th 

June  2.1, 

Left.     Died  July  4,  1864  ;  exh'n 

sachusetts,  age  19. 

28,  '64. 

asmia. 

Pennsylvania,  age  19. 

25,  '64. 

and  irritative  fever. 

1676 

Riling,  J.,  Pt.,  C,  159th 

April  13, 

Left.     Died  Oct.  6,  1863;  chronic 

1632 

Phyfe,\V.F.,Pt.,  E,  10th 

Sept.  27, 

Left;  anterior  post.  flap.    Surg.G. 

New  York. 

-,  '63. 

diarrhoea. 

New  York,  age  22. 

28,  '64. 

Chaddock,  7th  Mich.    Died  Oct. 

1677 

Ripley,  C.  A.,  Pt.,  E,  2d 

July  4, 

.     A.  Surg.  A.  F.  Marsh,  56th 

18,  1864:  exhaustion. 

Iowa. 

4,  '64. 

111.     Died  July  15,  1864. 

1633 

Pickens,    P.,  Serg't,  F, 

July  3, 

Left  ;  (also  wound  of  right  leg.) 

1678 

Ripley,  L.  D.,Pt.,E.10th 

Sept.  19, 

Left.     Died  October  17,  1864. 

141st  Pennsylvania. 

3.  '63. 

Died  July  10,  1863. 

West  Va.,  age  29. 

19,  '64. 

1634 

Pike,  S.,  Serg't,  1,  10th 

Aug.  28, 

Right.     D'ied  October  9,  1864. 

1679 

Ritka,    A.,  Pt,,  M,   4th 

Sept.  19, 

Right  ;  circ.    Died  Feb.  26,  1865  ; 

Ohio  Cavalry. 

28,  '64. 

N.  Y.  Cav.,  age  32. 

19,  '64. 

typhoid  fever. 

163.5 

Platts.N.,  Serg't,  D,100th 

July  22, 

Left.     Died  September  16,  1864. 

680 

Robarge,  L.  J.,  Corp'l,  I, 

Mar.  1, 

Left;  ciro.     A.  Surg.  J.  W.  Wil 

Illinois. 

2->,  '64. 

5th  Cavalry,  age  30. 

2,  '64. 

liams,  U.  S.  A.     Died  March  14, 

1636 

Pollsys,  T.  A.,  Serg'tJI, 

June  18, 

Right;  posterior  flap.    Surg.  J.  II. 

1864;  tetanus.     Spec.  2151. 

6th  Wisconsin,  age  25. 

19,  '64. 

Beech,  2'lth  Mich.  Gang.   Died 

1681 

Roberts,  W.  H.,  Pt.,  E, 

May  14, 

Left.     Died  May  23,  1864. 

June  30,  1864  ;  ha?morriiage. 

33d  Ohio. 

14.  '64. 

1637 

Pomeroy,  W.,  Pt.,  B,  1st 

June  18, 

Right  ;  circ.    Died  June  27,  1864  ; 

1682 

Robinson,  F.,  Pt.,  D,  3d 

Mar.  5, 

Left.   A.  Surg.  B.Durham,  .jr.,72d 

Maine  II.  A.,  age  30. 

18,  '64. 

pyaemia. 

Cavalry. 

5,  '64. 

111.  Died  June  22,  '64  ;  diarrhoea. 

II  38 

Pool,  E.  G.,  Pt.,  A,  12th 

Sept.  17, 

Right.    Died  October  14,  1862. 

1683 

Robinson,  D.  W.,  Pt.  F, 

May  27, 

Left.     Died  June  6,  1863. 

Massachusetts. 

17.  '62. 

53d  Mass.,  age  43. 

27,  '63. 

1639 

Poppleton,  B.  11.,  Pt.,  B, 

July  22, 

Left.     Surg.  W.  C.  Jacobs,  81st 

1684 

Robinson,  II.,  Capt.,  G, 

May  3, 

Left;  circ.     Died  May  11,  1863; 

7th  Iowa,  aged  21. 

22,'  '64. 

Ohio.    Died  Sept.  7,  1864. 

55th  Ohio. 

5,  '63. 

exhaustion. 

1640 

Posey,   E.,  Pt.,  A,  39th 

Oct.  28, 

Right.    Surg.M.Tucker,39th  Cl'd 

1685 

Robinson,  J.,  Pt.,K,123d 

Sept.  3, 

Left;  flap.     A.   A.  Surg.  J.  R. 

Colored  Troops. 

28,  '64. 

Troops.    Died  Nov.  9,'64  ;  hajm. 

Ohio,  age  24. 

4,  '61. 

Uhler.     Died  Sept.  10,  1804. 

1  FISHER  (G.  J.),  Report  of  Fifty-Seven  Casfs  of  Amputations,  in  the.  Hospitals  near  SJiarpsburg,  Md.,  after  the  Battle,  of  Antielam,  Kept.  17,  1862, 
in  Am.  Jour.  He.d.  Sci.,  1863,  Vol.  XLV,  p.  47.  2FlSHER  (G.  J.),  op.  ciL,  p.  47. 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER   THIRD. 


265 


No. 

NAUR,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AKD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1686 

Robinson,  J.  T.,  Pt.,  A, 

June  4, 

Left.     Surg.  E.  B.  Glick,   40th 

1730 

Shipper,  R.,   Corp'l,  C, 

Oct.  5, 

Right  :  circ.     Surg.  P.  N.  Woods, 

1st  Ohio  Artillery. 

4,  '64. 

Ind.     Died  June  26,  1864. 

12th  Illinois,  age  19. 

5,  '64. 

Sijth  Iowa.     Died  Dec.  26,  1864. 

1687 

Robinson,  P.  P.,  (Jorp'l, 

May  5, 

.     Died  May  6,  1864. 

1731 

Shoemaker,  G.,  Pt.,  B. 

July  2, 

—  .     Surg.  F.  Wolf,  39th  New 

A,  57th  Penn. 

6.  '64. 

39th  New  York. 

3,  '63. 

York.    Died  July  25,  1863. 

1688 

Kodgers,  J.  A.,Pt.,G,  1st 

Aug.  25, 

Left;   flap.     A.   A.  Surg.  J.   R. 

1732 

Shorey,  R.,  Pt.,  I,  17th 

Nov.  27, 

Right  ;  ant.  post.  flap.    Died  Dec. 

Cavalry,  age  19. 

26,  '04. 

Uhler.     Died  Oct.  2,  1864. 

Maine,  age  45. 

29,  '63. 

10,  1863:  gangrene. 

1689 

Rodgers,  W.  B.,  Pt.,  D, 

Sept.  17, 

Left.     Died  Oct.  17,  1862. 

1733 

Showalter,  J.,  Pt.,C,  53d 

June  3, 

Right.     Surg.  G.  L.  Potter,  145th 

88th  Penn. 

17,  '62. 

Penn.,  age  20. 

3,  '64. 

Penn.  Died  Junc24,'64.  Sp  665. 

1690 

Roff,  W.  H.,  Lieut.,  II, 

June  6, 

Left.     Surg.  P.  E.  Hubon,  28th 

1734 

Shuster,  G.,   Serg't,  G, 

June  27, 

Right.     Surg.  A.  C.  Messenger, 

2d  N.  Y.  H.  A.,  age  35. 

-,  '04. 

Mass.     Died  June  30,  1864. 

30th  Ohio. 

27,  '64. 

57th  Ohio.     Died  July  26,  1864. 

1G91 

Roarers,  G.,  Pt.,K,  104th 

July  8, 

Right.     Died  July  8,  1864. 

1735 

Silman.W.  L.,  Corp'l,  K, 

July  3, 

Left.     Died  July  28,  1863. 

Ohio,  age  19. 

8,  '64. 

32d  Mass. 

3.  '63. 

1692 

Rogers,  S.,   Pt.,   F,    1st 

June  18, 

Left.     Died  August  6,  1864. 

1736 

Simmons,  J.  K.,  Pt.,  D, 

April  1, 

Left;  (also  wound  of  right  leg.) 

Maine,  age  21. 

18,  '64. 

21i;th  Penn.,  age  38. 

1,  '65. 

Surgeon  A.  A.  White,  8th  Md. 

1693 

Rolfe,  G.,Pt.,H,  2d  N.Y. 

April  1, 

Left  ;  circ.     Died  April  21,  1865  ; 

Died  April  12,  1865;  pyaemia. 

Cavalry,  age  36. 

1,  '65. 

pyaemia. 

1737 

Simmons,  D.  F.,Pt.,G, 

April  30, 

Left,     Died  May  10,  1863. 

1694 

Rolls,   D.  B.,  Pt.,  D,  6th 

June  1, 

Right.     Died  June  26,  1864. 

38th  Mass. 

—  ,  '63. 

N.  V.  H.  A.,  age  42. 

1,  '64. 

1738 

Simmons,  S.  S.,  Sergt., 

Nov.  27, 

Right.     Died  December  9,  1863. 

1695 

Roper,  S.,  Pt.,  A,  140th 

June  16, 

Left;  circ.    Surg.  J.W.Wishart. 

D,  84th  Penn. 

28,  '63. 

Penn.,  age  43. 

17,  '64. 

140th  Penn.     Hasm.;  lig.  fem'l 

1739 

Simmons,  T.  JV.,  Corp'l, 

July  3, 

Right.     Died  July  16.  1863. 

art.     Died  Aug.  10,  '64  j  exh'n. 

C,  14th  Tenn. 

3,  '63. 

1696 

Rose,  W.H.,Pt.,C,  105th 

May  27, 

Right.  A.Surg.G.M.Trowbridge, 

1740 

Singer,  L.,  Pt.,  F,  174th 

July  11, 

Left;  haem.;  fern,  ligated.     Died 

Illinois. 

27,  '64. 

lythMich.   Supposed  to  be  dead. 

New  York. 

13,  '63. 

July  17,  1863. 

1697 

Ross,  E.,  Serg't,  G,  52d 

Dec.  13, 

.     Died  December  19,  1862. 

1741 

Sisey,    J.,  Pt.,  K,   21st 

June  27, 

Left.     Surg    C.  J.  Walton,  21st 

New  York. 

13,  '62. 

Kentucky. 

27,  '64. 

Ky.     Died  July  6,  1864. 

1698 

Ross,  R.  E.,  Corp'l,  H, 

Sept.  19, 

Left.     Died  Sept.  30,  1863. 

1742 

Sloan,  M.,  Pt  ,  H,  47th 

May  5, 

Left.     Died  May  7,  1864. 

3(ith  Indiana. 

20,  '63. 

Indiana. 

5,  '64. 

1699 

Rouark,  T.  H..Pt.,F,  1st 

Aug.  3, 

Left.    Surg  A.  A.White,8th  Md. 

1743 

Smith,  A.  C.,  Corp'l,  C, 

Mar.  19, 

Right.     Died  March  28,  1865. 

Maryland,  age  25. 

3/64- 

Died  Oct.  6,  '64.    Spec.  4855. 

20th  Connecticut. 

21,  '65. 

1700 

Roussel,  E.  G.,  Capt.,  G, 

Sept,  17, 

.    Died  October  11,  1862. 

1744 

Smith,  E.,  Pt.,  C,  18th 

May  4, 

Right:   circ.     Surg.   C.   Powers, 

7-,'d  Penn. 

17.  '62. 

N.  Y.  Cavalry,  age  38. 

4,  '64. 

160th  N.Y.  Died  June  19.  1864. 

1701 

Rowe,  A.  P.,  Pt.,  A,  1st 

June  1(5, 

Right;  (also  am  p.  finger.)    Haem, 

1745 

Smith,  H.,  Pt.,'l,  14th  N. 

June  7, 

Right  ;  flap  :  (also  left  leg  at  knee 

Maine  II.  A.,  age  3D. 

16,  '64. 

Died  July  2il,  '64  ;  gangrene  and 

Jersey,  age  24. 

7,  '64. 

joint.)     Died  June  17,  1864. 

pyaemia.     Spec.  29U7. 

1746 

Smith,  H.,  Pt.,  A,  88th 

June  18, 

Right.     Died  July  3,  1864. 

1702 

Rumbell,  J.  F.,Corp'l,F, 

Feb.  21, 

—  '-.    A.  Surg.  B.  Norris.U.  S.  A. 

Pennsylvania. 

18,  '64. 

7th  Infantry. 

22,  '62. 

Died  March  25,  1862. 

1747 

Smith,  il.D.,Pt.,H,  18th 

May  31, 

Right.     Died  June  19,  1864. 

1703 

Rumsev,  J.  W.,  Pt.,  A, 

June  2, 

Left.     Died  July  11,  1865;  fatty 

Infantry. 

31,  '64. 

3d  Md  ,  age  43. 

4,  '64. 

degenerat'n  of  heart.  Spec.  4290. 

1748 

Smith,  J.  F.,  Pt.,  C,  61st 

April  8, 

Right.  A.  Surg.  W.  B.  Hartman, 

1704 

Rupert,   H.,  Pt.,  M,  2d 

June  24, 

Left  ;  circ.    Died  July  8,  1864. 

New  York,  age  17. 

9,  '65. 

116th  Penn.     Died  May  24,  '65  ; 

Penn.  Cav.,  age  21. 

25,  '64. 

pyaemia. 

1705 

Russell,  A.  P.,  Capt.,  1st 

Sept.  20, 

Left  ;  circular.     A.  A.  Surg.  A.  A. 

1749 

Smith,  J.  N.,  Pt.,  E,  7th 

May  10, 

Left.     Died  July  3,  1864  ;  pya?m. 

Maine,  a<je  28. 

22,  '64. 

Younglove.    Died  Oct.  2,  1864. 

Wisconsin,  age  17. 

10,  '64. 

1706 

Russell,  W.,  Pt.,  B,  90th 

Dec.  13, 

Left.    Died  Jan.  1,  1863  ;  pysemia. 

1750 

Smith,  J.  W.,  Corp'l,  E, 

June  27, 

Right.     Died  July  18,  1864. 

Pennsylvania. 

13,  '62. 

42d  Indiana. 

27,  '64. 

1707 

Ryan,  W.  J.,  Pt.,  E,  2d 

Sept.  17, 

Right.     Died  October  2,  1862. 

1751 

Smith,  T.,  Serg't,  G,  4th 

June  18, 

Right  ;  ant.  post.  flap.   Died  June 

N.  Y.  State  Militia. 

17,  '62. 

N.  Y.  H.  A.,  age  22. 

18,  '64. 

29,  1864  ;  exhaustion. 

1708 

Sargent.O.  II.  P.,  Pt.,  G, 

May  1, 

.     Died  May  30,  1862  ;   py 

1752 

Smith,  W.,  Pt.,  B,  17th 

Sept.  19, 

Left.     Died  Oct.  11,  1863. 

22d  Mass,  age  30. 

1,  '62. 

aemia. 

Kentucky. 

19,  '63. 

1709 

Sclmefler,  T.,  Pt.,C,26th 

May  25, 

Right.     Died  June  20,  1864. 

1753 

Snodgrass,  N.,  Pt.,  F,  3d 

May  14, 

Right.     Died  July  29,  1864. 

Wisconsin. 

25,  '64. 

Tennessee,  age  24. 

14,  '64. 

1710 

Schlechter,  J.,  Pt.,—  ,5th 

I  'y  18,  '64, 

Right  ;  (also  fracture  of  left  leg.) 

1754 

Snvder.W.  H.,  Musician, 

Nov.  25, 

Right.    Died  December  23,  18C3. 

Cuvalrv,  age  27. 

Primary. 

Died  July  25,  1864. 

G,  23d  Kentucky. 

25,  '63. 

1711 

Schmidt,  J.,  Pt.,  A,  60th 

July  10, 

Left.     Died  July  11,  1863. 

1755 

Sockwell,  B.  F.,  Pt.,  D, 

Dec.  13, 

Laft.    Died  February  5,  1863. 

Indiana. 

11,  "'63. 

25th  New  Jersey. 

13,  '62. 

1712 

Schnapp,  C.,  Pt.,  I;  76th 

June  20, 

Left;  double  flap.     Surg.  J.  H. 

1756 

Sow,  J.  L.,  Serg't,  B, 

May  15, 

Right.     Died  July  16,  1864. 

New  York. 

21,  '64. 

Beech,  24th  Mich.     Gang.  Died 

124th  Ohio. 

15,  '64. 

July  24,  1864  ;  exhaustion. 

1757 

Sparry,  J.  E.,  Corp'l,  L, 

July  3, 

Right.     Died  July  15,  1863. 

1713 

Schemer,  W.,  Pt.,  E,  82d 

May  3, 

Right.     Died  June  5,  1863. 

1st  Vermont  Cavalry. 

3,  "fi:5. 

Illinois. 

3,  '63. 

1758 

Spaulding,    D.,   Pt.,  K, 

May  10, 

Left  ;  circ.     Died  May  20,  1864  ; 

1714 

Sch  wart/  waelder,  A.,Pt., 

Nov.  25, 

Right.     Died  Dec.  27,  1863. 

16th  Maine,  age  29. 

10,  '64. 

exhaustion. 

D,  32d  Indiana. 

25,  '63. 

1759 

Sporleder,    L.,    Pt.,    B, 

June  18, 

Left,     Died  June  19,  1864. 

1715 

Soott,  C.  L.,  Fife  Maior. 

June  27, 

Left.     Surg.  S.  H.  Kersey,  36th 

187th  Penn. 

18,  '64. 

3.Jth  Indiana. 

27,  '64. 

Ind.    Died  July  28,  1864." 

1760 

Sprague,  T.  M.,  Pt.,  C, 

Oct.  19, 

Left;  oval  skin  and  circ.  muscles. 

1710 

Scott,  W.,   Pt.,  C,  39th 

Oct.  13, 

Right  ;  circ.     D'ied  Nov.  10,  '64. 

1st  Maine. 

20,  '64. 

Surg.  G.  T.  Stevens,  77Ui  N.Y. 

Illinois,  age  ID. 

13.  '61. 

Died  Oct.  26,  '64;  toxicoluemia. 

1717 

Scarcey,  D.,  Pt.,  E,  19th 

Deo.  20, 

Right.   Died  Feb.  5,  '63;  pyaemia. 

1761 

Springer,  S.,  Pt.,  A,  37th 

June  18, 

Left  ;  circ.:  (also  w'd  right  thigh.) 

Kentucky. 

20,  '62. 

Wisconsin,  age  15. 

19,  '64. 

Surg.  S.  S.  French,  20th  Mich. 

1718 

Scidolph,  'I..  Pt.,  P,,  39th 

June  16, 

Left  ;  circ.    Surg.  J.  \V.  Wishart, 

Died  Sept.  4,  '64  ;  ch.  diarrhoea. 

New  York,  age  19. 

16.  '64. 

140th  Penn.    Died  Sept.  27,  '64. 

1762 

Stanislaus,  J.,  Pt.,  1,  1st 

Mar.  25, 

Right  ;  ant.  post.  flap.   Died  May 

1719 

Sevoy,  W.,  Pt.,  A,  27th 

May  18, 

Right  ;  (also  wound  of  left  heel  ) 

Maine,  age  46. 

25,  '65. 

16.  1865;  pyaemic  intoxication. 

Iowa. 

18,  '64. 

Died  May  21,  1864. 

1763 

Steel,  L.  T.,  Pt.,  F,  llth 

May  5, 

Right.     Died  May  19,  1864. 

1700 

Shank,    A.,  Pt.,  C,    1st 

Oct.  14, 

Right:  ant.  post.  flap.     Surg.  E. 

Pennsylvania. 

5,  *64. 

Peun.  Cavalry,  age  23. 

16,  '64. 

Bentley,  U.  S.  V.     Died  Oct.  24, 

1764 

Steele.G.  S.,Pt.,D.126th 

June  22, 

Left  ;  circ.  Surg.  A.  Van  Devere, 

1  863  ;  haemorrhage. 

New  York,  age  23. 

23,  '64. 

66th  N.  Y.    July  23,  haem.;  fern. 

1721!  Shanks,  J.,  Pt.t   D,  21st 

June  20, 

Left.    Surg.C.  J.  Walton,21st  Ky. 

lig.     Died  July"  29,  '64  ;  exh'n. 

Kentucky,  age  29. 

20,  '64. 

Died  July  17,  1864. 

1765 

Sterling,  E.E.,  Corp'l,  E, 

May  9, 

Rijrht  ;  flap  :  hapm.;  lig.  small  art. 

1722 

Shannon,  R.  G.,C:ipt.,  F, 

Mar.  21, 

RiffJit.    Surg.  A.  B.  Monohan,63d 

143d  Penn.,  aue  32. 

10,  ''64. 

Died  August  12,  '(>4  ;  pyaemia. 

25th  Indiana. 

21,  '65. 

Ohio.    Died  March  23,  1865. 

1766 

Stetson,  J.M.,  Pt.,  H,57th 

May  13, 

Right  ;  ant.  post.  flap.     Died  May 

1723 

Slui'p,  C.  D.,  Serg't,  D, 

July  2, 

Left  :  (also  wound  of  right  thigh.) 

Mass.,  age  17. 

13,  '64. 

29,  1864  ;  pyaemia. 

14;'th  Penn. 

3,  '63. 

Died  August  1U,  186:). 

1767 

Stevens,  D.  H.,  Pt.,  D, 

May  6, 

Right.     Died  June  19,  1864. 

1724 

Sharp,  J.,  Pt.,  E,  14th  N. 

July  30. 

Right  :  circ.    Surg.  J.  Oliver,  21st 

5Cth  1'enn.,  age  24. 

6,  '64. 

Y.  H.  A.,  age  20. 

33,'  '64. 

Mass.    Died  Sept.  8,'64;  pyaem. 

1768 

Steward,  C.  A.,  Pt.,  5th 

May  3, 

.     Died  May  11,  1863. 

1725 

Shattuok,  A.   B.,  Capt., 

Dec.  13, 

Right.     Died  December  17,  1832. 

Maine  Battery. 

3,  '63. 

10,  llth  N.  Hampshire. 

13,  'C2. 

1769 

>  Stewart.  J.,  Pt..  D,  77th 

Mar.  25, 

Right  and  left.    Died  April  17, 

]726 

Sha\v.A.  J.,Pt.,  11,  113th 

June  '-7, 

Left.     Died  July  19,  1864. 

1  770  $    New  York,  ajre  38. 

25,  '65. 

1865;  pyaemic  intoxication. 

Ohio. 

27,  '64. 

1771 

Stiles,  J.,  Pt.,  A,  2d  Del- 

July  2, 

Right.     Died  July  —  ,  1863. 

1727 

'S/<e//on,  J.  A.  J.,  Lieut., 

Aug.  30, 

.     Gang.     Died  Oct.  23,  '64; 

aware. 

-,  '63. 

G,  50th  Tennessee. 

30;  '64. 

pyaemia. 

1772 

Stoner,  W.  K.,  Pt,,  A, 

July  3, 

Right.     Surg.  A.  C.  Messenger, 

1728 

Shelvin,     W.,     Colored 

Aug.  31, 

Right.    Surg.  A.  T.  Hudson,  26th 

53d  Ohio. 

3,  '64. 

57th  Ohio.     Died  Sept.  15,  ''64. 

Pioneer. 

31,  '64. 

Iowa.    Died  Aug.  31,  1864. 

1773 

Stooksbury,  R.,  Serg't,  F, 

May  14, 

Right.     Surg.   D.  L.  Heath,  23d 

1729 

Shields,  P.,  Pt  ,  D,  6th 

April  29, 

Left.    A.  Surg.  J.  T.  Duffiold,  7th 

6th  Tennessee. 

14,  "'64. 

Mich.     Died  May  26.  1864. 

Wisconsin. 

29,  '63. 

Ind.    Bone  rem'd  :  hueni.;  litr.  of 

1774 

Stout,    S.,    Pt.,   I,  143d 

May,  '63, 

Right:  double  flap.    Surg.W.  F. 

fern.    June  9,  lig.  of  exter.  iliac. 

Pennsylvania. 

Primary. 

Humphrey.   149th  Penn.     Died 

Died  June  19,  '64.    Spec.  1143. 

July  11,  1863. 

'JONES  (J  ),  Incestiyations  upon  the  Mature,  Causes,  and  Treatment  of  Hospital  Gangrene  as  it  prevailed  in  the  Confederate  Armies,  in  United 
States  Sanitary  Commission  Memoirs,  1871,  Surgical  Volume  II,  p.  403. 

SURG.  111—^4 


266 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MIUTAKY 
DESCRIPTION,  AXD  ACE. 

DATES. 

Ol'KKATlOXS,   Ol'EKATOKS, 

RESULT. 

{NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  Ol'EKATOKS, 
RESULT. 

J1775 

'Stubblebein,  H.,  Pt.,  C, 

May  3, 

Left;  circ.    Died  June  2.  1863; 

1817 

Trint,  J.  M.,  Pt.,  I,  29th 

July  4, 

Left.     Gang.    Died  July  20,  '0;!  ; 

9(ith  Penn. 

3,  '63. 

pyaemia. 

Iowa,  age  22. 

4   '63. 

exhaustion. 

1776 

Sullivan,  M.,  Corp'l,  E, 

Aug.  20, 

Left.     Died  September  20,  1864. 

1818 

Tudar,  S..  Pt.,  G,   61st 

July  30. 

Right  ;  circ.    H:em.     Died  Sept. 

17th  Wisconsin. 

20,  '04. 

Virginia,  age  40. 

31,"'64. 

21,  1804. 

1777 

Snmmcrvillo,  .J.  H.,  Pt., 

Dec.  15, 

.    Feb.  15,  '03,  reamp.  in  mid. 

1819 

Turnball,  E.,  Corp'l,  K, 

June  3, 

Left;  circ.     Died  July  21,  1864; 

D.llth  Pa.Kes.,agel9. 

15,  '62. 

third.    Died  Feb.  28,  '03  :  pyaBin. 

48th  N.  York,  age  19. 

3,  '64. 

abscess  of  brain. 

1778 

Sumner,    F.  H.,  Pt.,  H, 

Feb.  7, 

Left  ;  ant.  post.  flap.     Died  Feb. 

1820 

Turnbaugh,  J.,   Pt.,   E, 

April  2, 

Loft.     Died  April  14,  '65;  exhaus 

3.ith  Mass.,  age  29. 

7,  '65. 

25,  1865;  pyaemia. 

208th  Penn.,  age  21. 

2,  '65. 

tion. 

my 

Silt  ton,  S.  S.,  Pt.,K,12th 

June  3, 

Right.     Surg.  F.  F.  Burmeister, 

1821 

Turner,  T.  C.,  Corp'l,  C, 

July  12, 

Left;  circ.    A.  Surg.  J.  C.  McKee, 

New  Jersey. 

3,  '64. 

69th  Penn.     Died  June  7,  1804. 

12th  Georgia,  age  29 

14,  '64. 

U.S.A.      Died  Dec.  20,  1804; 

Spec.  3304. 

exhaustion.     Specs.  2842,  3518. 

1780 

Swain,  J.  G.,  Pt.,  I,  20th 

Dec.  13, 

Left;  ant.  post,  flap.;  seq.  rem'd. 

Photo.  Set:,  Vol.  IV,  No.  105. 

Mass.,  age  19. 

13,  '62. 

Oct.  8.  reamp.  mid.  third.    Died 

!822 

Turney,  E.,   Serg't,  D, 

July  3, 

Right.    Surg.W.  H.Twiford,27th 

Oct.  1  0,  '03  ;  pvaem.     Spec.  1265. 

27th  Indiana. 

3.  '63. 

Ind.     Died  JulyO,  '03;  second 

1781 

Sweinhart,  P.,Pt.,C,47th 

Oct.  19, 

Left;  circ.     Died  Nov.  18,  1864; 

ary  haimnrrhuge. 

Pen  n.,  age  23. 

19.  '04. 

diphtheria. 

182: 

Upton,  A.,  Pt.,  D,  59th 

Jan.  11, 

Left.    Died  January  22,  1805. 

1782 

Swisher,  C.,   Pt.,  T!,  3d 

A  ug.  20, 

Right.     Died  in  the  hands  of  the 

Massachusetts. 

11,  '65. 

Ya.  Mounted  Infantry. 

20,  '63. 

enemy. 

1824 

Unknown,  85th  N.  York. 

My30,'62 

;  (liEem.)     Died. 

1783 

S  \vycr,  W.,  Pt.,  C,  143d 

May  10. 

Right  :'  flap.    Died  June  18.  1864  ; 

Primary. 

Pcnn.,  ago  24. 

10,'  '64. 

exhaustion. 

1825 

Unknown,  50th  Pennsyl 

May  6, 

Left.     Died  May  27,   1804  ;    ex 

1784 

Tack,  G.  !>.,  Pt.,  E,  77th 

May  12, 

Left.     Died  May  18,  1864. 

vania. 

7,  '64. 

haustion. 

New  York. 

12,  '64. 

1826 

Usher,  S.,  Lieut.,  G,  17th 

April  5, 

Left.     Died  April  7,  1865. 

1785 

Taggart,  C.  F.,  Maj.,2d 

Oct.  22, 

Left  ;  circ.  Surg.W.M.Weidman, 

Maine. 

5,  '65. 

Penn.  Cav.,  age  32. 

23,  '63. 

2d  Penn.  Cav.    Died  Oct.  24,  '03. 

1827 

Vache,  H.   W.,  Pt  ,  K 

June  3, 

Left  ;  flap.     Died  June  9,  1864. 

Spec.  1765. 

45th  Penn.,  age  20. 

3,  '64. 

1780 

Tanner,  L.  M.,  Corp'l,  E, 

April  2, 

Right.     Died  May  18,  1865  :  py 

1828 

Van  Blarcome,A.H.,Pt., 

May  10, 

Right  ;  circ.     Died  June  3,  1864. 

37th  Mass.,  age  21. 

2,  '65. 

aemia. 

D,  05th  N.  Y.,  age  21. 

10,  '64. 

1787 

Tanner,  H.  J.,  Serg't,  C, 

July  28, 

Right.     Died  August  21,  1864. 

1829 

Vance,   W.  H.,   Pt.,  G, 

May  25, 

Left.     Died  Juno  3,  1804. 

103d  Illinois. 

28,  '64. 

33d  Ohio. 

25/64. 

1788 

Taylor,  A.,   Pt.,  A,  1st 

May  5, 

.     Died  May  6,  1864. 

1830 

Vandamark,  D.,  Pt.,  B, 

Aug.  31, 

.     Surg.  T.  M.  Cook,   101st 

Vermont  Cavalry. 

5,  61. 

30th  Indiana. 

31,  '04. 

Ohio.     Died  Sept.  21,1804. 

1789 

Taylor,  D.  W.,  Pt.,  D, 

June  27, 

Left.     Surg.  T.  M.  Cook,  101st  O. 

1831 

Van  Gordon,  J.,  Pt.,  F, 

Sept.  29, 

Left  ;  cire.     Surg.  T.  II.  Squire, 

81st  Indiana. 

27.  '64. 

Died  July  3,  1804. 

58th  Penn. 

30,  '64. 

89th  New  York.     Died  October 

1790 

Taylor,   K.,   Pt.,  G,  5th 

July  3. 

.     Died  July  11,  1863. 

30,  1804. 

New  Hampshire. 

3,  '63. 

1832 

Van  Ingen.G.,  Adjutant, 

Sept.  17, 

.    Died  Oct.  20,  62  ;  diarrhrca. 

1791 

Taylor,  W.,  Pt  ,  E,  188th 

Mar.  31, 

Left.     Died  April  12,  1865. 

89th  N.  Y.,  age  £'9. 

19,  '62. 

New  York. 

31,  '05. 

1833 

Van   Vliet,    J.,    1't.,    H, 

May  25, 

Right:  (also  excision  of  right  ra 

17.42 

Terry,  W.  B.,  Pt.,  B,  6th 

Oct.  7, 

Left.     Died  Nov.  1,  1864. 

107th  New  York. 

25,"  '64. 

dius.)     Died  June  24,  1864. 

Connecticut. 

7,  '64. 

1834 

Vaughan,  J.,  Pt.,  F,  6th 

Jan.  2, 

Right.     A.  A.  Surg.  W.  B.  Cary. 

1703 

Theurer,  P.,  Pt.,  D,  82d 

May  25, 

Right  ;  circ.     Surg.  G.  M.  Beaks. 

Kentucky. 

4,  '63. 

Died  January  11,  1863. 

Ohio,  age  3.'. 

25,  '64. 

141st  N.  Y.      Died  July  14,  '64  ; 

1835 

Viele,  M.,  Pt.,  D,  lllth 

June  16, 

Left;  circ.    Surg.  J.  W.  Wishart, 

exhaustion. 

New  York. 

16,  '64. 

140th  Penn.    Died  June  27.'04. 

17!)4 

Thomas,  B.,  Pt.,  G,  70th 

May  15, 

Right.    A.  Surg  D.L.  Je\vett,20th 

1836 

Violet,  J.,Corp'l,  A,  13th 

Sept.  29, 

Left  ;  (also  wound  of  right  thigh.) 

Indiana. 

15,  '64. 

Conn.    Died  June  21,  1864. 

Penn.  Cav.,  age  22. 

29,  '64. 

Died  Jan.  20,  1865. 

179.') 

Thomas,  J.  L.,  Pt.,  15,  2d 

May  27, 

.    Died  June  19.  1862. 

1837 

Wager,    J.    A.,   1't.,  C, 

May  17, 

Left.  May  19,  rem.  of  bone.  Died 

Maine. 

27.'  '62. 

115th  N.  Y.,  age  19. 

17,"  '64. 

June  6,  1804  ;  irritative  fever. 

17% 

Tlitrmasrm.  .7..Pt.,B.49th 

July  14, 

Left  :  circ.     Died  July  20,  1864  ; 

1838 

Walby,  M.,  Pt.,  D,  114th 

Sept.  19, 

Left;  circ.     Surg.  L.  P.  Wagner. 

North  Carolina,  age  28. 

14,"'04. 

gangrene. 

New  York. 

19,  '64. 

114th  N.  Y.     Died  Oct.  7,  1804  ; 

1797 

Thompson,    G.,  Pt.,   A, 

June  3, 

Left;  circ.    Surg.  F.  F.  Burmeis- 

pyainin. 

71st  Pcnn.,  age  50. 

3,  '04. 

ter,  69th  Penn.     Died  Aug.  23, 

1839 

Walker,  A.  H.,  Pt.,  K, 

June  21, 

Right.     Surg.  R.  H.  Tipton,  90th 

1804  ;  ch.  diarrhoea.    Spec.  3489. 

31st  Indiana,  age  24. 

21,  '64. 

Ohio.    Died  JulylS,  '04;  pywm. 

1798 

Thompson,  T.  Ji.,  1't.,  G, 

July  2, 

Left.     Surg.  H.  M.  MoAbce,  4th 

1840 

Walker,  L.  M.,  Pt.,  A, 

June  22, 

Right.    Died  June  30,  1804. 

52d  North  Carolina. 

3,  '03. 

Ohio.     Dred  Aug.  9,  1803. 

39th  Mass.,  age  22. 

22,  '04. 

179!) 

Thompson,  K.W.,Pt.,G, 

July  22. 

Left.     Surg.  F.  N.  Barnes,  110th 

1841 

Walker,    S.,   Lieut.,  D, 

Dec.  13. 

Right.     Surg.  C.  Gray,  7th  N.  Y. 

53d  Ohio,  age  23. 

22,  '64. 

Illinois.    Died  Nov  2,1864. 

133d  Penn. 

13,  '62. 

Died  Dec.  18,  1802. 

1800 

Thompson,  Tr.,Pt.,I,  12th 

May  15, 

Right.    Died  June  27,  1804. 

1842 

Wallace,   W.  C.,  Capt., 

Aug.  19, 

Left;  cire.     Surg.  W.  V.  White, 

Virginia. 

15,"04. 

A,  Olst  Virginia. 

19,  '04. 

57th  Mass.    Died  Aug.  22,  1804. 

1801 

Thorp,    E.,   Pt.,  G,    1st 

Aug.  4, 

L't  :circ.  A.A.Surg.W.S.Adams. 

1843 

2Ward.D.,  Corp'l,  H,13th 

Oct.  19, 

R't.    Surg.  G.  T.  Stevens,  77th  N. 

Penn.  Art'y,  age  20. 

5,  '04. 

Haam.;  fern.  art.  tied.  Died  Aug. 

West  Va.,  age  19. 

20,  '04. 

Y.    Dec.  30,  rein,  of  bone.    Died 

12,  '64:  hsem.    Specs.  3929,  3900. 

Jan.  10,  '65.    Spe.cs.  4219,  4223. 

1802 

Tickner,  W.,  Pt.,  D,9Cth 

Sept.  17, 

Left.     Died  Nov.  10,  1862. 

1844 

IFard,  GMT.,  Pt.,K,  13th 

July  3, 

Left;  (also  wound  of  right  leg.) 

Pennsylvania. 

17,  '02. 

North  Carolina. 

3,  fe. 

Died  July  12,  1863. 

180:i 

Tiller,  G.  M.,  Lieut..  C. 

Dec.  15, 

Right;  circ.;  (also  w'nd  left  leg.) 

1845 

Ward,  J.,  Pt.,  C,  98th  N. 

May  16, 

Right.      Died   August  29,  1804  ; 

04th  Miss.,  age  20. 

15,  '64. 

A.A^Surg.F.B.Nossinger.   Died 

York,  age  21. 

16,  '64. 

exhaustion. 

Jan'l,  1865;  tetanus. 

1846 

Ward,  J.  H.,  Pt.,  D,  27th 

May  12, 

—  .     Surg.  L.  W.  Bliss,  51st  N. 

1804 

Tillinger,  C.,  Lieut.,  K, 

Aug.  10, 

.     Died  Sept.  5,  1861. 

Massachusetts. 

12,  '04. 

Y.    Died  May  —  ,  1804. 

3d  Missouri. 

10.  '01. 

1847 

Warner.  J..  Serg't,  F,  28th 

June  17, 

Right.     Surg.  E.  B.  Glick,  40th 

1805 

Tindall,  J.,  Pt.,  E,  1st 

Feb.  8, 

Left.     Died  Feb.  13,1804.    Spec*. 

Kentucky. 

17,  '04. 

Indiana.    Died  June  20,  1864. 

Delaware,  age  38. 

8,  '04. 

2115,2087,2041. 

18-18 

Watsoti,  J.  £T,Pt.,T,  26th 

June  3, 

.     Died  June  11,1864;  diar 

1806 

Tinker.G..  Corp'l,  I,  27th 

Nov.  25, 

Left;  circ.    Died  Jan.  25,  1864. 

North  Carolina. 

3,  '64. 

rhea. 

Illinois,  age  19. 

27.  '03. 

1849 

Watts,  T.,  Pt.,   F,  26th 

Nov.  27, 

Right.     Died  Dec.  9,  1863. 

1807 

Tipton,  S.,  Pt.,  II,  97th 

June  27, 

Left.     Surg.  J.H.  Hutchison,  15th 

Pennsylvania. 

27,  '63. 

Indiana. 

27,  '64. 

Mich.     Died  July  20,  180-1. 

1850 

Wearer,  A.,  Pt.,  G,  63d 

June  29, 

Right.     Died  June  29,  1864. 

1808 

Todd.O.W.,  Major,  91st 

Dec.  13, 

.     Died  Dec.  1  9,  1802. 

Georgia. 

29,  '64. 

Pennsylvania. 

13,  '62. 

1851 

Webster,   /?.  L.,  Pt.,   A, 

May4,'63, 

Left;  cirn.     Died  June  17,  1863; 

1809 

Tomilson,  A.,  Pt.,  I,  39th 

Aug.  10, 

Right;  circ.     Haem.     Died  Sept. 

21st  North  Carolina. 

Primary. 

debility. 

Illinois,  age  21. 

16,  '04. 

14,  '04  ;  syncope. 

1852 

Week,  I..Pt.,  D,  1st  New 

Dec.  13, 

Right.   'Died  March  21,  1863. 

1810 

Tomlinson,    A.,  Pt.,  E, 

June  1  , 

Right  ;  circ.     Surg.  P.  E.  Hubon, 

York  Artillery. 

13,  '62. 

110th  Penn.,  age  30. 

1,  '04. 

28th  Mass.    Died  June  18.  1804. 

1853 

Weir,J.  A.,  Pt.,  K,  3d 

July  —  , 

—  .     Died  July  8,  1863  ;  erysip 

1811 

Tompkins.G.,  Pt.,G,84th 

Dec.  31, 

Left.    Died  Jan.  19,  1863. 

Virffinia. 

—  ,':63. 

elas  ;  tetanus. 

1812 

Illinois. 
Tourtelotte.C.  A.,  Serg't, 

31,  '62. 
June  18, 

Left.     Died  August  15,  1864. 

1854 

Welin,  P.,  Pt..E,  1st  Min 
nesota. 

July  3, 
3,  '63. 

Left.     Died  July  26,  1863. 

II,  18th  Conn. 

18,  '64. 

1855 

Weller.G.  A.,Pt.,C,  54th 

May  15, 

Left.    Died  June  14,  1864. 

1813 

Toy,  J.,  Pt.,  E,  7th  Mis 

June  25, 

Left  ;  circ.     Surg.  J.  S.  Reeves, 

Pennsylvania. 

15,  '64. 

1814 

souri. 
Trauseht,  N.,  Pt.,F,  14th 

Oct.  19, 

78th  O.  Died  July  9,  '63  ;  pyiem. 
Right  ;  ant.  post,  flap  ;  (also  w'nd 

1850 

Wells,  'E.,   Pt.,  I.    12th 
Iowa,  age  21. 

Dec.  16, 
16,  '64. 

Right  ;  ant.  post.  flap.   Surg.  S.  W. 
Huff,  12th  Iowa.     Profunda  lig. 

Maine,  age  28. 

19,  '64. 

left  arm.)  Sphacelus;  phlebitis. 

Died  Dec.  21,  '64-;  haemorrhage. 

1815 

Tremlett,  II.  M.,  Lieut. 

Mar.  30, 

Died  Nov.  15,  '64  ;  pyaemia. 
Left.     Died  June  6,  1865. 

1857 

W'elman,  W.  F.,  Pt.,  I, 
1st  Minnesota. 

July  3, 
3,  ^S. 

Left.     Died  August  2,  1  863. 

Col.,  39th  Mass. 

30,  '05. 

1-..- 

Wesley,  D.  F.,   Corp'l, 

Oct.  19, 

Right.     A.  Surg.  W.  H.  B.  Past, 

1816 

Trimmer,  Adam,  Pt.,  H, 
143d  Penn.,  age  21. 

June  18, 
19,  '64. 

Left.    Died  August  14,  '04  ;  irri 
tative  fever. 

K,  128th  New  York. 

20,  '64. 

128th  N.  Y.    Femoral  lig.    Died 
Nov.  1,1864;  exhaustion. 

'  LIUELT,  (J.  A.),  Suppuratire  Osteo- Myelitis  (Acute)  following  Primary  Amputation  of  Left  Thigh  for  Gunshot  Injury,   in  United  States  Sanitary 
Commission.  Memoirs,  1870,  Surgical  Volume  I,  p.  280. 

*M(T.n.I.  (G.  M.),  in  rHwrratiort  Ttool-.     Ante-Mortnns  a»,J  Pnst-.Vortemx, Baltimore,  1805-66,  page  3. 


SECT.  III.] 


PRIMARY    AMPUTATION    OF    THIGH    IN    LOWER   THIRD. 


267 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1859 

Weymouth,   C.,   Pt.,  B, 

Feb.  11, 

Right  ;  circ.    Died  A  pril  20,  1865  ; 

1889 

irinw,J"..7.,Pt.,Clynch's 

Dec.  13, 

Right  ;  flap.  Surg.  E.  Hutchinson, 

3d  K.  H.,  age  19. 

11,  '65. 

pyaemia. 

Ga.  Battery,  age  18. 

14,  '64. 

137th  N.  Y.     Died  Jan.  20,  '65; 

J860 

Wheeland,   \V.  J..  Pt., 

April  1, 

Left  ;  ant.  post,  flap.     Died  April 

pysemia. 

E,  207th  Penn.,  age  32. 

1,  '65. 

16,  1865;  pyaemia. 

L89I 

Wood,  C.,  Pt.,A,  8th  N. 

June  5, 

Right;   cire.     Dr.  A.  Garcelon. 

1861 

AVheeler,  S.  P.,  Pr.,  H, 

May  15, 

Left.     Died  June  14,  1864. 

Y.  H.  A.,  age  20. 

5,  '64. 

Died  Aug.  1,  1864.     Spec.  2380. 

33d  Mass. 

15,  '64. 

1891 

Woodcock,  H..  Pt.,  H, 

June  17, 

Right.     Died  July  13,  '64  ;  shock 

1862 
1863 

(Whelpley,  J.,  Lieut.,  D, 

Mar.  25, 
25  '65. 

Both.     Died  March  25,  1865. 

1892 

109th  N.  York,  age  36. 
Woolford,  J.,  Pt.,G,19th 

18,  '64. 
July  30, 

and  irritative  fever. 
Left;  flap.     Surg.  F.  M.  Weld, 

>     ist  Maine. 

Col'd  Troops,  age  27. 

30,  '64. 

27th  C.  T.     Died  Aug.  10,  1864  ; 

1864 

Whitaker,  D.,  Serg't,  A, 

April  1, 

R't;  circ.;  (fract.  left  tibia;)  fem'l 

exhaustion. 

88th  Penn.,  age  20. 

1,  '65. 

lig.  Died  April  20,  '65  ;  pyaemia. 

1893 

Woolford.  W.  H.,  Pt.,  A, 

May  3, 

Right  :  ant,  post,  flap  ;  sloughing 

186"i 

Whituker,  M.,Corp'l,  3d 

Feb.  5, 

Right;  circ.     Surg.  M.  Brucker, 

4th  Virginia,  age  24. 

3,  %3. 

Died  July  13,  1863. 

Ohio  Batterv. 

5,  'C4. 

23d  Indiana.     Died  Mar.  26,  '64. 

1894 

Wray,  T.  S.,  Corp'l,  F, 

May8, 

Right  ;  double  flnp.     Died  Sept. 

186(i 

White,   S.,   Pt.,    I,   33d 

Julv  20, 

;  (also  wound  of  other  leg.) 

10th  Penn.  Res.,age  33. 

8,  '64. 

3,  1864. 

Indiana. 

—  ,  '64. 

Died  July  30.  1864. 

1895 

Wright,  G.  W.,  Serg't, 

May  5, 

Right.     Died  May  11,  1864. 

1867 

White,    B.  W.,  Pt.,   D, 

May  15, 

Right.    Died  June  12,  1864. 

G,3d  Vermont, 

5,  '64. 

118th  Ohio. 

15,  Vi4. 

1896 

Wright,  W.,  Pt.,  B,  8th 

May  7, 

Lfift.     Died  June  26,   1864;  ex 

1868 

White,    C.  D.,  —,    4th 

Deo.  16, 

Right;  flap.    Surg.  J.  R.  Ludlow, 

Connecticut,  age  47. 

7,  '64. 

haustion. 

Louisiana,  age  36. 

17,  '64. 

U.  S.V.    Died  Jan.  21,  1865. 

1897 

Yeagher,  F.,  Corp'l,  C, 

June  17, 

Right  ;  circ.  Surg.  J.  W.  Wishart, 

1869 

White,  If.  C.,  Pt,  H,  1st 

Julv  3, 

Right,     Surg.  J.  L.  Dunn,  109th 

26th  Mich.,  age  44. 

17,  '64. 

140th  Penn.     Haeni.;  lig.;  gang. 

North  Carolina. 

3,  '63. 

Penn.     Died  July  5,  1863. 

Died  July  5,  '64;  sec.  haem. 

1870 

White,  J.  S.,Pt.,D,  55th 

May  14, 

Right.     Died  June  14,1864;  ex 

1898 

Yockey,  P.,  Pt.,  D,  29th 

July  22, 

Right.     Sept.,  1864,  reamp.  mid. 

Penn.,  age  40. 

14,  '64. 

haustion. 

Ohio,  age  29. 

22.  '64. 

third.  Haem.;  fern,  and  external 

1871 

Whiteley,  J.,  Pt.,G,  97th 

June  19, 

Right  ;  circ.     Died  July  1,  1864. 

iliac  art'cs  ligated.     (Also  w'nd 

New  York,  age  40. 

19,  '64. 

right  arm.)    Died  April  23,  '65; 

1872 

Whitman,  J.  §.,  Pt.,  I, 

June  26, 

Right.    Died  July  4,  1864. 

chronic  diarrhoea. 

58th  Mass. 

27,  '64. 

1899 

Young,   M.  G.,   Pt.,  D, 

May  17, 

Left.  Gangrene;  diarrhoea.  Died 

1873 

Whitney,  H.  D.,  Pt,,  D, 

Dec.  13, 

.     Surg.  C.  S.  Wood,  66th  N. 

23d  Iowa. 

17,  '63. 

August  6,  1863. 

145th  Penn. 

13,  '62. 

York.    Died  Jan.  11,  1863. 

1900 

Young,  W.  F.,  Pt.,   A, 

Oct.  19, 

Left  ;    lat.  flap.     Hsem.;   inferior 

1874 

Wilcox.  D.,   Serg't,   K, 

Nov.  25, 

Right.     Surg.  E.  J.  Buck,  18th 

114  thN.  York,  age  26. 

19.  '64. 

perforating  artery  ligated.   Died 

103d  Illinois. 

25.  '63. 

Wis.    Died  Dec.  19,  1863. 

Nov.  27,  1864;  exhaustion. 

1875 

Wild,  W.  H.,  Corp'l,  C, 

Sept.  30, 

Left,     Died  Oct.  29,  '64  ;  pyaemia. 

1901 

Anderson,    H.,   Pt.,    D, 

Sept.  1, 

Right;  (alsow'ndlefthip.)   Surg. 

118th  Penn.,  age  31. 

Oct.  1,  '64. 

39th  Georgia. 

-,  '64. 

A.  C.  Messenger,  57th  Ohio. 

1876 

Wiley,    A.   J.,   Pt,,    H, 

June  I, 

Left  ;  circ.  Surg.D.F.McKinney, 

1902 

Barnum,  J.  C..  Corp'l, 

Aug.  31, 

Left.    Surg.  J.  A.  Lair,  53d  Ohio. 

87th  Penn.,  age  26. 

2,  '64. 

87th  Penn.     Gang.     Died  June 

D,  29th  Mississippi. 

31,  '64. 

9,  1864:  asthenia. 

1903 

Brockley,  W.,  Pt.,  D,  8th 

April  20, 

Right;  semi-lunar  flaps.     Surg. 

1877 

Wilhelm,  E.,  Pt.,  F,  81st 

Mar.  25, 

Left.    Died  April  8,  1865. 

North  Carolina. 

20,  '64. 

C.  H.  Ladd,  C.  S.  A. 

Penn.,  age  16. 

26,  '65. 

1904 

Casner,  D.,  Pt,,  E,  122d 

June  1, 

Left. 

1878 

Wilkes.J.,  Corp'l,  I,170th 

June  22, 

Left.     Surg.  J.  A.  Douglass,  llth 

Ohio. 

-,  '64. 

New  York,  use  31. 

22,  '64. 

Mass.     Died  July  12,  1864. 

1905 

Eggleston.    A.,    Pt.,  D, 

May  15, 

Right. 

1879 

Wilkon,  R.,Serg't,C,lst 

June  14, 

Right,    Died  Aug.  10,'63  ;  wound 

lllth  Penn. 

—  ,  '64. 

Louisiana. 

14,  '63. 

and  diarrhoea. 

1906 

Fender,  F.  D.,  Pt,,  G.lst 

Sept,  30, 

Left  ;  circular. 

1880 

Will,  T.,  Pt.,  G,21st  Pa. 

June  16, 

Right  ;  ant.  post.  flap.    Died  July 

South  Carolina. 

30,  '64. 

Cavalry,  age  39. 

16,  '64. 

31,  1864. 

1907 

Fierhaut,  R.,  Pt.,  B,  2d 

June!?, 

Right.     Not  a  pensioner. 

1881 

Willard,  A.,  Pt.,  G,  97th 

Sept,  17, 

Right.     Died  October  14,  1862. 

P.  H.  B.  Md. 

—  ,  '64. 

New  York,  age  26. 

17,  '62. 

1908 

Gnlledge,  J.,  Pt.,  D,  21st 

May  16, 

;  posterior  flap  ;  sloughing. 

1882 

Willard,  G.  W.,  Corp'l, 

Aug.  19, 

R't;  circ.   Surg.W.V.White,57th 

S.  Carolina,  age  51. 

17,'  '64. 

H,  57th  Mass.,  age  35. 

20,  '64. 

Mass.  Died  Sept.  16,'6'4  ;  pyaem. 

1909 

Harlien,  T.,  Pt.,  A,  12th 

June  2, 

1883 

1  Williams,   A.,   Pt.,  —  , 

Sept.  17, 

Left;  flap.     Confed.  surg.     Died 

Georgia. 

2,  '64. 

13th  Miss.,  age  25. 

is,  '62. 

Sept,  21,  1862;  pyaemia. 

1910 

McSparrain,  J.  W.,  Pt., 

May  27, 

Right.     Not  on  the  Pension  List. 

1884 

Williamson"  I'.  G.,  Pt,, 

July  3, 

Right.    Died  Sept.  5,  1863;  haem 

I,  62d  Penn. 

—  ,  '62. 

D,  5th  Texas,  age  24. 

3.  '63. 

orrhage. 

1911 

Nelson,  R.,   Pt.,  G,  7th 

Sept.  29, 

Left.     Not  a  pensioner. 

188.5 

Willis,  J.,  Pt.,  K,  2d  In 

July  3, 

Right.     Died  July  26,  1863. 

Col'd  Troops,  age  20. 

—  ,  '64. 

fantry. 

4,  '63. 

1912 

Powell,  T.  F.,  Adj't,  23d 

May  —  . 

.     Surgeon  W.  B.  Fox,  8th 

1886 

Wilson,  J.,  Pt.,  A,  27th 

Nov.  24, 

Right  ;  circ.    Surg.  B.  N.  Bond, 

North  Carolina. 

—  ,  '64. 

Michigan. 

Missouri. 

24,  '63. 

27th  Missouri.     Died. 

1913 

Price,  J.  W.,  Pt.,  I,  30th 

Sept.  ], 

Right  ;  flap.     Surgeon  J.  Pogue, 

1887 

Wilson,  T.  A..  Capt.,  B, 

April  1, 

.     Died  April  25,  1865. 

Georgia. 

1,  '64. 

66th  Illinois. 

146th  New  York. 

1,  '65. 

1914 

White,  J.  K.,  Corp'l,  B, 

April  20, 

Right;   Semi-lunar  flaps.     Surg. 

1888 

Wimberlij,    W.,  Pt.,  D, 

Dec.  16, 

Left  ;  lateral  flap.     Died  Dec.  18, 

24th  N.  C. 

20,  '64. 

C.  H.  Ladd,  C.  S.  A. 

4(>th  Tennessee,  age  22. 

17,  '64. 

1864  ;  haemorrhage. 

In  two  of  the  nineteen  hundred  and  fourteen  cases  the  amputation  of  the  thigh  was 
followed  by  successful  re-amputation  at  the  hip;2  in  five,  the  opposite  limb  was  amputated 
either  in  the  leg  or  in  the  ankle  joint;3  and  in  nine,  the  amputation  in  the  thigh  was  accom 
panied  by  operations  in  the  upper  extremities.4  The  seat  of  fracture  was,  in  the  lower  third  of 
femur,  in  four  hundred  and  twenty-six;  in  the  knee  joint,  in  eleven  hundred  and  thirty-three; 

1  FISHER  (G.  J.),  Report  of  Fifty-sei-en  Casts  of  Amputations  in  the  Hospitals  near  Sharpsburg,  Md.,  after  the  Battle  of  Antietam,  Sept.  17,  1862, 
in  Am.  Jour.  Me,d.  Sci.,  1863,  Vol.  XLV,  p.  47. 

2Case  of  Private  J.  Fabry,  K,  4th  Artillery  (TABLE  XXXII,  No.  267,  p.  248;  CASE  330,  p.  153;  and  TABLE  XVIII,  No.  2,  p.  159,  ante),  and  rase 
of  Private  R.  A.  Vide,  E,  43d  North  Carolina  (TABLE  XXXII,  No.  890,  p.  255;  CASE  334,  p.  157;  and  TABLE  XVIII.  No.  6,  p.  150). 

3  Sergeant  P.  Bradley,  16th  Michigan  (TABLE  XXXII,  No.  1071,  p.  257),  amputation  of  left  thigh  and  right  leg,  fatal    Pt.  C.  L.  Johnson,  B.  1st 
Tennessee  (TABLE  XXXII,  No.  1402,  p.  261),  amputation  left  thigh  and  right  leg,  fatal;  Pt.  L.  O.  Lamphere,  G,  21st  Connecticut  (TABLE  XXXII,  No. 
1445,  p.  262),  amputation  left  thigh  and  right  leg,  fatal ;  Pt.  J.  R.  Lewis,  II.  53d  Georgia  (TABLE  XXXII,  No.  1469,  p.  262),  amputation  of  left  thigh  and 
right  leg,  fatal;  Lieut,  A.  Birmingham.  A,  69th  New  York  (TABLE  XXXII,  No.  1049,  p.  257).  amputation  of  right  thigh  and  left  leg  at  ankle  joint,  fatal. 

4  Private  F.  Rose,  D,  57th  N.  Y.  (TABLE  XXXII,  No.  729,  p.  2j.i,  ante,  and  Second  Surg.  Vol.,  TABLE  LXVIII,  No.  892,  p.  71  J).  amputation  of  thigh 
and  arm,  recovery ;  Capt.  II.  Kircher,  E,  12th  Mo.  (TABLE  XXXII,  No.  471,  p.  250,  and  Second  Surg.  Vol..  TABLE  LXX,  No.  481,  p.  727),  amputation  of 
left  thigh  and  right  arm,  recovery;  Pt.  J.  S.  Fay,  F,  13th  Mass.  (TABLE  XXXII,  No.  273,  p.  248,  and  Second  Surg.  Vol.,  TABLE  CXXXIII,  No.  378,  p.  972), 
amputation  thigh  and  forearm,  recovery;  Corp'l  C.  Lawrence,  E,  90th  N.  Y.  (TABLE  XXXII,  No.  503,  p.  251.  ante,  and  Second  Surg.  Vol.,  TABLE  CXXXIII, 
No.  463,  p.  973),  amputation  of  thigh  and  forearm,  recovery;  Corp'l  T.  Costello,  E,  93d  Ind.  (TABLE  XXXII,  No.  167,  p.  247,  ante,  and  Second  Surg.  Vol. 
TABLE  CXXXIII,  No.  679,  p.  975),  amputation  of  thigh  and  forearm,  recovery;  Corp'l  A.  Kretzler,  D,  162d  N.  Y.  (TABLE  XXXII,  No.  487,  p.  250,  ante, 
and  Second  Surg.  Vol.,  TABLE  CXXXIII,  No.  756,  p.  976),  amputation  of  thigh  and  forearm,  recovery;  Corp'l  G.  W.  Hays,  K,  2d  Mich.  (TABLE  XXXII, 
No.  1336,  p.  260,  ante),  amputation  of  left  thigh  and  excision  of  right  knee  joint,  fatal;  Pt.  N.  W.  Henderson,  E,  123d  Ohio  (TABLE  XXXII,  No.  1338, 
p.  260,  ante,  and  Second  Surg.  Vol.,  TABLE  CXXVII,  No.  27,  p.  952).  amputation  of  thigh  and  excision  of  ulna,  fatal;  Pt.  J.  Van  Vliet,  II,  107th  N.  Y. 
(TABLE  XXXII,  No.  1833,  p.  266,  antf,  and  Second  Surg.  Vol.,  TABLE  CXXVII,  No.  66,  p.  952).  amputation  of  thigh  and  excision  of  radius,  fatal. 


268 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


IOHAP.  X. 


in  the  leg,  in  three  hundred  and  fifty-three;  and  in  the  foot,  in  two  instances.  Pyaemia  was 
noted  in  one  hundred  and  twenty-eight,  gangrene  in  one  'hundred  and  twelve,  and  tetanus 
in  seven  instances. 

Primary  Amputations  in  the  Shaft  of  the  Femur  without  Indication  of  the  Seat  of 
Incision. — Three  hundred  and  forty-five  primary  amputations  in  the  thigh  were  recorded 
in  which  the  precise  seat  of  the  operation  was  not  specified.  The  cases  are  well  authen 
ticated,  but  the  histories  are  frequently  deficient  in  detail.  In  twenty-one  the  issue  as  to 
fatality  could  not  be  ascertained.  Thirty-nine  were  successful  and  two  hundred  and  eighty- 
five  fatal,  a  mortality  of  87.9  per  cent.  The  thirty-nine  successful  operations  were  per 
formed  on  Confederate  soldiers;  the  two  hundred  and  eighty -five  fatal  operations  were 
performed  on  two  hundred  and  eighty-one  patients,  of  whom  two  hundred  and  thirty-six 
were  Union  and  forty-five  were  Confederate  soldiers.  The  operations  were  on  the  right 
side  in  one  hundred  and  five,  on  the  left  in  one  hundred  and -seven,  and  in  one  hundred 
and  thirty-three  instances  the  side  was  not  indicated.  Brief  abstracts  of  the  cases  will  be 
found  in  the  following  table : 

TABLE  XXXIII. 

Summary  of  Three  Hundred  and  Forty-Jive  Cases  of  Primary  Amputations  in  the  Thigh  for  Shot  Frac 
ture,  the  Point  of  Ablation  unspecified. 

Recoveries,  1—39 ;  Deaths,  40—324 ;  Results  unknown,  325 — 345. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPKRATOHS, 
RESULT. 

1 

Allen,  J.  T.,  Pt.,  F,  2d 

Aug.  20, 

—  .    Surg.  —  Thomas,  C.  S.  A. 

27 

Mullin,  T.  Q.,  Serg't,  E, 

May  31, 

.  Surg.  J.  T.  Gilmore.C.S.A. 

Florida. 

21,  '62. 

Recovery. 

llth  Mississippi. 

31  ,  '62. 

Disch'd  July  7,  1862. 

2 

Ard,  G.  W.,  Pt.,  K,  2d 

Sept.  17, 

Right.  Surgs.  G.  H.  Humphreys, 

'  28 

Pascoe,    C.   F.,  Pt.,  D, 

May  6, 

.    Surg.  D.  G.  Peats,  C.  S.  A. 

Georgia,  age  29. 

17,  '62. 

9th  N.  Y.,  and  T.  H.  Squire,  89th 

21st  Mississippi. 

7,  '64. 

Recovery. 

3 

Ashby,  D.  D.,  Pt.,  Jeff. 

July  3, 

N.  Y.     Disch'd  May  16,  '63. 
.     Surg.  —  Stone,  C.  S.  A. 

29 

Pitman,  W.  E.,  Lieut., 
E,  10th  Virginia. 

Aug.  9, 
11,  '62. 

.     Su'rg.W.Campbell.C.S.A. 
Recovery. 

4 

Davis  Legion. 
Bennett,  R.ll.,  Serg't.G, 

3,  '63. 
May  6, 

Recovery. 
.     Surg.  P.  Griffin,  C.  S.  A. 

30 

Powe,  T.  E.,  Captain,  C, 
8th  South  Carolina. 

July—  , 
—  ,  '63. 

Left.     Transferred  Sept.  14,  1863. 

18th  Mississippi. 

7,  '64. 

Recovery. 

31 

Raftray,  P.,  Pt.,  C,  21st 

May  6, 

Left.    Surg.  D.  G.  Peats,  C.  S.  A. 

5 

Bones,  T.  M.,  Serg't,  A, 

Sept.  19, 

.     Surg.  —  Griggs,  C.  S.  A. 

Mississippi. 

6,  '64. 

Recovery. 

6 

5th  Georgia. 
Booker,  J.  F.,  Serg't,  E, 

19,  '63. 
May  20, 

Recovery. 
.     Surg.  —  Headley,  C.  S.  A. 

32 

Rogers,  W.,  Pt.,  D,  33d 
Alabama. 

Sept.  20, 
20,  '63. 

.     Recovery. 

7th  Arkansas. 

20,  '62. 

Recovery. 

33 

Smith,  G.  T.,  Corp'l,  D, 

June  24, 

.     Surg.  J.  B.  Fontaine,  C. 

7 

Brown,  H.  C.,  1st  Georgia. 

Sept.  14, 

Left.  Point  Lookout  for  exch'nge. 

35th  Mississippi. 

24,  '63. 

S.  A.     Recovery. 

15,  '62. 

Dec.  13,1862.                                      34 

Smith,  S.  P.,  Pt.,  F,  16th 

Dec.  13, 

.     Surgeon  —  Snell,  C.  S.  A. 

8 

Caldwell,  J.,  Pt.,  H,  45th 

July  18, 

.     Recovery. 

Mississippi. 

13,  '62. 

Recovery. 

9 

Virginia. 
Carter.  H.,  Pt.,  A,  6th 

18,  '64. 
June  21, 

.     Surgeon  E.  M.  Seabrook, 

35 

Stewart,  J.  W.,  Pt.,  F, 
44th  Alabama. 

May  25, 
25,'  '64. 

Left.     Furloughed  July  24,  1864. 

Virginia. 

2:3,  '62. 

C.  S.  A.     Recovery. 

36 

Walker,   L.   A.,  Corp'l, 

April  14, 

.    Sure:.  —  Foulks,  C.  S.  A. 

10 

Clifttm.  T.  B..  Pt.,  I,  1st 
North  Carolina. 

July  2, 
2,  fe. 

.     Surg.  J.  B.  M.  Cromwell, 
P.  A.  C.  S.    Recovery. 

37 

Rogue's  Battalion. 
Wayne,  J.   J.,   Pt.,   A, 

14,  '63. 
July  10, 

Recovery. 
Left.     Nov.  19,  extr.  nee.  bone. 

11 

Dukes,  A.,  Pt.,  C,  17th 
Mississippi. 

July  —  , 
—  ,  '63. 

.     Transferred  Oct.  21,  1863. 

llth  Georgia,  age  33. 

11,  '63. 

Gangrene.     Exchanged  March 
3,  J864. 

12 

Eden,  C.  At.,  Serg't,  H, 

June  27, 

.     Recovery. 

38 

White,   D.    A.,   Pt.,  H, 

Sept.  19, 

.     Surg.  —  Brown,  3d  Ark. 

14th  Alabama. 

27,  '62. 

3d  Arkansas. 

30.  '63. 

Recovery. 

13 

Eller,  S..  Pt.,  H,  Slid  N. 

July  1, 

.     Surg.  —  Parson,  C.  S.  A. 

39 

Williams,  E.  G.,  Serg't, 

May  16, 

.     Recovery. 

14 

Carolina. 
Ether  idge,  J.  D.,  Pt.,  G, 

1,  '63. 
Dec.  13, 

Recovery. 
.     Surg.  —   Huit,  C.  S.  A. 

40 

E,  llth  Virginia. 
Ackerly,  H.  E.,  Pt.,  C, 

16,  '64. 
Dec.  13, 

—  .    Died  Dec.  24,  1862. 

14th  South  Carolina. 

13,  '62. 

Recovery. 

12th  New  York. 

13,  '62. 

15 

Garner,  F.  M.,  Pt.,  C, 

July  14, 

.     Surg.  J.  W.  McGee,  51st 

41 

Alfred,  L.  S.,  Corp'l,  B, 

Sept.  19, 

Left.     Died  October  8,  1863. 

51st  North  Carolina. 

14,  '63. 

N.  C.    Recovery. 

22d  Illinois. 

19,  '63. 

16 

Golladaij,  J.  T.,  Pt.,  I, 
52d  Virginia. 

Aug.  29, 
29,  '62. 

.     Surg.  —  Lewis,  C.  S.  A. 
Recovery. 

42 

Allman,  H.,  Pt.  ,  H,  38th 
Ohio. 

Sept.  1, 
1,  '64. 

Left.     Died  Sept.  8,  1864. 

17 

Grimes,   G.   C.,  Pt.,  C, 
14th  Alabama. 

May  24, 
25,  '64. 

Left.    Furloughed  July  20,  1864. 

43 

Anderson,  W.,  Serg't,  D, 
118th  Pennsylvania. 

Sept.  17, 
—  ,  '62. 

.     Died  September  19,  1862. 

18 

Hartley,  J.,  Pt.,  K,  7th 
Texas. 

Sept.  19, 
19,  '63. 

—  .     Surg.  G.  G.  Roy,  C.  S.  A. 
Recovery. 

I  44 

Armspoker,  J.,  Pt.,   H, 
96th  Ohio. 

Jan.  11, 
11,  '63. 

Left.   Surg.D.  W.Henderson,  9Cth 
Ohio.    Died  Jan.  22,  1863. 

19 

Herring,  J.  F.,  Pt.,   F, 
8th  N.Carolina,  age  42. 

Sept,  30, 
Got.  1,'64. 

Left.     Prison  Feb.  1,  1865. 

45 

Austin,    A.,    Lieut.,   1st 
New  Jersey  Cavalry. 

Aug.  9, 
9,  ?62. 

Right.     Died  August  9,  1862. 

20 

Hurst,   M.,  Pt.,  C,  12th 
Tennessee  Cavalry. 

July  13, 
13,  '64. 

Left.    Recovery. 

46 

Austin,  C.,  'Pt  ,  F,  18th 
Mass.,  age  26. 

Sept.  17, 
—  '62. 

.     Died  September  24,  1862. 

21 

Jackson,  J.  T.,  Pt.,  1,  1st 
Georgia,  age  18. 

Right.     Exchanged  Jan.  16,  '65. 

47 

Bachelor,  A.,  Pt.,  D,  5th 
Michigan. 

May  5, 
5,  ''62. 

—  .     Died  May  5,  1862. 

22 

Kiser,  J.  F.,  Pt.,  E,  25th 
Virginia. 

June  8, 
8,  '62. 

Left.     Surgeon  —  Opie,  C.  S.  A. 
Disch'd  August  29,  1862. 

48 

Baker,   E.,   Pt,  A,  6th 
Missouri. 

May  15, 
15,  '64. 

Right.     Surg.  S.  P.  Bonner,  47th 
Ohio.     Died  May  26,  1864. 

23 

Kissenger,  H.  H.,  Pt.,  F, 
24th  Virginia. 

Sept.  29, 
29.  '64. 

—  .     Surg.  —  Hope,  C.  S.  A. 
Recovery. 

49 

Baird,    R.,    Pt.,    C,   3d 
Tow&. 

July  12, 
)  '63. 

Left.     Died  July  15,  1863. 

24 

LeRoy,  J.,   Pt.,  D,  8th 
Alabama. 

Aug.  16, 
16,  '64. 

.     Surg.  —  Royston,  C.  S.  A. 
Recovery. 

50 

Barger,  J.   E.,    Pt.,    G, 

2(1  Virginia  flfiTC  40. 

May  30, 
—  ,  '64. 

Right.     Died  Junel4,'64;  pyaem. 

25 
26 

AlcCray,  J.  11.,  Pt.,  F, 

Sept  30, 
Oct.  1,'64. 
April  16, 
16,  '62. 

Left.     Prison  February  18,  1865. 

—  .     Surg.  —  White,  C.  S.  A. 
Recovery. 

51 
52 

Baxter,  C.,  Corp'l,  C,  9th 
New  York  Cavalry. 
Benson,  A.J.,Pt.,l,  5th 
Alabama. 

Aug.  29, 
29,  '64. 
May  5, 
5,  '64. 

Right.     Died  Sept.  1.  1864. 
Right.     Died  May  28,  1864. 

28th  Georgia,  age  30. 
Mealor,  JF.P.,Pt.,  Troup 
Artillery. 

1                                                                             li                                                                      i 

SECT.  III.] 


PRIMARY    AMPUTATIONS    OF    THE    THIGH. 


269 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPKKATOUS, 
RESULT. 

53 

Bernard,  O.,  Lieut.,  G, 

Deo.  17, 

.     Surg.  H.  P.  Ritter,  8th  N. 

99 

Dubindach,   C.,  Pt.,  C, 

July  14, 

Left.     Died  July  15,  1864. 

10th  North  Carolina. 

17,  '62. 

Carolina.     Died  Dec.  17,  1862. 

33d  Missouri. 

14,  '64. 

54 

Beverly,  G.  H.,  Pt.,  C, 

Dec.  13, 

.    Died  December  26,  1862. 

100 

Eddy,  A.  R.,  Pt,,  H,  1st 

Oct.  8, 

—  .     Died  October  10,  1862. 

3U  Cavalry. 

13,  '62. 

Mich.  Engineers. 

8,  '62. 

55 

Bishop,    G.    T.,    Pt.,    I, 

July  3, 

Left.     Died  July  12,  1863. 

101 

Edwards,  L>.,  Pt.,  B,  61st 

Sept.  30, 

Left.    Died  October  25,  1864  ;  py 

141st  Pennsylvania. 

3,  r(i3. 

North  Carolina,  age  44. 

30,  '64. 

aemia. 

56 

Blackburn,  i'.,   Pt.,    E, 

Aug.  30, 

—  .    Died  September  19,  1862. 

102 

Eikley,   G.,   Serg't,    E, 

Nov.  27, 

Right.    Died  December  11,  1863. 

73(1  Pennsylvania. 

30,  '62. 

7th  Ohio. 

27,  '63. 

57 

Blaisdell,  J.  H.  D.,  Pt., 

May  27, 

Right.    Died  May  30,  1863. 

103 

Ellis,  A.   C.,  Pt.,  B,  2d 

July  1, 

Right.    Dr.  Crawford.  Died  July 

H,  15th  New  Hani  p. 

27,  '63. 

Florida. 

3,  '62. 

4,  1862. 

58 

Blaxhaui,  R.,  Corp'l,  E, 

Sept.  17, 

—  .     Died  September  28,  1862. 

104 

Ershman,    F.,    Pt.,    G, 

July  1, 

.     Died  July  2,  1863. 

9th  New  York. 

17,  '62. 

147th  N.  Y.,  age  40. 

2.  r63. 

59 

Bohor,  A  ,  Pt.,  H,  100th 

June  1, 

Left;  (also  wound  right  thigh;) 

105 

Estergreen.  F.,  Pt.,  H, 

June  20, 

Left.     Died  July  3,  1864. 

New  York. 

1,  '62. 

gangrene.     Died  Juno  9,  1862. 

89th  Illinois. 

20,  '64. 

CO 

Bousner,  M.,  Pt.,  A,  5th 

May  31, 

.     Died  June  9.  1862. 

106 

Farley.-J.,  Lieut.,  G,  8th 

July  4, 

Left.    Died  December  5,  1863. 

Michigan. 

—  ,  '62. 

Missouri  Cavalry. 

4,  '63. 

61 

Bower,  A..  Pt.,  E,  lllth 

Mar.  31, 

Right.    Surg.W.Vasburgh,  lllth 

107 

Fichell,  A.,  Pt.,  B,  27th 

May  10, 

Right  ;  circ.     Died  May  18,  1864. 

New  York. 

31.  '65. 

N.  Y.     Died  March  31  ,  1865. 

Michigan,  age  20. 

10,  '64. 

62 

Boyles,  B.,  Pt.,  I,  28th 

July  12, 

Left.    Died  July  15,  1863. 

108 

Finlay,  J.,  Pt.,   C,  52d 

Dec.  13, 

—  .     Died  December  20,  1862. 

Illinois. 

—  ,  '63. 

New  York. 

13.  '62. 

63 

Broad,    L.,   Pt.,   C,   5th 

May  5, 

—  .     Died  May  7,  1862. 

109 

Finley,  M.  K.,  Lieut.,  F, 

April  8, 

—  .     Died  April  21,  1864. 

Michigan. 

5,  '62. 

162d  New  York. 

8,  '64. 

f>4 

Brown,  B.  F.,  Pt.,  C,  22d 

May  7, 

;  (also  w'nds  leg  and  neck.) 

110 

Fish,    E.  A.,  Capt.,  A, 

Sept.  29, 

Left.    Died  October  1,  1864  ;  ex 

Massachusetts,  age  23. 

7,  '64. 

Died  May  17,  '64  ;  ulceration  of 

81st  New  York,  age  42. 

29,  '64. 

haustion. 

jugular  vein.     Autopsy. 

111 

Fitzpatrick,   J.,    Corp'l, 

April  8, 

Left.     Died  April  —  ,  1864. 

65 

Brown,  W.  M.,   Pt.,  G, 

May  14, 

Right.     Died  May  14,  1864. 

F,  173d  New  York. 

8,  '64. 

12th  Illinois. 

14,  '64. 

112 

Flomerfield,  P.,  Pt.,  F, 

Sept.  17, 

Left.     Died  Sept.  18,  1862. 

66 

Burke,  T.  A.,  Lieut,,  E, 

June  15, 

Right.     Died  Sept.  1,  '64  ;  pyaem. 

69th  New  York. 

18,  '62. 

67 

16th  Iowa,  age  23. 
Buslinel).  11.  8.,  Corp'l, 

15,  '64. 
May  12, 

Right.     Died  May  21,  1864. 

113 

Flowers,  M.,Pt.,  H.  101st 
New  York,  age  26. 

Aug.  30, 
30,  '62. 

.    Sept.  19,  haem.,  40  oz.;  lig. 
femoral.      Died  Sept.  24,  1862; 

I,  17th  Michigan. 

12,  '64. 

exhaustion. 

68 

Cautrell,  A.  D.,  Pt.,  D, 

Dec.  31, 

Left.     Died  January  2,  1863. 

114 

Folk,  J.  S.,  Pt.,  B,  141st 

July  3, 

Left;    (also  wound  of  right  hip.) 

18th  Infantry. 

31,  '62. 

Pennsylvania. 

3,  fe. 

Died  July  27,  1863. 

69 

Cartwriarlit,  H.  C.,  Pt., 

April  8, 

Left.    Died  June  8,  1864. 

115 

Fosket,O.,Pt.,F.34thN. 

Dec.  13, 

Left.     Died  December  31,  1862; 

11.  13Uth  Illinois. 

8,  '64. 

York,  age  19. 

13,  '62. 

pyaemia. 

70 

Castar,    S.,   Pt.,    B,   2d 

July  2, 

Right.    Died  July  30,'63;  pyaem. 

116 

Foss,  J.,  Serg't,  C,  59th 

Sept.  17. 

Thigh  and  leg  amputated.    Died 

Wisconsin. 

3,  '63. 

New  York. 

17,  '62. 

Sept.  21,  18(j-3. 

71 

Chapman,  B  ,  Corp'l,  A, 

Feb.  14, 

Right.     Died  February  19,  1865. 

117 

Fouts,  M.N.,  Pt.,  G,  4th 

Oct.  23, 

Right.     Died  October  25,  1864. 

14th  N.  Y.  H'vy  Art. 

14,  '65. 

Missouri  S.  M.  C. 

23,  '64. 

72 

Chasteen.    M.,   Pt.,    D, 

Dec.  15, 

.   A.  Surg.  R.  J.  Hill,  45th  O. 

118 

Freeman,    A.,    Pt.,    A, 

May  15, 

Left;  stump  alive  with  maggots; 

81st  Indiana. 

15,  '64. 

Died  December  16,  1864. 

155th  Penn..  age  31. 

15,  '64. 

bled  to  death  May  26,  1864. 

73 

Cherrington.  C.  H.,  Pt., 

Oct.  19, 

.     Died  October  20,  1864. 

119 

Gartland,  J..  Color  Bear 

Sept.  17, 

Right.    Died  September  25,  1  862. 

K.  36th  Oliio. 

19,  '64. 

er,  A,  72d  Penn. 

17,  '62. 

74 

Clark,    D.    C.,    Pt.,   K, 

June  29. 

Right.     Died  July  1,  1864. 

120 

Gates,    J.,   Pt,,   F,   8th 

Sept.  17, 

Left.     Died  October  14,  1862. 

188th  Penn. 

29,  '64. 

Pennsylvania. 

17,  '62. 

75 

Clarke,    J.,    Serg't,    H, 

Mar.  13, 

—  .     Died  April  7,  1862. 

121 

Gillen,  'N.,  Pt.,   I,  69th 

Sept.  17, 

Left.     Died  September  27,  1862. 

27th  Ohio. 

13,  '62. 

Pennsylvania. 

17,  '62. 

76 

Coleman,  D.  G.,  Pt.,  A, 

May  3, 

Right.     Died  May  26,  1863. 

122 

Gillespie,  K.  G.,  Pt.,  F, 

July  —  , 

.     Died  July  8,  1863. 

30th  North  Carolina. 

3,  r63. 

Phillips'  Legion. 

—  ,  '63. 

77 

Collins,    II.,   Lieut.,  D. 

May  27, 

Left.     Surg.  A.  T.  Hudson,  26th 

123 

Gleasman.    C.,   Pt.,   H, 

Sept.  29, 

Left.    Died  Oct.  1,  1864  ;  haem. 

29th  Missouri. 

27,  '64. 

Iowa.     Died  June  3,  1864. 

117th  New  York. 

29,  '64. 

78 

Collins,    It.   J.,   Pt.,    F, 

Dec.  13, 

Left.    Died  December  30,  1862. 

124 

Glover,  W.  E.,  Pt.,  D, 

July  —  , 

Left.     Died  July  24,  1864. 

108th  New  York. 

13,  '62. 

118th  New  York. 

—  ,  '64. 

79 

Connell,    P.,  Corp'l,  E, 

Jan.  2, 

—  .     Died  Januarys,  1863. 

125 

Godbold,  H.  L.,  Lieut., 

Aug.  23, 

Left.     Died  Sept.  27,  '62  ;  pysem. 

35th  Indiana. 

3,  '63. 

F,  1st  Pa.  Art.,  age  23. 

23,  '62. 

80 

Couteil,  M.  K.,  Pt.,   A, 

Oct.  4, 

—  .     Died. 

126 

Golding,  J.  J.,  Corp'l,  A, 

July  —  , 

.     Died  July  17,  1863. 

13th  Missouri. 

4,  '62. 

3d  Battalion  S.  C. 

—  ,  '63. 

8L 

Cook,   C.   S.,  Corp'l,  I, 

April  13, 

Left.     Died  May  29,  1863;   chr. 

127 

Goodling,  G.,  Pt.,  F,  2d 

Sept.  17, 

Right.     Died  October  21  ,  1862. 

2."ith  Connecticut. 

13,  '63. 

diarrhoea. 

Delaware. 

17,  '62. 

82 

Cooper,   H.  M.,  Pt.,  H, 

AprilS, 

—  .     Died  April  28,  1864. 

128? 

Goodwell,     S.,    Pt.,    G, 

Mar.  30, 

Both.  Surgs.W.  D.  Murray,  161st 

2!)th  Wisconsin. 

8,  '64. 

129$ 

29th  Illinois. 

30,  '65. 

N.  Y.,  and  J.  W.  Angell,  23d 

83 

Cramer,  A.,  Ft.,  F,  31st 

June  5, 

Left.    Surg.B.N.  Bond,  27th  Mo. 

Wis.    Died  March  31,  1865. 

Missouri. 

5,  '63. 

June  12,  artery  sloughed;  nee.; 

130 

Gordon,  J.  B.,  Lieut.,  C, 

June  18, 

Left.     Died  June  19,  1864. 

reamp.      Surg.  C.  G.  Strother, 

1st  West  Virginia. 

18,  '64. 

31st  Mo.     Died  June  22,  1863. 

131 

Goukl,J.M.,Pt.,G,81st 

Aug.  6, 

Left:  circ.  Surg.  W.  H.  Rice,  81st 

84 

Cramer.  S.,  Pt.,  B,  H2d 

July  1, 

Left:  (also  amp.  arm.)  Died  July 

New  Y'ork.  age  21. 

6,  '64. 

N.  Y.    Died  Sept.  3.  1864. 

Pennsylvania. 

1,  '63. 

9,  1863. 

132 

Gould,   P.   II.,    Pt.,    H, 

Oct.  4, 

Right.     Died  October  20,  1862. 

85 

Cronstein,  M.,  Pt.,  F.  3d 

July  3, 

Right.     Died  July  6,  1863. 

8th  Wisconsin. 

4.  '62. 

Infantry. 

3,  f63. 

133 

Gregg,  J.   H.,  Capt.,  I, 

July  3, 

.     Died  July  3,  1863;  shock. 

86 

Cuff,    W.,  Pt.,   D,   llth 

June  7, 

Right.     Died  June  10,  1863. 

137th  New  York. 

3,  '63. 

Louisiana  C.  T. 

-,  '63. 

134 

Grunbine,  C.,  Pt.,  F,  93d 

May  5, 

Right.     Died  May  5,  1864. 

87 

Danfortli,    H.,    Pt.,    H, 

July  20, 

Left  ;  rearap.     Died  July  31,  '64. 

Pennsylvania. 

5,  '64. 

123<1  New  York. 

21,  '64. 

135 

Guy,  A.,  Pt.,  G,  51st  N. 

Oct.  1, 

Right.     Died  October  19,  1864 

88 

Davis,  J.,  Pt.,  F,  40th 

April  6, 

.     Died. 

Carolina,  age  44. 

1,  '64. 

pvasmia. 

Illinois. 

-  '62. 

136 

Gwinn.  F.,  Pt.,  F,  30th 

July  28, 

Left.     Died  September  6,  1864. 

8'J 

Davis,  M.,  Pt.,  E,  2d  N. 

July  —  , 

—  .     Died  July  7,  1863. 

Louisiana. 

28,  '64. 

Carolina  Batt. 

—  ,'  '63. 

137 

Hair,    J.,   Pt..   K,    61st 

June  1, 

Left.    Died  June  11,  1862. 

90 

Davis,  T.J.,  Pt.,  D,  40th 

April  30, 

Left.     Died  June  9,  1864. 

Pennsylvania. 

1,  '62. 

Iowa. 

—  ,  '64. 

138 

Hale,    'W.    H.,   Pt.,    F, 

May  10, 

Left.    Died  May  12,  1864. 

91 

Dawson,  W.  R  .  Pt.,  E, 

May  14, 

Left.     Died  May  23,  1864. 

I52d  New  York. 

10,'  '64. 

139th  Pennsylvania. 

14,  '64. 

139 

Halstead,  S.  F.,  Pt.,  K, 

July  3, 

Left.     Surg.  H.  M.  McAbee,  4tU 

92 

Dean,  W.  C..'  Serg't,  G, 

June  12, 

Right.     Died  June  15,  1864. 

lllth  New  York. 

3,  '63. 

Ohio.     Died  August  2,  1863. 

4(!th  Kentucky. 

12,  '64. 

140 

Hamilton,  J.  S.,  Serg't, 

Oct.  19. 

.     Died  October  20,  1864. 

93 

Deckftt,  J.  M.,  Lieut.,  H, 

July  —  , 

.     Died  July  7,  1863. 

A,  5th  West  Virginia. 

19,  '64. 

2d  N.  Carolina  Battery. 

—  .'  '63. 

141 

Harris,  S.,  Pt,.  H,  90th 

Dec.  15, 

Left.    Died  December  16,  1864. 

94 

Deivnger,  10.,  Corp'l,  E, 

Aug.  30, 

;  circ.     A.  Surg.  J.  A.  Arm 

Ohio. 

15,  '64. 

73d  Pennsylvania. 

30,  '62. 

strong,  73d  Penn.     Died  Sept, 

142 

Haslette,  F.  A.,  Pt.,  C, 

May  6, 

Right.     Died  May  17,  1864. 

22,  1862. 

45th  Pennsylvania. 

6,  '64. 

05 

Dessart.   G.,   Corp'l,   B, 

June  25, 

.     Died  July  18,  1862. 

143 

Hastings.  O.,  Pt.,B,  16th 

July  22, 

Left.     Surg.  II.  McKennan,  17tb 

74th  New  York,  age  21. 

25.  '62. 

Wisconsin. 

22,"  '6-1. 

Wis.     Died  July  22,  1864. 

96 

Devus,  P.,  Pt.,  E.  lllth 

July  2, 

.     Surg.  H.  M.  McAbee,  4th 

144 

Hawley,  R.,   Pt.,  K,  2d 

Oct.  27, 

.     Died  October  31,  1864. 

New  York. 

3,  '63. 

Ohio.     Died  July  12,  1863. 

South  Carolina. 

27,  '64. 

97 

Dooley.    J.,    Corp'l,    I, 

June  1.4, 

.     Died  June~30,  18(53. 

145 

Hewlett,  G.,Pt.,H,  llth 

May  5, 

Left.    Died  May  10,  1862. 

38th  Massachusetts. 

14.  '63. 

Mass.,  age  19. 

5,  '62. 

98 

Doty,    W.    F.,    Pt.,    E, 

Aug.  5, 

;  (also  wound  of  arm.)    Died 

146 

Hoffadin,  J.,  Pt.,  F,  7th 

Dec.  13, 

Right.     Died  January  4,    1863; 

21st  Indiana. 

5,  V62. 

August  6,  1862. 

New  York. 

13,  '62. 

pyaemia. 

270 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


'NO. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

147 

Holmes,  G.,  Pt.,  D,  6th 
New  Jersey. 

May  5, 
-,  fe. 

.    Died  May  10,  1862. 

195 

Martin,    J.,    Pt.,    I    2d 
Rhode  Island. 

May  14, 
14,   '64. 

.     Died  May  15,  1864. 

148 

Hopson,  A.,  Pt.,  B,  4th 

Dec.  13, 

Left.     Died  December  15,  1862. 

196 

Maxwell,  R.,  Lieut.,  H, 

Mav  8, 

Left.    Surg.  J.  J.  Comfort,  1  st  Pa. 

Vermont. 

13,  '62. 

1st  Penn.  Rifles. 

8,  ''64. 

Rifles.     Died  Mav  12,  1864. 

149 

Hubbell,  W.  W.,  Major, 

June  7, 

Right.    Died  June  7,  1864. 

197 

McCright,  C.  M.,  Corp  1, 

April  9, 

.     Died  April  10,  1865. 

62d  New  York. 

7,  '64. 

C,  52d  Indiana. 

9.  '65. 

150 

Hudson,  A.,  Pt..  B,  43d 

Nov.  5, 

.    Died  November  5,  1864. 

198 

McFall,  H.,Pt.,  H,  76th 

.Dec.  13, 

—  .     Died  December  13,  1862. 

Wisconsin. 

5,  '64. 

New  York. 

13,  '62. 

151 

Hughes.  E.,  Pt.,  E,  6th 

Sept.  28, 

Left  :  (also  wound  right  thigh.) 

199 

McMiller,C.,Pt.,C,85th 

Aug.  16, 

Left  ;  sloughing;  bfem.    Aug.  28, 

Colored  Troops. 

—  ,  '64. 

Died  Oct.  12,  1864. 

Pennsylvania. 

16,  '64. 

re-amp,  up.  third.     A.  Surg.  C. 

|l52 

Hughes,  G  .   Serg't,  B, 

July  3, 

Left.    Died  July  7,  1863. 

Wagner,  U.  S.  A.    Died  Sept.  4, 

lOoth  Pennsylvania. 

3,  '63. 

1864  ;  haemorrhage. 

153 

Hughes.  J..  Pt.,  G,  15th 

Sept.  17, 

Left.    Died  September  28,  1862. 

200 

MsNaughton,  J.  B.,  Pt., 

Dec.  13. 

Right.     Died  December  26,  1862. 

Massachusetts. 

—  ,  '62. 

F,  108th  New  York. 

13,  '62. 

154 

Hunter.  M.,  Pt.,  C,  21st 

July  14, 

—  .     Died  July—    1864. 

201 

Merrill,   W.  R.,  Pt.,  A, 

Dec.  13, 

—  .     Died  December  20,  1862. 

Missouri. 

14,  '64. 

6th  New  Hampshire. 

13,  '62. 

155 

Irish,  A.  J.,  Pt.,  G,  9th 

May  20, 

Right.      Died  May  22,  1864  ;  ex 

202 

Men-lit,   H,   Pt.,   1,  33d 

May  3, 

Left.     Died  May  29,  1863. 

Maine,  age  24. 

20,  '64. 

haustion  and  shock. 

New  York. 

3,  '63. 

156 

James,  W.,  Pt.,  I,  122d 

May  6, 

Right.    June  24,  pyaemia.    Died 

203 

Mertins,  H.,  Pt.,  H,  17th 

Nov.  25, 

Right.     Surg.  E.  J.  Buck,  18th 

Ohio,  age  29. 

6,  '64. 

July  2,  1864;  pyaemia. 

Iowa. 

25,  '63. 

Wis.     Died  Nov.  27,  1863. 

J57 

Jasper,   A.    F.,  Pt.,   E, 

May  15, 

Left,     Died  July  24,  1864. 

204 

Miller,  H.,  Pt.,  B,  147th 

July  2, 

Right.     Died  August  3,  1863. 

12th  Virginia. 

15,  '64. 

New  York. 

4,  '63. 

158 

Johnson,  J.,  Pt.,  A,  lllth 

April  2, 

Right.     Died  May  15,  1865. 

205 

Mills.  W.  F.,  Pt.,  E,  8th 

June  16, 

Right  ;  (also  int.  amp.  left  thigh.) 

New  Y'ork. 

2,  '65. 

N.  Y.  H.  A.,  age  42. 

16,  '64. 

Surg.  S.  H.  Plumb,  82d  N.  Y. 

159 

Johnson,  J.  E.,  Pt.,  A, 

July  3, 

Right.    July  22,  hasmorrh.    Died 

Died  June  23,  1864. 

153d  Penn.,  age  22. 

4,  "63. 

July  22,  1863  :  exhaustion. 

206 

Mills,  W.,  Pt.,  A,  130th 

Mar.  9, 

Left.     Surg.  V.  H.  Gregg,  124th 

160 

Jones.  B.  M.,  Pt.,  H,  5th 

May  —  , 

.    Erysipelas.    Died  June  3, 

Indiana. 

9,  '65. 

Indiana.     Died  March  9,  1865. 

North  Carolina. 

-,  '62. 

1862;  pyaemia  and  haemorrhage. 

207 

Montague,  L.,  Serg't,  G, 

Oct.  2, 

Right.     Died  December  1,  1864. 

161 

Jones,  R.  J.,  Pt.,  F,  18th 

Dec.  31, 

.     Died  January  10,  1863. 

12th  Ohio  Cav.,  age  19. 

-,  '64. 

Infantry. 

31,  '62. 

2C8 

Moore,  S.,  Pt.,  G,  51st 

Mav  12, 

Left.    Surg.  J.  S.  Ross,  llth  N.  H. 

162 

iJoyne,   Z>.,   —  ,   —  ,  1st 

, 

.     Re-amp.     Died  of  varioli. 

Pennsylvania. 

12,'  '64. 

Died  May  18,  1864. 

Louisiana. 

—  ,  '63. 

209 

Morrow.  E.  G.,  Capt.,  G, 

July  —  , 

.    Died  July  27,  1863. 

Keevitt,  F.,  Pt.,  I,  68th 

Julv  22, 

Left.    Surg.  H.  McKennan,  17th 

28th  North  Carolina. 

—,'63. 

Ohio. 

22,  "'64. 

Wisconsin.     Died. 

210 

Morton,  H.,  Pt.,  H,  81st 

May  17, 

Right  ;  (also  wound  of  cranium.) 

164 

Kehoe.  T.,  Pt.,  C,  107th 

Sept.  17, 

Right,    Died  September  29,  1862. 

New  York,  age  21. 

17,  '64. 

Died  May  26,  1864. 

Pennsylvania. 

17,  '62. 

211 

Moses,  J.,  Pt.,  K,  80th 

Oct.  8, 

Right.     D'ied  October  14,  1862. 

Kelley,   J.,  Pt.,  A,    1st 

Sept.  17, 

.    Died  September  21,  1862. 

Indiana. 

8,  '62. 

166 

Delaware. 
Kelso.    M.    C.,  Pt..    A, 

—  ,  '62. 
Dec.  13, 
13,  '62. 

Right.     Died  December  29,  1862. 

212; 

.Myer,    C.,  Pt.,  F,   30th 
Missouri. 

June  4, 
4,  '63. 

Both.     Surg.  M.  W.  Robbins,  4th 
Iowa.    Died  June  5,  1863. 

134th  Pennsylvania. 

167 

Kelton,  I.  J.,  Capt.,  21st 

Sept.  1, 

.     Dr.  Miller.  C.  S.  A.     Died 

214 

Nailor,  N.  A.,  Pt.,  B,  4th 

June  —  , 

Left.     Surg.W.S.  Tremaine,  31st 

Massachusetts. 

-,'62. 

September  24,  1862. 

Colored  Troops. 

—  ,  '64. 

Col'd  Troops.     Died  J  uly  8,  '64. 

168 

Kennedy,  J.  B.,  Capt., 

Dec.  13, 

Left.     Died  December  15,  1862  ; 

215 

Needick,  A.,  Serg't,  B, 

Sept.  17, 

.     Died  September  27,  1862. 

D,  1st  "Michigan. 

13,  '62. 

wounds. 

89th  New  York. 

—  ,  '62. 

'701 

Kenner.  H.,  Pt.,  —  ,  4th 

July  —  , 

Both.   Died  July  6,  1863. 

216 

Neice,  T.  F.,  Pt.,  K,  5th 

July  —  , 

.     Died  July  10,  1863. 

1  1  w; 

Virginia. 

—  ,  '63. 

Texas. 

—  '63. 

171 

King,  J.,  Pt.,  A,  7th  In 

Julv  3, 

Right.    Died  July  15,  1863. 

217 

Newsum,  W.  0  ,  Lieut., 

May  —  , 

Left.     Died  May  20,  1864. 

fantry. 

3,  '63. 

H,  4th  Alabama. 

—  ,  '64. 

172 

King,    P.,    Pt.,    B,    5th 

May  3, 

Left.     Died  May  12,  1863. 

218 

Nicholas,  C.,  Pt,,  D,  98th 

May  3, 

Left.     Died  May  12,  1863. 

Vermont. 

-,  '63. 

Pennsylvania. 

3,  '6.3. 

173 

Kinkle,   C.,  Pt.,   I.   23d 

Sept.  19, 

Right;  (also  wound  left  thigh.) 

219 

O'Connor,    M.,    Pt.,    F, 

Sept.  19, 

Left.     Died  September  25;  1863. 

Ohio. 

19,  '64. 

Died  October  —  ,  1864. 

16th  Infantry. 

—  ,  '63. 

174 

Kline,  C.  A.,  Pt.,  E,  26th 

Sept.  19, 

Right.     Died  Sept.  20,  1863. 

321 

Odom,  J.  C.,  Pt.,  G,  18th 

July  —  , 

.     Died  July  12,  1863. 

Ohio. 

19,  '63. 

Georgia. 

-,'63. 

175 

Knight,  B.  F.,  Pt.,I,  9th 

May  22, 

Right  ;  flap.    Surg.  E.  J.  McGoo- 

221 

Orr,  J.  A.,  Pt.,  G,  41st 

July  12, 

.     Died  July  15.  1863. 

Iowa. 

22,  '63. 

risk,  9tb  Iowa.  Died  June  20,  '63. 

Illinois. 

—  ,  '63. 

176 

Koff,   J.,   Pt.,    D,    46th 

May  25, 

Left.    Surg.  W.C.Bennett,  U.  S. 

222 

Ostar,  P.,  Pt,  I,  7th  N. 

Dec.  13, 

Left.     Died  December  30,  1862. 

Pennsylvania. 

25,  '64. 

V.     Died  July  25,  1864. 

York. 

13,  '62. 

177 

Kohl,  J.,    Pt.,    E,    26th 

May  27, 

Right,     Died  June  7,  1863. 

223 

Owen,  A.,  Serg't,  G,  1st 

Aug.  —  , 

Right.     Died  August  24,  1864. 

Connecticut. 

27,  '63. 

Confed.  Cavalry. 

—  ,  '64. 

178 

Lalone,  A.,  Pt,.  B,  27th 

May  6, 

Right.     Died  May  11,  1864. 

224 

Oxley,    B.    W.,  Pt.,    B, 

May  —  , 

Right.    Died  May  31,  1862. 

Michigan. 

-,'64. 

* 

24th  Virginia. 

—  ,  '62. 

179 

Lanfair.   S.  P.,   Pt.,  A, 

Mav  5, 

Right.     May  25,  26,   haem.;  lig. 

225 

Palmer,  G.,  Pt.,  B,  7th 

Sept.  17, 

.    Died  September  2o,  18(i2. 

37th  Mass.,  age  40. 

5,  '64. 

Died  May  "26.  1864;  exhaustion. 

Michigan. 

19,  '62. 

180 

Lawrence,  G.,  Pt.,C,  5th 

July  3, 

Left.    Died  July  15,  1863. 

226 

Peebles,  H.  T.,  Capt.,  C, 

April  9, 

.    Died  April  25,  1864. 

Michigan. 

3,  '63. 

32d  Iowa. 

9,  '64. 

181 

Lawrence,  J.  W.,  Pt.,  C, 

Aug.  —  , 

Right.    Died  August  26;  1864. 

227 

Perry,    D.,   —  ,   —  ,   7th 

May  —  , 

Right.     Died  May  14,  1864. 

9th  Kentucky. 

—  ,  '64. 

Michigan, 

—,"'64. 

182 

Lewin,  J.,  Pt.,  H,  142d 

June  3, 

Right.     Died  June  15,  '64;  hajm. 

228 

Petrey,   J.,    Corp'l,    K. 

Oct.  19, 

—  .     Died  October  20,  1664. 

New.  York,  age  20. 

3,  '64. 

8th  Vermont. 

19,  '64. 

183 

Lilly,  S.  W..  Pt.,  E,  6tb 

May5, 

Right.    Died  June  12,  1862. 

229 

Phillips,  J.,  Pt.,  H,  21st 

Dec.  31, 

.     Died  January  10,  1863. 

New  Jersey,  age  19. 

5,  '62. 

Illinois. 

31,  '62. 

184 

Livingston,   A.,  Pt.,  A, 

Sept.  17, 

Right.     Died  Nov.  25,  1862. 

230 

Pierce,  J.,  Serg't,  E,  43d 

Mar.  13, 

.     Died  March  21,  1862. 

2d  Sharpshooters. 

17,  '62. 

Ohio. 

13,  '62. 

185 

Loury,  M.F.,  Pt.,A,  6th 

July  28, 

Left.     Died  September  3,  1£64. 

231 

Pierce,  F.    M.,  Pt.,    A, 

Sept.  17, 

—  .     Died  September  —  ,  1862. 

Kentucky. 

28,  '64. 

lllth  Pennsylvania. 

17,  '62. 

186 

Lumbard.H.,Pt.,  D,46th 

April  8, 

.    Died  April  16,  1864. 

232 

Pleasure,  O.,  Pt,  F,  12th 

Sept.  3 

Right.     Surg.  E.  M.  Rogers,  12th 

Indiana. 

8,  '64. 

Wisconsin. 

3,  '64.  ' 

Wis.     Died  Sept.  29,  1864. 

187 

Lumpkin,  J.  W.,  Pt.,  H, 

Oct.  7, 

Right.    Died  October  9,  1864. 

233 

Pool,  I).  J.,  Pt.,  E,  18th 

Oct.  —  , 

.     Died  October  16,  1862. 

1st  Texas. 

7,  '64. 

South  Carolina. 

—  ,  '62. 

188 

Lynch,  P..  Pt.,  D,  73d 

Julv  2, 

Left.     Died  July  13,  1863. 

234 

Porter,  J.  A.,  Serg't,  K, 

Sept.  1, 

Right.    Died  September  14,  1864. 

New  York. 

-,  '63. 

74th  Indiana. 

1,  '64. 

189 

Mahaffey,  D.  D.,  Pt.,  E, 

June  18, 

—  .     Died  June  19,  1864. 

235 

Prentice,  H.,  Pt,  B,  21st 

May  3, 

Right.     Died  May  27,  1863. 

6:id  Pennsylvania. 

18,  '64. 

New  Jersey. 

-,'63. 

190 

Maloney,  R.,  Pt.,  E,  69th 

Sept.  17, 

Right.    Died  September  —  ,  1862. 

236 

Price,  J.  U.,  Serg't,  A, 

Oct.  3, 

Left.     Died  October  4,  1861. 

New  York. 

17,  '62. 

14th  Indiana. 

3,  '61. 

191 

Manley,  N.  F.,  Pt.,  D, 

May  16, 

Left.     Died  June  3,  1864. 

237 

Prouty,  L.,  Pt.,  D,  105th 

Oct.  8. 

.     Died  October  12,  1862. 

27th  Mass.,  age  39. 

16,  '64. 

Ohio. 

—  ,  '62. 

192 

Mansir,  W.  H.,  Pt.,  B, 

May  5, 

Right.     Died  May  82,  1864. 

238 

Pugh.W.  C.,Pt.,D,37th 

Oct.  8, 

—  .     Died  October  19,  1862. 

37th  Mass.,  age  19. 

5,  "64. 

Mississippi. 

8,  '62. 

193 

Manyfold,  J.  H.,  Pt.,  K, 

July  12, 

Right,     Died  July  28,  1863. 

239 

Rainer,  S.,  Pt.,  F,  61st 

July  -, 

.     Died  July  30,  1863. 

97th  Illinois. 

12,  '63. 

Georgia. 

—  ,  '63. 

194 

Martial,  J.,  Pt.,   C,  8th 

Jan.  11, 

Died  January  14,  1863. 

240 

Randolph,    R.,   Pt,   B, 

July  —  , 

.     Died  July  6,  1863. 

Missouri.      > 

11,  '63. 

16th  Georgia. 

—  ,  '63. 

1 FORMENTO  (F.),  jr.,  Notes  and  Observations  on  Army  Surgery,  1863,  p.  17. 


SECT.  II. I 


PRIMARY    AMPUTATIONS    OF    THE   THIGH. 


271 


NO. 

NAME,  MILITARY 
DKSCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  Act. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

241 

Ray-bum,  L.  C.,  Lieut., 

Sept.  19, 

—  .     Died  September  20,  1864. 

289 

Trone    A  ,    Pt.,   H,   3d 

Jan.  7, 

Left.    Died  January  18,  1864. 

242 

B,  13th  West  Virginia. 
Redman,   T.   C.,  Lieut., 

1!»,  '64. 
July  —  , 

Left  .     Died  A  ugust  2,  1  863. 

290 

Penn.  Cavalry. 
Tucker,  R.,  Pt.,  D,  14th 

-,  '64. 
Oct.  1, 

Left  ;  hsemorrh.  recurred.     Died 

C.  4th  Virginia. 

-,'63. 

Tennessee,  age  34. 

1,  '64 

November  4,  1864. 

243 

Reed,  L.  P..  Pt.,  H,  36th 

May  6, 

Right.    Died  May  12,  1864. 

291 

Turants,  L.,  Pt.,  C,76th 

July  3, 

Left.     Died  July  22,  1863. 

Massachusetts. 

6,  fo. 

New  York. 

5,  to. 

244 

Reifsnyder,  \V..  Ft.,  B, 

July  —  , 

Right.    Died  July  30,  1864. 

292 

Turner,  J   K.,  Pt.,   H, 

Oct.  8, 

Right.     Died  October  11,  1862. 

55th  Pennsylvania. 

—,''64. 

33d  Alabama. 

-,  '62. 

245 

Uenninger,    A.,  Pt.,    F, 

Dec.  13, 

—  .     Died  January  29,  1863. 

293 

Turway,  J.,  Pt.,  F,  6th 

May  6, 

Left.     Died  June  4.  1864. 

131st  Pennsylvania. 

13,  '62. 

Maryland,  age  24. 

6,  '64. 

246 

Reynolds,  E.,  Capt.,  D, 

Dec.  13, 

Left.     Died  December  24,  1862. 

294 

Unknown. 

July  3, 

Left.     Died  JulyS,  1863. 

59th  New  York. 

13,  '6~>. 

3,  to. 

247 

Roberts,  H.,  Pt.,  H,  5th 

Sept.  19, 

.     Surg.  J.  G.  F.  Holston,  U. 

295 

Uttley,   W.,   Serg't,  B, 

Sept.  17, 

Right.     Died  September  30,  1862. 

Iowa. 

19,  '62. 

S.  V.    Died  Sept.  23,  1862. 

59th  N.  Y.,  age  29. 

19,  '62. 

248 

Roberts,  W.  G.,  Pt.,  B, 

April  9, 

—  .     Died  April  14,  1865. 

296 

Vanalstein,  A.,  Corp'l,  A, 

Dec.  13, 

—  .    Died  December  14,  1862. 

1  2  ~'d  Illinois. 

9,  '65. 

105th  New  York. 

13,  '62. 

249 

Robinson,  S.  R.,  Pt.,  I, 

Feb.  15, 

Left.    Died  March  18,  1862. 

297 

Van  Outerstorp.J.,  Corp., 

June  18, 

.     Died  June  23,  1864. 

llth  Illinois. 

—  ,  '62. 

F.  4th  N.  Y.  H.  A. 

18,  '64. 

v.v  i 

Rowe,  J.  L.,  Serg't,  E, 

May  27, 

.     Died  June  6,  1862. 

298 

Voellinger,  J.,  Lieut.,  A, 

Sept.  19, 

Right,     Died  October  18,  1863. 

2d  Maine. 

—  ,  '62. 

27th  Illinois. 

19,  '63. 

251 

Ruby,  1.  W.,  Pt.,  C,  66th 

June  9, 

Right.   Surg.  J.  H.  Grove,  U.S.V. 

299 

Walker,  J.,  Pt.,  G,  35th 

Sept,  19, 

—  .     Died  October  10,  1863. 

Indiana. 

9,  '64. 

Died  June  14,  1864. 

Illinois. 

19,  '63. 

25J 

Jtudf.r,N.,Capt.,  H,  16th 

Sept,  14. 

.    Sept.  26,  hijeui.    Died  Sept. 

300 

Walters.   D.  N.,  Pt.,  C, 

May  15, 

Right.    Died  June  3,  1864. 

Georgia. 

15,  '62. 

27,  1862  ;  exhaustion. 

42d  Indiana. 

15,  '64. 

253 

Ryan,   J.,   Pt.,    D,    5th 

Sept.  19, 

.    Died  September  24,  1863. 

301 

Ward,   C.    W.,  Pt.,  H, 

Oct.  7, 

Right.    Died  October  9,  1864. 

Kentucky. 

—  ,  '63. 

6th  South  Carolina. 

7,  '64. 

254 

Scott,  L.  S.,  Lieut.,  B, 

Julv  1, 

Right;  (also  wound  of  left  thigh.) 

302 

Ward,  R.  F.,  Serg't,  B, 

May  16. 

—  .     Died  May  19,  1864. 

19th  Maine. 

2,  '63. 

Surg.  G.  Chaddock,  7th   Mich. 

39th  Iowa. 

16,  '64. 

Died  Julv  13,  1863. 

303 

Watson,  C.,  —  ,  —  ,   1st 

Sept.  17, 

;  (also  wound  of  arm.)    Died 

255 

Scott,  C.  1'.,  Pt.,  F,  An 

July  4, 

Left.     Died  July  6,  1863. 

Texas. 

—  ,  '62. 

September  —  ,  1862. 

thony's  Regiment. 

4,  '63. 

304 

Watson,  H.,  Pt.,  B,  4th 

Sept.  29, 

Right.    Died  November  9,  1864. 

256 

Sears,  W.    A.,   Pt.,   H, 

June  18, 

Right.     Died  June  20,  1864. 

Colored  Troops,  age  23. 

30,  '64. 

34th  Mass.,  age  33. 

18,  '64. 

305 

Webb,  A.  H.,  Serg't,  E, 

July  28, 

Right.    Died  August  4,  1864. 

257 

Sliac,    J.,    Pt.,    I,    15th 

July  —  , 

.    Died  August  12,  1863. 

7th  Mississippi. 

28,  '64. 

Louisiana. 

—  ,  '63. 

306 

Weber,  W.,  Pt.,  B,  73d 

May  5, 

—  .     Died  May  13,  1862. 

258 

Shellhart,  C.,  Pt.,G,  68th 

Julv  28, 

Left.     Surg.  E.  M.  Rogers,  12th 

New  York. 

-,  '62. 

Ohio. 

58,  '64. 

Wis.     Died  July  30,  1864. 

307 

Weir,  J.,  Corp'l,  K,  73d 

Sept.  19, 

Right.     Died  October  8,  1863. 

259 

Shurman,  J.  E.,  Pt.,  C, 

May  5, 

.    Died  May  5,  1864. 

Illinois. 

19,  '63. 

lllth  New  York. 

5,  *k 

308 

Welch,  J.  W.,   Pt.,   B, 

Sept.  19, 

Right.     Died  October  14,  1863. 

260 

Sink,  A.  J.,  Pt.,  A,  33d 

Julv  20, 

Left.     Died  July  21,  1864. 

125th  Ohio. 

19,  '63. 

20,  ''64. 

309 

Wells,  G.  E.,  Pt.,  B,  35th 

Left.    Died  December  29,  1862. 

261 

Smith,  H.,  Pt.,    F,  8th 

June  26, 

Right.     Died  July  21,  1862. 

Georgia. 

Alabama. 

—  ,  '62. 

310 

Westcott,  O.,Pt.,C,  121st 

May  3, 

Right.    Died  May  14,  1663. 

262 

Smith,  I.,   Pt.,  C,    15th 

May  27, 

Left.     Died  May  27,  1863. 

New  York. 

-,  '63. 

New  Hampshire. 

27,  '63. 

311 

Weston,   J.,   —  ,    B,   2d 

June  27, 

—  .     Died  July  24,  1862. 

263 

Smith,  J.,  Pt.,  C,  44th 

Dec.  31, 

—  .     Died. 

Infantry. 

37,  '62. 

Indiana. 

31,  '62. 

312 

White,    W.  A.,   Pt.,  C, 

Oct.  4, 

—  .     Died  Nov.  19,  1862. 

264 

Smith,  L.,  Pt.,  B,  118th 

Sept.  17, 

—  .     Died  September  17,  1862. 

43d  Ohio. 

4.  '62. 

Pennsylvania. 

17,  '62. 

313 

Whitman,  G.  W.,  Pt.,K, 

May  31, 

.     Surg.    A.   N.   Dougherty, 

265 

Sorrells,    W.,    Pt.,     H, 

Nov.  7, 

.     Died  November  14,  1861. 

7th  Michigan. 

31/62. 

U.  S.  V.     Died  June  1,  1862. 

27th  Illinois. 

7,  '61. 

314 

Williams.  F.  K.,  Serg't, 

June  26, 

Right.     Died  July  8,  1862. 

2S6 

Spencer,  S.  E.,  Pt.,  G, 

May  8, 

Left.    Surg.  J.  R.  Bailev,  8th  Mo. 

A,  8th  Alabama. 

26.  '62. 

8th  Missouri. 

9,  '62. 

Died  May  24,  1R62. 

315 

Wilson,  J.,  Pt.,  21st  N. 

Mar.  27, 

Left;  (also  amp.  arm.)     Surg.  C. 

21  i" 

Spoth,   A.,  Pt.,   F,   7th 

Sept.  17, 

Left.     Died  February  16,  1863. 

York  Batterv. 

27,  '65. 

Winne,77thlll.  DiedMar.27,'65. 

Michigan. 

17,  '62. 

316 

Wilson,  J.  F.',  Capt.,  G, 

Mar.  25, 

.    Surg.  J.  W.  Wisharf.  140th 

268 

Springer,  J.,  Pt.,  G,  53d 

July  —  , 

Right.     Died  July  31,  1863. 

140th  Pennsylvania. 

25,  '65. 

Penn.     Died  April  14,  1865. 

Illinois. 

—  ,  '63. 

317 

Witty,  T.T.,  Pt,,  E,  29th 

July  4, 

Right:  ha?morrh.;  pyasmia.  Died 

269 

Stafford,  L.  Pt.,  H,  43d 

Dec.  13, 

Right.    Died  December  26,  1  862  ; 

Iowa,  age  28. 

4,  to. 

September  7,  1863. 

New  York. 

J3,  '62. 

gangrene. 

318 

Wood,  P.,  Lieut,,  F,27th 

May  9, 

Left.     Died  May   13,  1864;   ex 

270 

Stamm,W.,  Pt.,  G,  151st 

Julyl, 

Right.   Died  August  1,  186& 

Mass.,  age  29. 

9,  '64. 

haustion. 

Pennsylvania. 

1,  to. 

319 

Wooden,  J.   W.,  Serg't, 

May  5, 

Left.    Died. 

271 

Steele,  G.  H.,  Serg't,  1C, 

Oct.  9, 

Right.     Died  November  12,  1864. 

D,  27th  N.  Carolina. 

5,  '64. 

1st  New  Hamp.  (Jav. 

9,  '64. 

320* 

Wooll,  G.,  Pt.,  A,  26th 

Dec.  13, 

Left.     Died  January  23,  1863. 

272 

Stephens,  E.,  Pt.,P.,  14th 

Julv  3, 

Left.     Died  July  6,  1863. 

New  York. 

13,  '62. 

Infantry. 

5,  '63. 

321 

Wright,  R.,  Pt.,  E,  93d 

Nov.  24, 

Left.    Died  November  24,  1863. 

273 

Stevens,  R.,  Pt.,  A,  llth 

Nov.  27, 

Right.     Died  December  8,  1863. 

Ohio. 

24,  '63. 

New  Jersev. 

27,  '63. 

322 

Yates,    W.   H.,    Pt.,  B, 

Sept.  17, 

.     Died  September  28,  1862. 

274 

Stine,   J.,  Pt.,   B,    14th 

Julv  —  , 

—  .     Died  July  30,  1863. 

5th  New  Hampshire. 

17,  '62. 

Louisiana. 

—  ,''6;>. 

323 

Young,    E.   C.,    Pt.,  H, 

Mav  6, 

Right.    Died  May  —  ,  1864. 

275 

Stowe,  J.  P.,  Pt,,  G,  15th 

Sept.  17, 

Right.     Died  October  1,  1862. 

36th  Massachusetts. 

-,  '64. 

Massachusetts. 

17,  '62. 

324 

Zoller,  J.,  Serg't,  F,  16th 

Oct.  7, 

Left,     Died  October  23,  1964. 

276 

Strayhome,  T.  A.,  Pt., 

Dec.  31, 

.     Died  January  25,  1863. 

New  York  H.  Art'y. 

-,  '64. 

E,  21st  Illinois. 

31,  '62. 

325 

Breij,  W.  H.,  Lieut.,  E, 

July  3, 

277 

Sullender,  11.  G.,  Pt.,  B, 

May  2, 

.     Died  May  13,  1863. 

53d  Virginia. 

-,  '63. 

143d  Pennsylvania. 

-,  to. 

326 

Case,  A.,  Pt.,  C,  8th  N. 

June  3, 

Right.     Surg.  J.  L.  Brenton,  8th 

278 

Summers,  J~.  G.,  Pt.,  B, 

Dec.  13, 

Left.     Died  December  29,  1862. 

York  H'vy  Art'y. 

-,  '64. 

Ohio.     Not  a  pensioner. 

13th  Mississippi. 

13,  '62. 

327 

Uiggin,  D.,  Pt.,  A,  12th 

June  2, 

Right. 

279 

Swart.  A.  XV.,  Corp'!,  I, 

July  3, 

Right.     Died  July  25,  1863. 

Georgia. 

3,  '64. 

20th  N.  Y.  S.  M. 

3,  to. 

328 

Elrod,    W.  B.,  Pt.,   G, 

Julv  —  , 

280 

Swinnford,   R.   M.,  Pt., 

May  22, 

Right;  flap.     Surg.  M.  W.  Rob- 

16th  Georgia. 

—,''63. 

B,  25th  Iowa. 

22,  '63. 

bins,  4th  Iowa.    IJied.Hily  5,  '63. 

329 

Foran,  J.,  Serg't,  C,  63d 

Mav  8, 

.     Surg.  P.  E.  Hubon,  28th 

281 

Taft,  E.,  Pt.,  E,  42d  N. 

Sept.  17, 

Right.     Died  October  7,  1862. 

New  York. 

8,  '64. 

Mass.     Not  a  pensioner. 

York. 

17,  '62. 

330 

Gaskin,  H.,  —,  18th  N. 

May  27, 

282 

Terrell,   J.,   Corp'l,    K, 

June  2, 

Left.     Died  June  17,  1864. 

Carolina. 

—  ,  '62. 

55th  Penn.,  age  22. 

2,  '64. 

331 

Glendi/,  R.  J.,  Lieut,,  C, 

July  —  , 

283 

Thorn,  T.  J.,  Lieut.,  D, 

July  3, 

Right;    (also  amp.  arm.)     Died 

4th  Virginia. 

—  ,  '63. 

16tb  X.  C.,  age  30. 

4,  '63. 

Julv  30.  1863;  py»mia. 

332 

Hagler,   C.,  Pt.,  F,  7th 

Dec.  13, 

Right. 

284 

Tibbetts,  E.  G.,  Pt.,  H, 

May  27, 

Right.    Died  July  14,  1863. 

North  Carolina. 

—  '62.' 

12th  Maine. 

27,  '63. 

333 

Hambrich,   J.,   Pt.,    A, 

July  —  , 

28")) 

Tieman.  II.,  Pt.,C,  119th 

June  21, 

Both.     Surg.  G.  P.  Oliver,  lllth 

24th  Georgia. 

—  ,  '63. 

286) 

New  York. 

21,  '64. 

Penn.,  and  J.  V.  Kendall,  149th 

334 

Jones,  G.  W..  Pt.,  A,  43d 

June  2, 

Left. 

N.  Y.    Died  June—  ,  1864. 

North  Carolina. 

3,  '64. 

287 

Tiltou,   G.    A.,    Pt.,   C, 

May  12, 

.     Surg.W.  C.  Shurlock,  51st 

335 

Kirkland,  W.  L.,  Pt.,K, 

May  28, 

.     Surg.  —  Taylor,  C.  S.  A. 

llth  New  Hampshire. 

12,  '64. 

Penn.     Died  May  29,  1864. 

4th  South  Carolina. 

28,  '64. 

288 

Trimble,  A.,  Corp'l,  E, 

Oct,8, 

.    Died  October  11,  1862. 

336 

Kroupe,   T.,  Pt.,  St.  M. 

April  23, 

10th  Wisconsin. 

-,'62. 

23d  C.  S.  A. 

—,'62. 

272 


INJUEIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

337 

McCauley,  T.,  Pt.,  G,  2d 

July  14, 

Right.     Not  a  pensioner. 

342 

Orender,   L.,  Pt.,  I,  2d 

July  —  , 

Illinois  Lt.  Art'y. 

—  ,  '64. 

South  Carolina. 

—  ,  '63. 

338 

McGthee,  W.  B.,  Pt.,  C, 

July  3, 

343 

Overton,  H.   T.,  Pt.,  A, 

Nov.  25, 

Right. 

17th  Mississippi. 

-,  '63. 

17th  Alabama. 

25,  '63. 

339 

Meadows,  H.  M  ,  Pt.,  A, 

July  28, 

Left. 

344 

Williams,  J.,  Serg't,  D, 

May  31, 

Left  on  field.     Not  a  pensioner. 

34th  Alabama. 

28,  '64. 

Od  Ohio  Cavalry. 

—  ,  'G4. 

340 

Morris,  J.  r.,Pt.,  B,34th 

Aug.  31, 

Left.     Surg.   A.   C.    Messenger, 

345 

Wina,   E.,   Pt.,   P,    5th 

Sept.  29, 

Left  ;  not  doing  well.     Not  a  pen 

Alabama. 

31,  '64. 

57th  Ohio. 

Colored  Troops,  age  30. 

—,'64. 

sioner. 

341 

O'Keefe,  P.,  Serg't,  C. 

July  28, 

Right. 

30th  Louisiana. 

28,  '64. 

In  three  hundred  and  forty-one  of  the  cases  enumerated  in  this  table  the  seat  of  frac 
ture  was  in  the  femur;  in  two,  in  the  knee  joint;  and  in  two,  in  the  leg.  In  four  fatal 
instances  both  thighs  were  primarily  amputated;  and  in  one,  primary  amputation  of  the 
thigh  was  performed  on  the  right,  and  intermediary  amputation  in  the  lower  third  on  the 
left  limb.1  In  three  cases,  an  arm,  and  in  one,  a  leg  were  simultaneously  removed.2 

INTERMEDIARY  AMPUTATIONS  IN  THE  SHAFT  OF  THE  FEMUR  FOR 
SHOT  INJURY. — This  category  comprises  thirteen  hundred  and  twenty  cases.  Four 
hundred  and  seventy-nine  proved  successful  and  eight  hundred  and  forty-one  were  fatal. 

Intermediary  Amputations  in  the  Upper  Third  of  the  Femur. — There  were  one  hun 
dred  and  forty-seven  intermediary  amputations  in  the  upper  third  of  the  femur,  with  fifty 
recoveries  and  ninety-seven  deaths.  The  right  limb  was  implicated  in  seventy-seven  cases, 
the  left  in  fifty-four,  and  in  sixteen  this  point  was  not  recorded.  The  modes  of  operation 
are  reported  as:  circular,  forty-six;  flap,  thirty-nine;  not  stated,  sixty-two. 

Successful  Cases  of  Intermediary  Amputations  in  the  Upper  Third  of  the  Femur. — • 
The  fifty  operations  of  this  group  were  performed  on  forty  Union  and  ten  Confederate 
soldiers.  Thirty-five  of  the  thirty-eight  pensioned  Union  soldiers  were  living  in  1879. 
The  injuries  were  caused  by  shell  in  five,  by  grapeshot  in  one,  by  solid  shot  in  one,  and  by 

small  missiles  in  forty-three  instances.  In  the  following 
case  the  patient,  an  employe'  of -the  Pension  Office,  was  in 
excellent  health  in  October,  1879: 

CASE  453. — Private  Lorenzo  E.  Dickey,  Co.  A,  4th  Maine,  aged  21  years, 
received  a  gunshot  wound  of  the  right  thigh,  at  Chantilly,  September  1,  1862.  He 
was  taken  to  a  field  hospital  in  the  vicinity  of  the  battle  ground,  where  the  limb 
was  amputated  at  the  upper  third,  on  the  fourth  day  after  the  reception  of  the 
injury.  On  September  8th,  the  patient  arrived  at  Washington  and  was  admitted 
to  Douglas  Hospital.  A  haemorrhage  from  the  femoral  artery,  to  the  amount  of 
tsventy  ounces,  occurred  on  October  16th,  and  was  controlled  by  pressure.  After 
this  the  case  progressed  favorably  and  the  wound  healed  about  January  1,  1863. 
About  two  months  later  the  patient  was  transferred  to  Lincoln  Hospital,  and  sub 
sequently  he  was  sent  to  St.  Elizabeth  Hospital,  whence  he  was  discharged  June 
16,  1863,  and  pensioned.  Mr.  Dickey  was  subsequently  appointed  a  clerk  at  the 
Pension  Office.  On  January  14,  1873,  he  visited  the  Army  Medical  Museum, 
being  in  as  good  general  health  as  he  had  been  previous  to  the  time  of  receiving 
the  injury,  and  suffering  no  pain  from  the  sturnp.  He  stated  that  his  weight  then 
was  194  pounds,  while  before  he  was  wounded  and  lost  his  leg  he  only  weighed 
1/0  pounds.  Owing  to  the  shortness  of  the  stump,  being  only  three  inches  long 
from  the  hip  joint,  he  is  unable  to  wear  an  artificial  limb  and  is  obliged  to  use 
crutches  in  walking.  A  copy  of  the  photograph,  taken  in  1873,  is  represented  in 
the  wood-cut  (FlG.  188).  His  pension  was  paid  September  4,  1879. 
1  Cases  of  Pt.  S.  Goodwell,  G,  29th  Illinois  (No.  128,  p.  269),  fatal;  Pt.  H.  Kenner,  4th  Virginia  (No.  169,  p.  270),  fatal ;  Pt.  C.  Myer,  F,  30th  Mis- 
212,  p.  270),  fatal;  Pt.  H.  Tieman,  C,  119th  New  York  (No.  285,  p.  271),  fatal.  In  the  case  of  Pt.  W.  F.  Mills,  E,  8th  New  York  H.  A.  (No. 

205,  p.  270),  primary  amputation  in  the  right  thigh,  and  subsequently  intermediary  amputation  in  the  left  thigh  was  performed. 

'An  arm  was  simultaneously  removed  in  the  cases  of  Pt.  S.  Cramer,  B,  142d  Pennsylvania  (No.  84,  p.  209,  and  Second  Surg.  Vol.,  TABLE  LXXV, 

No.  39,  p.  751);  Lieut.  T.  J.  Thorn,  D,  16th  North  Carolina  (No.  283,  p.  271,  and  Second  Surg.  Vol.,  TABLE  LXXV,  No.  15:i,  p.  752);  and  Pt.  J.  Wilson, 
t  New  York  Battery  (No.  315,  p.  271,  and  Second  Surg.  Vol.,  TABLE  LXXV,  No.  167,  p.  752).     In  the  case  of  Serg't  J.  Foss,  C,  59th  New  York  (No. 

116,  p.  269),  the  opposite  leg  was  amputated. 


SECT,  ill.]  INTERMEDIARY    AMPUTATIONS    OF   THE    THIGH.  273 

The  femur  was  fractured  in  its  upper  third  in  four  of  the  fifty  examples  of  this  group, 
necessitating  amputation  close  to  the  trochanters : 

CASE  454. — Captain  John  C.  Hilton,  Co.  K,  145th  Pennsylvania,  aged  22  years,  was  wounded  at  Gettysburg,  July  2, 
1863,  by  a  conoidal  ball,  which  fractured  the  right  femur  in  its  upper  third.  He  was  carried  to  the  field  hospital  of  the  1st 
division  of  the  Second  Corps,  where  Surgeon  C.  S.  Wood,  66th  New  York,  reports:  "The  bone  was  extensively  comminuted. 
I  amputated  the  thigh  about  one  inch  below  the  trochanter  major.  The  operation  was  not  performed  until  eleven  days  after  the 
receipt  of  the  injury,  yet  the  patient  at  this  date,  August  2d,  is  rapidly  improving."  The  patient  entered  Camp  Letterman 
hospital  August  5th,  where  Acting  Assistant  Surgeon  B.  F.  Butcher  notes:  "He  is  doing  very  well;  the  treatment  consists  of 
stimulants  and  nourishing  diet,  with  water  dressings  to  the  stump.  August  20th,  still  improving,  all  ligatures  were  removed, 
the  stump  healing  rapidly.  On  the  25th,  the  stump  had  entirely  healed,  and  on  September  1st,  he  left  the  hospital  on  leave  of 
absence."  This  officer  was  discharged  December  19,  1863,  entered  the  Veteran  Reserve  Corps  February  5,  1864,  was  mustered 
out  of  service  June  30,  1866,  and  pensioned.  His  pension  was  paid  June  4,  1879. 

CASE  455. — Private  Alvin  Hubbard,  Battery  M,  5th  Artillery,  aged  20  years,  was  wounded  at  Spottsylvania  Court 
House,  May  12,  1864,  by  a  solid  shot  or  a  large  fragment  of  shell,  which  struck  both  knees,  fracturing  the  patella  and  opening 
the  joint  of  the  right  knee,  and  inflicting  a  large  flesh  wound  on  the  inner  side  of  the  left  knee.  He  was  taken  to  the  field  hos 
pital  of  the  Artillery  Brigade,  Sixth  Corps,  and  on  the  14th  sent  to  Fredericksburg.  On  May  24th,  he  was  admitted  into  the 
Third  Division  Hospital,  Alexandria,  from  which  Surgeon  E.  Bentley,  U.  S.  V.,  reports:  "The  right  leg  and  knee  were  badly 
swollen,  painful  and  cedematous,  and  the  soft  parts  ecchymosed;  there  was  an  unhealthy  discharge  from  the  wound;  the  left 
knee  was  black  and  swollen,  but  the  joint  was  not  seriously  injured.  His  constitutional  condition  was  much  disturbed,  pulse 
quick  aud  frequent,  appetite  poor.  On  the  25th,  it  was  decided  to  amputate,  and,  after  placing  the  patient  under  the  influence 
of  chloroform,  Surgeon  Bentley  removed  the  right  thigh  just  below  the  trochanter  by  the  circular  operation;  free  incisions  were 
made  in  the  integuments  of  the  left  knee.  He  rallied  well  from  the  operation,  and  the  after  treatment  consisted  of  stimulants, 
opiates,  and  nourishing  diet.  On  October  7th,  he  was  transferred  to  the  First  Division  Hospital,  Alexandria;  on  February  25, 
1865,  to  the  hospital  at  Fairfax  Seminary;  and  finally  discharged  at  the  Judiciary  Square  Hospital,  Washington,  May  19, 1865." 
Examining  Surgeon  E.  H.  Wood,  of  Hersey,  Michigan,  September  5,  1877,  reports:  "The  stump  of  the  amputated  limb  is 
sound.  The  wound  on  left  knee  healed,  leaving  a  large  scar,  and  the  patella  so  dislocated  upward  that  this  leg  can  be  only  semi- 
flexed."  His  pension  was  paid  June  4,  1879. 

In  the  next  case  the  patient  died,  nearly  nine  years  after  the  operation,  of  tubercular 
disease  of  the  lungs  complicated  with  necrosis  of  the  stump  of  several  years  standing : 

CASE  456. — Private  J.  Frederick,  Co.  D,  15th  Massachusetts,  aged  35  years,  was  wounded  and  captured  at  Bristoe 
Station,  October  14,  1863.  After  remaining  a  prisoner  for  a  month  he  was  paroled  and  brought  to  Annapolis,  where  he  entered 
the  First  Division  Hospital  on  November  18th.  Assistant  Surgeon  W.  S.  Ely,  U.  S.  V.,  contributed  the  pathological  specimen 
(FlG.  189),  with  the  following  description  of  the  injury:  "A  fragment  of  a  shell  entered  the  left  thigh  in  its  middle  third  pos 
teriorly,  and  passing  directly  forward,  produced  an  extensive  comminution  of  the  femur  and  great  destruction  of 
muscular  tissue.  He  laid  upon  the  battle  field  without  medical  attendance  until  the  afternoon  of  the  following  day, 
when  he  was  conveyed  by  the  enemy  to  Gordonsville,  where  he  suffered  amputation  of  the  injured  limb  at  the  junc 
tion  of  the  upper  and  middle  third,  by  the  circular  method,  on  October  26lh.  When  admitted  here,  this  soldier 
gave  evidence  of  having  endured  a  full  share  of  the  exposure  and  neglect  to  which  our  captured  men,  as  a  general 
rule,  were  subjected.  His  system  was  found  to  be  excessively  reduced :  his  pulse  rapid  and  feeble;  anorexia  exist 
ing,  and  an  exhausting  diarrhoea  complained  of.  At  the  seat  of  the  operation  the  parts  gave  evidence  of  unhealthy 
reparation,  the  wound  was  open,  the  skin  retracted,  and  the  sawn  extremity  of  the  femur  protruding  beyond  the 
tissues  to  the  extent  of  one  and  a  half  inches.  It  was  thought  advisable  to  leave  to  nature  the  removal  of  the  pro 
truding  bone,  and  therefore  no  operative  interference  was  determined  upon.  The  patient's  body  was  thoroughly 
cleansed,  and  an  equable  temperature  maintained  in  his  room,  the  stump  washed  twice  with  alcohol,  and  lint  moist 
ened  with  diluted  alcohol  kept  applied.  Generous  diet  was  enjoined,  and  six  ounces  of  spiritus  ferment!  was  given 
daily.  For  the  diarrhoea  a  prescription  was  ordered  consisting  of  one  grain  of  sulphate  of  morphia,  ten  grains  of 
quinine,  one  and  a  half  drachms  of  diluted  sulphuric  acid,  and  one  ounce  of  water,  to  be  given  in  doses  of  a  tea-  FlG  189_ 
spoonful  three  times  a  day.  By  December  1st,  the  patient  was  slowly  improving,  the  diarrhoea  being  no  longer  Tubular  se- 
troublesome,  and  his  appetite  good,  though  his  pulse  still  continued  rapid.  The  stump  under  the  action  of  the  nearlvTins. 
alcohol  applied  locally,  combined  with  the  constitutional  measures  employed,  now  presented  a  granulating  surface,  removedistx 
and  the  granulations  were  slowly  extending  towards  the  extremity  of  the  bone,  one  inch  of  which  was  still  exposed,  amputation. 
His  treatment  was  yet  continued  with  the  exception  of  th#  prescription  for  the  diarrhoea,  for  which  a  mixture  of  sPee- 
twenty  grains  of  quinine,  one  and  a  half  drachms  of  muriated  tincture  of  iron,  and  ten  drachms  of  simple  syrup  was  substi 
tuted,  to  be  given  in  teaspoonfuls  one  hour  before  meals.  On  January  6th,  the  applications  of  alcohol  to  the  stump  were  discon 
tinued  ;  the  patient  still  doing  well  and  no  marked  change  having  occurred.  January  29th,  by  seizing  the  protruding  extremity 
of  the  femur  between  the  fingers  it  became  perceptible  that  a  slight  movement  of  rotation  could  be  made.  February  4th,  necrosis 
going  on  certain  but  slow;  considerable  movement  now  attainable,  causing  great  pain  to  the  patient;  muscles  of  affected  limb 
apparently  becoming  hypertrophied ;  general  health  of  patient  continuing  good.  February  26th,  protruding  bone  a  little  more 
mobile;  discharge  increasing  in  amount  and  becoming  offensive.  It  was  not  yet  deemed  advisable  to  interfere  with  the  natural 
process  going  on,  a  portion  of  the  fragment  not  being  sufficiently  separated  and  liable  to  break  off  if  extraction  was  attempted, 
thus  retarding  the  subsequent  reparative  process.  On  April  1st,  interference  was  deemed  proper,  the  fragment  appearing  to  be 
very  free.  Sensibility  being  too  great  to  operate  without  the  use  of  anaesthetics,  chloroform  was  administered,  the  extremity 
SUKG.  Ill— 35 


274  INJURIES    OF   THE    LOWER    EXTREMITIES.  ICHAP  x. 

seized  with  a  large  forceps  by  Surgeon  B.  A.  Vanderkieft,  U.  S..V.,  and  by  a  combined  motion  of  traction  and  rotation  the  sep 
arated  portion,  measuring  five  inches  in  length,  was  removed  entire.  The  patient  recovered  rapidly  from  the  anaesthetic  and  felt 
great  relief.  He  progressed  finely  and  the  stump  closed  rapidly,  and  the  result  of  waiting  upon  nature  in  this  case  proved  very 
satisfactory,  though  it  would  be  interesting  to  know  whether  a  second  operation  performed  at  the  time  of  the  patient's  admission 
would  have  prevented  necrosis  to  the  depth  at  which  it  was  found  to  exist."  The  patient  was  discharged  from  service  May  24, 
1864,  and  supplied  with  an  artificial  limb  by  B.  F.  Palmer,  of  Philadelphia,  five  months  afterwards.  He  died  March  13,  1872, 
Dr.  J.  Hyndman,  of  Boston,  certifying  that  his  death  was  caused  by  "tubercular  disease  of  the  lungs,  complicated  with  necrosis 
of  the  bone  of  the  amputated  limb"  of  several  years'  standing,  etc. 

Fatal  Cases  of  Intermediary  Amputation  in  the  Upper  Third  of  the  Thigh. — The 
ninety-seven  operations  of  this  category  were  performed  on  eighty-one  Union  and  sixteen 
Confederate  soldiers.  A  case,  in  which  the  amputation  had  been  preceded  by  primary 
excision  in  the  upper  third  of  the  femur,  has  been  detailed  on  page  205,  ante  (CASE  418, 
Corporal  J.  W.  Soule,  D,  6th  Michigan  Cavalry);  a  second  case  will  here  be  cited: 

CASE  457. — Private  J.  Kelly,  Co.  F,  1st  New  York  Cavalry,  aged  21  years,  was  wounded  near  Hagerstown,  July  7, 
1863,  and  admitted  to  hospital  at  Frederick  on  the  following  day.  Acting  Assistant  Surgeon  J.  H.  Bartholf  contributed  the 
specimen  (No.  3875,  Surgical  Section,  A.  M.  M.),  with  the  following  history:  "While  acting  as  a  scout  the  man  had  his  left  thigh 
fractured  by  a  cavalry  pistol  conoidal  shot,  at  a  point  a  little  above  the  junction  of  the  middle  and  lower  thirds.  The  ball,  much 
battered,  was  removed  from  under  the  skin  on  the  inner  side  of  the  limb,  three  inches  above  the  edge  of  the  condyle.  When 
admitted  into  hospital,  Smith's  anterior  splints  were  applied  and  continued  till  July  16th,  when  Buck's  extension  apparatus  was 
substituted,  with  sand  bags  to  the  side  of  the  limb.  Much  fcetid  pus  was  found  to  be  confined  in  the  limb,  which  was  let  out  by 
enlarging  the  opening.  The  patient  having  all  the  signs  of  pneumonia  of  the  left  lung,  an  oiled  silk  jacket  was  applied  around 
the  thorax.  July  18th,  patient  more  comfortable  with  the  change  of  appliance  to  the  limb;  six  ounces  of  milk  punch  given 
daily,  and  nourishing  diet.  19th,  rusty  colored  sputa  continuing,  with  but  little  cough;  double  friction  sound  over  heart;  heart's 
action  somewhat  turbulent.  21st,  pulse  120 ;  brown,  moist  fur  on  tongue ;  feeling  of  great  oppression  in  chest,  but  friction  sound 
over  heart  nearly  gone ;  some  diarrhoea;  suppuration  from  limb  very  free  and  somewhat  offensive.  Applied  oakum  dressings 
and  gave  pills  of  camphor  and  opium.  22d,  pulse  smaller;  cough  increasing;  pain  and  tenderness  to  pressure  of  limb  now 
extending  up  to  groin  and  becoming  more  acute  from  pus  burrowing  up  among  the  muscles;  diarrhoea  continuing  at  intervals. 
Increased  the  milk  punch  to  one  pint  per  day.  23d,  patient  very  feeble  and  in  a  very  critical  state;  thoracic  symptoms  dimin 
ishing.  27th,  all  chest  symptoms  gone;  thigh  in  bad  condition;  pus  burrowed  among  the  muscles  in  front  nearly  to  groin;  has 
two  troublesome  bedsores.  29th,  sleeps  tolerably  well  now;  vomited  once  after  tea,  but  has  no  chills.  31st,  pulse  still  120; 
erysipelatous  inflammation  about  the  wound.  The  best  of  diet  and  half  a  pint  of  milk  punch  is  given  daily.  August  5th,  the 
patient's  general  condition,  strength,  and  appetite  has  somewhat  improved  during  the  last  few  days.  The  diarrhoea  continues, 
however,  the  bedsores  are  very  troublesome,  and  the  fractured  bone  is  a  good  deal  necrosed,  and  abscesses  are  extensive  in  the 
thigh.  6th,  amputation  was  performed  by  Assistant  Surgeon  E.  F.  Weir,  U.  S.  A.,  at  4  P.  M.,  as  low  down  as  the  wound  would 
permit ;  method :  Flaps  of  skin  and  circular  of  muscles.  Two  and  a  half  inches  of  the  upper  fragment  of  the  bone  were  removed, 
when,  the  medullary  canal  and  periosteum  being  still  found  dead,  one  and  a  half  inches  more  of  the  shaft  were  taken  off,  thus 
getting  a  line  or  two  above  the  necrosis.  Four  fragments  were  found,  all  being  more  or  less  attached  by  periosteum  or  muscle, 
but  all  partially  denuded  of  periosteum  and  necrosed.  One  large  lower  fragment  embraced  the  greater  part  of  the  lower  third 
of  the  femur  and  was  considerably  denuded  and  necrosing,  showing  scarcely  any  effort  at  repair.  A  sinus  on  the  outer  and  front 
aspect  of  the  thigh,  found  at  the  amputation  to  reach  nearly  up  to  Poupart's  ligament,  had  a  counter  opening  then  made  in  its 
upper  extremity.  Reaction  did  not  take  place,  in  spite  of  all  efforts,  until  11  P.  M.,  and  not  decidedly  then,  vomiting  occurring 
at  intervals  and  some  delirium.  Patient  was  placed  on  a  water-bed  at  11  P.  M.  7th,  pulse  150  and  a  mere  thread;  condition 
very  precarious  indeed.  At  9  A.  M.,  patient  rallied  somewhat,  then  fell  asleep  and  slept  the  greater  part  of  the  day.  Adminis 
tered  beef  tea  and  milk  punch  alternately  throughout  the  day.  8th,  pulse  116  and  much  fuller;  flaps  sloughy  and  fcetid. 
Applied  the  strong  nitric  acid,  and  after  that  injected  a  mixture  of  hydrochloric  acid,  one  ounce;  laudanum,  two  ounces;  and 
water,  fourteen  ounces,  between  the  flaps  and  into  the  sinus,  after  which  oakum  dressing,  wet  with  the  same  wash,  was  applied. 
All  the  sutures  were  removed  but  one,  and  extension  was  applied  to  flaps,  to  prevent  retraction,  by  adhesive  strips,  string,  pully, 
and  weight.  Patient  has  considerable  diarrhoea,  and  takes  camphor  and  opium  pills;  is  also  ordered  ten  grains  of  tartrate  of 
iron  and  potassa  three  times  a  day.  9th,  pulse  136;  suppuration  from  stump  healthy  and  not  foetid;  diarrhoea  ceased  during 
night  but  recurred  this  morning.  Patient  has  aphthse  on  the  tongue  and  lips;  has  some  little  relish  for  food.  Opium  is  con 
tinued,  and  tincture  of  chloride  of  iron  is  substituted  for  the  tartrate  of  iron  and  potassa.  10th,  pulse  120;  diarrhoea  a  little 
better;  ordered  Hope's  mixture  for  it,  also  ten  grains  of  chlorate  of  potassg,  four  limes  a  day  for  stomatitis.  Stump  not  sloughy; 
good  flaps.  Patient  has  some  little  appetite  and  is  ordered  good  fo6*d,  with  one  pint  of  milk  punch  daily,  llth,  stump  in  good 
condition ;  diarrhoea  worse.  Gave  one  grain  of  opium  every  two  hours  and  continued  other  medicine.  12th,  stomatitis  and 
diarrhoea  ceased.  13th,  stomatitis  and  diarrhoea  returned.  Patient  losing  strength  and  wasting  in  flesh  ;  pulse  126;  pus  from 
stump  healthy.  14th,  pulse  128 ;  had  nausea  last  evening  and  vomiting  this  morning;  no  chill;  diarrhoea  slight;  granulations 
weak  and  pale.  Discontinued  the  tincture  of  iron,  and  prescribed  extract  of  nux  vomica,  four  grains,  and  pulverized  iron, 
twenty  grains,  to  be  made  into  sixteen  pills,  and  administered  one  three  times  a  day.  15th,  pulse  130;  some  nausea;  stomatitis 
very  bad;  diarrhoea  troublesome;  bedsores  painful.  Treatment  continued  and  brandy  mixture  ordered.  17th,  subsultus  ten- 
dinum.  18th,  patient  died.  Sectio  cadaveris  seventeen  hours  after  death:  Body  much  emaciated.  On  examining  the  stump 
found  sinuses  up  the  thigh  in  various  directions,  and  just  behind  the  trochanter  major  a  circumscribed  abscess  containing  about 
an  ounce  of  pus;  another  similar  one  near  the  trochanter  minor;  hip  joint  intact;  tissues  of  stump  very  unhealthy,  and  wound 
of  stump  pale  and  flabby  and  presenting  scarcely  any  granulations.  On  opening  the  chest  found  the  right  lung  healthy  and 


INTERMEDIARY    AMPUTATIONS    OF    THE    THIGH. 


275 


weighing  twelve  ounces;  left  lung,  upper  lobe  healthy;  lower  lobe  in  a  state  of  red  hepitization  through  nearly  its  entire  extent, 
and  permeable  to  air  here  and  there ;  weight  one  pound  and  two  ounces.  Pleura  healthy.  The  heart  was  contracted  and  firm, 
clots  in  both  sides  of  it,  especially  in  the  left;  valves  healthy;  no  evidence  of  endocarditis;  recent  pericarditis  well  marked; 
pericardium  throughout  adherent  by  new  false  membrane  becoming  organized,  susceptible  of  being  torn  off  by  little  force;  weight 
of  heart  ten  ounces.  Liver  moderately  contracted,  with  cirrhosis  and  a  little  hobnailed;  weight  three  pounds  and  two  ounces." 

TABLE  XXXIV. 

Summary  of  One  Hundred  and  Forty-seven  Cases  of  Intermediary  Amputations  in  the  Upper  Third  of 

the  Femur  for  Shot  Injury. 

[  Recoveries,  1—50 ;  Deaths,  51—147.  | 


NO. 

NAME,  MILITARY 
DESCRIPTION",  AND  AGE. 

DATES. 

OPERATION'S,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

'Anderson,   S.,    Pt.,   B, 

Sept.  19, 

;  erysipelas  ;  gangrene.    Re 

35 

Nehemiah,  C.  S.,  Pt.,  K, 

Dec.  7, 

Right,     Surg.  B.  O.  Reynolds,  3d 

20th  Alabama. 

22,  '63. 

covery. 

26th  Indiana,  age  32. 

31,  '62. 

Wis.  Cav.     Disch'd  J  une  9,  '63. 

2 

Beckart,  A.,  Pt.,  A,  74th 

Aug.  29, 

Left;  circ.     A.  Surg.  G.  M.  Mc- 

36 

Ochs,  H.  G.,  Pt.,  H,  54th 

May  15, 

Right  ;  circ.     Disch'd  Jan.  31  ,'65. 

New  York,  age  22. 

Sep.8.'62. 

Gill,  U.  S.  A.    Dis'd  May  22,  '63. 

Penn.,  age  26. 

23,  '64. 

3 

Bray,  J.  A.,  Pt.,  K,  3d 

June  27, 

Left.     Surg.  A.  Y.  P.  Garnett,  P. 

37 

O'Connor,    J.,    Pt.,    G, 

Sept.  17, 

Right;  flap.    Disch'd  June  27,  '63. 

Virginia. 

30,  '62. 

A.  C.  S.     Recovery. 

28th  Pennsylvania. 

Oct.  9,  '62. 

Died  April  13,  1867. 

4 

Briscoc,  L.   N.,  Pt.,  K, 

July  21, 

Left.    Surg.  —  Jennings,  C.  S.  A. 

38 

Page,  G.  L.,  Corp'l,  B, 

Sept.  19, 

Right.     Surg.  Bakeman,  C.  S.  A. 

7th  South  Carolina. 

29,  '61. 

Recovery. 

18th  Texas. 

26,  '63. 

Retired  Feb.  10,  1865. 

5 

Cain,  J.,  Corp'l,  I,  104th 

July  1, 

Left;  circ.     Surg.  E.  G.  Chase, 

39 

Perkins,  G.,  Pt.,  G,  2d 

Jan.  1, 

Left  ;  flap.     A.  Surg.  W.  T.  Men- 

New  York. 

5,  '63. 

104th   N.  Y.     Disch'd   Nov.  3, 

Kentucky. 

5,  '63. 

denhall,  57th  Ind.     Discharged 

1864.     Spec.  3022. 

March  30,  1863. 

6 

Calder,  J.,  Lieut.,  G,  2d 

Sept.  20, 

Right.    Surg.  W.  Varian,  U.  S.V. 

40 

Peters,  J.,Pt.,  A,  6Bth  N. 

July  21, 

Right.     Surg.  —  Walker,  C.S.A. 

Kentucky  Cav.,  age  28. 

27,  '63. 

Disch'd  March  1,  1864. 

York,  age  28. 

Aug.  12, 

Disch'd    Jan.    25,    1862.     Died 

7 

Cunningham,  E.H.,  Sgt, 

Aug.  9, 

Right.     Surg.  —  Davis,  C.  S.  A. 

1861. 

April  8,  1871. 

E,  9th  Louisiana. 

14,  '62. 

Recovery. 

41 

Porter,  C.,Citizen  of  Rus 

July  11, 

Right  (gang.;  aneurism):  lateral 

8 

Dalton.  T.W.,Pt.,G,83d 

Dec.  13, 

Left  ;  ant.  post,  flap  ;  gangrene. 

sell  ville,  Ky.,  age  17. 

21,  '64. 

flaps.     Dr.  J.  R.  Bailey,  of  Rus- 

New  York,  age  18. 

16,  '62. 

V.  R.  C.  June  21,  1863. 

sellville.    Recovery. 

9 

Darlington,  W.  B.,  Maj  ., 

Mav  5, 

Right  ;    circ.      Confed.   surgeon. 

42 

Roberts,  T.,  Guerilla,  age 

Feb.  10, 

Left  ;  ant.  post,  flap.     A.  A.  Surg. 

18th  Penn.  Cav.,  age  35. 

9,  '64. 

Disch'd  October  30,  1864. 

31. 

Mar.4,'64. 

P.  Gilroy.     Prison  June  26,  '64. 

10 

Dickey,  L.  E.,  Ft.,  A,  4th 

Sept.  1, 

Right  ;  haem.  from  femoral  artery. 

43 

Rovstou,  W.  H.,  Pt.,  C, 

Feb.  15, 

Left  ;  flap.     Disch'd  Nov.  8,  '62. 

Maine,  age  25. 

5,  '62. 

Disch'd  April  27,  1863. 

2d  Iowa,  age  24. 

Mar.6,'62. 

11 

Dun  lap,  J.  H.,  Pt.,  F,  3d 

De.14,'62, 

Right  ;  circ.   Surg.  C.  A.  Cowgill, 

44 

Schmidt,  H.,  Pt.,  G,  57th 

Oct.  4, 

Right:   flap.     Surg.  J.  R.  Zear- 

X.  Y.  Artillery. 

Ja.  11,'63. 

II.  S.  V.    Disch'd  April  15,  1863. 

Illinois. 

28,  '62. 

ing,  57th  Illinois.    (Amp.  arm.) 

12 

*Dwyer,  L.,  Pt.,  F,  14th 

June  30, 

Right  ;  circ.     Surg.  F.  Formento, 

Disch'd  Dec.  18,  1863. 

Louisiana. 

J'y  8,  '62. 

jr  ,  C.  S.  A.     Recover  v. 

45 

Seiter,  J.,  Serg't,  I,  7th 

Sept.  17, 

Right.     Disch'd  Dec.  15,  1862. 

13 

Eagan,  L.   W.,  Pt.,  —  , 

Aug.  30, 

Right.     Ass't  Surg.  B."  Howard, 

New  York. 

27,  '62. 

22d  New  York. 

.Sep.3,'62. 

U.  S.  A. 

46 

Spear,  W.  A.,Pt.,1,  112th 

Sept,  29, 

Right;   Confed.  surgeon.  Disch'd 

14 

Frederick,  J.,Pt.,D,15th 

Oct.  14, 

Left;  flap.     Confed.  surg.     Five 

New  York,  age  35. 

Oct.  2,'64. 

June  13,  1865. 

Massachusetts,  age  35. 

26,  '63. 

ins.  nee.  seq.  removed.     Disch'd 

47 

Velzy,  G.,  Corp'l,  K,  94th 

July  1, 

Left  ;  circ.     Surg.  R.  Loughran, 

May  24.  1864.    .JJpec.2232.    Died 

New  York,  age  21. 

8,  '63. 

20th  N.  Y.  S.  M.     Disch'd  July 

March  13,  1872  ;  tuberculosis. 

19,  1864. 

15 

Hanilin,  W.  H.,  Corp'l, 

Oct.  18, 

Left  ;  flap.     Surg.  N.  S.  Hamlin, 

48 

Vick,  E.  R.,  Pt.,  I,  30th 

July  1, 

.     Surg.—  Sacherell,  C.S.A. 

L,  7th  Missouri  Cav. 

No.18,'61. 

7th  Mo.  Cav.  Disch'd  Mav  5,  '62. 

North  Carolina. 

17,  r62. 

Recovery. 

16 

Hervey,  R.,  Pt.,  C,  82d 

July  1, 

Left.     Surg.  C.  Page,  U.'  S.  A. 

49 

Whitacre,  J.  R.,  Pt,  E, 

Aug.  30, 

Left:  circ.  A.  Surg.D.W.Voyles, 

Pennsylvania. 

-,  '62. 

Disch'd  Oct.  6,  1863. 

69th  Indiana. 

Sep.  6,  '62. 

66th  Ind.     Disch'd  Nov.  22,  '62. 

17 

Hilton,  J.  C.,  Capt.,  K, 

July  2, 

Right.     Surg.  C.  S.  Wood,  66th 

50 

Woodhouse,   J.,  Pt.,  I, 

Dec.  7, 

Right  ;  circ.  Surg.P.Harvey,  19th 

145th  Penn.,  age  22. 

12,  ^63. 

N.  Y.     Disch'd  Dec.  19,  1863. 

20th  Wisconsin,  age  28. 

11,  '62. 

Iowa.  Bone  remo'd.   Recovery. 

18 

Hobbs.L.  H.,  Pt.,  H,  27th 

Aug.  27, 

Right;    circ.     Transferred   Sept. 

51 

Acker,  D.,  Pt.,  D,  148th 

May  3, 

Right.     Died  June  3,  1863. 

Georgia,  age  33. 

Se.  17,'64. 

22,  1864. 

Pennsylvania. 

18,  '63. 

19 

Hnbbard,  A.,  Pt.,  Bat'ry 

Muy  32, 

Right  ;    circ.     Surg.  E.  Bentley, 

52 

Allen,  H.  H.,Pt.,F,100th 

May  12, 

Right;  circ.  Surg.  A.  F.  Sheldon, 

M,  5th  U.S.Art.,age20. 

25,  '04. 

U.  S.  V.     Disch'd  May  19,  1865. 

Penn.,  age  35. 

28,  '64. 

U.S.V.    Died  June  4,'64  :  exh'n. 

20 

Hugot,  J.,  Pt.,  H,  5th  N. 

Mav  5, 

Left;  circ.;  hyperostosis.  Disch'd 

53 

Allen,  L.  M.,  Pt.,  E,  10th 

April  6, 

(erysipelas;    haem.)      Died 

Jcrsev,  age  30. 

8,  '62. 

July  7,  1863.    Spec.  1256. 

Arkansas. 

M'y6,'62. 

May  6,  1862. 

21 

Iffla,  A.  G.,  Pt.,  C,  83d 

Sept.  17, 

Right.      Surg.  W.  T.  Thurston, 

54 

Anderson,  W.  G.,  Pt  ,  G, 

Dec.  13, 

Right  ;  flap.  Jan.  13,  15,  17,  hasm.; 

New  York. 

Oct.7,  '62. 

U.  S.  V.    Disch'd  Dec.  12,  1862. 

114th  Penn.,  age  16. 

1862, 

lig.  mus.  branch.     Died  Jan.  17, 

22 

James,  T..  Pt  ,  E,  147th 

Feb.  6, 

Left;  flap.     Disch'd  Sept.  6,  '65. 

Ja.  11,'63. 

1863;  exhaustion. 

New  York,  age  37. 

10,  '65. 

55 

Balcom,  M.  S.,  Pt.,  B, 

May  17, 

Right  (pyaemia  ;  diarrhoea)  ;  circ. 

23 

Jennings,  T.,  Pt.,—  ,24th 

Aug.  30, 

Right.     Ass't  Surg.  B.  Howard, 

12th  Conn. 

Je.  —,'64. 

A.  A.  Surg.  W.  S.  Ward.     Died 

New  York. 

Sep.5,'62. 

U.  S.  A. 

June  23,  1864  ;  shock. 

24 

Kane,  J.,  Serg't,  D,  2d 

May  6, 

Left,     Disch'd  March  27,  1865. 

56 

Barr,  R.G.,Capt.,B,49th 

May  10, 

Right  (gang.);  circ.     A.  A.  Surg. 

Michigan,  age  23. 

12,  '64. 

Penn.,  age  24. 

24,  '64. 

M.  C.  Mulford;  slough.     Died 

25 

Keeuan,  J.,  Pt.,  B,  3Gth 

Nov.  30, 

Right  (gang.);  ant.  post.  flap.  Dr. 

July  27,  1864  ;  diarrhoea. 

Illinois,  age  34. 

De.5,'64. 

Rainey,  Franklin,  Tenn.  Disch'd 

57 

Becht,    J.,    Pt.,    B,    7th 

Mar.  31, 

Right  (prim.  exc.  fern.);  ant.  post. 

June  12,  1865. 

Maryland,  age  38. 

Ap.12,'65. 

flap.  A.  A.  Surg.  J.  Tyson.  Died 

26 

King,  E.  S.,  Pt.,  E,  23d 

Julv  30, 

Left;    flap.     Surg.    E.  Bentlev, 

April  12,  1865;  shock. 

Colored  Troops. 

Au.'l2,'64 

U.  S.  V.     Disch'd  June  8,  1865. 

58 

Belden,  H.,  Pt.,  H,  171st 

June  12, 

Right  (hasm.);circ.     Surg.  A.M. 

27 

Kim,  P.,  Pt.,  A,  69th  In 

Aug.  30, 

Right  ;  circ.    Disch'd  Nov.  23,  '62. 

Ohio,  age  18. 

26,  '64. 

Speer,  U.  S.  V.    Died  June  27, 

diana. 

Sep.4,'62. 

1864;  shock. 

28 

Kniffeus,  C.,   Serg't,  D, 

July  1, 

Right;  circ.     Surg.R.  Loughran, 

59 

Blantin,  A.,  Pt.,  K,  15th 

Sept.  14, 

(frag's  removed)  ;  oval  flap; 

20th  New  York  S.  M., 

7,  '63. 

20th  N.  Y.  S.  M.    Neo.    Dissh'd 

South  Carolina,  age  37. 

26,  '62. 

slough.  Died  Oct.  1,  '62;  pyaem. 

age  29. 

August  9,  1864.     Spec.  4300. 

60 

Brinklev,  J.  If.,  Pt.,  A, 

June  —  , 

Left.     Surg.  —  Eads,  C.  8.  A. 

29 

Kreger,  J.,  Pt.,  C,  142d 

Dec.  13, 

Right.     Disch'd  April  22,  1864. 

28th  N.  Carolina. 

J'y  12,  '62. 

Died  August  4,  1862. 

Pennsylvania. 

21,  '62. 

61 

Bryan,  E.  G.,  Pt.,  E,  3d 

Oct.  19, 

Left  (mortification).   Died  Nov.  9, 

30 

Linehan,  T.,  Pt.,  D,  37th 

Mav  31. 

Right  ;  flap.     A.  A.  Surg.  G.  H. 

Mass.,  age  22. 

24,  '64. 

1864  ;  exhaustion. 

New  York,  age  19. 

Je.27,'62. 

Dare.     Haetn.;  lig.  fcm.  artery. 

62 

Bueson,  T.,  Pt.,  A,  142d 

Jan.  15, 

.     Surg.  J.  W.  Mitchell,  4th 

Disch'd   Sept.   26,  1862.     Died 

New  York. 

19,  '65. 

C.  T.    Died  Jan.  19,  1865. 

Julv  15,  1876. 

63 

Bnshnell,  E.,  Serg't,  G, 

De.31,'62, 

Left.     Died  Jan.  28,  '63  ;  shock. 

31 

Manghermar.  J.  G.,  Pt., 

Sept.  1  9, 

Right  ;  flap.   Surg.  H.  J.  Herrick, 

29th  Indiana. 

Ja.28,'63. 

K,  87th  Indiana. 

24,  '63. 

17th  Ohio.     Disch'd  May  7,  '64. 

64 

Carney,  J.,  Pt.,  B,  66th 

Sept.  17, 

.     Surg.   C.  S.  Wood.   66th 

32 

Masterson,    J.,    Pt.,    B, 

Sept.  17, 

Right  ;  circ.    Disch'd  Jan.  13/63. 

New  York,  age  20. 

27,  '62. 

N.  Y.     Died  Sept.  30,  1862. 

106th  Penn. 

21,  '65. 

65 

Chase,G.  L.,  Pt.,  D,  36th 

May  5, 

Right;  ant.  post.  flap.     Surg.  A. 

33 

Miller,  J.  II.,  Pt.,  E,  33d 

April  30, 

Right  ;    flap.      Confed.    surgeon. 

Mass.,  age  25. 

29,  %4. 

F.  Sheldon,  II.  S.V.     Died  June 

Iowa. 

M'y3,'64. 

Discharged,  1865. 

10,  1864  ;  exhaustion. 

34 

Neal,  W.  H.,  Pt.,  H,  9th 

Mav  27, 

Right  ;  circ.    Disch'd  Feb.  5,  '64. 

66 

Clinch,    T.,   Lieut.,    A, 

May  31, 

;  flap.     Died  June  8,  1862; 

Illinois,  age  20. 

30,  '63. 

Palmetto  S.  S. 

Je.  5,  '62. 

shock. 

'HiXKLEY  (H.),  Treatment  of  Hospital  Gangrene,  in  Confed.  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  132. 
2FORMENTO  (F.),  Notes  and  Observations  on  Army  Surgery,  New  Orleans,  1863,  p.  20. 


276 


INJURIES    OF    THE   LOWER   EXTREMITIES. 


[CHAP.  X. 


No 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AJ*U  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

67 

Clayborne,  J.  B.,  Pt.,  H, 

July  3, 

Right  (slough.;  haem  ):  circ.    A. 

99 

Labrie,  O.,  Pt.,  H,  126th 

July  9, 

Left  ;  circ.     A.  A.  Surg.  J.  C.  Shi- 

22d  N.  Carolina,  age  23. 

19,  63. 

Surg.  B.  Stone.  U.  S.  V.     Died 

Ohio,  age  23. 

12,  '64. 

mer.  Haem.  from  branch  of  prof. 

July  22/63  ;  exh'n.     Spec.  2056. 

art.:  lig.     Died  July  23,   1864. 

68 

Clodius,  C.,  Pt.,  A,  125th 

Mav  3, 

Left.     A.  Surg.  C.  H.  Lord,  102d 

Autopsy. 

Pennsylvania. 

17,  "63. 

N.  Y.     Spec,  1153. 

100 

Laughery,  J.,  Pt.,C,26th 

Ju'.y  2, 

Left  ;  hy?m.  from  femoral  artery. 

69 

Conrud,  F.,  It.,  E,  26th 

Dec.  13, 

Right.     Died  January  12,  1863  ; 

Pennsylvania,  age  27. 

7,  '63. 

Died  July  19,  1863;  exhaustion. 

New  York,  age  43. 

25,  '62. 

pysemia. 

101 

Lochner,  J.,  Pt.,  I,  13th 

Nov.  27, 

Lef-..     Died  November  30,  1863. 

70 

Con  way,  A.,  Pt.,  G,  34th 

Sept.  10, 

Right.     Died  Sept.  16,  1862;  te 

Illinois. 

30,  '63. 

Ohio. 

14,  '62. 

tanus. 

102 

4Lochterhand,E.,Pt,  H, 

June  17, 

Left;  circ.     A.  Surg.  G.  A.  Mur- 

71 

Cowan,  J.,  Pt.,  H,  155th 

June  26, 

Left  ;  ant.  post  flap.    A.  A.  Surg. 

37th  Wisconsin,  age  34. 

J'y  3/64. 

sick,  U.  S.  V.     Died  July  9/64  ; 

Penn.,  age  32. 

J'yll/64. 

A.  W.  R.  Andrews.     Died  July 

pyaemia.     Spec.  2738.  Autopsy. 

11,  1864  ;  syncope.     Spec.  3345. 

103 

Lounsbeck,   G.,  Pt.,  G, 

May  12, 

Right  (haem.).  flap.     A.  A.  Surg. 

Autopsy. 

64th  New  York,  age  28. 

18,  "64. 

H.  D.  Vosburg      Died  May  18, 

72 

1  Curtis,  G.  F.,  Corp'l,  C, 

May  31, 

Right  ;  circ.    A.  Surg.  G.  A.  Mur- 

1864  ;  exhaustion  from  haem. 

10th  N.  Jersey,  age  22. 

Je.  5/64. 

sick,  U.  S.  V.    Died  June  7,  '64; 

104 

Lutz,  J.,Pt.,B.,  1st  Penn. 

Dec.  13, 

Left;  haemorrhage,   'ig.  femoral 

exhaustion.    Autopsy. 

Reserves. 

20,  '62. 

artery.      Died  Dec.  22,    1862; 

73 

z  Davis,  II.  C.,  Pt.,  I,  46th 

May  1, 

Right  (haem.);  circ.     A.  A.  Surg. 

exhaustion. 

Indiana. 

10.  *63. 

L.  Dyer.     Died  May  18,  1863. 

105 

Mackay,  M.,  Pt.,  D,  26th 

Aug.  29, 

Left.    Surg.  O.  A.  Judson.U.S.V. 

74 

Dawson,  B,Pt.,D,  100th 

May  30, 

Left  ;  circ.     A.  Surg.  W.  Thom 

New  York. 

Sept.  12, 

Died    Sept.  17,    1862;    haemor 

Penn.,  age  18. 

Je.  5/64. 

son,  U.  S.  A.     Died  June  7/64  ; 

1862. 

rhage.     Spec.  4280. 

shock.     Spec.  3547. 

106 

Macon,  J.  M.,  Capt.,  A, 

May  5, 

.     Surg.  D.  Prince,  U.  S.  V. 

75 

Deal,   J.,    Pt.,    K,    81st 

May  8, 

Right  ;  circ.    A.  A.  Surg.  J.  New- 

19th  Miss.,  age  30. 

8,  1)2. 

Died  May  8,  1862. 

Penn.,  age  35. 

27/64. 

combe.     Died  June  6,  1864. 

107 

Mapes,  E.  A.,  Pt.,C,10th 

June  11, 

Right  (slough.);  circ   A.  A.  Surg. 

76 

De  Frend,  J.,  Pt.,  M,  4th 

Nov.  30, 

Right  ;  circ.     Surg.  S.  E.  Fuller, 

N.  Y.  Cavalry,  age  22. 

23,  "64. 

J.  P.  Nagle.     Died  June  30/64. 

Artillery,  age  21. 

De.3/64. 

U.  S.  V.     Died  Dec.   4,   1864  ; 

108 

Markins,  G.,  Pt.,  H,  2d 

Sept.  24, 

Right.    Died  September  29,  1863. 

haemorrhage  and  shock. 

W.  Virginia  M.  I. 

29,  '63. 

77 

Dibble,  H.,  Pt.,  F,  198th 

Mar.  31, 

Right  (ball  extr.);  flap.   Surg.  N. 

109 

McAllister,  D.,Pt..G,  3d 

July  9, 

Right;  flap;   skin  circ.  muscles. 

Penn.,  age  20. 

Ap.  6,  '65. 

R.  Moseley.U.S.V.    Died  April 

Maryland,  age  57. 

12,  '64. 

Died  July  13,  1864  ;  shock. 

12,  '65  :  nerv.  exh'n.    Spec.  4067. 

110 

McAtee,  G.,  Pt.,  E,  12th 

July  18, 

Right  ;  double  flap.     A.  Surg.  J. 

78 

Doane,  H.  H.,  Pt.,  1,1st 

May  21, 

Right  (mortification);  circ.   A.  A. 

Virginia,  age  19. 

28,'  '64. 

Willard,  1st  Md.  P.  H.  B.    Died 

Maine  H.  Art'y,  age  23. 

29,  '64. 

Surg.  J.  H.  Thompson.    Died 

July  29,  1864. 

June  1,  1864  ;  pyaemia. 

111 

*McLaughlin,G.,  Pt.,A, 

Aug.  27, 

;  ant.  post.  flap.     A.  Surg.  C. 

79 

Dougherty,  J.  J.,  Pt.,  C, 

May  18, 

Right.     A.  A.  Surg.  W.  C.  Dixon. 

84th  New  York,  age  25. 

Sept.  2, 

A.  McCall,  U.  S.  A.  Died  before 

1st  Me.  H.  Art.,  age  32. 

22,  '64. 

Died  May  25,  1864. 

1862. 

operation  was  completed. 

Ellsworth,  J.,  Pt.,  C,  1st 

July  3, 

Left.     Surg.  C.  S.  Wood,  66th  N. 

112 

McMullen,   M.,   Pt.,   G, 

Feb.  25, 

Rigut.     Dr.  P.  II.  Johnson,  Rich 

Minnesota. 

-,  '63. 

Y.     Died  July  20,  1863. 

Virginia  Grays. 

—  ,  '63. 

mond.     Died  eight  days  after 

81 

Fellows,   C.  B.,  Serg't, 

Sept.  29, 

Right  ;  anterior  post,  double  flap. 

operation.    Spec.  3016. 

H,  115th  N.  Y.,  age  26. 

Oct.  2/64. 

Confed.  surgeon.    Died  Nov.  1  1, 

113 

McNiece,  S.,  Pt.,  C,  19th 

Aug.  30, 

Right;  circ.     A.  A.  Surg.  B.  F. 

1  864  ;  congestion  of  lungs. 

Indiana. 

Sept.  22, 

Bowles.     Died  Sept.  25,   1862. 

82 

Fenner,  T.,  Pt.,  G,  142d 

Dec.  13, 

Left;  circ.     Surg.  J.  A.  Phillips, 

1862. 

Spec.  15. 

Pennsylvania. 

16,  '62. 

9th  Penn.  Res.     Died  Jan.  12, 

114 

Merritt,  C.  S.,  Corp'l,  D, 

April  6, 

;    double  flap.     Surg.  E.  C. 

1863;  wound. 

40th  Illinois. 

-,  '62. 

Franklin,  U.  S.  V.     Died  April 

83 

Fisher,    H.,   Serg't,    A, 

Oct.  19, 

Right  ;  lat.  skin  flap  ;  circ.  muse. 

28,  1862. 

10th  N.  Jersey,  age  21. 

22,  "64. 

Surg.  C.  II.  Andrus,  176th  N.  Y. 

115 

Murit,  B.,  Pt.,  H,  17th 

Aug.  30, 

.    Died  September  14,  1862. 

Died  Nov.  12/64  ;  exh'n.  Autop. 

New  York. 

—  ,  '62. 

84 

Frazier,  J.  H.,Pt.,  A,56th 

Dec.  6, 

Left;  ant.  post.  flap.    A.  A.  Surg 

116 

Murphy,  J.  M.,  Pt.,  E, 

Sept,  17, 

R't  ;  circ.     A.  A.  Surg.  A.  North, 

New  York,  age  25. 

11,  '64. 

W.  Balser.    Died  Dec.  13,  1864  ; 

27th  Georgia,  age  22. 

Oct.  10, 

Died  Oct.  21,  1862;  exhaustion. 

exhaustion. 

1862. 

Specs.  779,  871. 

85 

Gaw,  R.  P.,  Pt.,  B,  23d 

June  1, 

Left.     A.  Surg.  B.  Stone,  U.S.V. 

117 

Musser,  J.,  Capt,,  A,  46th 

April  —  , 

Left.    Died  April  24,  '62  ;  shock. 

Penn.,  age  52. 

9,  '64. 

Died  June  13,  1864.    Spec.  1407. 

Illinois. 

—  ,  '62. 

86 

Hite,  n.  S.,  Pt.,  A,  17th 

May  5, 

;  flap.     Surg.  D.  Prince.  U. 

118 

Noonan,  F.,  Pt.,  F,  18th 

Sept.  17. 

Right.     A.  Surg.  H.  A.  Dubois, 

Virginia. 

8,  '62. 

S.  V.     Died  May  9,  '62  ;  shock. 

New  York. 

Oct.  1/62. 

U.  S.  A.    Died   Aug.  8,  1863; 

87 

Hoffman,  C.,  Pt.,  A,  1st 

Aug.  1, 

Right  (haem.);  dou.  oval  skin  flap. 

tuberculous  disease.  Spec.  3886. 

Cavalry,  age  24. 

8,  '63. 

A.  Surg.  W.  Thomson,  U.  S.  A. 

119 

Nugent,   P.,  Pt.,  I,  5th 

July  2, 

Left  ;  circ.     A.  Surg.  B.  Howard, 

Died  Ang.  8,  '63  ;  shock.     Spec. 

Artillery. 

5,  '63. 

U.  S.  A.  •  Died  July  8,   1863. 

1679.     Autopsy. 

Spec.  1380. 

88 

Hostetter,  A.,  Corp'l,  K, 
45th  Penn.,  age  23. 

May  9, 
26,  '64. 

Right  ;  ant.  post.  flap.    Surg.A.F. 
Sheldon,  U.  S.  V.    Died  May  28, 

120 

Parrish,  P.  B.,  Serg't, 
D,  31st  N.  C.,  age  22. 

Sept.  29, 
Oct.  7/64. 

Right.    A.A.Surg.  E.  K.  Deemy. 
Died  October  9,  1864. 

1864  :  exhaustion. 

121 

Patten,  J.,  Pt.,  I,  3d  Wis 

May  25, 

Right;  circ.     A.  A.  Surg.  II.  S. 

89 

Howell,   J.,    Serg't,   K, 

July  9, 

Left  ;  amp.  mid.  third  ;  reamp.  up. 

consin,  age  21. 

Je.7/64. 

Kilbourne.    Died  July  22,  1864  ; 

110th  Ohio,  age  37. 

12,  '64. 

third  while  on  table.   A.  A.  Surg. 

exhaustion.     Spec.  3396. 

W.  S.  Adams.    Died  July  12, 

122 

Pierce,  T.  M.,  Pt.,  B,  1st 

May  19, 

Right  ;  circ.    Died  May  31,  '64  ; 

1864;  shock. 

Maine  Art'y,  age  16. 

25,  '64. 

asthenia.     Spec.  2617. 

90 

3Hutchings,  J.  B.,Pt.,G, 
6th  New  York  H.  Art., 

May  30, 
Je.  5/64. 

Left;  circ.     Surg.  J.  A.  Lidell, 
U.  S.  V.     Died  June  10,  1864  ; 

123 

Province,  S.,  Pt.,  I,  90th 
Pennsylvania. 

Aug.  31, 
Se.—  ,'62. 

.     Died  September  21,  1862. 

age  22. 

exhaustion.     Autopsy. 

124 

Radford,  V.,  Pt.,  K,  71st 

May  12, 

Left;  circ.      A.  A.  Surg.  J.  H. 

91 

Jarkson,  C.,  Corp'l,  G, 
2d  Michigan. 

June  25, 
28,  '64. 

Left.    (June  25,  exc.  fib.)    Surg. 
A.  F.  Whelan,  1st  Mich.  S.  S. 

Penn.,  age  29. 

19,  '64. 

Thompson.    Died  May  25,  1864  ; 
pyaemia. 

Died  July  2,  1864. 

125 

Razette,  V.,    Corp'l,  G, 

Mav  5, 

Right.     Died  June  1,  1864  ;  py- 

92 

Johnson,  J.,  Pt.,  A,  153d 

Oct.  19, 

Right  (haem.);  circ.  A.  A.  Surg.  J. 

57th  Mass,   ajre  33 

9  ''64 

New  York,  age  21. 

No.  9,  '64. 

Neff.  Died  Nov.  17/64  ;  pyaemia. 

126 

Robbins,  A.,'  Pt.,  G,  48th 

July  4, 

Left.    Died  July  9,  1864. 

93 

Jones,    T.,   Pt.,   H,    llth 

June  —  . 

Right.     Surg.  —  Ward,  C.  S.  A. 

Colored  Troops. 

7,  ''64. 

94 

Virginia. 
Jourman,  R.,  Pt.,  E,  35th 

J'ylO/62. 
Feb.  20, 

Died  July  16,  1862. 
R't  ;  flap.    Surg.  —  Hallyfield,  C. 

127 

Rowell,  A.,  Pt.,  F,  94th 
New  York. 

Aug.  31, 

Se.-/62. 

.     Died  September  10,  1862. 

Colored  Troops. 

26,  '64. 

S.A.  Died  June  5/65;  consump. 

128 

Rowland,  R.,  Pt.,  1st  N. 

June  19, 

Left;  ciro.     A.  A.   Surg.  W.  C. 

95 

Kelly,  J.,  Pt  ,  F,  1st  N. 
York  Cavalry,  age  21. 

July  7, 
Au.  6/63. 

Left  (ball  extr.>     A.  Surg.  R.  F. 
Weir,  U.S.A.  Erysipelas.  Died 

129 

York  Ind.  Bat.,  age  31. 
Ryder,    S.,    Pt.,    F,   1st 

27,  '64. 
Mav  31, 

Pryer.    Died  June  27/64  ;  exh'n. 
Left.  A.  Surg.A.  Ingram,  U.S.A. 

96 

Kerr,  R.  D.,  Pt.,  F,  5th 

May  6, 

Aug.  18/63.  Spec.  3895.    Autop. 
(haem  );  ant.  post.  flap.     A. 

Mass.  H.  Art'y,  age  39. 

Je.  5/64. 

Died  June  12,  18(i4;  exhaustion. 
Spec.  2824. 

N.  Carolina  Cavalry. 

23,  ''64. 

Surg.  W.  F.  Hichardson,  C.  S.A. 

130 

Smith,  —  ,  —  ,  14th  New 

July  21, 

.  Surg.  —  >Darby,  Hampton's 

Died  May  23,  1864. 

York  S.  M. 

27,  '61. 

Legion.     Died  July  27,  1861. 

97 
98 

Kisnt.r,    G.    W.,  Pt.,  E, 
19th  Mississippi. 
Knox,  T.  T.,  Pt.,  B,  1st 

June  —  , 
J'y  13/62. 
Oct.  19, 

Right.     Surg.  _  Ward,  C.  S.  A. 
Died  July  14,  1862. 
Left  (mortification);  lat.  skin  flap; 

131 

Soule,  J.  W.,  Corp'l,  D, 
6th  Michigan  Cavalry, 
age  27. 

July  8, 
29,  ^63. 

Right  (July  S,  exc.;  baam.  from 
sciatic  artery)  ;  ant.  post.  flap. 
Died  July  29,  18G3.    Spec.  3854. 

Maine,  age  40. 

22,  '64. 

circ.  sect.  muse.     Surg.  C.  H. 

Autopsy. 

Andrus.  176th  N.  Y.    Died  Nov. 

132 

Stanford,  G.,  Pt.,A,12th 

July  9, 

Left  ;  circular.     Died  same  day; 

10,  1864;  pyaemia. 

Georgia,  age  30. 

13,  '64. 

never  rallied. 

1  LIDKLL  (J.  A.),  On  the  Secondary  Traumatic  Lesions  of  Bone,  etc.,  in  U.  S.  San.  Com.  Memoirs,  Surg.  Vol.  I,  1870,  p.  383. 
2BttYAX,  i  J.),  Brief  Description  of  Sixteen  Cases  of  Amputations  Treated  in  the  Mary  Ann  Hospital,  Grand  Gulf,  Miss.,  in  Am.  Med.  Time*  Vol. 
VH,  1863,  page  5,  case  XIII. 

3  LIDELL  (J.  A.),  On  the  Secondary  Traumatic  Lesions  of  Bone,  etc.,  in  U.  S.  San.  Com.  Memoirs,  Surg.  Vol.  I,  1870,  p.  413. 

4  LIDELL  (J.  A.),  On  the  SecorVary  Traumatic  Lesions  of  Bone,  etc.,  in  U.  S.  San.  Com.  Memoirs,  Surg.  Vol.  I,  1870,  p.  409. 

•COUES  (E.),  Report  of  some  Cases  of  Amputations  and  Resections,  from  Gunshot  Wounds,  performed  at  the  Mount  Pleasant  U.  S.  A.  General 
Hospital,  by  C.  A.  McCall,  M.  D.,  U.  S.  A.,  in  Med.  find  Surg.  Reporter,  1862-3,  Vol.  9,  p.  194. 


SECT,  in.] 


INTERMEDIARY    AMPUTATIONS    OF   THE   THIGH. 


277 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

133 

Stiff,  D.  D.,  Serg't,  A,  2d 

June  10, 

Right  (ball  and  bone  extracted). 

140 

Vose,  E.,  Pt.,  I,  5th  New 

Dec.  13, 

Left.     Surg.  C.  8.  Wood,  66th 

Michigan  Cavalry. 

13,  '63. 

Died  one  hour  after.    Spec.  659. 

Hampshire. 

22/62. 

N.  Y.     Died  Dec.  23,  1862. 

Autopsy. 

141 

Warren,    C.,    Serg't,    I, 

Sept.  17, 

Left  (gang.);  flap.     Surg.  A.  N. 

134 

Still,  C.  B.,  Pt.,  B,  22d 

Sept.  1, 

Left.    Died  September  13,  1864. 

15th  Massachusetts. 

Oct.2,'62. 

Dougherty,  U.  S.  V.     Died  Oct. 

Indiana. 

-,  '64. 

2,  1862  ;  shock.     Spec.  379. 

135 

Tetard,  J.,  Serg't,  F,  Gth 
Infantry. 

July  1, 
4,  '63. 

Left  ;  double  skin  flap.     A.  Surg. 
B.  Howard,  U.S.A.     Died  July 

142 

Wheedon,  K.  A.,  Corp'l, 
K,  47th  N.  C.,  age  24. 

July  3, 
7,  '63. 

Left  ;  liaem.  from  muscul.  branch. 
Died  July  23,  1863;  pyaemia. 

13,  1863.     Hsem.     Spec.  1381. 

143 

Whitbeck,  W.,  Pt.,  E, 

July  —  , 

Right.     Surg.  C.  S.  Wood,  With 

136 

Thomas.  W.  C.,  Pt.,  G, 

Oct.  22, 

Right  ;  circ.     Died  Nov.  9,  1862. 

lllth  New  York. 

—,'63. 

N.  Y.     Died  July  14,  1863. 

7tli  Connecticut. 

No.  9,  '62. 

144 

Williams,  W.,Pt.,B,  24th 

July  1, 

Left.    Died  July  20,  1863. 

137 

Tompkins,  G.,  Pt.,  G,  1st 

July  3, 

Right  (July  4,  amp.  leg.;  gang.); 

Michigan. 

6,  '63. 

New  York  Bat'y,  age 

17,  '63. 

amp.  thigh  to  get  rid  of  putrid 

145 

Winchell,    G.,    Pt.,    D, 

May  12, 

Right;  circ.     Surg.  A.  Delaney, 

40. 

mass;  haem.;  lig.  fem'l  artery. 

14th  New  York  Art'y, 

29,  '64. 

U.  S.  V.    Died  June  2,  1864; 

Died  July  26,  1863;  pyjemia. 

age  18. 

congestion  of  lungs. 

138 

Underwood,  T.,  Pt.,  G, 

June  27, 

Right.     Surg.  W.  Faulkner,  83d 

146 

Woodward,  J.    T.,    Pt., 

June  3, 

;  circ.     Surg.  C.  B.  Herndon, 

1st  Mich.,  age  30. 

J'y9,'62. 

Penn.   Erysipelas  ;  gang.    Died 

D,  26th  Mississippi. 

23,  '64. 

C.  S.  A.     Anorexia  ;  bed  sores  ; 

August  11,  1862. 

diarr.    Died  July  15/64  ;  exh'n. 

139 

Verner,  J.,  Pt.,  I,  99th 

Aug.  28, 

Left.    Died  September  21,  1862  ; 

147 

Worchester,  S.  W.,  Pt., 

Sept.  19, 

Left  ;  flap.     Surg.  W.  A.  Barry, 

New  York. 

Se.18,'62. 

pyaemia. 

B,  9th  N.-Y.H.  Art'y. 

23,  '64. 

98th  Penn.     Died;  exhaustion. 

In  one  hundred  and  thirteen  of  the  above  cases  the  femur  had  been  fractured — in 
eighteen,  in  the  upper;  in  fifty,  in  the  middle;  in  fifteen,  in  the  lower  third;  and  in  thirty, 
without  indication  of  the  precise  location.  In  twenty-nine  instances  the  seat  of  fracture 
was  in  the  knee  joint,  and  in  five  in  the  leg.  In  one  case,  primary  amputation  in  the  upper 
third  of  right  arm,  in  three  instances  excision  in  the  thigh  or  bones  of  the  leg,  and  in  one, 
amputation  in  the  upper  third  of  the  same  leg  had  preceded  the  amputation  in  the  thigh.1 

Intermediary  Amputations  in  the  Middle  Third  of  the  Thigh. — The  four  hundred 
and  seventy-one  intermediary  amputations  in  the  middle  third  of  the  thigh  furnished  two 
hundred  and  sixty-six  deaths,  a  mortality  rate  of  56.4,  or  nearly  10  per  cent,  less  than  the 
intermediary  upper  third  amputations.  Seventy-two  of  the  four  hundred  and  seventy-one 
operations  were  performed  on  Confederate  soldiers.  The  right  limb  was  removed  in  two 
hundred  and  nine,  and  the  left  in  two  hundred  and  thirty-five  instances,  and  in  twenty- 
seven  the  side  was  not  indicated.  The  circular  and  the  flap  methods  were  each  employed 
in  one  hundred  and  sixty-three  cases;  in  one  hundred  and  forty-five  the  mode  of  operation 
was  not  stated. 

Successful  Cases  of  Intermediary  Amputations  in  the  Middle  Third. — One  hundred 
and  sixty-seven  of  the  two  hundred  and  five  operations  of  this  group  were  performed  on 
Union  soldiers.  All  but  seven  were  living  in  October,  1879.  Two  had  undergone  ante 
cedent  operations;  one  an  excision  at  the  knee  joint,  and  one  an  amputation  in  the  upper 
third  of  the  leg.2  Sequestra  were  removed  in  twelve,  and  fragments  or  protrusions  of  bone 
in  thirty-one  instances: 

CASE  458. — Sergeant  H.  Clark,  Co.  E,  125th  New  York,  aged  22  years,  was  wounded  at  the  Wilderness,  May  6,  1864, 
and  entered  the  Third  Division  Hospital,  Alexandria,  eight  days  afterwards.  Surgeon  E.  Bentley,  U.  S.  V.,  reported:  "The 
patient  was  admitted  with  a  shot  injury  of  the  left  knee  joint,  caused  by  a  conical  ball.  His  physical  state  was  good,  but  the 
condition  of  the  wounded  limb  was  such  as  to  give  no  hope  of  recovery  without  resorting  to  amputation.  The  operation  was 
performed  by  antero- posterior  Haps,  at  the  junction  of  the  middle  and  lower  thirds,  on  May  17th,  chloroform  being  used  as  the 
anaesthetic.  The  patient  did  not  rally  well,  and  fears  were  entertained  of  his  immediate  death.  He  had  chills  at  intervals  for 
a  week  or  ten  days.  By  June  10th,  the  stump  was  doing  well  and  parti}'  closed  by  first  intention,  though  there  was  profuse 
suppuration.  The  treatment  consisted  of  stimulants,  beef  tea,  iron,  and  quinine,  and  cold-water  dressings.  With  the  exception 
of  the  excessive  suppuration  the  patient  did  well  until  June  20th,  when  he  had  a  severe  chill,  and  stimulants  were  ordered  to 

Private  H.  Schmidt,  O,  57th  Illinois  (TABLE  XXXIV,  No.  44,  p.  275.  and  Second  Surg.  roL,  TABLE  LXVI1I,  No.  920,  p  711),  amputation  right 
thigh  and  right  arm  in  upper  thirds,  recovery;  Corp'l  J.  W.  Soule,  D,  6th  Miohifr.m  Cavalry  (TARI.E  XXXIV,  No.  131,  p.  27fi,  anil  TABLE  XXIII,  No.  51, 
p.  206,  ante),  primary  excision  of  femur  in  upper  third  and  amputation  of  thigh,  fatal;  Pt.  J.  Becht,  B,  7th  Maryland  (TAlil.E  XXXIV,  No.  57,  p.  275,  and 
TADI.E  XXIII,  No.  3,  p.  20fi,  ante),  primary  excision  in  middle  third  of  femur  and  amputation  of  thigh,  fatal ;  Corp'l  C.  Jackson,  2d  Michigan  (TAHLE 
XXXIV,  No.  91,  p.  27(5),  excision  of  upper  part  of  fibula  and  subsequent  amputation  of  thigh,  fatal ;  Pt.  G.  Tompkius,  G,  1st  New  York  Battery  (TABLE 
XXXI.V.  No.  137,  p.  277),  amputation  of  upper  third  of  leg  followed  by  amputation  in  thigh,  fatal. 

'Private  W.  M.  Constable,  H,  1st  Cavalry,  wounded  March  31,  1865;  primary  excision  of  knee  joint  March  31,  1865,  amputation  of  thigh  April  5, 
1865  (TA1U.E  XXXV,  No.  43,  p.  280);  Pt.  A.  J.  Cheever,  H,  16th  Massachusetts,  wounded  July  2,  1863,  amputation  of  leg  July  4th,  and  amputation  of 
thigh  July  18,  1803  (TABLE  XXXV,  No.  35,  p.  280). 


278 


INJUEIES    OF    THE    LOWER   EXTREMITIES. 


(CHAP.  X. 


FIG.  190.— 

Sequestrum, 
4J  ins.  long, 
remov'dnine 
months  aff?  r 
amputation. 
Spec.  666. 


FIG.  191.— Cast  of  stump  of  left 
thigh,  nineteen  months  after  am 
putation.  Spec.  294. 


be  used  freely,  and  quinine  was  given  in  large  doses.  The  secretion  having  become  watery  and  offensive,  the  dressings  were 
changed  frequently.  No  repetition  of  the  chill  occurred,  and  by  June  25th  the  patient's  countenance  had  changed  very  much 
for  the  better,  being  now  clear  instead  of  the  yellow  hue.  The  treatment  was  continued,  and  the  patient  steadily  improved,  his 
appetite  being  good  and  his  bowels  regular.  On  July  1st,  the  stump  had  closed  with  the  exception  of  one  opening,  which 
was  still  discharging  a  large  quantity  of  pus,  healthy  in  color  and  odor,  however.  On  July  7th,  the  patient  complained  of  pain 
just  below  the  great  trochanter,  caused  by  tumefaction  and  great  heat  of  the  skin,  for  which  tincture  of  iodine  was  applied,  fol 
lowed  by  a  tight  bandage,  and  morphia  was  administered.  On  July  10th,  an  abscess  was  opened  in  the  region  of 
the  great  trochanter  and  followed  by  a  thin  watery  discharge.  A  tent  was  then  introduced,  and  the  whole  stump 
being  much  swollen,  it  was  painted  with  tincture  of  iodine,  and  a  bandage  was  applied  tightly.  On  July  15th, 
another  abscess  was  forming  on  the  posterior  aspect ;  the  stump,  though  much  reduced  in  size,  was  still  discharging 
quite  freely.  On  July  20th,  the  patient  was  suffering  from  a  severe  diarrhoea,  and  his  diet  was  restricted,  and  lead 
and  opium  prescribed.  By  July  30th,  the  diarrhooa  was  checked;  the  abscess  on  the  posterior  aspect  of  the  thigh, 
having  formed  a  track  and  opened  at  the  end  of  the  stump,  evacuated  half  a  pint  of  healthy  pus.  The  stump  still 
continuing  to  discharge  large  amounts  of  pus,  the  bandage  was  kept  tightly  applied.  Diluted  creasote  was  also 
used  locally,  and  iron  and  quinine  was  continued  internally.  On  August  7th,  a  new 
abscess  was  opened  just  below  the  great  trochanter.  On  August  13th,  the  stump  still 
suppurating  freely,  an  injection  of  solution  of  chloride  of  zinc  was  commenced,  the 
bandage  being  continued,  and  the  patient  freely  stimulated  by  the  use  of  whiskey. 
After  this  date  several  abscesses  formed  on  different  parts  of  the  thigh,  which  were 
opened  and  discharged  large  quantities  of  pus.  By  proper  bandaging  the  limb  was 
finally  reduced  to  near  its  natural  size,  but  one  opening  remaining  at  the  end  of  the 
stump  and  discharging  a  limited  quantity  of  pus.  By  the  use  of  stimulants  and  nourish 
ing  diet  the  patient's  general  health  improved  so  as  to  enable  him  to  be  transferred  to 
hospital  at  Albany,  near  his  home,  on  November  llth."  The  description  of  two  sub 
sequent  operations  was  contributed  by  Assistant  Surgeon  J.  H.  Armsby,  U.  S.  V.,  in  charge  of  Ira  Harris  Hospital :  "At  the 
time  of  the  patient's  admission  his  constitutional  condition  was  bad,  being  pale,  weak,  and  emaciated.  The  stump  was  swollen 
and  inflamed,  and  there  were  several  small  fistulous  ulcers.  On  February  6, 1865,  a  sequestrum  (FlG.  190)  was  removed  through 
an  incision  about  five  inches  in  length  by  Acting  Assistant  Surgeon  H.  Pearce.  After  this  operation  the  stump  began  to  heal, 
and  continued  to  do  well  up  to  September  4,  1865,  when  the  patient  was  discharged  from  service.  On  December  9th,  following, 
he  applied  for  admission  into  the  Albany  City  Hospital.  The  stump  was  then  healed  with  the  exception  of  a  small  fistulous 
ulcer,  which  was  discharging  moderately.  There  was  but  little  swelling  and  pain,  but,  on  examination  with  the  probe,  naked 
and  carious  bone  could  be  discovered.  The  patient  having  been  placed  under  the  influence  of  chloroform,  two  elliptical  incisions 

were  made  on  the  extremity  of  the  stump,  including  the  ulcer,  and  the  tissues  were 
removed  down  to  the  bone,  thus  leaving  lateral  flaps.  A  chain  saw  was  then  introduced 
and  the  boue  cut  through  an  inch  and  a  half  higher  up,  after  which  the  flaps  were 
brought  together  and  secured  by  sutures.  Cold-water  dressings  were  applied  after 
the  operation."  A  cast  of  the  stump  (FlG.  191)  was  also  contributed  to  the  Museum 
by  Dr.  Armsby,  and  constitutes  Specimen  294  of  the  Surgical  Section.  Fourteen 
months  after  the  last  operation  the  patient  was  supplied  with  an  artificial  limb  by  E.  D. 
Hudson,  of  New  York  City.  Examiner  A.  P.  Cook  reported,  May  14,  1873:  "He  is 
unable  to  wear  an  artificial  limb.  The  femur  is  about  three  inches  shorter  than  the 
fleshy  stump.  The  stump  is  atrophied,  the  muscles  are  soft,  and  there  is  a  deep  cica 
trization  at  the  end,  which  is  very  tender."  The  pensioner  was  paid  June  4,  1879. 

CASE  459. — Lieutenant-Colonel  George  R.  Maxwell,  1st  Michigan  Cavalry,  aged 
22  years,  was  wounded  at  Five  Forks,  Virginia,  April  1,  1865.  He  was  taken  to  the 
field  hospital  of  the  Cavalry  Corps  and  remained  there  until  April  15th,  when  he  was 
sent  to  Washington  on  the  hospital  steamer  Connecticut,  and  admitted  to  the  Armory 
Square  Hospital  on  the  16th.  Acting  Assistant  Surgeon  C.  A.  Leale,1  in  a  special 
report  of  the  case,  furnishes  the  following  particulars:  "  The  left  knee  joint  was  opened 
by  a  conoidal  ball,  which  had  entered  opposite  the  head  of  the  fibula  and  was  extracted 
at  point  of  entrance.  He  was  very  ana3inic  and  in  a  generally  unfavorable  condition; 
extensive  suppuration  had  taken  place,  the  leg  had  become  infiltrated  with  serum,  the 
knee  joint  was  filled  with  pus,  and  the  muscles  of  the  thigh  had  been  separated  by 
extensive  abscesses  extending  as  high  as  the  apex  of  Scarpa's  triangle.  April  17th, 
no  change  in  his  condition;  he  was  placed  under  the  influence  of  ether,  and  the  thigh 
amputated  by  the  circular  operation,  at  the  middle  third,  by  Surgeon  D.W.  Bliss,  U.  S.V.; 
the  stump  was  dressed  with  water,  and  the  patient  placed  in  bed.  April  18th,  although  twelve  ligatures  had  been  applied, 
haemorrhage  continued  to  take  place  (he  being  apparently  of  a  hamorrhagic  diathesis),  and  altogether  about  eight  ounces  of 
blood  was  lost.  Applied  liquor  ferri  persulphas  by  a  camel's  hair  brush  to  the  whole  of  the  surface  of  the  wound,  which  had 
been  left  open  and  exposed  to  the  air  for  about  fifteen  minutes ;  this,  with  the  styptic,  entirely  checked  all  oozing.  April  COth, 
the  granulations  had  become  healthy;  about  two  drachms  of  pus  discharged  daily.  On  the  30th  the  stump  had  nearly  closed. 
June  23d,  a  piece  of  necrosed  femur  of  a  conical  shape,  and  about  four  inches  in  'ength,  was  removed.  August  Hth,  he  was 
mustered  out  of  service;  his  stump  (FlG.  19.!)  was  solid  and  in  good  condition."  The  pensioner  was  paid  June  4,  1879. 

'LEALE  «j.  A  ),  Intermediary  [Ixmnrrhage,   Parenchymatmis  in  Cliaracter,  following  Secondary  Amputation  of  Thigh;  Recovery,  in   United 
States  Sanitary  Coinmitsifm  Memoirs,  Surgical  Volume  1,  p.  176. 


Fin.  i9-j. — Amputating  <>f  left  thigh  at  mid 
dl«  third.     [From  a  photograph.] 


SECT.  III.] 


INTEKMEDIARY    AMPUTATIONS    OF    THE    THIGH. 


279 


FIG.  193.  — Upper 
portion  of  rigfht  tibia 
with  eccentric  splin 
tering.  Spec.  3558. 


FIG.  194.— 
Tubular  se 
questrum,  6 
ins.  long,  re 
moved  from 
right  femur 
four  months 
after  ampu 
tation.  Spec. 
3599. 


CASE  460. — Private  O.  Vezina,  Co.  B,  9th  New  Hampshire,  aged  24  years,  was  wounded  at  Tolopotomy  Creek,  May  31, 

1864,  and  admitted  to  the  field  hospital  of  the  2d  division,  Ninth  Corps,  where  Surgeon  J.  Harris,  7th  Rhode  Island,  noted: 
"Shot  wound  of  right  leg  by  mini6  ball."     Four  days  after  the  reception  of  the  injury  the  man  was  transferred  to 
Douglas  Hospital,  Washington,  where  the  limb  was  amputated.     Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  who 
performed  the  operation,  described  the  case  as  follows:  "The  missile  entered  over  the  anterior  surface  of  the  tibia 

at  about  the  junction  of  the  lower  thirds,  passed  obliquely  upward  and  inward,  fracturing  the 
bone  in  several  pieces  and  lodging  beneath  the  integuments,  whence  it  was  extracted  on  the  field. 
The  fibula  was  not  injured.  On  admission,  the  leg  was  erysipelatous  and  abscesses  were  bur 
rowing  above  and  below,  one  of  which  was  opened  below  the  internal  malleolus.  Poultices  were 
applied,  and  several  sloughs  of  the  integuments  came  away,  leaving  the  muscles  and  tendons 
exposed.  The  patient  suffered  constitutional  irritation  from  continual  pain  and  was  anxious  for 
amputation,  which  was  performed  on  June  llth,  by  the  antero-posterior  flap  method,  at  the  lower 
part  of  the  middle  third.  The  stump  was  dressed  with  equal  parts  of  tincture  of  opium  and 
tincture  of  camphor,  and  poultices  were  applied  until  June  18th,  when  the  sloughs  had  entirely 
separated.  After  this,  cold-water  dressings  were  used  and  the  stump  progressed  finely.  By 
September  1st,  it  had  been  healed  for  some  time,  with  the  exception  of  a  fistulous  opening  lead 
ing  to  necrosed  bone.  On  October  13th,  the  patient  having  for  some  days  suffered  from  great 
pain  and  consequent  inability  to  rest,  a  sequestrum,  six  inches  long  and  of  a  nearly  entire  circum 
ference,  was,  with  great  difficulty,  removed  by  Acting  Assistant  Surgeon  H.  Gibbons.  A  large 
formation  of  new  bone  was  discovered  around  the  cavity  thus  left  in  the  stump.  After  the 
operation  the  pain  ceased,  and  the  patient  again  became  cheerful  and  his  appetite  good.  On 
December  25th,  the  opening  had  almost  entirely  closed."  The  upper  portion  of  the  tibia  of  the 
amputated  limb,  showing  eccentric  splintering  by  the  missile,  and  necrosis  adjacent  to  the  seat 
of  the  fracture,  was  contributed  by  the  operator,  and  is  represented  in  the  wood-cut  (FlG.  193). 
The  sequestrum,  shown  opposite  (FlG.  194),  was  contributed  by  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A.  The  patient  was 
discharged  from  service  June  14,  1865,  and  furnished  with  an  artificial  limb  one  month  afterwards  by  B.  F.  Palmer,  of  Phila 
delphia.  The  pensioner  was  paid  June  4,  1878. 

In  the  following  instance  the  officer  remained  in  active  service  until  1870,  when  he 
was  retired.  He  died  in  1879: 

CASE  461.— Brigadier-General  T.  W.  Sherman,  U.  S.  V.,  Colonel  3d  U.  S.  Artillery,  was  wounded,  during  the  assault  on 
Port  Hudson,  May  27,  1863,  by  a  conoidal  musket  ball  passing  through  his  right  leg  and  causing  a  fracture  of  the  tibia  and 
fibula  at  the  upper  third.  When  conveyed  to  New  Orleans,  three  or  four  days  after  the  injury,  the  wound,  which  was  extensive 
and  greatly  lacerated,  was  found  to  have  been  very  tightly  sewed  up  with  one  continuous  suture,  the  cutting  out  of  which  gave 
exit  to  a  large  discharge  of  decomposing  coagula,  pus,  and  bone  splinters.  His  constitutional  symptoms  had  assumed  a  most 
aggravated  character,  and  the  patient  remained  in  a  very  discouraging  condition  for  nearly  two  weeks,  when  amputation  through 
the  middle  third  of  the  thigh,  though  only  offering  the  slightest  hope  of  success,  was  performed  by  Professor  Warren  Stone 
with  favorable  result.  The  injured  tibia  and  fibula  (Spec.  3804),  many  of  the  missing  fragments  of  which  were  discharged  from 
day  to  day  before  the  amputation,  were  contributed  to  the  Army  Medical  Museum  by  Professor  F.  Bacon,  of  New  Haven,  late 
Surgeon  U.  S.  V.  General  Sherman  was  mustered  out  of  the  volunteer  service  April  30,  1866,  and  retired  from  active  service 
December  31,  1870.  He  died  at  his  home  in  Newport,  R.  I.,  March  16,  1879.  (See  Circular  No.  6,  War  Department,  S.  G.  O., 

1865,  p.  38.) 

Fifteen  of  the  patients  survived  ulterior  operations — one  a  re-amputation  at  the  hip 
joint,1  ten,  re-amputation  of  the  thigh,  one  an  amputation  of  the  opposite  arm  and  leg  in 
consequence  of  an  accident,  and  three,  ligations  of  the  femoral  artery.  Consecutive  bleeding 
was  observed  in  nine,  pyaemia  in  two,  and  gangrene  in  fourteen  of  the  cases  of  this  group. 

Fatal  Cases  of  Intermediary  Amputation  in  the  Middle  Third  of  the  Thigh. — Two 
hundred  and  sixty-six  cases  belong  to  this  group.  Thirty-four  of  the  operations  were 
practised  on  Confederate,  and  two  hundred  and  thirty-two  on  Union  soldiers.  Pyaemia 
was  noted  in  forty-two,  gangrene  in  thirty-three,  tetanus  in  four,  erysipelas  in  four,  and 
haemorrhage  in  sixty-nine  instances.  The  Museum  possesses  specimens  in  eighty-nine  of 
the  two  hundred  and  sixty-six  cases: 

CASE  462.— Corporal  Clark  Chase,  Co.  B,  120th  New  York,  aged  23  years,  was  wounded  at  Cold  Harbor,  Virginia,  May 
31,  1864.  Surgeon  O.  Evarts,  20th  Indiana,  reported  the  admission  of  the  patient  into  the  hospital  of  the  3d  division,  Second 
Corps,  with  a  "shot  wound  of  the  left  thigh,  flesh;  simple  dressings."  He  was  transferred  to  Washington,  and  admitted  into 
Douglas  Hospital  on  June  4th.  Assistant  Surgeon  William  Thomson,  U.  S.  A.,  reported  :  "  Shot  fracture  of  right  femur,  lower 
part  of  middle  third.  The  patient's  condition  was  apparently  good,  his  pulse  full  and  strong.  The  bone  was  much  comminuted. 
There  was  no  inflammatory  action.  June  5th,  Assistant  Surgeon  W.  Thomson  administered  ether,  and  amputated  the  left  thigh  m 
the  upper  part  of  the  middle  third  by  the  circular  method.  8th,  pyasmia  developed,  ushered  in  by  a  chill.  10th,  chill;  conjunc- 
1  Sergeant  E.  D.  Ulmer,  G,  15th  New  Jersey.  (See  CA6E  333,  p.  156,  and  TABLE  XVIII,  No.  5,  p.  159,  ante,  and  TABLE  XXXV,  No.  183,  p.  282.) 


280 


INJURIES   OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


tiva  slightly  yellow,  llth,  haemorrhage,  to  the  extent  of  four  ounces,  from  a  muscular  branch,  which  ceased  spontaneously  and 
did  not  recur.  The  discharge  from  the  stump  was  very  dirty  and  offensive,  and  breath  sweetish.  He  died  June  12,  1864.  The 
autopsy  revealed  pyaemic  patches  in  the  lungs,  phlebitis  of  femoral  veins,  and  osteomyelitis  of  the  femur."  Dr.  Thomson  con 
tributed  the  pathological  preparation  of  the  femoral  artery  to  the  Army  Medical  Museum,  numbered  2509,  and  the  lower  two- 
thirds  of  the  femur,  numbered  3548,  of  the  Surgical  Section.  He  also  forwarded  the  upper  extremity  of  the  femur  (Spec.  6715, 
Surg.  Sect."),  removed  post-mortem.  A  longitudinal  section  of  the  specimen,  showing  osteomyelitis,  was  drawn  by  Hospital 
Steward  E.  Stauch,  and  is  copied  in  the  chromo-lithograph  (PLATE  XXVI)  opposite  p.  278. 

CASE  463.— Brigadier-General  E.  Kirby,  U.  S.  V.,  First  Lieutenant,  U.  S.  Artillery,  was  wounded  at  Chancellorsville, 
May  3,  1863.  He  was  admitted  to  the  Artillery  Brigade  Hospital,  Second  Corps,  whence  Surgeon  J.  H.  Merrill,  1st  Rhode 
Island  Artillery,  reported :  "  Wound  in  lower  third  of  left  thigh  by  two  bullets  from  a  spherical  case  shot.  Patient  sent  immedi 
ately  to  Washington."  Surgeon  B.  Norris,  U.  S.  A.,  under  whose  care  the  patient  came  to  Washington,  reported  the  following 
description  and  result  of  the  injury:  "Two  round  balls  entered  the  thigh  about  two  inches  above  the  condyles,  producing  a  com 
minuted  fracture  of  the  lower  third  of  the  femur.  The  case  came  under  my  treatment  on  May  5th,  and  amputation  at  the  middle 
third  by  the  circular  method  was  performed  on  May  10th.  The  tourniquet  was  used,  and  chloroform  employed  as  the  anaesthetic. 
One  ball  was  found  embedded  in  the  medullary  canal  of  the  femur,  and  the  other  in  the  vastus  externus  muscle.  The  operation 
was  followed  by  increase  of  fever,  which  rapidly  assumed  the  typhoid  type.  This  brave  young  officer  survived  the  operation 
eighteen  days,  and  died  of  pyaemia  May  28, 1863."  The  amputated  portion  of  the  femur  was  contributed  to  the  Museum  by  the 
operator  (Cat.  Surg.  Sect.,  1866,  p.  290,  Spec.  1076),  and  is  represented  in  PLATE  XLII,  opposite. 

TABLE  XXXV. 

Summary  of  Four  Hundred  and  Seventy-one  Cases  of  Intermediary  Amputation  in  the  Middle  Third 

of  the  Femur  for  Shot  Injury. 

[Cases  of  recovery,  1—205 ;  fatal  cases,  206 — 471.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Albert,  J.,  Pt.,  D,  46th 

Aug.  9, 

Left.     Surg.  D.  O.  Perry,   10th 

24 

Burgess,  D.  M.,  Pt.,  Mas- 

Nov.  3, 

Right.  Surg.  —Browne,  C.  S.  A. 

Penn.,  age  26. 

14,  '6-2. 

Me.  Necrosed.  Disc'd  Jan.4,'64. 

sier's  Battery. 

7,  '63. 

Recovery. 

•2 

Alexander,  J.  D.,  Pt.,  A, 

May  8, 

Right  ;    circ.     Confed.   surgeon. 

25 

Campbell,  W.,    Pt.,    C, 

Sept.  17, 

Right  ;  circ.     Nee.  bone  excised. 

8th  Maryland,  age  20. 

12,  V)4. 

Disch'd  June  20,  1865. 

69tb  Penn. 

21,  '62. 

Disch'd  July  29.  '63.    Spec.  3822. 

3 

Allhouse,  L.,  Pt.,  H,  63d 

May  5, 

Left;  circ.     A.  A.  Surg.  M.  F. 

26 

Campbell,  W.  P.,  Capt., 

De.31,'62, 

Right.     Surg.  J.  Avents,  C.  S.  A. 

Peun.,  age  20. 

27,  '64. 

Price.    Seq.  removed.    Disch'd 

D,  1st  Arkansas. 

Ja.27,:63. 

Furloughed  Oct.  1,  1863. 

May  24,  1865.     Spec.  2908. 

27 

Campbell,  W.  B.,  Pt.,  C, 

May  9, 

Left;  circ.     Surg.  D.  W.  Bliss, 

4 

Baker,  G.,  Teamster. 

Aug.  — 

Right;  flap.     Recovery. 

1st  Me.  H.  Art.,  age  20. 

Je.  1,'64. 

U.  S.  V.     Disch'd  Feb.  16,  1865. 

—  ,  '64. 

28 

Carey,  J.G.,Pt.,  D,106th 

May  14, 

Right  ;  circ.     A.  A.  Surg.  J.  H. 

5 

Baker,  J.  T.,  Pt.,  B,  72d 

July  1, 

Lett.     Surg.  —  Russell,  C.  S.  A. 

Pennsylvania. 

26,  '64. 

Thompson.  Disch'd  May  27,  '65. 

New  York. 

5,  '62. 

Disch'd  Aug.  2J,  1865. 

29 

Carey,   W.,  Pt,,  B,  13th 

April  7, 

Right.     Surg.  C.  H.  Mast'in,  C.  S. 

6 

1  Barker,  C.  R.,  Pt.,  D, 

July  21, 

Right.     Snrg.  —  Ford,  C.  S.  A. 

Arkansas. 

24,  '62. 

A.     Recovery. 

7th  Louisiana,  age  23. 

Aug.  9, 

Necro.;  dead  bone,  seven  and  a 

30 

Carl,  M.,  Pt.,  G,  107th 

Sept.  17, 

Left  ;  flap.     Disch'd  Feb.  17,  '63. 

1861. 

half  ins.  in   length,   extracted. 

Pennsylvania. 

—  ,  '62. 

Retired  Jan.  5,  1865. 

31 

Case,  J.  E.,  Pt.,  E,  16th 

Sept.  17, 

Left  ;  circ.    Dr.  P.  W.  Ellsworth, 

7 

Barleon,  G.,  Pt.,  C,  33d 

Jan.  3, 

Left;  flap.     Disch'd  April  27,'63. 

Conn.,  age  22. 

Oc.—  ,'62. 

Hartford,  Conn.     Seq.  remov'd. 

Ohio. 

10,  '63. 

Disch'd  Oct.  16,  '63.    Spec.  2859. 

8 

Bartmess,  G.  J.,  Serg't, 

Sept.  14, 

Left  i  flap.     Disch'd  Jan.  5,  1863. 

32 

Castor,  T.,    Pt.,    I,   5th 

May  6, 

Left  ;  circular.     Confed.  surgeon. 

G,  3(3th  Ohio. 

17,  '62. 

Died  Aug.  9,  1866;  ccmsumpt'n. 

Mich.,  age  26. 

11,  '64. 

Disch'd  Jan.  27,  1865. 

9 

Bell,   C.   E.,  Serg't,  C, 

Aug.  27, 

Right  ;  duub.  flap.    .A.  A.  Surg. 

33 

Champens,   W.,    Corp'l, 

July  11, 

Left;  flap.    Confederate  surgeon. 

74th  New  York. 

Sept.  4, 

U.  lleyburn.     Six  anda  half  ins. 

C,  76th  Penn.,  age  20. 

15,  '63. 

Disch'd  Aug.  24,  1864. 

1862. 

bone  removed.    Disoh'd  Jan.  23, 

34 

Chase,  P.  E.,  Pt.,  C,  7th 

Aug.  14, 

Right  ;  circ.     A.  A.  Surg.  II.  B. 

1863.     Spec.  323. 

Col'd  Troops,  age  25. 

19,  '64. 

White.      Fragments    removed. 

10 

Bennett,  D.,  Pt.,  K,  1st 

Mar.  23, 

Left;  flap.     Disch'd  June  18/62. 

Disch'd  May  26,  1865. 

W.  Virginia,  age  19. 

27,  '62. 

35 

Cheever,  A.  J.,  Pt.,  H, 

July  2, 

Left  (July  14,  amp.  leg).    Disch'd 

11 

Blazier,  T.  f'.,  Pt.,  C,  1st 

July  7, 

Left.     Recovery. 

16th  Mass.,  age  35. 

18,  m 

January  27,  1864. 

Texas. 

15,   63. 

36 

Christ,  A.  L.,  Corp'l,  A, 

Jan.  30, 

Right  ;  circ.  Surg.  E.  Bentley,  U. 

12 

Blodgett,  E.  F.,  Pt.,  D, 

May  5, 

Right  ;  flap.     Disch'd  August  22, 

5th  Penn.,  age  21. 

Fe.4,'64. 

S.V.    Gangrene.    Mustered  out 

4th  Vermont,  age  34. 

12,  '64. 

1864. 

Dec.  23,  1864. 

13 

Bodge,  G.  E.,  Pt.,  A,  5th 

Sept.  19, 

Right;  ant.  post.  flap.      A.  Surg. 

37 

Clark,  F.,  Corp'l,  F,  4th 

July  2, 

Left  ;  flap.     Surgs.  Ramsour  and 

Louisiana,  age  25. 

Oct.  10, 

—  Dorsev.  1st  Md.  Cav.  C.  S.A. 

Michigan,  age  21. 

16,  *63. 

Patterson,  C.  S.A.    Carious  bone 

1864. 

Exchanged  Feb.  16,  1865. 

rem'd.     Disch'd  June  14,  1864. 

14 

Boscroe,  S.,  Pt.,  M,  4th 

Feb.  22, 

Right  ;    circ.      Confed.   surgeon. 

3S 

Clark.H.,  Serg't,E,125th 

May  6, 

Left;    ant.  post.  flap.     Surg.  E. 

Cavalry,  age  21. 

25,  '64. 

Disch'd  July  15,  1865. 

New  York,  age  22. 

17,  '64. 

Bentley,  U.  S.V.     Seq.  four  and 

15 

Boss,  E.  P.,  Pt.,  K,  44th 

June  27, 

Right.     Disch'd  Feb.  28,  1863. 

a  half  ins.  long  rem'd.     Disch'd 

New  York. 

30,  '62. 

Sept.  4,  '65.    Specs.  294,  602,  666. 

16 

Boucher,  G.,  Pt.,  A,  76th 

July  1, 

Right  ;  circ.     Surg.  J.  M.  Farley, 

39 

Clark,  M.  D.,  Pt.,  D,  6th 

Mar.  31, 

Left;   circ.     Surg.  D.  W.  Bliss, 

New  York. 

6,  '63. 

84th  N.  Y.    Disch'd  Feb.  23,  '64. 

Ohio  Cav.,  age  18. 

Ap.5,'65. 

U.  S.V.     Disch'd  July  18,  1865. 

17 

Bowen,  J.  H.,  Corp'l,  C, 

July  1, 

Left  (gang.);  circ.     Disch'd  Dec. 

•Spec.  4058. 

10th  Indiana,  age  23. 

18,  '63. 

19,  1863. 

40 

Clune,  J.,Pt.,  F,  14th  In 

Aug.  30, 

Right  (haem.);  flap.    Disch'd  Jan. 

18 

Boyle,    M.,  Pt.,  F,   5th 

Aug.  9, 

Left  ;  flap.     Disch'd  Nov.  21,'62. 

fantry. 

Se.  5,  '62. 

2,  1863. 

Ohio. 

13,  '62. 

41 

Collins,  M.,  Pt.,  K,  13th 

Dec.  7, 

Left  ;  flap.     Surg.  A.  J.  Ritchie, 

19 

Brassell,  \V.,  Pt.,  M,  72d 

Sept.  17, 

Left;  lat.  flap.     A.  A.Surg.  J.H. 

Kansas,  age  26. 

10,  '62. 

2d  Kansas.     Dec.  25,  haem.:  lig. 

Penn.,  age  18. 

Oct7,'62. 

Bartholf.     Disch'd  Dec.  29.  '62. 

fem.  art.    Disch'd  May  13,  1864. 

Spec.  771.     Died  Jan.  20,  1865; 

42 

Conners,  W.  B.,  Pt.,  C, 

Oct.  5, 

Right  ;  circ.     Snrg.  W.  F.  West, 

consumption. 

28th  Illinois. 

19,  '62. 

28th  111.     Disch'd  April  4,  1863. 

20 

Brown,  J.,  Pt.,  H,  100th 

July  27, 

Right  ;  circ.     A.  A.  Surg.  W.  L. 

43 

Constable,  W.M.,Pt.,H, 

Mar.  31, 

Right  (Mar.  31,  exc.  knee  j't);  circ. 

New  York,  age  21. 

Au.  1,'64. 

Welles.     M.  O.  Feb.  9,  1865. 

1st  Cavalry,  age  26. 

Ap.5,'65. 

A.  A.  Surg.  F.  H.  Colton.    Seq. 

21 

Bruce,  J.,  Pt.,  B,  49th 

May  10, 

Right;    circ.     Confed.   surgeon. 

rem'd.     Disch'd  Nov.  18,  1865. 

Penn.,  age  21. 

14,  '64. 

Seq.  rein'd.   Prison  (sentence  G. 

44 

Cook,  J.  M.,  Lieut.,  E, 

May  3, 

Left.     A.  A.  Surg.  H.  W.  Duca- 

C.  M.)  July  3,  1865. 

119th  Penn.,  age  30. 

11,  '63. 

chet.     Disch'd   Aug.  19,  1863. 

22 

Bufllngton,  J.  D.,  Pt.,  A, 

Sept.  17, 

Right.     Surg.  —  Gray,  C.  S.  A. 

Died  July  28,  1865  ;  sunstroke. 

Huger's  Battery. 

21,  '62. 

Fnrloughed. 

Spec.  1119. 

23 

Biiffum,  T.  J.,  Corp'l,  K, 

July  18, 

Right  (mortificat'n);  ant.post.flap. 

45 

Cooper,    A.,  Corp'l,    F, 

Aug.  30, 

Left  ;  flap.    Disch'd  Dee.  11  ,  '62. 

100th  Now  York. 

23,  '63. 

Disch'd  Feb.  14,  '64.     Spec.  37. 

101st  New  York. 

Se.8,'62. 

'JONES  (J.),  Investigations  upon  tlie  Nature,  Causes,  and  Treatment  of  Hospital  Gangrene  at  it  prevailed  in  the  Confederate  Armies,  1861-1865, 
in  U.  S.  San.  Com.  Memoirs,  1871,  Surgical  Volume  II,  p.  267. 


SECT.  III.] 


INTERMEDIARY    AMPUTATIONS    OE    THE    THIGH. 


281 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

46 

Cortelyou,W.,Pt.,  B,9th 

April  19, 

Right.     Two   Confed.   surgeons.       85    Heffner,  J.,  Pt.,  C,  31st 

Sept.  19, 

Right  ;  circ.     Surg.  S.  J.  Young 

New  York. 

23,  '62. 

Bone  taken  away.     Recovery.                  Ohio,  age  24. 

24,  '63. 

7!!th  111.     Disch'd  July  5,  18641 

47 

Cronk,  E.,  It.,  F,  21st 

April  6, 

Left  ;  flap.    Surg.  E.  C.  Franklin.       86  .  Henderson.  N.  G.  B.,Pt., 

Oct.  2, 

Left.     Recovery. 

Missouri. 

15,  '62. 

U.  S.  V.     Disch'd  Aug.  29,  '62.    >        !     H,  3d  Texas. 

8,  '62. 

48 

Crosson,  Ji.  F.,  Pt.,  E, 

June  29, 

Left.   Surg.  R.  A.  Lewis,  P.  A.  C.       87  ,  Hill,  J.,  Pt.,  I,  3d  Wis- 

Sept.  17, 

Right  ;  flap.    Disch'd  Jan.  13,  '03. 

28th  Georgia. 

J'y  5,  '64. 

S.     Recover}-. 

cousin. 

20,  '62. 

49 

Cunningham,  J.  H.,  Pt., 

Oct.  4, 

Left.     Surg.  —  Palmer,  C.  S.  A.       88 

Hinsev,  A.,  Pt..  F,  85th 

July  19, 

Left;    flap.     Surg.    E.    Bntwell, 

I,  2d  Missouri. 

8,  '02. 

Recovery.                                                     Illinois,  age  17. 

25,"  '04. 

14th  .Mich.  Disch'd  June  15,  '05. 

50 

Cutsinger,  S.,  Pt.,C,  27th 

Sept.  17, 

Right.     D'isch'd  Jan.  10,  1863.            89    Hoffacker,    W.,   Corp'l, 

Mav  11, 

Right  ;  ant.  post.  flap.   Surg.  R.B. 

Indiana. 

21,  '62. 

II,   3d   Maryland,  age 

27,"  '64. 

Bontecou.  U.  S.  V.     Furlough'd 

51 

Daverio,  C.,  Pt.,  E,  3d 

Aug.  9, 

Left.     Sept.   2,  re-amp.:    gang.:                22. 

July  19,  '64.     Spec.  3003. 

Maryland,  age  26. 

12,  '62. 

nee.  bone  rem'd;  large  vessels       90 

Howard,  W.  H.,  Corp'l, 

June  18, 

Left  :  circ.    A.  Surg.  A.  Delaney, 

secured.     Disch'd  April  16,  '03. 

E,  147th  N.  Y.,  age  23. 

J'y  6,  '64. 

U.  S.  V.     Disch'd  June  23.  '05. 

52 

Davis,  D.  D.,  Pt.,K,  28th 

Julv  3, 

Left.     Exchanged  March  17,  '64. 

Spec.  2805. 

North  Carolina,  age  21. 

8,  '63. 

91 

1  Irens,  J.  S.,  Pt.,  I,  61st 

Dec.  13, 

Right;  circ.     Surg.  C.  S.  Wood, 

53 

Denton,  E.,    Serg  t,    H, 

Sept.  29, 

Left  ;  short  ant.,  long  post,  flap  ; 

New  York. 

16,  '62. 

60th  N.Y.  Nee.:  resec.  of  stump; 

112th  N.  Y..  age  42. 

Oct.  2,  '64. 

nee      Disch'd  Oct.  17,  1865. 

bone  and  necro.  bone  removed; 

54 

Dodge,  B.  C.,  Serg't,  M, 

Aug.  22, 

Left  ;  flap.     Dr.  Haggarty.    Dis 

osteomyelitis.    Dis'd  July  7,  '63. 

2d  Indiana  Cavalrv. 

31,  '62. 

charged  Feb.  —  ,  Ie63. 

92 

Ivens,  T.  S.,  Confederate 

Oct.  23, 

Left.     A".  A.  Surg.  F.  A.  Bushey. 

55 

Donahee,  P.,  Pt.,  C,  9th 

Jan.  11. 

Right;  circ.     Surg.  W.  Dicken- 

conscript. 

No.11,'64. 

Prison  March  3,  1805. 

Illinois,  age  If. 

Fe.  2,  '63. 

son,  U.  S.  V.     Dis'd  Julv  19,  '63. 

93 

James.  J.,  Pt.,  I,  2d  Iowa 

Nov.  19, 

Left;  circ.     A.  Surg.  J.  A.  Free 

56 

Donahue,  A.,  Pt.,  O'Har- 

April  6, 

Right.  Surg.C.  H.  Mastin.C.S.A. 

Cavalry,  age  20. 

28,  '64. 

man,  U.S.  V.  Haemorrhage:  lig. 

ris's  Battery. 

18,  '62. 

Recovered. 

Disch'd  April  20,'G5.  .Spec.  3753. 

57 

Donovan,   F.,  Serg't,   I, 

Nov.  25, 

Left;  ant.  post.   flap.     Surg.   H. 

94 

Jordan,  J.,   Pt.,   H,   1st 

Julv  6, 

Right  ;  end  of  bone  rem'd.    Duty 

90th  Illinois,  age  40. 

De.13,'63. 

Strong,   SJOth   Illinois.     Disch'd 
Feb.  24,  1805. 

95 

Maryland,  age  19. 
Keever,  J.   L.,   Pt.,  E. 

12,  V,3. 
May  12, 

Nov.  29,  1864. 
Left;  circ.     Surg.  D.  W.  Bliss, 

58 

Dumass,  M.  A.,   Pt.,  C, 

May  27, 

Right  ;  circ.     Disch'd  Oct.  16,  '62. 

91st  Penn.,  age  19. 

19,  '64. 

U.  S.V.    April  6.  '05,  seq.  rem'd. 

44th  New  York. 

Je.  17,  '02. 

M.  O.  Nov.  17,  1805. 

59 

Dunlap,  J.,  Pt.,  A,  14th 

Mav  5, 

Left:  circ.  A.  Surg.  J.  S.  Billings, 

.  96 

Kelly,  P.,   Pt.,  E,  37th 

Mav  3, 

Left.    M.O.  June  22,  1863.    Died 

Louisiana,  age  29. 

30,  "'62. 

U.  S.  A.     Prison  May  1,  1803. 

New  York. 

18,  '63. 

June  13,  '04;  general  debility, 

Spec.  32. 

result  of  injury. 

60 

Dwyer,  J.  M.,  Corp'l,  B, 

May  5, 

Left;  flap.     Surg.  I.  H.  Thomp 

97 

Kenny,  D.,  Pt.,  A,  16th 

De.31,'62, 

Left  ;  ant.  post.  "flap.     Duty  Nov. 

2Uth  Indiana. 

9,  '64. 

son,  124th  N.  Y.     Disch'd  Sept. 

Infantry,  age  40. 

Jan.  3,'63. 

28.  1804. 

1,  1804. 

98 

Kerrigan.  J.,  Pt.,  K,  5th 

Aug.  30, 

Right:  flap.     Surg.  J.   C.   Dorr. 

61 

Easterly,  A.  N.,  f>\.,  B, 

April  6, 

Right  (gang.);  circ.     Surg.  W.  J.  | 

New  York,  age  20. 

Sep.7,'62. 

U.  S.V.    Hsprn.;  exfol.  Disch'd 

24th  Iowa,  age  20. 

10,  '64. 

McKim,  15th  111.     Disch'd  Oct. 

July  20,  1803. 

5.  1864. 

99 

2Kimm,  J.,  Pt.,  E,  152d 

May  31. 

Left  :  double  flap.     Surg.  J.  A. 

62 

Farnum,  G.  W.,  Pt.,  E, 

June  1, 

Right;  flap.     Surg.  D.  W.  Bliss, 

New  York,  age  21  . 

J'ue6,'64. 

Lidell.  U.  S.  V.     Disch'd  Jan. 

llth  Vermont,  age  20. 

13,  '64. 

U.  S.  V.    Disch'd  Aug.  15,  1805. 

16.  1805. 

a3 

Fan-ell,  J.,  Pt.,  I,  119th 

July  1, 

Right;  flap.     Disch'd  -March  21,     100 

Kinnie,  A.,  Pt.,  H,  14th 

June  27, 

Left:    flap.     Disch'd    December 

New  York,  age  35. 

9.  '63. 

1804. 

New  York. 

J'y  1,  '62. 

13.  1802. 

64 

Fellsburg,  C.,  Corp'l,  D, 

July  1, 

Left;  flap.     July  16,  re-amp,  up.  •  101 

Knott,   E.,    Pt.,    D,   3d 

June  27. 

Right;  ant.  post.  flap.     Disch'd 

119th  N.  Y.,  age  23. 

5,  '63. 

third.     A.  Surg.  W.  H.  H.  Gin-  j 

New  Jersey. 

30,  '62. 

Sept.  3D,  1802. 

kinger.  27th  Penn.  Disch'd  Dec.  ' 

102 

Lanthrup.  J.  E.,  Pt.,  C, 

Feb.  9, 

Left.     Recovery. 

9,  1864. 

59th  Virginia. 

12,  '64. 

65 

Fifield,  L.  B.,  Pt.,A.16th 

Aug.  30, 

Right;  circ.   A.Surg.M.F.Bowes,  , 

103 

La  Page,  J.,  Pt.,  1.  147th 

July  2, 

Right;    fl:ip.     Disch'd   March  4, 

Mass.,  age  24. 

Sept.  20, 

12th  Penn.  Cav.  Exfol.  Disch'd' 

New  York,  age  40. 

6,  '63. 

1864. 

1862. 

Sept.  16,  1803-                                   104 

Lehr,  W.,  Corp'l,  K,  7th 

Mar.  23, 

Left:  flap.    A.  Surg.  C.  H.  Dcuig, 

65 

Fletcher,  W.,Pt.,H,  llth 

July  21, 

Left  ;  flap.     Surg.  —  Walker,  C. 

Ohio,  age  25. 

26,  '62. 

7th  Ohio.     Disch'd  July  3.  1862. 

Massachusetts. 

Au.15,'61. 

S.  A.     Disch'd  March  28,  1862. 

105 

Les,  J..  Pt.,  D,  6th  Con 

Mav  10, 

Right:  circ.     Julv  15.  1^05.  seq. 

67 

Flippo,    J.,  Unassigned 

Afar.  26, 

Right;  circ.     A.  A.  Surg.  I).  S. 

necticut,  age  34. 

J'ne'l,'l'4.      rem'd.      Disch'd"  Oct.  2£ 

Recruit,  age  25. 

Ap.  4,'64. 

Booth.     Returned  to  his  home 

Spec.  1557. 

June  3,  1804. 

106 

Linn,  M.,  Pt.,  A,   122d 

Mav  6, 

Left:  circ.  Surg.C.  Page.  U.S.A. 

68 

Flockhart,  D.  S.,  Corp'l, 

Nov.  7, 

Right  ;  circ.  A.  Surg.  P.C.  Davis. 

Ohio. 

27,  "'64. 

Disch'd  March  4.  1865. 

D,  119th  Penu.,  age  31. 

15,  '63. 

U.  S.  A.     Jan.  13.  64,  protrud'g 

107 

Locke,  J.C.,Pt.,E,  100th 

Aug.  30, 

Left  ;  circ.     Disch'd  June  29.  '03. 

bone  sawn  off.     Disch'd  June 

Pennsylvania. 

Se.'-'0,'02. 

15,  1865. 

108 

Loeb,  L.,  Pt.,  I,  3d  New 

June  27, 

Left.  Surg.  W.  H.  White.  U.S.V. 

69 

Foreman,  J.  W.,  Pt.,  II, 

Oct  9, 

Left;   circ.      A.  A.  Surg.  C.  II. 

Jersey. 

J'y  2,  '02. 

Disch'd  Oct.  1,  1802. 

13th  Infantry,  age  20. 

13,  '63. 

Wade.   Nov.  25.  '63.  three  ins.  of 

109 

Lofton,  E.,  Pt.,  F,  23d 

Julv  2, 

Left  (erysipelas).     Exch'd  April 

bone  rem'd.    Disc'dSept.  20,  '64. 

N.  Carolina,  age  22. 

5,  '63. 

27.  1804. 

70 

Givens,  J.  F.,  Pt.,C,  24th 

May  5, 

Right.     Recovery. 

110 

Lynch,  T.,  Pt.,  D,  40th 

Sept.  1, 

Right  :  circ.     July  3,  '04,  two  ins. 

Virginia. 

30,  "'62. 

New  York,  age  22. 

5,  '62. 

of  femur  sawn  off  and  seq.  rem'd. 

71 

Goebel,  J.,  Pt.,  E,  151st 

June  3, 

Left;  circ.     Disch'd  Oct.  7,  1804. 

Duty  Oct.  25.  1804. 

New  York,  age  39. 

8,  '64. 

Ill 

Lyon.  A.  E.,  Pt.,  E.  37th 

Aug.  8, 

Right  :  flap.  A.  A.  Surg.  J.  Prieto. 

72 

Gordon,    W.   Y.,   Serg't, 

July  22, 

.   Surg.  T.  E.  Chaille,  C.S.A. 

Iowa,  age  23. 

12,   64. 

Ha?m.:    lig.    fern.   art.     Diseh'd 

A,  loth  Texas. 

27.  '64. 

Recovery. 

Aug.  15,  1805. 

73 

Gowan,  J..  Corp'l,  B,  82d 

De.l7.'64. 

Left:  flap.   A.  Surg.  J.  T.  Brown,  ! 

112 

Lyons,  R..  Pt.,  D,  176th 

Sept.  22, 

Right  (gangrene):  ant.  post.  flap. 

Colored  Troops. 

Ja.  12/65. 

U.  S.  V.      Disch'd  June  24.  '65. 

New  York,  age  42. 

27,  '04. 

Disch'd  April  2.  1^00. 

74 

Graham,  F.,  Pt.,  A,  2d 

Oct.   19, 

Left;  circ.  Furloughed  March  10, 

113 

Machamer,   D.,  Pt.,  G, 

May  10, 

Left;  circ.     Surg.  G.  W.  Thorn- 

S.  Carolina,  age  37. 

23,  '64. 

1805. 

90th  Penn.,  age  22. 

14,"  '64. 

hill,  P.  A.  C.  S.     Sept.  15,  [64, 

75 

Gray,  W.,  Serg't,  G,  1st 

Mar.  25.     Left  ;  circ..     A.  Surg.  H.  Pinknpy. 

seq.  rem'd.     Disch'd  Dec.  5,'l>4. 

West  Virginia. 

Ap.  4,'G2.      83d  N.  Y.      Disch  d  Oct.  2.  '02". 

114 

Mackin.  J.,  Pt.,  H,  24th 

Dec.  13. 

Right:  circ.     Surg.  F.  G.  Snell- 

76 

Gunokl,    ./.,   Serg't,    E. 

Oct.  19, 

Right  :  flap.  Dr.  Duball.  Released 

Massachusetts. 

—  ,  '62. 

ing,  U.  S.  V.     Disch'd  June  25, 

4">th  Virginia,  age  22. 

23,  '04. 

April  1,  1865. 

1863.     Spec.  1620. 

77  |  Hafierman,  J.  T.,  I't..  K. 

July  3, 

Left  ;  flap.    Furloughed  Nov.  21. 

115 

Madden,  F..  Pt.,  H.  40th  '   July  2, 

Left:  flap.    Jan.  2:',  1804.  large 

18th  Virginia,  age  21. 

6,  ;63. 

1803. 

New  York,  age  18. 

7,  '63.         bulbous  mass  of  bone  removed. 

78 

Hamilton,  J.  H.,  Pt.,  M, 

\ug.  6, 

Left  ;  flap;  slough.     Discharged 

Disch  'd  April  23.  1804. 

15thN.Y.U.A.,age21. 

9,  '64. 

May  17.  1805. 

110 

Malloy,  M.,  Pt..  H.  69th  :  Sept.  17,    Right  ;  ant.  'post.  flap.     Surg.  M. 

79 

Harnev,  F.  W.,  Pt.,  B, 

Oct.  27. 

Right  ;  circ.     Surg.  —  Pope,  C.S. 

New  York. 

27,  '62. 

C.  Rowland,  Gist  N.  Y.     Oct.  4. 

8th  N.  Jersey,  age  li8. 

30,  '64. 

A.     Disch'd  June  18.  1805. 

lupm.:  lig.  fern.  art.    Jan.  15,'C3. 

80 

Harnnock,  J.'V\.,  A,  8th 

Mav  5, 

Right;  circ.   A.  Surg.J.S.  Billings,    j 

rem'd   soq.     Di«-h'd   .March  4, 

Alabama. 

19,"'62. 

U.  S.  A.     Prison  June  27,  1802! 

1803.     Spec.  3!  '57. 

Spec.  30.                                                117 

Maroney,  P.,  Pt..  G,  G3d  ;  Sept.  17,     Left;   (lap".                          '•'•.  rem'd 

81 

Halting,  L.,  Lieut.,  B, 

Julv  1, 

Left  ;  flap.    A.  A.  Surg.  J.  Swine-    ' 

New  York. 

27,  '62.        seq.     Disch'd  March  6,  18' 

7th  New  York. 

5.  '62. 

burne.     M.  O.  May  8.  1863.             118 

Marsh.  S.,  Corp'l.  B.  1st 

Nov.  27,     Right;  circ.     Surg.  E.   Bentlev, 

82     Hays,    J.,    Pt.,    A,    1st 

Sept.  1, 

Left  (extravasation,  mortification. 

Mass.  Cav.,  age  27. 

De.10,'63.      U.  S.V.    Pyarmia.    Dec.  20.  '04, 

Texas  Cav.,  age  22. 

10,  '63. 

and   synovitis)  :   circ.     Surg.  J. 

5  ins.  seq.  rem'd.     Disch'd  July 

Boekee.   U.  S.  V.      Discharged   < 

12.  1865. 

|     Nov.  3.  1804.     Spec.  4(iO.                  119 

Martin,  P.,  Pt..H,  39th  N.      Feb.  6,     Left  :  circ.  flap.     Surg.  J.  Aiken,  ! 

83 

Haywood,  J.,  Pt.,  D,  8th 

Feb.  20,  1  Left:  circ.     Surg.  —  Holmes,  C. 

York,  age  45.                     11,  '04.        71st  Penn.     Exf.    Disch'd  Dec. 

Colored  Troops. 

Ma.  1,'04.      S.  A.     Disch'd  Oct.  3.  1865. 

5.  1864.     Spec.  2039. 

84 

Hoarier,  B.,  Pt.,  G,  42d 

De.31,'62,  Right;  flap.     Disch'd  August  9,    '120 

Mason,  J.  H.,  Corp'l,  E,      Julv  1,     Right:  circ.  flap.     Disch'd  Jan. 

Illinois. 

Jan.  4,  '63.      1864. 

149th  Penn..  age  31.           8,  '03.         29,  1804. 

1  LIDELL  (J.  A.),  On  the  Secondary  Traumatic  Lesions  of  Bone,  etc..  in  U.  S.  San.  Com.  Memoirs,  1870,  Surgical  Volume  I,  p.  385. 

'LIDELL  (J.  A.),  On  Contusion  and  Contused  Wounds  of  Bone,  with  an  Account  of  Thirteen  Cases,  in  Am.  Jour.  Med.  Sci.,  N.  S.,  1865,  Vol.  L,  p.  20. 

SURG.  Ill— 36 


282 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

121 

'Maxwell.  G.  II.,  Lieut. 

April  1, 

Left;  circ.     Surg.  D.  W.  Bliss, 

157 

Rice,  T.  H.,  Pt.,  I,  31st 

June  5, 

Left.     Surg.  —  Dorsey,  C.  S.  A. 

Col.,  1st  Mich.  Cavalry, 

17,  '65. 

U.  S.  V.     Hsem.;  nee.  bone  re 

Tennessee. 

J'y  1,'64. 

Recovery. 

age  2J. 

moved.     M.  O.  Aug.  8,  1865. 

158 

Rich,  H.  C.,  Seaman.  U. 

Mar.  22, 

Left.     Surg.  S.  Moody,  C.  S.  A. 

12.' 

Mc'Jambridge,  ,S.,Pt.,  F, 

May  3, 

Left;  flap.  A.A.Surg.  F.  Hinkle, 

S.  N.,  age  22. 

Ap.  8,  '62. 

Piece  of  bone  rem'd.     Disch'd 

95th  Penn.,  age  17. 

28,  '03. 

Gangrene.     Disch'd  July  4,  '64. 

Dec.  1,  1862. 

123 

McCoy.   J.,   Pt.,  B,   3d 

May  10, 

Right  ;   flap.      Confed.  surgeon. 

159 

Richards.  J.  F.,  Pt.,  D, 

Sept.  11, 

Right  ;  flap.     Surg.  R.  C.  Bond, 

New  Jersey,  age  3?. 

13,'  '64. 

Slough  'g.     Disch'd  Sept.  2,  '65. 

15th  Indiana. 

16,  '61. 

15th  Ind.     Disch'd  May  24,  '62. 

124 

2McCreary,'S.  C.,  Pt., 

Sept.  1, 

Right  ;  flap.     Disch'd  Dec.  4,  '62. 

160 

Rickard,  H.  C.,  Pt.,  M, 

Sept,  19, 

Left  ;  circ.  A.  Surg.  J.G.'Thomp- 

F,  lOOth'Penn. 

14,  '62. 

llth  Vermont,  age  23. 

Oc.19,'64. 

son,  77th  N.  Y.    Hsem.    Disch  d 

125 

McDonald,  J.,  Fireman, 

Mar.  9, 

Right.      Surgs.   Macomber    and 

June  19,  1865. 

V.  S.  Steamer  Dragon. 

12,  '62. 

Bragg,  U.  S.  N.     Disch'd  Jan. 

161 

Robbins,  O.  P.,  Pt.,  H, 

June  27, 

Right  ;  ant.  post.  flap.     Surg.  D. 

13,  1863. 

10th  Pennsylvania. 

J'y23/62. 

Mc.Ruer,  U.  S.  V.    Disch'd  Feb. 

126 

McFarland,  W.  H.,  Pt., 

May  4, 

Right.     Confed.   surgeon.     May 

27,  1864.     Died  April  15,  1867. 

B,  Oth  Wis.,  age  19. 

7,  '6a 

14,  amp.  upper  third.     Disch'd 

Specs.  1129,  2377. 

March  21,  1804. 

162 

Ross,    J.,   Pt.,  C,    123d 

Oct.  7, 

R't:  flap.    Dr.  D.  Swain,  Shelby- 

127 

McGary,  E.,  Pt.,  B,  17th 

Dec.  20, 

Left;  flap.    A.A.Surg.  II.  T.  Sill. 

Illinois. 

18,  '63. 

ville,  Tenn.    Disch'd  Feb.  4/04. 

Illinois  Cav.,  age  20. 

23   '64. 

M.  O.  Dec.  15/65.  Subsequently 

163 

Rudy,  P.  H.,  Lieut.,  B, 

Sept.  30, 

.     Surg.  —  Montague,  C.  S. 

lost  the  other  leg  and  one  arm 

2d  Kentucky  Battery. 

Oc.13,'04. 

A.     Recovery. 

by  accident.    Died  Jan.  15,  '69. 

164 

Sackett,  V.  B.,  Pt.,  G, 

Aug.  9, 

Right,     Disch'd  Nov.  12,  1802. 

128 

McGrath,  J..  Pt.,  I,  4th 

April  16, 

Left;  ant.  post.  flap.     Surg.  — 

42d  Pennsylvania. 

12,   62. 

Artillery,  age  33. 

May  9,  '65. 

Board,  C.S.A.  Nee.  bone  retn'd. 

165 

Sadler,  J.,  Pt,,  M,  100th 

Aug.  29, 

Left  ;  circ.  flap.     Surg.  E.  Bent- 

Disch'd  Nov.  11,  '65.  Spec.  1408. 

Pennsylvania. 

Se.15,'62. 

ley,  IT.  S.V.  Disch'd  June  0/63. 

129 

McKenzio,  J..  Serg't,  I, 

July  21, 

Right;  flap.     Surgs.  Peachy  and 

166 

Schlotterback,  J.,  Pt.,  I, 

Aug.  30, 

Lett  ;  flap.     Disch'd  Dec.  27,  '62. 

79th  New  York. 

30,  '61. 

Gibson,  C.  S.  A.     Disch'd  Oct. 

75th  Ohio. 

Se.25,'62. 

Spec.  83. 

22,  1861. 

167 

Scott,  J.,  Serg't,  D,  34th 

May  10, 

Right;  circ.;  two  ins.  bone  rem'd. 

130 

McLaughlin,  J.,  Pt.,  A, 

May  2, 

Right  ;   circ.     Surgs.  Black  and 

Ohio,  age  27. 

20,  '64. 

Disch'd  May  3,  1805. 

3d  Alabama,  age  35. 

7,  ''(J3. 

Wilkerson,  C.  S.  A.    Recovery. 

168 

Scraggs,  J.  A.,  Pt.,  G, 

May  9, 

Left;   ant.  post.  flap.      Surg.  E. 

131 

AfcVairy,  T.  m,  Pt.,  B, 

Oct.  14, 

Left.     Furloughed  Jan.  22,  1864. 

llth  Virginia  Cavalry, 

15,  '64. 

Beutley,  U.  S.  V.     Gangrene. 

27th  North  Carolina. 

24,  '63. 

age  32. 

Prison  March  1,  1665. 

132 

tic  Vey,  W.,  Pt.,  F,  5th 

Sept.  19, 

Left.     Surg.  —  Roberts,  C.  S.  A. 

169 

Shepherd,  E.,  Pt.,  F,  1st 

July  21, 

Right  ;    flap.      Confed.'  surgeon. 

Texas. 

23,  '63. 

Disch'd  Oct.  16,  1863. 

Michigan. 

Au.  1,'61. 

Discharged. 

133 

Merrifield,  W.,  Pt.,  H, 

Aug.  22, 

Left;  circ.;  nee.  bone  removed. 

170 

Sherman,  T.  W.,  Brig 

May  27, 

Right.    Prof.  W.  Stone.    Retired. 

14th  W.  Va.,  age  18. 

28,  '64. 

Disch'd  July  19,  1865. 

adier  General,  U.  S.  V. 

J'e-,'63. 

Spec.  3604.     Died  March  16/79  ; 

134 

Miller,  E.,  Pt.,  D.  61st 

June  3, 

Right:  circ.      Disch'd  July   21, 

pneumonia. 

New  York,  age  27. 

8,  '64. 

1865. 

171 

Shubert,  P.,  Pt.,  G,  15th 

Oct.  21, 

Right  ;  circ.    Surg.  T.  R.  Crosby, 

135 

Miller,    J.   H.,   Pt.,    A, 

Dec.  13, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Massachusetts. 

No.—  ,'61. 

U.  S.  V.    Disch'd  Feb.  14,  '62. 

118th  Penn.,  age  21. 

18,  '62. 

A.  E.  Carothers.    Nee.   Disclrd 

172 

Smith,  B.,  Pt.,  C,  88th 

May  8, 

Left  ;  ant.  post.  flap.    Surgeon  J. 

March  21,  1864. 

Pennsylvania,  age  21. 

26,  ''64. 

Carroll,  C.  S.  A.    Necrosed  bone 

13:; 

MUller.  E..  Pt.,  F,  29th 

Aug.  29, 

Left;  circ.     Disch'd  June  9,  '63. 

rem'd.    M.  O.  Jan.  15,  1806. 

Ne-.v  York,  age  31. 

Se.5,'62. 

173 

Smith,   J.,   Pt.,  G,   73d 

June  15, 

Left  ;  flap.    Disch'd  Sept.  3,  1802. 

137 

Mullins.   P.,  Pt.,  K,  2d 

Aug.  28, 

Right;  circ.     A.  A.  Surg.  S.  R. 

New  York. 

25,  '62. 

Wisconsin,  age  20. 

Se.12,'62. 

Skillern.     Nee.  bone  sawn  off. 

174 

Snackenberg,  H.,  Pt.,  A, 

June  19, 

Right  ;  flap.  Dr.  E.  Evans.    Mus 

May,  1863,  reamp.  upper  third. 

Mo.  Home  Guards. 

22,  '61. 

tered  out  1861  . 

Disch'd  July  2,  '64.     Spec.  1227. 

175 

Spielman,    S.,   Pt.,    D, 

Sept.  19, 

Left;  circ.;  flaps.     Disch'd  Aug. 

138 

Munn,    I).    A.,    Pt.,    K, 

June  27, 

Right.     Surg.  —  Hoyt,  C.  S.  A. 

24th  Iowa,  age  28. 

22,  '64. 

23,  1865.     Spec.  4220. 

31th  North  Carolina. 

I'y  13,T,2. 

Disch'd  Sept.  28,  1862. 

176 

Stone,  C.  H.,  Pt.,  F,  5th 

June  3, 

Left;  circ.     Surg.  C.  Page,  II.  S. 

13.1 

Nicholas,  G.  J.,  Corp'l, 

May  3, 

Left.     Oct.  20,  1863,  flap  re-amp. 

New  Hamp.,  age  21. 

22,  '64. 

A.  Gang.  Dec.  18,  re-amp  mid. 

11,  73d  Pennsylvania. 

18,  V63. 

up.  third.     Disch'd  Feb.  10,  '65. 

third.     Disch'd  June  9,  18C5. 

140 

Norris,   J.,  Pt.,  I,  37th 

Aug.  21, 

Left  ;  ant.  post.  flap.     Surg.  Z.  E. 

177 

Sweatt,  W.,  Pt.,  K,  6th 

Aug.  29, 

Left  ;  ciro.     A.  Surg.  B.  A.  Clem 

Mass.,  age  36. 

26,  '64. 

Bliss,  U.S.  V.  Sloughing;  hasm. 

New  Hampshire. 

Se.  15/62. 

ents,  U.  S.  A.     Disclf  d  May  19, 

Sept.  24,  re-amp.;  nee.     Disch'd 

1863. 

Aug.  7,  1  865. 

178 

Taylor,  W.,  Pt.,  H,  42d 

Nov.  30, 

Left   (gang.);  circ.     Dr.  Raney, 

141 

Oatis,  J.,  Pt.,   H,   24th 

Aug.  30, 

Right  ;  dou.  flap.    A.  A.  Surg.  C. 

Illinois,  age  24. 

De.  4/64. 

Franklin,  Tenn.     Disch'd  June 

Xe\v  York,  age  20. 

Sep.9,'62. 

M.  Ford.     Disch'd  Mar.  24,  '65. 

29,  1865. 

14^ 

Paddnck,  J.,  Corp'l,  D, 

April  25, 

Right;  flap.     Surg.  —  Keller,  C. 

179 

Tomy,  E.  H.,  Pt.,C,  27th 

Sept,  17, 

Right;   flap.     Disch'd  Dec.   19, 

43d  Indiana. 

My  15,  '64. 

S.  A.     Disch'd  Aug.  23,  1864. 

Indiana. 

20,  '62. 

1802. 

14!! 

Page.  C.  W..  Serg't,  D, 

Sept.  17, 

Left.    Disch'd  Feb.  9.  1863. 

180 

Tonsing,  F.  H.,  Pt,,  B, 

July  1, 

Right;    flap.      Disch'd  July  15, 

3d  Wisconsin. 

20,  '62. 

107th  Ohio,  age  21. 

6,  '63. 

1804. 

141 

Perkins,  N.  B.,  Pt.,.5th 

May  3, 

Right.  A.Surg.A.Ingram.U.S.A. 

181 

Trainer,   J.,  Pt.,  C,  4th 

June  27, 

Left.     Disch'd  Oct.  15,  1862. 

Maine  Battery. 

23,  '63. 

Disch'd  Dec.  7,  1863.  Spec.  1156. 

New  Jersey. 

30,  '62. 

M5 

Pitcher.  J.,  Pt.,  K,  94th 

Aug.  30, 

Right  ;    lat.   flap  ;    mortification. 

I--:' 

Tricketts,  E!,  Pt.,C,  14th 

Oct.  19, 

Right;    circ.     Disch'd   Feb.   13, 

New  York. 

Sep.6,'62. 

Sept.  13,  re-amp.;  exfol.  Disch'd 

W.  Va.,  age  20. 

22,  '64. 

1805. 

Aug.  16,  '03.     Spec.  1225. 

183 

3Ulmer,  E.  D.,  Serg't,  G, 

Oct.  19, 

Left.   (Hsem.,  gang.)  A.A.Surg. 

140 

Pollock,  J..  Pt.,  K,  84th 

Sept,  2, 

Right  ;  ant.  post,  flap.     Sept.  12, 

15th  N.  Jersey,  age  22. 

No.14/64. 

E.  G.  Waters.     March  8,   18G5, 

Illinois,  age  42. 

6,  '64. 

hsem.     Disch'd  May  6,  1865. 

exfoliation  rem'd.   Disch'd  May 

147 

Postles,  W:  R.,  Corp'l, 

Dec.  13, 

Left:   circ.      Surg.  T.  Antisell, 

29,  1865.     Feb.  17,  '60,  amp.  hip 

A,  1st  Del.,  age  24. 

25,  '62. 

U.  S.  V.     Disch'd  Dec.  24,  1863. 

j'nt.  Recovery.  Specs.  107,  3734. 

Spec.  990. 

184 

Vezina,    O.,  Pt.,  B,  9th 

May  31. 

Right  (erysipelatousit]fi;ui).);ant. 

148 

Potter,  L.,  Pt.,  A,  5Cth 

July  1, 

Left  ;  flap.     Surg.  J.  H.  Brinton. 

New  Hamp.,  age  24. 

J'e  11/64. 

post.  flap.     A.  Surg.  W.  Thom 

Penn.,  ago  26. 

4,  '63. 

U.S.V.   July26,  re-amp.  Disc'd 

son,  U.  S.  A.    Oct.  15,  1864,  nee. 

June  18,  1865.    Spec.  1495. 

seq.  rem'd.     Disch'd  June   14, 

149 

Power.    J.    H.,   Pt.,   B, 

Sept.  20, 

Right;    circ.      Disch'd  Jan.   24, 

1805.     Specs.  3558,  3599. 

36th  Indiana. 

27,  '63. 

1864. 

185 

Vogelsang,  D.,Pt.,A,  1st 

Sept.  17, 

Left;  flap.     Disch'd  Nov.  25/02. 

150 

Preitling,   C.,    Hospital 

May  10, 

Right  (gangrene);  ant.  post.  flap. 

Minnesota. 

20,  '62. 

Steward,  39th  N.  York, 

17,  '64. 

Surgeon    E.  Bentley,  U.  S.  V. 

186 

Walker,  G.  W.,  Pt.,  D, 

Aug.  30, 

Right,     Surg.  E.  Bentley,U.S.V. 

age  24. 

Duty  Sept,  19,  1864. 

12th  Pennsylvania. 

Se.  21/62. 

Disch'd  June  18,  1804. 

151 

Pyle.  J..  Serg't,  B,  105th 

July  14, 

Left.     Ass't   Surg.  W.  B.  Witt, 

187 

Warren,   J.  A.,  Pt.,  C, 

Oct.  5, 

Right:  flap.     Surg.  W.  F.  West, 

Indiana,  age  36. 

24,  '03. 

69th  Ind.      (M.  O.  July  18,  '63.) 

28th  Illinois. 

28,  '62. 

28th  111.     Disch'd  Mar.  20,  '03. 

152 

Qnatc.,  It..  Pt.,   C,  45th 

July  -, 

Left.     Provost  Marshal  Septem 

188 

Waux,  J.,  Pt.,    E,   1st 

July  2, 

Right.  Surg.  P.  F.Whitohead,  P. 

N.  Carolina,  age  31. 

6,  '63. 

ber  10,  1863. 

Louisiana,  age  21. 

5,  '63. 

A.C.  S.     Retired  Jan.  30.  1805. 

153 

Kadley,  A.,  Pt.,  B,  44th 
New  York,  age  21. 

May  8, 
15,  ''64. 

Left  ;  ant.  post.  flap.     Ass't  Surg. 
S.  B.  Ward,  U.  S.  V.     Diseh?d 

189 

Wmtherhj,  L.  £T.,Corp'l, 
F,  10th  Ala.,  age  20. 

May  12, 
J'e  3/04. 

Right  ;  flap.     Retired  Dec.  9,  '64. 

Nov.  8,  1864. 

190 

Wheeler,  J.,Pt.,F,  16th 

Oct.  28, 

Right;  flap.     Surg.  J.  P.  Eriok- 

154 

Ray,    J.,    Pt.,    B,    57th 

July  3, 

Left  (gangrene).    Exch'd  March 

Kansas  Cav.,  age  30. 

Nov.  1, 

son,  10th  Kansas  Cav.     Disch'd 

Virginia,  age  29. 

6,  '63. 

7,  1864. 

1804. 

April  25,  1865. 

155 

Redding.  J.  31.,  Pt.,  A, 

Sept.  19, 

Left.     Surg.  H.  M.  Lawson,  C.  S. 

191 

Wilckens,H.,Pt.,K,  17th 

May  10, 

Left  ;  ant.  post.  flap.     A.  A.  Surg. 

5th  Georgia. 

Oct.  2,  '03. 

A.     Recovery. 

Infantry,  age  25. 

J'e  8/64. 

S.  D.  J.  Evans.    May  1  ,  '05,  nee. 

150 

Reveur,  J.,  Pt.,  E,  47th 

Feb.  20, 

Left;  flap.     Surg.  —  Harrington, 

bone  rem'd.     Disch'd  Aug.  26, 

New  York,  age  36. 

25,  '64. 

C.  S.  A.     Disch'd  May  1,  1865. 

1866.     Spec.  4347. 

1  LIDHLL  (J.  A.),  On  the  Wounds  of  Blood-vessels,  Traumatic  Hemorrhage,  Traumatic  Aneurism,  and  Traumatic  Gangrene,  in  U.  S.  San.  Com. 
Memoirs,  1870,  Surgical  Volume  I,  p.  176. 

2Lll)ELL  (J.  A.).  On  the  Wounds  of  Blood-vessels,  Traumatic  Hemorrhage,  Traumatic  Aneurism,  and  Traumatic  Gangrene,  in  U.  S.  San.  Com. 
Memoirs,  1870,  Surgical  Volume  T,  p.  57. 

3LIDELL  (J.  A.),  On  the  Secondary  Traumatic  Lesions  of  Bone,  etc.,  in  U.  S.  San.  Com.  Memoirs,  1870,  Surgical  Volume  I,  p.  440.  MORTON 
(T.G.),  On  Amputation  at  the  Hip  Joint,  etc.,  in  Am.  Jour.  Med.  Sci.,  N.  S.,  1866,  Vol.  LIT,  p.  17.  Circular  7,  S.  G.  O.,  1867,  pp.  51,  65. 


SECT.  III.] 


INTERMEDIARY    AMPUTATIONS    OF    THE    THIGH. 


283 


No. 

NAME,  MILITARY 
DESCUIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

192 

Willard,  L.  C.,  Pt.,  A, 

July  28, 

Right  (gang.);  circ.  flap.     Surg. 

226 

Bodman,  C.,  Pt.,  G,  llth 

July  —  , 

Right.    Died  August  15,  1863. 

64th  Illinois,  age  20. 

Aug.  23, 

J.  C.  Denise,  27th  Ohio.  Disch?d 

Infantry,  age  24. 

10,  '63. 

1864. 

July  6,  1865. 

227 

Bovard,  F.,  Pt.,  K,  1st 

June  25, 

(gangrane).     Died  July  3, 

193 

Williams,  L.,  Serg't,  C, 

Aug.  16, 

Right  ;  flap.     Dr.   Raylin.     Bis- 

Massachusetts. 

J'y  2,  '62. 

1862 

2d  Batt.  Cav.  Mo.  S.  M. 

19,  '62. 

charged. 

228 

Boyd,   J.,  Pt.,  C,    19th 

Jan.  2, 

Left.    Died  January  13,  1863. 

194 

Williams,    W.   S.,    Pt., 

Left.     Dr.  V.  B.  Thornton.     Re 

Ohio. 

-,  '63. 

Morgan's  Cavalry. 

covery.     Spec.  406. 

229 

Bradley,  J.,  Pt.,  F,  48th 

June  3, 

Right  (mortification:  haem.);  circ. 

195 

Williamson,  W.  H  ,  Pt., 

Oct.  19, 

Right  ;  circ.  A.  Surg.  J.  Homans, 

Pennsylvania,  age  21. 

8,  '64. 

A.  Surg.  H.  Allen.U.S.A.   Died 

D,  114th  N.  Y.,  age  24. 

23,  '64. 

jr.,  U.  S.  A.  Disch'd  May  13,  '65. 

J  une  9,  64;  shock,  etc.  Spec.  2931  . 

196 

Willis,  N.  P.,  Pt.,  U.  S. 

Feb.  3, 

Left;    circ.     Surg.  B.  N'.  Bond, 

230 

Brannagan,    J..    Pt.,    I, 

June  3, 

Left  ;  flap.    Surg.  F.  F.  Kurmeig- 

Signal  Corps,  age  23. 

10,  '65. 

27th  Mo.     Seq.  rem'd.     Disch'd 

69th  Pennsylvania. 

-,  '64. 

ter,  69th  Penn.     Died  June  14, 

Sept.  3,  1865. 

1864.    Spec.  1501. 

197 

Willson,  J.   P.,  Pt.,  K, 

Oct.  7, 

Right  ;  circ.     Disch'd  Feb.  2,'64. 

231 

Britton,  C.,  Pt.,  C,  12th 

Nov.  30, 

Left   (carious);  lat,  flap.    A.  A. 

12:id  Illinois. 

11,  '63. 

Kentucky,  age  40. 

De.30,'64. 

Surg.J.  E.Patterson.   Died  Jan. 

L9£ 

Wilson,  G.,  Serg't,  D,7th 

Sept.  17, 

Left.     Retired  September  22,  '64. 

6,  1865. 

Louisiana,  age  26. 

28,  '62. 

232 

Brizzee,  W.  J.,  Pt.,  G, 

June  22, 

Right.     Died  July  4,  1864. 

199 

Wilson,  W.,  Pt.,  B,  2d 

Nov.  21, 

Right  ;  flap.     A.  A.  Surg.  W.  P. 

46th  Pennsylvania. 

—  ,  '64. 

Colored  Troops. 

De.15,'63. 

Powell.    Disch'd  June  16,  1864. 

233 

Brown,  T.,  Pt.,  K,  5th 

Sept.  29, 

Left  :  circ.     A.  A.  Surgeon  H.  B. 

200 

Wingn,  T.,  8th  Ky.  Mt'd 

July  19, 

Left;  circ.  Surg.W.  H.Gobrecht, 

Col'd  Troops,  age  21. 

Oc.18,'64. 

White.     Died  Oct.  26.  1864. 

Infantry,  age  20. 

An.  4,  '63. 

U.  S.  V.    Pro.  Mar.  Dee.  19,  '63. 

234 

Bryant,  N.  B.,  Pt.,  K, 

May  5, 

Left  ;  ant.  post,  flap?    A.  Surg.  J. 

201 

Wooden,"  L.  W.,  Corp'l, 

Oct.  2, 

Right.    Nov.  1,  re-amp.    Surg.  S. 

19th  Miss.,  age  25. 

19,  V32. 

S.  Billings.  IT.  S.  A.    Gangrene. 

K,  3d  New  York  Cav. 

14,  '62. 

A.  Green,  24th  Mass.     Disch'd 

Died  May  26,  '62.  Aut.  Spec.  31. 

Feb.  17,  1803. 

235 

Buckey,  J.   E.,  Pt.,  E, 

June  5, 

Left;  ant.  post.  flap.     Died  June 

202 

Woodward,  O.  S.,  Col., 

May  5, 

Right.  Surg.  D.W.  Bliss,  U.S.V. 

7th  Maryland,  age  30. 

10,  '64. 

20,  1864. 

83d  Penn.,  age  27. 

15,  '64. 

M.  O.  Sept.  20.  1864.  Spec.  2269. 

236 

Burditt,   W.  C.,   Pt.,  I, 

Mav  19, 

Left;  circ.     A.  A.  Surg.  L.  Dar 

203 

Worthington,  A.  S.,  Pt., 

June  27. 

Left  (gang.);  circ.    A.  A.  Surg. 

4th  West  Virginia. 

26,'  '63. 

ling,  jr.     Died   May  31.    1863. 

D,  Ubth  Ohio,  age  21. 

J'yl6,'64. 

T.  H.  Hammond.     Discharged." 

Spec.  1625. 

204 

1  Young,  J.   W.,  Pt.,  D, 

Sept.  17, 

Left  ;  circ.     Furloughed  Novem 

237 

Burke,  W.,  Pt.,  G,  G9th 

Sept.  17, 

Right.    Died  September  27,  1862. 

13th  Miss  ,  age  22. 

20,  '62. 

ber  20,  1862. 

New  York. 

24,  '62. 

205 

Zahns,  J.,Pt.,A,  3d  Wis 

Aug.  y, 

Left;  flap.     Disch'd  Dec.  21,  '62. 

238 

Burroughs,  J.,  Serg't,  B, 

Sept.  20, 

Right.     (Sept.  28,  excis.  femur.) 

consin. 

14,S62. 

3d  Kentucky. 

-,  '63. 

Died  October  10,  1863. 

206 

Ackerman,    G.,   Pt.,  L, 

May  19, 

Left  ;  flap.     Surg.  E.  Bentley,  U. 

239 

Cadv,  T.  P.  "T.,  Pt.,  C, 

Oct.  3, 

Right.    Surg.  J.  F.  Hogden,  U.  S. 

6th  N.  Y.  H'vv  Art'y, 

25,  '64. 

S.  V.  Died  June  9,  '64;  pyaemia. 

12t'h  Illinois,  age  22. 

No.  1,'62. 

V.  Died  Nov.  8,  1862  ;  pyaemia. 

age  33.   • 

Spec.  2659. 

Fpec.  469. 

207 

Addy,    G.,  Pt.,    C,    7th 

Nov.  7, 

Right.     Surg.  E.  C.  Franklin,  U. 

240 

Carpenter,  H.  W.,  Pt,,K, 

Nov.  27, 

Right  ;  circ.     Surg.  E.  Bentley, 

Iowa. 

-,  '61. 

S.V.    Died  Dec.  12,  '61  ;  pneurn. 

3d  Michigan,  age  33. 

De.13,'63. 

U.  S.  V.    Died  Jan.  11.  '64  ;  py 

208 

Allen,  E.  H.,  Pt.,  A,  2d 

July  12, 

Left;  circ.    A.  A.  Surg.  W.  H. 

• 

aemia.  Autop.  Specs.  2011,2012. 

Massachusetts  Cav'lry, 

31,"'64. 

Randolph.    Died  Aug.  16,  1864  ; 

241 

Carpenter,  J.  H.,  Pt.,  E, 

June  22, 

Left  (exc.  fib.);  circ.    A.  A.  Surg. 

age  24. 

exhaustion. 

110th  Ohio,  age  40. 

J'y  5,  '64. 

J.  F.  Thompson.    Died  July  16, 

20!) 

Anderson,  G.W.,  Corp'l, 

July  2, 

;   haemorrhage.     Died  July 

'64  ;  pyaemia.    Spec.  2759. 

B,  73d  N.  York,  age  23. 

6,  '63. 

19,  1863. 

242 

Carr,  G.  W.,  Serg't,  G, 

June  18, 

Right:  circ.  Surg.  A.  F.  Sheldon, 

210 

Anderson.  W.,  Pt.,  l-\6th 

June  18, 

Right;  ant.  post.  flap.     Surg.  E. 

1st  Maine  H.  Artillery, 

J'y  3,  '64. 

U.S.V.     Died  July  10,  1864; 

New  York  H.  Artillery, 

J'y5,'64. 

Bentley,  U.  S.  V.   Died  July  17, 

age  42. 

exhaustion.    Spec.  £764. 

age  24. 

1864;  exhaustion.    Spec.  2831. 

243 

Casey,  M.,  Pt.,  K,  108th 

Sept.  17, 

Left.    Died  Oct.  3,  '62.  Spec.  380. 

211 

Atkins,  W.H.,Pt.,  1,  10th 

July  1, 

Right  :  flap.  July  26,  bone  rem'd; 

New  York. 

27,  '62. 

Massachusetts,  age  20. 

6,  '62. 

slough.;  hasm.;  lig.  fern,  art'ry. 

244 

Chamberlain,  R.,  Serg't, 

Sept.  17, 

Right.     A.  Surg.  J.  Oliver,  21st 

Died  Aug.  12,  '62;  exhaustion. 

I,  16th  Conn.,  age  43. 

Oc.15,'62. 

Mass.     Died  October  29,  1862. 

212 

Atkinson,  J.  M.,  Pt.,  A, 

May  12, 

Right.    (Haem.;  Mav  25,  lig.  fern. 

Spec.  274. 

3d  Indiana  Cav.,  age 

J'e2,'64. 

art'ry.)    A.  A.  Surg.  T.  Liebold. 

245 

Chandoin,  B.  P.,  Pt.,  A, 

Sept.  17, 

Left.    Surg.  A.  N.  Dougherty,  U. 

23. 

Died  June  7,  1864  ;  pyaemia. 

4th  Texas,  age  20. 

24,  '62. 

S.V.  DiedSept.29,'62.  Spcc.127. 

213 

Baily,  J.  E.,  Lieut.,  A, 

July  12, 

Right:  skin  flap;  circ.  sect.  mus. 

246 

Chase,  C.,  Corporal,  B, 

Juue  1, 

Right  ;  circ.    A.  Surg.  W.  Thom 

7th  Maine,  age  38. 

29,  '64. 

Surg.  H.  W.  Ducachet,  U.  S.  V. 

120th  N.  York,  age  23. 

5,  '64. 

son,  U.  S.  A.    Haem.    Died  July 

Died  July  31,  '64  ;  prostration. 

12,  1864  ;    pvasmia.     Autopsy. 

214 

Bailv,  W.,  Pt.,  E,  7th  N. 

June  2, 

Left  ;  ant.  post.  flap.     Surg.  R.  B. 

Specs.  3548,  2509,  6715. 

York,  age  23. 

25,  '64. 

Bontecou.  U.  S.  V.     Haem.  from 

247 

Christy,  W.  J.,  Pt.,  E, 

Aug.  16, 

Right;  circ.    A.  A.  Surg.  D.  Ken 

fern.  art.     Died  July  (i,  '64  ;  ex 

19th  Mass.,  age  23. 

Sep.8,'64. 

nedy.    Died  Sept.  22.  1864;  ex 

haustion.    Spec.  3037. 

haustion.     Spec.  3643. 

215 

Baker,  L.  D.,  Pt.,  G,  4th 

De.29,'62, 

Left.     Died  January  25,  '63;  ex 

248 

Coe,  W.   W.,  Serg't,  H, 

July  2, 

Right  ;  circ.:  slough.    Died  Sept. 

Iowa. 

Ja.20,'63. 

haustion. 

23d  X.  Carolina,  age  23. 

15,  '63. 

19,  1863. 

216 

Barnes,  L.,  Pt.,  I,  34th 

June  30, 

Right   (July  3.  ball  ext);   circ. 

249 

Cole,  C.  M.,  Pt.,  B,  48th 

July  19, 

Left.    Died  August  3,  1863. 

New  York,  age  19. 

J'y21,'62. 

Surg.  R.  B.  Bontecou,  U.  S.V. 

New  York. 

Au.  1,'63. 

Died  July  2£,  '62;  deeply  jaun 

250 

Coleman.  C.,  Pt.,  G,  1st 

Sept.  14, 

Right.  Surg.  H.  S.  Hewit.U.S.V. 

diced. 

Penn.  Reserves. 

23,  '62. 

Died,  Sept.  23,  '62,  on  operating 

217 

2  Barrett,  G.  Y.,  Pt.,  F, 

Dec.  13, 

Right.  (Dec.  16,  osteo-plast.  oper. 

table. 

5th    New    Hampshire. 

25,  '62. 

at  knee  joint.    A.  Surg.  J.  W.  S. 

251 

Collins,  J.  F.,  Pt.,  F,  2d 

Sept.  20, 

Right,     Surg.  A.  W.  Heise,  100th 

age  20. 

Goulev,U.  S.A.  Slough  ;  gang.; 

Kentucky. 

23,  '63. 

111.     Died  Oct.  5,  '63  ;  exh'n. 

hsem.)'    Surg.  J.  P.  Prince,  3:>th 

252 

Connors.  J.,  Pt.,  H,  7th 

June  16, 

Right  ;  circ.     Died  June  26,  '64. 

Mass.  DiedDec.28,'62.  Spef.536. 

N.Y.  H'vyArt.,age37. 

26,  '64. 

218 

3Bause,  J.,  Pt.,  B,  42d 

De.31,'62, 

;  lat.  flap.     Surg.  J.  Shrady. 

253 

Conrad,  H.,  Pt.,  I,  24th 

May  6, 

Left  (May  19,  excis.  fib.;  gang.); 

Indiana,  age  24. 

Jan.8,'63. 

jr.,  U.  S.  V.     Diarrhoea.     Died 

Michigan,  age  21. 

22,  '64. 

circ.  Surg.  O.  A.  Judson,  U.S.V. 

January  15,  1863. 

Died  May  27,   1864  ;    pyaemia. 

219 

Bell,  L.  H.,    Lieut.,  B, 

Sept.  20, 

Left.     Surgeon  I.  Moses,  U.  S.  V. 

Spec.  3653. 

1  1  3th  Ohio. 

30,  '63. 

Died  October  10,  1863. 

254 

Conway,  P.,  Pt.,  M,  1st 

Nov.  14, 

Left  (gang.);  circ*     A.  A.  Surg. 

220 

Benton,  H.  S.,  Serg't,  C, 

May  6, 

Left  :  dou.  flap.    Surg.  E.  Bentley, 

New  Hampshire  Cav. 

22,  '64. 

M.  Darrach.     Died  Dec.  18,  '64  ; 

7th  Mass.,  age  21. 

25,  ''64. 

U.  S.  V.     Died  June  17,  1864  ; 

pyaemia. 

pyaemia.     Spec.  2657. 

255 

Cooke.  A.  E.,  Serg't,  G, 

July  2, 

Left  :  flaps  sloughed.    Died  Aug. 

221 

Berkey.  C..  Pt.,  A,  Kith 

Aug.  30, 

Left  (Sep.  11,  haem.;  13,  14,  haem.: 

1  1th  Infantry,  age  20. 

Au.  1,'63. 

6,  18G3. 

Penn.  Reserves,  age  24. 

Se.  18/62. 

lig.  fern.;  Sept.  17.  haem.):  circ. 

256 

Creighton,  M.,  Serg't,  B, 

May  12, 

Left;  circ.     A.  A.  Surg.  T.  W. 

Died  Sept.  18,  1862.    Autopsy. 

9th  Mass.,  age  20. 

26,  '64. 

Miller.     Died  June  9.  1864  :  py 

222 

Berns,  J.  F..  Pt.,  F,  5th 

June  9, 

Left  :  ant.  post.  flap.     A.  Surg.  J. 

aemia  and  tetanus.     Spec.  2818. 

Ohio,  age  19. 

23,  '62. 

S.  Billings,U.S.A.    Hiem.  Died 

257 

Culbertson.D.  J.,  Serg't, 

June  1. 

Right  (nee.);  circ.     A.  A.   Surg. 

July  2,  '62.   Autopsy.    Spec.  23. 

A,  69th  Ohio,  age  25. 

16,  '64. 

J.  W.  Digbey.     Died  June  18, 

223 

Biehl,  N.,  Pt.,  I,  155th 
Pennsylvania,  age  27. 

June  19, 
J'yl9,'64. 

Right  (June  21,  -exc.  tibia;  gang.); 
circ.    Surg.  E.  Bentley,  U.  S.  V. 
Gang.:  ulcer'n  of  artery.     Died 

258 

Dareey.W.  H.,Pt.,D,6th 
Maryland,  age  23. 

May  31, 
J'ne9,'64. 

1864.     Spec.  3399. 
Left;  circ.     A.  A.  Surg.  J.Phil 
lips.     Died  June  24,  '64:  exh'n. 

July  21.  '64;  exh'n.     Autopsy. 

259 

Dai-is,  H.  A.,  Pt.,D,  12th 

April  7, 

Right  :  lat.  flap.     A.  Staff  Surg. 

Spec.  3337. 

N.  Carolina,  age  30. 

14,  '65. 

W.  J.  Burr,  U.  S.  A.   Died  April 

224 

Blanchard,  A.,  Serg't,E, 
92d  New  York. 

Mav  31, 
J'e  11,'62. 

Right;  flap.     A.  A.  Surg.  W.  K. 
Cleveland.    Died  June  13,  1862  : 

260 

Day,  J.  W.,  Corp'l,  H, 

July  20, 

24,  1865. 
Right.    Surg.  J.  B.Warwick,  91st 

pvlniujti 

91st  Ohio. 

23,  '64. 

Ohio.     Died  July  23,'64;  exh'n. 

225 

Blockle,  M..  Pt.,  A,4iith 
Iowa,  age  20. 

June  30, 
J'y6,'64. 

Right  ;  lat.  flap.    Surg.  J.  G.  Kee- 
non,  U.  S.  V.    Died  July  17,  '64. 

261 

Dean,   S.,   Pt.,  I,  lllth 
New  York. 

July  3, 
-,  '63. 

Left.     Surg.  O.  Munson,  108th  N. 
Y.    Died  August  9,  1863. 

"FISHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations  in  the  Hospitals  near  Sharpsburg,  Md.,  etc.,  in  Am.  Jour.  tied.  Set.,  N.  S.,  1863, 
Vol.  XLV,  p.  47.  2  PRINCE  (J.  P.),  Surgical  Cases,  in  Boston  Med.  and  Surg.  Jour.,  1863,  Vol.  LXV11I,  p.  69. 

3  SHRADY,  jr.  (J.),  Cases  in  Military  Surgery,  in  American  Medical  Times,  1863,  Vol.  VI,  p.  113. 


284 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

262 

Delaney,  J.,  Pt.,  G,  67th 

May  6, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

300 

Hall,  J.,   Pt.,   A,   12th 

May  10, 

Left;  ant.  post.  flap.     Surg.  R.  B. 

New  York,  age  20. 

27,  r64. 

J.A.  Bates.    Haem.;  lig.  fern.  art. 

Pennsylvania,  age  22. 

28,  '64. 

Bontecou,  U.  S.  V.    Died  May 

Died  July  10,  1864  ;  pyaemia. 

31,  1864  ;  exhaustion. 

263 

Demastf.rs,A.,  Pt.,  F,  7th 

Dec.  7, 

Right  (gang.);  circ.     Surg.  S.  D. 

301 

Hall,    P.,   Pt.,    D,  42d 

July  3, 

.     Died  July  15,  1863. 

Florida,  age  24. 

11,  '64. 

Turney,  U.  S.V.    Died  Dec.  14, 

Virginia. 

8,  '63. 

1864  ;  gangrene. 

302 

Hammond,  C.,  Pt.,   H, 

Aug.  29, 

Right;  circ.     A.  Surg.  J.  C.  Mc- 

264 

Dennison,  II.,  Pt.,E,123d 

June  15, 

Right.     Died  June  26,  1663. 

1  1th  Massachusetts. 

Se.  18,  '62. 

Kee,  U.  S.  A.     Died  Sept.  28, 

Ohio. 

—  ,  '63. 

1862.     Spec.  63. 

265 

Dick,  T.,  Pt.,  B,  6th  N. 

Mav  8, 

Left  ;  circ.;  sloughing.  Died  June 

303 

Hankins,  J.,  Pt.,  D,  4th 

Sept.  19, 

Right  ;  modified  flap.     A.  Surg. 

Hamp.,  age  23. 

11,  '64. 

12,  18(>4  :  pyaemia. 

New  Jersey. 

23,  '64. 

J.G.Thompson,  77th  New  York. 

266 

Dillon,  J.,   Pt.,  D.  34th 

June  1, 

Left  ;   flap.     A.  A.  Surg.  G.  W. 

Slough.      Died  Oct.  10,   1864; 

New  York,  age  19. 

13,  '62. 

Edwards.     Died  July  13,  1862; 

typhoid  fever. 

exhaustion. 

304 

ffargrow,  J.  H.,  Pt.,  D, 

Sept.  17, 

Right.  Surg.  H.  S.Hewit,  U.  S.V. 

267 

Dobey,  E.,  Pt.,  D,  14th 

Sept.  19, 

;  circ.    Surg.  J.  W.  Lawson, 

12th  North  Carolina. 

Oct.  7,  '62. 

Died  October  9,  1862.  Spec.  365. 

North  Carolina. 

Oct.4,'64. 

C.  S.  A.     Haem.     Died  October 

305 

Harman,  B.,  Pt.,  A,  50th 

Sept.  30, 

Left;  circ.     Surg.  G.  S.  Palmer, 

18,  1864  ;  exhaustion. 

Penn.,  age  24. 

Oc.14,'64. 

U.S.V.   Died  Oct.  17/64  ;  exh'n. 

268 

Donnelly,  J.,Pt.,B,198th 

Mar.  29, 

Right  ;  ant.  post.  flap.     Surg.  N. 

306 

Harris,  D.,  Pt.,  F,  59th 

July  15, 

Right  ;  flap.  A.  A.  Surg.  J.  Prieto. 

Penn.,  age  22. 

Ap.  7,  '65. 

R.  Moseley.U.  S.V.    Died  April 

Col'd  Troops,  age  22. 

24,  '64. 

Died  July  25,  1864  ;  tetanus. 

11,  1865;  exliaust'n.  Spec.  4069. 

307 

Harris,  J.,  Pt.,  A,  38th 

Sept.  29, 

Left:  flap,  A.A.Surg.  A.  B.  Cha- 

• 

Douglas,  A.  J.,  Pt.,  M, 
1st  Maine  H'vy  Art'y, 

May  19, 
31,  '64. 

Right   (haem.);  lat.  flap.     A.  A. 
Surg.W.  H.  Ensign.    Died  May 

308 

Col'd  Troops,  age  21. 
Harris,  K.  E.  U.,  Pt.,  F, 

Oc.22,'64. 
Mav  4, 

pin.    Died  October  24,  1864. 
Left  ;  circ.  Surg.C.D.Rice.C.S.  A. 

age  21. 

31,  1864.     Spec.  2388. 

57th  N.  C.,  age  27. 

30,  ''63. 

Gang.     Died  June  7,  1863. 

270 

Dovers,  C.,  Pt.,  D,  148th 

May  3, 

Left  (gang.).     Surg.  C.  S.  Wood, 

309 

Hartley,  W.,  —,  C,  6th 

Sept.  17, 

Right.    A.  Surg.  R.  F.Weir,  U.S. 

Pennsylvania. 

17,  "63. 

66th  N.  Y.     Died  May  19,  1863. 

Georgia. 

Oct.  3,  '62. 

A.    Pyaemia.   Died  Oct.  24,  '62. 

Spec.  1171. 

Spec.  872. 

271 

Drake,  J.  B.,  Pt.,  H,  62d 

July  1, 

Right  ;  circ.     A.  A.  Surg.  W.  K. 

310 

Hayden,G.,Corp'l,  B,lst 

July  3, 

Left  (haem.);  lig.  femoral  artery. 

Penn.,  age  22. 

27,  ^62. 

Cleveland.    Died  Augusts,  '62  ; 

Md.  Battery,  age  22. 

8,  '63. 

Died  Sept.  25,  1863;  exliaust'n. 

exhaustion. 

311 

Hayer,  G.,  Pt.,  K,  6th  N. 

May  19, 

Left  ;  circ.  A.  Surg.W.  F.  Norris, 

272 

Durgin,  P.  G*Pt.,H,6th 

Aug  30, 

Left.    A.  A.  Surg.  W.  K.  Cleve 

Y.  H.  Art'y,  age  27. 

Je.  16/64. 

U.  S.  A.    Haem.;  lig.  Died  June 

New  Hamp.,  age  19. 

Se.  19,'G4. 

land.    Died  Sept.  20,  1864. 

29,  1864  ;  pyaemia.     Autopsy. 

273 

Eaton,  J.  A.,  Lieut.,  D, 

May  10, 

Left  (sloughing).     A.  A.  Surg.  J. 

312 

Hedder,  W.,  Pt.,  C,  56th 

June  1, 

(amp.  knee  j't,  June  1);  haem. 

10th  N.  Hamp.,  age  24. 

21,  '64. 

Coloosdian.     Died  May  27,  '64. 

New  York. 

13,  '62. 

Died  July  3,  1862.    Spec.  4933. 

274 

Edson,  W.,  Pt.,  I,  5th  N. 

May  12, 

Left;  circ.    A.  A.  Surg.  J.  Phil 

313 

Henery,  J.  F.,  Adjutant, 

July  2, 

Right.     Died  July  24,  1863;  py 

Carolina,  age  22. 

20,  '64. 

lips.     Haem.;   lig.   fern,   artery. 

157th  N.  Y.,  age  24. 

20,  '63. 

aemia. 

Died  May  25,  '64  ;  haemorrhage. 

314 

Hennely,  P.,  Pt.,  K,  48th 

Aug.  29, 

Right.  Surg.O.A.  Judson.U.S.V. 

275 

Elliott,  P.,  Pt.,  B,  18th 

April  6, 

Left  ;  ant.  post.  flap.    A.  Surg.  W. 

Pennsylvania. 

Se.  12/62. 

Died  October  25,  1862;  pyaemia. 

Georgia  Bat'ry,  age  24. 

16,  '65. 

Carroll,  U.  S.  V.    Died  May  20, 

Spec.  184. 

1865;  exhaustion.    Spec.  4163. 

315 

Hezeltine,  L.,Pt..D,86th 

May  8, 

Left:  circ.     Surg.  O.  A.  Judson, 

276 

Elliott,  P.  M.,  Pt.,G,96th 

Nov.  3, 

Right  (yen.  haem.;  diarr.);   circ. 

New  York,  age  19. 

17,  '64. 

U.S.V.  Haem.  Died  June  9,  '64  ; 

Ohio,  age  20. 

30,  '63. 

A.  Surg.  P.  S.  Conner,  U.  S.  A. 

pyaemia. 

Died  Nov.  30,  1863.  ' 

316 

Bighsmith,  D.,  Pt.,  D, 

Sept.  19, 

Left;  circ.     Died  Oct.  20,  1864; 

277 

Evans,  S.  B.,  Corf  '1,  D, 

June  2, 

Left  ;  circ.    Surg.  J.  W.  Wishart, 

24th  Georgia. 

23,  '64. 

exhaustion. 

140th  Penn. 

9,  '64. 

140th  Penn.     Died  June  13,  '64. 

317 

Hill,  S.  W.,  Corp'l,  H, 

May  26, 

Right  ;  circ.     A.  A.  Surg.  IT.  M. 

278 

Evans,  W.  E..  Pt.,G,37th 

Dec.  16, 

Right  (haem.);   lat.  flap.     A.  A. 

36th  Wis.,  age  36. 

J'ne9/64. 

Dean.     Died  June  in,  1864  ;  ex 

Georgia,  age  28. 

20,  '64. 

Surg.B.L.  McClure.    Died  Dec. 

^ 

haustion.     Spec.  2490. 

24,  1864;  exhaustion. 

318 

Hollenback,  H.  W.,  Pt.. 

April  6, 

.     Surg.  E.  C.  Franklin,  U.S. 

279 

Fanning,  H.  C.,  Pt.,  D, 

Sept.  17, 

Right.    A.  Surg.  J.  Oliver,  21st 

A,  46th  Illinois. 

-,  '62. 

V.    Died  April  27,  1862. 

8th  Conn.,  age  18. 

Oc.17,'62. 

Mass.    Died  October  29,  1862. 

':• 

Honan,  M.,  Pt.,  B,  10th 

April  2, 

Right  ;  ant.  post.  flap.     Surg.  E. 

Spec.  287. 

Vermont,  age  24. 

7,  '65. 

Bentley,  U.  S.V.     Died  April 

280 

Fitzpatrick,  T.,  Pt.,  A, 

May  6, 

Left  ;  ant.  post.  flap.     Died  June 

10,  1865;  exhaustion. 

10th  Infantry. 

14,  '64. 

3,  1864;  exhaustion. 

320 

Hoysington,  A.,  Pt.,  A, 

June  26, 

Left;    circ.     A.   A.  Surg.  J.  H. 

281 

Frakes,  W.,  Pt.,  B,  26th 

Dec.  7, 

;  circ.     Surg.  T.  W.  Florer, 

8th  Michigan,  age  25. 

J'y  4,  '64. 

Thompson.     Died  July  29,  '64; 

Indiana,  age  19. 

12,  '62. 

26th  Ind.     Died  Dec.  26,  1862; 

pyaemia.     Spec.  2760. 

pyaemia  and  pneumonia. 

321 

Hughes,  J.O.,Pt.,  A,  1st 

Mav  19, 

Right  ;  oval  flap  ;  ciro.  of  muscles. 

282 

Furlong,  P.,  —  ,  E,  4th 

Sept.  17, 

—  '-  ;  flap.     Died  October  1,  '62  ; 

Maine  H.  Art'y,  age  29. 

22,'  '64. 

Surg.  N.  R.  Moseley,  IT.  S.V. 

New  York. 

Oct.  1,  '62. 

exhaustion  and  shock. 

Died  Mav  27,  1  864.     Spec.  2308. 

283 

Galiger,   M.,  Serg't,  G, 

July  2, 

Left  (haem.);  lig.  prof.  art.    Died 

322 

Irwin.  F.  H.,  Corp'l,  E, 

Mar.  25, 

Left;   circ*.     Surg.  D.  W.  Bliss, 

73d  New  York,  age  22. 

5,  '63. 

July  8,  1863;  exhaustion. 

93d  Penn.,  age  22. 

Ap.l4.'65. 

U.  S.  V.    Died  May  2,  '65  ;  py 

284 

Gibbs,  C.  E.,  Pt.,  E,  19th 

Dec.  7, 

Left  ;  ant.  post.  flap.    A.  Surg.  J. 

aemia.     Spec.  4077. 

Iowa,  age  21. 

30,  '62. 

J.  Sanders,  1st  Iowa  Cav.    Died 

323 

Janvrin,  G.  A.,  Pt.,  B, 

June  3, 

Right  ;  ant.  post.  flap.  Surg.  R.  B. 

Jan.  22,  1863. 

12th  N.  H.,  age  20. 

8,  '64. 

Bontecou,  U.  S.V.    Haem.  Died 

285 

Gilbert,  J.,  Pt..  G,  119th 

July  2, 

Right;  flap;  haem.;  gang.     Died 

June  11,  '64  ;  exh'n.    Spec.  3070. 

New  York,  age  38. 

6,  '63. 

August  13,  1863;  pyaemia. 

324 

Jenkins,  F.,  Pt.,  D,  1st 

Aug.  31, 

.     Died  October  2,  1862. 

286 

Gittens,  T.,  Pt.,  G,  12th 

Dec.  13, 

Left;  circ.     Surg.  E.  Bentley,  U. 

New  York. 

-,  '62. 

Mass.  ,  age  48. 

21,  '62. 

S.V.    Hapm.    Died  Jan.  1,  1863. 

325 

Jenkins,  J.,  Pt.,  D,  20th 

Dec.  7, 

;  circ.     Surg.  T.  W.  Florer, 

Autopsy.    Spec.  595. 

Wisconsin,  age  22. 

22  '62 

26th  Ind.     Died  Dec.  26,  1862; 

287 

Glenn,  J.  R.,  Pt.,  E,  32d 

Nov.  27, 

.     Surg.  J.  C.  Morgan,  29th 

haemorrhage. 

Alabama. 

De.  1,'63. 

Mo.    Gang.    Died  Dec.  5,  1863. 

326 

Johnson,  L,  Pt.,  C,  57th 

Nov.  30, 

Left  ;  lat.  flap.     A.  A.  Surg.  H.  C. 

288 

Goddard,  W.  A.,  Pt.,  F, 

May  20, 

Left  ;  flap.    A.  Surg.  A.  P.  Frick, 

Indiana,  age  27. 

De.28/64. 

May.    Died  Jan.  1.  1865;  exh'n. 

9th  Maine,  age  35. 

J'ne5/G4. 

103d  Penn.    Died  June  5,  1864. 

Spe'c.  3757. 

289 

Godwin,  C.,  Pt.,  E,  48th 

Dec.  13, 

Left  (gang'ns);  circ.     Died  Jan. 

327 

Jones,  A.,  Lieut.,  Texas 

Feb.  15, 

Right  ;  circ.  18th.  h;em.  from  fern. 

North  Carolina,  age  33. 

17,  '62. 

13,  1863. 

Regiment. 

Mar  .7/62. 

Died  March  18,  1862;  ha'in. 

290 

Going,  J.  K.,  It.,  G,  60th 

Sept,  19, 

Left  ;  circ.     Surg.  D.  Orsay,  C.  S. 

328 

Jones,  A.  D.,  Pt.,  B,  12th 

June  3, 

Right  ;  ant.  post.  flap.     Surg.  R. 

Georgia. 

22,  '64. 

A.    Gangrene.    Died  Oct.  6,  '64; 

New  Hamp.,  age  20. 

8,  '64. 

B.  Bontecou,  U.  S.V.  91h,  htrm. 

exhaustion. 

Died  June  11,  1864;  exliaust'n. 

291 

Gordon,  S.  I.,  Serg't,  B, 

Nov.  25, 

Right.     Died  December  27,  1864. 

Spec.  3062. 

1st  Alabama  Cavalry. 

—  ,  '64. 

329 

Jones,  W.  R.,  Pt.,  H,  32d 

June  27, 

Right  ;  ciro.    Surg.  E.  M.  Powers, 

292 

Gray,  N.,  Pt.,  II,  33d  N. 

May  3, 

Left  (gang.);  circ.    May  14,  haem. 

Ohio,  age  25. 

J'ylO/64. 

7th  Mo.  Died  July  13,  '64;  shock. 

Carolina,  age  26. 

10,  ''63. 

Died  May  15,  1863. 

330 

Keefe,  J.  A.,  Pt.,  H,  63d 

Sept.  17, 

Right.     A.  Surg.  L.   H.  Searle, 

293 

Gray.W.  A.,  Pt.,  K,13th 

June  1, 

Right  ;  ant.  post.  flap.     A.  Surg. 

New  York. 

Oc.10/62. 

26th  N.  Y.     Died  Oct.  IP,  1862; 

New  Hamp.,  age  25. 

13,  '64. 

S.B.  Ward.U-S.V.  Gang.  Died 

exh'n.     Spec.  813. 

June  25,  '64.  Autop.  Spec.  2709. 

331 

Keeley,   E.,    Serg't,   A, 

Aug.  7, 

Left;  circ.     Died  Nov.  28,  1864; 

294 

Greene,  A.,  Pt.,   E,  93d 

May  9, 

Right;   circ.     Surg.  E.  Bentley, 

15th  Infantry,  age  21. 

12,  '64. 

chronic  diarrhoea. 

Penn.,  age  34. 

29,  '64. 

U.  S.  V.     Died  June  2,  1864; 

332 

Kelly,  W.  D.,  Pt.,  I,  13th 

Jan.  2, 

.      Surg.  C.  J.  Walton,  21st 

haemorrhage.     Spec.  2661. 

Ohio. 

6,  '63. 

Ky.    Died  Jan.  9,  1863. 

295 

Grey.C.  C.,  Lieut.,  I,  4th 

Mav  6, 

Left  ;  circ.    Prof.  F.  H.  Hamilton. 

333 

Kielt,  J.,  Serg't,  C,  69th 

Sept.  17, 

Left  ;  lat.  flap.     Died  Oct.  25/62; 

Maine,  age  28. 

20,  ''64. 

Died  May  29,  1864  ;  pyaemia. 

New  York,  age  20. 

Oc.  10/62. 

pvaem.  Autop.  Specs,  'i  90,  873. 

296 

Grovendyke,  A.,  Lieut., 

Nov.  30, 

Right:  ant.  post.  flap.     A.  Surg. 

334 

Kirby,  E.,13rig.-General, 

May  3, 

Left.     Surg.  B.  Norris,  U.  S.  A. 

F,  124tli  Ind.,  age  34. 

De.25/64 

W.  B.  Trull,  U.  S.V.   Died  Dec. 

U.S.V. 

10,  '63. 

Died  May  28,  1863;    pyaemia. 

27,  1864  ;  exhaustion. 

Spec.  1076. 

297 

Gump,  II.,  Pt.,  D,  61st 

May  5, 

Left;  circ.     Died  June  9,  1864; 

335 

Koerner,  J.,  Corp'l,   E, 

April  2, 

Right  ;  circ.     Surg.  E.  Griswold, 

Penn.,  age  45. 

15,  '64. 

pyaemia.    Autopsy. 

10th  N.Y.H.A.,nge28. 

15,  '65. 

U.  S.  V.     Died  April  24.  1865. 

298 

Hack,  C.,   Pt.,  D,  15th 

Mar.  S, 

Left.     Died  April  18,  1865. 

336 

Kopp,  S.  S.,  Pt.,  E,  10th 

Aug.  28, 

Right.     Surg.  C.  Page,  U.  S.  A. 

Connecticut,  age  21. 

-,  '65. 

Penn.  Res.,  age  21. 

-ie.  20/62. 

Died  Sept.  22,  1862.     Spec.  76. 

299 

Hale,  J.  L.,  Pt.,  C,  31st 

Nov.  24, 

Left  ;  lat.  flap.     Surg.  J.  C.  Mor 

337 

Ladd,  G.  W.,  Pt.,  B,  2d 

Aug.  29, 

Right.     A.  A.  Surg.H.C.Heilner. 

Iowa. 

De.  3,  '63. 

gan,  29th  Mo.     Died  Dec.  3,  '63. 

New  Hamp.,  age  21. 

Se.  19/62. 

Died  Sept.  25,  1862.    Spec.  118. 

SECT.  III.J 


INTERMEDIARY    AMPUTATIONS    OF   THE   THIGH. 


285 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

338 

Landman,  J.,    Ft.,  —  , 

Sept.  17, 

Left  (ulcer'n  of  post.  tib.  artery; 

374 

McPherson,  D.,  Pt.,  E, 

June  2, 

Right;  circ.     A.  A.  Surg.  P.  C. 

6th  Georgia. 

Oct.  6,  '62. 

haem.);  flap.     Ass't  Surg.  H.  F. 

5th  Mich.,  age  24. 

14,  '64. 

Porter.  Died  June  20.  '64;  exh'n 

Weir,  U.  S.A.  Died  Oct.  14/62; 

and  pyaemia.    Spec.  2555. 

pneumonia.     Specs.  789,  875. 

375 

McPherson,  W.  H.,  Pt., 

Sept.  14, 

Right.     Surg.  —  Boyle,  C.  S.  A. 

339 

Lane,  T.,  Pt.,  F,  6th  N. 

May  19. 

Right  ;   circ.     Surg.  E.  I>entley, 

D,  50th  Georgia. 

24,  '(52. 

Died  Oct.  27/62.  Specs.  e:M,  874. 

Y.  H'vy  Art'y,  age  50. 

25,  '64. 

U.  S.  V.     Died  May  28,   1864; 

376 

McVeay,  J.,  Pt.,  E,  23d 

May  31, 

Right  ;  dou.  flap.  Surg.R.B.Bon- 

gangrene.     Spec.  2658. 

I'enn.,  age  25. 

J'ne7/62. 

tecou,  U.  S.  V.  Died  June  8,  '62. 

340 

Langford,  J".,Pt.,  E,  60th 

July  1, 

Left  ;  (lapof  skin  andcirc.  of  muse. 

377 

Medgley,  A.  W.,  Lieut., 

Mav  5, 

Left  (gang.).  Surg  G.T.Stevens, 

Georgia,  age  36. 

18,  '63. 

Died  August  10,  1863;  pyaemia. 

H,  10th  Massachusetts. 

10,  "'64. 

77th  N.Y.     Died  May  11,1864. 

Specs.  3856,  3968,  3987,  3988. 

378 

Meeker,  A.,  Pt.,  D,  loth 

Oct.  19, 

Left  (gang.);  oval  flap.    A.  Surg. 

341 

Lasley,   L.  C.,   Pt.,  H, 

Mar.  19, 

Right  ;  circ.   A.  A.  Surg.  1).  Shep- 

New  Jersey. 

24,  '64. 

E.  B.    Nims,    1st  Vt.  Cavalry. 

124th  Ind.,  age  19. 

Ap.  1,'65. 

pard.     Died  April  4,  '65  ;  shock 

Died  Nov.  6,  1864;  exhaustion. 

and  exhaustion. 

;r.:i 

Melhan,  W.,  Lieut.,  C, 

Mar.  31, 

Left  ;  circ.     Surg.  D.  W.  Bliss,  U. 

342 

Lawson,  L.  B.,  Pt.,  F, 

Sept.  19, 

Left  ;  modified  Hup.     A.  Surg.  J. 

188th  N.  Y.,  age  21. 

Ap.17,'65. 

8.  V.     Died  April  18/65;  exh'n. 

128th  New  York. 

26,  '64. 

G.  Thompson,  77th  N.Y.  Haem.; 

380 

Melman,  C.,  Pt,,  B,  1st 

Sept.  17, 

Right.     A.  Surg.  W.  M.  Notson, 

lig.  fern.  art.     Died  Oct.  4,  1864  ; 

New  Jersey,  age  17. 

Oc.  16/62. 

U.  S.  A.      Died  Oct.  28    I860 

exhaustion. 

Spec.  936. 

343 

Lobroke.  II.  F.,  Pt.,  A, 

May  3, 

Left.  (haem.).  Died  May  29,  1863; 

381 

»Mensh,  C.,  Pt,  IT,  33d 

Mav  5, 

;  dou.  flap.  Surg.  A.  B.  Mott, 

fith  Maine,  age  24. 

17,  '63. 

exhaustion. 

New  York. 

31,  ''62. 

U.S.V.    Died  June  7/62  ;  gang. 

344 

Lehman,  C.,  Lieut,  D, 

Sept.  13, 

Right.     Died  Oct.  9,  1862;  pros 

382 

Metzer,  W.,    Serg't,   E, 

April  23, 

Left.     A.  Surg.  G.  F.  Thompson, 

20th  New  York  S.  M. 

Oct.  4/62. 

tration.     Spec.  141. 

1st  Louisiana,  age  26. 

29,  '64. 

38th  Mass.     Haem.;  lig.  fern.  art. 

345 

Libbey,  J.,  Pt.,  G,  69th 

Sept.  17, 

Left.     Dr.  Green.     Died  Dec.  11, 

Died  May  15,  "64  ;  exhaustion. 

New  York. 

Oct.  8.'62. 

1862;  exh'n.  Autop.  Spec.  1099. 

383 

Mires,   E.,   Pt.,   A,  23d 

Nov.  30, 

;  circ.     Surg.  J.  R.  Ludlow, 

34(3 

Long,  J.,  Pt.,  E,  148th 

Mav  10, 

Right  ;  circ.     A.  A.  Surg.  F.  H. 

Michigan,  age  23. 

De.19/64. 

U.S.V.  Died  Dec.  20/64  ;  haem. 

Penn.,  age  29. 

J'ne'4,'64. 

Colton.  Died  June  4,  '64  ;  shock. 

384 

Mohre,  A.,  Pt.,  K,  104th 

June  1, 

Left.    Haem.;  lig.  fern.  art.    Died 

347 

Loomis,  J.,  Pt.,  G,  109th 

Mav  12, 

Right;  circ.   Surg.  A.  F.  Sheldon, 

Pennsylvania. 

9,  '62. 

June  19,  1862.     Autopsy. 

New  York,  age  31. 

J'ne'2/64. 

U.  S.  V.     Gang.;   diarrh.     Died 

385 

Moore,  W.,  Serg't,  I,  33d 

July  14, 

Left  ;  lat.  flap.  Surg.J.G.Keenon, 

June  19,  1864  ;  exhaustion. 

Missouri,  age  44. 

22,  '64. 

U.S.V.  Died  July  27/64;  exh'n. 

348 

Loutz,  J.,   Pt.,   D,  94th 

April  2, 

Left.  A.A.Surg.J.Tyson.  llsem.; 

386 

Morgan,  W.  E.,  Corp'l, 

April  6, 

.    Surg.  E.  C.  Franklin,  U.  S. 

New  York,  age  17. 

-,  '65. 

slough.;  lig.  fern.  art.    Died  May 

B,  57th  Illinois. 

-,  '62. 

V.     Died  April  26,  1H62. 

26,  1865:  exhaustion. 

387 

Morris,C.,  Corp'l,  F,  19th 

Dec.  7, 

Right  ;  ant.  post.  flap.  Surg.  H.  S. 

349 

Loveland,  J.,  Pt.,C,  16th 

Sept.  17, 

Left.     Surg.  T.  H.  Squire,  89th 

Iowa,  age  48. 

26,  '62. 

Churchman,  U.  S.  V.  Died  Dec. 

Connecticut. 

Oct.  7,'62. 

N.Y.   Died  Oct.  16,  1862  ;  haem. 

26,  1862  ;  shock. 

Spec.  3576. 

388 

Morrison,  W.  E.  L.,  Pt., 

Oct.  27, 

Left  (Oct.  27,  exc.  knee  j't);  circ. 

350 

Luce,  D.  A.,  Pt.,  C,  17th 

Sept.  30, 

Left;   circ.      Surg.  J.  T.  Kilby, 

1,  29th  Conn.,  age  21. 

Nov.  10, 

A.A.Surg.  J.  Pitkin.  Died  Nov. 

Vermont,  age  42. 

Oc.17,'64. 

P.  A.  C.  S.    Died  Dec.  9,  1864. 

1864. 

12,  1864;  exhaustion. 

351 

Luherman,  C.,Corp'l,  D, 

Sept.  19, 

Right  ;  circ.     Surg.  F.  Irish,  77th 

389 

Morriton,  T.  P.,  Pt.,  E, 

Nov.  30, 

Left  ;  ant.  post.  flap.     A.  Surg.  J. 

9th  Ohio. 

Oct.  7/63. 

Penn.     Died  Oct.  7,  1863. 

1st  Miss.,  age  26. 

Dec.  28, 

H.  Cruthers,  88th  Ohio.      Died 

352 

Lunceford.  T.  J.,  Serg't, 

Dec.  21, 

Left;  oval  flap;  circ.  sect.  muse. 

1864. 

Jan.  2,  1865;  haem. 

E,   2d   West    Virginia 

1864, 

A.  Surg.  R.  F.  Weir,  U.  S.  A. 

390 

Morse,  L.  O.,  Pt,,  1,17th 

Mav  9, 

Left  (slough'g);  circ.    A.A.Surg. 

Cavalry,  age  24. 

Jan.  9,  '65. 

Died  Jan.   17,   1865;    pyaemia. 

Vermont,  age  17. 

27.  '64. 

T.  W.  Carroll.    Flaps  slough'g  ; 

Autopsy.    Spec.  3811. 

gang.     Died  May  31,  1864. 

353 

Lynch,  C.,  Pt.,  A,  95th 

Mar.  31. 

Left  ;  lat.  flap.    Surg.  N.  R.  Mose- 

391 

Murphy,  D.,  Pt.,  F,  62d 

Dec.  13, 

Right  ;  circ.    Surg.  O.  A.  Judson, 

New  York,  age  22. 

Apr.7,'65. 

ley,  U.  S.V.     Died  June  24,  '65  ; 

Penn.,  age  18. 

27,  '62. 

U.  S.  V.    Jan.  4,  '63,  haem.  ;  lig. 

exhaustion.     Spec.  4071. 

fern.  art.   Died  Jan.  4/63  ;  exh'n. 

354 

Lyon,  S.,  Pt.,  C,  84th  In 

Sept.  19, 

Right  (erysip.;  rec't  haem.;  lig,; 

Spec.  637. 

diana,  age  23. 

Oct.  6,'63. 

gangrene).     Died  Oct.  8,  1863. 

392 

Noble,   S.,  Pt.,   I,   71st 

Sept.  17, 

Left.    A.  Surg.  W.  M.  Notson,  U. 

355 

Mallet,  J.  H.,Pt.,E,  19th 

Dec.  7, 

Left;  ant.  post.  flap.     A.  Surg.  J. 

Pennsylvania. 

Oct.  9/62. 

S.  A.     Died  Oct.  28,  1862. 

Iowa,  age  30. 

28.  '62. 

J.  Sanders,    1st   Iowa  Cavalry. 

393 

Nolf,  J.,  Pt.,  A,    155th 

Mar.  25, 

Left;  circ.    A.  A.  Surg.  L.  J.  Dra 

Died  Dec.  30,  '62  ;  haemorrhage. 

Penn.,  age  23. 

Ap.  7,  '65. 

per.    Haem.     Died  April  22,  '65. 

35G 

Mallott,  F.,  Pt.,  A,  92d 

Sept.  29, 

Left.  A.A.Surg.  B.  N.  McCleery. 

Autopsy.     Spec.  186. 

New  York,  age  21. 

Oc.15,'64. 

Died  October  27,  1864. 

394 

O'Brien,  J.,    Pt.,  F,   1st 

Nov.  25, 

Left.     D'ied  December  16,  1863. 

357 

Marquardt,   J.,   Pt,,   G, 

Mav  22. 

Right.     Surg.  E.  M.  Powers,  7th 

Ohio. 

—  ,  '63. 

llth  Wisconsin,  age  22. 

J'ue"8,'03. 

Mo.    Died  June  16,  1863  ;  phle 

395 

Osborne,  W.  P.,  Serg't, 

April  6, 

Right.  Haemorrhage.  Died  April 

bitis  and  pyaemia. 

A,  31st  Ind.,  age  26. 

13,  '62. 

15,  1862. 

358 

Marquis,  H.  M.,  Corp'l, 

Sept.  17, 

Left.     Surg.  H.  S.  Hewit,  U.  S.V. 

396 

Page,  J.  M.,  Pt.,  B,  27th 

Aug.  19, 

Right  ;  circ.     Surg.  T.  F.  Oakes, 

15,  23d  N.  Carolina. 

Oct.  8,  '62. 

Died  Oct.  18,  '62.     Spec.  369. 

Georgia,  age  :i7. 

22,  '64. 

56th   Mass.      Diarrhoea.      Died 

359 

Marston,  G.,  Pt,,  H,  4th 

Aug.  29, 

Right  (mortification);  circ.    A.  A. 

Sept.  16,  '64:  exh'n.     Autopsy. 

Vermont,  age  29. 

Se.  15/64. 

Surg.  J.  C.  Shinier.    Died  Sept. 

397 

Patterson,  T.  A.,  Serg't, 

May  10, 

;  ant.  post.  flap.     Surg.  C.  B. 

15/64  ;  shock.  Autop.  Spec.  3831. 

A,  43d  Alabama. 

13,  '64. 

Gibson,  C.  S.  A.    Died  May  16, 

360 

Martin,  H.,  Pt.,  H,  26th 

Sept.  19, 

Right.    Died  Sept.  30,  1863. 

1864  ;  exhaustion. 

Ohio. 

25,  '63. 

398 

Pearl,  S.,  Pt.,  F,  97th  N. 

May  6, 

Right.     A.  A.  Surg.  P.  C.  Porter. 

361 

Mask,  M.,  Pt.,  A,  23d  N. 

Sept.  14, 

Right.  Oct.  6,  8,  9,  ham.;  lig.  fern. 

York,  age  34. 

23.  ''64. 

Died  May  31,  1864  ;  exhaust'n. 

Carolina,  age  24. 

20,  '62. 

art.;  slough.     Died  Oct.  9,  1862; 

399 

Peasly,J.E.,Com.Serg't, 

May  31, 

Left  (gang.);  circ.    A.  A.  Surg.  J.' 

exhaustion. 

F,  6th  N.  Y.  H.  ArtY 

June  16, 

H.   Thompson.     Died  July,  18, 

362 

Maurer,  H.,  Corp'l,  K,7th 

Mar.  31, 

Left  ;  flap.     Surg.  N.  R.  Moseley, 

age  38". 

1864. 

1864  ;  exhaustion. 

Maryland,  age  24. 

A  p.  6/65. 

U.  S.  V.     Died   April  9,   1865; 

400 

Peters,    J.,  Pt.,    H,  8th 

Sept.  17, 

Right.   Surg.  H.  S.  Hewit.U.S.V. 

nerv.  exh'n  and  haem.  Spec.  4070. 

Penn.  Reserves. 

27,  '62. 

Died  October  2,  1862. 

363 

Mayer,  J.,  Pt.,  II,  44th 

I>ec.  13, 

Left.    Died  Dec.  20,  1862.     Spec. 

401 

Piersol,  C.,  Pt.,  G,  145th 

June  3, 

Left  (gang.;  diarrhoea).   A.  Surg. 

New  York. 

24,  '62. 

4154. 

Penn.,  age  19. 

J'y2/64. 

W.  F.  Norris,  U.  S.  A.     Died 

364 

Mayo,  G.  W.,  Serg't,  A, 

May  10, 

;  ant.  post.  flap.     Surg.  C.  B. 

July  12,  1864  ;  pyaemia. 

43d  Alabama. 

13,  '64. 

Gibson,  C.  S.  A.     Died  May  16, 

402 

Pinckney,  J.  C.,  Pt.,  I, 

July  19, 

Left  (gang.);  circ.  A.  A.  Surg.W. 

1864  ;  exhaustion. 

7th  Minnesota,  age  31. 

23,  '64. 

M.  Dowan.    Died  July  24,1864, 

365 

McAvory,W.,  Pt.,  G,73d 

July  2, 

Left  (haem.).    Died  July  11/63; 

while  chloroformed.    Autopsy. 

New  York,  age  20. 

8.  '63. 

exhaustion. 

403 

Pitcher,  DeW.,  Pt.,  K, 

April  7, 

;    ant.  post.  flap.      A.  Staff 

366 

McCarty.  J.,  Pt,,  I,  61st 

June  1, 

Left  ;  flap  ;  pyaemia.     Died  June 

2d  N.Y.  H.  A.,  age  20. 

13,  '65. 

Snrg.W.J.  Burr,  U.S.A.    Died 

Pennsylvania. 

7,  '62. 

11,  1862. 

Mav  4,  1865. 

367 

McOormick,  J.E.,  Pt.,E, 

Dec.  7, 

Right  ;  ant.  post.  flap.     A.  Surg. 

404 

Platt,  F.,  Pt,,  E,  72d  N. 

July  2, 

Left  (hem.).    Died  July  8,  1863  ; 

26th  Indiana,  age  22. 

12,  '62. 

E.  A.  Clark,  37th  111.    Died  Dec. 

York,  age  40. 

5,  '63. 

exhaustion. 

24,  1862  ;  haemorrhage. 

405 

Pool,  S.,  Pt.,  H,  23d  N. 

Dec.  13, 

Left.     Died  December  29,  1862. 

368 

McCoy,  J.,  Pt.,  B.  140th 

Mav  12. 

Riffht  ;  ant.  post.  flap.  Surg.R.  B. 

Jersey. 

25,  '62. 

Feuu.,  age  17. 

J'ne"3/C4. 

Bontecou.U.  S.V.    Haem.    Died 

406 

Porter,  W.,  Pt.,  H,  16th 

Sept.  17, 

Left.     Surg.  T.  H.  Squire,  89th 

June  8,  '64  ;  exh'n.    Spec.  3058. 

Connecticut. 

Oct.  8/62. 

N.Y.     Died  Oct.  10,  18U2. 

369 

McKee,  T.,  Pt.,  I,  123d 

June  15, 

.     Died  July  15,  1863. 

407 

Potter,  C.  II.,  Pt.,  C,  31st 

Mav  18, 

Right;  ant.  post.  flap.    A.A.Surg. 

Ohio. 

—  ,  "63. 

Maine,  age  16. 

29,'  '64. 

C.  T.  Trautman.     Huem.    Died 

370 

MoKenna,  P.,  Pt.,  I,  67th 

June  1, 

.     Died  June  18,  1862;  exh'n. 

June  3,  1864;  exhaustion. 

New  York,  age  30. 

16,  '62. 

408 

Raynor,  O.   W.,  Pt.,  G, 

April  6, 

Right  ;  ant.  post.  flap.     A.  Surg. 

371 

McLanghlin,  11.,  Pt,,  H, 

Mav  10, 

Left  ;  ant.post.flap.  Surg.E.  Bent- 

12th  Alabama,  age  18. 

17,  '65. 

W.  Carroll,  U.S.  V.  Haem.;  fern. 

142d  1'enn.,  age  21. 

23,'  '64. 

ley,  U.  S.V.  Gang.;  pyae.    Died 

art.  lig.    DiedMav6,  '05;  exh'n. 

June  7/64;  asthenia.    Autopsy. 

Spec.  4164. 

Spec.  2553. 

409 

Reigle,  J.,  Pt.,   H,  88th 

May  8, 

Right  ;  ant.  post.  flap.  Surg.  R.B. 

372 

MoMahon,  J.,  Pt.,  A,  61st 

Sept.  17, 

Left  (haem.).    Oct.  2,  fern.  art.  lig. 

Penn.,  age  Qii. 

28,  '64. 

Bontecou,  U.  S.  V.    June  8,  12, 

New  York. 

—  ,  '62. 

Died  Oct.  16,  1862. 

haem.:  lig.  fern.  art.  16,  24,  recur 

373 

Me  Mick  en,    N.,  Pt.,  A, 

July  2, 

Right  (sloughing)  .    Died  August 

rent  ha?m.;  re-lig.  Died  June  24, 

151st  Penn.,  age  24. 

Au.  I,  '63. 

12,  1863. 

1864;  haemorrhage. 

'PURDY  (E.  M.),  Cases  of  Gunshot  Wound,  in  American  Medical  Times,  1863,  Vol.  VI,  p.  66. 


286 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS.  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

410 

Reed,  AV.,  Ft.,  G,  39th 

Feb.  6, 

Right.   Surg.  J.Aiken,  71st  Penn. 

440 

Stewart,  E.,  Pt.,  B,  13th 

July  24, 

Left  ;  flap.     A  .  Surg.  J.  Willard, 

New  York,  age  30. 

11,   '04. 

Died  March  1,  1864  ;  tetanus. 

W.  Virginia,  age  25. 

28,  '6-1. 

IstMd.  P.H.B.  Died  Aug.  5/64. 

411 

Rentz,  J.  W.,  Lieut.,  13th 

Sept.  17, 

Right  ;  flap.     A.  Surg.  C.  P.  Rus 

441 

Stewart,  J.,  Pt.,  C,  26th 

Dec.  7, 

Left  (gang.);  circ.     Surg.  T.  W. 

Alabama,  age  21. 

Oct.  7,  '62. 

sell,  U.  S.  A.     Diarrhoea.     Died 

Indiana,  age  22. 

11,  '62. 

Florer,  26th  Ind.     Died  Dec.  24, 

Oct.  11,  1862.    Spec.  800. 

1862;  haemorrhage. 

412 

Rice,  S.H.,Corp'l,E,50th 

May  13. 

Right  ;  circ.    Died  June  7,  1864  ; 

442 

Stone,  B.,  Capt.,—,  llth 

Aug.  30, 

Right.     A.  Surg.  B.  Howard,  U. 

Penn.,  age  29. 

19,  '64. 

pyaemia. 

Massachusetts. 

Sep.4,'62. 

S.  A.     Died  Sept.  K),  1862. 

413 

Ricker,  J.,  Pt.,  K,  2d  N. 

May  5, 

Right;  circ.  Surg.R.B.Bontecou, 

443 

Stroup,  W.,  Seaman. 

Feb.  12, 

—  ;  double  flap.     Surg.  E.  C. 

Hampshire,  age  24. 

8,  '62. 

U.  S.  V.     Died  Sept.  21  ,  1862. 

—  ,  '62. 

Franklin,  U.  S.  V.     Died  March 

414 

Riggs,  I.,Pt.,  I,8th  Penn. 

Dec.  13, 

Left.  Surg.J.E.Summers.U.S.A. 

5,  1862. 

Reserves. 

29,  '62. 

Died  Jan.  10/63  ;  pyae.  Spec.  661. 

444 

Strunk,AV.C.,Pt.,G,56th 

July  30, 

Left  (slough.);  circ.     A.  A.  Surg. 

415 

Roberts,  W.  P.,  Pt.,  I, 

July  1, 

Right  ;  circ.     A.  A.  Surg.  J.  L. 

Mass.,  age  26. 

Au.l2,'C4. 

E.  Sevffarth.    Died  Aug.  12/64. 

42d  Mississippi. 

24,  \!3. 

Whitaker.     Diarr.     Died  Aug. 

445 

Sturdevant,  J.  H.,Pt.,C, 

May  12, 

Left,     A.  Surg.  M.  J.  Hyde,  2d 

5,  1863;  exhaust'n.     Spec.  2057. 

5th  Vermont,  age  20. 

24,  '64. 

Vt.    Necrosed.    Aug.  20.  liaem.; 

416 

Robertson,  G.,  Pt.,  A,  63d 

Sept.  17, 

Right  ;  flap.     A.  A.  Surg.  A.  V. 

re-amp.     Died  Aug.  21,  1864. 

New  York,  age  42. 

Oc.i7,'62. 

Cherbonnier.     Died  October  21, 

446 

Swink,   J.,  Pt.,  K,   5th 

May  3, 

Right  ;  circ.     Died  June—,  1863. 

1862.    -Spec.  360. 

Virginia,  age  18. 

12,  '63. 

417 

Robiuson,  Mary,  wife  of 

April  12, 

Right  ;  ant.  post.  flap.     Surg.  H. 

447 

Taylor,  T.L.,  Pt.,C,  82d 

Aug.  31, 

—  .     Died  October  9,  1862. 

Colored  soldier. 

21,  '64. 

Wardner,  U.  S.  V.    Died  April 

Ohio. 

—  ,  '62. 

26,  1864;  exh'n.     Spec.  3315. 

448 

Thompson,  A.,  Corp'l,  A, 

April  2, 

Right  (erysip.;  haem.).    Surg.  D. 

418 

Robinson,  W.  B.,  Pt.,  B, 

Nov.  6, 

Left  (haem.).     Died  Nov.  12,  '63. 

98th  Penn.,  age  29. 

25,  '65. 

W.  Bliss,  U.S.V.    Died  May  23, 

2d  E.  Tennessee. 

-,  '63. 

1865.     Spec.  4096. 

1    • 

Robison,  W.  R.,  Pt.,  D, 

May  15, 

Left;  circ.     A.   A.  Surg.  R.  L. 

449 

Thornbury,    L.,  Pt.,  C, 

July  25, 

Right  ;  circ.     A.  A.  Surg.  W.  L. 

29th  Alabama,  age  23. 

J'ne'7,'64. 

McClure.     Died  June  22,  1864  ; 

97th  Penn.,  age  20. 

Au.  1,'64. 

Welles.     Died  Sept.    13,  1864; 

exhaustion.     Spec.  3372. 

irritative  fever. 

420 

Rodden.M.  L.,  Serg't,  D, 

May  31, 

Left  ;  flap.     A.  A.  Surg.  W.  K. 

450 

Tournier,  L,  Pt.,  A,147th 

May  5, 

Left  ;  ant.  post.  flap.     Died  Aug. 

96th  New  York,  age  25. 

J'e  12/62 

Cleveland.    Died  June  17,  1862. 

New  York,  age  42. 

9,  '64. 

15,  1864. 

421 

Holland,  J.G.,  Serg't.  F, 

May  19, 

Right;  circ.     A.  A.  Surg.  W.  C. 

451 

Unknown. 

Dec.  7, 

Left.    Surg.  J.  P.  Root,  2d  Kansas 

7th  New  York  Artil'ry. 

26,  '64. 

Mulford.     Gang.    Died  June  2, 

11,  '62. 

Cavalry.     Died  Dec.  13,  1862. 

age  21. 

1864;  pyaemia.    Spec.  2381. 

452 

Vanderhoof,  N.  P.,  S'g't, 

May  1, 

Left  (hajm.);  circ.    Died  May  16, 

422 

Sargent,  C.  H.,  Pt.,  1,  6th 

Dec.  13, 

Right,    Died  Jan.  7,  1863  ;  shock 

B,  146th  N.  Y.,  age  21. 

5,  '63. 

1863.    Autopsy. 

N.  Hampshire,  age  25. 

1862, 

and  suppuration. 

453 

Walker,  J.,  Serg't,  F,  2d 

June  16, 

Left  (J'y  2,  haem.  recur'd;  gang.); 

Jan.  1,  '63. 

Maryland,  age  21. 

J'y  6,  '64. 

circ.     A.  A.  Surg.  J.  Winslow. 

423 

Scanlan,  P.,  Pt.,  G,  63d 

Dec.  14, 

Right.     A.  Surg.  G.  M.  McGill, 

Died  July  6,  1864  ;  asthenia. 

New  York,  age  34. 

26,  '62. 

U.S.A.     Haem.;  lig.  fern,  art.; 

454 

Walker,  P.,  Pt.,C,  3'th 

June  3, 

Right  ;  circ.     Surg.  S.  S.  French, 

hjem.  rec'd.    Died  Jan.  1  4,  1863  ; 

Wisconsin,  age  38. 

20,  '64. 

20th  Mich.   Kxf.  bone  extracted. 

haein.     Autopsy. 

Died  Aug.  22,  1864.    Spec.  3128. 

424 

Scanlon,  J.,    Pt.,  A,  3d 

Aug.  9, 

Left  ;  circ.   A.  Surg.  P.Adolphus. 

455 

Watts,  J.  H.,  Serg't,  K, 

Mar.  26, 

Left;  ciro.  Diarrhoea.  Died  April 

Maryland. 

15,  '62. 

U.  S.  A.     Died  Aug.  20,   1862. 

110th  Penu.,  age  24. 

Ap.  2,  '65. 

22,  1865;  exhaustion. 

Spec.  42. 

456 

Weaver,  J.,  Pt.,  G,  103d 

May  31, 

Left  ;  flap.     Died  June,  1862. 

425 

Schadot,  J.,  —  ,  G,  30th 

Sept.  17, 

Right.    Died  October  12,  1862. 

Penn.,  age  31. 

J'ne4/62. 

Ohio,  age  40. 

Oct.  8,  '62. 

457 

Welch,  E.,  Pt.,  I,  14th 

July  3, 

Right  ;  ant.  post.  flap.     Surg.  H. 

426 

Schock,  W.,  Corp'l,  K, 

Aug.  9, 

Left  ;  ant.  post,  flap.     A.  Surg.  J. 

Indiana. 

-,  '63. 

M.  McAbee,   4th   Ohio.     Died 

46th  Pennsylvania. 

16,  '62. 

B.  Brinton,  U.  S.  A.   Haem.;  lig. 

July  _,  1863. 

Died  Sept.  2,  1862.    Spec.  50. 

458 

Wells,  F.  M.,  Lieut  ,  D, 

May  2, 

Left,     Died  June  2,  1863.     Spec. 

407 

Sohuyler.W.  S.,A.D.  C. 

June  3, 

Left  ;  circ.     A.  Surg.  \V.  Thom 

132d  Pennsylvania. 

6,  '63. 

1064. 

and  Capt.,  155th  N.  Y., 

16,  '64. 

son,  U.  S.  A.    Died  June  20,  '64  ; 

459 

Westlake.W.W.,  Corp'l, 

July  2, 

Right.    Died  July  25,  1863;  teta 

age  24. 

exhaustion.     Spec.  3560. 

A,  17th  Conn.,  age  18. 

14,  '63. 

nus. 

428 

Secord,  J.,  Pt.,  B,    43d 

May  5, 

Left  (gangrene).  Surg.  G.  T.  Ste 

460 

Whitcher,  O.  B.,  Corp'l, 

June  1, 

Left;   ant.  post.  flap.     Surg.  E. 

New  York. 

10,  '64. 

vens,   77th   N.  Y.    Died  May, 

M,8th  New  York  H'vy 

13,  '64. 

Beutley,  U.  S.  V.     Haem.    Died 

1864;  gangrene. 

Artillery. 

June  18,  1864  ;  haemorrhage. 

429 

Sharon,  P.,  Pt.,  I,  153d 

Sept.  19, 

Right  (nearly  moribund  from  bsem. 

461 

Wilber,  N.,  Pt.,  C,  185th 

Mar.  29, 

Left  ;  eirc.     Surg.  D.W.  Miss,  U. 

New  York. 

Oc.18,'64. 

Oct.  12,  lig.  pop'l  art,);  lat.  flap. 

New  York,  age  31. 

Apr.2,'65. 

S.  V.     Died  April  18,  '65  ;  fract, 

Ass't  Surg.  C.  II.  Allen,  8th  Vt. 

of  cranium.    Spec.  4041. 

Died  Oct.  18,  1864;  exhaustion. 

462 

Wilbur,  W.  F.,Corp'l,  I, 

May  3, 

Left;  circ.    May  15,  haem.,  lig. 

430 

Shields,  H.,  Pt.,  C,  61st 

May  31, 

Right.     Died  July  3,  1862;  py 

29th  Ohio,  age  24. 

8,  M33. 

fern,  art.,  recur'd,  prof,  ligated. 

Pennsylvania. 

J'e—  ,'62. 

aemia.     Spec.  4940. 

Died  May  17,  1863. 

431 

Shire,  J.,  Pt.,  B,  5th  111. 

Feb.  11, 

;  ant.  post.  flap.     A.  Surg.  J. 

463 

Williams,  H.  P.,  Pt.,  G, 

May  5, 

Right  ;  ant.  post.  flap.     Surg.  R. 

Cavalry,  age  25. 

Mar.  6, 

B.  Ensey,  5th  Illinois  Cavalry. 

53d  Penn.,  age  17. 

20,  ''64. 

B.  Bontecou,U.S.V.    Died  June 

1863. 

Died  March  6,  1863. 

14,  1864  ;  pyaemia.    Spec.  3059. 

432 

Shultz,   B.,  Pt.,  H,    1st 

May  31, 

;  flap.     Died  June  15,  1862  ; 

464 

'Williams,   R.,  Pt.,    C, 

Sept.  16, 

Right;  flap.     A.  Surg.  C.  A.  Me- 

Penn.  Artillerv,  age  21. 

J'ne'9,'62. 

pyaemia. 

28th  Penn. 

30,  '62. 

Call,  U.  S.  A.     Died  October  2, 

433 

Singer,  W.  H..  Pt.,  C,7th 

Nov.  27, 

Left;  circ.     A.  A.  Surg.  J.  Cass. 

1862.    Spec.  59. 

Virginia,  age  22. 

De.15,'63. 

Dec.  22.  haem.    Died  Jan.  6.  '64. 

465 

Wilson,  W.,  Pt.,    I,  2d 

April  9, 

Right  ;  circ.     Surg.  F.  Bacon,  U. 

Specs.  2006,  2007,  2008. 

New  York  Cavalry. 

16,  '64. 

S.  V.     Died  April  28,  1864. 

434 

Smith,  H.  E.,Pt.,  E,  80th 

May  12, 

Right  (re'nt  hasm.);  eirc.     Surg. 

466 

Witman,  J.,  Pt.,  A,  16th 

May  10, 

Left;  ant,  post,  in  us.  flap.     Surg. 

New  York,  age  17. 

28,"  '64. 

D.  W.Bliss.  U.  S.V.     Died  June 

Michigan,  age  23. 

25,  '64. 

A.  F.  Sheldon,  U.  S.  V.     Died 

2.  1864.    Spec.  2371. 

May  27,  1864  ;  exhaustion. 

435 

Smith,  W.,  Corp'l,  I,  1st 

June  11. 

Left;  circ.    A.A.Surg.D.H.King. 

467 

Wolford,  J.  R.,  Serg't,  B, 

Sept.  19, 

Right,  (haem.).    Died  Nov.  13/63. 

N.Y.  Dragoons,  age  28. 

J'y  6,  '64. 

Died  July  17,  1864  ;  asthenia. 

30th  Indiana. 

Oc.19,'63. 

436 

Spencer,  J.,  Pt.,  G,  48th 

May  9, 

Right  ;  oval  flap.     Surg.  E.  Bent- 

468 

Wynne,  W.  G.,  Pt.,  F, 

Sept  17, 

Left  ;  flap.  A.  Surg.  P.Adolphus, 

Penn.,  age  19. 

16,  ''64. 

ley,  U.  S.  V.    Haem.;  lig.    Died 

66th  New  York. 

Oc.16,'62. 

U.  S.A.    Oct.  25,  haem.;  lig.  fern. 

May  31,  1864:  exhaustion. 

art.    Died  Nov.  3,  '62.   Autopsy. 

437 

Sproule,  L..  Pt,,  E,  37th 

De.  7,  '62, 

Right;  lateral  flap.     Surg.  H.  S. 

Spec.  746. 

Illinois,  age  23. 

Jan.  3,  '63. 

Churchman,  U.  S.V.    Died  Jan. 

469 

Wyznski,  C.,  Pt,,  B,  3d 

May  18, 

Left  ;  circ.     A.  A.  Surg.  R.W.W. 

9,  1863;  pysamia. 

Md,  Cavalry,  age  26. 

29,  '64. 

Carroll.     Died  May  31,  1864; 

438 

Squires,  L.,  Pt.,  D,  29th 

Aug.  9, 

Left  ;  ant.  post,  double  flap.     A.  | 

pyaemia. 

Ohio. 

15,  '62. 

A.  Surg.  J.  B.  Bellanger.     Died  I  470 

Yearby,  J.,  Waiter,  C, 

Aug.  7, 

Left;  flap.  A.A.Surg.H.B.White. 

Sept.  5,  1862  ;  exh'n.     Spec.  52. 

12th  N.  Hamp.,  age  25. 

12/64. 

Died  August  20,  1864  ;  exh'n. 

439 

Stevens,   J.,  Pt.,  E,  3d 

April  4, 

Left,     Surg.  J.  E.  Lynch,  1st  Mo. 

471 

Young,  G.  W.,   Pt.,  F, 

May  3, 

.    A.Surg.B.  Howard,U.S.A. 

Missouri  Cavalry. 

12,  '64. 

Cav.     Died  one  hour  after. 

114th  Pennsylvania. 

8,  '63. 

Died  May  —  ,  1863. 

The  seat  of  fracture  in  the  cases  enumerated  in  the  foregoing  table  was  in  the  middle 
third  of  the  femur  in  seventeen;  in  the  lower  third,  in  ninety-four;  in  the  femur,  without 
specification  of  third,  in  sixty-six;  in  the  knee  joint,  in  two  hundred. and  thirty-four;  in 
the  leg,  in  fifty-six;  and  in  the  ankle  joint  or  foot  in  four  instances. 


'COUE8  (E.),  Cases  of  Amputation*  and  Resections,  from  Gunshot  Wounds,  performed  by  Assistant  Surg.  C.  A.  McCa.ll,  V.  S.  A.,  in  Medical  and 
Surg.  Reporter,  1862-3,  Vol.  IX,  p.  195. 


SECT,  in.]  INTERMEDIARY    AMPUTATIONS    OF    THE    THIGH.  287 

Intermediary  Amputations  in  the  Lower  Third  of  the  Thigh. — There  were  six  hundred 
and  seventy-six  of  these  operations.  Two  hundred  and  seventeen  were  successful  and  four 
hundred  and  fifty-nine  terminated  in  death — a  mortality  of  67.9  per  cent., — exceeding  the 
fatality  of  the  intermediary  amputations  in  the  upper  third  by  1.9  per  cent,  and  the  same 
operations  in  the  middle  third  by  11.5  per  cent. 

Successful  Cases  of  Intermediary  Amputations  in  the  Lower  Third  of  the  Thigh. — 
Of  the  series  of  six  hundred  and  seventy-six  intermediary  amputations  in  the  lower  third 
two  hundred  and  seventeen  had  favorable  results,  comprising  thirty-one  Confederate  and 
one  hundred  and  eighty-six  Union  soldiers.  Of  the  latter,  one  hundred  and  eighty-four 
were  pensioned  and  one  retired,  and  eight  have  died  since  the  close  of  the  war  in  1865.  Of 
fifty-three  of  these  cases  pathological  specimens  are  preserved  in  the  Army  Medical  Museum. 

CASE  4G4. — Private  W.  Vanuatta,  Co.  D,  4th  Pennsylvania  Cavalry,  aged  24  years,  was  wounded  at  Upperville,  June 
21,  1863,  and  entered  Stanton  Hospital,  Washington,  three  days  afterwards.  Surgeon  J.  A.  Lidell,  U.  S.  V.,  reported:  "The 
patient,  a  man  of  sound  constitution,  had  received  a  wound  of  the  right  knee  by  a  carbine  ball.  The  missile  entered  the  limb 
on  its  anterior  inner  face  a  short  distance  below  the  joint,  passed  backward  and  upward,  and  escaped  through  the  popliteal  space, 
apparently  without  opening  the  joint.  From  the  course  and  direction  of  the  wound  the  upper  part  of  the  tibia  was  supposed  to 
be  injured.  At  the  time  of  admission  the  patient's  condition  was  good,  there  being  no  pain,  heat,  or  swelling  about  the  injured 
knee.  He  was  directed  to  refrain  from  using  it  by  remaining  quietly  in  bed,  to  have  ice  applied  to  the  wound  constantly  so  as 
to  lessen  the  danger  of  inflammatory  action,  and  to  be  supported  by  nutritious  diet.  Under  this  treatment  his  case  progressed 
without  an  untoward  symptom  until  July  5th.  At  inspection,  on  this  day,  I  especially  noticed  his  condition  as  very  promising, 
the  anterior  orifice  of  the  wound  being  nearly  healed.  But,  about  the  middle  of  the  following  night,  he  was  seized  with  great 
pain  and  distress  in  the  injured  knee,  and  full  doses  of  morphia  were  administered  without  producing  much  relief.  On  the 
following  morning  the  knee  was  found  to  be  greatly  swollen,  hot,  and  exceedingly  tender,  the  patient  complaining  of  intense 
gnawing  pain  in  it,  and  crying  out  from  agony  occasioned  by  it.  Although  his  pupils  were  markedly  contracted  from  the  large 
quantities  of  anodynes  taken,  his  countenance  was  expressive  of  great  distress;  pulse  frequent,  quick,  and  irritable;  skin  hot 
and  dry:  he  was  also  thirsty,  had  a  coated  tongue,  and  had  had  a  slight  chill.  Free  abstraction  of  blood  from  the  neighborhood 
of  the  knee  by  cups  was  ordered,  also  ten  grains  of  calomel,  and  anodynes  as  required.  On  July  7th,  the  patient's  condition  had 
not  materially  changed.  Seeing  that  the  arthritis  was  secondary  to  the  wound,  and  believing  that  it  was  associated  with  fracture 
and  comminution  of  the  upper  end  of  the  tibia,  amputation  appeared  to  be  the  proper  remedy.  The  operation  was  accordingly 
performed  by  Assistant  Surgeon  P.  C.  Davis,  U.  S.  A.,  in  the  lower  third  of  the  thigh,  by  the  circular  method,  about  midday — 
thirty-six  hours  after  the  attack.  Anaesthesia  was  produced  by  sulphuric  ether.  The  patient  bore  the  operation  well.  On 
examining  the  amputated  limb  the  inner  part  of  the  head  of  the  tibia  was  found  to  be  extensively  injured  by  the  bullet,  a  deep 
groove  having  been  made  in  the  bone,  associated  with  much  comminution,  and  some  of  the  broken  fragments  connected  directly 
with  the  joint.  The  cavity  of  the  knee  joint  was  found  to  contain  about  four  ounces  of  dirty-brown  colored  viscid  liquid,  in  which 
yellowish  shining  globules  (synovia),  looking  like  oil,  floated.  The  lining  membrane  of  the  joint  was  stained  with  a  dull  red  hue 
throughout  its  whole  extent  and  had  entirely  lost  its  polished  and  shining  appearance.  The  internal  semilunar  cartilage  com 
pletely  covered  the  opening  in  the  head  of  the  tibia.  On  July  10th,  the  patient  was  progressing  pretty  well."  On  October  2d, 
he  was  transferred  to  Turner's  Lane  Hospital,  Philadelphia,  where  a  second  operation  was  performed  by  Acting  Assistant 
Surgeon  C.  B.  King,  who  described  it  as  follows  :  "When  admitted,  the  femur  was  protruding  about  half  an  inch,  and  appeared 
to  be  dead  as  far  up  as  could  be  felt  with  the  probe,  a  ring  of  new  bone  being  thrown  around  it.  The  discharge  was  very  pro 
fuse.  On  October  5th,  the  patient  having  been  placed  under  the  influence  of  ether,  an  oval  incision  was  made  around  the  end  of 
the  bone  and  through  the  cicatrix  and  some  unhealthy  granulations,  when,  after  dissecting  the  muscles  for  a  short  distance,  the 
vitality  of  the  new  bone  was  found  to  be  small,  and  lateral  incisions  were  made  and  the  flaps  dissected  up  for  about  four  inches, 
where  the  new  bone  seemed  to  be  more  healthy,  and  was  sawn  off.  About  four  inches  of  the  remaining  dead  bone,  which  I 
judged  as  reaching  up  as  far  as  the  great  trochanter,  was  extracted  with  the  forceps.  The  femoral  artery  was  avoided  by 
making  the  internal  lateral  incision  below  the  vessel,  and  the  patient  lost  but  little  blood.  Three  or  four  small  arteries  were 
ligated,  and  the  wound  was  closed  with  iron  wire  and  adhesive  straps.  The  patient,  being  very  weak  from  suppuration  and  the 
shock  of  the  operation,  was  rallied  with  difficulty.  Cold-water  dressings  were  applied  and  stimulants  administered.  On  the 
following  day  the  patient  was  still  very  weak,  had  a  slight  fever  and  coated  tongue,  and  the  stump  was  very  much  inflamed  and 
swollen.  The  sutures  were  removed  and  the  straps  loosened,  and  milk  punch,  beef  tea,  and  generous  diet  were  ordered.  On 
October  12th,  the  inflammation  was  somewhat  reduced,  the  discharge  free  but  very  offensive,  and  the  patient  was  gaining  strength 
slowly  and  his  appetite  improving.  The  ligatures  were  now  removed.  On  October  18th,  the  bands  were  removed,  union  having 
taken  place  in  the  stump.  On  November  4th,  the  wound  had  closed  with  an  abundance  of  flap,  and  the  patient  was  going  about 
on  crutches.  On  November  16th,  he  was  transferred  to  Haddington  Hospital  for  the  purpose  of  getting  an  artificial  limb." 
Acting  Assistant  Surgeon  J.  R.  Levis,  in  charge  of  the  latter  hospital,  recorded  the  following  result  of  the  case:  "At  date  of 
admission  a  fistulous  opening  existed  in  the  stump,  and  on  examination  by  the  probe  the  whole  wall  of  this  sinus  was  found  to 
have  an  osseous  fell  leading  directly  to  the  end  of  the  femur,  where  loose  spiculse  of  bone  were  clearly  perceived.  A  small 
pledget  of  sponge  tent  was  applied,  and  on  November,  20th  the  orifice  was  well  dilated,  and,  with  the  dressing  forceps,  several 
pieces  of  bony  formation  were  removed,  which  crumbled  readily  under  pressure;  also  a  good  sized  spicula  from  the  sawed 
surface  of  the  femur.  Some  inflammation  followed  this  operation,  for  which  lead  and  opium  lotion  was  applied ;  perfect  quiet 


INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

was  enjoined,  and  anodynes  given  at  bedtime.  On  November  23d,  the  inflammation  was  still  continuing  and  the  patient  suffer 
ing  intense  pain  in  the  stump,  but  two  days  afterwards  both  were  subsiding.  On  December  1st,  another  examination  was  made 
by  the  probe  and  another  small  piece  of  bone  was  extracted.  By  December  10th,  his  health  had  improved,  the  discharge  had  much 
lessened,  and  the  stump  was  doing  well,  the  patient  stating  that  it  felt  better  than  at  any  previous  time.  In  January,  1864,  the 
patient  went  to  his  home  on  furlough,  and  in  the  following  month,  when  he  returned,  the  discharge  had  almost  ceased.  On 
March  1st,  the  sinus  had  closed  and  the  stump  was  apparently  sound."  The  patient  was  subsequently  transferred  to  Christian 
Street  Hospital,  and  was  discharged  from  service  June  7,  1864,  and  pensioned.  Examiner  J.  Walker,  of  Bethany,  Missouri, 
certified,  May  2,  1874  :  "I  find  him  unable  to  wear  an  artificial  limb  on  account  of  tenderness  and  shortness  of  the  stump.  HP 
is  unable  to  raise  the  stump  in  walking,  and  wears  a  wooden  peg  with  a  leather  socket,  buckled  around  his  waist.  He  is  also 
unable  to  raise  the  peg,  but  moves  it  by  moving  the  side  of  his  body.  The  stump  chafes  so  easily  that  he  can  wear  the  socket 
but  a  short  time,  and  then  has  to  use  a  crutch."  The  pensioner  was  paid  June  4,  1879.  The  bones  comprising  the  knee  of  the 
amputated  limb  were  transmitted  to  the  Museum  by  Surgeon  Lidell,  and  the  involucrum  and  sequestrum,  removed  at  the  second 
operation,  together  with  a  cast  of  the  stump,  were  contributed  by  the  operator.  (Cat.  Sury.  Sect.,  1866,  pp.  341,  309,  and  555, 
Specs.  1306,  2602,  and  1529.)  Specimen  2602  is  represented  in  FIG.  1  of  PLATE  LXX,  opposite  p.  242. 

CASE  465. — Corporal  H.  H.  Ellis,  Co.  I,  16th  New  York,  aged  23  years,  was  wounded  in  the  left  knee,  at  Fredericksburg, 
May  3, 1863.  Five  days  after  the  injury  he  was  admitted  into  Douglas  Hospital,  Washington,  whence  the  following  history  was 
received :  "  On  examining  the  wound  it  was  found  that  a  conical  ball  had  fractured  the  patella  so  extensively  as  to  involve  the 
joint.  On  May  13th,  there  were  symptoms  of  synovitis,  and  the  thigh  was  amputated  at  the  lower  third,  by  the  circular  method, 
by  Acting  Assistant  Surgeon  J.  E.  Smith.  Portions  of  clothing  were  removed  from  the  amputated  knee,  and  an  examination 
showed  that  the  patella  had  been  broken  into  numerous  fragments,  that  a  fissure  extended  through  the  inner  cartilaginous  face 
of  the  bone,  and  that  synovitis  had  been  developed.  The  patient  was  broken  down  with  diarrhoea.  The  stump  was  dressed 
with  alcohol,  and  stimulants,  quinine,  and  nutrients  were  given  as  largely  as  possible.  The  general  condition  of  the  patient  was 
so  unfavorable  that  no  effort  at  repair  was  perceptible  in  the  stump  for  many  days.  On  May  20th,  a  haemorrhage  of  several 
ounces  occurred  and  was  controlled  by  pressure.  During  the  following  night  the  bleeding  recurred  so  freely  as  to  render  a  liga- 
tion  of  the  femoral  artery  necessary,  which  was  performed  below  the  profunda  on  May  21st.  The  patient  was  so  prostrated 
from  the  loss  of  blood  that  he  almost  died  from  the  effects  of  the  ether.  The  most  careful  administration  of  whiskey,  ammonia, 
valerian,  and  morphia  alone  sustained  his  life  during  the  next  forty-eight  hours.  There  was  no  recurrence  of  hemorrhage  after 
the  ligation,  nor  did  this  ligature  of  the  main  artery  produce  the  slightest  perceptible  effect  upon  the  appearance  of  the  stump. 
The  usual  changes  were  resorted  to  in  the  various  astringents  given  for  the  diarrhoea,  nitrate  of  silver,  opium,  tannin,  and  sul 
phuric  acid,  all  proving  at  first  beneficial  and  then  losing  their  effect.  Lemon  juice  was  given,  as  the  patient's  stomach  would 
bear  it.  with  evident  benefit  as  an  antiscorbutic.  For  weeks  the  patient  hung  between  life  and  death.  His  whole  thigh  was 
much  swollen  and  very  tender  on  pressure;  the  incisions  were  healthy  in  appearance,  the  discharge  moderate,  and  the  granula 
tions  very  tedious.  Under  a  careful  treatment  he  gradually  grew  stronger,  his  diarrhoea  ceased,  and  the  stump,  though  yet 
greatly  swollen,  became  closed  excepting  at  the  inner  extremity,  where  the  end  of  the  femur  protruded,  the  flaps  from  the  first 
having  been  insufficient.  On  August  9th,  Dr.  Smith  was  ordered  to  remove  the  exfoliating  end  of  the  bone,  which  was  loose, 
and,  to  his  surprise,  proved  to  be  a  very  extensive  sequestrum  ten  inches  in  length.  Considerable  haemorrhage  supervened,  but 
after  the  operation  convalescence  was  very  rapid,  and  the  stump,  no  shorter  than  before,  soon  closed  entirely,  being  firm  and  in 
every  Avay  satisfactory.  A  formation  of  new  bone  could  be  plainly  felt  in  it.  The  patient  regained  his  flesh  and  strength,  and 
left  the  hospital  October  26,  1863,  his  term  of  service  having  expired  May  22d."  The  history,  with  the  sequestrum,  represented 
in  FIG.  1  of  PLATE  LXIX,  opposite  p.  224,  and  the  bones  of  the  amputated  knee,  were  contributed  to  the  Museum  by  Assistant 
Surgeon  W.  Thomson,  U.  S.  A.,  in  charge  of  Douglas  Hospital.  A  ligamentous  preparation  of  the  latter  specimen  constitutes 
No.  1852  of  the  Surgical  Section.  The  patient  was  subsequently  an  inmate  of  the  Post  Hospital  at  Albany,  and  afterwards 
entered  Central  Park  Hospital,  New  York  City,  to  be  fitted  with  an  artificial  limb  by  Dr.  E.  D.  Hudson.  He  left  for  his  home 
June  6,  1864.  His  pension  was  paid  June  4,  1879.  (See  wood-cut  64,  p.  63,  Circular  6,  S.  G.  O.,  Washington,  Nov.  1,  1865.) 

CASE  466. — Private  J.  Nash,  Co.  G,  143d  Pennsylvania,  aged  21  years,  was  wounded  at  North  Anna,  May  22,  1864. 
He  was  admitted  to  the  field  hospital  of  the  4th  division,  Fifth  Corps,  where  Surgeon  C.  W.  Chamberlain,  U.  S.  V.,  recorded: 
"Severe  shot  wound  of  right  knee  joint  by  musket  ball."  From  the  field  hospital  the  wounded  man  was  conveyed  to  Port 
Royal,  and  thence  by  steamer  to  Washington.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  reported  that  "  the  patient  entered  Armory  Square 
Hospital  May  29th,  having  undergone  circular  amputation  of  wounded  limb  at  the  lower  third  of  the  thigh  the  day  previous  to 
his  admission,  while  on  board  of  the  hospital  transport."  On  July  22d,  the  patient  left  for  his  home  on  furlough,  whence  he 
returned  several  months  afterwards,  and  subsequently  he  was  transferred  to  Judiciary  Square  Hospital.  Surgeon  E.  Griswold, 
U.  S.  V.,  in  charge  of  the  latter,  reported  that  the  presence  of  necrosed  bone  in  the  stump  having  been  indicated  by  suppuration, 
a  tubular  sequestrum,  eight  and  three-fourths  inches  long,  was  removed  on  April  9,  1865,  by  Acting  Assistant  Surgeon  F.  H. 
Hill.  On  June  22,  1865,  the  patient  was  discharged  from  service  and  pensioned,  having  been  previously  supplied  with  an 
artificial  limb  by  the  Jewett  Patent  Leg  Company  of  Washington,  D.  C.  His  pension  was  paid  March  4, 1879.  The  sequestrum 
(Cat,  Sim,.  Sect.,  1866,  p.  308,  Spec.  144)  is  shown  in  FIG.  2  of  PLATE  LXIX,  opposite  p.  224. 

Eight  of  the  patients  who  recovered  after  intermediary  amputation  in  the  lower  third 
have  died  since  the  close  of  the  war.  In  the  following  instances  the  pensioners  survived 
the  operation  three  and  nine  years  respectively: 

CASE  467.— Private  J.  Glassie,  Co.  B,  63d  New  York,  aged  22  years,  was  wounded  at  Cold  Harbor,  June  3,  1864,  and 
admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps.  Surgeon  W.  S.  Cooper,  125th  New  York,  noted :  "  Shot  wound 
of  left  leg;  amputation  at  lower  third  by  Surgeon  P.  E.  Hubon,  28th  Massachusetts."  One  week  after  the  reception  of  the  injury 
the  man  was  admitted  to  Emory  Hospital,  Washington,  where  Surgeon  N.  R.  Moseley,  U.  S.  V.,  recorded  that  the  limb  was 


SECT.  III.] 


INTEEMEDIAEY    AMPUTATIONS    OF    THE    THIGH. 


289 


FIG.  195. — Appearance  of  thigh  stump  after 
lateral  flap  operation.     [From  a  photograph.] 


re-amputated  above  the  knee  on  June  20th,  also  that  abscesses  formed  subsequently,  and  that  the  stump  of  the  femur  became 
hypertrophied.  On  March  10,  1865,  the  patient  was  transferred  to  Central  Park  Hospital,  New  York  City,  whence  Surgeon  B. 
A.  Clements,  U.  S.  A.,  reported  the  following:  ''When  admitted,  the  end  of  the  stump  was  red  and  inflamed,  and  there  were 
three  sinuses  leading  to  necrosed  bone.  On  March  19th,  chloroform  was  administered,  and  a  sequestrum  about  eight  inches 
long  was  removed  by  Acting  Assistant  Surgeon  S.  Teats.  The  patient  did  well  after  the  operation.  By  July  15th,  the  stump 
had  entirely  healed,  and  one  month  later  he  was  discharged  from  service."  The  man  subsequently  became  a  pensioner.  He 
died  at  Brooklyn,  New  York,  November  12,  1867.  The  removed  fragment  was  contributed  to  the  Museum  by  the  operator,  and 
constitutes  Specimen  3100  of  the  Surgical  Section.  A  representation  of  it  appears  in  FlG.  3  of  PLATE  LXIX,  opposite  p.  224. 

CASE  468. — Private  Alexander  McConkey,  Co.  D.  63d  Pennsylvania,  aged  48 
years,  was  wounded  at  the  Wilderness,  May  5,  1864,  by  a  conoidal  ball,  which  entered 
on  the  inner  condyle  of  the  left  knee,  passed  through  the  joint,  and  made  its  exit 
on  the  opposite  side.  He  was  conveyed  to  Washington,  and  admitted  into  the  Hare- 
wood  Hospital  on  May  14th.  Surgeon  E.  B.  Bontecou,  U.  S.  V.,  furnishes  the  follow 
ing  notes  of  the  case :  "An  examination  of  the  injury  was  immediately  made;  the  soft 
parts  around  the  wound  were  found  much  inflamed  and  the  joint  cedematous.  His 
general  condition  being  good,  it  was  decided  to  amputate  without  delay,  and  the  patient 
being  chloroformed,  Surgeon  Bontecou  removed  the  thigh  in  the  lower  third  by  the 
lateral  flap  operation.  The  stump  healed  favorably,  the  ligatures  came  away  on  the 
eighth  day,  and  the  patient  progressed  well  on  a  supporting  diet  until,  July  29th,  he 
had  so  far  recovered  as  to  be  about  on  crutches,  when  he  accidentally  fell,  injuring  the 
stump,  which  became  inflamed;  alcohol  and  water  dressings  were  applied.  On  August 
4th,  an  abscess  was  opened,  which  discharged  about  four  ounces  of  pus.  5th,  he  had 
a  severe  attack  of  diarrhoea,  which  was  checked  by  proper  treatment.  30th,  condition 
very  good;  a  small  sinus  still  exists,  owing  to  some  necrosed  bone."  He  was  trans 
ferred  to  Pittsburg,  April  3,  1865,  and  admitted  into  hospital  there.  The  wound  had 
entirely  healed,  and  he  was  discharged  May  19,  1865.  He  was  pensioned,  and  died 
May  15,  1873;  the  cause  of  death  is  not  satisfactorily  given.  The  pathological  speci 
men,  showing  the  bones  of  the  left  knee,  with  the  articular  extremity  of  the  femur 
shattered  (No.  3066,  Sect.  I,  A.  M.  M.,  Cat.,  1866,  p.  338),  was  contributed  by  the 
operator,  who  also  furnished  a  photograph  of  the  stump,  which  is  copied  in  the  adjoin 
ing  wood-cut,  FIG.  195. 

Fatal  Cases  of  Intermediary  Amputation  in  the  Lower  Third  of  the  Femur. — This 
group  comprises  four  hundred  and  fifty-nine  operations  performed  on  four  hundred  and  fifty- 
seven  patients,  in  two  instances  intermediary  amputations  in  the  lower  thirds  of  both 
thighs  having  been  performed: 

CASE  469. — Private  W.  Sailor,  Co.  E,  119th  Pennsylvania,  aged  40  years,  was  wounded  in  the  left  leg  by  a  conical  bullet, 
at  Kappahannock  Station,  November  7,  1863.  Two  days -afterwards  he  was  admitted  to  Stan  ton  Hospital,  Washington,  whence 
Surgeon  J.  A.  Lidell,  U.  S.  V.,  made  the  following  report:  "On  examination,  it  was  found  that  the  injured  leg  was  much 
swollen  and  dark  colored  on  its  anterior  surface,  that  there  was  no  pulsation  in  the  anterior  tibial  artery,  and  that  both  the  tibia 
and  fibula  were  extensively  comminuted,  with  much  laceration  of  the  soft  parts.  His  pulse  was  frequent  and  irritable,  and  he 
had  a  good  deal  of  constitutional  disturbance  and  fever  of  an  irritative  type.  On  November  14th,  the  fever  had  abated,  and  the 
general  condition  much  improved;  pulse  fuller  and  less  irritable;  appetite  better;  wound  suppurating;  discharge  thin,  dark 
colored,  and  offensive ;  leg  not  improved.  There  being  manifestly  no  hope  of  saving,  it,  the  bones  being  broken  and  the  soft 
parts  inflamed  nearly  up  to  the  knee  joint,  and  comminution  very  extensive,  the  limb  was  amputated  in  the  lower  third  of  the 
thigh.  The  operation  was  performed  by  the  circular  method  by  Assistant  Surgeon  G.  A.  Mursick,  U.  S.  V.,  under  sulphuric 
ether.  A  dissection  of  the  amputated  limb  showed  that  the  bones  were  extensively  comminuted  as  high  up  as  the  head  of  the 
fibula.  The  anterior  tibial  artery  was  found  to  be  divided  by  the  bullet  a  little  below  where  it  passes  through  the  interosseous 
membrane,  the  ends  being  separated  from  each  other  about  one  inch  and  retracted  within  the  sheath,  also  closely  contracted. 
The  cardiac  end  was  plugged  up  by  a  firm  coagulum  about  an  inch  in  length.  The  distal  end  was  also  plugged  up  by  a  small 
coagulum.  The  anterior  tibial  muscles  were  pale  yellow  in  color,  soft  and  greasy  to  the  touch  (fatty  degeneration).  The  patient 
bore  the  operation  well.  The  stump  was  dressed  with  lead  sutures  and  adhesive  plaster,  and  a  full  dose  of  morphine  was 
administered.  He  had  a  good  night's  rest  after  the  operation,  and,  on  the  following  day,  expressed  a  desire  for  food,  his  pulse 
being  full,  frequent,  and  quick  ;  bowels  confined,  for  which  a  dose  of  rochelle  salts  was  ordered.  On  November  17th,  suppura 
tion  commenced,  but  little  of  the  stump  being  united  by  adhesion ;  general  condition  good.  Prescribed  moderate  stimulation, 
with  whiskey.  18th,  edge  of  posterior  flap  looked  sloughy;  ordered  diluted  Labarraque's  solution  to  the  stump,  and  twenty 
drops  of  muriated  tincture  of  iron  every  six  hours  internally.  20th,  had  a  chill  in  the  morning,  followed  by  fever  and  sweat; 
skin  sallow  looking;  granulations  in  stump  looking  well,  except  on  the  posterior  flap,  a  small  portion  of  which  was  sloughing. 
Ordered  five  grains  of  quinine  every  six  hours,  twenty  drops  of  muriated  tincture  of  iron  every  four  hours,  and  one  ounce  of 
whiskey  every  three  hours.  21st,  had  a  chill  in  the  afternoon;  sallow  appearance  of  skin  deepened ;  pulse  irritable;  slight  sub- 
sultus;  bowels  not  moved  for  two  days.  Ordered  ten  grains  of  aloes  and  twenty  grains  of  rhubarb  to  be  given  at  once,  and 
continued  other  treatment.  22d,  had  chills  again  in  the  afternoon,  Avith  slight  delirium.  Ordered  one-twelfth  of  a  grain  of  cor 
rosive  sublimate,  with  three  grains  of  iodide  of  potassa,  every  four  hours,  and  continued  the  whiskey.  23d,  patient  vomited  in 
the  morning,  had  also  a  good  deal  of  fever.  Applied  sinapism  to  epigastrium.  24th,  rigors,  etc.,  in  the  morning;  treatment 
SURG.  Ill— 37 


590  INJUKIES    OF    THE    LOWEK    EXTREMITIES.  [CHAP.  X. 

continued.  25th,  rigors,  fever,  and  delirium;  skin  very  yellow.  28th,  rigors,  etc.;  urine  passed  involuntary;  bedsores  on 
sacrum.  Ordered  a  water  bed.  Patient  died,  exhausted,  on  December  1,  1863,  the  seventeenth  day  after  the  amputation  and 
the  eleventh  day  after  the  advent  of  the  purulent  infection.  Autopsy  twelve  hours  after  death:  Rigor  mortis  well  marked;  skin 
yellow;  some  emaciation;  stump  swollen  and  cedematous;  femoral  artery  well  plugged  up  in  stump;  end  of  femoral  vein  well 
sealed  up  in  stump;  femoral  vein  empty  and  collapsed  from  the  end  up  to  the  valve  at  the  first  anastomosing  branch,  a  distance 
of  about  six  inches;  the  vein  in  this  situation  about  as  large  as  the  artery;  the  walls  of  the  vein  also  much  thickened,  being 
about  as  thick  as  those  of  the  artery;  the  lining  membrane  looking  velvety,  wrinkled,  and  dirty  gray  in  color;  no  pus  in  vein. 
From  the  valve  above  mentioned  up  to  the  mouth  of  the  vena  profunda,  a  distance  of  about  two  and  a  half  inches,  the  femoral 
vein  was  filled  to  distension  with  fetid  broken  down  liquefied  blood,  its  lining  membrane  dirty  gray  colored  in  this  situation,  and 
its  walls  somewhat  thicker  than  natural ;  no  pus  revealed  in  this  locality  by  the  microscope.  At  the  mouth  of  the  vena  profunda 
the  femoral  vein  was  plugged  up  with  yellowish  white  fibrine ;  vena  profunda  and  many  of  its  branches  filled  and  knotted  with 
recent  coagulum ;  femoral  vein  also  filled  with  recent  coagulum  above  the  mouth  of  the  profunda  to  a  distance  of  about  two  and 
a  half  inches;  the  lining  membrane  of  the  profunda  and  part  of  the  femoral  vein  last  mentioned  stained  dark  red,  and  the  walls 
of  the  vessels  somewhat  thickened  in  same  locality.  A  thin  dark  colored  recent  coagulum,  not  filling  the  calibre  of  the  vein, 
extended  the  whole  length  of  the  external  iliac.  The  end  of  the  femur  in  the  stump  (FiG.  2,  PLATE  XLIII,  opposite)  was 
necrosed  to  the  extent  of  nearly  half  an  inch,  and  here  the  periosteum  was  thickened,  varying  from  a  line  to  one-third  of  an 
inch,  detached  and  gangrenous;  underlying  bone  white  in  color;  medullary  membrane  at  end  of  bone  gangrenous  and  dirty 
grayish  green  in  color  to  the  depth  of  about  one-third  of  an  inch;  medullary  membrane  elsewhere  more  vascular  tfian  natural, 
which  was  well  shown  by  splitting  the  bone  lengthwise  with  a  saw  (FiG.  1  of  PLATE  XLIII,  opposite).  Three  or  four  small 
superficial  abscesses  were  formed  about  the  right  extremity  of  the  spleen;  the  rest  of  that  organ  was  contracted  and  indurated. 
Five  or  six  small  superficial  abscesses  were  discovered  in  the  lungs,  the  pulmonary  tissue  surrounding  each  of  them  being  con 
solidated  by  inflammatory  action.  The  other  organs  were  natural,  and  the  blood  did  not  exhibit  any  abnormity."  The  femoral 
artery  (Spec.  1887)  and  the  femoral  vein  (Spec.  1888),  together  with  three  inches  of  bone  from  the  stump  (Spec.  1890),  and  the 
section  of  the  spleen  containing  the  metastatic  abscesses  (Spec.  1889,  shown  in  FiG.  3,  PLATE  XLIII,  opposite),  were  contributed 
to  the  Museum  by  Dr.  Lidell. 

In  the  following  instance  a  shot  injury  of  the  inner  condyle  of  the  right  femur  was 
followed  by  severe  secondary  arthritis,  which  necessitated  amputation.  The  autopsy 
revealed  suppurative  osteo-myelitis : 

CASE  470. — Private  J.  N.  Saxon,1  Co.  D,  9th  Louisiana,  aged  27  years,  was  wounded  in  the  right  knee,  at  Rappahannock 
Station,  November  7,  1863,  and  suffered  amputation  at  the  Stanton  Hospital,  Washington.  Surgeon  J.  A.  Lidell,  U.  S.  V.,  who 
performed  the  operation,  described  the  case  as  follows:  "A  conical  bullet  entered  the  knee  about  three  inches  above  the  patella, 
on  a  line  with  its  inner  margin,  passed  backward,  dowmvard,  and  a  little  inward,  and  escaped  at  the  inner  posterior  side,  about 
six  inches  below  the  joint.  The  inner  condyle  of  the  femur  was  fractured  by  the  missile  passing  through  it,  but  without  opening 
the  cavity  of  the  joint.  The  patient  stated  that  his  knee  was  bent  at  the  time  of  the  infliction  of  the  wound.  He  was  admitted 
two  days  after  the  injury  and  did  well,  having  good  spirits,  good  appetite,  and  but  little  pain  or  swelling  of  the  parts  until  the 
night  of  November  16th,  when  he  had  a  severe  chill,  accompanied  with  great  pain  in  and  about  the  knee,  and  the  injured  parts 
became  hot  and  swollen.  On  the  following  morning  he-exhibited  great  constitutional  disturbances:  skin  hot;  tongue  coated 
white;  pulse  very  rapid,  gaseous,  and  weak.  The  injured  knee  was  much  swollen  and  exquisitely  tender,  and  he  complained  of 
intense  pain  in  it ;  the  anterior  orifice  of  the  wound  presented  a  gelatinous  appearance,  with  elevated  and  everted  edges.  The 
patient  appeared  so  feeble  that  I  thought  he  would  not  then  bear  the  shock  of  an  amputation,  and  ordered  him  to  take  whiskey 
freely  with  anodynes.  The  next  day,  November  18th,  his  general  condition  appeared  unchanged  with  the  exception  of  his  pulse, 
which  was  stronger  and  not  gaseous,  being  120  by  the  watch.  He  had  not  slept  during  the  night,  and  complained  of  great  pain 
in  the  knee,  which  was  rather  more  swelled,  and  the  tumefaction  was  extending  up  the  thigh.  The  wound  presented  the  same 
gelatinous  appearance  as  the  day  before,  and  the  skin  over  the  saphenous  veins  looked  purple  colored,  but  the  veins  did  not 
exhibit  any  induration.  The  thigh  was  amputated  at  the  lower  third,  by  the  flap  method,  at  1  P.  M.,  about  thirty-six  hours 
subsequent  to  the  accession  of  the  secondary  arthritis.  The  patient  was  under  sulphuric  ether  and  bore  the  operation  well. 
Examination  of  the  amputated  member  showed  the  inner  condyle  of  the  femur  to  be  extensively  comminuted.  There  was  a 
layer  of  yellowish  gray  colored  plastic  exudation  on  the  articulating  surfaces  of  the  fragments  in  the  joint,  and  the  cavity  of  the 
joint  contained  about  three  ounces  of  reddish  brown  colored  liquid,  in  which  shining  globules  floated  resembling  oil  in  appear 
ance.  The  synovial  membrane  was  reddened,  especially  the  pouches  of  it  in  relation  with  the  quadriceps  extensor  cruris.  The 
subcutaneous  areolar  tissue  was  infiltrated  with  a  yellowish  serum.  The  bullet  was  ascertained  to  have  passed  behind  the  joint. 
On  the  day  following  the  operation  the  patient's  tongue  was  coated  and  his  appetite  poor;  he  had  also  moderate  diarrhoea,  the 
evacuations  being  very  offensive.  Five  grains  of  blue  mass  was  given  at  night,  and  free  stimulation  with  whiskey.  On  the 
20th,  the  patient  was  comfortable  and  the  stump  looked  well.  The  diarrhoea  was  unchanged,  but  during  the  following  several 
days  it  gradually  abated  and  the  patient  progressed  well  in  every  respect.  28th,  patient  cheerful;  tongue  clean;  appetite  good; 
bowels  regular;  stump  but  little  swollen;  granulations  healthy;  suppuration  moderate  in  quantity  and  laudable  in  quality. 
30th,  patient  appeared  to  be  doing  well,  but  complained  a  good  deal  of  pain  in  and  about  the  stump.  December  1st,  patient 
restless  and  complaining  of  increased  pain  in  the  stump,  especially  about  the  end  of  the  bone  ;  no  preternatural  swelling,  redness 
or  heat  in  the  stump.  Prescribed  one-fourth  of  a  grain  of  sulphate  of  morphia  and  one  drachm  of  Hoffman's  anodyne  every 
four  hours.  2d,  patient  more  restless,  appearing  much  agitated  and  very  nervous,  having  slept  but  little,  and  complaining  of 
agonizing  pain  about  end  of  bone  and  end  of  femoral  artery.  There  were  exacerbations  in  the  pain  and  sometimes  the  whole 
stump  ached,  but  there  was  no  febrile  excitement  and  nothing  untoward  in  the  appearance  or  feel  of  the  stump ;  neither  was  it 

1  LIDELL  (J.  A.),  in  Surgical  Memoirs,     *    *    by  the  United  States  Sanitary  Commission,  New  York,  1870,  Vol.  I,  p.  358,  gives  a  detailed  account 
of  this  case, 


Kip.  2. 


Fig.  3. 


PLATE   XL!II_  RESULT  OF   CSTEOMYEL!  i  IS 


SECT.  m.J  INTERMEDIARY    AMPUTATIONS    OF    THE    THIGH.  291 

swelled,  red,  or  hot.  3d,  patient  had  a  bad  night,  and  complained  much  of  sickening  pain  in  end  of  stump  and  in  bowels. 
About  7  A.  M.  the  ligature  separated  and  a  most  profuse  haemorrhage  occurred,  the  blood  pouring  out  in  a  stream  as  lar^e  as  the 
calibre  of  the  artery.  It  was  finally  stopped  by  digital  compression,  but,  in  the  meantime,  he  had  lost  more  than  six  pounds  of 
blood,  which  brought  him  very  low.  He  was  stimulated  as  freely  as  possible  with  whiskey  and  carbonate  of  ammonia,  but  did 
not  rally,  and  died  about  3  P.  M.  Autopsy  twenty-three  hours  after  death  :  Surface  of  body  very  pale  and  waxy  (exsanguinated); 
rigor  mortis  strong ;  superficial  lymphatic  ganglia  lying  along  the  vena  saphena  magna  of  amputated  thigh  all  enlarged  and 
exhibiting  a  faint  reddish  hue  on  section;  deep  ganglia  riot  affected;  stump  not  cedematous  and  no  part  sloughy;  stump  healed 
throughout  except  in  the  track  of  the  ligatures  and  at  the  end  of  the  bone.  The  femoral  ligature  had  come  away  and  the  end 
of  the  vessel  was  patulous,  uncontracted,  and  unobstructed.  The  c  ats  of  the  artery  were  infiltrated  with  blood  (recent)  at  its 
end  and  for  about  half  an  inch  above  it.  A  branch  of  considerable  sine  was  given  off  from  the  artery  about  three-fourths  of  an 
inch  above  its  end,  which  had  apparently  interfered  with  the  formation  of  a  suitable  clot  for  the  permanent  plugging  up  of  the 
vessel ;  there  had  been  but  little  effort  towards  occlusion.  No  other  abnormity  existed  in  the  artery.  The  end  of  the  femoral 
vein  was  well  sealed  up,  the  vein  itself  diminished  in  size  up  to  the  nearest  valve,  a  distance  of  about  an  inch,  and  its  walls 
thickened  in  same  locality  so  as  to  equal  those  of  the  femoral  artei-y;  lining  membrane  not  stained  with  blood;  no  emboli  and 
no  thrombi  found  anywhere,  and  no  vein  presenting  any  abnormity,  the  vena  profunda  not  being  overlooked.  A  remarkable 
osteophyte  was  found  in  relation  with  the  femoral  artery  and  vein  at  their  respective  ends  in  the  stump.  It  was  developed  from 
(connected  with)  the  linea  aspera,  a  little  above  the  end  of  the  femur,  and  thence  passed  horizontally  inward,  separating  or  fork 
ing  into  distinct  plates,  toward  the  ends  of  which  the  one  laid  in  front  of  and  was  closely  adherent  to  that  side  of  the  artery 
at  and  near  its  end ;  the  other  laid  behind  and  was  adherent  to  the  vein  at  and  near  its  end.  This  osteophyte  was  about  seven- 
eighths  of  an  inch  wide  where  broadest,  and  about  one-fourth  of  an  inch  thick.  It  was  of  recent  formation.  The  lower  part 
of  the  femur  in  the  stump  was  moderately  enlarged  by  deposit  (laminated)  of  new  bone  beneath  the  periosteum  (hyper-nutrition); 
this  membrane  was  detached  for  about  one-fourth  of  an  inch  above  the  line  of  the  saw  all  the  way  round  the  bone,  which  pre 
sented  a  dull  white  color  in  that  locality.  The  medullary  membrane  was  noticed  to  bulge  out  a  good  deal  at  the  end  of  the  bone 
and  to  present  a  dark  red  or  reddish  brown  color.  It  was  also  strong  and  tough  (flesh  like).  On  sawing  through  the  lower 
part  of  the  femur  lengthwise  and  cleaning  off  the  bone  dust  the  medullary  membrane  was  seen  to  be  more  vascular  than  natural ; 
the  medullary  tissue  exhibited  about  a  dozen  small  milk-colored  abscesses  on  the  surface  of  the  section,  showing  pus  under  the 
microscope,  and  varying  in  size  from  that  of  a  split  pea  to  a  mustard  seed.  The  osseous  tissue  outside  of  the  medullary  canal 
was  more  compact  and  heavier  than  natural  in  the  same  locality.  The  periosteum  was  thickened  to  the  extent  of  from  one  to 
three  lines  and  more  vascular  than  natural,  the  thickening  being  greatest  where  it  had  been  detached  from  the  bone.  There  was 
also  a  small  abscess,  flattened  in  shape,  and  holding  about  an  ounce  of  cream-like  pus,  in  the  quadriceps  extensor  cruris  muscle, 
and  the  red  muscular  tissue  in  immediate  relation  with  it  was  changed  to  a  dark  brown  color,  which,  however,  did  not  extend  to 
any  depth.  The  spleen  was  enlarged,  and  the  other  organs  all  exsanguinated  but  presenting  no  other  abnormity."  The  bones 
of  the  knee  of  the  amputated  limb  (Spec.  1819),  the  femoral  vein  and  artery  (Spec.  1892),  with  portion  of  the  osteophyte  attached, 
and  a  longitudinal  half  section  of  the  lower  end  of  the  stump  of  the  femur  (Spec.  1860,  shown  in  FIG.  4  of  PLATE  XLIII, 
opposite  p.  290)  four  and  one-fourth  inches  long,  were  contributed  to  the  Museum  by  the  operator. 

Gangrene  of  the  thigh  stump  was  reported  in  forty-seven  instances,  and,  in  the  follow 
ing  instance,  tetanus,  which  appeared  on  the  tenth  day  after  the  amputation,  hastened 
the  fatal  issue: 

CASE  471. — Captain  IV.  E.  Davis,  Co.  B,  30th  North  Carolina,  aged  25  years,  was  wounded  in  the  skirmish  at  Kelly's 
Ford,  Virginia,  November  7,  18G3.  He  was  conveyed  to  the  hospital  of  the  Third  Corps,  and,  November  10th,  was  transferred 
to  Washington  and  admitted  into  Douglas  Hospital.  Acting  Assistant  Surgeon  Carlos  Carvallo  reported  that  the  ball  entered  the 
anterior  external  aspect  of  the  right  leg  about  two  and  a  half  inches  below  the  inferior  edge  of  the  patella,  one  and  a  half  inches 
external  to  the  median  line  of  the  leg,  and  one  and  a  quarter  inches  below  the  head  of  the  fibula,  where  it  fractured  the  bone,  and 
descending  downward,  inward,  and  backward,  emerged  in  the  posterior  internal  aspect  of  the  leg,  midway  between  the  inferior 
edge  of  the  patella  and  the  internal  malleolus,  internal  to  the  bulk  of  the  gastrocnemius  muscle.  The  right  foot  was  cold,  of  a 
purple  hue,  and  entirely  senseless;  the  leg,  from  knee  to  upper  portion  of  lower  third,  was  swollen  and  emphysematous,  and  the 
middle  third  was  of  a  yellow  and  dark  green,  intermixed  with  a  brown-purple  hue.  Diagnosis:  Gangrene  of  the  foot  and  leg 
from  gunshot  wound  of  leg,  with,  most  probably,  injury  and  obliteration  of  the  main  arteries.  Amputation  was  the  sole  treat 
ment  indicated,  the  foot  and  lower  portion  of  the  leg  being  completely  mortified.  Assistant  Surgeon  W.  Thomson  amputated  the 
thigh  at  the  lower  third  by  the  circular  method.  The  femoral  was  secured  by  digital  compression  and  the  tourniquet.  Very 
little  arterial  blood  was  lost.  A  grain  of  morphia  was  administered  in  a  half  ounce  of  whiskey  immediately  after  the  operation, 
he  having  readily  revived  from  the  ether  narcosis,  and  he  stated  that  he  had  slept  undisturbed  during  the  operation,  without 
dreaming,  and  was  now  entirely  free  of  pain.  The  cut  surface  of  the  stump  showed  the  tissues  infiltrated  and  of  an  unhealthy 
appearance.  Stimulants  were  administered.  The  stump  was  dressed  with  dry  charpie.  At  night  the  pulse  was  130,  tongue 
moist,  skin  dry.  The  stump  was  boggy  and  crepitant  to  pressure,  and  a  dark  discoloration  was  visible  on  the  external  aspect 
extending  to  the  tensor  fascia  lata.  November  12th,  towards  evening  a  line  of  demarcation  was  visible  of  a  large  slough  in 
external  side  of  skin  flap,  no  discharge  from  stump;  tension  of  the  skin  caused  by  three  sutures,  which  were  removed,  followed 
by  gaping  of  the  flap.  About  9  P.  M.,  the  pulse  became  frequent  (145),  and  there  was  great  paleness  of  the  conjunctiva  and 
skin.  The  extensive  sloughing,  weak  pulse,  and  anagmic  appearance  presented  a  hopeless  prognosis.  Late  in  the  evening,  a 
strong  solution  of  bromine  was  directly  applied  to  the  surface  of  the  stump  by  means  of  charpie.  The  application  was  at  first 
painless,  but,  after  penetrating  the  mortified  tissues  and  coming  in  contact  with  sensitive  parts,  it  caused  such  pain  that  the 
patient  was  fortified  during  the  operation  by  a  half  ounce  of  sherry  wine  in  powdered  ice  and  one-half  grain  morphia.  13th, 
Dr.  Holly  touched  the  line  of  demarcation  (which  was  very  well  marked,  and  extended  to  the  whole  circumference  of  the  stump) 
with  pure  bromine,  by  means  of  a  flattened  stick,  in  order  to  facilitate  and  hasten  the  efforts  of  nature.  He  also  applied  Dr. 


292  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

Thomson's  solution  of  bromine  (composed  of  one  drachm  of  pure  bromine,  three  drachms  of  bromide  of  potassium,  and  three 
ounces  of  water),  by  means  of  a  glass  pipette,  to  all  the  sinuses  beneath  the  mortified  integuments  and  the  sinuses  near  the 
arteries;  besides  this  application,  after  carefully  washing  the  stump  with  "blue  wash"  (solution  of  permanganate  of  potassa), 
and  protecting  the  integuments  outside  with  castor  oil  and  the  surface  of  the  stump  with  a  thin  muslin  rag,  the  vapor  of  bromine 
was  administered  by  pouring  an  ounce  of  solution  of  bromine  on  charpie;  this  was  applied  to  the  face  of  the  stump  and  covered 
with  simple  cerate  spread  on  sheet  lint  and  inclosed  by  oil-cloth  and  a  bandage.  The  application  of  bromine  was  repeated  at 
1  and  7  P.  M.,  and  the  nourishing  food  and  stimulants  continued.  An  injection  of  soap  and  water  caused  the  first  passage  since 
the  date  of  the  injury  and  gave  great  relief.  14th,  the  effects  of  the  bromine  yesterday  had  hermetically  sealed  the  surface  of 
the  stump,  covering  it  with  a  yellowish  gray  matter,  which  was  removed  as  much  as  possible,  a  large  amount  of  mortified  integ 
uments  being  cut  away  and  three  loose  ligatures  removed.  Decubitus  of  gluteal  region,  somewhat  to  right  of  sacral  bone ; 
bedsore  the  size  of  the  palm  of  the  hand,  with  a  yellow  greenish  slough,  which  was  partly  removed  with  the  assistance  of  a 
scissors.  India-rubber  rings  employed,  and  ointment  of  cinchona  bark.  Bromine  was  freely  applied  four  times  during  the  day. 
There  was  an  abundant  discharge  of  thin  unhealthy  pus,  and  the  removal  of  a  great  quantity  of  slough  discovered  a  red  gran 
ulating  surface.  15th,  wound  dressed  with  bromine  at  9  A.  M.  and  4  P.  M.  Doing  very  well ;  slough  removed  in  large  pieces. 
17th.  large  quantity  of  sphacelated  integuments  removed  and  vapor  of  bromine  applied.  The  stump  was  exposed  for  an  hour 
to  a  painter's  view.  18th,  the  decubitus  is  becoming  the  most  painful  and  prominent  feature  of  his  complaint.  For  the  first 
time  he  had  a  free  passage  without  adjuvants;  slept  on  his  belly.  On  the  19th,  he  was  put  on  a  water  bed,  on  which  he  lay 
much  easier.  An  extensive  slough  was  removed  from  the  inferior  portion  of  the  flap,  as  also  from  the  decubitus,  which  discharges 
health v  pus  in  large  quantity;  could  see  an  artery  pulsating.  Bromine  applied  to  bedsore.  Patient  felt  bright,  and  eat  a  hearty 
dinner.  In  the  evening,  he  complained  of  a  little  pain  in  his  throat  resembling  tonsilitis.  20th,  on  examining  the  patient's  throat, 
it  was  found  that  he  could  only  open  his  jaws  enough  to  show  the  tip  of  his  tongue.  Tetanus  diagnosticated.  Nutritious  diet 
and  stimulants  were  given  as  usual.  At  4  P.  M.,  a  laxative  was  administered.  The  decubitus  was  dressed  with  pulverized 
cinchona.  The  stump,  which  had  a  beautiful  red  granulating  surface,  with  one  single  ligature,  was  dressed  at  night  with  castor 
oil.  He  had  had  contractions  and  jerking  of  the  stump  once  in  the  morning,  but  had  not  paid  any  attention  to  it  until  6  P.  M.,  at 
which  time  it  became  more  frequent,  recurring  nearly  every  half  hour;  three  ounces  of  brandy  and  a  half  grain  of  morphia 
were  ordered  at  10  and  12  P.  M.  and  2  and  4  A.  M.  21st,  trismus  well  confirmed.  Contractions  of  glottis  muscles  and  fits  of 
suffocation  after  taking  fluids,  though  administered  in  small  quantities  and  through  a  pipette.  There  was  rigidity  of  the  mas- 
seters  and  sterno-cleido-mastoid  muscles,  and  of  the  muscles  of  the  back  of  the  neck,  which  were  quite  hard.  The  head  inclined 
backward  and  to  the  left  side;  diificulty  of  articulation.  The  difficulty  of  swallowing  increased  and  only  fluid  nourishment  could 
be  taken.  He  gradually  sank,  and  died  November  22,  1863,  of  asthenia.  A.  post-mortem  examination  of  the  stump  was  made 
November  24th.  There  was  a  natural  clot  of  blood  at  the  distal  end  of  the  femoral  artery.  The  neurilemma  of  the  sciatic- 
nerve  appeared  thickened,  and  the  fibres  of  the  nerve  more  gross  and  coarse  than  usual.  The  ends  of  several  nerves  were 
strongly  attached  to  the  external  surface  of  the  stump.  The  body  and  spine  were  not  opened.  A  drawing,  by  Hospital  Steward 
E.  Stauch,  of  the  gangrenous  stump,  is  copied  in  the  chromo-lithograph,  PLATE  XXI,  opposite. 

CASE  472. — Sergeant  D.  A.  Barnett,  Co.  B,  99th  Pennsylvania,  aged  22  years,  was  wounded  at  Kelly's  Ford,  November 
7,  1863.  Surgeon  J.  W.  Lyman,  U.  S.  V.,  recorded  his  admission  to  the  field  hospital  of  the  1st  division,  Third  Corps,  with 
"shot  wound  of  left  knee  joint."  Two  days  after  the  reception  of  the  injury  the  wounded  man  Avas  transferred  to  Douglas 
Hospital,  Washington,  whence  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  reported  the  following  history:  "The  patient  was 
anaemic  when  admitted,  and  stated  that  very  free  haemorrhage  took  place  the  moment  he  was  wounded.  He  was  struck  by  a 
bullet,  which  entered  the  leg  at  the  lower  border  of  the  patella,  and  was  removed  through  an  incision  at  the  median  line  poste 
riorly,  four  inches  above  the  joint.  An  examination  showed  the  probable  obliteration  of  the  main  vessel,  since  there  Avas  no 
circulation  in  the  foot,  which,  with  the  leg  half  way  to  the  knee,  was  cold  and  purple  or  tallow  colored,  and  in  the  early  stages 
of  traumatic  sphacelus.  This,  added  to  the  direct  wound  of  the  knee  joint,  rendered  an  operation  necessary,  which  was  performed 
on  November  10th.  Ether  was  given,  and  the  limb  was  removed  by  Acting  Assistant  Surgeon  P.  R.  Holly,  at  the  lower  third  of 
the  thigh,  by  the  circular  method,  with  a  straight  cut  from  the  wound  of  exit  to  the  point  of  the  circular  incision.  The  opera 
tion  was  well  borne  and  there  was  no  serious  loss  of  blood.  On  examining  the  amputated  leg,  I  found  that  the  ball  had  com 
minuted  the  patella  and  passed  through  the  femur,  entering  at  the  outer  margin  of  the  inner  condyle  and  dividing  the  popliteal 
artery.  The  popliteal  space  contained  a  large  quantity  of  coagulated  blood,  and  the  ends  of  the  vessel  were  surrounded  by  a 
mass  of  pink-colored  and  semi-organized  clot,  sufficiently  firm  to  prevent  haemorrhage.  The  patient's  tongue  was  very  pallid 
and  his  whole  appearance  anaemic.  His  leg  soon  became  swollen  though  perfectly  white,  resembling  a  case  of  phlegmasia  alba 
dolens.  The  skin  was  smooth  and  blanched;  there  was  tenderness  along  the  line  of  the  bone  and  no  vigorous  effort  at  repair, 
the  edges  of  the  incision  being  pale.  The  discharge  consisted  of  dark  colored  ill-looking  pus,  and  the  whole  appearance  of  the 
stump  was  unfavorable;  the  edges  gaped  widely  apart.  On  November  20th,  a  slight  slough  appeared  on  the  posterior  lip  of  the 
stump,  and  two  days  afterwards  the  patient  had  a  severe  chill,  followed  by  profuse  perspiration  in  the  night  and  succeeded  by 
a  light  cough.  During  the  night  of  the  23d  there  was  another  severe  chill,  and  the  next  day  respiration  was  increased  in  fre 
quency  and  accompanied  by  pain  in  the  right  side.  There  was  no  perceptible  dullness  on  percussion,  but  on  auscultation  it  was 
found  that  inspiration  was  deep  and  a  little  labored,  while  the  expiration  over  both  lungs  anteriorly  was  prolonged  almost  as  in 
phthisis.  There  was  no  rale,  but  the  expiratory  sound  seemed  to  indicate  that  the  whole  lung  had  lost  some  of  its  elasticity 
and  returned  upon  itself  after  dilatation  with  apparent  difficulty.  Expectoration  was  slight,  very  tough  and  viscid;  the  pulse 
rapid  and  feeble;  the  skin  relaxed.  The  pulse  became  still  weaker,  and  the  respiration  more  hurried  until  almost  sighing;  the 
nervous  depression  increased.  The  breath  had  the  sweet  sickening  smell  resembling  the  odor  of  fermentation,  which  denotes 
pyaemia.  Death  occurred  at  8  A.  M.  on  November  26, 1863.  The  post-mortem  examination  was  made  six  hours  afterwards.  On 
opening  the  right  pleural  cavity  we  found  the  lung  coated  with  soft  greenish  colored  lymph,  and  there  was  an  effusion  amounting 
to  six  ounces  of  yellow  pus  and  serum,  separating  into  two  strata,  the  upper  serum,  the  lower  pus,  and  having  (under  the  micro 
scope)  the  usual  pus  corpuscles  floating  in  a  fluid  with  an  abundance  of  unrecognizable  debris.  There  seemed  to  be  also  a  thin 


SECT.  III.] 


INTERMEDIARY    AMPUTATIONS    OF    THE    THIGH. 


293 


layer  of  pus  beneath  the  pleura  anteriorly,  giving  that  portion  of  the  lung  a  yellowish  color.  The  upper  lobe  was  apparently 
normal;  the  lower  lobe  posteriorly  was  congested,  dark  in  color,  and,  on  division,  revealed  nodules  of  tissue  of  various  sizes  in 
all  stages  of  pathological  changes  from  acute  congestion  to  thorough  hepatization  and  yellow  softening.  The  diseased  spots  were 
in  dimension  from  the  size  of  half  an  English  walnut  to  that  of  a  split  pea,  the  large  ones  having  in  the  center  a  space  white  or 
yellow  in  color,  and  probably  breaking  down  rapidly.  The  outline  of  these  solidified  portions,  on  section,  suggested  the  idea 
of  embolism,  since  they  were  somewhat  triangular  in  shape,  with  the  base  at  the  pleural  surface  and  the  apex  at  the  deepest 
portion  of  the  lung,  giving  the  impression  that  a  circumscribed  area  of  lung  nourished  by  a  single  vessel  had  been  destroyed  by 
its  occlusion.  There  was  no  recent  effusion  in  the  left  pleural  cavity,  but  changes  in  the  parenchyma  similar  to  those  on  the 
right  side  were  discovered.  An  examination  of  the  vessels  of  the  stump  revealed  the  existence  of  inflammation  of  the  artery 
and  veins.  Both  the  femoral  artery  and  vein  at  the  point  of  their  escape  from  the  pelvis  were  normal.  The  femoral  vein  at  the 
entrance  of  the  saphena  was  filled  with  a  semi-organized  clot,  which  extended  through  the  saphena  and  femoral  to  a  point  two 
inches  from  the  cut  ends  of  these  vessels,  where  they  had  been  divided  on  the  face  of  the  stump.  (See  left-hand  figure  of  PLATE 
XX,  opposite  p.  294.)  These  vessels,  as  will  be  seen,  are  now  hard  and  firm  dark-red  cords,  of  course  entirely  impervious. 
The  artery  from  the  origin  of  the  profunda  to  a  point  two  inches  from  its  cut  termination  was  also  reddened,  and  its  inner  coat 
softened  and  easily  removable.  The  phlebitis,  with  its  occlusion  of  the  main  venous  trunks,  accounted  for  the  swollen  and 
white  condition  of  the  stump,  compared  above  to  the  condition  known  as  phlegmasia  alba  dolens.  In  making  this  dissection  it 
was  observed  that  the  inflammation,  apparent  in  the  artery  and  to  some  extent  circumscribed  (since  its  lower  extremity  yet 
contained  the  clot  formed  on  the  application  of  the  ligature  and  was  normal  both  in  color  and  firmness,  as  well  as  that  which 
occluded  the  veins),  had  extended  through  the  coats  of  these  vessels  from  without.  No  pus  was  found  in  the  veins,  and  no 
evidence  of  inflammation  except  the  marked  redness  of  the  coats  and  the  firm  and  clotted  coagulation  of  the  blood  within." 
Wet  preparations  of  the  femoral  and  profunda  arteries  (Spec.  2246),  the  femoral  and  saphena  veins  (Spec.  3991),  and  the  pop 
liteal  artery  and  vein  (Spec.  2247),  saved  from  the  stump,  were  contributed  to  the  Museum  by  Assistant  Surgeon  Thomson. 
Drawings  of  the  specimens  3991  and  2246  were  prepared  by  Hospital  Steward  Stauch,  and  are  represented,  the  former  on  the 
left  and  the  latter  on  the  right  side  of  PLATE  XX,  opposite  p.  294. 

CASE  473. — Corporal  L.  C.  Griffin,  Co.  D,  8th  North  Carolina,  was  wounded  in  the  left  knee  by  a  piece  of  shell,  at 
Winchester,  July  19,  1864.  He  was  conveyed  to  hospital  at  Richmond,  where  the  limb  was  amputated  at  the  lower  third  of  the 
femur  by  Dr.  Joseph  Jones.  The  patient  died  in  February,  1865.  The  specimen,  a  portion  of  the  stump  four  and  a  half  inches 
long,  was  contributed  to  the  Museum  by  Acting  Assistant  Surgeon  F.  Schafhirt.  It  constitutes  number  3141  of  the  Surgical 
Section,  and  exhibits  a  prodigious  involucrum.  The  bone  is  exceedingly  hyperostosed,  measuring  three  and  a  half  inches  in 
diameter  at  the  extremity.  The  extremity  and  central  portions  are  carious,  and  a  slight  sequestrum  is  contained.  A  representa 
tion  of  the  specimen  will  be  found  in  FIG.  4  of  PLATE  LXX,  opposite  p.  242. 

TABLE  XXXVI. 

Summary  of  Six  Hundred  and  Seventy-six  Cases  of  Intermediary  Amputations  in  the  Lower  Third 

of  the  Femur  for  Shot  Fracture. 

[  Recoveries,  1—217 ;  Deaths,  218—676.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Anderson,  J.,  Serg't,  I, 

July  3, 

Left;  ant.  post,  flap;  slough.;  nee. 

13 

Boebel,  H.,  Lieut.-Col., 

July  1, 

Right.     Disch'd  May  28,  1864. 

54th  New  York,  age  32. 

8,  '63. 

Aug.  2,  flap,  mid.  third.     Surg. 

26th  Wisconsin. 

4,  '63. 

C.W.  Hagen,  54th  N.Y.    Haem.; 

14 

Bonhomme,  E.,  Pt.,  E, 

April  10, 

Left  (April  10,  amp.leg.;  slough.); 

necro.  bone  removed.     Disch'd 

73d  Col'd  Troops,  age 

24,  '65. 

circ.     Surg.  F.  E.  Piquette,  86th 

Aug.  25,  1864.     Spec.  4358. 

27. 

C.  T.     Disch'd  June  17,  1865. 

o 

Askey,  J.,  Pt.,  F,  200th 

Mar.  25, 

Right  ;  circ.    Surg.  W.  G.  Hunter, 

Died  June  3,  1867  ;  marasmus. 

Pennsylvania,  age  18. 

28,  '65. 

211th  Penn.     April   11,  hsem.; 

15 

Bosworth,  C.  W.,  Pt.,  I, 

May  19, 

Left;   flap.     Surg.  D.  W.  Bliss, 

lig.  fern.  art.     Disch'd  July  28, 

1st  Maine  H'vy  Art., 

24,'  '64. 

U.  S.V.    Nee.  Disch'd  April  10, 

1865.     Spec.  3987. 

age  23. 

1865.  Jan.  9,'68,  flap,  mid.  third. 

3 

Austin,  G.  II.,   Pt.,    D, 

April  29, 

Left  (erysipelas).   A.  A.  Surg.  R. 

16 

Brown,  J.  T.,  Corp'l,  C, 

June  27, 

Left  (gang.);  circ.   A.  Surg.C.W. 

106th  New  York. 

May  22, 

W.  Hazlett.    Hsem.;  lig.  femoral 

10th  Illinois,  age  21. 

J'y2,  '64. 

Burke,  46th  Penn.     Gangrene; 

1863. 

art.;  rec'd.    Disch'd  Aug.  23,  '63. 

end  of  bone  rem'd.     Mustered 

4 

Bassett,  W.,  Pt.,  E,  4th 

June  27, 

Right  ;  flap.     Disch'd  January  7, 

out  August  31,  1864. 

New  Jersey,  age  20. 

J'yl,  '62. 

1863. 

17 

Buehler,  J.,  Pt.,  C,  41st 

May  2, 

Right  thigh  ;  circular  operation. 

5 

Bathurst,  J.  B.,  Pt.,  D, 

June  4, 

Left  ;  circ.     A.  A.  Surg.  J.  C.  Nel 

New  York. 

8,  '63. 

Disch'd  Nov.  28,1864. 

45th  Penn.,  age  19. 

16,  '64. 

son.    June  28,  nee.  bone  rem'd. 

18 

Buhner.  B.,  Pt.,  A,  71st 

Sept.  17, 

Right.    Discharged  Dec.  12,  '62. 

Disch'd  Nov.  20.  '65.  Spec.  2584. 

Pennsylvania. 

2(1,  '62. 

6 

Bailors,  P.,  Musician,  D, 

April  1, 

Left  ;  circ.     Surg.  J.  McL.  Hay- 

19 

Bflrle,  J.,  Corp'l,  K,  61st 

Aug.  25, 

Right;    double   flap.     Surg.  W. 

74th  Pennsylvania. 

6,  '62. 

ward,  12th    Mass.     Erysipelas. 

New  York,  age  52. 

Sept.  15, 

O'Meagher,  3?th  N.Y.   Re-amp. 

Disch'd  Aug.  23,  1862. 

1864. 

upper  third.     Disch'd  May  30, 

7 

Becker,  A.,  Pt.,   F,    3d 

May  10, 

Right  ;  flap.     Drs.  Fellerer  and 

1865.     Died  July  16,  18C8.' 

Missouri. 

19,'  '61. 

Comstock,  St.  Louis.     Disch'd. 

20 

Bunvell,  T.  J.,  Pt.,  H, 

Mar.  21, 

Right;  circ.     Surg.  A.  F.  Marsh, 

8 

Beers,  L.  R.,  Corp'l,  E, 

Sept.  29, 

Right  (gangrenous  slough.);  circ. 

81st  Ohio,  age  23. 

A  p.  2,  '65. 

5tith  111.     Disch'd  Sept.  11,  '65. 

188th  Penn.,  age  1!>. 

Oc.29,'64. 

A.  Surg.  S.  H.  Orton,  U.  S.  A. 

21 

Butler,  C.  H.,  Pt.,  H,  2d 

,  Oct.  19, 

Right;  flap.   A.Surg.  J.  J.  Meigs, 

Gang.      Disch'd  Nov.  9,  1865. 

Conn.  H.  Art'y,  age  20. 

22.  '64. 

llth  Vt.     Disch'd  Aug.  17,  '65. 

Spec.  3682. 

22 

Carlin,  J.,  Pt.,  I,  3d  Vt,, 

May  5, 

Left  ;  flap.    Surg.  E.  Phillips,  6th 

9     Bennett,  P.  L..Pt.,F,  1st 

Aug.  23, 

Left  ;  lat.  flap.    Surg.  N.  R.  Mose- 

age  20. 

9,  '64. 

Vt.     M.O.March  18,  18ti5. 

Maine  Cavalry,  age  24. 

30,  '04. 

ley,TJ.  S.V.  Nee.    Disch'd  Aug. 

23 

Carpenter,    H.,    Pt.,   A, 

May  3, 

Left.     Confed.  surgeon.     Disch'd 

12,  1865. 

121st  N.  York,  age  24. 

6,  '63. 

June  15,  1864. 

10     Beverlin,  G.,  Pt.,  B,  llth  \  June  17, 

Right  ;  circ.     Surg.  L.  R.  Stone,      24 

Casebolt,  T.  D.,  Pt.,  E, 

April  6, 

Left;  flap.     Disch'd  Oct.  19,  '62. 

West  Virginia.                |J'yo,'64. 

U.  S.  V.     M.  O.  Nov.  11,  1864. 

3d  Iowa,  age  21. 

9,  '62. 

11 

Biddle,  W.  B.,  Pt.,  K, 

Oct.  19, 

Left;  circ.  A.A.Surg.B.B.  Miles.   '  25 

Causdell,  J.  A..  Corp'l,  B, 

Dec.  15, 

Left;  flap.     A.  A.  Surg.  J.  H.  Mc- 

138th  Penn.,  age  27. 

27,  '64. 

Exfol.  rem'd.     Disch'd  July  18, 

10th  Minnesota,  age  27. 

19,  '64. 

Intire.    Slough'g.    Disch'd  May  ' 

1865.     Specs.  109,  3425. 

29,  1865. 

12 

Bloomer,   S.,  Serg't,  B, 

Sept.  17, 

Right.     A.  Surg.  E.  G.  Pugsley,  |    26 

Claden,  M.,  Pt.,  I,  108th 

May  14, 

Right  ;  circ.  A.Surg.J.M.Brown, 

1st  Minnesota,  age  24. 

20,  '62. 

1st  Minn.    Disch'd  Dec.  6,  '62.     ' 

Ohio,  age  31. 

22,  '64. 

U.  S.  A.     Disch'd  May  11,  '65. 

294 


INJURIES    OF    THE    LOWER   EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITAUY 
DESCRIPTION",  AND  AGE. 

DATES. 

OPEHATIONS,  OPERATOBS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

27 

Clarey,  P.,  Pt.,  I,  24th 
Michigan,  age  18. 

July  2, 
10,  '63. 

Left  (mortification);  circ.     Surg. 
A.  J.  Ward,  2d  Wis.      Rem  vd 

63 

Gardener,  J.,  Co'rp'l,  I, 
72d  Penn.,  age  21. 

Sept.  17, 
21,  '62. 

Left;  flap.     Surg.  M.  Rizer,  72d 
Penn.    Gang.    Disch'd  August 

nee.  bone  ;  gang.    Disch'd  Feb. 

4.  1863. 

26,  1864. 

64 

Gardner,  J.,  Pt.,—  ,  73d 

Aug.  30, 

Right.     Ass't  Surg.  B.  Howard, 

28 
29 

Clark,  S.  A.,  Pt.,  E,  1st 
Sharpshooters. 
Cleggett,  T.,  Pt.,D,  76th 
Colored  Troops,  age  45. 

Aug.  30, 
Se.22,'62 
April  2, 
24,  '65. 

Right  ;  flap.     Surg.  D.  W.  Bliss, 
U.  S.  V.     Disch'd  Jan.  29.  1863. 
Right  ;  ant.  post,  skin  flap  ;  circ.  of 
muse.     Surg.   F.   E.    Piquette, 

65 
66 

Ohio. 
Gayman,  S.,  Pt.,  B,  69th 
Indiana. 
George,  E.  L.,  Serg't,  G, 

Sep.5,'62. 
Aug.  30, 
Sep.:!,  '62. 
April  10, 

U.  S.  A. 
Left;  flap.     A.  Surg.  W.B.Witt, 
C9th  Ind.     Disch'd  April  29,  '63. 
Right  ;  circ.  Surg.F.  E.  Piquette, 

86th  C.  T.     Hffirn.;  lig.  femoral 

73d  Col.  Troops.age  30. 

23,  '65. 

86th  O.  T.     Disch'd  June  17,  '65. 

art.     Disch'd  July  22,  1865. 

67 

Gibson,   G.    S.,  Pt.,  H, 

Oct.  12, 

Right  (necrosis:  gang.);  circ.    A. 

30 

Cliff,  H.,  Serg't,  F,  76th 

July  1, 

Left  ;  circ.     Disch'd  Nov.  28,  '63. 

10th  Missouri,  age  19. 

No.10,'64. 

A.  Surg.  J.  J.   Bell.     Disch'd 

New  York,  age  34. 

5,  '63. 

June  1(),  1865. 

31 

Cocheran,  F.,  Pt.,  G,  9th 

July  9, 

Right  :  circ.     Fort  Monroe,  Sept. 

68 

Classic,  J.,  Pt.,  B,  63d 

June  3, 

Left   (June  3,  amp.  leg;  gang.); 

Louisiana,  age  1'J. 

14,  '64. 

20,  1864. 

New  York,  age  22. 

20,  '64. 

bilat.  flap.  Surg.  N.  R.  Moseley, 

32 

Cochran,  P.,  Serg't,  A, 

Dec.  1  6, 

Left;  ant.  post.  flap.     Ass't  Surg. 

U.  S.  V.     Necrosed  bone  rem'd. 

19th  Tennessee,  age  25. 

29,  '64. 

J.  H.  Cruthers,  88th  Ohio.     Pro 

Disch'd  Aug.  15,'C5.    Died  Nov. 

vost  Marshal  May  6,  1865. 

12,  '67.     Spec.  3100. 

33 

Cooley,  G.  W.,  Corp'l, 
E,  "5th  Ohio. 

May  2, 
12.  '63. 

Right.     May  27,  a'mp.  mid.  third. 
Disch'd  Jan.  22,  1864. 

69 

Golden,  P.,  Pt.,  H,  28th 
Massachusetts,  age  38. 

Aug.  30, 
Sep.9,'62. 

Left  ;  dou.  flap.     A.  A.  Surg.  J.  O. 
French.    June  30,  1863,  re-amp. 

14 

Corcoran,  P..Pt..C,  100th 

July  18, 

Right;    flap.     Disch'd   Aug.  25, 

mid.  third.     Disch'd  Jan.  5,  '64. 

New  York. 

21.  '63. 

1864.     Died  Jan.  28,  1868. 

Spec.  147. 

35 

Crawford,  jt.Jf.,  Corp'l, 

Mav  16, 

Left  ;  circ.     A.  Surg.  H.  E.  Good 

70 

Green,  H.,  Pt.,  K,  17th 

May  23, 

Right  ;  flap.     Surg.  D.  W.  Bliss, 

G,  33d  Tenn.,  age  28. 

19,"  '64. 

man,  U.  S.  V.    Provost  Marshal 

Maine,  age  24. 

Je.  10,  '64. 

U.  S.  V.    July  4,  haem.    Disch'd 

October  21,  1864. 

Nov.  21,1864.    Spec.  2498. 

36 

Critse,  1'.  L.,  Serg't,  C, 

Aug.  21, 

Right.  Surg.  —  Edwards,  C.S.  A. 

71 

Greene,  A.  H.,  Serg't,  B, 

June  27, 

Left.     Surg.  A.  D.  Palmer,  9th 

21st  Georgia,  age  44. 

29,  '64. 

Prison  Nov.  22,  1864. 

12th  New  York. 

30,  '62. 

Maine.     Disch'd  Feb.  24,  1863. 

37 

Curie,    H.,    Pt.,    F,  7th 

Aug.  16, 

Left  (August  17,  amp.  leg);  circ. 

72 

Grubbs,  H.  B.,  Pt.,  Car 

Sept.  14, 

Right.  Surg.  —  Roberson.C.S.A. 

Connecticut. 

19,  '64. 

Disch'd  June  10,  1865. 

ter's  Battery. 

18,  '62. 

FurloughedSept.21,  1864. 

38 

Curren,  T.  S.,  Pt.,  E,  7th 

Aug.  2G, 

Right  ;  flap.    Surgs.  Gleaves,  Mc 

73 

Halderman,  C.,  Pt.,  H, 

July  2, 

Right;   flap.     Surg.  H.  Palmer, 

Ohio. 

Sept.  1, 

Donald,  and  Searout,  C.  S.  A. 

llth  Penn.,  age  28. 

25,  '63. 

U.  S.  V.    Rem'd  bone.    Disch'd 

1861. 

Disch'd  July  17,  1862. 

October  6,  1863. 

39 

Darling.  R.  A.,  Pt.,  H, 

May  31, 

Right  ;  flap.     Surg.  D.  Prince,  U. 

74 

Hamilton,  J.,Pt.,C,  45th 

Sept.  14, 

Right.     Disch'd  Dec.  30,  1862. 

67th  New  York. 

Je.  3,  '62. 

S.  V.     Hiem.;  lig.  fern,  artery. 

Pennsylvania. 

17,  '62. 

Disch'd  August  9,  1862. 

75 

Hand,  C.,  Pt.,  B,  15th  N. 

May  12, 

Right  ;   circ.     Disch'd  June   17, 

; 

Darraugh,J.C..Lieut.,D, 

Oct.  1, 

Right  ;  lat.  flap.     Surg.  A.  Nash, 

Jersey,  age  33. 

16,  '64. 

1865. 

9th  Mich.  Cav.,  age  ]!). 

17,  '64. 

9th  Mich.  Cav.    Mustered  out. 

76 

Hannon,  M.,  Pt.,  K,  76th 

Sept.  14, 

Right  ;  circ.     Gang.;  bone  rem'd. 

41 

Davis,  L.,  Pt.,  A,9th  W. 

Aug.  26, 

Left  ;  circ.     A.  A.  Surg.  T.  J.  Du- 

New  York,  age  24. 

18,  '62. 

Sept.  12,  '63.  re-amp.,  circ  ,  mid. 

Virginia,  age  18. 

29,  '64. 

nott.     Sept.  3,  hsem.     Disch'd 

third  ;baem.  Disch'd  June24,  '64. 

Oct.  26,  '65.     Spe.cs.  1423,  ]  072. 

Died  June  22,  1870.    Spec.  4324. 

42 

Debold.C.A.,  Pt.,  H,21st 

July  24, 

Left;   circ.     A.  A.  Surg.  W.  S. 

77 

Barris,   C.   W.,  Pt.,  G, 

July  3, 

Left:  circ.  Surg.  —Clark,  C.S.  A. 

N.  Y.  Cavalry,  age  21. 

28,  '64. 

Adams.     Disch'd  Dec.  17,  1864. 

llth  Miss.,  age  20. 

15,  '63. 

Necrosed  bone  rem'd.     Exch'd 

43 

Deery,  P.,  Pt.,  C,  170th    Aug.  26, 

Left;  ant.  post.  flap.     Surg.  A. 

Nov.  12,  1863. 

New  York,  age  55. 

Sep.7,'64. 

Heger,  U.  S.  A.    Disch'd  Aug. 

78 

Hart,  B.  B.,  Scout,  H, 

Aug.  28, 

Right,  Surg.A.Wynkoop,U.S.V. 

15,  1865. 

24th  New  York,  age  33. 

Se.16,'62. 

Disch'd  Nov.  15,  1863. 

44 

De  La  Barr,  G.,  Pt.,  C, 

Mar.  19, 

Left;   double  flap.     Surg.  D.  S. 

79 

Hawkins,  W.  W.,  Serg't, 

May  5, 

Right  (May  6,  amp.  leg,  Teale's 

13th  Mich.,  age  16. 

27,  '65. 

Young,  21st  Ohio.    Disch'd  Oct. 

I,  93d  N.  York,  age  20. 

16,  '64. 

method).     April,    1865,  carious 

21,  1865. 

bone  rem'd.     Disch'd  July  12, 

45 

Devine,  J.,  Lieut.,  F,32d 

April  8, 

Left  ;   flap.    Disch'd  August  30, 

1865.     Spec.  4497. 

Iowa,  age  43. 

12,  '64. 

1864. 

80 

Hayes,  J.  W.,  Corp'l,  D, 

May  9, 

Rght;  circ.     A.  A.  Surg.  T.  W, 

46 

Dil!ey,J.L.,  Musician,  Q, 

April  2, 

Right  :  circ.     Surg.  J.  S.  Taylor, 

60th  Ohio,  age  19. 

27,  '64. 

Carroll.     Disch'd  April  17,  '65. 

62d  Ohio,  age  24. 

6,  '65. 

23d  111.    Disch'd  July  15,  1865. 

81 

Henning,  B.  D.,  Lieut., 

May  9, 

Right.    Surg.  N.  F.  Graham,  12th 

47 

Dillon,  G.,  Pt.,  F,  40th 

Sept.  1, 

Left.     Disch'd  March  14,    1863. 

F,3dPenn.  Res.,  age  29. 

14,  ''64. 

Ohio.     M.  O.  Sept.  26,  1864. 

New  York. 

10,  '62. 

Died  May  25,  1870. 

82 

Henderson,  J.,  Serg't,  A, 

May  10, 

Right  :  circ.    A.  A.  Surg.  F.G.H. 

48 

Dimmick,  L.  L.,  Pt.,  G, 

Oct.  8, 

Left  ;  circ.    A.  A.  Surg.  J.  Sloan. 

126th  N.  York,  age  29. 

30,  '64. 

Bradford.     Disch'd  Aug.  1,  '65. 

10th  Wisconsin. 

24,  '62. 

Rem'd  end  of   bone.     Disch'd 

83 

Herron,   J.,   Pt.,  I,   8th 

Mar.  31, 

Right;  ant.  post.  flap.   A.  A.  Surg. 

April  16,  1863. 

Penn.  Cav.,  age  18. 

Ap.5,'65. 

F.  H.  Hill.  Disch'd  Sept.  30,  '65. 

49 

Dunlap.R.K.,  Pt.,  I.4th 

Mav  3, 

.     Surgeons  Stroth  and  Saw 

Spec.  4044. 

Virginia. 

7,  '63. 

yer,  C.  S.  A.    Recovered. 

84 

Hess,  R.,  Pt.,  G,   153d 

July  1, 

Left  ;  ant.  post.  flap.     Mustered 

50 

Ellis,  A.,  Pt.,  F,  114th 

Oct.  19, 

Left.     A.  A.  Surg.  E.  G.  Waters. 

Pennsylvania. 

5,  '63. 

out  July  24.  1863. 

New  York,  age  21. 

No.  7,  '64. 

Disch'd  May  31,  '6.").    Spec.  3423. 

85 

Hewitt,  W.  E.,  Pt.,  I,  8th 

Oct.  3, 

Left.   Surg.  J.  E.  Murta,  8th  Wis. 

51 

Ellis.H.H..Corp'l,I,16th 

May  3, 

Left;   circ.      A.  A.  Surg.  J.  E. 

Wisconsin. 

8,  '62. 

Disch'd  Nov.  24,  1862. 

New  York,  age  23. 

13,  '63. 

Smith.     Haem.;  lig.  feui.  artery. 

86 

Hodgman,  O.,  Pt.,  K,  1st 

Sept.  5, 

Right;  flap.     A.  A.  Surg.  C.  C. 

Removed  exfol.  bone.     Disch'd 

Wis.  Cav.,  age  19. 

25,  '64. 

Joslin.     Disch'd  July  4,  1865. 

from  hospital  June  6,'64.   Specs. 

87 

Hoon,  E.  L.,  Pt.,  H,  102d 

Sept.  19, 

Right  :   lat.  flap.     A.  A.  Surg.W. 

1852.  1853. 

Pennsylvania,  age  23. 

28,  '64. 

S.  Adams.     Tub.  seq.  removed. 

52 

Emigh,  B.  F.,  Lieut.,  F, 

June  17, 

Left  ;  circ.    A.  A.  Surg.  F.  H.Col- 

Disch'd  Mar.  18,  '65.    Spec.  3860. 

2dPenn.  H'vy  Artil'ry. 

25,  '64. 

ton.    Sloughing  :  seq.  extracted. 

88 

Hope.  G.  W.,  Serg't,  A, 

Nov.  24, 

Right;    circ.  flap.     A.  Surg.  A. 

age  24. 

Disch'd  May  10,'65.    Spec.  3598. 

6th  New  York  Cavalry, 

De.3,'63. 

Ingram,  U.  S.  A.     Mar.  4,  1864, 

53 

Emmert,  G.  S..Corp'l,H, 

Dec.  7, 

Right:  flap.     Surg.  P.  Harvey, 

age  30. 

rem'd  nee.  end.  Duty  Nov.  11,  '64. 

:<7th  Illinois,  age  23. 

14,  '62. 

19th  Iowa.  Bonerem'd.  Disch'd. 

89 

Horner,  D.  J.,  Pt.  C,142d 

Dec.  13, 

Left.    Subsequent  operat'n.    Dis 

54 

Everett,  D.,  Pt.,  L,  15th 

June  15, 

Right  (mortification;  17th,  amp. 

Pennsylvania. 

21,  '62. 

charged  Feb.  19,  1864. 

Kansas  Cav.,  age  16. 

20,  '64. 

leg;  gangrene);  ant.  post.  flap. 

90 

Hosmer,  O.  M.,  Pt.,  F, 

Sept.  19. 

Left.     A.  A.  Surg.  E.  G.  Waters. 

Disch'd  Aug.  19,  1864. 

106th  N.  Y.,  age  20. 

Oc.l6.'64. 

Disch'd  May  3().'65.     Sp«c.3424. 

55 

Falconer,  D.  G.,  Lieut., 

Sept.  17, 

Right  :  ant.  post.  flap.     A.  Surg. 

91 

Honsley,   H.,   Cook.  F, 

April  2, 

Right  :  ant.  post,  flap  :  circ.  of  mus. 

B,  79th  N.  Y.,  age  25. 

Oct.  9.  '62. 

J.  B.  Brinton,  U.  S.  A.     V.  R.  C. 

33d  Wis.,  age  20. 

11,  '65. 

(amp.  left  leg).     Surg.  F.  E.  Pi 

July  20,  1863.     Spec.  453. 

quette,  86th  C.  T.     Recovered. 

56 

Farthing,  G.  W.,  Pt.,  D, 

.Iiilv  2, 

Left.    Recovery. 

92 

Howell,  A.,Corp'l,  K.lst 

April  1, 

Right:  flap,  skin  ;  circ.  muscles 

5th  Tennessee. 

7,  r63. 

N.  Y.  Cavalry,  age  21. 

7,  '64. 

A.  A.  Surg.  A.  R.  Gray.  Slough. 

57 

Fish,  R.  M.,  Pt.,  I,  24th 

July  1, 

Right  ;  circ.  Nov.  4,  2J  inches  end 

Disch'd  June  20,'64.  'Spec.  3947. 

Michigan,  age  22. 

6,  '63. 

of  bone  rem'd;  erysip.    Disch'd 

93 

1  Huber,  J.,  Pt.,  A,   1st 

Oct.  8, 

Left;    circ.;   gangrene.     Disch'd 

April  19,'65.    Specs.  1589,  2624. 

Kv.  Battery,  age  25. 

12,  '62. 

June  23.  1864. 

58 

Fitzmorris,E.,Pt..K,12th 

Aug.  30, 

Right:  circ.     Oct.  —  ,  seq.  rem'd. 

94 

Huffman,  F.  M.,  Pt.,  D, 

Aug.  29, 

Loft;   circ.     A.  A.  Snrg.  H.  C. 

New  York,  age  24. 

Sep.8,'62. 

Mustered  out.     Spec.  1051. 

3d  W.Virginia,  age  26. 

Sept.  15, 

Ilcilncr.     Ilsem.     Diseh'd  Feb. 

59 

Fletcher,   D.  C.,  Serg't, 

Sept.  1, 

Right;    circ.     Surg.  H.  Bryant, 

1862. 

13,  1863.     Spec.  120. 

H,  40th  New  York. 

18,  '63. 

IT.  S.  V.     Recovery. 

95 

Hutchings,  S.,  Lieut.,  G, 

May  10, 

Right;  double  flap.     Surg.  G.  E. 

60 

Frum,  P.,  Corp'l,  F,  3d 

Aug.  29, 

Left  (Aug.  29,  amp.  leg;  gang.); 

5th  Maine,  age  22. 

18,'  '64. 

Brickett,  21st  Maine.  M.  O.  July 

West  Virginia,  age  28. 

So.  21,  '62. 

gang.     Aug.  6,  '63,  seq.  rem'd. 

27,  1864. 

Disch'd  July  7,  '64.    Spec.  1665. 

96 

Johnson,  G.  H.,  Pt.,  F, 

Feb.  20, 

Left  (gangrene);   circ.     Surg.  — 

61 

Fuller,  P.,  Serg't,  G.  1st 

Aug.  5, 

Right.     Surg.  O.  B.  Payne,  10th 

8th  Colored  Troops. 

25,  '64. 

Holmes,  C.  S.  A.     Disch'd  Oct. 

Missouri  H.  G.,  age  41. 

19,  '61. 

Mo.    Two  subsequent  amput'ns. 

3,  1865. 

Disch'd  Oct.  25,  1865. 

97 

Jones,  J.  P.,  Pt.,  K,  52d 

July  1, 

Right.     Gangrene.     Exchanged 

62 

Gallana,  P.,  Pt.,  C,  llth 

April  1, 

Left  (gang.);  circ.     A.  A.  Surg. 

N.  Carolina,  age  21. 

14,  ''63. 

March  17,  1864. 

Penn.  Cav.,  age  35. 

7,  '65. 

Z.  P.  Dennler.     M.  O.  Jan.  17, 

98 

Joy,  A.,  Serg't,  C,  24th 

July  1, 

Left  ;  circ.     Surg.  ,1.  II.  Beech, 

1866.    Spec.  4045. 

Michigan. 

7,  fo. 

24th  Mich.    Disch'd  Oct.  18,  '63. 

"STANFORD  (R.  L.),  Bromine  in  Hospital  Gangrene,  in  American  Medical  Times,  1863,  Vol.  VII,  p.  24. 


PLATE    XX.      FEMORAL   ARTERY  AND     FEMORAL   VEIN    AFTER    AMPUTATION 


SECT.  III.] 


INTERMEDIARY    AMPUTATIONS    OF    THE   THIGH. 


295 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPKUATOUB, 
RESULT. 

NO. 

NAMK,  MILITARY 
DESCKUTION,  AND  AGE 

DATES. 

OPERATIONS,  OI-EUATOUB, 
RESULT. 

99 

Keefer,  C.,  Pt.,  E,  Kith 

Aug.  30, 

Left  ;  flap.     Surg.  J.  C.  Dorr,  U. 

136 

JUilJican,  G.  F.,  Corp'l, 

Aug.  19, 

Right  ;  ant.  post.  flap.     Surg.  — 

Mich.,  age  46. 

Sept.  12, 

S.  V.     Disch'd  October  5,  1865. 

H,  26th  Miss.,  age  35. 

29,  '64. 

Clark.C.S.A.  Trans.  Nov.  2,'65. 

1862. 

Spec.  4546. 

137 

Minehan,  A.,  Corp'l,  F, 

Aug.  21, 

Right  ;  circ.     Surg.O.  A.  JiuUon, 

100 

Kemp,  S.  P.,  Pt.,  1,  7th 

Aug.  9, 

Right  ;  double  flap.     A.  Surg.  T. 

27th  Mich.,  age  31. 

Se.  10,'64 

U.  S.  V.  Haeni.;  lig.  fem.  artery. 

Ohio. 

i4,m 

G.  Mackenzie,  U.  S.  A.   Disch'd 

Oct.  19,  re-amp.     Disch'd  May 

Oct.  20,  1862.    Specs.  51,  4477. 

19,  1865.     Spec.  3272. 

101 

Kent,  W.  E.,  Pt.,  C,  Oth 

Oct.  1, 

Left  (pyaem.  symptoms);  flap.   A. 

138 

Mitchell,  W..Pt.,  A,  122d 

Sept,  19, 

Left,  Teale's  method.  A.  Surg.  J. 

Ohio  Cavalry,  age  22. 

15,  '64. 

Surg.   P.    C.    Davis,   U.  S.  A. 

Ohio,  age  21. 

23,  '64. 

G.  Thompson,  77th  N.  Y.    Bony 

Disch'd  May  4,  1865. 

tumor,  and  seq.  rem'd.    Disch'd 

102 

Krider,  G.  C.,  Lieut.,  C, 

Mar.  25, 

Left  ;  circ.     Surg.  J.  H.  Kimball, 

Jan.  19,  1865. 

49th  N.  C.,  age  38. 

28,  '65. 

31st  Me.     Released  June  15,  '65. 

139 

Moore,  J.  L.,  Lieut.,  K, 

June  27. 

Left  (aneurism);  dou.  flap.    Surg. 

103 

Kuhns,  J.W.,Pt.,C,  llth 

Dec.  13, 

Left;  circ.     Disch'd  Nov.  14,  '63. 

10th  Penn.  Res.,  age  26. 

J'y24,'62 

R.  B.  Bontecou,  U.  S.V.    Hajm.; 

Pennsylvania. 

16,  '62. 

lig.fem.art.    Res'd  Jan.  21  ,  '63. 

104 

Kuoni,  0.,  Serg't,  C,  9th 

April  30, 

Right;  flap.     Disch'd  March  16, 

140 

Morton,  W.  G.,  Pt.,  F, 

Nov.  27, 

Right  ;  flap.    Surg.  A.  N.  Dough 

Wisconsin. 

M'vlO,'64. 

1865. 

4th  Ohio,  age  20. 

Dec.  3, 

erty,  U.  S.  V.     Disch'd  July  8, 

105 

Larck,  J.,  Pt,,  A,  5th  W. 

July  24, 

Left;  lateral  flap.     Disch'd  Jan. 

1863. 

1864.     Spec.  182. 

106 

Virginia,  age  22. 
Large.W.G.,  Pt.,K,  90th 

27,'  '64. 
April  29, 

10,  1865. 
Right  ;  flap.     Surg.  A.  \V.  Whit 

141 

Mulligan,  P.,Pt.,A,125th 
New  York,  age  44. 

June  17, 
J'yl3,'64 

Left  ;  circ.  Ass't  Surg.  A.  Ingram, 
U.  S.  A.    Necrosed  bone  rem'd. 

Pennsylvania,  age  21. 

May  15, 

ney,  13th  Mass.     Mustered  out 

Spec.  2866. 

1863. 

Dec.  13,  1864. 

142 

Musselman,  W.,  Pt.,  H, 

Sept.  19, 

Left  ;  circ.    Surg.  —Blair,  C.S.A. 

107 

Lauer,  J.  S.,  Pt.,  B,  5th 
New  Jersey. 

May  3, 

7,  '63. 

Left  ;    circ.     Surg.  J.  Dwindle, 
106th  Peun.  Disch'd  Mar.  28.'64. 

143 

49th  Virginia,  age  40. 
Myers,  G.,  Pt.,  1,  24th  N. 

Oc.25,'64 
Mar.  31, 

To  Fort  McHenry  Feb.  10,  1865. 
Left  ;  circ.     Dr.  J.  H.  Thompson. 

108 

Leonard,  J.,  Pt.,  E,  2d 

July  2, 

Left  ;  circ.     Nov.  7,  seven  inches 

York,  age  19. 

A  p.  6,  '65 

Disch'd  July  6,'65.    Spec.  4063. 

N.  Y.  S.  M.,  age  30. 

5,  '63. 

end  of  bone  rem'd.     Sent  to  In 

144 

Nash,  J.,  Pt.,  G,   143d 

May  22, 

Right;  flap.     April  9,  1665,  seq. 

sane  Asylum  June  6,  '64.     Spec. 

Penn.,  age  21. 

28,  '64. 

removed.     Disch'd  June  22,'65. 

2152. 

Spec.  144. 

109 

Lewis,  J.,  Pt.,  K,  47th 

April  3, 

Right  (gang.);  ant.  post,  skin  flap; 

145 

Peabody.  A.,  Pt.,  G,  43d 

Feb.  21, 

Lett;   flap.     A.  A.  Surg.   J.  F. 

Colored  Troops,  age  20. 

18,  '65. 

circ.  mus.   Surg.  F.  E.  Piquette, 

Missouri. 

March  15, 

Bruner.     Disch'd  June  30,  1865. 

86th  C.  T.     Disch'd  July  22/65. 

1865. 

110 

Little,    T.,  Pt.,  I,    19th 

July  2, 

Right;  lateral  flap.     Discharged 

146 

Perrott,  G.W.,  Corp'l.G, 

May  3, 

Right  ;  circular.  Confed.  surgeon. 

Maine,  age  28. 

6,  '63. 

August  1,  1864. 

21st  New  Jersey. 

10,  '63. 

Nee.  Dec.  3,  re-amp.  Dr.  Olcott, 

111 

Lothrop,  J.   H.,  Pt.,  P, 

Sept,  19, 

Left  ;  circ.   Confed.  surgeon.   Re- 

Jersey  City.    Recovery. 

Kith  Infantry,  age  21. 

24,  '63. 

amput'n  middle  third.     Disch'd 

147 

Fetters,  T.  T.,  Capt.,  B, 

April  6, 

Left;    ant.  post.  flap.     Released 

Nov.  18,  1864. 

34th  Virginia,  age  33. 

11,  '65. 

August  10,  1865. 

112 

Lowe,  II.  B.,  Serg't,  F, 

May  3, 

Left.      Ass't  Surg.  J.  S.  Ewing, 

148 

Phillips,  W.  M.,  Corp'l, 

Oct.  19, 

Right  ;  circ.    Surg.  R.  W.  Pease, 

5th  Wisconsin,  age  34. 

6,  '63. 

5th  Wis.  Disch'd  June  21,  '64. 

D,  121st  N.Y.,  age  28. 

Nov.  18, 

U.  S.  V.    Haem.    Disch'd  Jan. 

113 

Lynch,  J  ,  Pt,,  C,  47th 

July  30, 

Right;  circ.     A.  A.  Surg.  S.  J. 

1864. 

12,  1865. 

New  York,  age  30. 

Au.'3,'64. 

Holley.     Necrosed  bone  rem'd. 

149 

Pitts,  E.  W.,  Pt.,  B,  69th 

Jan.  30, 

Left.     Surg.  J.  Dwyer,  69th  N.Y. 

Disch'd  May  25,  1865. 

New  York,  age  19. 

Feb.2,'63 

Disch'd  Jan.  12,  1664. 

114 

Maedel,  C.,  Pt.,C,9th  111. 

Oct.  3, 

Left  ;  flap.    Surg.  E.  Guelick,  9th 

150 

Pixley,  P.,  Pt.,  A,  55th 

May  2, 

Left  ;  circ.     Disch'd  December  9, 

13,  '62. 

111.     Disch'd  Sept.  22,  1863. 

Ohio. 

7,  '63. 

1864. 

115 

Maron,    P.,    Pt.,   E,   2d 

May  3, 

Right  ;  circ.     Disch'd  August  21, 

151 

Place,  S.  W.,  Pt.,  G,  1st 

Oct.  19, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Mass.,  age  27. 

9,  '63. 

1863. 

Rhode  Island  Artil'ry, 

Nov.  10, 

B.  B.  Miles.     Exfol'n  removed. 

116 

Martz,  C.,  Pt.,  G,  64th 

Mar.  25, 

Right  (mort'n);  circ.;  nee.    Sept. 

age  28. 

1864. 

Disch'd  May  7,  '65.     Spec.  106. 

New  York,  age  26. 

30,  '65. 

26,  re-amp,  mid.  third    A.  Surg. 

152 

Powell,  J  ,  Pt,,  B,  29th 

April  30, 

Left  ;  circ.    Feb.  28,  '65,  necrosed 

J.  H.  Armsby,  U.S.  V.   Disch'd 

Iowa,  age  21. 

May  4, 

bone  came  away.    Disch'd  May 

Oct.  4,  '65.    'Specs.  2853,  3195. 

1864. 

22,  1865.    Spec.  228. 

117 

Matthews,  I.  W.,  Pt.,  K, 

July  24, 

Right.     Ass't  Surg.  L.  D.  Miller, 

153 

Priest,  C.,  Pt.,  H,  8th  N. 

Oct.  27, 

Right;    circ.     Disch'd   April   9, 

23d  Ohio,  age  24. 

Au.  4,  '64. 

IstN.  J.    Disch'd  Aug.  18,  1865. 

Hampshire,  age  20. 

Nov.  26, 

1863. 

118 

Maurer.A.J.,  Pt.,  B,  53d 

May  2, 

Left;  flap.     Disch'd  July  27,  '64. 

1862. 

Ohio. 

Je.  1,'63. 

154 

Pullen,  W.  H.,  Serg't,  I, 

July  2, 

Left;    flap.     Disch'd  September 

119 

Mayes,    S.,    Pt.,    F,  1st 

Oct.  1, 

Right;  flap.  A.  Surg.  P.  C.Davis, 

5th  Michigan,  age  24. 

7,  fo. 

14,  1864. 

Penn.  Cavalry,  age  20. 

12,  '64. 

U.S.A.     Disch  'd  May  6,  1865. 

155 

Rial,  J.,  Pt.,  B,  4th  Ohio, 

June  3, 

Right  :  ant.  post.  flap.     A.  Surg. 

120 

McAllister,   W.    H.  H., 

Dec.  13, 

Right;  circ.     A.  A.  Surg.  C.  W. 

age  22. 

15,  '64. 

W.  Thomson,  U.  S.  A.     Haem. 

Serg't,  G,  4th  Vermont, 

23,  '62. 

Filmore.    Bone  extracted.    Dis. 

Disch'd  July  8,   1865.     Specs. 

age  27. 

Sept.  19,  1864.     Spec.  200. 

3562,  3570. 

121 

McCombs,S.,Pt.,  A,  28th 

April  6, 

Right  ;  double  flap.     Surg.  E.  C. 

156 

Rice,  A.  D.,  Pt.,  F,  45th 

Sept,  17, 

Left;  circ.     A.  Surg.  J.  A.  Bige- 

Illinois,  nge  18. 

-,  '62. 

Franklin,  U.  S.  V.     Discharged 

Penn.,  age  23. 

Oct.  15, 

low,  8th  Conn.   Erysip.  Disch'd 

April  7,  1863. 

1862. 

April  2,  1863. 

122 

McConky.A.,  Pt.,  D,63d 

May  5, 

Left  ;  lat.  flap.  Surg.  R.  B.  Bonte- 

157 

Roberts,  C.,  Pt,,  E,  1st 

April  28, 

Left  ;  flap.    Surg.  N.  Gay,  U.S.V. 

Pennsylvania,  age  48. 

14,  ''64. 

cou,  U.S.V.  Disch'd  May  19,  '65. 

W.  Tenn.  Cavalry. 

Myl2,'63. 

Discharged. 

Died  May  15,  '73.     Spec.  3066. 

158 

Koberts.  C.    W.,   Pt,,  B, 

June  4, 

Left,    Surg.  —  Craft,  C.  S.  A. 

123 

McCormick,  M.,  Serg't, 

Sept.  19, 

Left;  flap.     A.  A.  Surg.  J.  R. 

12th  Mississippi. 

7,  '64. 

Disch'd  Jan.  15,  1865. 

F,  2d  Cavalry,  age  36. 

26,  '64. 

Uhler.     Disch'd  June  15,  1865. 

159 

Robinson,  E.  P.,  Pt.,  H, 

May  3, 

Left.     Surg.  G.  P.  Oliver,  lllth 

124 

McCray,A.F.,"Pt.,  E,6th 

Aug.  16, 

Left;  flap.     A.  Surg.  W.  H.  II. 

I2Cd  Penn.,  age  18. 

8,  '63. 

Penn.    Nee.  bone  rem'd.    M.  O. 

Missouri  Cavalry. 

19,  '62. 

Cundiff,  2dMo.S.M.C.  Disch'd. 

160 

Robinson,   J.    C.,   Brig. 

May  8, 

Left;  circ.  Surg.B.Norris.U.S.A. 

125 

McGarraghan,  H..Pt.,E, 

De.31/62, 

Right;  circ.     A.  A.  Surg.  J.  M. 

General  U.  S.  V. 

15/64. 

Retired  May  6,  '69.    Spec.  2268. 

24th  Ohio,  age  20. 

Jan.4,'63. 

Henderson.  Disch'd  May  14/63. 

161 

Robisho,  J.,  Pt.,  D,  76th 

April  9, 

Right  (sloug'h'g);  dtmb.  hit.  flap. 

126 

McGinley,  E.,  Corp'l,  I, 

Nov.  3, 

Right  (Nov.  11,  hffim.);  circular. 

Illinois,  age  23. 

M'y8,'65. 

A.  Surg.  A.  Hartsuff,  U.  S.  A. 

23d  Wisconsin,  age  30. 

13,  '63. 

Ass't  Snrg.  S.  McClellan,  13th 

Disch'd  Aug.  9,  1865.     Re-amp. 

Conn.     Disch'd  March  10,  '64. 

162 

Rose.  P.  B.,  Ass't  Surg. 

Oct.  27, 

Left;  circ.     Surg.  D.  W.  Bliss, 

127 

MeGlone,  H.  W.,  Pt.,  F, 

May  3, 

Right;  circ.     Surg.  II.  S.  Potter, 

5th  Michigan,  age  30. 

Nov.6,'64. 

U.  S.  V.    Disch'd  Mar.  28,  1865. 

55th  Ohio. 

12,  ''63. 

105th  111.     Disch'd  Aug.  5,  '63. 

163 

Russell.  Z.  B.,  Serg't,  B, 

Sept.  14, 

Right  ;  flap.     Discharged. 

128 

McGrognn,  J.,Pt.,  H,62d 

July  1, 

Left;  flap.      Disch'd  September 

7th  Wisconsin. 

17,  '62. 

Pennsylvania. 

5,  fe. 

15,  1862. 

164 

Sansom,    S.    B.,  Pt.,   I, 

May  3, 

Right;  sloughing.     Rem'd  end  of 

129 

Me  Mullen,  H.  1\,~P\.,G, 

July  9, 

Left;  circ.     Surg.  —  Todd,  6th 

14th  Indiana. 

15,  V63. 

bone.     Disch'd  Feb.  11.  1864. 

61st  Georgia,  age  23. 

25,  '64. 

Va.  (C.  S.  A.).    Exch'd.    Specs. 

165 

Schondan,  J.,  Pt.,IC,95th 

July  1, 

Left  ;  flap.    Surg.  G.  M.  Ramsay, 

2692.  3871. 

New  York. 

15,  ''63. 

95th  N.Y.    Bone  rem'd.  Disch  d 

130 

McMullen,  R.  J.,  Pt.,  I, 

May  3, 

—  (May  4,  amput'n  knee  joint.) 

Feb.  9,  1864. 

4th  Georgia,  age  20. 

23,  '63. 

Surg.  —  Philpot,  C.S.A.  Htem.; 

166 

Schrabaskie,  M.,  Pt.,  B, 

April  1, 

Right;  circ.     A.  A.  Surg.  D.  L. 

lig.  fern.  art.     Furl'd  Aug.  4,  '63. 

183d  Penn.,  age  46. 

8,  '65. 

Haight.  Seq.  rem'd.  June7,'66, 

131 

McWhinnie,   J.,   Serg't, 

May  3, 

Left  ;  circ.  Surg.  11.  E.Goodman, 

nee.  bone  rem'd  :  muse.  art.  lig. 

A,  20th  Conn.,  ago  24. 

26,  ''63. 

28th  Penn.     Necro.  bone  rem'd. 

Disch'd  Oct.  15/66.  Specs.  2452, 

Disoh'd  May  4,  '64.     Spec.  1284. 

14H4,  4956. 

132 

Mickle,  C.,  Pt.,  E,  83d 

July  1, 

Right.     Re-amp,  by  Dr.  Waters. 

167 

Scrotjrjs,  A.,  Pt.,  C,  48th 

Sept.  17, 

Right.  (Dec.  10,  end  bone  rom'd.) 

Penn.,  age  19. 

So,  '62. 

April,  '63,  seq.  rem'd.     Disch'd 

North  Carolina,  nge  19. 

20,  '62. 

Disch'd  from  hosp'l  Feb.  9/63. 

June  27,  1863. 

168 

Sedgewick,  P.,    Pt.,    E, 

July  2, 

Right  ;  circ.    Surg.  W.  S.  Cooper, 

133 

Miller,    C.,    Pt.,  B,  8th 

April  6, 

—  .  Surg.  E.C.  Franklin.U.S.V. 

125th  N.  York,  age  23. 

6,  ''63. 

125th  N.  York.   Bone  extracted. 

Illinois. 

-,  '62. 

Hastn.     Recovery. 

Disch'd  Sept.  —  ,  1864. 

134 

Milltr,  G.W.,  Pt.,  I,  61st 

July  1, 

Right  ;  flap,  skin  :  circ.  muscles. 

169 

Seiders,  J.  Y.,  Serg't,  K, 

July  1, 

Left  (gang.).  A.  Surg.C.  A.  Ham 

Georgia,  age  19. 

15,  ''63. 

A.  Surg.  R.  F.  Weir,  U.  S.  A. 

151st  Penn.,  age  30. 

8,  '63. 

ilton,  76th  N.  Y.     Recovery. 

Necrosis.     Paroled  Nov.  12,  '63. 

170 

Shackelford,  F.  W.,  Ft., 

De.31,'62, 

Right  ;    flap.     Disch'd  April  11, 

Spec.  3908. 

E,  15th  Ohio. 

Ja.26,'63. 

1863. 

135 

Miller,  J.,  Pt.,  1st  Ky. 

Nov.  30, 

Right  (gang.;  caries);  circ.    A.  A. 

171 

Shea,  J.  A.,  Pt.,  1st  Me. 

Oct.  19, 

Right;  nnt.  post.  flap.  A.  A.  Surg. 

Battery,  age  22. 

De.7,'64. 

Surg.  S.  T.  Williams.     Disch'd 

Battery,  age  21. 

25,  '64. 

E.  G.  Waters.     Disch'd  April  3, 

March  11,1865. 

1865.    Spec.  3427. 

296 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 

DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

172 

Shea,  J.,  Pt,  C,  5th  N. 

Oct.  11, 

Left.    Amp.  near  ankle  j't  ;  tissue 

206 

Ware.  J.  W.,  Pt,  H,  2d 

July  1, 

;  circ.     Furloughed  October 

York  Cavalry,  age  'M. 

16,  'G3. 

unhealthy;  re-amp.,  flap.    Surf. 
D.  W.  Bliss,  I*.  S.  V.     Disch'd 

207 

Mississippi,  age  23. 
Waters,   A.  S.,   Pt.,   E, 

9,  '63. 
July  1, 

7,  1863. 
Right;    circ.:    sloughing;   exfol. 

July  27,  'ti4.     Spec.  1736. 

157th  N.  York,  age  36. 

6,  '63. 

Disch'd  June  12,  1865. 

173 

Shepherd,  R.,Pt..F,  89th 

May  18, 

Left  ;  nap.    A.  Surg.  J.  A.  Meeks, 

208 

Weaver,  L..  Pt,  K,  153d 

July  1, 

Left  ;  circ.;  sloughing.    Mustered 

*" 

Indiana,  age  21. 

21,  '64. 

8Hth  Ind.     Disch'd  Mar.  17/65. 

Pennsylvania,  age  20. 

7,  '63. 

out  May  16.  1864. 

174 

Sheward,  H.,  Pt.,F,  65th 

Oct.  19, 

Right  (gang.):  flap.     A.  A.  Surg. 

209 

Weir,  T.  P.,  Pt  .  B,  5th 

Sept.  20. 

Right  :  ant.  post.  flap.    Recovery. 

New  York,  age  20. 

No.  1/64. 

C.1I.  Jones.  Disch'd  Apr.  22/65. 

Georgia. 

23,  '(13. 

175 

Shonio.  A.  B..  1't.,  G,  Cth 

May  4, 

Left  ;  circ.     Diseh'd  Oct.  17,  1863. 

210 

Welch,  J.,  Pt.,  D,  13th 

Nov.  7, 

Right.    Surg.  —  Ferraer,  C.  S.  A. 

Vermont. 

9,  '63. 

Arkansas. 

24,  '61. 

Recovery. 

17li 

Simeon,  E.  A.,  Serg't, 

Oct.  19. 

Left  (Oct.  21,  amp.  leg);  ant.  post. 

211 

Werneck,  F.  J.,  Capt., 

Aug.  29, 

Right;  flap.     A.  A.  Surg.  W.  B. 

B,  30th  Mass.,  age  34. 

26,  '64. 

flap.     A.  A.  Surg.  G.  W.  Fay 

D.  54th  New  York. 

Se.  3/62. 

Crain.     To  V.  R.  C. 

Necrosed  ;  re-amput's.     Disch'd 

212 

Whitehead,  W.  J.,  S'g't. 

May  5, 

Left.     Retired  Feb.  20,  1865. 

Oct.  16,  1865. 

C.  44th  Georgia. 

8,  '64. 

177 

Sisson,  J.,  Pt.,  H,  3th  N. 

June  16, 

Kight  ;  circ.    Disch'd  May  30,  '65. 

213 

Wickline,  J..  Serg't,  D, 

May  5, 

Left  ;    ant.  post.  flap.     Surg.  E. 

Hampshire,  age  17. 

21,  '64. 

63d  Penn.,  age  25. 

15,  "64. 

Bentley,  U.  S.V.     Disch'd  June 

178 

Sladd,  A.  A.,  1't.,  D,  42d 

Sept.  19, 

Right;  ciro.     Surg.  —  Orsay,  C. 

4,  1865". 

Virginia,  age  23. 

23,  64. 

S.  A.     Provost  Mar.  April  8/65. 

214 

Winkler,  J.,  Pt.,  C,  4th 

Aug.  30, 

Right.     A.  Surg.  B.  Howard.  U. 

179 

'Smith,   E.   E.,  Pt.,  A, 

Aug.  16, 

Right  :  circ.     A.  A.  Surg.  J.  C. 

Penn.  Reserves. 

Sep.5/62. 

S.  A.     Disch'd  Feb.  22,  ]  863. 

llth  Maine,  age  19. 

Sept.  14, 
1864. 

Morton.    Haem.;  lig.  fern,  art'ry. 
Nov.  10,  bone  rem'd;  nee.    Jan. 

215 

Worden,  W.  II..  Pt.,  F, 
Purnell  s  Legion,   age 

May  30, 
Je.  9/64. 

Left;  circ.   A.  Surg.  J.  B.  Baxter, 
16th  Maine.     Disch'd  May  9/65. 

19.'65.  amp.  hip  .i't.:  haem.;  lig. 

27. 

Spec.  3176. 

ex.  iliac  art.     Disch'd  May  27, 

216 

Worley.  R.  M.,   Serg't, 

Aug.  5, 

Lett.     Disch'd  Nov.  27,  '62.    Jan. 

1865.     Specs.  81,  3709. 

E,  22d  Kentucky. 

26,  '62. 

—  ,   1863,  re-amp.,  flap,  middle 

•- 

Smith,  W.,  Corp'l,  Bat'y 

Sept.  6, 

Right  ;  nirc.    Surg.  G.  Derby,  23d 

third.  Surg.H.Manfred,  22cl  Ky. 

H,  3d  N.  Y.  Artillerv. 

9,  '62. 

Mass.     Disch'd  Feb.  1,  1863. 

217 

Youlls,   G.  W.,   Pt.,   F, 

July  1, 

Left;  circ.  flap;   exfol.     Disch'd 

181 

Snyder,  W.  J.,  Pt.,  I,  42d 

Dec.  13, 

Left.     Surg.  II.  Bryant,  U.  S.  V. 

149th  Penn.,  age  22. 

8,  '63. 

Jan.  30.  1864. 

Pennsylvania,  age  25. 

28,  '62. 

Ihem.     Disch'd  Aug.  27,  1863. 
Died  O<'t.  25,  1865;  general  an 

218 

Adams.  A.  J.,  Corp'l,  A, 
4th  Batt.  Georgia  S.  S., 

Dec.  18, 
22,  '64. 

Left.      (Vermale's   method.)     A. 
Surg.W.  B.  Trull,  U.  S.V.  Died 

aemia.     Spec  585 

age  25. 

Dec.  25/64  ;  irritative  fever. 

182 

Stanly,   J.,   —,    A,    4th 

Jan.  2, 

Left.     Surg.  C.  J.  Walton,  21st 

219 

Adams,  J.  W.,  Pt.,  I,  2d 

June  1, 

Left;  ant.  post.  flap.  Surg.E  Bent- 

Florida. 

5,  '63. 

Ky.     Erysipelas.     Recovery. 

Vermont,  age  23. 

10.  '64. 

ley,U.  S.V.  (Gang.)    Died  June 

183 

Stewart.  J.E.,  Serg't,  H, 

July  2, 

Right.     A'ug.  28,  spic.  removed. 

1  0",  '64  ;  asthenia.     Spec.  2547. 

4th  Texus,  age  21. 

5,  '63. 

Exch'd  Nov.  12,  1863. 

220 

Akeman,   M.,  Serg't,  I. 

Dec.  4, 

Right  ;  flap.  Surg.H.  B.  Johnson, 

184 

Stevens,  F.  L.,  Serg't,  E, 
12l)th  X.  York,  age  19. 

Oct.  27, 
30,  '64. 

Right  :    ant.   post.  flap.     Confed. 
surgeon.     Disch'd  May  25/65. 

13th  Ind.  Cav.,  age  32. 

14,  '64. 

1  1  5th  Ohio.  Died  Dec.  19,  1864  ; 
ichorhaemia.     Autopsy. 

185 

Surface,  W.  J.,  1't.,  F, 

Aug.  9, 

Left  ;  ant.  post.  flap.     Surg.  J.  E. 

221 

Albright.    G.  M..  Capt., 

July  3, 

Right  ;  flap,  skin  ;  cir.  mus.    Died 

7th  Indtfiiifi. 

15,  '62. 

F,  53d  N.  C.,  age  36. 

11,  "'63. 

July  16,  1863.    Spfcs.3966,  3977. 

Nov.  18.  Inem.;  lig.  fern,  artery. 

222 

Allen,    —    Lieut.,    13th 

April  6, 

.  A.  Surg.  B.Howard,U.S.A. 

Disc'd  Oct.  27/63.  Specs.  40,  706. 

Louisiana. 

18,  '62. 

Died  April  26,  1862. 

186 

Su>tften,R.  J1.,  Pt.,  E,  1st 

Julv21, 

Right:  ant.  post,  flap;  gangrene; 

223 

Allen,   A.,   Pt.,   H,  5th 

April  6, 

.   Surg.  E.C.Franklin,U.S.V. 

Arkansas,  age  26. 

25,'  '64. 

sloughing.     Recovery. 

Artillery. 

-,  '62. 

(April  9,  excis.  tib.  and  fib.;  mor 

187 

Taylor.  M.II.,Pt.,U,  47th 

May  12, 

Left.     Surg.  J.  G.  Dudley,  P.  A. 

tification.)     Died  May  11,  1862. 

Alabama. 

23,  'M. 

C.  S.     Recovery. 

224 

Allen,  A.  T.,  Capt.,  H, 

June  3, 

Left  ;  circ.    A.  A.  Surg.  F.  H.Col- 

188 

Tedrow,  D.  W.,  Pt.,  D, 

May  2, 

Right  ;  circ.    Surg.  L.  G.  Meyers. 

llth  Conn.,  age  24. 

15,  '64. 

ton.     Died  July  6,  64  j  pyaemia. 

75th  Ohio. 

14,  '63. 

25th  Ohio.     Disch'd  June  6,  '64. 

Autopsy.     Spec.  3561. 

189 

Thrasher,  G.  M.,  Pt.,  C, 

Sept.  17, 

Left;    circ.      Surg.   A.   Ball,  5th 

225 

Allen,   W.,   Pt.,   G,  8th 

July  14, 

Right;  circ.     A.  A.  Surg.  T.  E. 

5th  Ohio. 

20,  '62. 

Ohio.     October,    1862,    re-amp. 

Va.  Cavalry,  age  23. 

27,'  '64. 

Mitchell.     Died  Aug.  10,  1864; 

Disch'd  Dec.  20,  1862. 

pyaemia.    Autopsy.    Spec.  3817. 

190 

Tonrtellotte,  T.   I.,  Pt., 
H,  57th  Mass.,  age  27. 

Mar.  25, 
28,  '65. 

Left  :  cire.     Surg.  W.  O.  McDon 
ald,  U.S.V.    Disch'd  Oct.  20/65. 

226 

Applegate,   H.,    Pt.,  K. 
64th  Ohio. 

De.31/62, 
Ja.  21/63. 

Lr-i't  thigh.      Died   January   29, 

1863. 

Spec.  4135. 

227 

Arkwith.  J.,  Pt..  D,  83d 

Dec.  13, 

Right   thigh.     Died   January  4, 

191 

Tract/,  M.  0  ,  Capt  .,  A, 

De.31,'62 

Right.     Surg.  R.  P.  Bateman,  P. 

New  York. 

28,  '62. 

1863. 

13th  Louisiana. 

Ja.11/63. 

A.  C.  S.     Recovery. 

228 

Ashley,   II.    ,1.,   Pt.,   K, 

Sept.  19, 

Left;  circ.     Died  Oct.  21,  1863; 

192 

Trumbaurer,  P.  S.,  Pt., 

Mar.  10. 

Left:  circ.;  flap.     Ass't  Surg.  W. 

87th  Indiana. 

—  ,  '63. 

pyaemia. 

H,  205th  Penn.,  age  20. 

15,  '65. 

Carroll,  U.  S.  V.     Disch'd  June 

229 

Ashton,   T.    G..  Pt.,  F, 

May  6, 

Left  ;  diarrhoea.     Died  June  10, 

9,  1865. 

51st  Penn.,  age  34. 

Je.  1/64. 

1864  ;  pyaemia. 

193 

Tully,  M.,   Pt.,   C,   10th 

June  3, 

Left:  ciro.    Surg.D.F.McKinney, 

230 

Atwood,  N.  11.,  Pt.,  C, 

April  2, 

Right  :  circ.     A.  A.  Surg.  F.  H. 

Now  Jersey,  age  35. 

8,  '64. 

87th  Penn.     Necro.  bone  rem'd. 

6th  Vermont,  age  22. 

13,  '65. 

Colton.     (Excis.  fibula.)     Died 

Disch'd  June  9,  1865. 

May  23,  '65  ;  pyaemia. 

194 

Turner.   J.,   Pt..  E,  5th 

Sept.  29, 

Lett:    flap.      A.  A.  Surg.  H.  B. 

231 

Badger,  O.,  Pt.,  E,  126th 

July  9. 

Left:  circ.   A.A.'Surg.A.R.Gray. 

Colored  Troops,  age  '24. 

Oc.l8.'64 

White.     Disch'd  April  14.  1865. 

Ohio,  age  23. 

12.  "'64. 

Died  July  20,  1864  /exhaustion. 

195 

Urquhart,  M.  J..  Cap*.. 

Sept.  20, 

Right  (gang.):  circ.     A.  Surg.  S. 

232 

Baldwin,  D.  IT.,  Pt  ,  G, 

Sept.  19, 

—  ;  circ.     Surg.  E.  A.  Brevard, 

D,  98th  Ohio. 

Oc.20/63 

M.  McClure,  37th  Ind.      (Also 

2d  North  Carolina. 

Oc.19/64. 

P.  A.  C.  S.     Gang.     Died   Oct. 

wound  of  breast  and  eye.)     Dis 

2:>,  1  864  .•  exhaustion. 

charged  March  1.  1864. 

233 

Barnett,   D.   A..   Serg't, 

Nov.  7, 

Left;  circ.  A.  A.  Surg.  P.R.Holly. 

196 

Vaden.W.B.,  Pt.,C,  09th 

May  7, 

Right.    Surg.  —  McNutt,  U.  S.  N. 

B,  99th  Penn.,  age  22. 

10,  '63. 

(Gang.)     Died   Nov.  26,   1863; 

Illinois,  age  lit. 

27,  '63. 

Re-amp.;  ciro.:  exfol.  bone  ext. 

pyaemia.  Specs.  2246,  2247,  3991. 

Disch'd  Nov.  15,  18ti4. 

234 

Barnhersel.  M.  J..  Pt..C, 

Aug.  28, 

Right.     Surg.  C.  Page,  U.  S.  A. 

197 

Vanderhoof,  W.  M.,  Pt.. 

May  4, 

Right  ;  circ.  Haem.   Disch'd  Feb. 

2d  Wisconsin,  age  21. 

Se.  21/62. 

Died  Oct.  7,  1862.     Spc.c.  77. 

I),  2<ith  New  Jersey. 

9,  '63. 

4,  1864. 

235 

Barry.  J..  Pt.,  I).  2d  N. 

May  16, 

Right:  flap.     A.    A.  Surg.  J.  S. 

198 

Vannetta,  W.,  Pt.,  D,  4th 

June  21, 

Right  ;  circ.    A.  Surg.P.C.  Davis, 

Hampshire,  age  20. 

25,  '64. 

Hill.  (May  16.  amp.  leg:  slough.: 

Penn.  Cavalry,  age  24. 

J'y  7/63 

U.  S.  A.     Oct.  5,  re-amp,  middle 

haem.)  Died  May  30,  '64  ;  exh'n. 

third.  Disch'dJune7/64.  Sprc*. 

236 

Bassheart,   W..    Pt.,    C, 

May  22, 

Loft;  circ.  A.  Surg.H.  M.Sprague. 

2602.  1336,  1529. 

116th  Pennsylvania. 

26,"  '63. 

U.S.A.    Died  .  I  une  1.  '63.    Spec. 

199 

Voorhees,  J.  K.,  Pt.,  G, 

May  3. 

Left;  flap.     Haem.     Disch'd  Oct. 

1624. 

107th  N.  York,  age  18. 

10,  ''63. 

7.  1863. 

237 

Baxter.  S..  Serg't,  I.  68th 

April  1,  i  Right;  circ.  skin  flap  and  circ.  of 

200 

Walker.  N.  J.,  Pt.,  C, 

July  12, 

Right  :  circ.  Surg.  A.  F.  Sheldon, 

Col'd  Troops',  age  23. 

12,  '65.        miis.    Sursr.  F.  E.  Piquette,  86th 

43d  N.  Carolina,  age  30. 

16,  ''64. 

U.  S.  V.     Released  July  5,  1865. 

C.  T.     Hasm.;  lig.  fern,  artery. 

Spec.  2879. 

Died  June  2,  '65;  exhaustion. 

201 

Walls.  D.,  Pt.,  —  ,  18th 

Jan.  3, 

Left.     Surg.  C.  J.   Walton,  21st 

238 

Bearlev,  J.  11..  Serg't.  I. 

Sept.  1, 

Right.     Surg.   W.   11.   Matchett. 

Florida. 

6,  '63. 

Kentucky.     Recovered. 

101st  "Ohio. 

8,  '64.          4(Mh  Ohio.  ~  H;em.:  lig.  femoral 

202 

Walsh,  P.,  Pt.,  A,  69th 

June  3, 

Left  (June  3,  exc.  tib.);  ant.  post. 

artery.     Died  Oct.  31.  1864. 

New  York,  age  29. 

9,  '64. 

flap.     A.  A.  Surg.  Riter.     Nee. 

239 

Bechtel.W.H.,  Corp'l.  A.     Oct.  ID.     Ri^hti  double  flap.     Surg.  R.W. 

bone  rem'd.    Disc'd  Sept.  20.'65. 

22d  Iowa,  age  23.            Nov.3,'i;-l.      Pease,  U.  S.V.  Died  Nov.  12/64. 

203 

Waman,  G.  W.,  Pt.,  E, 

Mar.  26, 

Right  ;    circ.     Disch'd  July   15, 

240 

Bennett,   H.,  Corp'l,  G, 

May  7,      Right:  flap.     Surg.  D.  W.  Bliss, 

47th  Ohio,  age  23. 

29,  '65. 

1865. 

6th  Maine,  age  20. 

14,64.         1'.  S.  V.     Pvrrmia.     Died  June 

204 

Ward,  G.  15..  Capt.,  K, 

May  3, 

Left.     Surg.  H.  W.  Ducachet,  II. 

•4.  1864.     Spec.  2272. 

14th  Indiana. 

30,  <<>3. 

S.  V.     Disch'd   Aug.  17,    1863. 

241 

Bettler,  P..  Pt.,  II.  9th   'April  30,    Left.  May  22  re-amp    Died  June 

Spec.  1191. 

Wisconsin.                        iM'y3/64.      21,  1864. 

205 

Ward,  J.H.,—  .B,Gobb's 

Sept.  14, 

Left  ;  flap.     Transferred  Decem 

242 

Bishop.  C.  C.,Pt.,  M,  8th     June  3.      Left  :  ant.  post.  flap.     Died  June 

Georgia  Legion. 

Oc.14/62 

ber  5,  1862. 

N.  Y.  H.  Art'y,  age  17. 

6.  '64.         26,  1864;  exhaustion. 

'WAGNER  (C.),  Report  of  Interesting  Surgical  Operation.*,  etc.,  p.  15.  MORTON  (T.  G.),  On  Amputation  at  the  Hip  Joint,  etc.,  in  Am.  Jour,  of 
the  Med.  Sciences,  Ar.  S.,  1866,  Vol.  LII,  p.  32.  PACKARD  (J.  H.),  On  Amputation  at  the  Hip  Jnint,  in  Xew  York  Med.  Journal,  1866,  Vol.  II,  p.  161. 
Circular  6,  S.  G.  O.,  1865,  pp.  49,  50.  Circular  7,  S.  G.  O.,  1867,  pp.  49,  65 


SECT.  JII.] 


INTERMEDIARY    AMPUTATIONS    OF    THE    THIGH. 


297 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AOE. 

DATES. 

OPERATION'S,  OPEHATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

243    Bissell,  A.  E.,  Corp'l,  I, 

July  23, 

Right.     (Spiculae  rem'd.)     Died 

278 

Clutz,  G.  W..  Pt.,  G,  83d 

May5, 

Left;  circ.  A.A.Surg.C.T.Traut- 

9th  N.  Hnmp..  age  23. 

26,  '64. 

October  8,  '64  ;  amputation 

Penn.,  age  23. 

19,  '64. 

man.     Died  Mav  25,  '64  ;  exh'n. 

244    Blackburn,  J.,  Corp'l.  K. 

Dec.  7, 

Right;  ant.  post.  flap.     A.  Surg. 

Spec.  3044. 

20th  VVis.,  age  22. 

11,  '62. 

J.  F.  Bruner,  7th  Mo.  Cavalry. 

;279 

Clyde,  C.,  Pt.,  I,  150th 

July  l, 

Right.    Surg.  P.  A.Quinan,  1  ">0th 

Died  Dec.  18,  '62;  haemorrhage.   I 

Pennsylvania. 

15/63. 

Pa.  Died  July  17.  '63.  Spec.1481. 

245    Blackmer.  C.  11.,  Pt.,  A, 

June  16, 

Left;  circ.     A.  A.  Sr.rg    M    F.     280 

Cole.  B.  W.,  Corp'l,  K, 

Dec.  13, 

Left  ;  circ.     Surg.  E.  Bentlev,  U. 

21st  Mass..  age  20. 

22,  '64. 

Prince.  Died  July  1,'U4  •  asihen. 

16th  Maine. 

21,  '62. 

S.  V.    Died  Dec.  27/62;  pyaem. 

24r,    Bloomer,  J.,  Pt.,  K,  170th 

Aug.  25, 

Right;  flap.  Surg.  N.  R.Moseley, 

Spec.  609. 

New  York,  age  44. 

Se.  18,V>4. 

U.  S.  V.     (Gang.    Sept.  12    ex.     281     CoJUns,   A.   D..    —,    H, 

Sept.  14, 

Left.     Dr.  Halsey.     Died  Oct.  2, 

fib.;   lig.  post,  tib.;    haem.     lig.  !| 

17th  South  Carolina 

27,  '62. 

1662.     Spec.  816. 

femoral.)     Died  Sept    2i  .1864; 

282 

Conner,  W.,  Pt.,  B,  llth 

Dec.  13, 

Left  ;  flap.    Surg.  J.  S.  DeBenne- 

cons'lirritab'y.  S/)cc*.T2:iH  3269. 

Pennsylvania  Res. 

19,  '62. 

ville,  1  1th  Penn.  Reserves.  Died 

247 

Bowers,  J.A.,  Pt..C.15th    Sept.  14. 

:  circ.;  gang.;  flaps  sloiiif  led. 

Jan.  2,  1863. 

S.  Carolina,  age  18. 

20,  '62. 

Died  Nov.  l>.  1862    pypniia. 

283 

Conroy.  D.,  Pt.,  D,  62d 

June  1, 

Right  ;  circ.   (mortification).     A. 

248 

Bowker.  J.,  Pt.,  B,  45th 

June  3, 

Right:  ant.  post.  fl*p.     Surg.  R. 

New  York,  age  23. 

6,  '64. 

A.  Surg.  J.  H.  Thompson.  Died 

Penn.,  age  25. 

8,   '64. 

B.  Bontecou,  1'.   S.  V.      Died 

June  22,  1864;  pyaemia. 

June  12,  1864;  exhaustvm. 

284    Coinvay,  T.,  Pt.,  I,  33d 

May  3, 

Left.     Died  June  4,  1863. 

249 

Bowser,   J.    F.,  Pt.,  B.     Mar.  30, 

Right  :  circ.    A.  A.  Surg.  Geo.  I'. 

New  York. 

-,  r63. 

llth  Penn.,  age  18.          |  April  11, 

llanawalt.   Haem.  recurred  ;  lig. 

285 

Coot,  J.,  Lieut.,  F,  10th 

Mav  5, 

Left  ;  flap.    Ass't  Surg.  J.  S.  Bill 

1865. 

fern.  art.     Died  May  21  ,  '65    py 

Alabama,  age  26. 

20,  '62. 

ings,  1'.  S.  A.     Diarrh.;  haem.; 

aemia.     Autopsy.     Spec.  1426. 

lig.     Died  May  25,  '62  ;  diarrh. 

250 

Bowyer,  H.L.,Capt.,  H, 

May  16, 

Right  (abscesses).    Died  Jiuie  13, 

286 

Corey.   O-  M.,    Pt.,    H, 

Oct.  19, 

Right  ;  ant.  post.  flap.  A.  A.  Snrg. 

31st  Illinois. 

23,  '63. 

lHt>3.   Haemorrhage.  Sprc.  1486. 

114th  N.  Y.,  age  21. 

29,  '64. 

W.  Kempster.     (Oct.  19,  amp. 

251 

Brandon,  E.  C..  Pt.,  K. 

May  10, 

Right;  circ.;  haem.:  lig  tem.  art. 

leg.;  haem.):  sloughing.      Died 

14th  Virginia,  age  23. 

19   '64. 

Died  June  24,  '64  ;  exhaustion. 

Nov.  11.  1864. 

252 

Brasier,  J.  P.,  Pt.,  C!75th    Avig.  30, 

Right.    A.A.Surg.H.  J.  Bigelow. 

287 

Correll,  L.,  Pt.,  G,  67th 

Sept.  19, 

Left:  modified  flaps.    A.  Surg.  J. 

Ohio.                                 Se.  —  ,'02. 

Necro.    Died  Dec.  12,'62:  exh'n. 

Penn.,  age  19. 

27,  '64. 

G.  Thompson,  77th  N.Y.    (Gan 

253 

Brassington,  J.,  Pt.,   H,     May  13, 

Left  ;  circ.    A.  Surg.W.  F.  Norris, 

grenous.)     Died  Sept.  27,  1864; 

9(ith  Penn.,  age  33.          ;    30,'  '64. 

U.S.A.    Recurrent  ham.    Died 

exhaustion. 

June  7.  '64;  exh'n.     Spec.  3539. 

288 

Cox,  W.  T.,  Pt.,  G,  8th 

April  9, 

Right  ;  circ.    A.Surg.  A.Hartsuff, 

254    Brennan,  J.,  Capt.,  A, 

Oct.  27 

Right,   Teale's  method.     A.    A. 

Illinois,  age  40. 

14,  '65. 

U.S.A.    (Gang.)    Died  May  5, 

Kith  Virginia,  age  29. 

Nov.  25, 

Surg.  C.  Eberhardt.    Died  Nov. 

1865  ;  profuse  haemorrhage. 

1*64. 

25,'64.     Autopsy.     Spec.  '.'A'.'S. 

289 

Crassen.   L.  M.,  Pt.,  L, 

June  6, 

Left  ;  circ.     Died  August  15,  '64. 

255 

Brenning,  C.  F.,  Corp'l, 

Oct.  14, 

Left  ;  bi-lat.  flap.     A.A.  Surg.  F. 

7th  N.Y.  H.  A.,  age  22. 

10,  '64. 

F,  49th  Ind  ,  age  25. 

21,  '64. 

llassenburg.      (Erysip.)      Died 

290 

Crawford,  J.  J.  S.,Pt..D, 

April  1, 

Right  ;  circ.    A.  Surg.W.  F.  Nor 

three  hours   after;   exhaustion. 

91st  New  York,  age  23. 

8,  '65. 

ris,  U.  S.A.     Died  April  14,'65  ; 

Autopsy.     Spec.  3740. 

exhaustion.     l?pr.c.  2963. 

256 

Briscoe.  M.,  Pt.,G,  155th 

June  3, 

Left.    Surg.  Gen.  A.  Garcelon,  of 

291 

Crawford,  W.  E.,  Pt.,  I, 

Mav  12, 

Left  ;  circ.     Surg.  N.  R.  Moseley, 

New  York,  age  42. 

8,  '64. 

Maine.    Haem.:  lig.  fern,  artery. 

5th  N.  Carolina,  age  32. 

23,'  '64. 

U.S.V.  Three  ins.  of  fern,  rem'd. 

Died  June  16,  1864:  haemorrh. 

Died  June  17,  '64.     Specs.  2563, 

257 

Brooks,  E.,  Pt.,  B,  188th 

June  3, 

Right  :  circ.    Surg.  O.  A.  Judson, 

4761. 

Penn.,  age  21. 

13,  '64. 

U.  S.  V.     Died  June  23,  1864; 

292 

Crocraft.  S.,  Pt.,  B,  121st 

Mar.  13, 

Right  ;  flap.     Surg.  N.  Gray,  U. 

pyaemia.    Autopsy.    Spec.  2941.  |l 

Col'd  Troops,  age  18. 

24,  '65. 

S.  V.     Died  April  6,  1865. 

258 

Brown,  JV.,  Pt.,  E,  56th 

JulyS,     —  -.    July  10,  lia-in.     Died  July 

293 

Cronin,  P.,  Pt.,  K,  20th 

June  30, 

;  lat.  flap.     Surg.  R.  B.  Bon- 

Virginia. 

9,  '63.         11,  1863;'  loss  of  blood. 

Massachusetts. 

J'y22,'62. 

tccou.U.S.V.    Died  July  24.  "62. 

259 

Bruen,  L.  B.,  Major,  12th 

May  13,    Left  :  circ.  A.  Surg.W.  Thomson. 

294 

Crossan,  A.,  Pt.,  E,  34th 

July  24, 

Left;  circ.    A.A.Surg.G.M.Paul- 

Infantry,  age  42. 

22,'  '64. 

11.  S.  A.    May  25.  erysip.    Died 

Ohio,  age  32. 

Aug.  3, 

lin.    Died  Aug.  24,  '64  :  pyaemia. 

June  21,  '64:  pyaem.    Spec.  3594. 

1864. 

A  utopsy. 

260 

Bubier,  F.,  Pt.,  G,  llth 

Aug.  14,    Left;  circ.    A.A.  Surg.  R.  O.  Sid- 

295 

Crowley,  P.,Serg't,G,lst 

June  20, 

Left;   flap      A.  A.  Surg.  F.  H. 

Maine,  age  20. 

21,  '64. 

ney.     Died  Sept.  13,  '64  ;  irrita 

Mass.  'Heavy  Artillery, 

July  11, 

Getchell.     (Erysipelas.)     Died 

tive  fever. 

age  23. 

1864. 

July  11.  1864.    Spec.  3662. 

261 

Bunnell,  J.,  Pt.,  D,  i'tli 

June  16,  i  Right.     Died  June  30,  1864. 

296 

Cummins,  A.  H.,  Pt.,  K, 

Dec.  13, 

Right.     Surg.  H.  Bryant,  U.  S.V. 

Indiana,  age  20. 

—  ,  '64.   ! 

34th  N.  York,  age  25. 

26,  '62. 

Ha?m.;  lig.  fern.  art.     Died  Jan. 

262 

Burdick,  W.  ('.,  Pt.,  G, 

Dec.  13,     Left.     Surg.  C.  S.  Wood,  66th  N. 

25,  '63:  exh'n.  Autop.  Spec.  589. 

7th  Rhode  Island. 

21.  '62. 

Y.     Died  Dec.  26,  1869. 

297 

Cunningham,  J.,  Pt  ,  I, 

Mav  12. 

Left  :  ant.  post,  flap  ;  haemorrhage. 

263 

Burke,   P.,  Pt.,  G,   10th 

Aug.  30, 

Right  :  haem.;  lig.  femoral  artery. 

13th  Georgia,  age  26. 

15,'  '64. 

Died  June  14,  1864  ;  exhaust  n. 

Infantry.                            iSe.ll.'62. 

Died  Sept.  14,  '62;  exhaustion. 

298 

Cupp,  W.,  Pt.,  A,  44th 

Aug.  31,    .     Died  September  30,  1862. 

264 

Burnett,  C..  Pt.,  C,  6(!th 

July  2, 

.     Surg.  «.'.  S.  Wood,  66th  N. 

New  York. 

Se.  —  ,'62. 

New  York. 

7,  '63. 

York.     Died  July  10.  1863. 

299 

Daggett,  S.W..Capt.,  B, 

June  18, 

Right:  ant.  post,  flap;  circ.  sect. 

265 

Burnliam,  II'.,  Serg't.  G, 

Oct.  19,     Right;    flap.      Surg.  A.  Chapel, 

1st  Me.  H.  A.,  age  32. 

27,  '64. 

muscles.     A.  Surg.  W.Webster. 

8th  Louisiana,  age  35. 

Nov.  5, 

IT.S.V.    (Gang.;  h;em  :  lig.  pop 

U.  S.  A.     Died  July  1,    1864; 

1864. 

liteal  art.)     Died  Nov.  14,  1864  ; 

exhaustion.    Spec.  2261. 

exhaustion. 

300 

Daily,  T.,  Serg't,  A,  63d 

Sept.  17, 

Left.    Surg.  H.  S.  Hewit,  U.  S.V. 

266 

Burrell,  J.,  Captain.  A, 

Oct.  19, 

Right  ;  circ.  A.Surg.J.G.  Thomp 

New  York. 

Oct.  3.  '62. 

Died  Oct.  8.  1862.     Spec.  448. 

121st  New  York. 

22,  '64. 

son,  77th  N.Y.  Hsem.  Died  Oct. 

301 

Dall,  J.  H.,Pt.,  H,  77th 

Sept.  1, 

Right;  circ.     A.  A.  Surg.  D.  H. 

30.  '64:  exhaustion.    Spec.  3V84  . 

Penn.,  age  23. 

15,  '64. 

Bell.     Recurrent  haemorrhage. 

267 

Butcher,  J.   S.,  Pt.,    F, 

Dec.  15, 

Left  thigh.     Died  January  9,  '65. 

Died  Sept.  26,  1864. 

100th  Illinois,  age  :!0. 

20,  '64. 

302 

Davidson,  J.,  Pt.,  G,  1st 

Mar.  31, 

Left.    Surg.  E.  Griswold,  U.  S.V. 

268 

Butler,    P.,    Pt.,    I,   7th 

Oct.  27,     Left.     A.  Surg.  J.  H.  Kinsman, 

Mich.  Cavalry,  age  21. 

Apr.7,'65. 

Died  April  8,  1865. 

Col'd  Troops.  age,  23. 

No.ll,  '64.      1'.  S.  A.     Died  Nov.  15,  1864. 

303 

Davis.  L.  T.,  'Pt.,  B.  3d 

Aug.  19, 

Right  :  double  flap.     A.  A.  Surg. 

26!)    Call,  J.,  Pt.,  !•:,  3d  Mich 

Aug.  30,    Left;  ant.  post.  don.  flap.     Ass't 

W.  Virginia   Cavalry, 

29,  '64. 

E.  K.  Deemy.   (Necrosis.)  Died 

igan. 

Sep.2,'62. 

Surg.  T.  G.  Mackenzie,  U.  S.  A. 

age  21. 

October  4,  1864  :  exhaustion. 

Died  Sept.  8,  1862. 

304 

Davis,   T.,  Pt.,  F,  25th 

Jan.  15, 

Right;    post.  flap.     A.  Surg.  J. 

270    Carlton.C.  C..Pt.,  B,  1st 

May  7, 

Left:  circ.     Surg.  N.  R.  Moseley. 

South  Carolina. 

Feb.  2. 

Vansant,  U.  S.  A.     Died  Feb.  9, 

Massachusetts,  age  35. 

22,  Y>4. 

U.  S.  V.     Haem.;  lig.  prof,  art'y; 

1865. 

1865;  pyaemia. 

recurrent  lupm.     Died  May  30, 

305 

Davis,  W.  E.,  Capt.,  B, 

Nov.  7, 

Right  :  circ.     A.  Surg.  W.  Thom 

1864;  haemorrhage. 

30th    North    Carolina, 

10,  '63. 

son.  U.S.  A.    (Gang.)  Died  Nov. 

271 

Carney,   C.,  Pt.,  C,   1st 

Sept.  14, 

Right.  Surg.  II.  S.  Hewit.U.S.V. 

age  25. 

22.'63;trism.  Autop.  Spec.  2236. 

Pennsylvania  Res. 

26,  '(12. 

Died  Oct.  17.  '62.     Spec.  376. 

306 

Dawson,  F.,  Bugler,  I, 

Oct.  19, 

Left  ;  flap,   skin  ;   circ.   muscles. 

272    Carrier,  M.  II..  Serg't,  E, 

May  27. 

Left.     (June  8,  excis.  humerus.) 

1st  Cavalry,  age  24. 

22,  '64. 

Surg.  W.  A.  Barry,  98th  Penn. 

25th  Connecticut. 

Je.  12,  '63. 

Died  June  15,  '63.     Spec.  1311. 

Ho?m.  recur'  d  :  slough  'g.    Died 

273    Carter,  J.,  Pt.,  H,  1st  W. 

June  18. 

Tiight;  circ.     A.A.  Snrg.  W.  H. 

Nov.  9,  '64  ;  exh'n  from  haem. 

Virginia  Cav.,  age  20. 

J'y4,'64. 

Phillips.      Died  July  9,    1864; 

307 

Decker,  N.,  Pt.,  C,  125th 

Sept.  17, 

Right.     Died  October   17,  1862. 

exhaustion. 

Penn.,  age  45. 

Oct.  6,  '62. 

Spec.  4827. 

274 

Christian,   S.  J.,  Pt.,  I, 

Dec.  7. 

Left:  ant:  post.  flap.     A.  Surg.  J. 

308 

DeCoureey,  G.,  Pt.,  F. 

Mar.  20, 

Right    (gangrene).      Died   April 

26th  Indiana,  age  20. 

12,  '62. 

F.  Bruner,  7th  Missouri  Cav'ry. 

101st  Indiana. 

—  ,  '63. 

•24,  1863. 

Died  Dec.  16,  1862. 

309 

Dener,    C.,  Pt.,    D,    6th 

June  3, 

Right   (June  12,  haem.:  lig.  ant. 

275    Claflin,  W.  X.,    Pt.,  G, 

May  3. 

Right,     Died  May  20,  1863. 

Conn.,  age  32. 

14,  '64. 

tib.  art.;  13,  ex.  piece  shell):  circ. 

6th  Vermont. 

18,  '63. 

A.A.  Surg.  S.  Coloosdian.    Died 

276  ;  Cleaver.  A.  R.,  Pt.,   A, 

June  1, 

Right  :  ant.  post.  flap.    Surg.R.B. 

June  18,  1864:  exhaustion. 

188th  Penn.,  age  18. 

19,  '64. 

Bontecou,  U.  S.  V.     Died  June 

310 

Dickey,  L.  W.,  Pt.,  G, 

June  21, 

Right;  circ.   Surg.  A.  F.  Sheldon, 

26,  1  864  :  typ.  fever,    Spec.  3060. 

40th  N.  Y.,  age  28. 

29,  '64. 

U.  S.  V.     Died  July   8,   1864  ; 

277    Clinton,    O.,  Pt.,  O,   2d    Sept.  19. 

Right:  skin   flap:   circ.  muscles. 

pyaemia. 

Conn.  Artillery,  age  111.      24,  '64. 

Surg.  \V.  A.   Harry,  98th  Penn. 

311 

Donnelly,  R.,Pt.,  A,  25th 

Aug.  30, 

Right;  flap.  Surg.  J.  E.  Summers, 

| 

(Erysipelas);  sloughing.     Died 

Ohio. 

Sept.  5, 

U.S.A.    Died  Oct.  20,'62;  osteo 

Nov.  15,  1864.     Autopsy. 

1862. 

myelitis.     Spec.  319. 

SURG.  111—38 


298 


INJURIES    OF    THE    LOV/KR    EXTREMITIES. 


ICIIAP.  x. 


NO 

NAMK,  MILITABY 
DESCRIPTION  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

312 

Doty,  N.,  Pt.,  E,  102d 

Sept.  19, 

Left  ;  oval  flap.     A.  A.  Surg.  T. 

343  I  Flammer,  T.,  Pt.,A,12th 

July  9, 

Right  ;  circ.     A.  A.  Surg.  W.  S. 

Penn.,  age  23. 

28,  '64. 

J.  Dunott.  Pytemic  chills.  Died 

Penn.  Cav.,  age  50. 

24,  ''64. 

Adams.     Hasm.  recur'd.     Died 

Nov.  7,   1864.     Autopsy.  Specs. 

Aug.  3,  1864;  exh'n.    Autopsy. 

1562,  3944. 

Specs.  3812,  3958. 

313 

Dougherty,  J.H.,Pt.,G, 

June  6, 

Right.     Surg.  W.  Watson,  105th 

344 

Flanders,    A.,    Pt.,    4th 

Aug.  16, 

Left  (slough'g;  necrosis).     A.  A. 

66th  N.  York,  age  35. 

9,  '64. 

Penn.     June  20,  luem.;  21st,  re 

New  Jersey  Artillery, 

Sept.  12,       Surg.G.A.Chesley.    Died  Sept. 

curred  ;  lig.  fem.  art.   Died  June 

age  43. 

1864. 

15,  1864  ;  luemorrhage. 

29,  1864  ;  pyaemia. 

345 

Fliegi,  H.,  Corp'l,  F,  7th 

Sept.  17, 

Right.     Hsem.     Oct.  11.  lig.  fem. 

314 

Dougherty,  M.,  Pt.,  E, 

Sept.  19, 

Left  ;  ant.  post.  flap.    A.  Snrg.  J. 

Michigan. 

Oct.  9,  '62.     art.     Died  Oct.  18,  1862. 

49th  Penn.,  age  35. 

26,  '64. 

G.  Thompson,  77th  N.  Y.     Nov. 

1346 

Flynn,   M.,  Pt.,  L,  21st 

July  16, 

Right;  circ,     A.  A.  Surg.  A.  R. 

4,  bone  reui'd;  hiem.;  lig.  fem. 

N.  York  Cav.,  age  19. 

Aug.  2, 

Gray.     Sloughing.     Died  Aug. 

art.    March  19/65.  lig.  fem.  art.; 

1864.          18,    1864;   pyiemia.      Autopsy. 

25,  lig.  ex.  iliac  art.     Died  April 

Specs.  3835,  3967. 

8,  18t>5.     Autopsy. 

347 

Folunsbee,  C.  M.,  Pt.,  B, 

Dec.  6, 

Right  ;  ant.  post.  flap.  A.  A.  Surg. 

315 

Douw,  J.  D.  P.,Capt.,K, 

Oct.  19, 

Right  ;  semi-lunar  Haps.  A.  Surg. 

157th  N.  York,  age  16. 

9,  '64. 

W.  Balser.      Sloughed  :    haein. 

121st  New  York. 

22,  '64. 

W.  G.  Bryant,  122d  Ohio.    Died 

Died  Dec.  26,  '64  ;  hectic  fever. 

Oct.  26,  1864;  exhaustion. 

348 

Foorhee.    W.    F..  Pt..  I, 

May  19,     Left  (gangrene);  circ.  A.  A.  Surg. 

316 

Doverspike,   H.,  Pt.,  I, 

June  1, 

Right.     A.  A.  Snrg.  C.  Curvullo. 

14th    North    Carolina, 

Je.'l.'64.:     II.  M.  Dean.     Died  June  17,  '64  ; 

82d  Penn.,  age  33. 

8,  '64. 

Died  June  i:t,  I86-).     N/w-c.  C01. 

age  22. 

fxlimistion. 

317 

Dow,  J.  M.,  Pt.,  E,  12th 

Juno  3,     Right:    lat.   flaps.     Surg.    N.   R.  ,  :j.]9    Forrester,  S.,  Corp'l,  E, 

S<>pi.  19, 

Lett:  modified  flaps.    A.  Surg.  J. 

New  Hamp.,  age  20. 

20,  '64. 

Moseley,   1'.   S.  V.     Died  July 

67th  New  York,  age  37. 

24.  '64. 

G.  Thompson,  77th  N.Y.     Phle 

7,  1864. 

bitis.     Died  Oct.  13/64;  pyaem. 

318 

Doyle,  E.,  Pt.,  F,  3d  Vt, 

May  10, 

Right  ;  ant.  post,  flaps.    A.  Surg. 

Autopsy.    Spec.  3273. 

age  28. 

15,  '64. 

A.  Delaney,  U.S.V.     Died  May 

350 

Foster,  R.,  Capt.,  E,  1st 

May  12, 

Left  ;  circ.    A.  A.  Surg.  F.  H.  Col- 

17,  1864;  exhaustion. 

New  Jersey,  age  39. 

27,  '64. 

ton.  Haem.;  lig.;  slough'g.  Died 

319 

Driseoll.C.,  Bugler,  14th 

Mar.  12, 

Right  (sloughing;  luem.);  bi-lut. 

June  14,  '64:  exh'n.   Spec.  3956. 

N.  Y.  Cavalry,  age  17. 

22,  'bo. 

flaps.     A.  A.  Surg.  F.  Banies. 

351 

France,  J.,Serg't,A,20th 

Dec.  7, 

Left:  flap.    A.  Surg.  J.  J.Sanders, 

Died  April  3,  1865;  pyaemia. 

Wisconsin,  age  25. 

10,  '62.   |     1st  Iowa  Cav.    Sloughed.    Died 

320 

Duffin,  M.,  Sergeant,  D, 

July  30, 

Right  ;  oval  flap.    Surg.  C.  Page, 

Dec.  21,  1862;  haemorrhage. 

29th  Col'd  Troops. 

Aug.  21, 

U.S.A.     Died  Aug.  31,  '64;  loss 

352 

Galawa//.  E.,  Pt.,  B,  2d 

May  16,     (gangrene);  circ.  Diedjune 

1864. 

of  blood  and  disc,  of  lung.    Auto. 

South  Carolina,  age  22. 

23,  '64.         15,1864;  pyaemia.     Autopsy. 

321 

Dunn,  J.,  Pt.,  Georgia 

Sept.  20, 

;  circ.     Died  Nov.  1,    1863; 

353 

Gallaher,  E.,Pt.,A,l  19th 

May  3,      Right;  ciro.     Surg.  R.  Reyburn, 

Sharpshooters. 

23,  '63. 

exhaustion. 

New  York,  age  17. 

27,  '63. 

U.S.V.     Died   June  20,    1863; 

322 

Dunsmore,  D.  F.,  Serg't, 

May  5, 

Right  ;  circ.     Died  Oct.  1,  1864. 

pyaemia.     Spec.  1601. 

G,  147th  N.  Y.,  age  20. 

31,  '64. 

354 

Gans,  E.,  Serg't,  E,  46th 

Aug.  19, 

Left;   circ.     A.   A.  Surg.  E.  P. 

323 

Durkee,  M.  B.,Curp'l,  E, 

Mar.  29, 

Left;  circ.     A.  A.  Surg.  J.  Wins- 

New  York,  age  20. 

31,  '64. 

Fitch.     Died  Oct.  1,  '64;  hectic 

185th  N.  York,  age  22. 

April  3, 

low.    Died  May  5,  1865;  pyaem. 

fever. 

1865. 

Autopsy.     Spec.  162. 

355 

Garble,   C.,   Pt..   G,   3d 

June  17, 

Right  ;  oval  flap.     A.  A.  Surg.  W. 

324 

Eaton,  C.  A.,  Pt.,  K,  39th 

May  9, 

Right  (May  12,  exe.  fibula  ;  17th, 

Maryland,  age  21. 

24.  '64. 

H.  Ensign.     Died  June  25,  1864. 

Mass.,  age  40. 

17,  '64. 

hu?m.);  ant.  post.  flap.    Surg.  A. 

Spec.  2392. 

F.  Sheldon,  U.  S.V.     Died  May 

356 

Gardiner,  P.,  Serg't,  K, 

Oct.  27,  i  Right  thigh.     Died  December  4, 

29,  1864;  exhaustion. 

21st  Penn.,  age  21.          No.26/64.1     1864. 

325 

Edwards,  B.,  Pt.,  D,17th 

May  5, 

Left;  ant.  post.  flap.    A.  A.  Surg. 

357 

Gay,  E.,  CorpM,  H,  18th     April  6,     (excision);  dou.  flop.    Surg. 

Vermont,  age  22. 

30,  ''64. 

C.  Eberhardt.   Gang.;  slough'g. 

Wisconsin.                             -,  '62.         E.  C.  Franklin,  U.  S.  V.     Died 

Died  June  13.  '64  ;  pyaemia. 

April  22,  1862  ;  pyaemia. 

326 

Edwards,  C.  H.,  Pt.,  C, 

May  16, 

Right  ;  double  flap.     Surg.  C.  B. 

358 

Geist,  L.,  Pt.,  E,  3d  Md.,     May  13, 

Left.     A.  A.  Surg.  F.  G.  1  1.  Brad 

24th  Virginia,  age  25. 

20,'  '64. 

Gibson,  C.  S.  A.     Died  May  31, 

age  21  . 

Je.  5/64. 

ford.     Died  June  22.  '64  ;  exh'n. 

1864  ;  gangrene. 

Spec.  2504. 

327 

Eldred,    H.,  Pt.,  E,  2d 

June  18, 

Left  (June  18,  amp.  leg.;  gang.); 

359 

Geller,  M.,  Pt..  D,  48th 

June  30, 

Left  :  ant.  post.  flap.     A.  A.  Surg. 

Sharpshooters,  age  27. 

J'yl,'64. 

ant.  post.  flap.    Surg.  R.  B.  Bon- 

New  York,  age  37. 

J'y4/64. 

T.  Liebold.     Sloughing;  haem.; 

tecou,  U.  S.  V.     Died  July   6, 

lig.  Died  Aug.  29/64  :  diarrhoea. 

1864;  tetanus. 

360 

}Gibsnn,  J.  ,1.,  —  ,  F,  7th    June  27. 

:  circular.     Died. 

328 

Ells,  J.,  Pt,,  C,  5lst  Illi 

Nov.  30, 

Left;  circ.     Surg.  J.  R.  Ludlow, 

Virginia. 

J'.v3/62. 

nois,  age  19. 

Dec.  19, 

U.S.V.     Hasm.     Died  Dec,  19, 

361 

Gilbert.  N.I/.,  Serg't,  F, 

July  20, 

Left  :  ant.  post.  flap.    A.  A.  Surg.  ! 

1864.         1864:  synovitis  and  pneumonia. 

58th  Virginia,  age  21. 

23,  ''64. 

C.  FI.  Ohr.     Died  Aug.  8,  1864. 

329 

Ellsworth.  C.W.,  Serg't, 

April  2, 

Left  ;  circ.     Died  May  18,  1865  ; 

Spec.  4272. 

B,  17th  Vt.,  age  33. 

6,  '65. 

exhaustion. 

362 

Gilkerson,    Hr.,   Pt.,    B,  '  Sept.  19, 

Left  ;  circ.     Surg.  E.A.  Brevard, 

330 

Emerson,  H.  S.,  Corp'l, 

May  19, 

Left  ;  circ.     A.  A.  Surg.  J.C.  Nel 

60th  Virginia. 

Oct.  18,        P.  A.  C.  S.     Died  Oct.  18,  1864  ; 

M,  1st  Maine  H'vy  Ar 

31,  '64. 

son.     Died  May  31,  '64  ;  exh'n. 

. 

1864. 

shock  of  operation. 

tillery,  age  32. 

Spec.  2469. 

363 

Gill,   B.  F.,  Pt.,   E,  7th 

Aug.  9, 

Left;  double   flap.     Surg.  J.  E. 

331 

Evans]  W.,  Pt.,  I,  10th 

July  27, 

Left  ;  circ.    A.  A.  Surg  C.T.  Bul- 

Ohio. 

15/62. 

Bummers,  IT.  S.  A.     Died  Aug. 

Connecticut,  age  21. 

Au.  1,'64. 

len.     Died  Aug.  18,  '64;  exh'n. 

29.  1862.     Spec.  39. 

£J2 

Evy,  R.,  Pt.,B,  1st  Mich. 

May  12, 

Right  (haem.);  circ.     A.  A.  Surg. 

364 

Gillinger.  J.,  Pt.,  K,  46th 

Aug.  9, 

Right  ;  ant.  post.  flap.  Surg.  J.  E. 

Sharpshooters,  age  28. 

27,'  '64. 

L.  C.  Dodge.     Died  June  6,  '64  ; 

Penn.,  age  29. 

15,  '62. 

Summers.  U.  S.  A.     Died  Sept, 

pyaemia.    Spec.  2357. 

15,  1862.     Spec.  48. 

333 

Ewing,  T.C.,  Pt.,  E,  31st 

June  22, 

Right  (bone  rem'd  ;  haem.):  circ. 

365 

Gilmore,  M..  Pt.,  D,  54th 

July  18, 

Left.     (23d.  excision  til).  ;md  fib.; 

Ohio,  age  18. 

July  18, 
1864. 

A.  Surg.  J.  M.  Brown,  U.  S.  A. 
Died  Au.  1,'64  ;  exh'n.  Jppcc.3389. 

;i,;t; 

Massachusetts. 
Glazier,  A.,  Corp'l,    B, 

27,"  '63. 
Aug.  25, 

mortificat'n.)     Died  July  27/63. 
Left  (Aug.  25,  patella  rem'd):  circ. 

334 

Exnor,  C.,—  ,  C,  1st  New 

Sept.  14, 

;  ciro.;  flaps  sloughed.    Died 

1st  Minnesota,  age  29. 

29,  '64. 

A.  A.  Surg.  D.  C.  Van  Slyck. 

Jersey. 

17,  '62. 

October  17,  1862. 

Died  Sept.  2,  1864;  gangrene. 

335 

F  ,  E.,  Private. 

Feb.  16. 

—  ;  circ.;  erysipelas  •  three  ins. 

367 

Glinney,  J.,  Pt.,  H,  81st 

De.13,'62, 

Right.    (Dec.  13,  amp.  leg.)    Died 

26,  '62. 

stump  rem'd.     Died   March  5, 

Pennsylvania. 

Ja.  1/63. 

Jan.  2,  1863;  shock  and  exh'n. 

1862;  exhaustion. 

368 

Golden',  0.  P.,—,  0.  1st 

Sept.  20, 

Right.     (Haemorrhage.)     Died  in 

336 

Fairchilds,  J.  O.,  Corp'l, 

Sept.  19, 

Left;  flap.     Surg.  W.  A.Barry, 

South  Carolina  Cav. 

Oc.19/63. 

ten  hours. 

K,  77th  New  York. 

23,  '64. 

98th  Penn.    Died  Sept.  —  ,  1864. 

369 

Gowan,    N.   P.,  Pt.,   C, 

July  1, 

Right,   Died  Sept.  25,  1863  ;  diar 

337 

Farrar,   G.    P.,    Pt.,  K, 

Mar.  29, 

Right  ;  ant.  post.  flap.     Surg.  N. 

150th  Penn.,  age  26. 

15,  ''63. 

rhoea. 

185th  N.  Y.,  age  20. 

April  5, 

It.  Moseley,  U.S.V.    Died  April 

370 

Graves,  L.  W.,  Pt.,  D, 

Oct.  29, 

Right.     A.  A.  Surg.  E.  G.  Waters. 

1865. 

10.  '65;  exhaustion.    Spec.  4040. 

1st  R.  Island,  age  19. 

Nov.  7, 

Died  Dec.  22,  1864  ;  exhaustion. 

338 

Farron,  A.  W.,  Lieut., 

July  3, 

Left.     Died  July  21,  1863  :  shock 

1864. 

Spec.  3430. 

8th  Georgia. 

21,  !63. 

of  operation.     Spec.  2048. 

371 

Green,  J.,  Pt.,   H,    82d 

June  1, 

Left.     Died  June  23,  1864. 

339 

Fayshon,  J.,  Pt.,  A,  57th 

May  5, 

Right;  circ.      Surg.  E.  Bentley, 

Ohio. 

-,  '64. 

Mass.,  age  23. 

25,  ''64. 

U.  S.  V.     Died  May   30,    1864  ; 

372 

Green,  J.  P.,  Corp'l,  D, 

Mav  6. 

Right  (haem.:  tourniquet  obstruct 

exhaustion. 

14th  Infantry,  age  25.     .   26,  '64. 

ing  yen's  ciroulat'n);  ant.  post. 

340 

Firth,  R.E.,  Pt.,  A,  157th 

Dec.  6, 

Left;  ant.  post.  flap.     A.  A.  Surg. 

flap.   Surg.  A.  F.  Sheldon,  U.S.V. 

New  York,  age  23. 

10,  '64. 

II.  Leaman.     Flaps  sloughed  ; 

Died  May  20,  1864  ;  exhaustion. 

haam      Died  Dec.  29,  1P64  ;  py- 

373 

Green,  W.  H.,  Serg't,  E,    Sept.  20, 

Left.     Died  October  21,  1863. 

semia.     Autopsy. 

26th  Ohio.                             —  ,  '63. 

341 

Fisher,  G.  A.,  Pt.,  K,  8th 

June  2, 

Right  ;  circ.  A.Surg.W.F.Norris, 

374 

Griffin,  L.  C.,  Corp'l,  D,     July  19,    Left.    Dr.  J.  Jones,  of  Richmond. 

New  York  H'vy  Art., 

15,  '64. 

U.S.A.    Haem.:  lig.    Died  June 

8th  North  Carolina.            22,  '64.        Died   Feb.—,  1865.     Autopsy. 

age  19. 

23/64  :py«e.  Autop.  Spec.  3563. 

Spec.  3141. 

342 

Fitch,  P.,   Pt.,    E,  61st 

April  7, 

Left  ;  ant.  oval  skin  flap.  A.  Surg. 

375 

Grubbs,   D.  A.,   Serg't,     May  3,      Left.    A.  Surg.E.J.  Marsh,  U.S.A. 

New  York,  age  34. 

18,  '65. 

W.  S.  Ely,  U.  S.  V.      Slough  'g  ; 

H,  95th  Penn.                       -,  1;3.     i     Died  Mav  31,  1863.     Spec.  1078. 

pyaemia.     Died  April  26,   1865. 

376 

Gujnn,  E.,  Pt.,  B,  138th      July  9,      Left  ;  circ.';  hapm.;  poplit'l  artery 

Spec.  4099. 

Penn.,  age  21.                  :    12,   64.        lig.     Died  July  22,  '64  ;  pyuem. 

1  SMITH  (E.  H.),  Report  of  Gates  of  Compound  Comminuted  Fracture  of  Femur,  etc.,  in  Confed.  States  Afed,  and  Surg.  Jour.,  1864,  Vol.  I,  p.  24. 


SECT.  III.] 


INTERMEDIARY    AMPUTATIONS    OF   THE    THIGH. 


299 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

377 

Hadm,  E.   R.,   Pt.,  F, 

May  10, 

Left  ;  circ.  A.  A.  Surg.  C.  P.  Big- 

410 

Hynes,  J.,  Pt.,  F,  18th 

May  25, 

Right.     (Gang.)     A.  Surg.  C.W. 

4th  Virginia  Cavalry, 

18,  '64. 

elow.    Died  May  25,  '64.    Spec. 

Infantry. 

June  16, 

Lawrence,  22d  Mich.    June  19, 

age  22. 

2289. 

1864. 

gang.;  bone  rem'd.     Died  June 

378 

'Haggerty,  F.,  Pt.,  G, 

Dec.  13, 

Right  ;  flap.    Died  Dec.  30,  1  862  ; 

22,  1864. 

14th  Indiana,  age  35. 

27,  '62. 

exhaustion. 

411 

Irvin,  R.,  Capt.,  B,  77th 

Jan.  11, 

Left.     Surg.  A.  H.  Hoff,  U.  S.  V. 

379 

Haldron,  J.  W.,  Pt.,  A, 

Nov.  9, 

;  circ.    Died  Nov.  21,  1864  ; 

Illinois. 

15,  '63. 

Died  Jan.  17,  1863.    Spec.  1490. 

17th  Va.  Cavalry, 

13,  '64. 

gangrene. 

412 

Jay,  J.  C..  Pt.,  K,  19th 

Dec.  7, 

Left  ;  circ.     Surg.  T.  W.  Florer, 

380 

Hammond,   A.,   Pt.,  H, 

April  2, 

Left  ;  circ.   A.  Surg.  W.  F.  Norris, 

Iowa,  age  18. 

11,  '60. 

26th  Ind.    Flap  sloughed.  Died 

lllth  N.  York,  ago  47. 

6,  '65. 

U.  S.A.  Haem.;  lig.    Died  April 

June  11,  1663;  pyaemia. 

16,'65;  pyaem.  Autop.  Spec.2652. 

413 

Jenkins.  J.  H.,  Serg't,  B, 

Feb.  25, 

Left  ;  circ.    Surg.  F.  Salter,  U.  S. 

381 

2  Hang,  G.,  Pt.,  G,  2d 

May  31, 

Right  ;  circ.     A.  A.  Surg.  C.  H. 

89th  Ohio,  age  24. 

29,  '64. 

V.     Sloughed.    Mar.  12,  ham.; 

Artillery,  age  27. 

June  14, 

Osborne.    Haem.    Died  June  21, 

lig.  profunda  artery.     Died  Mar. 

1864. 

1864  ;   pyaemia. 

16,  1864  ;  pyaemia. 

382 

Harding.  W.,Pt.,  B,  58th 

Sept.  29, 

Right  ;  flap.     A.  A.  Surg.T.  Hop 

414 

Johnson,  A.,  Pt.,  G,  91st 

April  1, 

Left  :  circ.  A.  A.  Surg.  T.  O.  Ban 

Pennsylvania,  age  22. 

Oct.  6,  '64 

kins.    Died  Oct.  6,  1864  ;  shock 

New  York,  age  27. 

9,  '65. 

nister.     Died  April  27,   1865; 

of  operation. 

pyaemia.    Spec.  4050. 

383 

Harouff,  J.,  Pt..  D,  56th 

Mar.  30, 

Right;  circ.     Died  April  29,  '65; 

415 

Johnson,  F.,  Pt.,  A,  10th 

Aug.  25, 

Right  :  lat.  flap.   Surg.N.R.Mose- 

Penn.,  age  27. 

Ap.25,'65. 

exhaustion.     Spec.  4106. 

New  York,  age  45. 

30,  '64. 

ley,  U.  S.  V.     Died  Jan.  23,  '65  ; 

384 

Harris,  W.  H.,   Pt.,  A, 

Mav  3, 

Left.     Died  May  14,  1863. 

exhaustion.    Spec.  1991. 

12th  New  Jersev. 

8,  '63. 

416 

Johnson,  L.,  Pt.,  B,  99th 

May  12, 

Left  ;  circ.     A.  A.  Surg.  F.  G.  H. 

385 

Harvey,  B.,  Pt.,"  A,  3d 

Sept.  20, 

Right  ;  circ.     Died  Oct.  21,  1863. 

Penn.,  age  21. 

SO,  '64. 

Bradford.     Died  May  25,  1864. 

Kentucky. 

Oct.  -,'63. 

417 

Johnson,  P.  L.,  Pt.,  D, 

May  3, 

Right  (abscesses);  circ.;  slough  'g; 

386 

Haskell,  J.  L.,  Pt.,   D, 

Mav  3, 

Left.   A.Surg.E.J.Marsh,  U.S.A. 

25th  Virginia,  age  22. 

23,  m 

femoral  art.  lig.    May  27,  bone 

7th  Maine. 

-,  '63. 

Died  June  3,  1863.    Spec.  1077. 

rem'd.     Died  June  2,  1863. 

387 

Haskins,  W.  H.,  Pt.,  K, 

May  10, 

Left  (Mav  14,   16,  haein.);    circ. 

418 

Johnston.  D.,  Pt.,B,  40th 

June  1, 

Right;  circ.     A.  A.  Surg.  T.  F. 

39th  Mass.,  age  23. 

18,  '64. 

A.  Surg.  W.  Thomson,  U.  S.  A. 

Mass.,  age  21. 

30,  '64. 

Belton.     Died  July  1,  1864. 

May  24,   haem.;   lig.     May  31, 

419 

Johnston,  J.,  Pt.,  B,  27th 

Dec.  13. 

Right.     Haem.;  lig.  fem.  artery; 

haem.;  lig.  fern.  art.    Died  May 

Connecticut. 

23,  '62. 

anaemi.  Died  Jan.5,'63.Spec.982. 

31,  1864  ;  exh'n.    Spec.  3522. 

420 

Johnston,  T.  H.,  Corp'l, 

May  16, 

Right.     (Gangrene.)     Died  May 

388 

Hays,  A.  H.,  Pt.,  B,  142d 

Dec.  13, 

Left.     Surg.  H.  Bryant,  U.  S.  V. 

D,  34th  Ohio. 

28.  '62. 

28,  1862. 

Penn.,  age  23. 

25,  '62. 

Hsm.;  lig.     Died  Jan.  10,  1863; 

421 

Jones,  G.  W.,  Pt.,  C,  14th 

Oct.  19, 

Right  ;  double  flap.    A.  A.  Surg. 

exhaustion.    Spec.  2558. 

New  York,  age  26. 

30,  '64. 

J.  R.  Uhler.     Died  Nov.  9,  '64. 

389 

Heafey,  J.,  Pt,,  F,  24th 

Aug.  14, 

Right;  circ.     A.  A.  Surg.  W.  L. 

422 

Jones,  H.,  Pt.,  C,  1st  N. 

May  19, 

Right  (gangrene);  ant.  post  flap. 

Mass.,  age  30. 

22,  '64. 

Welles.     Died  Sept.  14,  1864  ; 

York  Dragoons,  age  20. 

June  7, 

Surg,  A.  F.  Sheldon,  U.  S.  V. 

irritative  fever. 

1864. 

Died  June  7,  '64;  shock  andhaem. 

390 

Heath,  L.,  Serg't,  D,  2d 

June  18, 

Right  (excision  tibia);  circ.  A.  A. 

423 

Jones,  J.,  Serg't,  I,  65th 

Sept.  20, 

Right.    Died  October  18,  1863; 

Michigan,  age  22. 

July  7, 

Surg.  J.  H.  Thompson.     Haem. 

Ohio. 

Oc.—  ,'63. 

hemorrhage. 

1864. 

Julv  12,  lig.  fern.  art.  Died  July 

424 

4  Jones,  L.,  Pt,,  E,  25th 

July  11, 

Right  :  double  flap.    Died  Sept. 

28,  ^64  ;  pyaemia.    Spec.  2867. 

Indiana,  age  20. 

23,'  '63. 

16,  1863. 

391 

Hector,  O.,  Pt.,  K,  56th 

Mav  31, 

—  .     Died  June  13,  1862;  py 

425 

Kane,  G.  H.,  Pt.,  E,  1st 

Oct.  27, 

Left  (slough  'g);  circ.  A.  A.  Surg. 

New  York. 

J'e  8,  '62. 

aemia. 

Col'd  Troops,  age  17. 

Nov.  10, 

J.  Pitkin.    Died  Nov.  10,  1864  ; 

392 

Hendrix,  J.,  Pt.,C,  110th 

July  9, 

Right;  circ.     A.  A.  Surg.  G.  M. 

1864. 

exhaustion. 

Ohio,  age  27. 

14/64. 

Paullin.     Died  Aug.  11,  1864; 

426 

Keeth,  C.  B.,  Pt.,G,  26th 

Sept,  19, 

Left.    Died  Sept.  24,  1864. 

4 

pyaemia.    Autopsy.    Spec.  3842. 

Massachusetts. 

23,  '64. 

393 

Henefin,  G.,  Pt.,  F,  5th 

May  2, 

Left.     Surg.  G.  P.'  Oliver,  lllth 

427 

Kelly,  J.,  Pt.,  B,  2d  In 

Sept.  17, 

Left.    Died  Oct.  21,  1862.    Spec. 

New  Hampshire. 

8,  '63. 

Penn.     Died  May  13,  1863. 

fantry. 

Oc.l6.'62. 

2496. 

394 

Henry,  J.,  Serg't,  E,  llth 

May  12, 

Left  ;  ant.  post,  double  flap.     A. 

428 

Kelly,  J.,  Pt.,  D,   llth 

Mav  6, 

Right  ;  circ  ;  diarrhoea  ;  slough  'g. 

Infantry,  age  24. 

21,  '64. 

Surg.  G.  A.  Mursick,  U.  S.  V. 

Virginia,  age  24. 

J'e  15,  '64. 

Died  June  27,  1864  ;  exhaust'ii. 

Died  May  25  '64  ;  exh'n.  Autop. 

429 

Kelly,  P..  Pt.,  D,  102d 

June  1, 

Right.     (Haemorr.)     Died  June 

395 

Hess.  D.,  Pt.,   K,   56th 

May  8, 

Left  (gang.);  circ.  Surg.  E.  Bent- 

Pennsylvania. 

7,  '64. 

8,  1864. 

Penn.,  age  30. 

16,  '64. 

ley,  U.  S.V.    Gang.;  sloughing. 

430 

Kelly,  T.,  Pt.,  F,  20th 

Dec.  13, 

Left,     Died  January  5,  1863. 

Died  June  19,  1864  ;  asthenia. 

Massachusetts. 

26,  '62. 

Autopsv. 

431 

Keniston,  S.  E.,  Pt..  H, 

May  23, 

Right  (necrosis);  lat.  flap.    A.  A. 

396 

Hill,  J.  J.,  Pt.,  G,  47th 

Oct.  22, 

Left;  cir'e.     Died   Nov.  2,  1862. 

4th  Maine,  age  36. 

June  17, 

Surg.  H.  M.  Dean.     Died  June 

Pennsylvania. 

25,  '62. 

Spec.  731. 

1864. 

22,  '64;  exh'n.    Spec.  2575. 

397 

Hindman,  McC.,  Pt.,  B, 

May  27, 

Left:  flap.     Died  July  29,  1864  ; 

432 

Kennedy.  M.,  Pt.,G,24th 

June  1, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

78th  Penn.,  age  19. 

J'e  1,'64. 

pyaemia.     Autopsy. 

New  York. 

10,  '62. 

W.  Hunt.     Died  June  16,  1862  ; 

398 

Hine.   F.  T.,   Lieut.,  I, 

Nov.  30, 

Left,    Surg.  A.  P.  Dalrymple,  U. 

exhaustion. 

144th  N.  York,  age  34. 

De.20,'64. 

S.  V.    Di«d  Dec.  20.  18(i4. 

433 

Kent,  R.  H.,  Serg't,  F, 

Mav  3, 

Right.     Surg.G.  P.  Oliver.lllth 

399 

Hoffman,  M.,Pt.,F,  39th 

Mar.  31, 

Right  ;  circ.    A.Surg.W.  B.  Hart- 

141st  Penn. 

8,  '63. 

Penn.     Died  Mav  15,  1863. 

New  York,  age  35. 

Apr.3,'65. 

man,  116th   Penn.    Abscesses; 

434 

Kerr,  H.,  Pt.,  E,  139th 

Julv  12, 

Left:  circ.    A.  A.  Surg.  F.  S.  Bar- 

diarrli.  Died  May  24,  '65;  pyaein. 

Penn.,  age  33. 

Aug.  11, 

barin.   DiedSept.20,'64;pva?m. 

400 

Holmes,  G.,  Pt.,  F,  2d 

June  30, 

Left.    (Spieulae  removed.)    Died 

1864. 

Spec.  3004. 

Penn.  Art'}-,  age  20. 

—  ,  '64. 

July  12,  1864;  exhaustion. 

435 

Kimball,  F.,  Pt.,  E,  5th 

Aug.  30, 

Right.    Died  Oct.  7,  '62  ;  pyaemia. 

401 

Holmes.    G.  J.,  Pt.,   A, 

Mav  5, 

Left  ;  lat.  flap.     A.  A.  Surg.   M. 

New  York,  age  20. 

Se.20,'62. 

26th  Georgia,  age  24. 

30,  ''64. 

Sheffield.    Died  June  6,  1864; 

436 

5  King,  T.,  Corp'l,  H,  2d 

Mav  7. 

Right  (aneurism);  ciro.    A.  Surg. 

exhaustion. 

Cavalry,  age  24. 

14,  ''64. 

\V.  Thomson,  U.  S.  A.    Slough. 

402 

Horton,  E.,  Pt.,  A,  9th 

May  9, 

Left  ;  ant.  post.  flap.     Surg.  A.  F. 

Died  June  4,  '64  :  pyaemia.     Au 

New  York  H'vy  Art.. 

30,  '64. 

Sheldon,  U.  S.  V.     Died  June  3, 

topsy.     Spe.cs.  3545",  3529,  3579. 

age  31. 

1864;  shock. 

437 

King.  W.  S.,  —  ,  K,  28th 

Mav  5, 

Left  :'circ.  A.  Surg.  J.S.  Billings, 

403 

3Howell,    T.  R.,  —,   C, 

June  27, 

Left  ;  circ.     Died  July  4,   1862  ; 

Virginia,  age  32. 

17,  ''62. 

U.  S.  A.     Died  May  18,  1862. 

4th  Alabama. 

Jy2.'62. 

tetanus. 

438 

Kinney,    B.,  Pt.,  G,  2d 

Oct.  19, 

Left  ;  ant.  post.  flap.     A.  A.  Surg. 

KM 

Hubbard,  J.  H.,  Lieut., 

Dec.  13, 

Left.     Died  December  19,  1862. 

Connecticut,  age  43. 

Nov.  7, 

J.  J.  Cockrell.     Died  Nov.  12, 

D,  145th  Penn. 

17,  '62. 

1864. 

1864  ;  haemorrhage. 

405 

Hubbs,   J.   B.,   Pt.,    B, 

Dec.  13, 

Right.    (Haem,,recur'd;  lig.  fern. 

439 

Kinnev,  J.  H.,  Serg't,  F, 

Sept.  19, 

Left.     Died  October  21,  1863. 

142d  Penn..  age  20. 

26,  '62. 

art.)     Died  Jan.  12,  1863;  ex 

84th  Illinois. 

Oc.—  ,'63. 

haustion.     Spec.  652. 

440 

Kirby,  R.,  Pt.,  H,  12th 

Mav  3, 

Right.     Died  May  18,  1863. 

406 

Hug,  G.,  Drum  Major, 

Mav  21, 

Left.     A.  A.  Surg.  L.  Darling. 

New  Jersey. 

16.  '63. 

30th  Missouri. 

26,   '63. 

Gangrene.     Died  May  31,  1863. 

441 

Kirsherman,  J.  J.,Pt.,K, 

Sept.  20, 

.     Surg.  T.  H.  Squire,  89th 

Spec.  1626. 

118th  Penu. 

Oc.10,'62. 

N.Y.     Ham.    Died  Oct.  18,  '62. 

407 

Hnghbiinks.J.H.,Corp'], 

Nov.  20, 

Left.     Died  Nov.  26,  1  864,  during 

442 

Kitt,  J.,  Corp'l,  F,  54th 

April  6, 

.     Surg.  E.  C.  Franklin,  U.S. 

E.  17th  111.  Cav.,  age  20. 

26,  '64. 

operation. 

Ohio. 

-,  '62. 

V.     Died  May  18,  1862. 

408 

Huntingdon.  S.,  Serg't, 

Dec.  31, 

Right.     Died  January  19,  1803. 

443 

6Klumpeter,  H.,  Pt.,  I, 

Aus-.  29, 

.    Surg.  D."  P.  Smith,  U.  S.  V. 

B,  101st  Ohio. 

la.  —,'63. 

8th  New  York. 

Se.  17,  '62. 

Died  Sept.  21,  18C2.     Autopsy. 

409 

Ilyam,   D.,  Pt.,  C,    5th 

April  7, 

Right  (hnom.);  circ.     Surg.  O.  A. 

444 

Knapp,  C.  A.,  Pt.,  B,  6th 

Mav  10, 

Lett;  ant.  post.  flap.     Surg.  R.  B. 

New  Hamp.,  age  21. 

27,  '65. 

Judson,  U.  S.V.     Died  May  14, 

Vermont,  age  20. 

29,''64. 

Rontecou,  U.  S.  V.     Haem.;  lig. 

1865;  pyaem.  Autop.  Spec.  4228. 

fem.  art.  Died  June  4,  '64;  exh'n. 

1  LIDELL  (J.  A.),  On  the  Major  Amputations,  for  Injuries  in  both  Civil  and  Mil'ry  Practice,  in  Am.  Jour.  Med.  Sci's,  N.  S.,  1864,  Vol.  XLVII,  p.  367. 
2LlDELL  (J.  A.),  Ot^the  Wounds  of  Blood-vessels,   Traumatic  Haemorrhage,  Traumatic  Aneurism,  and  Traumatic  Gangrene,  in  V.  S.  Sanitary 
Commission  Memoirs,  1870,  Surgical  Volume  I,  p.  198. 

8  SMITH  (E.  H.),  Report  of  Cases  of  Compound  Comminuted  Fracture  of  Femur,  etc.,  in  Confed.  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  24. 
4  BRYAN  (J.),  Amputations  from  the  Armies  of  the  Southwest,  in  Am.  Med.  Kmes,  1863,  Vol.  VII,  p.  288. 
8 LlDELL  (J.  A.),  U.  S.  Sanitary  Commission  Memoirs,  1870,  Surgical  Volume  I,  p  141. 
"DUCACUET   H.  W.),  Cases  of  Military  Surgery,  in  Am.  Med.  Times,  1863,  Vol.  VI,  p.  137. 


300 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

445 

Knight,  B.,Pt.,E,  110th 

May  25, 

Right  :  circ.     A.  A.  Surg.  R.  H. 

481 

McConnell,  D.  W.,  Pt., 

April  6, 

—  .     (April  10,  amp.  knee  joint  ; 

Col'd  Troops,  age  24. 

J'e  1,'65. 

Blandry.     Died  June  15,  1865; 

H,  46th  Ohio. 

-,  '62. 

slough'g  ;  necrosis.)  Surg.  E.  C. 

pyaemia. 

Franklin,  U.  S.  V.    Died    April 

446 

KnigM,    W.   T.,  Corp'l, 

Mar.  25, 

Right  ;  circ.   Surg.  W.  L.  Baylor, 

25,  1862. 

C,  54th  N.  Carolina. 

Ap.  7,  '65. 

C.  S.  A.     Died  April  18.  1865. 

482 

McDonald,  J.,  Corp'l,  B, 

April  1, 

Left  ;  circ.     A.  A-  Surg.  H.  Gib 

447 

Langenderser,    M.,   Pt., 

Mar.  11, 

Right  ;  oblique  anterior  post.  flap. 

94th  New  York,  age  20. 

8,  '65. 

bons,  jr.     Haem.    Died  April  20, 

A,  189th  Ohio,  age  18. 

14,  '65. 

A.  A.  Surg.  J.  J.  Cockrell.  Bone 

1865;pyaem.  Autop.  Spec.  3200. 

rem'd.     Died  April  15,  1865. 

483 

McGee,  J.,  Pt.,  C,  6th 

De.29,'62. 

Left.     Died  February  2,  1863. 

448 

Laurier,   T.,   Lieut.,  K, 

June  1, 

Right.    (Gangrene.)    Died  in  two 

Missouri. 

Jan.  8,  '63. 

71st  New  York. 

8.  '62. 

hours  after  operation. 

484 

McHarvard,  T.,  Pt.,  C, 

July  2, 

.     Died  July  —  .  1863. 

449 

Lawton,  C.  M.,  Pt.,  H, 

June  3, 

;  ant.  post.  flap.     Surg.  R.  B. 

28th  North  Carolina. 

15,  ^63. 

58th  Penn.,  age  30. 

8,  '64. 

Bontecou,  U.  S.V.    Haem.    Died 

485 

McKittrick,  L.,  Pt..  A, 

Jan.  1. 

Left.     Died  February  13,  1863; 

June  11,  '64  ;  shock.     Spec.  3057. 

37th  Indiana. 

10,  '63. 

pyaemia.     Autopsy. 

450 

Leach,  W.  B.,  Pt.,  K,  2d 

June  1, 

Left  ;  ant.  post.  flap.     Surg.  R.  B. 

486 

McLean,  P.,  Pt.,  E,  86th 

April  10, 

Left  ;  circ.  skin  flaps  ;   cire.  sect. 

Conn.  H.  A.,  age  37. 

16,  '64. 

Bontecou,  U.  S.  V.     Died  June 

Col'd  Troops,  age  23. 

29,  '65. 

muscles.     Surg.  F.  E.  Piquette, 

19,  1864;  pyaemia.     Spec.  3032. 

86th  Col'd  Troops.     Died  May 

451 

Lee,    P.,    Pt.,   C,    142d 

May  12, 

Right  ;  ant,  post.  flap.     A.  Surg. 

8,  1865;  ac.  diarrhoea. 

Penn.,  age  20. 

24,  '64. 

A.  Ingram,  U.S.A.     Sloughing. 

487 

Mellick,  M.,  Pt.,  F,  llth 

Aug.  P, 

Right  ;  ant.  post.  dou.  flap.    Surg. 

Died  May  27,  1864. 

Pennsylvania. 

15,  '62. 

J.  E.  Summers,  U.  S.  A.    Haem. 

452 

Leedy,  D.,  Pt.,  F,  26th 

Aug.  8. 

;  flap.  Surg.  J.H.  Hutchison, 

from  w'd  in  axilla.     Died  Aug. 

Illinois. 

14,  '64. 

15th  Mich.     Died  Aug.  14,  1864. 

26,  1862.    Spec.  41. 

453 

Leslie,  W.,  Pt.,  B,  16th 

De.31,'62, 

Right  (gang.;  mortificat'n);  gan 

488 

Merron,  J.,  Pt.,  D,  12th 

May  9, 

Left;    circ.     A.  A.   Surg.  J.  O. 

Infantry. 

Jan.4,'63. 

grene.     Died  Jan.  9,  1863. 

Mass.,  age  31. 

16,  ''64. 

French.     Died  May  25,   1864; 

454 

Lindsay,  F..  Pt.,  C,  llth 

Dec.  13, 

Left.     Surg.  H.  Bryant,  U.  S.  V. 

pyae  mia.    Autopsy.    Spec.  2286. 

Penn.,  age  22. 

29,  '62. 

Died  January  4,  1863;  pyaemia. 

489 

Metitel,   F.,    Corp'l,   F, 

Nov.  27, 

Right  ;   ant.  post,  flap.     Surg.  C. 

Spec.  570. 

26th  Penn.,  age  20. 

De.23,'63. 

Page,  U.S.A.  Haem.    Died  Jan. 

455 

Linsenberger.W.R.,  Pt., 

May5, 

Left;  ant.  post.  flap.     Surg.  R.  B. 

19,  1864.     Specs.  1433,  2019. 

B,  139th  Penn.,  age  22. 

29,  V64. 

Bontecou,  U.  S.  V.     Died  June 

490 

Miller,  A.,  Pt.,  E,  95th 

May  3, 

Right  ;  circ.    Haem.;  lig.  fern.  art. 

7,  1864;  exhaustion.   Spec.  3041. 

Penn.,  age  18. 

14,  "'63 

Died  June  6,   1863.     Autopsy. 

456 

Livingston,  L.  A.,  Capt., 

July  2, 

Left.     (July  3,  amp.  leg  ;  erysip.) 

Spec.  1243. 

F,8th  Alabama,  age  23. 

14,  '63. 

Haem.     Aug.  4,  bone  excised. 

491 

Miller,  C.,  Corp'l,  K,  5th 

April  7, 

Left.     Surg.  B.  A.  Vanderkieft, 

Died  Sept.  27,  '63;  exhaustion. 

N.  Hampshire,  age  33. 

23,  '65. 

U.S.V.  Died  April  29,  '65.  Spec. 

457 

Llewellyn,  J.  T.,  Corp'l, 

Mar.  31, 

Left;  circ.    A.A.Surg.Z.P.Derm- 

4104. 

C,  13th  Ohio  Cavalry, 

April  11, 

ler.     Died  May  6,  '65  ;  pyaemia. 

492 

Miller,  L.,  Pt.,  D,  100th 

May  15, 

Left;  circ.;  necrosis.     Died  April 

age  21. 

1865. 

Spec.  40b2. 

Ohio,  age  25. 

18,  '64. 

4,  1865;  gangrene. 

458 

Lobden,    S.,   Pt.,   I,   2d 

Oct.  19, 

Right  ;  ant.  post.  flap.   A.  A.  Surg. 

493 

Miller,  L.  S.,  Pt.,  E,  12th 

Aug.  30, 

Right  ;  flap.  Surg.  B.A.Clements, 

Conn.  H'vy  Artillery, 

No.  2,  '64. 

C.  H.  Jones.     Died  Nov.  16,'64  ; 

Massachusetts. 

Sept.  18, 

U.S.A.     Died  October  3,  1862  ; 

age  22. 

exhaustion. 

1862. 

pyaemia.     Spec.  3493. 

459 

Lohr,  E.  J.,  Pt.,  B,  54th 

Julv  18, 

Left  ,  eirc.  A.A.Surg.J.H.Coover. 

494 

Miller,  S.  C.,  Pt.,  K,  8th 

April  9, 

Left  ;  bi-lat.  flap.     Ass't  Surg.  A. 

Penn.,  age  24. 

29,'  '64. 

Died  Aug.8,  '64  ;  pi.  -pneumonia. 

Illinois,  age  38. 

M'y8,'65. 

Hartsuff,  U.  S.  A.     Died  May  9, 

460 

Loid,  W.  H.,  Pt.,  B,  2d 

April  6, 

Right  ;  circ.    Surg.  O.  A.  Judson, 

1865. 

New  York  H'vy  Art., 

25,  '65. 

U.  S.V.    Phagedaen.    Died  May 

495 

Mills,  W.  F.,  Pt.,  E,8th 

June  16, 

Left.     (Prim.  amp.  right  thigh.) 

age  26. 

6,  1865;  exhaustion. 

N.  Y.  H.  A.,  age  42. 

—  ,  '64. 

Died  June  23,  1864. 

461 

Lave,  H.  T.,  Pt.,  C,  41st 

July  20, 

Left  ;  circ.     Died  Aug.  1,  1864. 

496 

Moan,  F.  H.,  Corp'l,  F, 

May  3, 

Right;  circ.;  haem.;  lig.  fen.  art. 

Alabama,  ago  30. 

31,  "'64. 

6th  Maine,  age  22. 

14,  '63. 

Died  May  23,  '63.     Spec.  1255. 

462 

Loveland,  W.  H.,  Capt., 

May  5, 

Left  ;  circ.    Med.  Ins.  F.  H.  Ham 

^Q71 

B,  4th  Mich.,  age  35. 

20,  '64. 

ilton,  U.  S.  A.  Haem.   Died  May 

4y  /i 

^iOfl 

Moore,  J.,  Pt.,  E,  46th 

Aug.  9, 

Both;  double  flap.    Surg.  J.  E. 

31,  '64;  exh'n.    Spec.  2287. 

4yoj 

Pennsylvania. 

15,^62. 

Summers,  U.  S.  A.     Died  Aug. 

46  1 

Luedick,W.,Pt.,C,37th 

Nov.  24, 

Right.     Died  January  4,  1864. 

26,  1862.     Specs.  46,  47. 

Ohio. 

De.16,'63. 

499 

Moorehouse,  O.  J.,  Pt., 

Nov.  24, 

Right  (ball  extr'd);  circ.     Surg. 

464 

Lynch,  A.  D.,  Pt.,  B,  2d 

June  2, 

Left  ;  circ.    Surg.  J.  W.  Wishart, 

H,  31st  Iowa. 

30,  '63. 

J.  C.  Morgan,  29th  Mo.    Died 

New  York  H'vy  Art., 

8,  '64. 

140th  Penn.     Died  July  4,  1864  ; 

Dec.  18,  1863. 

age  41. 

pyaemia. 

500 

More,  J.,  Pt.,  1,  76th  Col 

April  9, 

Right  ;  circ.  Surg  F.  E.  Piquette, 

465 

Lyons,  C.  H.,  Pt.,  K,  5th 

May  3, 

Right.     Surg.  G.  P.  Oliver,  lllth 

ored  Troops,  age  30. 

25,  '65. 

86th  Col'd  Troops.    Died  May  1, 

Ohio. 

-,  '63. 

Penn.     Died  May  13,  1863. 

1865  ;  exhanst'n  and  diarrhoea. 

466 

Madden,   C.,   Pt..  3d  S. 
Carolina  Art'y,  age  17. 

Sept.  17, 
Oct.  2,  '62. 

Right;  circ.  A.Surg.A.H.  Smith, 
U.S.A.     Haem.;  lig.  fern.    Died 

501 

Moriarty,  C.,  Pt.,  K,  8th 
New  Hampshire. 

April  13, 
M'yl,'63. 

Left.     Died  May  3,  1863. 

Oct.  8,  1862;  exh'n.     Autopsy. 

502 

Morse,    J.,    Pt.,   B,    2d 

June  16, 

Right.    (Amp.  leg.)    A.  A.  Surg. 

Specs.  777.  833. 

Penn.  Art'y,  age  22. 

25,  '64. 

E.  T.  Caswell.   Haemorrh.  Died 

467 

Mallett,  C.,    Serg't,   F, 

Dec.  13, 

Left.     Died  Jan.  2,  1863.     Hasm. 

August  10,  1864  ;  pyaemia. 

57th  New  York. 

28,  '62. 

Spec.  2451. 

503 

Murray,  H.  T..  Serg't,  I,  [NOV.  27, 

Right;  circ.     Surg.  E.  Bentley, 

468 

Marion,   G.   S.,  Pt.,  C, 

May  6. 

Left  ;  lat.  flap.  Surg.  R.  B.  Bonte 

6th  Maryland,  age  24. 

Dec.  10, 

U.  S.  V.     Died  Dec.  19,  '63;  py 

45th  Penn.,  age  21. 

15,  ''64. 

cou,  U.  S.  V.     Died  May  19,'64  ; 

1863. 

aemia.     Autopsy. 

pyaBinia.    Spec.  3055. 

504 

Murray,  W.,  Pt.,  C,  20th 

Deo.  7, 

Left  ;  lat.  flap.    Surg.  P.  Harvey, 

469 

Mark,  J.,  Pt.,  K,  110th 

Mar.  25, 

Left  ;  circ.     A.  Surg.  H.  Allen, 

Iowa,  age  25. 

20,  '62. 

19th  Iowa.     Died  Dec.  29,  1862; 

Ohio,  age  42. 

Ap.  3.  '65. 

U.S.A.     Died  April  23,  1865; 

pya?mia. 

pyaemia.    Autopsy.    Spec.  158. 

505 

Myers,  E.,  Pt.,  A,  154th 

May  3, 

.     Died  May  22,  1863. 

470 

Markle,  II..  Pt.,  C,  148th 

May  3, 

.     Surg.  C.  S.  Wood,  66th  N. 

New  York. 

16,  %3. 

Pennsylvania. 

-.  '63. 

Y.    Died  June  7,  '63.   Spec.  1172. 

506 

Myers,  H..  Pt.,  E,  93d 

May  12, 

Left  ;  ant.  post.  flap.     Surg.  R.  B. 

471 

Mars,    H.,   Pt.,   O.    5th 

Mar.  31, 

Right  ;  circ.    A.  Surg.W.  F.  Nor- 

Penn.,  age  23. 

31,  '64. 

Bontecou,  U.  S.V.    Haem.    Died 

New  York,  age  24. 

Ap.  9,  '65. 

ris,  U.  S.  A.     Died  April  22,  '65; 

June  11,  1864  ;  typhoid  fever. 

pyaemia.    Autopsy.    Spec.  3237. 

507 

Nance,  T.  J..  Pt..  H,30th 

April  4, 

Right    (April  4,  amp.  leg);  circ. 

472 

Marsh.  H.  F..  Pt.,  City 

June  13, 

Right  ;  circ.  A.  A.  Surg.  J.  Money- 

Texas  Cavalry. 

Mayl,'64. 

Surg.  C.   E.  Sxvascy,  U.  S.  V.; 

Batt'n,  Petersburg,  Va. 

20.  '64. 

penny.     Died  June  24,  1864. 

pyaemia.     Died  May  8,  "64  ;  ex 

473 

Martin,  C.,  Pt.,  C,  16th 

July  2, 

Right.     Haem.    July  14,  re-amp. 

haustion,  etc. 

Michigan,  age  19. 

5T  '63. 

mid.  third;  hasm.    DiedJuly21, 

508 

Nelson,  C.,  Pt,,  A,  129th 

Mar.  8, 

Right  (abscess);  skin  flap.     Ass't 

1863;  pyaemia.     Autopsy. 

Indiana,  age  18. 

29,  '65. 

Surgeon  E.  F.  Hendricks,  15th 

474 

Marx,  J.,   Pt.,   F,   24th 

Sept.  20, 

Left.  Sufg.I.  Moses.U.S.V.  Died 

Conn.     Died  April  13,  1865;  ex 

Illinois. 

30,  '63. 

Oct.  6,  1863.     Spec.  2127. 

haustion,  etc. 

475 

Marys,  D.,  Pt.,  C,  90th 

May  5, 

Right.  (Gang.;  May  10,  amp.  knee 

509 

Nelson,  D  ,  Pt.,  E,  13th 

Dec.  15, 

Right.     Died  Dec.  22,  1864. 

Pennsylvania. 

20,  '64. 

j't;  art.  sloughed;  haem.)   Surg. 

Colored  Troops. 

—  ,  "64. 

J.  Ebersole,  19th  Ind.  Died  May 

510 

Nicely,  M.,  Pt.,  E,  79th 

Sept.  19, 

Left  thigh.     Died  October  17,  '63. 

20.  1864.    Spec.  2340. 

Indiana. 

—  ,  '63. 

476 

Mather,  Z.  H.,  Serg't.  M, 

July  8, 

Left  (hasm.);  flap,  skin;  circ.  mus. 

511 

Dickinson,  A.,    Pt.,    G, 

July  3, 

.     Surg.  C.  S.  Wood,  66th  N. 

5th  Mich.  Cav.,  age  27. 

26,  Y63. 

Died  Aug.  19,  1863;    pyaemia. 

52d  North  Carolina. 

—  ,  '63. 

York.    Gang.  (prim.  amp.  arm). 

Autopsy.    Spec.  3963. 

Died  July  19,  1863. 

477 

McAnnay,  L.,  Corp'l,  L, 

Mar.  25, 

Left  (humid  gang.);  circ.     A.  A. 

512 

Noye,   C..   Pt.,   C,    63d     June  7, 

Right.     Died  July  14,  1863. 

20th  Penn.  Cav..age  21. 

Ap.  1,'65. 

Surg.  W.  B.  McCuusland.   Died 

Colored  Troops.              :   21,  '63. 

April  15,  1865;  pneumonia. 

513 

Ocker,  T.,  Capt.,  A,  6th     April  2, 

Left.     Died  May  3,  1865. 

478 

McCallum,  M..  Serg't.D, 

May3, 

Left.     A.  Surg.  W.  Thomson,  U. 

Maryland.                            —  .  '65. 

140th  Penn.,  age  32. 

9,  '63. 

S.  A.     Erysipelas.     Died  May 

514 

O'Ha'ra,  H.,  Pt.,  I.  19th    De.  7/62, 

Right  ;  4at.  flap.   Surg.P.  Harvey, 

- 

17,  1863;  pyaemia.     Spec.  1081. 

Iowa,  age  23.                   Jan.  1,'C3. 

19th  Iowa.     Died  Jan.  9,  1863; 

479 

Me  Cloud,  M.,  Pt.,  E,  32d 

Nov.  25, 

Left  ;  circ.     Surg.  J.  C.  Morgan, 

pyaemia. 

Alabama. 

De.3,'63 

29th  Mo.     Died  Dec.  —  ,  1863. 

515 

O'Reillv,  P.,  Pt.,  E,42il    Sept.  17, 

Left  ;  lat.  flap.    A.  A.  Surg.W.W. 

480 

McCormick,  C.,  Pt:,  A, 
57th  Penn.,  age  22. 

July  2, 
5/63. 

Left.     Haem.    Died  July  12,  '63; 
exhaustion. 

New  York,  age  20. 

Oct.  1,'KB. 

Keen,  jr.   Died  Oct.  6,  '62;  exh'n. 
Spec.  793. 

SECT,  m.] 


INTERMEDIAKY    AMPUTATIONS    OF    THE    THIGH. 


301 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AXD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AXU  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

516 

Osborn,  E.,  Pt.,  D,  91st 

Mar.  31  , 

Left  ;  semi-circ.   Surg.T.  R.  Cros 

549 

Reynolds,  H.  H.,  Pt.,  F, 

Sept.  4, 

Left.     A.  A.  Surg.  J.  H.  Bartholf. 

New  York,  age  20. 

Ap.  6,  '65. 

by,  U.S.V.   Died  April  18,  1865; 

1st  Mich.  Cav.,  age  28. 

18,  '64. 

Haem.;  lig.  popliteal  art.     Died 

pyaemia. 

Sept.  30.  18C4;  pyaem.     Autop. 

517 

Osborne,  S.,  Pt.,  M,  2d 

May  31, 

Right  (gang.);  double  flap.  A.  A. 

Spec.  3930. 

Conn.  H.  Art'y,  age  44. 

Je.27,'64. 

Surg.  W.  C.  Earle.     Died  June 

550 

Rice,    S.,  Pt.,   A,  142d 

Sept.  29, 

Left;  circ.    A.Surg  D.R.Brower, 

31),  1  864  ;  pyaemia. 

New  York,  age  27. 

Oc.14,'64. 

U.S.V.  Died  Oct.  21,  '64;  pyaem. 

518 

Osgood,  T.    J.,  Pt.,  A, 

Aug.  16, 

Right   (sloughing);  circ.     A.  A. 

551 

Richards,  E.,  Pt.,  H,  8th 

June  3, 

Left  (haem.);  ant.  post.  flap.  Surg. 

39th  Illinois,  age  20. 

Sept.  15, 

Surg.  J.  C.  Martin.     Hsem.;  lig. 

Maine,  age  20. 

9,  '64. 

R.  B.Bontecou.U.S.V.  Slough.  : 

1864. 

fem.  art.     Died  Sept.  28,  1864  ; 

haem.:  re-amp,  mid.  third.    Died 

exhaustion. 

June  l:i,'64  ;  exh'n.    Spec.  3064. 

519 

Paddock,  D.  G.,  It.,  G, 

May8, 

Right  ;  lat.  flap.  Surg.  R.  B.  Bon- 

552 

Ridy,  J.,  Pt.,  I,  9th  N. 

Oct.  19, 

Left  ;  circ.   A.A.  Surg.W.B.  Mor 

83d  Penn.,  age  23. 

16,  '64. 

tecou,  U.  S.V.    Hsem.;  lig.  fem. 

Y.  H'vy  Art'v,  age  41. 

25,  '64. 

rison.    Died  Nov.  11,  1864. 

art.     Died  May  24,  '64  ;  exh'n. 

553 

Ripley,  F.,  Pt.',  G,  10th 

May  5, 

.     (Gangrene.)     Surg.  G.  T. 

520 

Page,  A.,  Pt.,  B,  161st 

April  7, 

Right;  circ.     A.Surg.S.H.Orton, 

Massachusetts. 

10,  '64. 

Stevens,  77th  N.  Y.     Died  May 

New  York. 

15,  '64. 

U.  S.  A.    Died  April  27,  1864. 

13,  1864. 

521 

'Parker,  N.,  Corp'l,  B, 

May  10, 

Left.     (H«m.;  lig.  post.  tib.  art.; 

554 

Robbins,  E.  H.,  Serg't, 

May  6, 

Right  (haem.;  May  30.  lig.  fern. 

51st  Georgia,  age  40. 

June  2, 

hsem.  recurred  ;  lig.  fem.  art'y.) 

F,  15th  Mass.,  age  29. 

June  2, 

art.;  slough.;  haem.);  double  lat. 

1864. 

Died  June  2,  1864  ;  shock. 

1864. 

flap.     A.  A.  Surg.  J.  Ransom. 

522 

Parsons,  T.  H.,  Capt.,  C, 

May  3, 

Left;    circ.     A.  A.  Surg.  J.  O. 

Died  July  15,  1864. 

91st  Penn.,  age  29. 

11,  "'63. 

Stanton.      Abscess  ;    exostosis. 

555 

Robinson,  F.  B  ,  Pt.,  H. 

July  11, 

Left  (haem.):  circ.    Died  Aug.  10, 

Died  June  26,   1863;  pyaemia. 

7th  New  Hampshire. 

An.  1,'63. 

1863.     Spec.  1062. 

Spec.  1324. 

556 

Robinson,  J.,  Pt.,  D,12th 

Oct.  19, 

Right  :  ant.  post.  flap.  A.  A.  Surg. 

523 

Payne,  D.,    Pt.,    H,   2d 

Oct.  19, 

Left;  double  flap.     Surg.  R.  W. 

Conn.,  age  34. 

Nov.  4, 

C.H.Jones.  Nov.  11,  haem.;  fem. 

Conn.  H.  Art'y,  age  25. 

Nov.  2, 

Pease,  U.  S.  V.   Haem.;  lig.  fem. 

1864. 

art.  lig.  Died  Nov.  23,'64;  haem. 

1864. 

art.     Died  Nov.  17,  1864. 

Spec.  3443. 

524 

Payne,  G.  H.,Pt.,  K,64th 

Oct.  12, 

Left  (Oct.  21,  haem.;  lig.  pop.  art. 

557 

Rogers,  D.,  Pt.,  E,  1st  S. 

July  28, 

Left  :  double  flap.  A.  A.  Surg.W. 

New  York,  age  18. 

29,  '64. 

Oct.28,  haem.;  lig.fern.art.);  flap. 

Carolina,  age  22. 

Au21,'64. 

L.Hammond.  Died  Aug.  22,'64. 

A.  A.  Surg.  J.  C.  Norton.     Died 

558 

Rombaugh;   I.,   Pt.,    B, 

Sept.  17, 

Left.  Surg.C.  Page.U.S.A.  Died 

Dec.  4,  1864  ;  exhaustion. 

28th  Pennsylvania. 

Oc.13,'62. 

Jan.  5,  '63  ;  col.  diarr.  Spec.  1745. 

525 

Peck,  N.  A.,  Serg't,  D, 

May  3, 

Left.     (Gang.)    Died  June  2,  '63. 

559 

Rosenfelt,  N.,  Serg't,  D, 

July  2, 

Right.    Surg.C.W.  Jones,  U.S.V. 

2d  Rhode  Island. 

29,  "'63. 

Spec.  1181. 

26th  Penn.,  age  22. 

19,  '63. 

Slough.;  exc.endofbone;  haem.; 

526 

Perkins,  W.  J.,  Pt.,  A, 

June  18, 

Left.  Surg.F.  F.  Burmeister,69th 

lig.  fem.  art.     Died  Oct.  2,  1863. 

7th  C.  S.  Cav.,  age  24. 

—  ,  '64. 

Penn.     Died  June  28,'64.    Spec. 

Spec.  1699. 

4512. 

560 

Ross,  B.  W.,  Pt.,  C,  26th 

Dec.  13, 

Right,     Died  Jan.  9,  1863.    Spec. 

527 

Perry,  A.,  Pt.,  C,  6th  N. 

Aug.  16. 

Left  (art.  sloughed  ;  haern.);  circ. 

New  York,  age  22. 

29,  '62. 

577. 

York  Cav.,  age  24. 

Sept.  3, 

A.  A.  Surg.  B.  B.  Miles.     Died 

561 

Rowe,  J.  A.,  Pt.,  I,  3d 

Aug.  16, 

Left  ;  circ.    A.A.Surg.E.B.  Wool- 

1864. 

July  8,  '65;  osteo-inyelitis.  Spec. 

Maryland  Cavalry. 

28,  '64. 

ston.    Sloughing.   Died  Oct.  18, 

2965. 

1864;  exhaustion. 

528 

Perry,  W.,  Pt.,  A,  34th 

June  —  , 

Left.     (Irrita.  fever.)     Died  July 

562 

Royal,  R.  B.,  Pt.,  B,  6th 

June  3, 

Left  ;  circ.    Died  June  23,  1864. 

North  Carolina. 

J'y  8,  '62. 

16,  1862. 

Maine,  age  25. 

-,  '64. 

529 

Peters,  F.,  Pt.,  A,  49th 

June  1, 

Left;  circ.     A.  A.  Surg.  J.  Cass. 

563 

Ruhling,  F.J.,  Serg't,  E, 

June  1, 

Left  ;  lat.  flap.  Surg.  R.  B.  Bonte- 

Penn.,  age  24. 

7,  '64. 

Died  June  8,  1864;  exhaustion. 

112th  N.  Y.,  age  29. 

11,  '64. 

cou,  U.  S.  V.     Hsem.;  lig.  fem. 

530 

Philbrick,    II.,    Pt.,    D, 

June  15, 

Left  ;  circ.    A.  A.  Surg.  J.  Money- 

art.     Died  June  18,  1864  ;  gang. 

117thN.  Y.,  age  25. 

24,  '64. 

penny.  Died  June  27,  '64;  exh'n. 

Spec.  3050. 

531 

Phillips,  J.,  Pt.,  I,  37th 

June  —  , 

Right.     Surg.  —  Eads,  C.  S.  A. 

564 

Sackner,  J.  C.,  Pt.,  E, 

May  31, 

Left;  ciro.     A.  A.  Snrg.  F.  H. 

North  Carolina. 

J'y  3,  '62 

Died  July  7,  1802. 

2d  Michigan. 

June  24, 

Brown.     Died  June  24,    1862; 

532 

Pippin.   A.   P.,  Pt.,  D, 

April  9, 

Left;  flap.     Surg.  A.  McMahon, 

1862. 

shock. 

2d  Alabama,  age  18. 

26,  '65. 

U.  S.  V.     Died  May  11,  1865; 

565 

Sailor,  J.,  Serg't,  E,  45th 

Sept.  —  , 

Right.     Died  Oct.  1,  1863. 

suppuration  and  exhaustion. 

Ohio. 

30,  '63. 

533 

Polhemus,   J.,    Pt.,    F, 

May  3, 

Left  ;  circ.     Died  May  15,  1863  ; 

566 

Sailor,  W.,  Pt.,  E,  119th 

Nov.  7, 

Left  ;  circ.     A.  Surg.  G.  A.  Mur- 

137th  New  York. 

8,  '63. 

haemorrhage. 

Penn.,  age  40. 

14,  '63. 

sick,  U.  S.  V.    Died  Dec.  1,  '63  ; 

534 

Potter,   P.   B.,   Pt.,    D, 

May  6, 

Right.     Died  June  5,  1864. 

pyaemia.   Autopsy.  Specs.  1887, 

12th  Mass.,  age  24. 

27,  '64. 

1888,  1889,  1890. 

535 

Powers,  J.,  Pt.,  H,  74th 

Aug.  30, 

.    Died  Sept.  1  1,'62  ;  tetanus. 

567 

Salzman,  C.,  Pt.,  K,  2d 

De.27,'65, 

Left  (gang.),  ant.  post.  flap.     A. 

New  York. 

8ep.-,'63. 

Infantry,  age  31. 

Jan.  3,  '66. 

Surg.  C.  C.Gray.U.S.A.  Hsem.; 

536 

Prescott,  C.  R.,  Corp'l, 

July  21, 

;  circ.     Drs.  Darby  and  Con 

lig.  fem.  art.     Died  Jan.  13,  '66. 

F.,  14th  New  York  S. 

24,  '61. 

rad.     Exc.  end  of  fetnur.    Died 

Autopsy. 

M.,  age  27. 

Augusts,  1861. 

568 

Saltzman.W.C.,  Bugler, 

Oct.  19, 

Left  :  ant.  post.  flap.    A.  A.  Surg. 

537 

Preston,   T.,  .Serg't,    E, 

July  9, 

Left  ;  circ.     A.  A.  Surgeon  T.  J. 

1st  N.  Y.  Ind.  Battery, 

Nov.  16, 

E.G.  Waters.    Died  Nov.  22,  '64; 

14th  W.  Virginia  Cav., 

25,  '64. 

Dunott.     Died  August  2,  1864. 

age  21. 

1864. 

diphtheria.    Spec.  3731. 

age  21. 

Spec.  3911. 

569 

Sampson,  D.  B..  Pt.,  C, 

May  31, 

Left.     (Pyaemia.)    Died  June  26, 

538 

Price,  A.  H.,Pt  ,H,  188th 

May  30, 

Right  ;  circ.    Surg.  O.  A.  Judsou, 

6?th  New  York,  age  34. 

J'e—  ,'62. 

1862.      ' 

Penn.,  age  25. 

J'ne8,'64. 

U.  S.  V.    Died  June  13,  1864  ; 

570 

Saunders,  S.,  Pt.,  K,  52d 

June  16, 

Left.     A.  Surg.T.O.  Cornish,  15th 

shock.    .Spec.  2942. 

New  York. 

—  ,  '64. 

Mass.  Died  J'e  25,  '64.  Spfc.  204. 

539 

Pulhemus,  J.,  Pt.,  E,  1st 

Dec.  13, 

Left.     (Haem.)     Dec.  30,  haem.; 

571 

2Saxon,  J.  iV.,  Pt..  D,  9th 

Nov.  7, 

Right  ;  flap.     Surg.  J.  A.  Lidell, 

Mich.,  age  20. 

26,  '62. 

lig.  fem.  art.     Died  Jan.  15,  '63  ; 

Louisiana,  age  27. 

18,  '63. 

U.  S.V.     Osteo-myelitis.     Died 

exhaustion. 

Dec.  3,  1863;  hasm.     Autopsy. 

540 

Putnam,  G.  R.,  Pt.,  10th 

Aug.  25, 

Right  (sloughing);  ant.  post.  flap. 

Specs.  1819,  1860,  1892. 

Mass.  Batter}',  age  32. 

Sept.  23, 

Surg.  G.  S.  Palmer,  U.  S.  V. 

572 

3Schaffer,  C.,  Corp'l,  D, 

Aug.  24, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

1864. 

IlEein.     Died  Nov.  2,  1864. 

9th  Illinois  Cavalry. 

27,  '63. 

S.  R.  Coale.     Died  Sept.  12,  '63  ; 

541 

Rainier,  M.  G.,  Pt.,  G, 

Mar.  10, 

Left  (gang.);  flap.     Surg.  C.  A. 

pyaemia.    Spec.  2101  . 

124th  Indiana,  age  20. 

13,  '65. 

Cowgill,  U.S.V.    Died  March 

573 

Schaup,  H.,  Pt,,  K.lOOth 

May  14, 

Left;  circ.     A.  A.  Surg.  J.  S.  Hill, 

22,  1865  ;  shock. 

New  York,  age  29. 

J'e  11,  '64. 

Died  June  15,  1864;  shock. 

542 

Rairdon,  W..  Pt.,  I,  40th 

June  27, 

Right  (gang.);  circ.     A.  Surg.  C. 

574 

Schlaf,   A.,    Pt.,   B.   2d 

Nov.  30, 

Right  ;  ant.  post.  flap.  A.  A.Surg. 

Indiana,  age  3(5. 

July  9, 

C.  Byrne,  U.  S.  A.     Haem.;  lig. 

Penn.  Art'y,  age  42. 

Dec.  7, 

C.  W.  Harper.     Dec.  15,  haem. 

1864. 

Died  July  23.  '64  ;  haemorrhage. 

1864. 

Died  Dec.  16,  1864  ;  pyaemia. 

543 

Ramsey.  W.,  Pt.,  H,  6th 

April  1, 

Right;  circ.     A.  Surg.  W.  Thom 

575 

Schneider,   F.,   Pt.,    E, 

Dec.  7, 

Right;  lat.  flap.   Surg.P'.Harvey, 

Virginia  Cav.,  age  19. 

8,  '65. 

son,  U.  S.  A.    Sloughing.    Died 

20th  Wis.,  age  25. 

11,  '62. 

19th  Iowa.    Slough.    Died  Dec. 

April  18,  '65:  pyaemia.    Autop. 

18,  1862;  haemorrhage. 

544 

Ransom,  F.  H.,  Corp'l, 

May  16, 

Left.      (Gangrene.)      Died   May 

576 

Schweitzer,  S.,  Pt.,  A, 

July  7, 

Left.     A.  A.  Surg.  J.  C.  Shimer. 

D,  34th  Ohio. 

27,  '62. 

30,  1862. 

161st  Ohio,  age  18. 

21,  ''64. 

Slough.     Died  July  29,    1864. 

545 

Reeves,   G.  T.,  Pt.,  E, 

April  30, 

Left.    Died  May  5,  1864. 

Spec.  3920. 

29th  Iowa. 

M'y3,'64. 

577 

Seber,  J.W.,Pt.,  A,  76th 

July  1, 

Left.    July  20.  haem.;  August  3, 

546 

Reeves,  W.,  Pt.,  K,  llth 

May  24, 

Right.  Died  May  31,  '64;  tetanus. 

New  York,  age  27. 

4,   63. 

re  amp.;  15,  slough.   Died  Aug. 

Mass.,  age  45. 

28,  '64. 

29,  1863;  diarrhoea. 

547 

Reinliart.  L.,  Pt.,  F,  23d 

May  12, 

Left.    Surg.  O.  A.  Judson.U.S.V. 

578 

Sehman,  C.,  Pt.,  F,  28tb 

May  16, 

Left.     Died  June  1,  186-'. 

N.  Carolina,  age  3!). 

19,  '64. 

Ilaem.  Died  May  30/64  ;  pyaem. 

Ohio. 

30,  '62. 

548 

Kevin,    IK.,   Pt.,  D,  8th 

Feb.  20, 

Autopsy.     Spec.  2276. 
Left.     (Haem.)    Surg.  H.  L.  W. 

579 

Senior.  T.  H..Pt.,C,  10th 
Maine. 

July  2, 
18,  *63. 

Right;  circ.  Hasm.;  slough.  Died 
July24,'63;  pytemia.  Autopsy. 

Tenn.  Cavalry,  ago  21. 

Mar.5/64. 

Burritt,  U.S.V.     Gang.     Died 

580 

Sheridan.  N.  B.,  Pt.,  A, 

Dec.  13, 

Right.     Died  February  4,   1863. 

March  11,  1864.     Sp«:.~2228. 

90th  Pennsylvania. 

17,  '62. 

Autopsy. 

1 



'HOLLOWAY  (J.  M.),  Consecutive  and  Indeterminate  Hxmorrhage  from,  Large.  Arteries  after  Gunshot  Wounds,  etc.,  in  Am.  Jour,  filed.  Sciencett 
JV.  S.,  1865,  Vol.  L,  p.  344.    LIDELL  (J.  A.),  V.  S.  Sanitary  Commission  Memoirs,  1870,  Surgical  Volume  I,  p.  188. 

2LIDELL  (J.  A.),  On  the  Secondary  Iraumatic  Lesions  of  Bone,  etc.,  in  V.  S.  San.  Com.  Memoirs.  1870,  Surgical  Volume  I,  p.  358. 
"BRYAN  (J.),  loc  cit.,  p.  288. 


302 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

581 

Sherron,  L.,  —  ,  I,  12th 

Sept.  17, 

Right.  Asst.  Surg.  J.  A.  Bigelow, 

615 

Taylor,   C.    W.,  Pt.,  C, 

Dec.  13, 

Left.     (Hsem.;  gangrene.)    Died 

Ohio,  age  22. 

Oct.  14, 

8th   Conn.     Haem.     Died  Oct. 

60th  Georgia,  age  20. 

26,  '62. 

Dee.  28,  1862.    Spec.  638. 

1862. 

25,  1862. 

616 

Taylor,  J.,  Pt.,  H,  91st 

July  20, 

Left  (gang.);  ant.  post.  flap.  A.  A. 

582 

Shields,   J.  J.,    Pt.,    K, 

June  1, 

Left  (gang.);  flap.     A.  A.  Surg. 

Ohio,  age  32. 

Aug.  6, 

Surg.  M.  M.  Townsend.    Died 

105th  Penu.,  age  19. 

10,  '62. 

G.W.Edwards.     Died  June  30, 

1864. 

August  10,  '64.    Spec.  4273. 

1862.     Autopsy. 

617 

Taylor,  J.  G.,   Pt.,  G, 

Dec.  13, 

;  circ.     Surg.  E.  Bentley,  U. 

583 

Shuey,  A.  B.,  Corp'l,  C, 

Sept.  19, 

Right  ;  flap.    Surg.  W.  A.  Barry, 

12th  Mass.,  age  37.       * 

1  —  ,  '62. 

S.  V.    Dec.  28,  htemorrh.    Died 

93d  Pennsylvania. 

22,  '64. 

9»th  Penn.     Died  Sept.  27,  '64  ; 

Dec.  28,  1862. 

exhaustion. 

618 

Teagles.  B.  A.,  Pt.,  G, 

Feb.  6, 

Right.     Surg.  J.  Dwinelle,  106th 

584 

Six,  I.,  Pt,,  K,  14th  W. 

July  20, 

Left  ;  ant.  post.  flap.     Surg.  J.  B. 

126th  N.  York,  age  20. 

11,  '64. 

Penn.    Died  Feb.  19,  1864;  py 

Virginia,  age  16. 

26,  '64. 

Lewis,  U.  S.  V.     Aug.  3,  haem.; 

aemia.    Spec.  2045. 

lig.  fern.  art.     Died  Aug.  14/64  ; 

619 

Thompson,  J.  M.,  Pt.,  H, 

June  3, 

Left  ;  lat.  flap.     Surg.R.B.Bonte- 

haemorrhage.    Spec.  4270. 

12th  N.Hamp.,  age  20. 

9,  '64. 

cou,  U.S.V.     Died  June  15,  '64. 

58 

Smith,  A.  M.,  Pt.,  1,  10th 

July  9, 

Right;  circ.     A.  A.  Surg.  A.  R. 

620 

Thompson,  W.,  Pt.,  H, 

Mar.  25, 

Right.     (Dry  gangrene.)     Surg. 

Vermont,  age  20. 

Aug.  3, 

Gray.     Died  Aug.  8,  '64  ;  exh'n. 

69th  N.  York,  age  19. 

April  2, 

D.  W.  Bliss.     Pyaemia.     Died 

1864. 

Autopsy.    Spec.  3814. 

1865. 

April  15,  1865;  exhaustion. 

586 

Smith,  C.  D.,Pt.,H,  15th 

Sept.  17, 

Right.     Died  Sept.  27,  1862. 

621 

Thompson,  W.  H.,  Pt., 

June  3, 

Right  ;  flap.     Surg.A.  F.Sheldon, 

Massachusetts. 

24,  '62. 

C,  IstTJ.S.S.S.,  age  20. 

16,  '64. 

U.S.V.  Died  June  16,'64;  shock. 

587 

Smith,  E.  W.,  Capt.,  D, 

•Sept.  19, 

Right.     Died  October  16,  1863. 

622 

Thormsley,   J.,    Pt.,    I, 

Nov.  25, 

Right;   circ.;  gang.    Died  Dec. 

21st  Michigan. 

22.  'C3. 

9?th  Ohio,  age  18. 

De.  9,  '63. 

13,  1863. 

588 

Smith,    G.,    Pt.,  B,   2d  j  Aug.  10, 

.    Died  September  15,  1861. 

623 

Thorn,    S.   R.,   Pt.,    A, 

May  3. 

Left.     Surg.  G.  P.  Oliver,  lllth 

Infantry.                            ISep.l.'Gl. 

124th  Pennsylvania. 

7,  r63. 

Penn.     Died  May  8,  1863. 

589 

Smith,  J.,  Pt.,  B,  16~\1 

July  26, 

Right  ;  flap.     A.  A.  Surg.  C.  T. 

624 

Tibbetts,  W.  B.,  Serg't, 

Mar.  31, 

Left;  lat.  flap.  Surg.  E.tlriswold, 

New  York,  age  18. 

Au.  1,'64. 

Bullen.     Died  August  23,  18G4; 

K,  1st  Me.  Cav.,  age  28. 

Ap.13,'65. 

U.  S.  V.     Died  April  19,  1865. 

exhaustion. 

625 

Tibbs,   L.,    Serg't,    5th 

Sept.  29, 

Right  ;  circ.     A.  A.  Surg.  B.  T. 

590 

Smith,    J.,   Pt.,   V,   6th 

Sept.  29, 

Left  ;  circ.  A.  A.  Surg.  C.  C.  Ela. 

Col'd  Troops,  age  21  . 

Oct.  7,  '64. 

Crooker.     Haem.    Died  Oct.  19, 

Col'd  Troops,  age  27. 

Oct.  C,  '64. 

Hiem.     Died  Oct.  14,'G4  ;  haem. 

'64;  pyaem.  Autop.    Spec.  1049. 

591 

Smith,  J.,   Pt.,  B,  98th 

Nov.  25, 

Left.    Died  Dec.  4,  1863. 

626 

Timberlake,  T.,  Corp'l, 

Nov.  30, 

Right  ;  ant.  post.  flap.  A.  A.  Surg. 

Ohio. 

—  ,  '63. 

H,  25th  Ohio,  age  20. 

De.  5,  '64. 

11.  Seaman.  Dec.  12,  hasm.  Died 

592 

Smith,  J.  H.,  Lieut.,  G, 

Dec.  1C, 

Left  (gang.);  bi  -lateral  skin  flaps  ; 

Dec.  19,'64  ;  pyaemia.   Autopsy. 

34th  Georgia,  age  32. 

29,  '64. 

circ.  muse.     Surg.  J.  R.  Brust, 

627 

Tracy,   A.  L.,   Pt.,   K, 

July  2, 

Right.     Haem.;   lig.  fern,  artery. 

1st  Tenn.     Died  May  28,  1865; 

141st  Penn.,  age  35. 

5,  r63. 

Died  July  22,  '63  ;  exhaustion. 

exhaustion. 

628 

Tresonthick.S.H.,Capt, 

June  15, 

Left;  circ.     Surg.  A.  P.   Frick, 

593 

Smith,  It.  K.,Pt.,  K,l3th 

Oct.  25, 

Left  (Nov.  10,  pyaemia);  ant.  post. 

E,  18th  Penn.  Cavalry, 

23,  '64. 

103d  Penn.     Gang.     Died  July 

Missouri  Cav.,  age  21. 

Nov.  13, 

flap.     A.  Surg.  W.  H.  Warner, 

age  22. 

26,  1864. 

1864. 

3d   Wisconsin   Cavalry.     Died 

629 

Trimblv,  J.  E.,  Pt.,  D, 

Sept.  20, 

Left  ;  circ.    Died  Oct.  22,  1863. 

Nov.  13,  1864  ;  pyaemia. 

68th  Indiana. 

Got.  1,'63. 

594 

'Smith,  W.  L.,  Pt.,  I,  5th 

May  9, 

Left  ;  ant.  post.  flap.    A.  Surg.  G. 

630 

Truex,  J.  P.,  Corp'l,  F, 

May  31, 

Right.   A.  A.  Surg.  J.  H.  Thomp 

North  Carolina,  age  24. 

18,  '64. 

A.  Mursick,  U.  S.  V.    Died  May 

14th  N.  Jersey,  age  22. 

June  14, 

son.    Haem.;  fern.  art.  secured. 

31.  1  864;  pyaemia.     Autopsy. 

1864. 

Died  June  20,  18C4;  pyaemia. 

595 

Snider,  D.,  Pt.,  G,  4th 

May  6, 

Right  (slough.);  circ.  Surg.  R.  B. 

631 

Truitt,  H.  W.,   Pt.,   E, 

Aug.  21, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Maine,  age  47. 

20,  '64. 

Bontecou,  U.  S.  V.     Died  May 

137th  Illinois,  age  22. 

24,  '64. 

C.  H.  Wade.    Died  Sept.  26,'64  ; 

23,  1864  ;  haemorrhage. 

typhoid  fever. 

596 

Somers,  J.,  Pt.,  E,  C4th 

April  1, 

Left  ;  ant.  post.  flap.    A.  Surg.W. 

632 

Uhland,  F.,  Pt.,  G,  47th 

Oct.  22, 

Left,     Died  Oct.  30,  1862;  hsem. 

New  York,  age  21. 

10,  '6.3. 

F.  Norris,  U.  S.A.    Died  May  1, 

Pennsylvania. 

25,  '62. 

Spec.  732. 

18(55  ;  pysem.  Autop.  Spec.  2629. 

633 

Unknown,  Pt.,  23d  Ky. 

De31,'62, 

.     Died  January  5,  1863. 

597 

Sponholtz,  F.,  Pt.,  A,  5th 

May  3, 

Left,     Surg.  G.  P.  Oliver,  lllth 

Jan.  5,'63. 

New  Jersey. 

7,  '63. 

Penn.    Died  May  24,  1863. 

634 

Unks,  G.,  Corp'l,  L,  62d 

May  12, 

Left.     Gangrene.     Died  June  5, 

598 

Spring,  W.,  Pt.,  K,  19th 

Dec.  7, 

Left  ;  circ.  Surg.  G.tl.  Hubbard. 

Pennsylvania. 

30,  '64. 

1864  ;  pyaemia. 

Iowa,  age  20. 

11,  '62. 

U.  S.V.     Slough  'g.     Died  Dec. 

635 

Valley,  J.R.,Pt,,  I,  20th 

Feb.  7, 

Right;  circ.    A.  Surg.  J.Vansant, 

30,  1862. 

Maine,  age  20. 

23,  '65. 

U.S.A.  Died  Mar.  3,  '65;  pyaem. 

599 

Steadman,  W.,  Pt.,   A, 

May  16, 

Right.  Surg.  D.  P.  Smith,  U.S.  V. 

636 

Vunderslice.A.  H.,Corp, 

July], 

Left.     (Haem.)    Died  August  20, 

1st  Mass.  H'vy  Art'ry, 

25,"  '04. 

Died  June   8,   1864  ;    pyremia. 

E,  27th  Penn.,  age  30. 

16,  '63. 

1863;  colliquative  diarrhoea. 

age  21. 

Spfc.  3296. 

637 

Vermillye,  J.  C.,  Pt.,  K, 

May  12, 

Left  (haem.);  skin  flaps;  circ.  mus. 

:     .1 

Steele,   W.,  Pt.,   H.  2d 

Oct.  17, 

Left.     Died  November  9,  1864. 

124th  N.  York,  age  24. 

20,  '64. 

Surgeon  T.  R.  Crosby,  U.  S.  V. 

New  York  H'vy  Art'v. 

—  ,  '64. 

Haem.;  lig.  fern.  art.     IJied  May 

Steinhofer,   A.,   Pt.,   D, 

May  18, 

Left.     Died  May  30,   1864;   py 

28,  1864  ;  exhaustion. 

20th  Mass.,  age  24. 

27,'  '64. 

aemia.     Spec.  822. 

638 

Vest,  C.,  Pt.,  B,  42d  Vir 

May  12, 

Left  :  ant.  post.  (lap.     A.  Surg.  T. 

602 

Stephens,  E.,  Pt.,  I,  1st 

June  18, 

Left  (spic.  rem'd);  lat.  flap.  Surg. 

ginia,  age  23. 

19,'  '64. 

McMillin,  U.  S.  A.     Died  June 

Pennsylvania  Ilifles. 

July  15, 

N.  R.  Moseley,  U.  S.  V.     Died 

10,  1864  ;  pyaemia.    Spec.  2820. 

1864. 

April  11,  1865;  debility.     Spec. 

639 

Vincent,  R.,  Corp'l,  H, 

May  3, 

.     Surg.  G.  P.  Oliver,  lllth 

2874. 

149th  New  York. 

9,  fe. 

Penn.     Died  May  15,  '63;  haem. 

603 

Sterling,  G.,  Pt.,  I,  20th 

Sept.  30, 

Left  (Oct.  11,  amp.  leg;  gang.); 

640 

Vittman,  G.  L.,  Pt.,  K, 

Oct.  19, 

Right;  circ.     Surg.  R.  W.  Pease, 

Maine,  age  29. 

Oct.  15, 

bi-lat.  flap.     Died  Oct.  20,  1864  ; 

14th  N.Hamp.,  age  27. 

No.  2,  '64. 

U.  S.V.      Died  "Nov.   9,  1864; 

1864. 

exhaustion.    Spec.  3285. 

exhaustion. 

604 

Stoldt,   G.,  Capt.,   58th 

July  3, 

Left.     Died  July  21,"63  ;  tetanus. 

641 

Walker,   T.  S.,  Pt.,  D, 

May  3, 

Left.     Surg.  A.  N.  Dougherty.U. 

New  York. 

6,  '63. 

116th  Pennsylvania. 

15,  ''63. 

S.  V.    Died  May  23,  1863. 

605 

Stone,  G.  E.,  Pt.,  M,  1st 
Mass.  Art'y,  age  29. 

May  19, 
29.  '64. 

Right  ;  ant.  post.  flap.  A.  Surg.W. 
Thomson,  U.  S.  A.     Died  June 
18,  1864;  pyaemia.    Autopsy. 

642  ( 
643) 

Wallace,  D.,  Pt.,  I,  5th 
Artillery. 

July  1, 
4,  '63. 

Both;  circ.     Died  Aug.  2,  1863. 
Specs.  1383,  1384. 

606 

Story,  J.  C.,Pt.,D,  114th 

Sept.  19, 

Right  ;  circ.  Surg.  L.  P.Wagner, 

644 

Wallace,  W.,  Pt.,  E,  63d 

June  3, 

Right  ;  circ.  A.Surg.  S.  B.  Ward, 

New  York. 

24,  '64. 

114th  N.  Y.     Died  Oct.  7,  1864  ; 

New  York,  age  34. 

19,  '64. 

U.  S.V.     Died  July  14,'64  ;  py 

pyaemia.     Autopsy. 

aemia.     Spec.  2713. 

607 

Stover,  A.  W.,  Serg't,  I, 

June  20, 

Right:  circ.     A.  A.  Surg.  A.  N. 

645 

Walters,  C.,  Pt.,  H,  42d 

Sept.  30, 

Left;  circ.     Surg.  —  Whitman. 

20th  Maine,  age  a3. 

28,  '64. 

Brockway.    Died  June  30,  '64  ; 

New  York,  age  21. 

Oc.17,'64. 

Died  October  30,  186-1. 

shock. 

646 

Wannamaker,  D.,  Pt.,F, 

Aug.  28, 

.     (Sept.  7,  gang.)     Sept.  17, 

608 

Stowell,  P.  M.,  Pt.,  D, 

July  2, 

Left;  haem.;  lig.    Died  August  3, 

5th  New  York. 

Sep.9,'62. 

haem.     Died  Sept.  27,  18G2. 

70th  N.  York,  age  28. 

31,  '63. 

1863. 

647 

Ward,  J.,  Pt.,  I,  170th 

May  25, 

Right  ;  circ.  A.A.Surg.R.Ottman. 

609 

Strader,  F.  P.,  Capt.,  H, 

Nov.  2.3. 

Left.    A.Surg.C.C.Byrne.U.S.A. 

New  York,  age  30. 

30,'  '64. 

Died  July  12,  '64.    Spec.  2471. 

fith  Indiana,  age  26. 

De.  9,  '63. 

Died  Dec.  16,  1863;  pyaemia. 

648 

Watkins,  F.  M.,  Serg't, 

May  1  5, 

Right   (four  inches  tibia  rem'd  ; 

610 

Stringer,  T.  J.,  Pt.,  C, 

—  , 

Left.     Died  November  4,  1862. 

F,  57th  Indiana,  ago  24. 

30,  '64. 

caries);  ciro.     A.  Surg.  R.  Mc- 

98th  Ohio. 

Oc.—  ,'62. 

Neilly,  19th  Ohio.    Died  June 

611 

Stubbs,  J.P.,  Pt.,F,13th 

Sept.  19, 

;  circ.    A.  Surg.  —  D'Orsay, 

22,  1864;  exh'n.    Spec.  3368. 

Georgia. 

22,  '64. 

P.  A.  C.  S.    Died  Oct.  10,  1864  ; 

649 

Weatherell,  J.  H.,Capt., 

May  5, 

Right.     Surg.  H.  W.  Ducachet, 

pyaemia. 

C,  10th  Mass.,  age  39. 

19,  '64. 

U.  S.  V.     Haem.;  lig.  fern,  art'y. 

612 

Stuckey,  J.  E.,  Corp'l.B, 

Dec.  13, 

Right.     Died  November  17,  1863. 

Died  June  20,  1864  ;  pyaemia.' 

42d  Pennsylvania. 

24,  '62. 

650 

Weaver,  A.,  Pt.,  C,  2d 

June  8, 

Left;  circ.     Surg.  J.  Shrady,  2d 

613 

Sullivan,  J.  W.,  Pt.,  C, 

Oct.  19, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Tenn.,  age  35. 

19,  '63. 

Tenn.  Venous  hasm.   Died  June 

fith  Maryland,  age  18. 

Nov.  9, 

T.  F.  Murdock.    Died  Nov.  22, 

25,  1863. 

1864. 

1864;  exhaustion.    Spec.  3414. 

651 

Weaver,  J.  E.,  Pt.,  A, 

July  1, 

Left.     Surg.  W.  11.  Rulison,  9th 

G14 

*Tate,  J.  G.,  Pt.,  —  ,  53d 

Sept.  17, 

Left;  circ.     Died  Sept.  30,  1862; 

3d  Indiana  Cavalry. 

17,  '63. 

N.  Y.  Cavalry.    Died  Aug.  30, 

Georgia,  ago  20. 

29,  '62. 

pyaemia. 

1863.    Spec.  1482. 

1  LIUELL  (J.  A.),  On  the  Secondary  Traumatic  Lesions  of  Bone,  etc.,  in  U.  S.  San.  Com.  Memoirs,  1870,  Surgical  Volume  I,  p.  380.     LlDELL  (J.A.), 
On  Thrombosis  and  Embolism,  in  Am.  Jour,  of  the  Med.  Sciences,  JV.  S.,  1872,  Vol.  LXIV,  p.  356. 

2  FISHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations,  etc.,  in  Am.  Jour,  of  the  Med.  Sciences,  If.  S.,  1863,  Vol.  XLV,  p.  47. 


SECT.  III.] 


INTERMED1AKY    AMPUTATIONS    OF    THE    THIGH. 


303 


NO. 

NAME,  MILITARY 

DEbCUIl'lIO.V,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

No. 

NAME,  MILITARY 
DEsciumoN,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

652 

Wearer,  J.,  Pt.,  K,  59th 

June  17, 

:   post.   flap.     Died   July  2, 

665 

Wilkint,  T.  E.,  Corp'l, 

Oct.  19, 

;  circ.     (Haem.;  lig.  ant.  tib. 

Alabama,  age  36. 

23,  '64. 

1864. 

A,  49th  Virginia. 

31,  '64. 

and  pop.  arteries.)     Surg.  J.  M. 

653 

Weiser,   A.,  Pt..  I,  73d 

May  3, 

Left.     Died  June  3,  '63  ;  pyaemia. 

G.  McGuire,  C.S.A.    Slough'g; 

Pennsylvania. 

-,  '63. 

Spec.  1545. 

gaug.     Died  Nov.  12,'64  ;  haein. 

654 

Weiss,  C.,  Pt.,  F,  29th 

Aug.  28, 

.     Died  September  23,  1862. 

666 

Wilson,   C.  M.,   Pt.,  F, 

May  5, 

Left  ;  ant.  post.  flap.     Surg.  R.  B. 

New  York,  age  30. 

Se.—  ,'6-2. 

4th  New  York,  age  35. 

June  2, 

liontecou.  U.  S.  V.     Haem.;  lig. 

655 

Wells,  A.  A.,  Sergt,  I, 

May  3, 

Left.     Surg.  G.  P.  Oliver,  lllth 

1864. 

fern.  art.     Died  June  5,    1864  ; 

5th  New  Hampshire. 

8,  '63. 

Penn.     Died  Mav  15,  1863. 

exhaustion.     Spec.  3043. 

656 

Wenger,  W.,  Pt.,  E,  1st 

Nov.  25, 

Left.     Died  December  15,  1863. 

667 

Wilson,   G.,   Pt.,  F,  1st 

June  3, 

Right.     A.  A.  Surg.  W.  C.  Minor. 

Ohio. 

—  ,  '63. 

New  Jersey,  age  21. 

13,  '64. 

Diarrlio?a.     Died  June  2.),  '64. 

657 

Werber,  G..  Pt.,  K,  39th 

May  6. 

Left  ;  circ.     Surg.  E.  Bentley,  U. 

668 

Wilson,  G.  S.,  Adjutant, 

De.13,'62, 

Right.     Haeui.     Jan.  12,  lig.  fern. 

New  York,  age  31. 

25,  '64. 

S.  V.  Died  June  7,'G4;  asthenia. 

17th  New  York,  age  24. 

Ja.  12,'63. 

art.    Haem.  recurred  17  ;  21.  lig. 

658 

Whaley,  C.  H.,  Pt.,  G, 

Aug.  29 

Left.     (Gang.)     A.  A.  Surg.  J. 

fern,  iirtery.     Died  Feb.  7,  1863; 

14th  New  York. 

Sept.  2, 

Nichols.     Died   Sept.    6,    1862. 

pyaema. 

1862. 

Spec.  138. 

669 

Wilson,  T.  C.,   Pt.,   C, 

Sept.  19, 

Right.     Died  September  22,  1863. 

659 

Whallon,  W.  M.,  Pt.,  C, 

Dec.  13, 

Left.     (Dec.  14,  lig.  fern,  artery.) 

2fith  Ohio. 

22.  '63. 

129th  Penn.,  age  21. 

18,  '62. 

Dec.  24,  haem.;  lig.  fein.  artery. 

670 

Wilson,    W.  C.,  Pt.,  C, 

Aug.  16, 

Left.    Died  September  16,  1864; 

Died  June  4.  1863;  pyaemia. 

105th  Penn.,  age  21. 

Se.14,'64. 

pyaemia. 

660 

Wheeler,  H.  S.,  Serg't, 

Oct.  19, 

Right  ;  ant.  post.  flap.    A.  A.  Surg. 

671 

Wilson,    W.,  Sergt,  F, 

De.29,'63,!  Right  ;  circ.     Died  May  27,  1864. 

B,  2d  Conn.  H'vyArt., 

26,  '64. 

B.  B.  Miles.     Haem.;  lig.    Died 

9tb  Penn.  Cav.,  age  22. 

Ja.19,'64. 

age  29. 

Nov.  11/64  ;  ch.  diar.  Spec.  3434. 

672 

Wimer,  A.,  Pt.,  A,  139th 

May  5, 

Left.     Died  June  3,  1864. 

661 

Wiesmiller,  C.,   Pt.,    B, 

Dec.  13, 

Left.     A.  A.  Surgeon  D.  Weisel. 

Penn.,  age  21. 

13,  64. 

1  2th    Penn.    Reserves, 

25,  '62. 

Haem.;  lig.     Died  Dec.  27,  '62; 

673 

Wolf,  W.,  Pt.,  H,  91st 

June  18, 

Left  ;  ant.  post.  flap.     Surg.  E. 

age  22. 

exhaustion.     Spec.  569. 

Pennsylvania,  age  35. 

July  5, 

Bentley,  U.  S.  V.    Died  July  9, 

662 

Wilcox,   B.  F.,  Pt.,  B, 

July  3, 

Right  ;  ant.  post.  flap.  Surg.  J.  B. 

1864. 

1864  ;  exh'n.  Autop.  Spec.  2832. 

]35th  Ohio,  age  21. 

14,   Ii4. 

Lewis    1'    S    V      Haem      Died 

674 

Wollenweber,  L.,  Pt.,K, 

Dec.  ]3, 

Right.     Died  January  7,  1863. 

Aug.  5,  1864. 

90th  Pennsylvania. 

27,  '62.' 

663 

Will,   J.,    Pt.,    A,    10th 

Aug.  30, 

.    A.  Surg.B.Howard,U.S.A. 

675 

Woodward,  J.  A.,  Lieut., 

May  3, 

Right  ;  circ.     Died  June  1,  1863  ; 

New  York. 

Sep.5,'62.     Died  Sept.  —  ,  1862. 

I,  86th  N.  Y.,  age  20. 

11,  '63. 

pyffimia.     Autopsy. 

664 

'Wilkie,  T.,  Pt.,  D,  14th 

Sept.  17,  :  ;  ant.  post.  flap.    A.  Surg.  C. 

676 

Wright,  J.,  Pt.,  D,  7th 

June  4, 

Right  ;  ant.  post.  flap.     Surg.  R. 

Conn.,  age  40. 

Oct.  2,  '62.     A.  McCall,  U.  S.  A.     Died  O^t. 

New  York  H'vy  Art'y, 

19,  '64. 

B.  Bontecou,  U.  S.  V.     Haem. 

23,  1862;  pyaemia.     Autopsy. 

age  19. 

Died  June  29,  1864  ;  exhaustion. 

In  two  instances  intermediary  amputations  in  the  lower  third  of  both  thighs  were 
unsuccessfully  performed.  One  of  these  cases  is  detailed:2 

CASE  474. — Private  D.  Wallace,  Co.  I,  5th  Artillery,  aged  37  years,  was  wounded  in  both  legs,  at  Gettysburg,  July  1, 
1863,  and  suffered  amputation  at  the  field  hospital  of  the  2d  division,  Fifth  Corps.  Assistant  Surgeon  B.  Howard,  U.  S.  A., 
reported:  "The  patient  was  struck  by  a  rnini6  ball,  which  passed  through  one  knee  joint  and  shattered  the  patella  of  the  other. 
A  flesh  wound  was  also  received  by  another  shot  in  the  upper  third  of  the  left  thigh.  Both  thighs  were  amputated  by  the  circu 
lar  method  in  the  lower  third,  in  immediate  succession,  on  the  third  day  after  the  wound  was  received.  Very  little  blood  was 
lost  at  the  operation,  and  no  appreciable  oozing  had  occurred  by  the  next  day,  at  which  time  the  patient  was  in  such  good  spirits 
as  to  create  frequent  merriment  among  iiis  wounded  comrades  by  his  funny  witticism.  His  pulse  and  appetite  had  both  improved." 
The  patient  was  subsequently  transferred  to  Camp  Letterman,  where  he  was  received  on  August  1st,  in  a  very  exhausted  con 
dition,  the  stumps  not  having  been  dressed  for  two  days;  he  died  on  the  following  day,  August  2,  1863.  The  bones  of  the  knee 
joints  of  the  amputated  limbs  were  contributed  to  the  Museum  by  Dr.  Howard,  and  constitute  specimens  1383  and  1384  of  the 
Surgical  Section.  The  former  consists  of  a  ligamentous  preparation  of  the  right  knee,  from  which  the  patella  was  shot  away; 
the  latter  embraces  the  bones  of  the  left  knee,  the  condyles  of  the  femur  being  completely  shattered. 

The  amputations  in  the  foregoing  table  were  performed,  for  shot  injuries  of  the  lower 
third  of  the  thigh,  in  forty-one;  of  the  knee  joint,  in  four  hundred  and  thirteen;  of  the  leg, 
in  two  hundred  and  two;  and  of  the  ankle  joint  or  foot,  in  twenty  instances.  The  Museum 
possesses  specimens  in  two  hundred  and  three  of  the  six  hundred  and  seventy-six  cases  of 
intermediary  amputations  in  the  lower  third  of  the  thigh. 

Intermediary  Amputation  in  the  Shaft  of  the  Femur  without  Indication  of  the  Seat 
of  Incision. — In  twenty-six  only  of  the  thirteen  hundred  and  twenty  intermediary  opera 
tions  the  seat  of  operation  was  not  specified.  Seven  had  successful  and  nineteen  fatal 
terminations;  a  mortality  of  73.0  per  cent.  Eighteen  operations  were  performed  on  Union 
and  eight  on  Confederate  soldiers.  The  seat  of  fracture  in  the  twenty-six  cases  was  in  the 
lower  third  of  the  femur  in  two;  in  the  knee  joint,  in  three;  and  in  the  leg,  in  three  cases; 
in  eighteen  instances  the  fracture  was  recorded  to  have  been  in  the  femur,  but  the  precise 
point  was  not  indicated.  Such  meagre  details  as  are  reported  on  the  records  of  this  office 
will  be  found  in  the  table  on  the  next  page. 

'COUES  (E.),  Report  of  some  Cases  of  Amputations  and  Resections  from  Gunshot  wounds,  performed  by  Ast't  Surgeon  C.  A.  HcCall,  V.  S.  A.,  in 
Medical  and  Surgical  Reporter,  1862-3,  Vol.  IX,  p.  195. 

2The  other  instance  of  intermediary  amputation  <>t  Uuth  thighs  in  the  lower  thirds  is  that  of  Private  J.  Moore,  E,  46th  Pennsylvania  (TABLB 
XXXVI,  p.  300,  Nog.  497,  498,  ante),  wounded  Aug.  9,  18(2;  double  flap  amputations  at  lower  thirds  of  both  thighs,  Aug.  15,  1862;  death  Aug.  26,  1862. 


304 


INJURIES    OF    THE    LOWER    EXTREMITIES. 

TABLE  XXXVII. 


LCHAK  X, 


Summary  of  Twenty-six  Cases  of  Intermediary  Amputation  in  the  Thigh  for  Shot  Fracture,  the  Point  of 

Ablation  unspecified. 

[Recoveries,  1—7;  Deaths,  8— 26.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

o 
3" 

Grim,  P.,  Pt.,  F,  25th 

Virginia. 
Read,  J.  it.,  Pt.,  H,  48th 
Alabama. 
Siblei/,  R.    W.,  Pt.,   A, 

Aug.  9, 

29,  '62. 
Oct.  29, 
No.  13.  '63. 
June  13, 

Left.     Surgs.  Bland  and  Miller 
C.  S.  A.     Recovery. 
.     Surg.  —   Westmoreland, 
C.  S.  A.     Recovery. 
Left.     Surg.  J.  N.  K.  Monmonier, 

14 
15 

16 

Lohnes,  A.,  Pt.,  K.  104th 
New  York,  age  27. 
McDonald,  A.  O.,  Serg't, 
D,  7th  Mich.,  age  25. 
Peck,  M.  A.,  Pt.,  H,33d 

July  1, 
9,  '63. 
Dec.  13, 
28,  '62. 
April  30, 

Right.     July  22,  re-amp.     Died 
August  20,  1863. 
Left.     Died  January  2,  1863;  py 
aemia. 
.     Died  June  5,  1864. 

4 

6th  Louisiana. 
Stevens,  —  ,  Pt.,  —  ,  13th 

17,  '62. 
Aug.  30, 

8th  La.     Recovery. 
Right.     Ass't  Surg.  B.  Howard, 

17 

Iowa. 
Rankin,  W.  H.,  Pt.,  C, 

June*27, 

—  .     Died  July  21,  1862. 

5 

Massachusetts. 
Terry,  W.,  Pt.,  —  ,  76th 

Sep.4,'62. 
Aug.  30, 

U.S.A. 
Left.     Ass't  Surg.  B.  Howard, 

18 

95th  Pennsylvania. 
Rhoads,  D.  W.,  —  ,  llth 

J'ylO,'62. 
April  7, 

.     (Erysipelas;  haem.)    Died 

6 

.- 
9 
10 
11 

Pennsylvania. 
Vogt.  F.  E  .,  Serg't,  F, 
1st  Maryland. 
Williams,  G.  H,  Pt.,  B, 
7th  South  Carolina. 
Anderson,    A.,    Pt.,    B, 
"l.'d  Illinois. 
Dixon,  W.,  Pt.,  D,  14th 
N.  Carolina,  age  21. 
Fox,    M.,    Pt.,    B,    1st 
Michigan. 
Freyer,  W.,  Pt.,  K,  1st 
Michigan. 

Sep.3,'62. 
June  8. 
19,  '62. 
Sept.  19. 
27,  '63. 
April  6, 
22,  '62. 
May  12, 
19,  '64. 
Aug.  30, 
Sep.4,'62. 
Aug.  30, 
Sep.  2,  '62. 

U.  S.  A. 
Left.     Disch'd  June  28,  1864. 

.     Surg.  —  Carlisle,  C.  S.  A. 
Recovery. 
Left.     Died  April  28,  1862  ;  haem 
orrhage. 
.     Died  May  21,   1864;   py 
aemia. 
Right.     Ass't  Surg.  B.  Howard, 
U.  S.  A.    Died  Sept.  10,  1862. 
Right.     Ass't  Surg.  B.  Howard, 
U.S.A.     Died  Sept.  —  ,  1862. 

19 

20 
21 
22 
23 
04 

Kentucky. 
Rodgers.  E.  F.,  Serg't, 
C,  1st  Michigan. 

Ross,  C.,  Pt..  E,  5th  N. 
York,  age  17. 
Shields,   J.  A.,  Pt.,  K, 
105th  Penn.,  age  19. 
Sonderman,  C.,  Pt.,  K, 
17th  Illinois. 
Thornburg,  G.,  Pt.,  C. 
70th  Ohio. 
Waller,  D.  ./.,  —  ,  E,  23d 

M'y3,'62. 
Aug.  30, 
Sept.  6, 
1862. 
Aug.  30, 
So.  23,  '62. 
May  31, 
Je.  10,  '62. 
April  6, 
25,  '62. 
April  6, 
20,  '62. 
Sept.  14, 

May  3,  1862;  haemorrhage. 
Right.     Ass't  Surg.  B.  Howard, 
U.  S.  A.     Died  Sept.  16,  1802; 
pyaemia. 
Right;  circ.     Died  Oct.  7,  1862; 
pyaemia. 
.    June  17,  pyaemia.     Died 
June  30,  1862.    Autopsy. 
.     (Erysipelas;  haem.)    Died 
April  25,  1862. 
—  .     Died  May  2,  18o2;  haemor 
rhage. 
.     Sept.   15,    amp.   leg;   25, 

1-' 
13 

Harney,  R.,   Serg't,   A, 
29th  Mass.,  age  28. 

Legler,  G.,  Pt.,  K,  9th 
Wisconsin. 

J  une  2, 
14,  '64. 

April  30, 
M'y25,'64. 

Left  ;  circ.     A.  A.  Surg.  F.  G.  H. 
Bradford.     Died  June  26,  1864; 
exhaustion. 
Right,    Died  June  3,  1864. 

25 
26 

South  Carolina. 
Warren,  H.  M.,  Corp'l, 
D,  18th  Mass. 
Weston,  H.,  Pt,,  K.  15th 
Illinois. 

25.  '62. 
Dec.  13, 
20,  '62. 
April  6, 
25,  '62. 

haem.     Died  Oct.  13,  1862. 
Right.     Died  December  20,  1862. 

Right.     Died  May  13,  1862. 

SECONDARY  AMPUTATIONS  IN  THE  SHAFT  OF  THE  FEMUR.— There  were 
four  hundred  and  forty-two  cases  in  which  the  amputation  in  the  thigh  was  practised  sub 
sequent  to  the  thirtieth  day  after  the  reception  of  the  injury.  Two  hundred  and  thirty-nine 
recovered  and  two  hundred  and  three  died,  a  fatality  of  45.9  per  cent.,  or  3.9  per  cent,  less 
than  in  the  series  of  primary,  and  17.8  per  cent,  less  than  in  the  series  of  intermediary 
operations. 

Secondary  Amputations  in  the  Upper  Third  of  the  Shaft  of  the  Femur. — Fifty-five 
operations  of  this  nature  were  reported,  with  twenty-five  deaths,  or  a  mortality  of  45.4  per 
cent.  The  operations  were  performed  on  forty-five  Union  and  ten  Confederate  soldiers. 
In  thirty  the  right  limb,  and  in  twenty-one  the  left  limb,  was  involved,  and  in  four  this 
point  was  not  indicated. 

Recoveries  after  Secondary  Amputations  in  the  Upper  Third  of  the  Femur. — Thirty 
of  the  secondary  amputations  in  the  upper  third  of  the  femur  resulted  favorably,  six  on 
Confederate  and  twenty-four  on  Union  soldiers.  Twenty-three  of  the  latter  were  pensioned, 
and  all  but  one  were  living  in  October,  1879.  In  two  cases  the  lesions  were  consequent 
on  injuries  inflicted  by  shell,  in  one  by  grape  shot;  in  twenty-seven,  the  injuries  were 
believed  to  have  been  caused  by  small  projectiles.  Two  of  the  patients  had  undergone 
prior  operations,  one,  an  amputation  of  the  same  leg,  and  one,  an  excision  of  three  and  a 
half  inches  of  the  upper  third  of  the  femur.1  The  convalescence  was  retarded  by  pyaemia 
in  one,  by  gangrene  in  two,  and  by  haemorrhage  in  three  instances.  In  the  following  case 
bleeding  occurred  on  the  thirteenth  day,  but  was  readily  controlled  by  the  tourniquet  and  ice: 

CASE  475. — Captain  J.  A.  Bates,  Co.  D,  12th  New  York,  was  wounded  in  the  right  leg  at  Gaines's  Mill,  June  27,  1862, 
and  underwent  amputation  nineteen  months  afterwards.  Surgeon  A.  B.  Mott,  U.  S.  V.,  who  performed  the  operation,  made  the 
following  report  of  it:  "The  wound  was  caused  by  a  shell  which  splintered  the  tibia  about  midway  between  the  knee  and  the 
foot  without  completely  fracturing  it.  The  patient  entered  Ladies'  Home  Hospital,  New  York  City,  December  25,  1863,  and 

1  The  amputation  of  the  thigh  had  l>een  preceded  by  amputation  in  the  leg  in  the  case  of  C.  I5asim,  Pt.,  II,  8th  Pennsylvania  Reserves  (TAI)LE 
XXXVIII,  No.  2,  ]>.  308),  by  excision  in  the  shaft  of  the  femur  in  the  case  of  Pt.  S.  C.  Hall,  K,  3d  Indiana  Cavalry  (TAliLE  XXV,  No.  3,  p.  208,  ante, 
aud  TAliLK  XXXVIII,  No.  9,  p.  308). 


SECT.  III.] 


SECONDARY    AMPUTATIONS    OF    THE    THIGH. 


305 


thirty  days  afterwards  the  limb  was  amputated.  At  the  time  of  the  operation  the  leg  had  become  greatly  swollen  from  enlarge 
ment  of  the  bone,  the  skin  was  discolored  with  numerous  ulcerations,  and  there  was  an  immense  discharge  of  matter  from  the 
ulcers  and  from  an  abscess  about  the  knee  joint.  The  patient  was  in  a  very  low  and  emaciated  condition,  had  no  appetite,  and 
was  unable  to  sleep  without  taking  anodynes.  The  amputation  was  performed  at  the  upper  third  of  the  thigh  by  the  circular 
method,  and  was  attended  with  little  haemorrhage,  chloroform  being  used,  and  followed  by  prompt  reaction.  Ligatures  were 
applied  to  every  bleeding  vessel.  The  patient  did  well  from  the  time  the  operation  was  performed.  He  was  ordered  to  have 
two  pints  of  porter  and  six  ounces  of  brandy  daily,  together  with  nourishing  diet.  Some  haemorrhage  took  place  on  the 
thirteenth  day,  which  was  easily  controlled  with  the  tourniquet  and  ice,  but  recurred  one  week  afterwards.  On  June  12,  1864, 
the  patient  was  discharged  from  the  hospital  cured."  Captain  Bates  re-entered  the  Army  as  an  officer  of  the  43d  Infantry,  July 
28,  1866,  and  four  years  later  he  was  retired  from  active  service.  He  was  furnished  with  an  artificial  limb  by  B.  F.  Palmer,  of 
Philadelphia,  July  14,  1869. 

In  the  next  case  the  amputation  was  not  performed  until  seven  years  after  the  date 
of  the  reception  of  the  injury: 

CASE  476. — Private  Jesse  M.  Jones,1  Co.  K,  21st  Indiana,  aged 
29  years,  was  wounded  at  Baton  Rouge,  August  5,  1862,  by  a  musket 
ball,  which  fractured  the  right  femur  at  the  junction  of  the  middle  and 
upper  thirds.  He  was  taken  to  the  regimental  hospital,  remained  there 
one  day,  and  was  then  sent  on  a  hospital  transport  to  New  Orleans, 
the  limb  meanwhile  being  supported  by  bandages  and  pillows.  On 
arrival,  August  7th,  he  was  admitted  to  the  St.  James  Hospital,  where 
a  long  splint  was  applied,  seventeen  days  after  the  reception  of  the 
wound.  Ho  was  discharged  April  15,  1863,  and  pensioned.  On  No 
vember  14,  1866,  Examining  Surgeon  W.  J.  Hoadley,  of  Danville, 
Indiana,  reports  :  "The  wound  still  unhealed,  fracture  had  united  by 
large  deposits  of  bone;  limb  shortened  four  and  three-fourths  inches." 
In  January,  1869,  he  entered  Providence  Hospital,  Washington;  and, 
on  the  23d,  Dr.  D.  W.  Bliss,  late  Surgeon  U.  S.  V.,  amputated  the  thigh 
in  the  upper  third  by  the  antero-posterior  flap  method.  The  patho 
logical  specimen  was  presented  to  the  Army  Medical  Museum  by  the 
operator.  It  is  No.  5558  of  the  Surgical  Section  (FiG.  196),  and  shows 
great  deformity,  with  exfoliations  on  posterior  aspect,  and  a  fragment 
of  lead  imbedded  in  the  callus.  On  March  9,  1869,  Jones  visited  the 
Museum,  when  his  photograph  (A.  M.  M.  Card  Photographs,  Vol.  I, 
p.  27)  was  taken,  a  copy  of  which  is  shown  in  the  wood-cut  (FiG.  197). 
His  pension  was  paid  December  4, 1879. 

Of  four  of  this  series  of  thirty  cases  of  secondary  amputation  in  the  upper  third  of  the 
femur  the  specimens  are  preserved  in  the  Army  Medical  Museum: 

CASE  477. — Sergeant  J.  Hammill,  Co.  D,  8th  New  Jersey,  aged  23  years,  was  wounded  in  the 
right  knee,  at  Chancellorsville,  May  3,  1863.  From  the  field  he  was  conveyed  to  Potomac  Creek 
Hospital,  and  thence,  six  weeks  afterwards,  to  Washington,  where  the  injured  limb  was  amputated. 
Surgeon  D.  W.  Bliss,  U.  S.  V.,  who  performed  the  operation,  reported :  "The  wound  was  caused  by  a 
mini6  ball,  which  struck  the  external  condyle  of  the  femur  and  passed  directly  through,  comminuting 
the  condyles  and  lower  part  of  the  femur  and  opening  the  joint.  The  patient  was  admitted  to  Armory 
Square  Hospital,  June  14th.  He  was  then  suffering  from  profuse  suppuration  from  the  joint,  and  had 
a  large  abscess  attended  with  disintegration  of  the  tissues  of  the  calf  of  the  leg,  in  consequence  of 
which  he  was  in  a  very  reduced  condition.  There  were  no  symptoms  of  pyaemia,  however.  As  there 
was  no  possible  chance  of  life  for  the  patient  without  an  operation,  it  was  decided  to  amputate,  which 
was  done  on  June  16th,  by  the  circular  method,  at  the  junction  of  the  middle  and  upper  thirds.  The 
soft  parts  were  found  in  a  very  diseased  condition.  The  patient  stood  the  operation  well  and  progressed 
favorably.  Three  months  afterwards  he  was  transferred  to  St.  Elizabeth  Hospital."  The  man  was 
ultimately  discharged  from  Ward  Hospital,  Newark,  May  4,  1864,  having  been  previously  furnished 
with  an  artificial  limb  by  E.  D.  Hudson,  of  New  York  City.  He  is  a  pensioner,  and  was  paid  June  4, 
1878.  The  amputated  part  of  the  femur,  together  with  the  bones  of  the  knee,  were  contributed  to  the 
Museum  by  the  operator,  and  are  shown  in  the  cut  (FiG.  198).  The  specimen  shows  a  slight  deposit  of 
callus  on  the  border  of  the  fracture,  and  much  disorganization  of  the  articulation  by  suppuration. 

As  already  remarked,   one  of  the  twenty-three  pensioners  of  this    of  lower  third  of  right  fe- 

J  J  L  mur,  with  slight  deposit  of 

group  died  nearly  fifteen  years  after  the  operation : 

CASE  478. — Private  M.  Hartigan,  Co.  H,  108th  New  York,  aged  18  years,  was  wounded  in  the  left  knee,  at  Antietam, 
September  17, 1862.     He  was  moved  from  a  field  hospital  to  Frederick  twelve  days  after  the  injury,  and  two  days  later  to  Ches 
ter,  where  the  injured  limb  was  amputated.     Acting  Assistant  Surgeon  C.  J.  Morton,  who  performed  the  operation,  contributed 
'  An  account  of  the  case  has  been  published  in  Circular  No.  3,  Surgeon  General's  Office,  Washington,  1871,  p.  209. 

SUKG.  Ill— 39 


FIG.  196.— Rig-lit 
lemur  fractured  at 
junction  of  upper 
and  middle  thirds. 
Spec.  5558. 


FIG.  197. — Appearance   of  the 
weeks  after  operation.  [From  a  phi 


;t mil p  six 
tograph.J 


FIG.  198.  — Shot  fracture 


306  INJURIES   OF   THE    LOWER    EXTREMITIES. 

the  pathological  specimen  (Cat.  Sury.  Sect.,  1866,  p.  337,  Spec.  262),  with'the  following  details  of  the  case:  "The  wound  was 
produced  by  a  ball,  which  entered  near  the  centre  of  the  popliteal  space  and  emerged  at  outer  side  of  the  knee.  The  man 
walked  from  the  battle  field  to  the  field  hospital.  After  his  admission  to  Chester  Hospital,  on  October  2d,  the  wound  did  well 
for  u  few  days,  when  syuovitis  ensued,  and  the  knee  joint  became  highly  inflamed  and  painful  on  motion.  The  patient  was  also 
suffering  from  diarrhoea,  poor  appetite,  and  .was  much  emaciated.  About  a  week  afterwards  large  dissecting  abscesses  formed 
above  and  below  the  knee,  which  were  freely  opened,  and  compresses  were  then  applied  to  prevent  the  upward  tendency  of  the 
abscesses.  On  October  29th,  the  muscles  were  completely  dissected  with  pus  to  above  the  middle  of  the  thigh,  and  the  least 
movement  of  the  limb  would  cause  the  most  agonizing  pain;  the  patient's  appetite  now  being  completely  gone  and  his  emaciation 
very  great.  On  consultation,  it  was  then  decided  that,  as  the  only  means  of  preserving  life,  amputation  should  be  resorted  to, 
which  was  performed  about  four  and  a  half  inches  below  the  great  trochanter.  The  patient  spent  a  wakeful  night  after  the 
operation,  his  pulse  being  160;  but  after  several  days  he  began  to  rest  better  and  regained  some  appetite,  and  by  November  6th 
his  general  condition  was  much  improved,  the  stump  healing  nicely  and  showing  every  prospect  of  recovery.  By  December 
llth,  the  stump  was  nearly  healed  and  the  patient  had  almost  recovered.  Dissection  of  the  amputated  limb  showed  that  the  ball 
had  passed  through  the  joint  and  struck  the  outer  condyle  of  the  femur.  The  cartilage  of  the  femur  and  tibia  was  very  much 
roughened."  The  specimen  consists  of  a  ligamentous  preparation  of  the  bones  of  the  injured  knee.  The  patient  was  discharged 
from  service  May  19,  1863,  and  pensioned.  He  was  subsequently  supplied  with  an  artificial  limb  by  the  Palmer  Arm  and  Leg 
Co.,  by  whom  the  operation  was  described  as  having  been  performed  by  the  flap  method.  The  pensioner  died  April  1,  1877. 

Fatal  Cases  of  Secondary  Amputations  in  the  Upper  Third  of  the  Thigh. — The 
twenty-five  operations  of  this  group  were  performed  on  four  Confederate  and  twenty-one 
Union  soldiers.  In  one  instance  excision  in  the  middle  third  of  the  femur  had  preceded 
the  secondary  amputation.1  Four  patients  perished  from  pyaemia,  two  from  gangrene,  ten 
from  exhaustion,  three  from  shock.  In  one  instance  it  was  believed  that  chloroform  con 
tributed  to  the  unfortunate  result,2  and  in  five  the  cause  of  death  was  not  recorded. 

CASE  479. — Private  John  Pool,  Co.  H,  119th  Pennsylvania,  aged  23  years,  was  wounded  by  a  conoidal  ball,  at  Rappa- 
hannock  Station,  November  7,  1863.  He  was  admitted  into  the  Stanton  Hospital,  Washington,  November  9th.  Surgeon  John 
A.  Lidell,3  U.  S.  V.,  furnished  the  following  history,  with  the  specimen  (.No.  2229,  Sect  I),  to  the  Army  Medical  Museum  :  "The 
bullet  had  entered  the  lateral  and  external  part  of  the  left  thigh  near  the  junction  of  the  middle  and  upper  thirds,  and  passing 
downward,  inward,  and  somewhat  forward,  had  fractured  the  femur  at  its  middle.  The  missile  appears  to  have  been  split,  by 
contact  with  the  bone,  into  two  pieces,  which  made  their  escape  through  separate  openings  in  the  popliteal  space.  When  admitted 
the  knee  was  much  swollen  and  hot;  the  patella  floated  some  distance  above  the  femoral  condyles.  He  did  not  complain  of  pain, 
and  his  general  condition  was  favorable.  The  wounded  limb  was  propped  up  with  long  sand  bags  placed  on  either  side  of  it, 
and  moderate  extension  was  applied  by  a  weight  hanging  over  the  foot  of  the  bed  and  attached  to  the  foot  and  leg  by  strips  of 
adhesive  plaster.  Counter  extension  was  effected  by  elevating  the  foot  of  the  bed.  He  was  put  upon  supporting  diet,  and 
simple  dressings  applied.  The  inflammation  and  swelling  at  the  knee  gradually  subsided,  and,  on  December  1st,  had  entirely 
disappeared,  the  wounds  in  the  popliteal  space  closed;  the  wound  of  entrance,  however,  w;is  still  open  and  discharging.  On  the 
20th,  there  was  a  slight  hemorrhage  of  arterial  blood  from  the  wound  of  entrance,  which  was  readily  checked.  On  the  28th, 
the  limb  was  placed  in  Hodgen's  splint  to  facilitate  the  outflow  of  pus.  January  8,  1864,  the  wound  in  the  popliteal  space 
reopened  and  the  wounds,  both  of  entrance  and  exit,  discharged  freely.  24th,  pulse  110;  he  was  daily  becoming  more  feeble. 
On  exploring  the  wound  through  the  orifice  of  exit  with  N41aton's  probe  detached  fragments  were  found  at  the  seat  of  fracture. 
The  patient  was  etherized,  and  through  an  incision  about  four  inches  long,  made  in  the  back  part  of  the  thigh,  six  detached 
fragments  of  considerable  size,  the  largest  about  two  inches  long  by  three-fourths  of  an  inch  wide,  were  extracted.  The  supe 
rior  and  inferior  part  of  the  fractured  femur  were  found  to  be  held  in  proper  position  by  strong  splints  of  provisional  callus, 
which  had  been  thrown  out  on  the  inner  and  outer  sides  of  the  bone.  The  finger  could  be  readily  passed  between  the  broken 
extremities  of  the  bone,  both  ends  of  which  were  necrosed  but  not  yet  detached.  On  the  25th,  the  thigh  had  swelled  a  good 
deal  and  was  emphysematous,  but,  on  the  28th,  the  emphysema  had  disappeared  and  the  swelling  was  subsiding;  the  limb  was 
again  placed  in  Hodgen's  splint.  On  the  31st,  he  was  improving  in  every  respect.  On  February  14th,  he  was  doing  finely;  no 
night  sweats;  slept  well;  appetite  good;  pulse  80;  discharge  of  pus  moderate.  24th,  two  fragments  of  bone  were  extracted. 
March  1st,  a  diffuse  inflammation,  accompanied  with  redness  and  much  swelling,  attacked  the  thigh  and  spread  rapidly  through 
the  limb;  there  was  also  great  constitutional  disturbance.  After  a  time  this  inflammation  subsided  in  a  great  measure  but  left 
him  much  weakened.  About  April  1st,  another  attack  of  diffuse  inflammation  brought  him  still  lower.  18th,  the  whole  limb 
was  greatly  swollen  from  the  groin  to  the  toes;  a  small  slough  on  the  instep  separated;  the  knee  joint  was  extended  with 
effusion,  the  patella  floating  some  distance  above  the  femoral  condyles.  There  was  a  profuse  discharge  of  thin  pus  from  the 
wound  of  operation  in  the  back  part  of  the  thigh.  He  was  much  emaciated,  pale,  and  weak ;  pulse  frequent  and  feeble;  tongue 
red  and  inclined  to  be  dry;  appetite  capricious  and  poor,  and  he  was  subject  to  frequent  attacks  of  diarrhoea.  He  was  steadily 

'Case  of  Private  C.  Collar,  F,  45th  Illinois  (TABLE  XXVI,  No.  8,  p.  210,  ante,  and  TABLE  XXXVIII,  No.  34,  p.  308). 

*Case  of  Private  J.  Bradley,  D,  25th  North  Carolina  (TABLE  XXXVIII,  No.  32,  p.  308),  admitted  to  Chimborazo  Hospital,  Richmond,  June  25, 
1862,  with  a  slight  wound  of  patella  and  integuments  covering  it,  not  penetrating  joint.  July  llth,  patella  partially  necrosed;  gangrene  appeared  on 
inner  and  outer  aspect  of  knee  joint,  showing  tendency  to  spread.  July  18th,  amputation  of  thigh  at  junction  of  middle  and  upper  thirds.  Death  July 
18,  1862,  a  few  minutes  after  the  operation.  A  remark  on  the  hospital  register  explains :  "  The  wound  was  deemed  of  trifling  importance  until  the  llth, 
when  the  patella  was  discovered  to  be  necrosed.  The  chloroform  may  have  contributed  to  the  unfavorable  result,  for  it  caused  him  to  vomit  freely,  and 
he  was  unable  to  retain  any  stimulants  on  his  stomach." 

3LIDELL  (J.  A.),  On  Secondary  Traumatic  Lesions  of  Bone,  viz:  Osteo-myelitis,  Periostitis,  Ostitis,  Caries,  and  Necrosis,  in  U.  S.  Sanitary 
Commitsion  Memoirs,  1870,  Surgical  Volume  I,  p.  414. 


-  o 

z_  H 

'-  c 

_  3 

--  en 

-  O 


SECT.  HI.] 


SECONDAKY    AMPUTATIONS    OF    THE    THIGH. 


307 


failing,  and,  there  being  no  hope  of  saving  his  life  without  amputation,  he  was  placed  under  the  influence  of  sulphuric  ether, 
digital  compression  applied  to  the  femoral  artery,  and  the  thigh  amputated  in  the  upper  third,  by  the  double  flap  method,  bv 
Surgeon  .1.  A.  Lidell,  U.  S.  V.  The  femur  was  sawn  off  about  one  and  a  half  inches  below  the  trochanter  minor.  The  soft 
parts  of  the  thigh  were  so  much  diseased  as  not  to  admit  the  performance  of  the  operation  at  any  point  below.  But  little  blood 
was  lost  during  the  operation.  There  was  a  good  deal  of  shock,  but  he  reacted  promptly  afterward.  In  a  short  time  the  stump 
became  sloughy;  he  gradually  failed,  and  died  of  exhaustion  April  26,  1863.  On  examining  the  amputated  member,  extensive 
burrowing  of  pus  was  found  among  the  muscles  of  the  thigh,  and  numerous  small  pieces  of  the  bullet  and  fragments  of  bone 
sticking  into  the  soft  part  around  the  seat  of  fracture.  The  ends  of  the  broken  femur  were  not  in  apposition,  but  separated  from 
each  other  by  the  space  which  had  formerly  been  occupied  by  the  fragments  of  bone  extracted  by  operation.  Pretty  firm  union 
had,  however,  taken  place  by  means  of  a  bridge  of  new  bone  which  arched  over  the  chasm  in  front.  On  splitting  the  femur 
open  lengthwise  with  a  saw  the  marrow  presented  a  coppery-red  color,  and  there  were  abundant,  deposits  of  new  reddish  colored 
osseous  tissue  both  within  the  medullary  canal,  endostosis,  and,  external  to  the  bone,  periostosis,  for  a  considerable  distance 
above  the  fracture.  In  the  marrow  below  the  fracture  there  was  a  large-sized  chocolate-colored  spot,  the  result,  apparently,  of 
an  old  extravasation  of  blood.  The  substance  of  the  marrow  was  decidedly  tougher  than  normal.  There  was  a  considerable 
deposit  of  new  osseous  tissue  lying  between  the  periosteum  and  the  bone.  The  periosteum  itself  '"as  thicker  and  redder  than 
natural  in  that  locality,  and  from  it  these  laminae  of  new  osseous  tissue  had  been  developed.  Th  knee  joint  was  swelled  out 
with  a  straw-colored  jelly-like  substance;  the  synovial  fringes  were  reddened,  but  the  articular  cartilage  presented  no  abnormity." 
A  drawing  of  the  specimen,  No.  2229,  by  Hospital  Stewart  E.  Stauch,  is  copied  in  PLATE  LXVI,  opposite  p.  306. 

In  the  following  instance  amputation  was  performed  twenty-two  months  after  ike  injury. 
The  patient  had  been  discharged  and  pensioned,  but  the  wound  reopened,  allowing  the  end 
of  the  lower  portion  of  the  femur  to  protrude  through  a  fistulous  passage : 

CASE  480.— Private  P.  Eiley,  Co.  A,  10th  New  York,  aged  24 
years,  was  wounded  at  Cold  Harbor,  June  3,  1864,  and  admitted  to  the 
field  hospital  of  the  2d  division,  Second  Corps.  Surgeon  J.  F.  Dyer, 
19th  Massachusetts,  recorded :  "  Gunshot  fracture  of  left  thigh,  upper 
third."  Surgeon  J.  C.  McKee,  U.  S.  A.,  contributed  a  photograph,  which 
is  shown  in  the  wood-cut  (FiG.  199),  and  reported  as  follows :  "Admitted 
to  Lincoln  Hospital,  Washington,  June  llth,  with  a  gunshot  fracture 
of  the  left  femur,  the  ball  entering  the  anterior  surface  of  the  thigh  four 
inches  below  the  anterior  superior  spinous  process  of  ilium,  passing 
directly  backward,  producing  a  compound  comminuted  fracture  of  the 
upper  third  of  the  femur,  and  lodging  in  the  muscular  substance  of  the 
thigh  posteriorly.  Extension  and  counter-extension  were  used,  but  re 
moved  on  account  of  the  inflammation  of  the  parts  and  the  severe  pain 
produced.  Three  weeks  after  admission  free  incisions  were  made  for  the 
discharge  of  pus.  The  patient  slowly  recovered,  with  four  and  a  half 
inches  shortening  of  the  limb."  He  was  mustered  out  of  service  August 
1, 1865,  and  pensioned.  A  cast  of  the  injured  limb  in  this  case  was  also 
contributed  by  Dr.  McKee,  and  constitutes  specimen  4051  of  the  Surgical 
Section  of  the  Museum.  (See  Cat.  Surg.  Sect.,  1866,  p.  535.)  Examiner 
W.  H.  Thomson,  of  New  York  City,  certified,  January  22, 1866:  "A  ball 
entered  the  inner  aspect  of  the  left  thigh  and  fractured  the  femur  opposite 
the  great  trochanter.  The  limb  is  now  much  distorted  and  marked  with 
fistulous  passages,  from  one  of  which,  at  the  anterior  upper  third  of  the 
limb,  the  end  of  the  lower  portion  of  the  femur  protrudes.  He  should 
not  have  been  discharged  from  hospital  in  that  condition."  Dr.  M.  M. 
Marsh,  Surgeon  at  the  Lincoln  Hospital,  New  York  City,  certified :  "That 
in  the  month  of  April,  1866,  Peter  Eiley  came  into  the  hospital  for  an 
operation  on  a  shattered  femur  in  its  upper  third,  the  lower  fragment  of 
bone  protruding.  Amputation  was  performed,  and  the  patient  died  of 
pyaemia  May  7,  1866,  and  in  consequence  of  the  injury  received  in  the 
service  as  the  remote  cause."  (See  Photo.  Series,  A.  M.  M.,  No.  117.) 


FIG.  199. — Appearance  of  limb  a  year  after  injury, 
photograph.] 


[From  a 


Consecutive  bleeding  was  observed  in  three  instances,  two  of  which  necessitated  liga- 
tion  of  the  femoral  artery.  One  of  the  cases  is  detailed:1 

CASE  481.— Private  J.  B.  Lynn,  Co.  B,  83d  Ohio,  aged  19  years,  was  wounded  in  the  right  leg,  at  Fort  Blakely,  April 
9,  1865,  and  was  admitted  to  Sedgewick  Hospital,  Greenville,  four  days  afterwards.  Assistant  Surgeon  A.  Hartsuff,  U.  S.  A., 
who  amputated  the  injured  limb,  furnished  the  following  report  of  the  operation:  "The  wound  consisted  of  a  longitudinal  frac 
ture  of  the  upper  portion  of  the  tibia,  involving  the  knee  joint.  The  ball  passed  through  the  bone  downward  and  emerged 
opposite  the  tendon  of  the  gastrocnemius.  On  May  30th,  the  limb  being  infiltrated  with  serum  and  there  being  extensive  bur- 

1  The  other  instance  of  ligation  of  the  femoral  artery  is  that  of  Private  H.  Griffith,  E,  8th  New  York  Cavalry ;  wounded  at  Autietam,  September  17, 
1802 ;  shot  fracture  of  left  knee  joint.  Amputation  at  upper  third  of  thigh,  November,  1862 ;  ulceration  of  branch  of  femoral  nrtery,  haemorrhage ;  ligation 
of  femoral  at  Scarpa's  triangle,  November  19,  1862  ;  death  November  19,  18(i2.  Specimens  768  and  8o3,  Sect.  I,  A.  M.  M. 


308 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


(CHAP.  X. 


rowing  of  pus  from  phlegiuouous  erysipelas,  amputation  was  performed  at  the  upper  third  of  the  thigh  by  the  circular  method. 
No  sutures  were  introduced  on  account  of  the  condition  of  the  parts,  thereby  favoring  the  draining  of  the  serum.  Though  the 
patient  was  debilitated  and  much  emaciated,  he  finally  rallied  under  stimulants  and  nourishing  diet.  On  Jure  5th,  haemorrhage 
occurred,  amounting  to  over  twenty  ounces,  when  the  femoral  artery  was  immediately  cut  down  upon,  expo'  ed  in  its  continuity, 
and  ligated  about  an  inch  above  the  face  of  the  stump.  Death  occurred  two  days  later,  from  exhaustion.  The  ligatures  were 
found  to,  have  ulcerated  through,  the  arteries  being  patulous  and  showing  no  attempt  at  closing." 

TABLE  XXXVIII. 

Summary  of  Fifty-Jive  Cases  of  Secondary  Amputation  in  ike  Upper  Third  of  \he  Femur  for  Shot, 

Fracture. 

[Recoveries,  1—30;  deaths,  31 — 55.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Babson,C.L.,Pt.,K,16th 

De.13,'62, 

Left  ;  ciro.    A.  A.  Snrg.  A.  Cool- 

29 

Smith,  P.,  Pt.,  F,  5th  In. 

Feb.  22, 

Right  ;  flap.     A.  Surg.  B.  Norris, 

Maine,  age  21. 

Mar.  28, 

idge.     Disch'd  Oct.  16,  1863. 

fentry. 

M'y4,'62. 

U.  S.  A.     Disch'd  J  uly  13.  1  862. 

1863. 

30 

Walsh,   H.,  Landsman, 

July  16. 

Left;    circ.     Surg.  \V.  Johnson, 

•2 

Basim,   C.,  Pt.,  H,  8th 

Sept.  17, 

Right.  (Sept.  17,  amp.  leg;  gang.) 

U.  S.  S.  Mendota,  age 

Sept.  2, 

U.  S.  N.    Diseh'd  April  11  ,  1865. 

Penn.  Reserves,  age  20. 

Dec.  —  , 

Drs.  Jones,  Stewart,and  Thomp 

18. 

1804. 

Spec.  3213. 

1862. 

son,  Strattonville,  Pa.    Disch  d 

31 

Bosse,   E..    Pt.,    F,   8th 

June  8, 

Left;  lat.  flap  ;  hectic  fev.;  diarr. 

Dec.  6,  1862. 

New  York. 

J'yl5,'62. 

Died  Sept.  1,'62;  pyaem.  Autop. 

3 

Bates,  J.  A.,  Capt.,  D, 

Je.27,'62, 

Right;  circ.      Surg.  A.  B.  Mott, 

32 

Bradley,  J.,  Pt.,  D,  25th 

1 

.     (Necrosis;    gang.)      Died 

12th  New  York. 

Jan.  24, 

U.  S.V.    Feb.  6,  haem.  recurred. 

North  Carolina. 

J'yl8,'62. 

fi;w  minutes  after  operation. 

1864. 

Disch'd  June  12,  1864. 

33 

Byram,  W.,  Pt.,  K,  3d 

May  6, 

Right.     (July  150,    bone  rem'd.) 

4 

Brinker    J.  H.,  Pt.,  E, 

De.13,'62, 

Right  (necrosis);  flap.  A.  A.  Surg. 

Michigan  Cav.,  age  20. 

Aug.  7, 

Surg.  A.  Hammer,  U.S.V.    Died 

llth  Penn.,  age  ss3. 

Mar.  21, 

J.  H.  Thompson.     Discharged 

1864. 

August  10,  1864. 

1864. 

March  3,  1865. 

34 

Collar,  C.,  Pt.,  F,  45th 

Feb.  14, 

Right.     (March  12,  exc.)     Rurg. 

5 

Crede,  F.,  Pt.,  C,  178th 

April  9, 

Left  ;  ant.  post.  flap.     Surg.  J.  F. 

Illinois,  age  20. 

M'yl,'64 

\V.  J.  McKim,  15th  111.     Died 

New  York,  age  29. 

Sept.  1, 

Randolph,  U.  S.A.    Discharged 

May  9,  1864  ;  shock. 

1864. 

Oct.  21,  1865. 

35 

Cowperthwaite,C.,Corp.,  ;Oc.l2,'G3, 

Left;  circ,     A.  Surg.  A.  Ingram, 

6 

Drew,  D.,  Pt.,  F,  Phil- 

Au.31,'62, 

Left.    Surg.  —  Owens,  C.  S.  A. 

L,  lstN.J.Cav.,age22.  |jan.5.'G4. 

U.S.A.    Died  Jan.  6,  '64;  shock. 

lips'  Legion. 

Ja.31,'63. 

Recovery. 

36 

Cunningham,  O.  H.,  Pt., 

May2,'63, 

Right  (ball  ext.;  erysip.);  double 

7 

Eltett,  L.,  Pt.,  D,  16th 

May  3, 

;  circular.    Recovery. 

I,  82d  Ohio,  age  35. 

May3,'<!4. 

flap.    Surg.  D.W.'Bliss,  U.  S.V. 

Mississippi,  age  20. 

J'ne6,'63. 

Died  June  5,  '64.     Spec.  2254. 

8 

Glenn,   J.,  Pt.,  1C,   42d  De.20,'61, 

Right  ;  circ.     Surg.  E.  Shippen, 

37 

Ellithorpe,  P.  G.,  Pt.,  I, 

July  2, 

Left;  slough.;  iliar.;  haem.;  tourn. 

Pennsylvania. 

Fe.9,'62. 

U.  S.  V.     Disch'd  May  16,  1862. 

1st  Penn.,  age  20. 

Au.10,'63. 

Died  Oct.  5,  1863;  exhaustion. 

9 

Hall,  S.  C.,  Pt.,  F,  3d 

Nov.8,'63, 

Right.     (Exc.  femur.)     Surg.  T. 

38 

Fair,  F.B.,  Serg't,  H,2d 

April  7, 

Right  (frag's  bone  and  two  pieces 

Indiana  Cavalry. 

April  13, 

R.   Crosby,  U.  S.  V.     Disch'd 

New  York  H'vy  Artil 

Aug.  2, 

of  ball  rem'd  ;  hffim.);  ant.  post. 

1864. 

July  8,  1864. 

lery,  age  22. 

1865. 

flap.     A.  A.  Surg.  B.  B.  Miles. 

10 

Hammill,  J.,  Serg't,  D, 

May  3, 

Right  ;  circ.     Surg.  D.  W.  Bliss, 

Died  same  day.  .Specs.  1505,  2797. 

8th  New  Jersey. 

June  16, 

U.  S.  V.     Disch'd  May  5,  1864. 

39 

Goodsell,  A.,  Pt.,  H,  1st 

No.29,'64, 

Right.     Died  one  hour  after  oper 

1863. 

Spec.  1263. 

Colorado  Cavalry. 

Ja.14,'65. 

ation. 

11 

IIartigan,M.,Pt.,H,108th 

Sept.  17, 

Left  (synovitis);  flap.  A.  A.  Surg. 

40 

Griffith,  H.,  Pt.,  E,  8th 

Sept.  17, 

Left.    Surg.  H.  S.  Hewit,  U.  S.  V. 

New  York,  age  18. 

Oc.30,'62. 

C.  J.  Morton.     Disch'd  May  19, 
1863.    Spec.  262. 

New  York  Cavalry. 

Nov.  —  , 
1862. 

Haem  ;  Nov.  19,  lig.  fern,  artery. 
Died  Nov.  19,  '62.  Sptcs.WF,  855. 

12 

Henry,  D.P.,Pt.,H,  llth 

Oct.  4, 

Left.     Discharged  April  7,  1863. 

41 

Hughes,  S.  D.,  Pt.,   D, 

J'y  2,  '63, 

Right  ;  circ.     Surg.  A.  Heger,  U. 

Missouri,  age  29.             De.26,'62. 

14th    South    Carolina, 

Feb.  G, 

S.A.     Died  Feb.  16,  1864;  py 

13 

Hervey,  R.,  Pt.,  C,  82d     July  1, 

Left  ;  flap.     Surg.  C.  Page,  U.  S. 

age  38. 

1864. 

aemia.     Autopsy. 

Pennsylvania,  age  2D.       Aug.  1, 

A.    Aug.  12,  lig.  femoral  artery. 

42 

Humma,  L.,  Pt.,  H,  88th 

Au.30,'62, 

Left,     (Erysipelas.)    Surg.  D.  P. 

1862. 

March  28,  '63,  gen.  hsem.;  gang.; 

Pennsylvania. 

Jan.  20, 

Smith,  U.  S.  V.     Died  Jan.  20, 

• 

pyaemia.     Disch'd  Oct.  6,  1863. 

1863. 

1863.     Spec.  1  186. 

14 

Jarvis,  H.,  Pt.,  K,  55th  No.30,'64, 

Right  (disch'd  Nov.  25,  '65);  flap. 

43 

Icanbeny,  A.,  Pt.,K,  Gth 

Nov.  —  , 

Left  thigh.     Died  December  30, 

Massachusetts.                jM'y8,'G7. 

Dr.  A.  R.  Carey.     Recovery. 

Kansas  Cav.,  age  18. 

De.22,'63. 

1863. 

15 

Johnson,  C'.,  Pt.,  H,  13th  Oc.20,'63,  .     Surg.  —  "  Friend,  C.  S.  A. 

44 

Ivery,  N.,  Pt.,  B,  12th 

April  7, 

—  .  Died  three  hours  after  oper 

Louisiana.                        |J'yl4,'64.     Recovery. 

Michigan. 

M'yl5,'C2. 

ation;  exhaustion. 

16 

Jones,  J.  M.,  Pt.,  K,  21st  Au.  5,'G2, 

Right  (necrosis  ;  exfol.);  ant.  post. 

45 

Kreps,   J.,  Pt.,  C,  29th 

April  30, 

Right   (carious);    ant.   post.  flap. 

Indian!!,  age  29.                Jan.  23, 

flap.     Disch'd  April    15,   1863. 

Iowa,  age  16. 

July  9, 

A.  Surg.  E.  A.  Clark,  U.  S.  V. 

1869. 

Surgeon  D.  W.  Bliss,  U.S.V. 

1864. 

Died  Aug.  8,  1864  ;  pyaemia. 

Recovery.     Spec.  5558. 

46 

Luxford,  G.,  Pt,,  A,  50th 

Oct.  5, 

Right  (necrosis):  circ.  Surg.  S.  S. 

17 

Knox,  A.G.,Pt.,D,  18th 

Sept.  14,    Right;  fla'p.     Act.  Ass't  Surg.  A. 

Illinois,  age  16. 

Nov.  20, 

Boyd,  8-lth  Ind.     Died  Nov.  28, 

New  York,  age  19.          De.12,'62.      North.     Disch'd  Jan.  14,  1863. 

1864. 

1804:  exhaustion. 

18 

Kuhns,  W.  H.,  Serg't,  C,     May  31,    Right  ;  flap.     Discharged  July  6, 

47 

Lynn,  J.  B.,  Pt.,  B,  83d 

April  9, 

Right  (erysip.);  circ.   A.  Surg.  A.  ' 

102d  Pennsylvania.          J'y2,'G2.      1862. 

Ohio,  age  19. 

May  30, 

Ilartsuff,  U.  S.  A.     Ilaem.;  lig.  ' 

19 

Loggins,  W.,  Pi.,  E,  6th  De.21,  '62,  i  Right  ;  circular.     To  Prison  Nov. 

1865. 

fern.  art.     Died  June  7,  186:">. 

Texas  Cavalry,  age  21.  <Feb.-,'63.     9,  1863. 

48 

O'Brien,  D.,  Pt.,  H,  69th 

Sept.  17, 

Right  ;  flap.     Surg.  H.  S.  Hewit, 

20 

Morris,  T.  H.,  Pt.,  D,  6th 

A  p.  6,  '62, 

Right  (discharged  April  29,  1863. 

New  York. 

Dec.  5, 

U.  S.V.     Died  Dec.   16.  1862; 

Iowa,  age  21. 

Ap.5,'67. 

Suppuration,  erysip.,  etc.);  flap. 

1862. 

exh'n.  Autop.    Specs.  755,  1101. 

Dr.  H.  S.  Sawyer,  Ceuterville. 

49 

^easlee,  A.,  Pt.,  I,  22d 

June  27, 

Left.   Dr.  —  Halsted.    Died  Aug. 

Iowa.     1870,  stump  healthy. 

Mass.,  age  23. 

Au.14,'62. 

15,  1862. 

21 

Oal-u,  E.,  Pt,,  E,    14th     May  5. 

Right  thigh.     Recovery. 

50 

2  Pool,  J.,  Pt.,  H,  119th 

No.  7,  '63, 

Left  (frag's  bone  rem'd);  double 

22 

Louisiana.                        J'.y  9,  '62. 
Page,  W.  A.,  Pt.,  F,  21st    May  25, 

Left.  Surg.  —  Brundidge,  C.S.A. 

Penn.,  age  23. 

April  18, 
1864. 

flap.    Surg.  J.  A.  Lidell,  U.S.V. 
Sloughing.     Died  April  26,  '64  ; 

North  Carolina.               J'yl9,'62.      Recovery. 

exhaustion.     &pe,c.  2229. 

23 

Perry,  H.  D..Pt..  H,  19th  De.l3.'62, 

Left.  (Portion  of  ball  and  spiculae 

51 

Riley,  P.,  Pt.,   A,  10th 

J'e3,'G4, 

Left.     (Deformity;  fistulous  pas 

Mass.,  age  17.                    May  2!), 

removed  ;   necrosis  ;   deformity. 

New  York,  age  24. 

A  p.  -,'66. 

sage.)     Died  May  7,  'G6  ;  py«m. 

1866. 

Disch'd  Sept.  —  ,  1863.) 

52 

Seville,  W.  S.,  Pt.,  G. 

Sept.  17, 

Right  (deformity);  flap,  skin  ;  circ. 

24 

Plack,  J.  H.,  Corp'l,  F,   De.  29,61, 

Right.    Surg.W.  R.  S.Clark,  34th 

1st  Delaware.                       1862, 

muscles.     A.  Surg.  R.  F.  Weir, 

34th  Ohio.                        ;  Feb.-,  '62. 

Ohio.     Disch'd  May  24,  1862. 

Jan.  5, 

U.  S.  A.      Died  Jan.  10,  1863; 

25 

Rufus,  C.,  Pt.,  1st  Col'd     Jan.—.     Left  ;  flap.     Surg.  D".  O.  McCord, 

1863. 

shock.     Spec.  3866. 

Artillery,  age  25. 

M'hl,'64.      9thLa.C.T.     Duty  Feb.  10,'6G. 

53 

ShoffeM,  J.   IT.,  Pt.,  E,     July  3, 

Right  (thrombo.;  gang.;  erysip.); 

20 

Sears,  J.,  Pt.,  E,  43d  N. 

July  1,     Left  (sloughing);  flap.     Surg.  A. 

13th  Alabama,  age  20.      Nov.  1, 

circ.     Surg.  A.  Ileger,  U.  S.  A. 

York,  age  26.                    Aug.  19, 

B.  Shipman,  U.  S.  V.     Disch  d 

:     1863. 

Died  Nov.  2,  1863.     Autopsy. 

1862. 

Sept.  14,  1864. 

M 

Sims,  T.  B.,  Pt.,  F,  12th     Sept.  22, 

Right;  ant.  post.  flap.    A.  A.  Surg. 

27 

Shanen,  J.,  Pt.,  E,  170th     May  24, 

Right  ;  lateral  flap.     Surg.  T.  R. 

Tenn.  Cav.,  age  20. 

Nov.  7, 

M.  L.  Herr.    Died  November  22, 

New  York,  age  40. 

Oct.],  '64. 

Crosby,  U.  S.  V.     Oct.  6,  haem.; 

1864. 

1864;  exhaustion. 

lig.  fern.  art.  Disc'h  Aug.  15,'65. 

55 

Smith,  C.  A.,  Pt.,  C,  51st 

Nov.  30, 

Right  ;  ciro.    Surg.  J.  R.  Ludlow, 

28 

Sherwood,  G.  A.,  Corp'l, 

Sept.  17, 

Left  ;  flap.     A.  A.  Surg.  W.  M. 

Illinois,  age  41. 

1864, 

U.S.V.   Died  Jan.  8,  '65;  exh'n. 

G,  14th  Indiana.              Oc.25,'62. 

Hines.     Disch'd  Dec.  13,  1862. 

Jan.8,'65. 

'STURCis  (F.  D.),  Reports  nf  Hospital*,  in  American  Medical  Times,  1862,  Vol.  V,  p.  174. 

*LlDELL  (J.  A.),  Onthe  Secondary  Traumatic  Lesions  of  Done,  etc.,  in  U.  8.  Sanitary  Commission  Memoirs,  1870,  Surgical  Volume  I,  p.  414. 


SECONDARY    AMPUTATIONS    OF    THE    THIGH. 


309 


In  tim-o  of  the  fifty-five  cases  enumerated  in  the  foregoing  table  the  seat  of  injury 
was  in  the  upper  third;  in  twelve,  in  the  middle  third;  in  eleven,  in  the  lower  third;  in 
seven,  in  the  femur  without  precise  indication;  in  fifteen,  in  the  knee  joint;  and  in  seven 
cases  in  the  leg. 

Secondary  Amputations  in  the  Middle  Third  of  the  Femur. — The  one  hundred  and 
sixty-eight  cases  of  this  group  comprise  one  hundred  and  two  recoveries  and  sixty-six 
deaths,  a  mortality  of  only  39.2  per  cent.,  or  6.2  per  cent,  less  than  the  mortality  of  the 
secondary  upper  third  amputations.  Twenty-seven  of  the  one  hundred  and  sixty-eight 
operations  were  practised  on  Confederate,  and  one  hundred  and  forty-one  on  Union  soldiers. 
Of  one  hundred  and  sixty-two  cases  in  which  this  point  was  indicated,  the  injuries  were  on 
the  left  in  eighty-nine  and  on  the  right  side  in  seventy-three  instances. 

Cases  of  Recovery  after  Secondary  Amputation  in  the  Middle  Third  of  the  femur.— 
One  hundred  and  two  cases  belong  to  this  category.  The  injuries  were  caused  by  shell  in 
one,  by  solid  shot  in  two,  by  canister  shot  in  one,  and  by  small  projectiles  in  ninety-eight 
cases.  Nine  patients  were  Confederate,  and  ninety-three  Union  soldiers;  five  of  the  latter 
have  died  since  the  termination  of  the  War,  while  eighty-eight  remained  pensioners  in 
January,  1880. 

CASE  482. — Private  Andrew  Van  Vorst,  Co.  A,  134th  New  York,  age  18  years,  was  wounded  at  Gettysburg,  July  1, 
1863,  by  a  conoidal  ball  passing  through  the  right  knee  joint,  causing  a  comminuted  fracture.  He 
was  admitted  into  the  Camp  Letterman  Hospital  on  August  21st.  Acting  Assistant  Surgeon  W.  M. 
Welch,  under  whose  care  he  was  placed  October  28,  1863,  records :  "  Thigh  was  amputated  at  the 
middle  third  August  1st ;  the  stump  is  healing  finely  and  his  health  is  good."  He  was  sent  to  Balti 
more  November  8th,  where  he  remained  in  the  Newton  University  Hospital  until  April  23,  1864, 
when  he  was  sent  to  New  York  and  admitted  into  the  DeCamp  Hospital.  His  stump  had  entirely 
healed.  On  October  16th,  he  was  transferred  to  Albany  and  admitted  into  the  Ira  Harris  Hospital, 
from  whence  Assistant  Surgeon  J.  H.  Armsby,  U.  S.  V.,  reported  his  recovery  and  discharge  from 
service  August  11,  1865,  and  contributed  a  plaster  cast  of  the  stump  (A.  M.  M.,  Spec.  No.  417,  Sect. 
I,  Cat.  1866,  p.  554),  a  drawing  of  which  is  given  in  the  wood-cut  (FlG.  200).  His  pension  was  paid 
January  4,  1880. 

CASE  483.— Private  J.  Scheuermann,  Co.  K,  9th  Ohio,  aged  28  years,  was  wounded  at  Chickamauga,  September  19, 
1863,  and  admitted  to  the  field  hospital  of  the  3d  division,  Fourteenth  Corps,  where  Surgeon  J.  E.  Arter,  31st  Ohio,  noted: 
"  Shot  fracture  of  right  thigh."  Several  weeks  after  the  reception  of  the  injury  the  wounded  man  was  transferred  to  hospital 
at  Chattanooga,  subsequently  to  Bridgeport,  and,  on  December  llth,  to  Murfreesboro',  whence  Assistant 
Surgeon  G.  V.  Woolen,  27th  Indiana,  reported  the  case  as  follows:  "The  ball  entered  the  limb  anteriorly, 
about  four  inches  above  the  knee  joint,  passing  backward  and  upward,  fracturing  the  femur  at  the  junction 
of  the  middle  and  lower  third,  and  lodging  in  the  gluteus  maximus  muscle.  The  fracture  was  oblique  and 
lateral,  and  remained  ununited,  the  limb  being  shortened  about  three  inches.  The  ends  of  the  bone  were 
necrosed,  and  suppuration  profuse.  About  three  months  after  his  admission  the  patient  had  an  attack  of 
erysipelas,  which  subsided,  but  left  the  limb  in  an  cedematous  condition.  At  this  time  his  constitutional 
condition  had  become  very  feeble,  his  appetite  was  wanting,  and  he  was  unable  to  sleep  from  pain  in  the 
wound,  which  was  discharging  considerable  quantities  of  ichorous  pus.  It  was  then  deemed  proper  to 
remove  the  limb,  and  amputation  was  performed  by  Assistant  Surgeon  J.  E.  Link,  21st  Illinois,  on  March 
18,  1864.  The  operation  was  done  by  the  circular  method  at  the  junction  of  the  upper  and  middle  thirds, 
but  little  haemorrhage  taking  place.  The  ligatures  were  applied  and  chloroform  was  used.  The  patient 
rallied  well  from  the  operation,  and  immediately  began  to  improve  in  general  health.  In  the  course  of  a 
month  the  stump  had  closed."  The  patient  was  subsequently  transferred  to  Washington  Park  Hospital, 
Cincinnati,  mustered  out  of  service  July  14,  1864,  and  supplied  with  an  artificial  limb  of  Dr.  Ely's  pattern 
one  year  afterwards.  He  is  a  pensioner,  and  was  paid  September  4,  1879.  The  amputated  femur  was  con 
tributed  by  Surgeon  I.  Moses,  U.  S.  V.,  and  is  represented  in  the  cut  (FlG.  201),  showing  a  moderate  deposit 
of  callus  but  no  union  of  the  fracture. 

CASE  484.— Private  F.  Luck,  Co.  C,  21st  Wisconsin,  aged  21  years,  was  wounded  in  the  right  knee, 

at  Chaplin  Hills,  October  8,  1862.     He  was  admitted  to  hospital  No.  7,  Perryville,  and  discharged  from     turo  (if  middle  third 
service  February  15,  1863,  Surgeon  J.  G.  Hatchett,  U.  S.  V.,  certifying  to  "complete  destruction  of  the  use    of  rijjht  femur.  S;*c. 
of  the  knee,"  as  resulting  from  the  injury.     On  the  2d  day  of  the  following  December  the  man  entered 
Harvey  Hospital,  at  Madison,  whence  Surgeon  H.  Culbertson,  U.  S.  V.,  contributed  the  pathological  specimen  (No. 
Suryical  Section,  A.  M.  M.),  with  the  following  report:  "This  soldier  received  a  penetrating  wound  of  the  knee  j< 
was  unfortunately  discharged  at  the  breaking  up  of  the  Perryville  Hospital,  when  the  knee  was  still  running  and  not 


FIG.  200.  —  Appearance  of 
stump  three  months  after  am 
putation.  Spec.  417. 


310 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


progress  of  cure.  The  injury  was  caused  by  a  mini6  ball,  which  entered  posteriorly  and  to  the  iuside  of  the  tuberosity  of  the 
external  condyle  of  the  femur,  passed  obliquely  forward  and  slightly  inward,  fracturing  the  external  condyle  and  also  the  upper 
and  outer  margin  of  the  patella,  and  came  out  opposite  that  point  of  the  bone.  True  and  false  anchylosis  resulted,  the  former 
between  the  inner  condyle  and  head  of  tibia,  and  necrosis  of  the  inner  condyle  ensued.  At  the  time  of  the  patient's  admission 
the  state  of  the  parts  was  as  follows:  The  joint  was  enlarged  and  the  wound  open  over  the  external  condyle,  and  some  three 
inches  higher  up  the  thigh  another  opening  existed,  both  of  which  discharged  unhealthy  pus.  There  was  also  periostitis  extend 
ing  up  as  high  as  the  lower  fourth  of  the  femur,  and  the  soft  parts  about  the  joint  were  swollen  and  indurated  up  to  the  middle 
third  of  the  thigh.  Circulation  below  the  knee  was  extremely  feeble,  and  the  leg,  bent  upon  the  thigh  at  right  angle,  was 
extremely  emaciated.  The  patient's  constitution  showed  marked  evidence  of  scrofulous  diathesis.  At  first  I  determined  to  treat 
the  case  by  resection  of  the  joint,  but  on  reflecting,  and  with  the  advice  of  Dr.  E.  B.  Wolcott,  Surgeon  General  of  Wisconsin, 
I  decided  upon  amputation  as  affording  the  best  and  safest  means  for  the  removal  of  the  disease.  Just  before  the  operation, 
•which  was  done  on  January  3,  1864,  the  patient  fell  upon  the  floor  and  broke  the  union  between  the  tibia  and  inner  condyle  of 
femur;  yet  from  the  inflammatory  exudations  thrown  out  about  the  joint  it  was  found  impossible  to  straighten  the  limb,  though 
efforts  were  made  to  effect  this  object  while  he  was  under  the  influence  of  chloroform.  I  performed  the  amputation  at  the  middle 
third  of  the  thigh,  by  the  circular  method,  in  the  presence  of  Dr.  Wolcott,  Acting  Assistant  Surgeons  J.  J.  Brown  and  J.  Favill, 
and  Medical  Cadet  W.  B.  Buckley.  Nothing  unfavorable  occurred,  and  the  wound  healed  by  first  intention,  though  the  ligature 
applied  to  the  femoral  artery  has  not  yet  (February  7th)  come  away.  The  stump  now  certainly  demonstrates  the  superiority  of 
the  circular  over  the  flap  operation  of  this  member,  being  one  of  the  most  perfect  in  form  I  have  yet  seen.  This  case  illustrates 
the  efforts  of  nature  to  diminish  the  capacity  of  the  joint  by  anchylosis  and  the  exudation  into  it  of  plastic  organizable  material ; 
also  the  fact  that  penetrating  gunshot  wounds  of  the  knee  joint  will  require  amputation,  even  though  nature  be  given  fifteen 
months  in  which  to  effect  a  cure.  On  examination  of  the  morbid  specimen,  it  will  be  seen  that  the  ball^passed  through  the  can 
cellated  structure  of  the  external  condyle,  entering  the  cavity  of  the  joint  only  at  two  opposite  points,  thus  inflicting  upon  the 
synovial  membrane  but  a  slight  wound  so  far  as  extent  is  concerned.  Unquestionably  great  inflammation  must  have  followed 
the  wound,  as  is  proved  by  the  effects  observable.  But  nature  could  not  have  been  as  successful  had  the  external  condyle  been 
broken  into  fragments.  It  was  in  fact  a  penetrating  wound  of  a  portion  of  the  joint  which  inflicted  great  injury  to  it,  and  yet  it 
was  singularly  and  uncommonly  local,  the  wound  of  the  bone  appearing  as  though  it  might  have  been  made  with  a  circular 
punch.  The  fact  that  the  bones  entering  into  the  formation  of  the  joint  were  injured  in  so  limited  a  manner  would  seem  to  be  the 
reason  why  amputation  was  not  required  long  since."  Dr.  Culbertson  appends  the  following  remark  to  this  history:  "This  case 
is  cited  not  because  of  the  amputation  performed,  but  to  illustrate  the  great  efforts  of  nature  in  the  cure  of  penetrating  gunshot 
wounds  of  knee  joints,  and  also  her  failure  in  the  attempt."  Three  months  after  the  operation  the  patient  was  well  enough  to 
proceed  to  Chicago  for  the  purpose  of  being  fitted  with  an  artificial  limb,  and  on  May  28,  1864,  he  left  the  hospital  for  his  home. 
The  pensioner  was  paid  June  4,  1879. 

CASK  485. — Private  E.  Green,  Co.  K,  119th  Pennsylvania,  aged  35  years,  was  wounded  in  the  right  thigh,  at  Rappahau- 
nock  Station,  November  7,  1863,  and  was  admitted  to  Armory  Square  Hospital,  Washington,  two  days  afterwards.  Surgeon 
D.  W.  Bliss,  U.  S.  V.,  furnished  the  following  description  of  the  injury,  and  of  the  operation  which  he  per 
formed:  "The  missile,  a  conical  ball,  entered  one  and  a  half  inches  above  and  to  the  right  of  the  patella, 
passing  across  the  limb,  fracturing  the  femur  in  the  lower  third,  and  lodging  on  the  inner  and  posterior  side, 
nearly  opposite  the  point  of  entrance.  The  limb  was  treated  in  a  skeleton  fracture-box,  and  water  dressings 
were  used.  On  November  18th,  the  ball  was  extracted.  Haemorrhage  occurred  on  the  following  day,  and 
again  three  days  afterwards.  The  discharge  of  pus  became  copious  about  December  1st,  and  dry  gangrene 
of  the  toes  and  dorsum  of  foot  appeared.  The  upper  fragment  of  the  femur  protruded  one  and  a  half  inches, 
and  at  every  effort  to  extend  the  limb  so  as  to  retract  the  protruding  bone  violent  haemorrhage  ensued.  The 
patient's  system  was  greatly  reduced,  and  careful  attention  was  paid  to  retain  his  digestive  powers  by  a 
rotation  of  stimulants  and  nourishing  diet.  A  slight  change  in  the  position  of  the  limb,  on  December  28th, 
brought  on  a  haemorrhage  to  the  amount  of  twenty  ounces  in  three  minutes'  time — evidently  from  the  femoral 
artery,  which  was  then  controlled  by  pressure.  By  January  '20,  1864,  sloughing  of  the  heel  and  dorsum  of 
foot  had  commenced,  and  the  patient's  system  was  still  so  much  debilitated  that  a  decision  to  operate,  which 
had  been  retarded  as  calculated  to  prove  fatal,  was  now  arrived  at  as  a  last  chance  to  pi-eserve  life.  On  the 
following  day  the  thigh  was  amputated  at  the  middle  third  by  antero-posterior  flaps,  four  arteries  being  tied 
and  but  little  blood  lost.  Ether  was  used  as  the  anaesthetic.  At  the  operation  an  abscess  was  discovered  in 
the  anterior  flap  extending  upward  for  three  inches,  and  the  femoral  artery  was  found  to  be  destroyed  in  the 
upper  part  of  the  popliteal  space,  evidently  by  the  missile.  Above  the  point  of  the  amputation  the  vessel 
was  healthy;  but  no  clot  was  found.  The  vessels  of  the  leg  were  much  constricted.  The  lower  fragment  of 
the  femur  was  flexed  at  an  angle  of  thirty  degrees  with  the  leg,  and,  by  contraction  of  the  muscles  of  the 
thigh,  was  pressed  firmly  against  the  wounded  extremity  of  the  femoral  artery,  thereby  preventing  fatal 
haemorrhage.  The  flaps  of  the  stump  presented  an  unhealthy  appearance,  being  much  indurated  and  infil 
trated  with  serum.  Tincture  of  chloride  of  iron  was  applied  to  the  entire  surface  with  a  view  of  sthnulalin. 
obtaining  its  haemostatic  effect  upon  the  capillary  vessels  which  failed  to  contract  from  cold  and  exposure  to  the  air.  A  large 
tent  was  placed  through  the  fourchette  of  the  stump  so  as  to  prevent  the  accumulation  of  pus,  the  flaps  being  gently  brought 
together  and  tepid  \\ater  dressing  applied.  The  patient  improved  daily,  and  was  in  a  fair  way  of  recovery  one  week  after  the 
operation."  The  amputated  portion  of  the  femur  was  contributed  to  the  Museum  by  the  operator,  and  is  shown  in  the  wood-cut 
(FlG.  202).  The  specimen  shows  the  parts  about  the  fracture  to  be  dead  and  stripped,  and  its  upper  half  to  be  covered  with  an 
involucrum  of  foliaceous  callus  tolerably  donse  posteriorly,  also  some  periosteal  deposit  above  the  condyles.  The  patient  sub 
sequently  entered  Judiciary  Square  Hospital,  and  was  discharged  July  7,  1864.  He  was  furnished  with  an  artificial  leg  by  B.  F. 
Palmer,  August  26,  1865,  and  was  paid  as  a  pensioner  until  September  4,  1867,  since  when  he  has  not  been  heard  from. 


Fio.  202.— Shot 
comminution  of  the 
lower  third  of  right 
femur.  Spec.  2033. 

the  parts  and  of 


SECT,  in.] 


SECONDARY    AMPUTATIONS    OF   THE   THIGH. 


311 


FIG.  203.— Appearance  of  stump  two  mo 
after  amputation.     [From  a  photograph.] 


In  the  next  case  the  amputation  was  performed  five  years  after  the  reception  of  the 
injury,  owing  to  the  continual  recurrence  of  abscesses.  The  patient  died  eleven  years  after 
the  operation,  of  pulmonary  disease: 

CASE  486. — Private  Charles  M.  Bowen,1  Co.  A,  27th  Indiana,  aged  19  years,  was  wounded  at  Antietam,  September  17, 
1862.  He  was  taken  to  Frederick  and  admitted  to  No.  1  hospital  on  September  24th.  Acting  Assistant  Surgeon  J.  C.  Shimer 
records  the  following:  "A  conoidal  ball  had  entered  the  outer  aspect  of  the  left  thigh  about  five  inches  above  the  knee,  fractured 
the  femur,  and  passed  out  directly  opposite.  Buck's  apparatus  was  applied.  On  Octo 
ber  19th,  considerable  amount  of  callus  had  been  thrown  out,  and  there  was  some  union ; 
his  appetite  and  general  condition  were  good.  October  23d,  a  deep  but  circumscribed 
abscess  on  the  outer  side  of  middle  third  of  thigh  was  opened  and  evacuated.  30th, 
both  the  wounds  of  entrance  and  exit  were  enlarged  to  evacuate  pus  more  freely. 
December  5th,  he  has  improved  greatly;  passive  motion  has  been  employed  to  overcome 
stiffness  of  the  knee."  On  March  18,  1863,  he  was  able  to  walk  with  the  aid  of  crutches, 
and  the  wounds  had  nearly  healed.  A  slight  attack  of  erysipelas  yielded  readily  to 
treatment.  May  21st,  the  wound  took  on  a  gangrenous  condition,  for  which  strong 
nitric  acid  was  applied.  On  June  15th,  he  was  transferred  to  Baltimore.  The  wounds 
looked  healthy  and  his  general  condition  was  excellent.  He  entered  the  Jarvis  Hospital 
on  the  16th,  and  was  discharged  September  7,  1863.  The  femur  had  only  partially 
united;  the  sciatic  nerve  was  injured;  his  leg  was  partially  and  his  foot  entirely  para 
lysed.  He  received  a  pension,  and  was  employed  as  a  clerk  in  the  Interior  Department. 
Owing  to  a  recurrence  of  abscesses  he  entered  the  Providence  Hospital,  Washington,  in 
the  autumn  of  1867,  and,  on  November  llth,  the  limb  was  amputated  in  the  middle 
third  by  Dr.  D.  W.  Bliss,  late  Surgeon  U.  S.  V.  The  wound  healed  well,  and  a  photo 
graph  was  taken  at  the  Army  Medical  Museum  on' January  9,  1868,  at  which  time  the 
stump  was  firm  and  healthy.  The  specimen  was  contributed  to  the  Museum  by  the 
operator,  and  is  No.  4914,  Surgical  Section.  The  fragments  are  considerably  over 
lapped,  having  undergone  unusual  disturbance,  and  the  amount  of  callus  exceeds  what 
is  necessary  for  complete  union.  On  March  10,  1871,  the  patient  was  a  clerk  in  the 
Pension  Office ;  the  stump  was  healthy  but  his  general  health  poor.  He  died  March 
17,  1878,  of  phthisis  pulmoualis. 

The  amputation  in  the  thigh  in  the  one  hundred  and  two  cases  of  this  group  had  been 
preceded  by  other  operations  in  thirteen  instances,  viz:  by  amputation  at  the  knee  joint  in 
two,  by  amputation  in  the  leg  and  subsequent  amputation  at  the  knee  in  one,  by  ablation 
in  the  leg  in  six,  by  excision  in  the  shaft  of  the  femur  in  one,  and  by  excision  in  the  bones 
of  the  leg  in  three  instances.2 

Fatal  Cases  of  Secondary  Amputation  in  the  Middle  Third  of  the  Femur. — The 
sixty-six  operations  of  this  category  were  practised  on  forty-eight  Union  and  eighteen 
Confederate  soldiers.  Eight  autopsies  are  recorded  in  this  series,  and  twenty-five  path 
ological  specimens  are  preserved.  Pyaemia  was  observed  in  ten,  gangrene  in  fourteen,  and 
erysipelas  in  seven  cases.  In  nine  instances  copious  haemorrhages  preceded  the  amputation, 
and  in  eleven  haemorrhages  occurred  after  the  operation. 

CASK  487. — Private  L.  Williams,  Co.  C,  26th  Michigan,  aged  23  years,  was  wounded  at  Spottsylvania,  May  12,  1864. 
Surgeon  J.  E.  Pomfret,  7th  New  York  Artillery,  recorded  his  admission  to  the  field  hospital  of  the  1st  divjsion,  Second  Corps, 
with  "shot  wound  of  left  knee,  caused  by  a  mini6  ball."  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  who  contributed  the  path 
ological  specimen  of  the  case  (Cat,  Surg.  Sect.,  1866,  p.  343,  Spec.  2538),  reported  the  result  of  the  injury  as  follows:  "The 
wounded  man  entered  Lincoln  Hospital,  Washington,  May  30th.  He  was  a  man  of  nervous  and  irritable  tempei-ament.  When 
admitted  he  suffered  from  much  constitutional  derangement,  and  the  tissues  in  the  neighborhood  of  the  injured  joint  were  much 
enlarged,  tender,  and  painful.  Cold-water  dressings  were  used,  and  tonics  and  stimulants  were  administered.  On  June  13th, 
the  parts  above  and  below  the  knee  joint  being  infiltrated  with  pus  and  discharging  copiously  through  several  openings,  ampu- 

1  Circular  No.  3,  Surgeon  General's  Office,  Washington,  1871,  p.  205,  CASE  DLXXXV. 

2  The  limb  had  been  removed  at  the  knee  in  the  cafce  of  Corp'l  F.  Hare,  B,  Cth  Wisconsin  (TABLE  XXXIX,  No.  39,  p.  314),  and  of  Pt.  L.  C.  Young, 
A,  3d  Virginia  (TABLE  XXXIX,  No.  100,  p.  315).     In  the  case  of  Pt.  A.  Bronchard,  5th  New  Hampshire  (TABLE  XXXIX,  No.  11,  p.  313),  the  fracture  in 
the  foot  had  been  followed  by  excision  of  the  3d  and  4th  metatarsal  bones,  then  by  amputation  in  the  lower  third  of  the  let,',  then  by  amputation  through 
the  knee  .joint,  and  finally  by  amputation  in  the  thigh.     The  patients  who  had  undergone  amputation  in  the  leg  were  Corp'l  II.  W.  Hughes,  I,  133d  New 
York  (TABLE  XXXIX,  No.  43,  p.  314);  Pt.  W.  Stifle,  A,  29th  Ohio  (TABLE  XXXIX,  No.  86,  p.  314);  Pt.  J.  Bowen,  C,  4Cd  Illinois  (TABLE  XXXIX,  No.  8, 
p.  313;;  Pt.  B.  Nussbaumer,  B,  67th  Ohio  (TAISLE  XXXIX,  No.  67,  p.  314);  Corp'l  G.  Dewey.  M,  llth  Illinois  Cavalry  (TAI)U!  XXXIX,  No.  24,  p.  314); 
and  Lieut.  J.  II.  Bell,  D,  (ilst  Ohio  (TAHLE  XXXIX,  No.  5,  p.  313).    In  the  case  of  Corp'l  T.  Duggan,  M,  llth  Illinois  Cavalry  (TABLE  XXVII,  No.  -I, 
p.  212,  ante,  and  TABLE  XXXIX,  No.  26,  p.  314),  an  excision  in  the  shaft  of  the  femur  had  been  performed,  and  excisions  in  the  bones  of  the  leg  in  the 
oases  of  Pt.  S.  Montgomery,  I,  139th  Pennsylvania  (TABLE  XXXIX,  No.  63,  p.  314);  Pt.  W.  Stockdnle,  D,  48th  Indiana  (TAULK  XXXIX,  No.  87,  p.  314); 
and  Pt.  C.  Murphy,  D.  GPth  New  York  (TABLE  XXXIX,  No.  65,  p.  314). 


312  INJURIES    OF    THE    LOWER    EXTREMITIES.  fCHAP.  X. 

tation  waa  decided  upon,  and  performed  at  the  middle  third  of  the  femur  by  Acting  Assistant  Surgeon  A.  Ansell,  as  the  only 
chance  of  saving  the  patient's  life.  On  examining  the  injured  parts  after  the  operation  the  missile  was  found  to  have  passed 
through  the  joint,  comminuting  the  patella  and  knocking  away  the  head  of  the  tibia  on  its  inner  side.  The  subsequent  treat 
ment  consisted  of  cold-water  dressings  to  the  stump  and  the  administration  of  six  ounces  of  brandy  per  diem ;  one  grain  of 
sulphate  of  morphia  was  given  at  bedtime  after  the  operation.  Iron  and  quinine  were  prescribed  some  days  afterwards.  The 
patient  did  exceedingly  well,  and  the  stump  healed  kindly,  the  cicatrix  forming  perfectly  with  the  exception  of  one  small  open 
ing,  which  served  as  an  outlet  for  a  small  abscess  about  the  size  of  a  pigeon's  egg.  Hemorrhage  took  place  from  this  part  of 
the  stump  on  July  18th,  when  the  tourniquet  was  applied  to  the  femoral  artery,  which  had  the  effect  of  arresting  the  flow  of 
blood.  A  plug  of  lint  saturated  witli  a  solution  of  persulphate  of  iron  was  then  introduced  into  the  wound  and  the  tourniquet 
removed.  Haemorrhage  occurred  again  on  the  morning  of  the  following  day,  when,  on  consultation,  it  was  decided  to  open  the 
stump  and  ligate  the  bleeding  vessel.  This  was  also  done  by  Dr.  Ansell,  who  tied  the  femoral  as  well  as  two  muscular  arteries, 
which  had  been  opened  by  the  incision.  The  operation  was  performed  at  11.30  A.  M.,  and  the  patient  died  at  6  P.  M.  on  the 
same  day,  July  19,  1864,  not  having  rallied,  and  having  lost  altogether  about  twenty  ounces  of  blood.  The  interior  of  the 
Btump  was  found  to  be  perfectly  healthy,  with  the  exception  of  the  small  abscess  before  mentioned."  The  specimen  consists  of 
the  bones  of  the  amputated  knee,  showing  the  articular  surface  to  be  carious,  and  a  longitudinal  incomplete  fracture  extending 
between  the  condyles  two  and  a  half  inches  up  the  femur,  on  the  shaft  of  which  two  trivial  points  of  periosteal  thickening 
appear.  The  stump  of  the  femur,  showing  a  partially  detached  sequestrum  and  handsome  but  useless  foliaceous  deposit, 
together  with  a  wet  preparation  of  the  ligated  femoral  artery,  were  also  contributed  to  the  Museum  by  Acting  Assistant  Surgeon 
H.  M.  Dean,  and  constitute  specimens  2882  and  2883  of  the  Surgical  Section. 

CASE  488. — Captain  E.  W.  Capps,  Co.  C,  15th  Virginia  Cavalry,  aged  35  years,  was  wounded  at  Brandy  Station,  Virginia. 
October  11, 1863.  He  was  admitted,  on  October  21st,  into  Lincoln  Hospital,  Washington.  Assistant  Surgeon  H.  Allen,  U.  S.  A., 
reported :'  "A  conoidal  ball  entered  the  right  leg,  from  without  inward,  about  one  and  a  half  inches  below  the  patella,  passed 
through  the  anterior  portion  of  the  leg,  fractured  the  spine  of  the  tibia,  and  emerged  on  the  inner  side  of  the  limb.  On  admission 
a  bandage  was  found  applied  tightly  to  the  affected  part.  Upon  its  removal  the  joint  was  discovered  to  be  greatly  swollen 
from  effusion,  and  the  wounds  presented  an  inflamed  appearance.  Cold-water  dressings  were  applied.  No  constitutional 
symptoms  were  present.  After  the  effusion  in  the  joint  had  subsided  a  thorough  examination  of  the  wound  was  made.  The 
head  of  the  tibia  was  found  pierced  by  the  ball.  No  stellation  existed,  nor  was  the  joint  involved.  A  seton  of  tow  was  thrust 
through  the  wound  and  withdrawn,  bringing  away  several  small  fragments  of  bone.  On  October  21st,  a  small  abscess  was 
opened  in  the  popliteal  space.  The  patient,  from  this  time,  did  remarkably  well,  and  all  thought  him  to  be  out  of  danger.  On 
January  26,  1864,  however,  when  he  was  walking,  with  the  assistance  of  crutches,  from  one  ward  to  another,  he  stumbled,  and, 
in  order  to  preserve  his  balance,  bore  his  weight  upon  the  injured  limb.  The  following  day  an  erysipelatous  inflammation  set  in 
about  the  joint,  which  became  enormously  swollen.  He  was  restless  and  uneasy,  his  skin  hot  and  dry,  tongue  coated  with  a 
thick  whitish  fur;  he  had  severe  pain  in  the  head;  pulse  140;  anorexia  and  constipation  present.  On  January  29th,  a  sense  of 
decided  fluctuation  was  felt  in  the  joint,  and  it  was  thought  at  the  time  that  pyarthrosis  of  the  knee  joint  was  present.  He  had 
little  or  no  fever.  His  pulse  averaged  120  beats  per  minute,  soft,  compressible.  Face  very  pale,  mind  clear.  The  swelling  in 
the  course  of  a  week  had  gone  down  completely  from  the  limb  below  and  above  the  joint;  but  around  the  seat  of  injury  and 
joint  a  dull  purplish  red  color  lingered.  By  judicious  pressure  pus  could  readily  be  made  to  exude  through  the  internal  wound. 
Pus  had  burrowed  a  very  little  distance  in  the  parts  connected  with  the  popliteal  abscess  above  mentioned.  No  sinus  of  any 
extent  existed.  It  was  now  evident  that  the  case  was  one  demanding  amputation,  and,  the  patient's  condition  being  favorable, 
the  circular  operation  was  performed  by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  in  charge,  on  February  8th.  The  joint,  which 
gave  evidence  of  the  presence  of  pus  of  long  standing,  the  cartilages  being  denuded  and  partially  destroyed,  was  sent  to  the 
Army  Medical  Museum  (Specimen  2036  of  the  Surgical  Section).  The  patient  did  well  until  February  12th,  when  he  had  a 
severe  chill  which  lasted  forty  minutes.  This  was  followed  by  a  profuse  diaphoresis.  The  skin  became  cold  and  clammy,  the 
pulse  120  and  feeble.  On  the  following  day  he  had  another  chill,  and,  on  the  15th,  two  more,  one  in  the  morning  at  six,  the 
other  at  four  o'clock  in  the  afternoon.  Another  exacerbation  occurred  on  the  morning  of  the  16th.  In  other  respects  the  con 
stitutional  symptoms  of  what  was  evident  to  all  to  be  pyaemia  were  remarkably  slight.  His  tongue  remained  clean.  His  appetite 
continued  the  same.  There  was  no  vomiting,  no  fever  of  any  consequence  followed  the  chills;  his  pulse  varied  from  120  to  140, 
rapid  and  weak.  His  appearance  at  this  time  was  that  of  a  man  who  was  suffering  from  a  severe  haemorrhage;  his  anaamic 
condition  was  startling;  his  sclerotica  were  pearly  white,  his  lips  and  gums  pale,  his  finger  nails  blue.  He  had  a  slight  cough, 
though  no  expectoration.  His  most  distressing  symptom  was  the  colliquative  sweatings,  which  came  on  during  the  night,  and 
which  were  not  apparently  connected  with  the  chills.  The  limb  looked  well,  and  there  was  no  unusual  amount  of  pain  in  it. 
The  flaps  were  granulating  finely.  On  February  18th  the  sixth  chill  took  place,  and,  on  the  next  day,  the  seventh,  followed  by 
vomiting.  He  now  rapidly  sank,  and  died  on  February  20th,  at  four  o'clock  A.  M.  Autopsy:  Rigor  mortis  marked.  Adipose 
tissue  abundant.  Limb  much  swollen  and  of  a  tallow  color.  Upon  dissecting  out  the  vessels  the  tissues  of  the  thigh  were 
found  greatly  indurated,  especially  along  the  course  of  the  Hunterian  tract.  The  interior  of  the  femoral  vein  was  filled  with  a 
solid  black  clot,  which  was  firmly  adherent  to  the  walls  of  the  vein.  No  disintegration  noticed.  The  lower  third  of  the  vessel, 
that  which  had  lain  in  contact  with  the  suppurating  surface  of  the  stump,  was  stained  by  a  purulent  fluid  for  about  two  inches 
from  the  patulous  opening.  A  curious  appearance  was  observed  in  one  of  the  small  branches  of  the  prof'unda  vein  in  the  upper 
third  of  the  thigh.  It  presented  the  same  general  aspect  seen  in  the  patulous  end  of  the  femoral,  and  was  filled  with  pseudo- 
pus."  A  drawing  (made  by  Hospital  Steward  E.  Stauch,  and  copied  in  PLATE  XXIII,  opposite)  of  the  upper  two-thirds  of  the 
femur,  removed  at  the  post-mortem,  shows  the  separation  of  the  periosteum  in  osteomyelitis.  Upon  a  longitudinal  section  of  the 
femur  (PLATE  XLIX,  opposite  p.  314)  the  medulla  throughout  was  found  to  be  of  a  grayish-yellow  color,  which  was  more 
intense  at  the  region  of  the  trochanter  than  elsewhere.  Numerous  small  abscesses,  more  or  less  elliptical,  were  arranged  lineally 

1  A  condensed  abstract  of  this  case  was  published  by  Dr.  ALLKN  in  the  American  Journal  of  Medical  Scir.nre.s,  1865,  Vol.  XLIX,  p.  39,  in  connec 
tion  with  his  Remarks  on  the  I'athological  Anatomy  of  Osteomyelitis,  with  Cases. 


SEPARATION    OF    PERIOSTEUM    I  IN     OSTEOMYELITIS 


SECT.  III.] 


SECONDARY   AMPUTATIONS    OF   THE   THIGH. 


313 


down  the  central  portion  of  the  medulla.  The  bone  was  not  thickened  or  vascular.  The  periosteum,  however,  was  inflamed, 
and,  at  the  lower  two-thirds  of  the  specimen,  was  readily  stripped  from  the  bone,  where  it  presented  the  appearance  of  having 
been  pulled  away  from  the  femur  by  the  fibres  of  the  muscles  inserted  upon  it. 

CASE  489. — Lieutenant-Colonel  G.  F.  Lamon,  32d  New  York,  was  wounded  in  the  left  thigh,  at  Crampton's  Pass,  Sep 
tember  14,  1862.  He  was  conveyed  to  hospital  at  Burkittsville,  whence  Assistant  Surgeon  H.  A.  DuBois,  U.  S.  A.,  contributed 
the  pathological  specimen  (Cat.  Surg.  Sect.,  1866,  p.  287,  Spec.  792),  with  the  following  history:  "The  injury  was  caused  by  a 
minie"  ball,  producing  a  compound  comminuted  fracture  of  the  femur  in  the  lower  third,  which  was  treated  with  Smith's  anterior 
splints.  The  wound  suppurated  freely,  and  at  the  end  of  the  second  week  all  inflammatory  symptoms  had  subsided.  There 
was  no  pain  from  the  first.  On  November  3d,  I  found  recorded  in  the  case  book :  'A  speedy  recovery  beyond  doubt;  shortening 
about  an  inch.'  Several  days  after  this  bleeding  took  place,  whirh  was  thought  to  be  from  the  femoral.  The  artery  was  then 
compressed  with  the  finger  at  Poupart's  ligament  for  about  fifty  hours.  Up  to  the  time  of  the  haemorrhage  the  patient  had  an 
excellent  appetite;  but  he  now  sank  speedily  and  did  not  rally  for  two  days,  though  strongly  stimulated  and  receiving  the  most 
nourishing  diet.  On  November  9th,  the  thigh  was  removed  by  the  flap  method  by  Surgeon  L.  W.  Oakley,  2d  New  Jersey,  it 
being  decided  inexpedient  to  secure  the  artery.  The  patient  did  not  completely  recover  from  the  shock.  Eight  hours  after  the 
operation  he  commenced  to  sink  with  great  rapidity,  and  three  hours  later  he  died.  The  specimen  illustrates  well  the  nature  of 
a  wound  in  the  bone  caused  by  a  minie"  ball,  also  the  amount  of  union  after  two  months'  rest.  On  examining  the  removed  limb 
it  was  found  that  the  ball  had  brushed  the  artery,  and  that  the  artery  had  ulcerated  to  the  extent  of  about  one-third  of  an  inch. 
During  the  last  month  the  case  was  under  the  care  of  Surgeon  Oakley."  The  pathological  specimen  consists  of  the  amputated 
lower  half  of  the  femur,  and  exhibits  shortening,  with  slight  union  and  some  deformity,  the  fractured  extremities  being  necrosed 
and  spanned  at  points  by  new  bone. 

Of  the  sixty  fatal  secondary  operations  in  the  middle  third  of  the  thigh,  ten  had  been 
preceded  by  other  major  operations,  viz:  one  by  a  primary  amputation  in  the  middle  third 
of  the  opposite  thigh,  two  by  exarti dilations  at  the  knee  joint;  and  seven  by  amputations 
in  the  leg.1  In  one  instance  the  amputation  in  the  thigh  was  followed  by  exarticulation 
at  the  hip  joint.2 

TABLE  XXXIX. 

Summary  of  One  Hundred  and  Sixty-eight  Cases  of  Secondary  Amputation  in  the  Middle  Third  of  the 

Femur  for  Shot  Fracture. 

[Recoveries,  1—102;  Deaths,  103—168.] 


NO. 

NAME,  MIUTAUY 
DESCRIPTION,  AXI>  A(;E. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Abbott,  T.,  Pt.,  E,  7th 

Sept.  14, 

Left  (abscesses);  flap.    Surg.  H. 

11 

Bronchard,  A.,  Pt..  A, 

April  7, 

Left.    (Disch'd  April  12,   1865; 

Perm.  Reserves. 

Nov.  14, 

S.  Hewit,  U.  S.  V.     Discharged 

5th    New  Hampshire, 

1865, 

17,  exc.  met.;  May  15,  amp,  leg; 

18G2. 

Jan.  27,  1863. 

age  31. 

_. 

Feb.  18/66,  amp.  kn.jt.)  Reo'y. 

2 

Barger,  W.  M.,  Pt.,  H, 

April  7, 

Right;    flap.     Surg.   O.  Martin, 

12 

Brunemer,  J.  H.,  Corp'l, 

Sept.  14, 

Left  (gang.);  circ.    A.  A.  Surg. 

34th  Illinois. 

J'e  1,'62. 

U.  S.V.     Disch'd  July  22,  18G2. 

H,  7th  Wisconsin. 

De.  8,  '62. 

Q.  W.  Carey.    Disch'd  April  1, 

3 

Barnes,   B.    C.,    Pt.,  C, 

Mav  5, 

Left;   ant.  post.  flap.     Surg.  E. 

1863.    Spec.  917. 

146th  N.  York,  age  20. 

J'ne9,'P4. 

Donnelly,  2d   Penn.   Reserves. 

13 

Buckley,  J.,  Pt.,  A,  15th 

Aug.  7, 

Right  (haem.  post,  tib.);  circ.    A. 

Disch'd  Jan.  26,  1865. 

Infantry,  age  24. 

Sept.  12, 

A.  Surg.  P.  L.  Rice.    To  regi 

4 

Barnett,  W.  M.,  Pt.,  F, 

Nov.6,'63, 

Right  ;  flap.     Dr.  J.  W.  Ramsey, 

1864. 

ment  Dec.  7,  1864. 

10th  West  Va.,  age  18. 

Mav  25, 

Wilsonburg,  W.  Va.    Mustered 

14 

Burgenson,   S.,   Pt.,  F, 

De.31/fi2, 

Right;   flap.     Disch'd  July  13, 

18'65. 

out  May  —  ,  1865. 

15th  Wis.,  age  22. 

Mar.  17, 

1864. 

5 

Bell,   J.  11.,  Lieut.,  D, 

July  20, 

Left.     (July  20,  1864,  amp.  leg. 

1863. 

61st  Ohio,  age  52. 

1864, 

Disch'd  Dec.  15,  1864.    Neuralff. 

15 

Burnes,  W.,  Pt.,  A,  14th 

Sept.  19, 

Right;    flap.     Disch'd  Sept.  8, 

Oct.  27, 

aff  'n  of  stump.)  Dr.  D.  A.  Hart, 

Ohio,  age  36. 

No.24,'63. 

1864. 

1870. 

Cleveland,  Ohio.     Recovery. 

16 

Cain,  J.  II.,  Pt.,  I,  17th 

Oct.  21. 

Right;  flap.  Snrg.  I.Casselberry, 

C 

Besley,  S.  B.,  Corp'l.  H, 

Mav  5, 

Right  (gang.;  bonedis.);  circular. 

Illinois. 

No.30,'61. 

1st  Ind.  Cavalry.    Discharged. 

147th  N.  York,  age  30. 

Oct.  3/64. 

A.  A.  Surg.  C.  E.  Lee.    Disch'd 

17 

Capp,  A.,  Serg't,  B,  2d 

April  2, 

Right  (nee.);  circ.  Surg.  E.  Bent- 

August  17,  1865. 

Maryland,  age  24. 

Oct.  11, 

ley,  U.  S.  V.     Disch'd  Jan.  15, 

7 

Bowen,   C.   M.,  Pt.,  A, 

Sept.  17, 

Left.    (June,  '63,  nee.  bone  rem'd. 

1865. 

1866.    Spec.  4387. 

27th  Indiana,  age  19. 

1862, 

Disoh'd  Dec.  7/63.)     Dr.  D.  W. 

18 

Carey,   C.,   Pt.,   F,  5th 

Feb.  21, 

Left  ;  circ.     A.  Surg.  B.  Norris, 

Nov.  1], 

Bliss.    Spec.  4914.    Died  March 

Infantry. 

Ap.15,'62. 

U.  S.  A.    Discharged. 

1867. 

17,  '78;  phthisis  pulmonalis. 

19 

Coleman.  O.  A.,  Pt.,  B, 

No.18,'63, 

.    Surg.  C.  L.  Dunkley,  C.  S. 

8 

Bowen,   J.,  Pt.,  C,  42d 

Dec.  30, 

Right  (Dec.  31,  1862.  amp.  leg; 

3d  South  Carolina. 

Mar.4,'64. 

A.    Recovery. 

Illinois,  age  21. 

1862, 

June  17,  1863,  hsem.);  circular. 

20 

Conlon,  J.  II.,  Pt.,  B,  5th 

Mav  5, 

Left  ;  double  flap.    A.  A.  Surg.  J. 

June  21, 

Surg.  T.  D.  Fitch.  42d  Illinois. 

Wisconsin. 

J'e2"0/62. 

W.Dickie.     Disch'd  July  8/63. 

1863. 

Disch'd  April  28,  1864. 

21 

Crispin,   J.  A.,  Pt.,   A, 

Feb.  21, 

Right.  A.  Surg.  B.  Norris,  U.S.A. 

9 

Brader,  S.,  Pt.,  M,  4th 

June  12, 

Left  (carious):  circ.    A.  Surg.  C. 

3d  New  Mexico. 

Mar.-,'62. 

Disch'd  Feb.  28,  1863. 

N.  Y.  Cavalry,  age  25. 

Aug.  15, 

A.  McCall,  U.  S.  A.      Disch'd 

22 

Culley,  J.,  Pt.,  K,  7th 

May  18, 

Right  (caries:  erysip.);  circ.     A. 

1864. 

July  5,  I860.     Spec.  2927. 

Missouri,  age  23. 

1863, 

Surg.  II.  R.  Tilton,U.S.A.  Disc. 

10 

Bristcr,  J.  J.,  Pt.,G,  19th 

Se.  1!),  '63. 

Left.    (Diseb'd  ;  anch.  knee,  Julv 

Ap.10,'64. 

July  14,  1864.     Spec.  2677. 

Ohio,  age  23. 

Sept.  —  , 

22,  '64.)     Drs.  Smith  and  Hati- 

23 

Daniels,  S.,  Pt.,  K,  1st 

Aug.  10, 

Right;  circ.     Dr.  J.  P.  Coulter, 

1864. 

nan,  Huntington,  O.    Recovery. 

Iowa. 

Oc.—  ,'61. 

Marion,  Iowa.    Discharged. 

XXXI 


1  Primary  amputation  in  the  middle  third  of  the  opposite  thigh  had  been  performed  in  the  case  of  Pt.  S.  Baguley,  B,  5th  New  Hampshire  (TAlil.E 
:,  No.  703,  p.  235,  ante,  and  TABLE  XXXIX,  No.  105,  p.  315).    In  the  cases  of  Pt.  George  T.  Skilton,  I,  36th  Wisconsin,  at 


Case  of  Lieut.  C.  H.  Hawkins.  C,  4th  New  York  Calvary  (CASE  337,  p.  158,  and  No.  8  of  TABLE  XVIII,  p.  159,  ante 


SURG.  Ill — 40 


314 


INJURIES    OF    THE   LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

24 

Dewey,  G.,  Pt,  D,  51st 

De.13,'62, 

Left  (Dec.  H,  amp.  leg;  28,  re- 

58 

Martin,  JR.  €.,  Lieut.,  K, 

Sept.  19, 

.     Surgeon  —  Hall,  C.  S.  A. 

New  York. 

Jan.  -,'63. 

amp,  leg;  slough.);  double  flap. 

25th  Arkansas. 

Oc.20,'63. 

Recovery. 

A.  A.  Surg.W.V.  White.     Disc. 

f\nl    OQ     1  ft£T 

59 

McDonald,    S.   H.,   Re- 

De.25,'64, 

Right.      (Gangrene.)     Recovery 
Sept.  22  18b5. 

25 

•Draper,  L.  G.,  Lieut., 

Oc.19,'64, 

UCu  «;o,  looo. 
Left.     (M.  O.  Feb.  15,'6G,  deform 

60 

McDougall,  R.,  Corp'l, 

April  1, 

Left;  flap.     Disch'd  July  13,  "(J5. 

P,  75th  N.  Y.,  age  27. 

M'y  2,  '67. 

ity  of  limb.)  Dr.M.U.Bennedict, 

G,  2d  Mich.,  age  21. 

Je.  1,'64. 

late  Surgeon  75th  N.  Y. 

61 

McFarland,   D.,  Corp'l, 

June  16, 

Right;  circ.     A.  A.  Surg.  W.  L. 

26 

Dnggan,  T.,  Corp'l,  M, 

De.18,'62, 

Right  (disch'd  April  7,  '65);  flap. 

A,  22d  C.  T.,  age  22. 

Au.2,'64. 

Wells.     Disch'd  Sept.  7,  18G5. 

llth  Illinois  Cavalry. 

J'y5,'66. 

Surg.  E.  Andrews,  late  1st  111. 

62 

McWhinney,  F.,  Pt.,  A, 

April  2, 

Left  ;   circ.     Surg.  J.  B.  Larkin, 

Light  Artillery. 

123d  Illinois,  age  21. 

M'yll,'65. 

17th  Ind.     Disch'd  July  22.  'Ii5. 

27 

Durkee,  E.  W.,  Pt.,  G, 

April  6, 

Right;    circ.    Disch'd  July  16, 

63 

Montgomery,  S.,  Pt.,  I, 

May  12, 

Left   (May  12.   exc.  tibia);  flap. 

18th  Wisconsin. 

M'y20,'62. 

1862. 

139th  Penn.,  age  23. 

July  29, 

Surg.  E.  Bentley,  U.S.V.  Disch. 

28 

Dwyer,  J.,  Pt.,  G,  69th 

Sept.  17, 

Right.     Disch'd  April  27,   1863. 

1864. 

August  2,  1865. 

New  York,  age  33. 

Oc.20,'62. 

Died  April  9,  '70  ;  consumption. 

64 

Moore,  D.  A.,  Corp'l,  TI, 

J'el,'64, 

Right  (disch'd  Nov.  18,  '64);  bilat. 

Spec.  756. 

92d  New  York,  age  27. 

Jan.  13, 

flap.     Dr.  O.  F.  Parker,  Parish- 

29 

Eastman,  W.,Pt.,1,  114th 

Oct.  19, 

Right  ;  ant.  post.  flap.     Surg.  T. 

1865. 

ville,  N.  Y.    Recovery. 

New  York,  age  35. 

No.29,'64. 

Sim,  U.  S.V.     Disch'd  April  10, 

65 

Murphy,  C.,  Pt.,  D,  69th 

Sept.  17, 

Right  (March  18,  '63,  dead  bone 

1865.     Spec.  3474. 

New  York,  age  24. 

1862. 

exc.);  circ.   A.A.Surg.A.North, 

30 

Ekstrand,  J.  H.,  Lieut., 

Aug.  30, 

Left.     (Nov.  24,  '63,  shell  injury 

Mar.  23, 

Disch'd  Sept.  12,  -(i4.  Died  Dec. 

H,  13th  Col'd  Troops, 

1864, 

of  left  tibia.    Disch'd  Jan.  12, 

1803. 

28,  '64;  pneumonia.    Spec.  38G7. 

age  33. 

July  17, 

'65.  1868,  constant  pain  in  site  of 

66 

Nickerson,  C.,  Corp'l,  K, 

May  31, 

Right  (gangren's);  lat.  flap.  Surg. 

1868. 

first  wound;  cancerous  tumors 

1st  Maine  H'vy  Art'y, 

Oct.  27, 

N.  R.  Moseley,  U.  S.V.    Disch'd 

inv.  entire  knee  joint.)  Recov'y. 

age  23. 

1864. 

April  12,  1865.    Stump  dis'd,  re- 

Specs.  5479,  5480. 

amp.     Died  April  2'.»,'t'8  ;  tuber 

31 

English,  J.,  Pt.,  D,  23d 

Sept.  17, 

Right;  flap.     A.  Surg.  A.  Mass, 

culosis.     iSpee.  28D8. 

Ohio. 

Oc.23.'62. 

100th  Penn  .    Disch  'd  Mar.  6,  '63. 

67 

Nnssbaumer,  B.,  Pt.,  B, 

Ma.22,'62, 

Left.     (April  'J2.  1862,  nmp.  leg; 

3-2 

Everett,  P.,  Pt.,  K,  53d 

June  1, 

Left;  flap.     Surg.  P.  A.  Jewett, 

67th  Ohio,  age  27. 

,  '63. 

caries.     Disch'd  July  28,  1862.) 

Pennsylvania. 

Au.  1,'G2. 

U.  S.  V.     Disch'd  April  2,  1863. 

68 

Nutting,  J.,  Pt.,  F,  19th 

May  5, 

Right  ;  flap.     Surg.  —   Manson, 

33 

Pisk,  J.,   Pt.,  C,  4th  K. 

J'y  1,  '62, 

Left  (hsem.);  circ.    Surg.  J.  Neill, 

Maine,  age  21. 

Aug.  22, 

Hartland,  Maine.     Disch'd  Jan. 

Island  Bat'ry,  age  25. 

Ja.  17,'63. 

U.  S.  V.     Disch'd  Aug.  6,  1863. 

1864. 

26.  1865. 

34 

Galway,  R.,  Pt.,  E,  54th 

April  20, 

Right  (Dec.  15,  '65,  frag's  nee. 

69 

Page,  E.,  Corp'l,  11,  17th 

Sept.  20, 

Left  (gang.;  bone  diseased);  ant. 

New  York,  age  36. 

1865, 

bone  rem'd;  disch'd  June  22,  '66); 

Kentucky,  age  21. 

1863, 

post.  flap.    A.  A.  Surg.  P.  Peter. 

Sept.  8, 

flap.    A.  Surg.  G.  M.  McGill,  U. 

Jan.  24. 

Erysip.     March  2f>,'(>4.  exc.  end 

1866. 

S.  A.     Recovery. 

1864. 

fern.;   Oct.  20,  seq.  rem'd.  Duty 

35 

Gibson,  J.  W.,  Corp'l,  F, 

June  15, 

Right  ;  circ.    A.  Surg.  W.  G.  Bry 

Jan.  21,1865.     Spec.  21  96. 

123d  Ohio. 

July  26, 

ant,  122d  Ohio.    Disch'd  Feb. 

70 

Painter,  G.  W.,  Serg't, 

May  5, 

Left  :  flap.     A.  A.  Surgeon  J.  L. 

1863. 

13,  1864. 

H,  139th  Penn.,  age  24. 

J'e5,'C4. 

Stewart.     Disch'd  April  19,  '65. 

36 

Green,  E.,  Pt.,  K,  119th 

No.  7,  '63 

Right  (haem's  ;  dry  gang.);  ant. 

71 

Porter,   E.,   Pt.,   G,   2d 

June  1. 

Right  ;  circ.     A.  A.  Surg.  S.  N. 

Penn.,  age  35. 

Jan.  21, 

post.  flap.     Surg.  D.  W.  Bliss, 

Vermont,  age  37. 

Au.22,'64. 

floss.     Disch'd  June  12,  1865. 

1864. 

U.  S.  V.     Disch'd  July  7,  1864. 

72 

Powell,  J.  E.,  Serg't,  A, 

May  10, 

Right  ;  circ.   Surg.  C.  E.  Swasey, 

Spec.  2033. 

6th  Kans.  Cav.,  age  28. 

J'ell,'64. 

U.  S.  V.     Disch'd  Jan.  23.  '65. 

37 

Griffin,  W.,  Pt.,  A,  69th 

June  3, 

Right  ;  flap.     Surgeon  —  Gibbs, 

73 

Rand,  K.,  Corp'l,  C,  2d 

May  5, 

Left  (May  26,  hsem.:  gang:.);  circ. 

New  York,  age  20. 

Au.  2,  '64. 

C.  S.  A.     Recovery. 

Vermont,  age  23. 

J'e23,'64. 

A.  Surg'.  J.  C.  McKee,  U.  S.  A. 

38 

Griggt,  W.  I.,  Serg't,  A, 

Au.  9,  '62, 

.     Surg.  —  Douglass,  C.S.A. 

Nee.  bone  rem'd.     Disch'd  Oct. 

42d  Virginia. 

J'e20,'63. 

Recovery. 

28,  1865. 

39 

Hare,  F.,  Corp'l,  B,  6th 

May  5, 

Left  (May  6,  amp.  kn.  j't  ;  gang.); 

74 

Reed,  J.,   Pt..   K,   llth 

Feb.  5, 

Right  ;  circ.    Surg.  G.  S.  Kcmble, 

Wisconsin,  age  23. 

Au.  6,'64. 

circ.    Confed.  surgeon.    Disch'd 

Illinois,  age  37. 

Ma.24,'64. 

U.  S.  V.    DischM  June  22,  '64. 

May  22,  1865. 

75 

Rich,  R.  E.,  Pt.,  B,  19th 

Sept.  17, 

Left;  circ.    A.  A.  Surg.  P.  Mid- 

40 

Harvie,  W.  E.,  Pt.,  A,2d 

Oct.4,'63, 

Left  (symptoms  of  gang.);  flap. 

Massachusetts. 

No.lO,'G2. 

dleton.    Disch'd  Jan.  17,  1863. 

Kentucky. 

Jan.  10, 

Surg.  S.  J.  W.  Mintzcr,  U.  S.  V. 

76 

Robb,  B.  F.,  Pt,,  K,  26th 

May  3, 

Rig-lit.  (Gangrene.)    Surg.  D.  W. 

1864. 

Disch'd  March  21,  1864. 

Pennsylvania,  age  25. 

Aug.  6, 

Bliss,  U.  S.V.     Disch'd  Dec.  1  9, 

41 

Haycock,  H.  H.,  Pt.,  K, 

Oc.28,'63, 

Right;  circ.     A.  A.  Snrg.  H.  C. 

1863. 

1863.    Spec.  1582. 

137th  New  York,  age 

Mar.8,'64. 

May.     Disch'd  June  18,   1864. 

77 

Robertson.  W.B.,  Pt.,  H, 

J'e27,'62, 

Left  (erysip.);  flap.  Surg.  J.  Neill, 

21. 

Spec.  2201. 

27th  N.  York,  age  20. 

May  14, 

U.  S.  V.     Disch'd  Jan.  27,  18G4. 

42 

Howard,  W.  H.,  Pt.,  A, 

July  2, 

Left.     Discharged  June  3,  1864. 

ieG3. 

Spec.  1330. 

7th  Infantry,  age  24. 

An.  4,  '63. 

78 

Sauer,   C.,  Pt.,   I,  88th 

Nov.  25, 

Left;  flap.    Disch'd  Jan.  10,  '65. 

43 

Hughes,  H.W.,Corp'l,  I, 

J'el4,'63, 

Right  (amp.  leg  June  14,  '63;  dis. 

Illinois. 

De.30,'63. 

133d  New  York. 

Jan.  21, 

Oct.  12,    63);  circ.     Dr.  Olcott, 

79 

Scheuerman,  J.,  Pt.,  K, 

Se.  19/63, 

Right  (erysip.);  circ.    A.  Surg.  J. 

1864. 

Williamsburg,  N.Y.  Recovery. 

9th  Ohio,  age  28. 

Mar.  18, 

E.  Link^  21st  111.     Disch'd  July 

44 

Husband,  J.,  Serg't,  K, 

Mar.  18, 

Right  ;  circ.     Snrg.  A.  Hard.  8th 

1864. 

14.  1864.     Spec.  2802. 

5th  Penn.Art'y,  age  21. 

Ap  22,'65. 

111.  Cav.     Disch'd  Aug.  5,  1865. 

80 

Scott,   J.,   Pt.,  K,  18th 

June  18, 

Left;  circ.     A.  A.  Surg.  J.  C.  La- 

45 

Jefferson,  E.,  Pt.,  K,  1st 

July  2, 

Left   (gang.;  erysip.);  ant.  post. 

Massachusetts. 

Au.12,'64. 

mont.     Disch'd  Feb.  17,  1865. 

Minnesota,  age  19. 

Sept.  14, 

flap.     A.  A.  Surg.  B.  B.  Miles. 

81 

Schneider.M.,Pt.,F.26th 

July  1, 

Right:    ant.  post.  flap.     Disch'd 

1863. 

Disch'd  Dec.  9,  '63.     Spec.  17:i2. 

Wisconsin,  age  26. 

Aug.  13, 

Jan.  29,  1864. 

46 

Jones,   J.,   Pt.,  K,  13th 

No.13,'64, 

Right;  circ.     A.  A.  Surg.  T.  W. 

18G3. 

Tenn.  Cav.,  age  26. 

M'ylO,'65. 

Baugh.     Disch'd  Aug.  22,  1865. 

82 

Shaw,  J.W.,Pt.,  I,  lllth 

J'y  3,  '63, 

Right  (M.  O.  June  16,  1865;  '66, 

47 

Keigan,  P.,  Pt.,  D,  1st 

Mar.  26, 

Right;  flap.  A.  Surg.  J.  C.  Bailv, 

New  York. 

June  1, 

bonecame  away):  ant.  post.  flap. 

Colorado. 

Ap.26,'62. 

U.S.A.     Disch'd  Aug.  23,  1862. 

1872. 

II.  K.  Spooner,  late  Surg.  61st 

48 

Kelly,  B.,   Pt.,   G,  83d 

Sept.  17, 

Right  ;  circ.     A.  A.  Snrg.  W.  11. 

Ohio.    Recovery.    Spec.  G670. 

New  York. 

Oc.20,'62. 

Matlock.    Disch'd  March  7,'  63. 

83 

Stierrer,  J.  M.,   Pt.,  C, 

May  16, 

Left  ;  circ.    Furlonghcd  October 

Spec.  4826. 

2?th  S.  C..  age  38. 

J  'el  6,  '64. 

10.  1864. 

49 

Kelly,  M.,  Pt.,  B,  106th 

July  2, 

Left  ;  ant.  post.  flap.     A  .  A  .  Surg. 

84 

Steel,  J.L.,  Corp'l,  C,2d 

Nov.  3,   i  Left;  lat.  flap.     A.A.Surg.W.  P. 

Penn.,  age  23. 

Nov.  10, 

F.  Hinkle.     M.  O.  Sept.  10,  '64. 

Iowa  Cavalry,  age  26.    De  9D  '(>3      Kw<w>flnnH.~   niutfiM  Onf.  1   'fi4 

1863. 

Spec.  1994. 

85 

Stinson,  J.,  Pt.,  B,  99th 

July  2. 

Left  :  flap.     Surgeon  H.  Palmer, 

50 

King,  J.  M.,  Capt.,  C, 

Jan.  1, 

Right.    (Nee.  bone  rem'd.)  Surg. 

Penn.,  age  18. 

Sep.2,'G3. 

U.  S.  V.    Erysipelas;  abscesses. 

13th  Louisiana,  age  25. 

Sept.  15, 

A.  H.  Thurston,  U.  S.V.    Furl'd 

Mustered  out  Sept.  8,  1864. 

1863. 

Nov.  7.  1864.    Spec.  1918. 

86 

S  title,  W.,  Pt.,  A.  29th 

May8,'64, 

Riffht  (May  9,  '64,  amp.  Icjr  :  disc. 

51 

Kreidler,  C.  W.,  Pt.,  A, 

Apr.7,'62, 

Right  (disch'd  May  16,  '63;  bone 

Ohio,  age  21. 

March  15,      Aug.  16,  1865,  gangrene);  flap. 

15th  Infantry. 

May  21, 

diseased);  flap.  Dr.  G.  C.  Black- 

1866.          Recovery. 

1863. 

man,  late  Surg.U.  S.V.  Recov'y. 

87 

Stocdale,W.,Pt.,  D,48th 

May  14,    Rig-lit;    flap.      Confed.   surgeon. 

52 

LaMarsh,  J.,  Pt.,  I,  3d 

Sept.  19, 

Left;    flap.     A.  A.  Surg.  C.  W. 

Indiana,  age  28.              ,7'v  (";.  '<;:).     Mustered'out  July  15.  18G5. 

Vermont,  age  20. 

No.  1,  '64. 

Stinson.    Caries.    Disch'd  Aug. 

88 

Sullivan,  J.,  Pt.,H,15th 

No.  25,  '63,;  Right  :  (lap.    A.  Surg.  R.  Bartho- 

4,  1865. 

Indiana,  age  37. 

Jan.  22,       low,U.S.A.  Carious  bone  rem'd. 

53 

Litzinger,  R.  A.,  Corp'l, 

Feb.  21, 

Right  ;  circ.     A.  Surg.  B.  Norris, 

1864.         Disch'd  April  20.  '65.  Spec.  21  05. 

G,  2d  Cavalrv. 

.I'ne4,'62. 

U.  S.  A.     Discharged. 

89 

Surer,  J.,  Pt.,  H,  19th 

Jan.  2.    i  Right  :  flap.     Surg.  F.  Seymour, 

54 

Luck,   F.,  Pt.",  C,  21st 

Oct.  8,  '62, 

Right  (caries;  periostitis:  disch'd 

Illinois. 

M'h4,'63.     T.  S.V.    Disch'd  June  18,  1863. 

Wisconsin,  age  21. 

Jan.3,'64. 

Feb.  15,  1863);  oirc.     Surg.  II. 

90 

Thayer.  A.,  Pt.,  F.  48th 

May  7,     Itijrht  ;  flap.    Dr.  C.  Freiot,  Troy, 

Culbertson,  U.  S.V.    Spec.  2074. 

New  York,  ago  18. 

Sep.6,'64.     New  York.    Disch'd  January  4, 

55 

Lndis,    M.,  Pt.,   A,   2d 

Oct.  8,  '62, 

Right  ;  circ.    Surg.  J.G.  IT.itchitt, 

1865. 

Missouri,  age  37. 

Fe.11,'63. 

U.  S.  V.     Recovery. 

91 

Todd.  M.  A.,  Pt.,  E,  i<lth 

Aug.  29,    Left  ;  circ.      Retired   March   30, 

56 

Mangan,  J.,  Pt.,  H,  1st 

June  24, 

Left   (gang.;   haem.;   nee.);   circ. 

Alabama,  nge22. 

Oc.10,'64.      18G5. 

Artillery,  age  23. 

Oct.  24 

Surg.  E.  Bentley,  U.S.V.  Reg'l 

92 

Vanvourst.  A.  K.,  Pt.,A, 

July  1,     Right.    Disch'd   Aug.   11,   18G5. 

1864. 

Headquarters  Jan.  27,  1865. 

134th  N.  Y.,  ago  18. 

Au.  1,'G3.      Spec.  417. 

57 

Marshall,  J.,  Pt.,  1,  69th 

Mar.  19. 

Left;    flap.      Surg.  C.  O'Leary, 

93 

Ward,  F.,  Pt.,  D,  49th     April  6,     Lei't.     (Gangrene.)     Dr.  White. 

Ohio,  age  20. 

8ep.5,'65. 

U.  S.  V.    Disch'd  Feb.  6,  1  866. 

New  York.                       Myl2,'62. 

Disch'd  October  28,  1862. 

HOMANS  (J.,  jr.).  Cases  of  Gunshot  Fracture  of  tJir  Tliigli,  Results  of  Cfmse.rrative  Surgery,  in  Jiostim  Med.  and  Surg.Jtnirnal,  1865,  Vol.  72,  p.  29 


Me«l  K-  Sun>.  !li.-t.of  llic  M';ir  ol'tho  Rebellion,  P;«-I  III  Vol  ILC'linp  X 


i 


• 
f 


PLATE   XLIX.MEDULLARY   ABSCESSES    OF  THE    FEMUR 
I'iisr  nf  Ciml     K    \V    ('.-II.I.K     l."tth  \'il"Jlii!.'i 


SECT.  III.l 


SECONDARY    AMPUTATIONS   OF   THE    THIGH. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  ACE. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

94 

Wellman.J.  G.,  Serg't,  I, 

July  21, 

Right   (slough.;    necrosis);    long 

124 

2Hawkins,  C.  H.,  Lieut., 

J'e8,'62, 

Right.  (Oct.,  '62,  dis.  bone  rem'd.) 

27th  New  York,  age  25. 

Nov.  5, 

int.,  short  ext.  flap.   Dr.  R.  Steb- 

C,4th  New  York  Cav., 

April  29, 

Surg.  A.  B.  Mott.  1'.  S.V.  Sept., 

1861. 

bins,  AlleganjiCo.,  N.Y.  Disc'h 

age  23. 

1863. 

'63,  exc.  four  ins.     Amp.  hip  jt., 

Dec.  15,  1862.     Spec.  1067. 

Sept.  21,'<i4.     Died  Sept.  22,  '(M  ; 

95 

West,   W.,    Pt.,   V,   2d 

Jan.  17, 

Left  ;  flap.     A.  A.  Surg.W.  Dick 

syncope  from  shock. 

Ohio  Cavalry. 

Mar.  29, 

inson.    Disch'd  April  24,  1862. 

125 

Hindman,  W.  L.,  Pt.,  E, 

May  23, 

Left  (May  23.  amp.  leg;  gang.); 

1862. 

155th  Penn.,  age  20. 

June  24, 

circ.     A.  A.  Surg.  M.C.  Mulford. 

96 

Whiting,  C.,  Pt.,  C,  17th 

Aug.  30, 

Left  ;  ant.  post.  flap.    A.  Surg.W. 

1864. 

Died  June  24,  '(i4  :  inflammation 

New  York. 

Oct.  —  , 

E.Waters,  U.  S.A.    Discharged 

and  suppuration  of  stump. 

1862. 

March  25,  1863. 

126 

^Holland,  W.,  Pt.,  I,  6th 

June  1, 

Left  (erysip.;  gang.;  bone  rem'd; 

97 

Whortenbcrry,J.M.,Pt., 

De.31,'62, 

Left.    Surg.  F.  Seymour,  U.  S.V. 

N.  Carolina,  age  45. 

Aug.  4, 

haem.);  circ.    A.  A.  Surg.  T.  I.. 

B,  15th  Kentucky. 

Au.  -,'63. 

Disch'd  Feb.  15,  1864. 

1864. 

Leavitt.     Died  August  4,  18<t4. 

98 

Winning,  J.,  Pt.,  A,  125th 

May  14, 

Left  (gang.;  rupt.  pop.  art.);  ant. 

Spec.  2924. 

Ohio,  age  27. 

Oct.  12, 

post.  flap.    Surg.  H.  P.  Stearns, 

127 

Holmes,  J.,  Pt.,  D,  1st 

June  30, 

Left.     A.  A.  Surg.  S.  D.  Gross; 

1864. 

U.  S.V.   Heem.   Dec.  5,  re-amp. 

New  York,  age  26. 

Aug.  7, 

pyaem.     Died  August  19,  1862. 

upper  third.     Ilicms.     Disch'd 

1862. 

Autopsy.    Spec.  256. 

May  20,  1665. 

128 

Horey,  G.,  Pt.,  D,  10th 

Mar.  21, 

Right  (sloughing);  circ.     A.  A. 

99 

Wood,   W.   W.,  Pt.,  D, 

Sept.  20, 

Right.     Surg.  —  Agnes,  C.  S.  A. 

Illinois,  age  20. 

June  24, 

Surg.  E.  P.  Fitch.    Died  June 

4Cth  Georgia. 

De.27,'63. 

Recovery. 

1865. 

24,  65.  one  hour  after. 

100 

Young,  L.  C.,  Pt.,  A,  3d 

May  12, 

Eight.  (May  12,  ainp.  knee  joint.) 

129 

Ingram,  W.  A..  Serg't, 

Aug.  30, 

.     Died  October  4,  1862. 

Virginia. 

July  27, 

Surg.  W.  F.  Richardson,  C.S.A. 

B,  20th  N.  Y.  S.  M. 

—  ,  '62. 

1864. 

Gang.    Furl'd   Sept.  17,   1864. 

130 

Jackson,  H.  A.,  Lieut..  D, 

No.29,'64, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Spec.  5514. 

45th  Alabama,  age  29. 

Jan.  1, 

R.  McNeilly.    Died  Jan.  20,  '65  ; 

101 

Young,  M.,  Pt.,  F,  25th 

May  27, 

Right  ;  flap.     Dr.  J.  R.  Brouson. 

1865. 

exhaustion. 

New  York,  age  25. 

July  28, 

Nee.;  ervsip.    Jan.  3,  '63,  circ., 

131 

Jell,  F.,  Serg't,  I,  95th 

July  3, 

Right;  gang.;  haem      Died  Sept. 

1862. 

up.  third.     Disch'd  May  26,  '63. 

New  York,  age  35. 

Au.26,'63 

25,  1863  ;  exhaust'n  and  diarr. 

102 

Zweifel,   J.,   Corp'l,   F, 

J'y3,'63, 

Right  ;  circ.     A.  A.  Surg.  B.  B. 

132 

Johnson,   E.  F.,  Pt.,  I, 

Julv  3, 

Left.     Died  Sept.  7,  '63  ;  exh'n 

6th  Wisconsin,  age  23. 

April  14, 

Miles.     Disch'd  Nov.  10,  1864. 

8th  Georgia,  age  18. 

Au.l2,'G3. 

Spec.  1947. 

1864. 

Sjsec.  2256. 

133 

Kirke,  S.  H.,Pt.,K,  200th 

April  2, 

Left  (bone  carious);  ant.  post.  flap. 

103 

Allman,   G.  W.,  Pt.,  I, 

May  7, 

Left.    Died  August  7,  1864;  ex 

Pennsylvania,  age  19. 

May  22, 

Surg.  E.  Bentley,  U.  S.  V.  Dic.l 

8th  Iowa  Cavalry. 

—  ,  '64. 

haustion. 

1865. 

May  29,  '65  ;  prostration.'  A  utop. 

104 

Ambrose,  B.  J.,  Corp'l,  I, 

No.22,'63, 

Left.     (Gang.;  diarr.)     Feb.  10, 

134 

Lafferty,  J.  C.,  Capt.,  C, 

Oct.  5, 

Left  ;  circ.  A.  A.  Surg.  P.  L.  Rico. 

105th  Ohio,  age  24. 

Jan.  29, 

gang.:  14,  15,  haem.    Died  Feb. 

12th  Illinois,  age  21. 

Nov.9,'64. 

Died  Nov.  25,'64;  exhaustion. 

1864. 

18,  '64  ;  exh'n.    Spec.  2199. 

135 

Lamon,    G.    F.,    Lieut. 

Sept.  14. 

Left  (ulc.  fern,  art.;  haem.);  flap. 

105 

Baguley,  S.,  Pt.,  B,  5th 

April  7, 

Left  (April  8,  amp.  right  middle 

Col.,  32d-New  York. 

Nov.9,'G2. 

Surg.  L.  W.  Oaklev.  2d  N.  J. 

New  Hamp.,  age  21. 

June  3, 

third);  ant.  post.  flap.     Surg.  O. 

Died  Nov.  9,  '62.    Spec  792. 

1865. 

A.  Jndson,  U.  S.  V.    Died  July 

136 

Lemar,   J.    C.,   Pt.,    B, 

Jan.  11, 

Left.     (Synovitis.)     Died  June 

10,  1865;  exh'n.     Spec.  4232. 

97th  Illinois,  age  21  . 

My2f>,'63. 

23,  1863;  pyaemia. 

106 

Bauer,  P.,  Pt.,    B,   9th 

Feb.  14, 

Right  ;  double  flap.    Dr.  Briggs, 

137 

Linn,  H.,  Pt.,  A,  6th  Pa. 

Sept.  17, 

Left  (Dec.  4,  amp.    leg;   gang.: 

Illinois. 

Mar.  15, 

Nashville.     Mar.  23,  haem.;  lig. 

Reserves,  age  25. 

1862, 

nee.);  flap.     Surg.  J.  15.  Lewis. 

1862. 

fern.  art.  Died  May  5,'62;  exh'n. 

Jan.  15, 

U.S.V.    Haem.    Feb.  4,  '63,  lig. 

107 

Baling,    J.,   Serg't,    B, 

No.30,'61, 

Right  (carious);  oval  skin  flap. 

1863. 

fern,  art.;  March  5,  bone  rem'd. 

28th  Tenn.,  age  27. 

Feb.  1.8, 

Surg.  B.  B.  Breed,  U.S.V.   Died 

Died  March  31,  1863.     Autopsy. 

1865. 

April  26,  1865. 

Specs.  3818,  3983,  74H. 

108 

Brown,  H.  G.,  Corp'l,  B, 

June  17, 

Right  (Junel7,amp.leg;  slough.); 

138 

Long,  J.,   Pt.,  B,  47th 

May  1, 

Right.     Surg.  G.  Grant,  U.  S.  V. 

37th  Wisconsin,  age  21. 

July  21, 

flap.  Surg.N.R.Moseley.U.S.V; 

Indiana. 

J'e  10/63. 

Died  Jan.  15,  1864.     Spec.  1351  . 

1864. 

July  31,  bone  retn'd.  Died  Aug. 

139 

Matthews,  T.,  Pt.,  D,8th 

May  6, 

Right;  circ.     Surg.  D.  W.  Bliss. 

3,  1864.     Specs.  2897,  2945. 

Ohio,  age  32. 

June  10, 

U.  S.V.   Died  June  12,  '64  ;  amp. 

109 

Bryant,  E.  K.,Pt.,  H,  1st 

May  19, 
J'c20  '64 

Right  ;  circ.     A.  A.  Surg.  C.  W. 

TAf) 

MoTloiTi     \V        Qnrrr'i     T1 

1864. 

Spec.  2499. 

110 

*Capps,E.  W.,  Capt.,.C, 

Oct.  11, 

Carrier.  Died  July  o,  64  ;  pyaem. 
Right  (erysip.;  pyarthrosis);  circ. 

ITV 

cixun,   w  .,   oerg  i,  xj, 
23d  Illinois,  age  31. 

Sept.  24, 

Surg.  A.  M.  McLetchie.     Gang. 

15th  Virginia  Cavalry, 

1863, 

A.  Surg.  J.  C.  McKee,  U.  S.  A. 

1864. 

Died  Sept.  25.  1864. 

age  30. 

Feb.  8, 

Died   Feb.   20,  1864;   pyaemia. 

141 

McCann,  R.  H.,  Corp'l, 

May  3, 

Right.     Surg.  C.Witsell,  C.S.A. 

1864. 

Autopsy.     Spec.  2036. 

G,  13th  Miss.,  age  19. 

J'e7,'63. 

Died  July  2,  '63;  typ.  fever. 

111 

Carr,  W.  E.,  Pt,,  D,  27tli 

June  3, 

Left  ;  circ.    A.  A.  Surg.  J.  Morris. 

142 

McCure,  A.,  Pt,,  F,  3d 

Sept.  19, 

Right;  oval  flap.     Surg.  A.  At 

Mass  ,  age  21. 

Sc.8,'64. 

Died  October  7,  1864. 

Alabama,  age  19. 

Oct.  31, 

kinson,  C.  S.  A.     Died  Oct.  31, 

112 

Christiana,   G.,   Pt.,  A, 

July  2, 

Right.      (August  10,  amp.  leg.) 

1864. 

1864  ;  pneumouia. 

120th  N.  Y.,  age  36. 

Sept.  2, 

A.  A.  Surg.  H.  Leaman.    Died 

143 

4McGowan,  P.,  Pt.,  A, 

May  31, 

Left  (prof,  discharges;  erysip.); 

1863. 

Sept.  26,  1863  ;  exhaustion. 

61st  New  York,  age  32. 

J'yl5,'62. 

cire.    Dr.  W.  Parker.    Diarrh. 

113 

Cobb,  C.  P.,  Pt.,  F,  1st 

Mar.  31, 

Left;  ciro.     Surg.  A.  F.  Sheldon, 

and  gastric  irritability.    Died  in 

Michigan,  nge  20. 

June  3. 

U.  S.  V.     Died  July   1,  1865; 

the  course  of  twenty-four  hours 

186o. 

osteomyelitis.    Spec.  4215. 

144 

Meadows.  J.  W..  Pt.,  C, 

Xo.30,'(>4. 

Right;  bi-lat.  skin  flap;  circ.  sect. 

114 

Curly,  J.,  Pt.,  1C,  G9th 

fciopt.  17, 

Left;  flap.    Died  Oct.  27.  1862. 

16th  Tennessee,  age  CO. 

Jan.  24, 

mus.     A.  A.  Surg.  It.  McNeilly. 

New  York. 

Oc.20,'02. 

Spec.  4828. 

1865. 

Died  Jan.  31,  '65  ;  exhaustion. 

115 

Debar,   J.,    Pt.,  T,  88th 

Sept,  17, 

Left;  flap.  A.  Surg.  P.Adolphus, 

145 

«  Meyer,  S.,Pt.,H,  110th 

July  2, 

Left  (nee.;  bone  rem'd);  ant.  post. 

New  York. 

Oc.21,'62. 

U.S.A.    Nee.  bone  rem'd.    Died 

Pennsylvania,  age  25. 

Nov.  9, 

flap.     A.  A.  Surg.  W.  P.  Moon. 

Nov.  27,  '62.     Specs.  446,  447. 

1864. 

Died  Nov.  9,  1864. 

116 

Drain,  J.  F.,  Pt.,  A,  53d 

July  2, 

Left.     (July  4th,  amp.  leg,  nee. 

146 

Meyres,  D.  C.,  Serg't,  C, 

No.30,'64, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Virginia,  age  26. 

Oct.  9, 

bone  rem'd.)     Died  Nov.  5,  '63; 

7th  Mississippi  Battery, 

Jan.  1, 

W.  J.  R.  Holmes.    Died  Jan.  1  , 

1863. 

exhaustion.    Specs.  1963,  1975. 

ago  24. 

1865. 

1865;  exhaustion;  shock. 

117 

Eastman,  H.  J.,  Pt.,  F, 

Mar.  2, 

Left  (extracted  splinters  of  bone); 

147 

Patton,  S.,  Pt.,  G,  31st 

July  9, 

Left;  circ.     A.  A.  Surg.  J.  H. 

1st  Vt.  Cav.,  age  23. 

J'e6,'64. 

slough.  Died  Sept.  19,'64;  exh'n. 

Georgia,  age  42. 

Aug.  10, 

Coover.    Died  August  27,  1864  ; 

118 

Edwards,  J.  W.,  Pt.,  G, 

May  8, 

Left  (si.  ven.;  haem.);  circ.    A.  A. 

1864. 

exhaustion.     Spec.  3836. 

44th  Alabama,  age  26. 

Julv  11, 

Sun?.  T.  L.  Loavitt.     Died  Oct. 

148 

Pitcher,  A.,  Pt.,  G,  122d 

May  6, 

Left;  circ.     Surer.  D.W.  Bliss,  U. 

18U4. 

26,  '64  ;  dysentery.     •Spec.  2837. 

New  York,  age  25. 

June  7, 

S.  V.     Died  July  13,  '64.    Spec. 

119 

Ewing,  W.   E.,  Pt.,  C, 

July  2, 

.    (Gang.;  slough.;  haemorr.) 

1864. 

2449. 

2d  Wisconsin,  age  32. 

Au.13,'63. 

Died  Aug.  13,  1863  ;  shock. 

149 

Poucher,  A.,  Pt.,  A,  14th 

Aug.  29, 

Left,    A.  S.  J.  B.  Brinton,  U.  S.  A  . 

120 

Farley,  H.,  Pt.,  H,  61st 

May  5, 

Left;  cire.     A.  A.  Surg.W.  W. 

New  York. 

Oct.  4,  '62. 

Died  Oct.  21,  1862  ;  pyaemia. 

Pennsylvania,  age  27. 

J'yl5,'C4. 

Volk.     Died  Sept.  2,  1864. 

150 

Roe,  J.,  Pt.,  B,  42d  N. 

Sept.  17, 

Left.    A.  A.  Surg.  N.Webb.  Oct. 

121 

Flippin,  A.  11.,  Corp'l, 

July  20, 

Left  (tib.  carious);  circ.      A.  A. 

York. 

Oct.  27, 

29,  hasm.;  30,  rcc'rd,  lig.  femoral 

C,  33d  Miss.,  age  34. 

Nov.  14, 

Surg.  D.  D.  Talbot.     Died  Dec. 

1862. 

art.    Died  Oct.  30,  1862;  exh'n. 

1864. 

28,  1864  ;  exhaustion. 

Spec.  436. 

122 

Frost,  A.  C.,  Pt.,  C,  15th 

July  2. 

Left.     (Prim.  amp.  leg.)      Died 

151 

Roth,    J.,    Pt.,    K,    2d 

Au.30,'62, 

Left.    Died  Oct.  19,  1862.    Spec. 

Qo    10  »f?Q 

4014. 

123 

Goode,  W.  F.,  Pt.,  H,  2d 

OC.  l*i,  Oo. 

Sept.  17, 

oept.  10,  louo  ;  gangrene. 
Left;  flap,  skin;   circ.  mus.     A. 

152 

Roxbury,  C.  F.,  Pt.,  F, 

Sept.  17, 

Left  (erysip.);  flap  of  skin;  circ. 

Mississippi,  age  18. 

Dec.  22, 

Surg.  R.F.  Weir,  U.  S.A.    Dec. 

124th  Penn.,  age  29. 

1862, 

of  mus.     A.  Surg.  R.  F.  Weir, 

1862. 

27,  haem.;  gang.     Died  Jan.  15, 

Feb.  24, 

U.  S.  A.    Erysip.    Died  March 

'63  ;  pysem.    tepees.  3858,  3893. 

1863. 

11,  '63  ;  exh'n.  Specs.  3855,  :303. 

1  ALLEN  (H.),  Remarks  on  the  Pathological  Anatomy  of  Osteomyelitis,  with  Cases,  in  American  Jour.  Med.  Sciences,  1865,  N.  S.,  Vol.  XLIX,  p.  3!' 

2  WATERS  (E.  G.),  A  Report  of  Twelve  Gunshot  Fractures  of  the  Thigh,  in  Am.  Med.  Times,  1863,  Vol.  VI,  p.  185.    HAMILTON  (F.  H.),  Amputa 
tions  in  Gunshot  Fractures  of  the  Femur,  in  Am.  Med.  Times,  1864,  Vol.  VIII,  p.  1.     Circ.  6,  S.  G.  O.,  1865,  p.  50.     Circ.  7,  S.  G.  O.,  1867,  pp.  47,  65. 

'LEAVTTT  (T.  L.),  Tenacity  of  Human  Life  as  seen  in  Cases  of  Gunshot  Injuries,  in  Medical  and  Surgical  Reporter,  1865,  Vol.  XHI,  p.  205. 

'KENNEDY  (J.  T.),  Reports  of  Hospitals,  in  American  Medical  Times,  1862,  Vol.  V,  p.  105. 

8MOON  (W.  P.),  Case  of  Gunshot  Wound  of  the  Thigh,  in  American  Journal  Medical  Sciences,  N.  S.,  1868,  Vol.  LV,  p.  62. 


316 


INJURIES   OF    THE    LOWER    EXTREMITIES. 


(CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

153 
151 
155 

Ryall,  W.  C.,  Corp'l,  E, 
121st  Penn. 

Scott,  M.  E..  Pt.,  B,  17th 
Indiana,  age  25. 

Shindler  M.  Pt    H  43d 

De.13,'62, 
Feb.  4, 
1863. 
April  2, 
J'e2:t,'65. 

May  5, 

Left  (necrosis);  circ.   A.  Surg.  A. 
Hartsuff,  U.  S.A.   Died  Feb.  14, 
1863;  exh'n.    Spec.  1053. 
Left   (necrosis);    circ.     Surg.  H. 
Wardner,  U.  S.  V.    Died  July, 
19,  1865;  exhaustion. 
Left  (gang.);  ant.  post.  flap.  Surg. 

161 
162 
Ifffi 

Tafft,  F.  H.,  Pt.,K,  3d 

Rhode  Island  Artillery. 

Thomas,  J.,  *Pt.,  K,  30th 
Indiana,  age  26. 

Travicke.  W.  U.,  Pt.,  A, 

June  16. 
July  23, 
1862. 
Sept,  19, 
Dec.  18, 
1863. 
July  2, 

Left;  circ.    A.  A.  Surg.  W.  K. 
Cleveland.     Died  July  27,  '62; 
exhaustion. 
Left.     (Gang.)    Teal's  method. 
Dec.  31,  rupture  fern.  art.    Died 
Dec.  31,  '63;  haem.    Spec.  2172. 
Left.  Sloughing;  Aug.  18,  hsem.; 

156 
l,r>7 

New  York,  age  16. 

Skilton,  G.T.,Pt.,  1,  36th 
Wisconsin,  age  31. 

Storej-,J.M.,Pt.,II,37th 

June  IP, 
1864. 
June  3, 
Aug.  30, 
1864. 

J'y30,'G4, 

E.  Bentley,  U.  S.V.     Slough  'g  ; 
ha'm.     Died  June  27,  '64  ;  hsem. 
Right  (gang.;  ho?m.;  Aug.  8,  amp. 
knee;  gang.;  hcem.);  circ.     A. 
A.  Surg.  N.  F.  Martin.     Died 
Sept.  19,  1864;  exhaustion. 
Left.  (July  31,  amp.  knee  ;  hrcm.; 

164 

165 

8tb  Alabama,  age  46. 
Warner,  S.  N.,  Pt.,  H, 
83d  Penn.,  age  21. 
Williams,  L.,l't..C,  26th 
Michigan,  age  23. 

Au.6,'63. 
July  1, 
Au.  3,  '63. 
May  12, 
June  13, 
1864. 

gang.     Died  Sept.  4,  1863. 
Left.      Died    August    14,   1863; 
diarrhoaa. 
Left.     A.  A.  Surgeon  A.  Ansell. 
Htem.;  lig.  fern.  art.    Died  July 
19,  '64  ;  hoem.    Autopsy.    Specs. 
2882,  2883,  2538. 

158 

159 
160 

Wisconsin,  age  30. 

Stratton,  A.,Pt.,D,110lh 
Ohio,  age  21. 

Stuart,  S.  H.,  Pt.,  I),  2d 
Arkansas  Cavalry. 
Sullins,  W.,  Texan  Le- 
geon,  age  'JO. 

April  14, 
1865. 
May  5, 
June  24, 
1864. 
Sept.  27, 
,'64. 
De.21,'62, 
Fe.18,'63. 

gang.)    A.  Surg.  S.  H.  Orton.U. 
S.A.    Died  July  3,  '65;  gang. 
Left  (nee.;  pya?m.);ant.  post.  flap. 
A.  A.  Surg.  J.  Priestly.    Died 
June  29,  1864  ;  pysem.  Autopsy. 
Right.     Died  November  10,  1864. 

Left.    Died  March  2,  1863;  ery 
sipelas. 

166 

167 
168 

Winters,  L.,  Pt.,  K,  50th 
Georgia. 

Woolsey.A.,  Pt.,  II,  20th 
New  York. 
Zody,   A.  E.,  Capt.,  D, 
102d  Ohio,  age  28. 

July  3, 
Sept.  11, 
1863. 

Aug.  30, 
Oct.  1,'62. 
Se.24,'64, 
Jan.  26, 
1865. 

Right  (July  3,  amp.  leg;  slough.; 
bsem.);  circ.    A.  Surg.  B.  Stone, 
U.  S.V.    Died  Sept.  30,  1863; 
pytemia. 
Left.    Hsem.;  lig.  fem.  art.     Died 
Oct.  5,  1862  ;  exhaustion. 
Left  ;  (erysip.);  flap.    Surg.  R.  II. 
Gilbert,  U.  S.  V.     Diarr.     Died 
Feb.  21,  1865  ;  pytemia. 

The  seat  of  fracture  in  the  foregoing  one  hundred  and  sixty-eight  cases  was  in  the 
middle  third  of  the  femur  in  seven ;  in  the  lower  third  in  twenty-three ;  in  the  femur,  pre 
cise  seat  not  indicated,  in  twelve;  in  the  knee  joint,  in  sixty-eight;  in  the  bones  of  the  leg, 
in  forty-eight;  and  in  the  ankle  joint  or  foot,  in  ten  cases. 

Secondary  Amputations  in  the  Lower  Third  of  the  Femur. — Two  hundred  and  seven 
operations  of  this  group  were  reported.  One  hundred  and  seven  were  successful  and  one 
hundred  proved  fatal,  a  fatality  of  48.3  per  cent. 

/Successful  Cases  of  ^Secondary  Amputation  in  the  Lower  Third  of  the  Femur. — Four 
teen  of  the  one  hundred  and  seven  successful  secondary  operations  were  practised  on  Union 
and  ninety-three  on  Confederate  soldiers.  Eighty-nine  of  the  former  were  pensioned,  but 
seven  have  died  since  the  close  of  the  War.  The  side  of  operation  was  not  indicated  in 
seven  instances;  in  forty-four  the  right,  and  in  fifty-six  the  left  side  was  implicated.  Major 
operations  had  preceded  the  amputation  in  the  thigh  in  thirty-one  cases,  viz:  amputation 
at  the  knee  joint  in  four,  in  the  leg  in  twenty;  excision  in  the  bones  of  the  leg  in  six,  and 
amputation  of  the  opposite  leg  in  one  instance.1 

In  the  following  instance  the  amputation  was  performed  by  the  subperiosteal  flap, 
advocated  by  Assistant  Surgeon  George  M.  McGill,  U.  S.  A. 

CASE  490. — J.  H.  Allison,  a  farrier  of  Co.  I,  21st  Pennsylvania  Cavalry,  aged  19  years,  was  wounded  in  the  left  thigh, 
at  Amelia  Court  House,  April  5,  1865.  From  a  field  hospital  he  passed  to  the  Cavalry  Corps  Hospital  at  City  Point,  thence  to 
Annapolis,  and  afterwards  to  Baltimore,  where  he  entered  Jarvis  Hospital,  and  subsequently,  on  July  24th,  Hicks  Hospital. 
Assistant  Surgeon  G.  M.  McGill,  U.  S.  A.,  in  charge  of  the  latter,  reported  the  following  history:  "The  wound  was  caused  by 
a  mini6  ball,  which  entered  the  inner  aspect  of  the  lower  third  of  the  thigh  and  made  its  exit  posteriorly,  having  passed  down 
ward,  outward,  and  backward  behind  the  femur,  and  clipped  a  piece  from  the  posterior  surface  of  the  bone.  The  femoral  artery 
was  cut  by  the  bullet,  and  profuse  primary  haemorrhage  occurred  on  the  field,  followed  by  a  secondary  attack  on  May  19th,  and 
two  recurrences  since.  Each  secondary  haemorrhage  ceased  spontaneously  and  did  not  amount  to  more  than  a  teacupful.  About 

1  The  four  cases  in  which  the  amputation  in  the  thigh  was  preceded  by  exarticulation  at  the  knee  are :  Pt.  J.  M.  Brooks,  A,  17th  Pennsylvania 
Cavalry  (TABLE  XL,  No.  14,  page  320);  Pt.  H.  Desmond,  1,  28th  Massachusetts  (TABLE  XL,  3£o.  25,  p.  320);  Pt.  C.  H.  Rist,  A,  36th  Wisconsin  (TABLE 
XL,  No.  82,  p.  321);  and  Pt.  H.  Sholes,  D,  26th  New  York  (TABLE  XL,  No.  84,  p.  321).  Antecedent  amputations  in  the  leg  had  been  performed  in  the 
following  cases,  enumerated  in  TABLE  XL:  Pt.  D.  M.  Fletcher,  10th  Indiana  Battery  (No.  36,  p.  320);  Pt.  G.  Mclntire,  I,  7th  Maine  (No.  61,  p.  320);  Pt. 
J.  Morrin,  G,  126th  New  York  (No.  69,  p.  321);  Pt.  J.  B.  Bronson,  I,  14th  Ohio  (No.  13,  p.  320);  Lieut.  M.  A.  Cobb,  A,  23d  Alabama  (No.  20,  p.  320); 
Pt.  E.  Crawford,  F,  105th  Ohio  (No.  23,  p.  320);  Pt.  H.  S.  Dickens,  H,  126th  New  York  (No.  26,  p.  320);  Pt.  W.  F.  Dudley,  F,  1st  Maine  Cavalry  (No. 
28,  p.  320);  Corp'l  D.  C.  Eaton,  H,  5th  New  Hampshire  (No.  31,  p.  320);  Pt.  H.  Hadlow,  H,  81st  New  York  (No.  42,  p.  320);  Pt.  F.  Hoffman,  H,  2d 
Pennsylvania  Heavy  Artillery  (No.  47,  p.  320);  Pt.  I.  M.  Welsh,  B,  8th  Maine  (No.  101,  p.  321);  Pt.  B.  Thompson,  C,  28th  Pennsylvania  (No.  93,  p.  321); 
Pt.  W.  Bacon,  I,  7th  Maine  (No.  4,  p.  320);  Corp'l  A.  Bisbee,  B,  7th  Maine  (No.  9,  p.  320);  Corp'l  J.  Duran,  C,  17th  Maine  (No.  29,  p.  320);  Pt.  W.  II- 
Miller,  I,  72d  Pennsylvania  (No.  67,  p.  321);  Pt.  L.  N.  Kimball,  H,  22d  Massachusetts  (No.  53,  p.  320);  Pt.  J.  Kerrin,  G,  19th  Infantry  (No.  52,  p.  320); 
and  Pt.  H.  Pust,  K,  104th  Illinois  (No.  78,  p.  321).  Excision  in  the  bones  of  the  leg  had  been  performed  in  the  cases  of:  Pt.  J.  A.  Angell,  D,  1st  Wis 
consin  Cavalry  (No.  2,  p.  320);  Pt.  W.  H.  Bnrdick,  B,  82d  Pennsylvania  (No.  17,  p.  320);  Corp'l  T.  Odell,  H,  5th  Michigan  (No.  73,  p.  321);  Pt.  J. 
Fergus,  A,  70th  Indiana  (No.  :i4,  p.  320);  Serg't  J.  Lowth,  M,  4th  Wisconsin  Cavalry  (No.  57,  p.  320);  and  Pt.  E  A.  Bennett,  F,  44th  New  York  (No.  7, 
p.  320).  In  the  case  of  Pt.  II.  Brown  (No.  15,  p.  320),  K,  22d  Colored  Troops,  the  opposite  leg  had  been  previously  removed. 


UNIVERSITY 


Med.fi  Surg.  Hist,  of  the  War  of  the  Rebellion.  Part  ni.Vol.n.Chnp  X 


Op.  pag«  a  17. 


mvmssm 


'tfm&SM® 

'  &4^3*M 


Ward    phot 


PLATE     LXXII.    .   INVOLUCRA    OF    BONES    OF  THE    LEG. 


Fi£l.  1'i-ivntc  Olivfi-  I'jiyii 
1).  'll\  I'.S.  f'oloi-od  Troops 
Specinit-ii  47-10.  A.M.M. 


Fij^.  '2.  .Private  W  Milli-r 
1.7*2  PerniKylvmiin  Vols. 
Specimen  4172.  A.M.M. 


SECT.  III.J 


SECONDARY   AMPUTATIONS    OF    THE   THIGH. 


317 


FIG.  204.  —  Appearance  of 
stamp  of  left  thigh  four  weeks 
after  operation.  Spec.  403. 


FIG.  205. — Upper  portion 
of  left  tibia  and  fibula  and 
lower  portion  of  femur. 
Spec.  477. 


April  20th,  the  wound, was  attacked  with  gangrene.  The  knee  joint  at  first,  and  at  different  periods  since,  became  severely 
inflamed,  and  was  opened  eight  times,  discharging  a  serous  purulent  fluid  on  each  occasion.  The  leg  became  bent  at  right  angle 
with  the  thigh  and  firmly  anchylosed,  and  several  attempts  were  made  to  straighten  the  limb  by  means  of  anterior  splints, 
which,  however,  gave  the  patient  great  pain,  and  were  followed  on  each  occasion  by  erysipelas.  One  attack  of  this  disease 
supervened  about  December  13th,  leaving  the  limb  in  a  flabby  and  oedematous  condition,  and  with  several  indolent  ulcers,  which 
obstinately  refused  to  heal  and  were  a  source  of  great  anxiety  and  annoyance  to  the  patient.  On  February  16,  1866  the  limb 
being  found  in  a  sloughing  condition  and  the  patient  seeming  to  sink  gradually,  being  very  nervous,  sallow, 
and  anaemic,  and  his  pulse  very  weak,  quick,  and  irritable,  Acting  Assistant  Surgeon  H.  McElderry 
amputated  the  leg  by  my  direction.  The  operation  was  performed  in  the  lower  third  of  the  femur  through 
the  diaphysis,  by  forming  an  ample  anterior  flap  and  a  short  and  somewhat  thick  posterior  one,  and 
raising  a  very  long  and  wide  periosteum  flap.  The  periosteum  flap  was  raised  with  the  greatest  ease, 
and,  after  the  operation  was  completed,  was  folded  over  every  part  of  the  cut  surface  of  the  bone.  Great 
prostration  followed  the  operation,  from  which  the  patient  reacted  rather  slowly.  He  was  kept  under 
the  influence  of  morphia  the  first  several  days.  The  bandages  were  removed  and  the  stump  dressed  for 
the  first  time  on  the  third  day.  Fever  and  attacks  of  vomiting  appeared  on  February  19th,  but  after  the 
next  day  the  patient  improved  steadily  and  speedily.  The  last  ligatures  came  away  on  February  24th. 
During  the  progress  of  his  cure  his  blood  presented  the  remarkable  phenomenon  of  a  change  of  the 
white  corpuscles  into  red.  At  his  own  request  the  patient  was  discharged  from  service  March  20,  1866, 
at  which  time  he  was  able  to  sit  in  a  chair  all  day,  the  stump  being  perfectly 
well  with  the  exception  of  a  surface  granulation  in  the  cicatrix.  The  end  of 
the  bone  in  this  case  was  beautifully  rounded."  Dr.  McGill '  further  reported 
that  an  examination  of  the  amputated  limb  fully  corroborated  the  previous 
diagnosis  of  extensive  fatty  degeneration,  and  contributed  two  specimens  of 
the  case,  one  of  which,  embracing  the  amputated  femur  and  upper  portion  of 
tibia,  is  shown  in  the  cut  (FiG.  205).  The  other  specimen  consists  of  a  lig- 
amentous  preparation  of  the  tarsus  and  metatarsus  and  lower  portion  of  the 
bones  of  the  leg,  and  shows  anchylosis  of  the  ankle  joint  as  well  as  a  trans 
verse  fracture  in  the  astragalus,  believed  to  have  been  inflicted  after  the 
operation.  (Cat.  Sury.  Sect.,  1866,  p.  440,  Spec.  483.)  A  cast  of  the  stump,  made  four  weeks  after  the  amputation,  was  also 
contributed  by  the  same  donor,  and  constitutes  Specimen  403  of  the  Surgical  Section  (FiG.  204).  The  patient,  after  being 
discharged,  was  admitted  on  the  Pension  Rolls,  and  furnished  with  an  artificial  limb  two  years  afterwards.  The  Muscatine, 
Iowa,  Examining  Board,  on  June  4,  1873,  reported  that  "on  account  of  contraction  of  the  anterior  muscles  of  the  thigh,  pre 
venting  the  limb  from  being  carried  backward,  he  is  unable  to  wear  an  artificial  leg."  This  pensioner  was  paid  June  4,  1879. 

Necrosis  of  the  tibia  and  fibula  following  amputation  in  the  lower  third  of  the  leg, 
and  unhealthy  condition  of  the  soft  parts  of  the  stump,  rendered  secondary  amputation  in 
the  lower  third  of  the  thigh  unavoidable  in  the  following  instance : 

CASE  491. — Private  W.  H.  Miller,  Co.  I,  72d  Pennsylvania,  aged  21  years,  received  a  shot  fracture  of  the  tarsal  and 
metatarsal  bones  of  the  left  foot,  at  Antietam,  September  17,  1862.  Assistant  Surgeon  J.  J.  Woodward,  U.  S.  A.,  recorded  his 
admission,  six  days  after  the  injury,  to  the  Patent  Oflice  Hospital,  Washington,  where  the  injured  limb  was  amputated  on 
September  28th,  by  Acting  Assistant  Surgeon  P.  Middleton,  the  operation  being  performed  by  the  circular  method  at  the  lower 
third  of  the  leg.  Several  months  afterwards  the  patient  was  transferred  to  Armory  Square  Hospital,  and  subsequently  he  passed 
through  several  hospitals  in  Philadelphia,  entering  Christian  Street  on  March  21, 1864.  Acting  Assistant  Surgeon  R.  J.  Levis, 
in  charge  of  the  latter,  reported  that  he  found  the  patient's  general  health  feeble,  both  bones  of  the  stump  necrosed  in  nearly 
their  whole  length,  and  the  soft  parts  in  a  very  unhealthy  condition,  necessitating  a  re-amputation  at  the  lower  third  of  the 
thigh,  which  he  performed  by  the  antero-posterior  flap  method  on  April  28,  1864.  He  also  reported  that  the  patient  reacted 
promptly,  and  that  his  general  health  improved  greatly  after  the  second  amputation,  and  that  the  stump  healed  readily.  On 
September  3, 1864,  the  patient  was  discharged  from  service  and  became  a  pensioner.  He  was  paid  as  such  March  4, 1879.  The 
amputated  bones  of  the  foot  and  the  soft  tissues,  as  well  as  the  bones  removed  at  the  second  operation,  were  contributed  to  the 
Museum  by  the  respective  operators  (Cat.  Surg.  Sect.,  1866,  pp.  440,  503,  and  402,  Specs.  97,  2748,  and  4172).  The  last  of  these 
specimens  is  represented  in  FiG.  2  of  PLATE  LXXII,  opposite,  showing  the  dead  shafts  of  the  tibia  and  fibula  surrounded  by 
a  quite  complete  involucrum,  which,  in  size,  approaches  hypertrophy.  The  extremity  of  the  fibula  is  roughened,  but  softened 
as  if  carious.  The  tibia  approaches  roundness,  but  its  extremity  is  incomplete,  exhibiting  the  end  of  the  sequestrum. 

•The  late  Dr.  G.  M.  McGlLL  in  a  letter  to  the  Surgeon  General,  U.S.A.,  dated  April  12,  1866,  says:  "When  a  bone  is  cut  in  amputations, 
two  conditions,  I  believe,  must  result  from  the  action  of  its  distal  living  bone  tissues.  First,  metamorphosis  into  such  transitional  forms  as  will  connect 
with  ordinary  fibrous  tissue.  Second,  change  of  medullary  tissue  into  such  transitional  tissue  and  into  bone  proper.  If,  then,  we  a<lapt  living  transitional 
tissue  we  substitute  the  mere  action  of  union  the  cohesion  of  homologous  formed  material,  the  easiest  in  nature  apparently,  for  the  action  of  change  that 
reproduces  bone  out  of  medullary  tissue  and  forms  a  connective  tissue,  certainly  by  means  of  the  germinal  matter  that  lives  in  fully  formed  bone,  and 
that  has  already  performed  the  work  of  development  and  growth.  Again,  it  might  bo  reasoned,  a  priori,  that  in  changes  one  and  two,  made,  of  course, 
feebly  by  substance  of  exhausted  (?)  formative  energy,  the  least  injury  of  the  general  health  and  the  most  trifling  local  injury  are  calculated  to  kill  or  set 
the  germinal  matter  free  (in  the  form  of  pus),  and  so  throw  the  labor  of  formation,  and,  it  may  be,  an  added  one  of  separation,  upon  more  proximal  forms. 
Thus  we  have  sequestra,  thus  often  osteomyelitis  and  pyaomia.  With  periosteum  over  the  cut  end  of  a  bone,  we  have  a  tissue  there  whose  office  is  to 
form,  to  connect,  and  to  resist.  So  promising  have  the  results  of  amputations  with  a  periosteal  flap  been  in  my  hands,  that  I  am  constrained,  most 
respectfully,  to  call  your  attention  again  to  the  subject."  The  case  of  Allison  and  the  preceding  extract  from  Dr.  McGlLr.'B  letter  have  been  noted  in 
Circular  No.  3,  S.  G.  O.,  War  Department,  Washington,  1871,  p.  280,  CASK  4. 


31 K 


INJURIES    <SF    THE    LOWER    EXTREMITIES. 


ICHAP.  X. 


KlG.  206.  —  Appearance  of   stump  after 
amputation  in  lower  third  of  thigh. 


Amputation  at  the  knee  joint  had  preceded  amputation  of  the  thigh  in  the  next  case: 

CASE  492.— Private  Cutler  H.  Rist,  Co.  A,  36th  Wisconsin,  aged  18  years,  was  wounded  at  Cold  Harbor,  June  1,  1864, 
by  u  conoidal  ball,  which  entered  on  the  inner  and  posterior  portion  of  the  left  leg  and  caused  a  fracture  of  the  tibia,  which 
extended  into  the  knee  joint.  He  was  immediately  conveyed  to  the  field  hospital  of  the  2d  division,  Second  Corps,  where 
amputation  at  the  knee  joint  was  performed  by  Surgeon  J.  M.  Burr,  42d  New  York.  On  June  llth,  he  was  admitted  into 

Lincoln  Hospital,  Washington,  where  Acting  Assistant  Surgeon  C.  H.  Bowen  reported : 
"Date  of  operation.  June  3d;  amputation  at  knee  joint,  leaving  patella  and  condyles  of 
femur."  Dr.  Bowen  adds:  "Having  seen  several  of  these  operations  performed,  they 
have  all  died  in  periods  varying  from  six  to  twenty  days,  from  pyarnia,  tetanus,  etc., 
I  totally  discard  the  operation :  1st,  from  the  extensive  suppuration  from  the  condyles 
of  the  femur  and  from  the  patella,  from  the  duration  of  the  suppuration,  which  will 
continue  until  the  entire  cartilaginous  substance  from  condyles  and  patella  is  either  cut 
away  or  has  sloughed  off  by  the  work  of  nature,  after  which  comes  the  continuous 
discharge  of  the  synovial  fluid  from  ihe  wound.  In  the  case  of  Eist,  in  which  the 
limb  was  amputated  on  June  3,  1864,  the  synovia  still  exudes,  in  December,  1864,  in 
quantities  varying  from  a  teaspoonful  to  a  tablespoonful,  and.  more  especially,  after  the 
least  exertion,  such  as  walking  by  means  of  crutches;  besides,  the  cicati'ix  is  of  a  slough 
ing  character,  tending  to  gangrene.  December  14th,  amputation  not  healed;  continuous 
discharge  of  synovial  fluid,  more  especially  when  walking;  tendency  to  slough  ;  patient 
otherwise  in  a  healthy  condition,  and  desires  a  re-amputation,  and,  in  my  opinion,  the 
stump  will  never  heal  while  remaining  in  its  present  condition."  On  December  15, 1864. 
Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  amputated  the  thigh  at  the  lower  third;  skin 
flap  and  circular  section  of  muscles.  Simple  dressings  were  applied.  The  patient 
recovered,  rapidly.  He  was  transferred  to  Harvey  Hospital,  Madison,  Wisconsin,  on 
March  23d,  and  discharged  from  service  May  20,  1865.  His  pension  was  paid  March  4, 
1879.  Dr.  McKee  contributed  a  photograph  of  the  patient  (Contributed  Photographs,  Vol. 
II,  p.  25),  which  is  reproduced  in  the  wood-cut  (FlG.  206),  and  the  pathological  specimen 
which  consists  of  "the  extremity  of  the  left  femur  and  the  soft  tissues  forming  the  stumpi 
after  amputation  through  the  knee  joint."  (Catalogue  of  Surgical  Section,  A.  M.  M.,  1866, 
p.  502,  Spec.  3514.) 

Primary  amputation  of  the  right  leg  at  the  upper  third  and  secondary  ablation  at  the 
lower  third  of  the  left  thigh  were  performed  in  the  next  case.  The  patient  survived  the 
operations  eight  years: 

CASE  493. — Private  H.  Brown,  Co.  K,  22d  Colored  Troops,  aged  19  years,  was  wounded  in  both  legs,  at  Petersburg, 
July  30,  1864.  He  was  admitted  to  the  Eighteenth  Corps  Field  Hospital,  where  Surgeon  S.  A.  Richardson,  13th  New  Hamp 
shire,  recorded  "amputation  of  right  leg."  Surgeon  J.  H.  Taylor,  U.  S.  V.,  reported  the  following  history:  "The  patient  was 
admitted  to  Summit  House  Hospital,  Philadelphia,  August  17th,  with  shell  wound  of  both  legs,  the  right  leg  having  been 
amputated  at  the  upper  third  by  flap  method  on  the  field.  The  stump  of  the  right  leg  healed  entirely,  but  the  wound  of  the  left 
tibia,  which  was  injured  in  the  upper  third,  resulted  in  necrosis  of  the  bone  extending  into  the  knee  joint,  and  was  attended  by 
extensive  sloughing  of  the  soft  parts.  The  left  limb  was  amputated  on  March  19,  1835,  above  the  knee  joint,  by  Acting  Assistant 
Surgeon  O.  Shittler,  the  double  flap  method  being  employed  and  chloroform  used.  The  treatment  consisted  of  simple  dressings, 
tonics,  and  stimulants.  The  stump  healed  kindly  and  the  patient  progressed  well."  Several  months  after  the  operation  lie  w:is 
supplied  with  artificial  limbs  by  the  Palmer  Arm  and  Leg  Company.  At  the  closing  of  Summit  House  Hospital  the  patient  was 
transferred  to  Mower  Hospital,  and  subsequently  to  the  Post  Hospital  at  Philadelphia.  On  September  11,  1886,  he  left  for  his 
home,  cured,  having  been  discharged  from  service  to  date  from  March  20,  1865.  His  name  appeared  on  the  Pension  Rolls 
until  July  14,  1872,  when  he  died.  The  cause  of  his  death  has  not  been  ascertained. 

Fatal  Secondary  Amputations  in  the  Lower  Third  of  the  Thigh.- — One  hundred 
secondary  operations  in  the  lower  third  of  the  femur  proved  fatal.  Twenty-four  were 
practised  on  Confederate  and  seventy-six  on  Union  soldiers.  In  three  the  injuries  had 
been  caused  by  shell,  in  two  by  grapeshot,  and  in  ninety-five  by  small  projectiles.  Pyaemia 
was  noted  in  twelve,  tetanus  in  one,  and  gangrene  in  twenty-one  instances: 

CASE  494. — Private  W.  H.  Powell,  Co.  I,  3d  South  Carolina,  aged  20  years,  was  wounded  at  Antietam,  September  17, 1862, 
and  entered  hospital  No.  5,  Frederick,  November  25th.  Surgeon  H.  S.  Hewit,  U.  S.  V.,  recorded  the  following  history  :  "The 
patient  had  been  wounded  by  a  grapeshot  in  the  right  leg  and  through  the  ankle  joint,  for  which  amputation  had  been  performed 
at  the  middle  third  of  the  leg.  The  stump  was  doing  badly,  having  commenced  sloughing  on  the  outer  side.  There  was  also 
much  swelling.  The  granulations  on  the  inner  side  of  the  stump  were  very  exuberant.  Pain  in  the  knee  joint  indicated  carti 
laginous  inflammation.  Reamputation  was  deemed  necessary,  and  was  performed  by  Acting  Assistant  Surgeon  A.  V.  Cherbon- 
nier,  above  the  knee,  on  No%"ember  30th.  At  the  operation,  the  track  of  an  old  abscess  wns  discovered,  extending  some  distance 
up  the  thigh.  Two  days  afterwards  the  stump  showed  some  fungous  granulations  and  the  dressing  was  supplemented  with  a 
weak  solution  of  nitric  acid,  with  which  the  sinus  was  also  injected.  This  treatment  was  kept  up  until  December  10th,  when 


SECT,  ill.]  SECONDARY    AMPUTATIONS    OF    THE   THIGH.  319 

the  stump  had  assumed  a  healthy  appearance,  but  a  large  quantity  of  laudable  pus  was  being  discharged  from  the  si  HUB.  The 
injection  was  then  increased  and  a  tight  bandage  applied,  and  the  dressing  of  the  stump  was  changed  to  a  solution  of  tannin. 
On  the  20th,  the  stump  was  still  doing  well,  and  the  sinus  seemed  to  have  closed,  pus  having  ceased  to  come  from  it.  On  the 
24th,  the  stump  grew  painful  and  the  discharge  ceased.  Poultices  were  now  applied  and  tincture  of  iodine  used  to  the  hip. 
Iodide  of.  potassa  was  also  prescribed  in  doses  of  five  grains  three  times  a  day,  and  the  same  quantity  of  quinine,  and  one  half 
ounce  of  cod-liver  oil  every  four  hours.  On  the  26th,  the  patient's  condition  had  improved.  The  discharge  of  pus  having 
become  offensive,  the  stump  was  washed  with  a  dilution  of  chlorinate  of  soda,  the  poultice  discontinued,  and  wet  strips  applied." 
The  patient  was  transferred  to  hospital  No.  6  on  December  29th,  and  to  hospital  No.  1  six  weeks  later.  Assistant  Surgeon  R. 
F.  Weir,  U.  S.  A.,  in  charge  of  the  latter,  recorded  the  termination  of  the  case  as  follows  :  "At  the  time  of  admission  the  stump 
looked  healthy  and  was  suppurating,  and  the  patient  was  in  tolerable  good  health,  but  had  quite  a  large  bedsore  above  the 
sacrum,  which  was  healing.  He  was  taking  tonics  and  stimulants,  also  iron  mixture  and  cod-liver  oil,  and  the  stump  was 
dressed  with  oakum  saturated  with  acid  wash.  On  February  29th,  fluctuation  wras  detected  in  the  stump,  and  an  opening  was 
made  on  the  anterior  aspect  one  inch  long,  through  which  pus  escaped.  On  March  17th,  the  patient  complained  of  pain  in  the 
stump  and  more  pus  was  discovered  by  the  probe,  necessitating  another  incision,  one  and  one  half  inches  long,  to  be  made  to 
allow  it  to  escape,  after  which  poultices  were  applied.  Two  days  afterwards  an  abscess  was  discovered  on  the  anterior  aspect 
of  the  stump  and  just  opposite  the  point  of  the  previous  incision,  which  on  being  opened  evacuated  two  ounces  of  pus.  For 
some  days  after  this  the  patient  was  much  better  and  the  stump  was  improving  slowly.  One  month  later,  however,  he  was 
noticed  to  be  failing,  and  looking  very  pale  and  anaemic.  Erysipelas  was  discovered  in  the  stump  on  April  24th,  for  which  lead 
and  opium  lotion  was  applied.  At  the  same  time  the  patient  was  suffering  from  considerable  irritability  of  the  stomach,  being 
unable  to  retain  any  food  or  medicine  for  any  length  of  time.  Hydrocyanic  acid  having  been  administered  for  this  without  any 
good  effect,  lime  water  was  given,  which  appeared  to  relieve  the  patient  to  some  extent.  On  the  following  day  the  erysipelas 
was  found  to  be  extending  to  the  opposite  side  and  body,  and,  on  April  28th,  it  was  leaving  the  stump  and  was  spreading  still 
farther  upon  the  body,  the  patient's  condition  being  quite  feeble,  having  no  appetite,  his  tongue  coated,  skin  dry,  and  pulse 
weak.  During  the  two  following  days  he  was  in  a  critical  condition  and  unable  to  retain  anything  on  his  stomach,  nourishment 
being  given  by  the  rectum.  Hydrocyanic  acid  and  lime  water  were  now  used  without  benefit,  and  tincture  of  opium  was  sub 
stituted  with  apparent  relief.  On  the  morning  of  May  1st,  the  patient  appeared  brigliter,  having  rested  well  and  being  able  to 
retain  his  nourishment.  The  erysipelatous  inflammation  had  left  the  stump,  but  had  extended  across  the  body  and  was  spread 
ing  down  the  other  thigh.  In  addition  to  his  treatment  egg-mixture  and  tincture  of  iron  was  now  prescribed  for  the  patient. 
He  failed  rapidly  on  the  next  day,  and  died  on  the  morning  of  May  3,  1863.  At  the  post-mortem  examination  four  ounces  of 
purulent  serum  was  discovered  in  each  side  of  the  chest,  and  the  lungs  were  found  to  be  partly  congested,  with  small  calcareous 
deposits  in  the  upper  lobe  of  the  right  side.  The  heart  was  of  normal  size,  the  cavity  of  the  stomach  very  much  congested,  the 
liver  having  the  appearance  of  fatty  degeneration,  the  gall  bladder  very  much  distended,  and  the  kidneys  moderately  congested. 
The  tissues  about  the  stump  were  healthy,  but  on  opening  the  capsular  ligament  about  two  ounces  of  pus  was  found  around  the 
hip  joint.  The  cartilage  lining  the  acetabulum  was  softened,  and  in  some  places  entirely  gone.  On  dissecting  out  the  nerves 
the  bulbous  expansions  of  their  ends  were  shown  to  be  well  marked.  Above  the  saphenous  a  wire  ligature  was  found,  which 
seemed  to  have  given  rise  to  little  or  no  irritation.  The  patient  had  frequently  complained  of  pain  in  the  stump,  but  it  is  impos 
sible  to  say  whether  it  was  caused  by  this  ligature  or  by  the  abscesses  that  were  forming  from  time  to  time.  The  end  of  the 
stump  of  the  femur  was  found  to  be  surrounded  by  an  involucrum,  exposing  a  small  sequestrum  running  up  the  shaft."  The 
amputated  stumps  of  the  tibia  and  fibula  were  forwarded  to  the  Museum  by  the  operator,  and  the  stump  of  the  femur  was 
contributed  by  Acting  Assistant  Surgeon  A.  North.—  (Cat.  Surg.  Sect.,  18(i6,  p.  400,  Spec.  795,  and  p.  300,  Spec.  3837.) 

In  the  following  instance  Byrne's  amputation  at  the  ankle  joint  had  been  performed  on 
the  clay  of  the  injury,  but  continuous  sloughing  and  abscesses  followed,  and  amputation  at 
the  upper  third  of  the  leg  and  subsequently  at  the  lower  third  of  the  femur  were  practised: 

CASE  49.">. — Private  F.  M.  Bland,  Co.  D,  23d  Iowa,  received  a  shot  wound  in  the  left  foot,  during  the  engagement  at  the 
Black  Kiver,  May  19,  1863.  "  Syme's  amputation  at  the  ankle  was  performed  the  same  evening  at  a  field  hospital.  On  June 
13th,  the  patient  was  admitted  into  Adams  Hospital,  at  Memphis,  at  which  time  nearly  the  entire  flaps  had  sloughed  off  the 
stump  and  the  bones  were  exposed  to  view.  An  abscess  had  also  formed  at  about  the  middle  of  the  lower  third  of  the  leg,  and 
periostitis  of  the  tibia  and  fibula  existed  at  the  same  point.  The  general  condition  of  the  patient  was  low;  he  having  suffered 
from  diarrhoea  for  four  months.  He  was  put  upon  iron,  quinine,  stimulants,  and  astringents.  On  June  17th,  his  general  con 
dition  being  somewhat  improved  and  the  diarrhoea  checked,  it  was  decided  to  amputate,  which  was  accordingly  done  at  the 
junction  of  the  upper  and  middle  thirds  of  the  leg  by  Acting  Assistant  Surgeon  J.  Thompson.  I  saw  the  patient  for  the  first 
time  on  the  following  clay,  when,  though  in  a  low  condition,  he  seemed  to  be  rallying  from  the  shock  of  the  operation.  I  admin 
istered  iron,  quinine,  stimulants,  and  beef  tea,  and  had  water  dressings  applied  to  the  stump,  under  which  course  the  general 
condition  of  the  patient  gradually  improved.  The  stump  at  first  appeared  to  do  well,  but  before  many  days  began  to  discharge 
thin  ichorous  looking  pus.  This  was  the  condition  of  the  patient  when  his  ward  was  transferred  to  the  charge  of  Acting  Assistant 
Surgeon  W.  P.  Sweetland.  On  June  26th,  the  wound  gaped  open,  no  adhesions  having  formed  in  any  part  of  the  stump,  and 
the  Haps  soon  commenced  sloughing.  It  was  then  decided  that  the  only  chance  for  the  patient  rested  in  another  operation,  and 
accordingly,  on  July  2d,  the  thigh  was  amputated  at  the  middle  of  the  lower  third.  The  patient  seemed  to  bear  up  well  under 
the  operation,  and,  as  before,  seemed  at  first  to  be  doing  well.  But  soon  the  stump  became  gangrenous:  an  abscess  also  formed 
on  the  patient's  shoulder  below  the  clavicle,  the  edges  of  which  sloughed,  laying  bare  the  thyroid  axis  and  destroying  its 
branches.  On  July  13th,  the  patient  was  removed  to  my  ward  in  a  rapidly  sinking  condition.  He  died  on  July  16,  18G3." 
The  foregoing  history  was  transmitted  by  Acting  Assistant  Surgeon  B.  J.  Bristol,  and  the  bones  removed  at  the  second  amputa 
tion  were  contributed  to  the  Museum  by  Surgeon  J.  G.  Keenon,  U.  S.  V.  (Cat.  Surg.  Sect.,  1866,  p.  441,  Spec.  1706.)  The 
specimen  shows  the  extremities  to  be  necrosed,  no  reparativc  action  having  occurred. 


320 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


(CHAP.  X. 


TABLE  XL. 

Summary  of  Two  Hundred  and  Seven  Cases  of  Secondary  Amputation  in  the  Lowe)'  Third  of  the  Femur 

for  Shot  Fracture. 

I  Recoveries,  1—107;  Deaths,  108—207.] 


NO. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPEHATIONS,  OPERATORS, 
RESULT. 

1 

Allison,   J.,    Farrier,    I, 

Ap.  5,  '65, 

Left  (hsem's;  erysip.);  ant.  post. 

31 

Eaton,  D.  C.,  CorpM,  H, 

Sept.  17, 

Left.  (Sept.  17,  amp.  leg.)  Disc'd 

21st  Pennsylvania  Cav 

Feb.  16, 

flap.    A.  A.  Surg.  H.  McEldery, 

5th  New  Hamp.,  age  30. 

De.29,'62. 

March  13,  '03.     Died  July  1.  '63. 

alry,  age  19. 

1866. 

Disch'd  March  20,  1866.     Specs. 

32 

Elliott,  T.  A.,  Corp'l,  Shu- 

Jan.  4, 

.     Surg.  H.  McGuire,  C.  S.A. 

477,  403,  483. 

maker's  Battery. 

Fe.18,'62. 

Recovered. 

2 

Angell,  J.  A.,  Pt.,  D,  1st 

July  23, 

Right  (gang.;  Aug.  1,  '64,  excis. 

33 

EustisJ.  B.,Pt.,E,149th 

Oc.28,'63, 

Left  (haem.);  circ.     Surg.  W.  Va- 

Wisconsin  Cav.,  age  23. 

Sept.  18, 

tibia;  haem.);  circ.    A.  A.  Surg. 

New  York,  age  23. 

Jan.  21. 

rian,  U.  S.  V.    Disch'd  April  3, 

1864. 

J.  C.  Thorpe.    June  16,  '65,  re- 

1864. 

1864.     Spec.  2097.     Died   Feb. 

amp.     Recovery.    Spec.  5549. 

18,  1875;  consumption. 

3 

Arendt,  J.,  Pt.,  E,  5th 

Jan.  1, 

Left  ;  flap.  A.  Surg.  J.W.Pearce, 

34 

Fergus,  J.,  Pt,,  A,  70th 

May  14, 

Left  (June  24,  exc.  fib.;  gang.;  lib. 

Kentucky. 

Mar.1,'63. 

51st  Ind.     Disch  d  Nov.  17,  '63. 

Indiana,  age  34. 

Aug  15, 

art.  sloughed;  haem.);  circular. 

4 

Bacon,  W.,  Pt.,  I,    7th 

JV12,'64, 

Left  (amp.  leg;  nee.;  disch'd  June 

1864. 

Surgeon  R.  I,.  Stanford,  U.  S.  V. 

Maine,  age  21. 

,'66. 

16,  '65);  flap.    1870,  good  stump. 

Disch'd  Jan.  20,  1865. 

Spec.  2841. 

35 

Fisher,  A.,  Pt.,  C,  7th  N. 

June  17. 

Left  ;  circ.     Surg.  J.  W.  Merriam, 

5 

Bass,  J.  B.,  Pt.,  K,  59th 

M'h7,'62, 

Left  (disch'd  Sept.  20,  '62);  circ. 

Y.  H'vy  Art'y,  age  26. 

Oc.19,'64. 

U.  S.  V.     Disch'd  June  24,  1865. 

Illinois. 

Jan.  16, 

Dr.  S.  Cabbot,  Mass.  Hospital. 

36 

Fletcher,  D.  M.,Pt.,  10th 

Oc.27,'64, 

Right  (Oct.  28,  amp.  leg);   flap. 

IQfiQ 

Mustered  out  July  10,  J865. 

6 

Bassett.J.  P.,  Pt.,  1,  114th 

ioOo. 

Oct.  19, 

Left;  ant.  post.  flap.    A.  A.  Surg. 

37 

Fulwiler,  L.  is.,  Pt,  A, 

June  25, 

Left  ;  flap.    A  .  Surg.  P.  Goddard, 

New  York,  age  22. 

Nov.  29, 

A.W.Emory.    Disch'd  April  10, 

20th  Indiana. 

J'y26,'62. 

U.  S.  V.    Disch'd  Aug.  22,  1  862. 

1864. 

1865.    Spec.  3476. 

38 

Garlick,  J.,  Pt.,  I,  26th 

May  3, 

Rifiht;    flap.     Disch'd  June  27, 

7 

Bennett,  E.  A.,  Pt.,  F, 

May  22, 

Left.  (M.  O.  Oct.  11,  '64;  Dec..'G4, 

Pennsylvania,  age  21  . 

J'yll.'G3. 

1864. 

44th  New  York,  age  41. 

1864, 

nee.  bone  rem'd  ;  Jan.,  '69,  exc. 

39 

Glavin.'D.,  Pt.,  E,  87th 

June  1, 

Left  (frag,  of  bone  rem'd);  double 

Mar.2,'69. 

up.  frag,  fibula.)   Dr.  T.  Becket, 

New  York. 

July  2, 

flap.      A.  Surg.   W.   Thomson, 

Albany.     Re-amputation. 

1862. 

U.  S.  A.     Disch'd  Feb.  28,  1863. 

8 

Biddle,    D.,    Corp'l,   A, 

July  1, 

Left;  circ.;  gang.;  exfol.  Disch'd 

Spec.  4931. 

107th  Ohio,  age  23. 

Au.13,'63. 

June  24,  1864. 

40 

Graham,  R.  P.,  Pt.,  II, 

Oct.  5, 

Right  ;  circ.     A.  A.  Surg.  D.  C. 

9 

Bisbee,  A..  Oorp'l,  B,  7th 

Ap.16,'62, 

Right  (May  12,  1862,  amp.  leg; 

7th  Illinois,  age  23. 

Nov.  9, 

Bell.    Haem.;   lig.  fern,  artery. 

Maine,  age  25. 

Ap.  8,  '63. 

disch'd  Feb.  10,  1863);  circular. 

1864.         Disch'd  May  22,  1865. 

10 

Bishoff,  D.D.,Pt.  ,15,14th 

May9,'64, 

Left  (nee.);  circ.     A.  A.  Surg.  J. 

41 

Grant,  W.,  Pt.,  G,  9th  N. 

Oct.  19,  |  Right;  ant.  post.  flap.    A.  A.  Surg. 

West  Va.,  age  25. 

Mar.  13, 

H.  Butler.    Disch'd  May  20,  '65. 

York  Artillery,  age  36. 

No.26,'64. 

C.  H.  Jones.   Disch'd  Feb.  2,  '65. 

1865. 

42 

Hadlow,  H.,  Pi.,  H,  81st 

May  31, 

Right  (prim.  amp.  leg:  July  24, 

11 

Blakeley,  J.  W.,  Pt.,  F, 

J'y21,'61, 

Right  (disch'd  Sept.  29,  '62);  flap. 

New  York,  age  21. 

Aug.], 

gang.);  circ.     Aug.  15,  re-amp. 

llth  Massachusetts.        ^No.—  ,'62. 

Died  Jan.  30,  1870  ;  phthisis. 

1862. 

mid.  third.    Necrosed.     Disch'd 

12 

Boyd,   H.,   Pt.,  D,  51st 

May  25, 

Left  ;  lat.  flap.    A.  A.  Surg.  R,  H. 

May  2,  1863. 

Colored  Troops,  ngc  42. 

Je.25,'65. 

Blandry.     Recovered. 

43 

Hagadone,A.,  Serg't,  M, 

Aug.  25, 

Right  (gang.;  nee.);  flap.     A.  A. 

13 

Branson,  J.  B.,Pt.,I,14th 

Aug.  5, 

Right.    '(Pr.  amp.  leg.)     Disch'd 

2d  New  York  Heavy 

Nov.  21, 

Surg.  "\V.  II.  Ensign.     Disch'd 

Ohio,  age  18. 

—  ,  '64. 

June  21,  1865. 

Artillery,  age  29. 

1864. 

July  12,  1865.     Spe.c.  3436. 

14 

Brooks,  J.  M..Pt.,A.17th 

June  21, 

Left  (June  21,  amp.  knee  joint; 

44 

Ham,   W.,  Pt.,    G.    42d 

Sept.  20, 

Left  :.  circ.     A.Surg.N.Teal,  88th 

1'enn.  (,'av.,  age  28. 

Sept.  10, 

fang.);  ant.  post.  flap.    Disch'd 

Indiana,  age  20. 

De.  6,  '63. 

Indiana.    Disch'd  Sept.  30,  1864. 

1863. 

uly  28,  1865. 

45 

Hanley,  M.,  Pt.,  A,  18th 

June  13, 

Left;    circ.     A.  A.  Surg.  C.  II. 

15 

Brown,  H.,  Pt.,  K,  22d 

July  30, 

Left  "(July  30.  amp.  right  leg); 

Connecticut,  ;ige  19. 

Dec.  23, 

Jones.     Disch'd  June  15,  1864. 

Colored  Troops,  ago  19. 

1864. 

dou.  flap.   A.A.Snrg.O.Shittler. 

1863. 

Died  March  2,  1866.    Spec.  1993. 

Mar.  19. 

Disch'd  March  20,  1865.     Died 

46 

Hill,  G.  N.,  Corp'l,  A,:  5th 

Sept.  29, 

Left  ;  lateral  flap.     Recovery. 

1865. 

July  14,  1872. 

Colored  Troops,  age  21. 

De.29,'64. 

16 

Brown,  W.C.,  Pt.,  K,  93d 

Se.20,'63, 

Left  (erysip.);  ant.  post.  flap.     A. 

47 

Hoffman,  F.,  Pt.,  H,  2d 

June  18,. 

Left  (July  11,  amp.  leg);  flap.   A. 

Ohio,  age  215. 

April  12, 

Surg.B.E.Fryer.U.S.A.    Disc'd 

Penn.  Heavy  Artillery. 

Dec.  6,  '64 

A.  Surg.  J.S.  Waggoner.  Disch'd 

1864. 

Oct.  7,  1864.     Spec.  117. 

age  21. 

August  15,  1865.     Spec.  3714. 

17 

Burdick,  W.  II.,  Pt.,  B, 

Ap.  6,  '65, 

Right  (exc.  tibia;  disch'd  Oct.  12, 

48 

Hogg,  W.,  Pt.,  I,   76th 

May  5, 

Right  ;  ant.  post.  flap.     Surg.  E. 

82d  Penn.,  age  24. 

Mar.  27, 

1865);  flap.     Dr.  B.  E.  Phelps. 

New  York,  age  34. 

J'ne7,'G4. 

Donnelly,   2d   Penn.   Reserves. 

I860. 

Corry,  Pa.  1870,  stump  healthy. 

Disch'd  May  6,  1865. 

18 

Chase,H.\V.,Pt.,  H,  96th 

Sept.  29, 

Left  ;  flap.    A.  A.  Surg.  E.  Vogel. 

49 

Hubbard,  A.,  Pt.,  D,  6th 

July  22, 

Left   (inter,  amp.  leg;  ext.  nee.); 

New  York,  age  21. 

De.  1,  '64. 

Disch'd  April  14,  1865. 

New  York  Cav.,  age  31. 

1864, 

circ.  A.Surg.S.H.Orton.U.S.A. 

19 

Clapp,  F.,  Pt.,  K.2d  Mass. 

J'y  13/63, 

—  ;  circular.     A.  A.  Surg.  J.  F. 

Jan.  1,  '65. 

Disch'd  Nov.  7,  1805.    Spec.  278. 

Cavalry,  age  21.             !Mh  18,'64. 

Thompson.  Disch'd  Sept.  13,  '64. 

50 

Inman,  A.   W.,  Pt.,  B, 

May  27, 

Left;  circular.     Disch'd  June  15, 

20 

Cobb,  M.  A.,  Lieut.,  A, 

De.15,'64, 

Right  (Dec.  17,  amp.  leg:  gang.); 

124th  Ohio,  age  30. 

J'y  5,  '64. 

1865. 

23d  Alabama,  age  39. 

Jan.  19, 

bi-lat.  skin  flap  ;  circ.  sect.  muse. 

51 

Jinne.lt,  J.,  Pt.,  D,  67th 

De.29,'63, 

.     Surg.  —  Turner,  C.  S.  A. 

1865. 

A.  A.  Surg.  W.  I.  R.  Holmes. 

North  Carolina. 

J'e22,'64. 

Recovery. 

Provost  Marshal  June  3,  1865. 

52 

Kerrin,  J.,  Pt.,  G,  I'Jth 

Aug.  13, 

Right  (Aug.  13,  amp.  leg;  gang.); 

21 

Oomer,  C.  Serg't  F  13th 

Right.  Surg.  1.  1*.  Smith,  C.  S.  A. 

Virginia  Cavalry. 

Oc.20,'63. 

Recovery. 

*' 

1804. 

U.  S.  V.     Bone  rem'd.     Disch'd 

22 

Costello,  P.,  Pt.,  K,  88th 

No.25,'63, 

Right  ;  circ.     Surg.  G.  Grant,  U. 

June  4,  1865. 

Illinois,  age  26. 

July  18, 

S.  V.     Gang.    Disch'd  June  17, 

53 

Kimball,  L.  N.,  Pt,,  II, 

May  10, 

Right.     (May  10,  '64,  arnp.  leg; 

1864. 

1865.     Spec.  3006. 

22d  Mass.,  age  19. 

18"04, 

ham.;  lig.  'Disch'd  Oct.  17,'04.) 

23 

Crawford,E.,Pt.,F,105th 

Sept.  19, 

Right  (Oct.  4,  '63,  amp.  leg);  circ. 

Jan.  —  , 

Dr.  W.   11.  Thorndike,  Boston, 

Ohio,  age  20. 

1863, 

A.Surg.G.  M.  Sternberg.U.S.A. 

1867. 

Mass.     Recovery. 

Aug.  5, 

Haem's;  lig.  prof.  art.     Disch'd 

54 

Kirk,  W.  II.,  Capt.,  D, 

De.2!),'04, 

Right  :  circular.     Resigned  May 

1864. 

March  18,  1865.     Spec.  3108. 

3d  N.  C.  MTd  Infantry. 

Feb.4,'C5. 

15,  1805. 

24 

Deny,  J.  M.,Pt.,B,126th 

Sept.  21, 

Right  ;  nee.;  sect,  skin  flap.    A.  A. 

55 

Klammer,  A.,  Pt.,  E,  nth 

De.16,'64, 

Right  (nee.  fragm'ts  rem'd);  circ. 

Ohio,  age  23. 

Oct.  30, 

Surg.  B.  B.  Miles.  Disch'd  June 

Minnesota,  age  26. 

Feb.  10, 

A.A.Surg.H.M.  Lilly.     Disch'd 

1864. 

28,  1865.     Spec.  3417. 

1805. 

June  1,  1865.     Spec.  4245. 

25 

Desmond,  H.,Pt,  I,  28th 

De.13,'62, 

Right  (Dec.  21,'62,  amp.  knee  j't); 

56 

Love,  J.  W.,  Pt.,  D,  25th 

De.  7,  '64, 

Left  ;  oval  flap.     A.  A.  Surg.  G. 

'6? 

post  flip     Disch'd  Dec  22  '63 

An.  31  '05 

E  Sloat      Disch'd  Jan.  14  1866. 

26 

Dickens,  II.  S.,  P*.,  H, 

J'v2,'63, 

Left  (July  11,  amp.  leg);  ant.  post. 

57 

Lowth,    J.,   Serg't,    M, 

Aug.  24, 

Right  (gang.;    May  27,  '65,  exc. 

120th  N.  Y.,  age  30. 

April  24, 

flap.     A.  A.  Surg.  R.  J.  Lewis. 

4th  Wisconsin  Cavalry, 

1864, 

fib.;  lig.  post.  tib.  art'y);  at  con- 

1864. 

Disch'd  April  28/65.   Spec.  2740. 

age  26. 

June  2, 

dyles.     Surer.  H.  Culbcrtson,  U. 

27 

1  Doerllinger,  C.  H  ,  Lt.,      May  2, 

Left  ;  oirc.     Surg.  J.  A.  Lidell, 

1865. 

S.  V.     Disch'd  July  17,  1865. 

B,  2(ith  \Vis.,  age  20.     Je.27,'63. 

U.  S.  V.     Disch'd  Feb.  25,  1864. 

58 

Mason,    D.,    Corp'l,    G, 

May  14, 

Right  ;  circ.   A.  Surg.  C.W.  Law 

28 

Dudley,  W.  F.,  Pt.,  F,      Mar.  1, 

Left  (March  2,  amp.  leg;  gang.); 

104th  Illinois,  age  23. 

July  6, 

rence,  22d  Mich.     Disch'd  Jan. 

1st  Maine  Cav.,  age  24.    June  14, 

circular.     A.  Surg.  W.Webster, 

1864. 

6,  1865. 

1864. 

U.  S.A.     Disch'd  Aug.  14,  1865. 

59 

McClelland,  W.  II.,  Pt., 

De  18,'04. 

Right;    circ.      Confed.    surgeon. 

29 

Dnran,  J.,Corp'l,  C,  17th  ;M'y  C,'64, 

Left  (gang.;  Aug.  28,  amp.  leg); 

A,  12th  Ohio  Cavalry.    Feb.7,'65.|     Disch'd  Sept.  11,  1865. 

Maine,  age  23.                   May  18, 

circ.     Surg.  G.  Derby,  U.  S.  V. 

60 

McCue,  A.,  Pt.,  G,  21st 

Sep.  1,  '62,  Left  (disch'd  June  23/63);  circ, 

,     1865. 

Disch'd  August?,  1865. 

Massachusetts. 

Feb.  27, 

Dr.  B.  S.  Shaw,  Mass.  Hospital. 

30 

Eastman,  J.,  Pt.,  E,  1st 

Sept.  19, 

Right  (gang.);  circ.     A.  A.  Surg. 

1864. 

Recovery. 

Wisconsin. 

Dec.  25, 

W.E.Whitehead.   Disch'd  Nov. 

61 

Mclntire,  G.,  Pt.,  I,  7th 

May  10, 

R't  (May  11,  amp.  leg);  ant.  post. 

1863. 

29,  1864.     Died  April  10,  1870. 

Maine,  age  24. 

Oct.  16, 

flap.  A.  A.  Surg.  G.  E.  Brickett. 

Spec.  2035. 

1864. 

Hsem.     Disc.h'a  June  16,  1865. 

1  LIDELL  (J.  A.),  On  the  Major  Amputations  for  Injuries  in  both  Civil  and  Military  Practice,  in  Am.  Jour.  Mtd.  Kci.,  N.  S.,  1864,  Vol.  XLVII,  p.  368. 


SECT.  1 11.1 


SECONDARY    AMPUTATIONS    OF    THE    THIGH. 


321 


xo. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

XAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 
1 

62 

McLeppy.  J.,  Corp'l,  C, 

June  28, 

Right;  circ.     A.  A.  Surg.  J.  E. 

95 

Vogt,  M.,  Pt.,  I,  15th  N. 

May  19, 

Left  (gang.;  nee.);  ant.  post.  flap. 

20th  Indiana,  age  31. 

De.  6/62. 

Steel.     Disch'd  June  8,  1863. 

York  Artillery,  age  23. 

June  28, 

Surg.  R.  B.  Bontecou,  U.  S.  V. 

Specs.  1836,  4760. 

1864. 

Disch'd  Oct.  21/65.    Spec.  3C53. 

03 

McLin,  V.,  Pt.,  H,  7th 

July  3, 

Right  ;  ant.  post.  flap.     Surg.  C. 

96 

Wagenknight,  W.,  Pt., 

Sept.  20, 

Left  (gang.;  haem.);  circ.     A.  A. 

Wisconsin,  age  20. 

Aug.  3, 

W.  Jones,  U.  S.  V.     (August  6, 

G,  118th  Penn.,  age  38. 

Nov.  23, 

Surg.  J.  Cass.    Discharged  July 

1863. 

haem.;  lig.  fern,  artery:  disch'd 

1864. 

26,  1865. 

Sept.  6,  '6<l  .  )     Spec.?.  1  697,  2154  . 

97 

Wager,   G.  H.,  Pt.,  H, 

Aug.  30, 

Right  thigh.     Discharged  March 

64 

McMahon,  A.,  Pt.,G.  9th 

Sept.  17, 

Left.     Surg.  J.  B.  Lewis,  U.  S.  V. 

22d  New  York. 

L,  '62. 

11,  1863. 

New  York  S.  Militia. 

Oc.22/62. 

Disch'd  Jan.  9,  '63.     Spec.  449. 

98 

Wandel,  G.,  Pt.,  K,  7th 

Xo.27/63, 

Left  (gang.);  circ.     A.  A.  Surg. 

65 

McMurray.  J.  T.,  Serg't, 

July  2. 

Right  :  circ.;  end  of  fern,  rem'd. 

Ohio,  age  25. 

Mar.  15, 

M.  L.  Herr.     Duty  June  28,  '64. 

D,9th  Alabama,age  ^4. 

A  u.3,  '63. 

Exchanged  March  3,  1864. 

1864. 

Spec.  2202. 

66 

Miller,  J.  M.,  Pt.,  D,  6th 

May  27, 

Left  :  flap.    A.  A.  Surg.  R.  Koeler. 

99 

Waters,  W.  W.,  Serg't, 

Mar.  30, 

Right  (Disch'd  July  6,  '65)  ;  circ. 

Michigan  Artillery. 

J'y  IP/63. 

Disch'd  Sept.  22,  1863. 

K,  6th  Cavalry,  age  23. 

1865, 

Dr.  N.  S.  Lincoln,  Washington, 

67 

Miller,   W.   H.,    Pt.,   I, 

Sept.  17, 

Left  (Sept.  28/62,  amp.  leg;  nee.); 

Mar.  19, 

D.  C.    Recovery.    Spec.  4047. 

72d  Pennsylvania,  age 

1862, 

ant.  post.  flap.    A.  A.  Surg.  R.  J. 

1866. 

24. 

April  28, 

Levis.      Disch'd  Sept.  3,  1864. 

100 

Weiderecht,  M.,  Pt.,  D, 

No.25/63, 

Right  ;  circ.    A.  Surg.  R.  Bartho- 

1864. 

Specs.  97,  2748,  4172. 

6th  Ohio. 

Oc.19/64. 

low.U.S.A.  Disch'd  May  17/65. 

68 

Montana,  J.  R.,  Surgeon 

April  (i, 

Left.  (Ulceration.)  Langenbeek's 

101 

Welsh,  I.  M.,  Pt.,  B,  8th 

M'y'20,'64, 

Right.     (Amp.  leg;  nee.;  hoem.) 

from  Mexico. 

1862, 

method.     Dr.  Sutherland,  S.  C. 

Maine,  age  21. 

April  12, 

Surg.  G.  Derby,  U.  S.  V.    Dis- 

1865. 

69 

Morrin,  J.,  Pt.,  G,  126th 

July  3, 

Left   (July  4,  amp.  leg:  gang.; 

102 

Wey  mouth,    H.    G.  O., 

De.13/62. 

Lett  (ball  extr'd);  circ.;  flap.     A. 

New  York,  age  21. 

Nov.  3, 

hsem.);  ant.  post.  flap.    A.  Surg. 

Capt.,  K,  19th  Mass. 

Jan    17 

A.  Surg.  D.  R.  Good.     Disch'd 

1863. 

T.  C.  Brainerd,  U.  S.  A.     Seq. 

1863. 

April  8,  1863.     Spec.  701. 

and  fragments  rem'd.     Disch'd 

103 

White,  E.  S.,  Pt,,  F,  54tb 

Jan.  30, 

Right  thigh.    Recovery. 

June  18,  1865.   Specs.  2604,  1416. 

Virginia. 

Ap.  1/63. 

70 

Newman,  E.  B.,  Serg't, 

Feb.  20, 

Left  (disch'd  June  19,  1865,  limb 

104 

Wilder,  F.  W.,  Pt.,  A, 

July  2, 

Right  ;  ant.  posterior  flap.    A.  A. 

F,  48th  New  York,  age 

J864, 

distorted;  knee  i't  anchy.):  flap. 

59th  Georgia,  age  22. 

Oc.24/63. 

Surg.  J.  E.  Steel,U.S.A.  Prison 

23. 

June  18, 

Dr.  S.  Shove,  'Katonah,  N.  Y. 

April  19,  1864. 

1868. 

Recovery. 

105 

Wood,  M.  P.,  Pt.,  G,  43d 

May  16, 

.     Surgeon  —  Burk,  C.  S.  A. 

71 

Nichols,  L.,  Pt..  F,  157th 

July  1, 

Right  ;  haem.     A.  A.  Surg.  C.  H. 

Georgia. 

J'y26/63. 

Recovery. 

New  York,  age  18. 

Aug.  14, 

Jones.     Disch'd  May  31,  1864. 

106 

Wren,  R.  L.,  Pt.,  C,  15th 

No.  8/63, 

Left  ;  circ.    A.  A.  Surg.  P.  Peter. 

1863. 

Spec.  1670. 

Ohio,  age  26. 

Feb.1/64. 

Disch'd  July  28,  '64.    Spec.  2195. 

72 

O'Boyle,  M.,Pt,,E,  156th 

Oc.l'J/64, 

Left;  ant.  post,  flap;  skin,  circ. 

107 

Yearkes,  G.,  Pt.,  A,  3d 

Sept.  26, 

Left  :  ant.  post.  flap.     A.  A.  Surg. 

New  York,  age  17. 

Jan.  13, 

sect,  muscles.     A.  A.  Surg.  B.  B. 

Mary  land  Cav.,  age  30. 

No.22/64. 

J.  N.  Snively.    Spec.  3721. 

1  865. 

Miles.     M.  O.  1865.    Spec.  3728. 

108 

Anthony,  C.,Pt.  H  55th 

Right  :  flap.     A.  A.  Sur".  W.  L. 

73 

Odell.  T.,  Corp'l,  H,  5th 

J'e  18/64, 

Left  (slough.;  excis.  tibia);  flap. 

Penn.,  age  34. 

J'e  25,'64. 

Welles.  Died  July  12/64  ;  exh'n. 

Michigan,  age  20. 

Jan.  13, 

A.  A.  Surg.  G.  C.  Harlan.    Dis 

109 

Asliford,  W.  H.,  Pt.,  I, 

Oct.  19, 

.  Profuse  suppuration.  Surg. 

1865. 

charged  May  22,  1865. 

18th  Georgia. 

No.—  ,'64 

—  Love,  C.  S.  A.     Sloughing. 

74 

Ferryman,  J.  L.,  Pt.,  D, 

Sept.  19, 

Left.     Surgeon  A.  M.  Spalding, 

Died  Nov.  30,  1864  ;  gangrene. 

20th  Georgia. 

Oc.30/63. 

C.  S.  A.     Recovery. 

110 

Baesier,  J.  P.,Pt.,C,75th 

Aug.  29, 

;  thigh.     Died  December  12, 

75 

Potter,  II.  G.,  Serg't,  A, 

Se.20/64, 

Right.     (Synovia;  nee.)     A.  A. 

Ohio. 

,  '62. 

1862. 

74th  Indiana,  age  20. 

May  13, 

Surg.  J.  W.  Taylor.     Re-amp. 

111 

Ballinger,R.,Pt.,A,113th 

June  27, 

Left   (gang.)  ;  oval  flap.    A.  A. 

1865. 

mid.  third.    Disoii'd  June  20/65. 

Ohio,  age  29. 

Aug.  10, 

Surg.  J.  C.  Thorpe.    Died  Aug. 

76 

Potts,  N.  H.,  Serg't,  B, 

May  3, 

Left  (hoein.  recur'nt);  circ.    Surg. 

1864. 

12,  '64  ;  gang,  and  irrit.  fever. 

95th  Penn.,  age  22. 

J'ne5/63. 

R.  S.  Kemlerdine,  U.  S.  V.    Dis 

112 

Barrett,  G.,  Pt.,  C,  13th 

July  21, 

Left  (slough  'g);  flap.     A.  Surg. 

charged  August  24,  1864. 

Indiana,  age  22. 

Au.23/64. 

H.  M.  Sprague,  U.S.A.  Slough. 

77 

Powell.  S.  H.,  Oorp'1,  C, 

J'ly9/64, 

Right  (gang.;  nee.);  ant.  post.  flap. 

Died  Aug.  31,  1864  ;  exhaustion. 

14th  New  Jersey,  age 

Sept.  15, 

Surg.  T.  Sim,  U.  S.  V.     Disch'd 

113 

Beebe,  C.,  Serg't,  B,  3d 

May  28, 

Right  ;  circ.     Surg.  S.  E.  Fuller, 

24. 

1864. 

Jan.  3,  1865.     Spec.  3468. 

Wisconsin,  age  26. 

J'y  7/64. 

U.  S.V.    Died  Jiily7/64  ;  shock. 

78 

Pust,  H.,  Pt.,  K,  104th 

De.7/62, 

f,eft  (Dec.  11,  amp.  leg);  conical. 

114 

Bertsch,  W.,  Corp'l,  G, 

Aug.  29, 

;    thigh.      Died  October  7, 

Illinois,  age  25. 

Oct.  24, 

A.  A.  Surg.  R.  N.  Isham.    Dis 

58th  New  York. 

,  '62. 

1862. 

1863. 

charged  March  4,  1861. 

115 

Binns.  E.  D.,  Pt.,  K,  53d 

July  3, 

Right;   hsem.     Died  October  3, 

79 

Reid.  W.  F.,  Pt.,  A,  1st 

May  23, 

.     Surg.  —  Miller,  C.  S.  A. 

Virginia,  age  19. 

Se.  30/63. 

1863.     Spec.  1943. 

N.  C.  Battery. 

Se.  l'5/62. 

Recovery. 

116 

Black,  B.  F.,  Pt.,  A,  6th 

Sept.  19, 

Right;   circ.    Died  October  30, 

80 

Rice,  R.,  Pt..  I,  1st  Mis 

May  26, 

Right  (gang.);  circ.     A.  A.  Surg. 

Kentucky. 

Oc.30/63. 

1863;  haemorrhage.     Autopsy. 

souri  Cavalry,  age  23. 

Oc.27/63. 

A.L.Allen.  Disch'd  July  29/64. 

117 

Bland,  F.M.,Pt.,D,  23d 

Alay  19, 

Left.      (May   19,    Syme's  nmp.; 

81 

Ringold,  W.  H.,  Pt.,  I, 

June  1, 

Right  ;  flap.     A.  A.  Surg.  R.  J. 

Iowa. 

July  2, 

slough.;  June  17,  amp.  leg.)    A. 

188th  New  York,  age 

July  13, 

Levis.     Disch'd  Feb.  11,  1865. 

1863. 

A.Surg.W.P.Sweetland.  Gang. 

19. 

1864. 

Spec.  3680. 

Died  July  16,  1863.    Spec.  1706. 

82 

Rist,  C.  H.,  Pt.,  A,  36th 

June  1, 

Left.     (June  1,  amp.  knee  joint.) 

118 

Brady,   B.,   Pt.,  C,  4th 

May  24, 

Right;  circular.     A.  A.  Surg.  A. 

Wisconsin,  age  19. 

Dec.  15, 

Surg.  J.  C.  McKee.U.  S.A.  Dis. 

Infantry,  age  34. 

J'e  25/64. 

Ansell.     Died  Xov.  2,  1864. 

1864. 

May  20,  1865.     Spec.  3514. 

119 

Brooks,  J.  H.,  Pt.,  E,  1st 

Aug.  16, 

Left  (slough.;  haom.;  lig.  femoral 

83 

Shafer,  A.,  Pt.,  B,  13th 

Sept.  30, 

Left;"  circ.     A.  A.  Surg.  W.  II. 

Maryland  Cav.,  age  39. 

Sept.  28, 

art.);  circ.    A.A.Surg.J.C.  Mor 

Ohio  Cavalry,  age  18. 

Xov.  15, 

Coverton.    Seq.  rem'd.    Disch'd 

1864. 

ton.    Died  Oct.  17,  '64  ;  exh'n. 

1864. 

Aug.  5,  1865.     Spec.  3723. 

120 

Bullen,   B.    W.,  Lieut., 

No.30/64, 

Right.    (Dec.  31,  amp.  leg;  teta.) 

84 

Sholes,  H.,  Pt.,  D,  26th 
New  York,  age  20. 

De.13/62, 
Feb.  —  , 
1863. 

Right  (Dec.  15,  amp.  knee  joint; 
gang.);  ant.  post.  flap.  Surg.  D. 
W.  IJliss,  U.  S.V.    Disch'd  June 

121 

Darden's  Bat'y,  age  25. 
Callahan,  M.,  Corp'l,  K, 
1st  New  Jersey,  age  17. 

Jan.  6/65. 
June  11, 
Aug  3, 

Died  Jan.  7,  1865;  trismus. 
Left:  circ.    A.  A.  Surg.W.C.Mul- 
ford.     Died  August  5/64  ;  haem. 

4,  1863. 

1864. 

and  asthenia.    Spec.  2922. 

85 

Silsbee,  J.  H.,  Pt.,  C,  8th 

May  3. 

Left  ;  circ.      A.  A.  Surg.  W.  S. 

122 

Camp,  W.  II..Pt.,B,  203d 

Jan.  15, 

Left  ;  circ.    A.  Surg.  S.  H.  Orton, 

New  Jersey,  age  27. 

June  18, 

Ward.  Aug.  5,  re-amp.    Disch'd 

Penn.,  age  35. 

Mar.  5, 

U.  S.  A.     Died  March  15,  1865; 

1863. 

May  6,  1864. 

1865. 

haemorrhage. 

86 

Sloppy,  P.,  Pt.,  E,  148th 

May  10, 

.  Confed.  surgeon.   Necrosed 

123 

Cannivau,  C.  C.,  Pt.,  G, 

Aug.  30, 

(nee.;  aneurism);  ant.  post. 

Pennsylvania,  age  20. 

J'y<J.V64. 

end  femur  removed.    Recovery. 

88th  Pennsylvania. 

Oc.31/62. 

flap.     Died  Nov.  14,  1862. 

87 

Smith.  'M.,  Pt.,  G,  16th 

Au.30/62, 

.     Ass't  Surg.  M.  P.  Shelton, 

124 

Cogby,  H.  J.,  Corp'l,  B, 

May  3, 

Left.     (Bone  and  ball  removed. 

Virginia. 

May4/64. 

C.  S.  A.    Recovery. 

139th  Penn.,  age  25. 

J'ne9/63. 

Surg.  J.  H.Baxter,U.S.V.   Died 

88 

Sollers,  J.  II.,  Lieut.,  B, 

May  2, 

Right  ;  ant.  oval  flap.  A.  A.  Surg. 

June  17,  '63.     Specs.  1229,  1230. 

73d  Pennsylvania. 

July  28, 

T.  Liebold.  Exfol.  Disch'd  Oct. 

125 

Colby,  II.  A.,  Serg't,  G, 

June  18, 

Left  (nee.;  gang.);  nnt.  post.  flap. 

1863. 

9,  '63.    Died  Mar.  14,  '64  ;  fatty 

2dU.  S.  Sharpshooters, 

Oct.  20, 

Surg.  N.  R.  Moselev,  U.  S.  V. 

degenerat'n.  Autop.  Spec.  1808. 

age  23. 

1864. 

Died  Nov.  1,  1864.    Spec.  3319. 

89 

Stout,  A.  H.,  Pt.,  H,  13th 

Sept.  29, 

Left  (nee.):  flap.     A.  A.  Surg.  J. 

126 

Crocker.  W.,  Pt..  II,  42d 

Oct.  2, 

Right  (slough.);  Teale's  method. 

Pennsylvania  Cavalry, 

Dec.  3, 

II.  Thompson.    Disch'd  July  8, 

Virginia. 

Xov.  4, 

A.  Surg.  C.W.  P.  Brock,  C.S.A. 

age  25. 

1864. 

1865.     Spec.  3477. 

1863. 

Died  Xov.  9,  18tf3;  exhaustion. 

90 

Street,  B.,  Pt.,  E,  27th 

Auo-.  2, 

Left  ;  ant.  post.  flap.    Ass't  Surg. 

127 

Detloff,  E.,  Pt.,  H,  38th 

Aug.  7, 

Left  (Aug.  7,  amp.  leg;  gang.>: 

Indiana,  age  20. 

Sept.  7, 

G.  W.  Burke,  46th  Penn.     Mus 

Ohio,  age  26. 

Dec.  5, 

lat.  flap.     Surgeon  B.  B.  Creed. 

1864. 

tered  out  Feb.  7.  1805. 

1864. 

U.  S.V.    Died  January  16,  1865. 

91 

Sullivan,  E.,  Pt.,  D,  5th 
Infantry,  age  39. 

Feb.  21, 
M'yl4/G2. 

Left  ;  circ.    Ass't  Surg.  B.  Norris, 
U.  S.  A.     Disch'rt  Aug.  23,  1862. 

128 

Derr,  J.  W.,  Pt.,  E,  7th 
Maryland,  age  18. 

Mar.  31. 
May  15, 

Right  (March  31,  rem'd  patella); 
circ.    A.  A.  Surg.  F.  Hall.    Died 

92 

Taylor,  'W.,   Serg't,  B, 
106th  X.  York,  age  26. 

Sept.  19, 
Nov.  25, 

Left  (nee.):  ant.  pest.  flap.     A.  A. 
Surg.  J.  Xeff.     Disch'd  Aug.  6, 

129 

Doub1edav,W.O.,Corp.. 

1865. 
July], 

June  23,  '65;  exh'n.    Spec.  41!'9. 
Left.    Snrg.L.W.Oakley,  2d  X  .1. 

1864. 

1865.     Specs.  5,  4856. 

H,14th  Vt.,  age  41. 

Au.10,'63. 

Diarr.;dysen.  Died  Aug.  12/63. 

93 

Thompson,    B.,    Pt.,  C, 

Se.  17/62, 

Right  (Oct.  3,  amp.  leg  ;  erysip.; 

130 

Drake,  J.  H..  Pt.,I,71st 

June  1, 

Left.     (Knee  ulcerated.)     Dr.  II. 

28th  Penn.,  age  33. 

April  14, 

gang.);  flap  of  skin;  circ.  muse. 

Pennsylvania,  age  23. 

July  10. 

Marsh,    Albany,  N.  Y.      Died 

1863. 

Dis.  May  6/63.  Specs.  3883,  3965. 

1862. 

July  14,  1862.  " 

94 

Vannoy,  J.,  Pt.,  E,  3(ith 

Aug.  17, 

Left  thigh.     For  exchange  April 

131 

Efner,  J.  B.,  Pt.,  F,  4th 

June  14, 

Left  thigh.     Died  July  18,  1863. 

Virginia,  age  33.               Oo.27/64. 

8,  1865. 

Texas  Cavalry. 

,'63. 

SURG.  Ill— 41 


322 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

132 

Eline,  J.  A.,  Pt.,  D,  76th 

July  18, 

Left.     August   31,   haem.     Died 

163 

Maxfleld,  D.  E.,  Pt.,  E, 

Sept.  17, 

Lett;  circ.     A.  A.  Surgeon  A.  V. 

Pennsylvania. 

Au.20,'63. 

August  31,  1863;  exhaustion. 

97th  New  York,  age  20. 

Oc.22,'62. 

Cherbonnier.    Oct.  23,  25,  haem.; 

133 

Fenuimore,   H.,  Pt.,  E, 

Sept.  19, 

Left  thigh.     L)ied  November  2, 

lig.  femoral  artery.     Died  Oct. 

101st  Indiana. 

,'63. 

1863. 

27,  1862;   exhaustion. 

134 

Gates,  A.E.,  Pt,,  C,  18th 

June  5, 

Left  thigh.     Died  July  26,  1864. 

164 

McCreary,  G.  L.,Pt.,F, 

May  12. 

Right  ;  circ.  A.  A.  Surg.  F.  G.  H. 

Connecticut. 

J'y22,'64. 

100th  Penn.,  age  19. 

J'el'2,'64. 

Bradford.     Died  June  25,  1864  ; 

135 

George,  H.,  Captain,  A, 

Dec.8,'64, 

Left;  circ.  Surg.  C.  H.  Lord,  102d 

exhaustion. 

Louisiana  Zouaves.age 

J  'y  7,  '65.  1     N.  Y.     J  uly  2T,  ligature  torn  oft'  ; 

165 

McDerbit,   W.,   Pt.,  D, 

June  34, 

Right.     (Amp.  right  second  and 

25. 

hasrn.;  fatal. 

17:kl  New  York,  age  27. 

,  '63. 

third  fingers.)    Died  July  29,  '63. 

136 

Hull,  W.  H.,  Pt.,  I,  lirth 

May  24. 

Left  (slough.):  ant.  post.  flap.    A. 

166 

McGir,   E.,  Pt,,  F,   5th 

Aug.  30, 

—  .     Died  October  3,  1862. 

Maine,  age  18. 

Aug.  12, 

A.  Surg.  W.  H.  Randolph.   Died 

New  York. 

,  '(12. 

1864. 

Sept.  5,  '64  ;  pyaem.    Spec.  3025. 

167 

McHe.mii,  A.,  Pt.,15,  llth 

July  3, 

Right.     Died  August  23,  1863. 

137 

Hannans,  J.,  Pt.,  K,  97th 

May  20, 

Right.     (Ha>m.:  diarr.;  June  11, 

Mississippi,  age  26. 

Au.  -,  '63. 

Pennsylvania,  age  23. 

July  10, 

amputation  leg.)  A.  A.  Sorg.  W. 

168 

Miller,  A.  J.,  Pt.,  D,  5th 

Sept.  20, 

Right    (sloughing);    circ.      Died 

1864. 

Stillman.    Died  Sept.  20,  1864  ; 

Kentucky. 

No.  1,  '(i3. 

November  15,  1863. 

pytemia. 

169 

Millsap,  M..  Pt.,  I,  31st 

May  22, 

Right.     Died  July  6,  1863;  py 

138 

Harrimau,  R.  C.,  Pt.,  F, 

Aug.  16, 

Left;  circ.  A.  A.Surg.J.  C.Morton. 

Iowa,  age  23. 

J'o29,'63. 

aemia. 

llth  Maine,  age  39. 

Sept.  16, 

Sept.  23,  haemorrhage  ;  lig.  fem 

170 

Morgan,  J.,  Pt.,  E,  llth 

July  2, 

Right.   A.  Surg.  W.A.  Hammond, 

1864. 

oral  artery.     Died  Sept.  2li,  '64. 

Penn.  Reserves. 

Oct.  2.'6L 

U.S.A.     Died  October  4,  1861; 

Spec.  3711. 

exhaustion. 

139 

Harrington,  W.,  Pt.,  A, 

May  9, 

Left,    Teale's  method.     Surg.  R. 

171 

Munn,  W.,  Pt.,  I,  27th 

May  10, 

Right  (May  10,  amp.  leg;  gang.); 

106th  N.  York,  age  20. 

Sept.  11, 

15.  Bontecou,  U.S.V.  Died  Sept, 

Michigan,  age  31. 

Sept.  20, 

Teale's  method.    A.  A.  Surg.  C. 

1864. 

19,  '64;  exhaustion.    Spec.  3328. 

1864. 

F.  Trautman.     Died  Oct.  4,  '64  ; 

140 

Hartraan,  L.,  Pt.,  B,  2d 

July  2, 

Right;  ant.  post.  flap.     A.  Surg. 

exhaustion.    Spec.  2330. 

Infantry,  age  24. 

Oct.  19, 

H.  E.  Brown,  U.S.  A.    Died  Oct. 

172 

Nevins,  T.,  Pt.,  F,  63d 

Sept,  17, 

Lett,     (Joint  eroded.)      Surgeon 

1863. 

24,  '63;  exhaustion.     Autopsy. 

New  York. 

Oc.24,'62. 

H.  S.  Hewit,  U.  S.V.    Died  Oct* 

141 

Henderson,   E.,    Pt.,  13, 

De.16,'64, 

Left  (gang.);  bi-!at.  flap.     Surg. 

24,  1862  ;  shock.     Spec.  489. 

16th  N.  C.,  age  32. 

Jan.  24, 

B.  B.  Breed,  U.   S.  V.      Died 

173 

Ogden,    D.,    Pt.,   E,   2d 

Sept.  25, 

Left  (slough.;  ant.  (ib.  art.;  haem.); 

1865. 

April  3,  1865. 

Illinois  Cav.,  age  21. 

Nov.1,'64. 

semi-circ.  flap  of  skin  ;  circ.  inc. 

142 

Hines,  T.  I.,  Pt.,  D,  1st 

July  1, 

Rin-ht.   Died  September  17.  1863: 

thro.  mus.     Surg-.  C.Winne,77th 

Maryland,  age  32. 

Au.27,'63.;     hectic  fever. 

Illinois.  DiedNov.  6,  '64  ;  cxh'n. 

143 

Holbrook,  E.,  Corp'l,  15, 

June  3 

Left  (gang.);  circ.     Surg.  R.  B. 

174 

Otto,  B.  G.,  Serg't,  A, 

Aug.  30, 

.     Died  October  35,  38(i2. 

40th  Mass.,  age  25. 

July  12, 

Bontecou,  U.  S.  V.      Sloughing. 

48th  Pennsylvania. 

,  '62. 

1864. 

Died  July  30,  '64;  exhaustion. 

173 

Oi^en,  A.,  Serg't.G,  19th 

Sept.  17, 

Right;  circ.     A.  Surg.  C.  Bacon, 

144 

Holland,  A.,  Pt.,  B,  (ith 

May  6, 

Left  ;  ant.  post,  flap.     Surg.  E. 

Georgia. 

Oc.21,'62. 

U.  S.  A.    Died  October  28,  3862. 

New  Jersey,  age  2G. 

June  15, 

Beutlcy,  U.  S.V.     Died  July  21, 

Spec.  926. 

1864. 

3864.     Autopsy.     Spec.  3342. 

176 

J'atten,    W.  F.,  Pt.,  C, 

Nov.  30. 

Right  (Mar.  19,  amp.  leg;  gnng.; 

145 

1  House,  J.,Vi.,  K,  2d  Mis 

Aug.  1, 

Right.     (Gang.;    erysip.;    exfol.; 

9th  Mississippi,  age  24. 

1864, 

haem.);  ant.  post.  flap.    A.  Surg. 

sissippi,  age  Hi. 

Oc.29,'64. 

nee.)     Stump  swollen  greatly. 

Mar.  24, 

J.  C.  Thorpe,  U.  S.  V.     Died 

146 

Ingerson,  A.,  Pt,,  A,  123d 

May  15, 

Left  ;  ant.  post.  flap.     Surg.  J.  B. 

1865. 

April  20,  1865;  pyaemia. 

Ohio,  age  18. 

June  19, 

Lewis,  U.  S.  V.     Died  June  26, 

177 

Perry,   O.,   Pt.,  F,  41st 

July  12, 

Right.     (Prim.  amp.  leg;   gang.) 

1864. 

1864  ;  pyaemia. 

Illinois. 

,  '63. 

Died  September  12,  1863. 

147 

Jacobson,  F.,  Pt.,C,  llth 

June  18, 

Right  (June  18,  amp.  leg;  gang.); 

178 

'3Pettigrcw,  J.  A.,  Capt., 

J'e24,'63, 

Right  ;  circ.    A.  Surg.  J.  E.  Link, 

Connecticut,  age  18. 

Aug  90 

circ.     A.  A.  Surg.  W.  B.  Casey. 

C,  20th  Tennessee. 

Jan.4,'64. 

21st  111.      Died    Jan.  7,  1864; 

1864. 

Died  August  26,  1864. 

shock.     Spec.  2136. 

148 

Johnson,  D.  A.,  Pt.,  E, 

No.  7,'63, 

Right  (Nov.  7,  exc.  tib.);  circular. 

179 

*Powell,    W.  H.,  Pt.,  I, 

Sept.  17, 

Right.    (Sept.  18,  amputut'n  leg.) 

43d  New  York,  age  37. 

July  2, 

A.  A.  Surgeon  T.  B.  Townsend. 

3d  South  Carolina,  age 

Nov.  30, 

A.  A.  Surg.  A.  V.  Cherbonnier. 

1864. 

Gangrene.     Died  Aug.  6,  1864. 

20. 

1862. 

Erysip.  Died  May  2,  '63:  cxh'n. 

149 

Jones,  T.,  Pt.,  E,  70th 

July  3, 

Left  (haem.);  flap.     Surg.  C.  W. 

Autopsy.  Specs.  795,  3837,  3%2. 

New  York,  age  26. 

Au.  7,  '63. 

Jones,  U.  S.  V.    Died  Aug.  18, 

180 

Prentice,  S.  B.,  Pt.,C,  1st 

June  35, 

Left  (necrosis);  flap.    A.  Surg.  K. 

1863.    Spec.  1695. 

District  Columbia  Cav. 

J'y23,'G4. 

Curtis,  U.  S.  A.     Died  August", 

150 

Kenned;/,  /'.,  Pt.,C,  59th 

July  —  . 

Left    thigh.     Died    August    23, 

1864;  exhaustion. 

Georgia,  age  46. 

Au.  -,  '63. 

1863. 

181 

Rader,   J.,  Pt.,  F,  59th 

Aug.  19, 

Left  (Aug.  39,  exc.  tib.;  caries); 

151 

Kewley,  \V.  C.,  Pt.,  G, 

May  22, 

Right  ;    extensive   burrowing  of 

Illinois,  age  21. 

Dec.7,'64. 

circ.     A.  A.  Surg.  M.  L.  Ilerr. 

68th  Ohio,  age  46. 

J'e24,'63. 

pus.    A.  A.  Snrg.  J.  Thompson. 

Gang.     Died  Jan.  4,  '65  :  cxh'n. 

Died  July  11,'6:S.     Spec.  1702. 

182 

Richard,   J.,  Corp'l,  E, 

1  — 

Left.     Died  September  27,  1863. 

152 

Kightlinger,  J.,  Pt.,  F, 

Aug.  14, 

Left  (eedeniatous);circ.  Surg.  A. 

9th  Wisconsin. 

Se.23,'63. 

145th  Penn.,  age  23. 

Oct.  1,'G4. 

F.  Sheldon,  U.  S.  V.     Died  Oct. 

183 

Roberts,   J.  F.,  Pt.,  K, 

May  5, 

Left;   ant.  post.  flap.     Surg.  E. 

8.  1864;  exhaustion. 

147th   New  York,  age 

J'ne8,'64. 

Donnelly,  2d   Peun.    Reserves. 

153 

Lane,  W.,  Pt.,  I,  1st  E. 

De.31,'62, 

Left:  lig.  torn  off;  luem.;  re-lig. 

33. 

Died  Aug.  2,  1864  ;  chr.  diarr. 

Tennessee,  age  20. 

Mar.2,'63. 

Died  March  6,  1863. 

184 

Robinson,  A..  Pt.,  D,  8th 

May  8, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

154 

Langfield,W.  E.,  Pt.,  K, 

May  14, 

Right  (haem.);  flap.     A.  A.  Surg. 

Wisconsin,  age  30. 

J'ne-,'64. 

J.  N.  Sharpe.     Died  July  1,'64  ; 

7th  New  Hampshire. 

J'y2,'64. 

F.  H.  Getchell.     Died   July  5, 

exhaustion. 

1864  ;  exhaustion. 

185 

Rodrigues,  A.,  Corp'l,  C, 

May  15, 

—  ;  circ.     A.  A.  Surg.  R.  C.  C. 

155 

Langworthy,  S.,  Pt.,  15, 

May  14, 

Left  ;  flap.     A.  A.  Surgeon  F.  H. 

101st  Illinois,  age  23. 

J'y28,'64. 

Jones.   Gangrene.  Died  Aug.  3, 

117th  New  York,  age 

J'yl2,'64. 

Getchell.     Died  July  12,  1864  ; 

1864  ;  exhaustion.     Autopsy. 

28. 

exhaustion. 

186 

Schultz,  C.,  Pt.,  K,  5th 

De.16,'64, 

Left  (nee.  tib.);  circ.    A.  A.  Surg. 

156 

Lawrence,  T.  K.,  Pt..  G, 

July  3, 

Left  thigh.     Died  Aug.  19,  1863. 

Minnesota,  ago  44. 

Jan.  27, 

J.  G.  Harvey.    Died  Feb.  9,  '65  ; 

24th  Georgia,  age  31. 

Au.  6,  '63. 

1865. 

chronic  dysentery. 

157 

Lininger,  ,S.,  Pt.,  H,  74th 

Sept,  19, 

Right.    (Exc.  int.  condyle.)  Died 

187 

Scott,  L.,  Pt.,  F,  2d  New 

Sept.  20, 

Right  (Nov.  1,  giing.);  flap.  Surg. 

Indiana,  age  32. 

No.39,'63. 

December  7,  1863.     •' 

York   Mounted  Rifles, 

Nov.  39, 

E.  Beniioy,  II.  S.  V.     Died  Nov. 

153 

Locket/,  A.,  Pt.,1-1,  3d  Mis 

No.30,'64, 

liight  (gang.;  carious):  oval  flap. 

age  17. 

1864. 

30,  38(i4;  exhaustion. 

sissippi,  age  29. 

Fe.24,'65. 

A.  A.  Surg.  D.  D.  Talbot.    Died 

188 

Seiberlieh,  J.,  Corp'l,  F, 

May  16, 

Right  (erysip.);  circ.    A.  Surg.  D. 

April  27,  1865:  pyaemia. 

19th  Wisconsin,  age  23. 

June  28, 

R.  Brower,  U.  S.  V.     Died  July 

159 

2  Lootnis,   I.  A.,  Pt.,  G, 

Apr.6,'62, 

Right  (sloughing;   necro.);    ant. 

1864. 

13,  1864;  exhaustion. 

16th  Wisconsin,  age  23. 

Jan.  25, 

post.  flap.     Dr.  F.  II.  Milligan. 

189 

Sharp,  0.  D.,  Pt.,  II,  1st 

Sept.  17, 

Left  ;  gangrene.     Died  Nov.  21, 

1866. 

Died  February  18,  3866. 

North  Carolina. 

No.35,'62. 

1862. 

160 

Lovell,  P.,  Pt.,  C,  loth 

No.25,'63, 

Left  (exc.  tibia;  Jan.  10,  '64,  amp. 

190 

Shelly,  J.  J.,  Pt.,  B,  2d 

Ja.30,'62, 

Right.    Dr.  G.  II.  Higgins.    Died 

Feb.2  '64. 

'  '° 

Surgeon^R.  Bnrtholow,  U.  S.  A. 

Spec.  405. 

Died  Feb.  3,  3864.     Spec.  2108. 

191 

Staggs,  A.,  Pt.,  K,  10th 

July  3, 

Left.     Died  Sept.  1,  18(13;  pyxm. 

161 

Lumley,   F.  S.,   Pt.,  1  1, 

Xov.  24, 

—  -  ;  eirc.  A.  Surg.  J.  H.  Wilson, 

Kentucky  Cavalry. 

Au.  5,  '63. 

Autopsy. 

29th  Mississippi,  age  26. 

De.31,'63. 

73d  Penn.     Died  Jan.  5,  1864  ; 

192 

Stanley,  F.  E.,  Serg't,  A, 

April  13, 

Left.    (Haemorrhage.)    Died  May 

shock  and  gangrene. 

13th  Connecticut. 

.  ,  '03. 

29,  1863. 

162 

Lyons,  G.  W.,  Pt.,  I,  43d 

Oct.  4,  '62, 

Left.     (Necrosed  bone  removed.) 

193 

Sfcinton,  J.,   Pt.,  H,  2d 

July  3, 

Left.    (Chronic  diarrhoea.)    Died 

Ohio. 

Feb.2,  '63. 

Died  Aug.  14,  1863.     Spec.  968. 

Infantry,  age  40. 

Au.  8,  '64. 

August  11,  1863. 

'JONES  (J.),  Investigation  g  upon  the  Nature,  Causes,  and  Treatment  of  Hospital  Gangrene  as  it  prevailed  in  the  Confederate  Armies,  1861-1865, 
in  United  States  Sanitary  Commission  Memoirs,  1871,  Surgical  Volume  II,  p.  291. 

2 MILLIGAN  (F.  H.),  Amputation  of  the  Thigh  resulting  from  Injury  received  nearly  four  years  prior  lo  the  operation,  in  Cincinnati  Lancet  and 
Observer,  1869,  Vo3.  XII,  p.  590. 

3MOSKS  (I.),  Surgical  Notes  of  Cases  of  Gunshot  Injuries  occurring  durina  the  advance  of  the  Army  nf  the  Cumberland,  Summer  of  1863,  in 
American  Journal  of  the  Medical  Sciences,  1864,  N.  S.,  Vol.  XLVII,  p.  340. 

4FlSHER  (G.  J.),  Amputations  after  the  Battle  of  Antietam,  in  American  Journal  of  the  Medical  Sciences,  1863,  N.  S.,  Vol.  XLV,  p.  48. 


SECT.  III.J 


SECONDARY    AMPUTATIONS    OF    THE    THIGH. 


323 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OI'EKATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

194 

Teefle,    S.,  Pt.,    H,  9th 

Mar.  21  , 

Left;  circ.     A.  A.  Surg.  D.  Shep- 

202 

Wileman.  L.  G.,  Pt.,  C, 

Oct.  8, 

;    circular.      Surgeon   J.  G. 

Ap.21,'65 

'6° 

ll'ltchitt     Tf    ^    V       Died    T'tn 

195 

Thomas,  G.  M.,  Black 

Oct.  13, 

Right;  circ.    A.  Surg.  A.  Ingrarn, 

PI 

16,  1863.' 

smith,  I,  3d  Peim.  Cav. 

Nov.  23, 

U.S.A.     Died  Jan.  28,   1864; 

203 

Wilson,  S.,  Pt.,  I,  6th  N. 

May  10, 

Right  ;  circ.     Surgeon  G.  L.  I'an- 

1863. 

pyaemia.     Spec.  2821. 

Hampshire,  age  24. 

June  13, 

coast,  K.  S.  V.     Died  June  21, 

196 

Touhey,  J.  D.,Corp'l,  B, 

Aug.  30, 

Left.    (Haemorrhage.)    Died  Oct. 

1864. 

1864;  exhaustion.     Spr.c.2&Sl. 

14th  New  York. 

Oc.10,'62. 

13,  1862;  pyaemia. 

204 

Wingate,  B.,  Capt.,  D, 

Feb.  21, 

Right   (nee.);  circ.     A.  Surg.  15. 

197 

Turner,  J.  P.,Serg't,  I, 

Aug.  30, 

Left.      Died    October  18,   1862; 

5th  Infantry. 

May  19, 

Norris,  U.  S.  A.     Died  June  1. 

16th  Massachusetts. 

Oct.  9,  '62. 

pyaemia. 

1862. 

1862;    operation    and    diseased 

198 

Twining,  P.  E.,  Serg't, 

June  1, 

Left.     (June  1,  amp.  leg.)    A.  A. 

stomach. 

P,  36th  Wisconsin,  age 

Sept.  14, 

Surg.  M.  Rizer.  Slough'g.  Died 

205 

Wnrmsley,  L.   W.,  Pt.. 

July  2, 

Right  (July  6,  amp.  leg;  necr); 

26. 

1864. 

October  16,  1864. 

K,  8th  Florida,  age  35. 

Dec.  29, 

circ.      A.  Surg.  C.  W.  I'.  Brook, 

199 

Veasey,  J.  W.,  Pt.,  C,  3d 

Sept.  19, 

Right  ;  circ.  Surg.  —  Weatherby, 

1863. 

P.  A.  C.  S.     Died  Dec.  30,  1863  ; 

Alabama. 

Oc.25,'64. 

C.S.A.  Died  Nov.  14,'64;  exh'n. 

exhaustion. 

200 

Waters,  B.  G.,  Pt.,  H, 

Oct.  15, 

Left  (Oct.  15,  amp.  leg);  circular. 

206 

Wright,    J.   E.,  Pt.,  K, 

April  9, 

Left;  flap.     A.  Surg.  W.  H.  For- 

19th  Maine,  age  19. 

Nov.  27, 

Surg.  E.  Bentley,  U.  R.  V.  Died 

llth  Wisconsin,  age  23. 

June  18, 

wood,  U.  S.  A.    Died  June  26, 

1864. 

April  28,  '65.     Specs.  3445,  3446, 

1865. 

1865  ;  pyaemia. 

3447,  3448. 

207 

Wyatt,   /.,   Capt.,   10th 

Sept.  27, 

Left.     Died  November  25,  1864. 

201 

Wenzell,A.,Pt.,E,  121st 

J'y  1,  '63, 

Right  (fragra'ts  nee.  bone  rem'd); 

Missouri  Cavalry. 

No.23,'64. 

Pennsylvania,  age  21. 

Sept.  9, 

oval   skin  flap  ;    circ.  muscles. 

1864. 

A.  A:  Surg.  J.  H.  Jamar.     Died 

Sept.  28,  1864  ;  pyaemia. 

The  seat  of  fracture  in  the  foregoing  two  hundred  and  seven  cases  was  in  the  lower 
third  in  seventeen;  in  the  knee  joint,  in  seventy-three;  in  the  leg,  in  ninety-one;  and  in 
the  ankle  joint  or  foot  in  twenty-six  instances. 

Secondary  Amputations  of  the  Thigh,  Point  of  Ablation  not  specified. — Of  twelve 
secondary  amputations  in  which  the  seat  of  operation  was  not  indicated,  nine  were  per 
formed  on  Union  and  three  on  Confederate  soldiers ;  all  resulted  fatally.  Seven  operations 
were  on  the  right,  two  on  the  left  side ;  in  three  cases  this  point  was  not  recorded.  In  two 
instances  total  excision  of  the  knee  joint  and  in  two  other  cases  amputation  in  the  leg  had 
preceded  the  ablation  of  the  thigh.  One  of  the  latter  cases  is  here  detailed:1 

CASE  496. — Private  G.  R.  Hathaway,  Co.  A,  125th  Illinois,  aged  24  years,  received  a  shot  fracture  of  the  tarsal  bones 
of  the  left  foot,  at  Kenesaw  Mountain,  June  27,  1864.  Five  days  after  the  reception  of  the  injury  he  entered  the  field  hospital 
at  Chattanooga,  where  amputation  was  performed,  but  not  recorded.  Surgeon  B.  Cloak,  U.  S.  V.,  reported  the  termination  of 
the  case  as  follows:  "The  patient  was  admitted  to  Cumberland  Hospital,  Nashville,  July  llth,  having  undergone  amputation 
of  the  leg  below  the  knee  previous  to  his  admission.  On  August  llth,  a  second  amputation  was  performed  above  the  knee,  by 
the  antero-posterior  flap  method,  by  Acting  Assistant  Surgeon  J.  C.  Thorpe.  The  flaps  at  the  time  of  the  second  operation  had 
become  indolent  and  slightly  gangrenous  and  could  not  be  brought  to  cover  the  protruding  bones ;  the  patient's  condition  being 
weak  and  anaemic  and  his  tongue  whitish.  Stimulating  dressings  were  applied  to  the  stump  of  the  thigh,  which  looked  clean 
but  failed  to  close  by  first  intention,  though  it  became  covered  with  healthy  granulations.  The  patient  died  of  irritative  fever 
September  9,  1864." 

TABLE  XLI. 

Summary  of  Twelve  Fatal  Cases  of  Secondary  Amputations  in  the  Thigh  for  Shot  Fracture  of  the  Femur, 

tlie  point  of  Ablation  not  specified. 


No. 

1 

2 
3 

4 
5 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPKRATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

Dowd,   J.,    Farrier,    M, 
10th  Missouri  Cavalry, 
age  24. 

Edmondson,  W.W.,  Pt., 
C,  llth  Iowa,  age  20. 
Hathaway,  G.  R.,  Pt.,A, 

125th  Illinois,  age  24. 

Hawkins,  W.,  Pt.,C,  17th 
Ohio. 

Kellum,  T.  H.,  Pt.,  B, 
89th  Indiana,  age  18. 

April  18, 

1863, 

Right.     (April  19,  '63,  amp.  leg, 
lower  third;  1865,  gang.)  Nov., 
1867,  necrosis  ;  re-amp,  of  thigh. 
Died  Nov.  15,  1867. 
Right.     Died  September  3,  1864. 

Left  (int.  amp.  leg;  gang.);  ant. 
post.  flap.     A.  A.  Surgeon  J.  C. 
Thorpe.     Died   Sept.   9,  1864; 
irritative  fever. 
Right  ;  circ.     Surg.  S.  E.  Fuller, 
U.  S.  V.     Died  March  21,  1864  ; 
pyaemia. 
Right  ;  circ.   Surg.  E.  Powell,72d 
111.    Died  Aug.  3,  '64  ;  septasmia. 

6 

7 
8 

9 
10 
11 

Kiefer,  M.,  Pt.,  C,  31st 
Pennsylvania,  age  33. 
Turpen,   J.,    Pt.,    B,  2d 

Missouri,  age  36. 
Traube,  A.,  Corp'l,  E,  2d 
Missouri,  age  34. 

J  Unknown. 
3  Unknown. 

ra-ughn,  W.,  Pt.,  B,  13th 
South  Carolina. 
Whitbeck,    O..    Pt.,    D, 
109th  N.  York,  age  29. 

June  29, 
Au.  1,'62. 
Oct.  8, 
No.  -,  '62. 
Oct.  8,  '62, 
Mar.  25, 
1864. 
May  —  , 
,  '64. 
May  —  , 
,'64. 

.    Diarrhoea.     Died  August 
18,  1862  ;  exhaustion. 
Right.    Died  November  14,  1862. 

Left:  ant.  post.  flap.     A.  A.  Surg. 
P.  Gilroy.    Died  May  5,  1864. 

.   (Total  excision  knee  joint.) 
Fatal. 
.   (Total  excision  knee  joint.) 
Fatal. 
Right  thigh.    Died  June  26,  1864. 

Right.    (Typ.  fev.)    Dr.  G.  Burr, 
Binghamton.    Died  July  10/64. 

July  22, 
,  '64. 
June  27, 
Aug.  11, 
1864. 

Se.20,'63, 
Feb.  28, 
1864. 
May  18, 
J'y  18,  '64. 

May  6, 
J'y  9,  '64. 

3CULBERT8ON  (H.),  loc.  tit.     M(5GUIIiE  (H.),  loc.  Clt. 


324 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


AMPUTATIONS  IN  THE  CONTINUITY  OF  THE  FEMUR,  OF  UNCERTAIN 
DATE. — In  five  hundred  and  eighteen  cases  of  amputations  in  the  thigh  for  shot  injury 
the  intervals  between  the  injuries  and  operations  are  unknown,  one  or  the  other  or  some 
times  both  dates  having  been  omitted  in  the  reports.  The  ablations  were  practised  in  the 
upper  third  in  thirty-three,  in  the  middle  third  in  seventy,  in  the  lower  third  in  one  hun 
dred  and  four,  and  at  an  unspecified  portion  of  the  thigh  in  three  hundred  and  eleven 
cases.  Although  the  recorded  data  are  generally  meagre,  the  results  have  been  ascertained 
in  all  but  thirty-two  cases.  One  hundred  and  sixty- three  had  successful,  and  three  hundred 
and  twenty-three  fatal  terminations,  a  mortality  rate  of  66.4  per  cent. 

Amputations  in  the  Upper  Third  of  the  Thigh,  of  Uncertain  Date. — There  were 
thirty-three  amputations  in  the  upper  third  of  the  thigh,  in  which  the  length  of  interval 
between  the  injury  and  operation  could  not  be  ascertained.  Twenty-eight  of  the  patients 
were  Confederate,  and  five  were  Union  soldiers;  twelve  recovered  and  twenty-one  died. 

Successful  Cases  of  Amputation  in  the  Upper  Third  of  the  Thigh,  of  Uncertain  Date. 
The  twelve  operations  of  this  group  were  all  performed  on  Confederate  soldiers — on  the 
right  side  in  four,  on  the  left  in  three,  unspecified  in  five  cases.  The  nature  of  the  missiles 
and  the  methods  of  operating  are  not  recorded. 

Fatal  Cases  of  Amputation  in  the  Upper  Third  of  the  Thigh,  of  Uncertain  Date. — 
There  were  twenty-one  operations  of  this  class,  five  performed  on  Union  and  sixteen  on 
Confederate  soldiers;  eight  on  the  right  and  nine  on  the  left  limb;  in  four  cases  the  side 
was  not  specified.  No  antecedent  operations  were  recorded. 

TABLE  XLII. 

Summary  of  Thirty-three  Cases  of  Amputation  in  the  Upper  Third  of  the  Femur,  time  of  Ablation 

not  specified. 


No. 

NAME,  MILITARY 
DESCRIPTION",  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

2 
3 

4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
H 
15 
16 
17 

Anderson,  J.  E.,  Pt.,  F, 
Holcoinb'sS.C.  Legion. 
Brown,    S.,   Pt.,  C,  53d 
South  Carolina. 
Carroll,  J.,  —,  2d  South 
Carolina. 
Chambers,  D.  W.,  Pt.,  D, 
37th  North  Carolina. 
Freeman.R.,  Pt.,  P,  14th 
North  Carolina. 
Long,   J.  D.,  Pt.,  I,  1st 
Texas. 
O'liri/ant,  W.  H.,  Pt.,  F, 
2d  A.  Carolina  Hides. 
files,  J.  J/.,  Pt.,  I,  12th 
Mississippi,  age  23. 
Ward.   J.,    Pt.,  D,   8th 
Louisiana. 
White,  A.  C.,  Serg't,  H, 
5th  South  Carolina. 
Williamson,  G.  A.,  Col., 
2d  Arkansas. 
Wimmer,  J.  W.,  Pt.,  K, 
48th  North  Carolina. 
Anderson,  G.  B.,  Pt.,  F, 
41st  Alabama. 
Blankenship,  E.  P.,  Pt., 
E,  57th  Virginia. 
Boii'en,    J.,   Pt.,  E,    7th 
Virginia. 
Suforil,  P.  If.,  Pt.,  G, 
llih  Miss.,  age  20. 
Bnrley,lI.lI.,It.,G,4f>th 
Pennsylvania,  age  21. 

Furloughed  May  °7  1864 

Cleland,  D.,  Pt.,  D,  1st 
South  Carolina  Rifles. 
Dillings,  I.,  Pt.,  A,  5th 
Artillery,  age  34. 
Garreth,  \V.  A.,  Pt.,  B, 
45th  Penn.,  age  21. 
Kinsley,  J\,  Pt.,  G,  31st 
Virginia. 
Lofton,  J.,  Pt.,  G,   8th 
Louisiana. 
McWhorttr,J.B.,Pt.,-E, 
2d  S.  Carolina  Rifles. 
Neighbours,  W.,  Pt.,  K, 
3d  Georgia. 
Neil,  W.,  Pt.,  K,  14th  S. 
Carolina. 
Peterson,  L.,  Pt.,  K,  36th 
Wisconsin,  age  37. 
Sfyrist,  W.  D.,  It.,  I,  5th 
South  Carolina,  age  30. 
Snider.J.A.,  Pt.,  D,  12th 
Virginia  Cavalry. 
Troll,  J.  H.,  Serg't,  K, 
57th  North  Carolina. 
Underhill,  J.,  Pt.,  C,  1st 
N.  Carolina  Battery. 
Wlntn<ort>t.R.A.,Vorp'l, 
K,  64th  Georgia,  age  40. 
AVilkinson,  \V.,I't.,  1,  22d 
Col'd  Troops,  age  38. 
Wooddlt,  I'.  11.,  Corp'l, 
F,  19th  Virginia  Cav., 
age  25. 

Right.    Died  May  25,  1864. 
Left.     Died  January  9,  1865. 
Left.    Died  October  22,  1864. 
Right.    Died  June  7,  1864. 

Left.     Released  July  8,  1865. 

Right.     Provost  Marshal  May  31  , 
1865. 
Right.     Furloughed   September 
12,  1864. 
Left.     Furloughed  November  30, 
1864. 
Right.     Furloughed   September 
2,  1863. 

Dec.  3, 
,'64. 
Sept.  30, 
'61 

June  3, 

,  '64. 

May  2, 

April  26,' 
,  '63. 



Died  July  17,  '63;  haemorrhage. 
Right.     Died  October  7,  1864. 

Left.     Died  September  22,  1864. 
Left.     Died  June  16,  1864. 
Right.     Died  June  11,  1864. 

Left.     Died  July   16,  1864;  py 
aemia. 
Right.     Died  June  30,  1864  ;  py 
aemia. 
Left.     Died  December  17,  1862. 

Nov.  1, 
,'64. 
July  6, 
,  '64. 
Aug.  16, 
,  '64. 

1863. 
Right.     Retired  January  23,  1865. 

.    Surgeon  —  Momer,  C.  S.  A. 
Recoverj'. 
Left.     Furloughed  September  7, 
1864. 

June  3, 
'(54 

May'  28,' 

De.13,'62. 

N.  C.    Recovery. 
Left.     Died  September  21,  1864. 

—  .     Died  July  23,  1863. 
Left.     Died  August  15,  1863. 
Left.     Died  August  15,  1863. 

Right.     Extensive  bedsore  over 
sacrum.     Died  June  6,  1864. 

De.17,'62. 

July  —  , 
'63 

Aug.  16, 
'61 

Right.     Died  September  7,  1864; 
exhaustion. 
Right;  ant.  posterior  flap.     Died 
July  15,  1864. 

July  —  , 

'63 

June  15, 

July 

'6T 

circ.  Surg.W.S.  Love.I'.A.C.S. 
Died  Nov.  8,  1864  ;  exhaustion. 

May  12, 

,  '64. 

Amputations  in  the  Middle  Third  of  the  Thigh,  of  Uncertain  Date  — In  this  group 
are  recorded  seventy  cases,  of  which  thirty-four  were  successful,  twenty-nine  proved  fatal, 


SECT,  m.] 


AMPUTATIONS    IN    THE    THIGH    OF    UNCERTAIN    DATE. 


325 


while  the  result  in  seven  cases  could  not  be  ascertained.  Fifty-three  of  the  patients  were 
Confederate,  and  seventeen  Union  soldiers.  The  amputations  were  on  the  right  side  in 
twenty-eight,  on  the  left  in  thirty-one,  not  reported  in  eleven  instances.  The  seat  of  frac 
ture  in  these  cases  was  in  the  middle  third  of  the  femur  in  one,  in  the  lower  third  in  six 
teen;  in  the  femur,  precise  seat  not  recorded  in  forty-two;  in  the  knee  joint  in  seven,  and 
in  the  leg  in  four  instances. 

TABLE  XLIII. 

Condensed  Summary  of  Seventy  Cases  of  Amputation  in  the  Middle  Third  of  the  Femur, 

of  Uncertain  Date. 

[  Recoveries,  1-34  ;  Deaths,  35-63 ;  Results  unknown,  64-70.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 

C9 
30 
31 

33 
34 
35 
36 

Baldwin,  J.,  Pt.,  A,  26th 
North  Carolina. 
Boykin,  P.,  Pt.,  C,  19th 
Louisiana,  age  18. 
Clark,    J.,    Pt.,    D,    1st 
Louisiana  N.  G. 
Comer,  T.,  Capt.,  H,  5th 
South  Carolina. 
Cribb,  J.,  Pt.,  C,    49th 
Georgia,  age  32. 
Croft,  J.,  Pt.,  L,    50th 
Georgia. 
Dell,    P.,   Pt.,    C,    20th 
Louisiana. 
Edmonson,  J.  C.,  Pt.,  K, 
13th  Georgia. 
Evans,  W.  S.,  Lieut.,  B, 
4th  Georgia. 
Farr,  J.  B.,  Pt.,  I,  18th 
Tennessee. 
Fechner,  C.,  Pt.,  —  ,  3d 
Alabama,  age  28. 
Ferguson,  J.  G.,  Pt.,  A, 
12th  1'ennessee,  age  24. 
Foster,   P.,  Pt.,  I,  57th 
Virginia,  age  21. 
Gales,  P.  V.,  Musician.E, 
30th  Tenn.,  age  31. 
Hearn,  B.  L.,  Pt.,  H,  6th 
Georgia. 
Helms,  C.  A.,  Pt.,  B,  43d 
North  Carolina,  age  33. 
Hunt,  S.  J.,  Pt.,  D,  18th 
Virginia. 
Ingraham,L.,Pt.,  D,  42d 
Mississippi. 
Johnston,  W.  S.,  Pt.,  I, 
20th  North  Carolina. 
Kennedy,   T.  J.,  Pt.,  E, 
16th  Ark.  Car.,  age  Oo. 
May  ne,  J.  J.,  Pt.,A,  llth 
Georgia. 
Passons,  IP".,  Pt.,  F,  5th 
Kentucky  Cav.,  age  44  . 
'Powell,  J.  K.  !>.,—,  C, 
31st  Georgia. 
Praft  J  U.  Pt     F    7th 

July  2, 

'(J3 

Left  ;  gangrenous.    Paroled  Nov. 
12,  1863. 
Right.    Retired  Dec.  22,  1864. 

Left  thigh.     Duty  July  31,  1863. 

Left.    Furloughed  September  23, 
1864. 
Right.    Retired  October  31,  1864. 

.     Furloughed  July  3,  1863. 

Left  ;  flap.     Discharged  July  17, 
1865. 
Right.    Furloughed  November  8, 
1864. 
Right.     Furloughed  October  9, 
1864. 
Left.     Surg.  H.  W.  Brown,  P.  A. 
C.  S.    Recovery  Dec.  20,  1864. 
Right.    Retired  January  19,  1865. 

Left.     Retired  January  23,  1865. 

37 
38 
39 
40 
41 
42 
43 

44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
54 
55 
56 
57 
58 
59 
60 
61 
62 

63 
64 
65 
66 
67 
68 
69 
70 

Beiden,  R.,  Pt.,  H,  116th 
Pennsylvania,  age  24. 
Boswell,  J.,  Pt.,  B,  63d 
Georgia,  age  31. 
Butler,  W.  C.,  Serg't,  F, 
2d  Florida,  age  26. 
Chinn,  F.  E.,  Pt.,  H,  7th 
North  Carolina. 
Cobb,  J.,  Pt.,  G,  9th  Vir 
ginia,  age  22. 
Cobb,  L.  G.,  Pt.,  H,  45th 
North  Carolina. 
Conway,  J.,  Pt.,  F,  llth 
Infantry,  age  23. 

Davis,  J.  D.,  Corp'l,  D, 
8th  Virginia. 
Gohegan,  T.  O.,  Pt.,  D, 
19th  Mississippi. 
Goodman,E.,Pt.,D,  27th 
Pennsylvania. 
Hall,  J.  H.,  Pt.,  E,  43d 
Tennessee. 
Heath,  G.  E.,  Pt.,  I,  12th 
Massachusetts. 
Jones,  J.  C.,  Pt.,  F,  122d 
New  York,  age  26. 
Mallory,!.  r.,Pt.,E,45th 
North  Carolina,  age  24. 
Metz,   J.,  Pt.,    A,    68th 
Pennsylvania. 
M  ilroy,  J.  T.,  Pt.,  E,  45th 
North  Carolina. 
Robinson,  J.,  Pt.,  B,45th 
North  Carolina. 
Shtperd,  IT.  B.,  Pt.,  E, 
45th  Georgia,  age  30. 
Simons.  L.,  Pt.,  F,  7th 
N.Y.  H'vy  Art.,  age  27. 
Spiess,  H.,  Pt.,  1,  67th 
Ohio,  age  23. 
Suggett,  T.,  Pt.,  G,  24th 
Michigan. 
Sutton.O.  />.,Pt.,  D,45th 
Georgia. 
Thomas,  H.  L.,  Pt.,  F, 
45th  Penn.,  age  18. 
Walrnm.J.  P.,  Lieut.,  D. 
28th  Virginia. 
White,  T.  II.,  Pt.,  I,  Oth 
Wisconsin,  age  19. 
Williams,C..Contrab'nd, 
Government  employe. 

Winrjfield  jr.  L.  Pt.  D 

June  5, 
'61 

Left.    Died  June  23,  1864. 

Right;   circ.     Gang.;  diarrhoea. 
Died  July  21,  1864  ;  exhaustion. 
Left.    Died  August  15,  1863. 

Left.    Died  September  12,  1864. 

;  flap;  diarr.;  slough  'g;  haem. 
Died  Sept.  22,  '64  ;  pyae.    Autop. 
Right.    Died  August  16,  1863. 

Left.    Re-amputation  upper  third. 
August  11,  1863,  bone  cut  off. 
Died  Aug.  18,  1863;  exhaustion. 
Right.     Died  May  5,  1865. 

Right.     Died  August  18,  1863. 

Right.    June  18,   haem.;   lig.   of 
fern.  art.     Died  August  9,  1863. 
Left  thigh.     Died  July  2,  1864. 

Left.    Died  Sept.  12,  1863  ;  diar 
rhoea. 
Left  thigh.    Died  May  30,  1864. 

Right.    Died  August  12,  1863. 
Left.    Died  August  18,  1863. 
Right.     Died  August  12,  1863. 
Left.    Died  August  14,  1863. 

Aug.  31, 

'61 

June  19, 

'61 

May  27, 
,  '63. 
Aug.  16, 
,  '64. 

July  —  , 
,  '63. 

1864. 
Aug.  28, 
,'64. 
July  —  , 
,  '63. 
July  —  , 
,  '63. 

April  —  , 
,'65 

May  3, 
,'63. 
Jan.  2, 
,  '63. 
May  12, 
,'64. 
July  9, 
'£M 

Sept.  19, 
,  '63. 
May  2, 
'63 

1863. 

1863. 

July  20, 
,  '64. 
July  12, 
'64 

July  —  , 

'63 

Left  ;  ant.  posterior  flap.    Provost 
Marshal  March  7,  1865. 
Right.    Furloughed  December  6, 
1864. 
Right.   Retired  January  20,  1865. 

Right.     Paroled  May  31,  1865. 
Right.    Exchanged  Mar.  3,  1864. 
.      Furloughed  October  13, 

isea 

Right.    Retired  March  18,  1865. 
Left.     Exchanged  March  3,  1864. 

Right  ;    circ.      Prison   April  28, 
1865. 
;  circ.     Furloughed  August 
26,  1862. 
Right  ;  flap.     Released  June  28, 
1665. 
Left  :  flap.     Discharged  July  17, 
1865. 
Right.    Exchanged  October  13, 
1803. 
Right.    Retired  March  11,  1865. 

May  6, 
,  '64. 
July  —  , 
,'63. 
July  —  , 
,  '63. 
July  —  , 

Nov.  30, 
'64 

Sept.  30, 
'64 

July  18, 

July  2, 
'6*5 

July  —  , 
,'63. 

May  3, 

Sept.'  27,' 
,  '64. 

Aug.  9,— 
June  3. 
,  '64. 
May  10, 

aemia. 
Left.     Diarrhoea.    Died  July  9, 
1864  ;  exhaustion. 
Left.     June  5,  erysipelas.     Died 
August  13,  1864;  exhaustion. 
.     Died  August  3,  1863. 

Left  thigh.     Died  May  30,  1864. 
Left  thigh.     Died  July  29,  1864. 
Right  thigh.    Died  July  30,  1863. 

Right.    Died  September  14,  1864  ; 
wound. 

July  1, 

June  26, 
'6° 

June  16, 

'64 

Tennessee,  age  41. 
Satterwhite,D.S.,  I't.,G, 
7th  Georjria. 
Scott,  G.  W.,  Serg't,  H, 
7th  South  Carolina. 
Sharp,  W.  T.,  .Serg't,  G, 
22d  Georgia. 
Stegen,  J.  W  ,  Serg't,  D, 
5<!th  Virginia. 
Stout,  T.  N.,  Pt.,  C,  6th 
Louisiana. 
Sioicfgnotl,  J.  H.,  Pt.,  A, 
54th  X.  C.,  age  20. 
Z7n</crwno</../.,Corp'l,  K, 
Ifith  Georgia. 
WatsonJ.  B.,  Pt.,Cobb's 
Georgia  Cavalry. 
Wilkinson,  S.  !{.,  Pt.,  I, 
14th  Alabama. 
Williamson.  A.,  Seaman, 
St'r  Savannah,  age  55. 
Bag\)]i,A.  P  ,  Pt.,  E,  23d 
North  Carolina. 
Barker,  E.,  Pt.,  A,  2(ith 
North  Carolina,  age  21. 

18C5. 
Oct.  7, 
61 

July  —  , 
,  '63. 
Aug.  18, 
,  '64. 

July  —  , 

Feb.  6, 

Feb.  22, 
1865. 

U.  S.  V.     Died  l-'eb.  22,  1865; 
prostration. 
Right.      Died    of    pyaemia  and 
pneumonia  within  ten  days. 
;  circular. 

Left  thigh  ;  circular.     Not  a  pen 
sioner. 
Right  thigh. 

Left  thigh. 
Left  thigh. 
—  .    Not  a  pensioner. 
Left  thigh. 

June  27. 
'6° 

.    Furloughed  September  9, 
1863. 
Left.    Retired  March  3,  1865. 

.    Furloughed  September  17, 
1863. 
Left.     Exchanged  November  12, 
1863. 
Right.      Furloughed  September 
16,  1863. 
Left.     Recovered. 

Right.     Died  October  3,  1864. 
Left.     Died  August  12,  1863. 

58th  Virginia,  age  19. 
Bennett,  W.,  Pt.,  B,  13th 
South  Carolina,  age  1!>. 
Carmonay,    D.,  Pt.,  K, 
5th  Michigan. 
Coleman,  J.  L.,  Pt.,  B, 
9th  Virginia  Cavalry. 
Daniels,  W.,  Pt.,  K,  6th 
A  lahama. 
Edwards,  W.  H.,  Pt.,  G, 
41st  Virginia. 
Fullerton,W.,Pt.,G,GOth 
Ohio,  age  44. 
Phelix,  —  ,  Colored  serv 
ant,  age  25. 

An  n 

July  2, 

'(>3 

May  3,  '63. 

June  7, 
'61 



May  3, 
'03 

,  '63. 

Se.  30,'64, 

1864. 
July  _. 
,  '63. 

1  SMITH  (E.  H.),  Keport  of  Cases  of  Compound  Comminuted  Fracture  of  Femur,  in  Confed.  States  31«d.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  24. 


326 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Amputations  in  the  Lower  Third  of  the  Thigh,  of  Uncertain  Date. — This  group  com 
prises  one  hundred  and  four  cases,  with  thirty-seven  recoveries,  sixty-one  deaths,  and  six 
cases  in  which  the  final  result  could  not  be  ascertained.  The  operations  were  performed  on 
thirty-two  Union  and  seventy-two  Confederate  soldiers;  thirty-seven  amputations  being  on 
the  right  and  forty-six  on  the  left  side,  while  in  twenty-one  this  point  was  not  recorded. 
The  seat  of  the  injury  was  in  the  lower  third  of  the  femur  in  fifty-two,  in  the  knee  joint 
in  twenty  seven,  in  the  leg  in  twenty-four,  and  in  the  foot  in  one  instance.  In  one  of  the 
fatal  cases  the  patient  had  undergone  amputation  of  the  arm,  and,  in  a  second,  haemorrhage 
from  the  femoral  artery  was  followed  by  ligation  of  that  vessel. 

TABLE  XLIV. 

Condensed  Summary  of  One  Hundred  and  Four  Cases  of  Amputations  in  the  Lower  Third  of  the  Thigh, 

of  Uncertain  Date. 

[Recoveries,  1-37;  Deaths,  38-98;  Result  unknown,  99-104.] 


NO. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
54 
55 
56 
57 
58 
59 
60 
61 
62 
63 
64 
65 
66 

NAME,  MILITARY 
DESCRIPTION,  AXD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

I 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 

13 

14 
15 
16 
17 
18 
19 
20 

23 
24 
25 
26 
27 

C8 

30 
31 

33 

Adams.R.T.,  It.,  H,  21st 
Virginia,  age  19. 
Allen,  W.  S.,  Captain,  E, 
2d  Mississippi. 
Bowtn,    /?..   Ft.,   G,  1st 
South  Carolina. 
Burns,  G.,  Pt.,  D,  50th 
Virginia. 
Chamberlain.  W.A.,  Pt., 
A,  61st  Georgia. 
Clarke,  S.,  Pt.,  E,  23d 
North  Carolina. 
Coffee.,    L.,   Pt.,  E,  22d 
Alabama,  age  19. 
Craft,  J.  II.,  Pt.,  F,  7th 
Tennessee,  age  20. 
Fields,  L.,  Pt.,  Latham's 
Batterr. 
Foster,  ~S.,  Pt.,  A,    33d 
Alabama. 
Fountain,  A.  G.  C.,  Pt., 
E,  6th  S.  C.,  age  29. 
Faust,  E.  B.,  Pt.,  13,  13th 
Mississippi,  age  21. 
Gonton,  A.,  Pt.,  F,  25th 
North  Carolina. 
Hoye,B.  H.,  Serg't,  Fall 
ing  Battery,  age  23. 
King,  W.  A.,  Corp'l,  L, 
1st  South  Carolina. 
King,  W.  JJ.,  Pt.,  F,  2d 
Mississippi,  age  23. 
Klfckley,  J.  F.,  Pt.,  A, 
10th  Georgia. 
Lane.;/,  S.  L.,  Pt.,  B,  26tb 
North  Carolina. 
Maddox,  M.,  Corp'l,  F, 
7th  S.  Carolina,  age  19. 
Mahoney,  D.  A.,  Corp'l, 
A,  60th  Alabama. 
lfaud,J.P.,Yl.,  F,  10th 
Virginia  Cavalry. 
Mcrey,W.J.,Pt.,F,y»b 
Virginia,  age  24. 
Nowtand,  J.,  Serg't,  B, 
IstGa.,  Cobb's  Legion. 
Painter,  S.  B.,  Pt.,  H, 
65th  N.  C.,  age  19. 
Parks,  J.  D.,  Pt.,  A,  2d 
Mississippi. 
Phillips,   E.,  Serg't,  C, 
Gth  Miss.,  a.se  23. 
Prong,  A.,    Pt.,   11,    2d 
Louisiana. 
Reed,   A.,  Pt.,  B,  5th  S. 
Carolina. 
R?/an,E.,  Pt..B,  5th  Con 
federate,  age  35. 
Stnne,  S.  M.,  Pt.,  I,  55th 
North  Carolina. 
Strnud,  E.  D.,  Pt.,  H,  8th 
Alabama. 
Talley.  W.  O  ,  Pt.,G,  23d 
Virginia,  age  22. 
Thurman,  M.  P.,  Pt.,  K, 

June  2, 
,'64. 
Sept.  17, 
,'62. 
Sept.  30, 
,'64. 
July  —  , 
,'63. 
June  27, 
'g4 

May  3, 
,'63. 

Left.    Retired  February  10,  1865. 

Left.     Surg.  A.  Y.  P.  Garnett,  P. 
A.  C.  S.     Recovered. 
Right.    Furloughed  December  9, 
1864. 
Right;  bi-lateral  flaps.    Paroled 
August  24,  1863. 
Left  ;  flap.     Discharged  July  17, 
1865. 
Right.    Furloughed  June  16,  '63. 

Left  ;  flap.     Prison  July  4,  1865. 

Tunstall,  P.  A.,  Serg't, 
B,  34th  Virginia. 
Whitaker,  J.,  Capt.,  E, 
47th  Alabama. 
Witlter  spoon,  J.  C.,  Lt., 
D,  1st  S.  Carolina. 
Young,  J.  E.,  Pt.,  H,  7th 
Maine,  age  17. 
Ames,  E.  T.,  Pt.,  I,  1st 
N.Y.  Dragoons,  age  26. 
Asliwood,  T.  W.,  Pt.,  C, 
12th  Virginia  Cavalry. 
Becker,    C.,   Pt,,  C,   2d 
Tennessee,  age  25. 
Blackivood,  J.,   Pt.,   H, 
49th  North  Carolina. 
Boorman,  E.,  Pt.,  C,  6th 
New  Jersey. 
Bostwick,  D".,  Pt.,  C,  2d 
Michigan. 
Bradlty,  T.   C.,  Pt.,  K, 
22d  North  Carolina. 
Burgny,  H.    C.,  Pt.,  F, 
44th  Georgia. 
Byles,  M.,  Pt,,  F,  55th 
North  Carolina. 
Collins,  J.  C.,  Pt.,  C,  2d 
N.  York  M.  R.,  age  29. 
Connelly,  J.  A.,  Pt.,  G, 
100th  Pennsylvania. 
Duffy,  S.  K.,  Pt.,  D,48tb 
New  York. 
Evins,N.,  Pt.,  H,  Cobb's 
Georgia  Legion. 
Faircloth,  J.,Pt.,A,  59th 
Georgia. 
Fowler,  IV.  S.,  Pt.,B,10th 
N.  Carolina  Artillery. 
Freeland  J.  A     Pt.    G 

Left.    Furloughed  December  16, 
1864. 
Left;  circular.     Prison   October 
22,  1864. 
Left.     Furloughed  November  9, 
1864. 
Left.     Furloughed  June  29,  1864. 
Not  a  pensioner. 
Left  thigh.     Died  June  25,  1864. 

1864. 
July  2, 
,'63. 

Sept.  30, 
,'64. 
May  14, 
,'64. 
Mav  7, 
-','64. 

1,  1863  ;  pyaemia. 
Left  ;   circular.      Died  May  19, 
1865. 
Left.    Died  September  14,  1864. 

—  .     Died  May  14,  1862. 
Right.    Died  December  10,  1863. 
Right.     Died  September  1,  1864. 
Left.     Died  October  31,  1862. 
Left.     Died  September  13,  1864. 
Left  thigh.    Died  June  6,  1864. 

Right,  Surg.  G.B.Cogswell.  29th 
Mass.     Died  Dec.  6.  1863. 
Right  thigh.     Died  July  31,  1863. 

1864. 
M'y31,'62. 

J'e2,'64. 

Right.     Furloughed  October  5, 
1864. 
;  circular.    Transferred. 

Uight.     Provost  Marshal  May  31, 
1865. 
Left.    Retired  March  15,  1865. 

May  5, 
,'62. 
Nov.  24, 
,'63. 

1865. 
Nov.  29, 
1863. 

Sept.  307 
,'64. 
Aug.  16, 
,'64. 
Sept,  17, 
,'62. 
Aug.  —  , 
,'64. 

Left.     Prison  April  14,  1865. 

Right.    Furloughed  September  2, 
1864.                        • 
Right,     Dr.  Bads.     Transferred 
March  3,  1863. 
Right.     Furloughed  October  21, 
1864. 
Right.    Furloughed    October  6, 
1864. 
Righ  t.    Exchanged  March  1  7,  '64. 

Right.   Discharged  October  9,  '65. 

Left.     Surg.  —  Douglas,  C.  S.  A. 
Recovered. 
Right.     Retired  March  27,  1865. 

Left  thigh.     Recovered. 

Left.     Discharged  from  hospital 
July  2,  1865. 
.    Discharged  October  4,  'Gl. 

Left  ;  ant.  posterior  flap.    Provost 
Marshal  March  7,  1865. 
Left.    Duty  August  17,  1863. 

Left.     Furloughed  December  16, 
1864. 
Left.     Retired  December  31,  '64.  : 

Right.  Exchanged  November  12, 
1863. 
Right.  Furloughed  October  1,  '63. 

Left.     Retired  January  20,  1865. 

Right.     Furloughed  October  21, 
1864. 

1864. 
May  31, 
,'64. 
Nov.  21, 
,'63. 
July  18, 
,'li3. 

1864. 
Sept.  30, 
,'64. 

Right.     Died  January  26,  1865. 
Left  thigh.     Died  March  29,  1865. 
Left  thigh.     Died  May  20,  1862. 
Right.     Died  September  16,  1864. 
Right  thigh.    Died  June  16,  1863. 
—  .    Died  November  2,  1862. 

Right  :  double  flap.     Died  Aug. 
11,  1862. 
.     Died  July  31,  1863. 

Right  ;  circ.     Died  May  28,  1864  ; 
exhaustion. 
—  .     Died  May  16,  1862  ;  hem 
orrhage. 
Left.     Died  November  4,  1862. 

Right  thigh.     Died  June  17,  '64. 
.     Died  July  26,  1863. 
.     Died  July  9,  1862. 

Left.     Died  October  8,  1862;  py- 
spmia. 
Left  thigh.     Died  June  10.  1862. 

July  1, 
,'63. 

May  5, 

,'62. 

Mav  22, 
-,'64. 
Mar.  23, 
1862. 
Sept.  17, 
,'62. 
April  2. 
,'65. 
July  21, 
*gl_ 

Nov.'  30, 
'£4 

May  27, 
,'63. 

5th  New  Jersey. 
GHsson,  J.,  Pt.,  A,  llth 
Florida. 
Hamilton,  W.,  Pt.,  124th 
New  York,  age  44. 
Harmon,  J.  E.,  Pt.,  G, 
79th  Pennsylvania. 
Ingalls.A.  S.,  Major,40th 
New  York. 
Johnson,  D.R.,Pt.,T,82d 
New  York. 
Knapp,  E.,   Pt.,  A,  4th 
Vermont,  age  34. 
Knox,  J.  F.,  Pt.,  H,  13th 

Mav  3, 
1.'63. 
Oct.  8, 
,'62. 

1862. 
July  —  , 
,'63. 
May  5, 
,'64. 
May  5, 

'(]0_ 

Oct!  8,' 

,'62. 
May  16, 
'g4_ 

July  2, 
"'63. 
June  27, 
,'62. 

North  Carolina. 
Kuraeh,  C.,  Pt.,  D,  10th 
Ohio. 
Lovell,  D.O.,  Pt..  n,25th 
Massachusetts,  ago  25. 
Lovell,  W.  H.,   Pt.,   B. 
72d  New  York. 
Maloy,    P.,  Pt.,  D,  5th 
Cavalry. 
Martin,  C.,  Pt.,  I,  38th 
Illinois. 
Martin,  G.  C.,  Pt.,  G,  2d 
Maine. 

June  25, 
,'64. 
July  —  , 
,'63. 
July  2, 
,'63. 
May  5, 
,'64. 
June  12, 
,'64. 

1862. 
April  —  , 
,'62. 

6th  South  Carolina. 

SECT.  III.] 


AMPUTATIONS  IN  THE  THIGH  OF  UNCERTAIN  DATE. 


327 


NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

67 
68 
69 
70 
71 
72 
73 
74 
75 
76 
77 
78 
79 
80 
81 
82 
83 
84 
85 

Maxey,  D.  M.,  Serg't,  C, 
3d  Maine. 
May,   G.,  Pt.,  I,  55th  X. 
Carolina. 
May,  J.,  Pt.,  K,  9th  Ala 
bama,  age  2U. 
McDonald,  J.  M.,  Pt.,  G, 
21st  Georgia. 
itcElree.n,  £..Pt.,E,  20th 
Georgia,  age  18. 
McGovern,  J.,  Pt.,H,  9th 
Massachusetts. 
McKenzie,  J.  R.,  Pt.,  E, 
1st  Minnesota. 
McKerroll.J.M.,  Ensign, 
C.  1st  S.  C.  Cavalry. 
Mil!er.M.S..Pt.,E,  116th 
Ohio. 
Minple,    E.,    Serg't,  A, 
148th  Pennsylvania. 
Myers,  A.  Jt.,  Pt.,  I,  48th 
Virginia. 
Myers,  G.  K.,  Pt.,  E,  6th 
Virginia  Cavalry. 
Kettle.-!,  W.,  Pt.,  C,  llth 
South  Carolina. 
Peele,  J.  J.,  Pt.,  C,  3d  N. 
C.  Artillery,  age  19. 
Pegram,  S.',  Pt.,  E.  22d 
North  Carolina. 
Pellett,  S.  S.,  Pt..  D,  4th 
Louisiana,  age  24. 
Petersrm,  S.,  Pt..  I,  56th 
North  Carolina. 
Pilney,  G.  H.,  Pt.,  C,  2d 
N.  Y.  II.  A.,  age  25. 
Poole.  J.,  Pt.,    G,    13th 
Mississippi. 

July  2. 
,'63. 

Right.     Died  August  14,  1863. 
Right.    Died  September  10,  1864. 

.     Surg.  —  Thorn,  C.  S.  A. 
Died  Sept,  3,  1862. 

86 
87 
88 
89 
90 
91 
92 
93 
94 
95 
96 
97 
98 
99 
100 
101 
102 
103 
104 

Powers,  E.  6.,  Pt.,  K, 

40th  N.  C.,  age  27. 
Pridmore,  F.,  Serg't,  K, 
41st  Alabama. 
Reed,    F.,  Pt.,   A,  53d 
Illinois. 

Left;  flap.      Died  February  12, 
1865;  pyaemia. 
Right  thigh.     Died  April  6,  1865. 

Left.     (Amputation  arm.)     Died 
August  12,  1863. 
Left.     Died  September  9,  1864. 

J'y30,'62. 

July  12, 
,'63. 

May  28, 
'(54 

J'y30,'62. 

July  3, 
,'63. 

26,  1863. 
Left.    Died  August  14,  1864. 

.     Died  August  5,  1862;  ex 
haustion. 
Left  thigh.    Died  August  7,  1863. 

Right.     Died  August  22,  1864. 
Right.    Died  September  11,  1864. 
Right.     Died  August  1,  1863. 

Right.     Died  May  17,  '64  ;  morti 
fication  of  stump. 
Left  ;  slough  ;  haem.;  lig.  fern,  art.; 
haem.  recur'd.    Died  Oct.  10,  '64. 
Left.    Died  September  14,  1864. 

Left.    Died  February  12,  1865; 
pyaemia. 
Left.     Died  September  20,  1864. 

;  circular.     Died  August  20, 
1864. 
Right.    Died  January  2,  1865. 

Left  thigh.     Died  June  12,  1864. 
Died  August  28  1861 

South  Carolina. 
SeJoy,  A,,  Corp'l,  1C,  15th 
Louisiana. 
Smith,  W.  H.  H.,  Pt.,  G, 
55th  Penn.,  age  22. 
Smoot,  D.  J.,  Lieut.,  G, 
4th  North  Carolina. 
Snyder,  J.,    Pt.,    L,  2d 
Mich.  Cavalry,  age  33. 
Spain.  II.  P.,  It.,  D,  21st 
South  Carolina. 
Templin,  W.  C.,  Corp'l, 
C,  73d  Ohio. 
Thompson,  G.  T.,  Pt.,  F, 
56th  North  Carolina. 
Walker,  II.,  Pt.,  F,  27th 
Massachusetts,  age  35. 
Webb,  J.,  Pt.,  C,  5th  Ar 
kansas. 
Barrett,  J.  L.,  Pt.,   H, 
21st  Virginia. 
Pewell,J.  17.,  Pt.,  A,  4th 
Virginia  Cavalry. 
Prather,J.,  Pt.,  H,  41st 
Alabama. 
Racer,    W.,   Pt.,    Fry's 
Battery,  Orange  Art. 
Thomas,  C.,  Pt.,  G,  5th 
Col'd  Troops,  age  22. 
Tibbs,  J.  A.,  Pt.,  F,  50th 
Alabama. 

Sept.  29, 
,'64. 

Right.     Died  October  23,  1864. 

1864. 
Dec.  25, 
,'63. 

Right.     Died  April  12,  1864  ;  con 
gestion  of  the  brain. 
Left  thigh.    Died  June  9,  1864. 

Left  thigh.    Died  August  9,  1863. 
Left  thigh.    Died  April  12,  1865. 

Right.      Died  August  3,   1864; 
exhaustion. 
Left.     Died  November  2,  1862. 

Right  thigh. 
Right  thigh. 
Left  thigh. 
Left  thigh. 
Left  thigh. 
Left  thigh. 

June  5, 
,'64. 
July  3, 
.,'63. 
May  6, 
,'64. 

July  —  , 

,'<>3. 

July  14, 
-,'64. 
Oct.  8, 
.'02. 

1864. 

1865. 

1864. 
June  3, 
-g4 

July  21, 
,'61. 

Sept.  29, 
,'64. 

1865. 

Amputations  in  the  Continuity  of  the  Femur,  of  Uncertain  Date,  and  without  Indica 
tion  of  the  Seat  of  Operation. — In  three  hundred  and  eleven  cases  of  amputations  of  the 
thigh  the  interval  between  the  injury  and  the  operation  and  also  the  precise  seat  of  the 
operation  were  not  recorded.  The  operations  were  performed  on  three  hundred  and  nine 
patients,  in  two  instances  both  thighs  having  been  amputated;  seventy-nine,  among  them 
one  with  an  amputation  of  both  thighs,  recovered,  and  two  hundred  and  eleven  perished, 
while  the  fate  of  nineteen  could  not  be  ascertained,  giving  a  death-rate  of  72.7  per  cent, 
for  the  determined  cases.  Eighty-nine  were  Union,  and  two  hundred  and  twenty  were 
Confederate  soldiers.  The  three  hundred  and  eleven  operations  were  on  the  right  side  in 
eighty-nine  instances,  on  the  left  in  one  hundred,  and  not  stated  in  one  hundred  and  twenty- 
two.  Such  meagre  details  as  ace  entered  on  the  records  of  this  Office  will  be  found  in  the 
following  table: 

TABLE  XLV. 

Condensed  Summary  of  Three  Hundred  and  Eleven  Oases  of  Amputations  of  the  Thigh,  of  Uncertain 

Date  and  Seat. 

[Recoveries,  1-80;  Deaths,  81-292;  Result  unknown,  293-311.] 


No. 

1 
o 

3 
4 

5 
6 
7 

NAME,  MILITARY 
DESCRIPTION-,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

8 
9 
10 
11 
12 
13 
14 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

Barclay,  R.  G.,  Lieut., 
G,  5th  Louisiana. 
Bass.  J.,  Pt.,  F,  2d  South 
Carolina. 
Host.  H.  M.,  Pt.,  F,  1st 
North  Carolina,  uge  18. 
Bowie.  H.  L.,  Capt.,  H, 
6th  Alabama. 
Boyle,,  J.  R.,  Lieut.,  C, 
12th  South  Carolina. 
Bristnw,   J.    C.,   Pt.,  E, 
5th  Texas. 
Drown,  E.  Z.,  Pt.,  D,  1st 
South  Carolina. 

May  3, 
-",'63. 
July  —  , 
,'63. 
June  1, 
.'64. 
May  12, 
-,'64. 
July  1, 
,'63. 

Right.     Furloughed  October  26, 
1863. 
.     Transferred  Oct.  1,  1863. 

Right,   Retired  January  24,  1865. 
Left.    On  leave  July  4,  1864. 

Right.      Furloughed  March  12, 

1864. 

Brownfield,   T.  A*.,  Pt., 
G,  9th  Georgia. 
Bullard,  J.  N.,  Pt.,  G, 
12Jh  Georgia. 
Carlisle,  V.,  It.,  F,  40th 
Alabama. 
Carter.  J.  P.,  Pt.,  K,  2d 
Va.  Cavalry,  age  81. 
Christian,  J.  O.,  Serg't, 
D,  8th  Georgia. 
Daniels,  J.A.,  Pt.,  K,9th 
Georgia. 
Dunkin,  G.   W.,  Pt.,  D, 
33d  North  Carolina. 

Oct.  7, 
,'64. 
May  3,' 
','63. 

Left.    Furloughed  December  24, 
1864. 
Left.     Furloughed  June  24,  1863. 

Left  thigh.    Recovery. 
Right.  Retired  February  16,  1865. 

Right.  Furloughed  December  27, 
1864. 
Right.   Retired  December  16,  '64. 

.   Surg.  —  Hickerson,  C.S.A. 
Recovery. 

Sept.  30, 

Get'.  7,  ' 
,'64. 
June  30, 
,'62. 

Sept.  30, 
—  '64. 

Right.      Furloughed   November 
17,  1864. 

328 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


fCHAP.  X. 


No. 

15 
16 
17 
18 
19 
20 
21 
22 
23 
24 

26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
36 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 

49? 
505 

51 

52 
53 
54 
55 
56 
57 
58 
59 
60 
61 
62 

NAME,  MILITARY 
DESCRIPTION,  AND  AOE. 

DATFS. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

63 
64 
65 
66 
67 
68 
69 
70 
71 
72 
73 
74 
75 
76 
77 
78 
79 
80 
81 
82 
83 
84 
85 
86 
87 
88 
89 
90 
91 
92 
93 
94 
95 
96 
97 
98 
99 
100 
101 
102 
103 
104 
105 
106 
107 
108 
109 
110 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

Dunn,  S.  M.,  Lieut.,  A, 
Cabell's  Art'v  Batt'n. 
EargU,  W.  K.,Corp'l,  H, 
13th  South  Carolina. 
Edens,  W.  M.,  Pt.,  B,  9th 
Louisiana. 
Ennis,  H.,  Pt.,  F,  26th 
North  Carolina,  age  38. 
Evans,   C.,  Pt.,  I,   47th 
North  Carolina. 
Fadeley,  I.  P.,  Pt.,  K, 
33d  Virginia. 
Fears,  E.  B.,  Serg't,  E, 
3d  Georgia. 
Foster,  J.  A.,  Serg't,  F, 
52d  North  Carolina. 
Fowler,  E.  \V.,  Lieut.,  C, 
18th  North  Carolina. 
Frangan,  A.,  Corp'l,  C, 
2d  Missouri. 
Gammon.  O.  D.,  Pt.,  D, 
44th  Virginia. 
Gleadon,  G.  W.,  Pt.,  G, 
19th  Georgia. 
Haymon$,A.,  Pt.,  F,  12th 
Georgia. 
Hays,  B.  W.,  Pt.,  G,  17th 
Georgia. 
Hfderick,  H.  J.,  Pt.,  E, 
25th  Virginia. 
He.nde.mon,  D.  J.,  Pt.,  A, 
3.~>th  North  Carolina. 
Holmes,  M.C.,  Lieut.,  H, 
4th  Texas. 
Huffman,  \V.,  Pt.,  I,  1st 
Kv.  Cavalry,  age  19. 
Hughes   J     Pt.    F  54th 

June  4, 
,'64. 
July  3, 
,'63. 
,'65. 

May  5, 
,'64. 
Oct.  14, 
,'63. 
July  21, 
,'61. 
,'64. 

Right.   On  leave  August  12,  1864. 
Left.  Paroled  September  12,  1863. 

Left.     Discharged  September  26, 
1865. 
Right.    Retired  February  23/65. 

Left  thigh.     Fnrloughed. 
.     Recovery. 

Left.     Furloughed  January   17, 
1865. 
Right.     Released  June  14,  1865. 

Left.    Transferred  September  30, 
1664. 
Left.     Transferred  March  10,  '63. 

.     Furloughed  July  2,  1863. 

Shippey.  J.,  Pt.,  C,  5th 
South  Carolina. 
Singleton,  R.  L.,  Serg't, 
C,  17th  Tenn.,  age  22. 
Smith,  J.,  Pt.,  1,  1st  Mis 
souri  L.  A.,  age  22. 
Smith,  J.  C.,  Pt.,  G,  llth 
South  Carolina. 
Spainhond,  P.,  Pt.,  D, 
53d  North  Carolina. 
Spears,   A.  D.,   Pt.,  H, 
15th  South  Carolina. 
Stevens,  J.  G.,  Lieut.,  E, 
4th  Georgia. 
Stone,  J.  L.,  Pt.,  B,  37th 
Virginia. 
Stovall  J  E   Pt    B  21st 

• 

Dec.  31, 
,'62. 
June  18, 
'61. 

Oct.'  27,' 
,'64. 
July  —  , 
,'63. 
July  28, 
,'64. 
Oct.  12. 
,'63. 
May  3, 
,'63. 

Left.    Retired  March  18,  1865. 

Right.  Discharged  November  30, 
1861. 
Right.     Furloughed  January  21, 
1865. 
.      Exchanged    October  22, 
1863. 
Left.    Furloughed  September  6, 
1864. 
Left.     Furloughed  November  11, 
1863. 

,'64. 

Oct.  8, 
,'62. 
May  2, 
,'63. 
Sept.  17, 

'£;>_ 

Sept.'  

Georgia. 
Weeks,  W.,  Pt.,  C,  34th 
North  Carolina. 
Welch,  J.,  Pt.,  D,  3d  Ar 
kansas. 
Whitly,  D.,  Pt.,  H,  27th 
North  Carolina. 
Whitman,  R.  F.  Pt.  A 

Mav  3, 
,'63. 

Sept.  19, 
,'63. 

Right.     Furloughed  July  6,  1863. 
Right.     Retired  December  31/64. 

Right.      Transferred   September 
30,  1864. 
Left.     Discharged  November  5, 
1862. 
Left.     Furloughed  November  12,  ' 
1863. 
Right.     Furloughed  June  25,  '63. 

Right.    On  leave  August  15,  '64. 

Left.     Furloughed  February  21, 
1863. 
Left.     Furloughed  March  14,  '65. 

Right.     Died  May  27,  1864;  py. 
asmia. 
Left.     Died  August  26,  1864. 

.      Died  October  —  ,    1863; 
wound. 
Right.     Died  July  28,  1862. 

.     Died  January  1,  1864. 

March  4,  1863. 
Right.    Discharged  from  hospital 
May  28,  1863. 

44th  Alabama. 
Willis,H.C.,  Pt.,  B,  45th 
North  Carolina. 
Winslow,  E.  G.,  Pt.,  G, 
29th  Mississippi. 
Woodbridge,  \V.  B.,  Lt. 
Col.,  4tb  Va.  Cavalry. 
Youngblood,  fF.S.,Corp., 
A,  45th  Georgia. 
Zoble,  J.,  Pt.,  E,  3d  S. 
Carolina. 
Abernathy,  S.  M.,  Pt.,  B, 
28th  North  Carolina. 
Adicks,  H.,  Pt.,   I,  27th 
South  Carolina. 
Allen,  C.  A.,  Pt.,  E,  1st 
Michigan  Cavalry. 
Allen,  R.,  jr.,  Lieut.,  F, 
1st  Cavalry. 
Amos,   D.  J.,   Serg't,   1, 
5th  Georgia. 

Oct.  14, 
,'63. 

Right.     Discharged   August  29, 
1862. 
Left.     Furloughed  July  26,  1864. 

Right.     On  leave  September  26, 
1863. 
Left     Discharged  December  1, 
1864. 
Right.     Furloughed  June  11,  '63. 

Right.     Furloughed  June  25,  '63. 
.     On  leave  February  11/64. 
Right.    Retired  February  3,  1865. 
Left.     Furloughed  April  1,  1864. 
Right.     Retired  October  10,  1864. 

May  20, 
,'64. 
Aug.  30, 
,'62. 
Aug.  15, 
,'63. 
May  4, 
,'63. 
Mav  2, 
-",'63. 
Nov.  14, 
,'03. 
Sept.  30, 
,'ti4. 
Nov.  27, 
,'63. 

Nov.  —  , 
,'63. 

North  Carolina. 
Ime,  L.  C.,  Pt.,  F,  60th 
Georgia. 
James,  J,  W.,  Lieut.,  A, 
21st  Georgia. 
Jones,  O.   T.,  Pt.,  H,  2d 
S.  C.  Uifles.  age  21. 
Lawrence,  J.  H.,  Serg't, 
B,  4th  Virginia. 
Lawrence,  P.,Pt.,B,19th 
Louisiana,  age  2">. 
Lutz,  C..  Serg't,  Marine 
Corps,  U.S.  N.,  age  29. 
Mathews,  J.,  Pt.,  F,  32d 
North  Carolina. 
McDnniel.  J.  J.,  Serg't, 
F,  35th  Georgia. 
Miller,  S.,  Pt.,  A,  1st  Mo. 
.S.  M.  Cavalry. 
Minx,   It.,    Pt.,    H,  6th 
Georgia. 
Mook,  L.  A.,  Pt.,  G,  2d 
North  Carolina  ISat'ry. 
Morgan,  E.  C  ,  Serg't,  E, 
2d  S.  Carolina  Hides. 
Moss,    W.,  Pt.,    H,    4th 
Alabama. 
HalUn,  W.,  Pt.,  D,  45th 
Alabama. 
Nunnery,  J.  31.,  Pt.,  A, 
41st  Louisiana. 

Parker,   J.   A.,  Pt.,  L, 
Cobb's  Ga.  Leg.  Cav. 

Patterson,    P.    B.,   Pt., 
Adam's  Co.  Hampton's 
S.  Carolina  Legion. 
Patterson,    W.,  Pt.,  G. 
27th  North  Carolina. 
Perkins,  C.,  Pt.,  B,  1st 
Louisiana. 
Pierce,  r.M.,Pt..  B.Brad 
ford's  Battery,  age  22. 
Reid,  A.  J.,  Pt.,  I,  37th 
North  Carolina. 
Rhoades,C.A  ,  Serg't,  B, 
10th  Georgia. 
Roberts.  C.  M.,  Lieut.,  B, 
1st  N.  C.  Cavalry. 
Robertson  G.  7'.JV.,Corp., 
H,  Kith  N.  Carolina. 
Robertson,  J.A.,  Serg't, 
B,  12th  Georgia,  age  21. 
Robinson,  E.  is.  />.,Pt,,B, 
1st  South  Carolina. 
RtMedge,  R.  S.,  Corp'l, 
C,  1st  South  Carolina. 
Segrist,  D.  F.,  Pt.,  B,  4th 
Alabama. 

,'64. 

July  14, 
,'63. 
June  28, 
,'62. 
Dec.  5, 
,'C3. 

De.  9,  '64. 

Texas. 
Axhbi/,   W.,  Pt.,  F,  8th 
North  Carolina. 
Atridge,  R.,  Corp'l,  A, 
.  6th  Wisconsin. 
Ballentine,  J.  L.,  Serg't, 
A,  6th  South  Carolina. 
Barbor,  A.,   Pt.,   D,   3d 
Michigan. 
Barlow,  M.,  —  ,  D,  109th 
New  York,  nge  41. 
Baughan,  R.  E.,  Pt.,  D, 
21st  Virginia. 
Beaman,    C.    C.,  Pt.,   G, 
3d  Arkansas. 
Bellflower,    H.,    Pt.,   II, 
14lh  Georgia. 
Blair,  S.  F.,  Pt.,B,  38th 
Virginia. 
Bonncll    \V.  W.   Pt    I 

Discharged  Nov.  17.  1865. 
Right.     Transferred  April  9,  '65. 

Left.     Furloughed   February  9, 
1863. 

Sept.  17, 
,'62. 

Right,     Died  November  28,  1862. 
Right.     Died  March  28,  1865. 

.     Died  September  22,  1862  ; 
diarrhoea. 
Left.     Died  May  29,  1864. 

Left.     Died  June  4,  1865. 
Died  July  10  1863 

Aug.  30, 
,'62. 
,'64. 

,'C3. 

July  3, 
.'63. 

Right.      Transferred   August  3, 
1863. 

Left.     Furloughed  March  17,  '65. 

.     Discharged  September  9, 
1861. 
Left.     Transferred  February  11, 
1863. 
Right.     Parolsd  June  21,  1865. 

Both.     Furloughed  Aug.  2,  1864. 
.     Discharged  August  29,  '61. 

Jul  y 

July  21, 
—  -,'61. 
Oct.  8, 
,'62. 

,'63. 

July  —  , 
,'63. 
May  3, 
,'63. 
,'63. 

June  14, 
,'03. 
Sept.  17, 
,'62. 

Right.     Died  December  24,  1862. 
—  .     Died  July  15,  1863. 
Left.     Died  June  7,  1863. 
Left.    Died  December  9,  1863. 
.     Died  July  15,  1863. 
Right.     Died  November  1  ,  1862. 

Left.     Died  June  15,  1864  ;  py- 
a?mia. 

June  24, 
,'64. 

,'61. 

Sept.  17, 
,'62. 

26th  New  Jersey. 
Bowen,A.  P.,  Lieut.,  F, 
4th  Virginia. 
Brayman,  G..  Pt.,  E,  52d 
Massachusetts,  age  18. 
Bresuer,  J.,  Pt.,  H,  9th 
New  York. 
Brewer,  J.  C'.,Pt.,  D,  13th 
Mississippi. 
Bristor,  P.,  Pt.,  C,  16th 
Tennessee. 
Brown,   J.,    Pt.,  L,  1st 
Texas. 
Bryant,  J.S.,Pt.,  1,  100th 
Ohio. 
Bryant,  T.  D.,  Capt.,  A, 
27th  North  Carolina. 
Burrows.   P.   A.,  Pt.,  I, 
57th  Massachusetts. 
Burwenick,  A.,  Pt.,  A, 
1st  Kansas. 
Butler,  L.  P.,  Pt.,  H,  2d 
Ohio  Cav.,  age  18. 
Butler,  W.B.,  Pt.,  I,  50th 
Georgia. 
Campbell,  G.  J.,  Corp'l, 
D,  10th  Maine. 
Chadman,  J.  H.,  Colored 
Teamster. 

April  27,  1863. 

Oct.  8, 
,'62. 

Left  ;    circular.      Released   July 
13,  1865. 

Died  July  10  1863 

/63. 
May  8, 
','64. 

Right.     Died  June  1,  1864. 
Right.     Died  October  30.  1863. 

Left.      Died  June   1,    1864  ;    ex 
haustion. 
.     Died  August  24,  1861. 

Right.     Died  August  7,  1864. 
Left.    Died  August  7,  1863. 
.     Died  September  20,  1862. 
Left.     Died  August  13,  1863. 

May  3, 
,'63. 
Aug.  15, 
,'64. 
July  3, 
,'63. 
Feb.  6, 
,'65. 

Right.     Furloughed  June  23,  '63. 

Right.    Furloughed  September  9, 
1864. 
.    Paroled  September  5,  1863. 

Left.     Retired  March  17,  1865. 

.      Discharged    October  24, 
1862. 
Right.      Furloughed   November 
17,  1864. 
Right.  Discharged  June  26,  186-. 

May  6, 
,'64. 
Aug.  10, 
,'61. 
July  2, 
,'64. 

Tiilv 

Sept.  30, 
,'64. 

,'63. 
Aug.  9, 
.'62. 
July  3, 
,'63. 

SECT.  III.] 


AMPUTATIONS    IN    THE    THIGH    OF    UNCERTAIN    DATE. 


329 


No. 

Ill 

112 

113 
114 
115 
116 
117 
118 
119 
120 
121 
122 
123 
124 
125 
126 
127 
128 
129 
130 
131 
132 
133 
134 
135 
136 
137 
138 
139 
140 
141 
142 
143 
144 
145 
146 
147 
148 
149 
150 
151 
152 
153 
154 
155 
156 
157 
1C8 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

159 
160 
161 
162 
163 
164 
165 
166 
167 
168 
169 
170 
171 
172 
173 
174 
175 
176 
177 
178 
179 
180 
181 
182 
183 
184 
185 
186 
187 
188 
189 
190 
191 
192 
193 
194 
195 
196 
197 
198 
199 
200 
201 
202 
203 
204 
205 
206 

NAME,  MILITAKY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

Chappel,  B.  J.,  Lieut.,  I, 
21st  South  Carolina. 
Chappie,  J.  A.,  Capt.,  E, 
3d  Virginia  Cavalry. 
Cheevers,  K.,  Pt.,  F,  34th 
Georgia. 
Church,  W.,  Pt.,  K,  5th 
Vermont,  age  23. 
Clark,  J.  R.,  Serg't,  K, 
115th  New  York. 
Comer,   W.  E.,  Pt.,  C., 
34th  North  Carolina. 
Cone,   T.  J.,  Lieut.,  G, 
18th  Georgia. 
Conklin,  J.W.,Lieut.,  K, 
152d  New  York. 
Connor,  J.  B.,  Pt.,  F,  3d 
South  Carolina. 
Cook,  G.  M.,  in.,  B,  28th 
New  York. 
Cooper,  J.,  Pt.,  C,  73d 
Illinois. 
Copage,   W,  F.,  Pt.,  A, 
8th  N.  Carolina,  age  17. 
Crews,  B.,  Pt.,E,2dN. 
Carolina  Battery. 
Crowley,  T.,  Pt.,  A,  1st 
Minnesota. 
Cunningham,  P.,  Pt.,  E, 
5th  North  Carolina. 
Dumpert         Pt    H  4th 

Died  July  8  1864 

Hamlin,  J.,  Pt.,  D,   1st 
Penn.  Rifles,  age  28. 
Hancock,  T.,  Pt.,  I,  5th 
North  Carolina. 
Hannah,  E.  Ji.,  Pt.,  G, 
45th  Georgia. 
Hardsaw,  D.,Pt.,B,  17th 
Iowa. 
Harner,  W.   T.,  Serg't, 
E,  98th  Ohio,  age  39. 
Hartneady,  P.,  Pt.,  B, 
69th  New  York,  age  26. 
Hatley,  D.,  Pt.,  K,  21st 
North  Carolina. 
Hawes,  J.  E.,  Lieut.,  G, 
2d  Virginia  Battery. 
Hedriclc,  TF.,  Pt.,  C,  1st 
N.  Carolina  Jun.  Res. 
Henderson,  J.  M.,  Pt.,  F, 
2d  South  Carolina. 
Hera,  E.  A.  W.,  Pt.,  D, 
7th  Tennessee. 
Hernandez,  I.,Pt.,C,39th 
New  York. 
Hill,  L.  N.,  Pt.,  G,  14tb 
Georgia. 
Binds,  L.  A.,  Pt.,  H,  1st 
South  Carolina. 
Hoffman,  A.,  Pt.,  C,  30th 
New  York. 
Holder.  G.  A.,  Pt.,  H,  6th 
Alabama. 
Holmes,  B.,  Pt.,  F,  57th 
North  Carolina. 

Right.    Died  June  28,  1864. 
—  .     Died  July  12,  1863. 
.     Died  July  27,  1863. 
Left.    Died  August  15,  1863. 
.     Died  November  9,  1862. 
—  .    Died  June  11,  1864. 
.     Died  July  24,  1863. 
Left.    Died  December  24,  1862. 

Left.    Died  March  25,  1865;  ery 
sipelas  and  tetanus. 
Right.    Died  June  1,  1863. 

,'64. 

Left.    Died  September  24,  1864. 
Right.     Died  March  27,  1865. 

Right.     Died  August  19,  1862; 
chronic  diarrhoea. 
Right,    Died  August  15,  1864. 

Left.    Died  April  8,  1865. 
Left.     Died  July  7,  1862. 
Left.    Supposed  to  be  dead. 

July  —  , 
,'63. 
July  —  , 
,'63. 
May  14, 
,'63. 
Oct.  8, 
,'62. 
,'64. 

July  —  , 
,'63. 

,'62. 
'g4 

May  6, 
,'64. 
'go 

Aug.  9, 
,'62. 
Oct.  8. 
,'62 
June  3, 
,'64. 
July 

Right.     Died  October  30,  1862. 
Right.    Died  June  15,  1864. 
Died  July  16  1863 

May  6, 
,'64. 

Left.     Died  June  13,  1864. 
.     Died  January  9,  1863. 

Right.     Died  October  15,  1864; 
pneumonia. 
Right.     Died  November  17,  1862. 

Left.    Died  May  27,  1864;    py 
aemia. 
.     Died  July  17,  1863. 

Left.    Died  August  4,  1863. 
Right.     Died  October  1,  1863. 
.     Died  July  19,  1863. 

,'63. 
July  3, 
,'63. 
July  6, 
,'63. 

Right.     Died  July  27,  1863. 
Left.     Died  July  17,  1863. 

,'64. 

Sept.  17, 
,'62. 

Alabama. 
Damsoe,  C.  S.,  Serg't,  D, 
14th  South  Carolina. 
Dew,  J.,  Pt.,  B,  44th  N. 
Carolina. 
Donohoe,  F.,  Pt.,  B,  15th 
Louisiana. 
Dowdy,  J.,  Pt.,  B,  llth 
Virginia. 
Dufiield,W.,  Pt.,  D,  86th 
Illinois. 
Dtmbar,  A.B.,  Pt.,  1,  33d 
Massachusetts. 
Everett,  D.,  Pt.,  E,  7th 
Ohio. 
Fallen,  J.  S.,  Corp'l,  K, 
1  Ith  Georgia. 
Font,  L.  T.,  Pt.,  A,  llth 
Mississippi. 
Farris,  R.  E.,  Corp'l,  G, 
10th  Maine. 
Fieldsend,  H.,  Pt.,  I,  5th 
Connecticut. 
Fleming,  J.,  Pt,  K,  7th 
Louisiana. 
Frank,  A.,    Pt.,    I,    5th 
Louisiana. 
Freeman  B    Pt          5th 

July  —  , 
,'63. 

Right.     Died  July  23,  1863. 
Left.     Died  October  23,  1863. 

July  —  , 
,'63. 

tery. 
Holt,  R.  S.,  Pt,,  A,  Mor 
ris's  Artillery. 
Howard,  T.,  Pt.,  —  ,  28th 
North  Carolina. 
Bowse,   A.    J.,   Pt.,    C, 
Cobb's  Legion. 
Irwin,  J.  C.,  Pt.,E,  37th 
Mississippi. 
Jackson,  F.,  Pt.,  G,  27th 
North  Carolina. 
Jenkins,   S.,  Serg't,    B, 
6th  Louisiana. 
Johns,  —  ,  Corp'l,  E,  2d 
Infantry. 
Johnson,  W.,  Pt.,  F,  1st 
Tennessee. 
Johnston,  A.,  Pt.,  D,80th 
Ohio. 
Keith,  A.  B.,  Corp'l,  I. 
7th  Massachusetts. 
Kelly,  M.,  Pt.,  H,  43d 
North  Carolina. 
Kendrick,  T.  L.,  Pt.,  A, 
10th  Maine. 
King,  D.  K.,  Capt.,  B, 
48th  Alabama. 
Lair,  A.,  Serg't,  C,  1st 
Penn.  Cavalry. 
Letellier,  J.   C.,  Pt.,  E, 
19th  Virginia. 
Loyd,  B.  F.,  Pt.,  G,  22d 
Georgia. 
Mahon,    S.   B.,   Pt  ,  D, 
7th  Penn.  Reserves. 
Mathews,  J.,  Pt.,  I,  48th 
Georgia. 
McBride,  B.,  Pt.,  B,  42d 
Mississippi. 
McClendon,R.  L.,  Pt.,G, 
61st  Alabama. 
McCrae,   F.,  Serg't,  K, 
8th  South  Carolina. 
McCullough    IF.   Pt.  K 

,'63. 

,'64. 

June  27 
>g4 

May  15 
,'64 
Sept.  17 
,'62 

Left.     Died  May  22,  1864. 
Right.     Died  August  8,  1864. 

Left.    (Also  fracture  right  femur.) 
Died  June  25,  1864. 

July  —  , 
,'63. 

Oct.  8, 
,'62. 

.      Died  October  21,    1862; 
pyaemia. 
Right.    Pyaemia.   Died  March  21, 
1865. 
Right.     Died  April  11,  1865. 

.    Died  August  20,  1861. 
.    Died  October  26,  1862. 
Right.    Died  December  13,  1862. 
Left.    Died  June  2,  1863. 
Right.    Died  May  22,  1864. 

Right.     Died  September  31,  1862. 

Left.    Sloughing;  pyaamia.   Died 
December  26,  1862. 
Died  September  5,  1862. 

.     Died  August  19,  1862. 

Left.      Died  October    12,    1863; 
pyajmia. 

,'62. 

Aug.  9, 
,'62. 
Aug.  9, 
,'62. 

Aug.  10, 
,'61. 
Oct.  2, 
,'62. 
Oct.  3, 
,'62. 
May  3, 
,'63. 

Aug.  9. 
,'62. 

Texas. 
Freeman,  G.,  Pt.,H,  26th 
Michigan,  age  22. 
Funderbunk,  F.,  Pt.,  E, 
8th  Georgia. 
Gamage,   T.  B.,  Pt.,  E, 
!Hh  Georgia. 
Geron  AD   Pt.  C  84th 

'6-1 

Left.     Died  June  17,  1864. 
—  .     Died  August  28,  1861. 
—  .     Died  January  1,  1864. 

July  21, 
,'61. 
Dec.  5, 
,'63. 
July  21, 
,'61. 

Aug  9, 
,!62. 
,'65. 

—  .     Died  September  23,  1862. 
Left.     Died  April  19,  1865. 

New  York,  age  22. 
Gilbert    S  P     Pt     D 

Aug.  31. 

28th  North  Carolina. 
Gillespie,  P.,  Pt.,  K,  2d 
Michigan. 
Gluve,    F.,   Pt.,    A,   1st 
Minnesota. 
Goldxticker,  J.   A.,  Pt., 
A,  4th  Texas. 
Goodin,  H.,  Pt.,  I,  39th 

July  11, 
,'63. 
July 

Left,     Died  July  —  ,  1863. 

—  .     Died  September  4,  1862. 
Right.    Died  June  3,  1864. 
Right.     Died  April  11,  1865. 
Died  December  5  1864. 

,'63. 
July  —  , 
,'63. 
'64 

Left.     Died  July  15,  1863. 
Left.     Died  August  10,  1864. 

Right.     Died  January  29,  1864  ; 
anaemia. 
.     Died  July  14,  1863. 

—,'65. 

Illinois,  age  47. 
Goodman,  E.,  Serg't,  D, 
27rh  North  Carolina. 
Goodson,  J.  H.,  Pt.,  B, 

-  -  •  '64 

Left.    Died  November  3,  1864. 
.     Died  September  9,  1861. 
Left.     Died  May  22,  1864. 

July  —  , 
-,'63- 

6th  S.  C.  Cavalry. 
McDaniel,  J.  TF.,"Pt.,B, 
2d.Mississippi. 
McDonald,  J.  T.,  Pt.,  B, 
llth  Georgia. 
McElhany,  J.,    Pt.,   C, 
42d  Pennsylvania. 
McGuire,  M.,  Pt,  G,  4th 
Infantry. 
McMillen,    A.,   Pt.,    A, 
12th  Infantry. 
McNaughton,J.  B.,  108th 
New  York. 
Merrill,,  \J.,-pt.,Y,l9t\i 
Georgia. 
Miles,  J.  E.,  Pt.,  H,  18th 
Georgia. 

-V61- 

18th  North  Carolina. 
Gow.  E.  J.,  Pt.,  F,    1st 
South  Carolina  Cav. 
Goynes,  D.,  Pt.,  B,  14th 
Louisiana. 
Gradij,  J.    W.,  Pt.,   E, 
30th  North  Carolina. 
Greer,  J.  AT.,  Pt.,  C,  9th 
Georgia. 
Baines,  F.,  Pt.,  A,  8th 
Virginia. 
Hall,    H.,  Pt.,   H,    18th 
North  Carolina. 
Hamlet,   B.  O.,  Pt.,  A, 
2d  U.  S.  S.  S. 

J'ue6,'62. 

Sept.  17, 
,'62. 
Aug.  9, 
,'62. 
Dec.  13, 
,'62. 

Left.     Died  September  29,  1862. 

Oct.  21, 
,'61. 
July  —  , 
,'63. 
July 

.     Died  November  5,  1861. 

Left  .     Died  December  26,  1862. 
Died  September  25  1862 

Left,     Died  July  CO,  1863. 

Died  September  18  1862 

,'63'. 

SURG.  Ill— 4-2 


330 


INJUEIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

207 
208 
209 
210 
211 
212 
213 
214 
215 
216 
217 
218 

219) 
220/ 

221 
222 
223 
224 
225 
226 
227 
228 
229 
230 
231 
232 
233 
234 
235 
236 
237 
238 
239 
240 
241 
242 
243 
244 
245 
246 
247 
248 
249 
250 
251 
252 
253 
254 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

NO. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

Miller,   O.    O.,    Pt.,    B, 
145th  Penn.,  age  23. 
Millirons,   A.    B.,    Pt., 
Jordon's  Battery. 
Minrieck,  S.,  Corp'l,  B, 
10th  Wisconsin. 
Mitchel,  A.  S.,  Pt.,H,  7th 
Ohio  Cavalry,  age  21. 
Moss,   T.,   Pt.,    C,    10th 
Georgia. 
Moulton,  A.,  Pt.,  G,  3d 
New  Hamp.,  age  24. 
Mullen,  J.  H.,  Pt.,    G, 
37th  North  Carolina. 
Myers,  G.  Jf.,  Pt.,  A,  2d 
Virginia. 
Nail,  *P.^.,Pt.,F,68th 
North  Carolina. 
Nelms,  W.M.,Pt.,  D,  5th 
Texas. 
Nelson,  W.,  Pt.,  A,  Low- 
ther's  Battaliou. 
Nicholls,  W.,  Pt.,  1,  27th 
Alabama,  age  22. 

Nunenger,   G.,   Pt.,   A, 
58th  Virginia. 

O'Neil,  H.,  Pt.,    C,   1st 
Kansas. 
Otto,  F.,Pt.,H,  1st  Iowa, 
age  31. 
Padgett,  T.,  Pt.,  I,  1st 
Artillery. 
Park,  L.  "H.,  Pt.,  G,  21st 
Connecticut,  age  34. 
Parker,  S.  M.,  Pt.,  A,32d 
Mississippi. 
Parrish,  J.A.,Pt.,B,  12th 
Infantry. 
Parvin,  L.,  Pt.,  B,  7th 
Tennessee. 
Penno,  A.  B.,  Pt.,  B,  1st 
Rhode  Island. 
Perry,  C.,  Pt.,  F,   15th 
Massachusetts,  age  18. 
Peterson,  J.  H.,  Pt.,  H, 
33d  Alabama. 
Pierce,   W.  F.,  Pt.,  G, 
27th  Mississippi. 
Piper,  L.  R.,  Corp'l,  F, 
8th  Penn.  Reserves. 
Powell,  C.,  Pt.,   E,  9th 
Virginia. 
Pritchet,  J.,  Pt.,  G,  50th 
Indiana. 
Prilchett,  T.  R.,  Pt.,  K, 
55th  Virginia. 
Quinn,  W.,    Pt.,  —  ,  2d 
Vermont  Battery. 
Radford,  G.,  Corp'l,  B, 
26th  New  Jersey. 
Rawls,  J.  T.,  Pt.,  C,  3d 
South  Carolina  Cav. 
Reaser,  U.,  Pt.,  B,  151st 
Pennsylvania. 
Reed,  F.,  Pt.,  A,  53d  Illi 
nois. 
Reese,  J.,  Pt.,    E,   8th 
Georgia. 
Rhinebast,  J.,  —  ,  62d  N. 
York,  age  32. 
Roberts,  A.J.,  Pt.,  I,  48th 
Alabama. 
Robins,  W.  F.,  Pt.,  M, 
22d  North  Carolina. 
Rogers,  R.,  Corp'l,  K,  2d 
N.  Y.  Artillery,  age  21. 
Sann,  J.,  Pt.,  A,  7th  N. 
York  Heavy  Artillery. 
Saunders,   W.,    Pt.,    F, 
47th  Alabama. 
Sax,  —,  Capt.,  K,  37th 
Mississippi. 
Sensabauglin,  W.,  Pt.,  E, 
5th  Texas. 
Sheldon,  H.,  Pt.,  C,  8th 
Michigan. 
Simpson,  R.  H.,  Major, 
17th  Virginia. 
Sink,  J.,  Pt.,  F,  15th  N. 
Carolina. 
Smoke,  J.,  Pt.,  K,   llth 
South  Carolina. 
Spencer,  S.  G.,  Pt.,  D, 

,'64. 
,'63. 

Oct.  8, 
,'62. 
April  28, 
,'64. 

Left.     Died  May  23,  ]  864. 
Left.     Died  August  4,  1  863. 
.    Died  October  14,  1862. 

—  .      Died   October  14,   1864; 
chronic  diarrhoea. 
Right.     Died  June  20,  1863. 

Left.    Died  September  26,  1864. 
Died  July  13   1863 

255 
256 
257 
258 
259 
260 
261 
262 
263 
264 
265 
266 
267 
268 
269 
270 
271 
272 
273 
274 
275 
276 
277 
278 
279 
280 
281 
282 
283 
284 
285 
286 
287 
288 
289 
290 
291 
-',,, 
293 
294 
295 
296 
297 
298 
299 
:«>() 
301 

Stackhouse,  S.  W.,  Pt., 
G,  104th  Penn. 
Stanley,  G.,  Pt.,  H,  63d 
Pennsylvania. 
Stephens,  G.  W.,  Pt.,  F, 
3d  Vermont,  age  40. 
Sturtevant,  E.,  Serg't,E, 
llth  New  Jersey. 
Sullivan  D.   C.  Pt.,  E, 

June  1, 
,'62. 
May  5, 
,'64. 

—  .    Died  June  IP,  1862. 
Right.     Died.  »• 
Right.     Died  June  11,  1864. 
Left.     Died  July  13,  1863. 

July  —  , 

-,'63. 
'64. 

Aug.  13, 

,'64. 
Tulv 

llth  Mississippi. 
Sullivan,  W.  U.,  Pt.,  A, 
49th  Virginia. 
Tabor,  J.,  Pt.,  C,  4th  Vir 
ginia. 
Taylor,  W.    L.,    Pt.,  E, 
27th  North  Carolina. 
Terrell,  C.,  Pt.,  E,  15th 
Virginia. 
Thornton,  J.  W.,  Corp'l, 
B,  40th  Alabama. 
Tolin,  E.  S.,  Pt.,  I,  8th 
Alabama. 
Tyler,  E.,    Pt.,    E,   4th 
Rhode  Island. 
Tyrrell,  J.,  Pt.,  1,  8th  N. 
York  H.  Art'y,  age  46. 
Van  Aman,  J.,  Pt.,  A, 
57th  New  York,  age  20. 
Vanpell,  J.  S.,  Pt.,  H,  1st 
North  Carolina. 
Vaughn,  G.  W.,  Pt.,  H, 

,'64. 

26,  1864. 
Right.     Died  June  12,  1864. 

,'63. 
July  21, 
,'61. 

.    Attempted  to  tie  fem'l  art.; 
had  to  amp.     Died  Aug.  13,  '61. 

1863. 

ous  shock. 
Left,    Died  March  29,  1865. 

Right.     Died  February  12,  1864  ; 
pyaemia. 
Right.     Died  October  13,  1862; 
haemorrhage. 
Left.     Died  November  21,  1864. 

.     Died  June  9,  1862. 
Right.     Died  August  27,  1864. 

Right.     Died    under    operation, 
March  31,  1865. 
Right,    Died  June  25,  1863. 

.     Died  July  23,  1863. 
Left.    Died  July  25,  18G3. 

Left.     Died  November  1,   1863; 
tetanus. 
.    Died  July  29,  ]  862. 

Right,     Died  February  4,  1  865. 

Left.    Gangrene.     Died  August 
19,  1863. 
Right.  (W'ndofleftliiTig.)    Died 
June  5.  1864  ;  pyaemia. 
.     Died  January  7,  1864. 

Left.     Died  June  17,  1864. 
Left.     Died  November  1  ,  1862. 
Left.     Died  June  5,  1863. 
Right.    Died  August  29,  1864. 
Left.     Died  August  23,  1864. 
Left.     Died  June  17,  1864. 
—  .     Died  September  23,  1862. 
.     Died  August  17,  1862. 
.     Died  October  28,  1861. 
.     Died  June  1,1863. 
Died  July  °°    186°  •  py 

Oct.  22, 
,'64. 
Dec.  7, 
,'64. 

,'62. 

Aug.  10, 
,'61. 
Aug.  10, 
—  -,'61. 
July  —  , 
'63 

1864. 
Left.    Died  December  19,  1864  ; 
gangrene. 

Both.    Died  August  17,  1862. 

.    Died  August  21,  1861. 
.    Died  August  25,  1861  . 
.    Died  July  26,  1863. 
Left.    Died  June  1  1,  1864. 
Left.    Died  November  3,  1862. 
.     Died  August  23,  1862. 

Left.    Gangrene.    Died  Septem 
ber  24,  1864. 
.    Died  September  —  ,  1861. 

.     Died  eight  days  after  am 
putation. 
Right,    Died  October  26,  1862. 

Right.     Died  February  16,  1863. 
Right.     Died  January  1,  1863. 
—  .    Died  July  21,  1863. 
Left.     Died  November  26,  1862. 

Sept.^17, 

Oct.'  27,' 
,'64. 
June  1, 

,'62. 
*g4 

Mar.  31, 
1865. 

40th  North  Carolina. 
Wade,  H.,  Pt,,  C,  Cobb's 
Georgia  Legion. 
Wadkins,  C..  Serg't,  H, 
45th  North  Carolina. 
Wakefield,   L.,    Pt,,   C, 
3d  Iowa. 
Walker,   J.  M.,  Pt.,  F, 
48th  North  Carolina. 
Wallron,  W.,  Corp'l,  E, 
52d  Pennsylvania. 
Walls,  J.,  Scout. 

Ward.  J.  D.,  Serg't,  A, 
4th  Mississippi. 
Ward,  W.  F.,  Corp'l,  D, 
57th  Massachusetts. 
Wardlaiv,  J.  S.,  Serg't, 
G,  9th  Georgia. 
Weiand,  J.,  Pt.,  F,  148th 
Penn.,  age  30. 
Welch,  J.,  Pt.,  K,  98th 
Ohio. 
Whitcher,  J.  S..  Pt.,  I, 
116th  New  York. 
White,  B.  Y.,  Pt.,  1,  25th 
North  Carolina. 
Wilkcrson,  J.,  Pt.,  E,  1st 
Georgia  Cavalry. 
Williamson,  W.  if.,  Pt.. 
II.  57th  Alabama. 
Willis,    W.    W.,  Pt,,  I. 
21st  Virginia. 
Wilson,   C.,   Corp'l,   B, 
7th  Ohio. 
Wilson,  T.,  Pt.,  D,  18th 
Mississippi. 
Wingo,   M.   S.,  Pt.,   F, 
J  8th  Georgia. 
Wood.  I\  S.,  Lieut.,  C, 
4th  Texas. 
Wood,  W.  B.,  Serg't,  I, 
16th  Tennessee. 
1  Woods,  J.,  Pt.,  C,  14th 
Louisiana. 
Salman,  J.  W.,  Pt.,  G, 
2d  South  Carolina. 
Bonnell,  G.  B.,   Pt.,   C, 
2d  Florida. 
Campbell,  W.  G.,  Pt.,  D, 
45th  Alabama. 
Carnolf,  J.,  Pt.,  B,  1st 
New  Jersey  Cavalry. 
Champion,  J.  A.,  Pt.,  G, 
60th  Georgia. 
Collins,   B.  R.,   Pt.,  F, 
13th  Georgia. 
Cousins,  W.  T.,  Capt.,  C, 
17th  Georgia. 
Earhcart,  R..  Lieut.,  C, 
54th  Virginia. 
Freret,  J.,  Pt.,  —  ,  Wash 
ington  Artillery. 

May  16, 
,'64. 
Oct.  8, 
,'62. 
Aug.  9, 
?'62. 

July  —  , 

!£J-j 

July  12,' 
,'63. 

May  31, 

July  21, 

'61 

Sept.  17, 
,'62. 
Oct.  8, 
,'62. 

July  —  , 
,'63. 
May  6, 

Dec.  13, 
,'62. 
July  —  , 
,'63. 
Sept.  14, 
,'62. 

Dec.  5, 
,'63. 
May  12. 
,'64. 
Oct.  8, 
,'62. 
May  27, 

June  14, 
,'63. 
May  3, 

'63 

December  9,  1863. 
Left.     Died  August  20,  1863. 

Left.    Died  May  31,  1863. 

,'64. 
,'64. 

Aug.  9, 
-,'62. 
Aug.  9, 
,'62. 
Oct.  21, 
,'61. 
,'63. 

July  1, 
,'63. 
July  12, 
,'63. 
July  21, 
-,'61. 
May  31, 
,'62. 

.     Died  July  23,  1863. 

thigh  and  left  arm  amputat  'il. 
Died  August  12,  1863. 
.     Died  August  18,  1861. 

.     Died  August  14,  1863  ;  py 
aemia. 

Oct.  8, 
,'62. 

aemia. 
Left.     Died  November  14,  1862; 
typhoid  fever. 

,'63. 

May  19, 

,'64. 
,'64. 

.     Died  July  23,  1863. 
Left.    Died  June  13,  1864. 
Left.     Died  June  19,  1864. 

Oct.  7, 
,'64. 
July  —  . 

cide. 
Left  thigh. 

Left  thigh. 
Left  thigh. 
thigh. 
Right  thigh. 
Right  thigh. 
Left  thigh. 
Left  thigh. 
Left  thigh. 

Oct.  8, 
.'62. 
July  —  , 
'63 

1,  1864;  diarrhoea. 
.     Died   October  _16,    1862; 
gangrene. 
Left.     Died  July  21,  1863. 

Right.    Died  May  20,  1864. 

Oct.  8, 
,'62. 
June  2, 
,'62. 

May  12, 

J6i 

,'64. 

Left.    Died  October  23,  1863. 
Right.     Died  June  5,  1864. 
.     Died. 

,'64. 

July  —  , 
,'63. 

July  —  , 
,'63. 

76th  New  York. 

'HITCHCOCK  (A.).  Army  Medical  Intelligence,  in  fiaslim  Medical  and  SurgicalJournal,  1862,  Vol.  LXVI,  p.  361. 


SECT.  III.] 


AMPUTATIONS    IN    THE   THIGH. 


331 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

307 
308 
309 
310 
311 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

302 
303 

304 
305 
306 

Gcrdin,  W.  J.,  Pt..  H, 
5th  Georgia. 
Hagler,   J.   G.,    Pt.,  D, 
20th  Alabama. 
Benclrick,  W.  D.,  Pt.,  D, 
55th  North  Carolina. 
Bumant,  J.  A..  Capt.,  C, 
12th  South  Carolina. 
Jones,  H.  E.,  A.  A.  G., 
Grade's  Brigade. 

Right  thigh. 
Right  thigh. 
Left  thigh. 
Left  thigh. 
Right  thigh. 

Mass,  M.,  Pt.,  C,  49th 
North  Carolina. 
Norlow,  J.  R.,  Pt.,JD, 
41st  Georgia. 
Odam,  J.  J.,  Pt.,  F,  1st 
South  Carolina. 
Tucker,  D.,  Pt.,  F,  9th 
Arkansas. 
Williams,  J.,  Pt.,  C,  1st 
Texas. 

Right  thigh. 
Right  thigh. 
Left  thigh. 
Left  thigh. 
Right  thigh. 

Oct.  8. 
,'62. 
Sept.  30, 
,'64. 

'Ul 

The  seat  of  fracture  was  recorded  to  have  been  in  the  lower  third  of  the  femur  in 
two;  in  the  femur,  precise  location  not  specified,  in  three  hundred  and  four;  in  the  knee 
joint  in  one;  and  in  the  leg  in  four  instances.  The  two  patients  with  amputations  of  both 
thighs  were  Confederate  soldiers;  one  recovered  and  was  furloughed,  and  has  not  been 
heard  from  since;  the  other  died  shortly  after  the  operation. 

RECAPITULATION. — Six  thousand  two  hundred  and  twenty-nine  cases  of  amputation  in 
the  shaft  of  the  femur  have  been  enumerated  in  TABLES  XXX  to  XLV,  inclusive,  and  the 
results  ascertained  in  all  but  eighty  cases.  Two  thousand  eight  hundred  and  thirty-nine 
had  successful  and  three  thousand  three  hundred  and  ten  fatal  terminations,  a  mortality 
rate  of  53.8  per  cent.  Had  it  been  practicable  to  determine  the  issues  in  the  eighty  cases 
with  unknown  results  the  fatality  rate  would  only  be  slightly  modified.  Assuming  that  all 
these  eighty  cases  had  proved  fatal  the  mortality  would  be  54.4  per  cent.,  an  increase  of 
only  0.6  per  cent.;  or,  supposing  all  the  eighty  cases  terminated  successfully  the  decrease 
in  the  rate  of  mortality  would  be  0.7  per  cent.,  leaving  a  fatality  of  53.1  per  cent.,  a 
deviation  of  only  a  little  over  one  half  of  one  per  cent,  from  the  percentage  of  fatality 
obtained  in  the  determined  cases. 

In  five  thousand  seven  hundred  and  eleven  of  the  six  thousand  two  hundred  and 
twenty-nine  amputations  in  the  femur  the  precise  length  of  time  between  the  injury  and 
the  operation  was  recorded.  Three  thousand  nine  hundred  and  forty-nine,  or  over  two- 
thirds,  were  primary  operations;  one  thousand  three  hundred  and  twenty  intermediary, 
and  four  hundred  and  forty-two,  only,  secondary  operations.  In  the  three  thousand  nine 
hundred  and  forty-nine  primary  operations  the  results  were  not  ascertained  in  forty-eight 
instances;  one  thousand  nine  hundred  and  fifty-eight  were  successful,  and  one  thousand 
nine  hundred  and  forty-three  fatal,  a  mortality  rate  of  49.8  per  cent.  One  thousand  three 
hundred  and  twenty  intermediary  operations  were  followed  by  four  hundred  and  seventy- 
nine  recoveries  and  eight  hundred  and  forty-one  deaths,  a  fatality  of  63.7  per  cent.  Four 
hundred  and  forty-two  secondary  operations  comprise  two  hundred  and  thirty-nine  recov 
eries  and  two  hundred  and  three  deaths,  a  mortality  of  45.9  per  cent.  Of  the  remaining 
five  hundred  and  eighteen  cases  in  which  the  time  between  the  injury  and  operation  could 
not  be  ascertained,  thirty-two  were  recorded  as  without  result,  one  hundred  and  sixty- 
three  as  recoveries,  and  three  hundred  and  twenty-three  as  fatal,  a  death  rate  of  66.4  per 
cent.  The  foregoing  results  differ  somewhat  from  those  obtained  in  the  series  of  amputa 
tions  of  the  arm  (Second  Surgical  Volume,  p.  805).  In  the  latter,  the  primary  operations 
gave  a  mortality  of  18.4  per  cent.;  the  intermediary,  of  33.4;  and  the  secondary,  of  27.7 
per  cent., — the  fatality  of  the  secondary  operations  exceeding  that  of  the  primary, — while 
in  the  femur  the  mortality  of  the  primary  amputations  exceeds  that  of  the  secondary. 


332 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Considering  the  series  of  amputations  in  the  continuity  of  the  thigh  according  to  the 
seat  of  the  original  injury  (TABLE  XLVI)  it  will  be  seen  that  the  femur  had  been  fractured 
in  twenty-nine  hundred,1  or  in  46.6  per  cent,  of  the  total  number  of  amputations;  the 

TABLE  XLVI. 

Tabular  Statement  indicating  the  Seats  of  Injury  in  Six  Thousand  Two  Hundred  and  Twenty-nine 
Cases  of  Amputation  of  the  Thigh  after  Shot  Fractures. 


POINT  AND  PERIOD  OF  OPERATION. 

1 

o 

SEAT  OF  INJURY. 

FEMUR. 

KNEE  JOINT. 

LEO. 

ANKLE 
JOINT 

OR 

FOOT. 

UHPKB  THIKD. 

MIDDLI  THIRD. 

LOWEK  Turai). 

THIKD 
Nor  INDICATED. 

Recovery. 

J5 
a 

Undeter 
mined. 

Recovery. 

1 

r-t 

Undeter 
mined. 

Recovery. 

•3 
1 

Undeter 
mined. 

Recovery. 

3 

"5 

t- 

Undeter 
mined. 

Recovery. 

5 

'5 

^ 

Recovery. 

5 
'S 

^ 

Recovery. 

"a 
* 

fa 

SKAT  NOT  LOWER  MIDDLE  UPPER 
SPECIFIED.  THIRD.  THIRD.  THIRD. 

533 
147 
55 
33 
1  157 

19 
4 

1 

45 
14 
2 
6 

o 

92 
16 
7 

1 
?ft 

76 
34 
5 
3 

6(1 

0 

29 
5 
3 

21 
10 
8 
2 

92 
14 
6 
11 
155 
35 
11 
28 

112 
16 
1 
10 
127 
31 
1 
7 

1 

27 

8 
7 

10 

21 

8 

1 
3 

6 

4 
o 

1 

0-|0 

146 

8 
7 

248 
96 
42 
2 
581 
121 
33 
8 

105 
138 
26 
5 
552 
292 
40 
19 
2 
3 
4 
1 

33 

29 
25 
1 
157 
73 
45 
5 

25 
27 
23 
3 
196 
129 
46 
19 
9 

471 
1G8 
70 
1,914 
670 
207 

3 
3 

14 
4 
1 

41 
15 
3 
233 
18 
13 
24 
8 
1 

53 

8 
13 
179 
23 
4 
22 
6 
1 
I 

14 

\ 
6 

3 

4 

2 
5 
16 

15 
10 
1 

104 
345 

6 

31 
6 

275 
12 
1 

21 

20 

3 

12 

:n  i 

1 

1 

2 
3 

485 

/  • 
4 

.... 

3 

o 

77 

208 

19 

tl 

Aggregates  

6,229 

24  1  67 

o 

160 

198 

2 

607 

497 

20 

466   801 

56 

1,173 

'  , 
2,' 

1,226 
599 

379 

>  , 

ee 

30 

*  , 
« 

36 

,  • 
6 

2,  900 

knee  joint  in  twenty-three  hundred  and  ninety-nine,  or  38.5  per  cent.;  the  bones  of  the  leg 
in  eight  hundred  and  sixty-four,  or  13.8  per  cent.;  and  the  ankle  joint  or  foot  in  sixty-six, 
or  1.1  per  cent.  Of  the  twenty-nine  hundred  amputations  for  shot  fractures  of  the  femur 
twelve  hundred  and  fifty-seven  were  successful,  fifteen  hundred  and  sixty-three  fatal,  and 
eighty  results  could  not  be  ascertained,  a  mortality  of  55.4  per  cent.;  of  these  the  amputa 
tions  following  fractures  of  the  upper  third  had  a  fatality  of  7^.6  per  cent.;  those  following 
fractures  of  the  middle  third  a  mortality  of  55.3  per  cent.;  and  those  following  fractures  of 
the  lower  third  a  death  rate  of  45.0  per  cent.  The  ratio  of  mortality  of  the  twenty-three 
hundred  and  ninety-nine  amputations  following  shot  injuries  of  the  knee  was  51.1  per  cent., 
eleven  hundred  and  seventy-three  patients  having  recovered,  and  twelve  hundred  and 
twenty-six  having  died.  The  mortality  of  the  eight  hundred  and  sixty-four  amputations 
of  the  thigh  for  shot  injuries  of  the  leg  was  56.1  per  cent.,  four  hundred  and  eighty-five  of 
the  eight  hundred  and  sixty-four  operations  having  proved  fatal.  Finally,  the  sixty-six 

1  While  the  total  number  of  amputations  following  shot  fractures  of  the  femur  as  cited  in  this  table,  viz :  2,900,  agrees  with  the  total  number  of 
amputations  as  indicated  in  TABLE  XX,  page  175,  ante,  the  figures  in  several  of  the  subdivisions  have  been  slightly  modified,  as,  in  the  progress  of  the 
work,  the  results  as  well  as  the  seats  of  fracture  in  several  cases  classified  in  TAHLK  XX  as  "undetermined"  or  "unspecified"  were  ascertained.  Thus, 
the  number  of  amputations  for  fractures  of  the  upper  third  remains  the  same,  93  cases  with  24  recoveries,  67  deaths,  and  2  undetermined  results.  The 
amputations  for  fractures  in  the  middle  third  are  360,  as  in  TABLE  XX,  but  the  number  of  recoveries  is  increased  by  2,  while  the  undetermined  oases 
number  2  less.  Similarly  the  total  number  of  amputations  for  fractures  in  the  lower  third  is  increased  by  2,  and  those  for  fractures  with  unspecified  seat 
decreased  by  2,  the  seats  of  fracture  in  these  cases  having  been  determined  since  the  publication  of  TABLE  XX.  Finally,  the  results  have  since  been 
ascertained  in  5  cases  recorded  in  TABLE  XX  as  undetermined  with  unspecified  seat  of  injury,  thus  giving,  in  this  group,  46'6  recoveries  and  56  undeter 
mined  results  instead  of  401  recoveries  and  63  unknown  results. 


SECT,  m.]  AMPUTATIONS    IN    THE    THIGH.  333 

operations  for  shot  injuries  of  the  ankle  joint  or  foot  were  followed  by  thirty-six  deaths, 
a  fatality  of  54.6  per  cent.  Thus  it  would  seem  that  of  the  amputations  in  the  thigh  per 
formed  for  shot  fractures,  those  for  fractures  of  the  lower  third  of  the  femur  offered  the  best 
chance  for  life. 

The  point  of  section  or  ablation  in  the  thigh  was  in  the  upper  third  in  seven  hundred 
and  sixty-eight,  in  the  middle  third  in  one  thousand  eight  hundred  and  sixty-six,  in  the 
lower  third  in  two  thousand  nine  hundred  and  one,  ?"d  in  the  femur,  point  not  specified,  in 
six  hundred  and  ninety-four  instances.  The  mortality  rate  of  the  first  group  was  53.8  per 
cent.,  of  the  second,  44.5,  of  the  third,  53.6,  and  of  the  last,  80.7  per  cent.,  the  death  rate 
being  the  largest  in  amputations  in  the  upper  third,  next  in  the  amputations  of  the  lower 
third,  and  lowest  in  those  of  the  middle  third,  a  result  differing  from  that  obtained  in  the 
different  thirds  of  the  arm,  where  the  operations  in  the  upper  third  were  less  fatal  than 
those  in  the  lower  third  (Second  Surgical  Volume,  pp.  805,  806),  the  percentage  of  fatality 
after  amputation  in  the  upper  third  being  18.4,  in  the  middle  third  16.4,  and  in  the  lower 
third  26.0  per  cent. 

Of  the  six  thousand  two  hundred  and  twenty-nine  amputations  in  the  continuity  of 
the  femur  the  side  was  not  indicated  in  seven  hundred  and  nine  cases.  The  right  side  was 
involved  in  two  thousand  six  hundred  and  ninety-eight,  the  left  in  two  thousand  eight  hun 
dred  and  twenty-two.  Of  the  former,  one  thousand  two  hundred  and  ninety-six  recovered, 
one  thousand  three  hundred  and  seventy-three  died,  and  in  twenty-nine  cases  the  results 
were  unknown,  a  death  rate  of  51.4;  of  the  latter,  one  thousand  three  hundred  and  seventy- 
seven  recovered,  one  thousand  four  hundred  and  sixteen  died,  and  in  twenty-nine  cases 
the  results  were  undetermined,  a  mortality  of  50.7  per  cent.  This  would  point  to  the  fact 
already  noticed  in  the  discussion  on  the  amputations  of  the  shoulder  joint  and  arm  (Second 
Surgical  Volume,  pp.  655,  806),  that  the  left  extremity,  although  most  frequently  inter 
ested,  had  a  less  proportionate  fatality  than  the  right;  but  the  difference  in  the  mortality 
rates  of  the  two  sides  is  too  insignificant  to  allow  conclusions  to  be  drawn,  especially  as  the 
number  of  undetermined  cases  is  sufficiently  large  to  materially  modify  the  result. 

As  already  stated  on  page  214,  ante,  the  six  thousand  two  hundred  and  twenty-nine 
operations  were  performed  on  six  thousand  two  hundred  and  nine  patients,  twenty  having 
submitted  to  amputations  of  both  thighs.1  Four  thousand  seven  hundred  and  seventy-one 
were  Union,  and  one  thousand  four  hundred  and  thirty-eight  were  Confederate  soldiers.  Of 
the  Union  soldiers,  two  thousand  and  ninety-six  recovered  and  two  thousand  six  hundred  and 
fifty-seven  died,  while  the  results  in  eighteen  cases  were  undetermined,  a  mortality  of  55.9 
per  cent.  Of  the  Confederates,  seven  hundred  and  forty  survived,  six  hundred  and  thirty- 
six  died,  and  the  fate  of  sixty-two  remained  undecided,  a  fatality  of  46.2  per  cent. 

1  Of  the  twenty  cases  of  amputations  of  both  thighs,  three  were  successful,  viz:  Corporal  M.  Dunn,  H,  46th  Pennsylvania  (CASE  448,  p.  242,  and 
Nos.  239,  240,  TABLE  XXXII,  p.  248);  Private  C.  G.  Rush,  C,  21st  Georgia  (CASE  449,  p.  243,  and  Kos.  737,  738,  TABLE  XXXII,  p.  254);  Private  J.  A. 
1'arker,  L,  Cobb's  Legion  Cavalry  (Nos.  49,  50,  TABLE  XLV,  p.  328).  The  seventeen  fatal  cases  are:  Pt.  S.  Baguley,  B,  5th  New  Hampshire  (No. 
703,  TABLE  XXXI,  p.  235,  and  No.  105,  TABLE  XXXIX,  p.  105);  Serg't  T.  Doud,  C,  2d  Michigan  (CASE  442,  p.  226,  and  Nos.  800,  807,  TABLE  XXXI. 
p.  236);  Corp'l  J.  W.  Woodworth,  H,  llth  Infantry  (CASE  443,  p.  226,  and  Nos.  1143,  1144,  TABLE  XXXI,  p.  240);  Pt.  S.  Allen,  G,  59th  Massachusetts, 
Nos.  984,  985,  TABLE  XXXII,  p.  257);  Pt.  R.  S.  Michael,  A,  105th  Pennsylvania  (Nos.  1551,  1552,  TABLE  XXXII,  p.  2G3);  Pt.  D.  Nicholson,  H,  22d 
Massachusetts  (Nos.  1599,  1600,  TABLE  XXXII,  p.  264);  Serg't  E.  C.  Rabbit,  B,  10th  Missouri  (Nos.  1652, 1653,  TABLE  XXXII,  p.  2G4);  Pt.  J.  Stewart,  D, 
77th  New  York  (Nos.  1769,  1770,  TABLE  XXXII,  p.  265);  Lieut.  J.  Whelpley,  D,  1st  Maine  (Nos.  1862, 18C3,  TABLE  XXXII,  p. 267);  Pt.  S.  Goodwell,  G, 
29th  Illinois  (Nos.  128,  129,  TABLE  XXXIII,  p.  269);  Pt.  H.  Kenntr,  4th  Virginia  (Nos.  169,  170,  TABLE  XXXIII,  p.  270);  Pt.  C.  Meyer,  30th  Missouri 
(Xos.  212,  213,  TABLE  XXXIII,  p.  270);  Pt.  W.  F.  Mills,  E,  6th  New  York  H.  A.  (No.  205,  TABLE  XXXIII,  p.  270,  and  No.  495,  TABLE  XXXVI,  p.  300); 
I't.  II.  Tieman,  C,  119th  New  York  (Nos.  285,  286,  TABLE  XXXIII,  p.  271);  Pt.  J.  Moore,  E,  46th  Pennsylvania  (Nos.  497,  498.  TABLE  XXXVI,  p.  300); 
I't.  D.  Wallace,  I,  5th  Artillery  (Nos.  642,  643,  TABLE  XXXVI,  p.  302);  Pt.  G.  Nunenger,  A,  58th  Virginia  (Nos.  219,  220,  TABLE  XLV,  p.  330).  Of 
the  20  cases,  2  were  primary  operations  in  the  middle  thirds  ;  8,  primary  operations  in  the  lower  thirds ;  4,  primary  operations,  the  seat  not  recorded ;  ~, 
intermediary  operations  of  both  thighs  in  the  lower  thirds;  2,  amputations  of  both  thighs,  time  and  operation  not  stated;  1,  primary  amputation  of  the 
right  and  intermediary  of  the  left  thigh,  and  1,  primary  amputation  of  right  and  secondary  operation  in  left  thigh. 


334 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


The  following  tabular  statement  will  enable  the  reader  to  compare  the  results  of  the 
amputations  in  the  thigh  of  the  American  civil  war  with  those  of  other  wars : 

TABLE  XLVII. 
Results  of  Amputations  of  the  Thigh  on  the  Occasions  named  and  from  the  Authorities  quoted. 


ACTION,  ETC. 

AMPUTATIONS. 

PRIMARY  OPER 
ATIONS. 

INTERMEDIARY 
OPERATIONS. 

SECONDARY     j  OPERATIONS  OF 
OPERATIONS.    (  i  UNKNOWN  DATE. 

8 

3 

o 

Recoveries. 

Deaths. 

Result 
Unknown. 

Recoveries. 

Deaths. 

Result 
Unknown. 

Recoveries. 

1 

Result. 
1  Unknown. 

Recoveries. 

Deaths. 

Result 
Unknown. 

Recoveries. 

Deaths. 

Result 
Unknown. 

Siege  of  Spires  1689  (Diovis1) 

l 

1 

1 

i 

\ 

1 

1 

Battle  of  Dettingen   1743  (HOME3) 

1 

1 

Battle  of  Fontenoy,  1745  (FAURE,4  BOUCHER,5 

4 

1 

2 

o 
1 

1 

1 

0 

1 

j 

1 

Germany,  1756-17G3  (MEHEE,8  MURSIXXA9)  
Napoleonic  Ware,  1791-1815  (LARUEY,10  HEX- 

NEN,"    GUTHRIE,12    EUDE8,13    CARRE,14    Mi- 

3 

198 
4 

23 

15 
35 
37 

8 
5 

18 

20 

218 
13 
7 

2,748 

16 
806 
6 

33 

166 
19 
12 

798 
3,794 

7 

2 

112 

•_' 

9 
I' 
ll 
12 
1 
1 
8 

7 

90 

7 

1 

77 
o 

14 
o 

18 
23 
7 
4 
10 

12 

128 
6 
7 

1 

2 
9 

3 

9 

49 

21 

4 

54 

53 

5 

War  of  1812-14  (MAXN18) 

2 
1 

2 
7 

Revolution  in  Paris,  1830  (ARNAL.WMEXrERE,20 
1)  J  LARREV  21  H  LARREY  **  Roux23) 

4 

4 

2 

o 

o 

1 

Siege  of  Antwerp  1832  (H  LARREY24) 

12 

o 

.... 

1 

French  in  Algiers,  1830-1836  (BAUDEXS25)  
Spanish  Peninsular  War,  1836-37  (ALCOCK26)  .. 
Campaign  of  Constantine,  1837  (SEDILLOT27).  .. 
Campaign  in  Mexico,  1847  (PORTER,28  JARVIS29)  . 
Revolution  in  Milan  1848  (RESTELLI30) 

17 

18 

2 

5 

11 

1 

7 
1 

13 

7 

1 

1 

1 
7 

2 

4 
4 

3 

1 
3 

6 
3 

Paris,  1848  (HUGUIER,31  AMUSSAT.^BAUDEXS,33 
TORFRT  34  MATOAinNK  *5  Tinnx36) 

3 

1 

2 

90 

3 

128 

Sleswick-Holstein,    1848-1850    (STROMEYER,37 

DJORUF38) 

Revolution  in  Baden  1849  (BECK31) 

5 

1 

2 

5 

7 

Bombardment  of  Sv6aborg,  1855  (HEYFELDER40) 
Crimean  War,  1854-57  (MATTHEW,41  CHEXU,42 
HUliBEXET43)     

227 

14 
195 
3 

3 

87 
13 
6 

243 
342 
o 

2,033 

o 
611 
3 

29 

72 
6 
6 

514 
3,452 
5 

488 

165 

1,424 

24 

197 

.... 

38 

14 
171 

412 

1 
480 

488 

British  in  India,  1857-58  (WlLLIAMSOX,44  GOR 
DON48) 

1 

Italy,  1859-60  (CHEJJU,46  DEMME,47  GHERLM48)  .  . 
New  Zealand  War  1  863-65  (MOUAT49) 

1 

7 

41 

8 

1 

27 
7 
6 

106 

58 

16 
o 

1 

19 
4 

73 
3 

3 

35 
4 

Danish  War,   1864   (HEINE,80  LUCKE,81  OCH- 
WADT  62  NEUDORFER83)  .... 

3 

12 

1 

0 

9 
2 

18 

15 
2 

0 

.... 

Germany,  I860  (STROMEYER^FisCHER.^MAX- 

NEL,86  BECK,67  BlEFEL,88  MAA859)  

•Kb 

10 

7 

Austro-Italian  War  1866  (GRITTI60) 

United  States  Army  1865-70  (OTIS61) 

4 
149 

Franco-German  War,  1870-71,  Germans  (HE1N- 

ZEL62)                    .                                 ... 

8 

121 

359 

26 

16 
342 

6 
3,452 

7 

Franco-German  War,  1870-71,  French  (CHEXU63) 
Russo-Turkish  War,  1876  (TILING,64  STF.IXER68) 

0 

5 

502 

549 

Totals 

9,017 

1,419 

7,049 

406 

1,701 

14 

17 

53 

259 

771 

33 

737 

4,524 

Of  the  aggregate  of   nine  thousand   and  seventeen  amputations  in  the  thigh  here 
adduced,  five  hundred  and  forty-nine  were  undetermined,  one  thousand  four  hundred  and 

1 DIOXIS  (P.),  Cours  d'opCrations  de  Chirurgie,  ed.  par  G.  DE  LA  FAYE,  Paris,  4me  6d.,  1750,  p.  740.  2  SCHMUCKER  (J.  L.),  Vermischte  Chirurgische 
Schriften,  Berlin  und  Stettin,  1785,  B.  I,  p.  43.  3HOME  (FRANCIS),  Itedical  Facts  and  Experiments,  London,  17G3,  p.  115.  4FAUUE,  L'amputation  Ua.nl 
absolument  nf.cessaire,  etc.,  in  Prix  de  VAcad.  Royale  de  Chir.,  1819,  T.  Ill,  p.  337  (2  recoveries).  "BOUCHKU,  Obs.  sur  dcs  playes  d'armes  &  feu  com- 
pliqu'es  sur  tout  de  fracas  des  os,  in  Stem,  de  VAcad.  Roy.  de  Chir.,  Paris,  1753,  T.  II,  p.  470  (1  fatal).  GBAGIEU,  Examen  de  Plusieurs  Parties  de  la 
Chirurgie,  Paris,  1756,  T.  I,  p.  153  (1  fatal).  'BOUCHER,  in  Mem.  de  VAcad.  Roy.  de  Chir.,  Paris,  1753,  T.  II,  p.  477.  "MEHEK  (JEAN),  Traite  des  plains 
d'armes  a  feu,  Paris,  An.  VIII  (1799),  p.  215  (1  fatal).  "MURSIXNA  (C.  L.),  Neue  Med.  Chir.  Ceobachtungen,  Berlin,  179G,  pp.  177,  181  (2  recoveries). 
IOLARRKY  (D.  J.),  Clin.  Chir.,  Paris,  1829,  T.  Ill, p.  623  (7  recoveries);  and  Mem.  de  Chir.  Mil.  et  Camp.,  Paris,  1817,  T.  IV,  p.  53  (1  recovery);  and 
Relation  Hist,  et  Chir.  de  V Expedition  de  VArm.ee,  d' Orient,  Paris,  1803,  pp.  300,  432-433  (10  recoveries,  1  fatal).  »'  HKXXEX  (JOHN),  Principles  of  Mil 
itary  Surgery,  London,  1829,  pp.  27C,  278  (2  fatal).  "GUTHRIE  (G.  J.),  Gunshot  Wounds,  London,  1827,  pp.  260,  375  (5  recoveries,  8  fatal);  and  Com- 


SECT.  HI.]  SHOT    INJURIES    OF    THE    FEMUR.  335 

nineteen  had  successful,  and  seven  thousand  and  forty-nine  fatal  terminations,  a  death  rate 
of  83.2  per  cent. 

CONCLUDING  OBSERVATIONS  ON  SHOT  INJURIES  OF  THE  FEMUR. 

Until  the  middle  of  the  present  century  the  majority  of  the  writers  on  military  surgery 
insisted  upon  immediate  amputation  as  the  only  means  of  saving  life  in  comminuted  shot 
fractures  of  the  femur,1  while  there  were  a  few  only  who  questioned  the  necessity  of  the 
operation,  and  who  declared2  that  not  only  life  but  also  a  more  or  less  useful  limb  might  be 

mentaries,  London,  1855,  Cth  ed.,  p.  158  (77  recoveries,  62  fatal,  9  results  unknown).  I3EUDES  (P.  J.),  Sur  les  wantages  de  pratiquer  Vamputation  sur 
IP,  champ  de  bataille,  etc.,  Paris,  1815,  These,  p.  1C  (1  recovery).  u  CARRE  (A.  C.),  De  Vamputation  considert'e  comme  moyen  curatif  dans  les  accidens  de 
dubiliti.',  etc.,  Paris,  1815,  Thfise,  No.  9,  p.  13  et  seq.  (2  recoveries,  2  fatal).  1SMIREAU  (H.  L.  M.),  Sur  les  inconveniens  de  Vamputation  du  moignon  de  la 
cuisse  devenu  conique,  Paris,  1815,  pp.  15,  16,  Thfise  (1  recovery,  2  fatal).  16  ARXAL,  item,  sur  quelques  peculiarity  des  plaies  par  armes  a  feu,  in  Jour. 
Hebd.  de  M^'d.  et  de  Ckir.pral.,  Paris,  1831,  T.  Ill,  p.  36  (1  recovery).  " KLEIN  (D.  C.),  Practische  Ansichten  der  bedeutendsten  chirurgischen  Opera- 
lionen,  Stuttgart,  1815,  p.  35  (7  recoveries).  18MAXX  (J.),  Medical  Sketches  of  the  Campaign  of  1812-13-14,  Dedham,  181C,  p.  213  et  seq.  19ARNAL, 
in  Jour.  Held,  de  Mid.  et  de  Chir.  prat.,  Paris,  1831,  T.  Ill,  p.  36  (2  recoveries).  ^MEXIERE  (P.),  L' Hotel  Dieu  de  Paris,  en  Juillet  et  Aout,  1830, 
Paris,  1830,  p.  323  et  seq.  (-2  recoveries,  9  fatal).  Z'LARREY  (D.  J.),  din.  Chir.,  Paris,  1832,  T.  IV,  p.  282  (1  fatal).  »LARREY  (H.),  Relation  chirur- 
gicale  des  evi'nements  de  Juillet,  1830,  Paris,  1831,  p.  Ill  (4  recoveries,  1  fatal).  ^Roux  (PHIL.  J.),  Des  plaies  d'armes  dfeu;  Communications,  etc., 
Paris,  1849,  p.  37  (1  recovery,  3  fatal).  24LARREY  (H.),  Histoire  chirurg.  du  siege  de  la  citadelU  d'Anvers,  1833,  p.  311  et  seq.  (13  recoveries,  2  fatal). 
25BAUDEXS  (L.),  Clinique  des  Plaies  d' Armes  d  feu,  Paris,  1836,  p.  460.  x  ALCOCK  (R.),  Notes  on  the  lied.  Hist,  and  Stat.  of  the  British  Legion  in 
Spain,  London,  1838,  pp.  92,  95.  27SEDILLOT  (G.),  Campagne  de  Constantine  de  1837,  Paris,  1838,  p.  266.  28PORTER  (J.  B.),  Med.  and  Surg.  Notes  of 
Camp,  etc.,  in  Mexico,  1845-46-47-48,  in  Am.  Jour.  Med.  Sci.,  1852,  Vol.  XXIII,  N.  S.,  pp.  32,  37,  and  Vol.  XXIV,  p.  28  (1  recovery,  2  fatal).  » JARVIS 
(N.  S.),  Surgical  Cases  at  Monterey,  in  New  YorJc  Jour,  of  Medicine,  1847,  Vol.  VIII,  p.  158  (2  fatal).  ^RESTELLI  (A.),  Note  ed  Osservazioni  cliniche 
di  chirurgia  mil.,  in  Annal.  Univers.  di  Medicina,  1849,  Vol.  CXXX,  p.  243.  ^-^Des  plaies  d'armes  dfeu,  Paris,  1849,  Communications,  par  HUGUIER, 
p.  142  (5  recoveries);  AMUSSAT,  p.  57  (1  fatal);  BAUDEXS,  p.  224  (5  fatal);  JOBERT  DE  LAMBALLE,  p.  155  (1  recovery,  3  fatal);  MALGAIGXE  (1  unde 
termined);  Roux,  p.  38  (1  recovery,  3  fatal).  37STROMEYEH  (L.),  Maximen,  Hannover,  1855,  pp.  756,  757  (51  recoveries,  77  fatal).  ^DJOUUP,  Semxr- 
kninger  over  de  i  Krigen  1848-50  fnrctagne  Amputationer,  in  Hospitals-Meddelelser,  1852,  B.  V,  p.  106  (39  recoveries,  51  fatal).  *•  BECK  (B.),  Die  Schuss- 
wundcn,  Heidelberg,  1850,  p.  347  (7  recoveries,  6  fatal).  ^HEYFELDER  (J.  F.),  Die  Verwundungen  und  Operationen  in  Folge  des  Bombardements  von 
Sveaborg,  in  Deutsche  Klinik,  1855,  B.  VII,  p.  584-5.  41  MATTHEW  (T.  P.),  Med.  and  Surg.  Hist,  of  the  British  Army,  etc.,  in  the  years  1854-55-56, 
London,  1858,  Vol.  II,  p.  368  (62  recoveries,  119  fatal).  42CHEXU  (J.  C.),  Rapport,  etc.,  pendant  la  Campagne  d'  Orient  en  1854-55-56,  Paris,  1856,  p.  662 
(126  recoveries,  1,545  fatal).  43HOBBEXET  (C.  V.),  Die  Sanitdts-  Verhdltnisse  der  Russischen  Verwundeten,  etc.,  in  den  Jahren  1854-1)6,  Berlin,  J871, 
p.  182  (89  recoveries,  269  fatal,  488  undetermined).  *»  WILLIAMSON  (G.),  Military  Surgery,  London,  1863,  p.  XXVII  (14  recoveries,  1  fatal).  ^GORDON 
(C.  A.),  Experiences  of  an  Army  Surgeon  in  India,  London,  1872,  p.  26  (1  fatal).  46CHENU  (J.  C.),  Stat.  Mid.  Chir.  de  la  Campagne  d'ltalie  en  1859  et 
1860,  Paris,  1869,  T.  II,  p.  754  (79  recoveries,  257  fatal).  47DEMME  (H.),  Militdr-Chirurgische  Studien,  WUrzburg,  1861,  Zweite  Abth.,  p.  264  (110 
recoveries,  321  fatal).  48GHERIXI  (A.),  Rdazione  chirurgica  dell'Ospedale  militdre  provisorio  di  S.  Filippo,  in  Ann.  Universali  di  Med.,  Milano,  1860, 
Vol.  CLXXIII,  pp.  459,  460;  39  cases  (6  recoveries,  33  fatal).  49MOUAT,  The  New  Zealand  War  of  1863-64-65,  in  Stat.  San.  and  Med.  Reports  for  the 
Year  1865,  London,  1867,  Vol.  VII,  p.  513.  MHEIXE  (C.),  Die  Schussverletzungen  der  Unteren  Extremitdten,  Berlin,  1866,  p.  275  et  seq.  (3  fatal,  1  unde 
termined).  61LucKE  (A.),  Kriegschir.  Aphorismen,  in  LAXGEXBECK'S  Archiv,  1866,  B.  VII,  p.  25  (1  fatal).  52OCHWADT  (A.),  Kriegschir.  Erfahrun- 
gen,  Berlin,  1865,  Appendix  (Table  of  Operations)  (3  recoveries,  20  fatal).  M NEL'DO'RFER  (J.),  Aus  demfelddrztlichen  Berichte  ubtr  die  Verwundeten  in 
Xchkswig,  in  LAXGENBECK'S  Archiv,  1865,  B.  VI,  pp.  531,  532  (5  fatal).  MSTROMEYER  (L.),  Erfahrungen  uber  Schusswunden  im  Jahre  1866,  Han 
nover,  1867,  pp.  16,  17  (27  recoveries,  23  fatal).  &  FISCHER  (K.),  Militairdrztliche  Skizzen  aus  Siiddeutschland,  Aarau,  1867,  p.  90  (32  recoveries,  9  fatal, 
7  undetermined).  MMAXXEL(O.),  Kriegschir.  Beobachtungen,  in  Allg.  Wiener  Med.  Zeitung,  Jahrgang,  XII,  1867,  No. 48,  p.  403  (1  fatal).  57BECK  (B.), 
Kriegschir.  Erfahrungen  wdlirend  des  Fcldzuges  1866,  Freiburg  i.  B,  1867,  p.  333  (25  recoveries,  26  fatal).  ^BlEFEL  (R.),  Kriegschir.  Aphorismen  von 
18(36,  in  LANGENBECK'S  Archiv,  Berlin,  1869,  B.  XI,  p.  475  (7  fatal).  69MAA8  (II.),  Kriegschirurgische  Beitrage,  Breslau,  1870,  p.  73  (3  recoveries, 
6  fatal).  60GRITTI  (R.),  Nuovi  documenti  in  favore  della  cura  conservativa,  etc.,  in  Ann.  Unicersali  di  Med.,  Milano,  1868,  Vol.  CCV,  p.  518  et  seq. 
61  OTIS  (G.  A.),  Circular  No.  3,  War  Department,  S.  G.  O.,  Washington,  1871,  p.  205  et  seq.  (6  recoveries,  6  fatal);  17  amputations  following  shot  wounds 
are  reported  in  Circular  3,  but  5  of  these  cases  arc  from  the  American  civil  war,  1861-65,  and  are  included  in  the  preceding  tables  of  amputations.  ra  HEIX- 
ZEL,  Ueber  die  conservirende  Behandlung  der  Kniegelenkschiisse,  in  Deutsche  Militairdrzt.  Ztitschrift,  1875,  Jahrgang  IV,  pp.  358-59.  ^CHEXU  (J.  C.), 
Aper<;u  hist.  Stat.  et  Clin.  sur  le  service  des  ambulances  et  des  Hopitaux,  etc.,  Paris,  1874,  T.  I,  p.  493.  M  TILING  (G.),  Bericht  iiber  124  im  serbisch- 
liirkischen  Kriege,  etc.,  be.handelte  Schussverletzungen,  Dorpat,  1877,  pp.  66-69  (2  fatal).  65Sl"EIXER  (F.),  Aus  dem  Tagebuche  eines  deutschen  Arztes 
u'dhrend  der  Zc.it  des  Krieges  im  Oriente  1876,  in  Wiener  Med.  Wochenschrift,  1877,  p.  657  (2  recoveries,  3  fatal).  Of  these  9,017  operations  366  were  in 
the  upper  third  of  the  femur,  503  in  the  middle  third,  436  in  the  lower  third,  and  in  7,712  the  seat  of  ablation  was  not  specified.  The  results  in  the  upper 
third  amputations  were  133  recoveries,  232  deaths,  and  1  unknown  result,  a  fatality  of  63.5  per  cent.;  in  the  middle  third,  213  recoveries,  290  deaths,  or  57.6 
per  cent,  fatality;  in  the  lower  third,  211  recoveries  and  225  deaths,  a  mortality  of  51.6  per  cent.;  andln  the  femur,  seat  not  specified,  862  recoveries  and 
6,302  deaths,  with  548  undetermined  results,  a  fatality  of  87.9  per  cent. 

1 GUTHUIE  (G.  J.)  (Treatise  on  Gunshot  Wounds,  London,  1827,  p.  373)  remarks:  "Injuries  of  the  femur  from  musket  balls  are  the  more  common 
wounds  that  render  amputation  necessary,"  and,  on  p.  375,  "Upon  a  review  of  the  many  cases  I  have  seen  I  do  not  believe  that  more  than  one-sixth 
recovered  so  as  to  have  useful  limbs;  two-thirds  of  the  whole  died,  either  with  or  without  amputation ;  and  the  limbs  of  the  remaining  sixth  were  not 
only  nearly  useless,  but  a  cause  of  much  uneasiness  to  them  for  the  remainder  of  their  lives."  LARREY  (D.  J.)  (Clinique  Chirurgicale,  Paris,  1829,  T. 
Ill,  p.  636):  "Lorsque  les  coups  sont  regus  au  centre  ou  d  la  partie  sup6rieure  de  la  cuisse,  de  manifire  que  le  projectile  la  traverse  d'avant  en  arriere,  en 
fracturant  lo  femur,  1'amputation  dcvient  indispensable."  KEUVEGUEN  (II.  G.)  (-Des  cas  d'amputation  dans  les  plaies  d'armes  d  feu,  Paris,  1847,  p.  33) 
notices  one  or  two  recoveries  from'  pistol  shot ;  but  remarks  that  "  these  fortunate  results  must  be  regarded  as  exceptions  which  must  not  be  set  up  in 
opposition  to  the  regular  rule,  viz:  that  we  must  amputate  whenever  the  femur  is  fractured  by  shot."  SCHWARTZ  (H.)  (Beitrage  zur  Lehre  von  den 
Fchussiuunden.  Gesammelt  in  den  Feldzugen  der  Jahre  1848,  1849  und  1850,  Schlcswig,  1854,  pp.  155,  168)  cites  cases  of  shot  fractures  of  the  shaft  of  the 
fc'inur  of  the  Schleswig-Holstein  War,  1848-1850,  and  advises  primary  amputation  in  all  cases  of  extensive  comminuted  fractures,  whether  in  the  upper, 
middle,  or  lower  thirds  of  the  femur.  BLEXKINS  (G.  E.)  (in  his  article  Gunshot  Wounds,  in  COOPER'S  Diet,  of  Practical  Surgery,  London,  1861,  Vol.  I, 
p.  817)  remarks:  "Were  I  to  judge,  then,  from  iny  own  personal  observations  in  the  army,  and  from  some  other  cases  which  I  saw  under  my  colleagues, 
I  should,  without  hesitation,  recommend  immediate  amputation  in  all  cases  of  compound  fracture  of  the  thigh  caused  by  grapeshot,  musket  balls,  etc." 

2LE  DRAX  (H.  F.)  (Traite  ou  reflexions  tir.'es  de  la  pratique  sur  les  plaies  d'armes  d  feu,  Paris,  1737,  p.  221)  evidently  believed  that  a  useful 
limb  might  bo  preserved  after  comminuted  fracture  of  the  femur :  "Sans  parler  des  pansemens  qui  sont  enonc6s  dans  la  premiere  partie,  je  dirai  seulement, 
que  supposant  le  fcemer  fractur6  en  6clats,  et  qu'il  y  eut  lieu  d'esp6rer  de  conserver  la  cuisse,  on  doit  aprSs  avoir  fait  ce  que  1'art  present,  faire  ensorte 
de  fixir  lo  reste  des  pieces  fracturges,  de  mani6re  qu'elles  ne  jouent  pas  1'une  contre  1'autre,  comme  je  1'ai  dit  en  parlant  ties  playes  au  bras."  Hurix 
(Recherches  sur  le  resultat  des  fractures  de  la  moitic  supcrieure  de  la  cuisse,  etc.,  in  Rec.  de  Mem.  de  Med.  de  Chir.  et  de  Phar.  Mil.,  1854,  T.  XIV,  p.  253), 
on  page  272,  believes  that  the  facts  cited  by  him  "demontrent  que  Ton  ne  doit  pas  adopter  exclusivement  le  pr6cepte  de  recourir  toujours  a  1'amputation 
dans  les  cas  dont  il  s'agit,  et  qu'il  est  de  ces  fractures  dont  on  peut  espfercr  une  gu6rison  bonne  et  durable,  quoiqu'elle  ne  laisse  qu'un  membre  difforme." 


336 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


preserved  to  the  patient  by  an  expectant  conservative  mode  of  treatment.  From  the  fol 
lowing  statistical  summary  of  fractures  of  the  femur  treated  by  conservation,  recorded  in 
other  wars,  it  will  be  seen  that  of  a  total  of  three  thousand  four  hundred  and  seventy-four 
cases  only  about  two  hundred  and  fifty  antedated  the  year  1850.  But  with  improvements 

TABLE  XLVTII. 

Results  of  Shot  Fractures  of  the  Femur  treated  by  Conservation  on  the  Occasions  named  and  from  the 

Authorities  quoted. 


ACTION,  ETC. 

CASES. 

UPPER  THIRD. 

MIDDLE  THIRD. 

LOWEK  THIRD. 

SEAT 
NOT  INDICATED. 

1 
H 

Recovery. 

j3 
t. 

Result 
Unknown. 

Recovery. 

"a 
a 
Pw 

Result 
Unknown. 

Recovery. 

"3 
'a 

Result 
Unknown. 

Recovery, 

"a 
a 
fe 

Result 
Unknown. 

Recovery. 

3 

a 
PM 

Result 
Unknown. 

Battle  of  Moncontour  1569  (PARE1) 

1 
1 
2 
3 
1 
1 
3 
2 

9 
1 
1 
1 
82 
2 
27 
3 
9 
25 
9 

3 

22 
28 
17 
63 

555 
1* 

542 
11 
18 
29 
236 
26 
9 
811 
896 
11 

1 
1 
1 
3 
1 
1 
3 
2 

9 
1 
1 
1 
36 

0 

18 
3 
6 
2 

3 

12 
14 
3 
63 

1 

II 

Accidentally,  1608  (FAUBICIUS  HlLDAXUS2)  
Thirty-Years'  War  1618-1648  (SCHMIDT3) 

1 

1 

1 
3 

1 

1 

Franco-German  War  1C71  78  (PURMAXX4) 

Vaudois  War,  1686  (BELI.OSTE8)  
Siege  of  Milan,  1733  (DESPORT6)  

1 
2 
2 

3 

Battle  of  Dettingen,  1743  (RAVATOX7)  

1 

Fontenoy  and  Tournay,1745(FAURE,8BOUCHER9) 
Seven-  Years'  War,  1756-'63  (Bn.GUER,  "MEHEE," 
MURSIXXA12)  

5 

1 

Battle  of  Crevelt   1758  (MOSCATI13)  

1 

Battle  of  Prince  Town,  1777  (XEALE14)  

1 

Revolution  in  Paris,  1791  (DESAULT15)  

1 
4 

Napoleonic  Wars  1792  181516              .     

45 

1 

11 

2 
2 

20 

1 

1 

2 

20 

23 

War  of  1812-14  (TROWBRIDGE,17  HAMILTON,18). 
Revolution  in  Paris,  183010  

9 

8 
1 
4 

2 

1 

4 

1 

4 

5 

Revolution  in  Lyons.  1831  (G  ENSOUL10)   • 

2 

Siege  of  Antwerp,  1832  (H.  LARREY21)       .  . 

3 
23 
8 

1 

2 

1 

I 

French  in  Algeria,  1830-1836  (BAUDENS22)  

2 

23 
8 

1 

Spanish  Peninsular  War,  1836-37  (ALCOCK28)  
African  Campaigns,  1841-42,  and  accident,  1843 
(LEGOUEST  24  LE  CLERC26)  

1 

2 
6 
2 

1 

Revolution  in  Paris,  184826  

9 
14 
14 

1 

1 

2 

1 

6 
12 
3 

8 
12 
14 

War  in  Sleswick-Holstein,  1848-50  (STROMEYEK27) 
Revolution  in  Baden,  1849  (BECK'-'8)  

PensiouersattheInvalides,Paris,1847-53(HuTlNw) 
Bombardment  of  Sveaborg,  1855  (HEYFELDER30) 
Crimean  War,1854-57(MATTHEW,31  LOXGMORE,32 
CHEX'U  'H  BAUDEXS34)           

17 

28 

18 

1 

i 

153 

12 

231 
6 
9 
29 
128 
25 
4 
530 
811 
7 

402 

1 

311 
3 
9 

2 

43 

6 

86 
2 

1 

1 
1 

128 
1 
2 

20 
5 

19 
1 

68 

71 

401 

British  in  India  1857-58  (WILLIAMSON3*) 

Italian  War.lPSg-eOfCHEXU^ROUX.s'DRMME,38 
GHERIN'I30)                          .                          

o 

37 
4 
5 

44 
1 
5 

60 
1 

40 

79 

New  Zealand  War,  1863-65  (MOUAT40)  

Danish  War  1864  (HEIXE  4I  LOCKE42)      

3 

2 

Danish  Invalids  of  War  of  1864  (HAXXOVFR43).  .  . 
Six  Weeks'  War,  Germany,  186644  

29 

61 
1 
5 
233 

85 
4 

47 

11 
10 

12 

11 
9 
1 
55 
97 

5 

1 
o 

47 
20 

1 

6 
3 
3 

44 
127 

18 

100 
3 

26 

47 

Austro  Italian  War  1866  (R.  Gltrrn48) 

United  States  Army,  1865-70  (OTIS46)  

3 

T 

Franco-German  War,  1870-71  —  Germans47  

48 

78 
199 
1 

56 

20 

1 

o 

26 
14 

353 
388 
6 

104 
31 
;{ 

42 

Russo.  Turkish  War,  187640  

Totals  

3,474 

2,132 

1,242 

100 

489 

230 

4 

296 

148 

3 

307 

125 

3 

1,040 

73!) 

90 

'PARE  (A.),  Oeuvres  Completes,  6d.  MALGAIGXE,  Paris,  1840,  T.  II,  p.  170.  2FABRICIU8  HlLDAXUS,  Wund-Artzney,  Franckfurth,  1652,  p.  1207. 
3  SCHMIDT  (JOSEPH),  Speculum  Chirurgicum  oder  Spiegel  der  Artzney,  Augspurg,  1656,  pp.  148,  150.  4 PURMAXX  (M.  G.),  Funfftzig  Sonder-und  Wun- 
derbahre  Schusswunden-Curen,  Franckfiirt  und  Leipzig,  1721,  pp.  32,213,  250.  6BELLOSTE,  Le  Chirurr/ien  d'Hopital,  Paris,  1716,  p.  206.  "DEBPORT, 
Traite  des  Plaits  d'Armes  a  feu,  Paris,  1740,  p.  222.  7  RAVATOX,  Chirurgie  d'Armt'e  ou  TraM  des  Plaies  d'Armes  d.  Feu,  Paris,  1768,  pp.  338,  347,  350. 
"FAURE,  L 'amputation  etant  absolumcnt  necessaire,  etc.,  in  Prix  de  VAcad.  Royale  de  Chir.,  1819,  T.  Ill,  pp.  351  (1  recovery).  9 BOUCHER,  06.?.  svr 
des  Playes  d'Armes  a  feu  compliquees  surtout  de  fracas  des  os,  in  M'm.  de  VAcad.  Roy.  de  Chir.,  Paris,  1753,  T.  II,  p.  470  (1  recovery).  10BlLGUER  (J. 
U.),  Chirurgische  Wahrnehmungen,  Berlin,  1763,  pp.  458,  475,  476,  481,  482,  483  (6  recoveries).  "  MEHEE  (JEAN),  Traite  des  plaies  d'armes  a  feu,  Paris, 


SECT.  m.J  SHOT    INJURIES    OF   THE    FEMUR.  337 

in  the  manner  of  securing  immobility  of  the  limb,  in  facilitating  the  requisite  dressings 
and  in  the  means  of  transportation,  the  views  of  military  surgeons  experienced  a  change, 
and  the  field  of  conservative  treatment  of  shot  fractures  of  the  femur  became  enlarged 

o 

Baudens,  who  (as  indicated  \u  Note  4,  on  page  174,  ante),  in  1836,  strenuously  advocated 

An.  VIII  (17!)9),  p.  134  et  seq.  (-,'  recoveries).  "MUKSIXNA  (C.  L.),  Neue  Med.  Chir.  Beobachtungeu,  Berlin,  1790,  p.  138  (1  recovery.)  "MOSCATI,  in 
Mem.  de  I'Acad.  Roy.  de  Chir.,  Paris,  1768,  T.  IV,  p.  625.  14NEAL£  (H.  ST.  JOHX),  Chirurgical  Institutes,  London,  1805,  p.  251.  "DESAULT,  Plait 
d'arme  a  feu  tracersant  les  deux  cuisses,  in  Jour,  de  Chir.,  Paris,  1792,  T.  HI,  p.  KM.  10  LAIWKY  (1).  J.),  Clin.  Chir.,  1636,  T.  V,  p.  328  (1  recovery). 
HEXNEX  (JOHX),  Principles  of  Military  Surgery,  London,  1829,  pp.  113,  131  (1  recovery,  1  result  unknown).  GUTHlilE  (G.  J.),  Gunshot  Wounds, 
London,  1827,  p.  375  (18  recoveries,  J3  deaths).  EUDKS  (P.  J.),  Sur  les  wantages  de  pratiquer  Vamputation  sur  le  cluimp  de  bataille,  Paris,,  1S15 
ThSse,  p.  17  (2  fatal  cases).  FEXECH  (E.),  Sur  les  pieties  d'armes  a  feu  aux  extremites,  Paris,  1813,  Thdse,  pp.  10,  16  (2  recoveries,  5  fatal).  ElIHl.ICH 
(J.  A.;,  Chirurgische  Beobachtungen,  Leipzig,  Ifelo,  B.  II,  p.  156  (1  recovery).  FORGET,  Bull  de  la  Soc.  de  Chir.  de  Paris,  pendant  1855-56,  p.  230 
(1  recovery).  RlBES  (F.),  Mem.  sur  la  fracture  du  tiers  moyen  du  femur,  etc.,  in  Gaz.  Mid.  de  Paris,  1831,  T.  II,  pp.  l(!2-10(i  (7  recoveries,  15  fatal). 
HUTIX  (M.  F.),  Mem.  sur  la  necessite  d'extraire  les  corps  itrangers  et  les  esquilUs,  etc.,  in  Mem.  de  I'Acad.  Nat.  de  Med.,  185i.>,  T.  XVI,  pp.  444-448 
(3  recoveries).  BALLINGALL  (G.),  Outlines  of  Military  Surgery,  Edinburgh,  1855,  pp.  388-390  (I  recovery,  10  fatal).  LEGOUEST  (L.),  Mem.  de  la 
Soc.  de  Chir.,  Paris,  1863,  T.  V,  p.  166  (1  recovery).  17TKOWBKIDGE,  Gunshot  Wounds,  in  Boston  Medical  and  SurgicalJournal,  1838,  Vol.  XVIII,  p.  343 
(1  recovery).  "HAMILTON  (F.  H.),  A  Practical  Treatise  on  Fractures  and  Dislocations,  Philadelphia,  1875,  p.  518  (1  recovery).  "AUNAI.,  Mini,  sur 
quelques  peculiaritts  des  plaies  par  armes  a  feu,  in  Jour.  Ilebd.  de  Mid.  et  de  Chir.  prat.,  Paris,  1831,  p.  36  (4  recoveries).  MENIERE  (P.),  L'Uotel 
Dieu  Paris,  en  Juillet  et  Aout,  1830,  Paris,  1830,  p.  312  (4  recoveries,  7  fatal).  LAKKEY  (H.),  Relation  Chirurgicale  des  ivinements  de  Juillet,  1830, 
Paris,  1831,  pp.  102,  106  (2  recoveries).  ROUX  (PHIL.  J.),  Considerations  Cliniques  sur  les  blesses  a.  la  Charite,  Paris,  1830.  p.  50  (2  fatal).  JOBEUT 
1>E  LAMBALLE  (A.  J.),  Plaies  d'armes  a  feu,  Paris,  1833,  p.  262  (8  recoveries.)  20GEXSOUL,  Note  sur  les  blesses  recus  a  I'Hotel-Dieu  de  Lyon,  pendant 
les  troubles  de  1831,  in  Gaz.  Med.  de  Paris,  1833,  T.  IV,  p.  300.  S1  LAKKEY  (H.),  Histoire  chirurg.  du  siege  de  la  citadelle  d'Anvers,  1833,  p.  215.  »BAU- 
UEXS  (L.),  Clinique  des  Plaies  d' Armes  a  Feu,  Paris,  1836,  p.  460.  *3ALCOCK  (R.),  Notes  on  the  Med.  Ifist.  and  Stat.  of  the  British  Legion  in  Spain, 
London,  1838,  pp.  52,  95.  ** LEGOUEST,  in  Mem.  de  la  Soc.  de  Chir.  de  Paris,  1863,  T.  V,  p.  167  (2  recoveries).  25LE  CLERC,  Quelques  observations  par- 
ticulieres  de  plaies  d'armes  a  feu,  Strasbourg,  18-">2  (1  recovery).  26 Communications,  Des  Plaies  d'armes  d  feu,  Paris,  1849:  HUGUIER,  p.  131  (3 
recoveries,  2  fatal);  AMUSSAT,  p.  55  (1  recovery);  BAUDENS,  p.  231  (1  recovery,  1  fatal,  1  undetermined);  JoiiEKT  (UE  LAMBALLE),  p.  153  (2  recoveries, 
4  fatal);  MALGAIGNE,  p.  45  (2  recoveries,  2  fatal).  Bulletin  de  la  Hoc.  de  Chir.  de  Paris,  1855-56,  pp.  230-214:  GKKALUES  (1  recovery),  ROBERT  (I 
recovery),  DEXOXVILI.IEKS  (1  recovery).  "STROMEYER  (L.),  Maximen  der  Kriegsheilkunst,  Hannover,  1855,  pp.  756-57.  »>BECK  (B-),  Die  Schuss- 
wunden,  Heidelburg,  ia50,  p.  266.  »  HUTIN,  Recherches  sur  le  risultat  des  fractures  de  la  moitii  superieure  de  la  cuisse,  Paris,  1854,  pp.  10,  14,  and  Rfc. 
de  Mi'm.  de  Med.  de  Chir.  et  de  Phar.  Mil.,  Paris,  1854,  2""  ser.,  T.  XIV,  pp.  261,  263  (63  cases,  all  pensioners).  3UHEYFELUEK  (J.  F.),  Die  Verwundun- 
gen  und  Operationen  in  Folge  des  Bombardments  von  Sveaborg,  in  Deutsche  Klinik,  1855,  B.  VII,  p.  554.  31  MATTHEW  (T.  P.),  Med.  and  Surg.  Hist,  of 
the  British  Army,  etc.,  in  the  years  1854-55-56,  London,  1858,  Vol.  II,  pp.  355-56  and  361  (19  recoveries,  69  fatal).  3JLOXGMORE  (T.).  in  HOLMEs'S 
System  of  Surgery,  1870,  2d  ed.,  Vol.  II,  p.  225  (I  recovery).  ^CHEXU  (J.  C.),  Rapport,  etc.,  pendant  la  Campagne  d' Orient  en  1854-55-56,  Paris,  1856, 
p.  374  (126  recoveries,  333  fatal).  MBAUI)EXS  (L.),  La  Guerre  de  Crimte,  Paris,  1858,  p.  328  et  seq.  (7  recoveries).  K  WILLIAMSON  (G.),  Mil.  Surgery, 
London,  1863,  p.  XXVI.  ^CHENU  (J.  C.),  Stat.  Mid.  Chir.  de  la  Campagne  d'ltalie  en  1859-60,  Paris,  1869,  T.  II,  p.  715  (118  recoveries,  190  fatal). 
37 ROUX  (J.),  Dcsarticulation  de  la  cuisse,  Paris,  1860,  p.  16  (9  recoveries  not  in  CHEXU).  ^DEMME  (H.),  Militdr- Chirurgische  Studien,  Wurzburg,  1801, 
Zweite  Abth.,  p.  232  (79  recoveries,  86  fatal).  ^GHERIXI  (A.),  Relazione  chirurgica  dell  'Ospedale  Militare  provisorio  di  is.  Filippo,  iu  Annali  ffniver- 
sali  di  Medicina,  Milano,  1860,  Vol.  CLXXIII,  pp.  459,  460  (60  cases— 25  recoveries,  35  fatal).  40MOUAT,  The  New  Zealand  War  of  1863-64-65,  in  Stat. 
San.  and  Med.  Reports  for  the  year  1865,  London,  1867,  Vol.  VII,  pp.  502-3.  41  HELVE  (C.),  Die  Schussverletzungen  der  Unteren  Extremitdten,  Berlin, 
1866,  p.  238  et  seq.  (9  recoveries,  7  fatal).  42L(JCKE  (A.),  Kriegschirurgische  Aphorismen,  in  LANGENBECK's  Archiv,  B.  VII,  pp.  13,  21  (2  fatal).  43HAX- 
NOVER  (A.),  Die  Ddnischen  Invaliden  aus  dem  Kriege  1864,  Berlin,  1864,  p.  26  (29  cases,  all  pensioners).  44STUOMEYER  (L.),  Erfahrungen  i,ber  Schuss- 
wunden  im  Jahre  1866,  Hannover,  1867,  p.  53  (10  recoveries,  15  fatal).  FISCHER  (K.),  Militdrdrztliche  Skizzen  aus  Siiddeutschland  und  Bohmen, 
Aarau,  1867,  p.  83  (98  recoveries,  17  fatal,  47  result  unknown).  MAXXEL  (O.),  Kriegschirurgische  Beobachtungen,  in  Allg.  Wiener  Med.  Zeitung,  Jahrg, 
XII,  1867,  No.  48,  p.  403  (1  fatal).  BECK  (B.),  Kriegschirurgische  Erfahrungen  wdhrend  des  Feldzuges  18U6,  Freiburg  i.  B.  1867,  p.  294  (8  recoveries, 
9  fatal).  BIEFEL  (R.),  Kriegschirurgische  Aphorismen  von  1866,  in  LAXGENBECK's  Archiv,  Berlin,  1869,  B.  XI,  p.  445  (5  recoveries,  6  fatal).  MAAS 
(II.),  Kriegschirurgische  Beitrdge,  Breslau,  1870,  p.  40  (7  recoveries,  13  fatal).  ^GRITTI  (R.),  Nuovi  documents  in  favore  della  cura  conservativa  nelle 
fratture  del  femore  par  arma  da  fuoco,  in  Annali  Universali  di  Medicina,  Milano,  1868,  Vol.  CCV,  p.  518  et-seq.  4GOTIS  (G.  A.),  Circular  No.  3,  War 
Department,  S.  G.  O.,  Washington,  1871,  p.  70  et  seq.  47BECK  (B.),  Chirurgie  der  Schussverletzungen,  Freiburg,  1872,  p.  677  (87  recoveries,  44  fatal). 
BILLKOTH  (TH.),  Chirurgische  Briefe,  etc.,  Berlin,  1872,  p.  228  (9  recoveries,  12  fatal).  FISCHER  (G.),  Dorf  Floing,  etc.,  in  Deutsche  Zeitschrift  fur 
Chirurgie,  1872,  B.  I,  p.  185  (26  recoveries,  17  fatal,  4  undetermined).  FISCHER  (H.),  Kriegschirurgische  Erfahrungen,  Erlangen,  1872,  p.  177  (9  recov 
eries.  11  fatal).  GOLTDAMMER,  Bericht  iiber  die  Thdtigkeit  des  Reserve-Lazareths  des  Berliner  Hiilfsvereins,  in  Berliner  Klin.  Wochenschrift,  1871, 
No.  13,  p.  151  (4  recoveries,  2  fatal).  GRAF  (E.),  Die  Kdniglichen  Reserve- Lazarethe  zu  Dusseldorf  wdhrend  des  Krieges  1870-71,  Elberfeld,  1872,  p. 
62  (4  recoveries,  5  fatal).  GUTEKUNST.  Bericht  ueber  die  wdhrend  des  vorigen  Jahres  indem  Vereinspital  Ludivigsburg  aufgenommenen  ScJtussverletz- 
ungen,  in  Zeitschrift  fur  Wunddrzte,  Stuttgart,  1876,  B.  XXIII,  pp.  140,  146  (1  recovery,  2  fatal).  HEYFELUEU  (O.),  Berichte,  etc.,  in  Petersburg. 
Medizinische  Zeitschrift,  1871,  No.  1,  p.  57  (1  recovery).  KlRCHNER  (C.),  Aerztlicher  Bericht  ueber  das  K.  P.  Feld-Lazareth  im  Palast  zu  Versailles, 
Erlangen,  p.  54  (3  recoveries,  12  fatal).  KOCH  (W.),  Notizen,  etc.,  in  LANOEXBECK'S  Archiv,  1872,  B.  XIII,  p.  500  (7  recoveries,  11  fatal,  2  unde 
termined).  KUCHLEK  (H.),  Analecten  aus  der  Kriegsgeschichte,  in  Memorabilien,  B.  XVI,  1871,  p.  141  (2  recoveries,  9  fatal).  LOSSEN  (H.),  Kriegs 
chirurgische  Erfahrungen,  in  Deutsche  Zeitschrift  fur  Chir.,  1873,  B.  II,  p.  112  (9  recoveries,  6  fatal).  MAYER  (L.),  Kriegschir.  Mittheilungen,  in 
Deutsche  Zeitschrift  fur  Chir.,  1873,  B.  Ill,  pp.  49-52  (2  recoveries,  4  fatal).  MOSETIG  (V.),  Erinnerungen  aus  dem  Deutsch-Framosischen  Kriege,  in 
Der  Militdrarzt,  1872,  Jahrg.  VI,  p.  21  (1  recovery).  OTT,  OESTEKLEN,  und  ROMBERG,  Kriegschir.  Mittheilungen,  etc.,  Stuttgart,  1871,  p.  49  (8  recov 
eries,  5  fatal).  RurriiECHT  (L.),  Militdrdrztliche  Erfahrungen,  WUrzburg,  1871,  p.  74  (4  recoveries,  2  fatal).  SALZMANX,  Mittheilungen  aus  dem 
Vereinsspital  in  Esslingen,  in  Med.  Correspondenz-Blatt  des  Wi/rttemberg.  A"rztl.  Vereins,  1871,  B.  XLI,  pp.  148,  153  (1  recovery,  1  fatal).  ScilIX- 
ZINGER  (A.),  Das  Reserve- Lazareth  Schwetzingen,  Freiburg,  1873,  pp.  70,  71  (7  recoveries,  2  fatal).  SOCIN  (A.),  Kriegschirurgische  Erfahrungen. 
Leipzig,  1872,  p.  134  (16  recoveries,  6  fatal).  STEINBERG,  Die  Kriegslazarethe  und  Baracken  von  Berlin,  Berlin,  1872,  p.  147  (233  recoveries,  55  fatal, 
40  undetermined).  STOLL,  Bericht  aus  dem  K.  Wiirttembergischen  4  Feldhospital,  in  Deutsche  Mil.  Zeitschrift,  1874,  B.  Ill,  p.  197  (11  recoveries.  15 
fatal,  2  undetermined).  SruMl'F  (L.),  Bericht  iiber  das  Kriegsspital,  etc.,  Neuberghausen,  in  Bayerisches  Aerztl.  Intelligenz-Blalt,  1872,  p.  656  (9  recov 
eries,  3  fatal).  CZERXY  (VlNCEXZ),  Bericht  ueber  die  in  College  Stanislaus  in  Weissenburg  behandelten  Verwundeten,  in  Wiener  Medizinische  Wochen 
schrift,  1870,  No.  57,  p.  1373  (11  recoveries,  9  fatal).  BERTHOLD,  Statistik,  etc.,  in  Deutsche  Militdrarztliche  Zeitschrift,  1872,  B.  I,  p.  522  (65  recov 
eries — 4  in  upper,  2  in  middle,  4  in  lower  third,  and  55  in  which  the  seat  is  not  recorded;  all  pensioners).  48Cini'AL'LT  (A.),  Fractures  par  armes  a  feu, 
Paris,  1872,  p.  4  et  seq.  (10  recoveries,  2  fatal).  CHRISTIAN  (J.),  Relation  sur  les  plaies  de  guerre,  in  Gaz.  Med.  de  Strassbourg,  1872,  p.  283  (10  recov 
eries,  12  fatal).  COUSIN,  Ambulances  de  la  Presse  Frangaise,  in  L' Union  Mtdicale,  1872,  T.  XIII,  p.  148  (7  fatal).  DESPRES  (A.),  Rapport  sur  les 
travaux  de  la  7°>«  Ambulance  a  VArm.ee.  du  Rhin,  etc.,  Paris,  1871,  pp.  44,  46,  48  (5  recoveries,  12  fatal).  FEI.TX  et  GuOLLEMUXD,  Rel.  Clin.  sur  Ir* 
Ambulances  de  Haguenau,  in  Gaz.  Med.  de  Strasbourg,  1871,  No.  11,  p.  133  (11  recoveries,  3  fatal).  JOESSELL,  Ambulance  du  Petit- Quartier  a  Hariue- 
nau,  in  Gaz.  Med.  de  Strasbourg,  1871,  p.  8  (7  recoveries,  6  fatal).  MACCORMAC  (W.),  Notes  and  Recollections,  etc.,  London,  1871,  p.  109  (8  recoveries, 
20  fatal).  MOYXIER  (EUGENE),  Ambulance  de  la  Rue  Saint  Lazare,  in  Gaz.  des  Hopitaux,  1871,  Vol.  XLIV,  p.  44.-)  (J  recoveries,  1  fatal).  PAXAS  (F.), 
Mem.  sur  le  trailcmrnt  des  blessures,  etc.,  iu  Gaz.  hebdomadaire  de  Med.  et  de  Chir.,  1872,  T.  IX,  p.  391  (2  recoveries,  4  fatal).  POXCET  (F.),  Contribu- 
SUKG.  Ill— 43 


338  INJUKIES    OF   THE    LOWEE    EXTREMITIES.  [CHAP.  x. 

immediate  amputation,  and  who  yet,  in  1849, l  insisted  that  "les  fractures  du  corps  du  fe"mur 
demandent  impe'rieusement  1'amputation  immediate,"  acknowledged,  in  1858,  after  his 
experience  in  the  Crimean  War,  "cette  sentence  trop  absolue."-  The  successful  attempts 
at  conservation  in  shot  fractures  of  the  femur  recorded  from  the  Danish  War  of  1864,  by 
Heine,  from  the  Six  Weeks'  War  of  1866,  by  K.  Fischer,  Beck,  and  E.  Gritti,  and  from 
the  Franco-German  War  of  1870-71,  by  Beck,  H.  Fischer,  Lossen,  Rupprecht,  and  Socin 
among  the  Germans,  and  Chipault,  Feltz,  Grollemund,  Roaldes,  Se'dillot  and  others  among 
the  French  (TABLE  XLVIII  and  notes  on  p.  336),  stimulated  the  propensity  towards  con 
servative  opinions  in  war  surgery.  B.  Beck,  who,  in  1850,  insisted  upon  immediate  ampu 
tation,3  "be  it  in  the  field  or  in  cities  in  well  conducted  hospitals,  in  all  shot  fractures  of  the 
femur,  even  if  there  be  only  the  slightest  splintering  or  displacement  of  the  ends  of  the 
femur  in  oblique  fractures,"  conceded,  in  1872,  after  the  Franco-Prussian  War,4  that  "we 
have,  in  the  field  hospitals,  by  expectative  therapy  and  by  the  use  of  the  simplest  band 
ages,  saved  a  considerable  number  of  shot  fractures  of  the  femur."  Se'dillot5  declared  that 
"the  extreme  mortality  of  amputations  of  the  thigh  in  war  surgery,  and  the  annoyances 
and  accidents  to  which  the  apparatus  destined  to  replace  the  limb  are  liable,  have  led  us  to 
renounce  this  operation  in  all  cases  in  which  the  most  positive  necessity  does  not  require 
it."  Socin6  considers  it  "inexcusable  to  perform  in  a  case  of  shot  fracture  of  the  femur  for 
splintering  of  bone  alone,  the  primary  amputation  as  yet  advocated  by  the  first  authorities 
of  French  military  surgery.  Only  when  we  are  assured  that  the  vessels,  artery  and  vein, 
are  shot  through,  is  the  operation  justifiable." 

Already  in  the  early  part  of  the  War  of  the  Rebellion  many  American  surgeons  were 

tions,  etc.,  in  Montpellier  Midical,  1872,  T.  XXVIII,  pp.  41-43  (1  recovery,  4  fatal).  ROALUES  (A.  W.  DE),  Des  fractures  compliquees  de  la  cuisse, 
Paris,  1871,  p.  43,  etc.  (11  recoveries,  10  fatal).  SEDILLOT,  Du  traitement  des  fractures  des  membres par  armies  de  guerre,  in  Archives  Gentrales  de  Mcd- 
tcine,  1871.  4rae  ser.,  T.  XVII,  p.  423,  etc.  (25  recoveries).  TACHAUD  (E.),  Reflexions  pour  servir  d  I'histoire  de  la  Chirurgie,  iu  Gaz.  des  Hopitaux, 
1871,  p.  238  (1  fetal).  VASLIM  (L.),  Htude  sur  les  plaies par  armes  it  feu,  Paris,  1872,  pp.  102,  244  (7  recoveries,  3  fatal).  CHENU  (J.  C.)  (Apercu  hist, 
ttat.  tt  clinique,  etc.,  Paris,  1874,  T.  II,  pp.  153-1038)  names  705  pensioners  who  recovered  after  shot  fractures  of  the  femur;  12  of  them  have  been 
recorded  by  the  authors  just  quoted,  Y!Z:  CHIPAL'LT  (2),  CHRISTIAN  (2),  MACCORMAC  (1),  FELTZ  et  GROLLEMUND  (2),  ROALDES  (3),  and  SEDILLOT  (2), 
leaving  fi'.l3  cases  to  be  added  to  this  series,  viz:  151  in  upper  third,  58  in  middle  third,  110  in  lower  third,  and  374  in  which  the  location  of  the  injury 
was  not  specified.  MOS8AKOWSKY  (P.)  (Stat.  Bericht  ueber  1415  Franzbsische  Invaliden,  in  Deutsche  Zeitschrift  fur  Chirurgie,  1872,  B.  I,  p.  342) 
cites  19  cases  of  pensioners  after  shot  fracture  of  the  femur  not  reported  by  CHENU,  viz:  9  in  the  upper  third,  9  in  the  middle  third,  and  1  in  the 
lower  third  of  the  femur.  *  TILING  (G.),  Bericht  ueber  124  im  Serbisch-Tiirkischen  Kriege  im  Baracken  Lazareth  des  Dorpater  Sanitdts-  Train  Zu 
Swilainatz  behandelle  Schussverletzurtgeri,  Dorpat,  1877,  pp.  66-69  (1  recovery,  2  fatal).  KADE  (E.),  Das  Tempordre  Kriegslazareth  des  Kessoris  der 
Anstalten  der  Kaiserin  Maria,  in  St.  Petersburger  Med.  \\~ochenschrift,  1877,  No.  45,  p.  384  (4  recoveries,  2  fatal).  STEINEU  (F.),  Aus  dem  Tagebuche 
tines  Deittschen  Arztes  wahrend  der  Zeit  des  Krieas  im  Orient,  1876,  in  Wiener  Med.  Wochenscrift,  1877,  No.  28,  p.  681  (2  recoveries).  Of  the  3,474  cases 
of  shot  fractures  of  the  femur  treated  by  conservation  here  referred  to,  ,2,132  were  successful  and  1,242  were  fatal,  while  in  100  instances  the  result  could 
not  be  ascertained.  But  it  would  obviously  be  unfair  to  make  a  deduction  regarding  the  percentage  of  mortality  from  the  numbers  here  adduced.  Among 
the  oases  of  recovery  enumerated  are  63  pensioners  observed  by  HUTIN  (No.  29,  ante)  at  the  Hotel  des  Invalides  at  Paris  during  the  years  1847-1853 ;  29 
pensioners  recorded  among  the  Danes  after  the  Schleswig-Holstein  War,  1864,  by  HANNOVER  (No.  43,  ante);  65  pensioners  observed  by  BKKTHOLD  (No. 
47.  ante);  693  pensioners  tabulated  by  CHE\U  (No.  48,  ante):  and  19  pensioners  observed  by  MOSSAKOWSKY  (No.  48,  ante).  These  cases,  numbering 
869,  should  be  deducted  from  the  total  number  of  recoveries,  leaving  1,263  successful  to  1,242  fatal  cases,  a  mortality  of  49.5  per  cent.  Of  the  869  pen 
sioners  thus  deducted,  181  recovered  after  shot  fractures  in  the  upper  third  of  the  femur,  97  in  the  middle,  133  in  the  lower  third,  and  458  in  the  femur, 
third  not  specified.  Deducting  these  from  their  respective  categories  in  TABLE  XXXVI  there  remain  489—181—308  recoveries  in  the  upper  third  to  230 
deaths,  a  mortality  of  43.7  per  cent.;  296 — 97=199  recoveries  to  148  deaths  in  the  middle  third,  a  death  rate  of  42.6  per  cent.;  307 — 133^^174  recoveries  to 
125  deaths  in  the  lower  third,  a  fatality  of  41.8  per  cent.,  and  1040 — 458=582  recoveries  in  the  femur,  scat  unspecified,  to  704  deaths,  or  a  mortality  of  54.7. 

1  BAUDEXS  (L.),  Des  1'laies  d'armes  a  feu.     Communications,  etc.,  Paris,  1849,  p.  218. 

*BAL'DKNS  (I...)  (La  Guerre  de  Crimt'e,  Paris,  1858,  p.  131):  "Avant  la  guerre  de  Crim6e,  c'6tait  un  principe  g6n6ralement  accepte  qu'tine  fracture 
du  f6mur  d6termin6e  par  un  coup  de  feu  n^cessite  1'amputation.  II  y  a  lieu  de  penser  que,  grace  d  mes  nouveaux  appareils  d  fractures,  on  pent  en  appeler 
de  oette  sentence  trop  absolue;''  and,  on  p.  333,  "  Us  prouvent,  contrairement  a  1'opinion  re^ue,  que  les  fractures  eomminutives  du  femur  avec  pluie  nc 
gont  pas  fatalement  vonfees  d  1'amputation,  si  on  a  le  soin  d'extraire  les  esquillcs  et  les  corps  6trangers  pour  faire  d'une  plaie  cnmpliquee  line  plaie  simple, 
et  si  d  1'aule  d'un  appareil  a  fracture  convenable,  on  parvient  d  placer  le  membre  dans  une  immobility  complete,  sans  1'ebranler  meme  pendant  les 
pansements.  et  d  donner  uux  humiditds  pimilentes  un  facile  6c«ulement." 

3BECK  (B.).  Die  ScltujtswurKhn,  Heidelberg,  1650,  p  283.  4BECK  (B.),  Cliirurgie  der  Schussverlet~unyen,  Freiburg,  1872,  p.  691. 

*S£|ilLLOT  (Du  traitrment  des  fractures  des  membres  par  armes  de  guerre,  in  Arch.  Gin.  de  Mid.,  1871,  6me  serie,  T.  XVII,  p.  422)  remarks: 
"I/  extreme  mortalite.de  1'aroputation  de  la  cuisse  dans  la  chirurgie  de  guerre,  et  les  ennuis  et  les  accidents  que  causent  leg  moyens  de  prothese  destines  d 
remplacer  ce  membre.  nous  ont  conduit  d  renoncer  d  cette  operation  dans  tous  les  cas  ou  la  nficessite,  la  plus  6vidente  ne  1'imposait  pas.  Les  ablations 
partielles  ou  totales  par  un  boulet,  un  6clat  d'obus;  des  fracas  osseux  trds-etendus  avec  division  de  I'art6re,  de  la  veine  crurale  et  du  nerf  sciatique;  la 
gangrene,  les  fractures  avec  large  ouverture  du  genou  et  fragmentation  des  condyles  du  fiSinnr  et  du  tibia,  sont  les  seules  complications  qtii  semblent 
empdcher  absolument  la  conservation  de  la  cnisse." 

'  SOCIN  (A.)  (Krirgschirurgische  Krfahrungen,  Leipzig,  1872.  p.  128)  believes  that  the  experiences  of  the  late  campaigns  confirm  on  the  one  hand 
the  previous  reports  of  the  enormous  mortality  of  primary  amputations  of  the  femur,  and.  on  the  other  hand,  prove  that  the  conservative  treatment  is  not 
only  enabled  to  save  many  useful  extremities  but  gives  far  better  results  in  regard  to  mortality. 


SECT,  in.]  SHOT   INJUKIES   OF   THE    FEMUR.  339 

led  to  similar  conclusions.  Assistant  Surgeon  Philip  0.  Davis,  U.  S.  Army,  in  a  report  to 
the  Surgeon  General  of  his  services  from  June  1,  1861,  to  June  19,  1863.  remarked  that: 
"The  mortality  was  very  great  in  cases  of  amputations  for  compound  comminuted  fracture 
of  the  femur;  better  success  being  met  with  by  using  splints  and  other  appliances  adapted 
to  the  nature  of  the  cases."  (See  Appendix  to  Part  I  of  the  Med.  and  Surg.  Hist,  of  the 
War  of  the  Rebellion,  p.  15.)  Surgeon  A.  J.  Phelps,  U.  S.  V.,  in  his  observations  after 
the  battle  of  Chickamauga,  September  19,  1863,  stated:  "As  a  rule  a  gunshot  .fracture  of 
the  femur  should  not  be  amputated,  but  should  be  treated  with  the  expectation  of  saving 
the  limb.  Such  appliances  should  be  used  as  to  secure  drainage  from  the  wound  and  com 
fort  to  the  patient,  and  the  case  then  be  left  to  nature  supported  by  good  air  and  generous 
diet."  Surgeon  J.  S.  Woods,  99th  Ohio  Volunteers,  in  a  report  from  the  hospital  at  Chat 
tanooga,  declared:  "Amputation  is  almost  never  warrantable;  but  the  prospect  of  success 
warrants  the  effort  to  save  the  life  with  the  limb."  Surgeon  Henry  J.  Churchman,  U.  S.  V., 
detailed  eleven  cases  of  shot  fractures  of  the  femur  treated  at  the  hospital  at  Fayetteville, 
Arkansas,  and  arrived  at  the  following  conclusions:  "The  results,  so  far,  of  the  cases  given, 
force  me  to  believe,  Guthrie  and  others  to  the  contrary,  that:  1,  Gunshot  fractures  of  the 
femur,  as  a  rule,  do  not  require  amputation  to  save  life;  2,  As  a  rule,  none  should  be  ampu 
tated  save  those  where,  in  addition  to  comminution,  there  is  extensive  laceration  of  soft 
parts  or  serious  injury  done  to  principal  artery  or  nerve  or  both."  Surgeon  A.  W.  Heise, 
100th  Illinois,  who  had  observed  twelve  cases  of  commiuuted  fractures  of  the  thigh  at  the  first 
division,  Twenty-first  Corps,  field  hospital,  "of  which  six  had  recovered,  two  would  probably 
recover,  and  four  had  terminated  fatally,"  concludes  that  "the  results  of  these  few  cases, 
so  much  at  variance  with  the  experience  of  all  military  surgeons,  will  be  one  more  reason 
to  encourage  a  hope  for  a  favorable  result  from  conservative  treatment  of  these  unfortunate 
cases."  Like  views  were  entertained  by  Surgeon  I.  Moses,  U.  S.  V.,  Assistant  Surgeons 
A.  H.  Hoff  and  DeWitt  0.  Peters,  U.  S.  A.,  Assistant  Surgeon  A.  E.  Carothers,  U.  S.  V., 
Acting  Assistant  Surgeons  B.  B.  Miles,  J.  Swinburne,  E.  G.  Waters,  and  the  Confederate 
Surgeon  G.  M.  B.  Maughs.1  That  the  conservative  mode  of  treating  fractures  of  the  femur 
gave  the  best  results  and  was  most  zealously  advocated  by  surgeons  in  charge  of  general 
hospitals  remote  from  the  scene  of  conflict2  is  readily  understood  when  it  is  considered  that 

1  MOSES  (I.)  (Surgical  Notes  of  Cases  of  Gunshot  Injuries  occurring  during  the  Advance  of  the  Army  of  the  Cumberland,  in  Am.  Jour.  JJed.  Sci., 
54,  Veil.  XLVII,  p.  338):  With  our  ambulances,  "  easy  and  abundant,  and  the  hospitals  amply  supplied  with  everything  essential     .     .    we  ~ere  pre- 


1804 


pound  fractures  of  the  femur  received  by  Confederate  soldiers  at  the  battle  of  Gettysburg,  and  remarks:  "  The  general  condition  of  all  the  men  was  f 
above  my  expectations  of  finding  them,  considering  they  were  prisoners  of  war  and  liable  more  or  less  to  nostalgia.     .     .     The  treatment  they  hi 
received  was,  in  my  opinion,  in  conformity  with  the  laws  of  conservative  surgery,  yet  it  seemed  to  me  had  a  little  more  care  been  given  to  extension  __ 
counter-extension,  there  would  have  been  less  shortening  and  deformity."     CAHOTIIEUS  (A.  E.)  (On  Compound  Comminuted  Fracture  of  the  Femur  from 
Slinie  Balls,  in  Am.  Jour.  Med.  Sci.,  18C3,  Vol.  XLV,  p.  330,  et  seq.)  concludes:  "  That  the  operation  of  resection  is  not  advisable,  but  that  it  offers  a  more 
favorable  prognosis  as  a  primary  than  as  a  secondary  operation,"  and  advises  moderate  and  regular  extension  and  counter-extension  and  the  use  of  the 
anterior  wire  splint.     JlJLES  (B.  B.)  (Conservative  Treatment  of  Gunshot  Fractures  of  the  Knee-Joint,  in  Am.  Med.-Timcs,  18C4,  Vol.  VIII,  p.  50):  "In 


he  limb  in  place  and  the  patient  from  sleep.     The  wounds  were  carefully  examined,  and  all  foreign  bodies,  including  spicula  of  bone  immediately  in  the 
rack  of  the  ball,  removed.     .     .    As  a  general  rule,  ordinary  fractures  above  the  knee  from  rifle,  balls  should  never  carse  primary  amputation.'' 

'Surgeon  J.  T.  IIODGEN,  U.  S.  V.,  on  October  17,  180-',  reported  from  the  City  General  Hospital,  St.  Louis,  of  shot  fractures  of  the  femur,  that 
he  "  succeeded  in  saving  37  out  of  53  cases  admitted, "  and,  in  a  letter  dated  April  30, 1803,  suggests  that  "  amputation  for  these  fractures  should  seldom  be 
performed."  Surgeon  Joux  II.  liBBTTOX,  U.  S.  V.,  ou  Jlay  19, 1803,  in  a  report  to  the  Surgeon  General  U.  S.  A.,  on  Dr.  IlODGE.x's  cradle  splint,  take* 


340  INJUKIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.X. 

cases  reaching  these  hospitals  had  been  generally  selected  by  the  surgeons  in  the  field  as 
cases  in  which  there  existed  some  chance  of  saving  the  limb. 

But  while  many  of  the  American  surgeons  advocated  and  practised  conservative  meas 
ures  in  shot  fractures  of  the  thigh,  there  were  those  who  deprecated  the  frequent  attempts 
at  conservation,  and  who  were  of  the  opinion  expressed  by  Surgeon  S.  Hart,  U.  S.  V.,1 
that  "more  amputations  would  have  saved  more  lives."  Surgeon  T.  H.  Squire,  89th  New 
York  Volunteers,  wrote  in  1862,  after  the  battle  of  Antietam:  "A  badly  shattered  femur 
by  a  ball  through  the  thigh  should  always  be  amputated,  and  the  quicker  the  better." 
Surgeon  G.  D.  Beebe,  U.  S.  V.,  in  his  report  of  the  centre  division  of  the  Fourteenth  Corps, 
at  the  battle  of  Murfreesboro',  remarked:  "In  the  shaft  of  the  femur  I  believe  amputation 
is  the  true  conservative  course."  Surgeon  Gr.  A.  Collamore,  100th  Ohio  Volunteers, 
declares:  "In  fractures  affecting  the  lower  two-thirds  of  the  limb,  I  should  amputate  so  as 
to  remove  the  fractured  portion;"  and  Surgeon  H.  S.  Hewit,2  U.  S.  V.,  Medical  Director  of 
the' Army  of  the  Ohio,  reported,  in  September,  1864:  "Compound  comminuted  fractures  of 
the  thigh  were  almost  invariably  amputated  primarily  when  reaction  took  place."  Surgeon 
F.  Sorrel,3  Inspector  of  Hospitals  of  the  Confederate  States  Army,  also  favored  primary 
amputation  on  the  field  as  "the  greater  readiness  with  which  the  patient  can  be  transported 
from  the  field;  the  greater  ease  and  comfort  realized  under  these  circumstances,  when  the 
limb  has  been  removed ;  the  lesser  time  required  in  hospital  for  recovery,  would  all  seem  to 
point  to  its  adoption  as  the  wiser  policy." 

Reviewing  the  cases  of  injuries  and  operations  in  the  shaft  of  the  femur  recorded 
during  the  American  civil  war,  it  cannot  be  denied  that  the  results  of  the  conservative 
mode  of  treatment  as  well  as  of  the  amputations  have  been  very  gratifying.  The  three 
thousand  four  hundred  and  sixty-seven  cases  of  the  former  group  gave  a  mortality  of  49.9 
per  cent.,  while,  of  the  six  thousand  two  hundred  and  twenty-nine  cases  of  the  latter 
group,  53.8  per  cent,  were  fatal.  Less  favorable  were  the  results  of  excisions  in  the  shaft 
of  the  femur,  which  exhibited  a  mortality  of  69.4  per  cent,  in  the  one  hundred  and  seventy- 
five  cases  of  this  operation  recorded  on  the  registers  of  this  Office.  Of  the  six  thousand 
two  hundred  and  twenty-nine  amputations  of  the  thigh  it  is  true  only  two  thousand  nine 
hundred  were  performed  for  shot  fractures  of  the  femur,  while  the  remaining  three  thousand 
three  hundred  and  twenty-nine  were  done  for  shot  fractures  of  the  knee  joint,  leg,  or  foot, 
and  the  objection  may  be  made  that  it  would  be  unfair  to  compare  the  results  of  six 
thousand  two  hundred  and  twenty-nine  amputations  in  the  thigh  with  the  results  of  shot 
fractures  of  the  femur  treated  by  either  conservation  or  excision,  the  injuries  in  all  these 
cases  being  in  the  femur;  but  the  mortality  of  the  two  thousand  nine  hundred  amputations 
in  the  thigh  for  fractures  of  the  femur,  with  one  thousand  two  hundred  and  fifty-seven 

issue  with  the  latter  suggestion :  "  I  think  that  neither  an  examination  of  gunshot  iujuries  of  the  thigh  made  on  the  battle-field,  nor  of  the  study  of  the 
pathological  specimens  in  the  Army  Medical  Museum,  will  sustain  this  view  of  Dr.  HODGEN.  It  must,  moreover,  be  remembered  that  the  cases  sub 
mitted  to  the  treatment  of  this  surgeon  are  cases  which  have  reached  him  at  advanced  periods  after  the  reception  of  the  injuries;  that  they. have  been 
selected  by  the  surgeons  at  the  scene  of  conflict  as  cases  in  which  there  existed  some  chance  of  saving  the  limb.  They  were  forwarded  to  St.  Louis  for 
that  purpose,  and  not  for  amputation.  Were  the  worst  eases  sent  him,  I  doubt  much  if  his  results  would  be  as  encouraging.'1  From  his  experience, 
based  upon  the  cases  treated  by  him  at  the  Stewart  Mansion  Hospital,  Baltimore,  Assistant  Surgeon  DE  WITT  C.  PETEKS,  U.  8.  A.,  reported,  in  18(i:i: 
"My  experience  in  the  treatment  of  compound  fractures  of  the  thigh  caused  by  gunshot  wounds  and  by  other  kinds  of  violence  has  inclined  me  to  favor 
the  most  conservative  course  of  action.  In  cases  where  the  large  and  important  blood-vessels  and  nerves  have  escaped  injury,  and  where  there  is  not  any 
extensive  laceration  and  destruction  of  the  soft  parts,  when  the  constitutional  symptoms  are  not  alarming,  the  true  indications  are,  it  appears  to  me,  to  try 
and  save  the  limb.  Instances  where,  by  chance  or  accident,  the  surgeon  has  not  seen  the  case  in  time  to  perform  primary  amputation,  and'has  left  nature 
to  her  own  powerful  efforts,  which  have  been  finally  crowned  with  success,  are  by  no  means  infrequent,  and  these  instructive  cases  should  not,  in  my 
judgment,  be  overlooked  in  forming  our  opinions  in  deciding  whether  a  limb  should  be  sacrificed  or  not." 

Appendix  to  Part  I  of  the  Medical  and  Surgical  History  of  the  War  of  the  Rebellion,  p.  118. 

2 Appendix  to  Part  I  of  the  Medical  and  Surgical  History  of  the  War  of  the  Rebellion,  p.  ail. 

'SoilKEL  (F.),  Gunshot  Wounds — Army  of  Northern  Virginia.  [An  Extract  from  a  Report  on  the  Sickness  and  Mortality  in  tlie  Armies  of  the 
Confederate  States,  for  1863  ,  in  Confederate  States  Medical  and  Surgical  Journal,  Richmond,  18G4,  Vol.  I,  p.  154. 


SECT.  III.] 


SHOT    INJURIES    OF    THE    FEMUR. 


341 


recoveries,  one  thousand  five  hundred  and  sixty-three  deaths,  and  eighty  unknown  results, 
or  55.4  per  cent.,  exceeds  that  of  the  total  number  of  amputations  (53.8)  only  1.6  per  cent., 
leaving  the  relative  results  nearly  the  same — the  percentage  of  fatality  of  the  total  number 
of  amputations,  and  that  of  the  amputations  for  fractures  of  the  femur,  exceeding  the  fatal 
ity  of  the  conservatively  treated  cases  3.9  per  cent,  and  5.5  per  cent,  respectively.  But  it 
is  obvious  that  in  comparative  statements  of  cases  treated  by  conservation  and  by  amputa 
tion  the  majority  of  intermediary  and  secondary  operations  should  be  considered  only  an 
abandonment  of  the  conservative  treatment  made  necessary  by  subsequent  complications. 
To  arrive,  therefore,  at  a  correct  estimate  of  the  value  of  conservation,  we  must  contrast 
the  latter  with  the  primary  operations;  and  here  it  will  be  noticed  that  while  the  conserv 
ative  cases  presented  a  fatality  of  49.9  per  cent.,  the  mortality  of  the  primary  amputations 
was  49.8  per  cent.,  the  latter  offering  a  slightly  better  chance  for  the  preservation  of  life.1 

In  comminuted  fractures  of  the  upper  third  of  the  femur  surgeons  generally  consid 
ered  conservation  preferable  to  amputation.  Professor  F.  H.  Hamilton2  gave  it  as  his 
impression  that  "in  compound  gunshot  wounds  of  the  upper  third  of  the  femur  amputation 
should  never  be  performed."  Surgeon  Charles  O'Leary.3  U.  S.  V.,  found,  during  the 
Peninsular  campaign  in  1862,  that  "amputations  at  the  upper  third  of  the  thigh  proved 
fatal  within  a  short  time  in  all  cases.  The  results  of  this  operation  were  such  as  to  dis 
suade  us  from  resorting  to  it  in  subsequent  battles,  except  when  a  limb  was  in  such  a  con 
dition  as  to  make  its  removal  a  relief  to  the  patient."  Surgeon  G.  A.  Oollamore,4  100th 
Ohio  Volunteers,  who  advised  primary  amputation  in  shot  fractures  of  the  middle  and 
lower  thirds  of  the  femur,  declares  that  "if  the  fracture  occur  in  the  upper  third,  I  should 
prefer  to  trust  the  case  to  nature,  with  such  aid  from  position,  splints,  etc.,  as  could  be 
obtained."  Surgeon  J.  J.  Chisolm,5  Confederate  States  Army,  declares  that  "A  compound 
fracture  in  the  upper  third  of  the  thigh  should  be  treated,  in  every  respect,  as  if  in  the  arm. 
Unless  the  leg  is  so  mangled  that  an  amputation  is  an  act  of  necessity,  it  should  not  be 
thought  of."  That  these  views  largely  prevailed  among  the  surgeons  of  the  War  of  the 
Rebellion  is  apparent  from  a  comparison  of  the  number  of  cases  of  shot  fractures  of  the 
upper  third  of  the  femur  treated  by  amputation  with  those  treated  by  conservation.  In 
fifteen  hundred  and  seventy-seven  of  the  twenty-nine  hundred  amputations  for  shot  frac 
tures  of  the  femur  the  precise  seat  of  the  injury  was  recorded.  Of  these  fifteen  hundred 
and  seventy-seven  cases  the  injury  was  in  the  upper  third  in  only  ninety-three  instances, 
or  5.8  per  cent.,  while  in  two  thousand  seven  hundred  and  twenty-nine  of  the  three  thou- 

1  Professor  TH.  BlLLROTH  (Chirurgisclic  Brief e  aus  den  Kriegslazarelhen  in  Weissenburg  und  Mannheim,  1870,  Berlin,  1872,  p.  239)  contends  that 
the  intermediary  and  secondary  operations  should  be  grouped  with  the  conservation  cases,  and  this  result  compared  with  that  of  the  primary  operations: 


MODE  OF  TREATMENT. 

CASES. 

RECOVERY. 

FATAL. 

UNKNOWN. 

MORTALITY. 

Conservation   

3,467 

1,689 

1,684 

94 

49.9 

Excisions  (Intermediary  and  Secondary)  

67 

24 

42 

1 

63.0 

Amputations  (Intermediary  and  Secondary)   

1,762 

718 

1,044 

59.2 

Aggregate  

5,296 

2,431 

2,770 

95 

53.2 

..   .   ..                                                                 • 

or  a  fatality  oi  5:i.2  per  cent,  for  conservation  against  49.8  for  primary  amputation. 

2  HAMILTON  (F.  H.),  Amputations  in  Gunshot  Fractures  of  the  Femur,  in  American  Medical  Times,  1864,  Vol.  VIII,  p.  I. 

3O'LEAKY  (CllAUt.ES),  Surgeon  U.  S.  V.  "Extract  from  a  Narrative  of  his  Services  in  the  Volunteer  Medical  Staff,"  in  Appendix  to  Part  I  of  the 
Medical  and  Surgical  History  of  the  War  of  the  Rebellion,  p.  70. 

4  SMITH  (STEl'HEX),  Analysis  of  Four  Hundred  and  Thirty-nine  Recorded  Amputations  in  the  Continuity  of  tlie  Lower  Extremity,  in  United 
States  Sanitary  Commission  Memoirs,  1871,  Vol.  II,  p.  62. 

5CHlSOLM  (J.  J.),  A  Manual  of  Military  Surgery,  Columbia,  1864,  p.  394. 


342  INJURIES    OF    THE    LOWER   EXTREMITIES.  [CHAP.  X. 

sand  four  hundred  and  sixty-seven  cases  treated  by  conservation,  in  which  the  locality  of  the 
injury  was  ascertained,  twelve  hundred  and  fifty-four,  or  46  per  cent.,  or  nearly  one-half, 
were  for  fractures  in  the  upper  third  of  the  femur.  The  number  of  amputations  for  frac 
tures  in  the  middle  third  of  the  femur  was  three  hundred  and  sixty,  and  for  fractures  in 
the  lower  third  eleven  hundred  and  twenty-four,  while  of  the  cases  treated  by  conserva 
tion  those  for  fractures  in  the  middle  third  numbered  eight  hundred  and  fifty-five,  and 
those  for  fractures  in  the  lower  third  only  six  hundred  and  twenty. 

Ribes,1  Demme,2  Pirogoff,3.  and  others4  have  called  attention  to  the  great  fatality  fol 
lowing  shot  fractures  in  the  middle  third  of  the  femur,  and  Surgeon  E.  Andrews,5  1st 
Illinois  Artillery,  reports  to  have  had  a  similar  experience.  But  neither  the  results  of  the 
cases  treated  in  the  American  civil  war  (TABLE  XX,  p.  175,  ante)  nor  of  the  cases  collected 
in  TABLE  XLVIII,  on  p.  336,  appear  to  confirm  this  opinion.  In  the  former  the  percent 
age  of  fatality  is  46  per  cent,  for  fractures  in  the  upper  third,  40.6  per  cent,  for  fractures 
in  the  middle  third,  and  38.2  per  cent,  for  fractures  in  the  lower  third.  In  the  latter  the 
fatality  is  43.4  per  cent,  for  the  upper  third,  43.1  per  cent,  for  the  middle,  and  42.3  per  cent. 
for  the  lower  third,  thus  affirming,  in  shot  fractures  of  the  femur  at  least,  the  old  axiom 
that  the  gravity  of  injuries  of  the  extremities  steadily  augments  in  proportion  as  the  seat 
of  the  injury  approaches  the  trunk. 

When  it  had  been  decided  in  a  shot  fracture  of  the  femur  to  attempt  preservation  of 
the  limb,  all  loose  spiculse  and  foreign  bodies  were  carefully  removed,6  the  limb  was  then 
brought  as  near  as  possible  to  its  normal  position,  and  there  held  by  the  use  of  splints. 
The  extraction  of  splinters  retaining  any  connection  by  the  periosteum,  and  also  the 

practice  of  cutting  off  the  broken  ends  of  the  bone,  was  generally  deprecated.7 

* 

1  RlBES  (F.)  (Memoire  sur  la  fracture  du  tiers  moyen  du  femur  compliquee  de  plait,  et  produite  par  arme  &  feu,  in  Gazette  JUedicale  de  Paris, 
1831,  T.  II,  No.  12,  p.  101)  asserts:  "Toutes  les  fractures  du  fSmur  compliqu§es  de  plaie,  produites  par  un  corps  pousse  par  la  poudre  a  canon  sont  des 
maladies  graves;  mais  celles  qui  arrivent  au  tiers  moyen  de  cet  os  sout  extremement  dangereuses  et  presque  toujours  mortelles." 

2DEMME'S  (H.)  (Mililar  CJiirurgische  Studiert,  Wiirzburg,  1861,  p.  3612)  tabulations  show  a  similar  result  in  the  Italian  War  of  1859  ;  the  mortality 
of  fractures  in  the  middle  third  of  the  femur  being  60.87  per  cent,  to  58.14  of  the  upper  and  43.42  of  the  lower  thirds. 

3PlUOGOFF  (N.)  (Grundziige  der  Allgemtinen  Kricgschirurgie,  Leipzig,  1864,  pp.  783,  784)  remarks  that  in  the  hospitals  in  the  Caucasus  and  after 
the  Crimean  War  he  saw  20  cases  of  recovery  after  shot  fractures  of  the  upper  third  of  the  femur,  but  no  cases  of  recovery  after  fractures  of  the  middle 
third,  and  adds:  "Our  own  efforts — comparatively  few  in  comparison  to  the  number  of  amputations — to  cure  shot  fractures  of  the  middle  third  of  the 
femur,  miscarried." 

4  FISCHER  (II.)  (Kriegsclnrurgische  Erfahrungen,  Erlangen,  1872,  p.  178)  analyses  twenty  cases  of  fracture  of  the  femur  that  were  treated  by  him 
during  the  Franco- Prussian  War,  1870-71:  10,  with  6  deaths,  or  60  per  cent,  mortality,  were  in  the  upper,  5,  all  fatal,  were  in  the  middle,  and  5,  all 
recoveries,  were  in  the  lower  third  ;  and  reaches  the  conclusion:  "That  shot  fractures  in  the  middle  third  are  the  most  dangerous,  and  are  least  adapted 
to  conservative  treatment.  I  believe,  therefore,  that  it  would  be  best  to  amputate  primarily  in  extensive  comminuted  fractures  of  the  middle  third,  and 
to  attempt  conservative  treatment  only  in  shot  fractures  with  little  splintering.  Stress  should  be  laid  upon  this  rule,  as  especially  to-day,  too  little  primary 
amputating  is  done.  Primary  amputation  for  shot  fracture  of  the  femur  is  considered  almost  a  crime.  .  .  It  is  altogether  different  in  shot  fractures  of 
the  lower  third  of  the  femur ;  here  the  conservative  treatment  promises  the  best  results.  Between  the  two  stand  the  results  of  shot  fractures  in  the  upper 
third.  There  the  amputation  or  exarticulation  is,  under  all  circumstances,  a  dangerous  proceeding,  and  we  may,  therefore,  allow  the  conservative 
treatment  a  larger  field."  BECK  (B.)  (Chir.  der  Schussverletzunrjen,  1872,  p.  694)  remarks :  "  Fractures  of  the  middle  third  of  the  femur  near  the  junc 
tion  with  the  upper  third  always  impressed  me  most  unfavorably,  on  account  of  the  frequently  co-existing  injuries  of  the  blood-vessels." 

"ANDREWS  (E.)  (Complete  Record  of  the  Surgery  of  the  Batiks  fought  near  Vicksburg.  December  27,  28,  29,  30, 1862,  Chicago,  1863,  p.  37):  "It 
would  seem  that  shots  through  the  cancellar  tissue,  at  the  superior  fifth  of  the  femur,  are  much  less  dangerous  than  those  in  the  compact  bone  of  the 
shaft  below  ;  the  reason  is,  that  when  a  ball  bores  its  way  through  spongy  bone,  it  produces  only  a  moderate  amount  of  shattering,  owing  to  the  yielding 
character  of  that  tissue;  but  the  impact  of  a  mini6  bullet  upon  the  brittle  ivory  of  the  shaft  shatters  it  for  several  inches,  and  disperses  the  fragments 
with  the  force  of  an  explosion  among  all  the  surrounding  tissues,  producing  immense  disorganization.  These  cases  nearly  all  die  within  the  first  five 
days,  no  matter  what  treatment  is  adopted." 

6  The  records  show  that  fragments  of  bone  were  dislodged  in  288  instances  at  least,  of  which  170  had  successful  terminations. 

'Surgeon  A.  W.  IlEISE,  100th  Illinois,  who  observed  twelve  cases  of  comminuted  fractures  of  the  thigh  at  the  1st  division,  Twenty-first  Corps, 
field  hospital,  of  whom  six  had  recovered  with  union,  two  would  probably  recover,  and  four  had  terminated  fatally,  remarks,  in  a  communication  to  the 
Medical  Director  of  the  Twenty-first  Corps,  dated  February  4,  1863:  "In  all  these  cases  the  principal  vessels  had  escaped  injury.  Primary  sequestra,  or 
those  directly  and  completely  separated  by  the  force  of  the  projectile,  were  carefully  removed  by  making  a  liberal  incision  over  the  parts.  But  sequestra 
retaining  connection  by  periostea!,  muscular,  or  other  attachment,  I  did  not  interfere  with.  In  only  two  cases  I  found  that  during  the  process  of  suppura 
tion  sequestra  were  thrown  off.  In  the  majority  of  these  comminuted  compound  fractures  I  find  that  the  removal  of  splinters  retaining  any  connection 
with  periosteum  is  unnecessary  and  often  injurious,  as  is  also,  in  my  opinion,  the  practice  of  sawing  off  the  broken  ends  of  the  bones  projecting  from  the 
comminuted  parts.  I  am  strengthened  in  the  belief,  from  observation  made  here,  that  by  proper  treatment,  and  under  favorable  circumstances,  splinters 
become  impacted  in  callus,  and.  in  time,  unite  with  the  other  fragments  of  the  bone,  and,  in  this  manner,  a  cure  is  completed  without  operative  inter 
ference.  Whether  the  splinters  which  have  thus  become  impacted  in  callus  will  lead  to  mischief,  or  are  subsequently  discharged  as  if  they  were  so  many 
foreign  bodies,  the  future  will  determine."  Surgeon  A.  J.  PHELrs,  U.  S.  V.,  in  his  observations  after  the  battle  of  Chickamauga,  recommends  that 
"loose  spicula  only  should  be  removed,  and  resections  of  the  shaft  be  eschewed."  Surgeon  H.  S.  IlEWIT,  U.  S.  V.,  in  his  Report  on  the  Military  Med- 


SECT.  I.I1.J 


SHOT   INJURIES    OF    THE    FEMUR. 


343 


FIG.  207.— DESAULT'S  splint. 


The  plans  adopted  for  the  mechanical  support  of  the  fractured  thigh  bone,  for  main 
taining  proper  extension,  for  retaining  the  fractured  ends  in  accurate  apposition,  and  for 
facilitating  the  necessary  dressings,  during  transport  as  well  as  in  hospitals,  were  manifold 
and  ingenious,  and  doubtless  contributed  to  the  success  achieved  in  the  saving  of  useful 
limbs.  The  extended  position,  which  may  be  traced  back  to  Hippocrates,1  but  for  the 
systematic  and  rational  application  of  which  we  are  indebted  to  Desault,2  as  well  as  the 

icine.  Surgery,  and  General  Conduct  of  the  Medical  Department  of  the  Army  of  the  Ohio,  from  May,  1,  1864,  to  September  8,  1864  (Appendix  to  Part  I, 
lied,  and  Surg.  Hist,  of  the  War  of  the  Rebellion,  p.  311),  declares  "(he  principle  of  removing  fragments  primarily  when  detached  is  obvious  and  has 
been  recommended  to  the  surgeons  of  the  department."  Surgeon  W.  W.  BLAIK,  58th  Indiana,  in  "Report  of  the  Medical  Staff  of  the  1st  division  of  the 
Twenty-first  Corps,  at  the  Battle  of  Stone's  River  (Appendix  to  Part  I,  Med.  and  Surg.  Hist,  of  the  War  of  the  Rebellion,  p.  203),  states  that  "all  frag 
ments  of  bone  completely  separated  by  the  force  of  the  projectile  were  carefully  removed  by  making  an  incision  if  necessary ;  but  fragments  retaining 
connection  by  the  periosteum  were  not  removed,  and  in  only  two  cases  were  sequestra  thrown  off  during  the  process  of  suppuration."  Surgeon  HEXUY 
J.  CHURCHMAN,  U.  S.  V.,  in  charge  of  the  hospital  at  Fayetteville,  Arkansas,  insists  that  "the  comminuted  fragments,  if  small  and  detached,  should  in 
all  cases  be  removed  at  once  under  chloroform,  and  the  thigh  put  in  splints  so  as  to  keep  parts  in  proper  apposition  and  invite  callus — the  amount  of  exten 
sion  or  counter-extension  to  be  regulated  by  the  amount  of  comminution  or  loss  of  substance.  It  seems  to  me  that  the  inflammation  and  suppuration 
necessitated  by  an  unreduced  compound  comminuted  fracture  detach  the  periosteum  from  fragments,  and  not  from  fragments  alone  but  from  bone  gen 
erally,  while  the  system  wastes  from  suppurative  exhaustion  and  pyaemia.  Should  even  a  useless  limb  result  from  effort  to  save,  amputation  could 
subsequently  be  performed  under  far  more  favorable  circumstances  than  are  generally  found  in  the  crowded  wards  of  a  general  hospital." 

1  HIPPOCRATES,  Oeuvres  completes  par  fi.  LlTTRE,  Paris,  1841,  T.  Ill,  Des  Fractures,  Par.  19,  p.  483. 

2DESAULT  (P.  J.)  (Oeuvres  chirurgicales,  ed.  par  XAVIER  BlCHAT,  Paris,  1813,  T.  I,  p.  249,  and  PLATE  II)  employed  a  straight  outer  splint  to 
reach  from  the  hip  to  some  distance  beyond  the  foot ;  an  inner  splint  extending  from  the  periuaeum  and  terminating  opposite  the  end  of  the  outer  splint ; 
an  anterior  splint  reaching  from  the  abdomen  to  the  knee ;  and  an  extending 
and  counter-extending  band,  the  former  secured  to  the  foot  and  lower  extrem 
ity  of  the  long  splint,  the  latter  to  its  upper  extremity  after  being  passed 
under  the  perinseum.  Junkbags  and  the  SCULTKTU8  bandage  completed 
the  apparatus  (see  FIG.  207).  H.  J.  BRtfxxiXGHAUSEX  (Ueber  den  Bruch  des 
Schenkelbeinhalses  iiberhaupt,  und  insbesondere  eine  neue  method*.,  denselben 
ohne  Hinlten  zu  heile.n,  Wiirzburg,  1789)  fastened  the  broken  thigh  to  the 
sound  one,  a  principle  followed  by  HAGEDORN  (M.)  (Abhandlung  von  dem 
Bruch  des  SchenkelbeinUalses,  nebst  einer  ntuen  Methode,  denselben  leicht  und 
sicker  zu  heilen,  Leipzig,  1808)  in  his  apparatus,  which  makes  the  sound 
limb  the  extending  power,  both  feet  being  secured  to  the  foot-board,  and  the 
splint  to  the  sound  thigh.  The  apparatus  was  extensively  used  on  the  continent  of  Europe  as  well  as  in  England,  and  was  considered  a  most  simple  and 
effectual  apparatus.  To  obviate  the  principal  objection  to  DESAULT's  splint,  that  it  does  not  act  in  the  line  of  the  axis  of  the  broken  limb,  but  obliquely, 
drawing  the  upper  fragment  outwards,  PHILIP  SYXG  PHTSICK  (JOHN  SYNO  DORSEY,  Elements  of  Surgery,  Philadelphia,  1813,  Vol.  I,  p.  1G3)  lengthened 
the  outer  splint  (see  Flo.  208)  until  it  reached  nearly  to  the  axilla,  and  attached  to  its  inner  side,  at  about  two  inches  above  its  lower  end,  a  block 
grooved  on  its  inner  margin,  and  broad  enough  to  reach  the  line  of  the  middle  of  the  foot.  Counter-extension  was  thus  made  more  in  the  line  of  the  body. 
If  the  patient  experienced  any  difficulty  in  bearing  pressure  upon  the  top  of  the  foot,  Dr.  PlIYSICK  used  a  buckskin  gaiter  laced  around  the  ankle,  with 
straps  for  extension.  Dr.  HUTCHINSOX  added  a  notched  block,  over  which  the  extending  band  is  stretched,  throwing  the  direction  of  the  extension  in  the 
line  of  the  limb.  The  apparatus  of  ButtXNIXGH  AU6EX  as  well  as  of  HAGEDORN  prevented  the  lateral  movements  of  the  pelvis.  This  defect  was  partially 
overcome  by  WILLIAM  GIBSON,  of  Philadelphia  (Reflexions  on  the 
Treatment  of  Fractures  of  the  Thigh,  with  an  Account  of  a  New 
Apparatus,  in  the  Philadelphia  Jour,  of  the  Med.  and  Phys.  Sciences, 
1821,  Vol.  Ill,  p.  230,  etc.),  who,  in  a  case  of  oblique  fracture  of  the 
femur,  had  applied  DESAULT'S  splint;  but,  owing  to  the  obesity  of 
the  patient,  found  it  impossible  to  keep  up  extension  and  counter- 
extension  sufficient  to  prevent  the  overlapping  of  the  fractured  ends 
of  the  bone,  and  tried  the  method  of  HAGEDORX :  "  I  soon  found,  how 
ever,  that  simple  and  ingenious  as  it  was,  and  calculated  to  effect 
extension  and  counter-extension  to  a  much  greater  degree  than  that  of  DESAULT,  that  it  was  still  imperfect,  but  susceptible  of  such  changes  as  would 
make  it  a  most  valuable  acquisition."  Dr.  GlttSOX  constructed  two  splints  five  and  a  half  feet  in  length,  reaching  from  the  axilla  beyond  the  feet.  Both 
feet  were  confined  by  gaiters  to  a  foot-board,  which  was  firmly  supported  upon  the  ends  of  the  long  splints  through  mortises  near  its  edges.  But  as  both  feet 
are  imprisoned,  the  confinement  is  apt  to  become  irksome  to  the  patient,  and  it  is  difficult  to  prevent  bedsores,  to  give  the  patient  a  stool,  or  to  use  a  urinal. 
Subsequently,  Dr.  GIBSON  recommended  (Philadelphia  Journal  of  Med.  and  Physical  Sci.,  1822,  Vol.  V,  p.  372)  a  triangular  frame  presenting  a  single 
inclined  plane,  on  which  both  extremities  were  extended ;  the  feet  were  confined  to  a  foot-board,  and  counter-extension  was  made  by  the  weight  of  the  body. 
In  a  similar  manner  Dr.  E.  MlCHEXER  (Remarks  on  the  Treatment  of  Fractures  of  the  Femur,  in  the  American  Medical  Recorder,  1822,  Vol.  V,  p.  430) 
raised  the  limb  on  a  single-inclined  plane  to  receive  counter  extension  by  the  weight  of  the  body.  A  further  modification  of  DESAULT's  splint  was  that 
of  LUKE  HOWE  (Observations  on  the  various  methods  of  treating  the  fractures  of  the  Os  Femoris,  with  Cases,  in  which  a  new  apparatus  was  successfully 
used,  in  The  New  England  Journal  of  Medicine  and  Surgery.  1824,  Third  Series,  Vol.  Ill,  p".  234).  The  extension  was  made  at  the  foot  with  weight  and 
pulley ;  counter-extension  by  a  band  over  the  groin  and  ischiurn,  connected  by  a  strap  with  the  headboard  of  the  bed,  and  a  waist  band  was  buttoned  or 
sewed  on  the  pelvis  and  fastened  to  the  side  pieces  of  the  bedstead  by  bandages  or  tape.  The  pulley  and  weight  was  also  employed  by  WILLIAM  C. 
DAXIELL  (Method  of  Treating  Fracture  of  the  Thigh  Bone,  in  Am.  Jour.  Med.  Sci.,  1829,  Vol.  IV,  p.  330)  attached  to  a  handkerchief  passed  around  the 
ankle.  BOVEU'8  splint  (Traite  des  Maladies  Chirurgicales  et  des  Operations  qui  leur  conviennent,  Paris,  1831,  T.  Ill,  p.  305,  and  PL  III,  opposite  p.  640) 
is  composed  of  a  long  splint  for  the  external  side  of  the  limb,  with  a  foot-board,  which  was  moved  up  and  down  by  means  of  a  screw  for  the  purpose  of 
making  extension  ;  of  an  inside  splint  from  the  perinaeum  to  the  foot,  and  of  an  anterior  splint  reaching  from  the  groin  to  the  ankle.  A  padded  leather 
band  through  the  perina?um  and  buckled  into  the  upper  end  of  the  outer  splint  made  the  counter-extension.  A  modification  of  BOYEK'S  DESAULT  was 
used  by  Dr.  JOSEPH  E.  HARTSHORNE,  of  Philadelphia.  The  counter-extension  was  made  against  the  perinaeum  at  the  upper  end  of  the  inside  splint, 
and  both  splints  were  connected  at  the  lower  end  by  a  transverse  piece  through  which  a  long  wooden  screw  passed  having  a  foot-board  attached  to  it.  By 
this  arrangement  the  outer  splint  could  be  detached  from  the  inner  one  without  disturbing  either  the  extending  or  counter-extending  force.  The  splint  is 
figured,  after  nature,  by  H.  H.  SMITH  (The  Princip'es  and  Practice  of  Surgery,  Philadelphia,  1863.  Vol.  I,  p.  625).  LlSTOX's  modification  of  DESAULT 
(R.  LISTOX.  Practical  Surgery,  London,  1840,  p.  88)  consists  of  a  straight  splint  from  the  axilla  to  about  six  inches  below  the  foot,  perforated  with  two 
holes  at  the  upper  extremity  and  with  two  deep  notches  in  the  lower  end,  and  an  opening  to  receive  the  external  malleolus.  The  periueal  band  is  tied  to 
the  upper  end  of  the  splint ;  the  foot  is  secured  to  the  processes  at  the  lower  end  of  the  splint  by  a  roller  passing  from  one  to  the  other,  and  then  junkbag, 


FIG.  2CP.  -FHYBICK'S  modification  of  DESAULT'S  splint. 


344  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X 

seiniflexed  position,  which  was  brought  into  practice  chiefly  by  Percival  Pott,  found  their 
advocates,  although  the  former  was  perhaps  better  known  to  American  surgeons  through 
its  modifications  by  Physick,  Gibson,  and  others.  An  apparatus  on  the  plan  of  the  double- 

splint  and  thigh  are  all  bound  together  by  continuing  the  roller  up  the  limb.  The  apparatus  keeps  up  a  moderate  extension  and  counter-extension.  The 
splint  employed  by  W.  E.  HORXEU,  of  Philadelphia  (H.  H.  SMITH,  The  Principles  and  Practice  of  Surgery,  Philadelphia,  1863,  Vol.  I,  p.  627)  is  similar 
to  PIITSICK'S,  but  the  upper  extremity  of  the  inside  splint  is  slightly  carved  out  like  a  crutch  head,  and  has  stretched  across  it  a  soft  leather  strap.  On 
the  inside  of  the  upper  portion  of  the  splint  two  leather  loops  are  nailed  to  serve  for  the  attachment  of  the  counter-extending  band.  Extension  was  made 
by  adhesive  strips.  The  mode  of  making  extension  by  adhesive  strips  and  weight  is  said  to  have  been  first  employed  by  Dr.  JOSEPH  SWIFT,  of  Easton, 
Pennsylvania.  It  was  suggested,  in  1843,  by  Dr.  EXNIS,  a  pupil  of  Dr.  SWIFT,  to  Dr.  E.  WALLACE,  of  Philadelphia,  and  was  by  the  latter  successfully 
employed  in  a  case  of  simple  fracture  of  the  thigh  (Wif.  HUNT,  Extracts  from  Clinical  Lectures,  in  Pennsylvania  Hospital  Reports,  1869,  Vol.  II,  p. 
273).  The  same  mode  was  employed  by  Dr.  FREDERICK  D.  LENTE  in  1851,  in  the  New  York  Hospital  (F.  D.  LENTE.  A  statistical  and  critical  Account 
of  the  Fractures  occurring  in  the  New  York  Hospital,  etc.,  in  New  York  Jour,  of  JUed.,  1851,  Vol.  VII,  p.  179).  It  consisted  in  the  employment  of  broad 
strips  of  adhesive  plaster  (2J  or  3  inches),  which  were  applied  to  the  limb  previously  shaved,  on  either  side  of  it,  from  a  little  above  the  knee  to  below 
the  foot,  where  it  was  secured  to  the  ring  at  the  end  of  the  screw.  The  straps  are  confined  by  a  single  roller  bandage.  To  prevent  slipping  of  the  plaster 
the  extension  is  not  applied  until  some  hours  after  the  application  of  the  strips  to  the  limb.  In  1853,  Dr.  JOSIAH  CHOSIIY  (New  Mode  of  Extension  in 
fractures,  in  Am.  Jour.  Med.  Sci.,  1854,  Vol.  XXVII,  p.  76)  published  a  description  of  his  mode  of  procuring  extension  by  adhesive  strips,  which  he 
"  used,  for  the  first  time,  in  1849,"  and  which  he  believed  had  never  been  suggested  to  the  profession  in  a  manner  to  attract  the  attention  of  surgeons  until 
it  appeared  in  Professor  MUSSEY'S  Surgical  Report  to  the  American  Medical  Association  at  their  session  in  1850  (Transactions  of  the  Am.  Med.  Associa 
tion,  1850,  Vol.  Ill,  p.  382).  Dr.  D.  GILBERT  ( Cases  in  Surgery,  in  Am.  Jour  Med.  Sci.,  1851,  N.  S.,  Vol.  XXI,  p.  70)  substituted  a  movable  for  HUTCHIN- 
SON's  permanent  block,  which  he  attached  to  the  straps  of  a  common  tourniquet,  close  to  the  sole  of  the  foot,  placing  the  instrument  upon  the  distal  side 
of  the  block  and  regulating  the  extension  by  the  screw  of  the  tourniquet,  using  adhesive  plaster  as  a  counter-extending  bandage.  Similarly,  JOHN  NEILL 
(New  Means  for  making  Extension  and  Counter- Extension  in  Fractures  of  the  Leg  and  Thigh,  Philadelphia,  1855,  p.  4)  made  counter-extension  by 
means  of  adhesive  plaster.  The  ends  of  the  extending  and  counter-extending  strips  were  carried  through  their  respective  holes  at  the  upper  and  lower 
ends  of  the  splint  and  secured  to  each  other  about  the  middle  of  the  outer  splint.  By  twisting  these  united  bands  by  a  small  stick  the  extension  could 
be  increased  and  maintained.  J.  McF.  GASTON  (Counter- Extension  with  Adhesive  Plaster,  in  Sout)iern  Med.  and  Surg.  Jour.,  1859,  N.  S.,  Vol.  XV,  p. 
672)  adapts  adhesive  plaster  to  counter-extension  in  the  manner  of  GILBERT,  but  claims  superiority  in  this,  that  he  makes  the  attachment  of  the  strips  over 
the  spinous  process  of  the  ilium  and  the  trochanter,  thus  giving  more  fixed  resistance  to  the  force  of  extension.  Dr.  L.  A.  DUGAS  (On  the  Best  Plan  of 
Treating  Fractures  in  Country  Practice,  in  Southern  Med.  and  Surg.  Jour.,  1854,  Vol.  X,  p.  69)  employs  4  wooden  splints,  a  little  shorter  than  the  femur, 
secured  around  the  thigh  with  many -tailed  bandages,  a  long  splint  from  the  side  of  the  thorax  to  a  little  below  the  foot  secured  by  separate  ties  around  the 
abdomen,  pelvis,  thigh,  leg,  and  foot,  a  weight  fixed  to  the  ankle  and  hung  over  the  foot-board,  and  an  arch  of  crossed  hoops  to  protect  the  toes  from  the 
bed  clothes.  Dr.  H.  LENOX  HODGE  (Counter  Extension  in  Fractures  of  the  Femur,  in  Am.  Jour.  Med.  Sci.,  1860,  N.  S.,  Vol.  XXXIX,  p.  505)  devised  a 
modification  of  PHYSICK,  with  adhesive  strip  extension  and  counter-extension.  He  dispenses  with  the  perineal  band,  and  prevents  the  patient  from  rising 
or  sitting  during  treatment  by  a  piece  of  iron  attached  to  the  long  splint  which  extends  over  the  patient's  shoulder,  terminating  in  a  blunt  hook.  A  broad 
piece  of  adhesive  plaster  placed  on  the  front  and  back  of  the  chest,  and  secured  by  strips  around  the  body,  is  looped  over  a  small  block  of  wood  which  is 
attached  to  the  hook  at  the  end  of  the  metal  bar,  thus  making  counter-extension.  To  prevent  excoriation  or  sloughing  in  parts  under  pressure,  the  groin, 
or  the  perineum  and  the  ankle,  Dr.  B.  E.  COTTING  (Simple  Apparatus  for  Fractures  of  the  Thigh,  in  the  Boston  Med.  and  Surg.  Jour.,  1861,  Vol.  LXV, 
p.  129,  etc.)  recommends  a  band  of  stout  cotton  or  linen  cloth  made  to  fit  the  pelvis  and  upper  part  of  the  hips  closely,  and  a  stocking  on  the  leg,  with 
side  straps  of  strong  cotton  cloth,  which  should  hang  free  for  a  few  inches  below  the  foot.  By  these  straps  extension  is  made  on  the  DESAULT  splint,  the 
whole  leg  being  brought  down  with  great  steadiness,  and  without  the  slightest  danger  from  undue  pressure  on  any  particular  portion.  Dr.  J.  II.  PACK 
ARD  (On  the  Employment  of  India-Rubber  in  obtaining  Continuous  Extension  in  the  Treatment  of  Fractures  of  the  Femur,  in  Am.  Jour.  Med.  Sci.,  18fi2, 
Vol.  XLIV,  p.  90)  added  to  the  inner  and  lower  end  of  PHYSICK'S  long  outer  splint  a  pulley,  through  the  groove  of  which  he  ran  an  India-rubber  cord, 
secured  to  the  leg  and  ankle  by  adhesive  plaster.  The  rubber  cord  was  drawn  until  a  sufficient  degree  of  tenseness  had  been  obtained,  when  the  end 
was  tacked  to  the  outer  side  of  the  long  splint.  Two  or  three  inches  of  the  India-rubber  cord  should  be  free  between  the  adhesive  plaster  and  the  pulley 
in  order  to  make  the  elastic  force  operative.  A  similar  apparatus  is  figured  by  R.  BARWELL  (A  Treatise  on  Diseases  of  the  Joints,  London,  1865,  p.  266, 
etc.).  Dr.  T.  H.  BACHE  (F.  W.  SARGENT,  On  Jlandaging  and  other  Operations  of  Minor  Surgery,  Philadelphia,  1862,  p.  179)  cut  a  long  narrow  fenes- 
trum  in  PHYSICK'S  outer  splint,  extending  upwards  from  near  its  lower  extremity  ;  in  this  fenestrum  slides  an  iron  arm,  capable  of  being  firmly  fixed  by 
screw  clamps  at  any  point,  so  as  virtually  to  lengthen  or  shorten  the  splint  in  adaptation  to  limbs  of  different  lengths.  An  ingenious  apparatus  is  described 
and  figured  by  Dr.  HENRY  X.  HEWIT  (Original  Adaptation  of  Received  Principles  of  Treatment  in  Fracture  of  the  Thigh,  in  The  Medical  Record, 
1808-69,  Vol.  Ill,  p.  217):  "It  consists  of  two  light  flat  lateral  bars  of  steel  connected  by  a  cross-bar  below  the  sole  of  the  foot.  The  exterior  bar  or  splint 
extends  from  its  angle  with  the  cross-bar,  six  or  eight  inches  below  the  foot,  to  the  side  of  the  chest  opposite  the  nipple.  Two  flat  bands  of  steel  well 
padded  secure  it  to  the  chest  and  body.  The  inner  bar  reaches  nearly  to  the  perinaeum,  but  does  not  impinge,  and  the  floor  of  the  splint  is  of  flexible 
metal,  carefully  padded  by  a  continuation  of  the  bands,  which  secure  it  to  the  limb  and  buckle  in  front.  The  two  lateral  bars  opposite  the  thigh  are  fenes- 
trated,  and  nuts  are  inserted  capable  of  sliding  longitudinally,  through  which  play  the  screws,  which  can  be  used  for  the  exact  application  of  detached 
moulded  metallic  'splints  of  coaptation.'  " 

1  POTT  (PERCIVAL)  (Chirurgical  Works,  Dublin,  1778,  Vol.  II,  p.  304)  ascribed  the  cause  of  the  retraction  of  the  bone  in  fractures  of  long  bones 
to  the  tension  of  the  muscles:  "In  the  thigh,  the  case  is  still  more  obvious,  as  the  muscles  are  more  numerous  and  stronger.  The  straight  posture  puts 
the  majority  of  them  into  action,  by  which  action  that  part  of  the  broken  bone  which  is  next  to  the  knee  is  pulled  upward,  and  by  passing  more  or  less 
underneath  that  part  which  is  next  to  the  hip,  makes  an  inequality  or  rising  in  the  broken  part,  and  produces  a  shortness  of  the  limb."  He  discarded  all 
machinery  for  extension  in  use,  and  relied  on  the  relaxation  of  the  muscles  by  placing  the  knee  "in  a  middle  state,  between  perfect  flexion  and  extension," 
supporting  the  leg  and  foot  by  smooth  pillows,  and  inclining  the  patient's  whole  body  to  the  outside  of  the  fractured  femur.  The  same  position  was 
recommended  by  ROKEHT  WHITE  (The  Present  Practice  of  Surgery,  London,  1786,  p.  147)  in  fractures  toward  the  middle  or  lower  part  of  the  thigh 
bone,  in  "order  to  moderate  the  subsequent  tension;  but  as  soon  as  the  swelling  and  tightness  of  the  muscles  are  subsided,  the  limb  should  be  carefully 
and  gradually  brought  down,  and  the  toe,  knee,  and  groin  kept  in  a  direct  line  with  each  other."  A  double-inclined  plane  suspended  by  ropes  and  cross 
bar  from  a  ring  was  advised  by  J.  N.  SAUTER  (Anweisung,  die  Beinbriiche  der  Gliedmassen,  vorzuglich  der  complicirten,  und  den  Schenkelhalsbruch 
nach  einer  neuen,  Uichten,  einfachen  und  wohlfeilen  Melhode  ohne  Schienen  sicher  und  bequem  zu  heilen,  Konstanz,  1812).  The  apparatus  is  figured  by 
MATTHIAS  MAYOR  (Bandages  et  AppareiU  a  Pansements  ou  Nouveau  Systeme  de  Obligation  Chirurgicale,  Paris,  1838,  3"1"  §d.,  PL.  11,  FIG.  72).  Sir 
ABTLEY  COOPER  (Surgical  Essays  by  ASTLKT  COOPER  and  BENJAMIN'  TRAVERS,  London,  1819,  Part  II,  p.  49,  and  Fio.  5  of  PLATE  VIII)  placed  the 
patient  on  his  back,  brought  the  thigh  over  a  double-inclined  plane  composed  of  three  boards,  one  below  to  reach  from  the  tuberosity  of  the  ischium  to  the 
patient's  heel,  and  the  two  others  above,  with  a  joint  in  the  middle  by  which  the  knee  may  be  raised  or  depressed.  Sir  ASTLEY  COOPER,  who  had 
employed  this  double-inclined  plane  for  near  twenty  years,  ascribed  its  construction  to  Mr.  WHITE,  of  Manchester,  "  who  had  one  made  of  iron,  and 
hollowed  to  adapt  it  to  the  form  of  the  leg  and  thigh,  but  this  machine  was  too  heavy  and  too  complicated  for  use.  Mr.  JAMES,  of  Hoddesdon,  improved 
upon  Mr.  WHITE'S  idea,  by  having  the  instrument  made  of  wood,  with  movable  splints  upon  the  sides."  CHARLES  BELL  (Observations  on  Injuries  of 
the  Spine  and  of  the  Thigh  Bone,  London,  1824,  p.  45)  also  placed  the  patient  on  his  back  instead  of  the  side  as  advised  bv  POTT :  "  It  is  now  about  eighteen 
years  since  I  have  been  accustomed  to  show  the  application  of  the  double-inclined  plane  to  fractures  of  the  thigh  bone,  that  it  relaxes  the  muscle* 
inserted  into  the  inner  trochanter,  and  at  the  same  time  relaxes  all  the  muscles  on  the  back  part  of  the  thigh  by  the  bending  of  the  knee;  in  short,  that  it 


SECT.  IIt.| 


SECT    INJURIES    OF    THE    FEMUR. 


345 


inclined  plane  of  Pott,  introduced,  in  1854,  by  Professor  N.  R.  Smith,1  and  known  as  Smith's 
anterior  splint,  was  largely  employed  in  shot  fractures  of  the  femur  in  the  early  part  of  the 
war,  the  reports  indicating  that  it  was  used  in  at  least  two  hundred  and  eighty-eight  instances. 
Surgeon  J.  T.  Hodgen,  U.  S.  V.,  in  charge  of  the  City  General  Hospital,  St.  Louis,  forwarded, 

humours  the  natural  position  of  the  limb ;  and  that  instead  of  having  to  restrain  and  bring  down  the  upper  portion,  the  lower  part  is  raised  to  correspond 
with  it."  The  apparatus  is  figured  on  p.  346  of  Vol.  II  of  C.  BELL'S  System  of  Surgery,  London,  1841,  and  is  copied  in  the  adjoining  wood-cut  (FIG.  209). 
A  modification  of  BELL'S  apparatus  by  J.  'AMESBUUY  (Observations  on  the  Nature  and  Treatment  of  Fractures  of  the  Upper  Third  of  the  Thigh  Bone, 
London,  1628,  p.  132)  was  found  objectionable  on  account  of  its  cost  and  complicated  character.  It  consists  of  three  parts,  exclusive  of  straight  splints 
and  straps :  one  part  for  the  thigh,  one  for  the  leg,  and  the  third 
for  the  foot.  The  thigh  plane  again  consists  of  two  pieces 
arranged  to  make  the  upper  part  of  the  plane  conformable  to 
that  of  the  thigh.  Hinge  joints  connect  the  thigh  and  leg 
pieces,  and  the  foot-board  is  fitted  upon  the  leg  plane  by  means 
of  a  screw,  allowing  it  to  be  moved  at  a  greater  or  less  distance 
from  the  angle  of  the  two  planes.  A  steel  rod  connects  the  two 
planes  underneath,  by  which  the  angle  of  the  plane  may  be 
altered  at  pleasure.  The  apparatus  can  only  be  prepared  by 
the  manufacturer.  The  apparatus  of  MATTHIAS  MAYOU  (foe. 
cit.,  p.  6,  and  PL.  10,  FIGS.  66,  67,  and  68)  consists  of  two  planes 
made  of  wire  and  connected  by  a  hinge,  with  cords  to  suspend 
the  limb  from  the  bed  or  ceiling.  In  1828,  NATHAN  SMITH  FlG'  209—Double-inclined  plane  of  C.  BELL.  [After  BELL.] 

( Observations  on  Fractures  of  the  Femur,  with  an  Account  of  a  New  Splint,  in  The  Philadelphia  Monthly  Journal  of  Medicine  and  Surgery,  1828,  Vol.  II, 
p.  51)  perfected  an  apparatus  similar  in  principle  to  AMESBL'RY's  but  of  simple  construction  and  material.  It  consisted  of  two  thin  broad  pieces  of  bass  wood, 
so  warped  that  the  concavity  of  one  corresponded  to  the  convexity  of  the  under  surface  of  the  thigh,  and  the  other  to  that  of  the  leg.  Both  were  joined  by 
hinge-like  rivets.  A  strap  passing  from  the  upper  extremity  of  the  thigh-piece  to  the  lower  extremity  of  that  of  the  leg,  allowed  the  limb  to  be  fixed  at 
any  angle.  His  son,  NATHAN  R.  SMITH  (Description  of  an  Apparatus  for  the  Treatment  of  Fractures  of  the  Thigh  and  Leg,  in  The  Baltimore  Monthly 
Journal  of  Medicine  and  Surgery,  1830,  Vol.  I,  p.  305),  substituted  for  bass  wood  thick  binder's  board,  which  he  slightly  moistened  with  wetted  sponge 
and  shaped  into  a  semi-cylindrical  form  with  the  hand.  To  meet  certain  requirements,  which  N.  R.  SMITH  deemed  indispensably  necessary  in  the  treat 
ment  of  fractures  of  the  femur  (Observations  on  Fractures  of  the  Thigh  and  Leg;  with  a  Description  of  an  Apparatus  applicable  to  the  treatment  of  such 
injuries,  in  Baltimore  Medical  and  Surgical  Journal,  1833,  Vol.  I,  p.  13),  he  devised,  in  1833,  a  new  apparatus,  consisting  of  four  pieces,  viz :  two  concave 
planes,  the  one  adapted  to  the  inferior  surface  of  the  thigh,  the  other  to  that  of  the  leg.  These  are  united  by  a  hinge  corresponding  to  the  knee.  The 
third  piece  is  for  the  foot,  and  the  fourth  is  connected  with  the  thigh  piece,  and  extends  upward  beside  the  body.  To  allow  the  patient  to  change  his 
position,  Dr.  SMITH  suspended  the  limb  by  means  of  a  cord  attached  to  some  fixed  point,  as  already  indicated  by  SAUTER  and  MAYOR.  In  LONSDALE'B 
apparatus  (E.  F.  LOXSDALE,  A  Practical  Treatise  on  Fractures,  London,  1838,  p.  295)  the  thigh  and  leg  planes  were  joined  at  a  point  corresponding  to 
the  knee  by  a  hinge.  A  horizontal  plane,  joined  also  by  a  hinge  to  the  upper  part  of  the  thigh  plane,  was  serrated  at  the  foot  end,  allowing  the  leg  plane 
to  be  fixed  at  any  angle.  This  simple  apparatus  was  very  generally  used  in  the  Middlesex  Hospital,  London.  JOSIAH  C.  NOTT  (Description  of  a  Mod 
ification  of  the  Double  Inclined  Plane,  with  an  exposition  of  its  advantages  over  other  apparatus  for  fractures  of  the  lower  extremity,  in  Am.  Jour.  Med. 
Sci.,  1839,  Vol.  XXIII.  p.  21)  describes  and  figures  an  apparatus  similar  to  LONSDALE's,  with  the  addition  of  a  foot-board.  Three  narrow  slits  are  cut 
through  on  each  side  of  the  thigh  plane,  two  inches  from  the  edges.  Through  these  are  drawn  leather  straps,  long  enough  to  pass  around  the  limb  after 
the  pads  and  splints  are  applied.  By  means  of  buckles  at  the  end  of  the  leather  straps  the  limb  is  firmly  secured  to  the  plane.  The  apparatus  of 
MclNTYRE,  of  Newcastle  (WM.  FERGUSSON,  A  System  of  Practical  Surgery,  London,  1842,  p.  282),  is  better  known  in  its  simplified  form  by  R.  LlSTON 
(Practical  Surgery,  London,  1840,  p.  96).  It  consists  of  a  foot-board  of  wood,  and  a  thigh  and  a  leg  piece  of  sheet-iron  made  to  fit  the  limb,  and  capable 
of  being  elongated,  by  means  of  screws,  to  suit  any  limb,  or  of  being*  adjusted  to  any  angle.  A  cross  plate  of  iron  is  attached  to  the  foot  end  of  the 
apparatus,  which  is  so  arranged  that  it  will  always  rest  flat  on  the  bed,  whether  the  limb  be  raised  or  depressed. 

'SMITH  (N.  R.),  A  New  Instrument  for  the  Treatment  of  Fractures  of  the  Lower  Extremities,  in  the  Maryland  and  Virginia  Medical  Journal, 
January,  1860,  Vol.  XIV,  p.  1,  and  The  Anterior  Suspensory  Apparatus  for  the  Treatment  of  Fractures  of  the  Lower  Extremity,  in  Am.  Jour.  Med.  Sci., 
April,  1861,  N.  S.,  Vol.  XLI,  p.  346,  and  Treatment  of  Fractures  of  the  Lower  Extremity  by  the  Use  of  the  Anterior  Suspensory  Apparatus,  Baltimore, 
1867.  On  page  11,  etc.,  of  the  latter  work,  Professor  SMITH  describes  the  apparatus  as  follows:  "A  single  splint  constitutes  the  whole  of  the  rigid,  or 
supporting,  part  of  the  apparatus.  It  may  be  made  of  wood  or  wire  (FIG.  210).  The  first  employed  by  me  was  of  wood.  It  was  three  inches  broad  half 
an  inch  thick,  and  long  enough  to  extend  from  above  the  spine  of  the  ilium 
to  the  toes.  It  had  an  angle  corresponding  to  that  of  the  ankle,  another 
at  the  knee  more  obtuse,  allowing  the  leg  to  be  very  slightly  flexed,  and 
a  third  corresponding  to  the  hip,  still  more  obtuse,  slightly  flexing  the 
thigh  on  the  pelvis.  Two  staples,  by  which  to  suspend  it,  were  attached 
to  the  upper  surface,  one  a  little  above  the  knee  and  the  other  about  the 
middle  of  the  leg.  The  splint  may  be  sawed,  in  one  piece,  out  of  thick 
pine  plank,  or  may  be  made  of  three  pieces  united  at  the  angles  by  nails 
or  screws.  I  now  employ  a  splint  of  tinned  wire.  The  size  of  the  wire 
should  be  that  of  a  No.  10  bougie.  If  lighter  than  this  it  is  apt  to  spring 
too  much.  It  is  constructed  of  one  piece  of  wire  bent  twice  at  right 
angles,  at  each  extremity,  in  the  form  of  a  long  parallelogram  (FIG.  210). 
being,  however,  three  inches  and  a  half  wide  at  its  upper  extremity  and 
two  and  three-fourths  at  its  lower.  It  must  be  long  enough  to  extend 
from  a  point  a  little  above  the  anterior  spinous  process  of  the  ilium  to  an 
inch  beyond  the  toes  when  the  leg,  foot,  and  thigh  are  extended.  Three 
feet  eight  inches  will  be  sufficiently  long  for  most  adults.  A  little  excess 
of  length,  above  or  below,  is  unimportant.  The  side  pieces  are  to  be 
sustained  by  curved  cross-pieces  at  distances  of  about  five  inches,  firmly 
clinched  and  soldered  upon  them,  and  having  loops  in  their  centres  for 
the  attachment  of  the  hooks.  The  wire  frame  is  then  to  be  bent  by  the  surgeon  to  suit  the  case.  The  lower  angle  corresponds  to  the  ankle,  and  is  one 
of  aoout  120°,  to  secure  an  easy  posture  of  the  foot.  The  angle  at  the  knee  is  very  obtuse,  about  160°.  The  angle  at  the  hip  should  be  of  about 
the  same  degree.  The  angle  at  the  ankle  should  be  about  five  inches  from  the  extremity ;  that  of  the  hip  seven.  The  middle  bend  corresponds  to  the 
knee.  The  angles  are  easily  made  by  bending  the  splint  over  the  margin  of  a  strong  chair  or  table.  It  will  often  be  necessary  to  vary  these  angles  to 
suit  particular  fractures.  The  wire  frame  is  now  to  be  tightly  wrapped  with  a  muslin  bandage,  and  it  is  ready  for  application.  The  suspensory  apparatus 
SURG.  Ill— 44 


FIG.  210. — SMITH'S  anterior  splint. 


346 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


in  October,  1862,  to  the  Surgeon  General  a  description  of  a  cradle  splint,1  which  had  been 
successfully  employed  by  him  in  the  hospital  under  his  charge.  "By  this  arrangement," 
he  writes,  "we  have  succeeded  in  saving  thirty-seven  out  of  fifty-three  cases  admitted,  or 


is  simple  and  easy  of  application.  A  small  iron  pulley  is  to  be  screwed  into  the  ceiling,  over  the  bed  of  the  patient,  perpendicularly  over  the  middle 
of  the  shin,  or  nearly  so.  A  cord,  about  as  thick  as  the  wire  of  the  splint,  passes  over  the  pulley,  and  is  reeved  through  a  small  tent-block,  by 
which,  slipping  it  upward  or  downward,  we  elevate  or  depress  the  limb.  The  eccentric  pressure  prevents  the  weight  of  the  limb  from  causing  it  to 
slip;  If  not,  rub  the  cord  with  chalk.  This  single  cord,  which  depends  from  the  block,  has  a  loop  at  its  end,  about  two  feet  or  more  above  the  limb. 

Through  this  another  cord,  about  five  feet  long,  passes  and  hangs  double 
from  the  loop,  by  its  centre.  Each  end  has  a  hook  attached  to  it  of  the  form 
represented  in  the  cut  (FIG.  211).  It  is  made  of  much  smaller  wire.  When 
everything  is  ready  for  suspension,  these  hooks  are  to  be  attached  to  the 
loops  in  the  cross-bars.  The  application  of  the  apparatus  is  extremely 
simple.  The  limb  (we  are  now  supposing  a  fracture  of  the  thigh)  is  to  be 
carefully  adjusted  and  laid  on  pillows  still  supported  by  the  hands  of  assist 
ants.  The  splint  is  now  to  be  laid  along  the  upper  surface  of  the  limb,  the 
foot  portion  an  inch  remote  from  the  instep,  the  middle  angle  nearly  corre 
sponding  to  the  knee.  I  formerly  placed  a  long  narrow  compress  under  the 
splint,  but  it  is  generally  superfluous.  One  may,  however,  be  placed  on  the 
instep,  and  one  under  the  hip  extremity  of  the  splint.  I  now  pass  a  piece  of 
wet  bandage,  long  enough  to  embrace  the  limb  and  overlap,  under  the  foot 
and  over  the  splint,  so  as  to  embrace  both,  not  tightly.  I  pass  another,  also 
wet,  around  the  ankle,  another  beneath  the  knee,  a  fourth  above  the  knee, 
and  a  fifth  around  the  thigh  near  the  hip.  Button-hole  slits  may  be  made 
near  the  end  of  each  sling,  and  these  be  buttoned  on  to  the  loops  in  the  cross 
wires  of  the  splint.  The  limb  being  still  kept  extended  by  the  hands  of 
FIG.  211  -Shows  suspension  apparatus  and  the  member  attached  to  the  assistants,  the  hooks  are  now  to  be  applied.  It  is  very  important  to  select 
splint  by  the  slings  at  four  points,  preparatory  to  the  application  of  the 
bandage  [After  SMITH  1  properly  their  points  of  attachment  so  as  to  adjust  well  the  centre  of  gravity 

of  the  limb.     In  fractures  of  the  middle  of  the  thigh,  f  attach  the  upper 

hook  nearly  over  the  seat  of  the  fracture;  the  other  a  little  above  the  middle  of  the  leg.  By  pulling  upon  the  tent-block  the  limb  is  now  gently  raised 
from  the  pillows  and  hangs  suspended  in  the  slings.  Observe  now  whether  the  upper  portion  of  the  splint  presses  down  too  much  upon  the  thigh,  or 
springs  up  too  much  from  it.  If  the  former  occurs,  then  attach  the  upper  hook  higher;  if  the  latter,  attach  the  lower  one  lower.  But  this  may  be  cor 
rected,  if  slight,  by  slipping  the  cord,  with  the  hooks  attached,  through  the 
loop  of  the  single  cord  so  as  to  correct  the  bearings,  and  securing  it  with  a 
piece  of  twine  just  below  the  loop  to  keep  it  thus.  The  limb  being  now 
raised,  so  that  one  may  pass  his  hand  under  every  part  of  it,  the  application 
of  the  roller  is  made.  The  surgeon  commences  with  the  foot,  the  splint 
being  held  steady.  Three  or  four  turns  are  to  be.  made  loosely  around  the 
foot,  care  being  taken  not  to  press  it  upward  against  the  splint,  which  it 
must  never  touch.  Then  figure-of  8  turns  are  made  around  the  ankle  and 
foot,  and  the  roller  is  carried  upward  along  the  leg  and  thigh,  reversing, 
where  necessary  to  make  perfect  adaptation,  and  great  care  being  taken 
not  to  crowd  the  limb  too  firmly  against  the  splint.  On  reaching  the  hip 
with  the  roller,  a  few  spica  turns  are  to  be  made  obliquely  through  the 
groin  and  around  the  pelvis,  concluding  with  two  direct  turns  around  the 
pelvis  (Flo.  212).  I  often  besmear  the  whole  under  surface  of  the  bandage 
thus  applied  with  starch.  This  prevents  the  slipping  of  the  bandage,  and 
preserves  a  uniform  and  accurately  adapted  surface  of  support."  Fleet 
Surgeon  JAMES  C.  PALMER,  U.  S.  N.,  applied,  in  a  case  of  fracture  of  both 
thighs  (HERBERT  SMITH,  Assistant  Surgeon,  U.  S.  N.,  Case  of  Fracture 

of  Both  Thighs,  in  Am.  Jour.  Mcd.  Sci.,  1W>5,  Vol.  L,  p.  58),  a  modification 

FIG.  212. — Represents  the  member  as  completely  dressed  and  suspended.       .  _          ,  .  .    ,    ,.  . 

[After  SMITH  1  °f  SMITH  8  anterior  splint.    It  consisted  of  two  continuous  parallel  rods  of 

No.  9  iron  wire,  passing  over  the  anterior  surfaces  of  both  limbs,  from  the 

toes  upward,  arching  over  the  pubes  clear  of  the  anterior  spinous  processes,  and  bent  at  the  groins  at  an  angle  of  about  30  degrees.  The  abdominal  arch 
was  well  padded.  Holler  bandages  were  employed  as  usual,  and  the  limbs,  slung  separately,  were  suspended  by  a  single  cord  passing  over  a  pulley  at 
the  ceiling,  and  making  extension  at  an  angle  of  about  30  degrees. 

'Dr.  HODGEX  published  a  description  of  the  cradle  splint  in  the  American  Medical  Times,  New  York,  January  to  July,  1803,  Vol.  VI,  p.  245: 
"Having  experienced  great  difficulty  in  dressing  compound  fractures  of  the  femur  when  the  wound  was  on  the  posterior  part  of  the  limb,  I  at  length 
devised  the  apparatus  to  meet  this  difficulty.  The  wood-cut  (FlG.  213)  shows  the  construction  of  the  cradle,  so  that  I  need  only  give  the  measurements 
and  mode  of  application.  The  foot-board  is  four  inches  and  a  half  wide,  one  inch  thick,  and  fourteen  inches  high  (or  long),  supported  on  a  base  fifteen 

inches  long  and  one  inch  square.  The  centre  support  is  seven  inches  high,  eight 
inches  on  the  base,  and  one  inch  thick.  The  uprights  of  this  portion  are  one  inch 
wide  at  the  top  and  one  inch  and  a  half  wide  at  the  base ;  this  piece  is  placed 
twenty-one  inches  from  the  foot-board.  The  longitudinal  strips  are  forty-two 
inches  long,  one  inch  and  a  quarter  wide,  and  half  an  inch  thick ;  one  end  of  each 
of  the  four  is  fastened  by  screws  to  the  foot-piece,  two  at  the  base,  the  remaining 
two  above  them,  leaving  spaces  of  four  and  a  half  inches  between  the  lower  and 
upper  pieces.  The  lower  strips  are  fastened  to  the  outside  of  the  centre  support  at 
its  base,  the  upper  at  the  inner  side  of  the  upright  portion,  thus  forming  the  frame 
represented  in  the  cut  (FIG.  213).  This  may  bo  adapted  to  either  limb  by  binding 
the  ends  of  the  pieces  designed  for  the  porinaBum  and  pubes,  the  lower  one  from 


C 


FIG.  213.— HODGEX'B  cradle  splint  for  fractures  of  the  femur. 


above  and  the  upper  from  below,  and  shortening  them  so  that  the  foot  will  come  near  the  foot-board — the  upper  strip  passing  in  front  of  the  pubes  and 
the  lower  a  short  distance  from  the  perineum.  Strips  of  cotton  or  linen  cloth,  two  and  a  half  inches  wide,  are  now  placed  on  the  upper  longitudinal  bars, 
and  pinned,  so  that  they  form  a  double-inclined  plane  on  which  the  limb  may  rest.  These  suspension  strips  lire  placed  in  contact  with  each  other,  and, 
being  distinct,  any  one  may  be  removed  and  replaced  to  insure  cleanliness,  when  necessary,  without  disturbing  the  limb.  The  limb  is  then  prepared  by 
placing  broad  strips  of  adhesive  plaster  on  either  side  of  the  leg  and  securing  them  in  the  usual  manner  by  a  roller.  It  is  then  placed  on  the  suspension 


SECT.  III.] 


SHOT    INJURIES   OF   THE    FEMUR. 


347 


FIG.  S214.  -  HODGEN'8  splint  applied. 


oi  66  per  cent."  Surgeon  J.  H.  Brinton,1  U.  S.  V.,  to  whom  Dr.  Hodgen's  paper  was 
referred  by  the  Surgeon  General  for  examination  and  report,  recommended  that  a  "certain 
number  of  these  cradles  be  issued  to  the  surgeons  in  charge  of  the  Washington  hospitals, 
in  order  that  this  mode  of  treatment  be  fairly  tested.  I  do  not  anticipate  for  it  a  failure." 
In  the  campaign  before  Richmond,  in  1862,  Acting  Assistant  Surgeon  J.  Swinburne2  pro 
posed  apian  for  counter-extension  available  on  the  field,  whereby  the  stretcher  becomes  the 
splint,  and  the  system  of  extension  can  be  carried  into  effect  immediately  after  the  receipt 
of  the  injury.  In  1863,  Dr.  Hodgen3  proposed  a  second  apparatus,  "a  combination  of  the 

strips,  and  the  free  ends  of  the  adhesive  plasters  placed  around  the  foot 
board  and  secured  to  it.  A  strong  cord  is  fastened  to  the  middle  of  the  foot 
board  at  a  proper  height,  and  passed  over  a  pulley  which  is  to  be  screwed 
into  the  foot-board  of  the  bedstead.  A  bag  containing  from  five  to  twenty 
pounds  of  s:md  is  attached  to  the  cord,  and  this  weight  serves  as  an  extend 
ing  force.  Two  or  more  bricks  are  placed  under  each  of  the  legs  of  the 
bedstead  at  the  foot,  thus  elevating  it  four  or  six  inches  and  allowing  the 
weight  of  the  body  to  serve  as  the  counter-extending  force.  Thus  the  limb 
is  suspended  so  that  the  air  circulates  freely  under  and  about  it." 

1  Surgeon  J.  H.  BRINTON,  U.  S.  V.,  to  whom  the  paper  of  Dr.  HOD- 
GEN  was  referred  by  the  Surgeon  General  for  examination,  reports :  "  The 
essential  portions  of  this  treatment  seems  to  be  that  the  fractured  limb  is 
suspended  in  a  cradle  formed  by  strips  of  bandages  attached  laterally  to  a 
framework.  These  strips  are  so  arranged  as  to  form  a  double-inclined  plane.  Extension  is  obtained  by  the  attachment  to  the  foot  of  a  sand  bag  of  from 
five  to  twenty  pounds  weight.  By  raising  the  foot  of  the  bed  from  six  to  eight  inches,  the  weight  of  the  body  is  made  the  counter-extending  force.  Surgeon 
HODGEN  also  suggests  that  the  same  result  may  be  obtained  by  the  use  of  SMITH'S  anterior  splint,  widened  at  its  upper  end,  with  an  oblique  suspension 
for  procuring  counter-extension.  In  other  words,  this  latter  modification  is  almost  identical  with  this  apparatus  as  it  is  applied  in  our  eastern  hospitals  in 
the  treatment  of  compound  fractures.  The  only  difference  in  the  application,  according  to  the  views  of  Dr.  HODGEN,  is  the  absence  of  redundant  band 
ages.  The  advantages  which  Surgeon  HODGEN  claims  for  his  cradle  splint  is  the  increased  ventilation,  the  cleanliness,  and  the  ease  with  which  portions 
of  the  dressings  may  be  changed;  all  of  these  ends  are,  however,  attained  by  the  use  of  SMITH'S  anterior  splint,  judiciously  applied,  and  suited  to  the 
exigencies  of  each  individual  case.  From  a  careful  study  of  very  many  cases  of  gunshot  fractures  of  the  thigh,  both  in  our  western  and  eastern  hospitals, 
I  have  come  to  the  conclusion  that  the  treatment  by  suspension,  in  some  form  or  other,  is  preferable  to  the  use  of  the  DESAULT  or  other  immobile  appa 
ratus.  I  believe  that  the  methods  of  Surgeon  HODGEN  and  Dr.  SMITH  will  alike  be  productive  of  good  results,  when  properly  applied  and  carefully 
attended  to.  The  success  which  has  been  obtained  by  Dr.  HODGEN  I  do  not  attribute  so  much  to  the  new  form  of  dressing  employed  as  to  the  care,  time, 
and  attention  which  he  personally  bestows  upon  the  cases  under  his  charge.  .  .  I  would  state,  that  when  it  is  decided  to  try  and  save  the  limb,  I 
should  be  inclined  to  regard  the  treatment  suggested  by  Dr.  HODGEN  as  a  valuable  one.  It  possesses,  I  think,  all  the  advantages  of  the  anterior  splint, 
and,  in  the  hands  of  a  young  and  inexperienced  surgeon,  is,  perhaps,  more  manageable.  The  extension  can  be  more  readily  graduated,  and  the  limb  of 
the  patient  is  equally  open  to  the  inspection  of  the  surgeon.  The  chief  objection  to  its  employment  is  the  mobility  of  the  counter-extending  point.  This 
fact,  which  would  lessen  its  value  in  the  treatment  of  a  simple  fracture  of  the  thigh,  is  of  little  moment  in  the  class  of  cases  resulting  from  gunshot 
injuries.  In  the  latter,  the  life  of  the  patient  and  the  consolidation  of  the  fracture  are  the  chief  points  at  stake ;  shortening  or  deformity  matter  but  little. 
I  would,  therefore,  respectfully  suggest  that  a  certain  number  of  these  cradles  be  issued  to  the  surgeons  in  charge  of  the  Washington  hospitals,  in  order 
that  this  mode  of  treatment  may  be  fairly  tested.  I  do  not  anticipate  for  it  a  failure." 

2 The  plan  was  explained  in  a  paper  read  before  the  Xew  York  State  Medical  Society,  in  February,  1864  (Transactions  of  the  Medical  Society  of 
the  State  of  New  York,  1864,  p.  159),  and  a  MS.  copy  thereof  was  sent  to  the  Surgeon  General  U.  S.  A.,  by  Dr.  J.  V.  P.  QUACKKSBUSH:  Surgeon  Gen 
eral  of  the  State  of  Xew  York,  on  April  11,  1864 :  "As  soon 
after  the  injury  as  practicable,  to  place  the  patient  on  a  bed 
or  stretcher,  extend  the  limb  as  near  as  possible  to  its  normal 
length,  without  giving  too  great  pain,  retain  it  in  that  posi 
tion  by  fastening  the  patient's  foot  to  the  foot  of  the  bed  or 
stretcher  by  means  of  adhesive  plaster,  as  I  am  in  the  habit 
of  doing  in  ordinary  fractures  of  the  thigh  (FIG.  1!15).  Of 
course  there  should  be  no  bandaging  of  the  leg  or  thigh. 
Make  the  counter-extension  by  the  use  of  a  large  perineal 
belt  fastened  to  the  head  of  the  bed  or  stretcher.  In  order 
more  fully  to  make  the  stretcher  a  splint,  I  propose  to  place" 
two  sliding  iron  rods,  4,  4,  the  length  of  which  should  be 
from  8  to  12  inches,  and  placed  upon  the  handles  of  the  i<lu-  215—SwiNBUKNK's  plan  of  applying  early  extern.  [After  SWINBURNE.  | 

stretcher,  which  are  to  be  provided  with  thumb  screws,  3,  3,  to  keep  them  in  any  desirable  position,  and  allow  of  their  being  depressed,  elevated  or 
extended,  as  the  case  may  require.  The  foot-strap  or  cord  can  be  fastened  to  the  sliding  iron  rod,  4,  4,  at  the  foot  of  the  stretcher,  while  the  perineal 
belt,  2,  can  be  fastened  to  the  sliding  iron  rod  or  arm,  4,  4,  at  the  opposite  end.  Thus  making  an  apparatus  for  the  treatment  of  this  fracture  as  complete 
and  perfect  as  can  possibly  be  produced  in  private  practice ;  and  since  the  majority  of  these  fractured  bones  suffer  no  loss  of  substance,  why  should  we  not 
then  succeed  in  effecting  as  good  results  by  this  method  in  army  practice  as  in  private  practice?" 

3HODOKX  (J.  T.)  (0?!  the  Treatment  of  Gunshot  Fractures  of  the  Femur  and  Tibia,  in  American  Medical  Times,  1863,  Vol.  VII,  p.  160,  and  in 
The  St.  Louis  Medical  and  Surgical  Journal,  January  and  February,  1864,  Vol.  1,  p.  20):  "  The  body  of  the  splint  is  made  of  No,  2  iron  wire,  which  is 
suflicient  to  support  the  limb,  all  of  one  piece,  bent  as  seen  in  the  cut  (FIG.  216).  The  dimensions  are  as  follows:  Four  inches  across  the  bottom  of  the 
foot  :  twenty  two  inches  from  the  foot  to  the  bend  at  the  knee ;  twenty  inches  from  the  bend  of  the  knee  to  the  upper  ends  of  the  wire  (corresponding  to 
the  pubes  and  hip  when  applied).  These  upper  ends  are  eight  or  nine  inches  apart,  being  separated  by  a  bow  of  thick  wire;  another  similar  bow  is 
placed  at  the  knee,  having  a  span  of  six  inches.  These  two  bows  are  made  so  as  that  they  can  be  put  on  or  taken  off  without  disturbing  the  dressings, 
and  are  put  in  position  after  all  else  is  arranged — the  one  at  the  hip  having  a  loop  at  each  end  to  receive  the  upper  end  of  the  splint  wires,  the  other 
simply  hooks,  to  be  looped  on  at  the  knee.  A  roller  bandage  may  be  placed  around  the  hips  and  upper  end  of  the  external  limb,  the  splint  to  keep  the 
latter  in  place,  if  required.  How  applied :  A  bandage  is  applied  to  the  foot :  an  adhesive  strap,  three  inches  wide,  is  applied  to  each  side  of  the  leg, 
extending  four  or  five  inches  below  the  foot,  and  up  to  the  knee  in  case  of  fracture  of  the  femur ;  or  to  the  fracture,  in  case  the  tibia  is  the  injured  part. 
The  roller  is  then  extended  smoothly  over  the  adhesive  plasters.  That  limb  of  the  splint  designed  to  pass  next  the  pubes  is  bent  upward,  at  a  point 


348 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


(CHAP.  X. 


principles  of  Smith's  anterior  splint,  Swinburne's  extension,  and  the  strip  bandage  supports 
used  in  the  cradle  splints,"  which  he  had  found  in  some  respects  more  desirable  than  the 
cradle  splint.  Dr.  Gurdon  Buck's  apparatus,1  a  modification  of  Physick's  Desault,  in  which 
the  long  splint  was  dispensed  with,  and  constant  and  uninterrupted  extension  was  kept  up 

from  the  bend  of  the  knee  in  the  splint,  corresponding  to  the  distance  from  the  bend  of  the  knee  to  the  pubes  on  the  sound  side  of  the  body.  Strips  of 
bandages  three  inches  wide  are  now  looped  over  one  limb  of  the  splint,  continuously  from  the  upper  to  the  lower  end,  and  allowed  to  belly  downward 

a  distance  equal  to  two-thirds  of  the  diameter  of  that  part  of  the  extrem 
ity  designed  to  rest  upon  each  one :  the  other  ends  of  these  strips  are 
pinned  over  the  other  limb  of  the  splint,  thus  forming  a  double-inclined 
trough  in  which  the  extremity  is  now  to  be  placed  on  these  strips  of 
muslin.  The  free  ends  of  the  adhesive  strips  are  next  fastened  to  the 
cross-piece  at  the  foot,  three  inches  apart,  and  the  whole  suspended  from 
a  pulley  fixed  to  the  ceiling  or  a  frame ;  the  pulley  should  be  almost 
over  the  foot  if  the  ceiling  be  eight  or  ten  feet  high,  giving  the  suspend 
ing  cords  an  oblique  direction,  that  in  this  way  we  may  have  sufficient 
extension.  If  the  patient  is  disposed  to  slide  toward  the  foot  of  the  bed, 
this  must  be  elevated  on  two  bricks  under  each  of  the  legs  at  the  foot  of 
the  bedstead." 

'The  apparatus  used  in  the  New  York  hospitals  since  1859  (G.  F. 
SCHRADY.  Report  of  the  Proceedings  of  the  Medical  Society,  in  New 
York  Journal  of  Medicine,  18.r>9,  Vol.  VI,  3d  series,  p.  239)  is  ex 
plained  in  the  Am.  Med.  Times,  1861,  Vol.  II,  p.  214.  The  following 
description  is  taken  from  BUCK  (GUKDOX),  (Description  of  an  Improved 
Extension  apparatus  for  the  Treatment  of  Fractures  of  the  Thigh,  in 
The  Medical  Record,  1867-68,  Vol.  II,  p.  49):  "Articles  composing  the 
apparatus :  Two  bands  of  adhesive  plaster  spread  on  Canton  flannel  or 
thick  twilled  cotton ;  each  band  being  two  inches  and  a  half  wide  and 
two  feet  long.  At  the  end  of  one  of  the  bands  a  piece  of  elastic  rubber 
webbing,  two  inches  wide  and  ten  long,  is  attached.  At  one  end  of  the 
other  band  a  buckle  of  corresponding  width  is  fastened.  A  thin  block 
of  wood  three  inches  and  a  half  wide  transversely  and  three  inches  verti 
cally.  The  perineal  portion  consists  of  rubber  tubing  of  one  inch  calibre, 
having  inside  of  it  a  tube  of  muslin  stuffed  with  bran  and  left  an  inch 
longer  than  the  rubber  tube  at  both  ends.  At  each  end  of  the  muslin 
tube  a  metallic  ring  is  first  fastened,  and  then  shoved  within  the  rubber 
tube,  to  the  end  of  which  it  is  also  fastened.  This  arrangement  prevents 


FIG.  216. — J.  T.  HODGEX'S  suspension  apparatus. 


the  rubber  tube  from  being  over-stretched.     Two  straps  fastened  to  the 


rings  at  the  ends  of  the  perineal  portion  serve  to  lengthen  it  and  allow  it  to  be  made  fast  to  the  head  of  the  bedstead.  A  belt  that  passes  around  the  opposite 
side  of  the  body,  and  maintains  the  bearing  of  the  perineal  band  in  a  line  with  the  axis  of  the  body  and  limb.  The  perineal  portion  should  be  wound 
with  a  narrow  strip  of  Canton  flannel  or  other  soft  material,  and  this  should  be  changed  as  often  as  soiled.  Four  guttered  coaptation  splints,  covered 
with  flannel,  are  intended  to  surround  the  fracture  and  be  secured  in  place  by  three  elastic  bands,  each  having  a  buckle  at  one  end.  An  upright  support 
ing  a  pulley  wheel,  to  be  fastened  to  the  floor  by  three  screws,  opposite  the  foot  of  the  bed.  Jlode  of  application :  The  bands  of  adhesive  plaster  are  first 

to  be  applied,  one  on  either  side  of  the  limb  from 
a  point  above  the  ankle  up\vards  as  high  as  the 
seat  of  fracture.  The  limb  is  then  to  be  bandaged 
in  the  usual  manner,  beginning  at  the  toes  and 
covering  the  plasters,  but  leaving  their  lower  ends 
free.  The  band  of  elastic  webbing  is  next  passed 
around  the  sole  of  the  foot  and  fastened  to  the 
buckle  on  the  other  side  of  the  foot.  The  block 
of  wood  should  then  be  interposed  between  the 
loop  of  webbing  and  the  foot.  A  cord  fastened  to 
the  block  thus  adjusted  is  passed  over  the  pulley, 
and  has  a  weight  suspended  from  it.  This  arrange 
ment  combines  elasticity  with  the  extending  force, 
keeps  the  bands  stretched  out  smooth,  and  pre 
vents  pressure  upon  the  ankles.  The  amount  of 
weight  required  must  be  proportioned  to  the  resist 
ance  to  be  overcome  and  the  toleration  of  the  pa 
tient.  Sometimes  five  or  six  pounds  only  can  be 
borne  at  the  outset,  and  an  increased  weight  sub 
sequently.  After  a  fracture  has  taken  place  the 
sooner  the  limb  is  put  up  and  subjected  to  treat 
ment  the  better.  Spasmodic  twitchings  of  the 
muscles  are  controlled,  and  the  patient  made  com 
fortable  from  the  outset.  To  permit  the  applica- 


FIG.  217.— GUBDOX  BUCK'S  apparatus. 


tion  of  lotions  to  the  seat  of  injury  during  the  first  few  days,  the  bandage  should  not  be  carried  above  the  knee,  and  the  ends  of  the  plaster  should  be 
rolled  up  and  kept  in  reserve.  At  the  end  of  six  or  eight  days  the  plasters  may  be  extended  up  on  the  thigh  and  the  bandage  continued  over  them. 
The  coaptation  splints  are  now  to  be  applied  around  the  thigh  and  secured  by  the  three  elastic  bands.  To  complete  the  apparatus  the  perineal  band 
should  be  adjusted  and  its  ends  fastened  to  the  head  of  the  bedstead  so  as  to  be  in  a  line  with  the  axis  of  the  body  and  limb.  The  limb  should  be  raised 
on  a  hair  cushion  sufficiently  to  keep  the  heel  from  pressure.  In  the  employment  of  this  method  of  treatment,  experience  has  shown  that  in  a  large  majority 
of  cases  the  use  of  the  perineal  band  may  be  dispensed  with,  the  weight  of  the  body  being  sufficient  to  resist  the  extending  force.  This  resistance  may 
be  further  increased  by  raising  the  foot  of  the  bedstead  five  or  six  inches  above  the  floor.  The  advantages  claimed  for  this  method  over  others  hereto 
fore  in  use  are  its  great  simplicity  of  arrangement,  facility  of  management,  and  especially  the  comfort  it  affords  the  patient  during  a  long  confinement  in 
bed.  The  efficiency  with  which  uninterrupted  extension  of  the  limb  can  safely  be  kept  up  secures,  it  is  believed,  better  results  than  have  been  obtained 


SECT.  III.] 


SHOT    INJUEIES    OF   THE    FEMUK. 


349 


by  means  of  a  weight  and  pulley,  was  frequently  employed  during  the  war.1  Dr.  Vedder,2 
in  1862,  recommended  a  long  straight  splint,  which  by  a  mechanical  arrangement  may  be 
folded  in  the  middle  when  not  in  use,  and  securely  straightened  when  desired.  Extension 
is  made  by  a  rachet  pulley,  a  drawing  of  which  has  already  been  given  in  FIGURE  570,  on 
page  812  of  the  Second  Surgical  Volume.  During  the  last  year  of  the  war  a  combined 
splint  and  fracture  bed,  constructed  by  Dr.  I.  Langer,3  was  used  with  favorable  results  by 

by  any  other  method.  The  sitting  posture  may  be  allowed  without  disturbing  the  action  of  the  apparatus ;  an  indulgence  for  which  patients  are  always 
very  grateful,  and  one  which  greatly  alleviates  the  irksomeness  of  their  condition.  The  materials  required  for  employing  this  treatment  are  obtainable 
under  almost  any  circumstances,  the  only  indispensable  article  being  adhesive  plaster.  If  this  is  of  the  ordinary  description  it  is  better  to  use  it  of  double 
thickness.  All  the  other  articles  requisite  may  be  improvised.  The  elastic  band  may  be  dispensed  with,  and  a  round  stick  properly  placed  across  the 
foot  of  the  bedstead  may  serve  instead  of  a  pulley." 

'In  a  report  to  the  Surgeon  General,  in  February,  18H3,  Surgeon  H.  J.  CHUKCHMAX,  U.  S.  V.,  speaks  favorably  of  BUCK'S  pulley:  ''In  regard  to 
mechanical  appliances  I  much  prefer  BUCK'S  pulley  with  side  splints  rolled  in  muslin,  which  may  be  so  tacked  to  splints  as  to  permit  their  being  easily 
thrinvn  down  for  dressing  w  inspection.  Of  course  when  there  is  a  discharging  wound  the  splint  must  be  so  shaped  as  to  leave  wound  readily  accessible. 
In  lieu  of  the  usual  counter-extending  adhesive  strips  or  the  galling  periueal  baud,  I  propose  to  substitute,  when  attainable,  the  old-fashioned  ribbed  corset, 
lacing  up  in  front  with  side  buckles,  by  which,  with  strong  tapes,  the  body  may  be  secured  to  the  bunk  or  bedstead.  The  tape  might  be  tightened  or 
loosened  as  deemed  necessary.  This  apparatus  would  relieve  materially  the  vexation  of  spirit  to  both  surgeon  and  patient  necessarily  incident  to  the  old 
plan.  I  propose  this  in  connection  with  BUCK'S  pulley,  while  the  side  splints,  arranged  as  I  have  stated,  give  uniform  support  to  the  limb  in  its  whole 
extent  and  keep  it  in  proper  line.  In  the  absence  of  the  corset,  I  have  heretofore  advantageously  employed  in  several  instances  BUCK'S  pulley,  with  side 
splints  as  described,  and  elevation  of  foot  of  bed,  as  described  in  case  5.  The  corset  will  relieve  a  position  found  more  or  less  uncomfortable  to  patient. 
The  only  objection  in  theory  is  the  difficulty  of  defecation  when  bound  down  by  the  side  straps.  In  practice  there  is  uo  serious  difficulty  when  using  the 
bed-pan.  If  deemed  necessary,  however,  the  men  can  readily  unbuckle  the  straps  for  the  time." 

2  VEDDEK  (JOSEI'H  H.),  New  Apparatus  for  the  Treatment  of  Fractures  of  the  Long  Bones,  in  American  Medical  Times,  1862,  Vol.  IV,  p.  254. 

3  Under  the  direction  of  the  Medical  Director  of  the  Army  of  the  Potomac,  Colonel  T.  A.  McPAUI.lx,  Dr.  LANGKK'S  apparatus  was  tried  by  Sur 
geon  W.  L.  FAXON,  32d  Massachusetts,  who  reports,  on  March  28,  1865:  "I  have  the  honor  to  report  that  on  the  7th  and  8th  days  of  March.  18(i.~>,  I 
witnessed  the  application  of  Dr.  I.  LAXGEK'S  combined  splint  and  fracture  bed,  in  two  cases  of  compound  fracture  of  the  thigh,  one  near  the  trochanter 
major,  the  other  at  the  middle  third,  in  consequence  of  gunshot  injuries.     Each  of  the  patients  were  transferred  and  located  comfortably,  in  ten  minutes, 
from  the  beds  on  which  they  were  lying  to  Dr.  LAXGEK'S  beds,  with  the  aid  of  two  assistants.     Extension  and  counter-extension  were  applied  from  the 
beginning.     No  anaesthetics  were  given,  and  the  patients  have  evinced  no  suffering.     The  changing  of  the  sheets  lying  under  the  patients  and  the  evac 
uations  from  the  bowels  during  their  confinement 

were  effected  without  the  necessity  of  lifting  the 
patients  from  the  beds  they  were  first  put  on.  The 
discharge  of  the  matter  from  three  wounds  in  the 
first  case — the  bullet  entering  at  the  edge  of  the 
nates  on  the  left  side,  penetrating  the  left  thigh, 
and  entering  the  right  limb  one  inch  below  the 
tuberosity  of  the  ischium — as  well  as  from  the  two 
wounds  in  the  second  case,  has  not  at  any  time 
made  the  patients  uncomfortable,  as  the  matter  and 
the  water  used  for  cleansing  ran  off  freely.  The 
position  as  well  as  the  axis  of  the  limbs  are  nearly 
straight,  and  the  shortening  in  neither  case  exceeds 
one  inch.  I  consider  Dr.  LAXGEK'S  combined 
splint  and  fracture  bed  as  I  have  seen  it  in  opera 
tion  at  this  hospital  as  the  best  appliance  I  have 
used,  or  seen  used  in  the  army.  The  patient  can 
always  be  made  comfortable ;  he  seldom  requires 
opiates  to  procure  sleep  (in  neither  of  the  cases 
above  quoted  were  any  bed-sores);  the  patients 
can  always  be  kept  clean,  the  bed  clothing  is  not 
at  all  soiled,  one  nurse  can  take  care  of  as  many 
cases  as  of  simple  wounds,  and  the  operation  of 
lifting  and  shifting  the  patient  in  dressing  of  the 
wound  is  entirely  avoided,  an  object  of  great  im 
portance  to  all  concerned;  and  I  respectfully  request 
that  fifty  of  Dr.  LAXGKR'S  beds  be  furnished  for  use 
of  this  hospital,  if  possible."  This  report  received 
the  favorable  endorsement  of  the  Acting  Chief  Medical  Officer  of  the  Depot  Field  Hospital  at  City  Point,  Surgeon  G.  B.  PAHKEU,  U.  S.  V.,  and  was  for 
warded  to  the  Surgeon  General  of  the  Army  for  favorable  consideration  by  the  Medical  Director,  Colonel  T.  A.  McPAULIX.  Dr.  LAXGEli's  apparatus 
consists  of  a  triple-inclined  plane,  on  which  extension  and  counter-extension  of  the  fractured  femur  is  kept  up  by  the  weight  of  the  body  and  the  leg:  "It  is 
constructed  of  iron  and  covered  with  duck-cloth ;  its  weight  is  twenty-six  (2(i)  pounds,  including  the  straps  to  swing  the  apparatus  in  an  ambulance  wagon  or 
anywhere  else.  It  consists  of :  a.  One  head  piece,  b.  Two  trunk  bars.  c.  One  cross  piece,  d.  Two  thigh  pieces,  e.  Two  leg  pieces.  /.  Two  bows  under 
the  knees.  The  thigh  as  well  as  the  leg  piece,  for  the  injured  limb,  has  pins  to  support  the  straps  on  which  the  limb  rests,  a.  Head  piece  connected  with 
the  trunk  bars,  arranged  to  change  its  relative  position,  when  vertical,  to  form  a  shelter  to  the  head,  when  horizontal,  to  make  an  elongation  to  the  trunk  part 
for  the  head  to  rest  on,  or  sen-ing  instead  of  legs,  when  set  down,  with  a  strip  of  wood  at  its  opening  to  keep  it  spread;  it  is  covered  with  double  cloth, 
which  is  to  be  stuffed  if  chosen,  b.  Two  trunk  bars,  connected  with  the  head  piece  by  bolts  and  thumb-nuts ;  to  the  necks  of  the  bolts  straps  arc  fastened 
to  swing  the  apparatus.  On  each  of  the  bars  is  a  loop  for  an  additional  strap,  to  support  the  arm,  or  if  the  wounded  man  is  exposed  to  the  weather,  to 
attach  there  a  storm  hood.  Between  these  bars  cloth  is  stretched  for  the  patient  to  rest  on.  A  blanket  and  a  sheet  doubled  up  and  spread  over  the 
cloth  before  the  patient  is  laid  on  it  will  enhance  the  comfort.  These  trunk  pieces  are  connected  with  the  cross  piece  in  a  manner  as  to  allow  the  change 
of  their  relative  position  from  a  level  with  the  thigh  pieces  to  an  angle  of  45°.  c.  Cross  bar,  with  a  bend  nine  inches,  opening  to  receive  a  bed-pan  with 
a  neck  on  each  end,  to  rest  on  a  fulcrum  having  a  head  to  secure  against  slipping.  Near  the  angles  of  the  bend  are  two  holes  to  receive  the  screws  of  d. 
d.  Two  thigh  pieces,  rotating  in  a  loop  connected,  movable,  with  a  screw  and  thumb-nut,  with  the  cross-piece  so  as  to  allow  either  of  the  two  thigh  pieces 
to  elevate  or  lower  nearly  three-fourths  of  a  circle;  also  to  allow  to  separate  one  from  the  other;  but  if  wanted  stationary  they  are  fastened  together  by  a 


FIG.  218.— Dr.  I.  LANGEH'S  apparatus. 


350  INJUEIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

surgeons  of  the  Army  of  the  Potomac.  In  a  few  instances  the  single  long  splint  of  Dr. 
Kimball1  was  preferred.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  substituted  the  "bran  box 
for  Hodgen's  splint,  which  had  become  uncomfortable  and  difficult  to  adjust."2  Surgeon 
J.  T.  Woods,  99th  Ohio,  employed  the  double-inclined  plane  in  fractures  of  the  femur  near 
the  trochanters,  and  Desault's  splint,  or  some  modification  thereof,  in  fractures  of  the  middle 
third  of  the  femur.3  Surgeon  E.  McDonnell,  U.  S.  V.,  advised  that  in  fractures  of  the 
upper  third  of  the  femur  all  extension  apparatus  be  dispensed  with  as  liable  to  produce  a 
hiatus  between  the  fractured  ends,  leaving,  on  account  of  the  absence  of  periosteum  and 
nourishing  vessels,  no  chance  for  repair,  and  that  the  limb  be  simply  placed  in  an  easy 
position  regardless  alike  of  deformity  and  shortening.4  The  danger  of  producing  such  a 
separation  of  the  ends  of  bone  as  might  delay  if  not  interfere  with  the  union  of  bone  was 
pointed  out  by  Dr.  J.  R.  Lothrop,  at  the  Buffalo  General  Hospital,5  and  other  surgeons. 

The  method  of  wiring  together  the  fractured  ends  of  long  bones  proposed  by  Assistant 
Surgeon  B.  Howard,6  already  referred  to  in  the  Second  Surgical  Volume,  at  page  819,  found 

key;  four  holes  on  eacb  end,  to  adjust  the  length  and  to  connect  with  the  spreading  bows  under  the  knee  and  the  leg  pieces.  On  each  end  of  the  thigh 
pieces  are  slats  for  the  straps  to  swing  the  apparatus ;  when  the  two  thigh  pieces  are  connected  by  key  there  is  still  a  place  left  for  defecation,  e.  Two  leg 
pieces,  with  four  holes  on  each  end,  to  be  adjusted  and  connected  outside  of  the  end  of  the  thigh  pieces ;  the  cross  bars  of  each  have  a  hole  for  a  cord  to 
pass  through,  to  fasten  a  weight  to  the  foot  if  required ;  to  the  cross  bar  is  a  strap  fastened  to  swing  the  apparatus.  The  inner  comer  to  be  connected  with 
a  cord.  One  of  the  thigh  as  well  as  one  of  the  leg  pieces  has  pins  to  fasten  the  straps  stretched  across  for  receiving  the  injured  limb  to  rest  on.  The 
other  is  covered  with  cloth  ;  both  of  them  have  a  well  padded  cushion  secured  at  the  end  near  the  cross  piece,  f.  Bows  under  each  knee,  to  connect  by  a 
bolt  and  thumb-nut,  inside  of  the  ends  of  the  thigh  pieces,  to  keep  the  thigh  and  leg  piece  from  drawing  together  by  the  weight  of  the  limb  resting  on 
them.  To  these  two  bows  a  strap  is  attached,  which  fastens  to  the  floor,  preventing  side  motions  or  raising  the  whole  apparatus." 

'SARGENT  (F.  W.),  On  Bandaging  and  other  Operations  of  Minor  Surgery,  Philadelphia,  1862,  p.  182.  Dr.  KlMBALL'S  splint  extends  from  the 
axilla  to  below  the  foot,  but  is  so  contrived  as  to  be  capable  of  being  lengthened  at  each  extremity  by  sliding  bars.  The  upper  sliding  bar  terminates  in 
the  manner  of  a  crutch  ;  to  the  lower  is  secured  at  right  angles  a  transverse  bar,  which  is  moved  up  and  down  by  screw,  thus  regulating  extension  at  will. 
The  perineal  band  is  used,  but  may  be  discontinued  with  safety  by  moving  the  upper  crutch-like  sliding  bar  into  the  axilla. 

2Report  of  Assistant  Surgeon  Wll.  THOMSON,  U.  S.  A.,  in  charge  of  Douglas  Hospital,  Washington,  for  June,  1863  (File  A,  No.  103):  "It  is 
difficult  to  conceive  of  a  more  suitable  apparatus  for  compound  gunshot  fractures  of  the  thigh  than  the  Bran  Box,  properly  arranged.  The  limb  is  sup 
ported  at  every  point ;  the  skin  is  kept  cool  and  dry,  and  the  profuse  discharge  easily  removed  at  each  dressing.  Where  extension  is  desired,  it  can 
readily  be  made  by  fastening  the  adhesive  strips  attached  to  either  side  of  the  leg  to  the  box  and  then  adding  a  sufficient  weight  to  a  cord  fastened  to  the 
foot-board." 

3  In  his  report  from  the  hospitals  at  Chattanooga,  Surgeon  WOODS  remarKS:  "  The  limbs  were  placed  in  positions  most  comfortable  to  the  patient  for 
some  time,  when,  suppuration  having  at  last  become  much  reduced  in  quantity  and  the  reparative  callus  was  being  thrown  out,  they  were  (usually  under 
chloroform)  placed  in  some  form  of  splint  with  moderate  extension  and  counter-extension.     My  observation  led  me  to  conclude  that  the  double-inclined 
plane  is  inferior  save  where  the  fracture  is  within  a  short  distance  of  the  trochanter,  and  the  tilting  of  the  upper  fragment  requires  the  adaptation  of  the 
lower  fragment  to  it  by  changing  the  position  of  the  leg  from  the  straight  line,  and  possibly  when  the  fracture  is  so  low  down  that  the  condyles  are  drawn 
backward  and  downward.     SMITH'S  anterior  splint  failed  to  meet  my  expectations  in  every  particular.    If  it  be  applied  as  Dr.  SMITH  directs,  the  parts 
are  hidden  from  view,  sacculation  of  pus  occurs,  drainage  is  imperfect,  and  filth  accumulates  in  the  bandage.     If  the  leg  be  simply  suspended  in  the  wire 
frame,  sufficient  quietude  of  the  parts  is  not  maintained,  and  the  extension  is  neither  sufficient  nor  reliable,  and,  if  the  fracture  be  in  the  upper  third,  the 
motions  of  the  body  produce  movement  in  the  fractured  extremities — just  what  a  splint  is  designed  to  prevent.     The  splint  of  DESAULT,  modified  in 
various  ways  to  suit  particular  cases,  can  be  so  applied  as  to  secure  the  desired  immobility,  extension,  drainage,  exposure,  and  cleanliness.    My  impression 
from  observing  these  cases  leads  me  to  conclusions  briefly  summed  up  thus.     .     .     The  proper  dressing  of  a  limb  is  really  of  great  importance  and  very 
much  underrated.     That  'supporting'  diet  in  the  early  stages  of  these  injuries  is  over-estimated.     That  an  object  of  the  first  importance  is  to  secure  an 
abundance  of  fresh  air,  cleanliness,  and  perfect  drainage.     A  very  great  error  consists  in  excessive  bandaging — a  limb  is  better  off  without  bandaging  or 
splints  until  reparation  has  commenced.     The  covering  of  gunshot  wounds  with  lint,  either  picked  or  patent,  is  objectionable ;  the  pus  drying  at  the  edges 
glues  it  fast  and  is  not  permitted  to  drain  away.     The  best  splint  for  fracture  at  the  trochanter  major  or  immediately  above  the  condyles  is  some  form  of 
the  double-inclined  plane,  and,  for  fractures  in  the  middle  of  the  femur,  some  modification  of  the  DESAULT  splint." 

4  Surgeon  E.  MCDONNELL,  U.  S.  V.,  who  had  charge  of  a  field  hospital  after  the  battle  of  Antietam,  remarks,  in  a  special  report,  transmitted  in  Feb 
ruary,  1863,  of  a  fatal  case  of  fracture  of  the  upper  third  of  the  femur  treated  by  BUCK'S  apparatus:  "It  appears  to  me  the  lessons  most  practically 
deducible  from  the  foregoing  ease  are  two,  viz :  1st,  that  there  was  such  a  destruction  of  bone  that  when  the  limb  was  extended  by  BUCK'S  plan  a  hiatus 
was  produced  between  the  fractured  ends,  as  left  by  the  absence  of  periosteum  and  any  nutrient  vessels  no  chance  for  repair — hence  I  think  this  or  any 
apparatus  separating  the  fractured  bones  destructive  of  our  hopes  of  a  good  result.     This  case,  with  many  others  in  the  hospitals  of  Sharpsburg,  gave 
ample  scope  for  contemplation  on  the  different  methods  devised  by  distinguished  members  of  our  profession  to  advance  conservative  surgery.     The  result 
of  my  observation  is  that,  should  1  ever  have  charge  of  as  many  wounded  men  as  those  in  the  Sharpsburg  hospitals,  over  which  I  had  control,  I  should  in 
all  cases  of  badly  compound  comminuted  fractures  of  the  femur  in  the  upper  third  dispense  with  all  extension  apparatus,  and  simply  place  the  limb  in  an 
easy  position  regardless  alike  of  deformity  and  shortening  (amputation  being  out  of  the  question).     This  I  am  persuaded  is  the  treatment  to  save  most  lives." 

•LOTHROP  (J.  R.)_,  A  Case  of  Gunshot  Wound  of  the  Femur,  in  liuffalo  Med.  and  Surg.  Jour.,  1866,  Vol.  V,  p.  470. 

6 In  his  article  (The  Application  of  Sutures  to  Bone  in  Recent  Gunshot  Fractures,  in  the  Medico- Chirurgical  Transactions,  London,  1865,  Vol. 
XLVIII,  p.  252)  Dr.  HOWARD  defends  this  expedient:  "The  shock  of  the  operation  involved  in  this  plan  of  treatment,  superadded  to  that  of  the  original 
wound,  immediately  suggests  itself,  of  course,  as  an  objection  to  its  adoption.  Over  against  this,  however,  we  must  weigh  the  immediate  dangers  pre 
viously  enumerated  from  the  pressure  and  constriction  of  tight  dressings  attending  the  use  of  simple  splints.  Those  from  the  enclosed  fragments  and 
spiculae  during  transportation  being  in  continual  motion,  and  afterwards  awaiting  tedious  extrusion  by  the  slow  processes  of  nature,  keeping  the  patient 
in  a  condition  which  renders  him  continually  susceptible  to  various  intercurrent  diseases,  and,  should  union  be  ultimately  effected,  the  degree  of  effort 
called  forth  for  its  accomplishment  has  left  behind  such  a  surplus  of  provisional  callus,  and  other  pathological  changes  in  the  parts  adjacent,  as  seriously  to 
diminish  the  usefulness  of  the  limb  for  a  long  period,  with  a  still  further  danger  that  after  apparent  recovery  tertiary  sequestrse,  as  mentioned  by  Duruv- 
TUEN,  may  continue  to  be  extruded  for  ten,  fifteen,  or  even  twenty  years  thereafter.  In  the  operation  described  the  chief  causes  of  the  evils  above  enumer 
ated  are  removed.  Its  advantages  consists  mainly  in  this :  1st.  Negatively :  In  the  absence  of  everything  which  may  aet  as  a  foreign  body  and  dangerous 


SECT,  ill.]  SHOT   INJURIES   OF   THE    FEMUE.  351 

» 

even  less  favor  in  shot  fractures  of  the  femur  than  in  those  of  the  humerus,  and  it  seems 
that  in  one  instance  only  this  plan  was  attempted : 

CASE  497. — Private  H.  Ingalls,  Co.  B,  6th  Ohio  Cavalry,  was  wounded  during  the  engagement  near  the  Pamunkey 
River,  May  28,  1864.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Fifth  Corps,  whence  Surgeon  L.  W.  Reed,  U.  S.  V., 
reported  the  injury  as  a  "severe  shell  wound  of  the  left  thigh."  From  the  field  hospital  the  patient  was  moved  to  White  House 
Landing,  where  he  died  from  the  effects  of  his  injury  on  June  2,  1864.  This  case  has  been  identified  as  one  published  by 
Dr.  Benjamin  Howard,  late  Assistant  Surgeon,  U.  S.  A.  (Medico- Chirurgical  Transactions,  London,  1865,  Vol.  XLVIII,  p.  251), 
as  follows:  "On  May  29,  1864, 1  was  called  in  consultation  on  the  field  to  see  the  patient,  who  was  sixty  years  of  age  and  of 
broken  down  constitution ;  he  had  received  a  severe  fracture  of  the  femur  from  a  large  fragment  of  shell,  which  I  found  firmly 
wedged  into  the  botie  about  three  inches  above  the  knee.  From  this  point  there  proceeded  a  long  oblique  fracture,  running 
upwards  and  outwards,  with  some  comminution  of  the  inner  aspect  of  the  bone  in  the  vicinity  of  the  piece  of  shell.  The  sharp 
pointed  lower  fragment  was  overriding  the  upper,  causing  a  shortening  of  about  three  inches,  reduction  of  which,  with  such  a 
wound,  could  not  possibly  be  maintained  with  splints  alone  during  transportation.  Having  made  the  requisite  incision  and 
extracted  the  impacted  piece  of  shell,  I  proceeded  to  remove  the  looser  fragments;  then  causing  steady  extension  to  be  kept  up 
while  I  kept  my  finger  and  thumb  in  the  wound,  I  guided  the  fractured  ends  so  that  the  corresponding  serrations  were  accurately 
refitted  to  their  original  position  for  about  two  thirds  of  the  circumference  of  the  bone.  Having  somewhat  enlarged  the  incision, 
I  directed  the  limb  to  be  so  bent  upon  itself  as  to  slightly  reopen  the  fracture,  while  I  drilled  the  requisite  holes  and  passed  a 
suture,  which  firmly  secured  the  interlocked  fragments,  rendering  shortening  or  shifting  impossible.  A  straight  splint  was  then 
applied,  the  wound  being  left  exposed  for  the  repetition  of  cold-water  dressings.  After  the  operation  the  patient  ceased  to  com 
plain  of  pain  and  seemed  very  comfortable.  The  next  morning  he  was  hurried  away  in  an  ambulance  train,  and  I  saw  no  more 
of  the  case.  In  consideration  of  his  age,  the  nature  of  the  wound,  and  his  broken-down  constitution,  I  was  not  surprised  when 
subsequently  I  incidentally  heard  that  he  died  on  the  road  three  days  afterwards." 

The  amount  of  shortening1  of  the  injured  limb  was  indicated  in  seven  hundred  and 
thirty-two2  of  the  sixteen  hundred  and  eighty-nine  cases  of  recovery  after  shot  fractures  of 
the  femur  treated  by  conservation,  varying  from  one-quarter  of  an  inch  to  eight  inches, 
and  averaging  2.31  inches.3  In  fifty-two  cases  the  reports  indicated  shortening,  but  the 
precise  amounts  were  not  stated.  In  twelve  instances  it  was  recorded  that  there  was  no 
shortening  whatever,  and  in  eight  hundred  and  ninety-two  this  point  was  not  noted.  One 
instance  is  reported  in  which  the  limb  was  found  lengthened:4 

source  of  irritation.  2d.  Positively:  In  securing  complete  coaptation  and  perfect  rest.  This  plan  of  treatment  is  new  only  in  its  application.  Substan 
tially  the  same  operation,  including  the  use  of  the  wire  suture,  has  for  a  long  time  been  practised,  and  still  meets  with  general  approval,  as  a  secondary 
operation  for  uuunited  fracture.  Other  things  being  equal,  why  should  it  be  less  advisable  as  a  primary  one,  where,  in  the  absence  of  all  pathological 
changes,  we  have  a  healthy  condition  of  all  the  parts,  with  sound  bone  in  apposition  and  at  rest.  These  considerations  led  me  to  hope  for  a  healthy  pro 
cess  of  uninterrupted  repair,  with  speedy  use  of  the  limb  after  union.  The  selection  of  the  cases  (which  at  most  must  be  quite  limited  in  number,  either 
on  the  field  or  in  civil  practice),  the  amount  of  bone  which  may  be  with  propriety  removed,  etc.,  must,  of  course,  be  a  matter  of  careful  judgment.'' 

1  The  exact  amounts  of  shortening  in  the  732  cases  in  which  this  point  was  ascertained  are :  J  of  an  inch  in  1  instance ;  J  in  1 ;  J  in  20 ;  f  in  17 ;  1 
in  77;  IJ  in  19;  li  in  1;  H  in  80;  1|  in  13 ;  2  inches  in  179;  2J  in  2 ;  2Jin5;  2J  in  82;  2J  in  14  ;  2f  in  1;  3  in  111;  SJiuS;  3iin23;  3f  in  3;  4  in  42; 
4Jin6;  4J  in  1 ;  5  in  16  ;  5J  in  3 ;  6  in  5;  CJ  in  1 ;  7  in  2;  7J  in  1  ;  8  in  1. 

2  Assistant  Surgeon  DliWlTT  C.  PETEUS,  U.  S.  A.,  in  a  letter  to  Medical  Inspector  JOHN  M.  CUTLER,  U.  S.  A.,  dated  Jarvis  U.  S.  A.  General 
Hospital,  Baltimore,  January  11,  1804,  remarks :  "Recently  I  had  the  opportunity  of  hurriedly  examining  twenty-five  rebel  prisoners  who  were  wounded 
at  Gettysburg,  and  had,  up  to  a  late  period,  been  treated  in  hospitals  near  the  field.     They  were  lying  side  by  side  and  had  compound  gunshot  fractures 
of  the  femur.     M}1  time  was  limited,  as  they  were  under  orders  to  embark  for  exchange ;  but  I  measured  their  injured  limbs  and  found  the  greatest  amount 
of  shortening  to  be  four  inches,  and  the  least  about  one  inch.     Average  near  two  and  a  quarter  inches.    I  believe  you  were  instrumental  in  having  these 
bad  cases  retained  near  the  battle  field,  also  many  others,  and  the  happy  results  prove  your  wise  forethought.    I  have  long  argued  that  many  of  these  cases 
were  killed  by  transportation  employed  too  early.     The  cases  I  saw  fully  show  how  much  nature  can  do;  but  I  cannot  say  so  much  about  the  treatment, 
for  some  of  them  were  strangely  crooked,  bowing  every  way.    I  think  with  proper  extension  and  counter-extension  they  might  have  been  greatly 
improved.     I  thought  the  mention  of  them  might  be  interesting,  as  they  were  prisoners  and  depressed  in  spirits;  it  further  adds  to  our  knowledge  of 
nature's  reparative  powers  when  aided." 

3  The  instances  in  which  the  shortening  of  the  limb  after  recoveries  from  shot  fractures  of  the  femur  has  been  recorded  in  military  surgery  are  few : 
SxitOMEVER  (L.)  (Maximen  der  KriegsJieilkunst,  Hannover,  1855,  p.  724)  remarks  that  he  has  notes  regarding  the  length  of  the  limb  in  12  of  the  15 cases 
of  shot  fractures  of  the  femur  that  he  observed.     In  one  of  these  the  shortening  was  5  inches ;  in  1,  4  inches ;  in  4,  3  inches ;  in  5,  2  inches ;  and  in  1, 1  inch, 
averaging  2J  inches.     ClIKNU  (J.  C.)  (Rapport,  etc.,  pendant  la  Campagne  d' Orient  en  1854-55-56,  Paris,  1805,  p.  375  et  seq.)  cites  126  cases  of  recovery 
after  shot  fractures  of  the  femur.     The  amount  of  shortening  is  ascertained  in  32  cases,  varying  from  3  to  11  centimetres,  and  averaging  5.7  centimetres, 
or  about  2£  inches.     WILLIAMSON  (GEOKGE)  (Military  Surgery,  London,  1863,  p.  138)  reports,  from  the  mutiny  in  India,  in  1857-58,  13  cases,  viz:  "Limb 
3  inches  shorter  in  3;  Si  inches  shorter  in  1 ;  li  inch  shorter  in  4  ;  and  1  inch  shorter  in  5  instances;"  an  average  of  1.7  inch.    CllENU  (J.  C.)  (Stat.  il&d.  Chir. 
de  da  Camp,  d'ltalie  en  1859  et  I860,  Paris,  1869,  p.  715  et  seq.)  reports,  among  118  cases  of  recovery,  25  cases  with  shortening  varying  from  2  to  15  centi 
metres,  the  average  being  7  centimetres,  or  2J  inches.     BECK  (B.)  (Chirurgie  der  Schussverletzungen,  Freiburg,  i.  B.,  1872,  p.  694  et  seq.)  ascertained  the 
shortening  in  23  instances  varying  from  1  to  4J  inches,  averaging  2.25  inches.     CHENU  (J.  C.)  (Aperyu  Hist.  Stat.  et.  Clin.,  Paris,  1874,  p.  453  el  seq.) 
records  705  invalids  after  shot  fractures  of  the  femur  treated  by  conservation.     Shortening  is  stated  to  have  existed  in  426  instances  ;  in  201  cases  the 
amount  of  shortening  is  definitely  stated,  and  varies  from  3  to  23  centimetres,  averaging  7.4  centimetres,  or  very  nearly  3  inches.     According  to  these 
limited  statistics  the  average  shortening  in  shot  fractures  of  the  femur  is  2.7  inches. 

••Professor  F.  II.  HAMILTON  (A  Practical  Treatise  on  Fractures  and  Dislocations,  Philadelphia,  1875,  p.  516)  relates  the  following  case  as  an 
example  of  lengthening  of  the  limb  after  shot  fracture  of  the  femur:  "Melchior  BriStel,  Private,  12th  N.  Y.  V.,  was  wounded  in  June,  1862,  at  the  battle 
of  White  Oak  Swamp,  Virginia,  by  the  fragment  of  u  shell,  which  struck  the  left  leg  three  inches  above  the  eondyles.  He  was  taken  to  Richmond  as  a 
prisoner,  and  about  a  month  later  he  was. exchanged  and  sent  within  our  lines.  January  1,  1864,  I  found  him  in  the  United  States  General  Hospital^at 
Newark,  under  the  charge  of  Surgeon  Taylor.  The  wound  was  still  discharging  matter  occasionally,  and  several  fragments  of  bone  had  been  removed. 
Splints  were  not  applied  until  alter  his  exchange.  No  extension  was  ever  employed.  At  the  end  of  four  months  he  begau  to  walk  about  with  crutches. 


352  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

CASE  498. — Lieutenant  J.  Davis,  Co.  G,  73d  Ohio,  aged  35  years,  was  wounded  at  New  Hope  Church,  May  25,  1864, 
and  admitted  to  the  field  hospital  of  the  2d  division,  Twentieth  Corps.  One  week  after  receiving  the  injury  the  patient  was 
moved  to  Chattanooga,  where  the  wound  is  described  as  an  "injury  to  the  trochanter  major."  He  was  subsequently  sent  to  the 
Officers'  Hospital  at  Nashville,  whence  he  proceeded  to  his  home  on  leave  of  absence,  August  10th.  He  was  mustered  out  of 
service  May  5,  1865,  and  pensioned.  Examiner  O.  J.  Phelps,  of  Piketon,  Ohio,  certified,  July  25,  1865:  "The  ball  entered  at 
the  groin,  passed  through,  shattering  the  trochanter  major,  and  as  yet  rendering  the  limb  entirely  useless.  It  is  still  unhealed." 
Examiner  J.  Arnold,  of  Waverly,  December  12,  1871,  stated:  "The  hip  joint  is  rendered  entirely  useless.  There  are  two 
ulcerating  sores  that  discharge  very  much  all  the  time,  and  small  pieces  of  bone  are  taken  out.  Has  to  use  crutches  to  get 
about."  Examiner  W.  Scat-lock  found  no  improvement  in  the  pensioner's  condition  in  September,  1873,  and  reported,  two  years 
later:  "One  running  sore  still  exists  on  the  outer  side,  over  the  great  trochanter.  There  are  four  tender  cicatrices  that  have 
recently  healed,  two  on  the  inner  and  two  on  the  posterior  side,  ranging  from  four  to  six  inches  below  the  original  wound.  The 
limb  is  lengthened  some  three  inches,  and  its  movements  are  painful  and  limited.  The  wound  still  requires  dressing  once  or 
twice  a  day."  At  a  subsequent  examination,  in  1877,  the  limb  was  still  found  to  be  in  the  same  condition,  lengthened,  etc.,  and 
the  pensioner  was  reported  as  wholly  unfit  for  any  occupation  requiring  manual  labor.  The  pensioner  was  paid  Sept.  4,  1879. 

The  side  of  the  injury  was  recorded  in  three  thousand  and  thirty-six  instances;  four 
teen  hundred  and  thirty-one  were  on  the  right,  and  sixteen  hundred  and  five  on  the  left 
side.  Of  the  former,  six  hundred  and  sixty-one,  or  46.1  per  cent.,  and  of  the  latter  seven 
hundred  and  forty-three,  or  46.2  per  cent., -were  fatal.  Here,  as  well  as  in  the  cases  of  shot 
injuries  of  the  shoulder  joint  and  arm  (Second  Surgical  Volume,  pp.  610,  806),  the  left 
extremity  seemed  to  have  been  most  frequently  interested;  but  here,  also,  the  number  of 
cases  in  which  this  point  could  not  be  ascertained  (four  hundred  and  thirty-one)  prohibited 
definite  conclusions  on  this  subject.  In  two  hundred  and  eighty-four  cases  the  fractures  of 
the  femur  were  accompanied  by  lesions  of  other  portions  of  the  body:  fractures  of  the  bones 
of  the  head  in  nine  instances,  penetrating  wounds  of  the  chest  in  five,  penetrating  wounds 
of  the  abdomen  in  three,  fractures  of  the  pelvic  bones  in  thirteen,  fractures  of  the  upper 
extremities  in  thirty-three,  fractures  of  the  opposite  lower  extremity  in  twenty-five,  and  in 
one  hundred  and  ninety-six  instances  the  fractures  of  the  femur  were  accompanied  by  shot 
flesh  wounds  of  the  upper  or  lower  extremities.  Pyaemia  was  noted  in  one  hundred  and  fifty- 
one  instances  with  one  hundred  and  forty-seven  deaths;  tetanus  in  eighteen  with  seventeen 
deaths;  gangrene  in  fifty-three  with  thirty-two  deaths;  erysipelas  in  forty-six  with  twenty- 
six  deaths;  and  haemorrhage  in  one  hundred  and  thirty-three  with  one  hundred  and  eighteen 
deaths.  The  external  iliac  artery  was  unsuccessfully  ligated  in  one  instance: 

CASE  499. — Private  M.  Teel,  Co.  C,  73d  Indiana,  was  wounded  through  the  upper  third  of  the  right  thigh,  at  Stone 
River,  December  31,  1862.  Assistant  Surgeon  F.  L.  Town,  U.  S.  A.,  reported  that  the  wounded  man  was  admitted  into  hospital 
No.  4,  Nashville,  six  days  after  receiving  the  injury,  where,  by  reason  of  secondary  haemorrhage,  the  external  iliac  had  to  be 
ligated,  resulting  fatally  on  January  19,  1863;  also  that  the  severity  of  the  original  injury  was  sufficient  to  produce  death. 

The  femoral  artery  was  ligated  in  twenty-one  instances,  of  which  two  proved  success 
ful.  Socin1  has  remarked  that  in  a  shot  fracture  of  the  femur  "accompanied  by  an  injury 
of  the  artery  alone,  conservation  might  yet  be  attempted  after  an  utmost  early  ligation;" 
but  a  most  careful  examination  of  all  the  cases  of  shot  fractures  of  the  femur  treated  by 
conservation  during  the  American  civil  war  has  failed  to  disclose  a  single  instance  of  recov 
ery  after  fracture  of  the  femur  accompanied  by  an  unquestionable  primary  lesion  of  the 
femoral  artery.  In  the  following  instance  the  femur  had  been  fractured  and  the  femoral 
artery  severed  by  a  mini^  ball;  the  artery  was  promptly  ligated.  The  patient  survived 
nine  months  and  eleven  days,  but  finally  perished  from  the  effects  of  the  "injury: 

On  measuring  I  found  this  limb  lengthened  half  an  inch,  and  this  measurement  was  confirmed  by  Surgeon  TAYLOR  and  others.  There  was  no  anchylosis 
at  the  knee  joint."  Professor  HAMILTON  must  have  been  mistaken  as  to  the  name  of  the  patient.  The  name  of  Melchior  Bridtel  is  not  borne  on  the  rolls 
of  the  12th  New  York  Volunteers.  A  private,  Melchior  Breitel,  I,  12th  New  Jersey  Volunteers,  wounded  at  Chancellorevillo,  Virginia,  May  :!,  1803,  was 
admitted  to  the  Newark  U.  S.  A.  General  Hospital  with  a  gunshot  wound  of  the  thorax  and  the  left  arm,  September  !),  18b':i.  lit:  was  discharged  March 
••.'8,  1864,  and  has  been  a  pensioner  since.  The  records  of  the  Newark  hospital,  as  well  as  the  soldier's  certificate  of  disability,  and  the  certificates  of  two 
pension  examining  surgeons,  agree  in  the  diagnosis:  "Gunshot  wound  of  chest  and  left  arm,"  but  no  mention  is  made  of  a  shot  fracture  of  the  femur  or 
its  treatment,  and  Professor  HAMILTON  himself,  in  his  Lectures  on  Gunshot  Injuries  of  the  Chest,  in  American  Medical  Times,  1864,  Vol.  VIII,  p.  182, 
cites  the  case  as  an  example  of  perforating  wound  of  the  lung  followed  by  empyema,  without  mentioning  an  injury  of  the  femur. 
1  SOCIN  (A.),  Kriegschirvryischc  Frfahrunyen,  Leipzig,  187v>,  p.  lv!8. 


SECT.  III.] 


SHOT    INJUR1KS    OF    THK    FEMUR. 


353 


CASE  HOO. — Private  B.  M.  Dunn.  Co.  D,  1st  Louisiana,  was  wounded  in  the  right  thigh,  at  Gettysburg,  July  2,  1863, 
and  admitted  into  Camp  Letterman  four  weeks  after  the  injury.  Assistant  Surgeon  W.  F.  Richardson,  C.  S.  A.,  reported:  "He 
was  wounded  by  a  minie  ball,  which  entered  at  the  inner  anterior  portion  of  the  thigh  about  the  middle  third,  and  made  its  exit 
at  the  posterior  and  outer  portion,  severing  the  femoral  artery  and  fracturing  the  femur  in  its  course.  The  femoral  artery  was 
ligated  in  Scarpa's  space  on  the  day  of  the  injury.  When  admitted  in  my  ward  the  patient  was  suffering  intolerable  pain, 
occasioned  by  moving  him  four  miles  in  an  ambulance  over  a  rough  road,  without  splints,  sand-bags,  bandages,  or  any  other 
appliance  to  the  limb,  and  with  the  ends  of  the  bones  overlapping  each  other.  I  administered  chloroform  and  placed  the  bones 
in  apposition,  attaching  a  twenty-pound  weight  to  the  leg.  Three  days  afterwards  I  reduced  the  weight  to  ten  pounds,  and  on 
August  8th  Smith's  anterior  splints  were  applied.  One  ounce  of  whiskey  was  given  three  times  a  day.  The  patient  improved 
under  the  treatment  adopted.  On  August  Kith,  the  splint  was  readjusted,  and  again  on  September  1st,  when  the  wound  was 
found  to  look  well  and  healthy  and  to  be  still  discharging  laudable  pus.  After  this,  tincture  of  iron  in  doses  of  fifteen  drops  was 
given  in  addition  to  the  whiskey,  and  on  September  6th  the  ligature  was  removed.  On  September  8th,  the  patient  complained 
of  sharp  shooting  pains  around  the  wound,  extending  downward  to  the  knee;  he  was  placed  under  chloroform,  and  an  incision 
one  and  a  half  inches  long  was  made  behind  the  exit  wound,  through  which  four  or  five  small  pieces  and  one  large  piece  of  bone 
were  removed.  Considerable  haemorrhage  ensuing,  persulphate  of  iron  was  injected  in  the  wound,  after  which  the  leg  Avas  again 
placed  in  a  splint.  By  September  l'2th.  the  patient  was  again  improving.  On  October  10th,  the  wound  was  still  discharging 
freely,  and  the  thigh  was  much  swollen  and  very  painful.  The  patient  was  also  suffering  from  a  rather  troublesome  diarrhoea. 
On  November  10th,  when  he  was  transferred  to  Baltimore,  his  wound  was  still  suppurating  freely,  but  his  general  health  was 
improving  and  union  of  the  fractured  bone  was  firm,  so  that  he  could  bear  about  one-twelfth  of  his  weight  on  the  injured  limb." 
In  Baltimore,  the  patient  was  admitted  to  West's  Buildings  Hospital,  and  two  months  later  he  was  transferred  to  Point  Look 
out.  Surgeon  A.  Heger.  V.  S.  A.,  in  charge  of  the  latter  hospital,  reported  that  the  man  died,  from  the  effects  of  the  fracture  of 
the  femur,  April  13,  1864. 

TABLE  XLIX. 

Nummary  of  Twenty-one  legations  of  the  Femoral  Artery  in  Cases  of  Shot  Fractures  of  the  Femur 

treated  by  Conservation. 


No. 

NAME.  MILITARY 
DESCRIPTION,  AND  AI;K. 

DATE  AND  DESCRIPTION 
OF  INJURY.                         ±iJEW 

LIGATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Union  Lieutenant. 

Comminuted  fracture  upper    Femoral  artery  sloughed. 

Ligation  of  femoral  artery. 

Complete  recovery.  Exch'd. 

third  of  fem  ur.    Harrisburg. 

C.S.A.Med.and  Surg.Jour., 

Miss.,  July  14,  18C4 

Jan.,  1865,  Vol.  II,  p.  9. 

2 

Smith    F.  A.   Pt.  G   4th 

Conoidal  ball  fract're  of  lower 

Ligation  of  femoral  . 

Exchanged  April  27,  1864. 

Alabama,  age  24. 

third  of  left  femur.    Gettys 

burg,  July  2.  1863. 

3 

Wright,  M.,  Pt..  F.  25th 

Conoidal  ball  fractured  por-  :  Suppuration     fetid;     severe 

January  2,  1865,  ligation  of 

Incision    healed  :     ligatures 

Indiana,  age  18. 

tion  of  external  condyle  of      haemorrhage  from  vessels  in 

femoral    artery  ;     Scarpa's 

came  away  on  January  14. 

right  femur  and  passed  thro'       neighborhood   of   popliteal 

triangle,   by   Acting   Ass't       Discharged   July  8,    1865. 

popliteal  space.    Savannah.       (-pace  ;  controlled  tempora- 

Surgeon  E.  L.  Mola.                  V.  S.  San.  Com.  Memoirs, 

Dec.  11.  1864. 

rily  by  plugging. 

Surg.  Vol.  I.  p.  263. 

4 

Urixjl.'s.  A.  M.,  Lieut..  A. 

Pistol  ball  fracture  of  lower 

April  17,  haemorrhage  caused 

April  17,  ligation  of  femoral    Died  April  20.  '65.  Post-mor- 

26th  Virginia. 

third  right  femur.     Burks- 

by  a  sharp  spicula  of  bone 

artery  below  origin  of  pro-       tern.  :  ant.  wall  of  artery  had 

ville,  April  6.  1865. 

piercingthe  popliteal  art  "ry. 

funda.                                          sloughed  §ths  of  an  inch. 

A.M.M..  Specs.  4084.  4085. 

5 

Campbell.  J.  W.,  Pt..  A. 

Conoidal  ball  fracture  of  up 

August  13,  haem.  amounting 

Augnst  13,  ligation  of  fem 

Haem.  did  not  recur,  but  pa- 

17th  Virginia,  age  23. 

per  middle  and  lower  thirds 

to  60  ounces  from  femoral. 

oral  artery  in  continuity  in       tient  died  of  exhaustion  from 

<;f  femur.     August  4,  1864. 

Scarpa's  space.                       '     loss  of  blood,  Aug.  13,  '64. 

6 

Campbell,     S.,    Pt.,    H. 

Conoidal   ball  fractured  up 

J  une  10.  haem.  8  oz.;  profunda 

June  13,  ligature  around  the    Died  June  13,  1864  ;  asthenia. 

140th  Penn..  age  30. 

per  third  right  femur,  also       ligated  and  ligature  placed 

femoral  artery  by  Assistant 

A.  31.  M.,  Spec.  3557. 

wound  of  the  left  thigh,  etc. 

under  the   femoral.     June 

Surg.  W.  Thomson,  U.S.A. 

May  29,  1864.                              13.  hapm.  recurred,  2  oz. 

7 

Cox,  T.  C..  Pt.,  G.  88th 

Conoidal    ball    comminuted    January  9.  1863,  severe  h»m- 

January  10,  ligation  of  fem 

Died  Jan.  10,  1863;  autopsy; 

New  York. 

fracture  of  upper  third  of 

orrhage.  controlled  by  cold 

oral  artery  by  Acting  Ass't 

arten-  torn  for  an  inch  or 

left  femur.  Fredericksburg, 

water  and  compress.     Jan 

Surgeon  R.  Carroll.                   more,  apparently  by  slough 

Dec.  13,  IE  32. 

uary  10,  recurred. 

ing. 

8 

Coder,  D..Corp'l,  F,  16th 

Shot   entering    immediately 

June  8,  haemorrhage  amount 

June  9,   ligation  of  femoral    Died  June  10,  1864;  exhaus- 

Pennsylvania  Cavalry, 

over  femoral  artery,   right 

ing  to  5  oz.  from  femoral. 

artery  below  profunda  by 

tion  and  gangrene;  autopsy. 

age  23'. 

thigh,  splintering  trochan- 

June  9,  haemorrhage  recur-       Ass't   Surgeon   W.  Thorn- 

ter  minor.     Hanover  C.  H., 

red,  8  ounces.                              son,  U.  S.  A. 

May  28.  1864. 

!l 

Detweiler,  C..  Pt..  A,47th 

Conoidal  ball  wound  of  left 

Extensive  sloughing  March     March   10,  1865,  ligation   of 

Died  March  10,  '65;  exhaus 

Pennsylvania,  age  24. 

thigh,  injuring  femur  in  the 

5,  1865-  haem.  8  ounces  from       femoral  artery  in  continuity 

tion.     A.  M.  M.,  Spec.  1357. 

middle  third.   Cedar  Creek,       branch  ot  ext.  circumflex:       in    Scarpa's    triangle,   one 

Oct.  19,  1864.                          <     lig.  of  profunda.     March  9,       inch   below  origin  of  pro- 

femoral  sloughed  ;  haemor 

funda,   by  A.  A.  Surgeon 

rhage  20  oz. 

W.  P.  Moon. 

10 

Dunn,  B.  M.,  Pt.,  D,  1st 

Conoidal  ball  severing  fem-  '                                                        I  July  2    libation  of  the  fem-    Sept.  6,  ligature  rem'd  ;  con- 

Louisiana. 

oral  artery  and  fracturing                                                           oriil  in  Scarpa's  triangle.           siderable  haem.,  arrested  by 

middle  third  of  right  femur. 

persulp.  iron.     Died  April 

Gettysburg.  July  2,  1863.                                                                                                                        13,  1864. 

11 

Floyd,  J.,  Serg't  Major, 

Conoidal    ball    comminuted    June    19,    neighborhood    of    June  19,  ligation  of  femoral    June  20,  21,  bleeding  recur'd. 

13th  PennsvvaniaCav.. 

fracture  upper  third  of  left       wound  much  disorganized;  j     in     continuity   just    below       Died  June  25.  1864  ;  hasm- 

age  32. 

femur.     May  28.  1864.          :     haemorrhage  from  profunda,  1     Poupart's  ligament  by  Act.       orrhage. 

30  ounces.                               •     Ass't  Surg.  J.  Newcombe.  1 

12 

Freeman,  A.,  Pt.,  II,  61st 

Partial  fracture  in  the  upper  j  Nov.  3.  profuse  haemorrhage    Novembers,  ligation  of  fem-    Died  November  24.  1862;  ex- 

New  York,  age  19. 

third  of  the  left  femur  by       from  femoral  artery. 

oral  artery.                                  haustive  suppuration.     A. 

conoidal    hall.       Antictam. 

M.  M.,  Spec.  740. 

Sept.  17,  1862. 

13 

Geitz,    H.,    Pt.,   C,    15th 

Conoidal  ball  fracture  right     May   29,    haemorrhage   from     May  30,   ligation  of  femoral 

June  7,  hajm.  recurred.  Died 

New  York  Heavy  Artil 

thigh.     May  18.  1864. 

profunda  artery. 

artery  in  continuity  bv  Sur-      June  8,  1864. 

lery,  age  26. 

geon'D.  W.  Bliss.'U/S.  V. 

14 

Harper,  J..  Pt.,  H,   Kith 

Shot  fracture  of  right  thigh. 

Ligation  of  femoral  artery. 

Died  February  14,  1863. 

Infantry. 

Stone  River,  Dec.  31,  1862. 

SUKG.  Ill— 45 


354 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  AND  DESCRIPTION 
OF  INJURY. 

H^MOKRHAUK. 

LlGATTON   AND  OPERATOR. 

RESULT  AND  REMARKS. 

15 

16 
17 
1R 

Johnson,  V.,  Pt.,  I.  13th 
Indiana,  age  22. 

Kelly,  J.  A.,   I.ienl..   C.. 
9th  Missouri. 
Parker.   J.,    Corp'l.    H. 
58th  Mass..  age  38. 
Root,  J.  L..  Pt..  H.  77th 

Conoidal  ball  fracture  upper 
third    of   left    thigh    (also 
wound  right).    Petersburg. 
May  9,  1864. 
Shot  fracture  upper  third  left 
femur.     July  4,  1863. 
Conoidal  ball  fracture  of  mid 
dle  third  of  the  left  femur. 
Conoidal  ball  fracturo,  splin 

May  19.   haemorrhage   from 
profunda  ;  ligated  in  contin 
uity;   hsem.  recurred   May 
22;  26  ounces. 
July  12,  13,  haemorrhage,  7 
ounces,  from  profunda. 
Haemorrhage. 

May  2V1,  ligation  of  femoral 
artery  above  profunda. 

July  13,  ligation  of  the  fem 
oral  artery. 
June  27,  ligation  of  femoral 
artery. 
October  19.  ligation   of  the 

May  24.   haemorrhage  recur 
red.     Died  May  26,  1864. 

Died  July  13,  1863. 
Died  July  2,  1864. 
Died  November  1,  1864. 

19 
90 

New  York,  ago  —  . 

Sexton,   J.   31.,   Pt.,    A, 
4th   Virginia   Cavalry, 
age  22. 

Smith,  D.  R.   Pt.   I.  93d 

tering   left    thigh.      Cedar 
Creek.  Oct.  19,  1864. 
Conoidal    ball    comminuted 
fracture  mid.  thirdjof  right 
femur.     Monocacv,  July  9, 
1864. 

August    5.    femoral     artery 
sloughed  ;  haemorrhage   10 
ounces. 

femoral  artery. 

August  5,  ligation  femoral  in 
continuity  below  profunda, 
above  wound,  by  Act.  Ass't 
Surgeon  J.  H.  Coover. 
November,  1863.  ligation  of 

Aug.  6,  haem.recur'd,  12  oz.; 
ligation  of  profunda.    Died 
from  exhaustion  and  loss  of 
blood.    .4.JO/.,.Vpec.3971. 
Died  December  5,  1863. 

21 

Illinois. 

Walter,  V.,  Pt..  E,  8th 
Ohio,  age  24. 

femur.    Mission  Ridge,  No 
vember  25,  1863. 
Conoidal  ball  fracture  upper 
third  of  right  femur.   Spott- 
sylvania.  May  10,  1864. 

June  7.  hemorrhage,  16  07.  , 
from  femoral  artery. 

femoral  art'y  bv  Ass't  Surg. 
J.  S.  Prout,  26th  Missouri. 
June  9,  ligation  of  femoral 
artery  above  profunda. 

Died  June  17,  1864. 

The  profunda  was  successfully  tied  in  one  case,  and  the  circumflex  of  profunda  and 
the  popliteal  arteries1  were  unsuccessfully  ligated  in  one  instance  each.  In  one  case  it  is 
stated  that  the  femoral  vein  was  successfully  ligated  on  the  day  of  the  injury;  but  unfortu 
nately  neither  the  records  of  the  field  hospital  nor  of  the  Columbian  Hospital  at  Washing 
ton,  where  the  patient  was  treated  during  the  first  five  months  after  the  injury,  allude  to 
the  ligation  of  the  femoral  vein,  and  not  until  the  soldier  reached  the  hospital  at  Madison, 
Wisconsin,  is  the  operation,  said  to  have  been  performed  on  the  field,  mentioned,  probably 
upon  the  patient's  own  statement.  A  brief  account  of  the  case  is  appended : 

CASE  501. — Corporal  G.  Bulman,  Co.  G,  36th  Wisconsin,  aged  22  years,  was  wounded  through  the  upper  third  of  the 
left  thigh,  at  Hatcher's  Run,  October  27,  1864.  He  was  sent  from  the  field  to  Columbian  Hospital,  Washington,  several  days 
after  the  injury,  and  five  months  later  he  was  transferred  to  Harvey  Hospital,  Madison.  Surgeon  H.  Culbertson,  U.  S.  V.,  in 
charge  of  the  latter,  reported  that  the  femur  was  fractured  by  the  missile,  and  that  the  femoral  vein  had  been  ligated  on  the  day 
of  the  injury.  The  patient  was  discharged  from  service  May  22,  1865,  and  pensioned.  Examiner  W.  II.  Walker,  of  Fond  du 
Lac,  certified,  August  11,  1865 :  "  He  was  woimded  by  a  ball  through  the  upper  third  of  the  thigh  from  without  inward,  frac 
turing  the  femur.  The  muscles  are  adherent  and  the  thigh  is  diminished  in  circumference  two  and  a  half  inches.  The  circula 
tion  of  the  limb  is  much  impeded  from  extensive  loss  and  induration  of  the  soft  parts  from  hospital  gangrene."  Several  years 
after  the  same  examiner  reported  "deep  and  extensive  varices  and  ulceration  on  the  outer  aspect  of  the  calf  from  the  obstruc 
tion  of  the  circulation  of  the  limb.  The  pensioner  was  paid  December  4,  1879. 

A  fatal  instance  of  ligation  of  the  femoral  vein  and  the  profunda  artery  for  secondary 
haemorrhage  is  reported  by  Acting  Assistant  Surgeon  T.  J.  Dunott: 

CASE  502. — Private  E.  Gilkey,  Co.  C,  17th  Maine,  age  27  years,  was  wounded  at  Petersburg,  June  18, 1864,  and  admitted 
into  Campbell  Hospital,  Washington,  ten  days  afterwards.  Surgeon  A.  F.  Sheldon,  U.  S.  V.,  reported  :  "Shot  fracture  of  upper 
third  of  right  femur.  Haemorrhage  to  the  amount  of  twelve  ounces  occurred  on  July  5th,  when  the  femoral  vein  and  the  pro 
funda  artery  were  ligated,  the  ligature  of  the  former  being  applied  at  the  seat  of  the  injury.  Haemorrhage  recurred  on  July  7, 
1864,  when  the  case  resulted  fatally." 

Among  the  three  thousand  four  hundred  and  sixty-seven  cases  of  shot  fracture  of  the 
femur  treated  by  conservation  referred  to  in  this  Section,  were  two  thousand  eight  hundred 
and  thirty-nine  Union  and  six  hundred  and  twenty-eight  Confederate  cases.  The  ratio  of 

1  Surgeon  G.  M.  B.  MAUGHS,  P.  A.  C.  S.  (Conservative  Treatment  of  Compound  Comminuted  Fracture  of  the  Femur,  with  Cases,  in  Confederate 
States  Sled,  and  £urg.  Jour.,  1865,  Vol.  II,  p.  9),  reports  that  Private  W.  T.  Ivy,  19th  Mississippi  Cavalry,  aged  40,  was  wounded  at  Harrisburg,  July  M, 
1864;  compound  comminuted  fracture  of  femur,  upper  third;  ligation  of  arteria  profunda;  treated  by  position;  union  complete;  shortened  one  inch. 
Acting  Assistant  Surgeon  T.  J.  DUNOTT  reports  that  Private  E.  H.  Gibson,  Co.  A,  14th  New  Jersey,  aged  15,  was  wounded  at  Monocaoy,  July  9,  1864. 
A  conical  ball  perforated  the  right  thigh  in  the  upper  third,  on  the  anterior  aspect,  fractured  the  femur  without  producing  much  comminution,  and  emerged 
near  the  anus.  The  patient  was  admitted  into  the  hospital  at  Frederick,  and,  on  July  13th,  the  limb  was  placed  upon  a  double-inclined  plane.  On  July 
19th,  haemorrhage  set  in,  a  large  and  continuous  stream  flowing  out  of  the  anterior  wound.  Dr.  Dl'NOTT  immediately  enlarged  the  wound  and  tied  the 
circumflex  of  the  profunda  above  and  below;  on  July  20th,  violent  ha?morrhage  occurred  from  the  wound.  Compression  was  made  at  once,  and  a  plug 
of  lint  introduced.  A  hot-air  bath  was  ordered  and  stimulants  given,  but  the  patient  died  July  19,  1864,  two  hours  after  the  recurrence  of  the  haemorrhage. 
Surgeon  R.  NlCOl.1,6.  U.  S.  V..  reports  that  Private  C.  A.  Knight,  Co.  L.  2d  Illinois  Cavalry,  aged  24,  was  accidentally  wounded  at  Sikeston,  Missouri, 
May  4,  1862,  by  a  pistol  ball,  which  fractured  the  left  femur  three  inches  above  its  lower  extremity.  He  was  admitted  into  the  hospital  at  Quincy  on 
May  10th,  and  the  popliteal  artery,  which  was  wounded,  was  ligated  above  and  below  the  wound.  BUCK'S  apparatus  was  applied.  The  ligatures  came 
away  on  the  fourteenth  day.  The  wound  of  operation  had  nearly  closed  by  the  latter  part  of  August,  but  the  patient  was  reduced  by  diarrhoaa  and  died 
September  29,  1862. 


SECT.  III.] 


SHOT    INJURIES    OF    THE    FEMUR. 


355 


mortality  of  the  completed  cases  was  51.1  per  cent,  on  the  Union,  and  44.0  per  cent,  on  the 
Confederate  side,  as  exhibited  in  the  following  table: 

TABLE  L. 

Numerical  Statement  of  Union  and  Confederate  Soldiers  treated  by  Conservation  after  Shot  Fracture 

of  the  Femur. 


POINT  OF  FRACTURE. 

TOTAL  CASES. 

UXION  SOLDIERS. 

CONFEDERATE  SOLDIERS. 

Cases. 

Recoveries. 

Deaths. 

Unde 
termined. 

Ratio  of 
Mortality  of 
Determined 
Cases. 

Cases. 

Recoveries. 

Deaths. 

Unde 
termined. 

Ratio  of 
Mortality  of 
Determined 
Cases. 

Fracture  of  Upper  Third  

1,254 
855 
620 
738 

1,036 
699 
502 
002 

531 
421 
304 
85 

480 
274 
192 
480 

5 
4 
b' 
37 

46.5 
39.4 
38.7 
84.9- 

218 
156 
118 
136 

118 
79 
71 
60 

92 
68 
40 

58 

8 
9 
7 
18 

43.8 
46.2 
36.0 
49.1 

Fracture  of  Middle  Third  

Fracture  of  Lower  Third  

3,467 

2,  839 

1,  361 

1,426 

52 

51.1 

628 

328 

258 

4-2 

44.0 

The  rate  of  fatality  among  the  Confederates  as  exhibited  in  this  table  is  remarkably 
low;  but  it  must  be  taken  into  consideration  that  in  the  enumeration  of  the  Union  cases, 
made  up  to  a  large  extent  from  the  casualty  lists  of  the  various  corps,  are  included  even 
those  patients  who  died  within  the  first,  few  hours  after  the  reception  of  the  injury,  before 
means  of  transportation  could  reach  them,  while  the  Confederate  cases  of  a  similar  nature 
do  not  appear  in  these  statistics.1 

Excisions  in  the  /Shaft  of  the  Femur. — Although  the  number  of  excisions  in  the  shaft 
of  the  femur  practised  was  comparatively  large,  little  need  be  said  about  the  operation, 
which,  as  already  stated,  was  generally  considered  with  disfavor  by  the  American  surgeons, 
and  frequently  those  who  had  practised  it  became  its  strongest  opponents.2 

Amputations  in  the  Thigh. — While  the  experience  acquired  during  the  War  of  the 
Rebellion  indicates  that  the  attempts  to  save  the  limb  after  shot  fractures  of  the  femur 
have,  in  many  instances,  met  with  favorable  results,  there  are  a  large  number  of  cases  in 
which  primary  amputation  remains  the  only  alternative.  When  the  fracture  of  the  femur 
is  accompanied  by  great  comminution,  or  by  extensive  longitudinal  fissuring,  or  by  grave 
laceration  of  the  soft  parts,  or  by  primary  injury  of  the  femoral  artery  or  vein,  the  limb 
should  be  removed  at  once.  Furthermore,  the  crowded  condition  of  the  field  hospitals 
after  large  engagements,  the  infectious  diseases  likely  to  arise,  the  scarcity,  and  sometimes 

1  In  the  Confederate  Sttites  Medical  and  Surgical  Journal,  Richmond,  June,  1864,  Vol.  I,  p.  89,  wiil  be  found  a  consolidated  statement  of  compound 
fractures  of  the  femur  treated  without  operation,  compiled  from  the  records  of  the  Confederate  .Surgeon  General's  Office  from  June,  1862,  to  February  1, 
1864,  inclusive.     The  total  number  of  cases  treated  was  221,  of  which  116  recovered,  and  105  or  47.5  per  cent.,  had  a  fatal  termination. 

2  Surgeon  C.  A.  COWGILL,  U.  S.  V.,  who  excised  a  portion  of  the  shaft  of  the  femur  in  the  case  of  Private  I.  W.  Hall,  92d  New  York  (TABLE 
XXVI,  No.  17,  p.  2iO,  ante),  writes,  in  a  letter  to  the  editor  dated  Dover,  Delaware,  July  12,  1866:  "The  result  of  this  case  determined  me  never  to 
attempt  again  to  save  a  femur  fractured  by  a  gunshot  wound  by  excising  any  portion  of  its  continuity.     The  extraction  of  fragments  almost  entirely 
detached  and  displaced  is  all  that  I  would  do  in  a  similar  case.     In  severe  injuries  where  there  is  no  hope  of  saving  the  limb,  the  fracture  involving  the 
\ipper  third,  I  would  prefer  waiting  for  some  weeks  until  all  primary  irritation  had  subsided,  and  a  degree  of  tolerance  acquired  by  the  system,  and  then 
amputate,  believing  that  secondary  amputations  are  more  frequently  followed  by  successful  results  when  performed  in  the  upper  third  of  the  femur  than 


excisions  of  the  contin- 


a«n  inuiana,  wno  excised  in  me  cases  01  i-nvaio  \\isninirc.  ~'/m  inaiana  (i  AISLE  AAiv,  r<o.  ui,  p.  xvo,  aniei,  aim  i-nvaie  »  115011,  1.0111  ^>e»  uciai^ 
(TAiiLE  XXV,  No.  9,  p.  208,  ante),  in  a  letter  to  the  Surgeon  General  dated  July  27,  1866,  advises  primary  amputation  rather  than  excision,  providing  the 
patient  is  able  to  bear  up  under  the  shock  of  the  amputation,  and  remarks:  ''I  am  therefore  opposed  to  excision  of  the  shaft  of  the  femur  unless  the 
exigencies  of  the  case  demand  it."  Surgeon  A.  .1.  I'UKI.rs,  U.  S.  V.,  in  his  Report  of  the  Operations  of  the  Medical  Department  of  the  Left  Wing  of  the 
Fourteenth  Corps  at  the  Battle  of  Murfrcesboro  ,  in  Appended  Documents  to  Part  /,  Vol.  I,  Med.  and  Sury.  History  of  the  War  of  the  Rebellion.  Wash 
ington,  1870,  p.  260,  says:  "I  consider  exsectious  in  the  case  of  the  shaft  of  the  femur  should  very  generally  give  way  to  amputation.'1 


356  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

entire  want,  of  surgical  appliances  to  make  the  patient  with  a  fractured  thigh  bone  com 
fortable,  the  rough  transportation  to  which  the  wounded  man  is  liable  to  be  exposed,  are 
circumstances  which  will  sometimes  urge  the  military  surgeon  to  forego  all  conservative 
inclination  and  prefer  to  sacrifice  the  limb  rather  than  to  expose  the;  patient  to  the  risks 
attending  the  attempts  at  preservation.  Here,  as  well  as  in  all  questions  of  surgical  inter 
ference,  medical  officers  in  the  field  will  always  be  guided  by  the  circumstances  surrounding 
each  case. 

The  modes  of  operating  employed  were  the  flap  method1  and  its  various  modifications— 
the  anterior,  posterior,  aritero-posterior,  and  lateral  flaps — in  one  thousand  one  hundred 
and  forty-one,  the  circular  method  in  eight  hundred  and  sixty-three,  the  oval  flap  with 
circular  division  of  muscles  in  one  hundred  and  eight  instances;  but  it  is  difficult  to  draw 
correct  conclusions  from  the  recorded  cases  regarding  the  value  of  the  modes  practised. 
Surgeon  E.  Batwell,2  14th  Michigan  Volunteers,  observes:  "The  sort  of  operations  per 
formed  is  worthy  of  comment,  and  has  been  very  closely  watched,  to  try  and  give  a  prefer 
ence  to  either  circular  or  flap  operations,  based  on  observations  as  to  their  relative  merits  as 
far  as  healing  was  concerned;  but  no  difference  was  discernible,  except  in  lateral  flaps, 
where  the  protrusion  of  the  bone  through  the  incision  prevented  the  rapid  union  that  took 
place  in  the  antero-posterior  ones.  The  only  cases  in  which  the  healing  process  seemed 
retarded  were  those  in  which  the  operation  urged  by  Malgaigne  was  performed — oval  flaps 
with  circular  division  of  muscular  tissue.  The  chief  points  in  which  they  seemed  to  be 
deficient  was  the  small  anterior  flap  being  unable  to  support  the  weight  of  the  posterior- 
larger  one.  This  again  granulated  very  freely,  and  thereby  prevented  approximation  of  the 
edges,  and  a  large  granulating  surface  was  the  result,  instead  of  the  nicely  adjusted  linear 
mark  observable  in  either  the  flap  or  circular  operations.  From  the  observations  made  on 
the  subject,  I  would  urge  that  no  modifications  are  worthy  of  being  noticed  by  surgeons, 
and  that  the  circular  or  flap  operations  amply  fulfil  all  the  requirements  necessary."  The 
Army  Medical  Museum  possesses  seventy-nine  casts  of  stumps  after  amputations  in  the 
femur,  six  of  which  are  shown  in  the  accompanying  plate  (PLATE  LXXIIi).  FIGURES  1, 
2,  3,  and  5  represent  stumps  after  the  anterior,  posterior,  antero-posterior,  and  lateral  flap 
methods,  FIGURE  4,  after  the  circular  method,  and  FIGURE  6,  after  an  operation  by  the  flap 
of  skin  and  circular  division  of  muscles  method.  An  amputation  after  the  method  of 
Gritti,3  of  Milan,  is  reported  by  Surgeon  W.  Child,4  5th  New  Hampshire  Volunteers,  to 

'Surgeon  A.  J.  1'HELPS,  U.  S.  V.,  in  his  Report  of  the  Operations  of  the  Medical  Department  of  the  Left  Wing  of  the  Fourteenth  Corps,  at  the 
Battle  of  Murfreesboro' ,  remarks:  ''  The  method  of  amputation  employed  was,  very  generally,  the  flap.  Those  eases  of  flap  operation,  however,  that 
approached  nearest  to  the  circular  method  f'.id  best,  and  I  have  thought  that  our  success  would  be  greater  if  the  circular  method  was  adopted  more  gen 
erally.  The  only  hope  we  have  of  an  entire  success  is  union  by  the  first  intention  in  the  flap  operation,  and  this  depends  upon  the  subsequent  attention 
of  the  surgeon.  We  can  seldom  expect  to  realize  it  while  we  have  to  depend  upon  inexperienced  nurses  for  dressers.  The  weight  of  an  unsupported  flap 
will  invariably  break  those  tender  bonds  of  union  that  nature  so  readily  attempts.  (Appended  Documents  to  Part  I,  Vol.  I,  of  the.  If  ml.  and  Surg.  llist. 
of  the  War,  Washington,  1870,  p.  262.) 

'Extract  from  a  Report  on  the  Surgical  Operations  performed  after  the  Engagement  at  Jonesboro' ,  Georgia,  in  Appended  Documents  to  1'art  I,  Vol. 
I,  of  the  Med.  and  Knrg.  Hist,  of  the  War,  Washington.  187(1,  p.  :i04. 

3K.  GlUTTI  (Dell  ainputazione  del  femore  al  terzo  inferiore  e  della  disarticolazione  del  ginocchio.  Valore  retativo  di  cadanna  coll'  indicazione  di 
tin  nuovo  metodo  tlenominato  amputazione  del  femore  ai  condili  con  tzmbo  patellare,  in  Annali  Universali  di  Mediciiia,  Milano,  1857,  Vol.  CLXI,  p.  5. 
This  operation  will  be  referred  to  in  the  succeeding  section. 

4CHILD  (W.),  (iUITTI'S  Sitpra-condyloid  Amputation  of  the  Thigh,  in  the  Huston,  Med.  and  S-urg.  Jour.,  1879,  Vol.  CI,  p.  78:!.  J)r.  CllIM)  says: 
"  After  the  battle  of  Antietam  (September  17.  18P2)  it  was  determined  to  establish  upon  that  battle-field  a  hospital  for  such  severe  cases  as  could  not  bo 
conveniently  removed  to  the  general  hospitals.  Dr.  BKllNAUli  VAXHKUKIEFI'.  I'nited  States  volunteer  surgeon,  was  detailed  surgeon  in  charge  of  this 
hospital.  Among  the  patients  was  a  soldier  with  an  amputation  of  the  right  leg.  After  some  weeks  it  was  found  that  the  leg  must  be  amputated  at  or 
above  tho  knee  joint.  ])r.  VAXnEKKIKFT  decided  to  amputate  at  the  knee  joint  by  "a  new  operation"  (as  lie  said),  and  the  operation  was  certainly  new 
to  his  associates  and  assistants.  He  made  a  circular  incision  from  the  internal  tuberosity  of  the  tibia  across  the  leg  below  the  patella  to  the  head  of  the 
fibula,  dissected  this  flap  up  to  about  the  middle  of  the  patella,  cut  through  the  ligamentum  patella  close  to  the  lower  border  of  the  bone,  arid  turned 
back  the  flap.  He  then  made  the  posterior  flap  by  passing  tho  knife  beneath  the  femur  and  cutting  outward  and  downward.  lie  then  sawed  through 
the  femur  just  above  (lie  condyles,  and  removed  a  section  from  the  posterior  or  internal  surface  of  the  patella  by  the  saw.  Next  he  adjusted  the  sawn 
surface  of  the  patella  to  the  sawn  extremity  of  the  femur  and  adjusted  the  Haps  in  the  usual  manner.  The  patient  died  in  about  sixteen  hours,  on  account 
of  previous  exhaustion." 


in-'-  Hi-!  «<<'  ihc  WarofthchV-hcllinji  ]';ii-l  III.Vol  II.Cliop  * 


Slump    jiCtcr    ;un|  >n  t  ,i  1  ti  c.  i    liv 
iiiili-ri)      )>DSli'ricir  Hiips     SJ-M-I-.    IHI7 


'-.     Stiintp    .illcr  .)ni|)ut.il  ion    I>v 
posii'l-ior  Clap.        SJHM-     117 

}.     Stump    Jil'lci1    :un|)ii  tnlioM    by 
rm-ular   l!a|>.       Sjiec-.  .'«V2^' 

C>.    Slump    ;il'tfi-    ;iniputution    liy     f]np  of  skin 
;ui(1  cifculrir   ol    iniis<'U'.S      Spec    '2.'U)(» 


SKCT.  III.] 


SHOT    INJURIES    OF    THE    FEMUR. 


357 


half  <>f 
nutated 

dyles. 


FIG.  220.— The  same 


have  been  performed  by  Surgeon  B.  A.  Vanderkieft,  U.  S.  V.,  who  was  in  charge  of  the 
Smoketown  Hospital  after  the  battle  of  Antietam,  September  17;  1862.  Another  operation 
of  this  character  was  performed  by  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  December 
16,  1862,  three  days  after  the  battle  of  Fredericksburg:1 

CASE  503.— Private  Grey  Y.  Barrett,  Co.  F,  5th  New  Hampshire,  aged  20 
years,  was  wounded  at  Fredericksburg,  December  13, 1862,  by  a  musket  ball,  which 
entered  at  the  outer  condyle  of  the  femur,  passed  inward  and  upward,  and,  escaping 
posteriorly  in  the  middle  of  the  lower  third  of  thigh,  left  the  bone  much  comminuted 
at  its  exit.  He  was  admitted  to  the  hospital  of  the  1st  division,  Ninth  Corps,  where, 
on  December  16th,  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  amputated  the 
femur  a  short  distance  above  the  wound  of  entrance,  the  patella  being  included  in  the 
anterior  Hap;  the  line  of  section  not  having  escaped  the  wound,  another  third  of  an 
inch  was  removed  (FiG.  219);  the  femoral  surface  of  the  patella  was  then  sawn  off, 
and  the  two  cut  surfaces  of  the  bone  were  brought  in  apposition  (FiG.  220).  The 
laminated  portion  of  the  femur,  however,  was  fractured  half  an  inch  above  this  point, 
and  fissures  extended  two  inches  further.  The  operation  was  well  borne,  and  the 
case  continued  to  do  well  until  the  sixth  day,  when  sloughing  commenced ;  on  the 
eighth,  signs  of  gangrene  were  noticed  ;  and,  on  the  ninth,  December  25th,  Surgeon 
J.  P.  Prince,  3Cth  Massachusetts  Volunteers,  amputated  the  femur  in  the  middle 
third,  on  account  of  the  burrowing  of  pus,  for  secondary  haemorrhage  from  the  pop 
liteal.  No  plastic  deposit  could  be  observed  immediately  after  the  operation.  On 

the  next  day  he  was  transferred  to  Washington,  and  admitted  to  the  Douglas  Hos- 

The  lower    pital,  where  he  died  on  December  27,  1862.     The  pathological  specimen,  which  was 

right  femur  am-    contributed  to  the  Army  Medical  Museum  by  Dr.  Prince,  with  a  history  of  the  case,    with  the  sawn  surfaces 
auove  me  con-     .  _  '     of  the  patella  and  femur 

Spec.  536.  is  numbered  o.iu  ot  the  Surgical  Section.  in  apposition. 

Extension  as  a  means  of  covering  protruding  bones  after  amputation  of  the  thigh  was 
successfully  employed  at  the  City  General  Hospital,  St.  Louis,  after  a  plan2  devised  by 
Acting  Assistant  Surgeon  A.  S.  Barnes. 

How  far  the  size  of  the  thigh  presented  for  amputation  influences  the  result  of  the 
operation  cannot  be  ascertained  from  the  cases  recorded  in  the  preceding  pages.  M.  Bras- 
dor,3  in  1774,  observed  that  ''plus  la  plaie  de  1'amputation  a  de  surface,  plus,  toutes  choses, 
egales,  le  danger  que  court  le  malade  est  grand,"  and  Surgeon  M.  Goldsmith,  U.  S.  V.,4  in 
a  letter  to  this  Office  notices  the  influence  of  the  size  of  the  limb  upon  the  mortality  of 

1  An  account  of  this  case  by  Surgeon  JAMES  1'.  PKIXCE,  36th  Massachusetts  Volunteers,  has  been  published  in  the  Boston  Medical  and  Surgical 
Journal  1863,  Vol.  LXV1II,  No.  4,  p.  69,  and  by  Dr.  ROBERT  P.  WEIR  in  his  excellent  paper  On  GRITTl'S  Supra- Condyloid  Amputation  of  the  Thigh, 
in  The  Medical  Record,  New  York,  1879,  Vol.  XV,  p.  338. 

2HO1>GEX  (J.  T.).  Letter  to  the  Surgeon  General,  dated  April  30,  1863:  "The  accompanying  drawing  (FIG.  22J)  shows  its  application  to  the 
thigh.  The  same  is  also  applied  to  the  arms,  forearms,  or  legs.  From  three  to  six  adhesive  strips  are  applied,  extending  from  the  end  of  the  stump  up 
the  limb  to  near  the  next  joint;  this  is  then  covered  by  a  smoothly  applied  bandage.  The  free  ends  of  plaster  are  brought  together  several  inches 
below  the  end  of  the  stump  and  fastened  by  a  cord,  to  which  is  attached  a 
bag  of  sand  weighing  from  1  to  3  or  4  pounds;  the  cord,  passed  over  a 
pulley  placed  at  a  proper  point  on  the  bedstead,  the  bag  is  suspended,  thus 
making  gradual  constant  extension  on  the  flaps,  which  soon  elongate  and 
cover  the  protruding  bone.  Great  numbers  of  such  stumps  have  been 
brought  to  this  hospital,  in  many  the  bone  protruding  three  inches  or  more, 
and  in  but  one  case  have  we  thought  it  best  to  saw  off  the  end  of  the  bone; 
and  that  was  done  before  this  method  of  treatment  was  practised.  There 
have  been  very  few  cases  in  which  the  ends  of  bones  have  exfoliated,  and 
then  only  a  small  part  of  what  would  have  been  lost  if  the  usual  course 
had  been  pursued.  The  credit  of  introducing  this  new  method  of  covering 
protruding  bones  is  due  to  Acting  Assistant  Surgeon  A.  S.  I5AUXES  of  this 
city.''  Dr.  W.  \V.  IvKEX,  jr.,  in  a  letter  to  the  Surgeon  General's  Office, 

dated  V.   S.    A.  General    Hospital,    West   Philadelphia,    May  26,    1863, 

3  FIG.   2U1. — Dr.  A.  S.    I5ARNKS  S    method   ot    treating  amputations   with 

ascribes  this  plan  to  Assistant  Surgeon  A.  H.  SMITH.  U.  S.  A :  "Assistant     retracted  flaps. 
.Surgeon  A.  II.  SMITH.  U.  S.  A.,  who  was  with  me  at  Frederick,  and  after 
wards  here  and  now  at  Nashville,  while  at  Frederick  devised  a  very  ingenious  apparatus,  which  was  afterwards  adopted  at  hospitals  nearer  the  battle 
fields,  and  there  claimed  as  original,  and  now,  I  learn,  is  claimed  by  J.  T.  HODOEX,  Surgeon  U.  S.  V.,  of  St.  Louis.     The  apparatus  is  the  application  of 
adhesive  strips  to  the  flaps  after  amputation  (especially  in  the  thigh),  and  the  attaching  to  them  of  a  weight  running  over  a  pulley,  very  much  after  the 
plan  of  BUCK'S  apparatus  for  the  thigh,  the  object  being  to  prevent  retraction  of  the  flaps,  and  to  overcome  it  if  already  established.'' 

3  BKASDOK,  Essai  sur  Ics  amputations  dans  les  Articles,  in  Mem.  de  VAcad.  Roy.  de  Chir.,  Paris,  1774,  T.  V,  p.  757. 

4GOLUSMITII  (At.).  Letter  to  the  Surgeon  General,  dated  Jeffersonville,  Indiana,  October  18,  1865:  "It  has  been  a  subject  of  general  remark  in 
the  Army  that  a  much  larger  proportion  of  the  lean,  lithe,  active  men — hardy  men,  without  a  particle  of  encumbering  fat.  recovered  from  amputation, 
than  equally  hardy  men — men  oftentimes  of  much  more  muscular  development  and  strength,  with  a  larger  accumulation  of  fat.  Or,  in  other  words, 
that  small,  light,  active  men,  bore  amputation  of  the  thigh  better  than  larger,  stronger,  and  stouter  men  did.  That  other  things  being  equal,  the  general 


358 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


amputations,  especially  in  the  thigh,  a  subject  which  seems  to  him  of  "importance  enough 
to  challenge  the  attention  of  medical  men." 

Considering  the  results  of  the  amputations  according  to  the  ages  of  the  patients,  as 
represented  in  TABLE  LI,  the  mortality  rate  of  four  hundred  and  seventy-six  patients 
under  twenty  years  of  age  was  41.0  per  cent.;  of  thirteen  hundred  and  fifty-one  patients 

TABLE  LI. 

Statement  of  the  Ages  of  Six  Thousand  Two  Hundred  and  Nine  Patients  who  submitted  to  Amputation 

of  the  Thigh  for  Shot  Injury. 


AMPUTATION  OF  THIGH. 

UNDER  20. 

20-1-2-3-4. 

25-6-7-8-9. 

30-1-2-3-4. 

35-6-7-8-9. 

40  A 

1 

0) 

>• 

o 

g 

K 

S'D  OVER. 

AGE 

UNKNOWN. 

Recovery. 

3 

£ 

Result 
Unknown. 

Recovery. 

"5 
a 

|JH 

Result 
Unknown. 

Recovery. 

"3 
"3 

fc< 

Result 
Unknown. 

>» 

o 

1 
K 

a 

'<n 

Result 
Unknown. 

Recovery. 

d 

S 
fe 

3 

CQ 

fe 

Result 
Unknown. 

Recovery. 

"3 
'S 
fe 

Result 
Unknown. 

C  Upper  Third 

2°» 

9 

GO 
179 
276 

35 
84 
160 

11 

1 
1 

39 
110 
155 
1 
6 
19 
25 

19 
56 
93 
6 
8 
30 
49 
3 

1 

23 
67 
77 
2 
5 
11 
18 

16 
31 
57 
4 
8 
16 
35 

1 

9 

28 
41 

8 
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35 
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6 
9 
24 

10 
25 
32 
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7 
11 

7 
16 
46 
6 
5 
14 
21 

1 

90 
205 
279 
34 
26 
90 
67 
7 
13 
34 
26 

174 
'  226 
470 
245 
44 
90 
154 
13 
8 
16 
33 
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4 
7 
12 
20 

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S  •<  I  Lower  Third 

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187 

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o  $     Middle  Third     . 

1 
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a  o  1  Lower  Third 

1 
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305 

2 

220 

197 

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118 

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131 

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],737 

71 

between  twenty  and  twenty-five,  45.2  per  cent.;  of  seven  hundred  and  six  between  twenty- 
five  and  thirty,  43.3  per  cent.;  of  four  hundred  and  eighteen  between  thirty  and  thirty-five, 
47.2  per  cent.;  of  two  hundred  and  thirty  betweejn  thirty-five  and  forty,  51.3  per  cent.; 
and  of  two  hundred  and  twenty-six  above  forty  years  of  age,  58.4  per  cent. 

health  of  the  two  classes  being  alike,  the  injuries  and  subsequent  exposures  being  the  same,  the  mere  size  of  the  limb,  controlling  as  it  does  the  area  of  the 
traumatic  surfaces,  came  to  be  the  ruling  element  in  the  determination  of  the  question  of  amputation  in  line  cases.  Professor  BUSH,  of  the  Transylvania 
University,  was  sent  by  the  Governor  of  Kentucky  to  the  succor  of  the  wounded  at  the  bottle  of  Shiloh.  He  tells  me  that  among  those  with  amputated 
thighs,  very  few  large  fleshy  men  recovered,  while  much  the  larger  proportion  of  those  having  small,  lean,  muscular  limbs,  arrived  at  Louisville  in  good 
condition.  He  was  so  much  struck  with  this  observation,  that  out  of  it  he  has  drawn  for  himself  a  clinical  rule,  in  determining  the  question  of  amputation, 
not  a  dominating  rule,  but  one  having  much  to  do  with  the  question.  Dr.  BUSH'S  observation  is  all  the  more  pertinent  that  it  was  an  independent  one. 
All  of  the  leading  surgeons  with  whom  I  have  conversed  upon  the  subject  have  made  concurrent  observations.  For  myself.  I  have  been  so  impressed 
with  the  influence  of  the  mere  size,  volume,  or  thickness  of  the  limb  presented  for  amputation,  that  in  cases  where  the  question  was  debatable  the 
decision  in  the  wavering  balance  was  determined  by  the  extent  of  traumatic  surface  necessarily  incident  to  the  operative  procedure  required.  This 
consideration  had  all  the  more  weight  as  the  line  of  the  contemplated  division  approached  the  trunk.7' 


SECT.  IV.]  WOUNDS    AND    INJURIES    OF    THE   KNEE   JOINT.  359 


SECTION  IV. 


WOUNDS  AND  INJURIES  OF  THE  KNEE  JOINT. 


The  injuries  of  the  knee  joint  to  be  considered  in  this  Section  number  three  thousand 
four  hundred  and  forty-nine.  Twelve  were  punctured,  thirty-nine  incised,  and  three  thou 
sand  three  hundred  and  ninety-eight  shot  wounds.  Of  the  latter,  forty-three  were  shot 
contusions  and  three  thousand  three  hundred  and  fifty-five  shot  fractures.  The  injuries  of 
the  knee  from  blows,  falls,  or  railroad  accidents  are  reserved  for  a  future  chapter.  The 
number  of  cases  of  injuries  of  the  knee  joint  followed  by  amputations  of  the  thigh  is  very 
large.  Of  the  thirty-nine  patients  with  incised  wounds,  six  submitted  to  amputation;  of 
the  forty-three  shot  contusions,  ten,  and  of  the  three  thousand  three  hundred  and  fifty-five 
shot  fractures,  two  thousand  three  hundred  and  eighty-nine  were  succeeded  by  amputation 
in  the  thigh.  The  two  thousand  three  hundred  and  ninety-nine  cases  of  amputation  in 
the  thigh  for  shot  contusion  or  shot  fractures  of  the  bones  of  the  knee  joint  have  already 
been  cited  in  the  amputation  tables  of  the  preceding  section,  and  will  therefore  be  only 
briefly  alluded  to  in  the  concluding  remarks  of  this  Section. 

PUNCTURED    AND    INCISED    WOUNDS    OF    THE    KNEE    JOINT.— The 

instances  of  punctured  and  incised1  wounds  of  the  knee  joint  reported  on  the  records  num 
ber  fifty-one — twelve  punctured  wounds  and  thirty-nine  incised  wounds.  In  some  of  the 
cases,  undoubtedly,  the  cavity  of  the  joint  was  directly  implicated,  but  the  meagre  evidence 


tranchcnis,  Paris,  Thdse  Xo.  84,  1811,  p.  20)  records  two  cases  of  sabre  wounds  of  the  knee  joint :  Maker,  84th  line,  who  received.  7iear  Utrecht,  in  1804, 
a  sabre  wound  which  cut  the  upper  ligament  of  the  right  patella  and  penetrated  the  articulation.  The  parts  were  brought  together  and  cataplasms 
employed.  Abscesses  formed  on  the  interior  and  exterior  sides  of  the  knee,  which  were  opened,  and  a  seton  was  introduced  to  allow  the  escape  of  pus. 
The  wounds  healed  and  the  patient  recovered,  but  with  complete  anchylosis  of  the  knee  joint.  A  grenadier  of  the  54th  regiment  received,  in  a  duel,  a 


,-ithout  benefit.     The  soldier  demanded  amputation,  which  was  performed  on  the  fifth  day.     The  paticnl 
at  he  saw  several  patients  with  similar  wounds,  who  perished  because  amputation  had  not  been  risked. 


died  on  the  fifteenth  day.     I-AUliEY  adds  tli 


360  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

and  the  fact  that  the  injuries  in  several  of  the  cases  healed  with  very  slight  inflammatory 
action  render  it  possible  that  they  were  periarticular  wounds  only. 

Punctured  Wounds  of  the  Knee  Joint. — The  twelve  punctured  wounds  of  the  knee 
joint  terminated  in  recovery.  Seven  were  caused  by  bayonets,  two  by  knives,  two  by  falls 
on  nails,  and  one  by  a  fall  on  a  pair  of  scissors.  The  seven  cases  of  bayonet  wounds  are: 

CASE  504. — Private  C.  Smith,  Co.  H,  30th  Iowa,  aged  17  years,  received,  September  20,  1862,  a  bayonet  puncture  of  the 
left  knee  joint.  He  was  discharged  from  service  at  Beuton  Barracks  Hospital,  October  5,  1863,  Surgeon  J.  H.  Grove,  U.  S.  V., 
certifying  to  "anchylosis  and  chronic  synovitis"  resulting  from  the  wound.  His  claim  for  pension  was  rejected. 

CASK  505. — Private  J.  S.  Oldscamp,  Co.  K,  16th  Maine,  aged  22  years,  was  wounded  and  captured  at  Spottsylvania, 
May  S,  1864.  He  was  subsequently  exchanged,  and  ultimately  discharged  for  disability  June  22, 1865.  Examiner  C.  Rowland, 
of  Brooklyn,  New  York,  reported:  "A  bayonet  wound  penetrated  the  vight  knee;  also  a  shot  wound  of  right  thigh,  and  of  right 
foot  injuring  the  little  toe.  The  result  is  lameness  and  inability  to  labor."  The  man  was  a  pensioner  until  March  4, 1866,  when 
he  was  dropped,  his  disabilities,  in  the  opinion  of  the  examiner,  having  ceased. 

CASE  506. — Surgeon  W.  O'Meagher,1  37th  New  York,  reports:  "Private  received  an  accidental  wound  of  the 

knee  joint  between  the  border  of  the  patella  and  the  internal  condyle  of  the  femur.  At  first  little  was  thought  of  it,  a  few 
adhesive  straps  and  a  roller  bandage  being  applied,  and  the  patient  returned  to  duty.  In  a  few  days,  owing,  doubtless,  to  impru 
dence  and  over  exercise,  inflammation,  accompanied  by  pain,  fever,  swelling,  and  effusion,  set  in,  while  the  wound  assumed  an 
angry  fungoid  appearance;  but  by  means  of  rest  in  the  recumbent  position,  elevation  of  the  extremity,  and  water  dressing,  the 
pain  and  other  symptoms  slowly  abated  at  the  end  of  three  weeks,  leaving  the  patient,  however,  lame  and  stiff  at  the  joint.'' 

CASE  507. — Musician  J.  H.  Getman,  Co.  E,  115th  New  York,  aged  19  years,  was  wounded  at  Fort  Fisher,  January  16, 
1865.  He  was  conveyed  to  McDougall  Hospital,  New  York,  and  subsequently  to  Troy.  Surgeon  George  H.  Hubbard,  U.  S.  V., 
in  charge  of  the  latter  hospital,  reported  that  the  patient's  injuries  consisted  of  "a  bayonet  wound  of  the  posterior  portion  of  the 
right  knee  joint.'1  Getman  was  furloughed  April  28lh,  and  was  mustered  out  of  service  May  19,  1865;  he  is  a  pensioner. 

CASE  508. — Sergeant  S.  M.  Ingraham,  Co.  K,  64th  New  York,  aged  34  years,  received  a  bayonet  wound  of  the  left  knee, 
at  Spottsylvania,  May  12,  1864.  He  was  mustered  out  and  pensioned  October  13,  1864.  Examining  surgeons  represent  him  as 
suffering  from  permanent  weakness  of  the  knee  as  a  result  of  a  bayonet  wound  of  the  patella  followed  by  suppuration. 

The  remaining  two  cases  of  bayonet  wounds  of  the  knee  joint  have  already  been 
cited,  viz:  cases  of  Private  C.  A.  Ball,  Co.  K,  89th  New  York  (CASE  3,  page  6,  ante),  and 
Private  Lewis  Francis,  Co.  I,  14th  New  York  (CASE  331,  page  154,  ante).  The  former 
recovered  without  any  bad  results;  the  latter  after  amputation  in  the  middle  third  of  the 
thigh  and  subsequent  disarticulation  at  the  hip. 

Amputation  above  tlie  knee  was  advised,  but  refused  by  the  patient.  The  arteries  were  ligated  and  the  edges  of  the  wound  drawn  together  by  sutures, 
care  being  taken  that  synovia  and  blood  were  allowed  to  escape.  August  Gth,  inflammation,  swelling,  and  pain.  Synovia  continued  to  escape  until 
August  10th.  Death  from  exhaustion  August  23,  1813.  A  soldier  of  the  7th  line,  aged  27,  received,  on  August  16,  1813,  near  Dresden,  a  sabre  cut 
through  the  left  patella.  He  secured  the  wound  with  bandages,  and  was  received  into  the  military  hospital  on  August  24th.  very  much  exhausted. 
An  examination  revealed  a  cut  about  4  inches  in  length,  splitting  the  patella  and  opening  the  joint ;  blood  and  synovia  escaped  freely  and  symptoms 
of  tetanus  appeared.  August  28th,  escape  of  synovia  diminished.  September  1'Jth,  cut  edges  i.f  patella  were  united  and  the  escape  of  synovia  had 
ceased.  The  patient  recovered.  LEFKANCOIS  (JEAN)  (Dissertation  sur  les  plaies  jiem'trantcs  de  /'articulation  du  genou,  Paris.  18C-0,  These  No.  :>, 
pp.  17,  18)  cites  ttvo  cases:  A  soldier  of  the  7th  chasseurs  u  cheval  received,  in  December,  1814,  a  sabre  wound  across  the  anterior  part  of  the  right  knee, 
extending  from  the  internal  to  the  external  part  of  the  knee  and  opening  the  joint.  Simple  dressings  were  applied.  The  limb  was  painful  during  the  first 
eight  days;  tetanus  appeared  on  the  fifteenth  day  and  death  resulted.  A  soldier  of  the  18th  line  received  a  sabre  wound  on  January  15,  1815.  'The  cut 
was  transversely  across  the  upper  part  of  the  knee  joint  and  opened  the  cavity  of  the  joint  about  an  inch.  There  was  copious  haemorrhage.  The  edges 
were  brought  together  and  simple  dressings  applied.  There  was  little  pain  during  the  first  three  days  ;  but  on  the  fourth  there  was  some  fever  and  gastric 
disturbance.  Numerous  abscesses  appeared,  which  were  incised.  The  patient  recovered  in  27  days.  FociiMEIt  (JULES)  (Euai  sur  les  plaies  des  artic 
ulations,  Paris.  1823,  These  No.  150,  pp.  11,  14)  :  Bottari,  8th  guards,  received,  November  6,  1822,  a  sabre  puncture  over  the  left  patella  and  two  others  on 
the  anterior  and  upper  portion.  Considerable  swelling  ensued  and  synovia  escaped  through  the  small  wound.  By  November  15th  the  wound.had  cica 
trized  and  the  patient  was  able  to  walk;  there  was  very  little  stiffness  in  the  articulation.  A  young  chasseur  received,  in  1815,  a  sabre  wound  of  the 
external  portion  of  the  right  knee.  The  \voundgn-as  three  inches  long  and  penetrated  the  synovia!  capsule,  from  which  there  was  considerable  effusion. 
The  wounded  surfaces  were  brought  together  and  the  limb  permanently  extended.  On  the  tenth  day  cicatrization  was  complete.  MAI.I.E  (P.)  (Clin. 

Cliir.  de  I'hopital  Mil.  d' instruction  de  Strasbourg,  Paris,  18"8,  p.  022):  V ,  fusilier,  20th  line  ;  entered  hospital  at  Strasbourg  March  25,  1830,  with  a 

sabre  wound  of  the  right  knee.  The  tendons  of  the  extensor  muscles  if  the  leg  were  divided  near  the  insertion  at  the  upper  border  of  the  patella.  The 
wound  was  about  three  inches  long.  Clots  were  removed  by  the  finger,  the  wounded  surfaces  brought  together,  and  immobility  secured  by  splints. 
Inflammation  and  suppuration  ensued  and  the  patient  suffered  from  nausea  and  insomnia,  but  his  condition  improved  ;  he  had  recovered  on  June  12,  1830. 
OiiEXU  (J.  C.)  (Rapport,  etc.,  pendant  la  Campagne  d'  Orient  en  1854,  1855,  1850,  Paris,  18(J5,  p.  410)  tabulates  5  cases  of  recovery  after  sabre,  bayonet, 
and  lance  wounds  of  the  knee,  but  gives  no  details.  GARDEN'  (A.  M.)  (Conservative  Surgery — Treatment  of  Sicierd  Wound  of  the  Knee,  in  The  Lancet, 
1859,  Vol.  I,  p.  631):  On  September  13,  1857,  a  woman  received  sword  cuts  of  both  knees  ;  the  left  was  only  slightly  injured  ;  the  right  knee  was  opened 
and  a  portion  of  the  head  of  the  tibia  severed  ;  the  muscles  and  ligaments  attached  to  the  patella  were  cut  through,  leaving  the  patella  itself  attached  by 
a  very  small  piece  of  integument.  Limb  placed  in  position;  patella  replaced;  union  with  anchylosis  in  about  four  months.  WILLIAMSON  (GEOUGE) 
(.Military  Surgery,  London,  18(J3,  p.  173):  Private  John  (Umnell,  West  York  Rifle  1'egiment,  was  stabbed  in  the  left  knee  by  a  bayonet  on  February  5, 
1858.  The  wound  was  small  and  deep  and  just  beneath  the  level  of  the  patella;  the  pus  was  excessive;  delirium  and  great  agony  followed ;  knee 
became  swollen  ;  abscesses  formed  outside  of  the  joint  and  were  opened.  Profuse  purulent  discharge  continued.  April  (ith,  amputation  of  thigh  ;  patient 
.recovered.  The  specimen  is  preserved  in  the  Museum  of  the  Army  Medical  Department,  at  Netley,  and  is  numbered  3G33.  VOLKMANX  (R.)  (I'enetri- 
rende  Kniegdenkstvunde,  Zweimalige  Gelenkpunction,  Heilung  ohne  Ankylose,  in  Deutsche  Klinik,  \\.  XIII,  1801 .  p.  411):  A  mason,  on  June  23,  1861, 
received  a  sabre  wound  of  the  left  knee  joint ;  escape  of  synovia,  fever,  and  extensive  bun-owing  of  pus ;  incisions,  ice ;  recovery. 

1  O'MEAGHEH  (WILLIAM),  Cases  in  Military  Surgery — Bayonet  Wound  of  Knee  Joint — Synovitis,  in  Am.  Med.  Times,  1802.  Vol.  IV,  p.  7. 


SECT.  IV.J  INCISED    WOUNDS    OF    THE    KNEE    JOINT.  361 

The  instances  in  which  the  penetrations  of  the  knee  joint  were  caused  by  falls  on  nails 
or  scissors  or  by  knife  stabs  are: 

CASE  509. — Private  S.  Galliway,  Co.  B,  32d  Ohio,  was  injured  March  18,  18(53,  at  Lake  Providence,  by  falling  on  a  nail, 
which  entered  the  right  knee  joint  at  the  external  and  inferior  border  of  the  patella,  and  penetrated  downward  and  inward  about 
an  inch.  Surgeon  J.  T.  Hodgen,  U.  S.  V.,  reported  the  case,  and  that  the  man  entered  the  City  Hospital  at  St.  Louis  three 
weeks  after  the  reception  of  the  injury.  HeAvas  transferred  to  the  Veteran  Reserve  Corps  July  15,  1863;  he  is  not  a  pensioner. 

CASK  510. — Musician  B.  Williams,  Co.  C,  1st  New  York,  aged  17  years,  is  reported  by  Acting  Assistant  Surgeon  P.  B. 
Goddard  as  having  been  treated  at  the  Master  Street  Hospital,  Philadelphia,  from  August  12  to  November  26,  1862,  for  "  syno- 
vitis  of  the  knee  joint  from  puncture  by  a  nail  of  a  cracker  box  on  which  he  fell."  There  is  no  record  of  his  ever  having  applied 
for  a  pension. 

CASE  511. — Private  T.  A.  Jackson,  Co.  H,  1st  Rhode  Island  Cavalry,  aged  23  years,  entered  Satterlee  Hospital,  Phila 
delphia,  May  7,  1863.  Acting  Assistant  Surgeon  W.  W.  Keen,  jr.,  reported  :  "The  case  is  one  of  punctured  wound  of  the  knee 
joint  followed  by  partial  anchylosis.  The  patient  states  that  in  December,  1862,  he  fell  from  his  horse,  and  that  a  pair  of  scissors 
in  his  knapsack  punctured  the  right  knee  joint  and  broke  off;  that  the  points  were  removed  three  days  after  the  accident,  being 
three  inches  deep,  and  that  severe  inflammation  followed,  and  a  large  number  of  abscesses  formed  about  the  joint.  When 
admitted  the  injured  joint  was  smaller  than  the  sound  one,  the  hamstrings  were  contracted,  and  motion  was  limited  from  com 
plete  flexion  to  an  angle  of  135°  with  the  thigh.  On  motion  there  was  marked  crepitation,  the  movement  of  the  patella  being 
much  restricted.  The  cicatrix  of  the  wound  is  located  just  to  the  inside  and  above  the  tubercle  of  the  tibia,  and  all  about  the 
joint  are  old  cicatrices  from  abscesses.  The  evidence  of  penetration  of  the  joint  is  manifest,  both  by  the  position  of  the  cicatvix 
as  well  as  the  escape  of  synovia,  which  took  place  according  to  the  patient's  statement.  The  patient  walks  about  on  crutches, 
and  is  unable  to  bear  weight  on  the  limb."  He  was  discharged  from  service  June  1,  1863.  There  is  no  record  of  his  ever 
having  applied  for  pension. 

CASE  512. — Private  E.  Rice,  Co.  E,  100th  Indiana,  was  discharged  from  service  February  28,  1863,  by  reason  of  anchy 
losis  of  the  right  knee  joint.  Medical  Inspector  G.  T.  Allen,  U.  S.  A.,  reported  that  the  disability  arose  from  a  wound  inflicted, 
September  16,  1862,  by  a  pointed  knife  entering  beneath  the  patella  and  penetrating  the  knee  joint.  The  man  is  not  a  pensioner. 

CASE  513. — Private  D.  R.  Ewell,  Co.  G,  39th  Massachusetts,  received  a  knife  wound  of  the  left  knee  in  April,  1864.  He 
was  successively  admitted  to  the  regimental,  Harewood,  and  Portsmouth  Grove  hospitals,  and  returned  to  duty  May  26,  1864. 
He  is  not  a  pensioner. 

Incised  Wounds  of  the  Knee  Joint. — The  thirty-nine  cases  of  this  group  were  axe 
or  hatchet  wounds  with  the  exception  of  perhaps  one,  in  which  the  instrument  with  which 
the  injury  was  inflicted  is  not  named.  Thirty-three  cases  were  treated  without  operative 
interference  and  six  were  followed  by  amputations  in  the  thigh. 

Incised  Wounds  of  the  Knee  Joint  treated  without  Operative  Interference. — Thirty- 
three  cases,  of  which  four  proved  fatal,  are  included  in  this  category.  In  the  majority  of 
the  cases  the  reports  are  brief,  and  the  evidence  regarding  the  penetration  of  the  joint  is 
very  vague.  A  few  cases  of  recovery  are  cited: 

CASK  514. — Private  N.  Bacon,  Co.  C,  llth  Michigan,  aged  17  years,  entered  Cumberland  Hospital,  Nashville,  May  17, 
1864,  with  an  incised  wound  of  the  left  knee  joint,  caused  accidentally  by  an  axe  two  weeks  previously.  Surgeon  B.  Cloak, 
U.  S.  V.,  reported  the  case  and  that  the  patient  was  returned  to  duty  June  4,  1864.  The  man  is  not  a  pensioner. 

CASK  515. — Private  J.  H.  Fuller,  Co.  K.  3d  Massachusetts,  age  28  years,  received,  October  20,  1862,  an  injury  of  the 
left  knee  joint  by  a  hatchet,  which  penetrated  outside  of  the  patella  and  made  quite  a  deep  cut,  causing  much  arterial  haemor 
rhage.  The  patient  recovered,  and  was  discharged  April  1.  1863.  He  was  pensioned  on  account  of  lameness  and  anchylosis  of 
the  joint.  The  case  is  reported  by  Surgeon  Z.  B.  Adams.  32d  Massachusetts. 

CASK  516. — Private  L.  H.  Hudson,  Co.  K,  1st  Missouri  Engineers,  received  an  accidental  blow  from  an  axe  in  the  left 
knee  joint,  at  Waverly,  June  3,  1864.  The  patella,  half  the  capsular,  and  all  the  lateral  ligaments  were  severed,  allowing  the 
synovia  to  escape  from  the  joint.  The  patient  passed  through  various  hospitals,  and  was  discharged  January  11,  1865,  and 
pensioned.  Examining  surgeons  describe  him  as  very  badly  disabled  and  suffering  from  looseness  of  the  joint,  the  consequence 
of  loss  of  parts  of  the  outer  side  of  the  knee. 

CASK  517. — Private  W.  Trahey,  Co.  H,  71st  New  York,  was  discharged  from  service  May  31,  1862,  by  reason  of  lame 
ness  and  partial  anchylosis  of  the  knee  joint.  Surgeon  A.  J.  McKelway,  8th  New  Jersey,  certified  that  the  disability  was  caused 
by  a  wound  made  with  an  axe  in  February,  1862,  which  laid  open  the  joint.  The  man  is  not  a  pensioner. 

CASE  518. — Sergeant  A.  E.  Waterman,  Co.  H,  1st  Michigan  Light  Artillery,  is  reported  by  Acting  Assistant  Surgeon  U. 
O.  Farrand  as  having  been  admitted  into  St.  Mary's  Hospital,  Detroit,  August  20,  1864,  with  an  ''accidental  incised  wound  of 
the  right  knee,  penetrating  the  joint,''  and  that  he  was  returned  to  duty  October  3,  1864.  He  is  not  a  pensioner. 

CASE  519. — Private  J.  Williams,  Co.  H,  2d  Sharpshooters,  aged  32,  received  an  accidental  wound  of  the  right  knee  by 
an  axe,  April  3,  1864.     Assistant  Surgeon  W.  Webster,  U.  S.  A.,  in  charge  of  De  Camp  Hospital,  reported  that  the  joint  was 
penetrated  and  that  the  patient  was  returned  to  duty  May  27,  1864.     He  is  not  a  pensioner. 
SUKG.  Ill— 46 


362  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  X. 

The  evidence  in  the  remaining  twenty-three  cases1  of  recovery  after  incised  wounds 
of  the  knee  is  of  a  similar  nature.  The  fatal  cases  are : 

CASE  520. — Private  G.  M.  Sadler,  Co.  B,  22d  Michigan,  was  admitted  into  hospital  No.  3,  Nashville,  where  lie  died 
February  8,  1864  Surgeon  S.  D.  Turney,  U.  S.  V.,  reported  that  the  cause  of  death  was  "an  accidental  incised  wound  of  the 
left  knee  joint,  caused  by  an  axe,  and  inflicted  during  the  previous  month. 

CASE  521. — Sergeant  J.  A.  Wynkoop,  Co.  E,  39th  Iowa,  aged  26  years,  was  accidentally  wounded  at  Athens,  Georgia, 
April  30,  1864.  He  was  admitted  into  hospital  No  19,  Nashville,  whence  Surgeon  W.  H.  Thorn,  U.  S.  V.,  reported:  "An  axe 
wound  of  the  left  knee,  penetrating  the  joint.  Death  on  May  26,  18b'4." 

CASE  522. — Private  A.  Hatfield,  Co.  I,  129th  Illinois,  aged  25  years,  was  admitted  into  the  hospital  of  the  3d  division, 
Twentieth  Corps,  October  7,  1864,  with  an  accidental  incised  wound  of  the  right  knee,  inflicted  with  an  axe.  On  October  31st, 
he  was  transferred  to  hospital  No.  1,  Chattanooga,  whence  Surgeon  J.  H.  Phillips,  U.  S.  V.,  reports  that  he  died  on  December 
7,  1864,  "  of  incised  •wound  of  right  knee." 

CASE  523. — Private  A.  G.  Hill,  Co.  G,  43d  New  York,  aged  25  years,  was  admitted  into  Finley  Hospital,  Washington, 
March  25,  1864,  with  an  incised  wound  of  the  right  knee,  inflicted  with  an  axe,  accidentally,  at  Brandy  Station,  Virginia,  Feb 
ruary  19,  1854.  Surgeon  G.  L.  Pancoast,  U.  S.  V.,  reports  that  he  died  May  21,  1864,  from  the  effects  of  the  wound. 

Amputations  in  the  Thigh  after  Incised  Wounds  of  the  Knee  Jomtf.— -Burrowing  of 

pus,  extensive  sinuses  above  or  below  the  knee,  and  sloughing,  necessitated  amputation  in 
the  thigh  in  six  cases  of  incised  wounds  of  the  knee  joint.  Only  one  of  the  patients 
survived  the  operation: 

CASE  524. — Private  F.  O'Brien,  Co.  A,  4th  New  York,  aged  24  years,  was  cut  in  the  left  knee  by  an  axe  during  a  fight 
iu  a  private  house  near  Baltimore,  February,  1862.  He  was  admitted  to  hospital  in  Baltimore,  where,  on  account  of  the  diseased 
condition  of  the  injured  joint  and  adjacent  parts,  the  limb  was  subsequently  amputated  about  the  middle  of  the  thigh  by  Surgeon 
G.  Taylor,  U.  S.  A.  The  patient  was  discharged  from  service  April  28,  1863,  and  supplied  with  an  artificial  limb.  A  cast  of  the 
stump  was  contributed  to  the  Army  Medical  Museum  by  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  and  constitutes  specimen 
919  of  the  Surgical  Section.  The  man  subsequently  served  in  the  Veteran  Reserve  Corps,  and  was  discharged  December  15, 
1864.  His  application  for  pension  was  rejected. 

CASE  525. — Corporal  M.  J.  Allen,  Co.  I,  33d  Indiana,  aged  22  years,  while  putting  up  a  tent  on  June  17,  1865,  received 
an  axe  wound  of  the  right  knee  joint.  He  was  admitted  to  Brown  Hospital,  Louisville,  several  days  afterwards,  and  on  July 
27th  to  Crittenden  Hospital.  Assistant  Surgeon  J.  C.  G.  Happersett,  U.  S.  A.,  in  charge  of  the  latter,  reported  that  the  injured 
knee  was  affected  with  synovitis;  also  that  pus  had  penetrated  the  joint  and  was  burrowing  in  the  tissues  above  and  below, 
necessitating  amputation  of  the  thigh,  which  was  performed  July  31st,  by  Acting  Assistant  Surgeon  D.  J.  Griffiths,  at  the 
middle  third.  The  patient  died  of  diarrhoea  August  11,  1865. 

CASE  526. — Private  H.  C.  Frazer,  Co.  A,  40th  Ne\v  York,  while  cutting  wood,  on  June  20,  1862,  accidentally  struck  the 
left  knee.  He  entered  Ascension  Hospital,  Washington,  July  4th,  whence  Acting  Assistant  Surgeon  J.  W.  Bulkley  reported 
that  the  cut  ran  obliquely  across  the  outside  of  the  joint  and  had  nearly  healed  when  the  patient  was  admitted.  About  ten  or 
eleven  days  afterwards,  however,  the  leg  and  joint  became  greatly  swollen  and  inflamed,  the  skin  rapidly  assuming  a  bright  red 
color.  This  was  attended  with  excessive  pain  in  the  joint  upon  motion.  Ice,  cold  irrigations,  and  tincture  of  iodine  were 
applied,  and  salines,  small  doses  of  tartar  emetic,  and  sweet  spirits  of  nitre  were  administered.  Bandages  were  applied  from 
the  foot  to  the  knee  joint  with  good  effect.  On  July  20th.  a  small  incision  was  made  inside  the  ligamentum  patella  and  gave 
exit  to  a  large  amount  of  sanious  and  highly  offensive  pus.  About  July  27th,  the  pus  was  noticed  to  be  accumulating  in  the  joint 
and  burrowing  above  it  in  the  muscles  of  the  thigh.  The  bandage  was  still  used,  and  cold,  alternated  with  warm,  applications 
were  continued.  Quinine  and  tincture  of  iron  was  now  given,  and  beef  tea  and  brandy  punch  freely.  About  the  beginning  of 
August  an  incision,  made  in  the  calf  of  the  leg,  gave  exit  to  still  more  offensive  pus.  After  August  5th  the  patient  was  slowly 
sinking.  A  small  blackish  discoloration  was  then  seen  on  the  inside  of  the  leg,  midway  between  the  knee  and  the  ankle:  the 
foot,  which  from  the  first  had  remained  cedematous,  was  puffed  and  pitting  on  pressure.  On  August  13th  the  black  spot  was 
noticed  to  be  rapidly  increasing  and  was  recognized  as  gangrene,  when  a  lotion  of  nitric  acid  was  applied.  On  the  following 
day,  the  necessity  of  amputation  becoming  manifest,  two  doses  of  one-half  grain  of  morphia  each  were  administered,  after  which 
the  limb  was  removed  about  six  inches  below  the  trochanters  by  the  antero-posterior  flap  method.  The  operation  was  performed 
by  Surgeon  J.  C.  Dorr,  U.  S.  V.,  assisted  by  others,  the  patient  being  under  the  influence  of  chloroform,  and  losing  but  a  slight 
amount  of  blood.  Dead  and  disorganized  tissues  were  found  in  the  flaps  and  dissected  out,  after  which  the  lips  of  the  wound 
were  closed  by  silver  sutures  and  adhesive  plaster.  Stimulants  were  freely  given,  but  the  patient  sank  rapidly,  and  died  at  5 
P.  M.  on  the  same  day.  An  examination  showed  that  the  soft  parts  were  extensively  disorganized  nearly  to  the  trochanters; 
also  that  the  original  wound  had  communicated  with  the  knee  joint. 

CASE  527. — Private  R.  B.  Swift,  Co.  H,  1st  Regiment  Michigan  Engineers  and  Mechanics,  aged  23  years,  was  accident 
ally  cut  in  the  right  knee  joint  by  an  axe,  while  engaged  on  duty  on  the  Northwestern  Railroad  in  Tennessee,  November  24,  1863. 

'The  cases  are:  1.  Pt.  D.  Bird,  Co.  G,  107th  New  York;  2.  Pt.  G.  Blucher,  Co.  C,  119th  New  York;  3.  C.  Bradley,  Government  employe;  4. 
Pt.  A.  Capp,  Co.  II,  13th  Illinois;  5.  Pt.  J.  M.  Condon,  Co.  B,  3d  New  York  Cavalry;  (i.  Pt.  H.  Coon,  Co.  F,  14M  New  York;  7.  Pt.  T.  Decker,  Co. 
D,  15th  New  Jersey;  8.  Pt.  J.  Elliott,  Co.  E,  4th  California;  9.  Pt.  D.  Geigheimer,  Co.  B,  ]31st  New  York;  10.  Corp'I  J.  Howard,  Co.  D,  78th  Illinois; 
11.  Pt.  M.  Kelley,  Co.  B,  59th  Illinois;  12.  Pt.  J.  Kimball,  Co.  A,  1st  Wisconsin  Cavalry;  13.  Pt.  L.  B.  Lewis,  Co.  C,  llth  New  Hampshire;  14.  Pt.  H. 
T.  Marsh,  Co.  I,  8th  Ohio;  15.  Pt.  J.  Martin,  Co.  D,  Iu9th  New  York;  16.  Pt.  K.  M.  Morris,  Co.  C,  84th  Indiana;  37.  Serg't  J.  L.  Morse,  Co.  D,  21st  N. 
York  Cavalry;  18.  Pt.  G.  AV.  Proctor,  Co.  D,  IGth  Illinois;  19.  Pt.  H.  A.  Smith,  Co.  G,  141st  New  York;  20.  Pt.  E.  S.  Spangler,  Co.  F,  145th  Penn 
sylvania;  21.  Pt.  D.  A.  Stephens,  Co.  B,  2d  Penn.  Cavalry;  22.  Pt.  A.  M.  .Sutton,  Co.  L,  4th  New  York  Artilley;  23.  Pt.  J.  Wood,  Co.  G,  79th  Ohio. 


SECT,  iv.1  SHOT    INJURIES    OP    THE    KNEE    JOINT.  363 

On  the  following  day  lie  was  admitted  to  hospital  No.  3,  Nashville,  where  the  limb  was  amputated  on  January  5,  1864,  by  Sur 
geon  S.  D.  Turney,  U.  S.  V.,  at  the  lower  end  of  the  middle  third  of  the  thigh.  The  operation  was  performed  by  the  circular 
method  with  little  loss  of  blood,  chloroform  and  ether  being  used  and  four  ligatures  applied.  At  the  time  of  the  operation  the 
knee  was  greatly  swollen  and  very  painful,  the  internal  condyle  was  laid  bare  by  sloughing,  and  the  joint  had  opened  exten 
sively,  the  discharges  being  very  offensive.  There  were  also  extensive  sinuses  above  the  joint,  and  below  it  free  incisions  had 
been  made  to  effect  drainage.  The  patient  had  become  quite  reduced  and  was  unable  to  sleep  without  opiates.  He  slept  some 
during  the  night  following  the  operation.  Milk  punch  and  beef  tea  were  freely  given,  but  the  patient  died  from  exhaustion 
January  7,  1864.  The  case  was  reported  by  the  operator. 

CASE  528. — Private  E.  H.  Turner,  Co.  E,  1st  Maryland,  aged  23  years,  was  admitted  to  hospital  at  Frederick,  October 
3,  1864,  having  received  an  axe  wound  of  the  left  knee  joint.  Acting  Assistant  Surgeon  P.  O.  Cornish  reported  that  the  patient 
was  not  a  very  strong  man  and  apprehensive  of  a  fatal  result  from  the  first.  Two  and  a  half  hours  after  the  injury  the  wound 
was  firmly  closed  with  a  stitch  and  adhesive  plaster,  after  which  cold  lotions  were  used.  Two  days  afterwards  the  joint  became 
swollen  and  painful,  and,  on  October  12th,  synovia  was  flowing  from  the  wound,  the  patient's  tongue  was  coated,  and  his  appetite 
poor.  On  October  15th,  pus  having  formed  in  the  joint,  it  was  freely  opened  on  both  sides,  also  an  abscess  located  above  the 
knee  but  not  communicating  with  the  joint.  Diarrhoea  now  set  in  and  indications  of  pyaemia  came  on,  and  all  the  symptoms 
growing  worse,  amputation  of  the  thigh  at  the  middle  third,  by  the  circular  method,  was  performed  by  Assistant  Surgeon  R.  F. 
Weir,  U.  S.  A.,  on  October  18th.  An  examination  of  the  amputated  limb  disclosed  abscesses  above  and  below  the  knee  and  in 
the  popliteal  space,  and  showed  that  the  cartilages  of  the  joint  had  commenced  to  break  down.  The  treatment  consisted  of 
tonics,  opiates,  and  stimulants.  The  stump  having  commenced  to  discharge  unhealthy  pus,  it  was  opened  on  October  21st,  and 
washed  with  bromine  solution.  Subsequently  iodide  of  starch  was  administered,  and  iodine  was  applied  to  the  stump.  The 
patient  died  October  25,  1864.  The  post-mortem  examination  confirmed  the  existence  of  the  pyaemic  infection.  The  stump 
showed  no  reparative  process  around  the  bone,  numerous  small  abscesses  being  present  in  the  cellular  tissues  nearly  to  the  hip 
joint.  The  fascia  surrounding  the  femoral  vein  was  closely  adherent  from  inflammatory  action,  the  coats  of  the  vein  being  much 
thickened  and  filled  with  broken  down  clots.  The  valves  of  the  vein  and  the  coats  of  the  femoral  artery  were  also  thickened 
and  very  friable.  No  pus  was  found  in  the  hip  joint. 

In  the  next  case  the  external  wound  had  partly  healed  by  first  intention  so  that  a 
probe  could  not  be  made  to  enter  the  joint,  but  insidious  burrowing  of  pus  and  disorgan 
ization  of  the  tissues  finally  rendered  amputation  unavoidable: 

CASE  529. — Private  O.  F.  Reams,  Co.  B,  United  States  Engineers,  aged  23  years,  accidentally  cut  his  right  knee  joint 
open  with  an  axe  while  in  the  act  of  chopping  down  a  tree  in  camp,  on  March  12,  1864.  He  was  admitted  to  hospital  in  Alex 
andria,  March  21st.  at  which  time  there  was  but  little  suppuration,  the  external  wound  having  partly  healed  by  first  intention, 
so  that  a  probe  could  not  be  made  to  enter  the  joint.  The  patient  was  doing  very  well  and  had  a  good  appetite,  and  hopes  were 
entertained  that  the  joint  might  be  saved.  On  April  12th,  the  limb  was  somewhat  swollen  and  painful,  and  his  appetite  began  to 
fail.  On  April  22d.  fluctuation  was  distinctly  detected,  when  an  opening  was  made  and  two  ounces  of  pus  escaped  On  April 
24th,  the  thigh  was  amputated  in  the  upper  third  by  lateral  flaps,  by  Surgeon  E.  Bentley,  U.  S.  V.  The  tissues  below  the  point 
of  amputation  were  found  to  be  infiltrated  with  pus  and  badly  disorganized.  The  patient  reacted  well,  though  not  very  promptly. 
Pyaemic  chills  began  two  days  afterwards,  and  secondary  haemorrhage  set  in  on  April  28th,  when  the  femoral  artery  was  ligated 
just  below  Poupart's  ligament.  The  patient  died  from  the  effects  of  pyaemia,  May  1,  1864.  At  the  autopsy  large  quantities  of 
serous  fluid  were  found  in  the  pleural  cavities  and  a  number  of  pyaemic  abscesses  in  the  left  lung.  One  abscess  was  also  dis 
covered  in  the  spleen.  The  latter  organ,  together  with  the  bones  of  the  amputated  knee,  were  contributed  to  the  Museum,  with 
the  history,  by  the  operator,  and  constitute  specimens  2253  and  2234  of  the  Surgical  Section. 

SHOT  INJURIES  OF  THE  KNEE  JOINT.— Of  the  three  thousand  three  hun 
dred  and  ninety-eight  cases  of  shot  wounds  involving  one  or  more  bones  of  the  knee 
joint,  forty-three  were  designated  on  the  reports  as  shot  contusions,  and  three  thousand 
three  hundred  and  fifty-five  as  shot  fractures. 

SHOT  CONTUSIONS  OF  THE  KNEE  JOINT.  — Contusions  of  the  knee  joint1 
involving  the  condyles  of  the  femur,  the  patella,  or  the  head  of  the  tibia  by  small  projec 
tiles  or  fragments  of  shell,  were  noted  in  forty-three  instances.  Thirty-three  were  treated 
without  operative  interference,  and  ten  were  followed  by  amputation. 

'Examples  of  shot  contusions  of  the  knee  joint  are  reported  by  JOliEKT  1>E  LAMltAU.E  (Plaits  d'armes  it  feu,  Paris,  1833.  p.  065),  who  cites  two 
successful  cases.  CHENU  (J.  C.)  (Rapport,  etc.,  pendant  la  Campagnt  d  Orient,  Paris.  18<>5,  p.  410)  tabulates  70  cases  of  shot  contusions  of  the  knee 
joint,  of  which  4  proved  fatal.  ClIKXU  (J.  ('.)  (Slat.  Med.  Cltir.  de  la  Campagne-d' Italic  en  183!)  et  1800,  Paris,  18(W,  T.  II,  p.  7(it>)  records  21  cases  of 
shot  contusions  of  the  knee  joint ;  17  patients  recovered  and  4  died.  HEINE  (C.)  (Die  ScJitusvcrletzungen  dtr  Untercn  Extremitiiten.  Berlin,  18(J<>,  p.  57) 
cites  a  case  in  which  a  bullet  struck  the  lower  third  of  the  thigh  on  the  inside  just  above  the  knee,  passed  over  the  knee,  hugging  the  bone  closely,  and 
escaped  on  the  outer  side  of  the  knee.  On  the  third  day  after  the  injury  a  viscid  fluid  escaped  from  the  wound  of  entrance.  During  the  first  days  the 
symptoms  were  slight,  and  the  wounds  looked  well,  but  they  soon  assumed  an  angry  appearance.  Immense  infiltration  and  pyaemia  supervened,  and 
death  occurred  14  days  after  the  injury.  At  the  post-mortem  examination  the  bone  was  found  entirely  intact ;  no  roughening  was  noticeable,  the  peri 
osteum  only  being  partially  destroyed  where  the  ball  had  passed  along  the  bone.  .  .  The  synovial  sac  was  opened  at  its  inner  and  upper  circumfer 
ence  and  was  filled  with  pus.  STKOMEYEK  (L.)  (Erfaltruiigrn  iiber  Schitsswunden  im  Jahre  18Wi,  Hannover,  1867,  p.  55)  tabulates  8  shot  contusions  of 
the  knee  joint,  but  gives  no  results.  Uui'I'llECHT  (L.)  (Militdriirztliclte  Erfaltrungen  wdhrcnd  des  Deutsch-t'ra.mijsisdi<n  Krieges  im  Jahre  1810-71, 
WUrzburg,  1871.  p.  10)  tabulates  8  cases  of  shot  contusions  of  the  knee  joint  and  patella  but  does  not  indicate  the  results  in  the  cases. 


364  INJURIES    OF    THE    LOWER    EXTREMITIES.  fCHAP.  X. 

Shot  Contusions  of  the  Knee  Joint  treated  by  Conservation.  —  Of  the  thirty-three 

cases  of  this  group,  eleven,  or  33.3  per  cent.,  were  fatal.  More  or  less  swelling,  extensive 
inflammation  often  involving  the  synovial  membranes,  necrosis,  and  exfoliations  of  small 
pieces  of  bone,  abscesses,  and  effusions  into  the  joint  were  the  most 'prominent  symptoms 
following  shot  contusions  of  the  bones  of  the  joint,  and  the  cases  of  recovery  were  followed 
by  wasting  of  the  limb,  partial  or  complete  anchylosis,  and,  in  a  few  instances,  by  perma 
nent  enlargement  of  the  joint  and  exacerbations  of  pain  and  swelling  during  damp  seasons. 
Recoveries  after  Shot  Coiitusions  of  the  Knee  Joint  treated  by  Conservation. — Twenty- 
two  cases  of  this  group  are  reported.  The  patella  was  the  seat  of  the  contusion  in  nine, 
the  condyles  of  the  femur  in  seven,  the  patella  and  condyles  of  the  femur  in  two,  and  the 
head  of  the  tibia  in  one  instance;  in  three  cases  the  parts  injured  are  not  specified.  Four 
were  Confederate  and  eighteen  were  Union  soldiers.  Of  the  latter,  one  was  returned  to 
duty  and  afterwards  killed  in  battle;  fifteen  became  pensioners,  of  whom  one  died  of 
phthisis  four  years  after  the  injury;  two  have  not  applied  for  pensions. 

CASE  5:?0. — Private  C.  Bowers,  Co.  D,  84th  Pennsylvania,  aged  23  years,  was  wounded  in  the  left  knee,  at  Winchester, 
March  23,  1862,  a  ball  striking  the  patella,  passing  upward  one  and  a  half  inches,  and  lodging.  He  was  admitted  to  St.  Joseph's 
Hospital,  Philadelphia,  April  2d,  where  the  missile  was  extracted  by  an  incision.  Considerable  pain  and  inflammation  ensued, 
and  an  abscess  formed  above  the  wound,  discharging  itself  through  the  opening  made  for  the  removal  of  the  ball.  The  patient 
was  discharged  July  16,  1862,  and  pensioned.  Examining  surgeons  report  him  suffering  from  weakness  in  walking. 

CASK  531.— Private  G.  W.  Clark,  Co.  G,  126th  Ohio,  aged  27  years,  was  wounded  at  Winchester,  September  19,  1864, 
by  a  musket  ball,  which  passed  through  the  right  knee,  grazing  the  patella.  He  was  treated  at  various  hospitals,  and  was 
ultimately  mustered  out  June  25,  1865,  and  pensioned.  Examining  surgeons  report  partial  anchylosis  of  the  knee,  difficulty  in 
walking  up  and  down  hill,  and  considerable  wasting  of  the  limb. 

CASE  532. — Private  G.  Deacon,  Co.  G,  14th  Virginia  Cavalry,  aged  25  years,  was  wounded  at  Boorisboro',  July  8,  1863, 
by  a  spent  ball,  which  entered  the  outer  and  lateral  surface  of  the  right  knee,  passed  inward  and  forward,  striking  the  patella 
and  lodging.  He  entered  Frederick  Hospital  one  week  afterwards.  The  patient  stated  that  he  worked  the  ball  out  with  his 
fingers  on  the  field.  About  July  25th,  an  abscess  formed  at  the  point  where  the  ball  had  lodged,  when  the  external  opening  was 
enlarged,  allowing  the  escape  of  about  half  an  ounce  of  pus.  Though  no  synovial  fluid  escaped,  marked  evidence  of  the  joint 
being  involved  existed,  the  swelling  being  more  extensive  on  the  following  day  and  fluctuation  well  marked.  Tincture  of  iodine 
was  then  freely  applied  and  the  limb  was  placed  in  Smith's  anterior  splint.  By  August  10th  the  wound  was  nearly  closed,  the 
effusion  within  the  joint  had  almost  entirely  subsided,  and  the  patient  was  comfortable.  On  August  20th  the  wound  was  entirely 
healed,  the  appearance  of  the  joint  being  natural,  though  considerable  anchylosis  existed,  partly  perhaps  from  deposit  and  partly 
owing  to  long  continuance  in  one  position.  About  a  week  later  the  splint  was  removed,  and,  on  September  1st,  passive  motion 
was  exercised  without  producing  much  puiu  or  tenderness.  On  September  5th,  the  patient  was  transferred  to  Baltimore,  having 
considerable  and  daily  increasing  motion  of  the  knee.  The  man  was  paroled  for  exchange  September  25,  1863. 

CASE  533. — Private  J.  Hammond,  Co.  15.  98th  Ohio,  aged  25  years,  was  wounded  in  the  left  knee  by  a  musket  ball,  at 
Chickamauga,  September  20,  1863.  lie  was  admitted  to  hospital  at  Chattanooga,  whence  Surgeon  J.  T.  Woods,  99th  Ohio, 
reported:  "The  missile  entered  at  the  inner  hamstring  precisely  opposite  the  centre  of  the  patella,  and  emerged  an  inch  from 
the  inner  border  of  the  patella."  The  patient  was  transferred  to  hospital  No.  1,  Nashville,  where  he  was  discharged  from 
service  March  3,  1864,  by  reason  of  "chronic  synovitis  and  anchylosis  of  the  knee  joint."  His  name  was  subsequently  admitted 
on  the  Pension  Rolls,  examining  surgeons  certifying  to  his  disabilities,  and  reporting  some  enlargement  of  the  bone  and  also 
swelling  of  the  leg. 

CASE  534. — Sergeant  J.  Hendricks,  Co.  F,  105th  Pennsylvania,  aged  32  years,  was  wounded  in  the  right  knee,  at  Gettys 
burg,  July  2,  1863.  He  was  admitted  to  hospital  at  Annapolis  two  weeks  after  the  injury,  and  several  months  later  he  was 
transferred  to  Philadelphia.  Surgeon  I.  I.  Hayes,  U.  S.  V.,  in  charge  of  Satterlee  Hospital,  reported  that  the  wound  was  caused 
by  "a  rifle  ball  striking  the  inner  portion  of  the  patella  and  involving  the  knee  joint.  The  patient  recovered  with  an  ancliylosed 
joint.  He  was  assigned  to  the  Veteran  Reserve  Corps  December  11,  1863."  On  September  16,  1865,  the  man  was  discharged 
from  service,  and  subsequently  he  became  a  pensioner.  In  1878,  the  examining  surgeons  reported:  "The  power  to  extend  and 
flex  the  injured  knee  is  still  slightly  impaired." 

CASE  535. — Private  G.  Hodges,  Co.  B,  7th  Michigan,  aged  25  years,  was  wounded  at  Gettysburg,  July  2,  1863,  and 
entered  Satterlee  Hospital,  Philadelphia,  one  week  afterwards.  Acting  Assistant  Surgeon  M.  J.  Grier  noted:  "A  shot  wound 
of  left  knee  by  a  mini6  ball  passing  over  the  patella,  cutting  through  the  outer  laminae  of  the  ligamentum  patella  and  scratching 
the  surface  of  the  bone."  A  portion  of  the  patella  became  necrosed  during  the  progress  of  the  case.  The  wound  closed  about 
October  1st,  but  reopened  some  ten  days  later,  when  a  small  piece  of  bone  exfoliated.  The  wound  healed  about  November  1st. 
Some  days  afterwards,  however,  the  patient,  while  wrestling,  fell  on  his  injured  knee,  breaking  open  the  tissues  down  to  the  ten 
don  over  the  patella  for  an  inch  and  a  half  in  length.  After  this  rupture  reclosed  the  patient  had  an  attack  of  facial  erysipelas, 
which  was  cured,  and  subsequently  he  suffered  with  otorrhoea.  On  March  24,  1864,  the  patient  was  returned  to  his  regiment 
for  duty.  He  was  killed  at  the  battle  of  the  Wilderness,  May  6,  1864. 


SECT.  IV.]  SHOT    CONTUSIONS    OF    THE    KNEE    JOINT.  365 

CASE  536. — Corporal  L.  P.  Miller,  Co.  G,  124th  New  York,  aged  27  years,  was  wounded  at  Chancellorsville,  May  3, 

1863,  by  a  rninie'  ball,  which  entered  the  left  knee  one-half  inch  external  to  the  inner  condyle  of  the  femur  and  emerged  two 
inches  anteriorly,  bruising  the  bone.     Surgeon  D.  W.  Bliss,  U.  8.  V.,  reported  his  admission  to  Armory  Square  Hospital,  Wash 
ington,  May  8th,  with  the  knee  joint  in  a  swollen  condition.     Irrigation  was  made  by  water  dressings,  and  subsequently  tincture 
of  iodine  was  applied  to  the  knee.     By  June  6th  the  wound  had  nearly  healed,  but  there  was  considerable  effusion  in  the  joint 
and  contraction  of  the  flexor  tendons.     The  patient  subsequently  passed  through  several  hospitals,  was  assigned  to  the  Veteran 
Reserve  Corps  March  2,  1864,  and  ultimately  discharged  August  13,  18(55,  and  pensioned.     Examining  surgeons  report  swelling 
of  the  knee,  owing  partly  to  enlargement  of  bone  and  partly  to  ocdematous  condition  of  the  tissues;  also  anchylosis  from  injury 
of  the  bony  structures  and  from  contraction  of  the  tendons  and  ligaments. 

CASE  f>37. — Private  M.  Piggott,  Co.  K,  8Sth  New  York,  aged  19  years,  was  wounded  at  Savage  Station,  June  29,  1862, 
by  a  mini6  ball,  which  grazed  the  right  knee  joint  between  the  patella  and  the  inner  condyle  of  the  femur.  He  was  captured 
and  remained  a  prisoner  for  nearly  a  month,  when  he  was  exchanged  and  conveyed  to  Philadelphia.  Acting  Assistant  Surgeon 
J.  B.  Bowen  reported  that  the  patient  was  admitted  to  Fourth  and  George  Streets  Hospital,  suffering  from  synovitis  and  a  very 
painful  wound  as  well  as  a  much  swollen  knee.  The  treatment  consisted  of  cold-water  dressings,  and  afterwards  fly  blister  and 
solution  of  lead  and  opium  was  used.  On  August  24th,  the  adhesions  were  broken  up  by  Acting  Assistant  Surgeon  S.  D. 
Gross,  and  splints  were  applied.  This  was  followed  by  more  severe  painfulness  and  enlargement  of  the  knee.  The  patient  was 
discharged  from  service  and  pensioned  February  10,  1883,  Assistant  Surgeon  L.  D.  Harlow,  U.  S.  V.,  certifying  to  the  "  wound 
causing  an  external  communication  with  the  knee  joint  and  resulting  in  permanent  anchylosis.  Surgeon  E.  P.  Vollum,  U.  S.  A., 
reported  that  the  pensioner  subsequently  served  in  the  43d  Infantry  (Invalid  Regiment),  his  injured  knee  being  free  of  pain,  but 
perfectly  anchylosed  and  considerably  bent  inward,  and  flexed  so  that  the  heel  did  not  reach  the  ground  by  about  four  inches. 
On  May  10,  1869.  the  man  was  again  discharged  and  re-admitted  on  the  Pension  Rolls. 

CASE  538. — Brigadier  General  T.  G.  Pitcher,  U.  S.  V.,  was  wounded  at  Cednr  Mountain,  August  9.  1862,  by  a  musket 
ball,  which  entered  the  right  knee  at  the  internal  condyle  of  the  femur,  striking  the  bone  perpendicularly  upon  its  anterior  face. 
The  result  of  the  injury,  as  apparent  nine  months  after  its  reception,  was  recorded  by  Surgeon  R.  S.  Satterlee,  U.  S.  A.,  before 
whom  the  patient  appeared  for  examination  in  April,  1863,  as  follows:  "There  is  an  unusual  accumulation  of  fluid  in  the  joint, 
enlargement  of  and  more  or  less  painfulness  generally  of  the  knee,  and  inability  to  extend  the  leg  completely.  The  knee  is  sub 
ject  to  pain  and  swelling  during  cloudy  weather,  and  the  General  is,  at  all  times,  required  to  use  a  crutch  and  cane.  It  would  be 
exceedingly  imprudent  for  him  to  travel.  It  is  not  known  whether  the  missile  remains  in  the  knee  or  came  out."  General 
Pitcher  was  mustered  out  of  the  Volunteer  service  April  30,  1863,  returned  to  the  Regular  Army,  and  was  ultimately  retired 
June  28,  1878. 

CASE  539. — Adjutant  J.  E.  Toure.  Caswell's  Georgia  Sharpshooters,  was  wounded  at  Liberty  Gap,  June  25,  1863,  and 
admitted  to  hospital  at  Murfreesboro'  the  following  day.  Assistant  Surgeon  W.  P.  McCullough,  78th  Pennsylvania,  in  charge, 
recorded  the  following  history:  "A  gunshot  wound  of  left  knee  by  a  mini6  ball.  The  missile  struck  the  outer  condyle  of  the 
femur,  glancing  downward  and  opening  the  capsular  ligament  of  the  joint,  and  making  its  exit  at  the  middle  of  the  fibula.  The 
wound  looked  healthy  and  there  was  no  inflammation.  Ice  was  applied  to  the  knee.  One-half  ounce  of  whiskey  was  given 
three  times  a  day,  and  anodynes  at  bedtime.  On  July  27,  1833,  the  patient  was  sent  to  the  prison  at  Nashville,  his  wound  being 
entirely  well,  and  there  being  but  partial  anchylosis  of  the  joint."1 

Fatal  Cases  of  Shot  Contusions  of  the  Knee  Joint  treated  by  Conservation. — Ten  cases 
of  shot  contusions  of  the  knee  joint  terminated  fatally.  The  patients  survived  the  injury 
from  twenty  to  seventy  days,  experiencing  extensive  burrowing  of  pus  and  ulceration  of 
the  joint,  erysipelatous  swelling,  arterial  bleeding,  and,  in  one  instance,  gangrene.  A  few 
cases  are  detailed: 

CASE  540. — Private  G.  W.  Perkins,  Co.  G,  1st  Massachusetts  Cavalry,  aged  22,  was  wounded  at  Beverly  Ford,  June  9, 
18o'3,  by  a  pistol  ball,  which  entered  the  left  knee  at  the  lower  outer  edge  of  the  patella,  passed  downward,  and  came  out  over 
the  head  of  the  fibula.  Three  days  after  the  reception  of  the  injury  he  was  admitted  to  Douglas  Hospital,  Washington,  where 
he  was  etherized  and  an  incision  made  to  examine  the  wound,  when  the  head  of  the  tibia  was  found  to  be  grazed  and  the  joint 
opened,  allowing  synovia  to  escape  on  motion  of  the  limb.  Ice- water  dressings  were  applied  for  a  couple  of  days.  It  was  then 
resolved  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  in  charge  of  the  hospital,  to  lay  the  knee  joint  freely  open  by  means  of 
liberal  incisions  on  either  side  of  the  patella  and  through  the  original  track  of  the  wound.  By  this  means  it  was  hoped  to  give 
free  exit  to  pus,  which  was  already  filling  the  joint,  and  to  save  the  limb  with  anchylosis,  the  operation  being  adopted  as  the 
only  alternative  to  amputating  the  thigh.  A  large  quantity  of  bloody  pus  and  synovia  escaped  when  the  lateral  incisions  were 
made;  two  or  three  cutaneous  vessels  were  tied,  and  by  means  of  a  syphon  the  limb  was  kept  constantly  under  the  effect  of  ice 
water.  The  patient,  though  having  some  fever  and  retention  of  urine,  had  very  little  pain  in  the  knee  and  felt  comfortable. 
Morphia  and  sweet  spirits  of  nitre  were  prescribed.  On  June  17th,  there  was  some  fluctuation  along  the  base  of  the  internal 
condyle,  for  which  a  free  horizontal  incision  was  made,  and  tlaxseed  poultices  were  applied.  All  the  incisions  about  the  knee 
continued  to  discharge  freely.  About  one  week  later  an  crysipelatous  swelling  was  noticed,  a  deep-seated  abscess  having  appar 
ently  formed  and  fluctuation  being  detected  below  the  head  of  the  tibia.  A  large  quantity  of  pus  was  then  liberated  by  a  careful 
dissection,  and  the  painful  tension  of  the  leg  was  thereby  relieved.  On  June  26th,  the  patient  had  a  severe  chill  for  the  first 
time,  and  his  stimulants  were  at  once  increased  and  quinine  and  capsicum  added  to  the  prescription  of  morphia.  On  the  follow 
ing  day  the  fever  had  disappeared,  but  pneumonic  symptoms  were  detected,  and  a  mustard  plaster  was  applied  over  the  left  chest. 

1  This  case  has  been  noted  by  Surgeon  I.  MOSKS  (Surgical  Notes  of  Cases  of  Gunshot  Injuries,  etc.,  in  the  American  Journal  of  Medical  Sciences, 

1864,  Vol.  XLVII,  p.  H40). 


366  INJURIES    OF    THE    LOWER    EXTREMITIES.  ICHAP.  x. 

Suppuration  .still  continued  freely  from  all  the  openings.  On  the  morning  of  July  1st,  a  large  amount  of  arterial  blood  was 
found  to  have  escaped  through  the  incision  along  the  gastrocnemius  muscle,  and  compression  was  at  once  made  in  the  groin  and 
the  wound  was  cleaned  out  carefully,  the  source  of  the  hleeding  being  apparently  the  anterior  or  posterior  tibial  artery  near  the 
bifurcation,  and  too  deeply  seated  to  be  reached  without  careful  dissection.  Meanwhile  the  patient,  already  moribund,  was 
stimulated,  but  without  avail.  He  died  within  a  half  hour,  from  the  immediate  effects  of  the  haemorrhage.  At  the  autopsy  a 
diffused  abscess  was  found  following  the  course  of  the  vessels  in  the  popliteal  space  into  Hunter's  canal  but  not  otherwise 
involving  the  thigh;  all  the  connecting  tissue  in  the  ham  was  iw  a  sloughing  condition.  When  the  artery  was  dissected  out  the 
perforation  was  found  in  the  anterior  tibial,  about  three-fourths  of  an  inch  from  its  origin,  the  vessel  being  much  thickened,  soft, 
and  tough,  though  not  materially  diseased.  The  left  lung  was-  found  firmly  adherent  and  much  congested.  The  bones  com 
prising  the  injured  knee  joint  were  contributed  by  Dr.  Thomson  (Cat.  Surg.  Sect.,  1866,  p.  323,  Spec.  1339),  and  the  history  of 
the  case  was  furnished  by  Assistant  Surgeon  C.  C.  Lee,  U.  S.  A. 

CASE  541. — Private  J.  McAllister,  Co.  C,  72d  Pennsylvania,  was  wounded  in  the  right  knee,  at  the  Wilderness,  May  6, 
1864,  by  a  mini£  ball,  which  entered  four  inches  above  the  external  condyle  and  lodged  on  the  outside  of  the  patella,  without 
perforating  the  capsular  ligament.  Surgeon  D.  Prince,  U.  S.  V.,  reports  that  the  following  treatment  was  resorted  to  in  the 
case:  "The  bone  was  cut  down  upon  and  the  missile  pulled  out.  No  inflammation  of  the  joint  ensued  until  the  eleventh  day 
after  the  injury,  when  the  joint  swelled  and  became  excruciatingly  painful,  attended  with  free  discharge  of  synovia  from  the 
wound  in  front,  on  the  outer  side  of  the  patella.  On  May  18th,  this  opening  was  enlarged  and  a  counter-opening  was  made 
behind  the  external  lateral  ligament  and  tendon  of  the  biceps,  the  patient  being  under  the  influence  of  ether.  The  limb  was 
subjected  to  moderate  extension  for  the  following  purposes:  1st,  to  separate  the  opposing  joint  surfaces  and  obviate  the  ulcera- 
tion  attending  contact  and  pressure,  at  the  same  time  lessening  the  amount  of  irritation;  2d,  to  obviate  the  caries  and  necrosis 
of  bone  apt  to  follow,  and  making  bony  anchylosis  impossible;  3d,  to  preserve  the  limb  in  a  position  to  be  afterwards  useful. 
The  patient  was  relieved  of  suffering  by  the  incision  and  experienced  a  feeling  of  comfort  from  the  moderate  extension."  The 
records  in  this  case  show  that  the  patient  was  admitted  to  the  field  hospital  of  the  2d  division,  Second  Corps,  with  "shot  wound 
of  knee,"  and  Surgeon  T.  R.  Crosby,  U.  S.  V.,  reported  that  the  man  entered  Columbian  Hospital,  Washington,  May  28th,  with 
"shot  wound  of  right  knee  joint,"  of  which  he  died  on  the  following  day,  May  29,  1864. 

CASK  542. — Private  A.  D.  Seelye,  Co.  A,  136th  Pennsylvania,  was  wounded  at  Fredericksburg,  December  13,  1862,  by 
a  musket  ball,  which  entered  the  right  knee  over  the  external  condyle  of  the  femur  and  passed  out  in  the  popliteal  space.  He 
was  admitted  to  Lincoln  Hospital,  Washington,  ten  days  after  the  injury.  Cold-water  dressings  and  afterwards  iodine  tincture 
were  applied  at  first;  subsequently  warm  dressings.  The  wound  did  badly;  the  joint  became  inflamed,  and  unhealthy  pus  was 
secreted  in  large  amounts.  On  January  16,  1863,  an  incision  was  made  extending  six  inches  from  the  wound  of  entrance  up  the 
thigh.  Considerable  bleeding  followed  and  several  small  vessels  were  tied,  after  which  the  wound  was  packed  with  cotton 
bandages  soaked  in  persulphate  of  iron.  Another  lateral  incision,  two  and  a  half  inches  long,  was  made  below  the  popliteal, 
opening  an  abscess.  On  January  25th,  an  opening  was  made  opposite  the  large  one  for  the  purpose  of  better  drainage.  Up  to 
this  time  his  appetite  had  been  good,  but  now  it  failed,  and  the  patient  became  delirious  and  had  a  troublesome  diarrhoea.  The 
wound  remained  open  and  exposed  the  blackened  surface  of  the  femur  for  the  space  of  three  inches.  Death  supervened  on 
February  3,  1863.  At  the  post-mortem  examination  the  internal  condyle  was  found  to  be  injured  in  its  posterior  aspect.  The 
cartilages  of  the  joint  were  destroyed  and  the  surfaces  of  most  of  the  bones  roughened  and  honey-combed.  An  abscess  in  the  thigh 
had  dissected  the  femur  half  way  up  the  limb.  The  history  of  the  case  was  recorded  by  Acting  Assistant  Surgeon  T.  H.  Dearing. 

CASE  543. — Private  J.  Tetlow,  Co.  F,  23d  New  Jersey,  was  wounded  at  Fredericksburg,  December  13,  1862,  by  a  ball 
entering  the  outer  side  of  the  popliteal  space  of  the  right  leg.  The  patient,  a  strong  healthy  man,  was  admitted  to  hospital  at 
Alexandria  six  days  after  receiving  his  wound.  The  knee  was  tender  and  the  inflammation  slight  at  first,  but  soon  grew  worse. 
On  December  23d,  the  patient  had  a  chill  and  there  was  high  constitutional  fever,  with  great  swelling  and  pain  in  the  knee.  On 
the  following  day  the  ball  was  discovered  lying  loose  in  the  wound  and  was  removed.  On  December  29th,  pus  was  detected 
and  let  out  by  free  incision,  giving  much  relief.  Subsequently  the  patient  became  delirious  at  times,  and  on  December  31st  he 
again  had  a  chill,  with  pain  in  the  stomach.  He  died  January  2,  1863.  At  the  autopsy  it  was  ascertained  that  the  ball  had 
impinged  upon  the  under  side  of  the  internal  condyle,  killing  the  periosteum  for  over  a  space  -of  half  a  dime.  The  other  articu 
lating  bones  were  also  found  bare  of  periosteum,  and  pus  had  filled  the  knee  joint  and  dissected  up  the  lower  third  of  the  femur. 
The  case  was  reported  by  Acting  Assistant  Surgeon  G.  F.  French.1 

CASK  544. — Private  L.  D.  Wells,  Co.  D,  74th  Indiana,  aged  22  years,  was  wounded  at  Chickamauga,  September  20, 
1863,  by  a  musket  ball,  which  entered  about  two  inches  above  the  inner  condyle  of  the  right  femur,  passed  obliquely  under  the 
bone  between  the  two  condyles,  grazing  the  inner,  and  emerged  about  three  inches  below  the  head  of  the  fibula.  He  was 
admitted  to  hospital  at  Chattanooga,  and  thence  transferred  to  hospital  No.  8,  Nashville,  on  October  30th.  There  was  little 
swelling  of  the  parts,  and  the  relative  constitutional  condition  of  the  patient  was  good  until  he  became  greatly  prostrated  from 
haemorrhage,  the  precise  seat  of  which  could  not  be  determined.  On  November  17th,  the  femoral  artery  was  ligated  at  Scarpa's 
space  by  Surgeon  W.  C.  Otterson,  U.  S.  V.  Reaction  was  perfect  by  the  following  day.  The  limb  was  wrapped  in  cotton  bat 
ting.  No  particular  change  occurred  until  November  24th,  when  the  wound  suppurated  excessively  and  injections  of  solution 
of  sulphate  of  iron  were  ordered.  The  leg  and  foot  were  cedematous.  On  the  next  day  the  wound  made  by  the  operation  broke 
open  and  suppurated  freely.  On  November  27th,  the  patient  was  worse  in  every  respect  and  marks  of  gangrene  appeared. 
Remittent  haemorrhage  from  the  anterior  tibial  artery  caused  death  on  December  1, 1863.  The  autopsy  showed  that  the  ligature 
had  not  yet  cut  away.  The  femoral  was  obliterated  on  the  cardiac  side  for  about  one  inch  ;  the  profunda  was  greatly  enlarged. 
The  femoral  vein  was  discolored  and  contained  a  clot  three  or  four  inches  long  and  not  entirely  obstructing  the  circulation.  The 
structures  at  the  seat  of  the  haemorrhage  were  greatly  disintegrated.  Tl.e  hie  -ry  of  the  case  was  reported  by  the  operator. 


'BELLANGER  (J.  B.),  Report  of  Wve  Cases  of  Gunshot  Injury  of  the  Knee  Joint  treated  at  Mansion  House  Hospital,  Alexandria,  Virginia,  Slay 
Iti,  18(i3,  in  American  Journal  Medical  Sciences,  1863,  Vol.  XLVI,  p.  44. 


SECT.  IV.] 


SHOT    FKACTURES    OF    THE    KNEE    JOINT. 


367 


CASK  ."45. — Private  C.  Wertli,  Co.  K,  1st  New  York,  aged  22  years,  was  wounded  in  the  left  knee  and  right  ankle,  near 
Richmond.  June  30,  1862.  Acting  Assistant  Surgeon  J.  B.  Bowen  reported:  ''A  ball  entered  one  inch  above  the  knee,  and 
eiu.rged  at  the  inner  portion  of  the  leg  one  inch  below  the  patella,  grazing  that  bone  and  the  head  of  the  tibia;  the  other  ball 
entered  at  the  external  nialleolus  and  comminuted  the  tarsul  bones.  The  wounded  man  was  taken  prisoner  and  sent  to  Rich 
mond.  He  was  received  at  the  Fourth  and  George  Streets  Hospital,  Philadelphia.  July  23th,  in  a  debilitated  state  and  with  both 
wounds  in  a  very  bad  and  painful  condition,  there  being  synovitis  of  the  knee  and  purulent  discharges.  Linseed  poultices  and 
solution  of  sulphate  of  copper  were  applied  to  the  ankle,  and  cold-water  dressing  and  subsequently  blister,  followed  by  solution 
of  lead  and  opium,  were  used  to  the  knee.  The  patient  gradually  sank,  and  died  from  exhaustion  August  8,  1862.'' 

Amputations  after  Shot  Contusions  of  the  Knee  Joint. — The  ten  instances  comprising 
this  group  have  already  been  cited  in  the  tables  of  amputations  in  the  thigh  in  the  pre 
ceding  section  of  this  Chapter.  Five  were  intermediary  and  five  secondary  operations.1 
Eight  of  the  ten  operations  terminated  fatally. 

SHOT  FRACTURES  OF  THE  KNEE  JOINT.— The  cases  to  be  considered  in  this 
group  are  those  involving  primarily  the  bones  composing  the  knee  joint.  They  number 
three  thousand  three  hundred  and  fifty-five,  atid  are  classified  in  the  subjoined  table: 

TABLE  LII. 

Numerical  Statement  of  Thirty-three  Hundred  and  Fifty-jive  Cases  of  Shot  Fractures  of  the  Bones  of  the 

Knee  Joint. 


PARTS  INJURED. 

MODE   OF    TREATMENT. 

CONSERVATION. 

Excis.  OF  KNEE 
EXCISION  OF  KNEE    :,    J'T  FOLLOWED    AMPUTATION  AT  KNEE 
JOINT.                 :    BY  AMPUTAT'N                  JOINT. 
or  THIGH. 

AMP.  AT  KNEE 

j    BY  AMPUTAT'N 
1    OF  THIGH. 

AMPUTATIO> 
THIGH. 

OF 

| 

s 

o 

ill 

o 

o 

69 
9 

7 

1 
84 
22 
6 
56 
84 

Death. 

Undetermined. 

Mortality  Rate  of 
Determined  Cases. 

'_" 

Recovery. 

| 

Undetermined. 

a 
0 

Recoverj'. 

1   ! 
G 

5 

£? 

V 

1 

Death. 
Undetermined. 

W 

Recovery. 

i       :   . 

3    "      1            5 
o            a             o 

$ 

£ 

159 
17 
22 

4 

117 
47 
10 
137 

89 
8 
15 

30 
25 
4 
80 

1 

1 
4 

56.  3 
47.0 
68.1 

75.0 
26.3 
53.1 
40.0 
58.8 
76.0 

10 
4 
2 

8 
2 
1 
5 
14 

1 
1 

7 
3 
2 

2 

7 

Q 

.... 

2 

o 

4 

1 

3 

419       178 
68         26 
59         23 

20           9 
21           9 
85         55 

17  j         7 
285       H5 
1,403'     744 

241 
36 

11 
12 
30 
10 
170 
659 

Patella  and  Condyles  of  Femur  .. 
Cond.  of  Femur  and  Head  of  Tibia 
Cond.  of  Femur,  Patella,  and  Head 
of  Tibia         .   .           .... 

1 

1 

1 

1 

1 

1 

Patella,  not  opening-joint  primarily 
Patella,  opening  the  joint  primarily 
Patella  and  Head  of  Tibia  .... 

1 

1 

1 
1 
4 
12 

1 
1 
1 
7 
13 

1 

2 

13 

1 

1 
1 
2 

•1 

1 

Head  of  Tibia 

2 
1 

11 

2 

3 

3 

868 

338 

521 

9 

60.6 

49 

8 

38 

3 

7 

1 

6 

49 

25 

23 

1 

5 

« 

1 

2,377   1,166 

1,211 

It  will  be  seen  that  the  table  embraces  a  great  variety  of  injuries.  In  two  hundred 
and  eighty-three  instances  the  bony  lesion  interested  the  patella  only;  in  five  hundred  and 
ninety-four  the  condyles  of  the  femur  were  fractured;  in  eighty-nine  the  condyles  of  the 
femur  and  the  patella;  in  eighty-six  the  condyles  of  the  femur  and  the  head  of  the  tibia; 
in  twenty-seven  the  condyles  of  the  femur,  the  patella,  and  the  head  of  the  tibia:  in 
thirty-three  the  patella  and  the  head  of  the  tibia;  in  four  hundred  and  forty  the  head  ot 

'The  cases  of  intermediary  operations  are:  Pt.  J.  Kimm,  E,  li)2d  New  York,  recovery  (No.  99,  TABLIC  XXXV,  i>.  281);  Pt.  C.  Kerkey,  A.  10th 
Pennsylvania  Reserves,  fatal  (No.  221,  TABLE  XXXV,  p.  283);  Serg't  J.  Walker,  F,  2d  Maryland,  fatal  (No.  453,  TABLE  XXXV,  p.  28(5);  Serg't  M. 
Akeman,  I,  13th  Indiana,  fatal  (No.  220,  TABLE  XXXVI,  p.  296);  Pt,  J.  Wright,  D,  7th  New  York  Heavy  Artillery,  fatal  (No.  H7(i,  TAIILK  XXXVI.  |>. 
303).  The  secondary  operations  are:  Pt.  7.  Bradley,  D,  25th  North  Carolina  (No.  32,  TABLE  XXXVIII,  p.  308);  Pt.  J.  Jones.  1C,  13th  Tennessee  Cav 
alry,  recovery  (No.  40.  TABLE  XXXIX,  p.  314);  Corp'l  R.  H.  McCann,  Q,  13th  Mississippi,  fatal  (No.  141,  TAIILK  XXXIX,  i>.  :u:»;  I't.  T.  Nevins.  K, 
G3d  New  York,  fatal  (No.  172.  TABLE  XL,  p.  322);  Corp'l  J.  D.  Touhey,  B,  14th  New  York,  fatal  (No.  196,  TABLE  XL,  p.  323). 


368  INJURIES    OF    THE    I.OWI1R    EXTREMITIES.  fCHAP.  x. 

the  tibia  was  involved;  and  in  one  thousand  eight  hundred  and  three  the  fractured  portion 
of  the  articulation  was  not  specified.  Eight  hundred  and  sixty-eight  were  treated  on  the 
expectant  conservative  plan  ;  forty-nine  by  excision;  seven  by  excision  and  subsequent  ampu 
tation  of  the  thigh;  forty-nine  by  amputation  through  the  articulation;  rive  by  amputation 
at  the  knee  joint  and  subsequent  amputation  of  the  thigh;  two  thousand  three  hundred  and 
seventy-seven1  by  amputation  of  the  thigh,  six  of  which  were  followed  by  amputation  at 
the  hip.'2 

SHOT  FRACTURES  OF  THE  BONES  OF  THE  KNEE  JOINT  TREATED 
BY  CONSERVATION. — Of  the  three  thousand  three  hundred  and  fifty-five  cases  of  shot 
fractures  of  the  bones  of  the  knee  joint,  eight  hundred  and  sixty-eight,  or  about  one-fourth, 
were  treated  throughout  without  operative  interference.3  The  results  in  nine  instances 

1  There  are  noted  in  this  table  2,3S'.»  amputations  of  the  thigh  f..r  sh<,t  fractures  of  tlie  bones  of  the  knee  joint,  of  which  11!  had  been  preceded  by 
excisions  or  amputations  at  the  knee  joint,  and  (i  had  been  followed  by  disarticulatiou  at  the  hip.  To  these  J.:*9  amputations  should  be  added  10  opera 
tions  for  shot  contusions  of  the  knee  joint,  making  the  total  of  2.399  cases  of  thigh  amputations  for  shot  injuries  of  the  knee  joint,  as  indicated  in  TAltLK 
XI, VI,  on  page  332,  ante. 

"Cases  of  Pt.  Julius  Fabry,  Co.  1C,  4th  Artillery  (CASE  330,  p.  153.  and  No.  2  of  TAIJI.E  XVII,  p.  15!>):  1't.  Eben  K.  Smith,  Co.  A.  llth  Maine 
(CASK  3:)2,  p.  155,  and  No.  4  of  TABLE  XVII,  p.  159);  Serg't  E.  I).  Ulrner,  Co.  G,  15th  New  Jersey  (CASE  333,  p.  15(i.  and  No.  5  of  TAIU.K  XVII,  p.  159); 
Pt.  It.  A.  Vick,  Co.  10,  43d  North  Carolina  (CASE  334,  p.  157,  and  No.  C  of  TABLE  XVII,  p.  159);  Henry  Campbell,  sutler's  clerk  (CASE  335,  p.  157,  and 
No.  7  of  TAUI.E  XVJI.  p.  159),  and  Pt.  Lewis  Larry,  Co.  A,  1st  New  Orleans  Regiment  (CASE  33(i,  p.  158,  and  No.  9  of  TABLE  XVII,  p.  159). 

a Examples  of  shot  wounds  of  the  knee  joint  treated  without  operative  interference  have  been  cited  by  FRAMBESAKIUS  (N.  A.)  (Canonum  et  Con- 
sultationum,  Librilll.  quibus  aphoristica  metlwdus  medendi  omnibus  affectibus  corporis  continetur,  Paris,  15i:5):  A  ball  lodged  in  the  knee  joint  appeared 
afterwards  on  the  surface  and  was  cut  out.  SCHMIDT  (J.)  (Speculum  Chirurgicum  oder  Spiegel  der  Arztne.i.  Augspurg.  1(>56,  pp.  153  et,  se</.):  On  Decem 
ber  12,  1032.  a  Swedish  dragoon  was  shot  through  both  knees;  both  patellas  were  fractured;  the  patient  recovered,  but  could  walk  only  poorly  on  crutches. 
In  October,  Ki47,  a  Bavarian  soldier  was  shot  through  the  right  knee;  he  remained  for  three  days  without  assistance;  a  "jury  of  six"  recommended  ampu 
tation  ;  Dr.  SCHMIDT  refused  to  operate,  dressed  the  wounds,  and  placed  the  limb  in  a  straight  position  ;  pieces  of  bone  came  away ;  recovery  in  six  weeks. 
G.  ISasch,  shot  through  the  left  knee  joint,  May  18,  1648;  fracture  of  bones;  recovery.  Th.  Rosen,  shot  through  right  knee:  recovery.  Z.  Neschin.  shot 
through  right  knee,  May  20,  1648;  swelling;  suppuration  relieved  by  incision;  recovery.  GUILLEMEAU  (J.)  (Les  Oe.urres  de  Chirurgie,  Rouen,  1G49, 
Chap.  IV,  p.  (i52):  M.  de  la  Tour  received,  in  the  barricades  of  Paris,  a  shot  wound  of  the  left  knee  joint :  ball  entered  above  the  crest  of  the  tibin, 
fractured  "  le petit  fossile"  in  several  pieces.  Barber-surgeon  Habicot  made  an  incision  and  removed  the  spiculae ;  recovery.  WISEMAN  (K.)  (Severall 

Chirury.'call  Treatises,  London,  Ki7«,  p.  430):  A  page  of  Lieut.  General  D.  L was  shot  through  the  knee,  the  ball  fracturing  the  joint :  excessive  pain 

and  aneurismal  bleeding;  putrefaction,  delirium,  spasms,  death.  BELLOSTE  (Le  Chirurgien  d'Uopital,  Paris,  171(i,  p.  21(i):  A  captain,  shot  through  the 
right  knee,  at  Pignerol,  in  1G91 ;  extensive  suppuration;  wound  of  entrance  enlarged  by  incision;  recovery  in  five  months.  MoiiAXl)  (Opuscules  de 
Chirurgie,  Paris,  1768,  T.  II,  p.  252):  General  Keith,  shot  at  the  siege  of  Okzakow,  in  1738,  through  the  right  knee  ;  extensive  suppuration  followed;  two 
pieces  of  cloth  escaped;  the  General  recovered  and  was  afterwards  killed  at  the  battle  of  Chemnitz.  DESl'Oin  ( Traite  des  plaits  d'armes  a  feu,  Paris, 
1749.  p.  22-'  et  seq.):  A  cannonier,  at  the  siege  of  Milan,  in  1733,  received  a  shot  wound  of  the  knee  joint,  fracturing  the  inferior  extremity  of  the  femur; 
wound  enlarged  and  the  ball,  found  embedded  in  the  femur,  removed.  The  patient  recovered  in  two  months.— A  soldier,  shot  in  the  right  knee,  at  the 
battle  of  Parma,  in  1733-  the  ball  lodged  in  the  joint.  The  extenial  condyle  of  the  femur  was  fractured;  the  ball  was  extracted,  and  the  patient  recov 
ered  with  complete  anchylosis.  A  volunteer  was  shot,  in  Corsica,  in  the  outer  and  anterior  part  of  the  knee.  The  wound  was  enlarged  and  fragments  of 
the  outer  condyle  of  the  femur  and  of  the  patella  were  removed,  and  the  ball  extracted;  the  patient  recovered  in  two  and  a  half  months.  TIIEDEN  (J. 
C.  A.)  (Neue  Remcrkungen  und  Erfahrunijen  zur  Sereicherung  der  YVnndarzne.ykunft,  Berlin,  1782,  1?,  I.  p.  78):  Major  Kamke,  wounded  at  Striegau,  in 
1745 :  the  ball  perforated  both  condyles  of  the  femur ;  the  wound  was  enlarged  and  a  large  number  of  spiculss  removed  from  the  extremity  of  the  femur ; 
recovered  with  a  stiff  knee  joint.  BOUCllElt  (Observations  sur  des  playes  d'armes  u  feu,  etc.,  in  Alem.de,  I'Acad.  Roy.  de  Cltir.,  Paris,  1753,  T.  II,  p.  295): 
A  drummer,  wounded  May  2,  1749.  at  Lille,  through  the  internal  condyle  of  the  femur:  wound  enlarged  and  fragments  removed;  recovery,  with  stiff 
knee  and  one  and  a  half  inch  shortening.  BELMAS  (BORUEXAVE)  (Precis  deplusieurs  observations  sur  les  plaijcs  d'armes  .'  feu,  etc..  in  Mem.  de  I'Acad. 
Roy.  de  Chir.,  Paris,  1753,  T.  11,  p.  527):  A  captain  of  an  Algerian  vessel  was  shot  through  the  knee,  the  ball  carrying  away  about  throe  inches  of  the 
upper  part  of  the  tibia.  i»  small  portion  of  the  patella,  the  head  of  the  fibula,  and  a  portion  of  the  condyle  of  the  femur.  Dr.  BELMAS  removed  several 
fragments,  and  the  patient  recovered  with  anchylosis  of  the  knee  joint.  Two  similar  cases  are  detailed  by  MEHEE  (J.)  (Traite  des  plain  d'armes  it  feu, 
Paris,  An.  VIII  (1800),  p.  175):  A  cavalier,  wounded  at  Ludzerberek ;  the  ball  passed  through  the  right  knee  from  before  backwards,  shattering  the 
patella  and  the  condyles  of  the  femur:  extensive  incisions  were  made  and  numerous  pieces  of  bones,  some  loose,  some  partly  attached,  were  removed; 
recovery,  with  complete  anchylosis.  A  laborer  of  Meaux  was  shot  through  the  right  knee  from  the  outer  to  the  inner  side,  shivering  the  articulation  ; 
swelling  of  the  thigh  and  gangrene ;  large  incision  to  allow  the  escape  of  fetid  pus ;  a  piece  of  bone  the  size  of  a  dollar,  and  of  the  thickness  of  the  little 
finger,  from  the  condyles  of  the  femur,  was  removed,  and  other  sharp  points  of  bone  were  cut  off;  15  days  later  another  piece  of  bone,  an  inch  long,  from 
the  loose  portion  of  the  shaft  of  the  femur,  was  removed ;  recovery,  with  hardly  any  defect  of  the  articulation.  HUNTER  (JOHN)  (A  Treatise  on  the  Jllood, 
Inflammation,  and  Gunshot  Wounds,  London,  4to,  17B4,  p.  531):  A  French  soldier  at  Bellisle,  in  17(il,  shot  through  the  knee,  the  ball  traversing  the 
joint  without  fracture  of  bones;  recovery.  L.  J.  RABASSE  (Sur  les  plaies  des  articulations  faitcs  par  les  armes  dfeuou  les  instrumens  tranclians.  These 
a  Paris.  1811,  No.  84,  pp.  10,  18):  General  Charles  de  Lameth,  wounded  at  the  siege  of  New  York  1783,[H  the  ball  traversing  the  left  kneo  through  the 
condyles  in  its  greatest  diameter  from  the  right  to  the  left.  The  patient,  who  was  treated  by  Surgeon-Major  ROBILLAKD,  of  the  French  army  in  the 
United  States,  recovered  without  the  least  immobility  of  the  limb.  In  a  second  case  the  eondyles  of  the  femur  were  fractured,  and  the  ball  lodged. 
The  missile  could  not  be  found.  Extensive  swelling  followed,  but  the  patient  recovered  in  about  three  months,  with  anchylosis  of  the  knee.  The 
author  regrets  that  the  man's  pantaloons  were  not  examined,  as  the  ball  might  have  been  found.  DKSAULT  (Journal  de  Chirurgie,  Paris,  1791,  T.  I, 
p.  321):  V.  Viry,  aged  15  shot  in  the  right  knee  on  January  (i,  17!'0;  fracture  of  the  patella  and  the  condyles  of  the  femur;  recovery  without  anchy 
losis.  GEltMAIX  LEVIKLS  (Essai  sur  lex  avantages  qu'il  peut  y  aroir  a  amputer  la  cuisse,  lorsqu'itn  coup  de  feu  a  travers:'  I' articulation  du  ge.noti,  ou 
lorfquf.  la  balle  y  eat  demeuree  profonddment  engagie,  Paris,  These,  Vol.  XXXII,  An  Xl-1803,  p.  40  et  seq.)  cites  six  fatal  cases:  J.  Bourdon,  wounded 
in  I'.aly,  November  22,  1793;  shot  wound  of  knee  joint;  bones  not  fractured;  fatal.  Young  man,  aged  20;  shot  through  knee  joint  in  June,  1797; 
bones  crushed;  amputation  refused;  fatal.  Two  soldiers  shot  in  the  knee  joint  in  October,  1793.  The  patella  and  the  condyles  of  the  femur  were 
fractured  in  one  case ;  the  ball  lodged;  erysipelatous  swelling;  death.  In  the  other  case  the  ball  passed  through  the  joint,  perforating  the  condyles 
of  the  femur;  several  spiculae  were  removed;  suppurative  fever  and  death.  Captain  Milet,  72d  Grenadiers,  shot  through  the  knee  joint  June  27.  1798; 
no  bony  lesion;  suppuration  relieved  by  incision;  fever;  death.  Barot,  72d  Grenadiers,  shot  in  the  right  knee  on  October  2,  1799;  extreme  pain, 
swelling,  inflammation,  and  death.  PERCY  (Manuel  du  Chirurgien- D'Armee,  Paris,  1792,  p.  1U4)  alludes  to  the  ease  of  M.  d'Almons,  an  engineer; 


SECT.  iv.|  SHOT    FRACTURES    OF    THE    KNEE    JOINT.  369 

could  not  be  ascertained.  Three  hundred  and  thirty-eight  were  successful,  and  five  hundred 
and  twenty-one  fatal,  a  mortality  of  60.6  per  cent. 

Recoveries  after  Shot  Fractures  of  the  Bones  of  the  Knee  Joint  treated  by  Conserva 
tion. — Examples  of  the  three  hundred  and  thirty-eight  recoveries  after  shot  injuries  of  the 
bones  of  the  knee  joint  treated  throughout  on  the  expectant  plan,  will  be  cited  in  the  order 
of  the  groups  indicated  in  TABLE  LII.  In  the  following  five  cases  the  joint  was  opened 
and  the  condyles  of  the  femur  injured: 

CASE  546. — Captain  A.  P.  Fisk,  Assistant  Adjutant  General,  U.  S.  V..  was  wounded  at  Fair  Oaks,  June  1,  1862,  by  a 
conoida!  musket  ball,  which  entered  the  inner  side  of  the  right  knee  and  was  cut  out  from  beneath  the  skin  on  the  outer  aspect. 
The  haemorrhage  following  the  injury  was  slight.  The  case  was  reported  by  Surgeon  G.  Grant,  U.  S.  V.,  who,  together  with 
Surgeons  J.  A.  Lidell  and  A.  N.  Dougherty,  was  satisfied  that  the  joint  was  implicated.  Immediate  amputation  was  advised 
but  rejected  by  the  patient.  The  pain  in  the  joint  was  excruciating.  Surgeon  Grant  dressed  the  wound,  after  which  the  patient 

the  ball  encrusted  itself  in  the  condyle  of  the  femur,  and  the  patient  recovered.  WEDEKIND  (GEORGE)  (Nachrichten  ueber  das  FranzBsische  Kriegs- 
apitalwesen,  Leipzig.  1798,  B.  II,  p.  £05):  J.  H.  Barzou,  Corporal,  10th  demi- brigade  of  Light  Infantry;  shot  comminution  of  right  knee,  in  1795, 

near  Uastadt :  tetanus:  death.     CHEVALIER  (T.)  (A  Treatise  on  Gunshot  Wounds,  1804,  p.  116):  J.  T ,  aged  19,  August  27,  1799,  external  condyle 

of  femur  split ;  October  1st,  a  piece  of  bone  removed ;  10th.  amputation  proposed  but  abandoned  as  the  patient  fainted  on  moving ;  death  in  a  few  days. 
At  the  post-mortem  the  ball  was  found  in  the  internal  condyle  of  the  femur.  LAUKEY  (D.  J.)  (Mem.  de  Cliir.  Mil.  ft  Camp.,  Paris,  1812,  T.  Ill,  p.  236): 
Ibrahim,  a  mameluke,  received,  in  August,  1799,  a  shot  fracture  of  the  patella;  the  ball  traversed  the  knee  joint;  the  patient  recovered.  FENECH 
(E.)  (Obs.  recueillies  d  Varmce  d'Espagne  svr  les  plates  d'armes  a  feu  aux  extremites,  Paris  Thesis.  1813,  pp.  13,  19):  Obs.  XIII,  soldier  of  62d  regiment, 
wounded  at  Yimeira,  in  Spain,  August  17,  1808  ;  fracture  of  inner  condyle  of  femur;  recovery.  Obs.  XXVIJ,  Gracieux,  Adjutant,  62d  regiment,  wounded 
August  17,  1808;  fracture  of  patella  and  inner  condyle  of  femur;  fatal.  MEALOXIER  (Sur  les  plaies  de  I' articulation  du  genoufa  ites  par  les  armes  tiifeu, 
Paris,  These  No.  16,  1814,  pp.  19,  22,  24):  Lecoeur,  50lh  line,  shot  through  the  right  knee,  at  Salamanca,  July  12,  1812;  the  ball  traversed  the  joint; 
no  bony  lesion ;  death.  A  dragoon,  10th  line,  in  Calitzia,  in  1806,  was  shot  in  the  left  knee;  ball  lodged  in  the  external  condyle  of  the  femur;  incision 
made,  and  ball  and  large  fragment  of  bone  removed;  death.  A  soldier,  at  Pultusck,  December  26,  1806,  received  a  shot  fracture  of  the  inner  condyle 
of  the  femur,  the  ball  traversing  the  joint;  tumefaction;  death.  DEGUISE  (CH.)  (Dissertation  sur  les  plaies  des  articulations,  Paris  These,  1815,  No.  4, 
p.  17):  A  sub-lieutenant  of  the  80th  line;  shot  in  Spain,  through  the  knee;  no  lesion  of  bone;  complete  recovery.  BLONDEAU  (J.)  (Propositions 
de  patkologie  fondies  sur  des  observations,  Paris,  1815,  These  No.  64,  p.  21,  Obs.  X):  A  soldier  at  the  battle  of  Aropiles,  in  Spain,  in  1810,  was  shot 
in  the  right  knee,  the  ball  lodging  under  the  patella,  whence  it  was  removed ;  he  recovered.  BELL  (C.)  (Report  on  Gunshot  Wounds  of  the  Knee  Joint  in 

Surgical  Observations ;  being  a  Quarterly  Report  of  Cases  in  Surgery  treated  in  the  Middlesex  Hospital,  London,  1816,  p.  429):   D ,  shot  in  the 

knee  September  6,  1812;  ball  lodged  in  condyle  of  femur;  recovery.  TROWliKIDGE  (A.)  (Gunshot  Wounds,  in  Boston  Medical  and  Surgical  Journal, 
1838,  Vol.  XVIII,  p.  342):  Colonel  McNeil,  shot  in  the  knee,  at  the  battle  of  Bridgewater,  July  25,  1814 ;  the  ball  entered  above  the  patella  and  injured 
the  condyles  of  the  femur;  recovery,  with  partial  anchylosis.  MANN  (JAMES)  (Medical  Sketches  of  the  Campaigns  of  1812-13-14,  etc.,  Dedham,  1816, 
p.  211):  A  soldier  of  the  33d  regiment,  admitted  into  hospital  at  Burlington  with  a  shot  wound  through  the  knee;  amputation  proposed  but  refused; 
sinuses  laid  open  and  a  spiral  bandage  applied  from  foot  to  trunk;  recovery,  with  a  stiff  joint.  EHULICH  (J.  A.)  ( Chir.  Beobachtungen,  Leipzig,  1815, 
B.  II,  p.  115):  A  soldier  of  the  5th  Italian  regiment,  aged  22,  shot  at  Liitzeu,  May  3,  1813,  through  the  right  knee  joint,  fracturing  the  external 
condyle  of  the  femur  and  internal  condyle  of  tibia ;  recovery,  with  anchylosis  of  joint.  CHAMPION  (L.)  (Traite  de  la  Resection  des  os  caries  dans  leur 
continuile  on  Uors  des  articulations,  Paris,  1815,  No.  11,  p.  77,  Obs.  XIV):  Chauveau,  42d  demi-brigade,  shot  in  the  right  knee,  at  Ltltzen,  May  2, 
1813;  ball  struck  internal  condyle  of  tibia  and  lodged,  and  was  removed  in  April,  1814,  by  chiseling  away  the  carious  surface  of  the  bone;  recovery, 
with  good  use  of  limb.  BLKNKIXS  (G.  E.)  (Article  Gunshot  \Younds,  in  COOPER'S  Dictionary  of  Practical  Surgery,  London,  1861,  Vol.  I,  p.  816):  A 
soldier  of  the  95th  regiment  was  shot  through  the  knee  joint,  at  Merksam,  near  Antwerp,  in  1814 ;  he  died  after  several  months'  suffering.  CAilliUAY 
(Journal  de  Chirurgie,  par  M.  MALGAIGNE,  1846,  T.  IV,  p.  361):  A  young  man,  aged  15,  shot  through  the  patella,  at  the  storming  of  Cambria,  near  Water, 
loo,  in  1815;  recovery.  HEXNEN  (Joiix)  (Principles  of  Military  Surgery,  London,  1829,  p.  147  et  seq.):  A  soldier,  shot  in  the  knee  joint  at  the  storming 

of  Nivelle,  Nov.  10,  1813,  the  ball  perforating  the  join*;  inflammation,  and  death  on  the  fourth  day.    Lieutenant-Colonel  R ,  shot  in  the  right  knee 

joint,  June  18, 1815;  the  patella  was  fractured;  the  missile  lodged  ;  recovered,  with  good  use  of  limb,  in  about  five  weeks.     Major  B .  aged  28,  received 

a  shell  wound  of  the  right  knee,  June  18,  1815;  the  patella  was  fractured  and  the  femur  grazed;  fever;  swelling  of  lower  part  of  thigh;  incision  on 
external  part  of  thigh  four  inches  deep:  a  pint  of  pus  evacuated;  July  6th,  portion  of  patella  removed;  recovery,  with  complete  anchylosis.  BEGIN 

(L.  J.)  (Memoire  sur  le  traitcment  des  plaies  des  articulations,  in  Kec.  de  Mem.  de  Med.  de  Chir.,  etc.,  1825,  T.  XVI,  1st  s6r.,  p.  6):  J.  A ,  chasseur, 

wounded  at  Barcellona,  Spain,  September  15,  1823 ;  fracture  of  patella  and  condyle  of  femur ;  recovery.  JOBERT  UE  LAMISALLE  (Plaies  d'armes  dfeu, 
Paris,  1833,  p.  266  et  seq.)  gives  brief  details  of  11  penetrating  wounds  of  the  knee  joint  from  the  revolution  in  Paris,  in  1830;  10  recovered  and  1  proved 
fatal.  In  the  fatal  case  the  femur  and  tibia  were  interested  ;  of  the  10  cases  of  recovery  the  condyles  of  the  femur  were  injured  in  5,  and  in  5  there  was 

no  bony  lesion.     LAKKEY  (II.)  (Kel.  cln'r.  des  ecenemens  de  Juillet,  1830,  Paris,  1831,  p.  110):  C ,  50th  line,  in  July,  1830,  received  a  shot  in  the  left 

knee;  the  internal  condyle  of  the  tibia  was  fractured;  swelling,  pain,  and  infiltration,  and  death  on  August  25,  1830.  MEXIERE  (P.)  (L' Hotel  Dieu  de 
Paris  en  July  et  Aout,  18:50.  Paris,  1830,  pp.  314-320)  briefly  cites  5  cases  ;  4  were  fatal  and  the  result  in  1  is  not  indicated.  In  one  case  the  head  of  the 
tibia  was  fractured ;  in  the  other  4  cases  no  mention  is  made  of  fracture  of  the  bony  structure.  ARNAL  (Mem.  sur  quelques  particular  it(s  des  plaies  par 
armes  a  feu,  in  Jour.  univ.  et  hebd.  de  Med.  et  de  Chir.,  Paris,  1831,  T.  Ill,  p.  38)  alludes  to  8  cases  of  shot  wounds  of  the  knee  joint,  with  injuries  of  the 
bony  structure;  all  recovered  with  false  anchylosis.  DE  MOUTAIX  (Observation  d'un  coup  de  feu  ayant  travcrs^  I 'articulation  tibio-femorale  droite : 

gw'rison  avec  ankylose,  in  Rec.  de  Mem.  de  Med.  de  Chir.  et  de  Phar.  Mil.,  1839,  1st  ser.,  T.  XLVI,  p.  9Vi):  C ,  48th  line;  perforation  of  knee  joint; 

articular  surfaces  ploughed  through  ;  recovery,  with  anchylosis.  ALCOCK  (R.)  ( Observations  on  injuries  of  Joints,  in  Med.-Chir.  Transactions,  1840,  Vol. 
XXIII,  pp.  £60,  261)  tabulates  18  cases  of  shot  wounds  of  the  knee  joint;  3  recovered,  15  were  fatal.  HOME  (WILLIAM)  (Report  on  various  cases  of 
Gunshot  Wounds  received  in  actions  in  Upper  Canada,  in  1858,  in  Edinburgh  Med.  and  Surg.  Jour.,  1840,  Vol.  LIV,  p.  28)  relates  a  case  of  fracture  of 
condyle  of  femur,  the  ball  traversing  the  joint ;  recovery,  with  anchylosis.  WARD  (BRAXSliY  COOPER,  The  History  of  a  Gunshot  Wound  in  which 

'he  Patella  u-as  carried  away  and  the  Knee  Joint  completely  laid  open,  in  GUY'S  Hospital  Reports,  J840,  Vol.  V,  p.  88):  E.  M ,  patella  shot  away, 

November  2,  1838;  joint  opened;  recovery,  with  considerable  motion  of  joint;  walks  without  a  cane.  BAUDEXS  (L.)  (Clinique  des  Plaies  d'armes 
'I  feu,  Paris,  1836,  p.  446):  A  sergeant,  20th  regiment,  in  1631,  was  shot  through  the  condyles  of  the  right  femur;  small  fragments  of  bone  removed  from 
osseous  channel ;  recover)-,  with  slight  anchylosis.  WILLIAMSON  (G.)  (Military  Surgery,  London,  1863,  p.  172)  cites  a  case  from  the  war  in  India,  in 
1833:  E.  Marr,  20th  regiment ;  patella  fractured,  joint  opened  October  21,  1833;  recovery,  with  anchylosis  ;  died  19  months  later,  of  disease  of  the  liver. 
LEHEUT  (06s.  Cliniqucs  sur  les  plaies  d'armes  a  feu  et  sur  quelques  avtres  blcssures,  in  Arch.  Gen.  de  Mid.,  1845,  T.  VII,  IV  ser.,  p.  327):  Ottwiller, 
aged  24,  wounded  at  Trient,  May  21,  1844 ;  joint  perforated ;  recovery,  with  good  use  of  limb.  Coudray,  aged  35,  ball  passed  through  the  joint  behind 
the  patella ;  several  pieces  of  the  patella  and  head  of  the  tibia  removed ;  severe  pain  and  inflammation  ;  death.  The  space  assigned  to  this  section  ot 
Chapter  X  will  not  permit  a  detailed  reference  to  the  cases  of  shot  wounds  of  the  knee  joint  treated  by  conservation  during  the  last  30  years.  A  numer 
ical  statement  of  these  cases  will  be  given  in  the  concluding  remarks  of  this  section  of  Chapter  X. 
SURG  ITT— 17 


370  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.X. 

was  sent  to  the  rear,  where  he  was  examined  by  Assistant  Surgeon  A.  J.  Baxter,  U.  S.  A.,  who  stated  that  he  found  the  inner 
condyle  of  the  femur  fractured  and  that  he  passed  his  finger  into  the  joint.  The  patient  was  subsequently  sent  to  New  York, 
where  he  came  under  the  care  of  Dr.  Willard  Parker.  Surgeon  J.  F.  Hammond,  U.  S.  A.,  August  19,  1862,  certified  to  a 
description  of  the  wound  and  stated:  "The  knee  is  swollen  and  the  joint  semiflexed.  The  orifices  of  the  wound  are  healed,  but 
one  retains  the  crust,  It  is  subjected  to  passive  motion  and  gradual  extension."  In  a  certificate  dated  three  months  later, 
Surgeon  Hammond  reported:  "He  is  gradually  convalescing  from  the  gunshot  wound  of  the  knee  joint  described  in  my  former 
certificate.  He  cannot  flex  his  leg  quite  to  a  right  angle,  and  the  knee  becomes  painful  and  swollen  when  exercised,"  etc. 
Surgeon  Grant  added  to  his  report  that  Captain  Fisk  ultimately  recovered,  and  served  as  Assistant  Adjutant  General  in  the 
Department  of  the  East.  He  was  mustered  out  of  service  November  22,  1865.  He  did  not  apply  for  pension  until  nearly 
thirteen  years  afterwards,  when  the  New  York  City  Examining  Board  described  his  condition  as  follows:  '•  "Circum 

ference  of  right  knee  over  patella  one-half  inch  larger;  loss  of  bone  probably  from  both  the  femur  and  tibia;  bony  projection  on 
one  side  of  aperture  of  exit.  Motion  of  extension  nearly  complete;  flexion  one- third  impaired.  External  curvature  of  the 
limb  at  knee  joint,  Crepitus  on  motion  in  joint;  pain  from  effort  always,  from  change  of  weather,  and  also  from  maintaining 
one  position;  walking  and  standing  particularly  irksome,"  etc.  Captain  Fisk  was  paid  as  a  pensioner,  September  4,  1879. 

CASE  547. — Private  P.  Stuck,1  Co.  E,  116th  Pennsylvania,  aged  18  years,  was  wounded  in  the  right  knee,  at  Spott- 
sylvania,  May  12,  1864,  and  entered  Douglas  Hospital,  Washington,  six  days  afterwards.  Acting  Assistant  Surgeon  H.  Gib 
bons,  jr.,  described  the  case  as  follows:  "The  missile,  probably  a  rninig  ball,  entered  at  the  inner  border  of  the  patella  and 
escaped  a  little  external  to  the  center  of  the  popliteal  space,  going  directly  through  the  joint  and  grooving  the  articular  surface 
of  the  internal  condyle,  but  passing  mainly  through  the  intercondyloid  notch.  The  patient  was  a  man  of  delicate  organization. 
He  had  but  little  constitutional  disturbance  and  not  much  inflammation  in  the  joint,  which,  however,  was  somewhat  swollen. 
Simple  water  dressings  were  applied.  The  discharge  was  free,  abundant,  and  thin,  the  pus  being  mixed  with  synovial  fluid. 
On  June  9th;  there  was  some  loss  of  appetite,  with  small,  frequent  pulse,  and  the  patient  complained  of  pain  in  the  knee,  which 
was  swollen  considerably.  Flaxseed  poultices,  applied  for  two  or  three  days,  procured  a  free  discharge  from  the  posterior 
wound  (the  anterior  wound  having  healed),  when  the  symptoms  immediately  abated.  In  the  latter  part  of  August  the  patient 
began  to  walk  about  on  crutches,  the  leg  being  flexed  at  an  angle  of  about  135°  with  the  thigh.  The  discharge  was  now  not  so 
copious,  nor  the  pain  at  all  severe;  his  appetite  was  fair,  bowels  regular,  sleep  refreshing,  etc.,  as  had  indeed  been  the  case 
during  the  greater  part  of  the  time.  In  the  latter  part  of  October,  in  order  to  reduce  the  flexion,  the  limb  was  bandaged  to  a 
double-inclined  plane  splint,  which  resulted  in  almost  entire  extension  without  occasioning  any  bad  symptoms  in  the  joint  or  con 
fining  the  patient  to  his  bed.  For  the  following  eight  months  nothing  of  special  interest  occurred,  though  there  were  several 
inflammatory  attacks,  moderate  in  degree  and  readily  subdued  by  poulticing.  On  these  occasions  abscesses  sometimes  formed 
on  the  posterior  thigh.  The  case  is  doubly  interesting  from  the  fact  that  the  wound  only  received  the  ordinary  dressing  of  cold 
water  on  cloths,  with  charpie  to  absorb  the  discharge.  Tincture  of  iodine  and  poultices,  or  hot  fomentations  with  flannel  cov 
ered  with  oiled  silk,  were  used  when  signs  of  inflammation  showed  themselves.  No  ice  was  used  in  the  treatment,  A  photo 
graph  (Surg.  Phot.  Series,  No.  63,  A.  M.  M.)  of  the  patient,  taken  July  9,  1865,  is  represented  in  FIG.  2  of  PLATE  LXVIII. 
The  soldier  was  discharged  from  service  July  13,  1865,  in  good  health,  the  posterior  wound  being  still  open  and  permitting  the 
introducing  of  a  probe  for  three  inches.  There  was  also  a  large  deposit  of  new  bone,  and  the  patella  was  firmly  anchylosed  to 
the  femur.  Some  motion  of  the  joint  remained."  Examiner  H.  Brubacker,  of  Somerset,  Pennsylvania,  certified,  September  23, 
1867 :  "The  knee  is  very  much  enlarged,  and  the  muscles  of  the  thigh  are  gradually  shrinking  away.  The  wound  is  still  dis 
charging  pus  very  freely,  and  there  is  evidently  some  disease  of  the  bones  about  the  joint,  which  keeps  up  the  discharge."  In 
January,  1876,  the  same  examiner  reported:  "The  joint  is  completely  anchylosed  and  the  leg  flexed  upon  the  thigh,  so  that  the 
heel  cannot  be  made  to  touch  the  ground.  He  walks  on  the  front  of  the  foot.  The  ball  of  the  foot  behind  the  great  toe  is 
enlarged,  hardened,  and  tender,  which  renders  walking  very  difficult.  The  leg,  including  the  thigh  and  hip,  is  becoming 
atrophied.  His  condition  is  gradually  growing  worse."  The  pensioner  was  paid  March  4,  1880. 

CASE  548. — Private  J.  C.  Simmerman,  of  the  Marine  Corps,  aged  21  years,  while  serving  on  board  of  the  U.  S.  Steamer 
Minnesota,  was  wounded  in  the  knee  during  the  attack  on  Fort  Fisher,  January  15,  1865.  He  was  treated  at  the  Naval  Hos 
pital  at  Portsmouth,  whence  he  was  discharged  June  19,  1865,  and  pensioned,  by  reason  of  "shot  wound  of  left  knee  joint, 
causing  compound  fracture,  and  resulting  in  anchylosis  of  the  joint  with  incapacity  to  use  the  leg,  which  may  ultimately  require 
amputation."  In  the  succeeding  year,  while  at  Philadelphia,  the  pensioner  presented  himself  for  treatment  to  Dr.  G.  H. 
Napheys,  formerly  connected  with  the  Navy  and  with  the  Army,  who  made  the  following  report  of  the  case  (Medical  and 
Surgical  Reporter,  Vol.  XVI,  1867,  p.  307):  "He  was  struck,  while  lying  down,  by  a  grapeshot  entering  the  inner  condyle  of 
the  femur  and  passing  through  the  articulation.  When  discharged  from  hospital  his  knee  was  perfectly  stiff  and  flexed  at  right 
angle.  Afterwards  there  was  a  constant  discharge  and  the  passage  from  time  to  time  of  pieces  of  bone  from  the  part,  the  last 
fragment  coming  away  in  June,  1866.  When  he  presented  himself  at  the  clinic  he  had  bony  anchylosis  of  the  wounded  knee, 
and  the  leg  was  flexed  at  such  an  angle  with  the  thigh  that  the  distance  between  the  heel  and  the  corresponding  buttock  was 
only  seven  and  a  half  inches.  The  operation  consisted  in  breaking  up  the  extensive  osseous  adhesions  by  means  of  perforators 
and  other  instruments.  The  hamstring  muscles  were  divided  subcutaneously.  The  limb  was  then  bandaged  throughout  its 
whole  length.  It  was  afterwards  placed  upon  a  double-inclined  plane  with  a  screw  arrangement,  so  that  it  could  be  gradually 
brought  down.  About  two  months  after  the  operation  the  limb  was  straightened  sufficiently  to  enable  him  to  rest  on  the  ball  of 
the  foot,  which  is  all  that  can  be  desired.  The  heel  is  somewhat  elevated ;  it  will  be  brought  down  at  some  future  time  by 
dividing  subcutaneously  the  tendo-Achilles.  He  walks  readily  by  the  aid  of  a  cane.  On  April  1,  1867,  the  patient  writes  that 
he  has  good  motion  of  the  ankle  joint  and  walks  with  increasing  ease  and  comfort."  The  Philadelphia  Examining  Board,  in 
1873,  and  at  subsequent  dates,  certified  to  the  injury  and  to  firm  anchylosis  as  resulting  therefrom,  together  with  dislocation  of 
the  tibia  backwards.  In  1873,  the  leg  was  described  as  being  flexed  at  an  angle  of  25°,  and  two  years  later  at  40°,  with  the 
heel  drawn  up  two  and  a  half  inches.  An  operation  on  account  of  necrosed  bone  is  also  alleged  to  have  been  performed. 

Circular  No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  1865,  p.  37. 


Mril.fi-  Sui-j.  Ili.-l.oi'  the  War  of  the  Rebellion.  I'ari  III  .Vol. II.  ni;i|>.\ 


PLATE   LXVIII._  RESULTS    OF    SHOT     INJURIES    OF    THE     KNEE-JOINT. 

l'  ('as.'   of'  IViv;il<-   I'clci 
ll(i  I  I -MILS  viva  i  titi 


SECT.  IV.] 


SHOT    FRACTURES    OF    THE    KNEE    JOINT. 


371 


Examiner  J.  A.  Armstrong,  of  Camden,  reported,  September  17,  1877 :  "At  present  the  leg  is  in  a  straight  position,  the  knee 
joint  anchylosed,  and  the  parts  surrounding  it  calloused  and  indurated."  At  a  subsequent  examination  by  the  Board  the  thigh 
and  leg  were  represented  as  being  much  wasted,  and  the  condition  of  the  foot  was  described  as  that  of  a  case  of  "talipes  equinus." 
The  pensioner  was  paid  December  4,  1879. 

CASE  549. — Private  N.  Gray,  Co.  H,  4th  Maine,  aged  24  years,  was  wounded  in  the  right  knee  joint,  at  the  Wilderness, 
May  5,  1864,  and  entered  Harewood  Hospital,  Washington,  three  weeks  afterwards.  Surgeon  R.  B.  Bontecou,  U.  S.  V.  con 
tributed  the  following  history :  "The  ball  entered  in  the  middle  of  the  internal  condyle  three-fourths  of  an  inch  above  the  inferior 
margin,  passing  in  an  oblique  direction  inward  and  downward.  At  the  time  of  his  admission  the  general  state  of  his  health  was 
good  and  color  of  skin  normal ;  knee  joint  a  little  swollen.  The  patient  complained  of  a 
fixed  pain  right  below  the  centre  of  the  patella,  which  was  increased  by  pressure  upon  the 
patella.  The  thigh  was  swollen,  especially  on  the  inner  side,  about  five  inches  upward, 
and  fluctuating.  On  enlarging  the  opening  upward  a  quantity  of  pus  was  discharged  and 
the  ball  was  discovered  and  removed.  The  hole  made  by  the  ball  was  one  inch  deep;  its 
direction  inward  and  downward.  An  ice  bag  was  applied  to  the  joint.  On  June  2d,  an 
incision  was  made  in  the  fossa  poplitea  three  inches  long,  and  the  lower  third  of  the  pos 
terior  side  of  the  femur  was  found  to  be  surrounded  with  pus,  but  the  bone  was  yet  covered 
with  periosteum.  The  discharge  was  free  and  copious;  the  ice  was  still  kept  on.  On  July 
20th,  there  was  cedema  of  the  right  leg,  which  was  bandaged  from  the  toes  to  the  knee 
joint;  discharge  healthy  and  copious.  Solution  of  chlorinate  of  sodse  was  now  used  in 
the  dressing.  By  September  1st,  the  wound  was  doing  well,  discharging  but  little,  and 
the  incision  in  the  fossa  poplitea  being  healed.  Exudation  below  the  patella  had  disap 
peared,  and  the  movements  of  the  knee  joint  were  perfectly  free  and  painless.  The  patient 
went  on  furlough,  and  returned  on  September  14th.  Small  pieces  of  bone  were  coming 
from  the  wound  in  the  condyle;  movement  of  the  joint  perfect.  On  December  1st,  erysip 
elas  of  the  right  leg  commenced  below  the  patella,  attended  with  high  fever,  vomiting, 
and  headache.  For  this  ten  drops  of  muriated  tincture  of  iron  were  given  every  three 
hours.  By  December  10th,  the  erysipelas  had  disappeared  and  the  patient  was  doing  well. 
The  process  of  exfoliation  was  going  on  slowly  on  January  1,  1865.  On  February  13, 
1805,  the  patient  was  discharged  from  service,  the  process  of  exfoliation  not  yet  having 
terminated,  but  the  knee  joint  being  of  normal  size  and  color,  and  its  movements  perfectly 
free  and  painless  in  every  direction."  Examiner  I.  H.  Harding,  of  Ellsworth,  Maine,  Feb-  .S 
ruary  1,  1867,  certified  to  the  injury  and  added:  "The  joint  and  leg  are  weakened  and 
atrophied  so  much  that  he  walks  quite  lame."  The  Boston  Examining  Board  reported, 
September  13,  1875 :  "  There  are  two  large  adherent  cicatrices  in  the  popliteal  space,  which 

impair  the  motions  of  the  hamstrings."     The  pensioner  was  paid  December  4,  1879.     The 

,  .  r>r,->\  •  /•         i  i  o  -n  /•  n  VlG.  222. — Shot  fracture  of  internal  con- 

wood-cut  (±IG.  x22)  is  a  copy  of  a  photograph  contributed  by  burgeon  Bontecou  (Card    <i  vie  of  right  femur.    [From  a  photograph.] 

PJiotographs,  Vol.  3,  p.  22). 

In  the  next  instance  a  conoidal  ball  struck  the  left  knee,  passing  through  the  centre  of 
the  patella  and  through  the  inner  condyle  of  the  femur: 

CASE  550. — Private  J.  T.  Long,  Co.  G,  16th  Wisconsin,  aged  26  years,  was  wounded  at  Shiloh,  April  6,  1862.  Acting 
Assistant  Surgeon  J.  A.  Murphy,  in  charge  of  Third  Street  Hospital,  Cincinnati,  described  the  injury  as  "wound  of  the  left  knee 
joint,"  and  reported :  "A  ball  entered  the  centre  of  the  patella  and  passed  inward  and  backward,  escaping  through  the  inner 
condyle  of  the  femur.  The  patient  entered  this  hospital  May  2d,  having  been  brought  here  on  a  hospital  boat  from  Pittsburg 
Landing.  He  was  free  from  fever  and  diarrhoea,  and  his  general  health  on  admission  was  excellent.  In  stature  six  feet  and 
two  inches,  well  and  strongly  developed  in  every  respect,  he  was  a  man  who  had  always  enjoyed  very  good  health  and  never 
indulged  in  ardent  spirits.  The  injured  joint  was  much  swollen  and  very  red  when  he  arrived  here;  a  copious  discharge  of  pus 
and  sy  no  vial  fluid  was  escaping  from  the  wounds.  A  few  days  afterwards  a  large  abscess,  exterior  to  the  joint,  developed  itself 
and  was  opened,  discharging  about  one  pint  of  pus.  After  this,  from  time  to  time  until  the  wounds  healed,  sixteen  abscesses 
formed  around  the  joint  and  in  the  leg  as  low  down  as  the  middle  third.  They  were  opened  and  healed  readily.  Cold-water 
dressings  and  fomenting  poultices  were  the  only  applications  used  to  the  wounds.  He  was  kept  on  low  diet  throughout  the 
treatment.  Tonics  were  given  for  a  very  short  time  and  then  discontinued,  as  the  inflammation  about  the  wound  seemed  to 
increase  under  their  use.  On  the  subsidence  of  the  inflammation  about  the  joint  crepitation  could  be  heard  in  moving  the  patella; 
a  fissure  could  also  be  felt  in  the  patella.  On  July  16,  1862,  the  patient  was  discharged  from  service.  At  that  time  he  had 
mobility  of  the  joint  and  was  able  to  walk  with  great  ease  to  himself.  Just  before  completing  extension  or  flexion,  however,  he 
would  feel  a  slight  obstruction,  causing  him  to  make  an  increased  effort  to  complete  the  extension  or  flexion,  when  the  former  or 
the  latter  was  accomplished."  The  man  subsequently  became  a  pensioner,  the  nature  of  his  injury  being  corroborated  by 
various  examining  surgeons,  the  last  of  whom,  Dr.  W.  T.  Nichols,  of  Meuomonee,  stated  November  17,  1877,  that  "  the  wounded 
joint  is  weak  and  the  leg  a  little  lame."  The  pensioner  was  paid  June  4,  181$. 

CASE  551. — Sergeant  P.  H.  McGrew,  Co.  F,  17th  Ohio,  aged  22  years,  was  wounded  in  the  left  knee  while  on  picket 
near  Corinth,  May  22,  1862.  He  was  discharged  from  service  at  Camp  Chase,  March  18,  1863,  Surgeon  D.  Stanton,  U.  S.  V., 
certifying  to  ''partial  anchylosis  and  necrosis  of  head  of  tibia  resulting  from  a  shot  wound  through  the  knee  joint."  Dr.  W.  L. 
Schenck,  late  Surgeon  17th  Ohio  Volunteers,  who  personally  treated  the  case,  communicated  the  following  history:  "The  mis 
sile,  supposed  to  have  been  a  small  conical  ball,  entered  just  above  the  outer  tuberosity  of  the  left  tibia  and  passed  diagonally 
through  the  joint,  slightly  fracturing  the  articulating  surface  of  both  condyles  of  the  femur  and  the  spine  of  the  tibia.  I  was  at 


372 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


2-~>3-W  urdof 


FJG.._>04  ._Woundof 
xit  at  left  knee  joint. 

*        * 


the  Brigade  Hospital  at  the  time,  a  mile  or  two  in  the  rear,  and  did  not  see  the  wound  for  two  days.  The  knee  had  become 
very  painful  then  and  was  greatly  swollen,  so  I  concluded  there  was  no  time  to  consider  the  propriety  of  an  operation,  and  put 
the  patient  upon  active  antiphlogistic  treatment  with  irrigation  to  the  parts.  The  next  day  Medical  Directors  Smith  and  Strew. 
with  several  other  surgeons,  called  to  see  the  case,  and  all,  excepting  Surgeon  I.  A.  Coons,  38th  Ohio,  and  myself,  decided  in 
favor  of  exsection  or  amputation  ;  but  I  was  allowed  to  use  my  own  judgment,  declined  to  operate,  and  continued  the  treatment. 
When  the  acute  stage  had  passed  and  suppuration  was  well  established,  I  used  water  dressings  and  prescribed  a  liberal  diet. 
with  some  preparation  of  iron  —  hydrochlorate  of  the  sesquioxide,  iodide,  citrate  with 
quinine,  or  phosphate  with  lime,  etc.  When  the  pain  was  intense  or  destructive  meta 
morphosis  greatly  in  excess,  opium  and  brandy  was  administered.  On  the  15th  of  June,  I 
received  a  leave  of  absence,  and  was  permitted,  through  the  kindness  of  the  General  Com 
manding  and  the  Medical  Director,  to  take  the  patient  with  me  to  Ohio.  He  was  carried 
on  a  stretcher  over  all  the  bad  roads  from  Corinth  to  Pittsburg  Lauding  and  there  placed 
on  a  cot,  from  which  he  was  not  removed  until  he  reached  my  home  in  Franklin,  Ohio, 
where  I  treated  him  until  the  expiration  of  my  furlough.  During  that  time  several  small 
pieces  of  bone  were  removed,  and  when  I  left  him  the  outer  wound  had  healed  and  he  was 
able  to  go  about  his  room  on  crutches.  I  left  him  in  charge  of  the  Ladies'  Aid  Society,  who 
cared  for  him  until  he  was  able  to  go  to  his  home  in  Lancaster,  Ohio.  On  the  15th  of 
December  following  he  wrote  to  ine>:  'Since  leaving  Franklin  there  have  two  tolerably 
large  and  twenty-three  small  pieces  of  bone  come  out  of  my  knee.  It  is  getting  along  fine. 
I  can  put  out  my  foot  and  take  a  good  old-fashioned  step,  such  as  I  used  to  take  in  the  long 
marches  down  in  Dixie.  I  do  nothing  for  it  now  but  wash  it  in  salt  water.  I  am  in  n 
hurry  for  it  to  get  well  that  I  may  get  satisfaction  out  of  those  rebels,'  etc.  After  McGrew 
-  ^a(^  ^een  discharged  ^rom  service  for  disability,  he  recovered  sufficiently  to  again  enter 

entrance  at  left  knee,    the  army,  and  accepted  a  commission  as  1st  Lieutenant  of  the  178th  Ohio.     On  April  2, 
DrTcHKNckK.Th  by    1885>  he  wrote  to  me  from  Shelby  ville,  Tennessee  :  'Thanks  to  you  this  leg  of  mine,  which 
so  many  predicted  would  have  to  come  off  or  be  worthless,  is  worth  a  good  many  cork 

legs  yet.  I  can  do  anything  with  it  but  run,  and  that  is  not  in  our  line.  I  was  at  a  ball  the  other  evening  and  danced  several 
sets.  That  is  better  than  even  you  expected.'  By  this  time  the  injured  joint  was  sound  and  the  leg  could  be  straightened  or 
bent  to  a  right  angle."  Lieutenant  McGrew  left  the  service  in  April,  1865.  He  had  been  a  pensioner  under  his  former  designa 
tion  until  his  re-entry  into  the  service  in  September,  1864,  since  when  he  has  not  communicated  with  the  Pension  Bureau. 
Drawings  of  the  wounds  of  entrance  and  exit,  shown  in  the  wood-cuts  (FlGS.  223,  224),  were  contributed  by  Dr.  Schenck. 

Iii  the  following  remarkable  case  the  ball  passed  diagonally  through  the  left  elbow, 
entered  the  left  knee  joint,  and  lodged  in  the  outer  condyle  of  the  femur,  where  it  remained 
innocuously  for  over  fifteen  years:1 

CASE  552.  —  Lieutenant  E.  B.  Blake,  Co.  F,  35th  Massachusetts,  aged  25  years,  was  wounded  at  the  battle  of  Antietam, 
September  17,  1862.  While  he  was  stooping  down  to  tie  his  handkerchief  around  the  thigh  of  a  bleeding  comrade  whose  leg 
had  been  earned  away  by  a  cannon  ball,  he  received  a  shot  which  passed  diagonally  through  the  left  elbow  and  entered  the 
outer  aspect  of  the  left  knee  joint.  Copious  bleeding  from  the  exit  wound  in  the  elbow  denoted  injury  in  the  large  vessel.  The 
bleeding  was  checked  by  a  strap  around  the  arm.  He  limped  off  on  his  injured  leg  to  the  nearest  ambulance  station,  where  the 

wound  in  the  knee  joint  was  examined  by  a  surgeon.  The  probe  entered  the 
joint  freely;  but  the  ball  could  not  be  detected.  From  the  strongly  bent 
position  of  the  limb,  it  had  apparently  escaped  the  tibia  and  passed  in  be 
tween  the  condyles  of  the  femur,  where  it  was  securely  lodged  and  concealed. 
His  arm  and  leg  had  water  dressings  applied,  and  were  put  in  splints;  and 
he  was  immediately  placed  in  the  cars  and  transported  to  Boston,  where  he 
arrived  in  the  course  of  a  week,  with  many  other  soldiers,  some  of  whom 
had  received  equally  serious  wounds,  and  to  whom  the  danger  of  transporta 
tion,  except  under  existing  circumstances,  would  have  been  considered  almost 
a  fatal  movement.  The  foregoing  account  is  taken  from  J.  Mason  Warren's 
Suryical  Observations,  with  Cases,  etc.,  Boston,  1867,  p.  563.  Dr.  Warren 
attended  Lieutenant  Blake  on  his  arrival  in  Boston.  He  was  then  in  a  feeble 
condition,  having  an  almost  constant  diarrhoea.  Dr.  Warren  remarked:  ''It 
is  probable  that  to  this  condition  he  owed  his  safety."  The  knee  joint  was 
free  from  pain  and  inflammation,  but  the  wound  on  the  outside  suppurated  slightly.  It  was  dressed  with  a  ham  splint  and 
kept  in  a  state  of  entire  rest.  The  elbow  joint  was  quite  loose,  both  condyles  broken  off,  the  joints  swollen,  with  an  effusion  on 

1  Examples  of  missiles  remaining  lodged  in  the  bones  of  the  knee  joint  have  been  reported  by  PEKCY  (Manuel  da  Chirurgien  d'Armie  ou  Instruc 
tion  de  Chir.  Mil.,  Paris.  1792,  p.  16'4),  who  alludes  to  a  case  in  which  the  missile  became  iucrusted  in  the  condyles  of  the  femur  "hasard  heureux  dont 
on  a  eu  tin  exemple  dans  la  personne  de  M.  d'Almons,  ingcnic'hr  employ6  dans  la  dernieire  guerre."  RAUASSE  (L.  J.)  (Considerations  g'nerales  sur  If.s 
plaies  des  articulations  faites  par  les  armes  a  feu  ou  le,s  instru.me.ns  Iranchans,  Paris,  1811,  These  No.  84,  p.  18)  reports  that  Weber,  a  miner  at  the  siege 
of  Dantzig,  iu  April,  1807,  was  struck  by  a  ball  at  the  outer  portion  of  the  left  knee  joint.  From  the  depression  and  cavity  in  the  external  coudyle  of  the 
femur  the  ball  was  believed  to  have  lodged  in  the  articulation,  as  there  was  no  wound  of  exit.  Futile  searches  for  the  missile  were  made  ;  extensive 
swelling  followed,  but  the  patient  recovered  in  about  three  months  with  anchylosis  of  the  knee.  BELL  (C.)  (Report  on  Gunshot  Wounds  of  the  Knee 
Joint  in  Surgical  Observations  ;  being  a  Quarterly  Report  of  Cases  in  Surgery  treated  in  the  Middlesex  Hospital,  London,  1810,  p.  429):  Russian  General 
Baron  Driesen,  wounded  at  Borodino,  September  6,  1812;  musket  ball  struck  the  inner  condyle  of  the  left  femur  ;  ball  remained  in  condyle  ;  improved  in 
spring  of  1813.  Wound  closed  and  reopened  in  18H>:  inflammation,  abscess,  incision;  amputation  January  7,  1817;  recovery.  ALCOCK  (11.)  (  ^.'isvroo- 


FlG.  225. — Anterior  and  posterior  views  of  the  left  elbow 
joint.     Spec.  6811. 


Med.ft  Surg.  Hirft.  of  the  War  of  the  Rebellion,  Part  lU.Vol.U.Cliap.X 


Ward    phot. 


T  Sinclair*  San  lith 


PLATE     LXVII.._  BALL    LODGED    IN    OUTER   CONDYLE  OF  LEFT    FEMUR    OVER   15  YEARS, 
('use-   of'  I.H'iiti-nurit    K.B.    (  'o  F,  35  L.h  Mnjs.stu-lm.sctl  s 


SCOT.  IV.) 


SHOT    FRACTURES    OF    THE    KNEE    JOINT. 


373 


PIG.  226. —  Appearance  of 
knee  joint  nine  years  after  in 
jury.  [From  a  photograph.] 


the  inside,  a  bullet  hole  below  the  joint  on  the  outside  and  above  it  on  the  inside.  The  elbow  was  made  immovable  with  splints, 
and,  after  a  moderate  amount  of  inflammation,  which  at  no  time  amounted  to  anything  threatening,  both  the  knee  joint  and  the 
elbow  joint  did  perfectly  well ;  and  at  the  end  of  two  months  he  was  able  to  go  out  of  doors.  He 
finally  recovered  all  the  motions  of  the  elbow  joint;  he  could  walk  without  the  least  sign  of  lameness, 
the  ball  still  remaining  in  the  knee.  The  power  of  entire  flexion  only  of  the  leg  was  wanting.  He 
continued  actively  engaged  ill  business  until  February  11,  1878,  when  he  died  of  pneumonia.  An 
autopsy  was  made  by  Dr.  J.  Foster  Bush,1  of  Boston,  who  presented  the  specimens  of  the  injured  elbow 
and  knee  to  the  Army  Medical  Museum,  where  they  are  numbered  6811  and  6812,  respectively,  of 
Section  I.  There  was  not  a  trace  of  caries  in  the  cancellated  structure  around  the  ball.  The  artic 
ulated  cartilages  were  perfectly  smooth,  and  the  foreign  body  had  apparently  remained  innocuously  in 
the  outer  condyle  for  over  fifteen  years.  The  bones  of  the  elbow  are  shown  in  the  wood-cut  (FlG.  225); 
the  articular  extremities  of  the  femur  and  tibia  (Spec.  6812,  and  Photo.  Scries,  No.  366,  A.  M.  M.) 
are  represented  in  PLATE  LXVII,  opposite  p.  372,  a  vertical  section  of  the  femur  bisecting  the  ball. 
CASE  553. — Private  J.  McDonnell,  Co.  C,  124th  Ohio,  was  wounded  at  Chickamauga,  Sep 
tember  19,  1863,  by  a  conoidul  ball,  which  entered  over  the  inner  crest  of  the  left  tibia,  passed  upward 
through  the  inner  condyle  of  the  femur  and  lodged.  He  was  made  a  prisoner,  and  confined  at  Bich- 
mond,  Danville,  and  Andersonville.  Treatment:  Two  stitches  in  the  wound  and  cold-water  dress 
ings.  A  portion  of  the  ball  was  removed,  also  sixteen  spiculse  of  bone  at  various  times.  He  suffered 
from  scurvy  whilst  in  prison;  was  exchanged  March  28,  1865,  and  finally  discharged  from  service 
July  8,  1865,  from  Camp  Chase,  Ohio.  He  received  a  pension  of  six  dollars  per  month.  Mr. 
McDonnell  called  at  the  Army  Medical  Museum  September  17,  1872,  made  the  above  statement,  and 
exhibited  his  wound,  when  the  photograph  (No.  329,  Surg.  Phot.  Series,  A.  M.  M.)  was  taken,  of  which 
the  annexed  wood-cut  (FlG.  226)  is  a  copy.  His  general  health  was  indifferent.  There  was  a  large 
cicatrix  on  the  inner  side  of  the  knee  joint,  and  several  smaller  ones  about  three  inches  above  the 
outer  condyle;  there  was  tenderness  and  preternatural  mobility  about  the  joint;  it  seemed  to  have 
undergone  a  spontaneous  dislocation,  the  femur  and  patella  projecting  forward  over  the  tibia.  The 
foot  could  be  inverted  and  everted  much  farther  than  usual,  and  the  limb  was  shortened  about  two 
inches.  He  could  walk  with  comparative  ease,  and  could  readily  ascend  a  stairway.  A  plaster  cast 
of  the  injured  knee  was  made  and  numbered  6199  of  the  Surgical  Series.  His  pension  was  paid 
December  4,  1879. 

In  the  next  case  a  round  musket  ball  passed  through  the  middle  of  the  patella  and, 
perforating  the  joint,  crushed  the  articular  ends  of  the  femur  and  the  tibia: 

CASE  554. — Private  X.  Gauter,  Co.  D,  14th  Missouri  Home  Guards,  aged  18  year?,  was  wounded  in  the  right  knee,  at 
Lexington,  September  18, 1861,  and  was  conveyed  to  St.  Louis  one  month  afterwards.  Assistant  Surgeon  S.  M.  Horton,  U.  S.  A., 
in  charge  of  the  New  House  of  Refuge  Hospital,  reported:  "This  is  a  case  of  gunshot  wound  through  the  knee  joint,  which  at 
present  (September  17,  1862)  is  discharging  sanious  pus  at  the  point  of  entrance,  from  which  pieces  of  necrosed  bone  are  being 
extracted  every  few  days.  The  use  of  the  limb  is  but  partial,  the  joint  being  rendered  immovable.  The  patient  came  here  from 
the  City  General  Hospital  on  5th  Street  seven  months  ago.  He  had  been  wounded  by  a  round  musket  ball,  which  penetrated 
the  patella  through  its  centre,  going  right  through  the  joint  and  escaping  through  the  popliteal  space,  crushing  in  its  course  the 
articulating  ends  of  the  femur  and  the  tibia."  The  patient  was  discharged  from  hospital  June  3,  1863,  and  pensioned,  his  term 
of  service  having  expired  one  month  after  being  wounded.  Examiner  W.  P.  Boulware,  of  Lexington,  Missouri,  at  successive 
dates  certified  to  the  injury  and  reported  anchylosis  of  the  knee  joint  as  resulting  therefrom.  Dr.  F.  Cooley,  of  the  Kansas  City 
Examining  Board,  reported  September  17,  1875,  that  he  found  "depression  with  adherent  cicatrix  over  the  patella,  and  also 
adherent  cicatrix  with  considerable  loss  of  bone  on  outer  condyle  of  femur,  so  that  I  can  pass  my  fingers  into  it  for  three-fourths 

lions  on  Injuries  of  Joints  and  their  Treatment,  in  Medico  Chirurgical  Tranasactions,  London,  1840,  Vol.  XXIII,  p.  298)  records  a  case  in  which  the  ball 
remained  in  the  condyle  for  four  years:  "A  sailor  of  a  man-of-war  steamer,  in  1836,  received  a  musket  shot  while  rowing  a  boat  employed  in  the  dis 
embarkation  of  troops.  He  was  immediately  forwarded  to  one  of  the  hospitals,  under  my  direction,  in  San  Sebastian.  Although  there  was  every 
reason  to  believe  that  the  ball  had  lodged  in  the  cancellated  structure  of  the  femar,  yet,  from  the  absence  of  any  detached  portion  of  bone,  or  rough  frac 
ture  in  the  articulating  surface  of  the  bone,  so  far  as  I  could  ascertain,  I  felt  warranted  in  an  endeavour  to  save  the  limb.  In  a  few  weeks  the  wound 
healed,  and  the  knee,  to  all  appearance,  was  undiseased, — the  patient  only  complaining  of  some  weakness  and  difficulty  in  walking,  with  occasional  pain; 
he  was  invalided  home.  Three  months  ago  he  came  to  me  with  a  request  that  I  would  amputate  his  leg,  for  that,  to  use  his  own  expression,  'it  so  both 
ered  him'  in  walking,  and  gave  him  occasionally  such  acute  pain,  that  he  would  infinitely  rather  stump  about  on  a  leg  of  wood.  Not  being  attached  to 
any  metropolitan  hospital,  I  sent  him  down  to  the  Westminster,  to  my  friend,  Mr.  GUTHHIE,  who  removed  the  leg,  which  externally  presented  a  cicatrix, 
but  no  other  mark  of  injury  or  disease,  past  or  present.  The  ball  was  found  to  have  passed  through  the  internal  condyle,  and  presented  a  somewhat  flat 
tened,  yet  convex,  smooth  surface,  on  a  level  with  the  articulating  surface,  resembling  a  piece  of  metal  let  in.  It  had  fissured  the  bone  (as  may  be  seen 
in  a  very  slight  and  hasty  sketch  I  made  at  the  time)  and  this  fissure  had  been  nearly  entirely  filled  up  with  osseous  matter.  In  four  years  the  only 
mischief  done  to  the  joint  was  some  thickening  of  synovial  membrane  and  a  partial  absorption  of  cartilages.  No  very  active,  acute,  or  destructive 
disease  had  been  developed  either  at  the  time  of  the  accident  or  since."  ROCCO  GKITTI  (Nuovi  Documenti  in  favore  della  euro,  conservativa  nelle  frat- 
ture  delfemore  per  arma  dafuoco,  in  Annali  Universali  di  Medicina,  Melano,  1868,  Vol.  CC V,  p.  524,  case  37) :  Pompeo  Morandi,  3d  Volunteers,  wounded 
at  Monte  Suello  ;  wound  of  knee  joint  with  lodgement  of  the  ball  in  the  condyle  ;  recovery.  The  ball  remains  in  the  joint,  which  is  anchylosed.  STKO- 
MEYEll  (L.)  (Erfahrungen  iiber  Schusswunden  im  Jahre  1866,  Hannover,  1867,  p.  58)  remarks:  "Among  the  noteworthy  cases  of  shot  fractures  of  the 
knee  joint  treated  by  conservation,  is  the  case  of  a  young  officer,  the  bullet  yet  remaining  in  the  outer  condyle  of  the  left  femur.  .  .  At  present  there 
is  no  exudation  into  the  capsule,  and  the  ball  lies  so  near  the  surface  that  it  can  be  felt  through  the  soft  parts  covering  it.  But  as  it  is  nearly  immovable, 
and  causes  hardly  any  suppuration,  it  has  been  considered  the  wisest  course  to  avoid  operative  interference."  GROSS  (S.  D.)  (A  Si/stem  of  Surrjer;/,  Phil 
adelphia.  1872,  5th  ed.,  Vol.  I,  p.  1039):  Knee  joint  opened  by  a  pistol  ball,  which  lodged  permanently  in  one  of  the  condyles  of  the  femur;  recovery 
with  slight  lameness. 

'Brsil  (J.  F.).  Penetrating  Gunshot  Injury  of  the.  Elbow  and  Knee  Joints,  in  Ro.itnn  Me.dirnl  and  Surgical  Journal,  1879,  Vol.  C,  p.  14-t. 


374 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


of  an  inch.  There  is  also  loss  of  portion  of  the  tibia  some  four  inches  below  the  patella,  and  I  find  very  large  varicose  veins 
of  the  leg  and  thigh.  The  knee  is  entirely  anchylosed.  Just  below  the  condyle,  on  the  outer  part,  there  is  a  small  hard  sub 
stance,  the  size  of  a  goose-shot,  floating  under  the  skin.  The  muscular  tissues  on  the  outer  and  lower  part  of  the  thigh  are 
destroyed.  I  also  find  shortening  of  the  limb  one  and  a  half  inches,  and  the  old  cicatrices  look  as  though  they  might  break  out 
at  any  time,"  etc.  Subsequently  the  same  Board  found  increase  of  size  and  number  of  varicose  veins,  tumefaction  of  limb,  etc. 
The  pensioner  was  paid  December  4,  1879. 

In  the  following  four  cases  tke  patella  was  fractured.     In  two  of  the  cases  the  synovial 
sac  was  involved;  in  one  instance  both  knees  were  injured: 

CASE  555. — Private  W.  H.  Hirst,  Co.  A,  118th  Pennsylvania,  aged  22  years,  was  wounded  through  the  left  knee,  at 
Shepherdstown,  September  20,  1862.  Surgeon  J.  Neill,  U.  S.  V.,  reported:  "The  wounded  man  was  admitted  to  Broad  and 
Cherry  Streets  Hospital,  Philadelphia,  September  27th,  with  a  compound  comminuted  fracture  of  the  patella  involving  the  knee 
joint.  The  injury  was  produced  by  a  minie"  ball,  which  entered  in  front,  one  inch  above  the  patella,  passed  downward  and  out 
ward,  and  made  its  exit  on  the  outer  side  of  the  leg  just  below  the  head  of  the  fibula.  At  the  time  of  admission  the  patient's 
general  condition  was  good,  but  the  knee  was  very  much  inflamed  and  the  wound  suppurated  freely.  Flaxseed  poultices  were 
applied  around  the  joint,  and  the  limb  was  kept  at  rest  in  a  fracture  box;  the  patient  was  ordered  a  good  diet,  with  tonics  and 
stimulants.  A  few  days  afterwards  a  large  abscess  formed  on  the  outer  side  of  the  thigh  a  short  distance  above  the  joint,  which 
was  opened  and  discharged  freely.  Under  the  treatment  adopted  the  patient  improved  rapidly,  the  limb  bidding  fair  to  be  a 
useful  one.  One  fragment  of  bone  was  extracted."  The  fragment  of  the  patella  removed  from  the  wound  is  Specimen  No.  670 
of  the  Army  Medical  Museum.  The  patient  was  subsequently  transferred  to  Haddington  Hospital  and  thence  to  Christian  Street. 
On  July  4,  1864,  he  was  discharged  from  service  and  pensioned,  Acting  Assistant  Surgeon  R.  J.  Levis  certifying  to  "wound  of 
-knee  joint,  resulting  in  great  lameness  from  anchylosis."  The  Philadelphia  Examining  Board  at  various  intervals  certified  to  the 
injury  and  its  results,  and  described  the  limb  as  wasted  and  the  veins  varicosed.  The  pensioner  was  paid  December  4,  1879. 

CASE  556. — Corporal  D.  Golden,  Co.  M,  14th  New  York  Artillery,  aged  33 
years,  was  wounded  at  Petersburg,  June  17,  1864.  He  was  admitted  to  the  field 
hospital  of  the  1st  division,  Ninth  Corps,  where  Surgeon  M.  K.  Ilogan,  U.  S.  V., 
noted  :  "Wound  of  left  knee  by  minie"  ball;  simple  dressings  applied."  From  the 
field  the  wounded  man  passed  to  the  Depot  Hospital  at  City  Point,  and  thence,  on 
July  2d,  to  Harewood  Hospital,  Washington.  Surgeon  E.  B.  Bontecou,  U.  S.  V., 
in  charge  of  the  latter,  described  the  injury  as  "a  wound  through  the  patella,"  and 
reported  that  the  patient  was  discharged  from  service  April  14,  1865,  for  total  dis 
ability.  Examiner  C.  C.  Bates,  of  Potsdam,  N.  Y.,  April  29,  1865,  certified  :  *  * 
"He  can  flex  but  cannot  extend  the  leg,  except  enough  to  touch  the  toe  to  the 
floor.  Thigh  and  leg  much  atrophied;  knee  much  swollen  and  painful.''  Exam 
iner  G.  R.  Baldwin,  of  Fort  Scott,  Kansas,  reported  November  13,  1877 :  "  The 
pensioner  received  a  wound  of  the  left  knee.  The  ball  entered  at  the  lower  border 
of  the  patella,  passed  outward  and  upward,  and  made  its  exit  at  the  outer  border 
of  the  patella.  Synovial  fluid  escaped.  There  is  a  large,  irritable,  and  tender 
cicatrix.  The  patella  is  immovably  attached  to  the  tibia.  The  leg  requires  rest, 
motion  and  strength  being  very  much  impaired.  Pain  is  a  prominent  symptom." 
The  pensioner  was  paid  September  4,  1879.  A  photograph  (Card  Photographs, 
Vol.  I,  p.  17),  represented  in  the  annexed  wood-cut  (FiG.  227),  was  contributed  by 
Surgeon  R.  B.  Bontecou,  U.  S.  V. 

CASE  557. — Private  W.  Patterson,  Co.  K,  6th  Wisconsin,  aged  36  years, 
was  wounded  through  both  knees,  at  Gainesville,  August  28,  1862.  He  was  treated 
at  Carver  Hospital,  Washington,  whence  he  was  discharged  and  pensioned  Decem 
ber  9,  1862,  Surgeon  O.  A.  Judson,  U.  S.  V.,  certifying  to:  "Shot  wound  of  both 
knee  joints,  involving  a  fracture  of  the  right  patella  and  causing  extensive  effusion 
in  the  left  knee  joint."  Examiner  J.  Hobbins,  February  18,  1863,  certified  to 
"imperfect  flexion  and  limited  and  difficult  extension,"  resulting  from  the  wounds. 
Examiner  D.  C.  Green,  of  Mauston,  Wisconsin,  reported,  April  28,  1870:  "The 
wound  was  caused  by  a  ball  which  entered  the  left  knee  at  the  left  side  and  passed  through,  striking  the  bone.  The  missile 
then,  being  slightly  turned  in  its  course,  struck  the  right  knee  and  passed  through  it  anteriorly,  fracturing  the  patella  and  lacer 
ating  the  muscles  badly.  At  present  both  knee  joints  are  stiff."  Subsequent  examiners  report  no  additional  information.  The 
pensioner  was  paid  December  4,  1879. 

CASE  558.— Private  J.  W.  Warrington,  Co.  C,  110th  Ohio,  was  wounded  on  April  2,  1865,  at  Petersburg,  by  a  round  ball 
from  a  spherical  case  shell.  The  ball  entered  the  centre  of  the  patella,  and,  producing  a  stellate  fracture  of  that  bone,  passed 
downward,  backward,  and  inward,  and  was  cut  out,  on  the  field,  one  and  a  half  inches  below  the  tuberosity  of  the  tibia.  On 
April  12,  1865,  the  patient  was  admitted  into  Judiciary  Square  Hospital.  There  was  no  pain  in  the  knee  joint,  and  but  little 
swelling.  The  treatment  had  been  limited  to  dressings  of  cold  water,  which  were  continued  for  a  few  days,  and  followed  by 
applications  of  ice.  The  patient  was  removed  to  Douglas  Hospital  June  19,  1865,  when  three  small  necrosed  fragments  of  the 
patella  were  removed.  A  photograph  of  the  patient,  taken  July  9,  1865,  is  No.  64,  Sary.  Phot.  Scries,  A.  M.  M.  The  wounds 
had  healed  and  the  patient  walked  about  with  a  cane.  There  was  at  no  time  any  indication  of  the  formation  of  pus  within  the 
joint.  The  facts  of  the  case  were  communicated  by  Acting  Assistant  Surgeon  H.  S.  Colton.  Warrington  was  discharged  July 
24,  1865,  and  pensioned.  He  was  paid  September  4,  1879. 


FIG.  227. — Appearance  of  knee  joint  a  few  months 
after  injury.     [From  a  photograph.] 


SECT.  IV.J  SHOT    FRACTURES    OF    THE    KNEE    JOINT.  375 

Fracture  of  the  head  of  the  tibia  and  of  the  patella  was  noted  in  the  next  example: 

CASE  559. — Corporal  G.  L.  Keyser,  Co.  B,  8th  Pennsylvania  Cavalry,  aged  21  years,  was  wounded  at  "Snicker's  Gap, 
November  1,  1862,  and  admitted  to  hospital  at  Knoxville  two  days  afterwards.  Surgeon  B.  Beust,  U.  S.  V.,  reported:  "A  gun 
shot  wound  through  knee  joint.  The  patient,  a  man  of  small  stature  and  delicate  appearance,  was  in  a  kneeling  posture  when 
he  was  struck  by  a  conical  ball,  which  entered  the  right  knee  at  the  inner  side  of  the  patella,  near  the  lower  border,  striking 
against  the  inner  condyle  of  the  tibia,  producing  considerable  injury  by  shivering  to  some  extent  the  epiphysis,  and  emerging  on 
the  outer  side  of  the  leg  two  inches  below  the  joint.  When  the  patient  was  brought  here  the  knee  was  much  swollen  and  pain 
ful.  Applications  of  cold  water  were  immediately  made  and  continued  for  four  weeks.  When  the  active  inflammation  had 
entirely  subsided,  a  small  quantity  of  healthy  pus  was  discharged  from  both  openings.  The  patient,  feeling  strong  and  quite 
well  at  this  time,  became  careless  and  moved  his  leg,  in  consequence  of  which  very  active  and  extensive  inflammation  set  in. 
The  cold-water  dressings  were  then  (December  3d)  changed  to  warm  flaxseed  poultices.  From  the  15th  to  the  31st  of  December 
the  patient  suffered  much  from  irregular  chills,  delirium,  sleepless  nights,  and  loss  of  appetite,  and  showed  great  symptoms  of 
exhaustion.  Large  quantities  of  foDtid  pus  were  discharged  from  both  openings.  On  December  31st,  an  examination  was  made 
with  the  finger,  which  proved  the  upper  portion  of  the  tibia  to  be  much  fissured.  Amputation  was  then  proposed  but  objected 
to  by  the  patient,  who  wished  to  save  his  limb  if  there  was  any  possible  chance.  He  continued  to  fail,  and  his  night  vigilance 
and  loss  of  appetite  persisted  undiminished.  On  January  6,  1863,  the  fever  assumed  a  periodical  character,  coming  on  in  the 
afternoon.  For  this  he  was  treated  with  quinine  and  morphine,  followed  by  wine  and  cinchona  bark.  Since  then  he  has 
improved  rapidly.  By  January  31st,  the  patient  had  regained  a  good  appetite,  slept  well,  and  was  improving  in  strength ;  the 
discharge  of  pus  was  now  very  slight  and  healthy.  He  will  undoubtedly  recover  if  no  unexpected  change  or  accident  occurs  to 
intercept  or  impede  the  restorative  progress."  Three  weeks  later  the  patient  was  transferred  to  Camden  Street  Hospital,  Balti 
more,  whence  Acting  Assistant  Surgeon  E.  G.  Waters  reported  the  following  result  in  the  case:  ''When  admitted  his  condition 
was  moderately  good,  the  knee  being  much  swollen  and  inflamed,  however,  for  which  solution  of  lead  and  opium  was  applied. 
Small  fragments  of  bone  came  away  at  various  times  from  the  external  opening.  Absolute  rest  was  maintained,  and  mercurial 
ointment,  with  camphor,  was  used  locally  to  diminish  the  swelling.  On  May  30,  1863,  the  patient  was  discharged  from  service, 
with  his  knee  joint  permanently  anchylosed  and  some  deformity  consequent  upon  a  partial  dislocation  of  the  extremity  of  the 
femur  inwardly."  The  man  became  a  pensioner;  but  in  the  following  year  he  re-entered  the  army  as  Lieutenant  of  the  195tli 
Pennsylvania,  and  while  belonging  to  that  organization  sustained  an  additional  injury  to  his  wounded  limb  by  a  railroad  acci 
dent  in  October,  1864.  He  was  ultimately  mustered  out  February  26,  1865,  when  his  name  was  again  placed  on  the  Pension 
Rolls.  Examiner  J.  S.  Crawford,  of  Williamsport,  at  successive  dates  certified  to  the  injury  and  its  results,  and  added,  in  Jan 
uary,  1867,  that  the  injured  joint  was  very  much  enlarged.  On  July  16,  1873,  he  reported:  "The  leg  is  flexed  on  the  thigh  at 
an  angle  of  about  forty  degrees,  with  an  enlargement  on  the  inside  of  the  joint.  The  flexion  of  the  knee  shortens  the  limb, 
which  throws  the  weight  in  walking  on  the  toes  and  necessitates  a  high  heel  to  the  boot.  The  thigh  and  leg  are  both  very  much 
atrophied  and  he  complains  of  soreness  in  the  joint."  No  changes  were  reported  in  the  condition  of  the  patient  in  September, 
1875,  since  when  he  has  been  exempted  from  further  examinations.  His  pension  was  paid  June  4,  1879. 

In  the  succeeding  six  cases  the  seat  of  fracture  appeared  to  be  confined  to  the  head 
of  the  tibia: 

CASE  560. — Private  John  O'Neil,  Co.  M,  1st  Artillery,  aged  26  years,  was  wounded  at  Pocotaligo,  October  22,  1862. 
On  the  following  day  he  was  admitted  to  hospital  at  Hilton  Head,  where  Assistant  Surgeon  J.  Bell,  U.  S.  A.,  recorded:  "Gun 
shot  wound  by  a  ball  from  a  spherical  case,  in  left  side  of  left  knee,  entering  deeply  and  lodging."  The  patient  w7as  subsequently 
transferred  to  hospital  No.  1,  at  Beaufort,  whence  Surgeon  F.  L.  Dibble,  6th  Connecticut,  reported  that  he  was  discharged 
March  7,  1863,  by  reason  of  "a  gunshot  wound  involving  the  left  knee  joint."  Examining  Surgeon  J.  E.  King,  of  Buffalo, 
certified  May  19,  1863:  "The  ball  entered  near  the  head  of  the  tibia,  passing  through  and  lodging  in  the  popliteal  space,  whence 
it  has  been  extracted  by  incision.  The  wound  is  healed,  leaving  the  leg  useless.  There  is  complete  anchylosis,  and  wasting  of 
leg,"  etc.  In  February,  1867,  the  pensioner  enlisted  in  the  44th  Infantry  (Invalid),  in  which  organization  he  served  until  March 
29,  1869,  when  he  was  again  discharged.  Examining  Surgeon  J.  W.  Toward,  of  Augusta,  Maine,  at  various  subsequent  dates 
examined  the  pensioner,  and  described  the  injury  by  the  ball  "  breaking  both  bones  and  remaining  embedded  in  the  joint.  Leg 
quite  crooked,  appearing  as  if  upper  ends  of  bone  had  been  pushed  outward ;  knee  slightly  bent  and  perfectly  stiff,  swelling 
badly  after  walking ;  limb  painful  to  hip  joint."  The  pensioner  was  paid  December  4,  1879. 

A  case  in  which  the  missile  was  extracted  from  the  head  of  the  tibia  six  months  after 
the  injury  and  the  patient  finally  recovered  with  a  useful  limb,  is  reported  by  Surgeon  R. 
A.  Kinloch,1  P.  A.  G.  S.  A  brief  abstract  is  appended: 

CASE  561.— Private  L.  C ,  6th  South  Carolina,  aged  17  years,  was  wounded  at  Seven  Pines,  May  31,  1862.     The 

ball  entered  upon  the  inner  side  of  the  right  knee,  apparently,  a  line  or  two  below  the  articulation ;  there  was  no  orifice  of  exit. 
When  wounded  he  was  lying  on  his  back,  reloading  his  gun,  With  his  knee  slightly  flexed.  The  patient  walked  some  distance 
after  he  was  shot  without  experiencing  very  great  pain.  On  the  following  day  he  was  sent  to  the  St.  Charles  Hospital,  at  Rich 
mond.  The  limb  was  then  much  tumefied  and  very  painful.  In  the  opinion  of  most  of  the  examining  surgeons  the  ball  had 
lodged;  but  a  few  of  them,  after  the  progress  of  the  case,  were  inclined  to  believe  that  it  had  escaped  through  the  orifice  of 
entrance.  He  remained  in  hospital  until  August  3d,  never  leaving  his  bed,  and  scarcely  ever  changing  from  the  supine  position ; 
he  suffered  continually  from  fever,  and  a  portion  of  the  time  from  traumatic  delirium.  About  the  middle  of  October  he  tried  the 

1  KlNLOCll  (R.  A.) ,  Case  of  Gunshot  Wound  of  the  Knee  Joint.    Ball  lodged  in  the  Head  of  the  Tibia— Extracted  through  the  Joint  Six  Months 
after  the  Accident — Recovery  with  a  Useful  Limb,  in  Confederate  States  Medical  and  Surgical  Journal,  1804,  Vol.  I,  p.  102. 


376 


INJURIES.  OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


use  of  crutches,  but  was  compelled  to  take  to  bed  again,  and  was  a  week  in  recovering  from  a  very  painful  and  inflamed  condi 
tion  of  the  limb  engendered  by  the  efforts  he  had  made.  The  patient  enjoyed  the  comforts  of  a  home  and  good  nourishing  diet, 
and  gained  flesh  and  strength;  but  the  irritation  of  the  knee  persisted  in  a  sub-acute  form,  and  the  wound  continued  to  discharge, 
the  suffering  being  always  less  when  the  discharge  was  free.  On  November  23,  1862,  he  was  seen  by  Dr.  Kinloch.  The  limb 
was  flaccid  and  attenuated.  A  fistulous  opening  upon  the  inner  side  of  the  joint,  just  below  the  articular  margin  of  the  tibia, 
indicated  the  original  orifice  of  entrance,  which  was  discharging  a  thin  pus.  The  joint  was  imperfectly  anchylosed ;  the  leg  very 
slightly  flexed  upon  the  thigh.  Dr.  Kinloch  believed  the  ball  had  lodged  in  the  head  of  the  tibia  and  determined  to  search  for 
it.  On  November  29th,  the  patient  was  fully  chloroformed.  A  semi-lunar  flap  of  integuments,  including  the  fistulous  opening, 
was  dissected  and  turned  up  from  the  deeper  tissues  over  the  inner  side  of  the  joint;  with  the  finger,  and  afterwards  with  a  large 
probe,  the  track  of  the  ball  could  be  traced  through  the  lateral  ligament  of  the  joint  to  the  depth  of  several  inches.  The  lateral 
ligament  was  incised  freely  and  a  piece  of  necrosed  bone,  a  portion  of  the  articulating  surface  of  the  tibia  about  the  size  of  the 
last  phalanx  of  the  finger,  was  discovered  and  turned  out.  As  the  joint  was  but  slightly  flexed  the  finger  could  only  advance  to 
a  certain  depth  because  of  the  inner  condyle  of  the  femur.  Forcible  flexion  of  the  joint  was  instituted  and  the  finger  pushed  on 
into  a  deep  cavity  in  the  outer  portion  of  the  head  of  the  tibia,  where  it  rested  upon  the  foreign  body,  which  was  seized  with  a 
pair  of  bullet  forceps  and  extracted  with  great  ease.  It  proved  to  be  a  large  mini6,  much  flattened,  and  having  a  piece  of  the 
patient's  pantaloons  attached.  A  sponge  full  of  warm  water  was  thrown  two  or  three  times  into  the  joint  to  wash  out  the  debris 
from  the  cavity  in  which  the  ball  had  rested.  The  tegumentary  flap  was  brought  into  position  and  secured  by  three  points  of 
suture,  only  the  dependent  corner  of  the  wound  being  kept  open  by  a  tent;  the  limb  was  extended  upon  a  bolster,  cold-water 
dressing  applied,  and  a  full  anodyne  administered.  The  wound  healed  kindly,  and  in  three  weeks  the  patient  experienced  a  feel 
ing  of  relief  that  he  had  not  known  since  the  accident.  In  a  letter  to  Dr.  Kinloch,  dated  April  23,  1864,  the  patient  states: 
"The  only  drawback  to  my  convalescence  was  an  attack  of  erysipelas,  in  January  1863,  which  I  attributed  to  imprudence  in 
eating.  On  the  17th  of  February,  1863.  I  began  to  move  about  on  crutches,  the  wound  having  entirely  healed  before  this. 
Since  then,  the  limb  has  gained  rapidly  in  strength.  In  May,  I  laid  aside  my  crutches  and  took  to  using  a  stick.  I  can  now 
walk  a  mile  without  resting,  and  often  walk  some  without  my  stick.  My  joint  is  stiff,  but  I  think  I  shall  some  day  be  able  to 
run.  I  can  now  run  a  few  steps,  and  can  truly  say  the  leg  is  well.  I  practise  walking  without  my  stick  as  much  as  I  can." 

CASE  562. — Private  M.  Hoffman,  Co.  H,  8th  New  Jersey,  aged  21  years,  was  wounded  at  Williamsburg,  May  5,  1862. 
He  was  admitted  to  the  field  hospital  at  Allen's  Farm,  where  his  injury  was  recorded  as  "  a  serious  wound  of  the  left  knee  joint." 
From  the  field  the  wounded  man  was  moved  to  Hygeia  Hospital  at  Fort  Monroe,  whence  he  was  sent  to  his  home  on  furlough 
May  21st.  Surgeon  R.  B.  McCay,  U.  S.  V.,  reported  that  the  patient  was  discharged  from  Chesapeake  Hospital  September  6, 
1862,  by  reason  of  "partial  stiffness  of  the  knee  joint  resulting  from  the  wound."  The  man  was  subsequently  admitted  on  the 

Pension  Rolls,  his  physicians  certifying  to  the  following  description  of  his  injury:  "A ball 
entered  the  popliteal  space,  passed  into  the  knee  joint,  and  produced  partial  anchylosis, 
within  all  probability  obliterating  the  synovial  sac ;  perceptible  crepitation  resulted, 
together  with  inability  to  extend  the  limb."  Assistant  Surgeon  R.  B.  Browne,  U.  S.  V., 
who  contributed  the  photograph  of  the  patient  (Contributed  Photographs,  Vol.  XII,  p.  5) 
shown  in  the  adjoining  wood-cut  (FlG.  228),  reports  the  following  history:  "The  missile 
entered  about  one  inch  below  and  behind  the  knee,  directly  in  the  median  line  of  the  limb, 
passed  upward,  forward,  and  inward  through  the  head  of  the  tibia,  and  lodged,  as  was 
surmised  at  the  time,  somewhere  in  the  centre  of  the  joint,  between  the  head  of  the  tibia 
and  the  internal  condyle  of  the  femur.  After  his  admission  into  hospital  the  patient  was 
strongly  advised  to  submit  to  amputation  of  the  thigh.  To  this  he  stoutly  objected,  how 
ever,  and  shortly  afterwards  he  was  sent  to  his  home  on  fui'lough,  where  I  saw  him  and 
commenced  the  treatment  of  his  case  somewhere  about  the  1st  of  June,  1862.  I  searched 
carefully  for  the  bullet  but  was  unable  to  reach  it.  The  patient  had  but  little  pain,  was 
in  good  health,  strong  and  robust,  and  the  wound  suppurated  nicely.  There  was  little  or 
no  inflammation  of  the  joint,  nor  could  I  detect  any  synovia  in  the  discharge.  The  treat 
ment  was  therefore  simple.  I  made  use  of  emollient  applications  and  enjoined  rest,  but 
not  perfect  rest,  as  I  permitted  him  to  move  carefully  about  the  house.  The  wound  healed 
about  the  middle  of  July,  from  which  time  he  was  able  to  go  about  on  crutches,  the  limb 
being  flexed  at  an  angle  of  135°,  or  rather  incapable  of  extension  beyond  that  point. 
About  the  middle  of  the  following  September  I  entered  the  army  as  Surgeon  of  the  31st 
New  Jersey,  and  consequently  lost  sight  of  the  patient  until  the  summer  of  1863,  when  I 
was  mustered  out.  At  this  time  he  had  regained  some  mobility  of  the  joint  and  could,  by 
giving  the  limb  a  peculiar  twist,  make  apparent  the  position  of  the  bullet.  He  himself  at 
least  was  so  confident  of  its  whereabouts  that  I  concluded  to  cut  down  to  the  point  indi 
cated  with  a  narrow-bladed  bistoury.  This  operation  I  performed  on  September  7,  1863, 
being  aided  by  Dr.  Edward  Swift,  of  Easton,  Pennsylvania,  who  put  the  patient  under 
the  influence  of  an  anaesthetic.  I  entered  the  knife  immediately  over  the  middle  and 
inside  of  the  joint  and  fortunately  struck  the  bullet  in  its  centre,  about  an  inch  below  the 
integuments.  I  then  enlarged  the  opening  just  far  enough  to  enable  me  to  extract  the  missile  with  the  aid  of  a  forceps,  and 
quickly  closed  the  wound  so  as  to  admit  as  little  air  as  possible.  A  small  quantity  of  synovial  fluid  made  its  escape.  The  ball, 
which  proved  to  be  a  spherical  one,  five-eighths  of  an  inch  in  diameter,  was  slightly  battered,  and  appeared  to  have  embedded 
itself  between  the  articulating  extremities  of  the  femur  and  the  tibia,  being  fairly  covered  by  the  synovial  sac.  The  limb  was 
then  placed  in  a  splint  and  kept  at  perfect  rest  until  all  fear  of  inflammation  of  the  joint  had  subsided.  The  wound  healed  by 
first  intention,  and  in  one  month  the  patient  was  again  able  to  get  about  with  the  aid  of  crutch  and  cane,  both  of  which  he  dis- 


Fio.  2-J8. — Shot  perforation  of  the  head  of 
the  left  tibia.     [From  a  photograph.] 


SHOT    FRACTURES    OF    THE    KNEE    JOINT. 


377 


pensed  with  after  a  period  of  five  months.  When  last  I  saw  him,  in  July,  1868,  the  man  was  walking  with  scarcely  a  limp,  free 
from  all  pain,  in  perfect  health,  and  without  deformity  excepting  a  slight  bony  prominence  where  the  ball  had  been  extracted. 
The  joint  retained  all  its  motions  except  that  of  extension,  which  was  limited,  the  leg  assuming  an  angle  of  about  170°  when  fully 
extended."  Various  examining  surgeons  at  successive  dates  have  certified  to  the  pensioner's  disability,  which  is  rated  one-half. 
His  pension  was  paid  June  4,  1879. 

The  following  interesting  case  was  reported  to  this  Office  as  an  illustration  of  control 
ling  inflammation  of  the  knee  joint  through  ligation  of  the  femoral  artery.  The  details 
were  given  by  Assistant  Surgeon  A.  A.  Woodhull,  U.  S.  A.,  in  an  essay  on  "Ligation  of 
Arteries  as  a  Means  of  modifying  Traumatic  Inflammation  of  the  Joints"  read  before  the 
Atlanta  Academy  of  Medicine,  at  its  meeting,1  June  1,  1874.  The  subject  of  preventing 
or  controlling  inflammation  of  the  joints  through  cutting  off  the  supply  of  blood  was,  in 
the  early  part  of  the  present  century,  considered  by  D.  L.  Rogers: 

CASE  563  — Captain  W.  H.  Jordan,58  9th  Infantry,  was  wounded  in  the  right  knee,  at  the  battle  of  Gaines's  Mill,  on  the 
afternoon  of  Friday,  June  27, 1862.  "  I  saw  him  not  far  from  the  line  of  battle  shortly  after  he  was  shot,  and  had  him  conveyed 
to  my  field  station  hard  by.  By  examination  with  the  little  finger  I  satisfied  myself  that  the  joint  was  perforated  and  that  the 
articulating  surface  of  the  tibia  was  grooved  as  if  by  a  round  ball  or  buckshot.  He  was  immediately  put  into  an  ambulance 
wagon  and  sent  across  the  Chickahominy  to  the  field  hospital  at  Savage  Station,  a  few  miles  distant.  This  was  the  general  ren 
dezvous  for  the  disabled  of  General  McClellan's  army,  and  in  addition  to  the  commissioned  medical  officers  there  were  present 
a  few  civil  surgeons  who  had  volunteered  their  temporary  services.  Among  them  was  Dr.  David  L.  Rogers,  of  New  York,  who 
had  long  been  an  advocate  of  the  control  of  traumatic  inflammation  of  the  joints  by  the  liga 
tion  of  the  main  artery  of  supply. s  As  I  am  informed,  the  wounded  officer  would  not  consent 
to  primary  amputation  as  was  proposed,  and  Dr.  Rogers  then  suggested  the  ligation  of  the 
femoral  at  the  apex  of  Scnrpa's  triangle,  with  the  view  of  preventing,  or  at  least  of  modify 
ing,  the  inevitably  ensuing  inflammation  of  the  joint.  This  was  acceded  to,  and  it  was  at 
once  done  I  believe  by  Dr.  Rogers  himself.  The  operation  must  have  been  performed  within 
forty  hours  of  the  reception  of  the  injury,  and  was  probably  done  on  the  succeeding  day,  for 
the  hospital  was  abandoned  on  Sunday,  the-29th,  the  second  day  after  the  battle.  The  gen 
eral  belief  that  the  serious  operation  of  ligating  the  femoral  would  add  to  instead  of  detracting 
from  the  perils  already  due  to  the  wounded  joint,  the  fact,  as  it  was  understood,  that  the 
severely  wounded  whom  the  Army  of  the  Potomac  was  obliged  to  leave  at  Savage's  were 
conveyed  to  Richmond,  a  distance  of  about  fifteen  miles,  over  rough  roads,  and  the  unfortunate 
condition  of  that  city  as  to  temperature,  supplies,  and  general  accommodations,  precluded,  in 
my  mind,  the  possibility  of  this  officer  surviving  the  double  injury,  as  we  were  tempted  to 
call  it.  Accordingly,  in  writing  to  his  friends  at  the  north,  he  was  reported  as  having  prob 
ably  died  of  his  wounds  in  the  hands  of  the  enemy;  for,  at  that  time,  there  was  no  exchange 
of  prisoners.  Between  three  and  four  weeks  after  the  battle,  however,  an  exchange  or  release 
on  parole  of  the  wounded  was  negotiated,  and,  witli  the  first  boat  load  from  Richmond  that 
passed  Harrison's  Landing,  I  was  sent  north  for  a  few  days.  To  my  great  surprise,  on  this 
boat  I  found  my  friend,  greatly  emaciated  and  suffering;  but  the  ligature  had  come  away 
successfully,  and  the  primary  violence  of  the  joint  inflammation  was  fairly  overcome.  At 
that  time,  although  both  wounds  were  suppurating,  the  incision  over  the  artery  gave  quite  as 
much  apparent  trouble  as  the  original  injury.  His  general  strength  was  much  prostrated 
and  lie  appeared  to  be  in  a  condition  of  hectic  irritation,  lie  was  carried  to  Baltimore,  and 
I  saw  no  more  of  him  until  the  following  December,  when,  on  being  ordered  out  of  the  field, 
it  so  happened  that  I  was  for  a  time  placed  in  charge  of  sick  and  wounded  officers  in  that  city.  At  this  date  his  general  health 
was  good,  the  wound  in  the  knee  had  healed,  the  incision  in  the  thigh,  singularly,  had  not  entirely  cicatrized,  and,  which  was 
of  the  most  inconvenience,  the  leg  was  partly  flexed  upon  the  thigh  and  was  fixed  by  false  anchylosis.  This  condition  must  be 
attributed  to  the  position  that  the  limb  had  naturally  assumed  under  the  influence  of  whatever  inflammation  had  occurred  at  the 
time  of  the  severest  suffering,  and  which  his  medical  attendant  had  neglected  or  feared  to  alter  while,  the  healing  was  in  progress 
lest  the  inflammation  might  be  again  excited.  Fortunately  there  was  no  torsion,  whence  it  may  be  inferred  that  the  morbid 
action  was  not  severe.  In  a  week  or  two  he  passed  from  under  my  charge  to  that  of  Surgeon  Thomas  P.  Gibbons,  U.  S.  V., 
but  I  saw  him  frequently  during  the  winter  of  1862-(>I?.  By  the  repeated  application  of  force,  sometimes  with  the  hands  and 

1  The  essay  is  only  briefly  adverted  to  on  page  '288  of  the  Atlanta  Medical  and  Surgical  Journal,  1874-75,  Vol.  XII.  A  manuscript  copy  of  the 
lecture  was  forwarded  to  the  Surgeon  General's  Office  by  its  author. 

"The  case  is  identical  with  the  case  referred  to  at  the  meeting  of  the  New  York  State  Medical  Society  in  February,  18(33,  by  Dr.  JOHN  Swix- 
UURNR  (Resection  of  Joints  and  Conservative  Surgery,  in  Transactions  of  the  Medical  Society  of  the  State  of  New  Tori;,  for  the  year  1SOJ,  Albany,  1803, 
p.  170,  and  Medical  and  ^Surgical  Reporter,  1803,  Vol.  IX,  p.  401):  "A  captain  in  the  Regular  Army  was  wounded  by  a  ball  passing  through  the  knee 
joint.  We  could  not  ascertain  to  a  certainty  that  the  same  was  injured,  as  the  course  of  the  ball  was  directly  through  the  centre  of  the  joint,  from  side  to 
side,  so  it  is  pcsslble  that  only  the  cartilage  was  wounded.  L'r.  ROGERS  tied  the  femoral  artery,  so  as  to  interrupt  and  break  the  current  of  blood  to  the 
injured  ports.  'When  I  last  saw  him,  thirty  days  a;;er  the  injury,  Ihere  had  been  little  inflammation,  and  the  prospects  were  good  for  entire  recovery.  I 
have  since  learned  that  he  7tas  entirely  recovered,  with  a  good  limb." 

3Ror,EHS  (DAVID  L.),  A  memoir  on  the  utility  of  tying  Large.  Arteries,  in  preventing  Inflammation  in  wounds  of  the  principal  joints  and 
important  surgical  operations,  illustrated  by  cases,  in  New  Yorl;  Medical  and  Physical  Journal,  1824,  Vol.  Ill,  p.  453. 

SURG.  Ill — 46 


FIG.  229.— Appearance  of  limb  18  years 
after  injury.     [From  a  photograph.] 


378  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

sometimes  with  a  screw  apparatus,  the  adhesions  were  gradually  broken  up,  and  he  gained  a  fair  passive  use  of  the  joint;  in  the 
spring  he  was  able  to  go  on  sick  leave  to  his  home  in  Ohio,  and  in  the  summer  of  1863  was,  I  believe,  assigned  to  duty  as  a 
mustering  officer.  He  saw  no  more  campaign  service,  but,  while  the  war  was  still  in  progress  (I  think  in  1863).  joined  his  regi 
ment  on  the  Pacific  coast.  It  is  now  nearly  twelve  years  since  he  was  shot,  and  it  is  more  than  eleven  years  since  I  have  seen 
or  heard  directly  from  him ;  but  I  have  seen  officers  who  have  served  with  him  in  garrison  who  were  not  aware  that  lie  had  been 
wounded.  I  should  suppose  that  he  is  practically  a  sound  man,  although  it  is  probable  that  he  cannot  discharge  the  more 
fatiguing  duties  of  the  field."  A  letter  of  inquiry  by  the  editor,  in  March,  1880,  elicited  the  following  response  from  Captain 
Jordan:  "Recruiting  Rendezvous,  U.  S.  Army,  No.  9  South  Clark  Street,  Chicago,  Illinois,  April  2d,  1880.  Dear  Doctor: 
Your  letter  of  the  29th  ult.  was  received  yesterday.  In  reply  thereto,  I  would  inform  you  as  follows — viz:  The  ball  (spherical) 
with  which  I  was  wounded  entered  just  below  the  patella  through  the  left  side  of  the  ligament  of  the  same  and  the  head  of  the 
tibia,  and  passed  out  a  little  below  the  centre  of  the  popliteal  space.  The  synovial  sac,  I  think,  was  injured,  although  I  did 
not  have  synovitis,  as  the  doctors  feared,  but  am  under  the  impression  that  some  synovial  fluid  escaped  from  the  joint.  There  was 
profuse  bleeding;  so  much  so,  that  my  pantaloon  leg  and  stocking  had  to  be  cut  oft'  on  account  of  being  so  stiff  from  the  blood. 
I  have  never  had  any  pain  in  the  knee  except  when  I  have  hurt  it.  There  is  no  stiffness  except  after  using  the  limb  in  march 
ing  or  much  dancing.  The  joint  is  nearly  as  good  as  the  other  one,  although  I  cannot  flex  the  wounded  limb  quite  as.  much  as 
the  other  one.  No  bone  came  out  of  or  was  removed  from  the  wounded  joint.  The  patella  of  the  wounded  limb  is  one  inch  and 
a  half  lower  than  the  other  one.  The  femoral  artery  was  ligated  a  little  over  half  way  up  from  the  knee,  to  prevent  inflamma 
tion.  I  am  not  certain  whether  Dr.  Rogers  or  Dr.  A.  K.  Smith  did  it.  Dr.  Woodhull  attended  me  in  hospital  in  Baltimore  ns 
late  as  February,  1863,  and  saw  me  on  the  ferry  boat  between  Oakland  and  San  Francisco  in  September,  1877.  A  few  days 
after  I  was  wounded  I  was  taken  prisoner  and  remained  so  about  three  weeks.  I  was  then  taken  to  Baltimore,  Maryland,  where 
I  remained  in  hospital  until,  in  February,  1863, 1  was  granted  a  sick  leave,  and  was  on  crutches  thereafter  for  about  six  months. 
When  my  wound  had  healed  while  in  hospital,  my  limb  was  stiffened  with  the  lower  part  of  the  leg  at  right  angles  to  the  upper 
part.  Dr.  Woodhull  and  another  surgeon  placed  me  under  the  influence  of  chloroform  and  partially  removed  the  stiffness.  I 
'  then  wore  an  apparatus  for  about  six  months  until  the  limb  had  become  very  nearly  as  straight  as  the  other,  i.  e.,  straight 
enough,  my  other  leg  being  a  little  knock-kneed.  *  *  Very  respectfully,  your  obed't  servant."  (Signed.)  WM.  H.  JORDAN, 
Captain,  9th  Infantry.  The  letter  was  accompanied  by  a  photograph,  a  copy  of  which  is  shown  in  FiG.  229. 

Ligation  of  the  femoral  artery  for  secondary  haemorrhage  was  successfully  performed 
in  two  instances  of  shot  fracture  of  the  head  of  the  tibia: 

CASE  564. — Lieutenant  Thomas  W.  Robertson,  79th  New  York,  was  wounded,  on  June  16,  1862,  in  the  assault  on  the 
works  on  James  Island,  by  a  musket  ball,  which  struck  the  outer  side  of  the  head  of  the  left  tibia  and  passed  upwards  and 
lodged,  as  was  believed,  in  the  intercondyloid  notch  of  the  femur,  or  somewhere  about  the  knee  joint.  Amputation  of  the  thigh 
was  advised  but  refused  by  the  patient.  The  limb  was  then  placed  in  an  easy  position  and  cold-water  dressings  were  applied. 
The  patient  was  treated  in  the  regimental  hospital  until  June  28th,  when  he  was  sent  to  New  York.  On  July  6th,  there  was 
profuse  haemorrhage  from  the  anterior  tibial  artery.  On  July  8th,  the  femoral  artery  was  tied  by  Professor  Willard  Parker. 
At  this  date  the  knee  joint  was  excessively  swollen,  and  there  was  free  suppuration  from  the  wound.  After  a  very  protracted 
confinement  the  patient  ultimately  recovered,  with  complete  anchylosis  of  the  knee  joint,  the  straight  position  of  the  limb  being 
preserved.  Lieutenant  Robertson  was  transferred  to  the  Veteran  Reserve  Corps  on  February  29,  1864,  and  was  on  duty  at 
Emory  Hospital  in  1865.  On  July  18, 1865,  the  photograph  (Sury.  Phot.  Series,  No.  78,  A.  M.  M.)  was  taken,  a  copy  of  which 
is  shown  in  FiG.  I  of  PLATE  LXVIII,  opposite  p.  370.  The  facts  of  the  case  were  communicated  by  Surgeon  N.  R.  Moseley, 
U.  S.  V.,  who  reported  that  Professor  Parker  and  the  other  surgical  advisers  of  Lieutenant  Robertson  entertained  no  doubt  that 
the  knee  joint  was  primarily  involved  in  this  case.  The  exact  location  of  the  hall  was  never  ascertained.  Lieutenant  Robertson 
was  discharged  and  pensioned.  Examining  Surgeon  E.  Bradley,  of  New  York,  reported  October  24,  1866:  "Ball  shattered 
upper  third  of  left  fibula;  resection  of  a  portion  followed.  The  femoral  artery  had  to  be  tied.  Knee  is  anchylosed,  foot  atro 
phied,  cold,  paralyzed,  and  limb  of  little  more  use  than  an  artificial  limb."  Examiner  Th.  F.  Smith,  in  September,  18F3,  states: 
"Ball  entered  outside  of  upper  part  of  left  leg  and  has  never  been  removed;  there  is  a  large  cicatrix  on  the  opposite  side  of  the 
leg,  the  result  of  an  abscess;  complete  anchylosis  of  the  knee  joint."  Drs.  J.  F.  Ferguson  and  M.  K.  Hogan  report,  Septem 
ber  7,  1875:  "The  femoral  artery  has  been  tied.  The  knee  joint  is  solidly  anchylosed."  The  Examining  Board,  consisting  of 
Drs.  S.  S.  Burt,  A.  B.  Judson,  and  Wm.  O.  McDonald,  state,  September  14, 187? :  "Left  knee  anchylosed,  nearly  straightened; 
femoral  artery  tied  on  left  side."  Pension  paid  March  3,  1880. 

CASE  565. — Private  A.  J.  Scott,  Co.  A,  9th  Maine,  aged  24  years,  was  wounded  at  Deep  Bottom,  August  16,  1864,  and 
admitted  to  hospital  at  Beverly  six  days  afterwards.  Assistant  Surgeon  C.  Wagner,  U.  S.  A.,  reported:  "Shot  wound  of  right 
leg,  injuring  the  head  of  the  tibia.  Secondary  haemorrhage  took  place  from  the  anterior  tibial  artery  and  sixteen  ounces  of  blood 
was  lost  on  December  17th,  when  the  femoral  artery  was  ligated  in  its  continuity  at  the  lower  third  of  the  thigh  by  Acting 
Assistant  Surgeon  J.  C.  Morton.  Chloroform  was  used  and  the  patient  reacted  promptly.  Two  weeks  after  the  operation  he 
had  recovered."  He  was  discharged  from  service  June  6,  1865,  and  pensioned.  Examiner  C.  E.  Snow,  of  Calais,  Maine, 
March  7,  1866,  certified  to  the  wound  and  to  its  being  "well  healed;  but  there  is  considerable  lameness  as  yet,  the  weakness  of 
the  joint  forbidding  any  continued  use  of  the  limb."  Examiner  E.  H.  Vose  in  his  report,  April  15,  1874,  stated  that  the  ball 
lodged  and  remained  in  the  bone  for  four  months;  also  that  when  it  was  extracted  haemorrhage  occurred  and  necessitated  liga- 
tion  of  the  femoral.  "Head  of  tibia  enlarged  and  somewhat  tender  to  the  touch.  Rheumatism  from  the  joint  downwards.  Leg 
weak,  and  he  cannot  bear  his  weight  upon  it  when  at  work  ;  foot  slightly  extended;  walks  lame  with  a  peculiar  swinging  gait." 
In  the  following  year  the  same  examiner  described  the  joint  as  stiff;  circulation  feeble;  considerable  numbness  on  inner  side  of 
leg,  eto..  and  added:  "He  has  been  under  my  personal  observation  for  eight  years  and  the  disability  has  largely  increased." 
.11. -r  was  paid  December  4,  1879. 


SECT.  IV.l 


SHOT    FRACTURES    OF    THE    KNEE    JOINT. 


379 


The  series  of  recoveries  after  shot  fractures  of  the  knee  joint  will  be  concluded  with 
three  examples,  in  which  particular  bones  injured  were  not  specified: 

CASE  566. — Private  H.  W.  Pomroy,  Co.  F,  1st  Maine  Heavy  Artillery,  aged  36  years,  was  wounded  at  Laurel  Hill, 
May  19. 1864,  and  entered  Mount  Pleasant  Hospital,  Washington,  three  days  afterwards.  Assistant  Surgeon  IT.  Allen,  II.  S.  A., 
reported:  "The  wound  was  apparently  through  the  knee  joint.  A  conoidal  ball  entered  at  the  inner  border  of  the  right  patella 
and  made  its  exit  posteriorly  at  the  external  central  part  of  the  popliteal  space,  on  a  line  with  the  inferior  border  of  the  condyh-s. 
The  progress  of  the  case  has  been  imperfectly  recorded.  All  that  can  be  ascertained  is  to  the  effect  that  the  patient  was  bed 
ridden  for  eight  weeks;  that  in  the  third  week  two  pieces  of  bone  were  removed  from  the  posterior  wound,  and  in  the  fifth  week 
two  others  were  taken  out;  also  that  he  suffered  greatly,  and  according  to  his  account  had  marked  rigors.  The  patient  came 
under  my  notice  in  January,  1865,  when  presenting  himself  for  discharge.  At  this  time  the  appearance  of  the  limb  was  as  fol 
lows:  The  entire  extremity  was  rigid,  the  knee  joint  permanently  auchylosed,  and  the  region  of  the  joint  much  swollen:  all 
original  contour  of  the  outline  was  destroyed,  and  the  integuments  were  semi-cedematous  up  to  the 
hip  joint.  The  skin  was  of  a  dead  purplish  red  color  and  extremely  sensitive,  especially  around 
the  knee  joint.  The  surgeons  at  the  field  hospital  were  desirous  of  amputating  the  limb,  but  the 
patient  refused  to  give  his  consent,  and  the  case  was  then  treated  conservatively.  The  patient 
was  discharged  from  service  January  26,  1865,  and  asserted,  prior  to  his  departure  for  his  home, 
that  should  the  limb  continue  to  be  so  excessively  painful  he  would  have  it  amputated.  Thus  it 
is  shown  that,  should  conservative  treatment  be  successful  in  this  class  of  cases,  the  limb  resultant 
of  months  of  suffering  is  apt  to  be  worse  than  useless."  Examiner  R.  K.  Jones,  of  Bangor,  Octo 
ber  8,  1866,  certified:  "The  wound  is  healed  and  he  retains  the  power  of  flexing  the  leg  slowly 
and  feebly  to  an  angle  of  135°.  He  walked  with  crutches  till  the  fall  of  1865.  He  now  walks 
with  one  cane,  flexing  the  body  on  the  left  thigh  and  swinging  with  much  effort  the  right  limb 
forward — not  flexing  the  knee.  The  foot  and  leg  swell  much  after  use  and  are  now  cedematous. 
The  outside  of  the  leg  and  foot  are  numb.  He  suffers  much  from  pain  after  use,"  etc.  Subsequent 
examiners  substantially  show  the  same  disabling  effects,  and  the  BangoV  Board  in  September, 
1876,  described  the  exit  wound  as  very  tender,  and  stated  that  a  solid  substance  like  a  buckshot 
or  a  spicula  of  bone  could  be  felt  under  the  cicatrix.  The  pensioner  was  paid  June  4,  1879. 

CASE  567. — Allison  Shutter,  Drummer,  Co.  C,  7th  Pennsylvania  Reserves,  received,  in 
one  of  the  earlier  of  the  seven  days'  battles  before  Richmond,  in  June,  1862,  a  shell  wound  of  the 
left  knee  joint.  He  was  taken  prisoner,  and  while  he  was  in  the  enemy's  lines  it  was  decided  that 
primary  excision  of  the  knee  joint  should  be  performed  on  the  field.  The  operation  was  com 
menced,  but  was  interrupted  by  an  advance  of  the  Union  troops,  who  regained  the  ground 
they  had  lost  earlier  in  the  day.  The  parts  were  brought  in  apposition  and  the  limb  secured  to  a 
splint,  and  the  patient  was  sent  to  Fort  Monroe,  and  admitted  to  Hygeia  Hospital  on  June  30th. 
On  July  6th,  he  was.  sent  to  Philadelphia  on  the  steamer  Daniel  Webster.  He  was  admitted,  on 
July  7th,  to  the  Satterlee  Hospital.  The  wound  cicatrized  and  left  a  comparatively  useful  limb. 
This  soldier  was  discharged  February  5,  1883,  by  Surgeon  I.  I.  Hayes,  U.  S.  V.,  for  "lameness 
resulting  from  a  shell  wound  of  the  left  knee."  His  name  does  not  appear  on  the  Pension  List. 
The  photograph  of  the  patient  (Sury.  Phot.  Series,  No.  204,  A.  M.  M.),  represented  in  FIG.  230. 
was  contributed  by  Surgeon  R.  B.  Bontecou,  U.  S.  V. 

CASE  568. — Private  C.  Volgel,  Co.  F,  14th  Connecticut,  aged  37  years,  was  wounded  before  Petersburg,  October  2, 1864, 
and  admitted  to  the  field  hospital  of  the  2d  division,  Second  Corps,  where  Surgeon  I.  Scott,  7th  West  Virginia,  recorded:  "Shot 
fracture  of  right  knee."  Surgeon  J.  C.  McKee,  U.  S.  A.,  reported  that  "the  patient  was  admitted  to  Lincoln  Hospital,  Wash 
ington,  October  8th,  with  shot  wound  of  right  knee  joint,  the  ball  entering 
antero-posteriorly,  severing  the  capsular  ligament  on  its  internal  aspect 
and  opening  the  joint.  When  admitted,  the  parts  were  highly  inflamed 
and  synovial  fluid  was  constantly  discharging  from  the  wound.  The  limb 
was  placed  in  a  box  splint  and  surrounded  with  bran.  Improvement 
followed  the  treatment.  In  the  course  of  three  months  recovery  had 
taken  place  with  complete  anchylosis  of  the  joint."  On  June  2,  1865, 
the  patient  was  discharged  from  service  and  pensioned.  Examiner  H.  L. 
Burritt,  of  Bridgeport,  Connecticut,  at  successive  periods  certified  to  the 
character  of  the  wound  and  to  the  leg  being  fixed  "in  a  nearly  straight 
position ;  joint  painful  and  whole  limb  swollen  on  motion  and  useless." 
The  pensioner  was  paid  December  4, 1879.  A  photograph  of  the  injured 
limb,  taken  at  Lincoln  Hospital,  was  contributed  by  Surgeon  McKee 
(Contributed  Photographs,  Vol.  3,  No.  34),  and  is  represented  in  the  wood 
cut  (FiG.  231). 

The  records  in  the  cases  of  recovery  after  shot  fracture  of  the  bones  of  the  knee  joint 
treated  by  conservation  show  that  of  the  three  hundred  and  thirty-eight  patients,  fifty- 
nine  recovered  with  complete,  and  one  hundred  and  sixty-five  with  partial  anchylosis;  in 
twenty-three  instances  impaired  motion,  with  lameness  or  weakness  of  the  limbs,  or  partial 


FIG.  230.— Appearance  of  left 
knee  joint  about  2  months  after 
injury.  [From  u  photograph.] 


FIG. 231.— Auchylosed  knee 
[From  a  photograph.] 


nt.  about  (J  months  after  injury. 


380 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


phtb 


paralysis  with  atrophy  of  muscles,  was  indicated;  in  eight  instances  the  motions  of  the 
joint  were  reported  perfect,  and  in  eighty-three  cases  the  condition  of  the  limb  has  not 
been  ascertained.  Thirty-two  of  the  patients  were  Confederate  and  three  hundred  and 
six  Union  soldiers.  Two  hundred  and  thirty-six  of  the  three  hundred  and  six  Union 
soldiers  became  pensioners;  but  twenty  of  them  have  died,  since  the  close  of  the  War,  of 
lisis  and  other  diseases,  and  one  has  committed  suicide. 

Fatal  Cases  of  Shot  Fractures  of  the  Bones  of  the  Knee  Joint  treated  by  Conserva 
tion. — This  group  comprises  five  hundred  and  twenty-one  cases.  The  graver  complica 
tions  were  pyaemia  in  seventy-seven  instances,  tetanus  in  two,  gangrene  in  seventeen,  and 
erysipelas  in  eighteen  instances.  Forty-three  of  the  patients  were  Confederate  and  four 
hundred  and  seventy-eight  Union  soldiers. 

CASE  509. — Private  S.  Eisner,  Co.  E,  7th  Michigan,1  aged  29  years,  was  wounded  on  picket  near  Chantilly,  June  19, 
1863,  by  a  carbine  shot,  which  entered  the  left  thigh  anteriorly  at  about  its  middle,  passed  downward  and  inward,  and  lodged 
beneath  the  integument  on  the  inner  side  of  the  knee  joint.  He  was  brought  to  Washington  and  admitted  to  Stunton  Hospital 
six  days  after  being  wounded.  On  June  27th,  a  conical  ball  was  readily  extracted  through  an  incision, 
its  situation  being  superficial.  The  joint  at  this  time  was  neither  swollen  nor  tender  and  did  not 
appear  to  be  involved  in  any  way.  On  July  2d,  some  pain  and  swelling  was  noticed  for  the  first  time, 
when  an  ice-bag  was  applied  to  the  knee.  Two  days  later  the  swelling  had  extended  up  the  thigh, 
and  by  July  6th  there  was  well-marked  erysipelas  as  well  as  effusion  in  the  knee  joint.  Tincture  of 
iodine  was  applied  and  tincture  of  muriate  of  iron  was  administered;  stimulants  were  given  freely. 
By  July  8th,  the  erysipelas  had  extended  clear  up  to  the  groin.  On  July  12th,  the  discharge  of  pus 
was  free,  and  in  consequence  the  tension  and  swelling  of  the  thigh  were  sensibly  diminished.  The 
patient,  however,  was  manifestly  failing.  On  July  18th,  he  was  seized  with  diarrhoea,  and  death 
supervened  in  the  evening.  The  autopsy  showed  that  the  bullet  had  lacerated  the  sartorius  muscle 
extensively  and  splintered  the  internal  condyle  of  the  femur.  The  joint  arid  the  cellular  tissues  of  the 
thigh  were  filled  with  dark  colored  and  very  offensive  pus,  and  the  articular  surfaces  of  the  femur  and 
tibia  were  denuded  of  cartilage.  Surgeon  J.  A.  Lidell,  U.  S.  V.,  who  furnished  the  history,  with  the 
pathological  specimen  (FiG.  232)  and  the  missile  (Specimen  3074,  Surgical  Section,  A.  M.  M.),  remarks  : 
"The  case  interested  me  greatly,  because  when  the  bullet  was  extracted  there  was  not  the  slightest 
evidence  of  injury  to  the  inner  condyle,  nor  indeed  to  any  other  bone  whatever.  The  bullet  was 
located  quite  superficially  and  not  in  relation  with  the  injured  condyle.  During  the  eight  days  which 
elapsed  between  the  receipt  of  the  wound  and  the  extraction  of  the  missile  said  bullet  must  have 
slipped  away  from  the  bone  into  a  new  position.  When,  therefore,  on  July  2d,  some  inflammatory 
trouble  in  the  knee  appeared,  we  thought  it  was  not  due  to  an  injury  of  the  bone,  but  that  the  involvement  of  the  joint  originated 
from  the  soft  parts.  The  case  also  affords  a  good  illustration  of  the  obscurity  of  the  symptoms  and  the  difficulty  of  diagnosis 
which  may  attend  a  serious  gunshot  injury  of  an  articulation  so  thinly  covered  with  soft  parts  and  so  easy  of  examination  from 
every  side  as  the  knee  joint." 

CASE  570. — Private  A.  Simms,  19th  Georgia,  was  wounded  in  the  right  knee,  at  Antietam,  Sep 
tember  17,  1862,  and  treated  at  a  hospital  near  Sharpsburg.  Surgeon  J.  H.  Ranch,  U.  S.  V.,  forwarded 
the  specimen  (FiG.  233),  with  the  following  history:  "This  was  a  robust  young  man,  19  years  old. 
The  surgeon  who  first  attended  him  could  not  find  the  ball,  the  external  opening  of  the  wound  being 
about  four  inches  below  the  knee  joint,  but  was  satisfied  that  it  had  passed  obliquely  in  the  direction  of 
the  knee  joint.  Acting  Assistant  Surgeon  H.  De  Young  called  my  attention  to  this  case  five  weeks 
after  the  man  was  wounded.  His  limb  was  much  swollen,  and  his  constitutional  symptoms  such  that  I 
decided  against  amputation,  which  was  proposed,  and  placed  him  on  a  stimulating  and  nourishing  diet, 
hoping  that  we  thus  might  get  him  into  a  fit  condition  for  an  operation.  For  a  week  he  seemed  to 
improve,  but  after  this  he  lost  his  appetite,  and  gradually  sank  from  exhaustion,  and  died  on  November 
10,  1862.  This  man's  life  would  no  doubt  have  been  saved  had  an  immediate  amputation  of  his  limb 
been  made."  The  specimen  consists  of  the  bones  of  the  knee,  with  the  outer  condyle  shattered,  and 
shows  that  there  lias  been  a  trivial  deposit  of  callus,  with  much  caries  and  destruction  of  the  articular 
surfaces  of  the  joint. 

CASE  571. — Private  I.  N.  Sarvis,  Co.  C,  131st  Pennsylvania,  was  wounded  at  Fredericksburg, 
December  13,  1862,  and  was  admitted  to  Mount  Pleasant  Hospital.  Washington,  four  days  afterwards. 
Acting  Assistant  Surgeon  J.  C.  Wyer  forwarded  the  pathological  specimen  (FiG.  234)  and  reported  the 
following  detailed  history:  "Sarvis  received  his  wound  by  a  ball  perforating  the  patella  of  the  left 
with°onter  condyle  of  femur  'fff.  passing  through  the  knee  and  making  its  exit  at  a  point  nearly  opposite  in  the  popliteal  space, 
shattered.  Sprc.  351.  When  admitted  his  whole  constitution  was  suffering  from  the  effects  of  the  injury  ;  the  pulse  quick  and 

frequent  (120),  denoting  irritability;  the  skin  dry  and  hot;  appetite  poor;  sensibility  of  the  joint  extreme,  the  patient  shrieking 
on  account  of  the  pain  occasioned  by  the  slightest  motion  of  the  limb.     The  discharge  from  the  wound  consisted  of  synovia  and 
1  A  brief  abstract  of  this  case  was  published  in  Circular  No.  (i.  War  Department.  8.  G-.  O..  Washington.  1865,  p.  36. 


FIG.  232.— The  bones  of 
the  left  knee ;  the  posterior 
portion  of  the  internal  con 
dyle  is  split  off.  Spec.  1 399. 


SKCT.  rv. J  SHOT    FRACTURES    OF    THE    KNEE    JOINT.  381 

thin  unhealthy  pus.  There  was  nothing  peculiar  about  the  aspect  of  the  limb  except  a  general  tumefaction.  The  tongue  was 
furred  lightly,  and  the  expression  anxious;  bowels  constipated.  On  the  tenth  day  after  admission  he  was  attacked  with  a  severe 
chill,  which  was  followed  by  fever,  and  from  this  period  the  hectic  flush  began  to  appear  upon  the  cheeks  periodically.  Sub 
sequently  there  were  recurrences  of  the  rigors.  Occasionally  the  mind  wanders.  The  features  are  pinched,  the  skin  is  sallow, 
and  countenance  exhibits  the  icteroid  appearance  always  present  in  pyaemia.  There  is  great  thirst,  and  the  respiration  is  quick 
and  irregular.  On  December  28th,  he  was  attacked  with  a  cough,  the  expectoration  being  tough,  gelatinous,  and  streaked  with 
blood.  Auscultation  revealed  crepitant  and  sibilant  rales  through  both  lungs.  On  the  5th  of  January,  18(53,  Surgeon  J.  H. 
Briuton,  U.  S.  V..  visited  the  hospital  and  his  attention  was  called  to  the  case.  At  this  period  the  case  was  one  of  well-marked 
pyaemia;  the  lung  complication  Dr.  Brinton  pronounced  as  multiple  or  metastatic  abscess.  6th,  no  abatement  in  any  of  the 
symptoms.  7th,  rales  and  rhonchi  still  audible  through  the  lungs;  pulse  continues  120  beats  in  the 
minute;  skin  dry  and  hot;  tongue  dry  and  fissured;  appetite  much  impaired;  patient  lies  drowsy  and 
dull  most  of  the  time.  The  discharge  from  the  knee  is  profuse,  ichorous,  and  of  a  sickening  odor.  From 
the  8th  to  13th  the  symptoms  have  continued  the  same:  respiration  quick,  pulse  130;  tongue  dry  and 
crusty;  discharge  from  the  knee  ichorous  and  extremely  offensive ;  expectoration  rusty  and  gelatinous. 
Has  had  slight  rigors.  Rales  and  rhonchi  still  present.  Complains  of  pain  on  the  least  motion  of  his 
body.  Urine  scanty  and  turbid ;  bowels  constipated ;  loss  of  appetite.  Continues  in  a  semi-comatose, 
dull  condition.  14th:  This  morning  he  is  unable  to  protrude  his  tongue;  the  features  are  pinched  and 
sunken ;  pulse  very  feeble  and  rapid ;  deep  hectic  flush.  Evening :  has  been  moaning  all  day  and  refused 
his  stimulants.  The  peculiar  odor  is  very  evident.  Died  at  4.30  A.  M.  on  January  15,  1863.  Autopsy 
eight  hours  after  death:  Rigor  mortis  was  still  present;  emaciation  extreme.  The  thorax  being  laid 
open  revealed  the  superior  lobes  of  the  lungs  apparently  healthy,  but  upon  removing  them  the  inferior 
lobes  were  found  to  be  consolidated  and  studded  with  abscesses  varying  in  size  from  a  pea  to  larger  ones, 
the  diameter  of  which  measured  about  half  an  inch.  The  consolidation  and  effusion  extended  also  to  the 
dependent  portions  of  the  superior  lobes.  There  was  considerable  effusion  in  the  left  pleural  cavity.  The  condyles  of  femur  perfb- 
heart  was  perfectly  normal;  no  deposit  upon  the  valves.  A  small  clot  was  discovered  in  the  right  ven 
tricle;  there  was  also  some  of  the  separated  fibrin;  no  effusion  in  the  pericardium.  The  inferior  lobes  of  both  lungs  sank 
readily  in  water.  On  making  the  incision  to  resect  the  knee  joint,  pus  escaped  from  beneath  the  muscles  of  the  lower  third  of 
the  thigh.  There  was  a,  good  deal  of  disintegration  of  the  tissues.  The  extremities  of  the  femur  and  tibia  were  entirely  sep 
arated,  the  crucial  ligaments  having  been  destroyed  by  the  ball  in  its  passage  through  the  joint  and  the  capsule  ulcerated 
through  at  several  points.  The  patella  was  perforated  about  its  centre,  dividing  it  into  several  fragments,  which,  however,  were 
retained  in  position  by  the  ligamentum  patellae.  The  internal  condyle  of  the  femur  was  crumbled  into  small  fragments,  and  a 
deep  furrow  marked  the  course  of  the  ball."  In  addition  Dr.  Wyer  remarks  that  "at  no  period  since  his  admission  has  an 
operation  been  admissible,"  also  that  the  patient  had  likewise  a  wound  of  the  right  shoulder,  involving  the  joint.  The  specimen 
consists  of  the  bones  of  the  injured  knee. 

CASE  572. — Private  E.  Overman,  Co.  H,  1st  Ohio  Cavalry,  received  a  shot  wound  of  the  right  knee  joint,  at  Mission 
Ridge,  October  24,  1863.  Surgeon  I.  Moses,  U.  S.  V.,  contributed  the  pathological  specimen  (Cat.  Surg.  Sect.,  1866,  p.  332,  Spec. 
2137),  with  the  following  history:  "A  ball  entered  the  external  condyle  of  the  femur,  penetrating  the  joint  and  lodging  in  the 
cancellated  structure.  He  was  taken  to  hospital  in  Chattanooga,  where  the  missile  was  extracted,  and  where  he  remained  for 
nearly  two  months.  On  December  20th,  I  saw  him  for  the  first  tune  in  hospital  at  Murfreesboro',  to  which  place  he  had  been 
removed  by  railroad,  a  distance  of  a  hundred  miles.  The  knee  was  very  much  swollen,  the  joint  and  surrounding  tissues  infil 
trated  with  pus,  and  there  was  general  prostration  of  vital  force.  Incisions  were  freely  made  to  evacuate  pus,  and  the  symptoms 
generally  improved.  But  on  January  10,  1864,  the  patient  was  attacked  with  vomiting  and  prostration,  and  the  left  leg  as  far 
as  the  knee  became  gangrenous.  He  died  on  the  following  day."  The  specimen  comprises  the  bones  of  the  injui'ed  knee  joint 
and  shows  the  articulating  surfaces  to  be  completely  destroyed  by  suppurative  action. 

CASE  573. — Private  W.  J.  Lowry,  Co.  E,  25th  Ohio,  was  wounded  at  Bull  Run,  August  30,  1862,  and  admitted  to  hos 
pital  at  Alexandria  several  days  afterwards.  Surgeon  E.  Bentley,  U.  S.  V.,  reported :  "A  mim'6  ball  passed  through  the  right 
thigh  antero-posteriorly,  terribly  shattering  the  lower  third  of  the  femur,  opening  the  knee  joint,  and  driving  fragments  of  bone 
into  it.  The  wounded  man  laid  exposed  on  the  battle  field  for  two  days  and  was  then  removed  in  an  army  wagon.  He  was 
treated  by  rest  and  stimulants.  The  patient  died  from  pyaemia  and  exhaustion  October  3,  1862,  not  having  been  in  condition  for 
an  operation  at  any  time  before  his  death." 

In  a  case  of  grapeshot  wound  of  the  left  knee  an  abscess  was  found,  at  the  post 
mortem  examination,  which  extended  from  two  inches  below  the  greater  trochanter  to  a 
point  two  inches  below  the  articular  surface  of  the  tibia: 

CASE  574. — Private  T.  J.  Barnett,  Co.  I,  40th  Illinois,  aged  24  years,  was  wounded  at  Mission  Ridge,  November  25, 
1863,  and  admitted  to  the  field  hospital  of  the  4th  division,  Fifteenth  Corps.  Surgeon  W.  W.  Bridge,  46th  Ohio,  described  the 
injury  as  "a  severe  grapeshot  wound  of  the  left  knee  joint,"  and  reported  that  the  patient  was  transferred  to  the  General  Field 
Hospital  at  Chattanooga,  December  20th.  Acting  Assistant  Surgeon  C.  E.  Ball  communicated  the  result  of  the  case  from  the 
latter  hospital  as  follows :  "When  admitted  the  patient  was  very  much  emaciated,  his  injured  knee  and  leg  being  badly  swollen 
and  the  knee  very  painful  on  the  slightest  touch  or  movement;  pulse  110.  About  a  pint  of  pus,  thin,  very  fetid,  and  of  greyish 
color,  was  discharged  daily.  The  wound  ceasing  to  suppurate  sufficiently,  I  made  an  incision  just  above,  and  by  keeping  the 
whole  extent  of  the  leg  bandaged  reduced  the  swelling  in  a  few  days.  The  discharge  of  pus,  however,  continued  the  same  in 
amount  and  character.  The  patient  was  kept  on  nourishing  diet,  tonics,  stimulants,  and  anodynes  the  whole  time  he  was  in 
hospital;  but  he  gradually  grew  weaker,  and  died  January  14,  1864.  The  autopsy  disclosed  a  large  sloughing  wound  on  the 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


anterior  surface  of  the  knee  joint;  the  patella  fractured  in  four  fragments.  On  laying  open  the  thigh  an  abscess  was  found 
extending  from  two  inches  below  the  great  trochanter  to  a  point  two  inches  below  the  articular  face  of  the  tibia,  containing 
ichorous  pus  with  masses  of  cheesy  appearance  and  consistence.  The  knee  joint  was  opened  posteriorly  as  well  as  anteriorly, 
and  the  ligaments  and  cartilages  were  somewhat  softened.  A  portion  of  the  articular  surface  of  the  tibia  was  laid  bare;  the 
limb  generally  infiltrated  with  serum."  The  lowest  third  of  the  femur  of  the  wounded  hmb,  being  also  injured,  was  forwarded 
to  the  Museum  by  Dr.  Ball,  and  constitutes  specimen  2168  of  the  Surgical  Section,  showing  a  longitudinal  fissure  to  the  extent 
of  four  inches  on  the  posterior  surface  of  the  shaft,  the  articulating  surface  being  destroyed  by 
suppuration. 

CASE  575. — Private  W.  J.  D.  Parks,  Co.  H,  132d  Pennsylvania,  was  wounded  at  Freder- 
icksburg,  December  13, 1862,  and  entered  the  Harewood  Hospital,  Washington,  on  December  18th. 
Surgeon  T.  Antisell,  U.  S.  V.,  recorded  as  follows:  "Gunshot  wound  in  right  knee,  opening  the 
joint.  Ball  entered  on  the  inner  side  of  the  patella  on  a  level  with  it,  and  emerged  at  the  popliteal 
space.  Patient  in  general  poor  health  and  anaemic.  Cold-water  dressings  were  used  December 
22d ;  irritative  fever ;  tongue  dry ;  pulse  100.  He  continued  to  decline,  there  being  no  time  at 
which  he  could  bear  an  operation.  He  died  on  December  28,  1862.  Post-mortem:  Inner  condyle 
of  femur  fractured.  Ball  passed  directly  into  the  joint,  cutting  a  part  of  the  crucial  ligament  and 
emerging  from  below  into  the  popliteal  space.  Suppuration  and  burrowing  of  pus  existed  on  outer 

The  bones  of  the  injured  knee  are  shown  in 
Assistant  Surgeon  W.  A. 


235.— The  bones  of  the 
riirht  knoe.  with  the  inner  con- 


side  of  thigh,  extending  four  inches  above  the  joint." 

the  annexed  cut  (FiG.  235).     The  specimen  was  contributed  by  Actin 

dyle  und  the  head  of  the  tibia     Harvey,  and  shows  that,  besides  the  injury  to  the  inner  condyle  of  the  femur,  the  head  of  the  tibia 
fractured  posteriorly.   Spec.  98:i.  ' '  J     J  J 

was  fractured  posteriorly. 

CASH  f>76. — Private  J.  Traverse,  Co.  I,  7th  Michigan,  aged  26  years,  was  wounded  at  Antietam,  September  17,  1862, 
and  admitted  to  hospital  No.  1,  Frederick,  twelve  days  afterwards.  Acting  Assistant  Surgeon  R.  Davies  furnished  the  follow 
ing  minutes  of  the  case:  "Wound  in  the  left  knee  by  a  bullet.  No  inflammation  followed.  The  missile  was  first  perceived 
October  27th,  being  situated  at  the  outside  of  the  patella,  two  inches  from  the  tubercle  of  the  tibia  and 
directly  under  the  integument.  On  extracting  it  about  half  a  dozen  drops  qf  synovia  escaped,  the  joint 
being  opened  to  a  very  small  extent  by  the  edge  of  the  base  of  the  bullet.  Wound  closed  by  plaster. 
October  29th,  inflammation  of  the  joint  having  set  in,  cupping  to  the  amount  of  six  ounces  was  resorted  to; 
ice  applications  and  opiates;  low  diet.  October  30th,  measurements  around  the  left  or  affected  knee  show, 
above  the  patella,  thirteen  and  a  half  inches;  across  the  patella,  fourteen  and  three-quarter  inches;  and 
below  the  patella,  eleven  and  a  half  inches;  while  at  the  right  or  sound  knee  they  show  thirteen,  fourteen, 
and  eleven  inches  respectively.  November  4th,  patient  had  a  sleepless  night  and  pain,  notwithstanding  a 
dose  of  morphia.  There  is  an  opening  on  the  outer  side  of  the  patella,  from  which  pus  is  freely  escaping. 
The  injured  knee  now  measures  fourteen  inches  above,  sixteen  and  a  half  inches  across,  and  thirteen  and 
a  half  inches  below  the  patella.  13th,  measurement  shows  fourteen,  fifteen,  and  thirteen  inches  above, 
across,  and  below  the  patella.  Two  openings  have  been  made  on  the  inner  side,  one  opposite  the  upper 
border  of  the  patella  and  the  other  four  inches  above.  Pus  of  a  healthy  character  exudes.  Complains 
of  much  startling  pain  at  times,  in  the  intervals  is  not  in  much  pain;  pulse  100.  14th,  there  was  a  chill, 
and  again  the  next  day.  16th,  another  chill.  Burrowing  of  pus  on  the  inside  of  the  thigh.  Discharge 

Via.  '-.>:!<!.— The  bones     thin  jn  quality,  like  dirty  greenish  water.     The  slightest  pressure  above  and  below  the  patella,  especially 
of  the  left   knee;    thn  ,..'.,  °     ...  . 

patella  is  fnu-turedinid     on  the  inner  side,  induces  an  immediate  escape  of  pus.     No  pain  or  redness  in  course  of  the  saphena  vein. 

involved1  "ftnec*™"  ^as  hiccough;  skin  hot;  pulse  120.  20th,  discharge  as  thin  and  watery  as  possible,  emerging  upon  the 
slightest  pressure  at  any  part  of  the  thigh;  surface  of  body  and  extremities  bathed  with  perspiration;  pulse 
too  fast  to  be  counted.  Patient  evidently  sinking.  Died  on  November  21,  1862.  Post-mortem:  A  collection  of  partially  fluid 
dark  blood  was  found  in  the  thigh,  corresponding  to  the  attachments  of  the  inner  and  outer  layers  of  the  fascia.  The  periosteum 
was  easily  detached  over  the  lower  two-thirds  of  the  femur,  on  the  anterior,  interior,  and  external  portions;  bone  laid  bare  for 
about  the  size  of  a  sixpence  at  the  lower  portion  of  the  femur.  The  articular  surface  of  the  femur  was  entirely  bare,  as  was  also 
its  anterior  and  lateral  borders.  The  borders  and  the  articular  surface  of  the  head  of  the  tibia  were  bare  and  the  bone  rough 
ened,  and  there  was  fracture  and  bony  separation  of  the  patella  into  three  portions.  There  was  a  sequestrum  about  the  size  of  a 
nut  on  the  left  side  of  the  tubercle  of  the  tibia."  The  bones  of  the  knee  were  contributed  to  the  Museum  by  Acting  Assistant 
Surgeon  Davies,  and  are  represented  in  the  annexed  wood-cut  (FiG.  236). 

CASE  577. — Private  W.  West,  Co.  C,  51st  Georgia,  nged  17  years,  was  wounded  at  South  Mountain,  September  14,  1862, 
and  admitted  to  hospital  at  Frederick  three  days  afterwards.  Acting  Assistant  Surgeon  W.  W.  Keen,  jr.,  reported  :  "  Gunshot 
wound  of  left  knee  joint,  a  ball  passing  through  the  head  of  the  tibia,  involving  the  joint.  There  was  also  a  flesh  wound  of  the 
right  leg  just  below  the  knee  joint.  Irritative  fever  ensued  and  continued  for  one  week  after  the  patient's  admission.  The 
treatment  was  supporting  and  poultices  were  applied  to  the  joint,  which  improved  in  external  appearance.  Pieces  of  the  artic 
ular  surface  of  the  tibia  were  nearly  detached  on  September  25th.  Two  days  later  suppuration  was  free  and  of  a  flocculent 
character;  tongue  dry  and  furred;  pulse  116.  On  October  4th,  the  joint  was  laid  open  by  free  incisions  on  each  side  of  the 
patella,  when  the  pus  was  found  to  be  burrowing  up  the  thigh  to  a  very  great  extent.  On  October  8th,  the  condition  of  the 
thigh  was  apparently  improved,  but  the  pulse  was  no  better  and  the  patient  had  a  severe  chill.  He  continued  to  grow  weaker. 
On  October  13th,  there  was  some  haemorrhage  from  the  wound,  and  on  the  following  day  the  patient  died.  At  the  post-mortem, 
examination  a  broad  abscess  was  discovered  to  extend  from  the  knee  to  the  groin.  The  ball  was  found  to  have  passed  directly 
through  the  joint  from  side  to  side,  knocking  off  pieces  of  the  internal  condyle  of  the  femur  and  the  articular  surface  of  the 
tibia.  This  patient  had  been  told  at  an  early  stage  of  the  treatment  that  his  limb  ought  to  be  amputated.  But  he  expressed  his 
certainty  of  recovering  without  amputation  and  begged  off,  declaring  his  readiness  arid  willingness  to  incur  all  risks  of  that 


SECT.  IV.  | 


SHOT    FRACTURES    OF    THE    KNEE   JOINT. 


383 


FK;.  237. — Shot  perforation  of 
innor  ttibcrosity  of  the  left  tibia. 
Spec.  :i5fi. 


FIG.  238. — Shot  comminution 
of  head  of  right  tibia.  Spec.  7fiO. 


course.     He  was  therefore  not  operated  upon."     The  bones  of  the  injured  knee  joint,  showing  the  articular  surfaces  to  be  eroded, 
were  contributed  to  the  Museum  by  Acting  Assistant  Surgeon  J.  H.  Bartholf,  and  constitute  specimen  825  of  the  Surgical  Section. 

CASE  578. — Private  J.  W.  Shcttles,  2d  Mississippi,  was  wounded  at  Antietam,  September  17, 1862,  and  admitted  to  a  hospital 
near  Shurpsburg.  Surgeon  J.  H.  Ranch,  U.  S.  V.,  contributed  the  specimen  represented  in  the  annexed 
wood-cut  (FiG.  237),  and  reported:  "This  man  was  wounded  through  the  knee  joint,  from  the  effects 
<>f  which  he  died  on  November  9,  1862.  Had  this  man  been  operated  upon,  I  am  satisfied  his  life 
would  have  been  saved."  The  specimen  consists  of  the  bones  of  the  left 
knee  with  the  inner  tuberosity  of  the  tibia  perforated  obliquely  down 
ward  by  a  round  ball.  The  articular  surface  is  eroded  by  suppuration. 
The  bullet  is  seen  at  the  point  of  entrance,  whither  it  appears  to  have 
gravitated  through  its  own  track  and  where  the  fragments  are  necrosed. 
The  partial  fracture  of  the  shaft  of  the  tibia  has  been  slightly  consoli 
dated  by  effusion  of  callus. 

CASE  579. — Private  P.  Gregory,  Co.  IT,  1st  Delaware,  was  wounded 
in  the  right  knee,  at  Antietam,  September  17,  1862.     Surgeon  I.  Scott, 
7th  West  Virginia,  noted  his  admission  to  the  field  hospital  of  the  3d 
division,  Second  Corps,  with  "wound  of  leg."     On  September  27th,  the 
wounded  man  was  transferred  to  hospital  No.  1,  Frederick,  where  he 
died  October  16, 1862.     The  specimen,  shown  in  the  cut  (FiG.  238),  was 
preserved  at  the  post-mortem  examination  and  contributed  to  the  Museum 
by  Acting  Assistant  Surgeon  W.  W.  Keen,  jr.     It  consists  of  the  upper 
portion  of  the  bones  of  the  leg,  with  the  head  of  the  tibia  shattered  by 
a  ball  passing  through  it  transversely.     The  fragments  are  necrosed. 
CASE  580. — -Private  J.  McNulty,  Co.  E,  22d  Michigan,  was  wounded  in  both  knees,  at  Chickamauga,  September  19, 18(53, 
and  admitted  to  hospital  at  Chattanooga  some  days  afterwards.     Surgeon  J.  T.  Woods,  99th  Ohio,  reported:  "  Fracture  of  head 
of  each  tibia;  patient  suffering  from  chronic  diarrhoea;  simple  treatment.     Haemorrhage  occurred;  popliteal  artery  and  branch, 
with  popliteal  vein,  ligated.     Gangrene  set  in  below  the  location  of  the  ligatures,  and  death  supervened  October  15,  18fi2." 

CASE  581. — Sergeant  J.  McCarthy,  Co.  C,  149th  New  York,  was  wounded  at  Wauhatchie,  October  27, 1863,  and  admitted 
to  the  field  hospital  of  the  1st  division,  Fourteenth  Corps.  Surgeon  W.  M.  Wright,  79th  Pennsylvania,  reported:  "He  was 
wounded  by  a  conical  leaden  bullet,  which  entered  on  the  posterior  aspect  of  the  right  leg  about  four  inches  below  the  knee, 
taking  an  upward  course,  and  passing  out  just  one  inch  beneath  the  patella.  The  wound  was  probed  by  a  competent  surgeon, 
who  concluded  that  it  was  not  a  case  warranting  amputation,  although  in  the  end  it  might  prove 
to  have  been  judicious.  Two  or  three  days  afterwards  the  patient  complained  of  severe  pain  in 
the  knee  which  required  large  doses  of  anodyne  to  alleviate.  The  pus  assumed  a  thin  watery 
consistence  of  a  brownish  coffee-like  appearance  and  discharged  quite  freely;  odor  somewhat 
unpleasant  though  not  fetid.  The  limb  was  greatly  increased  in  size  throughout  its  whole  extent, 
and  to  the  touch  it  gave  evidence  of  oedema.  Several  days  later  pressure  upon  the  knee  gave  a 
crackling  sensation  to  the  hand,  giving  unmistakable  evidence  that  the;  joint  was  implicated. 
The  patient  died  on  the  morning  of  November  8,  1863,  after  extreme  suffering  during  the  previous 
twenty-four  hours.  During  the  period  succeeding  the  first  three  days  there  was  great  gastric 
irritability  which  remedies  failed  to  correct.  During  the  last  two  days  the  discharges  from  his 
bowels  were  black,  and  for  twelve  hours  previous  to  death  a  black  substance,  resembling  thin 
coffee  grounds  somewhat  and  amounting  \o  a  pint  probably,  was  discharged  from  the  mouth. 
An  examination  of  the  limb  after  death  showed  a  fracture  of  the  head  of  the  tibia  behind, 
external  to  the  popliteal  notch,  extending  into  the  articulating  surface  from  an  inch  and  a  half 
below  it.  Necrosis  of  the  bone  had  commenced  to  a  slight  degree.  The  femur  and  fibula  were 
untouched." 

CASE  582. — Private  B.  Madden,1  Co.  A,  28th  Massachusetts,  was  wounded  at  Fredericks- 
burg,  December  14,  1862,  by  a  shell  in  the  left  knee  joint.  He  was  admitted  to  Douglas  Hos 
pital,  Washington,  twelve  days  afterwards.  Medical  Cadet  S.  T.  Kingston,  TJ.  S.  A.,  contributed 
the  pathological  specimen,  represented  in  the  annexed  wood-cut  (FiG.  239),  and  reported  that 
"the  patient  died  December  29,  1862,  from  the  effects  of  a  shell  wound  in  the  left  knee."  The 
specimen  consists  of  a  ligamentous  preparation  of  the  injured  knee,  showing  fearful  laceration  and 
complete  destruction  by  the  missile,  two  fragments  of  which  are  mounted  with  the  preparation. 

CASE  583. — Private  F.  L.  Mellott,  Co.  K,  12th  Pennsylvania  Reserves,  was  wounded  at  South  Mountain,  September  11, 
1862.  Acting  Assistant  Surgeon  G.  W.  Corey  reported:  "He  was  wounded  by  a  musket  ball  entering  the  left  knee  near  the 
lower  border  of  the  patella,  a  little  to  the  outer  side  of  the  ligamentum  patella,  passing  obliquely  backward  and  outward  through 
the  outer  tuberosity  of  the  tibia  and  through  the  head  of  the  fibula.  The  man  was  brought  to  the  temporary  hospital  at  Middle- 
town  some  time  in  the  night  following  the  battle,  and  the  second  day  after  the  injury  the  femoral  artery  of  the  wounded  limb 
was  tied  by  the  Surgeon  in  charge  for  the  purpose  of  keeping  down  the  inflammation  and  saving  the  limb.  Water  dressings 
were  applied  and  stimulants  and  anodynes  freely  administered.  About  six  days  after  the  battle  the  hospital  was  permanently 
established  and  the  patient  came  under  my  care.  At  this  time  I  found  him  suffering  from  severe  pain,  the  redness  and  swelling 


FIG.  239.— Destruction  of  left  k  IK 

by  a  shell  explosion.     Spec.  70!'. 


1  This  case  has  been  alluded  to  and  the  specimen  figured  in  Circular  No.  C,  War  Department,  S.  G.  O.,  Washington,  1865,  pp.  37,  38,  FIG.  50. 


384  INJURIES    OF    THE    LOWER -EXTREMITIES.  [CHAP.  x. 

of  the  joint  being  moderate,  suppuration  profuse,  and  the  temperature  of  the  parts  below  as  I  expected  to  find  it.  In  fact  t>o 
marked  was  this  latter  symptom  that  I  feared  the  occurrence  of  gangrene  of  the  part  and  immediately  discontinued  the  water 
dressing.  Gangrene,  however,  did  not  set  in;  but  the  soft  tissues,  wherever  the  limb  rested  on  the  pillow,  sloughed  very  rap 
idly,  indicating  the  low  vitality  of  the  parts.  The  treatment  from  this  time  consisted  of  emollient  applications  and  stimulant 
and  astringent  lotions,  with  a  free  use  of  alcoholic  stimulants  internally.  The  case  went  on  for  some  time  without  any  marked 
change,  the  discharge  becoming  more  profuse  and  the  sloughs  extending  and  presenting  no  disposition  to  granulate.  Finally 
diarrhoea,  loss  of  appetite,  night-sweats  and  delirium  supervened,  and  death  resulted  on  October  28,  1862, — forty-three  days 
after  the  reception  of  the  injury.  An  examination  of  the  joint  after  death  showed  the  most  perfect  destruction  of  the  synovial 
membrane  and  of  the  articular  cartilages  and  other  soft  tissues."  The  bones  of  the  fractured  knee  joint  were  contributed  to  the 
Museum  by  Dr.  Corey,  and  constitute  specimen  915  of  the  Surgical  Section.  The  specimen  shows  the  condyles  to  be  split 
vertically,  the  inner  one  being  broken  posteriorly  and  nearly  detached,  and  the  articular  space  eroded  by  suppuration.  The 
fractured  extremities  of  the  tibia  and  fibula  are  thoroughly  carious. 

Four  hundred  and  seventy-eight  of  the  five  hundred  and  twenty-one  fatal  cases  of 
shot  fractures  of  the  knee  joint  treated  by  conservation  were  Union  and  forty-three  were 
Confederate  soldiers.  Specimens  illustrating  the  nature  of  the  various  injuries  of  the  bones 
of  the  knee  are  preserved  in  the  Army  Medical  Museum  in  ninety-nine  cases. 

The  side  of  the  injury  was  reported  in  seven  hundred  and  ninety-seven  of  the  eight 
hundred  and  sixty-eight  cases  of  shot  fractures  of  the  knee  joint.  The  right  side  was 
involved  in  four  hundred  and  thirty-one,  the  left  in  three  hundred  and  sixty-six.  Of  the 
former,  one  hundred  and  seventy-four  were  successful,  two  hundred  and  fifty-four  were 
fatal,  and  three  undetermined,  giving  a  mortality  rate  of  59.3  per  cent.;  of  the  latter,  one 
hundred  and  fifty-two  were  successful,  two  hundred  and  thirteen  fatal,  and  one  undeter 
mined — a  mortality  rate  of  58.3  per  cent.,  or  1  per  cent,  in  favor  of  the  injuries  gf  the 
left  side.  Of  eight  hundred  and  sixty-eight  patients,  seven  hundred  and  eighty-seven  were 
Union  soldiers.  Three  hundred  and  six  recovered;  four  hundred  and  seventy-eight  proved 
fatal,  and  in  three  cases  the  result  was  not  ascertained — a  fatality  of  60.9  per  cent.  Of 
eighty-one  Confederate  soldiers,  thirty-two  recovered,  forty-three  died,  and  six  cases  were 
undetermined — a  mortality  of  57.3  per  cent.,  or  3.6  per  cent,  less  than  the  percentage  of 
deaths  among  the  Union  soldiers.  In  forty-four  instances,  with  twenty-four  recoveries  and 
twenty  deaths,  fragments  of  the  patella  or  of  the  articulating  ends  of  the  -femur  or  tibia 
were  removed. 

EXCISIONS  AT  THE    KNEE   JOINT   FOR   SHOT    INJURY.— As  far  as  the 

records  of  this  Office  indicate,  fifty-seven  excisions  at  the  knee  joint  for  shot  injury  were 
performed  during  the  American  civil  war,  the  first  operation  having  been  done  on  September 
15, 1862,  at  the  Fairfax  Seminary  Hospital,  near  Alexandria,  Virginia.  It  is  to  be  regretted 
that  the  name  of  the  operator  in  this  instance  is  not  reported.  Prior  to  that  time  there 
were  recorded  eighteen  examples  of  this  operation  for  shot  injury, — fifteen  in  Europe,1  and 

'Excision  of  the  patella  for  shot  fracture  is  mentioned  by  J.  CH.  A.  THEUEX  (Neue  Bemerkungen  und  Erfahrungen  zur  Bercicherung  der  Wund- 
arzntykunst,  Berlin  und  Stettin,  1782,  B.  I,  p.  101):  "I  cannot,  therefore,  approve  of  the  excision  of  the  patella  fractured  by  shot,  which  I  have  seen 
undertaken  by  somebody  but  very  unfortunately,  as  gangrene  and  death  supervened."  No  pia^iculars  are  recorded.  KAJETAX  v.  TEXTOK  (LUDWIG 
FUCHS,  Veber  Resection  im  Kniegelenke,  Inaug.  Diss.,  AVlirzburg,  1854,  p.  9,  No.  13)  resected,  on  November  4,  1847,  the  fractured  condyles  of  the  femur 
of  a  laborer,  aged  37,  shot  in  the  left  knee  while  poaching ;  death  from  pyaemia,  November  11, 1847.  KXOUKE,  of  Hamburg  (L.  SxuoMEYElt,  Maximen  dcr 
Kriegshcilkunst,  Hannover,  1861,  p.  523,  note,  and  GUULT  (E.),  Die  Gelenk- Resect  ionen  nach  Schussverletzungcn,  Berlin,  1879,  p.  1189),  resected  the  joint 
in  the  case  of  Carl  Kunsch,  aged  121,  wounded  August  13, 1849 ;  missile  entered  the  upper  part  of  the  right  leg,  at  the  inner  side  of  the  crest  of  the  tibia, 
and  emerged  at  the  same  height  posteriorly;  inner  half  of  upper  portion- of  tibia  shattered.  On  August  15th,  decapitation  of  tibia  and  fibula,  sawing  off 
2J  inches  of  each.  By  November  1st,  firm  union  between  femur  and  leg.  Left  hospital  in  June,  1850.  Seen  by  the  operator  in  the  summer  of  1859, 
carrying  a  heavy  basket,  entirely  well,  and,  with  the  exception  of  stiffness,  not  suffering  from  any  inconvenience  from  the  leg.  On  January  17,  1875,  the 
operator  reports  the  patient  as  having  a  blooming  complexion,  being  well  fed,  and  having  maintained  his  family  without  assistance.  He  was  able  to  carry 
150  pounds  ;  fur  the  past  two  years  the  strength  of  the  leg  has  diminished,  compelling  him  to  earn  his  bread  as  a  night-watchman.  He  was  able  to  walk 
two  or  three  miles  (German)  a  day  without  tiring.  He  has  continuously  used  a  linen  bandage  two  inches  wide  and  four  yards  long  to  support  the  leg  since 
leaving  hospital.  Cicatrix  sound,  pale,  and  movable.  The  limb  is  (J  centimetres  shortened.  FAHLE  (F.  ESMARCII,  Vebcr  Jtesectionen  nach  Kchusswun- 
den,  Kiel,  1851,  p.  133)  operated  in  the  case  of  Philip  Blumenthal,  volunteer,  2d  Chasseur  Corps,  2d  Co.,  wounded  in  a  reconuoissance,  December  31,  1850, 
a  ball  entering  the  outer  side  of  the  left  knee.  On  January  3,  1851,  by  Dr.  STJIOMEYEU'S  advice,  the  patella,  1*  inches  of  the  condyles  of  the  femur,  and 
portions  of  the  tuberosities  of  the  tibia  were  excised;  death  February  3,  1851.  J.  II.  LAKIX  (T.  P.  M  vrniEW,  Med.  and  Surg.  Hist,  of  the  British  Army 
which  served  in  Turkey  and  the  Crimea,  London,  1858,  Vol.  II,  p.  379,  and  GUULT  (E.,  toe.  cit.,  p.  126):  Case  of  II.  Gribbins,  77th  British  Regiment,  aged 
19,  wounded  Sept.  8, 1855,  during  the  retreat  from  the  Redan,  in  the  left  knee  ;  Sept.  30,  1855,  excision  of  about  1 J  inches  of  the  condyles  of  the  femur  and 


SECT.   IV.] 


EXCISIONS    AT    THE    KNEE    JOINT. 


385 


three  on  this  continent.1  Eight  of  the  operations  had  been  successful,  nine  fatal,  and  in 
one  instance  the  result  had  not  been  ascertained.  The  results  of  the  fifty-seven  cases  of 
excision  of  the  knee  joint  of  the  American  civil  war  are  indicated  in  the  following  table: 

TABLE  LIII. 
Classified  Statement  of  Fifty-seven  Cases  of  Excisions  at  the  Knee  Joint  for  Shot  Fracture. 


PARTS  EXCISED. 

TOTAL  CASES. 

TIME  OF  OPERATION. 

PlilMAUY. 

INTERMEDIARY. 

SprnvnARY  I!  TIME  NOT  SPECI 
FIED. 

3 

5 

Recovery. 

.= 

« 
8 

C 

4 
1 
16 
4 

;  ;  Undeter- 
;  *•*  :  mined. 

Ratio  of 
mortality  of 
determined 
cases. 

g 

3 
- 

2 
2 
'10 

6 
5 
1 
6 

Recovery. 

Death. 

Undeter 
mined. 

1 

3 

0 

Recovery. 

Death. 

U 

Recovery. 

Death. 

-." 

Recovery. 

Death. 

Undeter 
mined. 

Condyles  of  the  Femur  

5 
3 

19 

1 
3 
T 

80.0 
50.0 
84.2 
57.1 
100.0 
75.0 
87.5 

o 

l 

1 
1 

1 

1 

1 

1 

Condyles  of  the  Femur  and  Patella  

1 
3 

10 
3 

5 

1 

1 
6 
1 

Condyles  of  the  Femur,  Patella,  and  Head  of  Tibia 
Condyles  of  the  Femur  and  Head  of  Tibia  

1 

5 

1 

3 

2 

1 

Patella  or  portion  thereof  

q 

q 

2 

2 
1 
1 

1 
2 

1 

1 

1 

Head  of  Tibia  

4 

10 

57 

1 
1 

3 
7 

2 

1 

1 

1 

1 

Parts  not  specified 

4 

5 

1 

1 

3 

1 

1 

1 

1 

1 

12 

3 

10 

44 

3 

81.4      32 

26 

2 

13 

7 

4 

5 

3 

1 

In  three  instances  the  terminations  were  not  ascertained;  ten  operations  were  followed 
by  recovery  and  forty-four  by  death,  a  fatality  of  81.4  per  cent.     As  indicated  in  TABLE 

a  thin  slice  of  the  head  of  the  tibia ;  patella  removed ;  death  Oct.  28,  1855.  JOHN  BROWN,  Assistant  Surgeon  Bengal  Medical  Sen-ice  (Edinburgh  Mtd. 
Jour.,  1860,  Vol.  VI,  p.  320):  Case  of  Mahun  Singh,  aged  30,  wounded  Jan.  16, 1858,  in  an  attack  on  the  English  at  Alumbaugh.  Wound  over  the  left  knee; 
limb  severed  and  hanging  by  a  shred  of  skin  ;  also  compound  fracture  of  patella  of  right  knee.  Left  femur  immediately  amputated  at  middle  third,  and 
right  knee  resected  by  an  H-incisiou ;  no  haemorrhage,  no  anaesthetic  used ;  death  on  the  evening  of  Jan.  17.  1858,  frum  the  effects  of  shock.  J.  NEUDORFER 
(Handbuch  der  Kriegschirurgie  und  der  Operationslehre,  Leipzig,  1872,  Zweite  Halfte,  p.  1545  et  seq.)  gives  details  of  six  operations  performed  by  himself: 
Johann  Zelenka,  Austrian  Infantry  Regiment  E.  H.  Rainer,  wounded  at  Solferino  June  24,  1859.  Shot  fracture  of  left  hand,  causing  amputation  of  index 
and  middle  fingers,  and  shot  wound  of  thoracic  parietes,  and  a  shot  fracture  of  the  left  knee  joint.  November  20,  1859,  resection  of  about  2J  inches  of  the 
end  of  the  femur,  a  thin  slice  of  the  head  of  the  tibia,  and  part  of  the  patella.  Wound  healed  in  three  months,  leaving  several  fistulas.  He  could  bend 
the  joint  to  an  angle  of  from  5  to  8  degrees.  Johann  Dubou,  Prince  Hohenlohe  Austrian  Infantry  Regiment.  Shot  fracture  of  the  right  knee  joint. 
September  8,  185'.),  secondary  operation,  by  reason  of  progressive  caries;  death  September  24,  1859.  Michael  Fonta,  5th  Austrian  Infantry  Regiment. 
Wounded  at  Solferino  June  24,  1859.  Shot  fracture  left  knee  joint.  Resection  February  10,  1860;  death  from  exhaustion  February  28,  I860.  Abraham 
Maksa,  Prince  Wasa  Austrian  Infantry,  3d  Co.,  wounded  at  Solferino  June  24,  1859,  in  the  right  knee  joint.  Resected  February  11,  1800.  Complete 
recovery.  Antonio  Mazzini;  shot  fracture  of  right  knee  joint.  Resection  March  20,  1800,  of  condyles  of  femur  (about  nine  months  after  injury),  in 
hospital  at  Veronu.  Sent  home  six  weeks  after  the  operation  in  a  fair  way  of  recovery.  Not  heard  of  afterwards.  Anton  Potesch,  Austrian  Infantry 
Regiment  "  Kaiser."  Wounded  in  right  knee  joint.  Resection  May  18,  1800  (about  a  year  after  injury)  ;  death  from  pysemia  May  22,  1860.  D.  W. 
CROMPTOX,  of  Birmingham  (Medical  Times  and  Gazette,  1861,  Vol.  I,  p.  518):  George  W.,  aged  19,  wound  in  left  knee  joint  by  accidental  discharge  of 
gun,  December  26, 1860.  Admitted  the  saint-  day  into  Birmingham  General  Hospital.  Resection  of  the  joint,  sawing  off  a  thin  portion  of  the  head  of  the 
tibia  and  corresponding  thin  portion  of  the  condyles,  after  which  nearly  the  entire  shattered  condyle  of  the  femur  was  sawn  off  diagonally,  and  numerous 
shot  were  removed.  The  patella,  as  well  as  the  articular  cartilage  of  the  parts  not  resected,  was  left  intact.  April  5,  1861,  discharged  from  hospital 
cured.  Could  walk  with  ease  with  the  aid  of  a  cane.  Limb  from  J  to  f  inch  shortened.  HuTCHINSON,  of  London  (Lancet,  1861,  Vol.  I,  p.  386):  A 
healthy  young  man,  who  bad  been  severely  wounded  February  13,  1861,  in  both  legs,  at  a  distance  of  twelve  paces,  by  the  accidental  discharge  of  a  gun 
loaded  with  No.  6  shot  and  :i  pasteboard  stopper.  The  charge  penetrated  just  over  the  right  knee,  going  diagonally  downward  through  the  condyles  of 
the  femur,  and  entering  the  inner  side  of  the  left  leg  below  the  knee  and  behind  the  inner  margin  of  the  tibia,  lodging  superficially  on  the  outer  side  of 
the  left  leg.  Admitted  into  London  Hospital  February  13.  1861.  Resection  an  hour  after  injury,  removing  about  an  inch  and  a  half  of  the  femur,  a  very 
thin  slice  of  the  tibia,  and  extirpating  the  entirely  intact  patella;  death  February  23,  1861,  of  tetanus.  HEXUY  SMITH  (Medical  Times  and  Gazette,  1863. 
Vol.  II,  p.  376):  John  II.,  aged  29,  private,  English  Fusileer  Guard,  wounded  at  the  battle  of  Inkerman,  November  10,  1854,  in  the  left  knee  joint. 
Ball  lodged  in  popliteal  space  and  extracted  in  hospital  at  Scutari.  Resection  September  6,  1862,  at  King's  College  Hospital,  London.  Discharged  from 
hospital  December  9,  1862,  cured.  The  cases  of  LAHREY,  PERCY  and  LAURENT,  and  CHAMPION,  cited  by  OSCAR  HEYFELDER  (Lehrbuch  der  Resec- 
tionen,  Wien,  1803,  p.  135)  and  by  H.  Cui.liERTSON  (Excision  of  the  Larger  Joints,  Prize  Essay,  Philadelphia,  1876,  p.  188,  in  Trans.  Am.  Med.  Assoc., 
Supplement  to  Vol.  XXVII),  have  been  omitted.  In  LAUREY'S  case  (D.  J.  LARREY,  Mem.  de  Chir.  Mil.  et  Camp.,  Paris,  1812,  T.  Ill,  p.  256)  of  an 
Arab,  named  Ibraham,  only  loose  fragments  of  the  patella  were  removed.  The  cases  ascribed  to  PERCY  and  LAURENT  are  evidently  the  operations 
referred  to  by  them  in  their  article  Resection,  in  Diet,  des  Sci.  Med.,  Paris,  1820,  T.  XLVII,  p.  555:  the  operations  were  for  disease  of  the  knee  joint  and 
were  performed  by  MOREAU.  In  the  operation  ascribed  to  CHAMPION,  which  is  found  in  his  Traiti  de  la  Resection  des  os  caries  dans  leur  continuite,  ou 
hors  le.s  articulation*,  Paris,  1815,  No.  II,  p.  77,  carious  bone  was  chiseled  away  from  the  tibia  to  allow  the  removal  of  the  ball. 

'GURDON  BUCK  (Excision  of  the  Knee  Joint  ffir  Anchylosis,  in  New  York  Med.  Times,  March,  1854,  Vol.  Ill,  p.  205):  Gunshot  wound  of  knee 
joint,  received  about  April  20,  1853 ;  healed  with  anchylosis  at  an  angle  of  about  135  degrees  upon  the  thigh.  August  9,  1853,  adhesions  broken  up:  * 
slice  removed  from  the  inferior  surface  of  the  condyles  of  the  femur,  including  the  pulley-like  surface  intervening  between,  and  the  articular  surface  of 
the  tibia  on  a  level  with  the  upper  extremity  of  the  fibula;  coaptation  of  cut  surfaces,  which  were  held  together  by  a  wire;  the  wound  healed  in  nine 
weeks.  Dr.  BUCK  exhibited  the  patient  to  the  New  York  Academy  of  Medicine,  February  1 ,  1854.  E.  S.  COOPER  ( Case  of  Bisection  of  the  Knee  Joint 
in  consequence  of  Disfane  nf  Bone*  caused  by  a  gunshot  wound,  in  The  Cleveland  Medical  Gazette,  1861,  Vol.  Ill,  p.  604):  N.  F.,  aged  24,  shot  through  the 
SUUG.  Ill— 49 


386  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  X. 

LII,  page  367,  the  articulation  was  primarily  involved  in  fifty-six  instances;  in  the  remain 
ing  case  the  operation  was  performed  for  shot  fracture  of  the  upper  thirds  of  the  bones  of 
the  leg. 

Primary  Excisions  at  the  Knee  Joint. — In  thirty -two  of  the  fifty-seven  cases  of 
excision  of  the  knee  joint  performed  during  the  American  civil  war  the  operation  was  done 
within  forty-eight  hours  after  the  reception  of  the  injury.  The  results  in  two  of  the  thirty- 
two  cases  could  not  be  ascertained;  four  of  the  patients  survived  the  operation,  and  in 
twenty-six  instances  death  resulted,  a  mortality  rate  of  86.6  per  cent. 

Recoveries  after  Primary  Excision  of  the  Knee  Joint. — Portions  of  the  condyles  of 
the  femur  and  the  head  of  the  tibia  were  removed  in  three  of  the  four  cases  of  this  group; 
in  the  remaining  case  the  extremity  of  the  tibia  and  the  patella  were  excised.  Three 
operations  involved  the  right  limb  and  one  the  left.  Two  were  Confederates  and  two 
Union  soldiers.  In  one  of  the  four  instances  amputation  of  the  thigh  became  necessary  on 
the  fifth  day,  and,  although  the  patient  survived  both  operations,  the  case  cannot  well  be 
cited  as  an  instance  of  recovery  after  primary  excision  at  the  knee  joint: 

CASE  584. — Surgeon  A.  W.  Bailey,  1st  South  Carolina  Infantry,  of  Barnwell  District,  reports'  the  following  remarkable 
example  of  successful  partial  excision  of  the  right  knee:  "Lieutenant  J.  W.  Harlee,  Co.  I,  1st  South  Carolina  Regiment,  Brat 
ton's  Brigade,  aged  about  27  years,  and  of  robust  constitution,  was  wounded  in  the  battle  of  the  Wilderness,  May  0,  18G4.  / 
mini6  ball  passed  laterally  through  the  right  knee  joint,  fracturing  the  head  of  the  tibia.  A  curved  incision  was  made,  extend 
ing  from  one  condyle  to  the  other,  reaching  just  below  the  inferior  border  of  the  patella.  All  the  ligaments,  with  the  synovia! 
sac,  were  divided,  and  the  semilunar  cartilages  removed.  A  transverse  section  of  the  head  of  the  tibia,  embracing  the  fractured 
portion,  was  made  above  the  articulation  with  the  fibula.  The  patella  was  not  ablated.  The  wound  was  closed  with  sutures 
and  adhesive  straps,  and  the  limb  secured  to  a  long  outside  splint.  The  next  day  he  was  transported  about  twenty-five  miles 
over  a  rough  road  to  the  rear,  and  two  of  the  sutures  cut  out,  thereby  exposing  the  internal  condyle.  In  a  short  time  the 
exposed  surface  was  covered  with  healthy  granulations  and  the  space  soon  filled  up.  In  the  course  of  six  or  eight  weeks  true 
anchylosis  had  taken  place,  and  the  wound  healed,  except  a  small  place  where  the  condyle  was  exposed,  leaving  a  small  fistula, 
which  healed  in  a  short  time  afterwards.  This  officer,  who  returned  to  his  command  to  be  retired  on  the  Invalid  Corps,  gives 
the  following  account  of  the  treatment  carried  out  after  being  sent  to  the  General  Hospital :  He  Avas  furnished  with  a  quart  of 
good  whiskey  daily,  and  requested  to  drink  as  much  as  he  could,  and  use  the  balance  on  his  leg.  He  says  he  drank  the  quarter 
portion  each  day,  and  dressed  his  wound  twice  daily  with  one  part  of  whiskey  to  three  of  water.  His  leg  is  about  three  inches 
shorter  than  the  other;  he  wears  a  high  heel  and  thick  sole  to  his  boot,  by  which  means  he  is  enabled  to  walk  without  crutches, 
and  even  dance  with  ease." 

CASE  585. — Private  W.  F.  Jackson,  Co.  G,  6th  South  Carolina,  aged  21  years,  received  a  shot  fracture  of  the  left  knee 
joint,  near  Richmond,  October  7,  1864.  He  underwent  the  operation  of  excision  on  the  day  of  the  injury,  at  the  hands  of  Sur 
geon  Stony,  C.  S.  A.,  who  removed  the  condyles  of  the  femur  and  the  detached  fragments  of  the  patella  through  a  straight 
incision  in  the  line  of  the  wound.  Fragments  of  bone  continued  to  discharge  for  about  twelve  months  after  the  operation,  after 
which  time  the  wound  remained  perfectly  healed.  The  case  was  reported  by  Dr.  C.  H.  Ladd,  late  Surgeon  56th  North  Carolina, 
who  stated  that  when  last  heard  from,  in  December,  1872,  the  man  had  very  limited  motion  of  the  injured  joint.  The  records 
of  Jackson  Hospital  (Confederate),  Richmond,  show  that  the  patient  was  admitted  with  "shot  wound  of  knee  joint,  treated  by 
ablation  of  patella,"  and  that  he  was  furloughed  March  13,  1865.  In  a  letter,  written  and  forwarded  in  1868,  the  man  repre 
sented  his  wounded  limb — which,  in  the  opinion  of  all  who  examined  it,  had  undergone  "one  of  the  most  remarkable  surgical 
operations" — as  "a  good  sound  leg,  which  answers  every  purpose." 

CASE  586. — Private  A.  Rider,  Co.  G,  76th  Pennsylvania,  aged  25  years,  was  wounded  in  the  right  knee,  at  Pocotaligo, 
October  22,  1862,  and  admitted  to  hospital  No.  1,  Beaufort,  two  days  afterwards.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  contributed 
the  pathological  specimen  (FlG.  240)  and  the  following  report:  "The  missile  was  a  rough  leaden  canister  ball  of  ordinary  size, 
which  entered  the  limb  over  the  front  of  the  external  condyle,  passing  through  the  posterior  margin  of  it,  opening  the  capsule 
and  lodging  in  the  popliteal  space.  The  circulation  and  appearance  of  the  limb  was  good,  but  there  was  some  swelling  of  the 
knee  and  pain  on  motion  or  to  the  touch.  The  bullet  was  removed  from  beneath  the  integuments  by  incision  on  the  morning  of 
his  admission.  Resection  of  the  lower  portion  of  the  condyles  of  the  femur  was  done  the  same  day,  at  3  P.  M.,  and  the  semilunar 
cartilages  removed  from  the  tibia.  The  H-incision  was  employed,  and  the  transverse  cut  united  by  lead  wire  accurately.  Morphia 
was  applied  to  the  wound,  and  wet  lint  and  the  ice  bag  kept  constantly  in  use.  On  the  next  day,  the  patient's  bowels  not  having 

knee  joint,  in  June,  1857 ;  fracture  of  condyle  of  femur  and  upper  part  of  tibia.  October  25,  1857,  excision  of  condyles  of  femur,  of  more  than  an  inch 
of  the  head  of  the  tibia,  and  of  the  patella;  complete  recovery.  CHAULKS  A.  Poi'E  (Complete,  Osseous  Anchylosis  of  the  Knee  Joint.  Successful!;/ 
operated  on  by  Barton's  method,  in  Am.  Jour.  lied.  Kci.,  1861,  Vol.  XLII,  p.  298,  and  St.  Louis  iled.  and  Surg.  Journal,  May,  1861.  Vol.  XIX,  p.  211): 
Mr.  A.,  a  healthy  man,  aged  40,  received,  when  about  10  years  old,  an  accidental  shot  wound  of  the  knee,  the  ball  passing  just  below  the  right  knee  joint. 
The  articulation  became  secondarily  involved  and  complete  osseous  anchylosis  resulted.  For  long  years  he  wore  a  wooden  peg  with  the  knee  resting  in 
a  socket  at  its  upper  extremity,  for  purposes  of  locomotion.  March  14, 18G1 ,  resection  of  knee  by  Dr.  POPE,  assisted  by  Drs.  SMITH,  GllEGOny,  and  DF.WF.Y. 
Recovery;  walks  without  a  stick  ordinarily. 

1  Bailey  (A.  W.),  A  case  of  Knee-joint  Resection,  in  Southern  Medical  and  Surgical  Journal,  1866,  Vol.  XXI,  p.  460. 


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SECT,  iv.l  PRIMARY    EXCISIONS    AT   THE    KNEE    JOINT.  387 

been  moved  for  some  days,  an  ounce  of  sulphate  of  magnesia  was  administered.  October  30th,  diarrhoea  having  been  trouble 
some  for  twenty-four  hours,  pills  of  argentum,  opium,  and  camphor  were  given,  and  on  the  following  day,  the  diarrho3a  still 
continuing  and  there  being  some  febrile  symptoms,  spirits  of  mindererus  was  prescribed  and  milk  porridge  for  diet.  Wet 
dressings  with  ice  were  continued  until  November  2d,  when  cerate  dressings  and  dry  lint  with  ice  bag  were  ordered.  Starch 
and  laudanum  injections  arrested  the  looseness.  The  limb  had  been  kept  on  a  pillow,  and  great  pain  was  experienced  on  the 
slightest  movement  until  I  constructed  a  rest  for  it  out  of  two  parallel  cushions  of  hay  tacked  on  a  plank,  leaving  a  space  under 
the  knee  unstuffed.  When  laid  on  this,  on  October  27th,  the  limb  was  very  comfortable.  Before  that  time  the  poor  fellow  had 
frequently  regretted  that  it  was  not  removed.  The  transverse  incision  healed  without  suppuration,  and  no  swelling  of  the  limb, 
above  or  below  the  knee,  took  place.  The  only  ligature  employed  was  on  the  azigos  artery,  which  came  away  November  16th. 
Scarcely  any  inflammation  about  the  knee  took  place  until  November  18th,  when  I  observed  that  the  line  of  incision,  which  had 
healed  many  days  ago,  reopened  in  places  and  discharged  pus.  Cerate  dressings  were  applied  and  straps  to  approximate  the 
lateral  wound;  the  limb  exposed  and  a  wet  napkin  kept  on  the  knee.  December  1st,  the 
bones  have  apparently  united  and  there  is  very  little  discharge,  the  incisions  having  healed, 
with  the  exception  of  a  point  on  either  side  of  the  joint,  from  which  a  few  drops  of  pus  are 
escaping.  The  patient  suffers  no  pain,  and  I  shall  to-day  flex  the  knee  a  trifle  permanently. 
The  leg  was  kept  on  a  straight  plank  and  between  the  hay  cushions  until  December  20th, 
when  I  put  the  limb  in  a  starch  bandage,  well  stiffened  by  strips  of  pasteboard.  On  Decem 
ber  26th,  I  slit  the  bandage  open  from  the  toe  to  the  hip  and  discovered  some  erythematous 
blush  on  the  skin,  also  a  slight  general  disturbance,  accompanied  by  dry  tongue.  The 
febrile  symptoms  yielded  readily  to  acidulated  drinks  and  a  little  spirits  of  mindererus.  On 

December  28th,  the  patient  was  sent  to  a  Northern  hospital  by  the  steamer  Star  of  the 

FIG.  240.  — Condyles  of  right   femur 
South.     1  saw  the  man  in  hospital  at  lort  Wood  in  July  following.     He  was  not  able  to     primarily  excised.    Spec.  2030. 

walk  then,  but  subsequently  he  did  so  with  the  assistance  of  a  cane,  and  was  discharged." 

The  records  of  Fort  Wood  Hospital,  Bedloe's  Island,  show  that  the  patient  was  admitted  December  31st,  and  that  he  was 
discharged  August  28,  1863,  Acting  Assistant  Surgeon  O.  W.  Gibson  certifying  to  the  disability  arising  from  "resection  of 
knee  joint."  Five  months  afterwards,  when  making  an  application  for  pension,  the  man  was  examined  by  Surgeon  J.  A. 
Wolf,  29th  Pennsylvania,  who  certified  to  the  following  disabilities  as  resulting  from  the  wound:  "He  has  anchylosis  of  the 
injured  joint,  also  paralysis  of  both  inferior  extremities.  He  is  now  permanently  confined  to  his  bed.  being  entirely  unable  to 
move  his  body  or  inferior  extremities."  The  reports  of  different  examining  surgeons  show  no  improvement  in  his  condition  up 
to  September,  1874,  at  which  time  the  pensioner  was  exempted  from  further  examinations.  The  photograph  represented  in 
FIGURE  2  of  PLATE  LXV,  opposite  page  386,  was  obtained  from  Dr.  Bontecou,  who  mentioned  that  the  paralysis  came  on 
some  time  after  the  patient's  recovery  from  the  operation  and  after  his  arrival  at  home.  He  also  suggested  that  the  attack 
"may  have  been  caused  by  malarial  poison."  In  several  letters  received  from  the  pensioner,  the  last  one  being  dated  April  14, 
1877,  he  depicts  his  condition  as  that  of  "a  poor  wreck,"  and  states  that  owing  to  "the  lower  portion  of  his  body  being  entirely 
powerless  from  the  effects  of  the  wound"  he  is  obliged  to  keep  in  his  bed  all  the  time.  His  pension  was  paid  December  4, 1879.1 

In  the  following  instance  the  primary  excision  was  followed  five  days  later  by  a  suc 
cessful  intermediary  amputation  of  the  thigh  at  the  junction  of  the  middle  and  lower  thirds 
of  the  femur: 

CASE  587. — Private  W.  M.  Constable,  Co.  H,  1st  U.  S.  Cavalry,  aged  26  years,  was  wounded  in  the  right  knee,  at  Din- 
widdie  Court  House,  March  31,  1865.  He  was  admitted  to  a  Cavalry  Corps  field  hospital,  whence  Assistant  Surgeon  E.  J. 
Marsh,  U.  S.  A.,  reported:  "Severe  fracture  of  external  condyle  of  femur  and  of  head  of  tibia  by  a  bullet;  treated  by  excision; 
missile  removed  ;  chloroform  used."  Five  days  after  the  date  of  the  wound  the  limb  was  amputated  by  the  circular  method  at 
the  junction  of  the  middle  and  lower  thirds  of  the  thigh.  This  operation  was  done  at  Judiciary  Square  Hospital,  Washington, 
by  Acting  Assistant  Surgeon  F.  H.  Colton,  who  also,  three  months  later,  at  Douglas  Hospital,  performed  a  second  operation, 
removing  a  sequestrum,  two  inches  long  and  one-fourth  inch  wide,  from  the  stump.  By  August  29th  the  stump  had  entirely 
healed,  and  one  week  afterwards  an  artificial  limb  was  fitted  by  the  Jewett  Patent  Leg  Co.  The  patient  was  subsequently  dis 
charged  from  Harewood  Hospital,  November  18,  1865,  and  pensioned.  Several  years  afterwards  he  served  for  a  period  in  the 
44th  Regiment  (Invalid)  of  Infantry.  The  pensioner  was  paid  March  4,  1880. 3 

Fatal  Cases  of  Primary  Excision  at  the  Knee  Joint. — Twenty-six  primary  excisions 
of  the  knee  joint  terminated  fatally.  In  ten  instances,  the  condyles  of  the  femur,  the 
head  of  the  tibia,  and  the  patella;  in  two,  the  condyles  of  the  femur;  in  three,  the  con 
dyles  of  the  femur  and  head  of  tibia;  in  one,  the  head  of  the  tibia;  and  in  five,  the  patella 
were  the  parts  excised;  in  five  instances  the  excised  portions  were  not  specified: 

CASE  588. — Private  J.  F.  Black,  Co.  H,  26th  Illinois,  was  wounded  in  the  left  knee,  at  Jonesboro/  September  2,  1864. 
Surgeon  W.  M.  Cake,  53d  Ohio,  reported  his  entrance  into  the  field  hospital  of  the  4th  division,  Fifteenth  Corps,  with  "a  frac 
ture  and  comminution  of  the  patella  by  a  bullet;  exsection  of  patella  by  Surgeon  D.  Halderman,  46th  Ohio,  six  hours  after  the 
injury,  under  chloroform."  Two  days  after  the  operation  the  patient  was  transferred  to  the  general  field  hospital  of  the  Fifteenth 
Corps,  where  he  died  September  11,  1864. 

"See  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  1865,  p.  58.  LYOX  (I.  W.),  Excision  of  the  Knee  and  Hip  Joints,  in  Am.  Jour. 
Wed.  Set.,  1865,  Vol.  XI,IX,  N.  S.,  p.  64  ;  CULHEKTSOX  (H.),  Excision  of  the  Larger  Jointt  of  the  Extremities,  Prize  Essay,  in  Transactions  of  the  Am. 
Med.  Assoc.,  Philadelphia,  1876,  Supplement  to  Vol.  XXVII,  p.  182.  2See  TABLE  XXXV,  No.  43,  p.  280. 


388  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

CASE  589. — Private  T.  Clark,  Co.  D,  2d  New  Hampshire  Cavalry,1  was  vrounded  near  Alexandria,  Louisiana,  May  4, 
1864.  Surgeon  C.  Powers,  160th  New  York,  in  charge  of  the  Alexandria  Hospital,  reported  his  admission  with  "a  wound  of 
the  right  knee  joint,  a  ball  entering  the  inner  condyle  of  the  femur,  passing  behind  the  blood-vessels,  and  emerging  two  inches 
above  the  joint  on  the  outer  side.  The  internal  condyle  was  shattered,  but  there  was  no  appearance  of  injury  to  the  blood 
vessels.  Prostration  was  not  great,  the  pulse  being  90,  but  not  strong.  Amputation  was  immediately  advised,  but  the  patient 
positively  refused  to  submit  to  it,  preferring  rather  to  lose  his  life  than  his  limb.  Chlorof<>nn  was  then  administered  and  excision 
was  performed  by  Assistant  Surgeon  J.  Romans,  jr.,  U.  S.  A.,  removing  two  inches  of  the  femur  and  half  an  inch  of  the  tibia 
through  a  horizontal  incision.  The  patient  reacted  slowly.  The  wound  was  brought  together  with  sutures  and  the  limb  was 
placed  in  a  fracture-box.  A  full  anodyne  was  administered  to  enable  the  patient  to  sleep.  Next  moming  all  that  part  of  the 
limb  below  the  incision  was  found  to  be  cold  and  without  pulsation  in  any  of  the  arteries.  On  May  5th,  the  patient  was  moved 
on  board  of  a  transport  for  the  purpose  of  being  conveyed  to  hospital  at  New  Orleans.  He  continued  to  sink,  and  died."  The 
records  of  the  Hospital  Steamer  Laurel  Hill  show  that  the  patient's  death  occurred  on  May  7,  1864.  Four  years  afterwards  the 
operator  communicated  the  following  additional  information  in  the  case:  "My  view  of  the  cause  of  death  is  this:  The  bullet  in 
its  course  lacerated  somewhat  the  coats  of  the  popliteal  artery.  The  anastomosis  was  cut  off  by  the  division  of  the  arterial 
branches  of  the  popliteal  in  the  incision,  which  was  the  usual  semilunar  one,  running  from  the  posterior  edge  of  one  condyle  to 
the  other.  The  dorsalis  pedis  beat  strongly  for  several  hours  following  the  operation,  after  which  pulsation  gradually  ceased  in 
it,  and  the  limb  became  cold  and  then  gangrenous  below  the  line  of  the  incision  and  the  bullet  wound.  Undoubtedly  a  clot 
formed  in  the  popliteal,  and,  afterwards,  the  coats  of  the  artery  gave  way  more  or  less,  thus  causing  the  haemorrhages.  The 
weather  was  very  hot  and  the  hospital  boat  very  crowded  and  on  a  narrow  river;  but  these  circumstances  had  nothing  to  do 
with  the  patient's  decease,  which  was  caused,  I  believe,  by  occlusion  of  the  popliteal  artery." 

CASK  590. — Corporal  S.  B.  Carlton,  Co.  I,  4th  Maine,  was  wounded  at  Chancellorsville,  May  3,  1863,  and  admitted  to 
the  field  hospital  of  the  1st  division,  Third  Corps.  Surgeon  E.  L.  Welling,  llth  New  Jersey,  recorded:  "Shot  wound  of  left 
knee;  resection  of  internal  condyle  of  femur;"  and  reported  the  patient's  death  May  9,  1863. 

CASK  591.—  Private  C.  Crowley,  Co.  C,  8th  New  Hampshire,  was  wounded  at  Port  Hudson.  May  27,  1863,  and  entered 
the  field  hospital  of  the  Nineteenth  Corps.  Surgeon  M.  D.  Benedict,  75th  New  York,  reported:  "Shot  wound  of  right  knee  by 
musket  ball ;  resection."  Surgeon  A.  H.  Van  Nostrand,  4th  Wisconsin,  recorded  that  the  wounded  man  was  admitted  to  hospital 
at  Baton  Kouge,  May  30th,  with  a  "shot  injury  to  the  right  knee  joint,"  of  which  he  died  June  17,  18G3. 

CASK  592. — Corporal  C.  Dewell,  Co.  F,  74th  Indiana,2  aged  27  years,  was  wounded  by  a  round  ball,  at  the  taking  ol 
Missionary  Ridge,  November  25,  1863,  the  missile  entering  the  inner  aspect  of  the  right  knee  joint,  fracturing  the  inner  condyle 
of  the  femur,  passing  obliquely  downward  and  outward,  and  lodging  in  the  head  of  the  tibia.  He  was  conveyed  to  hospital 
No.  6,  at  Chattanooga,  where,  on  the  next  day,  he  was  placed  upon  the  operating  table,  when  the  wound  was  examined.  On 
consultation  it  was  determined  to  practise  exsection  as  affording  the  best  means  of  saving  the  man's  life.  A  semilunar  flap  was 
resorted  to,  the  incision  including  the  wound  made  by  the  ball  as  well  as  the  opening  made  in  examining  the  wound.  The 
patella,  seven-eighths  of  an  inch  of  the  femur,  and  five-eighths  of  an  inch  of  the  tibia  were  removed;  no  arteries  were  tied — two 
or  three  were  twisted  with  the  forceps.  The  patient  did  well  until  about  Christmas,  when  he  began  to  show  marked  symptoms 
of  nervous  exhaustion,  which  continued  to  increase  in  spite  of  the  most  sustaining  treatment.  He  gradually  sank  until  Jan 
uary  18,  1864,  when  he  died.  The  operation  was  performed  by  Surgeon  J.  Haller,  38th  Ohio,  and  the  history  was  communicated 
by  Surgeon  J.  R.  Arter,  31st  Ohio. 

CASK  593. — Private  J.  Forster,  Co.  C,  15th  New  York  Artillery,  was  wounded  before  Petersburg,  July  9,  1864,  and 
entered  the  field  hospital  of  the  2d  division,  Fifth  Corps.  Surgeon  T.  M.  Flandrau,  146th  New  York,  reported :  "  Severe  shell 
wound  of  both  legs.  Exsection  of  left  and  part  of  right  patella."  Three  days  after  the  reception  of  the  injury  the  patient  was 
moved  to  the  corps  hospital  at  City  Point,  where  he  died  July  25,  1864. 

CASE  594. — Private  J.  P.  Goforth,  Co.  K,  llth  South  .Carolina,  aged  25  years,  was  wounded  near  Petersburg,  and  sent 
to  the  division  hospital  in  the  city  about  two  hours  after  the  injury,  June  24,  1864.  Surgeon  Samuel  Logan,  C.  S.  A.,  reported:3 
"A  gunshot  wound,  penetrating  the  left  knee  joint  obliquely,  tearing  away  both  articular  surfaces,  but  producing  no  splintering  of 
the  cancellated  structure  or  shafts,  merely  grooving  the  articular  surfaces  and  fracturing  the  patella.  The  pulse  was  at  90,  and 
there  was  slight  shock  or  constitutional  disturbance.''  As  the  general  hospital  where  he  could  be  permanently  treated  was  less 
than  a  quarter  of  a  mile  from  the  place  where  he  was  wounded,  and  the  excellent  state  of  the  patient's  general  health  and 
nature  of  the  wound  were  encouraging,  Dr.  Logan  considered  the  case  as  one  in  which  excision  was  justifiable,  the  patient  pre 
ferring  any  risk  to  the  loss  of  his  limb.  He  was  placed  under  chloroform  a  few  hours  after  the  injury,  June  24,  1864,  and  the 
operation  was  performed  by  H-'mcision,  the  cross  cut  including  both  orifices  of  the  wound.  The  contused  soft  parts  were 
removed  with  the  patella  after  the  articular  surfaces  of  the  femur  and  tibia  had  been  sawn  off.  The  parts  seemed  to  present 
favorable  conditions  for  a  speedy  union.  A  long  splint  was  applied  to  the  wound.  On  June  28th,  Dr.  Logan  found  the  patient 
comfortable,  the  pulse  at  110,  skin  warm  and  moist.  The  wounds  were  slightly  swollen  but  not  painful.  The  limb  was  dressed 
•with  Smith's  anterior  wire  splint  and  suspended,  water  dressing  being  employed  by  irrigation.  July  1st,  the  patient  was  found 
restless,  the  pulse  at  120;  tongue  dry;  the  wounds  were  erysipelatous  in  appearance  and  swollen.  The  patient  sank  and  died. 
Surgeon  Logan  could  not  ascertain  the  precise  date,  but  it  was  prior  to  July  14,  1864. 

CASE  595. — Private  G.  Gregory,  Co.  K,  57th  New  York,  aged  28  years,  was  wounded  at  Fredericksburg,  December  13, 
1862.  Surgeon  C.  S.  Wood,  66th  New  York,  reported  that  he  was  admitted  to  the  field  hospital  of  the  1st  division,  Second 

1  See  Circular  No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  186o,  p.  59,  and  CfUVEKTSON  (H.),  Excision  of  the  Larger  Joints  of 
the  Extremities,  Prize  Essay,  in  Transactions  of  the  American  Medical  Association,  Philadelphia,  187(i.  Supplement  to  Vol.  XXVII,  p.  184,  Case  No.  15. 

2  See  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  18C5.  p.  58,  and  Cf  LEERT60N  (II.).  Excision  of  the  Larger  Joints  of  the  Extremities, 
in  Transactions  of  the  American  Medical  Association.  Philadelphia,  1876.     Prize  Essay.     Supplement  to  Volume  XXVII,  p.  182.  Case  10. 

'LOGAN  (SAMUEL),  Report  of  Two  Cases  of  Primary  Resection  at  tlte.Knee  Joint  for  Gunshot  Wounds,  in  Southern  Med.  and  Surg.  Jour.,  1866, 
Volume  XXI,  p.  293. 


SECT.  IV.]  PRIMARY    EXCISIONS    AT    THE    KNEE    JOINT.  389 

Corps,  with  "exsection  of  the  left  knee  joint,  performed  by  some  unknown  surgeon,"  and  that  the  limb  was  placed  in  a  long 
padded  splint,  bandaged  in  its  whole  length,  and  dressed  with  cold-water  applications.  Surgeon  W.  Clendenin,  U.  S.  V., 
reported  that  the  patient  was  admitted  to  Emory  Hospital,  Washington,  December  26,  1862,  with  gunshot  wound,  and  that  he 
died  the  same  day. 

CASE  596. — "Private  E.  M.  Hogston,  Co.  D,  4th  Virginia,  aged  29  years,  was  wounded  in  the  right  knee  joint,  at  Chan- 
cellorsville,  May  3,  1863,  a  ball  entering  through  the  patella,  fracturing  the  inner  condyle  and  lodging.  In  addition  there  was 
a  flesh  wound  of  the  same  leg.  The  patient  positively  and  persistently  declined  amputation,  which  was  urgently  recommended. 
As  a  final  resort,  resection  was  advised  and  accepted  in  preference  to  amputation.  The  operation  was  performed  on  May  5th,  the 
joint  being  opened  by  an  H-incision,  and  the  fragments  of  the  fractured  patella  removed  with  the  ball  lodged  in  the  inner  condyle. 
The  synovial  membrane  and  articular  cartilages  of  the  articular  surfaces  were  carefully  dissected  out,  and,  in  addition,  a  thin 
slice  of  bone  was  removed  from  the  contiguous  surfaces  of  the  condyles  and  upper  surface  of  the  tibia,  so  that  when  the  parts 
were  brought  into  apposition  an  obtuse  angle  was  formed  at  the  joint  site.  The  limb  was  firmly  fastened  to  a  well  padded  and 
suitably  arranged  posterior  angular  splint;  the  joint  was  dressed  with  dry  lint  and  oiled  silk  covering.  On  May  10th,  the 
wound  was  suppurating  freely.  12th,  still  doing  well.  14th,  weaker,  with  tendency  to  diarrhoea,  loth,  gangrene  of  thigh. 
17th,  patient  died."  The  history  was  contributed  by  Dr.  I.  W.  Walls,  late  Surgeon  P.  A.  C.  S.,  in  November,  1877. 

CASE  597. — Private  J.  Lambert,  Co.  E,  1st  Michigan  Cavalry,  aged  33  years,  was  svounded  in  the  left  knee  joint,  at 
Cold  Harbor,  May  31,  1864.  Surgeon  W.  H.  Rulison,  9th  New  York  Cavalry,  reported  that  resection  was  performed  at  the 
field  hospital  of  the  1st  division,  Cavalry  Corps.  Acting  Assistant  Surgeon  S.  Graham  reported  that  the  patient  was  admitted 
to  Emory  Hospital,  Washington,  June  7th,  in  a  weak  and  debilitated  condition,  caused  by  a  ''shot  fracture  of  the  knee  joint, 
the  head  of  the  tibia  having  been  excised"  before  admission.  Tonics,  stimulants,  and  nourishing  diet  constituted  the  treatment, 
and  water  dressings  and  bandages  were  applied  locally.  The  patient  became  delirious  June  12th,  and  died  June  16,  1864. 

CASE  598. — Private  E.  Lewis,  Co.  B,  87th  Pennsylvania,  was  wounded  .at  Winchester,  September  19,  1864.  Surgeon 
R.  Burr,  67th  Pennsylvania,  described  his  injury  as  a  "severe  wound  of  the  right  thigh  by  a  minie'  ball,  fracturing  the  cou- 
dyles"  of  the  femur,  for  which  "resection"  was  performed  at  the  field  hospital  of  the  3d  division,  Sixth  Corps.  Acting  Staff 
Surgeon  N.  F.  Graham  reported  that  the  patient  was  admitted  to  the  general  field  hospital  at  Sandy  Hook  six  days  after  the 
date  of  the  battle,  and  that  he  died  of  his  injury,  a  "shot  wound  of  the  right  knee,"  on  October  10,  1864. 

CASE  599. — Sergeant  Henry  J.  Moore,  Co.  F,  7th  Maine,  aged  24  years,  received,  May  12,  1864,  a  shot  wound  of  the 
left  knee  joint,  at  the  battle  of  Spottsylvania.  Surgeon  F.  M.  Everleth,  7th  Maine,1  practised  a  primary  total  excision  on  the 
morning  of  the  reception  of  the  injury  "by  making  an  anterior  incision  across  just  below  the  joint,  curving  up  over  the  external 
condyle,  and  joining  at  right  angles  an  incision  extending  over  the  internal  condyle;  one  inch  and  a  half  of  the  femur,  with  a 
conoidal  ball  implanted,  was  removed  by  sawing  squarely  through  the  condyles,  and  the  articular  surface  of  the  tibia  was 
removed,  being  bruised.  No  ligatures  were  required.  The  specimen  was  sent  to  the  Museum  at  Washington  with  an  account 
of  the  case."  The  patient  was  admitted  May  24,  1864,  to  the  Third  Division  Hospital,  at  Alexandria,  with  the  left  lower 
extremity  in  a  fracture  box,  the  wound  being  partially  closed  by  sutures  and  discharging  little  pus.  The  patient  was  prostrated 
by  the  fatigues  of  transportation,  and  he  died  of  exhaustion  May  26,  1864. 

CASE  600. — Private  /.  Moore,  Co.  B,  44th  Alabama,  received  a  shot  fracture  of  the  right  knee  joint  October  1,  1864,  for 
which  resection  by  a  semilunar  flap  was  performed  on  the  following  day.  The  record  of  the  case  was  found  on  the  Confederate 
register  of  Howard  Grove  Hospital,  Richmond,  where  the  patient  died  October  22,  1864. 

CASE  601. — Lieutenant  G.  W.  Pettigrew,  Co.  A,  26th  Georgia,  was  wounded  and  captured  at  Fredericksburg,  December 
13,  1862.  Surgeon  C.  J.  Nordquist,  83d  New  York,  recorded  his  admission  to  the  field  hospital  of  the  2d  division,  First  Corps, 
with  "shot  wound  of  left  knee;  patella  removed."  Acting  Assistant  Surgeon  J.  D.  Robinson  reported  that  the  patient  was 
admitted  to  the  Patent  Office  Hospital,  Washington,  December  25th,  and  that  he  died  of  his  injury,  "a  shot  wound  of  left  side 
and  knee,"  December  30,  1862.2 

CASE  602.— Dr.  J.  J.  Knott,  late  Surgeon  of  the  Confederate  army,  in  a  letter  from  Griffin,  Georgia,  November  6,  1868, 
makes  mention  of  the  following:  "I  practised  excision  of  the  knee  joint  in  one  case  only.  This  was  performed  on  a  German, 
belonging  to  the  Federal  army,  after  the  battle  of  the  Wilderness,  in  May,  1864.  The  patient  died  from  the  effects  of  chloroform." 

CASE  603. — Private  J.  Wheeler,  Co.  E,  97th  New  York,  was  wounded  at  Fredericksburg,  December  13,  1862.  Surgeon 
C.  J.  Nordquist,  83d  New  York,  recorded  his  admission  to  the  field  hospital  of  the  2d  division,  First  Corps,  with  "shot  wound 
of  knee ;  patella  removed."  On  December  25th,  the  wounded  man  was  admitted  to  the  Patent  Office  Hospital,  Washington, 
whence  Assistant  Surgeon  G.  W.  Hoover,  132d  Pennsylvania,  reported  that  the  patient  died  from  the  effects  of  a  "wound  of  the 
left  knee  joint,"  February  1,  1863.3 

1  At  the  date  of  the  publication  of  this  case  in  Circular  No.  6,  S.  G.  O.,  1865,  p.  59,  the  operator's  name  and  the  date  of  the  excision  were  unknown ; 
but  these  particulars  were  communicated  in  a  letter  to  Assistant  Surgeon  General  C.  H.  CUANE,  dated  Waldoboro,'  Maine,  March  26,  1868,  by  Dr.  P.  M. 
EVEHLETH.     The  specimen,  with  the  impacted  ball  in  the  condyles,  and  the  account  of  the  case,  alluded  to  by  Dr.  EVERLETH,  it  has  been  impossible  to 
trace  in  the  Museum.     See  also  CULHEHTSON  (H.),  Excision  of  the,  Larger  Joints  of  the  Extremities,  Prize  Essay,  in  Trans.  Am.  Med.  Assoc.,  Philadel 
phia,  1876.     Supplement  to  Vol.  XXVII,  p.  184,  Case  16. 

2  A  letter  of  inquiry  was  addressed,  in  February,  1868,  by  the  editor  to  Dr.  R.  S.  Dana,  formerly  Surgeon  107th  Pennsylvania,  who,  in  an  answer 
dated  March  23,  1868,  states:  "1  have  written  to  several  of  the  surgeons  who  were  there,  to  learn  if  possible  more  of  the  case  than  I  can  recollect ;  one 
answer  only  has  been  returned.     From  all  that  I  can  learn  or  remember  of  the  case,  Lieutenant  Pettigrew  was  operated  on  by  Dr.  E.  G.  Chase,  Surgeon 
104th  New  York,  and  Dr.  J.  F.  Hutchinson,  at  that  time  Surgeon  of  the  107th  Pennsylvania.     The  operation  was  the  resection  of  the  head  of  the  fibula, 
which  was  destroyed  by  a  ball,  the  operation  not  involving  the  knee  joint  proper." 

3In  response  to  the  editor's  letter  of  inquiry.  Dr.  R.  S.  Dana,  of  Morrisville,  Pennsylvania,  formerly  Surgeon  107th  Pennsylvania,  wrote  under 
date  March  L'3,  1868 :  "  Private  Jerome  Wheeler  I  cannot  be  so  positive  about,  but  think  that  he  was  operated  on  by  Drs.  Nordquist  and  Coxe,  Surgeons 
of  New  York  regiments,  and  that  in  his  case  the  joint  was  penetrated  by  a  ball,  aud  the  operation  consisted  in  the  removal  of  the  upper  portion  of  the 
head  of  the  tibia  and  the  opposing  surface  of  the  condyles  of  the  feniur,  calculating  that  bony  union  and  a  fixed  knee  would  result,  shortening  the  limb 
from  1  to  1 J  inches.  The  result  of  the  operation  we  know  nothing  about,  as  the  hospital  WHS  cleared  as  rapidly  ns  possible." 


390  INJURIES   OF   THE    LOWER   EXTREMITIES.  [CHAP.  X. 

CASE  604. — Corporal  J.  White,  Co.  I,  21st  South  Carolina,  aged  25  years,  was  wounded  June  24,  1864,  at  Petersburg 
He  was  conveyed  to  the  division  field  hospital  in  the  city,  and,  two  or  three  hours  after  the  injury,  was  examined  by  Surgeon 
Samuel  Logan,1  C.  S.  A.,  who  found  that  the  missile,  probably  a  conical  musket  ball,  had  passed  through  the  external  condyle 
of  the  right  femur,  laying  open  the  joint  freely  and  carrying  away  a  portion  of  the  articular  surface.  There  was  a  slight  flesh 
wound  in  the  right  arm.  The  case  was  considered  favorable  for  excision,  and  the  operation  was  done  immediately  by  Dr.  Logan, 
through  an  H-incision,  removing  an  inch  from  the  condylesof  the  femur,  slicing  off  the  top  of  the  tibia,  and  removing  all  con 
tused  soft  parts.  The  limb  was  bound  to  a  long  external  splint.  June  26th,  the  wounds  were  somewhat  swollen,  and  the 
dressing  had  caused  pain  by  undue  pressure.  The  patient  was  restless,  with  pulse  at  115.  June  27th.  general  symptoms 
unaltered.  The  limb  is  as  much  swollen  but  is  more  comfortable  since  the  dressings  have  been  arranged.  June  28th,  the  flesh 
wound  in  the  arm  is  painful  and  swollen.  The  leg  is  less  swollen,  and  union  appears  to  betaking  place.  July  8th,  general  con 
dition  favorable;  pulse  110;  leg  somewhat  swollen.  All  retentive  apparatus  was  removed;  every  movement  of  the  body  or 
limb  thus  disturbed  the  relations  of  the  osseous  surfaces.  Dr.  Logan  did  not  see  the  patient  again,  but  he  heard  that  death 
occurred  prior  to  July  15,  1864. 

In  three  instances  of  primary  excision  at  the  knee  joint  recourse  was  had  to  amputa 
tion  of  the  thigh.  Death  ensued  in  two,  four,  arid  thirty-nine  days,  respectively: 

CASE  605. — Private  J.  W.  Derr,  Co.  E,  7th  Maryland,  aged  18  years,  was  wounded  at  Hatcher's  Run,  March  31,  1855, 
and  admitted  to  the  field  hospital  of  the  2d  division,  Fifth  Corps.  Surgeon  A.  A.  White,  8th  Maryland,  reported :  "A  musket 
ball  struck  the  patella  of  the  right  knee  laterally,  shattering  the  patella  into  a  number  of  fragments,  but  not  involving  the  knee 
joint  proper.  I  excised  the  entire  patella,  carefully  dissecting  it  from  its  covering."  Surgeon  A.  F.  Sheldon,  U.  S.  V.,  reported 
that  the  patient  was  admitted  to  Campbell  Hospital,  Washington,  April  5th,  with  the  incised  wound  of  the  operation  healing  by 
first  intention.  After  doing  well  for  three  weeks,  inflammation  commenced  and  suppuration  became  very  great.  Circular  ampu 
tation  through  the  lower  third  of  the  thigh  was  performed  on  May  15th,  by  Acting  Assistant  Surgeon  F.  Hall,  after  which  there 
was  favorable  progress  for  a  time.  On  June  10th,  there  were  signs  of  morbid  poisoning,  and  on  June  15th  the  stump  was 
opened,  allowing  a  canal  filled  with  pus  to  discharge.  Death  resulted  from  exhaustion  June  23,  1885.  The  amputated  part  of 
the  femur,  together  with  the  upper  portions  of  the  tibia  and  fibula,  were  contributed  to  the  Museum  by  Surgeon  Sheldon,  and 
constitute  specimen  4199  of  the  Surgical  Section. 

CASE  606. — Corporal  A.  Glazier,  Co.  B,  1st  Minnesota,  aged  29  years,  was  wounded  at  Reams's  Station,  August  25,  1864. 
Surgeon  N.  Hayward,  20th  Massachusetts,  reported  the  injury  as  a  "shot  fracture  of  the  left  knee  joint,"  for  which  he  performed 
excision  at  the  field  hospital  of  (he  2d  division,  Second  Corps.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  reported  that  the  patient  was 
admitted  to  the  Armory  Square  Hospital,  Washington,  August  28th,  in  a  low  condition  and  suffering  severe  pain  from  nervous 
spasms  of  the  limb,  caused  by  a  wound  of  the  knee  joint  with  slight  fracture  of  the  external  condyle,  the  patella  having  been 
removed  on  the  field.  Circular  amputation  at  the  lower  third  of  the  thigh  was  performed  by  Acting  Assistant  Surgeon  D.  W.  C. 
Van  Slyck  on  the  day  after  admission.  Chloroform  inhalation  induced  alarming  symptoms,  and  electricity  was  resorted  to. 
Opium  and  alcoholic  and  diffusible  stimulants  were  administered.  Gangrene  appeared  in  the  stump  the  second  day  and  spread 
rapidly.  Death  resulted  on  September  2,  1864. 

CASE  607. — Private  W.  E.  L.  Morrison,  Co.  I,  29th  Connecticut,  aged  21  years,  was  wounded  near  Richmond,  October 
27,  1864,  and  admitted  to  the  Flying  Hospital  of  the  Tenth  Corps.  Surgeon  M.  S.  Kittinger,  100th  New  York,  recorded:  "Shot 
wound  of  left  knee;  excision  of  knee  by  Surgeon  A.  C.  Barlow,  62d  Ohio."  The  subsequent  progress  and  the  result  was  reported 
by  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  as  follows:  "The  patient  was  admitted  to  hospital  at  Fort  Monroe,  October  30th, 
with  shot  fracture  of  knee  joint.  Circular  amputation  at  the  middle  third  of  the  thigh  was  performed  on  November  10th  by 
Acting  Assistant  Surge^p  J.  Pitkin.  Chloroform  and  ether  constituted  the  anaesthetic.  The  patient  died  November  12,  1H64, 
of  exhaustion." 

To  the  primary  cases  of  excision  at  the  knee  here  detailed  should  be  added  six  instances 
observed  by  Professor  Hunter  McGuire,2  of  Richmond,  formerly  Surgeon  of  the  Confederate 
States  Army: 

CASES  608-613. — "In  May,  1864,  at  Spottsylvania  Court  House,  the  operation  was  performed  in  six  cases  by  some 
surgeons  sent  from  this  city  to  our  assistance.  Not  to  subject  them  to  the  danger  of  transportation,  I  left  these  cases,  with  others 
too  badly  hurt  to  be  moved,  in  a  hospital,  prepared  for  them  near  the  field  of  battle,  and  in  charge  of  one  of  the  best  surgeons  in 
the  army,  Dr.  Taylor,  who  gave  ihein  every  possible  attention.  Three  of  them  died  before  the  end  of  the  third  day.  In  two  of 
fhe  cases,  secondary  amputation  was  performed  with  a  view  of  preserving  life,  but  unsuccessfully,  and  the  sixth  lingered  for 
about  four  weeks,  I  think,  and  proved  fatal  from  sheer  exhaustion.  Such,  as  far  as  I  can  gather,  is  the  melancholy  record,  and 
although  the  number  is  too  small  to  justify  a  comparison  with  amputation,  I  do  not  think  there  is  any  one  who  saw  the  six 
patients  I  have  reported — men  who  a  day  or  two  before  were  stout,  strong  and  brave  soldiers — who  would  not  agree  with  me 
in  saying,  this  operation  for  wounds  occurring  upon  the  battle  field  is  nothing  more  nor  less  than  butchery." 

Primary  Excisions  at  the  Knee  Joint  of  Undetermined  P^esult. — The  results  of  two 
of  the  thirty-two  primary  excisions  at  the  knee  joint  could  not  be  ascertained: 

CASE  614. — Private  A.  McDowell,  Co.  K,  1st  North  Carolina,  received  a  shot  fracture  of  the  patella  and  the  external 

1  LOGAN  (S.)t  Report  of  two  cases  of  Primary  Resection  at  the  Knee  Joint  for  gunshot  wound ;  death  resulting  in  both  cases,  in  Southern  Medical 
and  Surgical  Journal,  1866,  Vol.  XXI,  p.  295. 

2MCGUIKE  (HUNTER),  Clinical  Remarks  on  Gunshot  Wounds  of  Joints,  delivered  January  10,  1866,  at  Howard's  Grovo  Hospital,  in  Richmond 
Medical  Journal,  1866,  Vol.  I,  p.  263.  CULBEKTSOX  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities.  Prize  Essay,  in  Trans.  Am.  Med.  Aisoc., 
Philadelphia,  1876.  Supplement  to  Vol.  XXVII,  pp.  184,  186. 


SECT,  iv.]  INTERMEDIARY    EXCISIONS    AT    THE   KNEE   JOINT.  391 

condvle  of  the  femur  by  a  mini6  ball,  at  Hauover  Junction,  May  24,  1864.  He  was  admitted  to  tbe  Receiving  and  Wayside 
Hospital,  Richmond,  where,  on  May  26th,  he  was  placed  under  the  influence  of  chloroform,  and  excision  of  the  fractured  parts 
was  performed  by  Surgeon  C.  B.  Gibson,  C.  S.  A.  Splints  and  water  dressings  were  used  after  the  operation.  Reaction  wa» 
fully  established  on  the  following  day.  On  May  30th,  the  wound  looked  well,  and  the  patient  was  transferred  to  another  hospital 
at  the  request  of  Dr.  Gibson.  The  record  of  the  case  was  obtained  from  the  Confederate  register  of  the  Receiving  and  Wayside 
Hospital,  Richmond. 

CASE  615. — Among  the  names  of  wounded  men  admitted  to  the  Nineteenth  Corps  field  hospital  from  the  battle  of  Port 
Hudson,  May  27,  1863,  Surgeon  M.  D.  Benedict,  75th  New  York,  includes  that  of  "Private  A.  W.  Mousky,  Co.  B,  4th  Wiscon 
sin,"  whose  injury  Avas  reported  as  follows:  "Shot  wound  of  right  leg;  excision  of  knee  joint."  It  has  not  been  practicable  to 
ascertain  the  termination  of  the  case. 

Intermediary  Excisions  at  the  Knee  Joint. — Thirteen  cases  were  referred  to  this 
group;  one  only  proved  successful,  a  ratio  of  fatality  of  92.3  per  cent.  The  operations 
were  practised  on  ten  Union  and  three  Confederate  soldiers. 

Recovery  after  Intermediary  Excision  at  the  Knee  Joint. — A  successful  intermediate 
operation1  was  performed  on  a  captain  of  the  Confederate  army  wounded  at  Mine  Run, 
November  27,  1863.  He  was  last  heard  from  in  1877,  fourteen  years  after  the  operation. 
He  then  experienced  only  little  disability,  principally  due  to  shortening,  and  he  could  walk 
for  miles  without  fatigue. 

CASE  616. — Captain  Charles  Knowlton,  10th  Louisiana,  of  Ewell's  Corps,  aged  26  years,  was  wounded  at  Mine  Run, 
Virginia,  November  27,  1863,  by  a  conoidal  musket  ball,  which  grooved  the  outer  condyle  of  the  right  femur,  barely  touched  the 
cartilage,  opened  the  synovial  sac,  was  deflected,  and  lodged  near  the  upper  edge  of  the  patella,  whence  it  was  removed,  on  the 
field,  through  an  incision,  after  the  wounded  man  had  walked  half  a  mile  to  the  rear  leaning  on  the  shoulder  of  one  of  his  men. 
He  was  then  transported  over  rough  roads  in  an  ambulance  to  the  nearest  railway  station,  and  conveyed  to  Richmond,  and 
entered  general  hospital  No.  4  two  days  after  receiving  the  injury.  His  condition  on  admission  was  good.  There  appeared  to 
have  been  no  haemorrhage.  The  movements  of  the  knee  joint  were  perfect.  Moist  dressings,  absolute  rest,  and  saline  aperients 
were  ordered.  On  December  2d,  a  serous  or  synovial  discharge  from  the  wound  was  observed.  This  became  slightly  puriform 
on  the  following  day.  Still  there  was  no  mark  of  inflammatory  reaction.  On  December  8th,  there  was  much  pain  in  the  joint 
and  the  discharge  was  increased.  Warm  fomentations  were  substituted  for  the  cold  dressings.  His  pulse  rose  to  104.  On  the 
9th,  the  joint  was  excessively  inflamed  and  the  pulse  was  128.  Surgeon  James  B.  Read,  P.  A.  C.  S.,  in  consultation  with  Sur 
geons  C.  B.  Gibson  and  M.  Michel,  decided  that  excision  of  the  joint  was  expedient.  The  operation  was  performed  by  Surgeon 
Read.  An  elliptical  incision  with  its  concavity  upward  was  made  to  extend  from  one  condyle  to  the  other,  passing  below  the 
patella  and  dividing  its  ligament.  The  joint  was  then  laid  open,  and  an  inch  and  a  half  of  the  condyles  of  the  femur  and  an  inch 
of  the  tibia  were  sawn  off.  The  patella  was  also  removed.  No  ligatures  were  required.  The  section  of  the  femur  was  made 
obliquely  downward  and  backward;  the  section  of  the  tibia  was  the  reverse  of  this,  so  that  when  the  extremities  were  approx 
imated  the  limb  was  slightly  flexed.  The  synovial  sac  was  reddened  and  contained  a  turbid  flocculent  fluid.  The  sawn  ends 
of  the  bones  were  then  wired  together.  The  limb  was  then  placed  in  a  long  well  padded  fracture  box.  After  a  few  days  a  long 
bracketed  splint  was  substituted  for  the  fracture  box.  He  had  a  liberal  stimulating  diet  of  eggs,  oysters,  and  beef  tea,  with  half 
an  ounce  of  brandy  every  two  hours.  The  patient  was  restless  and  irritable,  and  on  December  16th,  and  again  on  the  20th, 
had  venous  haemorrhage  to  the  extent  of  a  few  ounces,  the  bleeding  being  arrested  on  both  occasions  by  the  use  of  persulphate 
of  iron.  There  was  tumefaction  about  the  joint  and  burrowing  of  pus,  until  Acting  Assistant  Surgeon  Howell  L.  Thomas  sug 
gested  a  suspension  of  the  limb  by  Smith's  anterior  splint.  By  January  3d,  the  internal  half  of  the  horse-shoe  incision  had 
closed.  The  patient  enjoyed  an  excellent  appetite,  which  was  appeased  by  venison,  turkey,  partridges,  and  other  hearty  food, 
and  a  pint  of  porter  daily.  By  the  middle  of  February  there  was  only  a  small  fistulous  orifice  remaining  of  the  wound,  which 
discharged  a  thin,  sero-purulent  matter.  A  starch  bandage  was  now  applied,  with  an  aperture  over  the  unhealed  portion  of  the 
wound.  All  the  wires  had  been  removed  at  this  date  except  one.  In  March,  the  patient  sat  up  daily  and  attempted  to  walk  on 
crutches.  In  April,  he  Avas  discharged  from  the  hospital;  his  limb  was  supported  by  a  leathern  splint.  There  was  still  slight 
motion  between  the  femur  and  tibia,  but  the  ligamentous  union  appeared  quite  firm.  He  subsequently  went  to  the  West  Indies. 
At  Nassau,  Dr.  Hunt,  of  New  Orleans,  removed  the  starch  bandage  and  found  the  consolidation  was  very  firm.  In  a  few  months 
Captain  Enmclton  laid  aside  his  crutches  and  walked  very  satisfactorily.  He  returned  to  Louisiana  in  1866.  He  was  able 
not  only  to  walk  almost  as  well  as  ever,  but  to  dance  even  the  round  dances.  His  address  as  a  purser  on  the  steamship  "Sen 
ator,"  one  of  the  Pacific  mail  steamers  plying  between  San  Francisco  and  San  Luis  Obispo,  having  been  discovered,  Surgeon 
Charles  McCormick,  U.  S.  A.,  at  San  Francisco,  examined  his  limb,  December  17,  1868,  and  had  prepared  the  photograph  from 
which  FiGCRE  1  of  the  lithographic  plate  (PLATE  LXV)  opposite  p.  386  was  taken.  There  was  no  evidence  of  disease  about 
tbe  cicatrix.  The  muscular  development  of  the  limb  was  good;  and  the  inability  to  flex  it  at  the  knee  was  the  only  inconvenience 
suffered,  a  result  as  gratifying  as  it  is  unusual.  A  letter  from  Surgeon  Charles  C.  Keeney,  U.  S.  A.,  Medical  Director  at  San 
Francisco,  dated  April  20,  1877,  mentioned  that  he  had  met  Captain  Knowlton  about  a  year  previously  and  learned  that  he 
experienced  no  disability  save  that  due  to  the  shortness  and  stiffness  of  the  limb,  and  walked  for  miles  without  fatigue. 


392 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Spec.  1065. 


PIG.  242.— Left  knee 

lifter  excision.     Spec. 
629,  A.  M.  M. 


Flo.  241!. — Soft   parts  from 
same  excision.    Spec.  600. 


fatal  Instances  of  Intermediary  Excision  at  the  Knee  Joint.  —  This  group  comprises 
twelve  cases,  ten  in  the  Union  and  two  in  the  Confederate  armies: 

CASE  617.  —  Private  O.  Derocher,  Co.  1,  1st  Maine  Heavy  Artillery,  aged  31  years,  was  wounded  in  the  right 
knee,  at  Spottsylvania,  May  19,  1864,  by  a  conoidal  musket  ball,  which  fractured  and  comminuted  the  patella. 
Three  days  after  the  reception  of  the  injury  he  was  admitted  to  Emory  Hospital,  Washington,  the  soft  parts  about 
the  knee  being  badly  swollen.  On  May  23d,  the  inner  half  of  the  patella  was  excised  by  Surgeon  N.  R.  Moseley, 
U.  S.  V.  The  operation  was  followed  by  cold-water  dressings.  By  May  30th  erysipelas  had  invaded  the  limb,  for 
which  carron  oil  and  copper  wash  was  applied,  and  tincture  of  iron  was  administered.  Stimulants  and  generous  diet 
were  allowed  liberally.  The  patient  died  from  the  effects  of  constitutional  irritation  and  exhaustion,  June  10,  1864. 
The  history  and  the  excised  bone  (FlG.  241),  consisting  of  two  fragments  (Cat.  Surg.  Sect.,  1866,  p.  363,  Spec.  1065), 
were  contributed  by  the  operator.1 

CASE  618.  —  Private  Charles  F.  Gould,  Co.  I,  1st  Pennsylvania  Reserves, 
was  wounded  at  the  second  battle  of  Bull  Run,  August  30,  1862.  A  musket  ball 
appeared  to  have  entered  the  outer  side  of  the  joint  near  the  head  of  the  tibia. 
The  patient  was  sent  to  Fairfax  Seminary  Hospital,  near  Alexandria,  September 
9,  1862.  On  September  15th,  an  excision  of  the  knee  joint  was  performed.  The 
condyles  of  the  femur,  the  patella,  and  the  heads  of  the  tibia  and  fibula  were 
removed  through  an  H-shaped  incision.  The  wound  united,  and  there  seemed 
every  prospect  of  a  satisfactory  result,  when,  on  October  8th,  symptoms  of 
pyaemia  were  developed,  and  death  ensued  October  12,  1862.  The  pathological 
preparation  was  forwarded  to  the  Army  Medical  Museum  by  Acting  Assistant 
Surgeon  T.  0.  Bannister.  The  specimen  represented  in  the  left-hand  wood-cut 
(FlG.  242)  shows  the  osseous  portion,  while  the  appearance  of  the  soft  parts  are 
shown  in  the  right-hand  wood-cut  (FlG.  243).  (See  Cat.  Surg.  Sect.,  1866,  pp. 
336,  500.)- 

CASE  619.—  Corporal  G.  W.  Hays,  Co.  K,  2d  Michigan,  aged  19  years, 
was  wounded  in  both  knees,  at  Petersburg,  June  17,  1864.  Surgeon  R  B. 
Bontecou,  U.  S.  V.,  reported:  "He  was  admitted  to  Harewood  Hospital,  Wash 
ington,  June  20th,  suffering  from  amputation  at  the  lower  third  of  the  thigh, 
performed  on  the  field  for  a  shot  wound  of  the  knee  joint  by  a  ball,  which  frac 
tured  the  condyles  of  the  femur  and  the  patella.  The  right  knee  was  also  wounded,  a  ball  entering  the  joint,  fracturing  the 
patella,  and  denuding  the  condyles  of  the  femur  and  the  head  of  the  tibia.  Extensive  suppuration  followed  in  the  right  knee, 
and  an  abscess  burrowed  half  way  up  the  thigh  ;  the  joint  itself  became  entirely  disorganized  and  much  swollen."  On  June  24th, 
resection  of  about  two-thirds  of  the  condyles  of  the  femur,  with  the  entire  patella  and  the  articular  face  of  the  tibia,  was  per 
formed  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.  Sulphuric  ether  was  used  as  the  anaesthetic.  The 
stump  of  the  left  thigh  progressed  very  satisfactorily  towards  healing,  while  the  resected  joint  com 
menced  to  fill  up  with  healthy  granulations  also  and  looked  well  in  other  respects.  Profuse  suppu 
ration  of  healthy  looking  pus,  however,  continued.  The  constitutional  treatment  was  mainly  directed 
towards  supporting  the  strength  of  the  patient,  and  consisted  of  stimulants,  tonics,  and  nourishing 
diet.  The  right  thigh  and  leg  were  supported  and  kept  in  place  by  means  of  a  wide  board,  to  which 
a  bag  of  bran  was  attached  and  so  arranged  as  to  embrace  the  parts  on  either  side,  it  being  readily 
adjusted  and  kneaded  to  suit  the  manipulations  during  dressing.  The  entire  extremity,  from  the  foot 
to  the  great  trochanter,  was  confined  in  a  Scultetus'  bandage.  The  patient  did  tolerably  well  up  to  June  30th,  from  which  date 
he  became  drowsy  and  was  only  waked  with  difficulty.  He  continued  so,  with  intervals  of  wakefulness,  until  his  death,  which 
occurred  on  July  2,  1864,  from  exhaustion.  There  were  no  pysemic  symptoms.  The  exsected  patella  and  condyles  of  the  femur 
were  contributed  to  the  Museum  by  the  operator  and  are  represented  in  the  cut  (FlG.  244).  3 

CASE  620.  —  "  Private  J.  W.  Holtzman,  Co.  B,  2d  Virginia,  about  35  years  of  age,  was  wounded  at  Chancellorsville,  May  3, 
1863.  a  ball  entering  the  knee  joint  through  the  patella  and  lodging  in  the  head  of  the  tibia.  The  patient  persistently  declined 
amputation  and  other  active  interference  until  much  suffering  and  pain  induced  him  to  accept  the  chances  of  a  resection,  which 
was  reluctantly  performed  on  May  10th.  The  joint  was  laid  open  by  a  semilunar  incision,  the  synovial  membranes  and  cartilages 
were  removed,  and  thin  slices  of  the  contiguous  surfaces  of  the  condyles  and  head  of  tibia  were  taken  off.  The  limb  was  placed 
in  a  posterior  angular  splint  and  carefully  watched.  The  patient,  however,  finally  succumbed  to  diarrhoea  and  exhaustion  about 
May  20,  1863."  The  history  of  the  case  was  communicated  by  Dr.  I.  W.  Walls,  late  Surgeon  P,  A.  C.  S.,  in  November,  1877. 
CASE  621.  —  Private  M.  B.  Horan.  Co.  F,  63d  New  York,  was  wounded  at  Antietam,  September  17,  1862,  and  entered 
Frederick  Hospital  one  week  afterwards.  Surgeon  H.  S.  Hewit,  U.  S.  V.,  contributed  the  pathological  specimen  (Cat.  Surg. 
Sect.,  1866,  p.  290,  Spec.  445),  and  reported  the  case  as  a  "partial  resection  of  the  knee  joint,  performed,  October  4th,  for  a  shot 
injury  of  the  condyles  of  the  femur,  and  followed  by  death  October  14,  1862."  The  specimen  consists  of  thirteen  minute  frag 
ments  of  dead  bone.  • 

'See  also  CULBEHTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities,  in  Trans.  Am.  filed.  Assoc.,  Philadelphia,  1876.  Supplement  to 
Vol.  XXVII,  p.  188,  Case  11. 

2  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  1865,  p.  60;  CULBEKTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities. 
Prize  Essay,  in  Trans.  Am.  Ned.  Assoc.,  1876,  p.  182,  Case  8. 

s  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  1865,  p.  59;  CULBERTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremitia. 
Prize  Essay,  in  Transact.  Am.  Med.  Assoc.,  Philadelphia,  1876.  Supplement  to  Vol.  XXVII,  p.  184,  Case  17. 


FIG.  244.— The  patella  and 
condyles  of  the  right  femur. 
Spec'.  3046. 


SECT,  iv.]  INTERMEDIARY    EXCISIONS    AT   THE    KNEE    JOINT.  393 

CASE  622. — Private  H.  Lawson,  Co.  D,  36th  Colored  Troops,1  aged  17  years,  was  accidentally  wounded  March  5,  1864, 
and  entered  Point  Lookout  Hospital  six  days  afterwards.  Surgeon  A.  Heger,  U.  S.  A.,  reported:  "He  was  admitted  with  shot 
fracture  of  the  right  knee  joint,  caused  by  a  conical  musket  ball,  which  entered  one-half  inch  inside  of  the  tuberosity  of  the  tibia 
and  emerged  at  the  middle  of  the  popliteal  space.  The  knee  joint  was  inflamed  and  suppurating;  the  patient,  suffering  from 
acute  bronchitis,  was  otherwise  in  good  constitutional  condition.  On  March  12th,  resection  of  the  knee  joint  was  performed  by 
a  longitudinal  incision  seven  inches  long  over  the  anterior  border  of  the  internal  lateial  ligament,  dividing  the  capsule  and  crucial 
ligament,  and  removing  the  fractured  portions  of  the  tibia  and  the  articular  cartilages.  All  the  cartilaginous  covering  of  the 
femur  and  the  tibia  was  removed  with  a  scraper;  the  nynovial  membrane  was  destroyed  by  iodine;  no  arteries  ligated;  wound 
closed  by  sutures  of  iron  wire.  The  ansesthetic,  consisting  of  chloroform,  acted  well  for  forty-five  minutes.  After  the  operation, 
which  was  performed  by  Acting  Assistant  Surgeon  T.  Liebold,  the  limb  was  placed  at  once  in  a  plaster  of  Paris  splint,  enclosing 
the  whole  extremity.  The  next  day  an  opening  was  cut  over  the  wound  so  as  to  permit  its  being  syringed  with  tepid  water  four 
times  a  day.  Solution  of  permanganate  of  salts  was  also  applied,  and  oakum  was  used  to  absorb  the  discharge.  For  the  bron 
chial  affection  wine  of  antimony  and  infusion  of  ipecacuanha  was  prescribed.  The  patient  died  during  a  paroxysm  of  cough 
ing,  March  24,  1864.  The  post-mortem  examination  exhibited  extensive  inflammation  of  the  bronchii,  the  smallest  ramification 
being  filled  with  pus ;  other  organs  healthy.  The  parts  operated  on  looked  well.  Good  pus  was  found  in  the  bursa  mucosa 
quadriceps." 

CASE  623. — Private  J.  Miller,  Co.  A,  3d  Pennsylvania  Cavalry,2  aged  38  years,  was  wounded  at  Mine  Run,  November 
27,  1863,  by  a  conical  ball,  which  entered  the  right  knee  above  and  internal  to  the  patella  and  emerged  below  and  external  to 
that  bone.  The  missile  fractured  the  patella,  denuded  the  external  condyle  of  the  femur  of  a  portion  of  its  articulating  surface, 
and  fractured  the  outer  articulating  surface  of  the  tibia.  The  wounded  man  was  admitted  to  the  Third  Division  Hospital, 
Alexandria,  December  5th,  considerably  prostrated  and  the  parts  being  tumefied.  Two  days  after  admission  chloroform  was 
administered  and  resection  was  performed  by  Surgeon  E.  Bentley,  U.  S.  V.,  who  removed  the  patella  and  half  an  inch  of  the 
articulating  surfaces  of  the  femur  and  tibia.  The  subsequent  treatment  consisted  of  simple  dressings,  tonics,  stimulants,  and 
nourishing  diet.  There  was  profuse  suppuration.  The  patient  progressed  favorably  for  one  week,  when  he  was  seized  with 
chills  accompanied  by  loss  of  appetite,  quick  and  feeble  pulse,  and  sallow  hue  of  skin.  He  died  of  pysmia  December  18,  1863. 
The  history  was  reported  by  the  operator. 

CASE  624. — Sergeant  G.  Northard,  Co.  G,  2d  Ohio  Cavalry,3  aged  23  years,  was  wounded  at  Five  Forks,  April  1,  1865. 
Surgeon  W.  W.  Bowlby,  3d  New  Jersey  Cavalry,  reported  his  admission  to  the  field  hospital  of  the  3d  division,  Cavalry  Corps, 
with  "  severe  shot  wound  of  right  knee."  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  in  charge  of  Harewood  Hospital,  Washington, 
subsequently  operated  on  the  injured  limb,  of  which  he  contributed  a  photograph  (Contr.  Photo's,  S.  G.  O.,  Vol.  I,  No.  41),  with 
the  following  history:  "The  patient  was  admitted  April  5th.  He  had  been  wounded  by  a  ball  entering  just  above  the  patella, 
through  which  it  passed  and  which  it  fractured  into  six  fragments.  Ranging  downward  and  outward  the  missile  fractured  the 
external  condyles  of  the  femur  and  escaped.  On  April  8th,  the  patient  was  etherized,  when  the  fractured  patella  and  a  fragment 
of  the  external  condyle  of  the  femur  were  removed.  The  constitutional  state  of  the  patient  at  the  time  of  the  operation  was  very 
good.  After  the  operation  the  limb  was  placed  in  a  box  containing  bran  and  the  patient  was  put  on  low  diet.  Subsequently  the 
limb  was  placed  upon  a  light  open  splint,  extending  from  the  tuberosity  of  the  ischium  to  a  point  near  the  heel,  and  suspended 
by  a  cord.  The  patient  was  put  on  nutritious  diet,  with  wine  and  porter.  On  April  13th,  he  was  transferred  to  a  tent  ward. 
Up  to  this  time  he  had  suffered  considerable  pain  in  the  joint  and  was  very  restless  and  irritable.  His  appetite  now  became  poor, 
and  hiccough  and  vomiting  set  in.  Suppuration  was  profuse.  The  patient  died  April  22.  1865,  from  exhaustion." 

CASE  625. — Private  J.  Noble,  Co.  D,  30th  Ohio,  was  wounded  at  South  Mountain,  September  14,  1862,  and  admitted  to 
hospital  No.  5,  Frederick,  four  days  afterwards.  Surgeon  H.  S.  Hewit,  U.  S.  V.,  recorded:  "'Comminuted  fracture  of  right 
knee  by  minie  ball.  Excision  of  a  large  portion  of  knee  joint  on  September  30th.  Death  on  October  5,  1862." 

CASE  626. — Private  D.  F.  Eogers,  Co.  I,  49th  Georgia,4  aged  34  years,  was  wounded  at  Petersburg,  April  2,  1865,  by  a 
muskot  ball,  which  struck  the  right  knee  joint  anteriorly,  passed  through  the  patella,  comminuting  it  completely,  and  the  outer 
condyle,  and  made  its  exit  at  the  outer  posterior  aspect.  He  was  admitted  to  the  general  hospital 
at  Fort  Monroe,  April  13th.  Surgeon  D.  G.  Rush,  101st  Pennsylvania,  who  operated  in  the  case 
after  applying  an  ansesthetic  composed  of  chloroform  and  ether,  reported  as  follows:  "My  attention 
was  called  to  the  case  on  April  18th,  when  the  patient  was  suffering  from  great  pain,  and  the  knee, 
leg,  and  thigh  were  extremely  swollen.  A  dense  fibrous  involucrum  of  the  joint  closed  the  track 
of  the  ball,  thus  preventing  the  escape  of  pus.  I  at  first  decided  to  lay  the  joint  freely  open  and  to 
remove  the  patella  only,  but  discovering  the  disorganized  and  injured  state  of  the  condyles,  they 
were  also  removed,  with  little  hope  of  saving  the  patient,  however,  the  operation  being  performed  at  PIO.M45.— Bones  of  right  knee 

£XCIS6<1        OD€C.  421^;. 

too  late  a  period.     A  piece  of  catheter  was  fixed  in  the  joint  to  drain  it.     Cold-water  dressings  were 

applied.  The  patient  rallied  perfectly  and  lived  comfortably  for  six  days.  He  died  of  exhaustion  the  eighth  day.  He  could 
not  have  survived  amputation  twenty-four  hours.  I  think  this  operation  could  be  performed  with  success  primarily  in  cases  in 
which  the  patella  and  condyles  alone  are  involved."  The  excised  bones  were  contributed  to  the  Museum  by  the  operator,  and 
are  represented  in  the  cut  (FiG.  245). 


1  CULBKIITSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities.     Prize  Essay,  in  Trans.  Am.  Med.  Assoc.,  Philadelphia,  1876.     Supplement 
to  Vol.  XXVII,  p.  190,  Case  17. 

2  See  CULBERTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities.     Prize  Essay,  in  Trans.  Am.  Med.  Assoc.,  Philadelphia,  1876.     Supple 
ment  to  Vol.  XXVII,  p.  184  ;   Circular  No.  6,  War  Department,  S.  G.  O..  Washington,  1865,  p.  59. 

3CULliEinsON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities.    Prize  Essay,  in  Trans.  Am.  Med.  Assoc.,  Philadelphia,  1876.     Supplement 
to  Vol.  XXVII.  p.  186,  Case  29. 

*  See  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  1865,  p.  60 ;  CULBEKTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities. 
Prize  Essay,  in  Trans.  Am.  Herl.  Assoc.,  Philadelphia,  1876.     Supplement  to  Vol.  XXVII.  p.  186,  Case  30. 
SURG.  Ill— 50 


394 


INJURIES    OF    THE    LOWER   EXTREMITIES. 


[CHAP.  X. 


FlO.  246.-Right  femur, 
tibia,  and  fibula,  after 
excis'n  of  joiut  surfaces. 
Spec.  1909. 


CASE  627. — Corporal  J.  Sims,  Co.  B,  4th  Ohio,1  aged  23  years,  was  wounded  at  Mine  Run,  November  27,  1863,  by  a 
conoidal  ball,  which  entered  the  right  knee  joint  just  below  the  patella,  on  the  inner  and  anterior  aspect,  fracturing  the  inner  con- 
dyleand  opening  the  joint,  passed  downward  and  forward,  and  was  extracted  about  four  inches  from  point  of  entrance.  He  was 
admitted  to  the  Third  Division  Hospital,  Alexandria,  December  5th.  "At  the  time  of  admission  the  joint 
and  thigh  were  very  much  inflamed  and  discharging  pus  copiously,  and  the  man  was  much  prostrated  and 
terribly  anxious  as  to  the  result  of  the  wound.  But  after  being  washed  and  fed  and  otherwise  cared  for, 
he  appeared  much  recruited.  On  the  8th  of  December  the  operation  of  excision  of  the  knee  joint  was 
performed  by  Surgeon  E.  Bentley,  U.  S.  V.,  who  removed  one  inch  of  the  femur  and  about  one  and  a  half 
inches  of  the  tibia  and  fibula.  The  haemorrhage  was  slight,  but  the  condition  of  the  tissues  was  not  very 
satisfactory.  The  patient  endured  the  operation  well  under  the  influence  of  chloroform,  and  reacted  well. 
On  the  following  day  he  complained  of  severe  pain  over  the  lung  on  the  right  side  of  the  chest,  which 
continued  for  several  days.  On  the  10th,  he  had  a  severe  chill  at  night,  which  was  followed  by  two,  more 
severe,  on  the  llth.  Stimulants  were  freely  given  with  raw  eggs  well  beaten  up,  and  beef  essence  for  diet. 
He  continued  to  have  chills  till  the  night  of  the  13th,  when  he  was  seized  with  a  very  severe  one,  from 
which  he  never  rallied.  He  died  on  the  morning  of  December  14,  1863.  The  post-mortem  examination 
showed  no  attempt  at  repair,  there  being  considerable  sloughing,  while  on  the  inside  of  the  thigh  there 
were  numerous  small  abscesses.  The  heart  and  left  lung  were  healthy,  but  the  right  lung  was  infiltrated 
with  pus,  and  a  single  large  abscess  appeared  upon  the  surface  of  the  inferior  lobe.  There  was  no  pus 
nor  abscess  found  in  the  liver,  but  it  was  very  much  softened."  The  history,  with  the  post-mortem  speci 
men,  represented  in  the  cut  (FlG.  246),  was  contributed  to  the  Museum  by  the  operator.  Surgeon  J.  B. 
Briuton,  U.  S.  V.,  who  examined  the  limb  two  days  after  the  patient's  decease,  found  "the  whole  joint  one 
suppurating  mass;  pus  extending  up  and  down,  far  down  under  the  gastrocnemius  and  up  between  the  muscles  on  the  inside 
of  the  thigh  ;  a  long  abscess  in  the  sheath  of  the  vessels,  extending  up  to  the  middle  of  the  thigh;  small  clot  in  femoral  artery, 
thin  and  three  inches  long;  none  in  femoral  vein;  surrounding  tissues  of  vessels  hardened  in  some  places  where  pus  had  not 
readied;  long  membrane  of  femoral  vein  of  dirty  gray  color  and  softened;  clot  in  saphena  vein." 

CASK  628. — Corporal  I.  Wells,  Co.  A,  33d  Wisconsin,2  aged  42  years,  was  wounded  at  Tupelo,  July  15,  1864,  and 
admitted  to  Adams's  Hospital,  Memphis,  five  days  afterwards.  Assistant  Surgeon  J.  M.  Study,  U.  S.  V.,  reported:  "Shot 
wound  of  left  knee  by  a  conical  ball,  fracturing  the  patella  and  opening  the  joint;  missile  emerged  over  internal  condyle.  On 
July  21st,  the  inner  third  of  the  patella  was  removed  through  a  vertical  incision  by  Acting  Assistant  Surgeon  K.  W.  Coale. 
The  constitutional  condition  of  the  patient  at  the  time  of  the  operation  was  good.  Cold-water  dressings  were  applied  to  the 
parts,  and  stimulants,  with  beef  juice,  was  given  freely.  The  patient  appeared  to  improve  up  to  July  26th,  after  which  date  he 
commenced  to  decline.  Pyaemia  developed  on  July  29th,  and  from  that  time  he  continued  in  a  comatose  condition.  Death 
resulted  on  August  2,  1864." 

Secondary  Excisions  at  the  Knee  Joint. — Seven  examples  of  secondary  excision  at 
the  knee  joint  are  recorded;  four  were  successful  and  three  fatal,  a  rate  of  mortality -of 
42.8  per  cent.  The  patients  were  all  Union  soldiers. 

Examples  of  Recovery  after  Secondary  Excision  at  the  Knee  Joint. — Of  the  four 
patients  of  this  group,  two  were  pensioners  in  1880;  one  has  never  applied  for  a  pension, 
and  one  died  two  years  and  a  half  after  the  operation : 

CASE  629. — Private  E.  Jewell,  Co.  I,  8th  New  Jersey,  aged  19  years,  was  wounded  at  Williamsburg,  May  5,  1862,  a 
musket  ball  fracturing  both  bones  of  the  right  leg  near  their  articulation  at  the  knee.  He  was  sent  to  Hygeia  Hospital,  Fort 
Monroe,  and  thence  in  the  following  month  to  Philadelphia,  where  he  entered  Fifth  Street  Hospital  on  June  8th.  Acting  Assist 
ant  Surgeon  A.  C.  Bournonville,  in  charge  of  the  latter,  reported  that  "the  leg  was  bent  at  a  right  angle  with  the  thigh  and  had 
been  in  that  position  since  the  injury.  Caries  had  taken  place,  and  an  excision  of  the  head  of  the  fibula  and  partial  resection  of 
the  head  of  the  tibia  was  performed.  The  patient  is  now  (November  6th)  doing  well,  and  has  been  able  to  rise  and  walk  about 
the  ward  with  the  aid  of  crutches."  The  patient  was  subsequently  transferred  to  Haddington  Hospital,  and  was  discharged 
February  23,  1863,  and  pensioned.  Pension  Examiner  A.  W.  Woodhull,  of  Newark,  October  24,  1868,  described  the  injury: 
"A  conoidal  ball  fractured  both  bones  of  the  right  leg  just  below  the  knee  joint.  Large  portions  of  bone  have  been  lost  either 
by  operation  or  nature.  The  bones  are  now  extensively  necrosed  and  enlarged,  and  there  are  two  large  sinuses,  which  always 
suppurate.  The  leg  is  shortened  four  or  five  inches,"  etc.  The  Newark  Board  reported,  in  September,  1875,  that  the  limb  is 
greatly  atrophied  and  deformed.  Two  years  later  the  same  board  reported  "contraction  of  muscles  of  calf,  producing  talipes 
equinus;  anchylosis  of  ankle  and  partial  of  knee.  Wound  open."  The  pensioner  was  paid  March  4,  1880. 

CASE  630. — Private  J.  E.  Berry,  Co.  B,  5th  Missouri  State  Miiitia,  aged  22  years,  was  wounded  by  guerrillas  in  Carroll 
County,  Missouri,  December  1,  1862,  a  musket  ball  fracturing  the  external  condyle  of  the  femur  and  lodging  in  the  knee  joint. 
Acting  Assistant  Surgeon  J.  Thorne,  who  described  the  injury,  reported  that  the  wounded  man  was  successfully  treated  in  hos 
pital  at  Kansas  City  for  pyaemia,  the  systemic  infection  of  which  had  appeared  prior  to  the  patient's  admission,  and  was  attended 
with  formation  of  pus  in  the  knee  joint.  In  addition,  Dr.  Thorne  also  reported  that  the  operation  of  removing  the  external  con 
dyle  of  the  femur,  together  with  the  bullet,  was  performed  on  May  10,  1863,  the  missile  being  found  embedded  in  the  articulation. 

'See  Circular  No.  C,  War  Department,  S.  G.  O.,  Washington,  1865,  p.  59;  CULHEKTSOX  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities. 
Prize  Essay,  in  Trans.  Am.  Med.  Assoc.,  Philadelphia,  1876.  Supplement  to  Vol.  XXVII,  p.  184,  Case  13. 

2 See  CULHEUTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities.  Prize  Essay,  in  Trans.  Am.  Med.  Assoc.,  Philadelphia,  1876.  Supple 
ment  to  Vol.  XXVII,  p.  190,  Case  15;  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  1865,  p.  60. 


SECT.  I  V.I 


SECONDARY    EXCISIONS    AT   THE    KNEE    JOINT. 


395 


The  records  of  the  hospital  do  not  show  the  exact  dates  of  admission  or  disposition  of  the  patient.  Adjutant  General  S.  P. 
Simpson,  of  Missouri,  communicated  that  Berry  was  mustered  out  of  service  June  22,  1863.  There  is  no  record  of  his  ever 
having  applied  for  pension. 

CASE  631. — Private  J.  Friel,  Co.  F,  2d  Kentucky,  aged  29  years,  was  wounded  in  the  right  knee  joint,  at  Chickamanga, 
September  19,  1863.  Dr.  G.  E.  Fuller,  of  Brooklyn,  late  Surgeon  U.  S.  V.,  reported  the  following  history :  "The  wound 
was  caused  by  a  musket  ball,  which  entered  just  over  the  external  condyle  of  the  femur,  passed  obliquely  downward  and 
inward,  and  emerged  at  the  junction  of  the  middle  and  lower  thirds  of  the  tibia.  He  was  in  the  hands  of  the  rebels  for  eleven 
days,  and  was  then  taken  to  hospital  No.  3,  at  Chattanooga.  On  January  18,  1864,  he  was  transferred  to  hospital  No.  8,  at 
Nashville,  where  he  first  came  under  my  observation.  At  this  time  the  leg  was  flexed  upon  the  thigh  at  something  less  than 
a  right  angle.  Anchylosis  of  the  knee  joint  had  taken  place  and  the  patella  was  firmly  attached  to  the  condyles  of  the  femur. 
Both  the  original  wounds  were  healed,  but  there  was  still  some  purulent  dis 
charge  from  an  abscess  about  four  inches  below  the  knee  joint.  Under  a 
general  tonic  treatment  he  rapidly  improved  in  strength  and  flesh,  the  abscess 
healed,  and  he  was  about  the  ward  on  crutches,  being  anxious  to  be  discharge'd. 
On  March  19th,  he  was  transferred  with  other  convalescents,  and  I  lost  sight 
of  him.  I  had  no  reason  to  doubt  the  entire  recovery  of  this  patient,  after  a 
fracture  of  the  femur  and  also  a  wound  of  the  knee  joint.  The  external  treat 
ment  consisted  of  cold-water  dressings."  Surgeon  G.  F.  French,  U.  S.  V., 
under  whose  notice  the  patient  came  before  his  transfer,  in  a  communication 
citing  instances  of  successful  conservatively  treated  cases  of  shot  fractures  of 
the  knee  joint,  corroborated  Dr.  Fuller's  description  of  the  wound  and  its 
results,  and  added  that  the  missile  in  its  course  "fractured  the  head  of  the 
tibia  into  the  joint."  The  patient  subsequently  entered  Jeffersonville  Hospital, 
and  lastly  Main  Street  Hospital,  Covington,  where  he  was  mustered  out,  by 
expiration  of  service,  January  26,  1865,  and  pensioned.  About  twenty  months 
afterwards  the  pensioner,  with  his  injured  knee  joint  in  a  diseased  condition, 
entered  the  Good  Samaritan  Hospital,  at  Cincinnati.  Dr.  G.  W.  Haile,1  the 
resident  physician,  reported:  "The  patient,  being  in  an  anaemic  condition  on 
admission,  was  ordered  iron  and  generous  diet,  under  which  his  health  soon 
began  to  improve.  On  October  15,  1866,  Professor  G.  C.  Blackman  operated 
for  the  removal  of  the  dead  bones,  which  could  be  readily  felt  with  the  probe. 
A  crucial  incision  was  made  along  the  outer  aspect  of  the  joint,  when  some 
detached  fragments  of  bone  were  found  and  removed,  as  was  also  the  outer  por 
tion  of  the  head  of  the  tibia,  which  was  in  a  carious  condition.  The  wound 
healed  very  kindly,  and  the  parts  seemed  for  a  while  to  be  in  a  healthy  condi 
tion  ;  but  in  the  course  of  a  month  from  this  operation  the  patient  suffered  at  times 
violent  pains  in  the  part,  and,  on  the  20th  of  November,  a  large  collection  of 
pus  had  formed  in  the  joint,  nearly  a  pint,  mingled  with  fragments  of  necrosed 
bone,  having  been  discharged  during  the  twenty-four  hours.  His  health  began 
again  to  fail,  but  under  the  influence  of  tonics  and  a  generous  diet  it  was  so 


FIG.  247. — Appearance  of  right  knee  after  excision  of 
the  patella  and  the  articular  ends  of  the  femur  and  tibia. 
[From  a  photograph. 1 


far  improved  on  the  14th  of  December,  that  Professor  Blackman,  in  the  presence  of  the  class  of  the  Medical  College  of  Ohio, 
exsected  the  joint.  An  incision,  resembling  the  letter  H,  was  made  on  the  anterior  aspect  of  the  joint,  exposing  the  articular 
surfaces  of  the  tibia  and  femur.  With  the  ordinary  amputating  saw  an  inch  and  a  half  of  the  condyles  of  the  femur,  in  a 
softened  and  carious  condition,  was  removed,  together  with  about  one  inch  of  the  head  of  the  tibia.  The  bone-gouge  forceps 
were  then  employed  to  take  away  every  suspicious  looking  portion  and  to  round  off  the  posterior  margins  of  the  divided 
surfaces,  so  as  to  render  the  popliteal  vessels  less  liable  to  injury.  The  patella  was  removed.  As  the  leg  had  been  for  a  long 
time  somewhat  flexed  upon  the  thigh,  it  was  necessary  to  resort  to  considerable  and  prolonged  force  to  overcome  this  contraction. 
At  length  the  ends  were  found  to  be  in  apposition,  and  more  of  the  soft  parts  included,  when  the  flaps  were  brought  together, 
and  the  limb  was  placed  in  a  neat  and  carefully  padded  fracture  box.  During  the  operation  the  loss  of  blood  was  trifling;  but 
shortly  after  the  patient  had  been  removed  to  his  bed  considerable  haemorrhage  occurred.  It  appeared  to  come  from  no  partic 
ular  vessel,  but  there  was  a  general  oozing  from  the  cut  surfaces,  which  lasted  several  hours.  The  dressings  were  not  disturbed 
for  four  days,  the  blood  being  wiped  away  as  far  as  practicable,  with  a  sponge,  while  *the  odor  of  that  which  could  not  be 
removed  without  disturbing  the  parts  was  corrected  by  disinfectants.  Cold  applications  were  applied  over  the  joint;  but  little 
irritation  followed,  and  the  transverse  incision  healed  by  primary  adhesion.  A  little  pus  was  discharged  for  several  days  through 
the  lateral  incisions,  after  which  it  became  very  slight,  and  on  the  twenty-first  day  the  entire  wound  seemed  to  have  almost 
perfectly  united.  On  the  eighteenth  day  after  the  operation  there  was  secondary  haemorrhage  from  a  small  superficial  vessel 
and  about  ten  or  twelve  ounces  of  blood  were  lost  before  it  was  discovered.  It  was  readily  controlled  by  pressure.  Although 
perfect  union  between  the  tibia  and  femur  seemed  about  this  time  to  have  taken  place,  the  patient  was  ordered  to  remain  per 
fectly  quiet  until  the  end  of  the  eighth  week,  when  he  was  allowed  to  walk  on  crutches.  Just  ten  weeks  from  the  operation  he 
left  for  his  home  in  Ironton,  Ohio,  and  from  a  letter  since  received  froiw  him  he  seems  highly  pleased  with  the  result  of  the 
operation."  Examining  Surgeon  G.  K.  Taylor,  of  Cincinnati,  June  25,  1867,  certified  to  the  injury  and  that  "  the  joint  is  com 
pletely  anchylnsed,  with  the  leg  shortened  several  inches.  He  has  also  'talipes  equinus'  of  the  right  foot."  Examining 
Surgeon  D.  C.  Wilson,  of  Ironton,  Ohio,  at  several  subsequent  examinations,  also  described  the  leg  as  "auchylosed  in  a  straight 

1  HAILE  (G.  W.),  Good  Samaritan  Hospital,  Surgical  Clinic,  by  Prof.  BLACKMAN.     Exsection  of  the  Knee  Joint  for  Gunshot  Injury,  in  Cincinnati 
Journal  of  Medicine,  1867,  Vol.  II,  p.  157. 


396 


INJURIES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


position,  with  four  inches  shortening."  Examiner  C.  K.  Crennit,  of  Jackson,  Ohio,  on  April  29,  1879,  reported  the  "muscles 
below  the  wound  considerably  atrophied,  but  sufficient  to  bear  the  weight  of  the  body."  The  pensioner  was  paid  December  4, 
1879.  The  wood-cut  (FiG.  247)  is  a  representation  of  a  photograph  contributed  by  the  operator. 

CASE  632. — Private  S.  Miller,  Co.  L,  1st  Missouri  State  Militia  Cavalry,1  aged  27  years,  was  accidentally  shot  in  the 
right  knee,  by  the  discharge  of  his  pistol,  near  Independence,  December  28,  18G2.  The  ball  passed  through  the  outer  condyle 
of  the  femur,  going  obliquely  through  the  patella  and  lodging  in  the  head  of  the  tibia.  Three  months  after  the  injury  the 
wounded  man  entered  the  Kansas  City  Hospital,  where,  on  April  7, 1863,  Acting  Assistant  Surgeon  J.  Thorne  performed  excision 
of  the  outer  condyle  of  the  femur,  with  part  of  the  shaft,  removing,  by  an  oblique  section,  two  and  a  half  inches  of  the  f<;mur, 
together  with  the  patella  and  the  articulating  surface  of  the  tibia.  No  anaesthetic  was  used.  At  the  time  of  the  operation  the 
leg  had  become  extensively  inflamed,  the  wound  was  found  full  of  shattered  bone,  and  an  extraordinary  amount  of  pus  was 
corning  out  of  the  joint.  Metastatic  abscesses  had  appeai'ed  in  the  popliteal  space.  The  patient  had  been  suffering  from  severe 
pain  and  was  almost  insensible ;  pulse  120  and  feeble.  He  had  also  severe  diarrhoea  and  was  much  emaciated,  his  skin  being  dark 
and  dry  almost  like  parchment.  The  patient  sank  after  the  operation,  but  on  the  next  day  he  revived  and  continued  to  do  well. 
London  porter  was  given  as  tonic.  Complete  union  took  place  and  complete  anchylosis  resulted,  with  the  limb  bent  about  ten 
degrees,  so  as  to  be  almost  as  good  as  ever  in  walking.  The  details  of  the  case  were  reported  by  the  operator.  The  patient  was 
discharged  from  service  December  7,  1863,  and  pensioned.  He  died  August  15,  1865.  Dr.  F.  A.  Simmons,  of  Rochestei1,  Mis 
souri,  certified  that  he  attended  the  pensioner  from  the  time  he  returned  to  his  home,  and  found  that  the  injury  had  produced 
extensive  suppuration,  involving  the  leg  and  the  thigh;  also  that  he  was  very  much  emaciated,  and  that  metastatic  or  pyaemic 
abscesses  appeared  in  various  parts  of  his  body,  which  caused  his  death. 

Fatal  Cases  of  Secondary  Excision  at  the  Knee  Joint. — Three  instances  are  recorded. 
In  one  the  entire  knee  joint  was  excised;  in  the  second  case  the  patella  was  removed;  and 
in  the  third  case  the  heads  of  the  tibia  and  fibula  were  resected: 

CASE  633. — Private  G.  Lewis,  Co.  B,  19th  Indiana,2  aged  22  years,  was  wounded  at  Gettysburg,  July  1,  1863.  He 
remained  for  two  months  at  the  First  Corps  field  hospital,  was  then  admitted  to  Camp  Letterman,  and  subsequently  transferred 
to  Baltimore,  where  he  entered  McKim's  Mansion  and  afterwards  Jarvis  Hospital.  Assistant  Surgeon 
D.  C.  Peters,  U.  S.  A.,  in  charge  of  the  latter,  reported:  "The  patient  was  admitted  November  17th, 
with  a  wound  of  the  right  knee  joint  by  a  round  musket  ball,,  which  lodged  in  the  inner  coudyle. 
The  position  of  the  missile  was  detected  by  the  N61aton  probe.  Two  weeks  after  the  date  of  admis 
sion  the  wounded  joint  was  in  a  state  of  disorganization  and  pouring  oft'  a  large  quantity  of  highly 
offensive  pus,  and  the  entire  knee  joint  was  excised  by  Acting  Assistant  Surgeon  F.  Hinkle,  the 
patient  having  protested  against  amputation.  Ether  was  used  and  an  H-incision  employed;  wire 
sutures  were  applied  to  draw  the  sawn  bones  together.  At  the  time  of  the  operation  the  patient  was 
feverish  and  unable  to  sleep  from  pain  in  the  wound;  pulse  100;  skin  dry;  secretions  scanty;  appetite 
wanting.  On  the  twelfth  day  he  was  seized  with  a  violent  chill,  which  lasted  two  hours  and  recurred 
every  other  day.  Death  resulted  from  pyaemia  on  December  23,  1863.  At  the  autopsy  both  lungs 
were  found  filled  with  pus,  the  right  being  covered  with  abscesses.  Six  ounces  of  pus  was  also  dis 
covered  in  the  left  pleural  cavity  and  four  ounces  of  fluid  in  the  pericardium.  The  wounded  parts  were  healed  externally  and 
the  bones  in  apposition ;  but  no  signs  of  union  were  manifest."  The  excised  bone,  embracing  five-eighths  of  an  inch  of  the  upper 
extremity  of  the  tibia  and  nearly  two  inches  of  the  lower  portion  of  the  femur,  with  the  bullet  remaining  lodged  in  the  inner 
condyle,  was  contributed  to  the  Museum  by  the  operator,  and  is  represented  in  the  annexed  cut  (FiG.  248). 

CASE  634. — Private  D.  Sexton,  Co.  H,  llth  Massachusetts,  aged  18  years, 
was  wounded  at  Bull  Run,  August  29,  1862.  Surgeon  D.  P.  Smith,  U.  S.  V., 
recorded  his  admission  to  Fairfax  Seminary  Hospital,  September  9th,  with  "shot 
wound  of  left  knee  joint,"  and  reported  that  secondary  resection  of  the  patella  was 
performed,  also  that  the  patient  died  November  6,  1862,  from  the  effects  of  his  wound 
and  "exsection  of  the  patella."  The  wood-cuts  are  representations  of  two  post 
mortem  specimens,  contributed  by  Surgeon  Smith,  one  of  which  (FiG.  249)  consists 
of  a  dried  ligamentous  preparation  of  the  bones  of  the  knee,  presenting  the  appear 
ance  of  inflammation  having  been  followed  by  anchylosis;  the  other  (FiG.  250) 
comprises  the  soft  structures  of  the  knee,  and  shows  an  H-shaped  cicatrix,  the 
horizontal  portion  being  four  inches  and  the  upright  three  inches  in  length.  The 
integument  appears  to  have  sloughed  over  a  large  portion  of  the  front  of  the  knee 
and  to  have  cicatrized  imperfectly,  while  on  the  lateral  and  posterior  portions  there 
are  marks  of  several  abscesses. 

CASE  635. — Dr.  H.  Culbertson  tabulates3  a  secondary  operation,  performed 
by  Surgeon  J.  T.  Hodgen,  U.  S.  V.,  at  the  City  Hospital,  St.  Louis,  Missouri,  in 
the  fall  of  1862,  on  a  United  States  soldier,  for  a  transverse  shot  wound  of  the  head 
of  the  tibia,  in  which  a  U-incision  was  employed,  and  one  inch  of  the  head  of  the 
tibia  and  the  tip  of  the  fibula  was  removed,  resulting  fatally  in  three  days. 

1  Circular  No.  6,  S.  O.  O.,  1865,  p.  60. 

2  See  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  1865,  p.  59;  CULBEUTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities, 
in  Trans.  Am.  Med.  Assoc.,  Philadelphia,  1876.    Prize  Essay.     Supplement  to  Vol.  XXVII,  p.  182. 

3  CULBERTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities.     Prize  Essay,  in  Trans.  Am.  Med.  Assoc.,  Philadelphia,  1876.     Supplement 
to  Vol.  XXVII,  p.  188,  Case  9. 


Fir:.  248.  —  Extremities  of 
the  right  femur  and  tibia;  the 
missile  rests  in  the  inner  con 
dyle.  Spec.  1956. 


\ 


FiG.  249  —  Bones  of 
left  knee  after  excision 
ofthepatella.  Spec. 556. 


FIG.  250.-Soft  structures 
of  the  knee  after  excision 
of  the  patella.  Spec.  607. 


SECT.  IV.]  AMPUTATIONS    AT    THE    KNEE    JOINT.  397 

Excisions  at  the  Knee  Joint  of  Uncertain  Date. — Five  cases  belong  to  this  group; 
one  proved  successful,  three  were  fatal,  and  the  result  in  one  is  undetermined.  The  meagre 
details  of  these  cases  are  of  little  value  for  statistical  purposes: 

CASE  636. — Sergeant  L.  E.  McWhorten,  Co.  C,  60th  Georgia,  appears  recorded  on  the  Confederate  register  of  Jackson 
Hospital,  Richmond,  as  having  undergone  "excision  of  knee  joint"  for  gunshot  wound  received  August  28,  1862,  and  as  having 
been  "furloughed  September  24,  1864." 

CASE  637. — Private  E.  Bigman,  Co.  D,  26th  South  Carolina,  appears  recorded  on  the  Petersburg  Confederate  general 
hospital  as  having  been  admitted  August  6,  1864,  with  "resection  of  the  patella  and  partial  resection  of  the  knee  joint,"  per 
formed  by  reason  of  "gunshot  wound,"  and  as  having  "died  August  23,  1864." 

CASE  638.— Lieutenant  /.  M.  Dickens,  Co.  C,  44th  Tennessee,  aged  30  years,  appears  recorded  on  the  register  of  Con 
federate  hospital  No.  4,  Richmond,  as  having  received  a  "shell  wound  of  both  patellas  and  of  the  left  little  finger,"  for  which 
"ablation  of  the  left  patella  and  amputation  of  the  injured  finger  was  performed  May  20,  1864."  His  entrance  into  the  hospital 
was  dated  two  days  after  the  operation,  and  his  death,  preceded  by  febrile  excitement,  was  noted  June  5,  1864. 

CASE  639. — Private  S.  Lininger,  Co.  H,  74th  Indiana,  aged  32  years,  was  wounded  at  Chickamauga,  September  19,  1863. 
He  was  admitted  to  the  general  field  hospital  near  Chattanooga  (date  not  recorded),  where  Surgeon  J.  A.  Stillwell,  22d  Indiana, 
noted  the  following:  "Shot  wound  of  right  knee  joint;  excision  of  internal  condyle  of  femur.  Thigh  amputated  at  junction  of 
middle  and  lower  thirds  on  November  19th.  Stump  opened  and  dressed  November  23d.  Milk  punch  given  freely.  November 
26th,  stump  granulating  some;  resin  cerate  applied  and  stump  bandaged  as  tight  as  it  would  bear.  On  November  30th,  the 
sutures  all  sloughed  out;  granulations  poor.  December  6th,  patient  transferred."  Surgeon  L.  D.  Waterman,  39th  Indiana, 
reported  that  the  patient  was  admitted  to  the  general  hospital  at  Bridgeport,  and  that  he  died  on  the  following  day,  December 
7,  1863. 

CASE  640. — Private  L.  T.  Huffman,  Co.  E,  57th  North  Carolina,  appears  noted  on  the  records  of  Confederate  hospital 
No.  4,  Richmond,  as  having  been  admitted  December  15,  1862,  with  "  excision  of  knee  joint,"  performed  for  shot  wound.  The 
result  of  the  operation  was  not  recorded. 

AMPUTATIONS  AT  THE  KNEE  JOINT.— One  hundred  and  eighty-nine  exam 
ples  of  exarticulation  at  the  knee  joint1  for  shot  fractures  are  found  on  the  returns.  The 
results  of  two  cases  could  not  be  ascertained;  eighty-one  were  followed  by  recovery,  and 
one  hundred  and  six  by  death,  giving  a  mortality  of  56.6  per  cent.,  thus  exceeding  the 

1  The  operation  of  amputation  at  knee  joint,  mentioned  by  HIPPOCRATES  ( CEuvres  completes,  par  £.  LlTTRE,  Paris,  1844,  T.  IV,  p.  285)  and  GUT 
l)E  CHAULIAC  (La  Grande  Chirurgie  de  GUY  UE  CHAULIAC,  Rouen,  1615,  p.  464),  was  advocated  by  J.  GUILLEMEAU  (Les  (Euvres  de  Chirurgie,  Rouen, 
1649,  p.  710)  as  preferable,  under  certain  circumstances,  to  amputation  in  the  thigh  :  "  Vray  est  que  si  la  gangrene,  ou  fracas  d'os,  finissoit  a  la  joincture 
du  genoiiil  ou  fort  proche  d'icelle,  sans  monter  au  dessus,  comme  au  commencement  de  la  cuisse,  1'amputation  se  doit  plustost  faire  en  la  joincture  que  de 
coupper  plus  haut,  et  prineipalement  en  la  cuisse :  car  les  accidens  en  seroient  tousiours  pires,  a  raison  des  vaisseaux,  veines,  arteres  et  nerfs,  lesquels  tant 
plus  on  tire  et  montevers  le  hant,  tant  plus  sont  trouuez  gros:  joint  aussi  qu'il  conniendroit  appuyer  la  partie  cicatrisee  sur  la  jambe  artificielle,  comme  si 
on  lacouppoit  &  la  joincture."  The  statement  of  R.  B.  SABATJEU  (Mid.  Operatoire,  Paris,  1824,  T.  IV,  p.  548)  and  others  that  the  operation  had  been 
performed  by  FAISRICIUS  HILDANUS  in  1581,  is  evidently  erroneous.  The  latter  (Opera  qua  extant  omnia,  Francofurti,  1646,  p.  805)  amputated  the  hand 
at  the  wrist  joint  for  shot  injury,  in  a  young  man  of  Dusseldorf,  in  1581,  and  adds :  "  Sin  Sphacelus  poplitem  superarit,  in  ipsa  genu  articulatione  incisio 
faciendaveniet."  Cases  of  amputation  at  the  knee  joint  for  disease  are  cited  by  J.  L.  PETIT  ( (Eurres  Completes,  Paris,  1844,  p.  814),  BlUSUOR  (Essai  sur 
les  amputations  dans  les  articles,  in  Mem.  de  I'Acad.  Roy.  de  Chir.,  Paris,  1774,  T.  V,  p.  771),  and  others;  but  the  first  examples  of  this  operation  in 
military  surgery  are  mentioned  by:  MlCHAELlS  (Brief e  aus  New  York,  in  RICHTEIS'S  Chirurgische  Bibliothek,  Gottengen,  1782,  B.  VI,  p.  125),  who 
visited  the  wounded  Frenoh  in  Charleston,  left  there  by  Count  D'Estaing  after  his  unsuccessful  expedition  to  Savannah,  in  September,  1779.  He  found 
4  cases  of  amputations  at  the  knee  joint ;  all  proved  fatal.  The  surgeon  in  charge  ascribed  these  unfortunate  results  partly  to  venereal  poisoning,  partly 
to  scorbutus,  and  partly  to  the  insalubrious  air  of  Charleston.  JOBKKT  DE  LAMBALLE  (Plaies  d'armes  u  feu,  Paris.  1833,  p.  293):  A.  M.,  aged  15,  shot 
in  left  leg  July  28,  1830 ;  amputation  at  the  knee  joint  two  months  after  injury.  VELPEAU  (Nouveaux  Elements  de  Medecine  Operatoire,  Paris,  1839, 
T.  II,  p.  521)  states  that  disarticulation  of  the  leg  had  been  successfully  practised  once  since  1830,  by  M.  NlVERT,  of  Azai-le-Rideau,  on  a  man  whose  leg 
had  been  fractured  by  shot.  BAUDEXS  (L,.)  (Clinique  des  plaits  d'armes  a  feu,  Paris,  1836,  pp.  532,  536):  A  soldier,  wounded  at  Tafna,  January  26,  1836, 
in  right  knee  ;  patella  shattered ;  ball  lodged  in  condyle  of  femur ;  amputation  through  joint ;  portion  of  condyles  removed ;  recovery,  with  serviceable 
stump.  A  soldier  of  the  13th  regiment,  wounded  April  1,  1836,  at  Atlas;  fracture  of  the  head  of  the  tibia;  amputation  through  joint ;  recovery.  SEDIL- 
LOT  (G.)  (Campagne  de  Constantino  de.  1837,  Paris,  1838,  p.  266)  tabulates  3  fatal  cases  of  exarticulation  at  the  knee  for  shot  injuries.  SMITH  (STEPHEN) 
(Cases  in  Surgery— Amputation  at  the  Knee  Joint,  by  \V.  PAitKEU,  in  New  fork  Jour,  of  Med.,  1852,  Vol.  IX,  p.  318):  A  saddler,  shot  in  the  leg;  ampu 
tation  at  the  knee  joint  with  a  razor,  the  surgeon  having  no  other  instrument;  recovery  with  a  good  stump,  which  was  tender  on  pressure.  Dr.  I.  MOSES 
(T.  M.  MARKOE,  Amputation  at  the  Knee  Joint — Illustrated  by  the  Cases  which  have  occurred  in  American  practice,  and  mainly  by  those  which  have 
bf.en  treated  in  the  New  York  Hospital,  in  The  New  York  Jour,  of  Ned.,  1856,  Vol.  XVI,  p.  30)  operated  in  the  case  of  J.  Senno,  a  Mexican,  aged  26, 
who  had  received  a  shot  fracture  of  the  left  tibia  in  June,  1854;  amputation  at  the  knee  November  22,  1854;  recovery,  with  firm  stump,  in  six  weeks. 
MAZANOWSKY  (JOSEPH)  (Zur  Exarticulatinn  im  Kniegelenke,  in  LAXGEXBKCK's  ArcMv  fur  Klin.  Chir.,  1866,  B.  VII,  S.  489):  Osman  Babassy,  aged 
2">,  wounded  in  the  Crimea,  July  17,  1R54 ;  fracture  of  bones  of  both  legs;  January  30,  1855,  exarticulation  at  knee  joint  after  BAUDEXS;  recovery. 
CHEXU  (J.  C.)  (Rapport,  etc.,  pendant  la  Campagne  d'  Orient  en  1854-55-56,  Paris,  1865,  p.  416)  tabulates  67  cases  of  amputation  at  the  knee  joint ;  5  were 
successful  and  62  proved  fatal.  The  successful  cases  are :  J.  P.  Bernad,  80th  line,  shot  fracture  of  left  leg,  September  8,  1855 ;  primary  disarticulation. 
A.  A.  Boullier,  97th  line,  shot  fracture  of  right  leg,  June  7,  1855;  primary  amputation  at  the  knee.  J.  N.  Dewatine,  82d  line;  shot  comminution  of 
right  leg,  September  20,  1854,  at  the  Alma ;  amputation  on  the  same  day.  L.  A.  Roudil,  3d  Zouaves ;  shot  fracture  of  right  leg  at  Inkerman.  November 
5,  1?54;  exarticulation  at  knee.  J.  B.  Sainpy,  26th  line,  shell  fracture  of  left  leg,  September  8,  1855;  primary  exarticulation.  MATTHEW  (T.  P.) 
(Med.  and  Surg.  Hist,  of  the  British  Army  in  the  years  1854-55-56,  London,  1858,  Vol.  II,  p.  368)  tabulates  7  amputations  at  the  knee  joint ;  3  were  suc 
cessful  and  4  fatal ;  the  3  successful  cases  were  all  primary;  of  the  4  fatal  cases,  3  were  primary  and  1  secondary.  CHEXU  (J.  C.)  (Stat.  Med.-Chir.  de 
la  Camp.  d'Jtalie  en  1859  el  1860,  Paris,  1869,  T.  II.  p.  775)  tabulates  4  cases  of  amputations  at  the  knee  occurring  in  the  French  army  during-  the  cam 
paign  in  Italy  in  1859-60;  1  recovered,  3  died.  The  instance  of  recovery  is  detailed:  L.  Dumas,  37th  line,  comminuted  fracture  of  upper  third  of  left 
leg,  Solierino,  June  24,  185!);  amputation  at  the  knee  December  19,  1859;  recovery,  with  good  stump,  February  25,  1860.  The  same  author  states  that 


398 


INJURIES   OF    THE    LOWER   EXTREMITIES. 


[CHAP.  X. 


fatality  of  amputations  in  the  continuity  of  the  femur  by  2.8  per  cent.  One  hundred  and 
eight  were  primary  operations,  fifty-one  intermediary,  and  twenty-six  secondary,  while  in 
four  instances  the  period  of  operation  was  not  indicated: 

TABLE  LIV. 
Summary  of  One  Hundred  and  Eighty-Nine  Amputations  at  the  Knee  Joint  for  Shot  Fracture. 


OPERATIONS. 

CASES. 

RECOVERY. 

DEATH. 

UNDE 
TERMINED. 

MORTALITY  RATE 
OF  DETERMINED 
CASES. 

108 

50 

57 

] 

53.2 

51 

16 

34 

] 

08.0 

26 

14 

53.8 

4 

3 

25.0 

189 

81 

106 

2 

56.6 

Fifty-four  of  the  one  hundred  and  eighty-nine  exarticulations1  at  the  knee  were  per 
formed  for  lesions  of  the  bones  of  the  knee  joint.  In  the  remaining  one  hundred  and 
thirty-five  cases  the  original  injuries  were:  Fractures  of  one  or  both  bones  of  the  leg  in 
one  hundred  and  sixteen,  fractures  of  the  ankle  joint  in  thirteen,  and  fractures  of  the  bones 
of  the  foot  in  six  instances. 

Primary  Amputations  at  the  Knee  Joint. — Of  one  hundred  and  eight  operations  of 
this  group,  fifty  were  followed  by  recovery,  fifty-seven  by  death,  and,  in  one  instance,  the 
final  result  could  not  be  determined.  The  mortality  rate,  53.2  per  cent.,  exceeds  that  of 
the  primary  amputations  in  the  lower  third  of  the  thigh  (TABLE  XXIX,  p.  213)  4.5  per 
cent.,  and  that  of  the  primary  operations  in  the  thigh,  whether  in  the  upper,  middle,  or 
lower  thirds,  3.2  per  cent. 

Recoveries  after  Primary  Amputations  at  the  Knee  Joint. — Thirty-eight  of  the  fifty 
successful  primary  operations  were  performed  on  Union,  and  twelve  on  Confederate  soldiers. 
Thirty-seven  of  the  thirty-eight  Union  soldiers  became  pensioners,  and  six  have  since  died, 
one,  one  year;  one,  two  years;  one,  five  years;  two,  sixteen  years;  and  one,  eighteen  years 

3  amputations  at  the  knee  were  performed  on  Austrian  soldiers  ;  all  proved  fatal.  According  to  B.  BECK  (Kriegs-Chirurgische.  Erfahrungen  wa.hre.nd 
des  Feldzuges,  1866,  Freiburg,  i.  B.,  1867,  p.  340),  the  operation  was  successfully  performed  in  1866,  in  WUrzburg,  by  LlXHART.  OTIS  (G.  A.)  (A  Report 
of  Surgical  Cases  treated  in  the  Army  of  the  United  States  from  1865  to  1871,  Circular  No.  3,  War  Department,  S.  G.  O.,  Washington,  1871)  records  2 
successful  operations:  Pt.  T.  Nipple,  3d  Cavalry;  March  31, 1870,  pistol  ball  wound  of  right  kuee,  perforating  head  of  tibia;  May  3,  amputation  through 
knee  joint,  sawing  off  about  an  inch  of  the  condyles  after  the  manner  of  Mr.  GARDEN*,  of  Worcester,  by  Ass't  Surgeon  J.  D.  HALL,  U.  S.  A.;  recovered, 
with  a  well  rounded  stump.  Pt.  L.  Shire,  3d  Cavalry;  wounded  by  Apache  Indians  October  6,  1870;  ball  embedded  itself  in  internal  condyle  of  left 
femur;  October  llth,  amputation,  sawing  off  about  an  inch  of  the  condyles,  by  Ass't  Surgeon  J.  D.  HALL,  U.  S.  A.;  recovery,  with  a  good  stump. 
CHEXU  (J.  C.)  (Aperfu  Hist.  Stat.  et  Clin,  etc.,  pendant  la  guerre  de  1870-71,  Paris,  1874,  T.  I,  p.  493)  tabulates  23  amputations  at  the  knee  ;  5  were 
successful  and  18  fatal.  BECK  (B.)  (Chirurgie  der  Schussverletzungen,  1872,  p.  852):  U.  O.  L.,  43d  East  Prussian  Infantry;  shot  fracture  of  both  bones 
of  right  leg  January  15,  1871;  exartieulation  at  knee  joint  January  23,  1871;  periostitis  of  lemur;  recovery  in  6  weeks;  stump  not  well  covered. 
FISCHER  (G.)  (Dorf  Fining  und  Schloss  Versailles,  in  Deutsche  Ztitschrift  fur  Chirurgie,  3872,  B.  I,  p.  187)  tabulates  1  secondary  amputation  at  the 
knee  joint ;  the  result  is  not  stated.  GRAF  (E.)  (Die  Kimiglichen  Reserve-Lazarethe,  zu.  Diissddorf wahrend  des  Krieges,  1870-71,  Elberfeld,  1872,  p.  53): 
Martinet,  shot  fracture  of  fibula;  exarticulation  at  knee  by  BCCHXEK;  death.  LO8SEX  (II.)  (Kriegschirurgische  Erfahrungen,  in  Deutsche  Zeitschrift 
fur  Chirurgie,  1873,  B.  II,  p.  137)  mentions  a  case  of  successful  primary  exarticulation  at  the  knee.  SOCIN  (A.)  (Kriegschirurgische  Erfahrungen, 
Leipzig,  1872,  p.  153)  tabulates  3  fatal  cases  of  amputation  at  the  knee  joint,  but  gives  no  details.  Of  the  128  cases  referred  to  in  this  note  25  recovered, 
102  died,  and  the  result  in  1  case  is  undetermined ;  11  were  primary,  2  intermediary,  7  secondary,  and  108  were  operations  of  undetermined  date. 

1  To  these  189  cases  of  amputation  at  the  knee  joint  for  shot  fractures  should  be  added  6  exarticulations  for  shot  flesh  wounds,  cited  in  the  first 
section  of  this  Chapter,  on  page  56,  making  a  total  of  195  cases,  with  82  recoveries,  111  deaths,  and  2  undetermined  results.  In  an  article  by  Dr.  J.  H. 
BRIXTO.v,  On  Amputation  at  the  Knee  Joint  and  at  the  Knee,  in  The  Am.  Jour,  of  the  Med.  Sci.,  April,  1868,  Vol.  LV,  p.  311.  occurs  the  following:  "In 
a  communication  from  Surgeon  OTIS,  received  since  the  preceding  pages  were  penned,  the  following  additional  information  has,  with  the  permission  of 
the  Surgeon  General,  been  furnished  to  the  writer.  The  whole  number  of  cases  of  knee  joint  amputations  recorded  in  the  Surgeon  General's  Office  is  two 
hundred  and  eleven.  Of  these,  iiinety-six  recovered,  one  hundred  and  six  died,  one  is  still  under  treatment,  and  in  eight  the  result  is  undetermined." 
This  information  was  furnished  to  Dr.  BlUNTON  in  the  early  part  of  1868,  when  every  moment  of  the  editor's  time  was  occupied  with  the  analysis  of  the 
injuries  of  the  head,  and  when,  with  the  limited  clerical  assistance  at  his  command,  it  had  only  been  possible  to  examine  into  the  details  of  such  cases  as 
were  under  immediate  discussion.  Although  there  were  entered  on  the  records  at  that  time  211  cases  of  alleged  exarticulations  at  the  knee,  it  has  been 
ascertained  from  subsequent  careful  analysis  and  comparisons,  and  from  additional  information  gathered  from  artificial  limb  statements  and  pension 
records,  that  16  of  these  211  cases  were,  in  reality,  amputations  of  the  femur  immediately  above  the  condyles.  The  editor  exceedingly  regrets  to  have 
been  the  cause  of  this,  although  unavoidable,  erroneous  statement  in  Dr.  BUIXTON'S  excellent  paper  on  knee  joint  amputations. 


SECT.  IV.]  PRIMARY    AMPUTATIONS    AT    THE    KNEE    JOINT.  399 

after  the  exarticulation  at  the  knee.  In  one  instance,  the  case  of  Corporal  Lapham,  1st 
Vermont  Cavalry,  detailed  on  page  224,  ante,  the  opposite  thigh  was  simultaneously  removed 
at  the  middle  third;  in  six  instances  the  exarticulation  was  followed  by  amputation  in  the 
thigh,  viz:  four  in  the  lower  and  two  in  the  middle  thirds. 

CASE  G41. — Private  L.  J.  Matson,  Co.  K,  2d  Ne\v  York  Cavalry,  aged  21  years,  was  wounded  at  Petersburg,  April  1, 
1863.  T\vo  days  after  the  reception  of  the  injury  he  was  admitted  to  the  Depot  Hospital  at  City  Point,  whence  he  was  forwarded 
to  Washington.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  contributed  a  photograph  of  the  wounded  man  (Contrib.  Photo's,  S.  G.  O., 
Vol.  VIII,  p.  21),  with  the  following  history:  "The  patient  was  admitted  to  Harewood  Hospital,  April  5th,  suffering  from 
amputation  at  the  left  knee  joint,  which  was  performed  on  the  field  by  the  antero-posterior  flap  method,  for  shot  wound  of  the 
leg  involving  injury  to  the  knee  joint.  The  operator  and  the  extent  of  the  injury  were  unknown.  At  the  time  of  admission  the 
condition  of  the  stump  and  the  constitutional  state  of  the  patient  were  tolerably  good.  The  parts  subsequently  became  gangren 
ous;  but  by  timely  application  of  eschai-otics,  and  by  supporting  treatment  throughout,  the  patient  did  well  and  made  fair  progress 
in  his  recovery.  A  part  of  the  femur  was  removed  with  the  dressing  forceps."  The  patient  subsequently  passed  through  Lin 
coln  and  Armory  Square  Hospitals,  and  on  September  2,  1865,  he  was  discharged  from  service,  and  furnished  with  an  artificial 
limb  by  the  Jewett  Patent  Leg  Company.  The  pensioner  was  paid  December  4,  1879.  In  his  application  for  commutation  he 
represented  the  stump  as  being  in  a  sound  condition. 

CASK  642. — Private  R.  Kelly,1  Co.  A,  U.  S.  Engineer  Battalion,  aged  23  years,  was  wounded  in  the  left  knee  by  one  of  the 
sharpshooters  in  front  of  Petersburg,  August  18,  1864.  Assistant  Surgeon  G.  M.  McGill,  U.  S.  A.,  reported:  "The  ball  entered 
somewhat  to  the  left  of  the  median  line,  near  the  tuberosity  of  the  tibia,  passed  upward  and  backward,  and  lodged  in  the  face  of 
the  external  condyle,  partially  embedding  itself  crosswise.  On  consultation  with  Surgeon  J.  R.  Ghiselin  and  Assistant  Surgeon 
J.  R.  Gibson,  U.  S.  A.,  and  Acting  Assistant  Surgeon  B.  F.  Goodrich,  who  had  charge  of  the  case,  it  was  decided  to  amputate 
through  the  knee  joint.  I  introduced  a  scalpel  opposite  the  termination  of  the  external  condyle  and  outlined  an  anterior  flap — 
the  lowermost  part  of  which  was  two  inches  below  the  terminal  insertion  of  the  quadriceps  extensor — with  a  firm  cut  that 
divided  the  skin  and  the  superficial  fascia:  terminating  the  primary  incision  of  the  anterior  flap  opposite  a  point  of  the  internal 
condyle  corresponding  to  the  point  of  introduction  opposite  the  external  condyle.  From  this  termination  the  scalpel  was  reversed 
and  the  inner  half  of  the  posterior  flap  formed,  the  depth  of  my  incision  being  sufficient  to  insure  section  of  the  superficial  fascia 
as  well  as  the  skin  proper.  The  knife  was  then  removed  and  reinserted  near  the  original  point  of  entrance  from  which  the  outer 
half  of  the  posterior  flap  was  formed.  This  posterior  flap  was  very  long,  extending  fully  half  way  down  the  leg,  and  the  angles 
of  the  union  of  the  anterior  and  posterior  lines  of  incision  were  made  very  acute,  so  that  retraction  would  not  tend  to  separate 
the  angles  of  the  stump  by  drawing  the  sac  of  the  stump  tightly  over  the  large  extent  of  bone  substance  left.  The  anterior  flap 
was  now  raised,  and  in  raising  it  I  took  care  to  dissect  so  as  to  inflict  as  little  injury  as  possible  to  the  superficial  fascia.  The 
ligament  of  the  patella  was  incised  closely  above  the  tuberosity  of  the  tibia,  and  the  patella,  with  its  connections,  was  left 
untouched  so  far  as  practicable.  The  ligaments  remaining  were  then  divided  at  their  insertion  and  so  cut  through  that  the  semi- 
lunar  cartilages  remained  in  the  stump.  All  the  ligaments  having  been  thus  severed,  I  cleared  the  posterior  flap  with  a  large 
operating  knife,  cutting  in  the  plane  of  the  retracted  posterior  skin  flap,  outlined  as  described  above.  This  procedure  afforded 
a  base  of  flesh  to  what  was  essentially  a  skin  flap,  in  addition  to  which  I  found  that  by  the  method  adopted  the  fleshy  part  of 
the  posterior  flap  had  been  so  formed  as  to  expose  so  much  of  the  anterior  surface  of  the  deep  posterior  layer  of  crural  fascia 
that  a  fibrous  sheet  fitted  upon  the  synovial  surfaces  exposed  by  the  removal  of  the  tibia.  I  now  cut  away  all  points  and  strips 
of  cartilage  or  fibrous  tissue  accidentally  made  in  operating.  The  ball  was  elevated  from  its  bed  in  the  face  of  the  external 
condyle  and  this  bed  cleared.  Nothing  unusual  took  place  in  the  subsequent  steps  of  the  operation;  unfortunately,  however, 
the  silk  ligature  threads  used  were  rotten.  There  was  also  a  ball  hole  in  the  anterior  flap  besides  the  wound  in  the  face  of  the 
condyle  to  complicate  the  case.  The  latter  was  oozing  blood  from  its  sides  when  last  observed.  Throughout  the  operation  any 
injury  to  what  was  left  of  the  synovial  sac  was  avoided.  September  9th,  patient  is  doing  very  well;  none  of  the  ligatures  have 
yet  come  away,  and  gentle  traction  met  with  firm  resistance  this  morning.  The  patient  is  afflicted  with  pains  of  a  darting  lanci 
nating  character,  shifting  in  location.  The  wound  of  entrance  in  the  outer  border  of  the  anterior  flap  has  healed  rapidly  by 
granulation,  and  to  a  great  extent  the  flaps  have  united.  A  sinus,  the  mouth  of  which  is  to  the  right  of  the  middle  of  the 
cicatricial  line,  communicates  with  the  bed  of  the  ball;  but  so  little  discharge  takes  place  through  this  that  the  bed  is  thought  to 
be  already  filled  with  callus.  A  peculiar  ' leaden'  feeling  about  the  patella  has  been  observed  by  the  patient.  He  is  not  able  to 
move  this  bone,  but  moves  the  thigh  without  pain.  September  14th,  patient  is  doing  finely.  One  of  the  ligatures  on  the  inside, 
that  of  an  articular  artery,  has  broken  off  short.  The  popliteal  ligature  has  not  yet  separated.  September  22d,  the  patient  has 
steadily  improved.  The  tumor  of  the  stump  has  subsided  and  the  line  of  the  cicatrix  is  somewhat  depressed.  There  is  still 
discharge  from  where  the  ligature  is  broken  off,  and  it  is  probable  that  the  knot  of  this  ligature  will  remain  in  the  stump  for 
some  time.  The  main  ligature  has  not  yet  come  away ;  the  thread  being  fine  and  rotten,  I  dreaded  to  pull  it  even  gently.  The 
patella  is  now  freely  movable  up  and  down,  to  the  right  and  left.  The  capsule  of  the  joint,  as  a  whole,  has  adhered  strongly  to 
the  condyloid  surfaces  of  the  femur,  and  affords  a  sufficient  stay  to  the  connected  muscles.  On  September  27th,  the  patient  was 
sent  away  to  West  Point,  New  York.  He  was  then  able  to  walk  on  crutches,  and  I  had  only  to  regret  that  knots  of  all  the 
ligatures  remained  in  the  stump,  having  considered  it  inexpedient  to  search  for  them.  On  his  way  to  West  Point  the  patient — 
as  he  informed  me  by  letter— was  attacked  with  what  he  termed  gangrene,  rendering  some  operation  necessary,  which,  I  believe, 
was  performed  at  West  Point.  From  his  description  of  it  I  understood  that  this  operation  did  not  extend  to  interference  with 
the  bone  or  the  remains  of  the  synovial  sac."  Surgeon  J.  F.  Head,  IT.  S.  A.,  certified  to  the  patient  being  treated  in  hospital  at 
West  Point.  The  man  was  discharged  by  expiration  of  service,  January  23,  1865,  and  pensioned,  and  after  reaching  his  home 
he  was  supplied  with  an  artificial  limb  by  the  Palmer  Arm  and  Leg  Company.  The  Brooklyn  Examining  Board,  December  16, 

1  Abstracts  of  this  case  have  been  cited  by  MAUKOE  (T.  JI.),  Amputation  at  the  Knee  Joint,  in  New  York  Medical  Journal,  1868,  Vol.  VI,  p.  503, 
CASE  XXXli,  and  in  Circular  No.  3,  War  Department,  S.  G.  O.,  "\Vashington,  1871,  p.  278. 


400  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  X. 

1874,  certified  to  the  amputation,  and  to  the  patella  being  unremoved"  and  remaining  embedded  in  the  extensor  muscles  of  the 
anterior  surface  of  the  stump;  also  to  the  integuments  being  adherent  to  the  stump  and  parts  so  thin  that  an  artificial  limb  can 
be  worn  but  little  of  the  time  without  creating  inflammation.  The  pensioner  was  paid  December  4,  1879. 

CASK  643. — Private  E.  Baker,  Co.  A.  38th  Wisconsin,  aged  17  years,  was  wounded  in  the  right  leg,  before  Petersburg, 
July  17,  1864,  and  admitted  to  the  field  hospital  of  the  3d  division,  Ninth  Corps.  Surgeon  M.  K.  Hogan,  U.  S.  V.,  recorded : 
"The  ball  entered  at  the  outer  tuberosity  of  the  tibia,  ranged  inward  and  slightly  upward,  and  embedded  itself  between  the 
tuberosities.  The  synovial  membrane  was  lacerated  and  synovia  escaped.  The  leg  was  amputated  by  Surgeon  A.  F.  Whelan, 
1st  Michigan  Sharpshooters,  the  operation  being  performed  on  Butcher's  plan."  From  the  field  hospital  the  wounded  man  was 
moved  to  City  Point,  and  thence  to  Philadelphia.  Surgeon  S.  J.  W.  Mintzer,  U.  S.  V.,  reported  that  "the  patient  was  admitted 
to  South  Street  Hospital,  July  26th,  his  right  leg  having  been  amputated  on  the  field,  on  the  day  following  the  injury,  at  the 
knee  joint,  and  the  patella  removed.  When  admitted,  parts  of  the  integuments  had  sloughed  away,  leaving  the  extremity  of 
the  bone  exposed.  On  July  30th,  haemorrhage  occurred  without  much  loss  of  blood,  from  which  the  patient  rallied,  though 
much  weakened  by  diarrhoea.  A  narrow  semicircle  of  bone  was  removed,  after  which  granulations  began  to  cover  it.  There 
was  considerable  suppuration  from  the  depth  of  the  posterior  flap."  About  eight  months  afterwards  the  patient  was  supplied 
with  an  artificial  limb,  and  on  May  30,  1865,  he  was  discharged  from  service.  The  pensioner  was  paid  December  4,  1879.  In 
his  application  for  commutation  he  stated  that  the  stump  of  his  amputated  limb  remained  in  good  condition. 

Fatal  Cases  of  Primary  Amputation  at  the  Knee  Joint.  —  Fifty-seven  cases  were 
reported;  in  fifty-one  instances  the  patients  were  Union,  and  in  six  Confederate  soldiers. 
Seven  deaths  were  referred  to  pyaemia,  two  to  tetanus,  three  to  haemorrhage,  one  to  gan 
grene,  one  to  typhoid  fever,  and  seventeen  to  exhaustion.  The  average  period  between  the 
day  of  the  operation  and  the  date  of  death  was  forty-one  days. 

CASE  644. — Private  W.  Stanley,  Co.  H,  53d  Pennsylvania,  aged  26  years,  was  wounded  at  Fredericksburg,  December 
13,  1862.  He  was  admitted  to  a  Second  Corps  field  hospital,  and  thence  transferred  to  Washington.  Assistant  Surgeon  C.  C. 
Lee,  U.  S.  A.,  reported:  "The  patient  entered  Douglas  Hospital  December  26th,  having  received  a  comminuted  fracture  of  the 
upper  third  of  the  right  leg,  for  which  amputation  through  the  knee  joint  was  performed  the  following  day.  He  stated  that 
haemorrhage  was  profuse  both  before  and  since  the  amputation.  The  stump  sloughed  somewhat  and  did  badly.  On  March  1, 
1863,  when  I  took  charge  of  the  case,  the  stump  was  tightly  bandaged  from  above  downward,  the  extremities  being  swollen  and 
bulbous,  and  the  thigh  completely  honeycombed  in  appearance  by  small  abscesses  and  sinuses  for  six  inches  above  the  condyles. 
The  bandage  was  removed  and  the  sinuses  and  abscesses  laid  open.  The  patient  was  also  greatly  enfeebled  by  chronic  diarrhoea, 
from  which  he  had  suffered  for  six  months,  and  which,  though  checked  from  time  to  time,  always  returned  with  full  force.  In 
this  state  he  vacillated  from  better  to  worse  until  April  20th,  when,  without  any  ostensible  cause,  he  was  seized  with  obstinate 
nausea  and  vomiting.  This  resisted  every  means  employed  to  remedy  it  and  exhausted  what  little  strength  remained  in  the 
patient.  He  sank  steadily  until  the  night  of  April  26,  1863,  when  he  expired  of  sheer  debility.  At  the  autopsy,  the  thoracic 
viscera  were  found  healthy  with  the  exception  of  old  pleuritic  adhesions  on  the  right  side;  lungs  crepitant  throughout  and  with 
out  tubercular  deposit.  The  liver  and  kidneys  were  shrunken  and  showed  evidence  of  chronic  congestion,  but  were  otherwise 
normal;  stomach  and  spleen  healthy.  In  the  large  intestines  well-marked  congestion  was  observed  and  partial  maceration  of 
the  mucous  membrane,  which  was  here  and  there  dotted  with  dark  maculae.  These  spots  were  surrounded  by  depressions  and 
apparent  cicatrices  in  the  mucous  membranes,  and  were  thought  to  be  the  result  of  ulcers  that  had  already  cicatrized.  The 
condition  described  was  chiefly  noticed  in  the  upper  portion  of  the  rectum.  The  small  intestines  were  here  and  there  greatly 
congested,  but  no  ulceration  was  detected.  The  stump  had  healed  completely;  but  from  the  removal  of  the  patella  in  the  opera 
tion  and  the  subsequent  emaciation  of  the  patient  the  edges  of  the  condyles  were  too  superficial  to  have  borne  pressure  with 
success.  A  large  abscess,  which  had  been  very  troublesome  during  life,  existed  between  the  rectus  and  cruraeus  muscles.  The 
latter  was  wasted  to  the  last  degree,  but  seemed  to  have  protected  the  bone,  which  was  not  diseased.  A  very  complete  calca 
reous  degeneration  of  the  mesenteric  glands  should  also  have  been  noted  above."  The  lowest  portion  of  the  femur  was  saved 
and  contributed  to  the  Museum  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.  (Cat.  Sury.  Sect.,  1866,  p.  ',563,  Spec.  1240.) 

CASE  645. — Major  A.  McQ.  Corrigan.  9th  New  York  Cavalry,  aged  27  years,  was  wounded  in  the  right  leg,  at  Meadows 
Bridge,  May  12, 1864.  Surgeon  A.  P.  Clark,  6th  New  York  Cavalry,  described  the  injury  as  follows:  "At  the  time  of  receiving 
the  wound  he  was  in  command  of  a  detachment  of  his  regiment  and  at  a  considerable  distance  in  advance,  endeavoring  to  force 
the  enemy  from  his  entrenchments  on  the  other  side  of  the  bridge,  when  he  was  struck  by  a  conical  musket  ball,  which  passed 
from  the  anterior  to  the  posterior  aspect  of  the  limb,  fracturing  the  upper  extremity  of  the  tibia  and  wounding  the  anterior  tibial 
artery.  The  haemorrhage  was,  in  a  measure,  controlled  by  the  men  who  brought  the  patient  a  short  distance  to  the  rear,  where 
a  tourniquet  was  applied.  A  few  minutes  afterwards  the  enemy  was  dislodged,  when  orders  were  received  for  the  troops  to  cross 
as  speedily  as  possible,  and  the  train  was  not  allowed  to  halt  until  it  reached  Mechanicsville,  five  miles  distant,  where  Acting 
Assistant  Surgeon  C.  Rodgers,  assisted  by  another  medical  officer  and  myself,  amputated  the  leg  at  the  knee  joint,  adopting  the 
method  of  double  flaps  and  removing  the  patella  and  a  section  of  the  condyles  of  the  femur.  The  patient  was  then  placed  in  an 
ambulance  and  taken  to  Haxall's  Landing,  which  place  was  reached  on  May  15th,  and  whence  he  was  sent  by  water  to  general 
hospital."  Acting  Assistant  Surgeon  T.  Liebold  communicated  the  following  termination  of  the  case:  "The  patient  was 
admitted  to  Point  Lookout  Hospital  May  16th.  The  stump  was  much  inflamed  and  the  pus  retained  by  sutures,  which  were 
removed.  Two  days  after  his  admission,  secondary  haemorrhage  came  on  at  noontime.  Happening  to  be  near  at  the  time  I  was 
enabled  to  stop  it  immediately,  so  that  not  more  than  from  four  to  six  ounces  of  blood  was  lost.  The  stump  was  then  opened 
again  entirely  and  the  anterior  tibial  artery,  from  which  the  ligature  had  come  off,  was  religated  in  a  few  minutes  by  Surgeon  A. 
Heger,  U.  S.  A.,  in  charge  of  the  hospital.  The  patient  died  May  28, 1864,  from  exhaustion,  having  had  severe  diarrhoea  and 
profuse  discharge  of  pus  from  an  abscess  in  the  stump.  He  was  also  attacked  with  vomiting  of  bile." 


SECT.    IV.) 


PBIMARY    AMPUTATIONS    AT    THE    KNEE    JOINT. 


401 


TABLE  LV. 
Summary  of  One  Hundred  and  Eight  Canes  of  Primary  Amputation  at  the  Knee  Joint  for  Shot  Fracture. 

[Recoveries,  1-50;  Deaths,  51-107;  Result  unknown,  108.] 


DATE 

DATE 

No. 

DESCRIPTION,  AND  AGE. 

OF 

INJURV. 

NATURE  OF  INJURY. 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Baker,    E.V.,    Pt.,  A,   38th 

July  17, 

Rifle  ball  fracture  of  bones  of 

July  18, 

Flap  ;  remov'g  patella  ;  Butch 

July  30th,  hsem.     Semicircle  of 

Wisconsin,  age  17. 

1864. 

right  leg,  involving  knee. 

1864. 

er's  operation,  by  Surg.  A.  F. 

bone  removed.     Disch'd   May 

Whelan.  1st  Mich.  S.  S. 

30,  1865. 

o 

Becker,   H.,   Serg't,   F,   5th 

July  3, 

Conoidal  ball  comminuted  head 

July  4, 

Antero-posterior  flap  

Stump  heal'd  by  first  inten.  Disch. 

Mich.  Cavalry,  age  27. 

1803. 

of  left  tibia. 

1803. 

Dec.  14,  '63.  '(Also  fract.  jaw.) 

3 

Begle.  G.,  Pt.,  E,  91st  Indi 

Aug.  3, 

Conoidal    ball  fracture  of  left 

Aug.  3, 

Flap  ;  thro'  condyles  of  femur, 

Stump  perfectly  healed.     Disch. 

ana,  age  22. 

1864. 

leg,  involving  knee  joint. 

1864. 

by  Surg.  J.  T.  Woods,  99th  O. 

June  21,  1865! 

4 

Kowe.n.  H.,  Pt.,  K,  52d  North 

July  3, 

Shot  fracture  of  left  leg.    (Also 

July  3, 

Amputation  at  knee  joint  

Recovery,  January  12,  1804. 

Carolina. 

1863. 

wound  of  right  ankle.) 

1803. 

5 

Bragg,   W.,    Serg't,    F,   8th 

Mav  27, 

Conoidal  ball  fracture  of  left 

May  27, 

Flap  amputation,  by  Assistant 

Discharged  April  6,  1865. 

Penn.  Cavalry,  age  23. 

1864. 

tibia. 

1864. 

Surg.  H.  G.  Chritzman,  8th 

Penn.  Cavalry. 

6 

Brooks,  J.  M.,  Pt.,  A,  17th 

June  21, 

Cannon  shot  fracture  two  ins. 

June21, 

Amputation  at  knee  joint  

Sept.  10,  amp.  lower  third  thigh. 

Penn.  Cavalry,  age  28. 

1863. 

below  left   knee  joint,  sever 

1863. 

Disch'd  July  28,  1865.    (TABLE 

ing  leg. 

XL,  No.  14.  p.  320.) 

7 

Credon,.).,  Pt.,  A,  91st  New 

May  27, 

Musket  ball  comminuting  left 

May  27, 

Ant.  and  post,  flaps;  one  half  of 

September  1st,  entirely  healed. 

York,  age  45. 

1863. 

patella  and  opening  knee  joint. 

1863. 

patella  retained,  by  A.  Surg. 

Discharged  Mar.  29,  1866.    The 

J.  T.  Myers,  91st  New  York. 

stump  is  tender. 

8 

Darkes,  J.,  Pt.,  B,   10th  In 

Aug.  19, 

Disrupture  of  left  leg  at  upper 

Aug.  20, 

Anterior  rectangular  flap  ampu 

August  30,  gangrene.     To  regi 

fantry,  age  33. 

1864. 

third  by  a  solid  shot. 

1864. 

tation,  involving  patella,  lat 

mental   headquarters  Dec.  17, 

eral  and  inferior  surfaces  of 

1864.     Stump  healed. 

condyles,    by    Surg.    A.   A. 

White,  8th  Maryland. 

9 

David,  T.,  Pt.,  A,  90th  Penn 

Dec.  13, 

Shot  fracture  of  right  tibia  and 

Dec.  13, 

Flap  amputation  at  knee,  re 

Disch'd  Feb.  21,  1803.    Died  Feb. 

sylvania,  age  27. 

1862. 

fibula,  upper  third. 

1862. 

taining  patella  and  condyles, 

25,  1870.    BRINTON  (J.  H.),  On 

by  Ass't  Surg.  C.  C.  Lee,  U. 

Amp.  at  the  Knee  Joint,  etc.,  in 

S.  Army. 

Am.  Jour.  Med.  Sci.,  1868,  Vol. 

LV,  p.  324. 

10 

Dow,  G.  E..  Pt.,  G,  12th  N. 

June  3, 

Grape  shot  fracture  of  left  leg. 

June  3, 

Flap  amputation  at  knee  joint. 

June  23d,  haem.;  24th,  lig.  fern. 

Hampshire,  age  22. 

1864. 

1864. 

artery.     Disch'd  Nov.  18,  1864. 

11 

Everett,  J.,  Serg't,  G,  142d 

Mav  23, 

Conoidal  ball  fracture  of  right 

May  24, 

Lateral  flap  ;  patella  retained  ; 

Discharged    January    22,    1865. 

Pennsylvania,  age  27. 

1864. 

tibia  and  fibula. 

1864. 

a  small  section   of  condyles 

Spec.  4857. 

size  of  ahalf  dollar  remo'd,  by 

Surg.  J.  Ebersole,  19th  Ind. 

12 

Freeman,    C.,  Pt.,  B,  210th 

Mar.  31, 

Conoidal  ball  fracture  and  great 

April  1, 

Antero-posterior  flap  ;   remov 

Discharged  Aug.  3,  1865;  good 

Pennsylvania,  age  32. 

1865. 

splinteringof  patella  and  tibia 

1865. 

ing  patella,   by  Surg.  J.  J. 

stump. 

of  left  leg. 

Comfort,  190th  Penn. 

13 

Gallot.   E.  F.,  Pt.,  E,  146th 

June  2. 

Conoidal  ball  comminuted  frac 

June  3, 

A  ntero  posterior  flap,  by  Surg. 

Discharged    January    20,    1865. 

New  York,  age  26. 

1864. 

ture  of  upper  third  of  left  leg. 

1864. 

La  Grange,  C.  S.  A. 

Healthy  stump. 

14 

Hare,  F.,  Corp'l,  B,  6th  Wis 

May  5, 

Shot  fracture  of  bones  of  left 

May  6, 

Amputation  at  knee  joint,  by  a 

Gang.    Aug.  0,  re-amp,  mid.  th'd 

consin,  age  23. 

1864. 

leg. 

1864. 

Confederate  surgeon. 

thigh.     Disch'd  May  22,  1805. 

(TABLE  XXXIX,  No.39,  p.  314.) 

15 

Harkins,  J.  B.,  Pt..  K,  119th 

Dec.  13. 

Shot  wound  of  the  left  leg  

Dec.  13, 

Amputation  at  knee  joint,  by 

Disch'd  Mar.  19,  1863.     Diseased 

Pennsylvania,  age  22. 

1862. 

1802. 

Surgeon  J.   P.  Leidy,  J19th 

stump  :  violent  neuralgia  :  hec 

Pennsylvania. 

tic  fever;  exhausting  diarrhoea. 

Died  May  19,  18(57. 

16 

Heinle,  J.,  Pt.,  G,  51st  Penn 

June  3, 

Shell  wound  of  right  leg,  upper 

June  3, 

Flap;  by  Surg.  A.  F.  Whelan, 

Discharged  June  1,  1865.     Died 

sylvania,  age  23. 

1864. 

third. 

1864. 

1st  Michigan  S.  S. 

May  1,  1870. 

17 

Herbert,  C.,  Pt..  C,  69th  N. 
York,  age  19.    (Alias  Chas. 

Aug.  25. 
1804. 

Two  shot  wounds  of  right  leg 
by  conoidal  balls,  fracturing 

Aug.  27, 
1864. 

Long  posterior  flap,  by  a  Con 
federate  surgeon. 

Discharged  June  9,  1805.     Can 
not  wear  an  artificial  limb. 

St.  J.  Nichols.) 

heads  of  both  bones  and  their 

lower  thirds. 

18 

Hopkins,    W.,    Pt..    E,    6th 

Sept   10, 

Conoidal  ball  penetrating  cav 

Sept.  17,  i  Amputation  at  knee  joint,  by  a 

Sound    stump.     Disch'd    March 

Michigan  Cavalry,  age  32. 

1863. 

ity  of  left  knee  joint. 

1863. 

Confederate  surgeon. 

23,  1864. 

19 

Ilcm-ard.  J.    W.,  Corp'l,   D, 

Mav  12, 

Shot  wound  of  knee  joint 

May  12 

Amputation  at  knee  joint 

Recovery. 

61st  Virginia. 

1864. 

1864. 

20 

Ivey,  A.,  .Serg't,  D,  7th  Wis 

July  1, 

Shot  fracture  of  upper  third  of 

July  1, 

Bi-lateral  skin  flap,  by  Surg.  J. 

Discharged  May  14,  1804. 

consin,  age  20. 

1863. 

left  tibia. 

1863. 

Ebersole,  19th  Indiana. 

21 

Jones.  11.  (J.,  Lieut.,  E,  15th 

May  16, 

Shot  wound  of  knee  joint 

Mav  16, 

Amputation  at  right  knee  joint. 

Recovery. 

Virginia. 

1864. 

1864. 

22 

Kama;,   W.  H.,  Pt.,  G,  llth 
Virginia  Cav..  age  40. 

June  9, 
1863. 

Conoidal  ball  frn^ture  of  head 
of  left  tibia. 

June  10, 
1863. 

Amputation  left  knee  joint,  by 
a  Union  surgeon. 

Exchanged  and  furloughed  Mar. 
12,  1864. 

O;j 

Kaul,  J.,  Pt.,  G,  29th   New 

Aug.  29, 

Musket  ball  perforated  head  of 

A  tiff  29 

Double  flap  amputation 

Mar.  12,  1863,  patella  raised  and 

York,  age  21. 

1862. 

right  tibia  :  joint  not  involved. 

v  ft             » 

1862. 

movable.    Disch'd  April  30,  '63. 

Died  Dec.  13.  1878;  dropsy. 

24 

Kelly,  R.,   Artificer,    U.    S. 

Aug.  18, 

Conoidal  ball  entered  near  tu- 

Aug.  18, 

Antero-posterior  flaps  ;  patella 

Disch'd  Jan.  23,  1805.     MARKOE 

Engineers,  age  23. 

1864. 

berosity  of  left  tibia,  lodging 

1864. 

not  removed,  by  Ass't  Surg. 

(T.  M.),   Amp.  Knee  Joint,  in 

on  external  condyle  of  femur, 

G.  M.  McGill,  U.  S.  A. 

N~.  r.  Med.  Jour..  1867-68,  Vol. 

slightly  injuring  it. 

VI,  p.  503.     Stump  tender. 

25 

Kerr,  G.,  Serg't,  H,  2d  Cav 

June  11, 

Conoidal  ball  wound  of  upper 

June  1  1. 

Amputation  at  knee  joint,  by 

Disch'd  October  17,  1864.     Died' 

alry,  age  41. 

1864. 

third  of  right  leg.                           1861. 

Union  surgeon. 

1865. 

*iO 

Kuhn,  A.,  Pt.,  F,  99th  Ohio. 

July  19, 

Conoidal  ball  comminuted  frac-    .hilv  19. 

Short  flap,  leaving  condyles  of 

Discharged  June  21,  1865. 

age  28. 

1864. 

ture  of  right  tibia,  extending 

1864. 

femur  intact,  by  Surg.  J.  T. 

nearly  to  knee  joint. 

Woods,  99th  Ohio. 

-'7     Lapham.  C.  N.,  Corp'l,  K,  1st 

July  8, 

Both  legs  carried  away  by  a 

July  10, 

Amputation  left  knee  joint  by 

Disch'd  August25,  1864.     (CASE 

Vermont  Cavalry,  age  23. 

1863. 

solid  shot. 

1863. 

ant.  -post,  flap  'also  amp.  right 

436,  p.  224,  and  No.  336,  TABLE 

thigh,  middle  third),  by  Surg. 

XXXI,  p.  231.) 

L.  P.  Woods,  5th  N.  Y.  Cav. 

28 

Leonard.   tV.  J..  Pt.,  K.  43d 

May  16, 

Shot  comminution  of  tibia  and 

May  16, 

Antero-posterior  flap;   remov 

Recovered  July  31,  1864. 

Alabama,  age  20. 

1864. 

fibula  just  below  knee  joint. 

1864. 

ing  patella. 

29 

Matson,  L.  J..  Pt.,  K,  2<t  N. 

April  21. 

Conoidal  ball  wound  of  left  log, 

April  1. 

Antero-posterior  flap  amputa 

Gangrene  ;  Sloughing.    Portion  of 

York  Cavalry,  ago  21. 

1865. 

injuring  knee  joint.                         18(!.">. 

tion. 

femur   removed   with    forceps. 

Discharged  Sept.  2,  1865. 

30 

McGee,  J.,  Pt..  G,  2d  Rhode 

May  5, 

Conoidal  ball  fracture  of  right 

Mav  5. 

Short  post,  flap  ;  patella  remo'd. 

Discharged  Oct.  1"),  1864.  Stump 

Island,  age  22. 

1864. 

libia  and  fibula. 

1664. 

by  Surg.  (  ',.  W.  Carr,  2d  R.  I. 

never  healed  entirely. 

31     Me  Mullen,  R.  J..  Pt..  I.  4th 

May  3, 

Shot  fracture  of  the  leg  Mn  v  4. 

Amputation  at  knee  joint  

Protrusion  of  condyle!    May  23d, 

Georgia,  age  20. 

1863. 

1863. 

amp.  thigh,  lower  third.     June 

oth,  hpein.;  lig.  femoral  artery. 

Recovery.      (TABLE    XXXVI, 

No.  130,  p.  295.) 

SURG.  Ill— 51 


402 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 
INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMAP^S. 

32 

Mitchell,  A.,  Pt.,  F,  Palmetto 

May  24, 

Shot  wound  of  the  upper  ex 

May  25, 

Amputation  at  knee  joint  

Slough'g;  both  condyles  exposed. 

S.  S.,  age  17. 

1864. 

tremity  of  tibia. 

1864. 

Furloughed  Sept.  10,  1864. 

33 

Muir,  L.,  Pt...  I,  5th  Vermont, 

May  5, 

Shot  fracture  of  left  leg  four 

May  6, 

Circular    amputation   at  knee 

Discharged  May  22,  '65.    Stump 

ago  25. 

1864. 

inches  above  ankle. 

1864. 

joint. 

enlarged  :  cannot  use  nrtif.  leg. 

34 

O'Brien,  P.,  Pt.,  F,  39th  N. 

Aug.  14, 

Conoidul    ball  fracture  of  left 

Aug.  10. 

Flaps,  by  Surg.  N.  Hay-ward, 

Discharged  June  19,  1865.    Died 

York,  age  27. 

1864. 

tibia  two  ins.  below  knee  j't. 

1864. 

20th  Mass. 

August  11,  1866. 

35 

Pace,  H.,  Pt.,  G.  113d  Penn 

May  ."),     Conoidal  ball  fract.  of  artieula- 

May  5, 

Skin  flaps,  by  Surg.  J.  Eber- 

Discharged  August  31,  1864. 

sylvania,  age  33. 

1864. 

ting  surface  head  of  right  tib. 

1864. 

sole,  19th  Indiana. 

36 

Padgett,   C.   S.,    Serg't,   K, 

June  3, 

Conoidal  ball  comminuted  frac 

June  4, 

Antero-post.     flaps;    retaining 

Discharged  July  13,  1865.    BiiiN- 

12th  New  Jersey,  age  23. 

1864. 

ture  of  right  tibia  and  fibula. 

1864. 

patella  but  removing  articular 

TOX  (J.H.),Am.  Jour.  McJ.  Sci., 

(Also  fracture  of  left  radius.) 

surface  of  condyles,  by  Surg. 

1868,  Vol.  55,  p.  322. 

A.  Satterthwaite,  12th  N.  J. 

37 

Kaftay,  P.,  Pt.,  C,  21st  Mis 

May  6. 

Shot  wound  of  left  knee. 

May  6, 

Amputation  at  knee  joint  

Retired  January  31,  1865. 

sissippi,  age  40. 

1864.  ' 

1864. 

38 

Rist,  C.  H.,  Pt.,  A,  36th  Wis 

June  1, 

Conoidal  ball  fracture  of  upper 

June  1, 

Osteoplastic.    leaving    patella 

Ulceration  of  cartilages.    Dec.  15, 

consin,  age  19. 

1864. 

third  of  left  tibia,  extending 

1864. 

and  condyles,  by  Surg.  J.  M. 

amp.  thigh,  lower  third.    Dis- 

into  knee  joint. 

Burr,  42d  New  York. 

chargedMav20,'(i5.   Sj>ec.  3514. 

(CAKE  492,  V  318,  and  TABLE 

XL,  No.  82,  p.  321.) 

39 

Rogers,  .1.  W.,    Pt.,  D,  6th 

Aug.  18, 

Conoidal  ball   fracture  of  left 

Aug.  19. 

Flap  amputation  at  knee  joint. 

Bone  protruded.     Disch'd  March 

Wisconsin,  age  47. 

1864. 

tibia  and  fibula  immediately 

1864. 

23,  1865. 

below  knee. 

40 

Sholes,  H..  Pt.,  D,  26th  New- 

Dec.  13, 

Shot  wound  of  right  knee  

Dec.  15. 

Amputation,  by  Surg.  T.  Sim, 

Gang.     March,  1863.  amp.  thigh, 

York,  age  20. 

1862. 

1862. 

u.  s.  v. 

low.  third.    Disch'd  Dec.  11,  '63. 

(TABLE  XL,  No.  84,  p.  321.) 

41 

Stewart,  W.,  Pt,,  K,  2d  Mich 

June  17. 

Shell  wound  just  below  right 

June  17. 

Antero-posterior  flaps;  remov 

Sloughing.    Discharged  May  4, 

igan,  age  22. 

1864. 

knee,  nearly  severing  leg. 

1864. 

ing  patella  and  condyles,  by 

1965.     Tender  cicatrix. 

Surg.  S.  S.  French,  20th  Mich. 

42 

Stmtton,    E.   L.,    Capt  ,    F, 

May  3, 

Conoidal  ball  fracture  of  head 

May  4, 

Amputation  knee  joint,  leaving 

Discharged  January  3.  1864. 

12th  New  Jersey,  age  24. 

1863. 

of  right  tibia. 

1863. 

patella  intact,  by  Ass't  Surg. 
J.  T.  Calhoun,  IT.  S.  A. 

;:, 

Struble,  E.  H.,  Pt.,  F,  19th 

May  22, 

Shell,  taking  off  left  leg  below 

May  22. 

Flap  amputation,  by  Surg.  F. 

Discharged  March  16,  1863. 

Ohio,  age  25. 

1862. 

knee. 

1862. 

T.  Hurxthal,  19th  Ohio. 

44 

Swittenburg,  J.  C.,  Capt.,  II, 

Aug.  21, 

Conoidal  ball  shattering  upper 

Aug.  21. 

Amputation  at  knee  joint,  by 

Exchanged  February  23,  1865. 

Kith  Miss.,  age  27. 

1864. 

third  left  leg. 

1864. 

Surg.  J.  Ebersole,  19th  Ind. 

••  , 

Trent    S.  A.,   Pt.    2d  Rich 

May  12, 

Gunshot  wound  of  knee 

May  1  2. 

Amputation  at  knee  joint,  by 

Retired  Novembers,  1864. 

mond  Howitzers. 

18(54.  ' 

1864. 

Surg.  —  Capers,  C.  S.  A. 

46 

Turner,  J.  L.,  P.,  G,  1st  S. 

July  1, 

Shell  wound  of  right  leg,  in 

July  2, 

Amputation  at  knee  joint  

Exchanged  March.  3,  1864. 

Carolina,  age  20. 

1803. 

volving  knee  joint. 

1863. 

47 

Unknown    RITP  Rbont  *}0 

Dec.  13 

Shot  fracture  of  the  leg 

Primary 

Long  ant.  and  short  post,  flaps  : 

Recov'd,  with  good  stump.  BIEIN- 

'  ^ 

1862. 

patella  and  condyles  retained, 

TON  (J.  II.),  On  Amp.  atllie  Knee 

by  Surg.  J.  H.  Brinton.U.S.V. 

Joint,  etc.,   in  Am.  Jour.  Mrd. 

Sci.,  1868,  Vol.  LV,  p.  316. 

48 

Wheeler,  T.  H.,  Serg't.  E, 

May  31, 

Shot  wound  of  right  tibia  and 

May  31, 

Flap  amputation,  by  Surg.  G. 

June   10th,   gangrene.      Disch'd 

1st  Mich.  Cav.,  age  32. 

18"64. 

fibula,  implicating  knee  joint. 

1864. 

K.  Johnson,  1st  Mich.  Cav. 

Nov.  12,  1864. 

49 

Woodruff.  A.  O.,  Corp'l,  D, 

July  3, 

Conoidal  ball  fracture  of  upper 

July  3, 

Amputation,  by  Ass't  Surg.  B. 

Discharged  May  28,  1864.     Poor 

5th  Artillery,  age  23. 

1863. 

third    of    left    tibia.      (Also 

1863. 

Howard,  U.  S.  A. 

stump,  with  very  thin  covering. 

wound  of  right  leg.) 

50 

Ymtng,  L.  C.,  Pt.,  A,  3d  Vir 

May  12, 

Pistol  ball  injuring  both  right 

May  14, 

Long  anterior  flap,  by  Surg.  C. 

July  27th,  amp.  thigh,  mid.  third; 

ginia  Cavalry,  age  31. 

1864. 

tibia  and  femur,  involving  the 

1864. 

B.  Gibson,  C.  S.  A. 

gangrene;  recovery.  Spec.  5514. 

knee  joint. 

(TAB.  XXXIX.No.  100,  p.  315.) 

51 

Barger,  J.   C.,   Pt.,   G,    52d 

May  30, 

Shot  wound  right  leg  and  left 

Primary 

Amputation  at  knee  joint  .   . 

Died  June  14,  1864. 

Virginia,  age  40. 

1864. 

shoulder. 

52 

Barker,  J.,  Pt.,  I,  o8th  Mass., 

June  17, 

Shot  wound  left  leg  and  right 

June  17. 

Oval  flap  amput'n  at  left  knee 

Died  June  28,   1864.      (  TABLE 

age  42. 

1864. 

thigh. 

1864. 

and  amp.  low.  third  r't  thigh. 

XX  XII,  No.  1014,  p.  257.) 

53 

Bates.   O.   S..   Pt',   A,   20th 

June  24, 

Shell  fracture  of  middle  third 

June  24. 

Antero-posterior    flap,   at    left 

Gangrene.     Died  August  19,  '64  ; 

Mass.,  age  24. 

1864. 

of  left  leg. 

1864. 

knee  joint,  by  Surg.  N.  Hay- 

exhaustion. 

ward,  20th  Mass. 

54 

Bingham,  D.,Corp'l,  H,118th 

June  26, 

Shot  shattering  right  leg  ex 

June  26. 

Double  flap  ;  condyles  of  femur 

Gang.;  lisem.     Died  July  25,  '64  ; 

Pennsylvania,  age  36. 

1864. 

tensively. 

1864. 

sawn  off  and  patella  removed. 

pyaemia. 

r>5 

Briggs,  J.,  Pt..  A,  20th  New 

Dec.  13, 

Shot  fracture  of  left  tibia  

Dec.  13, 

Amputation  at  knee  joint,  re 

Died  December  1  3.  1  862. 

York. 

1862. 

1862. 

taining  patella. 

56 

Brooks,  E.,  Pt.,  K,  19th  Vir 

April  20, 

Shell  fracture  of  right  leg  

April  20. 

Amputation  at  knee  joint  

Erys.;  bedsores;  large  abscesses. 

ginia,  age  26. 

1865. 

1865. 

Died  May  11,  '(!.">:  exhaustion. 

57 

Butler.  G..  Pt.,  C,  8th  New 

Aug.  JO. 

Fracture  of  left  le*^  by  a  fracr- 

Aug.  16, 

Amputation  at  knee  joint 

Died  November22,  1864  ;  chronic 

Jersey,  age  19. 

1864. 

ment  of  shell. 

1864. 

diarrhoea. 

58 

Campbell,  B.  J.,  Pt.,  H.  5th 

Aug.  19. 

Shot  wound  of  right  leg,   in 

A  ug.  20. 

Flap  amputation  at  knee  joint. 

Died  September  1'A  1864. 

New  York,  age  22. 

1864. 

volving  knee  joint. 

1864. 

59 

Chase,  J.  B..  Pt.,  K,  24th  N. 

June  16, 

Shot  fracture  of  left  tibia  and 

June  16, 

Amputation  at  knee  joint  

July  7th,  lig.  fern,  artery.     Died 

York  Cavalry,  age  49. 

1864. 

fibula. 

1864. 

July  9,  1864  ;  constitutional  irri 

tation. 

60 

Clark,    W.,    Pt.,    A,     lllth 

Sept.  17 

Shot  fracture  of  right  leg  

Sept.  J7 

Amputation  at  knee  joint.  .   . 

Died  October  10,  1862. 

Pennsylvania. 

1862. 

1862. 

61 

Cole,  F.,  Pt.,  G,  61st  New    July  3, 

Shot  fracture  of  both  bones  of 

July!!. 

Amputation  at  knee  joint,  by 

Died  July  9,  1863. 

York.                                           1863. 

left  leg. 

1863. 

Surg.  C.  S.  Wood,  66th  N.Y. 

62 

Conland,  ().,   Pt.,  I,  (Ust  N. 

Mar.  25, 

Shot   wound   of  the  left   knee 

Mar.  25. 

Amputation  at  knee  joint,  by 

Died  April  19,  1865. 

York. 

186o. 

joint. 

1865. 

A.Surg.C.S.Hoyt,12Gth  N.Y. 

63 

Cornell.  J..  Pt.,  B,  7th  West 

May  31, 

Shot  fracture  of  left  knee  joint. 

Primary 

Amputation  at  knee  joint,  by 

Died  June  3,  1864. 

Virginia. 

1864. 

Surg.  M.  Rizer,  72d  Penn. 

64 

Corrigan,    A.   McQ.,   Major, 

May  12, 

Conoidal  ball  fracture  of  upper 

May  12, 

Antero-posterior  flap:  remov'g 

May  18th.  haem.,  6  oz.;  popliteal 

9th    New    York    Cavalry, 

1864. 

extremity  of  right  tibia  and 

18u4. 

patella  and  a  section  of  con 

artery  ligated;  diarrlwa.  Died 

age  27. 

wound  of  ant.  tibial  artery. 

dyles  of  femur,  by  A.  A.  Surg. 

May  '28,  1864;  exhaustion. 

('.  Rodgers  and  Surg.  A.  P. 

Clark,  Gth  N.  Y.  Cavalry. 

65 

Councell,    E.    C.,   Col.,   16th 

Aug.  21. 

Musket  ball  fracture  of  right   Aug.  21. 

Antero-posterior  flap,  by  Surg. 

Sept.  2d,  hsem.,  14  oz.;  Sept.  3d, 

Miss.,  age  32.                          ;    1864. 

leg  near  knee.                                1864. 

A.  A.  White.  8th  Maryland. 

lig.  femoral  ;   Sept.  10th,  haem. 

recurred  and  proved  fatal. 

66 

Douglass,  J.,  Serg't,  G,  63d    Nov.  24. 

Fract  ure  of  right  leg.  extending  ,  Nov.  24. 

Amputation  at  knee  joint  

Died  November  25,  1864. 

Indiana. 

1864 

to  knee  it.  by  a  cannon  ball.  ;     1864. 

67 

Draher,    W.,    Pt.,    B,    51st 

June  3,    Shot  fracture  of  upper  third  of    June  3. 

Lateral  flap  amp.  at  knee  joint, 

June  llth,  hajm.     Died  June  24, 

Pennsylvania,  age  32.               1864.         left  leg.  (Wound  of  shoulder.)       1HM. 

by  Surg.  A.  F.  Whelan,  1st 

1864  ;  exhaustion. 

Michigan  S.  S. 

68 

Conoidal  ball  fracture  of  right   June  18, 

Amputation  at  knee  joint  

Parts  gangrenous.    Died  August 

19th  Indiana,  age  22.                18G4. 

leg.                                                     1864. 

17,  1864,  of  injury. 

69 

Gervig,  II.,  Pt.,  K,  15th  N.    Mar.  3), 

Conoidal  ball  fracture,  involv-    Mar.  31, 

Amputation  at  knee  joint,  by 

Died  April  7,  1865;  exhaustion. 

York  Artillery,  age  28.             1865. 

ing  right  knee  joint.                      1865. 

Surg.  A.  A.  White,  8th  Md. 

SECT.  IV.] 


PRIMARY    AMPUTATIONS    AT    THE    KNEE    JOINT. 


403 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
Ol'ERA- 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

70 

Gooley,  N.,  Pt,  C,  73d  Ohio. 

May  25, 

Shot  wound  of  the  knee.   (Also 

May  25,  i  Amputation  at  knee  joint,  by 

Died  August  14.  1864.  .  . 

1864. 

wound  of  neck.) 

1864.    |     Surg.  I.  N.  Himes,  73d  Ohio. 

71 

Gould,    M.    W.,   Corp'l,   H, 

May  14, 

Conoidal  ball  fracture  of  left 

May  15,    Circular  amput'n  at  knee  joint.    Died  September  19,  1864  ;  chronic 

3Cith  Illinois,  age  20. 

1864. 

tibia  and  libula  in  mid.  third. 

1864.                                                                 diarrhoea. 

72 

Grice,  T.,  Pt.,  E,  38th  Col'd  Sept.  29,  :  Conoidal  ball  fracture  of  right 

Sept.  29,   Amputation  at  knee  joint  Died  March  21,  1865. 

Troops,  age  22.                          1804.    j     leg. 

1864. 

73 

Gutiek,  W.  O.,  Corp'l,  M,  1st 

Aug.  27,   Shot  fracture  of  the  right  leg. 

Aug.  27,   Disarticulation  at  knee  joint,  by    Died  September  3,  1863. 

Iowa  Cavalry. 

1863. 

1863.         Surg.J.C.  Lynch,  IstMo.  Cav. 

74 

Harbor,  E..  Pt.,  G,  21st  Vir 

Aug.  4,     Shell  fracture  of  right  tibia  and 

Aug.  4,    Anterior  skin  flap;  patella  re-  ;  Died  Aug.  20,  1864  ;  exhaustion 

ginia  Cavalry,  age  33. 

1864. 

fibula,  extending  into  knee  j't. 

1864.         moved  ;    condyles  of   femur      consequent  upon  excessive  ich- 

uudisturbed.                                   orous  discharge  :  autopsy. 

75 

Hedder,  W.,  Pt,,  C,  56th  N. 

June  1,    Shot  fracture  of  leg,  involving 

June  1,    Amputation  at  knee  joint  June  13th,  amp.  thigh,  mid.  third; 

York. 

1862.        the  knee  joint. 

1862.    ;                                                             29th,  haem.     Died  July  3,  1862; 

exh.,  diar.,  bed  sore.  Kpec.  4933. 

76 

Hughes,  A.  J.,  Pt.,  B,  14th    May  5, 

Conoidal    ball   wound  of  left 

May  5,  :  Antero-posterior  flap  at  knee    Died  June  6,  1864.    Card  Photo's 

lufautry,  age  26. 

1864. 

knee. 

1864.        joint.                                                A.  M.  M.,  Vol.  2,  p.  45. 

77 

Johnson,  T.  II.,  Pt.,  F,  95th 
Ohio. 

Aug.  30, 
1862. 

Gunshot  wound  

Aug.  31,   Amputation  at  left  knee  joint.    Died  September  21,  '62  ;  tetanus. 

1862. 

78 

Jiidd,  W.  B.,  Adjutant,  97th 

Feb.  7, 

Shot  fracture  of  knee,  severe.  . 

Feb.  7,  '  Amputation  at  knee  joint  Died  February  19,  1865. 

New  York. 

1865. 

1865.    j 

79 

Kennedy,  J.  A.,  Corp'l,  H, 

Sept.  1, 

Conoidal   ball  fracture  of  the 

Sept.  2,    Flap  amputation  at  knee  joint.    Died  December  24,  1864  •  chronic 

38th  Ohio,  age  24. 

1864. 

right  tibia. 

1864. 

pneumonia. 

80 

Koch,  J.  H.,  Serg't,  F,  69th 

June  Hi, 

Grapeshot  fracture  of  left  knee 

June  16, 

Circular  amput'n  at  knee  joint,    July  3,  4,  haem.,  15  oz.;  lig.  fern. 

Penn.,  age  22. 

1864. 

joint. 

1864.        by  Surg.  G.  L.  Potter,  145th  ;     artery.     Died  July    12,~18t>4  ; 

Pennsylvania.                                exhaustion. 

81 

Krowlow,   H.,  Pt.,  A,   66th 

Mar.  31  , 

Shot  wound  of  the  right  leg.  .  . 

April  1,!  Antero-posterior  flaps  at  knee    Gang.;  slough.;  femur  protrud.; 

New  York,  age  18. 

1865. 

1865. 

joint. 

haem.;  femoral  artery  lig.:  June 

23d,  recur'd;  re-lig.    Died  June 

24,  1865:  exhaustion. 

82 

Lepper,  W.  F.,  Pt.,  H,  143d 

May  5, 

Conoidal  ball  fracture,  involv 

May  5, 

Antero-posterior  flaps  at  knee    Died  May  15,  '64,  haem.  il)  BuiN- 

Pennsylvania. 

1864. 

ing  right  knee  joint. 

1864. 

joint,   leaving  condyles  and      TOS(J.Jl.),Am.Joitr.jUed.Sci., 

patella,  probably  by  Surg.  J.       1868,  Vol.  55,  p.  316. 

II.  Brinton,  U.  S.  V. 

83 

Long,  J.  W.,  Serg't,  I,  8th 

Dec.  16, 

Conoidal  ball  fracture  of  right 

Dec.  17, 

Flap,  by  Surg.  J.  R.  Ludlow, 

Dec.  18th,  haem.;  lig.  int.  artic.  art.; 

Kansas,  age  23.                          1864. 

leg. 

1864. 

U.  S.  V. 

Dec.  25th,  haem.  fromext.  artic. 

art.,  1  qt.  Died  Deo.  26,  J864. 

84 

Long,  W.,  Pt.,  A.   1st  Mis-  Sept.  21, 

Shot  wound,  involving  head  of 

Sept.  21, 

Amputation  at  knee  joint  Died  October  27   1862'  pyaemia 

souri  Artillery,  age  40.         :    1862. 

right  tibia  and  patella. 

1862. 

Spec.  467. 

85 

Matthews,    S.,    Pt.,   A,   93d    May  15, 

Shot  comminuted   fracture  of 

May  17, 

Lateral  flao  at  knee  ioint  Alnv3(lth   hspm  .•  rpc..Tnnp3  S  R 

Pennsylvania,  age  28.               18ti4. 

left  tibia  and  libula. 

1864.                                                                 12;  lig.  pop.  artery;  haem.  June 

16.    Died  June  17,  64  ;  pyaemia. 

80 

McCullough.  W.  T.,  Serg't,   AUB-.  —  . 

Gunshot  wound  of  leg  

On  field. 

Amputation  at  knee  joint  L'g-  sloug  •  haem  •  attempt  to  lig  • 

I,  2d  New  York. 

1862. 

tetanic  sj-mp.     Died  Sept.  7,  '62. 

87 

Merrill,  S.,  Pt.,  I,  39th  Mass.,     Feb.  7, 

Shot  fracture  of  upper  third  of    Feb.  7, 

Flap  amputation  at  knee  joint.    Typhoid  symptoms.  Died  March 

age  39.                                         1865. 

right  tibia. 

1865. 

3,  1865;  pyaemia. 

88 

Opperman.   J.,   Pt.,    E,   8th    May  5, 

Conoidial  ball  fracture  of  left 

On  field.  Amputation,  by  Surg.  N.  Hay- 

Bone  removed.     Died  May  15, 

New  Jersey.                                 1864. 

knee  joint. 

ward,  20th  Mass. 

1864. 

89 

1'armenter,  -E.   M.,    Pt.,    I,   Sept.  17, 

Gunshot  fracture  of  leg 

On  field.'  Amputation  at  left  knee  joint.. 

Died  October  13,  1862. 

15th  Massachusetts.                  1862. 

90 

Rathburne,  £>.,  Pt.,  C,  36th    May  31, 

Conoidal  ball  fracture  of  right 

May  31,   Flap,  through  the  knee  joint, 

Sloughing.     Died  June  9,  1864  ; 

Wisconsin,  age  27.                      1864. 

tibia. 

1864.    i     by  Surg.  N.  Hay  ward,  20th 

pyaemia;  autopsy.     U.S.San. 

Massachusetts. 

Com.  Mems.,  Surg.  Vol.  I,  p.  372. 

91 

fiea,  J".,  Pt.,  H,24th  Virginia.    May  16, 

Conoid,  ball  fract.  of  patella  and 

May  18,  Long  posterior  flaps,  by  Surg. 

Bone  protruded.    Died  July  19, 

,     1864. 

articular  surf,  of  head  of  tibia. 

1864.         C.  B.  Gibson,  C.  S.  A. 

1864. 

93 

Ribinger,    It.,    Pt.,    15,   27th  .  June  11, 

Gunshot  wound  of   the   knee 

June  11,'  Amputation  at  the  knee  joint.. 

Died  June  15,  1862. 

Pennsylvania.                              1862. 

joint. 

1862. 

93 

Roberts',   E.   P.,   Corp'l,   G,    Feb.  18, 

Shell  shattering  both  bones  of 

Feb.  18, 

Antero-posterior  flap,  Bauden's 

Slough.;  cond.  pro.  Died  Apr.  22, 

107th  Illinois,  age  20.                 1865. 

left  leg  in  upper  third. 

1865.         operation,  by  Surg.  E.  Ship- 

'65;  pyae.  BRINTOX  (J.H.),  Am. 

!     pen,  U.  S.  V. 

Jour.  Mcd.  &cj'.,'(>8,Vol.55,p.321. 

94 

Russell,     J.,    Pt.,     D,    27th    July  30, 

Fracture  of  upper  third  of  right 

July  30.   Double  skin  flap,  by  Surg.  A. 

Thigh  inflam.;  disch.  from  cud  of 

Michigan,  age  51. 

1864. 

leg  by  a  Conoidal  ball. 

1864.    ,     F.  Whelan,  1st  Mich.  S.  S.          stump.  Died  Aug.  !8,'61  ;asthe. 

95 

Scott,  J..  Pt.,  F,  1st  N.  Y.    May  31, 

Conoidal  ball  shattering  bones 

June  1,    Amputation  at  knee  joint  Sloug*.  June  16,  ham.:  lt?(h,lig. 

Dragoons,  age  33. 

1864. 

of  left  leg. 

1864.                                                                fern.  art.  Died  June  18,  '64  ;  col. 

96 

Slater,  I'.,  Pt..  I,  370th  New 

May  24, 

Fracture  of  upper  third  of  left 

May  26,    Amputation  at  left  knee  j't,  by    Died    June  4,   1864;    effects  of 

York,  ago  45.                               1864. 

leg  by  a  Conoidal  ball. 

1864.         Surg.  N.  Hay  ward,  20th  Mass.      wounds. 

97 

Smith,  H.,  Pt.,  I,  14th  New  •  June  7, 

Conoidal  ball  wound  of  left  leg 

June  7,    Flap  amp.  at  left  knee  j't  and    Died    June    17.    1864.     (TABLE 

Jersey,  age  24.                           1864.        and  right  thigh. 

1864.        amp.  right  thigh,  lower  third.       XXXII,  No.  1745.  p.  265.) 

98 

Stanley,   W.,    Pt.,   II,    53d  Dec.  13,  Conoidal  ball  fracture  of  upper 

Dec.  14,   Amputation  at  knee  joint,  re-    Stump  swollen  and  bulbous.thigh 

Pennsylvania,  age  26.           l    1862. 

third  of  right  leg. 

1862.         moving  the  patella.                       honey-comb,  by  small  abscesses; 

chronic  diarrh.     Died  April  26, 

1863:  exhaustion.    Spec.  1240. 

99 

Storey,  J.  M.,  Pt.,  H,  37th    Jnlv  3() 

Grapeshot  fracture  of  left  tibia 

July  31,    Amnilt.itinn  nt  knpp  i't    T5ntrh-     Slimrrh        \r.<r.  !f,tli.  lisnm.:  Anr. 

Wisconsin,  age  30. 

1864. 

and  fibula. 

1864. 

er's  operation,  by  Surg.  A.  F.       14,  1865,  amp.  thigh,  mid.  third. 

Whelan,  1st  Mich.  S.  S.                Died  July  3,  65:  gang.  (T.\1!LE 

XXXIX.  "No.  157.  p.  316.) 

100 

Sutton,  G.  H.,  Pt..  B,  Pur-  Aug.  18, 

Fract.  of  mid.  third  of  left  tibia 

Aug.  19,   Amp.  at  knee  joint,  by  Surg.    Died  September",  1864  ;  exhaus- 

noil's  Md.  Legion,  ago  34.     :     1864. 

and  fibula  by  Conoidal  ball. 

1864.    j     A.  A.  White,  8th  Maryland.        tion. 

101 

Swan,   D.  K.,   Pt.,   F,  38th    Sept.  1, 

Shot  fracture  of  the  right  tibia. 

Sept.  1,    Antero-posterior  flaps  ;  remov-    Died  December  26.  1864. 

Ohio,  age  18.                              1H64. 

1864.         ing  condyles. 

102 

Thompson,  I.  R.,  Pt.,  I,  6th    May  11, 

Shell  comminuted  fract.  of  left 

May  12,   Antero-posterior  flaps,  by  Surg.    Died  June  27,  1864;  exhaustion. 

Wisconsin,  age  29.                     1864. 

tibia  and  fibula  near  knee. 

1864.    \     A.  J.  Ward,  2d  Wisconsin. 

103 

Tilhurv,   G.,   Pt.,    E,    74th    May  27, 

Shot  fracture  of  the  right  leg.  . 

May  27,   Amp.,  by  Surgs.  W.  P.  Pierce, 

Died  June  12,  1664. 

Illinois.                                        1864. 

1864.        88th  Il'l.,  and  II.   E.  Hasse, 

2-Ith  Wis. 

104 

Turner,  W.  H.,  Serg't,  6th 

May  6, 

Cannon   ball   struck  left    leg, 

May  6, 

The  patella,  condyles.  and  sy- 

May  20th,  haem.,  4oz.;  haemorrh. 

New  York  Battery,  age  26. 

1864. 

fracturing  the  tibia  and  the 

1864.         novial  surfaces  were  not  re 

recurred  ;  flaps  opened,  sloughy 

fibula. 

moved:  and   the  capsules  nf 

tissue   removed  :    end   of  bone 

thejoint.divided  at  their  distal       necrosed.     Died  May  27,  1864; 

by  Ass't  Surg.  (1.  M.  McGill, 

U.  S.  A. 

105 

Waldenburg,  G  ,Pt.,A,46th    July  30,   Conoidal  hall  fracture  of  right 

July  30,  Butcher's  operation  ;  long  ant.    Abscess:  diarrhoea.     Died  Aug. 

New  York,  age  29.                    1864.         tibia.     (Also   wound  of   left 

18*64.         flap;  small  portion  ntVundylos 

15,  1864  ;  exhaustion. 

heel.) 

sawn  off  articulating  surface, 

by  Surg.  A.  F.  Whelan,  1st 



Michigan  S.  S. 

INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X 


NO. 

NAME,  MIUTAUY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATUUE  OF  IXJUKY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

106 
107 
108 

Westaoott    11     Pt     V    19th 

Dec.  13, 

186:2. 
Oct.  8, 
186-2. 
MavlS, 
1864. 

Shot  fracture  of  lef 

Dec.  13, 

1862. 
Oct.  8, 
1862. 
May  Ki, 
18C4. 

Amputation  at  knee  joint  

Died  December  30,  1862. 

Died  November  14,  "62;  typhoid 
fever. 
May  15th,  transferred  to  private 
quarters. 

Massachusetts. 
Wood,  W.  B..  Serg't,  I,  IGth 
Tennessee. 
Baker,  J.  ."?.,  Pt.,   D,  SSth 
Virginia. 

Conoidal  ball  fracture  of  patella 
and  head  of  tibia. 

Large  posterior  flap,  by  Surg. 
C.  B.  Gibson,  C.  S.  A. 

Intermediary  Amputations  at  the  Knee  Joint.  —  Fifty-one  intermediary  operations 
gave  a  fatality  of  68.0  per  cent.,  only  sixteen  of  the  fifty  determined  cases  having  a  suc 
cessful  issue.  Three  patients  submitted  to  re-amputation  in  the  thigh;  one  survived  and 
two  succumbed. 

Recoveries  after  Intermediary  Amputation  at  the  Knee  Joint. — Of  the  sixteen  cases 
of  this  group  three  were  Confederate  and  thirteen  Union  soldiers.  *  The  latter  are  all  pen 
sioners,  and  were  living  in  August,  1880.  In  one  instance  primary  amputation  in  the 
upper  third  of  the  leg  had  preceded  the  exarticulation  at  the  knee,  and  in  a  second  case 
haemorrhage  to  the  amount  of  sixteen  ounces  occurred  from  the  popliteal  artery  seven  days 
after  the  amputation.  The  bleeding  vessel  was  ligated,  but  haemorrhage  recurring  three 
days  later,  the  femoral  was  successfully  ligated: 

CASE  646. — Private  D.  Meikle,  Co.  B,  llth  Massachusetts,  aged  20  years,  was  wounded  at  Bull  Run,  August  30,  1862, 
and  admitted  to  Fairfax  Seminary  Hospital  nine  days  afterwards.  Surgeon  D.  P.  Smith,  U.  S.  V.,  reported:  "The  case  was 
one  of  gunshot  wound  of  left  knee  joint,  and  the  sequence  of  the  injury  was  an  amputation  at  the  knee  joint,  performed  by  lateral 
flaps,  on  September  28th.  Secondary  haemorrhage  to  the  amount  of  sixteen  ounces  occurred  on  October  4th  from  the  popliteal 
artery,  when  the  stump  was  opened,  the  vessel  dissected  up  for  about  two  inches,  and  again  tied.  Three  days  afterwards  haem 
orrhage  recurred ;  the  stump  was  again  reopened  and  the  artery  dissected  up  into  Hunter's  canal,  where,  becoming  the  femoral, 
it  was  then  ligated.  No  further  bleeding  took  place,  and  the  patient  recovered  Avith  a  beautifully  firm  and  broad  stump."  The 
patient  was  discharged  from  service  December  16,  1862,  and  pensioned.  He  was  paid  March  4,  1880.  The  stump  was  described 
to  be  in  good  condition  in  the  pensioner's  application  for  commutation. 

CASK  647. — Private  J.  M.  McGee,  Co.  E,  119th  Pennsylvania,  age  19  years,  was  wounded  at  the  Wilderness,  May  5, 
1864.  Surgeon  E.  15.  P.  Kelly,  95th  Pennsylvania,  recorded  his  admission  to  the  field  hospital  of  the  1st  division,  Sixth  Corps, 
with  "shot  wound  of  right  knee  by  a  conical  ball.''  Surgeon  E.  Bentley,  U.  S.  V.,  who  operated  in  the  case,  made  the  following 
report :  "The  patient  entered  Third  Division  Hospital,  Alexandria,  three  weeks  after  receiving  a  wound  of  the  right  knee  joint, 
the  ball  passing  beneath  the  patella.  The  bones  were  not  much  fractured,  but  the  joint  Avas  swollen  and  painful  and  the  leg 
oedematous.  Circular  amputation  at  the  knee  joint,  by  skin  flaps,  was  performed  on  June  2d,  sulphuric  ether  being  employed  as 
the  anaesthetic.  At  the  time  of  the  operation  the  patient  had  become  very  weak,  his  pulse  quick  and  feeble,  and  he  perspired 
considerably,  had  cough  and  spat  up  blood.  He  reacted  very  well.  Tonics,  stimulants,  and  nourishing  diet  were  given,  and 
simple  dressings  used.  The  wound  healed  up  kindly,  and  the  patient's  general  condition  became  much  improved."  The  patient 
was  subsequently  treated  at  various  hospitals,  and  finally,  after  being  provided  with  an  artificial  leg,  he  was  discharged  Septem 
ber  9,  1865,  and  pensioned.  Examining  Surgeon  E.  A.  Smith,  of  Philadelphia,  certified  to  "amputation  at  the  knee  joint,  with 
preservation  of  the  patella."  The  pensioner  was  paid  March  4,  1880.  In  his  application  for  commutation  he  represented  the 
stump  of  the  amputated  limb  as  being  in  a  "sound"  condition. 

CASE  648. — Private  W.  H.  Thomas,  Co.  A,  17th  Infantry,  aged  19  years,  was  wounded  at  Bull  Run,  August  29,  1862, 
receiving  a  shot  fracture  of  the  upper  third  of  the  right  leg.  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  reported  that  he  ampu 
tated  the  leg  on  the  field,  on  September  1st,  at  the  knee  joint,  including  the  removal  of  the  patella  in  the  operation,  which  was 
performed  by  the  double  flap  method.  Several  days  after  the  date  of  the  injury  the  wounded  man  was  removed  to  Washington 
and  admitted  to  Ascension  Hospital,  whence  Surgeon  J.  C.  Dorr,  U.  S.  V.,  described  his  case  as  follows :  "After  his  admission, 
the  sutures  were  found  upon  examination  to  have  given  away  and  the  flaps  were  gaping.  The  patient  had  been  much  exhausted 
by  long  marching  prior  to  the  battle,  and  it  was  feared  that  he  would  not  survive  the  effects  of  the  operation.  Stimulants,  beef 
tea,  and  quinine  were  freely  given,  and  finally,  after  repeated  relapses,  he  has  now  (December  3d)  nearly  recovered,  the  stump 
being  covered  with  fine  granulations,  and  his  strength  having  recuperated  to  its  normal  standard."  The  patient  subsequently 
passed  through  Carver  and  St.  Elizabeth  Hospitals,  and  on  June  16,  1863,  he  was  discharged,  having  been  previously  furnished 
with  an  artificial  leg.  He  afterwards  entered  the  Veteran  Reserve  Corps,  and  was  ultimately  discharged  from  service  AprU  5. 
1864,  and  pensioned.  He  was  paid  March  4,  1880.  In  his  application  for  commutation  he  reported  the  stump  as  being  in  a 
good  condition. 

Fatal  Cases  of  Intermediary  Amputation  at  the  Knee  Joint. — The  thirty-four  opera 
tions  were  performed  on  three  Confederate  and  thirty-one  Union  soldiers.  Primary  excision 
of  three  inches  of  the  fibula,  and  primary  amputation  of  the  leg  at  the  upper  third,  had 


SECT.  1V-1 


INTERMEDIARY    AMPUTATIONS    AT    THE    KNEE    JOINT. 


405 


preceded  the  exarticulation  at  the  knee  in  one  instance  each.  Death  was  ascribed  to 
pyaemia  in  eleven,  to  haemorrhage  in  two,  to  gangrene  in  six,  and  to  exhaustion  in  eight 
instances.  Autopsies  were  recorded  in  four  cases,  and  of  nine  cases  specimens  are  preserved 
in  the  Army  Medical  Museum. 


649.  —  Private  M.  13.  Aseltyne,  Co.  F,  10th  Vermont,  aged  22  years,  was  wounded  in  the  left  foot,  at  Mine  Run, 
November  27,  18G3,  and  entered  the  Third  Division  Hospital,  Alexandria,  one  week  afterwards.  Acting  Assistant  Surgeon  A. 
P.  Crafts  reported:  "A  conical  ball  entered  the  anterior  surface  of  the  foot,  fractured  the  cuneiform  bones,  and  was  extracted 
through  the  orifice  of  entrance,  on  the  field.  At  the  time  of  the  patient's  admission  there  was  much  tumefaction  and  inflamma 
tion  of  the  foot  and  leg,  which  at  first  seemed  to  yield  to  treatment.  But,  on  December  10th,  evidences  of  gangrene  began  to  show 
themselves,  and  four  days  afterwards  the  leg  was  amputated  at  the  knee  joint  by  Surgeon  E.  Bentley,  U.  S.  V.  The  operation 
was  performed  by  the  circular  method,  and  by  retaining  the  patella  after  disarticulating  the  joint.  Chloroform  constituted  the 
anaesthetic.  Simple  dressings  were  used  to  the  stump,  and  tonics  and  stimulants,  including  iron  and  quinine,  and  acetate  of 
ammonia  were  given  in  the  treatment.  On  December  20th,  there  were  symptoms  of  pyremia.  The  patient's  countenance  became 
sallow  and  anxious,  a  severe  chill  occurred,  and  hiccough  set  in,  followed  by  loss  of  appetite  and  by  profuse  sweating.  Death 
supervened  on  December  27,  1863.  At  the  post-mortem  examination  the  liver,  kidneys,  spleen,  and  intestines  were  found  healthy, 
the  lungs  much  discolored,  and  some  effusion  in  the  cavity  of  the  chest.  There  was  also  great  hypertrophy  of  the  heart  and 
some  effusion  within  the  pericardium."  A  section  of  the  stump,  made  by  Surgeon  J.  H.  Brinton,  U.  S.  V.,  showed  the  femur  to 
be  healthy,  although  denuded  of  periosteum  for  six  inches  above  the  joint.  The  synovial  membrane  on  the  crucial  ligament  was 
congested,  and  the  cartilage  of  the  femur  was  thinned  and  softened,  the  whole  color  being  changed  and  absorption  commencing. 
The  ligature  of  the  popliteal  artery  had  partially  sloughed,  and  the  base  of  the  long  internal  clot  had  come  down  and  projected 
through  the  opening  made  by  sloughing  in  the  walls  of  the  vessel.  The  artery,  showing  its  condition  as  described,  was  con 
tributed  to  the  Museum  by  the  operator.  A  wet  preparation  of  it  constitutes  specimen  1989  of  the  Surgical  Section,  and  a 
chromo-lithographic  representation  is  shown  on  PLATE  XXII,  opposite  page  736  of  the  Second  Surgical  Volume. 

CASE  650.  —  Corporal  A.  A.  Lepper,  Co.  L,  8th  Iowa  Cavalry,  aged  27  years,  was  wounded  in  the  left  leg,  at  the  battle 
of  Cassville,  May  20,  1864.  He  was  admitted  to  hospital  at  Chattanooga  on  the  following  day,  and  ten  clays  afterwards  he  was 
transferred  to  hospital  No.  8,  Nashville,  whence  Acting  Assistant  Surgeon  R.  T.  Higgins  made  the  following  report:  "The 
injury  consisted  of  a  compound  fracture  of  the  tibia  at  the  upper  third.  The  day  after  admission  the  leg  was  placed  in  a  box 
splint  and  kept  there  until,  finding  that  the  limb  could  not  be  saved,  amputation  or  excision  was  determined  upon;  the  foot 
having  become  considerably  swollen  and  slightly  cedematous,  and  the  wound  discharging  ichorous  pus.  On  June  8th  and  10th, 
the  patient  also  had  severe  chills,  each  attack  lasting  from  twenty  minutes  to  half  an  hour;  pulse  feeble  and  frequent;  appetite 
wanting.  Upon  a  thorough  examination  of  the  parts,  amputation  was  decided  to  be  the  more  advisable  operation,  and  was  per 
formed  at  the  knee  joint,  on  June  13th,  by  Surgeon  R.  R.  Taylor,  U.  S.  V.,  in  charge  of  the  hospital.  Rectangular  flaps  were 
made,  with  circular  section  of  muscles,  and  the  condyles  of  the  femur  were  taken  off  in  the  operation,  chloroform  being  employed 
as  the  anaesthetic.  Two  ounces  of  whiskey  and  forty  drops  of  laudanum  were  administered  at  once  after  the  operation,  and 
mustard  plasters  were  applied  to  the  ankle  and  wrists.  The  patient  reacted  slowly.  Milk  punch  and  beef  tea  were  given 
alternately  every  twenty  minutes  in  half-ounce  doses.  On  the  following  day  he  was  troubled  with  colliquative  diarrhoea  and 
involuntary  discharges  and  began  to  sink  rapidly.  There  was  also  another  chill,  but  not  so  severe  as  the  previous  ones,  and  on 
the  second  day  the  upper  flap  was  found  to  be  sloughing,  dark  in  color,  and  gangrenous.  Stimulants  and  nourishments  were 
continued  freely.  Death  occurred  on  June  16,  1864.  At  the  post-mortem  examination  the  lungs  were  found  to  be  engorged  and 
slightly  hepatized  and  the  intestinal  canal  slightly  inflamed,  the  other  organs  being  normal.  The  clot  found  in  the  femoral  vein 
was  slightly  adherent  and  the  internal  coat  of  the  vein  very  much  inflamed.  The  cause  of  death  was  thought  to  be  pyaemia." 
The  upper  half  of  the  tibia  of  the  amputated  leg,  a  large  fragment  of  it  being  partly  necrosed  and  remaining  in  position,  was 
contributed  to  the  Museum  by  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A.,  and  is  specimen  numbered  3758  of  the  Surgical  Section. 

TABLE  LVI. 
Summary  of  Fifty-one  Cases  of  Intermediary  Amputations  at  the  Knee  Joint  for  Shot  Fractures. 

[Recoveries,  1  —  16  ;  Deaths,  17  —  50  ;  Unknown  result,  51.] 


NO. 

NAJIE,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATUKK  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Sutler,  T.  J.,  Lieut.,  A,  38th 

July  3, 

Fracture  of  upper  third  <if  left 

July  19, 

Amputation  nt  knee  joint,  by 

To  prison  April  23,  1864  ;  after 

Virginia,  age  28. 

1863. 

leg  by  conoklal  ball. 

1863. 

A.  A.  Surg.  L.  Fisher. 

wards  exchanged. 

2 

Clark,  O.  11.,  Serg't,   II,   1st 

NOV.;.'?, 

Pistol  ball  wound  of  left  knee 

Dec.  2, 

Flap  amputation  at  the  knee 

Discharged  Oct.  4,  1864.    Stump 

Mass.  Cav.,  age  30. 

18(i3. 

joint. 

1863. 

joint. 

tender. 

3 

Desmond,  H.,  Pt.,    I,    28th 

Dec.  1  3, 

Fracture  of  head  of  right  tibia 

Dec.  21, 

Amputation  at  the  knee  joint. 

Secondary   amp.  lower  third   of 

Mass.,  age  29. 

18(12. 

and  patella;  colloidal  ball. 

1862. 

thigh.     Disch'd  Dec.  2?,  1803. 

(TABLE  XL,  No.  2">,  p.  3-JO.) 

4 

Frame,  J.  31.  F.,  Pt.,  15.  4th 

Sept.  19, 

Fracture   and   extensive  com 

Sept.  22,   Circular    amputation,    patella 

Stump  sloughed  ;  typhoid  fever. 

Virginia,  age  33. 

ISC'). 

minution  of  right  tibia  3  ins. 

1864. 

retained,  by  Assistant  Surg. 

Released  June  28,  1865. 

below  knee  joint. 

O.  M.  ISurdctte,  P.  A.  C.  S. 

5     Hun-ley.    I..   M.,    Serg't,    I, 

July  2, 

Shot  fracture  of  both  bones  of 

July  5, 

Flap  amputation,  bj-  Surg.  F. 

Sept.  24th,  entirely  healed.    Dis 

/1st  JNew  \  (irk,  age  21. 

1SU3. 

left  leg  in  lower  third. 

1863.         Prentice,  73d  New"  York. 

charged  April  19,  1865. 

6 

Laasiter,   V.  M.,  Pt..  K,  32d 

May  20, 

Ciinoidul  ball  fracture  of  both 

June  5,     Amputation  through  condyles, 

Post,  ilap  slough.:  June  10,  haem.; 

Texas,  age  17. 

1804. 

bones  of  right  leg  in  middle 

1804.         removing  patella;    long  ant. 

stump  cicat'd  ;  recovery.    C.  S. 

third. 

j     short  post,  flaps. 

JUed.andSurg.Jour.,\o\.2,  p.28. 

406 


INJURIES    OF    THE    LOWER    EXTREMITIES 


[CHAP.  X. 


NO. 

NAME,  MILITARY 

DESCKIi'TlO.N,   AND  AGE. 

DATE 

OF 

IXJUUY. 

NATURE  OF  IXJUUY. 

DATE 

OF 

OPEBA- 

TIOX. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

7 

McCaigue,  S.  B.,  Corp'l,  H, 

May  12, 

Shell  fracture  of  bones  of  left    May  27, 

Amputation,  bv  Ass't  Surg.  A. 

Mustered  out  July  13,1865.     He 

183d  Penn.,  age  21. 

1864.        leg:  primary  amputation  up-      1864. 

Delaney,  U.  S.  V. 

has  caries  of  right  tibia.    Stump 

per  third  ;  sloughing. 

tender. 

8 

McGee,    J.,    Pt.,    E,    119th 

May  a,    Conoid,  ball  passed  ben'thpatel.    June  2. 

Circular  skin  flaps,  by  Surg.  E. 

Discharged  September  9,  18G5. 

Pennsylvania,  age  19. 

18U4. 

rt  knee,  bones  not  much  tract.  ,    180*1. 

Bentley,  U.  S.  V. 

9 

Meikle,    I).,    Pt.,    B,     llth 

Aug.  30, 

Shot  wound  of  left  knee  joint.   Sept.  28, 

Lateral  'flaps,  by  Surg.  D.  P. 

Oct.  4,  hsem.:  lig.  of  popliteal;  7th, 

Massachusetts,  age  20. 

1802. 

1802. 

Smith,  U.  8.V. 

haem.;  lig.  fern.   Dis.  Dec.  16,  '62. 

10 

Nolan.  P.,  Pt..  G,  13th  Mass., 

Aug.  29, 

Musket  ball  fracture  of   right    Sept.  :!, 

Markoo's  operation;  patella  re 

Patella  raised  4  inches.     Disch'd 

age  21, 

1862. 

tibia  and  fibula.                             1862. 

tained  :  condylcs  sawn  off,  by 

August  29,  1803. 

Surg.  E.  Donnelly,  2d  Pa.  It. 

11 

Palmer,  E.,  Pt.,  6th  Maine 

Aug.  9, 

Shell  fracture  of  right  tarsus,   Aug.  14, 

Anterior  operation  ;    articular 

Discharged  Oct.  23.  1862.     Spec. 

Battery,  age  19. 

181.2. 

metatarsus,  and  tibia.                   1802. 

surfaces  of  condyles  sawn  off, 

53.    BUINTON  (,}.!!.),  Am.  Jour. 

leaving  patella,  by  Surg.  E. 

Med.  Sci.,  18G8,  Vol.  55,  p.  322. 

Bentley,  U.  S.  V. 

12 

Pittman.  W.,  Pt.,  G,  148th 

May  9, 

Shell,  carrying  away  external   May  Id', 

1'oste.  muscular  flap,  by  Surg. 

Disch'd  June  22,'G5.   1870,  stump 

Penn..  age  23. 

1864.         of  inalleulns  of  right  ankle.         1804. 

E.  Bentley,  U.  S.  V. 

sound. 

13 

Shambaugh,  C.,   Corp'l,   B, 

Aug.  29,  ;  Musket  ball   fracture  of  both    Sept.  4, 

Single  upper  flap,  patella  not 

Stump  healed:  patella  movable 

llth  Penn.  Res.,  age  24. 

1862.    i     bones  of  left  leg  in  upper  third. 

1802. 

removed,  bv  Ass't  Surg.  15. 

4  ins.  up  the  limb.     Discharged 

Howard.  U.'S.  A. 

May  22,  1863. 

14 

Sheppard,   P.,   Pt..   C,   34th 

Mav  31,    Shot  fracture  of  right  leg  ..  .  .  .  |  June  5, 

Circular    amputation   at   knee 

Discharged  April  2,  1803.     Can 

New  York,  age  25. 

1862. 

1862. 

joint. 

not  wear  artificial  limb. 

15 

Thomas,  \V.  11..  Pt.,  A,  17th 

Aug.  29,   Conoidal  ball  fracture  of  right  |  Sept.  1, 

Double  flap  2^  ins.  long,  rem'g 

Sutures  gave  way  ;  flaps  gaped. 

Infantry,  age  19. 

18C2. 

tibia  and  iibula  3  ins.  below  |    18G2. 

patella  and  art.  surfaces,  by 

Disch'd  April  5,  1804.     Stump 

joint. 

A.  Surg.  B.  Howard,  U.  S.  A. 

good,  1870. 

16 

Wright,    O.,    Pt.,    B,    15-th 

Dec.ll/Musket   ball    wound   of   right    Dec.  14, 

Flap  amputation,  by  a  Confed 

Discharged  January  19,  1863. 

Penn.  Res.,  age  20. 

1802.         leg,  involving  knee  joint.          i    1SG2. 

erate  surgeon. 

17 

Aseltyne,  M.  B.,  Pt.,  F,  10th 

Nov.  27,  Conoidal  ball  fracture  of  cunei-    Dec.  14, 

Circular  amp.,  leaving  patella, 

Died    Dec.   27,   18G3;    pyaemia. 

Vermont,  age  24. 

18G3.         form  bones  left  foot  :  inflam-      18G3. 

by  Surg.  E.  Bentley,  U.  S.  V. 

Autopsy.     Spec.  1989. 

ination  of  foot  and  leg. 

18 

Bailey,  W.  H..   Pt.,   A,  2d 

June  9,    Shot  fracture  of  right  le"r  JunelS, 

Amputation  at  the  knee  joint. 

Sloughing  ;  hiemorrhage,  20  oz. 

New  York  Cav.,  age  23. 

1863.                                                                18G3. 

Died  June  29,  1803. 

19     Blancbeau,  P.,   Pt.f  I,  28th 

June  4, 

Fracture  of  exter.  condyle  and    June  8, 

Skin  flap,  1  inch  of  condyle,  in 

June   12th,   gang.;    14th,    liaem. 

Massachusetts,  age  22. 

1864. 

slight  fract.  of  inter,  condyle      18G4. 

cluding  fract.  portion,  rem'd, 

Died  June  16th,  '04;  gangrene 

of  right  femur. 

by  A.Surg.S.B.Wurd.U.S.V. 

and  haemorrhage.     Spec.  2656. 

20 

Britton,   M.,    Corp'l.   F,   7th 

Ucc.  13,  !  Musket  ball  fracture  of  cuboid   Dec.  2G, 

Circular,  by  Surg.  E.  Bentley, 

Jan.  7,  '03,  hsem.:  lig.  fern.;  gang. 

Penn.  lies.,  age  21. 

1862.         and  astragalus  of  right  foot. 

1802. 

U.  S.  V. 

Died  Jan.  12,  1803.     Spec.  4541. 

21 

Carroll,     F.,    Pt.,    K,    45th 

June  3,    Shot   injury  of  right    fibula  ;    June  18, 

Ant.  -post,  flap,  rem'g  patella,  by 

Hsem.  from  ant.  tibial  art.     Died 

Pennsylvania,  age  23. 

1804.         primary  excision. 

18G4. 

Surg.  R.  B.  Bontecou,  U.  S.V. 

June  22,  1804  :  exhaustion. 

22 

Danzenbaker,  L.  11.,  Pt.,  D, 

June  2,    Grapeshot  struck  inner  condyle 

June  7, 

Circular  amp.,   skin  flaps,  by 

Died  June  12,  1804  ;  gangrene. 

10th  New  Jersev,  age  21. 

1864.        of  femur;  joint  opened.     "          18G4. 

Surg.  E.  Bentley,  U.  S.  V. 

23 

Eno,  C.,  Pt.,   B,  91st  Ohio, 

July  20,   Musket  ball"  fract.  right  tibia;  !  July  31, 

Antero-posterior  flap,  by  Surg. 

Diarrhoea.    Died  August  9,  1864. 

age  23. 

1864.         leg  swollen  and  ecchymosed.       1804. 

J.  B.  Lewis,  U.  S.  V. 

24 

Farley,  A..  Pt.,  I.  83d  New 

May  9,  '••  Shot  fraot.  inter,  malleolus  of  r't   May  15, 

Circular  bv  skin  flaps,  by  Surg. 

Died  June  1,  '04  :  pyaemia.    Spec. 

York,  age  51. 

1804. 

ankle  j  t  :  tissues  oadeinatous,  '    1  b04. 

E.  Bentley,  U.  S.  V. 

2655. 

pus  extend,  nearly  to  knee  j't. 

25 

Fuller,   C.   E.,  Pt.,  D,  36th 

June  3,     Conoidal  ball  t'rnot.  ofos-caleis?     June  9. 

Skin  flap,  i  inch  of  condyle 

Gangrene.     Died  June  13,  1864; 

Wisconsin,  age  25. 

1864. 

left  foot  and  leg  in  very  bad      18G4. 

removed,   by  Ass't  Surg.  S. 

pyasmia.     Spec.  2600.     (Ampu 

condition. 

B.  Ward.  U.  S.  V. 

tation  was  a  last  resort.) 

26 

Glazier,  J.  M.,  Pt.,  H,  55th 

May  31,   Wounds  through  both  ankles  ;    June  4, 

Antero-post.  flap  «tt  left  knee 

Died  June  10,  1862;  pyaemia. 

New  York,  age  27. 

1862. 

comminution  left  ;  fract.  right;  '    1802. 

joint,  bv  Surg.  R.  13.  Bontecou, 

swollen  and  sloughing. 

r.  s.v. 

27 

Headley,  S.  G.,  Pt.,  F,  12th 

May  10,   Conoidal  ball  commin.  fract.  of  Mav  18, 

Flap   amputation,    by   A.   A. 

Tendency  to  slough.     Died  May 

New  jersey,  age  34. 

1864. 

up.  third  of  right  lib.  and  fib.;  ;     1804. 

Surg.  W.  II.  Ensign. 

30,  1864. 

j't  swollen  and  erysipelatous. 

• 

28 

Ilennessij,    D.,    Pt.,    I,    8th 

May  5, 

Shot  frac!.  up.  third  left  tibia;    May  17, 

Amputation  at  knee  joint,   by 

Died  August  27.  ]  802.    Spec.  929. 

Alabama. 

1862. 

knee  joint  opened  by  fissures. 

1802. 

A.  Surg.  J.S.  Billings,  U.S.A. 

29 

Hicks,    W.,  Serg't,   B,    14th 

July  1, 

Left  tibia  seriously  injured  and    July  25. 

Long  ant.  flap,  leaving  patella 

Slough.     Died  Aug.  10,  '63  ;  oxli. 

Tennessee,  age  28. 

1803. 

partly  fractured:  sloughing  :  '     1863. 

and  condyles.  by  A.  A.  Surg. 

Spec.  2051.     BUINTOX   (J.  11.), 

hoem.  from  post,  tibial  artery. 

•J.  A.  Draper. 

Am.  Jour.  Mcd.  Sci.,  1868,  Vol. 

55,  p.  324. 

30 

Hoscid,  A.,  Pt.,  I,  4th  Mary 

May  7, 

Conoidal  ball  fract.  of  malleo-  'May  15, 

Ant.  post.  flap,    retaining  pa 

Slough.   Died  May  28.  '04  ;  gang.; 

land,  age  27. 

1804. 

lus  and  astragalus;  left  foot      18'64. 

tella  and  condyles,  by  Ass't 

absorption.    Am.Jour.Me.d.Sci., 

and  ankle  much  swollen. 

Surg.  H.  Allen,  U.  S.  A. 

1805,  XLIX.  p.  33. 

31 

Jewell,    W.,    Pt.,    D,     59th 

May  10, 

Conoidal  ball  fracture  of  meta-    May  22, 

Long  post,  flap,  by  Surg.  C.  B. 

Mav  24th,  delirium.     Died  May 

Georgia. 

1804. 

tarsal  bones.                                     1864. 

Gibson,  C.  S.  A. 

29,  1804. 

32 

Lepper,  A.  A.,  Corp'l,  L,  8th 

May  20, 

Comminuted  fract.  up.  third  of  June  13, 

Rectangular  flaps;  circ.   sect. 

Slough.:  gang.;  colliquativcdiar. 

Iowa  Cavalry,  age  27. 

1804. 

left  tibia  by  con.  ball;    foot 

1864. 

muscles:  condyles  sawn  off, 

Died  June  10,   1804;  pyaemia. 

swollen  and  cedematous. 

by  Surg.  H.  It.  Taylor,  U.S.V. 

Spec.  3758. 

33 

McConnell,  D.  W..  Pt.,   H, 

April  6, 

Shot  fracture  of  the  leg  April  10. 

Amputation,  by  Ass't  Surg.  W. 

Slough.:    iiitermed.  amp.  thigh. 

4Gth  Ohio. 

1862. 

1802. 

I).  Turner,  1st  Illinois  Light 

Died  April  25.  1802.     (TAHLK 

Artillery. 

XXXVI,  No.  481,  p.  300.) 

34 

McFarlaml,  A.,  Pt.,  I,  150th 

Mav  10, 

Ball  lodging  in  articulation  be-  '  May  27, 

Anteriorcival  skin  flap,  by  Surg. 

May  29th.  gamy.,  which   caused 

Penn.,  age  23. 

1864. 

side  right  external  malleolus  ;       1804. 

E.  Bentley,  U.  S.  V. 

death  Juno  7,1804. 

tissues  cedi'matous. 

35 

McKenna,  J.,    Pt.,   D,   39th 

April  2,    Conoidal   ball    wound   of   left   April  24, 

Circular    amputation    at   knee 

Died  May  2,  1805;  exhaustion. 

New  Jersey,  age  2!». 

1865. 

ankle  ;  infiltration   of  pus  in 

1865. 

joint,    by  Surg.  E.   Bentley, 

tissues  of  leg. 

U.  S.  V." 

36 

Mansfield,  M.,  Corp'l,  F,  2d 

Mav  31, 

Shot  fracture  of  right  tibia,  ex 

June  4, 

Post,   flap  ;    ant.  incision  from 

Died  June  16,  1864  ;  pyaemia. 

Connecticut  H'vy  Artillery, 

1864. 

tending  into  knee  joint. 

1804. 

condyle  over  mid.  of  patella, 

age  21. 

and  condyles  sawn  off,  by  A. 

A.  Surg.  J.  F.  Thompson. 

37 

Marys,  D.,  Pt.,  C,90th  Penn 

Mav  5, 

Shot  wound  of  right  leg  ;  parts 

May  10, 

Amputation  at  knee  joint,  by 

Popliteal  sloughed  :  luem.,  50  oz. 

sylvania. 

1864. 

gangrenous. 

1804. 

Surg.  J.  Ebersole,  19th  Ind. 

May  20th,   amp.   thigh.     Died 

Mav20,'G4.  Spec.  2340.  (TABLE 

XXXVI.  No.  475,  p.  ."00.) 

38 

Mearns,  J.,  Pt.,  D,  154th  N. 

May  4, 

Shot  wound  of  leg  

May  14, 

Amputation  at  the  knee  joint. 

Died  June  7,  1803;  haemorrhage 

York,  age  22. 

18G3. 

18G3. 

and  anasmia. 

39 

Murray,  J.,  Pt.,  B,  51st  N. 

May  6, 

Shot  wound  of  right  ankle.  .  .  . 

Mav  18, 

Amputation  at  the  knee  joint. 

Died  May  20,  1864. 

York. 

1804. 

1864. 

40 

Ostre,  P.,  Pt.,  H,  72d  New 

Mav  10, 

Conoidal  ball  fracture  of  tibia. 

May  21, 

Long  anterior,  short  post,  flap,     Died  June  1,  '(54  ;  pyaemia.     U.  S. 

York,  age  21. 

18"G4. 

ankle  joint  opened;  leg  swol 

1864. 

leaving  patella.  byAss't  Surg.       .Van,  Com.  Mans.,  Surg.  Vol.  1, 

len  to  knee. 

(',.  A.  Mtirsick,  U.  S.  V.                p.  522. 

41 

Parks,  L.  C.,  Pt.,   E,    llth 

June  1, 

Ball  lodged  in  condyle  of  left 

June  7, 

Ant.  skin  and  post.  muse,  flaps  : 

,Iune  10th.  gangrene.     Died  June 

Vermont,  age  28. 

1864. 

femur,   splitting  it  into  knee 

1864. 

J  inch  of  condyles  of  femur 

17,  1864  ;  prostration. 

joint. 

removed,  by  Surg.  E.  Bent- 

ley,  U.  S.  V. 

SECT.  IV.] 


SECONDARY    AMPUTATIONS    AT    THE    KNEE    JOINT. 


407 


NO. 

NAME,  MILITARY 
DESCRIPTION,  A.ND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

42 

Rhinehart,  C.,  Pt,,  K,  74th 

Aug.  27, 

Shot   wound  of  leg;   primary 

Sept.  21, 

Circular  amputation  at    knee 

Died  September  23,  1862;  gan 

Pennsylvania,  age  21. 

1862. 

amputation  up.  third  ;  slough 

1862. 

joint,  by  Surg.  E.  Bent  ley, 

grene. 

ing. 

U.  S.  V. 

43 

Sandford,    W.    W.,    Pt.,  F, 

Dec.  18, 

Ball  passed  between  bones  of 

Jan.  10, 

Antero-posterior  flaps;  condyles 

Jan.   llth,   chill   and   dyspnrea. 

103d  Pennsylvania,  age  21. 

18G2. 

right  leg  3  ins.  below   knee 

1863. 

were  sawn  off  and  patella  re 

Died  Jan.  12,  1863;  pyaemia. 

joint  ;  tibia  indented  ;  pus  in 

moved,  by  Surg.  E.  P.  Mo- 

synovial  cavity. 

rony  2d  Maryland. 

44 

Schreiber,   A.,  Pt.,  A,  50th 

May  10, 

Wound  of  both  legs  ;  fracture 

May  19, 

Antero-posterior  flap,  remov'g 

June  1st,  pysemic  symp.     Died 

Pennsylvania,  age  17. 

1864. 

of  right  tibia:    round   ball; 

1864. 

patella,  by  Surg.  11.  B.  Bonte- 

June  9,  1864;  pyaemia. 

19tb.  haetn.;  lig.  post.  tib.  art. 

cou,  U.  S.  V. 

45 

Sheldon.    C.   S.,   Serg't,  G, 

June  3, 

Grapeshot  fract.  left  ext.  inalle- 

June  22, 

Anterior  post,  flap,  bv  Surg.  K. 

Progress  unfavorable.  Died  June 

12th  New  Hampshire,  age 

1864. 

olus.  communicating  with  an 

1864. 

B.  Bontecou,  U.  S.'V. 

27,  1864;  exhaustion. 

81. 

kle  joint;  gangrenous. 

46 

Sweeney,   J.,    Pt.,    H,    9th 

July  18, 

Right  leg  shattered  by  a  grape- 

July  27, 

Posterior  flap  amputation  at  t  he 

Died  July  28,  1863. 

Maine. 

1863. 

shot. 

1863. 

knee  joint. 

47 

extending  into  knee  joint. 

days  af 

leaving  patella;  sawing  oil'  ti]  is 

ation  ;  exhaus.:  pyaemic  symp. 

ter  inju 

of  condyles,  by  Ass't  Surg. 

BRINTON  (J.  ll.).Am.Jr>ur.Med. 

ry. 

C.  C.  Lee.  U.  S.  A. 

Sci.,  1868,  Vol.  5.3,  p.  324. 

48 

Veazie,  C.   IT.,    Pt.,    C,   1st 

Nov.  27, 

Fract.  and  extensive  comminu 

Dec.  6, 

Antero-posterior  flap  through 

Dec.  10th,  gangrene.     Died  Dec. 

Mass.  Cavalry,  age  21. 

1863. 

tion  of  r't  tibia  and  fibula  near 

1863. 

knee  joint,  by  Surg.  E.  Bent- 

21,  1863;  pyj-emia;  autopsy. 

ankle  j't;  much  ecchymosed. 

ley,  U.  S.  V. 

49 

Velsor,  A.,  Pt.,  D,  127th  N. 

Nov.  30, 

Ball  thro,  head  of  tibia,  fract. 

Dec.  9, 

Antero-posterior  skin  flaps,  by 

Died  Dec.  22,  1864  ;  pytemia. 

York,  age  36. 

1864. 

tibia  and  fibula;  knee  joint 

1864. 

Ass't  Surgeon  C.  F.  Reber, 

involved. 

U.  S.  V. 

50 

Wilhelm,   J.,   Pt.,    A,   37th 

May  17, 

Musket    ball    fracturing  both 

May  31, 

Amputation  at  the  knee  joint, 

Diffused  abscess  extending  to  hip. 

Ohio, 

1862. 

bones  of  left  leg  in  middle  ; 

1864. 

by  Surg.  J.  F.  Gabriel,  llth 

Died  June  14,  1862. 

sloughing. 

Ohio. 

51 

Chandler,  A.  J.,  Lieut.,  G, 

May  26, 

Fracture  of  right  tibia,  middle 

June  21, 

Amputation  at  knee  joint  thro' 

June  30,  '64,  sloughing  of  stump. 

40tb  Georgia,  age  25. 

1864. 

third  ;    conoidal   ball  ;    large 

1864. 

condyles,  leaving  patella. 

C.  S.  Med.  and  Surg.  Jour.,  Vol. 

ulcer  in  leg. 

2,  p.  33. 

Secondary  Amputations  at  the  Knee  Joint. — The  secondary  exarticulations  at  the 
knee  joint  numbered  twenty-six;  twelve  were  successful  and  fourteen  were  fatal,  a  mortal 
ity  of  53.8  per  cent.  In  four  cases  excision  in  bones  of  the  leg,  in  four  amputation  of  the 
leg,  and  in  one  amputation  of  a  toe,  had  preceded  the  amputation  at  the  knee. 

Successful  Cases  of  Secondary  Amputation  at  the  Knee  Joint. — The  patients  were  ten 
Union  and  two  Confederate  soldiers.  Two  of  the  ten  Union  soldiers  have  since  died;  the 
remaining  eight  were  pensioners  in  1880.  In  the  following  instance  primary  amputation 
in  the  middle  third  of  the  leg  had  been  performed  for  shot  fracture  of  the  ankle  joint. 
Sloughing  and  ulceratiori  followed,  and  the  limb  was  exarticulated  at  the  knee  fourteen 
months  after  the  ablation  of  the  leg: 

CASE  651. — Private  W.  Neveling,  Co.  N,  71st  Pennsylvania,  aged  26  years,  was  wounded  at  White  Oak  Swamp,  June  30, 
1682,  and  was  admitted  to  Broad  and  Cherry  Streets  Hospital,  Philadelphia,  one  month  afterwards.  Surgeon  J.  Neill,  U.  S.  V., 
reported  :  "The  injury  was  produced  by  a  mini£  ball,  which  entered  the  outer  side  of  the  right  ankle 
joint  and  passed  directly  through,  severely  comminuting  the  bones.  Amputation  of  the  leg  at  the  middle 
third  was  performed  the  same  day  on  the  field,  the  operation  being  performed  by  the  double  flap  method. 
The  wounded  man  was  taken  prisoner  and  remained  on  the  field  for  ten  days,  when  he  was  sent  to  Rich 
mond.  After  being  paroled  he  was  brought  to  this  hospital,  entering  on  July  30th,  at  which  time  the 
flaps  had  sloughed  and  both  bones  were  protruding  from  the  stump.  There  was  also  profuse  discharge 
of  unhealthy  pus,  and  the  patient's  health  was  very  much  broken  down.  Stimulating  poultices  were 
applied,  and  the  patient  was  ordered  extra  diet,  with  tonics,  milk  punch,  and  beef  tea.  Under  the  treat 
ment  adopted  new  tissue  developed  in  the  stump  arid  the  patient  improved;  but  his  recovery  was  neces- 
saiily  slow.  On  November  13th,  a  piece  of  necrosed  bone,  four  inches  in  length,  was  removed  from  the 
fibula,  and  three  days  later  a  large  piece  was  removed  from  the  tibia.  After  this  the  stump  improved 
rapidly  and  the  patient's  general  condition  continued  very  good  until  March  15,  1833,  when  he  injured 
the  ^tump  by  a  fall.  Immediately  after,  sloughing  recommenced,  which  was  not  checked  until  a  month 
had  elapsed  and  produced  a  condition  of  the  parts  from  which  recovery  was  slow.  Under  the  application 
of  fermenting  poultices,  with  solution  of  chloride  of  zinc  and  sulphate  of  copper  used  alternately,  the 
nicer  slowly  diminished.  On  June  22d,  when  the  patient  was  transferred  to  Satterlee  Hospital,  the  lower 
end  of  the  stump  appeared  to  be  made  up  of  a  carneo-osseous  matter,  on  the  extremity  of  which  there 
remained  an  nicer  about  two  inches  in  diameter."  Acting  Assistant  Surgeon  T.  G.  Morton  reported  the 
subsequent  progress  of  the  case  at  Satterlee  Hospital  as  follows:  "At  the  time  of  admission  the  stump 
was  still  unhealed,  and  from  the  end  of  the  bone  a  bulky  exostosis  sprang  out  as  large  as  an  orange.  The  tissue  over  this  growth 
was  constantly  ulcerating  and  painful,  and  the  disease  continued  to  involve  the  tibia  further  up,  reaching  as  high  as  the  liga- 
mentous  patella.  On  August  2?th,  I  proposed  amputation  at  the  knee  joint  for  the  reason  that  less  shock  follows  that  operation 
and  a  better  stump  is  obtained,  with  more  power,  from  non-division  of  the  muscles  of  the  thigh  and  non-interference  with  the 
medullary  canal,  lessening  the  danger  of  pyaemia.  I  made  a  long  anterior  and  short  posterior  flap,  leaving  the  patella  in. 


FIG.  251 . — Ilypcrostosis 
of  bones  of  risrht  leer,  after 
amputation.  Spec.  xi778. 


408  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

No  necrosis  followed  the  operation,  and  the  patient  recovered  with  a  most  useful  and  firm  stump."  The  patient  was  discharged 
from  service  March  3,  1864,  and  pensioned.  He  was  paid  December  4,  1879.  The  specimen,  numbered  2778  of  the  Surgical 
Section,  is  represented  in  the  annexed  cut  (FlG.  251),  and  forwarded  to  the  Museum  by  the  operator,  shows  an  extraordinary 
osseous  formation  at  the  divided  extremities  of  the  tibia  and  fibula,  due  to  an  exaggeration  of  the  natural  process  by  which  the 
extremities  of  the  bones  are  rounded  off,  and  presents  the  histological  characters  of  ordinary  callus.  The  sequestrum,  removed 
from  the  fibula  prior  to  the  second  amputation,  was  also. contributed  by  Surgeon  Neill,  and  a  cast  of  the  stump  of  the  disartic 
ulated  knee  was  furnished  by  Surgeon  I.  I.  Hayes,  U.  S.  V.  The  former  is  numbered  specimen  668,  and  the  latter  2458  of  the 
Surgical  Section.1 

CASE  652. — Corporal  E.  C.  Wright,  Co.  H,  21st  New  Jersey,  aged  19  years,  was  wounded  at  Frederick sburg,  May  3, 
1863,  by  a  solid  ghot,  which  carried  off  his  right  foot.  Amputation  of  the  leg  by  posterior  flap,  at  the  junction  of  the  middle  and 
lower  third,  was  performed  on  the  field  by  Surgeon  D.  McNeill,  21st  New  Jersey,  and  several  days  afterwards  the  patient  was 
sent  to  Washington,  where  he  entered  Judiciary  Square  Hospital.  He  was  discharged  from  service  June  13,  1863,  and  pen 
sioned.  Subsequently  the  stump  became  diseased,  inducing  the  pensioner,  in  January  following,  to  seek  relief  by  treatment  at 
St.  Luke's  Hospital,  New  York  City.  The  tibia  became  necrosed  and  cloaca  formed,  leading  to  sinuses  in  the  substance  of  the 
bone,  so  that  an  injection  would  find  its  way  through  the  canals.  On  June  23,  1864,  amputation  through  the  knee  joint  by 
antero-posterior  flaps  was  performed  by  Dr.  Gurdon  Buck,  the  cartilages  and  patella  being  allowed  to  remain.  Sulphuric  ether 
was  used  as  the  anaesthetic.  At  the  time  of  the  operation  the  patient  was  in  feeble  condition,  owing  not  only  to  the  amount  of 
pus  discharged  from  the  stump,  but  also  to  the  presence  of  an  abscess  in  the  region  of  the  liver,  which  had  formed  some  months 
after  the  first  amputation.  This  abscess  discharged  itself  by  a  track  passing  between  the  ribs  over  the  right  lobe  of  the  liver. 
There  had  been  no  admixture  of  bile,  however,  in  the  discharge,  nor  did  jaundice  exist  at  any  time.  A  succession  of  abscesses 
formed  during  the  healing  of  the  stump.  The  first  appeared  at  the  upper  boundary  of  the  synovial  sac  and  was  freely  laid  open 
by  Dr.  Buck.  Six  days  after  the  operation  a  tendency  to  slough  appeared,  and  permanganate  of  potash  was  applied  to  the 
affected  parts.  Dr.  Buck's  method  of  extension  by  weight  and  pulley,  with  bands  of  adhesive  plaster,  was  also  used  to  prevent 
the  retraction  of  the  edges  of  the  flaps  and  maintain  them  in  apposition.  This  afforded  great  relief  to  the  patient,  steadying  the 
limb  and  taking  all  the  strain  off  the  flaps.  On  September  1,  1864,. the  patient  was  discharged  from  hospital,  the  stump  being 
solid  and  well  rounded.  The  abscess  in  the  side  had  ceased  to  discharge.  In  the  following  month  the  pensioner  was  fitted  with 
an  artificial  leg  by  Dr.  E.  D.  Hudson,  of  New  York  City.  Pension  Examining  Surgeons  who  have  inspected  the  stump  have 
described  it  as  a  "very  good"  one,  and  the  pensioner  has  reported  its  condition  as  "sound  and  healthy."  He  was  paid  March 
4,  1880. 

CASE  6"3. — Private  H.  A.  Steward,  Co.  B,  8th  Pennsylvania  Reserves,  aged  23  years,  received  a  fracture  of  the  right 
leg  by  a  fragment  of  a  shell,  at  Gaines's  Mill,  June  27,  1862.  He  was  conveyed  to  Washington,  where  he  remained  under 
treatment  at  the  Cliff  burn  Hospital  until  November  20,  1862,  when  he  was  discharged  and  pensioned,  Surgeon  H.  Bryant,  U.  S.  V., 
certifying  to  "exsection  of  a  large  portion  of  the  tibia  in  consequence  of  the  wound."  Examiner  George  McCook,  of  Pittsburg, 
December  17,  1863,  testified  to  the  injury,  and  that  "exfoliation  is  going  on  in  a  slight  degree.  He  can  walk  inconveniently," 
etc.  The  pensioner  subsequently  entered  the  Good  Samaritan  Hospital,  Cincinnati,  where  the  injui'ed  limb  was  amputated  on 
April  1,  1867,  by  Dr.  Thomas  H.  Kearney,  who  certified  as  follows:  "I  amputated  the  log  through  the  knee  joint,  the  section  of 
the  bone  being  performed  through  the  condyles  of  the  femur.  The  amputation  was  rendered  necessary  in  consequence  of  inflam 
mation  of  the  tibia,  leading  to  abscesses  and  general  infiltration  of  the  tissues.  Removal  of  the  condyles  was  necessitated  in 
consequence  of  the  want  of  sufficient  healthy  integument  to  cover  them.  The  wound  he  had  received  involving  the  tibia,  doubt 
less  left  it  impaired  in  vitality  and  prone  to  attacks  of  inflammation,  such  as  rendered  its  removal  ultimately  necessary."  The 
Quincy  Examining  Board,  in  1872,  reported  that  "the  flaps  have  sloughed  from  gangrene,  leaving  the  bone  only  covered  with 
tender  cicatricial  tissue,  which  often  gives  away  and  becomes  an  open  ulcer,"  etc.  The  pensioner  was  paid  March  4,  1880. 

Fatal  Cases  of  Secondary  Amputation  at  the  Knee  Joint — Fourteen  operations  were 
performed,  three  on  Confederate  and  eleven  on  Union  soldiers.  The  fatal  results  were 
attributed  to  pyaemia  in  three,  to  erysipelas  in  one,  to  exhaustion  in  eight  instances: 

CASE  654. — Private  P.  Fallon,  Co.  D,  llth  Infantry,  aged  20  years,  was  wounded  in  the  left  leg,  at  Gaines's  Mill.  June 
27,  1862.  He  was  captured  by  the  enemy  and  remained  a  prisoner  for  one  month,  when  he  was  exchanged  and  conveyed  by  the 
Hospital  Steamer  Daniel  Webster  to  Philadelphia.  Acting  Assistant  Surgeon  R.  R.  Thomas  recorded  the  following  description 
of  the  case:  "The  patient  entered  the  Episcopal  Church  Hospital  July  30th,  there  being  an  irregular  cavity  in  the  front  of  his 
injured  leg,  running  into  the  tibia  but  not  reaching  the  fibula.  He  had  been  wounded  by  a  bullet,  which  entered  about  nine 
inches  above  the  inter-malleolar  space,  and  was  extracted,  in  part,  two  days  after  his  admission.  The  opening  in  the  leg  was 
about  one  and  a  half  inches  square  and  about  one  inch  deep,  its  sides  being  formed  by  necrosed  bone  and  injured  flesh.  Pieces 
of  bone  had  been  taken  out  on  previous  days,  and  the  patient  was  doing  well.  On  August  6th,  Acting  Assistant  Surgeon  R.  S. 
Kenderdine  amputated  the  leg  at  the  knee  joint.  On  August  22d,  secondary  haemorrhage  occurred  from  ulceration  and  resulted 
in  considerable  loss  of  blood,  the  patient  being  found  quite  blanched.  A  tourniquet  was  then  applied  and  the  instruments  were 
gotten  ready  to  tie  the  bleeding  vessel ;  on  loosening  the  tourniquet,  however,  the  bleeding  was  found  to  be  arrested  and  no  liga- 
tion  necessary.  The  patient  died  October  6,  1862,  worn  out  by  puriform  discharges  and  of  pyaemia.  The  end  of  the  stump  was 
in  pretty  good  condition,  but  large  abscesses  had  formed  in  the  thigh,  and  his  back  was  covered  with  bed  sores."  The  upper 
half  of  the  amputated  tibia,  with  the  integument  over  the  wound  of  entrance,  enlarged  by  sloughing,  attached,  was  contributed 
to  the  Museum  by  the  operator  (Cat.  Sunj.  Sect.,  1866,  p.  396,  Spec.  500).  The  specimen  shows  an  oblique  fracture  of  the  bone, 
with  comminution,  and  a  portion  of  the  bullet  remaining  in  the  medullary  canal.  The  cavity  in  the  shaft  is  also  exhibited,  and 
the  posterior  surface  of  the  shaft  is  covered  with  a  moderate  layer  of  new  osseous  tissue. 

1  A  brief  abstract  of  this  case  was  published  by  Dr.  JOHN  H.  BRINTOX,  On  Amputation  at  the  Knee.  Joint  and  at  the  Knee,  in  Am.  Jour.  Mf.d.  Sci., 
1868,  Vol.  LV,  p.  3i9. 


SECT.  IV.J 


SECONDARY    AMPUTATIONS    AT    THE    KNEE    JOINT. 


409 


TABLE  LVII. 
Summary  of  Twenty-six  Cases  of  Secondary  Amputation  at  the  Knee  Joint  for  Shot  fracture. 


[Recoveries,  1— 12;  Deaths,  13—26.1 


NO. 

NAME,  MILITAUY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATUKK  OF  INJURY. 

DA-IK 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Brady.  J.    W.,  Pt.,  E,    Gth 

Aug.  29, 

Shot  wound  of  the  leg  '  Nov.  20 

Amp.  at  left  knee  j't,  by  Surg. 

Recovery. 

Louisiana. 

186V. 

1863. 

J.  C.  Nott,  C.  S.  A. 

2 

Bronchard,  A.,  Pt.,  A,  5th 

April  7, 

Fract.  meta.  bones  of  left  foot  ;   Feb.  18, 

Amputation   at  knee  joint,  in 

Amputation  of  thigh  nearmiddle; 

New  Hampshire,  age  31. 

1865. 

oonoidal  ball;  April  17,  exc. 

1866. 

New  York  City  Hospital. 

recovery  ;  1870,  stump  healthy. 

ineta's  ;   May   15,   amp.   leg. 

(TABLK  XXXIX,  No.  11,  p.313.) 

Disoh'd  Aug.  12.  1865. 

3 

Frost,    N.   G.,    Pt.,  G,    32d 

July  30. 

Shot  fi-act.  left  leg  :  prim.  amp. 

Mav  29, 

Amp.  knee  joint,   patella  re 

April,  1866,  leg  in  bad  condition  ; 

Maine,  age  34. 

1864. 

at  mid.  third.     Disch'd  Feb. 

1865. 

tained,  by  Dr.  J.  Lord,  Nor 

1870,  stump  tender  and  irreg 

8,  1865. 

way,  Maine. 

ular. 

4 

Marseiu,    J.,   Pt.,   A,    115th 

Feb.  20, 

Musk't  ball  lodged  in  r't  patella; 

Mav  28, 

Antero-posterior  flap  ;    1    inch 

Haemorrhage  :  ice  ;  flap  healed  al 

New  York,  age  28. 

1864. 

remo'd  on  21st.     Disch'd  May 

1866. 

of  extremity  of  oondyles  of 

most  by  first  intention  ;  left  hos 

2:!,'65  ;  anchy.  knee  j'nt.  May, 

femur  sawn   off;   patella  re 

pital  cured,  July  28/66.     BlUX- 

186(i,  leg  atrophied  ;  condy.  of 

tained,  by  Dr.  E.  Mason,  New 

TOX  (J.H.)..-lm.  Jour.  Med.Sci., 

femur  eroded. 

York  City. 

1868,  Vol.  55,  p.  321. 

5 

Neveling,  W.,  Pt.,    N,  71st 

June  30, 

Con.  ball  shattering  bones  of 

Aug  27,   Long  ant,  and  short  post,  flap, 

Disch'd  March  3,  '64.    Specs.  668, 

Pennsylvania,  age  26. 

1862. 

right  ankle.    Prim.  amp.  mid. 

1863. 

retaining  patella  and  condy  les 

2458,  2778.    BRINTON  (J.  H.), 

third;    sloughing.      Nov.  13, 

of  femur,  by  A.  A.  Surg.  T. 

loc.  cit.,  p.  319. 

sequestra  removed. 

;     G.  Morton. 

6 

Pattee,  J.  H.,  Pt.,  D,  26th 

Sept.  19, 

Shotfract.  mid.  third  of  left.  tib.    Jan.  24,    Circular  amputation,  by  Surg. 

Disch'd  July  14,    1864;    stump 

Ohio,  age  23. 

1863. 

Sept.  21,  exo.  2  ins.;  boneexf.; 

1864.         J.  Y.  Finley,   2d  Kentucky 

sound,  1870. 

separation  of  bone  2  ins. 

Cavalry. 

7 

Perigo,  H.  C.,  Pt.,  B.   12th 

June  27, 

Hound  ball  fract.  of  mid.  third 

Mar.  14,   Long  anterior  flap,  leavingcon- 

Recovery  rapid  ;  discharged  Nov. 

New  York,  age  30. 

1862. 

right  tibia;  nee.;  large  seq.      1863.        dyles  and  patella,  by  A.  A. 

14.  186:i.   Spec.  2065.    BKIXTOX 

firmly  set.                                                       Surg.  J.  A.  Draper. 

(J.  II.),  loc.  cit.,  p.  323. 

8     Reeder.   J.   H.,  Pt.,    E,    1st 

Aug.  12, 

Fract.  upper  third  of  left  tibia;    Mar.  19,   Double  flap,  by  A.  A.  Surg.  O. 

Discharged  Nov.  8,  1865.     Died 

Colored  Troops,  age  22. 

1864. 

conoidal  ball  ;  necrosis. 

1865.    !     Shiftier. 

August  5,  1870. 

9     Steward,  11.  A.,  Pt.,  B.  8th 

June  27, 

Fraet.  right  tibia  ;  shell  ;  excis. 

April  1, 

Amputation  ;  removal  of  con- 

Gangrene;    sloughing  of   flaps; 

Pennsylvania,  age  23. 

1862. 

tibia.     Discharged   Nov.   20, 

1867. 

dyles  necessitated  by  want  of 

1872,  tender  covering  of  stump 

1862  ;  exfoliation  ;  general  in 

healthy  integument,   by   Dr. 

often  gives  way  and  becomes 

filtration  of  tissues. 

T.  II.  Kearney.  Cincinnati. 

an  open  ulcer. 

10 

Wall.  \V.,  Pt.,  D,  52d  North 

July  3. 

Con.  ball  fract.  left  tib.  and  met- 

Aug.  4, 

Flap  amputation,  leaving  pa 

Exchanged  March  17,  '64.    Spec. 

Carolina,  age  22. 

1863. 

atarsal  ;  tissues  slough,  nearly 

1863. 

tella  and  condyles,  by  A.  A. 

2061.  BRLNTON  (  J.  H.),  loc.  cit.. 

two-thirds    circumference    of 

Surg.  J.  A.  Draper. 

p.  324. 

leg- 

11 

Walter,    G.,    Pt.,    H,    98th 

July  2, 

Shell  fract.  of  mid.  third  of  left 

Nov.  8, 

Ant.  post,  flap,  retaining  patel 

Disch'd  Aug.  2,  1865.  Spec.  2791. 

Pennsylvania,  age  37. 

1863. 

leg;    gangrene;    tibia  much 

1863. 

la  and  condyles  of  femur,  by 

Died  Dec.  5,   1873.     BuiNTON 

diseased. 

A.  A.  Surg.  M.  S.  Perry. 

(J.  11.),  loc.  cit.,  p.  319. 

12 

Wright,  E.  C.,  Corp'l,  H,  21st 

May  3, 

Solid  shot  taking  off  right  foot  ; 

Juno  23, 

A'nt.  post,  flap,  cartilages  and 

Succession  of  abscesses.     Buck's 

New  Jersey,  age  19. 

1863. 

amp.  juncture  of  low.  thirds; 

1864. 

patella  allowed  to  remain,  by 

method  of  extension  to  prevent 

necrosis  of  tibia.    Discharged 

Dr.  Gurdon  Buck,  New  York 

retraction  of  flaps.     Recovered 

June  13,  1863. 

City. 

Sept.  1,  1864. 

13 

Adams,  D.  F..  Pt.,  A,  55tb 

July  l, 

Shot  fract.  June.  low.  thirds  left 

Aug.  29, 

Flap  amputation  left  knee  joint, 

Ascites;  general  anasarca.    Died 

North  Carolina. 

1863. 

tibia  (also  fract.  or'oital  arch 

1863. 

leaving   patella,    by    A.    A. 

Sept.  20,  1863.     Spec.  2049. 

and  flesh  wounds  right  leg): 

Surg.  C.  G.  M.  Griffith. 

necrosed  tibia. 

14 

Billington.  H.,   Pt.,  I,  110th 

Aug.  in, 

Conoidal  ball  inj'y  of  left  tibia; 

Sept.  26, 

Antero-posterior  flap,  bv  Ass't 

Died   September  28,    1864;    ex 

New  York,  age  45. 

1864. 

gangrene  ;  tibia  necrosed. 

1864. 

Surg.  C.  Wagner,  LI.  S.  A. 

haustion. 

15 

Fallon.   P.,   Pt.,  D,  llth  In 

June  27, 

Shot  lodged  in  left  leg.  Aug.  I, 

Aug.  6, 

Amputation  at  the  knee  joint, 

Aug.  22d,  haem.  from  ulcer.ition  ; 

fantry,  age  20. 

1862. 

ball  cxt.;  cavity  in  front  of  leg 

1862. 

by  A.  A.  Surg.  R.  S.  Ken- 

large  abscess  in  thigh  ;  bed  sores. 

excavated   into    tibia  1   inch 

derdine. 

Died  Oct.  6,  1862;  exhaus.  and 

square  and  deep. 

pyiemia.     Spec.  500. 

16 

Forbes,  W.  A.,  Pt,,  A.  55th 

July  1, 

Con.  ball  fract.  lower  third  left 

Aug.  6, 

Flap  amputation,  leaving  pa 

Died  August  11,   1863;  exhaus 

North  Carolina,  age  24. 

1863. 

tibia;  caries  and  nee.:  slough.; 

1863. 

tella,  by  Ass't  Surg.  B.  Stone, 

tion.     Spec.  2058. 

bone  exposed  one  fourth  its 

U.  S.  V. 

length. 

17 

Foster,  W.,  Pt.,  A,  22d  Ind., 

Aug.  7, 

Shot  fract..  fourth  toe,  left  foot  ; 

Nov.  24, 

Circular  amputation,  by  Ass't 

Died  November  27,  1864. 

age  22. 

1864. 

con.   ball;  amp.  toe;   gang.; 

1864. 

Surg.  11.  McGowan,  U.  S.  V. 

dis.  of  tibia  :  caries. 

18 

Garrity,  M.,  Pt.,  I,  9th  Mass., 

May  5, 

Right  tibia  extensively  commi 

June  10, 

Ant.  skin   and  post,  muscular 

Never  rallied  thoroughly;  wound 

age  25. 

1864. 

nuted   near  crest  ;   con.   ball 

1864. 

flaps;  condyles  of  femur  re 

did  well,  nearly  uniting.     Died 

lodged  ;  suppurat'n  from  knee 

moved,  bv  Ass't  Surg.  S.  B. 

June  17,  '64  ;  prostration.    Spec. 

to  ankle. 

Ward,  U.'S.  V. 

2551. 

19 

Grainger,  S.  M.,  Pt.,  A,  38th 

Dec.  30, 

Shot  fracture  of  left  tibia  and 

Mar.  15, 

Malgaigne's  oval  flap  amputa 

April  1,  1863,  haetn.  from  branch 

Indiana,  age  23. 

1862. 

fibula.   Jan.  14,  1863,  excision 

1863. 

tion  at  the  knee  joint. 

of  popliteal  :  sloughing.     Died 

fractured  portions.     Feb.  20, 

April  23,  1863  ;  pyaemia. 

gangrene. 

20 

Kane,  W.  H.,  Serg't,  1,  115th 

Aug.  16, 

Con.  ball  injury  of  left  tibia; 

Sept,  17, 

Antero-posterior  flap,  by  Ass't 

Sept.  25th,  haem..  15  oz.;  lig.  fern. 

New  York,  age  23. 

1664. 

gangrene  ;  tibia  exposed  five 

1864. 

Surg.  C.  Wagner,  U.  S.  A. 

Died  Sept.  26,  1864  ;  exhaustion 

inches. 

and  haemorrhage. 

21 

Peddie,  J.,  Pt.,  B,  139th  N. 

June  3. 

Shell  fracture  lower  third  left 

Aug.  1, 

Antero-posterior  flap,  by  Surg. 

Died  August  18,  1864;   exhaus 

York,  age  24. 

1864. 

tibia  ;  gangrenous. 

1864. 

R.  B.  Bontecou,  U.  8.  V. 

tion.     Spec.  3065. 

22 

Sager.    S.,  Pt..  K,   5th  Ver 

June  29. 

Fracture  middle  third  of  left 

Oct.  6, 

Antero-posterior  integument'ry 

Died  Oct.  9,  1862;  pyaemia.  Spec. 

mont,  age  18. 

1862. 

tibia   and  fibula  by  a  round 

1862. 

flap;    patella    and    condyles 

270.     BUIXTOX  (J.  H.),  loc.  cit., 

ball. 

were  left. 

p.  323. 

23 

Sharp,    T.,    Corp'l,   I,    38th 

Feb.  6, 

Conoid,  ball  fract.  of  right  tibia; 

April  5, 

Circular  amp.  at  knee  joint,  bv 

Gangrene.     Died  June  23,  1864  ; 

Illinois,  age  30. 

1864. 

injury  of  artery.     Feb.  7,  exc. 

1864. 

Surg.  I.  Moses,  U.  S.  V. 

erysipelas. 

tibia;  slough.;  bones  carious; 

.  tibia  separated  3  inches. 

24 

Skilton,  G.  T.,  Pt.,  I,  36th 

June  3, 

Conoidal  ball  fract.  of  low.  third    Aug.  8, 

Antero-posterior  flap,  bv  Surg.  [  Aug.  10th,  gangrene  :  condyles  of 

Wisconsin,  age  31. 

1864. 

right  tibia  and  fibula  ;  gang.; 

1864. 

R.  B.  Bontecou,  U.  S.'V.               femur  protr.:  haem.     Aug.  30th, 

sloughinjr  of  post,  tibial  art.; 

amp  of  thigh.     Died  Sept.  19, 

August  4,  haemorrhage. 

1864.      (TABLE    XXXIX,    No. 

156,  p.  316.) 

25 

Toppings,  E.,Corp'l,  D,147th 

June  18, 

Conoidal  ball  fract.  of  mid.  third 

Oct.  10, 

Posterior  flap,  removing  patel 

October  20th.partial  union.    Died 

New  York,  age  29. 

1864. 

of  right  tibia  ;  necrosis. 

1864. 

la,  by  A.  A.  Surg.  H.  Board- 

May  1  1,  1865  ;  variola. 

man. 

26 

Waddell,  W.  E.,  Pt.,  H,  1st 

Julv  3 

Conoidal  ball  fracture  of  exter 

Aug.  8, 

Flap,  leaving  patella,  by  A.  A. 

Died  August  12,  1863;  exhaus 

Virginia,  age  33. 

1863. 

nal  malleolus  of  right  tibia, 

1863. 

Surg.  C.  G.  M.  Griffith. 

tion.    Spec.  2064. 

opening  ankle  joint  jslough'g. 

SURG.  Ill— S2 


410 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Amputations  at  the  Knee  Joint  of  Uncertain  Date. — The  date  of  the  exarticulation 
at  the  knee  was  not  reported  in  four  cases.  Two  of  the  patients  were  Confederate  and  two 
Union  soldiers.  Of  the  latter  one  died,  the  other  is  a  pensioner.  The  meagre  details  are 
recorded  in  the  following  summary : 

TABLE  LVIII. 
Summary  of  Four  Cases  of  Amputation  at  the  Knee  Joint  of  Uncertain  Date. 

[Recoveries,  1—3;  Death,  4.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

2 
3 

Faubion,    H.,    Pt.,   K,    9th 
Texas. 

Keefe,    P.,    Seaman,    U.   S. 
Brig  Perry,  age  24. 
Moore.  J.  R.,  Lieut.,  K,  33d 

Before 
June  H), 
1863. 
April  28, 
18(33. 
Before 

Gunshot  wound;  fract.  of  knee 
joint. 

Shot  wound  of  left  ankle  
Shot  fracture  of  left  leo- 



Amputation  at  the  left  knee 
joint. 

Amputation  at  the  knee  joint.  . 

Transferred  August  19,  18fi3. 

Discharged  November  12,  1864  ; 
pensioned. 
Transferred  September  30   1864 

4 

North  Carolina. 
Call,  G.,  Pt.,  H,  18th  Ohio. 

Aug.  2C, 
1864. 
Dec.  31, 

Died  January  1C   1863 

1862. 

Adding  to  the  one  hundred  and  eighty-nine  cases  of  amputations  at  the  knee  joint 
performed  for  shot  fracture  during  the  American  civil  war,  six  cases  of  exarticulation  for 
shot  flesh  wounds,  cited  in  TABLE  VII,  on  p.  56,  one  hundred  and  twenty-eight  cases  col 
lected  in  Note  1,  on  p.  397,  and  four  operations  performed  by  medical  officers  of  the  United 
States  Arrny1  since  1871 ,  not  heretofore  published,  we  have  in  the  annals  of  surgery  a  total 

1  The  exarticulations  at  the  knee  joint  performed  in  the  United  States  Army  since  the  date  of  the  publication  of  Circular  3,  A  Report,  of  Surgical 
Cases  Treated  in  the  Army  of  the  United  States  from  1865  to  1871,  Washington,  War  Department.  S.  G.  O.,  1871,  are:  1.  Private  G.  Grove,  Co.  F,  2d 
Infantry,  aged  34  years,  while  firing  a  small  swivel  gun  near  Mount  Vernon  Barracks,  Alabama,  July  5,  1875,  was  wounded  by  the  bursting  of  tho  piece, 
a  fragment  of  which,  weighing  six  and  a  half  pounds,  passed  through  his  left  leg,  earning  away  a  portion  of  both  bones  to  within  a  short  distance  of  the 
knee  joint,  destroying  the  main  arteries  and  lacerating  the  soft  parts.  The  fracture  extended  into  the  articulation.  The  man  had  been  drinking  excessively, 
and  the  injury  occurring  some  distance  from  the  post,  considerable  haemorrhage  took  place  before  assistance  could  be  procured  and  a  tourniquet  applied. 
While  bein'.j  conveyed  to  hospital  he  fainted  several  times  and  had  involuntary  evacuations  of  faces  and  urine.  No  reaction  taking  place  and  the  venous 
haemorrhage  being  uncontrollable,  the  patient  was  with  difficulty  etherized,  and  disarticulation  was  rapidly  performed  by  Assistant  Surgeon  J.  1C.  Corson, 
U.  S.  A.  The  operation  was  performed  without  removing  the  patella,  the  condyles  of  the  femur  being  sawn  through,  and  a  long  anterior  and  short  posterior 
flap  being  made.  There  was  scarcely  any  arterial  haemorrhage,  and  only  two  vessels  besides  the  popliteal  were  ligated.  Reaction  was  slow,  and  irritability 
of  the  stomach  great  on  account  of  the  large  amount  of  liquor  imbibed.  The  wound  was  closed  with  silk  sutures;  adhesive  strips  and  water  dressings  and 
carbolic  acid  solution  were  applied.  The  case  progressed  favorably  and  the  stump  had  almost  closed,  the  man  being  able  to  sit  up,  when,  on  July  27th, 
erysipelas  ensued  with  symptoms  of  an  alarming  nature.  Sloughing  of  the  flaps  followed,  and  an  abscess  formed  on  the  outer  side  of  the  thigh.  Under  the 
local  application  of  hot  fomentations  and  the  internal  administration  of  tincture  of  chloride  of  iron  the  inflammation  subsided.  About  one  month  afterwards 
the  stump  had  almost  entirely  healed,  having  the  appearance  of  being  a  good  one  as  regards  bearing  pressure.  On  December  (i,  1875,  the  patient  being 
entirely  cured,  he  was  discharged  from  service  and  sent  to  the  Soldiers'  Home.  The  bones  of  the  amputated  log  and  the  removed  ends  of  the  condyles  of 
the  femur,  together  with  the  fragment  of  the  gun  which  inflicted  the  injury,  were  contributed  to  the  Museum  by  the  operator,  and  constitute  specimen  6581 
of  the  Surgical  Section.— 2.  Sergeant  H.  F.  Gude,  Co.  G,  12th  Infantry,  was  wounded  in  the  battle  at  the  Modoc  Caves,  Lava  Beds,  California,  April  15, 
1873.  by  a  conical  bullet,  which  caused  a  compound  comminuted  fracture  of  the  right  tibia  at  tho  upper  third  and  wounded  the  posterior  tibial  artery.  Both 
ends  of  the  vessel  were  ligated  and  temporary  splints  were  applied  on  the  field.  The  wounded  man  was  conveyed  to  hospital  at  Peninsula  Tula  Lake, 
California,  where  Smith's  anterior  splints  were  employed.  The  leg  was  swollen,  and  mortification  had  appeared  about  the  wound  on  April  19th,  when 
amputation  at  the  knee  joint  was  performed  by  Assistant  Surgeon  H.  McElderry,  U.  S.  A.,  the  patella  being  dissected  out  and  the  articulating  surface  of 
the  femur  removed.  The  patient  suffered  high  surgical  fever  and  constitutional  excitement.  During  the  period  of  suppuration  the  flaps  retracted  and  the 
suture  was  torn  out.  The  treatment  consisted  of  antiseptic  applications,  tonics,  and  stimulants.  In  October  following  the  stump  had  healed,  and  on  Jan 
uary  7,  1874,  the  patient  was  transferred  to  his  command. — 3.  Private  F.  Ileber,  Co.  M,  1st  Cavalry,  aged  32  years,  was  wounded  in  the  right  arm  and 
right  leg  during  the  fight  at  Clearwater  River,  I.  T.,  July  11,  1877.  He  arrived  at  the  field  hospital  at  Grangevillc  three  days  alter  tho  injury,  and  six 
days  later  he  reached  the  post  hospital  at  Fort  Lapwai.  During  the  night  previous  to  his  arrival  at  the  latter  place  a  profuse  haemorrhage,  probably  from 
the  anterior  tibial  artery,  occurred,  which  was  quickly  arrested  by  compression  of  the  femoral  artery  by  Surgeon  G.  M.  Sternberg.  U.  S.  A.,  who,  as  soon 
as  candle  lights  could  be  procured  and  a  tourniquet  applied,  placed  the  man  under  the  influence  of  ether  and  enlarged  the  wound  in  the  upper  part  of  the 
calf  of  the  leg  for  the  purpose  of  securing  the  bleeding  vessel.  It  was  then  discovered  that  the  head  of  the  tibia  was  badly  shattered  by  the  ball,  which 
entered  two  inches  below  the  knee  joint,  perforating  the  bone  and  comminuting  it  to  a  considerable  extent  posteriorly ;  and  amputation  through  the  knee 
joint  was  at  once  decided  upon  as  preferable  to  ligation  of  the  femoral  with  a  certainty  almost  that  amputation  would  have  to  be  performed  subsequently. 
The  operation  was  performed  by  Surgeon  Sternberg,  with  the  assistance  of  the  Hospital  Steward  only,  the  patient  being  feverish  from  his  wound,  which 
had  been  painful,  and  fatigued  from  his  transportation  in  a  farm  wagon.  The  stump  was  dressed  with  carbolic  acid  mixture.  A  largo  portion  of  the 
wound  healed  promptly,  but  some  sloughing  occurred  near  the  centre  of  the  extremity  of  the  stump.  On  August  7th.  when  the  patient  was  transferred 
to  Fort  Vancouver,  only  a  space  the  size  of  a  half-dollar  piece  remained  to  be  filled  by  granulations.  On  March  115,  1878,  the  patient  was  discharged 
from  sen-ice  entirely  cured  — 4.  Beatrice  Hanciva,  a  woman  twenty-two  years  of  age  and  in  the  third  month  of  pregnancy,  was  accidentally  shot,  at  or 
near  Fort  Clark,  Texas,  November  28,  1871.  A  full  charge  of  buckshot,  discharged  at  a  distance  of  a  few  feet,  passed  through  her  right  leg  at  the  junc 
tion  of  the  middle  and  upper  third,  shattering  the  bones  and  extensively  destroying  (he  soft  parts.  Acting  Assistant  Surgeon  A.  L.  Buflington  failed  to 
obtain  the  consent  of  the  patient  and  her  relatives  to  an  amputation  until  December  2d,  when,  in  consultation  with  Assistant  Surgeon  J.  II.  Patzki,  U.  S.  A., 
amputation  through  the  knee  joint  was  decided  upon.  The  amputation  was  performed  with  long  anterior  and  short  posterior  flaps,  retaining  the  patella 


SECT,  iv.)  SHOT    INJURIES    OF   THE   KNEE   JOINT.  41 1 

of  three  hundred  and  twenty-seven  amputations  at  the  knee  joint  for  shot  injury,  with  one 
hundred  recoveries,  two  hundred  and  twenty-four  deaths,  and  three  undetermined  results, 
giving  a  mortality  rate  of  69.1  per  cent. 

CONCLUDING  OBSERVATIONS  ON  SHOT  INJURIES  OF  THE  KNEE 
JOINT. — With  a  very  few  exceptions,1  writers  on  military  surgery  prior  to  the  American 
civil  war2  agreed  that  shot  wounds  of  the  knee  joint  with  fracture  of  the  articulating  sur 
faces  of  the  bones  required  immediate  amputation,  and  the  correctness  of  this  rule  seems 
to  have  been  generally  accepted  by  the  medical  officers  serving  in  the  Union  and  Confed 
erate  armies.  Surgeon  T.  H.  Squire,  89th  New  York  Volunteers,  in  his  note-book  of 
surgical  cases  at  the  Big  Spring  Hospital,  near  Sharpsburg,  Maryland,  on  October  16, 1862, 
writes:  "Every  knee  joint  fractured  by  a  ball  should  be  amputated,  and  the  quicker  the 
better.''  Surgeon  David  Judkins,  U.  S.  V.,  at  the  West  End  Military  General  Hospital, 
Cincinnati,  in  September,  1862,  reports:  "I  have  had  three  cases  here  of  shot  wounds  in 
the  knee  joint,  admitted,  one  in  twelve,  another  in  fifteen,  and  a  third  in  seventeen  days 
after  the  reception  of  the  injury,  in  all  of  which  the  hope  of  successful  issue  in  the  removal 
of  the  leg  by  amputation  had  passed  away.  They  all  died.  The  operation  should  have 
been  performed  on  the  field."  Surgeon  H.  S.  He  wit,  U.  S.  V.,  in  charge  of  the  Frederick 
Hospital,  Maryland,  January,  1863,  argues:  "The  absolute  law  of  strictly  primary  ampu 
tations  in  perforations  of  the  knee  joint  has  been  distinctly  asserted.  In  compound  frac- 

but  dividing  the  rectus  tendon  and  extirpating  the  lower  bursa.  The  condyles  were  not  removed,  and  only  four  ligatures  were  required.  The  wound 
was  closed  by  stitches  and  adhesive  straps.  The  stump  was  dressed  with  carbolated  ointment,  and  when  suppuration  had  commenced  it  was  syringed 
twice  a  day  with  solution  of  permanganate  of  potash.  The  popliteal  ligature  came  away  on  the  twelfth  day.  The  patient  (who  remained  ignorant  of  the 
loss  of  the  limb)  continued  to  do  well,  the  wound  healing  kindly,  until  December  20th,  when  rigors  were  soon  followed  by  marked  S3'mptoms  of  pyaemia, 
which  terminated  her  life  on  December  29th.  She  aborted  a  few  days  before  death. 

1  JOBERT  PE  LAMUALLE,  who,  according  to  PAL'!.  (Die  Conservative  Chirurgie  der  Gliede.r  oder  Darstellung  der  Mittel  and  Methoden,  welche  zur 
Vermeidung.  respective  Beschrdnkung,  der  Amputution  vnd  Knochen-Resectionen  sich  darbieten,  Breslau,  1859,  p.  192),  was  the  onlv  advocate  of  con 
servative  measures  in  shot  fractures  of  the  knee  joint,  contended  (Des  p  laics  d'armes  a  feu.  Communications  par  MM.  les  Docteurs  BAUDENS,  etc.,  Paris, 
1849,  p.  Ki6):  ''Les  plaies  p6netrantes  de  1'articulation  du  genou,  regardees  principalement  connne  necessitant  1'amputation,  ont  6te  traitees  par  la  position 
horizontale  et  par  uue  medication  antiphlogistique  tres  energique  et  les  cataplasmes  froids  C'e  traitement  a  et6  egalement  employe,  soit  que  les  os  fussent 
interesses,  ou  que  la  membrane  synoviale  ait  6to  seule  ouverte.  Trois  malades  ont  gu6ri  sur  six,  et  ou  sait  que  JOHN  BELL  avait  defie  qu'on  lui  montrat 
une  guerison  surmille."  But  nearly  fifty  years  before  JOIJEKT,  JEAN  MEHEE  (Trait '  des plaies  d'armes  ufeu,  Paris.  An.  VIII,  p.  170)  had  urged  conserva 
tion  in  such  cases :  "  Une  balle  pent  causer  un  grand  delabrement  dans  ces  articulations,  briser  les  os,  dechirer  les  tendons,  les  ligamens.  les  capsules ; 
accidens  tous  fort  graves,  mais  qui  n'indiquent  point  1'amputation.  Une  balle,  quelque  violente  contusion  qu'elle  cause,  ne  sauroit  detruire  les  ressources 
des  parties  qu'elle  frappe,  et  la  contusion  qu'elle  petit  causer  ne  s'etendant  que  dans  son  trajet  et  dans  les  parties  qu'elle  divise,  ne  presente  qu'une  indica 
tion  principale,  celle  des  incisions.  Lorsque  ces  incisions  sont  bieu  dirig6es,  et  que  1'escarre  est  divisee,  tous  les  accidens  que  pourroit  entrainer  1'espece 
de  contusion  que  la  balle  a  faite,  cessent,  et  1'amputation  ne  sauroit  etre  indiquee." 

2WisKMAN  ilv.)  (Severall  Chirurgicall  Treatises,  London,  167(>,  p.  430)  cites  a  case  of  shot  fracture  of  the  knee  joint:  "Death  followed,  as  com 
monly  it  doth  in  all  such  Wounds  of  the  great  joints.  Therefore  at  sea,  while  they  are  warm  with  heat  of  Fight,  we  dismember  them.'1  DESPOKT  ( Traite 
des  J'laies  d'Armts  ufeu,  Paris,  1749,  p.  225):  "  Si  toute  I'extremit6  inferieure  du  femur  est  fracassee  et  toute  la  partie  superieure  du  tibia,  et  plus  encore 
si  ces  deux  os  sont  fraeasses  a  la  fois,  il  est  absolument  indispensable  de  couper  la  cuisse.''  SCHMUCKEU  (J.  L.)  (Vermischte  Cliirurgische  Schriften, 
Berlin  und  Stettin,  1785,  B.  I,  pp.  37,  38)  declares  that  when  the  bones  of  the  knee  joint  are  comminuted,  its  ligaments  are  torn,  or  when  the  popliteal 
artery  is  shot  through,  amputation  must  be  performed  at  once:  "The  sooner  the  Qperation  is  done  the  better  will  be  the  result."  THOMSON  (JOHN) 
(Report  of  Observations  made  in  the  British  Hospitals  in  Belgium  after  the.  Battle  of  Waterloo,  Edinburgh,  1816,  p.  243):  "Immediate  amputation  has 
generally  been  acknowledged  to  be  particularly  necessary  in  wounds  in  which  bullets  have  passed  through  the  knee  joints  and  have  fractured  the  articu 
lating  surfaces  of  the  bones.  Almost  every  case  of  this  kind  which  we  saw  in  Belgium  seemed  to  afford  a  proof  of  the  propriety  of  this  rule  in  military 
surgery."  HEXNEN  (JOHN)  (Observations  on  some  important  points  in  thepractice  of  Military  Surgery,  Edinburgh,  1818,  p.  159):  "In  my  own  practice, 
I  have  met  with  only  two  cases  where  the  limb  was  saved  after  a  serious  injury  of  the  knee  joint,  and  in  one  of  them  only  was  the  perfect  use  of  it 
restored."  GTTHKIK  (G.  J.)  (Treatise  on  Gunshot  Wounds,  London,  1827,  p.  379):  "Wounds  of  the  knee  joint,  with  fracture  of  the  great  bones  com 
posing  it,  from  musket  balls,  require  amputation  .  .  from  an  extensive  practice  in  wounds  of  the  knee  joint,  with  fracture  of  the  articulating  surface  of 
the  femur  or  tibia,  1  have  no  hesitation  in  declaring  amputation  to  be  imperiously  demanded,  and  that  it  ought  to  be  performed  with  the  least  possible 
delay  consistent  with  propriety ;  and  on  no  account  should  the  surgeon  wait  to  give  the  wound  a  trial ;  for  I  most  solemnly  protest,  I  do  not  remember  a 
case  recover  in  which  I  knew  the  articulating  end  of  the  femur  or  tibia  to  be  fractured  by  a  ball  that  passed  through  the  joint,  although  1  have  tried  great 
numbers,  even  to  the  last  battle  of  Toulouse."  In  1855,  in  his  Commentaries  on  the  Surgery  of  the  War  in  Portugal,  Spain,  France,  etc.,  London,  Gth 
ed.,  1855,  p.  82.  the  same  author  remarks:  "Wounds  of  the  knee  joint  from  musket  balls,  with  fracture  of  the  bones  composing  it,  require  immediate 
amputation,  for  although  a  limb  may  be  sometimes  saved,  it  cannot  be  called  a  recovery,  or  a  successful  result,  where  the  limb  is  useless.1'  ESMARCH 
(F.)  ( Ueber  Ite.sectionen  nach  Schttsswunden.  Kiel,  1851,  p.  129):  "All  shot  wounds  of  the  knee  joint  in  which  the  epiphysis  of  the  femur  or  tibia  has  been 
injured  demand  immediate  amputation  of  the  thigh ;  this  is  a  deplorable  sentence,  already  given  by  the  best  authorities,  mid  which  our  experience  has 
fully  confirmed."  MACLEOD  (G.  II.  B.)  (A'otes  on  the  Surgery  ff  the  War  in  the  Crimea.  London,  1858,  p.  310)  remarks:  "The  knee  when  penetrated 
by  gunshot,  presents  an  injury  of  the  gravest  description.  Taking  much  interest  in  cases  of  this  description,  I  visited  every  one  I  could  hear  of  in  camp, 
and  can  aver  that  I  have  never  met  with  one  instance  of  recovery  in  which  the  joint  was  distinctly  opened,  and  the  bones  forming  it  much  injured  by  a 
ball,  unless  the  limb  was  removed."  LOHMEYEK  (C.  1'.)  (Hie  Schusswunden  und  ihre  Jiehandlung,  Gottingen,  1859,  p.  202):  "  But  when  the  capsule  is 
opened  and  the  condyles  of  the  femur  or  tibia  are  injured,  the  prospect  for  the  preservation  of  the  limb,  and.  should  the  latter  be  attempted,  for  the  pres 
ervation  of  life,  is  very  poor.  Therefore  amputation  of  the  thigh  is  always  indicated  in  such  wounds,  and  is  to  be  performed  as  early  as  possible.' 


412  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

tures  of  the  thigh  the  fatal  result  is  usually  the  indirect,  in  gunshot  wounds  of  the  knee  the 
direct,  result  of  the  accident.  Much  greater  latitude  both  as  respects  operation  and  the 
period  of  operation  in  the  former  than  in  the  latter  class  of  cases,  for  obvious  reasons, 
must  be  allowed.  The  shock  of  a  wound  of  the  knee  joint  when  recognized  by  the  system 
is  profoundly  constitutional  and  speedily  fatal,  in  obedience  to  an  obscurely  understood 
physiological  law.  When  the  joint  has  been  pierced  and  rent  in  the  wedge-like  manner 
described,  molecular  death  commences.  The  system  does  not  immediately  recognize  the 
fact,  and  this  explains  the  delay  of  shock  and  the  delusive  appearance  which  these  cases 
present.  At  a  varying  period  of  from  three  to  ten  or  twelve  days,  according  to  constitu 
tional  and  local  circumstances  and  the  rapidity  of  interstitial  degeneration,  postponed  shock 
occurs,  commencing  with  undefined  but  threatening  expressions  of  uneasiness,  and  attain 
ing  its  full  development  in  surgical  rigor  and  fatally  declining  reaction  in  typhoid  surgical 
fever,  with  pyaemia,  traumatic  pneumonia,  purulent  cachexia,  or  uraemia,  as  the  case  may 
be,  and  all  equally  indicating  hopeless  injury  overwhelming  vital  force."  Surgeon  A.  B. 
Crosby,1  U.  S.  V.,  advised  amputation  in  shot  fractures  of  the  articulating  surfaces  of  the 
knee  joint,  and  added:  "Slight  injuries  of  this  joint,  it  is  true,  may  recover  under  favorable 
circumstances,  although  injuries  seemingly  insignificant  often  prove  fatal."  Surgeon  J.  T. 
Woods,  99th  Ohio  Volunteers,  gave  it  as  his  experience2  that  "if  bony  structure  is  involved, 
fracture  and  comminution  produced,  the  only  warrantable  procedure  is  amputation,  the 
attempt  to  save  the  limb  no  less  than  a  wanton  robbing  of  the  unfortunate  sufferer  of  the 
only  chance  for  life,  by  operative  procedure."  Based  upon  his  experience  as  medical 
inspector  during  the  War.  Professor  F.  H.  Hamilton  declared,  immediately  after  its  close, 
that  the  surgeon  should  not  attempt  to  save  the  limb3  "when  the  fracture  implicates  the 
knee  joint,  or  even  when  it  is  near  the  knee  joint,  experience  having  shown  that  amputa 
tions  near  the  knee  joint  give  a  better  percentage  of  recoveries  than  any  other  thigh  ampu 
tations,  while,  on  the  other  hand,  attempts  to  save  the  limb  in  these  cases  give  a  worse 
percentage  of  success  than  in  any  other  fractures  of  the  thigh."  Equally  emphatic  are  the 
opinions  of  the  surgeons  of  the  Confederate  army.  Dr.  Hunter  McGuire4  says:  "As  Med 
ical  Director  of  a  large  army,  and  one  more  actively  engaged,  probably,  than  any  similar 
force  in  the  late  Confederacy,  I  saw  a  larger  number  of  these  cases  of  wounds  of  the  knees 
involving  the  extremity  of  the  bones,  but  not  one  which  recovered  without  amputation. 
Whenever  the  surgeon  persisted  in  his  effort  to  save  the  limb,  the  patient  died."  Confed 
erate  Surgeon  J.  W.  Thompson,5  of  Kentucky,  maintained:  "Gunshot  wounds  of  the  knee 
joint  have  claimed  much  attention  during  the  past  half  century  in  both  military  and  civil 
practice.  I  feel  confident  that  the  surgical  experience  in  our  late  war  in  reference  to  this 
class  of  wounds  is  largely  in  favor  of  primary  amputation,"  and  Confederate  Surgeon  T.  Gr. 
Richardson6  declared  that  during  his  whole  experience  in  the  army  he  did  not  witness  "a 
single  recovery  without  amputation  from  unmistakable  gunshot  wound  of  the  knee  joint, 
with  injury,  however  slight,  to  the  femur  or  tibia."  The  attempts  at  conservation  after 
shot  fractures  of  the  knee  joint  were  therefore  fewer  than  those  after  shot  fractures  of  the 

1  CROSBY  (A.  B.).  Gunshot  Injuries  of  the  Knee  Joint  requiring  Amputation,  in  Transactions  of  the  New  Hampshire  Medical  Society,  1864,  p.  31. 

2  WOODS  (J.  T.).  Gunshot  Knee  Joint  Injuries,  in  Ohio  Medical  and  Surgical  Journal,  1864,  Vol.  XVI,  p.  297. 


N  (P.  H.),  A  Treatise  on  Military  Surgery  and  Hygiene,  New  York.  1865,  p.  400. 

4McGuiUE  (HuNTF.lt),  Clinical  Remarks  on  Gunshot  Wounds  nf  Joints,  delivered  January  10,  1866,  at  Howard's  Grove  Hospital,  in  Jtidimond 
Medical  Journal,  I860,  Vol.  I,  p.  260. 

5  THOMPSON  (J.  W.),  Cases  nf  Resection  —  Fractures  of  Upper  Third  of  Femur  —  Gunshot  Wounds  of  Knee  Joint,  in  Nashville  Medical  Journal, 
I860,  Vol.  I,  p.  342. 

"RICHARDSON  (T.  G.),  Gunshot  Wounds  of  the  Knee  Joint,  in  New  Orleans  Medical  and  Surgical  Journal,  1866-67,  Vol.  XIX,  p.  57. 


SECT.  IV.]  SHOT    INJURIES    OF    THE    KNEE    JOINT.  413 

femur.  We  have  seen  on  page  175,  ante,  that  of  six  thousand  five  hundred  and  seventy- 
six  shot  fractures  of  the  shaft  of  the  femur,  three  thousand  four  hundred  and  sixty-seven, 
or  over  one-half,  were  throughout  treated  without  operative  interference;  but  in  only  eight 
hundred  and  sixty-eight,  or  about  one-fourth  of  the  three  thousand  three  hundred  and 
fifty-five  reported  cases  of  shot  fractures  of  the  articular  extremities  of  the  bones  of  the 
knee  joint,  conservation  of  the  limb  was  attempted,  and  this  preference  for  amputation  in 
shot  fractures  of  the  knee  joint  was,  in  many  instances,  not  so  much  due  to  the  teachings 
of  the  masters  of  surgery  of  the  first  half  of  the  present  century  as  to  the  sad  experience 
gained  from  the  attempted  practice  of  conservative  measures  which  a  number  of  the  Amer 
ican  surgeons  were  desirous  to  give  a  fair  trial.  Surgeon  J.  Moore,  U.  S.  A.,  Medical 
Director  of  the  Department  of  Tennessee,  after  the  battle  of  Chattanooga,  in  November, 
1863,  declared  that:  "The  attempts  at  conservative  surgery  in  wounds  of  the  knee  joint 
were  not  encouraging.  Of  sixteen  cases  reported  as  occurring  in  the  2d,  3d,  and  4th 
divisions,  seven  underwent  primary  amputation  and  seven  were  treated  without  amputa 
tion.  On  the  twenty-fifth  day  one  case  not  amputated  had  died  and  only  two  reported 
favorable  for  recovery."  Surgeon  M.  Gr.  Sherman,  in  charge  of  the  2d  division,  Twenty-first 
Corps,  in  a  letter  to  Medical  Director  A.  J.  Phelps,  reports  cases  of  shot  wounds  of  the  knee 
joint  observed  by  him,  and  remarks:  "Believing  the  surgeon  who  saves  a  limb  is  more 
justly  entitled  to  credit  than  he  who  operates  scientifically,  I  was  inclined  to  be  conserva 
tive  in  my  practice  and  treatment  of  those  who  came  under  my  care,  and  operated  only  when 
it  was  fully  apparent  the  patient  could  not  be  saved  without  an  operation,  and  was  com 
pelled,  as  a  result,  to  perform  more  secondary  operations  than  I  otherwise  should  have  been." 
Surgeon  I.  Moses,  U.  S.  V.,  believing  that  in  cases  of  shot  wounds  of  the  knee  "the  patients 
had  not  so  much  died  from  the  injury  itself  as  from  timid  surgery,"  the  surgeon  failing  to 
freely  lay  open  the  joint,  determined  to  save  the  limb  in  a  number  of  cases  under  his 
charge  at  the  hospital  at  Chattanooga,  in  the  summer  of  1863;  but  the  ultimate  results 
were  very  discouraging,1  and  Surgeon  Moses  had  to  admit2  that  he  had  "lost  confidence  in 
the  possibility  of  saving  gunshot  wounds  of  the  knee  joint,  involving  fractures  of  the  con- 

1  Dr.  I.  MOSF.S  (Surgical  Notes  of  Cases  of  Gunshot  Injuries  occurring  during  tlie  advance  of  the  Army  of  the  Cumberland,  in  the  summer  of  186:5, 
in  Am.  Jour.  Med.  Science,  April,  1864,  Vol.  XLVII,  pp.  339  et  seq.):  "  Ten  cases  of  wounds  of  the  knee  joint  were  admitted."     "  Of  these,"  Dr.  MO8ES 
reports  ''three  died  without  operation;  one  died  after  amputation;  one  died  of  secondary  haemorrhage  from  a  branch  of  the  popliteal  artery;  three  wore 
nearly  recovered  when  1  left  the  post,  September  15  [18(i3],  and  two  remained  with  fair  chances  of  ultimate  recovery.     Thus  we  have  one-half  the  cases, 
which  will,  in  all  probability,  be  saved  with  useful  limbs  and  various  amounts  of  motion  in  the  joints."     Surgeon  MOSES  admits  that  "these  cases  were 
treated  under  the  most  favorable  circumstances ;  the  physical  condition  of  the  men  was  most  excellent,  and  soon  after  the  reception  of  the  injury  they  wore 
taken  to  well-appointed  hospitals,  surrounded  with  comfort  and  with  every  luxury  of  diet  at  command,  and  skilful  surgical  attendance."     But  let  us 
examine  the  five  cases  of  alleged  recovery  after  shot  fractures  of  the  knee  joint,  cited  by  Dr.  MOSKS,  and  see  how  his  expectations  were  realized:  Private 
A.  Loutenschlager  (MOSES,  loc.  cit.,  CASE  V,  p.  341;,  Co.  A,  77th  Pennsylvania,  admitted  to  general  field  hospital  at  Murfreesboro',  Juno  27,  1863,  who,  it 
was  thought  on  September  15,  1803,  would  "recover  with  an  anchylosed  joint,"  died  on  September  26,  1863,  in  consequence  of  active  inflammation  and 
burrowing  of  pus  in  the  joint  and  up  the  thigh.     Captain  1'ettigrew.  20th  Tennessee  (MOSES,  loc.  cit.,  CASE  III,  p.  340),  admitted  to  general  field  hospital 
at  Murfreesboro'.  June  27,  1863,  and  declared  "beyond  all  danger"  on  September  Kith,  submitted  to  secondary  amputation  in  the  lower  third  of  the 

thigh  on  January  4,  1864.  and  died  on  January  7,  1864.     (See  TABLE  XL,  No.  178,  p.  322,  ante.)    In  the  case  of  Adjutant  Y [/.  R.  Youre],  Caswell's 

Georgia  Sharpshooters  (MosES,  loc.  cit.,  CASE  II,  p.  340),  admitted  to  hospital  No.  1,  Murfreesboro1,  June  26,  1863,  no  information  later  than  July  27, 1863, 
can  be  obtained,  when  the  prisoner  was  sent  to  Nashville  with  wound  healed  and  partial  anchylosis  of  joint.     Sergeant  Haynie  (MOSES,  loc.  cit.,  CASE  I, 
p.  :!40).  10th  Ohio  Cavalry,  wounded  at  Hoover's  Gap,  June  24.  1863  [not  June  6,  1863,  as  stated  by  Dr.  MOSES],  and  admitted  to  hospital  at  Murfreesboro', 
June  27th,  recovered,  was  promoted  to  1st  Lieutenant,  and  mustered  out  with   his  regiment  July  24.  1865.     This  case  is  reported  on   the  Murfreesboro' 
hospital  register  as  "a  fracture  of  the  patella,  carrying-  away  the  upper  half  of  it  and  opening  the  knee  joint."     Uaynie  is  not  a  pensioner.     Private  Edward 
Phipps,  Co.  F,  6th  Indiana  (MOSES,  loc.  cit.,  p.  341,  CASK  IV).  also  wounded  at  Hoover's  (Jap,  Tennessee,  June  24,  1863,  and  admitted  to  hospital  at  Mur 
freesboro',  June  27th  :  recovered,  and  was  discharged  September  20,  1864,  with  almost  complete  anchylosis.     He  is  a  pensioner,  and  Pension  Examiner 
G.  W.  MEAI'.S  reported,  on  September  24.  1864  :   "  Hall  entered  inside  right  knee,  and  ranging  outward  and  downward,  escaped  about  two  inches  lower 
clown,  upon  outside,  passing  into  joint  on  inside  and  through  upper  part  of  head  of  tibia  on  outside  ;     .     .     leg  weak,  and  a  partial  anchylosis  exists  with 
slight  angle  at  the  knee."     In  September,  1877,  the  Dayton  Board  of  Examiners  stated :  '•  There  is  a  creaking  in  the  joint  on  motion  being  made,  and  par. 
tial  anchylosis ;  leg  is  weak,  and  he  carries  a  cane  constantly."     Granting  that  in  the  two  cases  cited  last  the  articular  extremities  of  the  femur  or  tibia 
were  implicated,  which  is  by  no  means  certain,  we  find  that  of  the  8  cases  treated  conservatively,  possibly  3.  or,  considering  the  case  of  Youre  as  unde 
termined,  only  2  recovered,  a  mortality  rate  of,  respectively,  60.5  or  71.4  per  cent.     As  the  cases  cited  by  Surgeon  MOSES  have  been  made  a  basis  for  the 
advocacy  of  conservative  measures  in  shot  fractures  of  the  knee  joint  by  DEININGEH  (C.)  (Veber  die  conservative  Behandlung  der  Schusswunden  des 
Knief/elenkes,  MUnchen,  1867,  p.  28)  and  by  other  European  surgeons,  it  has  been  deemed  best  to  refer  to  the  cases  here  somewhat  in  detail. 

2  MOSES  (I.).  Surgical  Notes  of  Cases  of  Gunshot  Injuries  occurring  near  Chattanooga  in  the  Battles  of  September,  October,  and  November,  1803,  in 
American  Journal  Medical  Science,  October,  1864,  Vol.  XLV11I,  p.  363. 


INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

dyles  of  the  femur  or  head  of  the  tibia,  under  the  usual  circumstances  of  bustle  and  con 
fusion  of  the  field,  and  repeated  removals  of  wounded  in  ambulances  to  the  rear." 

When  it  is  considered  that  of  three  thousand  three  hundred  and  fifty-five  shot  injuries 
of  the  knee  joint  with  lesion  of  the  articulating  surfaces  of  the  bones,  grouped  in  TABLE 
LII,  on  page  367,  only  eight  hundred  and  sixty-eight,  with  three  hundred  and  thirty-eight 
recoveries,  were  conservatively  treated,  and  that  in  these  eight  hundred  and  sixty-eight 
cases  are  included  one  hundred  and  seventeen,  with  eighty-four  recoveries,  in  which  the 
synovia*!  cavity  was  not  primarily  opened  and  only  the  patella  fractured;  furthermore,  that 
with  the  exception  of  a  few  instances,  in  which  amputation  was  refused  or  in  which  the 
cases  came  to  the  notice  of  the  surgeons  at  a  period  when  the  proper  time  for  amputation 
had  passed,  the  cases  reserved  for  conservative  treatment  were  those  deemed  to  have  the 
best  chances  of  a  favorable  result,  the  percentage  of  mortality  (60.6  per  cent.)  must  be 
regarded  as  very  large,  and  the  question  naturally  arises  whether  fewer  attempts  at  con 
servation  would  not  have  saved  more  lives.  It  has  already  been  pointed  out  on  page  332 
that  the  mortality  of  the  two  thousand  three  hundred  and  ninety-nine  amputations  of  the 
thigh  after  shot  fracture  of  the  knee  joint  was  only  51.1  per  cent.  Of  these  two  thousand 
three  hundred  and  ninety-nine  amputations  in  the  thigh  for  shot  wounds  of  the  knee  joint, 
one  thousand  five  hundred  and  twenty-five,  with  six  hundred  and  sixty-nine  deaths,  were 
primary  operations,  giving  a  mortality  of  43.8  per  cent.,  while  eight  hundred  and  thirty- 
nine,  with  five  hundred  and  thirty-two  deaths,  or  63.4  per  cent,  fatality,  were  intermediary 
or  secondary  operations,  performed,  generally  as  a  last  resort,  when  it  became  evident  that 
a  continuance  of  the  conservative  treatment  would  inevitably  lead  to  a  fatal  issue.  Thus 
it  will  be  seen  that  the  mortality  after  shot  fractures  of  the  bones  of  the  knee  joint  treated 
conservatively,  even  under  the  most  favorable  circumstances,  exceeded  the  mortality  after 
primary  amputation  in  the  thigh  by  16.8  per  cent. 

Shot  fractures  of  the  knee  joint  by  small  projectiles,  in  their  early  stages,  are  among 
the  most  deceptive  of  serious  injuries.  Surgeon  H.  S.  Hewit,  U.  S.  V.,  observed,  in  a 
report  from  Frederick  Hospital,  in  January,  1863:  "The  conical  wedge-like  missile,  pro 
pelled  by  an  irresistible  force  and  revolving  with  the  rapidity  of  a  steam  augur,  pierces, 
bores,  arid  comminutes  without  occasioning  great  displacement.  The  bones  are  broken  into 
a  great  number  of  minute  fragments  which  are  still  held  together  by  their  capsular  and 
ligamentous  investments.  The  destruction  is  as  great  ab  interno,  as  it  would  be  ab  externo 
by  crushing  between  a  railroad  carriage  wheel  and  the  iron  rail."  Deluded  by  the  seeming 
insignificancy  of  the  external  injury,  the  patient  not  rarely  refuses  to  submit  to  amputation 
until  the  moment  of  hopeful  operation  has  passed.  Several  cases  of  recovery  after  severe 
comminuted  fractures  of  the  bones  of  the  knee  joint  are,  it  is  true,  recorded  in  the  annals 
of  surgical  literature.  Such  examples  have  been  cited  among  the  cases  of  shot  injuries 
adduced  in  Note  3,  on  page  368,  and  similar  instances  will  be  found  among  the  cases  col 
lected  in  the  appended  table  (TABLE  LIX,  page  417),  in  which  it  has  been  attempted  to 
give  a  numerical  summary  of  the  cases  of  this  nature  recorded  by  writers  on  surgery;  but 
these  fortunate  results  only  seem  to  indicate,  as  Professor  von  Langenbeck1  remarks :  "that 
if  amputation  is  refused,  the  surgeon  must  never  despair  of  saving  life." 

It  has  been  shown  on  page  28  that  of  three  hundred  and  fifty-one  cases  of  shot  wounds 
of  the  knee  joint  with  either  primary  or  secondary  involvement  of  the  joint  capsule,  but 
without  lesion  of  the  bony  structure,  ninety-eight,  or  27.9  per  cent.,  proved  fatal.  The 

1  LANGEXBKCK.  (B.  V.),  Uebtr  die  Schussfracturen  der  Gelenke  und  ihre  Behandlung,  Berlin,  1868,  p.  28. 


SECT.  IV.j 


SHOT    INJUKIES    OF    THE    KNEE    JOINT. 


415 


attempt  to  save  the  limb  should  always  be  made  in  injuries' of  this  nature,  and  amputation 
has  not  been  advocated  by  military  surgeons,  although  Schwartz1  remarks  that:  "According 
to  our  experience  we  cannot  find  fault  with  the  surgeon  who,  in  a  case  of  clearly  defined 
extensive  wound  of  the  joint  capsule,  prefers  immediate  operation  to  generally  useless 
attempts  at  conservation  with  subsequent  secondary  amputation."  Stromeyer,  Langen- 
beck,  Legouest,2  and  others  believe  simple  wounds  of  the  joint  capsule,  without  lesion  of 
the  bony  structure,  to  be  very  rare;  but  the  records  of  the  American  civil  war,  of  the 
Franco-Prussian  War  of  1870-71,  and  of  the  Russo-Turkish  War  of  1877  (TABLE  LIX, 
page  417),  furnish  examples  of  such  injuries,  and  the  experiments  of  Woods,3  Simon,4  and 

1  SCHWARTZ  (HARALD),  Beitrage  zur  Lehre  von  den  Schusswunden,  Scbleswig,  1854,  p.  ]73. 

2  .STROMEYElt  (L.)  (Erfahrungen  ilber  Schus$wunden  im  Jahre  1800,  Hannover,  1807,  p.  57):  "I  will  not  deny  that  there  are  cases  in  which  an 
opening  in  the  knee  joint  made  by  a  bullet  will  heal,  but  they  must  be  very  rare.     1  have  not  and  do  not  expect  to  see  one,  because  a  ball  which  opens 
the  joint  must,  as  a  rule,  interest  one  of  the  articulating  ends."     LANGKXBECK  (B.  v.)  (Ueber  die  Schussfracturen  der  Geknke  itnd  Hire  Behandlung, 
Berlin,  J808,  p.  36):  "That  the  knee  joint  can  be  shot  through  from  before  backwards  without  lesion  of  bone  I  cannot  think  possible.     There  will  alwftys 
be  more  or  less  deep  grooving  of  the  condyles,  and  I  have  been  able  to  feel  the  grooving  in  two  cases  of  recovery."     LEGOUEST  (L.)  (Trait ' de  Cliirurgie 
d'Armee,  Paris,  1872,  p.  444):  "On  voit  cependaiit  quelquefois  des  balles  atteindre  et  meme  traverser  de  part  en  part  de  grandes  articulations  sans  toucher 
les  os.     Xous  avons  traite,  pendant  la  cainpagne  d'Orient  (1855),  un  militaire  qui  eut  manifestement  1'articulation  du  genou  ouverte  par  une  balle :  le  pro 
jectile  passa  immediatement  au-dessus  de  la  rotule  entre  le  tendon  de  cet  os  et  les  condyles  du  femur  sans  fracturer  ni  les  uns  ni  les  autres  et  sans  meme 
determiner  d'accidents  serieux ;  mais  ce  sont  la.  de  rares  exceptions." 

3  WOODS  (J.  T.)  (Gunshot  Knee  Joint  Injuries,  in  Ohio  Med.  and  Surg.  Jour.,  1864,  Vol.  XVI,  p.  295):  "  The  joint  is  only  traversed  by  the  ball, 
no  fracture  being  inflicted,  or  at  most  simply  a  grooving  or  abrasion  of  the  articular  cartilages  occurring.     This  idea  seemed  to  find  confirmation  in  the 
fact  that  in  these  cases  the  ball  uniformly  passed  antero-posteriorly,  or  laterally  in  certain  directions  at  the  level  of  the  joint,  thus  affording  the  first  quali 
fication  of  this  occurrence.     Passing  antero-posteriorly  the  nearly  level  articular  surface  of  the  tibia,  the  large  size  of  the  inter-condyloid  notch  would, 
especially  if  the  knee  were  partially  bent,  render  the  passing  of  a  ball,  without  violently  impinging  on  bony  structure,  quite  easy  of  occurrence ;  and 
similar  considerations  of  anatomy  and  varied  position  seemed  to  afford  a  similar  explanation  to  the  harmlessness  of  the  balls — cases  where  their  course 
was  laterally  through  the  anterior  third  of  the  joint.     These  theoretic  views  it  was  found  quite  easy  to  demonstrate  upon  the  dead  subjects ;  making  a 
slit  in  the  ligamentum  patellae  below  the  patella  itself,  passing  in  a  narrow  bladed  knife  to  clear  away  the  sort  parts,  and  slightly  flexing  the  leg  upon 
the  thigh,  I  was  enabled  to  introduce  through  the  joint  into  the  popliteal  space  a  round  piece  of  wood  one-third  greater  in  diameter  than  a  minie  ball,  and 
by  flexing  the  leg  to  a  right  angle  with  the  thigh,  the  space  between  the  bones  of  the  joint  on  the  anterior  aspect  was  found  to  be  quite  sufficient  for  the 
passage  of  a  minie  ball  laterally,  and  through  the  tense  skin  the  opening  would  be  so  small  that  when  the  leg  was  straightened  it  would  appear  to  have 
entered  immediately  below  the  inner  condyle." 

4  SIMON  (Kriegschirurgische  Mitlhc.ilu.ngtn.  Zur  Prognose  und  Behandlung  der  Schusswunden  des  Kriegele.nkes,  in  Deutsche  Klinik,  1 871,  B.  XXIII, 
p.  258  et  seq.)  tried  to  "determine  these  questions  by  experimental  means,  and  obtained  surprisingly  clear  results.     I  had  three  round  iron  rods  made  pro 
vided  with  very  sharp  points ;  one  of  the  rods  had  the  thickness  of  a  Chassepot  missile,  the 
other  that  of  the  Prussian  Langblei,  and  the  third  a  yet  greater  thickness;  and  with  these  I 
attempted  to  penetrate  the  knee  joints  of  dead  bodies  in  various  directions.     With  the  limb 
extended  it  was  impossible  to 

push  any  one  of  the  rods  through, 

bone  being  struck  everywhere. 

But  on  very  little  flexion,  with 

the  knee  bent  at  170°,  the  joint 

became  so  far  opened  that  one 

could  put  the  thinnerrod  through 

the   intercondyloid   notch  with 

the  greatest  ease,  and  without 

touching  the  bones  immediately 

below  the  lower  margin  of  the 

patella  through  the  ligamentum 

patellae  as  well  as  by  the  sides 

of  the  same  (Fir,.  252).     The 

rod  penetrated  antero-posterior- 
fr^^^M^lA^^f^8^'^^    ly  through  the   middle  of  the    FIG.  253.-The  same,  with  greater  flexion.     [After  SiMus.l 

joint,  and  appeared  in  the  popli 
teal  space  or  several  centimetres  above  the  same.  When  the  rod  was  pushed  in  at  the  median  line  of  the  extremity  immediately  below  the  patella,  or 
through  the  ligamentum  patellae,  it  would  also  appear  in  the  median  line  on  the  posterior  aspect ;  but  when  it  penetrated  beside  the  ligamentum  patellne, 
the  rod  had  to  be  forced  through  the  joint  in  a  somewhat  oblique  direction,  and  its  point  would  appear  on  the  posterior  aspect  one  to  two  centimeters 
distant  from  the  median  line.  The  rod  of  the  calibre  of  the  Prussian  Langblei  could  be  pushed  through  the  joint  in  the  same  direction  without  injury  to 
the  bone,  if  the  flexion  of  the  joint  was  increased  to  an  angle  of  150°;  and,  with  a  still  greater  flexion,  at  an  angle  of  130°,  the  perforation  could  be  accom 
plished  with  ease  by  the  third  or  the  thickest  of  the  rods.  But  in  these  greater  flexions  the  point  of  the  rod  appeared  in  the  posterior  side  of  the  thigh 
much  higher,  about  0  to  12  centimeters,  above  the  popliteal  space  (FIG.  253),  and  these  various  experiments  proved  that  the  greater  the  flexion  in  which 
the  knee  was  perforated  the  higher  the  exit  wound  came  to  be  located.  Nor  could  the  joint  be  penetrated  from  side  to  side  when  the  limb  was  in  a  straight 
position.  But  when  the  knee  was  bent  to  an  angle  of  105°,  the  front  portions  of  the  articular  surfaces  of  the  femur  and  tibia  would  separate  sufficiently 
to  allow  the  thinner  rod  to  be  pushed  through  the  anterior  third  of  the  joint,  and,  on  greater  flexion,  the  space  between  the  bones  would  open  to  such  a 
degree  that  the  iron  rod  of  the  calibre  of  the  Prussian  Langblei  penetrated  (FlG.  254).  After  withdrawing  the  rod  mid  stretching  the  knee,  essential  local 
changes  wore  observed  in  the  aperture  of  the  canal,  which  were  brought  about  by  displacement  of  the  bones  and  of  the  skin.  The  knee  pan  elevated 
itself  out  of  the  sulcus  intercondylicus  upon  which  it  had  been  held  down,  and  the  anterior  parts  of  the  articulating  surfaces  of  the  femur  and  the  tibia 
fixed  themselves  so  upon  each  other  that  one  could  neither  penetrate  from  the  front  nor  from  the  side  towards  the  middle  of  the  joint.  But  the  wound 
in  the  skin  suffered  the  greatest  displacement.  In  the  penetrations  from  before  backward,  the  entrance  aperture,  which,  when  the  knee  was  bent,  was 
located  Immediately  below  the  lower  margin  of  the  patella,  either  in  the  middle  or  at  the  side  of  the  ligamentum  patella:,  pushed  itself  upwards  upon 
the  lower  part  of  the  patella,  so  that  this  bone,  being  covered  by  periosteum  and  a  mass  of  fibrous  bands,  formed  the  underlying  base  of  the  wound  in 
the  skin.  The  opening  in  the  synovial  membrane  was  thereby  so  completely  closed  that  the  synovia  could  not  at  all  or  only  very  sparingly  ooze  out 


416  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

Socin1  clearly  prove  their  feasibility.  Hoffmann2  states  that  among  shot  wounds  of  the 
knee,  examples  of  missiles  striking  the  knee,  running  around  under  the  skin,  and  escaping 
on  the  opposite  side,  are  very  frequent;  but  no  examples  of  such  injuries  were  recorded 
from  our  civil  war,  and  it  can  hardly  be  believed,  as  von  Langenbeck3 justly  remarks:  "That 
when  the  wound  of  entrance  is  in  the  middle  of  one  side  and  the  wound  of  exit  in  the  middle 
of  the  other  side  of  the  joint,  or  when  the  former  is  in  front,  the  latter  in  the  bend  of  the 
knee,  the  ball  should  pass  around  the  joint. — the  angular  projections  of  the  condyles  and 
of  the  edges  of  the  patella  would  not  permit  it." 

Analyzing  the  eight  hundred  and  sixty-eight  cases  of  shot  fractures  of  the  bones  of  the 
knee  joint  treated  by  conservation  (TABLE  Lli,  p.  367,  ante),  we  find  that  in  one  hundred 
and  seventeen  cases  the  patella  alone  was  injured,  without  lesion  to  the  synovia]  cavity; 
eighty-four  were  successful,  thirty  proved  fatal,  and  in  three  instances  the  result  was  unde 
termined,  a  fatality  of  26.3  per  cent.,  or  1.6  per  cent,  less  than  that  of  the  cases  of  pene 
tration  of  the  joint  capsule  without  bony  lesion.  Ten  cases  of  fractures  of  the  patella  and 
head  of  tibia  gave  a  mortality  of  40.0  per  cent.,  and  of  seventeen  cases  of  fractures  of  the 
patella  and  condyies  of  femur_47.0  per  cent,  proved  fatal.  In  the  majority  of  the  cases  of 
these  two  groups  the  missile  grazed  the  joint  on  the  side,  grooving  or  fracturing  the  bone 
and  only  slightly  injuring  the  joint  capsule.  Forty-seven  instances  of  fractures  of  the 
patella  with  primary  lesion  of  the  joint  cavity  gave  a  mortality  of  53.1  per  cent.  Of  the 
remaining  six  hundred  and  seventy-seven  cases  with  fractures  either  of  the  condyles  of  the 
femur  or  the  head  of  the  tibia  or  both,  or  of  the  femur,  tibia,  and  patella,  two  hundred  and 
seventeen  recovered,  four  hundred  and  fifty-four  proved  fatal,  and  six  were  undetermined, 
a  mortality  of  67.6  per  cent.,  exceeding  the  mortality  rate  of  primary  amputations  in  the 
lower  third  of  the  thigh  18.9  per  cent.  On  examining  the  reports  of  the  eight  hundred 
and  sixty-eight  cases  of  shot  fractures  of  the  bones  forming  the  articulation  of  the  knee,  it 
was  found  that  pya9mia  supervened  in  seventy-seven  instances,  all  proving  fatal, — haemor 
rhage  in  twenty-five,  with  nineteen  deaths, — hospital  gangrene  in  twenty,  with  seventeen 
deaths, — phlegmonous  erysipelas  in  twenty,  with  eighteen  deaths, — and  tetanus  in  two,  both 
resulting  fatally.  Fragments  of  bone  or  sequestra  were  removed  in  forty-four  instances, 
twenty  belonging  to  the  group  of  fatal  cases. 

The  consideration  of  the  shot  wounds  of  the  knee  joint  treated  by  conservation  will  be 
concluded  by  an  enumeration  of  such  cases  from  other  wars  and  from  accidents  in  civil  life. 

from  under  the  edge  of  the  membrane.     At  the  wound  of  exit  upon  the  posterior  aspect  of  the  knee  the  displacement  of  the  skin  m:ide  itself  also  apparent, 
but  in  a  reversed  direction,  namely,  from  above  downward,  entirely  in  accord  with  the  fact  that  the  anterior  opening  was  made  during  tension,  the 
/f^  posterior  during  great  relaxation  of  the  skin.     Hence,  too,  the  parallelism  of  the  subcutane 

ous  and  of  the  skin  wound  on  the  posterior  aspect  was  so  completely  broken  up  that  with 
the  finest  probe  we  could  only  penetrate  to  the  depth  of  the  skin  wound.  By  stretching,  after 
transverse  perforations,  the  anterior  part  of  the  articular  end  of  the  tibia  laid  itself  against 
that  of  the  femur,  so  that  the  synovial  membrane,  and  with  it  the  wound,  was  so  compressed 
that  ihe  joint  became  closed  beneath  the  gaping  skin  wound.  The  openings  in  the  skin  moved 
either  upon  the  condyles  of  the  tibia  or  of  the  femur.  The  displacement  here  was  generally 
much  less,  and,  in  several  instances,  one  could  see  beneath  the  entrance  aperture  of  the  skin 
the  compressed  opening  in  the  synovia!  capsule.  As  a  rule  also  synovia  escaped  from  these 
transverse  perforations.  .  .  After  these  experiments  and  observations  at  the  patient's  bed 
side,  no  doubt  really  remains  to  be  overcome  that  so  inexplicable  swiftly  healing  shot  injuries 
of  the  knee  are  to  be  taken  up  as  wounds  in  which  the  knee  joint  was  perforated  during  flexion 
(to  bring  ah  ut  a  perforation  of  the  joint  the  flexion  need  not  be  greater  than  that  produced  in 
ordinary  walking  by  the  advancing  leg)  by  the  missile  without  injury  to  the  bone,  anu  which 
through  the  displacing  of  the  skin,  on  straightening  the  joint  immediately  after  the  injury, 
FIG.  254,-Transverse  perforation.  [After  SlMOX. ]  wcre  change(l  fr()m  open  into  subciltaneous  joint  wounds." 

1  SOCIN  (AUGUST),  KriegsclrirurgiscJie  Erfahrungen,  Gesammelt  in  Carlsruhe  1870  und  1871.  Leipzig,  1872,  p.  168,  and  PLATE  IX. 
2 HOFFMANN,  Ueber  Verletzungen  lies  Kniegelenks  durch  KleingeAvelirprajectileundderen  Beliandlung,  in  Deutsche  MilitairdrztUche.  Zeitschrift, 
Berlin,  1875,  Jahrgang  4,  p.  243. 

'LANGENBECK  (B.  v.),  Ifeber  die  Schussfracluren  der  Gelenke  und  ihre  Behandlung,  Berlin,  1868,  p.  37. 


\ 


SKCT.  IV.) 


SHOT    INJURIES    OP    THE    KNEE    JOINT. 

TABLE  LIX. 


417 


Shot  Wounds  of  the  Knee  Joint  treated  by  Conservation  on  the   Occasions  named  and  from  the 

Authorities  quoted. 


OCCASIONS. 

CASES. 

No  BONY  LESION. 

FRACTURE  OF 
BONE  INDICATED. 

>           i          9 
8         o        "3        S 

5                 CJ                -*3                *•* 

Ratio  of 
Percentage. 

Recovery. 

1 
fe 

Unknown. 

Recovery. 

1 

34 
1 
1 
3 
19 
1 
92 

i 

Cases  prior  to  1846  (Note  3  on  page  368,  ante) 

99        61        37 

2           1           1 

1      37.7 
'    50.0 

8 

3 

53 
1 
2 
7 
5 

1 

War  in  Mexico,  1846-48  (JARVIS,1  PORTER2)     

Revolution  in  Baden,  1848  (SIMON*)   .  .  . 

321 

'    33.3    

Revolution  in  Paris,  1848  (BAUDEN8,  HUGUIEK,  JoiiERT  DE  LAMHAI.LE4) 
Schleswig-Holstein  War,  1848-50  (STROMEYER*) 

10           7           3 

30  0 

24           5         19 

i    79.  1    - 

Campaign  in  Algiers  1854-57  (BERTHERANDC) 

2                       1 

1     100.  0 
67.3 

1 

Crimean  War,  1854-57  (CHENU,7  MATTHEW,8)        

138         45         93 

2 
1 

1 

1 

43 

Campaign  in  Nicaragua,  1856  (MOSEB9) 

1            l 

British  in  India,  1857-58  (WILLIAMSON,"  GORDON  ll  WOODS12)                          642 

33.3 

3 

2 

Italian  War,  1859-60  (CHENU,13  DEMME14)                                                             Hf>  •      4u         :i(i 

i    42.  3 

49 
1 

1 

40 
4 
3 

41 
23 

20 

13 

36 
1 
3 

29 
2 

New  Zealand  War,  1863-65  (MOUAT18) 

2           11 

50.0 



Danish  War,  1864  (HEINE16)  

4           1           3    .. 

75.0 

Austro-Prussian  War,  1866  (BlEFEL,17  K.  FISCHER,18  GRlTTl,19  LANOEN- 
BECK,20  MAAS,21  STROMEYER22)  

78         44         34 

43.5 

4 

5 

Revolution  in  Japan,  1868  (SlDDALL73) 

6  !        4           2 

United  States  Army,  1865-70  (OTIS24)  

4           4 

44 

10 

18 

4 

Franco-German  War,  1870-71  (GERMANS28) 

166         85  :      79           <J      48.  1 
88         33         49           6      59.7 
58         38         15           5      28.3 

17         17 

14 
3 

65 
46 
IS 

2 
6 
2 

Franco-German  War,  1870-71  (FRENCH215)  

Russo-  Turkish  War,  1877  (BERGMANN,27  A88ENDELFT28) 

3 

Isolated  Cases  since  1846  (HARRIS,29  COBB,30  Ross,31  SCHUH,W  VAN  BU- 
REN,33  I8NARD,34  JOHNSON,38  ROOKER,36  ATLEE,37  MAIR,*8  HUBBARD,39 
HOLDEN,40  POWELL,41  KOBER,4'  VOLKMAXN,43  CHANDLER,44  GROSS48) 

309 

Aggregates  

793       402       376         15      48.  3  !      93         26           3 

350 

12 

It  is  noticeable  that  all  the  isolated  cases  of  shut  injuries  of  the  knee  joint  collected 
from  civil  life  since  1846,  seventeen  in  number,  recovered,  and  it  is  only  reasonable  to  sup- 

1  JARVIS  (N.  S.)  (Surgical  Cases  at  Monterey,  iu  New  York  Journal  of  Medicine,  1847,  Vol.  VIII,  p.  158):  Soldier  of  4th  U.  S.  Infantry;  fracture 
of  patella  by  grapeshot.  Died,  seven  days  after  injury,  of  tetanus. — 2 PORTER  (.T.  B.)  (Medical  and  Surgical  Notes  of  Campaigns  in  the  War  with  Mex 
ico,  during  the  years  1845,  '46,  '47,  and  '48,  in  Am.  Jour.  Med.  Sci.,  1852,  Vol.  XXIII,  p.  33):  Case  of  G.  R.  Brush,  Hays's  Rangers,  wounded  at  Monterey, 
September  22,  184(1;  musket  ball  perforated  left  patella;  considerable  inflammation;  fragments  of  broken  patella  kept  in  place.  Recovered.  Seen  at 
Vera  Cruz  iu  the  autumn  of  1847,  serving  with  a  mounted  company  of  Texans,  at  which  time  there  was  no  stiffness  of  the  joint  and  but  little  deformity. — 
3  SIMON  (G.),  Weber  Schusswunden ,  Giessen,  1851,  p.  90'. — lDes  plaie.s  d'armcs  a  feu ;  Communications,  etc.,  Paris,  1849,  par  BAUDENS,  p.  231  (1  fatal); 
HUGUIER,  p.  131  (4  recoveries):  JOBERT  DE  LAMBALLK,  p.  153  (3  recoveries,  2  fatal). — 'STKOMEYER  (L.),  Maximen  der  Kriegslieilkunst,  Hannover, 

1855,  pp.  756,  757.— "BERTHEEAND  (A.),  Campagnes  de,  Kabylie,  Paris,  1862,  pp.  110,  2CT.— 7CHENU  (.f.  C-),  Rapport,  etc.,  pendant  la  Campagne  d' Orient 
en  1854,  "5."),  '56,  Paris,  1865,  p.  410  (37  recoveries,  87  fatal). — *  MATTHEW  (T.  P.),  Med.  and  Surg.  History  of  the  British  Army,  etc.,  in  the  years  1854, 
'55,  '56,  London,  1858,  p.  350  (8  recoveries,  6  fatal). — 9MosES  (I.)  (Military  Surgery  and  Operations  following  the  Battle  of  Kivas,  Nicaragua,  April, 

1856,  in  Am.  Jour.  Med.  Sci.,  1857,  Vol.  XXXIII,  p.  28):  Case  of  Major  Markham  ;  ball  struck  on  inside  and  a  little  above  patella,  involving  cavity  of 
joint;  synovial  fluid  oozing  from  wound;  absolute  rest  and  abstemiousness  enjoined,  and  cold  dressings  applied.     Recovery,  with  free  motion  of  joint. — 
10  WILLIAMSON  (G.),  Military  Surgery.  London,  1863,  pp.  170,  172  (4  recoveries). — "GORDON  (C.  A.),  Experiences  of  an  Army  Surgeon  in  India,  London, 
1872,  p.  25  (1  fatal). — 12  WOODS,  Description  of  a  Mortal  Gunshot  Wound  perforating  the  Knee  Joint,  in  Dublin  Medical  .Press,  1862,  Vol.  XLVII,  p.  158 
(1  fatal).— '3 CHENU  (J.  C.),  Stat.  Med.   Chir.  de  la  Camp.  d'Jtalie,  en  1859  r.t  1860,  T.  II,  p.  766  (45  recoveries,  22  fatal).— '4 DEMME  (H.),  Militiir- 
Chirurgische  Studien,  WUrzburg,  1861,  Zweite  Abth.,  p.  274  (4  recoveries,  14  fatal).— 15MOUAT,  The  New  Zealand  War  of  1863,  '64,  '65,  in  Stat.  San. 
and  Med.  Reports  for  the  year  1865,  London,  18C7,  Vol.  VII,  p.  5<)9. — 16HEINE  (C.),  Die  Schustverletzungen  der  unteren  Extremitdten,  Berlin,  1866,  p. 
371. — I7BIEKEL  (K.),  Im  Re.sene-Lazareth.  Kriegschirurgische  Aphorismen  i-on  1866,  in  LANGENBECK'S  Archiv  fur  Klin.  Chir.,  Berlin,  1869,  B.  XII. 
p.  449  (5  recoveries,  8  fatal).— I8FISCHER  (K.),  Militairdrztliche  Skizze.n,  Aarau,  1867,  p.  93  (25  recoveries.  21  fatal).— 19Rocco  GKITTI,  Nuovi  docu- 
menti  in  favore  della  cura  conservativa  nelle  fractura  del  femore  par  arma  da  fuoco,  in  Annali  Universali  di  Medicina,  1868,  Vol.  CCV,  p.  527  (0 
recoveries,  1  fatal). — ™LANGENBECK.  (B.  v.),  Utber  die  Schussfracture.n  der  Gelenke  und  ihre  Behandlung,  Berlin,  1868,  p.  30,  etc.  (9  recoveries,  2  fatal).  — 
21  MAAS  (II.),  Kriegschirurgische  Bcitrdge  aus  dem  Jahre  1866,  Breslau,  1870,  pp.  52,  54  (2  recoveries,  2  fatal). — "STROMEYER  (L.),  Erfahrungtn  ubcr 
Schusswunden  im  Jahre  1866,  Hannover,  1867,  p.  58  (1  recovery). — '^  SlDDALL  (J.  B.),  Surgical  Experiences  in  Military  Hospitals  in  Japan,  in  St. 
T/iomas's  Hospital  Reports,  London,  1874,  Vol.  V,  p.  95.— 24 OTIS  (G.  A.),  Circular  No.  3,  War  Department,  S.  G.  O.,  Washington,  1871,  pp.79,  80.— 
25 BECK  (B.),  Chirurgie  der  Schussverletzungen,  Freiburg,  i.  B.  1872,  pp.  609  et  seq.  (16  recoveries,  11  fatal).     BlLLROTH  (T.),  Chirurgische  Briefe  aus 
fltn  Kriegs-Lazarethen,  Berlin,  1872,  p.  230,  etc.  (2  recoveries,  6  fatal).     BOCK,  Verhandlungen  der  Militairdrztlichen  Gesellschoft  zu  Orleans  im  Winter 
1870-71,  in  Deutsche  Militairdrztliche  Zeitschrift,  Berlin,  1872.  Jahrg.  I,  p.  265  (1  recovery).    BURKHARDT,  Aus  der  Schweizer— Ambulance,  in  Lure,  in 
Correspondenz-Blatt  fur  Schweizer  Aerzte,  Bern,  1871,  Jahrg.  I,  p.  217  (3  fatal).    CZKRNY  (V.),  Bericht  iiber  die  im  College  Stanislaus  in  Weissenbur;/ 
behandelten  Verwundeten,  in  Wiener  Med.  Wochenschrift ,  1870,  No.  60,  p.  1447  (5  fatal).     FISCHER  (G.),  Dorf  Floing  und  Schloss  Versailles,  in  Deutsclf 
Zeitschrift  fur  Chirurgie,  Leipzig,  1872,  B.  I,  p.  240  et  seq.  (3  recoveries,  2  fatal,  2  unknown).     FISCHER  (H.),  Kriegschirurgische  Erfahrungen,  Erlangen, 
1872,  p.  202  (8  recoveries,  9  fatal).     GEI88EL  (R.),  Kriegschirurgische  Rfminiscenzen  von  1670  bis  1871,  In  JD^itsche  Zrittchrift  fur  Chirurrrir. 

Suno.  Ill— 53 


418  INJURIES    OF    THE    LOWEK    EXTREMITIES.  [CHAP.  X. 

pose  that  similar  instances  with  fatal  issue  occurred  during  the  same  period,  but  were  not 
reported  by  the  attending  surgeons.  The  percentage  of  fatality  (48.3)  must  therefore  be 
considered  as  too  favorable.  Attention  should  here  be  called  to  the  favorable  results  claimed 
to  have  been  achieved  in  the  late  Russo-Turkish  War,  1877,  by  Professor  Bergmann.  Of 
twenty-one  cases  without  bony  lesion,  eighteen  recovered  and  the  results  in  three  were 
undetermined.  None  had  died  at  the  date  of  Professor  Bergmann's  report.  Of  thirty-one 
instances  of  shot  fracture  of  the  bones  of  the  knee  joint,  two  had  undetermined  results, 
twenty  recovered,  and  nine  died,  giving  the  favorable  mortality  of  31.0  per  cent.  Professor 
Bergmann  had  hoped  to  have  occasion  to  try  Lister's  antiseptic  mode  of  treatment  on  the 
field  of  battle,  and  had  provided  himself  with  a  complete  outfit  for  that  purpose ;  but  he  soon 
realized  that  in  the  excitement  and  confusion  following  an  engagement  it  was  impossible1  to 
proceed  with  the  care  and  precision  requisite  to  a  successful  practice  of  Lister's  somewhat 

1875,  B.  V,  p.  45  (1  recovery,  3  fatal).  GRAF  (E.),  Die  Koniglichen  Reserve-Lazanthe  zu  Dusseldorf  wahrend  des  Krieges  1870-71,  p.  G7  (G  recoveries, 
5  i'atal).  HEINZEL,  Ueber  die  conservirende  Behandlung  der  Kniegelenkschiisce,  etc.,  in  Deutsche  Militairdrztliche  Zeitschrift,  Berlin,  1875,  4  Jahrg.. 
p.  318  (1  recovery).  KlRCHNER  (C.),  Acrztlicher  Bericht  iiber  das  A'.  P.  Feld-Lazareth  im  Palast  zu  Versailles,  Erlangen,  1872,  p.  GO  (8  recoveries, 
11  fatal).  KOCH  (\V.),  Notizen  tiler  Schussverletzungen,  in  LANGENUECK's  .-I rchiv  fur  Klin.  Chir.,  Berlin,  1872,  B.  XIII,  p.  512  (3  fatal).  LOSSES 
(II.),  Kriegschirurgische  Erfahrungen  aus  den  Barackenlazarethen  zu  Mannheim,  Beidclburg  und  Karlsruhe  1670  und  1871,  iu  Deutsche  Zcitschrift  fiir 
Chirurgic,  Leipzig,  1873,  B.  II,  p.  128  (8  recoveries).  Lt'CKK  (A.),  Kriegschirurgische  Fragen  und  Bcmerkungen,  Bern,  1871,  p.  02  (1  fatal).  MAYER 
(L.),  Kriegscliirurgische  Mittheilungen  aus  den  Jahren  1870-71,  in  Deutsche  Zeitschrift  fiir  Chirurgic,,  1873,  B.  Ill,  p.  83  (1  recovery,  1  fatal).  MOSETTO, 
Erinnerungen  aus  dem  deutsch-franzosischen  Kriege,  in  Der  Militdrarzt,  with  Wiener  Medizinische  Wochcnschrift,  1872,  p.  92  (1  recovery).  OTT, 
Slittheilungen  aus  dem  Ludwigsburgtr  Reservespital,  in  Med.  Corre.spondenz-Bla.tt  des  Wiirttemberg.  drztl.  Vereins,  Stuttgart,  1871,  B.  XLI,  p.  156 
(2  recoveries,  1  fatal).  SALZMAXX,  Mittheilungen  aus  dem  Vereinsspital  in  Esslingen,  in  Med.  Correspnndenz-Blatt  des  Wiirltemberg.  iirztl.  Vereins, 
1871,  B.  XLI,  pp.  138,  154,  155  (3  recoveries,  1  fatal).  SCHAFl'EU  (T.),  Chirurgische  Studien  und  Untersuchuiigen  aus  dem  Fcldzuge  von  1870,  in  LAX- 
GEXi;ECK's  Archiv  fiir  Klin.  Chir.,  1872,  B.  XIII,  p.  102  (1  recovery,  1  fatal).  SCHIXZIXGEU  (A.),  Das  Reserve- Lazarc.th  Schwetzingen  im  Kriege 
1870-71,  Freiburg,  i.  B.,  1873,  p.  76  (4  recoveries,  2  fatal).  SciIL'l.r.ER  (M.),  Kriegschirurgische  Skizzcn  aus  dem  deutsch-franzosischen  Kriege  1870-71, 
pp.  C7,  G8  (2  recoveries).  ScnWAliE,  Verhandlungen  der  Militairdrztlichen  Gesellschaft  zu  Orleans  im  Winter  1670-71,  in  Deutsche  Militairdrztlichf. 
Zeitschrift,  1872,  B.  I,  p.  480  (1  fatal).  SOCIX  (A.),  Kriegschirurgische  Erfahrungen,  Leipzig,  1872,  p.  174  (15  recoveries,  10  fatal).  STOI.L,  Bericht 
aus  dem  Koniglich  Wiirttembergischen  4.  Feldspital  von  1870-71,  in  Deutsche  Mililairdrztliche  Zeitschrift,  1874,  B.  Ill,  p.  205  (2  recoveries,  2  fatal). 
STUJU'F  (L.),  Bericht  ueber  das  Kriegs-Spital  des  St.  Georg-Ritter- Orde ns  zu  Neuberghausen  im  Jahre  1870-71,  in  Aerztliches  Intelligenz-Blatt,  Mun- 
chen,  1872,  p.  657  (1  fatal). — 26CHH'AULT  (A.),  Fractures  par  armes  a  feu,  Paris,  1872,  p.  37  (3  recoveries,  3  fatal).  CHRISTIAN  (J.),  Relation  sur  les 
plaies  de  guerre  observers  a  I'ambulance  de  Bischwiller,  1870-71,  in  Gaz.  Med.  de  Strasbourg,  167L-73,  p.  283  (3  recoveries,  6  fatal).  COU61X  (A.),  His- 
toire  Cliirurgicale  de  I'ambulance  de  I'&ole  des  Ponts  et  Cliaussces,  in  L' Union  Medicale,  1872,  T.  XIII,  p.  157  (3  recoveries,  1  fatal).  DESl'KES  (A.), 
Rapport  sur  les  travaitx  de  la  7e  ambulance  a  VarmeeduRhin  et  a  I'armfe  de  la  Loire,  Paris,  1871,  pp.  46,  48  (G  recoveries.  ~G  fatal,  5  unknown).  FELTZ 
ET  GKOI.I.EMUNII,  Relation  clinique  sur  les  ambulance  de  Eaguenau,  iu  Gaz.  Med.  de  Strasbourg,  1671,  p.  145  (4  recoveries).  GOLTDAMMEU,  Bericht 
iiber  die  Tlidtigkeit  des  Reserce-Lazaretts  des  Berliner  Hilfsvereins  in  tier  Garde-  Ulanen-Kaserne  zu  Muabit,  in  Berliner  Klin.  Wochenscrift.  1 871,  Jalirg. 
VIII,  p.  150  (3  recoveries).  GORDON  (C.  A.),  Lessons  on  Hygiene  and  Surgery  from,  the  Franco-Prussian  War,  London,  1813,  p.  157  (G  recoveries). 
GROSS  (F.),  Notice  sur  I'liopital  civil  pendant  le  siege  et  le  bombardemcnt  de  Strasbourg,  in  Gazette  Med.  de  Strasbourg,  1871,  p.  189  (2  fata)).  JOESSEL, 
Ambulances  de  Haguenau,  in  Gazette  Med.  de  Strasbourg,  1871,  p.  21  (1  recovery).  MACCORMAC  (W.),  Notes  and  Recollections  of  an  Army  Surgeon, 
London,  1871,  p.  128  (3  recoveries,  9  fatal).  MUNDY,  Revue  Medico- Cliirurgicale  des  Ambulances,  in  Gazette  des  Hopitaux,  1870,  p.  593  (1  fatal.  1 
unknown).  PONCET  (F.),  Contribution  a  la  Relation  medicale  de  la  guerre  de  1870-71,  in  Montpellier  Medical,  1872,  T.  XXVIII,  pp.  41,  44  (1  fatal). 
VASLIX  (L.),  £tude  sur  les  plaies  par  armes  a  feu,  Paris,  1872,  p.  189  (1  recovery).  '-'BERGMANS  (E./,  Die  Behandlung  der  Schusswunden  des  Kniege- 
lenks  im  Kriege,  Stuttgart,  1878  (26  recoveries,  14  fatal,  5  unknown).— 28ASSENDELFT,  loc.  cit.,  p.  44  (12  recoveries,  1  fatal).— w  HARRIS  (S.  N.),  Gunshot 
Wound  of  the  Knee  Joint,  with  Transverse  Fracture  of  the  Patella,  in  Charleston  Medical  Journal  and  Review,  1848,  Vol.  Ill,  p.  42  (1  recovery). — 
soCOHli  (YV.  II.),  Case*  and  Observations,  in  Western  Journal  of  Medicine  and  Surgery,  1854,  Vol.  II,  4th  ser.,  p.  435  (1  recovery).—31  Ross  (F.  A.),  Gun 
shot  Wound  of  the  Knee  Joint,  in  New  Orleans  Medical  and  Surgical  Journal,  September,  1850,  p.  178  (1  recovery).— ^SCHUH,  Ausschneidcn  cincr 
Kartdtschenkugel  aus  dem  Kniegelenke,  in  Wiener  Med.  Wochenschrift,  1851,  p.  129  (1  recovery).— 33VAX  BUHEN  (W.  H.),  Gunshot  Wound  of  Knee 
Joint,  in  New  York  Medical  Times,  August,  3855,  Vol.  IV,  p.  387  (1  recovery).— MISNAHD  (C.),  Plaies  penetrantes  du  genou,  in  L' Union  Medicale, 
Paris,  1865,  T.  XXVIII,  2«  s6r.,  p.  595  (1  recovery).— x  JOHNSON  (R.  H.),  Gunshot  Wound  of  the  Knee  Joint,  in  Cincinnati  Lancet  and  Observer,  Cincin 
nati.  18G9,  Vol.  XII,  p.  659  (1  recovery). — ^ROOKKll  (J.  L),  Gunshot  Wound  of  the  Knee  Joint,  with  fracture  of  the  Patella,  in  Western  Join-,  of 
Med.,  18C8,  Vol.  HI,  p.  281  (1  recovery.)— 37  AlLEE  (W.  F.),  Case  of  Gunshot  Wound  of  the  Knee  Joint ;  Removal  of  the  Ball  from  the  Articulation  and 
Recovery,  in  Am.  Jour.  Med.  Sci.,  1867,  Vol.  L1V,  p.  127  (1  recovery).— ^M  AIR,  Schwere  Kiirpcrverletzung  durch  einen  Sclirotschuss  in  das  Knie,  in 
Friedreich's  Blatter  fiir  gerichtliche  Medicin  und  Sanitdtspolizei,  Niirnberg,  1873,  B.  XXIV,  p.  11  (1  recovery).—3"  IIUliBAKL)  (L.),  Gun-ihot  Wound  in 
the  Knee-joint,  in  Pacific  Hied,  and  Surg.  Jour.,  1870,  Vol.  IV,  p.  302  (1  recovery).— 40IIOLDEN,  Gvnshot  Wound  into  the  Knee-Joint,  in  British  Medical 
Journal,  London,  1871,  Vol.  I,  p.  169  (1  recovery).— 41  POWELL  (J.  L.)  (Cases  of  Gunshot  Wounds  of  Knee  Joint  and  Pelvis,  iu  Virginia  Med.  Monthly^ 

Richmond,  1875,  Vol.  II,  p.  35):  Case  of  Lieut.  G.  L ,  Co.  I,  5th  Infantry,  aged  32,  wounded  in  fight  with  Indians,  September  9,  1674,  near  Washitu 

River,  Texas;  fracture  of  patella  and  inner  condyle  of  fomur  of  left  knee;  recovery.— ^KOliER  (G.  M.)  (Report  of  a  Case  of  Gunshot  Wound  of  the 

Right  Knee-Joint  and  Right  Hand,  in  Am.  Jour.  Med.  Sci.,  187G,  Vol.  LXXII,  p.  427):  Case  of  Serg't  E.  MoM ,  aged  24,  accidentally  wounded 

December  5,  1874;  a  load  of  duckshot  entered  the  right  knee,  involving  the  tuberosity  of  the  external  condyle;  lacerated  wound  of  right  hand;  ring 
finger  amputated  through  middle  of  second  phalanx.  Carbolated  lotions  applied  to  the  knee  without  avail ;  injections  of  solution  of  iodine  substituted ; 
recovery,  with  anchylosed  joint. — 43VOLKMANN,  Verhandlungen  der  Deutschen  Gesellschaft  fiir  Chirurgie,  \1  Congress.  Berlin,  1877,  p.  39  (1  recovery). 

«"  CHANDLER  (\V.  T.)  (Conservatism  in  the  Treatment  of  Gunshot  Wounds  of  the  Knee,  in  Louisville  Medical  Mews,  1677,  Vol.  HI,  p.  159):  R.  J ,  aged 

18 ;  ball  entered  about  1  inch  above  patella,  passed  downward  through  the  knee,  fractured  the  femur,  and  emerged  in  thu  popliteal  space ;  amputation 
advised  but  not  allowed  by  patient;  recovery,  with  probably  a  useful  limb. — 46  GROSS  (S.  D.)  (A  Si/stem  of  Surgery,  Philadelphia,  1872,  5th  cd.,  Vol.  I, 
p.  1039):  Shot  wound  of  the  knee  joint ;  recovery. 

1  BERGMANN  (E.)  (Die  Behandlung  der  Schusswunden  des Knicgelenks  im  Krieyv,  Stuttgart,  1878,  p.  15):  ''In  the  night  of  the  extensively  planned 
and  so  gloriously  successful  crossing  of  the  Danube,  I  was  at  the  place  of  first  dressing  with  a  complete  LISTER  apparatus,  with  spray  and  excellently 
prepared  gauze,  aided  by  my  Dorpat  assistant,  well  schooled  in  the  application  of  antiseptic  dressings.  The  number  of  wounded  was  small,  not  exceed 
ing  480,  and  plenty  of  helping  hands  were  present.  The  wounded  were  brought  to  us  in  very  little  time  after  receiving  their  injuries — in  short,  I  could 
not  help  taking  hold,  as  I  have  just  explained,  of  the  gunshot  fractures,  and  amongst  them,  also,  of  the  fcnee  wounds.  But  I  soon  desisted  from  my 


SECT.  IV.]  SHOT    INJURIES    OF    THE    KNEE    JOINT.  419 

complicated  mode  of  treatment.  Discarding  the  use  of  the  spray  apparatus,  he  dressed  the 
wounds,  immediately  after  the  bleeding  had  ceased,  thickly  with  salicylic  cotton  or  jute, 
covering  the  same  with  a  Mclntosh  rubber  cloth,  and  applied  the  gypsum  bandage  without 
fenestration  over  the  entire  extremity  and  part  of  the  pelvis. 

Adding  to  the  seven  hundred  and  ninety-three  cases  collected  in  TABLE  LLX,  p.  417, 
the  three  hundred  and  thirteen  cases  of  capsule  wounds  (page  28,  ante]  and  the  eight  hun 
dred  and  sixty-eight  cases  of  shot  fracture  of  the  knee  joint  treated  by  conservation  during 
the  American  war  (TABLE  LIT,  p.  367,  ante),  we  have  a  total  of  one  thousand  nine  hundred 
and  seventy-four  cases.  The  bony  structure  was  not  involved  in  four  hundred  and  thirty- 
five,  with  three  undetermined  cases,  three  hundred  and  thirty-seven  recoveries,  and  ninety- 
five  deaths,  or  a  mortality  rate  of  21.9  per  cent.  In  one  thousand  five  hundred  and  thirty- 
nine  cases,  lesion  of  the  articulating  ends  of  the  knee  joint  was  indicated;  of  these,  six 
hundred  and  forty-seven  were  recoveries,  eight  hundred  and  seventy-one  proved  fatal,  and  in 
twenty-one  the  results  remained  undetermined,  a  fatality  of  57.3  per  cent. 

Excision  at  the  Knee  Joint. — The  results  of  the  excisions  at  the  knee  joint  performed 
during  the  late  civil  war,  whether  the  operations  were  primary,  intermediary,  or  secondary, 
were  not  very  encouraging,  forty-four  of  the  fifty-four  cases  in  which  the  issues  were 
ascertained  having  terminated  fatally,  a  mortality  of  81.4  per  cent.,  exceeding  the  mortal 
ity  rate  of  the  amputations  in  the  thigh  (53.8)  by  27.6  per  cent.  Of  the  ten  patients  who 
survived  excisions  at  the  knee  joint,  one,  Private  W.  M.  Constable,  1st  U.  S.  Cavalry 
(CASE  587,  p.  387,  ante],  submitted  to  successful  amputation  at  the  junction  of  the  middle 
and  lower  thirds  of  the  thigh  five  days  after  the  excision.  Another,  Private  S.  Miller,  1st 
Missouri  Cavalry  (CASE  632,  p.  396,  ante],  was  discharged  the  service  and  pensioned;  but 
died  two  years  and  four  months  after  the  operation,  from  extensive  suppuration  of  the  leg 
and  thigh  and  metastatic  and  pysemic  abscesses  in  various  parts  of  the  body.  As  regards 
the  results  of  the  instances  of  excisions  at  the  knee  joint,  these  cases,  therefore,  must  also 
be  considered  as  failures.  Of  the  remaining  eight  cases  three  recovered  with  fair  use  of 
limb.  In  the  case  of  Lieutenant  J.  W.  Harlee,  1st  South  Carolina  (CASE  584,  p.  386,  ante], 
the  upper  portion  of  the  head  of  the  tibia  was  excised.  The  patella  was  not  removed. 
The  leg  is  shortened  three  inches;  but  with  the  aid  of  a  high  heel  and  thick  sole  to  the  boot 
the  patient  can  walk  without  crutches.  Private  W.  F.  Jackson,  6th  South  Carolina  (CASE 
585,  p.  386,  ante],  in  whose  case  the  condyles  of  the  femur  and  the  patella  were  removed, 
has  a  "good  sound  leg  which  answers  every  purpose."  In  the  case  of  Captain  Charles 
Knowlton,  10th  Louisiana  (CASE  616,  p.  391,  ante],  one  and  a  half  inches  of  the  condyles 
of  the  femur,  one  inch  of  the  tibia,  and  the  patella  were  excised.  Firm  ligamentous  union 
followed,  and,  when  last  heard  from  in  1877,  the  patient  could  "not  only  walk  almost  as 
well  as  ever,  but  could  dance  even  round  dances."  Less  favorable  than  in  the  three  fore 
going  cases  was  the  result  in  the  case  of  Private  J.  Friel,  2d  Kentucky  (CASE  631,  p.  395, 
ante).  As  in  the  case  of  Knowlton,  the  entire  articulation,  viz:  one  and  a  half  inches 
of  the  condyles  of  the  femur,  one  inch  of  the  tibia,  and  the  patella,  was  removed.  The 
patient  recovered  with  an  anchylosed  joint  and  four  inches  shortening;  but  the  muscles  of 
the  limb  below  the  knee  became  considerably  atrophied  and  contracted,  producing  "talipes 

efforts,  for  I  was  unable  to  disinfect,  cleanse,  and  wash  out  scrupulously,  to  bandage  and  to  place  in  position  with  the  care  that  this  dressing,  according'  to 
my  conviction  and  experiences,  absolutely  requires.  The  water  which  we  drew  at  the  banks  of  the  Danube  to  solve  our  carbolic  acid  in  was  anything 
but  clear  and  transparent,  being,  on  the  contrary,  turbid  with  slime,  mud,  and  sand.  For  the  purpose  of  filtering,  or  even  ccoking  itself,  time  and  means 
were  wanting.  The  spray  apparatuses  immediately  became  choked  and  spoiled,  and  in  spite  of  a  superabundant  addition  of  carbol  crystals,  the  water 
intended  for  disinfection  retained  its  putrid  odor." 


420  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

equinus"  while  the  muscular  development  of  Captain  Knowltoris  leg  remained  excellent. 
In  the  case  of  Private  Anson  Rider  (CASE  586,  p.  386,  ante),  in  which  the  condyles  of  the 
femur  and  the  semilunar  cartilages  from  the  tibia  had  been  excised,  the  patient  was  able  to 
walk  with  the  assistance  of  a  cane  at  the  time  of  his  discharge  ten  months  after  the  oper 
ation.  Both  lower  extremities  afterwards  became  paralyzed;  but,  according  to  the  Pension 
Examining  Surgeon's  report,  this  may  have  been  caused  by  malarial  poisoning.  Private 
E.  Jewell's  (CASE  629,  page  394,  ante)  limb  became  atrophied  and  deformed,  with  contrac 
tion  of  the  muscles  and  distortion  of  the  foot.  A  portion  of  the  head  of  the  tibia  and 
the  head  of  the  fibula  had  been  excised.  The  evidence  in  the  cases  of  Private  J.  E.  Berry 
(CASE  630,  page  394,  ante)  and  Sergeant  L.  R.  McWhorten  (CASE  636,  page  397,  ante)  is 
rather  unsatisfactory,  and  beyond  the  fact  that  the  former  was  mustered  out  forty-three 
days,  and  the  latter  furloughed  twenty-seven  days  after  the  operation,  nothing  is  known 
of  their  subsequent  histories.  As  in  the  excisions  at  the  elbow,  the  operations  performed 
by  the  Confederate  surgeons  would  seem  to  have  given  the  best  results;  but  it  must  be  con 
sidered  that,  with  the  exception  of  the  remarkable  case  of  Captain  Knowlton,  the  histories 
of  the  Confederate  patients  end  with  their  discharge  from  hospital.  In  the  cases  of  the 
Union  soldiers  the  records  are  completed  up  to  the  present  writing,  and  the  remote  results 
are  found  far  less  gratifying  than  the  conditions  of  the  patients  at  the  time  of  their  discharge 
from  the  service  would  seem  to  have  warranted.  For  instance,  in  the  case  of  Private  Mil 
ler  the  success  reported  was  so  remarkable  as  to  lead  the  editor,  in  the  preliminary  report,1 
published  immediately  at  the  close  of  the  war  in  1865,  to  doubt  its  authenticity.  But,  as 
stated  above,  and  in  CASE  632,  p.  396,  ante,  subsequent  reports,  while  verifying  the  account 
of  the  operative  interference,  revealed  also  the  final  fatal  issue.  These  unfavorable  results 
would  seem  to  justify  the  declarations  of  Surgeon  D.  P.  Smith,2  U.  S.  V.,  that  "this  opera 
tion  should  be  utterly  discarded  from  the  list  of  operations  to  be  performed  for  gunshot 
injury;"  of  Surgeon  H.  S.  Hewit,3U.  S.  V.,  that  it  is  "highly  questionable  whether  excision, 
gouging,  or  resection  of  any  kind  is  to  be  permitted  in  traumatic  surgery  of  the  knee;"  and 
of  Dr.  John  Ashhurst,  jr.,4  that  "excision  of  this  joint  should  be  banished  from  the  practice 
of  military  surgery."  The  results  of  this  operation  in  the  late  European  wars  (TABLE  LX, 
p.  422)  were  equally  discouraging.  In  the  Schleswig-Holstein  War  of  1864,  the  mortality 
after  knee  joint  excision  was  85.7  per  cent.;  in  the  Austro-Prussian  War  of  1866,  86.6  per 
cent.;  in  the  Franco-Prussian  War  of  1870-71,  80.0  per  cent.;  and  in  the  Russo-Turkish 
War  of  1876-77,  100.  per  cent.;  and,  while  some  of  the  European  surgeons5  yet  hope  for 

1  Circular  No.  6,  War  Department,  S.  G.  O.,  Washington,  November  i,  1865.     Reports  on  the  Extent  and  Nature  of  the  Materials  available  for 
the  preparation  of  a  Medical  and  Surgical  History  of  the  Rebellion,  Philadelphia,  1865,  p.  CO. 

2  Surgeon  D.  P.  SMITH,  in  charge  of  Fairfax  Seminary  Hospital,  declares  (Experiences  in  Military  Surgery,  in  American  Medical  Times,  18C3,  Vol. 
VI,  p.  100):  "I  am  prepared  to  utterly  discard  this  operation  from  the  list  of  operations  proper  to  be  performed  for  gunshot  or  other  injury,  for  this  reason, 
even  in  civil  practice,  where  every  advantage  of  rest  and  careful  nursing  can  be  had,  it  is  a  doubtful  remedy.     But  it  is  admissible  because  it  is,  or  should 
be,  always  done  for  caries,  which  should  most  certainly  be  considered  by  every  surgeon  as  imperatively  demanding  as  thorough  excision  as  cancer." 

3Surgeon  H.  S.  HKWIT,  in  his  Report  of  the  Surgery  of  the  U.  S.  A.  General  Hospital  No.  5,  at  Frederick,  Md.,  in  1862  (B.  MSS.  33,  p.  37), 
states:  "  Three  partial  resections  of  the  knee  were  performed.  The  operation  consisted  in  laying  open  the  joint,  removing  the  fragments,  and  smoothing 
the  abraded  and  roughened  surfaces.  In  one  case  the  whole  of  the  internal  condyle  and  two- thirds  of  the  head  of  the  tibia  were  taken  away,  leaving  the 
patella  untouched.  In  the  other  cases  the  operation  was  confined  to  the  head  of  the  tibia.  They  all  three  failed,  as  might  have  been  expected;"  nod  on 
p.  43  adds:  "The  experiment  of  incising  the  knee  joint  and  partially  resecting  signally  failed.  It  was  undertaken  after  consultation  with  several  eminent 
civil  and  military  surgeons,  and  I  do  not  regret  it,  although  the  result  of  my  experience  has  determined  me  never  to  repeat  it.  It  is  highly  questionable 
whether  excision,  gouging,  or  resection  of  any  kind  is  to  be  permitted  in  traumatic  surgery  of  the  knee." 

*AsnnunsT  (.TOILS,  Ju.),  The  Principles  and  Practice  of  Surgery,  2d  edition,  Philadelphia,  1878,  p.  166. 

*HEIXK  (C.)  (Die  Schussverlf.tzungen  der  Unteren  Extremiti:ten,  Berlin,  1866,  p.  395)  regrets  that  excision  at  the  knee  joint  was  not  more  frequently 
performed,  and  hopes  that  in  a  future  campaign  the  question  as  to  its  value  may  be  more  definitely  settled.  SEXFTLEliEN  (HUGO)  (lieobachtungen  und 
Bemerl-ungen  ueber  die  Indikationen,  dtn  Ueilungsprocess,  nnd  die  Nachbehandlung  der  Rcstctionen  grosserer  Gelenke,  in  LANGEKBECK'8  Archiv,  B.  Ill, 
Berlin.  1862,  p.  101)  declares  the  introduction  of  the  excision  at  the  knee  joint  in  military  surgery  a  problem  of  the  future,  which  he  hopes  will  take  the 
place  of  amputation  in  the  thigh.  BlLLROTll  (TH.)  (ChirurgischeEricfe,  Berlin,  1872,  p.  2(57):  "  The  unfavorable  results  of  this  operation  in  war  seem  to 
prove  that  the  therapeutic  of  knee  joint  injuries  by  resection,  until  now,  has  not  accomplished  any  more  than  before ;'"  but  adds,  on  p.  271 :  "  To  discard 
primary  respctioti  altogether,  the  observations  are  yet  too  few."  STAHK  (W.)  (Veitriige  zu  der  Statislik  und  den  Endresultaten  der  Gelcnkresectionen,  in 


SECT.  iv.J  SHOT    INJURIES    OF    THE    KNEE   JOINT.  421 

better  results  in  future  wars,  considering  the  number  of  observations  on  record  too  few  to 
arrive  at  general  conclusions,  and  while  others,1  basing  their  opinions  generally  on  the  more 
propitious  results  obtained  in  civil  practice,  approve  of  the  operation  under  favorable 
circumstances,  the  most  experienced2  have  declared  themselves  against  the  expediency  of 
excision  at  the  knee  joint  in  times  of  war,  and  only  perform  it  when  amputation  has  been 
refused  by  the  patient. 

Of  the  fifty-seven  patients  on  whom  excision  at  the  knee  was  performed,  thirty-five 
were  Union  and  twenty-two  were  Confederate  soldiers.  Of  the  former  six  survived,  twenty- 
eight  died,  and  one  result  remained  undetermined,  a  mortality  rate  of  82.3  per  cent.  Of 
the  latter  four  recovered,  sixteen  died,  and  the  terminations  in  two  cases  could  not  be  ascer 
tained,  a  fatality  of  80.0  per  cent.  In  twenty-six  instances — 7  recoveries,  18  deaths,  and  1 
undetermined  case — the  right  limb  was  injured;  in  seventeen — 1  recovery  and  16  deaths — 
the  left;  in  fourteen  instances  the  side  injured  was  not  recorded.  In  seven  cases,3  with  1 
recovery,  the  excision  at  the  knee  was  succeeded  by  amputation  in  the  thigh. 

V.  CZERXY,  BeitrVge  zur  Operative*,  Chirurgie,  Stuttgart,  1878,  p.  325)  trusts  that  "primary  excision  may  retain  its  place  in  wur  surgery."  SuciN  (A.) 
(Kriegschirurgische  Erfahrungen,  Leipzig,  1872,  p.  1C9),  although  he  performed  4  excisions  at  the  knee  joint,  all  of  which  proved  fatal,  concludes:  "For 
all  cases  in  which  not  only  the  nature  of  the  injury,  but  also  the  surrounding  circumstances  permit  it,  I  would  recommend  the  primary  excision.  I  live 
yet  in  hope  that  this  operation  will  retain  its  place  in  military  surgery."  Professor  v.  XUSSBAUM,  on  the  other  hand,  considers  excision  at  the  knee  joint 
in  peace  as  well  as  in  war  as  a  less  dangerous  operation  than  amputation  in  the  thigh  (  Ueber  die  Resectionen  des  Kniegelenks,  in  Aerztliches  Intelligent 
blatt,  1873,  No.  9,  p.  136):  Dr.  NU8SBAUM  performed,  during  the  Franco- Prussian  War,  1870-71,  26  excisions  at  the  knee  joint  (25  on  the  battlefield  and  1 
in  hospital),  and  claims  that  7  of  these  operations  terminated  successfully.  But  Professor  E.  GURLT,  in  his  exhaustive  work  :  Die  Gelenk-  Resectionen 
nach  Schussverletzungen,  etc.,  Berlin,  1879,  p.  603,  etc.,  thoroughly  analyses  the  results  in  the  alleged  cases  of  recovery  after  excision  in  the  knee  joint  by 
V.  NUSSBAUM,  and  proves  that  in  one  case  the  excision  was  followed  by  amputation  in  the  thigh  terminating  in  death  ;  that  in  another  the  pati«nt  died 
after  4  years  of  suffering  from  fistulous  openings  in  the  joint;  that  in  the  remaining  four  cases  no  subsequent  history  can  he  obtained,  as  the  names  given 
by  Dr.  XUSSBAUM,  after  a  most  careful  scrutiny,  cannot  be  found  on  the  official  muster  rolls,  nor  among  the  claimants  for  pension;  and  Professor  GURLT 
concludes,  therefore,  that  of  the  excisions  performed  by  v.  NU68BAUM  only  one  can  be  claimed  with  certainty  as  a  successful  operation. 

1  RUPPRECHT  (L.)  (Militiirarztliche  Erfahrungen,  Wtlrzburg,  1871,  p.  82):  "Resection  at  the  knee  should  not  be  performed  unless  immediately 
after  the  operation  the  measures  are  at  hand  for  the  most  careful  after  treatment  and  perfect  rest."  KtiSTEll  (E.)  (Zur  Resection  des  Kniegelenks  im  Kriege.  .* 
in  Deutsche  Militairilrztliche  Zeitschrift,  187;!,  p.  447):  "Primary  total  excision  of  the  knee  joint  for  shot  injuries,  unless  contravened  by  especially 
unfavorable  circumstances,  is  preferable  to  amputation."  FEHR  (M.)  (Ueber  die  Resection  im  Kniegelenk,  in  Berliner  Klinische  Wochenschrift,  1872, 
No.  4(>)  concludes  that :  "  In  superficial  shot  injuries  of  the  epiphysis  of  the  femur  or  tibia,  excision  at  the  knee  joint  is  indicated  whenever  the  external 
circumstances  are  favorable  and  whenever  by  resection  of  the  bony  structure  everything  obnoxious  can  be  removed.  KOENIG  (Beitrllge  zur  Wiirdigumj 
df.r  Resection  des  Kniegelenkes  nach  Schussverletzungen,  in  Berliner  Klinische  Wochenschrift,  1871,  No.  30,  p.  355),  from  his  experience  in  civil  life  ami 
in  military  hospitals  far  remote  from  the  seat  of  war,  is  inclined  to  favor  excision  at  the  kuee  in  military  surgery,  while  Oberstabsarzt  J.  ECKER  (Zur 
Total  Resection  des  Kniegelenkes,  in  Wiener  Medicinische  Wochenschrift,  No.  34,  1877,  p.  817)  defends  the  operation  on  the  ground  of  art  and  humanity. 

2MACCoilMAC  (\VM.)  (Notes  and  Recollections  of  an  Ambulance  Surgeon,  London,  1871.  p.  119):  "Excision  for  wounds  of  the  knee  maybe  success 
fully  performed  in  civil  practice,  but  is  not  justifiable  in  military."  LOCKE  (A.)  (Kriegschirurgische  Fragenund  Bemerkungen,  Bern,  1871.  p.  GO):  "  Resec 
tioii  of  the  knee  in  war  surgery  has  not  recommended  itself;  I  only  perform  it  when  amputation  is  refused;  and  I  cannot  boast  of  my  success."  COUSIN 
(A.)  (De  la  valeur  de  la  resection  du  genou  en  temps  de  guerre,  in  Bull.  Gen.  de  la,  Therapeutique  Med.  et  Chir.,  Paris,  1873,  T.  84,  p.  161):  "  Mais,  en  temps 
do  guerre,  a  la  suite  des  batailles  qui  amenent  fatulement  rencombremeut  des  ambulances,  la  necessit6  des  Evacuations  successives  des  blesses  avec  des 
moyens  de  transport  le  plus  souvent  defectueux  et  partant  I'irnpossibilit6  d'assurer  aux  oper6s,  d'une  part,  les  soins  minutieux  dont  ils  doivent  e'tre  1'objet, 
1'isolement,  seule  gnrantie  certaine  contre  I'infection  purulente  et  la  septic6inie,  et,  d'autre  part,  I'immobilisation  absolue  du  membre  blesse,  condition 
sine  qua  non  du  succds  de  1'expectation  ou  de  la  resection,  selon  que  Ton  a  adopt6  1'uu  ou  1'autre  de  ces  modes  de  traitement,  toutes  ces  conditions  d£leo- 
tueuses  que  nous  venous  d'enum6rer  expliquent  et  justifieut  la  reprobation  dont  les  chirurgiens  militaires  ont  frapp6  la  resection  du  genou."  Sl'ILLMANN 
(E.)  (De  la  resection  du  genou  envisagee  au  point  de  vue  du  traumatisme,  in  Archives  Generates  de  Medecine,  1868,  T.  XI,  ser.  VI,  p.  690)  cites  19  cases  of 
excision  at  the  kuee  joint  with  only  2  recoveries,  and  exclaims:  "Toutes  les  illusions  doivent  tomber  devaut  une  pareille  experience;  la  rdsection  no 
pent  s'appliquer  a  la  chirurgie  d'arm6e,  si  ce  n'cst  dans  des  conditions  Ires  exceptionnelles."  CZERNY  (VixcEXZ)  (Bericht  ueber  die  im  College  Stanislaus 
in  Weissenburg  behandelten  Verwundeten,  in  Wiener  Med.  Wochenschrift,  1870,  No.  59,  p.  1429),  on  account  of  his  many  sad  experiences,  "could  not 
persuade  himself  to  perform  knee  joint  resection  again."  Induced  by  the  excellent  results  achieved  in  civil  practice,  Generalarzt  BECK  recommended 
and  practised  primary  excisions  in  cases  of  shot  fractures  of  the  articular  extremities  without  lesion  of  the  blood  vessels  and  without  extensive  laceration 
of  the  soft  parts.  "The  results,"  he  remarks  {Chirurgie  der  Schussverletzungen,  Freiburg,  i.  B.  1872,  p.  883),  ">n  no  way  came  up  to  my  expectations, 
although,  with  the  exception  of  two  cases,  the  operation  was  clearly  indicated,  the  condition  of  the  wounds  was  well  suited  to  the  operation,  and,  with 
one  exception,  the  operations  were  skilfully  performed,  and  in  one  instance  only,  too  early  transportation  perhaps  interfered  with  the  result.  Of  the  nine 
patients  operated  upon,  seven  died;  of  the  remaining  two,  one  had  to  have  the  thigh  amputated  afterwards,  and  one  only,  therefore,  survived  with  preser 
vation  of  the  limb."  LEGOUKST  (L.)  (Traite  de  Chirurgie  d'armee,  Paris,  1872,  p.  57!)):  "Xous  doutons  que  la  resection  du  genou  puisse  jamais  etre 
substitu6e  d'une  maniere  genurale  a  1'amputation  de  lacuisse,  dans  la  chirurgie  d'armee.''  LOTZHECK  (Zur  Kniegelenk-Resection  nach  Schussverletzungen, 
in  Aerztliches  Intelligenz-Blatt,  1872,  No.  32,  p.  419)  advises  amputation  in  thelower  third  of  the  femur  as  preferable  to  excision.  PIUOGOFF  (N.)  (Btricht 
ueber  die  Besichtigung  der  Mil.-Sanitiltsanstalten  in  Deutschlnnd,  etc.,  im  Jahre  1870,  Leipzig,  1871,  p.  110)  has  not,  in  the  seventy  hospitals  he  visited,  seen 
a  single  case  of  recovery  after  amputation  in  this  joint.  HUKTER  (C.)  (Klinik  der  Gelenkkrankheittn  mit  Einschluss  der  Orthopxdie,  Leipzig.  1870-71,  p. 
507):  "  Resection  of  the  knee  joint  in  perforating  shot  wounds  must  not  be  performed  when  the  accompanying  fracture  of  the  femur  or  tibia  extends  beyond 
the  joint  surface.  It  must  also  not  be  performed  when  the  necessary  guaranty  cannot  be  had  for  careful  attention  and  after  treatment  of  the  wounded.'1 

3 The  cases  in  which  the  excision  at  the  knee  joint  was  followed  by  amputation  in  the  thigh  arc:  1.  Private  \V.  E.  L.  Morrison,  1,  29th  Connecticut 
(TABLE  XXXV,  No.  388,  p.  ?85,  and  CASE  607,  p.  390),  intermediary,  in  middle  third  of  femur;  fatal.— 2.  Private  W.  M.  Constable,  H,  1st  Cavalry 
(TABLE  XXXV,  No.  43,  p.  280,  and  CASE  587,  p.  387),  intermediary,  in  the  middle  third;  recovery.— 3.  Corporal  A.  Glazier,  B,  1st  Minnesota  (TABLE 
XXXVI,  No.  366,  p.  298,  and  CASE  606,  p.  390),  intermediary,  in  lower  third;  fatal.— 4.  Private  J.  W.  Derr,  E,  7th  Maryland  (TABLE  XL,  No.  128,  p.  321, 
and  CASE  COS,  p.  390),  secondary  operation  in  lower  third;  fatal.— 5.  Private  S.  Lininger,  H,  74th  Indiana  (TABLE  XL,  No.  157.  p.  322.  nnd  CASE  639,  p. 
397),  secondary  operation  in  lower  third;  fatal.— C,  7.  Two  unknown  Confederate  soldiers  (TABLE  XL1.  p.  303.  Nos.  9,  10,  and  CASES  611,  612,  p.  390). 


422 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


TABLE   LX. 
Excisions  ai  the  Knee  Joint  for  Shot  Injury  on  the  Occasions  named  and  from  the  Authorities  quoted. 


OCCASIONS. 

CASES. 

PKIJIARY. 

INTERMEDIARY. 

SECONDARY. 

PERIOD 
UNKNOWN. 

0 

Recovery. 

"3 
1 

Result 
M  Unknown. 

Mortality  of 
Determined 
Cases. 

Recovery. 

"3 
1 

Recovery. 

"3 
"a 
PM 

.  c 

If 

Recovery. 

1 
fc 

Result 
>—  Unknown. 

Recovery. 

"3 
"5 
h 

Prior  to  September  15   1862  (Note  1   p  384) 

18 
2 

7 
o 

8 
2 

1 
1 

9 

52.9 
.0 

o 

3 

o 

1 



6 

3 

~ 

Accidents  1862  1863  (VERNEUIL1) 

Danish  War,  1  864  (NEUDORFER,2  LCEWENHARDT,3  OCHWADT,4 
ESMARCI-I  6  LANGENBECK6)                                                        

6 

1 

13 

85.7 
50.0 

2 

1 

1 

1 

3 

French  in  Mexico  and  Algiers,  1865  (NEUDOUFER,7  DAUVE8) 
SixWeeks'War,186G(BAERWINDT,9BlEFEL,10BURCIIARDT,n 
BUSCH,12  FIEBER,13  HA1IX,14  JUNG,18   KOXIG,16  LANGEN 
BECK  '7  MlDOELDORPF  I8  RAST  "  TEXTOR  20  WAGNEH21) 

1 

86.6 

1 

7 

1 
1 

5 

1 

Accidents,  1866-1868  (BUXMANN,22  THOMPSON,23  OATMAN24). 
Franco-Prussian  War,  1870-71  (GUKLT25)  

3 

3 

IT 

.0 

0 

60 

80.0 
33.3 

100. 
.0 

9 

1 

14 
1 

o 

1 

35 

1 

1 

10 

3 

1 

Accidents,  1871-1873  (NEWMAN,26  MINER,27  MEU6EL28)  
Russo-Turkish   War,   1876-1877    (REYHER,29   BERGMANN,30 
KADE  31  RuooucK32) 

3       2 

1 
6 

1 

o 

1 

1 

] 

Accident  1876  (TwiTCHFLL33) 

133 

1 

96 

23 

1 

3 



35 

2 

73.2 

14 

46 

1 

n 

22 

1 

'VERNEUIL  (A.)  (De  la  resection  du  genou,  iu  Gazette  Hebd.  de  M&d.  et  de  Chir.,  Paris,  1862,  T.  IX,  No.  46,  p.  722):  A  young  man,  aged  18,  in  the 
fall  of  1862  received  a  pistol  shot  in  the  knee  joint ;  resection,  five  days  after  injury,  of  the  articulating  ends  of  the  bone ;  cicatrized  in  seven  weeks.  In  a 
communication  to  the  Societe  de  Chirurgie  (  Gaz.  des  Hop.,  Paris,  1864,  No.  54,  p.  215),  at  their  meeting  of  April  27,  1864,  VERNEUIL  related  the  case  of  a 
poacher  shot  through  the  patella  in  1863;  neither  femur  nor  tibia  fractured ;  secondary  excision  of  condyles  of  femur  and  tibia ;  recovery  with  anchylosis 
in  HJ  months. — 2 NEUDORFER  (J.)  (Uandbuch  der  Kriegschirurgie  und  der  Operation slchre,  Leipzig,  1872,  Zweite  Halfte,  Zweite  Abtheilung,  p.  1546, 
and  GUKLT  (E.)  (Die  Gelenk-Kescctionen  nach  Scliussverletzungen.  litre,  Geschichtf,  Statistik,  Endresultate,  Berlin,  1879,  p.  278):  Ferd.  Blumaner,  27th 
Austrian  Infantry  Regiment,  1st  Co.,  wounded  February  6,  1864,  at  Oversee,  by  ricochet  snot  in  the  left  knee.  March  11,  18G4,  resection  in  hospital  at 
Schleswig.  Death  April  2,  1864.  Wasil  Dumma,  30th  Austrian  Infantry,  wounded  at  Oversee,  March  5,  1864,  in  the  left  knee  joint.  Wound  healed 
rapidly  in  seven  weeks,  but  broke  open  again  and  suppuration  ensued.  Resection  March  13,  1864.  Amputation  of  thigh  April  8,  1804.  Death  from 
exhaustion  April  13,  1864. — 3 Prussian  Staff  Surgeon  LCEWENIIARDT  operated  in  the  case  of  Peter  Jensen  Ugle,  4th  Danish  Infantry,  aged  27,  wounded  at 
.  Alsen,  June  29,  1864 ;  epiphysis  of  the  right  femur  perforated  antero-posteriorly,  and  external  condyle  shattered.  July  13,  1864,  resection,  by  H-incision,  in 
hospital  at  Ulderup:  about  4  inches  of  the  femur,  the  patella,  and  a  slice  of  the  tibia  removed.  Recovered,  and  living  in  1874  (C.  HEINE,  Die  Schuss- 
verletzungen  der  Untcren  Extremitdten,  Berlin,  1866,  p.  393,  and  GuitLT,  Joe.  cit.,  p.  318). — 4 OCHWADT  (A.)  (Kriegschimrffische  Erfaltrungen,  etc., 
wiihrend  des  Krieges  gegen  Danemark  1864,  Berlin,  1865,  Anhang,  Tdbelle  der  Operationen,  p.  VI,  No.  20,  and  GURLT,  loc.  cit.,  p.  319):  Sb'ren  Jacobsen, 
9th  Danish  Infantry,  wounded  at  Diippel,  April  18, 1864,  in  the  left  knee  ;  epiphysis  of  the  femur  split  into  three  parts  and  joint  opened;  patella  and  tibia 
intact.  Resection  April  19,  1864,  in  hospital  at  Flensburg.  Only  the  epiphysis  of  the  femur  was  removed.  Death  May  7,  1864. — 8EBMAHCH'S  case  of 
Chremers  Petersen,  9th  Danish  Infantry,  -wounded  at  Diippel,  April  18,  1864,  in  the  right  knee;  joint  opened;  resection  in  hospital  at  Broacker,  April  21, 
1864,  by  oval  incision;  patella  retained.  Death  May  1,  1864  (GURLT  (E.)  (toe.  cit.,  p.  319). — °B.  v.  LANGENBKCK  twice  excised  the  knee  joint  in  the 
Schleswig-Holstein  campaign  of  1864:  Jensen,  3d  Danish  Infantry,  wounded  at  Alsen,  June  29,  1804,  through  the  right  joint,  shattering  the  bone;  ampu 
tation  was  refused;  subperiosteal  resection,  with  inner  longitudinal  incision;  patella  retained,  July  19,  1864.  Death  July  22,  1864.  Stjernholm,  18th 
Danish  Infantry,  wounded  at  Alsen,  June  29,  1864  ;  penetrating  shot  wound  of  right  knee  joint.  August  1st,  subperiosteal  resection  of  both  carious  ends 
of  the  joint.  Death  August  7,  1864  (GURLT,  loc.  cit.,  p.  319). — 7 NEUDORFER  (J.)  (IlandbucJi  der  Kriegschirurgie  und  der  Operationslehre,  Leipzig,  1872, 
Zweite  Halfte,  Zweite  Abth.,  p.  1550,  and  GURLT,  loc.  cit.,  p.  328):  Kaspar  Ruppnik,  1st  Austrian-Mexican  Chasseur  Co.,  aged  41,  wounded  at  Tlapa- 
coyan,  November  22,  1865,  in  the  left  knee;  patella  shattered,  joint  opened  on  the  outer  side.  December  28th,  resection.  Living  in  1872,  his  confessor 
writing  from  Schwarzenberg  that  the  injured  extremity  is  entirely  stiff;  that  he  is  unable  to  do  any  hard  labor,  but  can  make  considerable  journeys  with 
the  aid  of  a  cane. — 8  DAUVE  (Lesions  traumatiques  des  deux  genmix  par  coup  de  feu. — Articulation  du  genou  gauche  ouverte  el  broyee  ;  resection  du 
genou,  in  Rec.  de  Mem.  de  Aled.  de  Cliir.  et  de  Phar.  Mil.,  Paris,  18G7,  T.  XIX,  3me  s6r.  p.  29):  An  Arab,  nearly  20  years  of  age,  was  shot  in  both  knees,  on 
July  26,  1865,  and,  on  the  following  day,  was  admitted  into  the  hospital  at  Boghar.  The  upper  part  of  the  internal  rondyle  of  the  right  femur  was  frac 
tured,  but  the  capsule  was  not  thought  to  be  interested;  two  small  pieces  of  bone  were  removed.  The  injury  of  the  left  limb  was  more  severe.  The 
internal  condyle  of  the  femur  was  crushed  and  the  articulation  largely  opened.  Amputation  proposed  but  not  allowed  by  the  patient.  July  27th, 
patella  removed,  and  portion  of  condyles  of  femur  and  tibia  excised.  Death  August  II),  1865. — '  BAERWINDT,  of  Frankfurt,  operated  in  the  case  of  W. 
Ranch,  2d  Silesian  Grenadiers,  No.  11,  8th  Co.,  aged  26,  wounded  at  Vettingen.  July  26, 1866,  in  the  left  knee  joint.  Septembpr2d,  admitted  into  Garrison 
hospital  in  Frankfurt,  a.  M.  Resection  of  both  condyles  in  their  middle  September  12th ;  ball  not  found.  Death  October  5,  1866  (GUULT,  loc.  cit.,  p.  397)- 
10BiEFEL  (II.)  (Im  Reserve- Lazareth.  Kriegschirurgische  Aphorismen  von  1866,  in  LANOENKKCK'S  Arcliiv  fur  Klin.  Chir.,  Berlin,  1869,  B.  XI,  p.  450): 
Joh.  Palyo,  34th  Austrian  Infantry,  13th  Co.,  aged  24,  wounded  at  Koniggratz,  July  3,  18G6,  in  the  left  knee  joint,  shattering  the  patella.  July  8th, 
admitted  into  reserve  hospital  at  Landeshut.  Resection  August  9th.  Death  September  14,  1866. — n  Dr.  BURCIIARDT  excised  the  knee  in  the  case  of 
Josef  Drozdz,  20th  Austrian  Infantry,  aged  27,  wounded  at  Koniggratz,  July  3,  1866,  close  beneath  the  right  knee.  Resection  July  10th,  removing  the 
patella  and  portions  of  the  tibia  and  condyles  of  the  femur.  July  19th,  haemorrhage  from  popliteal  artery  ;  ligation  of  femoral  artery.  Death  20  minutes 
afterwards,  July  19,  1866  (GURLT,  loc.  cit.,  p.  487). — 12Dr.  Buscn  (ScilOLZ  W.)  (Bericht  iiber  das  Verwundeten-Spital  Schloss  Hradek  bei  Koniggratz 
vom  28.  August  bis  zu  dessen  Aujlasung  am  6.  November  1866,  in  Allgcmeine  Militararztliclie  Zeitung,  1867,  S.  324,  357,  and  GURLT,  loc.  cit.,  p.  486):  Case 
of  Joh.  Necasek,  Corporal,  74th  Austrian  Infantry,  aged  24.  wounded  at  Problus,  July  3,  1866,  in  the  right  knee  joint;  the  ball  lodged  and  was  removed 


SECT.  IV.]  SHOT    INJURIES    OF    THE    KNEE    JOINT.  423 

Amputations  at  the  Knee  Joint. — As  indicated  in  TABLE  LIV,  on  page  398,  the  fatal 
ity  of  one  hundred  and  eighty-seven  cases  of  amputation  at  the  knee  joint  in  which  the 

<m  the  Uth  day.  July  13th,  conveyed  to  Castle  Ilmdek  Hospital.  Resection  July  15th ;  fistulas,  erysipelas,  etc.,  ensued,  and  on  July  3,  1867,  at  the  solicita 
tion  of  the  patient,  amputation  was  performed  in  the  middle  third  of  the  thigh.  Dr.  BUSCH  performed  two  additional  operations  in  18GG:  Alfred  Graf, 
sublieutenant,  Austrian  Cuirassiers  Regiment,  Xo.  2,  aged  18,  wounded  at  Koniggratz,  July  3,  186G,  through  the  right  knee  joint,  fissuring  the  femur 
extensively.  Admitted  into  Castle  Ilradek  Hospital.  Resection,  July  27th,  of  about  four  inches  of  the  lower  end  of  the  femur  and  patella.  Death  Aug. 
2,  1866.  Anton  Dnnda,  8th  Austrian  Infantry,  aged  25,  wounded  at  Koniggratz,  July  3, 1866,  in  the  left  knee  joint.  Admitted  into  Castle  Hradek  Hospital. 
August  1st,  resection  of  about  1J  inch  of  end  of  femur.  August  6th,  ligation  of  femoral  artery  below  Poupart's  ligament  on  account  of  arterial  haemor 
rhage.  Death  August  7,  1866  (GURLT,  loc.  cit.,  pp.  487,  488). — 13FlKBEK  (CAUL)  (Chirurgische  Studien  und  Erfahrungen  mit  Zv.gr  undelegung  der  im 
italienischcn  Feldzuge  des  Jalires  18G6  gemachten  Beobachtungen,  in  Allgemeine  Wiener  Med.  Zeitung,  1875,  No.  21,  p.  202):  Nicolo  Pinosco,  1st  Italian 
Grenadier  Regiment,  wounded  at  Custoza,  June  24,  18GG,  in  the  left  knee  by  a  grenade  splinter;  patella  shattered,  joint  opened.  Admitted  into  hospital 
at  Verona.  Resection  July  7th;  pieces  of  patella  entirely  extirpated;  both  condyles  removed.  Death  on  the  evening  of  July  9,  1866.— '4Dr.  HAHN 
operated  on  Carl  Bcihm,  42d  Austrian  Infantry,  wounded  at  Koniggratz,  July  3,  1866,  through  the  right  knee  joint.  Admitted,  July  6th,  into  hospital  at 
Horic.  August  7th,  resection  of  about  1  inch  of  tibia  and  fibula  and  1J  inch  of  femur.  August  27th,  haemorrhage,  followed  by  death  in  a  few  minutes 
(GuiiLT,  Inc.  cit.,  p.  488). — 16Dr.  JUNG,  of  Frankfurt,  a.  M.,  operated  in  the  case  of  Gustav  Hombogen,  non-commissioned  officer  of  Magdeburg  Fusileer 
Regiment,  No.  36,  aged  23,  wounded  at  Vettingen,  July  26,  1866;  penetrating  shot  wound  of  the  knee  joint.  Admitted  into  Relief  Hospital  Xo.  4,  Frank 
furt,  August  9th.  Resection,  August  15,  1866,  of  knee  joint.  Death  from  pyaemia  August  19,  1866  (GuilLT,  loc.  cit.,  p.  398). — IBK6.\IG  (Beitrdge  zur 
Resection  des  Kniegclcnkes,  in  Archie  fur  Klin.  Chir.,  18C8,  B.  IX,  s.  465,  and  GURLT,  loc.  cit.,  p.  485):  Leopold  Anzenberger,  Austrian  Infantry  Regi 
ment,  No.  40,  aged  25,  wounded  near  Aschaffenburg,  July  14,  18GG,  in  the  left  knee  joint.  On  September  10th  he  was  admitted  into  hospital  at  Ilanau. 
Resection,  September  llth,  of  about  2i  centimetres  (broad)  of  the  femur,  the  fractured  patella,  and  a  piece  of  Hie  tibia  about  a  centimetre  broad. 
Living  October  11),  1874,  having  been  engaged  in  shoemaking  for  three  years.  Leg  shortened  2  inches. — I7  B.  V.  LANGENBECK  ( Ueber  die  Schusi-fracturen 
der  Gelcnlce,  etc.,  Berlin,  1868,  p.  33.  and  GUULT,  loc.  cit.,  p.  398):  Case  of  Simon  Bach,  Pommeranian  Field  Artillery,  aged  24,  wounded  at  Koniggratz, 
July  3,  1866;  right  knee  joint  shattered  by  splinter  of  grenade;  capsule  opened.  Admitted  into  hospital  at  Milowie,  July  30th.  Subperiosteal  resection 
of  the  knee  joint.  Death  August  5,  1860. — 18Dr.  MlDDELDORPF  operated  on  Constantin  v.  Memerty,  2d  Lieutenant,  7th  East  Prussian  Infantry,  No.  44, 
aged  23,  wounded  at  Koniggratz,  July  3,  1866.  Besides  two  slight  flesh  wounds,  the  left  knee  joint  was  shattered  by  a  piece  of  grenade,  the  patella 
carried  off,  and  the  joint  opened.  Resection,  July  10th,  in  hospital  at  Koniginhof.  Death  from  pyaemia,  July  27,  1866  (GURLT,  loc.  cit.,  p.  398). — 
19  Surgeon  RAST  excised  the  knee  in  the  case  of  Michael  Maier,  1st  Bavarian  Infantry,  aged  2G,  wounded  at  Vettingen,  July  26,  18G6,  at  inner  condyle  of 
left  knee.  Admitted  into  hospital  at  Wilrzburg  August  18th  ;  resection,  August  30th,  of  condyles,  patella,  and  a  slice  of  tibia.  Death,  September  17, 1866, 
from  pyainia  (GURLT,  loc.  cit.,  p.  418). — 20  Professor  KARL  TEXTOR,  in  the  case  of  Andreas  Jorg,  9th  Bavarian  Infantry,  3d  Co.,  resected  the  knee  joint 
in  hospital  at  Wttrzburg.  Death  August  1C,  18GG  (GURLT,  loc  cit.,  p.  419).— 21Generalarzt  WAGNER,  in  the  case  of  Franz  Skazel,  Field  Chasseur  Bat 
talion,  No.  27.  aged  20,  wounded  at  Koniggratz,  July  3,  1866,  in  the  left  knee,  and  admitted  into  hospital  at  Gorlitz  on  July  30th,  removed,  on  August 
3ist,  the  patella.  Death  September  29,  1866  (GURLT,  loc.  cit.,  p.  488). — 22  Surgeon  BUXMANN:  Case  of  Corporal  H.  Schildgen,  Hessian  Sharpshooter 
Corps,  aged  30,  wounded  accidentally,  September  16,  1866,  in  the  right  knee ;  joint  opened,  tibia  and  fibula  uninjured.  Resection  of  knee  joint  about  16 
or  18  hours  after  injury;  removal  of  patella,  head  of  fibula,  articular  portion  of  tibia,  and  the  splintered  femur  1J  inch  above  its  articulating  extremity. 
Recovered  July  21,  1875;  shortening  10  centimetres;  walks  about  all  day,  but  feels  very  tired  in  the  evening.  Cicatrix  adherent;  total  anchylosis  of 
joint;  leg  entirely  straightened;  can  walk  up  hill  easier  than  down  hill;  uses  no  supporting  apparatus  (GURLT,  loc.  cit.,  p.  1191). — "THOMPSON  (HEXHY) 
( Gunshot  Wound  of  the  Knee — Excision  of  the  Knee  Joint,  in  The  Dublin  Quarterly  Journal  of  Medical  Science,  1868,  Vol.  XLVI,  p.  27):  Case  of  Peter 
McSorley,  a  carpenter,  shot  February  29,  18(i8,  in  his  bent  right  knee.  Admitted  into  Tyrone  County  Infirmary  at  Omagh.  March  1,  1868,  resection 
of  2.V  inches  of  the  femur,  a  very  thin  slice  of  the  head  of  the  tibia,  and  all  the  fragments  of  the  patella,  shot,  and  pieces  of  lead.  For  weeks  afterwards 
pieces  of  bone,  lead,  shot,  etc.,  continued  to  discharge.  July  1,  1868,  patient  able  to  go  about  with  the  aid  of  a  crutch  and  cane  and  without  splints,  limb 

being  shortened  about  H  inch.—24  OATMAN  flUA  T.)  (Excision  of  the  Knee  Joint,  in  Pacific  Med.  and  Surg.  Jour.,  1869,  Vol.  Ill,  N.  S.,  p.  56):  C.  G , 

of  Yolo  County,  California,  aged  16,  wounded  March  10,  1868;  penetrating  shot  wound  of  knee  joint,  resulting  in  caries.  Resection  May  21,  1868; 
removal  of  lower  portion  of  condyles,  anterior  articular  surface  of  femur  beneath  the  patella,  the  patella,  head  of  tibia,  and  fragments  of  fibula. 
October  15,  1868,  amputation  of  thigh  on  account  of  continuous  progress  of  caries  of  the  femur  and  leg ;  recovered. — 26  For  details  of  the  cases  of  excision 
of  the  knee  joint  of  the  Franco-Prussian  War  of  1870-71,  the  reader  is  referred  to  the  exhaustive  work  of  Professor  E.  GURLT,  Die.  Gelenk-Resectionen 
nach  Schussverletzungen,  etc.,  Berlin,  1879,  pp.  602,  etc.  From  a  careful  and  critical  examination  of  the  sources  at  his  command,  Dr.  GURLT  collects  75 
authentic  cases  of  excisions  at  the  knee  joint  performed  during  that  short  but  decisive  struggle:  15  were  successful  and  GO  proved  fatal,  a  mortality  rate 
of  80.0  per  cent. — -''XEW5IAN  (Wll.)  (Gunshot  Wound  of  Right  Knee  Joint,  twenty-fire  years  ago — Removal  of  Lower  Half  of  Patella  (carious),  and  of 
shot  imbedded  in  inner  Condyle  of  Femur,  from  a  patient  aged  55,  in  St.  Bartholomew's  Hospital  Reports,  London,  1874,  Vol.  X,  p.  392),  in  the  case 

of  J.  T ,  accidentally  shot  in  the  right  kneo.     Excision  March  29,  1871.     Recovery,  with  bony  anchylosis. — "MINER  (J.  S.)  (H.  CUMiERTSON, 

Excision  of  the  Larger  Joints  of  the  Extremities.  Prize  Essay,  in  Trans.  Am.  iled.  Assoc.,  Philadelphia,  1876,  Supp.  to  Vol.  XXVII,  p.  186,  Case  No. 
37):  Thomas  S.  Cobb,  of  Buffalo,  N.  Y.,  aged  35,  received,  on  November  8,  1871,  a  pistol  shot  in  the  articulating  surface  of  the  tibia.  Resection,  on 
November  10th,  of  both  surfaces  of  joint.  Died  15  days  afterwards  of  pyaemia.— ^Dr.  MEUSEL  (Einc,  Kniegelenkrescction  nach  Schussverletzttng,  in  Ber 
liner  Klin.  Wochcnschrift,  1875,  XII  Jahrg,  S.  272):  Case  of  Zeiss,  aged  25,  wounded  November  1,  1873,  by  a  revolver  shot  in  the  left  knee ;  ligamcntum 
patella?  perforated,  missile  lodged  in  the  epiphysis  of  the  tibia  about  5  centimetres  deep.  Resection  November  9,  1873.  removing  a  piece  from  the  con 
dyles  of  femur  4  centimetres  thick,  without  touching  the  patella,  and  resecting  the  tibia  so  as  to  leave  the  fibula  joint  unopened.  Discharged  from  treat 
ment  April  8,  1874,  walking  on  crutches;  he  subsequently  accustomed  himself  to  walk  with  a  light  cane;  shortening  5  centimetres. — ^REYIIER  (G. 
TILING,  Bericht  iiber  124  im  Serbisch-Tiirfischen  Kriege  im  Baracken-Lazareth  des  Dorpater  Sanilats-Ti-ains  zu  Swilainatz  belinndelte  Schussverlet- 
zungen,  Dorpat,  1877,  pp.  67,  68,  and  GURLT,  loc.  cit.,  p.  1160)  performed  3  excisions  at  the  knee  joint  during  the  Russo-Turkish  War,  1876-78 :  Rista 
Bokowitsch,  nged  35,  wounded  September  18,  1876,  in  the  external  condyle  of  the  right  femur;  ball  removed.  Resection  of  knee  joint  SeptemberSl,  1876, 
at  Swilainatz.  Death  September  22, 1876.  Radojiza  Schiwanowitsch,  aged  40 ;  admitted  into  hospital  at  Swilainatz,  September  2, 187G,  with  penetrating 
shot  wound  of  left  knee  joint,  fracturing  the  femur,  received  several  days  previous.  Resection  of  entire  lower  portion  of  femur.  Died  September  13, 187G. 
Gaja  Miliwojewitsch,  aged  34,  admitted  into  hospital  at  Swilanatz,  August  22,1876,  with  a  shot  wound  of  left  knee  joint  received  two  and  a  half  weeks 
previously.  Resection  of  both  condyles  of  femur,  August  23,  1876.  Death  from  pyaemia  August  31,  187G. — 30BERGMAN.v  (E.)  (Die  Behandlung  der 
Schusswunden  des  Kniegelenks  im  Kriege,  Stuttgart,  1878,  pp.  30,  31):  Aleksci  Neboschenko,  Russian  Regiment  WoUiynicn.  aged  27.  wounded  at  the 
crossing  of  the  Danube,  June  15,  1877,  in  the  right  knee  joint.  Primary  resection  of  the  shattered  condyles  of  femur.  Death  July  2,  1877,  from  pyamiin. 
31KADE  (E.)  (Das  tewpordre  Kriegslazareth  des  Rcssorts  der  Anstalten  der  Kaiserin  Maria  im  Kloster  Mariahimmelfahrt  bei  Sistowa,  in  St.  Peters- 
burger  Sled.  Wochenschrift,  1877,  S.  381.  1878,  s.  19):  Peter  Petrunja,  14th  Russian  Sharpshooter  Battalion,  wounded  on  the  Nicolai  Mountain.  August 
13,  1877.  through  the  left  knee.  Resection,  October  5,  1R77,  in  hospital  at  Sistowa,  of  articulating  ends  of  femur  and  tibia.  Death  October  8,  1877. — 
32RUDnuCK  operated  twice  during  the  Russo-Turkish  War,  1876-78  (SociM  ottomane  de  secours  aux  blessfs  et  malades  militaires  constitute  d'apres  la 
Convention  de  Geneve,  Vol.  Ill,  Ambulances  fixes  et  mobiles  du  Croissant  rouge,  Constantinople,  1878,  pp.  137,  232):  Ahmed  Ibrahim,  wounded  September 
8,  1877,  in  the  right  knee.  Resection,  September  22,  1877,  of  the  condyles  and  articular  facet  of  the  tibia,  in  hospital  Le  Mevle-Hane,  at  Philippopolis. 
Hassan  Ali,  penetrating  wound  of  right  knee  joint;  ball  in  one  of  the  condyles  of  the  femur.  Resection.  October  25,  1877,  of  knee  joint,  in  field  hospital 
No.  5,  at  Orkhanie.  Death  from  pyaomia. — 33RlcilARDSON  (A.  P.)  (Proceedings  of  the  Connecticut  River  Valley  Medical  Association,  in  Boston  Med. 
and  Surg.  Jour.,  1878,  Vol.  XCVIII,  p.  43):  A  girl,  aged  14,  accidental  shot  wound  of  knee  joint,  in  1876 ;  excision  of  articular  end  of  bones  by  Dr. 
TWITCHELL,  of  Keene,  N.  H.  Recovery,  with  2  inches  shortening  and  a  useful  leg. 


424  INJURIES    OF    THE    LOWER    EXTREMITIES.  [OHAV.  X. 

final  issues  were  determined  was  56.6  per  cent.,  viz:  fatality  of  one  hundred  and  seven 
primary  operations,  53.2  per  cent.;  of  fifty  intermediary,  68.0  per  cent.;  of  twenty-six 
secondary,  53.8  per  cent.;  and  of  four  operations  in  which  the  date  of  the  amputation  was 
not  ascertained,  25.0  per  cent.  These  results  do  not  sustain  the  opinion  expressed  in 
the  preliminary  report,  issued  in  1865,  that  the  mortality,  especially  of  primary  amputa 
tions  in  the  lower  third  of  the  thigh,  is  much  larger  than  that  of  the  exarticulations  at  the 
knee  joint.  It  will  be  remembered  that  the  fatality  of  the  amputations  in  the  lower  third 
of  the  thigh  was  53.6  per  cent.,  and  of  the  primary  amputation  in  the  lower  third  only 
48.7  per  cent.  (TABLE  XXIX,  p.  213),  or  3  and  4.5  per  cent.,  respectively,  less  than  that 
of  the  corresponding  groups  of  amputations  at  the  knee  joint,  and  the  former  operation 
would,  therefore,  seem  to  give  a  better  chance  for  life  than  the  latter.  It  must  also  be 
taken  into  consideration  that  in  8,  or  nearly  10  per  cent.,  of  the  eighty-one  cases  of  recovery 
after  amputation  at  the  knee,  amputation  in  the  thigh  subsequently  became  necessary. 

The  mode  of  operation  in  amputations  at  the  knee  joint  has  been  varied  in  many 
ways:  by  a  semilunar  incision  .in  front  and  a  long  posterior  flap  behind,  as  practised  by 
Hoin,  in  1764;1  by  the  long  anterior  flap  of  Le'veille';2  by  the  anterior  and  posterior  semi 
circular  flaps  of  N.  Smith,3  the  patella  being  retained;  by  the  circular  method  of  Velpeau,4 
three  or  four  inches  below  the  patella;  by  the  oval  method  of  Baudens,5  consisting  of  one 
flap,  long  anteriorly  and  short  posteriorly;  by  the  lateral  flaps  of  Rossi;6  and  by  three  sub 
cutaneous  flaps  (one  anterior  and  one  posterior,  the  latter  split  up  along  the  middle  of  the 
popliteal  space)  from  the  circumference  of  the  upper  part  of  the  leg,  as  proposed  by  Pan- 
coast.7  Syme,8  in  1845,  made  a  semilunar  incision  on  a  line  with  the  upper  edge  of  the 
patella  and  a  long  flap  from  the  calf  of  the  leg,  after  the  manner  of  Hoin,  but  he  removed 
the  condyles  and  the  patella.  Garden,9  since  1846,  cut  an  anterior  semioval  skin  flap, 
removing  the  patella  and  portions  of  the  condyles  of  the  femur.  Operations  similar  to 
Garden's  were  performed  by  Melchiorj10  in  1850  and  1851,  but  the  patella  was  retained 
in  these  cases.  In  1857,  R.  Gritti  proposed  to  cut  an  anterior  rectangular  flap,  to  saw 
through  the  condyles  of  the  femur,  to  remove  a  segment  of  the  inner  portion  of  the  patella 
and  to  place  the  sawn  surfaces  in  apposition,  to  secure  in  this  manner  a  sound  surface  to 

1  BRASDOII  (Sur  les  amputations  dans  les  articles,  in  Mem.,  de  VAcad.  Roy,  de  C'ltir.,  Paris,  1774,  T.  V,  p.  773;,  who  practised  the  operation  at  Dijon, 
in  1764,  on  a  laborer  who  had  fallen  from  a  building.  2LEVEILLfc  (J.  B.  F.),  Nouvelle  doctrine  chirurgicale,  Paris,  1812,  T.  IV,  p.  586. 

3  SMITH  (NATHAN)  ( On  Amputation  at  the  Knee  Joint,  in  the  American  Medical  Review  and  Journal,  1825,  Vol.  II,  p.  370)  marked  "two  points  one 
on  the  out  and  the  other  on  the  inside  of  the  limb,  the  latter  half  an  inch  below  the  head  of  the  tibia,  and  the  other  opposite  to  it.  Then  draw  u  semicircular 
line  from  one  point  to  the  other,  over  the  anterior  part  of  the  leg,  and  in  such  a  direction  that  its  lower  part  shall  touch  the  lower  part  of  the  tubercle  on 
the  tibia  into  which  the  ligament  of  the  patella  is  inserted,  and  then  mark  another  circle  on  the  posterior  part  of  the  leg,  exactly  corresponding  to  the 
former.  The  above  lines  limit  the  two  flaps,  the  former  of  which  will  be  formed  of  the  patella  and  its  ligament,  together  with  the  investing  integuments, 
and  the  latter  of  the  head  of  the  gastrocnemius,  the  tendons  of  the  flexor  muscles,  and  the  popliteal  blood-vessels  and  nerves.  The  operator  should 
first  raise  the  anterior  flap  with  the  patella,  which  will  expose  the  anterior  part  of  the  joint  and  render  the  division  of  the  lateral  ligaments  easy.  Two 
or  three  strokes  of  the  knife  will  then  complete  the  section  of  the  lower  flaps,  with  the  crucial  ligaments." 

4VELPEAU  (A.),  Memoire  sur  I 'amputation  de  la  jambe  dans  I' articulation  du  genou,  et  description  d'un  nouvcau  procede  pour  pratiquer  cette 
operation,  in  Archives  Genirales  de  Medecine,  8me  annee,  T.  XXIV,  1830,  p.  58. 

*BAVDEXS  (L.)  (Clinique  des  plaies  d'armes  <t  feu,  Paris,  1830,  p.  537,  and  Desarticulation  cnxo  femoral  et  tibio-femorat,  in  Bulletin  de  I'Acad. 
Roy.  de  Mid.,  Paris,  1836,  T.  I,  p.  324)  recommends  a  combination  of  the  oval  and  flap  methods.  A  long  oval  flap  anteriorly,  commencing  five  inches 
below  the  patella,  is  dissected  and  turned  up  ;  the  ligaments,  muscles,  and  vessels  are  next  divided  by  a  circular  incision,  the  articulation  la  opened,  and 
the  semilunar  cartilages  and  crucial  ligaments  detached  as  in  the  circular  process  of  VELPEAU. 

6  ROSSI  (R.),  Eltmensde  Medecine  Operatoire,  Turin,  1806,  T.  II,  p.  227. 

7PAXCOAST  (JOSEPH),  A  Treatise  on  Operative  Surgery,  Philadelphia,  1846,  p.  171. 

8  SYME  (JAME?),  Surgical  Cases  and  Observations,  in  London  and  Edinburgh  Monthly  Journal,  1845,  p.  339. 

9 GARDEN  (HENRY  D.)  (On  Amputation  by  Single.  Flap,  in  British  Medical  Journal,  1864,  Vol.  I,  p.  416):  It  consisted  "in  reflecting  a  rounded  <jr 
gemi-oval  flap  of  skin  and  fat  from  the  front  of  the  joint;  dividing  everything  else  straight  down  to  the  bone;  and  sawing  the  bone  slightly  above  the 
plane  of  the  muscles ;  thus  forming  a  flat-faced  stump  with  a  bonnet  of  integument  to  fall  over  it."  The  patella  was  not  retained  in  this  operation. 

10 MELCHIORJ  (G.)  (Caso  di  amputazione  sopracondiloidea  del  femore  col  metndo  del  dott.  ROCCO  GlUTTI,  doe  con  lembo  patellarc,  per  ferita  da 
arma  dafuoco;  prectduto  da  allri  due,  in  cuifu  conservata  larotelladisarticolando  il '  ginocchio ed  amputando ai condili  femorali ;  in  Annali  Universali 
di  Medicina,  Miluno,  18G7,  Vol.  CO,  pp.  370,  371);  but  in  these  operations  the  entire  patella  was  retained.  One  of  the  patients  on  whom  the  amputation 
was  performed  recovered  from  the  operation,  but  died  of  recurring  cancerous  tumors  four  and  a  half  months  after  the  operation.  The  patella,  deprived 
of  its  cartilage,  was  found,  held  by  adhesions,  in  the  intercondyloid  notch ;  the  skin  of  the  flap  adhered  to  the  condyles.  In  the  other  case,  the  operation 
was  performed  at  the  level  of  the  condyles  for  a  railroad  accident,  in  1851.  The  anterior  flap  sloughed,  but  filially  the  patella  became  unchylosed  to  the 
outer  part  of  the  femur  and  the  patient  recovered  with  nn  excellent  stump. 


SECT,  iv.]  SHOT    INJURIES    OF    THE    KNEE   JOINT.  425 

the  stump.1  From  the  records  it  would  seem  that  this  mode  of  amputating  at  the  knee 
joint  was  practised  once  only  during  the  late  civil  war  in  the  case  of  Private  C.  H.  Hist, 
36th  Wisconsin  (CASE  492,  p.  318,  and  TABLE  LV,  p.  402,  No.  38),  who  subsequently 
underwent  secondary  amputation  in  the  lower  third  of  the  thigh;  although,  as  already 
stated  on  page  357,  ante,  similar  procedures  were  employed  by  Surgeon  B.  A.  Vanderkieft, 
U.  S.  V.,  and  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  in  two  instances  of  amputations 
in  the  lower  third  of  the  femur.  In  the  Danish  War  of  1864,  the  Austro-German  War  of 

1 R.  GRITTI,  Dell'  amputazione  del  femore  al  terzo  inferiore  e  delta  disarticolazione  del  ginocchio.  Valore  relative  di  cadauna,  coll'indicazione  di 
un  nuovo  metodo  denominate  amputazione  del  femore  ai  condili  con  lemlo  patellare,  in  Annali  Universali  di  Medicina,  Milano,  1857,  Vol.  CLXI,  p.  5. 
The  author,  who  found  no  occasion  to  practise  the  amputation  on  the  living  subject,  gives,  on  page  18,  a  minute  description  of  the  operation,  of  which  the 
following  is  a  brief  outline  :  An  incision  is  made  from  the  upper  edge  of  the  head  of  the  fibula  transversely  across  the  leg,  about  one  inch  below  the 
patella,  to  the  inner  tuberosity  of  the  tibia.  From  the  extremities  of  this  incision  a  vertical  cut  is  made  upward  to  the  level  of  the  middle  of  the  patella. 
The  rectangular  flap  thus  outlined  is  dissected,  the  joint  is  opened  by  cutting  through  the  ligamentum  patellae.  The  patella  is  then  thrown  back,  and 
a  segment,  about  two  lines  in  thickness,  removed  from  the  inner  surface  by  a  small  saw.  The  condyles  of  the  femur  are  eawn  through.  The  posterior 
flap  is  then  made  by  an  incision  direct  to  the  bone,  connecting  the  upper  extremities  of  the  lateral  cuts.  This  flap  is  separated  from  the  femur  for  a  short 
distance,  the  periosteum  cut  through,  and  the  limb  removed.  The  vessels  are  ligatetl,  the  sawn  bony  surfaces  arc  placed  together,  and  the  edges  of  the 
flaps  secured  by  several  interrupted  sutures.  Professor  J.  NEUDORFER,  in  the  preface  to  his  Handbuch  der  Kriegschirurgie.  Ein  Vademecumfiir  Feldarzte, 
Leipzig,  18f>4,  Erste  Halfte,  p.  IX,  claims  that  he  performed  an  operation  similar  to  GltlTTl's  in  1859:  "The  work  of  GRITTI  was  unknown  to  me;  but 
it  struck  me,  in  the  fall  of  1859,  to  combine  exarticulation  at  the  knee  with  resection,  and  to  practically  test  it,"  and  on  p.  1559  of  the  Zweite  Ilalfte 
states  that  he  performed  the  operation  in  1859,  but  he  fails  to  give  details  of  the  case.  In  an  article,  Beitrag  zur  Amputation,  in  Vierteljahrschrift  fur 
die  Praktische  Heilkunde,  Prag,  1860,  Vol.  I,  p.  80,  Professor  SZYMANOWSKY  advocates  GRITTl's  mode  of  operation,  and  details  his  experimental  efforts 
on  the  cadaver;  but  at  that  time  he  found  no  occasion  to  employ  this  method  on  the  living  subject.  SAWOSTITZKI  seems  to  have  been  the  first  to  prac 
tically  test  GRITTI'S  operation,  in  1802.  The  case  is  published  in  the  St.  Petersburger  Medicinische  Zeitsclirift,  1862,  B.  Ill,  p.  372 :  The  patient,  aged  19, 
fell  from  a  wagon  and  received  a  fracture  of  the  right  leg.  The  operation  was  performed  according  to  GlUTTl'S  mode  as  described  by  SzYJIAXOWSKY; 
the  sawing  of  the  patella  caused  the  only  difficulty ;  the  sawn  surfaces  of  the  femur  and  patella  fitted  readily;  the  wounds  healed  principally  by  first 
intention.  On  the  sixth  day  after  the  operation  the  patella  was  found  to  have  been  drawn  upwards  on  the  anterior  surface  of  the  femur  by  the  quadri 
ceps,  and  could  not  be  replaced.  The  patient  recovered  with  a  good  stump.  The  first  recorded  operation  after  shot  injury  is  a  case  reported  by  SZY- 
MAXOWSKY  (Die  Rechtfertigung  der  GltiTTl'schen  Operation  durch  Wort  und  That,  in  Vierteljahrschrift  fiir  die  Praktische  Ecilkunue,  I'rag,  1866,  B.  II, 
S.  38):  "February  5,  1863,  shot  fracture  of  leg,  gangrene ;  GlUTTl'S  operation  with  dissection  of  the  synovial  pouch;  gangrene  of  thigh  ;  death.  The 
patella  was  found  unmoved  upon  the  sawn  surface  of  the  femur."  In  the  Schleswig-Holstein  War  of  1864, 10  cases  of  GRITTI'S  operation  were  reported. — 
A.  LUCKE  (Kriegschirurgische  Aphorismen  aus  dem  zwciten  Schleswig-Bolsteinschen  Kriege  im  Jahre  1864,  in  LANGEXHECK's  Archiv  fur  Klin.  Chir., 
Berlin,  I860,  B.  VII,  pp.  23,  24,  134,  147)  reports  4  cases. — 2.  Christian  Balzer,  24th  Regiment,  shot  wound  of  left  knee  joint,  June  29,  18G4;  amputation 
June  30th,  by  Surgeon  SCHILLING;  fatal. — 3.  Thomas  Thomsen,  9th  Danish  Infantry,  shot  wound  of  right  knee,  April  18, 1864;  amputation  April  2?th.by 
Dr.  LfJCKE;  death  May  1,  1864. — 4.  Carl  Neumann,  4th  Guards,  shot  wound  of  right  knee  joint,  April  18,  1864  ;  amputation  by  Dr.  LlJCKE,  April  2Gth; 
recovery. — 5.  Hoffmann,  wounded  in  right  knee,  February  2,  1864  ;  amputation  February  10th,  by  Dr.  LlJCKK  ;  death  about  the  end  of  February.  Six 
other  cases  of  the  War  of  1864  are  mentioned  by  C.  HEINE  (Die  Schussverletzungen  der  unteren  Extremitdten,  etc.,  in  LANGENliECK's  Archiv  fiir  Klin. 
Chir.,  1866,  B.  VII,  p.  C07. — 6.  Prussian  soldier,  shot  fracture  of  the  leg.  Operation  by  Generalarzt  von  LANGEXBECK  ;  fatal. — 7.  Primary  operation  by 

Professor  ESMARCII,  at  the  hospital  at  Breaker,  April  18,  1864,  for  shot  wound  of  upper  extremity  of  tibia;  fatal. — 8.  L.  Chr ,  8th  Prussian  Grenadiers, 

comminution  of  left  leg,  April  18,  1864.     Operation,  April  18,  1864,  by  Staffsurgeon  OCHWADT,  at  Flensburg;  fatal.     (See  also  OCHWADT,  Kriegschir. 

Erfahrungcn,  Berlin,  1865,  No.  18  of  Table  of  Operations). — 9.  Private  J.  K ,  9th  Danish  Infantry,  wounded  April  18,  1864;  operation,  April  21st,  by 

Staflsurgeon  FISCHEK,  at  the  Latin  School  Hospital  at  Flensburg,  for  shot  fracture  of  the  tibia  with  splintering  into  knee  joint;  the  patient  died  eight  days 
after  the  operation.  The  autopsy  showed  that  no  consolidation  of  the  femur  and  patella  had  taken  place. — 10,  11.  After  the  naval  engagement  at  Helgo 
land,  in  1864,  two  of  these  operations  were  performed ;  one  at  the  hospital  at  Altona,  by  L)r.  STEINLECHXER  (H.  KUCIXIC,  Bericht  iiber  die  Verwundeten, 
der  K.  K.  Kriegsmarinc,  in  Allgeineine  Militararztliche  Zeitung,  1864,  B.  V,  p.  52):  Sailor  A.  Gaspare,  of  Frigate  Radetzky,  shot  fracture  of  left  leg. 
May  9th  ;  amputation  after  GRITTI,  May  13th;  recovery.  The  other  (HEINE,  loc.  cit.,  p.  CCS,  and  SALZMAXN,  Die  GlUTTl'sche  Operationsmethode  und 
ihre  Verwerthung  in  der  Krirgscltiriirgie,  in  B.  VON  LANGENBECK'S  Archiv  fiir  Klinische  Chirurgie,  Berlin,  1860,  B.  XXV,  p.  662)  was  the  case  of  an. 
Austrian  naval  cadet,  wounded  in  the  same  engagement;  amputation  after  GRITTI  on  the  day  of  the  injury,  May  9,  1864.  It  is  stated  that  union  oi  the 
patella  had  taken  place,  but  that  on  his  return  to  Austria  the  patient  fell  upon  his  stump,  necessitating  amputation  in  the  middle  third  of  the  thigh. — 
12.  MEI.CllIORJ  (G.)  (Annali  Universali  di  Medicina,  1667,  Vol.  CO,  p.  374):  P.  Pietro,  5th  Italian  Artillery,  aged  27,  shot  in  the  right  leg,  July  21, 186(i . 
GlUTTl'S  amputation  August  16th ;  recovery.  Of  the  Austro-Prussian  War  of  1866,  seven  operations  after  GRITTI'S  method  are  reported  by  SALZMAXX 
(loc.  cit.,  p.  669,  etc.). — 13.  Austrian  soldier,  aged  17,  comminution  of  left  leg  by  shell,  at  Konigsgratz,  July  3,  1866;  operation  July  3d;  healed  by  first 
intention;  August  12th,  recovered. — 14.  Prussian  Infantry  soldier,  comminution  of  bones  of  right  leg,  Konigsgratz,  July  3, 1866;  operation  at  Castle  Prim, 
July  15th,  by  Dr.  BUSCII ;  death  same  day. — 15.  Franz  AValichowski,  comminution  of  lower  third  of  left  tibia  und  fibula,  and  of  right  elbow  joint ;  July 
15th,  resection  of  elbow  joint ;  July  27th,  GRITTl's  amputation  at  knee  joint ;  death  August  15, 1866 ;  operation  by  Dr.  BUSCII. — 16.  Johann  Bielin,  8th  Aus 
trian  Infantry,  fracture  of  tibia  and  laceration  of  the  peronacus,  July  3,  1866;  operation  by  Dr.  BROCK,  July  27, 1866;  death  from  pyaemia. — 17.  Austrian 
soldier,  shot  fracture  of  head  of  tibia,  July  3d;  amputation  at  Nechanic,  August  10,  1866,  by  Dr.  BUSCII;  death  from  pyaemia,  August  10,  1866. — 18. 
Austrian  soldier,  shot  fracture  of  leg;  operation  at  the  hospital  at  Nedelist,  by  Dr.  SPAXXER;  death  50  days  after  the  operation. — 19.  O.  Weiser,  3d 
Baden  Infantry,  shot  fracture  of  right  leg,  Werbach,  July  24,  1866;  operation  by  Dr.  MfJLLER,  August  2d ;  death  August  9,  1866.  Of  the  Franco- 
Prussian  War  of  1870-71,  Staffsurgeon  SALZMANN  (loc.  cit.,  p.  674,  etc.)  collects  15  cases,  viz :  20.  G ,  94th  French  Infantry,  shell  laceration  of  both  calves. 

August  22,  1870;  GRITTl's  operation  at  the  knee  on  one  limb;  amputation  in  the  thigh  on  the  other,  August  23d;  operation  by  Dr.  MtJI.I.EK;  death 

August  24,  1870.— 21.   T.  II ,  1st  French  Infantry,  shell  fracture  of  left  leg,  August  18,  1870;  operation,  August  24th,  by  tr.  MARQUARPT;  death.- 

22.  Private  A.  Ihl,  88th  Infantry,  comminution  of  left  leg,  September  1,  1870;  amputation,  September  4th,  by  Dr.  LAXG  (?);  recovery,  with  good 
stump.— 23.  A.  Brauer,  3d  Grenadiers,  splintering  of  left  tibia,  August  18,  1870 ;  GRITTl's  operation  by  Dr.  MATZ,  September  7th  ;  recovery,  with  tender 
stump. — 24.  Reimnnn,  14th  Bavarian  Infantry,  shot  fracture  of  right  leg;  gangrene;  operation,  September  13th,  in  hospital  at  Aix-la-Chapelle,  by  Dr. 
BllAXDlS;  death  in  a  week.— 25.  (J.  G.  Renner,  46th  Prussian  Infantry,  shot  fracture  of  right  leg;  GlUTTl'S  amputation  performed  by  Dr.  STAHL,  October 
17th,  at  the  7th  field  hospital  of  the  IXth  Corps;  recovery,  with  good  stump.— 26.  W.  Pluta,  1st  Posen  Infantry,  No.  19;  groove  shot  of  right  tibia,  with 
opening  of  the  joint,  October  7,  1870 ;  amputation  by  Dr.  MOLLElt,  October  25th,  at  the  7th  field  hospital  of  the  Xth  Corps  at  Hngondange ;  death  October 
31,  1870.— 27.  Private  P.  H.  KfJPPEU,  C.r)th  Infantry,  comminution  of  left  leg.  October  28, 1870 ;  operation  by  Dr.  M  BLLKR,  November  1 9th,  at  Hagondange  ; 
death  from  pyaemia,  November  24,  1870.— 28.  J.  Ollngnon,  13th  French  Infantry,  shot  fracture  of  left  tibia,  August  18,  1870;  operation  by  Dr.  MOLLKK, 
in  hospital  at  Nancy,  March  2,  1871 ;  recovery  in  29  days.— 29.  Lieut.  W.  von  du  Prel,  Infantry  body  guard,  shot  fracture  of  left  knee  joint,  September 
1,  1870;  GRITTI'S  operation,  by  Professor  V.  NUSSHAUM,  at  Bazeijles,  September  1st;  September  14th,  resection  of  exposed  portion  of  femur;  death 
September  25, 1870.— 30.  P.  Zoll,  10th  Bavarian  Infantry,  shot  fracture  of  left  leg  at  Remilly,  August  31,  1870 ;  operation  by  Dr.  LOTZliliCK,  September  8th ; 
death  September  17,  1870.— 31.  O.  Willner.  9th  Bavarinn  Infantry,  ngpd  04,  shell  fracture  of  leg  near  the  knee  joint,  October  7,  1870:  GiMTTl's  umputa- 
SUHG.  Ill — 54 


426  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

1866,  and  the  Franco-Prussian  War  of  1870-71,  Gritti's  operation  was  performed  in  a 
number  of  instances,  and,  in  1870,  a  modification  of  Gritti's  plan  was  presented  by 
Stokes,1  but  the  results  of  these  operations  in  war  surgery  have  not  been  very  favorable, 
and  the  opinions  of  military  surgeons  generally  are  recorded  against  its  performance." 

In  nine  of  the  one  hundred  and  eighty-nine  cases  of  exarticulation  at  the  knee  the 
condyles  of  the  femur  and  the  patella  were  removed;  in  sixteen  the  condyles  were  removed 
and  the  patella  retained;  in  seven  the  condyles  were  retained  and  the  patella  removed;  in 
twenty-eight  the  condyles  and  the  patella  were  retained;  and  in  one  hundred  and  twenty- 
nine  instances  this  point  was  not  indicated. 

Regarding  the  value  of  the  stump  after  knee  joint  amputations,  the  records  would 
seem  to  confirm  the  opinions  of  Velpeau,  Stephen  Smith,  Markoe,  and  Syme,3  that  the 
stump  formed  by  the  articular  surface  of  the  lower  extremity  of  the  femur  is  as  well,  and 
perhaps  better  adapted  to  the  successful  wearing  of  an  artificial  limb  than  the  thigh  stump. 
Of  the  eighty-one  cases  of  recovery  after  amputation  at  the  knee,  the  condition  of  the  stump 
is  known  in  sixty  instances;  in  forty  it  is  recorded  as  sound  and  healthy,  and,  in  twenty, 
as  tender  or  painful,  or  as  not  allowing  the  use  of  an  artificial  apparatus. 

tion,  by  NEUIIOFER,  October  8th  ;  discharged  the  service  July  17,  1871,  and  died  in  February,  1872;  stump  had  healed  after  tedious  exfoliations  of  small 
particles  of  bone,  but  union  of  bone  of  the  cut  surfaces  of  the  femur  and  patella  had  not  taken  place. — 32.  F.  Borron,  9th  French  Chasseurs,  aged  29, 
shot  fracture  of  right  leg,  October  11,  1870,  at  Artenay:  operation  by  v.  NUSSBAUM,  October  llth;  result  undetermined. — 33.  J.  Krum,  1st  Bavarian 
Jaegers,  shot  fracture  of  left  leg,  October  11,  1870;  operation,  October  15th,  by  LOTZUECK;  result  unknown. — 34.  G.  Koflcr,  3d  Bavarian  Infantry,  shot 
fracture  of  left  knee  joint,  October  11,  1870;  operation  by  LOTZBECK,  October  21st;  death  October  25,  1870.  The  results  of  two  of  the  34  amputations 
at  the  knee  after  GRITTI'S  method,  here  cited,  are  7iot  recorded;  10  had  successful  and  22  fatal  issues,  a  mortality  rate  of  68.7  per  cent. 

'STORES  (WILLIAM)  (On  Supra- Condyloid  Amputation  of  the  Thigh,  in  Medico- Cliirurgical  Transactions,  London,  1870,  Vol.  LIII,  p.  180). 
The  author  claims  that  his  mode  differs  from  GRITTI'S  in  the  following  particulars :  "1.  That  the  femoral  section  is  made  in  all  cases  at  least  half  an  inch 
above  the  antero-superior  edge  of  the  condyloid  cartilage.  2.  That  in  all  cases  the  cartilaginous  surface  of  the  patella  is  removed.  3.  That  the  flap  is 
oval,  not  rectangular.  4.  That  there  is  a  posterior  flap  fully  one-third  of  the  length  of  the  anterior  flap."  In  regard  to  the  second  point  of  modification, 
Dr.  STORES  remarks  that  "much  importance  was  not  attached  by  GRITTI  to  the  removal  of  this  portion  of  the  bone,"  and,  in  proof  thereof,  cites  three 
cases  reported  by  MELCHIORJ,  in  two  of  which  the  articular  surface  of  the  patella  was  not  removed.  Dr.  STOKES  evidently  overlooked  the  fact  that  these 
two  operations  were  performed  G  and  7  years  before  Dr.  R.  GlUTTI  proposed  his  osteoplastic  operation,  while  the  third  operation,  in  which  the  inner  surface 
of  the  patella  was  removed,  was  performed  in  18fiG,  or  9  years  after  Dr.  GRITTI'S  plan  had  been  published.  Dr.  GlUTTI  (loc.  cit.,  p.  18)  clearly  insists 
upcn  the  division  of  the  patella,  and,  in  FIG.  Ill,  at  the  conclusion  of  his  article,  delineates  the  manner  of  the  division. 

2  BECK  (B.)  (Kriegs-Chirurgische  Erfahrungen  wiihrend  des  Feldzuges  1866,  Freiburg,  i.  B.,  1867,  p.  62):  "  GRITTl's  operation,  which  must  be 
designated  as  one  entirely  without  purpose,  is  to  be  rejected  as  oce  too  complicated,  having  no  advantages  and  only  disadvantages."    ZEIS  (E.)  (Einige 
Bemerkungen  zur  Wiirdigung  der  Exarticulation  des  Unterschenkels  im  Kniegelenke,  in  Arch.fiir  Klin.  Chir.,  Berlin,  18(iC,  B.  VII,  p.  770):  ''I  confess 
that  my  great  predilection  for  this  operation,  by  which,  when  successful,  unquestionably  great  advantages  are  gained  for  the  patient,  has  greatly  dimin 
ished,  and  I.  therefore,  do  not  feel  encouraged  to  perform  the  operation  after  GRITTI,  as  the  dangerous  consequences  alluded  to  by  me  must  be  the 
same."     Dr.  II.  F.  WEIR  (Ore  GRITTI'S  Supra-condijloid  Amputation  of  the  Thigh,  in  the  Medical  Record.  New  York,  1879,  Vol.  XV,  p.  342)  tabulates  76 
operations  after  GlUTTI,  of  which  54  recovered  and  22  died,  and  remarks,  on  p.  341 :  "  For  gunshot  wounds  or  compound  fractures  involving  the  condyles 
of  the  femur,  its  practicability  is  yet  undetermined,  and  time  will  probably  record  an  adverse  judgment  against  it  in  such  cases.     For  diseases  of  the 
knee  joint  it  affords  a  better  operation,  in  my  judgment,  than  disarticulation,  which  has  lately  been  revived."     The  unfavorable  results  of  the  few  cases  of 
GRITTI'S  amputation  after  shot  injuries  that  the  editor  has  been  able  to  collect  would  seem  to  confirm  the  conclusions  of  Dr.  WEllt.     Dr.  SAT.ZMAXN  (loc.  cit., 
in  Archiv  fur  Klin.  Chir.,  Berlin,  1880,  B.  XXV,  p.  658):  ''  Taking  into  consideration,  besides  the  high  mortality,  the  disadvantages  of  a  complicated 
operative  technic,  requiring  a  certain  aptitude  and  at  least  36  minutes  time,  the  readily  injured  and  for  transport  little  adapted  stump,  liable  to  displace 
ment  of  the  patella,  and  bleeding  from  the  popliteal  artery ;  farthermore,  the  slow  healing  process  with  its  uncertain  results ;  we  must  come  to  the 
conclusion  that  neither  on  the  field  of  battle  nor  in  the  field  hospitals  GRITTI'S  operation  seems  to  have  any  value  as  an  operation  in  war  surgery." 

3  VELPEAU  (A.)  (Memoire  sur  I' amputation  de  la  janibe  dans  I' articulation  du  genou,  et  description  d'un  iiouveau  procede  pour  pratiquer  cctte 
operation,  in  Archives  Generates  de  JUtdecine,  8""1  ann6e,  T.  XXIV,  1830,  p.  60)  considers  amputation  at  the  knee  preferable  to  amputation  in  the  thigh  as 
being  less  dangerous,  easier  performed,  and  furnishing  a  good  stump  for  the  use  of  a  wooden  leg.     SMITH  (STEPHEN)  (Cases  in  Surgery. — Amputation  at 
the  Knee  Joint.     By  W.  PAKKER,  M.  D.,  Professor  of  Surgery  in  the  College  of  Physicians  and  Surgeons,  New  York.     Reported  by  STEPHEN  SMITH, 
in  the  New  York  Journal  of  Medicine  for  November,  1852,  Vol.  IX,  p.  326)  arrives  at  the  following  conclusions:  "1.  That  amputation  at  the  knee  joint 
is  a  justifiable  operation,  as  respects  the  nature  of  the  structures  engaged.     2.  That  it  is  a  justifiable  operation  as  respects  the  point  of  election.    3.  That 
the  stump  formed  by  the  articular  surface  of  the  lower  extremity  of  the  femur  is  as  well  adapted  to  the  adjustment  of  an  artificial  limb,  and  to  sustain 
and  transmit  the  weight  of  the  body,  as  when  the  operation  is  performed  in  the  continuity  of  the  thigh-bone.''    MAI:KOE  (T.  M.)  (Amputation  at  the 
Knee  Joint,  Illustrated  by  the  Cases  which  hare  occurred  in  American  practice,  and  mainly  liy  those  which  hare  been  treated  in  the  Jfew  York  Hospital, 
in  New  York  Jour,  of  Med.,  New  York,  1856,  Vol.  XVI,  N.  S.,  p.  35,  etc.)  presents  eight  points  of  comparison  between  this  operation  and  the  amputation 
in  the  thigh,  all  favoring  knee  joint  amputation.     SYME  (JAMES)  (On  Amputation  at  the  Knee,  in  Edinburgh  Medical  Journal,  Edinburgh,  1866,  Vol.  XI, 
p.  874)  concludes  that  the  resulting  stump  is  comfortable  and  serviceable.     MAKKOE  (T.  M.)  (Amputation  at  the  Knee  Joint,  in  Few  York  Medical 
Journal,  1868,  Vol.  VI,  p.  509)  sums  up  the  cases  of  amputation  in  the  thigh  and  at  the  knee  joint  performed  from  1830-18C4,  in  the  New  York  Hospital, 
both  showing  a  mortality  of  54  per  cent.,  and  admits  that  as  far  as  the  percentage  of  fatality  is  concerned  "this  exhibit  shows  no  advantage  on  the  side  of 
the  knee  joint  operation."  but  claims  a  decided  advantage  for  the  usefulness  of  the  knee  joint  stump.     In  this  opinion  he  is  corroborated  by  Dr.  E.  D. 
HUDSON,  the  ingenious  deviser  of  various  mechanical  appliances  for  the  relief  of  maimed  soldiers ;  but  the  latter  (Meclianical  Surgery. — 1  'rothe  tic  Appliances 
and  Apparatus  for  Amputations.  Resections,  etc..  New  York,  1878,  p.  24)  deprecates  the  removal  of  the  condyles  as  an  operation  neither  "sustained  by 
any  rational  hypothesis  nor  practised  on  any  scientific  principles.     Except  disease  or  injury  of  the  condyles  compel  their  excision,  their  thin  anatomical  and 
functional  vestments  should  be  kept  inviolate  from  knife  and  saw.     The  condyles,  their  cartilage  and  vestment,  as  constituted,  are  nature's  strongest,  most 
tolerant  and  important  supports  in  the  entire  body,  and  when  these  parts  are  amputated  or  disturbed,  a  valid,  a  positive  reason  should  exist  for  so  doing." 


SECT,  v.l  WOUNDS    AND    OPERATIONS    IN    THE    LEG.  427 


SECTION  V. 


WOUNDS  AND  OPERATIONS  IN  THE  LEG. 


The  consideration  of  examples  of  simple  and  compound  fractures,  of  burns,  frost-bites, 
and  other  miscellaneous  injuries  of  the  leg  will  be  reserved  for  Chapter  XII,  and  as  no 
cases  of  sabre  or  bayonet  injuries  of  the  tibia  and  fibula  are  recorded,  it  remains  therefore 
only  to  examine  the  instances  of  shot  injuries  of  this  portion  of  the  human  structure. 
There  are  found  on  the  registers  one  hundred  and  eighty-three  shot  contusions,  and  eight 
thousand  nine  hundred  and  eighty-eight  shot  fractures,  making  a  total  of  nine  thousand 
one  hundred  and  seventy-one  shot  injuries  of  the  bones  of  the  leg.  Four  thousand  one 
hundred  and  three  were  treated  by  conservation,  and  in  five  thousand  and  sixty-eight 
instances  operative  interference  was  resorted  to,  viz:  excision  in  the  bones  of  the  leg  or  at 
the  knee  in  three  hundred  and  eighty-eight;  amputation  in  the  leg  in  three  thousand  seven 
hundred  and  thirty-six;  amputation  in  the  leg  and  subsequent  exarticulation  at  the  knee 
in  three;  amputation  in  the  leg  and  subsequent  amputation  in  the  thigh  in  thirty-nine; 
exarticulation  at  the  knee  joint  in  one  hundred  and  one;  exarticulation  at  the  knee  and 
ablation  in  the  thigh  in  seven;  and  amputation  in  the  thigh  in  seven  hundred  and  ninety- 
four  instances.  The  exarticulation  a  at  the  knee  joint  and  the  amputations  in  the  thigh 
following  shot  fractures  of  bones  of  the  leg  have  already  been  considered  in  the  preceding 
sections  of  this  Chapter,  leaving  the  amputations  in  the  leg  to  be  examined  in  this  Section. 

SHOT  CONTUSIONS  OF  THE  BONES  OF  THE  LEG.— One  hundred  and  eighty- 
three  examples  of  shot  contusions  of  the  bones  of  the  leg  are  entered  on  the  records.  The 
injuries  involved  the  tibia  in  one  hundred  and  thirty-six,  the  fibula  in  twenty,  the  tibia 
and  fibula  in  twelve  instances,  and  in  fifteen  cases  the  precise  seat  of  the  injury  was  not 
specified.  One  hundred  and  sixty-five  cases,  of  which  fifteen  resulted  fatally,  were  treated 
throughout  by  expectation;  in  eight  amputation  in  the  leg  was  resorted  to,  unsuccessfully 
in  four;  one  was  followed  by  an  unsuccessful  amputation  at  the  knee;  and  nine — three 
successful  and  six  fatal — by  amputation  in  the  thigh. 

Shot  Contusions  of  the  Bones  of  the  Leg  Treated  by  Conservation. — Of  the  one 
hundred  and  sixty-five  cases  of  this  group,  fifteen,  or  9.09  per  cent.,  had  fatal  terminations. 
The  right  limb  was  injured  in  sixty-six,  the  left  in  seventy-eight,  and  in  twenty-one  cases 
the  side  was  not  indicated.  Sequestra  or  exfoliations  were  removed  in  twenty-two  instances. 
In  one  hundred  and  thirty-two  of  the  one  hundred  and  sixty-five  cases  the  tibia  was  the 
seat  of  the  injury,  the  lesion  generally  being  on  the  inner  anterior  flat  surface. 

Recoveries  after  Shot  Contusions  of  the  Bones  of  the  Leg  treated  by  Conservation.— 
Generally  the  healing  process  was  very  slow,  and  not  rarely  attended  by  necrosis  of  the 
bone  and  tedious  exfoliation,  as  in  the  following  instances: 


428 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  256.— 
Exfoliation 
from  right 
tibia.  Spec. 
2620. 


CASE  655. — Sergeant  J.  Meier,  Co.  H,  52d  New  York,  aged  43  years,  was  wounded  at  Spottsylvania,  May  12,  1864,  by 
a  musket  ball,  which  entered  the  middle  third  of  the  right  leg  and  injured  the  tibia.  Surgeon  D.  II.  Houston,  2d  Delaware, 
reported  that  the  wounded  man  was  admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps,  where  the  missile  was 
extracted.  Two  weeks  after  the  reception  of  the  injury  he  was  sent  to  Washington,  and  several  days  later  to  Philadelphia. 
Assistant  Surgeon  T.  C.  Brainerd,  U.  S.  A.,  reported  that  "the  patient  entered  Broad  and  Cherry  Streets  Hospital  May  31st, 
the  wound  being  healthy  at  date  of  admission  and  continuing  so  until  July  3d,  when  sloughing  set  in.  This  was  successfully 
treated  by  applications  of  nitric  acid,  followed  by  dressings  of  coal  oil,  together  with  internal  administration  of  tincture  of  chlo 
ride  of  iron,  porter,  and  generous  diet.  By  July  12th,  the  wound  was  again  granulating  and  his  general  health  improving. 
Complete  cicatrization  being  prevented  by  the  presence  of  dead  bone,  that  portion  of  the  tibia  was  removed  by  Acting  Assistant 
Surgeon  D.  W.  Cadwallader,  on  October  1st,  through  an  incision  over  the  spine.  The  small,  fragments  of  bone  were  then 
thoroughly  washed  out  with  a  syringe  and  the  parts  coaptated  by  adhesive  plaster,  over  which  simple  water  dressing  was 
applied.  Cicatrization  progressed  rapidly  and  was  complete  by  October  28,  1864,  when  the  patient  was  discharged  from  hos 
pital,"  his  term  of  service  having  expired  three  weeks  previously.  The  removed  sequestrum,  six  inches  long,  and 
contributed  by  the  operator,  is  represented  in  the  wood-cut  (FiG.  255).  Examining  Surgeon  G.  J.  Fisher,  of  Sing 
Sing,  N.  Y.,  August  22,  1865,  certified  to  the  injury,  and  stated:  "The  front  of  the  injured  leg  is  covered 
with  delicate  blue  integument,  not  perfectly  healed.  He  is  unable  to  labor,  and  an  artificial  leg  would 
be  far  preferable."  The  New  York  Examining  Board  reported,  September  3,  1873:  "There  has  been 
considerable  loss  of  osseous  substance.  The  entire  anterior  and  inner  aspect  of  the  middle  and  upper 
portion  of  the  leg  is  covered  with  encrustations,  and  there  is  periostitis  and  necrosis  of  bone  at  present." 
At  subsequent  examinations  the  same  indurated,  ulcerated,  and  partly  indolent  condition  of  the  parts, 
interfering  with  locomotion,  was  reported.  The  pensioner  was  paid  December  4,  1879. 

CASE  656. — Corporal  G.  Ditch,  Co.  D,  82d  Ohio,  aged  21  years,  received  a  shot  wound  of  the  right 
leg,  with  injury  to  the  tibia,  at  Gettysburg,  July  1,  1863.  He  was  admitted  to  Satterlee  Hospital,  Phil 
adelphia,  eight  days  after  the  injury.  Acting  Assistant  Surgeon  M.  Lampen  contributed  the  patholog 
ical  specimen,  represented  in  the  annexed  cut  (FiG.  256),  with  the  following  report:  "The  injury  was 
caused  by  a  round  ball,  which  entered  the  leg  anteriorly  at  the  junction  of  the  upper  with  the  middle 
FIG.  253.—  third  of  the  tibia.  On  admission  the  wound  was  in  a  healthy  condition.  Hospital  gangrene  first 
hequestriun  appeare(j  on  July  23d,  and  spread  rapidly  for  several  days.  Creasote  mixture  and  yeast  poultices  were 
tibia.  Spec,  used  to  the  wound  and  tonics  internally,  which  treatment  was  continued  for  two  weeks,  when  all  signs 
of  the  disease  had  disappeared,  a  small  portion  of  the  tibia  being  left  exposed.  The  patient's  general 
health  was  good  with  the  exception  of  an  obstinate  intermittent  fever,  which  yielded  but  temporarily  to  quinine.  On  September 
26th,  a  segment  of  bone  about  five  inches  long,  one  and  a  half  inch  in  width  at  its  widest  part,  and  from  one-eighth  to  one-fourth 
of  an  inch  thick,  was  removed  from  the  wound,  the  entire  exfoliation  of  it  having  taken  place  in  a  few  days  from  the  time  it 
was  first  observed.  During  the  succeeding  days  several  small  spiculse  of  bone  were  removed,  after  which  exfoliation  still  pro 
gressed  downwards,  indicating  that  more  bone  would  have  to  be  removed."  In  October  the  patient  was  transferred  to  Seminary 
Hospital,  Columbus,  and  lastly  he  was  sent  to  Camp  Dennison,  where  he  was  discharged  March  30,  1864,  and  pensioned. 
Examining  Surgeon  R.  L.  Sweeney,  of  Marion,  Ohio,  describes  the  injury  as  follows:  "A  gunshot  wound  by  a  musket  ball 
impinging  on  the  leg  just  above  the  junction  of  the  middle  and  upper  thirds  of  the  tibia.  Contraction  and  adhesion  of  the 
muscles  afterwards  resulted  from  gangrene."  The  same  Examiner  reported,  in  1870,  that  the  wound  had  reopened  and  after 
wards  again  closed  imperfectly.  On  June  21,  1874,  he  stated  that  "the  wound  is  still  open  and  the  bone  diseased;"  and  in 
September,  1877,  he  reported  a  "large,  adherent,  and  irritable  cicatrix  over  the  spine  of  the  tibia,  with  malformation  of  the 
bone."  The  pensioner  was  paid  December  4,  1879. 

CASE  657. — Corporal  H.  Rail,  Co.  D,  15th  New  York  Heavy  Artillery,  aged  22  years,  was 
wounded  at  the  battle  of  Old  Church,  May  30,  1864.  Surgeon  L.  W.  Read,  U.  S.  V.,  reported  his 
entrance  into  the  field  hospital  of  the  3d  division,  Fifth  Corps,  with  "shot  wound  of  left  leg." 
Surgeon  B.  B.  Wilson,  U.  S.  V.,  in  charge  of  Stauton  Hospital,  Washington,  contributed  the  path 
ological  specimen  (No.  4337  of  the  Surgical  Section,  A.  M.  M.),  with  the  following  history:  "This 
young  man  was  admitted  to  this  hospital  on  June  4th.  He  had  been  wounded  by  a  mini6  ball,  which 
passed  across  the  spine  of  the  tibia  about  four  inches  from  the  head  of  the  bone,  bruising  it  and 
denuding  it  of  periosteum  along  the  track  of  the  ball.  He  was  somewhat  debilitated  when  admitted, 
but  being  young  and  of.  good  constitution,  his  general  condition  was  not  unfavorable.  He  was 
treated  with  applications  of  cold  water  and  ice  dressings  to  the  wounded  limb,  and  stimulating  and 
supporting  constitutional  remedies.  During  the  month  of  June  and  the  beginning  of  July  the  limb 
was  highly  inflamed,  and  there  was  profuse  suppuration  and  some  sloughing  in  the  vicinity  of  the 
wound;  with  considerable  sympathy  of  the  general  system  as  manifested  by  chills,  great  debility, 
loss  of  appetite,  and  general  febrile  action.  In  the  month  of  July,  deep-seated  fluctuation  having 
been  observed  in  the  course  of  the  shaft  of  the  tibia,  the  pus  was  evacuated  by  free  incisions  in  the 
direction  of  the  length  of  the  limb,  with  great  relief  to  the  patient.  The  periosteum  was  found  to 
FIG.  257.— Appearance  of  ^e  extensively  separated  and  the  shaft  of  the  bone  necrosed.  During  the  months  of  September, 

limb  fourteen  months  after  in-  October,  November,  and  December  his  condition  gradually  improved  as  the  process  of  formation  of 
jury.  [From  a  photograph.]  ...  .  . 

the  involucrum  and  the  separation  of  the  necrosed  portion  went  on.     A  number  of  cloacse  formed  in 

the  line  of  the  incisions  for  liberating  pus,  through  which  the  necrosed  bone  could  be  felt  gradually  becoming  detached  from  the 
living  portion.  The  limb  was,  during  this  time,  for  the  most  part  treated  with  emollient  poultices.  About  the  first  of  January 
the  upper  part  of  the  shaft  of  the  tibia  could  be  distinguished  at  the  position  of  the  original  wound,  and  about  March  1st,  upon 
seizing  it  with  a  forceps  the  whole  dead  mass  could  be  moved  within  the  sheath  of  the  investing  new  bone.  The  operation  for 


Mod  H  Surj.  lli.-l.of  UK-  War  of  the  Rebellion,  Part  III  Vol  .11. (.'Imp. X. 


Ward   phot. 


T  Sinclair  »  »<m  Uth 


PLATE    LXXI._- TUBULAR     SEQUESTRA    AND    PIECES    OF    NECROSED 
BONE    FROM     TIBIA. 


Fig.L-Ccjrporal  Henry  Rail, 
D.  IS    New  York  H.A,   Spec.  4337,  A.M.  M. 

Fig  2..  Private  .lo.seph  Wjilkep, 
A.  7   AVlscoiisin  Vols.   Speo.  3283,  AMM. 


R^.  .'J._  Private  O.M.  Armstrong, 
B,  120  Xew  York  Vols.  Spec.  3284 ,  A.  M.  M. 

Fig4_Private   GeurpV  fulloiii, 
D.  83  Ohio  Vols   Spec.  2099,  A.M.M. 


SECT.  V.]  SHOT    CONTUSIONS    OF    THE    TIBIA    AND    FIBULA.  429 

the  removal  of  necrosed  bone  was  performed  by  Surgeon  A.  N.  Dougherty,  U.  S.  V.,  on  March  14,  1865,  by  turning  back  the 
soft  parts  on  each  side  from  an  incision  through  the  centre  of  the  cloacae,  and  cutting  away  with  the  mallet  and  chisel  sufficient 
of  the  new  growth  to  permit  the  sequestrum  to  be  lifted  directly  from  its  bed.  It  was  found  to  consist  of  the  entire  shaft  of  the 
tibia  from  one  epipliysis  to  the  other,  except  small  portions  eroded  by  the  absorbents.  The  after-treatment  consisted  of  simple- 
water  dressings  with  slightly  stimulating  applications,  and  was  unmarked  with  any  noteworthy  complication.  On  June  6, 1865, 
the  patient  was  discharged  on  certificate  of  disability,  being  able  to  walk  with  ease  and  comfort,  though  the  wound  was  not 
entirely  healed.  In  July  a  photograph  was  taken,  of  which  the  adjoining  wood-cut  (FlG.  257)  is  a  copy.  He  left  the  hospital 
in  July  and  returned  in  the  following  month,  asking  to  be  employed  under  contract.  Since  that  date  he  has  been  doing  duty  as 
chief  nurse  of  one  of  the  wards  of  this  hospital,  being  in  robust  health,  though  his  limb  was  not  yet  entirely  healed."  The  speci 
men,  consisting  of  a  sequestrum  nine  inches  long  and  eleven  smaller  pieces  of  necrosed  bone,  is  shown  somewhat  reduced  ill 
FIG.  1  of  PLATE  LXXI,  opposite  page  428.  Examiner  T.  F.  Smith,  of  New  York  City,  September  22,  1873,  certi 
fied:  "Shot  fracture  of  left  tibia,  with  union  and  great  loss  of  bone  substance,  leaving  a  cicatrix  over  the  anterior 
surface  of  the  bone  nine  inches  in  length,  red,  unhealthy,  and  ulcerating,"  etc.  The  Brooklyn  Examining  Board 
reported,  September  8, 1877 :  "  We  find  an  adherent,  chronically  inflamed  cicatrix  extending  along  the  anterior  face  of 
the  left  tibia  from  below  its  head  to  within  three  inches  of  the  ankle.  There  is  tenderness  on  pressure.  He  requires 
the  application  of  a  bandage,  and  complains  of  pain  in  damp  or  cold  weather.  The  usefulness  of  the  limb  is  well 
nigh  destroyed."  The  pensioner  was  paid  March  4,  1880. 

CASE  658. — Private  W.  Hargrave,  Co.  C,  142d  New  York,  aged  25  years,  was  wounded  at  Chapin's  Farm, 
September  29,  1854.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported  his  admission  to  hospital  at  Fort  Monroe, 
October  4th,  with  "shot  wound  of  right  leg  at  middle  third  by  a  mini6  ball."  On  December  20th,  the  patient  was 
permitted  to  leave  for  his  home  on  furlough,  and  in  June  following  he  entered  the  Ira  Harris  Hospital,  Albany, 
whence  Assistant  Surgeon  J.  H.  Armsby,  U.  S.  V.,  contributed  the  specimen,  represented  in  the  annexed  cut  (FlG. 
258),  with  the  following  description :  "  The  ball  struck  the  tibia  without  fracturing  it.  The  leg  became  inflamed  and 
tender  and  a  number  of  fisttilous  openings  appeared.  By  exploring  with  the  probe  a  large  sequestrum  was  discovered 
on  July  15th.  when  chloroform  was  administered  and  the  necrosed  bone  was  withdrawn  with  a  forceps  through  a 
straight  incision  four  inches  long.  After  this  operation  the  wound  healed  rapidly."  The  patient  was  mustered  out  of 
service  July  17,  1865,  but,  owing  to  his  becoming  insane  for  u  time,  he  did  not  apply  for  a  pension  until  seven  years  FlG-  258.— 
afterwards.  Examining  Surgeon  B.  F.  Sherman,  of  Ogdensburg,  N.  Y.,  October  9,  1872,  certified  to  the  injury,  and  questrum 

added  that  "the  skin  is  now  closely  attached  to  the  bone,  and  the  slightest  abrasion  produces  a  sore  difficult  to  heal.  f.r,Vm  Ieft 

"  A  tibia.  Spec. 

There  are  now  two  small  unhealed  surfaces.     The  man  states  he  suffers  great  pain  in  the  leg  at  night  after  walking."  420. 
In  1877,  the  wound  was  reported  as  healed.     The  pensioner  was  paid  March  4,  1880. 

CASE  659. — Private  J.  C.  Coats,  Co.  I,  5th  Vermont,  aged  22  years,  was  wounded  at  Fredericksburg,  December  13, 
1862.  He  was  conveyed  to  Harewood  Hospital,  Washington,  and  transferred  to  Satterlee,  Philadelphia,  December  23d.  Acting 
Assistant  Surgeon  W.  W.  Keen,  jr.,  from  the  latter  hospital,  described  the  wound  as  "  an  injury  of  the  right  tibia,"  and  reported: 
"The  man  had  been  hit  by  a  fragment  of  a  shell,  which  struck  his  left  shoe  without  seriously  injuring  the  foot ;  it  then  glanced 
and  struck  the  right  tibia  antero-internally  in  the  lower  third.  On  admission  to  the  hospital  there  was  a  swelling,  fluctuating 
but  quite  tense,  at  the  point  of  the  injury  in  the  leg,  which  I  opened  by  an  incision  about  three-fourths  of  an  inch  long.  About 
an  ounce  and  a  half  of  coagulated  blood  and  some  pus  was  evacuated,  and  poultices  were  ordered  to  be  applied.  The  wound 
did  well  till  January  1,  1863,  when  it  began  to  enlarge  and  look  very  much  like  hospital  gangrene.  I  suspected  this  the  more 
from  the  prevalence  of  this  disease  at  that  time  in  the  ward.  The  edges  of  the  wound  had  become  everted,  its  base  rather  ashy 
grey,  and  the  discharge  unhealthy,  and  a  considerable  circle  of  inflammation  was  around  the  opening.  But  the  characteristic 
stinging  pain  being  absent,  I  determined  not  to  treat  it  as  hospital  gangrene  but  by  the  ordinary  measures  for  inflammation.  I 
ordered  three  compound  cathartic  pills  to  be  taken  and  tincture  of  iodine  to  be  applied  locally,  also  a  large  poultice.  On  Jan 
uary  6th,  the  wound  had  increased  to  two  and  one-fourth  inches  in  diameter,  but  was  still  entirely  without  the  peculiar  pain  of 
hospital  gangrene,  when  I  ordered  a  mixture,  consisting  of  half  an  ounce  of  hydrochloric  acid,  two  ounces  of  laudanum,  and 
one  pint  of  water,  to  be  used  locally  with  lint.  The  acid  wash  was  gradually  diluted,  and  finally  abandoned  on  January  25th. 
The  patient  being  rather  anaemic,  I  ordered  two  grains  of  quinine  and  four  ounces  of  milk  punch  to  be  given  daily.  On  Jan 
uary  30th  another  abscess  was  opened,  and  on  February  9th  yet  another,  each  being  preceded  by  severe  pain,  tenderness,  and 
swelling.  No  doubt  they  as  well  as  the  original  one  were  the  result  of  severe  local  periostitis.  They  were  readily  subdued 
by  cathartics  and  poultices,  with  morphia  at  night.  No  bone  was  at  any  time  discharged,  although  considerable  depression 
existed  on  the  tibia  from  absorption  of  the  tissue.  On  February  20th,  the  patient  was  transferred  to  Brattleboro',  the  wound 
having  almost  entirely  healed  and  there  being  but  little  depression."  The  man  entered  the  Marine  Hospital  at  Burlington,  and 
on  March  8,  1864,  was  assigned  to  the  Veteran  Keserve  Corps,  and  discharged  July  13,  1865,  and  pensioned.  Examining  Sur 
geon  A.  P.  Belden,  of  Whitehall,  N.  Y.,  reported  the  wound  as  being  in  an  inflamed  condition,  and  added  that  "it  opens  at  any 
time  the  limb  is  much  used  in  standing  or  walking.  There  is  adhesion  of  the  peroneus  longus  muscle  and  ligament,  and  inflam 
mation  produced  partial  anchylosis  of  the  ankle  joint."  Examiner  J.  Lambert,  of  Salem,  N.  Y.,  August  10,  1878,  reported  that 
"the  injured  bone  is  necrosed  for  about  three  inches  and  demands  an  operation."  The  pensioner  was  paid  September  4,  1880. 

In  the  next  instance  copious  haemorrhage  followed  the  injury,  and  the  femoral  artery 
was  successfully  ligated  in  Scarpa's  triangle: 

CASE  660. — Private  T.  Dassel,  Co.  G,  60th  Indiana,  aged  25  years,  was  severely  wounded  in  the  right  leg,  at  Arkansas 
Post,  January  11,  1863.  He  was  placed  on  board  of  a  hospital  steamer  several  days  after  the  reception  of  the  injury  and  con 
veyed  to  St.  Louis,  where  he  entered  Lawson  Hospital,  January  22d.  Surgeon  C.  T.  Alexander,  U.  S.  A.,  in  charge,  reported: 
"The  wound  \vas  located  on  the  inner  side  of  the  upper  third  of  the  leg  and  the  tibia  was  slightly  injured.  Haemorrhage  to 
the  amount  of  eight  ounces  occurred  from  the  anterior  tibial  artery  on  February  20th,  on  account  of  which  the  femoral  artery 


430  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

was  ligated  in  Scarpa's  triangle.  Pysemic  infection  also  existed,  which  was  successfully  combated  with  the  administration  of 
quinine  and  brandy."  The  patient  was  discharged  from  service  December  22,  1863,  and  pensioned.  Examining  Surgeon  B.  J. 
Day,  of  Evansvillc,  Indiana,  on  April  25,  1864,  certified  to  the  anterior  wound  as  "still  discharging,"  and  reported  the  same  as 
"recently  healed,  in  September,  1865,  leaving  a  deep  and  adherent  cicatrix."  Examiner  I.  Casselberry  subsequently  certified: 
"The  ball  injured  the  tibia  without  fracturing  it."  At  later  examinations  chronic  inflammation  of  the  bone  and  the  impaired 
usefulness  of  the  leg  was  described.  The  pensioner  was  paid  March  4,  1880. 

Fatal  Cases  of  Shot  Contusions  of  the  Bones  of  the  Leg  treated  by  Conservation. — 
Fifteen  of  the  one  hundred  and  sixty-five  cases  of  this  group  proved  fatal : 

CASE  661. — Private  J.  Buchfinck,  Co.  A,  16th  Michigan,  aged  26  years,  was  wounded  at  Poplar  Grove  Church,  Septem 
ber  30,  1864,  and  admitted  to  the  field  hospital  of  the  1st  division,  Fifth  Corps,  with  "severe  wound  of  left  leg,  caused  by  a 
musket  ball."  A  week  later  the  man  was  transferred  to  Harewood  Hospital,  Washington,  whence  Surgeon  R.  B.  Bontecou, 
U.  S.  V.,  contributed  the  specimen  and  reported  the  result  of  the  case:  "The  leg  was  wounded  in  the  lower  third,  the  ball  passing 
anterior  to  the  tibia  and  injuring  the  periosteum.  The  patient,  although  weak,  did  tolerably  well  up  to  October  13th,  at  which 
time  the  parts  became  gangrenous,  destroying  the  tissues  from  the  ankle  joint  to  the  upper  part  of  the  middle  third  of  the  leg 
and  leaving  the  tibia  exposed  for  about  six  inches.  Under  the  application  of  escharotics  the  wound  became  healthy  and  the  limb 
improved  until  January  2, 1865,  when  gangrene  reappeared  and  the  tissues  of  the  heel  commenced  sloughing,  the  exposed  tibia 
being  necrosed  and  exfoliating.  In  addition  to  escharotics  the  treatment  was  supporting  throughout.  The  patient  died  of 
exhaustion  January  26,  1865."  The  specimen  (No.  3609,  Surgical  Section,  A.  M.  M.)  consists  of  the  tibia,  and  shows  one  longi 
tudinal  half  of  the  bone  to  be  necrosed  and  nearly  separated,  the  other  portion  being  sheathed  with  callus. 

CASE  662. — Corporal  T.  N.  Chapin,  Co.  JI,  21st  Michigan,  aged  35  years,  was  wounded  at  the  battle  of  Stone  River, 
January  1, 1863,  and  admitted  to  the  field  hospital  of  the  1st  division,  Fourteenth  Corps,  with  "shot  wound  near  the  left  ankle." 
Assistant  Surgeon  C.  C.  Gray,  U.  S.  A.,  contributed  the  specimen  (Cat.  Surg.  Sect.,  1866,  p.  375,  Spec.  1916),  with  the  following 
history :  "  The  ball  entered  at  the  inner  side  of  the  middle  of  the  calf  of  the  leg,  passed  obliquely  downward  under  the  bone,  and 
came  out  a  little  above  and  posterior  to  the  malleolus.  The  patient  was  admitted  to  hospital  No.  8,  Nashville,  January  19th, 
his  wound  being  erysipelatous,  with  great  swelling  of  the  entire  leg.  Gangrene  invaded  the  limb  so  as  to  destroy  the  soft  struct 
ures  covering  the  tibia  for  nearly  half  way  around  the  leg,  and  from  within  two  inches  of  the  insertion  of  the  tendon  of  the 
patella  to  a  point  about  three  inches  from  the  ankle  joint.  The  bone  was  exposed  and  became  badly  necrosed.  Chlorinated 
solution  of  soda  in  its  full  strength,  and  applied  with  picked  lint,  was  used  three  times  a  day  in  the  treatment,  with  general 
stimulants,  bromine  being  used  in  the  room  as  a  general  fumigant.  The  gangrene  was  arrested  in  about  four  weeks.  The 
patient  died  June  1,  1863.  Two  weeks  previous  to  his  death  granulations  were  feebly  struggling  to  extend  over  the  diseased 
bone,  much  of  which  was  covered.  The  patient's  general  condition  had  become  very  low;  his  stomach  refused  almost  every 
thing,  and  the  first  symptoms  of  hydrothorax  presented  themselves.  The  autopsy  disclosed  the  chest  full  of  serum,  also  slight 
recent  pleuritic  adhesions."  The  specimen  shows  the  diseased  portion  of  the  contused  tibia  encircled  with  a  fringe  of  callus. 

CASE  663. — Private  N.  Hollenbeck,  Co.  F,  7th  New  York  Heavy  Artillery,  aged  37  years,  was  wounded  at  Tolopotomv 
Creek,  May  30,  1864.  He  was  admitted  to  Emory  Hospital,  Washington,  June  8th,  with  "shot  wound  of  left  leg,  over  tibia." 
Acting  Assistant  Surgeon  A.  McLetchie  contributed  a  specimen  (Cat.  Surg.  Sect.,  1866,  p.  519,  Spec.  3133),  with  the  following 
report :  "The  wound  was  caused  by  a  mini6  ball,  which  entered  the  leg  directly  over  the  spine  of  the  tibia,  middle  third,  injuring 
the  periosteum  but  not  splintering  the  bone  itself.  The  missile  was  extracted  through  the  wound  of  entrance.  The  wounded 
man  was  admitted  to  Patterson  Park  Hospital,  Baltimore,  June  llth.  He  was  in  a  very  asthenic  condition,  and  I  ordered  stim 
ulants  and  good  nourishing  diet.  About  the  18th  of  June  gangrene  set  in,  manifesting  itself  by  constitutional  symptoms,  fever, 
loss  of  appetite,  etc.,  some  days  before  the  distinctive  symptoms  appeared  in  the  wound.  The  disease  was  treated  with  nitric  acid, 
cautery,  dressings  of  chlorinate  of  soda,  linseed  poultices,  charcoal,  turpentine,  and  linseed  oil,  with  frequent  use  of  the  syringe. 
On  August  llth,  he  was  returned  from  the  gangrene  ward  with  the  wound  much  enlarged,  but  entirely  free  from  gangrene,  and 
nearly  four  inches  of  the  bone  exposed.  Tincture  of  chloride  of  iron  was  administered  daily,  and  milk  punch,  from  tlie  first 
appearance  of  the  disease.  Diarrhoea,  which  had  been  checked  on  his  entrance  into  the  hospital,  now  set  in  again,  complicated 
with  acute  dysentery,  and  was  treated  with  chalk  mixture,  vegetable  astringents,  and  pulverized  iron  and  opium.  But  the 
patient  gradually  wasted  away  from  the  steady  strain  on  his  system,  and  died  August  26,  1864."  The  specimen  is  a  wet  prep 
aration  of  the  leg,  showing  a  contusion  in  the  middle  third  of  the  tibia,  and  necrosis  extending  up  the  shaft  of  the  bone  on  its 
posterior  surface  to  near  its  head,  also  two  openings  from  ulceration  in  the  lower  third. 

Shot  Contusions  of  the  Bones  of  the  Leg  followed  by  Amputations. — In  eighteen 
instances  the  shot  contusions  of  the  bones  of  the  leg  were  followed  by  amputation :  eight 
in  the  leg,  one  at  the  knee  joint,  and  nine  in  the  thigh.  The  cases  of  amputation  in  the 
thigh  and  at  the  knee  joint  have  already  been  cited  in  SECTIONS  2  and  3  of  this  CHAPTER.1 
The  cases  of  amputation  in  the  leg  will  be  briefly  reported: 

'Amputations  in  the  thigh  for  shot  contusions  of  the  bones  of  the  leg:  Corp'l  S.  B.  Besley,  H,  147th  New  York  (TABLE  XXXIX,  Xo.  6,  p.  3K<), 
secondary,  middle  third;  recovery.  Ft.  C.  C.  Cannivan,  G,  88th  Pennsylvania  (TA13LE  XL,  No.  123,  p.  321),  secondary,  lower  third;  fatal.  Pt.  C.  P. 
Cobb,  F,  1st  Michigan  (TABLE  XXXIX,  No.  113,  p.  315,,  secondary,  middle  third ;  fatal.  Serg't  H.  A.  Colby,  G,  2d  U.  S.  8.  S.  (TABLE  XL,  No.  125,  p. 
3J1),  secondary,  lower  third;  fatal.  Pt.  J.  C.  Lemar,  B,  97th  Illinois  (TAJ5LE  XXXIX,  No.  136,  p.  215),  secondary,  middle  third;  fatal.  Serg't  Z.  H. 
Mather,  M,  5th  Michigan  Cavalry  (TABLE  XXXVI,  No.  476,  p.  300),  intermediary,  lower  third;  fatal.  Pt.  J.  Moran,  1,  Cth  New  York  (TABLE  XXXI, 
No.  <J7U,  p.  238),  primary,  middle  third;  fatal.  Corp'l  E.  McGinley,  I,  23d  Wisconsin  (TABLE  XXXVI,  No.  126,  p.  £05),  intermediary,  lower  third; 
recovery.  Corp'l  S.  H.  Powell,  C,  14th  New  Jersey  (TABLE  XL,  No.  77.  p.  321),  secondary,  lower  third ;  recovery.  Amputation  at  the  kuce  joint  for  shot 
contusion  of  the  tibia  was  performed  in  the  case  of  Pt.  W.  W.  Sandford,  F,  103d  Pennsylvania  (TABLE  LVI,  No.  43,  p.  407),  intermediary;  fatal. 


SECT.   V.] 


AMPUTATIONS    AFTER    SHOT    CONTUSIONS    OF    THE    BONES    OF    THE    LEG. 


431 


CASE  604.— Sergeant  R.  T.  Beatty,  Co.  H,  22(1  Pennsylvania  Cavalry,  aged  27  years,  was  wounded  in  thu  right  leg,  at 
Mount  Veruon  Forge,  September  27,  18G4,  by  a  musket  ball,  which  injured  the  tibia.  He  was  discharged  from  service  for  dis 
ability,  December  20,  1804,  and  pensioned.  Extensive  necrosis  followed  the  injury,  finally  involving  nearly  the  entire  shaft  of 
the  tibia  and  rendering  amputation  necessary.  The  operation  was  performed,  December  27,  18G5,  below  the  knee,  by  Pension 
Examining  Surgeon  C.  A.  Rahter,  of  Harrisburg,  Penn.,  and  resulted  successfully.  In  his  application  for  commutation,  the 
pensioner  described  the  stump  as  being  in  a  fair  condition. 

CASE  665. — Private  W.  Bell,  Co.  I,  7th  Michigan,  aged  34  years,  was  wounded  in  both  lower  extremities  and  the  head 
at  Antietam,  September  17,  1862,  one  ball  grazing  the  right  tibia  and  fibula  on  their  posterior  surfaces  just  above  the  ankle 
joint.  The  patient  became  a  great  sufferer  from  extreme  irritation  of  his  nervous  system  and  great  irritability  of  the  stomach. 
Repeated  appearances  of  gangrene  necessitated  amputation,  which  was  performed  on  November  3d,  about  one  inch  below  the 
tubercle  of  the  tibia,  by  Surgeon  J.  O.  Bronson,  U.  S.  V.  Under  the  administration  of  vigorous  tonics  and  stron«-  stimulants 
including  narcotics,  the  patient  gradually  improved,  and  was  able  to  start  for  his  home  December  5,  1862,  when  he  received  his 
discharge  from  service.  He  died  March  30,  1874,  of  typhoid  fever.  A  ligamentous  preparation  of  the  bones  of  the  foot  and 
the  lower  portion  of  the  leg  constitutes  specimen  254  of  the  Surgical  Section  of  the  Museum,  contributed  by  the  operator. 

CASE  666. — Private  J.  L.  Hosford,  Co.  H,  4th  Vermont,  aged  21  years,  was  wounded  at  the  Wilderness,  May  5,  1864, 
by  a  musket  ball,  which  entered  the  right  leg,  striking  the  tibia  above  the  malleolus  and  lodging.  He  was  admitted  to  Cumden 
Street  Hospital,  Baltimore,  where,  on  May  21st,  an  abscess  was  opened,  through  which  the  missile,  together  with  several  pieces 
of  bone,  were  discharged.  Considerable  erysipelatous  inflammation  followed,  attended  with  profuse  and  very  fetid  discharge, 
and  the  limb  became  exceedingly  painful,  necessitating  its  removal.  The  operation  was  performed  by  the  skin-flap  method, 
at  the  middle  third,  by  Surgeon  Z.  E.  Bliss,  U.  S.  V.,  on  May  31st.  The  patient  recovered  and  was  furnished  with  an  artificial 
leg.  He  was  discharged  March  20,  1865,  and  pensioned. 

CASE  607. — Private  J.  Esses,  Co.  K,  108th  Ohio,  aged  16  years,  received  a  gunshot  contusion  of  the  right  tibia,  near 
Kenesaw  Mountain,  June  23,  1864.  He  entered  hospital  No.  2,  Nashville,  where  flap  amputation  of  the  leg  at  the  upper  third 
was  performed,  by  reason  of  gangrene,  on  July  26th,  by  Acting  Assistant  Surgeon  J.  A.  Hall.  The  patient  recovered,  and  was 
discharged  May  22,  1835,  and  pensioned. 

Four  of  the  eight  cases  of  amputation  in  the  leg  for  shot  contusions  of  the  tibia  or 
fibula  had  fatal  terminations: 

CASE  663. — Private  J.  Dicey,  Co.  F,  17th  Michigan,  received  a  flesh  wound  of  the  left  thigh  and  a  contused  wound  by  a 
shell  on  the  fore  part  of  the  middle  of  the  right  leg,  at  Antietam,  September  17,  1862.  He  entered  Casparis  Hotel  Hospital, 
Washington,  October  13th,  with  the  latter  wound  in  a  gangrenous  condition  and  the  tibia  denuded  of  periosteum  for  four  or  five 
inches.  The  best  antiseptic  remedies  failing  to  check  the  spreading  of  the  disease,  the  limb  was  amputated  on  October  21st,  by 
Acting  Assistant  Surgeon  L.  Heard,  some  five  or  six  inches  below  the  knee.  The  patient  was  very  feeble  and  failed  to  rally. 
He  died  October  24,  1862.  The  amputated  bones  of  the  leg  were  contributed  to  the  Museum  by  the  operator,  and 
constitute  specimen  212  of  the  Surgical  Section,  A.  M.  M. 

CASE  609. — Private  G.  WTilson,  Co.  B,  1st  Ohio  Artillery,  aged  21  years,  was  wounded  in  the  left  leg,  at 
Chickamauga,  September  20,  1863.  Acting  Assistant  Surgeon  M.  L.  Hurr,  who  amputated  the  injured  limb  at 
hospital  No.  1,  Nashville,  contributed  the  specimen  (FlG.  259),  with  the  following  history:  "The  injury  was  caused 
by  a  mini6  ball,  which  passed  across  the  crest  of  the  tibia  at  its  middle  third,  merely  cutting  the  tissues  covering  it 
and  slightly  injuring  the  bone.  The  man  bandaged  his  wounded  leg  and  remained  with  his  regiment  about  a  week, 
when  the  limb  became  very  sore.  He  was  then  sent  to  hospital  at  Stevenson,  Alabama,  where  he  i-emained  until 
he  came  here  on  October  14th.  On  examination  I  found  the  tibia  denuded  of  periosteum  for  about  four  inches  below 
the  wound  and  for  some  distance  above.  The  integuments  were  in  a  highly  inflammatory  condition,  excessively 
painful,  and  suppurating  freely,  the  pus  being  of  a  very  offensive  character.  The  patient  was  pale,  though  not  much 
emaciated;  his  appetite  good;  bowels  costive.  Tincture  of  chloride  of  iron  and  whiskey  were  prescribed.  The 
leg  was  bandaged  from  foot  to  knee  so  as  to  maintain  equable  pressure,  and  constant  application  of  cold  water 
was  made.  He  continued  to  grow  worse,  the  leg  being  very  painful  and  the  discharge  very  profuse,  and  on  Octo 
ber  25th  I  found  upon  examination  that  the  patient  also  had  hypertrophy  of  the  heart,  from  which  he  suffered 
considerably.  On  November  2d,  I  observed  hectic  or  indication  of  irritative  fever  for  the  first  time.  His  appetite 
was  still  good,  and  he  complained  of  no  pain  except  in  the  leg;  but  he  was  very  weak  and  pale.  Quinine,  with 
morphia,  was  administered  every  three  hours.  On  November  6th,  the  patient  having  expressed  his  wish  of  taking 
advantage  of  surgical  interference,  the  limb  was  amputated  at  the  upper  third.  Chloroform  and  sulphuric  ether 
constituted  the  anaesthetic.  No  reaction  took  place,  and  the  patient  died  the  next  morning.  At  the  post-mortem 
examination  four  ounces  of  watery  fluid  were  found  in  each  pleural  cavity,  with  slight  pleuritic  adhesions  on  the 
right  side  and  small  multiple  abscesses  through  both  lungs,  the  posterior  portion  of  each  being  engorged.  Some  of 
the  abscesses  contained  an  inspissated  matter  or  pus,  not  well  broken  up.  The  heart  was  very  much  enlarged  and 
weighed  seventeen  and  a  half  ounces;  the  pericardium  contained  two  or  three  ounces  of  fluid,  but  the  valves  were  Portion ot left 
not  diseased.  Four  or  five  large  abscesses  were  found  on  the  anterior  surface  of  the  right  lobe  of  the  liver,  which  tibia  amputa- 
organ  contained  eight  and  a  half  ounces  of  pus.'1  The  specimen  consists  of  the  injured  tibia,  being  thoroughly  contusion, 
denuded  of  periosteum  and  necrosed  in  its  greatest  extent. 

CASE  670. — Corporal  G.  L.  Stephens,  Co.  I,  30th  Maine,  was  wounded  at  Cane  River,  April  23,  1834,  by  a  musket  ball, 
which  entered  the  left  leg,  injuring  the  tibia  but  not  fracturing  it.  One  week  after  receiving  the  injury  he  was  admitted  to  hos 
pital  at  Baton  Rouge,  where  the  missile  was  extracted  from  the  calf  the  leg  on  May  15th.  By  reason  of  erysipelatous  inflam 
mation  of  the  foot  and  leg,  attended  with  sloughing  ulceration,  circular  amputation  of  the  leg  at  the  middle  third  was  performed, 
on  August  2d,  by  Surgeon  D.  W.  Taylor,  34th  Indiana.  The  patient  died  August  15,  1864,  from  exhaustion. 


432 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAT.  X. 


CASE  671. — Captain  F.  L.  Thompson,  Co.  D,  36th  Mississippi,  aged  29  years,  was  wounded  at  Nashville,  December  16, 
1864.  by  a  musket  ball,  which  entered  the  right  leg  over  the  anterior  aspect  of  the  tibia,  five  inches  above  the  ankle  joint,  passed 
downward,  and  lodged  directly  over  the  dorsura  of  the  foot.  Erysipelatous  inflammation  ensued;  the  ankle  joint  opened;  tibia 
denuded  of  periosteum.  On  December  31st,  the  patient  suffering  from  much  pain  and  being  apparently  threatened  with  tetanus, 
the  leg  was  amputated,  by  the  circular  method,  at  the  junction  of  the  upper  and  middle  third,  by  Acting  Assistant  Surgeon  C. 
H.  Fisher.  The  patient  was  much  emaciated,  and  died  of  exhaustion  January  9,  1865. 

SHOT  FRACTURES  OF  THE  BONES  OF  THE  LEG.— Eight  thousand  nine  hun 
dred  and  eighty-eight  cases  of  shot  fractures  of  the  bones  of  the  leg  are  reported,  and  the 
results  have  been  ascertained  in  all  but  two  hundred  and  seventy-eight  cases.  The  tibia 
was  injured  in  two  thousand  five  hundred  and  eighty-eight,  the  fibula  in  one  thousand  and 
thirty-three,  the  tibia  and  fibula  in  one  thousand  four  hundred  and  fifty-one  instances,  and 
in  three  thousand  nine  hundred  and  sixteen  cases  the  diagnosis  failed  to  indicate  the  precise 
seat  of  the  bony  lesion. 

TABLE  LXI. 

Numerical  Statement  of  the  Nature  and  Treatment  of  Eight  Thousand  Nine  Hundred  and  Eighty-eight 

Shot  Fractures  of  the  Bones  of  the  Leg. 


TREATMENT. 

CASES. 

FRACTURES  OF 
THE  TIBIA. 

FKACT.  OF 

THE  FllJULA. 

FRACTIIUKSOF 
TIIETIIIIAANI) 

FlIJULA. 

BONE  NOT  SPE 
CIFIED. 

8 

3 

o 

Recovery. 

"3 
fe 

Result  Un 
determined. 

Ratio  of 
Mortality. 

Recovery. 

3 

? 
fe 

Result  Un 
determined. 

Recovery. 

1 

h 

Result  Un 
determined. 

Recovery. 

Fatal. 

Result  Un 
determined. 

b 

1    i 

&      £ 

Result  Un 
determined. 

3,938 

339 
19 
2 
5 
22 
1 
3,728 
3 
39 
100 

785 

3,296 

248 
15 

2 
10 
1 
2,354 

o 

19 
40 
3 

344 

528 

87 
4 
2 
3 
12 

114 
4 

13.8 

25.9 
21.0 
100. 
60.0 
54.5 

1,737 

109 
11 

201 

39 
1 

34 

o 

721 

119 
2 

78 

41 

1 
1 

7 

295 

19 
2 

75 
7 

4 

543       174 
1 

69 

Followed  by 
Excision  111  the  Bones  of  the  Leg  

Excision  in  Bones  of  Leg  and  Amp.  of  Leg  

Excision  in  Leg  —  Amp.  in  Leg  —  Amp.  in  Thigh.. 
Excision  in  Leg  —  Amp.  at  Knee  Joint  

2 
5 

1 

4 

1 

1 

1 

Excision  in  Leg  —  Amp.  in  Thigh  

5 

r, 

o 

1                1 

Excision  at  the  Knee  Joint  

1 
539 
1 
f) 

Amputation  in  the  Leg  

1,215 

5i> 
4 
441 

159 

34.0 
33  3 

151 

88 

1 

8 

13 

206 

10 

1,656       908 
1           1 
6:      11 
14  '       26 
I           2 
137       217 

148 

.... 

Amputation  in  Leg  —  Amp.  at  Knee  Joint  

Amputation  in  Leg  —  Amp.  in  Thigh  

1 

51.2 
59.0 
57.1 

3 
11 

3 

20 

1 

(; 

Amputation  at  Knee  Joint  

1 

1°5 

n 

Amputation  at  Knee  Joint  —  Amp.  in  Thigh  

o 

Amputation  in  Thigh  

56.1 

69 

95 

452 

-*/  — 
588 

8 
864 

V  

20 

130 

109 

Aggregates  

8,988 

6,334 

2,376 

278 

27.2 

2,098 
o 

38 

ICO 
I,  OX 

9 

1,013   424 
MsT 

14 

2,359   1,340 

iuue 

217 

Three  thousand  nine  hundred  and  thirty-eight,  or  less  than  one  half  of  the  cases,  were 
treated  by  conservation,  and  five  thousand  and  fifty,  or  56.2  per  cent.,  were  followed  by 
operation,  viz:  three  hundred  and  forty  by  excision,  forty-eight  by  excision  and  subse 
quent  amputation,  and  four  thousand  six  hundred  and  sixty-two  by  amputation  either  in 
the  leg,  at  the  knee,  or  in  the  thigh.  It  has  already  been  stated  on  page  175,  ante,  that 
of  the  six  thousand  five  hundred  and  seventy-six  instances  of  shot  fracture  of  the  thigh 
bone,  operative  interference  was  resorted  to  in  three  thousand  one  hundred  and  nine,  or 
47.3  per  cent.,  thus  showing  that  the  percentage  of  operations  after  shot  fractures  of  the 
bones  of  the  leg  exceeded  that  after  shot  fractures  of  the  femur  by  8.9  per  cent. 

SHOT  FRACTURES  OF  THE  BONES  OF  THE  LEC  TREATED  BY  CON 
SERVATION. — The  results  as  to  fatality  were  ascertained  in  three  thousand  eight  hun 
dred  and  twenty-four  of  the  three  thousand  nine  hundred  and  thirty-eight  shot  fractures  of 
one  or  both  of  the  bones  of  the  leg  treated  without  operative  interference,  giving  a  mortal- 


SECT.  V.| 


SHOT    FRACTURES    OF    THE    TIBIA    TREATED    BY    CONSERVATION. 


-133 


ity  rate  of  13.8  percent.  In  seven  hundred  and  eighty-six  cases  the  seat  of  injury  was  not 
specified;  in  the  remaining  three  thousand  one  hundred  and  fifty-two  cases  the  tibia  was 
implicated  in  nineteen  hundred  and  seventy-two,  the  fibula  in  eight  hundred  and  six,  and 
both  bones  in  three  hundred  and  seventy-four  instances,  with  death  rates  of  10.3,  7.8,  and 
20.3  per  cent.,  respectively. 

SHOT    FRACTURES    INVOLVING    THE    TIBIA    TREATED    BY    CONSERVATION. The   tibia   alone  W3S 

involved  in  nineteen  hundred  and  seventy-two  instances,  or  in  over  one-half  of  the  total 
number  of  cases  of  shot  fractures  of  the  leg  treated  conservatively.  Of  the  nineteen  hun 
dred  and  thirty-eight  instances  in  which  the  results  were  determined,  two  hundred  and  one 
proved  fatal,  a  mortality  of  10.3  per  cent. 

Recoveries  after  Shot  Fractures  of  the  Tibia  treated  by  Conservation. — A  few  of  the 
one  thousand  seven  hundred  and  thirty-seven  instances  of  this  group  will  be  detailed: 

CASE  672. — Private  J.  Wells,  Co.  G,  71st  Pennsylvania,  aged  26  years,  was  wounded 
in  the  right  leg,  at  Spottsylvania,  May  12, 1864.  He  entered  Columbian  Hospital,  Washington, 
and  was  subsequently  transferred  to  Harewood  Hospital.  Surgeon  R.  B.  Bontecou,  U.  S.  V., 
in  charge  of  the  latter,  contributed  the  photograph  (Card  Photographs,  Vol.  3,  p.  30,  A.  M.  M.). 
and  reported  that  the  patient  was  discharged  from  service  June  29,  1865,  by  reason  of  "shot 
comminuted  fracture  of  the  tibia  at  the  middle  third."  Examiner  C.  C.  Halsey,  of  Montrose, 
Penn.,  December  4,  1865.  certified  to  the  injury,  and  stated:  "The  wound  at  point  of  entrance 
is  not  sound  and  the  skin  for  from  two  to  three  inches  around  it  is  a  mass  of  scabs  and  sores. 
He  complains  of  pain  about  the  ankle  and  foot."  The  man  drew  pay  as  a  full  pensioner  until 
September  4, 1866,  after  which  time  he  ceased  to  communicate  with  the  Pension  Office  for  nearly 
thirteen  years,  when  he  reapplied  and  was  restored,  having  in  the  meantime  changed  his  resi 
dence  tt)  the  State  of  Mississippi.  Examiner  T.  G.  Birchets,  of  Vicksburg,  reported,  February 
16,  1880:  "The  wound  is  about  the  middle  of  the  shaft  of  the  tibia,  resulting  in  a  very  large 
scar,  and,  from  feeling,  there  has  been  loss  of  bone.  His  personal  appearance  is  healthy. 
There  is  no  disability."  The  pensioner  was  paid  March  4,  1880,  having  his  rate,  in  consequence 
of  the  last  Examiner's  report,  reduced  from  total  to  one- fourth. 

CASK  673. — Private  W.  Kelly,  Co.  C,  149th  New  York,  aged  30  years,  received  a  shot 
fracture  of  the  left  tibia  by  a  minUi  liall,  at  Williamsport,  July  11,  1863.  He  was  admitted  to 
Frederick,  and  subsequently  passed  through  various  hospitals,  being  ultimately  discharged  from 
service  at  Harewood,  Washington,  June  19, 1865.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  in  charge 
of  the  latter  hospital,  contributed  the  photograph  represented  in  the  annexed  cut  (FiG.  260), 
and  reported  that  the  patient's  disability  was  total.  Examiner  G.  W.  Cook,  of  Syracuse,  N.  Y., 
February  25,  1867,  certified  to  "shot  wound  of  left  leg  at  middle  third,  fracturing  the  tibia.  A 
part  of  the  bony  substance  was  removed,  leaving  a  large  and  extensive  excavation,  cicatrix, 
and  deformity,  with  several  minute  fistulre.  Abscesses  frequently  form ;  the  knee  is  stiff  and  the 
leg  bad."  Subsequent  examiners  report  the  same  description  of  the  injury  and  its  results.  The  pensioner  was  paid  March  4, 1880. 

CASE  674. — Private  S.  Prillaman,  Co.  G,  24th  Virginia,  aged  28  years,  was  wounded  and  captured  at  Williamsburg, 
May  5,  1862.  He  was  admitted  to  Camden  Street  Hospital,  Baltimore,  nine  days  after  the  injury,  whence  Acting  Assistant 
Surgeon  E.  G.  Waters  reported  the  following  history:  "A  bullet  entered  the  anterior  and  inner  aspect  of  the  left  leg  five  inches 
above  the  ankle  joint,  fracturing  the  bone  at  that  point  through  its  continuity  and  comminuting  the  entire  shaft  for  four  inches 
upward,  where  a  second  solution  of  the  continuity  was  produced.  The  missile  on  coming  in  contact  with  the  bone  separated 
into  three  portions,  one  passing  inward,  backward,  and  slightly  upward,  and  emerging  posteriorly  through  the  calf  of  the  leg; 
the  second  passed  upward,  backward,  and  outward,  lodging  under  the  integuments  on  the  outer  aspect  of  the  leg;  the  third 
passed  into  the  canal  of  the  shaft,  then  upward,  destroying  the  continuity  of  the  bone  and  lodging  some  four  inches  above  the 
point  of  entrance.  The  two  last  mentioned  fragments  were  subsequently  discovered  and  removed.  When  admitted  the  patient 
was  much  broken  down  in  health,  having  little  or  no  appetite  and  his  complexion  being  sallow.  The  leg  was  much  swollen  and 
discharging  profusely.  It  was  placed  at  once  in  the  anterior  splint  and  emollient  poultices  were  applied.  Some  days  later  the 
limb  below  the  knee  assumed  a  livid  line,  giving  rise  to  apprehensions  of  gangrene.  This  appearance,  however,  readily  yielded 
to  the  free  exhibition  of  quinine  and  stimulants,  with  cataplasms  of  bran  and  yeast  applied  locally,  and  the  attempt  to  save  the 
limb  was  persevered  in.  On  June  24th,  the  patient  was  put  under  the  influence  of  chloroform  and  the  denuded  fragments  of 
bone  were  removed.  The  centre  of  the  entire  length  of  the  fractured  shaft  was  taken  out,  leaving  only  a  thin  scale  on  each  side 
attached  to  healthy  periosteum.  It  was  hoped  that  nature  would  fill  the  cavity  thus  left  and  consolidate  the  limb.  This  expec 
tation  was  fully  answered  in  the  sequel.  During  his  stay  in  the  hospital  the  patient  suffered  nine  distinct  attacks  of  erysipelas, 
several  of  them  being  of  extraordinary  severity,  even  for  cases  of  gunshot  fracture,  the  writer  having  had  under  his  care  nearly 
two  hundred  cases  of  the  disease  resulting  fiom  such  causes  and  met  with  not  more  than  two  or  three  of  equal  violence.  The 
first  attack  came  on  about  July  1st,  extending  no  higher  than  the  knee,  and  yielding  after  five  days  treatment.  On  September 
28th,  the  patient  was  suffering  from  the  fifth  attack,  and  several  fistulous  orifices  were  noticeable  over  the  anterior  aspect  of  the 
SURG.  Ill— 55 


FIG.   260.— Shot  fracture  of   left 
tibia.     [From  n  photograph.] 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


leg,  between  the  points  of  the  fracture,  through  which  the  probe  detected  necrosed  bone.  It  was  then  deemed  expedient  to 
remove  several  more  detached  fragments  of  bone,  and  -with  this  view  the  fistulous  orifices  were  dilated  and  a  number  of  pieces 
were  seized  and  withdrawn.  Afterwards  the  leg  became  enormously  swollen  and  the  discharge  grumous  and  offensive.  The 
tissues  around  the  knee  joint  also  began  to  sympathize  with  the  general  disturbance  and  swelled  to  twice  their  natural  size. 
About  October  Gth,  fluctuation  manifested  itself  over  an  extensive  surface  about  the  joint,  when  a  bistoury  was  carefully  intro 
duced  to  the  depth  of  an  inch,  giving  exit  to  a  quantity  of  sero-purulent  fluid.  The  patient  was  actively  plied  with  stimulants 
and  tonics,  the  leg  was  maintained  in  the  suspensory  splint,  and  bran  and  yeast  cataplasms  were  kept  constantly  applied,  under 
which  treatment  the  inflammation  and  swelling  rapidly  subsided,  the  discharge  soon  became  healthy,  and  the  patient's  strength 
and  spirit  revived.  He  finally  recovered  with  a  strong  and  fine  limb,  an  anchylosed  knee  joint,  and  a  semi-flex ed  leg.  On  June 
27,  1863,  he  left  the  hospital  cured,  to  be  sent  south,  having  been  for  thirteen  consecutive  months  under  my  care.  All  of  the 
sinuses  (of  which  there  were  many)  had  healed  prior  to  his  discharge  except  two,  and  these  were  satisfactorily  ascertained  not 
to  communicate  with  dead  bone  but  with  aponeurotic  expansions.  Bony  union  had  taken  place  to  an  ample  extent,  the  entire 
canal  of  the  shaft — which  as  above  stated  had  been  opened  for  the  distance  of  four  inches — being  filled  in  its  entire  depth  with 
new  osseous  tissue."  This  patient  was  heard  from  at  his  home  in  Franklin  County,  Virginia,  in  1877,  fifteen  years  after  the 
injury,  when  his  condition  was  described  in  a  letter  as  that  of  a  "bad  cripple." 

CASE  675. — Private  T.  Schrup,  Co.  B,  10th  New  York  Cavalry,  aged  22  years,  was  wounded 
in  the  left  leg,  near  the  South  Side  Railroad,  April  2, 1865.  He  was  conveyed  to  the  Depot  Hospital 
at  City  Point  two  days  after  the  injury,  and  transferred  to  Washington  April  30th.  Surgeon  R.  B. 
Bontecou,  U.  S.  V.,  in  charge  of  Harewood  Hospital,  contributed  the  photograph  shown  in  the 
adjoining  cut  (FlG.  261),  and  described  the  injury  as  "a  shell  wound,  severely  fracturing  the  tibia, 
lower  third.  On  admission  the  patient  was  in  good  health ;  condition  of  injured  parts  good,  although 
severely  lacerated.  Treatment:  Simple  dressings,  splints,  and  supporting  diet.  The  parts  healed 
kindly,  and  the  patient  was  doing  well  when  transferred  to  Lincoln  Hospital,  July  20,  1865."  He 
was  discharged  from  service,  at  the  latter  hospital,  August  12,  1865,  Surgeon  J.  C.  McKee,  U.  S.  A., 
certifying  to  "partial  paralysis  of  the  left  foot  and  leg,  resulting  from  the  wound."  Immediately 
after  being  discharged  the  patient  made  an  application  for  pension,  and  was  examined  by  M.  D.  Ben 
edict,  Pension  Examining  Surgeon,  who  described  the  fractured  bone  as  "united  with  slight  shortening 
and  some  deformity,"  and  the  limb  as  useless  for  the  time  being.  The  man  has  not  been  heard  from 
since  filing  his  application. 

CASE  676. — Sergeant  J.  R.  Rice,  Co.  K,  1st  Vermont  Cavalry,  aged  30  years,  was  wounded 
in  a  cavalry  charge  between  Hagerstown  and  Williamsport,  July  6,  1863,  by  a  minie  ball,  which 
entered  the  outer  aspect  of  the  lower  portion  of  the  right  leg,  fracturing  the  tibia  and  lodging  in  the 
bone.  Two  days  after  the  injury  he  was  admitted  to  hospital  at  Frederick,  whence  Acting  Assistant 
Surgeon  W.  S.  Adams  reported  as  follows :  "  The  patient  was  admitted  under  care  of  Acting  Assistant 
Surgeon  W.  P.  Morgan,  who  removed  a  few  fragments  and  placed  the  limb  in  Smith's  anterior  splint. 
His  general  condition  was  good.  On  July  22d  the  patient  came  under  my  care,  when  I  found  that  he 
had  considerable  irritative  fever;  tongue  disposed  to  be  dry;  slight  diarrhoea  and  but  little  appetite; 
limb  painful  and  oedematons.  I  took  off  the  splint  to  examine  the  limb  and  removed  several  frag 
ments  of  bone  and  the  missile,  which  was  found  embedded  in  the  medullary  cavity  about  two  inches 
below  the  point  of  the  injury.  Stimulants,  with  tonics  and  good  diet,  were  ordered.  By  August  1st,  the  appearance  of  the 
limb  had  much  improved,  the  patient  having  experienced  but  little  pain  since  the  removal  of  the  ball ;  appetite  and  general 
condition  improving.  On  August  14th,  his  countenance  had  assumed  a  sallow  appearance,  and  he  had  a  slight  headache, 
accompanied  by  constipation  of  bowels,  for  which  three  compound  rhubarb  pills  were  administered.  Three  days  later  there 
was  well-marked  jaundice,  when  pills  of  blue  mass  and  compound  extract  of  colocynth  were  prescribed.  By  August  21st,  the 
jaundice  was  disappearing;  condition  of  leg  good.  On  September  1st,  union  of  bone  seemed  quite  firm;  wound  yet  discharging 
quite  freely.  The  limb  now  was  allowed  to  rest  on  pillows  during  the  day  time  and  suspended  in  splints  at  nights.  On  Septem 
ber  20th,  the  splint  was  removed  from  the  leg,  union  being  firm,  with  no  evidence  of  necrosis,  and  the  wound  healing  kindly. 
About  October  1st,  the  patient  was  going  around  on  crutches,  and  two  weeks  later  he  laid  these  aside  and  walked  with  a  cane, 
the  wound  having  all  closed  with  the  exception  of  an  opening  barely  large  enough  to  admit  a  probe,  On  February  1,  1864, 
the  patient  was  furloughed,  having  been  able  for  a  considerable  time  to  walk  without  the  aid  of  a  cane  and  the  wound  being 
healed."  He  was  subsequently  promoted  to  Lieutenant,  and  ultimately  mustered  out  of  service  June  21,  1865.  In  1876,  when 
applying  for  pension,  he  was  examined  by  Surgeon  C.  B.  Currier,  of  Middlebury,  Vermont,  who  reported  that  "from  loss  of  bone 
there  is  a  .depression  as  large  as  a  twenty-dollar  piece  and  about  one-eighth  of  an  inch  deep ;  cicatrix  tender  to  the  touch ;  cedema 
of  leg  and  foot;  leg  one  and  a  half  inch  shorter  than  the  other;  muscles  of  leg  flabby  and  evidently  weak.  He  cannot  stand  or 
walk  much;  health  good."  The  pensioner  was  paid  September  4,  1880. 

CASE  677. — Captain  W.  W.  Ellis,  Co.  D,  61st  Pennsylvania,  aged  23  years,  was  wounded  in  the  left  leg,  at  Chancellors- 
ville,  May  3, 1863,  and  entered  Douglas  Hospital,  Washington,  five  days  afterwards.  Assistant  Surgeon  W.  Thomson,  U.  S.  A., 
reported:  "This  officer  suffered  a  fracture  of  the  tibia  near  its  middle  by  a  ball,  which  entered  posteriorly  at  the  gastrocnemius 
muscle,  and  was  retained.  The  fracture  united  without  exfoliation,  necrosis,  or  even  free  suppuration.  The  leg  was  placed  in 
a  bran  box  and  dressed  with  cold-water  applications.  The  patient  suffered  from  severe  catarrh,  which  yielded  to  treatment. 
There  was  also  hyperaesthesia  of  the  foot,  for  which,  before  the  patient  left  on  furlough  in  June,  I  made  an  incision  in  search  of 
the  ball  and  disturbed  the  cicatrix  with  good  effect,  relieving  the  nervous  irritation  of  the  foot.  When  the  patient  returned 
from  furlough,  September  1st,  he  was  ordered  to  report  to  Surgeon  M.  Clymer,  U.  S.  V.,  for  treatment,  and  I  lost  sight  of  him. 
His  recovery  was  good,  but  the  leg  was  yet  feeble  and  contracted,  owing  to  want  of  passive  motion  while  at  his  home."  Cap 
tain  Ellis  resigned  January  1,  1864,  and  was  commissioned  in  the  Veteran  Reserve  Corps,  in  which  organization  he  served  until 


FIG.  201.— Shell  fracture  of 
lower  third  of  left  tibia.  [From 
a  photograph.] 


1 


PLATE    LXXIV.    UPPER    PORTION   OF    RIGHT    TIBIA    SAWN   LONGITUDINALLY. 

1 .  2 .  Out CT  Yii'M-s  .'{ .  4  .  IniH'r  MCMVS  . 

Case  ol'C'oloiu'I  VT.F.Liynch.  ")8  llliimis  Volunteers  . 

Spoc-inifii  <>7S4 .  Sin  «   S«-i  t     A . M .  M  . 


SECT.  v.J  SHOT    FRACTURES    OF    THE    TIBIA    TEEATED    BY    CONSERVATION.  435 

March  13,  1866,  when  he  was  mustered  out  and  pensioned.  Examining  Surgeon  G.  Urquhart,  of  Wilkesbarre,  Pennsylvania. 
August  22,  1866,  certified  to  half  an  inch  shortening  of  the  limb;  also  to  painfulness,  weakness,  and  occasional  lameness.  Exam 
iner  J.  W.  Martin,  of  Red  Oak,  Iowa,  reported,  September  4,  1873:  "There  are  large  cicatrices  on  the  left  side  of  the  tibia;  leg 
bent  and  shortened ;  foot  swollen  and  tender,  and  muscles  shrunken  above  the  ankle.  He  suffers  extreme  pain  in  the  leg  and  is 
unable  to  bear  much  weight  upon  it;  general  health  not  good."  The  pensioner  was  paid  September  4,  1880. 

CASE  678. — Private  J.  Walker,  Co.  A,  7th  Wisconsin,  aged  27  years,  was  wounded  at  the  Wilderness,  May  6,  1864. 
Surgeon  C.  N.  Chamberlain,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  4th  division,  Fifth  Corps,  with  "shot 
fracture  of  left  leg,  caused  by  a  minie  ball.''  On  May  12th,  the  wounded  man  entered  Armory  Square  Hospital,  Washington, 
where  his  injured  leg  was  operated  on  by  Surgeon  D.  W.  Bliss,  U.  S.  V.,  who  made  the  following  report  of  the  case:  "The  ball 
was  found  embedded  in  the  shaft  of  the  tibia  at  about  its  middle,  whence  it  was  extracted  on  August  13th.  The  leg  went 
through  all  the  symptoms  of  neci-osis  of  one  or  both  the  bones,  the  first  signs  of  which  appeared  on  August  19th.  On  October 
10th,  the  patient  was  placed  upon  the  operating  table  and  four  inches  of  the  shaft  of  the  tibia  was  removed,  together  with  all  the 
necrosed  spicula  of  bone.  Chloroform  was  used  as  the  anaesthetic.  Simple  dressings,  stimulants,  and  nourishing  diet  constituted 
the  treatment.  The  patient  did  well  after  the  operation."  He  was  discharged  from  service  January  24,  1865,  and  pensioned. 
Examiner  A.  McBean,  of  Chippewa  Falls,  Wisconsin,  certified,  July  9,  1867:  "The  remaining  portion  of  the  bone  from  the 
ankle  joint  to  within  four  inches  of  its  head  has  become  carious.  A  large  open  ulcer  is  the  consequence."  Examiner  F.  A. 
Reckard  reported,  March  4,  1874:  "The  wound  is  yet  open  and  discharging  from  an  orifice  some  four  inches  in  length.  The 
remainder  of  the  tibia  is  badly  diseased  and  portions  have  come  away  at  different  times.  The  limb  is  very  much  swollen  at 
times  and  retains  him  in  bed  for  months."  The  pensioner  was  paid  March  4,  1880.  The  bone  removed  consists  of  a  sequestrum 
six  inches  in  length,  and  for  four  inches  is  tubular.  It  was  contributed  to  the  Museum  by  the  operator,  and  is  numbered 
specimen  3283  of  the  Surr/ical  Section.  The  specimen  is  shown  in  FIGURE  2  of  PLATE  LXXI,  opposite  page  428. 

CASE  679. — Private  A.  Elmer,  Co.  I,  69th  Pennsylvania,  aged  21  years,  was  wounded  at  Petersburg,  June  18,  1864,  and 
admitted  to  the  field  hospital  of  the  2d  division,  Second  Corps.  Surgeon  J.  F.  Dyer,  19th  Massachusetts,  reported:  "Shot 
fracture  of  left  leg  by  mini6  ball;  anterior  tibial  artery  divided.  Ligation  performed  by  Surgeon  N.  Hayward,  20th  Massachu 
setts."  Surgeon  B.  B.  W'ilson,  U.  S.  V.,  reported  that  the  wounded  man  was  admitted  to  Stanton  Hospital,  Washington,  July 
1st,  with  "  shot  fracture  of  left  tibia,  lower  third,"  for  which  splints  and  simple  dressings  were  used,  and  that  he  was  furloughed 
January  4,  1865.  The  patient  was  subsequently  transferred  to  Satterlee  Hospital,  Philadelphia,  whence  he  was  discharged  July 
7,  1865.  by  reason  of  "'lameness  resulting  from  the  injury,"  and  pensioned.  Examiner  A.  D.  Newell,  of  New  Brunswick,  N.  J., 
March  5,  1878,  certified  to  the  wound  and  fracture,  and  stated:  "The  bone  is  not  sound  now.  The  wounded  leg  is  smaller. 
The  tendo-achillis  has  contracted  so  that  in  walking  his  toes  strike  the  ground — is  quite  lame."  The  pensioner  was  paid 
December  4, 1879. 

In  the  following  instance  a  portion  of  the  missile  remained  lodged  in  the  tibia,  keeping 
the  wound  open  until  the  time  of  the  officer's  death,  twelve  years  after  the  injury: 

CASE  680.  — Colonel  W.  F.  Lynch,  58th  Illinois,  aged  25  years,  was  wounded  at  Yellow  Bayou,  May  18,  1864.  Surgeon 
G.  L.  Lucas,  47th  Illinois,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Sixteenth  Corps,  with  "a  bullet  frac 
ture  in  right  leg;  missile  extracted  by  Surgeon  J.  E.  Murta,  8th  Wisconsin."  From  the  field  hospital  the  patient  proceeded  to 
his  home,  and,  on  February  7,  1865,  he  was  mustered  out  by  expiration  of  service.  His  condition  at  this  time  was  described 
by  Surgeon  B.  Norris,  U.  S.  A.,  as  follows:  "The  wound  is  a  very  remarkable  one  of  the  tibia,  about  two  inches  from  the 
knee  joint,  being  a  perforation  of  the  bone  to  the  depth  of  more  than  an  inch,  and  open  as  an  augur  hole.  A  fetid  discharge 
escapes  through  the  opening,  and  the  soft  tissues  around  it  are  inflamed  over  a  circle  of  more  than  two  inches  in  diameter. 
These  signs  indicate  disease  which  can  only  be  entirely  removed  by  amputation  of  the  leg.  I  further  certify  that  in  conse 
quence  of  this  wound  his  nervous  system  has  become  morbidly  excitable  and  his  health  so  much  impaired  as  to  unfit  him  for 
any  regimental  duty."  About  a  year  after  his  muster  out  of  service  Colonel  Lynch  received  a  commission  as  an  officer  of  the 
Regular  Army,  and,  on  December  15,  1870,  he  was  finally  placed  on  the  retired  list  with  the  rank  of  Brigadier  General.  Acting 
Assistant  Surgeon  F.  H.  Atkins  reported  that  this  officer  died,  from  the  ultimate  effects  of  his  wound,  on  December  29,  1876,  at 
Fort  Larned,  Kansas,  and  contributed  the  pathological  specimen  numbered  6734  of  the  Suryieul  Section,  and  represented  in  PLATE 
LXXIV,  opposite  p.  434,  with  the  following  information  in  regard  to  the  case:  "A  portion  of  lead  was  cut  out  on  the  inner  aspect 
of  the  limb  a  long  time  after  the  injury,  while  another  portion  remained  lodged  in  the  bone.  The  wound  of  exit  healed  early, 
both  the  soft  and  osseous  tissues;  but  the  anterior  wound  remained  open  up  to  the  time  of  his  death,  small  pieces  of  dead  bone 
being  occasionally  removed,  and  a  profuse  and  extremely  offensive  discharge  continuing.  All  efforts  on  the  part  of  many  able 
surgeons  to  induce  the  patient  to  submit  to  the  removal  of  the  dead  or  diseased  interior  of  the  tibia  were  futile  until  within  three 
months  of  his  death,  when  he  desired  an  operation,  which  I  refused  in  view  of  his  previous  disease  and  present  prostration,  a 
position  concurred  in  by  Assistant  Surgeon  W.  S.  Tremaine,  U.  S.  A.,  who  saw  him  during  consultation  on  December  11,  1P76. 
Meanwhile,  in  the  winter  of  1675-6,  he  had  a  serious  illness,  apparently  of  pyaemic  character.  About  July  1,  1876,  a  severe 
pneumonia,  followed  by  diarrhoea,  nearly  proved  fatal,  and  after  that  there  was  constant  diarrhoea  and  almost  complete  interrup 
tion  of  the  digestive  functions.  From  October  until  his  death  the  apparently  tuberculous  disease  in  his  left  lung'  progressed 
rapidly,  a  large  cavity  forming.  His  death  seemed  to  result  from  inanition.  No  general  autopsy  was  permitted,  though  the 
upper  half  of  the  tibia  was  allowed  to  be  removed.  The  bone  was  ripped  by  a  saw  longitudinally,  the  incision  running  obliquely 
backward  and  inward  to  avoid  cutting  the  wound  of  entrance.  A  condition  of  the  bone  was  displayed  which,  in  my  opinion, 
would  have  given  prompt  and  absolutely  favorable  results  had  excision  of  the  diseased  portion  been  performed  at  any  time  prior 
to  the  winter  of  1875-6.  A  cavity  averaging  one  and  one-fourth  inch  in  diameter,  and  located  most  favorably  for  removing  the 
dead  bone  successfully,  was  found  directly  behind  the  wound  of  entrance.  The  cavity  was  lined  throughout  by  a  membrane 
continuous  with  the  edges  of  the  soft  tissues  and  the  skin.  The  dead  bone  approached  the  surface  of  the  tibia  rarely  as  near  as 
one-third  of  an  inch,  and  the  kneu  joint  about  one  inch,  extending  only  one-half  to  three-fourths  of  an  inch  below  the  wound  of 
entrance.  At  the  lowest  part  of  the  cavity,  on  the  posterior  segment,  there  was  a  group  of  black  masses,  white  internally.  A 


436 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


minute  portion  of  this  substance,  treated  with  carbonate  of  soda  on  charcoal  under  the  blowpipe,  gave  numerous  metallic  globules, 
malleable  under  pressure,  showing  that  the  mass  was  part  of  the  missile — now  carbonate  of  lead  within  and  sulphuret  without. 
The  upper  third  of  the  tibia  was  greatly  hypertrophied." 

Fatal  Cases  of  Shot  Fractures  of  the  Tibia,  treated  by  Conservation. — Two  hundred 
and  one  cases  of  this  group  were  reported,  the  fatal  issue  being  generally  ascribed  to  pyaemia, 
gangrene,  or  exhaustion: 

CASE  681.— Private  I.  D.  Mason,  Co.  D,  17th  Maine,  aged  30  years,  was  wounded  at  the  Wilderness,  May  5,  1864,  by  a 
musket  ball,  which  entered  the  external  aspect  of  the  left  leg,  fracturing  the  tibia  immediately  below  its  head,  passed  into  the 
right  leg  about  two  inches  lower  down,  fracturing  the  right  tibia  also,  and  lodging.  The  wounded  man  was  treated  at  Fred- 
ericksburg  until  May  25th,  when  he  was  admitted  into  Douglas  Hospital,  Washington,  in  a  typhoid 
state.  Death  took  place  from  exhaustion  May  31, 1864.  The  upper  halves  of  the  bones  of  both  legs  are 
represented  in  the  adjacent  cuts  (FiGS.  262,  263),  exhibiting  each  tibia  to  be  shat 
tered  in  the  upper  third,  and  showing  incipient  necrosis  as  the  only  observable 
change.  The  history  and  the  specimens  were  contributed  by  Assistant  Surgeon 
W.  Thomson,  U.  S.  A. 

CASE  682. — Corporal  W.  Smith,  Co.  K,  1st  Louisiana,  aged  18  years,  was 
wounded  at  Gettysburg,  July  2,  1863,  by  a  musket  ball,  which  fractured  the  left 
tibia  at  the  lower  third.  On  July  27th,  he  was  admitted  to  Camp  Lettermau,  the 
leg  being  considerably  swollen  and  painful.  Acting  Assistant  Surgeon  P.  S. 
Leisenring  reported  that  the  limb  was  placed  in  a  fracture  box  and  solution  of 
lead  and  opium  applied.  On  August  6th,  the  use  of  flaxseed  poultices  was  com 
menced,  and  an  abscess  opened  posterior  to  the  wound.  After  this  there  was 
some  improvement.  On  August  18th,  the  fracture-box  was  removed,  and  four 
days  later  the  patient  was  able  to  move  his  limb.  The  administration  of  febrifuge 
remedies,  including  quinine,  was  subsequently  prescribed,  the  patient  having  a 
severe  chill  on  August  25th.  Another  abscess,  forming  anterior  to  the  tibia,  was 
lanced  several  clays  afterwards,  after  Avhich  there  was  improvement  for  some 
days.  On  September  14th,  the  patient  came  under  the  care  of  Assistant  Surgeon 
R.  G.  Southall,  C.  S.  A.,  who  found  him  very  much  emaciated  and  with  several 
ulcers  on  the  leg.  The  patient  was  also  troubled  with  diarrhoea  and  had  lost  his  appetite.  Under  the  administration  of  tonics, 
stimulants,  and  astringents,  and  the  application  of  stimulating  lotions  and  nitrate  of  silver,  the  patient  slowly  mended  until 
September  22d.  when  the  ulcers  assumed  a  phagedenic  form  and  the  improvement  ceased.  On  September  28th,  two  spiculse  of 
considerable  size  were  removed  from  the  tibia.  Acting  Assistant  Surgeon  W.  M.  Welch  reported  the  termination  of  the  case  as 
follows:  "The  case  came  under  my  charge  on  October  13th.  The  bone  had  united,  but  the  leg  presented  two 
ulcers  near  the  region  of  the  wound,  which  had  sloughed  largely.  Nitric  acid  applications  were  resorted  to. 
under  which  treatment  the  leg  improved  until  October  24th,  when  the  ulcers  again  became  phagedenic  and 
nitric  acid  was  again  resorted  to.  Bromine  was  also  used,  but  neither  remedy  produced  any  salutary  effect. 
the  patient's  s\'stem  lacking  sufficient  vitality  to  separate  the  sloughs  from  the  living  tissues.  The  patient  also 
continued  to  be  a  sufferer  from  obstinate  diarrhoea,  which  baffled  ;ill  treatment.  He  died  from  exhaustion 
November  3,  1863.  On  examination,  the  fractured  portion  of  the  tibia  was  found  to  be  very 
feebly  united;  callus  insufficient  in  quantity  and  unhealthy  in  quality.  The  proximate  portion 
<>f  the  fibula  was  also  diseased."  The  lower  third  of  the  bones  of  the  wounded  leg,  represented 
in  the  cut  (FlG.  264),  were  contributed  to  the  Museum  by  Acting  Assistant  Surgeon  E.  T. 
Townsend.  The  specimen,  to  which  a  sequestrum  remains  attached,  shows  the  fractured  shaft 
of  the  tibia  to  have  been  invaded  by  caries  to  a  considerable  degree  and  a  large  portion  of  i1 
lost  by  suppuration. 

CASE  683. — Private  -/.  Guy,  Co.  D,  39th  North  Carolina,  aged  19  years,  was  wounded 
in  the  left  leg,  at  Stone  River,  December  31,  1862.  Surgeon  C.  W.  Horner,  U.  S.  V..  reported  : 
''The  injury  was  caused  by  a  conical  ball,  which  passed  from  the  inner  to  the  outer  aspect  «t 
the  middle  third  of  the  leg,  producing  a  comminuted  fracture  of  the  tibia  and  carrying  away 
one  and  a  half  inch  of  its  shaft.  The  man  was  captured  soon  after  the  reception  of  the  wound 
and  carried  to  hospital  at  Murfreesboro',  where  he  remained  until  August  1,  1863,  when  he 
was  sent  to  the  Prison  Hospital.  According  to  his  statement  no  splints  had  been  applied  to  the 
limb.  On  January  4,  1864,  the  patient  was  admitted  to  Hospital  No.  I,  at  Nashville,  at  which 
time  he  was  very  much  reduced,  even  to  emaciation,  numerous  and  large  abscesses  having 


Fin.  262.— Shot  fracture 
of  upper  third  of  left  tibia. 
Spec.  3549. 


FK  ;.  2t>.">.— -Shot  fracture 
fright  tibia.    Spec.35W. 


• 


FIG.  264.— Shot 

fracture  of  lower     fornie(l  about  the  leg  and  particles  of  bone  being  brought  away  with   the  discharge  from  th 
Spec.  1930. 


Kir,.  265. —  Por 
tions  of  the  bones 
of  the  left  leg,  with 
shot  fract  tire  of 
tibia  at  junction  of 
middle  and  upper 
thirds.  Spec.  2184. 


wound.  The  upper  fragment  of  the  tibia  was  displaced  outward  and  forward,  and  an  interval 
of  about  an  inch  existed  between  it  and  the  lower  fragment.  The  head  of  the  fibula,  too,  was 
displaced  upward  and  outward,  and  the  slightest  motion  of  the  limb  produced  excessive  pain.  The  patient  had  no  appetite; 
stomach  irritable;  pulse  quick  and  weak.  Erysipelas  also  supervened,  and  severe  cough  and  diarrhoea.  The  former  was 
checked  and  the  wound  healed ;  but  the  cough  and  diarrhoea  continued  troublesome  and  persistent.  The  pulmonic  trouble  became 
more  aggravated,  and  the  patient  died  February  15,  1864."  The  bones  of  the  injured  leg,  represented  in  the  annexed  cut  (FlG. 
205\  were  forwarded  to  the  Museum  by  Acting  Assistant  Surgeon  R.  T.  Higgins,  and  a  cast  of  the  limb,  taken  some  weeks  prior 
to  the  patient's  decease,  and  contributed  by  Ass't  Surgeon  C.  J.  Kipp,  U.  S.  V.,  constitutes  specimen  6683  of  the  Surgical  Section* 


SECT.  V.] 


SHOT    FRACTURES    OF    THE    FIBULA    TREATED    BY    < 'OBSERVATION. 


437 


SHOT  i RACTUKES  OF  THE  FIBULA  TREATED  BY  CONSERVATION. — The  results  of  the  injuries 
were  ascertained  in  seven  hundred  and  ninety-nine  of  the  eight  hundred  and  six  cases  of 
this  group.  Seven  hundred- and  twenty-one  recovered  and  seventy-eight  died,  a  mortality 
of  9.7  per  cent. 

Examples  of  Recovery  after  8hot  Fractures  of  the  Fibula  treated  by  Conservation. — 
These  injuries  healed  without  serious  complications;  but  it  would  appear  from  the  records 
of  the  Pension  Office  that  the  movements  of  the  ankle  joint  frequently  remained  impaired: 

CASE  (584. — Private  A.  McPhee,  Co.  B,  16th  New  York,  aged  20  years,  was  wounded  in  the  left  leg,  at  Gaines's  Mill, 
June  27,  1862.  He  was  convoyed  to  hospital  at  Fort  Monroe,  and  several  days  afterwards  to  Philadelphia.  Assistant  Surgeuu 
C.  W.  Horner,  U.  S.  V.,  in  charge  of  Wood  Street  Hospital,  reported:  ''He  was  wounded  l>y  a  ininie  ball,  which  entered  the 
leg  on  its  outside  at  the  middle,  fractured  the  fibula  extensively,  and  passing  downward  made  its  way  to  the  inside  of  the  limb 
below  the  ankle,  where  it  was  retained,  and  whence  it  was  removed  at  the  Pennsylvania  Hospital  about  the  10th  of  July.  He 
was  transferred  to  this  hospital  October  (5th.  His  treatment  consists  of  bandaging,  occasional  poultices,  and  cerate  dressing. 
The  patient  is  progressing  favorably."  He  was  discharged  January  19,  1863,  and  pensioned.  Examining  Surgeon  J.  Cummis- 
kev,  of  Philadelphia,  February  6,  18(53,  certified  to  "elevation  of  the  heel  and  stiffness  of  the  ankle  joint  resulting  from  the 
wound.  He  is  very  lame,  and  obliged  to  carry  a  cane  in  walking."  Examiner  E.  H.  Lesvis,  of  Car 
ver,  Minnesota,  reported,  August  5,  1874:  "At  present  the  lower  or  articulating  portion  of  the  fibula 
is  in  a  process  of  acute  caries:  ankle  joint  anchylosed,  pus  discharging  from  six  sinuses,"  etc.  The 
St.  Paul  Examining  Board  reported,  several  years  afterwards,  that  "the  wound  continually  opens 
and  discharges,  small  pieces  of  bone  escaping.  Cicatrix  large  and  weak;  motion  of  ankle  much 
impaired.  The  greater  toe  is  doubled  under  and  the  tendo-achillis  hampered  by  the  wound."  The 
pensioner  was  paid  March  4,  1880. 

CASE  685. — Corporal  C.  A.  Woodruff,  Co.  A,  10th  Vermont,  aged  19  years,  was  wounded 
through  the  right  leg,  at  Cold  Harbor,  June  3,  1864.  He  was  admitted  to  Mount  Pleasant  Hospital, 
Washington,  four  days  after  the  injury,  and  subsequently  to  Brattleboro'.  On  December  27th,  the 
patient  was  transferred  to  Sloan  Hospital,  Montpeliet*,  whence  Surgeon  H.  Janes,  U.  S.  V.,  contributed 
the  photograph  (FiG.  266),  with  the  following  history:  "The  wound  was  caused  by  a  musket  ball, 
which  entered  about  the  middle  of  the  leg,  on  the  outer  and  posterior  aspect,  passed  forward  and 
emerged  anteriorly  between  the  tibia  and  fibula,  two  inches  below  the  point  of  entrance,  fracturing  the 
fibula.  Several  pieces  of  bone  wrere  removed  at  the  time  of  the  injury.  Gang7-ene  followed,  and  the 
wound  opened  to  the  size  of  an  open  hand.  The  wound  of  entrance  closed  in  April,  1865,  but  that  of 
exit  had  not  healed  at  the  time  of  his  discharge  from  service.  He  was  then  obliged  to  use  a  crutch  in 
walking.  The  patient  also  had  a  congenital  malposition  of  the  heart,  which  he  never  discovered  until 
the  time  of  his  enlistment,  the  location  of  it  being  on  the  right  side,  with  the  apex  beating  under  the 
right  nipple.  His  chest  was  well  formed,  and  he  was  a  stout  and,  excepting  his  wound,  a  healthy 
man."  The  patient  was  discharged  from  service  August  18,  1865,  and  pensioned.  Examiner  G.  B. 
Bullard,  of  St.  Johnsbury,  Vermont,  certified,  on  January  25,  1866,  that  particles  of  bone  were  still 
being  discharged  from  the  wound,  and  the  pensioner  complained  of  stiffness  of  the  ankle  joint,  and 
that  he  was  unable  to  bear  his  weight  on  his  right  foot  or  walk  without  crutches.  He  was  last  paid 
September  4,  1866,  since  when  he  has  not  been  heard  from. 

Fatal  Cases  of  Shot  Fractures  of  the  Fibula  treated  by  Conservation. — Seventy-eight 
cases  are  recorded  in  this  group.  The  fatal  issue  was  frequently  due  to  complications,  as  in 
the  following  instance,  in  which  the  patient  died  with  the  ordinary  symptoms  of  typhoid 
fever  eight  days  after  the  reception  of  the  injury: 

CASE  686.— Sergeant  D.  P.  Spicer,  1st  Iowa  Battery,  was  wounded  in  the  right  leg,  at  Eesaca,  May  15, 1864,  and  admitted 
to  the  field  hospital  of  the  4th  division,  Fifteenth  Corps.  Dr.  J.  M.  Woodworth,  Surgeon  1st  Illinois  Light.  Artillery,  and  Med 
ical  Inspector,  contributed  the  following  report :  "A  gunshot  wound  just  below  the  knee  joint,  fracturing  the  head  of  the  fibula 
and  passing  out  at  the  centre  of  the  lower  border  of  the  popliteal  space.  The  artery  was  not  wounded.  The  subject  was  a 
large,  healthy,  muscular  man,  about  30  years  old.  After  his  admission  to  hospital  the  fragments  of  bone  were  removed,  the 
wound  was  cleansed  and  cold-water  dressing  applied.  The  wound  looked  well  until  the  morning  of  the  18th,  when  it  presented 
a  red  inflamed  margin,  with  tumefaction  of  the  surrounding  soft  parts  and  enlargement  of  the  veins  of  the  thigh.  A  thin 
sunious  discharge  exuded  from  the  opening,  and  the  entire  limb  as  far  as  the  swelling  extended  was  remarkably  hot;  pulse  full 
and  strong.  The  patient  was  separated  from  the  rest  of  the  wounded,  and  his  treatment  was  the  same  as  in  similar  cases.  On 
May  "20th,  the  wounded  limb  was  tensely  swollen  from  tint  ankle  to  the  body.  At  first  the  surface  of  the  inflamed  part  was 
florid,  but  it  became  yellowish  and  mottled  with  greenish-purple  gangrenous  blotches.  It  was  completely  blistered  with  the 
stronger  preparation  of  iodine,  and  kept  imbued  Avith  a  mixture  of  tincture  of  chloride  of  iron,  creasote,  and  tincture  of  iodine 
in  alcohol.  The  patient  was  also  kept  on  a  full  course  of  tonics,  stimulants,  and  generous  diet.  The  disease  or  erysipelatoiia 
inflammation  did  not  extend  further,  but  the  pulse  grew  more  and  more  feeble.  The  patient  became  incoherent  in  mind  and 
sank  steadily,  expiring  on  May  23,  1864.  He  died  with  the  ordinary  symptoms  of  the  more  grave  form  of  typhoid  fever." 


FIG.  266. — Shot  fracture  of 
right  fibula.  [From  a  pho 
tograph.] 


INJURIES    OF 'THE    LOWER    EXTREMITIES.                                             [CHAP.  x. 
SHOT    FRACTURES    INVOLVING    BOTH    BONES    OK    THE    LEG    TREATED    BY    CONSERVATION. The 

shot  fractures  involving  both  bones  of  the  leg,  while  far  less  numerous  than  those  of  the 
tibia  or  of  the  fibula,  largely  exceeded  them  in  fatality,  seventy-five  of  the  three  hundred 
and  seventy  determined  cases  having  resulted  in  death,  a  mortality  of  20.2  per  cent. 

Examples  of  Recovery  after  Shot  Fractures  involving  both  Bones  of  the  Leg  treated 
by  Conservation. — There  were  two  hundred  and  ninety-five  instances  belonging  to  this 
group.  In  nearly  all  the  cases  there  was  more  or  less  shortening  of  the  limb,  and  in  some 
instances  considerable  deformity,  especially  convexity,  but  many  of  the  patients  recovered 
with  useful  limbs: 

CASE  687.— Private  B.  F.  Hayner,  Co.  H,  125th  New  York,  aged  19  years,  was  wounded  at  Gettysburg,  July  3,  1863. 
He  remained  at  the  Second  Corps  Hospital  for  one  month,  when  he  \vns  transferred  to  Camp  Letterman.  Acting  Assistant 
Surgeon  W.  B.  Jones  reported:  "Compound  fracture  of  right  and  left  tibia,  lower  third,  by  a  piece  of  shell,  which  struck  the 
outer  side  of  the  left  leg,  passed  transversely,  and  grazed  the  anterior  aspect  of  the  right  leg.  Cold-water  and  simple  cerate 
dressings  were  used;  splints,  etc.  Union  took  place  in  both  legs,  and  by  September  IMh  the  patient  was  cured,  but  still  unable 
to  walk."  He  was  transferred  to  McKim's  Mansion  Hospital,  Baltimore,  October  2Ikl,  and  subsequently  to  Camden  Street. 
Surgeon  Z.  E.  Bliss,  U.  S.  V.,  in  charge  of  the  latter,  corroborated  the  description  of  the  injury,  and  reported  that  the  fracture 
box  was  used  in  the  treatment  of  both  legs;  also  that  in  April,  1864,  the  wound  of  the  right  leg  had  closed,  while  that  of  the 
left  leg  was  still  unhealed,  there  being  slight  lateral  curvature  in  both  legs;  the  patient  able  to  walk  well  with  the  aid  of  a  cane. 
The  patient  subsequently  passed  through  different  hospitals,  and  on  August  27,  1864,  he  was  returned  to  his  command  in  the 
field.  Being  found  entirely  unfit  for  duty,  he  was  returned  to  hospital  for  treatment  until  June  5,  1865,  when  he  was  mustered 
out  of  service  and  pensioned.  Examining  Surgeon  E.  B.  Bontecou,  of  Troy,  N.  Y.,  reported  April  7,  1875,  that  "the  tibia  and 
fibula  were  both  broken  in  the  right  leg,  and  have  united,  with  some  deformity,  leaving  a  useful  limb.  The  left  leg  has  united 
with  an  outwardlv  curved  deformity,  and  there  remains  some  carious  bone  in  the  tibia,  with  a  h'stulous  opening  and  constant 
discharge,  considerable  tumefaction  and  inflammation  in  the  vicinity  of  the  wound.  There  is  considerable  loss  of  soft  parts, 
leaving  a  long  cicatrix,  and  the  limb  is  lame  in  consequence  of  the  injury."  Substantially  the  same  was  reported  at  subsequent 
examinations.  The  pensioner  was  paid  December  4,  1879. 

CASE  688. — Private  M.  Lynn,  Co.  I,  26th  Pennsylvania,  aged  26  years,  was  wounded  at  Chancellorsville,  May  3,  1863. 
He  was  admitted  to  the  field  hospital  of  the  2d  division,  Third  Corps,  where  Assistant  Surgeon  E.  Marshall,  124th  New  York, 
recorded  "shot  fracture  of  left  leg."  Surgeon  J.  A.  Lidell,  U.  S.  V.,  reported  as  follows:  "The  patient  entered  Stanton  Hos 
pital,  Washington,  June  15th,  with  compound  fracture  of  tibia  and  fibula  at  the  middle  third,  caused  by  a  minie"  ball  entering  at 
the  posterior  and  inner  side  of  the  calf  of  the  leg  and  escaping  in  front.  At  the  time  of  his  admission  the  leg  was  in  a  fracture 
box;  the  wound  suppurated  freely;  patient's  general  condition  good.  Previous  to  his  entrance  to  this  hospital  several  detached 
fragments  of  bone  had  been  removed,  and  a  portion  of  the  bullet  had  also  been  extracted;  subsequently  about  half  a  dozen  more 
fragments  of  bone  were  removed  at  different  times.  Splints  and  water  dressings  were  used.  About  July  1st,  the  fracture  had 
united,  and  one  month  later  there  was  firm  union  of  the  bones  and  the  wound  was  healing  rapidly.  On  September  22d,  the 
patient  received  a  furlough  and  was  allowed  to  go  to  his  home  for  two  months.  The  orifice  of  entrance  healed  about  the  1st  of 
October,  and  before  the  patient  was  transferred  to  Philadelphia,  in  April,  1864,  the  orifice  of  exit  had  also  closed.  The  atrophy 
of  the  wounded  limb  had  disappeared  entirely  and  the  muscles  of  the  leg  acted  freely,  the  patient  being  able  to  walk  well  with 
out  the  aid  of  a  cane  and  without  limping.  There  was  no  shortening,  and  no  deformity  aside  from  some  loss  of  osseous  tissue 
at  the  seat  of  the  fracture.  The  patient  stated  that  the  wounded  limb  had  not  caused  him  to  feel  sick  at  any  time.  He  made 
the  best  recovery  of  any  case  of  shot  fracture  of  the  leg  that  has  come  under  my  observation."  After  his  transfer  the  patient 
was  admitted  to  McClellan  Hospital,  whence  he  was  returned  to  duty  May  31st,  to  be  discharged.  He  was  mustered  out  of 
service  June  18, 1864,  and  pensioned.  The  Philadelphia  Examining  Board  at  different  dates  certified  to  the  injury,  and  reported 
that  an  adherent  cicatrix  resulted,  causing  impaired  use  of  the  limb;  also  that  the  fractured  space  had  filled  with  cartilaginous 
tissue.  The  pensioner  has  been  exempted  from  further  examinations  since  1873.  He  was  paid  December  4,  1879. 

In  the  following  cases  a  longitudinal  incision  was  made  along  the  crest  of  the  tibia, 
and  a  number  of  pieces  of  both  the  tibia  and  fibula  were  removed: 

CASE  689.— Private  S.  McNitt,  Co.  D,  4th  Delaware,  aged  23  years,  was  accidentally  shot  in  the  left  leg,  while  in  camp 
near  Fairfax  Court  House,  October  22,  1863.  Surgeon  D.  S.  Hopkins,  4th  Delaware,  reported:  "The  ball  entered  the  limb 
posteriorly,  at  the  junction  of  the  upper  with  the  middle  third,  passed  directly  through,  causing  a  compound  comminuted 
fracture  of  the  tibia  and  fibula,  and  came  out  anteriorly,  carrying  with  it  fragments  of  bone.  Comparatively  slight  haemorrhage 
ensued,  and  that  principally  of  a  venous  character.  An  examination  showed  that  although  extensive  laceration  of  the  soft  parts 
had  taken  place,  yet  the  arteries  were  found  entire  and  pulsation  at  the  extremities  very  perceptible.  The  leg  was,  therefore, 
placed  in  a  horizontal  position  and  loose  spiculsc  of  bone  were  removed.  Cold-water  dressings  were  applied,  and  the  patient 
was  made  as  comfortable  as  circumstances  would  permit.  Solution  of  morphia,  two  grains  to  an  ounce  of  water,  was  adminis 
tered  at  intervals  of  an  hour  until  the  patient  became  quiet.  Next  morning,  October  23d,  his  system  seemed  to  have  suffered 
but  little  from  the  shock,  he  being  comparatively  comfortable.  More  minute  examination  revealed  the  fact  that  a  number  of 
pieces  of  bone  still  remained  in  the  wound,  which  it  was  deemed  necessary  to  remove.  Accordingly  a  longitudinal  incision  was 
made  along  the  crest  of  the  tibia,  the  patient  being  under  the  influence  of  chloroform,  and  several  spiculsc  of  bone  were  taken 
out  varying  in  length  from  one  to  two  and  a  half  inches.  The  largest,  from  the  crest  of  the  tibia,  included  in  its  thickness  much 


SECT.  V.]         SHOT    FRACTURES    OF    TIBIA    AND    FIBULA    TREATED    BY    CONSERVATION.  439 

of  the  cancellated  structure  of  the  bone,  as  was  the  case  with  each  piece  removed ;  the  average  breadth  was  three-fourths  of  an 
inch.  After  the  fragments  had  been  removed  the  parts  were  coaptated,  the  limb  was  adjusted  in  a  fracture-box,  and  cold-water 
dressings  were  reapplied.  The  patient  was  comparatively  comfortable  during  the  night."  Some  months  after  the  reception  of 
the  injury  the  patient  was  admitted  from  the  field  into  hospital  at  Alexandria,  and  lastly  he  was  transferred  to  Tilton  Hospital, 
Wilmington,  where  he  was  discharged  June  19,  1835,  Surgeon  E.  I.  Baily,  U.  S.  A.,  certifying  to  the  shot  fracture  resulting 
in  "  necrosis  and  shortening  of  the  leg."  The  Wilmington  Examining  Board,  in  describing  the  injury,  December  f>,  1871, 
reported:  "Large  and  irregular  cicatrices  in  front  and  rear  of  the  limb;  unnatural  condition  of  skin  ;  shortening  of  leg  by  an 
incli  and  a  half.  On  account  of  occasional  suppuration  and  exfoliation  the  limb  has  become  much  weakened  and  the  convexity 
of  it  more  marked.  The  disability  is  permanent  in  its  present  degree."  After  another  inspection  two  years  later  the  pensioner 
was  exempted  from  further  examinations.  He  was  paid  September  4,  1880. 

In  the  next  case  a  sequestrum  nine  inches  and  a  half  in  length  was  removed.  New 
bone  of  sufficient  thickness  had  formed  to  hold  the  limb  in  its  normal  position.  The  patient 
died,  nine  years  after  the  reception  of  the  injury,  of  dropsy: 

CASE  G90. — Lieutenant  C.  G.  Martyn,  Co.  A,  2d  New  York  Heavy  Artillery,  aged  29  years,  was  wounded  at  Deep  Bot 
tom,  August  14,  1834,  and  entered  Armory  Square  Hospital,  Washington,  three  days  afterwards.  Assistant  Surgeon  C.  A. 
Leale,  U.  S.  V.,  contributed  the  pathological  specimen  (FiG.  267),  and  the  following  history  of  the  case:  ''He  was  wounded  by 
a  mini6  ball,  which  entered  the  right  leg  between  the  tibialis  anticus  and  extensor  longus  digitorum  muscles,  opposite  the  centre 
of  the  middle  third  of  the  tibia,  passed  through  the  leg  transversely,  fracturing  the  tibia  and  fibula,  and  made  its  exit  at  the 
anterior  lateral  aspect  of  the  soleus  muscle.  Immediately  after  the  reception  of  the  injury  the  patient  was  removed  to  a  field 
hospital,  and  on  the  following  day  he  was  placed  under  the  influence  of  chloroform,  when  several  spiculae  of  bone  were  removed. 
Splints  were  then  applied,  and  he  was  transferred  to  Washington,  where  the  wound  was  dressed  and  the  limb 
placed  in  a  fracture-box.  The  general  condition  of  the  patient  at  that  time  was  good.  On  account  of  great  pain 
the  fractuT-e-box  was  removed  on  October  7th,  and  Smith's  anterior  splint  was  adjusted,  which  allowed  the  patient 
to  rest  more  comfortably.  On  November  1st  the  splints  were  removed,  and  the  limb  was  laid  on  a  pillow  and 
dri-ssed  twice  a  day  with  simple  dressings.  The  wound  had  now  nearly  closed,  but  several  sinuses  existed  and 
communicated  with  the  bone,  and  the  fracture  had  not  yet  united.  By  March  16,  1865,  the  patient  was  able  to 
leave  his  bed  and  walk  on  crutches.  He  first  came  under  my  charge  on  April  1st,  when,  on  an  examination  with 
the  probe,  I  found  the  sinuses  to  communicate  with  dead  bone;  the  discharge  of  pus  was  about  three  ounces  per 
diem;  appetite  and  general  condition  good.  The  discharge  continuing  to  increase  and  the  patient  gradually  grow 
ing  weaker,  he  was  placed  under  the  influence  of  ether  on  April  25th,  and  an  incision  was  made  nine  inches  in 
length  over  the  anterior  portion  of  the  tibia,  when  it  was  found  that  necrosis  extended  to  within  two  inches  of  the 
ankle  joint  and  nearly  to  the  head  of  the  tibia.  A  sequestrum  nine  and  a  half  inches  long  was  then  removed,  also 
several  small  pieces,  and  in  the  operation  a  longitudinal  piece  of  newly  formed  bone  had  to  be  withdrawn.  After 
the  removal  of  the  necrosed  portion,  new  bone  was  found  of  sufficient  thickness  to  hold  the  foot  in  its  proper  posi 
tion.  The  loss  of  blood  during  the  operation  amounted  to  about  ten  ounces.  The  wound  was  dressed  with  charpie 
and  cold  water,  and  the  patient  took  stimulants  and  an  anodyne  every  four  hours.  On  the  next  day  he  was  very 
weak  and  had  continued  nausea,  no  appetite,  and  vomited  all  food  as  soon  as  swallowed,  not  being  able  to  retain 
brandy  even,  which  increased  the  nausea.  Two  ounces  of  beef  tea  was  then  given  every  four  hours>  but  it  also 
was  nearly  all  thrown  off.  On  April  27th,  he  was  still  weaker  and  the  nausea  continued,  when  two  ounces  of  '& 

champagne  with  ice  was  administered  every  four  hours,  and  four  ounces  of  beef  tea,  per  enema,  was  given  three  ge^ue8tnim~94 
times  a  day.  This  was  continued  for  two  days,  when  the  patient  had  a  well-marked  chill  and  was  sinking  fast,  ins.  long,  from 
his  nausea  having  increased  to  such  an  extent  that  the  sight  of  other  patient's  food  caused  him  to  vomit.  On  April  ^"^439! 
30th.  he  was  worse  in  every  respect,  when  doses  of  five  grains  of  oxalate  of  cerium  was  ordered  to  be  given  when 
ever  the  patient  felt  as  though  he  would  immediately  vomit.  By  9  o'clock  P.  M.  he  had  used  six  powders,  not  having  vomited 
once  since  taking  the  first,  and  having  retained  food  eaten  at  noon.  The  champagne  and  beef  tea  were  continued.  By  May  6th 
great  improvement  was  noticed,  and,  there  being  no  nausea  or  vomiting,  the  powders  were  discontinued.  The  Avound  was  now 
granulating  finely,  and  the  discharge  consisted  of  perfectly  healthy  pus.  About  June  25th,  the  patient  could  leave  his  bed  and 
sit  in  a  chair,  the  cavity  having  nearly  filled  and  the  wound  being  healthy  and  reduced  to  about  half  the  size  of  the  incision.  He 
had  perfect  use  of  the  ankle  joint  and  the  tibialis  anticus  muscle,  and  there  was  all  probability  of  a  very  useful  limb.  By  July 
15th,  he  could  bear  considerable  weight  on  the  injured  leg.''  The  patient  was  subsequently  transferred  to  Douglas  Hospital, 
where  he  was  discharged  from  service  by  special  order  of  the  War  Department,  October  13,  1865.  In  his  publication1  of  the 
case  Dr.  Leale  mentioned  Surgeon  D.  W.  Bliss,  U.  S.  V.,  as  the  operator,  and  added  that  he  saw  the  patient  again  just  before  he 
left  Douglas  Hospital,  at  which  time  the  limb  was  in  a  healthy  condition  and  the  wound  had  nearly  closed,  leaving  three  small 
openings,  which  were  prevented  from  closing  by  the  great  tension  on  the  newly  formed  integuments.  There  was  also  slight 
contraction  of  the  tendo-achillis,  which  could  be  easily  overcome,  although  every  possible  care  had  been  taken  to  guard  against 
that  result.  The  patient's  name  was  subsequently  admitted  on  the  Pension  Rolls,  and  afterwards  he  obtained  employment  in  the 
New  York  City  Custom  House.  Dr.  G.  K.  Smith,  of  Brooklyn,  May  11,  1874,  certified  that  the  patient,  after  receiving  his  dis 
charge  from  service,  entered  Bellevue  Hospital,  New  York  City,  where  "Professor  J.  K.  Wood  performed  an  operation  on  his 
leg,  cutting  the  tendo-achillis,  and,  I  think,  he  also  removed  a  large  portion  of  the  fractured  bone.  The  wound  healed  in  1866, 
but  soon  broke  open  again,  and  continued  to  discharge  until  the  month  of  June,  1873,  when  it  finally  healed.  After  leaving 
Bellevue  Hospital  he  came  under  my  care,  and  though  his  health  was  feeble,  he  performed  his  duties  at  the  Custom  House,  with 
occasional  loss  of  time,  until  the  wound  healed,  in  June,  1873.  From  that  date  his  health  failed  rapidly.  His  liver  began  to 

1  LEALE  (C.  A.),  Extensive  Necrosis  of  the  Shaft  of  the  Tibia  following  Gunshot  Fracture  of  the  Bone,  in  United  States  Sanitary  Commission 
Memoirs,  Surgical  Volume  I,  New  York,  1870,  p.  492. 


440  INJURIES    OF   THE    LOWER    EXTREMITIES.    -  [CHAP.  X. 

increase  in  size,  the  heart  became  irregular  in  its  action,  respiration  difficult  and  circulation  very  feeble.  At  length  dropsy  set 
in,  and  he  died  December  1,  1873.  An  external  examination  showed  the  liver  to  be  nearly  twice  its  normal  size,  and  I  have  no 
doubt  that  death  was  caused  by  a  waxy  degeneration  of  the  liver,  the  result  of  the  shot  fracture." 

CASE  691. — Captain  E.  Bernard,  Co.  I,  Goth  New  York,  aged  29  years,  received  a  gunshot  wound  through  the  left  leg 
just  below  the  knee,  fracturing  the  tibia  and  fibula,  at  Malvern  Hill,  July  1,  1862.  He  was  conveyed  to  Harrison's  Landing, 
and  thence  by  steamer  to  Fort  Monroe.  From  there  he  proceeded  to  his  home  in  New  York  City,  where  he  obtained  the  profes 
sional  attendance  of  Dr.  L.  A.  Sayre,  who  subsequently  furnished  the  following  report  of  the  case:  ''I  was  called  to  see  Captain 
Bernard  on  July  12th,  when  he  had  just  arrived  from  Fort  Monroe,  and  was  supposed  to  be  in  a  dying  condition  from  septicasmia. 
Many  surgeons  who  had  seen  him  at  Harrison's  Landing  and  Fort  Monroe  had  all  advised  amputation  of  the  wounded  limb.  The 
leg  had  become  about  two  and  a  half  inches  shorter  than  the  other  and  very  much  twisted  on  its  axis.  Extensive  suppuration 
extended  up  the  thigh  and  down  the  leg,  both  openings  having  been  hermetically  sealed  with  closely  packed  lint,  which,  when 
soaked  off,  caused  the  escape  of  a  greater  amount  of  imprisoned  pus  than  I  have  ever  seen  from  a  single  wound.  Mingled  in 
the  pus  there  was  also  a  large  quantity  of  very  finely  broken  tip  and  macerated  bone,  and  over  the  tubercle  of  the  tibia  a  loose 
fragment  was  detected  which,  when  cut  down  upon,  escaped,  having  the  appearance  of  a  polished  metal,  like  a  silver  sixpence, 
and  the  shape  of  a  hollow  segment  of  a  robin's  egg.  This  fragment,  which,  before  extracting,  I  had  suspected  to  be  a  loose 
piece  of  bone,  the  patient  declared  to  be  'the  end  of  an  explosive  ball.'  His  thigh' at  this  time  was  so  infiltrated  with  pus  as  to 
make  amputation  hazardous.  I  therefore  made  free  incisions  for  its  escape  and  drainage,  and  treated  the  limb  by  extension  and 
plaster-of-paris,  using  adhesive  plaster,  weight  and  pulley  over  the  foot  of  the  bed,  which  was  elevated  to  make  the  body  act  as 
a  counter-extending  force.  Several  large  fragments  of  bone,  having  been  macerated  in  the  pus  so  long,  were  subsequently  easily 
picked  out  without  removing  the  periosteum.  He  made  a  very  satisfactory  recovery  with  but  very  little  shortening,  although 
there  must  have  been  more  than  an  inch  of  entire  bone  removed.  There  is  still  (1874)  a  small  piece  of  dead  bone  remaining, 
which,  however,  gives  uo  trouble  as  long  as  he  wears  the  tent  to  keep  up  the  drainage.  Whenever  he  leaves  this  out  and  the 
wound  closes,  he  becomes  sick  until  the  discharge  again  takes  place.  I  have  been  anxious  to  remove  the  diseased  part,  but  he 
can  never  find  time  for  that  purpose,  having  to  work  constantly  for  his  living  and  being  too  poor  to  lay  up  for  the  operation." 
The  New  York  City*  Examining  Board,  on  October  1,  1877,  reported  the  sinus  leading  to  dead  bone  as  still  open,  having  never 
ceased  to  discharge,  and  requiring  constant  dressing.  Captain  Bernard  obtained  his  discharge  from  service  October  '22,  1863, 
and  has  since  become  a  pensioner.  He  was  paid  September  4,  1880. 

In  a  number  of  cases  of  recovery  after  shot  fracture  of  both  bones  of  the  leg,  the  knee 
joint  or  the  ankle  joint  or  both  became  partially  or  totally  anchylosed: 

CASE  692. — Major  A.  J.  Bolar,  12th  Pennsylvania  Reserves,  aged  31  years,  was  wounded  in  both  legs  and  captured  at 
Fredericksburg,  December  13,  1862.  After  remaining  a  prisoner  some  weeks  he  was  exchanged  and  conveyed  to  Annapolis, 
where  he  was  admitted  to  hospital  on  February  '21,  1863.  Acting  Assistant  Surgeon  J.  H.  Longnecker  reported :  "  This  officer 
was  wounded  in  the  left  leg  by  a  round  ball  entering  three  inches  below  the  knee  joint  and  fracturing  the  fibula ;  also  by  a  buck 
shot  in  the  same  locality  and  a  mini6  ball  entering  the  external  upper  third  of  the  leg.  There  was  compound  fracture  of  both 
the  tibia  and  fibula.  The  ball  has  never  been  found,  and  is  supposed  to  have  lodged  in  the  muscular  part  of  the  leg.  The  right 
leg  was  also  wounded  by  a  mini6  ball  entering  at  the  outer  tuberosity  and  passing  under  the  patella.  At  the  time  of  admission 
the  wound  of  the  right  leg  was  open  and  discharging.  On  September  9th,  when  the  patient  was  put  under  my  care,  it  had 
closed  and  there  was  anchylosis  of  the  knee  joint.  The  left  leg  was  very  much  swollen  and  inflamed,  there  being  two  angry 
looking  ulcers  about  three  or  four  inches  below  the  knee  joint,  with  a  tendency  to  sloughing.  The  patient's  general  health  was 
good.  Charcoal  poultices  were  ordered,  to  be  renewed  twice  a  day.  On  September  21st,  fiaxseed  was  substituted  for  the 
charcoal,  the  wound  looking  more  healthy  and  granulating,  with  not  so  much  swelling  or  redness,  and  the  pain  less  acute.  On 
October  1st,  two  small  fistulous  openings  remained,  discharging  a  thin,  sanious,  arid  offensive  ichor  with  small  parts  of  decayed 
bone,  which  were  injected  with  a  mixture  of  opodeldoc  and  sweet  oil  twice  a  day.  By  November  1st,  the  discharge  was  much 
less  and  of  a  better  quality,  the  leg  of  natural  size,  and  the  patient  able  to  walk  much  easier  with  the  aid  of  crutches.  About 
December  1st,  there  was  still  slight  discharge,  the  pus  being  mixed  with  small  black  particles,  indicating  exfoliation.  Gradual 
improvement  continued,  and  one  month  later  the  patient  was  able  to  walk  by  the  support  of  a  cane."  He  was  honorably  dis 
charged  from  service  January  30,  1864,  and  subsequently  entered  the  Veteran  Reserve  Corps,  being  ultimately  mustered  out 
June  6,  1865,  and  pensioned.  Examining  Surgeon  G.  R.  Lewis,  of  Indiana,  Pennsylvania,  certified,  February  8,  1867:  "The 
pensioner  was  wounded  in  the  left  leg  by  several  balls,  one  being  still  unremoved.  The  wound  is  still  discharging  and  requires 
to  be  dressed  daily.  He  was  also  wounded  in  the  right  knee,  the  ball  lodging.  Complete  anchylosis  resulted."  On  September 
21,  1875,  the  same  Examiner  reported :  "The  ball  in  the  left  leg  has  not  been  removed  and  the  wound  still  discharges,  etc. 
There  is  partial  stiffness  of  the  knee  joint,  and  he  is  totally  disabled  for  manual  labor."  Examiner  M.  L.  Miller,  of  Blairsville, 
Pennsylvania,  September  4,  1877,  certified  to  the  injuries  and  added:  "There  has  been  much  muscular  waste  and  tenderness  of 
the  parts  (left  leg),  and  there  is  discharge  of  offensive  matter  from  the  place  of  injury,  requiring  daily  dressing."  The  pensioner 
was  paid  September  4,  1880. 

CASE  693. — Assistant  Surgeon  A.  H.  Laridis,  35th  Ohio,  aged  39  years,  was  wounded  near  Kenesaw  Mountain,  June  22, 
1864,  by  a  twelve-pound  solid  shot,  which,  after  hitting  a  tree  and  bounding  off,  struck  his  right  leg,  causing  fracture  but  not 
breaking  the  skin.  Surgeon  F.  D.  Morris,  of  the  regiment,  reported  that  the  missile  fractured  both  bones  of  the  limb  midway 
between  the  knee  and  the  ankle,  and  that  the  soft  parts  were  much  contused.  The  patient  was  admitted  to  the  field  hospital  of 
the  3d  division,  Fourteenth  Corps,  where  he  received  a  leave  of  absence  on  the  following  day.  He  was  mustered  out  of  service 
September  27,  1864,  and  pensioned.  Examining  Surgeon  J.  S.  McNeeley,  of  Hamilton,  Ohio,  certified,  October  31,  1865: 
"The  leg  was  struck  at  the  posterior  part  of  the  middle  third,  fracturing  both  the  tibia  and  fibula  and  lacerating  the  gastrocne- 
mius  and  soleus  muscles.  The  resulting  cicatrices  have  formed  adhesions  to  the  adjacent  parts,  entirely  destroying  their  action. 
In  adjusting  the  fracture  complete  apposition  was  not  attained,  and,  from  extension  of  inflammation,  there  is  partial  anchylosis 


SECT,  v.]          SHOT    FRACTURES    OF    TIBIA    AND    FIBULA    TREATED    BY    CONSERVATION.  441 

of  both  kuee  and  ankle  joints,  rendering  locomotion  Loth  painful  and  difficult."     Subsequent  examiners  report  no  additional 
information.     The  pensioner  was  paid  September  4,  1879. 

Both  bones  of  the  left  leg  as  well  as  of  the  left  forearm  were  fractured  in  the  next  case. 
The  arm  was  amputated  at  the  middle  third,  but  the  patient  was  so  utterly  prostrated  that 
amputation  in  the  leg  was  deemed  inadvisable: 

CASE  694. — Sergeant  J.  McLeer,  Co.  C,  84th  New  York,  aged  23  years,  was  wounded  by  a  shell  in  the  left  arm  and  left 
leg,  at  Bull  Run,  August  29,  1862.  He  entered  Mount  Pleasant  Hospital,  Washington,  several  days  afterwards.  Assistant 
Surgeon  C.  A.  McCall,  U.  S.  A.,  in  charge,  describes  the  injury  of  the  arm  as  a  compound  comminuted  fracture  of  the  radius, 
ulna,  and  elbow  joint,  and  that  of  the  leg  as  a  fracture  of  the  tibia  and  fibula,  lower  third,  and  reports:  "On  or  about  the  2d  of 
September  I  amputated  the  arm  at  the  middle  third  (Second  Surgical  Volume,  TABLE  LXXVIII,  p.  765,  No.  167),  and  would 
have  also  amputated  the  leg,  but  that  the  utter  prostration  of  the  patient  threatened  death  upon  further  surgical  procedure. 
Operating  on  the  leg  was  therefore  left  to  a  future  time;  but  as  symptoms  of  promise  developed  themselves  afterwards,  an  efi'ort 
was  made  to  save  the  leg,  which,  after  long  and  critical  treatment,  was  successful,  although  the  limb  was  left  somewhat  shortened 
and  to  a  considerable  extent  unfit  for  useful  progression.  The  case  was  one  of  singular  interest  to  myself  and  staff,  proving  as 
,  it  did  the  wonderful  endurance  of  the  human  system  and  the  almost  strained  limit  to  which  conservative  surgery  may  trust 
nature.  It  had  been  looked  upon  and  classed  by  me  as  an  excision  of  the  lower  portion  of  both  bones  of  the  leg:  for  though 
no  special  operation  was  performed,  yet  I  know  I  was  over  half  an  hour  cleaning  out  the  broken  fragments  and  adjusting 
loosened  spiculse  before  trusting  it  to  the  fracture-box."  In  a  published  account  of  the  case1  it  is  mentioned  that,  under  a  tonic 
and  stimulant  treatment  and  the  application  of  simple  absorbent  dressings  to  the  parts,  the  stump  of  the  arm  healed  rapidly. 
The  patient  was  discharged  from  service  July  27,  1863,  and  pensioned.  On  September  22,  1880,  he  was  examined  by  the 
Brooklyn  Pension  Board,  who  certified  to  the  loss  of  his  left  arm  and  added:  "There  is  evidence  of  a  compound  comminuted 
fracture  of  the  tibia  and  fibula  of  the  left  leg  in  the  lower  third.  Portions  of  both  bones  were  removed.  The  cicatrices  of 
entrance  and  exit  of  the  missile  are  found  upon  the  internal  and  anterior  aspects  of  the  part.  In  the  latter 'situation,  over  the 
tibia,  a  firmly  adherent  cicatrix,  three  inches  long  by  one  inch  wide,  is  present.  The  leg  is  bowed  outward  to  a  very  marked 
degree,  the  fibula  being  very  prominent  and  thickened.  There  is  shortening  of  the  limb  of  about  one  inch.  The  extensor 
tendons  are  not  full  in  their  movements,  being  partially  bound  down  by  cicatricial  tissue,  and  the  ankle  is  somewhat  stiffened 
and  restricted  in  its  motion.  The  great  toe  is  not  supple,  since  the  plantar  tendons  are  somewhat  contracted.  Altogether  the 
objective  signs  show  that  the  original  Avound  was  of  the  most  severe  character.  In  manual  labor,  walking,  standing,  etc.,  the 
member  would  speedily  become  the  seat  of  great  swelling  and  pain,  as  is  the  case  after  any  unusual  exercise." 

Fatal  Cases  of  Shot  Fractures  of  both  Bones  of  the  Leg  treated  by  Conservation.- — Of 
the  seventy-five  instances  of  shot  fractures  of  the  tibia  and  fibula  with  fatal  issues  three 
will  be  detailed: 

CASE  695. — Private  G.  F.  Skinner,  Co.  H,  6th  Maine,  aged  30  years,  was  wounded  at  Chancellorsville,  May  3,  1863, 
and  admitted  to  Douglas  Hospital,  Washington,  five  days  afterwards.  Assistant  Surgeon  C.  C.  Lee,  U.  S.  A  ,  reported:  "This 
man  suffered  a  comminuted  fracture  of  the  left  leg  from  a  musket  ball,  which  entered  one-half  inch  internally 
to  the  spine  of  the  tibia,  passed  through  antero-posteriorly,  and  emerged  at  a  corresponding  point  at  the 
back  of  the  leg.  Much  contusion  and  ecchymosis  existed  at  the  time  of  his  admission  to  the  hospital,  and 
but  for  the  high  state  of  inflammatory  action  then  existing  the  leg  would  have  been  removed.  The  limb 
was  then  placed  in  a  fracture-box  filled  with  bran,  and  covered  with  water  dressings;  nutrients  and  stimu 
lants  were  given  freely.  No  change  was  perceptible  until  the  morning  of  May  16th,  when  the  foot  and  leg 
were  found  in  a  state  of  advanced  gangrene.  To  show  how  rapidly  this  condition  supervened  it  is  only 
necessary  to  state  that  a  most  careful  examination  during  the  previous  evening  failed  to  reveal  anything  of 
the  kind,  the  patient  in  all  respects  seeming  as  well  as  usual.  By  the  next  morning  this  condition  of  the 
leg  was  rapidly  extending  up  the  thigh,  the  soft  tissues  of  which  became  boggy  and  crepitant;  the  patient 
being  bathed  in  clammy  sweats,  and  his  circulation  so  depressed  that  the  pulse  was  imperceptible  at  the 
wrist,  though  at  the  groin  it  was  160  per  minute.  At  the  same  time  the  patient's  spirits  were  not  at  all 
depressed,  and  he  could  hardly  believe  he  was  in  any  danger.  His  prostration  was  such  that  amputation 
was  deferred ;  but  the  most  energetic  stimulation  failed  to  bring  his  condition  into  one  of  sufficient  reaction 
to  bear  the  operation.  He  gradually  sank,  and  died  at  2  o'clock  on  the  morning  of  May  17,  1863.  At  the 
autopsy,  the  internal  organs  were  discovered  to  be  generally  healthy.  The  bone  was  found  to  be  exten 
sively  comminuted,  with  a  portion  of  the  bullet  lying  upon  the  lacerated  and  obliterated  posterior  tibial 
vessels,  thus  probably  furnishing  the  main  cause  of  the  gangrene.  No  secondary  abscesses  were  found, 
and  it  was  concluded  that  the  patient  had  died  in  the  primary  stage  of  blood  poisoning."  The  upper  halves 
of  the  injured  bones,  showing  a  transverse  fracture  of  the  fibula  and  comminution  of  the  tibia,  with  the  bat-  left  tibia  and  fibula, 
tered  bullet  attached,  were  contributed  to  the  Museum  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  and  are 
shown  in  the  annexed  cut  (FlG.  268). 

CASE  696.— Private  J.  Bailey,  Co.  B,  211th  Pennsylvania,  aged  29  years,  was  wounded  at  Petersburg,  April  2,  1865. 
Surgeon  A.  F.  Whelan,  1st  Michigan  Sharpshooters,  reported  his  admission  to  the  field  hospital  of  the  3d  division,  Ninth  Corps, 
with  "Canister  shot  fracture  of  right  leg."  Surgeon  E.  Bentley,  U.  S.  V.,  recorded  the  result  of  the  injury  as  follows:  "The 

'CoUEiS  (ELLIOTT),  Report  of  some  Cases  of  Amputations  and  Resections  from  Gunshot  Wounds,  performed  at  the  Mount  Pleasant  U.  S.  General 
Hospital  by  C.  A.  McCALL,  M.  D.,  U.  S.  A.,  in  Medical  and  Surgical  Reporter,  New  York,  186-2-3,  Vol.  IX,  p. -229. 

SURG.  Ill— 56 


442  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

man  was  admitted  to  Slough  Hospital,  Alexandria,  four  days  after  receiving  his  wound.  The  tibia  and  fibula  were  badly  shat 
tered.  Cold-water  dressings  were  employed,  and  tonics  and  stimulants  were  freely  administered,  together  with  all  the  nourish 
ment  the  patient  would  take.  He  died  May  2,  ISoo,  from  the  severity  of  suppurutive  inflammation  of  the  wound.  The  autopsy 
showed  the  tibia  to  be  comminuted  for  several  inches  at  the  upper  third  and  the  fibula  fractured  at  the  lower  third,  no  union 
having  taken  place.  The  wound  was  gangrenous." 

In  the  following  instance  of  lesion  of  both  bones  of  the  leg  in  the  middle  third,  osteo 
myelitis  of  the  medulla  of  the  femur  was  noted  at  the  autopsy.  The  upper  and  lower 
thirds  of  the  tibia  were  found  upon  opening  to  be  quite  healthy : 

CASE  697.— Musician  G.  H.  Potter,  Co.  E,  60th  Ohio,  aged  14  years,  was  wounded  in  the  right  leg,  before  Petersburg, 
July  16,  1864.  Surgeon  P.  A.  O'Connell,  U.  S.  V.,  recorded  the  following  description  of  the  injury  at  the  field  hospital  of  the 
3d  division,  Ninth  Corps:  "A  ball  entered  the  outer  side  of  the  limb  about  the  upper  third  of  the  fibula;  exit  below  on  anterior 
aspect,  gouging  tibia  and  fibula."  The  wounded  man  was  conveyed  to  the  Depot  Hospital  ;it  City  Point  the  day  after  the  injury, 
and  one  week  later  he  was  transferred  to  Fairfax  Seminary  Hospital.  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  in  charge  of  the 
latter,  made  the  following  report:  "On  entering  the  hospital  the  lad  was  in  fine  spirits,  though  somewhat  anaemic;  wound  look 
ing  well.  On  August  5th,  the  wound  assumed  an  indolent  appearance  and  the  discharge  became  greater  and  more  fetid.  Bro 
mine  was  thoroughly  applied  in  the  ordinary  way  and  at  first  checked  the  progress  of  the  disease.  But  the  patient  appeared  to 
have  no  recuperative  energy  and  a  tendency  to  subcutaneous  sloughing  was  evinced,  which,  by  the  12th  of  August,  had  increased 
BO  far  as  to  necessitate  the  slitting  up  of  the  integuments  and  a  second  rigorous  application  of  bromine.  It  was  observed  during 
the  operation  that  the  tibia  was  exposed  and  a  superficial  area  of  bone  was  being  thrown  off.  The  patient  was  exceedingly 
irritable,  appetite  capricious.  The  wound  still  presented  a  gluing  and  unhealthy  appearance,  and  the  tendency  to  undermining 
continued  in  spite  of  all  efforts  to  check  it.  The  patient  gradually  sank.  By  September  15th,  violent  and  persistent  vomiting 
came  on,  and  from  this  time  until  the  date  of  his  death,  September  '2(5,  1834,  he  was  almost  entirely  sustained  by  beef  tea  encmata. 
He  had  no  chills  and  no  discoloration  of  skin,  and  his  mind  at  all  times  was  clear.  Autopsy:  emaciation  extreme;  limb  not 
much  swollen;  foot  somewhat  ocdematous;  ulcer  extending  from  four  inches  below  the  knee  to  the  ankle  joint;  femoral  vein 
healthy;  internal  organs  all  healthy  except  the  liver,  which  was  exceedingly  fatty.  The  outer  surface  of  the  tibia  at  the  middle 
third  was  dead  and  much  blackened  from  the  action  of  the  vapor  of  the  bromine,  and  the  living  bone  around  its  borders  was 
covered  with  several  roughened  spiculae  of  bone.  Upon  opening  the  tibia  the  upper  and  lower  thirds  were  found  to  be  quite 
healthy,  but  the  middle  third  was  the  seat  of  varied  diseased  action.  The  walls  at  this  point  were  partially  necrosed,  of  a 
greyish  slate  color,  roughened,  and  so  thin  that  at  one  point  they  appeared  to  be  nearly  destroyed.  The  medullary  substance  at 
this  place  was  shrunken,  of  £l  blackish  grey  color,  and  closely  adherent  to  the  posterior  and  lateral  walls  of  the  cavity.  No 
new  deposit  of  bone  was  seen.  The  tissues  both  above  and  below  this  point  had  taken  on  active  efforts  of  repair.  The  cavity 
of  the  medulla  was  much  contracted  by  delicate  cancelli  extending  from  either  side,  and  the  original  walls  of  the  cavity  for  the 
extent  of  a  full  inch  either  way  were  vascular  and  thickened.  The  medulla  lying  in  the  diminished  calibre  of  canal  was  of  a 
lively  red  color,  filled  with  blood,  and  presented  all  the  appearance  of  a  highly  nourished  medium.  As  above  observed,  no 
inflammation  was  noticed  in  either  extremity  of  the  affected  bone.  Upon  examination  of  the  femur  an  interesting  appearance 
was  presented.  The  walls  of  the  bone  were  much  thickened  and  dotted  with  reddish  spots;  the  enlarged  nutritious  arteries  and 
the  periosteum  were  also  thickened,  vascular,  and  easily  detached.  When  the  bone  was  opened  the  upper  two-thirds  of  the 
medulla  were  found  to  be  acutely  inflamed,  which  as  usual  was  more  intense  towards  the  neck  of  the  bone  than  elsewhere." 
The  tibia  and  fibula  of  the  injured  leg,  contributed,  with  the  history,  by  Dr.  Allen,  constitute  specimen  2G33  of  the  tiuryical 
Section  of  the  Museum.1 

The  precise  seat  of  the  bony  lesion  was  not  indicated  in  seven  hundred  and  eighty-six 
of  the  three  thousand  nine  hundred  and  eighty-eight  cases  of  shot  fractures  of  the  bones 
of  the  leg  treated  by  conservation.  The  results  in  sixty-nine  of  these  cases  were  not 
ascertained;  five  hundred  and  forty-three  patients  recovered  and  one  hundred  and  seventy- 
four  died,  a  mortality  of  24.2  per  cent. 

An  analysis  of  the  cases  of  shot  fracture  of  the  bones  of  the  leg  treated  by  conserva 
tion  indicates  that  pyaBrnia  was  noted  in  eighty-one  instances  (six  recoveries  and  seventy- 
five  deaths),  gangrene  in  seventy  (forty  recoveries,  thirty  deaths),  tetanus  in  twenty-four 
(two  recoveries,  twenty-two  deaths),  erysipelas  in  forty-five  (thirty-five  recoveries,  ten 
deaths),  and  in  three  hundred  and  forty-seven  cases  (two  hundred  and  ninety-nine  recov 
eries,  forty-two  deaths,  and  six  undetermined  results)  fragments  of  bone  or  sequestra  were 
removed.  Secondary  haemorrhage  is  reported  in  sixty-five  instances  (twenty-four  recov 
eries,  forty-one  deaths),  and  in  twenty-six  instances  ligation  of  the  tibial,  popliteal  or  fem 
oral  arteries  were  performed,  viz:  ligation  of  anterior  tibial  artery  in  five  (three  recoveries, 
two  deaths);  of  anterior  tihial  and  popliteal  in  one  (fatal);  of  anterior  and  posterior  tibials 

1  ALLKX  (II.),  Remarks  on  the  Pathological  Anatomy  of  Osteomyelitis,  with  Cases.     Gunshot  Wound  of  the  Rigid  Leg  ,-  phagedcna  ;  no  pytemia  ; 
in  American  Journal  ilediail  Sciences,  18G5,  Vol.  XLJX,  N.  S.,  p.  44. 


SECT,  v.l         SHOT    FRACTURES    OF   TIBIA    AND    FIBULA    TREATED    BY    CONSERVATION. 


443 


in  one  (fatal);  of  posterior  tibial  in  eight  (five  recoveries,  three  fatal);  of  -  -  tibial  in  one 
(fatal);  of  popliteal  in  five  (two  recoveries,  three  fatal);  and  of  femoral  in  five  (two  recoveries 
and  three  fatal).  Details  of  the  five  cases  of  ligation  of  the  femoral  artery  are  adduced: 

CASE  698 — Private  J.  W.  Moore,  Co.  I,  13th  Mississippi,  aged  23  years,  was  wounded  and  captured  at  Gettysburg, 
July  2,  1863.  Surgeon  H.  Janes,  U.  S.  V.,  reported:  "Compound  fracture  of  right  leg,  middle  third.  Haemorrhage  from  the 
posterior  tibial  artery  occurred  to  the  amount  of  one  pint  daily  from  July  12th  to  July  17th,  when  the  femoral  artery  was  ligated 
in  the  continuity."  The  patient  recovered,  and  was  transferred  to  Baltimore  October  15th,  the  wound  having  entirely  healed. 
Surgeon  T.  H.  Bache,  U.  S.  V.,  reported  that  he  was  paroled  from  West's  Building  Hospital,  and  sent  south  November  12,  18G3. 

CASE  699. — Corporal  P.  Lahany,  Co.  G,  5th  Vermont,  aged  21  years,  was  wounded  at  Petersburg,  April  2,  1865,  and 
admitted  to  the  field  hospital  of  the  2d  division,  Sixth  Corps,  where  Surgeon  S.  F.  Chapin,  139th  Pennsylvania,  recorded:  "Shot 
fracture  of  left  leg."  Surgeon  D.  P.  Smith,  U.  S.  V.,  reported  the  wounded  man's  entrance  into 
Fairfax  Seminary  Hospital,  April  6th,  with  "  Shot  fracture  of  left  fibula,"  but  made  no  record  of  any 
surgical  treatment  in  the  case.  On  May  30th,  the  patient  was  transferred  to  Baxter  Hospital, 
Brattleboro',  and  subsequently  to  Sloan  Hospital.  Montpelier.  Surgeon  H.  Janes,  U.  S.  V.,  in  charge 
of  the  latter,  contributed  a  photograph  of  the  patient,  which  is  copied  in  the  wood-cut  (FlG.  269), 
together  with  the  following  history:  "The  wound  was  produced  by  a  mini<5  ball,  which  entered 
the  leg  on  the  outer  side  two  inches  below  its  middle,  passed  backward  and  inward,  fracturing  the 
fibula,  and  emerging  posteriorly  one  inch  lower  than  the  point  of  entrance.  Several  fragments 
of  bone  were  removed  on  the  field  four  hours  after  the  injury.  Secondary  haemorrhage  occurred 
on  April  9th,  for  which  the  femoral  artery  was  ligated  in  Scarpa's  space  by  Dr.  Smith,  at  Fairfax 
Seminary  Hospital.  The  patient  was  much  prostrated  after  the  operation,  and  artificial  heat  was 
required  for  about  a  week  to  keep  up  the  temperature  of  the  limb.  No  recurrence  of  the  haemor 
rhage  took  place,  and  the  wound  closed  rapidly  after  the  operation.  At  the  time  of  his  admission 
to  Sloan  Hospital,  June  12th,  both  wounds  were  nearly  healed  and  he  could  walk  without  crutches, 
but  could  not  bring  the  heel  to  the  ground  on  account  of  contraction  of  the  muscles  of  the  calf.  In 
the  early  part  of  July  an  abscess  formed  at  the  place  of  ligation,  which  healed  however  in  a  short 
time.  On  August  llth,  the  patient  was  discharged  from  service,  though  unable  to  leave  the  hos 
pital  on  account  of  an  abscess  at  the  original  wound,  caused  by  a  fragment  of  necrosed  bone.  Three 
weeks  afterwards  the  abscess  had  nearly  healed  and  he  left  the  hospital  in  good  health,  but  still 
unable  to  get  the  heel  to  the  ground.  This  patient  had  also  been  wounded  through  both  buttocks, 
at  the  Wilderness,  May  5,  1864,  from  which  injury  he  had  recovered  in  three  months,  when  he 
rejoined  his  command  for  duty."  Various  surgeons,  at  consecutive  intervals,  certified  to  the  injuries, 
and  Examiner  F.  W.  Goodall,  of  Bennington,  October  5,  1877,  adds:  "The  left  leg  below  the  knee 
is  one-half  smaller  than  its  mate,  one-half  smaller  at  the  calf,  and  one-quarter  at  the  ankle;  muscles 
attached  to  the  integument  on  back  of  leg,  impairing  the  action  of  the  tendo-achillis.  1  also  find  a  large  cicatrix  in  the  left 
triangle  of  Scarpa,  from  ligation  of  the  femoral  artery."  The  pensioner  was  paid  March  4,  1880. 

CASE  700. — Corporal  J.  Ferguson,  Co.  G,  142d  Pennsylvania,  was  wounded  in  the  right  leg,  at  Fredericksburg,  Decem 
ber  13,  1862.  He  remained  at  a  First  Corps  field  hospital  for  one  week  and  was  then  transferred  to  the  Patent  Office  Hospital, 
and  subsequently  to  Stanton  Hospital,  Washington.  Surgeon  J.  A.  Lidell,  U.  S.  V.,  in  charge  of  the  latter,  described  the  case 
as  follows:  "The  wound  was  produced  by  a  bullet,  which  passed  through  the  calf  of  the  leg  in  the  upper  third  in  a  downward 
and  outward  direction.  The  wound  did  well  until  the  middle  of  January,  when  the  granulations  assumed  an  unhealthy  appear 
ance  and  the  discharge  became  thin  and  serous.  The  patient  also  exhibited  typhoid  symptoms,  having  a  hot  skin,  frequent 
pulse,  and  dry  red  tongue,  watchfulness,  and  no  appetite.  This  went  on  until  the  morning  of  January  23d,  when  haemorrhage 
occurred  unexpectedly  from  the  external  orifice  behind  the  fibula.  The  bleeding  was  readily  controlled  by  application  of 
pressure  by  bandage  and  ice,  the  patient  having  lost  about  ten  ounces.  Throughout  the  day  and  the  night  following  the  loss  of 
blood  by  oozing  was  very  little,  but  on  the  following  morning  haemorrhage  recurred  from  the  internal  orifice,  behind  the  tibia 
this  time.  This  amounted  to  from  four  to  six  ounces,  and  was  also  readily  controlled  by  the  application  of  persulphate  of  iron, 
lint,  ice,  and  bandaging.  In  the  meantime  the  typhoid  symptoms  became  more  marked.  The  patient  also  complained  of  great 
tenderness  throughout  the  leg  and  thigh  ;  the  inguinal  glands  were  somewhat  swollen  and  tender,  and  there  was  dusky  redness, 
with  soreness  in  the  track  of  the  long  saphenous  vein.  His  skin  was  now  pale  and  yellow.  On  the  morning  of  January  25th, 
another  slight  bleeding  occurred  from  the  internal  wound  and  was  readily  controlled  by  pressure.  A  marked  increase  of  the 
swelling  was  now  noticed,  extending  from  the  leg  to  the  thigh,  especially  over  the  external  and  internal  condyles  and  the  pop 
liteal  space,  and  infiltration  with  blood  was  suspected.  The  patient  was  now  very  pale  and  expressed  a  great  deal  of  anxiety, 
his  pulse  being  120,  quick  and  weak.  The  first  day  the  hremorrhage  was  thought  to  come  from  the  peroneal  artery,  the  next 
day  from  the  posterior  tibial,  but  now  we  were  uncertain  in  regard  to  the  source  of  the  bleeding,  and  the  case  presented  an 
unpromising  appearance  on  account  of  the  debility  from  the  loss  of  about  eighteen  ounces  of  blood  superadded  to  his  typhoid 
condition.  We  then  decided  to  tie  the  femoral  artery  at  the  apex  of  Scarpa's  space  as  affording  the  best  chance  of  benefit, 
which  operation  I  performed  without  any  difficulty  on  the  afternoon  of  January  25th,  forty-three  days  after  the  reception  of  the 
wound.  On  the  following  morning  the  patient  appeared  brighter;  pulse  130;  tongue  more  moist ;  leg  getting  warmer  down  to 
the  ankle.  The  plugs  being  removed  some  dark  offensive  blood  flowed  away.  In  the  evening  his  foot  was  cold,  leg  cooler,  and 
blackness  was  extending  across  the  leg  in  the  track  of  the  wound.  Patient  had  a  slight  chill;  somewhat  delirious;  pulse  130 
and  weak;  tongue  dry.  On  the  morning  of  January  27th  the  patient  looked  better;  pulse  132  and  stronger;  leg  warm  and 
blacker;  foot  pale  and  swelled ;  serous  infiltration  and  discoloration  extending  up  the  thigh.  The  next  day  the  patient  presented 
a  pale  yellow  hue;  blackness  of  limb  deepening  and  extending,  having  reached  the  lower  end  of  the  incision  made  for  the  liga- 


Fiu.  269.— Shot  fracture  of  left 
fibula  and  ligation  of  femoral. 
[From  a  photograph.] 


444  INJURIES    OF    THE    LOWER    EXTREMITIES.  ICIIAI-.  X. 

lion  ;  odor  gangrenous.  Death  supervened  on  the  evening  of  January  29,  1863.  The  autopsy  showed  that  the  bleeding  did  not 
come  from  the  posterior  tibial  or  peroneal  artery,  but  from  the  lower  part  of  the  popliteal,  which  had  been  opened  to  a  large 
extent  by  ulceration.  Some  loose  splinters  of  bone  were  also  found,  the  ball  having  grazed  the  hind  part  of  both  the  tibia  and 
fibula.  On  the  proximal  side  of  the  ligature  the  clot  was  firm,  closely  attached  to  the  walls  of  the  artery,  and  about  three-fourths 
of  an  inch  long,  with  its  apex  pointing  upward  towards  the  heart.  There  was  also  a  firm  clot  on  the  distal  side,  adherent  to  the 
walls  of  the  artery,  but  much  smaller  than  the  proximal  one."  A  piece  of  the  femoral  artery,  about  four  inches  long  and 
embracing  the  seat  of  the  ligature,  was  contributed  to  the  Museum  by  Surgeon  Lidell,  and  constitutes  specimen  1140  of  the 
Surgical  Section. 

CASE  701.- — Sergeant  J.  Daly,  Co.  K,  82d  New  York,  aged  27  years,  was  wounded  in  the  left  leg,  at  the  Wilderness, 
May  G,  1864,  and  admitted  to  Douglas  Hospital,  Washington,  six  days  afterwards.  Assistant  Surgeon  W.  Thomson,  II.  S.  A., 
described  the  injury  as  "'-a  gunshot  fracture  of  the  fibula,"  and  reported:  "On  May  17th,  a  bullet  was  extracted  fiom  the  inner 
side  of  the  leg,  through  a  deep  and  oblique  incision  two  or  three  inches  below  the  knee.  Three  days  afterwards  three  haemor 
rhages  occurred  from  the  posterior  tibial  artery,  amounting  to  one,  three,  and  ten  ounces  respectively,  and  necessitating  ligation 
of  the  femoral  artery,  which  was  performed  below  the  profunda  in  Scarpa's  space  by  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A. 
Ether  was  used  as  the  anaesthetic.  On  the  following  day  there  was  venous  haemorrhage  to  the  amount  of  four  ounces.  A 
further  loss  of  eight  ounces  of  blood  took  place  on  May  25th,  and  of  one  and  a  half  ounces  the  next  day.  Four  more  attacks 
followed  on  June  1st,  each  causing  the  loss  of  one-half  ounce  to  an  ounce  of  blood,  and  being  checked  by  compression  over  the 
femoral  where  it  emerges  from  the  pelvis.  Death  resulted  from  exhaustion,  June  3,  1864.  At  the  post-mortem  examination  the 
ligature  was  found  to  have  nearly  sloughed  through;  clot  below,  but  none  above  it." 

CASE  702. — Corporal  H.  Day,  Co.  A,  6th  Alabama,  was  wounded  in  the  right  leg,  at  Chancellorsville,  May  3,  1863.  The 
records  of  Chimborazo  Confederate  Hospital  No.  4,  Richmond,  show  his  admission  May  14th,  with  the  following  description  of 
the  injury  and  its  result:  "The  ball  entered  at  the  external  malleolus,  slightly  fracturing  the  fibula,  ranging  upward  and 
inward,  and  making  its  exit  about  an  inch  and  a  half  from  the  posterior  edge  of  the  tibia  and  about  four  inches  from  the  knee 
joint.  On  May  26th,  a  haemorrhage  from  the  upper  wound  estimated  at  from  ten  to  twelve  ounces,  and  probably  coming  from 
the  posterior  tibial  artery,  was  arrested  by  compression  of  the  femoral  on  the  pubis,  after  which  a  tourniquet  was  applied  to 
the  thigh.  On  May  28th,  another  haemorrhage  occurred  from  the  upper  wound  and  from  fifteen  to  twenty  ounces  of  blood 
were  lost,  when  it  was  checked  by  introducing  the  fingers  into  the  wound  and  seizing  the  vessel  and  adjacent  tissues.  Liga- 
tion  of  the  femoral  artery  was  then  performed.  The  tissues  were  found  to  be  disorganized  and  reduced  to  a  soft  pulpy  mass, 
in  which  it  was  impracticable  to  define  any  healthy  structure.  While  preparing  for  the  operation  the  patient  had  a  slight 
convulsion,  and  for  a  few  moments  all  proceedings  were  suspended  in  anticipation  of  immediate  death.  Haemorrhage  did  not 
recur  after  the  operation.  On  June  2d,  there  was  a  slight  chill  followed  by  fever.  On  the  next  day  the  discharge  from  the 
upper  wound  was  of  a  greenish-gray  color,  offensive  in  odor,  and  indicative  of  gangrene.  Gangrenous  symptoms  increased,  and 
by  June  4th  the  foot  and  leg  were  livid  and  swollen,  odor  very  offensive.  He  died  in  a  comatose  condition,  June  5,  1863,  the 
whole  leg  and  thigh  having  become  thoroughly  gangrenous.  It  is  probable  that  the  posterior  tibial  artery  was  not  divided  by 
the  ball,  but  opened  by  the  softening  of  the  tissues  subsequent  to  the  occurrence  of  the  wound." 

EXCISIONS  IN  THE  CONTINUITY  OF  THE  BONES  OF  THE  LEG  FOR 
SHOT  INJURY. — Three  hundred  and  eighty-seven  examples  of  excision  in  the  bones  of 
the  leg  are  recorded.  Two  hundred  and  fifteen,  or  over  one  half  of  the  total  number  of 
these  operations,  were  primary,  eighty-seven  intermediary,  and  fifty  secondary;  in  thirty- 
five  instances  the  interval  between  the  dates  of  injury  and  operation  could  not  be  ascer 
tained.  Two  hundred  and  seventy-five  of  the  patients  survived  the  operation,  one  hundred 
and  eight  died,  and  in  four  the  results  were  undetermined,  a  mortality  rate  of  28.2  per  cent. 
In  comparing  the  results  of  the  excisions  and  amputations  in  the  long  bones  of  the  upper 
extremity  it  will  have  been  noticed  that  in  the  upper  arm  the  fatality  of  the  excisions 
(28.5)  exceeded  that  of  the  amputations  (23.6)  by  4.9  per  cent.,  while  in  the  forearm  the 
mortality  of  the  amputations  (13.9)  was  2.7  per  cent,  in  excess  of  the  death  rate  of  the 
excisions  (11-.2).  Similarly,  in  the  lower  extremity,  we  find  that  while  the  fatality  of  the 
excisions  in  the  shaft  of  the  femur  (69.4)  surpasses  that  of  the  amputations  through  the 
thigh  (53.8)  by  15.6  per  cent.,  the  excisions  in  the  continuity  of  the  bones  of  the  leg  show 
a  death  rate  of  28.2  per  cent.,  or  4.7  per  cent,  less  than  the  fatality  after  amputations  in  the 
leg  (32.9  per  cent.).  It  would  appear,  therefore,  that  in  the  arm  and  thigh  amputations 
were  less  fatal  than  excisions,  while  in  the  forearm  and  leg  the  mortality  of  the  amputations 
exceeded  that  of  the  excisions.  The  low  rate  of  fatality  after  excisions  in  the  forearm  or 
leg  may  be  ascribed  to  the  fact  that  in  the  large  majority  of  the  cases  of  recovery  portions 
of  one  of  the  bones  of  the  forearm  or  the  leg  only  were  excised;  in  the  cases  in  which  the 
excision  extended  to  both  bones  of  the  limb,  the  mortality  exceeded  that  of  the  amputations. 


SECT.  V.] 


PEIMARY    EXCISIONS    IN    THE    BONES    OF    THE    LEG. 


445 


TABLE  LXII. 

Numerical  Statement  of  Three  Hundred  and  Eighty-seven  Excisions  in  the  Bones  of  the  Leg  for  Shot 

Fracture. 


OPERATIONS. 

1 

o 

CASES. 

EXCISIONS. 

TIBIA. 

FIBULA. 

TIBIA  AND 
FIBULA. 

BONES  NOT 
SPECIFIED. 

Recovery. 

Death. 

Undeter 
mined. 

Mortality 
rate  of  deter 
mined  cases. 

Recovery. 

Death. 

Undeter 
mined. 

Mortality 
rate  of  deter 
mined  cases. 

Recovery. 

Death. 

Undeter 
mined. 

Mortality 
rate  of  deter 
mined  cases. 

Recovery. 

Death. 

X 

'"3  2 
II 
S 

Recovery. 

Death. 

215 
87 
50 
35 

148 
58 
42 
27 

67 
29 
8 
4 

4 

31.1 
33.3 

16.0 
12.9 

69 
24 
26 

17 

30  .... 
9  ... 

5  .... 
3       2 

30.3 
27.2 
16.1 
15.0 

78 
31 
13 
9 

32 

15 

1 
1 

2 

29.0 
32.6 
7.1 
10.0 

3 
3 

1 

5 
4 
o 

100.0 
57.1 
40.0 

1 

1 

Time  between  injury  and  operation  not  recorded. 

387 

275 

108 

4 

28.2 

136 

47 

o 

25.6 

131     49 

2 

27.2 

7 

11 

61.1 

1 

1 

Primary  Excisions  in  the  Shaft  of  the  Tibia,  of  the  Fibula,  or  of  both  bones. — The 

series  of  two  hundred  and  fifteen  primary  excisions  in  the  bones  of  the  leg  contains  one 
hundred  and  forty-eight  recoveries  and  sixty-seven  deaths,  a  mortality  rate  of  31.1  per  cent. 
Portions  of  the  tibia  were  excised  in  ninety-nine,  of  the  fibula  in  one  hundred  and  ten,  and 
of  the  tibia  and  fibula  in  five  instances;  in  one  case  the  seat  of  excision  was  not  specified. 
The  operations  were  performed  on  one  hundred  and  ninety-two  Union  and  twenty- three 
Confederate  soldiers. 

Recoveries  after  Primary  Excisions  in  the  Continuity  of  the  Bones  of  the  Leg. — There 
were  one  hundred  and  forty-eight  recoveries  after  primary  excisions  in  the  continuity  of  the 
bones  of  the  leg;  in  sixty-nine,  portions  of  the  tibia,  and  in  seventy-eight,  parts  of  the  fibula 
had  been  excised;  in  one  instance  the  bone  was  not  indicated.  No  instances  of  recovery 
after  primary  excision  in  both  bones  of  the  leg  are  recorded.  The  one  hundred  and  forty- 
eight  operations  were  performed  on  seventeen  Confederate  and  one  hundred  and  thirty-one 
Union  soldiers.  Of  the  latter  one  hundred  and  twenty-four  were  pensioned;  but  ten  have 
died  since  the  date  of  their  discharge — two  of  phthisis,  and  three  of  remote  effects  of  the 
injury;  in  five  instances  the  cause  of  death  was  not  reported.  In  the  following  five  cases 
from  three  to  six  inches  of  the  tibia  were  excised: 

CAKE  703. — Private  J.  Hogan,  Co.  F,  127th  Pennsylvania,  aged  41  years,  was  wounded  in  the  right  leg,  at  Fredericks- 
hurg.  December  13,  18(52.  Surgeon  J.  E.  MacDonald,  79th  New  York,  reported  his  admission  to  the  field  hospital  of  the  1st  and 
2d  divisions.  Ninth  Corps,  and  described  the  injury  as  "fracture  of  the  tibia,"  for  whicli  "resection  of  six  inches"  of  the  bone 
\v;is  performed.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  contributed  the  following  history  of  the  case:  "This  man  was  struck 
by  a  minio  ball  four  inches  below  the  knee  joint.  The  tibia  was  extensively  comminuted,  the  fibula  being  uninjured.  A  resec 
tion  of  the  shaft  of  the  tibia  from  a  point  just  below  the  tubercle  to  (about)  seven  inches  below  was  performed  by  Surgeon  J.  P. 
Prince,  36th  Massachusetts,  at  a  field  hospital.  The  man  was  admitted  to  Douglas  Hospital  December  26th.  The  dressing 
consisted  in  keeping  the  incision  open  with  charpie  to  encourage  granulations  from  the  bottom  of  the  wound.  On  February 
26.  186:?,  a  crown-shaped  exfoliation  (Spec.  2237,  Sect.  I,  A.  M.  M.)  was  removed  from  the  end  of  the  lower  portion  of  the  tibia. 
The  wo'ind  now  healed  rapidly,  no  change  having  been  made  in  the  dressing  and  the  leg  being  retained  in  quietness  by  a  frac 
ture  box  filled  with  bran.  His  general  health  became  perfect  as  the  discharge  ceased.  On  May  1st,  several  small  exfoliations 
were  removed  from  the  spongy  portion  of  the  tibia  at  the  superior  part  of  the  wound.  There  was  of  course  no  reproduction  of 
the  tibia  and  no  conservative  hypertrophy  of  the  fibula,  and  hence  the  leg  was  perfectly  helpless.  Before  the  fistulous  orifice 
had  entirely  closed  at  the  upper  portion  of  the  incision,  well  marked  but  mild  hospital  gangrene  appeared.  The  sloughing 
extended  very  deeply  as  far  as  the  lower  side  of  the  tibia.  Several  applications  of  bromine  checked  the  spread  of  the  gangrene 
but  not  until  a  large  excavation  had  been  caused.  This  filled  up  gradually,  the  patient  got  up  on  his  crutches  and  with  the  aid 
of  a  starched  bandage  hobbled  painfully  about  the  wards.  His  term  of  enlistment  expired  on  May  29,  1863,  but  he  remained 
until  October  12th,  when  be  returned  to  his  home.  No  more  useless  or  unphilosophical  operation  coidd  be  devised  than  the 
one  done  in  this  case.  The  leg  was  perfectly  helpless,  a  hiatus  of  nine  or  ten  inches  existing  in  the  tibia  and  there  being  no  hope 
of  any  further  improvement  from  the  lapse  of  time;  fibula  no  larger  than  natural.  Unless  some  novel  means  of  support  can  be 


446 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  x. 


applied  this  man  will  be  infinitely  worse  oft'  than  with  an  artificial  leg."  Examining  Surgeon  S.  T.  Charlton,  of  Harrisburg, 
reported  in  October.  1866:  "There  is  complete  atrophy  of  the  whole  limb,  as  well  as  deformity  from  curvature  at  the  point  of 
resection  and  the  pushing  out- of  the  head  of  the  fibula  from  its  articulation.  He  cannot  walk  or  stand  upon  the  limb  without 
the  use  of  a  cumbrous  apparatus  furnished  by  the  Government,"  etc.  At  subsequent  examinations  no  change  or  improvement 
was  reported.  The  pensioner  died  May  24,  1877.' 

CASE  704. — Lieutenant  O.  R.  Fyler,  Co.  I,  2d  Connecticut  Heavy  Artillery,  aged  25  years,  was  wounded  in  the  left  leg, 
at  Opequan  Creek,  September  19,  1864.  He  was  admitted  to  the  field  hospital  at  Winchester,  where  Surgeon  E.  B  P.  Kelly, 
95th  Pennsylvania,  recorded  a  "shot  fracture  of  the  tibia,  middle  third,  by  a  mini6  ball,  followed  by  exsection,  the  same  day, 
of  three  inches  of  the  bone  by  Surgeon  H.  Plumb,  2d  Connecticut  Artillery."  Acting  Assistant  Surgeon  J.  H.  Bartholf  made 

the  following  report:  "The  patient  entered  Frederick  Hospital  on  November  12th.  On 
December  15th,  I  discovered  and  removed  the  ball,  or  what  appeared  to  be  the  greater 
part  of  it,  from  the  lower  part  of  the  wound,  close  to  the  upper  extremity  of  the  lower 
fragment.  It  was  embedded  about  two  inches  and  found  to  be  exceedingly  battered  and 
misshapen.  The  patient  informed  me  that  Smith's  anterior  splints  were  used  and  con 
tinued  for  three  weeks  after  the  injury.  A  plaster-of-Paris  splint  was  then  applied,  with 
which  he  came  here,  having  traveled  by  the  rough  railway  from  Winchester  without 
inconvenience.  I  found  him  with  his  limb  looking  well,  but  there  was  no  union  of  bone 
and  no  coaptation  even  of  the  ends,  the  fibula  of  course  holding  the  extremities  apart. 
Besides  removing  the  ball,  as  stated,  and  a  few  small  fragments  of  bone,  the  patient's 
treatment  in  this  hospital  consisted  of  simple  dressings  and  the  continued  use  of  the 
plaster-of-Paris  splint.  On  January  13,  1865,  he  left  on  leave  of  absence,  his  general 
condition  being  excellent  and  the  wound  presenting  a  granulating  surface  five  inches  long. 
No  deposit  of  bony  matter  in  the  interspace  between  the  ends  of  the  bone  could  be  discov 
ered.  The  sawn  face  of  the  upper  fragment  came  away  in  the  early  part  of  January." 
The  patient  was  discharged  from  service  April  6,  1865,  and  pensioned,  and  subsequently 
supplied  with  a  supporting  apparatus  for  his  injured  limb  by  Dr.  E.  D.  Hudson,  of  New 
York  City.  Examining  Surgeon  H.  E.  Gates,  of  Litchfield,  Connecticut,  certified,  June 
4,  1877:  "The  wound  was  from  aminie^  ball  received  directly  in  front,  striking  the  tibia, 
mashing  that  bone  and  lodging  in  it;  it  remained  there  two  months,  causing  exfoliation, 
profuse  discharge,  and  an  attack  of  gangrene.  Resection  was  done  the  day  the  injury 
was  received,  the  periosteum  being  removed  (or  badly  torn)  with  three  inches  of  the  bone. 
It  is  supposed  that  the  periosteum  was  so  badly  torn  as  not  to  be  able  to  repair  the  loss 
of  bone  substance.  Present  aspect :  whole  leg  and  thigh  atrophied.  The  fibula  is  bowed 
outward  and  there  is  partial  dislocation  of  its  head.  The  leg  bends  easily  at  the  seat  of 
the  injury  and  no  weight  can  be  borne  upon  it.  I  have'no  doubt  the  fibula  would  instantly  give  way  if  the  applicant  stood  upon 
it.  There  is  great  tenderness  at  the  head  of  the  fibula  from  stretching  of  the  ligaments,  the  line  of  support  from  the  bending  of 
the  leg  being  thrown  outward  toAvards  this  articulation.  The  pensioner  wears  an  appliance  weighing  seven  pounds,  which 
incases  the  limb  and  gives  the  only  support.  The  disability  is  progressive  on  account  of  displacement  and  bending  of  fibula,  etc. 
I  consider  his  present  condition  worse  than  if  he  had  amputation  above  the  knee;  locomotion  is  very  painful  indeed/'  etc.  The 
pensioner  was  paid  March  4,  1880.  In  the  accompanying  wood-cut  (FiG.  270)  the  appearance  of  the  limb  about  one  year  after 
the  excision  is  shown. 

CASE  705. — Colonel  W.  T.  Fitch,  29th  Ohio,  aged  40  years,  was  wounded  at  Mill  Creek,  May  8,  1864.  He  entered  the 
field  hospital  of  the  2d  division,  Twentieth  Corps,  where  Surgeon  A.  Ball,  5th  Ohio,  recorded :  "  Shot  compound  fracture  of  right 
tibia ;  resection  at  middle  third  by  Surgeon  A.  K.  Fifield,  29th  Ohio."  Surgeon  J.  E.  Herbst,  U.  S.  V.,  reported  that  the  patient 
entered  the  Officers'  Hospital,  Nashville,  four  days  after  he  was  wounded,  having  undergone  excision  of  about  three  inches  of  the 
shaft  of  the  tibia  by  a  longitudinal  incision  of  four  inches  over  the  crest.  Chloroform  was  used  and  prompt  reaction  followed 
the  operation.  The  limb  was  placed  in  a  box-frame  splint  and  wet  applications  were  made.  On  June  20th  the  patient  left  for 
his  home  on  leave  of  absence,  the  wound  being  in  excellent  condition.  On  October  13,  1864,  Colonel  Fitch  resigned  and 
obtained  his  discharge  from  service,  and  subsequently  he  became  a  pensioner,  his  physician  testifying  that  "the  wound  on  the 
surface  has  healed,  but  the  vacancy  caused  by  the  removal  of  the  bone  has  not  yet  filled  up."  Examiner  W.  M.  Eames,  of  Ash- 
tabula,  Ohio,  certified,  September  15,  1865,  that  "the  leg  is  now  very  small  and  weak  and  of  no  manner  of  use  in  walking,  a 
source  of  constant  discomfort.  The  foot  is  cold  and  swollen  and  not  under  the  control  of  the  muscles.''  On  December  8,  1870, 
when  the  pensioner  visited  the  Army  Medical  Museum,  he  was  in  good  general  health  and  his  wound  soundly  healed;  but  the 
bone  remained  ununited,  the  calf  of  the  leg  entirely  atrophied,  and  the  foot  swollen  and  useless.  He  also  stated  that  "he 
regretted  greatly  that  amputation  had  not  been  performed."  The  Cleveland  Examining  Board  at  subsequent  dates  reported 
that  the  pensioner  was  obliged  to  wear  steel  splints  on  the  outer  and  inner  aspect  of  the  leg.  In  September,  1877,  the  cicatrix 
was  described  as  being  quite  irritable  and  as  ulcerating  and  discharging  often.  The  pensioner  was  paid  December  4,  1879. 

CASE  706. — Private  D.  M.  Gould,  Co.  D,  102d  New  York,  aged  21  years,  was  wounded  in  the  left  leg,  at  Dallas,  May 
27,  1804.  Surgeon  A.  Ball,  5th  Ohio,  reported  his  admission  to  the  field  hospital  of  the  2d  division,  Twentieth  Corps,  with 
"shot  fracture  of  tibia;  resection  of  four  inches  by  Surgeon  C.  H.  Lord,  102d  New  York."  Ten  days  after  receiving  the  injury 
the  wounded  man  was  conveyed  to  Chattanooga,  and  subsequently  he  passed  through  different  hospitals,  entering  Ira  Harris 
Hospital,  Albany,  on  February  9, 1865.  Assistant  Surgeon  J.  H.  Armsby,  U.  S.  V.,  in  charge  of  the  latter,  contributed  a  plaster 


FIG.  -J70.—  Excision  of  three  inches  of  the 
left  tibia.     [From  a  photograph.] 


1  A  detailed  history  of  the  case  will  be  found  in  American  Journal  of  Medical  Sciences,  New  Series,  1804,  Vol.  XLVII,  p.  395,  Report  of  Gates  of 
Hospital  Gangrene  treated  in  Douglas  Hospital,  Washington,  D.  C.,  by  WILLIAM  THOMSON,  M.  D. 


SECT.  V.) 


PRIMARY    EXCISIONS    IN    THE    BONES    OF    THE    LEG. 


417 


Flu.  271.— Lertleff  af 
ter  excision  of  4  inches 
of  shaft  of  tibia.  .Spec. 
2552.  [From  a  cast.] 


cast  (Spec.  '2552,  Sect.  I,  A.  M.  M.)  of  the  injured  limb,  represented  in  the  annexed  cut  (FiG.  271),  and  reported  the  patient's 
discharge  from  service  July  20,  1865,  by  reason  of  disability  resulting  from  the  wound.  Examining  Surgeon  J.  B.  Chapin, 
of  Canandaigua,  N.  Y.,  reported,  July  2,  1869:  "The  disability  had  its  origin  in  a  gunshot  wound  of  the  upper  third  of  the  tibia. 
The  bone  was  shattered,  leaving  the  head  uninjured.  The  operation  of  resection,  by  which  four  inches  of  the  tibia  was  removed, 
was  performed.  The  fibula  is  thrown  out  of  line  externally  by  the  action  of  walking  and  the  weight  of  the 
body,  and  a  false  joint  exists  below  the  knee  joint.  The  limb  requires  a  splint  and  bandage  to  be  applied 
constantly  for  support,  and  in  addition  the  pensioner  requires  the  aid  of  a  cane/'  etc.  The  Canandaigua 
Examining  Board  certified,  September  4,  1877,  to  the  following:  "Leg  shortened  about  two  inches;  false 
joint,  large  cicatrix  along  spine  of  tibia;  upper  end  of  fibula  projecting.  Leg  curved  outward.''  Tin- 
pensioner  was  paid  March  4,  1880. 

CASE  707. — Sergeant  J.  Measor,  Co.  C,  137th  New  York,  aged  37  years,  was  wounded  in  the  left 
leg,  atWauhatchie,  October  29,  1863,  and  admitted  to  the  field  hospital  of  the  2d  division,  Twelfth  Corps. 
Surgeon  G.  Perin,  U.  S.  A.,  reported  the  injury  as  a  "fracture  of  the  tibia,"  for  which  excision  was  per 
formed  at  the  upper  third  by  Surgeon  A.  K.  Fifield,  29th  Ohio.  Assistant  Surgeon  H.  T.  Legler,  U.  S.  V., 
reported  that  the  wounded  man  entered  the  general  hospital  at  Bridgeport  three  days  after  receiving  the 
injury,  and  that  he  left  for  his  home  on  furlough  April  4,  1834.  Acting  Assistant  Surgeon  J.  \V.  Robie 
reported  that  the  patient  was  subsequently  admitted  to  Ladies'  Home  Hospital,  New  York  City,  where  a 
second  operation  for  the  removal  of  bone  became  necessary,  by  reason  of  necrosis,  on  August  22d.  He 
was  discharged  from  service  April  5,  1865,  and  pensioned.  From  a  description  of  the  case  by  Dr.  E.  T). 
Hudson,  of  New  York  City,  who  supplied  the  pensioner  with  a  surgical  apparatus  for  the  wounded  limb,  it 
appears  that  the  total  amount  of  bone  removed  comprised  three  and  a  half  inches,  the  first  operation 
consisting  of  the  posterior  and  main  part  of  the  shaft  of  the  tibia,  while,  at  the  second,  the  remaining 
anterior  portion  was  removed  by  Acting  Assistant  Surgeon  J.  C.  Stone.  Examining  Surgeon  D.  W.  Hunt, 
of  Fairmont,  Minnesota,  reported:  "The  wounded  limb  is  much  smaller  than  the  other,  the  muscles  being 
shrunken  and  somewhat  shorter  than  the  other.  The  deformity  modifies  his  gait  very  much,  causing  an 
appearance  of  lameness."  The  pensioner  was  paid  December  4,  1879. 

In  the  next  case  six  inches  of  the  fractured  fibula  were  excised,  and  the  posterior  tibial 
artery  was  successfully  ligated  for  secondary  hemorrhage: 

CASE  708. — Private  J.  Leichty,  Co.  F,  8th  Pennsylvania  Reserves,  aged  21  years,  received  a  shot  fracture  of  the  fibula 
of  the  left  leg,  at  Spottsylvania,  May  11,  1864.  Surgeon  L.  W.  Read,  U.  S.  V.,  reported  that  he  was  admitted  to  the  field 
hospital  of  the  3d  division,  Fifth  Corps,  where  "resection  was  performed  by  Surgeon  T.  Jones,  8th  Pennsylvania  Reserves." 
Assistant  Surgeon  A.  Ingram,  U.  S.  A.,  contributed  the  following  history:  "The  wounded  man  entered  Judiciary  Square  Hos 
pital,  Washington,  May  18th.  About  six  inches  of  the  injured  fibula  had  been  excised  on  the  field.  Secondary  haemorrhage 
occurred  from  the  posterior  tibial  artery  to  the  amount  of  thirty -two  ounces,  when  the  vessel  was  ligated  in  the  wound.  By 
June  14th  the  patient  was  progressing  well.  Cold-water  dressings  were  used,  and  milk  punch  and  a  supporting  treatment  was 
administered."  The  patient  was  subsequently  transferred  to  hospital  at  Alexandria,  whence  he  was  discharged  from  service 
January  11,  1865,  and  pensioned.  Examining  Surgeon  J.  McCullock,  of  Huntingdon,  Pennsylvania,  April  18,  1867,  described 
the  wound,  and  added  that  the  "leg  has  sloughed  largely  and  discharged  a  number  of  pieces  of  bone,  the  last  one  about  three 
weeks  ago.  Since  that  time  the  wound  has  healed;  tendons  back  of  knee  contracted;  walks  lame;  wound  painful,"  etc.  Exam 
iner  A.  B.  Brumbaugh  reported,  in  1877,  that,  as  a  result  of  the  resection,  "The  foot  cannot  be  planted  even,  as  it  would  turn 
outward  from  the  want  of  fibular  support,  and  he  has  to  keep  his  shoe  blocked  up  accordingly  to  support  the  foot.  The  toes  of 
the  left  foot  tend  to  turn  downward,  like  hooks,  from  injury  to  the  nerves  and  muscles.  The  leg  is  not  quite  but  almost  useless 
for  all  purposes  of  manual  labor."  The  pensioner  was  paid  March  4,  1880. 

Of  the  one  hundred  and  forty-eight  survivors  after  primary  excision  in  the  bones  of 
the  leg  nineteen  submitted  to  subsequent  operations,  viz:  fourteen1  to  amputation  in  the 
leg;  one2  to  exarticulation  at  the  knee;  and  four3  to  amputation  in  the  thigh. 

fatal  Cases  of  Primary  Excision  in  the  Continuity  of  the  Leg. — The  sixty-seven  fatal 
cases  of  primary  excision  in  the  bones  of  the  leg  comprised  thirty  excisions  in  the  shaft  of 
the  tibia,  thirty-two  in  the  shaft  of  the  fibula,  and  five  of  both  bones  of  the  leg.  Subse- 

1  In  nine  of  the  fourteen  cases  of  amputations  in  the  leg  the  operation  was  performed  in  the  upper  third,  viz:  Pt.  S.  B.  Andrews,  Co.  F,  70d  Penu.. 
right  log,  secondary  operation  ;  Pt.  L.  Arnold,  Co.  G,  143d  Penn.,  right  leg,  intermediary  operation:  Lieut.  Col.  W.  W.  Dudley,  19th  Indiana,  right  leg, 
intermediary  operation  ;  Corp'l  W.  H.  Goldsmith,  F,  2d  New  Hamp.,  left  leg,  secondary  operation ;  Pt.  D.  A.  Hatch,  C,  t-'d  Mass.,  right  leg,  secondary 
operation,  Spec.  2155,  A.  M.  M.;  Corp'l  C.  McCarty,  E,  1st  N.  Y.,  right  leg,  secondary  operation;  Pt.  T.  Powell,  F,  6th  U.  S.  C.  T.,  left  leg,  secondary 
operation:  Musician  C.  A.  Runyan,  F,  9th  N.  Y.  H.  A.,  left  leg,  secondary  operation;  Pt.  P.  O'Rourke,  F,  7th  N.  Y.  H.  A.,  left  leg,  intermediary  oper 
ation,  Specs.  1502  and  3546,  A.  M.  M.     In  five  cases  the  operation  of  amputation  was  performed  in  the  middle  third,  viz:  Pt.  T.  Beirn,  G,  60rh  Illinois, 
left  leg,  intermediary  operation;  Pt.  J.  R.  Cowling,  A,  62d  Penn.,  right  log,  secondary  operation  ;  1't.  P.  Steif,  K,  139th  N.  Y.,  right  leg,  intermediary 
operation;  Pt.  J.  Koehler,  I,  150th  Penn.,  left  leg,  intermediary  operation.  Specs.  2404  and  3533,  A.  M.  M.;  Pt.  J.  J.  Toomey,  I,  29th  Penn.,  left  leg, 
intermediary  operation,  Spec.  3361,  A.  M.  M.     These  cases  will  appear  in  the  tables  of  amputations  in  the  leg. 

2  Amputation  at  the  knee  joint  was  resorted  to  in  the  case  of  Pt.  J.  H.  Pattee,  Co.  D,  2fith  Ohio  (TABLE  LVII,  p.  409,  No.  6). 

3 Two  o  Jhe  four  cases  of  amputation  in  the  thigh  were  done  in  the  middle  third,  viz:  Pt.  S.  Montgomery,  I,  139th  Penn.,  left  thigh,  secondary 
operation  (TABLE  XXXIX,  p.  314,  No.  63):  Pt.  \\.  Stocdale,  D,  48th  Indiana,  right  thigh,  secondary  operation  (TABLE  XXXIX,  p.  314,  No.  87);  nm» 
two  in  the  lower  th'.rd,  viz:  Corp'l  M.  Uunn.  II,  4(ith  Penu.,  both  thighs,  primary  operations,  Spec.  3193  (CASE  448,  p.  242,  and  TABLE  XXXII,  p.  248,  Nos. 
239,  240);  Pt.  P.  Walsh,  A,  G9th  N.  Y.,  left  thigh,  intermediary  operation  (TABLE  XXXVI,  p.  296,  No.  202). 


448 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAT.  X. 


quent  amputation  was  performed  in  fourteen  instances,  three  times  in  the  leg,1  twice  at  the 
knee  joint,2  eight  times  in  the  thigh,3  and  once  in  the  leg  with  subsequent  re-amputation  in 
the  thigh.4  The  patients  were  sixty-one  Union  and  six  Confederate  soldiers.  Pyremia  was 
noted  in  eight,  gangrene  in  twelve,  erysipelas  in  four,  and  haemorrhage  in  fifteen  instances. 

CASE  709. — Private  N.  Biehl,  Co.  I,  155th  Pennsylvania,  aged  27  years,  received  a  shot  fracture 
of  the  right  tibia,  at  Petersburg,  June  19,  1804.  He  was  conveyed  to  the  field  hospital  of  the  1st  division, 
Fifth  Corps,  where  excision  was  performed  but  not  recorded,  and  whence  he  was  transferred  to  City 
Point  and  subsequently  to  Alexandria.  Surgeon  E.  Bentley,  U.  S.  V.,  who  amputated  the  limb,  reported 
the  following  history:  "The  patient  was  admitted  to  the  Third  Division  Hospital  June  28th.  Exsection 
had  been  performed  on  June  21st,  in  the  field,  by  Surgeon  J.  A.  E.  Read.  155th  Pennsylvania,  who 
removed  t\vo  inches  of  the  middle  third  of  the  tibia  by  a  straight  incision  four  inches  in  length.  "When 
admitted  the  lips  of  the  wound  were  widely  separated,  having  apparently  never  been  brought  together 
closely  or  supported  except  by  straps  and  bandages.  The  incision  remained  open  in  its  whole  length, 
leaving  a  portion  of  the  crest  of  each  extremity  exposed  and  uncovered  of  periosteum.  The  granulations 
were  healthy  and  covered  with  laudable  pus ;  but  the  leg  and  foot  were  badly  swollen,  particularly  about 
the  ankle,  where  the  integument  was  cedematous  and  pitted  deeply  on  pressure.  Water  dressings  were 
applied  to  the  wound  and  stimulants  were  given  internally.  On  July  14th,  gangrene  appeared  in  the 
wound.  Remedies  used  successfully  in  other  cases  signally  failed  in  this.  The  disease  extended  along 
the  medullary  cavity  of  the  bone  and  the  muscles  behind,  seemingly  bidding  defiance  to  local  applica 
tions  and  becoming  very  offensive.  The  patient  sank  very  rapidly  under  the  effects  of  the  pain  and 
poison,  and  the  loss  of  blood  from  an  artery  opened  by  ulceration.  On  July  19th,  amputation  at  the 
middle  third  of  the  thigh  was  performed  by  circular  skin  flaps.  The  patient  was  much  prostrated  at  the 
time  of  the  operation;  had  no  appetite,  great  thirst,  and  dry  tongue;  face  sunken  and  anxious;  pulse 
quick  and  tremulous.  Alcohol  was  applied  to  the  stump,  which  was  covered  with  a  compress  wet  with 
the  same.  Whiskey  and  morphine  was  given  internally.  The  next  day  gangrene  attacked  the  stump, 
spreading  rapidly  on  its  face  and  extending  three  inches  up  the  inner  side  of  the  thigh.  The  patient 
died  on  July  21,  1864,  of  exhaustion.  The  post-mortem  examination,  twenty-two  hours  after  death, 
revealed  extensive  gangrene  of  the  stump  and  mortification  extending  to  the  body."  The  bones  of  the 
wounded  leg,  showing  the  tibia  to  be  dead  for  one  inch  on  each  side  of  the  excision,  were  contributed  by 
Dr.  Bentley  and  are  shown  in  the  annexed  cut  (FlG.  272). 

CASE  710. — Corporal  P.  Lovell,  Co.  C,  10th  Missouri,  aged  41  years,  was  wounded  at  Mission 
Ridge,  November  2o,  1863.  He  entered  the  field  hospital  of  the  :'.d  division,  Fifteenth  Corps,  where 
Surgeon  J.  L.  Prout,  26th  Missouri,  noted:  " Fracture  of  leg  and  wound  of  right  shoulder,  resection  of 

portion  of  tibia."     Assistant  Surgeon   J.  J.  Whitney,  8th  Wisconsin,  reported   the  following  history: 
FIG.  272.— Bones  of  right     J 
leg.  with  2J  inches  of  tibia       The  patient  was  of  previous  good  constitution,  but  asthmatic.     He  was  severely  wounded,  the  left  tibia 

excised.    Spec.  3337.  being  fractured  at  the  junction  of  the  middle  and  lower  third.     Two  and  a  half  inches  of  bone  were 

resected  the  evening  following  the  injury.  Up  to  the  time  of  the  patient's  admission  to  the  general  field  hospital  at  Chatta 
nooga,  December  20th,  no  attempts  at  repair  had  taken  place,  the  wound  granulating  feebly  and  suppuration  being  profuse. 
On  January  10,  1864,  secondary  haemorrhage  occurred  from  the  posterior  tibial  at  its  superior  portion:  tissue  of  the  calf  infil 
trated,  and  blood  flowing  from  the  posterior  wound  at  the  seat  of  the  fracture.  Up  to  this  date  the  patient  had  been  generally  quiet 
and  had  had  a  good  appetite;  no  diarrhoea,  chills  or  fever.  Assistant  Surgeon  R.  Bartholow.  U.  S.  A.,  in  charge  of  the  hospital, 
being  called  in  consultation,  it  was  determined  to  amputate  below  the  knee,  which  operation  was  then  immediately  performed 
by  him,  at  the  junction  of  the  upper  and  middle  thirds,  by  the  circular  fiap  incision.  During  the  operation  the  fibula  was  found 
to  be  fractured  just  below  its  articulation  with  the  tibia,  when  a  longitudinal  incision  was  made  and  the  upper  fragment  was 
smoothly  excised.  On  January  15th,  the  stump  was  sloughing  somewhat;  discharges  comparatively  healthy,  patient  having  no 
constitutional  symptoms.  On  the  following  day  there  was  a  profuse  hremorrhage,  the  ligatures  having  sloughed  away,  and  the 
patient  losing  about  sixteen  ounces  of  blood.  The  bleeding  was  controlled  by  the  application  of  cold  and  pressure.  The  skin 
about  the  stump  now  assumed  a  puffy  erysipelatous  character;  patches  looking  gangrenous;  bone  protruding  and  healthy  look 
ing;  pulse  100  and  feeble.  The  treatment  up  to  this  time  had  been  decidedly  supporting,  such  as  quinine,  wine,  beef  tea,  and 
milk.  On  January  17th,  another  haemorrhage  occurring,  I  opened  the  wound  down  to  the  bleeding  point  and  applied  actual 
cautery,  which  instantly  staunched  the  flow.  The  dead  portions  of  tissue  were  all  cut  away  and  the  stump  was  dressed  with 
common  solution  of  bromine.  This  treatment  was  continued  until  the  19th,  when  the  artery  opened  again  late  in  the  evening, 
but  the  bleeding  was  controlled  so  soon  that  he  lost  only  about  four  ounces;  actual  cautery  was  again  employed.  On  January 

1  The  three  amputations  in  the  leg  were  done  in  the  upper  third,  viz.,  cases  of:  ]'t.  J.  S.  Deu-es,  II,  18th  Virginia,  primary  operation  ;  Capt.  II.  R. 
Schwerin,  C,  119th  New  York,  right  leg.  interim-diary  operation  ;  Pt.  R.  Whistler,  H,  49th  Ohio,  right  leg,  secondary  operation. 

2  Amputation  at  the  knee  joint  was  performed  in  the  eases  of:  Pt.  V.  Carroll,  K.  45th  Penn.,  right  leg,  intermediary  operation  (TABLK  LVI.  p.  40G, 
No.  21):  and  Corp'l  T.  Sharp,  I,  38th  Illinois,  right  leg,  secondary  operation  (TAliI.E  LVII,  p.  409,  No.  23). 

'Subsequent  amputations  in  the  thigh  were  performed  in  the  cases  of:  Corp'l  C.  Jackson,  G,  2d  Michigan,  left  thigh,  intermediary  operation  in 
upper  third  (TABLE  XXXIV,  p.  270,  No.  91);  Pt.  J.  II.  Carpenter,  E,  1 10th  Ohio,  left  thigh,  intermediary  operation  in  middle  third,  ftprc.  275!',  A.  M.  M. 
(TABLE  XXXV,  p.  283,  No.  24]);  I't.  N.  Biehl,  I,  155th  Penn.,  right  thigh,  intermediary  operation  in  middle  third,  Spec.  3337,  A.  M.  M.  (TABLE  XXXV, 
p.  283,  No.  223);  Pt.  N.  II.  Atwood,  C,  fith  Vermont,  right  thigh,  intermediary  operation  in  lower  third  (TAUI.K  XXXVI,  p.  290,  No.  230);  Pt.  C.  A. 
Eaton,  K,  39th  Mass.,  right  thigh,  intermediary  operation  in  lower  third  (TAHI.K  XXXVI.  p.  298.  No.  324):  Pt.  I).  A.  Johnson.  E,  43d  N.  V.,  right  thigh, 
secondary  operation  in  lower  third  (TABLE  XL.  p.  322,  No.  14f):  I't.  .1.  liader.  F,  SUth  Illinois,  left  thigh,  secondary  operation  in  lower  third  (TAltLR  XL, 
p.  322,  No.  181);  Serg'tL.  Heath,  D,  2d  Michigan,  right  thigh,  intermediary  operation  in  lower  third,  Spec.  2867,  A.  M.  M.  (TABLE  XXXVI,  p.  299,  No.  390). 

4 Case  of  Corp'l  P.  Lovell,  Co.  C,  10th  Missouri,  left  thigh,  secondary  operation,  Spec.  2108  (TABLE  XL,  p.  322,  No.  160). 


SECT.  V.] 


PRIMARY    EXCISIONS    IN    THE    BONES    OF    THE    LEG. 


419 


21st  the  patient  was  much  the  same;  stump  looking  better;  pulse  110  and  full;  appetite  good;  no  pyoeinic  symptoms.  Artnnl 
cautery  was  applied  every  third  day,  thus  anticipating  the  occurrence  of  haemorrhage.  On  January  28th,  the  outer  portion  of 
the  stump  was  gangrenous  and  looked  badly;  patient  now  failing;  slough  cleansed  and  bromine  applied  with  good  efiVcf.  On 
January  31st,  the  artery  gave  away  further  above,  bleeding  again  profusely,  when  actual  cautery  and  pressure  were  successfully 
employed;  patient  losing  eight  ounces  of  blood  ;  very  feeble;  gangrene  progressing.  Haem 
orrhage  recurring  on  the  morning  of  February  2d,  I  consulted  with  the  other  members  of 
the  faculty,  when  it  was  icsolved  to  re-amputate,  which  was  promptly  done  by  Assistant 
Surgeon  R.  Bartholow  by  circular  incision  above  the  condyles  of  the  femur.  The  operation 
was  endured  but  indifferently  well.  Ether  was  solely  employed  in  the  production  of  anaes 
thesia.  The  patient  did  not  rally,  his  stomach  rejecting  all  food  and  stimulants;  pulse  100 
and  very  feeble  ten  hours  after  the  operation.  He  died  February  3, 1864."  The  specimen 
(No.  2108,  Sui-ff.  Sect.),  comprising  the  two  lower  thirds  of  the  tibia  and  fibula  and  repre 
sented  iu  the  wood-cut  (FiG.  273),  was  contributed  by  the  operator. 

CASE  711. — Sergeant  L.  Heath,  Co.  D,  2d  Michigan,  aged  22  years,  received  a  shot 
fracture  of  the  right  leg,  before  Petersburg,  June  18,  1864.  He  was  admitted  to  the  field 
hospital  of  the  3d  division,  Ninth  CO1'PS>  where  excision  was  performed  but  not  recorded. 
Assistant  Surgeon  A.  Ingram.  U.  S.  A.,  contributed  the  pathological  specimen,  shown  in  the 
annexed  cut  (FiG.  274),  with  the  following  report:  "The  patient  entered  Judiciary  Square 
Hospital,  Washington,  July  1st,  with  a  wound  about  the  junction  of  the  upper  and  middle 
thirds  of  the  tibia.  Resection  of  about  two  inches  of  the  continuity  of  the  bone  was  per 
formed  on  the  day  of  the  injury.  The  tibia  was  somewhat  shattered  for  about  an  inch 
above  and  below  the  points  of  resection.  Amputation  at  the  lower  third  of  the  thigh  was 
performed  in  this  hospital  on  July  7th,  by  Acting  Assistant  Surgeon  J.  H.  Thompson,  the 
condition  of  the  injured  parts  and  the  constitutional  state  of  the  patient  rendering  the  opera- 
The  circular  method  was  chosen  and  ether  was  used  as  the  anaesthetic.  Tonics  and  stimu 
lants  were  administered  after  the  operation.  Haemorrhage  to  the  amount  of  six  ounces  occurred  from  the  femoral  artery  on  July 
12th,  when  the  vessel  was  taken  up  in  Scarpa's  triangle.  Death  occurred  from  pyaemia  July  28,  Ie64.''  The  specimen  (No. 
2867,  Surg.  Sect.)  consists  of  the  upper  half  of  the  injured  tibia  and  shows  the  extremities  to  be  somewhat  irregularly  necrosed. 

TABLE  LXIII. 
Summary  of  Two  Hundred  and  fifteen  Primary  Excisions  in  the  Bones  of  the  Leg  for  Shot  Injury. 

[Recoveries,  1—148;  Deaths,  149—215.] 


FIG.  273.— Lower 
thirds  of  left  tibia 
and  fibula.  Spec. 
2108. 


tiou  necessary. 


FIG.  274. —  Upper 
half  of  right  tibia. 
Two  inches  of  shaft 
have  been  excised. 
.Spec.  2867. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS.  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  ANH  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1     Adams,    I.    X.,   Pt.,    D, 

April  2, 

Left  ;  5  inches  lower  part  tibia  ex 

14 

Carson,   J.  W..   Pt.,   B, 

June  18, 

Left  ;   4   inches   of  fibula.     Dis 

110th  Ohio,  age  29. 

2.  1865. 

cised  :  amputation  leg  April  12. 

7th  Ohio,  age  25. 

19.  1864. 

charged  July  5,'65  ;  leg  disabled. 

Disch'd  Sept.  11,  '65;  leg  useful. 

15     Chandler.  N.  W.,  Lieut., 

June  17, 

Left  ;  portion  of  upper  third  tibia 

2     *AUen,  ,  Major. 

April  6, 

Right;  6  inches  fibula.  Surgs.  B. 

H,    109th   New    York, 

18,  1864. 

excised.     Surg.  \V.  B.  Fox,  8th 

—  ,  18(52. 

W.  Avent  and  J.W.  Thompson, 

age  21. 

Mich.  Disc'd  Nov.  5,  '64  ;  unable 

C.  S.  A.     1866,  walks  well. 

to  walk  without  assistance. 

3     Andrews.  S.  B.,  Pt..  F, 

May  10, 

Right  :   2i   inches   tibia,   middle 

16     Clark,   G..    Lieut.  Col., 

April  2. 

Right  :  3  inches  upper  third  tibia 

72(1  1'enn.,  age  28. 

10,  1864.       third  ;  amputation  leg  Sept.  27. 

119th  Penn..  age  44. 

2,  1865. 

excised.  Must'd  out  June  19/65. 

Discharged  Nov.  27,  18G4. 

17     Clark,  J.,  Pt,   D,  26th 

Sept.  3, 

Left  :  2J  inches  of  fibula  excised. 

4 

Arnold,  L.,  Pt.,  G,  143d 

May  25,     Right  ;  tibia;  amp    leg  Mav  29. 

Illinois,  age  49. 

3,  1864. 

Ass't  Surg.  D.  Haldennan,  46th 

Penn.,  age  20. 

25,  18G4.  ;     Discharged  June  17,  1865." 

Ohio.     Disch'd  June  29,  1865; 

5 

Bain,   T.,    Pt.,   G,   60th 

July  4,     Left  ;  4  inches  tibia,  lower  third. 

can  only  walk  with  crutch. 

Illinois,  age  34. 

4,  1864.       Surg.  E.   But  well.    14th  Mich. 

18     Coddington,  R.,  Pt,,  C, 

Mav  3, 

Right  ;  4  inches  fibula  excised. 

Gangrene;  non-union.    Aug.  1, 

21st  New  Jersev,  age 

3,  1863. 

Mustered  out  June  19,  '63  ;  limb 

amp.  leg.    Disch'd  Mav  9,  '65.  i 

23. 

useless.     Died  May  4,  1867. 

6 

Bell,  U.  V.,  Pt.,  I,  5th 

July  2,     Right:  3j  inches  fibula,  middle 

19     Collier,  C..  Pt.,   G,  4th 

Mav  3. 

Right  :  5  inches  mid.  third  tibia 

Virginia. 

2.  1863. 

third.     Recovery. 

Ohio. 

5,  1863. 

excised.     Disch'd  Mar.  31,  '64  ; 

7 

Bennett,  N.,   Corp'l,  A, 

Oct.  8. 

Left  :  middle  third  tibia  excised. 

use  of  splint  necessary. 

7th  Michigan. 

8,1864.        Disch'd  July  18,  1865;   perma 

20     Collins,  F.,  Pt.,  A,  184th 

Oct.  19, 

Left  ;  2  ins.  fibula,  middle,  exc'd. 

nently  lame. 

New  York,  age  35. 

19,  1864. 

Disch'd  May  22,  1865. 

8 

Binqham.  J.  .If.,  Pt.,  K, 

Mar.  25,    Right;  mid.  third  tibia  excised. 

21     Cooper,  J.,  Pt.,  C,  10th 

April  2, 

Left  ;  2  inches  middle  third  tibia 

56th  N.  C.,  age  37. 

25,  1865.       Ass't  Surg.  E.  M.  Sinyser,  48th 

N.  Y.  Artillery,  age  25. 

2,  1865. 

excised.     A.  Surg.  O.  S.  Cope- 

Peon.     Released  Aug.  2,  1865. 

land,  10th  N.  Y.  Artillery.    Dis 

9 

Bovie,   P.    P..    Pt.,    B, 

July  4,     Left  ;  li  inch  lower  third  fibula. 

charged  July  19,  1865;  partial 

129th  Indiana. 

4,  1864.        Surg.   C.   D.   Moore,  13th  Ky. 

anchylosed  ankle  .joint. 

Disch'd  May  29,  1865;  partially 

22     Copeland,  M.,  Pt..  M,  1st 

Mar.  31, 

Right  :  upper  third  iibulaexcis'd. 

anchylosed  ankle. 

Maine  Cav.,  age  18. 

31,  1865. 

Disch'd   July   19,   1865.     1867. 

10     Bowers,  G.,  Pt.,  B,  77th 

Sept,  19, 

Right  :   5  inches  lower  half  fibula 

bone  discharged. 

i     New  York,  age  31. 

19,  1864.      excised.     Surg.  G.  T.  Stevens, 

23     Cowling.  J.  R.,  Pt.,  A, 

Julv  2, 

Right  :  3  inches  mid.  third  tibia 

77th    N.  Y.     Gang.:  haem.:  lig. 

62d  Penn.,  age  21. 

3,  1863. 

excised.      Surg.  J.   Kerr,   6'Jrt 

post,  tibial.    Diseh'd  June5.'65. 

Penn.     Mustered  out  Julv  l.\ 

11 

Brandon,  J.  <7.,Pt..Clay- 

Nov.  30, 

Right  ;  4  inches  mid.  third  tibia 

1864.     Amp.  leg  Sept.  21,  '1864. 

borne's  Escort,  age  19. 

Dec.  1, 

excised.     Sent  to  Provost  Mar 

24     Crawford.   L.  S.,  Pt.,  F, 

Sept.  22, 

Left  ;  3  inches  mid.  third  fibula 

1864. 

shal  March  27.  1865. 

126th  Ohio,  asre  21. 

22.  1864. 

excised.     Disch'd  Mar.  C,  1865. 

12     Brown.  W.C.,  Corp'l,  K,    Aug.  16,    '"iglit  :  portion  of  middle  third  of 

25     Croston.  W.,   Pt.,  F.  1st 

Aug.  15, 

Right:    portion   of  fibula.     Dis 

141st  Penn.,  age  21. 

17,  1864.        ibia:  removal  exfoliated  bone.  ' 

Mass.  II.  Art.,  age  24. 

15.  1864. 

charged  July  27.  1865. 

Disch'd  June  27,  '65:  necrosis. 

26     Crow.   E..   Pt..   C.  123d 

June  22, 

Left  ;  2  inches  middle  third  fibula 

13 

Burton,  G.  \V.,  Pt.,   E, 

April  2, 

Left  :  middle  third  tibia  (fracture 

New  York,  age  20. 

22,  1864. 

excis'd.  Surg.J.  Chapman.  12Cd 

.l*h  Wisconsin,  age  20. 

2,  1865. 

and    trephining    of    occipital). 

N.  Y.     Disch'd  March  27.  1865. 

Discharged  July  24.  18(!5:  leg 

27 

Denny.    M.,    Serg't,    F, 

Julv  20, 

Left  :  lower  third  fibula  excised. 

disabled. 

70th  Indiana,  age  37. 

20,  1864. 

Disch'd  July  7,  1865. 

1  THOMPSON  (J.  W.),  Cases  of  Resection.     Fractures  of  Upper  Third  of  Femur.     Gunshot  Wounds  of  Knee  Joint,  etc..  in  Nathmlle  Medical  Jour 
nal,  1866,  N.  S.,  Vol.  I,  p.  341  ;  and  Resection  of  the  long  Bones,  in  the  Medical  Record,  New  York,  Vol.  Ill,  1868-69,  p.  28. 

SURG.  Ill— 57 


450 


INJURIES    OF    THE    LOWEE    EXTREMITIES. 


[CHAP.  X. 


NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

NO 

DESCRIPTION,  AND  AGE. 

DATES. 

RESULT. 

Ii  (J. 

DESCRIPTION,  AND  AGE. 

RESULT. 

28 

Diekerson,  C.,  Corp'),  C, 

Dec.  4, 

Right  ;   2  inches  fibula   excised 

57 

Hersh,  Z.  E.,  Capt.,  B, 

April  2, 

Left  ;  3  inches  of  fibula  excised. 

51st  Indiana,  age  25. 

5,  1864. 

(also  fracture  left  tibia).     Mus 

87th  Penn.,  age  24. 

2,  1865. 

Mustered  out  June  29,  1865. 

tered  out  Mar.  8.  '65;  paralysis. 

58 

Hinsdale,    A.,     Pt.,    E, 

July  2, 

Left  :  4  inches  lower  third  tibia 

29 

Dodds,  W.  P.,  Pt.,   D, 

July  2, 

Left;  portion  uf  fibula.     Paroled 

137th  N.  York,  age  20. 

2,  1863. 

excised.    Surg.  H.  E.  Goodman, 

17th  Miss.,  ape  21. 

2,  1863. 

November  12,  1863;  union. 

28th  Penn.  Disch'd  May  15/65  ; 

30 

Driggs,  J.A.,  Pt.,  E,67th 

Oct.  27, 

Right;  2  inches  mid.  third  tibia 

ankle  joint  anchy.;  deformity. 

Ohio,  age  22. 

27,  1864. 

excised.     Surg.  A.  C.  Barlow, 

59 

Hogan,  J.,  Pt.,  F,  127th 

Dec.  13, 

Right  ;  6  ins.  middle  tibia  exc'd. 

62d  Ohio.    Disch'd  May  1  6,  '65  ; 

Pennsylvania,  age  41. 

14,  1862. 

Surg.  J.  P.  Prince,  36th  Mass. 

ligameutous  union  only. 

Exful.  of  sequestra.     Mustered 

31 

Dudley,  W.  W.,  Lieut. 

July  1, 

Right;  3  inches  mid.  third  fibula 

• 

out  May  29,  1863;  8  ins.  separa 

Col.,  19th  Ind.,  age  22. 

3,  1863. 

excised.     Surg.  J.  E.  Ebersole, 

tion  ;  deformity.     Died  May  14, 

19th  Ind.   Gang.;  hsem.   July  9, 

1877.     Spec.  2237. 

amp.  leg.     Disch'd  April  9,  '64. 

60 

Hollcroft,  W.,  Serg't,  L, 

April  8, 

Left  ;  3  inches  middle  third  fibula 

32 

Dunham,  H.,  1't.,  I,  2d 

Dec.  31, 

Right  ;  most  of  mid.  third  of  tibia 

2d  N.  Y.  Cav.,  age  24. 

8,  1865. 

excised.     Disch'd  July  3,  1865. 

Ohio,  age  23. 

18G2, 

excised.    Disch'd  August  3,'63; 

61 

Hope,   J.,   Pt.,  D,   51st 

July  30, 

Left  ;    portion   of   tibia  excised. 

Jan.  1,  '63. 

shortening  3  inches. 

New  York. 

30,  1864. 

Mustered  out  May  19,  1865. 

33 

Dunn,    M.,    Corp'l,    H, 

May  25, 

Left  ;  head  of  fibula  excised  (also 

62 

Hoy,   M.,    Pt.,    B,   61st 

May  3, 

Left  ;  portion  of  fibula  excised. 

46th  Penn.,  age  21. 

—  ,  18G4. 

amp.  rightthigh).  May27,  amp. 

New  York. 

3,  1863. 

Surg.  T.  C.  Wallace,  6Jst  N.  Y. 

left  thigh  ;  re-amp,  right  thigh. 

Recovery  July  14,  1863. 

Disch'd  August  17,  1865.     Died 

63 

Hurst,  \V.  L.,  Corp'l,  E, 

Sept.  20, 

Left  :  3  inches  middle  third  fibula 

October  23,  1877.     Spec.  3193. 

115th  Illinois. 

20,  1863. 

excised.     Disch'd  Aug.  3,  1864. 

34 

Farusworth,  R.  R.,  Pt., 

July  3, 

Right  ;  upper  and  middle  thirds 

64 

Ibach.   F.,   Pt.,   A,  9Dd 

May  5, 

Left  ;  2  inches  middle  third  tibia 

C,  7th  Mich.  Cavalry, 

4,  1803. 

tibia.    Aug.  6,  excised.   Disch'd 

Pennsylvania,  age  16. 

5,  1864. 

excised.     Disch'd  Oct.  6,  1864  ; 

age  32. 

July  1,  1864;  bone  diseased. 

permanently  disabled. 

35 

Ferguson,  W.  J.,  Pt.,  H, 

July  22, 

Left  ;  4J  inches  tibia,  upper  third, 

65 

Johnson,  J.  F.,    Serg't, 

June  20, 

Left  ;  4  ins.  middle  tibia  excised. 

81st  Ohio,  age  34. 

22,  1864. 

exc'd."  Surg.W.  C.  Jacobs,  81st 

H,  9th  Indiana,  age  26. 

20,  1864. 

Diseh'd  Nov.  4,  1864;  shorten 

Ohio.     Oct.  7,  spiculse  removed. 

ing  2  ins.  and  firm  union. 

Disch'd  May  12,  1865;  caries. 

66 

Johnson,  S.  P.,  Pt.,  B, 

July  28, 

Right  ;  portion  of  tibia  excised. 

36 

Fitch,  W.  T.,  Col.,  29th 

May  8, 

Right  ;  3  ins.  tibia,  middle,  exc'd. 

13th    South    Carolina, 

28,  1864. 

Surg.  D.   W.   Maull,  1st   Del. 

Ohio,  age  40. 

8,  1864. 

Surg.  A.  K.  Fifield,  2'.!th  Ohio. 

age  29. 

Sent  to  prison  Feb.  5,  1865. 

Resigned  Oct.  13,  1864.     1870, 

67 

Jones,  S.  W.,  Corp'l,  A, 

Oct.  8, 

Left  ;  2  inches  fibula  excised  ;  lig. 

bone  not  united. 

4th  Delaware,  age  29. 

8,  1864. 

post,  tibial  and  peroneal  arteries. 

37 

Flynn,  J.  P.,  Pt.,  E,  56th 

May  6, 

Left;   1  inch  fibula,  lower  third, 

Surg.  A.  A.  White,  8th  M:iry- 

Mass.,  age  34. 

6,  1864. 

exc'd.  Surg.J.  Barber.  1st  Penn. 

land.     Disch'd  June  22,  1865 

Reserves.    Disch'd  July  12,  '65; 

68 

Keech,  H.,  Pt.,  K,  2d  N. 

May  2, 

Left  ;  2  inches  fibula,  up.   third, 

ankle  lame. 

York  Cavalry. 

3,  1864. 

excised.     Ass't  Surg.  C.  H.  An- 

38 

Frair,  J.  E.,  Pt.,  F,  9th 

Oct.  19, 

Right;  4  inches  mid.  third  fibula; 

drus,  128th  N.  Y.     Furloughed 

N.  Y.  H.  Art.,  age  19. 

21,  1864. 

necrosis.  Disch'd  May  31,  1865  ; 

June  19,  1864. 

requiring  continuous  bandaging. 

69 

King,  J.  R.,  Serg't,  H, 

May  5, 

R't  ;  2  ins.  mid.  third  fibula  exc'd. 

39 

Freeman,  D.  B.,  Pt.,  G, 

Sept.  19, 

Left  :  3  inches  middle  third  fibula 

6th  Maryland,  age  21. 

6,  1864. 

Ass't  Surg.  R.  L.  Disbrow,  14th 

10th  Vermont,  age  22. 

21,  18C4. 

exc'd.     A.  Surg.  W.  G.  Bryant, 

N.  J.     Disch'd  May  18,  1865. 

122d  Ohio.    Disch'd  May  31  ,'65. 

70 

Koehler,  J.,  Pt.,  I,  150th 

May  5, 

Left;  4  ins.  low.  third  fibula  exc'd. 

40 

French,  G.  W.,  Pt.,  A, 

June  3, 

Left;  3  inches  upper  third  fibula 

Pennsylvania,  age  36. 

5,  1864. 

Surg.  W.  T.  Humphrey,  149th 

27th  Mich.,  age  27. 

3,  1864. 

excised.    Surg.H.E.  Smith,  27th 

Penn.  May  29,  amp.  leg.  Disc'd 

Mich.    Disch'd  April  18,  1865. 

April  19,  '65.     Specs.  2404,  3533. 

41 

Fuller,  A.,  Pt.,  G,  109th 

July  30, 

Left  ;  3  ins.  fibula,  low.th'd,  exc'd. 

71 

Lamb,  J.  M.,  Tt.,  A,  58th 

June  18, 

Right  ;  2  inches  upper  third  fibula 

New  York,  age  22. 

30,  1864. 

Surg.W.C.  Shurlock.  51st  Penn. 

Mass.,  age  22. 

18,  1864. 

excised.    Disch'd  July  31,  1865  ; 

Disch'd  May  16/65;  walks  well. 

wears  bandage. 

42 

Fyler,  O.  R.,  Lieut.,  I, 

Sept.  19, 

Left;  3  inches  middle  third  tibia 

72 

Lawcook,  T.,Pt.,K,151st 

Oct.  19, 

Left  :  2  ins.  low.  third  fibula  exc'd; 

2d  Conn.  Artillery,  age 

19,  1864. 

excised.     Surg.  H.  Plumb,  2d 

New  York,  age  31. 

19,  1864. 

caries.     Diseh'd  June  12,  1865; 

25. 

Conn.  Art.    Disch'd  April  0/65; 

ankle  deformed. 

deformity  of  tibia. 

73 

Leichty,  J.,  Pt.,  F,  8th 

May  11, 

Left  ;  (i  ins.  mid.  third  fibulaexc'd. 

43 

Gardner.   C.  J.,  Pt.,  B, 

Oct.  1, 

Left  ;  middle  third  fibula  excised. 

Pennsylvania,  age  21  . 

11,  1864. 

.    Surg.  T.  Jones,  8th  Penn.  Res. 

6th  N.  Hamp.,  age  32. 

1,  1864. 

Surg.  S.  Cooper,  6th  N.  Hamp. 

Ha?m.,  32  oz.;  lig.  posterior  tibial 

Disch'd  June  19,  1865. 

artery.     Disch'd  Jan.  11,  1865; 

44 

Gibbons,  J.,  Corp'l,   C, 

Dec.  13, 

Right  ;  3  inches  mid.  third  fibula 

bone  discharged,  1867. 

90th  Illinois,  age  22. 

15,  1864. 

exc'd.  Surg.  I.  N.  Barnes,  116th 

74 

Lewis,  J.,   Pt.,  G,  12th 

May  30, 

Right  ;  3  inches  mid.  third  fibula 

111.     Mustered  out  June  5,  1865. 

Mass.,  age  19. 

30,  1864. 

exc'd.     Surg.W.  H.  W.  Hinds, 

45 

Gibbons,  T.,  Pt.,  A,  125th 

June  16, 

Left  ;  fibula,  lower  third,  excised. 

12th  Mass.  Disch'd  March  8/65; 

New  York. 

16,  1864. 

Surg.  P.  E.  Hubon,  28th  Mass. 

regeneration  of  bone. 

Mustered  out  May  31,  1865. 

75 

Lisle,  J.  D.,  Pt.,  C,   1st 

July  3, 

Left;  portion  of  tibiaexc'd.    Surg. 

46 

Goldsmith,  W.H.,  Corp'l, 

June  9, 

Left;  4  inches  middle  third  tibia 

Maryland. 

4,  1863. 

A.  Chapel,  U.  S.V.     Removal  of 

F,  2d  New  Hampshire, 

9,  1864. 

excised.     Surg.  G.  P.  Greeley, 

fragments.    Disch'd  May  14/64. 

age  24. 

4th  N.  Hamp.    May  15/65,  amp. 

Spec.  1655. 

leg.     Disch'd  Oct.  14,  1865. 

76 

Lyon,  C.,  Pt..  D,  190th 

May  12, 

Left  ;  H  inch  up.  third  tibia  exc'd. 

47 

Gould,   D.  M.,  Pt.,  D, 

May  27, 

Left  ;  4  inches  up.  third  tibia  ex 

Pennsylvania,  age  25. 

12,  1864. 

Surg.  B.  Rohrer,  10th  Penn.  Res. 

102d  New  York,  age  21. 

27,  1864. 

cised.     Surg.  C.  II.  Lord,  102d 

Disch'd  January  16,  1865;  one 

N.  Y.     Disch'd  July  20,  1865  ; 

inch  shortening  ;  deformity. 

constant  support  required;  false 

77 

Mattern,  L.,  Pt.,  F,  184th 

May  30, 

Left  ;  4  inches  middle  third  fibula 

joint.     Spec.  2">52. 

Pennsylvania,  age  19. 

30,  1864. 

excised.     Surg.   M.    Rizer,  72d 

48 

Graham,  J.,  Pt.,  B,  74th 

June  21  , 

Right  ;  middle  third  tibia  excised. 

Penn.     Disch'd  May  27,  1865. 

Illinois. 

21,  1864. 

Surg.W.  P.  Pierce,  88th  Illinois. 

78 

Maves,  J.  H.,  Corp'l,  F, 

Mar.  25. 

Right  ;  5  inches  mid.  tibia  exc'd.. 

Disch'd  June  6,  186.');  necrosis. 

6th  Ky.  Cavalry. 

25,  1863. 

Disch'd  Sept.  16,  1863. 

49 

Green,  F.  F.,  Pt.,  B,  12th 

July  1, 

Left  ;  lower  portion  of  fibula  ex 

79 

McCandless,  A.,  Corp'l, 

Sept.  3, 

Left;  (i  inches  middle  tibia  exc'd. 

Georgia,  age  21. 

3,  1863. 

cised.     Paroled  Nov.  12,  1863. 

K,  8th  Ohio   Cavalry, 

6,  1864. 

Discharged  Juno  28,  1865  :  limb 

50 

Gurlr.y,  W.  H.,  Pt.,  D, 

July  3, 

Left  ;  3  inches  middle  third  tibia 

age  35. 

shortened  2  inches.     Died  Feb. 

4th  N.  Carolina,  age  30. 

3,  1863. 

excised.    Exch'd  Nov.  12,  1863. 

18,  1877;  phthisis. 

51 

Hall,  J..  Corp'l,  A,  107th 

Mar.  19, 

Left;  portion  of  fibula  excised. 

80 

McCarty,  C.,  Corp'l,  E, 

June  30, 

Right;  3  inches  middle  third  tibia 

New  York. 

19,  1865. 

Discharged  July  15,  1865. 

1st  New  York,  age  28. 

30,  1862. 

excised;  nee.;  slough.   Aug.  28, 

52 

Hannoway,  J.,   Pt.,  A, 

Aug.  15, 

Right  ;  i  inch  fibula,  lower  third, 

leg  amp.     Disch'd  May  11,  1863. 

69th  N.  Y.,  age  39. 

15,  1864. 

excised.     Surg.  G.  Chaddock, 

Died  August  21,  1867. 

7th  Mich.    Disch'd  June  23,  '65. 

81 

McCracken,  R.W.,  S'g't, 

June  17, 

Right  ;  upper  third  fibula  excised. 

53 

Harris,  H.  A.,  Lieut.,  B, 

July  2, 

Left  ;  4  inches  fibula,  upper  third. 

C,  170th  N.  Y.,  age  32. 

17,  1864. 

Surg.  F.  Douglas,  170th  N.  Y. 

Kith  Mass.,  age  22. 

—  ,  1863. 

Disch'd  Dec.  19,    1863.      Died 

Also  wound  <  if  anterior  tibial  art 

June  24,  1865. 

ery  and  side.   June  22,  ligation. 

54 

Hatch,  D.  A.,  Pt.,  C,  2d 

July  3, 

Right;  2  inches  mid.  third  tibia 

Disch'd  Jan.  20,   1865;  anchy 

Massachusetts,  age  25. 

5,  1863. 

excised.    Surg.AV.  H.  Heath,  2d 

losis  of  ankle  joint. 

Mass.     Amp.  leg  Dec.  16.     Dis 

82 

McDonald,  B.,  Pt.,A,  8th 

1    c.  16, 

Right;  3  inches  lower  third  fibula 

charged  April  2,  '64.  Spec.  2155. 

Kansas,  age  28. 

1864. 

excised.   A.A.Surs.  M.  L.  Ilerr. 

55 

Hendley,  J.  B.,  Pt.,  D, 

June  27, 

Left;  :i^  inches  mid.  third  fibula 

Duty  August  1,  1865. 

46th  Ohio. 

27,  1864. 

exc'd.    A.  Surg.  D.  Halderman, 

83 

McGuire,  J.,  Pt.,  F,  20th 

Dec.  13, 

Right  ;  4  inches  mid.  third  fibula 

46th  Ohio.     Disch'd  Apr.  10/65. 

Massachusetts. 

13,  1862. 

and  splinters  of  tibia  excised. 

56 

Henry,  C.,  Pt.,  I,  29th 

May  15, 

Right  ;  3  ins.  low.  th'd  tibia  exc'd. 

Disch'd  May  28,  1863  ;  shorten 

Pennsylvania,  age  19. 

15,  1864. 

Surg.  G.  P.  Oliver,  lllth  Penu. 

ing  ;  deformity. 

Disch'd  June  29,  1865;  necrosed 

84     McKim,  W.,  Pt.,  L,  8tli 

.Tune  11, 

Left  ;  middle  third  fibula.    Dis 

bone  removed  ;  deformity. 

Penn.  Cav.,  age  23. 

11,  1864. 

charged  Nov.  10,  1864. 

1 

SECT.  V.J 


PRIMARY    EXCISIONS    IN    THE    BONES    OF    THE    LEG. 


451 


NO. 

NAME,  MILITARY 
DESCUIPTIOX,  A.ND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MII.ITAHY 
DESCRIPTION,  AXD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

83 

Measor,    J.,    Serg't,    C, 

Oct.  29, 

Left  ;  post,  portion  up.  third  tibia 

117 

Sodon,  R.  D.,  Corp'l,  I, 

May  25, 

Left  ;    portion   of   tibia  excised. 

137th  N.  York,  age  37. 

29,  1803. 

exc'd.    Surg.  A.  K.  t'ilield,  2!:th 

33d  New  Jersey. 

25,  1864. 

Sitrg.  J.  Roily,  3:;d  New  Jersey. 

Ohio.     Aug.  22,  1864,  excision 

Disch'd  July  14,  1805. 

anterior  portion.     Disch'd  April 

118    Sprague,  O.,  Pt.,  I,  8th 

June  15, 

Left;    portion  of  fibula   excised. 

5,1805;  shortening;  deformity. 

Connecticut. 

15,  1864. 

Disch'd  July  19,   1K65;  partial 

86 

Montgomery,  S.,  Pt.,  I, 

May  12, 

Left;  2  inches  tibia  excised.   July 

anchylosis  of  ankle  ji.int. 

13:)th  Pennsylvania. 

12,  1804. 

29,  amputation  thigh.     Disch'd 

119 

Spring.  W.F.,  Serg't,  C, 

Mav  14, 

Lett;  6  ins.  tibia  excised.  Surg. 

August  2,  1865. 

44th  Illinois,  age  y!*. 

15/1804. 

W.  I'.  Pierce,  88th  HI.     Disch  d 

-; 

Moore,  J.W.,Major,  97th 

June  22, 

Left  ;  2  inches  lower  third  fibula 

Mar.  18.  '05;  non-union;  useless. 

Ohio. 

22,  1804. 

excised.   Surg.  E.  15.  (5  lick,  4lth 

120 

Steih,  D.,  Pt.,  F,  9th  N. 

Oct.  19, 

R't  ;  inn.  part  low.  th'dtibiaexc'd. 

Indiana.    Resigned  Oct.  7,  1804. 

Y.  Il'vy  Artillery. 

20,  1864. 

Disch'd  June  20,  18'i5;  necrosis. 

88 

Moore,    W.,    Corp'l,  E, 

June  3, 

Right  ;  portion  of  fibula  excised. 

121 

Stermer,  P.,  Pt.,  F,  5th 

Nov.  25, 

Left  ;  3  ins.  low.  third  fibula  exc'd. 

71st  Penn  ,  age  29. 

3.  1804. 

Discharged  March  22,  1805. 

Iowa,  age  25. 

25,  1803. 

A.Surg.W.  11.  Darn  iw,.r)ih  Iowa. 

89 

Morse,  F.E.,Pt.,H,  17th 

Mav  12, 

Right  ;  lower  third  tibia  excised. 

Disch'd  July  18,  1804. 

Maine,  age  23. 

12,  1804. 

Disch'd  May  11,  1865;  necrosis 

122 

Stevenson,  J.  A.,  Adj't, 

April  1, 

Right  ;  3  inches  middle  third  tibia 

and  exf  illation. 

llth  Penn.,  age  27. 

1,  1805. 

excised.     Surg.  J.  \V.  Anawnlt, 

90 

Morse,  S.  C.,  Pt.,  F,  97th 

May  10, 

Right  ;  2J  inches  low.  third  fibula 

llth  Penn.    Disch'd  July  1,  '65  ; 

New  York,  age  25. 

11,  1864. 

excised.    Disch'd  Dec.  12,  1804. 

separation  of  1  h  inch. 

91 

Mosier,  W.,  Pt.,  C,  148th 

May  10, 

Left;   3J   inches  fibula  excised. 

123 

Stief,  P.,  Pt.,  K,  139th  N. 

July  30, 

Right  ;  lower  third  tibia  excised; 

Pennsylvania,  age  35. 

10.  1804. 

Disch'd  May  9,  '05.    1809,  caries. 

York,  age  39. 

30,  1804. 

hasm.  A  ug.  1  0  amp.  le":.  Disc'd. 

92 

Moury,    B.    S.,    Pt.,   B, 

Oct.  29, 

Left  ;  port.ion  of  mid.  third  tibia 

124 

Stinebuck.  P..,  Serg't,  E, 

Nov.  24,    Right  :  3J  ins.  fibula  exc'd.  Stirg. 

137th  New  York. 

29,  1863. 

exc'd.     Surg.  J.  L.  Dunn,  109th 

2d  Michigan,  age  27. 

25,  1863. 

J.  P.  Prince,  30th  Mass.  Disch'd 

Penn.    Disch'd  May  24,  1865. 

May  25,  1804;  lame. 

93 

O'Connor,!.,  Pt.,G,  90th 

Dec.  13, 

Right  ;  5  inches  mid.  thi»d  fibula 

125 

Stocdale,\V.,  Pt.,  B,  48th 

May  14, 

Right;  portion  «,f  fibula  excised. 

Illinois,  age  23. 

13,  1864. 

excised.   Ass't  Surg.  C.  15.  Rich 

Indiana,  age  28. 

14,  1803. 

July  0,  amputation  thigh.     Dis 

ards,  U.S.  V.    Disch  dJuneO,  '05. 

charged  July  15,  1805. 

94 

O'Mnley,  J.,  Pt.,  L,  2d 

July  1, 

Left  ;  upper  third  tibia.     Disch'd 

126 

Strass,  G.  N.,  Serg't,  E, 

June  30, 

Left  ;  2  inches  of  tibia  excised. 

N.  Y.  M.  R.,  age  32. 

1,  1864. 

July  31,  1865;  leg  Hexed. 

10th  Alabama,  age  25. 

30.  1864. 

Furloughed  Sept.  3<>,  1804. 

95 

O'Rourke,  P.,  Pt.,  F,  7th 

May  :U, 

Left  ;  6  ins.  low.  third  tibia  exc'd. 

127 

Sweet,  15.  R.,  Pt.,A,26th 

June  14. 

Left  ;   upper  third  tibia  excised. 

N.Y.  H'vyArt.,  age  41. 

31,  1864. 

Surg.  (}.  L.  Potter,  145th  Penn. 

Conn.,  age  45. 

14.  1863. 

Mustered  out  August  17,  1803. 

June  6,  leg  amputated.    Disch'd 

128 

Sweitzer.C.,  Pt.,A,208th 

Mar.  25, 

Left  :  3  inches  middle  third  fibula 

July  28,  '05.     Specs.  1502,  3546. 

Pennsylvania,  age  44. 

25,  1805. 

excised:    gang.     Disch  d   July 

96 

Pattee,  J.  H.,Pt.,H,  26th 

Sept.  19, 

Left  ;  2  ins.  low.  third  tibia  exc'd. 

15,  J805.     Died  March  14,  1875. 

Ohio,  age  23. 

21,  1863. 

Jan.  21,  1864,  amp.  knee  joint. 

129 

Taylor,  W.C.,  Pt.,  M,  4th 

Aug.  25, 

Right  ;  2  inches  internal  edge  up. 

Discharged  July  14,  1804. 

Wisconsin  Cav.,  age  23. 

27,  1864. 

third  tibia  excised.     A.  A  Surg. 

97 

Peden,  W.  B  ,  Corp'l,  A, 

Nov.  29, 

Right  ;  amp.  left  leg.    Surg.  J.  P. 

J.  F.  Musgrave.   Dis.  Mar.  5.'05. 

]7th  Mississippi. 

29,  1803. 

Prince,  30th  Mass.    Exchanged. 

130 

Thiebeau,  A.,  Serg't,  I, 

April  6, 

Left  :  middle  third  fibula  excis'd. 

98 

Penroad,  G.  W.,  Pt.,  E. 

Sept.  30, 

Left  ;  2  inches  middle  third  fibula 

24th  New  York  Cav. 

6,  1805. 

Discharged  June  28.  1805. 

l.'Jth  Ohio  Cavalry,  age 

30,  1864. 

excised.    Surg.  W.  C.  Shurlock. 

131 

Thistlewood,  R.  K.,  Pt., 

Sept.  19, 

Left  ;  lower  third  tibia   excised. 

22. 

51st  Penn.    Disch'd  Nov.  21,  '05; 

E,  7th  Maine. 

19,  1864. 

Surg.  G.  T.  Stevens,  77th  N.  Y. 

cartilaginous  union  to  tibia. 

Discharged  April  :!,  1805. 

99 

Pitts,  B.  F.,  Pt.,  K,  123d 

May  25, 

Left  ;  2J  inches  mid.  third  fibula 

132 

Thomas,  AV.,Pt.,K,110th 

Mar.  25, 

Right  :  mid.  third  fibula  excised. 

New  York,  age  25. 

27,  1864. 

exc'd.    A.  Surg.  L.W.  Kennedy, 

Ohio,  age  24. 

25,  1805. 

Discharged  June  20,  1805. 

123d  N.  Y.     Disch'd  April  3,'05. 

133 

Toomey,  J.  J.,  Pt..I,29th 

May  15, 

Left  ;   lower  third  tibia  excised.. 

100 

Posey,  O.,  Pt.,  H,    31st 

July  22, 

Left  ;  3  inches  lower  third  fibula 

Pennsylvania,  age  21. 

15,  1864. 

Surg.  H.  B.  Whiton.  00th  N.  Y. 

Illinois. 

22,  1804. 

excised.    Disch'd  July  19,  1805; 

May  31,  amputation  leg.     Dis 

ligameutous  union. 

charged  July  2,  '05.    Spec.  3361. 

101 

Powell,    T.,  Pt.,  F,  6th 

Jan.  15, 

Left;  3  inches  lower  third  tibia 

134 

Trent,  J.  L.,  Corp'l,  B, 

May  5, 

Right;  lower  third  tibia  excised. 

Colored  Troops,  age  30. 

15,  1865. 

excised  ;  necrosis.  April  26,  '65, 

63d  Penn.,  age  24. 

5,  1864. 

Surg.  G.  T.  Stevens,  77th  N.  Y. 

amp.  leg.     Disch'd  Oct.  14,  '65. 

Disch'd  May  4,  '05  ;  3  ins.  short. 

102 

Powers,  R.M.,  Serg't,  E, 

Nov.  30, 

Left  ;  2  inches  upper  third  fibula 

135 

Tucker,  N.,  Pt.,  B,  43d 

July  30, 

Left  ;  2J  ins.  low.  third  tibia  exc'd. 

4yth  Tenn.,  age  25. 

30,  1864. 

excised.   Transferred  to  Provost 

Colored  Troops. 

31,  '1864. 

Surg.  F.  M.  Weld,  27th  C.  T. 

Marshal  Jan.  3,  1805. 

Disch'd  May  27,  1805*  atrophy. 

103 

Ready,  W.  B.,  Corp'l,  E, 

Nov.  16, 

Right;  por.  low.  third  tibia  exc'd. 

136 

Verstrappen,  J.,  Pt.,  H, 

April  6, 

Left;  4  inches  middle  third  fibula 

2d  Michigan,  age  25. 

16,  1863. 

Disch'd  June  11,  1864;  perma 

1st  Maine,  age  20. 

6,  1865. 

excised.     Must,  out  July  2,  '05; 

nently  lame.    Died  Sept.  9,  '06, 

anchylosis  ankle  joint. 

ulterior  effect  of  injury. 

137 

Walsh.  P.,  Pt.,  A,  69th 

June  3, 

Left  ;  portion  of  upper  third  tibia 

104 

Ried,  J.  H.,  Lieut.,  K,  3d 

Nov.  29, 

Right  ;  5  ins.  fibula  excised.     To 

New  York  N.G.,  age  29. 

3,  1864. 

exc'd.   Surg.  J.  A.  Spencer,0!ith 

Miss.,  age  20. 

3(i,  1864. 

Provost  Marshal  March  7,  1865. 

N.  Y.    June  H,  amputat'n  thigh. 

105 

Rogers,  S.  T.,  Lieut.,  A, 

June  27, 

Left  ;  2  inches  upper  third  fibula 

Disch'd  Sept.  20,  1805. 

80th  Illinois,  age  23. 

27,  1864. 

excised.   July  17,  excision  head 

138 

Warfield.  A.  B.,  Serg't,  E, 

May  25, 

Left;  small  portion  fibula  excis'd. 

of  fibula.   Disch'd  Oct.  25,  1804  ; 

7th  Rhode  Island. 

25,  1864. 

Surg.  J.  Harris,  7th  R.  I.     Dis 

passive  motion  only. 

charged  June  3,  1805. 

106 

Ronald,  J.  S.,  Corp'l,  A, 

June  18, 

Left  ;  4  inches  lower  third  fibula 

139 

Warren,  D.  A.,  Serg't.C, 

Mar.  19, 

Left  ;  lower  third  fibula  excised. 

97th  New  York,  age  30. 

18,  1864. 

excised.  Disch'd  June  23,  1805; 

55th  Ohio,  age  29. 

19,  1865. 

Discharged  July  3,  1865. 

constant  bandaging  ;  anch.  ank. 

140 

Wehmhoff,    H.,  Pt.,  P, 

May  14, 

Left  ;  2  inches  middle  third  tibia 

107 

Rose,  F.,  Pt.,  L,  1st  Mis 

Dec.  25, 

Left  ;  4J  inches  middle  third  tibia 

12th  Missouri,  age  30. 

14,  1864. 

excised  :  necrosis.     Discharged 

souri  Artillery,  age  19. 

26,  1803. 

excised.     Disch'd  Jan.  27,  1865. 

Sept.  19,  1864:  anch  y.  ank.  joint. 

108 

Rosemond,  \V.  E  ,  Capt., 

June  22, 

Left  ;  1  J  inch  middle  third  fibula 

141 

Weyl,  J.,  Serg't,  E,  5th 

Dec.  16, 

Right  ;  2J  inches  lower  third  tibia 

A,  97th  Ohio,  age  23. 

22,  1804. 

excised.  Surg.  E.  B.  Click,  40th 

Minnesota,  age  32. 

16,  1864. 

excised.     Disch'd  April  14,  '05. 

Indiana.     Disch'd  Oct.  7,  1864. 

Died  Jan.  20,  '77  :  absc.  of  over. 

109 

Runyan,C.  A.,  Musician, 

May  3, 

Left;  4  ins.  tibia  excised.     Surg. 

142 

Wiggs,  B.,  Pt.,  K,  43d 

July  11, 

Left  ;  3  inches  middle  third  fibula 

F,  !)th  New  York  Il'vy 

3,  1863. 

S.  A.  Sabin,  9th  N.  Y.  Heavy 

North  Carolina,  age  24. 

11,  1864. 

exc'd.    Surg.  —  Brewer,  C.S.  A. 

Artillery,  age  19. 

Artillery.     Oct.  17,  leg  amputa 

To  prison  February  5,  1  805. 

ted.     Disch'd  July  26,  1865. 

143 

Wilkins,J.S.,~L\e\it.,H, 

Sept.  3, 

Left;  2  inches  lower  third  fibula 

110 

Rusk,  ,T.D.,Pt.,G,  ]  07th 

May  31, 

Left  ;  4  inches  lower  third  fibula 

21st  Miss.,  age  20. 

—  ,  1804. 

excised.     To  prison  Dec.  9,  '04. 

Illinois,  age  26. 

31,  1864. 

excised.     Surg.  J.  W.  Lawton, 

144 

Williams,  J.6.,  Capt.,  D, 

July  3, 

Right  :  upper  third  tibia  excised. 

U.  S.V.     Disch'd  Dec.  12,  1864  ; 

12th  Mass.,  age  43. 

—  ,  1863. 

Disch'd  June  8.  '04.     Died  April 

uses  crutches. 

4,  1875;  phthisis  piilmonars. 

111 

Ryan,  P..  Pt.,K,9th  Con 

Jan.  5, 

Right;    1J  inch  upper  third  tibia 

145 

AVilliamson.R.J.,  Lieut., 

May  29, 

Left;  3  ins.  up.  third  tibia  exc'd. 

necticut,  age  19. 

5,  1804. 

excised.    Surg.  E.  A.  Thompson, 

D,  66th  111.,  age  27. 

29,  1864. 

Surg.   J.    Pogue.  00th    Illinois. 

12th  Me.    Disch'd  May  17,  1865'; 

Disch'd  Jan.  4.  '05;  leg  useless. 

knee  joint   anchyl'd;   3  inches 

146 

Wilson,  S.,  Pt.,  E,  7th 

Oct.  27, 

Right;  lower  third  fibula  excised. 

shortening.     Spec.  2530. 

West  Virginia. 

27,  1864. 

Surg.  W.  I.  Burr.  42d  N.  York. 

112 

Sieger,  J.,  Pt.,  K,  16th 

Mav  8, 

Right  ;  middle  third  tibia  excised  ; 

Mustered  out  June  29.  1805. 

Michigan,  age  21. 

8,  1864. 

caries.     Disch'd  Feb.  20,  1865; 

147 

Wilson,  T.  C.,  Capt.,  D, 

July  9, 

Left  ;  2  inches  lower  third  fibula 

deformity. 

27th  Virginia,  age  23 

9,  1804. 

excised.     To  prison  Oct.  9.  '04. 

113 

Smith,  E.  J.,  Corp'l,  H, 

May  23, 

Left  ;  middle  third  tibia  excised. 

148 

Zimmerman,  J.,  Serg't, 

Oct.  19, 

Right  ;  4  inches  lower  tliinl  fibula 

56th  Pennsylvania. 

23,  1864. 

Disch'd  July  1,  1805;  shorten 

E,  1st  West  Va.,  age  23. 

22,  1804. 

excised.    Disch'd  July  -^7,  1865; 

ing  i  inch. 

partial  anchylosis  ankle. 

114 

Smith,  S.  B.,  Pt.,  I,  15th 

Oct.  7, 

Right  ;  4  ins.  middle  third  fibula 

149 

Adams,  M.,Pt,B,  130th 

July  21, 

Left  :  2  ins.  mid.  third  tibia  exc'd. 

Alabama,  age  25. 

7,  1804. 

excised.     Retired  Feb.  9,  1865. 

Indiana,  age  24. 

21,  1864. 

Surg.  J.  \V.   Lawton,  I".  S.  V. 

115 

Snooks,  I.,  Serg't,  H,  23d 

Oct.  in, 

Left  ;  mid.  th'il  tibia  exc'd  ;  necro. 

Gangrene.    Died  Sept.  20.  1804. 

Ohio. 

19,  1804. 

Disch'd  May  9,  1805:  deformity. 

150 

Alley,  S.  D.,  Pt.,  B,  99th 

May  25, 

Left:  li  inch  fibula  exc'd.    Surg. 

116 

Snow,  n.,  Pt.,  L,  4th  Va. 

May  5, 

Right  ;  portion  of  head  of  fibula 

Indiana. 

25,  1864. 

R.  M.Trris.   103d  Illinois.     Died 

Cavalry,  age  23. 

5,  1864.       excised.     To  prison  Jan.  27,  '05. 

Sept.  3,  1864. 

452 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

NO 

NAME,  MILITARY 

DATES 

OPERATIONS,  OPERATORS, 

No. 

DESCRIPTION,  AXI>  AGE. 

DATEB. 

RESULT. 

DESCRIPTION,  AND  AGE. 

RESULT. 

151 

Atwood,  N.  H.,  Pt,,  C, 

April  2, 

Right  ;  portion  of  fibula  excised  ; 

182 

Jamison,  B.  A.,  Pt.,  A, 

July  3, 

Left;    lower  third  tibia  excised. 

6th  Vermont,  age  22. 

2,1865. 

slough'g.    April  13,  amp.  thigh. 

21st  Virginia,  age  21  . 

6,  1863. 

Surg.  J.  A.  Wolf,  -J9th   Penn. 

Died  May  23,  1865:  pyaemia. 

Died  July  18.  18(13:  tetanus. 

152 

Babcock,  E.  H.,  Pt.,  K, 

July  3, 

Left  ;  port.  up.  third  fibula  :  gang. 

183 

Johnson,  D.  A.,  Pt.,  E, 

Nov.  7, 

Right  ;  portion  of  tibia  excised  ; 

1st  Michigan  Cavalry, 

3.  L863. 

Oct.  18.  haem.,  3  pts.;  lig.  ante. 

4Jd  New  York,  age  37. 

7.  186:i. 

non-union.     July  2,  j8(>4,  amp. 

age  39. 

tibia!  artery.    Died  Oct.  18,  '63, 

thigh.     Died  August  6,  1864. 

effects  of  hiem.    Spec.  2(511  . 

!l84 

Lancaster,  W.  B.,  Pt.,  B, 

June  18, 

Right  :  middle  third  tibia  exc  d  ; 

153 

Barrett,  J.  E.,  Lieut.,  D, 

June  15, 

Left  :  2  inches  middle  third  fibula 

66th  N.  C.,  age  20. 

18,  1864. 

gangrene.     Died  July  16,  18l>-1. 

9  1st  Indiana. 

15,  1864. 

excised.     Surg.  J.  W.  Lawton, 

185 

Lay,   T.  S.,  Pt..  D,  53d 

Mar.  25, 

Left;  head  of  fibula  and  pan  of 

U.  S.  V.     Died  July  20,  1864. 

Georgia,  age  21. 

25,  1865. 

tibia  exc  d.     D:ed  April  21,  '65. 

154 

Biehl,  N.,  Pt.,  I,  155th 

June  19, 

Right;  2ins.mid.  third  tibia  exc'd. 

186 

Lemon,  T.  A.,  Corp'l,  A, 

May  11, 

Lef'.    8  inches  tib.  a  t  xcised.  Died 

Pennsylvania,  uge  27. 

21,  1864. 

Surg.  J.A.  E.  Reed,  155th  Penn. 

61st  Pennsylvania. 

11,  1864. 

May  16,  1864. 

July  19,  amp.  thigh.    Died  July 

187 

Lohser,  A.,  Pt.,  I,  24th 

May  25, 

Left;  nj  inches  u.id  third  fibula 

21,  1864  :  exhaust'n.   Spec.  3337. 

Michigan,  age  20. 

25,  1864. 

excised;    also   wound  of   right 

155 

Blair,  W.  F.,  Pt.,  H,  5th 

May  12, 

Left  ;  3  inches  lower  third  fibula 

ankle.     Died  June  17,  1864. 

Penn.  Res.,  age  28. 

12,  1864. 

excised.     Surg.  B.  Rohrer,  10th 

188 

Lovell,  P.,  Corp'l,  C.lOth 

Nov.  25, 

Left;  2J  inches  lower  third  tibia 

Penn.  Res.   Wire  sutures.    Died 

Missouri,  age  41. 

25,  1863. 

exc'd.    Jan.  10,   64.  haem.  from 

June  12,  1864  ;  pyaemia. 

post.  tib.  art.;  amp.  leg;  slough.; 

156 

Canfield,  D.,  Serg't,  M, 

June  17 

Right  ;  2  ins.  lower  third  excised. 

haem.;  gang.  Feb  2,  amp.  thigh. 

14th  N.Y.  H.A.,age20. 

17,  1864. 

Died  July  28,  1864. 

Died  Feb.  3,  1864.     S/>ec.  2108. 

157 

Canter,   J.,  Pt..,   E,  53d 

June  27, 

Left;  3  inches  middle  third  tibia 

189 

Mann,  A.  A..  Corp'l.  A, 

April!, 

Right;  middle  thirl  tibia  exc'd. 

Ohio. 

28,  1864. 

exc'd.     Surg.  A.  C.  Messenger, 

16th  Maine. 

1,  1865. 

Died  April  24,  186"). 

57th  Ohio.     Died  July  3,  1864. 

190 

Martz.  S.  V.,  Pt.,  I.  87th 

Mav  18, 

Right  ;  upper  third  fibula  exc'd. 

158 

Carpenter,  J.  H.,  Pt.,  E, 

June  22, 

Left;  1J  inch  upper  third  fibula 

Pennsylvania. 

18,  1864. 

Died  June  4,  1864. 

110th  Penn.,  age  40. 

22,  1864. 

excised.     July  5,  1864,  amputa 

191 

'Mclnt_yre,  A.,Corp'l,  D, 

June  22, 

Left;  2  inches  upper  third  fibula 

tion  thigh.     Died  July  16,  1864  ; 

6th  New  York  Heavy 

23,  1864. 

exc'd.    Aug.  5,  parench.;  ha-m. 

pyaemia.     Spec.  2759. 

Artillery,  age  37. 

Died  Aug.  10,  1864;  pya'inia. 

159 

Carroll,  F.,  Pt.,  K,  45th 

June  3, 

Right  ;  3  ins.  middle  third  fibula 

192 

Meade,  L.,  Pt.,  B,  2d  N. 

June  18, 

Right;  middle  third  tibia  exc'd. 

Penn.,  age  23. 

4,  1864. 

excised  ;  haem.,  8  oz.     June  18, 

York  M.  R.,  age  17. 

18,  1864. 

Died  July  17,  1864. 

1864,  amput'n  knee  joint.    Died 

193 

ilunn,  J.,  Pt.,   E,  15th 

Oct.  7, 

R't  ;  3J  ins.  mid.  th'd  tibia  exc'd. 

June  22,  1864  ;  exhaustion. 

Alabama,  age  32. 

7,  1864. 

Died  July  9,  '65  ;  chr.  diarrhoea. 

160 

Carter,  T.F.,Pt.,E,  12th 

May  13, 

Right;  2  inches  tibia  and  fibula 

194 

Norman,  C.  H.,  Pt.,  K, 

May  8, 

Left;   portion  of  fibula  excised. 

Indiana. 

14,  1864. 

excised.    Surg.  W.  Lomax,  12th 

8th  Maryland,  age  20. 

8.  1864. 

Died  May  22,  '64  ;  haemorrhage. 

Indiana.     Died  May  31,  1864. 

195 

Rader,  J.,  Pt.,  F,  59th 

Aug.  19, 

Left  ;  4$  inches  middle  third  tibia 

161 

Chaffee,  A.  J.,Pt.,E,  44th 

July  3, 

Right  ;  3  inches  tibia  exc'd  ;  also 

Illinois,  age  21. 

19,  1864. 

exc'd.     Dec.  7,  '64,  amp.  thigh  : 

New  York,  age  28. 

4.  1863. 

wound  left  leg.     Died  Aug.  16, 

gang.    Died  Jan.  4,'65;  exhaus. 

1863;  diarrhoea  and  erysipelas. 

196 

Reed,  N.  H.,  Pt.,H,  30th 

June  15, 

Right  ;  middle  third  tibia  fxr'd. 

162 

Cook,J.  T.,  Pt.,K,2dN. 

April  1, 

Left;  portion  of  tibia  exc'd;  also 

Iowa. 

15,  1864. 

Surg.  B.  A.  Bond.  27th  Missouri. 

York  Cavalry. 

1,  1865. 

w'ndofarm.     Died  April  11,  '65. 

Died  July  10,  1864. 

163 

Cosman,  W.  T.,  Corp'l, 

Sept.  17, 

:  portions  of  tibia  and  fibula 

197 

Rice,  H.,  Corp'l,  C,  36th 

Mav  25, 

Right;    head   of  fibula  excised. 

F,  9th  New  York  S.  M. 

20,  1862. 

exc'd.  Died  Oct.  2,  '62  :  pyaemia. 

Massachusetts. 

—  ,  "1864. 

Died  June  1,  1864.  of  wound. 

164 

Cramp,  T.,  Pt.,  G,  5th 

Dec.  16, 

Right:  4  ins.  low.  third  tibia  exc'd. 

198 

Rice,  W.,  Pt.,  B,    14th 

June  22, 

Right  ;  3  inches  mid.  third  fibula 

Minn.,  age  33. 

17,  1864. 

Surg.  V.  B.  Kennedy,  5th  Minn. 

Kentucky,  age  29. 

22,  1864. 

excised.     Surg.  J.  W.  Lawton. 

Lac.  wound  post,  t'ibial  artery. 

U.  S.V.     Died  Sept.  22,  1864. 

Dec.  27,  lig.     Died  Feb.  4,  1865. 

199 

Robbins,  J.  A.,  Capt.,  G, 

June  29, 

Left  :  2J  inches  upper  third  fibula, 

165 

Davis,  S.,  Pt.,  F,  27th 

Mav  24, 

Left  ;    portion  of  fibula  excised. 

129th  Indiana. 

29,  1864. 

including   the    head,     excised. 

Michigan. 

24,  1864. 

Surg.  A.  F.  Whelan,  1st  Mich. 

Surg.  S.  K.Crawford,  50th  Ohio. 

S.  S.     Died  May  30,  1864. 

Died  July  24,  1864. 

166 

Deegan,    T.,    Capt.,    C, 

Dec.  13, 

Left  ;   portion  of  fibula  excised. 

200 

Root.  W.  R.,  Pt,,  E,  7th 

June  3, 

;    portion  of  fibula  excised. 

107th  Pennsylvania. 

13,  1862. 

Died  January  9,  1863. 

N.  Y.H'vy  Artillery. 

3,  1864. 

Surg.  G.  L.  Potter,  145th  Penn. 

167 

Dewts,  J.  S.,  Pt.,  H,  18th 

May  12, 

;  portion  of  lower  end  fibula 

Died  June  9,  18(i4. 

Virginia. 

12,  1864. 

excised.     May  14,  amputation 

201 

Rutledge,  T.,  Lieut.,  G, 

Dec.  15, 

Left  ;  2  inches  middle  third  fibula 

0 

of  leg.     Died  May  21,  1864. 

33d  Missouri. 

15,  1864. 

excised.     Surg.  A.  T.  Tiartlt-tt, 

168 

Dodson,  J.  S.,  Serg't,  H, 

July  22, 

Right  ;   3J  inches  tibia  excised. 

33d  Mo.     Dec.  26,  ha?m..  32  ••<?.. 

99th  Indiana. 

23,  1864. 

Ass't  Surg.  D.  Halderman,  46th 

Died  Dec.  28,  1864.     Spec.  6(,:i4. 

Ohio.     Died  August  18,  1864. 

202 

Sanders.  G.  W.,  Corp'l, 

Sept.  19, 

Left;  2  inches  lower  third  tib;a 

169 

Eaton,  C.  A.,  Pt.,  K,  39th 

May  9, 

Left  ;  portion  of  upperthird  fibula 

K,  26th  Ohio. 

21,  1863. 

excised.     Died  Oct.  22,  1863. 

Mass.,  age  40. 

9,  1864. 

excised.     May  17,  haemorrhage, 

203 

Schwerin,  H.  R.,  Capt., 

May  2, 

Right   (May  3,  spicula  and  ba.'l 

30  oz.;  amputation  thigh.     Died 

C,  119th  New  York. 

5,  1863. 

rem.);  exc.  in  mid.  third.     Surg 

May  29,  1864:  exhaustion. 

J.  D.  Hewett,  1  1  9th  N.  Y.    Maj 

170 

Greenstreet,  J.,  Pt.,  F, 

May  27, 

Left  ;  3  inches  fibula  exc'd.  Surg. 

9,  amp.  of  leg.  Died  May  10,  '63. 

32d  Missouri. 

27,  '1864. 

G.  L.  Carhart,  31st  Iowa.     Died 

204 

Sharpe,  T.,Corp'l,  I,38th 

Feb.  6, 

Right;  por.  of  tibia  exc'd.  Surg. 

June  20,  1864. 

Illinois,  age  30. 

7,  1864. 

J.  Y.  Finley.  2d  Ky.  Cav.   April 

171 

Haas,    P.,  Pt.,  E,    64th 

Jan.  1, 

Left  ;  middle  third  tibia  excised. 

5,  amp.  knee  joint.     Died  June 

Ohio. 

4,  1863. 

A.  Surg.  L.  C.  Fonts,  94th  Ohio. 

23,  1864;  erysipelas. 

Died  Jan.  26,  1863  ;  gangrene. 

205 

Smith,  J.,  Pt.,  I,  lllth 

July  20, 

Right  ;  portion  of  fibula  excised. 

172 

Harrison,  G.  C.,  Corp'l, 

May  27, 

Left;    portion   of   tibia   excised. 

Pennsylvania. 

20,  1864. 

Died  July  21,  1864. 

K,  102d  New  York. 

27,  1864. 

Surg.  C.  H.  Lord,  102d  N.  York. 

206 

Smith,  'J.,  Pt.,  F,  17th 

June  17, 

Right  ;  portion  of  fibula  excised. 

Died  June  9.  1864. 

Vermont,  age  40. 

17,  1864. 

Died  July  6,  1864. 

173 

Heath,  L.,  Serg't,  D,  2d 

June  18, 

Right;    2   inches  tibia.     July  7. 

207 

Springer,    J.  M.,  Chap 

May  15. 

Right;  2|  inches  mid.  third  tll/ia 

Michigan,  age  22. 

18,  1864. 

amp.  thigh.     Died  July  28,"'64. 
Spec.  2807. 

208 

lain,  3d  Wis.,  age  37. 
Thompson,  W.  B  ,  Pt., 

15,  1864. 
Dec.  17, 

exc'd.  Died  May  22,  '64;  pya?m. 
Right;  3  inches  excised.     A.  A. 

174 

Henderson,  W.,   Serg't, 

June  1, 

Right  ;  middle  third  fibula  exc'd. 

K,  124th  Ohio,  age  19. 

18,  1864. 

Surg.  L.  Sinclair.     Died  Feb.  2, 

E,  83d  New  York. 

1,  1864. 

Died  June  11.  1864. 

1865;  gangrene. 

175 

Hensler,  J.,  Pt.,  F,  29th 

June  21, 

Right;  fibula;  lig.  ant.  tib.  artery. 

209 

Utzey,  G.  C.,  Pt..  G,  4th 

May  29, 

;  5  inches  of  tibia  excised. 

Pennsylvania. 

21,  1864. 

Surg.  J.  A.  Wolf,  29th  Penn. 

South  Carolina  Cav. 

30,  1864. 

Surg.  C.   I!.  Gibson,  C.   S.   A. 

Died  July  9.  1864. 

Died  June  24,  1864. 

176 

Herzog,  F.,  Pt.,  C,  8:Jd 

May  12, 

Right  ;  3  ins.  fibula  exc'd.     Died 

210 

Walton,    J.,    Corp'l,  G, 

July  27, 

Left  ;  port,  of  fibula  exc'd.     Died 

New  York,  age  29. 

12.  1864. 

May  30.  1864  ;  exhaustion. 

20th  Ohio,  age  28. 

—  ,  1864. 

Sept.  26,  1864;  dysentery. 

177 

Hiney,  W.  H.,  Lieut.,  C, 

June  1, 

Right  :  3  inches  upper  third  fibula 

211 

Whistler,  R.,  Pt.,H,  49th 

June  2, 

Right;    portion  of  tibia  excised. 

50th  Pennsylvania. 

1,  1864. 

excised.     Died  July  8,  1864. 

Ohio. 

2,  1864. 

July  5,  leg  amputated.      Died 

178 

Hitchings,  W..Pt,,H,  8th 

April  9, 

Left  :  middle  third  fibula  excised. 

July  14,  18(14  ;  pyaemia. 

Illinois. 

9,  18(55. 

Died  April  17,  1865:  gangrene. 

212 

William?,  J.  S.,  Pt.,  F, 

Nov.  30, 

Left;  4  inches  of  fibula  excised. 

179 

Hughes,  N.,  Pt.,  M,  3d 

Nov.  16, 

Right  ;    portion  of  tibia  excised. 

127th  New   York,  age 

Dec.2,'64. 

A.  A.  Surg.  H.  Lcaman.     Gan 

Artillery. 

—  ,  1863. 

Died  December  18,  1863. 

35. 

grene.     Died  Doc.  4.  1864. 

180 

Jackson,  C.,  Corp'l,  G, 

June  25, 

Left  ;  partial  excision  of  fibula. 

213 

Wii;ingmire,  S.,  Pt.,  C, 

May  25, 

Right  ;  portion  of  tibia  excised. 

2d  Michigan. 

25,  1864. 

Surg.  A.  F.  Whelan,  1st  Mich. 

29th  Pennsylvania. 

25,  1864. 

Surg.  G.  P.  Oliver,  lllth  Penn.  > 

S.  S.     June  28.  '64,  amp.  thigh. 

Died  June  17,  1864. 

Died  July  2,  1864. 

214 

Wilson,  J.  M.,  Pt.,  D,  2d 

May  5, 

;  portion  of  upperthird  tibia 

181 

Jackson,W.,  Pt,,  E,  97th 

May  11, 

Left  ;  4  inches  middle  third  fibula 

U.  S.  Sharpshooters. 

5,  1864. 

excised.     Died  May  29,  1864. 

New  York,  age  34. 

11,  1864. 

exc'd.     Surg.  W.  B.  Chambers, 

215 

Woodward,  E.  F.,  Pt.,  I, 

Dec.  13, 

Left;  part  of  tibia  and  radius  ex 

97th  N.  Y.     Died  June  1,  1864. 

53d  Pennsylvania. 

13,  1862. 

cised.    Died  Jan.  6,  1863. 

1  LIDELL  (J.  A.).  Resff.tion  of  Fibula  in  Continuity  for  Gunshot  Fracture,  etc.,  in  United  Mates  Sanitary  Commission  Memoirs,  New  York,  1870. 
Surgical  Volume  I,  p.  530. 


SECT.  V.)  INTERMEDIARY    EXCISIONS    IN    THE    BONES    OF    THE    LEG.  453 

Of  the  two  hundred  and  fifteen  primary  excisions  in  the  continuity  of  the  leg,  forty-two 
with  twelve  deaths  were  in  the  upper,  eighty-four  with  twenty-one  deaths  in  the  middle, 
forty-six  with  eight  deaths  were  in  the  lower  third  of  the  leg,  and  in  forty-three  instances 
with  twenty-six  deaths  the  seat  of  the  operation  was  not  indicated. 

Intermediary  Excisions  in  the  Continuity  of  the  Bones  of  the  Leg. — Eighty-seven 
excisions  in  the  leg  were  intermediary  operations;  of  these  twenty-nine  proved  fatal,  a 
mortality  rate  of  33.3  per  cent.  Portions  of  the  tibia  were  excised  in  thirty-three,  of  the 
fibula  in  forty-six,  and  of  both  bones  in  seven  instances,  and  in  one  case  this  point  was 
not  recorded. 

Recoveries  after  Intermediary  Excisions  in  the  Continuity  of  the  Bones  of  the  Leg. 
The  fifty-eight  successful  intermediary  operations  were  performed  on  fifty-one  Union  and 
seven  Confederate  soldiers.  One,  an  officer,  is  still  (November,  1880)  in  active  service, 
another  has  been  placed  on  the  retired  list,  and  forty-nine  became  pensioners*.  Of  the  lat 
ter,  five  have  died  since  the  date  of  their  discharge — two  from  debility,  one  from  phthisis, 
and  two  from  causes  not  recorded.  Four  patients  submitted  to  subsequent  operations — one 
to  amputation  in  the  leg1  and  three  to  ablation  in  the  thigh.2 

CASE  712. — Colonel  H.  A.  Morrow,  24th  Michigan,  aged  33  years,  received  a  shot  fracture  of  the  upper  third  of  the 
fibula  of  the  right  leg,  at  the  Wilderness,  May  6,  1864.  Five  days  after  being  wounded  he  entered  the  Seminary  Hospital, 
Georgetown,  where  his  injured  limb  was  operated  upon  by  Surgeon  H.  W.  Ducachet,  U.  S.  V.,  who  reported  the  following : 
"  When  admitted  the  patient  had  no  appetite  and  was  feverish,  very  nervous  and  irritable,  complaining  of  every  noise.  The 
wounded  leg  was  very  much  swollen,  painful,  and  discharging  an  unhealthy  sanious  pus.  Resection  of  three  inches  of  the  upper 
third  of  the  fibula  was  performed  on  May  llth,  chloroform  being  used.  The  patient  suffered  intensely  for  twenty-four  hours 
after  the  operation,  when  he  began  lo  improve.  There  were  no  unfavorable  symptoms  afterwards.  Simple  dressings  were 
applied.  The  patient  left  the  hospital  on  leave  of  absence  July  1,  1864."  Colonel  Morrow  subsequently  returned  to  the  field 
and  again  held  active  commands.  He  was  mustered  out  of  the  Volunteer  Service  after  the  close  of  the  war  in  1865,  and  recom- 
missioned  in  the  36th  regiment  of  Infantry  of  the  Regular  Army  in  the  following  year,  since  when  he  has  been  promoted  to 
Colonel  of  the  21st  Infantry. 

CASE  713. — Private  G.  Fuller,  Co.  H,  19th  Maine,  age  18  years,  was  wounded  in  the  left  leg,  at  Ream's 
Station,  August  25,  1864,  and  entered  Emory  Hospital,  Washington,  three  days  afterwards.  Acting  Assistant 
Surgeon  J.  M.  Downs  forwarded  the  specimen  (FlG.  275),  with  the  following  description  of  the  injury:  "The 
wound  was  produced  by  a  musket  ball,  winch  passed  through  the  leg  near  the  ankle,  shattering  the  lower 
third  of  the  fibula  in  its  course.  Upon  examination  the  operation  of  excision  was  thought  advisable, 
and  was  performed,  on  August  29th,  by  Surgeon  N.  R.  Moseley,  U.  S.  V.,  who  removed  two  and  a  half 
inches  of  the  fibula  near  the  ankle  joint  through  an  incision  three  and  a  half  inches  long.  Ether  and 
chloroform  constituted  the  anaesthetic."  The  patient  was  subsequently  transferred  to  Webster  Hospital, 
Manchester,  and  on  May  27,  1865,  he  was  mustered  out  of  service  and  pensioned.  Various  examining 
surgeons  certified  to  the  injury  and  operation,  and  Dr.  C.  B.  Pearson,  of  Spring  Green,  Wisconsin, 
February  5,  1873,  added:  "The  wound  is  healed,  but  the  muscle  has  grown  fast  to  the  tibia  so  as  to 
destroy  action  of  the  tendons,"  etc.  Subsequent  examiners  corroborate  the  previous  reports.  The  pen 
sioner  was  paid  December  4,  1879. 

FIG.  275.—  CASE  714. — Private  W.  H.  Curtin,  Co.  H,  23d  Massachusetts,  aged  20  years,  was  severely  wounded 

half  inches  i"  the  left  leg,  at  Whitehall,  December  15,  1862.  Surgeon  C.  A.  Cowgill,  U.  S.  V.,  reported:  "The 
cfsed"'^*'  wounded  man  was  admitted  to  Academy  Hospital,  New  Berne,  five  days  after  receiving  the  injury.  The 
1910.  fibula  was  badly  comminuted  and  shattered.  On  December  26th,  I  excised  six  and  a  half  inches  of  the 

bone,  including  the  finely  comminuted  portion.  The  patient  recovered  pleasantly  and  has  gone  home  on 
furlough,  able  to  walk  comfortably."  He  subsequently  entered  Foster  Hospital,  where  he  was  discharged  May  28, 
1863.  Examining  Surgeon  W.  C.  Robinson,  of  Portland,  October  10,  1863,  described  the  injury  and  reported :  "A 
large  cicatrix  nearly  the  whole  length  of  the  leg,  showing  the  nature  of  the  operation.  It  appears  that  nature  is  in  J^*f  fiiche* 

a  measure  restoring  the  bone.     A  large  ulcer  still  exists  at  the  point  where  the  ball  entered  the  leg.     He  has  walked    of  fibula  ex- 

a  cised.  Spec. 

with  a  crutch  until  recently;  is  now  able  to  walk  with  a  cane."     Several  months  alter  being  discharged  the  man     1326. 

re-enlisted  in  the  Veteran  Reserve  Corps,  whence  he  was  ultimately  mustered  out  November  16, 1865,  and  pensioned. 

The  Portland  Examining  Board  reported,  September  4,  1873,  that  "the  nerves  were  injured  so  that  the  foot  is  greatly  impaired 

in  its  motions."     At  a  subsequent  examination  it  was  stated  that  "the  tendo-achillis  is  contracted,  so  that  there  is  butlittle  antero- 

'Case  of  Private  D.  P.  Griswold,  Co.  C,  7Gth  New  York,  right  leg.  secondary  amputation  in  the  middle  third. 

2  Cases  of  Pt.  W.  II.  Burdick,  Co.  B,  82d  Pennsylvania,  right  thigh,  secoudary  operation  in  lower  third  (TABLE  XL,  p.  320,  No.  17);  Pt.  I.  A. 
Angell,  Co.  D,  1st  Wisconsin  Cavalry,  right  thigh,  secondary  amputation  in  lower  third  (TABLE  XL,  p.  320,  No.  2);  Pt.  E.  A.  Bennett,  Co.  F,%44th  New 
York,  left  thigh,  secondary  amputation  in  lower  third  (TABLE  XL,  p.  3x?0,  No.  7). 


454 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


posterior  motion  of  the  ankle  joint.     The  leg  is  atrophied  and  the  parts  bound  down  by  the  indurated  cicatrix."     The  pensioner 
was  paid  December  4,  1879.     The  specimen  represented  in  the  wood-cut  (FlG.  276)  was  contributed  by  the  operator. 

Fatal  Cases  of  Intermediary  Excisions  in  the  Bones  of  tlie  Leg. — The  twenty-nine 
operations  of  this  group  were  performed  on  Union  soldiers.  Pyaemia  was  noted  in  eleven, 
gangrene  in  eight,  and  erysipelas  in  one  case.  Subsequently,  amputation  in  the  leg  was 
performed  in  one,1  exarticulation  at  the  knee  in  one,2  and  amputation  through  the  thigh  in 
five  instances.3  Reports  of  post-mortem  examinations  were  received  in  five  instances. 

CASE  715.— Private  H.  M.  Grimes,  Co.  C,  116th  New  York,  aged  24  years,  was 
wounded  at  Port  Hudson,  May  27,  1863.  Surgeon  C.  B.  Hutchins,  116th  New  York, 
reported  his  admission  to  the  field  hospital  of  the  1st  division,  Nineteenth  Corps,  with  "shot 
wound  of  leg ;  severe."  Assistant  Surgeon  P.  S.  Conner,  U.  S.  A.,  who  operated  in  the 
case  and  contributed  the  pathological  specimens  (FlGS.  277,  278),  reported  the  following 
description  of  the  injury  and  its  results:  ''The  man  was  wounded  in  the  left  leg  by  a  minie 
ball,  which  was  found  to  have  struck  the  tibia  anteriorly,  causing  compound  comminuted 
fracture.  He  was  admitted  into  University  Hospital,  New  Orleans,  May  30th,  where,  a  few 
days  laten,  several  loose  fragments  of  bone  having  been  removed  and  the  extent  of  the  injury 
Fmirinii  of  determined,  the  entire  fractured  portion  was  resected,  amounting  to  nearly  five  inches  of  the 
tibia,  witL  tibia,  and  including  the  shaft  to  within  less  than  an  inch  from  the  ankle  joint.  The  ball  was 
baH.i'xcis'd.  found  to  be  wedged  in  among  the  fragments  and  the  fibula  uninjured.  The  case  progressed 
Spec.  1307.  very  favorably  until  early  in  July,  when  diarrhoea  came  on,  which  caused  the  patient's  death 
August  14,  1863.  The  bones  of  the  injured  leg  (FlG.  278)  indicate  the  extent  of  the  reparative  process, 
and  the  probabilities  that  the  man  would  eventually  have  had  a  serviceable  leg  had  he  lived."  The 
extremity  of  tlie  lower  fragment  is  carious,-a  spur  from  the  upper  fragment  projecting  three  inches 
downward,  and  the  face  of  the  fibula  is  involved  in  callus. 

CASE  716. — Private  H.  Mink,  Co.  H,  4th  New  York  Heavy  Artillery,  aged  20  years,  -was  wounded 
at  Petersburg,  April  2,  1865,  and  was  conveyed  to  City  Point  two  days  afterwards.  Acting  Staff  Sur 
geon  J.  Aiken  recorded  his  admission  to  the  Depot  Hospital  of  the  Second  Corps  with  "compound 
fracture  of  left  leg."  On  April  15th  the  wounded  man  was  transferred  to  the  First  Division  Hospital, 
Annapolis,  where  the  injured  limb  was  operated  on  by  Surgeon  B.  A.  Vanderkieft,  U.  S.  V.,  who  reported 
as  follows:  ''The  wound  was  produced  by  a  minie  ball,  causing  a  compound  comminuted  fracture  of  the 
tibia  and  oblique  fracture  of  the  fibula  at  the  middle  third  of  the  leg.  Resection  was  performed  on  April 
17lh,  removing  a  longitudinal  portion  of  the  fibula  and  parts  of  the  upper  and  middle  thirds  of  the  tibia, 
one  being  five  inches  in  length,  two  others  one  and  a  half  inches  each,  and  three  smaller  pieces.  Very 
little  inflammation  existed  at  the  time  of  the  operation,  and  the  patient  was  in  good  condition.  Chloro 
form  constituted  the  anaesthetic.  Oakum  dressings  were  applied  and  quill  sutures  used  as 
means  of  partial  coaptation  of  the  flap.  Purulent  accumulations  were  removed  by  the  syringe. 

Eight  ounces  of  wine  were  given  daily.  Progress  was  favorable."  Three  weeks  after  the  date  of  the  operation  the 
patient  was  transferred  to  the  Second  Division  Hospital.  Annapolis,  where  he  died  of  exhaustion,  May  11,  1865. 
Surgeon  G.  S.  Palmer,  U.  S.  V.,  in  charge  of  the  latter  hospital,  reported  that  the  patient  when 
admitted  was  in  a  moribund  condition,  also  that  the  wound  was  in  an  unhealthy  state  and  filled  with 
maggots.  The  excised  bone,  shown  in  the  wood-cut  (FlG.  279),  was  contributed  by  the  operator. 

CASK  717. — Corporal  W.  N.  Esworthy,  Co.  E,  1st  Pennsylvania  Cavalry,  aged  24  years,  was 
wounded  in  the  left  leg.  at  White  House  Landing,  June  21,  1864,  and  admitted  to  Carver  Hospital, 
Washington,  two  days  afterwards.  Surgeon  O.  A.  Judson,  U.  S.  V.,  reported:  "The  missile,  sup 
posed  to  be  a  conoidal  ball,  entered  the  leg  anteriorly  about  three  inches  below  the  knee  joint,  passed 
backward  and  outward,  making  its  exit  posteriorly  and  producing  a  compound  comminuted  fracture 
of  tbe  upper  third  of  the  tibia.  Supporting  treatment  was  adopted  and  simple  dressings  applied. 
Erysipelas  attacked  the  wound  on  June  27th,  but  yielded  readily  to  an  application  of  solution  of 
copperas.  By  July  1st  no  erysipelatous  spmptoms  were  present ;  constitutional  state  of  patient  good ; 
wound  secreting  laudable  pus  in  large  quantity.  On  July  6th,  the  patient  was  anaesthetized  and 
excision  of  about  five  inches  of  the  upper  third  of  the  shaft  of  the  tibia,  by  means  of  the  chain  saw, 


left  leg:,  with  four  ami  a 
° 


was  performed  by  Acting  Assistant  Surgeon  O.  P.  Sweet,  making  a  straight  incision  over  the  crest 


Pio.  280 —Five 

ins.  of  left  tibia 


of  the  tibia.  The  wound  was  then  filled  with  scraped  lint,  cold-water  dressings  were  applied,  and 
stimulants  given  freely.  The  patient  appeared  to  be  doing  quite  well  up  to  July  18th,  the  wound  exc'd.  5pec.-J'J40. 
filling  with  healthy  granulations  and  secreting  laudable  pus.  For  ten  days  previous,  however,  he  had  anorexia,  and  this  morn 
ing  he  bad  a  very  severe  chill.  A  recurrence  of  chills  followed  every  morning  and  sometimes  two  or  three  times  during  the  day, 
and  these  were  followed  by  other  pyscmic  symptoms,  the  integuments  assuming  a  deep  icteric  tinge;  pulse  rapid  ;  slight  cough; 

'Case  of  Private  A.  E.  Luther,  Co.  E.  M  Massachusetts  Cavalry,  left  leg.  intermediary  operation  at  junction  of  upper  and  middle  thirds. 

2Case  of  Prhate  S.  M.  Grainger.  Co.  A,  38th  Indiana,  left  leg,  secondary  operation  (TAlil.K  LV11,  page  4C!).  No.  19). 

'Cases  of  I't.  II.  Conrad.  I,  -J-lth  Mich.,  left  thigh,  intermediary  operation  in  middle  third,  Spec.  3t>Tj3  (TAr.l.r.  XXXV,  p.  283,  No. 253) :  I't.  A.  Allen, 
II,  5th  I".  S.  Artillery,  intermediary  operation,  lower  third  iTAJ'.l.F.  XXXVI.  p.  29(i,  No.  2C3):  Cor]1'1  ''••  (:«v.  II,  Ifth  Wisconsin,  intermediary  operation 
iu  lower  third  (TA11I.K  XXXVI.  p.  C'.'t".  No.  :i.r;7).  ljt.  M.  C.ilinore.  I>.  .",4th  Mass.,  left  thigh,  intermediary  operation  in  lower  third  (TAia.K  XXXVI.  p.  -J.'.i8, 
No.  3()5);  I't.  J.  Bloomer,  K,  ITUth  N.  Y.,  right  thigh,  intermediary  opemtiou  iu  lower  third,  Sped.  'MM,  Ifcioy,  A.  M.  M.  (TAliLE  XXX  VI,  p.  ^'J7,.Ni>.  ;MtJ). 


SECT.  V.] 


INTERMEDIARY    EXCISIONS    IN    THE    BONES    OF    THE    LEG. 


455 


anorexia  continuing.  The  treatment,  decidedly  stimulating  and  tonic,  was  continued.  The  symptoms  continued  in  a  more 
aggravated  form  and  the  patient  steadily  sank,  the  whole  surface  of  his  body  being  of  a  deep  yellow  color.  He  died  on  July  23, 
1864.  At  the  autopsy  a  large  number  of  metastatic  abscesses  were  found  in  both  lungs;  liver  enlarged;  spleen  also  enlarged, 
dark  colored,  and  soft.  A  purulent  offensive  fluid  mixed  with  lymph  was  shown  in  the  left  pleural  cavity,  and  a  large  disinte 
grated  clot  in  the  femoral  vein."  The  excised  bone,  contributed  by  Surgeon  Judson  and  exhibiting  superficial  necrosis,  is  rep 
resented  in  the  wood-cut  (FlG.  280). 

TABLE  LXIV. 
Summary  of  Eighty-seven  Intermediary  Excisions  in  the  Bones  of  the  Leg  for  Shot  Injury. 

[Recoveries,  1-58;  Deaths,  59-87.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AXL)  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPEKATOUS, 
RESULT. 

1 

Angcll,  I.  A.,  Pt.,  D,  1st 

July  23, 

Right  ;  gang.;  7  inches  mid.  third 

23 

House,  T.  J.,  Pt.,K,  16th 

Sept.  30, 

Right  ;  head  of  fibula  and  part  of 

Wisconsin  Cav'ry,  age 

Aug.  1, 

tibia  excised.    A.  A.  Surg.  J.  C. 

Illinois,  age  22. 

Oct.  15, 

shaft  excised.     Dutv  Nov.   14, 

23. 

1864. 

Thorpe.     Sept.  —  ,  hsem.;  18th, 

1863. 

1863.     Died  Dec.  2G.'  1866. 

amp.  thigh.     Disch'd  Jan.  7,'G5. 

24 

Hnugh,  S.  R.,  Serg't,  A, 

Sept.  17, 

Left  ;  5J  inches  upper  third  tibia 

Re-amp.  June  1C,  '65.  Spec.  5549. 

107th  Penn.,  age  32. 

Oct.  4,  '62. 

excised.     Disch'd  Feb.  3,  18G4  ; 

2 

Bennett.  E.  A.,  Pt.,  F, 

Mav  22, 

Left:  middle  third  fibula  excised. 

ntn-union;  limb  useless;  deform 

44th  N.  York,  age  41. 

31,  1804. 

A.A.  Surg.  R.  Ottman.    Disch'd 

ed  ;  should  be  amputated. 

Oct.  11,  '64.     Amputation  thigh 

25 

Howard,  J.  M.,  Pt.,  F, 

May  16, 

Right  ;  3  inches  of  tibia  excised. 

3 

Botjer,  G.  C.,  Pt.,  II,  2tl 

Sept.  19, 

March  2,  1809  ;  re-amputation. 
Left  ;  2  ins.  in  length,  J  inch  in 

26 

49th  N.  C.,  age  24. 
Jenkins,  \V.  H.,  Pt.,  Ash 

23/1864. 
Sept.  17, 

Furloughed  August  22,  1864. 
Left;   3  inches  fibula  in   middle 

North  Carolina,  age  20. 

25,  1864. 

depth  of  upper  third  tibia  exc'd. 

land  Battery,  nge  25. 

Oct.  15, 

third  excised.     To  prison  April 

Surgeon  A.  Atkinson,  C.  S.  A. 

1862. 

10,  1863. 

To  prison  Feb.  1G,  18G5. 

27 

Jordan,  W.  B.,    Corp'l, 

Aug.  21, 

Right  ;  2J  ins.  lower  third  fibula 

•! 

Burdiek,  W.  H.,  Pt.,  B,  !  April  (i, 

Right  -,  2  inches  middle  third  tibia 

I,  Gth  Vermont,  age  20. 

29,  1864. 

excised.    A.  Surg.  C.  Bacon,  jr., 

8,M  Pennsylvania,  age 

13,  18G5. 

excised.     Disch'd  Oct.  12,  18G5. 

U.  S.  A.     Disch'd  July  19,  1865. 

21. 

Amp.  thigh  March  27,  1866. 

28 

Langton,  A.,  Pt.,  E,  27th 

May  3. 

Right  ;  4  inches  middle  third  tibia 

5 

Burke,  J.  C.,  Pt.,  H,  78th 

Mav  3, 

Right  ;  2  ins.  mid.  th'd  tibia  exc'd. 

Indiana. 

17,  1863. 

excised.    Disch'd  Feb.  19,  1864  ; 

New  York,  age  20. 

18,  1863. 

Disch'd  March  18,  '64  ;  caries. 

exfol.;  short.  1  inch.    Spec.  1280. 

6 

Carse,   G.  15.,  Cap!.,  C, 

Mav  2, 

Right  ;  3  ins.  fibula  exo'd.  Disc'd 

29 

Lohr,  S.  G.,  Serg't,  G, 

Dec.  13, 

Right  :  6  ins.  middle  third  fibula 

4Uth  New  York. 

30.  1863.  |     Dee.  15,  1803;  slight  shortening. 

19th  Infantry,  age  26. 

25,  1862. 

excised  ;  gang.  Disch'd  Feb.  25, 

7 

Casper.  J.  M.,  Corp'l,  K, 

May  23,    Right  ;  partial  excision  of  upper 

1863  ;  paralysis  of  toes. 

7th  Wisconsin,  age  21. 

June  13, 

third  fibula.     A.  A.  Surg.  P.  C. 

30 

Lotts,  P.,  Pt.,  K,  5th  — 

Mav  3, 

:  2  inches  upper  third  tibia 

1864. 

Porter.     Disch'd  Mar.  24,  18G5; 

9,  1863. 

exc'd.     Recovery:  useful  limb. 

partial  paralysis  foot. 

31 

Lucas,   W.    J.,   Pt.,  H, 

Aug.  25, 

Left  ;  2^  ins.  low.  th'd  fibula  exc'd. 

8 

Charles,  R  Y.,  Corp'l,  G, 

June  1, 

Left  ;  3  ins.  mid.  third  tibia  exc'd. 

148tb  Penn.,  age  21. 

29,  1864. 

Surg.   N.  R.  Moseley,  U.  S.  V. 

1st  New  Y  Tk  Drag's, 

15,  18.J4. 

Surg.  R.  B.  Bontecou,  U.  S.  V. 

Disch'd  Mar.  27,  '65  ;  anch.  ank. 

age  22. 

Disch'd  May  6,  1865;  necrosis; 

Died  June  7,  1868.    Spec.  1982. 

shortening. 

32 

'Lynn,  A.,  Pt.,  F,  47th 

Oct.  19, 

Right  ;  2J  ins.  middle  third  tibia 

9 

Collins,  O.,  Pt.,  D,  151st 

Nov.  27, 

Left  ;  3  inches  lower  third  fibula 

Pennsylvania,  age  18. 

Nov.  1, 

excised.    A.  A.  Surg.W.  Kemp- 

New  York,  age  32. 

Dee.  9, 

exc'd.   ,'jurg.  E.  Bentley.U.S.V. 

1864. 

ster.     Disch'd  Oct.  14,  1865. 

1803. 

Ligation  post,  tibial  art.;  haem. 

33 

Lytle,  H.,  Serg't,  A,  83d 

Sept.  30, 

Right  ;  2.V  ins.  mid.  th'd  fibula  and 

Disch'd  Feb.  25,  1865. 

Pennsylvania,  age  22. 

Oct.  17, 

half  the  thickness  of  tibia  exc'd. 

10 

Coyle,  M.,  Pt.,  B,  81st 

June  3, 

Right;  3  inches  mid.  third  fibula 

1864. 

A.  A.  Surg.  J.  II.  Robinson.   Dis 

Pennsylvania,  age  23. 

15,  18G4. 

e'xe'd.   Surg.  E.  Bentlev.U.S.V. 

charged  July  31,  1865;  necrosis. 

Disch'd  Oct.  3,  1865.     Died  Jan. 

34 

Malow,  L.,  Pt.,  F,  24th 

Sept.  19, 

Left  ;  upper  third  tibia  excised. 

27,  '76  ;  debility,  result  of  w'nd. 

Illinois. 

29,  1863. 

Surg.  I.  Moses,  U.  S.  V.  Disch'd 

11 

Crowley,  J.,  Pt,,  E,  5th 

Sept.  20, 

Right  ;  head  and  3  ins.  up.  third 

August  6,  '64  ;  periostitis.    Died 

New  York,  age  25. 

Oct.  20, 

fibula   excised.     Disch'd   Nov. 

June  10,  1876.    Spec.  2149. 

18G2. 

22,  1862.     Bone  diseased.     Died 

35 

Mann,  O.  L.,  Lieut.  Col., 

May  20, 

Left  ;  portion  of  mid.  tibia  excised. 

July  10,  1871. 

39th  Illinois,  age  31. 

June  8, 

A.  Surg.  E.  McClellan,  U.  S.  A. 

12 

Curtin,  M.  11.,  Pt.,H,  23d    Dec.  15, 

Left  ;    6J   inches  fibula  excised. 

1864. 

Diseh'd  Dec.  G,  '65.     1870,  bone 

Massachusetts,  age  20.  !  20,  1862. 

Surgeon  C.  A.  Cowgill.  U.  S.V. 

discharging. 

Disch'd  May  28,'6:i.    Spec.  13-26. 

36 

Merrihew,  D.  J.,  Corp'l, 

Mar.  25, 

Right  ;  2  inches  lower  third  fibula 

13 

Farnin,  J.,  Lieut.,  I,  1st  De.31,'G2, 

Right  ;  largo  portion  mid.  third 

I,  121st  N.  Y.,  age  22. 

April  8, 

excised.    A.  A.  Surg.  J.  H.  Rob 

Kentucky,  age  25.           Jan.5,'(i3.     tibia  excised;  fibula  exfoliated. 

1865. 

inson.     Disch'd  Aug.  2,  1865. 

Disch'd  June  18,'G4;  short.  l£in.; 

37 

Minor,  W.W.,  Pt.,  H,2d 

Mav  5, 

Right  ;  8  inches  lower  part  fibula 

deformity. 

Wisconsin,  age  46. 

30,  1864. 

excised.  Disch'd  Sept.  23,  1864  ; 

14 

Fellows,  J.,   Corp'l,  D, 

Sept.  19,    Left  ;  3  inches  middle  third  tibia 

bone  carious. 

100th  Illinois,  age  24. 

24,  18li3.      excised.    Disch'd  Aug.  11,  18G4; 

38 

Morrow,  11.  A.,Col.,  24th 

May  G, 

Right  ;  portion  of  up.  third  fibula 

caries  ;  shortening. 

Michigan,  age  33. 

11,  1864. 

excised.   Surg.  II.  VV.  Ducachet, 

15 

Fuller,  G.,  Pt.,  H,  19th 

Aug.  25, 

Left  ;  2J  inches  lower  third  fibula 

U.  S.V.     Disch'd  June  30,  1865. 

Maine,  age  18. 

29,  18G4. 

excised.     Surg.  N.  R.  Moseley, 

39 

Naslv  O.  T.,  Pt,,  K,  12th 

Aug.  23, 

Left  ;  4  inches  middle  third  fibula 

U.  S.  V.     Disch'd  May  27,  1865. 

Wisconsin,  age  21. 

29,  1864. 

excised  and  arterv  lig.     Surg. 

Spec.  1910. 

A.  J.  Miller,  13th  Iowa.  Disch'd 

10 

Griffin,  D.  O.,Pt.,K,  17lh 

April  G. 

Left;   li  inch   lower  third  tibia 

June  30,  1865. 

Illinois,  age  24. 

—  ,  18G2. 

excised.     Disch'd  Oct.  15,  18G2  : 

40 

Oberrender,  J.  S..  Lieut., 

Mav  6, 

Left  ;  2  inches  lower  third  fibula 

toes  and  heel  contracted. 

E,  96th  Penn.,  age  35. 

14,  1864 

excised.   A.  A.  Surg.  J.  O.  Stan- 

17 

Gould,  J.  A.,  Pt.,H,  llth 

Sept.  30, 

Left  ;  3  ins.  low.  third  fibula  exc'd. 

ton.      Disch'd   Sept.  20,    1864; 

New  Hamp.,  age  39. 

Oct.  9, 

Surg.  G.  L.  Panooast,  U.  S.  V. 

anchylosis  ankle  joint. 

1864. 

Gangrene.     Disch'd  Feb.  G,  '65. 

41 

Olinger,  G.,  Pt.,  D,  100th     Aug.  G, 

Left;  '4  inches  mid.  third  fibula 

18 

Green,  W.  C.,  Lieut.,  II, 

June  1, 

Left;  middle  third  fibula  excised. 

Ohio,  age  22.                     Sept.  J. 

excised.      Gangrene.      Disch'd 

37th  New  York,  age  22. 

20,  18G2. 

Disch'd   Sept.    13,    18G2:    bone 

1864.         Mav  26,  1865. 

united;  J  inch  shortening. 

42     Peters,  M.  H.,  Lieut.,  F,      May  9, 

Right  ;  2J  ins.  middle  third  tibia 

19 

Griswold,  D.  P.,  Pt.,  C. 

July  1, 

Right  ;  portion  of  mid.  third  tibia 

74th  Ohio,  age  21.            15,  J  864. 

excised.   Surg.  C.  N.  Ellinwood. 

76th  N.  York,  age  19. 

5,  1863. 

excised.    Disch'd  Sept.  23,  1864. 

74th  111.     Disch'd  July  10,  1865  ; 

May  11,  186'.),  amputation  leg. 

bone  discharging. 

20 

Harvey,  G.,  Pt.,  D,  63d 

Mav  3, 

Right  :  2  ins.  lower  third  fibula 

43 

Pfeifer,  J.,  Pt.,  F,  108th    Mav  14, 

Left  ;  2  inches  lower  third  fibula 

Pennsylvania,  age  24. 

12,  1863. 

excised.     Mav  21,  haem.,  12  oz. 

Ohio,  age  19.                      21,  1864. 

excised.     A.  Surg.  C.  C.  Bvrne. 

Disch'd  Jan.  22,  1864. 

U.  S.  A.    Disch'd  Mav  23,  1865  ; 

21 

Hayward,    R.,    Pt.,    E, 

Oct.  29, 

Right  ;  upper  third  excised. 

anchylosis  ankle  joint. 

Knapp's  Peun.  Bat'ry, 

Nov.  12, 

Surg.  I.  Moses,  U.  S.V.   Disch'd 

44     Pierce,  W.  K.,  Serg't,  D, 

May  10, 

Left:   2  inches  upper  third  tibia 

age  2-1. 

1863. 

August  13,  '64;  union;  deform 

183d  Penn.,  ago  20. 

June  5, 

exc'd.  Surg.  E.  Bentley,  IT.  S.V. 

ity;  shortening. 

1864. 

Disch'd  July  15,  1865;  *  inch 

22 

Herrald,   S.,  Pt.,  II,  2d 

Sept.  19, 

Right  ;  middle  third  tibia  exc'd. 

shortening:  exfoliation. 

Kentucky  Cavalry. 

29,  1863. 

Surg.  I.  Moses,  U.  S.V.   Disch'd 

45 

Ravmoud.  J.  O..  Serg't. 

Mav  3, 

Left;  2  inches  lower  third   tibia 

Nov.  12,  1864;   reproduction  of 

E",  60th  N.  Y.,  age  29. 

17,  1863. 

excised.     Disch'd  Mar.  21,  1864. 

bone.     Spec.  2148. 

Sept.,  1877,  exfol.;  deformity. 

KEMI'STEK  (W.),  Report  of  an  Exsection  of  Right  Tibia  ;  Recovery,  in  American  Journal  of  Medical  Sciences,  1866,  N.  S.,  Vol.  LI,  p.  279. 


456 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY      ,  n.Tr, 
DEJCRIPTIOX,  AXL>  AGE. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  SIJLITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

46 

Salsbury,  D.,  Pt.,K,24th  De.31,'62, 

Left  -,  2  inches  middle  third  tibia 

67 

Esworthy,  W.  N.,  Corp'l, 

June  21, 

Left  ;  5  ins.  up.  third  tibia  exc'd. 

Wisconsin,  ago  29.          Ja.  15,'63.|     excised.    Disch'd  Aug.  12,  18G5; 

E,   1st  JVnn.  Cavalry, 

July  6, 

A.  A.  Surg.  O.  P.  Sweet.     Died 

great  lameness. 

age  24.                             :     1864. 

July  23,  '64  ;  pyaein.    Spec.  2940. 

47 

1  Saunders,  N.,  Pt.,  18th 

Oct.  21, 

Left  ;  5  inches  lower  third  fibula 

68 

Forester,  G.  W.,  Pt.,  A,     June  3, 

Right;  4   ins.   lower  third  fibula 



31,  1861. 

exc'd  (hxmorrhage).  Sent  home 

188ih  Penn.,  age  45.         15,  1864. 

excised.     A.  A.  Surg.  F.  G.  H. 

in  two  months. 

Bradford.      Died  July  6,  1864; 

48 

Sloan,  J.,  Pt.,  K,  100th 

Sept.  19, 

Left  ;  2  ins.  low.  third  tibia  exc'd. 

irritative  fever. 

Illinois. 

23,  18G3. 

Disc'd  Feb.  19,  1865  ;  limb  much 

69 

Freeman,  G.  B.,  Pt.,  F,     June  3, 

Right  ;  lower  third  fibula  oxc'd 

deform.;  false  joint  ;  short  3  ins. 

58th  Mass.,  age  32. 

!),  1864. 

and  lig.  posterior  tibial  artery. 

49 

Smith,  J.  E.,  Corp'l,  E, 

Aug.  16, 

Right  ;  6  inches  fibula   excised. 

Surg.  O.  A.  Judson,  U.  S.  V. 

7th  Conn.,  ago  £6. 

Sept.  7, 

Disch'd  May  22,  1865  ;  club  foot, 

Died  June  17,  '64;  exhaustion. 

18G4. 

anchylosis  ankle  joint. 

70 

Gay,  E.,  Corp'l,  H,  18th 

April  6, 

.     Ass't  Surg.  W.  D.  Turner, 

50 

Stinson,   IV.  C.,  Pt.,  H, 

.Tulv  3, 

Right  ;  middle  third  tibia  excised. 

Wisconsin. 

—  ,  1862. 

1st  Illinois  L.  Art'y.     April,  '62, 

49th  Virginia. 

8,  1863. 

Surg.  J.   A.   Wolf,   29th  Penn. 

amputation   thigh.     Died  April 

Paroled  Sept.  25,  1863. 

22,  1862;  pyaemia. 

51 

Swift,  F.  B.,  Pt.,  C,  8th 

May  12, 

Left:  2^  inches  lower  third  fibula 

71 

Gilmore,  M.,  Pt.,  D,  54th 

July  18, 

Left  ;  6  ins.  tibia  and  1  inch  lower 

Michigan,  age  25. 

28,  1864. 

excised.     A.  Surg.  S.  B.  Ward, 

Massachusetts. 

23,  1863. 

part  fibula  exc'd.   Slortification. 

U.  S.  V.     Gangrene.      Disch'd 

July  27,  amputat'n  thigh.     Died 

Oct.  6,  1864;  anchy.  ank.  joint. 

July  27,  1863. 

52 

Taunt,   H.,   Pt.,   B,   2d 

Oct.  19. 

Left  ;  head  and  2J  inches  fibula 

72 

Golden,  J.  P.,  Pt.,  F,  6th 

Mav  19, 

Right  ;  4  inches  lower  third  fibula 

Wisconsin,  age  19. 

29,  1663. 

and  frag's  of  tibia  exc'd.     Surg. 

New  York  H'vy  Art'y, 

29,  "1864. 

exc'd.    A.  A.  Surg.  O.  P.  Sweet. 

O.  A.  Judson,  U.  S.  V.     DiselVd 

ago  27. 

Died  June  9,  1864;  pyaemia. 

January  17,  1865  ;  lameness  and 

73 

Grainger,  S.  SI.,  Pt.,  A, 

Dec.  31, 

Left  ;  fraet.  portions  of  tibia  and 

paralysis  foot. 

38th  Indiana,  age  23. 

1862, 

fibula  excised.    Gang.    Slar.  15, 

53 

Washburn,  A.  S.,  Serg't, 

Nov.  30, 

Right  ;  5  inches  lower  third  fibula 

Jan.  14, 

amp.  knee  joint.     April  1,  haetn. 

C,  127th  N.  Y.,  age  27. 

Dec.  7, 

excised.  A.  A.  Surg.  H.Leaman, 

1863. 

Died  April  23,  1863. 

1864. 

Disch'd  May  26,  1865. 

74 

Grimes,    H.  M.,   Pt,,  C, 

May  27, 

Left;  4&  inches  lower  third  tibia 

54 

Welch,  P.  H.,  Lieut.,  C, 

Slav  6, 

Left;  4  ins.  fibula,  middle,  exc'd. 

116th  New  York. 

June  —  , 

excised.     Died  Aug.  14,   1863; 

lllth   New   York,  age 

16,  1864. 

A.  A.  Surg.  J.  O.  Stanton.    Dis 

1863. 

diarrhoea.     Fpecs.  1307,  2956. 

23. 

charged  Oct.  29,  1864  ;  exfol. 

75 

Jones,  A.  M.,  Ft.,  H,  21st 

June  2, 

Left  ;  4  ins.  mid.  th'd  fibula  exc'd. 

55 

Wilcox,   M.   B.,   Corp'l, 

May  12, 

Right  ;  3  inches  mid.  third  fibula 

Mass.,  age  22. 

25,  1864. 

A.  A.  Surg.  F.  G.  11.  Bradford. 

B,  58th  Mass.,  age  19. 

29,  1864. 

exc'd.   Surg.  E.  I!entlev,U.S.V. 

Died  June  30.  '64  ;  exhaustion. 

Disch'd  July  20,  1805. 

76 

Luther,  A.  E.,  Pt.,  E,  3d 

Mar.  4, 

Left  ;  3  inches  fibula,  lower  third, 

56 

Williams,  F.  M.,  Pt.,  D, 

May  15, 

Right  ;  4  inches  middle  third  tibia 

Slass.  Cavalry,  age  32. 

13,  1864. 

excised.     A.  A.  Surg.  U.  W.  W. 

12th  Tenn..  age  24. 

30,  1864. 

exc'd.  To  Pro.  Mar.  June  11,  '65. 

Carroll.   Peroneal  art.  wounded. 

57 

Wright,  II.  C.,  Capt.,  G-, 

May  7, 

Left  ;  lower  third  fibula  excised. 

Slar.  15.  hasm.;  19th,  amp.  leg. 

42d  New  York,  age  2(i. 

17,  1864.       A.   A.  Surgeon  J.  M.  SfoCalla. 

Died  April  6,  1864  ;  pyaemia. 

Disch'd  .July  13,   1864;   partial 

77 

McGuire,  T.,  Pt.,  D,  53d 

Dec.  13, 

Left  (hiBin.);  3  ins.  up.  extremity 

anchylosis  ankle  pint. 

Pennsylvania,  age  19. 

31,  1862. 

fibula  excised  ;  lig.  fern,  artery; 

58 

Younfj,  W.  H.,  French's 

Nov.  30,    Left;  1J  inch  lower  third  fibula 

sphacelus.     Died  Jan.  3,  1863. 

Division,  age  34. 

Dec.  24,       exo'd.     A.  A.  Surg.  M.  L.  Herr. 

78 

Slink.  II.,  Pt.,  H,  4th  N. 

April  2, 

Left  ;  portion  upper  third  tibia  and 

1864. 

To  Provost  Marshal  Feb.  (i,  '65. 

York  Heavy  Artillery. 

17,  1865. 

fibula  exc'd.     Surg.  B.  A.  Van- 

59 

Allen,    A.,   Pt.,    11,   5th 

April  6. 

:  por.  oftibiaand  fibula  exc'd. 

age  20. 

derkieft,  U.  S.  V.    Died  Slay  11, 

Artillery. 

10,  1862. 

A.  Sura.  W.  D.  Turner,  1st  111. 

1865;  exhaustion.     Spec.  4101. 

L.  A.    Mortiflcat'n.   April,  1862, 

79 

Mitchell.  S.,  Pt.,D,  ia9th 

June  3, 

Left;  2  inches  fibula,  upper  third, 

amp.  thigh.     Died  May  1  1  ,  1862. 

Pennsylvania,  age  23. 

27,  1864. 

exc'd  (haem.);  lig.  peroneal  art. 

GO 

Barney,  W.,  Pt.,  F,  1st 

Jan.  2, 

Right  ;  6  inches  lower  part  fibula 

A.  A.  Surg.  II.  W.  Slerrill.  Died 

Ohio  Artillery. 

11,  1863. 

excised.     Died  July   14,    1863; 

Aug.  7,  1864  ;  chronic  diarrhoea. 

phthisis  pulmonulis. 

80 

Partridge.G.V.,  Saddler,     April  2, 

Left;  portion  of  tibia  exc'd,  also 

til 

Bloomer,  J.,Pt..K.  170th 

Aug.  25, 

Right  ;   mid.  third  fibula  excised. 

B,  4th  Slass.  Cavalry,     9,  1864. 

lig.  ant.  tibial  art.     A.  A.  Surg. 

New  York,  age  44. 

Sept.  12, 

A.A.Surg.W.H.  Ensign.  Gang.; 

age  21. 

W.  A.  Green  leaf.  April  27,  hasm. 

1864. 

luem.;  lig.  femoral.  Sept.  18/64,  | 

Died  Slay  2,  1864  ;  pyasmia. 

amputation  thigh.     Died  Sept.  i 

81 

Perkins,   P.   D.,  Pt.,   B, 

June  3, 

Left  ;   !i  inch  fibula  exc'd,  upper 

21,  1864;  constitutional  irritabil-  j 

12th  New  Hampshire, 

13,  1864. 

third.  "A.  Surg.  II.  Allen.  U.S.  A. 

ity.     Specs.  3250,  3269. 

age  32. 

(I-Isem.)     Died  Juno  25.    1864  ; 

G-2     Brown,  O.,  Pt.,  A,  147th 

July  1, 

Right  ;  portion   of  tibia  excised. 

pyaemia. 

New  York. 

6,  1863. 

Died  July  14,  18f>3. 

82 

Shoroy,    I!,  Pt.,    D,   3d 

May  10, 

Right  ;  6  ins.   tibia  excised.     A. 

63     Bull,  J.  H.,  Serg't,  H, 

Mav  15, 

Left  (necrosis);  3?s  ins.  tibia  exc'd. 

Slaine,  age  30. 

June  8, 

Surg.  A.  Delanv,  U.  S.  V.   June 

9-1  tli  Ohio,  ;ige  21. 

June  13, 

A.  A.   Surg.  1LC.  May.     Died 

1864. 

26,  gang.     Died  July  1,  1864. 

1864. 

June23,'6'l  ;  pyaein.    Spec.  3367. 

83 

Sprague,  O.,  Pt.,  F,  73d 

Slay  5, 

Right;   2  ins.  middle  third  tibia 

04     Conrad,  H.,  I't.,  I,  24th 

May  (i. 

Left;  1  inch  up.  third  fibiilaexc'd. 

New  York,  age  45. 

June  2, 

excised.     Surg.  11.  15.  Bontecou, 

Michigan,  age  21.' 

19,  1864. 

Surg.  O.  A.   Judson.  U.   S.   V. 

1864.     !     U.  S.V.     Died  July  6,  1864;  ex- 

Post,  tibial  art.  divided  ;  gang. 

haustion. 

Slay  22,  amp.  thigh.    Died  May 

84 

Tobin,  T.,  Pt.,    E,  Gist 

June  3, 

Right  :  3  inches  lower  third  tibia 

27/1864  ;  pyaemia.     Spue.  3653. 

New  York,  age  23. 

8,  1864. 

exc'd.  Surg.  K.  Bentley,  U.S.V. 

65 

Curtis,  F..  Pt.,  17th  Ver 

June  2, 

Right;  2.V  inches  low.  third  fibula 

Died  June  22,  '64  :  pyuimia. 

mont,  ago  31. 

9,  1864. 

excised.     Surg.  O.  A.  Judson, 

85 

Travis,  S..  Pt.,  H,  137th 

Oct.  28, 

Left;  portion  middle  third   tibia 

U.  S.  V.    Juno  11,   1864,  haam. 

New  York,  age  22. 

No.l9,'G.3J     exo'd.  Died  Nov.  23,'G3;  pyiem. 

Died  June  17,  1864;  exhaustion. 

80 

Welsh,  D.  G.,Pt.,F,  28th 

Dec.  13, 

Right  ;  lower  third  fibula  exc'd. 

GO     DeWitt.J.  E.,  Pt.,  A,9th 

June  21, 

Right  ;  por.  up.  third  fibula  exc'd 

New  Jersey. 

26,  '62. 

Died  Jan.  5,  1863. 

N.  Y.  Cavalry,  age  23. 

25,  18G4. 

and  peroneal  artery  lig.     A.  A. 

87 

White.  S.  G!.Pt..A,  14th 

Aug.  21, 

Left;  2  inches  lower  third  fibula 

Surg.  O.  P.  Sweet.     Prostration 

Now  York  H'vy  Artil 

Sept.  1, 

exc'd.     A.  A.  Surg.  R.  K.  Price. 

and   haemorrhage.     Died  June 

lery,  age  37. 

1864. 

Sloughing.  Died  Sept.  13,  1864; 

25,  1864  ;  exhaustion. 

exhaustion. 

Twenty-one  intermediary  excisions,  with  eight  deaths,  were  in  the  upper  third  of  the 
log;  thirty-five,  with  seven  deaths,  in  the  middle  third;  twenty-four,  with  nine  deaths  in 
the  lo\ver  third;  and  in  seven,  with  five  deaths,  the  precise  locality  was  not  indicated. 

Secondary  Excisions  in  the  Continuity  of  the  Bones  of  the  Leg. — In  point  of  mor 
tality,  the  secondary  excisions  in  the  bones  of  the  leg  were  attended  by  better  results  than 
the  primary  and  intermediary  operations,  only  eight  of  the  fifty  cases  of  this  group  having 
fatal  issues.  The  excision  included  both  bones  in  five,  the  tibia  alone  in  thirty-one,  and 
the  fibula  in  fourteen  instances. 

1  HOLLOWAY  (J.  SI.),  Consecutive  and  Indeterminate  Uxmorrhage  from  Large  Arteries  after  Gunshot  Wounds;  with  Report  of  Cases  treated  by 
Different  Methods ;   Appreciation,  in  American  Journal  Medical  Sciences,  1865,  Vol.  L,  N.  S.,  p.  348. 


SECT,  v.]  SECONDARY    EXCISIONS    IN    THE    BONES   OF    THE    LEG.  457 

Recoveries  after  Secondary  Excisions  in  the  Continuity  of  the  Bones  of  the  Leg. — This 
group  includes  forty-two  operations,  five  performed  on  Confederate  and  thirty-seven  on 
Union  soldiers.  Three  of  the  latter,  it  appears,  never  applied  for  pensions,  and  thirty-four 
became  pensioners  after  their  discharge  from  the  service.  Four  have  since  died — two  from 
remote  results  of  the  injuries,  one  from  phthisis,  and  one  from  cause  not  stated.  Of  the 
complications  during  treatment  are  noted  gangrene  in  five  instances  and  hemorrhage  in  one. 

CASE  718. — Corporal  J.  Downey,  Co.  D,  56th  Pennsylvania,  aged  23  years,  was  wounded  in  the  left  leg,  at  Bull  Run, 
August  28,  1802.  He  was  admitted  to  Eckington  Hospital,  Washington,  several  days  afterwards,  where  the  injury  was  noted 
but  no  treatment  recorded.  Surgeon  J.  Hopkinson,  U.  S.  V.,  in  charge  of  Mower  Hospital,  Philadelphia,  made  the 
following  record  of  the  case:  "The  wound  was  caused  by  a  ball,  which  entered  the  outer  side  of  the  tibia,  fractur 
ing  the  bone,  and  emerging  on  the  inner  side  of  the  leg  at  the  lower  third.  The  tibia  was  resected  at  Eckington 
Hospital,  from  where  the  patient  was  transferred  to  this  hospital  September  23,  1863,  the  wound  being  nearly 
healed.''  Subsequent  entries  show  that  in  addition  to  applications  of  water  dressings  to  the  wound  the  patient  for 
a  time  received  treatment  for  a  syphilitic  affection.  He  remained  in  the  hospital  until  January  17,  1865,  when  he 
was  mustered  out  and  pensioned.  Examining  Surgeon  D.  W.  Shindle,  of  Sunbury,  Pennsylvania,  certified  to  the 
fracture  and  excision,  and  added:  "The  wound  healed,  leaving  the  leg,  however,  very  crooked,  shortened,  and 
necessarily  much  weakened,  and  rendering  his  locomotion  unsteady,  difficult,  and  at  times  painful,  also  liable  to 
tire  in  standing  as  well  as  walking.  General  system  much  impaired."  The  pensioner  died  of  phthisis  puhnonalis, 
October  20,  1870,  his  attending  physician  testifying  that  the  injury  remained  "  a  constant  source  of  irritation  until  a 
short  time  previous  to  his  death.  Exfoliation  of  bone  was  frequent,  resulting  in  nervous  prostration,  innutrition, 
and  impairment  of  his  general  health,  a  condition  favorable  to  the  development  of  tubercle.  He  never  would 
undergo  an  operation  for  the  removal  of  sequestra,"  etc.  The  specimen  (FlG.  281),  embracing  the  removed  portion 
of  the  tibia  and  showing  some  periosteal  thickening,  was  forwarded  by  Surgeon  J.  R.  Smith,  U.  S.  A.,  having  been  excised  on 
October  4,  1802. 

CASE  719. — Private  J.  Lagro,  Co.  F,  10th  Vermont,  aged  18  years,  was  wounded  at  Cold  Harbor,  June  3, 1864.  Surgeon 
R.  Barr,  67th  Pennsylvania,  reported  his  admission  to  the  field  hospital  of  the  3d  division,  Sixth  Corps,  with  "shot  fracture  of 
left  leg,  caused  by  a  musket  ball."  Assistant  Surgeon  W.  Webster,  U.  S.  A.,  described  the  injury  as  a  "  compound  fracture  of  the 
tibia  and  fibula  at  the  upper  third,"  and  reported:  "The  patient  entered  DeCamp  Hospital,  David's  Island,  twelve  days  after  he 
was  wounded.  On  July  30th,  the  parts  being  gangrenous,  excision  was  performed  by  Acting  Assistant  Surgeon  H.  Sanders, 
who  removed  about  four  inches  of  the  tibia  and  three  inches  of  the  fibula.  Ether  was  used  as  the  anaesthetic.  The  patient 
did  well  after  the  operation."  On  February  10,  1865,  he  was  transferred  to  Burlington,  and  subsequently  to  Sloan  Hospital, 
Montpelier.  Surgeon  H.  Janes,  U.  S.  V.,  in  charge  of  the  latter,  contributed  a  photograph  (Card  Photographs,  A.  M.  M.,  Vol. 
II,  p.  1),  and  reported  that  the  patient  was  able  to  walk  with  crutches,  but  could  not  bear"  much  weight  on  the  limb.  Several 
months  afterwards  the  patient  was  re-transferred  to  De  Camp  Hospital  for  the  purpose  of  having  his  wounded  leg  fitted  with  an 
apparatus,  which  was  supplied  by  Dr.  E.  D.  Hudson,  of  New  York  City.  He  was  ultimately  discharged  October  26,  1865,  and 
pensioned.  Examiner  O.  F.  Fassett,  of  St.  Albans,  certified,  September  10,  1866:  "Wound  of  left  leg,  with  fracture  of  both 
bones.  It  is  now  an  open  sore  from  necrosis.  The  bones  have  never  united  except  by  ligament,  so  that  a  false  joint  now 
exists.  The  bone  is  much  denuded  and  so  much  deformity  exists  that  no  treatment  but  amputation  can  be  of  any  benefit;  the 
leg  is  worse  than  useless."  In  1877,  the  same  examiner  again  reported  "the  wound  still  an  open,  suppurating,  and  dischai'ging 
sore,  the  bone  being  extensively  diseased.  The  disease  is  so  near  the  joint  that  amputation  must  be  above  the  knee.  His  con 
dition  now  is  worse  than  with  loss  of  the  leg  above  the  knee.  The  leg  is  bent  into  a  curve  and  greatly  deformed."  Three  years 
later  the  disease  of  the  bone  was  reported  to  be  extending  almost  or  quite  to  the  joint,  and  the  pensioner's  health  as  failing  in 
consequence  of  the  suppuration,  his  appearance  being  pale,  anaemic,  emaciated,  and  weak.  He  was  paid  June  4,  1880. 

CASE  720. — Private  R.  L.  Noe,  Co.  D,  5th  Michigan,  aged  35  years,  was  wounded  at  Fair  Oaks,  May  31,  1862,  and 
entered  De  Camp  Hospital,  David's  Island,  two  weeks  afterwards.  Acting  Assistant  Surgeon  J.  E.  Steel  reported:  "He  was 
wounded  by  a  rifle  ball,  which  passed  through  the  fibula  of  the  left  leg  about  the  middle.  The  patient  had  received  no  previous 
treatment.  After  the  removal  of  several  small  pieces  of  bone  and  some  blue  cloth  the  wound  healed ;  but  subsequently  it  again 
suppurated  and  continued  to  do  so  for  two  months.  I  then  deemed  it  necessary  to  exsect  (with  the  approval  of  Surgeon  J. 
Simons,  U.  S.  A.,  in  charge  of  the  hospital)  the  entire  fibula.  The  patient  having  been  placed  under  the  influence  of  chloroform, 
I  made  an  incision  from  the  head  of  the  bone  to  within  an  inch  of  the  external  malleolus  and  found  that  it  was  difficult  to  remove 
the  bone  in  longer  pieces  than  about  three  inches,  some  of  them  of  coui-se  being  much  smaller  and  adherent  to  the  tendons, 
which  had  to  be  pulled  oft'  with  the  forceps.  On  carefully  examining  the  bone  I  found  that  about  one  inch  of  the  external  mal 
leolus  could  be  preserved,  Avhich  was  done,  thereby  avoiding  the  opening  of  the  ankle  joint.  The  operation  was  attended  with 
a  great  deal  of  venous  haemorrhage ;  but  there  being  no  artery  of  any  importance  severed,  it  was  not  found  necessary  to  apply 
any  ligature.  No  sutures  were  employed,  the  lips  of  the  wound  being  brought  together  by  adhesive  plaster  and  then  firmly 
bandaged.  The  wound  healed  two-thirds  of  its  length  by  first  intention.  The  patient  recovered  in  three  weeks  and  was  able 
to  leave  the  hospital  six  weeks  after  the  operation."  He  was  discharged  from  service  December  31,  1862,  and  pensioned 
Examiner  M.  L.  Green,  of  Pontiac,  Michigan,  certified,  May  7,  1863:  "The  fibula  has  been  removed  and  the  leg  is  now  useless, 
having  no  support  upon  the  outer  side.  Can  never  be  of  any  service  to  him."  Examining  Surgeon  C.  Earl  subsequently 
reported:  "There  remains  a  cicatrix  extending  from  knee  to  ankle,  involving  the  tendons  and  muscles  and  causing  loss  of  power 
of  leg.  The  tibialis  anticus  muscle  is  destroyed."  In  September,  1877,  the  same  examiner  stated:  "Near  the  ankle  the  cicatrix 
has  the  appearance  of  breaking  out  again  soon,  as  the  tissues  are  getting  dark  and  infiltrated."  The  pensioner  was  paid  March 
SURG.  Ill— 58 


458 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


4,  1880.     The  head  of  the  removed  fibula  together  with  part  of  the  necrosed  shaft,  contributed  by  the  operator,  constitute 
specimen  1003  of  the  Surgical  Section  of  the  Museum. 

Three  of  the  forty-two  survivors  of  secondary  excision  in  the  bones  of  the  leg  after 
wards  submitted  to  amputation  in  the  lower  third  of  the  thigh.1 

fatal  Cases  of  Secondary  Excisions  in  the  Continuity  of  the  Bones  of  the  Leg. — The 
eight  operations  of  this  group  were  performed  on  Union  soldiers.  The  fatal  issue  was 
ascribed  to  pyaemia  in  one,  gangrene  in  one,  haemorrhage  in  one,  shock  of  operation  in  one, 
and  to  exhaustion  and  typho-malarial  fever  in  two  cases  each.  In  one  instance  the  excision 
was  followed  by  amputation  in  the  leg  and  subsequent  amputation  in  the  thigh.2 

CASE  721. — Private  E.  J.  Wyman,  Ct>.  A,  6th  Wisconsin,  aged  22  years,  was  wounded  in  the  right  leg,  at  Hatcher's  Run, 
February  7,  1865.  Surgeon  D.  C.  Chamberlain,  94th  New  York,  reported  his  admission  to  the  field  hospital  of  the  3d  division; 
Fifth  Corps,  and  described  the  injury  as  a  "fracture  of  tibia."  From  the  field  the  wounded  man  passed  to  the  Point  Lookout 
Hospital,  subsequently  to  Judiciary  Square  Hospital,  Washington,  and  on  June  15th  to  Harvey  Hospital,  at  Madison.  Surgeon 
H.  Culbertson,  U.  S.  V.,  in  charge  of  the  latter,  who  operated  in  the  case,  communicated  the  following  description  of  the  result : 
"The  tibia  was  fractured  in  the  upper  fourth.  On  July  2d,  when  the  operation  was  performed,  the  wound  was  apparently 
healing,  but  had  recently  been  gangrenous.  Venous  hasmorrhage  appeared,  and  the  bone  was  carious  and  softened.  Some  new 
bone  had  been  thrown  out  at  the  seat  of  the  fracture  and  had  also  become  diseased.  This  presence  of  diseased  bone  and  unheal 
thy  discharges  induced  the  haemorrhage  and  previous  gangrene  and  caused  the  patient's  constitutional  condition  to  be  much 
impaired.  The  operation  consisted  of  the  excision  of  five  inches  of  the  shaft  of  ihe  tibia,  beginning  opposite  the  opening  of  the 
interosseus  membrane,  making  an  incision  in  the  middle  line  of  the  bone,  and  separating  the  skin,  periosteum,  and  muscles  by 
enucleation.  The  chaJin  saw  was  then  passed  beneath  the  bone  below,  the  shaft  sawn  through  and  raised  from  below  upward. 
At  the  upper  part  the  bone  was  divided  with  the  forceps.  No  vessels  were  divided  or  important  nerves  injured  during  the  oper 
ation.  Chloroform  was  used  as  the  anaesthetic  with  good  effects.  The  edges  of  the  wound  were  approximated,  having  been 
packed  with  lint,  and  persulphate  of  iron  was  used  at  the  seat  of  the  venous  haemorrhage,  a  light  bandage  being  applied  over  all. 
The  limb  was  secured  in  a  plaster-of-Paris  splint  and  arranged  so  as  to  expose  the  wound.  The  treatment  consisted  of  animal 
broths,  alcoholic  stimulants,  quinine,  and  iron.  The  case  did  well  for  one  week,  Avhen  the  patient  had  a  slight  chill,  which 
recurred  at  regular  intervals  morning  and  evening,  and  was  followed  by  fever  and  sweating.  Antiperiodics  were  persistently 
used  without  any  good  effect.  The  patient  died  of  exhaustion,  resulting  from  typho-malarial  fever,  July  23,  1865.  The  wound 
had  been  lacking  in  action,  but  the  matter,  though  sparse,  was  healthy." 

TABLE  LXV. 
Summary  of  Fifty  -Secondary  Excisions  in  the  Bones  of  the  Leg  for  Shot  Injury. 

[Recoveries,  1-42;  Deaths,  43-50.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

|NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Barber,  C.,  Pt,  E,  88th 

July  1, 

Left  ;  portion  of  upper  third  fibula 

9 

Collins,  M.,  Pt.,  G,  1st 

Aug.  30, 

Right;  head  of  fibulaexc'd.  Surg. 

Penn.,  age  30. 

Dec.  19, 

exc'd.  Surg.C.  N.  Chamberlain, 

Michigan. 

1862, 

D.  P.  Smith,  U.  S.  V.     (Necro.) 

1863. 

U.  S.V.    Disch'd  Sept.  17,  1864; 

Mar.  17, 

Disch'd  April  27,  '63  ;  anchylosis 

ankle  joint  anchylosed. 

1863. 

knee  joint.     Spec.  1193. 

2 

Bounting,  R.  A.,  Corp'l, 

July  1, 

—  *-  ;  por.  of  up.  third  tibia  exc'd. 

10 

Davis,  W.,  Pt,  D,  89th 

Nov.  25,, 

Right  ;  mid.  third  of  tibia  exc'd. 

K,  16th  Mich.,  age  26. 

Sept.  4, 

A.  A.  Surgeon  A.  W.  Colbum. 

Illinois,  age  27. 

1863, 

Surgeon  L.  D.  Harlow,  U.  S.  V. 

1862. 

Disch'd  Nov.  17,  1802;  lame. 

June  10, 

Feb.  4,  15,  1865,  sequestra  rem'd. 

3 

Brown,  J,  Pt.,  D,   5th 

June  27, 

Left;  por.  of  tibia,  mid.th'd,  exc'd. 

1864. 

Disch'd  June  17,  '65.    Died  July 

U.  S.  Artillery,  age  25. 

Sept.  6, 

Disch'd  Dec.  29,  '62.    Legshort- 

26,  1876;  bone  diseased. 

1862. 

ened  and  distorted.     Spec.  412. 

11 

Downey,  J.,  Corp'l,   D, 

Aug.  28, 

Left  ;  4  J  ins.  low.  third  tibia  exc'd. 

4 

Brunett,  N.,  Pt.,  G,  1st 

June  17, 

Left;  head  and  2  ins.  fibula  exc'd. 

56th  Penn.,  age  23. 

Oct.  4, 

Disch'd  Jan.  17,  '65;  leg  crooked. 

Penn.  Rifles,  age  22. 

Nov.  28, 

A.A.  Surg.C.  B.  King.   (Xecro.) 

1862. 

Died  Oct.  20,  1876;  plith.  jiulmo. 

1864. 

To  Vet.  Res.  Corps  May  1,  1865. 

Spec.  555. 

5 

Bryant,  J.,  Pt.,  B,  62d 

June  27, 

Right  ;    portion  of  middle   third 

12 

Fergus,  J.,  Pt.,  A,  70th 

May  14, 

Left;  Sins.  mid.  third  fibula  exe'd. 

Pennsylvania,  age  40. 

July  29, 

tibia  excised.     Disch'd  Jan.  30, 

Indiana,  age  34. 

June  24, 

A.  A.   Surg.  T.  H.  Hammond. 

1862. 

1863;  necrosis;  shortening  and 

1864. 

Gang.;  post,  tibialart.  sloughed; 

deformity. 

bsem.    Aug.  15,  18fi4,  amputat'n 

6 

Bullock,  J.  L.,  Corp'l,  C, 

De.16,'64, 

Left  ;  3J  inches  middle  third  tibia 

thigh.     Disch'd  Jan.  20,  1865. 

5th  Minnesota,  age  36. 

Jan.  25, 

excised.    A.  A.  Surg.  J.  Butter- 

13 

Fitzgerald,  T.  J.,  Pt,,  K, 

Sept.  19, 

Left  ;  2J  inches  middle  third  tibia 

1865. 

baugh.     Disch'd  Nov.  23,  1865  ; 

6th  Louisiana. 

De.—  ,'64. 

exc'd.     Released  Aug.  25,  1865. 

leg  scarcely  of  any  use;  cartil- 

14 

Fowler,  L.,  Pt.,  E,  6th 

Au.30,'G2, 

Right  ;  3  inches  lower  third  tibia, 

aginious  union  only. 

Wisconsin,  age  27. 

Feb.  16, 

3  of  its  thickness  excised.    Duty 

7 

Canty,  T.  F.,  Pt.,  D,  63d 

Aug.  14, 

Right;  Sins.  low.  th'dfibulaexe'd. 

1863. 

July  1,  1863. 

New  York,  age  24. 

1864, 

Dr.  J.  E.  Pomfret.  Disch'd  May 

15 

Grav,  E.  T.,  Pt.,  B,  38th 

Aug.  4, 

Left  :  4  ins.  tibia  and  8  ins.  fibula 

,'66. 

30,  '65;  bone  exfol.;  unbealedm 

Ohio,  age  23. 

Sep.4,'64. 

excised.     Disch'd  May  12,  1865. 

1872  ;  requires  bandages,  1875. 

16 

Harris,  ,/.,  Pt.,  H,  12th 

Sept,  17, 

;  fract.  por.  upper  thirds  tibia 

8 

Collins,  J.,  Pt.,  B,  12th 

Sept.  17, 

Left  ;  por.  of  up.  third  tibia  exc'd. 

South  Carolina,  age  30. 

1862, 

and  fibula  exc'd.     A.  A.  Surg. 

Mass.,  age  19. 

Nov.  11, 

A.  A.  Surg.  A.  V.  Cherbonnier. 

Jan.  26, 

A.  North.     To  Provost  Marshal 

1862. 

To  Vet.  Res.  Corps  Julv  1,  1863. 

1863. 

May  16,  1863. 

t.  J.  Fergus,  A,  70th  Indiana,  left  thigh,  secondary  operation  in  lower  third  (TABLE  XL,  page  320,  No.  34);  Corp'l  T.  O'Dell,  Co.  H, 
high,  secondary  operation  in  lower  third  (TABLE  XL,  page  321,  No.  73);  Serg't  J.  Lowth,  M,  4th  Wisconsin  Cavalry,  right  thigh, 


1  Cases  of:  Pt. 
5th  Michigan,  left  thigh, 

secondary  operation  in  lower  third  (TABLE  XL,  p.  320,  No.  57). 

2  Case  of  Pt.  H.  Linn,  A,  6th  Pennsylvania  Reserves,  left  leg  amputated  Dec.  4,  1862,  in  middle  third;  January  15,  1863,  amputation  in  thigh  at 
middle  third;  haemorrhage,  Feb.  4,  1863,  ligation  of  femoral  artery;  death  March  31,  1863.     Specs.  748,  3818,  3983  (TABLE  XXXIX,  p.  315,  No.  137). 


SECT.  V.] 


EXCISIONS    IN    THE    BONES    OF  THE    LEG    OF    UNCERTAIN    DATE. 


459 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AXI>  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

17 

Holt,   T.,    Pt.,   G,    15th 

Sept.  17, 

Left  :  head  of  fibula  exc'd.    Surg. 

33 

Smith,  G.,  Pt.,  A,  1st  N. 

March  !», 

Left  ;  portion  of  lower  third  tibia 

Mass.,  age  19. 

18(52, 

S.  D.  Freeman,  II.  S.V.  Disch'd 

York  Cavalry,  age  34. 

Sept.  —  , 

excised.     Surgeon  A.  B.  Mott, 

Feb.2,'b3. 

Feb.  4,  1864.     Spec.  1109. 

1803. 

U.  S.  V.     Discharged   Aug.  5, 

18 

Jones.  E.  P.,  Pt.,  K,  22d 

Sept.  20, 

Left  ;  necrosed  ends  of  mid.  third 

1804;  1806,  bone  diseased;  1873, 

Michigan. 

1803, 

tibia  exc'd.     A.  A.  Surg.  D.  O. 

bone  healed. 

Jan.  10, 

Farrand.     Gang.    Disch'd  Oct. 

34 

Thompson,  T.  E.,  Corp'l, 

May  20, 

Right  ;  2  inches  tibia,  lower  third, 

1864. 

12,  1864. 

I,  89th  New  York,  age 

1864, 

exc'd.    Ass't  Surg.  W.  D.  Wool- 

19 

Lagro,  J.,  Pt.,  F,    10th 

June  3, 

Left  ;  4  inches  tibia  and  3  inches 

24. 

July  1, 

vert  on,  U.  S.  A.     Disch'd  Oct. 

Vermont,  age  18. 

1804, 

fibula,  up.  third,  exc'd.    A.  A. 

1864. 

11,  1865.     Died  May  3,  1873; 

July  30, 

Surg.  H.  Sanders.     (Gangrene.) 

lungs  diseased. 

18(34. 

Disc'dOct.  20,  '05;  much  deform.; 

35 

Vaughn,   A.  S.,  Pt.,  K, 

July  1, 

—  ;  3J  inches  lower  third  tibia 

false  joint. 

57th  Virginia,  age  24. 

Aug.  4, 

exc'd.    A.  A.  Surg.  E.  Borck.jr. 

20 

Lennox,  W.,  Pt.,  F,  82d 

July  3, 

Left  ;  middle  third  tibia  excised. 

1803. 

(  N  ecrosis.  )    Paroled  A  ugust  22, 

New  York. 

Sept.  —  , 

Surgeon  A.  B.  Mott,  U.  S.V. 

1803. 

1863. 

(Necrosis.)      Discharged    July 

36 

Vollmer,  M.,Pt.,C,  136th 

July  4, 

Left;  1J  inch  fibula,  lower  third, 

25,  1864. 

New  York,  age  29. 

Au.25,'03. 

excised.     Disch'd  July  8,  1805. 

21 

Lord,  B.  E.,Pi.,  11,24th 

Sept.  14, 

Left  ;  3J  inches  upper  third  tibia 

37 

Waldron,  S.  H.,  Pt.,  B, 

May  3, 

Right:  3  inches  middle  third  fibu 

Georgia,  age  23. 

Nov.  26, 

excised    (caries    and    necrosis). 

17th  Maine,  age  19. 

Nov.  3, 

la.    A.  A.  Surgeon  K.  Seyfl'arth. 

1862. 

Paroled  April  27,  1863. 

18G3. 

(Caries  ;   sloughing.)      Disch'd 

22 

Lowth,  J.,  Serg't,  M,  4th 

Aug.  24, 

Right  ;  6  inches  upper  part  fibula 

July  0,  1865. 

Wisconsin  Cuv.,  age  26. 

1804, 

excised.     Surg.   H.  Culbertson, 

38 

White,  J.  W.,    Pt.,    C, 

June  27, 

Right  ;  3  inches  tibia,  lower  third, 

May  27, 

U.  S.  V.    Lig.  post,  tibial  artery 

113th  Ohio,  age  19. 

J'y30,'04. 

excised.    Disch'd  Feb.  22,  1805  ; 

1805. 

(caries;  gang.).    June  2,  amp. 

wound  open. 

thigh.     Disch'd  July  17,  1805. 

39 

Williams,  J.  M.,  Serg't, 

J'e24,'G3, 

Right  ;  3  inches  lower  third  tibia 

23 

Luce,  J.  B.,  Pt.,  F,  179th 

June  17, 

Right  ;  8J  ins.  tibia  exc'd.    A.  A. 

G,  2d  Georgia,  age  23. 

Feb.  15, 

excised.     Assistant  Surg.  J.  E. 

New  York,  age  30. 

Oct.  24, 

Surg.W.  P.  Moon.   (Sloughing; 

1864. 

Link,  21st  111.     Provost  Marshal 

18C4. 

bone  diseased.)     Disch'd  Dec. 

April  15,  1864. 

31,  1864  ;  leg  useless. 

40 

Williamson,  J.,  Pt.,  G, 

June  16, 

Left  :  5  inches  middle  third  tibia 

24 

Mcllheran,    J.,    Pt.,    C, 

July  22, 

Right  ;  up.  third  and  head  of  tibia, 

57th  New  York,  age  42. 

Nov.  7, 

excised.     A.  A.  Surgeon  W.  P. 

llGth  Illinois,  age  24. 

18G3, 

except  shell  of  bone  articulating, 

1864. 

Moon.  Discharged  June  28,  '65  ; 

March  7, 

excised.     Surg.   J.  G.  Keenon, 

new  bone  formed. 

1864. 

U.S.V.  (Carious.)  Disch'd  Feb. 

41 

Wilson,  G.  E.,  Pt.,  D, 

Oct.  19, 

Right  :  3i  inches  fibula,  in  middle 

24,  1805. 

30th  Mass.,  age  23. 

1864, 

third,  excised.    A.  A.  Surg.W.  P. 

25 

McQuiggan,  J.,  Pt.,  E, 

July  1, 

Left  ;  middle  third  tibia  excised. 

March  2, 

Moon.  (Necrosis.)  Lnsch'd  July 

82d  Peun.,  age  20. 

Sept.  1, 

A.  A.  Surgeon  G.  H.  Dare.    De 

1805. 

22.  1865.     Spec.  1479. 

1862. 

cember,  1802,  another  operation. 

42 

Wilson,  J.,  Pt.,  E,  15th 

Aug.  7, 

Right  ;    3  inches    tibia    excised. 

Discharged  July  3,  1803.     Spec. 

Infantry,  age  21. 

Xov.5,'04. 

Disch'd  April  1,  1865. 

428. 

43 

Ackley,'j.  B.,  Pt.,  I,  7th 

June  —  , 

Left  ;  4  of  shaft  of  fibula  excised  ; 

20 

Mears,  J.  E.,  Pt.,  G,  81st 

July  1, 

Right  :  middle  third  tibia  excis'd. 

Infantry. 

J'y  29/02. 

missile  extracted.     Died  August 

Pennsylvania,  age  20. 

Aug.  21, 

Disch'd  Feb.  27,  1863  ;  consider 

13,  '02  ;  typh.  fever. 

1862. 

able  shortening  and  deformity. 

44 

Evans,  L.,  Pt.,  D,  llth 

July  26, 

Left  ;  3  inches  middle  third  tibia 

Spec.  398. 

Michigan,  age  19. 

Oct.  4, 

excised.  Ass't  Surg.W.B.Trull, 

27 

Noe,  R.  L.,  Pt.,   D,  5th 

May  31, 

Left  ;  almost  entire  fibula  excis'd. 

1864. 

U.  S.  V.     Died  March  12,  1865; 

Michigan,  age  35. 

Nov  — 

A.  A.  Surg.  J.  K.  Steele.    Disc'd 

exhaustion. 

1862. 

Dec.  31,  1862;  leg  of  not  much 

45 

Hockirk,  O.  D.,  Pt.,  A, 

Sept.  29, 

Left  :  small  por.  upper  thirds  both 

service.     Spec.  1003. 

46th  New  York,  age  25. 

Dec.  4, 

bones  exn'd.     A.  A.  Surg.  B.  N. 

28 

Odell,  T.,  Corp'l,  H,  5th 

June  18, 

Left  ;  up.  third  tibia  exc'd.   A.  A. 

1864. 

McCleery.    July,  1805,  erysip.; 

Michigan,  age  20. 

Sept,  7, 

Surg.  J.  M.  Boisnot.  Sloughing. 

gang.;  diarr.     Died  Aug.  14,'05. 

1864. 

Jan.  13,'G5,  amp.  thigh.   Disch'd 

46 

Holmes,  H.,  Pt.,  H,  50th 

Nov.9,'64, 

Right  ;  por.  of  tibia  exc'd.     Died 

May  22,  1865. 

Colored  Troops. 

J'y20,'65. 

July  24,  '05;  shock  of  operation. 

29 

Ohmit,  S.  K.,  Pt.,  D,  1st 

June  30, 

Left  ;  6  inches  lower  third  tibia 

47 

Linn,    H.,    Pt.,    A,    6th 

Sept.  17, 

Left;  large  por.  of  tibia  and  fibula 

Penn.  lies.,  age  20. 

1862. 

excised.     A.  A.  Surgeon  J.  H. 

Penn.  Res.,  age  25. 

Dec.  3, 

exc'd.     A.  A.  Surg.  A.  V.  Cher- 

Sept.  23, 

Boone.    Disch'd  Feb.  23,  1803  ; 

1862. 

bonnier.  Dec.  4,  amp.  leg  ;  hsem.; 

1862. 

complete  anchylosis  ankle,  and 

gang.;  necro.    Jan.  15.  03,  amp. 

partial  knee  joints. 

thigh.     Feb.  4,  lig.  fern,  artery; 

30 

Peters,  W.,  Pt.,  B,  8th 

June  27, 

Left  ;  3  J  inches  upper  third  fibula 

necro.;  haem.     Died  March  31, 

Penn.  Res.,  age  20. 

18G2, 

exc'd.     A.  A.  Surg.  T.  Artaud. 

1803.     Specs.  748,  3818,  3983. 

Feb.2/63. 

Discharged  November  28,  1865. 

48 

Pickell,   G.  F.,  Pt.,  K, 

Aug.  30, 

Left  ;  fractured  ends  upper  third 

Spec.  1110. 

13th  New  York,  age  17. 

Oct.6,'G2. 

tibia  excised.     Died  October  29, 

31 

Pritchard,    R.,    Pt.,    K, 

May5,'G4, 

Left  ;  3  inches  lower  third  tibia 

1802;  pyaemia. 

ll'Jth  Peun.,  age  29. 

Jan.  15, 

excised.     Discharged  June  19, 

49 

Richardson,  H.S.  ,  Lieut., 

July  12, 

Left  :  4  inches  middle  third  tibia 

1865. 

1865.     Necrosis.     Died   March 

27th  Michigan. 

1803, 

exc'd.  Surg.C.S.Tripler.U.S.A. 

2,  1871. 

Jan.5,'64. 

(Necrosis.  )     Died  Jan.  3  1  ,  1864  ; 

32 

Simmons,  A.  R.,  Pt.,  I, 

Aug.  29, 

Left  ;  3  inches  middle  third  fibula 

malignant  measles. 

2d  N.  llainp.,  age  20. 

1802, 

excised  and  sequestrum  of  tibia 

50 

Wyman,  E.  J.,Pt.,A,6th 

Feb.  7, 

Right  ;  5  inches  upper  third  tibia 

Sept.  16, 

removed.    Ass't  Surg.  H.  Allen. 

Wisconsin,  age  22. 

July  2, 

excised.     Surg.  H.  Culbertson, 

1864. 

U.  S.  A.     (Discharged  Nor.  20, 

1805. 

U.  S.V.     (Bone  carious;  venous 

1862;   non-union;  necro.);  w'nd 

hsem.;  gangrene.)  Died  July  23, 

re-opened.     1877,  bone  carious. 

1865;  typb  old  malarial  fever. 

Excisions  in  the  Continuity  of  the  Bones  of  the  Leg  of  Uncertain  Date. — In  thirty- 
five  instances  of  excision  in  the  bones  of  the  leg,  either  the  time  of  injury  or  of  operation 
or  of  both  were  not  recorded.  Twenty-seven  of  the  patients  survived  the  operation,  four 
died,  and  in  four  the  final  issue  could  not  be  ascertained.  The  excision  was  confined  to 
the  tibia  in  twenty-two,  to  the  fibula  in  twelve  instances,  and  in  one  case  portions  of  both 
tibia  and  fibula  were  excised.  Of  the  cases  of  recovery  of  this  group  nineteen  were  Union 
and  eight  Confederate  soldiers.  Seventeen  of  the  nineteen  Union  soldiers  were  subse 
quently  borne  on  the  Pension  Roll;  one  has  since  died,  and  another  had  the  limb  removed 
at  the  knee  joint.1  The  four  fatal  operations  were  performed  on  three  Confederate  and  one 
Union  soldier;  pyaemia  being  cited  as  the  cause  of  death  in  two  instances. 

'Case  of  Pt.  II.  A.  Steward,  Co.  B,  8th  Pennsylvania  Reserves,  secondary  operation  at  right  knee  joint  (TABLE  LVII,  p.  409,  No.  9). 


460 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


TABLE  LXVI. 
Summary  of  Thirty-jive  Cases  of  Excisions  in  the  Bones  of  the  Leg  for  Shot  Injury  of  Uncertain  Date. 

[  Recoveries,  1—07 ;  Deaths,  28— 31 ;  Unknown  Results,  35— 35.] 


No. 

NAME,  MILITARY 
DESCRIPTION",  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Davis,  J.  L.,  Pt.,  F,  27th 

June  27, 

Right;  lower  third  tibia  excised. 

19 

Quirk,    P.,     Lieut.,    2d 

June  9, 

Left;  3  inches  lower  third  tibia 

New  York. 

,  '62. 

Disch'd  Sept.  24,  1862    necrosis. 

Cavalry. 

'63,  

excised.     Retired  Jan.  5,  1865  ; 

{  2 

Freehand,  R.,  Pt.,  G,  1st 

Nov.  8, 

Right  ;  portion  of  tibia  excised  ; 

uses  staff  in  walking. 

3 

Cavalry,  age  22. 
Gardner,  W.  H.,  Lieut., 

,  '(i3. 
July  —  , 

necrosis.     Duty  Feb.  IS,  1865. 
;  por.  of  tibia  excised.     Pa 

20 

Steward,  H.  A.,  Pt.,  B, 
8th  Pennsylvania  Re 

June  27, 
,'62. 

Right  ;  large  portion  tibia,  upper 
third,  excised.    Disch'd  Nov.  20, 

K,  3d  Alabama. 

,  '63. 

roled  October  24,  1863. 

serves,  age  23. 

1862.     April   1,  1867,   amputa 

4 

Garrett,  J.,  Pt.,  H,  12th 

Aug.  21, 

Right  ;  4  ins.  middle  third  fibula 

tion  at  knee  joint. 

Miss.,  age  24. 

'64,  

excised.     Retired  Mar.  25,  1865. 

81 

Stineman,  M.  C.,Pt,  M, 

July  2, 

Right  ;   5J  inches  mid.  third  tibia 

5 

Harrell,  J.  P.,  Pt.,  F,  82d 

Sept.  19, 

Right  ;  portion  upper  third  fibula 

62d  Penn.,  age  25. 

,'63. 

excised.    Disch'd  Sept.  8,  1864  ; 

Indiana. 

'63,  

excised.     To   Vet.  Res.  Corps. 

leg  shortened  and  bent. 

Disoh'd  June  17,  1865. 

22 

Walker,    R.,   Serg't,    I, 

Sept.  17, 

Left  ;  3  inches  lower  third  tibia 

6 

Harris,  J.  D.,  Serg't,  C, 

May  6, 

Right  ;  portion  of  fibula  excised. 

104th  New  York. 

,  '62. 

excised.    Disch'd  Dec.  20,  1862  ; 

14th  Alabama,  age  3L. 

'64. 

Retired  Feb.  15,  1865. 

1J  inch  shortening. 

7 

Hull,  F.  S.,  Pt.,  G,  8th 

June  14, 

Right  ;  por.  of  middle  third  fibula 

23 

Walker,  W.  T.,  Pt.,  G, 

Sept.  14, 

Left  ;  5  inches  upper  third  fibula 

Vermont,  age  34. 

'03,  

excised.     Disch'd  June  22,  '64. 

12th  Massachusetts. 

,  '62. 

excised.    Disch'd  Dec.  13,  1862. 

1865,  exfoliation  necrosed  bone. 

24 

Warren,  0.,  Serg't,    B, 

Oct.  27, 

Right  ;  portion  of  tibia,  low.  third, 

8 

Imbrie,  D.,  Pt.,  K,  10th 

June  27, 

Right  ;  1  inch  of  fibula  excised. 

44th  N.  C.,  age  24. 

,  '64. 

excised.     Retired  Feb.  28,  1865  ; 

Penn.  Res.,  age  19. 

,  '62. 

Disch'd  Nov.  27,  1862. 

partial  anchylosis  ankle  joint. 

9 

Johnson,  W.  B.,  Lieut., 

Nov.  25, 

Left;  2  inches  lower  third  tibia 

25 

Wheeler,  G.,  Pt.,  K,  6th     May  19, 

Left  ;  middle  third  fibula  excised. 

E,  26th  Ohio. 

'63,  

excised.     Disch'd  Oct.  19,  1864. 

N.  Y.  Artillery,  acre  43.    ,  '64. 

Disch'd  Jan.  7,  1865. 

1866,  bone  carious  and  exfol'ing. 

26     Williams,  J.  H",  Corp'l.      Oct.  21, 

Left  ;  por.  low.  third  tibia  exc'd. 

HI 

Jordan,  N.,  Pt.,  C,  19th 

Nov.  30, 

Left  ;  3  ins.  mid.  third  tibin  exc'd. 

E,  15th  Massachusetts.    '01,  

Disch'd  Oct.    14,    1862.      Died 

Tennessee,  age  19. 

'64,  

To  Pro.  Marshal  April  (!,  18C5. 

April  6,  1863. 

11 

Kubn,  H.,  Ft.,  H,  lllth 

Sept.  17, 

Left  ;  portion  of  lower  third  fibula 

27 

Williams,  J.  O.,  Pt.,  E, 

July  1, 

Left  ;  3  inches  lower  third  fibula 

Pennsylvania,  age  21. 

1862. 

excised.    Disch'd  Jan.  10,  1863; 

143d  Penn.,  age  25. 

f-63. 

excised.     Disch'd  May  9,  1864; 

anchy.  ankle  joint. 

shortening;  anchy.  ankle  joint. 

12 

Lautenshlager,   S.,    Pt., 

July  1, 

Left  ;  por.  of  low.  third  tibia  exc'd. 

28 

Baldwin,  H.  J.,  Pt.,  E, 

May3, 

Left;  4  ins.  tibia  exc'd.  (Necrosis.) 

G,  24th  Michigan. 

'63,  

Disch'd  March   28,  1864;  false 

27th  Indiana. 

,'63. 

Died  June  15,   18C3;  pyaemia. 

joint  in  tibia  ;  unable  to  bear  his 

Spec.  1283. 

weight  on  leg. 

29 

lDukoy,    S.  L.,   Pt.,   D, 



Left  ;  4  inches  middle  third  tibia 

13 

Lewis,  W.  B.,  Pt.,  B.  1st 

July  1, 

Right  ;  4  ins.  middle  third  tibia 

15th  Texas,  age  24. 

excised  ;  erysipelas  ;  gangrene. 

Texas,  age  20. 

'62,  

excised.     Recovery. 

I 

Died  of  pyaemia. 

14 

Marshall.  M.  F.,  Pt.,  B, 

May  5, 

Right  ;  por.  of  middle  third  tibia 

30 

Farr,   T.  A.,  Serg't,  B,  — 

Left  ;    portion   of   tibia   excised. 

5th  New  Jersey. 

excised.    Disch'd  Sept.  25,  1862. 

llth  South  Carolina. 

Died  May  29,  1864. 

15 

Me.tcalf,  ./.,  Serg't,  1.  54th 

Mar'.  25,' 

Left  ;  1  J  inch  of  lower  third  tibia 

31 

Gray,  J.  F.,  Pt.,  B,  4th 

Mar.  —  , 

Left;  12  inches  of  fibula  excised. 

North  Carolina,  age  29. 

,  '65. 

excised.     Released  Aug.  25,  '65. 

Georgia. 

,  '65. 

Died  April  28,  1865. 

16 

Mullins,   J.,  Serg't,    D, 

July  1. 

Left  ;  5  ins.  tibia  and  por.  of  fibula, 

32 

Knowles,  L.   T.,  Pt.,  F, 

Aug.  15, 

Right  ;  portion  of  fibula  excised. 

12th  Massachusetts. 

,  '63. 

upper  third,  exc'd;  gang.     Dis 

9th  Georgia. 

'64,  

charged  May  6,  '64.   1877,  bone 

33 

Parnell,  J.,  Pt.,  I,    14th 

Aug.  16, 

Right;  portion  of  tibia  excised. 

still  diseased. 

South  Carolina. 

'64,  

17 

Perrin,  J.   T.,  Capt.,  E, 

May  20, 

Right:  portion  of  upper  third  tibia 

34 

Sullnot,    J.    B.,  Pt.,  C, 

Oct.  19, 

Left  ;  partial  excision  of  tibia. 

26th  Virginia. 

,  '64. 

exc'd.  Furloughed  Aug.  29,'64. 

44th  Georgia. 

'64,  

18 

Pettee,  L.,  Lieut.,  llth 

July  2, 

Right;  1J  inch  lower  third  tibia 

35 

Tatley,  S.,  Pt.,   C,  41st    Aug.  19, 

Left  ;  2J  inches  fibula  excised. 

Infantry. 

,'63. 

excised.     Duty  Nov.  24,  1863. 

Virginia,  age  25.               '64,  

The  side  injured  was  not  indicated  in  twelve  of  the  three  hundred  and  eighty-seven 
cases  of  excisions  in  the  continuity  of  the  bones  of  the  leg.  The  right  limb  was  fractured 
in  one  hundred  and  sixty-three — one  hundred  and  sixteen  recoveries,  forty-five  deaths,  two 
unknown  results, — and  the  left  in  two  hundred  and  twelve — one  hundred  and  fifty-four 
recoveries,  fifty-six  deaths,  and  two  unknown  results. 

AMPUTATIONS  IN  THE  CONTINUITY  OF  THE  LEG  FOR  SHOT  FRAC 
TURES. — The  precept  of  Guthrie2  that  "a  leg  should  be  seldom  amputated  for  a  fracture 
from  a  musket  ball"  seems  to  have  been  very  generally  disregarded  by  the  surgeons  of  the 
American  civil  war.  Of  eight  thousand  nine  hundred  and  eighty-eight  cases  of  shot  frac 
tures  in  the  continuity  of  the  bones  of  the  leg,  of  which  88.4  per  cent,  were  caused  by 
musket  balls,3  amputation  was  performed  in  four  thousand  seven  hundred  and  ten,4  or  52.4 
per  cent.  Of  these  four  thousand  seven  hundred  and  ten  cases  of  amputations  for  shot 

1  AMJKKteO.N,  Pyttnda  supervening  upon  Hospital  Gangrene,  in  U.  S.  Sanitary  Cominissicn  Memoirs,  New  York,  1871,  Surgical  Volume  11,  p.  443. 

2  GUTHUIE  (G.  J.),  Commentaries  on  the  Surgery  of  the  War,  etc.,  sixth  edition,  London,  1855,  p.  150:  "The  bones  of  the  leg  being  more  exposed, 
admit  of  greater  liberties  being  taken  with  them,  and  of  larger  portions,  or  even  parts,  being  taken  away  successfully,  than  ought  to  be  attempted  in  the 
thigh.     A  leg  should  therefore  be  seldom  amputated  for  a  fracture  from  a  musket  ball." 

3  The  nature  of  the  missile  was  reported  in  6,336  of  the  8,988  cases  of  shot  fractures  in  the  continuity  of  the  bones  of  the  leg  without  primary 
injury  to  the  knee  or  ankle  joints:  79  were  caused  by  cannon  or  solid  shot;  654  by  shells ;  5,603  by  musket,  pistol,  or  other  small  balls;  and  in  2,652 
instances  the  missile  was  not  specified. 

4 See  TAIJLK  LI,  p.  432,  ante.  The  cases  are:  19  excisions  in  the  leg  followed  by  amputations  in  the  leg:  2  excisions  in  the  leg  with  subsequent 
amputations  in  the  leg  and  thigh ;  5  excisions  in  the  leg  followed  by  amputations  at  the  knee  joint ;  22  excisions  in  the  leg  followed  by  amputations  in  the 
thigh  ;  3,728  amputations  in  the  leg  ;  3  amputations  in  the  leg  and  subsequent  amputation  at  the  knee  joint ;  39  amputations  in  the  leg  followed  by  ampu. 
tations  in  the  thigh  ;  100  amputations  at  the  knee  joint;  7  amputations  at  the  knee  joint  followed  by  amputations  in  the  thigh;  and  785  amputations  of 
thigh  ;  a  total  of  4.710  amputations  following  shot  fractures  in  the  bones  of  the  leg. 


SECT.  V.] 


PKIMARY  AMPUTATIONS  IN  THE  LEG. 


461 


fractures  of  the  bones  of  the  leg,  eight  hundred  and  seven  performed  in  the  thigh  and  one 
hundred  and  twelve  performed  at  the  knee  joint  have  already  been  considered  in  the  pre 
ceding  two  sections  of  this  chapter.  Deducting  these  from  the  four  thousand  seven  hundred 
and  ten  cases  of  amputations  for  shot  fractures  in  the  bones  of  the  leg,  there  remain  three 
thousand  seven  hundred  and  ninety-one  cases  of  ablation  in  the  leg,  to  which  should  be 
added  one  thousand  six  hundred  and  sixty-one  amputations  in  the  leg  following  shot  frac 
tures  of  the  ankle  joint  or  foot,  making  a  total  of  five  thousand  four  hundred  and  fifty-two 
cases  of  amputations  in  the  leg  to  be  considered  in  this  section.  A  numerical  statement 
of  the  cases  is  contained  in  the  following  table: 

TABLE  LXVII. 
Numerical  Statement  of  Fifty-Jour  Hundred  and  Fifty -two  Amputations  in  the  Leg  for  Shot  Injury. 


CASES. 

UPPER  THIRD. 

MIDDLE  THIRD. 

LOWER  THIRD. 

SEAT  NOT  RE 
CORDED. 

•ss 

OPERATIONS. 

•d 

V 

a 

fS 

"2 
1 

1 

rrt 
1 

1 

f? 

1 

£  = 

>, 

g 

£              1 

ft 

1 

o 

a 

3  1 

1 

^ 

i 

o 
t> 

-: 

§ 

^     i     ^ 

—3      ** 

> 

j 

1C 

a 

1 

•d 

t  » 

5 

I 

"3    •d 

a 

§ 

•s 

-= 

2     '     § 

cj    -d 

5 

| 

"S 

•d 

o 

O       C 

o 

EH 

« 

ft 

P 

rtft 

H 

ft 

P 

H 

H 

ft 

D 

H      '     PS 

ft  P 

H 

PS 

ft 

P 

3,  392 

2,307 

1,032 

51 

30.9 

1,029 

771 

04Q 

q 

892 

736 

150 

6 

900       676 

915 

q 

571 

194 

418 

94 

1,046 

682 

364 

34.7 

296 

194 

10" 

368 

258 

110 

335 

215 

190 

47 

15 

444 

327 

117 

26.3 

133 

96 

17 

174 

137 

17 

121 

86 

15 

16 

a 

8 

Time  between  injury  and  oper- 

570 

245 

240 

85 

49.4 

51 

33 

18 

47 

39 

8 

51 

34 

17 

421 

139 

197 

85 

[ 

J 

ll 

5,452 

3,561 

1,  753 

138 

32.9 

1,509 

1,094 

406 

9 

1,481 

1,  170   305 

6    1,407 

1,011 

387   9 

1,  055 

286 

655 

114 

In  one  hundred  and  thirty-eight  of  the  five  thousand  four  hundred  and  fifty-two 
instances  of  amputations  in  the  leg  the  final  result  could  not  be  ascertained;  three  thousand 
five  hundred  and  sixty-one  had  successful,  and  one  thousand  seven  hundred  and  fifty-three 
fatal  terminations,  a  mortality  rate  of  32.9  per  cent.  Three  thousand  three  hundred  and 
ninety-two  were  primary,  one  thousand  and  forty-six  intermediary,  four  hundred  and  forty- 
four  secondary,  and  five  hundred  and  seventy  were  operations  of  unspecified  date,  the 
primary  amputations,  by  far  the  most  numerous,  comprising  69.4  per  cent,  of  the  cases  in 
which  the  time  between  the  injury  and  the  operation  could  be  ascertained. 

PRIMARY  AMPUTATIONS  IN  THE  CONTINUITY  OF  THE  LEG  FOR  SHOT 
INJURY. — Of  the  three  thousand  three  hundred  and  ninety-two  primary  operations,  one 
thousand  and  twenty-nine  were  in  the  upper  third,  eight  hundred  and  ninety-two  in  the 
middle  third,  nine  hundred  in  the  lower  third,  and  in  five  hundred  and  seventy-one  the 
seat  of  the  operation  was  not  indicated. 

Primary  Amputations  in  the  Upper  Third  of  the  Leg  for  Shot  Injury. — The  results 
in  nine  of  the  one  thousand  and  twenty-nine  instances  of  this  group  were  not  ascertained; 
seven  hundred  and  seventy-one  had  successful,  and  two  hundred  and  forty-nine  fatal  term 
inations,  a  mortality  of  24.4  per  cent. 

jExamples  of  Successful  Primary  Amputations  in  the  Upper  Third  of  the  Leg. — The 
seven  hundred  and  seventy-one  amputations  of  this  group  were  performed  on  seven  hun- 


462  INJURIES    OF    THE    LOWER   EXTREMITIES.  [CHAP.  x. 

dred  and  sixty-six  patients,  live  being  successful  amputations  of  both  legs  in  the  upper 
third.     One  of  the  cases  of  double  amputation  will  be  given  in  detail: 

CASE  722.— Private  S.  L.  Willson,  Co.  D,  ?2<1  New  York,  aged  18  years,  was  wounded  at  Gettysburg,  July  2,  1863. 
He  was  admitted  to  the  field  hospital  of  the  2d  division,  Third  Corps,  whence  Surgeon  C.  K.  Irwin,  72d  New  York,  reported: 
"Compound  comminuted  fracture  of  right  and  left  leg  by  mini<5  ball,  followed  by  amputation  of  both  legs."  Surgeon  H.  Janes, 
U.  S.  V..  forwarded  the  following  history:  "The  patient  entered  Camp  Letterman  August  30th.  Both  of  his  legs  had  been 
shattered  at  the  lower  third,  and  amputation  was  performed  at  the  upper  third  on  the  day  following  the  injury.  The  stumps 
granulated  well  and  the  patient's  general  health  was  good.  Simple  dressings,  with  tonics  and  stimulants,  constituted  the  treat 
ment.  On  October  21st,  when  the  man  was  transferred  to  another  hospital,  the  stumps  were  in  tolerable  good  condition.  There 
had  been  ulcers  in  the  cicatrices,  threatening  gangrene,  which  was  controlled  with  citrine  ointment,  leaving  small  abrasions." 
The  patient  subsequently  passed  through  hospitals  at  Baltimore  and  Alexandria,  and  lastly  he  was  transferred  to  Rochester, 
where  he  was  discharged  May  31,  18C5,  and  pensioned.  Since  leaving  the  service  he  has  been  furnished  at  regular  intervals 
with  artificial  le^s  of  the  "  Bly"  pattern,  which  he  reports  as  satisfactory,  and  the  use  of  which  enabled  him  to  accept  and  hold 
employment  as  messenger  of  the  U.  S.  Senate  at  the  Capitol  building  for  a  number  of  years.  In  his  several  applications  for 
these  artificial  limbs  he  described  the  stumps  as  being  in  good  condition.  His  pension  was  paid  March  4,  1880. 

Brief  histories  of  the  remaining  four  instances  of  successful  primary  amputation  in  the 
upper  third  of  the  leg  are  related  in  the  foot-note.1 

CASE  723.— Corporal  J.  H.  Wilkins,  Co.  E,  1st  Louisiana,  aged  25  years,  was  wounded  at  Port  Hudson,  June  14,  1863, 
and  conveyed  to  New  Orleans  three  days  afterwards.  Assistant  Surgeon  P.  S.  Conner,  U.  S.  A.,  recorded  his  admission  to 
University  Hospital,  with  "amputation  of  left  leg  performed  on  the  battle  field,"  also  his  departure  on  furlough  October  26th. 

Several  weeks  afterwards  the  patient  entered  Central  Park  Hospital,  New  York  City,  whence 
Surgeon  B.  A.  Clements,  U.  S.  A.,  reported  the  following  history:  "The  wound  was  caused  by 
a  musket  ball,  which  passed  through  the  middle  of  the  leg  antero-posterioriy,  comminuting  both 
bones  badly  and  wounding  the  arteries.  There  .was  much  haemorrhage.  Amputation  through 
the  upper  third,  by  antero-posterior  flaps,  was  performed  under  chloroform  one-half  hour  after 
the  injury.  At  first  sutures  and  water  dressings  were  applied.  The  parts  united  mostly  by  first 
intention  and  had  entirely  healed  at  the  end  of  six  weeks.  When  admitted  to  this  hospital, 
November  12th,  the  stump  was  in  good  condition  and  the  patient's  general  health  good.  On 
December  20th,  he  contused  the  stump  by  a  fall,  which  was  followed  by  great  swelling,  heat, 
and  pain.  Four  days  later  an  abscess,  which  had  formed  two  inches  above  the  cicatrix  on  the 
anterior  face  of  the  stump,  was  opened,  when  one-half  ounce  of  pus  was  discharged.  By  Feb- 
ruai7  %25>  18G4>  the  inflammation  and  swelling  had  subsided,  but  there  remained  considerable 
rigidity  of  the  knee  joint,  flexion  and  extension  being  imperfect.  Three  weeks  later  the  swelling 
of  the  stump  had  entirely  subsided,  and  several  months  afterwards  flexion  was  again  restored,  though  extension  was  not  perfect. 
When  discharged  from  service,  August  9,  1864,  the  patient  had  had  an  artificial  limb  for  about  one  month,  not  being  able  to  use 
it  very  well  owing  to  the  want  of  perfect  extending  power,  but  improving  with  it  constantly."  The  pensioner  was  paid  March 
4,  1880.  A  cast  of  the  stump  (Spec.  4371,  A.  M.  M.),  presenting  an  excellent  appearance,  with  the  wound  well  united,  was 
contributed  by  Acting  Assistant  Surgeon  G.  F.  Shrady,  and  is  represented  in  the  wood-cut  (FlG.  282). 

CASE  724. — Private  Z.  Holcomb,  Co.  B,  36th  Ohio,  aged  26  years,  was  wounded  at  Opequan  Creek,  September  19, 1864. 
He  was  admitted  to  the  field  hospital  at  Winchester,  and  thence  removed,  on  November  12th,  to  Frederick  Hospital.  Assistant 
Surgeon  R.  F.  Weir,  U.  S.  A.,  in  charge  of  the  latter  hospital,  made  the  following  report:  "On  examining  the  patient  it  was 
found  that  he  had  undergone  an  amputation  of  the  right  leg  at  the  upper  third,  which  was  performed  for  a  shell  wound  of  the 
same  at  the  middle  and  lower  thirds.  The  stump  is  nearly  healed.  He  had  also  a  shot  wound  of  the  thigh  of  the  same  limb, 
the  ball  lodging.  The  latter  wound  was  supposed  to  be  a  simple  flesh  wound  and  had  entirely  healed,  the  missile  having 
evidently  passed  downward,  for  it  could  not  be  felt.  On  December  1st,  there  was  evidence  of  the  formation  of  an  abscess  on 
the  posterior  portion  of  the  thigh,  at  the  lower  part  of  the  upper  third,  and  poultices  were  ordered  to  be  applied.  On  December 
5th,  the  fluctuation  being  well  marked  over  the  abscess,  a  free  incision  was  made  and  about  an  ounce  of  pus  evacuated.  On 
introducing  the  finger  the  missile  was  then  discovered,  which  proved  to  be  a  cast-iron  ball  from  a  Shrapnell  shell,  and  was 
removed  by  means  of  a  forceps  by  Acting  Assistant  Surgeon  W.  S.  Adams.  On  further  examination  of  the  limb  quite  an 
amount  of  callus  was  found  around  the  femur  at  the  junction  of  the  upper  and  middle  thirds,  and  on  questioning  the  patient  he 
stated  that  his  surgeon  had  informed  him  that  a  non-comminuted  fracture  was  produced  by  the  missile;  also  that  a  conptntion 
splint  had  been  applied  for  the  same.  On  measurement  there  was  found  to  be  a  little  over  one  inch  shortening.  On  December 


be! 

Ji 


Jersey,  age  35,  wounded  at  Roanokc  Island,  February  8,  1802,  by  a  cannon  ball.     Two  hours  after  the  injury  Surgeons  J.  H.  Thompson,  U.  S.  V.,  and 
II.  W.  Rivers,  4th  Rhode  Island,  removed  both  legs  about  two  inches  below  the  knee  joint.     The  patient  was  discharged  and  pensioned  September  30, 


to  Bcaverdale,  Alabama. — 4.  Corp'l  James  Tanner,  Co.  C,  8?th  New  York,  received  a  shell  wound  of  both  legs,  at  Dull  Run,  Virginia,  August  M,  IS(>J. 
Both  limbs  were  removed  on  the  field,  at  the  upper  thirds.  The  stumps  healed  perfectly,  and  the  patient  was  discharged  October  15, 18G2,  and  pensioned. 
In  1874,  he  declared  that  the  cicatrices  had  become  adherent  to  bone  and  were  very  tender.  He  was  paid  June  4,  1880. 


SECT.  V.]  PRIMARY    AMPUTATIONS    IN    THE    LEG.  463 

21st,  when  the  patient  was  transferred,  his  general  condition  was  good  and  the  wounds  were  entirely  healed."  The  missile 
was  contributed  to  the  Museum  by  the  operator,  and  constitutes  specimen  1498  of  the  Surgical  Section.  The  patient  subsequently 
entered  Camden  Street  Hospital,  Baltimore,  and  afterwards  Broad  and  Cherry  Streets  Hospital,  Philadelphia,  and  on  May  20, 
1865,  he  was  discharged  from  Chester  Hospital  and  pensioned.  Two  months  afterwards  he  was  supplied  with  an  artificial  limb 
by  the  Palmer  Arm  and  Leg  Company  of  Philadelphia.  Examiner  A.  B.  Monahan,  of  Jackson,  Ohio,  September  6,  1876, 
certified :  "  The  pensioner  has  lost  his  right  leg  three  inches  below  the  knee  joint.  The  stump  is  tender  and  he  cannot  wear  an 
artificial  leg.  There  is  also  a  wound  of  the  right  thigh,  the  ball  striking  the  femur,  upper  third,  and  passing  down  about  three 
inches,  where  it  lodged  and  was  removed.  There  is  caries  of  the  femur  and  the  wound  is  open,  small  spicula?  of  bone  being 
sloughed  through  the  opening.  The  thigh  is  painful,  lame,  etc."  The  pensioner  was  paid  September  4,  1880. 

In  the  following  instance  the  amputation  was  performed  close  to  the  knee  joint,  through 
the  tuberosity  of  the  tibia,  and  the  fibula  was  disarticulated — a  method  advocated  and 
frequently  performed  by  the  elder  Larrey  i1 

CASE  725. — Private  J.  Strider,  Co.  K,  56th  North  Carolina,  aged  34  years,  was  wounded  at  Plymouth,  April  20,  1864, 
by  a  minie"  ball,  which  produced  a  compound  comminuted  fracture  of  the  right  tibia.  Surgeon  C.  H.  Ladd,  C.  S.  A.,  who  ampu 
tated  the  leg  on  the  day  of  the  injury,  reported:  "The  operation  was  performed  by  the  circular  skin-flap  method  close  to  the 
knee  joint,  and  the  fibula  was  disarticulated.  The  stump  healed  by  first  intention.  I  have  never  before  or  since  performed  an 
amputation  so  close  to  the  knee  joint;  think  it  might  often  replace  disarticulation  at  the  knee  joint  or  amputation  above."  The 
patient  recovered  and  was  retired  from  service  January  17,  1865. 

One  of  the  seven  hundred  and  seventy-one  survivors  after  primary  amputation  in  the 
upper  third  of  the  leg  subsequently  underwent  amputation  at  the  knee  joint,  and  nine, 
amputation  in  the  thigh: 

CASE  726. — Private  J.  Morrin,  Co.  G,  126th  New  York,  aged  21  years,  was  wounded  at  Gettysburg,  July  3,  1863,  and 
admitted  to  the  field  hospital  of  the  3d  division,  Second  Corps.  Surgeon  I.  Scott,  7th  West  Virginia,  recorded:  "Compound 
comminuted  fracture  of  left  leg  by  miiiie"  ball,  followed  by  posterior  flap  amputation  by  Surgeon  J.  Aiken,  71st  Pennsylvania." 
The  patient  remained  in  hospital  at  Gettysburg  for  three  months  and  was  then  transferred  to  Philadelphia,  whence  Surgeon  J. 
Hopkinson,  U.  S.  V.,  in  charge  of  Mower  Hospital,  reported  the  following  description  and  progress  of  the  case:  "The  tibia  and 
fibula  had  been  shattered  to  such  an  extent  that  amputation  below  the  knee  was  rendered  necessary  on  the  field.  When  admitted 
to  this  hospital,  September  9th,  the  flaps  were  open  and  the  ends  of  the  bones  exposed.  Gangrene  had  set  in  and  the  patient 
was  in  a  low  and  typhoid  condition.  A  solution  of  sulphate  of  copper  was  applied  to  the  stump,  and  quinine  with  tincture  of 
chloride  of  iron  was  prescribed  internally;  milk  punch  and  beef  tea  at  pleasure.  The  patient  improved 
under  the  treatment  until  November  3d,  when  haemorrhage  from  the  anterior  tibial  took  place  at  11^  p.  M. 
Amputation  of  the  lower  third  of  the  thigh  (see  TABLE  XL,  No.  69,  p.  321,  ante)  by  antero-posterior  flaps 
was  then  resorted  to  by  Assistant  Surgeon  T.  C.  Brainerd,  U.  S.  A.  Sixteen  ounces  of  blood  were  lost. 
Injections  of  brandy  and  carbonate  of  ammonia  were  given  to  induce  reaction,  which  took  place  six  hours 
after  the  operation.  After  reaction  had  fully  set  in  the  patient  continued  to  improve  until  recovered.  The 
ligatures  were  removed  on  November  19th.  By  January  9,  1864,  the  cicatrix  had  entirely  healed,  leaving 
a  most  excellent  stump."  The  subsequent  record  of  the  case  was  furnished  by  Surgeon  B.  A.  Clements, 
U.  S.  A.,  who  re-ported  that  "the  patient  was  admitted,  March  30,  1864,  to  Central  Park  Hospital,  New 
York  City,  where  several  months  later  two  sinuses  were  discovered  in  the  cicatrix  of  the  stump,  leading  to 
necrosed  bone.  On  November  23d,  the  patient  was  put  under  the  influence  of  chloroform  and  a  trans 
verse  incision,  three  inches  long,  was  made  across  the  lower  edge  of  the  flap,  when  it  was  found  that  a  ring 

of  boue  had  exfoliated  from  the  end  of  the  femur,  but  was  still  bound  down  by  an  overlapping  growth  of        Fir-  283^— Bones  of 

„  ,  ,„.  .         .  .  stump  of  leTt  leg-  three 

new  bone  trom  the  endosteum.     llns,  with  a  portion  of  the  new  growth,  was  removed  by  Acting  Assistant    months  after  amputa- 

Surgeon  S.  Teats,  assisted  by  Acting  Assistant  Surgeon  J.  K.  Merritt."  The  patient  remained  under  treat-  tion-  Spec-  2(i04- 
ment  until  June  17,  1865,  when  he  was  discharged  from  service  and  pensioned.  Examining  Surgeon  R.  C.  Dunham,  of  Seneca 
Falls,  N.  Y.,  August  6,  1873,  certified  to  amputation  of  the  thigh  and  added :  "There  is  no  amount  of  flesh  over  the  end  of  the 
bone;  it  is  covered  by  the  skin  only,  and  it  appears  to  be  very  tender  to  the  touch.  He  cannot  wear  an  artificial  limb  very  long 
at  any  time  to  be  of  any  use  to  him  by  way  of  walking  or  standing,"  etc.  The  pensioner  was  paid  June  4,  1880.  The  stumps 
of  the  tibia  and  fibula,  removed  at  the  second  amputation,  and  the  nearly  circular  sequestrum,  together  with  four  small  frag 
ments  removed  at  the  last  operation,  were  contributed  to  the  Museum  by  the  operators.  They  constitute  specimens  2604  and 
1416,  respectively,  of  the  Suryical  Section.  A  representation  of  the  former  appears  in  the  wood-cut  (FiG.  283). 

Six  hundred  and  twenty-seven  of  the  patients  who  recovered  after  primary  amputa 
tion  in  the  upper  third  of  the  leg  were  Union  soldiers.  Of  these,  three  officers  were  retired 
from  the  service,  and  six  hundred  and  twenty-one  enlisted  men  became  pensioners.  The 


464 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


names  of  three  of  the  patients  cannot  be  found  on  the  Pension  Rolls.     Fifty-one  of  the 
pensioners  have  died  since  the  date  of  their  discharge. 

CASE  727. — Private  J.  Walsh,  Co.  A,  57th  Massachusetts,  aged  39  years,  was  wounded  at  Fort  Steadman, 
March  25, 1865,  by  a  musket  ball,  which  fractured  the  left  leg  in  the  upper  third,  perforating  the  tibia  transversely 
and  completely  destroying  the  upper  part  of  the  fibula.  Surgeon  M.  K.  Hogan,  U.  S.  V.,  reported  the  wounded 
man's  admission  to  the  field  hospital  of  the  1st  division,  Ninth  Corps,  where  the  leg  was  amputated  below  the 
knee  by  Surgeon  W.  C.  Shurlock,  51st  Pennsylvania.  Assistant  Surgeon  S.  Adams,  U.  S.  A.,  who  contributed 
the  amputated  bones  (Spec.  4081),  represented  in  the  annexed  wood-cut  (FlG.  284),  reported  that  the  patient 
nearly  died  during  the  operation  from  the  effects  of  chloroform,  having  become  pulseless  and  his  respiration 
having  ceased.  One  week  after  the  reception  of  the  injury  the  patient  was  sent  to  City  Point,  and  afterwards  ho 
passed  through  various  hospitals,  being  ultimately  discharged  from  service  September  12,  1865,  and  pensioned. 
In  the  statement  subsequently  furnished  by  B.  F.  Palmer,  of  Philadelphia,  for  an  artificial  leg,  the  amputation  was 
described  as  having  been  performed  by  the  "flap  method."  In  his  application  for  commutation,  dated  1870,  the 
pensioner  described  the  condition  of  the  stump  as  "sound  and  free  from  pain,"  and  its  length  as  "one  inch  and 
three-fourths  from  the  patella."  The  pensioner  was  paid  March  4,  1875.  He  is  reported  as  having  died  since 
that  date. 

Examples  of  fatal  Primary  Amputations  in  the  Upper  Third  of  the  Leg. 
Two  hundred  and  forty-nine  cases  of  amputation  in  the  upper  third  of  the  leg 
were  performed  on  two  hundred  and  forty-eight  patients,  in  one  instance  both 
legs  having  been  primarily  amputated  in  the  upper  third: 

CASE  728. — Private  J.  H.  Metz,  Co.  G,  9th  Regiment  Veteran  Reserve  Corps,  aged  33  years,  was  wounded  in  the  left 
leg,  near  Fort  Stevens,  Defences  of  Washington,  July  11,  1864.  Surgeon  O.  A.  Judson,  U.  S.  V.,  made  the  following  report  of 
the  injury:  "A  conoidal  ball  entered  the  limb  anteriorly,  passed  through  transversely,  and  produced  a  compound 
comminuted  fracture  at  the  upper  third  of  the  tibia,  the  man  by  his  weight  soon  after  fracturing  the  fibula.  He  was 
conveyed  to  Carver  Hospital,  Washington,  where  the  leg  was  amputated  at  the  upper  third,  by  the  lateral  flap 
method,  by  Medical  Inspector  J.  Wilson,  U.  S.  A.,  on  the  day  of  the  injury.  The  patient  was  anaemic  and  very 
nervous  at  the  time  of  the  operation.  Cold-water  dressings  were  applied.  On  the  following  day  the  clot  had  formed 
beneath  the  flaps,  rendering  it  necessary  to  cut  the  suture  and  reopen  the  wound.  The  clot  was  then  turned  out 
and  the  flaps,  after  remaining  open  for  some  time,  were  closed  up  again.  On  July  13th,  the  flaps  looked  dark  and 
were  opened  again,  when  a  strong  solution  of  sulphate  of  copper  was  applied.  Sloughing  commenced  the  next 
day,  causing  the  tibia  to  protrude.  Citrate  of  iron  and  quinine,  with  stimulants,  were  administered  freely  and 
the  external  applications  repeated.  By  July  17th  granulations  were  starting  up  over  a  portion  of  the  surface  of 
the  flaps.  Secondary  hfemorrhage  occurred  on  the  following  day.  The  patient  appeared  greatly  exhausted,  had 
very  poor  appetite,  and  was  troubled  with  diarrhoea.  Dry  dressings  were  now  applied  to  the  stump.  On  July 
23d  an  abscess  was  found  to  have  formed  above  the  knee,  after  which  sloughing  extended  upwards.  The  patient 
continued  to  sink,  his  diarrhoea  resisting  all  treatment;  pulse  rapid;  skin  of  an  icteric  tinge.  Death  occurred 
from  exhaustion,  July  28,  1864.  At  the  autopsy  pus  was  found  to  have  burrowed  up  the  outer  and  posterior 
portion  of  the  leg,  extending  to  the  dorsum  of  the  ilium.  The  pus  was  of  a  dark  color  and  contained  a  large 
quantity  of  free  fat.  The  right  lung  adhered  to  the  wall  of  the  chest  anteriorly,  otherwise  healthy.  Both  lobes 
of  the  left  lung  were  slightly  congested ;  heart  normal ;  liver  somewhat  congested  and  gall-bkidder  distended  with 
bile;  spleen  covered  on  lower  portion  with  patches  of  lymph;  stomach  distended  with  dark  fluid.  The  mucous 
membrane  of  the  small  intestine  was  thickened  and  covered  with  pseudo-membrane,  easily  removable."  The 
ainputateS  bones  of  the  leg  (Spec.  3166),  represented  in  the  wood-cut  (FlG.  285),  were  contributed  to  the  Museum  by  Acting 
Assistant  Surgeon  A.  W.  Merrill. 

CASE  729. — Private  G.  Kronmiller,  Co.  C,  14th  New  York  Heavy  Artillery,  aged  38  years,  was  wounded  before  Peters 
burg,  July  9,  1864,  and  admitted  to  the  field  hospital  of  the  1st  division,  Ninth  Corps.  Surgeon  M.  K.  Hogan,  U.  S.  V.,  reported: 
"Fracture  of  left  tibia  by  min56  ball;  leg  amputated  at  junction  of  upper  and  middle  thirds  by  Surgeon  T.  F.  Oakes,  56th 
Massachusetts."  The  wounded  man  was  sent  to  the  Depot  Hospital  at  City  Point  the  day  following  the  injury,  and  two  weeks 
later  he  was  transferred  to  Philadelphia.  Acting  Assistant  Surgeon  R.  J.  Levis  recorded  the  following  result  of  the  case  :  "The 
patient  was  admitted  to  South  Street  Hospital  on  July  26th.  He  stated  that  he  reacted  tolerably  well  after  the  amputation  was 
performed,  but  felt  weak  from  diarrhoea  and  previous  loss  of  blood.  At  the  time  of  his  admission  the  tibia  was  exposed  nearly 
two  inches  anteriorly,  caused  by  the  sloughing  of  the  flaps.  The  granulations  were  healthy,  but  his  condition  was  weak.  On 
August  3d,  his  general  condition  was  much  improved  and  the  granulations  were  apparently  extending  themselves  over  a  portion 
of  the  bone,  which,  however,  was  black  in  color.  Some  days  afterwards  the  patient  was  attacked  with  diarrhoea,  and  on  August 
16th  the  parts  showed  some  disposition  to  slough,  when  diluted  creasote  and  afterwards  Labarraque's  solution  was  applied. 
By  August  20th  the  diarrhoea  had  changed  into  dysentery;  general  condition  weak;  pulse  100  to  110  arid  feeble;  some  enlarge 
ment  of  liver,  and  icteroid  complexion.  On  August  30th  the  sloughing  had  ceased  and  the  diarrhoea  was  relieved;  but  the 
patient  had  cough,  dulness  and  crepitation  being  heard  over  the  inferior  portion  of  the  right  lung.  This  condition  continued 
nearly  the  same  for  some  days,  expectoration  being  more  free  and  the  diarrhoea  again  increasing  for  a  time.  By  September  20th 
the  stump  was  gradually  healing,  excepting  where  the  bone  protruded.  October  3d,  liver  less  large;  subcrepitant  rales  in  lower 
portion  of  right  lung  posteriorly  up  to  the  middle  of  the  base  of  the  scapula;  rales  heard  in  left  lung  posteriorly  also,  but  no 
change  in  resonance.  In  this  manner  the  patient  remained,  with  occasional  improvements,  until  October  7th,  when  the  diarrhoea 


-1    .  ,. 


FlO.  285.— 
Fracture  of  left 
tibia  and  fibula 
in  upper  third. 
Spec.  3166. 


SECT,  v.]  PRIMARY    AMPUTATIONS    IN    THE    LEG.  465 

increased  much  and  he  began  to  sink  gradually.  Death  occurred  on  October  8,  1864.  The  autopsy  showed  the  lower  lobe  of 
the  i-ight  lung  partly  solidified  and  studded  with  unsoftened  tubercles.  The  rest  of  the  posterior  right  lung  was  congested  and 
filled  with  frothy  exudation ;  left  lung  congested  and  likewise  filled  with  frothy  liquid.  In  the  anterior  lower  lobe  a  small 
abscess  was  found  containing  about  a  drachm  of  pus;  the  anterior  portions  of  both  lungs  were  mostly  respirable.  The  liver 
was  somewhat  enlarged  and  undergoing  fatty  degeneration ;  spleen  congested  and  enlarged.  The  lower  part  of  the  colon  showed 
evidence  of  chronic  inflammation,  the  mucous  membrane  being  dark,  thickened,  and  degenerated.  This  condition  diminished 
higher  up,  but  in  no  part  was  the  colon  healthy.  Part  of  the  iliurn  was  inflamed;  mucous  coat  of  stomach  much  thickened  but 
not  inflamed."  The  upper  part  of  the  amputated  tibia,  exhibiting  the  seat  of  the  fracture,  was  contributed  to  the  Museum  by 
Surgeon  H.  Ludington,  100th  Pennsylvania,  and  constitutes  specimen  6529  of  the  Surgical  Section. 

In  one  of  the  two  hundred  and  forty-nine  fatal  cases  of  primary  amputation  in  the 
upper  third  of  the  leg  the  operation  was  followed  by  exarticulation  at  the  knee  joint,  and 
in  nine  by  amputation  in  the  thigh:1 

CASE  730. — Private  B.  G.  Waters,  Co.  H,  19th  Maine,  aged  19  years,  was  wounded  at  Petersburg,  October  15,  1864. 
Surgeon  I.  Scott,  7th  West  Virginia,  reported  that  "he  entered  the  field  hospital  of  the  2d  division,  Second  Corps,  with  shot 
fracture  of  leg,  caused  by  a  minie  ball,  for  which  Surgeon  W.  ,T.  Burr,  42d  New  York,  performed  amputation."  Surgeon  E.  Bent- 
ley,  U.  S.  V.,  reported  the  following  result  of  the  case:  "The  patient  was  admitted  to  Baptist  Church  Hospital  at  Alexandria 
six  days  after  being  wounded.  His  left  leg  had  been  amputated  at  the  upper  third  by  anterior  and  posterior  flaps  on  the  day  of 
the  injury.  When  admitted  his  general  health  was  fair,  although  he  complained  of  considerable  pain  and  required  opiates  to 
procure  sleep.  The  integument  over  the  spine  of  the.  tibia  was  black  and  had  commenced  to  slough.  This  continued  until  the 
ends  of  both  bones  were  exposed  and  the  stump  around  presented  a  large  mass  of  sloughing  tissue.  Stimulating  lotions  were 
applied  and  some  improvement  followed;  all  sloughing  ceased  and  granulations  commenced;  but  the  granulations  were  pale 
and  flabby,  the  edges  of  the  integument  everted,  and  the  patient  suffered  excessive  pain.  On  November  18th,  sloughing 
reappeared  and  extended  rapidly  towards  the  popliteal  region.  He  was  also  troubled  some  with  diarrhoea,  having  about  four 
passages  daily.  He  was  daily  growing  weaker  from  suffering  and  loss  of  appetite,  and  the  stump  became  so  painful  that  lie 
would  cry  out  frequently,  complaining  of  spasmodic  twitching.  Taking  these  circumstances  arid  the  danger  of  secondary 
haemorrhage  into  consideration,  the  limb  was  reamputated  in  the  lower  third  of  the  femur  (see  TABLE  XL,  No.  200,  p.  323,  ante) 
on  November  24th,  by  Assistant  Surgeon  W.  A.  Harvey,  U.  S.  V.,  who  used  sulphuric  ether  as  the  anesthetic  and  performed  the 
operation  by  the  circular  method.  Three  days  after  the  operation  the  patient's  appetite  had  improved  and  he  could  sleep  well, 
was  more  cheerful,  and  complained  of  but  little  pain.  No  union  had  yet  taken  place  in  the  stump,  but  suppuration  had  com 
menced.  On  December  7th,  when  transferred  to  Prince  Street  Hospital,  he  was  still  doing  well.''.  The  subsequent  records 
show  the  patient  died  of  exhaustion  April  25,  1865.  The  stumps  of  the  tibia  and  fibula,  removed  at  the  second  amputation, 
together  with  portion  of  the  popliteal  vein,  external  and  internal  popliteal  nerves,  were  contributed  to  the  Museum  by  Surgeon 
E.  Bentley,  and  constitute  specimens  3445,  3446,  3447,  and  3448,  respectively,  of  the  Surgical  Section. 

In  the  next  cftse  haemorrhages  from  the  stump  occurred  twenty-four  days  after  the 
operation.  The  patient  died  from  exhaustion  four  days  later: 

CASE  731. — Private  G.  Hoascb,  Co.  E,  110th  Ohio,  aged  45  years,  was  Avounded  in  the  left  leg,  at  Monocacy,  July  9, 
1864,  and  admitted  to  hospital  at  Frederick  the  following  day.  Assistant  Surgeon  E.  F.  Weir,  U.  S.  A.,  reported:  "The  injury 
was  produced  by  a  mini6  ball,  which  fractured  both  bones  at  the  lower  third.  The  leg  was  removed  on  July  llth.  at  the  upper 
third,  by  the  circular  method,  by  Acting  Assistant  Surgeon  W.  S.  Adams.  At  the  time  of  the  operation  the  patient's  condition 
was  very  poor  from  diarrhoea  and  the  fatigue  of  marching;  the  leg  swollen,  sloughing,  and  threatened  by  gangrene.  On  July 
20th  there  was  slight  sloughing  of  the  flaps,  and  yeast  poultices  were  applied.  On  the  following  day  the  slough  was  carefully 
trimmed  away  with  scissors,  and  permanganate  of  potassa  was  applied  in  full  strength  by  means  of  a  mop,  after  which  the  end 
of  the  stump  was  covered  with  oakum  wet  with  a  dilution  of  the  permanganate  of  potassa,  and  the  whole  enwrapped  with  oiled 
silk.  On  July  25th  the  slough  came  away  nicely  and  a  good  granulating  surface  was  found  beneath  it;  general  condition  of 
patient  slightly  improved.  Haemorrhage  occurred  at  1  A.  M.  on  August  4th,  and  another  at  5  A.  M.,  when  thirty-two  ounces  of 
blood  were  lost.  Bleeding  was  controlled  by  the  application  of  a  tourniquet  before  the  attending  medical  officer  arrived,  and  no 
attempt  to  ligate  was  made.  At  9  A.  M.  the  patient  was  found  with  his  extremities  cold  and  pulseless,  and  when  the  tourniquet 
was  removed  the  bleeding  had  ceased.  Stimulants  were  then  ordered  to  be  given  freely  and  a  hot-air  bath,  a  nurse  being  placed 
by  the  side  of  the  bed  to  watch  the  stump.  At  11  A.  M.,  a  slight  oozing  was  observed  from  the  posterior  tibial,  which  was 
drawn  out  and  ligated.  On  the  morning  of  August  6th  the  ligature  came  away  during  the  dressing  of  the  stump ;  the  patient 
had  not  yet  rallied  from  the  attack  of  hemorrhage;  treatment  continued.  The  patient  died  of  exhaustion  on  August  8,  1864. 
An  examination  of  the  stump  showed  total  absence  of  the  clot  in  the  cut  extremities."  The  amputated  bones  of  the  leg,  exhib 
iting  a  bad  comminution  throughout  the  lower  third  of  the  tibia  and  a  transverse  fracture  in  the  fibula,  were  contributed  to  the 
Museum  by  the  operator,  and  constitute  specimen  3829  of  the  Surgical  Section. 

1  The  limb  was  subsequently  amputated  at  the  knee  joint  in  the  case  of  Pt.  C.  Rhinehart,  K,  74th  Pennsylvania  (TABLE  LVI,  CASE  42,  p.  407); 
intermediary  operation.  Amputation  in  the  thigffwas  performed  in  the  following  9  cases :  Pt.  G.  Tompkins,  G,  1st  N.  V.  Battery,  intermediary  operation 
in  upper  third  of  thigh  (TABLE  XXXIV,  Xo.  137,  page  277);  Pt.  W.  L.  Hindman,  K,  355th  Pennsylvania,  secondary  operation  in  middle  third  of  thigh 
(TAlil.K  XXXIX,  No.  12"),  page  315);  Pt.  L.  Winters,  K,  50th  Georgia,  secondary  operation  in  middle  third  of  thigh  (TABLE  XXXIX,  Xo.  lu'ti,  page  31  (J); 
Corp'1  II.  G.  Brown,  B,  37th  Wisconsin,  secondary  operation  in  middle  third  of  thigh  (TAIU.K  XXXIX.  Xo.  108,  page  315);  Pt.  O.  51.  Corey,  H,  114th  Xew 
York,  intermediary  operation,  lower  third  of  thigh  (TA1SLE  XXXVI,  Xo.  286,  page  297);  Pt.  E.  De  Hoff,  H,  38th  Ohio,  secondary  operation,  lower  third  of 
thigh  (TABLE  XL,  Xo.  127,  page  321);  Pt.  H.  E.  Eldred,  E,  2d  U.  S.  S.  S.,  intermediary  operation,  lower  third  of  thigh  (TABLE  XXXVI.  Xo.  327,  page  298); 
Pt.  J.  Morse,  B,  2d  Pennsylvania  Heavy  Artillery,  intermediary  operation,  lower  third  of  thigh  (TABLE  XXXVI,  Xo.  502,  page  300);  Pt.  B.  G.  Waters,  H, 
19th  Maine,  secondary  operation,  lower  third  of  thigh.  Specs.  3445,  344(i,  3447,  3448  (TABLE  XL,  Xo.  200,  page  323). 
SURG.  Ill— 59 


466 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


ICHAP.  X. 


TABLE  LXVIII. 

Summary  of  One  Thousand  and  Twenty-nine  Cases  of  Primary  Amputations  in  the  Upper  Third  of  the 

Leg  for  Shot  Injuries. 


f  Recoveries,  1—771;  Deaths,  772— 1020  ;  Result  unknown,  1021—1029.] 


NO. 

NAME,  MILITARY 
DESCRIPTION',  AND  AC.K. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Abrams,  A.J.,  Serg't,  K, 

June  22, 

Right;  ant.  post.  flap.     Surg.  S. 

41 

Bouch,  W.  B.,  Pt.,  B, 

Sept.  21, 

Left;  ant.  post.  flap.     Surg.  E.  R. 

9th  N.  Y.  Heavy  Artil 

22,  '64. 

A.  Sahin,  9th  N.  Y.  H'vy  Art'y. 

139th  Penn.,  age  24. 

22,  '64. 

Umberger,  93d  Penn.     Disch'd 

lery,  age  33. 

Disch'd  Feb.  25,  1865. 

July  11,  1.865. 

2 

Adams,  J.  H.,  Pt.,  F,  3d 

July  2, 

Left.     Surg.  —  Rouch,  C.  S.   A. 

42 

Bovee,  J.  N.,  Pt.,  E,  18th 

June  27, 

Right.      Confcd.   surgeon.     Dis 

Arkansas,  age  21. 

2,  '63. 

Paroled  Nov.  12,  1863. 

New  York,  age  19. 

i.'9,  '62. 

charged  Sept.  15,  1862. 

3 

Adams,  W.,  Pt.,  D,  7th 

May  16, 

Right.     Furloughed  July  28,  '64. 

43 

Boyle,  J.,  Pt,  G,   34th 

Oct.  13, 

Right.     Disch'd  March  18,  1865. 

South  Carolina,  age  38. 

16,  '64. 

Mass.,  age  20. 

14,  '64. 

4 

Alkin,  A.  S.,  Serg  t,  K, 

July  20, 

Left  :  flap.     Disch'd  Mar.  13,  '65. 

44 

Bradley,  H.,  Corp'l,  Ord 

Aug.  9, 

Left;  circ.    Sunr.W.  O  'Meagher, 

18th  Indiana,  age  27. 

20,'  '64. 

nance  Depart.,  U.S.A., 

!),  f64. 

69th  N.  Y.    Disch'dMay  31,  '65. 

5 

Allen.  J.    W.,  Pt.,  King 

Sept.  14, 

—  .     Surg.  —  Robertson.     Re 

age  34. 

(Also  wound  of  left  foot.) 

William  Artillery. 

14,  '63. 

covery. 

45 

Bradley,  L.  F.,  Corp'l,  I, 

Sept.  29, 

Left  ;  flap.     Disch'd  Oct.  8,  1  865. 

6 

Allen,  L.  F.,  Pt.,  1,  35th 

Dec.  13, 

Left.     Discharged  June  6,  1863. 

8th  Conn.,  ago  22. 

29,  '64. 

New  York. 

13,  '62. 

46 

Bradley,  P.,  Pt.,  E,  104th 

June  16, 

Left:  ant.  post,  flap.    Discharged 

7 

Andrews,A.,Pt.,G,  27tb 

July  3, 

Right.    Discharged  Jan.  11,  1864. 

New  York,  age  38. 

16,  '64. 

July  31,  1865.    Spec.  257.    Died 

Ohio,  age  39. 

3,  '63. 

July  30,  1870. 

8 

Andrews,  J.  N.,  Serg't, 

July  1, 

Left:  circular.   Exchanged  Sept. 

47 

Brady,  J.,  Capt.,  G,  26th 

Sept.  19, 

Left.      Surg.    J.  G.   Bradt,  26th 

F,  5th  Ala.,  age  29. 

1,  '63. 

25,  1863. 

Massachusetts,  age  33. 

20,  '64. 

Mass.     Disch'd  Dec.  31,  1864. 

9 

Andrews,  O.  'J'.,  Lieut., 

April  6, 

Right.     Discharged    August   21, 

48 

Branch,   E.  B.,   Pt.,   D, 

May  3, 

Left  ;  circ.     Surg.  G.  T.  Stevens, 

C,  15th  Illinois. 

8,  '62. 

1862. 

77th  N.  York,  age  20. 

3,  '"63. 

77th  N.  Y.     May  17.  '(i4,  re-amp. 

10 

Audrus,   C.  E.,  Pt.,  K, 

June  3, 

Left;  circ.     Surg.  M.  Rizer,  72d 

leg.     Disch'd  Sept.  20,  1864. 

106th  Penn.,  age  20. 

3,  '64. 

Penn.     Discb'd'Dec.  28,  1864. 

49 

Brandenberg,  A.,  Serg't. 

April  2, 

Right  ;  circ.     Surg.  E.  K.  Fore- 

11 

Aney,  T.  L.,  Pt.,  K,  56th 

July  1, 

Right;    circular.      Disch'd  Jan. 

H,  6th  Maryland. 

2,  '65. 

roan,    6th    Maryland.      Disch'd 

Penn.,  age  18. 

3,  '63. 

17,  1865. 

July  13,  1865.  " 

12 

Arnell,  J.,  Pt.,  B,  14th 

April  30, 

Right;   flap.     Discharged   Nov. 

50 

Brannan,  J.,  Pt.,  C,  44th 

July  2, 

Right;  flap.  July  12,  hiein.;  post. 

Iowa,  age  19. 

30,  '64. 

15,  1864. 

New  York,  age  26. 

4,  '63. 

tibial  lig.;  15th,  haem.;  femoral 

13 

Avers,  J.  M.,  Pt.,  F,  76th 

Julv  11, 

Left;  circ.     Mustered  out  Nov. 

ligated.    Recovery. 

Pennsylvania. 

13,'  '63. 

—  ,  1864. 

51 

1  Brannan,  M.,  Corp'l,  B, 

June  3, 

liight;  don.  skin  Hap.     A.  Surg. 

14 

Bagwell,   N.  B.,  Serg't, 

Sept.  17, 

Left.     Union    surgeon.    Retired 

9th  Mass.,  age  30. 

4,  '64. 

J.   Ryan,   9th    Mass.      Disch'd 

B,  38th  Georgia. 

19.  '62. 

Dec.  30,  1864. 

A  ugust  20,  1864. 

15 

Barrett.  F.  J.,  Corp'l,  D, 
59th  New  York. 

May  3, 
4,  '63. 

Right;  flap.   A.  Surg.W.  J.  Burr, 
59th  N.  Y.  Disch'd  April  18,  '64. 

52 

Breen,   J.,   Pt.,  B,  15th 
Connecticut. 

Dec.  13, 

13,  '62. 

Right.     Discharged  June  18,  '63. 

16 

Barron,  W.,  Serg't,  B,  2d 

April  9, 

Right;  post.  flap.     Disch'd  Oct. 

53 

Breeze,  S.,  Pt.,  C,  76th 

Aug.  16, 

Left;  flap.     Disch'd  Nov.  29,  '64. 

Corps  d'Afrique,age24. 

9,  '63. 

5,  1863.     Spec.  1420. 

Penu.,  age  45. 

16,  '64. 

Died  of  prostration  August  11, 

17 

Bartholomew,*;.,  Corp'l, 

Sept.  19, 

Left  ;  flap.    Disch'd  June  1,  1865. 

1869. 

D,  67th  Penn.,  age  23. 

19,  '64. 

Died  Nov.  14,  1867. 

54 

Brest,  J.  P.,  Pt.,  E,  100th 

June  2, 

Left;  ant.  post.  flap.     Surg.   H. 

18 

Bartlett,  J.,  Pt.,  (i,  5th 

Oct.  19, 

Right  ;  lateral  flap.     Confederate 

Penn.,  age  24. 

3,  'u'4. 

Ludington,   100th    Penn.      Dis 

N.  Y.  H'vy  Artillery, 

19,  '64. 

surgeon.    Disch'd  July  4,  1865. 

charged  May  6,  1865. 

age  20. 

Spec.  3092. 

55 

Bridge.  J.,  Pt.,  K,  57th 

May  3, 

Right;  circ.     Surg.  C.  S.  Wood. 

19 

Basine,    C.,  Pt.,  H,  8th 

Sept.  17, 

Right.    Discharged  Dec.  6,  1862; 

New  York,  age  20. 

3,  '63. 

66th  N.  Y.    Gangrene.    Disch'd 

Penn.  Res.,  age  20. 

17,  '62. 

gang.    Dec.,  1862,  amp.  thigh. 

Sept.  24,  1863. 

1870,  stump  sound. 

56 

Bridges,  J.  W.,  Pt.,  K, 

Aug.  19, 

Left  ;  lat.  flap.     To  prison  March 

20 

Battelle,  C.  P.,  Serg't.  A. 

Mar.  25, 

Left  ;  ant.  post.  flap.    Discharged 

6th  Georgia,  age  24. 

20,  '64. 

28.  1865. 

59th  Mass.,  age  20. 

25,  '65. 

July  13,  1865. 

57 

Briggs,  H.'  E.,  Pt.,  G,  3d 

Sept,  17, 

Right.     Discharged  Dec.  27,  '62. 

21 

Baughman,    J.,  Pt.,  M, 

Aug.  15, 

Right  ;  flap.    Surg.  G.  W.  Bowen 

\\isconsin. 

17,  '62. 

5th  Col'd  Cavalry,  age 

15,  '64. 

and  A.  Surg.  J.  Swan,  5th  Col'd 

58 

Brith,J.  //..Surgeon,  1st 

June  9, 

.     Surg.  B.  D.  Lay,  C.  S.  A. 

20. 

Cavalry.    Disch'd  Feb.  15,  1865. 

Missouri. 

9,  '63. 

Recovered. 

22 

Beach.  J.  (alias  Smith), 

Mar.  25, 

Left  ;  circular.    Surg.  M.  C.  Row 

59 

Britten,   W.    B.,  Serg't, 

June  17, 

Left  ;  flap.     Surg.W.  B.  Fox,  8th 

Pt.,  D,  28th  Mass.,  age 

25,  '65. 

land,  61st  N.  Y.     Disch'd  July 

F,  60th  Ohio,  nge  23. 

17,  '64. 

Mich.     Disch'd  Jan.  10,  1865. 

20. 

15,  1865. 

60 

Britton,   J.,    Serg't,    H, 

Sept,  30, 

Left;  double  flap.     Disch'd  Aug. 

23 

Bean.  W.  II.,  Pt.,  K,  8th 

June  17, 

Left;  circular.  Furloughed  Sept. 

18th  Massachusetts. 

30,  '64. 

21,  1865. 

North  Carolina,  age  26. 

17,  '64. 

16,  1864. 

61 

Brockham,   A.,    Pt.,   E, 

Sept.  29, 

Left  ;    post.  flap.     Disch'd  June 

24 

Beardsley,  W.  W.,  Pt., 

Aug.  29, 

R't;flap.    A.Surg.A.W.Munson, 

58th  Penn.,  age  47. 

29,  '64. 

27,  1865. 

IT,  82d  Ohio. 

30,  '62. 

82d  Ohio.    Disch'd  Nov.  3,  1862. 

62 

Broderick,    J.,    Pt.,    D, 

May  3, 

Right;  circ.    Surg.  C.  N.  Cham 

25 

Beaumont,  S.,  Capt.,  E, 

Dec.  17, 

Left  ;  circ.    Surg.  J.  A.  Wolf,  29th 

36th  New  York. 

3,  ''63. 

berlain,  U.  S.  V.  '  Disch'd  Aug. 

29th  Penn.,  age  26. 

17,  '64. 

Penn.     Must,  out  July  11,  1865. 

7.  1863. 

26 

Beeson,  W.  H.,  Pt.,  G, 

June  1, 

Right;    flap.     Disch'd  Julv  20, 

63 

Brondstettcr,  W.,  Pt.,  G, 

Dec.  16, 

Left;  double  flap.     Surg.  G.  A. 

82d  Penn.,  age  22. 

2,  '64. 

1865.     Died  Jan.  3,  1870.  " 

9th  N.  Jersey,  age  21. 

16,  '62.' 

Otis,  27th  Mass.     Disch'd  Jan. 

27 

Bersehig,  A.,  Pt.,  A,  23d 

Sept.  22, 

Left  ;  ant.  post.  flap.    Discharged 

21,  1864. 

Ohio,  age  20. 

22,  '64. 

Jan.  5,  1865. 

64 

Brown,  H.,   Pt.,  K,  22d 

July  30, 

Right.     March  19.  1865,  amp.  left 

28 

Bierce,    P.,    Pt.,  A,   1st 

Nov.  13, 

Left;    flap.     Dec.  25,  amp.  arm. 

Col'd  Troops,  age  19. 

30,  '64. 

thigh.     Disch'd  Mar.  20,  1865. 

Ohio  Artillery,  age  20. 

13,  '63. 

Disch'd  August  29,  1864. 

65 

Brown,  M.,  Pt..  E,  99th 

Aug.  6, 

Left.    Surg.  A.  M.Wilder.U.S.V. 

29 

Biyby,   W.  A.,  Pt.,  K,  1st 

June  27, 

Right.     Surg.  —  Evans,  C.  S.  A. 

Ohio,  age  20. 

7,  '64. 

Nov.  14,  re-amp.     Mustered  out 

South  Carolina. 

27,  '62. 

Disch'd  August  6,  1864. 

May  30,  1865. 

30 

Bingenheimer,  C.,  Corp'l, 

Mar.  30, 

Left  ;  flap.  Surg.  J.  W.  Green,95th 

66 

Bruback,  D.,  Pt.,  15,  1st 

June  30, 

Right.      (Jonl'cd.    surgeon.     Dis 

A,  33d  Vvis..  age  30. 

30,  '65. 

111.    Disch'd  June  20,  1865. 

Penn.  L.  Art'y,  age  21. 

Jyl,'62. 

charged  Dec.  3,  186;.'. 

31 

Bird,  S.  A.,  Pt.,  G,  12th 

Julv  1, 

Right.     Exchanged  Nov.  12,  '63. 

67 

Bryan,  I>.  M.,  Pt,.B,  84th 

Oct.  27, 

Left;  flap.     Disch'd  Sept.  2,  '65. 

South  Carolina,  age  26. 

2,  '63. 

Penn.,  age  19. 

28,  '64. 

32 

Black,  L.  C.,  Lieut.,  F, 

Sept.  19, 

Left.     Surg.  J.  M.  Lawson,  30th 

68 

Buckner,  1!.,  Pt.,  G,  Kith 

Aug.  13, 

Right;   ant.   post.   flap.     Disch'd 

12th  Georgia,  age  21  . 

19,  '64. 

N.  C.     To  prison  Dec.  9.  1864. 

New  York  H'vy  Art'y, 

13,  '64. 

Nov.  17,  1864.     Died  March  3, 

33 

Blake,  C.  A.,  Pt.,  C,  14th 

Oct.  19, 

Right  ;  ant.  post.  flap.     Disch'd 

age  43. 

1865;  inflammation  of  stump. 

New  Jersey,  age  24. 

19,  '64. 

July  7,  1865. 

69 

Bullctt.  J.,  Pt.,  C,  13th 

Doc.  16, 

Right;   flap.     A.  A.   Surg.  J.  S. 

34 

Blomley.  A.,  Corp'l,  A, 

June  18, 

Right  ;  circ.     Surg.  J.  Kerr,  62d 

Col'd  Troops,  age  24. 

16,  '64. 

(liltner,  U.  S.  A.     Disch'd  July 

91st  Penn.,  age  27. 

20.  '64. 

Penn.     Disch'd  Sept.  27,  1864. 

15,  1865. 

3.") 

Bobo,  J.  E.,  Pt.,  E,  Hoi- 

Mar.  2!), 

Right;  circ.     Released  June  14, 

70 

Bumm,  J.,  Pt.,  F,  29th 

June  15, 

Right;  flap.      Surg.  J.  A.  Wolf, 

comb's  Legion,  age  18. 

29,  '65. 

1865. 

Pennsylvania,  age  20. 

15,  '64. 

29th  Perm.     Disch'd  Aug.  4,  '65. 

36 

Bodwell,  J.,  Serg't,  G, 

Dec.  15, 

Right;  ant.  post.  flap.     Surg.  D. 

71 

Burk,   'J..   Pt.,   F,   38th 

Feb.  6, 

liight  :  circular.     To  prison  June 

71st  Ohio,  age  22. 

15,  '64. 

C.  Patterson,  124th  Ohio.    Dis 

Georgia,  age  23. 

7,  '65. 

8,  1865. 

charged  May  12,  1865. 

72 

Burnett.  J.,  Pt.,  D,  107th 

May  3, 

liight  ;  circ.    Disch'd  Sept.  18/63. 

37 

Boliannan,  J.  IF.,  Corp'l, 

Aug.  14, 

Left  ;  double  flap.   Released  June 

New  York,  age  iitf. 

5,  '63. 

G,  8th  Georgia,  age  24. 

14,  '64. 

28,  1865. 

73 

Bun-ell,  J.,  Pt.,   K,  9th 

Feb.  8, 

Left.     Surg.  L.  Braanti,  9th  New 

38 

Boon,  W.  J.,  Pt.,  A,  5th 

May  3, 

—  .     Furloughed  July  23,  1863. 

New  .Terse}-. 

8,  '62. 

Jersey.     Disch'd  Aug.  18,  1802. 

North  Carolina,  age  27. 

—  ,  '63. 

74 

Byers,  A.  F.,  Pt.,  H,  1st 

Jan.  6, 

Right;    circular.      Disch'd    May 

39 

Bornman,  J.  M.,  Corp'l, 

Sept.  22, 

Right  (also  w'd  left  leg  and  hand)  ; 

Tennessee. 

6,  '65. 

26,  1865. 

I,  61st  Penn.,  age  28. 

22,  '64. 

flap.     Surg.  G.  R.  Lewis,  61st 

75 

Byrne,  J.,  Pt.,   F,   llth 

July  3, 

Left.     Surg.  -  White,  C.  S.  A. 

Penu.     Disch'd  July  21,  1865. 

North  Carolina. 

5,  '"63. 

Recovered. 

40 

B-ntntr,  JV.  J.,  Pt.,  I,  33d 

July  10, 

Left  ;  circular.     Provost  Marshal 

76 

Cadon,  Z.  P.,  Pt.,E,llth 

July  2, 

Left.      Union   surgeon.      Exch'd 

Mississippi,  age  22. 

11,  '64. 

March  7,  1865. 

Virginia,  age  26. 

3,  ''63. 

Nov.  12,  1863. 

"LlUELL  (J.  A.),  Primary  Amputation  of  Right  Le.g,  for  Injury  inflicted  ly  a  Cannon  Ball ,-  Pytemia  developed  thirty-one  days  afterwards  with 
well-marked  symptoms,  in  V.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I.  New  York,  1870,  page  53.1. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


467 


NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPEHATORS, 
RESULT. 

77 

Cage,  J.,  Serg't,  E,  7th 

April  2, 

Left;    circular.     Released    May 

123 

Conover,  J.,  Pt.,  C,  82d 

May  3, 

Left  ;  flap.  Surg.  L.  M.  Emanuel, 

Tennessee,  age  24. 

2,  '65. 

30,  1865. 

Pennsylvania. 

3,  '63. 

82d  Penn.     Disch'd  Sept.  5,  '63. 

78 

Cahill,  T.  J.,  Lieut,  D, 

July  3, 

R't.     Surg.  R.  Gibbon,  28th  N.  C. 

124 

Conk,  A.  W.,  Pt.,  F,  55th 

Mav  2, 

Right.     A.  Surg.  W.   J.  Green, 

7th  N.  C.,  age  26. 

4,  '63. 

Retired  March  1,  1865. 

North  Carolina. 

2,  '63. 

44th  N.  C.     Recovery. 

79 

Calkins,  E.  D.,   Pt,  A, 

Sept.  17, 

Left.    Disch'd  January  5,  1863. 

125 

Cook,  W.  W.,  Pt,  G,  2d 

Mav  3, 

Left;  flap.     Surg.  W.'  J.  Sawin, 

6th  Wisconsin. 

17,  '62. 

Vermont. 

3,  '63. 

2d  Vt.     Disch'd  April  12,  1864. 

80 

Callaghan,  D.,  Pt.,  C,  1st 

Oct.  5, 

Left  :  flap.     Discharged  May  30, 

126 

Coons,   H.,  Pt..  I,  103d 

Nov.  25, 

Left.     Discharged  June  8,  1864. 

Kansas. 

5,  "02. 

1863. 

Illinois,  age  28. 

27,  '63. 

81 

Callahan,  R.,  Corp'l,  G, 

Jan.  15, 

Right  ;  circ.     Surg.  G.  C.  Jarvis, 

127 

Copps,   W.  P.,  Pt.,    A, 

June  3, 

Right  ;  flap.     Surg.  D.  M.  Good 

203d  Penn.,  age  23. 

15,  '65. 

7th  Conn.     Discharged. 

40th  Mass.,  age  27. 

3,  '64. 

win,   3d   Vermont.     Gangrene. 

82 

Campbell.  W.  R.,  Pt.,  K, 

Nov.  :-:o, 

Right;    ciro.     To  Provost    Mar 

Disch'd  Feb.  15,  1865. 

2d  Arkansas,  age  24. 

30,  '64. 

shal  March  15,  1865. 

128 

Corley,  J.  D.,  Corp'l,  H, 

Oct.  15, 

Right;  flap.     Surg.  W.  B.  Water 

83 

Cantelli,  A.,  Pt.,  A,  1st 

May  27, 

Left  ;  circular.     Disch'd  Feb.  27, 

1st  Arkansas,  age  32. 

17,  '64. 

man,  1st   Ark.      Disch'd  July 

Artillery. 

27,'  '63. 

1864.     Spec.  1026. 

20,  1865. 

84 

Carbeny,  «A".,Corp'l,Ches- 

May  2, 

.     Surg.  —  Hunter,  C.  S.  A. 

129 

Coughlin,M.,Pt,A,15th 

Aug.  7, 

Left;  flap.     Disch'd  July  15,  '65. 

apeake  Artillery. 

2,  %3. 

Recovery. 

Infantry,  age  42. 

7,  '64. 

Died  April  13,  1870. 

85 

Carey,  J.,  Pt,  H,  3d  N. 

May  16, 

Right:    circular.     Disch'd   May 

130 

Cowan,  W.,  Pt.,  E,  21st 

Mar.  19, 

Left  ;  circ.     Disch'd  July  20,  '65. 

Hampshire,  age  37. 

18,  '64. 

30.  1865. 

Michigan,  age  33. 

19,  '65. 

86 

Carmady,  R.,  Pt.,B,  13th 

Jan.  2, 

Right  ;  flap.     Surg.  F.  Pratt,  13th 

131 

Coyle,  P.,   Pt.,  E,  90th 

May  5, 

Right.     Mustered  out  Julyl,  '65. 

Michigan,  age  34. 

2,  '63. 

Mich.    V.  R.  Corps.    Died  1876. 

Penn..  age  22. 

6,  '64. 

87 

Carpenter,  J.  V.,  Pt.,  B, 

May  12, 

Right;  post.  flap.     Mustered  out 

132 

Crabtree,  N.,Pt,F,112th 

Nov.  18, 

Left  ;  flap.     Disch'd  July  i!3,  '64. 

70th  New  York,  age  43. 

12,  '64. 

Dec.  5,  1864. 

Illinois,  age  22. 

18,  '63. 

88 

Carson,  W.,  Pt.,  K,  llth 

July  2, 

Right;    flap.    Disch'd  June  10, 

133 

Craig,  W.,  Pt.,  K,  53d 

Mar  10 

New  Jersey,  age  22. 

3,  '63. 

1865. 

Indiana,  age  33. 

10,  '65. 

11,  1865. 

89 

Casada,   A.  P.,  Serg't, 

July  2, 

Right.     Surg.  —  Means,  C.  S.  A. 

134 

Crallwell,  W.  H.,  Pt..  A, 

Sept.  1, 

Right  ;  flap.    Surg.  C.  N.  Fowler, 

E,  llth  Ga..  age  20. 

2,  '63. 

Exchanged  Jan.  10,  1864. 

14th  Ohio,  age  19. 

2,  '64. 

105th  Ohio.  Disch'd  Nov.  18,  '65. 

90 

Cashdollar,  L.  W.,  Pt., 

Sept.  19, 

Right  ;  flap.   Surg.  C.  H.  Andrus, 

135 

Cranston,  D.  J.,  Pt,  H, 

Nov.  27, 

Left  ;  flap.    Disch'd  April  26,  '65. 

C,  128th  N.  Y.,  age  21. 

20,  '64. 

176th  N.Y.    Oct.  27,  hsem.;  post. 

26th  Iowa,  age  21. 

27,  '63. 

tib.  lig.    Disch'd  May  30,  1865. 

136 

Cresswell,   W.,   Pt.,   C, 

Jan.  9, 

Left  ;  circ.  Surg.  —White,  C.S.A. 

91 

Castatar,   A.  J.,  Serg't, 

Aug.  29, 

.    Discharged  Feb.  11  ,  1863. 

1st  New  York  Rifles. 

11,  '63. 

Gang.     Disch'd  Sept.  26,  1863. 

G,  20th  Indiana. 

29,  '62. 

137 

Critchett,  T.,  Pt.,  1,  12th 

April  30, 

Right;  flap.     Surg.  A.  M.  Clark, 

92 

Cavanaugh,  G.E.,  Serg't 

Dec.  13, 

Left.     Discharged  April  9,  1864. 

Massachusetts. 

30,  '63. 

U.  S.V.     Disch'd  Aug.  19,  1863. 

Major,  20th  Indiana. 

13,  '62. 

138 

Crocker,  A.  B.,  Corp'l,  I, 

Sept.  17, 

Left.     Surg.  D.  E.  Kelsey,  64th 

93 

Cavanagh,  W..  Pt.,  D, 

July  18, 

Right;   ant.  post.  flap.     Confed. 

64th  New  York. 

18,  '62. 

N.  Y.     Bone  cut  off.     Disch'd 

5th  N.Y.  H.  A.,  age  30. 

19,  '64. 

surgeon.     Disch'd  Oct.  21,  1865. 

Dec.  6,  1862. 

94 

Cavil,  E.,  Pt.,  B,  44th 

Dec.  16. 

Right  ;  circ.     Surg.  —  Brothers, 

139  !  Crocker,  P.  B.,  Serg't,  F, 

Aug.  29, 

Left.     Disch'd  January  15,  1863. 

Miss.,  age  19. 

17,  '64. 

C.  S.  A.    Pro.  Mar.  Mar.  30,  '65. 

14th  New  York. 

30,  '62. 

95 

Champeau,  A.  L.,  Pt,  E, 

Aug.  21, 

Left;  circ.  Surg.  C.  B.  Park,  llth 

140 

Crooks,  A.,  Pt.,  D,  149th 

July  1, 

Right;  post.  flap.     Surg.  W.  T. 

llth  Vermont,  age  24. 

21,  '64. 

Vermont.     Disch'd  July  25,  '65. 

Pennsylvania,  age  23. 

2,  '63. 

Humphrey,  149th  Penn.  Disch'd 

96 

Chapin,  A.,Pt,  B,  10th 

Oct.  8, 

Right;  flap.  Siug.  S.  Marks,  10th 

July  26,  1865 

Wisconsin. 

10,  '62. 

Wis.     Disch'd  Dec.  9,  1862. 

141 

Crowe,   J.,   Pt.,   I,   63d 

Feb.  1, 

Left.     Disch'd  April  30,  1862. 

97 

Cherry,  I.,  Pt.,  C,  19th 

June  18, 

Right;    flap.     Disch'd  June  13, 

New  York. 

1,  '62. 

Indiana,  age  17. 

19,  '64. 

1865.    Died  Oct.  13,  1867. 

142 

Curie,    H.,   Pt.,   F,   7th 

Aug.  16, 

Left.     Confed.  surg.     Re-amp,  in 

98 

Childers.  A.  A.,  Pt.,  F, 

Oct.  19, 

Right;    circ.    Exchanged  Octo 

Connecticut,  age  27. 

17,  '64. 

thigh  Aug.  19,   1864.     Disch'd 

2d  N.  C.,  age  19. 

19,  '64. 

ber  27,  1864. 

June  10,  1865. 

99 

Christner,  W.,  Corp'l,  B, 

July  26,  I  Right.    Disch'd  March  8,  1865. 

143 

Currier,  C.  P.,  Serg't,  I, 

Mav  8, 

Left  ;  fla->.     Surg.  —  Mitchell,  C. 

2d  Maryland,  age  26. 

26,  '64. 

39th  Mass..  age  27. 

9,  '64. 

S.  A.     Disch'd  March  10,  1865. 

100 

Clark,    J.,    Pt.,  I,    41st 

Nov.  25, 

Left.    Disch'd  July  28,  1864. 

144 

Currev,  J.  B.,  Corp'l,  F, 

Sept.  19, 

Left.     Surg.  W.  O.   Hudson,  4th 

Ohio,  age  45. 

25,  '63. 

4th  Texas. 

20,  '63. 

Alabama.     Recovery. 

101 

Clark,  L.  R.,  Capt,  F, 

Oct.  27, 

Right;  flap.     Surg.  H.  W.  Car 

145 

Dale,  G.  H.,  Pt.,  B,  22d 

July  2, 

Right    Surg.  —  McCadden,  C.  S. 

117th  New  York. 

27,  '64. 

penter,    117th  N.  Y.     Disch'd 

North  Carolina. 

2,  '63. 

A.    Retired  Feb.  13.  1865. 

March  20,  1865. 

146 

Damon,    A.,    Serg't,   I, 

July  2, 

Left;  flap.     Surg.  N.  Havward, 

102 

Clark,  P.  D.r  Corp'l,  E, 

May  5, 

Right  ;  circ.    Disch'd  June  5,  '65. 

19th  Mass.,  age  20. 

3,  '63. 

20th  Mass.  Disch'd  April"  12,  '64. 

3d  Vermont,  age  24. 

5,  '64. 

Died  Nov.  14,  '68  ;  dis.  of  liver. 

147 

Danbert,  J.,  Pt,  D,  24th 

Feb.  7, 

Right;  circ.     Surg.  J.  H.  Beech. 

103 

Clark,  S.,  Pt.,  F,   12th 

July  9, 

Left.    Exchanged  Sept.  21,  1864. 

Michigan,  age  23. 

7,  '65. 

24th  Michigan.      Disch'd   May 

Georgia  Bat'ry,  age  20. 

9,  '64. 

16,  1865. 

104 

Clark.  S.  W.,  Corp'l,  G, 

June  17,    Left  :  circ.  (also  wound  lie-lit  le<y). 

148 

Davenport,  J.  C.,  Pt.,  C, 

May  3, 

:  flap.     Furloughed  July  1, 

2d  Penn.  H.  A. 

17,  '64. 

Disch'd  April  29,  1865. 

53d  Georgia. 

3,  '63. 

1863. 

105 

Clay,   R.,    Pt,,    B,  65th 

Nov.  26, 

Right.    Discharged  June  5,  1865. 

149 

David,    A.,    Pt,  H.  1st 

Aug.  29, 

.     Disch'd  Nov.  30,  1862. 

Illinois,  age  23. 

26,  '64. 

New  York. 

-,'62. 

106 

Cleary,  M.,  Pt.,  D,  5th 

Nov.  4, 

Left;  circular.    Disch'd  August 

150 

Davis,  C.,  Pt..  G.  48th 

April  2, 

Left  ;  ant.  post,  skin  flap  ;  circular 

Cavalry,  age  24. 

4,  '62. 

18.  1863. 

Colored  Troops,  age  23. 

2,  '65. 

sect.  mus.     Surg.  N.  N.  Horton, 

107 

Clements,  J.,Pt.,F,  18th 

Dec.  13, 

Left.     Disch'd  August  28,  1863. 

47th  C.  T.     Disch'd  Aug.  7,  '65. 

Massachusetts. 

14,  '62. 

151 

Davis  J  H    Pt.  D  97th 

June  27, 

Right;  flap.     Surg.  E.  B.  Glick. 

108 

Clements.  S.  W.,  Pt.,  F 

Nov.  25, 

Right  ;  flap.    Surg.  H.  McHenry, 

Ohio,  age  22. 

27,  '64. 

40th  Ind.     Gangrene.     Disch'd 

40th  Indiana. 

27,  '63. 

125th  Ohio.     Disch'd  Oct.  7,'64. 

October  31,  1865. 

109 

Closser,  S.,  Pt..  F,  104th 

July  1, 

Right;  flap.     Disch'd  March  25, 

152 

Davis.  J.  S.,  Pt.,  (',,  17th 

Mar.  10, 

Left  ;  circ.     Released  May  1  9,  '65. 

New  York,  age  26. 

2,  '63. 

1864. 

North  Carolina,  a.se  38. 

12,  '65. 

110 

Cobaugh,  W.  D.,  Pt,  II, 

Jan.  7, 

Left.     Disch'd  June  15,  1864. 

153 

Decker,  B.,  Pt.,  K,  38th 

May  3,      Left     Disch'd  August  28,  1863. 

3d  Penn.  Cav.,  age  27. 

7,  '64. 

New  York. 

3.  '63. 

111 

Cobett,  G.  W.,  Serg't,  F, 

May  10, 

Right;   ant.  post.  flap.     Disch'd 

154 

Decker.  H.,  Pt.,  B,  95th 

Oct.  27, 

Left  ;  circ.     Ass't  Surg.  F.  Whit 

22d  Mass..  age  30. 

10,  '64. 

October  17,  1864. 

New  York,  age  42. 

28,  '64. 

man,  58th  Mass.     Mustered  out. 

112 

Cole,   E.,   Pt.,  F.  120th 

July  2, 

Right:  flap;  ha?m.;  lig.  muscular 

Died  Sent.  25.  1867.  of  iniurv. 

New  York,  age  24. 

4,  '63. 

branch.     Disch'd  April  20,  1  804. 

155 

DeForrest,  D..   Pt.,  H, 

Dec.  10,  I  Right  ;  ant.  post.  nap.     A/Surg. 

113 

'Coles,  H.  C.,  Pt.,  B.  4th 

May  19, 

"Rio-lit  •     p.irn.       Fnrlinnrliprl   .ftinft 

100th  N.  York,  age  26. 

10,  '63. 

J.  W.  Applegate,  U.  S.  V.    Dis 

Tenn.  Cav..  age  18. 

19,'  '64.        30.  1864. 

charged  Sept.  22,  1864. 

114 

Culestock.W.W.,  Corp'l, 

May  8, 

Right  ;    ant.  post.  flap.     Disch'd 

156 

DeJean.  C.,  Corp'l.  H, 

Mav  2, 

Left  ;    flap.     Disch'd   December 

K.  16th  Mich.,  age  24. 

9,  '64. 

Dec.  9.  1864. 

55th  Ohio. 

4,  '63. 

29,  1863. 

115 

Collier,,!.  W.,  Pt.,  "Hart's 

May  3, 

.     Surg.  A.  Bowie,  C.  S.  A. 

157 

Delany,  W.,  Corp'l,  A, 

Aug.  25, 

Left.     Confed.  surgeon.    Disch'd 

Battery. 

3,  '63. 

Recovered. 

5th  N.  Hamp.,  a<re  29. 

27,  '64. 

October  29,  1864. 

116 

Conklin,  A.,  Pt.,K,]09th 

June  17, 

Left  ;  flap.     Disch'd  May  15,  '65. 

158 

Delbriger,   W.,    Pt,   E, 

Oct.  5, 

Left;  flap.    Disch'd  April  7,  '63. 

New  York. 

17,  '64. 

25th  Indiana,  age  24. 

5,  '62. 

117 

Conklin,  A.  J.,  Pt.,  D, 

Dec.  13, 

Left;  circ.     Disch'd  Oct.  1,  1863. 

159 

Dempsey.    J.,    Pt..    C, 

Dec.  13, 

Left  ;  flap.     Disch'd  April  19,  '64. 

106th  Penn.,  age  23. 

13,  '62. 

116th  Penn.,  age  26. 

14,  '62. 

118 

Conley.  J.  II.,  Serg't,  G, 

Nov.  27, 

Right;  circular.    Recovery. 

160 

Devlin,  J..  Pt.,  I,   61st 

Dec.  7, 

Left:   ant.  post  flap.     Surg.  — 

llth  Virginia,  age  30. 

27,  '64. 

New  York,  age  20. 

8,  '64. 

Richards,  C.  S.  A.     Discharged 

119 

Conley,  W.,  Pt.,  G,  17th 

Mar.  16, 

Left  ;    ant.  post.  flap.     Surg.  E. 

Nov.  7,  1865. 

New  York,  age  25.             17,  '65. 

Batwell,    14th   Mich.     Disch'a 

161 

Deyoe.  N.  W.,  Corp'l,  E, 

July  2, 

Left  ;  ant,  post.  flap.    Discharged 

July  25,  1865. 

61st  New  York,  age  21. 

2,  '63. 

March  2.  1864.     Spe.c.  4374. 

120 

Connel.   J.,  Pt,  C,   7th  \  May  12,    Left;  circ.     Disch'd  Dec.  3,  1863. 

162 

Dickson.  A.    S.,  Corp'l, 

June  27, 

Right  ;  ant.  flap.      Surg.  J.  W. 

Missouri. 

12,  '63. 

H,  125th  111.,  age  26. 

27,  '64. 

McGee,   57th  N.  C.     Mustered 

121 

Conner,  C.  R.,  Corp'l,  B, 

May  27,     Right  ;  circ.  Surg.  T.  F.  Duncan, 

out  June  9,  1865. 

19th  Ohio,  age  19. 

28,  '64.        P.  A.  C.  S.     Disch'd  Aug  2,  '05. 

163 

Diedrich,  H.,  Corp'l,  I, 

Oct,  21  , 

Right  :  circ.    Surg.  J.  C.  Morgan. 

122 

Connolly,    D.,    Pt,    B,      June  3,     R't;  flap.    Con.  surg.    (Also  other 

30th  Iowa,  agn  23. 

21  ,  '63. 

29th   Mo.     Gangrene.     Disch'd 

164th  N.Y..  age  22.            ".'64.         wounds.)     Disch'd  June  19,  '65. 

May  I."..  1W5. 

1  O'KEKKE  ( D.  C.i,  Surgical  Cases  of  Interest,  treated  at  Institute  Hospital,  Atlanta,  Ga..  etc.,  in  Confed.  States  Me'!.  •» 


468 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

164 

Dines,  D.,  Ft.,  D,  27th 

July  22, 

Right;  flap.     Surg.  A.  B.  Mono- 

207 

Evercost.  G.,  Corp'l.  B. 

July  4, 

Left  :  flap.   Surg.  F.  M.  Rose,  43d 

Ohio,  age  21. 

22,  '64. 

han,   63d  Ohio.     Disch'd  July 

27th  Ohio,  age  26.    ' 

4,  '64. 

Ohio.    Gangrene.    Disch'd  July 

24,  1865. 

17,  1865. 

165 

Dolley,  T.  W.  Corp'l,  K, 

April  9, 

Left  ;  circ.     Disch'd  Nov.  22,  '64. 

208 

Everett,  D.,  Pt.,  L,  15th 

June  15, 

Right;  ant.  post,  flap;   slough.; 

30th  Maine,  age  22. 

9,  '64. 

Died  Aug.  4,  '67  ;  phth.  pulmo. 

Kansas  Cav.,  age  18. 

17,  '64. 

gangrene.    June  20,  re-amp,  in 

and  chr.  diarrhoea.     Spec.  4299. 

thigh.     Disch'd  Aug.  19,  1864. 

166 

Donaghy,  W.,  Seaman, 

Nov.  4, 

Right;  circ.     Surg.  L.  C.  Fonts, 

209 

Failing,  J.,  Pt.,  A,  122d 

May  6, 

Left.     Disch'd  July  6,  1865. 

gunboat  Tamah,agc  27. 

4,  '64. 

2d  Tcnn.     Duty  Feb.  7,  1865. 

New  York,  age  21. 

7,  '64. 

167 

Donahue,  J.,  Pt.,  H,  07th 

Oct.  19, 

Right;    circ.     Disch'd   June  28, 

210 

Farnsworth,  J.  W.,  Pt., 

June  17 

Left;  flap.     Surg.  T.   F.  Oakes, 

Penn.,  age  38. 

21,  '64. 

1865. 

F,  57th  Massachusetts. 

18,  '64. 

56th  Mass.    Mar.  23,  '65,  re-amp'. 

168 

Donaldson,  L.  J.,  Pt.,  F, 

May  12, 

Left  ;  flap.    Surg.  E.  L.  Hill,  20th 

Disch'd  June  2,  1865. 

2l)th  Ohio. 

12,  'C3. 

Ohio.    Disch'd  August  14,  1863. 

211 

Farry,   M.,  Pt.,  I,  38th 

Oct.  19, 

Right;  flap.    Disch'd  July  12,  '65. 

169 

Donnelly.    J.,    Pt.,    A, 

May  17, 

Left;   flap.     Surg.   E.   Harrison, 

Massachusetts,  age  30. 

19,  '64. 

Died  Oct.  12,  '69  ;  consumption. 

124th  Illinois. 

17,''G3. 

68th  Ohio.    Disch'd  Aug.  10/63. 

212 

Fehrman,  H.,  Corp'l,  I, 

Aug.  18, 

Left;  flap.    Disch'd  June  2,  1865. 

170 

Doolan,  P..  Pt.,  B,  90th 

Mav  5, 

Right;  flap.    Disch'd  Dec.  10.'64. 

1st  Maryland,  age  25. 

19,  '64. 

Penn.,  age  45. 

5,  '64. 

213 

Felloon,  R.,  Pt..  E,  6th 

June  27, 

Right  ;  post.  flap.     Disch'd  Oct. 

171 

Dooley.    H.  C.,  Pt.,  C, 

Mar.  27, 

Right.     Surg.  T.  W.  Flora,  26th 

Michigan,  age  43. 

27,  '63. 

5,   1863.    Died    Nov.   6,    1867; 

2lith  Indiana,  age  27. 

27,  '65. 

Ind.     Disch'd  June  2,  1865. 

chronic  diarrhoea. 

172 

Dorsey,    J.,  Corp'l,    H, 

Nov.  29, 

Right  ;  gangrene.     Disch'd  July 

214 

Fentress,  H.,  Pt.,  C,  6th 

Aug.  30, 

.     Surgeon  J.  H.  Clairbome, 

16th  Kentucky,  age  21. 

30,  '(54. 

17,  1865. 

Virginia. 

31,  '(12. 

P.  A.  C.  S.     Recovered. 

173 

Porsey.  E.  W.,  Lieut.,  B, 

July  2, 

Right  ;  circ.     To  prison  January 

215 

Ferguson,  A.,  Lieut.,  33d 

Nov.  30, 

Right  ;  ant.  post.  flap.     To  Prov. 

llth  X.  C.,  age  24. 

2,  '63. 

29,  1864. 

Alabama,  age  32. 

30,  '64. 

Marshal  Feb.  14,  1865. 

174 

Dougall,  J.  8.,  Pt.,  H, 

Aug.  30, 

Left.    Surgeon  W.  Frothingham, 

216 

Fink,  J.,  Pt.,  E,  8th  N. 

June  16, 

Right  :  flap.     Surg.  N.  Hayward, 

44th  New  York. 

30,  '62. 

44th  N.  Y.    Disch'd  Oct.  27,  '62.' 

Y.  Heavy  Artillery. 

17,  '64. 

20th  Mass.     Disch'd  July  4,  '65. 

175 

Dougherty,  H.,  Colonel, 

Nov.  7, 

Left  (also  w'nds  of  arm  and  lung). 

217 

Fisher,  C.'S.  M.,  Pt,,  H, 

June  18, 

Right.     Disch'd  Feb.  7,  1865. 

2Cd  Illinois. 

—  ,  '61. 

Mustered  out  May  7,  '63.     Died 

2d  Penn.  Art'y,  age  23. 

19,  '64. 

176 

Douglass,  J.    C.,  Capt., 
II,  2d  Missouri. 

Oct.  4. 
4,  '62. 

April  7,  '68  ;  wound  of  long. 
.    Recovered. 

218? 
219) 

Fisher.  E.  H.,  Lieut.,  A, 
21st  Indiana. 

Oct.  20, 
20,  '62. 

Both.     Surg.  E.  Reed,  21st  Ind. 
Disch'd  Nov.  20,  1863. 

177 

Dow,  J.  H.,  Pt.,  II,  2Pth 

July  30, 

Left  :  circular.     Disch'd  May  26, 

220 

Fitch,  G.,  Serg't.  C,  6th 

June  3, 

Right:  double  flap.     Discharged 

Massachusetts,  ago  36. 

30,  '64. 

1865. 

Vermont. 

3,  '64. 

Oct.  28,  Ib64. 

178 

Dowliug.W.,  Pt.,F,59th 

Aug.  14, 

Left  ;  long  ant.  post.  flap.     Surg. 

221 

Flaherty,  T.,  Pt.,  C,  8th 

May  27, 

Left;  circ.    Disch'd  Nov.  1,  1863. 

New  York,  age  28. 

15,  '04. 

S.  H.  Plumb,  59th  N.  Y.    II»m. 

New  Hampshire. 

27,  '63. 

Disch'd  August  18,  18G5. 

222 

Flanders,  W.M.  F.,  S'g't, 

June  18, 

Right  ;  circ.     Disch'd  December 

179 

Downing.  F.  T.,  Corp'l, 

Dec.  13, 

Right.      Surg.   J.   F.   Whitbeck, 

G,  16th  Mass.,  ago  23. 

19,  '64. 

28,  1865. 

F,  108th  New  York. 

14,  '62. 

1  08th  N.  Y.    Disch'd  A  ug.  6,'63. 

223 

Flanigan,  M.,Lieul.Col., 

July  1, 

Left.     Disch'd  Nov.  24.  1863. 

180 

Dresson,  G.  F.,  Pt.,  A, 

Dec.  13, 

Left.     Disch'd  August  29,  1863. 

24th  Mich.,  age  37. 

1.  '63. 

35th  New  York. 

13,  '62. 

224 

^Fleming.  R.  J.,  Serg't, 

May  14, 

Right;    flap.     Surgeon  —  Hall, 

181 

Duffy,  J.  P.,  Ft.,  O,  28th 

Sept.  17, 

Right.     Disch'd  June  27,  1863. 

D,  20th  Tenn.,  age  x;5. 

14,  '64. 

C.  S.  A.   Sloughing.   Recovery. 

Pennsylvania. 

17,  '62. 

225 

Fletcher.  D.M.,Pt.,  10th 

Oct.  27, 

Right:  flap;  re-amput'n  in  thigh. 

182 

Duffey,    O.,    Serg't,    G, 

Aug.  16, 

Right  ;  double  flap.     Confederate 

Ind.  Battery,  ago  24. 

28,  '64. 

Mustered  out  July  10,  1865. 

48th  New  York,  ago  23. 

l(i,  '64. 

surgeon.    Disch'd  Nov.  30,  1864. 

226 

Foley,  W.,  Pt.,  I,  62d  N. 

Mar.  25, 

Right  ;   ant.  post.  "flap.     Disch'd 

183 

Dunlap,  J.  R.,    Ft.,   C, 

July  3, 

Right.      Exchanged    September 

York,  age  43. 

25,  '65. 

Oct.  26,  1865. 

Davis  Cavalry,  acre  20. 

3.  ''t;3. 

25,  1863. 

227 

Ford,  T.,   Pt.,  K,   35th 

Aug.  19, 

Right  ;  ant.  post.  flap.     Surg.  G. 

184  |  Dunn,  W.  F.,  Serg't,  E, 

Oct.  5, 

Left;  flap.    Disch'd  June  14,  '65. 

Mass.,  age  33. 

20,  '64. 

W.  Snow,  35th  Mass.     Disch'd 

93d  Illinois,  age  'M. 

5,  '64. 

April  1,  1865. 

185 

Durand,  E.,  Pt.,  K,  31st 

J  une  4, 

Right:  circ.     Stirg.  P.  S.  Arndt, 

228 

Foreman,    R.,    Pt.,    D, 

July  9, 

Right;  flap.     A.  A.  Surg.  G.  M. 

Wisconsin,  age  37. 

5,  '64. 

31st  Wis.     Disch'd  Feb.  9,  '65. 

151st  N.York,  age  17. 

10,  '64. 

Paullin.     Disch'd  Sept.  4,  1865. 

Died  April  28,  "iO  :  consumption. 

Spec.  2341. 

186 

Durnap,  J.  B.,  Pt.,  D, 

June  20, 

.  Surg.  VV.  H.  Lipscomb,  C. 

229 

Forrester,  M..  Pt.,E,  26th 

July  3, 

Left.     Exchanged  March  3,  1864. 

Perrin's  Ala.  Battery. 

20,  '63. 

S.  A.     Recovery. 

North  Carolina. 

3,  '63. 

187 

Dwyer,  A.,  Serg't,  G,  3d 

Oct.  7, 

Right  ;  flap.     Disch'd  March  28, 

230 

Foster,  W.  G.,   Pt.,  E, 

July  2, 

Right;    flap.     Disch'd   Nov.   24, 

New  York. 

7,  '64. 

1865. 

16th  Maine. 

3,  '63. 

1863. 

188 

Bakes,  J/.,    Pt.,    I,    23d 

July  1, 

Left.     Exchanged  Sept.  25,  1863. 

231 

Foust,  E.,  Sergeant,  C, 

Oct.  19, 

Right;   flap.      Disch'd    May  17, 

North  Carolina,  age  19. 

2,  '63. 

126th  Ohio. 

19,  '64. 

1865. 

189 

Ecliols.  J.,  Pt.,  II,  24th 

May  16, 

—  :  flap.     Surg.  C.  B.  Gibson, 

232 

Fowler,   E.  B.,  Pt.,  F, 

July  3, 

Left.     Surg.  G.  L.  Potter,  145th 

Virginia. 

17,''64. 

C.  S.  A.     Transferred. 

27th  Connecticut. 

4,  '"63. 

Peun.     Disch'd  July  27,  1863. 

190 

Edmunds,  C.,  Pt.,  L,  1st 

May  3, 

Right.     Surg.  C.   S.  Wood,  66th 

233 

Francis,  W.,  Pt..  A.  117th 

Sept.  29, 

Left  ;  ant.  posterior  flap.    Disch'd 

Ohio  Batterv. 

3.  ''63. 

N.  Y.     Disch'd  Feb.  23,  1864. 

New  York,  age  21. 

30,  '64. 

May  31,  1865. 

191 

Edson.  S.VV.,"Pt.,E,  22d 

May  10, 

Left  ;  ant.  post.  flap.     Surg.  I.  H. 

234 

Frank.  C.,  Pt.,  K.  149th 

Mav  25, 

Left;    circ.;   gangrene.      Disch'd 

Massachusetts,  age  29. 

10,"'04. 

Stearns,    2-Jd     Mass.      Disch'd 

New  York,  age  34. 

2o,"'64. 

August  18,  1865. 

Jan.  8,  1865. 

235 

Freed,J.  M..PI..G,  89th 

April  !), 

Right;  flap.     Disch'd  June  5,  '65. 

192 

Edwards,  F.  W.,  Pt.,  II, 

May  19, 

Right;  flap.     Disch'd  July  8,'64. 

Indiana,  age  23. 

9,  '65. 

1st  Mass.,  age  22. 

19,'  '64. 

236 

Freeman,  J.  D.,  Pt.,  F, 

Sept.  19, 

Right  ;  lateral  flap.     Discharged 

193 

Elliott,  J.  H.,  Corp'l,  G, 

Oct.  13, 

Right  ;    circ.     Disch'd  February 

15th  W.  Va.,  age  33. 

l!t,  '64. 

June  19,  1865. 

34th  Mas?.,  age  21. 

14,  '64. 

4,  1865. 

237 

French,    B.   F.,   Pt.,  H, 

July  2, 

Right;    circ.     Disch'd   June   14, 

194 

Elliott,  P.,  Pt.,  K,  15th 

Sept.  17. 

Left;  circ.     Disch'd  Dec.  4,  1862. 

20th  Maine,  ago  21. 

4,  '63. 

1864. 

Massachusetts. 

17,  T.2. 

Died  Dec.  4,  1863.     Spec.  4200. 

238 

Frum,  P.,  Corp'l,  F,  3d 

Aug.  29, 

Left.    Surg.R.W.  Hazlett,  2d  W. 

195 

Ellis,  A..  Pt.,  A,142d  N. 

May  16, 

Left  ;  flap.     Discharged. 

West  Virginia,  age  28. 

29,  '62. 

Va.  Gangrene;  re-amp,  in  thigh 

York,  ng<>  40. 

16,  '64. 

Sept.  21,  1862.     Disch'd  JulvT, 

196 

Ellis,  T.  S.,  Pt.,   G,  2d 

Aug.  29, 

Left  ;  circ.     Disch'd  April  25,  '63. 

1864.     Spec.  1665. 

U.  S.  Sharpshooters. 

30,  '62. 

2.39 

Fuller,  W.  H..  Pt.,  H, 

Sept.  19, 

Right;  oval   flap.     Surg.  O.  11. 

197 

Ellis,  \V.,   Pt.,   A,  14th 

April  (i, 

Right.     Disch'd  June  7,  1862. 

5th  New  York  Cavalry, 

19,  '64. 

Armstrong,  5th  N.  Y.  Cavalry. 

Illinois, 

6,  '62. 

age  23. 

Disch'd  March  16,  1865. 

198 

Ellin,    W.  T.,  Capt..   B, 

Aug.  21, 

Left  :  comb'n  flap  and  circ.   'Surg. 

240 

Furman,  R.,  Corp'l,   B, 

June  3, 

Left  ;  long  post.  flap.    Ass't  Surg. 

24th  N.  C.,  age  32. 

21,  '64. 

—  Wilson,  C.  S.  A.    Furl'd  Oct. 

8th  New  York  Heavy 

4,  '64. 

C.  H.  Pegg,  8th  N.  Y.  11.  Arfy. 

21,  1664. 

Artillery,  age  24. 

Gang.     Disch'd  Aug.  30,  1865. 

199 

Ellison,  Ar.  A.,  Pt.,   B, 

July  3, 

Right.      Surgeons   Schaffer  and 

241 

Galavan.'D.,  Pt.,  II,  26th 

June  14, 

Right  ;  circ.     Disch'd  August  17, 

16th  Georgia,  age  18. 

3,  '63. 

Bnsch,  C.  S.  A.     Retired  Feb. 

Connecticut. 

14,  '63. 

1863. 

1,  1865. 

242 

Gale,   A.,    Pt.,    B,   51st 

Sept.  14, 

Right.     Surg.  J.  L.  Dodge,  51st 

200 

Enerlish,  W.  W.,  Pt.,  H. 

Aug.  30, 

Right  :    circ.      Confed.   surgeon. 

New  York. 

15,  '62. 

N.  Y.    -Disch'd  March  4.  1803. 

71st  Indiana. 

30,  '62. 

Disch'd  Nov.  28,  1662. 

243 

Gallant,  W.  H.,  Pt,,  F, 

Mar.  25, 

Left.     Discharged  July  1,  1865. 

201 

Erway,   J.    B.,    Pt.,  G, 

May  3, 

Lefr.     Surg.  W.  F.  Humphrey, 

122d  Ohio,  age  23. 

25,   Go. 

149th  Pennsylvania. 

3.  '63. 

14!)th  Penn.     Discharged. 

244 

Gant,M.,Pt.,B.  8th  Penn. 

Sept,  14, 

Left  ;    flap  :    gangrene.     Disch'd 

202 

Evans,    A.,    Serg't,    II, 

Dec.  13, 

Right.     Surg.  C.  S.  Wood,  66th 

Reserves,  age  18. 

14,  '62. 

January  16,  1863. 

66th  Now  York. 

13,  '62. 

N.  Y.     Disch'd  Feb.  21,  1863. 

245 

Ganto,  L.  it.,  Pt..  H,  9th 

Oct.  7, 

Left.     Surg.  T.  C.  Pugh,  C.  S.  A. 

203 

Evans,  J.,  Pt.,  C,  96th 

May  12, 

Lett;    circ.     Disch'd   March   23, 

Georgia. 

7,  '64. 

Recovery. 

Penn.,  age  30. 

13,'  '64. 

1865. 

246 

Garland.  J.  C.,  Capt.,  A, 

July  4, 

Right.     Union   surgeon.      Ilacm. 

204 

Evans,   S.  P.,  Capt.,  A, 

May  14, 

Left;  circ.     Mustered  out,  1865. 

Glen's  Reg't,  age  31. 

4,  '63. 

To  prison  April  21,  1864.   ' 

5th  Tennessee. 

15,'  '64. 

247 

Geary,   M.,    Serg't,    C, 

Sept.  17, 

Left  ;  flap.     Ass't  Surgeon  T.  A. 

205 

Evans,    W.,    Lieut.,  F, 

Mav  16, 

Left:  circ.     Confederate  surgeon. 

128th  Pennsylvania. 

19,  '62. 

Hchvig,  128th  Penn.     Mustered 

100th  N.  Y.,  ago  27. 

17/64. 

Disch'd  Jan.  26,  1865. 

out  May  19.  1863. 

20ii 

Evers,  B.,  Pt..  G,  IGtli 

Mav  23, 

Right;    flap.     Disch'd  June   19, 

248 

Geddes,  G.,  Pt.,  K,  126th 

Dec.  13, 

Left;    circ.     Disch'd   March    19. 

Michigan,  age  20. 

23,'  '64. 

1865. 

Pennsylvania. 

14,  '62. 

1863. 

1 0'KEEFE  (D.  C.),  Surgical  Cases  of  Interest,  treated  at  Institute  Hospital,  Atlanta,  Ga.,  May  and  June,  1864,  in  Confederate  Stales  Medicnl  and 
Surgical  Journal,  Richmond,  1865,  Vol.  2,  p.  30. 


SECT.  V.] 


PEIMARY    AMPUTATIONS    IN    THE    LEG. 


469 


NO. 

NAME,  MILITARY 
DEscmrnoN,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

249 

Gerhard,  P.,  Corp'l,  K, 

Mar.  31, 

Left  ;  large  post.,  short  semi-lunar 

291 

Hammond,  G.,Pt.,A,  1st 

Aug.  16, 

Left  ;  aut.  flap.    Surg.  R.  A.  Dod- 

1st  Maryland,  age  45. 

31,  '65. 

flap.     Disch'd  Oct.  11,  1865. 

Maryland  Cav.,  age  25. 

16,  '64. 

son,  1st  Maryland  Cav.    Disch'd 

250 

Gervin,  J.  G.,  Corp'l,  D, 

Dec.  17, 

Right.     Surg.  G.  W.  Brady,  8th 

May  18,  1865. 

8th  Tenn.  Cav.,  age  31. 

17,  '64. 

Tenn.     Disch'd  June  26,  1865. 

292 

Haucock,E.  A.,  Capt.,B, 

Mar.  16, 

Left  ;  flap.     Surg.  C.  Helms,  92d 

251 

Getchell,  H.  W.,  Pt.,  K, 

June  18, 

Left  ;    ant.  post.  flap.       Disch'd 

9th  Penn.  Cav.,  age  25. 

16,  '65. 

111.    Mustered  out  July  18,  1665. 

1st  Me.  H.  Art,,  age  24. 

19,  '64. 

June  6,  1865. 

293 

Harlocker,  H.  H.,  Pt.,  C, 

May  5, 

Right  ;    flap.     Discharged   May 

252 

Gibbonv,  8.  H.,  Pt.,'  C, 

May  31, 

Right.     Surg.  G.  Chaddock,  7th 

6th  Wisconsin,  age  18. 

7,  '64. 

26,  1865. 

7th  Mich.,  age  25. 

J'e  2,  '62. 

Mich.     Disch'd  Sept,  25,  1862. 

294 

Harris,  W.C.,  Lieut.,  D, 

Nov.  27, 

Left.     Surg.  —  Mitchell,  C.  S.  A. 

253 

Gibbs,  G.,  Pt.,  G,  25th 

Oct.  5, 

Right,     Surg.  B.  F.  Stephenson, 

2d  Louisiana. 

27.  '63. 

Recovery. 

Indiana,  age  36. 

5,  '62. 

14th  111.     Disch'd  April  7,  1863. 

295 

Harris.W.  H.,  Pt.,  K,  1st 

July  9, 

Left  ;  circ.     Surgeon  —  Newell, 

254 

Gibson,   T.,  Pt.,  B,  5th 

Aug.  29, 

Left  ;  circ.     Disch'd  Feb.  9,  1863. 

Potomac   Home   Brig 

9,  '64. 

C.  S.  A.     Disch'd  June  G,  1865. 

New  Jersey. 

29,  '62. 

ade,  age  22. 

255 

Gibson,  W.'B.,  Pt.,   F, 

April  30, 

Left;  flap.     Discharged  Sept.  2, 

296 

Hart,  A.  W.,Pt.,B,  185th 

Mar.  29, 

Right  ;    flap.     Discharged   Sept. 

33d  Iowa,  age  24. 

M'y2,'64. 

1865. 

New  York,  age  19. 

30,  '65. 

25,  1865. 

256 

Gilliglten,  J.  3/.,Pt.,  A, 

Jan.  11, 

Right,     Transferred  to  Confed 

297 

Hart,  W.  H.,  Serg't,  C, 

July  2, 

Right  ;  flap.    Surg.  F.  Wolf,  39th 

16th  Georgia,  age  30. 

11,  '65. 

erate  hospital. 

lllth  N.  York,  age  41. 

3,  '63. 

N.  Y.     Disch'd  March  12,  1864. 

257 

Gillis,    8.,  1't.,  K,   68th 

May  16, 

Left  ;  flap.  Surg.  E.Harrison,  68th 

298 

Hartley,  H.  U.,  Pt.,  7th 

June  2, 

.     Surgeon  F.  M.  Hereford, 

Ohio. 

16,  '63. 

Ohio.     Disch'd  Dec.  10,  1863. 

Mississippi  Artillery. 

3,  '63. 

P.  A.  C.  S.     Recovery. 

258 

Gillroy,  B.,  Pt.,  H,  6th 

April  6, 

Left.     Recovered. 

299 

Harwood,   T.  F.,  Serg't, 

July  1, 

.     Surgeon  —  Harris,  C.  S.  A. 

Tennessee. 

6,  '62. 

K,  53d  Virginia. 

3,  '62. 

Recovery. 

259 

Godfrev.  A.  A.,  Pt.,  A, 

Dec.  13, 

Left.     Discharged  July  23,  1863. 

300 

Hastings,  W.,  Pt.,  E,  2d 

April  4, 

Left  ;  ant.  post,  flap  ;  profuse  pri 

2d  Maine,  age  23. 

13,  '62. 

Artillery,  age  27. 

4,  '64. 

mary  haemorrhage.    Discharged 

260 

Godfrey,  C.  P.,  It.,  F, 

May  12, 

Left  ;  flap.     Surg.  W.  B.  Fox,  8th 

Jan.  20,  1865. 

109th  N.  Y.,  age  22. 

13,  '64. 

Mich.     Disch'd  May  23,  1865. 

301 

Hastness,  O.,Pt.,  E,  llth 

June  14, 

Left.     Surg.  G.  C.  Harlan,  llth 

261 

Gough,  J.  F.  K.,  Pt.,  B, 

June  14, 

Right  ;  flap.    Disch'd  October  19, 

Penn.  Cav.,  age  21. 

14,  '63. 

Penn.  Cav.    Disch'd  May  3,  '64. 

173d  New  York. 

14,  'G3. 

1863. 

302 

Hawkins,  F.  A.,  Pt.,  B, 

Sept.  17, 

Right.    Surg.  McAden,  13th  N.C. 

262 

Good,  A.,  Col'd  laborer, 

Aug.  9, 

Right  ;  circ.  Ass't  Surg.  W.  Blun- 

13th  North  Carolina. 

18,  '62. 

Recovery. 

Quartermaster  Depart 

9,  ?64. 

dell,  5th  N.  J.    Recovered  June 

303 

Hayes,A.G.,Pt.,C,  110th 

May  6, 

Left  ;  flap.      Surg.  D.   S.   Hays, 

ment,  age  30. 

26,  1865.     Spec.  4153. 

Pennsylvania,  age  20. 

G,  '64. 

110th  Penn.  Disch'd  April  6/65. 

263 

Goodsell,  J.  B.,  Corp'l, 

Sept,  19, 

Left;  flap.     Ass't  Surgeon  C.  H. 

304 

Haynes,  S.  M.,Corp'I,  B, 

Sept.  30, 

Left  ;  flap.     Disch'd  July  3,  1865. 

K,  114th  N.  Y.,  age  23. 

20,  '64. 

Allen,   8th   Vermont.     Disch'd 

59th  Alass.,  age  32. 

Oct.  1,'G4. 

April  13,  1865. 

305 

Hays,  J.  K.,  Pt.,  G,  28th 

June  17, 

Right.     Transferred  July  14,  '64. 

264 

Goodwin.  S.  U.,  Pt.,  E, 

June  3, 

Right;   flap.     Surg.  D.  Merritt, 

Georgia,  age  18. 

17,  '64. 

188th  Penn.,  age  24. 

3,  '64. 

55th  Penn.  (also  wound  left  leg). 

306 

Heary,  P.,  Pt.,  B,  46th 

July  30, 

Left  ;  ant.  post.  flap.    Surg.W.  B. 

Disch'd  Sept.  19,   1864.      Died 

New  York,  age  20. 

31,  '64. 

Fox,  8th  Mich.    Disch'd  March 

August  12,  1867. 

30,  1865. 

265 

Graham.  J.   Q.,  Pt.,  D, 

May  12, 

Right;  flap.      Disch'd  April  30, 

307 

Helm,  E.  B.,  Pt.,  B,  4th 

April  2, 

Right;   flap.     Disch'd  June  20, 

llth  Infantry,  age  18. 

12,  '64. 

1865. 

New  Jersey,  age  28. 

2,  '65. 

1865. 

266 

Gray,   E..   Pt,,   C,  llth 

April  2, 

Right;  flap.  Surg.  J.W.Anawalt, 

308 

Henderson,   W.  P.,  Pt., 

Oct.  27, 

.     Recovery. 

Pennsylvania,  age  21. 

2,  '65. 

llth  Penn.  Disch'd  Sept.  30,  '65. 

I,  Hampton  Legion. 

—  ,  '63. 

267 

Gray,  J.,  Pt.,  K,  1st  West 

July  18, 

Right  :  flap.  Disch'd  Nov.  26,  '64. 

309 

Henry,   E.,   Pt.,   C,   1st 

Feb.  20, 

Left  ;  flap.     Ass't  Surgeon  H.  C. 

Virginia,  age  26. 

18,  '64. 

Died  December  17,  1873. 

Col'd  Troops,  age  21. 

20,  '65. 

Merry  weather.  5th  Col'd  Troops. 

268 

Gray,  J.  R.,  Pt.,  C,  2d 

Nov.  30, 

Right  ;  ant.  post.  flap.     To  Prov. 

Disch'd  Oct.  18,  1865. 

Arkansas,  age  25. 

De.  1,'64. 

Marshal  March  7,  1865. 

310 

Henthorne,   E.,   Pt.,  E, 

June  5, 

Left;  flap.    Surg.  D.  Baguley,  1st 

269 

Greaney,  P.,  Serg't,  D, 

Sept.  17, 

Left  ;  flap.     Surg.  R.  Loughran, 

116th  Ohio,  age  24. 

6,  '64. 

W.  Va.     Disch'd  July  5,  1865. 

80th  New  York,  age  43. 

19,  '62. 

80th  N.  Y.     Disch'd  Dec.  6,  '62. 

311 

Herron,  J.,  Pt,,  I,4th  Del 

Aug.  21, 

Right  ;  flap.    Disch'd  May  29,'65. 

Died  July  31,  1874. 

aware,  age  23. 

21,  '64. 

270 

Green,  B.,  Pt.,  H,  37th 

Sept.  30, 

Right  ;   ant.  post.  flap.     Disch'd 

312 

Hershberg,   D.,  Pt.,    F, 

Nov.  23, 

Right;  post.  flap.     Ass't  Surg.  J. 

Col'd  Troops,  age  27. 

30,  '64. 

April  14,  1865. 

G2d  New  York. 

23,  '61. 

R.  Smith,  U.  S.  A.     Discharged 

271 

Green,    G.,   Corp'l,    H, 

May  14, 

Left.    Surgeon  J.  McCurdy,  llth 

April  23,  1862. 

llth  Ohio. 

14,'  '64. 

Ohio.    Mustered  out  June,  1864. 

313 

Hill,  C.  M.,  Pt.,  G,  64th 

May  12, 

Left  ;  circ.    Surg.  J.  W.  Wishart, 

272 

Green,  J.,  Pt.,  H,  65th 

Aug.  6, 

Left:  flap.     Surg.  A.  M.  Wilder, 

New  York,  age  28. 

12,  '64. 

140th  Penn.  Disch'd  July  13,'G4. 

Indiana,  age  36. 

6,  '64. 

U.  S.  V.     Disch'd  June  9,  1865. 

314 

Hill,  G.  A.,  Pt.,  K,  13th 

Oct.  19, 

Right  ;   ant.  post.  flap.     Disch'd 

273 

Green.  W.  U..  Pt.,  H,  2d 

Sept.  19, 

.     Transferred  Nov.  15,  1864. 

West  Virginia,  age  18. 

19,  '64. 

June?,  1865. 

South  Carolina. 

19,  '64. 

315 

Hill,  R.  A.,  Pt.,  A,  155th 

Sept.  14, 

Left  :  ant.  post.  flap.    A.  A.  Surg. 

274 

Greenwald,  A.,  Seaman, 

June  28, 

Right.     Discharged  April  24,  '63. 

Pennsylvania,  age  20. 

15,  '62. 

W.  H.  Butler.     Gang.    Disch'd 

U.   S.   Steamer   J.    P. 

28,  '62. 

June  9,  1863.    Spec.  179. 

Jackson,  age  22. 

316 

Hill,  S.  P.,  Pt.,  A,  7th 

Aug.  23, 

Right;    flap.     Surg.  —  Gurley, 

275 

Gridlev,  C.  W.,  Corp'l, 

Mar.  31, 

Left;   circ.     Mustered  out  Sept. 

Kentucky  Cavalry. 

24,  '62. 

C.  S.  A.     Disch'd  July  14,  1863. 

G,  53d  Penn.,  age  27. 

31,  '05. 

8,  1865. 

317 

Hilton,  N.,  Pt.,  B,  16th 

Dec.  31, 

Right.   Surg.  C.  S.  Mus'croft,  10th 

276 

Griffin,    J.,    Pt..    G,    2d 

Mar.  5, 

Right  :  flap.    Surg.W.  A.  McCul- 

Infantry. 

31,  '<52. 

Ohio.     Recov'd  June  27,  1863. 

Colored  Troops. 

5,  '65. 

ley,  2d  Col'd  Troops.     Disch'd 

318 

Hiltz,   J.  W.,  Capt.,  C, 

Sept.  19, 

Right  ;  flap.   Surg.W.  S.  Newton, 

June  9,  1865. 

23d  Ohio,  age  33. 

19,  '64. 

91  st  Ohio.     Disch'd  A  ug.  2,  '65. 

277 

Grimaldi,  M.,  Pt.,  I,  82d 

May  12, 

Right  ;  circ.     Surg.  S.  H.  Plumb, 

319 

Himelberger,  H.,  Pt.,  F. 

June  16, 

Right  ;  circ.     Surg.  H.  F.  Lyster, 

New  York,  age  23. 

13,  '64. 

82d  N.  Y.    Disch'd  Dec.  6,  1864. 

5th  Mich.,  age  26. 

17,  '64. 

5th  Mich.    Disch'd  April  11,  '65. 

278 

Grimes,    W.  M.,  Pt.,  B, 

Dec.  13, 

Left.     Surg.  J.   Evans,  3d  S.  C. 

320 

'Hobart,  H.,  Lieut.,  2d 

Sept.  17, 

Right  ;  post.  flap.     Recover}-. 

3d  South  Carolina. 

13,  '62. 

Recovery. 

Louisiana,  age  26. 

17,  '62. 

279 

Grimm,  L.,  Pt.,  A,  121st 

Dec.  13, 

Right.     Disch'd  August  10,  1863. 

321 

Hodge,  A.  D.,  Corp'l,  A, 

Jan.  30, 

Left;  flap.     Surg.  G.  C.  Harlan, 

Penn.,  age  44. 

13,  '62. 

llth  Penn.  Cav.,age  32. 

30,  'G3. 

llth  Penn.   Cavalry.      Disch'd 

280 

Groove,  W.  S.,  Pt.,  B, 

May  6, 

Right.     Surg.  E.  R.  Umberger, 

August  27,  1864. 

93d  Penn.,  age  16. 

6,  '64. 

93d'Penn.    Disch'd  June  15,  '65. 

322 

Hodge,   T.,  Pt.,  A,  17th 

July  20, 

Left.     To  prison  Oct.  31,  1864. 

281 

Gross,  E.,  Pt.,  E,  102d 

Sept.  19, 

Right  :  flap.    Disch'd  May  31,  '65. 

Alabama. 

20,  '64. 

Penn.,  age  28. 

19,  '64. 

323 

Holcomb,Y.,  Pt.,B,3Gth 

Sept.  19, 

Right  ;  flap.    Disch'd  May  20,  '65. 

282 

Grove,  G.W.,  Serg't,  D, 

June  22, 

Right;  flap.     Disch'd  August  18, 

Ohio,  age  26. 

19,  '64. 

Spec.  1498.    (Also  w'd  at  thigh.) 

6th  Maryland,  age  24. 

22,  '64. 

1865. 

324 

Holley,  J.  H.,  Pt.,C,38th 

Sept.  29, 

Right  ;  flap.    Disch'd  Sept.  7,  '65. 

283 

Gulledge,J.  W.,  Pt.,  K, 

May  16, 

;  flap.     Surg.  C.  B.  Gibson, 

Col'd  Troops,  age  19. 

29,  '64. 

59th  Alabama. 

17,  '64. 

C.  S.  A.     Retired  Jan.  2,  1865. 

325 

Hollinger,C.,  Pt.,F,  55th 

Mar.  16, 

Left  ;  flap.     Disch'd  July  19,  '65. 

284 

Gulseth,  O..  Pt.,  K,  3d 

Mar.  16, 

Left  ;    ant.    post.   flap.      Disch'd 

Ohio,  age  21. 

16.  '65. 

Wisconsin,  age  24. 

16.  '65. 

July  18.  1865. 

326 

Hopes,   J.,    Pt.,    M,   2d 

June  9, 

Right.     Disch'd  Nov.  10,   1863. 

285 

Hafferin.  C.,  Pt.,  F,  65th 

Oct.  19, 

Right  ;  circ.     Surg.  C.  B.  Hutch- 

Cavalry. 

9,  '63. 

Died  1868. 

New  York,  age  19. 

20,  '64. 

ins,  116th  N.  Y.     Haemorrhage. 

327 

Horton,  F.  B.,  Pt.,  D,  8th 

Sept.  29, 

Left,     Sent  to  prison  May  30,  '65. 

Disch'd  October  28,  1865. 

North  Carolina,  age  18. 

30.  '64. 

286 

Haganeier,  F.  H.,  Pt.,  F, 

May  3, 

Right  ;    post.  flap.      Discharged 

328 

Horton,  J.  R.,  Serg't,  D, 

Mar.  31, 

Right  ;   ant.  post.  flap.     Disch'd 

73d  N.  York,  age  23. 

4,  '63. 

October  G,  1864. 

17th  Penn.,  age  41. 

Ap.  2,  '65. 

August  12.  1865. 

287 

Halderman,  P.,  Pt.,  K, 

Oct.  28, 

Left;    flap.     Discharged  March 

329 

Horton,  S.  J.,  Corp'l,  E, 

July  22, 

Left  ;  ant.  post.  flap.     To  Provost 

13th  Penn.  Cav.  .age  20. 

29,  '64. 

29,  1865. 

7th  Texas,  age  23. 

22,"  '64. 

Marshal  Dec.  8,  1864. 

288 

Haley,  R.  F.,  Corp'l,  E, 

Sept.  17, 

Right.      Surgeon   G.  Chadwick, 

330 

Hovatter,  M.  J.,  Pt.,  F, 

Oct.  13, 

Right  ;  ant.  post.  flap.     Surg.  W. 

18th  Mississippi. 

19,  '62. 

7th  Michigan. 

15th  West  Va.,  age  40. 

13,  '64. 

S.  Walsh.  15th  West  Virginia. 

289 

Hall,  L.  J.,  Pt.,  I,  147th 

May  6, 

Left  ;  double  flap.      Surg.  H.  H. 

Disch'd  July  4,  1865. 

New  York,  age  19. 

6,  '64. 

Hubbard,  I'.  A.  C.  S.      Disch'd 

331 

Howard,  E.,  Pt.,  F,  3d 

July  2, 

Right;  circ.    Disch'd  October  12, 

March  18,  1865. 

Infantry,  age  32. 

4,  '63. 

1863. 

290 

Halleck,  S.   K.,  Pt.,  B, 

Oct.  27, 

Left  ;   circ.     Disch'd  October  5, 

332 

Howard,  J.  W.,  Corp'l, 

Mav  12, 

Left.    Confederate  surgeon.    Re 

148th  N.  York,  age  18. 

28,  '64. 

1865. 

D,  61st  Virginia. 

12,"  '64. 

covery. 

1  FISCHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations  in  the  Hospitals  near  Sharpsburg,  Md.,  after  the  battle  of  Antietam,  etc..  in  American 
Journal  Medical  Sciences.  1863,  Vol.  XLV,  p.  48. 


470 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATOKS, 
RESULT. 

333 

Hubbard,  G.  E.,  Pt.,  F, 

Sept.  17, 

Left  ;  flap.     Ass't  Surg.  J.  S.  Em 

375 

Lawson,  B.  F..  Corp'l,  F, 

Dec.  16, 

Left  :  flap.     Transferred  July  31  , 

9th  New  Hamp.,  age  18. 

17,  '62. 

erson,  9th  N.  H.     Discli'd  Feb. 

89th  Illinois,  age  23. 

16,  '64. 

1865. 

4,  1863. 

376 

Lee,  C.  P.,  Pt.,  H,  8th 

May  5, 

Left  ;  flap.     Disch'd  Sept.  12,  '64. 

334 

Hummel,  G.,  Lieut.,  B, 

Sept.  17, 

Left.    Disch'd  Feb.  15,  '63.    Died 

New  Jersey,  age  21. 

(i.  '64. 

Died  May  18.'  1867. 

28th  Ohio. 

18,  '62. 

May  25,  1865;  cong.  pneumonia. 

377 

Lee,  D.  L.,  Serg't,  E,71st 

Dec.  16, 

Left;  flap.    Surg.C.N.  Hoagland, 

33a 

Huston.    R.,    Corp'l,    I, 

May  11, 

Right;  flap.     Surg.  H.  M.Craw 

Ohio,  age  21. 

16.  '64. 

71st  Ohio.   Disch'd  April  22,  '65. 

58th  Illinois,  age  19. 

12,  '64. 

ford,  58th  111.     Mustered  out. 

378 

Leggett,  R.,  Lieut.  Col., 

July  25, 

Left.     Surg.  M.  T.  Newton,  10th 

336 

Hutchinson,  J.,  Ft.,  I,  2d 

Oct.  19, 

Left;  long  post.  flap.     Surg.  H. 

10th  Connecticut. 

25,'  '63. 

Conn.      Disch'd   Aug.  23,  1864. 

Connecticut,  age  20. 

19,  '64. 

Plumb,  2d  Conn.  H'vy  Artil'ry. 

Died  Sept.  18/74  ;  chr.  phthisis. 

Disch'd  Sept.  13,   1865.     Died 
Sept   10   18o9 

379 

Lennox,  J.  H.,  Pt.,  B,  3d 

April  6, 
6   '62. 

.     Confederate  surgeon.    Re- 

337 

Hutson,  W.,  Pt.,  G,  28th 

Sept.  17, 

Right  ;  ci'rc.     Surg.  H.  E.  Good 

380 

Leonard,  H.  D.,  Corp'l, 

June  2, 

Right  ;'flap.    Disch'd  Jan.  19,  '65. 

Pennsylvania. 

19,  '62. 

man,  28th  Penn.     Disch'd  July 

D,  92d  X.  Y.,  age  29. 

2,  '64. 

Died  Mar.  21.  '70;  consumption. 

21,  1863. 

381 

Lewis,  E.G.,  Pt.,  K,  8th 

April  2, 

Right  ;  circ.     Disch'd  Nov.  4,  '65. 

338 

Ingrain,  J.,  Pt.,  A,  1st 

Dec.  13, 

Right;   circ.     Disch'd  July  11, 

New  Jersey,  age  18. 

2.  '65. 

Pennsylvania  Artil'ry. 

13,  '62. 

1863.    Spec.  1775. 

382 

Leuscher,  \V.,Pt.,  C,  6th 

July  18, 

Left.     Surg.  —  Colton,  C.  S.  A. 

339 

Jackson,  G.  L.,Serg't,  B, 

July  28, 

Right  ;  circ.    To  Provost  Marshal 

Conn.,  age  36. 

20,'  '63. 

Disch'd  Sept.  6,  '64.   Died  since. 

17th  Alabama,  age  21. 

29,  '64. 

Dec.  1,  1864. 

383 

Lewis,  R.,  Lieut.  ,B,  Pal 

Oct.  7, 

Left  ;  flap.    Released  May  8,  '65. 

340 

Jarrrll,  C.,  Pt.,  G,  30th 

June  3, 

.     Surg.  —  Hunter,  C.  S.  A. 

metto  S.  S.,  age  23. 

7.  '64. 

Virginia. 

3,  '64. 

Recovery. 

384 

Lewis,    W.,   Corp'l,    C, 

July  22, 

Left  ;  flap.     Discharged  June  27, 

341 

Jensen,  P.,Corp'l,G.15th 

Feb.  6, 

Right;  double  flap.     Discharged 

39th  Ohio,  age  30. 

22,  '64. 

1865. 

N.  Y.  H.  A.,  age  24. 

6,  '65. 

Nov.  20.  1865. 

385 

Linker,  J.,  Corp'l,  B,  7th 

July  3, 

Left.    Surg.  —  Higginbotham,  C. 

342 

Jesse.  T.  H.,  Pt.,  A,  15th 

June  27, 

Right  ;  ant.     Surg.  R.  Q.  Stoney, 

North  Carolina,  age  24. 

4,  '63. 

S.  A.     Transferred  Nov.  25,  '63. 

Georgia. 

28,  '62. 

C.  S.  A.     Recovery. 

386 

Little,  G.W.,Pt.,  1,  24th 

May  6, 

Right.  Surg.  —  Mitchell,  C.  S.  A. 

343 

Johnson,  A.   O.,  Pt.,  C, 

July  2, 

Right.    Exchanged  Nov.  12,  '63. 

Georgia. 

6,  '64. 

Recovery- 

11  th  Georgia,  UCTG  !!)• 

3,  '63. 

387 

Livermore,  W.  H.,  Pt., 

July  28, 

Right  ;  circ.     Surg.  I.  N.  Barnes, 

344 

Johnson,   E.  H.,  Pt.,  E, 

Sept.  2, 

Right  :    circ.     Disch'd  January 

H,  55th  Illinois,  age  17. 

28,'  '64. 

116th  Illinois.    (Hsem.)    Disch'd 

4Cth  Indiana,  age  26. 

2,  '64. 

28,  1865. 

February  5,  1865. 

345 

Johnson,  G.,  Col'd  serv 

Dec.  14, 

Left  ;  flap.     Surg.  W.  F.  Smith, 

388 

Loafman,  W.  J.,  Pt.,  F, 

April  7, 

Left.     Disch'd  June  24,  1862. 

ant,  age  21. 

14,  '64. 

73d  Penn.     Duty  June  1,  1865. 

9th  Kentucky. 

7,  '62. 

346 

Johnson.  J.,  Pt.,  D,  9th 

Aug.  18, 

Left  :  circ.    Disch'd  April  14,  '65. 

389 

Loeweg,  M.,Pt.,D,  125th 

June  17, 

Right  ;  lateral  flap.     Discharged 

New  Jersey,  age  20. 

18,  '64. 

New  York,  age  19. 

17,  '64. 

October  21,  1865. 

347 

Jones,  G.  H.,  Pt.,  I,  2d 

July  i, 

;  flap.     Surg.  —  Hubbard, 

390 

Lohr,    N.,  Pt.,  F,    55th 

June  17, 

Left  ;  flap.     Surg.  G.  T.  Stevens. 

Mississippi,  age  20. 

3,  '63. 

2d  Miss.    Retired  Aug.  29,  1864. 

Pennsylvania,  age  26. 

18,  '64. 

77th  New  York.    Disch'd  March 

348 

Jones,   L.,   Pt.,   E,    5th 

Mar.  16, 

Right  ;  post,  flap;  gang.    Disch'd 

16,  1865. 

Conn.,  age  40. 

16,  '65. 

August  11,  1865. 

391 

Long,  G.  P.,  Pt.,  4th  In 

Mar.  16, 

Left;  flap.  Surg.  E.  Switt,U.S.A. 

349 

Jones,  W.  15.,  Pt.,  B,  5th 

Nov.  25, 

Left;    circ.  flap.     Disch'd   June 

diana  Battery. 

16.  '62. 

Disch'd  Dec.  8,  1863. 

Kentucky,  age  38. 

26,  '63. 

22,  1864. 

392 

Long,  J.  J.,  Pt.,  C,  139th 

May  12, 

Left.     Surg.  S.  F.  Chapin.  139th 

Joseph,  C.,  Pt.,  B,  100th 

June  16, 

Left.  Surg.  H.  Luddington,  100th 

Pennsylvania,  age  30. 

13,  '64. 

Penn.     Disch'd  May  12,  1865. 

Pennsylvania. 

16,  '62. 

Penn.     Disch'd  Sept.  17,  1862. 

393 

Long,  J.   S.,  Pt.,  F,  33d 

Mar.  19, 

Right;    flap.     Disch'd   June  28, 

351 

Joyce,  A.  J.,  Pt.,  E,  16th 

July  3, 

Left  ;  antero-post.  flap.     Surg.  J. 

Ohio. 

21,  '65. 

1865. 

Michigan,  age  20. 

3,  '63. 

Thomas,   118th    Penn.      Ham. 

394 

Long,  L.  R.,  Pt.,  I,  17th 

JulyH, 

Left  ;  flap.     Discharged  Nov.  16, 

Disch'd  March  18,  1864. 

Pennsylvania. 

14,'  '63. 

1863. 

352 

Jubb,  O.  A.,  Pt.,  M,  7th 

Aug.  25, 

Left  ;  circ.     Surg.  G.  S.  Dilts,  5th 

395 

Loomis,  J.,Serg't,B,56th 

April  9, 

Right  ;  double  flap.     Surg.  C.  E. 

Mich.  Cavalry,  age  24. 

25,  '64. 

N.  Y.  Artillery.   Gang.   Disch'd 

New  York,  age  23. 

9,  '65. 

Briggs,  54th  Mass.     Discharged 

August  9,  1865. 

October  13,  1865. 

353 

Keenan,  L.,  Pt.,  E,  140th 

July  3, 

Right.     Surg.  C.  S.  Wood,  66th 

396 

Loomis,   R.  D.,  Pt.,  H, 

May  12, 

Left  ;  circ.  Ass't  Surg.  S.  Adams, 

Pennsylvania,  age  18. 

4,  '63. 

N.  Y.     Disch'd  Jan.  25,  1864. 

57th  Mass.,  age  32. 

13,  '64. 

U.S.A.    Disch'd  Sept.  12,  1865. 

Died  Feb.  22,  1868. 

397  ( 

1  Lorence,  J.,  Corp'l,  K, 

Feb.  8, 

Both  :  flap.  Surg.H.W.Rivers,4th 

354 

Kelly,  P.,  Pt.,  G,  3d  Ar 

May  4, 

Left.     Disch'd  June  26,  1862. 

398s 

9th  New  Jersey,  age  35. 

8,  '62. 

R.  I.  .and  Surg.  J.  11.  Thompson, 

tillery,  age  27. 

4,  '62. 

U.  S.  V.     Disch'd  Sept.  30.  '62. 

355 

Keuney,   J.,  Corp'l,   E, 

April  2, 

Left;  circ.    Mustered  out   Sept. 

399 

Levering,  H.  B.,  Pt.,C, 

Sept.  19, 

Left;   circ.     Surg.  D.  F.  Leavit, 

10th  Conn.,  age  33. 

2,  '65. 

29,  1865. 

3d  Mass.  Cav.,  age  23. 

19,  '64. 

3d  Mass.  Cavalry.     Discharged 

356 

Kenney,  J.,  Pt.,  K,  20th 
Massachusetts. 

Sept.  17, 

17,  '62. 

Left.    Discharged  Feb.  10,  1863. 

400 

Lovett,  J.  H.,  Corp'l,  F, 

May  16, 

June  10,  1865. 
Left;  circ.     Disch'd  June  14,  '65. 

.. 

Kennidy,  I.  S.,  Pt..  H, 

May  3, 

Right;  circular.    Recovery. 

40th  Mass.,  age  19. 

16,  '64. 

5th  Virginia. 

4,  '63. 

401 

Lowell,  C.,  Lieut.  ,C,  7th 

May  5, 

Right  ;  fl;ip.     Surg.  W.  Buck,  6th 

358 

Keiner,   W.,  Serg't,   E, 

July  24, 

Left  ;  circ.     Surg.  C.  Bower,  6th 

Maine,  age  29. 

5,  ''64. 

Maine.     Disch'd  Oct.  3,  1864. 

Cth  Penn.  Reserves. 

24,  '61. 

Penn.  Reserves.     Disch'd  Mar. 

402 

Lowry,  T.,  Pt.,  F,  48th 

July  18, 

Right  ;  circ.     Surg.  G.W.  Miller, 

26,  1862. 

New  York. 

20,'  '63. 

97th  Penn.   Disch'd  Aug.  25,  '63. 

359 

Kerrin,  J.,  Pt.,  G,  ]9th 

Aug.  13, 

Right;  flap;  gang.:  re-amputat'n 

403 

Luckenbach,O.A.,Capt., 

Aug.  9, 

Right  ;  flap.     Surg.  T.  Antisell, 

Infantry,  age  27. 

13,  '64. 

thigh.     Disch'd  June  4,  1865. 

C,  46th  Pennsylvania. 

11,  '62. 

U.  S.  V.     Disch'd  Oct.  2,  1862. 

360 

Kiscadeu,  J.,  Pt.,  C,  99th 

Oct.  27. 

Left  ;  ant.  post.  flap.    Discharged 

404 

Luffman,  M.  M.,  Pt.,  A, 

June  18, 

Right  ;  flap  ;  gangrene.    Disch'd. 

Pennsylvania,  age  21. 

28,  '64. 

August  7,  1865. 

3d  Delaware,  age  22. 

J9,  '64. 

361 

Kitson,  T.  W.,  Miss.  Ma 

Mar.  26, 

Left.     Surgeon  J.  Roberts,  Miss. 

405 

Luke,   J.,    Pt.,  K,  99th 

May  5, 

Left;   flap:   gangrene.      Discli'd 

rine  Brigade. 

26,  '62. 

Mar.  Brig.    Disch'd  Nov.  21,  '63. 

Pennsylvania,  age  20. 

5,  '64. 

March  16,  1865. 

362 

Knight,  M.,Pt.,  D,  56th 

May  27, 

Left  ;  flap.  Surg.  D.  A.  La  Force, 

406 

Lunon,  G.,  Pt.,  B,  22d 

Sept.  19, 

Right  ;  circ.  Surgs.  J.  W.  H.Vest, 

Colored  Troops. 

.27  ,''6.-.. 

56th  Col'd  Troops.   Discharged. 

Iowa. 

20,  '64. 

28th  Iowa,  and  J.  C.   Shradcr, 

363 

Knittle,  J.,  Pt.,  D,  150th 

June  1, 

Right  ;   circ.     Discharged  Juno, 

22d  I  ,\va.     Disch'd  May  29,  '65. 

Pennsylvania,  age  1  9. 

3,  '64. 

1§65. 

407 

Lupton,  T.,  Corp'l,  A,2d 

June  16, 

Right;  Hrc.   Surg.J.W.  VVishart, 

364 

Koehler,  F.,  Pt.,  I,  7th 

July  H, 

Left  ;  ciro.  Disch'd  May  14,  1864. 

N.  Y.  H.  Art'y,  age  19. 

17,  '(14. 

140th  Penn.  Discli'd  Nov.  28,  '64. 

Connecticut. 

11,  '63. 

Died  Oct.  4.  1875.     Spec.  1510. 

408 

Macomber,   C.,    Pt.,   B, 

May  12, 

Left;  flap.     Surg.  S.  S.  French, 

365 

Kuchman,  D..Pt.,B,29th 

Aug.  29, 

Right.   Disch'd  January  27,  1863. 

20th  Mich.,  age  29. 

12,  '64. 

20th  Mich.     Disch'd  Jan.  26,  '65. 

New  York. 

29.  '62. 

409 

Muggard,  J.,  Pt..K,  13th 

Oct.  19, 

Left;  post.  tlap.  Ass't  Surg.  E.  L. 

366 

Kuemmel,  H.,  Corp'l,  II, 

July  30, 

Right  :  lateral  flap.     Surg.  A.  F. 

Mississippi,  age  18. 

20,  '64. 

De  Long.  77th  New  York.     To 

2d  Michigan,  age  22. 

30,"  '64. 

Whelan,lst  M-ich.S.  S.  Disch'd 

Provost  Marshal  April  1,  1865. 

March  17,  1865. 

410 

MaJiony,  G.,  Pt.,  B,  19th 

Aug.  29, 

Right.     Surg.  R.  Hatty,  19th  Ga. 

367 

Kuen.W.,  Corp'l.  E,  55th 

May  16, 

Right;    flap.     Disch'd  April   29, 

Georgia. 

29,  '62. 

Recovery. 

Pennsylvania,  age  22. 

16,  '64. 

1865. 

411 

Manchez,  E.,  Pt.,  B,  17th 

May  27, 

Right;  circ.     Ass't  Surg.  D.  C. 

368 

Kuhn,  L.,  Serg't,  B,  88th 

Nov.  25, 

Right  ;  flap.     Surg.  L.  D.  Water 

Missouri,  age  23. 

27,'  '64. 

Greenleaf,  4th   Iowa.     Disch'd 

Indiana,  age  24. 

25,  '63. 

man.  39th   Ind.     Disch'd  July 

September  15,  1804. 

4,  1864. 

412 

Mangan,  M.,  Lieut.,  E, 

July  2, 

Right;   flap.     Resigned  April  3, 

369 

Kyner.J.  H.,Pt.,  F,  46th 

April  6, 

Right;  flap.  Disch'd  June  30,  '62. 

Qth  Wisconsin,  age  33. 

3,  ''63. 

1864. 

Ohio. 

8,  '62. 

413 

Mann,  E.  M.,  Pt.,  llth 

May  3, 

Right.     Discharged. 

370 

Lackey,  L.,  Pt.,  A,  209th 

Nov.  17, 

Right  ;  long  post,  and  short  ant. 

New  York  Battery. 

3,  *63. 

Pennsylvania,  age  20. 

18,  '64. 

flap;  gangrene.     Disch'd  April 

414 

Manning,  W.,  Corp'l,  I, 

Aug.  16, 

Left;  flap.     Surg.  N.  Havward, 

11,  1865. 

20th  Mass.,  age  21. 

16,  '64. 

20th  Mass.     Disch'd  May  10.  '65. 

371 

Lahon.  R.  E..  Lieut.,  F, 

Aug.  30, 

.     Surg.  —  Morgan,  C.  S.  A. 

415 

Mars,    U.,  Pt.,    K,  34th 

May  2, 

Right.     Discli'd  July  17,"l863. 

23d  Georgia. 

30,  '63. 

Recovery. 

Indiana. 

2,  '63. 

(372 

Latimer,  O'.  P.,   Pt.,  E, 

Sept.  1. 

Left  ;  circ.     Surg.  C.  N.  Fowler, 

416    Martin,   A.  }!..    Pt.,  G, 

July  28, 

Left  ;  ant.  post.  llap.     To  Provost 

10.")th  Ohio,  age  29. 

1,  '64. 

105th  Ohio.    Disch'd  Mar.  7,  '65. 

17th  Ala.,  age  39. 

28."  '64. 

Marshal  Dec.  28.  1864. 

373 

Lawrence,  It.  E.,  Pt.,  F, 

June  3, 

Right;   circ.  flap.     Disch'd  May 

417    Martin,  E.T.,  l't.,B,  56th 

June  20, 

Right:  circ.    Disch'd  Mar.  31.  '65. 

81st  New  York,  age  20. 

3,  '64. 

23,  1865. 

Pennsylvania,  age  21. 

20,  '64. 

Died  Jan.  18,  '69  :  absc.  of  brain. 

374 

Laws.    B.,  Pt.,  E,   30th 

Feb.  11, 

Right;    flap.     Disch'd  Oct.   18, 

418  |  Martin.  F.,  Pt.,  H,  19th 

July  1, 

Right  ;    flap.     Disch'd   April   9, 

Col'd  Troops,  age  23. 

11,  '65. 

1865.     Died  Oct.  5,  1868. 

Massachusetts. 

2,  '62. 

1863. 

1  THOMPSON  (J .  II.),  Report  of  Cases  occurring  at  the  Battle  of  Roanokr  Island,   Virginia,  in  Am.  Mail.  Times,  Vol.  I V,  1862,  page  199. 


SECT.  V.] 


PRIMARY  AMPUTATIONS  IN  THE  LEG. 


471 


No 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

XO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

419 

Martin,  R.,  Pt.,  A,  13th 

Dee.  17, 

Left  ;  flap.  A.  A.  Surg.  J.  S.  Gilt- 

463 

Michaels,  J.,  Pt.,  A,  16th 

April  6, 

Left  ;  circ.    Surg.  G.W.  Eastman, 

Col'd  Troops,  age  40. 

17,  '64. 

iier.     Disch'd  August  12,  18fi5. 

Wisconsin. 

8,  '62. 

16th  Wis.    Disch'd  Aug.  15,  '62. 

420 

Martin,  R.,  Ft.,  \i~ih  N. 

June  20, 

Left  ;  circ.     Duty  Sept.  12,  1864. 

464 

Micue,  P.,  Pt.,  G,  34th 

Oct.  13, 

Left;    ant.    post.  flap.      Disch'd 

York,  age  24. 

21,  '64. 

Massachusetts,  age  33. 

13,  '64. 

May  20.  1865. 

4-21 

Martin,  \Y.,  Corp'l,  1,  6th 

Sept.  19, 

Left;  Surg.  —  Gardner.    Disch'd 

465 

Miles,   A.,  Pt.,  G,  15th 

Mar.  31, 

Right  ;  lateral  flap.     Discharged 

Indiana,  age  30. 

21,  '63. 

June  8,  1864. 

• 

N.  Y.  H.  Art'y.  nge  18. 

Ap.  1,'65 

August  2,  1865. 

422 

Mason,  R.  U.,  Pt.,  Ash- 

July  2, 

Right.   Confed.  surgeon.   Retired 

466 

Miles,  F.  N..  Pt.,  F,  29th 

Oct.  19, 

Left:  flap.     Disch'd  January  21, 

land's  Va.  Bat'y.age  36. 

3,  '63. 

March,  1865.  (Also  w'd  left  leg.) 

Maine. 

20,  '64. 

1865. 

423 

Mathis,   W.    M.,  Pt.,  I, 

Aug.  21, 

Right;  circular.     Transferred. 

467 

Miller,  J.  K.,  Serg't,  E, 

April  2, 

Right;  post.  flap.     Disch'd  Aug. 

1  1th  Ala.,  age  27. 

21,  '64. 

205th  Pennsylvania. 

3,  '65. 

18.  1865. 

424 

Matthews,  D.,Pt.,B,39th 

April  2, 

Left;  circ.;  gangrene.    Recovery 

468 

Miller,  W.,  Pt.,  E,  15th 

July  5, 

Right  ;  flap.    Surg.  E.  M.  Rogers, 

New  Jersey,  age  28. 

2,  '65. 

August  2,  1865. 

Iowa,  age  25. 

5,  '64. 

12th  Wis.  Must,  out  Feb.  1  1,  '65. 

425 

Matthews.  S.  J.,  Serg't, 

July  2, 

Right  ;   circ.     Paroled   Sept.  25, 

469 

Mink,  J.,  Pt.,  A,  61st  N. 

April  7, 

Right;  ant.  post.  flap.     Disch'd 

I,  9th  Ala.,  age  22. 

3,  '63. 

1863. 

York,  age  18. 

7,  '65. 

November  25,  1865. 

426 

Matthews,  T.,  Lient.,  F, 

Aug.  9, 

Left  ;  circ.     Disch'd  Dec.  29,  'b'2. 

470 

Mishaw,  E.,  Pt.,C,  118th 

Sept.  20, 

Right,     Surg.  J.  Thomas,  118th 

46th  Pennsylvania. 

11,  '62. 

Pennsylvania. 

22,  '62. 

Penn.     Disch'd  April  21,  1863. 

427 

Maxwell,  W.  E.,  Corp'l, 

May  8, 

Right  ;  flap.     A.  Surg.  J.  T.  Duf- 

471 

Mitchell,    W.,    Pt.,    K, 

June  8, 

Uight.     Disch'd  Oct.  17,  1862. 

G,  95th  N.  Y.,  age  22. 

8/64. 

field,  7th  Indiana.    Disch'd  Jan. 

27th  Pennsylvania. 

—  ,  '62. 

7,  18C5. 

472 

Mizner,  W.,  Pt.,  H,34th 

Mar.  19. 

Left  ;  circ.     Disch'd  June  16,  '65. 

428 

McCaigue,  S.  B.,  Corp'l, 

May  12, 

Left.     Surg.W.  J.  Burr,  42d  New 

Illinois,  age  21. 

20,  '65. 

H,  183d  Pennsylvania. 

12,  '64. 

York.    May  27,  amp.  knee  .joint. 

473 

Moats,  M.,  Pt.,  F,  15th 

Sept.  19, 

Right  ;  flap.     Disch'd  June  9,  '65. 

Mustered  out  July  13,  1865. 

West  Virginia,  age  24. 

19,  '64. 

429 

McCarty,  J.,  Pt.,  M,  4th 

Nov.  5, 

Left;  flap;  gangrene;  subsequent 

474 

Moffatt,   R.,    Serg't,   K, 

July  15. 

Left  ;  flap.     Surg.  F.  C.  Reamer, 

Artillery. 

5,  '64. 

operation.     Discharged. 

121st  Penn..  age  23. 

15,"  '64. 

143d  Penn.     (Also  excis.  hum.) 

430 

McOlnre,  VV.  H.,  Pt.,  A, 

July  2, 

Left;  post,  flap;  haem.     Disch'd 

Disch'd  June  29,  ]865. 

137th  N.  York,  ago  46. 

3,  '63. 

May  17,  1864. 

475 

Moneyhan,  B.  F.,  Pt.,  D, 

April  17, 

Right.    Surg.V.  H.  Coff.nan,  34th 

431 

McCluskey,  P.,   Pt.,  B, 

Dec.  13, 

Right.     Discharged   August   17, 

24th  Indiana,  age  26. 

17.  '6J. 

Iowa.     Disch'd  Sept.  12,  1865. 

69th  New  York. 

13,  '62. 

]863. 

476 

Monroe,  H.,  Pt.,  I,  20th 

June  22, 

Right;   flap;  haem.:  lig.  femoral. 

432 

McConnell,  J.  E.,Pt,  B, 

June  18, 

Left;  flap.     Surg.  J.  H.  Beech, 

Maine,  age  25. 

22,  '64. 

Disch'd  January  13.  1865.    Died 

24th  Mich.,  age  19. 

18,  '64. 

24th  Mich.     (Also  wound  right 

May  16,  1870;  phthisis  pulmo. 

leg.)     Disch'd  Sept.  12,  1865. 

477 

Mooney,  J.,  Pt.,  D,  13th 

May  10, 

Left  ;  flap.     Disch'd  May  27,  '65. 

433 

McCord,  M.  D.,  Corp'l, 

Aug.  25, 

Left;  flap.    Confederate  surgeon. 

New  York,  age  29. 

11,  '64. 

A,  4th  N.  Y.  H.  Art'y, 

27,  '64. 

Disch'd  May  20,  1865. 

178 

Moore,   C.   W.,    Lieut., 

Dec.  10, 

Left;  flap.     Mustered  out   June 

age  25. 

15th  Ohio  Battery. 

10,  '64. 

20,  1865. 

434 

McGalliard,  W.M..Cap., 

July  2, 

Right  ;  circ.     Hasmorrhage.     To 

479 

Moore,  D.,  Colonel,  21st 

April  6, 

Right.     Mustered  out   Feb.   12, 

E,  8th  La.,  age  25. 

3,  '63. 

prison  Mar.  2,  1864. 

Missouri. 

6,  '62. 

1865. 

435 

McGce,A..  Serg't,  D,  7th 

Oct.  19, 

Right  ;  post.  flap.    Ass't  Surg.W. 

480 

Moore,  D.  A.,  Capt.,  B, 

June  30, 

Right  ;  flap.    Surg.  A.  N.  Dough 

South  Carolina,  age  23. 

20,  '64. 

A.  De  Long,  77th  New  York. 

61st  New  York,  age  29. 

30,  '6-'. 

erty,  U.  S.  V.     To  V.  R.  C. 

To  Provost  Marshal  April  1,'65. 

481 

Jfoore,  J.  A.,  Pt.,  Gi  38th 

May  16, 

:  circ.     Furloughed  July  20. 

436 

McGee,  A.  S.,  Pt.,  D,  5th 

June  29, 

Right  ;    flap.      Confed.  surgeon. 

Virginia,  age  26. 

16,'  '64. 

1864. 

Vermont,  age  43. 

30,  '62. 

Disch'd  Feb.  11,  1863. 

482 

Morgan,  J.,  Pt..  K,  14Cd 

Dec.  13, 

Right  ;    flap.     Confed.   surgeon. 

437 

McGlynn,M.,  Pt.,  D,63d 

Sept.  17, 

Left.     Discharged  Dec.  30,  1862. 

Pennsylvania. 

15,  '64. 

Disch'd  June  22,  1865. 

New  York,  age  36. 

17,  '62. 

483 

Morgan,  J.,  Pt.,  B,  26th 

Oct.  19, 

Right.     Surg.  G.  McDonald,  22d 

438 

McGowan,  J.,  Pt.,C,94th 

April  2, 

Right;    circ.     Disch'd  July  27, 

Virginia,  age  21. 

19,  '64. 

Va.     To  prison  Feb.  16,  1865. 

New  York. 

3,  '65. 

1865. 

484 

Morgan,  J.  C.,  Serg't,  D, 

Mar.  31, 

Right;  oval   flap.     Surg.  D.  C. 

43!) 

McGrath,  W.,  Pt..  E,  3d 

Feb.  2, 

Right;  ant.  post.  flap.     Surg.  M. 

7th  Wisconsin,  age  25. 

31,  '65. 

Ayres,  7th  Wis.     Disch'd  July 

Rhode  Island  H.  Art'y, 

2,  '64. 

S.  Kittinger.  100th  New  York. 

20.  1865. 

age  48. 

Disch'd  Oct.  14,  '64.    Spec.  2910. 

485 

Moris,  U.,   Pt.,  K,  34th 

May  16, 

Right  ;  flap.    Disch'd  July  18,'63. 

440 

McGuire,  C.,  Corp'l,  G, 

July  1, 

Left;  flap;  haBin.     Disch'd  June 

Indiana,  age  36. 

16,  '63. 

19th  Indiana,  age  31. 

2,  '63. 

11,  1864.     Died  Feb.  7,  1870. 

486 

Morningstar,  J.  J.,  Pt., 

July  11, 

Left;  circ.    Confederate  surgeon. 

441 

Mcllane,  H.,  Major,  12th 

Nov.  30, 

Left  ;  oval  flap.    To  Pro.  Marshal 

D,  76th  I'enn. 

13,  '63. 

Disch'd  Jan.  17,  1864.  Spec.  473. 

Louisiana,  age  26. 

De.  I,'(i4. 

March  27,  1865. 

487 

Morrin.  J..  Pt,,  G,  126th 

July  3, 

Left;  post.  flap.    Surg.  J.  Aiken, 

442 

MoHenry,  U.  \V.,  1't.,  K. 

July  2, 

Right;    flap.     Disch'd  July  11, 

New  York,  age  21. 

4,  '63. 

71st  Penn.     Haem.;  amp.  thigh 

105th  Penn.,age21. 

2,  '63. 

1865. 

Nov.  3.     Disch'd  June  18,  1865. 

443 

Mclntire,  G..  Pt.,  I,  7th 

May  10, 

Right.    Surg.  F.  M.  Everleth,  7th 

Specs.  1416,  2604. 

Maine,  age  24. 

10,  '64. 

Maine.     Oct.   16,   amp.   thigh. 

488 

Morris,  A.W.,  Pt.,  B,  6th 

June  16, 

Left;  circ.     Ass't  Surg.  D.  Hal- 

Disch'd  June  16,  1865. 

Iowa,  age  21  . 

16,  '64. 

dennan,    46th    Ohio.      Disch'd 

444 

Mclntosh,    J.    B.,  Brig. 

Sept.  19, 

Right.     Retired  July  30,  1870. 

July  10,  1865. 

General  U.  S.  V. 

19,  '64. 

489 

Morrison,  A.,  Pt.,  K,23d 

July  24, 

Left  :  circ.    Discharged  March  1  . 

445 

McKalvey,   J.,   Pt.,    I). 

Mav  31, 

Left.     Discharged  June  10,  1863. 

Illinois,  age  23. 

24,'  '64. 

1865. 

10_'d  Pennsylvania,. 

31,"  '62. 

490 

Moss,  J.  E.,  Corp'l,  E, 

Nov.  25, 

Left:  flap.     Surg.  H.  McHenry, 

446 

McKenno»,  M.  J.,  1't.,  F, 

June  27, 

Right.  Confederate  surgeon.  Re- 

36th  Illinois. 

27,  '63. 

125th  Ohio.     Disch'd  Sept.  24, 

8th  (Jeorgia. 

28,  '6-i. 

covery. 

1864. 

447 

McKnight,  J.,  Pt.,  B,  2d 

Deo.  13, 

Right;  circ.     Disch'd   April  13, 

491 

Mount,  D.  M.,  Serg't,  B, 

Dee.  13, 

Right.    Mustered  out  June  5,  '63. 

Delaware,  age  45. 

14.  '62. 

1864.     Died  in  1864. 

35th  New  York. 

13,  '62. 

448 

McLaugltUn.,  A.,  Pt.,  C, 

Mar.  25, 

Left  ;  circ.    A.  Surg.  E.  P.  Roche, 

492 

Mullen,  J.,  Pt.,  C,  30th 

Get.  19, 

Right  :    flap.     Disch'd  February 

24th  X.  C..  age  17. 

25,  '65. 

35th  Mass.  Releas'd  June  14/65. 

Mass.,  age  20. 

20,  '64. 

12.  1865. 

449 

McLuughlin,  T.  A.,  Pt., 

Oct.  19. 

Left  ;  circ.     Surg.  G.  T.  Stevens, 

493 

Muller,  H.,  Pt.,  E,  45th 

June  3, 

Left  ;  ant.  post.  flap.     Surg.  11. 

K,  29th  Maine,  age  22. 

20,  '64. 

77th  N.  Y.    Disch'd  July  19,  '6.5. 

New  York. 

3,  '62. 

Ideler,  45th  N.  Y.     Discharged 

450 

McLean,  G.,  Pt.,E,  173d 

April  9, 

Right;  circ.    Disch'd  August  21, 

Nov.  1,  1862. 

New  York,  age  28. 

!),  '64. 

1864. 

494 

Muller,   M.,  Pt.,  F,  4th 

April  2, 

Left;   flap.     Disch'd   October  1, 

451 

Mc.Murtrio,    T.,   Lieut., 

Dee.  13, 

Left  ;  Hap.    Confederate  surgeon. 

N.  Y.  H'vy  Artillery. 

2,  '65. 

1865. 

12th  Pennsylvania. 

14,  '62. 

V.  R.  Corps  Oct.  18.  1863. 

495 

Mulligan,  J.,  Pt.,  E,  '5th 

Mar.  22, 

Right:  flap;  gangrene.     Disch'd' 

452 

Me  Nab,  J.  U.,  Pt.,  G,  3d 

May  10, 

Left.  Surg.D.L.Ileath,  23d  Mich. 

N.  Y.  Cavalry,  age  18. 

23,  '64. 

October  28,  1864. 

Tennessee,  age  21. 

12.  '64. 

Disch'd  July  6,  1865. 

496 

Munday,  L.    G.,   Pt.,   I, 

June  20, 

Right;  circular.    Recovery. 

453 

J/cAawiee,    G.,   Pt.,    1st 

July  1, 

Left  ;  flap.  A.  Surg.  J.  W.  Jones, 

26th  Virginia,  age  38. 

20.  '64. 

Virginia  Art'v,  age  19. 

2,  '63. 

C.  S.  A.    Retired  Sept.  28,  1  864. 

497 

Mundy,  F.  H.,Pt.,G,  83d 

Dee.  13, 

Left;    circ.:    gangrene.     Disch'd 

454 

McRay,    G.  A~,  Pt.,  G, 

April  2. 

Left.     Released  June  29,  1865. 

New  York,  age  20. 

14.  '62. 

Nov.  22.  1863 

5th  N.  C.  Cav.,  age  22. 

2,  '65. 

498 

Murray,  J.  H.,  Pt  ,  D,  2d 

May  3, 

Left;   double  flap.     Ass't  Surg. 

455 

Mmsels,  J.,  Pt..  G,  31st 

Oct.  19, 

Right;  flap.     Surg.  II.  F.  Butt, 

Vermont. 

3,  '63. 

A.  A.  Atwood,  2dVt.     Disch'd 

Georgia,  age  42. 

19,  '64. 

I'.A.C.S.     To  prison  Jan.  5,  '65. 

April  13,  1864. 

456 

Medley,  J.,  Pt.,  A,  22d 

Oct.  27, 

Right;  circ.    Mustered  out  Mar. 

499 

Myers,  H.,  Pt.,  F,  119th 

Nov.  7, 

Lett.  Surg.  P.  Lculv,  119th  I'enn. 

Col'd  Troops,  age  25. 

27,  '64. 

1H,  1S65. 

Penn.,  nge  39. 

7,  '63. 

Disch'd  June  27,  1864. 

457 

Meekins,  J.  D.,   Pt.,  E, 

June  3, 

Left:  circ.    Surg.  J.  W.  Wishart, 

500 

Neal,  T.,    Pt.,    C,   28th 

May  15, 

Left  ;  flap.     Disch'd  Oct.  3,  1863. 

]-18th  Penn..  age  23. 

3,  '64. 

140th  Penn.  Disch'd  May  29,  '65. 

Iowa,  age  19. 

15,'  '63. 

458 

Merry,  T.  a.,  Ft.,  E,  4th 

May  3, 

Left  ;  flap.     Transferred  Sept.  8, 

501 

Neff,  J.,  Corp'l,  B,  25th 

Mav  16. 

Right;    circ.      Confed.    surgeon. 

North  Carolina,  nge  20. 

3,  '63. 

1863. 

Mass.,  age  25. 

18,"  '64. 

Disch'd  Sept.  6,  1865. 

459 

Messmore,  J.,  Pt.,I),10th 

May  19, 

Right  ;  ant.  post.  flap.     Disch'd 

502 

Newton,  W.   J.,  Lieut., 

May  3, 

—  .   Surg.W.  A.Spence,C.S.A. 

Infantry,  age  22. 

19,  '64. 

April  8,   1865.     Died   May  27, 

K,  40th  Virginia. 

3,  '63. 

Recovery. 

1871  ;  epilepsy  and  oonsumpt'n. 

503 

Nicholson,  J.,  Pt.,  C,  8th 

Aug.  20. 

Left;    lat"  skin   flap.     Surg.    A. 

400 

Meyer,  P.,  Serg't,  A,  16th 

Aug.  24, 

Right;    flap.     'Disch'd  Jan.   13, 

N.  Y.  Cavalry,  age  47. 

20,  '64. 

Hard.  8th  Illinois  Cav.    Disch'd 

Indiana,  age  26. 

24,  '64. 

1865.     Died  Dec.  4,  1868. 

Nov.  19,  1864. 

461 

Meyers,  J.,  Pt.,   E,  5th 

July  3, 

Left.     Disch'd  December  13,  '63. 

5C4 

Nimoeks,  R.  J.,  Pt.,  B, 

July  22, 

Right;   circ.     Disch'd  June  30, 

New  Jersey,  age  36. 

3,  '63. 

25th  Wis.,  age  44. 

23,'  '64. 

1865. 

462 

Meyers,  W.,  Pt.,  G,  2d 

Aug.  30, 

Left.     Disch'd  November  13,  '62. 

505 

Nolan,   K.,   Pt.,  K,  22d 

Mav  17, 

Right;    circ.     Disch'd   Feb.    13. 

Infantry. 

31,  '62. 

Indiana,  age  20. 

17,"  '64. 

1865.     Died  May  26,  1867. 

472 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


(CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
KF.SULT. 

:NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

506 

Norton,  E.  D.,  Corp'l,  I, 

June  17, 

Left  ;  post.  flap.    Disch'd  Nov.  26, 

549 

Platz,  A.,  Musician,  A, 

May  22, 

R't  ;  flap.     A.  Surg.  J.  C.  Norton, 

llth  Conn.,  age  21. 

19,  '64. 

1864. 

19th  Infantry,  age  18. 

22,  '64. 

U.  S.  V.    Disch'd  Jan.  17,  1865. 

507 

Norton,  J.,  Seaman.  U.S. 

July  9, 

Left.     Surg.  —  Johnson,  U.  S.  N. 

550 

Popp,  M.,  Pt.,  E,    55th 

May  22, 

Left  ;  flap.     Disch'd  Sept.  26,  '63. 

S.  Montaiik,  agp  25. 

9,  '64. 

Disch'd  Oct.  24,  1864. 

Illinois. 

22,  '63. 

Died  June  13,  1874. 

508 

Novell,  W.    W.,  Corp'l, 

May  31, 

Right.     Surg.  J.  M.  Holloway, 

551 

Porter,   H.,  Pt.,  G,  13th 

July  1, 

Left  ;  circ.   July  30,  re-amputat'n. 

F,  49th  Va.,  age  22. 

J'e  1,'62. 

C.  S.  A.     Retired  Mar.  15,  1865. 

Massachusetts. 

2,  '63. 

Disch'd  Jan.  30,  1864. 

509 

O'Brien,  J.,   1't.,  A,  7th 

May  22, 

Right  ;  eirc.     Disch'd  June  4,  '64. 

552 

Pyle,  J.  M.,  Pt.,  H,  89th 

May  18, 

Right;    flap.     Disch'd   May  21, 

Missouri. 

22,  '63. 

Indiana,  age  24. 

18,"  '64. 

1865. 

510 

O'Brien,  M.,  Pt.,  E,  2d 

Aug.  9, 

Right.     Surgeon  E.  McDonnell. 

553 

Rabbidan,  L.,Pt.,F,  14th 

June  23, 

Right;  flap.  Surg.  H.  McKennan, 

Massachusetts,  age  26. 

11,  'ti2. 

U.  S.  V.     Disch'd  Dec.  6,  1862. 

Wisconsin,  age  21. 

23,  '64. 

17th  Wis.     Disch'd  Sept.  1,  '65. 

511 

Ogden,  M.   H.,  Pt.,  H, 

June  18, 

Left  ;  flap.     Disch  'd  July  21  ,  '65. 

554 

Radichel,  C.,  Pt.,  F.  6th 

Feb.  5, 

Right.     Disch'd  August  23,  1865. 

1,8th  I'enn.,  ago  21. 

18,  '64. 

Wisconsin,  age  40. 

7,  '65. 

512 

Ohm,    F.,  1't.,  O,    37th 

April  2, 

Left  ;  flap.  Surg.W.  C.  Sum-lock, 

555 

Rady,  D.,  Colored. 

May  14, 

Left.     Recovery.     Spec.  1809. 

Wisconsin,  age  40. 

2,  '65. 

51st  Penn.     Disch'd  Sept.  7,  '65. 

14,'  '63. 

513 

Oliver,  J.  W.,  Corp'l,  D, 

May  3, 

Left;  flap.     Furloughed. 

556 

Ralston,  R.,  Musician,  C, 

Oct.  26, 

Right;  flap.   Surg.  A.T.  Hudson, 

12th  Georgia,  age  21. 

3,  '63. 

26th  Iowa,  age  22. 

26,  '63. 

26th  Iowa.  Disch'd  June  25,  '64. 

514 

O'Neil,  J.,  Pt.,  0.  28th 

Sept.  17, 

Left.    Surg.  II.  E.  Goodman,  28th 

557 

Ralyea,  A.,  Pt.,  G,  147th 

Feb.  6, 

Left;  ant.  post.  flap.    Surg.  A.  S. 

Pennsylvania: 

17,  '62. 

Penn.     Disch'd  Nov.  15,  1862. 

New  York,  age  25. 

6,  '65. 

Coe,  147th  New  York.     Disch'd 

515 

Opperman.  P.,Pt.,E,  6th 

Aug.  16, 

Right;  flap.    Surg.  B.  E.  Osborn, 

June  14,  1865. 

Missouri  Cavalry. 

17,  '62. 

1st  Mo.  S.  M.  Cav.  Disch'd  Jan. 

558 

Rauscher,  C.,  Pt.,  B,  42d 

Aug.  15, 

Left;  flap.  Disch'd  April  5,  1865. 

9,  1863. 

Indiana,  age  26. 

15,  '64. 

516 

Ormsby,  S.  S.,  Corp'l,  K, 

June  18, 

Right;  cire.     Surg.  W.  C.  Shur- 

559 

Rawls,    H.,   Pt.,  D,  2d 

Aug.  31, 

;  anterior.     Ass't  Surg.  F.  R. 

50th  Penn.,  age  26. 

19,  '64. 

lock,  51st  Penn.     Disch'd  May 

Georgia. 

31,  '62. 

Gregory,  C.  S.  A.     Recovery. 

29,  1865. 

560 

Read,  C.  A.,  Serg't,  A, 

Sept,  13, 

Right;  flap.    Surg.W.  H.Wilbur, 

517 

Osborn,  J.  H.,  Serg't,  I, 

June  29, 

Left;circ.  A.  Surg.O.H.  Adams, 

1st  Mass.  Cav.,  age  24. 

13,  '63. 

1st   R.  I.  Cav.     Disch'd   April 

8th  N.  Y.  Cav.,  age  24. 

29,  '64. 

8th  N.  Y.  C.    M.  O.  June  7,  '65. 

16,  1864. 

:,;,- 

O'Shaughnessy,  J.,  Pt., 

Jan.  1, 

Right;  circ.     Surg.  A.  I.  Cum- 

561 

Reeh,  F.,  Pt.,E,  2d  Dela 

May  10, 

Right;   flap.     Surg.  J.  W.  Wis- 

P,  42d  Mass. 

3,  '63. 

ming,  42d  Mass.    Discharged. 

ware,  age  21. 

10,  '64. 

hart,  140th  Penn.     Mustered  out 

519 

O'Sullivan,   D.,   Corp'l, 

July  2, 

Right;  circ.    A.  Surg.  C.Wagner, 

June  3,  1864. 

F,  3d  Infantry,  age  28. 

2,  '63. 

U.  S.  A.     Disch'd  Jan.  8,  1864. 

562 

Redman,  T.,  Serg't,  K, 

July  10, 

Right  ;  post.  flap.    Veteran   Re 

Spec.  4375. 

5th  Cavalry,  age  26. 

10,'  '63. 

serve  Corps  Oct.  30,  1863. 

520 

Overman,  A.  A.,  Serg't, 

May  19, 

Left;  flap.     Disch'd  August  10, 

563 

Reeder,G.W".,Pt.,  B.llth 

May  5, 

Left  ;  circ.    Surg.  J.W.  Anawalt, 

A,  93d  Indiana. 

19,  '63. 

1863.                                                || 

Penn.,  age  31. 

5,  '64. 

1  1th  Penn.   Disch'd  A  ug.  16,  '64. 

521 

Sept.  17, 

Rifjlit  •  circ.     Discli'tl  DecGrnbGi* 

564 

Reeves,  J.  H.  Pt.  G  39th 

MIX'    Ifl 

I  oit  •  fl'in     Sure               C  S    \- 

Purnell  Legion. 

17,  '62.' 

6,  1862. 

Illinois,  age  24. 

»v    J  "» 
18,  '64. 

Dis'ch'd  March  19,  1865. 

522 

I'aden,  P.,  Fireman,  U.S. 

Mar.  28, 

Right  ;  post.  flap.    Surg.  —  Ellis, 

565 

Refolt,   E.,  Pt.,  G,  22d 

Oct.  9, 

Right;  flap.    Disch'd  Feb.  28,  '63. 

Gunboat  Diana. 

30,  '63. 

U.  S.  N.     Disch'd  Dec.  31,  1863. 

Indiana. 

10,  '62. 

Died  April  16,  '64;  small-pox. 

523 

Paliu,  R.  D.,  Pt.,  B,  9th 

June  8, 

Left  ;  post.  flap.     Surgeon  S.  A. 

566 

Reider,G.W.,Pt..C,14th 

May  24, 

Right;    circ.;    erysipelas;    gang. 

N.Y.  H'vy  Art.,  age  26. 

8,  '64. 

Sabin,  9th  N.  Y.     Disch'd  Jan. 

Infantry,  age  34. 

24,  '64. 

Disch'd  March  6,  1866. 

20,  1866. 

567 

Reiff,  E.,"Pt.,  A,  12th  In 

July  2, 

Left  ;  circular.     Discharged. 

524 

Parker.  B.,  Pt.,  G,  2d 

July  3, 

Rigiit.     Paroled  Nov.  12,  1863. 

fantry,  age  19. 

3,  '63. 

South  Carolina,  age  27. 

3,  '63. 

568 

Reiley,  J.,  Pt.,  C,  7th  N. 

June  17, 

Left  ;  lat.  flap.     Surg.  J.  W.  Wis- 

525 

Parker,  C.,  Pt.,  C,  150th 

July  1, 

Right;   ant.  post.  flap.     Disch'd 

York  Heavy  Artillery, 

18,  '64. 

hart,  140th  Penn.     Disch'd  Mav 

Penn.,  age  23. 

1,  '63. 

January  29,  1864. 

age  29. 

16,  1865.    Died  Feb.  14,  1876; 

526 

Parker,  C.W.,Pt.,D,13th 

Sept.  30, 

Left.    Discharged  June  21,  1865. 

consumption. 

New  Ilamp.,  age  21. 

30,  '64. 

569 

Restle,  M.,  Serg't,  G,52d 

Feb.  3, 

Left  ;  long  post,  and  short  anterior 

51-7 

Parker,  £/.,  Pt.,  H,  44th 

May  2. 

;  circ.     Transferred  May  26,  '  j 

New  York,  age  28. 

3   '65. 

flap.    Disch'd  Dec.  1,  1865. 

Georgia,  age  21. 

3,  '63. 

1863. 

!  570. 

Reynolds,  J.  S.,  Lieut., 

May  28, 

Left;  circ.     Surg.  11.  K.  Clark, 

5^8 

I'arkes,  J.  M.,  Serg't,  B, 

July  20. 

Left  ;  ant.  post.  flap.     Surg.  J.  H. 

H,  10th  N.  Y.  Cavalry, 

29,  '64. 

10th  N.  Y.  Cav.     Disch'd  Sept. 

20th  N.  C.,  age  27. 

21,  '64. 

Ayers,  34ih  Ohio.     To  Provost 

age  38. 

8,  1864. 

Marshal  Nov.  1,  1864. 

571 

Rice,  F.R..  Lieut.,  F.lst 

Dec.  13, 

Left  ;  flap.   Surg.  D.  P.  Chamber- 

529 

Pnrlon.A.  B.,  Pt.,G,193d 

Oct.  14, 

Right  ;  flap.  A.  Surg.  L.  Phinney, 

Michigan. 

13,  '62. 

lin,  4th  Michigan.    Veteran  Re 

New  York. 

14,  '65. 

193d  N.  Y.     Discharged. 

serve  Corps  July  2.  1863. 

530 

Parmenter,  J.,  Capt.,  E, 

June  3, 

Right  ;  ant.  skin  flap.    A.  Surg.  J. 

572 

Rider,  J.  A.,  Pt.,  A,  4th 

May  3, 

;  circ.     Surg.  —  Walls,  C.  S. 

118th  N.  Y.,  age  42. 

3,  '64. 

G.  Portcous,118th  N.Y.  Disch'd 

Virginia,  age  30. 

4,  '63. 

A.     Nov.  12,  1877;  good  stump. 

Nov.  15,  1864. 

573 

Riley,  J.,  Ordinary  Sea 

Jan.  15, 

Right.     Disch'd  July  14,  1865. 

531 

Paxton,    J.  T.,  Pt.,  H, 

Mar.  27, 

Right  :  circ.    Surg.  P.  Harvey,  IT. 

man,  U.  S.  S.  Wabash. 

16,  '65. 

I'.'th  Iowa,  age  21. 

27,  '65. 

S.  V.     Must,  out  July  10,  1865. 

574 

Roberts,  G.  W.,  Pt.,  B, 

July  1, 

Right;  circular.     Ass't  Surg.  J. 

r.32 

Peet,  G.  W.,  Serg't,  A, 

Dec.  13. 

Left.     Discharged  March  8,  1863. 

1st  Maryland  Artillery, 

1,  '62. 

S.  O'Donncll.  Purnell  Legion. 

SUthN.Y.  S.  M.,  age  26. 

13,  '62. 

age  16. 

Disch'd  May  18.  1863. 

533 

Pels,  A.,  Pt.,  B,  4th  New 

June  37, 

Right;    circ.     Diseh'd  Sept.  28,  1  575 

Roberts,    H.,  Lieut.,  H, 

Aug.  29, 

Left  ;  circ.    A.  Surg.  T.  F.  Oakes, 

York  Artillery,  age  29. 

19,  '64. 

1864. 

1st  Massachusetts. 

29,  '62. 

1st  Mass.     Digch'd  Feb.  5,  1864. 

534 

Penninyton,  J.  i'..Pt.,D, 

May  3. 

Left  :  flap.     Transferred  May  24, 

576 

Roberts,  J.  B.,  Corp'l,  K, 

Mar.  19, 

Left  ;  oblique  flap.     Confederate 

26th  Alabama,  age  18. 

4,  '63. 

1863. 

88th  Indiana,  age  31. 

20,  '05. 

surgeon.    Gangrene.    Mustered 

535 

Perkins,  M.V.  15.,  Corp'l, 

July  18. 

ll't;  circ.  A.  Surg.  F.  15.  Kimball, 

out  June  7,  1805. 

F,  7th  New  Hampshire. 

20,  '63. 

3d  N.  11.     Disch'd  Nov.  14,  '63. 

577 

Roberts,  M.,  Pt.,  H,  21st 

April  1, 

Right;  double  flap.     Discharged 

530 

Perry,  A.,  Pt.,  C,  44th 

Dec.  13, 

Left  ;  flap.     Disch'd  Feb.  28,  '63. 

'  N.  Y.  Cavalry,  age  18. 

3,  '65. 

September  14,  1865. 

New  York. 

13,  '62. 

578 

Robinson,  J.  B.,  Lieut., 

May  12, 

Right;  ant.  post.  flap.     Surg.  C. 

537 

Peters,  A.,  Pt.,  E,  37th 

June  17, 

Left  :  circ.    Surg.  W.C.  Shurloek, 

C,  2d   Penn.  Reserves, 

12,  '64. 

Bowers.  6th  Penn.  Ites.    Disch'd 

Wisconsin,  age  37. 

18,  '64. 

51st  .  Penn.    Gangrene.    Disch'd 

age  32. 

June  16,  1864.     Spec.  4511. 

May  23,  1865.     Spec.  3129. 

579 

Robinson,  W.,Pt.,  D,  82d 

May  10, 

Right;  circ.     Surg.  S.  11.  Plumb, 

538 

Peters,  S.,  Pt  ,  C,  139th 

Sept.  21, 

Left  ;  ant.  post.  flap.    Discharged 

New  York,  age  41  . 

11,  '64. 

82d  N.  Y.     Disch'd  Nov.  10,  '64. 

Pennsylvania,  age  19. 

21,  '64. 

June  6,  1865. 

Spec.  4372. 

539 

PctcrsJMd,  W.  J.,  Pt.,C, 

Nov.  30, 

Right  ;  circ.     Surg.  —  Hamilton, 

580 

Rodrjers,   T.  J.,  Pt.,  D, 

July  3, 

Right.      Confed.   surgeon.      Ex 

1st  Alabama,  age  21. 

Dec.  2. 

1st  Ala.     To  Provost  Marshal 

50th  Georgia. 

3,  '63. 

changed  March  17,  1864. 

1864. 

May  (i.  1865. 

581 

Rodgers,  W.  H.,  Corp'l, 

May  5, 

Right  ;  flap.     Surg.  LeG.  Capers, 

540 

Pe.llirjrr.ui,    F.,    Pt.,    K, 

June  1, 

Right  ;  cire.     Retired  Jan.  18,'65. 

A,  146th  N.  Y.,  age  38. 

6,  '64. 

C.  S.  A.     Disch'd  Nov.  19,  1864. 

13th  North  Carolina. 

1,  '64. 

582 

Ross.  I.  C.,  Pt.,  F,  15th 

Nov.  25. 

Left;  circular  flap.     Surg.  H.  E. 

541 

Petty,  G.  B.,  Corp'l,  E, 

June  29, 

Right  ;    flap.     Confed.   surgeon. 

Indiana,  age  29. 

27,  '63. 

Ilasse,  24th  Wisconsin.   Disch'd 

5th  Vermont. 

30,  '62. 

Disch'd  Jan.  31,  1863. 

April  21,  1864. 

540 

Phillips,  I}.  F.,  Captain, 

Nov.  30, 

Right  ;  fire.    To  Provost  Marshal 

583 

Rosselit,  M.,Pt  ,F,  118th 

Dec.  29, 

Left.    Surg.J.  W.Alexander,  lf>ih 

ago  29. 

De.  1,'C4. 

April  6,  1865. 

Ohio,  age  25. 

30,  '63. 

Penn.  Cav.  Disch'd  Nov.  2J,'64. 

543 

Phittips.J.J.,  Serg't,  II, 

May  15, 

Right:  ant.  post.  flap.     A.  Surg. 

Died  Julvll,'71;  tuber.  disease. 

3:'d  Tennessee,  age  32. 

17,  '64. 

H.  E.  Goodman,  U.  S.  V.     To 

584 

Rouischkolb,  F.,  Pt.,  E, 

Sept.  17, 

ll't  ;  lat.  flap.     Surg.  C.  S.  Wood, 

Provost  Marshal  Dec.  1,  1864. 

66th  New  York,  age  4  1  . 

17,  '62. 

With  New  York.     Disch'd  Dec. 

544 

Pidgeon,  J.,  Pt.,  G,  22d 

Sept.  18, 

Right;  flap.    Disch'd  May  22,'65. 

31,  1862. 

Colored  Troops,  age  38. 

20,  '64. 

585 

Rouse,  T.  D.,  Pt.,  F,  2d 

July  2, 

Right.     Exchanged  Nov.  12,  '63. 

545 

Tierce,  D.  M.,  Pt.,  A,  4th 

June  1  8, 

Right;    circ.     Disch'd  May  12, 

North  Carolina,  age  20. 

2,  '03. 

Delaware,  age  19. 

18,  '64. 

1864. 

586 

Rudrauff,  W.  H.,  Lieut., 

June  1, 

Left;    circ.     Surg.  L.   Emanuel, 

546 

Pierce,  W.,  Lieut.,  Aus 

Sept.  20, 

Right.     Surg.  —  Kratty,  C.  S.  A. 

F,  82d  Penn.,  age  24. 

1,  '64. 

82d  Penn.    Disch'd  Sept.  2;!.'04. 

tin's  Sharpshooters. 

2(1.  '6:i. 

Recovery. 

587 

Russell,  E.  M.,l't.,A,  1st 

Sept.  14. 

Left.     Disch'd  November  ?9,  '62. 

547 

Pike,  H.  L.,  Lieut.,  Bat 

May  5, 

Left.     Surg.  St.  John  W.  Mintz- 

Penn.  Reserves. 

14,  '62. 

tery  H,  1st  Artillery. 

5,  '62. 

ner,  26th  Penn.     Retired   Feb. 

588 

Russell.  J.  IL.Pt.  ,15,29th 

Oct.  27, 

Right  ;  flap.    Surg.  A.  C.  Barlow, 

21,  '67.     Died  March  25,  1875. 

Connecticut,  age  20. 

28,  '04. 

62d  Ohio.     Disch'd  May  16,  '65. 

548 

Plant,  U.,  Pt.,  I),  7th  In 

Dec.  13, 

Left.    Disch'd  September  8,  1865. 

589 

Russell,  P.  A.,  Corp'l,  G, 

June  18, 

Left;  flap.     Discharged  Nov.  4, 

fantry,  age  19. 

14,  '62. 

89th  New  York,  age  24. 

18,  '64. 

1PC4. 

SECT.  V.) 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


473 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

590 

Ruth,  R.  A.,  Pt.,  E,  59th 

June  2, 

Right;   flap.     Disch'd   June   13, 

630 

Smith,   J.,   Pt.,   C,  22d 

June  27, 

Right  ;  post.  flap.    A  .  Surg.  S.  A  . 

Massachusetts,  age  19. 

4,  '64. 

1865. 

Indiana,  age  22. 

27,  '64. 

Simpson,   52d    Ohio.     Disch'd 

591 

Ryan,    J.,   Pt.,   E,    10th 

Sept.  19, 

Left  ;  circ.  Surg.  I.  Moses.U.S.V. 

June  20,  1865. 

Wisconsin,  age  23. 

21.  '63. 

Disch'd  Sept.  30,  1864. 

631 

Smith,  J.,  Pt.,  C,   69th 

May  16, 

Left;  flap.     Surg.  J.W.Wishart, 

592 

Sampson,  C.  H.,  Serg't, 
A,  3d  Maine,  age  30. 

July  1, 
1,  '62. 

Right  ;  flap.     Disch'd  Dec.  4,  '62. 
Died   Jan.  28,  1*70;   effects  of 

632 

New  York,  age  24. 
Smith  J.  B.,  Pt.,  H,  9th 

16,  '64. 
July  13, 

140th  Penn.  Disch'd  Mar.10,'05. 
Right  ;  flap.     Discharged. 

sunstroke. 

Michigan. 

14,"  '02. 

593 

Sanders,  J.  A.,  Corp'l,E, 

Aug.  21, 

Left;  flap.     Exchanged. 

633 

Smith,  J.  L.,  Lieut.,  F, 

June  27, 

Left.     Resigned  March  7,  180!!. 

7th  S.  C.  Bat'  y,  age  30. 

21,  '64. 

4th  Michigan. 

28,  '62. 

594 

Santy,  J.,  Pt.,    C,   91st 

Oct.  6, 

Left  ;  flap.     Surgeon  J.  M.  Leet, 

634 

Smith,  J.  R.,  Pt.,  C,  14th 

July  1, 

Right.     Surg.  J.  J.  Knott,  I'.  A. 

Ohio,  age  21. 

7,  '64. 

U.  S.V.     Disch'd  May  20,  1805. 

South  Carolina. 

2,  m 

C.  S.     Recovery. 

595 

Saul,   F.,  Pt.,  G,   183d 

June  16, 

Right;  circ.  Surg.  J.W.Wishart, 

035 

Smith,  P.,  Pt.,  K,  12th 

April  7, 

Left.     Surg.  H.  Wardner,  U.S.V. 

Pennsylvania,  age  21. 

17.  '64. 

HOthPenn.  Disch'd  Apr.  27,  '65. 

Illinois,  age  42. 

7,  '62. 

Disch'd  August  1.  1802. 

596 

Saxon,  T.  If.,  Pt.,  E,  4th 

May  3, 

;  ant.  and  post.  flap.     Rapid 

636 

Smith,  V.,  Pt.,  E,  49th 

Dec.  £8, 

Left;    flap.     Disch'd  March  29, 

North  Carolina,  age  20. 

3,  '63. 

ly  improving. 

Indiana. 

28,  '62. 

1863. 

597 

Scott,  J.  G.,  Pt.,  D,  77th 

May  6, 

Left  ;  circ.  (also  amp.  right  at  low. 

637 

Smith,  W.,  Pt.,   H,  93d 

Sept.  22, 

Left  ;  ant.  post.  flap.     Recovered 

New  York,  age  23. 

6,  ''64. 

third).     Surg.    E.  B.  P.  Kelly, 

Pennsylvania,  age  23. 

22,  '64. 

Nov.  27,  1864. 

95th  Penn.     Disch'd  Nov.  3,  '64. 

638 

Smith,  W.  D.,  Serg't,  D, 

July  2, 

Left  :  flap.  A.  Surg.C.  Bacon,  jr., 

Spec.  513. 

6th  N.  Jersey,  age  35. 

3,  '63. 

U.  S.  A.    Disch'd  Nov.  21,  1803. 

598 

Scott,  O.  D.,  Pt,,  F,  17th 

June  7, 

Right  ;  ant.  post.  flap.     Disch'd 

639 

Smith.  W.  H.,  Pt.,  F,  4th 

May  5, 

.     Surg.  W.  P.  Young,  4th 

Vermont,  age  21. 

7,  '64. 

May  18,  1805. 

Georgia. 

5,  '"64. 

Georgia,     Recovery. 

599 

Scroggs,  W.,  Pt.,  I,  39th 

Juno  18, 

Right  ;    flap.      Provost   Marshal 

640 

Smith,  W.   N.,    Pt.,  H, 

Aug.  12, 

Right  ;  ant.  post.  flap.     Assistant 

North  Carolina,  age  19. 

19,  '64. 

October  21.  1864. 

52d  Penn.,  age  19. 

12,  '64. 

Surg.   J.   Flowers,   5Cd    Penn. 

600 

Scroth,  J.,  Serg't.C,  19th 

May  14, 

Left:    circ.    Disch'd  November 

Disch'd  Nov.  14,  1864. 

Infantry,  age  24. 

14,  '04. 

10,  1864. 

641 

Smith,    W.  P.,   Pt.,  1st 

July  2, 

Right.     Surg.  —  Jones,  C.  S.  A. 

601 

Seaman,'  \V.  P.,  Pt.,  C, 

Aug.  14, 

Right  ;  flap.    Disch'd  October  1  0, 

Richmond  Howitzers. 

3,  '03. 

Disch'd  Feb.  18,  1864. 

llth  Missouri. 

14,  '62. 

1802. 

042 

Snarr,  P.  H.,  Lieut.,  B, 

Sept.  19, 

Left.     Exchanged  November  22, 

602 

Seaver.C.  E.,  Pt.,  1,  13th 

July  3, 

Right:  flap.     Surg.  G.   Nichols, 

18th  Va.  Cav.,  age  33. 

20,  '64. 

1864. 

Vermont,  age  28. 

4,  '"03. 

13th  Vt.     Disch'd  Nov.  7,  1803. 

043 

Snodgrass,  J.  ^4.,Pt.,  F, 

Jan.  10, 

Right.     To  prison  May  4,  1863. 

603 

Secor,  J.  S.,  Pt,,  A,  9th 

Oct.  19, 

Right;    flap.     Disch'd  June   29, 

6th  Texas. 

10,  '63. 

N.Y.  H'wArt.,  age  19. 

20,  164. 

1865. 

644 

Snyder,  J.,  Pt.,  B,  4th  N. 

Aug.  25, 

Left;  single  flap.     Disch'd  Feb. 

604 

Segar,   E.,'  Pt.,   K,    22d 

April  29, 

Left  ;  anr.  posterior  flap.   Surg.  J. 

Y.  H'vv  Art'y,  age  48. 

26,  '64. 

7,  1865. 

New  York,  age  21. 

Majrl, 

Ebersoie,  19th  Indiana.  Disch'd 

645    Snyder,  J.,  Pt.,  G,  149th 

May  10, 

Right  ;  flap  (amp.  left  leg,  lower 

1863. 

Nov.  19,  1864.     Spec.  1146. 

Pennsylvania,  age  19. 

11,  ''04. 

third).     Disch'd  July  21,1865. 

605 

Seiforth,  M.,  Pt.,  1,  124th 

Mar.  10, 

Left;    post.  flap.      Surg.  V.  H. 

646 

Southard,  S.  M.,  Pt.,  I, 

July  3, 

Left;    ant.  post.  flap.     Surg.  O. 

Indiana,  age  17. 

10,  '65. 

Gregg,  124th  Indiana.    Disch'd 

14th  Vermont,  age  33. 

3,  '63. 

Munson,  108th  N.  Y.    Disch'd 

June  30,  1805. 

Dec.  2,  1864. 

606 

Sellers,  J.  B.,  Pt.,  I,  27th 

May  25, 

Left  ;  circular.     Discharged. 

647 

Spare,  A.,  Pt.,  K,  187th 

June  18, 

Left  ;  flap.    Disch'd  Jan.  13,  '65. 

Indiana,  age  21. 

26,  '64. 

Penn.,  age  37. 

19,  '64. 

007    Shanger,  A.,  Serg't,  B, 

July  2, 

Left.     Disch'd  June  4,  1&04. 

648    igpath.  J.  F.,  Serg't,  1st 

Sept,  17, 

Right  ;  posterior  flap. 

86th  New  York,  nge  31. 

2,  '63. 

Louisiana,  age  20. 

18,  '62. 

(508    Shappee,  W.  A.,  Ft,,  A, 

April  6, 

Right;    flap.     Disch'd   June   C8, 

649    Spenard,  B.,  Pt.,  G,  llth 

Oct.  19, 

Right;  ant.  post,  flap.     Surg.C. 

81st  Pennsylvania. 

8,  '05. 

1865. 

Vermont,  age  21. 

19,  '64. 

B.  Park,   llth   Vermont.     Dis 

609  :  Sharp,  W.  II.  11.,  Serg't, 

Mar.  10, 

Left  ;   ant.  post.  flap.     Surg.  C. 

charged  July  21,  1865. 

L,  9th  Penn.  Cavalry, 

16,  '65. 

Helm,  92d  Illinois.    Discharged 

650    flpence,  J.  D.,  Corp'l,  C, 

Oct.  19, 

Right  ;  posterior  flap.    Surg.  J.  G. 

age  24. 

Sept.  12,  1865. 

3d  S.  Carolina,  age  20. 

20,  '64. 

Hardy,  6th  N.  C.     To  Provost 

610 

Shaw,    J.,  Pt.,   C,    19th 

July  3, 

Right.     Surg.  N.  Hay  ward,  20th 

Marshal  April  8,  1865. 

Maine,  age  28. 

4,  "63. 

Mass.     Disch'd  Feb.  8,  1865. 

651  ,  Spencer,  M.  L.,  Pt.,  K, 

Jaly  30. 

Right;  circ.     Disch'd  March  27, 

61  1    Sheehan,  M.,Pt.,  11,100th 

July  18,     Right:  ant.  post.  flap.     Assistant 

4th  Kentucky,  age  24. 

A  u.l.  '64. 

1865. 

New  York. 

18,   63. 

Surg.  W.  D.  Murray,  100th  N.Y. 

052 

Sperry,  E.  F.,  Pt.,  B,  3d 

April  6, 

Right;  flap.    Disch'd  August  4, 

Disch'd  Feb.  3.  1804. 

Iowa,  age  20. 

7,  '62. 

1862. 

612 

Shephard,-G.,  Pt.,  K,  3d 

Oct.  19, 

Right  ;  flap.     Disch  d  September 

053 

Sprague,  O.,  Pt.,  B,  9th 

Sept.  29, 

Left  ;  ant.  post.  flap.    Discharged 

Vermont,  age  32. 

19.  '64. 

1.  1805. 

Vermont,  age  18. 

30,  '64. 

Sept.  6,  1865. 

013 

Shields,  T.,  Pt.,  G,  62d     May  3, 

Left  ;  post.  flap.     Discharged. 

054 

Sprowl,  T.  J.,  Corp'l.C, 

May  12, 

Left;  flap.    Disch'd  Jan.  15,  1865. 

New  York.                          3,  '63. 

12th  N.Jersey,  age  19. 

12,  '64. 

614    Shoals,  J.,  Corp'l.C,  27th     Mar.  8, 

Left;  flap.    Confederate  surgeon. 

055 

Starin,  P.  D.,  Pt.,  H,  43d 

Nov.  5, 

Right  ;  flap  (amp.  left  leg,  lower 

Mass.,  age  1!).                     10,  '65. 

Disch'd  Sept.  4,  186."). 

Wisconsin,  age  19. 

5,  '64. 

third).     Disch'd  July  2,  1865. 

615    Sibley,   R.,  Pt.,   E,    Oth  :  Aug.  31, 

Right;    circ.      Disch'd  July   15, 

656 

Stebbins,  M.  M.,  Serg't. 

Sept.  19, 

Left;  posterior  flap.     Surg.  J.  G. 

Missouri,  age  27.                31,  '04. 

1805. 

|     K,  26th  Mass.,  age  23. 

19,  '64. 

Bradt.  20th  Mass.   Disch  d  July 

616    Siegrist,  J.  E.,  Serg't,  C,     Sept.  17, 

Left  ;  flap.     Disch'd  Feb.  17,  '63. 

3,  1865. 

7th  Pennsylvania.              17,  '62. 

657    Steineman,   J.,    Pt.,   K.    Aug.  31, 

Right  ;  flap.   A.  Surg.  C.  B.  Rich 

617    Simmons,  if.  IT.,  Capt.,     July  2, 

Right;  circ.  Surg.  —  Hill.C.S.A. 

i     37th  Ohio,  age  19. 

31,  '64. 

ards.  30th  Ohio.     Disch'd  May 

F,  2d  Miss.,  age  24.             2,  f03. 

Hrem.;  lig.  fein.     Provost  Mar 

18,  1865. 

shal  March  17,  1864. 

658    Steingraber,  W..  Pt.,  E, 

July  22, 

Left;  lateral  flap.     Disch'd  July 

018    Simmons,  W.  S.,  Lieut..     Feb.  20, 

Left  ;  post.  flap.     A.  Sure.  II.  C. 

25th  Iowa,  age  20. 

23,"  '64. 

12,  1865. 

A,  5th  Colored  Troops,  !   20,  '65.        Merry  weather,5th  Col'd  TrA>ps. 

651)    Steinwater,  J.,  Pt.,  Pur- 

Aug.  30, 

Right,     Disch'd  August  14,  1863. 

619 

age  24. 
Sine.  J.  F.,  Pt.,  G,  90th    Dec.  13, 

Disch'd  May  15.  1865. 
Left;    flap.    'Disch'd   April   15, 

cell's  Battery.Virgiuia. 
600    Stephens,  J.,  Serg  t,  K, 

30.  '02. 
Sept.  20, 

Left;  flap.    Confederate  surgeon. 

Pennsylvania. 

14,  '62. 

1863. 

19th  Illinois,  age  25. 

21,  '03. 

Disch'd  June  24.  1864. 

620 

Singleton.  J.  R.,S'g't,  M, 

Sept.  19, 

Left  ;  ant.  post.  flap.    Discharged 

661    Stevens,  R.,  Pt.,  F,  107th 

May  25, 

Right;  flap.     Surg.  P.  II.  Flood, 

16th  N.Y.  Cav.,  nffe  26.     1  !>",  '64. 

June  1,  1865. 

New  York,  age  25. 

26,  '04. 

107th  N.  Y.   Disch'd  Mar.  2.  '65. 

621 

Skelton,  J.,  Serg't  Major,     June  28, 

Right  ;  flap.     Surg.  <V.  B.  Mona- 

602    Stevens,  W.  P.,Corp'l,B, 

Oct.  19, 

Right  ;   ant.  post.  flap.      Disch'd 

2?th  Ohio,  age  27.           .   28,  '64. 

han,   63d  Ohio.     Disch'd  Feb. 

;     184th  N.  York,  age  19. 

19,  '04. 

July  27,  1805. 

17,  1805. 

003    Stitle,   W.,   Pt.,   I,   29th 

May  8, 

Right  ;  circ.     Surg.  A.  K.  Fifield, 

022    Skinner,   M.  C.,  Pt.,   E,     June  18,    Lett;  ('ire.     Surg.  W.  P.  Pierce, 

Ohio,  age  21. 

9,  '64. 

29th  Ohio.  Disch'd  Aug.  10,  '65. 

36th  Illinois,  age  2?.           18,  '64.        88th  111.     DischM  Feb.  27,  1865. 

March  15,  1800,  amp.  thigh. 

6J3    Slavan.  J.,  Pt.,  B,  170th    June  Ifi. 

Left  ;  ant.  post.  flap.     Discharged 

664    Stoddard,  T.,Pt.,G,  64th 

Mar.  25, 

Left  :  circ.    Surg.  W.  J.  Burr.  42d 

New  York,  age  48.             17.  '64. 

Nov.  7,  1865.     Died  March  30, 

New  Yrork,  age  19. 

26,  '65. 

N.  Y.     Disch'd  August  2,  1805. 

1873;   pyaemia. 

665    Stone,  J.  G.,  Pt.,  K,  7th 

Oct.  1, 

Right  ;  circ.     A.  A.  Surg.  W.  H. 

024    Small,   R.,   Pt.,  F,  34th     Nov.  30,    Right  ;    ant.  post.   flap.     Disch'd 

N.  Hampshire,  age  21. 

1,  '63. 

Finn.     Disch'd  April  28,  1864. 

Colored  Troops,  age  18.     30,  '04.        Dec.  23,  186.). 

Spec.  4188. 

025 

Smalhvood.W.J..  Lieut.,      Oct.  1,      Left:  circ.    Sure.C.W.  McMillin, 

GOO    Stone,  S.  H.,  Serg't,  B, 

Dec.  28,  !  Left.    Surg.  W.  C.  Shurlock.  51st 

j     A,  7th  Kentucky.                 1,  '62.         1st  Teun.    Resitrned  Jan.  2:i,'03. 

37th  VVis.,  age  27. 

28.  '64. 

Penn.     Disch'd  June  18,  1805. 

026    Smith,  A.  A.,  Pt.,  A,  3d    April  9. 

Left;  flap.     Surg.  F.  L.  Dibble, 

667    Stonebreaker,  D.  T.,  Pt., 

Sept.  22, 

Right;  flap.  Disch'd  June  10,  '05. 

Rhode  Island  Art'rv.         9.  '03. 

Oth  Conn.     July  10.  amp.  right 

F,  14th  W.  Va.,  age  22. 

22,  '04. 

leg.     Disch'd  August  25,  1804. 

008    Stonehouse,  J.,Pt.,F,7th 

June  18, 

Left  ;  lateral  flap.     Disch'd  Sept. 

Spec.  1103. 

Wisconsin,  age  21  . 

18,  '64. 

28,  1804. 

627  :  Smith,  G.  T.,  Pt.,F,  13th    June  21, 

Left;  flap.    Surg.A.  W.Whitney, 

669  i  Storey,  J.  H.  R.,  Serg't, 

May  28, 

Right;  circ.     Mustered  out  Jan. 

Mass.,  age  22.                  j   21,  '64. 

Kith  Mass.    Disch'd  Oct.  17,  '04. 

F,  li)9th  Penn.,  age  25. 

28,"  '04. 

17,  1866. 

028 

Smith,  II.,  Pt.,   E,  llth    Sept.  13, 

Left;  flap  (amp.  arm).     Surg.  C. 

670    Storm,  H.  F.,  Pt.,  C,  71st 

Aug.  30. 

Left.     A.  Surg.  J.  D.  Gatch,  16th 

!     Vermont,  atre  19.                13,  '64. 

B.  Park,  llth  Vermont.     Sept. 

i     Indiana. 

30,  '62.' 

Ind.     Disch'd  Nov.  27,  1862. 

26,  hsem.;  ant.  tib.  lig.     Disch'd 

i71    Stout,  J.,  Pt.,  D,  101st 

May  15, 

Right  ;   ant.  post.  flap.     Disch'd 

Sept.  14,  1865. 

Illinois,  age  25. 

15,"  '04. 

January  18,  1865. 

629 

Smith,  If.  C.,  Pt.,  E,  5th    July  22,     Right  ;    circ.      Provost    Marshal 

672    Stratton,  C.  H.,  Pt,,  F. 

Feb.  8, 

Right  ;  circ.     Disch'd  August  7, 

Mississippi,  age  24.            23.  '64.        and  exchanged. 

25th  .Massachusetts.             8.  '02. 

1802. 

»FISHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations  in  Hospitals  near  Sharpsburg,  Md.,  etc.,  in  Am.  Jour.  Med.  Sciences,  Vol.  XLV,  p.  48. 
SUKG.  Ill— 00 


474 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Ne. 

NAME.  MILITARY 
DESCRIPTION.  AND  AOE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

073 

Stricter,  J.,  Pt.,  K,  56th 

April  20, 

Right;  circ.  skin  flap;  fibula  dis 

718 

Wagner,  D.,  Pt.,  H,  90th 

Dec.  13, 

Right.     Disch'd  August  5>4,  1864. 

North  Carolina,  age  34. 

20,  '64. 

articulated.     Surg.  C.  H.  Ladd, 

Penn.,  age  23. 

13,  '62. 

56th  N.  C.     Retired  Jan.  17,  '65. 

719 

Wagner,  J.,  Pt.,  C,  69th 

Dec.  13, 

Left.     Disch'd  December  16,  '63. 

674 

Strock,  S.  D.,  Corp'l,  F, 

July  2, 

Right;  circ.   Surg.  J.W.Wishart, 

Penn.,  age  36. 

13,  '62. 

140th  Penn.,  age  36. 

3,  r63. 

140th  Penn.     Disch'd  Jan.4,'64. 

720 

Walbert,  J.,  Pt.,  D,  25th 

June  16, 

Right  ;  circ.;  gangrene.     Disch'd 

675 

Sullivan,  J.,  Pt.,  E,  64th 

Oct.  4, 

Left;  flap.     Disch'd  April  6,  '63. 

Michigan,  age  21. 

16,  '64. 

Sept.  13,  1865. 

Illinois. 

6,  '62. 

Died  Dec.  2,  1867. 

721 

Wallace,  D.,  Corp'l,  A, 

June  19, 

Left  ;  flap.     Discharged. 

676 

Sullivan,  M.,  Pt..  H,  2d 

June  17, 

Left  :  flap.     Surg.  S.  S.  French, 

10th  N.  Y.  Cavalry. 

19,  '64. 

Michigan,  age  27. 

18,  '64. 

20th  Mich.    Disch'd  Mar.  29,  '65. 

722 

Walker,    J.,    Corp'X  C, 

Sept.  19, 

Left;  flap.     Surg.  S.  F.  Chapin, 

677 

Summers,  J.,  Capt.,  B, 

May  3, 

Left  ;  circular  ;  gang.    Recovery. 

139th  Penn.,  age  24. 

20,  '64. 

139th  Penn.  Disch'd  Apr.  20,  '65. 

5th  Alabama. 

4,  fe. 

723 

Walker,   J.   S.,  Pt.,  K, 

July  1, 

Right:    flap.     Disch'd   May   31, 

678 

Sumner,   A.,  Pt.,  B,  3d 

May  2, 

—  .     Ass't  Surp-.  R.  E.  Dennis, 

llth  Penn.,  age  22. 

2,  '63. 

1865. 

North  Carolina. 

3,  '63. 

C.  S.  A.     Recovery. 

724 

Walker,   L.  J.,  Pt.,  B, 

July  1, 

Loft;  flap.     Surg.  J.  H.  McAden, 

679 

Swank,    H.   J.,  Pt.,  G, 

Sept.  19, 

Right  ;  flap.     Discharged   April 

13th  N.  C.,  age  21. 

2,  '63. 

13th  N.C.     Paroled  Oct.  22,  '63. 

126th  Ohio,  age  23. 

19,  '64. 

3^1865. 

725 

Walker,  W.S.,  "Brigadier 

May  20, 

Left  (also  other  wounds).     Ex 

680 

Swarman,  F.,  Corp'l,  E, 

Sept.  17, 

Right.     Disch'd  and  pensioned. 

General,  age  42. 

20,"  '64. 

changed  Sept.  19,  1864. 

12th  Massachusetts. 

18.  '62. 

726 

Walsh,  J.,  Pt.,  A,  57th 

Mar.  25, 

Left;  flap.  Surg.W.  C.  Shurlock, 

681 

Swarthout,  O.,  Corp'l,G, 

May  12, 

Left;    ant.  post.  flap.       Disch'd 

Mass.,  age  39. 

25,  '65. 

51st  Penn.  Disch'd  Sept.  12,  '65. 

86th  N.  Y.,  age  19. 

12,  '64. 

Nov.  10,  1864. 

Spec.  4018.    Died  after  1875. 

682 

Sweet,  J.  O.,  Serg't,  C, 

June  9, 

Right;  flap.     Surg.  S.  Maguire, 

727 

Ward,  J.,  Corp'l,  H,  56th 

July  1, 

Left;  circ.     Disch'd  May  21,  '65. 

12th  Ohio,  age  21. 

9,  '64. 

45th  Ky.    Disch'd  Dec.  20,  1864. 

Penn.,  age  31  . 

2,  '63. 

683 

Sweetland,  L.    D.,   Pt., 

June  14, 

Left  :  flap.    Disch'd  August  26, 

i728 

Warner,   J.  C.,  Pt.,  A, 

Mar.  19, 

Right  ;  flap.  Surg.T.B.  Williams, 

E,  128th  Ohio. 

15,  '63. 

1863. 

12lst  Ohio,  age  21. 

20,  '65. 

121st  Ohio.  Disch'd  June  25,  '65. 

684 

Sweezy,  L.  A.,  Pt.,  F, 

July  3, 

Right  ;  flap.     Disch'd  December 

729 

Warner.  N.C.,  Lieut.,  E, 

Aug.  16, 

Right;    flap.     Disch'd   Dec.   15, 

7th  Mich.  Cavalry. 

4,  '63. 

14,  1863. 

39tb  Illinois,  age  34. 

16,  '64. 

1864. 

685 

Swett,  G.  W.,  Serg't,  K, 

April  23, 

Right  ;  circ.    Surg.  S.  C.  Gordon. 

730 

Warner.  T.,  Pt.,  H,  8th 

June  3, 

Right;  flap.   Surg.  G.  Chaddock, 

30th  Maine. 

23,  "64. 

1st  La.    Disch'd  June  23.  1864. 

N.  Y.  H.  Art'y,  age  32. 

4,  '64. 

7th  Mich.     Disch'd  Dec.  12,  '65. 

July  2, 

Left;  flap.     Disch'd  Jan.  19,  '64. 

731 

Warren,  J.  M.,  Pt.,  H, 

June  1, 

Right;    circ.     Disch'd   Oct.    16, 

686 

Swett,   V.  W.,  Pt.,    A, 

4,  '63. 

Died  Mar.  24,  '72;  phth.  pulmo. 

106th  N.  York,  age  21. 

1,  '64. 

1864. 

14th  Infantry,  age  22. 

Oct.  19, 

Left  ;  posterior  flap.     Surg.  G.  T. 

732 

Washburne,  J.,  Pt.,  A, 

Sept.  29, 

Left  ;  circ.    Confederate  surgeon. 

687 

Swords,    W.  J.,  Pt.,  H, 

20,  '64. 

Stevens,  77th  N.  Y.  Exchanged 

142d  N.  York,  age  32. 

Oct.  1,  '64. 

Disch'd  June  14,  1865. 

51st  Georgia,  age  20. 

Feb.  16,  1865. 

733 

Wathier,  F.,  Pt,,  D,  2d 

Nov.  8, 

Left.     Discharged  July  2,  1804. 

688? 

Tanner,    J.,   Corp'l,    C, 

Aug.  30, 

Both  ;  flap.     Discharged  October 

Artillery,  age  28. 

8,  '63. 

liS'.IS 

87th  New  York. 

30,  '62. 

15,  1862. 

734 

Weber,  A.,  Pt..  D,  20th 

Sept.  17, 

Left;  ant.  post.  flap.      Surg.  J. 

690 

Tanton.  H.  J.  D.,  Pt.,  C, 

July  2, 

Right.     To  Pro.  Marshal   Sept. 

New  York. 

17,  '62. 

Hausen,   20th   N.   Y.     Disch'd 

47th  Alabama,  age  33. 

3,  '63. 

10,  1863. 

Dec.  6,  1862. 

691 

Tatro,  L.,  Pt.,  E,  27th 

May  16, 

Right  ;  flap.     Disch'd  A  ugust  23, 

735 

Weber,  J..  Pt.,  H,  150th 

Mar.  2, 

Left;  circ.    Disch'd  August  30, 

Massachusetts,  age  19. 

16,  '64. 

1865. 

New  York. 

3,  '65. 

1865. 

692 

Taylor,  J.,  Pt.,  K,  8th 

Sept.  20, 

Left  ;  flap.     Surg.  E.  M.  Seeley, 

1736 

Webner,  C.,  Pt,,E,lllth 

June  1, 

Left;  flap.     Surg.  P.  E.  Hubon, 

Kansas,  age  23. 

20.  '63. 

21st  111.     Disch'd  May  20,  1864. 

New  York,  age  22. 

1,  '64. 

28th  Mass.     Disch'd  July  4,  '65. 

693 

Taylor,  S.,  Pt.,  E,  22d 

Sept.  14, 

Left  :  flap.    Surg.W.  F.  Hutchin- 

Spec.  4878. 

New  York,  age  24. 

14,  '62. 

soni  22d  N.Y.    Disch'd  Dec.  19, 

737 

Weeks,  H.  C.,  Serg't,  E, 

Oct.  19, 

Left  ;  circ.    Disch'd  June  8,  '65. 

1862.    Spec.  2303. 

6th  N.  Y.  H.  A.,  age  21. 

19.  '64. 

694 

Tebbetts,  E.  W.,  Pt.,  D, 

May  10, 

Right;    flap.      Disch'd  June  3, 

738 

Weeks,  T.,  Pt.,   G,    1st 

July  3, 

Left.     Surg.  —  Frost,  C.  S.  A. 

7th  N.  Hamp.,  age  44. 

10,  64. 

1865. 

South  Carolina,  age  19. 

3,  *63. 

Exchanged  Sept.  25,  1863. 

695 

Thomas.C.,  Pt.,  D,  121st 

Dec.  13, 

Lett;  gangrene.     Disch'd  Aug. 

739 

Welch,  J.,  Corp'l,  A,  52d 

June  16, 

Left  ;  flap.    Surg.  J.  W.  Wishart, 

Pennsylvania,  age  26. 

13,  '62. 

12,  1863. 

New  York,  age  35. 

16,  '64. 

140th  Penn.     May,  '65,  necrosed 

696 

Thompson,  A.  E.,  Pt.,  A, 

July  12. 

Left.    Surg.  J.  L.  Dicken,  47th 

end  of  tibia  removed.     Disch'd 

29th  Wisconsin,  age  Ifi. 

12,  '63. 

Indiana.     Disch'd  Oct.  1,  1863. 

July  29,  1865. 

Died  July  Ifi.  1864. 

740 

Welsh,  A.,  Pt.,  H,  9th 

June  29, 

Left."    Surg.  —  Kelly,  12th  Ala. 

697 

Thompson,  J.  J/.,  Pt.,  F, 

July  2, 

Left  ;   flap.     Paroled   November 

Pennsylvania  Cavalry. 

—  ,  '62. 

Disch'd   Sept.  26,  1862.     Died 

21st  Miss.,  age  20. 

3,  '63. 

12.  1863. 

Oct.  16,  1865. 

698 

Thompson,  J.  S.,  Pt.,  F, 

Nov.  30. 

Right;  circular.     Transferred. 

;741 

Werner,  F.,  Pt.,  C,  13th 

July  21, 

Right:  flap.     Disch'd  March  6, 

31st  Miss.,  age  21. 

Dec.  I,  '64. 

New  York. 

23,  '61. 

1862. 

699 

Thompson,    L.,    Pt.,  B, 

Sept.  1, 

Right:  circ.     Surg.  S.  C.  Moss, 

742 

Wliatlei,.  T.  J.,  Pt.,  D, 

July  2, 

Left  ;  circ.     To  Provost  Marshal 

78th  Illinois,  age  22. 

1,  '64. 

78th  111.     Disch'd  May  26,  1865. 

8th  Alabama,  age  23. 

2,  '63. 

Sept.  17,  1863. 

700 

Thompson.  R.,  Pt.,  T,5th 

Sept.  17, 

Right;  circ.     A.  Surg.  S.  Adams, 

743 

Wheoler.W.  W.,  Corp'l, 

May  27. 

Right  ;  circ.     Disch'd  January  8, 

Artillery,  age  20. 

17,  '62. 

U.S.A.    Disch'd  Mar.  30,  1863. 

D,  22d  Indiana,  age  25. 

28,"  '64. 

1865. 

701 

Tinker,  W.  H.,  Pt..B,5th 

Sept.  27, 

Right.     Dr.  E.  McCuen,  Louis 

744 

Whitbeck.  G.  H.,  Pt.,  E, 

July  2, 

Right  ;  flap.    Disch'd  May  30.  '64  . 

Mo.  S.  M.,  age  23. 

27,  '61. 

iana,  Mo.  Disch'd  Feb.  10,  1862. 

134th  N.  Y.,  age  19. 

3,  '63. 

Died  July  21,  '77  ;  cerebritis. 

702 

Traut,  W.,  Pt.,  C,  20th 

June  17, 

Right;  half  circ.,  with  posterior 

745 

Whitney,  A.,  Pt.,  B,  5th 

June  29, 

Left.     Oct.  11,  1862,  re-amputa 

Michigan,  age  31. 

17,  '64. 

flap.     Surg.  S.  S.  French,  2()th 

Vermont. 

30,  '62. 

tion.    Disch'd  Sept,  25,  1863. 

Mich.     Disch'd  June  24,  1865. 

746 

Whitten,  L.  T.,  Pt.,  B, 

Aug.  19, 

Right;  circ.     Surg.  S.  A.  Green, 

i03j 

Trim,  S.  H.,  Pt.,  B,  41st 

May  21, 

Both;  circ.    Surg.  J.  D.Jackson. 

40th  Mass.,  age  23. 

19,  '63. 

24th  Mass.     Discharged. 

704) 

Alabama,  age  19. 

21,"  '64. 

44th  Tenn.    Furl'd  July  13.  '64. 

747 

Wieland,  J.,  Pt.,  A.  43d 

April  6, 

Right;  flap.    Disch'd  October  10, 

705 

Troy,  B.  F.,  Pt.,  G,  10th 

May  16, 

Right;  left  leg  amp.,  mid.  third. 

Illinois. 

6,  '62. 

1802. 

Iowa. 

1C,  '63. 

Disch'd  Sept.  3,  18(i3. 

748 

Wike,   G.,  Pt,,  F,  55th 

Sept.  29, 

Left;  flap.  A.  Surg.  H.C.  Merry- 

706 

Tucker,  J.  M.,  Pt.,  A, 

Aug.  29, 

Left;  circ.     Disch'd  Mar.  0,  18(i3. 

Pennsylvania,  age  23. 

29,  '64. 

weather,  5th  Col'd  Troops,  and 

20th  Indiana. 

29,  '62. 

Died  March  20.  1864. 

Surg.  T.  H.  Squire,  89th  N.   Y. 

707 

Turner,  C.A.,Pt.,  1,  13th 

June  5, 

Left:  ant.  post.  flap.  Surg.  A.  W. 

Disch'd  May  17,  1865. 

Mass.,  age  21. 

5,  '64. 

Whitney,  13th  Mass.      Disch'd 

749 

AVilbur,   M.  J.,  Pt.,  C, 

May  27, 

Right;  circ.     Surg.  B.  B.Wilson. 

Nov.  6,"65.     Died  Aug.  17,  1875. 

261  h  Maine. 

27,"  '63. 

U.  S.  V.    Disc-h'dAug.  17,  1863. 

708 

Twaits,  J.  B.,  Serg't,  H, 

Aug.  29, 

Left.     Discharged  Feb.  9,  1863. 

750 

Wilds,  J.,  Pt.,  K,  121st 

Feb.  6, 

Right;  circ.     Mustered  out  May 

14th  N.Y.  S.  M..  age  24. 

30.  '62. 

Pennsylvania,  age  25. 

6,  '65. 

18,  1865. 

709 

Twinem,  H.,  Pt..A,  122d 

May  6, 

Left  ;  flap.  Surg.  Gillispie,C.S.A. 

751 

Wilkins,  J.  H.,Corp'l,E, 

June  14, 

Right  ;  ant.  post.  flap.     Disch'd 

New  York. 

7,  r64. 

Disch'd  Julv20,  '65.  Died,  1874. 

1st  Louisiana,  age  25. 

14,  '63. 

Aug.  9.  1804.     Spec.  4371. 

730 

Uncleson,  J..  Landsman, 

Mav  3, 

Right.      Disch'd   April  3,  1865. 

752 

Williams,  G.,Pt.,G,50th 

April  10, 

Left;  ant.  post,  flap;   circ.  sect. 

IT.  S.   Gunboat    Com. 

4,  '03. 

1875.  chronic  ulcer;  necrosis. 

Colored  Troops,  age  35. 

10.  '65. 

muscles.     Disch'd  June  10,  '05. 

Barney,  age  23. 

,753 

Williams,  G.,  Lieut.,  4th 

July  2, 

Right  :  flap.     Retired  November 

711 

VanAlstyne,  I.,  Pt.,  B, 

June  3, 

Left  ;  circ.     Surg.  J.  W.  Wishart, 

Infantry. 

3,  '63. 

11,  1803. 

7th  N.  Y.  Heavy  Artil 

3,  '64. 

140th   Penn.      Disch'd  Aug.  9, 

754 

Williams,   G.,   Quarter- 

Mav  25, 

Loft  :  flap.    Act.  Staff  Surg.  C.  B. 

lery,  age  23. 

1865. 

mast's  emplove\age  20. 

26,"  '65. 

Richards.  U.  S.  A. 

712 

Van  Fosson,  W.  E.,  Pt., 

July  3, 

Right  :  circ.    Surg.  C.  B.  Gibson, 

755 

Willson.C.  C.,'Pt.,  I,  6th 

Aug.  5, 

Left  :  flap.     Disch'd  October  16, 

F,  52d  Virginia. 

5,  '63. 

C.  S.  A.     Retired  Feb.  17,  1865. 

Michigan. 

5,  '62. 

1802. 

713 

Vincent,  G.  W.,  Pt.,  D, 

June  16. 

Right  ;  ant.  post.  flap.     Surg.  J. 

756) 

Willson.S.  L.,Pt.,D,72d 

July  2, 

Both  :  flap.     Surg.  C.  K.  Invin, 

88th  New  York,  age44. 

18,  '64. 

W.  Wishart,  140th  Penn.     Dis 

757  ( 

New  York,  age  18. 

3,  '63. 

72d  N.  Y.     Disch'd  May  31,  "05. 

charged  March  2.  1865. 

i758 

Wilson,  J.E.,Pt.,G,  67th 

June  16, 

Loft:  flap.     Mustered  out  July 

714 

Vining,    R.  H.,  Pt.,  H, 

June  15, 

Left  ;  circular.  Surg.G.  A.  Colla- 

Now  York,  age  23. 

16,  '64. 

15,  1805. 

112th  Illinois,  age  16. 

15,  '64. 

more,  100th  Ohio.     Discharged 

759 

Winklehaus,  J.,  Pt.,  K, 

Sept.  17, 

Left  ;  lat.  flap.   Surg.  C.  S.Wood. 

Feb.  21,  1865. 

66th  New  York. 

17,  '62. 

00th  K.  Y.     Disch'd  Nov.  6,  '62. 

715 

Vogt,   G.,  Pt.,   D,    61st 

July  20, 

Left.    Discharged  June  22,  1865. 

760 

Winn,B.  D.,  Pt.,  A,  143d 

May  6, 

Left;  circ.     Disch'd  June  15,  '65. 

Ohio,  age  27. 

21,  '64. 

Pennsylvania,  age  24. 

8,  '64. 

716 

Vorce,  E.,  Pt.,  B,  14th 

May  12, 

Left  ;  flap.     Disch'd  May  20,  '65. 

701 

Winn.  J.  W.,  Corp'l,  B, 

Sept.  14, 

Left.     Disch'd  December  22,  '62. 

Infantry,  age  35. 

12,  '64. 

Died  August  23,  1870. 

6th  Wisconsin. 

14,  '62. 

717 

Vossler,  J.,  Pt.,  G,  16th 

Oct.  7, 

Right  ;  circ.     Disch'd  July  6.  '65. 

;762 

Winstead,   T.  T.,  Pt.,  I. 

July  2, 

Right  :  flap.    Surg.  J.W.  Tracey. 

N.  Y.  H.  Art'y,  age  20. 

7,  '64. 

30th  N.  C.,  age  18. 

2,  '63. 

14th  N.  C.    Exch'd  Nov.  12,  '03. 

SECT.  V.I 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


475 


No. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS.  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

763 

Wisnor.  .1.  \V.,  Ca-t.,  D, 

April  9. 

Left.     Surg.  C.  Davis,  97th  111. 

805 

Cain.C.,  Pt.,  D,  52d  New 

June  16, 

Right.     Surg.  G.  L.  Potter,  145th 

97th  Illinois. 

9,  '(15. 

Mustered  out  May  15,  1865. 

York. 

16,  '64. 

Penn.     Died  June  24,  1864. 

764 

Wondens,  G.,Pt.,B,  14th 

June  2, 

Right.     Discharged  Aug.  6,  1861. 

806 

Cain,  T.,  Pt.,  E,  96th  N. 

Sept.  29, 

Right.     Died  October  15,  1864  ; 

Pennsylvania. 

2,  '61. 

York,  age  40. 

29,  '64. 

exhaustion. 

765 

Wood,  J.  1$..  Lieut.,  M. 

June  21, 

Right;  post.  flap.     Disch'd  Oct. 

807 

Camp,  W.  H.,  Pt.,  I,  40th 

June  —  , 

Left.    Died  July  3,  1864. 

]7tb  I'enn.  Cav.  .age  24. 

21.  '63. 

6,  1863. 

Alabama. 

—  ,  '64. 

766 

Woolley.  11.  A.,  Pr.,   F, 

July  2, 

Right.     For  exchange  Nov.  12, 

808 

Campbell,  D.;Pt.,E,  llth 

June  3, 

Right;  circular;  bone  necrosed. 

8th  Alabama,  age  52. 

3,  '"6:5. 

1863. 

N.  Hampshire,  age  28. 

3,  '64. 

Died  July  12,  1864. 

767 

Wucherer,    C..     i't.,  D, 

Aug.  22, 

Left.    Confederate  surgeon.   Dis 

809 

^Cannon,  S.  />.,  Pt.,  D, 

May  18, 

Left.     Died  June  25,  1864  ;  gan 

Gist  Ohio. 

23.  '62. 

charged  Nov.  27,  1862. 

2d  Ala.  Cav.,  age  22. 

18,  '64. 

grene. 

708 

Yarian,  J.,  Pt.,  A.  35th 

Hoc.  16, 

Left;  ant.  posterior  flap.    Disch'd 

810 

Carman,  L.  A.,  Serg't,  A, 

Oct.  19, 

Right.     Ass't  Surg.  H.  M.  Lyons, 

Indiana,  age  27. 

16,  '64. 

May  25,  1865. 

24th  Iowa,  age  22. 

20,  '64. 

24th  Iowa.    Died  Nov.  14,  1864  ; 

769 

Yoder,  A.,Corp'l,  E,55th 

May  16, 

Left;  flap.    Confederate  surgeon. 

irritative  fever;  exhaustion. 

Pennsylvania,  age  24. 

18,  '64. 

Disch'd  June  8.  1865. 

811 

Carney,  P.,  Pt.,  A,  48th 

July  12, 

L't.  A.  Surg.R.  L.VonHarlingen, 

770 

Young,  L.R.,Pt.,K,  31st 

June  17. 

Right:  circ.    Surg.  J.D.Mitchell, 

Illinois. 

12,  '63. 

53d  Ohio.     Died  July  26,  1863. 

Maine. 

17,  '64. 

31st  Maine.    Disch'd  Jan.  14,  '65. 

812 

Carr,  C.  C.,  Pt.,  D,  14th 

Oct.  19, 

Left;  circular:  sloughing.     Died 

771 

Yunkings,  E.,Pt..H,  42d 

Dec.  13. 

Left;  cire.     Disch'd  June  29,  '63. 

N.  Hampshire,  age  21. 

20,  '64. 

Nov.  25,  1864  ;  anaemia. 

Pennsylvania. 

15,  '62. 

813 

Carroll,  P.,Corp'l,C,  22d 

Dec.  29, 

Left  ;  erysipelas.    Died   Feb.  2, 

772 

Abbert.  C.,  Pt.,  A,  38th 

June  17, 

Left.     Died  June  21,  1864. 

Kentucky. 

29,  '62. 

1863. 

Wisconsin. 

17,  '64. 

814 

Carter,  J.,  Pt.,  I,    10th 

Aug.  21, 

Left;  flap.     Died  Sept.  15,  1864; 

773 

Adams,  I.  N.,  Serg't,  K, 

Sept.  1, 

Left.     Died  November  4,  1864. 

Florida,  age  46. 

22,  '64. 

pyaemia. 

125th  Illinois. 

1,  '64. 

815 

Cecil,  H.,Pt.,B.  3d  Iowa. 

July  12, 

Left.     Died  July  22,  1863. 

774 

Adams,  J.,  Pt.,  G,  59th 

June  30, 

Right  ;  ant.  posterior  flap.     Died 

12,  '63. 

Massachusetts,  age  21. 

30,  '64. 

August  8,  1864  ;  pyaemia. 

816 

Chaffee,  W.  R.,  Pt.,  A, 

May  16, 

Right;    flap.     Died   August  31, 

775? 

Albert,   J.,   Pt.,  F,  "1st 

Oct.  12, 

Both.     Died  November  4,  1864; 

142d  N.  York,  age  28. 

16,  '64. 

1864. 

776J 

New  York,  age  19. 

13,  '64. 

pyaemia. 

817 

Chase,  H.  C.,  Serg't,  B, 

April  9, 

Right.     July  1  8,  bone  exfoliated. 

777 

Alexander.  R.,  Pt.,  L,  2d 

Aug.  14, 

Right  ;  circ.     Died  Sept,  7,  1864  ; 

30th  Maine,  age  28. 

10,  '64. 

Died  July  20,  1864;  gangrene. 

N.Y.  H'vv  Art.,  age  42. 

14.  '64. 

gangrene. 

818 

Clark,  G.  W.,  Pt.,  C,  93d 

April  2, 

Left:  circular.     Died   April  28, 

778 

Atkinson,  '.!.,  I't.,  I,  4th 

July  12, 

Left;  flap;  head  of  fibula  excised. 

Penn.,  age  36. 

3,  '65. 

1865;  pyaemia. 

Iowa. 

14,  '63. 

Died  August  3,  1863. 

819 

Clark,  J.  W.,  Serg't,  I, 

July  19, 

Left.     Surg.  E.  Shippen,  U.  S.  V. 

779 

Babcoek.  E.,  Pt.,  B,  10th 

April  2, 

Left.    Died  May  9,  1865;  exhaus 

129th  Indiana,  age  37. 

19,  '64. 

July  19,  haem.;  lig.  of  ant.  tibial  ; 

N.Y.  H'vv  Art.,  age  39. 

2,  '65. 

tion. 

gangrene.     Died  Sept.  19,  1864. 

780 

Barry,  J.,  Pt.,  D.,  2d  N. 

May  16. 

Right;    haem.,   20  oz.     May  25, 

820 

3Cloar,  W.  F.,  Pt.,  A,  33d 

Aug.  30, 

Right;  flap.     Sept.  21,  gangrene. 

Hampshire,  age  20. 

16,  '64. 

amp.  thigh.     Died  May  30,  '64  ; 

Tennessee,  age  24. 

30,  '64. 

Oct.  5,  haemorrhage.    Died  Oct. 

exhaustion. 

12,  1864  :  pyaemia. 

781 

Bartholomew,  A.  L.,  Pt., 

June  5, 

Left.  Died  June  28,  '64  ;  pyaemia. 

821 

Closson,  1.  H.,  Capt.,  H, 

Oct.  27, 

Right.    Died"  November22,  1864. 

F,  3d  Vermont,  age  25. 

5,  '64. 

91st  Pennsylvania. 

27,  '64. 

I  C.-, 

Basum,  A.,  Pt.,  F,  63d 

May  5, 

.     Surg.  G.  T.  Stevens,  77tb 

822 

Cochrane.  J.,  Lieut,,  K, 

May  16, 

Lett.     Died  May  28,  '64  ;  exhaus- 

Pennsylvania. 

5,  '64. 

N.  Y.     Died  May  18,  1864. 

67th  Ohio,  age  28. 

16,'  '64. 

tion  from  haemorrhage. 

783 

Bell,  J.'W.,Corp'l,  1,  73d 

Mar.  19, 

Right.     Died  March  30,  1865. 

823 

Coleman,  J.,  Pt.,  F,  75th 

May  7, 

Left.    Died  May  10.  1862. 

Ohio. 

19.  '65. 

Ohio. 

7,  '62. 

784 

Bennett.    C.,  Pt.,  G,  2d 

June  28, 

Right.  Surg.  J.W.Wishart,140th 

824 

Collins,   T.,  Pt.,  K,  1st 

June  18, 

Left  ;  ant.  post,  flap  ;  gangrene. 

New  York  Artillery. 

28,  '64. 

Penn.    Died  July  27,  1864. 

Me.  H'vyArt.,age21. 

19,  '64. 

Died  July  9.  1864. 

785 

Bernhard,  A.,  Pt.,  K,  4th 

Feb.  25, 

Right.     Mar.  5,  18,  hasm.,  16oz. 

825 

Corey,   O.    M.,   Pt.,  H. 

Oct.  19, 

Right.     Oct.  29,  haem.;  amputa 

Ohio  Cavalry,  age  35. 

25,  '64. 

each  time;  lig.  popliteal.    Died 

114th  N.  York,  age  21. 

19,  '64. 

tion  thigh.     Died  Nov.  11,  1864. 

March  22,  1864  ;  pyaemia. 

826 

Corser,  C.  M.,  Pt.,  H,  1st 

June  1  9, 

Right  (wound  of  arm,  hip,  and 

786 

Bing,  A.,  Lieut.,  A,  2d 

Oct.  3, 

Left  (haemorrhage).    Died   Oct. 

Ohio  Artillery. 

20,  '64. 

foot).     Died  June  25,  1864. 

Iowa. 

4,  '62. 

5,  1862. 

827 

Coverdale,  J.  B.,  Pt.,  A, 

Nov.  7, 

Left.     Died  November  28,  1861. 

787 

Blair,  L.,  Pt.,  F,  9th  Ver 

Sept.  28, 

Left.     Died  November  13,  1864; 

22d  Illinois. 

9,  '61. 

mont. 

29,  '64. 

pyaemia. 

828 

Croyle,  J.,  Pt.,  I.  54th 

Sept.  19, 

Right  ;  ant.  posterior  flap.     Died 

788 

Boring,  R.  M.,  Pt.,  K, 

July—, 

Right.    Died  July  23,  1863. 

Pennsylvania,  age  20. 

20,  '64. 

Dee.  20,  1864  ;  typhoid  fever. 

4th  Georsria. 

>p,3 

829 

Cummings,  J.  S.,  Pt.,  B. 

June  18, 

Left;   circ.     Surg'.  B.  N.  Bond, 

789 

Boughton,  S.  E.,  Pt..G, 

June  27. 

Right  ;  flap.     Surg.W.  H.  Hoag, 

70th  Ohio,  age  16. 

18,  '64. 

27th  Mo.    Died  July  7.  1864: 

134th  N.  York,  age  21. 

27,  '64. 

134th  N.  Y.     Died  Feb.  17,  '65  , 

pneumonia. 

typhoid  pneumonia. 

830 

Davis,  J.  D..  Corp'l.  D, 

June  6, 

Left  ;  ant.  post.  flap.     Surg.A.  T. 

790 

Bowen,  F.  P.,  Lieut.,  L, 

May  28, 

Left;  circ.     Died  June  15,  1864  ; 

33d  Missouri,  age  23. 

6,  '64. 

Bartlett,   33d  Mo.     Died  Oct. 

4th  Penn.  Cav.,  age  26. 

28.'  '64. 

pyaemia. 

11,  1864. 

791 

Bovd,    J..  Pt.,    D,    52d 

June  28. 

Right;  circ.     Died  Aug.  7,  1864  : 

831 

Dawson,  H.,  Pt.,  A,  49th 

May  10, 

Left  ;  ant.  post.  flap.    Surg.  F.  M. 

Ohio,  age  'JO. 

28,  '64. 

exhaustion. 

New  York,  age  25. 

10,"'64. 

Everleth.  7th  Me.     Died   June 

792 

Boyer.    J.,  Pt.,   I,  102d 

July  2, 

Right,     Died  July  3,  1863. 

16,  1864  ;  exhaustion. 

New  York. 

3,  '63. 

832 

Dean,  W.,    I't.,    B,    1st 

Oct.  29, 

Right  ;  flap.    Died  March  25,  '65  ; 

793 

Boyle,   P.,  Pt.,   B,  19th 

Aug.  26, 

Right  (also  wound  of  thigh  and 

Cavalry,  age  39. 

—  ,  '64. 

chronic  diarrhoea. 

Georgia,  age  51. 

26,  '64. 

scrotum);  ant.  post.  flap.     Died 

833 

DeHoff,'E.,  Pt.,  H,  38th 

Aug.  7, 

Left  ;  ant.  post,  flap  ;   gangrene. 

Sept.  2.  1804;  exhaustion. 

Ohio,  age  33. 

7,  '64. 

Dec.  5,  amp.  thigh.     Died  Jan. 

794 

Bradley.   J.,  Maj.,  H2d 

Dee.  13, 

Left.    Died  Jan.  3,  1863  ;  tetanus. 

16,  1865. 

Pennsylvania. 

13.  '62. 

834 

Dempson,  C.,  Corp'l,  G, 

May  12, 

Left.     Died  June  9,  '64  ;  pyaemia. 

795 

Branson,  \V.,  I't.,  I,  8th 

July  5, 

Right  (also  wound  lung).     Died 

32d  Mass..  age  32. 

12,  '64. 

New  York  Cavalry. 

5.  '63. 

July  25.  1863.     Spec.  3843. 

835 

Densmore,  F.  M.,  Pt.,  F, 

July  20, 

Left.     Died  July  24,  1864. 

796 

llrileii,    E.,    I't.,   F,    2d 

Sept.  27, 

Left;  circ.     Died  Nov.  9,  1864; 

40th  Indiana. 

20,'  '64. 

Tennessee,  age  2(i. 

27.  '64. 

exhaustion. 

836 

Dewes,  J.  S.,  Pt.,  H,  18th 

May  1  2, 

;  post.  flap.     May  12,  partial 

797 

Erodes,  K.,  Pt.,  E,    8th 

Aug.  21, 

Right;  circ.     Died  Oct.  6,  1864; 

Virginia. 

14,"  '64. 

exc.    Surg.  C.  B.  Gibson.C.S.A. 

Maryland,  age  03. 

21.  '64. 

gangrene. 

Died  May  21,  1864. 

798 

Brooks,  H.,  Pt.,  K,  20th 

Mar.  25. 

Right:  typhoid  symptoms.    Died 

837 

Dillon,  J.,  Pt.,  E,  56th 

July  30, 

Right;  long  posterior  flesh  flap. 

Michigan,  age  22. 

25.  '65. 

April  14,  1865. 

Mass.,  age  43. 

30,"'64. 

Surg.  T.  V.  Oakes,  56th  Mass. 

799 

Brown,      G.,      Laborer, 

Aug.  9. 

Right.     A.  Surg.  J.  T.  Calhonn, 

Died  Ausr.  6,  1864  ;  exhaustion. 

Quartermaster's  Dep't- 

—  ,  '64. 

IF.  S.  A.    Died  August  29,  1864  ; 

838 

Dimond,  J.,    Serg't,  K, 

Mav  12, 

Left.     Surg.  J.  W.  Wishart,  140th 

went. 

pyaemia.     Spec.  4152. 

61st  New  York. 

12,'  '64. 

Penn.   (Tibialartery  wounded.) 

800 

Brown,  H.  G.,  Corp'l,  B, 

June  17. 

Right;  circ.     July  21,  amputat'n 

Died  Mav  12,  1864. 

37th  Wisconsin,  age  21. 

17.  '64. 

thigh  ;    31,   three  inches  femur 

839 

Droker,  A.,  Pt.,  B,  57th 

Dec.  31, 

Left.    Died  January  8,  1863. 

removed.    Died  Aug.  3,  1864; 

Indiana. 

31,  '62. 

pyaemia.    »S>«c.s-.  2897,  2945. 

840 

Dunham,  J.  H.,  Pt.,  D, 

Oct.  27, 

Right.      Surg.   N.  Y.  Leet,  76th 

801 

Brown,  W.,  Pt.,  B,  174th 

Dec.  7, 

Left  ;  ant.  post.  flap.    Surg.  F.W. 

117th  N.  Y.,  age  32. 

27,  '64. 

Penn.  Died  Xov.'l  7/64;  pj-aem. 

Ohio,  age  32. 

7,  '64. 

Morrison,    ]74th    Ohio.      Died 

841 

Eldred.  H.  E.,  Pt.,  E,  2d 

June  18, 

Left;   circ.     June  25.  gangrene. 

Dec.  23.  1864  ;  pyaemia. 

U.  S.  Sharpshooters.age 

18,  '64. 

July  1  ,  amputation  thigh.    Died 

802 

Bryan,  C.,  Pt.,  H,  119th 

May  10, 

Left.     Died  June  23,  1864. 

27. 

July  6,  1864  ;  tetanus. 

Pennsylvania,  age  24. 

—,"'64. 

842 

Engleman,  W.,  Pt.,  K, 

June  10, 

Right  ;    circ.     Surg.  J.  Wasson, 

803 

1  Bandy,  C.,  Pt.,  F,  6th 

May  10, 

Left  ;  circ.     Died  June  17,  1864  ; 

9th  Iowa  Cav.,  age  14. 

10,  '64. 

9th  Iowa  Cavalry.     Died  July 

Wisconsin,  age  30. 

11,'  '64. 

pyaemia. 

1,  1864  :  exhaustion. 

804 

Burns,  J.,  Pt.,  F,  140th 

Dec.  7, 

Left;  flap.     Surg.  H.  B.  Johnson, 

843 

Evans,  If.,  Pt.,  E,  25th 

Aug.  21, 

Right.   Died  September  11  ,  1864. 

Indiana,  age  22. 

7.  '64. 

115th  Ohio.    Died  Feb.  26,  1865. 

South  Carolina,  age  45. 

21,  '64. 

'LlDELL  (J.  A.),  Example  of  Pyarthrosis  and  Spreading  Osteomyelitis,  in  U.  S.  Sanitary  Commission  Memoirs,  New  York,  Surg.  Vol.  1,  p.  395. 
2O'KEEFE  (D.  C.),  Surgical  Cases  of  Interest,  treated  at  Institute  Hospital,  Atlanta,  Ga.,  May  and  June,  1864,  in  Confederate  States  Medical  and 
Surgical  Journal,  Volume  2,  p.  29. 

3  JONES  (J.),  Case  of  Pyiemia  Supm-ening  upon  Hospital  Gangrene,  in  U.  S.  San.  Com.  Memoirs,  New  York,  1871,  Surg.  Vol.  II,  pp.  3:!7  and  439. 


476 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


XT  i-» 

NAME,  MILITARY 

Ol'EItATlOXS,   OPERATORS,            XTri            NAME,  MILITARY 

T*  *  TI7C 

OPKISATIOXS,  OPERATORS, 

iso. 

DESCRIPTION,  AND  A(,R.       ' 

RESULT. 

DE8CRI1TION,  AND  AGE. 

RESULT. 

844 

Everson.J.,  Pt.,  P,  lllth 

June  19, 

Right.     Surg.  G.  L.  Potter,  145th 

887 

King,  T.,  Serg't,  C,  71st 

July  2, 

Left.     July  15,  haem.    Died  July 

New  York. 

19,  '64. 

Penn.     Died  July  8,  1804. 

New  York,  age  20. 

3,  '63. 

15,  1803. 

845 

Fieger.  J.,  Corp'!,  B,98th 

April  2, 

Right  ;  circ.    Died"  May  18,  1865  ; 

888 

Knapp,  A.  J.,  Pt.,  F,  93d 

May  14, 

.    Surg.  J.  B.  Rice,  72d  Ohio. 

Pennsylvania,  age  30. 

2,  '05. 

exhaustion. 

Indiana.                              14,  '63. 

Died  July  27,  1863. 

840 

Fleshman,    E.,    Pt.,  E. 

June  27, 

Left.    Surg.  A.  M.Wilder.U.S.V. 

889 

Knowlton,  C.  C.,  Pt.,  I, 

Sept.  20, 

Left.    Oct.  —  .  slough.:  maggots  ; 

118tu  Ohio. 

C-7.  '64. 

Died  July  19,  1864. 

22d  Mass.,  age  22. 

20,  '02. 

bed-sores.    Died  Oct.  13,  1862. 

847 

Fry,    G.,   Pt.,    K,   16th 

May  14. 

Left.     Died  May  19,  1864. 

890 

Kronmiller,   G.,  Pt,  C, 

July  9, 

Left.     Surg.  T.  F.  Oakes,  56th 

Kentucky. 

14,"'64. 

14th  New  York  Heavy 

10,  ''64. 

Mass.     Died  October  8,    1804. 

848 

Fuller,  B.  ZT.,Pt.,B,  12th 

July  9. 

:  double  flap.     Surg.  C.  H. 

Artillery,  age  38. 

Spec.  6529. 

Georgia. 

10,  '64. 

Todd,  C.  S.  A.    Died  Aug.  19, 

891 

Laws,   C.,   Pt.,   E,   43d 

July  30, 

Left;  circ.  Surg.  D.  MacKay  ,29th 

1864;  exhaustion;  diarrhoea. 

Colored  Troops. 

30,  '04. 

Col'd  Troops.    Died  Aug.  6,'04. 

849 

Gaylord,  A.,  Pt.,  B,  75tb 

Oct.  8, 

Right.    Died  October  14,  1862. 

892 

Lease,  H.  A.,  Pt.,E,  14th 

Oct.  4, 

Left.     Died  Nov.  14,  '62;  wound 

Illinois. 

8,  '62. 

Missouri. 

—  ,  '02. 

and  amputation. 

850 

Gibson,    W.,   Serg't,  C, 

June  17, 

Right.     Died  June  18,  1804. 

893 

Lee.  H.,  Pt,  D,  9th  Col 

Dec.  5, 

Right;  flap.     A.  A.  Surg.  J.  S. 

27th  Michigan. 

17,  '64. 

ored  Troops,  aged  21. 

6,  '64. 

Giltner.     Died   Dec.  '23,  1864  ; 

851 

Gillatt.C.W.,  Pt.,A,56th      July  1, 

Right.     Died  June  23,  1804  ;  chr. 

.  pyaemia. 

Pennsylvania,  age  19.         2,  '03. 

diarrhoea;  phthisis  pulmonalis. 

894 

Leininger,    A.,    Pt.,    E, 

April  2, 

Right  ;  flap.    Died  May  17,  1865; 

852 

Gillespie,  J.,  Pt.,  !•',  59th 

Dec.  15, 

Right:  ant.  post,  flap  ;  gangrene. 

98th  Pennsylvania. 

2,  '65. 

exhaustion. 

Illinois.  as;e  29. 

15,  '64. 

Died  Feb.  2,  1805;  gangrene. 

895 

Lenzenmeyer,  R.,  Serg't, 

July  3, 

Right.     Died  July  23,  1863. 

853 

Goddard,  J.  F.,  Pt..  A, 

July  22, 

Right  ;  ant.  post.  flap.     Died  Jan. 

F,  2d  Pennsylvania. 

3,  '63. 

57th  Georgia,  age  28. 

22."'64. 

1,  1865;  chronic  diarrhoea. 

896 

Lewis,  J.  R.,  Pt.,  G,  53d 

July  3, 

Right  (also  amputat'n  left  thigh). 

854 

Goodell,   L.,   Pt.,  C,  2d      Nov.  4, 

Left;  ant.  post.  flap.    Surg.W.  J. 

North  Carolina,  age  32. 

3,  ''63. 

Surgeon  J.  J.  Knott,  P.  A.  C.  S. 

Vermont,  age  2:!. 

4,  '63. 

•Sawin,  2d  Vt.     Erysip.;  gang.; 

Died  July  10,  1863. 

tibia  exfol.     Died  June  6,  1864  ; 

897 

Limb,  W.  P.,  Pt.,  B,26th 

June  20, 

Right.     Surg.  W.  B.  McGavran, 

pseudo-membranous  croup. 

Ohio. 

20,  '64. 

26th  Ohio.     Died  Aug.  8,  1864. 

855 

Gould,  J.  L.,  Serg't,  G. 

July  2, 

Left.     Died  July  8,  1863. 

898 

Linch,  N.,  Pt.,  B,  163d 

Dec.  13, 

Right.     Died  December  21,  1862. 

4th  Texas. 

—  ,  '63. 

New  York. 

13,  '62. 

856 

Greenhart,  H..  Pt.,G.9th     Oct.  19, 

Left  ;  flap  ;  erysipelas.   Died  Oct. 

899 

Lympus,  N.  S.,  Pt.,  K, 

Dec.  13, 

Left  ;  flap.    Acting  Staff  Surg.  C. 

Connecticut,  age  45. 

19,  '64. 

31,  1864;  tetanus. 

10th  Iowa. 

13,  '64. 

B.Richards,  U.S.A.  (Alsow'nd 

857 

Groesbeck,  W.,  Pt.,  B, 

Aug.  0, 

Right.     Died  August  25,  1864. 

of  arm.)     Died  Dec.  14,  1864. 

74th  Indiana. 

6,  '04. 

900  ,  Lynch,  M.,  Serg't,  C,  2d 

Oct.  19, 

Right.     Died  December  14,  1864. 

858 

Hagan,  P.,  Pt.,  A,  7th 

Sept.  19, 

Left  ;   oval   skin   flap  ;  anaemia  ; 

Vermont,  age  22. 

19,  '64. 

Michigan. 

19.  '64. 

gang.    Died  Oct.  19,  '64  ;  pysem. 

901 

Maddox,  W.  /.,  Pt.,  A, 

May  3, 

Right,     Surg.  J.  J.  Knott,  P.  A. 

&>9 

Hammer,  H.,  Pt.,  F,  15th 

Nov.  25, 

Right;  circ.:   gang.     Died  Dec. 

53d  Georgia. 

—,''03. 

C.  S.     Died  June  18,  1863. 

Indiana,  age  24. 

27,  '63. 

6,  1803. 

902 

Marcev,  H.  P.,  Pt.,  K, 

May  17, 

Right;  flap.  June  8.  haemorrhage. 

8CO 

Hammond,    S.,    Pt.,   B, 

July  12. 

Left.    Surg.W.  Lomax,  12th  Ind. 

llth  Penn.  Cav.,age  23. 

17,  '64. 

Died  June  25,  1864:  haem. 

1,7th  Indiana. 

12,  '63. 

Died  August  5,  1803. 

903 

Martin,  D.,  Pt.,  C,~28th 

Nov.  27, 

Right.     Died  December  17.  1863. 

801     Han-is,.!),  W.  11.,  Pt.,  B, 

May  10, 

Right  :  ant.  post,  flap  :  sloughing. 

Pennsylvania. 

27,  '63. 

4ih  Michiiran,  age  24. 

10,  '64. 

Died  May  21,  1804;  p3'aemia. 

904 

McCard'le,  J.,  Pt.,  E,  2d 

July  2, 

Left  (also  amp.  right,  low.  third). 

862 

Ilaskill,  J.M.,  Serg't,  A, 

July  •_', 

Left  (also  right  knee);  sloughing. 

Penn.  Artillery,  age  23. 

2,  '64. 

Died  July  3,  1804. 

3-Jd  Mass.,  age  28. 

3,  '63. 

Died  Aug.  25,  1803;  diarrhoaa. 

905 

McCarmichael'  A.,    Pt., 

Nov.  30, 

Left  ;  ant.  post.  flap.     Died  Mar. 

863 

Hawkins,  G.  W.,  Capt., 

Oct.  27, 

Left.  Surg.M.  S.  Kittenger,  100th 

D,  7th  Miss.,  age  43. 

Dec.1,'64. 

3,  1805. 

I,  97th  Pennsylvania. 

27,  '64. 

N.  Y.     Died  Oct.  27,  1804. 

906 

McCluskev,    P.,  Serg't, 

Dec.  13, 

Left.    Jan.  3,  '63,  haem.;  lig.  post. 

8G4 

Hayden,  F.W.,"Serg't,F, 
34th  Mass.,  age  25. 

Oct.  13, 
14,  '64. 

Left  ;  ant.  post.  flap.     Died  Nov. 
9,  1864;  exhaustion. 

907 

F,  26th  N.  Y.,  asre  27. 
McDemitt,  T.  J.,  Pt.,  E, 

13,  '62. 
May  10, 

tibial.     Died  January  11,  1863. 
Right  ;  flap.     Died  September  8, 

665     'Hill,    J.,    Pt.,    A,    32d 

May  11, 

Right;   ant.  post.  flap.     May  22, 

49th  Penn.,  age  25. 

10,'  '64. 

1864. 

i     Massachusetts,  age  49. 

12,  '04. 

haem.    Died  May  22,  '64  ;  pysem. 

908 

McDermott,  O.,  Pt,  M. 

June  20, 

Left  ;  ant,  post.  flap.     Surg.  C.  C. 

8GG    Hindman,  W.  S.,  Pt.,  E, 

May  23, 

Left.    June  24,  amputation  thigh. 

1st  Mass.  H'vy  Art'y, 

20,  '64. 

Jewett,  16th  Mass.    Died  July 

155th  Penn.,  age  20. 

—  ,  '64. 

Died  June  24,  1864. 

age  30. 

17,  1864.     Spec.  4579. 

807 

Hoasch,  G.,Pt.,  E,  110th 

July  9, 

Left:  circ.     A.  A.  Surg.   W.  S. 

909 

McDevift,  J.,  Pt.,  I,  7th 

June  3, 

Left;  circ.     Surg.  J.  Harris,  7th 

Ohio,  age  45. 

11,  '64. 

Adams.  Aug.  4,  haem.:  lig.  post. 

Rhode  Island,  age  27. 

3,  '64. 

R.  1.     Gangrene.     Died  July  8, 

tilt.    Died  Aug.  8,  '64  ;  haemor 

1  864  ;  pyaemia. 

rhage.     Spec.  3829. 

910 

MoElhannon,  W.  J.,  Pt., 

June  26, 

Right  (also  five  other  wounds). 

808 

Holmes,  R.  A.  R.,  Pt.,  T, 

May  16, 

Right  ;  circ.     Died  May  27,  1864  ; 

B,  45th  Illinois. 

—  ,  '63. 

Died  July  15,  1863  ;  pyaemia. 

3d  N.  Ham  p.,  age  35. 

16,  '64. 

exhaustion. 

911 

McLean,  M.,  Pt.,  B,  80th 

May  27, 

Right.     Surg.  J.  T.  Woods.  9!>th 

809 

Hough,  J.,  Serg't.  H,  15th 

Aug.  19, 

Right;  flap.    Died  Aug.  31,1864  ; 

Illinois. 

27,"  '64. 

Ohio.     Died  June  1,  1864. 

N.Y.  H'vyArt.,age47. 

19,  '64. 

exhaustion. 

912 

McMillan.  J.,  Pt.,  H,  4th 

June  24, 

Right  :  circ.  A.  Surg.W.  B.  Price, 

870 

Hufnagle,  J.,  Pt.,  A,  4th 

May  12, 

Right  ;  circ.     Died  June  8,  1864  ; 

Penn.  Cavalry,  age  18. 

26,  '64. 

4th  Penn.  Cavalry.     Died  July 

Vermont,  age  34. 

12,"  '64. 

dysentery. 

9,  1804:  asthenia. 

671 

Hughes,    G.,   Pt.,  I,  8th     June  1, 

Left  ;  apparently  flap.  Died  July 

913 

McNeil,  F.,  Pt.,  E,  114th 

Sept.  19, 

Right  ;  circ.   Surg.  L.  P.Wagner. 

North  Carolina.                   2,  '64. 

9,  1804  ;  exhaustion. 

New  York,  age  23. 

19,  '64. 

114th  N.  Y.     Died  Oct.  8,  180-1  : 

872 

Hunt,  T.,   Pt.,   A,   44th 

July  3, 

Right.     Died  July  25,  1863. 

pyaemia. 

New  York. 

—  ,  ''03. 

914 

Mensen,  M.,  Pt,  E,  22d 

May  25, 

Left.     Died  June  12,  1804. 

873 

Hunter.  J.,  Corp'l,  B,  7th 

Oct.  5, 

Left;  flap.     Died  Oct.  21,  1804; 

Wisconsin. 

25,  '64. 

Illinois. 

5.  '64. 

exhaustive  suppuration. 

915    Metz,  J.  H.,  Pt.,  G,  9th 

July  11, 

Left;  lat.  flap.     Surg.  J.  Wilson, 

874 

Ingram,  G.  W.,  Pt.,    A,      .Tnlv  2       T.pft      .Tnlw  90  "  huwnnrrh     12  ra 

Veteran  Reserve  Corps, 

n,"'G4. 

Med.  Insp.  U.  S.  A.     Died  July 

08th  Penn.,  age  25. 

4,  '63. 

Died  July  24,  '63;  haemorrhage. 

age  33. 

28,  1864;  exhaust  'n.   Spec.  3100. 

875 

Johnson,  C.  L.,   Pt.,  B, 

Aug.  6,     Right  (also  amptitat'n  left  thigh). 

916  ;  Mier,    J.,  Pt.,  I,    113th 

June  27, 

Left.     Died  July  0,  1864. 

1st  Tennessee. 

6,  '04. 

Died  August  21,  1804. 

Ohio. 

27,  '04. 

870 

Johnson,  F.,  Pt.,  D,117th 

Oct.  27.     Right  (also  flesh  wound).     Died 

917    Miller,  J.,  Pt.,  D,  157th 

June  17, 

.     Died  June  23,  1804. 

Col'd  Troops,  age  20. 

27,  '64.        Nov.  16,  1864:  exhaustion. 

Pennsylvania. 

17,  '64. 

877 

Johnson,  J.,  Pt.,  E,  57th 

May  27, 

Right  :  flap.     Surg.  E.  B.  Glick, 

918    Miller,  'L.,  Pt.,  K,  56th 

April  19, 

Left  ;  ant.  skin  and  post.  mus.  skin 

Indiana,  age  31. 

27,  '64.        40th  Indiana.    Died  Sept.  1,  '64. 

N.  Carolina,  age  26. 

19,  '64. 

flap.     Surg.  C.  H.  Ladd,  50th 

878 

Johnson.  H.,  Pt.,  D,  7th 

June  17,    Left.     Died  June  29,  1804. 

N.  C.     Probably  died. 

N.  Hampshire,  age  21.      17,  '64. 

919    Miller,  M.,   Pt.,  B,  40th 

Dec.  31  , 

Left.     Died  December  31.  1802. 

879 

Johnson,  R.  H.,  Pt.,   C,  ;  Sept.  29,    Right.    Surg.  T.  H.  Squire,  89th 

Indiana. 

31,  '62. 

139th  New  York.               29,  '64. 

New  York.     Death  (?). 

920    Miller.  W.,Serg"t,G,45th 

May  2, 

Left;  flap.     Died  May  28,  1863. 

880 

Hauler,  N.,  Pt.,  A,  100th     Nov.  25,     Loft:  including  head  of  fibula; 

New  York. 

3,  '63. 

Illinois,  age  24.    .               27.  '63.        gang.     Died  Dec.  10,  1864. 

921    Moffitt,  B.  L.,  Lieut.,  —  , 

May  5, 

Right  (also  flesh  wound  of  leg). 

881 

Kennedy  E    Pt    F  13th     v,.v.  t      T  ,><•*.  ,.;...  .,,1.,,.       i\;..,i 

•I      A    V'pr.r     TprCpV 

5,  '64. 

Died  May  8,  1864. 

Virginia,  age  25. 

7,  '65.        exhaustion. 

922    Molter,   P.,   Pt.,   H,  6th 

May  10, 

Left;  cire.-  diarrhoea.    Died  July 

882    Kennedy,  J.rpt.,  A.  (,9th      June  3.     Right  :  flap.    Surg.  J.  A.  Spencer, 

Wisconsin,  age  23.             11,  '64. 

6.  1864;  exhaustion.  Spec.  3574. 

New  York,  age  30.          :     5,  '64.         69th  N.  Y.  N.  G.    Died  June  12, 

923    Monaghan,  M.,  Pt.,  C,  2d    June  16, 

Left  ;  C'irc.     July  20,  lig.  femoral  ; 

:     1864:  exhaustion. 

Michigan,  age  43.              17,  '64. 

gangrene.     Died  J  uly  25,  1804  ; 

883 

Kenion,  R.,  Pt.,  E.  149th    June  27,    Left  ;    flap.     Surg.  J.  L.    Dunn. 

haemorrhage. 

New  York,  age  25.            27,  '64.        109th  Penn.     Died  Mar.  4,  1865; 

924    Moody,  J.,  —,  —,  age  20.     May  —  . 

.     Died  May  28,  1863. 

small-pox. 

—,"'63. 

884 

Kennerson,  A..  Serg't.  K,     June  10,    Right;  lateral  flap.     Died  Aug. 

925    Moore,  J.  H.,  Lieut.,  A,     Sept.  1, 

Left.    Surg.W.  Lomax,  12th  Ind. 

17th  Maine,  age  33.        >    16.  '64.        4,1864. 

100th  Indiana. 

2,  '64. 

Died  October  1,  1864. 

885 

Kimple,    A..   Lieut.,  C,  .  Aug.  31,    Right.    Died  September  17,  1804. 

926    Aoore.  W.,  Pt.,  K,  14th 

July  20, 

Left.     Died  Aug.  4,  '04  ;  nervous 

25th  Iowa.                            31.  '64.   ; 

West  Virginia,  age  34.      21,  '64. 

prostration  and  emaciation. 

886 

King,  H.  M.,  Corp'l.  H,      May  5,      Right.  Surjr.  J.W.\Visliart,140th 

927  '  Morse,  J.,Pt.,B,  2d  Penn. 

July  10, 

Right.     Haemorrhage.     July  25, 

145th  Penn.,  age  27.       ,    7,  '64.        Penn.    (Gangrene.)    Died  May 

H'vy  Artillery,  age  22. 

—  ,  '64. 

1864,  amp.  thigh.     Died  August 

27,  1864;  exhaustion. 

10,  1864  ;  pyaemia. 

'LlDKLL  (J.  A.),  Example,  of  Osteomyelitis  with  Thrombosis,  in  U.  S.  Sanitary  Commission  Memoirs,  New  York,  1870,  Surgical  Volume  I,  p.  404. 
and  American  Journal  Medical  Sciences,  N.  S.,  1872,  Vol.  LXIV,  p.  358. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


477 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AXD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

923 

Morris,  S.  P.,  Serg't,  K, 

July  2, 

Left.     Died  July  12,  1863.                 973  Snodderv.  L..Pt..II.  57th 

June  14, 

Left.     Died  July  14,  1864. 

20th  Pennsylvania. 

2,  '63. 

Indiana. 

—  ,  '64. 

929 

Mullen,  W.,  Pt.,  J,  105th 

Aug.  12, 

Left;  flap;  diarrhoea.   Died  Aug. 

974 

Snodgrass,  J.,  Pt.,C,36th 

June  27, 

Left  ;  circ.     Surgs.  H.  E.  Hasse, 

Pennsylvania,  age  40. 

12,  '04. 

29,  1864. 

Illinois. 

27,  '64. 

24th  Wis.,  and   W.   P.  Pierce, 

930 

Murphy,   It.  /.,  Pt.,  C, 

May  3, 

Left;  ant.  post,  flap;  erysipelas. 

88th  Illinois.     Died  July  17,  '64. 

45th  Georgia,  age  35. 

3,  '63. 

Died  May  24,  1803;  gangrene 

975 

Snow,  J.,  Pt.,  C,  169th  '•  June  30, 

Left;  large  post,  and  inus.  flap; 

of  stump. 

New  York,  age  27. 

30,   04. 

sloughing;  haemorrhage.    Died 

931 

Murphy,   T.  J.,  Pt.,  H, 

Sept.  19, 

—  ;  circ.;  typhoid  fever.     Died 

October  15,  1864. 

30th  North  Carolina. 

19,  '04. 

October  10,  1804  ;  cachexia. 

976 

Stalze,  W.  B.,  Corp'l,  B, 

July  18. 

Right;    haem.   from   gangrenous 

932 

Newell,  R.  J.,  Corp'l,  D, 

July  1, 

Right.     Sura;.  S.  H.  Plumb,  82d 

62d  Ohio. 

—  ,  '03. 

stump,  fatal  July  31,  1803. 

19th  Maine.                          —  .  "'03. 

N.Y.     Died  July  10,  1863. 

977 

Stanley,  W.,  Lieut.,  G, 

Deo.  15, 

Left;  circ.    A.  A.  Surg.  A.  Rolls. 

933 

Nichols,    F.  C.,  Pt.,  F,    Sept.  19, 

Eight;    flap.      Died  October  5, 

12th  Mo.  Cav.,  age  30. 

17,  '04. 

Mortification.    Died  Deo.  19.'04. 

159th  New  York. 

19,  '64. 

18b'4;  gangrene.                                978 

Sullivan,  H.,  Pt.,  D,llth 

July  2, 

Left.     Died  November  25,  1864. 

934 

O'Daniel,  T.,  Pt.,  F,37th 

June  11, 

Right.     Died  July  4,  1804. 

Mass.,  age  39. 

4,  ?63. 

Kentucky,  age  18. 

11.  '04.                                                                    ;  979 

Swain,  F.  F.,  Capt,,  E, 

Aug.  6, 

Right.     Surg.  J.  \V.  Lawton,  U. 

935 

Odom,  J.,  "Serg't,  H,  21st 

Aug.  21,    Right.     Surg.   A.  A.  White,  8th 

123d  Indiana,  age  45. 

—  ,  '04. 

S.  V.    Gang.    Died  Aug.  23,:G4. 

South  Carolina,  age  30. 

21,  '64. 

Md.     Died  Sept.  13,  1804. 

980 

Taft,   G.  R.,  Capt.,  A., 

June  14, 

Right;   gangrene;   harm  rrhago  ; 

930 

Oliver,  H.,  Pt.,  K,  19th 

July  3, 

Right.     Surg.  A.  J.  Billings,  19th 

53d  Massachusetts. 

14,  '63. 

lig.  femond.  Died  July-1!.  1H03; 

Maine. 

3,  '03. 

Maine.     Died  July  11,  1803. 

pyaemia. 

937 

Osborne,  W.,  Serg't,  K, 

June  17,    .     Surg.  G.  L."  Potter,  145th 

981 

Theobald,  D.,Pt.,G,97th 

June  18, 

Right.    Died  June  £2,  1804. 

57th  New  York,  age  42. 

17,  '64.        Penn.     Died  July  2,  1864. 

New  York. 

18,  '64. 

038  :  Owens,  T.    D.,    Pf.,  H, 

May  22, 

Left  ;    pvaemia.     Died  July   12, 

982 

Thewing,  H.  S.,  Pt..  C, 

May  31, 

Right;  ant.  post,  flap;  sloughing. 

81st  Illinois,  age  25.            23,  '03. 

1803. 

4th  Michigan,  age  18. 

31,  '04. 

Died  June  19,  1864;  exhaustion. 

939 

Parks,    J.,  Pt.,  E,   91st1  June  18,    Left;  lat.  flap.    June  30,  haem.; 

983 

Tichenor,  G.,  Pt.,  F,  9th 

Oct.  19, 

Left.    Died  November  20,  1864  ; 

Pennsylvania,  age  38. 

18,  '04. 

femoral  lig.     July  0,  fern,  delig. 

N.  Y.  H'vy  Artillery. 

19,  '64. 

pyaemia. 

Died  July  12,  '04;  haemorrhage. 

984 

Titan,    N.,   Pt.,  H,   7th 

April  7. 

Right  ;  circ.     Died  May  8,  1865; 

940 

Parsell.  M.,  Pt.,  K,  5th 

April  6, 

Left  ;  ant.  post.  flap.     Died  April 

New  York,  age  21. 

8,  '65. 

pyaemia. 

Wisconsin,  age  33. 

8,  '05. 

19,  1805. 

985 

Toinpkins,  G.,  Pt.,  G,  1st 

July  3, 

Right  (also  wound  of  left);  gang. 

941 

Parsons,  J.,  Pt.,  F,  80th 

May  14,    Right.     A.  A.  Surg.  L.  Darling. 

N.  Y.  Heavy  Artiller}-, 

4,  '"03. 

July  17.  amp.  thigh;  21,  haem.; 

Indiana. 

14,'  '64. 

Died  July  15,  1864. 

age  45. 

femoral  ligated.     Died  July  26, 

942 

Phillips,  N.,Pt.,  A,  188th 

Feb.  6, 

Right  ;  circ.     Died  February  18, 

1803;  pyaemia;  haem.;  gang. 

New  York,  age  20.             6,  '65. 

1865;  pyaemia. 

986 

Toomey,  J.,  Pt,,  I,  1st 

Aug.  29, 

Left  ;  ant.  post,  skin  flap.     Surg. 

943 

Pierson,  E.  J.,  Pt.,  B,    Mar.  31. 

Left.     A.  Surg.  W.  B.  Hartman, 

New  Jersey  Cavalry 

29,  '64. 

A.  Hard,  8th  111.  Cav.  Lfied  Sept. 

19th  Virginia.                    A  p.  1,  '65. 

116th  Penn.     Died  April  12,  '65. 

age  30. 

28,  '64  ;  pneumonia.    Spec.  3158. 

944 

Pierson,  J.,  Pt.,  F,  80th    May  14, 

Right.     Died  June  15,  1804. 

987 

Torrence,  G.  A..  Corp'l, 

May  13, 

Left.     Surg.  A.  T.  Hudson,  26th 

Indiana.                                —  .  '64. 

A,  4th  Iowa. 

13,'  '64. 

Iowa.     Died  May  20,  1864. 

945 

Posey,  E.,  Corp'l,  E,  30th      Oct.  4, 

Right;  circ.    Died  November  9, 

988 

Tripp,  J.  W.,  Pt.,  A,  1st 

Mav  25, 

Right;  ant.  post.  flap.     Surg.  A. 

Colored  Troops,  age  41.      4,  '64. 

1804  ;  pyaemia. 

Michigan,  age  18. 

25,'  '64. 

F.  Whelan,  1st  Michigan  S.  S. 

946 

Posey,   J.,  Pt.,   D,  21st    June  20, 

Right  ;  flap.    Surg.  J.  T.  Woods, 

Died  June  8,  1864  ;  pyaemia. 

Kentucky,  age  34. 

20,  '64. 

99th  Ohio.     Died  Aug.  12,  1804. 

989 

Turner,  H.   W.,  Serg't. 

Nov.  ::o, 

Right  ;  ant.  post.  flap.     Surg.  — 

947 

Pouffe,  L.'G.,  Corp'l,  E, 

Mar.  25, 

Right.    Surg.  D.  C.  Roundy.  37th 

G,  1st  Alabama,  age  24. 

Dec.1,'64. 

McMahon,  C.  S.  A.    Died  Mar. 

17th  North  Carolina. 

25,  '65. 

Wisconsin.     Died  April  10,  '65; 

4,  1865;  small-pox. 

irritative  fever.     Spec.  4032. 

990 

Unknown,   I.  B.,    148th 

May  3, 

.     Surg.  C.  S.  Wood,  66th  N. 

948 

Ramer,  J.  P.,  Corp'l,  K, 

June  6, 

Left.     Died  June  25,  1864. 

Pennsylvania. 

—  ,  '63. 

York.    Haem.    Died  of  pyasmia. 

5th  N.  Hamp.,  age  25. 

0,  '64. 

991 

Unknown,    J.,   Colored 

Dec.  —  , 

Right,     Died  December  19,  1864. 

949 

Ranaghan,    J.,    Pt.,    E, 

May  18, 

.     Surg.  G.  L.  Potter,  145th 

servant,  age  30. 

—  ,  '64. 

09th  New  York. 

18,  '64. 

Penn.     Died  June  10,  1804. 

992  Vail,  W.,  Pt.,  A,  2d  N. 

Oct.  19, 

Right  ;  oval  skin  flap.     Surg.  D. 

950 

Rathburn,  J.  H.,  Pt.,  F, 

June  16. 

Right;  ant.  post,  flap;  dysentery.  >'\ 

York. 

19.  '64. 

B.  Van  Slvck,  22d  N.  Y.  Cav'y. 

149th  Penn.,  age  22. 

16,  '04. 

Died  July  10,  1864. 

Died  Oet/27,  1864  ;  tetanus. 

951 

Re.ddick,  W.  J.,  Pt.,  C, 

Sept.  19, 

;  circular.     Died  November;    993 

Valentine,  R.  H.,  Pt.,  D, 

April  7,  »  Right.     Died  April  11,  1865. 

20th  North  Carolina. 

19,  '64. 

7,  1864  :  pyaemia. 

5th  New  York. 

7,  '65. 

952 

Reinhart,  C.,Pt..  K,  74th 

Aug.  27, 

;  ant.  post,  flap  ;  sloughing  ;      994 

Van  Carder,  J.,  Pt.,  F, 

Sept.  28,  :  Left.     Died    October    30,   1864  ; 

Pennsylvania,  age  21. 

—  ,  '62. 

re-amp,  knee  joint.    Died  Sept. 

58th  Penn.,  age  22. 

—  ,  '64. 

exhaustion. 

23,  1863;  gangrene. 

995  Vannatter,  W.  A.,  Pt.,  I, 

Dec.  13, 

Right.     Confed.  surgeon.     Gan 

953 

Rhodes,  J.  H.,  Pt.K,  5th 

May  3, 

Right,     Surg.  G.  P.  Oliver,  lllth 

121st  Penn.  Reserves. 

15,  '62. 

grene.     Died  Feb.  13,  1863. 

New  Jersey. 

3,  V>3. 

Penn.     Died  May  13.  1863. 

996 

Walker,   F.,    Corp'l,  K, 

May  22, 

Right.     Died  May  22.  1863. 

954 

Ring,  P.,    Pt.,    E,    69th 

June  3, 

Right  ;  circ.     Died  June  21,  1864. 

47th  Ohio. 

22/63. 

New  York,  ase  45. 

3,  '64. 

- 

997 

Walker,  J.  B.,  Serg't,  K, 

Sept.  14, 

Right;   ant.  lat.  flap.     A.  Surg. 

955 

Rouch,  J.  T.,  Pt.,  A,  8th 

Mav  5, 

Left.     Died  May  18,  1864. 

12th  Missouri  Cavalry, 

14,  '64. 

J.  M.  Study.  U.  S.V.  Gangrene. 

Maryland. 

5,  '64. 

age  22. 

Died  Sept.'  19,  1864:  pyaemia. 

956 

Rouse,  G.  W.,  Adjutant, 

July  28, 

Right.     Died  August  4,  1864. 

998 

Wallick.  E.  F  ,  Pt.,  E, 

Sept.  19, 

Left.     Died  Sept.  23,  1804  ;  shock 

100th  Illinois. 

28,  '64. 

126th  Ohio. 

19,  '64. 

of  operation. 

957 

Ryan,  J.  C.,  Corp'l,  K, 

Dec.  13, 

—  .    Died  January  0,  1803. 

999 

Walters,  B.  G.,  Pt.,  H, 

Oct.  15, 

Left  :  flap.    Surg.W.  J.  Bun-,  42d 

Oth  Ne\y  Hampshire. 

13,  '02. 

19th  Maine,  age  19. 

15,  '64. 

N.  Y.     Slough.     Nov.  27,  amp. 

958 

Sanders.   C.  W.,  Pt,,  B, 

May  31, 

Right  ;  ant.  post,  flap  ;  sloughing. 

thigh.  Died  April  28.  '65;  exh'n. 

4th  S.  C.  Cav.,  age  23. 

31,  '64. 

Died  June  11,  1804;  pyasmia. 

Specs.  3445,  3440,  3447,  3448. 

959 

Savage,   J.,    Major,   2d 

Aug.  9, 

.      Died  October  22,    1802; 

1000 

Wannamaker,J.  ir.,Pt., 

Aug.  22, 

Right.    Surg.  G.W.  Metcalf,  76th 

Massachusetts,  age  20. 

9,  '62. 

haemorrhage. 

F,  25th  S.  C.,  age  27. 

22,  '64. 

N.  Y.   Died  Aug.  26,  '64  ;  exh'n. 

900 

Sawney,    L.,   Serg't,  F, 

June  25, 

Left;  flap.     Died  July  1,  1803; 

1001 

Ward,  L..  Corp'l,  B,  94th 

June  18, 

Right.     Died  August  5,  1864. 

79th  Pennsylvania. 

26.  '03. 

pyaemia. 

New  York,  age  18. 

19,  '04. 

901 

Schoeneck,J.,Pt.,B,55th 

June  3,     Left;  ant.  post,  flap;  sloughing. 

1002 

Warren,  R.,  Pt.,  C,  17th 

July  1  , 

Left.     Died  July  17,  1863. 

Pennsylvania,  age  30. 

5,  '64. 

Died  July  9,  1804  ;  gangrene. 

Connecticut. 

-,  '63. 

962 

Scott,    S.,  Pt.,   A,    48th 

April  1,    .     Sur>.  H.  Osborne,  51st  C. 

1003 

Weaver,   C.  D.,  Pt.,  H, 

Dec.  15. 

Left  ;  ant.  post.  flap.     Died  Dee. 

Colored  Troops. 

1,  '65. 

Troops      Died  April  3,  1865. 

43d  Mississippi,  age  33. 

15,  '04. 

25,  1864  ;  shock. 

903 

Sheridan,  S.,  Pt.,  B,  12th 

Dec.  15, 

Right;  flap.     A.  A.  Surg.  J.  S. 

1004 

Weed,  A.  1ST..  Pt.,C,10th 

May  3, 

—  ;  flap.     Died  July  9,   1803; 

Colored  Troops,  age  28. 

17,  '04. 

Giltner.     Died  Jan.  2,  1865. 

Georgia,  age  24. 

4,  '63. 

gangrene. 

9(54 

1  Shields,  R.,  Corp'l,  G, 

Nov.  27, 

Right.     Surg.  D.  B.  Allen,  30th   ;1005 

Weight,  J.,  Pt.,  A,  148th 

July  3, 

Left.     Died  July  24,  1863. 

4th  Iowa,  age  24. 

27,  '63. 

Iowa.   Died  Jan.  14,  '64  ;  pyaem.  ' 

Pennsylvania. 

3,  '63. 

965 

Sliolan,  A.,  Pt.,  D,  121st 

May  18, 

Right  ;  circ.;  slough.;   diarrhoea.    1006 

Westerfnan,  WT.,  Pt.,  C, 

June  3, 

Left;  flan.     Died  June  14,  1864; 

1 

Pennsylvania,  age  40. 

18,'  '64. 

Died  May  26,  1804;  exhaustion.   | 

2d  New  Hamp..  age  28. 

3,  '64. 

gangrene. 

'966 

Shull,  V.,  Pt.,    D,  13th 

May  19, 

Right.     Died  June  16,  1804. 

1007 

White,  L.,  Serg't,  F,  7th 

May  5. 

Right.     Died  May  5,  1864. 

1 

Indiana,  age  22. 

19.  '64. 

New  Jersey. 

5,  '64. 

967 

Sill,   \V.  J.,    Lieut.,  C, 

July  1, 

Left.     Died  July  21,  1863.               1008|  Whiting,  T'.  J.,   Serg't- 

May  6, 

Left   (also  amp.  finger).      Died 

75th  Pennsylvania. 

—  ,  %63. 

;     Mai  or,  2d  Michigan. 

6,  '64. 

May  13,  1804. 

968 

Skinner,  J.,  Col'd  team-    Sept.  20, 

Right.    Died  September  25,  1864. 

1009 

TVJnttalcer,  J.  P.,  Pt.,  A, 

June  16, 

Right  ;  circular.     Died  July  20, 

ster.  acre  56.                        20,  '64. 

17th  N.  C.,  age  44. 

10,  '04. 

1864. 

909  !  Smith,  ~G.    IK.,    Pt.,    E,     Sept.  29, 

Right;    flap;    sloughing.     Died    1010 

Williams,  C.  D.,  Pt.,  E, 

June  19, 

Left.     Surg.  P.  E.  Hubon,  28th 

63d  Tennessee,  ago  30.     29,  '64. 
970    Smith,  J.  C.,  Corp'l,  A,     April  2, 

October  21,  1864.                                         35th  North  Carolina. 
Right;  ant.  post.  flap.     Died  May    1011   Williams,  J.  M.,  Pt.,  H, 

19,  '6-1. 
Sept.  19, 

Mass.     Died  June  20,  1864. 
Left;    mortification.      Sept.  20, 

14th  N.Y.  H.  A.  .age  27. 

2,  '65. 

16,  1865. 

26th  Ohio. 

19,  '63. 

amputation  of  thigh.     Died. 

;  971  !  Smith,  J.  J.,  Pt..  D,  5th 
Tenn.  Cavalry,  nsc  21. 

April  7, 
9,  '62. 

Right;  circular.     Died  May  21, 

1862. 

1012 

Williams,  J.  H.,  Major, 
18th  Indiana. 

Oct.  19, 

20,  '04. 

Right  (also  w'nd  left  thigh)  ;  circ. 
Died  Oct.  24,  '64  ;  shock  of  op'n. 

972 

Smithus,  E.,  Pt.,F,  127th 

July  28, 

Right:   double  flap.     Act.  Staff 

1013  Wilson,  R.,  Pt.,  E,  29th 

July  3d, 

Left:   flap.     Surg.  F.  M.  Weld, 

Illinois,  age  25. 

28,'  '64. 

Surg.  C.  B.  Richards,  U.  S.  A. 

Colored  Troops. 

31,  '04. 

27th  Col'd  Troops.     Died  Aug. 

Died  Aug.  18,  1864. 

20,1864;  diarrhoea  and  exh'n. 

1  LlDELL  (J.  A.),  Pyxmia  connected  with  Thrombosis,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  New  York.  1870,  page  550. 


478 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

1014 

1015 
1016 
1017 
1018 
1019 
1020 

1021 

NAME,  MILITAUT 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

1023 
1023 
1024 
1025 
1026 
1027 
1028 
1029 

NAME,  MIUTAUY 
DESCRIPTION,  AND  AGK. 

DATES. 

OPERATIONS,  OPERATORS. 
RESULT. 

Winters,  L.,  Pt.,  K,  50th 
Georgia. 

Wise,  G.  A.,  Pt.,  F,  25th 
South  Carolinn,  ape  24. 
Wolf,  A.  M.,  Pt.,  C,  62d 

July  3, 
3,  '63. 

Aug.  21, 
21,  '64. 
May  8, 
8,  '64. 
April  12, 
12,  '65. 
Sept.  19, 
19,  '63. 
May  25, 
25,  '64. 
Dec.  13, 
13.  '62. 

May  18, 

—  .'  '<>4. 

Right.     Aug.  25.  slough.;  hasm. 
Sept.  11,  amput'n  thigh.     Died 
Sept.  30,  1863;  pyaemia. 
Right.     Died  September  2,  1864  ; 
effects  of  wound. 
Right.     Died  July  20,  1864. 

Left.     Died  May  14,  1865;   men 
ingitis. 
Right.     Died. 

Right.     A.  Surg.  J.  P.  Dowling, 
29th  Penn.    Died  Aug.  28.  1  864. 
Left   (thigh  and  chest  wound). 
Surg.  C.  S.  Wood,  66th  N.  Y. 
Died  Dec.  13,  1862. 
Left.     Surg.  X.   Hay  ward,  20th 
Massachusetts. 

Gorntoe,  M.  Z.,  Pt.,  H, 

9th  Georgia. 
McCowan,  W.  C.,  Pt.,  2d 
Mississippi. 
Mast,  D.  P.,  Lieut.,  D. 
Jst  North  Carolina. 
1  O'Brien.  M.  J..  Pt.,  10th 

Oct.  7, 
—  ,  '64. 
July  —  , 

Mar.  31, 
,  31.  '65. 
Sept.  17, 

Left. 

.     Surg.    C.   S.   Wood,  66th 
New  York. 
Right. 

Right;  circular;  sloughing. 
Left;  flap. 

Left.      Surg.   W.   Graham,  40th 
Illinois. 
Left.     Surg.  G.  L.  Potter.  145th 
Peun.  (Also  woundof  right  leg.) 

Pennsylvania. 
Wood,  /?.#.,  Pt.,  D,  ]<lth 
Virginia  Art'v,  age  18. 
Votes,   T.,  Pt.',  V,  21st 
Ohio. 
Ztllman.   I.   C.,  Pt.,  B, 
58th  Alabama,  age  18. 
Zimmerman,  M.,  Pt..  H, 
81st  Pennsylvania. 

Bennett,  M.,  Pt.,  A,  69th 

Georgia,  age  31. 
Scott.  J.  C'.,  Corp'l,  A, 
42d  Miss.,  age  30. 
Steward,  ,  Lieut.,  I, 
llth  Georgia,  age  41. 
Tutter,  G.  W.,  Pt.,  G,  3d 
Arkansas. 
Vanzoger,  J.,  2d  Missis 
sippi  Battery. 

38.  '62. 
July  1, 
2,  '63. 
Nov.  22, 
22,  '64. 
May  18, 
—  ,  '64. 
Oct.  5, 
—  ,  '62. 

New  York. 

Primary  Amputations  in  the  Middle  Third  of  the  Leg  for  Shot  Injury. — Eight  hun 
dred  and  ninety-two  of  the  three  thousand  three  hundred  and  ninety-five  primary  amputa 
tions  in  the  continuity  of  the  bones  of  the  leg  were  performed  in  the  middle  third.  The 
result  in  six  of  these  cases  was  not  determined;  seven  hundred  and  thirty-six  proved  suc 
cessful,  and  one  hundred  and  fifty  were  fatal,  a  mortality  of  16.9  per  cent.,  or  7.5  per  cent, 
less  than  that  of  the  primary  ablations  in  the  upper  third  of  the  leg. 

Examples  of  Successful  Primary  Amputations  in  the  Middle  Third  of  the  Bones  of  the 
Leg. — The  operations  of  this  group  numbered  seven  hundred  and  thirty-six;  one  hundred 
and  fifty-five  were  performed  on  Confederate  and  five  hundred  and  eighty-one  on  Union 
soldiers.  Of  the  latter  the  names  of  five  hundred  and  seventy-six  are  found  on  the 
Pension  Rolls;  two  are  retired  officers,  and  three  do  not  seem  to  have  applied  for  pensions. 
Twenty-seven  have  died  since  the  date  of  their  discharge  from  the  service — one  of  erysip 
elas,  one  of  epilepsy,  one  of  congestion  of  the  brain,  seven  of  phthisis,  three  of  accidents, 
and  fourteen  of  causes  not  stated. 

CASE  732. — Private  D.  S.  Crawford,  Co.  A,  47th  Pennsylvania,  aged  20  years,  was  wounded  at 
Cedar  Creek,  October  19,  1864,  and  admitted  to  Camden  Street  Hospital,  Baltimore,  one  week  afterwards. 
Assistant  Surgeon  G.  M.  McGill,  U.  S.  A.,  contributed  the  pathological  specimen  shown  in  the  adjoining 
wood-cut  (FlG.  286),  with  the  following  description:  "The  patient  had  received  a  shot  fracture  of  the  right 
leg  at  the  lower  third,  for  which  amputation  was  performed  the  same  day  at  the  middle  third.  Necrosis 
of  the  stump  of  the  tibia  ensued  to  the  extent  of  several  inches,  necessitating  resection,  which  was  per 
formed  by  Acting  Assistant  Surgeon  W.  G.  Smull  on  March  24,  1865,  chloroform  being  used  and  the 
operation  performed  by  lateral  flaps.  The  patient  did  very  well  afterwards.  The  upper  portion  of  the 
stump  healed  by  first  intention."  The  patient  was  subsequently  transferred  to  Jarvis  Hospital,  where  he 
was  discharged  from  service  May  31,  1865,  and  afterwards  supplied  with  a  "Palmer"  artificial  leg.  His 
pension  was  paid  June  4,  1880.  In  his  applications  for  commutation  he  described  the  condition  of  the 
stump  as  "'continuing  good."  The  specimen,  No.  4225,  Sunjical  Section,  A.  M.  M.,  consists  of  bones  of  the 
stump,  removed  at  the  second  operation,  and  measuring  five  inches  in  length.  A  large  sequestrum  extends 
the  entire  length,  embraced  by  an  involncrnm,  which  is  wanting  on  the  anterior  border;  and  the  fibula, 
well  rounded,  has  joined  its  extremity  to  the  tibia. 

CASE  733. — Private  D.  Jerman,  Co.  F,  190th  Pennsylvania,  aged  23  years,  was  wounded  before 
Petersburg,  July  11,  1864.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Fifth  Corps,  whence 

i>f  right  leg,  five"  months     Surgeon  L.  W.  Read,  U.  S.  V.,  reported:  "Severe  wound,  with  fracture  of  right  leg,  caused  by  a  solid  shot, 
after  amputation.    Spec.     and  followe(1  by  air,putation  at  middle  third."     The  operation  was  performed  by  the  flap  method.     From 
the  field  the  patient  was  transferred  to  City  Point,  thence  to  Beverly  Hospital,  and  subsequently  he  passed 

through  various  hospitals  in  Philadelphia,  where  he  was  supplied  with  a  "Palmer"  artificial  leg.  On  August  7,  1865,  he  was 
discharged  from  service  and  pensioned.  In  his  subsequent  application  for  commutation  for  an  artificial  limb  he  represented  the 
stump  as  being  "sore  occasionally,"  and  mentioned  Surgeon  L.  W.  Bead,  U.  S.  V.,  as  the  operator.  The  pensioner  died  May  9, 
1880,  his  attending  physician  certifying  that  "the  stump  of  the  limb  was  diseased  and  in  an  ulcerating  condition,  resulting  in 
his  death."  The  colored  lithograph  opposite  (PLATE  LXXVI)  is  a  copy  of  a  drawing  by  Hospital  Steward  E.  Stanch,  made 
immediately  after  the  amputation,  and  shows  the  comminution  of  the  bone,  and  especially  the  terrible  laceration  of  the  soft  parts, 
caused  bv  the  missile,  a  solid  shot. 


280. — Bony  stump 


bllEU  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations  in  the  Hospitals  near  Skarpsbunj.  Md.,  in  Am.  Jour.  Med.  Sci's,  1863,  Vol.  XLV,  p.  < 


-.     o 

m 

r     3) 

;_  > 

=       O 
•:       2 

-o 


.SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LKG. 


479 


FIG.  287.-Bony 
stump  of  the  left 
leg,  five  months 
after  amputat'n. 
Spec.  4:^0. 


FIG.  288.— Stump  after  an- 
tero-posterior  flap  amputa 
tion.  Spec.  4305. 


CASE  7.34. — Private  F.  \V.  Knight,  Co.  E,  llth  Vermont,  aged  21  years,  was  wounded  in  the  right  leg,  at  Winchester 
September  19,  1864,  by  a  minie"  ball,  which  passed  through  the  ankle  joint.  He  was  conveyed  to  the  Depot  Hospital  of  the 
Sixth  Corps,  where  amputation  was  performed  but  not  recorded.  Surgeon  F.  V.  Hayden,  U.  S.  V.,  noted  the  following  history : 
"The  wounded  man  was  admitted  to  Sheridan  Hospital,  Winchester.  October  5th,  with  amputation  of  the  right  leg  at  middle 
third,  performed  the  day  after  the  injury  by  Surgeon  W.  A.  Barry,  98th  Pennsylvania,  the  flap  method  being  used,  with  circular 
section  of  the  muscles.  Erysipelas  appeared  a  few  days  after  the  operation.  One  and  a  half  inches  of  protruding  bone  was 
removed  on  October  10th.  The  treatment  consisted  of  stimulants  and  tonics,  including  quinine,  etc."  On  December  5th,  the 
patient  was  transferred  to  Frederick  Hospital,  and  two  weeks  later  to  Central  Park,  New  York  City,  whence  Acting  Assistant 
Surgeon  S.  Teats  contributed  the  specimen,  No.  4330,  Surgical  Section,  A.  M.  M.,  represented  in  the  annexed  cut  (FiG.  287), 
with  the  following  result  of  the  case:  "The  stump  became  painful  and  tender,  its  end 
cold  and  bluish  in  appearance,  and  a  circular  exuberant  ulcer  formed  in  the  cicatrix. 
On  February  15,  18G5,  chloroform  was  administered  and  re-amputation  was  performed 
by  the  circular  method  by  Surgeon  B.  A.  Clements,  U.  S.  A.  Sutures,  adhesive  straps, 
and  water  dressings  were  applied  after  the  operation.  The  result  was  favorable  and 
the  stump  healed."  The  patient  was  discharged  from  service  August  17,  1865,  and 
pensioned,  having  been  previously  furnished  with  an  artificial  leg  by  Dr.  E.  D.  Hudson, 
of  New  York  City.  In  his  applications  for  commutation  the  pensioner  reported  the 
stump  as  remaining  in  ''good  condition."  His  pension  was  paid  March  4,  1880.  The 
specimen  consists  of  the  re-amputated  stumps  of  the  tibia  and  fibula,  showing  an 
excellent  deposit  of  callus  but  being  carious  internally. 

CASE  735. — Private  J.  Shaud,  Co.  K,  93d  Pennsylvania,  aged  26  years,  was 
wounded  at  Fair  Oaks,  May  31,  1862.  He  was  conveyed  to  White  House  Landing 
and  thence  by  transport  steamer  to  New  Haven,  Connecticut.  Surgeon  P.  A.  Jewett,  U.  S.  V.,  in 
charge  of  Knight  Hospital,  recorded  the  wounded  man's  admission,  June  9th,  with  "  amputation  of  leg," 
and  reported  that  he  recovered  and  was  transferred  to  New  York  City  January  19,  1864,  "to  be 
furnished  with  a  wooden  leg."  Surgeon  B.  A.  Clements,  U.  S.  A.,  reported  that  the  patient  was  dis 
charged  from  service  at  Central  Park  Hospital  March  9,  1864,  by  reason  of  "  loss  of  right  leg  by  pi'imary  amputation,  performed 
for  shot  fracture  involving  the  ankle  joint."  A  cast  of  the  stump  (Spec.  4305,  Suryical  Section,  A.  M.  M.),  showing  the  cicatrix 
to  be  located  on  the  anterior  face  above  the  extremity,  was  contributed  by  Acting  Assistant  Surgeon  G.  F.  Shrady,  and  is  shown 
in  the  adjoining  wood-cut  (FiG.  288).  Dr.  E.  D.  Hudson,  of  New  York  City,  who  supplied  the  pensioner  with  an  artificial  leg 
before  he  left  the  hospital,  described  the  stump  as  having  been  formed  by  an  "antero-posterior  flap  amputation  at  the  junction 
of  the  middle  and  lower  thirds"  of  the  limb.  The  pensioner  was  paid  June  4,  1880.  He  reports  the  condition  of  the  stump  as 
remaining  sound  and  healthy. 

In  the  following  instance  both  legs  were  successfully  amputated  at  the  middle  thirds 
one  day  after  the  injury: 

CASE  736. — Private  E.  B.  Higyinbotham,  Co.  F,  38th  Georgia,  appears  recorded  on  a  Confederate  hospital  register  as 
having  had  "both  legs  fractured  by  gunshot,  at  Spottsylvania  Court  House,  May  12,  1864,"  for  which  "both  limbs  were  ampu 
tated  at  the  middle  third  by  Surgeon  W.  J.  Arrington,  P.  A.  C.  S.,  on  the  following  day."  The  man  recovered,  and  was  subse 
quently  furnished  with  artificial  legs  by  the  Confederate  Association  for  the  relief  of  maimed  soldiers. 

Fatal  Primary  Amputations  in  the  Middle  Third  of  the  Bones  of  the  Leg. — The  one 
hundred  and  fifty  operations  of  this  group  were  performed  on  twenty-two  Confederate  and 
one  hundred  and  twenty-eight  Urik>n  soldiers.  Exhaustion,  pyaemia,  and  gangrene  were 
reported  as  the  principal  causes  of  death. 

CASE  737.  —-Private  E.  J.  Valleley,  Co.  A,  3d  Rhode  Island  Artillery,  aged  18  years,  was  wounded  by  the  explosion  of 
the  magazine  of  the  Gunboat  "George  Washington,"  near  Beaufort,  S.  C.,  April  10,  1863.  His  injuries  comprised  two  scalp 
wounds  of  no  great  importance,  a  compound  fracture  of  the  upper  fifth  of  the  right  ulna,  a  fracture  of  the  right  femur  at  its  middle, 
and  compound  comminuted  fracture  of  the  bones  of  the  right  leg  and  foot.  There  was  most  alarming  nervous  depression.  Stim 
ulants  and  nourishment  were  liberally  supplied,  but  no  decided  reaction  followed.  Forty-eight  hours  after  the  receipt  of  the  injuries 
it  was  thought  best  to  amputate  the  leg,  which  operation  was  performed  at  the  middle  third  on  April  12th.  After  the  operation  the 
thigh  continued  to  swell  till  it  reached  an  enormous  size,  which  circumstance  gave  reason  to  believe  that  the  femoral  artery  had 
been  ruptured  by  the  fractured  ends  of  the  femur.  The  patient  was  delirious  a  good  part  of  the  time  after  the  operation.  He  died 
on  the  morning  of  April  14,  18o3.  There  was  no  attempt  at  union  in  the  incisions  that  were  made  for  the  removal  of  the  limb, 
and  the  stump  had  an  unhealthy  look,  the  discharge  being  of  an  ashy  color  and  past}'  consistence.  For  two  days  before  he  died 
he  was  isolated  from  the  other  wounded  patients.  After  death  a  large  quantity  of  bloody  serum  was  found  in  the  cellular  tissue 
of  the  thigh;  the  artery  and  vein  were  entire  in  their  whole  length.  The  lower  fragment  of  the  femur  was  pushed  up  behind  the 
lower  end  of  the  upper  fragment,  denuding  the  latter  of  its  periosteum  for  more  than  three  inches.  The  amputated  portions  of  the 
tibia  and  fibula  were  found  to  be  both  broken  at  the  junction  of  the  malleoli  with  these  bones,  the  tibia  being  stripped  of  peri 
osteum  for  about  four  inches  upward  from  the  joint.  The  fibula  was  also  broken  about  three  inches  above  the  joint.  The 
posterior  end  of  the  os-calcis  was  broken  oft',  and  this  bone  was  extensively  fissured  and  otherwise  injured;  the  cuboid  bone  was 
comminuted.  The  wound  in  the  soft  parts  was  about  four  inches  long,  running  upward  from  the  superior  surface  of  the  astrag 
alus  on  the  inner  side  of  the  leg,  and  the  tibia  protruded  some  two  inches.  The  history,  together  with  the  specimen  (No.  1165, 
Surf).  Sect.,  A.  M.  M.),  consisting  of  the  amputated  bones  of  the  leg,  was  contributed  by  Surgeon  F.  L.  Dibble,  6th  Connecticut. 


480 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


CASE  738.— Brigadier  General  G.  W.  Taylor.  U.  S.  V.,  was  wounded  in  the  left  leg,  at  Bull  Run.  August  27,  186^.  The 
character  of  the  injury  and  its  result  was  reported  by  Assistant  Surgeon  J.  B.  Brinton,  U.  S.  A.,  as  follows:  "A  ball  entered  at 
the  inner  edge  of  the  tibia,  about  six  inches  above  the  internal  malleolus,  passed  directly  through  and  comminuted  the  bone  very 
badly  for  about  six  inches  above  and  below,  making  two  openings  of  exit  on  the  anterior  and  outer  aspect  of  the  leg  about  five 
inches  above  the  external  malleolus.  The  patient  was  admitted  into  the  Mansion  House  Hospital,  Alexandria,  thirteen  hoxrs 
after  the  reception  of  the  injury,  where  Surgeon  J.  H.  Brinton,  U.  S.  V..  amputated  the  limb  by  the  double  flap  method  at  the 
middle  third.  The  operation  was  performed  twenty-six  hours  after  the  reception  of  the  injury,  the  patient  losing 
considerable  blood  and  all  the  vessels  requiring  ligation.  He  had  been  with  the  army  through  the  Peninsular 
campaign  and  his  blood  appeared  to  be  very  much  vitiated  by  morbific  influence  of  malaria.  After  the  amputa 
tion  it  was  discovered,  what  was  previously  suspected,  that  the  fibula  was  not  broken  by  the  force  of  the  ball,  but 
by  the  weight  of  the  patient  coining  upon  it  suddenly  when  the  support  from  the  tibia  was  destroyed  by  its  fracture. 
The  patient's  arterial  system  did  not  fully  react;  his  pulse,  which  was  feeble,  tremulous,  and  very  irregular  at 
times,  evidently  denoted  a  depraved  condition  of  the  system.  He  refused  to  take  stimulants  except  sparingly. 
This  condition  continued  until  September  1,  1862,  when  he  died  at  4  o'clock  A.  M.  He  was  under  the  influence  of 
chloroform  during  the  operation."  The  amputated  parts  of  the  tibia  and  fibula  (Spec.  313,  Surg.  Sect.,  A.  M.  M.), 
represented  in  the  wood-cut  (FlG.  21~9),  were  contributed  to  the  Museum  by  the  operator. 

CASE  739. — Lieutenant  C.  J.  Sergeant,  Co.  F,  7th  Iowa,  aged  31,  was  wounded  in  the  left  leg,  during  the 
siege  of  .Atlanta,  August  11,  1864.  Surgeon  J.  M.  Woodworth,  1st  Illinois  Light  Artillery,  described  the  injury 
as  an  "extensive  fracture  of  both  bones  of  the  leg,  produced  by  a  musket  ball,  for  which  amputation  was  per 
formed  on  the  same  day  by  Surgeon  W.  R.  Marsh,  2d  Iowa,  at  the  field  hospital  of  the  2d  division,  Sixteenth 
Corps."  Five  days  after  the  date  of  the  injury  the  patient  was  moved  to  the  field  hospital  at  Marietta,  and  two 
months  later  he  Avas  transferred  to  Chattanooga,  thence  to  Nashville,  and  later  to  the  Officers'  Hospital  at  Louis 
ville.  Surgeon  F.  Greene,  U.  S.  V.,  in  charge  of  the  latter,  described  the  amputation  to  have  been  performed  by 
the  "  antero-posterior  flap  method  at  the  middle  third,"  and  reported  that  "  for  a  month  after  the  operation  oozing 
of  blood  continued  from  the  stump,  the  patient's  condition  being  feeble.  Gangrene  supervened  in  the  latter  part 
of  September,  chiefly  attacking  the  anterior  flap.  The  bone  became  necrosed,  and  in  October  two  pieces  were 
removed  and  the  gangrene  controlled."  The  patient  was  lastly  admitted  to  Grant  Hospital,  Cincinnati,  where  he 
obtained  a  leave  of  absence  on  December  12th.  He  died  at  his  home  in  Ottumwa,  Iowa,  April  10,  1865.  his 
attending  physician,  Dr.  J.  C.  Hinley,  certifying  that  "his  disease  was  pyajmia,  being  caused  by  the  amputation 
of  one  of  his  lower  extremities,  the  stump  of  which  never  healed." 


FIG.  28!).-Left 
tibia  fractured 
by  a  musket 
bal I;  fibula  frac 
tured  by  the 
subject'sweight 
suddenly  com 
ing  upon  it. — 
Spec.  313. 


TABLE  LXIX. 

Summary  of  Eight  Hundred  and  Ninety-two  Cases  of  Primary  Amputations  in  the  Middle  Third  of 

the  Leg  for  Shot  Injuries. 


[Recoveries,  1—736;  Deaths,  737— 88G;  Results  unknown,  887— 892.  J 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS. 
RESULT. 

1 

Abbott.  F.A.,  l»t.,K,  7th 

May  16. 

Left  ;  double  flap.     Mustered  out 

17 

Bailey,  />.,  Pt.,  I),  7th  S. 

Aug.  21, 

Right.      Provost   Marshal    April 

N.  Hampshire,  age  38. 

17,  "64. 

December  22,  1864. 

Carolina  Bat  ry,  age  44. 

21,  '64. 

1,  1865. 

2 

Ackerman,  ,1.  11.,  I't.,  C, 

Jan.  11, 

Left;  flap.     Surg.  G.  L.  Carhart. 

18 

Buird,  J.  N.,  Corp'l,  A, 

April  7, 

Left.     Discharged. 

31st  Iowa,  age  24. 

11,  "03. 

31st  Iowa.  Disch'd  April  13,  '63. 

34th  Illinois. 

'I   '62 

: 

Allen,  U.  F..Pt.,  F,  120th 

Nov.  2, 

Left;  flap.     Surg.  11.  A.  Reynolds, 

19 

Raird,  J.   T.,  Lieut.,  C, 

Aug.  19, 

Left;  circular;  gangrene.  Trans 

New  York,  age  20. 

2,  '64. 

1st  Me.  H'vyArt'y.     Recovery. 

16th  Vii^inia.  age  31. 

20.  '64. 

ferred  Nov.  !).  1864. 

April  9,  1870.  stump  good. 

20 

Baldis,  J.,  Pt.,  C.  3Uth 

July  2, 

Left;    ant.  post.  flap.     Surg.  F. 

4 

Alt,    M.,    Pt.,    F,     26th 

May  16, 

Right;  circ.     Surg.  J.  S.   Prout. 

New  York,  age  £7. 

2,  '63. 

Wolf,  39th   X.  Y.     Discharged 

Missouri. 

17,  '63. 

2(ith  Missouri.     Gang.;    crysip. 

April  10.  1864. 

Disch'd  Oct.  24,  1863.                        21 

Ball,  Tl.  G.,    Serg't,  D, 

Mar.  31. 

Left:   lateral   flap.     Surg.  A.  S. 

' 

Ambrose.  R.,  Pt..  !•',  8th 

May  7, 

Right  ;  flap.    Surg.  M.  Storrs,  Sth 

147th  N.  York,  nge  20. 

A  p.  1,'65. 

Coe.  147th  New  York.     Disch'd 

Conn.,  age  27. 

7,  '64. 

Conn.     Disch'd  May  7,  1865. 

August  2,  1865. 

•  : 

Anderson,  J..Pt.,  1C,  18th 

July  22, 

Right;   flap.     Surg.  A.  B.  Mono- 

22 

Iianentinr,i;.W.,V\..\l, 

Oct.  1. 

L't;  oval  flap.  Surg.  A.G.Emory, 

Missouri,  age  20. 

22,"  '64. 

han.  63d  Ohio.     Disch'd  Aug. 

14th  Tennessee,  age  25. 

1.  '61. 

C.  S.  A.     Retired  Jan.  20,  1865 

2.  186.'). 

23 

Barber,  S.  M.,  Capt.,  II, 

May  22, 

Right;  flap.     Surg.  J.  Pomerene, 

7 

Anderson.  W.,Pt.,H,.r,th 

Sept.  21), 

Left;  circ.     Surg.   If.  C.  Merry- 

42d  Ohio. 

22,"  '63. 

42d  Ohio.     Disch'd  Mar.  15,  '64. 

Col'd  Troops,  age  18. 

29,  '04. 

weather.   5th   Colored   Troops. 

24 

Hates.  C.,  Corp'l,  G,  51st 

Sept.  17, 

Left  ;  ant.  post.  flap.    Surg.W.  II. 

Disch'd  May  8,  1863. 

New  York,  age  23. 

1L<,  :6,'. 

Leonard,    51st    N.   Y.     Disch'd 

.-' 

Andrews.  A.  S.,  Capt.,  B, 

June  9, 

.    Surgeon  —  Gill,  C.  S.  A. 

January  17.  1863. 

2d  North  Carolina. 

!),  '63. 

Recovery. 

25 

Bates,  O.  W.,  Pt.,  M,  1st 

•\pril  6, 

Right  ;    flap.      Discharged    Sep 

9 

An'ilim,    N.    J.,  I't.,  I, 

Do.  31.  '62. 

.     Recovery. 

Me.  Il'vv  Art.,  age  37. 

(i,  '65. 

tember  12,  1865. 

24th  Tennessee. 

Jan.  2,  '63. 

23 

Baum,  F.W.,  Pt.,C,  10th 

Nov.  25, 

Left  ;  circ.     Surgeon  R.  J.  Mohr, 

10 

Apple.  L.,  I't.,  I,  1st  Flor 

Deo.  7, 

Right;    circ.      Provost   Marshal 

Missouri. 

25,  '63. 

10th  Iowa.    Disch'd  Apr.  22.  '64. 

ida  Cavalry,  ago  33. 

8.  '64. 

March  4,  1865. 

27 

Baxter,  W.  11  ,  Lieut.,  K, 

June  27, 

Right  :    flap.     Discharged    Dec. 

11 

Armstrong,  j.  M.,  Pt.,  K, 

July  21, 

Left:  flap.    Surg.  M.W.  Thomas, 

113th  Ohio,  age  21. 

27,  '64. 

29,  1864. 

i:;th  Iowa. 

21,  ''64. 

13th  Iowa.    nisch'dJuly21,'65. 

2S 

Bean,   Wr.    R.,    Pt.,    7th 

May  12, 

Left:  circ.     Discharged  Septem 

12 

Ashlerman,    J.,   Pt  ,    B, 

June  17, 

Left;  flap.     Surg.  M.  C.  Wood- 

Maine  Bat'rv,  age  27. 

12,'  '64. 

ber  5,  1864. 

r-lst  Ohio. 

18,  '62. 

worth.  51st  Ohio.     Disch'd  Feb. 

29 

Beaton,  1J.  P.)  Serg't,  M, 

June  !', 

Right:    flap.     Surg.  W.   II.   Me- 

23.  1863. 

2d()hioCav.,  age  21. 

10,  '63. 

Reynolds,    2d    Ohio    Cavalry. 

13 

Augustine,  F.,  Pt..I,  21st 

Miiv  14, 

Left:   flap.      Discharged.     1870, 

Disch'd  Oct.  15.  1864. 

Wisconsin,  age  24. 

14,'  '64. 

stump  sound. 

30 

Beatty,  T.,  Pt.,  I,  4th  N. 

June  3, 

Left;  flap.     Discharged  January 

14 

Averill,  J.  B.,  Pt.,  E,  8th 

Sept.  19, 

Right  :  circ.    Surg.  J.  G.  Thomp 

York  Artillery,  age  39.       3,  '04. 

26,  1864. 

Vermont,  age  23. 

ID,  '04. 

son,  77th  N.  York.     Gangrene. 

31 

Bee,  1).  II.,  Pt",  A,  6  1st  |  July  12, 

Right  ;  ant.  post.  flap.  A.  A.  Surg. 

Disch'd  Oct.  11,  1865. 

Penn.,  age  25.                      12,  '64. 

M.  F.  Price.     M.  O.  Sept.  7,  '64. 

15 

Babbitt,  .1.   W.,  Pt.,  C, 

July  1, 

Right;  flap.     Surg.  A.  J.  Ward. 

33 

Beeman,G.W..Pr.,  K,  2(1 

Oct.  19, 

Right;  circ.     Surg.W.  A.  Barry, 

24th  Michigan. 

2,  '63. 

2d  Wis.     Disch'd  Nov.  6,  1863. 

Conn.  II.  Art.,  age  20. 

20,  '64. 

!)8th  I'enn.    Disch'd  July25,'65. 

16 

Bailey,    A.  W.,  Pt.,  A. 

Sept.  14, 

Left  ;  flap.     Disch'd  Dec.  13,  '62. 

33 

Beer,  A.  G.,  Pt.,  D,  20th  De.31,'62, 

Left.     Surg.  M.  M.  Stimmel.  26th 

24th  New  York. 

16,  '62. 

Died  October  11,  1867. 

Ohio.                                :Jan.l.'63. 

Ohio.     Disch'd  Aug.  9,  1863. 

SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


481 


No. 

NAME,  MILITARY 
DESCUU'TION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AXD  AGE. 

i  _»__ 
DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

34 

Beers,  B.,  Pt.,   D,  69th 

Nov.  25, 

Right;    circ.     Disch'd   May  20, 

76 

Brown,  C.  K.,  Pt.,  A,  7th 

May  8, 

Left;  circ.     Surg.  A.  J.  Ward,  2d 

Ohio,  age  21. 

27.  '63. 

1864. 

Wisconsin,  age  24. 

9,  '64. 

Wis.     Disch'd  July   16,   1864. 

35 

Beers,  J.  H.,  Pt.,  E,  146th 

Sept,  16, 

Right  ;  circ.     Surg.  A.  A.  White, 

Feb.  6,  '65,  amp.  leg.  Recovery. 

New  York,  age  29. 

17,  '64. 

8th  Md.     Disch'd  March  23,  '65. 

77 

Brown,  J.  M.,  Pt.,  D,  5th 

July  2, 

Right.     A.  Surg.  T.  C.  Hill,  5th 

36 

Bennett,  M.,Pt.,  15,  125th 

Mar.  31, 

Left  ;  flap.     Surg.  W.  S.  Cooper, 

Alabama,  age  28. 

2.  '63. 

Ala.     Paroled  Sept.  25,  1863. 

New  York. 

31,  '65. 

125th  N.Y.  Disch'd  Aug.  12,'65. 

78 

Brown,  W.   M.,  Pt.,  F, 

July  20, 

Left  ;  ant.  post.  flap.    A.  Surg.  A. 

37 

Bennett,  R,  H.,  Pt.,   D, 

Sept.  29, 

Right;  flap.      Disch'd  May   17, 

91*  Ohio,  age  23. 

21,  '64. 

Titus,  31st  W.Virginia  Cavalry. 

7th  C.  Troops,  age  23. 

3:i.  '64. 

1865. 

Disch'd  January  31,  1865. 

38 

Benson,    L.   W.,  Pt.,  I, 

Sept.  17, 

Right  ;  flap.   Surg.  A.  S.  Warner, 

79 

Bullard,  F.  W.,  Pt.,  B, 

May  6, 

Left:  flap.    Confederate  surgeon. 

16th  Conn.,  age  -10. 

19,  '62. 

16th  Conn.     Disch'd  Jan.  23,'63. 

57th  Mass.,  age  19. 

8,  '64. 

July  7.  1865,  re-amputation  leg. 

39 

Berg,  M.,Pt..B,  7th  Kan 

Dec.  24, 

Left.     Discharged  April  7,  1863. 

Disch'd  Nov.  23.  1865. 

sas  Cavalry. 

24,  '62. 

80 

Bumgardner,  S.,  Serg't, 

Sept,  22, 

Left  (also  amputation  right  foot). 

40 

Biddle.    A.  'lL,   Pt.,   K, 

Dec.  13, 

Left.     Discharged  June  29,  1863. 

F,  14th  W.  Va.,  age  35. 

23,  '64. 

Disch'd  March  4.  1865. 

24th  New  Jersey. 

14,  '62. 

81 

Bunger.W.,  Pt.,G,  118th 

May  1, 

Left;   flap.     Disch'd   August   1, 

41 

Biggert,  H.,  Pt.,  L,  15th 

July  2, 

Right  ;  flap.     Surg.  J.  W.  Alex 

Illinois. 

1,  %3. 

1863. 

Penu.  Cavalry. 

2,  '63. 

ander,  15th  Pennsylvania  Cav 

82 

Burd,  S.,Corp'l,  B,  188th 

Sept.  29. 

Right;  ant.  post.  flap.     Disch'd 

alry.     Disch'd  June  16.  1864. 

Pennsylvania,  age  24. 

Oct.  1/64 

September  23,  1865. 

42 

Bitten,  L.  C.,  I't.,  K,  1st 

Mav  31, 

R't  :  circ.     Surg.  G.  M.  Brennan, 

83 

Burke.  "./.,  Pt.,  A,  13th 

June  4, 

Left  ;  flap.     Disch'd  May  25,  '65. 

U.  S.  S.  S.,  age  21. 

31,"  '64. 

1st  Sharpshooters.  Disch'd  Sept. 

New  Hamp.;  age  23. 

4,  '64. 

Died  5Iarch  31,  1870;  epilepsy. 

13,1864.     Re  amp.  April  7,  '66. 

84 

Burns,   B.,  Pt.,    B,   22d 

Sept.  17, 

Right  ;  circ.     Disch'd  May  6,  '63. 

43 

Bixby,  L.  C.,Pt.,G,  45th 

Feb.  11, 

Right;  flap.     June,  1862,  re-amp. 

New  York,  age  24. 

17  '62. 

Spec.  2540. 

Illinois. 

11,  '62. 

Disch'd  July  23,  1862. 

85 

Burns,  R.,  Pt.,  A,  35th 

Mar.  7, 

Right  ;  flap.     Disch'd  August  2, 

44 

Blake,  J.,   Pt.,  K,  20th 

Dec.  13, 

Left.      Surg."  N.   Hayward.  20th 

Illinois. 

7,  '62. 

1862. 

Massachusetts. 

15,  '62. 

Mass.     Disch'd  Oct.  1.  1863. 

86 

Burns,R.  R.,  Pt.,  C.  14th 

June  26, 

Left.     Retired  February  20,  1865. 

45 

Blakf.ley,  II.  P.,  Pt.,  F, 

July  2, 

Right.  Confederate  surgeon.  Pa 

Tennessee,  age  25. 

26,  '64. 

14th  South  Carolina. 

3,  '(53. 

roled  Sept.  5.  1863. 

87 

Burr,  D.  B.,  Pt.,  A,  14th 

Dec.  13, 

Right.    Surg.  G.  T.  Stevens,  77th 

46 

Blakla,  W.,  Pt.,  E,  46th 

Aug.  16, 

Right;  flap.     Surg.  W.  B.  Fox, 

Connecticut,  age  28. 

13,  '62. 

N.  Y.     Re-amp.     Disch'd  Mav 

New  York,  age  29. 

16,  '64. 

8th  Michigan.     Discharged. 

23,  1864.     Died  April  28,  1868"; 

47 

Blevins,  J.,  Pt.,  E,  49th 

April  9, 

Right;  ant.  post.  flap.     Surg.  G. 

consumption. 

Illinois,  age  21. 

9,  '64. 

L.  Lucas.   47th   111.     Stustered 

88 

Burst,  J.  W.,Lieut,,  105th 

Mav  26, 

Right;  flap.  Surg.  A.  51.  Reagan. 

out  Sept.  9,  1  865. 

Illinois,  age  22. 

26,"  '64. 

70th  Ind.     Gangrene.     Disch'd 

48 

Bloxon,  W.   N.,  Pt.,  E, 

Sept.  7, 

Left;  flap.    Disch'd  5Iay  26,  '65. 

October  19,  1864. 

22d  C.  Troops,  age  20. 

8,  '64. 

89 

Buslt,  J.  F.,  Pt.,  G,  Kith 

July  9, 

Left  ;  circ.     Surg.  C.  H.  Todd,  C. 

41) 

Bocklay,  H.,  Pt.,  D,  2d 

Dec.  13, 

Right  ;    circular.     Disch'd  April 

Georgia. 

11,  r64. 

S.  A.     Exchanged  Sept.  21,  '64. 

Maryland,  age  22. 

13,  '62. 

21,  1863. 

90 

Bushnell,  M.  D.,  Corp'l. 

June  24, 

Right  ;  flap.     Surg.  J.  Reily,  33d 

50 

Bodley,   C.,    Corp'!,    K, 

5Iay  16, 

Right;    flap.     Disch'd   June   16, 

H,    154th   New   York, 

24,  '64. 

N.  J.    Gangrene.    Disch'd  Aug. 

28th  Iowa,  age  24. 

16."  '63. 

1865.     Died  June  17.  1870. 

age  22. 

12,  1865.     Died  June  5,  1866. 

51 

Boehme,  F.,  Pt.,  C.  20th 

May  6, 

Left  .-  circ.    Confederate  surgeon. 

91 

Busick,  D.  W.,  Serg't,  E. 

July  2, 

Left.    Surg.  P.  G.  Robinson,  22d 

51ass.,  age  27. 

7,  ^64. 

Discharged.    1870,  stump  good. 

22d  North  Carolina. 

2,  '63. 

N.  C.     Paroled  Sept.  12,  1863. 

52 

Bond,  J.  D.  51..  Pt.,  C. 

Sept.  1, 

Right:  flap.  Surg.T.  B.Williams, 

92 

Butler,.!.  H.,  Pt.,E,  30th 

June  20, 

Right;  circ.     Surg.  G.  J.  Potts, 

78th  111.,  age  38. 

2,  '64. 

12lst  Ohio.     Disch'd  May  6,'65. 

Col'd  Troops,  age  26. 

20,  '64. 

23d  Colored   Troops.     Disch'd 

53 

Bunedun,   C.  W.,  Pt.,  G, 

July  1, 

Left.    Union  surgeon.    Recovery. 

July  25,  '65.     Died  Nov.  10,  '67. 

7th  Virginia  Cavalry. 

1.  '63. 

93 

Butts,  J.   W.,  Capt.,  H, 

July  12, 

Left."  Surg.W.  P.  Young,  4th  Ga. 

54 

Book,  (J.,  Pt.,  E,  6th  Col 

Feb.  11, 

Left;  circ.     Surg.  N.  S.  Barnes, 

4th  Georgia,  age  25. 

12,"  '64. 

To  prison  Feb.  5,  1865. 

ored  Troops. 

11.  '65. 

U.  S.V.    Recovery  May  6,  1865. 

94 

Cady,  E.  A.,  Pt.,  H,  33d 

May  3, 

Left;   circ.;    re'vmp.:    gangrene. 

55 

Booth,  J.  L.  Pt..  B,  12th 

June  13, 

Right;  ant.  post.  flap.      Confed. 

New  York,  age  21. 

3,  '63. 

Disch'd  Nov.  14,  1863. 

W.  Virginia,  age  22. 

14,  '63. 

surgeon.     Disch'd  May  15.  '65. 

95 

Cain,    F.,    Pt.,   E,    40th 

Nov.  25, 

Right  :  gangrene.     Disch'd  Oct. 

56 

Boucher,  P.,  Pt.,  I,  28th 

June  3, 

Right  :  lateral  flaps.     Surg.  P.  E. 

Indiana,  age  19. 

26,  '63. 

12,  1864. 

Massachusetts,  age  26. 

3.  '64. 

Hubon,    28th    5Iass.      Disch'd 

96 

Cain,  R.  M.,  Pt.,  C,  18th 

Sept.  9, 

Left.     Surg.  —  Green,  C.  S.  A. 

Nov.  28,  1664. 

Mississippi. 

9,  '63. 

Recovery. 

57 

Bowen.   J.,   Pt.,  C,  42d 

Dec.  30, 

Right.      Surg.  T.  I).  Fitch.  42d 

97 

Campbell.  J.  F.,  Pt.,  G, 

June  27, 

.     Surg.  C.C.Clarke,  C.S.  A. 

Illinois,  age  21. 

31,  '62. 

Illinois.     Hiem.     June  20,  1863. 

9th  Alabama. 

27,  '63. 

Recovery. 

amp.  thigh.    Dis.  April  28,  1864. 

98 

Canfield,  M.,  Pt.,  B,  34th 

June  5, 

Left  ;  flap.     Surg.  R.  R.  Clarke, 

58 

Bowland.W.,Pt.,C,  142d 

Ort.  13, 

Left:   flap.      Surg.   D.  McFalls, 

Mass..  age  34. 

5,  '64. 

34th  51ass.     Disch'd  5Iay  31,  '65. 

New  York,  age  21. 

13,  '64. 

142d  N.  Y.     Gang.     Oct.  27,  re- 

99 

Carpenter.C.G.,  Pt..  Bat 

51  ay  3. 

Right  :  flap.     Surg.  C.  S.  Wood, 

amput'n.     Disch'd  Sept.  11.  '65. 

tery  H,  1st  Art.,  age  25. 

5,  '63. 

66th  N.Y.     Disch'd  Feb.  23,  '64. 

59 

Bowman.  H.  A..  Pt..  G, 

July  21, 

Left  ;  flap.     Surg.  E.  T.  Perkins. 

100 

Carroll,  F.,  Pt.,  D,  32d 

Dec.  6, 

Left  :    post.  flap.      Surg.  C.  51. 

2d  N.  Hampshire. 

23,'  'bl. 

71st  N.  Y.  S.  M.     Disch'd  Nov. 

Col'd  Troops,  age  29. 

6.  '64. 

Wight,  32d  Col'd  Troops.     Dis 

1,  1861. 

charged  May  24,  1865. 

60 

Boi/d,  J.  E.,  Pt.,  I,  41th 

Dec.  14, 

Right.     Surgeon   G.  McDonald, 

101 

Carroll,  P.,  I't.,  G,  19th 

Feb.  16, 

Right.     A.  A.  Surg.  J.  E.  Lynch. 

Tennessee. 

14,  '63. 

22d  Virginia.     Recovery. 

Penn.  Cavalry. 

16,  '65. 

Disch'd  June  7,  1665. 

61 

Bradin,  R..  Lieut.,  E,7th 

June  16, 

Right  ;  ant.  post.  flap.     Surg.  J. 

102 

Carter,  S.  H.,  Corp'l,  A, 

June  6, 

Left  :    circ.;    gangrene.     Disch'd 

N.  York  Heavy  Artil 

17,  '64. 

E.  Pomfret.  7th  N.  Y.  H'vy  Art. 

:i6th  Mass.,  age  20. 

6,  '64. 

June  16,  1865. 

lery,  age  34. 

Disch'd  January  27,  1865. 

103 

Catlin,  I.  S.,  Col.,  109th 

July  30, 

Left.      Surgeon  W.  B.  Fox,  8th 

62 

Bra'ci(j,  J.  W.,  Pt.,G,  25th 

Dec.  13, 

.     Surg.  —  Blandy,  C.  S.  A. 

New  York,  age  30. 

30,  '64. 

5Iich.     5Ius.  out  June  4,  1865. 

Virginia. 

13,  '61. 

Recovery. 

104 

Cavwood.P.,Pt.,B.110th 

June  14, 

Right;  flap.     Ass't  Surg.  R,  R. 

63 

Braillie,   J.,  Pt.,  A,   1st 

July  3, 

Right  :   circ.     Disch'd  February 

Ohio. 

14,  '63. 

5IcCandliss,   110th  Ohio.     Dis 

Artillery,  age  33. 

3.  '63. 

29.  1864. 

charged  Aug.  26,  1863. 

64 

Brannon,  P.,  Pt.,  E,  28th 

Oct.  5. 

Left.      Surg.  W.  F.  West.   28th 

105 

Chad  wick,  J.  A.,  Pt.,  D, 

Aug.  16, 

Lett.     Disch'd  January  20,  1865. 

Illinois. 

5,  '62. 

Illinois.     Disch'd  April  7,  1863. 

9th  Maine,  age  22. 

17,  '64. 

65 

Brantley.  L.   <;.,   Pt.,  C, 

July  3. 

Left.      Surg.  .1.  A.  Vigae,  33d  N. 

106 

Chalfant,  F.  D.,  Serg't, 

July  18, 

Right.  Coufed.  surgeon.   Disch'd 

33d  North  Carolina. 

4,  '63. 

Carolina.     Recovery. 

F,  4th  W.  Va.,  age  21. 

19.  '64. 

June  24,  1865. 

66 

Bray.J'..  Pt.,  G,  1st  Mas 

Oct.  2, 

Right:    ciro.      Surg.  O.  Everts, 

107 

Chamberlain.  D.,  Serg't, 

April  1, 

Left  ;  flap.     Disch'd  June  28,  '65.  ! 

sachusetts  H'vy  Artil 

4,  '64. 

20th  Indiana.     Gangrene.    Dis 

D,  21st  Penn.  Cavalry, 

2,  '65. 

lery,  age  33. 

charged  June  14,  1865. 

age  30. 

67 

Bremenkamp,  F..  Pt..  A, 

April  6, 

Left;    circular.     Disch'd    March 

108 

Chamberlain,  T.,  Corp'l, 

5Iar.  19, 

Right  ;  double  flap.    Confederate 

9th  Illinois. 

7.  '62. 

13.  1863. 

B,  79th  Penn..  age  26. 

19.  '65. 

surgeon.  Disch'd  June  28,  1865. 

68 

Bridgem,  L.  H.,  Serg't, 

May  3, 

Right.     Disch'd  Sept.  15,  1863. 

109 

Chamberlain,  W.  H.,  Pt., 

Nov.  25, 

Left:  circ.  Surg.A.  5I.McMahon,  ; 

II,  26th  New  Jersey. 

3,  '63. 

II,  42d  Illinois,  age  21. 

27,  '63. 

64th  Ohio.    Gangrene.   Disch'd  ' 

69 

Brining,  .1.,  Pt.,  E,  116th 

Oct.  19, 

Right:    flap.     Discharged   Aug.  : 

Sept.  27,  1864. 

New  York,  age  19. 

20,  '64. 

I.  18(55. 

110 

Chapman,  J.  II.,  Capt., 

Aug.  9, 

Right.    Surg.  A.  51.  llelmer,  26th 

70 

Bronson.  D..  Pt.,  II,  (ith 

Mav  30, 

Right:  ant.  post,  skin  flap:  circ. 

B,  5th  Connecticut. 

1  1,  '62. 

N.  Y.     Veteran  Reserve  Corps 

N.  Y.  Artillery,  ago  29. 

31,"  '64. 

sect.  mus.     Disch'd  Feb.  25,  '65. 

September  2,  1863. 

71 

Bronson,  J.  B..Pt.  ,1,14th 

A  ug.  5, 

Right.     Surg.  G.  E.  Sloat,  14th 

111 

Charlton,  O..  Pt.,  E,  34th 

Sept.  10, 

Right;  flap.     Disch'd  March  15. 

Ohio,  ago  18. 

5,  '64. 

Ohio.    Amputation  thigh.    Dis 

Ohio. 

10,  '62. 

1863.     Died  Sept.  4.  1870. 

charged  June  21.  1865. 

112 

Chichester.    A.,   I't.,   E, 

Nov.  30, 

Right  :  post.  muse.  flap.     Disch'd 

72 

Brookings,  D.,  Serg't,H, 

June  16, 

Right  :  ant.  skin  and  post,  rnuso. 

127th  N.  Y..  age  24. 

30.  '64. 

5?av  23.  1865. 

17th  Maine,  age  22. 

16,  '64. 

flaps.      Disch'd   Jan.  10.   1865. 

113 

Chiddes,  C.,  Pt.,  D,  13th 

Dec.  17, 

Right  :  flap.     A.  A.  Surg.  J.  S. 

Died  Dec.  6,  1870. 

Colored  Troops. 

18,  '64. 

Giltner.     Discn'd  Aug.  8,  1665. 

73 

Brotherson,    C.,    Pt.,   G, 

Sept.  19, 

Left  :  ant.  post.  flap.    Discharged 

114 

Christenson,  W.,  Pt.,  I, 

Mav  7, 

Right;    circ.      Confed.   surgeon. 

151st  N.  Y..  age  30. 

19,  '64. 

August  11,  1865. 

115th  N.  Y.,age  23. 

7,  '64. 

Disch'd  51ay  30,  1665. 

74 

Brott,  J.   C.,  Pt.,    I!,  2d 

June  2, 

Left:  circ.     Surg.  G.  L.  Potter, 

115 

Clardy,  J.B.,  Pt.,C,24th 

Sept.  20, 

.     Surg.  J.  L.  Cunningham. 

N.Y.  H'vy  Art.,  age  24. 

2,  '64. 

145th  Penn.     Recovery. 

Alabama. 

20,  '63. 

24th  Alabama.     Recovery. 

75 

Brower,  H.'H..  Serg't,  D. 

May  10, 

Right  ;  flap.     Surg.  M.  Rizer,  72d 

lie' 

Clark,  E.  T.,  Pt.,  E,  77th 

Nov.  30, 

Right:    flap.     Surgs.  White  and 

10th  N.  Y.,  age  21. 

10,"  '64. 

Penn.     Skiy  15.  amputation  leg. 

Penn.,  age  20. 

DC.  1,'64. 

Hanna,  C.  S.  A.    Disch'd  April 

Disch'd  Nov.  2.  1865. 

21,  1865. 

SURG.  Ill— 61 


482 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

117 

Clark,  H.  B.,  Pt.,  F,  20th 

May  4, 

Left  ;  circular.    Confed.  surgeon. 

158 

Daniels,  H..  Pt.,  C,  5th 

June  2, 

Left;  circ.      Surg.  J.  W.  Buck- 

Maine. 

6,  '64. 

Disch'd  Nov.  22,  1864. 

N.  Hampshire,  age  22. 

2,  '64. 

man,  5th   N.  11.     Disch'd  Oct. 

118 

Clark,  J.   B.,   Pt.,  llth 

Sept.  19, 

Right;  flap.     Surg.  C.  B.  Park, 

15,  1864. 

Vermont,  age  29. 

19,  '64. 

llth  Vt.    (Wnd  arm,  necrosed.) 

159 

Daniels,  J.,  Pt.,  K,  47th 

May  16, 

Right  ;    circular.      Disch'd   Oct. 

Disch'd  Sept.  28,  1805. 

Indiana. 

17,  '63. 

14,  1863. 

119 

Class,   C.,  Pt.,  G,  25th 

Feb.  8, 

Left  ;  circ.   Surg.  G.  A.  Otis,  27th 

160 

Danuiker,  E.  T.,  Serg't, 

Sept.  17, 

Right  ;  flap.     Surg.  M.  Rizer,  7M 

Mass.,  age  26. 

8.  '62. 

Mass.     Disch'd  Aug.  14,  1862. 

A,  1st  Maryland  Art'v. 

17.  '62. 

Pcnn.     Disch'd  July  4,  1863. 

120 

Clayton,  H.,  Pt.,  E,  77th 

Oct.  19, 

Right;  ant.  post.  flap.     Surg.  G. 

161 

Vavey,  T.  1'.,  1't.,  I,  (ith 

Mar.  5, 

.  A.  Surg.  R.  E.  Hill,  C.  S.A. 

New  York,  ago  20. 

19,  '64. 

T.  Stevens,  77th  N.  Y.   Disch'd. 

Texas. 

5,  '64. 

Retired  December,  1864. 

121 

Clement,  J.  M.,  Serg't,  I, 

July  22, 

Left  ;  ant.  post.  flop.    Returned  to 

162 

Davis,  B.  W.,  Corp  1,  B, 

June  17, 

Left  :  circ.  Surg.  W.  C.  Shurlock, 

43d  Georgia,  age  25. 

23,'  '64. 

Provost  Marshal  Dec.  1,  1864. 

24th  N.Y.  Cav.,age23. 

19,  '64. 

51st  Penn.   Disch'd  May  31,  '65. 

122 

Clements,  F.  S.,  Pt.,  D, 

June  1, 

Right  ;  circ.     Disch'd  September 

163 

Davis,  F.  M.,  Serg't,  A, 

Sept.  1!', 

.      Surg.    J.    T.  Grant,  32d 

6th  N.  Y.  H.  A.,  age  22. 

1,  '64. 

17,  1864. 

32d  Tennessee. 

21,  '63. 

Tennessee.    Recovery. 

123 

Clingman,  G.W.,  Pt.,  A, 

May  8, 

Left;   circ.     Disch'd   September 

164 

Davis,  H.  T..  Pt.,  G,  5th 

Mav  5, 

Right  :  ant.  post.  flap.     Disch'd 

88th  Penn.,  age  33. 

8,  T>4. 

21,  1864. 

Vermont,  age  24. 

7,  r64. 

January  13.  1865. 

124 

Clinton,    F.  D..  Pt.,   C, 

Dec.  13, 

Right;  circ.    Surg.  J.  Riley,  25th 

165 

Davis,  J.  B.,  Pt.,  I,  96th 

Sept.  14, 

Right;  circular.     Disch'd  March 

25th  New  Jersey. 

14,  '62. 

N.  J.     Disch'd  Feb.  2,  1863. 

Pennsylvania. 

15,  '62. 

1.  1863. 

125 

Closs,  W.,  Pt.,  K,  10th 

April  2, 

Left;   circ.     Surg.  G.  H.  Blick- 

166 

Dawson,  A.  J.,  Pt.,  G, 

Mar.  25, 

Left.     Released  June  24,  1865. 

N.  Y.  Heavy  Artillery, 

3,  '65. 

hahn,  28th  C.  Troops.     Disch'd 

49th  Virginia,  age  30. 

25,  '65. 

age  37. 

August  11,1865. 

167 

Day,  C.  H.,  Pt.,  A,  32d 

May  12, 

Right;   circular.     Disch'd  Aug. 

126 

Clunk,  J.,  Pt.,  F,  76th 

June  18, 

Right  ;    flap.     Surg.  A.  Sabine, 

Maine,  age  30. 

12|  '64. 

26,  1864. 

Ohio,  age  18. 

18,  '64. 

76th  Ohio.    Disch  d  May  23,  '65. 

168 

Decker,  P.,  Pt.,  I,  23d 

May  12, 

Left;    flap.     Snrg.  M.  Brucker, 

127 

Cobb.G.W.,  Pt.,  K,20th 

Mav  5, 

Left  ;  ant.  post.  flap.   Confederate 

Indiana. 

14,  '63. 

23d  Ind.     Disch'd  Aug.  8,  1864. 

Maine,  age  21  . 

7,  '64. 

surgeon.     Disch'd  May  7,  1865. 

169 

Deckertt,  A.,Pt.,  B,  79th 

Mar.  19, 

Right;    flap.     Disch'd  June   11, 

128 

Cobb,  J.  P.  C.,  Capt.,  H, 

Sept.  19, 

Left:  circ.  Surg.B.M.Crowell.lst 

Penn.,  age  19. 

19,  '65. 

1865. 

2d  North  Carolina. 

20,  '64. 

N.  C.     Exch'd  Dec.  9,  1864. 

170 

DeForest.A.,  Pt.,  D,15th 

Mar.  31, 

Left  :    circ.     Disch'd   September 

129 

Cobb,  M.  A.,  Lieut.,  K, 

Dec.  15, 

Right;  circ.     A.  A.  Surgs.  J.  C. 

N.Y.  H'vy  Art.,  age  40. 

31,  '65. 

20,  1865. 

23d  Alabama,  age  37. 

17,  '64. 

Thorpe  and  J.  R.  Holmes.   Gan 

171 

Demasner,  J.  G.,  Pt.,  H, 

Oct.  19, 

Left  ;  flap.     Discharged  Septem 

grene.    Jan.  9,  '65,  amp.  thigh. 

30th  Mass.,  age  36. 

20,  '64. 

ber  5,  1865. 

Provost  Marshal  June  3,  1865. 

172 

Deniston,  W.  H.,  Corp'l, 

April  7, 

Left;    flap.     Surg.  S.  T.  Trow- 

130 

Cochennour,  J.  S.,  Capt., 

Sept.  1, 

Left  :  circ.  Surg.  E.  Batwell,  14th 

A,  15th  Ohio. 

8,  '62. 

bridge,    8th    Illinois.      Disch'd 

H,  60th  Illinois,  age  34. 

1,'64. 

Mich.     Disch'd  Dec.  14,  1864. 

June  2,  1862. 

131 

Cogswell,  A.  H.,  Pt.,  B, 

Oct.  27, 

Loft  ;  flap.    Confederate  surgeon. 

173 

Dennis,  A.,  Pt.,  G,  79th 

Sept.  19, 

Left  :  flap.     Surg.  W.  M.  Wright, 

1st  Mass.  H.  A.,  age  18. 

29,  '61. 

Disch'd  Sept.  11,  1865. 

Pennsylvania. 

19,  '63. 

79th  -Penn.     Dfsch'd  Feb.  9,  '64. 

132 

Cole,  A.  J.,  Pt.,  C,  44th 

Dec.  13, 

Right  :   circular.     Disch'd  April 

174 

Dennis,  A.,  Pt.,  D,  38th 

Dec.  11, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

New  York. 

15,  '62. 

8,  1863. 

Indiana,  age  132. 

12,  '64. 

E.  Jennings.   Dis.  Mar.  10,  1865. 

133 

Cole,  W.,   Pt.,   H,   31st 

May  18, 

Right;  flap.   To  Veteran  Reserve 

175 

Denny.  F.  J.,  Serg't,  A, 

July  28, 

Right  ;  circ..;  gangrene.     Disch'd 

Massachusetts,  age  21. 

18,  '64. 

Corps  Nov.  IP,  1864. 

1st  Cavalry,  age  26. 

28,  '64. 

Nov.  22.  1864. 

134 

Coogan,  R.,  Pt.,  E,  4th 

Oct.  16, 

Right.     Disch'd  Jan.  12,  1863. 

176 

De.pratto,  J.,  Pt.,H,lIth 

July  2, 

Left.     Surg.  J.  Harrison,  C.  S.A. 

Artillery. 

16,  '62. 

Virginia,  age  27. 

3,  '63. 

Exchanged  Nov.  12,  1863. 

135 

Cook,  A.,  Pt.,   E,   31st 

June  27, 

Right  ;  flap.     Surg.  E.  J.  McGor- 

177 

Devall,  E.,  1't.,  K,  llth 

Mar.  14, 

Right  ;  flap.   Surg.  G.  Derby,  23d 

Iowa,  age  34. 

27,  '64. 

risk,  9th  Iowa.    Gang.    Disch'd 

Connecticut,  age  19. 

—  ,  '62. 

Mass.  HsDin.  Disch'd  Oct.15,  '62. 

January  26,  1865. 

17,- 

Dewalt,   J.  S.,  Pt.,  M, 

June  2, 

Left  :   ant.  post.  flap.     Surg.  II. 

136 

Coombs,  L.,  Pt.,  K,  4th 

Mav  24, 

Right  ;    flap.     Confed.    surgeon. 

100th  Penn.,  age  IP. 

3,  '64. 

Ludingtoi),  100th  Penn.    Mus 

Infantry,  age  28. 

26,''64. 

Disch'd  November  14,  1865. 

tered  out  Sept.  7,  1864. 

137 

Cooper,  J.,  Pt.,  F,  47th 

July  22, 

Right  ;  flap.     Surg.  I.  N.  Barnes, 

179 

Dewey,  G.,  I't.,  D,  51st 

Dec.  13, 

Left;  slough.     Dec.  28.  re-amp. 

Ohio,  age  25. 

23,  '64. 

116th  111.    Disch'dDec.  3,  1864. 

New  York. 

14,  '62. 

Jan.,  1863,  amp.  thigh.  Disch'd 

138 

Corbet,  J.,  Pt.,  G,  12th 

Oct.  19, 

Left  ;  double  flap.     Ass't   Surg. 

Oct.  23,  1863. 

Maine,  age  26. 

20,  '64. 

W.  C.  Towle,  U'th  Maine.    Dis 

180 

Dibble,  C.  A.,  Serg't,  E, 

Mav  1, 

Left  :  circular.     Disch'd  Septem 

charged  June  21,  1865. 

29th  Wisconsin. 

3,  '63. 

ber  7,  1863. 

139 

Corlew,  H.  M.,Corp'l,  G, 

June  2, 

Right  ;  double  flap.     Surg.  C.  B. 

181 

Dibble.   H.,   Corp'l,   G, 

June  15, 

Left  ;  circular.     Disch'd  Septem 

Llth  Vermont,  age  19. 

2,  '64. 

Park,  1  1th  Vt.     Dis.  Oct.  27,'64. 

14th  New  York  Cav. 

15,  '63. 

ber  24.  1863. 

140 

Costello,  H.,  Pt.,  D,  24th 

Aug.  16, 

Left  ;  post,  flap  ;  necro.     Disch'd 

182 

Dicker  son,  J.  M.,  Pt.,  I, 

May  1  5, 

Right  ;  circ.    Surg.C.  J.  Bellows, 

Massachusetts,  age  30. 

16,  '64. 

January  25,  1865. 

18th  Alabama,  age  23. 

15,''64. 

7th  Ohio.     To  Provost  Marshal 

141 

Cotton,  S.   O.,  Capt.,  A, 

Mav  6, 

.   Union  surgeon.   Recovery. 

December  1,  1864. 

4th  Louisiana. 

6,  '64. 

183 

Dickson,   J.  H.,  Pt.,  C, 

May  12, 

Right;    flap.      Discharged  Jan 

142 

Crago,  G.W.,  Pt.,D,89* 

Sept.  20. 

Right  ;  circular.     Disch'd  Feb.  7, 

llth  Infantry,  age  19. 

12,  '64. 

uary  3,  1865. 

Ohio. 

22,  '63. 

1864. 

184 

Dickson,  W.,Pt.,  1,  109th 

July  20, 

Right  :  ant.  post.  flap.     Surg.  J. 

143 

Crane,  A.  F.,  Serg't,  H, 

Dec.  13, 

Left.    Disch'd  February  6,  1863. 

Pennsylvania,  age  24. 

20,''64. 

A.  Wolf,    29th  Penn.      Diselrd 

145th  Penn. 

13,  '62. 

April  20,  1865. 

144 

Crawford,  D.,  Pt.,  G,  1st 

July  28, 

Right  ;  flap.     Surg.  D.  W.  Maull, 

185 

Donley,J.P..Pt.,L,  18th 

June  15, 

Left;    ant.  post.  flap.     Dec.  23, 

S.  C.  Rifles,  age  34. 

28,"  '64. 

1st  Del.     To  prison  Jan.  21,  '65. 

Penn.  Cavalry,  age  40. 

15,  '64. 

re-amp.     Disch'd  Mar.  15,  1865. 

145 

Crawford,  D.  S.,  1't.,  A, 

Oct.  19, 

Right  :  flap.      A.  A.  Surg.  W.  G. 

186 

'Donsheidt,  W.,  Pt.,  I, 

Sept.  19, 

Left;  circ.  Ass't  Surg.  S.  Adams. 

47th  Penu.,  age  20. 

19,  '64. 

Smull.     Necrosis.     Discharged 

5th  Artillery,  age  29. 

19,  '62. 

U.  S.  A.     Disch'd  May  3,  1863. 

May  31,  1865.     Spec.  4225. 

187 

Doty,  J.  S.,  Pt.,  D,  19th 

June  16, 

Left;  flap.     July  7,  re-amputat'n. 

146 

Crosby,  D.  P.,  Pt.,  I,  6th 

Sept.  30, 

.   Union  surgeon.   Recovery. 

Michigan. 

16.  '64. 

Disch'd  July  17,  1865. 

South  Carolina. 

30,  '64. 

188 

Dougherty,  J.L.,  Serg't, 

July  6, 

Left  :  flap.     Drs.  F.  Dorsey  and 

147 

Crowe,  D..  Pt.,  E,  107th 

Sept.  17 

Right.    Discharged  May  15,  1863. 

M,  18th  Penn.  Cavalry, 

7,  '63. 

N.  B.  Scott,   llagerstown,  Md. 

New  York. 

19,  '62. 

age  24. 

Disch'd  Dec.  19,  1864. 

148 

Ouniff,  J.,  Pt.,  H,  35th 

Feb.  15, 

Left;    flap.      Ass't   Surg.  J.  T. 

189 

Dougherty,  S..Pt.,  I,  8th 

Dec.  13, 

Left;    flap.     Disch'd  March   14, 

New  Jersey,  age  26. 

15,  '64. 

Lanning,   35th   N.  J.    Disch'd 

Penn.,  age  27. 

13,  '62. 

1864. 

June  4,  1865. 

190 

Douglas,  W.,  Pt.,  B,  6th 

June  1  8, 

Left  ;  ant.  post.  flap.     Ass't  Surg. 

149 

Cunningham,  C.,  Pt.,  D, 

Julv  2, 

Right  ;  ant.  post.  flap.     Confed. 

Wisconsin,  age  34. 

19,  '64. 

J.  C.   Hall.  6th  Wis.     Disch'd 

140th  Penn.,  age  20. 

4,  '63. 

surgeon.    Disch'd  Feb.  22,  1864. 

May  4,  1865. 

]50 

Curley,   M.,   Pt.,  G,  2d 

June  1, 

Left  ;  circ.     Surg.  H.  Plumb,  2d 

191 

Downing,  D.  J.,  Capt., 

July  1, 

Left;  flap.     Surg.  E.  G.  Chase, 

Conn.  H.  A.,  age  2G. 

1,  '64. 

Conn.  H.  A.  Disch'd  Mar.18,'65. 

H,  97th  N.  Y.,  age  22. 

1,  '63. 

104th  N.Y.    Resig'd  Feb.  12,  '64. 

151 

Curran,  T.,   Pt.,  H,  2<1 

April  6, 

Left  ;    flap.     Subsequent    opera 

192 

Drake,  A.  H.,Pt.,C,13th 

Mar.  18, 

Left  ;  flap.     Disch'd  July  26,  '65. 

Iowa. 

6,  '62. 

tion.     Disch'd  Oct.  14,  1862. 

Michigan. 

20,  '65. 

152 

Curry,   J.,   Pt.,   H,   7th 

Mav  5, 

Right.     Confed.  surgeon.     May 

193 

Drake,  C.  N..Pt.,  C,  12th 

July  2, 

Left.     Surg.  H.  B.  Fowler,  12th 

Maryland,  age  21  . 

6,  '64. 

19,  1865,  re-amp.     Discharged 

N.  Hampshire,  age  24. 

3,  '63. 

N.  H.     Disch'd  March  16,  1864. 

November  3.  1865. 

194 

Duddenhausen,  A.,  Pt., 

Sept.  2, 

Right.     Discharged  May  4,  1865. 

153 

Daicy,  G.  W.,  Corp'l,  D, 

June  3, 

Left:  circ.     Surg.  G.  L.  Potter, 

G,  17th  N.  Y.,  age  24. 

3,  '64. 

53d'  Penn..  age  29. 

3,  '64. 

145th  Penn.  Disch'd  July  6,  '65. 

195 

Dudley,  W.  F.,Pt.,F,  1st 

Mar.  1, 

Left.  Surg.  W.  A.  Spence,  C.S.A. 

154 

Dale,  H.,  Pt.,  F,  5th  N. 

June  3, 

Right  ;  flap.     Surg.  J.  H.  Buck- 

Maine  Cavalry. 

2,  '64. 

June  14.  amp.  thigh.     Disch'd 

Hampshire,  age  26. 

3,  '64. 

man,  5th   N.  H.     Disch'd  May 

August  14,  1665. 

6,  1865. 

190 

Duey,  J.,  Pt.,   C,   54th 

Julv  22, 

Left;  circ.     Surg.   I.  N.  Barnes. 

155 

Daller,  J.,  Pt.,  D,  llth 

May  16, 

Right;  flap.     Surg.  J.  A.  Comin- 

Ohio,  age  25. 

23,  "'64. 

116th  111.     Mustered  out  Oct.  24, 

Indiana,  age  25. 

16,  '63. 

gor,  llth  Indiana.  Disch'd  July 

1865.     Died  July  22,  1870: 

31,  1863. 

197 

Duffy,  P.  H.,  Pt.,  B,  2d 

Feb.  22, 

Left  :  flap.    Ass't  Surg.  B.  Norris, 

156 

Dalrymple.   J.,    Pt.,   B, 

Oct.  10, 

Left:   circ.     Surg.  J.  P.  Prince. 

Colorado. 

.23,  '62. 

U.  S.  A.     Disch'd  July  16,  1862. 

79th  N.  York,  age  29. 

10,  '63. 

36th  Mass.    Gangrene.   Disch'd 

198 

Durkee,  W.  P.,  Pt.,  B, 

Dec.  13, 

Left  :    circ.;   gangrene.     Disch'd 

Feb.  15,  1865.    Re  amp.  1868. 

4th  Vermont,  age  22. 

14,  '62. 

April  25,  1863. 

157 

Dangerfield,  L.  J.,  Pt., 

June  3, 

Left.     Surgs.  Yost  and  White, 

199 

Eades,  J.  M.,  Corp'l,  F, 

June  15, 

Right  :  flap.  Surg.  A.  W.  Reasran, 

Richard's  Cavalry. 

3,  '61. 

C.  S.  A.     Recovery. 

70th  Indiana,  age  23. 

15,  '64. 

70th  Ind.     Disch'd  June  8,  1865. 

'FISHER  (G.  J.),  Report  of  Fifty-seven  Canes  of  Amputations,  in  f)ie  Hospitals  near  Sharpsburg,  Md.,  after  the  Battle  of  Antietam  September  17, 
1862,  in  American  Journal  Medical  Sciences,  1863,  Vol.  XLV,  p.  48. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN  'THE    LEG. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

200 

Eaton,  D.  C.,  Corp'l,  H, 

Sept.  17, 

Left.     Surg.  L.  M.  Knight,  5th  N. 

242 

Fryer,    E.,    Pt.,  A,  1st 

June  3, 

Left;  flap.     Surg.  D.  W.  Maull, 

5th  N.  Hamp.,  age  30. 

17,  '62. 

H.    Gangrene.     Dec.  29,  amp. 

Delaware,  age  33. 

3,  '64. 

1  st  Del.     M.  O.  Nov.  19,  1864. 

thigh,  lower  third.     Discharged 

243 

Fuller,  C.,  Pt.,  K,  14th 

June  18, 

Right  ;  flap.    Disch'd  July  7,  '65. 

Mar.  13,  1863.     Died  July  1,'63. 

N.Y.  H'vyArt.,agel9. 

20,  '64. 

201 

Eaton,  G.,  Pt.,  D,  121st 

Nov.  7, 

Right.     Disch'd  June  15,  1864. 

244 

Furney,  M.,  Pt.,G,  126th 

Sept.  22, 

Left;  flap.     Disch'd  March  27, 

New  York,  age  27. 

7,  '63. 

Ohio,  age  26. 

23,  '64. 

1865. 

202 

Eckerman,  D.  F.,Pt.,  H, 

Aug.  5, 

Right  ;  flap.     Surg.W.  R.  Marsh, 

245 

Fyans,  A.,  Corp'l,  F,  32d 

May  7, 

Left.     Surgeon  F.  H.  Hamilton, 

2d  Iowa. 

5,  ?64. 

2d  Iowa.  Disch'd  June  20,  1865. 

New  York. 

8,  fe. 

U.  S.  V.     Disch'd  July  15,  1862. 

203 

Edleman,    W.,    Pt.,    K, 

June  15, 

Right  ;  circ.     Surg.  D.  Johnson, 

246 

Gallup,  E.  A.,  Pt.,  L,  1st 

June  1, 

Left;    double    flap.      Gangiene. 

129th  111.,  age  26. 

16,  '64. 

129th  111.     Gangrene.     Disch'd 

Vt.  H'vy  Art.,  age  21. 

2,  '64. 

Discharged  Oct.  21,  1865. 

June  6,  1865. 

247 

Ganster,  W.  A.,  Pt.,  D, 

Aug.  18, 

Right  ;  circ.     Surg.  E.  Jackson, 

204 

Ehret,  J.,  Pt.,  G,  1st  N. 

July  28, 

Left;  circ.     Surg.  W.W.  L.  Phil 

Independent  Penn.  Ar 

18,  '64. 

30th  Colored  Troops.    Disch'd 

Jersey  Cav.,  age  19. 

28,  '64. 

lips.  1st  N.  J.  Cavalry.    Disch'd 

tillery,  age  21. 

Jan.  3,  1865. 

Nov.  11,  1864. 

248 

Garner,  J.,  Pt.,  I,  5th  N. 

Sept.  17, 

Right.      Union    surgeon.      Fur- 

205 

Ehrman,  C.,    Serg't,  C, 

June  25, 

Right;  circ.  Surg.A.Sabine,76th 

Carolina. 

17,  '62. 

loughed  Dec.  19,  1862. 

17th  Mo.,  age  28. 

25,  '64. 

Ohio.     Disch'd  March  14,  1865. 

249 

Garvin,    M.,    Corp'l,  C, 

June  18, 

Right.     Surg.  O.  J.  Evans,  40th 

206 

Eisert,  C.  H.  F.,  Pt.,  C, 

May  12, 

Left;  ant.  post,  flap;  sloughing; 

40th  New  York,  age  33. 

18,  '64. 

N.  Y.     Disch'd  March  4,  1865. 

17th  Infantry,  age  38. 

12,  '64. 

exfol.    Veteran  Reserve  Corps 

250 

Gaskins,  J.,  Pt.,  D,  4th 

July  1, 

.    Recovery. 

March  3,  1865. 

Virginia  Battery. 

1,  '62. 

207 

Elliott,    T.,    Corp'l,   A, 

May  10, 

Right  ;    circ.      Surg.    P.  Leidy, 

251 

Gates,  E.  B.,  Capt,,  H, 

June  30, 

Left.  Surg.  M.  S.  Kittinger,  100th 

119th  Penn.,  age  20. 

10,  '64. 

119th  Penn.    Disch.  June  15,  '65. 

4tb  Pennsylvania. 

J'yl,'62. 

N.  Y.     Disch'd  Oct.  31,  1862. 

Died  Oct.  29,  '73  ;  cong.  brain. 

252 

Gieseke,  A.,  Pt.,  I,  12th 

July  17, 

Left;  flap.  Surg.J.Spiegelhalter, 

208 

Erving,  R.  M.,Pt.,B,26th 

Sept.  19, 

Right  ;  long  post,  flap  ;  slough.; 

Missouri. 

17,  '63. 

12th  Mo.     Disch'd  April  14/64. 

Mass.,  age  20. 

19,  '64. 

necrosis.     Disch'd  Nov.  7,  1864. 

253 

Gilbert,  D.  .R.,Pt.,K,  23d 

July  2, 

Right.     Exchanged  Nov.  12,  '63. 

209 

Mstis,  F.  M.,  Pt.,  D,  34th 

July  30, 

.     Surg.  —  Mason,  C.  S.  A. 

South  Carolina,  age  35. 

3,  '63. 

Virginia. 

30,  '64. 

Retired  Feb.  17,  1865. 

254 

Gillen,J.,  Pt.,  A,  35th  N. 

Dec.  9, 

Left;  double  flap.     Surg.  A.  B. 

210 

Everts,  D.,  Pt.,  H,  142d 

Oct.  27, 

Right;  circ.     Surg.  G.  C.  Jarvis, 

Jersey,  age  23. 

9,  '64. 

Monahan,  63d  Ohio.     Trismus. 

New  York,  age  24. 

27,  '64. 

7th  Conn.    Disch'd  June  26,'65. 

Transferred  April  14,  1865. 

211 

Faas,   C.,  Serg't,  I,  7th 

June  1, 

Right.  Surg.  O.Adams,  7th  Mass. 

255 

Gilkerson,  J.,  Corp'l,  G, 

April  6, 

Right  ;  circular.    Mustered  out. 

Massachusetts. 

1,  '62. 

Disch'd  Sept.  28,  1862. 

140th  Pennsylvania. 

6,  '65. 

212 

Facks,  J.,  Corp'l,  B,  6th 

July  1, 

Left;  flap.     Disch'd  March  16, 

256 

Gillighan.  H.,  Pt.,  K,22d 

May  11, 

Left  ;  ant  post.  flap.     Surg.  I.  H. 

Wisconsin,  age  32. 

3,  %3. 

1864. 

Mass.,  age  23. 

11,  '64. 

Stearns,  22d  Mass.     Discharged 

213 

Fairley,  H.,  Pt.,  I,  28th 

July  2, 

Left.     Surg.  Z.  E.  Bliss,  U.  S.  V. 

October  17,  1864. 

Massachusetts,  age  34. 

4,  '63. 

Bone  removed;  haein.     Disch'd 

257 

Gilmore,  T.,  Pt.,  1,  107th 

May  25, 

Left  ;  circular.    Discharged  July 

March  22,  1865. 

New  York,  age  21. 

27,  '64. 

20,  1865. 

214 

1Faiver,  A.  J.,  Pt.,  18th 

Sept.  17, 

Left  ;  posterior  flap. 

258 

Ginnings,  E.  K.,  Pt.,  K, 

Mar.  22, 

Right  ;    lateral   flaps.     Surg.  A. 

Miss.,  age  19. 

18,  '62. 

26th  Illinois,  age  19. 

22,  '65. 

T.  Hudson.  26th  Iowa.    Disch'd 

215 

Fallen,  T.,  Pt.,  D,  llth 

May  3, 

Right  ;  flap.     Disch'd  September 

June  27,  1865. 

Massachusetts. 

3,  fe. 

21,  1863. 

259 

Glatzel,    P.    P.,  Pt.,  E, 

June  1, 

Left  ;  flap.     Disch'd  Sept.  21,  '65. 

216 

Farmer,  If.,  Pt.,  —  ,  13th 

Aug.  16, 

Right,     Surg.  —  Bace,  C.  S.  A. 

26th  Wisconsin,  age  28. 

1,  '64. 

North  Carolina. 

16,  '64. 

Retired  Jan.  9,  1865. 

260 

Glynn,  M.,  Pt.,  A,  107th 

Mar.  16, 

Right  ;  ciro.     Surg.  P.  H.  Flood, 

217 

Farmer,  T.  F.,  Serg't,  G, 

Sept.  30, 

Left  ;  flap.    Confederate  surgeon. 

New  York,  age  48. 

16,  '65. 

107th  N.  Y.  Disch'd  Feb.  20,  '66. 

51st  New  York. 

30,  '64. 

Disch'd  Jan.  5,  1865. 

261 

Godchalke,  A.,  Capt.,H, 

Sept.  19, 

Left;  flap.     Surg.W.  M.  Wright, 

218 

Farns  worth,  E..  jr.,  Lieut., 

Oct.  19, 

Left.     Surgeon  J.  G.  Bradt,  26th 

79th  Pennsylvania. 

19,  '63. 

79th  Penn.  Nov.  21,  '65,  re-amp. 

C,  2Gth  Massachusetts. 

20,  '64. 

Mass.     Disch'd  Feb.  11,  1865. 

23d,  ham.     M.  O.  June  30,  1  866. 

219 

Fan-ell,  W.,  Pt.,  F,  158th 

Sept.  29, 

Left  :  circ.    Disch'd  April  11,  '65. 

262 

Goery,  L.,  Serg't,  B,90th 

Sept,  17, 

Right.     Disch'd  Nov.  20,  1862. 

New  York,  age  32. 

29,  '64. 

Pennsylvania. 

17,  '62. 

220 

Farthing,  W.  G.  W.,  Pt., 

July  2, 

Left.    Paroled  November  12,  '63. 

263 

Goodno'w,  A.  H.,  Pt.,  C, 

May  13, 

Right  ;  flap.  Surg.  A.T.  Hudson, 

1).  5th  Texas,  age  26. 

3,  '63. 

30th  Iowa,  age  22. 

13,  '64. 

26th  Iowa.    Disch'd  June  16,'65. 

221 

Faulkner,  L.,  Pt.,  C,  2d 

April  13, 

Right;    flap.     Disch'd    October 

264 

Goslon,  L.,  Lieut.,  I,  33d 

April  2, 

Right;  circular.    Released  June 

Artillery. 

14,  '63. 

10,  1863. 

N.  Carolina,  age  22. 

3,  '65. 

9,  1865. 

222 

Fellers,  J.  A.,  Pt,,  I,  87th 

Sept.  19, 

Left  ;  flap.     Mar.  22,  '65,  re-amp. 

265 

Gosper,  J.  J.,  Lieut.,  C, 

Dec.  4, 

Left.     Surg.  D.  MacKay,  29th  C. 

Pennsylvania,  age  2l  . 

20,  '64. 

Disch'd  May  20,  '65.   Spec.  4198. 

29th  C.  Troops,  age  24. 

4,  '64. 

Troops.     Disch'd  May  15,  1865. 

223 

Felman,  J.  R.,  Capt,  I, 

July  3, 

Right.     Surg.  F.Wolf,  39th  N.Y. 

266 

Graham,  G.  W.,  Serg't, 

Dec.  16, 

Right  ;  flap.     Surg.  V.  B.  Kenne 

108th  New  York. 

3,  '63. 

Disch'd  April  22,  1864. 

E,  7th  Minnesota,  age 

17,  '64. 

dy,  5th  Minn.     Disch'd  April  4, 

224 

Fenlin,  W.  H.,  Serg't,  F, 

Dec.  13, 

Right;    flap.     Disch'd  June  14, 

24. 

1865. 

88th  Pennsylvania. 

15,  '62. 

1864. 

267 

Graham,  R.,  Pt.,  A,  98th 

April  17, 

Right;  flap.     Ass't  Surg.  A.  T. 

225 

Ferguson,  j'.  W.,  Pt.,  I, 

July  22, 

Right  ;   ciro.     Transferred  Sept. 

Illinois,  age  19. 

18,  '64. 

Barnes,  98th  111.     Disch'd  July 

19th  Alabama,  age  24. 

23,'  '64. 

22.  1864. 

23,  1864. 

226 

Ferriter,J.,  Pt.,Letcher's 

July  2, 

Right.   Retired  February  9,  1865. 

268 

Grant,   J.,  Pt.,  F,  12th 

Deo.  13, 

Right.    Ass't  Surg.  J.  G.  Wilbur, 

Battery. 

2,  '63. 

Rhode  Island. 

14,  '62. 

18th  Mass.     Disch'd  Mar.  13,  '63. 

227 

Fieldson,  T.,  Serg't,  F. 

Mar.  25, 

Right  ;  flap.     Surg.  "W.  C.  Shur- 

269 

Graves,  B.  V.,  Pt,,  Cren- 

June  27, 

.    Surg.W.C.Warreu,C.S.A. 

14th  New  York  Heavy 

25,  '65. 

lock,  51st  Penn.     Disch'd  Nov. 

shaw's  Va.  Battery. 

27,  '62. 

Retired  Feb.  22,  1865. 

Artillery,  age  21. 

6,  1865.     Spec.  1145. 

270 

Greely,    P.,  Pt.,  A,   1st 

July  21, 

Left  ;  flap.     Surg.  L.  J.  Dixon, 

228 

Fink,  F.,  Pt.,  B,  5th  New 

June  2, 

Right  ;    flap.      Confed.   surgeon. 

Wisconsin,  age  22. 

21,  '64. 

IstWis.     M.  O.March  1,  1865. 

York,  age  18. 

2,  '64. 

Duty  Oct.  19,  1864. 

271 

Green,  D.  M.,  Pt.,A,97th 

June  12, 

Right  ;  circ.     Surg.  W.  B.  Cham 

229 

Fletcher,  T.,  Pt.,  I,  82d 

July  2, 

Right;  nap.     Disch'd  July  4,  '64. 

New  York,  age  26. 

13,  '64. 

bers,  97th  N.  Y.    Disch'd  June 

New  York,  age  23. 

2,  '63. 

13,  1865. 

230 

Foote,  D.  W.,  Lieut.,  I, 

Oct.  5, 

Left.     Surg.  B.  F.  Keables,  3d 

272 

Green,  E.,  Pt.,  H,  5th  N. 

May  5, 

:  flap.     Discharged  October 

3d  Iowa,  age  33. 

5,  '62. 

Iowa.     Resigned  Aug.  21,  1863. 

Carolina  Bat'y,  age  23. 

6,  '62. 

17,  1862. 

231 

Foss,  J.  A.,  Serg't,  C,  1st 

April  2, 

Left.     Surg.  F.  M.  Everleth,  7th 

273 

Greenison,  S.  W.,  Pt.,  E, 

Aug.  21, 

Right.  Surg.W.P.Young,C.S.A. 

Maine,  age  22. 

2,  '65. 

Me.    Disch'd  July  2,  '65.  Bone 

4th  Georgia. 

21,  '64. 

Exchanged. 

removed  in  1867. 

274 

Greentodl.J.  A.,Pt..Bal- 

Sept.  17, 

Right.  Surg.  R.  A.  Lewis.C.S.A. 

232 

Foster,  M.  F.,  Serg't,  H, 

June  17, 

Left  .-  flap.     Disch'd  May  23,  '65. 

timore  Light  Artillery. 

17,  '62. 

Recovery. 

59th  Mass.,  age  26. 

18.  '64. 

Died  Aug.  23,  '76;  tuberc.  dis. 

275 

Griffith.  W.  C.  P.,  Pt.,  H, 

May  14, 

Right  :  ant.  post.  flap.  Ass't  Surg. 

233 

Fought  v,  G.  W.,  Serg't, 

Dec.  28, 

Right;  flap.    Surg.  E.O.F.  Roler; 

80th  Indiana,  age  20. 

15,  '64. 

W.  P.   Welborn,  8nth  Indiana. 

B,  57tli  Ohio. 

28,  '63. 

55th  111.     Disch'd  Mar.  7,  1863. 

Disch'd  May  18,  1865. 

234 

Franklin,  J.  S.,  Serg't, 

Aug.  29, 

Right.    Surg.  J.T.  Calhoun,  74th 

276 

Grim,  G.  W.,  Corp'l,  V, 

Feb.  5, 

Right  ;  ant.  post.  flap.     Disch'd 

A,  74th  New  York. 

30,  '62. 

New  York.    Disch'd  Oct.  29,  '62. 

6th  Ohio  Cav.,  age  30. 

5,  '65. 

August  16.  1865. 

235 

Franklin,  S.,  Pt.,  G,  54th 

Nov.  30, 

Left  ;  circ.     Disch'd  July  2,  1865. 

277 

Gross,    W.,  Pt.,  C,  7th 

Dec.  13, 

Right.     Gangrene.     Discharged 

Massachusetts,  age  42. 

Dec  1,  '64. 

Penn.  Res.,  age  27. 

13.  '62. 

May  2,  1863. 

236 

Frazier,  W.,  Pt.,  I,  140th 

April  6, 

Right  ;  flap.    A.  Surg.  B.  F.  Hill, 

278 

Grove,    S.,    Pt.,    K,    3d 

July  12, 

Left  •  flap.     Discharged  October 

Pennsylvania. 

6,  '65. 

140th  Penn.    Disch'd  June  27, 

Iowa. 

14,  '63. 

13,  1863. 

1865. 

279 

Groves,  C.  H.,Pt.,K,18th 

Nov.  7, 

Left.     Surg.  W.  Holbrook,  18th 

237 

Free,  S.  S.,  Pt.,  B,  170th 

May  18, 

Right  ;  flap.    Surg.  D.  W.  Maull, 

Massachusetts,  age  2'*. 

7   '63. 

Mass.     Disch'd  March  28,  1864. 

New  York,  age  20. 

18,  '64. 

1st  Del.     Disch'd  Nov.  10,  1864. 

280 

Haclder,  J.P.,  Serg't,  K, 

Nov.  30, 

Left  ;  circ.     To  Provost  Marshal 

238 

Freiclrich,  J.,  Corp'l,  K, 

June  18, 

Right  ;  flap.     Surg.  W.  B.  Fox, 

3d  Mississippi,  age  23, 

30,  '64. 

March  7,  1865. 

2d  Michigan,  age  28. 

18,  '64. 

8th  Mich.    Discli  d  July  4,  1865. 

281 

Hadlow,  H.,  Pt.,  H,  81st 

May  31, 

Right.    Confed.  surgeon.    Gang. 

239 

Frost,  L.  G.,  Pt.,  C,  3d 

Alay  10, 

Right;  flap.     Surg.  T.  Hndreth, 

New  York,  age  21. 

J'e  1,'62. 

Aug.  1,  amp.  thigh:   15,  re-ninp. 

Maine,  age  23. 

10.  '64. 

3d  Me.     Disch'd  Nov.  19,  1864. 

thigh.     Disch'd  May  2.  186:!. 

240 

Frost,  N.  G.,  Pt.,  G,  32d 

July  30, 

Left  ;  flap.     Disch'd  Feb.  8,  1865. 

282 

Hahn,  M.,  Serg't.  C,  26th 

Mar.  19, 

Left  ;  circular.     Disch'd  Nov.  23, 

Maine,  age  34. 

30,  '64. 

May,  1865,  amp.  knee  joint. 

Wisconsin,  age  32. 

19,  T,5. 

1865. 

241 

Fry,  H.S.,  Corp'l,  B,12th 

Mar.  27, 

Left;    flap.     Disch'd  September 

283 

Haight,    O.,  Pt.,    L,   2d 

April  7, 

Right  ;  flap.    Disch'd  June  6,  '65. 

Iowa,  age  24. 

27,  '65. 

25,  1865. 

1 

N.  Y.  H.  Art'y,  age  26. 

8,  '65. 

1  FISHER  (G.  J.).  Report  of  Fifty-seven  Cases  of  Amputations,  in  the  Hospitals  near  Sharpsburg,  Md.,  after  the  battle  of  Antielam,  September  17, 
1862,  in  American  Journal  Medical  Sciences,  Volume  XLV,  page  48. 


484 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Vr» 

NAME,  MILITARY 

1)  ATKS. 

OPERATIONS,  OPERATORS. 

K           NAME,  MILITARY         r>  .-,-,.*          OPERATIONS.  OPERATORS, 

iNO. 

DESCRIPTION,  AND  AUE. 

RESULT. 

L  •  DESCRIPTION,  AND  AGE.    *•                               RESULT. 

1 

284 

Hallam,  H.  C.,  Pt..  Fred- 

Mav  2, 

Right.     Ass't  Surg.  H.  L.  Hines, 

327 

Hochstetler,  C.,  Pt.,  D,    June  18, 

Right;  ant.  posterior  double  flap. 

ericksburg  Artillery. 

2,  !63. 

C.  S.  A.     Recovery. 

54th  Penn..  age  19.            18,  '64. 

Disch'd  April  1,  1865. 

235 

Ilullett,    D.,   Serg't,    F, 

April  2, 

Right  ;  ant.  post.  flap.     Disch'd 

328 

Hotfses,  R.  W.,  Corp'l,  E,      May  5, 

Right  ;  circular.   Disch'd  Decem 

67th  Ohio,  age  2-1. 

2,  '65. 

July  29,  1865. 

20th  Maine,  age  29. 

6,  '64. 

ber  12,  1864. 

286 

Halsey,  H.,  Pt.,  F,  48th 

Mav  11, 

Left  ;  circular.    Disch'd  January 

329 

Hogue,  W.,  Pt.,  G,  83d 

July  1, 

Right.   Discharged  May  30,  1863. 

Pennsylvania,  age  26. 

11,'64. 

5,  1865. 

Pennsylvania,  age  24.        1,  '62. 

287 

Hamil,  T.,  Serg't,E,12th 

Sept.  19, 

Right  ;    flap.     Surg.    —  Lamar, 

330 

Holladay,  J.  F.,  Pt.,  C,    Mar.  12, 

Right;    flap.     Disch'd  July   23, 

Georgia. 

19,  '64. 

C.  S.  A.      To   Fort   McHenry 

48th  Ohio,  age  22. 

13,  '63. 

1863. 

Jan.  5,  1865. 

331 

Hood,  i.  E.,  Serg't,  F, 

July  30, 

Left;  circ.     Surg.  G.  W.  Snow, 

J288 

Hamilton,  T.  P.,  Pt.,  K, 

April  29, 

Left.  Surg.  J.  Ebersole,  19th  Ind. 

35th  Mass.,  age  23.         '    30,"  '64. 

35th  Mass.   Disch'd  April  12,  '65. 

13th  Georgia. 

—  ,  '63. 

Prison  June  25,  '63.     Spec.  4819. 

332 

Hooks,  B.  A.,  Pt.,  B,  59th 

Aug.  14, 

Right.      To  prison   October  15, 

289 

Hamilton,  W.  J.,  Serg't, 

May  23, 

Left  ;  circ.     Surg.  C.  Bower,  6th 

Georgia,  age  27. 

14,  '64. 

1864. 

J,    llth    Pennsylvania 

23,  '64. 

Penn.  Reserves.     Mustered  out 

333 

Hope,  J.,  Pt.,  H,  2d  Vir-     Nov.  6, 

Left;  flap.  Surg.  W.Wynne,  14th 

Reserves,  age  23. 

June  13,  1864. 

ginia,  age  30.                       8,  '63. 

Penn.  Cav.  Disch'd  June  29,  '64. 

290 

Hammer,  G.,  Serg't.  E, 

June  14, 

Left;  circ.     Surg.  J.W.Wishart, 

334 

Horton,  B.  J.,  Lieut.,  I,   De.31,'62 

Left.     Resigned  June  10,  1863. 

52d  New  York,  age  37. 

15,  '64. 

140th  Penn.  Disch'd  May  22,'65. 

24th  Ohio. 

Jan.1,'63 

291 

Hanlon,  W.,  Pt.,  E,  27th 

July  21, 

Right  ;  flap.     Surg.  —  Smith,  C. 

335 

Hough,  W.,  Pt.,  A,  58th 

July  14, 

Right  ;  flap.     Mustered  out  May 

New  York. 

23.  '61. 

S.  A.     Must,  out  May  31,  1863. 

Illinois. 

14,  '64. 

3,  1865. 

292 

Hannah,  G.,  Pt.,  G,  3d 

July  22, 

Left  ;  circ.     To  Provost  Marshal 

336 

Howard,  W.  F.,  Pt.,  I, 

Sept.  18, 

Right  :  flap.  Surg.  W.  H.Th;r,-»r, 

Florida,  age  24. 

22,  '64. 

Dec.  1,  1864. 

14th  N.  Ilamp.,  age  24. 

19,  '64. 

14th  N.  H.     Disch'd  Jan.  !l,''65. 

293 

Hardin,    J.,    Lieut.,    G, 

May  25, 

Left;  flap.     Disch'd  Oct.  13,  '64. 

337 

Howie,  ^.iV.,Pt.,B,53d 

Sept.  5, 

Right;  flap.     Surg.  L.  Hill,  53d 

101st  Illinois,  age  39. 

26.  '64. 

Oct.,  1865,  re-amputation. 

North  Carolina,  age  31. 

6,  '64. 

N.  C.    Recovery  Jan.  8,  1865. 

294 

Harding,  W.  R.,  Pt.,  C, 

Sept.  17, 

Right.     Furloughed. 

338 

Hubbard,  J.  M.,  Serg't, 

Sept.  17, 

Left  ;  flap.     Transferred  Decem 

15th  North  Carolina. 

17,  '62. 

II,  2d  Miss.,  age  26. 

17,  '62. 

ber  14,  1862. 

295 

Harper,  F.  M.,  Pt.,C,  6th 

April  10, 

.    Confederate  surgeon.    Re 

339 

Hudson,  J..  Pt.,  H,  31st 

May  12, 

Left;  circ.     A.  Snrg.  A.  C.  Mills, 

Mississippi. 

11,  '63. 

covery. 

Indiana,  age  25.                 12,  '63. 

1  25th  111.    Disch'd  Oct.  16,  1863. 

296 

Harrell,  If.  D.,  Pt.,  G, 

Sept.  30, 

Left.     To  prison  January  23,  "65. 

340 

Huffman,  C.,  Pt.,  K.  7th    Feb.  15, 

Right;  double  flap;  re-amput  n. 

31st  N.Carolina,age22. 

30,  '64. 

Illinois,  age  17. 

15,  '62. 

Discharged  May  1  ,  1862. 

297 

Harrigan,  J.  M.,  Corp'l, 

Dec.  4, 

Right  ;    circular.     Disch'd   May 

341 

Hugqins,   A.    C.,   Serg't 

Apr!  120, 

.     Surg.  W.  'R.  Wilson,  24th 

A,  20th  Ohio,  age  22. 

4,  '64. 

15,  1865. 

Maj.,  24th  N.  Carolina.      20,  '64. 

N.  C.     Retired  Feb.  24,  1865. 

298 

Harriger.  J.,  Serg't,  B, 

July  2, 

Right  ;  flap.     Surg.  —  Patterson, 

342 

Hunn,  W.  R.,  Corp'l,  A,     Oct.  19, 

Rifrht  ;  flap.  Surg.  G.  T.  SteveLS, 

105th  Penn.,  age  19. 

2,  '63. 

C.  S.  A.     Disch'd  Sept.  8,  1864. 

122d  N.  Y.,  age  35. 

20,  '64. 

77th  N.  Y.     Disch'd  May  31,'6.">. 

299 

Harrington,  G.  W.,  Pt., 

Aug.  5, 

Left;  flap.     Surg.  J.  Haller,  38th 

343 

Idner,  G.  W.,  Pt.,  I,  23d 

May  12, 

Right  ;  circ.     Surg.  M.  Bruckei, 

K,  38th  Ohio,  age  22. 

5,  T64. 

Ohio.     Gangrene.     Discharged 

Indiana. 

12,"  '63. 

23d  Ind.     Disch'd  Aug.  7,  1863. 

May  27.  1865. 

344 

Ingraham,  ff.,Pt..H,43d 

May  30, 

Right  ;  circ.    A.  Surg.  J.  T.  Duf- 

300 

Harris,   J.  M.,   Pt.,  D, 

July  3,     Right.     Surg.  —  Butler,  ('.  S.  A. 

North  Carolina,  age  49. 

June  1, 

iield,   7th   Indiana.     To   prison 

37th  Virginia. 

3,  '63.         Exchanged  March  3,  1864. 

1864. 

Dec.  30,  1864. 

301 

Harris,   L.,    Corp'l,    G, 

May  5,   !  Left  ;  flap.     Disch'd  Jan.  23,  '65. 

345 

Inmau,  ,S.,  Pt.,  F,   16th     April  1, 

Right;  flap.    Discharged  August 

143d  Pennsylvania. 

7,  f64. 

Maine,  age  31.                     2,  '65.        23,18(15. 

302 

Harris,  L.  S..  Corp'l,  C, 

June  14,    .    Surg.  —  Metoalfe,  C.  S.  A. 

346 

Irvin,  J.,  Lieut.,  E,  45th     May  18, 

Right  ;  circ.     Surg.  II.  E.  Smith, 

Jeff.  Davis  Legion. 

14,  '64.        Recovery. 

Penn.,  age  36.                    18,  '64. 

27th  Mich.     Disch'd    Jan.  18, 

303 

iHarwood,   E.   F.,    Pt., 

Sept.  17,    Right  :  post.  flap.     Doing  well. 

1865.     Died  April  17,  1871. 

18th  Mississippi,  age  30. 

17,  '62. 

347 

Irving,  W.,  Major,  38th     Aug.  5, 

Left;  flap.    Surg.  J.  Bailor,  38th 

304 

Hasenour,  G.,  Pt.,  1,  49th 

May  1  6,    Left  :  flap.  Surg.  J.  A.Ritter,  49th 

Ohio,  age  30.  '                     5,  y64. 

Ohio.     Must,  out  July  12,  1865. 

Indiana. 

16,  '63.        Indiana.     Disch'd  Feb.  8,  18G4. 

348 

Isham,  F.  W.,  Corp'l,  D,     Mar.  31, 

Left;  circ.    Surg;  D.C.  Ayers,7th 

305 

Havens,  J.  8.,  Pt.,  H,  33d 

Dec.  13, 

Right.     Discharged. 

7th  Wisconsin,  age  32.   ;    31,  '65. 

Wis.     Disch'd  June  13,  1865. 

New  York. 

13,  '62. 

349 

Jackson,    J.,   Serg't,  F, 

Dec.  37, 

Right;    circular.     Disch'd   July 

306 

Hawkins,  W.W.,  Serg't, 

May  5,     Right.    Ass't  Surg.  A.  B.  Haines, 

12th  Mo.  Cav.,  age  22.       18,  '64. 

2,  1865. 

I,  93d  N.  York,  age  21. 

6,  *64. 

20th  Ind.     May  16,  amp.  thigh. 

350 

James,  J.,  Pt.,   B,  57th  i    Oct.  5, 

•Right  ;  ant.  post.  flap.  Surg.  J.  R.  ( 

Disch'd  July  12,'(>5.    ^>ec.4497. 

Illinois,  age  18.                    5,  '64. 

Zcaring,  57th  111.     Discharged 

307 

Ilaynes,  C.  H.,  Serg't,  E, 

May  5, 

Left  :  flap.    Confederate  sure-eon. 

July  22,  1865. 

20th  Maine,  age  28. 

7,  '64.         Disch'd  April  10,  18H5. 

351 

Jecko.P.,  Serg't,  D,  15th 

Nov.  29, 

R't  ;  flap.   A.  Surg.  W.  L.  Graves.  • 

308 

Heist,  E.,   Pt.,  E,  27th 

June  8,     Left;  flap.    Discharged  Septem- 

Missouri,  age  29.               29,  '64. 

6th  Ark.,  C.S.A.     Disch'd  July 

Pennsylvania. 

10,  '62. 

berl6,  1862. 

31,  1865.     Also  amp.  forearm. 

309 

Heist,  J.  A.,  Pt.,  G,  6th 

July  6, 

Left;  flap.     Confederate  surgeon. 

352 

Jedowin,  T.,  Pt.,  C,  1st    Mar.  25, 

Left  ;  flap.     Surg.  J.  J.  Meigs,  3d 

Michigan  Cavalry. 

6,  '63. 

July  27,  re-amp.      Discharged 

Vt.  H'vy  Art.,  age  17.       25,  '65. 

Vermont.    Disch'd  Sept.  14,  '65.  ' 

May  21,  1864. 

353 

Jellison,  N.  F.,  Pt.,  llth    Sept.  19, 

Left.     Disch'd  April  4,  1803. 

310 

Hemingway,  N.  M.,  Pt., 

Dec.  13, 

Right;    circular.     Disch'd  June 

Ohio  Battery.                   |   20,  '62. 

II,  32d  Mass.,  age  17. 

13,  '62. 

18,  1863. 

354 

Jenne,   R.  C.,  Corp'l,  J,     April  2, 

Right  ;   flap.      Surg.  L.  W.  Bliss,  : 

311 

Hemminway,  A.,  Pt.,  K, 
4'Jth  New  York,  age  25. 

May  6, 
6,  r64. 

Right  ;    circ.    flap.      Discharged 
March  30,  1865. 

355 

17th  Vermont,  age  20. 
Jerinan,  D.,  Pt.,F,  19Cth 

2,  '65. 
July  11, 

51st  N.  Y.     Disohyd  Oct.  13,  '65. 
Right  ;    flap.     Surg.  L.  W.  Read, 

312 

Henderson,  S.  K.,  Pt.,  F, 

June  5,     .     Surgs.  Bell  and  Cross,  C. 

Penn.,  age  23.                 '    11,'  '64. 

U.  S.  V.     Disch'd  Aug.  7,  1865.  ! 

36th  Virginia. 

5,  '64. 

S.  A.    Retired  Dec.,  1864. 

Died  May  9,  '80  :  ulcera.  stump. 

313 

Hendricks,    M.,    Pt.,   K, 

Jan.  2, 

Left.     Discharged  February  28, 

356 

Johnson,  A.,  Pt.,  K,  1st 

July  7, 

Left;  circular.     Discharged. 

70th  Indiana. 

2,  '63. 

1663. 

N.  J.  Cavalry,  aere  11>. 

8.  '64. 

314 

Hondrickson,   J.,  Lieut. 

Dec.  ]3, 

Right.     Mustered  out  June  30, 

357    Johnson.  G.,  Pt.,"A,43d     Oct.  27, 

Right;   circ.     Surg.  E.  Jackson, 

Col.,  83d  New  York. 

13,  '62. 

1866. 

Colored  Troops,  age  38.     27,  '64. 

30th  C.  T.    Diseh'd  Sept.  14,  '65. 

315 

Hessler,  P.,  Pt.,  K,  82d 

May  18, 

Right  ;  circ.     Surg.  S.  II.  Plumb, 

358 

Johnson,  J.,  Pt.,  G,  17ih 

Nov.  11, 

Right;  circular.     To  prison  Feb. 

New  York,  age  23. 

18,  '64. 

82d  New  York.     Disch'd  June 

Virginia,  age  18. 

12,  '64. 

JO,  1865. 

9,  1865. 

359 

Johnson,  J.  M.,  Pt.,  C,  3d     June  3. 

Right.    Surg.  D.  E  Wolf,  3d  Del.  , 

316 

Hibbs,  T.,  Pt.,  G,  2d  N. 

June  ], 

Left;  cire.     Surg.  G.  L.  Potter, 

Delaware,  age  31  . 

3,  '64. 

(Also  amp.  at  left  ankle  joint.) 

Y.  H'vy  Art.,  age  47. 

1,  '64. 

145th  Penn.  Gangrene.  Disch'd 

Discharged  June  8,  1865. 

Nov.  4,  1865.     Re-amp.  1866. 

360 

Johnson,  W.  T.,  Pt.,  I, 

Aiiff.  6, 

Left;  flap;    Surg.  T.  B.Williams, 

317 

Hickey,   P.,  Pt.,   E,  3d 

May  14,     Right.     Discharged  December  7, 

113th     Ohio,    age    21.      6,  '"64. 

121st   Ohio.     Disch'd   May  23, 

N.  Y.  Artillery,  age  31. 

14,  '64.        1864. 

(Alias  T.  F.  Ricker.) 

1865.     Died  May  11,  1874. 

318 

Hicks.   J.,    Pt.,    B,    Cth 

May  14,    Left;  circular.     Discharged  No- 

361 

Johnstone,    R.,    Pt.,   G,     April  1, 

Right  ;   circular.     Disch'd   Sept. 

Tennessee. 

14.  '64.        vember  21,  1865. 

121st  Penn.,  age  31.            2,  '65. 

30,  1865. 

319? 

320) 

Higginbotham,  E.B.,¥t., 
F,  38th  Georgia. 

May  12,    Both.   Surgeon  W.  J.  Arrington, 
13,  '64.        P.  A.  C.  S.     Recovery. 

362    Jnline,W.  II.,Pt..E,12th     Miiy  10, 
Penn.  Reserves,  age  20.     10,  '64. 

Left;  ciro.  flap.    Surg.  B.  Rohrer,  ! 
10th   Penn.  Reserves.     Disch'd  : 
March  24,  1865. 

321 

Higgins,  V.   X.,  Pt.,  H, 

Mav  4,     Left.     Discharged  June  9,  1863. 

363    Jones,  W.,  Corp'l,  H,  8th    June  22, 

Left;    ant.  post.  flap.     Surg.  G. 

2d  Maine,  age  24. 

5.  '63.    i 

New  York  H'vy  Art.,      23,  '64. 

Chaddock,  7th  Mich.     Disch'd 

322    Ililler,  J.  A.,  Corp'l,  P,     Sept.  26,    Left  ;  post.  flap.     Surgeon  A.  P. 

age  25. 

December  5,  1864. 

9th  New  York  Cavalry,      26,  '64.        Clark,  6th  N.  Y.  Cav.     Disch'd 

561    Jimr*,  JT.  M.,  Serg't,  K,      July  2.      Right.     Exchanged     March     17, 

age  26. 

June  29,  1865. 

50th  Georgia,  acre  22. 

4,  '63. 

1864. 

323 

Hines,  G.W.,  Pt.,C,  98th 

Pec.  17,     Right;  circular;  gang.     Disch'd 

!65    Jones,  W.  I>7,  Pt.,~F,  12th    July  21, 

Left;  flap.    Surg.  E.  M.  Rogers, 

Ohio,  age  19. 

17,  '64.        May  26,  1805. 

Wisconsin,  age  24. 

21,  '64. 

12th  AVis.    Disch'd  June  1  ,  1865.  '• 

324    llinson.  J.  L.,  Lieut.,  I, 

Sept.  19,    R't:  circ.     Surg.  —  Weatherby, 

566    Jones,  W.   S.,    Lieut.,   I,      Jan.  2, 

Left  ;    flap.     Disch'd   November 

6th  Alu'nuna,  age  29. 

19,  '64.        C.  S.  A.     To  prison  Dec.  9,  '64. 

2d  Arkansas,  age  21.          3,  '63. 

7,  1864. 

325    Hinson,  J.W.,  Pt.,C,  33d 

June  29,    Right;   flap.     Surg.  J.  Bennett, 

367    Jones,  Z.,  Pt.,  B,  24th  N.     April  2, 

Left.     Released  July  22,  1865. 

Indiana,  age  22. 

29,  '64.        19th  Mich.    Disch'd  July  21,  '65. 

Carolina,  age  25. 

2,  '65. 

326    Hobbs,  J.,  Pt.,  B,  39th 

Sept.  19,  1  Right  ;    flap.     Disch'd   January 

•568    Jordan,  J.  I'.,  Lieut.,  B, 

May  29, 

.     Surg.  —  Price.    7th   Vir 

Indiana. 

19,  '63.        9,  1864. 

7th  Virginia  Cavalry. 

29,  '64. 

ginia.     Furloughed. 

'FISHER  (G.  J.).  Report  of  Fifty-seven  Cases  of  Ampvtatirms.  in  tlie  Hospitals  -near  FSharpsbvnj.  Md.,  after  the  battle  of  Antietam,  Se.ptrmlit 
18(>2.  in  A  ni'rican  Journal  Medical  Sciences,  Volume  XLV,  page  48. 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


485 


KTr^ 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

TJr> 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

ttO. 

DESCRIPTION,  AXI>  AGE. 

RESULT. 

liv'. 

DESCRIPTION,  AND  AGE. 

DATES. 

RESULT. 

369 

Jowers,  W.,  Pt.,  F,  17th 

July  2, 

Right  ;    flap.     Re-amput'n.     Ex 

408  j  3Laiorence,  J.  It.,  Lieut., 

Sept.  17, 

Right;   post.  flap.      Transferred 

Miss.,  age  39. 

3.   63. 

changed  March  17,  1864. 

!    1,  1st  Louisiana,  age  33. 

17,  '62. 

November  28,  1862. 

370 

Kapp,   J.,    Pt.,    I,    17th 

Jan.  11, 

Right;  ant.  post.  flap.     Surg.  E. 

409  ,  Lee,  A.  W.,  Pt.,  K,  2d 

Aug.  16, 

Right;  circ.    Disch'd  June27,  '65. 

Missouri. 

1  1,  '63. 

C.  Franklin,  U.  S.  V.     Disch'd 

N.Y.  H'vy  Art.,  age  22. 

17,  '64. 

Died  Sept.  25,  "68;  consumption. 

Jan.  22.  1864. 

410    Lemmon,  E.,  Pt..  E,  16th 

Dec.  29, 

Left  ;  flap.     Surg.  J.  Pomerene, 

371 

Kaufman,  W.,  Serg't.  E,     Jan.  11, 

Right  ;    flap.      Discharged   May 

Ohio. 

30,  '62. 

42d  Ohio.     Disch'd  April  3,  '63. 

3d  Missouri.                          11,  '63. 

29,  1863. 

411 

Lentz,  D.,    Pt.,   L,   5th 

Oct.  6, 

Left  ;  circ.     A.  Surg.  J.  McCann, 

372 

Kean.  R.  M.,  Pt.,  F,  50th     July  2, 

.     Surg.  J.  L.  Harris,  C.S.  A. 

Penn.  H'vy  Artillery, 

6,  '64. 

5th  Penn.  Heavy  Artil'y.     Dis 

Georgia.                                 4.  '63. 

Paroled  Nov.  12,  1863. 

age  40. 

charged  June  8,'  1865. 

373 

Keffer,"  H.,  Pt.,  K,   55th     June  3, 

Left;    flap.     Discharged   March 

412 

Leonard,  A.  G.,  Pt.,  B, 

Sept.  26, 

Right  :  flap.     Discharged  March 

Pennsylvania,  age  23.     ,     3,  '6-1. 

2,  1865. 

1st  W.Va.  Cav.,  asje23. 

28,  '64. 

27,  1865. 

374 

Keister,  J.  >F.,Serg't,6th     May  5, 

.     Surg.  G.  Whitfield,  12th 

413  |  Lewis,  J.W.,  Pt.,  lO:«h 

Nov.  16, 

Left  :  flap.     Discharged  May  17, 

Alabama.                             6,  '64. 

Alabama.     Recovery. 

Kentucky,  age  21. 

17,  '63. 

1864. 

370 

Keller,  I.  N.,  Corp'!,  B,     Sept.  1, 

Left;  flap.     Surg.  D.'  S.  Young, 

414    Light,  O.H.,Pt.,F,  12th 

Dec.  13, 

Right;    circ.     Discharged  April 

21st  Ohio,  age  2-,'.               1,  '64. 

21st  Ohio.     Disch'd  Feb.  21,  '65. 

i     Rhode  Island. 

13,  '62. 

6,  1863. 

376 

Kelly,  K.,   Pt.,   A,  29th    Sept.  17, 

R't  ;  flap.  Surg.  G.  B.  Coggswell, 

415    Little,  A.,  Pt.,  F,  106th 

June  1, 

Right  ;  flap.     Surgeon  M.  Rizer, 

Massachusetts-.                    18,  '62. 

29th  Mass.     Disch'd  Mar.  3,  '63. 

Penn..  age  22. 

1,  '64. 

72dPenn.    Disch'd  April  15.  '65.  : 

377    Kelly,  L.  C.,  Corp'l,  K,     Jan.  27, 

Right  ;  flap.  Surg.  M.  M.  Hooton, 

416    Locke,  W.  $.,  Pt.,  K,  41st 

Sept.  20, 

Right.     Surg.  J.S.Cain,  C.S.  A. 

52d  Ohio,  age  21.               28.   b'4. 

86th  111.     Disch'd  Jan.  26,  1865. 

Mississippi. 

20,  '63. 

Recovery. 

378  !  Keltner,  S.,  Pt.,  I,  fifth  !  Dec.  19, 

Right;   ant.  post.   flap.     Disch'd 

417    Lockett.  E.  F.,  Pt.,  C,  23d 

May  3, 

Left.     Ass't  Surg.  —  Dennis,  23d 

Ohio,  age  18.                   •    10,  '64. 

J\me  30,  186.">. 

Virginia. 

3,  '63. 

Virginia.     Recovery. 

379    Kendall,  T.  C.,  Car*.,  B,      May  4, 

Right  :  circ.  Surg.E.G.Greenleaf, 

418    Loclce.tt.  W.  F.,  Pt.,  E, 

Oct.  19, 

Right;  circ.     Surg.  J.  Watkins, 

21st  X.  J.,  age  35.               C,  '63. 

54th  N.  C.     Mustered  out  June 

36th  Virginia,  age  20. 

19,  '64. 

36th  Va.     To  Provost  Marshal 

19,  1863. 

February  11,  1865. 

380    Kenfield.  C.  P>.,   I't.,  K.     Sept.  17, 

Right  ;  flap.     Surg.  G.  W.  Snow, 

419    Loetech.C.,  Serg't,  B,  2d 

June  18, 

Left:   flap.     Snrg.  E.  Griswold, 

35th  Massachusetts.           19,  '62. 

35th  Mass.     Disch'd  Mar.  4,  '63. 

Penn.  Art'ry,  age  36. 

—  ,  '64. 

2d  Penn.    Disch'd  Oct.  19,  1865. 

381 

Kennedy,    J.,    Pt.,    5th     June  5, 

Left.     Surg.   C.  Carle,   41st  111. 

420    Long,  J.  C.,  Pt.,  A,  3d 

Oct.  11, 

Right.     Surg.  E.  W.  H.  Beck,  3d 

Ohio  Battery.                      5,  '63. 

Gangrene.     Disch'd  Sept.  8,  '64. 

Indiana  Cav.,  age  22. 

11.  '63. 

Ind.  Cav.    Disch'd  April  6,  '64. 

380    Kent,  L.  S.,  Pt.,  G,  4th    Aug.  31, 

Left.     Recovered. 

421    Long,  J.  D..  Pt.,  C,  15th 

De.31,'62, 

Left,    Discharged  March  6,  1  863. 

Louisiana. 

31,    64. 

Indiana. 

Jan.  1,  '63. 

383 

Keuworthy,  L.,  Pt.,   B,     Mar.  1C, 

Left  ;  flap.     Surg.  J.  A.  Stillwell, 

422 

Lord,  T.  W.,  Lieut,,  K, 

May  3, 

Left;    flap.     Surg.  C.  S.  Wood, 

22d  Indiana,  age  23. 

16,  '65. 

22d  Ind.    Disch'd  June  12,  1865. 

17th  Maine. 

3.  '63. 

66th  N.  Y.     Disch'd   Sept.  10, 

384 

Kcrr,  J.  If.,  Lieut.,  H, 

July  20, 

Left.    Confederate  surgeon.     To 

1863.   Re-amp.  November,  1864. 

57th  X.  C.,  age  20.          1   —  ,  '64. 

prison  February  16,  1865. 

423    Lorell,B.  L.,  Pt.,  B,  17th 

Aug.  7, 

.    Surg.  R.  Fleming,  C.  S.  A. 

385    Keziah,  P.G'.,Pt.,  F,35th  ;  May  19, 

.     Surg.  C.  J.  O'Hagan,  35th 

Virginia  Cavalry. 

7,  %4. 

Recovery. 

North  Carolina. 

20,  '64. 

N.  C.    Recovery. 

424  :  Lucore,    L.,  Pt.,  C,  1st 

Dec.  13, 

Right  ;     flap.      Discharged   Sep 

386,  ^Kidd,  W.  J.,  Pt,,  49th    Sept.  17, 

Left:  post.  flap.     Transferred. 

Penn.  Rifles. 

13,  '62. 

tember  28,  1863. 

Virginia,  age  26.             i    17,  '62. 

425    Luzader,  T.,  Pt.,  C,  33d 

Sept.  27, 

Left.      Discharged    October  29, 

367    KHlebrr.il-,  «r.  H.,  Pt..  C,      July  2, 

Left.    Surg.  —  Etheridge,  C.S.A. 

Ohio,  age  21. 

27,  '62. 

1862. 

12th  Georgia,  age  22.         2,  r63. 

Exchanged  Nov.  12,  1863. 

426  :  Lyons,    W.,  Pt.,  E,    1st 

Oct.  12, 

.     Ass't  Surg.  M.  P.  Shelton, 

388 

Kissinger,    //.,    Pt.,   F, 

Sept.  —  , 

Right.     Doing  well  October  25, 

Tennessee  Cavalry. 

12,  '63. 

C.  S.  A.    Recovery. 

34th  Virginia. 

29,  '64. 

1864. 

427 

Jfa6ers,£f.5.,Pt.,H,llth 

July  2, 

Left.  Surg.  L.  L.  Saunders,  P.  A. 

389 

Knight,  C.  E.,Pt.,F,  19th 

Dec.  7, 

Right;  flap.     Surg.  M.  B.  Coch- 

Alabama,  age  24. 

3,  '63. 

C.  S.    8th,  re-am  putatiou.    Ex 

Iowa. 

8,  '62. 

ran,  1st  Iowa  Cavalry.    Disch'd 

changed  Nov.  12,  1863. 

April  25,  1863. 

428    Mainor,   J.  M.,  Pt.,  B, 

De.31,'62, 

Right.    Surg.  —Gardner,  C.S.A. 

390    Knight,  F.W.,  Pt.,  E.  1st 

Sept.  19, 

Right  ;  flap  of  skin,  circ.  of  mus. 

37th  Georgia,  age  22. 

Jan.  1,  '63. 

Recovery. 

Vt.  H'vy  Art.,  age  21. 

20,  '64. 

Feb.  15,  reamputat'n.     Disch'd 

429 

Male,   G.   W.,  Seaman, 

Mar.  13, 

Left;  flap!   Surg.  J.  Wise,  U.S.X. 

Aug.  17,  1865.     Spec.  4330. 

Baron  DeKalb,  U.  S.  N. 

13,  '63. 

Disch'd  Oct.  22,  1863. 

391 

Knowles,  J..  Corp'l,  K, 

July  15, 

Left;  flap.     Discharged  October 

430    Maley,   J.,   Pt.,  H,  7th 

May  14, 

Left;  flap.     Surg.  G.  C.  Jarvis, 

114th  Illinois.                       15,  '64. 

9.  1864. 

Conn.,  age  26. 

14,  '64. 

7th  Conu.    March  2.  '65,  re-amp. 

392 

Koch,  D.,  Pt.,  A,   54th  i  Aug.  29, 

Right.     Surg.  C.  W.  Hagen,  54th 

Discharged  Sept.  13,  1865. 

New  York.                         29,  '62. 

N.  Y.   Sept.  3,  re-amp,  up.  third. 

431 

Malloy,  P.,  Pt.,  A,  10th 

Sept.  19, 

Right  ;  flap.     Surg.  —  Pitts,  2d 

Disch'd  April  14,'64.  Spec.  6707. 

Tennessee,  age  38. 

21,  '63. 

Miss.    To  Provost  Marshal  June 

393 

Koch,  II.,  Serg't,  F,  82d 

May  25, 

Left  ;  circular.    Discharged  A  ug. 

14,  1864. 

Illinois,  age  26. 

26,  '64. 

31,  1865. 

432 

Malters,  B.,  Pt,,  A,  108th 

Julv  3, 

Right  ;  ant.  post.  flap.     Surg.  O. 

394 

Koehler,  A.,  Pt.,  D,  4th 

Dec.  13, 

Right.     Discharged  August  28, 

New  York,  age  17. 

3,  r63. 

Munson,   108th  N.  Y.     Hsem.; 

New  York. 

13,  '62. 

1863. 

lig.  ant.  tibial  artery;  necrosed. 

395 

Kopp,   E.,   Pt.,  K,   12th 

Mar.  25, 

Left;  flap.  Surg.A.Satterthwaite, 

Disch'd  Nov.  3,  '64.     Spec.  4323. 

New  Jersey,  age  32.          27,  '65. 

12th  N.  J..  and  A.  Staff  Surg.  W. 

433    Manahard,  W.  E.,  Pt., 

May  31, 

.     Surgeon  II.  H.  Hubbard, 

J.Burr,U.S.A.  (Also  amp.  right 

G,  2d  Mississippi. 

31,  '62. 

P.  A.  C.  S.     Recovery. 

leg,  low.  third.)  April  2,  slough. 

434    Maugan.  R.,  Lieut.,  D, 

June  24, 

Lett.     Surg.  S.  H.  Kersey,  36th 

Discharged  Oct.  3,  1865. 

75th  Illinois. 

24,  '64. 

Indiana.     Disch'd  Dec.  2,  1864. 

396 

2Kosack,  O.,  Pt.,  K,  2d    Dec.  13. 

Left  ;    gangrene.     Disch'd  June 

435    M<tnsnn,n.  W.,  Serg't,!!, 

April  2, 

Right;  circular.     Released  June 

Maryland,  age  26.              13,  '62. 

15,  1864.    iipcc.  6706. 

7th  Tenn.,  age  22. 

3,  '65. 

14,  1865. 

397    Kriner.  J.,  Tt,  13,  48th     Oct.  29. 

Right  ;  circ.  Surg.W.O'Meagher, 

436    Mapes,    W.  Tf.,  Pt.,  F, 

Oct.  19. 

Right  :  ant.  post.  flap.     Surg.  N. 

Pennsylvania,  age  26.       29,  '64. 

69th  N.  Y.     Disch'd  June  6,  '65. 

5th  X.  Y.  Cav.,  age  42. 

20,  '64. 

D.  Ferguson,  8th  N.  Y.  Cavalry. 

398 

Lao/,  J.    P.,  Capt.,   B,     May  3, 

Right.     Surg.  P.  F.  Whitehead, 

Disch'd  May  3,  1865. 

44th  Virginia.                       3,  '63. 

C.  S.  A.     Recovery. 

437 

Martin,  F.  S.,  Pt.,  F,  2d 

Oct.  19, 

Left  ;  ant.  post.  flap.    Surg.  M.  J. 

399    Laird,  I>.  P.,  Pt.,  D.  49th    Aug.  21, 

Right  :  flap.  Surg.G.  T.  Stevens, 

Vermont,  age  21. 

20,  '64. 

Hyde,  2d  Vt.     Oct.  31,  bone  re 

New  York,  age  lit.            21,  '64. 

77th  N.Y.     Disch'd  July  18,  '65. 

moved.     Disch'd  Aug.  25,  1865. 

400  :  Langfit.   J.  W.,  Pt.,  A,      May  5, 

Left  :    flap.     Surg.  W.  V.  White, 

Accidentally  killed  Oct.  1  1,  '65. 

100th  Penn.,  age  21.        |     7,  '64. 

57tb  Mass.     Dis.  July  18.  1865. 

438    Martin,   J.,    Pt.,    L,   2d 

June  1  6, 

Right  ;  circ.     Amp.  toes,  left  foot. 

401    Lariviere.  A..  Pt.,  1),  5th    July  10, 

Left  ;  flap.    A.  Surg.  A.  R.  Stone, 

N.Y.  H'vy  Art.,  age  21. 

16,  '64. 

Disch'd  Nov.  11,1864.     May  11, 

Mich.  Cavalry,  a-e  35.      10,  '63. 

5th  Michigan  Cavalry.     Disch'd 

1865,  re-amputation. 

December  7,  1863. 

439  :  Martin,  W.,  Pt.,  D,  7th 

May  18, 

Right  ;  flap.  Confederate  surgeon. 

402 

Larkins,  W..  Pt.,  G,  91st  1  Mar.  31, 

Left  ;   ant.  post.  flap.     Surg.  R. 

Maine,  age  16. 

18,  '64. 

Recovery. 

New  York,  age  19.             31,  '65. 

Morris,  91st  N.Y.     Discharged 

440    Mason,  D.  L.,Pt..B,  38th 

July  30, 

Right  :  ant.  post.  flap.     Surg.  W. 

July  21,  1865. 

Wisconsin,  age  15. 

30,  '64. 

B.  Fox.  8th  Michigan.     Disch'd 

403    Lathrop,    W.,    Pt.,     F,     April  2, 

Left;  ciro.    Surg.  J.Westfall,67th 

July  11,  1865. 

67th  Ohio,  age  18.              2,  '65. 

Ohio.     Disch'd  Aug.  12,  1865. 

441    Mason,  E.F.,Pt.,C,  29th 

July  3, 

Left  ;  flap.     Snrg.  A.  K.  Fifield. 

404 

Latimer,  J.   T.,  Pt..  L, 

May  2, 

;  flap.     Transferred  June  9, 

Ohio,  age  19. 

3,  '63. 

29th  Ohio.    Discharged  Novem 

3d  Alabama,  age  21. 

3,  <63. 

1863. 

ber  20,  1863. 

405 

Latta,  W.  T.,  Pt.,  A,  53d    July  10, 

Right.    Surg.  E.  M.Waters,  P.  A. 

442    Masterson,  P.,Pt..A,f>9th 

Aug.  25, 

Left:    double   flap.     Discharged 

Georgia,  age  22.              ,    10,  '63. 

C.  S.     Exch'd  March  17.  1864. 

New  York,  ago  51. 

27,  '64. 

July  24,  1865. 

406    Law.  A.  H.,"  Pt.,  C,  33d    July  20, 

Left:  flap.     Gangrene.     Disch'd 

443    Maunj,  J.,  Pt.,  E,  31st 

June  2, 

.'    Retired  January  31,  186">. 

Indiana,  age  24.                  20,  '64. 

July  21,  1865. 

Georgia,  age  38. 

3,  '64. 

407    Lawrence.  C.  P..  Pt.,  B,     July  2, 

Left;"  circ.     Surg.  7,.  B.  Adams. 

444    May,  E.  A.,  Pt.,  A,  27th 

Nov.  16. 

Right  ;    flap.     Discharged   June 

32d  Mass.,  age  21.           :     3,  '63. 

32d  Mass.     Disch'd  July  27,  '64. 

Michigan,  age  21. 

17,  '63. 

3ri864. 

1  FISHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations,  in  the  Hospitals  near  Sharpsburg.  3Id.,  after  the  Battle  of  Antietam,  September  17, 
1862,  in  American  Journal  Medical  Sciences,  Vol.  XLV,  p.  48. 

3  THOMSON  (WILLIAM),  Report  of  Cases  of  Hospital  Gangrene  treated  in  Douglas  Hospital,  Washington,  D.  C..  in  American  Journal  Mcdiral 
Sciences,  Vol.  XLVII,  p.  380. 

3FisiiEii  (G.  J.),  Rejvirt  of  Fifty-seven  Canes  of  Amputations,  in  the  Hospitals  near  Sharpsburg,  Md.,  after  the  Uattlt  of  Antietam,  September  17, 
1862.  in  American  Journal  Medical  Sciences,  Vol.  XLV.  p.  48. 


486 


INJURIES    OF    THE    LOWEE    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

445 

May.  J.  H.,  Pt.,  D,  22d 

Sept.  21, 

Right  ;    circ.      Discharged  May 

487 

Munger,  L.  L.,  Pt.,  E, 

Sept.  17, 

Left  ;  circular.     Discharged. 

Col'd  Troops,  Hge  37. 

21,  '04. 

22,  1865. 

105th  New  York. 

17,  '62. 

446 

May,  P.  J.,  Pt.,  C,  1st  R. 

May  3, 

Right  ;  ant.  post,  flap  ;  nee.  bone 

488 

Murphey,  J.  F.,  Pt.,  B, 

Sept,  16, 

—  .     Surg.  —  Trescott,  C.  S.  A. 

Island  Art'ry,  age  20. 

4,  r03. 

removed.    Disch'd  Aug.  9,  1864. 

28th  North  Carolina. 

16,  '64. 

Retired  January  30,  1865. 

447 

McCandless,  G.,  Pt.,  K, 

Nov.  7, 

Right.      Disch'd    May   3,    1864. 

489 

Myers,   P.,   Pt.,    M,  1st 

Sept.  5. 

Left:  circ.     Surg.W.  II.  Thome, 

118th  Peun.,  age  48. 

7,  '63. 

Perished  Nov.  20,  1868,  in  a  se 

Wis.  Cav.,  age  22. 

5,  '64. 

U.  S.  V.     Discli  'd  Aug.  30,  1865. 

vere  snow  storm. 

490 

Nance.  R.  G.,  Capt.,  B, 

July  28, 

Right;    flap.      Surg.   A.  Goslin, 

448 

McCloy.  R.,  Pt.,  A,  10th 

April  6, 

Left;  ant.  post,  flap.;  sloughed; 

40th  Illinois,  age  42. 

28,  '64. 

4Hth  111.     Aug.  2,  re-amputat'n. 

New  York,  age  18. 

7,  '65. 

exfol.     Disch'd  Oct.  21,  1865. 

Discharged  Jan.  7,  1865. 

449 

McClure,  S..  Pt.,  H,  83d 

May  19, 

Left  ;  circ.    Surg.  E.  C.  Franklin, 

491 

Neeley.J.  T.,  Pt.,  F,  2Ist 

July  4, 

Left.     Exchanged  March  17,  '64. 

Indiana,  age  28. 

20,  '63. 

U.  S.  V.     Gangrene.     Disch'd 

Mississippi,  age  19. 

6,  '63. 

February  23.  1864. 

492 

Neighbors,  W.R..  Lieut., 

Sept.  20, 

—  .     Surg.  —  Berton,  C.  S.  A. 

450 

•M.-Comas.  D.  H.,  Serg't, 

Sept.  30, 

Right.  Surg.W.C.  Shurlock,  51st 

G,  4th  Tenn. 

20,  '03. 

Recovery. 

E,  8th  Mich.,  age  21. 

30,  '64. 

Penn.     Disch'd  June  11,  1865. 

493 

Nelson,  E.,  Pt.,  H,  7th 

May  22, 

Right  ;  fla'p.    Surg.W.  Berry,  7th 

451 

McCoy,  J.,  Pt.,  A,  64th 

May  9, 

Right  ;    circ.     Confed.   surgeon. 

Kentucky. 

22,'  '63. 

Kentucky.     Disch'd  Aug.  8,  '63. 

Ohio,  age  20. 

10,  V64. 

Disch'd  April  27,  1865. 

494 

Nelson,  S.,  Pt.,  B,  22d 

July  20, 

Left;  flap."  A.Surg.C.  S.  blanch- 

452 

McCoy,  W.,  Pt.,  G,  5th 

Aug.  5, 

Right;  lateral  flap.     To  Provost 

Wisconsin,  age  20. 

20,  '64. 

ard,  22d  Wis.     Disch'd  J  uly  4, 

Tenn.  Cav.,  age  19. 

5,  '64. 

Marshal  Nov.  23,  1864. 

1865.     Died  Feb.  25,  1867. 

453 

McDonald,  J.  H.,  Pt.,  A, 

July  20, 

Left;  circular.     To  Provost  Mar 

495 

'Neveling,  W.,  Pt.,   N, 

June  30, 

Right;  double  flap.  Sept.  1,  1863, 

23d  Miss.,  age  19. 

21,  '64. 

shal  December  1,  1864. 

71st  Penn.,  age  26. 

30,  '02. 

amp.  knee  joint.     Disch'd  Mar. 

454 

McParland,  G.  P.,  Lieut. 

July  2, 

Right.     Mustered  out  July   27, 

3,  1864.     Specs.  668,  2458,  2778. 

455 

Col.,  151st  Penn. 
McFarland,J.  H.,Capt., 

2,  '63. 
May  16, 

1863. 
Right.     Surg.  —  Node,  C.  S.  A. 

496 

Newton,  J.  B.,  Lieut.  ,K, 
28th  Illinois. 

Oct.  5, 
6,  '62. 

Right.  Discharged  June  10,  1863. 

456 

G,  1st  Missouri. 
McGiveney,  J.,   Corp'l, 

17,  '63. 
May  18, 

Recovery. 
Right  ;  circular.    Disch'd  March 

497 

Noyes,  C.  II.,  Serg't,  H, 
169th  N.  York,  age  21. 

Jan.  16, 
16,  '65. 

Left  ;  ant.  post.  flap.    Discharged 
Nov.  3.  1865.     Spec.  3512. 

457 

D,  155th  N.  Y.,  age  26. 
McGowan,  J.,  Pt.,  C,  6th 

18,  '64. 
May  5, 

17,  1865. 
Right  ;   circular.     Disch'd  Aug. 

498 

Nutter,  L.  S.,  Pt.,  A,  5th 
New  Hamp.,  age  16. 

July  1, 
3,  '62. 

Left  :  flap.  Surg.G.  B.Coggswell, 
29th  Mass.     Jan.  3,  '63,  re-amp. 

Vermont,  age  26. 

5,  %4. 

2,  1865. 

Disch'd  Sept.  25,  1863. 

458 

McGrath,  M.,  Pt.,K,27th 
Mass.,  age  26. 

Mar.  14, 
14,  '62. 

Left;  circ.     Swrg.  G.  Derby,  23d 
Mass.     Disch'd  Sept.  21,  1862. 

499 

Nutter,   W.  S.,   Pt,,  A, 
42d  Missouri,  age  22. 

May  18, 
—  ,  '65. 

Right;  flap.  Surg.S.Ilart,U.S.V. 
Disch'd  June  28,  1865. 

459 

McGuire,  J.,  Pt.,  A,  12th 

Dec.  13, 

Left  ;  circ.   Surg.  A.  W.Whitnev, 

500 

O'Brian,  T.,  Corp'l,  D, 

Sept.  17, 

Right;  flap.     Surg.  L.  Reynolds, 

Massachusetts,  age  27. 

14,  '62. 

13th  Mass.    Disch'd  Apr.  30,  '63. 

69th  New  York. 

19,  '62. 

63d  N.  Y.    Disch'd  Mar.  4,  1863. 

460 

McGuire,T.,Pt.,A,105th 

Dec.  13, 

Left.     Discharged,  1863. 

501 

O'Brien,  J.,  Pt.,  E,  188th 

Mav  16, 

Right  ;  flap.    Disch'd  Dec.  23,  '64. 

New  York. 

14,  '62. 

Pennsylvania,  age  26. 

16,''64. 

Insane  Asylum  1870. 

461 

McMullen,  W.,  Pt.,  H, 

Aug.  9, 

Right;    flap.      Discharged  Jan 

502 

2O'  Connor.    D.,    Pt.,   C, 

Sept.  21, 

Left:  circ.     April  14,  '64,  re-amp. 

60th  Ohio. 

11,  '62. 

uary  15,  1863. 

Cobb's  Legion,  age  28. 

21,  '63. 

To  prison  Oct.  4,  '64.    Spec.  2212. 

462 

McN'aughton.  C.,  Serg't, 

May  2, 

Left  ;  circ.     Ass't  Surgeon  R.  A. 

503 

O'Keefe,  R.,  Pt.,  A,  1st 

Oct.  7, 

Right  ;    flap.     Discharged  Aug. 

I,  5th  Michigan. 

2,  '63. 

Everett,  5th  Mich.     Discharged 

Artillery,  age  21. 

7,  '64. 

28.  1865. 

Dec.  11,  1863. 

504  ;  Oliver,  D.  S.'Pt.,  E,  6th 

July  22, 

Right  :  ant.  post.  flap.  To  Provost 

463 

Mears,    T.,  Pt.,  H,   61st 

June  23, 

.     Recovery. 

;     Kentucky,  age  24. 

23,  '64. 

Marshal  Dec.  8,  1864. 

Virginia. 

23,  '64. 

505 

Oliver,  J.  B.,  Corp'l,  6th 

May  28, 

Left;  cire.     Surg.  A.  Wood,  1st 

464 

Meinhardt,  J.,  Corp'l,  D, 

Mar.  8, 

Left  ;  flap.     Surg.  C.  Cook,  12th 

N.  Y.  Battery,  age  21. 

28,  '64. 

Mass.  Cav.  Disch'd  Aug.  18.'64. 

12th  Missouri. 

8,  '62. 

Missouri.     Discharged. 

506 

Orkney,  J.  A.,  Corp'l.A, 

Aug.  25, 

Right;  ant.  post.  flap.     Disch'd 

465 

Meissner,  G.  H.,  Pt.,  F, 

Aug.  3, 

Right,     Surg.  J.  Chapman,  123d 

4th  Ohio,  age  25. 

27,  '64. 

December  21,  1864. 

3d  Wisconsin,  age  26. 

3,  '64. 

N.  Y.    Disch'd  May  27,  1865. 

507 

O'Rourke,  M.,  Pt,,M,6th 

May  9, 

Left;   flap.     Disch'd   March   16, 

466 

Merry,    E.  W.,    Serg't- 

July  20, 

Left;  flap.     Surg.  D.  S.  Young, 

N.Y.  H'vy  Art.,  age  23. 

10,  '64. 

1865. 

Maj.,  21st  Ohio,  age  21. 

20,  '64. 

21st  Ohio.     Mustered  out  May 

508 

Ostrander,  C.  W.,  Lieut., 

May  6, 

Right;    ant.  post.  flap.     Confed. 

31,  1865. 

C,  122d  N.  Y.,  age  31. 

7.  '64. 

surgeon.    Disch'd  March  10,  '65. 

467 

Metz,  L.,  Lieut.,  E,  78th 
New  York,  age  28. 

June  15, 
J6,  '64. 

Left  ;  flap.     Discharged  July  12, 
1864. 

509 

Ostrander,    M.,   Pt,,    F,  i  Nov.  30, 
15th  N.Y.  Cav.,  age  19.     30,  '64. 

Right  ;  lat.  double  flap.    A.  Staff 
Surg.  N.  P.  Graham.     Disch'd 

468 

Miller,  I.  D.,  Pt.,  C,  llth 

May  12, 

Right  ;  flap.     Discharged  March 

August  18,  1865. 

Infantry,  age  24. 

13,  '64. 

27,  1865. 

510 

Otts,   F.  M.,  Serg't,  B,    July  20, 

Left  ;  circ.     To  Provost  Marshal 

469 

Miller,   J.,  Pt,,  C,  19th 

Oct.  27, 

Left  ;  ant.  post.  flap.    Discharged 

31st  Miss.,  age  23.             21,  "64. 

April  2,  1865. 

Wisconsin,  age  27. 

29,  '64. 

May  22,  1865. 

511    Parker,   J.,   Lieut.,    B,    May  19, 

Left.     Surg.  —  Dickson.  C.  S.  A. 

470 

Miller,  J.  II,  Pt.,  A,  54th 

July  22, 

Right;    flap.     Ass't  Surg.  C.  B. 

14th  Louisiana. 

20,  '64. 

Recovery. 

Ohio,  age  35. 

23,  '64. 

Richards,  30th   Ohio.     Disch'd 

512 

Patterson,  G.  G.,  Pt.,  B, 

Dec.  31, 

Left  ;    flap.     Discharged   March 

May  20,  1865. 

44th  Illinois.                        31,  '62. 

31,  1863. 

471 

MiUer,  J.  T.,  Lieut.,  E, 

July  1, 

R't.     Surg.  J.  McAlpine,  C.  S.  A. 

513  :  Patterson,  J.  M.,  Pt.,  K,    July  20, 

Left  ;  circular.     Furloughed  Oct. 

38th  Virginia,  age  24. 

1,  '63. 

Exch'd  and  furloughed,  1864. 

50th  Alabama,  age  34.     20,'  '64. 

18,  1864. 

472 

Miller,  W.,  Pt.,  A,  4th 

July  3, 

Left  ;  post.  flap.    Surg.  H.  M.  Mc- 

514    Patterson,  J.  W.,  Pt.,  E,      Oct.  8, 

Right;  flap.  Surg.  .T.A.  Stillwell, 

Artillery,  age  28. 

4,  '63. 

Abee,  4th  Ohio.     Headquarters 

42d  Indiana.                        9,  '62. 

22d  Ind.     Disch'd  Dec.  17.  1862. 

March  26,  1864. 

515    Patterson,  T.  B  ,  Serg't,    Sept.  19, 

Left  ;    flap.     Surg.  W.  S.  Love, 

473 

Milliken,  G.  A.,  Corp'l, 

July  2, 

Left  ;  flap.     Surg.  J.  B.  LeBlond, 

H,  51st  Ala.,  age  30.      j    19,  '64. 

C.S.A.     To  prison  Jan.  5.  1865.  ' 

1,  1st  Minnesota,age21. 

3,  '63. 

1st  Minn.     Disch'd  Dec.  15,  '63. 

516    Patton,  J.  F.,  Pt.,  K,  6th    Sept.  30, 

Right:  double  flap.     Transferred 

474 

Mills,  II.   L.,  Serg't,  H, 

Dec.  16, 

Risjht;  flap.     Disch'd  October  5, 

Georgia.                              30,  '64. 

October  8,  1864. 

7th  Minn.,  age  31. 

16,  '64. 

1865. 

517 

Paul,    D.,    Pt.,   I,    103d    Nov.  25, 

Right:    flap.      Surg.  R.  Morris. 

475 

Milner,S.,Serg't,G,  10th 

Oct.  8, 

Left.     Surg.  C.  S.  Muscroft,  ]  nth 

Illinois,  age  23.                  25,  '63. 

103d  Illinois.     Disch'd  June  6, 

Ohio. 

10,  '62. 

Ohio.     Disch'd  Dec.  14,  1862. 

1864.     Died  June  12,  1870. 

476 

Mitchelfelder,  E.,  Pt.,  B, 

Dec.  13, 

Left;   double  flap.     To  Veteran 

518 

Pavne,    M.,   Corp'l,    A, 

June  26. 

Left;  ant.  post.  flap.     Surg.  I.  V. 

163d  New  York. 

14,  '62. 

Reserve  Corps  Feb.  29,  ]864. 

14th  -N.  Y.  H'vy  Art'y, 

26,  '64. 

Mullen,  14th  N.  Y.  H'vy  Art  y. 

477 

Monaghan,    T.,    Pt.,  A, 

Dec.  13, 

Right,     Surg.  L.  Reynolds.  63d 

acre  26. 

Disch'd  Dec.  29,  1864. 

63d  New  York,  age  50. 

14,  '62. 

N.  Y.     Disch'd  Aug.  31,  1863. 

519    3Peeblcs,  D.  P.,  Pt.,  D, 

Sept.  17, 

Right;    post.  flap.     Discharged 

Died  December  25,  1874. 

18th  Miss.,  age  22. 

19,  '62. 

November  10.  1862. 

478 

Monroe,  J.  M.,  Pt.,G,42d 

Dec.  28, 

Left  :  flap.     Discharged  April  2, 

520 

Penet,  J.  D.,  Capt.,  A, 

Oct.  30, 

Left;  circ.     A.  A.  Surg.  H.  R. 

Ohio. 

28,  '62. 

1863. 

144th  N.  York,  :ige  25. 

30,  '64. 

Durant.     Must.  out.Tune25.  '65. 

479 

Moon,  J.  B.,  Pt.,  E,  71st 

Aug.  30, 

Right;    flap.     Discharged  Octo 

521 

Perry,  E.  J.,  Corp'l,  C,     April  2, 

Left  ;  flap.     Surg.  J.  11.  Kimball, 

Indiana. 

31,  '62. 

ber  1,  1862. 

61st  Mass.,  a<re  21.              3,  '65. 

32d  Me.     Disch'd  J  ul  y  27,  1865. 

480 

Moore,  S.  H.,Pt.,  A,  30th 

Nov.  27, 

Right  ;  flap.  Surg.  A.T.  Hudson, 

522    Peters,    J.,   Pt'.,    K,   1st    Sept.  14, 

Right;    flap.     Surg.   B.   F.    Ste 

Iowa,  age  31. 

27,  '63. 

26th  Iowa.     Disch'd  Jan.  1,  '65. 

Kansas.                               15,  '63. 

venson,  14th  111.    Mustered  out 

481 

Moore.    T.,  Pt.,  B,  Aus 

May  25, 

.     Surg.  W.  A.  Holt,  C.  S.  A. 

June  17,  1864. 

tin's  Louisiana  Bat'ry. 

25,  '64. 

Retired  March  21,  1865. 

52:!    Peterson,  D.  M.,  Pt.,  M,     Oct.  18, 

Left    circ.  A.A.Surg.J.L.Wade. 

482 

Morse,  B.  P.,  Corp'l,  A, 

Sept.  17, 

Left.     Discharged  December  6, 

2d  Mass.  Artillery.             18,  '64. 

Disch'd  March  30,  1865. 

5th  New  Hampshire. 

17,  '62. 

1862. 

524    Pfeiffer,  O.,  Pt.,  B,  47th    Aug.  18, 

Left  ;   flap.      Discharged   March 

483 

Morse,  W.  B.,  Pt.,  11,1st 

June  18, 

Left  ;  flap.    Discharged  July  8, 

Pennsylvania,  age  19.    '    19.  '64. 

15,  1805. 

Mass.  Artillery,  age  23. 

19,  '64. 

1865. 

525    Phelps,  H.,  Pt..  K,  llth     Oct.  19, 

Right  ;    post.  flap.      Discharged 

484 

Mortanto,  L.,  Pt.,G,  57th 

Aug.  25, 

Right  ;  dou.  flap.     Surg.  —  Tay 

Vermont,  age  20.                 20,  '04. 

September  11,  1805. 

New  York,  age  59. 

27,  '64. 

lor.  C.S.A.    Disch'd,)une16,'65. 

526 

Phelps,  M.,  Pt..  F,  10th     Mar.  21, 

Left  ;  bilateral  flap.    Surg.  A.  15. 

485 

Mosrly,   W.    D.,   Pt.,  G, 

Sept.  20, 

Right  ;  circ.  Surg.  J.W.  Lawson, 

Illinois,  age  35.                   21,  '65. 

Monohan,   63d   Ohio.      Disch'd 

25th  Va.  Cav.,  age  27. 

20,  '64. 

P.  A.  C.  S.    To  prison  Jan.  5.  '65. 

June  30,  1865. 

486 

Midler,  W.,  Pt.,  II,  20th 

Jan.  2, 

Right.    Surg.W.  A.  Holt,  C.  S.A. 

527    Piclcett.  IT.,  Pt.,  G,  27th     Oct.  14, 

Right  ;    Hap.      Confed.   surgeon. 

Louisiana. 

2,  '63. 

Recovery. 

North  Carolina. 

15,  '63. 

Recovery. 

1  BuiNTON  (J.  H.),  On  Amputation  at  the  Knee  Joint  and  at  /he  Knee,  in  American  Journal  Medical  Sciences,  1868,  Vol.  LV,  p.  319. 
*  Ll  DELI.  (J.  A.),  On  the  Secondary  Traumatic  Lesions  nf  Bone,  etc.,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  p.  459. 
3  Fisi!  Kit  (G.  J.),  Report  of  Fifty -seven  Cases  (if  Amputations  in  the  Hospitals  near  Sharpsburg,  Md.,  etc.,  in  American  Journal  Medical  Sciences, 
1863,  Vol.  XLV,  p.  48. 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


No. 

NAME.  MILITARY 
DESCRIPTION.  AND  A(;E. 

DATKS. 

OPERATIONS.  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION',  AND  AGE. 

DATF.S. 

OPERATIONS,  OPERATORS, 
RESULT. 

528    I'ierce,  A.  .1  ,  Curp'l,  E, 

July  1, 

Right;  flap.     Surg.  E.  G.  Chase, 

573 

liogers,   J.   H.,  Pt.,  D, 

May  10, 

Left  ;  ant.  post.  flap.    Surg.  W.  S. 

104th  N.York,  age  21. 

2,  '63. 

104th  N.Y.    Disch  'd  Aug.  9,  '64. 

125th  N.  Y.,  age  35. 

10,  '64. 

Cooper,    125th   N.  Y.     Disch'd 

529 

Pinckney,  J.,  Pt.,  E,  5th 

Mar.  20, 

Left;  Hap.     Surg.  L.  Barnes,  6th 

June  24.  1865. 

Col'd  Troops,  age  20. 

21,  "'65. 

C.  Troops.     Disch'd  Oct.  18,'65. 

574 

Rolltton,   G.   IV..  Capt., 

Dec.  16, 

Right;  circ.     Surg.  —  Mitchell, 

530 

J*leasants,     G.    S.,   Pt., 

July  1, 

Right.      Exchanged   March   17, 

H,  9th  Ark.,  age  33. 

16,  '64. 

4th  Ark.     To  Provost  Marshal 

Page's  Virginia  Bat'ry, 

3,  '63. 

1864. 

March  7,  1865. 

age  19. 

575 

Ropp,    S.,    Pt.,    I,    42d 

Dec.  16, 

Right  ;  ant.  post.  flap.     Disch'd 

531 

Pool,  J.  D.,  Pt.,  I,  148th 

June  18, 

Right  ;  circ.:  gangrene.     Disch'd 

Illinois,  age  42. 

16,  '64. 

July  6,  1865. 

New  York,  age  19. 

18,  '64. 

July  27,  1865. 

576 

Ross,  L.,  Corp'l,  C,  39th 

July  22, 

Left.     Furloughed  Nov.  10,  1864. 

532 

Porus,  J.,  Pt.,   F,   25th 

May  28, 

Left.     Surg.  C.  Robertson,  159th 

Ohio,  age  30. 

—  ,  '64. 

Connecticut. 

28,  '63. 

N.  Y.     Uisch'd  Aug.  26,  1863. 

577 

Ross,  L.  T..  Serg't,  A, 

May  22, 

Left;  flap.     Discharged  August 

533 

Potts,  J.  G.,  Tt.,  B.  14th 

July  1, 

Right  ;  flap.    Surg.  J.  M.  Farley, 

81st  Illinois. 

22,  '63. 

5.  1863. 

N.  Y.  S.  11.,  age  32. 

2,  '63. 

84th  N.Y.  Disch'd  Nov.  28,  '63. 

578 

Rowley,  R.,  Pt,,  G,  29th 

May  1, 

Left;  flap.     Discharged  July  16, 

534 

Pousch,  J.,  Pt.,  B,  47th 

Mar.  31. 

Right  ;  flap.  Surg.  V.B.Kennedy, 

Wisconsin. 

2,  "63. 

1863. 

Illinois,  nge  22. 

31,  '65. 

5th  Minn.  Disch'd  Feb.  16,  1866. 

579 

Rucker,  A.,  Pt.,  B.  10th 

Oct.  19, 

Left  ;  circular.     Discharged  May 

535 

Powell,  K.  II.,  Serg't,  C, 

Sept.  7, 

.     Surg.  —  Swann,  C.  S.  A. 

West  Virginia,  age  35. 

20,  '64. 

14,  1865. 

6th  Georgia. 

9,  '64. 

Recovery. 

580 

Rudiger,  J.,  Corp'l,  A, 

July  2, 

Right;  circ.     Surg.  C.  S.  Wood, 

536 

Powers,  L.  J.,  Pt.,  F,  2d 

June  9, 

Right.     Surg.  A.  Hard,  8th  111. 

66th  N.  York,  age  24. 

3,  '63. 

66th  N.  Y.     Disch'd  Dec.  8.  '63. 

Massachusetts. 

9,  '63. 

Cavalry.     Disch'd  January  25, 

581 

Ryan.  S.  W.,  Corp'l,  B, 

May  9, 

Left  ;  flap.    Surg.  B.  Rohrer,  10th 

1864.     Spec.  1219. 

191st  Penn.,  age  20. 

10,  ''64. 

Penn.  Reserves.     Disch'd  Feb. 

537 

Presan,   H.,    Pt.,  I,    1st 

Aug.  16, 

Left  ;  flap.     Discharged  January 

16,  1865. 

Maryland  Cavalry. 

16,  '64. 

15,  1865. 

582 

Sanborn.  J.  O.,  Pt.,  E, 

Sept.  17, 

Right  ;  circular.     Disch'd  March 

538 

Pretty  man,  J.  J.,  Pt.,  I, 

Oct.  19, 

Right  ;  ant.  post.  flap.     Mustered 

10th  Maine. 

19,  '62. 

23,  1863. 

lltli  West  Va.,  age  25. 

20,  '64. 

out  June  17,  1865. 

583 

Sanders,  C.  H.,  Pt.,  H, 

July  1, 

Left.     Recovered  and  paroled. 

539 

Price,  J.  T..  Pt.,  C,  5th 

Sept.  19, 

Left  ;   ciro.     Surg.  I.  F.  Pearson, 

38th  Georgia,  age  25. 

2,  '63. 

North  Carolina,  age  26. 

19,  '64. 

5th  N.  C.    To  prison  Feb.  25,'65. 

584 

Sans  Souci,  L.,Corp'l,  E, 

Dec.  16, 

Left  ;  flap.   Surg.  V.  B.  Kennedy, 

540 

Priest,  A.  M.,  Pt.,  M,  1st 

Aug.  25, 

Right  ;    flap.     Discharged  July 

5th  Minn.,  age  45. 

17,  '64. 

5th  Minn.    Disch'd  April  25,  '60. 

D.  C.  Cavalry,  age  20. 

25,  '64. 

21,  1865. 

585 

Sargent,  C.  A.,  Pt.,  B, 

Dec.  13, 

Left.     Feb.  7,  '63,  hsem.;  lig.  ant. 

541 

Priest,  J.  T.,  Pt.,  B,  36th 

June  3, 

Left;  flap.     Discharged  June  17, 

4th  Vermont,  age  24. 

13,  '62. 

tibial.     Disch'd  August  25,  '63. 

Massachusetts. 

3,  '64. 

1865. 

586 

Sargent,  L.  N.,  Pt.,  G, 

May  31, 

Right.     Discharged  July  18.  '65. 

542 

Prueller,  F.,  Pt.,  H,  39th 

Oct.  13, 

Right.      Confed.   surgeon.     Dis 

9th  N.  Hamp.,  age  28. 

31,  '64. 

Spec.  3072. 

Illinois,  age  46. 

13,  '64. 

charged  October  17,  1865. 

587 

Sarver,   W.    J.,  Pt.,  D, 

Aug.  16, 

Left;  circular. 

543 

Purman,  J.  J.,  Lieut.,  A, 
140th  Penn.,  age  2.J. 

July  2, 
3,  '63. 

Left  ;  flap.     Discharged  May  23, 
1864. 

588 

Virginia  Artillery. 
Sawyer,  O.,  Pt.,  E,  29th 

16,  '64. 
Oct.  19, 

Left  ;  circ.     Surg.  J.  F.  Day,  jr., 

544 

Quintan,  M.,  Pt.,  E,  14th 

July  1, 

.     Surg.  —  White,  C.  S.  A. 

Maine,  age  33. 

19,  '64. 

29th  Me.     Disch'd  May  30,  '65. 

Louisiana. 

2,  '63. 

Recovery. 

589 

Sayles,    H.,    Serg't,   E, 

May  22, 

Left;  flap.     Surg.  J.  E.  Murtha. 

545 

Quinn,  J.,  Pt.,   D,  12th 

May  12, 

Right  ;    circular.      To   regiment 

8th  Wisconsin. 

22,  '63. 

8th  Wis.     Disch'd  June  3,  1864. 

Infantry,  age  19. 

13,  '64. 

June  27,  1864. 

590 

Schaniski,L.,Saddler,G, 

Nev.  3, 

Left  ;  circ.    Confederate  surgeon. 

546 

Quinn,  J.,    Pt.,  C,    73d 

Dee.  16, 

Right;   ant.  post.  flap.     Disch'd 

1st  Louisiana  Cavalry, 

3,  '63. 

Pieces  of  necros'd  bone  remov'd. 

Pennsylvania,  age  34. 

16,  '64. 

June  28,  1865. 

age  43. 

(Also  left  little  finger  shot  off.) 

547 

Race,  J.,  Pt.,  B,   194th 

Mar.  22, 

Left;  circ.  A.  A.  Surg.  J.  F.Cleve 

Disch'd  Feb.  1,  '64.     Died  Sept. 

New  York,  age  42. 

22,  '65. 

land.     Disch'd  July  19,  1865. 

20,  '70  ;  erysipelas  and  pyaemia. 

548 

Rackmyer,  P.  N.,  Pt.,  I, 

Sept.  29, 

Right  ;  ant.  post.  flap.     Confed. 

Spec.  4310. 

115th  N.  York,  nge  21. 

Oct.  1,  '64. 

surgeon.     Disch'd  April  6,  1865. 

591 

Schweitzer,  J.,    Pt.,   H, 

Aug.  16, 

Right  ;  double  flap.     Confed.  sur 

549 

Ramaley,L.,Pt.,F,139tb 

Sept.  19, 

Right  ;  lat.  flap.     A.  Surg.  S.  B. 

47th  N.  York,  age  35. 

17,  '64. 

geon.     Disch'd  June  24,  1865. 

Pennsylvania,  age  20. 

19,  '64. 

Sturdevant,  139th  Penn.    Disc'd 

592 

Scott,   J.   T.,  Serg't,  A, 

July  2, 

Right  ;    circular.     Retired  Feb 

February  1  0,  1865. 

Philips's   Georgia  Le 

3,  '63. 

ruary  7,  1865. 

550 

Rand,  M.,  Serg't,  C,  16th 

July  3, 

Left  ;   flap.     Surg.  C.  C.  Jewett, 

gion,  age  21. 

Massachusetts. 

4,  '63. 

16th  Mass.     Disc'd  April  ]2,'64. 

593 

Seagle,    P.,    Serg't,   B, 

Sept.  19, 

Left  ;  flap.     Surgeon  —  Atkins, 

551 

Ranger,  G.,  Pt.,  I,  122d 

Mar.  25, 

Left  :  ant.  post.  flap.   Discharged 

23d  N.  C.,  age  27. 

20,  '64. 

C.  S.  A.     To  prison  Feb.  16,  '65. 

New  York,  age  42. 

25,  '65. 

July  6,  1865. 

594    Seaton,  J.  A.,  Pt.,B,  13th 

May  12, 

Left  ;  circular.    Disch'd  October 

552 

Rankin   J,  S.    Pt..  Orr's 

.Fill..  OS 

12   '63. 

5.  1863. 

S.  C.  Rifles."                      28,  '64.' 

Orr's  S.  C.  Rifles. 

595 

Secor,  E.  C.,  Serg't,  H, 

July  3J 

Left;  flap.     Discharged  August 

553 

Ranzow,  H.,  I't.,  II,  16th 

Dec.  13, 

Left;  flap.  Surg.  E.  Batwell,14th 

61st  New  York,  age  20. 

4,  '63. 

24,  1864. 

Illinois,  age  34. 

13,  '64. 

Mich.     Disch'd  July  6,  1865. 

596    Seibert,  J..  Pt.,  E,~100th 

Aug.  30, 

Left  ;  circ.  Surg.  M.  S.  Kittenger, 

554 

Ratcliffe,  J.  K.,  Corp'l, 

April  13, 

Right.     Discharged   August  22, 

New  York. 

30,  '63. 

100th  N.Y.  Disch'd  Sept.  22/64. 

II,  18th  La.,  age  28. 

13,  '63. 

1863. 

597 

Seng,    T.,  Pt.,    A,  41st 

July  2, 

Left:  circular.     Discharged  May 

555 

Raymond.  J.  R.,  Serg't, 

July  20, 

Left  ;    flap  ;   gangrene.     Disch'd 

New  Jersey. 

4,  '63. 

17,  1864. 

A,  lllth  Penn.,  age  22. 

20,  '64. 

May  22,  1865. 

598    Shafer.  J.,  Sergeant.  K, 

April  1, 

Right;    circular.    Disch'd  Jir.ie 

556 

Reed,  G.  R.,  Pt.,  I,  18th 

Dec.  13. 

Right.    Discharged  April  21,  '63. 

198th  Penn.,  age  44. 

1,  '65. 

21,  1865. 

•  Massachusetts,  age  29.       15   '62. 

599    Sharp     J    H     Pt.     F 

Right  :   circ.     Furloughed  Octo 

557 

Reeve,  J.  H.,Capt.,  K,3d 

Jan.  12, 

Right  ;  ant.  post.  flap.     Surg.  G. 

1     Cobb's  Ga.  Legion. 

ber  17,  1864. 

New  York,  age  24. 

12,  '65. 

C.  Jarvis,  7th   Conn.     Disch'd 

600  :  Sharpe,  G.,  Pt.,  C,  38th 

Oct.  19, 

Right  :  ant.  post.  flap.     Disch'd 

June  26,  1865.     Spec.  6934. 

Massachusetts,  age  27. 

19,  '64. 

March  30,  1865. 

558 

Resa,  F.,  Pt.,  B,  3dlo\va, 

Oct.  5, 

Right  ;    flap.     Discharged   April 

(iOl    Shaud,   J.,   I't.,  K,  93d 

May  31, 

Right:   ant.  post.  flap.     Disch'd 

age  29. 

6,  '62. 

7,  1S63. 

Pennsylvania,  age  26. 

J'e'2,'62. 

March  9,  1864.    Spec.  4305. 

559 

Reynold,   J.,  Corp'l,  D, 

Sept.  19, 

Right;  lat.  oval  flap.    Surg.  N.  S. 

602    Shears,  'C.  R..  Serg't,  C, 

May  11, 

Right  ;  circ.     A.  A.  Surg.  D.  O. 

12th  Conn.,  age  24. 

19,  '64. 

Snow,  153d  N.  Y.     Discharged 

26th  Michigan,  age  31. 

13,"  '64. 

Farrand.     Disoh'd  May  2,  1865. 

March  10,  1865. 

603    Sherwood,  D.,    Pt.,    E, 

May  27, 

Left:  flap.     Surg.  C.  Robertson, 

560 

Reynolds,  J.,  Pt.,  A,  6th 

May  9, 

Left  ;  ant.  post.  flap.    Discharged 

131st  New  York. 

27,  '63. 

159th  N.Y.     Discharged  Octo 

Connecticut,  age  24. 

10,  ''64. 

November  4,  1865. 

ber  20,  1863. 

561 

Reynolds,  S.  II.,  Serg't, 

Dec,  13, 

Right.     Discharged  June  5,  1863. 

604    Siemens,  H.,  Pt.,  B,  39th 

July  3, 

Right  :  flap.     Mustered  out  June 

A".  1st  Mass.  Battery. 

13,  '62. 

New  York,  age  26. 

4,  '63. 

29,  1864.     Died  Dec.  10,  1867. 

562 

Rice.    C.,  Pt.,    D,    87th 

Sept.  19, 

Left.     Discharged  April.17,  1864. 

605    Skeen,  Wm.,  Pt.,  G,  87th 

April  2, 

Left  ;  ant.  post.  flap.    Discharged 

Indiana,  age  331 

20,  '63. 

Pennsylvania,  age  21. 

2,  '65. 

September  25,  1865. 

563 

Ricliardson,  J.  M.,  Capt. 

Sept.  19, 

.    Surg.W.  T.  Sutton,C.S.A. 

606    Skinner,  J.,  Pt.,  E,  5th 

June  22. 

Left;  circ.    Confederate  surgeon. 

and  A.  A.  General. 

19,  '64. 

Recovery. 

Connecticut,  age  20. 

23,  '64. 

Gangrene.  Disch'd  Aug.  22,  '65. 

564 

Rider,    J.,  Pt.,   B.   49th 

Aug.  21, 

Right;  flap.    Surg.G.T.  Stevens, 

607    Slater,  E.,  Pt.,  D,  10th 

Nov.  19, 

Right;   flap.     Surg.  M.  Hawes, 

New  York,  age  40. 

21,  '64. 

77th  N.  Y.    Discharged  Dec.  19, 

Ohio  Cavalry,  age  31. 

19,  '64. 

loth   Ohio    Cavalry.      Disch'd 

1864.     Spec.  2460. 

• 

June  18,  1865. 

565 

Riggins,  J.,  Pt.,  II.  99th 

May  12, 

Left  :  flap.     Disch'd  Sept.  24,  '64. 

608    Slaver.  H.  P.,  Corp'l,  E, 

Aug.  17, 

.     Surg.W.  S.  Love,  C.  S.  A. 

Pennsylvania,  age  29. 

12,"'64. 

Died  Aug.  15,  '68  ;  consumpt'u. 

i     36th  Virginia. 

19,  '64. 

Retired  Feb.  14,  1865. 

566 

Roache,  F.  T.,  Pt.,  A,32d    Sept.  24, 

R't  ;  circ.     Surg.W.  V.  Harrison. 

609   Sloan,  W.  A.,  Pt..  H.lOth 

Sept.  19, 

Right  :  flap.    Surg.  W.  A.  Barry, 

Virginia. 

24,  '6-1. 

C.  S.  A.     Trans.  Oct.  26,  1864. 

1     Vermont,  age  26. 

19,  '64. 

98th  Penn.  Disch'd  Sept.  11,  '65. 

567 

Rohb,  L.  A.,  Corp'l,  L, 

Sept.  17, 

Left  ;  circ.  Surg.  H.  E.Goodman, 

610    Small.   T..  Pt.,  H,  60th 

Nov.  27, 

Left  :  circ.     Vet.  Reserve  Corps 

28th  Pennsylvania. 

17,  '62. 

28th  Penn.     Dis.  Nov.  27,  1862. 

New  York,  age  19. 

27,  '63. 

Nov.  19,    1864.     Died  July  6, 

5C8 

Roberts.  H.,   Serg't.  K, 

May  22, 

Left  ;  flap.     Discharged  May  30, 

1870;  consumption. 

47th  Illinois,  age  38. 

23,  '63. 

1864. 

611  '  Smith,  A.,  Pt.,  G,  18th 

Aug.  29.  i  Left.  Surg.  A.  J.  Semmes.C.S.A. 

569 

Robertson.  J.  F.  M.,  Cor 

July  1, 

.    Surg.  —  McAden,  C.  S.  A. 

'     Georgia. 

31,  '62.   i     Recovery. 

poral,  H,  13th  Tenn. 

2,  '63. 

Recovery. 

612    Smith,  D.  F.,Pt.,B,  12th 

July  2, 

Loft;  flap.     Surg.  J.  M.  Merron, 

570 

Robinson,  B.,  Serg't,  D, 

June  29, 

Right  ;  circ.  Surg.W.  P.  Russell, 

New  Hamp.,  age  20. 

2,  '63. 

2d   N.  II.     Discharged  March 

5th  Vermont. 

30,  '62. 

5th  Vt.     Disch'd  Oct.  22,  1862. 

17,  1864. 

571 

Rode,  C.,    Pt.,  G,  123d 

June  13, 

Left.     Discharged  Aug.  26,  1863. 

613 

Smith,  E.,  Pt.,  G,  45th 

June  3, 

Left;  circ.     Surg.  T.  Christ,  45th 

Ohio. 

14,  '63. 

Pennsylvania*  age  26. 

3,  '64. 

Penn.     Disch'd  July  4,  1865. 

572 

Roe,  D.  W.,  Pt.,  E  69th 

liar.  25, 

Right  •    circ     Discharged   Aug 

614 

Smith,  Q.  H.,  Pt.,  F,  7th 

July  1, 

Left;  flap.     Discharged  Decem 

New  York. 

26,  '65. 

14,  1865. 

Wisconsin,  age  21. 

2,  '63. 

ber  22,  1863. 

488 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


"Vr\ 

NAME,  MILITARY 

OPERATIONS.  OPERATORS, 

No 

NAME,  MILITARY 

D  ATES 

OPERATIONS,  OPERATORS, 

JN  v*» 

DESCRIPTION,  AND  AGE. 

RESULT. 

DESCRIPTION,  AND  AGE. 

RESULT. 

615 

Smith,  H.,  Pt.,  H,  13th 

April  9, 

Right;    circ.     Disch'd   Jan.   30, 

655 

Thurber,  F.  N.,  Pt.,  II, 

June  16, 

Left.     Discharged  September  9, 

Connecticut,  age  34. 

10.  '64. 

1865.     Died  June  28,  1869. 

3d  New  Hampshire. 

10,  '62. 

1862. 

616 

Smith,  H.  D.,  Pt.,  C,  2d 

May  3, 

Right;    flap.     Discharged   Aug. 

656 

Tilbe,  R.,  Corp'l,  E,  17th 

Aug.  21. 

Right  ;  ant.  post.  flap.  A.  Surg.  C. 

Delaware,  age  31. 

3,  '63. 

10,  1864. 

Connecticut,  age  24. 

21,  '63. 

Mudge,  1st  N.  York  Engineers. 

617 

lSmilh,    L.,    Serg't,    H. 

Sept.  17, 

Left  ;    circular;    gang.     Disch'd 

Disch'd  July  2,  1864. 

ICth  Georgia,  age  31. 

18,  '62. 

March  6,  1863. 

657 

Tillson,W.  F.,  Lieut.,  G, 

April  2, 

Right  :    necrosed  bone  removed. 

618 

Smith,  T.  A.,  Corp'l,  A, 

Aug.  !>, 

Right;  flap.  Surg.  W.O.Bennett, 

4th  Vermont,  age  22. 

2,  '65. 

Mustered  out  Sept.  28,  1865. 

5th  Conn.,  age  21. 

11,  '62. 

5th  Conn.     Gangrene.    Disch'd 

058 

Todd,  J.,  Pt.,  C,  43d  N. 

Aug.  21. 

Right;  circ.  Surg.  W.  T.  Brewer, 

July  30,  1803. 

Carolina,  age  38. 

21,  '04. 

43d  N.  C.     Trans.  Jan.  8,  1865. 

619 

Smithson,    C..    Pt..    C, 

Oet.  1, 

Left:  flap.    Surg.  D.  Meeker,  F. 

659 

Traumicht,   H.,   Pt.,  E, 

Oct.  8, 

Left  ;  circ.     Surg.  C.  Spinzig,  2d 

116th  Col'cl  Troops. 

1,  '64. 

S.  V.     Disch'd  May  31,  1865. 

2d  Missouri. 

8,  '02. 

Mo.     Disch'd  Dec.  17,  1864. 

620 

SnellinQ,  E.A.,  Pt.,  Not- 

June  22, 

Left  (also  right,  low.  third).    Con 

660 

Triridle,  J.,  Pt,,  K,  56th 

July  21, 

Left;  flap.     Discharged  August 

tawav's  Artillery. 

22.  '64. 

federate  surgeon.     Recovery. 

Massachusetts,  age  22. 

21,  "'64. 

23,  1865. 

621 

Snow,  JB.  N.,  Pt.,  C,  97th 

Sept.  17, 

Left.     Discharged  November  30, 

661 

Tripp,  E.  .Corp'l.  1,140th 

June  18, 

Right  ;  flap.     Surg.  T.  M.  Flan- 

New  "Sprit. 

—  ,  '62. 

1862. 

New  York,  age  28. 

18,  '64. 

dreau,   140th   N.  Y.      Haemor 

622 

Snyder,  G.,  Pt.,  K,  200th 

Mar.  25, 

Right  ;  flap.     Discharged  July  4, 

rhage.     Disch'd  June  24,  1865. 

Pennsylvania. 

25,  '65. 

1865. 

bbS3 

1'nsket,  A.  J.,  Pt.,  E,  1st 

June  12, 

Right  ;  flap.     Surgeon  —  Wier. 

623 

Speer,   A.  C..  Lieut.,  A, 

July  5, 

Rip'.t;  flap.     Surg.  E.  Batwell, 

Michigan,  age  30. 

12,  '64. 

C.  S.  A.     Disch'd  Sept.  8.  J805. 

14th  Mich.,  age  30. 

5,  ''64. 

14th  Mich.     Disch'd  Nov.  1,  '64. 

603 

Troy,  B.  F.,  Pt.,  G,  10th 

May  10, 

Left   (amp.  right,   uppor   third). 

624 

Speer,  A.  C.,  Pt.,  K,  4th 

Mar.  25. 

Right;  circular.     Released  June 

Iowa. 

10,  '63. 

Discharged  Sept.  3.  1803. 

Georgia,  age  37. 

25,  '65. 

28.  1865. 

664 

'Tucker,  W.,  Pt.,  K,  13th 

Sept.  17, 

Left  ;  flap.     Surg.  J.  T.  Gilmore, 

625 

Spe!lman,T.,Pt.,  F,  37th 

Sept.  19, 

Left  ;  circ.  A.  Surg.  J.  G.Thomp 

Mississippi,  age  21. 

17,  '62. 

C.  S.  A.     Retired  Jan.  31,  1805. 

Massachusetts,  age  21. 

20,  '04. 

son,  77th  N.  Y.    Disch'd  Jan.  17, 

665 

Tyson,  J.  H.,  Pt.,  H,  51st 

Sept.  30, 

Left.     Released  July  26,  1805. 

1866.     July8,  '68,  re-amputat'n. 

North  Carolina,  age  22. 

30,  '64. 

626 

Spiker,  J.,  Pt.,  K,  100th 

July  11, 

Left;  flap.   Surg.W.C.  Shurlock, 

666 

Urich,  C.,  Pt.,    E,  45th 

July  1, 

Left  ;    post.  flap.     Disch'd  April 

Pennsylvania,  age  21. 

11,  '64. 

51st  Penn.     Disch'd  June  1,  '05. 

New  York,  age  20. 

2,  r63. 

2,  1804.     Died   June   12,  1870. 

627 

Spivey,A.A.,  Pt.,  1),  54th 

Aug.  21, 

Left;  circular.     To  Provost  Mar 

Spec.  4307. 

North  Carolina,  age  21. 

21,  '64. 

shal  October  25,  1864. 

667 

Utz,  C.  E.,  Pt.,  5th  Ohio 

July  12, 

Left.     Surg.  W.  S.  Edgar,  32d 

628 

Sprague.  F.  E.,  Pt.,  A, 

Sept.  19, 

Left;  circ.  Surg.  J.G.  Bradt.26th 

Battery. 

12,  ''03. 

Illinois.     Discharged. 

20th  Mass.,  age  20. 

20,  '64. 

Mass.     Disch'd  Nov.  7,  1804. 

068 

Valentine.  L.  W.,  Pt.,  H, 

May  3, 

Left;  double  flap.     Surg.  F.   S. 

Springer,    F.,     Pt.,    G, 

Sept,  14, 

Left;  circular.    Furloughed  Dec. 

6th  Maine. 

5,  ''63. 

Holmes,  Oth  Me.    Haemorrhage. 

Cobb's  Ga.  Legion. 

15,  '62. 

19,  1862. 

Disch'd  October  27,  1863. 

•   1 

Springsteen.  W.  E.,  Pt., 

Sept.  1, 

Left  ;  flap.  Surg.  E.  Batwell.  14th 

669 

Van  Doozer,  B.  S.,  Pt., 

April  9, 

Risrht  ;  circ.    Discharged  July  G, 

G,  14th  Mich.,  age  24. 

1,  '64. 

Mich.     Disch'd.  Aug.  11,  1865. 

B,  58th  Illinois,  age  19. 

9,  '05. 

1865. 

631 

Stampen.  W.  H.,  Pt.,  D", 

Aug.  21, 

Right.     Exchanged  October  27, 

670 

Van  Kirk,  J.,  Pt.,  C,  1st 

May  28, 

Left  ;  ant.  post.  flap.     A.  A.  Surg. 

43d  N.  Carolina,  age  22. 

21,  '64. 

1864. 

Penn.  Cavalry,  age  23. 

28,"  '64. 

W.  H.  True.     M.  O.  Sept.  9,  '04. 

632 

Starr,  R.  H.,   Serg't,  K, 

May  17, 

Right  ;  circ.    Surg.  W.  P.  Peirce, 

071 

Vann.  L.,  Pt.,  A,   llth 

Sept.  17, 

.     Surg.  —  Bacon,  C.  S.  A. 

36th  Illinois,  age  24. 

18,"  '64. 

88th  111.     Disch'd  Jan.  6,  1805. 

Florida. 

18,  '64. 

Recovery. 

633 

Steece.    J.,  Pt.,   G,  4th 

Oct.  —  , 

Left.     Discharged  March  12,  '63. 

672 

Van  Ness,  J.,  Pt.,  C,  43d 

Oct.  19, 

Left;  double  flap.     Surg.  G.  T. 

Ohio  Cavalry. 

—  ,  '62. 

New  York,  age  20. 

19,  '04. 

Stevens,  77th  N.  Y.     Gangrene. 

634 

Steel,  S.  G.,  Pt.,  H,149th 

Mar  8. 

Left;   flap.     Discharged  July  4, 

Disch'd  May  16,  1805. 

Pennsylvania,  age  33. 

8,  '64. 

1865. 

673 

Verner,  W.,  Landsman, 

Aug.  5, 

Right.     Surg.  J.  C.  Palmer,  U.  S. 

035 

Stever,   O.,    Serjft,    A, 

Sept.  29, 

Right;  long  post.  flap.     A.  Surg. 

U.S.S.IIartford,age20. 

5,  '64. 

Navy.     Disch'd  May  5,  1805. 

90th  New  York,  age  28. 

29,  '64. 

H.  C.  Merryweather,  5th  Col  d 

674 

Vide,  E.  C.,  Pt.,  E,  7th 

Nov.  14, 

.     Retired  February  11,  1805. 

Troops.     Discharged. 

North  Carolina. 

14,  '62. 

G36 

Stewart,  C.  W.,  Pt.,  D, 

May  5, 

Left  ;  flap.     Discharged  May  0, 

675 

Waber,  W.,  Pt.,  C,  44th 

De.31,'62, 

Left  ;  flap.     Discharged  May  19, 

4th  Maryland,  age  18. 

5,  '64. 

1865. 

Illinois. 

Jan.  1,  '03. 

1VJ3. 

637 

Stiles,  J.,  Corp'l,  I),  27th 

Dec.  14, 

Right  ;  flap.     Surg.  A.  Nash,  9th 

676 

Wade,  G.  B.,  Pt.,G,  13th 

April  0, 

Right:    flap.     Discharged   Aug. 

Kentucky,  age  22. 

14,  '63. 

Mich.  Cav.  Disch'd  May  17,  '04. 

Missouri. 

6,  '62. 

21,  1862. 

038 

Stinebaugh.  G.  15.,  Pt., 

Sept.  1, 

Left;  flap.     Surg.  C.  N.  Fowler, 

077 

Wagner,  G.,Pt..D,  Inde 

Sept.  9, 

Right;    lat.   flap.     Surg.   S.   W. 

H,  38th  Ohio,  age  24. 

1,  '64. 

105th   Ohio.     Discharged  July 

pendent  Battalion  New 

9,  '63. 

Gross,  U.  S.  V.     Disch'd  June 

14,  1805. 

York  Vols. 

23,  1804. 

639 

St.  Julien.  J.,Pt.,  C,8th 

May  4, 

Right.    Surg.  —  Mammir,C.S.A. 

078 

Walcott,  W.  H.,  Lieut., 

July  3, 

Left.     Ass't  Surg.  J.  S.  Billings, 

Louisiana. 

5,  '63. 

Recovery. 

B,  17th  Infantry. 

3,  '63. 

U.S.A.     Re-amputation.     Re 

640 

Stonehouse.   S.,  Pt.,  H, 

June  18, 

Left  :  flap.     Surg.  H.  E.  Smith, 

tired  January  7,  1PG5. 

27th  Michigan,  age  31. 

20,  '64. 

27th  Mich.  Bonerem'd.  Disch'd 

079 

Walker,  F.,  Pt.,  F,  24th 

Oct.  7, 

Right.     Duty'  Feb.  10,  1865. 

June  8,  1805.     Spec.  P.203. 

Michigan,  age  24. 

7,  '64. 

641 

Stratton,  J.  P.,  Serg't.D, 

Dec.  16, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

080 

Walker,  J.,   Pt.,  B,  8th 

June  3, 

Left  ;  long  post.,  short  ant.  flap. 

31st  Indiana,  age  22. 

10,  '64. 

T.  C.  Eakin.     Erysipelas.    Dis 

New  York  Heavy  Ar 

4,  '64. 

Surg.  C.  11.  I'cgg,  8th  N.  York. 

charged  April  11,  1805. 

tillery,  age  19. 

II.  A.     Disch'd  Sept.  14,  1865. 

642 

Strode,  C.  E.,  Pt.,  H,  5th 

June  28, 

Right  ;  circ.  A.  Surg.  A.  Mather- 

081 

Wallingford.  G.,  Pt.,  G, 

May  6, 

Right  ;  ant.  post.  flap.      Confcd. 

Texas  Cavalry,  age  19. 

28,  '63. 

son,  TI.  S.  N.     Bone  removed. 

17th  Maine,  age  46. 

7,  '64. 

surgeon.    Disch'd  Nov.  29,  1S04. 

To  prison  April  28,  1864. 

682 

Walsh,  J.,  Pt.,  A,  64th 

May  12, 

Right  :  lat.  flap.    Surg.  C.  T.  Kcl- 

643 

Stubbs,  R..  Pt.,  F,  4th 

Sept.  17, 

Left  ;  post.  flap.     Ass't  Surg.  C. 

New  York,  age  42. 

13,'  '64. 

sey.  64th  N.  Y.     Disch'd  Julv 

Rhode  Island,  age  25. 

18.  '02. 

L.  Duffell.  51st  Pcnn.     Disch'd 

30,  1865. 

Nov.   7,    1863.     Re-amputation 

€83 

Walsh,  J.,  Corp'l,  K,  37th 

April  2, 

Right  :  circ.     Surg.  E.  M.  White, 

Sept.  19,  1805. 

Massachusetts,  age  24. 

2,  '65. 

37th  Mass.   Disch'd  Sept.  12,'05. 

644 

Suttin,  R.  C.,  Pt.,  A,  4th 

July  6, 

.     Surg.  —  Redruff,  C.  S.  A. 

084 

Wandrey,  A.,  Serg't,  K, 

July  1, 

Ri^ht  ;  circ.     Ass't   Surg.  P.  S. 

Mississippi. 

6,  '63. 

Recovery. 

2d  Wisconsin,  age  25. 

3,  '63. 

Arndt.  2dWis.    Dis.  April  1,  '04. 

045 

Switzer,  J.  C.,Pt.,  A,  22d 

Sept.  19, 

Right;  circ.     Ass't  Surg.  W.  G. 

085 

Ward,   J.,   Pt.,  C,  88th 

Aug.  29, 

Left  ;  ant.  post.  flap.     Surg.  J.  S. 

Iowa. 

21,  '64. 

Bryant,    122d    Ohio.      Disch'd 

Pennsylvania,  age  25. 

30,  '62. 

Jemison,  80th   N.   Y.     Disch'd 

October  4,  1865. 

September  29,  1863. 

646 

SyTfes,  A.,    Pt.,    B,    6th 

June  2, 

.     Ass't  Surg.  —  Wcatherly, 

(i86 

Warden,  W.  H.,  Serg't, 

April  9, 

Left;  double  lateral  flap.      Dis 

Alabama. 

S3,  '64. 

P.  A.  C.  S.     Recovery. 

P,  70th  Illinois,  nge  22. 

9,  '65. 

charged  June  24.  1865. 

647 

Tait.  G.  F.,  Captain,  B, 

May  6, 

Left  :  circ.    Surg.  B.  Ge'sner,  10th 

687 

Warford,S.  J.,Pt.,  B.Sth 

Jan.  2, 

Left;  flap.     Discharged  Novem 

10th  New  York. 

6.  '64. 

N.  Y.     Disch'd  Aug.  10,  18G4. 

Kentucky,  age  24. 

2,  '63. 

ber  JO,  1803. 

648 

Taylor.    M.  A.,    Corp'L 

Dec.  13, 

Right  ;  ant.  post.  flap.     Surg.  C. 

;-> 

Warner,  J.  T.,  Corp'l,  K, 

Sept.  30. 

Left  ;  ant.  post.  flap.    Discharged 

D,    13th   New    Hamp 

14,  '62. 

Gray,  7th  N.  Y.     Disch'd  June 

118th  N.  York,  age  22. 

30,  '64. 

September  12,  1865. 

shire,  ago  40. 

8.  1864.     Spec.  0700. 

689 

Warwick,  N.,  Pt.,B,13th 

May  18. 

Left  :  flap.     Discharged. 

649 

Taylor,  T.,  Pt.,  G,  155th 

Sept.  30, 

Riffht  ;  ant.  post.  flap.      Surg.  J. 

Infantrv. 

20,'  '03. 

Pennsylvania,  age  22. 

30,  '64. 

A.  E.  Reed,  155th  PennT     Dis 

690 

Watson,'  W.,  Pt.,  M,  2d 

June  H, 

Left:    circular.     Disch'd  Marrt 

charged  June  8,  1805. 

Artillery,  age  27. 

11.  '04. 

18,  1865. 

650 

Terrell,  J.  J..  Lieut.,  I. 

July  1, 

.     Surg.  —  Manson.  C.  S.  A. 

091 

Wcatherlow,  S.,  Serff  t, 

July  4, 

night.      Discharged    December 

1st  North  Carolina. 

1,  '62. 

Recovery. 

I,  12(ith  N.  Y.,  age  25. 

4,  '03. 

25,  1864. 

651 

Thomas,  A.,  Seaman,  U. 

Aug.  20, 

Left,     Recovery  March  7,  1865. 

692 

Wearer.  T.,  Pt.,  H,  GOth 

Nov.  30. 

I'ight  ;  circ.    To  Provost  Marshal 

S.   Gunboat   Choctaw, 

20,  '64. 

Georgia,  age  2."). 

De.  1.'64. 

March  7,  1805. 

age  2(i. 

j  693 

Weber,  W.,  Pt.,  K,  2d 

June  10, 

Right;  circ.     Surg.  J.  W.  Wis- 

652 

Thomas,  P.,  Pt.,  I,  7th 

Dec.  15, 

Left  ;  circular.    A.  A.  Surg.  J.  H. 

New  York  Heavy  Ar 

11,  '04. 

liart,   14()th  Pcnn.     Discharged 

Ohio  Cavalry,  age  40. 

10,  '04. 

Mclntyre.    Disch'd  May  17,  '05. 

tillery,  age  22. 

December  9,  1864. 

053 

Thomas,  H.,  Pt.,  K,  13th 

April  29, 

Left.    Surg.  J.  Ebersole,  19th  In 

694 

Wells,  H.  W.,  Serg't,  H, 

Dec.  13, 

Right.     Discharged  May  3,  1804. 

Georgia,  nge  18. 

21),  '03. 

diana.    Exch'd  June  25,  1803. 

16th  Maine,  age  20. 

14,  '62. 

654 

Thompson,  C.  H..Pt.,C, 

Dec.  13, 

Left  ;  circular.     Discharged  Sep 

695 

Welsh,  M..  Pt.,  E,  102d 

July  27, 

Riffht;    lat.   flap.     Disch'd   Oct. 

18th  Massachusetts. 

14,  '02. 

tember  18,  1803. 

New  York. 

27,  '64. 

21,  1805.     Re-amputation. 

'FlSHEK  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations,  in  the  Hospitals  ntar  Sharpslurr/,  Md.,  after  the  battle  of  Anlietaiit,  in  American 
Journal  Medical  Sciences,  1863,  Vol.  XLV,  p.  48.  ZPI8HEU  (G.  J.),  Inc.  cit.,  p.  48. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


489 


v          NAME,  MILITARY         r)ATIi.R 
iNO-  DESCRIPTION,  AXD  AGE.    J 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

696 

Welsh,  M.,  Pt.,  H,  49th 

May  10, 

Right;   circular.     Disch'd  Janu 

740 

Armstrong,  J.  G.,  Pt.,  G, 

Nov.  29, 

Right.     Surg.  J.  P.  Prince.  36th 

Pennsylvania,  age  20. 

11,  '64. 

ary  22,  1865. 

8th  Michigan. 

29,  '63. 

Mass.     Died  Dec.  27,  1863. 

C97 

Welsh,  >..  Pt.,  C,  34th 

June  18, 

Right;    flap.     Discharged   April 

741 

Austin,   E.   B.,    Pt.,   A, 

May  14, 

Right.    Died  June  30,  1864  ;  py- 

Ohio,  age  27. 

18,  '64. 

1,  1865. 

lllth  Ohio. 

14,  '64. 

arnia. 

698 

West,  G.  F.,  Pt.,  I,  5th 

April  2, 

Left;  circ.     Discharged  July  12, 

742 

Axtelle,F.II.,Pt,,B,34th 

June  5, 

;    circular.     Died  July  21, 

Wisconsin,  age  J8. 

2,  '65. 

1865. 

Massachusetts. 

6,  '64. 

1864  ;  pyasmia. 

699 

Westbrook,   J.,   Pt.,  A, 

Sept.  17, 

Right  ;  ant.  post.  flap.     Disch'd 

743 

Bailey,  S.  G.,  Lieut.,  H, 

Mav  3, 

Right.     Died  May  30,  1863;  py 

104th  New  York. 

17,  '62. 

December  26,  1862. 

5th  Maine,  age  29. 

3,  '63. 

aemia. 

700 

Wester,  AM.,  Pt.,I,  30th 

July  3, 

Right.     Surg.  G.  W.  Briggs,  30th 

!?44 

Bailey,  S.  W.,  Serg't,  I, 

Sept.  19, 

Right;  flap.  Surg.  G.  T.  Stevens, 

North  Carolina,  age  24. 

3,  '63. 

N.  C.    Paroled  Nov.  25,  1863. 

2d  Vermont,  age  31. 

20,  '64. 

77th  N.  Y.     Died  October  21. 

701 

Wheeler.  C.,  1't.,  1,  4th 

Feb.  11, 

Right  ;    circular.      Disch'd  July 

1864  :  diphtheria. 

Colored  Troops. 

11,  '65. 

25,  1865.                                            745 

Ballard,  J.,  Pt.,  G,  143d 

May  5, 

Right.     Surg.  II.  F.  Lyster,  5th 

702 

Wheeler,  E.  11.,  Pt.,  G, 

May  3, 

Left.    Surg.  N.  A.  Hursam,  17th  ' 

Pennsylvania. 

5.  '64. 

Michigan.     Died  May  16,  1864. 

17th  Maine,  age  22. 

3,  '63. 

Maine.     Disch'd  Dec.  16,  1863.      746 

Hammond.   C.,  Pt.,  Car 

Mav  14, 

Right.     Surg.  II.  F.  Lvster.  5th 

703 

Wheeler,  H.,Pt.,D,125th 

July  2, 

Right  ;  flap.    Surg.  W.  S.  Cooper, 

ter's  1st  Virginia  Bat 

14,'  '64. 

Michigan.     Died  May"  26,  1864. 

New  York,  age  22. 

3,  '63. 

125th  N.  Y.     Dis.  June  20,  1864. 

tery,  age  38. 

704 

Whitcoinb,W.\V.,Corp., 

July  2, 

Right  :  circ.    Surg.  H.  B.  Fowler,     747 

Barnes,  B.  J..Pt.,E,10th 

July  22, 

Left.     Surg.  M.W.  Robbins,  -1th 

C,  llth  Mass.,  age  21. 

4,  '63.        12th  N.  H.    Disch'd  Nov.  21,  '63. 

South  Carolina. 

—  ,  '64. 

Iowa.     Died  July  30,  1864. 

705 

WhitltKk,  O.  J.,  Pt.,  15. 

Mav  3,     .      Surg.  P.  F.  Whitehead,  i  748    Binger,   L.,  Pt.,  E,  5th 

Nov.  25, 

Right;  circular  ;  gangrene.   Died 

44th  Virginia. 

4,  '63.         P.  A.C.  S.    Retired  Dec.  28.  '64.            1     Kentucky. 

26,  '63. 

December  17,  1863. 

706 

Whitman,  F.  M.,  Pt,,  G, 

May  18, 

Right;  ant.  post.  flap.     Surg.  T.   ,749 

Bohrer,  C.,  Pt.,  G,  107th 

July  1, 

Right.    Died  July  16,  1863. 

35th  Mass.,  age  25. 

—  ,  '64. 

F.  Oakes.  56th  Mass.     Disch'd 

Ohio. 

—  ,  '63. 

Dec.  15,  1864.    Re-amputation. 

750 

Bradley,  J.,  Pt.,  K,  1st 

May  19, 

Left.    Died  June  22,  1864. 

707 

Wicks,  W.,  Pt.,  H,  8th 

Oct.  27, 

Right  ;   circular.     Disch'd   Sept. 

Mass.  11'  vy  Art..  age  33. 

19,  '64.   ! 

New  Jersey,  age  23. 

29,  '64. 

23,  1865. 

751 

Brongher,  S.  II.,  Serg't, 

Mav  5, 

Right:  ant.  post.  flap.     Surg.  L. 

708 

Wierman,  j".  H.,  Pt.,  A, 

April  9, 

Left:  circ.  Surg.W.  A.  Babcock, 

C,  142d  Penn.,  age  20. 

5,  '64. 

Holt,  C.  S.  A.     Died  April  4, 

69th  Indiana,  age  24. 

9,  '65. 

76th  111.     Disch'd  June  5.  1865. 

1865  ;  pleurisy. 

709 

Wilburn.  J.  M.,  Pt,,  D, 

May  14, 

Left  ;  flap.     Surgs.  B.  G.  Pierce, 

752 

Bruce.  L.  H.  C.,  Corp'l, 

May  18, 

Right  ;    circ.     Surg.  C.  Powers, 

03d  Indiana,  age  23. 

15,   64. 

96th  111.,  and  H.  E.  Hasse,  24th 

K,  14th  Iowa.                     18,  '64. 

160th  N.  Y.     (Also  wound  of 

AVis.    Disch'd  Nov.  21,  1864. 

thigh.)     Died  June  14,  1864. 

710 

Wiley.    W.    C.,  Pt.,  E, 

July  3. 

Left:  flap.     Surg.  J.   Ash,  70th 

|753 

Brugart.    C.,   Lieut.,  I,     July  1, 

Right.     Died  July  16,  1863. 

70th  New  York. 

3,  '63. 

X.  Y.     Discharged. 

26th  Wisconsin.                 —  .  "63. 

711 

Wilkinson.  J.  A,,  Serg't, 

Aug.  25, 

.    Surg.  C.  C.  Henkel.C.S.A. 

754 

Burdett,  C.,  Corp'l,   II,     July  3, 

Left;    circular.     Died  July  26, 

F,  23d  Virginia. 

25,  '64. 

Retired  December  30,  1864. 

X.'d  Massachusetts.               4,  '63. 

1863. 

712 

Williams,  J.,  Pt,,  B,  5th 

May  8, 

Right;    circ.     Surg.  B.  Rohrer,   ^755 

Burns,  F.,  Pt.,  11,  88th 

June  19, 

Left.     Surg.  P.  E.  Hubou,  28th 

Penn.  Reseryes,  age  24. 

8,  '64. 

10th  Penn.  Res.     Disch'd  June                New  York. 

-,  '64. 

Mass.     Died  June  26,  1864  ;  ty 

8.  1865.     Spec.  2969. 

phoid  fever. 

713 

Williams,  J.  If.,  Pt.,  I, 

Aug.  5, 

Left.     Surg.  —  Patton,  C.  S.  A.     756    Carter.  C.,  Pt.,  G,  61st 

July  15, 

Right;   circ.;    erysipelas;   gang. 

2d  Kentucky. 

5,  '62. 

Recovery. 

Col'd  Troops,  age  40. 

15,  '64. 

Died  Aug.  5,  1864;  gangrene. 

714 

Williams.  R.  ~\V.,  Serg't, 

Mar.  25, 

Right  ;  circ.     A.  Surg.  S.  Adams, 

757  !  Cassidy,  I.,  Pt.,  H,  16th 

June  17, 

Right.     Surg.  J.  T.  Kimbly,  llth 

I.  57th  Mass.,  age  22. 

25,  '65. 

U.  S.  A.     Disch'd  Oct.  30,  1865. 

Kentucky. 

17,  '64. 

Kentucky.     Died  June  17,  1864. 

Spec.  4028. 

758  :  Chapel,  G.,  Pt.,  B,  6th 



Left  ;  ant.  post.  flap.     Died  May 

710 

Williams,  T.,  Serg't,  K, 

June  4,     Right  :  flap.     Surg.  J.  B.  Ensey, 

1     Virginia,  age  19. 

27,  1864;  prostration. 

5th  Illinois  Cavalry. 

5,  '63.         5th  111.  Cav.     Dis.  Aug.  11  ,  '63. 

759    Clevantine,  J.,  Serg't,  F, 

June  3, 

.    Died  June  12,  1864. 

71G 

Williams,  T.,l't.,  E,"l7th 

Dec.  14,  i  Riffht;  flap.     Surg.  P.  H.  Clem- 

:     150th  Pennsylvania. 

3,  '64. 

Col'd  Troops,  age  25. 

15,  '64. 

ons,  17th  Col'd  Troops.     Mus 

760  !  Colcord.  C.  E..  Serg't,  C. 

Mav  16, 

Left.    Died  June  27,  '64;  tetanus. 

tered  out  May  3J  ,  1865. 

4th  N.  Hamp.,  age  26. 

16,"  '64. 

717 
718 

Williams,  T.  G.,  Pt.,  1, 

23d  North  Carolina. 
Willis,  F.  J.,  Serg't,  A, 

July  2, 
3.  '63. 
July  30, 

Left.     Paroled*  September  25,  '63. 
Right  ;  circ.     Surg.  L.  W.  Bliss, 

761) 
762[ 

Vooksey,  A.  J.,  Pt.,  D,  3d 

Miss.,  age  35. 

Dec.  15, 

16,  '64. 

Both  ;   circ.     Died  Jan.  2,  1865  ; 
exhaustion  from  sloughing. 

51st  New  York,  age  24. 

30,  '64. 

51st  N.  Y.     Disch'd  Mar.  1,  '65. 

763 

Cork.  L,  Serg't,  C,  4th  ,  Sept.  29, 

Left  ;  flap.    Died  Oct  ober  1  ,  1864. 

719 

Willis,  N.  J.,  Pt.,  D,  15th 

May  20, 

Left  ;    circular.     Discharged  De- 

Col'd  Troops,  age  25. 

29,  '64. 

V 

N.Y.  IIv'yArt,,age)9.      20,"  '64.        cember  30,  1864. 

764  1  Craig,  J.  S.,  Pt.,  H,  14th 

Dec.  13, 

Right.     Died  January  6.  1863. 

720 

Wilson,W.L.,  Lieut.,  H,    Nov.  25,    Left.     Sur<r.  —  Gunnal,  C.  S.  A. 

Indiana.                               13,  '62. 

15th  Alabama. 

26,  '63. 

Recovery. 

765 

Crumley,  H.  W.,  Corp'l,  !  July  18, 

Left.     Died  July  28,  '64;  tetanus. 

721 

Wilson,  W.  P.,  Serg't.  F, 

July  1, 

Left  ;  flap.    A.  Surg.  P.  S.  Arndt. 

D,  110th  Ohio,  age  20.      18."'64. 

19th  Indiana,  age  35. 

2,  '03. 

2d  Wis.     Disch'd  Dec.  13,  1863. 

766    Curran,  G.,  Pt.,  1,  124th     July  29, 

Left  ;  ant.  post,  flap  ;  gangrene. 

722 

Wilson,  W.  W.,  Serg't, 

June  9, 

Right;    flap.      Confed.   surgeon.                 New  York,  age  33.             29,  '64. 

Died  Aug.  26,  1864  ;  exhaust'n. 

G,  66th  Ohio. 

10,  '62.         Disch'd  Jan.  6,  1863.                        7(i7    Currv,  D.,  Pt.,  K,    6th     July  9, 

Right;  circ.     Surg.  C.  H.  Todd, 

723 

Winus,  T.,  Pt.,  A,4thN. 

Aug.  23,    Loft;  flap.     Surg.  O.  L.  Potter.    !             Louisiana.                           11,  '64. 

C.  S.  A.     Died  July  16,  1864. 

Y.  H'yy  Art.,  age  20. 

24;  '64. 

145th  Penn.     Dis.  June  16,  '65. 

768    Curtis,  J.,  Pt,,   C,  28th  ;  May  10, 

Left;  flap.     Surg.  P.  E.  Hubon, 

721 

Wood,  E.  R.,  Pt.,  B,  18th    June  17,    Right.     Surg.  L.  Holbrook,  18th 

Massachusetts,  age  26.       11,  '64. 

28th  Mass.     Died  Mav  17,  1864. 

Connecticut.                         18.  '6-1.   ;     Conn.     July  29,  amput'n  thigh. 

769  i  Day,  J.  E.,  Lieut.,   K, 

Aug.  28, 

Left.     Surg.  R.  W.  Hazielt.  5th 

Discharged  May  4,  1865. 

3d  West  Virginia. 

28,  '62. 

West  Virginia  Cavalry.    Died 

725 

Wood,    G.,   Pt.,   D,  33d    Mar.  19,  ;  Left;  c\rc.     Confederate  surgeon. 

Sept.  27,  1862;  pyaemia. 

Ohio,  age  25.                      20,  '65.        Discharged  July  31,  1865. 

770 

Deneza.  C.,  Pt.,  L,  5th 

Oct.  23, 

Left,     Died  Nov.  "10,  1864;  gan 

726 

Wood,  M.,  Serg't,  C,  1  1th    Sept.  19, 

Left;  double   flap.     Surg.  C.  B. 

Mo.  Mil.  Cav.,  age  30. 

23,  '64. 

grene. 

Vermont,  age  19.                 lit,  '64. 

Park,  jr..  llth  Vermont.    Disc'd 

771 

Drain,  J.  F.,  Pt,,  A,  53d  J  July  2. 

Left.     Oct.   1,  hoem.:   9th,   amp. 

July  6.  1865. 

Virginia,  age  26.                 4,63.         thigh.    Died  Nov.  ~>.  If-'n3;  ex- 

727 

Woodruff,  S.  B.,  Serg't,    Aug.  10, 

Left  ;  circ.     Surg.  J.  C.  Welch, 

haustion.     Specs.  1963,  1975. 

F,  20th  Ky.,age2!. 

10.  '64. 

20th  Kv.     Disch'd  Mar.  10.'  65. 

772    Durkin.   J.  W.,  Pt.,  F, 

Mar.  31,     Left;  gangrene.     Died  April  25, 

728 

Woodward,  W.,  Pt.,  B.     Oct,  19,     Left  ;  circular.    Discharged  June 

:     120th  N.  York,  age  35.      31,  '65.        1865." 

116th  New  York. 

20,  '64. 

6.1865.                                            773    Edwards,  B.  T.,  Serg't,  \  ,'64,    Right.    Died. 

729 

Workman,    H.,    Pt.,   E. 

Jan.  11, 

Left;  circ.     Surg.  J.  Pomerene,  '          i     E,  19th  S.  Carolina.         Primary. 

83d  Ohio,  age  18.               ]l,  '63. 

42d  Ohio.     Diseh'd  Dec.  17,  '64!     774    Elmer,    A.,  Pt.,  F,    1st    Mar.  31,    .     Died  May  14,  1865. 

730 

Wright,  E.  C.,  Corp'l,  II,      May  3, 

Right;  posterior  flap.     Surg.  I).                New  York  Cavalry. 

31,  '65. 

21st  N.  Jersey,  age  19.       3,  '63. 

McXeill,21stN..T.  Disch'd  June     775    Emerson,  C.  A.,  Pt.,  H, 

June  27,    Right.     Died  July  18,  1864. 

13,1863.     Amp.  knee  joint.                    ,     97th  Ohio. 

27,  '64.   ! 

731    Wmiderlin,  J.  E.,  l't..r,      Mav  3,     Left:  flap.     Mustered  out  April     776    Farman,  D.,  Corp'l,  H,    Aug.  16,    Right.     Died  October  in.  1864; 

33d  New  York,  ne'e  27.      5.  '63. 

1.1864.                                                         155th  Penn.,  age  23.           10,   64.        exhaustion. 

732   Yaeger,  W.,  Pt.,  B,  26th    May  14,    Left;  flap.    Surg.  J.W.  Hastings,     777    Fisher,  (',.,  Pt,  D,  24th     May  18,  |  Right.    Died  July  14,  1864  ;  ex- 

Wisconsin,  age  24.             14."  '64.   .     33d  Mass.    Done  rein.    Disch'd.   !             N.  Y.  Cavalry,  age  44. 

19,  '64.   i     haustion. 

733  i  Yoder,  N.  W.,  Lieut.,  A,      Jan.  2.      Left.     Discharged  July  30,  1863.     778    Folkarts,  J.,  Pt.,  K,  5th 

July  2,     Right.    Died  September  5.  1863; 

51st  Ohio.                           —  ,  '63.        Drowned  March  9,  1877.                            Michigan,  age  50.                3,  '63.         exhaustion. 

734 

York.  J.  C.,  Pt.,  C,  94th    Aug.  19,    Right  ;  circ.     Discharged  March     77!)    French.  D.  H.,  Serg't,  E, 

Oct.  13,     Right;  ant.  post.  flap.    Died  Nov. 

New  York,  age  28. 

20,  'C4. 

17,  1865.                                                       34th  Mass.,  age  24. 

14,  '64.   i     13,  1864  ;  exhaustion. 

735 

Zibble,  A.  H.,  Pt.,  L,7th    July  10. 

Right;    circ.      Confed.   surgeon.     780    Gibson,  C.  O.,  Pt.,  H,  4th 

Oct.  19,  'Right.    Died  November  26,  1861; 

Mich.  Cavalry,  age  18.      10,"  '(14.        Discharged  May  19,  1865. 

Vermont,  age  31. 

19,  '64. 

diphtheria. 

•36 

Zwickcr,  E.,  Pt.,  B,  7th 

Aug.  9, 

Right;  double  flap.     Discharged     781 

Ginnicker.  C.  B.,  Lieut., 

May  5, 

Right,    Died  June  9,  1864. 

Ohio. 

11,  '60. 

October  27,  1862. 

D.  9th  Mass.,  age  27. 

—  ,  '64. 

737 

Alcock,  A.O.,Pt.,C,lCth 

May  10, 

Left.    Died  June  16,  1864.                782 

Givens,   S.,  Pt,,  A,  9th 

Sept.  29, 

Left.      Died  October  21,   1864; 

New  York,  age  41. 

10.  '64. 

Col'd  Troops,  age  28. 

29,  '64. 

exhaustion. 

738 

Aldrioh.    J.,    Corp'l,  F.      Feb.  6,     Left  ;  double  flap.     Died  March     783 

Goodrich,  M.  B.,  Lieut., 

May  5, 

Left;  flap.     Died  June  14,  1864; 

188th  N.  York,  age  43.       6.  '65.         2,  1865;  pyaemia. 

11,  93d  Penn.,  age  25. 

5,  '64. 

pyaemia. 

739    Anderson.  D.,  Corp'],  H,    Aug.  21,    Right  (also"  amp.  left  leg.  lower     784 

Goudv,  C.  W.  C.,  Pt.,  D, 

May  19, 

Right;  gangrenous.     Died  May 

7th  Maryland,  age  41.       21.  '64.        third).     Died  Oct.  1,  1864.                          1st  Mass.  H.  A.,  age  22. 

19,  '64. 

24,  1864. 

SURG.  Ill— 6'2 


490 


INJURIES   OF    THE    LOWER    EXTREMITIES. 


[CHAP.  x. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPEUATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

785 

Gray,  J.  C.,  Pt.,  B,  10th    July  22, 

Right  ;  ant.  posterior  flap.     Died 

827    McEntyre,    D.,   Pt.,  B, 

May  15, 

Right  ;  single  post.  flap.     Gang. 

Texas,  age  20.                   24,  '64. 

March  13,  1865. 

lOOth'N.  Y.,  age  22. 

15,  '64. 

Died  July  20,  1864. 

786 

Green,    M.,    Pt.,    B,    2d    June  17, 

Right.     Surg.  S.  S.  French,  20th 

828    McLane,\V.,  Pt.,  D,  69th 

May  12, 

Right.     Died  May  26,  1864:  py 

Michigan,  age  20.              17,  '64. 

Mich.   Died  July  2,  1864;  irrita 

Pennsylvania. 

12,  '64. 

aemia. 

tive  fever. 

829    Mecham.J.  E..Corp'l,H, 

Dec.  15, 

Right;   flap.     Died  January  16, 

787 

Greene.  W.  P.,  Lieut.,  A,    Sept.  22,    Left;  circ.     Died  Oct.  31.  1864  ; 

114th  111.,  age  20. 

15,  '64. 

1865. 

14th  West  Virginia.           23,  '64. 

irritative  fever. 

830    Mills.   A..    Pt.,    K.    6th 

Nov.  30, 

Right  ;  ant.  post.  flap.     Surg.  — 

788 

Hatch,  A.,  Sorg  t,  A,  7th    Aug.  16, 

R't.   Surg.G.  C.  Jan-is.  7th  Conn. 

Mississippi,  age  24. 

Dec.1,'64. 

Wayles.C.  S.A.     Died  May  13, 

Connecticut,  age  22. 

16,  '64. 

Died  Sept.  9,  1864  ;  exhausfn. 

1865;  exhaustion. 

789 

Hatch.  T..Pt.,  D,  1st  Me. 

June  19, 

Right;  flap;  pyaemia.   Died  July 

831    Modlin.  J.  H.,  Serg't,  C. 

Mav  30, 

Right.     Sui-ff.  S.  H.  Kersey,  36th 

Heavy  Art'y,  age  45. 

19,  '64. 

13,  1864;  exhaustion. 

36th  Indiana,  age  24. 

30,'  '64. 

Indiana.     Died  July  23,'  1864;  ; 

790 

Haynes,  H.,  1't.,  C,  14th 

May  24, 

Left;  circular.     Died  August  20, 

chronic  diarrhoea. 

Infantry,  age  19. 

25,  '64. 

1864. 

832    Moore,  A.  J.,  Pt.,  D,  50th 

May  10, 

Left  (also  flesh  wound  right  leg). 

791 

Hayward,  J.  W.,  Pt.,  A, 

Sept.  29.    Right.     Died  October  31,  1864; 

Pennsylvania. 

10.  '64. 

Died  May  13,  1864. 

9th  C.  Troops,  age  25. 

30,  '64. 

tetanus. 

8133 

Morris,  'W.  F.,  Pt.,  A, 

July  22, 

Right  ;  circ.    A.  Surg.C.  B.  Rich 

792 

Hella,  C.,  Pt.,  B,  121st 

Dec.  13, 

Left.    Died  March  5,  1863  ;  gan 

116th  Illinois. 

22,  '64. 

ards,   30th   Ohio.      Erysipelas. 

Pennsylvania. 

13,  '62. 

grene. 

Died  August  5,  1864. 

793 

Hewlett,  J.,  Pt.,  E,  30th 

Mar.  25, 

Right.     Died  April  25,  1865. 

834 

Munn.  W.,  Pt.,  I,  27th 

Mav  10, 

Right  ;  ciro.;  gangrene.   Sept.  20, 

Virginia. 

25,  '65. 

Michigan,  age  31. 

10,"'64. 

amp.  thigh.     Died  Oct.  4,  1864  ; 

794 

Hobart,  C.  J.,  Pt.,  I,  27th 

Sept.  14, 

Right;    circular;    slough.     Died 

exhaustion.     Spec.  3330. 

New  York. 

15,  '62. 

October  28,  1862  ;  pleur.  eff'n. 

835 

Nason,    II.,   Pt.,  C,   1st 

Nov.  30, 

Left  ;   flap  (also  amp.  right  leg, 

795 

Hollanbeck.   S.,  Corp'l, 

Aug.  15, 

Left  ;  flap.     Died   September  7, 

Ehode  Island  Artil'ry, 

Dec.  2,  '63. 

lower  third).     Died  December 

D,  52d  N.  Y.,  age  28. 

16,  '64. 

1864. 

age  38. 

21,  1863;  pyasmia. 

796 

Hopkins,  S.  M..  Lieut.,  I, 

Dec.  13, 

Left;  flap.     Died  December  26, 

.836 

Neff,   J.,    Pt.,    K,    10th 

May  10, 

Left  ;  flap.    "Died  May  28,  1864. 

12th  Kbode  Island. 

13,  '62. 

1862. 

Massachusetts,  age  27. 

10,  '64. 

797 

Irwin,  D.,  Pt.,  G,  IstMd. 

Aug.  16, 

Left.    Died  September  1,   1864; 

837 

Noe.  A.  W.,  Pt.,  E,  13th 

Nov.  27, 

Left.     Surg.  S.  C.  Plummer,  13th 

Cavalry,  age  21. 

16,  '64. 

mortification. 

Illinois. 

27,  '63. 

Illinois.     Died  Dec.  19,  1863. 

798 

Irwin,   T.,  Pt.,  C,  14th 

Mav  10, 

Right;  circular.     Died  June  10, 

838    Nolan,  R.,  Pt.,  B,  12th 

Dec.  15, 

Left.     A.  A.  Surg.  J.  S.  Giltner. 

New  Jersey,  age  20. 

10,"  '64. 

1«64  ;  gangrene. 

Col'd  Troops,  acre  24. 

17,  '64. 

Died  Dec.  30,  1864  :  gangrene. 

799 

Jacobson,  F.,  Pt.,C,  llth 

June  18, 

Right  ;  circ.:  gangrene.    Aug.  20, 

839    Pucie.,  •?•  C.',  Serg't,  II, 

Nov.  30, 

Left  ;  circular  ;  gangrene.     Died 

Connecticut,  age  18. 

18,  "64. 

re-amp,  thigh;  gangrene;  haem. 

15th  Miss.,  age  25. 

Dec.2,'64. 

March  26,  1865;  pneumonia. 

Died  August  26.  1864. 

840    Park,  A.  G.,  Pt.,  K,  llth 

Sept.  19, 

Left.     Died  October  23,  1864. 

800 

Job,  J.,  Pt.,  M,  2d  New 

June  16,    Right.  Surg.  J.W.  Wishart,  140th 

West  Virginia. 

19,  '64. 

York  Artillery. 

16,  '64.        Penn.     Died  July  11,  1864.            841  •  Pierson.  W.  C.,  Pt.,  F, 

Dec.  16, 

Right  :  circular.     Died  February 

801 

Johnson,  J.  W.,  Pt.,  II,     Nov.  30,    Right;   circ.     Surg.  —  Ruskin,   | 

14th  Texas,  age  25. 

16,  '64. 

11,  1865:  exhaustion. 

19th  Arkansas,  age  25.    Dec.l,'64.|     C.  S.  A.     Died  Mav  27.  1665.      !  842 

*  Powell,  W.  B.,  Pt.,  I,  3d 

Sept.  17,    Right;    flap;    slough.;    necrosis. 

802 

Johnson,  M.  ]i.,  Pt.,  G,    Sept.  14,    .     Died  October  7,  1862.                       South  Carolina,  age  20.     18".  '62.        Nov.  30,  amp.  thigh.    Died  Mav 

Kith  Georgia.                       16,  '62. 

2,  1863:  exhausfn.   Specs.  3962. 

803 

Jones.  L.,  Pt.,  D,  58th     June  3,     Right;  flap.     Died  July  1,  1864.  | 

795,  3837. 

Massachusetts,  age  45.       3,  '64.                                                                  843    Preston.  J.  A.,  Serg't,A,     May  11, 

Right;    flap.     Died   August  20, 

804 

Jullivett.N.,  Pt.,  D,  98th    Sept.  29,    Right  (also  amp.  arm).     Surg.  J. 

1st  Mich.  Cav.,  age  32. 

11,  '64. 

1864. 

New  York,  age  19.            30,  '64.        A.  Bigelow,   8th   Conn.     Died 

844    Pvles.    W.    IF..   Pt..   II. 

Aug.  4, 

Left  ;  circ.  sect,  skin  and  muscles. 

,     October  9,  1864  ;  exhaustion. 

llth  West  Virginia,  age 

5,  '64. 

A.  A.  Surg.  W.  B.  Crain.     Ery 

805 

Kirk,    A.,    Pt.,    K,  95th!  May  12,  'Left;    circular.     Died  May  31,    I 

32. 

sipelas.    Died  August  11,  1864. 

New  York.                          12,  '64.        1864;  exhaustion.                            845    Queen,    G.,  Pt.,   E,   1st 

Aug.  17,    Left.     Died  September  1  1  ,  1864  ; 

80<!    Klock,  M.,    Pt.,  15,  <Jth    Dec.  16,  |  Right  ;  ant.  post,  flap  ;  sloughing.1              Col'd  Troops,  age  20. 

17,  '64.        exhaustion. 

Minnesota,  age  51.              Hi,  '64.        Died  Dec.  29,  '04  ;  irrita.  fever.       84G    Quin,  ./..  Pt.,  A,  Austin's  De.30,'62,   Left.     Sur-r.  E.  Swift,  II.  S.  A. 

807 

Korff,  C.,  Corp'l,  B.  6th     Dee.  4.     Left  :  ant.  post.  flap.   A.  A.  Surg.   i 

Sharpshooters,  age  30.    Jan.  1,  '63.      Hsem.     Died  January  8,  1863. 

Indiana.                                 4,  '64.         J.  E.  Patterson.     Died  Decem-     847    Raymond,  W.  M.,~Capt..     Dec.  10,     Left  ;  ant.  post.  flap.     Jan.  12,'65, 

ber  11.  1864. 

D.  52d  Indiana.                   16.  '64.        re-amputation.     Died    Jan.    13. 

808 

Kruppel,  L.,  Corp'l,  D, 

June  17, 

Left.  Died  June  24,  '64:  pyaemia. 

1865;  irritative  fever. 

46th  Xew  York,  age  37. 

17.  '64. 

848    Remkwitz.  G.  A..  Pt.,  G, 

Oct.  8,      :  typhoid  fever.     Died  Nov. 

809 

Larabee,  J.,  Pt.,  E,75th 

July  1,     Left;  hsem.:  lig.  femoral.     Died                24th  Illinois. 

8,  '62.         19,  1862. 

Ohio,  age  19. 

1,  '63.         August  20,  1863:  pneumonia.        849    Roberts.  L,  Pt.,  1',  100th 

Dec.  15, 

Left;  flap.     Died  December  22, 

810 

LaRose,   C.,   Corp'l,  H, 

May  5.     Left.     Died  May  30.  1864.                           Col'd  Troops,  age  22. 

15,  '64. 

1864  ;  effects  of  amputation. 

93d  New  York,  age  27. 

6,  '64. 

850    Robinson,  G.  H..  Pt.,  D, 

May  12,  i  Right.     Died  May  25,  1864. 

811 

Lee,  T.,  Pt.,  E,43d  New 

July  12,    Right;  circ.     A.  A.  Surg.  M.  F.                39th  Illinois. 

12  ,'64. 

York,  age  45. 

12,  '64.   ;     Price.     Died  Nov.  14,  1864.         :  851  i  Roehl.  C.,  Corp'l.  E,  21st     May  1. 

Left;  double  flap;  slough.     Died 

812 

Levan,   G.  W.,  Pt.,  C, 

Dec.  13,    Right.     Died. 

Iowa.                                    1,  '63. 

May  20,  1863. 

131st  Pennsylvania. 

—  ,  '62.                                                                 852    Sapp.  W.  E.,  Musician,    June  23,    Left.'    Died  July  31.  1864. 

813 

Lewis,    N.,    Lieut.,   C,     Oct.  19,     Right;    sloughing.      Died   Nov.                A~,~llth  N.  J.,  age  20.        23.  '64. 

1  14th  Xew  York. 

19,  '64.        30,  1864  :  pyaemia.                        i  853    Saunders.J.,  Pt.,  E,  95th     Feb.  6,     Right  ;  post.  flap.     Died   March 

814 

Lewzader,   W.,  Pt.,    B, 

June  15,    Left;    gangrene.     Died  July  4,            i     New  York,  age  3:).              6,  '65.         19,  1865;  tetanus. 

!>th  Indiana,  age  24. 

la,  '64.  ;     1864.                                                     854    Sehweichardt,  F.,  Pt..D,     June  26, 

Left.     Surg.  C.  S.  Frink,  U.  S.  V. 

815 

Livingstone,L.  yl.,Capt., 

July  2,      Left  jerysip.  July  14,  amp.  thigh:                 16th  Illinois,  age  38.       \   26,  '64. 

Died  July  7,  1864. 

F.8tii  Alabama,  age  23. 

3,  '63.         haem.     Aug.  4,  "three  ins.  bone     855    Seerwald,  C.,  Pt.,  A,  8th     July  3,     Right.     Died  August  7,  1863. 

removed.     Died  Sept.  27,  1863  :    j         !     Ohio. 

—  ,  '63. 

erysipelas;  haemorrhage.             ,  856    Sergent,  C.  J.,  Lieut.,  F, 

Aug.  U,    Left  ;  ant.  post.  flap.    Surg.W.  R. 

81G 

Long,  O.,  Pt.,  G,    40th 

Sept.  19,    Left  ;  flap.    Died  October  6,  1  864  ;                7th  Iowa,  age  31  . 

11,  '64. 

Marsh,  2d  Iowa.     October,   64, 

Pennsylvania. 

19,  '64.        exhaustion. 

necrosed  bone  removed.     Died 

817 

Longe,  J.,  Pt.,  L,   llth 

June!,     Right.     Died  September  2,  1864. 

i     April  10,  1865. 

Vermont,  age  18. 

2,  '64.                                                                      857    Sharp,  D.  C.,  Pt.,  B,  Kid     Oct.  28.     Left.     Nov.  10,  erysipelas.    Died 

818 

Lozo,  J.,  Corp'l,  B,  21&t 

Mar.  19,    Right.     Died  May  18,  1865;  py-                Iowa,  age  25.                     29,  '62.        Nov.  18,  1862;    erysipelas   and 

Michigan,  age  22. 

19.  '65.        asrnia.                                                                                                                          pyaemia.     Spec.  470. 

819 

Magner,  E.,  Pt.,  I,  60th 

Sept.  17,    .     Died  October  20,  1862.          858    Sherman,  R.  T.,  Pt.,  F.    May  12,  '  Right.     Surgeon  I!.  Rohrer,  10th 

New  York.                          —,'62.                                                                                  2d  Pennsylvania  Ues.,      12,"  '64. 

Penn.  Res.     Died  June  3,  1664  ; 

820 

Mann,  B.  11.,  Lieut.,    I.     M;i\-  20.     Riirht.     Dird   M.iv  24    IRI14-  PV.                  n<rp  01 

exhaustion.     Sppc.  4510. 

59th  Virginia,  age  44. 

20,  '64.        haustion.                                           '  8.7.)    Sinkswillr.r,  J.,   Pt.,  K,     May  30, 

I'ight;  circular.    Bone  removed. 

821 

Manny,  !>.,  Pt.,  7th  New    June  28,  i  Left  ;   sloughed.     Died  July  24,            i     52d  Virginia,  age  34.         31,"  '64. 

Died  August  12,  1864. 

York  Battery,  age  24. 

28,  '64. 

1864.                                                  860  ,  Small,  J.  \V.  M.,  Corp'l,     July  2, 

Left.     Died  July  14,   1863;  py- 

822 

Marshall,  B.  V.,  Pt.,  A,    Sept.  14,    Right  ;  Teal's  method.     Surg.  R.  '          i  •  D,  17th  lnfantry,age~32.       3,  '63. 

zemia. 

1st  N.Hampshire  H'vy     14,  '64.        B.  Bontecou,  U.  8.  V.     (Also     861    Smith.  G.  R.,  Pt.,  I,  50th     Oct.  27, 

Right.     Died  October  30,  1864. 

Artillery.                                                  wound  of  thigh,  fract.  left  foot.)            !     New  York.                           27,  '64. 

Haemorrh.    Died  Sept.  14.  1864  ;     862    Smith,  L.  C.,  Serg't,  G,     May  10, 

Right  ;  flap.     Died  May  27,  1  864  . 

exhaustion.     Spec.  3245.                         i     4th  Mich.,  age  26.               11,  '64. 

823 

McCarthy,  D.,  Corp'l,  C,    Sept.  19,    Left  ;  circular.     Died  October  7,     863    Spriggs,   I.    B.,  Pt.,   D.     May  14, 

Right  ;  circ.     Surg.  S.  K.  Craw 

26th  Massachusetts.           19,  '64.   ,     1864.                                                             118th  Ohio,  aire  20.            15   '64. 

ford,  50th  Ohio.     Died  Sept.  1, 

824 

McClure,  D.,Pt.,  D,28th 

July  30,  :  Right:  flap.     Surg.  D.  MacKay, 

1864  ;  pyaemia. 

Colored  Troops. 

30,  '64.        29th  Col'd  Troops.     Died  July     864 

Storm.  J.,  Pt.,  A,   17th    May  19, 

Right.     Died  July  15,  1863. 

30,  1864. 

Wisconsin.                            19,  '63. 

825 

McCullough,  L.,  Corp'l,    July  20,    Left;  circ.     Died  Feb.  26,  1865;  :  865 

Stout,  C.  R.,  Pt.,  K,  25th     July  1, 

Right.     Died  July  14,  1864  ;  tet 

H,  31st  Miss.,  age  19. 

21,  '64. 

chronic  diarrhoea. 

Massachusetts,  atre  20. 

1,  '64. 

anus. 

826 

McDermott,  E.,  Pt.,  II, 

June  20,    Left  ;    circular.    Died  June  27, 

866    Sturtevant,  L.,  Serg't,  F, 

April  2, 

Right  ;   lateral  flap.     Died  May 

7thN.Y.H.Art.,  age  48. 

20,  '64. 

1864  ;  exhaustion. 

IstMe.  II.  Art'y,  age  22. 

2,  '65. 

14,  1865;  exhaustion. 

1  FISHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations,  in  tlie  Hospitals  near  Skarpsburg,  Aid.,  after  the  battle  of  Antietam,  in  American 
Journal  Medical  Sciences,  1863.  Vol.  XLV,  p.  48. 


SECT.  V.) 


PETMARY  AMPUTATIONS  IN  THE  LEG. 


491 


No. 

NAME,  MILITARY 
DESCUITTIOX,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

867 

Taylor,  A.,  Pt.,  I,  15th 

Oct.  19, 

Right:  flnp.    Died  November  18, 

!880 

Watson,  W.,  Pt.,  C,  4th 

May  13, 

Left.  Surg.  J..Spiegelhalttr,  Ifth 

New  York,  age  40. 

19,  '64. 

1H64  ;  pyajmia. 

Iowa. 

13,  '64. 

Missouri.     Died  May  14,  1864. 

868 

Taylor,    G.    W.,    Brig. 

Aug.  27, 

Left;  double  flap.     Surg.  J.  H. 

881 

White,   A.,    Pt,,  C,   2d 

Oct.  19, 

Right  ;    cire.      Died  October  21, 

General  U.  S.  V. 

28,  '62. 

Brinton,  U.  S.  V.     Died   Sept, 

Virginia  Cavalry. 

19,  '64. 

1864  ;  erysipelas. 

1,  1862r;  exhaustion.     Spec.  313. 

882 

Wiuslow.  S.,  Pt.,  I,  37th 

April  2, 

Left.     Died  April  24,  1865;  py- 

869 

Thiback,  H.,  Pt.,  D,  5th 

May  10, 

R't  :  circ.     Surg.  O.  E.  Crane,  5th 

Massachusetts. 

2,  '65. 

rernia. 

Wisconsin,  age  30. 

10,"  '64. 

Wis.  DiedJuneo,  "64;  pyaemia. 

883 

Word,  W.  F.,  Corp'l,  G, 

May  16, 

Right  ;    flap.      Died    September 

870 

Thompson,  J.  T..  Pt.,  H. 

Sept.  30, 

Left  (also  w'nd  of  pelvis;.     Died 

48th  New  York,  age  22. 

16,''64. 

23,  1864. 

51st  N.  Carolina.agelO. 

30,  '64. 

Oct.  10,  1864  :  exhaustion. 

884 

Wyman,  A.  R.,  Corp'l, 

June  22, 

Left  :  circ.     Surg.  W.  A.  Child, 

671 

Thompson,  T.  N.,  Vt.,D, 

June  2, 

Right  (also  w'd  of  thigh  and  fract. 

B,  9th  New  York  H'vy 

22,  '64. 

10th  Vermont.     Died   July  10, 

8th  New  York  Heavy 

3,  '64. 

left  leg).     Surg.  S.  H.  Plumb, 

Artillery,  age  27. 

1864;  tetanus. 

Artillery,  age  17. 

82d  N.  Y.     Died  June  24,  1864. 

885 

Yardley,  W.,  Pt.,—  ,  85th 

Mar.  10, 

Right  ;  circular.     Died  March  27, 

872 

Tracy,  G".  B.,  Serg't,  E, 

May  12, 

Left.     Died  June  6,  '64;  pyaemia. 

New  York,  age  19. 

10,  '65. 

1865;  typhoid  fever. 

9th  'N.  Hamp.,age28. 

12,  V54. 

886 

Young.  H.  E.,  Pt.,  B,  1st 

April  26, 

Right.     Surg.  J.  Robarts,  1st  M. 

873 

Troope,  S.,  Pt.,  B,  12th 

Dec.  15, 

Left  ;  flap.   A.  A.  Surg.  J.  S.  Gilt- 

Miss.  Marine  Brigade, 

26,  '63. 

Marine  Brigade.     May  15,  re- 

Col'd  Troops,  age  28. 

16,  '64. 

ner.     Died  Dec.  30,  64  ;  gang. 

age  18. 

amputat'n;  haemorrhage.    Died 

874 

Twining,  L.  C.,  Serg't, 

Mar.  19, 

Right  (also  fracture  left  fibula). 

May  31,  1863. 

B,  136th  New  York. 

19,  '65. 

Died  April  8,  1865;  pya?mia. 

:887 

Bradford,  F.  L.,  Pt.,  A, 

Sept.  1, 

Left. 

875 

Twining,  P.E.,Serg't.F, 

June  1, 

Left;  cir.     Surg.  S.  H.  Plumb, 

10th  Mississippi. 

1,  '64. 

36th  Wisconsin,  age  26. 

3,  '64. 

82d  N.  Y.    Sept.  14,  amp.  thigh. 

888 

Emfi-nger,  E,,  Pt.,  E,  7th 

Aug.  31, 

. 

Died  October  16,  1864. 

Mississippi. 

31,  '64. 

876 

Vallcley,  E.  J.,  Pt.,  A,  3d 

April  9, 

Right  Calso  fract.  ulnaand  femur). 

889 

Gambill,  A.  M.,  Pt.,  A, 

May  1, 

Right. 

R.I.  Artillery,  age  18. 

11,  '63. 

Died  April  14,  '63.     Spec.  1165. 

6th  Missouri. 

—,''63. 

877 

Vetter,  J.  C.,  Pt.,  G,  26th 

May  3, 

Left.    Died  May  18,  1863. 

890 

^O'Brien,  J.,Pt.,  1st  Va., 

Sept.  17, 

Left  ;  post,  flap  ;  sloughing.    Re 

Wisconsin. 

3,  '63. 

age  30. 

19,  '62. 

covery  doubtful. 

878 

Wait,  B.,  Corp'l,  C,  16th 

Aug.  19, 

Right  ;  flap.    Died  September  18, 

891 

Oxford,  E.  J.,  Serg't,  E, 

Aug.  31, 

Left. 

Michigan,  age  30. 

20,  '64. 

1864  ;  pyaemia. 

2d  Georgia. 

31,  '64. 

879 

1  Waters.  W.,Pt,,K,  123d 

May  15, 

Right  (also  amp.  left  hip  joint). 

892 

Weaver,  T...  Pt.,  H,  66th 

Nov.  30, 

Right  ;  circular. 

New  York. 

15,  '64. 

Rurg.  J.  W.  Brock,  66th  Ohio. 

Georgia,  age  25. 

Dec.1,'64. 

Died  May  15,  1864. 

Primary  Amputations  in  the  Lower  Third  of  the  Leg  for  Shot  Injury. — There 
appear  on  the  jecords  of  this  Office  nine  hundred  examples  of  primary  amputation  in  the 
lower  third  of  the  leg.  Six  hundred  and  seventy-six  terminated  successfully,  two  hundred 
and  fifteen  fatally,  and  the  results  in  nine  instances  are  not  recorded,  a  fatality  of  24.1  per 
cent.,  exceeding  the  mortality  of  the  primary  amputations  in  the  middle  third  7.2  per  cent. 

Successful  Primary  Amputations  in  the  Lower  Third  of  the  Bones  of  the  Leg. — The 
six  hundred  and  seventy-six  operations  of  this  group  were  performed  on  six  hundred  and 
seventy-three  patients,  three  being  amputations  of  both  limbs.  Five  hundred  and  thirty- 
two  were  Union  and  one  hundred  and  forty-one  were  Confederate  soldiers.  Of  the  former, 
five  hundred  and  twenty-eight  were  pensioned  or  placed  on  the  retired  list;  forty-three  of 
these  have  died  since  the  date  of  their  discharge.  In  fifty-two  instances  re-amputation  in 
the  leg  and  in  six  amputation  in  the  thigh  was  subsequently  performed. 

CASE  740. — Lieutenant  E.  F.  O'Brien,  Co.  A,  28th  Massachusetts,  aged  29  years,  was  wounded  at  Cold 
Harbor,  June  3,  1864.  Surgeon  W.  S.  Cooper,  125th  New  York,  reported  his  admission  to  the  field  hospital  of 
the  1st  division,  Second  Corps,  with  "shot  fracture  involving  the  left  ankle;  leg  amputated  at  lower  third  by 
Surgeon  P.  E.  Hubon,  28th  Massachusetts."  Five  days  after  the  reception  of  the  injury  the  patient  entered 
Armory  Square  Hospital,  Washington,  and  one  month  later  he  proceeded  to  his  home  on  leave  of  absence.  He 
was  discharged  from  service  October  13,  1864,  and  afterwards  entered  the  Veteran  Reserve  Corps,  in  which 
organization  he  served  until  April  17, 1867,  when  he  was  mustered  out  and  pensioned.  Subsequently  he  obtained 
employment  as  clerk  in  the  Post  Office  and  Interior  Departments  at  Washington.  In  May,  1869,  when  visiting 
the  Army  Medical  Museum,  he  was  in  excellent  health,  and  stated  that  he  had  worn  a  "Salem''  artificial  leg 
with  satisfaction  for  over  five  years.  In  his  application  for  a  new  artificial  limb,  supplied  in  1880,  the  pensioner 
reports  the  stump  as  continuing  in  ''very  good  condition."  His  pension  was  paid  September  4,  1880.  The 
amputated  bones  of  the  leg,  together  with  the  astragalus  (Spec.  4494,  Surg.  Sect.,  A.  M.  M.),  were  contributed 
to  the  Museum  by  the  operator,  and  are  represented  in  the  wood-cut  (FlG.  290),  showing  the  tibia  to  be  shattered 
into  the  ankle  and  the  fibula  fractured  transversely. 

CASE  741. — Lieutenant  Robert  Catlin,  5th  U.  S.  Artillery,  was  wounded  in  an  engagement  on  the  Weldon 
Railroad,  near  Petersburg,  August  21,  1864,  by  a  twelve-pound  round  shot  which  crushed  his  left  foot.     Three 
hours  after  the  reception  of  the  injury  the  limb  was  amputated  in  the  lower  third,  by  circular  incision,  by  Surgeon 
W.  B.  Fox,  8th  Michigan.     The  wound  healed  rapidly,  and  Lieutenant  Catlin  was  able  to  be  about  in  a  month.     Dr.  S.  Weir 
Mitchell,3  who  had  the  patient  under  treatment  for  a  period  of  three  years  on  account  of  neuralgia  of  the  leg  stump,  published  an 

1  Circular  No.  6,  S.  G.  O.,  November  1,  1865.     Circular  No.  7,  S.  G.  O.,  July  1,  1867,  pp.  29,  58. 

2  FISHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations,  in  the  Hospitals  near  Sharpsburg,  Md.,  after  the  battle  of  Antietam,  September  17, 
1862,  in  American  Journal  Medical  Sciences,  Volume  XLV,  page  48. 

s  MITCHELL  (S.  W.),  The  Relations  of  Pain  to  Weather,  being  a  study  of  the  natural  history  of  a  case  of  Traumatic  Neuralgia,  in  American 
Journal  of  Medical  Sciences,  1877,  Vol.  LXXI1I,  p.  306. 


FIG.  290.— The 
lower  portion  of 
the  bones  of  the 
left  leg  and  the 
astragalus.  The 
tibia  isshattered 
into  the  ankle. 
Spec.  4494. 


492 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FlG.291.-Sixias.rf 

the  stump  oft  he  bones 
of  the  left  leg,  show 
ing  a  massive  invo- 
lucrum.  Spec.  1526. 


elaborate  account  of  the  results  of  his  observations.  In  July,  1866,  Lieutenant  Catliu  was  promoted  Captain.  Dr.  John  H. 
Brinton,  in  the  spring  of  1875,  at  the  request  of  Dr.  Mitchell,  exsected  one  and  a  half  inches  of  the  peroneal  nerves,  but  without 
material  influence  on  the  neuralgic  pains.  The  patient  was  furnished  with  an  artificial  limb  by  A.  A.  Marks,  of  New  York. 
He  \vas  placed  on  tlie  retired  list  as  captain  December  15,  1870. 

CASE  742. — Private  J.  Cavanaugh,  Co.  C,  7th  "Wisconsin,  aged  27  years,  was  wounded  before  Petersburg,  June  18,  1864, 
by  a  shell,  which  caused  a  fracture  of  the  lower  portion  of  the  left  leg,  involving  the  ankle  joint.  Surgeon  C.  N.  Chamberlain, 
U.  S.  V.,  reported  that  the  injured  leg  was  amputated  at  the  field  hospital  of  the  4th  division,  Fifth  Corps.  Surgeon  B.  B.  Wilson, 
U.  S.  V..  contributed  the  pathological  specimen,  No.  1526,  Surg.  Sect.,  A.  M.  M.,  shown  in  the  adjoining  wood-cut  (FlG.  291), 
and  reported  the  following  history  of  the  case:  "The  patient  was  admitted  to  Stanton  Hospital,  Washington,  from  City  Point, 
July  1st.  He  had  suffered  amputation  of  the  leg  at  the  lower  third,  by  the  circular  method,  the  day  after  he  was  wounded,  being, 
according  to  his  statement,  in  a  high  fever  at  the  time  of  the  operation.  He  was  treated  with  stimulants,  and  ice  dressings?  locally. 
During  the  month  of  September  the  limb  became  much  swollen  and  abscesses  formed  in  the  line  of  the  middle  third  of  the  bone, 
which,  after  discharging,  left  fistulous  openings,  clearly  indicating  necrosis  of  the  shaft  of  the  tibia.  His  term  of 
service  having  expired,  the  patient  was  discharged  October  5, 1864,  but  being  unable  to  leave,  he  was  retained 
as  a  patient  in  the  hospital.  The  shaft  of  the  tibia  being  evidently  extensively  necrosed,  I  determined  to 
perform  another  amputation  above  the  diseased  portion.  This  operation — though  opposed  by  the  medical 
staff  of  this  hospital  and  by  Surgeon  A.  N.  Dougherty,  U.  S.  V.,  as  well  as  Surgeon  T.  F.  Betton,  1st 
U.  S.  V.  V.,  who  saw  the  case — was  preferred  by  me  to  that  of  exsecting  the  sequestrum  for  the  reason  that 
it  involved  no  more  danger  and  would  give  the  patient  a  much  better  stump  (though  six  inches  shorter)  for 
fitting  an  artificial  limb.  The  operation  was  performed  one  inch  below  the  tubercle  of  the  tibia,  by  the  cir 
cular  method,  on  February  25,  1865,  and  the  stump  was  treated  with  cold-water  dressings.  Traumatic 
ei'ysipelas  followed  (an  epidemic  of  erysipelas  breaking  out  in  the  hospital  the  same  week),  and  for  a  few 
days  fears  were  apprehended  as  to  the  result.  The  patient,  however,  made  a  good  recovery,  and  by  March 
15th  the  inflammation,  which  had  extended  to  the  abdomen,  had  subsided.  Before  he  finally  left  the  hospital 
the  patient  received  an  artificial  limb,  on  which  he  walked  with  great  ease  and  comfort.  The  specimen 
indicates  clearly  and  in  a  marked  degree  the  efforts  of  nature  in  throwing  off  dead  bone  and  supplying  its 
place  by  new  growth.  The  adventitious  process,  thrown  out  to  unite  the  amputated  ends  of  the  tibia  and 
fibula  and  thus  give  the  extremities  of  those  two  bones  firmness  and  solidity,  shows  to  how  great  an  extent 
the  reparative  process  can  be  carried.  By  what  agency  the  want  of  bony  matter  at  this  point  was  perceived  and  its  deposit 
determined  at  the  proper  place  and  in  the  proper  form  is  beyond  the  scope  of  human  knowledge  at  the  present  time.  The  fact, 
however,  evidences  the  powers  of  nature  to  accommodate  herself  to  circumstances  and  to  repair  in  a  limited  degree  the  effects 
of  losses  which  are  irremediable."  The  specimen,  consisting  of  the  re-amputated  stumps  of  the  bones  of  the  leg  joined  by  osseous 
deposit  at  their  lower  extremities,  shows  a  massive  involucrum  except  on  the  anterior  border,  where  a  heavy  sequestrum  is 
visible.  The  patient  became  a  pensioner  after  leaving  the  hospital.  On  September  2,  1874,  he  was  examined  by  Dr.  C.  F. 
Falley,  pension  examiner  at  Lancaster,  Wisconsin,  who  certified  to  the  loss  of  the  leg  and  reported:  "The  amputation  has  left 
rather  an  irritable  stump,  but,  as  his  cork  leg  does  not  press  on  it,  I  do  not  think  it  any  great  injury  in  wearing  an  artificial  limb. 
He  can  flex  and  extend  the  stump  freely,"  etc.  The  pensioner  was  paid  March  4, 1880.  In  his  application  for  an  artificial  leg  he 
reported  that  Surgeon  D.  C.  Ayres.  7th  Wisconsin,  performed  the  first  amputation. 

CASE  743. — Private  F.  Grahame,  Co.  A,  6th  Wisconsin,  aged  26  years,  was  wounded  at  Spottsylvania,  May  10,  1864. 
Surgeon  C.  N.  Chamberlain,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  4th  division,  Fifth  Corps,  with  "shot 
fracture  of  right  ankle  joint,  followed  by  amputation  of  leg  at  lower  third."  The  wounded  man  was  conveyed 
to  Armory  Square  Hospital,  Washington,  several  days  after  the  reception  of  the  injury,  and  two  months  later  lie 
was  transferred  to  Harvey  Hospital  at  Madison,  where,  on  September  7th,  a  second  operation  was  performed  by 
Surgeon  H.  Culbertson,  U.  S.  V.,  who  made  the  following  report :  "The  stump  of  the  tibia  became  necrosed  from 
the  lower  end  to  its  tuberosity.  New  bone  formed,  but  the  necrosed  portion  was  not  separating.  There  were 
several  cloacae,  and  the  lower  end  of  the  tibia  projected  through  the  soft  parts  of  the  stump.  The  patient  was 
in  an  anaemic  condition  and  his  system  was  failing  from  the  constant  discharge  and  reflex  irritation  from  the 
diseased  stump.  Designing  to  resect  the  diseased  tibia,  I  made  an  incision  from  the  tuberosity  of  the  bone 
down  to  its  lower  extremity,  but  on  separating  the  soft  parts  I  found  the  disease  so  extensive  as  to  lead  me  to 
amputate  by  a  short  anterior  and  a  long  posterior  flap  at  the  tuberosity  of  the  tibia.  In  notching  the  tibia  the 
periosteum  was  pushed  back,  the  notch  sawed  off,  and  the  periosteum  laid  over  the  surface  of  the  bone.  The 
anterior  and  posterior  tibial  arteries  were  ligated.  Simple  dressings  were  applied  after  the  operation,  and  quinine 
and  iron  was  administered.  The  sutures  were  removed  on  the  fifth  day  and  the  ligatures  came  away  on  the 
fourteenth  day.  The  wound  steadily  healed."  The  re-amputated  stump  of  the  tibia  and  fibula  (Spec.  3696, 
Sury.  Sect.,  A.  M.  M.),  the  latter  being  well  rounded  and  united  at  its  extremity  with  the  former,  were  con 
tributed  to  the  Museum  by  the  operator,  and  are  represented  in  the  wood-cut  (FlG.  292).  The  specimen  shows 
a  sequestrum  in  the  tibia  six  inches  long;  over  the  upper  part  of  the  anterior  border  the  involucrum  is  wanting. 
The  patient  was  discharged  from  service  August  22,  1865,  and  pensioned,  having  been  previously  furnished 
with  a  "Ely"  artificial  leg.  In  his  application  for  commutation  he  described  the  stump  as  continuing  in  "healthy  condition." 
This  pensioner  was  paid  March  4,  1880. 

In  the  following  instance  both  legs  were  amputated  in  the  lower  thirds  on  the  day  of 
the  injury.     The  patient  survived  the  operation  ten  years: 

CASE  744. — Private  D.  Lee,  Co.  G,  2d  New  York  Artillery,  aged  20  years,  was  wounded  in  both  legs  by  a  shell  during 
the  siege  of  Petersburg,  June  16,  1864,  and  entered  Harewood  Hospital.  "Washington,  six  days  afterwards.     Surgeon  R.  B. 


FIG.  292.— Ke- 
araputated  por 
tions  of  the  right 
tibia  nncl  fibula. 
Spec.  3ti96. 


SKCT.  v.]  PRIMARY    AMPUTATIONS    IN    THE    LEG.  493 

Bontecou,  U.  S.  V.,  reported:  "  The  patient  Lad  both  legs  amputated  by  Assistant  Surgeon  O.  S.  Paine,  2d  New  York  Artillery, 
on  the  day  he  wa.s  wounded,  the  operation  being  performed  by  the  circular  method  at  the  lower  thirds.  He  stated  that  he 
was  in  good  health  at  the  time  of  the  operation.  At  the  time  of  his  admission  he  was  suffering  from  diarrhoea,  and  there  were 
symptoms  of  gangrene  in  the  stump  of  the  right  leg,  the  tibia  and  fibula  protruding;  granulations  of  stump  of  left  leg  not  very 
good.  The  treatment  was  supporting,  and  included  opiates,  astringents,  and  the  external  application  of  solution  of  chloride  of 
lime  to  the  gangrenous  stump.  By  June  26th  the  patient  was  improving  and  the  granulations  had  become  healthy.''  He  was 
subsequently  transferred  to  the  General  Hospital  at  Rochester,  discharged  May  31,  1805,  and  pensioned,  having  been  previously 
furnished  with  artificial  legs  of  the  "Ely"  pattern.  In  his  application  for  artificial  limbs,  dated  1870,  the  pensioner  described 
the  stumps  as  being  in  a  "sound  condition."  He  died  September  25,  1874.  Though  the  immediate  cause  of  his  death  was  not 
ascertained,  the  pensioner's  health  had  been  reported  as  having  become  very  much  impaired. 

Fatal  Primary  Amputations  in  tlie  Lower  Third  oj  the  Leg. — -Two  of  the  two  hun 
dred  and  fifteen  operations  of  this  group  were  double  amputations;  the  operations  were 
therefore  performed  on  two  hundred  and  thirteen  patients,- — one  hundred  and  ninety-one 
Union  arid  twenty-two  Confederate  soldiers.  Re-amputation  in  the  leg  was  performed  in 
seven  and  amputation  in  the  thigh  in  two  instances. 

CASE  745. — Private  W.  J.  Holmes,  Co.  G,  33d  Mississippi,  aged  18  years,  was  wounded  in  the  left  leg,  at  the  engagement 
of  Peachtree  Creek,  near  Atlanta,  July  20,  1864,  and  suffered  amputation  two  days  afterwards.  About  four  months  after 
losing  his  limb  he  was  taken  prisoner  at  Franklin,  Term.,  whence  he  was  conveyed  to  Nashville  and  sub 
sequently  to  Louisville.  Surgeon  R.  R.  Taylor,  U.  S.  V.,  who  contributed  two  post-mortem  specimens 
from  the  stump,  reported  the  result  of  the  case  as  follows:  "The  patient  was  admitted  to  Crittenden  Hos 
pital  on  December  9th.  He  was  suffering  from  chronic  diarrhoea,  of  which  he  died  December  23,  1864. 
His  left  leg  had  been  amputated  by  the  circular  method,  at  the  lower  third,  in  consequence  of  gunshot 
fracture  of  the  lower  portion  of  the  tibia  and  fibula.  In  October  a  portion  of  the  fibula  came  away,  after 
which  the  stump  healed  rapidly.  At  the  time  of  his  death  the  stump  was  entirely  well.  The  accompany 
ing  specimens  are  intended  simply  to  illustrate  the  changes  in  the  cut  ends  of  the  bouts  and  nerves.  The 
latter,  consisting  of  the  extremities  of  the  posterior  and  anterior  tibial  and  of  the  musculo-cutaneous 
nerves,  are  bulbous."  The  nerve  portions  constitute  specimen  4244  of  the  Surgical  Section  of  the  Museum. 
A  representation  of  the  specimen  of  the  bones  of  the  stump  (Spec.  4243,  Sury.  Sect..  A.  M.  M.)  appears 
in  the  wood-cut  (FlG.  293).  In  the  history  of  the  specimen  on  page  400  of  the  Catalogue  of  The  Sur'jical 
Section  of  the  U.  S.  A.  Medical  Museuiii,  Washington,  I860,  it  is  remarked  that  "though  the  stump  is  said 
to  have  been  entirely  healed,  *  *  the  specimen  shows  the  extremity  and  posterior  surface  of  the  tibia 
necrosed."  In  a  letter  dated  December  18,  1867,  Dr.  II.  M.  Lilly,  late  Acting  Assistant  Surgeon,  states 
that  he  prepared  this  specimen,  and  adds:  "I  can  corroborate  Surgeon  R.  R.  Taylor's  statement  that  the  Of  ieft~ieg,  five'months 
stump  was  entirely  healed.  In  explanation  of  the  necrosed  appearance  of  the  end  and  posterior  portion  ^VI  amputation.  Spec. 
of  the  tibia,  I  offer  the  following  history  of  the  preparation  of  the  specimen  as  possibly  giving  it  the  appear 
ance  of  necrosis.  Owing  to  the  inconvenient  arrangements  of  the  hospital  (the  hospital  not  being  finished  at  that  date).  I  macer 
ated  the  specimen  in  a  tin  can  in  my  private  room.  Under  such  circumstances  it  was  of  course  desirable  to  destroy  completely 
all  effluvium.  To  this  end  I  supplied  the  water  in  the  can  liberally  with  the  solution  of  permanganate  salts  furnished  by  the  Medical 
Purveyor.  May  it  not  be  that  the  chemical  action  of  these  salts  has  slightly  damaged  the  specimen,  giving  it  a  partially  necrosed 
appearance?" 

CASE  746. — Private  B.  Spriggle,  Co.  I,  17th  Pennsylvania  Cavalry,  aged  28  years,  was  wounded  in  the  engagement  near 
Funkstown,  July  10.  1863,  and  entered  the  General  Hospital  at  Frederick  ten  days  afterwards.  Assistant  Surgeon  R.  F.  Weir. 
U.  S.  A.,  reported:  "He  was  wounded  by  a  minie  ball,  which  entered  the  outer  side  of  the  left  foot  just  below  the  external 
malleolus,  passing  directly  through,  involving  the  bones  of  the  ankle  joint  and  emerging  three-fourths  of  an  inch  below  the 
internal  malleolus.  The  leg  was  amputated  at  its  lower  third  by  flap  operation  the  same  day  he  received  the  injury.  At  the 
time  of  admission  the  stump  looked  well  and  there  was  healthy  suppuration;  patient  doing  well  constitutionally,  suffering 
none  and  having  good  appetite.  He  was  allowed  a  generous  diet,  and  in  addition  one-half  pint  of  port  wine  daily,  and  the 
stump  was  dressed  with  adhesive  plaster  straps  and  cold-water  applications.  On  August  4th,  the  flaps  having  firmly  adhered, 
the  straps  were  taken  off  the  stump  and  simple  cerate  dressing  was  applied.  Two  days  afterwards  the  patient  was  able  to  sit  up  for 
a  few  hours  in  a  chair,  and  on  the  next  day  an  abscess  was  opened  which  had  formed  near  the  end  of  the  stump.  The  patient's 
appetite  now  had  become  a  little  depraved  and  he  had  some  irritation  of  the  stomach.  During  the  evening  of  August  7th  he 
had  a  severe  chill,  followed  by  some  fever  the  next  morning.  Quinine  and  fever  mixture  was  then  prescribed  and  the  wine  con 
tinued.  August  9th,  pulse  106  and  rather  feeble;  appetite  not  improving;  some  discharge  still  coming  from  the  superficial  abscess. 
On  August  10th,  the  patient  had  improved  a  little,  but  the  granulations  were  not  looking  very  healthy  and  the  stump  was  ordered 
to  be  dressed  with  Hay's  lotion.  On  the  following  day  there  was  another  chill;  pulse  130;  no  improvement.  On  August  12th, 
the  chills  continued,  the  tongue  looking  pale,  and  the  pulse  being  accelerated;  but  the  patient  was  apparently  much  better.  A 
bandage  was  applied  to  prevent  the  burrowing  of  pus  towards  the  knee  joint.  August  13th,  pulse  134  and  very  irregular;  tongue 
dry:  patient  complaining  of  a  great  deal  of  thirst,  having  some  cough,  and  gradually  sinking.  Milk  punch  wa.s  now  substi 
tuted  for  the  wine.  The  next  day  the  patient  was  very  delirious,  the  pulse  accelerated  and  threadlike;  great  deal  of  tenderness 
in  the  knee;  joint  doubtless  involved;  fluctuations  detected.  August  15th,  patient  sinking  and  still  very  delirious;  pulse  156;  a 
good  deal  of  subsultus;  very  little  diarrhoea;  tongue  red  and  dry;  knee  joint  seemingly  enlarging.  Patient  taking  no  nourish 
ment  but  beef  tea,  having  no  relish  for  other  food;  stimulants  and  opiates  administered  in  large  doses.  Death  occurred  at  ll..)5 


494 


INJURIES    OF    THE    LOWEE    EXTREMITIES. 


[CHAP.  X. 


A.  M.  on  August  16,  1863.  On  dissecting  up  the  integuments  and  opening  the  chest  during  the  post-mortem  examination,  the 
lungs  were  found  to  be  healthy  and  weighing  eighteen  ounces;  heart  normal  and  weighing  eight  ounces;  liver  healthy  and 
weighing  three  pounds  and  fifteen  ounces;  weight  of  spleen  seven  ounces,  and  weight  of  kidneys  nine  ounces.  On  removing 
both  bones  of  the  leg  from  the  point  of  the  operation  to  the  knee  joint,  a  circumscribed  abscess,  containing  about  an  ounce  of  pus, 
was  found  in  the  belly  of  the  gastrocncmius  muscle.  The  knee  joint  contained  between  three  and  four  ounces  of  pus.  The 
capsule  was  broken  down  and  the  pus  extended  up  the  outer  side  of  the  thigh  about  six  inches  above  the  joint;  cartilage  quite 
soft  and  commencing  to  erode  around  its  edges."  The  bones  of  the  stump,  exhibiting  a  minute  sequestrum,  nearly  separated  on 
the  carious  extremity  of  the  tibia,  were  contributed  to  the  Museum  by  Acting  Assistant  Surgeon  J.  C.  Shinier,  and  constitute 
specimen  3878  of  the  Surgical  Section. 

CASE  747. — Private  A.  C.  Paine,  Co.  F,  42d  New  York,  aged  30  years,  was  wounded  in  both  lower  extremities,  at  the 
battle  of  Gettysburg,  July  3,  1863.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Second  Corps,  where  Surgeon 
I.  Scott,  7th  West  Virginia,  recorded  the  injury  as  "fracture  of  both  feet,  caused  by  a  solid  shot,"  necessitating  '' primary  ampu 
tation  of  both  legs  at  the  lower  third,  which  operation  was  performed  by  Surgeon  H.  M.  McAbee,  4th  Ohio."  Surgeon  H.  Janes, 
U.  S.  V.,  recorded  that  the  patient  died  at  the  Seminary  Hospital,  Gettysburg,  July  23,  1863,  from  the  effects  of  his  injuries. 

TABLE  LXX. 

Summary  of  Nine  Hundred   Cases  of  Primary  Amputations  in  the  Lower  Third  of  the  Leg  for  Shot 

Injuries. 

[Recoveries,  1— 676;  Deaths,  677—891 ;  Results  unknown,  892—900.] 


No 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

DESCRIPTION,  AND  AGE. 

DATKS. 

RESULT. 

DESCRIPTION,  AND  AGE. 

D  ATES. 

RESULT. 

1 

Abbey,  C.  F.,  Serg't,  C, 

Mar.  16, 

Left;  circ.     Surg.  P.  H.  Flood, 

27 

Barnes,  W.H.,Pt.,  B,  3d 

Jan.  3, 

Left;  circ.     Surg.  W.  L.  Peck, 

107th  New  York. 

16,  '65. 

107th  N.  Y.  Disc'd  Aug.  23,  '65. 

Ohio. 

4,  '63. 

3d  Ohio.     Discharged. 

2 

Abbott,  U.S.,  Pt.,  D,32d 

Aug.  14, 

Right  ;  lateral  flap.     Surg.  J.  C. 

28 

Bartholomew,  C.  F.,  Pt., 

July  12, 

Left,    Surg.  J.  B.  Hinkle.C.  S.  A. 

Wisconsin,  age  20. 

14,  '64. 

Denise.  27th  Ohio.    Discharged 

D,  3d  Iowa. 

12,  '03. 

Discharged  Dec.  29,  1  863. 

July  17,  1865. 

29 

^Barwick,  J.  H.,  Pt.,  —  , 

Sept.  17, 

Right;  circular.     Doing  well. 

3 

Allen,  C.,  Lieut.,  H,  llth 

May  22, 

Right.     Surg.  H.  P.  Strong,  llth 

6th  S.  C.,  age  20. 

17,  '02. 

Wisconsin. 

23,  '63. 

Wis.     Resigned  Jan.  11,  1864. 

30 

Bass,   G.,   Pt.,    B,   34th 

June  5, 

Right;  circular.  Discharged  Oct. 

4 

Almany,  J.,  Pt.,  B,  9th 

Sept.  19, 

Left;  flap.    Discharged  January 

Massachusetts,  age  21. 

5,  '04. 

17.  1864. 

Kentucky,  age  39. 

20,  '63. 

28,  1864. 

31 

Bass,  J.  C.,  Pt.,  I,  5th 

Oct.  19, 

.     Recovered. 

5 

Arnelunxen,  M.,  Lieut., 

Aug.  29, 

Right,     Surg.   L.    Schultz,  68th 

Virginia  Cavalry. 

19,  '64. 

H,  68th  New  York. 

297  '62. 

N.  Y.     Mar.  29,  1863,  re-amp. 

32 

Bassett,   O.  J.,   Pt.,  F, 

June  15, 

Right;   circ.     Discharged    Feb. 

mid.  third.    Disch'd  Aug.  3,  '63. 

70th  Indiana,  age  18. 

15,  '04. 

27,  1865.     Died  June  10,  1872. 

6 

Andrew,  J.  J.,   Pt.,   E, 

Oct.  22, 

.    Confederate  surgeon.    Re 

33 

Bates,  C.  A.,  Pt.,  D,  57th 

Aug.  19, 

Right;  flap.     Surg.  W.V.White, 

26th  North  Carolina. 

24,  '64. 

covered. 

Massachusetts,  age  18. 

20,  '64. 

57th  Mass.    Disch'd  Mar.  10,  '05. 

7 

Annand,  A.,  Adj't,  28th 

May  18, 

Left.     Nov.  20,   removal   of  ne 

34 

Bauvais,  D.,  Pt.,  H,  97th 

Feb.  6, 

Right  ;  lateral  flap.     Discharged 

Massachusetts,  age  30. 

19,  '64. 

crosed  bone.  Disch'd  May  6,'65. 

New  York,  Bge  25. 

7,  '65. 

Aug.  17,  1805. 

8 

Antis,  T.  S.,  Pt.,  L,  2d 

July  2, 

Left  ;  circ.    Surg.  R.  T.  Paine,  2d 

35 

Bay,  M.  S.,  Lieut.,   K, 

July  3, 

.    Exchanged  September  15, 

N.  Y.  M.  R.,  age  22. 

3,  '64. 

N.  Y.  M.  R.     Discharged  Feb. 

38th  N.  C.,  age  30. 

3,  '*63. 

1803. 

25,  1865. 

36 

Bayless,  B.   J.,  Pt.,  F, 

July  20, 

Right.      Surg.    E.    Hutchinson, 

9 

Armstrong,  A.  H.,  Corp'l, 

Sept.  19, 

Left  ;  flap.    Surg.  J.  N.  Freeman, 

137th  N.  Y.,  age  20. 

20,  '64. 

137th  N.  Y.    Aug.  8,  '04.  re-amp. 

A,  100th  N.  Y.,  age  22. 

19,  '04. 

106th  N.  Y.     Discharged. 

at  up.  third.  Disch'd  June  16,  '65. 

10 

Armstrong,  S.  J.,  Pt,,  C, 

July  14, 

Left.     Discharged  December  26, 

37 

Beath,  R.  B.,  Capt.,  G, 

Sept  29, 

Right;  circ.   flap.     Surg.  D.  G. 

1st  Michigan  Cavalry. 

16,  '63. 

1863. 

6th  C.  Troops,  age  25. 

Oct,l,'64. 

Rush,  101st  Penn.     Discharged 

11 

Augustine,   A.,    Pt.,   B, 

Sept.  17, 

Left  ;  ciro.     Discharged  Dec.  13, 

Sept.  20,  1805. 

50th  Pennsylvania. 

17,  '62. 

1802.     Died  Aug.  20,  1869. 

38 

Bedford,  P.  B.,  Corp'l, 

July  3, 

Right.    Transferred  to  prison  De 

12 

Auman,  P.,  Pt.,  H,  211th 

April  2, 

Left  ;  flap.     Surg.  W.  G.  Hunter, 

B,  50th  Ga.,  age  36. 

4,  '03. 

cember  5,  1803. 

Pennsylvania. 

2,  '65. 

211th  Penn.  Disch'd  July  20,  '65. 

39 

Beers,  C.  E.,  Serg't,  G, 

June  30, 

Left;  flap.     Surg.  W.  H.  Rice, 

13 

Ayres,  "//.,  Pt.,  B,  27th 

Aug.  25, 

Left.     Surg.  E.  L.  Howard,  27th 

81st  New  York,  age  25. 

30,  '04. 

81st  N.  Y.    Diseh'd  Dec.  29,  '04. 

North  Carolina. 

26,  '04. 

N:  C.     Furloughed. 

40 

Beers,  E.  J.,  Corp  1,  C, 

June  27, 

Right.     Surg.    T.   B.   Williams, 

14 

Babb,  J.  A.,  Corp'l,  K, 

Aug.  3, 

Left  ;  circ.     Discharged  July  18, 

113th  Ohio,  age  27. 

27,  '04. 

121st  Ohio.     Re-amput'n.     Dis 

10th  Indiana,  age  24. 

o    'li4 
o,    ot. 

1865.     Died  Feb.  17,  1806. 

charged  May  10,  1805. 

15 

Babcock,  E.  A.,  Pt.,  G, 

June  18, 

Left  ;   circ.     Surg.   T.  M.  Flan- 

41 

Bell,    F..    Capt..    I,    1st 

July  3, 

Right.     Surgeon  C.  Bower,  6th 

146th  N.  Y.,  age  18. 

18,  '64. 

drau,  146th  N.  Y.     Discharged 

Pennsylvania  Rifles. 

3.  '03. 

Penn.  Res.     Disch'd  Oct.  19,  63. 

May  18,  1865. 

42 

Bell,  J.,  Pt,  G,  12th  Ga. 

Sept,  19, 

R't.  Surg.  S.V.  D.Ilill,P.  A.C.  S. 

16 

Babe,  R.,  Pt.,  D,  97th 

Mav  20, 

Right;  circ.     Surg.  J.  R.  Ever- 

Battalion,  age  26. 

20,  '04. 

Trans,  to  Pro.  Mar.  Apr.  1,  '05. 

Pennsylvania,  age  22. 

20,'  '64. 

hart,   97th   Penn.     Discharged 

43 

Bell,  J.  H.,  Lieut.,   D, 

July  20, 

Left  ;  flap.    Surg.  II.  K.  Spooner, 

August  20,  1864. 

Gist  Ohio,  age  52. 

20,  '64. 

Olst  Ohio.    Disch'd  Deo.  ]  5,  '64. 

17 

Badger,  S.,  Pt.,  F,  26th 

July  1, 

Right.     Gangrene.     Transferred 

Oct.  27,  '70,  amp.  thigh  at  mid. 

North  Carolina,  age  17. 

1,  '63. 

for  exchange  March  3,  1804. 

third  for  neuralgic  air.  of  stump. 

18 

Baker,  L.  A.,  Capt.,  A, 

Aug.  16, 

Left.     Surg.  C.  M.  Clark,  39th 

44 

Bender,  P.,  Pt,,  B,  74th 

July  2, 

Right  ;  circular.  Discharged  J  uly 

39th  Illinois,  age  29. 

16,  '04. 

111.     Discharged  Dec.  17,  1864. 

New  York,  age  35. 

3,  '63. 

25,  1804. 

19 

Baldwin,  R.  F.,  Lieut., 

Nov.  :;o, 

Left  ;    ant.  post.  flap.     Surg.  — 

45 

Bennett,  E.  F.,  Pt.,  B, 

July  11, 

Left.     Confed.   Surg.     Necrosis. 

F,  1st  Arkansas,  age  25. 

Dec.1,'64. 

Mitchell,  1st  Ark.     Transferred 

70th  Pennsylvania. 

13,  '63. 

Oct.  0,  amp.  at  mid.  third.     Dis 

to  Pro.  Mar.  Feb.  6,  1865. 

charged  July  21,'04.  Spec.  4308. 

20 

Bales,    A..    Pt.,   A,   4th 

June  1, 

Left;  circ.     Asst.    Surg.    II.   D. 

46 

Bennett,  F.  H.,  Corp'l, 

May  10, 

Right;  ant.  post.  flap.     Surg.  J. 

Indiana  Cav.,  age  19. 

1,  '64. 

Garrison,   4th  Ind.  Cav.     Dis 

G,  48th  New  York,  age 

17,  '64. 

L.  Mulford,  48th  N.  Y.      Dis 

charged  Nov.  1,  1864. 

23. 

charged  May  24,  1865. 

21 

Banton,    S.   A.,   Pt.,   K, 

July  2, 

Left.     Paroled  Sept.  22,  1863. 

47 

Bennett,  G.  B.,  Serg't,  I, 

Mar.  16, 

Left;  circ.     Surg.  P.  II.  Flood, 

20th  N.  C.,  age  19. 

2,  fa. 

3d  Wisconsin,  age  36. 

10,  '05. 

107th  N.Y.  Disch'd  June  14,  '05. 

22 

Barber,  C.,  Pt.,  F,   Cth 

May  13, 

Right  ;  ant.  post.  flap.     Surg.  W. 

48 

Benton,  E.,   Pt,,   Hart's 

Oct.  14, 

Left.     Surg.  —  Green,  C.  S.  A. 

Iowa,  age  28. 

13,  '04. 

Lomax,  12th  Ind.     Discharged 

Battery. 

15.  '03. 

Recovered. 

July  10,  1805. 

49 

Bergeron,  J.,  Pt.,  H,39th 

May  9, 

Right  ;    flap.     Discharged  April 

23 

Barfield,  T.,  Serg't,   L, 

Sept.  20, 

.     Surg.  —  Walker,  C.  S.  A. 

Massachusetts,  age  20. 

9,  '04. 

7,  1805. 

8th  South  Carolina. 

21,  '03. 

Recovered. 

50 

Beto,  R.  W.,  Lieut,,  II, 

May  13, 

Right  (also  flesh  wound  left  arm); 

24 

Barqe,  A.  L.,  Corp'l,  B, 

Aug.  24, 

.     Surg.  —  Mathis,  C.  S.  A. 

56th  N.  C.,  age  20. 

14,  '04. 

gangreno.    Exch'd  Aug.  18,  '04. 

28th  Georgia. 

24,  '04. 

Recovered. 

51 

Betterley,  C.  M.,  Pt.,  II, 

Mar.  29, 

Right;    flap.     Discharged  July 

25 

Barnes,    I.   M.,    Pt.,   F, 

Jan.  29, 

Right;   flap.     Asst.  Surg.  J.  P. 

198th  Penn.,  age  27. 

29,  '05. 

6,  1805. 

83d  Illinois. 

29,  '03. 

McClanahan,  83d  111.     Disch'd 

52 

Beverly,  D.,  Serg't,  D, 

Sept.  17, 

Left.     Discharged  Dec.  0,  1802. 

April  10,  1864. 

97th  New  York. 

18,  '62. 

26 

Barnes,   M.   J.,  Pt.,   E, 

July  6, 

Left.     Surg.  G.  H.  Parks,  05th 

53 

Birns,    W.    G.,   Pt.,  D, 

July  3, 

Right.     Surg.  —  Baxter,  C.  S.  A. 

65th  Illinois. 

6,  '62. 

111.     Discharged  Aug.  19,  1862. 

50th  Virginia. 

3,  '63. 

Rccovcnl. 

'FISHER  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations,  in  thr.  Hospitals  near  SJiarpsburg,  Md.,  after  the  Battle  of  Antietam,  September 
17,  1862,  in  American  Journal  Medical  Sciences,  1863,  Vol.  XLV,  page  48. 


SECT.  V 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


495 


No. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

54 

Black,  G.,  Serg't,  C,  4th 

May  8, 

Left  ;  circ.     Surg.  —  Mitchell,  C. 

91 

Carshaw,  W.  E.,  Pt..  E, 

July  1, 

Left;  circ.    A.  Surg.  P.  S.  Arndt, 

Maryland,  age  "3. 

8,  '64. 

S.  A.    Disch'd  Nov.  11,  1864. 

14th  N.Y.  State  Militia. 

l,  *63. 

2d  Wis.     Disch'd  Nov.  20.  1  863. 

55 

Blair,  J.  £.,  Pt.,  A,  10th 

Sept.  17, 

Left  ;  Surg.  R.Y.Royston.C.S.A. 

92 

Carter,    C.   A.,   Pt.,   B, 

June  J  7, 

Left  ;  circ.     Disch'd  June  28,  '65. 

Alabama. 

18,  '62. 

Recovered. 

llth  Maine,  age  21. 

17,  '64. 

Re-amp,  below  knee.   Died  Oct. 

56 

Blanchard,  C.,   Pt.,  H, 

Sept.  29, 

Right  ;  flap.     A.  Surg.  M.  Hines, 

31,  1869,  from  chronic  diarrhoea. 

9Gth  N.  Y.,  age  29. 

29,  '64. 

96th  N.Y.    Disch'd  Apr.  17,  '65. 

93 

Carter,  W.  A.,   Pt.,  D, 

May  12, 

Right;  flap.  Discharged  July  28, 

Re-amp,  at  mid.th'd  June  15,'65. 

148th  Penn.,  age  26. 

13,  '64. 

1865. 

57 

Bloom,  C.,   Pt.,   D,   2d 

June  3, 

Left;  circular.     Discharged  Jan. 

94 

Carter,   W.  F.,    Pt.,  G, 

Sept.  22, 

Left.      Transferred    to    Provost 

N.  H.,  age  2:3. 

4,  '64. 

8,  1865. 

45th  N.  C.,  age  21. 

22,  '64. 

'  Marshal  June  1,  1865. 

58 

Bcehme,  U.  F.,  Pt.,  A, 

April  2, 

Left  ;  circ.     April  10,  hrem.  from 

95 

Case,  C.  P.,  Pt.,  D,  8th 

May  2, 

Left.     Discharged  May  24,  1864. 

52d  New  York,  age  25. 

4,  '65. 

ant.  and  post.  tib.  arteries;  necro. 

Penn.  Cavalry,  age  18. 

3,  '63. 

bone  removed.  Disch'd  Nov.  14, 

96 

Case,   S.,    Pt.,   C,   llth 

May  22, 

Left:  flap.     Discharged  Aug.  20, 

1865.    Died  Aug.  18,  1874. 

Wisconsin. 

23,'  '63. 

1863. 

59 

Bonhomme,  E.,  Pt.,  E, 

April  10, 

Left;  ant.  post,  flap;  slough.  Apr. 

97 

Castello,  P.,  Pt.,  F,  3d 

Sept.  17, 

Left.     Surg.  —  Mitchell,  C.S.  A. 

73d  C.  Troops,  age  27. 

10,  '65. 

24,  '65,  re-amp,  low.  third  thigh. 

Alabama. 

18,  '62. 

Recovered. 

Discharged  J  une  17,  "65.     Died 

98 

Casto,  A.  H.,  Serg't,  G, 

June  10, 

.     Surg.  —  Bee,  C.S.  A.  Re 

June  3,  1867;  marasmus. 

17th  Virginia. 

10,  '63. 

covered. 

60 

Banner,  R.,  Pt.,  D,   1st 

Nov.  30, 

Right  ;    circular.     Provost  Mar 

99 

'Catlin,  R.,   Lieut.,   D, 

Aug.  21, 

Left  ;  circ.   Surg.  W.  B.  Fox,  8th 

Mississippi,  age  21. 

Dec.1,'64. 

shal  March  2,  1865. 

5th  U.  S.  Artillery. 

21,  '64. 

Mich.   Retired  Dec.  15,  '70.  Ex- 

61 

Boyle,  P.,  Pt.,  G,  24th 

Oct.  8, 

Left.    Feb.  9,  1863,  re-amp,  mid. 

section  of  1J  in.  peroneal  nerve 

Mississippi,  age  48. 

8,  '62. 

third,   circ.   lat.  flaps.     Trans 

'    by  Dr.  J.  H.  Brinton,  1875. 

ferred  Oct.  8,  1863. 

100 

Cavanaugh,  J.,  Pt.,  C, 

June  18, 

Lett;  circ.     Surg.  D.  C.  Ayres, 

62 

Braekett,  E.  J.,  Pt.,  D, 

Sept.  30, 

Left;  flap.     Surg.  S.  Cooper,  6th 

7th  Wisconsin,  age  21. 

19,  '64. 

7th  Wis.     Disch'd  Oct.  5,  '64. 

35th  Mass..  age  22. 

30,  '64. 

N.  H.    Discharged  Jan.  18,  '65. 

Spec.  1526.   Feb.  25,  '65,  re-amp. 

63 

Brady,  F.,  Pt.,  K,  46th 

July  20, 

Right;   circ.     Discharged  Aug. 

1  inch  below  tubercle  of  tibia. 

Pennsylvania,  age  22. 

21,  '64. 

25,  1865. 

101 

Cavender,  ~L.,  Pt.,  H,  3d 

May  5, 

Left  ;  flap.     Discharged  Feb.  10, 

64 

Brazell,"  M.,  Pt.,  F,  61st 

July  20, 

Right;  flap.  Disch'd  Apr.  26,  '65. 

Michigan,  age  22. 

5,  '64. 

1865. 

Illinois,  age  38. 

21,"'64. 

He-amp,  mid.  third  July  17,  '65. 

102 

Chalfant,  G.  W.,  Pt.,  E, 

July  19, 

Left.  Surg.  H.M.  Duff,  52d  Ohio, 

65 

Bickford,  C.,  Corp'l,  G, 

Oct.  19, 

Left  ;  circ.     Disch'd  Mar.  30,  '65. 

52d  Ohio,  age  21. 

19,  '64. 

Two   subsequent   amputations. 

14th  Maine,  age  21  . 

20,  '64. 

Died  Jan.  27,  '69  ;  consumption. 

Discharged  Oct.  17,  18(i5. 

66 

Brian,  W.,  Capt.,  K,  3d 

Dec.  13, 

Left.   Confed.  Surg.   Discharged 

103 

Chartier,  N.  A.,  Pt.,  A, 

June  18, 

Right.     Surg.  W.  C.   Shurlock, 

Pennsylvania  Res. 

13,  '62. 

Sept.  15,  1863. 

37th  Wisconsin,  age  20. 

18,  '64. 

51st  Penn.    Disch'd  June  26,'u3. 

67 

Brockway,  J.  W.,  Capt., 

July  30, 

Left;  circ.     Surg.  J.  P.  Prince, 

104 

Chase,   G.   W.,    Corp'l, 

May  12, 

Right  :  circ.     Surg.  T.  F.  Oakes, 

C,  29thC.  T.,  age  29. 

Au.1,'64. 

36th  Mass.    Disch'd  Mar.  9,  '65. 

G,  56th  Mass.,  age  25. 

12,  '64. 

56th  Mass.    Disch'd  Dec.  15,  '64. 

68 

Brooks,  F.  C.,  Pt.,  D,  3d 

Julyl, 

Left  ;  circ.     Surg.  C.  W.  McMil 

105 

Christ,  W.,  Pt.,  1,  57th 

June  16, 

Left;  flap.     Surg.  J.  W.  Lyman, 

East  Tenn.,  age  20. 

1,  '64. 

lan,  1st  East  Tenn.    Gangrene. 

Pennsylvania,  age  23. 

17,  '64. 

57th  Penn.  Disch'd  Sept.'S.  '65. 

Discharged  Feb.  26,  1865. 

106 

Christian,  G.  L.,  Serg't, 

May  12, 

.     Surg.  —  Roscoe,  C.  S.  A. 

69 

Brothers,  C.  P.,  Serg't, 

Aug.  21, 

.     Surg.  —  Loben,  C.  S.  A. 

2d  Richm'd  Howitzers. 

12,  '64. 

Retired  Oct.  12,  1864. 

II,  llth  South  Carolina. 

21,  '64. 

Recovered. 

107 

Church,  J.  P.,  Capt.,  K, 

Deo.  16, 

Right  ;  ant.  post.  flap.   Surg.  W.F. 

70 

Brown,  T.,  Pt.,  K,  15th 

July  3, 

Left  ;  ant,  post.  flap.    Discharged 

48th  Tennessee,  age  33. 

17,  '64. 

Westmoreland,  5:'d  Tennessee. 

Massachusetts,  age  21. 

4,  '63. 

Jan.  2!>,  1864. 

Trans,  to  Pro.  Mar.  March  7,  '65. 

71 

Brown,  W.F.,  Serg't,  G, 

Dec.  13, 

Left  ;  circular.    Discharged  June 

108 

Clark,  A.,  Lieut.,  F,  llth 

May  18, 

Left;  flap.     Surg.  N.  F.  Blunt, 

24th  New  Jersey. 

13,  '62. 

29,  1863. 

Maine,  age  25. 

19,''64. 

llth  Me.     Disch'd  July  10,  '65. 

72 

Brubakor,    D.,    Pt.,    C, 

Dec.  13, 

Left;  flap.    Mustered   out  May 

109 

2  Clark,  H.  W.,  Pt.,  H, 

May  13, 

Left;  lat.  flap.;   and  right  foot. 

127th  Pennsylvania. 

15,  '62. 

29,  1863. 

100th  N.  York,  age  30. 

13,  '64. 

Chopart's  op.     Surg.  M.  S.  Kit- 

73 

Bryan,  W.  A.,   Pt,,   C, 

Dec.  13, 

Right.   DischargedFeb.il,  1863. 

tinger.  100th  N.  Y.     Discharged 

1  1th  Penn.  Reserves. 

15,  '62. 

Dec.  13,  1864.     Spec.  2857. 

74 

BurdM.I.J.,  Pt.,  Hamp 

May  31, 

—  .     Surg.  —  Darby,  C.  S.  A. 

110 

Clark,  J.,   Pt.,   E,  89th 

July  27, 

Left  ;  ant.  post.  flap.     Discharged 

ton  Legion. 

J'e  1,'62. 

Recovered. 

Illinois,  age  29. 

28,  '64. 

Dec.  1,  1864. 

75 

Burk,  C.  J.,   Serg't,  A, 

Nov.  27, 

Right  ;  circ.     Surg.  J.  W.  Wis- 

111 

Clark,  P.,  Pt.,  D,  140th 

July  2, 

Right;  haem.;  lig.  of  post,  tibial 

140th  Peuu.,  age  44. 

28,  '63. 

hart,  140th  Penn.     Discharged 

New  York,  age  28. 

3,  '63. 

arterv.     Recovered. 

March  16,  1865. 

112 

Clay,  W.  C.,  Pt.,  D,  2d 

May  31, 

Left;  circ.  Surg.W.  B.  Reynolds, 

76 

Burke,  M.,  Pt.,  D,  20th 

May  10, 

Right.     Surg.  X.  Hayward,  20th 

U.  S.  S.  S.,  age  35. 

31,'  '64. 

2d  U.S.S.S.  Uisch'd  Mar.22,'G5. 

Mass,  age  22. 

10,  '64. 

Mass.   Discharged  Oct.  12,  1664. 
Spec.  517. 

113 

Clayton,  G.,  Pt.,  I,  4th 
N.  Hampshire,  age  37. 

May  16, 
16,'  '64. 

Right  :    flap.     Discharged   Sept. 
27,  1864. 

77 

Burkett,  J.,  Pt.,  M,  5th 

April  9, 

Right;  flap.  Surg.  A.  K.  St.Clair. 

114 

Clayton,  H.,  Pt..  A,  74th 

June  15, 

Right  ;  circ.     Discharged  March 

Cavalry. 

9,  '65. 

1st    Michigan    Cavalry.      Dis 

Indiana,  age  44. 

15,  '64. 

17,  1865. 

charged  August  10,  1865. 

115 

Clearwater,  R.,  Pt.,  G, 

Sept.  20, 

Right  ;  flap.     Surg.  J.  Y.  Finley, 

78 

Burr,  C.  M.,  Pt.,  E,  2d 

Oct.  19, 

Right  ;  ciro.    Surg.  II.  Plumb,  2d 

125th  Illinois,  age  33. 

21,  '63. 

2d  Kentucky  Cav.     Discharged 

Conn.  H.  A.,  age  21. 

20,  '64. 

Conn.  H.  A.  Disch'd  June  9,  '65. 

Feb.  18,  1864. 

79 

Burt,  A.  W.,  Lieut,,  A, 

July  2; 

Left.     Paroled  Nov.  14,  1863. 

116 

Clemens,  H.,Pt.,H,  12th 

July  18, 

Right;  flap.     Surg.  R.W.  Pease, 

7th  S.  C..  age  22. 

3,  '63. 

New  York. 

18,  '61. 

•  12th  N.  Y.     Duty  Sept.  9,  1861. 

80 

Burtner,  J.,   Corp'l,   E, 

April  19, 

Left  ;   ant,   post.   flap.     Surg.  — 

117 

Cochran,  S.  H.,  Pt.,  A, 

Oct.  28, 

Left;  circ.  Surg.  —Skinner,  44th 

103d  Penn.,  age  19. 

20,  '64. 

Gott,  21  st  Ga.    Discharged  Apr. 

2d  S.  C.  Rifles,  age  20. 

29,  '63. 

Ala.     Furloughed  Mar.  14,  '65. 

19,  1865. 

118 

Colburn,  A.  T.,  Pt,,  A, 

Oct.  13, 

Left  ;  circ.     Nov.  23,  removal  of 

81 

Bushey,   F.  P.,  Pt.,  C, 

May  18, 

Left  ;  flap.     Surg.  W.  V.  White, 

34th  Mass.,  age  23. 

14,  '64. 

two  inches   tibula   and  fibula. 

56th  Mass.,  age  22. 

18,  '64. 

57th  Mass.     Necrosis.     Dec.  25, 

Disch'd  May  11,  1865. 

lateral  flap  amp.,  middle  third. 

119 

Colby,  A.  T.  G.,  Pt.,  B, 

Dec.  13, 

Right.     Re-amp.  6  inches  below 

Disch'd  Apr.  3,  '65.     Spec.  4336. 

28th  New  York. 

14,  '62. 

knee.     Disch'd  Jan.  21,  1863. 

82 

Butler,  J.  H.,  Lieut.,  G, 

Nov.  8, 

Left.     Surg.  E.  W.  H.  Beck,  3d 

120 

Collins,  A.,   Pt.,   D,  2d 

Aug.  16, 

Left.    Discharged  May  15,  1865. 

2d  Artillery. 

8,  '63. 

Ind.  Cav.     Aug.  5,  1864,  rein.  6 

Pennsylvania,  age  19. 

17,  '64. 

ins.  tibia  from  stump.     Retired 

121 

Collins,  J.,  Pt.,  C,  82d 

June  3, 

Right  ;  ant,  post.  flap.     Surg.  S. 

Feb.  7,  1865. 

New  York,  age  20. 

3,  '64. 

II.  Plumb,  82d  N.  Y.     Disch'd 

83 

Bvington,  A.,  Corp'l,  I, 

June  2, 

Right;  circ.     Surg.  A.  P.  Clark, 

June  30,  1865.    Spec.  1524. 

6th  N.  Y.  Cav.,  age  25. 

2,  '64. 

6th  N.  Y.  Cav.  Discharged  Sept. 

122 

Colomy,  M.  G.,  Pt.,  K, 

Sept.  30, 

Right  ;  circ.      Discharged   Aug. 

20,  1864. 

31st  Maine,  age  42. 

Oct.  1,  '64. 

24,  1865. 

84 

Caldwell,  J.  P.,  Pt.,  A, 

July  30, 

Left  :  flap.     Discharged  May  23, 

123 

Comerford,    J.,   Pt.,   B, 

Feb.  6, 

Left;  flap.  Snrg.  B.  Gesner.  10th 

.  115th  N.  Y..  age  39. 

30/64. 

1865. 

10th  New  York,  age  21. 

6,  '64. 

N.  Y.     Disch'd  July  10,  1864. 

85 

Call,  C.  K.,  Pt.,  K,  35th 

Dec.  13, 

Left  ;  flap  ;  bone  removed.     Dis 

Spec.  4302. 

Massachusetts,  age  24. 

14,  '62. 

charged  Mar.  5,  1863. 

124 

Compton,  T.,  Pt.,  D,  29th 

May  2, 

Left.   A.  Surg.  J.  T.  Brown.  94th 

86 

Cann,   C.,   Pt.,   D,  30th 

July  30, 

Left  ;   circ.     Surg.  D.  MacKay, 

New  Jersey. 

2,  '63. 

N.  Y.     May  20,  re-amp,  at  mid 

New  York. 

Au.1,'64. 

27th  C.  T.    Disch'd  Dec.  20,  '64. 

dle  third.     Disch'd  June  30,  '63. 

87 

Carey,  J.  H.,  Pt.,  D,  27th 
Michigan,  age  26. 

June  3, 
3,  '64. 

Right;  circ.  Surg.  A.  F.  Whelan, 
1st  Michigan  S.  S.     Discharged 

125 

Conaway,    J.,    Pt.,    H, 
1  3th  Pen  n  .  Cav.  ,  age  37. 

Aug.  14, 
14,  '64. 

Right.    Surg.  G.T.Stevens.  77th 
N.  Y.     Discharged  June  21,  '65. 

October  28.  1864. 

126 

Condon,  E.,  Pt.,   F,  1st 

Oct.  19, 

Right  ;    flap.     Discharged  July 

88 

Carney,  P.,  Pt.,   A,  2d 

Dec.  13, 

Right,   Discharged  April  7,  1863. 

Maine. 

19,  '64. 

20,  1865. 

Maine. 

13,  '62. 

127 

Connelly,  J.  F.,  Pt.,  G, 

Oct.  19, 

Right;  ant.  post.  flap.     A.  Surg. 

89 

Carpenter,  S.  B.,  Pt..  F, 

June  1  0, 

Left;  flap.  Surg.  C.  B.  Park,  llth 

7th  Maine,  age  30. 

19,  '64. 

D.  H.  Armstrong.  160th  N.  Y. 

llth  Vermont,  age  20. 

10,  '64. 

Vt.    Discharged  Dec.  24,  1864. 

Disch'd  Mar.  8,  1865.     June  3, 

90 

Carr,  H.  C.,  Pt.,  B,  22d 

Oct.  8, 

Left  ;  flap.     Discharged  Feb.  10, 

1869,  re-amp,  at  June.  mid.  and 

Indiana. 

9,  '62. 

1863. 

lower  thirds.    Spec.  524. 

1  MITCHELL  (S.  W.),   The  Relations  of  Pain  to  Weather,  being  a  study  of  the  natural  history  of  a  case  of  Traumatic  A'euralgia,  in  American 
Journal  of  Medical  Sciences,  1877,  Vol.  LXX1II,  page  306. 

2  SMITH  (STEPHEN),  Analysis  of  439  recorded  amputations  in  the  Continuity  of  the  Lower  Extremity,  in  Vnited  States  Sanitary  Commission 
Memoirs,  Surgical  Volume  II,  New  York,  1871,  pages  110,  140. 


496 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP,  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AKU  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

123 

Conner,  H.,  Pt.,  D,  20th 

May  24, 

Left  ;  ant.  post.  flap.     Discharged 

170 

Diamond,  R.,  Pt.,  K,  3d 

Sept.  19, 

Left;  circ.     Surg.  A.  Bowie,  3d 

Massachusetts,  age  35. 

24,  '64. 

April  17,  1865. 

Alabama,  age  25. 

19,  '64. 

Ala.     To  prison  Jan.  5,  1805. 

12!) 

Conover,  J.,  Pt.,  C,  33d 

May  25, 

Left  :    ant.   post.   flap.     Surg.  J. 

171 

Dietrich,  C.,  Pt,  E,  91st 

A  prill  3, 

Left.     Discharged  April  10,  1864. 

New  Jersey,  age  45. 

25,  '64. 

Reily,  33d   N.  J.      Discharged 

New  York. 

13,  '63. 

March  16,  1865. 

172 

Dillon,  J.,  Pt.,  K,  20th 

Dec.  13, 

Left.     Surg.  X.  Hayward,  20th 

130 

Cooley.  S.I.,  Pt.,K,97th 

June  18, 

Right;  circ.    Surg.  W.  B.  Cham 

Massachusetts. 

13,  '02. 

Mass.     Disch'd  Aug.  12,  1803. 

New  York,  age  23. 

18,  '64. 

bers,   97th   N.  Y.     Discharged 

173 

Divers,  P.  D.,  Pt.,  K,  1st 

May  5, 

Left.    Snrg.  —  Graham,  C'.  S.  A. 

Oct.  27,  1864. 

Virginia. 

5,  r64. 

Recovered. 

131 

Cook,  S.  A.,  Pt.,  A,  2d 

Sept.  17, 

Left  ;  flap.    Surg.  A.  J.  Ward,  2d 

174 

Douglas,  J.  II.,  Pt.,  G, 

July  3, 

Right  :  oirc.     Asst.  Surg.  E.  T. 

Wisconsin. 

17,  '62. 

Wis.     Discharged  Dec.  6,  1802. 

91st  Penn.,  age  33. 

3,  '03. 

Whiitingham,  t;.  S.  A.    Disch'd 

132 

Cornell,   M.  E.,  Pt.,   E, 

May  14, 

Right:  flap.    Surg.  W.  P.  Pierce, 

Feb.  8,  '05.     Died  June  30,  '77. 

36th  Illinois,  age  21. 

15,  '64. 

88th  111.     Disch  d  Oct.  29,  1864. 

175 

Dowd,  J.,   Farrier,    M, 

April  18, 

Right.     Surg.  P.  N.  Woods,  39th 

133 

Cornish,   J.,    Serg't,    B, 

July  30, 

Right  ;  circ.     Surg.  F.  M.  Weld, 

10th  Missouri  Cavalry, 

19,  '63. 

Iowa.     Disch'd.     Jan.  25,  1804, 

39th  Colored  Troops. 

Au.1,'64. 

27th  Colored  Troops.     Disch'd 

age  24. 

amp.  thigh  ;  necro.     Nov..  '07, 

Dec.  21,  1864. 

re-amp.     Died  Nov.  15.  1807. 

134 

Coruish,  J.,  Pt.,  F,  8th 

Aug.  15, 

Right;   circ.      Discharged  Feb. 

176 

Downing,  H.,  Pt.,  C,  4th 

July  1, 

Left.     Discharged  Aug.  30,  1802. 

Colored  Troops,  age  35. 

16,  '64. 

11,  1865. 

Rhode  Island  Artil'rv. 

1,  r02. 

135 

Corson,  G.  F.,  Serg't,  B. 

Oct.  1, 

Left;  circ.     Surg.  C.  M.  Clark, 

177 

Downs,    S.    N.,   Pt.,   H, 

June  18, 

Right  :  flap.     Surg.  S.  H.  Plumb, 

7th  N.  H.,  age  27. 

1,  '64. 

39th  111.     Re-amp,   mid.   third. 

19th  Maine,  age  25. 

18,  '64. 

82d  N.  Y.     Disoh'd  Mar.  10,  '65. 

Discharged  May  7,  1865. 

178 

Dreibilbis,    A.,    Pt.,    G, 

Juno  1, 

Right;  circ.     Surg.  D.W.  Bland, 

136 

Cotton,  G.   E.,   Pt.,   M, 

Aug.  25, 

Right  ;  circ.  Surg.  J  AV.  Wishart, 

96th  Penn.,  age  21. 

3,  '64. 

90th  Penn.     Disch'd  Apr.  0,  '65. 

4th  N.  Y.H.  A.,  age  25. 

26,  '64. 

140th  Penn.  Disch'd  July  6,  '65. 

1.79 

Drost,    M.,    Pt.,   K,  1st 

June  3, 

Right;  flap.    Discharged  June  3, 

137 

Couse,    F.    H.,    Pt.,    B, 

Dec.  13, 

Left  ;  circ.     Discharged  August 

Maryland,  age  29. 

4,  '04. 

1865. 

83d  Pennsylvania. 

14,  '62. 

27,  1863. 

180 

Drury,  J.  T.,  Lieut..  I, 

Sept.  19, 

Left  ;  circ.    Surg.  A.  Ewing,  13th 

138 

Cox,    E.,    Pt.,    I,    Kith 

Sept.  20, 

Right.     Surg.  L.  Holt,  C.  S.  A. 

17th  Indiana,  age  25. 

19,  '63. 

Mich.     Disoh'd  June  1,  L864. 

Louisiana. 

22  '63. 

Recovered. 

181 

Uunkin,  J.H.,  Pt'.,  E,  6th 

May  12, 

Left  ;  circ.      Surg.  T.  B.  Ward, 

139 

Cox,  L.  C.,  Corp'l,   D, 

Dec.  15, 

Right;  ant.  post.  flap.     A.  Asst. 

Virginia. 

13,  '64. 

Gth  Virginia.     Recovered. 

6th  Tenn.,  age  29. 

16,  '64. 

Surg.  J.K.  Simmons.     Disch'd. 

182 

Dunn,  J.  R.,  Pt.,  H,  90th 

May  15, 

Left;  flap.     Discharged  January 

140 

Coy,  S.,  Pt.,  K,2d  Mich 

June  17, 

Left;  flap.     Disch'd  Apr.  15,  '65. 

New  York,  age  35. 

15,  '04. 

25,  1805. 

igan,  age  33. 

18,  '64. 

Died  Nov.  20,  1868,  of  phthisis 

183 

Durall,  A.,  Pt.,  A,  1st 

July  14, 

Right.     To  prison  March  22,  '65. 

pulmonalis. 

Virginia  Art'y,  age  18. 

14,  '04. 

141 

Grain.  I,.  G.,  Serg't,  C, 

July  22, 

Right  ;  flap.     Surg.  A.  B.  Mona- 

184 

Dyer,  C.  F.,  Pt,,  A,  12th 

Dec.  13, 

Left  ;  ant.  post.  flap.    Oct.  8,  '63, 

39th  Ohio,  age  23. 

24,  '64. 

han,    63d    Ohio.      Discharged 

Mass.,  age  24. 

14,  '62. 

re-amp,  middle  third.     Disch'd 

August  9,  1865. 

March  17,  1864. 

142 

1  Crawford,  R.  D.,  Pt., 

Sept.  17, 

Right;  circular.     Recovered. 

185 

Eaton,  G.W.,  Pt.,  A,  Gth 

June  3, 

Left;  flap.     Discharged  Decem 

Gth  S.  Carolina,  age  27. 

18.  '62. 

Maine,  age  21. 

3,  '04. 

ber  3,  If  64. 

143 

Cregar,  H.,  Pt.,  F,  35th 

July  21, 

Left  ;  circ.     Surg.  C.  N.  Fowler, 

186 

Edmunds,  J.,  Pt.,  I,  32d 

Feb.  11, 

Right:    circ.     Discharged  Octo 

Ohio,  ::ge  20. 

21,  'G4. 

105th  Ohio.  Diseh'd  June26,'65. 

Col'd  Troops,  age  27. 

11,  '65. 

ber  i-8,  1805. 

Died  November  29,  1866. 

187 

Edwards,  J.  A.,  Pt.,  G, 

Sept.  1, 

Right:  tlap.     Surg.  C.  H.  Mills, 

144 

Crew,   J.,    Pt.,    K,   31st 

May  27, 

Left  ;  circ.     Disch'd  Dec.  3,  1803. 

10th  Mich.,  age  24. 

2,  '64. 

125th  111.     Disch'd  July  I.  '05. 

Illinois,  age  30. 

27,  'G3. 

Died  Dec.  23,  1809. 

188 

Eisenhart,S.A.,Corp.,M, 

June  24, 

Right  ;  circular.    Discharged  Oc 

145 

Crilley.    O..    Serg't,    E, 

June  21, 

Left  ;   ant.  post.  flap.     Surg.  J. 

8th  Penn.  Cav.,  age  26. 

25,  '04. 

tober  19,  1804. 

81st  Pennsylvania,  age 

21,  '64. 

W.  Wishart,  140th  Penn.    Dis 

189 

Eldridge,  N.,  Pt.,  D,  77th 

Mar.  25, 

Left:  circ.    Surg.  E.  Phillips,  Oth 

21. 

charged  January  6,  1865. 

New  York,  age  27. 

25,  '05. 

Vermont.    Disch'd  Aug.  12,  '05. 

14C 

Croft,  A.  C.,  Pt.,  D,  7th 

Sept.  14, 

Left;  circular.     Discharged  July 

190 

Elligott,  T.,  Pt,,  I,  lODth 

Dec,  13, 

Left;  long  post.  flap.  Discharged 

Wisconsin. 

10,  '62. 

23,  1803. 

New  York. 

14,  '02. 

Nov.  0,  1863.     Spec.  2714. 

147 

Cross,   H.,  Pt.,   A,   16th 

Sept.  1, 

Left;   circular;  gangrene.     Dis 

191 

Elliott,     J.,    Lieut.,    2d 

Aug.  21, 

Left;  circ.     Surg.  A.  F.  Whelan, 

Infantry,  age  19. 

1,'G4. 

charged  May  20,  1865. 

Artillerj'. 

21,  '04. 

1st  Mich.  S.  S.     Retired  Feb.  1, 

148 

Cunningham,  R.,  Pt.,  E, 

May  7, 

Right  ;    flap  ;    erysipelas.      Dis 

1865.     Died  April  18,  1871. 

8th  Iowa  Cav.,  age  18. 

7,  r64. 

charged. 

192 

Elliott,  W.,  Pt.,  A,  7th 

Oct.  23, 

Right  ;  flap.     Surg.  G.  C.  Jarvis, 

149 

Cunningham,  W..  Pt.,H. 

Aug.  29, 

Left  :  circ.     Surg.  D.  Baguly,  1  st 

New  Hamp.,  age  22. 

23,  '04. 

7th  Conn.     Disch'd  June  I3,'05. 

1st  W.  Virginia,  age  23. 

29.  '02. 

W.Va.     Disch'd  Mar.  16,1803. 

193 

Ellis,  L.,  Pt.,  Oth  Maine 

June  3, 

Left  ;   llap.      Disch'd   December 

150 

Daniels.  D.  B.,  Pt.,  K, 

Feb.  15, 

Right;    circ.     Discharged  May 

Battery,  age  23. 

3,  '04. 

29,  1804. 

7th  Illinois. 

17,  '62. 

1.  1802. 

194 

Engle,  G.   W.,    Pt.,   E, 

Aug.  28, 

R't  ;  dou.  Ha]).     Surg.  J.  E.  Sum- 

151 

Daniels,  V.,  Pt..  K,  70th 

April  1, 

Right.     Discharged  July  7,  1804. 

llth  Ohio  Cav.,  age  19. 

29,  '02. 

mers,U.S.A.  Disc'dMar.14,'63. 

New  York,  age  39. 

1,  '64. 

Spec.  2211. 

Died  Jan.  18,  1  871.     Spec.  314. 

152 

Daniels,  W.  11.,  Pt..  B, 

May  20, 

Left  ;  circular.     Discharged  Mar. 

195 

Erskine,  W.  M.,  Pt.,  B, 

May  31, 

Left.    Surg.  C.  II.  Pegg,  8th  N.  Y. 

1st  Mass.  I-I'vv  Art'v. 

20,  '64. 

11,  1865. 

1st  Maine  Heavy  Artil 

31,  '64. 

Art.    July  0,  re-amp,  at  up.  th'd. 

153 

Danley,  S.  B.,  Serg't,'  B, 

May  12, 

Left  ;  ant.   post.   flap.     Surg.  R. 

lery,  age  20. 

Disch'd  Oct.  28,  '64.     fipec.3173. 

15th  N.  J.,age  27. 

12,'  '64. 

Sbarpe,  15th  N.  J.     Discharged 

196 

Evertson,  J.,  Lieut.,  G, 

July  3fc 

Left.     Surg.  G.  Chaddock,   7tb 

May  23,  1865. 

82d  New  York,  ago  27. 

4,  TG3. 

Mich.     Disoh'd  June  12,  1804. 

154 

Danver,  J.  IT.,  Pt.,H,  1st 

July  3, 

Right.     Paroled  Sept.  25,  1863. 

197 

Fairy,  P.  W.,  Serg't,  G, 

May  28, 

Left  ;  ant.  post.  flap.    Recovered. 

Virginia. 

3,  '03. 

4th  S.  C.  Cav.,  age  29. 

29,  '64. 

155 

Davidson,  A.  J.,  Pt.,  B, 

Aug.  7, 

.     Surg.  —  Fleming,  C.  S.  A. 

198 

Fan-ell,  T.,  Pt.,  E,  lllth 

Mar.  31, 

Right  ;  flap.     Surg.  W.  Vosburg, 

17th  Virginia. 

7,  '04. 

Recovered. 

New  York. 

31,  '65. 

lllth  N.Y.    Disch'd  July  25,  '65. 

156 

Davis.   E.,  Pt.,  D,  70th 

April  12, 

Left  ;  ant.  post,  skin  flap  and  oirc. 

199 

Favour,  C.  L.,  Corp'l,  II, 

Julyl, 

Left  :   flap.     Discharged  Novem 

Col'd  Troops,  age  37. 

12,  '60. 

section  of  muscles.    Discharged 

10th  Maine,  age  21. 

2,  '63. 

ber  28,  1803. 

June  17,  1865. 

200 

1'ayent,  F.,  Pt.,  D,  7th 

May  5, 

Right  ;  circ.     Disch'd  Oct.  3,  '64. 

157 

Davis,  G.,Pt.,F,2d  Mich 

Nov.  16, 

Left  :  flap.     Discharged  May  31  , 

Wisconsin,  age  23. 

7,  '64. 

Stump  nevf  r  healed  permanent 

igan,  aged  23. 

16,  '63. 

1804. 

ly.     Died  (Jot.  8.  1870. 

158 

Davis,  J.,  Pt.,  A,  28th 

Sept.  17, 

Right  :    flap.     Discharged   Sept. 

201 

Fennee,  J.,  Pt.,  E,  6th 

May  22, 

Right  ;  flap:  gangrene.     Disch'd 

Pennsylvania. 

17,  '62. 

25.  1863. 

Missouri. 

22,  '03. 

October  18,  1863. 

159 

Davis,  J.  A.,  Pt.,  F,  5th 

Dec.  15, 

Right  ;  cire.     A.  A.  Surg.  J.  H. 

202 

Ferguson,  A.,Pt.,G,88th 

May  8, 

Right:  circ.  Surg.  J.W.  Rawlins, 

Iowa  Cavalry,  age  23. 

17,  '64. 

Mclntyre.  Disch'd  June  29,  '05. 

Pennsylvania,  age  21  . 

9,  '64. 

88th  Penn.     Disch'd  July  4,  '65. 

160 

Vavis,  R.  L,  P't.,  B,  Pur- 

June  20, 

Right.     Surg.  —  Capot,  C.  S.  A. 

203 

Ferris,  j.  A.,  Pt.,  A,2d 

June  1, 

Right  ;  circ.    Surg.  II.  Plumb,  2d 

cell  Battery. 

26,  '02. 

Discharged  Oct.  28.  1864. 

Conn.  H.  Art.,  age  29. 

1,  '64. 

Conn.  Art.    Gangrene.    Disch'd 

161 

Dean,  S.  If.,  Pt.,  F,  Gth 

Feb.  12, 

Right.     Surg.  C.  J.  Towles,  C. 

August  4,  1805. 

Georgia  Cavalry. 

12,  '62. 

S.  A.     Recovered. 

204 

Fezer,   H.,  Pt.,    K,   7th 

Nov.  27, 

Left;  oirc.     Surg.  C.  J.  Bellows. 

162 

Dearolf.  E.,  Pt.,  II,  127th 

May  19, 

Right  :  flap.     Surg.  J.  R.  Gore, 

Ohio,  age  2!  . 

~7,   03. 

7th  Ohio.     Disoh'd  June  24,  '64. 

Illinois,  age  31  . 

19,  '63. 

127th  111.  Disch'd  Aug.  27,  '64. 

205 

Fink,  R.  P.,  Pt.,  F,  10th 

April  21, 

Right  :  eirc.     Disch'd  September 

103 

Deforest,  M.  J.,  Capt.,  B, 

June  3, 

Left  ;  flap.     Discharged  October 

Penn.  Cavalry,  age  21. 

22,  '04. 

28,  1664. 

81st  .V.  Y.,  ago  25. 

3,  '04. 

27.  1864. 

206 

Finkbeiner,  C.,  Pt.,  L,  3d 

Oct.  25, 

Right  ;  flap.     Disch'd  March  17, 

164 

Deighton.  J.,  1't.,  I,  6th 

Sept.  29, 

Right  ;   flap.     Discharged   April 

Ohio  Cavalry,  age  18. 

25,  '04. 

1805. 

Colored  Troops. 

29,  '04. 

19,  1865. 

207 

Fisher,   J.,    Pt.,  E,  8th 

Mar.  9, 

Left.     Discharged  June  25,  1864. 

105 

DC  Lai'S/htf-r,  A.,  Lieut., 

Aug.  21, 

—  .     Surg.  G.  S.  West,  C.  S.  A. 

Indiana  Cav.,  age  18. 

9,  '64. 

D,  5th  Florida. 

21.  '04. 

Recovered. 

208 

Fisher,  J.,  Pt.,  D,  70th 

July  30, 

Left  ;  circ.    Surg.  D.  Merritt,  55th 

166 

Dennis,A.W.,  Pt.,  D,  1st 

May  5, 

Left;  circular.     Discharged  Jan. 

Pennsylvania,  ago  21. 

31,  '64. 

Penn.    Re-amputation.   Disch'd 

N.  Y.  Artillery,  age  18. 

6,  ''62. 

13,  1863. 

January  27,  1865. 

167 

Derr,  J.,  Pt.,   K,  148th 

May  10, 

Right  ;   flap.      Discharged  Feb. 

209 

Fisk,  J..  Corp'l,  D,  19th 

Mar.  27, 

Left.    Surg.  L.  M.  Sloanaker,19th 

Pennsylvania,  age  26. 

10,  ''04. 

10.  1865. 

Iowa,  age  24. 

27.  '65. 

Iowa.     Disch'd  June  5,  1805. 

168 

De  Tar,    T.,  Capt.,   D, 

Dec.  16. 

Right  :  flap.  Surg.V.B.  Kennedy, 

210 

Fitch,  E.,  Corp'l,  D,  23d 

Sept.  19, 

Left  :  circ.    Surg.  J.  M.  McGuire, 

32d  Iowa,  age  37. 

17,  '04. 

5th  Minn.    Disch'd  May  15,  '65. 

Virginia. 

20,  '64. 

C.  S.  A.     To  prison  Jan.  5.  1865. 

169 

Dewey,  D.  A.,  Serg't,  B, 
121st  N.  Y.,  age  23. 

May  6, 
7,  '64. 

Right  ;  flap.    Surg.  —  Moffatt,  C. 
S.  A.     Disch'd  June  29,  1865. 

211 

Flemmer,  C.,  Pt.,  II,  4th 
Col'd  Troops,  age  20. 

June  15, 
15,  '64. 

Left;  circular.     Discharge*!  I'd). 
10,  1865. 

1  FlSFIF.R  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations,  in  the  Hospitals  near  Sharpsburg,  Md.,  after  the  Battle  of  Antietam  September  17, 
1862,  in  American  Journal  Medical  Sciences,  1806,  Vol.  XLV,  p.  48. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


497 


NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

Vr» 

NAME,  MILITARY 

DATES 

OPERATIONS,  OPERATORS, 

No. 

DESCRIPTION,  AND  AGE. 

i 

DATES. 

RESULT. 

i-N  \J, 

DESCRIPTION,  AND  AGE. 

RESULT. 

212 

Flesh,    J.,    Pt.,  1?,    73d 

May  14, 

Right  ;  flap.     Surg.  f.  N.  Hines, 

254 

Greenfield,  C.  S.,  Pt.,  B, 

Sept.  14, 

Left;  flap.     Discharged  Novem 

Ohio,  age  23. 

14,  '64. 

73d  Ohio.     Disch'd  Sept.  24,'64. 

19th  Illinois. 

14,  '61. 

ber  19,  1861. 

Died  Dec.  3,  1868  ;  consumption. 

255 

Greer,  D.,  Pt.,  F,  90th 

July  1, 

Left  :  circ.     Disch'd  May  9,  1864. 

213 

Flower,  E.  W.,  Pt.,  E, 

May  24, 

Right;  circ.     Surg.  W.  C.  Shur- 

Pennsylvania,  age  45. 

2,  '63. 

Died  March  1,  1865. 

8th  Michigan,  age  22. 

24,  '64. 

lock,    51st    Peun.      Discharged 

256 

Gregory,  A.  H.,  Pt.,  K, 

Sept.  17, 

.     Surg.  J.  II.  McAden,  13th 

February  1,  1865. 

13th  North  Carolina. 

17,  '62. 

N.  C.     Recovered. 

214 

Fluetsch,  J.  L.,  Pt..  K, 

Mav  14, 

Left;  circ.     Surg.  W.  P.  Pierce, 

257 

Griffin.  G.  W.,  Pt.,  G,  1st 

Oct.  27, 

Right;  flap.     Discharged  August 

15th  Missouri,  nge  30. 

14.'  '64.  ' 

88th  111.     Disch'd  Mar.  20,  '65. 

N.  Y.'  Art'y,  age  23. 

28,  '64. 

2,  1865. 

215 

Flynn,   Patrick,   Pt.,  0, 

May  5, 

Left;  flap.     Surg.  G.  T.  Stevens, 

858 

Griffin.  T.  11.,  Lieut.,  C, 

July  2, 

Right.  Surg.J.T.Gilmore.C.S.A. 

12th  Infantry,  age  31. 

5,  r64. 

77th  N.  Y.     Disch'd  Feb.  28,'65. 

18th  Miss.,  nge  25. 

3,  '03. 

Exchanged  Oct.  20,  1863. 

Died  April  13.  1872. 

259 

Gullisath,  B.,  Capt.,  F, 

Dec.  10, 

Right.     Discharged  May  15,  '65. 

216 

Foley,  J.,  Serg't,  E,  35th 

July  14, 

Left;  circ.      Surg.  G.  L.  Lucas, 

5th  Pei,  D.  Cav.,  age  27. 

11,  '64. 

Iowa,  age  25. 

14.  '64. 

47th  111.     Disch'd  Oct.  17,  1865. 

260 

Gulmire,  N.,  Serg't,  II, 

Nov.  22, 

Left  ;  flap.     Surg.  J.  P.  Prince, 

217 

Folk,   N.,    Pt.,    K,   93d 

Sept.  22, 

Left;  flap.  Surg.E.R.  Umberger, 

8th  Michigan,  age  20. 

23,  '63. 

36th  Mass.     Disch'  1  May  4,  '64. 

Pennsylvania,  age  31. 

22,  '64. 

93d  Penn.  Re-amp,  at  June.  mid.  :  261 

Gutman,  C.,  Pt.,  B,  19th 

Oct.  27, 

Right  :  circ.     Surg.  J.  Harrison. 

and  lower  thirds.     Discharged   : 

Wisconsin,  age  27. 

29,  '64. 

C.  S.  A.    Disch'd  May  23,  1865. 

October  2,  1«65.                             '  262 

Haight,  L.,  Pt.,  F,  6th 

July  24, 

Right.     Surgeon  E.  Powell,  72d 

218 

Folsoin,  H.  W.,  Pt.,  E. 

April  1), 

Left:  flap.     Discharged  July  7, 

Michigan,  age  23. 

24,'  '64. 

111.    Gang.    Disch'd  Jan.  3,  '65. 

31st  Maine,  age  2(i. 

6,  '65. 

1865.                                                   263 

Halford,  J.  If.,  Pt.,  G,    July  28, 

Left  ;  flap  ;  gang.    Recovered. 

219 

Ford,  T.,  Pt.,  C,  69th  In 

April  9, 

Left  ;  flap.    Surg.  W.  A.  Babcock,  j  I 

12th  Louisiana,  age  26.     28,  '64. 

diana. 

9,  '65. 

76th  111.     Mustered  out,  1865.        264 

Hallr.wanger,  J.,  Serg't.  '   July  3, 

Left.     Exchanged  November  12, 

220 

Foster,  T.  F.,  Lieut.,  H, 

July  20, 

Right  :  ant.  post.   flap.     Provost 

H,  3d  S.  C.,  age  24.            4.  '63. 

1863. 

55th  Alabama,  age  24. 

21,"'64. 

Marshal  Dec.  8,  1864. 

265 

Hammond,  G.M.,  Lieut.,     July  2, 

Left  ;  circular.     Discharged  Sep 

221 

Foy,     P.,     Pt.,    H,    8th 

May  1, 

Right;    circ.     Discharged    Feb 

A,  86th  New  York.            2,  '63. 

tember  22,  1863. 

Pennsylvania. 

i,  la. 

ruary  16,  18(14. 

266 

Hammond,  J.  A.,  Corp'l,  !  Aug.  14, 

Left  :    circ.      Discharged    April 

232 

Friel,    J.,    Pt.,    H,    (i3d 

Aug.  29, 

Right.      Discharged   January  5, 

C,  llth  Maine,  age  22.       14,  '64. 

17,  1865. 

Pennsylvania. 

29,  '62. 

1863. 

267 

Hamriclt,  !T.,Pt.,D,19th     Oct.  13, 

.    Surg.  —  Grammon.C.S.A. 

223 

Fry,  J.  J.,  Pt.,  D,  78th 

Sept.  1, 

Left;  double  flap.     Surg.  S.  C.    1 

Virginia  Cavalrv.              13,  '63. 

Recovered. 

Illinois,  age  20. 

1,  '64. 

Moss,  78th  111.    Gangrene.    Dis-  !  268 

Handley,  J.  R.,  Pt.,  K.    June  18, 

Left;  circ.     Surg.  G.  T.  Stevens, 

charged  July  6,  1865. 

llth  Conn.,  age  23.            18,  '64. 

77th  N.  Y.     Disch'd  May  7,  '65. 

224 

Fulkineer,  J.  M.,  Pt,  E, 

July  24, 

Left  ;  flap.     A.  Surg.  T.  Morton,     269 

Hanlin,  T.,  Pt.,  E,  10th    Sept.  19, 

Right  :    flap.     Discharged  July 

3d\V.Va.  Cav.,agel9. 

24,  '64. 

3d  West  Virginia  Cavalry.   Dis-  , 

West  Virginia.                   20,  '64. 

20.  1865. 

charged  July  18,  1865.                   :  270 

Hargrove,  B.  F.,  Lieut.,  i  Nov.  30, 

Right  :    circ.      Provost   Marshal 

225 

Gallup,  S.  H.,  Corp'l,  G, 

June  5 

L't  ;  post.  flap.  Surg.  L.Holbrook, 

L,  12th  La.,  age  31.          30,  '64. 

March  7,  1605. 

18th  Conn.,  age  4:!. 

5,  '64. 

18th  Conn.  Disch'd  May  4,  1865.     271 

Harmon,  S.,  Pt.,  1,  105th     April  9, 

Right  ;  flap.     Mustered  out  July 

226 

Ganthrop,  H.,  Lieut.,  F, 

April  1, 

Right.     Surg.  D.   E.  Wolfe.  3d 

Pennsylvania,  age  27.        9,  '65. 

1,  1865. 

4th  Delaware,  age  24. 

1,  '65. 

Delaware.     Recovered.                   272 

Barneu.  W.  A..  Pt..  B.      Mav  5. 

Left.     Surg.  E.  L.  Howard,  27th 

227 

Garrity,  T..  Pt.,  D,  24th 

June  1, 

Right;  circ.     Surg.  S.  A.  Green,                27th  North  Carolina.          5,  f64. 

N.  C.     Furloughed  Jan.  23,  '65. 

Alassachusetts. 

1,  '63. 

24th  Mass.  Disch'd  Sept.  21/63.     273  |  Harris,  A.,  Pt.,  A,  57th  '  April  6, 

Right.     Discharged  June  13,  '62. 

Nov.  30,  '67,  re-amp,  mid.  third.            ,    Ohio.                                    7,  '62. 

Gnt/>Jioll       I"*       If        <*anr't 

M.,  ..     1  O 

T  oft  •    H  mi  HI  A    Hun         vinro-      TT      P          O'M        TT/i  rr/c/tH       'J"      T      1-*t       R         V*ktr     1  ft 

aicnen,  i_>.  **•,  '^erg  T, 
E,  1st    Maine    Heavy 

tly  1™, 

19,  '64. 

i-cu,  uouuit?  iid.p.      r»ur£f.    n.    r.      4***  '  xzt*/  /  t-su/i,    j.  •/.,  ITU,  JD,     i>ov.  io» 
Lyster,  5th  Mich.    Disch'd  June                15th  Georgia.                     18,  '64. 

15th  Georgia.     Recovered. 

Artillerv,  age  24. 

24,1865.                                             275:  Hart,  C.,  Pt.,  D,  148th     May  3, 

Right.     Surg.  G.  L.  Potter,  145th 

229 

Gault,  T."  J.,  Pt.,  F,  3d 

Mav  14, 

Right  ;  flap.     Discharged.                            Pennsylvania.                     3,  '63. 

Peun.     Disch'd  Sept.  19,  1863. 

Tennessee,  age  22. 

14/64.                                                                  276    Hart,  G.  W.,  Pt.,  C,  30th    Sept,  19. 

Left  ;  circular.    Discharged  May 

230 

Gavin,  S.,  Pt.,  L,   15th 

Mar.  8, 

Left;  flap.    Confederate  surgeon. 

Indiana. 

21.  '63. 

12.  1864. 

Connecticut. 

10,  '65. 

Disch'd  June  29,  1865.                   '  277 

Hastings,  J.  K..  Pt.,  H, 

July  2, 

Right.     Surg.  J.  Kerr,'  62d  Penn. 

231 

Geiger,  J.,   Pt.,  D,  46th 

June  20,     Kight  ;  circular.    Disch'd  Mav  29, 

62d  Peun.,  uge  24.               3,  '63. 

July  13,  re-amp,  middle  third. 

Pennsylvania,  age  27. 

20,  '64. 

1865. 

Dis'ch'd  Sept.  20,  1864. 

232 

Geissler.  E.,  Corp'l,  K, 

Aug.  17,    Left  ;  dou.  flap.     Sur«-.  H.  Fearn,     278    Huvs.G.,  I't..C,  6th  N.Y.     Oct.  19. 

Right  ;    post.  flap.     Discharged 

3d  N.  J.  Cav..  age  36. 

19,  '64. 

175th  N.  Y.  Disch'd  Sept.  23,  '65.                H'vy  Art'y,  age  34. 

20,  '64. 

September  12,  1865. 

233 

Gibson,    II.,    Corp'l,   F, 

Mar.  19. 

Left;  flap.    Confederate  surgeon.     279  :  Hazelbaker,  A.  J.,  Pt.,     Dec.  7, 

Right;  circ.     Surg.  C.  H.  Hood, 

21st  Michigan,  age  30. 

20,  '65. 

Discharged.                                                     G.  181st  Ohio,  age  27.         7.  '64. 

U.  S.  V.     Discharged. 

234 

Gilmore,  G.,  Pt.,  G,  33d 

Mar.  31, 

Right  :  eirc.  Surg.  A.  T.  Bartlett.     280,  Heffler,   J.,  Pt.,  K.  6th    July  23, 

Right.   Discharged  June  15,  1864. 

Illinois,  age  19. 

31,  '65. 

33d  Mo.     April  22.  rem.  of  half                Maryland,  age  37.              23,"  '63. 

inch  of  bone.    Diso'd  Oct.  15/65.     281    Helsabeck.  G.  J.,  Pt.,  C,    July  28, 

Right;  flap.     Surg.  D.W.  Maull, 

235 

Gladsm,  W.  D.,  Serg't, 

Aug.  21, 

.  Surg.  W.  R.  Wilson,  C.  S.  A.                33d  N.  C.,  age  20.               28."  '64. 

1st  Del.     To  prison  Dec.  14/64. 

D,  44th  N.  Carolina. 

21,  '64. 

Retired  Feb.  17,  1865.                     282    Benson,  J.  f.,  Pt.,  M.7th     July  1, 

Left.     Exchanged  Sept.  25,  1863. 

236 

Glascoe,  W..  Pt.,  G,  29th 

Oct.  27, 

Left;   circ.     Surg.  G.  C.  Jarvis, 

South  Carolina,  age  19.       2,  '63. 

Connecticut. 

27,  '64. 

7th  Conn.     Discli'd  Aug.  7.  '65.     283    Herrick,  M.  S.,  Lieut.,E,  i  April  26, 

Right.   Surg.  N.  Smith,  6th  Mass. 

237 

Glaser.  J.,  Serg't,  C.lSth 

July  8,     Kight:    circular.     Disch'd   April                 8th  Massachusetts.             26,  'Cl. 

Disch'd  May  21.  1861. 

N.Y.  H'vyArt.,a?e37. 

9,  '64.         13,  1865.                                               284 

Hess,    G.,    Pt.,    I,    28th 

June  24, 

Left  ;  flap.  Surg.  H.  E.Goodman, 

238 

Glassie.  .].,  Pt.,  B,  03d 

June  3, 

Left  ;  oval  Hap.    Surg.  P.  E.  Hu-                Penn.,  age  18.                     24,  '64. 

U.  S.  V.     Disch'd  May  29.  1865. 

New  York,  age  22. 

3,  '64. 

bon,  28th  Mass.    June  25,  amp.     285    Hibbs,  ,S.T.,Pt.,H,  107th     June  1. 

Left  ;  flap  (also  flesh  wound  right 

lower  third  thigh.     Mar.  19,  '65,                 Illinois,  ago  19.                    1,  '64. 

leg).     Disch'd  May  27,  1865. 

seq.  rem.     Disch'd  Aug.  15,  '65.     286    Hibner,  C.,  Pt.,  K,  5th 

May  6, 

Right;    ant.  post.  flap.     Confed. 

Died  Nov.  12,  '67.  Spec.  3100. 

Michigan,  age  30. 

6,  '64. 

surgeon.     Caries.     Discharged 

239 

Gondennau,  C..   Pt.,  C, 

Juue  8, 

Left  ;  circular.     Discharged  May 

Jan.  21,  1865.     March  13,  1865, 

98th  Penn.,  age  19. 

8,  '64. 

30,  1865. 

re-amp,  upper  third  :  circular. 

240 

Goodwin,  A.,  Corp'l,  B, 

June  27, 

Left;  circ.  A.Surg.C.B.Richards,    -287 

Hiekie,  J.,  Pt.,  A,  10th 

June  3, 

Right  :  flap.     Surg.  W.  A.  Child. 

30th  Ohio,  age  20. 

27,  '64. 

30th  Ohio.     Disch'd  Feb.  17,'65.    '• 

Vermont,  age  18. 

3,  '64. 

10th  Vt.     Disch'd  June  27,  1865. 

241 

Goodspeed,  H.  M.,  S'g't, 

July  4, 

Right  ;  circ.    Surg.  S.  II.  Kersey,     288 

Higgins,  D.,  Pt.,  G,  llth 

June  2, 

Left  ;  unt.  post.  flap.    Surg.  C.  B. 

C,  30th  Indiana,  nge  25. 

4,  '64. 

36th  Ind.     Duty  Sept.  21.  1864. 

Vermont,  age  30. 

2,  '64. 

Park,  llth  Vermont.  Gangrene. 

242 

Gordon,    C.  71..  Pt.,  B, 

Nov.  30, 

Right;  ciro.    To  Provost  Marshal 

Disch'd  August  11,  1865. 

33d  Miss.,  age  24. 

30,  '64. 

March  7,  1865.                                   ;  289 

Hill,    S.,  Pt.,  D,    198th 

Mar.  31, 

Left;    flap.     Disch'd  August  7, 

243) 

Gordon,  J..  Teamster  U. 

Aug.  30. 

Both.     A.  A.  Surg.  M.  J.  Davis. 

Penn.,  age  30. 

31,  '65. 

1865. 

2445 

S.  service,  age  38. 

Sep.1,'62. 

Recovered.                                        290 

Hinohey,  F  ,  Pt.,  D,  8th 

June  16, 

Left;  circ.     Surg.  M.  F.  Regan, 

245 

Gordon,  W..   Pt.,  C,  2d 

May  9, 

Right.     A.  Surg.  G.  H.  Noyes,  2d 

N.  Y.  Heavy  Artillery, 

16,  '64. 

164th  New  York.     Disch'd  July 

Iowa  Cavalrv. 

9,  r62. 

Iowa  Cav.    Disch'd  Aug.  11,  '62. 

age  21. 

27,  1663. 

246 

Grahame,  F.,  Corp'l,  A, 

Mav  10, 

Right.     Sept.  7,  re-amp,   at   tu 

291    Hihson,  J.  D.,  Pt.,  A,57th 

Dec.  10, 

Left.     Surg.  R.  S.  Peebles,  P.  A. 

Oth  Wis..  age  26. 

10,'  '64. 

bercle  of  tibia.    Disch'd  August 

<     North  Carolina. 

12,  '64. 

C.  S.   Fnrloughed  Jan.  26,  1865. 

22.  1865.     Spw.  369(i. 

292  '  Hobbs,  J.,  Pt.,  II,  15th 

Nov.  30, 

Left  ;  flap.     To  Provost  Marshal 

247 

Grant,  A.  A.,  Pt.,  A,  2d 

Mav  5, 

Left  :    flap.     December  2,   bone 

Tennessee,  age  25. 

30,  '04. 

March  7,  1865. 

Vermont,  age  27. 

6,  '64. 

removed.     Disch'd  May  29,  '65. 

293    Holland,  T.  F.,  Pt.,   E,      May  (i, 

Right  :  flap.    Surg.  A.  Holt.  C.  S. 

248 

Grant,  A.  Z).,  Pt.,  C,  8th 

July  2, 

Right.     Exchanged  Nov.  12.  '63. 

2d  Rhode  Island.                8,  '64. 

Discharged. 

South  Carolina,  age  19. 

2,  '63. 

294 

Holman,  J.G.,  Serg't,  F, 

Mav  27, 

Right:  circ.     Surg.   E.  Guelich. 

249 

Grant.  E.L..Pt.,F,145th 

June  8, 

Right  ;  circ.     Surg.  G.  L.  Potter, 

52d  Illinois,  age  22. 

27,'  '64. 

9th  Illinois.     Disch'd  July  6/05. 

Pennsylvania,  age  20. 

8,  '64. 

145th  Penn.  Disch'd  May  15,  '65.    I  295 

Holmes,  W.  L.,  1't.,  1,  1st 

May  19, 

Right  ;  circ.     Surg.  H.  F.  Lvster, 

250     Grant,  '  T.,  Pt.,   D,  21st 

June  18, 

Right.    Surg.  G.  T.  Stevens.  77th 

Me.  H'vyArt'y,  age  33. 

20,'  '6-1. 

5th  Mich.     Disch'd  Jan.  20,  '65. 

South  Carolina,  age  19. 

19,  '64. 

N.  Y.     To  prison  Sept.  23,  1864.  '  296 

Holton,  C.,   Pt!,  G,  4th    Sept.  27, 

Right;  ant.  post.  flap.     Disch'd 

;251  I  Green,  P.,  Pt..  A.  fifth 

Mar.  21, 

Right  :  flap.   Surg.  J.  Pogue,66th 

Tenn.  Cav.,  age  21.           27,  '64. 

June  20,  1865. 

Illinois,  age  23. 

22,  '05. 

Illinois.     Disch'd  July  7.  1865.   1J297 

Hoon,    S.,    Pt.,   D,    63d    July  22, 

Left  ;  flap.   Surg.  N.  Gav,  U.S.V. 

•  252 

Green,  W.  J.,  Pt.,  F,  42d 

Mav  15, 

Right  ;  ant.  post.  flap.     Provost 

Ohio,  age  21.                      22,"  '64. 

Disch'd  March  12,  1865.     Died 

Georgia,  age  20. 

16,'  '64. 

Marshal  Dec.  1,  1864. 

Oct.  11,  1867;  consumption. 

253 

Greene,  J.  II.,  Pt.,  A,  7th 

Dec.  13, 

Right  ;   ant.  post.  flap.     Disch'd 

2o.fi 

Hoover    J.  W.,  Pt,,  K. 

Mav  9, 

Left;  circular.    Disch'd  Septem 

Rhode  Island. 

13,  '62. 

February  6.  1863. 

20th  Indiana,  age  24. 

9.  '64. 

ber  12,  1864. 

SURG.  Ill— 63 


498 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS,       j  Vn 
RESULT. 

NAME,  MILITARY         TUTFS 
DESCRIPTION,  AND  AGE.  ' 

OPERATIONS,  OPERATORS, 
UESULT. 

299 

Hostetter,  C.,  Corp'l,  L, 

April  5, 

Uight;    circular.     Disch'd  July 

341 

Kidder,  N.  P.,Pt.,M,  1st 

Nov.  12, 

Left;  flap.     Surg.  J.  W.  Smith, 

1st  Penn.  Cav.,  age  19. 

5,  '65. 

7,  1865. 

N.  H.  Cavalry,  age  20. 

12.  '64. 

2d  Ohio  Cav.     Disc.  June  2,  '65. 

300 

Hotchkiss,  L.  P.,  Lieut., 

Mar.  31, 

Uight.      Mustered  out  May  30, 

342 

Kierman,  M.,  Pt.,  II,  2d 

May  27, 

Left  ;  flap.     Disch'd  April  18,  '64. 

B,  189th  N.  Y.,  age  23. 

31,  '65. 

1865. 

Louisiana. 

28,  '63. 

July  2,  1864,  re-amputation. 

301 

Hough,   P.,    Pt.,    I,   7th 

May  23, 

.     Surg.  —  Triplet!,  C.  S.  A.     343 

Kimball,  L.  N.,  in.,  H, 

May  10, 

Uight;  ant.  post,  flap:  small  art. 

Louisiana. 

23,  '62. 

Uetired  Feb.  21,  1864.  » 

22d  Mass.,  age  19. 

10,'  '64. 

ligated.     Disch'd  Oct.  17,  1864. 

303 

Hoyt,    S.,  Pt,,  B,    16th 

June  27, 

Left.     A.  A.  Surg.  J.  Swinburne. 

Jan.,  '67,  amp.  thigh,  low.  third. 

Michigan,  age  24. 

29,  '62. 

Jan.  6,  "63,  re-amp,  middle  third.     344  !  Kimberly,  C.  A.,  Lieut., 

Sept.  29, 

Left;    circular.     Disch'd   March 

Discharged  August  24,  1864.                 i     B,  112th  N.  Y.,  ago  22. 

29.  '64. 

23,  1865. 

303 

Hubbs,  A.  H.,  Corp'l,  B, 

May  6, 

Uight;    ant.  post.  flap.     Confed.     345    Kinnard.  II.,  Pt.,  H,  39th 

July  30, 

L't  ;  circ.  Surg.  D.  MacKay,  29th 

122d  N.  York,  age  21. 

7,  '64. 

surgeon.     Disch'd  June  14,  '65.  |J 

Colored  Troops. 

31,'  '64. 

C.  Troops.    Disch'd  Deo.  20,  '64. 

304 

Huddleston,  S.  H.,  Pt., 

Mar.  25, 

Left  ;    circular.     Ueleased  June     346 

Kinner,   G.  W.,  Corp'l, 

July  10, 

Uight.     Disch'd  June  10,  1865. 

G,  44th  Va.,  age  25. 

25,  '65. 

14,  1865. 

G,  139th  N.  Y.,  age  31. 

10,'  '64. 

305 

Hughes,  H.  H.,  Pt.,  C, 

April  8, 

Left  ;  flap.     Discharged  June  10,  i  347 

Kirkpatrick,  W.,  Pt.,  C, 

Aiiij.  18, 

Left;  flap.     Surg.  W.  C.  Jacobs, 

4th  Indiana,  age  28. 

8,  '64. 

1864. 

2d  Iowa,  age  1  8. 

18  ,'64. 

81st  Ohio.     Disoh'd  Mar.  23,  '65. 

306 

Hughs,  P.,  Pt.,  I,  17th 

Sept.  20, 

Bight  ;   flap.      Confed.    surgeon. 

348 

Kirvvin,  P.,  Pt.,  A,  155th     May  18. 

Left  ;  circ.     Disch'd  Mar.  27,  '65. 

Ohio. 

22,  '63. 

Disoh'd  January  21,  1864. 

New  York,  age  20.             18,  '64. 

Died  April  3,  '68:  consumption. 

307 

Hulbert,  E.  1).,  Serg't,  K, 

May  27, 

Right  ;  flap.    Discharged  August   1  349 

Knecht.    A.,   Lieut.,   A,  :  Aug.  7, 

Uight;  flap.  .  Surg.   H.  M.  Duff. 

83d  Pennsylvania. 

28,  '62. 

14,  1862.     Died  June  13,  1868  ; 

52d  Ohio,  age  27.                 7,   64. 

52d  Ohio.    Disch.  March  18,  '65. 

consumption. 

350 

Knight,  J.  J.,  Pt.,  I,  31st    Sept.  1  9, 

Uisrht  ;  circ.     A.  Surg.  —  Dorscv, 

308 

Huntlev,  O.  P.,  Pt.,  A, 

May  7, 

Right  ;  ant.  posterior  double  flap. 

Georgia,  age  25. 

21,  '64. 

1st  Md.  Cav.,  C.  S.  A.     To  Pro 

5th  Mich.,  age  42. 

7,  '64. 

Surg.  W.  O.  Hudson,  4th  Ala. 

vost  Marshal  April  1,  1865. 

.  • 

Disch'd  May  5,  1865.                       351 

Knott,  D.,  Pt.,  K,  4th  N. 

June  1, 

Uight  ;    circular.     Disoh'd   May 

:  u  >:  ' 

Hurley,  M.,  Pt,,  C,  101st 

Mar.  15, 

R't  ;  flap.    Surg.  J.  M.  Chapman, 

Jersey,  age  40.                    1,  '64.  M 

3,  1865. 

Illinois,  age  39. 

15,  '65. 

123d  N.  Y.    Disch'd  June  15,  '65.    '  352 

Knowlton,  II.  L.,  Corp'l, 

June  1, 

Left;  flap.   Surg.  D.  M.  Goodwin, 

310 

Hyde,  A.  J.,  Pt.,  H,  21st 

May  14, 

Right;  flap.     Surg.  J.  T.  Reeve,  ij 

H,  llth  Vt.,age22. 

1,  '64. 

3d  Vt.     Disch'd  June  2,  1865. 

Wisconsin,  age  27. 

14,  '64. 

21st  Wis.     Disch'd  Mav  22,  '65. 

353 

Kopp,  E.,  Pt.,  K,  12th  N.     Mar.  25, 

Uight;  flap.     March  27,  left  mid. 

311 

lago,   H.,    Pt.,    C,    5lst 

May  6, 

Uight;  flap.     Surg.  W.  C.  Shur- 

Jersey,  age  32. 

26,  '65. 

third,    flap.      Surg.  A.  Satter- 

Pennsylvania,  age  21. 

•»  7,  '64. 

lock,  51st  Penn.     Disch'd  June 

thwaite,  12th  N.  J.,  and  Acting 

16,  1865. 

Staff  Surg.  W.  J.  Burr.     Dis 

312 

Jackson,  J.  A.,  Corp'l,  D, 

Sept.  19, 

Left;  cire.     Surg.  C.  F.  Crehore, 

charged  Oct.  3,  1865. 

4'Jth  Penn.,  a««  3:,'. 

19,  '64. 

37th  Mass.     Disch'd  Sept.  8,  '65. 

354 

Kriuinger,  C.,  Corp'l,  C,     May  '.'i. 

Uight.     Surg.   I).  J.  Griffith,  2d 

313    Jameson,  A.  W.,  Pt.,  G, 

Dec.  13, 

Left  (also  w'nd  of  arm  and  face). 

2d  Kentucky.                      21,  '62. 

Ky.     Disoh'd  Jan.  19,  1863. 

4th  Ohio. 

13,  '62. 

June  24,  '63,  re-amp,  mid.  third. 

355 

Kunz,  L.,  Pt.,  E,  126th     May  6, 

Uight  ;  flap.     Discharged  March 

Disch'd.  Dec.  25,  1863. 

Ohio,  age  46.                       6,  '64. 

7,  1865. 

314  1  Jellison,  C.  W.,  Pt.,  C, 

May  19, 

Uight  ;  circular.   Disch'd  Decem 

356 

Lad  ford.  S.  E.,  Pt.,  II,  2d     Jul  v  3, 

Right.      Exchanged    November 

1st  Me.  II.  Art.,  age  22. 

19,'  '64. 

ber  3,  1864. 

N.'C.  Battery,  age  20.         3,  '63. 

12,  1863. 

315    Johnson,  C.,   Serg't,   K, 

Nov.  30, 

Left  ;  ant.  post.  flap.    Discharged     357 

LaFleur,  A.  B.,  Serg't,     May  10, 

Uight;  flap.     June  20,  2  ins.  of 

5(ith  N.  Y.,  age  22. 

30,  '64. 

July  9,  1865. 

H,  4th  Mich.,  age  22.          10,  '64. 

stump  removed.  Dis.  June  5,  '65. 

3Ui    Johnson,  F.  M.,  Pt,,  A, 

Oct.  8, 

Uight,  Discharged  Feb.  21,1  863. 

358 

Lambeth,  A.  M.,  Pt.,  1'., 

May  9, 

—  .  Surg.R.  J.  Hicks,  23d  N.C. 

38th  Indiana. 

8,  '62. 

23d  North  Carolina. 

it,  '64. 

Uecovered. 

317 

Johnson,  II.  C.,  Serg't, 

Feb.  24, 

Left  ;  circ.    Surg.  F.  Salter,  U.  S. 

359 

Lampman,    A.,    Pt.,   K, 

Juno  22, 

Left.     Surg.W.  J.  Burr,  42d  Now 

C,  ~'8th  Ky.,  age  25. 

25,  '64. 

V.     Feb.  26,  post,  tibial  artery 

36th  Wis.,  age  36. 

23,  '64. 

York.     Disch'd  Aug.  24,  1864. 

lig.    July  11,  re-amp,  mid.  third. 

360 

Lampman,  J.  M.,  Corp'l, 

Nov.  16, 

Left;  flap.    Confederate  surgeon. 

Disch'd  June   24,    1865.     Died 

II,  17th  Mich.,  age  26. 

17,  '63. 

Discharged  May  17,  1864. 

June,  1877;  effects  of  fall  on  ice. 

361 

Lancaster,  T.  W.,  Pt.,  K, 

May  12, 

Left;  ant.  post.  flap.    Surg.W.  J. 

318 

Johnson,  J.,  Pt.,  H,  1st 

June  15, 

Left  ;  flap.     Surg.  U.  B.  McXary, 

42d  New  York,  age  44. 

13,  '64. 

Burr,   42d   N.  Y.      Uecovered. 

Ohio  Cavalry,  age  25. 

15,  '64. 

3d  Ky.  Cav.     Disc.  May  30,  '(i5. 

Transferred  .July  18,  '64.     Died 

319    Johnson,  N.,  Pt.,  H,  14th 

July  30, 

Left  ;  flap.      Surg.  W.  V.  White, 

March  8,  1865. 

N.  Y.  H.  Art.,  age  24. 

Aug.1,'64. 

57th  Mass.     Disch'd  Oct.  21,  '65. 

362 

Langstnn,  W.,  Pt.,  F,  1st 

Sept.  17, 

Uight.      Discharged    November 

3211    Johnson,  \V.,  Serg't,  K, 

June  19, 

Uight;  flap.     Surg.  H.  E.  Smith, 

Texas,  age  37. 

18,  '62. 

12,  1862. 

27th  Mich.,  age  32. 

11),  '64. 

27th  Mich.   Disch'd  Sept.  19,  T>5.     363 

Lapp,    C.,    Pt.,    F,    .r)th 

Mav  25. 

Left;    flap.     Surg.  W.   Altman, 

321 

Johnston,  L.   A.,  Capt., 

Dec.  13, 

Right;    flap.      Confed.    surgeon. 

Ohio,  age  22. 

26,  '64. 

28thPenn.    Disch'd  Feb.  24.  '65. 

H,  11  tli  Penn.  UPS. 

15,  '62. 

Discharged  Oct.  5,  1863.                  364 

Larabee,  C.,  Pt.,  A,  142d 

Oct.  27, 

Left;  circ.     Surg.  A.  C.  Barlow, 

322    Jones,  A.  J.,  Pt.,  L,   1st 

Oct.  19, 

Left.     Discharged  May  12,  1865. 

New  York,  age  46. 

27,  '64. 

62d  Ohio.     Necrosis.     Juno  15, 

| 

Ohio  Battery. 

20,  '64. 

1865,  re-amp,  mid.  third.     Dis 

323 

Jones,  T.,  Pt..  M,  2d  X. 

Aug.  14, 

Uight;   ant.  post.  flap.     Disch'd 

charged  Oct.  13,  '65.   Spec.  4328. 

York  Artillery. 

14,  '64. 

May  31,  1865. 

365 

Latney,  T.,  Pt,,  D,  36th 

April  6, 

Uight.     Discharged  January  31, 

324 

Jones,  W.,  Pt.,  A,  20th 

Mar.  31, 

Left  ;  flap.     Discharged  June  19, 

Col'd  Troops,  age  21  . 

7,  '65. 

1866. 

Maine,  age  27. 

31,  '65. 

1865. 

366 

Law,    H.,  Pt.,   D,    34th 

De.31,'62, 

Uight  ;  flap.    Confed.  surg.   Jan. 

325 

Jordan,  G.  P.,  Corp'l,  V, 

May  3, 

Uight  ;  flap.    Disch'd  September 

Illinois. 

Jan.2,'63. 

27,  re-amputation.    Discharged. 

17th  Maine,  age  34. 

3,  '63. 

16,  1863. 

367 

Lauf,  J.,  Pt.,  F,  91st  N. 

Mar.  31, 

Left;  ant.  post.  flap.     Discharged 

326 

Joye,  T.  K.,  Pt.,  E,  6th 

Mav  6, 

.     Surg.  U.  H.  Jordan,   6th  1 

York,  age  22. 

31,  '65. 

July  27,  1865. 

South  Carolina. 

6,  '64. 

S.  C.    Uccovered.                         j.368? 

Lee,  D.,  Pt.,  G,  2d  N.  Y. 

June  16, 

Both  :  circ.    A.  Surg.  O.  S.  Paine. 

327 

'Judge,  H  ,  Pt..  I),  90th 

Mar.  31, 

Left;  circ.    A.A.Surg.T.T.  Smi-  I1  369) 

H'vy  Artillery,  age  20. 

16,  '64. 

2d  N.  Y.  ll'vy  Art'v.     Disch'd 

Illinois,  age  23. 

Ap.1,'63. 

ley.   Disch'd  Feb.  20,  '64.    Aug. 

May  3!  ,  '65.     Died  Sept.  25,74. 

3,  '64,  re-amp.,  flap,  mid.  third.      :  370 

Lehr,  G.  M.,  Corp'l,  G, 

Mav  22, 

Uight;  flap.     Ass't  Surg.  II.  M. 

328 

Jung,  H.,  Pt.,  I,  46th  N. 

Aug.  30,    Uight.     Surgeon  O.'Shenk,  46th 

llth  Missouri. 

24,  "'63. 

Spraguo,  U.  S.  A.     Discharged. 

York. 

30,  '62.        N.  Y.     Disch'd  Dec.  30,  1862.       .371 

Le.mons,  J.,  Pt.,  K,  38th 

An?.  30, 

Left.  Surg.  —  McAlbine,  C.S.A. 

'329 

Justice,    T.    J.,   Pt..    F. 

Oct.  27,     Uight;  ciro.     Surg.  M.  S.  Kittin-   , 

Virginia. 

30^  '62. 

Uecovered. 

67th  Ohio. 

28,  '64.       ger,  100th  N.  Y.     Discharged.       372 

Le  Roy,  J.  D.,  Pt.,  C, 

May  19, 

Left:  circ.  Surg.  W.S.  Thompson, 

330 

Kanyon,   E.  H.,  Corp'l, 

July  12,     Right;  flap.  Surg.  B.  F.  Keables, 

4th  N.  Y.  Art.,  age  44. 

20,  '64. 

U.  S.  V.     Disoh'd  March  7,  '65. 

P,  3d  Iowa. 

12,  '63. 

3d  Iowa.     Disoh'd  May  20,  '64. 

373 

Lewis,  J.  A.,  Pt.,  F,  17th 

July  28, 

Right  ;  circular.    Sept.  8,  re-amp. 

331 

Kasmire,  C.   P.,  Serg't. 

Sept.  19, 

Right  ;  circular.    Disch'd  March 

Florida,  age  22. 

28,'  '64. 

in  up.  third.   Trans.  Sept.  22,'ti4. 

A,  3d  Me.  Cav.,  age  x!8. 

19,  '64. 

16,  1865. 

374 

Linn,  E.  D.,  Pt.,  C,  178th 

Doc.  14, 

Right;  ant.  post.  flap.     Surg.  J. 

332 

Kelly,  V.  A.,Pt.,  H,  18th 

May  30, 

Left  ;  flap.     Discharged  Septem 

Ohio,  age  36. 

14,  '64. 

Campbell,  178th  Ohio.     Disch'd 

Infantry,  age  '.23. 

30,  '64. 

ber  20,  1864. 

June  29,  1865. 

333 

Kelly,  G.,  Pt,,  C,  122d 

Dec.  31, 

Left;  flap.     Discharged  April  7, 

375 

Little,    F.,    Pt.,   B,    53d 

June  3, 

Uig-ht;  circ.  Surg.  J.W.Wishart, 

Illinois. 

31,  '62. 

1863. 

Penn.,  age  18. 

3,  '64. 

140th  Penn.    Oct.  15,  excision  of 

334 

Kelly,  J.,  Pt.,  H,   107th 

June  19, 

Left;  ant.  post.  flap.    Surg.  J.  P.  1 

1  inch  tibia  and  fibula.     Disch'd 

Pennsylvania,  age  23. 

20,  '64. 

Hutchinson,  107th  Penn.    Disc'd 

December  8,  1864. 

May  28,  1865.     Spec.  4141. 

376 

Little,  J.  S.,  Lieut.,  A, 

May  23, 

R't  ;  flap.    A.Snrg.  J.  D.  Stewart, 

335 

Kelly,  J.,  Pt.,  G,   38th 

Feb.  16, 

Right  ;  flap.     Surg.  W.  C.  Shur- 

93d  New  York,  age  29. 

23,  '64. 

74th  N.Y.     Disoh'd  Sept.  26,  '64. 

Wisconsin,  age  24. 

16,  '65. 

lock,  51st  Penn.  Dis.  Oct.  11,  '65.     377 

Littleficld.  I.,Pt..  K,31st 

July  30, 

Left;   circular.     Disch'd  Decem 

33G 

Kelly,    T.,   Pt.,  I,    llth 

May  18, 

Right:  flap.     Surg.  N.  F.  Blunt,                Maine,  age  26. 

30,'  '64. 

ber  23,  1864. 

Maine,  age  39. 

18,  '64. 

llth  Me.     Must,  out  Nov.  18,'64.     378    Livingston,  II.  B.,Pt.,  A, 

May  16, 

Right  ;  flap.    Surg.  J.  L.  Mulford, 

337 

Kelly,  W.,  Pt.,  G,  26th 

Nov.  6, 

Left;  flap.     Discharged  Decem-            j    48th  New  York,  age  30. 

16,'  '64. 

48th  N.Y.     Disch'd  Oct.  19,  '64. 

Iowa,  age  48. 

C,  '62. 

ber  26,  1862.                                     379  ;  Lockwood,  J.,  Pt.,G,  5th 

Aug.  29, 

Right;  ant.  post.  flap.     Surg.  P. 

338 

Kennedy,  J.  M.,  Corp'l, 

July  10, 

Left  ;    ant.  post.   flap.     Surg.  J.                West  Virginia,  age  29. 

29,  '62. 

U.  Randall,  5th   VV.  Va.     Dis 

G,  20th  Me.,  age  25. 

10,  '64. 

Thomas,  118th  Penn.     Disch'd 

1 

charged  March  24,  1863. 

April  18,  1865. 

380  i  Loveland,   W.,   Pt.,    E,    Julv2't, 

Right;    circular.      Surg.  J.  W. 

339 

Kenner,  L.    C.,  Pt.,  H, 

July  2, 

Left.    Discharged. 

20th  Conn.,  age  35.             20,  '64. 

Terry,  20th  Conn.     Discharged 

71st  New  York,  age  21. 

3,  '63. 

January  21,  1865. 

340 

Kenney,  C.,  Pt.,  B,  21st 

May  24, 

Left  ;  ant.  post.  flap.    Discharged 

381    Lucius,  W.  M.,  Colored 

June  8, 

Right.     Transferred  June  17,'64. 

Maine,  age  39. 

24,  '64. 

February  11,  1865.                                      serv't,  2d  Mich.,  age  12. 

8,  '64. 

1  SMILEY  (T.  T.),  G-unshot  Wounds,  from  Arkansas  Post,  in  the  Boston  Medical  and  Surgical  Journal,  1863,  Vol.  LXIX,  p.  157. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


499 


No 

NAME.  MILITARY 

DATES 

OPERATIONS.  OPERATORS, 

No. 

NAME,  MILITARY 

DATE*          OPERATIONS,  orKi;.\'ioi>. 

DESCRIPTION,  AND  AGE. 

RESULT. 

DESCRIPTION,  AXU  AGK. 

RESULT. 

382 

Lynch,  D.,  Pt.,  A,  33d 

Mar.  30, 

Left";  circular.     Disch'd  July  17, 

418 

Mclnturf.  S.,   Pt.,  I,  2d 

Oct.  10, 

Left;  ant.  post.  flap.     Surg.  J.  T. 

Wisconsin,  age  29. 

30,  '65. 

1865. 

East  Tenn.,  age  29. 

10.  '63.        Smith,  2d  Ohio  Cav.     Disch'd. 

383 

Lynch,  M.  J.,  Pt.,  B,  3d 

Oct.  22, 

Right  ;  circ.     Disch'd  March  10, 

419 

McLain,  E.,  Pt.,  D,125th 

May  14.     Left;  circ.     Discharged  June  •_'!, 

N.  Y.  Light  Artillery, 

22,  '64. 

'65.    March  12,  '65,  rem.  4  ins. 

Ohio,  age  20. 

16,  '64.        1865. 

age  20. 

necro.  fibula.     Spec.  1406. 

420 

McLean,  J.,   Lieut.,   A, 

April  6,     Left.      Resigned   September   23, 

384 

Lyons,  J.,  Pt.,  11,  20th 

July  28, 

Right  :    flap.     Confed.    surgeon. 

40th  Illinois.                         6,  '62.          1862 

Mass.,  age  27. 

28,  '64. 

Disoh'dDec.  28.  1864. 

421     3McQuaid,     !•'.,    Pt.,    C. 

Juno  IS.  !  Right:  ant.  post,  (lap:  gangrene. 

385 

Mab,  E.,  Pt.,  II,  24th  In 

May  16. 

Right;  flap.     Surg.  K.  B.  Jessup, 

95th  New  York,  age  22. 

18,  '64.        Diseh'd  Nov.  29.  1864.    Nov.  28. 

diana. 

17,  '63. 

24.h  Ind.     Disch'd  July  31,  '63. 

1865,  sequestra  removed. 

386 

Mace,  J  ,  Pt.,  B,  4th  N. 

June  12, 

Left  :  circ.     Surg.  B.  G.  Streeter, 

42-.>     Meader,    G.    P.,    Pt.,   G.      Oct.  19,     Left.     Disch'd  August  12.   1865. 

Y.  Cav.,  age  22. 

12,  '64. 

4th  N.  Y.  Cav.     Discharged. 

29th  Maine,  age  25.         -   20.  'M.   : 

387 

Mahari,  J.,  Pt.,  G,  18th 

Oct.  19. 

Right;    circular.      Disch'd  ,  I  ulv 

423 

Merretl,  J..  Serg't,  D,  8th 

Nov.  30,    Left;  circular.     Provost  Marshal 

Penn.  Cav.,  age  19. 

21,  '64. 

17,  1865. 

Arkansas,  age  29.             Dec.l.'fi4.      March  7.  1865. 

388 

Major,  W.  T.,  Corp'l,  E, 

July  30, 

Left  ;  long  post.  flap.    Surg.  J.  L. 

424 

Mershon,  J.  N.,  Pt.,  6th 

May  30,    Left  ;  circular.     Discharged  Sep 

4efth  N.  Y.,  age  29. 

30,  '64. 

Mulford,   48th   N.  Y.     Disch'd 

N.  Y.  Battery,  age  19. 

31,  "'64. 

ternber  24.  1H64. 

July  14,  1865. 

425 

Met-/,,    J.,  Pt.'    G,    142d 

May  22, 

Left;   circular;   gangrene:   bone 

389 

Malock,A.  F.,  Pt.,  B,  23d 

July  1, 

Left.     Retired  from  service  Dec. 

Penn.,  age  20. 

22,'  '64.   !     removed.     Disch'd  July  4.  1865. 

N.  C.,  age  29. 

2,  "63. 

21,  1864. 

426 

Miller,    C.,    Pt.,    H,    2d 

Sept.  29, 

Right:  double  flap.    Confederate 

390 

Malone,  M.,  Pt.,  K,  6th 

July  1, 

Right  ;  circ.     Transferred  for  ex 

Penn.  Art  y,  age  44. 

30.  '64. 

surgeon.     Discli'd  July  12,  '65. 

N.  C.,  age  26. 

2,  '63. 

change  September  10,  1863. 

427 

Miller,  H.  H.,  Corp'l,  K, 

Aug.  29, 

Left  ;  flap.     Surg.  H.  W.  Carpen 

391 

Malony,  M.,  Pt.,  G,  25th 

July  3, 

—  -.    Snrg.  G.  I,.  Miller,  C.  S.  A. 

117th  N.  Y.,  age  24. 

29,  '64. 

ter,    117th   N.   Y.      Discharged 

Virginia. 

3,  '63. 

Recovered. 

May  31,  1865. 

392 

Mance,  G.,Serg't,C,14th 

May  8, 

Right:    flap.     Discharged  Sept, 

428 

Miller,  -P.  D.,  Corp'l,  I, 

June  1, 

Right  ;  circ.;  gangrene.    Disch'd 

N.  Y.  S.  Militia,  age  24. 

8,  '64. 

27,  1864. 

87th  Penn.,  age  25. 

1,  '64. 

October  13,  1864. 

393 

'Mansur,  N.,  Pt.,  A,  5th 

July  27, 

Right;  bilat.  flap.     Surg.  J.  H. 

429 

Miller,  R.  M.,  Pt.,G,  14th 

May  3, 

Right.  A.  Surg.  J.  E.  Logan,  14th 

N.  Hampshire,  age  42. 

27,"  '64. 

Buckman,  5th  N.  H.    Disch'd 

North  Carolina. 

3,  '63. 

N.  C.     Recovered. 

June  18,  1865. 

430 

Miller,    W.    S.,  Pt.,  H, 

May  18, 

Left;   circ.     Surg.  .I.W.Wishart, 

394 

Marple,  T.  J.,  Corp'l,  K, 

June  18, 

Left  ;  circular.     Discharged  Oct. 

116th  Penn.,  age  19. 

18,  '64. 

140th  Penn.  Disch'd  July  10/65. 

91st  Penn.,  age  34. 

18.  '64. 

21,  1864. 

Feb.,  1871,  re-amp,  in  up.  third. 

395 

Marsh,  E.  C.,  Pt.,  H,  8th 

June  3, 

Right  ;  flap.     Surg.  W.  B.  Fox, 

431 

Mills,  II.,   Pt.,   A,    14th 

July  10, 

Right  ;  flap.     Sura-.  G.  W.  Snow, 

Michigan,  age  17. 

3,  '64. 

8th  Michigan.     Discharged. 

N.  Y.  Art'y,  age  22. 

10,"  '64. 

35th   Mass.     Diseh'd  June  19, 

396 

Martin,  A.  P.,  Pt..  I,  5th 

June  2, 

Left:  circular.    June  7,  re-amp. 

1865;  subsequent  operation. 

Tenu.,  age  21. 

2,  '64. 

mid.  third.    Disch'dMar.  31,  '65. 

432 

Miser,  J.  W.  K.,  Pt.,  G, 

July  3. 

L't:  circ.  A.  Surg.  C.  B.Richards, 

397 

Martin,  F.,  Pt.,  K,  17th 

Mar.  19, 

Left  ;  circular.    Discharged  June 

30th  Ohio,  age  20. 

3,  '64. 

30th  Ohio.    Disch'd  June  15/65. 

New  York,  age  25. 

19,  '65. 

9,  1865. 

Nov.  24/66,  re-amp,  upperthird. 

398 

Martin,  J.  I.,  Serg't,  B, 

April  2, 

Left;    circular.     Released  July 

433 

Mitchell.  C.  L.,  Serg't, 

Nov.  30, 

Riffht;  flap.      Disch'd  Aug.  29, 

41st  Tenn.,  age  23. 

2,  '65. 

5,  1865. 

F,  55th  Mass.,  age  35. 

Dec.  1/64. 

1865. 

399 

Martin,  L.,  Pt.,  E,  29th 

July  30, 

Left  ;  circ.  (also  right  arm  at  up. 

434 

Molter,  J.,  Pt.,  D,  39th 

Dec.  1, 

Left  ;  circ.     Confederate  surgeon. 

Colored  Troops. 

30,"  '64. 

third).     Surg.  D.  MacKay,  29th 

New  York,  age  25. 

3.  '63. 

Disch'd  August  31,  1864. 

Col'd  Troops.    Also  w'd  of  face. 

435 

Moore,  J.  B.,  Pt.,  D,  12th 

July  20, 

Right  :  circular.     Recovered. 

Discharged  Dec.  6,  1865. 

Tennessee. 

20,  '64. 

400 

Martins,  W.  F.,  Capt.,  I, 

May  19, 

Left  ;  flap  (also  w'd  right  elbow). 

436 

Moore,  W.  H.,  Cotnm'y 

Mar.  2, 

Right  :  ant.  post.  flap.     Surg.  P. 

1st  Mass.  H.  A.,  age  47. 

19,"  '64. 

Disch'd  Oct.  5,  '64.     Spec.  4498. 

Serg't,  8th  New  York 

2,  '65. 

E.  Sickler,  8th  N.  Y.  Cavalry. 

401 

Mathews,  H.  C.,  Pt.,  H, 

April  2, 

Left;  circ.    June  23,  '65,  re-amp. 

Cavalry,  age  24. 

Disch'd  June  19,  1865. 

116th  Ohio,  age  21. 

2,  '65. 

in  middle  third.     Disch'd  Sept. 

437 

Morris,  T.,  Pt.,  F,  4th  R. 

July  30. 

Right  ;  ant.  post,  flap  (also  w'd  of 

8,  1865.     Spec.  4334. 

Island,  age  22. 

31/64. 

•  left  leg).     Disch'd  Mar.  11,  '65. 

402 

MoAnalty,  H..  Corp'l,  A, 

Aug.  25, 

Left.     Ass't  Surg.  H.  S.  Bradley, 

438 

Morrison.  T.  W.,  Pt,  I, 

July  28, 

Tlight  :  flap.     A.  Surg.  C.B.  Rich 

69th  New  York. 

27,  '64. 

C.  S.  A.   Disch  d  March  27,  '65. 

83d  Indiana,  age  30. 

29,'  '64. 

ards,   30th   Ohio.      Discharged 

403 

McCarty.  P.,  Pt.,  F,  16th 

May  28, 

Left;  ant.  post.  flap.     August  20, 

November  29,  1864. 

Infantr}',  age  19. 

28.  '64. 

re-amp.     Disch'd  March  22,  '65. 

1H!I 

Morrison,  W.  H.,  Pt.,  F, 

June  14, 

Left  ;  lat.  flap.     Surg.  E.  S.  Hoff 

Died  Nov.  4.  1879. 

90th  New  York. 

14,  '63. 

man,  90th  N.  Y.    Disch'd  Sept. 

404 

McClaughry,Yv'.,  Pt.,  A, 

June  3, 

Left;  lateral   flap.     Surg.  J.  A. 

29,  1864.     Died  July  8,  1869; 

155th  N.  Y.,  age  34. 

3,  '64. 

Spencer,   182d   N.  Y.     Disch'd 

consumption. 

April  13,  '65.    Oct.  3,  '68,  re-amp. 

440 

"Morrissey,  I'.,    Pt,,  K, 

Dec.  11, 

Left,     Surg.  N.  Hayward,  20th 

at  middle  third. 

20th  Mass.,  age  39. 

12,  '62. 

Mass.     Disch'd  June  18,  1864. 

405 

2McCollom,  J.,Corp'l,  B, 

Sept.  29, 

Left  ;  ant.  post.  flap.    Disc'd  June 

July25/64,  re-amp.,  flap.    Died 

IstD.  C.  Cav.,  age  23. 

29,  '64. 

23,  1865.     Oct.  12,  '65,  re-amp. 

October  26,  1870. 

406 

McOommon,  J.  S.,Capt., 

Juno  27, 

Left  ;  flap.    Surg.  J.  W.  Hastings, 

441 

Morrow,  B.  M.,  Major, 

April  2, 

Right  ;  circ.    Surg.W.G.  Hunter, 

K,  73d  Ohio,  age  26. 

27,  '64. 

33d  Mass.     Disch'd  Nov.  2,  '64. 

205th  Penn.,  age  30'. 

2,  '65. 

211thPenn.    Disch'd  June  3/65. 

407 

McCoy,  J.,  Pt.,  F,  64th 

May  18. 

Left.     Surg.  G.  L.  Potter,  145th 

Died  March  7,  '67  ;  consumpt'n. 

New  York,  age  23. 

18,  '64. 

Penn.      Disch'd  Jan.  20,  1866. 

442 

Mullen,  E.,  Pt.,  G,  161st 

Feb.  16, 

Left;  circ.  A.  Surg.  J.  S.  Dolson, 

Died  May  29,  1868. 

New  York. 

16,  '63. 

161stN.Y.    Disch'dMav  31/83. 

408 

McCracl;en,J.D.,  Lieut., 

Nov.  30, 

:    ant.  post.  flap.     Surg.  — 

443 

Mitlvay,  M.,  Pt.,  G,  25th 

July  3, 

Left.    Snrg.  G.  L.  Miller.  C.  S.  A. 

K,  7th  Texas,  age  37. 

De.  1.'64. 

Richardson.    7th   Texas.     Pro 

Virginia. 

3,  '63. 

Retired  January  4,  1865. 

vost  Marshal  March  7,  1  865. 

444 

Murdock,  J.,  Pt.,  I,  7th 

Oct.  19, 

Right;  ant.  post.  flap.    Surg.  G. 

409 

MoCurley,  F..  Serg't,  I, 

June  1, 

Left  ;  flap.     Surg-.  C.  T.  Simpers, 

Maine,  age  44. 

21,  '64. 

T.  Stevens,  77th  N.  Y.     Disch'd 

6th  Maryland,  age  30. 

1,  '64. 

6th  Md.     Disch'd  Nov.  10,  1864. 

June  22,  1865. 

410 

Me  Donald,  B..Pt..B,l  6th 

Oct.  7, 

Right  ;  circ.     Disch'd  August  11, 

445 

Murphy,    J.  L,   Pt.,   D, 

July  2, 

Left  ;  circ.     Transferred  for  ex 

N.  Y.  H.  A.,  age  35. 

7,  '64. 

1865. 

14th  Virginia,  age  21. 

4,  '63. 

change  Nov.  12,  1863. 

411 

McDonald,    J.,    Pt.,    K, 

Oct.  3, 

Right;  bi-lat.  flap.      Discharged 

446 

Murphy.  W.  H.,  ls:t  S'g't, 

Nov.  16, 

Left  ;  ant.  post.  flap.    Surg.  B.  N. 

1  1th  Penn.  Cav.,  age  24. 

3,  '64. 

Sept.  19,  '65.     Died  September 

B,  3  1st  Mo.,  age  20. 

16,  '64. 

Bond,  27th  Mo.     Disch'd  April 

26,  1866;  chronic  diarrhoea. 

24,  1865. 

412 

McElroy,  C.,  Pt.,  E,  36th 

June  1, 

Right;  ant.  post.  flap.     Surg.  H. 

447 

Musselman.  A.  L.,  Corp'l, 

Dec.  16, 

Right;  flap.     Disch'd  June  2/65. 

Wisconsin,  age  31. 

1,  '64. 

A.  Martin,  IT.  S.V.    Discharged 

D,  71st  Ohio,  age  22. 

16,  '64. 

May  6,  1865. 

448 

Mi/ear,  F.,  Pt.,  B,  2d  Va. 

July  9, 

Right.     Surg.  —  Carter,  C.  S.  A. 

413 

McGee,  J.  H.,  Pt.,  L,  1st 

Oct.  19, 

Right:    circ.     Disch'd   May   17, 

Reserves. 

9,  '64. 

Recovered. 

414 

Ohio  L.  Art,,  age  24. 
McGlaflin,  C.,  Pt.,  K,  3d 

19,  '64. 
Sept.  19, 

Right  ;  flap.     Surg.W.  A.  Barry, 

449    Nellis.  F..,  Serg't,  B,  6th 
Connecticut. 

Aug.  28, 
28,  '64. 

Left  ;  circ.  Surg.  G.C.  Jarvis,  7th 
Conn.     Disch'd  Aug.  14,  1865. 

Vermont,  age  20. 

19,  '64. 

98th   Penn.     Discharged  Octo 

450    Neville..  W.,  jr.,  Pt.,  A, 

May  3, 

Left.     Surgeon  G.  A.  Nott,  P.  A. 

ber  3,  1865. 

3d  Alabama. 

3.  '63. 

C.  S.     Recovered. 

415 

McGuire,  H.,Pt.,G.120th 

Oct.  27, 

Left;  circ.     Disch'd  June  16,  '65. 

451 

Newman,  J.,  Pt.,  F,  84th 

May  8. 

Right;  circ.  Surg.  O.  Smith.  14th 

New  York,  asre  34. 

28,  '61. 

New  York,  acre  31. 

9,  '64. 

N.Y.  State  Militia.     Oct.  5,  seq. 

4-io    Mr-Henry,  J.  11..  Pt.,  II. 

July  7. 

Left  ;  flap.    Surg.  A.  Goslin.  48th 

removed.     Disch'd  June  6,  '65. 

48th  Illinois,  age  21. 

7,  '63. 

111.     Discharged  Nov.  12,  1864. 

Spec.  3278. 

Died  April  5/1868. 

452 

Newman,  P.,  Pt.,C,  182d 

Aug.  25, 

Left  ;  flap.  Surg.  L.  G.  Hunt,  27th 

417 

Mclntire,   II.  M.,  Lieut. 

June  30,    Left.     Disch'd  January  7,  1863. 

New  York,  age  37. 

27   '64. 

N.  C.     Also  four  other  wounds. 

Col..  1st  Penn.  Res. 

30,  '62.        Died  June  12,  1863. 

Disch'd  Sept.  13.  1865. 

l  (W.).  Surgical  Cases  from  Field  Hospitals,  in  the  Medical  and  Surgical  Reporter,  1865,  Vol.  XII,  p.  253. 

2MOKGAX  (C.  R.),  Re-amputation,  for  Intense  Neuralgia  in  a  Stump.  Anxsthesia  induced  by  Nitrous- Oxide  Gas.  Surgical  Clinic  by  Dr.  T.  G. 
MOUTON,  in  Medical  and  Surgical  Reporter,  1865,  Vol.  XIII,  p.  365. 

3Ln>ELL  (J.  A.),  Clironic  Osteo-myelitis  of  Tibia  following  Primary  Amputation  and  Sloughing  of  Stump,  etc.,  in  U.  S.  Sanitary  Commission 
Memoirs,  New  York,  1870,  Surgical  Volume  I,  p.  297. 

^THOMSON  (VVM.),  Report  of  Cases  of  Hospital  Gangrene  treated  in  Douglas  Hospital,  Washington,  D.  C.,  in  American  Journal  Medical  Science, 
1864,  N.  S.,  Vol.  XLVII,  p.  384. 


500 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

453 

Newman,    W.,    Pt.,    D, 

May  25, 

Right  ;  flap.    Surg.  J.V.  Kendall, 

496 

Kay,  AT.,  Capt.,  D,  6th 

May  30, 

Left.    Surg.  J.  G.  Hardy.  C.  S.  A. 

J49th  N.  York,  age  20. 

20,  '64. 

149th  N.Y.     Disch'd  Oct.  5,  '05. 

North  Carolina, 

30,  '64. 

Recovered. 

454 

Nichols,  J.  B.,  Pt.,  A,  8th     Nov.  4, 

Left  :  circular.    Discharged  Slav 

497 

Rea,W.M.,Pt.,K,  140th 

Mav  8, 

Right  ;  circ.  Surg.  J.AV.  Wishart, 

Michigan,  age  35.           :    4.  '64. 

25,  1805. 

Pennsylvania. 

8,  '64.' 

140th  Penn.  Disch'd  May  29,  '65. 

455 

Formon,  W.  H.  H.,  Pt.,     July  2, 

Left;  llap.     Surgeon  —  Davids, 

498 

Reed,  j".  M.,  Pt.,  B,  10th 

May  22, 

Right  :  circ.   Discharged  Septem 

H,  50th  Ga..  ago  22.           3,  '63. 

C.  S.  A.     Also  w'nd  right  thigh. 

Iowa. 

23,  '03. 

ber  28,  1863. 

Exchanged  Nov.  12,  1803. 

499  ;  Reen,    C.,    Lieut.  Col., 

April  2. 

Left.     Discharged  June  29,  1865. 

456 

Northrop.  A..  Corp'l,  G,     June  20, 

Left;  flap.    Discharged  April  20, 

98th  Penn..  age  35. 

2,  '65. 

107th  Pennsylvania. 

20,  '64. 

1865. 

500 

Regan,  D.,  Pt.,  A,  59th 

July  7, 

Left;  flap.     Surg.  T.  F.  Oakes, 

457 

'O'Beirne,  W.,   Pt.,    D, 

July  27, 

Left;  circ.     Surg.  P.  K.  Hiibou, 

Mass.,  age  25. 

7.  '64. 

50th  Mass.     Disch'd  June  2,  '65. 

28th  Mass.,  age  23.         ,   27,  '64. 

28th  Mass.     Disch'd  Oct.  9,  '64. 

Died  April  22,  1809.  Spec.  6533. 

Nov.  15,  '07,  re-amp,  mid.  third. 

501     RcilVrt.    L.,    Serg't,    D, 

Oct.  3, 

Left.     A.  Surg.  J.  W.  S.  Gouley, 

458 

O'Brien.  E.  F.,  Lieut.,  A,     June  3, 

Left;  ciro.     Surg.  P.  E.  Hubon, 

21fth  New  York. 

4,  '61. 

U.  S.  A.     Disch'd  Dec.  13,  1801. 

28th  Mass.,  age  29.             3,  '64. 

28th  Mass.     Disch'd  Oct.  13.  '64. 

502 

Reisinger,  C.  S..  Serg't, 

June  19, 

Left:  flap.     Surg.  W.  F.   Hum 

Subs.  V.  R.  C.     Spec.  4494. 

11.  150th  1'enn.,  age  25. 

19,  '64. 

phrey,  149th  Penn.    Discharged. 

459 

O'Brien,  H.,  Pt.,  C,  170th    June  16, 

Left;    flap.      Surg.   F.  Douglas, 

503    Relyea,  W.,  Pt.,  11,  77th 

May  3, 

Left  :  flap.     Discharged  Novem 

New  York,  age  35.            18,  '64. 

170th  N.  Y.    Disch'd  Oct.  10,  '65. 

New  York. 

3.  '63. 

bers,  1803. 

Mar.  1,  1867,  bi-lateral  flap  am 

504 

Rennoe,  D.  M.,  Pt.,  H, 

Jan.  2, 

Right;  flap.     Discharged  March 

putation  at  middle  third. 

29th  Indiana. 

2,  '63. 

23,  1863. 

460 

O'Brien,  J.,  Pt,,  G,  fi6th    June  22, 

Right  ;  lat.  flap.  Confed.  surgeon. 

505    Reynolds,  M.,Pt.,J,114th 

Oct.  19, 

Right  ;  lateral  flap.     Discharged 

New  York,  age  50. 

23,  '64. 

Disch'd  Oct.  21,  1865. 

New  York,  age  27. 

20,  '64. 

June  12,  1865. 

461 

O'Dougherty,  B.,  Serg't, 

June  22, 

Right  :  circ.     Surg.  J.  Reilv,  33d 

506 

Rice,  C.  H.,  Pt!",  F,  129th 

Dec.  13, 

Right  ;    flap.      Discharged   Hay 

H,  33d  N.  J.,  age  29. 

22,  '64. 

N.  J.     Disch'd  April  3,  1865. 

Pennsylvania. 

14,  '62. 

25,  1863. 

462 

O'Driscoll,  B.  J.,  Lieut., 

June  16, 

R't:  flap.     Surg.  W.  O'Meagher, 

507 

Rice,  M.  G.,  Pt.,  I,  27th 

June  18, 

Left  ;  circ.     Surg.  G.  T.  Stevens, 

C,  188th  New  York. 

16,  '64. 

C9th  N.  Y.     Disch'd  Jan.  17,  '65. 

Mass.,  age  31. 

18,  '64. 

77th  N.  Y.     Disch'd  Oct.  3,  '05. 

463 

O'Keer,  J.  M.,  Pt.,  D,  1st 

Nov.  7, 

Left.     Transferred  to  prison  Mav 

508 

Rich,  W.  H..  Corp'l,  F, 

Sept.  8, 

Left  ;  ant.  post.  flap.    Surg.  S.W. 

Texas,  age  27. 

7,  '64. 

30,  1865. 

4th  N.  H.,  age  20. 

8,  '63. 

Gross,  U.  S.  V.     Disch'd  June  1  , 

464 

Osborne,  E.  J.,   Pt.,  B, 

Dec.  15, 

Right;  flap.     A.  A.  Surg.  F.  G. 

1864.     Spec.  4315. 

18th  Ohio,  age  21. 

17,  '64. 

Albright.     Disch'd  April  6,  '65. 

509  :  Ridenour,  C.,  Corp'l,  I,      May  5, 

Right  ;  flap.    Discharged  Decem- 

465 

Ostrander,  P.  V.  L.,  Pt., 

May  13, 

Right;  circ.     Ass't  Surg.  W.  D. 

7th  Maryland,  age  22.         5,  ^64.        ber  12.  1864. 

B,  100th  N.  Y.,  age  28. 

13,  '64. 

Murray,  100th  New  York.     Dis 

510    Rifenverrick.W.  M.,Cor-    May  12, 

Left;  flap.      Surg.  W.  F.   Hum 

charged  January  13,  1865. 

poral,  H,  149th  Penn.. 

12,  '64. 

phrey,  149th  Peun.     Discharged 

466 

Overslrut,  W.  J.,  Pt.,  K, 

Nov.  30, 

Right  ;  ant.  post.  flap.  To  Provost 

age  30. 

January  26,  1865. 

43d  Miss.,  age  20. 

30,  '64. 

Marshal  March  1,  1865. 

511    Riley,    S.,  Pt.,  K,   10th     Aug.  3, 

Left  ;  circular.     Discharged  Feb 

467? 

Page,    F.,    Pt.,    K,    3d 

April  16, 

Both  ;  circ.     Discharged  August 

Indiana,  age  23.                  3,  '64. 

ruary  21,  1865. 

468$ 

Michigan.                            16,  '62. 

16,  1862. 

512 

Sister,    T.    W.,   Pt.,   H,      May  3, 

;  circular.     Recovered. 

469 

Palmer,  J.,  Corp'l,  F,  62d 

Oct.  13, 

Left;  circular.     Surg.  A.  C.  Bar 

13th  S.  C.,  age  19.              4,  fe. 

Ohio,  age  22. 

13,  '64. 

low,  62d  Ohio.     Discharged. 

513    Rittfnliouse,,  J.  H.,  Pt.,    Sept.  26, 

.     Surg.  —   Hoyt,  C.  S.  A. 

470 

Parker,  D.,  Pt.,  F,  61st 

July  2, 

Left  ;   circular  ;   gangrene.     Dis 

E,  51st  Georgia. 

26,  '64. 

Retired  February  1  0,  1805. 

New  York,  age  29. 

4,  *G3. 

charged  Dec.  8,  1804. 

514  •.  Robar,    A.,    Pt.,    I.    6th     May  10, 

Left.     Discharged  August  25,  '04. 

471 

Partain,  J.,  Pt.,  U,  Phil 

May  6, 

Right    (also  amputation  middle 

Vermont,  age  10.               11,  '64. 

ip's  Legion,  Georgia. 

6,  '64. 

third  right  arm).     Recovered. 

515    Robertson.  W.  T.,  Pt.,  D,  ;  May  31, 

Left.  Union  surgeon.  Recovered. 

472 

Patten,  G.  W.,  Corp'l,  F, 

Mar.  25, 

Left  ;  circular.     Discharged  Sep 

j     llth  Mississippi.               J'e  2,  '62. 

1st  Maine,  age  18. 

25,  '65. 

tember  11,  1865. 

516  '  Robinson,  S.  C.,  Pt.,  C.      July  2, 

Right;    circ.      Recovered.      Dis 

473 

Paul,  P.,   Pt.,   F,  3d  In 

May  1, 

Left  ;  circular,     Discharged  Feb 

12th  New  Hampshire.        3,  '63. 

charged. 

fantry,  age  27. 

lj£3. 

ruary  11,  1864. 

517 

Robinson,  T.  B..  Corp'l,     May  12, 

Left  ;  flap.     Surg.  M.  Rizer,  72d 

474 

Percy,  J.,  Serg't,  B,  5th 

SepT  17, 

Right.  Confederate  surgeon.  Re 

B,  72d  Penn.,  age  32.        12,'  '64.        Penn.     Disch'd"  Feb.  15,  1805. 

Alabama. 

17,  '62. 

covered. 

518 

Robnault,  J.,  Pt,,  B,  1  1th    Dec.  13,     Right  ;  flap.    Discharged  Decem- 

475 

Perkins,  P.,  Pt.,  G,  7th 

Sept.  18, 

Left  :  circular.  A.  A.  Surg.  M.  H. 

Pennsylvania,  age  27.       14,  '62.        ber  10,  1863. 

Kentucky,  age  20. 

19,  '64. 

Head.     Disch'd  Oct.  5,  1  804. 

519 

Roe,  E.,  Pt.,  Texas  Bat-    Deo.  15,    Left;  circular.     To  Provost  Mar- 

476 

Perry,  L.,  Corp'l,  G,  3d 

July  2, 

Left.     Transferred  for  exchange 

tery,  age  20.                        16,  '64.        shal  March  7,  1805. 

Arkansas,  age  25. 

2,  '63. 

November  12,  1863. 

520 

Rogers,  J.,  Pt..  B,  29th  i  Oct.  27,     Right;  circ.    A.  Surg.  II.  Grange, 

477 

Peters,  W.,  Pt.,  C,  139th 

Sept.  19, 

Right;    flap.      Discharged   May 

Conn.,  age  38.                      27,  '04.        7th  Col'd  Troops.     Discharged 

Penn.,  age  22. 

19,  '64. 

6,  1865. 

April  11,  1805. 

478 

Pettet,  J.  A.,  Pt.,  B,  8th 

Mar.  23, 

Left  ;  flap.     Discharged  May  22, 

521 

Rosevelt,  G.  W.,  Serg't. 

July  2, 

Left;  flap.  Surg.St.J.W.Mintzer, 

Wisconsin. 

23,  '65. 

1865. 

K,  20th  Penn. 

4,  f63. 

26th  Penn.    Disch'd  Mar.  14,  '64. 

479 

Pheiffer,  P.,  Pt.,  A,  llth 

Aug.  22, 

Right;   sloughing.     Dec.  8,  flap 

522 

Runeiman,    F.,    Pt.,    H, 

Nov.  22, 

Left:  circ.      Surg.  J.  P.  Prince, 

Penn.  Cav.,  age  35. 

22,  '04. 

re-amp,  middle  third.     Disch'd. 

27th  Mich.,  age  30. 

22  '63. 

36th  Mass.     Disch'd  Jan.  20,'05. 

480 

Pickering,  B.,Pt.  A,  llth    Nov.  25, 

Right.     Discharged  August   22, 

523 

Runyon,  S.   C.',  Pt.,  H, 

July  0, 

Right;    posterior  flap.      Disch'd 

Michigan,  age  22.            :    25.  '63. 

1864. 

2d  Penn.  Art'y,  age  46. 

6,  '64. 

July  18,  1865. 

481 

Pierce,  F.  O.,  Serg't,  B, 

Oct.  19, 

Right  :  ant.  post.  flap.  Surg.  E.F. 

524 

Ryerson,  J.,  Pt.,  E,  13th 

July  30,     Left  •  circ.     Surg.W.  B.  Fox,  8th 

14th  N.  H.,  age  28. 

20,  '04. 

Ward,  38th  Mass.     Discharged 

Ohio  Cavalry. 

30,'  '64.        Michigan.     Discharged. 

September  11.  1865. 

525 

Rynearson,    L,    Pt..   B,     May  5.      Left:  circular.    Discharged  Nov. 

482 

Pleasants,   J.    W.,    Pt., 

Sept.  19, 

Left  ;  circ.     Surg.  G.  W.  Semple, 

110th  Ohio,  age  20. 

6,  '64. 

2,  1864. 

B,  Richmond  Howitzer 

19,  '64. 

P.  A.  C.  S  .     To  Provost  Marshal 

526 

Sanders.  J.   H.,  Pt.,  D,     Sept.  19, 

Right  ;    circ.      Discharged   June 

Battery,  age  22. 

April.  1,  1865. 

34th  Mass..  age  31.            19,  '04.        8,1865. 

483 

Plumstead.M.  K.,  Serg't, 

June  3. 

Right  :  circ.    Disch'd  Mar.  30/64. 

527 

Savage,  H.  F.,  Pt,,  A.  1st    Aug.  26,    Left  :  flap.     Disch'd  Dec.  29,  '64. 

H,  131st  N.  Y.,  age  21. 

3,  '63. 

Died  Jan.  11,  1867;  typh.  fever. 

Maine  Art'y,  age  18.      i    20,  '64.        Re-amp,  at  middle  third. 

484 

Pohner,  M.,  Pt.,  D,  23d 

July  27, 

Right:  circ.  Surg.  A.  M.Morrison, 

SOQ 
icD 

Scofield.  R.'Pt.,  A,  9th    Sept.  29,  ;  Right  ;  circular.  Discharged  Sep- 

Kentucky,  age  21.          i   27,  '64. 

23d  Ky.     Disch'd  April  28,  '05. 

Colored  Troops.                 29,  '64.        tenibcr  7,  1  865. 

485 

Polly,  M.  H.,  Corp'l,  A, 

July  3, 

Rigut  ;  circ.  Surg.O.  S.Copeland, 

529    Scott,  H.,  Pt.,  C,  2d  Del-     May  2,     Right  ;  circ.    Discharged  August 

10th  N.Y.  II.  A.,  age  23. 

3,  '64. 

10th  N.Y.  Art.    Dis.  May31,'65. 

aware.                                  4,  '63.        20.  1803. 

486 

Pnole,  W.  /?.,  Serg't,  I,     Nov.  16, 

Right  ;    circ.     To   Provost   Mar 

530 

Scott,  J.  G.,  Pt.,  D,  77th      May  6,      Right  ;  circ.;  flap  (also  left  at  up. 

5th  S.  C.,  age  33. 

16,  '63. 

shal  December  1,  1864. 

New  York,  ago  23.              6,  '64.         third).   Surg.E.Pi.  P.  Kelly.  f»."th 

487 

Porter,  J.,   Pt.,  E,  16th 

Aug.  16, 

Right  :  lat.  flap.     A.  Surg.  A.  F. 

IVziu.     Discharged  Nov.  3,  180-1. 

Penn.  Cav.,  age  20.           1C,  '04. 

Herman,  16th     Penn.  Cavalry. 

;    £;«".•.  513. 

H;em.     Disch'd  April  6,  1865.        531     Scrorinins,  T.  G.,  Serg't,      July  9,      Left.     Exchanged  September  21, 

488 

Porter,  W.,  Pt.,  B,  60th    April  2, 

Left  ;  ant.  post.  flap.    A.  Surg.W. 

\     A,  31st  Ga.,  age  22.            9,  '64.    :     1864. 

Ohio,  age  22.                       2,  '65. 

Carrol],   U.   S.  V.     Discharged 

532    Scullion,  J.,  Pt.,  E,  155th  ,  June  16,    Right:    circ.      Discharged  June 

July  17,  1865.    Spec.  4140.  Died 

New  York,  age  20.             17.  '04.        1.1805. 

i 

June  22,  1868. 

533    Secor,    I.,   Pt."  D,    28th     Juno:!,      Loft:  circ.     Surg.   P.  K.  lhib.ni. 

489 

Powell,  J.  E.,  Pt.,  H,  7th  :  May  14, 

Right;    circ.      Confed.  surgeon. 

Mass.,  age  23.                       3,  '04.         2.-'ih  Mass.     Disch'd  Feb.  0,  "65. 

S.  C.  Battery,  age  26.         14,'  '64. 

Furloughed  July  23.  1804. 

534 

Seibert,  J.,  Pt.,  II,  53d    Nov.  27,    Left  :  ant.  post.  flap.     Sury.  J.  W.' 

490 

Prizer,  W.  J.,  Serg't,  A,    Nov.  30, 

Right  :  lateral  flap.     To  Provost 

Penn.,  age  21.                     27,  '03.   ;     Wishart.  1-JOth   Trim.     Disi-h'd 

9th  Arkansas,  age  24.      Dec.],  '64. 

Marshal  March  7.  1805. 

March   28,    1865.     Killed    DC-. 

491 

Quint),  J.A.,Pt.,  K,  109th    July  30, 

Right.      Surg.  W.  C.   Shurloek, 

22,  1879;  railroad  aci-idrnt. 

New  York,  age  20.             30,  '64. 

51st  Penn.     Disch'd  Jan.  30,  '65. 

535    Seitzmeyer,  J.L..  Pt.,  E,     Sept.  29,    Left  ;  circular.     Discharged  July 

492 

Quinn.  P.,  Pt.,  D,  5th  N.     July  18. 

Left;  flap.     Discharged  October 

5th  Penn.  Cav.,  age  21.  <•  29,  '64.        18,  18:.  5. 

Y.  H'vy  Art'y,  age  27.       19,"  'C4. 

17,  1805.     Died  May  17,  1S74. 

530    Sessions,  G.  W.,  Pt.,  K,      Julyl,      Right:  ant.    Surg.  T.  C.  Hill.  5lh 

493 

Rafford,  O.,  Pt.,  II,  20th    Sept.  30, 

Right;    circ.      Discharged   Feb 

5th  Alabama,  age  22.          1,  '63.         Ala.    Exchanged  Nov.  I'?;  1803. 

Maine,  age  28.                  Oct.  1,'64. 

ruary  21.  1865. 

537    Setley,  S.,  Pt.,  F,  58th    April  17,  '  Left:  circ.     Snnr.  K.  P.  Morong. 

494 

Rank,  B.  H.,  Pt.,  K,  51st     June  3, 

Left;  flap.    Discharged  July  18, 

;     Penn.,  age  19.                      17,  '63.        2d  Md.     Disch'd  Oct.  7.  lf-04. 

Penn.,  age  27.                  i     3,  '64. 

1805. 

538    Shaff,    P.,   Pt.,    F,  llth      Oct.  2,      Left;  circ.    Surg.  L.C.  Woodman, 

495 

Rathburn,  W.,    Pt.,    H,  ;  Dec.  13, 

Right  ;  circ.     Discharged  March 

Mich.  Cav.,  age  38.            2,  '64. 

llth    Michigan  Cavalry.      Dis 

7th  Rhode  Island. 

13,  '02. 

6,  1863. 

! 

charged  July  1,  lt-b'5. 

1  O'MEAGHER  (W.),  Surgical  Cases  from  Field  Hospitals.     Amputation  of  Left  Leg,  Lower  Third,  Stump  healed  in  three  weeks,  in  Medical  and 
Surgical  Reporter,  Philadelphia,,1805,  Vol.  XII,  p.  253. 


SECT.  V.J 


PRIMARY   AMPUTATIONS    IN    THE    LEG. 


501 


No 

NAJIE,  MILITARY 

DATES 

OPERATIONS,  OPERATORS, 

No 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

Dnsciiii'Tiox,  AMD  AGE. 

RESULT. 

DESCRIPTION,  AND  AGE. 

RKSULT. 

539 

,  Sharp,  J.W.,  Pt.,  G,  5th 

Oct.  19, 

Left;circ.     Surg.  R.  Watts,  133d 

580 

Stein     F.     Pt.    H    10th 

July  3, 

Right.      Discharged     December 

Georgia,  age  26. 

19,  '64. 

N.  Y.    To  Pro.  Mar.  April  8,  '65. 

Infantry. 

3,  '63. 

23,  1863.     Spec.  1454. 

540 

Shay,   AI.,  Pt.,  K,  94th 

June  IS, 

L't  ;  circ.  Surg.D.A.Chamberlain, 

J581 

Stetler,    J.  A.,  Pt.,    A, 

June  18, 

Right  ;  flap.    Surg.  F.C.  Reamer, 

New  York,  age  21. 

19,  '64. 

94th  N.  Y.     Disch'd  Mar.  2,  '65. 

143d  Penn.,  age  19. 

18,  '64. 

143d  Peun.     Disch'd  June  1/65. 

541 

Sheets,./.  S..  Pt.,  E,  52d 

Oct.  19, 

Left;  Hap.      Surg.  C.  B.  Gibson, 

Re-amp,  at  mid.  third  Jan.,  1867. 

Virgiiiia,  age  ~2. 

19,  '64. 

C.  S.  A.     Trans,  for  exchange 

582 

Stevens,  J.,  Pt.,  C,-79th 

July  20, 

Left  ;  circular.     Discharged. 

February  10.  1865. 

Ohio,  age  45. 

i-'J  ,  '64. 

542 

Sheibly,  T.  J.,  I't.,  B.  1st 

May  8. 

Left  :  circ.     Surg.  J.  J.  Comfort, 

583 

Stewart,  J.,  Pt.,  K,  1st 

Aug.  19, 

Right;  circ.     Surg.  A.  A.  White, 

Penn.  Hides,  age  19. 

9,  ''64. 

1st  Penn.  Rifles.     Disch'd  Nov. 

Maryland,  age  24. 

20,  '64. 

8th  Md.     Disch'd  Aug.  1,  1865. 

18,  1864. 

584 

Stewart,  R.  F..  Capt.,  B, 

June  17. 

Left;  circ.     A.  A.  Surg.  W.  H. 

543 

Shell,   J.,    Pt.,   H,  13th 

Nov.  11, 

Right;  flap.     Surg.  W.  H.  Mat- 

179th  N.  York,  age.  'M. 

17,  '64. 

Randolph  .    Disch'd  Jan.  (i,  1  865. 

Tenu.  Cavalry. 

12,  '64. 

lock,  13th  Tenn.  Cav.     Disch'd 

Died  August  30,  1870. 

July  21,  1865. 

585 

Stewart,  T.  G.,  Pt.,  D, 

Dec.  16, 

Left  ;  circular.    Discharged  July 

544 

Wiell,W.T.,  Serg't,  18th 

Sept.  17, 

Right  ;  circular.     Doing  well. 

36th  Illinois,  age  41. 

16,  '64. 

12,  1865.     Died  July  1,  1870. 

Mississippi,  age  24. 

18,  '62. 

586 

Stills,   J.,  Pt.,  D,    90th 

Sept.  4, 

Left  ;  flap.    Surg.  A.  C.  Fosdick. 

545 

Simons,  C.   11.,    Pt.,   K, 

June  17, 

Left  :  ant.  post.  flap.    Discharged 

Indiana,  age  20. 

4,  '63. 

90th  Ind.     April  22,  '64,  re-amp. 

59th  Mass.,  age  33. 

17.  '64. 

May  11,  1865. 

atrtid.  third.    Disc.  Nov.  11/64. 

54li 

Simuums,  C.,  Pt.,  L,  6th 

Sept.  19, 

Right  ;  flap.    A.  Surg.G.  R.  Rich 

587 

Stokes,  C.,  Serg't,  C,  7th 

Dec.  7, 

;  circular.     To  Provost  Mar 

Mich.  Cav.,  age  21. 

19,  '64. 

ards,  1st  Mich.   Cavalry.     Dis 

Florida,  age  35. 

7,  '64. 

shal  March  7,  1865. 

charged  May  3,  1865. 

588 

Stone,  J.  F.,  Pt.,  E,  29th 

Nov.  30, 

Left  ;  circ.     Surg.  —  Lynch,  C. 

547 

Simmons,  S..  Pt.,  I,  20th 

July  20, 

Left  ;  circular.     Transferred  Sep 

Mississippi,  age  23. 

De.  1/64. 

S.  A.     To  Pro.  Mar.  May  6,  '65. 

Miss.,  age  x;2. 

20,"  '64. 

tember  22.  1864. 

589 

Street,  T.  G.,  Pt.,  C,  7th 

May  (i. 

Right;  circ.     Discharged  March 

]546 

Simmons,  W.  J.,  Pt.,  10, 

Nov.  30, 

Right  ;  circular.  To  Provost  Mar 

Maryland,  age  19. 

7,  '64. 

24,  1865. 

37th  Georgia,  age  22. 

Dec.  1/64. 

shal  March  7,  1865. 

590 

Striep,  M.,  Corp'l,  B,  6th 

Aug.  29, 

Right;  flap.     Discharged. 

549 

.Simpson,  K.  A.,  Serg't, 

Oct.  19, 

Left  ;  ant.  post.  flap.    A.  Surg.  B. 

N.  Y.  Cavalry,  age  25. 

29,  '64. 

B,  30th  Mass.,  age  34. 

21,  '64. 

Pordyce,    160th   N.   Y.     Gang. 

591 

Strolmber.    G.,    Pt.,  A, 

Oct.  27, 

Left;  circular.    Discharged  Mav 

Oct.  26,  re-amput'u  thigh,  low. 

188th  N.  Y.,  age  20. 

27,  '64. 

26,  1865. 

third.     Disch'd  Oct.  16,  1865. 

592 

Strong,  L.  M.,  Pt.,  K,  3d 

April  2, 

Left  ;  ant.  post.  flap.     Surg.  J.  J. 

550 

Simpson,  J.  If.,   Pt.,   I, 

Sept.'  3. 

Left.     Surg.  J.  Evans,  M  S.  C. 

Vermont,  age  21. 

2,  '65. 

Meigs.  3d  Vermont.     Disch'd. 

7th  S.  C.,  age  29. 

4,  '64. 

To  Provost  Marshal  for  exch'ge 

593 

Stroup,   C.  W.,  Pt.,   H, 

July  3, 

Right.     July  11,  reamp.     Trans 

February  11,  1865. 

52d  N.  C.,  age  29. 

3,  '63. 

ferred  for  exch.  Nov.  12,  1863. 

551 

Sinclair,  F.  C.,  Lieut.,C, 

Nov.  6, 

Right;  ant.     Surg.  S.  V.  D.  Hill, 

594 

Suidon,  J.  K.,  Lieut.,  F, 

July  2, 

Right;  circ.      Recovered.      Ex 

13th  Mississippi. 

8,  '63. 

C.  S.  A.     Recov'd;  exchanged. 

24th  Virginia,  age  22. 

3,  '63. 

changed. 

552 

Slade,  S.  G.,  Pt.,  A,  13th 

July  9, 

Left.     Exchanged. 

595 

Stiratt,  J.  G.,  Pt.,  F,  7th 

July  3. 

Right.      Paroled    September   5. 

Georgia,  age  24. 

9,  '64. 

North  Carolina. 

3,  '63. 

1863. 

553 

Sinedberg,  W.  K.,  Capt., 

May  5, 

Right.     A.  Surg.  J.  S.  Smith,  IT. 

596 

Talenfero,  W.  M.,  Corp'l, 

Oct.  11, 

.    Surg.  —  Lee,  C.  S.  A.  Re 

F,  14th  Infantry. 

5,  '64. 

S.  A.    June,  1864,  re-amputat'u 

E,  2d  Va.  Cavalry. 

11,  '63. 

covered. 

mid.  third.     Retired  Dec.  15,  '70. 

597 

Taylor,  J.W.,  Pt.,C,  5th 

April  27, 

Left  ;  flap.     A.  Surg.  O.  H.  Arm 

554 

Smith,A.  R.,  Pt.,  F,  16th 

Nov.  30, 

Left  ;  circular.     To  Provost  Mar 

N.  Y.  Cavalry,  age  44. 

27,  '64. 

strong,  5th  N.  Y.  Cav.    Disch'd 

South  Carolina,  age  24. 

30.  '64. 

sh*!  March  29,  1865. 

Oct.  6,  1864.    Spec.  2244. 

555 

Smith,    C.,    Pt.,    K,    1st 

April  1, 

Right  ;  flap  ;  gangrene.     Disch'd 

598 

Taylor,  J.,  Pt.,  B,    5th 

Feb.  19, 

Left  ;  ant.  circ.     Ass't  Surg.  G.  V. 

Maryland,  age  42. 

2,  '65. 

October  11,  1865. 

Colored  Troops. 

20,  '65. 

R.  Merrill,  6th  Colored  Troops. 

556 

Smith,  C.  G.,  Pt.,  F,  4th 

Sept.  17, 

Left  :  circ.    A.  Surg.  J.  R.Gibson, 

Discharged  Nov.  10,  1865. 

Infantry,  age  26. 

17,  '62. 

U.  S.  A  .     Disch'd  Aug.  22,  '64. 

599 

Taylor,    W.    T.,    Serg't 

Mar.  25. 

Right;  circular.     Released  June 

1557 

Smith,O.  G.,  Pt.,  H,  102d 

May  15, 

Right  ;  circ.     Surg.W.  Hamilton, 

Maj.,  56th  N.C.,  age  24. 

25,  '65. 

19,  1865. 

Illinois,  age  18. 

16,  '64. 

102dlll.     Disch'd  May  18,  1865. 

600 

Teel,  H.,  Corp'l,  H,  122d 

Sept.  19, 

Left  ;  ant.  post  flap.     Ass't  Surg. 

558 

Smith,  D.,   Pt.,  G,  2  1st 

Aug.  21, 

Left  ;  ant.  post,  flap  ;  gang.     Dis 

Ohio,  age  22. 

19,  '64. 

J.  G.  Thompson,  77th  N.  York. 

Penn.  Cav.,  age  24. 

21,  '64. 

charged  August  2,  1865. 

Discharged  August  14,  1865. 

559 

Smith,  F.,  Serg't,  G,  7th 

Mar.  25, 

Right  ;  ant.  circular.    Surg.  H.  N. 

601 

Temple,   B.,    Serg't,  E, 

July  2, 

.     Recovered.     Transferred 

Louisiana,  age  28. 

25,  '65. 

Young,  C.  S.  A.    Released  June 

21st  Virginia. 

2,   63. 

July  15,  1863. 

14,  1865. 

602 

Thaj/er,  Vr.  S.,  Lieut.,  H, 

April  18, 

Left.     Surg.  J.  R.  Ward,  C.  S.  A. 

560 

Smith.  H.  C..  P«.,G,  30th 

Nov.  24, 

Right  ;  Hap.    Surg.  A.T.  Hudson, 

llth  Virginia. 

18,  '64. 

Recovered. 

Iowa,  age  32. 

25,  '63. 

26th  Iowa.     Disch'd  Feb.  1,  '65. 

603 

Thomas,  H.H.,  Serg't,  B, 

July  3, 

Right.    Paroled  October  24,  1863. 

56J 

Smith,  J.  C.,  Pt.,  I,  24th 

May  16, 

Left  ;  flap.     Discharged  Septem 

26th  N.  C.,  age  23. 

3,  '63. 

Iowa,  age  20. 

16,  '63. 

ber  18,  1863. 

604 

Thomas,  H.    S.,  Major, 

April  5, 

Right  ;  flap.    Discharged  August 

562 

Smith,  J.  L.,  Pt.,  C,  12th 

May  3, 

Left  ;    gang.     Transferred  June 

1st  Penn.  Cav.,  age  26. 

5,  '65. 

17,  1865. 

North  Carolina. 

3,  '63. 

9,  1863. 

605 

Thomas,  J.,  Pt.,  I,  30th 

July  30, 

Right  :  flap.     Surg.  G.  R.  Potts, 

563 

Smith,  J.  M.,  Pt.,  I,  23d 

July  (>. 

Right.    Surg.  —  Morgan,  C.  S.  A. 

Col'd  Troops,  age  22. 

30,*'64. 

23d  Col'd  Troops.     Discharged 

Georgia. 

7,  '64. 

Retired  February,  1865. 

August  23,  1865. 

564 

Smith,  J.  M.,Pt.,K,15oth 

Oct.  27, 

Right  ;  flap.     Surgeon  F.  Wvlie, 

606 

Thomas,  S.  B.,  Pt.,  H, 

Mar.  25, 

Right  ;  circ.     Surg.  E.  P.  Roche. 

New  York,  age  53. 

28,  '64. 

1  55th  N.  Y  .    Disch'd  May  27,  '65. 

37th  Virginia,  age  40. 

26,  '65. 

Released  June  14.  1865. 

565 

Smith,    X.,    Pt.,    II,    2d 

May  9. 

Right.    Surg.  G.  Reeder,  2d  Iowa 

607 

Thomas,  W.  B.,  Corp'l,  E, 

May  6, 

.    Surg.  G.  S.  West,  C.  S.  A. 

Iowa  Cav..  age  26. 

9,  '62. 

Cavalry.     Disch'd  Aug\  12,  '62. 

7th  Georgia. 

7,  '64. 

Retired  February  11.  1865. 

566 

Smith,    S.,    Pt.,    K.    4th 

Mar.  25, 

Left  ;    circular.     Released   June 

608 

Thornton,  M.  L.,  Pt.,  K. 

Oct.  19, 

Right  :  circ.  (also  amp.  right  arm 

Georgia,  age  17. 

25,  '65. 

M,  1865. 

31st  Georgia,  age  22. 

19,  '64. 

at  mid.  third).    Surg.  G.  G.  But 

567 

Snelliny,  E.  A.,  Pt.,  Not- 

June  22. 

Right  (also  left  leg  at  mid.  third). 

ton,  31st  Georgia.     To  Provost 

ta  way's  Artillery. 

2.>,  '64. 

Confed.  surgeon.     Recovery. 

Marshal  April  8,  1865. 

568 

Snugg's,  W.,  Pt..  11,  14th 

Alav  12. 

Right  ;  flap.     To  prison  October 

609 

Thornton,  R.  B.,  Pt.,  F, 

July  1, 

Left.     Transferred  for  exchange 

North  Carolina,  age  18. 

12,'  '64. 

17,  1864. 

12th  N.  C.,  age  21. 

2,  '63. 

September  25,  1864. 

569 

Snyder.    J.   D.,    Pt.,  G, 

May  10, 

Left  ;  flap  (also  amp.  right  leg,  up. 

610 

Thurlkil,  J.,  Pt.,  G,31st 

Oct.  27, 

Left;  circular.    Discharged  Aug. 

149th  Penn.,  age  19. 

11,  '64. 

third).     Disch'd  July  21,  1865. 

Col'd  Troops,  age  29. 

28,  '64. 

23,  1865. 

570 

Sopor.  Ij-  Serg't.  A,  llth 

April  2. 

Left  :  flap.  Surg.  C.  IJ.  Park,  llth 

611 

Tnrrei/son,  T.  N.,  Corp'l. 

May  8, 

.    Surg.  W.  J.  Allen,  C.  S.  A. 

Vermont,  age  32. 

2,  '65. 

Yermont.    Disch'd  Sept.  14,  '65. 

C,  35th  Va.  Battery. 

8,  ''64. 

Recovered. 

571 

Spraker,  W.,   Serg't,  I, 

July  2, 

Left  ;  circular.     Disch'd  May  3, 

612 

Torry,  A.,  Pt.,  H,  99th 

Sept.  16, 

Left;  circular  flap.     Surg.  D.  S. 

64th  X.  Y.,  age  24. 

4,  '63. 

1864.     Sptc.  4364. 

Peiin.,  age  30. 

16,  '64. 

Hays,  110th  Penn.    Discharged 

572 

Spratt.  J.  R.,  Lieut.,  K, 

May  25, 

Right.   Surg.  'NY.  C.  Bennett,  U.S. 

June  1,  1865.     Spec.  4113. 

33d  Indiana,  age  27. 

23,  '64. 

V.     Discharged  Feb.  3,  1865. 

613 

Travis,   C.,  Pt.,  E,  23d 

July  29, 

Left;  flap.     Discharged  January 

573 

StalrjW.  M.  J/.,  Pt.,  B, 

Sept.  16, 

Left.   Surg.  —  McFarland.C.S.A. 

Missouri,  age  30. 

29,  '64. 

20,  1865. 

SOtli  Tenn. 

16,  '63. 

Recovered. 

614 

Tribou,  D.  W.,  Corp'l, 

Sept.  17, 

R't.     Surg.G.  B.  Coggswell,  29th 

574 

Stanwcll,  B.  L.,  Pt.,  A, 

Sept.  19, 

Right:  circ.  Surg.  —  Weatherby, 

C,  29th  Mass. 

17.  '62. 

Mass.     Disch'd  Jan.  13,  1863. 

12th  Alabama,  age  22. 

21,  '(>•!. 

6th  Alabama.     To  prison  Jan 

615 

*Trimble,  J.   E.,    Major 

July  3, 

.    Surg.  H.  McGuire.C.  S.  A. 

uary  5,  18;>5. 

General,  C.  S.  A. 

3,  '63. 

Transferred  August  18,  1863. 

575 

Starin.  F.  D.,  Pt.,  II,  43d 

Nov.  n, 

Left  ;  !Iap  (also  amp.  right  leg,  up. 

616 

Tullis,  J.  IT.,  Lieutenant, 

July  2, 

Left.     Surg.  J.  McC.  Greene,  C. 

Wisc'iiisin,  a:^o  19. 

5,  '64. 

third).     Disch'd  July  2,  1865. 

Hardaway's   Alabama 

2,  '63. 

.S.  A.     Recovered.     Trans,  for 

576 

Stark,  II.  M.,  Pt..G,  18th 

May  3  1, 

Left  ;  ciro.     Surg.  S.  Marks,  10th 

Battery,  age  24. 

exchange  March  17,  1864. 

Infantry,  aye  19. 

31,  '64. 

\Vis.     (Also  wound  right  foot.) 

617 

Turner,   G.,  Pt.,  E,  1st 

May  31, 

Right;    flap.     Discharged   Sep 

Disch'd  Dec.  2>,  1S64. 

Mich.  Cav.,  age  34. 

31,'  '64. 

tember  24,  1864. 

577 

Starr.  A.  D.,  Pt.,  H,  4th 

May  27, 

Left:  circ.  Surg.  B.N.  Bond,  27th 

618 

Tuttle,  R.  S.,  Corp'l,  F, 

July  11. 

Right;  circ.     Surg.  J.  P.  Prince. 

Iowa,  ago  20. 

27,'  '64. 

Mo.     Disc.h'd  May  23,  1865. 

27th  Michigan. 

11,  "'63. 

36th   Mass.    Discharged   Sept. 

578 

Step!,  E.  B.,  Pt.,  I,  35th 

Dec.  13, 

Left.     Surg.  W.  A.   Madill,  23d 

16,  1863. 

New  York. 

13,  '62. 

New  York.     Disch'd  June  6,'63. 

619 

Tyrrell,  J.  C.,  Serg't,  I, 

Dec.  13, 

Right  ;  flap.  Surg.W.  D.  Newell, 

579 

Stegor,    .J.,   Pt.,   G,  52d 

Juno  1, 

Left.     Discharged  September  14, 

28th  New  Jersey. 

13,  '62. 

28th   N.   J.     Discharged  July 

New  York. 

1,  '62. 

1862. 

6,  1863. 

1  FISIIKU  (G.  J.),  Report  of  Fifty-seven  Cases  of  Amputations  in  the  Hospitals  near  Sharpsburff,  Md.,  etc.,  in  American  Journal  Medical  Sciences, 
1863,  Vol.  XLV,  N.  S..  p.  48. 

2MuGL'li:K  (II.).  Clinical  RemarJcs  on  Gunshot  Wounds  of  Joints,  etc.,  in  Richmond  Medical  Journal,  1866,  Vol.  I,  p.  150. 


502 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


Mn 

NAME,  MILITAKY 

Ol'KliATIOXS.    OPERATORS, 

Vit 

NAME,  MILITARY 

D  \TI":? 

Ol'EKATIONS.    OPERATORS, 

JJXU. 

DESCRIPTION,  AND  AGK. 

RESULT. 

AU. 

DESCRIPTION,  AND  AUK. 

RESULT. 

020 

Underwood,  L.  A.,  Cor 

April  2,  :  Left  ;  flap.     Disch'd  Aug.  10,  '65. 

661 

Woerts,  C.,  Pt.,  I,  ]08th 

Aug.  14, 

Left;  circ.     Surg.  C.  Spinzig,  2d 

poral,  F,  4th  Vermont, 

2.  '65.         (Also  wounds  of  right  shoulder 

Ohio,  age  20. 

14,  '04. 

Mo.     Disch'd  June  16,  1805. 

age  21. 

;     and  left  hand.  ) 

662 

Wolcott,   II.  P.,   Lieut.. 

Dec.  31, 

Left  :  flap.     Surg.A.G.  Hart,  41st 

621 

Van  Kirk,  A.  .1.,  Pt,  1). 

May  12,     Right  ;    circular.      Surg.    J.  W. 

K,  41st  Ohio. 

31,  '02. 

Ohio.     Disch'd  May  27,  1803. 

140th  Penu.,  age  21. 

12,  '64.        Wishart,  140th  Penn.'  Disch'd 

663 

Wolf,  M.,  Pt.,  A,   160th 

Oct.  19, 

Right;    circ.     Discharged    .Inly 

April  16.  1865. 

New  Y'ork,  age  21. 

20,  '04. 

10,  1865. 

622 

Van   Kuren,    J.,  Corp'l, 

Mav  8, 

Left  ;  flap.    Confederate  surgeon. 

664 

Wood,  W.    Hf,    I't.,    I, 

July  3. 

Right:     circ.      Discharged    July 

B,  1st  Mich.,  age  25. 

8,  ?64.         Discharged  May  11,  18G5. 

120th  N.  Y.,  age  23. 

5,  '"03. 

24.  1865. 

CJ3 

Vanoeker,     L.,    1't.,    F. 

Aug.  30,    Left.      Discharged    October  2'.), 

005 

Woodruff,    J.,    Pt..    K, 

July  4. 

Left.     Dec.  18.  re-amp,  at  June,  of  ' 

104th  New  York. 

30,  '62.        ]NI2. 

57th  Mass..  age  26. 

4,  '04. 

mid.  and  up.   thirds.     Dec.  22, 

624 

Vanpelt,    1>.   P.,    I't.,  1. 

June  1, 

Left  ;  circular.     Discharged  Feb 

ha?m.     Disch'd  June  27,  1805. 

14th  N.  J.,  age  24. 

1,  "64. 

ruary  3,  1865. 

606 

Woodward,    J.,    Pt.,  (', 

July  1, 

Right:  ant.  post.  flap.   Surg.  J.M. 

025 

Van  Scheffelin,  A.,  I't.. 

Nov.  18,    Right.      A.  Surir.  N.  It.  Barnes, 

14th  N.  Y.  S.  M. 

1.  '63. 

Farley.  14th  N.Y.  S.  M.     Dise'd 

E,  76th  N.  Y.,  age  30. 

19,  '63. 

70th  N.  Y.    Disch'd  J  uly  22,  '64. 

Feb.  -JO,  1804.     ftjjn:  430!). 

626 

Vincent,   H.  G.,  Pt.,  II. 

April  6, 

Right.     Discharged  June  18,  '62. 

667 

Worley,  C.  L.  F.,  It.,  A, 

July  1, 

Right.     Retired  October  14,  1H04. 

15th  Iowa,  age  21. 

7,  '62. 

5th  Ala.,  age  22. 

1,  '63. 

627 

Voaglin,  F.,  Pt.,  G,  44t*t 

Sept.  17, 

Left.    Dec.  16.  reseo.  of  nee.  tibia. 

668 

Wrieth,  II.,  Pt.,  B,  20th 

July  28, 

Left;  flap.    Confederate  surgeon. 

Alabama. 

17,  '62. 

Furloughed  March  2.  1863. 

Mass.,  age  26. 

29,  '04. 

Discharged  August  13,  1805. 

628 

Wallace,  G.   11.,  Pt.,   I, 

Julv  !>, 

Right;  flap.     Discharged  March 

669 

Wright.  P.,  Pt.,  H,  39th 

Feb.  11, 

Left;  flap.     A.  Surg.  F.  B.  Kim- 

9th  C.  Troops,  age  22. 

9,  '64. 

21,  1865. 

Col'd  Troops,  age  29. 

11,  '65. 

ball,   3d  New  Hamp.     Disch'd 

1  Warner,  G.,  Lieut.,  K. 

Mar.  14, 

Right;  circ.     Surg.  G.  A.  Otis, 

October  19,  1865. 

27th  Mass.,  age  26. 

14,  '62. 

27th  Mass.     Recov.,  prom.,  and 

670 

Wvbourn.W.  A.,  Serg't, 

Feb.  0. 

Right;   circ.      Surg.  A.   S.   Cue, 

transferred  to  Vet.  Res.  Corps. 

I,  147th  N.  Y.,  age  23. 

C,  '65. 

147th  N.  Y.    Duty  April  3,  J865. 

630 

Waterhouse,  B.  W.,  Pt., 

July  24, 

Right  ;  ant.  post.  flap.     Surg.  — 

Prom.  Lieut.    Dis.  June  7,  1805. 

ft,  23d  Ohio,  age  27. 

24,  '61. 

Duffv,  C.  S.  A.     Disch'd  May 

671 

Yateg,  S.,  Corp'!,  H,  33d 

Mar.  25, 

Left:    circular.     Released  June 

18,  1865. 

Virginia,  age  38. 

26,  '65. 

14.  1865. 

631 

Watrous,  H.  S.,  Pt.,  A, 

July  1, 

Left.      Trans,    to    Headquarters 

672 

Yerkes,  W.   H.,  Pt.,  C, 

Sept.  17, 

Right.    1  Hseharged  May  1  J  ,  1803. 

2d  Artillery,  age  20. 

1,  '63. 

January  17,  1864. 

128th  Pennsylvania. 

17,  '62. 

632 

Watson,  W.  H,  Pt.,  A, 

Aug.  18, 

Right  ;  circular.     Recovered. 

673 

Young,  F.V.,Pt.,  1,111th 

May  6, 

Right  :    flap.      Confed.   surgeon. 

33d  Alabama,  age  24. 

18,  '64. 

New  York,  age  18. 

6,  '64. 

Discharged  June  16,  1865. 

633 

Weaver,  J.,  Pt.,  K,  12Gth 

Sept.  19, 

Right;  circular  (also  wound  left 

674 

Young,  G.  A.,Pt.,  F,5th 

Nov.  7, 

Left.     Discharged  August  19,  '04. 

Ohio,  age  20. 

]!),  '64. 

leg).     Discharged  June  2,  1865. 

Artillery,  age  23. 

7,  '63. 

634 

Webb,  J.,  Pt.,  C,  155th 

May  8, 

Left  ;  ant.  post.  flap.    Discharged 

675 

Young,  j'.  B.,l't.,  K,  llth 

Mav  16, 

Left  :  flap.     Surg.  R.  B.  Jessup, 

Penn.,  age  2(i. 

8,  '64. 

April  6,  1865. 

Indiana,  age  21  . 

17,"  '03. 

24th  hid.     Discharged  August 

633 

Webber,  ir.  A.,  Capt.,  A, 

May  10, 

.   Surg.  C.C.  Henkle.C.S.  A. 

31,  1864. 

23d  Virginia. 

10,'  '64. 

Recovered. 

076 

Ziegler.S.  R.,  Pt.,A,49th 

May  5. 

Left;  flap.     Discharged  Novem 

636 

Weber,  T.,  Pt.,  5th  Ohio 

July  12, 

Left;   ant.  post.  flap.     Surg.  C. 

Penn.,  age  23. 

6,  '04. 

ber  10,  1864. 

Batter)-,  age  20. 

12,  '63. 

Carle,  41st  111.     Gang.     Oct.  7, 

077 

Abbott,  J.  I.,  Pt.,  C,  2d 

June  27, 

Right:    circular.      Died    August 

re-amp,  by  Luke's  flap  method. 

Conn.  H.  A.,  age  20. 

27,  '64. 

20,  1804  ;  typhoid  fever. 

Discharged  Sept.  13.  1864. 

678 

Adams,  N.,  Pt.,  D,  30th 

June  17, 

Left.     Died  June  29,  1£64;  gan 

637 

Weeks,  J.,    I't.,    K,  4th 

Dec.  7, 

Loft;  circular.     To  Provost  Mar 

Wisconsin,  age  34. 

17,  '64. 

grene. 

Florida,  a^e  20. 

7,  '64. 

shal  March  21,  1805. 

079 

Anderson,  D.,  Corp'l,  H, 

Aug.  21, 

Left  (also  amp.  right  leg  at  mid 

038 

Welch,  J.  M.,  Pt.,  B,  9tu 

Oct.  29, 

Left  ;  flaps.     Surg.  D.  B.  Allen, 

7th  Maryland,  age  41. 

21,  '04. 

dle).     Died  Oct.  1,  1864. 

Iowa,  age  19. 

29,  '63. 

30th  Iowa.   Disch'd  Aug.  26,  '64. 

680 

Angell,   G.  W.,   I't.,  K, 

Dec.  31, 

—  ;  erysipelas.     Re-amputat'n. 

639 

Weschke,  C.,l't,,  U,  67th 

May  12, 

Right:  ant.  post.  flap.     Surg.  R. 

18th  Ohio. 

—  ,  '62. 

Died  March  18.  '63  ;  exhaustion. 

New  York,  age  30. 

12,  '64. 

Sharp,  15th  N.  Jersey.     Disch'd 

681 

Arahood,  J.,  Pt.,  C,  17th 

Sept.  19, 

Left.      Died   October    17,    1803; 

May  11,  1865. 

Ohio. 

—  ,  '63. 

pneumonia. 

640 

West,  J.  SI.,  Pt.,  C,  9:th 

Mav  26, 

Left;    circ.     Surg.   E.   B.  Glick, 

682 

Artc,  Ph.,    Saddler,   H, 

Aug.  11, 

Left:  flap.     Died  November  17, 

Ohio,  age  30. 

26,'  '64. 

40th  Ind.     Disch'd  Nov.  12,  '64. 

17th  Penn.Cav.,  age24. 

11,  '64. 

1864. 

Spec.  3395. 

683 

Austin,  J.,  Pt.,  G,   IHh 

De.31,'62, 

Right.     Died  January  20,  1803. 

041 

Wetherbee,  J.  M.,  S'g't, 

Nov.  27. 

Left.     April  4,  18(54,  re-amp,  in 

Michigan. 

Jan.  1,  '03. 

B,  151st  N.  Y.,  age  25. 

27,  '63. 

upper  third.     Discharged  July 

684 

"Austin,  S.  J.,  Pt.,  A,  33d 

June  1, 

Right.     Died  July  18,  1864. 

6,  1865. 

Massachusetts. 

1,  '04. 

642 

Whartum,J..l>t.,K,  10th 

May  2, 

Right.     Recovered. 

685 

Baker,  S.,  Pt.,  B,  8th  W. 

Aug.  23, 

Left.     Died  September  20,  1803. 

Louisiana. 

2,  '63. 

Virginia. 

—  ,  '03. 

643 

Wheeler,  J.R.,Pt.,C,2d 

Dec.  13, 

Left.     Re-amp,  in  upper  third  in 

686 

Bakehouse,  II.,  Pt.,  B, 

June  3, 

Left  :    circular.      Died   April   9, 

Vermont,  age  25. 

13,  '62. 

1863.     Disch'd  April   22,  1864. 

82d  Penn.,  age  36. 

3,  '04. 

1865. 

Spec.  1  358. 

687 

Banks,    S.,    Pt.,  C,  43d 

July  30, 

Lelt  (also  ampiitat'n  right  thigh). 

644 

White,   A.,   I't.,   E,  52d 

Sept.  5, 

Right;  flap.  DiscVd  Sept.  20,'64. 

Colored  Troops. 

30,  '04. 

Surg.  D.  MacKay,  29th  Colored 

Penn.,  age  23. 

5,  '63. 

Re-amputation  May,  '65.     Died 

Troops.     Died  July  31,  1864. 

May  8.  1865. 

688 

Barstow,  T.  A.,  Serg't, 

May  27. 

Right.     Died  May  27,  1863. 

645 

White.  B.  E.,  Pt.,E,  16th 

July  3, 

Left.      Discharged    October  29, 

B,  15th  New  Hamp. 

27,'  '63.' 

Vermont. 

4.  '03. 

1863. 

689 

BaTnftt.D.  J.,V\.,  B,  42d 

May  15, 

Left.    Surg.  E.  Hutchinson,  137th 

646 

White,  J.  E.,  Serg't,  F, 

Oct.  19, 

Left;  lat.  flap.     A.  Surg.  D.  II. 

Alabama. 

—,"'64. 

N.  Y.     Died  May  25,  1864. 

160th  X.  York,  age  34. 

21,  '64. 

Armstrong,    160th    New   Y'ork. 

690 

P.assett.G.  L.,Pt.,G,19th 

May  15, 

Left.     Died  May  I'd.  1804. 

Discharged  April  28,  1865. 

Michigan.    • 

15,'  '04. 

647 

Wliitesell,  D.  A.,  Serg't, 

July  2, 

Left:  flap.  A.Surg.H.K.Spooner, 

691 

Bates,  E.  C.,  Pt..  C,  9th 

June  30, 

Right.       Died  August   12,   1864  : 

C,  5th  Art'y,  age  20. 

3,  '63. 

55th  Ohio.     Disch'd  Oct.  12/03. 

Maine,  age  17. 

30,  '04. 

exhaustion. 

fi48 

Whitlow,  J.  II.,  Pt.,  A, 

Julv  2, 

Right.    Retired  February-2,  1865. 

692 

Baysman,T.,Pt.,D,  14th 

Mar.  30, 

Right  (also  w  (1  left  leg  and  hand); 

57th  Virginia. 

3,  '03. 

Col'd  II.  Art'y,  age  22. 

—  .  '65. 

sloughing.     Died  May  16,  '05. 

649 

Wilcox,  B.    F.,  Pt.,  E, 

Julv  20, 

Right    flap;  gangrene.     Disch'd 

693 

Billings,  D.,  Serg't,  A, 

July  20, 

Right.     Died  October  9,  1804. 

149th  N.  York,  age  22. 

20,"  '64. 

August  8.  1  865. 

149th  New  Y'ork. 

20,'  '64. 

650 

Wilder,  W.  W.,  Pt.,  K, 

Aug.  29, 

Right;  double  flap.     Discharged 

094 

Bird.    E.,    Pt.,    II,    8th 

Sept.  30, 

Left.      Died   October  24,    1804; 

3d  Mich.,  age  27. 

30,  '62. 

July  30,  1863. 

Michigan,  age  19. 

Oct.  1/64. 

exhaustion. 

651 

Williams,  H.,Pt.,K,  98th 

April  9, 

Left;  circ.  (amp.  right  foot,  Hey's 

695 

Black,  A.,  Pt.,  A,  3d  N. 

.Inly  30, 

Left;  circular  :  sloughing.    Died 

Pennsylvania,  age  23. 

9.  '65. 

method).     Disch'd  Oct.  6.  1865. 

Jersey,  age  43. 

30,  '64. 

August  28,  1804:  pyaemia. 

652 

Williams,  J.  B.,  Pt.,  H, 

Julv  19, 

Left:    flap.     Discharged  Julv  4, 

096 

Boling"  R.  E.,  Corp'l,  D, 

June  24, 

Left.     Died  July  25,'  1804. 

2d  Penn.  Art.,  age  27. 

19,  '64. 

1865. 

6th  Kentucky  Cavalry. 

24,  '04. 

653 

Williams.  S.  W.,  Serg't, 

Oct.  26, 

Right;  circ.     Discharged  Feb.  4, 

697 

Borosky,  J.,  P1..A,  199th 

April  9. 

Right.     Surg.  C.  M.  Clark,  39th 

•  C,27th  MIL.  age  29. 

26,  '63. 

1864.     Died  Dec.  19.  1871. 

Pennsylvania. 

9.  '65. 

Illinois.     Died  May  8.  1865. 

654 

Williams,  W.  P.,  Pt.,  B, 

Sept.  29, 

Left  ;    circular.     Disch'd   March 

698 

Bounds,  0.  J.,  Pt..  II,  39th 

Dec.  16, 

Right;  circular.     A.  A.  Surg.  R. 

188th  Penn.,  age  18. 

29,  '64. 

26,  1865. 

Alabama,  age  18. 

16,  '64. 

L.  McClure.    Died  Feb.  2,  1805; 

655 

Willis,  W.,   Pt.,    I,  8th 

Mar.  20, 

Right:  lateral  flap.     Surg.  J.  D. 

chronic  diarrhcra. 

Maine. 

27,  '63. 

Mitchell,  8th   Maine.     Disch'd 

699 

Boivcn,   ft.,   Pt.,   E,    32d 

Mav  15, 

.     Died  May  23,  1804. 

December  24.  1863. 

Alabama. 

.—."'64. 

656 

Willison,  S.  D.,  Pt.,  C, 

June  3, 

Right.     Discharged  February  4, 

700 

Bowman,  D..Pt.,  B,  15th 

Juno  3, 

Left.     Died  July  18,  1864. 

2d  Mich.,  age  28. 

3,  '64. 

1865. 

Infantry,  age  24. 

3,  '64. 

657 

Wilson.  U.,   Pt.,  A,  73d 
Ohio,  age  29. 

Oct.  29, 
29,  '63. 

Right.    Discharged  February  24, 
1864.     Died  in  1865. 

701 

Boyd,  W.J.,  Pt.,  D,  21st 
North  Carolina,  age  28. 

Oct.  19, 
19,  '64. 

Right:    circular.     Died   Novem 
ber  10,  1864;  pyaemia. 

658 

Wilson,    R.    E.,   Major, 

Nov.  30, 

Left:  circular.     To  Provost  Mar-     702    Briggs.    K.    C.,    Pt.,   P., 

Sept.  19,    .    Died  October  21,  1863. 

37th  Georgia,  age  33. 

De<!.l.'G4. 

shal  March  18,  1865.                                      125th  Ohio. 

19.  '63. 

659 

Wilson,  S.  L.,  Lieut.,  F, 

Dec.  29, 

Left.     Discharged  August  14,  '03. 

703    Brown,   A.,   Pt.,   A,   5th 

Julv  7, 

Left.     Died  July  24,  1864. 

114th  Ohio. 

29,  '62. 

N.  Y'.  Cavalry,  age  47. 

9,  '04. 

600    Wise,  W.  M.,  Lieutenant. 

May  15, 

Right.    Surg.  F.  A.  Walker.    Re- 

704 

Bryan,   M.   W.,   Pt.,   G, 

Aug.  7,     Right  (amputation  arm).    Died 

15,  '64.   j     covered.     Furloughed. 

11th  Michigan. 

7,  ^04.        September  6,  1864. 

1  OTIS  (G.  A.),  Army  Meilical  Intelligence,  in  IJoston  Medical  and  Suryical  Journal,  1862,  Vol.  LXVI,  p.  239. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


503 


NO. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

705 

Bryant,  J.,  Pt.,  G,  23d 

May  14, 

Right.     Died  July  14,  1864. 

749 

Green,  J.  L.  W.,  Pt.,  F, 

Dec.  13. 

Right:   circular.     Died  January 

Michigan. 

14,  '64. 

26th  New  York. 

13,   62. 

2,  1863. 

786 

Bunn,  J.  K.,  Pt.,  6th  N. 

May  28. 

Left  ;   circular.     Died  June  22, 

750 

Green,  R.  B.,  Pt.,  G,  7th 

Dec.  13, 

Left.    Died  January  2,  1863. 

York  Battery,  age  19. 

28,":64. 

1864  ;  pyaemia. 

Rhode  Island. 

—  ,  '62. 

707 

Burge,  W.,  Pt,  K,  103d 

Nov.  25, 

Left.     Surg.  J.  Hutchison,   15th 

701 

Griffith,  J.,   Pt.,  H,  4th 

June  2, 

Right  ;  circular  ;  sloughing.  Died 

Illinois. 

25,  '63. 

Michigan.     Died  Dec.  16,  1863. 

Delaware,  age  39. 

4,  '64. 

July  1,  1804. 

708 

Burr,   G.,    Pt.,   K,  25th 

June  30, 

Left;  sloughing,     Died  July  12, 

752 

Hall,  H.,    Pt.,    K,    50th 

July  22, 

Right.     Surg.  J.  C.  Welch.  20th 

Mass.,  ago  39. 

30,  '64. 

1804  :  exhaustion. 

Ohio,  age  20. 

22,  '64. 

Kentucky.      Gangrene.      Died 

709 

Campbell,  S.,  Pt,  A,  63d 

June  3, 

—  •.     Surg.  J.W.  Wishart,  140th 

Septembers,  1804. 

New  York. 

3,  '64. 

Penn.     Died  June  8,  1864. 

753 

Hall,  J.  F.,  Pt.,  B,  68th 

July  3. 

Right.     Died  August  1,  1803 

710 

Carknaril,  J.  E..  Pt.,  E. 

June  10, 

Left  ;  circ.     Surg.  J.  E.  Pomfret, 

Pennsylvania. 

-,  '«»; 

7th  N.  Y.  Heavy  Artil 

17,  '64. 

7th  N.  Y.  H'vy  Artillery.    Died 

754 

Hanson.  J.,   Pt,  K,    3d 

July  4. 

Left.     Died  July  9,  1804. 

lery,  age  21  . 

July  28,  1864. 

Wisconsin. 

—  ,  '64. 

711 

Carney,  A.   li.,  Pt.,  E, 

Mar.  25, 

Right.     Died  April  19,  1865. 

755 

Harrigan,W..Pt.,M,24th 

June  16, 

Right.     Died  July  13,  1864. 

55th  N.  Carolina. 

25,  '65. 

N.  York  Cav.,  age  21. 

10,  '04. 

712 

Carrington,  W.  1  1  .,  Serg't, 

Mar.  14, 

Left.     Died  May  9.  1862. 

756 

Harris,  R..  Pt.,  G,  132d 

Feb.  1  . 

Left:  circ.     A.  Surg.  J.W.  Gray, 

E,  51st  New  York. 

14,  '62. 

New  York,  age  20. 

2,  '04. 

96th  N.  Y.     Died  May  20,  1864, 

713 

Chedister,  J.  A.,  Pt,  I, 

Sept.  3, 

Left.     A.  A.  Surg.  J.  R.  Uhler. 

unTlcr  intt.  chlo.  during  operat'n. 

15th  West  Va.,  age  30. 

4,  '64. 

Died  October  3,  1804. 

757 

Hart,   J.,   Pt.,   G,    74th 

July  22, 

Right.     Died  August  14,  1864. 

714 

Childers,JU.,  Pt,  G,  15th 

April  6, 

Left.     Died  May  5,  1805;   gan 

Indiana,  age  29. 

22  "  '04 

Virginia,  age  42. 

8,  '05. 

grene. 

758 

Hartman,  T.  R..  Serg't, 

Mar.  30, 

Right:  lateral  flap.     Died  June 

715 

Christy,  D.  L.,  Serg't,  C, 

May  5, 

Left  ;    circular.     Died   June   18, 

K,  88th  Penn.,  age  21. 

31,  '65. 

7,  1865.      . 

102d  1'eun.,  age  24. 

6,  '04. 

1804  ;  exhaustion. 

759 

Henry,   P.,  Pt.,  C,  78th 

May  31. 

Left.     Died  July  15.  1804. 

716 

Cobleigh,  J.  W.,  Serg't, 

Mar.  25, 

Right  :  flap.     Died  March  28,  '05  ; 

Pennsylvania. 

31,  '64. 

A,  IstVt  H.  A.,  age  24. 

25,  '65. 

exhaustion. 

760 

Higgius",  A..Pt.  E.  104th 

Aug.  l!», 

Left;  ant.  post.  flap.    Surg.  E.  G. 

717 

Cogan.W.  Il.,l't,  l!,69th 

Aug.  16, 
1  6   '04 

Left.     Died  September  16,  1804  ; 

New  York,  age  23. 

19,  '64. 

Chase,  104th  N.  Y.     Died  Sept. 
*^3  1804  •  erv**iix*l'is 

718 

>Cox,J.  /•'.,Capt.,D,  29th 

Aug.  31, 

Left;    gangrene;    erysip.     Died 

761 

Hilsondegen,  J.,  Pt.,  F. 

Sept.  30, 

Left,     Died   November  0,    1804  : 

Mississippi,  age  31. 

31,  '04. 

October  31,  1864. 

16th  Michigan. 

30,  "64. 

pyaemia. 

719 

Crowlev,  J.,  Pt.,  K,  88th 

May  1, 

Right  (also  amp.  left  great  toe); 

702 

Hinkle,J.  H.,Pt.,I,70th 

May  15, 

Left.     Died  June  1,  1864. 

New  York. 

1,  "03. 

haem.     Died  May  26,  1863. 

Indiana. 

15,  '64. 

720 

Culler,  M.,   Pt.,   IF,  73d 

Nov.  30, 

Left,     Died  December  28,  1864. 

763 

Hobson,  .I.E.,  Pt.,  Brook's 

May  2, 

;  flap;  typhoid  fever;  haem. 

Illinois,  age  22. 

Dec.1,'04. 

1st  Va.  Art'v,  age  23. 

4,  ;63. 

Died  May  29,  1863. 

721 

Daugherty,  J.,  Pt.,C,  1st 

July  1, 

Left  (also  w'd  of  leg).  Surg.G.  W. 

764 

Holmes,  W.  j'.,V\.,(',,  33d 

July  20, 

Loft  ;  circ.     Died  Dec.  24,  1804  ; 

Delaware. 

1.  '03. 

New,  7th  Ind.     Died  July  3,  '63. 

Mississippi,  age  18. 

22,  '04. 

chr.  diarrh.     Specs.  4243,  4244. 

722 

Davis,  A.  W.,  Corp'l,  F, 

July  12, 

Right.     Confed.  surgeon.     Aug. 

705 

Honestea,  L.,Pt,  B,  10th 

May  5, 

Right.     Died  November  2,  1804; 

14th  N.  C.,  age  24. 

12,  '04. 

4,  re-amp,  upper   third.      Died 

Infantry,  age  18. 

5,  '64. 

variola. 

Aug.  10,  1804.     Spec.  2923. 

766 

Howell,  J.  H.,  Pt.,C,  23d 

May  14. 

Left.      Surg.  D.  L.   Heath,  2:  Id 

723 

Davis,  W.,  Pt.,  H,  48th 

June  3, 

Right  ;    circular.     Died  Septem 

Michigan. 

14,"  '64. 

Mich.     Died  July  6,  1804. 

Pennsylvania,  age  28. 

3,  '64. 

ber  5,  1864  ;  diarrhoea. 

767 

2  Hoyt,  H.  H.,  Pt.,  D,  6th 

Oct.  2.', 

Right  ;  post.  flap.  'A.  A.  Surg.  T. 

724 

Davis,  W.,  Pt.,   A,  31st 

July  30, 

Left;  ant.  post.  flap.     Died  Sept. 

Connecticut. 

24,  '62. 

T.  Smiley.     Died  Oct.  30,  1862; 

Maine,  age  19. 

3  1,  "'04. 

(i,  1864  ;  pyaemia. 

gangrene'.     Spec.  733. 

725 

DeBarr,  G.,  Pt,  B,  109th 

July  14, 

Loft  ;  pyaemia.    Died  September 

7>  - 

Hubbard,  J.,  Pt.,  I,  10th 

Dec.  14, 

Left  ;  circ.    Surg.  G.  A.  Otis,  27th 

New  York,  age  35. 

14,'  '04. 

25,  1864. 

Connecticut,  age  !>8. 

14,  '02. 

Mass.    Haem.    Died  Dec.  10,  '02. 

726 

Detchon,  W.  F.,  Pt.,  9th 

July  30, 

Left;  circular;  sloughing.     Died 

769 

Hukill,  W.   T.,   Pt.,  E, 

May  16, 

Right.     Surg.  J.  Pogue,  GOth  111. 

Co.,  00th  Ohio,  age  19. 

30,"  '04. 

August  13,  1804;  exhaustion. 

66th  Illinois. 

16,'  '64. 

Died  July  9.  1804  ;  pyaemia. 

727 

Devereux,  C..  Corp'l,  F, 

Oct.  19, 

Right  :  ant.  post.  flap.   Died  Nov. 

770 

Hyatt,  C.,  Capt,  E,  Oth 

Aug.  21, 

Left.     Die'd  September  22,  1864. 

1  1th  Vermont,  age  33. 

19,  '04. 

17,  1864;  exhaustion. 

Wisconsin. 

21,  '04. 

728 

frangan,  C.,  Pt,  H,  32d 

Nov.  25, 

Left.     Died   March   2,  1864;  in 

771 

Ingraham,  G.  M.,  Pt.,  M, 

June  24. 

Left;  circular.     Died  August  10, 

Alabama,  age  28. 

—  ,  '63. 

flammation  lungs. 

4th  N.  Y.  H.  A.,  age  19. 

24,  '04. 

1864. 

729 

Easterbrook,  S.,   Pt.,  F, 

May  12, 

Right.     Died  May  24,  1804  ;  ery 

772 

Johnson,  J.  M.,  Pt.,  E, 

July  30, 

Left;  circ.     Surg.   F.  M.  Weld. 

R.  Island  Art.,  age  48. 

12,  '64. 

sipelas. 

43d  Col'd  Troops. 

30,"  '64. 

27th  C.  T.     Died  Aug.  5,  1864. 

730 

Edson,   H.,  Pt.,  C,  22d 

May  10. 

Left  ;  ant  post.  flap.     Surg.  I.  H. 

773 

Johnson,  T.  B.,  Pt.,  II, 

Nov.  30, 

Left  ;    circular.     Died    May  27, 

Massachusetts,  age  35. 

11,  '64. 

Steans,  22d  Mass.      Sloughing. 

19th  Arkansas,  age  35. 

30,  '64. 

1865. 

Died  Juno  30,  1804;  exhaustion. 

774 

Johnson,    Z.,   Pt.,  I,  8th 

May  9, 

Left.     Died  June  6,  1862. 

731 

Elder,   W..   Pt,   F,    03d 

May  5, 

Right  (also  tract,  cranium);  circ. 

Wisconsin. 

—  ,  '62. 

Pennsylvania,  age  21. 

6,  '"64. 

Died  May  30,  1804. 

775 

Jones,    P.,   Pt.,    I,    9th 

Sept.  29, 

Right.     Died  October  12,  1804. 

732 

Fisher,  L>.  E.,  Pt,  B.  Oth 

July  20, 

R't.     Surg.  A.  M.Wilder,  U.  S.V. 

Col'd  Troops,  age  23. 

29,  '64. 

Pennsylvania,  age  31. 

20,"  '64. 

Died  Nov.  12,  '04  ;  exhaustion. 

776 

Kendall,  Z.,  Pt.,  G,  llth 

June  1, 

Left.     Surg.  H.  Plumb,  2d  Conn. 

733 

Flore,  C.,  Pt.,   G,    10th 

April  5, 

Left  ;  circ.     A.  Surg.  F.  H.  Milli- 

Vermont. 

1,  '04. 

H.  A.     Died  Oct.  31,  1804. 

Minnesota,  age  23. 

5,  '65. 

gan,   10th  Minn.     April  20,  re- 

777 

Kent,  H.  O.,  Pt.,  E,  4th 

Dec.  13, 

Right.    Died  December  19,  1862: 

amputation.    Died  May  11,  '05. 

Vermont. 

13,  '62. 

tetanus. 

734 

Fogle,  M.  P.,  Corp'l,  A, 

June  14, 

Right.     Surg.  R.  Watts,  "jr.,  133d 

778 

Kipp,  G.  J.,  Pt,    I.  1st 

May  5, 

Left.     Died  June  20,  1864. 

133d  New  York,  age  31. 

14,  '63. 

N.  Y.     Haem.;  lig.  post,  tibial. 

New  Jersey,  age  21. 

5,  '64. 

Died  Nov.  17,  1803. 

779 

Krappman,  A.,   Pt.,  A, 

July  2, 

Left.    July  16,  haemorrhage,  24 

735 

Forbes,  J.  K.,  Pt,,  A,  5th 

Sept.  19. 

Left     Died  September  23,  1862. 

40th  N.  York,  age  29. 

4,  '63. 

ounces  ;  fatal. 

Iowa. 

19,  '62. 

780 

Lamphere,  L.  O.,  Pt,,  E, 

June  30. 

Right  (also  amput'n  left  thigh): 

736 

Foxier,  C.  R,  Pt.,  D,  27th 

Aug.  21, 

Right  ;  circular  ;  pyaemia.    Died 

21st  Conn.,  age  19. 

30,  '04. 

sloughing.     Died  July  22,    64; 

South  Carolina,  age  29. 

22,  '64. 

September  17,  1804. 

tetanus. 

737 

Fox,  J.  M.,  Pt.,  C,  61st 

July  22, 

Left.     Died  August  27,  1804. 

781 

Larkins,  J.,  Pt.,  E,  37th 

July  30, 

Right:  circ.     Surg.  G.  W.  Snow, 

Ohio. 

22,  '64. 

Wisconsin. 

30.'  '64. 

35th  Mass.     Died  July  30,  18'i4. 

738 

Francis,  C.,  Pt.,  H,  83d 

Juno  27, 

Left.     Aug.  6,  ro-amput'n.    Died 

782 

Laughlin,  E.  AV.,  Pt.,  E, 

Jan.  11, 

Left.     Feb.  9,  re-amput'n.     Died 

Pennsylvania. 

28,  '62. 

August  9,  18(52;  pyaemia. 

77th  Illinois,  age  19. 

11,  '63. 

February  1  9,  1863  ;  pyaemia. 

739 

Frost,  A.  C.,  Pt.,C,  15th 

July  2, 

Left.    Sept  12,  amp",  thigh.  Died 

783 

Layton,  J.,  1't.,  F,  4th 

June  19, 

Right.     Surg.  W.  Watson,  105th 

Massachusetts. 

—  ,  '63. 

Sept,  10,  1863  ;  gangrene. 

N.  Y.  Heavy  Artillery. 

20,  '64. 

Pennsylvania.     Died  June   28,  ' 

740 

Fry,  W.  H.,  Pt.,  H,  50th 

May  12, 

Left     Died  June  14,  1864. 

1864.  'Spec.  2649. 

Pennsylvania,  age  21. 

13,"  '64. 

784 

Leesholts,   W.,   Pt.,   G, 

May  25, 

Right.     Surg.  H.  B.Whiton,  60th 

741 

Galligh'er,  T.,  Pt.,  D,  4th 

June  3, 

Left.     Died  June  11,  1864. 

147th  Pennsylvania. 

25,'  '04. 

N.  Y.     Died  June  4,  1864. 

Delaware. 

3,  '64. 

785 

Leight,  E.  P.,  Serg't  Maj., 

May  4, 

Right;  circular.     Died  July  12. 

742 

Gerhart,  J.,  Pt.,  B,  49th 

May  10, 

Left.     Died  June  1,  '04  ;  pyaemia. 

1st  Mass.  Cav.,  age  24. 

4,  '"04. 

1864. 

Pennsylvania,  age  32. 

10,  '64. 

786 

Lieber,  J.,  Corp'l,  B,  1st 

Nov.  24, 

Left     Died  December  27,  1863. 

743 

Gibbs,  M.,  Pt.,  C,  139th 

April  2, 

Left  ;  ant.  post.  flap.     Died  May 

Ohio. 

24,  '63. 

Pennsylvania,  age  32. 

2,  '05. 

10,  1865  ;   exhaustion. 

787 

Littlefield,  L.  P.,  Pt.,  K, 

May  19, 

Right;    flap:    erysipelas;    gang. 

744 

Gillam,  J.    11.,   Pt.,  K, 

Sept.  14, 

:  sloughing.     Died  October 

1st  Mass.  H'vy  Art'y. 

19,'  '64. 

Died  May  24.  1864. 

15th  North  Carolina. 

16,  '62. 

12,  1862. 

788 

Livingston,  J.,  Pt.,  A,  1st 

May  9, 

Right;  lateral  flap.     Surg.  S.  S. 

745 

Goodsell,  C.  H.,  Pt.,  C, 

May  3, 

Left.     Died  August  3,  1863. 

Mich.  S.  S.,  age  18. 

10,  "'64. 

French.  20th  Michigan.      Died 

124th  New  York. 

3,  fS3. 

June  21,  1864;  pyaemia. 

746 

Goodwin,  T.,  Pt.,  H,  22d 

May  15, 

Left  :  circ.     Surg.W.  C.  Bennett, 

789 

Lockland,  B.,  Pt.,  C,  3d 

Sept.  23, 

Left.     Died  October  11,  1803. 

Wisconsin. 

15,"  '64. 

U.  S.  V.     Died  July  12,  1864. 

Artillery,  age  25. 

23,  '03. 

747 

Graff,    S.,    Pt.,    B,    83d 

May  3, 

Right.     Died  July  3,  1863. 

790 

Long.  M.'B.,  Pt,  B.  12th 

Aug.  30. 

Loft.     Surg.  E.  M.  Rogers,  12th 

Pennsylvania. 

3,  '"63. 

Wisconsin,  age  24. 

30,  '04. 

Wis.     Died  Nov.  23,  1864. 

7-18 

Grant,   P.,  Pt.,   B,  67th 

May  12, 

Left.     Died  May  24,  1864. 

791 

3Looney,  M.,  Pt.,  B,  1st 

May  31, 

Left;  circular.     Died  June8,'64: 

Ohio. 

12,  '64. 

Mass.  Cav.,  age  23. 

J'el,'04. 

pyaemia. 

1  JONES  (J.),  Investigations  upon  the  Nature,  Causes,  and  Treatment  of  Hospital  Gangrene,  etc.,  in  U.  S.  San.  Com.  Mem.,  Surg.  Vol.  II,  p.  260. 

2SMILEY  (T.  T.),  Twenty  Cases  of  Gunshot  Wounds,  in  Boston  Medical  and  Surgical  Journal,  1863,  Vol.  68,  p.  419. 

3Lll>KI.T.  (J.  A.).  On  lite  Secondary  Traumatic  Lesions  nf  Bone,  etc.,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  N.  Y.,  1870,  p.  283. 


504 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS.  OPERATORS. 
RESULT. 

No. 

NAME,  MILITARY          ., 
DESCRIPTION,  AND  AGE. 

OPERATIONS,  OPERATORS, 
RESULT. 

792 

Loper,  It.,   1't.,   F,  25th 

May  14, 

Left.     Died  July  21',  1864. 

839 

Roach,  W.,  Pt.,  F,  27th 

June  18, 

Left.     Surg.  G.  T.  Stevens,  77th 

Michigan. 

14,"  '04. 

Massachusetts,  nge  44.       18,  '64. 

New  York.     Died  July  6,  1864  ; 

|793 

%Lottridge,  D.  P.,  I't.,  M,     Dec.  6, 

Left  :  circular.     Died.  December 

exhaustion. 

2d  New  York  C'avalrv.  ;    6,  '04. 

20,  1804;  exhaustion. 

840 

Rogers,  J.  F.,  Pt.,G,  24th     April  8, 

Right.     Died  May  17,  1864. 

794 

Lovilett,  P.C.J't.,  H,  1st     May  19. 

Right:  flap.     Died  June  7,  1864. 

Iowa.                                    8~  '64. 

Mass.  H.  Art'v,  ago  23. 

19,  '04. 

841     Rosser,  J.,  Pt,,  B,  110th     Oct.  19, 

Left.     Died  October  24,  1864. 

795 

Luther,    F.,  Corp'l,    K, 

July  3, 

Right.    Surg.  C.  S.Wood,  00th  N. 

Ohio. 

19,  '04. 

52d  North  Carolina. 

—  ,  ?63. 

Y.     Died  Sept.  14,  1863. 

842 

Ryan,    T.,    Pt.,    E,   8th 

Aug.  21, 

Right  ;  circ.     Surg.  A.  A.  White, 

796 

Magnus.  X.,  Pt.,  A,  llth 

Aug.  25, 

Left;  Teal's  method.    Surg.  C.E. 

Maryland,  ago  23. 

21,  '04. 

8th  Md.     Haem.,  32  oz.     Died 

Colored  Troops.                 20.  '0-1. 

Swasev.  1'.  S.  V.     Died  March 

Sept.  16,  1864;  haemorrhage. 

12.  1865. 

843    Sabine,  C.  D.,  Corp'!,  II, 

April  9, 

Left;   circ.  (also  w'nd  clavicle); 

797 

Marks,  P.,  Corp'l,  A,  1st     July  2, 

Right.     Surg.  C.  S.  Wood,  60th 

100th  New  York. 

11,  '63. 

slough.;  pneum.    Died  April  30, 

Minnesota.                         '    2,   63. 

N.  Y.     Died  July  24,  1803. 

1863;  pyaemia.    Spec.  1188. 

798 

Marquis,  W.  II.,  Pt.,  K,    Aug.  27, 

Left  (amp.  right  shoulder  joint); 

844    Sackhimer,  G.F.,  Serg't, 

June  22, 

Left;    circular.     Died  June  29, 

8:Jd  Penn.,  age  20.           :    27,  '03. 

lig.  brachial.    Died  Sept.  12.  '03. 

H,  81st  Penn.,  age  27. 

24.  '64. 

1864  ;  gangrene. 

799 

Marsh.  W.W.,  Pt.,  I,  14th    .July  20, 

Loft:  flap.     Surg.  W.  V.  White, 

845    Snncerman,  G,  Corp'l,  G, 

May  5, 

Left:    circular.      Died  May   30, 

New  York  Heavy  Ar-     2<i,  '64.        r>7th  Mass.     Died  Jan.  S3,  1  865  ;                105th  Penn.,  nge  34. 

5,  '04. 

1804  ;  exhaustion. 

tillery,  age  29.                                       phthisis  pulmonalis.                         810    Sanford,  L.,  Bugler,  C, 

July  3, 

Left.     Died  July  12,  1863. 

800 

Martin,   F.,  Pt.,   K,  1'th    July  24,  ;  Left  ;  flap.     Died  Aug.  7,  1801; 

73d  Ohio. 

—  ,  "'63. 

Maine,  age  20.                    24,"'64. 

exhaustion.                                      i  847    Schappie,  N.,  Pt.,  K,  7th 

April  7, 

Left;  flap:   gangrene;   anannia; 

801 

McAfoot.  (J.  W.,  Pt.,  A,     Dee.  13. 

Left  ;  erysipelas.     Died  April  11, 

New  York,  age  30. 

8,  '05. 

diarrhoea.     Died  May  12,  1865. 

8th  Penn.  lies.,  age  20.       ].">.  '02. 

1803:  nvmmia. 

848 

Schmehl,    M.,    Pt.,    D, 

Mar.  31, 

Left.   April  24,  re-amput'n.    Died 

802 

McCuhan,  J.  D.,  Pt.,  H, 

.Inly  20,  !  Left.     Died  July  2,">,  1864. 

198th  Penn.,  age  19. 

31,  '05. 

April  25,  1805:  tetanus. 

40th  Pennsylvania. 

20."  '04. 

849 

Seville,  J.,  Pt.,  II,  123d 

Dec.  13, 

Left.    Died  December  26,  1862; 

803 

McCardle,  J.,  Pt.,  E,  2d 

July  2, 

Right  (also  amp.  left  upper  third). 

Pennsylvania. 

—  ,  '62. 

tetanus. 

Pennsylvania,  age  23. 

2,  '04. 

Died  July  3,  1804.                           850 

Shannon,  E.,  Pt.,  I,  38th 

April  13. 

Lett.     Died  May  5,  1863. 

804 

McCool,  A.,  Pt.,  E,  188th 

June  1, 

Right  (also  flesh  w'd  right  thigh); 

Massachusetts. 

13.  '63. 

Pennsylvania,  age  21. 

1,  '64. 

circular.     Died  July  21,  1804.       i  851 

Shea,  D.,   Pt.,   F,   13th 

June  3, 

Left.     Died  June  25,  1864. 

805 

McCool,  J.G.,Pt.,  I,  44th 

Sent.  19, 

Left.     Died  October  13,  1863.                 ;     New  Hampshire. 

3,  '64. 

Illinois.                                  19.  '03. 

'  852    Simmington,  J.  S.,  S'g't, 

Sept.  10, 

Right.     Surg.  E.  A.  Clarke,  8th 

801 

McGraw,  F.,  Pt.,  K,  42d 

July  3, 

Right.     Died  August  14,  3803. 

i     B,  10th  Illinois  (Jay. 

10,  '63. 

Mo.  Cav.     Died  Oct.  9,  1863. 

New  York. 

3,  '«3. 

8.">3    Smiley,    W.   J.,  Pt..  F, 

June  24, 

Right.     Died  September  22,  1864. 

807 

Mc.Guire,  J.,  Corp'l,  D, 

Mav  5, 

Left.    Died  May  14,  1804;  haem 

9th  Alabama  Cavalry. 

—  ,  '04. 

40th  New  York,  age  21. 

5,  *64. 

orrhage  and  exhaustion. 

854    Smith,  G.  M.,  Pt.,  B,  Oth 

June  20, 

Right.     Died  July  18,  1863;  py- 

808 

McMillan/I'.,  Col'd  serv 

Nov.  25, 

Left.    Surg.  A.  M.Wilder.T.S.V. 

Ohio  Cavalry,  age  38. 

21,  '63. 

aomia. 

ant,  r>0th  Pennsylvania. 

25,  '03.        Died  Decembers.  1803. 

855    Smith,  .1.  S.,  Pt.,  F,  2d 

June  2, 

Left;  flap.     Dr.  A.  Garcelon,  of 

809 

Meekins,  J.,   Pt.',  F,  2d 

July  18,     Right;    flap.     Died   August   11,: 

N.Y.  H'vy  Art.,  age  17. 

2,  '64. 

Maine.     Died  July  29,  1864. 

Penn.  Art'v,  age  45. 

18,  '04.        If  64. 

850    Smith.  W.    H..  Pt..   II. 

June  1, 

Left.     Died  June  28,  1864. 

810 

Mitchell.  C.   J5.,  Lieut., 

Sept.1,     Left.     Died  September  20,  1804. 

23d  Penn.,  age  22. 

1,  '64. 

E,  14th  Ohio. 

—  ,  '04. 

857 

Southworth,  W.  B.,  Pt., 

Nov.  25, 

Left.     Died  April  2,  1864,  of  ty 

811 

Mitchell,  W.  J.,  Pt.,  F, 

June  17.    Right.     Died  July  21,  18G4. 

F.  42d  Illinois,  age  25. 

25,  '63. 

phoid  fever. 

50th  Mass..  age  40. 

18,  '04. 

858 

Spriggle,  15.,  Pt.,  J,17th 

July  10, 

Left  ;  flap.     Died  August  16,  '63. 

812 

Miz:elle,  R.,  Pt,,  D,  17th 

May  21, 

Left;  circular.     Died  August  1, 

Penn.  Cavalry,  age  28. 

10,  '63. 

Spec.  3878. 

North  Carolina,  age  18. 

21,"  '64. 

1804. 

859 

Stahli,  U.,  Pt.,"B,  187th 

Aug.  19, 

Left  ;  circular.     Died  September 

813 

Monson,  J.,  Pt.,  H,   2d 

June  1, 

Left;  circular.     Died  August  30, 

Penn.,  age  17. 

20,  '64. 

7,  1864  :  pyaemia. 

Conn.  H.  Art.,  age  27. 

3,  '04. 

1804. 

860 

Stiers,  W..  Pt.,  A,  97th 

June  22, 

Right.     Died  July  27,  1864. 

814 

Moore,  A.,  Pt.,  A,  61st 

July  12, 

Left;    gangrene.      Died   August 

Ohio. 

22,  '64. 

Pennsylvania,  age  25. 

12,  '04. 

7.  1804. 

861 

Stiteler,  C.,  Pt.,  D,  16th 

Sept.  19, 

Right.    Died  September  29,  '63  : 

815 

Moreloc'k,W.,Pt.,  1,  19th 

May  15, 

Left.    A.  Surg.  D.L.  Jewett.  20th 

Infantry. 

19,  '63. 

tetanus. 

Michigan. 

15,  '64. 

Conn.     Died  June  24,  1804. 

862 

Stover,  J.  II.,  Pt.,  188th 

June  1, 

Left;  ant.  post,  skin  flap.     Died 

816 

Murray,  J.,  Pt.,  D,  51st 

May  0, 

Right.     Died  May  20,  1804. 

Pennsylvania,  age  21. 

1,  '64. 

June  30,  1864:  gangrene. 

New  York. 

—  ,  '64. 

863 

Sutfin.  M.,  Pt.,  II,  8th  N. 

June  3, 

Left.     Died  August  13,  1804. 

817 

Myres,G.,  Corp'l,  li,  14th 

Aug.  18, 

Right  ;   circular.    Died   Septem 

Y.  H'vy  Art'v,  age  28. 

3,  '64. 

Infantry,  age  23. 

18.  '64. 

ber  11,  1804. 

864 

Swinger,  J.,Pt'.,K,  130th 

Aug.  3, 

Right.     Surgeon  J.  W.  Lawton, 

818 

Nash,  ./.'  V.,  Serg't,  K, 

July  20, 

Right.     Sept.  20,  re-amputation. 

Indiana,  age  1  8. 

3,  '64. 

U.  S.  V.     Died  Sept.  1,1864. 

40th  Miss.,  nge  17. 

20,  '04. 

Died  October  4,  1804. 

865 

Sykes,  W.  E.,  Corp'l,  G, 

May  19, 

Left  ;  flap.     Died  June  1,  1864. 

819 

Xason,  H.,  1't.,  C,  1st  R. 

Nov.  30, 

Right  (also  amp.  left,  mid.  third); 

1st  X.  Y.  Art'y,  age  47. 

19,  '64. 

Island  Art  'y,  age  38. 

Dec.  2,  '63. 

circular;  gangrene.     Died  Dec. 

860 

Taylor,   W.    W.,  Pt.,  G, 

Aug.  20, 

Right  ;   circular.    Died  Septem 

21,  18013;  pvajmia. 

25th  S.  C.,  age  25. 

21,  '04. 

ber  12,  1804;  pya-mia. 

820) 

Nock,   P.,    Pt.,    E,    1st 

May  27, 

Both.    Died  May  27,  1803. 

867 

Taylor,  W.,  Pt.,  II,  65th 

Sept.  19, 

Left.     Died  October  13,  1863. 

821J 

Louisiana. 

27,"  '03. 

Ohio. 

19,  '63. 

822 

O'Neil,  E.,  Pt.,  K,  124th 

May  31, 

Right.     Died  June  21,  1864. 

868 

Tliilks,M.  J.,  Pt..A,19th 
Virginia. 

July  2, 
—  ,  '63. 

Right.     Died  August  G,  1803. 

823? 

Ohio. 
Paine,  A.  C.,  Pt.,  F,  42d 

31,  '64. 
July  2, 

Both.     Surg.  II.  M.  McAbce,  4th 

869 

Thomas,  F.,  Corp'l,  10th 

July  14, 

*  .     Died  July  17,  1864. 

8245 

New  York. 

3,  '63. 

Ohio.     Died  July  23,  1803. 

>7'i 

Michigan. 
Tibbetts,  S.,  Corp'l,  D, 

—  ,  '64. 
June  18, 

Left  ;  circular.    A.  A.  Surg.  O.  W. 

825 

Palm,   J.,   Pt.,    F,    22d 

Aug.  21, 

Left;  circular.     A.  Surg.  C.  W. 

1st  Me.  H.  A.,  age  29. 

20,  '64. 

Peck.     Died  July  30,  1804. 

Penn.  Cavalry,  age  19. 

22,  '04. 

Stinson.  23dlll.  Died  Sept.  2/04. 

871 

Timer,  F.,  Pt.,  F,  189th 

Mar.  30. 

Left  :  gangrene.    Died  April  28, 

620 

Parker,  M.    F.,  Pt.,    E, 

May  15, 

Left.  A.  Surg.  G.  M.Trowbridge, 

•New  York. 

31,  '05. 

1865;  exhaustion. 

19th  Michigan. 

15,  '64. 

19th  Mich.     Died  May  25,  1804. 

872 

Van  Buren,  J.  II.,  Pt.,  G, 

Sept.  19, 

Left  ;  circular.     Died  October  7, 

827 

Patterson,  J.,  Pt.,  G,  2d 

June  16, 

Right.     Died  June  22,  J  804. 

2d  Conn.  H'vy  Art'y. 

19,  '64. 

1864;  exhaustion. 

Penn.  H.  Art'}",  age  29. 

10,  '04. 

873 

Vandruff,  H.  C.,  Corp'l, 

Dec.  16, 

Left.     A.  A.  Surg.  J.  C.  Thorpe. 

828 

Perry,    A.,   Pt.,   E,  6th 

Dec.  13, 

Right.     Died  January  27,  1863. 

A,  !)7th  Ohio. 

16,  '64. 

Died  January  !>,  1865. 

New  Hampshire. 

13,  '62. 

874 

Wakefield.W.,Pt.,E,  2d 

Mar.  31, 

Left.     Surg.  S.  H.  Plumb,  82d  N. 

829 

Perry,   O.,  Pt.,   F,  41st 

July  12, 

Right;    gangrene;    amp.   thigh. 

Ohio  Cavalry,  age  20. 

A  p.  1,'65. 

York.     Died  "June  4,  1805. 

Illinois. 

12,  '63. 

Died  September  12.  1803. 

ft7r 

Ward,  T.,  ('apt.,  F,  67th 

Oct.  13, 

Left.     Died  October  21,  1804. 

830 

I'hillips,  W.  A.,  Pt.,  B, 

July  12, 

Left;  ciro.     Surg.  W.  P.  Young, 

Ohio,  age  31. 

13,  '64. 

14th  Georgia,  age  25. 

13,  'C4. 

4th  Georgia.     Died  July  24,  '04. 

870 

Wassenberg,   J.,  Pt.,  I, 

Nov.  25, 

Left.     Surg.  J.  Reily,  33d  N.  J. 

831 

Pickle,  A.  H.,Pt.,G,68th 

July  2, 

Left.  July  10,  haemorrhage,  24  oz. 

27th  Penn.,  age  23. 

25,  '63. 

Died  April  1<>,  1804. 

Pennsylvania,  age  25. 

—  ,  *63. 

Died  July  12,  1863. 

877 

Webster,  G.  W.,  Pt.,  I, 

May  6, 

Left.    Died  May  27,  1864. 

832 

Potter,    II.  W.,  It.,  G, 

July  2, 

Right.     Died  August  18,  1863. 

7th  Maryland. 

6,  r64. 

14th  Infantry. 

4,  fe. 

878 

Welch,  J.'B.,  Pt.,G,  35th 

July  14, 

Left.     Died  July  19,  1864. 

833 

Price.  R.  S.,  Pt.,  B,  1st 

July  3, 

Right  (also  amp.  forearm);  colliq. 

Iowa. 

14,  '04. 

N.  J.  Artillery,  age  25. 

4,  '63. 

diarr.    Died  Aug.  22,  '03;  exh'n. 

879 

Wells,  W.W.,  Lieut.,  F, 

May  20, 

Left;  circ.     Surg.  C.  A.  Cowgill, 

834    Quinn,  J.,  Sergeant,  A, 

Aug.  25, 

Right  ;    double   flap.      Surg.  N. 

58th  Penn.,  age  30. 

20,  '04. 

U.  S.  V.    June  (i,  re-amputation. 

17()th  New  York,   age 

25,  '64. 

Hay  ward,  20lh  Mass.  Necrosed  ; 

Died  Juno  11,  '04  ;  exhaustion. 

45. 

removal  of  6  ins.  tibia.     Died 

880 

Weyman,  J.  B.,  Pt.,  A, 

July  20, 

Left  :  circular.     Died  September 

Nov.  5,  1804.     Spec.  3320. 

Cth  Kentucky,  age  22. 

21,  '0-1. 

27,  1804:  chronic  diarrhoea. 

835 

Ransom,  J.  D.,  Capt.,  C, 

Sept.  29,    Right.     Surg.  D.  G.  Rush,  101st 

B61 

Wheatly,  J.,  Pt.,  C,  61st 

May  3, 

Right.     Died  May  21,  1803. 

142d  N.  Y.,  age  29. 

Oot.1,'64.     Penn.  Died  Nov.  10/64;  pyaem. 

Ohio. 

3,  '63. 

836 

Reed,  J.  M.,  Adj't,  10th 

April  2,     Right.     Died  April  0,  1805." 

882 

Whittier,  F.  M.,  Pt..  K, 

June  27, 

Right.     Died  July  18,  1804. 

Vermont. 

2,  '65. 

14th  Kentucky. 

27,  '64. 

837 

Reither.  J.   G.,  Pt.,  F, 

Oct.  27, 

Left.     Surg.  A.  M.  Clark,  U.  S.V. 

883 

Wilson,  A.  N.,  I't.,  I,  5th 

Aug.  30, 

Right.     Died  October  10,  1802. 

142d  N.  Y.,  age  26. 

27,  '64. 

Died  Nov.  28,  1804;  pyaemia. 

New  York. 

30,  '62. 

838 

Riley,    J.,    Pt.,   B,    9th 

Sept.  28, 

Left.     Died  October    31,    1864;  ij  884 

Wilson,  W.  C.,  Pt.,  B, 

Dec.  13, 

Left.    Died  January  13,  1863. 

Vermont,  nge  21. 

—  ,  '64. 

exhaustion. 

4th  Vermont.                      13,  '02.  j 

SECT.  V.) 


PRIMARY    AMPUTATIONS   IN    THE   LEG. 


505 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

885 

Wilts,  B.  F.,  Pt.,  A,  21st 

Dec.  31, 

Left.     Died  January  7,  1863. 

893 

Ball,   P.,  Pt.,  F,  3d  In 

May  3, 

.     Ass't  Surg.  J.  S.  Billings, 

Illinois. 

31,  '62. 

I 

fantry. 

3,  fo. 

U.  S.  A. 

886 

Wimpfler,  S.,  Pt.,  C,  9th 

Nov.  25, 

Left  (also  amp.  elbow  joint).  Died1  894 

Blackwell,    W.,   Pt.,   B, 

Mar.  19, 

Right. 

Ohio. 

25,  '63. 

December  9,  1663. 

1st  S.  C.  Artillery. 

]9,  '65. 

887 

AVinget,  C.  B.,  Pt.,  1!,  1st 

.lime  3, 

Left;  circ.     Surg.  A.  F.  Whelan,     890 

Culp,  T.  H.,  Lieut.,   H, 

Oct.  7, 

Left. 

Michigan,  nge  45. 

3,  '64. 

1st  Mich.  S.  S.     Died  July  5,    i 

9th  Georgia. 

—  ,  '64. 

1864;  exhaustion.                            896 

Page,  L.  L.,  Pt.,  E,  24th 

May  18, 

Right. 

888 

Woodrum,  J.,  Sergeant, 

Aug.  16, 

Right  ;  circ.    Surg.  W.  F.  Rich 

Georgia. 

—  ,  '64. 

I-'renoh's  Virginia    Ar 

—  ,  '04. 

ardson,  P.  A.  C.  S.     Died  Sep 

897 

Reed.  J.  W.,  Pt.,  K,  2d 

Mav  6, 

Right. 

tillery. 

tember  3,  1864  ;  pysemia. 

Louisiana. 

—  ,  '64. 

889 

Woods,  I.,  Pt.,  F,  19!ltli 

April  9, 

Right.     Died  May  29,  1865.             898 

Simms,  D.  L.,  Pt.,  C,  1st 

Oct.  1, 

Left;  circular  (also  severingtibial 

Perm.,  age  r>7. 

!>,  '65. 

Battery  Va.  Artillery. 

1,  '64. 

artery). 

890 

Wright,  A.  M.,  Capt.,  F, 

June  16, 

Left.     Died  July  2,  1864.                  899 

Speck,  A.,  ft.,  A,   17th 

Oct.  21, 

57th  X.  York,  age  22. 

Hi,  '64. 

Tennessee. 

—  ,  '61. 

891 

Wright,  D.,  Pt.,  G,  92d 

June  27, 

Left.     Died  July  17,  1864  ;    py 

900 

Thrift,    W.  H.,  Pt.,  A, 

•   pirpnlflr 

Ohio,  age  24. 

27,  '64. 

aemia. 

1st  S.'c.  Rifles. 

' 

892 

Bailey,  N.,  Pt.,  B,  14th 

Mav  12, 

Left. 

Infantry. 

—  ,  '64. 

In  thirty-eight  of  the  nine  hundred  cases  of  primary  amputations1  in  the  lower  third 
of  the  leg,  the  side  was  not  reported;  four  hundred  and  sixty-nine  operations  involved  the 
left,  and  three  hundred  and  ninety-three  the  right  limb.  Specimens  of  forty  cases  belong 
ing  to  this  group  are  preserved  in  the  Army  Medical  Museum. 

Primary  Amputations  in  the  Leg  for  Shot  Injury  in  •which  the  seat  of  Operation  was 
not  indicated. — In  five  hundred  and  seventy-one  of  the  three  thousand  three  hundred  and 
ninety-two  primary  amputations  in  the  continuity  of  the  bones  of  the  leg  the  seat  of  the 
operation  was  not  specified.  The  results  in  twenty-nine  cases  were  not  ascertained.  One 
hundred  and  twenty-four  operations  proved  successful,  and  four  hundred  and  eighteen 
fatal,  a  mortality  of  77.1  per  cent. 

Examples  of  Recoveries  after  Primary  Amputations  in  the  Continuity  of  the  JB ones  of 
the  Leg,  seat  of  operation  not  specified. — The  one  hundred  and  twenty-four  operations  of 
this  group  were  performed  on  one  hundred  and  twenty-three  patients,  in  one  instance  both 
limbs  having  been  removed.  One  hundred  and  seventeen  were  Confederate  and  six 
Union  soldiers: 

CASE  748. — Private  J.  B.  Barron,  Co.  I,  Cobb's  Georgia  Legion,  was  wounded  in  the  leg,  and  captured  at  Soutli  Moun 
tain,  September  14,  1862.  Assistant  Surgeon  H.  A.  Du  Bois,  U.  S.  A.,  described  the  injury  as  a  "gunshot  compound  commi 
nuted  fracture  of  both  bones.  The  man  was  admitted  to  the  field  hospital  at  Burkettsville,  where  amputation  by  the  circular 
method  was  performed  forty-eight  hours  after  the  reception  of  the  wound.  The  patient  recovered."  After  his  recovery  he  was 
paroled  and  sent  south.  The  Confederate  hospital  records  show  that  he  was  admitted,  on  December  4th  following,  to  the  general 
hospital  at  Petersburg,  whence  he  was  furloughed  two  weeks  later  and  proceeded  to  his  home. 

In  the  following  instance  both  legs  were  successfully  amputated  by  a  Confederate 
surgeon  on  the  day  of  the  injury: 

CASE  749. — Corporal  J.  W.  Alexander,  Co.  K,  13th  Mississippi,  was  wounded  at  the  battle  of  Fredericksburg,  December 
11,  1862.  His  injury  appears  recorded  on  a  Confederate  hospital  register  as  "gunshot  fracture  of  both  legs,  followed  by  ampu 
tation  of  both  legs  the  same  day  by  Surgeon  J.  T.  Gilmore,  C.  S.  A."  The  man  recovered,  and  was  subsequently  furnished  with 
artificial  limbs  by  the  Confederate  Association  for  the  relief  of  maimed  soldiers. 

Of  the  six  Union  soldiers  one,  an  officer,  remained  in  the  service  and  was  afterwards 
killed  in  battle;  three  were  pensioned,  and  two  do  not  seem  to  have  applied  for  pensions; 
one  of  the  pensioners  died  six  years  after  the  operation. 

CASE  750. — Lieutenant-Colonel  George  H.  ~Wardv15th  Massachusetts,  was  wounded  in  the  action  at  Ball's  Bluff.  October 
21,  1801.  Surgeon  A.  B.  Crosby,  U.  S.  V.,  states  :  "The  wound  was  inflicted  by  a  bullet;  primary  amputation  was  performed, 
the  ankle  being  shattered  and  the  circulation  cut  off."  Lieutenant-Colonel  Ward  recovered,  was  promoted  to  the  Colonelcy  of 
his  regiment,  which  he  rejoined  in  February,  1863,  and  was  killed  at  the  battle  of  Gettysburg,  July  2, 1863. 

CASE  751. — Private  M.  Higman.  Co.  B,  46th  Pennsylvania,  aged  29  years,  was  wounded  by  a  shell  in  the  right  leg,  at 
Cedar  Mountain,  August  9,  1862.  He  fell  into  the  hands  of  the  enemy  and  suffered  primary  amputation.  Two  weeks  after 
wards  he  was  conveyed  to  the  Hotel  Hospital,  at  Piedmont,  where  he  remained  until  exchanged  during  the  following  month. 
Surgeon  R.  B.  McCay,  U.  S.  V.,  recorded  that  the  patient,  after  being  paroled  by  the  enemy,  was  admitted  to  the  Chesapeake 
Smrto.  Ill— 64 


506 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


ICIIAP.  X. 


Hospital,  Fort  Monroe,  and  Surgeon  A.  E.  Stocker,  U.  S.  V.,  reported  that  he  was  discharged  January  6,  1863.  by  reason  of 
"  loss  of  right  leg."     He  was  a  pensioner  until  June  14,  1868,  when  he  died.     The  cause  of  his  death  has  not  been  ascertained. 

Fatal  Cases  of  Primary  Amputations  in  the  Leg,  seat  of  Operation  not  indicated.— 
This  group  includes  four  hundred  and  eighteen  amputations  performed  on  four  hundred  and 
twelve  patients;    three  hundred  and  forty-nine  were  Union  and  sixty-three  Confederate 
soldiers.     In  three  instances  re-amputation  in  the  thigh  became  necessary. 

CASE  752. — Private  J.  Jameson,  Co.  A,  29th  Illinois,  aged  24  years,  was  wounded  at  the  battle  of  Spanish  Fort,  March 
2'J,  1865,  by  the  explosion  of  a  shell,  which  caused  flesh  wounds  of  the  left  shoulder  and  left  hip  and  fracture  of  the  tibia  and 
flbula  of  the  right  leg.  Assistant  Surgeon  W.  E.  Waters,  U.  S.  A.,  reported  that  the  wounded  man  was  admitted  to  the  Six 
teenth  Corps  Field  Hospital,  where  the  injured  "leg  was  amputated  by  Surgeon  S.  L.  Cheamy,  29th  Illinois."  Surgeon  J.  15. 
G.  Baxter,  U.  S.  V.,  reported  the  following  result:  "The  patient  entered  Barracks  Hospital  at  New  Orleans  eight  days  after 
being  wounded.  He  had  undergone  antero-posterior  flap  amputation  of  the  leg  on  the  field.  The  flesh  wounds  were  granu 
lating  feebly.  Secondary  haemorrhage  took  place  from  the  anterior  tibial  on  April  4th,  amounting  to  thirty  ounces,  and  being 
controlled  by  manual  pressure  on  the  groin  for  forty-eight  hours.  The  patient  was  also  troubled  with  some  diarrhoea;  he  had  a 
good  constitution,  however.  Both  bones  protruded  from  the  stump,  and  no  union  of  the  flaps  took  place  up  to  April  12th,  when 
one  inch  of  the  h'bula  was  resected  by  Assistant  Surgeon  E.  McClintock,  U.  S.  V.,  who  performed  the  operation  without  using 
anaesthetics.  The  patient  died  April  18,  1865." 

CASE  753. — Private  £.  Watson,  Co.  C,  118th  Pennsylvania,  was  wounded  in  the  left  leg  during  the  engagement  at  tin- 
crossing  of  the  Potomac,  on  September  20,  1862.  Surgeon  E.  McDonnell,  U.  S.  V.,  contributed  the  following  description  of  the 
injury  and  its  result:  "The  wounded  man  was  conveyed  to  the  German  Reformed  Church  Hospital  at  Sharpsburg,  where  the 
leg  was  amputated  below  the  knee  on  September  21st.  The  operation  was  performed  for  compound  fracture  of  the  leg.  On 
September  "28th  the  patient's  condition  was  favorable,  but  during  the  following  two  days  it  was  critical.  On  October  1st,  the 
aspect  of  the  stump  was  unhealthy,  the  entire  flap  threatening  to  slough;  no  union;  discharge  black,  sanious,  and  unhealthy. 
During  the  next  two  days  he  mended  somewhat,  and  on  October  4th  he  was  much  improved.  The  difficulty  in  the  case  was  a 
complete  falling  apart  of  the  flaps,  there  being  no  union  whatever.  The  posterior  flap  was  large  and  heavy  and  composed  of 
the  thick  muscles  of  the  calf  of  the  leg,  making  a  bad  wound  to  heal  by  granulations,  the  bone  being  exposed.  October  llth. 
the  patient's  system  has  been  sinking.  He  has  some  diarrhoea  and  tympanitis,  and  was  restless  and  delirious  during  the  night. 
He  must  die  unless  the  whole  stump  is  removed  by  an  operation  above  the  knee,  and  I  have  become  sick  of  amputating  thighs 
secondarily.  October  13th,  condition  very  low;  pulse  at  times  not  perceptible;  jaws  and  body  rigid.  Patient  had  a  passage 
from  the  bowels  during  the  night  and  passed  water  quite  freely.  Small  doses  of  brandy  and  morphine  were  admimstered ;  no 
relief.  October  14th,  at  8  P.  M.,  applied  a  large  bread  poultice  to  stump.  H:emorrhage  from  stump  occurred  during  the  follow 
ing  night.  Death  at  11.30  A.  M.  on  October  15,  1862." 

TABLE  LXXI. 

Summary  of  Five  Hundred  and  Seventy-one  Cases  of  Primary  Amputations  in  the  Leg  for  Shot  Injury, 

the  point  of  operation  unspecified. 

[Recoveries,  1—104;  Deaths,  125 — 542;  Results  unknown,  ,r>43 — 571.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AUK. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  ACE. 

DATES. 

O  PEUATIONS,  OPERATORS, 
RESULT. 

>{ 

Alexander,  J.  W.,  Corp'l, 

Dec.  11, 

Both.   Surg.J.T.Gilmore,C.S.A. 

1C 

Birrd,  L.  S.,  Serg't,  D, 

May  3, 

.     Surg.  A.  S.  Flinn,  C.  S.  A. 

2) 

K,  13th  Mississippi. 

11,  '02. 

Recovery. 

10th  Virginia. 

4,  '03. 

Recovery. 

3 

Anderson,  J.  (1.,  1't.,  D, 

Sept.  17, 

.     Surg.  —  Black,  C.  S.  A. 

17 

Calhoun,  I'.  J.,  Pt.,  C, 

July  1, 

Left.  Surg.  II.  F.  Campbell,  P.  A. 

4th  Virginia. 

17,  'G2. 

Recovery. 

1st  Texas. 

3,  '02. 

C.  S.     Recovery. 

4 

At  well,  C'.  /.,  Pt.,  L,  1st 

Aug.  29, 

Right.     Surg.  W.  H.  Priolean,  P. 

18 

Calvert,  J.    W.,  Pt.,  A, 

May  0. 

.    Surg.  —  Brown,  2d  S.  C. 

South  Carolina. 

29,  '0;>. 

A.  C.  S.     Recovery. 

2d  South  Carolina. 

0,  ?64. 

Rifles.     Recoveiy. 

r 

Ildilty,  A.  B.,  Serif  't  K 

Nov.  25, 

Left.     Surg.  Smith    C.  S.  A. 

19 

Carnal    A      Pt      F    3d 

Dec  12 

Sure*                   7th    S    C 

29th  Tennessee. 

25,  '03. 

Recovery. 

South  Carolina. 

13,  '02.' 

Recovery. 

G 

Barnard,  A.  11.,  Pt.,  II, 

Sept.  30, 

Left   (right  leg   wounded).     To 

20 

Carroll,  J.,  Serg't,  C,  2d 

Dec.  13, 

.    Surg.  D.  A.  Maxwell,  P.  A. 

8th  N.  C.,  age  20. 

30,  '04. 

prison  February  22,  1865. 

South  Carolina. 

14,  '03. 

C.  S.     Recovery. 

7 

Barney,  J.,  Pt.,  I,  28th 

July  12, 

Left,     Discharged    October    31, 

21 

Carroll,  S.,  Pt.,  A,  52d 

Aug.  28, 

Right.     Surg.  —  Leethe,  C.  S.  A  . 

Illinois. 

12,"  't!3. 

1803. 

Virginia. 

28,  '02. 

Recovery. 

8 

Barron,  J.    13.,   Pt.,    (',, 

Sept.  14, 

;  circular.     Furloughed  De 

22 

Claxton,  A.  J.,  Pt.,  E, 

May  14, 

Right.     Transferred  May  28,  '04. 

(Jobb's  Ga.  Legion. 

1C,  '02. 

cember  9,  1802. 

18th  Tennessee. 

—  ,  '64. 

9 

Berry,  J.  II.,  Pt.,  G,  25th 

May  5, 

.     Recovery. 

23 

C/ai/burn,    E.,    Pt.,    II, 

May  2, 

Left;  flap.     Furloughed  Septem 

Virginia. 

0,  '64. 

55th  Virginia. 

2,  '03. 

ber  24,  1803. 

10 

Hir.kM,N.J..V\.,h.,4.m\ 

Oct.  14, 

—  .    Ass't  Surg.  B.Chears,  48th 

24 

Clinton,    T.  L.,  Pt.,  II, 

May  2, 

Right.     Surg.   R.  J.  Hicks.  23d 

North  Carolina. 

15,  '03. 

North  Carolina.     Recovery. 

23d  North  Carolina. 

2,  ;C3. 

North  Carolina.     Recovery. 

11 

Bishop,  II.    I).,    Pt.,  K, 

June  30, 

—  .   Surg.  —  Capeheart,  C.S.  A. 

25 

Cotfy,    D.,    Pt.,    P.,    32d 

July  22, 

Left.     Transferred. 

Kith  Virginia. 

30,  'OJ. 

Recovery. 

Alabama. 

22,  '04. 

12 

Btakemore,   W.  T.,  Cap 

M  a  v  20, 

Eight.     Surg.    R.   D.    Jackson, 

26 

1  Collins,  J.,  Pt.,  F,  10th 

Sept.  19, 

—  ;  flap.    Recovery. 

tain. 

20,'  '04. 

C.  S.  A.     Recovery. 

South  Carolina. 

19,  '03. 

13 

Boatwrif/ht,  J.  D.A.,  Pt., 

May  0, 

.     Surg.  M.  S.  Thomas,  P.  A. 

27 

Conrad,  B.  F.,  Lieut.,  A, 

May  0, 

.     Surg.  —  Horton,  C.  S.  A. 

D,2d  Florida. 

0,  '04. 

C.  S.    Recovery. 

35th  Virginia. 

7,  '04. 

Recovery. 

14 

Broksher,  C.  E.,  Sorg't, 

July  2, 

Right.     Paroled"  September  25, 

28 

Cooper,  A.   B.,   Pt.,  D, 

May  14, 

Right.     Transferred  June  10,  'M. 

K,  24th  (la.,  ago  27. 

4,  '03. 

1803. 

18th  Alabama. 

—  ,  '04. 

1!) 

lirowne,    S.  B.,   Pt.,   15, 

June  30, 

—  .    Confederate  surgeon.    Re 

»~j 

Cormicle,  K.  SI.,  Pt.,  II, 

Oct.  11, 

.    Surg.  —  Owens.    "Recov 

llth  Alabama. 

30,  '02. 

covery. 

4th  Virginia  Cavalry. 

11,  '63. 

ery. 

1  TERRY  (C.),  Report  of  Wounded  treated  in  Field  Hospital  of  Iliiidman's  Division  after  the  battle  of  Chickamaiiya,  in  Confederate  States  Medical 
aiid  Surgical  Journal,  1804,  Vol.  I,  p.  70. 


SECT.  V.] 


PRIMARY    AMPUTATIONS    IN-   THE    LEG. 


507 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

30 

Crawford,  E.  D.,  Pt.,  A, 

June  11, 

—  .    Union  surgeon.    Recovery. 

77 

McNiel,  II.   M.,  Pt.,  E, 

April  20, 

Left;   ant.  skin.  post.  nius.  skin 

7th  Georgia. 

11,  '64. 

56lh  N.  C.,  nge  26. 

20,  '64. 

flap.    Surg.  C.  11.  Ladd.C.  S.  A. 

31 

Cross,  J.  W.,  Pt.,  C,  Ga. 

Aug.  1, 

Left.     Surg.  —  Metcalf,  C.  S.  A. 

Disch'd  June  15,  1864. 

Legion  Cavalry. 

Recovery. 

78 

Michie,  I).,  Pt.,  A,  Jeff.      July  9, 

Left.     Recovery. 

32 

Dry,  O.  F.,  Pt."    1!;  2d 

June  27, 

Right.     Surg.    H.  11.   Hubburd, 

Davis  Legion. 

9,  '63. 

Mississippi. 

27   '(  >2. 

1'.  A.  C.  S.     Recovery. 

79 

lMiddlelon,   J.,    Pt.,   L, 

Sept.  I1.), 

;  flap.  Surg.T.P.  Bailey,10th 

33 

Eehaluz,    J.   F.,   Corp'l, 

May  3~l  , 

Left.     Discharged  December  12, 

10th  South  Carolina. 

19,  '63. 

S.  C.     Trans.  Oct.  31,  1863. 

II.  05th  New  Turk. 

31.  '62. 

1862. 

80    Miller,  L.,  Pt.,  Pure-ell's    Aug.  29, 

Left.     Surg.  —  Haynes,  C.  S.  A. 

34 

Falkland,  J.  B.,  1't.,  D, 

Sept.  30, 

Left.     To  prison  April  13,  1865. 

Battery. 

29,  '62. 

Transferred  Jan.  30.  1863. 

8th  N.  C.,  age  22. 

30,  '64. 

81    Miller,  I'.,  Pt.,  11,  33d 

July  21, 

.   Surg.  H.  MeG  uire,  C.S.  A. 

35 

Fisher,  C.,    Pt.,   G,   2d 

July  3, 

Virginia. 

21,  "61. 

Recovery. 

North  Carolina. 

3,  '63. 

82 

Mills,  J.   P.,  Lieut.,  G, 

May  3, 

Left.     Transferred  July  9,  1863. 

'36 

Flaherty,  G.  W..  Pt.,  A, 

July  20, 

Left.     To   prison  November   10, 

21st  Mississippi. 

—  ,  "<J3. 

31st  Mississippi. 

20,'  'W- 

1864. 

83 

Mitchell,   T.  I'.  K.,  Pt., 

July  3, 

Left.     Paroled  September  5,  '63. 

37 

Folkes,  W.  C.,  Pt.,  Shoe- 

Julyl. 

.     Recovery. 

D,  1st  Tennessee. 

—  ,  '63. 

maker's  Battery. 

2,  '63. 

M    Moody,  1C.  J.,  Pt.,  B,  5th 

May  5, 

Left.     Paroled  August  31,  1862. 

38 

Ford,  J.  A.,  Pt.,  11,  23il 

May  2, 

•  .     Ass't   Surg.  B.  Howard, 

North  Carolina. 

—  ,  '62. 

North  Carolina. 

2,  ''63. 

U.S.A.     Recovery. 

85 

Moore.  A.  E.,  Pt.,  K,  4th 

Nov.  1, 

Left.     Ass't  Surg.  F.  Gill-am,  C. 

39 

*Foxworth,  C.B.,  Pt.,  I, 

Sept.  19, 

.     Transferred  October  9,  '63. 

Virginia  Cavalry. 

1,  '62. 

S.  A.     Recovery. 

10th  South  Carolina. 

19,  '63. 

Recovery. 

M;    Moore,    d.    IF.,    Pt.,    C, 

July  28, 

Left.     To   prison   February   18, 

40 

Frazier,  G.  W.,  1't.,  D, 

May  8, 

.     Surg.  1'.  F.  \Vhitehead,  P. 

19th  Alabama. 

28,  '64. 

1865. 

37th  Virginia. 

8,  '62. 

A.  C.  8.     Recovery. 

87 

Moyer.  V.,  Pt.,  B,  19th 

July  22. 

Right.     To  prison  November  10, 

41 

Fuller,  TF..  Serg't,  G.lst 

July  21, 

.     Surg.  —  Sloan,  C.  S.  A. 

South  Carolina. 

22,  '64. 

1864. 

South  Carolina. 

22.  '63. 

Recovery. 

88 

Nash,  P.  W.,  Pt.,  E,  llth 

Aug.  29, 

.     Surg.  —  Ward,  C.  S.  A. 

42 

Green,  II.  \V.,  Pt.,  Bean- 

Julyl, 

.     Recovery. 

Mississippi. 

30,  '62. 

Recovery. 

regard's  Artillery. 

1,  '"62. 

89 

Nolen,  F.  J.,  Pt.,  A,  83d 

June  27, 

Right.     Discharged  January  20, 

43 

Gregory,   J.   T.,  Pt.,  E, 

May  6, 

.     Surg.  —  Brown,  3d  Ark. 

Pennsylvania. 

27,  '62. 

1863. 

3d  Arkansas. 

7,  '64. 

Retired  March  20,  1865. 

90 

Norton,  W.    C.,  Pt.,  B, 

July  1, 

Left.  Surg.  H.  H.  Ilubbard,  P.  A. 

44 

Scot  17 

Ass't    c^  nrfr                    16th 

1    '63. 

C.  S.     Recovery. 

16th  Mississippi. 

17,  '62.' 

Mississippi.     Recovery. 

91 

O'Niel,   C.,  Pt..  G,  5th 

Right.     Paroled  August  31,  1862. 

45 

Harrell,  E.  B.,  1't.,  D, 

May  4, 

.     Ass't  Surg.  —  Saunders. 

North  Carolina. 

48th  Georgia. 

4,  '63. 

Recovery. 

92 

Outlaw,   J.  E.,  Pt.,   A, 

Oct.  19, 

Left;  post.  flap.  Surg.R.  J.I  licks. 

40 

Bart,  R.A.,  Pt.,  D,  12th 

May  2, 

.     Snrg.  T.  B.  Wilkinson,  P. 

23d  N.  Carolina,  age  26. 

19,  '64. 

23d  N.  C.     Trans.  Jan.  8,  1865. 

North  Carolina. 

2,  r63. 

A.  C.  S.     Recovery. 

93 

Parker,  J.   C.,   Pt.,   A, 

Sept.  30, 

Right.     To  prison  April  13,  1865. 

47 

Barrey,  J.,  Pt.,  E,  5th 

May  5, 

—  .     Transferred  June  8,  1862. 

8th  N.  Carolina,  age  26. 

30,  '64. 

North  Carolina. 

5,  ''62. 

94 

1'rdtn.  IF.  B.,  Corp'l,  A, 

Nov.  29, 

Left  (also  resection  bones  of  right 

48 

Botiield  D.    Pt.   II,  5th 

Hip"lit     T1  1  1  rl  01  1  p"li  p*l  T^Wirnirv  **() 

17tli  Mississippi. 

29,  '63. 

leg).     Surg.  J.  1*.  Prince,  lioth 

Tennessee. 

1862. 

1863. 

Mass.     Exchanged. 

49 

Biggins,  J.,  Pt.,  C,  C3d 

June  22, 

.     Surg.  —  Hunt,  C.  S.  A. 

95    Proctor,   S.  A.,  1't.,  F, 

July  1, 

.     Surg.  T.  P.  Bailey,  12th  S. 

Virginia. 

22,  '64. 

Recovery. 

12th  S.  Carolina. 

3,  '(53. 

Carolina.     Recovery. 

50 

Hignian.  M.,  Pt.,B,  46th 

Aug.  9, 

Right.     Discharged  Jan.  6,  1863. 

!>6    J'utnam,  W.  A.,  Pt.,  B, 

Aug.  21, 

.     Ass't  Surg.  C.  Duffy,  24th 

Pennsylvania,  age  30. 

9,  V2. 

Died  June  14,  1868. 

49th  North  Carolina. 

21,  '64. 

N.  C.     Retired  Jan.  28,  1865. 

51 

Bowell,  C.,  Pt.,    E,  5th 

Oct.  4, 

.    Union  surgeon.    Feb.  6,  '63, 

97 

Raburii,  J.  M.,  Corp'l,  F, 

Sept.  1  9, 

.     Ass't  Surg.  F.  R.  Gregory, 

Missouri. 

4,  '62. 

re-amputated.     Recovery. 

25th  Tennessee. 

19,  '63. 

C.  S.  A  .     Recovery. 

52 

Ilubbard,  J.  A.,  Pt..  A, 

Mar.  31, 

Right.   Surg.  M.  C.  Rowland.61st 

98 

Richardson,  D.,   Pt.,  I, 

Dec.  11, 

.     Ass't  Surg.  R.  R.  Murphy, 

18th  Virginia. 

A  p.  1,'65. 

N.  Y.     Released  June  6,  1865. 

61st  N.  Carolina. 

11,  '63. 

Kith  N.  ('..     Recovery. 

53 

Hunter,   J.   B..   Pt.,   I, 

June  30, 

.      Surg.  H.  \V.  Thompson, 

99 

Roberts,    J.,    Lieut.,    I, 

May  3, 

—  —  .    Surg.  —  Fleinming,C.S.A. 

28th  Virginia. 

30,  '62. 

C.  S.  A.     Recovery. 

48th  Virginia. 

3,  '63. 

Recovery. 

54 

James,  D.  If.,  Corp'l.  G, 

Sept  30, 

Right.     Released  June  21,  1865. 

100 

Rodgers,   T.  M.,  Pt.,  C, 

Jan.  1, 

Right.     Nurg.  —  Manney,C.S.A. 

8th  N.  Carolina,  age  23. 

Ot.1,'64. 

llth  Tennessee. 

1,  '63. 

Transferred  August  3,  1863. 

55 

Johnson,    C.   L.,  Serg't. 

May  <!, 

—  .     Surg.   J.    E.  Chancellor, 

101 

Ruby,  C.  W.,  Pt.,  D,  42d 

July  1, 

.     Paroled  August  22,  1863. 

L,  7th  South  Carolina. 

6,  '64. 

C.  S.  A.     Recovery. 

Mississippi,  age  29. 

2,  '63. 

5(i 

Jones,  B.  C.,  Capt.,  E, 

June  27, 

.     Surgeons  Dunn  and  Lee, 

102 

'Susse/l,   W.,  Corp'l,  I, 

Sept.  19, 

Left.     Transferred  September  30, 

56th  Virginia. 

27,  '62. 

C.  S.  A.     Recovery. 

28th  Alabama. 

19,  '63. 

1863. 

57 

Kirl-land,  J.  G.,  Pt.,  D, 

May  25, 

.     Surg.  —  Lamond,  C.  S.  A. 

103 

Rvss.J.  J.,  Pt.,  D,  18th 

May  2, 

;  circular.  Transferred  June 

2d  South  Carolina. 

25,  '6!. 

Recovery. 

N.  Carolina,  age  27. 

2,  '63. 

5,  1863. 

58 

Kirldoj,   r>.    C.,  Lieut., 

Sept.  19, 

.    Surg.  —  Johnson,  C.  S.  A. 

104 

Sadler,  A.  D.,  Serg't,  G, 

Dec.  11, 

Right  (also  amp.  left  foot)  .    Surg. 

D,  15th  S.  Carolina. 

19.  '63. 

Recovery. 

21st  Mississippi. 

11,  '62. 

—  Hill,  C.S.  A.     Recovery. 

59 

Lansing,  J.,  Serg't,  K, 

July  1, 

Left.  Surg.  —  Strickland,  C.S.  A. 

105 

Sounders,  G.  L.,  Pt.,  G, 

May  5, 

.     Recovery. 

5tli  Louisiana. 

3,  '63. 

Discharged  Dec.  8,  1864. 

24th  Virginia. 

5,  '62. 

GO 

Lead,,    B.   F.,   Pt.,   H. 

May  27, 

Left.     To  Provost  Marshal  Aug. 

106 

Scarborough,  D.  J..  Pt., 

Aug.  24, 

Right.     Surg.  P.  B.  Henderson, 

10th  Arkansas. 

27,'  '63. 

7,  1863. 

H,  14th  S.  Carolina. 

24.  '64. 

P.  A.  C.  S.     Recovery. 

Cl 

Le.wis.    T.   N.,    Pt.,    A, 

May  16, 

Left.     Recovery. 

107 

S/iarrer,  J.,  Pt.,  H,  48th 

June  22, 

.     Recovery. 

57th  Georgia. 

16.'  '63. 

Mississippi. 

22,  '62. 

62 

Lewis,    W.   M.,  Pt.,   1), 

July  14. 

Right.     Recovery. 

108 

Shcdd,  W.  H.  U.,  Pt.,  C, 

Sept.  21, 

Right.     Surg.    —    Powell,    41st 

1st  Tennessee. 

14,''63. 

41st  Mississippi. 

21,  '63. 

Mississippi.     Recovery. 

63 

Lietner,  W.  Z.,  ('apt.,  E, 

July  2, 

Right.    Surg.  —  Lamond,  C.S.  A. 

109 

Slusser,  S.  S.,Ft.,H,  12th 

May  6, 

.     Surg.  W.  H.  Burton,  7th 

2d  South  Carolina. 

3,  '63. 

Recovery. 

Virginia. 

6.  "64. 

Va.  Cavalry.     Recovery. 

64 

Lilly,  E.  J.,  Pt.,  C,  23d 

May  3. 

.    Surg.  R.  J.   Hicks,  23d  N. 

110 

Still,  B.,  Pt.,  C,  9th.  Ga. 

Oct.  14, 

Left.     Surg.  G.  F.  Cooper.     Re 

North  Carolina. 

3,  '63. 

Carolina.     Recovery. 

14,  '64. 

covery. 

65 

Lonan    IF  If    Capt    G 

May  !•( 

Right.  Surij.  J.  B.  Kdclin  C.S.  A. 

111 

111 

Stiiiesprino   TF.  B.   Pt. 

May  3, 

4th  Georgia  Cavalry. 

15."  '64.' 

Recovery. 

E.  10th  Virginia.  ' 

3,  '63.' 

Recovery. 

66 

Love,  W.,  Lieut.,  K,  40th 

July  20,    Left.     To"  prison    November  10.     112 

Stone,  S.,   Pt.,   B,   37th 

May  3, 

.    Surg.C.  C.  Henkle,  C.S.  A. 

Mississippi. 

20,"  '64. 

1864. 

Virginia. 

3,  '63. 

Recovery. 

67 

Loivell,   E.  P.,   Pt.,   II, 

May  5, 

.     Surg.  L.  P.  Warren.  26th 

113 

Tulift.ro,  J.  M.,  Pt.,  H., 

Sept.  16, 

.     Surg.  —  Bland,  C.  S.  A. 

26th  N.  Carolina. 

5,  '64. 

North  Carolina.     Recovery. 

52d  Virginia. 

18,  '62. 

Recovery. 

C8 

Mallard,  W.  W.,  Pt.,  E, 

May  3, 

.    Furloughed  June  10,  1863. 

114 

Terry,  R.  L.,  Pt.,  C,  78th 

June  27, 

Lett.     Mustered  out  June  7,  1865. 

3()th  N.  C.,  age  30. 

—  .  ''63. 

Illinois. 

—  ,  '64. 

69 

Marburg,  E.,  Lieut.,  7th      July  4,     Left.     To  prison  August  13,  18C3. 

115    Thompson,.!.  IF.,  Corp'l, 

Dec.  11, 

Right.     Surg.  —  Austin,  C.  S.  A. 

Missouri  Cavalry. 

—  ,  '63. 

II,  13th  Mississippi. 

11,  '62. 

Recovery. 

70 

Mayer.  C.,  Serg't,  II.  Gth     July],      .     Surg.  W.  A.  Robertson,  C. 

116    'Todd,  IF./-'..  Pt.,—  ,10th 

Sept.  19, 

;  erysipelas. 

Louisiana. 

1,  '62. 

S.  A.     Retired  Feb.  1,  1865. 

South  Carolina. 

19,  '63. 

71 

McClendm,  W.  M.,  Pt., 

July  2, 

Right.     To   prison   January   25. 

117 

Tracy,  J.  N..  Corp'l,  I, 

May  1, 

Left.     Recovery. 

D.  8th  Gf  :.rgia.                   —  ,  '63. 

1864. 

5th  Missouri. 

1,  f63. 

72 

McCoy.  E.  C.,  Pt.,  B,  ls>t  i  Aug.  29,    .     Surg.  W".  A.  Robertson.  C. 

118 

Triplett,  B.  F.,  Pt.,  Stu 

Oct.  15, 

Right.    Surg.  J.  H.  Murray,  P.  A. 

South  Carolina.                   29.  '62. 

S.  A.     Recovery. 

art  Horse  Artillery. 

15,  '63. 

C.  S.     Recovery. 

73 

McDoul,  J.,  Pt.,  G,  21st      May  2, 

:  flap.     Transferred  May  26, 

119 

Vann,  C.,  Pt.,   F,    12th 

Dec.  16, 

Right.     Exchanged  January   16, 

Georgia,  age  21.                 3,  '63.         1863. 

Georgia,  age  16. 

16.  '64. 

1865. 

74 

McFull,   J.  A..    Pt.,   F,     May  14,    Left.     Transferred  June  9,  1864. 

120 

Walker,  B.    C.,  Pt.,  B, 

July  ), 

.     Paroled  August  22,  1863. 

18th  Tennessee.               '    14,'  '64. 

26th  N.  C.,  age  19. 

3,  '63. 

75 

McLewis,  A.,  Major,  2d    Sept.  19, 

.     Surer.  —  Headly,  C.  S.  A. 

121 

Walker,  J.,  Pt.,  A,  23d 

June  27. 

Right.     Surgeon  —  Rievers,  28th 

Georgia.                              19.  '63.        Recovery! 

Virginia. 

27,  '62. 

Virginia.     Recovery. 

76 

McXeely,  IF.  TF.,  Serg't.      May  2.      .     Recovery. 

122 

Ward,  G.H.,  Lieut.  Col., 

Oct.  21, 

Left.    Recovery.     Killed  at  Get 

B,  9th  Louisiana. 

4,  '63. 

15th  Massachusetts. 

21,  '61. 

tysburg. 

and  Surgical  Journal,  1864,  Vol.  I,  p.  76. 


508 


INJURIES    OP  THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

123 

Wa<iland,  W.  7f.,Pt.,  K, 

Oct.  15, 

.   Surg.  J.  T.  Gilmore,C.S.A. 

173 

Bucklin,  G.,  Pt.,  K,  12th 

Dec.  13, 

Right.     Died  January  9,  1803. 

19th  Virginia. 

15,  '61. 

Discharged  February  22,  1S62. 

Rhode  Island. 

13,  '62. 

124 

Webb,  J.  B.,  Serg't,  O, 

Aug.  1, 

.     Recovery. 

174 

Bulley,  J.,  Pt.,  E,  16th 

May  3, 

—  .    Died  May  20,  1863. 

13th  Virginia  Cavalry. 

1,  V63. 

New  York. 

3,  r63. 

125 

Abbott.  (>.,  Pt.,  H,  7th 

July  11, 

Right.     Died. 

175 

Bunker.  C.  L.,  Pt.,  I,  1st 

June  10, 

Right.    Died  June  28,  1864. 

New  Hampshire. 

—  ,  '63. 

Me.  Heavy  Artillery. 

—  ,  '04. 

126 

Ackennan,  W.,  Pt.,  H, 

June  8, 

;  gangrene.     Died  June  15, 

176 

Burke.    P.   E.,  Colonel, 

May  16, 

Left.    Surg.  W.  R.  Marsh,  2d 

8th  New  York. 

8,  '62. 

1862;  tetanus. 

66th  Illinois. 

16,  '04. 

Iowa.    Died  May  19,  1864. 

127 

Acres,  G.  C-,  Pt.,  D,  4th 

July  28, 

Left.    Surg.  B.  N.  Bond,  27th  Mo. 

177 

Bnrnes,   J.   P.,    Pt.,    II, 

Oct.  1!», 

Left;    flap.     Died    October    28, 

Iowa. 

28,  '64. 

Died  Augusts,  1864. 

13th  West  Virginia. 

19,  '64. 

1864  ;  pyajmia. 

128 

Adsit,  J.  E.,  Pt.,  F,  97th 

Sept.  17, 

Right.     Died  October  17,  1862. 

178 

Butler,  M.,  Pt.,  D,  15th 

June  ',!, 

Left  (also  wound  buttock).    Died 

New  York. 

17,  '62. 

New  York. 

3,  '64. 

June  19,  1864;  pyaemia. 

129 

Anderson,    A.,    Pt.,   G, 

Sept.  19, 

.     Died  January  10,  1803. 

179 

Buxton,  A.,  Capt..  H,  2d 

May  5, 

.     Died  May  7,  1864. 

26th  Missouri. 

19,  '62. 

U.  S.  .Sharpshooters. 

6,  '64. 

130 

Andrews,  A.  J.,  Lieut., 

Dec.  13, 

Right.     Died  January  26,  1863. 

180 

Bybce,  J.,   Pt.,   F,    21st 

June  20, 

.     Surg.  C.  J.  Walton,  21st 

C,  104th  New  York. 

13,  '62. 

Kentucky. 

20,  '64. 

Kv.     Died  June  20,  1864. 

131 

Andrews,  T.,  Pt.,  C,  20th 

June  3, 

Right  (also  wound  of  shoulder). 

181 

Byers,    —  ,    Pt.,  E,    5th 

July  3, 

Right.     Died  July  24,  1863. 

Michigan. 

—  ,  '04. 

Died  June  8,  1864. 

Alabama. 

—  ,  '63. 

132 

Amick,  W.  M.,    Serg't, 

June  18, 

Right.     Died  August  11,  1864. 

182 

Byrne,  W.E.,Pt.,K,42d 

July  2, 

—  .     Died  July  24,  1863. 

H,  55th  Penn.,  age  22. 

18,  '64. 

New  York. 

—  ,  "'03. 

133 

Amidon,  E.   H.,  It.,  B, 

June  19, 

Left.     Surg.  C.  Miller,  36th  Wis- 

183 

Cahill,  D.,  Pt.,  E,  10th 

Oct.  8, 

Left.    Died  October  15,  186'J. 

ID,  '64. 

cousin      1  Heel  July  *J   1864 

i(JO 

134 

Allen,  J.  W.,  Pt.',  H.lst 

Oct.  8, 

—  .     Died  October  20,  1862. 

184 

Cain.  Win.,  Pt.,  F,  7th  N. 

June  10, 

Left.     Surg.   S.  H.  Plumb,  82d 

Tennessee. 

8,  '62. 

Y.  H'vy  Art'y,  age  23. 

10,  '64. 

N.  Y.     Died  July  25,  18G4. 

135 

Alverd,   A.   O.,   Pt.,  C, 

May  31, 

Left.     Died  June  12,  1862. 

185 

Callnwa'y,  R.  W.,  Capt., 

July  —  , 

.     Died  July  16,  1863. 

100th  New  York. 

—  ,  '62. 

K.  22d  Georgia. 

—  ,  '63. 

136( 

Arkerson,  A.,  Pt.,  D.llth 

June  18, 

Both.     Died  June  19,  1864. 

186 

Campbell,  J.  B.,  Pt.,  F, 

Mav  15, 

Left.  Confederate  surgeon.    Died 

137J 

Infantry. 

18,  '04. 

3d  Tennessee. 

—,"'64. 

May  24,  1864. 

138 

Arnold,  "T.,  Pt.,   F,  7th 

Feb.  21, 

.     Died  February  26,  1802. 

187 

Campher.  L.,  Serg't,  D, 

Sept.  29, 

Left.      Died    October  27,    1864; 

Infantry. 

22,  '62. 

4th  C.  Troops,  age  20. 

30,  '04. 

exhaustion. 

139 

Atheain,   J.,   Serg't,  II, 

Jan.  U, 

Left.     Died  February  5,  1863. 

188 

CaiT,  W.,  Serg't,  I,  12th 

July  3, 

Left.     Died  July  14,  1863. 

25th  Iowa. 

—  ,  '03. 

Massachusetts. 

—  ,  ^63. 

140 

Bailey,   S.  W.,   Pt.,  H, 

May  27, 

Left.     Died  May  28,  1863. 

189 

Cathcart,  B.  F.,  Pt.,  G, 

July  3, 

Right.    Died  August  in,  1803. 

6th  Michigan. 

27,  '63. 

141st  Pennsylvania. 

—  ,   63. 

141 

Baker,   A.,   Pt.,   G,   3d 

Nov.  27, 

Left   (also  amp.  fingers).     Died 

190 

Clialker,  W.  ~1L,  Pt.,  A, 

July  3, 

.    Died  July  10,  1803. 

Missouri. 

27,  '03. 

December  28,  1863:  pyaemia. 

48th  Georgia. 

—  ,  '63. 

142 

Barrett,  E.,  Pt.,  K,  14th 

Mar.  23, 

Right.     Died  April  2,  1802. 

191 

Champlain,   J.,  Pt.,   D, 

July  3, 

Left.    Died  July  0,  18C3;  htem- 

Indiana. 

23.  '62. 

12th  Infantry. 

—  ,  '63. 

orrhage. 

143 

Baxter,  W.,  Pt.,  K,  3d 

May  15, 

Right.     Died  June  18,  1804. 

192 

Chandler,  J.  S.,  Pt.,  E, 

Mav  14, 

Left.     A.  Surg.  J.  F.  Smith,  55th 

Wisconsin. 

—  ,  '64. 

11  1th  Illinois. 

14,'  '64. 

Illinois.    Died  May  10,  1864. 

144 

Rcckert,  E.,  Pt.,  C,  25th 

Dec.  13, 

.     Ass't  Surg.  H.  R.  Wirtz, 

193 

Chedister,  J.  O.,  Pt.,  I, 

Nov.  7, 

.     Died  November  30,  1861. 

Ohio. 

—  ,  '61. 

U.  S.  A.    Died  Jan.  28,  1862. 

7th  Iowa. 

7,  '61. 

145 

Bockstine,  F.,  Lieut.,  I, 

July  20, 

Left.    Died  July  20,  1864. 

194 

Chism,    R.,    Serg't,    K, 

Mav  7, 

Left.     Died  June  1,  1864. 

82d  Illinois. 

20,  '64. 

91st  Penn.,  age  21. 

—  ,  ''64. 

140 

Beeson,  W.  H.,   Serg't, 

July  2, 

.     Died  July  10,  1862. 

195 

Church,  R.,  Pt.,  C,  40th 

Nov.  24, 

Right.     Died  December  4,  1863. 

G,  62d  Pennsylvania. 

4,  '02. 

Ohio. 

24,  '03. 

147 

Beers,   C.,   Pt",    K,   7th 

July  3. 

Right.     Died  July,  1863. 

196 

Clayton,  J.,  Pt.,  F,  4th 

June  18, 

Right.     Died  June  28,  1864. 

New  Jersey. 

3,  '63. 

N.  Y.  H'vy  Artillery. 

18,  '04. 

148 

Bihl,   A.,    Pt.,    E,   82d 

May  3, 

Left.    Died  May  31,  1863. 

197 

Cliff,  J.,  Recruit,  Col'd 

1864. 

Left.     Died  November  16,  1864. 

Illinois. 

3,  '63. 

Troops. 

149 

Binyham,  W.  11.  M.,  Pt., 

Sept.  19, 

.     Died  October  6,  1864. 

198 

Cleoman,  P.,  Pt.,  K,  86th 

May  3, 

Right.     Died  May  20,  1863. 

B,  54th  N.  Carolina. 

19,  '64. 

New  York. 

3,  '63. 

150 

Bitner,  J.,  Pt.,  K,  102d 

Oct,  19, 

Left.    Died  October  20,  1864. 

199 

Clyde,  O.  C.,  Pt.,  Phil- 

July  1, 

Right.    Died  July  20,  1863. 

Pennsylvania. 

19,  '64. 

lips's  Legion.  Georgia. 

3,  '63. 

151 

Blackwell,   G.,   Pt.,   B, 

July  14, 

.     Surg.  A.  T.  Bartlett,  33d 

200 

Cole,  J.,  Serg't,  Kane's 

June  8, 

Left.     Died  June  11,  1862. 

7th  Minnesota. 

14,  '64. 

Mo.     Died  August  6,  1864. 

Penn.  Rifles. 

8,  '62. 

152 

Blakley,  J.  L.,  Pt.,  A, 

June  16, 

Left;  post.    flap.     Died  July  2, 

20] 

Cole,  M.  R.,  Pt.,  A,  6th 

May  31, 

.     Died  May  31,  1804. 

52d  New  York,  ago  47. 

17,  '64. 

1864  ;  pyaemia. 

Indiana. 

31,  ''04. 

153 

Blanchard,   J.,    Pt.,   C, 

June  14, 

Riffht.    Surg.  T.  B.  Reed,  U.  S.  V. 

202 

Cole,  S.  B.,  Pt.,  H,  18th 

Sept.  14, 

.  .     Died    October    21,    1862;  ; 

91st  New  York. 

14,  '63. 

Died  June  21,  1863. 

New  York. 

10,  '62. 

exhaustion. 

154 

Blootnestine    J.    Pt.    F 

Sept.  17, 

Died  September  21  1862 

ono 

Colstpn    It    Lieut  -Col 

Died  December  ^3   1  ^6'? 

4th  New  York. 

—  ,  '62.' 

~u>> 

2d  Virginia. 

155 

Bower,   J.,    Pt.,   A,  5th 

May  4, 

(also  wound  of  arm).     Died 

•N  '  1 

Colum,    W.,   Corp'l,  G, 

July  1, 

.  —  .     Died  July  6,  1803. 

New  Jersey. 

—  ,  ''62. 

May  17,  1862. 

21st  Mississippi. 

1,  f03. 

15(i 

Bowman,  J.,  Pt.,  I,  46th 

July  20, 

Right.     Died  September?,  1864. 

205 

Conrad,  C.,  Pt.,  G,   12th 

May  H 

Loft  ;  flap.  Surg.  J.  Spiegehalter, 

Pennsylvania. 

20,'  '64. 

Missouri. 

14,  '04. 

12th  Mo.     Died  May  22,  1804. 

157 

Boyles,'  C.,  Pt.,  G,  55th 

July  20, 

Left.     Died  July  21,  1864. 

206 

Cooper,  W.,  Pt.,  D,  2d 

Aug.  28, 

Right.     Died  October  24,  1864. 

Alabama. 

—  ,  '64. 

Cavalry,  age  22. 

28,  '64. 

158 

Brady,  P.,  Corp'l,  II,  3d 

Oct.  8, 

Left.    Died  November  7,  1862. 

207 

Crowell,  S.W.,  Lieut.,  I, 

June  IS,    Right.    Died  June  28,  1864. 

Ohio. 

8,  '62. 

1st  Me.  H'vy  Artillery. 

18,  '04. 

159 

Br.inson,   J.,   Serg't,  F, 

June  27, 

Left.     Surg.   W.  Graham,   40th 

208 

Crowningshield,   L.  C., 

Dec.  25, 

Right    (also    amp.   arm).      Died 

40th  Illinois. 

27,  '04. 

Illinois.    Died  July  23,  1864. 

Pt.,  G,  142d  N.  Y. 

25,  '04. 

January  11,  1865. 

ICO 

Brierly,  J.,  Pt.,  D,  97th 

May  20, 

Left.     Died  May  22,  1864. 

209 

Cuppernell,  L.,  Pt.,   K, 

Mav  3, 

.    Died  May  15,  1863. 

Pennsylvania. 

—  ,  '04. 

121st  New  York. 

3,  '63. 

161 

Brink,  E.,  Seaman,  Gun 

Oct.  11, 

Right.     Died  June  28,  1864  ;  ex 

210 

Curtain,  P.,  Pt.,  E,  152d 

Nov.  0, 

.     Surg.  J.  L.  Breuton,  8th 

boat  Maratanza. 

—  ,  '62. 

haustion. 

New  York,  age  32. 

(i,  '64. 

Ohio.    Died  Nov.  12,  1804. 

162f 

Drinkman,    A.,    Pt.,    G, 

Aug.  11, 

Both.     Died  August  12,  1864. 

211 

Davenport,  C.  O.,  Pt.,  G, 

Sept.  19, 

.     Died  September  25,  1804  ; 

163J, 

79th  Pennsylvania. 

11.  '64. 

36th  Virginia. 

—  ,  '64. 

exhaustion  ;  shock. 

164 

Bronsher,  L,  Pt.,  D,  81st 

May  22, 

Left.     Died  June  14,  1863;  py 

212 

Davis,   J.,   Pt.,   E,   8th 

July  2, 

.     Died  July  11,  1803. 

Illinois,  age  25. 

22,"  '03. 

aemia. 

Virginia. 

—  ,  '03. 

165 

Brown,   A.,    Pt.,    I,   3d 

Nov.  27, 

Right.    Died  December  14,  1863. 

213 

Dean.W.  J.,Pt.,  D,  10th 

Sept.  19, 

—  .     Died  September  30,  1  862. 

North  Carolina. 

—  ,  '63. 

Missouri. 

19,  '02. 

166 

Brown,    CA    Lieut.,    E. 

July  18,    Right.     Died   August  13,  1863; 

-.'I  1 

De  Gouth,   B.,   Pt.,  M, 

May  6, 

Right.     Died  May  13,  1864. 

100th  New  York. 

20,  '63. 

tetanus. 

5th  Artillery. 

0,  '64. 

167 

Brown,  H.  F.,  Corp1!,  I, 

Sept.  19, 

Right.    Died  September  19,  1804. 

215 

Demay,  H.,  i't.,  D,  20th 

May  3, 

Right.     Died  May  31,  1863. 

14th  New  Hampshire.       19,  '(14. 

Connecticut. 

3.  '63. 

168 

Brown,  J.  D.,  Pt.,  B,  3d 

July—,    .     Died  July  18,  1803.              :  216 

Demby,  W.  H.,  Serg't, 

Feb.  11, 

Left;  circular.     Died. 

North  Carolina. 

—  ,  '03. 

G,  4t'h  Col'd  Troops. 

11,  '05. 

1(59 

Brown,  R.,  Pt.,  G,  49th     June  7,     Right.     Died  June  14,  1803.              217 

Dennison,  C.  E.,  Capt., 

Dee.  31, 

Right.     Died  January  15,  1863. 

Colored  Troops.                  —  .  '63. 

B,  18th  Infantry. 

31,  '62. 

170 

Brown,  JF.£>.,Pt.,Ander-     July:!,     .     Died  July  11,  1863.                218 

Dettmer,  G.,  Pt.,  E,  82d 

July  20, 

Right.     Died  August  8,  1864. 

son's  Chesapeake  Bat  'y. 

—  ,  '03. 

Illinois. 

20,  '64. 

171 

Brown,  W.  M.,    1't.,  G, 

May  14, 

Right.    Died  June  1,  1804.               219 

Dixon,  J.,  Pt.,  —  ,  18th 

Aug.—, 

Left.     Died  August  10,  1864. 

12th  Illinois. 

—  ,  64. 

1 

Infantry. 

—  ,  '64. 

172 

Bryant,  W.,  Pt.,  D,  19th 

Jan.  2, 

Left.     Died  January  20,  1863.        j  220 

Dolph,  I.,  Pt.,  C,  136th 

Dec.  13, 

Left.     Died    January   15,   1863; 

Ohio. 

—  ,  '63. 

ll 

Pennsylvania. 

13.  '02.        pyaemia. 

SECT.  V.] 


PRIMARY    AMPUTATIONS    IN    THE    LEG. 


509 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS.        -.,_ 
RESULT. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

221 

Donahay,  T.,  Pt.,A,19th     May  15, 

Right.      Snrg.  J.  Bennett,  19th     268    Grover,  C.  D.,  Serg't,  F, 

April  13, 

.     Died  April  16,  1863. 

Michigan.                            15,  '64. 

Mich.     Died  May  23,  1864.                        25th  Connecticut,               13,  '63. 

222    Doster,"  J.,  Pt,,  C,  90th     Deo.  31, 

Left.     Died  February  9,  1863.          269  1  Groves,  J.,    Pt.,  F,  7th     May  3,     Left.     Died  June  11,  1803. 

Ohio.                                ,   —  ,  '62. 

Massachusetts.                    3,   63. 

223    Dougnn,  S.  W.,  Corp'I,    Sept,  19. 

Left  (also  wound  of  right  wrist).     270    Guild,  J.,  Pt.,  C,    153d    Sept.  19,    Right.     Died  September28,  1864. 

C,  8th  Kansas.                 ,    19.  '63. 

Died  September.  1863.                                New  York.                      :   19,  '64. 

224    Duncan,  J.  B.,  Capt.,  H,      Oct.  5, 

.     Died  July  18.  1864:  denil-     271    Halfhill,  G.,  Pt.,  I,  21st     May  22, 

(wound  of  both  legs).     Died 

32d  Illinois.                           5,  '62. 

ity  resulting  from  injury.                            Iowa. 

22,   63. 

June  9,  1863. 

225    Dungan.  J.  W.,  Lieut.,    June  27, 

Lett.     Died  July  4.  1864.                  272    Ball,  J.  F.,  Pt.,  B,  22d 

May* 

;  flap.     Died  May  24,  1863  ; 

1     A,  113th  Ohio.                    27,  'G4. 

i     Virginia,  age  25. 

4,  %3. 

typhoid  fever. 

226  '  Eaton.  I.  V.,  Pt.,  D,  4th  i   July  2, 

Right.     Died  August  18,  1863.         273    Hanley,  O.,  Pt.,  B,  31st 

July  20, 

Left.     Died  August  27,  1864. 

Maine.                                  2,  '63. 

Mississippi. 

—  ,  '64. 

227    Eberly.  C.,  Pt.,  C,  98th    May  12, 

Left.     Died  May  20,  1864.                 274    Harard,  J.  AV.,  Pt.,  E,  3d    Sept.  30, 

Right.     Died  October  2,  1864. 

Pennsylvania.                     12  '64. 

Colored  Troops.                 30,  '64. 

228    Efford,  W.,  Pt.,  G,  53d-     Oct.  5, 

.     Died.                                         275    Hardy,  II.  J'.,Pt.,F,llth     July  2, 

Left.     Surg.  H.  M.  McAbee,  4th 

Indiana.                               5,  '62.- 

Mississippi.                      :    3,  '63.    :     Ohio.     Died  July  20.  1863. 

•J-,".)    Elliinvood,  A.  AV.,  Pt.,     June  3, 

Left.     Died  July  6,  1864.                  276    Harriman,    C.,    Pt.,    E.      July  2.     Left  (also  fract.  right  leg).     Died 

F,  2.)th  Mass.,  age  21.         ;j,  '64. 

19th  Maine. 

2,  '63.         July  7,  1863:  hsBmurrhajr*. 

230 

Emmel,  P.,  Pt.,  E,  163d    Dec.  13, 

Left.    Died  January  5,  1863.            277    Harris,  A.  C.,  Pt.,A,  43d 

May  14, 

Left.    Died  May  22,  1864. 

New  York.                         ]:j,  '62. 

Georgia. 

—  ,  T>4. 

231    Enos,  J.,  Teamster,  39th      Oct.  8, 

Right.     Died  October  25,  1862.        278    Haskall.H.  A.,Pt.,C,  4th 

Sept.  29, 

Left.    Died  October  9,  1864. 

Indiana.                               8,  '62. 

New  Hamp.,  age  24.       Oct.  1,64. 

232    Erisman,  J.,  Pt.,  D,  57th     Sept.  ], 

Left.     Died  September  20,  1864.      279 

Haskinson,   A.,  Pt.,    G, 

Dec.  31, 

Left.     Died  January  8,  1863. 

Indiana.                                —  ,  '64. 

84th  Illinois. 

31,  '62. 

233 

E  ,  J.  N.  P  July  3, 

.     Died  July  3,  1863.               ,  280    Hatley,  —,    Pt.,   I,  52d 

July  2, 

.     Died  July  17.  1863. 

3,  '63. 

North  Carolina. 

—  ,  ^63. 

234    Esson,  H.  J.,  Pt.,  G,  17th     May  12, 

—  .     Died  May  21,  1864.                281    Hawkins,  A.,  Pt.,  K,  4th 

May  6, 

Right,     Died  May  13,  1864. 

Michigan.                           12,  '64. 

I     Maine. 

7,  '64. 

23r.    Faber,  AV.,  Pt.,  H.  47th    May  26, 

Left.    Died  September  7.  1863.        282    Heath,  J.,  Serg't,  K,  2d 

Right.    Died  October  24,  1864. 

Ohio. 

26,  '63. 

Colored  Troops. 

1864. 

236    Farrell,  J.,  Pt.,  F,  2d  R. 

May  5, 

Right.     Died  June  6,  1864.             '  283    Heighly,  H.  O.,  Pt.,  C, 

July  2, 

Left.     July  17,  haem.,24oz.,  from 

Island,  age  33.                :    5,  '64. 

*     1st  U.  S.  Sharpshooters, 

3,  '63. 

post,  tibial.    Died  July  18,  1863; 

237 

Farrington,    P.,  Pt.,  G,  :   July  3, 

Right.     Died  July  10,  1863..                        age  25. 

haemorrhage. 

8~'d  New  York.               :    3,  '63. 

284    Hess,  T.  W.,  Pt.,  K,  8th 

Sept.  30, 

Left.     Died  October  7,  1864  ;  irri 

238 

Feller,  J.,  Serg't,  A,  21st  i  Aug.  21, 

Left.     Died  October  2,  1864.                        North  Carolina. 

30,  '64. 

tative  fever. 

Ohio.                                   _,  '64. 

1  285    Hesterly,  P.,  Pt.,  B,  12th 

Sept.  17, 

Left.     Died  October  11,  1862. 

239 

Fightrnaster,  G.  W.,  Pt.,  !  May  22, 

Right,     Died  May  28,  1863;  py-                Alabama. 

17,  '62. 

F,  22d  Kentucky.           !   —  ,  '63. 

aeinia.                                             .  :  286    Hevener,  AV.  C.,  Serg't, 

Oct.  5, 

.     Died  October  5,  1862. 

240 

Finclteler,  If.  S.,  PT.,  A,  !  July  28, 

Right,    Died  August  11,  1864.                    E,  28th  Illinois. 

5,  '62. 

40th  Alabama.                   28  ,"'64. 

287    Higgins,  F.  M.,  Pt.,  B, 

Dec.  13, 

Right.     Died  December  27,  1862. 

241 

Follet,  L.  D.,  Pt.,  D,  92d  ,  June  1, 

Left.     Died  June  14,  1864.                           5th  New  Hampshire. 

13,  '62. 

New  York,  age  38.         |     1,  '64. 

'288    Hill,  AV.  S.,    Serg't,  F, 

June  3, 

Right  (also  w'nd  of  back).    Died 

242 

Ford,  J.  H.,  Pt.,  C,  9th    May  22, 

Right  ;  double  flap.     Snrg.  A.  T. 

62d  Penn.,  age  24. 

3,  '64. 

June  14,  1864. 

Iowa.                                   —  ,  '63. 

Hudson,  26th  Iowa.     Died  June     289    Hinchman.  J.  1!.,  Serg't, 

July  18, 

Left.    Died  July  25,  1864. 

24,  1863.                                                        L,  54th  Penn.,  age  23. 

18,  '64. 

243 

Foss,  C.A.,  Lieut.,C,  72d  ;   July  3, 

.    Died  July  7,  1863.                  290    Hogan,  J.,  Pt.,  I,   56th 

May  6, 

Right.     Died  May  13,  1864. 

New  York.                         —  ,  '63. 

Massachusetts. 

—  ,  ''64. 

244 

Foss,  J.,  Serg't,  C,  59th    Sept.  17, 

(also  amp.  other  thigh  and     291    Eolloway,  B.  H.,  Corp'I, 

July  3, 

.     Died  July  10,   1863;  py 

New  York.                           17,  '62. 

w'dofarm).     Died  Sept.  21.  '62.                D,  13th  Georgia. 

—  ,  S63. 

aemia. 

245 

Fowler.  R.  II.,  Serg't,  A,    Dee,  13. 

—  .     Died  December  17,  1862.       292    Holmes,     F.,    Corporal, 

June  8, 

Left,     Died  June  14,  1862. 

27th  Connecticut. 

13,  '62. 

Kane's  Penn.  Rifles. 

8,  '62. 

246     Froni-r.     I).   ('.,   Pt.,   ft, 

May  2, 

Right.     Died  May  20,  1863.              293    Hoover,  F.  M.,  Pt.,  B, 

May  6, 

Left.    Died  May  27.  1864. 

141st  Pennsylvania. 

3.  '63. 

83d  Penn..  age  24. 

6,  '64. 

247 

Friel,  G.,  Pt.*  D,  2d  Ky.    Sept.  1  0, 

Left.     Died  December  1,    1863,     294 

Horminger,  G.,  Pt.,  H, 

May  3, 

.     Died  May  24,  1863. 

19.  '63. 

while  a  prisoner. 

1st  New  Jersey. 

3,  "63. 

248 

Fritz,  J.,  Pt.,   A,  124th     May  15, 

Right.     Died  July  18,  1864.             295    Home,  G.,  Ft.,"  A,  15th 

June  19, 

Right.     Died  June  26,  1864. 

Ohio.                                     —,"'64. 

N.  Y.  H'vy  Artillery. 

19,  '64. 

219    Fulton,  ft.  ,Liput.,C,  88th 

Dec.  13, 

(also  wound  of  side).     Died     296    Horner,AV.,  Pt.,  H,  155th 

June  17, 

Left.    Died  June  24,  1864. 

Pennsylvania. 

13,  '62. 

December  30,  1862. 

Pennsylvania. 

—  .  '64. 

2.-.0    Harrison.  M.,Pt.,B,126th 

July  2, 

Right.     Died  July  18,  1863.              297  .  Hortort',   D.   F.,  Pt.,  D, 

May  14, 

Right;  circ.  (also  left  leg).     Died 

New  York.                            2,  '63. 

25th  North  Carolina. 

14,  '64. 

June  13,  1864. 

251 

Geary,  AV.  T.,  Pt,,    E,    Sept,  27, 

Left  (also  partial  fract.  right  leg)  .     298 

Horton,  II.  R.,  Pt.,F.  7th 

June  24, 

Left.    Died  July  4,  1864  ;  exhaus 

10th  Conn.,  age  19. 

28,  '63. 

Died  October  7,  1863. 

R.  I.  Battery,  age  37. 

—  ,  '64. 

tion. 

252 

Gehring,  J.,  Pt.,  G,  59th 

Oct.  8, 

.     Died  October,  1862.               299 

Howard.  H.,  Pt.,  D,  20th 

July  1, 

Left,     Surg.  N.  Hayward,  20th 

Illinois. 

8,  '62. 

Massachusetts. 

1,  '63. 

Mass.     Died  July  8,  1863. 

253 

Gentry,  L.,  Pt.,  B,  33d 

July  20, 

Left.     Died  Septembers,  1864.        300    Howe,  D.,  Serg't,  C,  1st 

May  12, 

'  .     Died  May  22,  1864. 

Mississippi. 

—,''64. 

New  York. 

12,  '64. 

254 

Gilbei-t,P.,Seaman,Guu-      Mar.  1, 

.     Died  March  4,  1862.               301    Howe,    G.  W.,   Pt..    E, 

May  15, 

Right.     Died  May  21,  1864. 

boat  Tyler. 

^  '(52. 

34th  Massachusetts. 

15,'  '64. 

2.-,5    Gilchrisf,  J.  E.,   I't.,  15, 

May  31, 

Left.     Died  June  5,  1864.                 !  302 

Hubbard,  E.,  Corp'I,  B, 

Dec.  29, 

.     Died  January  1,  1863  ;  ty 

78th  Pennsylvania. 

31.  '64. 

3d  Kentucky. 

—  ,  '62. 

phoid  symptoms. 

25(5    Gleiini,   J..  Pt.,  II,  81st 

Dec.  13, 

Right    Jan.  1,  '63,  re-amp,  thigh.    303    Hubbard,  AVlB..  Pt.,  E, 

April  6, 

Right.     Died  April  18,  1862  ;  py 

Pennsylvania. 

13.  '62. 

Died  Jan.  2,  '63:  shock  andexh'n.               2d  Kentucky. 

—  ,  '62. 

aemia. 

•j.Y?    Goodwin,  A.  X.,  Lieut., 

July  20, 

Left.    Died  July  27,  1863.                304 

Huylics.   J.  H.,  Pt.,  A, 

July  3, 

Left.    Died  July  28,  1863. 

A,  9th  Maine. 

—  ,"'63. 

28th  Virginia. 

—  ,  '63. 

258     Grant,  W.  D.,  Lieut.,  B, 

April  5, 

Right.    Died  April  16,  1865.            305 

Hughs,  P.AV.,  Pt.,A,5th 

June  1, 

Right  (also  wound  of  left  leg). 

18th  Georgia, 

5,  '65. 

I 

New  York. 

—  ,  '64. 

Died  June  4,  1864. 

259    Green.  J.,  'Pt.,  D,  69th 

May  5, 

Left.     Died  May  5,  1862.                  306 

Hunt,   J.,   Pt.,    H,    7th 

Mar.  23, 

.     Died  April  5,  1862. 

Pennsylvania. 

5,  "tez. 

— 

Ohio. 

—  .  '62. 

260    Gregory.  O.,  Pt..  H,  7th 

Mar.  23. 

—  .     Died  A  pril  12,  1862.               307  '  Hyatt,  J.,  Corp'I,  F,  48th 

July  18, 

Right.      Died  August   9,   1863; 

Ohio." 

23,  '62. 

New  York. 

18,  '63. 

chronic  diarrhoea. 

261 

Grey,  A.  R.,  Pt.,  G,  7th 

May  8, 

Left.     Died  May  13,  1864.                308 

Jackson,  J.,  Pt.,  D,  1st 

June  20, 

.     Died  June  25,  1864. 

AVisconsin. 

8,  '64. 

Maine  H'vv  Artillery. 

20,  '64. 

2G2    Gridley,  E.,  Pt..  II.  57th 

Dec.  13, 

Right.     Died  December  17,  1862.     309    Jacobs,  C.,  Pt.,  B,  19tb 

Sept.  19, 

Left.     Died  September  —  ,  1863. 

Pennsylvania. 

!3,  '62. 

Ohio. 

19,  '63. 

263    Gridley,    AV.,     Pt..    A, 
136th  Pennsylvania. 

Dee.  13, 
13.  '62. 

Right.     Died  December  18,  1862.     310 

Jamison.  J.,  Pt.,  A,  29th 
Illinois,  age  24. 

Mar.  29, 
29,  '65. 

Right  ;  ant.  post,  flap.    Surg.  S.  L. 
Cheaney,  29th  Illinois.     April  4, 

264    Griflith.  J.  L.,  Pt.,  I,  22d 

May  22, 

—  .     Died  May  24,  1863. 

haem.     Died  April  18,  1865. 

Iowa. 

22,'  '63. 

:3ii 

Jesse,  J.  P.,  I't..  C.  37th 

July  2, 

Left.     Died  July  4.  1863. 

265    Grogan,  C.  H.,  Serg't.  1, 
6th  Connecticut. 

July  11, 
-,  '63. 

.     Died  July  23,  1863. 
312 

A'irginia. 
Johnson,  C.,  Pt.,  G,  1st 

4,  '63. 
April  26, 

Left.     Died  April  26,  1863. 

266    Grossman,    W.,    Pt.,  C, 

May  8, 

Right.    Surg.  B.  Rohrer,  10th  Pa. 

Wisconsin  Cavalry. 

26,  '63. 

11  th  Penn.  lies.,  age  23. 

9,  '64. 

Res.     (Also  amp.  arm.)     Died    313 

Jollife,  J.,  Pt.,  F,  70th 

July  2, 

Left.     Died  August  4,  1863. 

August  3,  1864. 

New  York. 

2,  '63. 

267    Grotenhaus,  J.,  Pt.,  D,     May  6, 

.    Died  May  19,  1864.                 314 

Jones,  W.  P.,  Pt..  D,  2d 

July  2, 

.     Died  July  20,  1863. 

8th  Michigan. 

—  ,  '64. 

Georgia. 

—  ,  '63. 

510 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


(CHAP    X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

315 

Jones,   W.,   Corp'l,  23d 

July  —  , 

Right.     Died  July  17,  1863. 

364 

Mclntyre,  S.,  Pt.,A,  30th 

July  22, 

Right.     Died  August  18,  1864. 

Wisconsin. 

—  ,  '63. 

Illinois. 

22,  '64. 

316 

Kahoe,  M.,  Pt.,  I,  113th 

June  27, 

Right.     Died  August  21,  1864. 

365 

McKeney,   J.,    Pt.,    K. 

Sept.  17, 

—  .     Died  September  24,  1  862. 

Ohio. 

27,  '64. 

108th  New  York. 

17,  '62. 

317 

Kalchback.   J.,  Pt.,  —  , 

Sept.  5, 

Right.    Died  September  10,  1864. 

366 

McKenna,P.,Pt.,G,10th 

July  3, 

Left.     Died  July  11,  1863. 

16th  Infantry. 

—  ,  '64. 

Infantry. 

—  ,  '63. 

318 

Keely,    B.,    Pt.,  F,  7th 

Oct.  4, 

.     Died  October  4,  1862. 

367 

McLaughlin,  M.,  Pt.,  C. 

May  30, 

Left.     Died  June  23,  1864. 

Illinois. 

4,  '62. 

46th  Pennsylvania. 

30,"  '64. 

319 

Kellogg,  T.  A.,  Corp'I, 

July  3, 

Left.     Died  July  24,  1863;  gan 

368 

McMurtrie,  A.  H.,  Lieut., 

July  12, 

Right.     Died  July  25,  1863. 

A,  14th  Infantry. 

—  ,  '63. 

grene. 

D,  3d  Iowa. 

—  ,'  '63. 

320 

Kilcs,  J.  G.,Pt.,  A,  124th 

May  5, 

Right.     Died  May  24,  1863. 

369 

Medway,W.,  Pt.,C,  75th 

May  27, 

Right.    Died  July  3,  1863;  gan 

New  York. 

—  ,  ''63. 

Colored  Troops. 

—  ,  '63. 

grene. 

321 

King,   G.,   Pt.,  K,  54th 

Aug.  30, 

Right.    Died  August  31,  1862. 

370 

Merwin,   C.   N.,  Drum 

June  14, 

Left,  Surg.  E.  A.  Thompson,12th 

Massachusetts. 

31,  '62. 

mer,  A,  13th  Conn. 

—  ,  '63. 

Maine.     Died  July  6,  1863. 

322 

King,    I.,  Pt.,  E,  126th 

May  21  , 

Right,    Died  May  29,  1864;  py- 

371 

Middleton,    J.,    Pt.,    H, 

May  22, 

Left.     Died  May  28,  1863. 

Ohio,  ace  21. 

21,  '64. 

temia. 

22d  Iowa. 

—,•'63. 

323 

Krumolhein,  W.,  Corp'l, 

Nov.  24, 

Right.     Died  February  12,  1864. 

372 

Miller,  C.,  Pt,,  H,  26th 

July  2, 

Right.     Died  July  10,  1803. 

E,  2d  Missouri. 

24,  '63. 

Pennsylvania. 

—  ,  '63. 

324 

Kuster,   J.  W.,  Pt.,  F, 

1862. 

Right.     Died  June  25,  1862. 

373 

Miller,  J.W.,  Pt.,  E,  21st 

June  14, 

.     Died  June  17,  1863. 

57th  Pennsylvania. 

Maine. 

14,  '63. 

325 

Laib,  F.,  Serg't,  A,  7th 

July  3, 

.    Died  July  —  ,  1863. 

374 

Miller,  L.,  Pt,,  G,  96th 

May  14, 

Right,     Died  May  27,  1864. 

New  Jersey. 

3,  '63. 

Illinois. 

—  ,  '64. 

326 

Lambert,  W.  H.,  Pt.,  H, 

April  !), 

.    Died  May  26,  1864. 

375 

Miller,  W.,  Pt.,  C,  13th 

July  —  , 

Left,     Surg.  W.  M.  Wright,  79th 

160th  N.  Y.,  age  31. 

9,  '64. 

Ohio. 

—  ,  '64. 

Penn.     Died  August  18,  1864. 

327 

Lamponi,  D.,  Pt.,  II,  8th 

May  27, 

Left.    Died  June  1,  1863. 

376 

Miller,  W.,  Pt.,  E,  153d 

July  2, 

Left.     Died  July  9,  1863. 

New  Hampshire. 

27,  '63. 

Pennsylvania. 

—  ,  '63. 

328 

Langdon,  B.,  Pt.,  H,  93d 

May  23, 

Left.    Died  June  8,  '64;  pyaemia. 

377 

Millsaps,  G.  W.,  Pt.,  A, 

June  22, 

Left;  circular.     Died  September 

New  York,  age  19. 

23,  '64. 

7th  N.  Carolina,  age  18. 

23,  '64. 

1,  1864;  exhaustion. 

329 

Lawrence,  J.  B.,  Capt., 

May  16, 

Left,     Died  May  30,  1864. 

378 

Mitchell,  M.  L.,  Pt.,  G, 

Sept.  19, 

Right.     Died  October  9,  1863. 

H,  9th  N.  J.,  age  30. 

16,  '64. 

74th  Indiana. 

19,  '63. 

3.30 

Lehman,  J.   J.,  Pt.,  C, 

May  12, 

Right.     Died  May  25,  1864. 

379 

Mobtei/,  H.    M.,   Pt.,  A, 

July  20, 

Left.     Died  July  30,  1864. 

5()th  Pennsylvania. 

12,  '64. 

55th  Alabama. 

-,'64. 

331 

Lerch,    J.,    Pt.,   B,    9th 
1'enn.  Reserves. 

Sept,  14, 
—  ,  '62. 

Left,    Died  October  21,  1862. 

380 

Montgomery,  R.  S.,  Pt., 
I,  105th  Pennsylvania. 

Dec.  13, 

13,  '6'.'. 

Left.     I  )ied  December  23,  1862. 

332 

Lewis,  II.  F.,  Lieut.,  D, 

July], 

Left.    Died  July  2,  1863. 

381 

Moore.  C.  H.,  Pt.,  F,  13th 

July  3, 

Left,     Died  July  7,  1863. 

145th  Pennsylvania. 

—  ,  ^63. 

Mississippi. 

—  ,  '63. 

333 

Lewis,  L.,  Pt.,  E,  55th 

June  5, 

Left.    Died  August  2,  1864  ;  ex 

382 

Morrill,  F.  I,.,  Lieut.,  D, 

June  30, 

Left.     Died  July  13,  '64  ;  tetanus. 

Pennsylvania,  age  18. 

—  ,  '64. 

haustion. 

3d  New  Ilamp.,  age  23. 

30,  '64. 

334 

Lininger,W.,Pt.,B,145th 

July  2, 

Right.     Died  July  18,  1863. 

383 

Moser,  J.,  Pt.,   H,  15th 

Sept.  19, 

Left.     Died  October  11,  1864. 

Pennsylvania. 

2,  r63. 

New  York  Artillery. 

19,  '64. 

335 

Livcly,"L.,  Pt.,  K,  12th 

Dec.  13, 

.     Died  December  15,  1862. 

384 

Moss,  J.,  Pt.,  H,  3d  Ohio. 

Oct.  8, 

—  .     Died  October  —  ,  1862. 

Massachusetts,  age  27. 

13,  '62. 

—  ,  '62. 

336 

Aug.  21, 

Left.    Died  en  route  to  hospital. 

385 

Mounts,  N.,  Pt.,  B,  121st 

June  27, 

Right  (also  wound  of  shoulder). 

60th  Ohio. 

-,'64. 

Ohio. 

27,  '64. 

Died  June  28,  1864. 

337 

Locke.   P.,  Pt.,   F,  22d 

Oct.  8, 

Left.     Died  October  16,  1862. 

386 

Mowers,  H.,  Pt,,  1,  117th 

May  14, 

Right;  gangrene.     Died  June  27, 

Indiana. 

—  ,  '62. 

New  York,  age  38. 

14,  '64. 

1864  ;  exhaustion. 

338 

1*00.11,  N.  B.,  Pt,,  I,  4th 

April  —  , 

Right.     Died  April  6,  1865. 

387 

Muller,    W.,  Corp'l,  G, 

July  3, 

;    tetanus.      Died  from  ex 

Virginia. 

—  ,  '65. 

1st  Virginia. 

—  ,  '63. 

haustion. 

339 

Lotz,  C.,  Corp'l,  K,  151st 

July  2, 

Left,     Died  July  9,  1863. 

388 

Mullins,  C.  P.,  Capt,,  A, 

April  8, 

Right.     Died  May  6,  1864. 

Pennsylvania. 

2,  m 

130th  Illinois. 

8,  '64. 

:!4<« 

Luallcn,  J.,  Pt,,  D,  13th 

Jan.  15, 

Both.    Surg.  L.  Barnes,  6th  C.  T., 

389 

Munsell,  E.,  Pt,,  I,  22d 

May  7, 

Right.    Died  May  7,  1864. 

34  li 

Indiana. 

15,  '65. 

and  Ass't  Surg.  H.  C.  Merry- 

Massachusetts. 

7,  '64. 

weather,  5th  C.  T.     Died  Jan 

390 

Munson,  L.  F.,   Pt.,  A, 

Dec.  14, 

Left.  Surg.  F.G.  Snelling,U.S.V. 

uary  23,  1  865. 

10th  Connecticut. 

14,  '62. 

Died  Dec.  29,  1862;  exhaust'n. 

3-12 

Lynch,  M.,  Pt.,   K,  9th 

Dec.  13, 

Left.     Died  December  31,  1862. 

391 

Murphy,  C.,  Pt.,  A,  63d 

Sept.  17, 

—  .     Died  September  18,  1862. 

Massachusetts. 

—  ,  '62. 

New  York. 

17,  '62. 

343 

Madden,  M.,  Pt.,  A,  4th 

Sept.  19, 

Right.     Died  December  20,  1863. 

392 

Murphy,  J.  C.,  Pt.,  G, 

May  3, 

Left   (also  wound  of  right  leg). 

Kentucky. 

19.  '6:3. 

llth  Massachusetts. 

3,  '63. 

Died  May  11,  1863. 

344 

Mahorner,    11.,   Pt.,    F, 

July  2, 

Right.     Surg.  II.  M.  McAbee,  4th 

393 

Nance,  T.  J.,  Pt.,  H,  30th 

April  4, 

Right.    Surg.  C.  E.  Swasey,  U.S. 

Ojrj 

llth  Mississippi. 

3,  '63. 

Ohio.     Died  July  27,  1863. 

Texas  Cavalr}-. 

4,  '64. 

V.     May  1,  amp.  thigh.     Died 

Ml  V 

Manson,    J.   P.,  Pt.,   A. 

Dec.  13, 

Both  ;  flap.     Died  December  25, 

May  8,  1864;  pysemia. 

.Md} 

121st  Pennsylvania. 

13,  '62. 

1862. 

394 

Xewton.,  T.,  Pt,,  A,  10th 

1864. 

;  gangrene.     Died  May  24, 

347 

Markteller,  W.,    Pt.,  F,, 

Dec.  10, 

Right.     Died  December  28,  1864. 

Louisiana. 

1864. 

5th  IVnn.  Cavalry. 

—  ,  '64. 

395 

Nichols,    G.,  Serg't,  E, 

Sept.  24, 

—  .     Died  September  24,  1  864. 

348 

Mfinm,  J.,  Pt.,  C,  55th 

July  20, 

.     Died  July  29,  1864. 

4th  Colored  Troops. 

24,  '64. 

Alabama. 

—  ,  '64. 

396 

Nicholson,    G.,    Pt.,    11, 

July  2, 

Right.    Surg.  F.  Wolf,  39th  K.  Y. 

349 

Martin,   J.,   Pt.,    E,  8th 

May  9, 

Right.     Died  September  8,  1864  ; 

126th  New  York. 

3,  '63. 

Died  .Inly  15,  1863. 

Connecticut,  age  19. 

9,  '64. 

exhaustion. 

397 

Nolan,  P.,  Serg't,  K,  19th 

June  19, 

Left.    Surg.W.  J.  Burr,42d  N.  Y. 

350 

Marx,  A.,    Pt.,  C,  14th 

Mar.  23, 

Loft.     Died  April  8,  1862. 

Massachusetts. 

19,  '64. 

Died  Juno  21,  1864. 

Indiana. 

23,  '62. 

398 

Nutter,  H.  F.,  Corp'l,  L, 

April  2, 

Left  (also  wound  left  arm).    Surg. 

351 

Marx,    P.,    Pt.,  A,    1st 

July  2, 

—  .     Died  July  24,  1863. 

31st  Maine. 

2,  '65. 

L.  W.  Bliss,  51st  N.  Y.     Died 

Minnesota. 

—  ,  '63. 

April  3,  1865. 

352 

Mason,  M.,  Pt.,  O,  5th 

July  2, 

Right.     Died  July  9,  1863. 

399 

O'Neil,   H.,    Corp'l,    K, 

1865. 

Left.    Died  February  9,  1865. 

North  Carolina. 

—  ,  '63. 

79th  Penn.,  ago  28. 

353 

Mathewx,  J.,  Corp'l,  B, 

May  14, 

Right.     Died  June  12,  1864. 

400 

Osborn,  W.  D.,  Corp'l,  I, 

June  14, 

Right.     Died  June  24,  1863. 

47th  Georgia. 

14,''64. 

26th  Connecticut. 

14,  '63. 

354 

Mattoon,  II.,  Pt.,  D,  2d 

June  10, 

Left.     Died  Juno  14,  1864. 

401 

Owens,   J.,    Pt.,   F,  8th 

Dec.  17, 

Right.     Died. 

Conn.  H.  Art.,  age  30. 

10,  '6-1. 

Tennessee  Cavalry. 

17,  '64. 

355 

Maynard,  G.,  Pt.,  145th 

May  12, 

.     Died  May  16,  1864. 

402 

Paisley,  W.,  Pt.,  H,  32d 

Oct.  5, 

.     Died  October  5,  1862. 

Pennsylvania. 

12,  '64. 

Illinois. 

5,  '62. 

356 

Maywood,    D.,    Pt.,    E, 

July  2, 

Right.     Died  July  15,  1863. 

403 

Parker,  A.  M.,  Lieut.,  B, 

July  3, 

Right.     Died  July  21,  1863. 

74th  New  York. 

2,   (>3. 

llth  Georgia. 

—  ,  '63. 

357 

McCafTertv,  W.,  Serg't, 

Julvl, 

Left.     Died  July  12,  1863. 

404 

Parks,  G.,  Pt.,  1,  3d  Iowa. 

Oct.  5, 

Left.     Died  October  17,  1862. 

C,  121st  i'enn. 

1,  '63. 

5,  '62. 

358 

McCartney,  ().,   Pt.,   E, 

June  2, 

Left  (also  wound  left  shoulder). 

405 

Parr,   W.,   Pt.,  D,  38th 

May  5, 

.     Died  May  11,  1862. 

106th  New  York. 

2,  '64. 

Died  June  3,  1864. 

New  York. 

5,  f62. 

359 

McCune,  A.,  Capt.,   G, 

J  une  6, 

Left.     Died  June  9,  1864. 

406 

Patterson,  J.,  Pt,,  G,  30th 

May  18, 

Lett.     Surg.  S.  C.  Plummer,  Kith 

74th  New  York. 

6,  '64. 

Missouri. 

—  ,'  '63. 

Illinois.     Died  June  16,  1863. 

360 

McDonald,  E.  P.,  Pt.,  II, 

Dec.  16, 

Right.    A.  A.  Surg.  J.C.Thorpe. 

407 

Paul,  E.,  Pt,,  I,  1st  Min 

July  2, 

.     Died  July  13,  1863. 

28th  Kentucky. 

16,  '64. 

Died  December  16,  1864. 

nesota. 

2,  63. 

361 

McDowell.  A.,  Corp'l,  D, 

July  ]. 

Left.     Died  July  3,  1863. 

408 

Pellcy,    R.,    Serg't,    G, 

July  2, 

.     Died  July  4,  1863. 

72d  Pennsylvania. 

—  .  ''63. 

53d  North  Carolina. 

2,  '63. 

362 

MoGinniken,  C.  B.,  Lt., 

May  5, 

Right.     Died  May  5,  1864. 

409 

Perkins,  D.,  Pt.,  F,  8th 

July  —  , 

Left.     Died  July  5,  1864. 

D,  9th  Mass.,  age  25. 

5,  '64. 

Maine. 

—,"'64. 

3(53 

McGraw.  F.,  Pt,,  A,  40th 

May  16, 

Left.     Died  May  22,  1864. 

410 

Perkins,  D..  Pt.,  H,  4th 

Sept.  17, 

.     Died  October  2,  1862  ;  ery 

Massachusetts,  age  28. 

16,  '64. 

Penn.  Reserves. 

18,  '62. 

sipelas. 

TRIMARY    AMPUTATIONS    IN    THE    LEG. 


511 


No. 

NAME,  MILITARY          DATES          OPERATIONS,  OPERATORS, 
DESCRIPTION,  AND  AGE.                                   RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  ASD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESfLT. 

411 

Phillips,  P.,  Pt.,  B.  1st     May  9,     .     Died  May  9,  1864. 

458 

Savage,  W.  E:,  Pt..  K, 

Sept.  19, 

Left.     Surg.  L.  P.  Wagner,  1  1  4th 

Rhode  Island  Artillery.       9,  '64.     1 

114th  New  York.               19,  '64. 

N.  Y.     Tetanus.     Died  Oct.  27, 

41-2 

Pickett,  J.  W.,  Pt.,   G,      July  3.  .  Left.     Died  July  28,  1863. 

1864  ;  phthisis  and  exhaustion, 

13th  Alabama.                    —  ,  '63.                                                                      459 

Saxby.W.  H.,  Pt.,   K,     May  27, 

Right.     Died  May  30,  1863. 

413 

Pierce,    A.,    Pt.,    1,   7th     June  8,      Right.     Died  June  20,  1864. 

91st  New  York,  age  22.      1'7,  '63. 

Rhode  Island.                      8,  '64. 

460 

Scliell,  J.,  Pt.,  I,  1st  N.  '  Aug.  19, 

Left.     Died  August  27,  1864. 

414 

Pierce,  L.  D.,  Pt.,  K,  63d     May  9,     Left.     Died  June  9,  1862. 

York  Artillery.                    19,  '('A. 

Ohio.                                i    9,  '62. 

461 

Schilling,  J.,  Pt.,  F,  3d     Jan.  11,     Right.     Died  January  24.  1863. 

415 

Pike,  W.,   Pt.,  B,  75th  !    Oct.  8,      Left.    Died  October  15,  1862. 

Missouri.                               11,  '63. 

Illinois.                                  8,  '62. 

462 

Schwab,  D..  Pt.,  H-,  33d     May  3,      Left.     Died  June  10,  1863. 

416 

Pilgrim,  M.,  Pt.,  C,  1st    June  14,    Right.     Died.                                                 New  York. 

—  .  '63. 

Louisiana.                            14,  '63.                                                                      463    Scott,  C.V..  Lieut.,  G,  1st 

Oct.  19,     Left  ;  posterior  flap.     Died  Jan- 

417 

Pine,  J.,  Pt.,  I,  3d  In-  j   July  3,     Right.     Died  July  25,  1863. 

Rhode  Island  Battery.      19,  '64.        uary  21.  1865. 

fantry. 

—  ,   63. 

464 

Scott,  H.  R.  K.,  Lieut., 

July  3,     Right.     Died  July  29,  1863. 

418 

Pinney,  A.  N.,  Capt.,  II, 

July  130, 

Right  (also  amp.  arm).     Surg.  G. 

H,  8th  Alabama.                —  ,  "'63. 

27th  Colored  Troops. 

30,  '64. 

J.  Potts,   23d   Colored   Troops. 

465 

Scott.  J.,  Pt.,  I.  1st  New     June  1.     Left.     Died  June  19,  1864. 

Died  August  8,  1864. 

York  Dragoons. 

1,  '64. 

419 

PItimer,    A.  E.,  Pt.,  C, 

May  10, 

Left.     Surg.  W.  J.  Burr,  42d  N.     466 

Scott,  J.  W.,  Pt.,  D,  2d 

July  1, 

Right.     Died  Augusts,  1863. 

19th  Maine,  age  31. 

10,"  '64. 

Y.     Died  June  4,  '64  ;  pyaemia.   1 

Wisconsin. 

2,  '63. 

420 

Pool,    J.,    Pt.,    B,    16th 

July  —  , 

(also  amp.  arm).     Died  July     467 

Sernson,   S.  A.,   Pt.,  G, 

July  14, 

—  .     Died  July  17,  1864. 

Georgia. 

—  ,  '63. 

6,  1863. 

12th  Iowa. 

14,  '64. 

421 

2'oole,  M.  C..  Pt.,  I,  13th 

May  12, 

Left   (also  wound  right).     Died    468( 

Shearer,  F.,  Pt,,  I,  35th 

Dec.  15, 

Both.     Died  December  16,  1864. 

Georgia,  age  20. 

14,"  '64. 

June  4,  1864;  pyaemia.                   4(>9S 

Indiana. 

15,  '64. 

422 

Potter,  H.   11..  Pt.,   G, 

July  —  , 

Right.     Died  August  18,  1863.          470    Shinn,    W.,    Pt.,   I,   5th 

June  18, 

Left.     Surg.  S.  II.  Plumb,  82d  N. 

14th  Mississippi. 

—,"'63. 

New  Jersey. 

18,  '64. 

Y.     Died  June  18,  1864. 

423 

Potter,   W.   A.,   Pt.,  B, 

April  6, 

.     Died  April  11,  1862.               471    Shores,   P.,  Pt.,  D,  40th 

July  8, 

Left.     Died  July  18,  1864. 

55th  Illinois. 

—  ,  '62. 

Illinois. 

8,  '"64. 

424 

Potts,    J.    C.,  Capt.,   F, 

Sept.  19,    Right.     Died  October  4,  1863.          472    Simpson.  II.,  Pt.,D,  137th    June  15, 

Left.     Died  July  11,  1864. 

39th  Indiana. 

19,  '63.                                                                                  New  York.                        !    15,  '64. 

425 

Powell,  J.,  Serg't,  1,10th 

May  16,    .     Died  May  26,  1863.                 473    Slattery.  E.  T.,  Serg't,  I,     April  7, 

Right.    Died  April  17,  1862. 

Iowa. 

—  ,  '63. 

55th  Illinois. 

7,  '62. 

426 

Price,   A.,   Pt.,  A,   58th 

April  8,     Left.     Died  April  9,  1864.                 474    Small,  J.  F.,  Pt..  B,  1st    June  18, 

.     Died  June  29,  1864. 

Illinois. 

8,  '64. 

Mass.  H'vy  Artillery.        18,  '64. 

427 

Proctor,  L,  1't.,  E,  1  10th 

Juno  1, 

Right.     Died  Juno  2,  1864.                475    Smeltz.  J.  M.,  Pt.,  I,  98th    June  27, 

Right.    Died  July  5,  1864. 

Ohio. 

—  ,  '64. 

Ohio. 

27,  '64. 

428 

Proseus.  E..  Pt.,  E,  lllth 

July  2,      Left.     Surg.  H.  M.  MeAbee,  4th     476    Smith.  R.  M.    Pt..  K.  8tb 

Sept.  17, 

Right.    Died  September  28,  1862. 

New  York. 

3,  '63.         Ohio.     Died  July  10,  1863. 

Florida. 

17,  '62. 

429 

Prugine,  J.   L.,   Pt..    F, 

July  3,     Right.      July    10,  'haemorrhage.     477    Smith,  E.,  Pt.,  H,  2d  N. 

June  17, 

Left.     Died  June  28,  1864. 

1st  Penn.  Artillery. 

5,  '63.         Died  July  20,  1863;  exhaustion.   <             York  H'vy  Artillery. 

18,  '64. 

4:K> 

Pullin.  C,.  B..  Corp'l,  II, 

Dec.  14,     .     Died  December  14,  186,'.        478    Smith,  K.,  Pt.,  C,  llth 

Aug.  14, 

Right;    circular.     Died   Septem 

35th  New  Jersey. 

14,  '62. 

I 

Maine,  age  42. 

H,"  '64. 

ber  4,  18(54;  pyaemia. 

431 

Piinly.    J.    A.,    Pt.,    E, 

May  22.     Right.     Died  June  3,  1863  ;  py-     479    Smith,  P.,  Corp'l,  C,  3d 

Aug.  16, 

Right.     Aug.  22,  amp.  left.     Died 

72d  Illinois,  age  24. 

22,  '63. 

semia. 

New  Hainp.,  age  19. 

16,  '64. 

August  30,  1864:  exhaustion. 

432 

Putnam.   S.,   Serg't.    E,     Dec.  13,     Left  (wound  of  arm  and  breast).     480    Snapp.W.,  Serg't,  F,  5th 

Dec.  31, 

Left.     Died  April  7,  1863. 

145th  Pennsylvania. 

13,  '62.        Died  December  13,  1862. 

Kentucky. 

31,  '62. 

433 

Quinly.    J.,   Pt.,   B,  5th 

Aug.  30,    .     Surg.  P.   R.  Randall,  5th     481    Spinning,  W.  W.,  Pt.,  B, 

Sept.  19, 

Left.     Died. 

W.  Virginia,  age  42. 

30,  '62.        W.  Va.     Died  Sept.  —  ,  1862.                     93d  Ohio. 

19,  '63. 

434>    Randall.  A..  Pt.,  C,  35th 

Dec.  13,    Both.     Died  December  15,  1862.      48~    St.^!\sl'f^',D'  F''  1>t-1  C' 

May  14, 

Left.     Died  May  28,  1864. 

435^      New  York. 

,.,   v-o                                                                                        .52d  Alabama. 
'                                                                             483    Stanley,  W.,  Pt.,  II,  53d 

—  ,  '64. 
Dec.  13, 

Right.     Died  April  26,  1863;  am- 

436 

Rapcr,    W.,   Pt.,    G,   5th      May  5,      Right  (also  w'd  right  arm  ;  haem.;                 Pennsylvania. 

13,  '62. 

putation  and  diarrhoea. 

North  Carolina.                    5,   62. 

lig.  axillary).     Died   June   14,     484    Starr.  A.,  Pt.,  G,   106th 

July  3, 

Left.     Surg.  O.  Munson.  108th  N. 

1862:  exhaustion.                                             Pennsylvania. 

3,  '63. 

Y.    Died  July  15.  1863. 

437 

Rn>l,   A.  J.,   I't..  K.  34th      July  3,      Left.     Died  July  31,  |H13.                   485    Shphnix,   J.    D.,   Pt.,  C, 

July  3, 

—  .     Died  July  18,  1863;  ha?m 

North  Carolina. 

3,  '63.                                                                                         17th  Mississippi. 

—,"'63. 

orrhage. 

438 

Ray.  S.,  Serg't.  D,  84th      Sept.  2,     (also  amp.  arm).     Sure.  T.      486    Stephenson,  W."  <  '.,   Pt., 

July  12, 

Left  (also  wound  of  thigh).    Died 

Illinois.                                   -J,  '(••!.         M.  Cook,  101st  Ohio.     Died  Sop-                 C,  3d  Iowa. 

—  ,  '63. 

July  23.  1863. 

tember  (i,  18(i4. 

487     Stern,    P.,    Pt.,    B,    29th 

Aug.  28, 

."    Surg.  S.  S.  Schultz,  26th 

439 

Rml,   C.   11.,   Serg't,   F,      July  3,      Left.     Died  August  13,  1863. 

New  York. 

—  .  '62. 

Penn.     Died  Sept.  22,  1862. 

7th  North  Carolina.             3,  '"63.                                                                      '  488    Stevens.  .1.  C.,  Capt.,  II. 

April  (i, 

—  .     Died  April  16,  1862. 

•MO     R.-eder.  ('.,  Pt.,  F.  134th      (M.  19,      Right.     Died  October  19,   1864.                      46th  Illinois. 

6,  '62. 

New  York.                              19,  '64.    i                                                                       4S1     Stevens,   M.,   Pt.,  15,  1st 

July  9, 

Left.     Died  July  9,  1864. 

441    /.Veres,  L.A.,  Pt  .D,  15th     July  3.      .     Died  July  14,  1863  ;  py- 

New  York  Engineers. 

9,  '64. 

(loorgia.                                   3,  '63.          a'mia. 

490    SHnbacker.    J.,    Pt.,   H, 

May  12, 

Left.     Died  May  20,  1864. 

412    Reiminger.    A.,    Pt.,   F,     Dec.  13.     Left.     Died  January  2,  1863. 

56th  Penn.,  age  36. 

—  .  '64. 

131st  Pennsylvania. 

13,  '62.    j 

491     Stockhamnier.  F..  Serg't. 

May  14, 

—  .     Died  May  22,  1864. 

443    Rhinelmrt,  A.  R.,  I't.,  11, 

May  3,    'Left.     Died  M::y  25,  1863. 

G,  12th  Missouri. 

—,"'64.' 

124th  New  York. 

3.  '63.                                                                       492    Stone.  D.  C.,  Serg't,  F, 

Oct.  5, 

.     Died  October  9,  1  862. 

444    Rice,   11.  J.,   1't.,   A.  3d 

Oct.  8.       Right.      Died  November  4,  186'.':                  28th  Illinois. 

5,  '62. 

Ohio. 

8.  '62. 

typhoid  fever.                                \  493    Stone,  —  ,  Page's  Battery. 

July  2, 

Left.     Died  July  11,  1863. 

445    Rice,  J.  H..  1't..  B,  11  tli 

Julv  3.      .     Died  July  11,  1863. 

2,  '63. 

New  Jersey. 

3.  '63. 

494    Stonestifler,   J.,  Pt.,  E, 

June  18, 

Right.     Died  June  18,  1864. 

446    Richard,    J.,    Corp'l,    I'-,      .May  Id.     Left  (also  flesh  w'nd  right  thigh).                  1st  Maryland. 

18.  '64. 

143d  Penn.,  age  23,             10,  '64.    i     Died  August  4,  1864.                     j  495    Stouteng'er,    J.,   Pt.,  G,      July  2, 

.     Died  July  —  ,  1863. 

447     Rickard     N..  I't..  A     "(Itli        M:iv  '!                          Died   M:iv   I'l    1HIM                                        147H,   Vnw  V.irt 

2,  '63. 

Pennsylvania. 

—  ,  '64.                                                                    ,496    Stowbridge,   B..   Pt..    I, 

April  8, 

Left.     Died  April  8,  1865. 

448 

Roberts,  P.,  Pt.,  II,  41st 

July   12.    Right.     Died  July  24,  1863. 

82d  Colored  Troops. 

8,  '65. 

Illinois. 

—  ,"  '63. 

i  497 

Spears.  T.   W.,   Pt.,   B, 

Oct.  19, 

.     Died  October  22.  1864. 

449     Robinson.  W.,  1't.,  1.6th 

May  5, 

.     Died  June  2,  1862. 

29th  Maine. 

19,  '64. 

!     New  Jersey. 

498 

Sperl,    II.,    Pt..    II,   2d 

Dec.  1. 

Right.     Surg.  J-  S.  Ross,  1  1  th  N. 

450    Rodders.   S.'  E..   Pt..  C. 

Oct.  8.' 

Right.     Died  October  25,  1862.      ( 

Maryland. 

1,  '63. 

Hampshire.     Died  Dec.  5,  186:?. 

15th  Kentucky. 

8,  '62. 

499 

Tatlo'ck,  A.,  Pt.,  E,  53d 

Oct.  5, 

.  "Died  October  16,  18G2. 

451     Rogers,    R.,    I't.,   1!,  6th 

July  14,     Left.     Died  July  30,  '63  ;  wounds. 

Indiana. 

5,  '62. 

Michigan  Cavalry. 

—,"'63. 

500 

Taylor.  G..  Pt.,  G,  lllth 

July  2, 

.     Died  July  20,  1863. 

452    Rollins,   E.    (i.,   I't.,   A, 

May  3, 

Left.     Died  June  2,  1863. 

New  York. 

3,  '63. 

12th  New  Hampshire,    j     3,  '63. 

501 

Terwillager.   T.    S.   G., 

May  5, 

.     Died  May  26,  1864. 

453    Ross,  E.  D.,  Pt.,  I,  5th 

May  5, 

.     Died.                                                   Pt.,  B.  120th  N.  Y. 

5,  ''64. 

Michigan. 

5,  '62. 

502    Tewcl,  AV.,  Pt.,  A,  15th 

Sept.  19, 

;  Hap.     Died  September  —  •, 

454    Sosser.  E.  A.,  Pt.,  C,  10th 

July3, 

—  .     Died  July  6,  1863. 

West  Virginia. 

19,  '64. 

1864. 

Georgia. 

—  ,  '63. 

503     Thomas,   G.  B.,  Pt.,  C, 

Julv  _,     .     Died  July  10,  1863. 

455    Rue,   M.,   Pt.,  K,   lllth 

July  1, 

Left.     Surg.  11.  M.  MeAbee,  4th 

51st  Georgia. 

—,"'63.   : 

New  York. 

—  ,  ''63. 

Ohio.     Died  July  4,  1863. 

504    Thomas,  I.,  Pt.,  H,  8th 

Dec.  31, 

.     Died  January  8,  1863. 

456  !  Ryan,  S.,  Corp'l,  C,  66th 

June  J5, 

Right.     Died  July  2,  1864. 

Kentucky. 

31,  '62. 

Ohio. 

15,  '64. 

505    Thompson,  P.,  Corp'l,  E, 

Nov.  27, 

Right  (flesh  w'nd  left  leg).     Ass't 

457    Sarles,    A.,   Pt.,   F,  53d 

Oct.  5, 

.     Died  November  3,  1862. 

30th  Iowa. 

27,  '63. 

Surg.  S.  S.  Buck,  103d  Illinois. 

Illinois. 

—  ,  '62. 

Died  December  12,  1863. 

512 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

500 

Tiffany,   J..  Lieut.,    D, 

July  3, 

—  .     Died  July  10,  1863. 

539 

Yantz,    J.,    Pt.,    I,    9th 

Mar.  7, 

Left.     Died  March  12,  1862. 

27th  Virginia. 

3,  '63. 

Iowa. 

—  ,  '62. 

507 

Tinkham,  C.  G.,  Serg't, 

Sept.  17, 

Left.     Died  September  30,  1862. 

540 

York,   15.  F.,  Pt.,  F,  2d 

Dec.  13, 

Right.     Died  December  27.  1862. 

A,  12th  Mass.,  age  36. 

17,  '62. 

Maine. 

13,  '62. 

508 

Tolbogs,  R.  V.,  Pt.,  C, 

Oct.  5, 

Right.     Died  October  14,  1864. 

541 

York,  J.  M.,  Pt.,  E.  66th 

May  10. 

—  .     Died  May  22,  1804. 

39th  Iowa. 

—  ,  '64. 

Illinois. 

1C,'  '04. 

509 

Trowbridge,  .1.  E.,  S'g't. 

July  3, 

.     Died  July  14.  1863. 

542 

Young,  J.,  Pt.,  V,  28th 

Oct.  19, 

Right.     Died  October  20.  1804. 

E,  £th  N.  V.  Cavalry. 

—  ,  '63. 

Iowa. 

IS),  '04. 

510 

Trumbull,     A.,    Pt.,  K, 

May  27, 

Right.     Surg.  C.   A.  Robertson, 

543 

Bnlman,  J.  W.,  Pt.,  G,  2d 

Oct.  7, 

Left. 

159th  New  York. 

27.  '63. 

159th  N.  Y.     Died  June  23,  '03. 

South  Carolina. 

—  ,  '04. 

511 

Tubbs,  15.N.,  Pt.,—  ,81st 

July  2, 

.     Captured  and  died   while 

544 

Boroff,  J.  H..  Serg't,  A. 

June  5, 

Right. 

Pennsylvania. 

4,  '62. 

in  prison. 

123d  Ohio. 

—  ,  '04. 

512 

KA\ 

Cook         I  ieut   Col     8th 

T-»M      1  1 

T  lift- 

gofY's  amp.  other  foot.     Surg.  J. 

tri.l 

Virginia  Cavalry. 

llllu.    1  '  . 

11.  '05. 

i  jeii. 

T.  Gilmore,  C.  S.  A.     Died. 

546 

Derr,  A.  ./.,  Corp'l,  C, 

May  3, 

;   circular  ;   sloughing. 

513 

Van  Kleet,  C.   H.,    Pt., 

June  3, 

Left;  circ.     Surg.  G.  T.  Stevens. 

37th  N.  C.,  age  31. 

4.  '63. 

G.  77th  N.  Y.,  age  21. 

3,  '64. 

77th  N.  Y.     Died  July  20,  1864  ; 

547 

Harrison,  L.,   Corp'l,  F, 

Oct.  4, 

Left. 

exhaustion,  diarrhoea. 

63d  Ohio. 

—  ,  '02. 

514 

Vanwinkle,  M..  Pt.,  E. 

July  2, 

Left,     Surg.  H.  M.  McAbce,  4th 

548 

Hemingway,   T.,  Pt.,  15, 

Oct.  13, 

Left. 

lllth  New  York. 

3,  %3. 

Ohio.     Died  July  27,  '63  ;  gang. 

Hampton's  Legion,  S.C. 

—  .  '64. 

515 

Varney,    A.  C.,   Pt.,  K, 

Aug.  6, 

Left.     Died  August  21,  1863. 

549 

James,  F.  M.,  Pt.,  B,  31st 

July  20, 

Left. 

Hth  Maine. 

6,  '63. 

Mississippi. 

—,''04. 

T.16 

Virgin.  A.  J..Pt.,K,  25th 

Jan.  11, 

Right.     Died  January  15,  1863. 

550 

Kelley,  J.  JF.,Pt.,G,  40th 

July  20, 



Iowa,  age  25. 

—  ,  '63. 

Mississippi. 

—,"'64. 

517 

Wagnor,   E.  R..  Pt.,  A, 

June  14, 

Right.     Died  August  13,  180:!. 

551 

Linebcrger,  J.  L.,  Pt.,  H, 

May  2. 

Left.     Ass't  Surgeon  B.  Howard, 

75th  New  York. 

14,  '63. 

23d  North  Carolina. 

2,  '63. 

U.S.  A. 

518 

Wales,  W.,  Pt.,  F,  51st 

Dec.  31, 

Left.     Died  January  7,  1863. 

552 

Lisebone,  J.  ff.,  Pt.,  2Sth 

July  27. 

.  

Ohio. 

31,  '62. 

North  Carolina. 

—  ,  '62. 

519 

Wullaok.  I.,  Pt.,  G,49th 

Nov.  24, 

Right.     Died  November  27,  1863. 

553 

Mason,  W.  A.,  Pt.,  B,  82d 

Aug.  28. 



Ohio. 

24,  '63. 

Ohio. 

—  ,  '62. 

520 

Waller,  D.  J..  —,  E,  23d 

Sept.  14, 

.     Sept.  25,  haem.;  amputat'n 

554 

McCrai/,  C.  B.,  Corp'l,  1, 

May  15, 

Right. 

South  Carolina. 

15,  '62. 

thigh.     Died  Oct.  13,  1862. 

36th  Alabama. 

—  ,  '64. 

521 

Walters,  J.  II.,  Pt.,  K, 

Aug.  22, 

Left;  flap.     Died   September  3, 

555 

Razenmand,  C.,  Pt.,  

May  —  , 



14th  New  York. 

22,  '62. 

1862. 

—  ,  '64. 

522 

Wanzer,  J.,  Pt.,  G,  12th 

April  6, 

—  .     Died  April  14,  1862. 

556 

Read.W.  H,  Pt,  A,  58th 

July  13, 

Left.     Supposed  to  h:ivn  died. 

Illinois. 

6,  '62. 

Illinois. 

13.  '64. 

523 

Watson,  S.,Pt.,C,  118th 

Sept.  21, 

Left.     October  14,   hemorrhage. 

557 

Hf.arly,  W.,  Pt.,  —  ,  37th 

May  27, 



Pennsylvania. 

21,  '62. 

Died  Oct.  15,  1862;  tetanus. 

North  Carolina. 

—  ,'  '62. 

524 

Welch,  W.,  Pt..  I,.  8th 

June  3, 

Left  ;  gangrene.    Died  July  1  3, 

558 

Reedy,  D.E..Pt.,E,48th 

June  3, 



N.  Y.  H.  A.,  age  43. 

4,  '64. 

1804. 

Pennsylvania. 

—  .  '04. 

525 

Welker,  J.,  Pt.,  G,  35th 

Sept.  19, 

Left.     Died  October  11,  1863. 

559 

Rinehaft,  L.,  Pt.,  E,  32d 

June  20, 

Right. 

Illinois. 

19,  '63. 

Indiana. 

20.  '64. 

520 

Wickham,  1.,  Pt.,A,  13th 

July  22, 

Left  (also  wound  left  arm).     Died 

500 

Robertson,  A.  S.,  Pt.,  —  . 

Oct.  5, 



Iowa. 

22,  '64. 

July  27,  1804. 

28th  Illinois. 

—  ,  '62. 

527 

Wilburn,  J.  C.,  Pt.,  D, 

May  23, 

Right.     Died  May  28,  1863  ;  py- 

561 

Rot  brock,  B.,  Pt.,B,  81st 

Dec.  13, 

Right  (also  wound    of   side  and 

2?d  Kentucky. 

—  ,  '63. 

semia. 

Pennsylvania. 

13,  '02. 

foot). 

528 

Willey,  C.W.,  Corp'l,  C, 

June  14, 

Left.    Died  June  14,  1863. 

502 

Soherring,  H.  P.,  Pt.,  —  , 

June  5, 

Right. 

2t)th  Connecticut. 

14,  '63. 

4th  Maryland. 

—  ,  '64. 

529 

Williams.  J.  M..  Corp'l, 

Dec.  31, 

.     Died  January  24,  1863. 

563 

Sherrill,  J.  M.,  Pt.,  D, 

I,  69th  Ohio. 

31,  '62. 

18th  North  Carolina. 

530 

Williston,  R.  S,  Serg't, 

Aug.  9, 

(also  wound  of  hand).    Died 

564 

Smith,    J.,    Pt.,   D,    9th 

Oct.  4, 



G,  2d  Massachusetts. 

9,  '62. 

August  9,  1862. 

Illinois. 

—  .  '62. 

531 

Willson.    J.  W.,  Major, 

Sept.], 

Right.     Died  Oe'ober  3,  1864. 

565 

Songtitery.  J,Pt,E.55th 

July  20, 

Left. 

Hth  Ohio. 

1,  '64. 

Alabama. 

—  ,  '64. 

532 

Winchester,   W.  H.,  Lt., 

July  1, 

Left.     Died  August  1,  1863;  py 

506 

Stephens,  J.  F.,  Pt.,  A, 

May  3, 

;   flap. 

1,  13th  N.  C.,  age  23. 

2,  '63. 

aemia. 

49th  Georgia,  age  23. 

4.  '63. 

533 

\Vinegar,A.,Pt.,F,  lllth 

May  6, 

Left.     Died  June  13,  1864. 

507 

Swaford,  W.  H.,  1't.,  C, 

July  20, 

Left. 

New  York,  age  18. 

6,  ''64. 

3:!d  Mississippi. 

—  ,'  '64. 

534 

Winemiller,  J.C.,  Serg't, 

Aug.  16, 

Right.     Died  August  24,  1864. 

568 

Talifero,  —  ,  Lieut.,  9th 

Nov.  5, 



L,  1st  Md.  Cavalry. 

16,  '64. 

Virginia  Cavalry. 

5,  '62. 

535 

Wood,K.C.,Pt.,B,'l41st 

July  3, 

Right.     Died  July  13,  1863. 

569 

Willard,  J.,  Pt.!  A,  — 

Aug.  14, 

Right. 

Pennsylvania. 

—,''63. 

South  Carolina. 

—  ,  '64. 

536 

Woodsi'de,H.,Pt.,C,  81st 

May  —  , 

Left.     Died  July  1,  1863. 

570 

Williams,  T.  J.,  Pt.,  H, 

July  28, 

Left. 

Illinois. 

—  ,"  '63. 

20th  South  Carolina. 

—  ,"  '64. 

537 

Worcester,  J.  H.,  Lieut., 

July  11, 

Left;  flap.     Died  July  26.  1863. 

571 

Wilson,  A.   W.,  Pt,  C, 

July  28, 

Left. 

II.  7th  New  Hamp. 

—  ,  '63. 

19th  Louisiana. 

—,''64. 

538 

Worcester,  O.  P.,  Pt.,  C, 

Mar.  23, 

.     Died  April  15,  1862. 

7th  Ohio. 

—  ,  '62. 

Of  the  five  hundred  and  seventy-one  operations  recorded  in  the  foregoing  table  the 
amputation  was  performed  in  the  right  limb  in  one  hundred  and  seventy-seven,  in  the  left 
limb  in  two  hundred  and  eight  cases;  in  one  hundred  and  eighty-six  instances  the  side 
was  not  indicated. 

INTERMEDIARY  AMPUTATIONS  IN  THE  CONTINUITY  OF  THE  LEG  FOR 
SHOT  INJURY. — One  thousand  and  forty-six  of  the  five  thousand  four  hundred  and  fifty- 
two  amputations  in  the  leg  were  intermediary  operations.  The  results  were  determined  in 
all  cases;  six  hundred  and  eighty-two  were  followed  by  recovery,  and  three  hundred  and 
sixty-four  by  death,  a  mortality  rate  of  34.7  per  cent.,  exceeding  that  of  the  primary  oper 
ations  (30.9  per  cent.)  3.8  per  cent.  Two  hundred  and  ninety-six  operations  were  performed 

'HOLLOWAY  (J.  M.),  Comparative  Advantages  of  Pirogoff't,  Syme's,  and  Chopart's  Amputations  and  Excision  of  the.  Ankle  Joint  by  Hancock's 
Method,  after  Gunshot  Wounds  and  otJier  Injuries,  in  American  Journal  Medical  Sciences,  Vol.  LI,  p.  85. 


SECT.  V.J 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


513 


in  the  upper,  three  hundred  and  sixty-eight  in  the  middle,  and  three  hundred  and  thirty-five 

in  the  lower  third  of  the  leg;   in  forty-seven  the  seat  of  the  amputation  was  not  indicated. 

Intermediary  Amputations  in  the  Upper  Third  of  the  Leg  for  Shot  Injury. — Two 

hundred  arid  ninety-six  operations  were  recorded;   one  hundred  and  ninety-four  had  suc 
cessful,  and  one  hundred  and  two  fatal  terminations,  a  mortality  of  34.4  per  cent. 

Successful  Intermediary  Amputations  in  the  Upper  Third  of  the  Leg. — The  one  hun 
dred  and  ninety-four  operations  were  performed — one  on  a  civil  employe,  twenty-two  on 
Confederate,  and  one  hundred  and  seventy-one  on  Union  soldiers.  Of  the  latter,  one  officer 
was  placed  on  the  retired  list,  and  one  hundred  and  sixty-eight  enlisted  men  became  pen 
sioners,  of  whom  twenty  have  died  since  their  discharge.  In  three  instances  the  amputa 
tion  in  the  leg  was  followed  by  amputation  in  the  thigh.1 

CASE  754. — Colonel  F.  Fessenden,  30th  Maine,  aged  25  years,  was  wounded  in  the  right  leg  during  an  engagement 
near  Cane  River,  April  23,  1864,  and  entered  St.  James  (Officers')  Hospital,  New  Orleans,  six  days  afterwards.  Assistant 
Surgeon  S.  H.  Orton,  U.  S.  A.,  reported:  "The  tibia  was  fractured  irregularly  for  two  and  a  half  inches  at  the  upper  part  of  the 
middle  third,  two  pieces  of  bone  being  entirely  detached.  Flap  amputation  at  the  upper  third  was  performed  on  April  30th,  by 
Surgeon  F.  Bacon,  U.  S.  V.;  chloroform  was  used.  At  the  time  of  the  operation  the  periosteum  was  detached,  with  infiltration 
of  pus  beneath  the  integuments  down  to  the  ankle  joint.  The  patient's  constitutional  condition  was  good  and  he  progressed 
favorably.  He  was  granted  a  leave  of  absence,  and  left  the  hospital  May  18,  1864."  The  specimen  (3603)  shown  in  the 
annexed  wood-cut  (FiG.  294)  was  contributed  to  the  Museum  by  the  operator,  with  the  following  supplementary  description 
of  the  case:  ''The  tibia  was  splintered  by  a  glancing  bullet,  which  did  not  lodge  in  the  leg  and  made  but  a 
single  wound  in  the  integuments.  The  fibula  was  not  fractured  and  has  not  been  preserved.  I  first  examined 
the  wound  some  seven  days  after  it  had  been  received  and  was  surprised — in  view  of  its  apparently  small 
extent — to  find  the  bones  stripped  of  periosteum  and  evidently  dead  for  a  distance  of  several  inches  above  and 
below.  One  of  the  fissures  ran  directly  across  the  nutrient  foramen.  The  artery  had  been  ruptured  at  that 
point  and  considerable  haemorrhage  had  ensued,  the  blood  being  evidently  infiltrated  through  the  calf  of  the  leg. 
To  this  fact  I  attributed  the  loss  of  vitality  which  had  taken  place  even  in  the  larger  fragments  of  the  bone.  The 
leg  was  amputated  without  delay  immediately  after  the  examination."  After  leaving  the  hospital  Colonel  Fes 
senden  returned  to  active  service,  and  was  promoted  to  Brigadier  General  and  subsequently  to  Major  General. 
He  was  retired  from  service  November  1,  1866.  At  the  battle  of  Shiloh,  April  7,  1862,  he  had  also  been 
wounded  in  the  arm. 

CASE  755. — Private  J.  Wheeler,  Co.  A,  8th  Connecticut,  aged  23  years,  was  wounded 
at  Antietam,  September  17,  1862.  Surgeon  T.  H.  Squire,  89th  New  York,  recorded  hi* 
admission  to  the  Locust  Spring  field  hospital,  near  Sharpsburg,  and  noted  the  following 
description  of  the  case:  "The  wound  was  through  the  right  ankle  joint  by  a  musket  ball. 
The  leg  was  amputated  one  week  after  the  injury  by  Surgeon  W.  H.  Leonard,  51st  New 
York,  at  the  junction  of  the  upper  and  middle  thirds.  The  flaps  sloughed  and  the  ends  of 
both  bones  became  exposed,  being  surrounded  by  red  granulations.  By  a  healing  pro 
cess  the  stump  slowly  changed  for  the  better,  the  efforts  of  nature  being  supported  by 
treatment  as  good  as. could  be,  and  the  patient  being  cheerful  and  expecting  a  good  recov 
ery.  On  November  12th,  the  ends  of  the  bones  exfoliated  and  were  taken  away,  after 
which  the  stump  improved  and  the  patient's  general  health  became  quite  good."  He  sub 
sequently  passed  through  hospitals  at  Frederick,  was  transferred  to  Knight  Hospital, 
New  Haven,  and  finally  admitted  to  Central  Park,  New  York  City,  October  30,  1863. 
Acting  Assistant  Surgeon  S.  Teats  reported  from  the  latter  hospital  that  "the  stump  had 
healed  up  perfectly  sound  by  June  1,  1863;  also  that  the  patient  had  been  discharged 
from  service  November  17,  1863,  and  received  an  artificial  leg.  •  The  man  has  been  paid 
as  a  pensioner  to  September  4,  1880.  In  his  application  for  commutation,  dated  1875,  he  described  the  stump  as  being  "very 
uneven  and  sensitive;"  but  five  years  later  he  reported  its  condition  as  "sound."  A  plaster  cast  of  the  stump  (Spec.  2746), 
contributed  by  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  is  represented  in  the  annexed  wood-cut  (FiG.  295).  The  specimen 
indicates  the  amputation  to  have  been  performed  by  the  posterior  flap,  while  the  cicatrices  resemble  those  following  a  circular 
operation.  The  integument  on  the  anterior  surface  appears  tightly  drawn  over  the  bone. 

CASE  756. — Brigadier-General  H.  E.  Payne,  U.  S.  V.,  aged  37  years,  was  wounded  at  Port  Hudson,  June  14,  1863. 
He  was  conveyed  to  the  field  hospital  of  the  3d  division.  Nineteenth  Corps,  whence  Surgeon  S.  C.  Hartwell,  38th  Massachusetts, 
reported:  "Shot  wound  of  left  leg."  Two  days  after  the  reception  of  the  injury,  which  involved  the  fracture  of  both  bones  of 
the  leg,  he  was  conveyed  to  New  Orleans,  whence  Dr.  P.  C.  Boyer  reported  that  the  patient  "was  under  treatment  at  the  Hotel 
Dieu  Hospital  from  June  16th  to  July  22d  for  gunshot  wound  of  leg  and  amputation."  The  operation  was  performed  by  Dr. 

1  Two  of  the  operations  were  done  in  the  middle  third  of  the  thigh :  Cases  of  Ft.  A.  J.  Cheever,  H,  16th  Mass.  (TAliLK  XXXV,  No.  35,  p.  280,  ante): 
Corpora]  H.  W.  Hughes,  I,  133d  New  York  (TABLE  XXXIX,  No.  4::,  p.  314,  ante);  and  one  in  the  lower  third:  Ft.  F.  Hoffman,  H,  2d  Penn.  Artillery 
(TABLE  XL,  No.  47,  p.  320). 

SURG.  Ill— 65 


FIG.  294.~Right 
tibia  fractured 
in  middle  third. 
Spec.  3603. 


FIG.  295.  —Stump  after 
flap  amputation  at  junc 
tion  of  upper  and  middle 
thirds  of  leg.  Spec.  2746. 


514 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP    X 


FlG.296.-Frac- 
tured  portion  of 
right  tibia ;  :ie- 
crosis.  Sp.2587. 


Warren  Stone,  of  New  Orleans,  on  June  23d,  four  inches  below  the  knee;  the  patient  entirely  recovered  and  became  able  to 
walk  with  the  aid  of  an  artificial  limb.  General  Paine  ultimately  resigned  his  commission  May  15,  1865,  after  which  he  was 
pensioned.  Since  leaving  the  service  he  has  served  as  a  member  of  Congress,  and  has  been  Commissioner  of  Patents. 

CASE  757. — Private  A.  Rutter,  Co.  C,  100th  Pennsylvania,  aged  20  years,  was  wounded,  at  Bethesda  Church,  June  2, 
1864.  Surgeon  M.  K.  Hogan.  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Ninth  Corps,  with  "shot 
fracture  of  right  leg  by  minie"  ball."  Surgeon  G.  L.  Pancoast,  U.  S.  V.,  who  amputated  the  limb,  made  the  following  report: 
"The  wounded  man  was  admitted  to  Finley  Hospital,  Washington,  on  June  15th,  from  the  field  hospital.  His  injury  consisted 
of  a  compound  comminuted  fracture  of  the  right  tibia,  for  which  amputation  was  performed  at  the  upper  third  on 
June  20th.  The  operation  was  done  by  the  flap  method  and  chloroform  was  used  as  the  anaesthetic,  the  patient's 
general  condition  being  excellent.  After  two  days  of  suffering  the  patient's  progress  of  recovery  was  rapid. 
Cold-water  dressings  were  applied."  Apart  of  the  amputated  tibia  (Spec.  2587),  showing  fracture  in  the  upper 
third  and  exhibiting  well-marked  necrosis,  was  contributed  by  the  operator  and  is  represented  in  the  wood-cut 
(FlG.  296).  The  patient  was  subsequently  transferred  to  Judiciary  Square  Hospital,  where,  after  being  fur 
nished  with  an  artificial  limb  by  Jewell's  Patent  Leg  Co.,  he  was  discharged  from  service  May  4,  1865,  and 
pensioned.  His  pension  was  paid  June  4,  1880.  In  his  applications  for  commutation  he  reported  the  condition 
of  the  stump  as  continuing  "all  right." 

CASE  758.— Sergeant  W.  F.  Johnson,  Co.  H,  84th  Illinois,  aged  19  years,  was  wounded  in  the  right  leg, 
at  Dallas,  May  30,  1864.  Surgeon  J.  D.  Brumley,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the 
1st  division,  Fourth  Corps,  with  "shot  fracture  of  tibia,  lower  third."  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A., 
vyho  amputated  the  limb  at  the  Field  General  Hospital  at  Chattanooga,  made  the  following  report:  "The 
wounded  man  was  admitted  June  6th,  and  on  the  following  day  circular  amputation  was  performed  at  the  junc 
tion  of  the  upper  and  middle  thirds  of  the  leg.  Chloroform  constituted  the  anaesthetic.  The  patient's  consti 
tutional  condition  at  the  time  of  the  operation  was  good,  but  the  injured  parts  were  swollen,  infiltrated,  and  cedematous,  and 
there  was  some  erysipelatous  inflammation.  Two  days  afterwards  the  parts  assumed  a  decidedly  gangrenous  appearance,  and 
the  pus  become  fetid,  black,  and  profuse.  This  rapidly  increased,  though  liquor  of  chlorinate  of  soda  was  freely  applied. 
On  the  third  day  pure  bromine  was  applied,  which  arrested  it.  A  second  application  gave  the  parts  a  healthy  aspect,  granula 
tions  springing  up  at  once.  Tonics  and  stimulants  were  given  internally."  On  August  29th,  the  patient  was  transferred  to 
hospital  No.  19,  at  Nashville,  where  he  obtained  a  furlough  and  was  allowed  to  proceed  to  his  home.  In  the  following  Novem 
ber  he  entered  the  Post  Hospital  at  Rock  Island,  whence  Acting  Assistant  Surgeon  P.  Gregg  reported  that  "either  in  conse 
quence  of  deficient  flap  or  subsequent  sloughing  the  bones  protruded  and  became  necrosed.  It  was  deemed  necessary  by  Surgeon 
W.  Watson,  U.  S.  V.,  in  charge,  and  myself  to  re-amputate.  I  performed  the  operation  on  May  17,  1665.  It  was  necessary  to 
remove  the  head  of  the  fibula.  The  joint  is  useless  for  any  practical  purpose."  The  patient  was  discharged  from  service  August 
10, 1865,  and  pensioned,  since  when  he  has  been  supplied  with  artificial  limbs  at  stated  intervals.  Surgeon  G.  G.  Craig,  of  Rock 
Island,  who  examined  the  stump  on  February  9,  1677,  reported  that  "the  patella  and  a  portion  only  of  the  head  of  the  tibia 
are  remaining,  which  are  drawn  back  and  anchylosed."  The  pensioner  was  paid  June  4,  1880. 

CASE  759. — Lieutenant-Colonel  E.  P.  Taft,  9th  New  York  Heavy  Artillery,  aged  32  years,  was  wounded 
in  the  left  leg,  at  the  battle  of  Monocacy,  July  9,  1864.  Assistant  Surgeon  T.  H.  Helsby,  U.  S.  A.,  reported: 
"The  patient  was  admitted  to  hospital  at  Frederick  the  day  after  receiving  the  injury,  which  consisted  of  a 
fracture  of  the  tibia  and  fibula  in  the  lower  third,  caused  by  a  conical  bullet.  Buck's  extension  apparatus  was 
applied,  with  water  dressings  to  the  wound,  and  a  generous  diet  was  ordered.  Secondary  haemorrhage  having 
occurred  from  the  posterior  tibial  artery,  it  became  necessary  on  July  22 d  to  amputate  the  limb.  The  opera 
tion  was  performed  by  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  in  the  upper  third,  near  the  tubercle,  by  the 
circular  method.  At  the  time  of  the  operation  the  parts  were  in  an  unfavorable  condition  from  fading  erysip 
elas  and  loss  of  blood,  and  the  constitutional  state  of  the  patient  was  anaomic  and  depressed.  Simple  dress 
ing  was  applied  and  a  good  diet  administered.  Secondary  haemorrhage  occurred  from  the  stump  on  July  24th, 
for  which  the  popliteal  artery  was  ligated  in  the  stump.  Moderate  sloughing  was  arrested  by  the  application 
of  a  solution  of  permanganate  of  potash,  and  the  after  treatment  consisted  of  quinine,  porter,  and  stimulants. 
On  September  7th,  the  patient  received  a  leave  of  absence.  When  he  left  the  hospital  he  was  in  fine  spirits, 
his  appetite  and  general  condition  was  good,  and  the  stump  looked  healthy  and  was  almost  healed."  The 
amputated  bones  of  the  leg  (Spec.  3926),  showing  the  tibia  to  be  shattered  and  the  fibula  fractured  transversely, 
Avere  forwarded  to  the  Museum  by  the  operator  and  are  represented  in  the  wood-cut  (FlG.  297).  Lieutenant- 
Colonel  Taft  was  mustered  out  November  28,  1864,  and  subsequently  re-commissioned  as  Colonel.  He 
became  a  pensioner  after  being  ultimately  discharged  from  service.  Dr.  AVilliam  G.  David,  of  Lyons,  N.  Y., 
who  testified  that  he  was  the  attending  physician  of  the  pensioner,  reported  that  "the  shock  to  his  constitu 
tion  from  the  wound  and  loss  of  the  limb,  as  well  as  the  long-continued  and  excessive  discharge  from  the 
stump,  so  prostrated  and  reduced  him  that  he  never  recovered  his  health,  but  continued  anasmic,  and  died  of 
dropsy  on  January  20,  1867." 

Fatal  Intermediary  Amputations  in  the  Upper  Third  of  the  Leg. — The  operations 
belonging  to  this  group  number  one  hundred  and  two — fifteen  performed  on  Confederate  and 
eighty-seven  on  Union  soldiers.  Erysipelas  was  noted  in  five,  tetanus  in  six,  gangrene  in 
eighteen,  and  pyaemia  in  nineteen  instances.  Specimens  in  twenty-two  of  the  cases  are 
preserved  in  the  Army  Medical  Museum. 


Flff.  207  — Lower 
third,  left  leg::  tibia 
shattered  and  fibula 
transversely  frac 
tured.  Spec.  39-30. 


SECT.  V.] 


INTERMEDIARY    AMPUTATIONS    IN    THE   LEG 


515 


CASE  760. — Private  J.  N.  Coder,  Co.  K,  46th  Pennsylvania,  was  wounded  in  the  left  leg,  at  Cedar  Mountain,  August  9, 
1862.  He  was  admitted  to  Wolfe  Street  Hospital,  Alexandria,  five  days  afterwards,  where  amputation  was  performed  by  Acting 
Assistant  Surgeon  S.  E.  Fuller,  who  reported  the  following  history:  "A  rifle  ball  passed  through  the  leg,  fracturing  the  tibia 
about  its  middle.  The  limb  was  amputated  three  inches  below  the  knee  joint  by  the  circular  method,  by  order  of  Surgeon  J.  E. 
Summers,  U.  S.  A.,  in  charge  of  the  hospital,  on  August  27th.  Three  days  after  the  operation  the  stump  had  become  much 
swollen,  with  red  streaks  extending  up  the  limb;  no  suppuration.  Quinine  and  brandy  were  ordered  internally  and  warm- 
water  dressings  were  applied  to  the  stump.  August  31st,  patient  much  the  same;  treatment  continued,  and  limb  painted  with 
muriated  tincture  of  iron  as  far  as  the  redness  extended.  September  1st,  swelling  great  and  no  suppuration  ;  sutures  removed 
and  some  thick  dark-colored  fetid  matter  washed  out  of  the  stump.  September  4th,  redness  disappeared;  swelling  less;  no 
suppuration.;  treatment  continued.  On  September  7th  some  sloughing  of  the  stump  appeared,  when  lint  wet  with  solution  of 
chloride  of  soda  was  applied,  and  the  parts  were  occasionally  touched  with  nitric  acid.  On  September  14th  about  two  inches 
of  the  soft  parts  came  entirely  away,  leaving  a  granulating  surface,  and  the  patient  appeared  better  and  had  good  appetite.  On 
September  16th,  I  called  at  2  A.  M.,  found  the  peroneal  artery  bleeding  freely,  and  applied  a  tourniquet  to  the  femoral,  giving 
brandy  and  opium  internally.  There  was  no  return  of  the  haemorrhage,  but  the  patient  gradually  sunk,  and  died  September  19, 
1862."  The  amputated  tibia,  showing  periostitis  to  have  covered  the  shaft  with  a  delicate  coating  of  callus,  was  contributed  by 
the  operator,  and  is  specimen  321  of  the  Surgical  Section  A.  M.  M. 

CASE  761. — Private  G.  Kimmel,  Battery  I,  1st  New  York  Light  Artillery,  was  wounded  in  the  right  leg,  at  Chancellors- 
ville,  May  3. 1863.  Assistant  Surgeon  J.  R.  Smith,  136th  New  York,  recorded  the  wounded  man's  admission  to  the  field  hospital 
of  the  2d  division,  Eleventh  Corps,  May  15th,  and  his  "death  from  pyaemia,  after  amputation  of  the  leg  below  the  knee,  June 
3,  1863."  Surgeon  R.  Thomaine,  29th  New  York,  who  contributed  the  specimen  (No.  1542)  shown  in  the 
adjoining  wood-cut  (FlG.  298),  reported  that  the  attempt  was  made  to  save  the  leg,  but  amputa 
tion  had  to  be  performed  thirteen  days  after  the  reception  of  the  injury  on  account  of  suppuration. 
The  specimen  consists  of  the  amputated  bones  of  the  leg,  exhibiting  the  tibia  to  be  shattered  in 
the  upper  third,  and  showing  a  decided  effort  of  nature  to  throw  off  the  dead  bone. 

CASE  762. — Private  E.  Williams,  Co.  F,  136th  Pennsylvania,  aged  45  years,  was  wounded 
at  Fredericksburg,  December  13,  1862.  Surgeon  C.  J.  Nordquist,  83d  New  York,  reported  his 
admission  to  the  field  hospital  t>f  the  2d  division.  First  Corps,  with  "shot  wound  of  right  leg." 
Surgeon  O.  A.  Judson,  U.  S.  V.,  contributed  the  pathological  specimen  with  the  following 
description:  "The  wound  was  caused  by  a  mini6  ball  entering  the  upper  part  of  the  middle 
third  of  the  tibia,  passing  obliquely  downward  and  backward,  fracturing  the  bone  in  its  course 
and  wounding  the  anterior  tibial  artery,  and  emerging  through  the  gastrocnemius  muscle.  The 
patient  was  admitted  to  Carver  Hospital,  Washington,  December  21st.  The  leg  Avas  placed  in 
a  fracture  box  and  the  bone  kept  well  in  apposition.  Water  dressings  were  applied.  The  patient 
progressed  favorably  until  December  28th,  when  a  profuse  and  continually  recurring  haemorrhage 
set  in  which  resisted  ordinary  measures  for  its  control.  Amputation  was  accordingly  resorted 
to,  and  performed  at  the  upper  third  of  the  leg  by  flap  operation.  On  January  1,  1863,  haem 
orrhage  to  the  amount  of  thirty  ounces  occurred  from  the  anterior  tibial  artery  in  the  stump, 
which  was  laid  open  and  the  bleeding  vessel  was  secured.  But  the  patient  gradually  sank,  and 
died  the  evening  of  the  same  day.  His  system  was  also  infected  with  pyaemia.  Examination  revealed  an  oblique  fracture  of 
the  tibia,  also  that  a  piece  of  bone  had  been  driven  into  the  anterior  tibial  artery.  The  inter-muscular  tissues  of  the  limb  were 
distended  by  pus."  The  wood-cut  (FlG.  299)  is  a  representation  of  the  amputated  shaft  of  the  tibia  (Spec.  634),  which  was 
comminuted  in  the  middle  third  but  shows  very  little  displacement  of  fragments. 

TABLE   LXXII. 

Summary  of  Two  Hundred  and  Ninety-six  Cases  of  Intermediary  Amputations  in  the  Upper  Third  of 

the  Leg  for  Shot  Injuries. 

[Recoveries,  1—194;  Deaths,  195—296.] 


FIG.  298.— Portions 
of  bones  of  right  leg; 
tibia  fractured  in  up 
per  third.  Spec.  1542. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Adams,  \V.  J.,  Pt.,  A, 

Sept.  14, 

Right.  Discharged  Nov.  29,  1862. 

9 

Barron,  J.  G.,  Pt.,  C,  4th 

May  3, 

Left;  flap.    Surg.  C.  S.  Wood, 

12th  Ohio. 

17,  '62. 

Suicide  January  4,  1870. 

Artillery,  age  19. 

18,  '63.       66th   New   York.      Discharged 

2 

Ames,  G.  \V.,  Pt.,  E,  3d 

Aug.  30, 

Left;  circular.     A.  A.  Surg.  R. 

August  20,  1863. 

Michigan,  age  20. 

Sept.  15, 

Ottman.     Discharged  July  26, 

10 

Barrows,  H.  C.,  Pt.,  F, 

July  18, 

Left  ;  circ.    Confederate  surgeon. 

1862. 

1863. 

9th  Maine. 

21,  '6:i. 

Discharged  March  8,  1864. 

3 

Antry,  W.  W.,  Serg't,  C, 

April  6, 

Left;  circular.    To  prison  April 

11 

Beaty,  M.,  Pt.,  C,  149th 

May  3, 

Right,     Ass't  Surg.  D.  H.  Strick 

24th  N.  C.,  age  25. 

9,  '65. 

17,  1865. 

New  York. 

16,  '63. 

land,  lllth  Pcun.     Discharged 

4 

Armstrong,   R.,  Pt.,  G, 

July  2, 

Left  (also  wound  left  arm);  post. 

March  31,  18G4.     Spec.  1271. 

14th  Infantry,  age  23. 

9,  '63. 

flap.  Ass't  Surg.  W.  U.  Ramsay, 

12 

Bechtel,  H.,  Pt.,  I,  51st 

Dec.  10, 

Left;    ant.  post,  flap;  gangrene. 

U.S.A.    Diseh'd  Sept.  15,1863. 

Indiana,  age  24. 

21,  '64. 

Discharged  June  x!7,  1865. 

5 

Arnold,  L.,  Pt.,  G,  143d 

May  25, 

Right  (May  25,  exo'n  tibia):  flap. 

13 

Beckel,  M.,  Pt.,  A,  25th 

De.31,'62, 

,Right.     Surg.  J.  Blount,  25th  111. 

Pennsylvania,  age  20. 

29,  '64. 

A.  A.  Surg.  C.  Darby.     Diseh'd 

Illinois. 

Jan.6,'63. 

Discharged  July  20,  1863. 

June  17,  1865. 

14 

Billings,   C.   T.,  Pt.,  D, 

July  10, 

Right  ;     circular.        Exchanged 

6 

Baker,  D.,  Lieut,  G,  8th 

Sept.  19, 

Left  ;  ant.  post.  flap.    To  Veteran 

7th  South  Carolina. 

14,  '63. 

July  23,  186o. 

Kansas,  age  30. 

23,  '63. 

Reserve  Corps  June  28,  1864. 

15 

Booth,  H.,  Pt.,  H,  40th 

Aug.  29, 

Left  ;  post.  flap.     A.  Surg.  G.  M. 

7 

Barnes,    II.   H.,  Pt.,  B, 

5th  Vermont,  age  47. 

May  5, 
12,  ^64. 

Left  ;  flap.    Discharged  July  15, 
1865. 

New  York. 

Sep.(i,'(J2. 

McGill,  U.  S.  A.     Discharged 
July  7,  1863.     Spec.  1966. 

8 

Barne.lt,  A.  J.,  Serg't,  D, 
32d  Georgia,  age  35. 

July  2, 
6,  %3. 

Right  ;  flap.  Exchanged  Septem 
ber  25,  1863. 

16 

Bowen,  F.  A.,  Serg't,  K, 
36th  New  York. 

July  1, 
6,  '62. 

Left  ;  flap.     Discharged  October 
1,  1862. 

516 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAT.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION',  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AOE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

17 

Bowers,   E.,  Pt.,  B,  2d 

Mar.  6, 

Right;  circ.  Confederate  surgeon.     56 

Dudley,  \V.  W.,  Lieut. 

July  1, 

Right.     Dr.  S.  O.  Kinger,  Littles- 

Col'd  Troops,  age  25. 

9,  '65. 

Discharged  Jan.  18,  1866. 

Colonel,  19th  Indiana. 

9,  '63. 

town.     (July  3,  excision  fibula: 

18 

Bowles,   J.    L.,  Pt,   A, 

Sept.  1, 

Right  ;    post.  flap.      Discharged 

gangrene;  haemorrhage.)     Dis 

10]  st  New  York. 

4,  '62. 

February  12,  1863. 

charged  April,  J864. 

19 

Bowman,  F.  M.,  Pt.,  H, 

May  16. 

.     Re'tired  February  9.  18C5. 

57 

Duffy.  H.,   Pt.,   G,  8th 

Oct.  27, 

Left  ;  circular.     Confederate  sur 

1st  Missouri. 

19.  '63. 

New  York,  age  19. 

30,  '64. 

geon.     Disch'd  Aug.  7,  18S5. 

20 

Bradish,  A.  L.,  Pt.,  K, 

May  3, 

Left;  flap.     Surg.  F.  S.  Holmes, 

58 

Duffy,  P.,  Pt.,  A,  50th 

May  24, 

Left  ;  ant.  post.  flap.     A.  A.  Surg. 

6th  Maine,  ape  40. 

6.  '63. 

6th  Maine.    Discli'd  Aug.  21  ,'63. 

Massachusetts,  age  45. 

June  17, 

H.  M.  Dean.     Discharged  Aug. 

21 

Brings.  D.  J.,  Pt.,  B,  1st 

July  21, 

Right  ;  circ.  Surg.  St.  G.  Peachy, 

1864. 

24,  1865. 

Michigan. 

26,"  '61. 

P.  A.  C.  S.     Discli'd  Jan.  26,  '63. 

59 

Duncan,  J.   F.,  Pt..  H, 

July  2, 

Right.      Exchanged     November 

22 

Brooks,  E.,  Pt.,  C,  145th 

May  3, 

Left;  post.  flap.     Ass't  Surg.  L. 

4th  Alabama,  age  19. 

29,  ''63. 

12,  1863. 

New  York,  age  18. 

17,  '63. 

W.  Kennedy,   123d  New  York. 

60 

Elmer.    IL,   Corp'l,    A, 

July  2, 

Right.    Discharged  February  19, 

Discharged'  August  21,  1863. 

llth  Mass.,  age  24. 

12,  '63. 

1864. 

23 

Brooks,  S.  S.,  Pt.,  B,  8th 

Oct.  19, 

Left;    lateral   oval   flap.     A.  A. 

61 

Farmer,  M.    S.,  Pt.,  B, 

Feb.  15, 

Left.  A.  Surg.  A.  P.  Shackloford, 

Indiana,  age  23. 

29,  '64. 

.Slug.  R.  H.  Sterling.     Discli'd 

17th  Kentucky. 

25,  '62. 

17th   Kentucky.     Discli'd  July 

July  28,  1865. 

16,  1862. 

24 

Brown,  H.,  Corporal,  I. 

Sept.  30, 

Left:  anterior  posterior  flap.  Con 

62 

Fessenden,  F.,  Colonel, 

April  23, 

Right;  flap.     Surg.  F.  Bacon,  U. 

50th  Penn.,  age  31. 

Oct.  14, 

federate   surgeon.     Discharged 

30th  Maine. 

30,  '64. 

S.V.  Promoted  Brig.  Gen.  May, 

1864. 

March  19,  1865. 

1864,  and  retired.     Spec.  3603. 

25 

Brown,  P.  J.,  Pt.,  K,24th 

Jan.  3, 

Right  :    circ..     Furloughed   June 

63 

Fleming,  S.,  Pt.,  D,  12th 

June  13, 

Kight.  A.  Surg.  S.  P.  Bryan,  12th 

Alabama,  age  24. 

1863. 

16,  1863. 

West  Virginia. 

19,  '63. 

West  Virginia.     Disch'd  April 

2ti 

Buttle,  S.  \V.,    Pt.,    0. 

May  31. 

Right  ;  circ.     A.  Surg.W.  Thom 

21,  1864. 

36th  New  York. 

June  20, 

son.     June   ~8.  hsem.     Disch'd 

64 

Flyhouse,P.,Pt.,A,10th 

May  6, 

Left  ;  circular.    Recovery.    Acci 

1862. 

May  25,    1863.     Died  Jan.   28, 

Infantry,  age  27. 

12,  '64. 

dentally  killed  Jan.  26,'  1865. 

1869.     Spec.  4937. 

65 

Foss,   H.,    Pt.,    H,    9th 

Sept.  19, 

Right.      Conl'ed.   surgeon.      Dis 

27 

Carnaban.  T.  A.,  Corp'l. 

June  30, 

Left.     Discharged  September  2, 

Ohio,  age  25. 

23,  '63. 

charged  June  4,  1H64. 

J,  9th  Pennsylvania. 

J'y3,'62. 

1862. 

C6 

Fox,  J.  N.,  Pt.,  K,  24th 

Nov.  25, 

Right;  post,  flap  (haemorrhage). 

28 

Case,   II.,    Pt.,   I,    12th 

Aug.  i;9, 

Right  :  flap.     Act.  Ass't  Surg.  D. 

Alabama. 

Dec.8,'63. 

Exchanged  February  14,  1864. 

New  York. 

Sep.8.'62. 

Weisel.     Disch'd  Nov.  11,  1862. 

67 

Friend,  J.,  Pt.,  E,   43d 

Mar.  4, 

Left.   Surg.  F.  M.  Rose,  43d  Ohio. 

29 

Catew,J.  /'.,  Pt.,  E.llth 

July  3, 

Left.      Union   surgeon.      Trans 

Ohio. 

20,  '62. 

Discharged  August  7,  1862. 

Virginia. 

10,  '63. 

ferred  July  23.  1863. 

68 

Fuchs,    F.,    Serg't,    A, 

Mar.  23, 

Left;  flap.     Discharged  July  18, 

30 

Cavanaugh,   J.,   Pt  .   P.. 

Sept.  17, 

Left.      Surg.  I!.  A.  Vanderkicft, 

5th  Ohio. 

30,  '62. 

1862. 

12th  Massachusetts. 

Oct.  15, 

U.  S.  V.    Discharged  December 

69 

Gage,  C.  F.,  Pt.,  I,  15th 

Sept.  17, 

Left.     Surg.  S.  N.  Sherman,  34th 

1862. 

27,  1862. 

Massachusetts. 

20,  '02. 

N.Y.    Discharged  Jan.  10,  1863. 

31 

Chapman,  J.  P.,  Pt.,  I, 

July  9, 

Left  (also  w'nd  chest  and  thigh); 

70 

Galloway,  E.  T.,  Pt,,  D, 

May  5, 

Right  :  circ.    Surg.  J.  A.  Phillips, 

61st  Georgia,  age  27. 

21,  '64. 

circ.    Surg.  C.  H.  Todd,  C.  S.  A. 

56th  Penn.,  age  15. 

29,  ''64. 

9th   Penn.   Reserves.      Disch'd 

Exchanged  Oct.  17,  1864. 

May  19,  1865. 

32 

Cheevrr,  A.  J.,  Pt.,  K, 

July  2, 

Left     July  18.  amputation  thigh, 

71 

Garvin.  M.,  Pt.,  D,  69th 

July  1, 

Right;  circ.     A.  A.  Surg.  D.  W. 

16th  Massachusetts. 

14,  ^63. 

middle  third.     Discharged  Jan 

New  York,  age  22. 

18,  '62. 

Cheever.    Disch'd  May  22,  1863. 

uary  27,  1864. 

Died  June  23,  1869:  consump 

33 

Clark,  G.  \V.,  Serg't,  C, 

Aug.  30, 

Right.    A.  Surg.  IS.  Howard,  U.S. 

tion.     Spec.  22. 

30th  New  York. 

Sept.  6, 

A.     Disch'd  Nov.  22,  '62.     Died 

72 

Gates,  C.  II.,  Pt.,  H,  1st 

July  2, 

Right  ;  circ.     Surg.  N.  Hay  ward, 

1862. 

April  17,1868. 

New  York,  age  20. 

5,  ;63. 

20th  Mass.     Disch'd  Oct.'  17,  '64. 

34 

Clark,  W.  S.,  Pt.,  G,  5th 

May  2, 

Left  ;  circular.     Discharged. 

73 

George,  G.  W.,  Lieut.,  I, 

Sept.  17, 

Left.     Surg.  L.  M.  Knight,  ."th  N. 

Artillery. 

21,  ''63. 

5th  New  Hampshire. 

21    '62. 

H.     Disch'd  March  7,  1863. 

:;:, 

Clements',  I.  N.,  Pt.,  F, 

May  5, 

Left  ;  circ.     Confederate  surgeon. 

74 

Glenn,    E.,    Corp'l,    D, 

Sept.  20, 

Right;  circ.  (other  w'nds).    >surg. 

122d  New  York,  age  23. 

10,  '64. 

Disch'd  November  30,  1864. 

24th  Wisconsin,  age  19. 

30,  '63. 

T.  L.  Magce,  51st  111.     Disch\l 

36 

Colson.C.  H.,Pt.,  B,  31st 

July  3, 

Right:  circular.  Discharged  Jan 

Nov.  28,  1864.     Insane.  1872. 

Maine,  age  22. 

30,  \A. 

uary  6.  1865. 

75 

Goodrich,  L.  II.  ,  Tt.,  B, 

May  4, 

Left;  flap.     Confederate  surgeon. 

37 

Connolly,    T.,    Pt.,    H, 

Feb.  20, 

Left;    ant.   post.  flap.     Surg.  E. 

6th  Vermont,  age  30. 

7,  T63. 

May  10.  ha'in.:  lig.  ant.  tibia). 

115th  N.  Y.,  age  20. 

24,  '64. 

Giddings,  C.  S.  A.      Discharged 

Discharged  March  19,  J864. 

June  9,  1865. 

76 

Graham,  W.  IL,  Pt.,  E, 

June  5, 

Left;  circ.  (recur,  haemorrhages). 

38 

Cooper,  AV.  H.  M.,  Pt., 

Aug.  27, 

Kight  ;  flap.  A.  Surg.  Green,  19th 

1st  W.  Virginia,  age  21  . 

25,  '64. 

Discharged  November  2(i,  1864. 

K,  ll.'th  Indiana,  age  22. 

27,  '62. 

Ind.     Disch'd  August  26,  1863. 

Died  December  9,  1867. 

39 

Cotter,  T..  Pt.,  F,  30th 

May  27, 

Left;  flap.     Surg.  S.  K.  Towle, 

77 

Grant,  A.  D.,  Pt.,  K,  8th 

Oct.  19, 

Left:  ant.  post.  flap.     A.  A.  Surg. 

Massachusetts. 

June  4, 

30th  Mass.     Discharged  August 

Vermont,  age  21. 

Nov.  13, 

A.W.  Emory.  Discharged  June 

1863. 

25,  1863. 

1864. 

28.  1865.     Spec.  3470. 

40 

Cotton,   T.,  Pt.,  I,  26th 

July  7, 

Right:    flap.      Discharged  July 

78 

Grant,   J.,    Pt.,    A,    7th 

Sept.  14, 

Left.     Ass't  Surg.  A.  II.  Smith. 

Col'd  Troops,  age  38. 

10,   64. 

7.  1865. 

Wisconsin. 

Oct.  4, 

U.  S.  A.     Gangrene.      Disch'd 

41 

Courtney,  A.  H.,  Corp'l, 

July  1, 

Left.     Paroled  September  22,  '63. 

1862. 

April  2,  1863.     Specs.  741.  78.'). 

V,  26th  N.  C.,  age  26. 

6,  '63. 

79 

Greenough,  L.,   Pt.,  B, 

May  17, 

Right  ;  flap.     Discharged  March 

42 

Covert,  A.,  Pt.,  I,  12th 

April  6, 

Left;    flap.     Discharged  August 

1st  La.  Cavalry,  age  23. 

20,  '63. 

14,  1864. 

Michigan. 

May  1.  '62. 

8,  1862. 

80 

Grigsby,  P.,  Pt.,  C,  7ih 

De.27,'62, 

Right.     Surg.  A.  K.  Fificld,  29th 

43 

Craft.  W.  S.,  Capt.,  H. 

May  27, 

Right:  ant.  post.  flap.  A.  A.  Surg. 

Ohio." 

Ja.20,'63. 

Ohio.     Disch'd  Aug.  13,  1863. 

1st  Penn.,  age  23. 

June  17, 

W.  II.  Finn.     Discharged  Sep 

81 

Guilford,  G..  Pt.,  A,  67th 

July  18, 

Right;  ant.  post,  flap  (two  w'nds 

1864. 

tember  27,  1864. 

Ohio,  age  20. 

21,  '63. 

of  left  leg);  gangrene.     Disch'd 

44 

Curtz,   G.    R.,    Pt.,   H, 

May  6, 

Right;   flap.     Diseh'd  April  20, 

August  23,  J864.     Spec.  4304. 

("1st  Penn.,  age  18. 

9,  '64. 

1865.     Died  December  28,  1874; 

82 

Hachmann,   J.,   Pt.,  B, 

Aug.  30, 

Left.     Ass't  Surg.   A.   M.  Clark, 

chronic  bronchitis. 

41st  New  York. 

Se.  14,  '62. 

U.  S.  V.     Disch'd  Oct.  7,  1863. 

45 

Davis,   H.,   Pt.,    K,    1st 

Aug.  10, 

Right.    Discharged  December  30, 

83 

Hall,  J.  ().,  Pt.,  D,  8th 

June  16, 

Left  ;  circ.     A.  Surg.  G.  F.Wins- 

Kansas. 

—  ,  '61. 

1861. 

N.  Y.  Heavy  Artillery, 

21,  '64. 

low,  U.  S.  N.    Gangrene.     Dis 

46 

Davis,  M.,  Pt.,  F,  14th 

Sept.  19, 

Left  ;  circular.    Discharged  July 

age  28. 

charged  June  19,  '65.     Spec.  50-.'. 

New  Hamp.,  age  19. 

22,  '64. 

19,  1865. 

H 

Hamilton,  A.  C.,  Pt.,  H, 

Jan.  1, 

Right:    flap.     Discharged    April 

47 

Davis,    W.  B..    Pt.,   C, 

Oct.  27. 

Right:    ant.  post.  flap.     Disch'd 

18th  Ohio. 

15,  '63. 

27,  1863. 

10th  New  York,  age  21. 

Nv.  4,  '64. 

July  27.  1865. 

85 

Hammond,  R.,    Pt.,   A, 

April  7, 

Right  ;    flap.      Discharged    Feb 

48 

Day,  H.  F.,  Pt.,  F,  12th 

July  2, 

Right;  .out.  post.  flap.    A.  A.  Surg. 

15th  Ohio,  age  24. 

11,  '62. 

ruary  21,  1863. 

New  Hampshire. 

29,  ^63. 

J.  Dickson.      Discharged  July 

86 

Ilarkins.'T.,  Pt.,  1,  115th 

July  3, 

Right  ;  flap.   Discharged  Septem 

9,  1864.     .Spec.  1611. 

Pennsylvania,  age  21. 

10,  ''63. 

ber  20,  1864. 

49 

Decatur,  D.  !•".,  Pt.,  K, 

Sept.  17, 

Right.   A.  A.  Surg.W.  E.  Towns- 

87 

Hatch,  6.  C.,  Pt.,  C,  48th 

Aug.  29, 

Right;   ant.  post.  flap.     Disch'd 

35th  Massachusetts. 

Oc.17,'62. 

end.     Disch'd  March  13,  1863. 

Pennsylvania,  age  29. 

Sep.  5.  '62. 

September  29,  1863. 

50 

DfAman,  J.  B.,  Pt.,  A, 

July  2, 

Left.     Surg.  —  Harrison,  C.  S.  A  . 

88 

Bauer,  L.,   Pt.,   C,  1st 

Aug.  10, 

Right;  circular.     Discharged. 

56th  Virginia,  age  30. 

5,  '63. 

Paroled  Sept.  25,  1863. 

Missouri  Lt.  Artillery.     Sep.  4,  '61. 

5] 

Decry,   8.,  Pt.,  K,  90th 

July  13, 

Left  ;  flap.    Surg.  A.  H.  Van  Xos-      89 

Hay,   T.  H.,  Lieut.,  B,  :  July  2, 

Left.     Surg.  Z.  F,.  Bliss,  U.  S.  V. 

New  York. 

21,  '63. 

trand,  4th  Wisconsin.      Disch'd 

54th  New  York.                  23,  '63. 

Discharged  June  19,  1864. 

December  10,  1863.                            90 

Hibbard,   J.   J.,  Serg't,     July], 

Left  ;  circular.    Discharged  June 

52 

De  Laney,  C.,  colored, 

Mar.  10,  !  Left;  flap.     A.  Surg.  E.  Gregory, 

D,  7th  Wisconsin.              20,  '63. 

6,  1864. 

civilian,  age  47. 

April  4,       17th  Conn.  April  9,  haemorrhage.      91 

Heart,  \V.  A.,  Corp'l,  D,     June  9, 

Right.     A.  A.  Surg.  W.  B.  Grain. 

1865.         Recovery  May  18,  1865.                        :     29th  Ohio.                           —  ,  '62. 

Disch'd   Dec.   23,   1862.      Died 

53 

Dew,   A.,    Pt.,    I,    31st 

Sept.  20,    Right  (necro.;  gang.):  ant.  post. 

September  24,  '72;  colliquative 

Ohio,  nge20. 

Oct.  4,        flap.     A.  A.  Surg.  C.  E.  Bovle.                                                                          i     diarrhoea.     SJMT.  4544. 

1863.         Discharged  February  3.  1865.         92     TTf-dopotli,  J.  P.,  Pt.,  A,    May  16.     Left;  post.  (lap.     Retired  Decera- 

54 

Diviney,  P.,Pt.,  B,  170th    June  16,    Left  ;  lat.~flap.     Dr.  A.  Garccl.m,                 31st  "  N.  C..  age  25.            J'ne7,'64.      her  8.  1864. 

New  York,  ago  23.            20,  '64.        of  Maine.     Discharged  Feb.  1.      93     Hoffman,  F.,  Pt.,  H,  M    June  18,    Left;  cire.  A.  A.  Surg.  J.  Money  - 

1865.     .Spec.  2775.                                        Penn.  Heavy  Artillery,    July  18,       penny.    Necrosis.    Deo.  6,  1864. 

55 

Down,  H.,  Pt.,  K.  44th 

June22,    Left  ;  circ.     A.  Surg   A.  Delany.                 H&P  18.                                    1864.          amputation  thigh.     Discharged 

New  York,  age  22. 

J'y6,  '64.      Disnh'd  Mar.  18,  '65.    Spec.2807.                                                                              Aug.  15,  1865.     Spec.  3714. 

SECT.  V.J 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


NO. 

NAME,  MILITAUY 
DESCRIPTION,  AND  AGK. 

DATKB. 

OPERATIONS,  Ol'KIJATOUS, 
RESULT. 

No. 

NAMK,  MILITAKV 
DESCUIPTIOX,  AND  AGE. 

DATES. 

Ol'EKATIONS,  OPERATORS, 
RESULT. 

94 

Holtinsworth.J.  W.,  Ser 

Dec.  15, 

Left  ;  ant.  post.  flap.     A.  A.  Surg. 

134 

Myers,    M.    S.,   Pt.,    F, 

July  1, 

Right  ;    circ.     Discharged   Sept. 

geant,  G,  22d  Alalinina, 

16,  '64. 

A.  Rolls.      Haemorrhage.      To 

76th  New  York.                 22,  "'63. 

26,  1864.     Spec.  2456. 

age  22. 

Provost  Marshal  March  27,  1865. 

135 

Nearce,  J.,  Pt.,  H,  27th     Nov.  7, 

Right  :    flap.      Surg.  E.  H.  Bow 

95 

Hooper,  G.   A.,  Pt.,  M. 

Oct.  2, 

Right     circular.     Disch'd   April 

Illinois.                                 14,  '61. 

man,  27th  Illinois.     Discharged 

1st  Maine  Cav.,  age  25. 

29,  '64. 

15,  1865. 

August  7,  1863. 

96 

Housely,  H.,  Cook  with 

April  2, 

Left;  ant.  post,  skin  flap,  circ.  of 

136 

Neff,  W.  W.,  Pt.,  G,  6th  ,   July  6, 

Left;  flap.     Confederatesurgeon. 

the  33d  Wisconsin,  age 

11,  '05. 

muscles.    Alsoauip.  right  thigh. 

Michigan  Cav.,  age  18.      9.  '63. 

Disch'd  May  24.  '64.    Spec.  6691. 

20. 

Surg.  F.  E.  Piquette,  86th  Col'd 

137    Newton,  W.  C.,  S'erg't,      Oct.  5, 

Right.    Discharged  April  7,  1863. 

Troops.     Recovery. 

G,  3d  Iowa.                     i    8,  '62. 

97 

Hughes,  H.  W.,  Corp'l, 

June  14, 

Right.     A.  Surg.  J.  Homans,  jr., 

138    Nichols,  A.  F.,  Pt.,  G,      May  9, 

Left;  circular.     Duty  September 

I,  133d  New  York. 

24,  '63. 

U.  S.  A.     Disch'd  Oct.  12,  1863. 

4th  Penn.,  age  22.              13,  ''64.    !     19.1864. 

Amputation  thigh.     Recovery. 

139    O'Leary,  J.,  Pt.,  A,  8th     Aug  9.      Left  ;  long  post.  flap.     Surjr.  J.  E. 

98 

Hughes,  J.  D.,  Serg't,  15. 

June  10, 

Left:  ant.  post,  skin  flap.     A.  A. 

Infantry. 

14,  '62.        Summers,  U.  S.  A.    Discharged 

Morgan's  Cav.,  age  31. 

23,  '64. 

Surg.  I.  L.  Stockwell.     Hasmor. 

June  16,  1863.     Spec.  3646. 

To  Provost  Marshal  Oct.  13,  '64. 

140 

O'Rourke.P.,  Pt.,  F,7th     May  31, 

Left;  circ.     A.  Surg.  W.  Thom 

99 

Hunt,  II.  C.,  Pt.,  C,  22d 

July  20, 

Left  ;  circ.     Surg.   E.  L.  Bissell, 

New  York  Heavy  Ar-     June  6, 

son,  U.  S.  A.     (May  31.  excision 

Wisconsin,  age  31. 

29,  '64. 

5th  Conn.     Disch'd  Aug.  22,'65. 

tillery,  age  41.                      1864. 

6  ins.  tibia.)     Discharged  July 

TOO 

Htitchinson,  H.,  Corp'l, 

Mar.  8. 

Right.     Surg.  E.  B.  Haywood,  C. 

28,  1865.     Specs.  1502,  3546. 

G,  15th  Conn  ,  age  25. 

14.  '65. 

S.  A.     Disch'd  Nov.  7,  1865. 

141 

Oviatt,  F.V.,  Pt.,  A,  37th    Aug.  21, 

Right;  semi-oval  skin  flap,  circ. 

101 

Irons,  D.  II.,  Pt.,  A,  (ith 

Sept.  29, 

Right.    Discharged  May  16,  1865. 

Massachusetts,  age  37.      Sept.  2, 

tissue  flaps.     A.  A.  Surg.  G.  H. 

Colored  Troops,  age  24. 

Oct.2,'64. 

1864. 

Dare.     Disch'd  Aug.  2,  1865. 

102 

Jeffords,  F.,  Pt.,  C,  77th 

April  4, 

Right  :  flap.    Surg.  A.  Campbell, 

142  ;  Oivens,  J.,  Pt.,  H,  10th     July  1, 

;  circ.     Surg.  —  Rosser,  C. 

New  York. 

7,  '62. 

77th  N.  Y.     Disch'd  June  9,  '62. 

Louisiana. 

21.  '62. 

S.  A.     Retired  March  1.  1865. 

103 

Johnson,  A.  C.,  Pt.,  C, 

Sept.  26, 

Right;  ant.  post.  flap.     A.  Surg. 

143    Owens,  W.,  Pt.,  H,  Elli 

Oct.  25, 

Right;  ant.  post.  flap.     A.  Surg. 

3d  Michigan. 

29,  '61. 

J.W.  S.  Gouley,  U.  S.  A.     Dis 

ott's  Regiment,  age  39.  \  Nov.  15, 

W.  H.Warner,  3d  Wis.  Cavalry. 

charged  Jan.  26,  1862.  Spec.  345. 

1864. 

Exchanged  January  27,  1865. 

104 

Johnson,  W.  F.,  Serg't, 

May  30, 

Right  :  circular.     A.  Surg.  C.  C. 

144    Paine,  H.  E.,  Brigadier    June  14, 

Left.     Dr.  Stone,  New  Orleans, 

H,  84th  Illinois,  age  19. 

June  7, 

Byrne,  V.  S.A.     May  17,  reamp. 

General,  U.  S.  V.,  age     24,  '63. 

La.     Resigned   May   15.    1865. 

1864. 

leg.     Discharged  June  8,  1865. 

37. 

Commissioner  of  General  Land 

105 

Jokel,  O.,  Pt.,  K,  15th 

Nov  30, 

Right:  circ.  Confederatesurgeon. 

Office  in  1878. 

Missouri,  age  23. 

Dec.5,'64. 

Discharged  August  1,  1865. 

145 

Portingall,  L,  Pt.,  E,  3d     Mav  16, 

Right;  flap.  Confederatesurgeon. 

10G 

Jones,  J.  A.,  Pt.,  I,  8th 

Feb.  20, 

Left  ;  circular.     Discharged  Oct. 

N.  Y.  Artillery,  age  21.      19,"'64. 

Discharged  June  25,  1865. 

Colored  Troops. 

M'hG.'G4. 

5,  1865. 

146 

Post,  T.  H.,  Pt.,  H,  2d     Oct.  19, 

Left:  circ.  A.  A.  Surg.  R.  Bartho- 

107 

Keeney,  R.,   Corp'l,  K, 

May  5, 

Left:  circ.  A.  A.  Surg.  D.G.Cald- 

Infantry,  age  30. 

24,  '63. 

low.     Nov.,  gangrene.    Disch'd 

143d  Pe:iii.,  age  21. 

30,  '64. 

well.     Disch'd  Nov.  17,  1864. 

February  18,  1864. 

108    Kchr,  C.,  Pt..  I,  58th  N. 

Aug.  30, 

Left  ;  circular.     Discharged  Feb 

147 

Power.  W.,  Corp'l,    D,    July  30, 

Right;  flap.     A.  A.  Surg.  S.  J. 

i  ork,  age  3a. 

Sep.2,'62. 

ruary  1,  18t>4. 

47th  New  York,  age  23. 

Aug.  3, 

Holly.     Disch'd  March  2,  1865. 

109 

Kenyon,  L.,  Pt.,  1),  28th 

Aug.  9, 

Left  ;  "circ.     Disch'd  Nov.  10,  '62. 

1864. 

Died  Sept.  18,  '70  ;  consutnpt'n. 

New  York,  age  20. 

12,  '62. 

Died  September  12,  1868. 

148 

Proper,  J.,  Pt.,  K,  20th 

Sept.  1, 

Right;  circular.     A.  A.  Surg.  C. 

110 

Kerns,   G.   D.,    Pt.,    II, 

June  18, 

Left;  circ.     A.  A.  Surg.  W.  E. 

New  York. 

12,  '62. 

M.  Ford.     Discharged  Novem- 

15,")th  Penn.,  age  19. 

30,  '64. 

Sparrow.    Disch'd  Jan.  10,  1865. 

27.  1862. 

111 

Kinney,    1.    N.,  Pt.,  D, 

Mar.  7, 

Right.     A.  Surg.  W.  S.  Grimes, 

149 

Rand,  W.  H.,  Pt.,  F,  4th 

July  3. 

Left;    flap.      Ass't  Surg.   H.  M. 

32th  Illinois. 

26,  '62. 

4th  Iowa.     Disch'd  July  30,  '62. 

Mass.  Cavalry,  age  19. 

22,  '64. 

Sprague,  U.  S.  A.     Discharged 

112 

Klinker,  H.,  Pt.,  C,  26th 

July  1, 

Left.     Surg.  J.A.Armstrong,  75th 

December  13,  1864. 

Wisconsin,  age  28. 

7,  '63. 

Penn.     Disch'd  April  9.  1865. 

150 

Rapp,  A.,  Pt.,  I,  5th  N. 

May  3. 

Right;  post,  and  ant.  flaps.    Surg. 

113 

Koeth,  G.,  Pt.,  B,  140th 

May  8, 

Right;   post.    flap.      Discharged 

Jersey. 

10,  ^63. 

G.  P.  Oliver,  lllth  Penu.     Dis 

New  York,  age  24. 

14V'64. 

April  28,  1865. 

charged  Mar.  18,  '64.  Spec.  6695. 

1!4 

Krieger,  A.,  Pt.,  B,  43d 

April  6. 

Left:  flap.     Discharged  August 

151 

Rewitzer,  E.,  Pt.,  1,  15th  j  May  27, 

Left;   flap.     Mustered  out  Aug. 

Illinois. 

9,  '62. 

7,  1862. 

New  Hampshire. 

J'e4,  '63. 

15,  1863. 

115 

Lacl-eij,  J.,  Sergeant,  G, 

May  5, 

Left  :  circular.     Paroled  July  12, 

152 

Ritter,  J.  J.,  Serg't.  B,  1st 

Sept.  19, 

Left.     Surg.  —  Fithian.  C.  S.  A. 

14th  La.,  age  23. 

12,  *64. 

1865. 

Kentucky,  age  30. 

Oc.17,'63. 

Discharged  June  18,  1864. 

116 

Lawson,  J.,  Pt.,  H,  12th 

Dec.  13, 

Right:  flap.     Discharged  August 

153 

Ritter,  M/V.,  Lieut.,  C, 

Sept.  14, 

Right.     Resigned   February   14, 

Penn.  Reserves,  age  21. 

17,  '62. 

24,  1864. 

23d  Ohio. 

17,  '62. 

1863. 

117 

Leonard,  J.,  Pt..  D,  3Cth 

July  1, 

Left.     Surg.  A.  B.  Mott.  U.  S.  V. 

154 

Rolph,  S.,  Pt.,   H,   8th 

Mar.  23, 

Left  ;  circ.     Surg.  G.  W.  Clippin- 

New  York,  age  21. 

13,  "'62. 

Discharged  May  6,  1863. 

Ohio. 

27,  '62. 

ger,  14th  Indiana.     Discharged 

118 

Lucas,  J.  P..  Lieut.,  E, 

Dec.  13. 

Right.    Confed.  surgeon  ;   gang. 

October  25,  1862. 

5th  Penn.  Reserves. 

17,  '62. 

Discharged  Sept.  17,  1863. 

155 

Rowe,  R.  W.,  Pt.,  H,  1st 

Aug.  10, 

Left  ;  flap.     A.  Surg.  S.  H.  Mel- 

119 

Marble,   .1.  D.,   Pt.,  D, 

Aug.  28, 

Right;  circ.      Discharged  Janu 

Missouri  Artillery. 

24,  '61. 

eher.  5th  Mo.     Discharged. 

7th  Wisconsin. 

Sep.  1,  '62. 

ary  22,  1863. 

156 

Ruffenah,  J.,  Serg't,  E, 

May  3, 

Left:  flap.     Retired  February  22, 

120 

Martin,   J.,  Pt.,  G,  4th 

Sept.  17, 

Left;  flap.  A.  A.  Surg.  J.  H.  Pea- 

48th  Miss.,  age  31. 

10,  '63. 

1865. 

New  York,  age  27. 

Oct.  12, 

bodv.  Disch'd  Dec.  13.  '62.  Died 

157 

Rutter,  A.,  Pt.,  C,  100th 

June  2, 

Right;   flap.     Surg.  G.   L.   Pan- 

1862. 

Dec.  24,  '76.    Specs.  744,  4433. 

Pennsylvania,  age  20. 

20,  '64. 

coast.   U.  S.  V.     Disch'd  May 

121 

Martin.  S.  J.,  Serg't,  G, 

Mar.  14, 

Right  ;  flap.    Surg.  J.  S.  Redh'eld, 

4,  1865.     Spec.  2587. 

6th    Kansas    Cavalry, 

21.  '64. 

6th   Kansas   Cavalry.     Disch'd 

158 

Sandford,  R.  L.,  Corp'l, 

Sept.  17, 

Left.     Surg.  M.  Storrs.  8th  Conn. 

age  27. 

October  7,  1864. 

E,  118th  Penn.,  age  30. 

Oc.15,'62. 

Discharged  March  16,  1863. 

122 

McCracken,  J.H.,  Corp'l, 

May  8, 

Right  ;  circ.     Surg.  S.  Moore,  C. 

159 

SaruJford.  W.  R.,  Pt.,  D, 

July  3, 

Right.     Surg.  —  Dorbet.  C.  S.  A. 

A,  8th  Md.,age24. 

12,  '64. 

S.  A.     Disch'd  March  17,  1865. 

23d  Virginia,  age  25. 

17,  *63. 

Necrosis  ;  haemorrhage  ;  erysip 

123 

McDonald,  J.  S.,  Capt., 

May  6, 

Right  'also  other  wounds);  circ. 

elas.     Exch'd  March  17,  1864. 

15,    15th   New   Jersey, 

13,  '64. 

Surg.  L.  W.  Oakley,  2d  N.  J. 

160 

Shantz,  J.  J.,  Pt.,  K,  1st 

Feb.  G, 

Right;   circ.     Discharged   Aug. 

age  22. 

Discharged  December  15,  1864. 

Michigan,  age  33. 

10,  '65. 

4,  1865. 

124 

McGuire,  J.,  Pt.,  F,  73d 

May  4, 

Right;  circ.     Surg.  A.  B.  Mott, 

161 

Smith,  R.  A.,  Pt.,G,  77th 

April  6, 

Right.      Discharged    September 

New  York,  age  17. 

21,  '63. 

U.  S.  V.     Disch'd  May  11,  1865. 

Ohio. 

11.  '62. 

29,  1862. 

125 

'McKnight,    J.,    Pt.,  A, 

Dec.  16, 

Left:  flap.    Surg.  I.  F.'Galloupe, 

162 

Spahman,  J.,  Pt.,  F,  62d 

July  1, 

Left;  flap.     Discharged  October 

17th  Mass.,  age  25. 

29,  '62. 

17th   Mass.     Discharged   June 

Pennsylvania. 

4,  '62. 

14,  1862. 

2.  1863. 

163 

Squire,  W.  P.,  Pt.,  C, 

Sept.  2, 

Left;  circ.     A.  Surg.  T.  A.  Mo- 

126 

McLanghlin,  H.,  Pt.,  E, 

June  27, 

Left.    Confederate  surgeon.    Dis 

75th  Illinois,  age  20. 

19,  '64. 

Graw,  U.  S.  V.     Disch'd  March 

10th  Infantry,  age  22. 

30,  '62. 

charged  January  22,  1863. 

6,  1865.    Sept.,  1865,  amp.  thigh, 

127 

McNauny,    C.,    Pt.,   G, 

Aug.  26, 

Left:  circ.      A.  A.   Surg.  C.  H. 

middle  third:  gangrene. 

100th  N.  York,  age  35. 

Sejtt.  21, 

Jones.     Discharged  June  1,  '65. 

164 

Stack,  W.,  Boatswain's 

Mar.  20, 

Right.      Dr.   Langler,    U.   S.   N. 

1864. 

Spec.  3432. 

Mate,    U.   S.    Steamer 

26,  '65. 

Discharged    August    18,    1865. 

128 

Metcalf,    L.   II.,  Pt.,  E, 

July  21, 

Left;    flap.     Surgs.  Gibson   and 

Meteor,  age  25. 

Died  July  29,  1872. 

llth  New  York. 

26,'  '61. 

Peachy,  C.  S.  A.     Discharged. 

165 

Starkey,  G.  L.,  Pt.,  D, 

July  2, 

Left  ;  circ.    A.  Surg.  H.  C.  Leveu- 

129    Milan,   J.,    Pt.,   G,    1st 

July  2, 

Right  :  short  ant.,  long  post.  flap. 

19th  Maine,  age  21. 

11,  '63. 

sallcr,  19th  Maine.     Recovery. 

T  exas,  age  30. 

23,  ?63. 

A.  A.  Surg.  B.  Stone.  Recovery. 

Died  January  31,  1877. 

Spec.  2052. 

166 

Steele,  W.,  Pt.,  G,  70th 

July  22, 

Left  ;  flap.     Discharged  January 

130    MHle,  J.  M.,  Serg't,  G, 

Sept.  20, 

.     Sure.  J.  T.  Gilmore.  C.  S. 

New  York. 

Au.3,'63. 

30,  1864. 

8th  South  Carolina. 

27,  '63.        A  .     Recovery. 

167 

Sullivan,  J.,  Pt.,  D,  6tb 

Aug.  29, 

Left.    Discharged   May  Z.  1863. 

131    Miller,  C.,   Pt.,   (!.   S.'th 

Juno  30,    Left:  circular.     Aujr.  14.  lucmor-  ', 

Massachusetts. 

Sep.-,  '62. 

Died  April  8.  '70:  lung  disease. 

Pennsylvania,  age  19. 

July  30. 

rhage:  ligation  femoral  artery. 

168 

Sullivan,  P.,  Corp'l,  K, 

May  2,    'Left;  flap.     Discharged  Septem- 

1862. 

Discharged  June  29,  1863. 

82d  Illinois. 

6/62.    i     ber  11,  1P63. 

132    Mundhenk,  H.  W.,  Pt., 

May  9,      Left  :  circular.     A.  A.  Surer.  L.  E. 

169    Taft,  E.  P.,  Lieut.-Col., 

July  9,     Left  (haein.t;  circ.    A.  Surg.  R.  F. 

1     B,  913(1  Ohio,  aye  20.          2!>.  "'G4.        Tracy.     Necrosis.     Discharged 

9th  New  York  Heavy 

23,  "'64.        Wier,  U.  S.  A.     Ligation  popli- 

February  17,  1865. 

Artillery,  age  32.                                ;     teal   artery.     Disch  d    Nov.  28, 

133    Murphy,  J.,  Pt.,  F,  5Cd 

May  5, 

Left  :  ant.  post.  flap.    Discharged 

1864.      Spec.  3926.     Died   Jan. 

Pennsylvania,  age  21. 

13,  '62. 

August  9,  1864. 

;     20.  1867  ;  dropsy. 

'GALLOUPK  (I.  F.),  Army  Medical  Intelligence,  in  Boston  Medical  and  Surgical  Journal,  1863,  Vol.  LXVIII,  p.  205. 


518 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


TCr» 

NAME,  MILITARY       ;r»,Tir=         OPERATIONS.  OPERATORS, 

,.           NAME.  MILITARY 

D  VTFS         OPERATIONS,  OPERATORS, 

SHUf 

DESCRIPTION,  AND  AGE. 

RESULT. 

DESCRIPTION,  AM)  AOE. 

RESULT. 

170 

Thomas,  J.  A.,  Pt.,  K, 

July  2, 

Left.     Surg.  H.  M.  McAbee,  4th 

209 

Buck,  M.  II.,  Pt.,  B,  — 

Nov.  27, 

Left  :  flap.     Surg.  E.  Bentley,  U. 

lllth  N.  York,  age  19. 

10,  ^03. 

Ohio.     Haemorrhage.     Disch'd 

Infantry,  age  25. 

Dec.  13, 

S.V.    Gangrene.    Died  Decem 

April  25,  1804. 

1803. 

ber  24,  1803;  pyaemia. 

171 

Tracy,    G.,  Pt.,    M,  1st 

Mar.  31, 

Left  ;  circ.  A.  A.  Surg.  F.  II.  Col- 

210 

Burns,  II.  C.,  Serg't,  H, 

Oct.  21, 

Left;  circ.     A.  Surg.  T.  A.  Mc- 

Maine  Cavalry,  age  29. 

Ap.18,'65.:     ton.     Disch'd  July  13,  18C5. 

7th  Penn.  Cav.,  age  39. 

Nov.  2, 

Graw,  U.  S.V.   Gangrene.  Died 

172 

Turner.  J.  W.,  Pt.,  A,    Sept.  27,    Right;  circular;  gangrene.    Dis- 

1804. 

November  19,  '04  ;  exhaustion. 

5th  C.  Troops,  age  34.     Oct.  3,  '(14.  '     charged  March  xl,  18G5. 

211    Butts,  J.  II.  ,  Pt.,F,  120th 

Dec.  13, 

Left.     Jan.  —  ,  1803.  re-amp,  leg; 

173 

Tyrrell,  1'.,  Pt.,  F,  4th    Sept.  17,    Right  ;  flap.    Surg.  H.W.  Rivers, 

Pennsylvania. 

2'i,  '02. 

haemorrhage.     Died  Jan.  30,  '03. 

Khode  Island,  age  18. 

Oct.  5, 

4th  R.  1.     Discharged  March  0, 

212 

Cain,    P.,  Pt.,    D,   88th 

May  18, 

Left;    flap  (erysipelas);    haemor 

1802. 

1803.     Died  Dec.  10,  1871. 

New  York,  age  34. 

June  8, 

rhage.   Died  June  14,  '04  ;  haem 

174 

Vangorp,  J.,  Pt.,  C,  1st 

Oct.  5, 

Riffht  ;    flap.     Discharged   Feb 

1804. 

orrhage.     Spec.  2480. 

Missouri. 

9,  '62. 

ruary  24,  1863. 

213 

Camp,  T.  S.,  Serg't,  C, 

May  3, 

Left.     Surg.  G.  P.  Oliver,  lllth 

175 

Wald,  C.,  Pt.,    C,  68th 
New  York,  age  25. 

July  2, 
9,  '03. 

Right  ;  circular.  Discharged  Jan 
uary  19,  1804. 

214 

2d  Infantry. 
Campbell,  W.  II.,  Pt.,  B, 

8,  '"03. 
June  3, 

Penn.     Died  May,  1803. 
Left;  circ.      A.  A.  Surg.  H.  M. 

176 

Warren.  E.  E..  Corp'l,  I, 

Nov.  26, 

Left.     A.  A.  Surg.  W.  H.  Butler. 

139th  N.  York,  age  23. 

17,  '04. 

Dean.     Died  June  28,'04  ;  hasm. 

144th  New  York. 

29,  '02. 

Discharged  February  25,  1863. 

215 

Canfield,  D.  W.,  Pt.,  M, 

June  17, 

R't  ;  flap.     Surg.  C!.  L.  Pancoast, 

177 

Watson,  C.,   Corp'l,    C, 

Aug.  24, 

Right  ;  flap.     Surg.  J.  E.  Quidor, 

14th  N.Y.  H.A.,  ngeOl. 

28,  '64. 

U.  S.  V.     Died  July  28,  1864. 

6th  Kansas  Cavalry. 

Se.l9,'C2. 

U.  S.  V.    Disch'd  Aug.  26,  1803. 

216 

Castle,  W.,  Pt.,  1),  17th 

Sept.  21, 

Left;  ant.  post,  skin  flap.     A.A. 

178 

Watts,  T.,  Pt.,  D,  40th 

Sept.  1, 

Right  ;    circ.      Discharged  May 

Maine,  age  39. 

29,  '64. 

Surg.  J.   S.   Waggoner.     Died 

New  York. 

5,  '62. 

23.  1863. 

Sept.  30,  1804  ;  tetanus. 

179 

Webber,   E.,  Corp'l,  H, 

Aug.  !), 

Left.     A.  Surg.  J.  Wightinan,  2d 

217 

Ce.cH,  B.,  Lieut.,  K,  1st 

May  24, 

Left.     (May  24,  amput'n  at  ankle 

2d  Massachusetts. 

12.  '62. 

Mass.     Disch'd  Jan.  15,  1803. 

Virginia  Cavalry. 

—  ,  '04. 

joint.)     Died  June  22,  1804. 

180 

Weiss,   E.,    Pt.,  A,    1st 

Aug.  10, 

Right;  flap.    Discharged  Novem 

218 

Clare,  J.,  Pt.,  C,  145th 

May  2, 

.     Surg.  G.  P.  Oliver,  lllth 

Missouri  Lt.  Artillery. 

Sep.4,'01. 

ber  29,  1B61. 

New  York. 

8,  '03. 

Penn.     Died  May  15,  1803. 

181 

Welch,  T.,  Pt.,  D,  3lith 

De.20,'02, 

Right  ;  flap.    Discharged  October 

219 

Cloniger,  J.  W.,  Pt.,  K, 

Sept.  27, 

Left.     Surg.  A.  T.  Barnes,  98th 

Illinois. 

Jan.  5,  '63. 

12,  1863. 

72d  Indiana,  age  22. 

Oc.l4,'G4. 

Illinois.     Died  Nov.  9,  1804. 

182 

Whalley,  E.,  Pt.,  B,  18th  De.13,'62, 

Left  ;  circular.    Discharged  April 

220 

Coder,  J.  N.,  Pt.,  K,  40th 

Aug.  9, 

Left  ;  circ.  A.  A.  Surg.  S.  E.  Ful 

Massachusetts,  age  30.    Jan.3,'63. 

25,  1863. 

Pennsylvania. 

27,  '02. 

ler.     Erysipelas  ;   haemorrhage. 

183 

Wheeler,  J.,  Pt.,  A,  8th 

Sept.  17,    Right  ;  post.  flap.     Surg.  W.  IT. 

Died  Sept.  19,  1802.     Spec.  321. 

Connecticut,  age  23. 

23,  '62. 

Leonard,  51st  N.  Y.    Hemorrb.; 

221 

Crabe,  A.  B.,  Pt.,H,  58th 

June  4, 

Left  ;  flap.   A.  A.  Surg.  J.  C.  Nel 

exfol.;  bone  removed.     Disch'd 

Massachusetts,  age  18. 

10,  '64. 

son.     Died;  irritative  fever  and 

November  16,  1863.     Spec.  2740. 

exhaustion.     Spec.  2585. 

184 

White,  F.,  Pt.,  G,  119th 

May  5. 

Left  ;  eire.    Surg.  P.  Leidy,  1  IHth 

222    Davidson,  J.,Pt.,  E,  88th 

Aug.  30, 

Right.    Surg.  E.  Bentley,  U.  S.V. 

Pennsylvania,  age  21.    ;    9,  rC4. 

Penn.    Disch'd  October  27,  1804. 

Pennsylvania. 

So.  12,  '02. 

Died  September  25.  1802. 

Died  Dec.  2,  '73;  consumption. 

223    Delaney,  J.,  Pt.,  G,  07th 

May  6, 

Left  ;  circ.  Surg.  R.  B.  Bontecou, 

Spec.  1425. 

New  York,  age  20. 

27,  "'04. 

U.  S.  V.     Died  July  10,  1804  ; 

185 

White,  J.,    Pt.,  I,   14th 

May  5, 

Right.     Discharged  October  11, 

exhaustion. 

Jiidiiiiici  flfifG  iJ3. 

18,  '64. 

1  864. 

224    Dow,  W.  R.,  Pt.,  E.  15th 

May  10. 

Left.    Died  June  18,  1864  ;  diph 

186 

White,  R.,  Pt.,  B,  17th 

April  2, 

Right;  flap.  A.Surg.  R.W.Coale, 

New  Jersey,  age  35. 

J'e2,'04. 

theria. 

Indiana,  age  35. 

7,  '65. 

U.  S.  V.    Disch'd  May  31,  1865. 

225    Ellis,  C.  F.,  Pt.,  I,  20th 

Dec.  13, 

Left.     Surg.  P.  Pineo,  U.  S.  V. 

187 

Whitehouse,  J.,  Pt.,  F, 

April  7, 

Right  ;  circ.  A.A.  Surg.  J.  Sweet. 

Massachusetts,  affo  23. 

—  ,  '02. 

Died  January  7,  1803. 

5th  N.  Hamp.,  age  17. 

20,  '05. 

Disch'd  Sept.  29,  1805.     Died 

226    Eshleman,  I.,Pt.,  E,  17th 

Aug.  25, 

Left.     Surg.  Z.  E.  Bliss.     (Gan 

February  9,  1808.     Spec.  4007. 

Penn.  Cavalr}-,  aere  31. 

Sep.7,'64. 

grenous.)     Died  Sept.  23,  1804. 

188 

Whitner,  D.,  Corp'l,  A, 

July  1, 

Left  ;  circular.     Discharged  Feb 

227    Ettinger,   I.,    Serg't,   F, 

Aug.  29, 

Right;  flap.     Surg.   E.   Bentley, 

107th  Ohio,  age  21. 

24,  63. 

ruary  7,  1804. 

Cth  New  Jersey. 

Sept.  19, 

U.  S.  V.     Died  September  20, 

189 

Williams,  S.  J.,  Pt.,  B, 

De.31,'62. 

Right.     A.  Surg.  H.  M.  Duff,  52d 

1862. 

1802;  pyaemia. 

24th  Wisconsin. 

Jan.6,'63.     Ohio.     Disch'd  Feb.  25,  1863. 

228    Fisher,   A.,   Pt.,  H,  6th 

May  3, 

Left.  Surg.  C.  H.  Lord,  102d  N.Y. 

190 

Wilson,  J.,  Pt.,  E,  56th 

May  31,  '•  Right  ;  circular.   Discharged  Au- 

New  Jersey. 

—  ,  "'03. 

(Also  w'nd  of  right  leg.)     Died 

New  York,  age  25. 

J'e  3,  '02.     e-ust  9,  1862. 

May  20,  1  863. 

191 

Winter,  A.  .Corp'l,  C,  6th 

July  18, 

Left.    Confederate  surgeon.  Dis 

229  ;  Ganges.  P.,  Pt.,  II,  32d 

Nov.  30, 

Left.     Died  December  27,  1864  ; 

Connecticut. 

21,  '03. 

charged  February  20,  1864. 

Cord  Troops,  age  23. 

Dec.4,'04. 

pyaemia. 

192 

Woods,    W.  B.,  Pt.,  C, 

June  30, 

;  flap.     Surg."  A.  Wauld,  C. 

230 

Gerral,  J.,  Pt.,  D,  14tb 

May  1, 

Right.     Died  May  10,  1803. 

llth  Alabama,  age  25. 

J'y  3,  '02. 

S.  A.     Recover}'. 

Indiana. 

15,  '63. 

193 

Yingling,    G.,    Pt.,    D, 

Oct.  27, 

Right  ;    circ.     Confed.   surgeon. 

231 

Gray,  J.   A.,  Lieut.,  B, 

Sept.  5, 

Left;  flap.      A.  A.   Surg.  J.   11. 

105th  L*enn.,  age  37. 

No.22,'64. 

Discharged  June  26,  1865. 

8th   Indiana    Cavalry, 

22,  '04. 

Green.      (Gangrenous.)      Died 

194 

'Zuelch,  G.,  Serg't,  1C, 

Dec.  13, 

Left;  circ.    Surg.  C.  Gray,  7th  N. 

age  32. 

October  2,  1864;  pyaemia. 

7th  New  York,  age  25. 

18,  '02. 

Y.     Gang.    Disch'd  May  8,  '63. 

232 

Gressnon,  E.,  Pt.,   Dar- 

Dec.  16, 

Left;  ant.  pest.  flap.    A.  A.  Surg. 

Died  July  2,  '70;  heart  disease. 

den's  Louisiana  Batte 

19,  '04. 

R.  L.  McClure.     Died  Decem 

195 

Ackland,  G.,  Corp'!,  H, 

April  4, 

Left;  ant.  post.  flap.    A.  A.  Surg. 

ry,  age  28. 

ber  2'!,  1804  ;  exhaustion. 

21st  Missouri,  age  25. 

24,  '05. 

R.  W.  Tooker.    April27,  hrem.; 

233 

Grobe,   C.  W.,   Pt.,  F, 

July  1, 

Left  ;  circular.     Died  September 

29,  lig.  fern.     Died  May  1  ,  1  805. 

153d  Penn.,  age  31. 

19,  ''03. 

4,  1803  ;  erysipelas. 

196 

Adair,  F.  M.,  Pt.,  D,  32d 

April  8, 

Left  ;  ant.  post.  flap.     Surg.  J.  B. 

234 

Haines,  J.,  Pt.,  A,  20th 

May  12, 

Left.    July  7,  hemorrhage.   Died 

Texas,  age  27. 

13,  '65. 

G.  Baxter,  U.  S.V.     Died  April 

Michigan,  age  40. 

28,"  '04. 

July  8,  1864. 

22,  1805;  typhoid  pneumonia. 

235 

Ball,  W.H.,  Pt.,  D,  llth 

May  9, 

Left;  circ.   A.  Surg.II.  C.Roberts, 

197 

Allen,  J.  P.,  Pt.,  D,  7th 

May  5, 

Left.     Surg.  G.  T.  Stevens,  77th 

South  Carolina,  age  34. 

10,  ''04. 

U.  S.  V.     Died  May  16,  1804. 

Massachusetts. 

10,  '64. 

N.  Y.     Died  May  —  ,  1864. 

236 

Hathaway.G.  U.,  Pt..  A, 

June  27, 

Left.    Aug.  11,  amputation  thigh. 

198 

Ash,  G.   W.,  Corp'l,  K, 

July  27, 

Right  ;  circ.     A.  A.  Surg.  C.  S. 

125th  Illinois,  nge  24. 

July  —  , 

Died  September  9,  1804;  irrita 

23d  Kentucky,  age  31. 

Au.12,'64. 

Merrill.    Irritative  fever.    Died 

1804. 

tive  fever. 

August  13,  1804;  non-reaction. 

237 

Herdman,G.,Pt.,G,  121st 

Nov.  17, 

Right:  posterior  flap.  A.  A.Surg. 

199 

Bates,  S.,  Pt.,  I,  14th  N. 

July  9, 

Right.  A.  A.  Surg.  G.  M.  Paullin. 

New  York,  ago  20. 

19,  '03. 

W.  M.  Hudson.     Died  Novem 

Jersey,  age  18. 

29,  r64. 

(Haemorrhage.)     Died   August 

ber  24,  1803. 

23,  1804;  pyaemia.    Spec.  3941. 

238 

Hogan,  D.,  Pt.,  H,  170th 

May  24, 

Right  ;  Kit,  flap.     A.  A.  Surg.  R. 

200 

Beck,    W.    A.,    Pt.,   F, 

Sept.  19, 

;  circular.    Ass't  Surg.  J.  M. 

New  York,  age  40. 

30,'  '04. 

Ottman.     Died  June   20,   1804. 

Thomas's  Legion. 

Oct.  4, 

Lawson,  30th  N.  C.    Died  Octo 

Spec.  2472. 

1864. 

ber  6,  1  804  ;  py<emia. 

239 

Holmes,  J.  B.,  Pt.,  F,  1st 

May  19, 

Right.    Surg.  D.W.  Bliss,  U.  S.V. 

201 

Bee,  J.  L.,  Pt.,  B,  4th  S. 

May  30, 

Right  ;  oval  flap.     A.  Surg.  J.  C. 

Maine  Heavy  Artillery, 

25,  '64. 

Died  Juno  7,  '04  ;  haemorrhage 

Carolina  Cav.,  age  21. 

June  29, 

McKee,  U.  S.  A.    Died  July  2, 

age  18. 

and  diarrhoea. 

1864. 

1864.     Spec.  2716. 

240 

Homer,  C.  H.,  Corp'l,  L. 

June  24, 

Left;  flap.     Surg.  B.  S.  Hcrndon, 

202 

Benson,  N.,  Pt.,  C,  45th 

July  12, 

Left  ;  circ.  A.A.  Surg.  N.  A.  Rob- 

10th  N.  Y.  Cav.,  nge  33. 

J'y  9,  '64. 

C.  S.  A.     Died  Sept.  9,  1804. 

N.  Carolina,  agp  42. 

Ang.1,'64. 

bins.     Died  Aug.  7,'64  ;  exhaus. 

241 

Hood,  T.  M.,  Lieut.,  G, 

April  0, 

.    Surg.  E.  C.  Franklin,  U.  S. 

203 

Bland,  F.  M.,  Pt.,  D,  23d 

May  10, 

Left.     A.  A.  Surg.  J.  Thompson. 

40th  Illinois. 

12,  '02. 

V.     Died  April  20,  1802. 

Ohio. 

June  17, 

(May  19,  Symc's  amp.  ankle  j't  ; 

242 

Hotaling,  A.,  Serg't,  A, 

June  22, 

Left:   circular.     A.  A.  Surg.  W. 

1803. 

periostitis.)    July  2,  amp.  thigh. 

7th  N.  Y.  H.  A.,  age  25. 

J'yl3,'64. 

W.  Valk.     Died  July  20,  1804. 

Died  July  10,  1803;  exhaustion. 

243 

Hughs,  E.,  Pt.,  G,  124th 

May  3, 

Left.    Surg.  G.  P.  Oliver,  lllth 

Spec.  1700. 

New  York. 

9,  '03. 

Penn.     Died  May  10,  1803. 

204 

Ely,  E.  P.,  Pt.,  A,  83d 

July  1, 

Left.    Died  July  25,  1802. 

244    Hurlbnt,  A.  R.,  Capt..A, 

May  5, 

Left.     Surg.  G.  T.  Stevens.  77th 

Pennsvlvania,  age  23. 

5,  -02. 

!     5th  Vermont,  age  27. 

10.  ''04. 

N.  Y.     Died  June  0,'64  ;  pyaem. 

205 

Bond,   A.,   I't.,  K,  27th 

July  3, 

Left.     Died  September  30,  1863; 

245    Huston,  A..  Pt.,  H,  12th 

July  20, 

Right  :  flap.   Surg.  G.  W.  Brooks, 

Pennsylvania,  age  37. 

7,  '63.    1     exhaustion  :  diarrhoea. 

Ohio  Cavalry,  age  18. 

28,"  '04. 

12th  Ohio.     Aug.  28,  hiemorrh. 

206 

Brooks.  11.,  Pt.,  K,  20th     Mar.  8.     Right    (gangrene).     Died   April 

Died  Sept.  15,  '04  ;  hectic  fever. 

Michigan,  age  22.              25.  '6.").        14,1805. 

246 

Jones.   J.,    Pt.,   I,   27th 

Aug.  9.  !  Loft  ;  ant.  post.  flap.     A.  Surg.  J. 

207 

Brown,  T.    C.,    Pt.,    F,   De.3I,'02,   Right.     Died  January  21,  1863. 

Indiana. 

15,  '02.   I     U.  Brinton.   U.  S.  A.     Aug.  If, 

34th  Illinois.                     Ja.  12,'63. 

hasm.;  ligation  of  ant.  tibia!  and 

208 

Brownfield,  G.,  Pt.,  19th    Sept.  10,    Right:  sloughing.    Died  Novem- 

interosscous  arteries  :  gangrene. 

Indiana  Bat'ry,  age  24.  Oct.8,'63.     ber  19,  1803. 

Died  August  20,  1802. 

1  THOMSON  ( W.),  Report  of  Cases  of  Hospital  Gangrene  treated  in  Douglas  Hospital,  Washington,  in  A  m.  Jour.  Med.  Sci's,  1804,  Vol.  XLVII,  p.  389 


SECT.  V.] 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


519 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RKSULT. 

NO. 

NAME,  MILITARY 
DESCRIITIOX,  AND  AGE. 

DAJES. 

OPERATIONS,  OPERATORS, 

RESULT. 

247 

Kelly,    P.,    Pt.,    I,  65th 

Oct.  19, 

Left  ;  circ.     A.  A.  Surg.  J.  Neff. 

274 

Redmond,  J.  W.,  Pt.,  D, 

Aug.  21, 

Left;  circ.     A.  A.  Surg.  J.  Cass. 

New  York,  age  26. 

27,  '64. 

Died  Nov.  8.  1864  ;  pyaemia. 

25th  S.  C.,  nge  45. 

31,  '64. 

Died  Sept.  3,  1864  ;  diarrhosa. 

248 

Kimmel,  G..  Pt.,  Battery 

May  3, 

Right.     Died  June  3,  1863;  py 

275 

Roberts,  W.  J.,   Pt.,  D, 

Sept.  19. 

—  —  ;   circular.     A.  Surg.  G.  M. 

I,  1st  New  York  Light 

16,  '63. 

aemia.     Spec.  1542. 

4th  North  Carolina. 

24,  '64. 

Burdett,  P.  A.  C.  S.     llasmor- 

Artillery. 

rhage.     Died  October  11,  1864  ; 

249 

Kirb>/,  H.   W.,    Pt.,    B, 

May  19, 

;  posterior  flap.     Died  May 

exhaustion. 

27th  S.  C..  age  50. 

1864. 

26,  1864  ;  pyaemia. 

276 

Schwerin,  H.  R.,  Capt., 

May  2, 

Right.    Surg.  J.  D.  Hewett,  119th 

250 

Klump,  G..  1't.,  D.  98th 

July  11, 

Right  ;  circ.  (haemorrhage).   Died 

•  C,  119th  New  York. 

9,  r63. 

N.Y.   (Haem.;  May  5,  excision.) 

Pennsylvania,  age  50. 

26,  '64. 

August  3,  1864.     Spec.  2888. 

Anaemic.     Died  May  10,  1863. 

251 

Lamoy,'  W.   H.,   1't..  I. 

Mar.  31, 

Right  ;  post.  flap.     Surg.  N.  R. 

277 

Sheldon,  B.,  Corp'l,  C, 

Oct.  28, 

Right  ;  circ.    Surg.  O.  A.  Judson, 

97th  New  York,  age  30. 

April  11, 

Moseley,  U.  S.  V.     Died  April 

4th  N.  Y.  Heavy  Artil 

Nov.  12, 

UtS.  V.     Died   Nov.  16,   1864; 

1865. 

27,  186o;  exhaustion. 

lery,  age  29. 

1864. 

pyaemia. 

252 

Latime.r,  J.  W.,  Pt.,  G, 

July  3, 

Left.     Aug.  15,  gangrene.     Died 

278 

Shepjard,  M.,  Pt.,  C,  7th 

May  21, 

Right;   oval.     A.  A.  Surg.  J.  C. 

9th  Virginia,  age  24. 

8,  '63. 

Sept.  8,  1863;  gang.;  diarrhosa. 

N.  Y.  Heavy  Artillery, 

June  6, 

Nelson.     Died  June   11,  1864; 

Spec.  1977. 

age  4  1  . 

1864. 

diarrhoea.     Spec.  2475. 

253 

Lattin,  J.  M.,  Capt.,  E, 

June  21, 

Left  ;  circular.    Surg.  A.  B.  Mott, 

279 

Shull,  W.  J.,  Pt.,  F,  37th 

Jan.  2, 

Left.    Surgeon  C.  J.  Walton,  21st 

lllth  N.  York,  age  28. 

J'y  13,'64. 

U.  S.  V.     Died  July  15,  1864. 

Indiana. 

5,  '63. 

Kentucky.     Died  January  11, 

254 

Loftice,  D.,  Pt..  K,  5th 

May  14, 

Left  ;  circ.    A.  A.  Surg.  M.  L. 

1863;  tetanus. 

Tennessee,  age  26. 

June  1, 

Herr.     Died  June  10,  J864;  ex 

280 

'  Skinner,  J.  S.,  Pt.,  K, 

May  2, 

Right.    Surg.  J.  A.  Lidell.U.S.V. 

1864. 

haustion.     Spec.  3503. 

2d  New  Jersey. 

16,  '63. 

(Also  woundof  left  foot.)    Died 

255 

Luther.  A.  K.,  Pt.,  E,  3d 

Mar.  4, 

Left  ;  circ.    A.  A.  Surg.  R.  W.W. 

May  20,  1863;  pyaemia. 

Mass.  Cavalry,  age  32. 

19,  '64. 

Carroll.     (March   13,  excision; 

281 

Stalker,G.W.,Pt.,I,83d 

July  2, 

Left.     Died  July  10,  1863;   tet 

15,  haemorrhage.)     Died  April 

Pennsylvania,  age  23. 

9,  r63. 

anus. 

6,  1864  ;  pyaemia. 

282 

Stander,  C.,  Pt.,  D,  17th 

Dec.  13, 

Left.     Died  December  23,  1862. 

256 

McBride,  F.,  Pt.,  H,  75th 

May  3, 

Right.     Died  May  12,  1863  ;  py 

Infantry. 

20,  '62. 

Ohio. 

9,  '63. 

aemia. 

283 

Stetson,  M.,  Pt.,  A,  35th 

Aug.  29, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

257 

McDermott,  J.,  Pt.,  A, 

June  3, 

Left  ;  ant.  post.  flap.    Surg.  N.  R. 

New  York. 

Sept,  5, 

R.  Reyburn.     Gangrene.     Died 

155th  New  York. 

12,  '64. 

Moseley,  U.  S.  V.    Died  July 

1862. 

September  11,  1862. 

7,  1864. 

284 

Stout,  J.  H.,  Pt.,  B,  13th 

April  12, 

Right;  flap.     Surg.  H.  Wardner, 

258 

McGeary,  J.  S.,  Corp'l, 

Dec.  13, 

Right  ;  ant.  post,  skin  flap.    A.  A. 

Tenn.  Cav.,  age  16. 

16,  '64. 

U.  S.  V.    Died  April  29,  1864; 

H,    8th    Pennsylvania 

28,  '62. 

Surg.  D.  Weisel.     Died  Feb.  5, 

diarrhoea.     Spec.  3314. 

Reserves,  age  20. 

1863;  pneumonia.     Spec.  206. 

285 

Strasburg,  W.,  Pt.,  F,8th 

June  3, 

Right.     Surg.  S.  H.  Plumb,  82d 

259 

McKay,  G.W.,  Capt.,  K, 

July  24, 

Right  ;  flap.    A.  Surg.  C.  W.  Stin- 

N.Y.  H'vyArt.,  age  11-. 

6,  '64. 

N.  Y.  Died  July  5,  '64;  pyaemia. 

34th  'Ohio,  age  23. 

29,  '64. 

son,  23d  111.    Died  Aug.  13,  '64. 

286 

Tefft,   J.  A.,   Corp'l,  I, 

Mar.  31, 

Right.     A.  A.  Surg.  C.  E."  Golds- 

260 

McKenna,  J.,  Pt.,  I,  llth 

Aug.  30, 

.      Ass't   Surg.  B.  Howard. 

146th  N.  York,  age  25. 

April  25, 

borough.     Erysip.;  typhoid  fev. 

Pennsylvania. 

Sept.  3, 

U.  S.  A.     Died   September  18, 

1865. 

Died  May  25,  1865;  prostration. 

1862. 

1862;  tetanus. 

287 

Thayer,  A.  H.,  Pt.,  H, 

May  21, 

Left  ;  circ.     A.  Surg.  H.  C.  Rob 

261 

McQune,  A.,  Pt..  H,  14th 

May  12, 

;  flap.     A.  A.  Surg.  J.  H. 

40th  Mass.,  age  39. 

25,"'64. 

erts,  U.  S.  V.     Died  J  une  8,  '64  ; 

Infantry,  age  40. 

23,  '64. 

Thompson.     May  26,  haemorrh. 

exhaustion. 

Died  June  11,  18(i4  ;  exhaustion. 

288 

Thompson,  J.  W.,  Pt.,  G, 

July  3, 

Left.     (Also  flesh  wound  thigh.) 

262 

Me  Williams.  D.  Jr.,  Pt., 

July  2, 

Left   (necrosis).     Died  Sept.  11, 

10th  Alabama,  age  38. 

Aug.  1, 

Aug.  19,  slough.     Sept.  8,  haera. 

B.  17th  Miss.,  age  34. 

-,  ^63. 

1863.    Spec.  1979. 

1863. 

Died  Sept.  18,  '63  ;  haemorrhage 

263 

Mills,  N.W.,Lieut.-Col., 

Oct.  4, 

Right;    circular.     Died  October 

and  gangrene.     Spec.  1974. 

2d  Iowa. 

11,  '62. 

12,  1862;  tetanus. 

289 

Van  Buskirk,  I.,  Lieut., 

May  3, 

Right.  Surg.W.  H.  Twiford,27th 

264 

Moore,  C.,  Serg'f,  D,  42d 

July  2, 

Left   (haem.;   July  24,  lig.  post. 

F,  27th  Indiana. 

16,  '63. 

Indiana.     Died   May  20,  1863. 

New  York. 

Aug.  1, 

tibial).   Aug.  20,  capillary  haem. 

Sprc.  1149. 

1863. 

Died  Sept.  5.  1863.     Spec.  1648. 

290 

Van  Antwerp,  W..  Lieut., 

May  8, 

Right;  circular.     A.  A.  Surg.  G. 

265 

Moore,  G.W.,  Corp'l,  C, 

June  3, 

Left  ;  circ.  A.  A.  Surg.  C.  P.Bige- 

F,  13th  Indiana,  age  24. 

21,  "'64. 

Coloosdian.   Died  May  26,  1664; 

8th  N.  Y.  Art'v,  age  26. 

13,  '64. 

low.     Died  June  20,  1864  ;  hasm. 

exhaustion. 

266 

Moore.  R.  A.,  Serg't,  I, 

Deo.  13, 

Right.     Died  January  8,    1863; 

291 

Vaughn,  N.,  Pt.,  H,  1st 

April  1, 

Left  :  circular.    A.  A.  Surg.  C.  B. 

4th  Penn.  Reserves. 

29.  '62. 

haemorrhage.     Spec.  581. 

Virginia,  age  30. 

20,  '65. 

Wright.    (Gangrene.)    Haemor 

267 

Myrcs,  D.  T.,  Pt.,  H,5!st 

De.  16,^64, 

Left.     A.  A.  Surg.  W.  Anderson. 

rhage;  ligation  posterior  tibial. 

Indiana,  age  20. 

Jan.4,'65. 

Died  January  9,  1865. 

Died  April  30,  1865  ;  exhaustion. 

2(i8 

Norris.   J.,  Pt.,  K,  68th 

July  2, 

Left;  haemorrhage,  16  oz.     Died 

292 

Wade,  II.  P.,  Pt.,  K,  32d 

July  2, 

Left.    Died  July  31/63;  pyaemia. 

Pennsylvania,  age  30. 

28,  '63. 

August  1,  1863. 

Massachusetts,  age  30. 

5.  '63. 

269 

O'Leary,  T.,  Pt.,  K,  4th 

May  2, 

Right.     Surg.  G.  P.  Oliver,  11  1th 

293 

Whitney,  A.  S.,  Pt.,  E, 

May  8, 

Right;  circular.     A.  A.  Surg.  C. 

Artillery. 

8,  '63. 

Peun.     (Also  wound  of  left  leg.) 

3d  New  Jersey,  age  22. 

28,  "64. 

A.  Lindsay.     Died  June  13,  '64  ; 

Died  May  14.  1863. 

pyaemia.     Spec.  4576. 

270 

Passenge,  C.  E.,  Serg't, 

Oct.  26, 

Left  ;  circ.  Surg.  S.  S.  Boyd,  84th 

294 

Williams.    E.,    Pt..    F, 

Dec.  13, 

Right;  flap.  (Haemorrhage.)  Jan. 

E,  37th  Illinois,  age  23. 

Nov.  24, 

Ind.     (Haemorrhage;   ligation.) 

J36th  Penn.,  age  45. 

28.  '62. 

1,  '63,  lig.  ant.  tibial.    Died  Jan. 

1864. 

Died  December  13,  1864. 

3,  1863,  haemorrhage.  Spec.  634. 

271 

Randall,   C.  E.,   Major, 

Nov.  30, 

Left;   circ.     Surg.  A.  Wynkoop, 

2'.).". 

Wood.   J.,    Pt.,    A,   3d 

May  18, 

Right  ;  double  flap.     A.  A.  Surg. 

2oth  Ohio,  age  26. 

Dec.8,'64. 

U.  S.  V.     Died  Dec.  15,  1864. 

Maryland  Cavalry,  age 

June  3, 

C.  Bausch.    Died  June  11,  1864; 

272 

Ray,  J.  L.,  Pt.,  D,  10th 

June  9, 

Left.   A.  A.  Surg.  D.  Buck.   Died 

21. 

1864. 

pyaemia. 

Kentucky  C'av.,  nge  18. 

19,  '64. 

June  26,  1864  ;  exhaustion. 

296 

York.  M..  Pt.,  E,  120th 

July  2, 

Left.     A.  A.   Surg.    F.   Hinkle. 

273 

Reddick,  ~M.,  Pt.,  K,  1st 

Jan.  2, 

Right.     Surg.  C.  J.  Walton,  21st 

New  York,  age  20. 

27,  '63. 

(Gang.)  July  28,  amp.  right  leg, 

Florida. 

5,  '63. 

Ky.     (Also  wound  of  left  foot.) 

lower  third.  "Died  Aug.  8,  1863; 

Died  January  8,  1863. 

exhaustion.     Specs.  1605,  1609. 

The  operations  were  performed  in  the  right  leg  in  one  hundred  and  twenty-seven  and 
in  the  left  leg  in  one  hundred  and  fifty-eight  instances;  in  eleven  cases  the  side  was  not 
indicated. 

Intermediary  Amputations  in  the  Middle  Third  of  the  Leg. — Three  hundred  and 
sixty-eight  cases  of  intermediary  amputations  in  the  middle  third  of  the  leg  are  found  on 
the  records.  The  terminations  are  ascertained  in  all:  two  hundred  and  fifty-eight  ended  in 
recovery  and  one  hundred  and  ten  in  death,  a  mortality  rate  of  29.8  per  cent. 

Recoveries  after  Intermediary  Amputations  in  the  Middle  Third  of  the  Leg. — The 
two  hundred  and  fifty-eight  operations  of  this  group  were  performed  on  two  hundred  and 
thirteen  Union  and  forty-four  Confederate  soldiers;  in  one  instance  the  patient  was  a  citizen 
employ^.  Of  the  two  hundred  and  thirteen  Union  soldiers  the  names  of  two  hundred  and 

.  A.),  On  the  Major  Amputations  for  Injuries  in  both  Civil  and  Military  I'ractice,  in  Am.  Jour.  Med.  Sci't,  1864,  Vol.  XL VII,  p.  365. 


520 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  300.— Stump  of  left  leg  10  months  after  circu 
lar  amputation  in  middle  third.  Spec.  4318.  [From 
a  cast.] 


ten  were  found  on  the  Pension  Rolls.  Fourteen  have  died  since  the  date  of  their  discharge, 
one  from  constant  discharge  of  stump,  six  from  phthisis,  and  seven  from  causes  not  stated. 
In  four  instances  amputation  in  the  thigh  was  subsequently  performed. 

CASE  763. — Private  G.  W.  Smith,  Co.  F,  76th  New  York,  aged  20  years,  was  wounded  in  the  left  leg,  at  Gettysburg, 
July  1,  1863.     He  was  conveyed  to  a  field  hospital  of  the  First  Corps,  where  amputation  was  performed  but  not  recorded. 

Surgeon  H.  Janes,  U.  S.  V.,  reported  that  the  wounded  man  was  admitted  to  Camp 
Letterman  August  20th,  his  injured  leg  having  been  previously  amputated,  also 
that  the  patie'nt  did  well  afld  required  no  other  treatment  than  simple  dressings  to 
the  wound.  Surgeon  B.  A.  Clements,  U.  S.  A.,  reported  the  following  description 
and  termination  of  the  case:  "The  injury  involved  the  ankle  joint  and  was  caused 
by  a  mini£  ball,  which  passed  through  antero-posteriorly,  fracturing  the  bones. 
The  leg  was  amputated  by  the  circular  method,  at  the  Express  Office  Hospital, 
Gettysburg,  five  days  after  the  reception  of  the  injury.  The  man  at  the  same  time 
was  wounded  by  another  ball  in  the  upper  part  of  the  left  thigh.  This  was  a  flesh 
wound  and  healed  in  about  two  months.  The  stump  healed  kindly,  and  was 
entirely  well  when  the  patient  was  transferred  to  Central  Park  Hospital,  New 
York  City,  on  October  14th.  In  December  following  the  stump  ulcerated  and  a 
portion  of  a  ligature  escaped,  after  which  it  again  healed/'  On  May  20,  18(54, 
when  discharged  from  service  at  his  own  request,  the  patient's  general  condition  was  good  and  motion  of  the  knee  joint  perfect. 
After  leaving  the  hospital  he  was  furnished  with  a  "Palmer"  artificial  leg.  In  his  application  for  commutation  the  pensioner 
describes  the  stump  as  remaining  in  "good  condition,"  and  states  that  Surgeon  J.  H.  Beach,  24th  Michigan,  performed  the 
amputation.  The  pensioner  was  paid  March  4,  1880.  A  cast  of  the  stump  (Spec.  4318),  showing  amputation  to  have  been 
performed  at  the  middle  third,  and  exhibiting  the  curious  marking  of  an  equal-armed  cross  on  the  cicatrix,  was  contributed  by 
Acting  Assistant  Surgeon  G.  F.  Shrady,  and  is  represented  in  the  wood-cut  (FiG.  300). 

CASE  764. — Private  G.  Cullom,1  Co.  D,  83d  Ohio,  aged  20  years,  was  severely  wounded  in  the  left  ankle  joint,  at  Cham 
pion  Hills,  May  16, 1863.  He  entered  and  remained  at  a  field  hospital  for  three  weeks,  when  he  was  sent  on  board  of  a  Hospital 
transport.  Assistant  Surgeon  H.  M.  Sprague,  U.  S.  A.,  recorded  the  wounded  man's  admission  on  board  of  the  Steamer  City 
of  Memphis,  June  8th,  and  his  transfer  to  Jackson  Hospital,  Memphis,  June  14th.  Surgeon  W.  Watson,  U.  S.  V.,  in  charge  of 
Jackson  Hospital,  contributed  the  pathological  specimen  with  the  following  history:  "The  patient  was  under  the  attendance  of 
Acting  Assistant  Surgeon  J.  Witham.  When  admitted  he  was  very  much  reduced  by  diarrhoea,  greatly  emaciated,  and  suffering 
from  extensive  bed-sores  over  the  sacrum.  He  had  undergone  amputation  of  the  wounded  leg,  eight  inches  below  the  knee,  pre 
vious  to  admission,  and  both  bones  were  protruding  from  the  stump.  Simple  dressings  were  used  and  adhesive  plasters  applied 
to  the  bed-sores,  and  he  was  allowed  a  generous  and  nourishing  diet,  with  porter.  On  June  18th,  he  was  placed  upon  a  water- 
bed,  after  which  a  constant  but  slow  improvement  ensued  and  the  stump  was  healing.  On  August  2."th  the  bone,  having  become 
entirely  detached,  was  removed.  After  this  operation  the  patient's  progress  was  more  rapid,  and  he  acquired 
strength  enough  to  go  about  on  crutches.  On  September  30th,  when  the  patient  was  transferred  to  St.  Louis, 
the  stump  had  nearly  healed."  The  removed  fragment  (Cat.  Surf/.  Sect.,  1866,  p.  405,  Spec.  2099),  consisting 
of  semi-tubular  sequestrum  from  the  tibia,  five  inches  in  length,  is  represented  on  PLATE  LXXI,  FIGURE  4, 
opposite  page  428.  The  patient  was  discharged  from  service,  at  Jeft'erson  Barracks  Hospital,  October  19.  1863, 
and  pensioned.  In  the  following  year  he  was  supplied  with  an  artificial  limb  by  Dr.  Douglas  Bly  who 
described  the  amputation  as  having  been  performed  by  the  flap  method.  In  his  application  for  commutation, 
dated  1870,  the  pensioner  stated  that  his  limb  was  amputated  twenty-five  days  after  the  reception  of  the  injury. 
The  pensioner  died  August  27,  1872,  of  consumption,  superinduced  by  the  amputation,  his  attending  physician 
certifying  that  the  stump  never  healed  and  never  ceased  to  suppurate,  discharging  fragments  of  bone  at  times. 
CASE  765. — Private  J.  Sterritt,  Co.  C,  119th  Pennsylvania,  aged  39  years,  was  wounded  iu  the  lower 
part  of  the  left  leg,  at  Spottsylvania,  May  10,  1864.  Surgeon  O.  A.  Jiidson,  U.  S.  V.,  contributed  the  patho 
logical  specimen,  shown  in  the  annexed  wood-cut  (FiG.  301).  with  the  following  history:  "The  wound  was 
caused  by  a  conoidal  ball  entering  the  leg  antei'iorly  about  three  inches  above  the  ankle  joint,  passing  trans 
versely  through,  producing  compound  comminuted  fracture  of  the  lower  third  of  the  tibia  and  involving  the 
ankle  joint.  The  man  entered  Carver  Hospital.  Washington,  three  days  after  being  wounded.  At  the  date  of 
his  admission  the  injured  ankle  was  tumid,  red,  and  painful,  and  the  foot  fpdematous;  but  his  constitutional 
state  was  good  and  there  was  no  emaciation.  On  May  14th  the  patient  was  etherized  and  the  parts  were 
examined,  when  the  severity  of  the  fracture  was  discovered  and  pus  was  found  to  have  burrowed  freely  about 
the  ankle  joint.  Consequently  the  leg  was  amputated  at  the  middle  third  by  the  skin-flap  method  and  circular 
section  of  muscles.  The  operation  was  performed  by  Acting  Assistant  Surgeon  O.  I'.  Sweet.  The  patient  reacted  well  from 
the  shock  of  the  operation  and  continued  to  do  well.  Simple  dressings  were  applied  to  the  stump  and  stimulants  were  admin 
istered.  About  half  of  the  anterior  flap  sloughed,  but  by  June  1st  the  stump  looked  well  and  secreted  laudable  pus ;  granulations 
red  and  healthy.  About  June  12th  an  abscess  formed  on  the  crest  of  the  tibia,  probably  resulting  from  necrosis  of  a  small  por 
tion  of  the  bone.''  The  patient  recovered  and  subsequently  passed  through  different  hospitals,  being  ultimately  discharged 
August  7,  1865,  and  pensioned.  Previous  to  leaving  the  service  he  was  supplied  with  an  artificial  leg.  In  his  application  for 
commutation,  dated  1870,  he  described  the  condition  of  the  stump  us  "-unhealthy  at  present,"  and  six  years  later  he  reported  it 
as  "inclined  to  be  sore."  The  pensioner  \\sis  paid  June  4, 1880.  The  specimen  (No.  2284)  consists  of  the  amputated  portions 

1  BRYAN  (JAMES),  Seventeen  Additional  Cases  of  Amjmtatims  from  the  Armies  of  the,  South-  West,  in  American  Medical  Timet,  1863,  Vol.  VII,  p.  288. 


FIG.  301. — Frac 
tures  in  lower  thirds 
of  the  bones  of  loft 
leg.  Spec.  2i.>84. 


SECT.  v.J  INTERMEDIARY    AMPUTATIONS    IN    THE    LEG.  521 

of  the  bones  of  the  leg,  and  shows  the  extremities  of  the  fibula  to  have  been  carried  away  and  the  adjacent  portion  of  the  tibia 
to  be  broken.  Another  fracture,  where  the  bone  was  chipped,  is  also  exhibited  five  and  a  half  inches  above  the  joint,  from  which 
longitudinal  fractures  extend  into  the  articulation. 

CASK  766. — Sergeant  J.  Peart,  Co.  A,  21st  New  York  Cavalry,  aged  22  years,  was  wounded  in  the  left  leg,  at  Ashby's 
Gap,  July  18, 1864.  and  entered  the  General  Hospital  at  Frederick  nine  days  afterwards.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A., 
in  charge,  reported  tlie  following  history:  "The  injury  was  caused  by  a  minie  ball,  which  shattered  the  tibia  near  the  ankle. 
When  admitted  here  the  limb  was  in  a  very  bad  state,  being  codematous,  ecchymosed,  and  discolored.  Amputation  of  the  leg  in 
the  middle  third  was  performed  by  Acting  Assistant  Surgeon  J.  H.  Bartholf  on  July  31*t,  by  lateral  flaps  of  skin  and  fascia  and 
circular  method  through  muscles.  The  patient's  constitutional  condition  at  the  time  of  the  operation  was  fair  and  his  health  good. 
One  week  afterwards  the  stump  became  gangrenous,  when  nitric  acid  was  applied  with  success.  The  patient's  progress  went  on 
gradually  to  recovery.  Though  the  stump  was  not  entirely  cicatrized  at  the  end  of  three  months  it  was  in  good  shape  and  there 
was  no  retraction  of  the  flaps,  extension  of  them  by  weight  and  pulley  having  been  adopted  at  the  beginning.  The  stump  was 
healed,  and  the  patient  in  good  health  on  December  20th,  when  he  was  transferred  to  Central  Park  Hospital,  New  York  City, 
for  an  artificial  limb."  The  patient  was  discharged  from  service  at  the  latter  hospital  May  '23,  1865,  and  pensioned,  and  several 
weeks  afterwards  he  was  furnished  with  an  artificial  leg.  In  his  application  for  commutation  the  pensioner  described  the  stump 
as  continuing  in  a  "healthy  condition.''  His  pension  was  paid  March  4,  1830. 

CASE  *767. — Private  C.  Burbridge,  Co.  K,  88th  Pennsylvania,  aged  40  years,  was  wounded  at  Spottsylvania,  May  10, 

1864,  and  entered  Mount  Pleasant  Hospital,  Washington,  three  days  afterwards.     Assistant  Surgeon  C.  A.  McCall,  U.  S.  A., 
reported:  "The  injury  was  caused  by  a  minis'  ball  entering  at  the  internal  malleolus  of  the  right  leg,  comminuting  the  fibular 
extremity  and  the  astragalus  and  laying  bare  the  tendon.     The  parts  became  swollen,  tense,  and  discolored,  and  synovitis  was 
fully  developed.     Amputation  at  the  junction  of  the  middle  and  lower  thirds  of  the  leg  was  performed  by  the  antero-posterior 
flap  method  on  May  24th,  by  Acting  Assistant  Surgeon  P.  C.  Potter.     The  anaesthetic  was  made  up  of  two  parts  chloroform  and 
one  part  ether.     At  the  time  of  the  operation  the  patient  was  in  a  weak  and  debilitated  condition  and  failing  hourly,  suffering 
from  nervous  trembling,  restlessness,  exhausting  insomnia,  and  severe  pain,  which  was  lancinating  and  at  times  grinding  and 
unsupportable.     There  was  also  copious  discharge  of  ichor  from  the  wound,  and  a  sinus  and  abscess  had  extended  up  the  limb 
and  was  opened  a  day  or  two  before  the  operation.     Interrupted  sutures  were  applied  to  the  stump,  which  broke  out  from 
ulceration  of  the  flaps  on  the  third  day.     Straps  were  then  used  and  a  tendency  to  slough  counteracted  by  antiseptic  poultices. 
Tonics  and  malt  drinks  were  administered.     By  June  30th,  the  sloughing  had  stopped  and  abundant  granulations  were  springing 
up.     The  greatest  point  of  difficulty  in  this  case  was  produced  by  the  flaps  falling  asunder  at  each  dressing,  thus  breaking  up 
the  nearly  healed  union  and  allowing  the  tibia  to  protrude."     In  the  following  month  the  patient  was  transferred  to  York,  and 
subsequently  he  passed  through  various  hospitals  at  Philadelphia,  being  ultimately  discharged  from  service  at  Chester,  June  27, 

1865,  and  pensioned.     He  had  been  previously  supplied  with  an  artificial  leg.     In  his  application  for  commutation,  dated  1870, 
the  pensioner  described  the  stump  as  being  "tender;"  but  in  his  subsequent  statements  he  represented  it  in  "good  condition." 
The  pensioner  wTas  paid  June  4,  1880. 

Fatal  Cases  of  Intermediary  Amputation  in  the  Middle  Third  of  the  Leg. — The  one 
hundred  and  ten  operations  of  this  group  were  performed  on  one  hundred  and  nine  patients, 
in  one  instance  both  legs  having  been  amputated.  Ninety-eight  were  Union  and  eleven 
Confederate  soldiers.  In  one  case  the  amputation  in  the  leg  was  followed  by  amputation 
in  the  thigh  in  the  lower  third.  Death  is  ascribed  to  pysemia  in  thirty-four,  exhaustion 
in  eighteen,  gangrene  in  five,  and  tetanus  in  four  instances. 

CASE  768. — Private  J.  Heakin,  Co.  D,  6th  U.  S.  Cavalry,  aged  24  years,  was  wounded  in  the  right  ankle,  at  the  battle 
of  Old  Church,  May  31,  1864.  He  was  admitted  to  Stanton  Hospital,  Washington,  four  days  afterwards,  where  amputation 
was  performed  by  Surgeon  J.  A.  Lidell,  U.  S.  V.,  who  made  the  following  report:1  "The  wound  was  inflicted  by  a  minis'  ball, 
which  entered  anteriorly,  passed  backward  and  inward,  apparently  going  close  to  the  posterior  tibial  artery  and 
escaping  behind  the  lower  end  of  the  tibia.  The  ankle  joint  was  involved.  The  parts  became  swollen,  red,  and 
tender.  During  the  night  of  June  7th  the  patient  had  secondary  haemorrhage  from  the  wound,  losing  about  a 
pint  of  blood,  bright  red  in  color.  On  the  following  day  the  leg  was  amputated  at  the  place  of  election  by 
double  flap  method,  the  anterior  flap  being  shorter  than  the  posterior,  and  the  tibia  being  divided  after  the 
procedure  of  Sanson.  Sulphuric  ether  constituted  the  anaesthetic.  The  loss  of  blood  was  trifling  during  the 
operation  and  the  patient's  general  condition  at  the  time  was  favorable,  there  being  no  constitutional  disturbance 
worth  mentioning.  The  shock  of  the  operation  was  little  and  passed  away  quickly;  reaction  moderate.  The 
patient  died  of  pyaemia  June  21,  1864.  The  examination  of  the  injured  member  showed  the  lower  end  of  the 
tibia  to  be  badly  comminuted  into  the  ankle  joint,  which  was  filled  with  pus.  The  posterior  tibial  artery  was 
grazed  by  the  bullet  and  some  very  smail  fragments  of  bone  had  been  driven  into  it.  The  haemorrhage 
occurred  on  the  detaching  of  these  fragments  by  suppuration,  together  with  the  separation  of  the  bruised  tissue  30"— Bones 

belonging  to  the  wall  of  the  artery.  The  astragalus  was  uninjured."  The  latter  bone  and  the  lower  portion  of  of  the  right  ankle 
the  amputated  tibia  (Spa:  2470)  were  contributed  to  the  Museum  by  the  operator,  and  are  represented  in  the  l^"el  spec.  2410. 
wood-cut  (FiG.  302). 

CASE  769. — Private  W.  Nixon,  Co.  H,  20th  Illinois,  was  wounded  in  the  lower  part  of  the  right  leg,  near  Kenesaw 

Mountain,  June  17, 1864,  by  a  musket  ball  striking  the  anterior  surface  of  the  tibia  and  entering  the  bone.     He  was  admitted  to 

a  field  hospital  at  Big  Shanty,  and  thence,  ten  days  later,  to  the  general  hospital  at  Rome.     Slight  haemorrhage  is  said  to  have 

1  LIDELL  (J.  A.),  Secondary  Hamorrhagc  from  Posterior  Tibial  Artery,  etc.,  in  U,  S.  Sanitary  Commission  Memoir*,  New  York,  1870,  Vol.  I,  p.  23. 

SURG.  Ill— 66 


522 


INJUKIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


occurred  on  June  21st,  and  while  being  transported  in  the  railroad  cars  from  Big  Shanty  to  Rome  the  patient  bled  to  syncope. 
After  several  more  slight  haemorrhages,  which  were  temporarily  checked  by  plugging  the  wound,  it  was  found  that  the  bleeding 
could  no  longer  be  restrained,  it  being  impossible  to  secure  the  vessel  at  the  point  of  the  injury  on  account  of  extensive  dis 
organization  around  the  wound  as  well  as  on  account  of  the  depth  of  the  artery  and  the  uncertainty  of  finding  it.  Amputation 
was  then  decided  upon  and  performed  through  the  middle  third  of  the  leg,  on  July  6th,  by  Surgeon  G.  F.  French,  U.  S.  V. 
The  ball  was  found  in  the  medulla  of  the  amputated  bone,  and  the  bleeding  vessel  was  discovered  to  be  the  anterior  tibial  arterv. 
At  the  time  of  the  operation  the  patient  was  enfeebled  by  the  loss  of  blood.  Reaction  was  fair,  but  his  condition  was  low; 
pulse  feeble;  lips  and  skin  very  pale.  For  some  days  his  condition  continued  very  crit 
ical.  On  July  27th,  a  slight  diarrho?a  came  on  and  the  patient's  .condition,  although 
improved,  was  still  critical.  On  August  3d,  colli()uative  diarrhoea  set  in  and  the  patient's 

strength  was  fast  failing;  pulse  flagging;  appetite  entirely  lost.     He  died 

on  August  19,  18*34,  of  exhaustion,  though  every  eifort  had  been  made 

from  the  beginning  to  sustain  his  strength  by  a  nutritious  diet  and  the 

generous  use  of  stimulants.     At  the  time  of  his  death  the  stump  had  almost 

entirely  healed      The  amputated   tibia  (Spec.  3382),  longitudinal Iv  frac 
tured,  with  a  battered  colloidal   ball  lodging  in  the  lowest  third  of  the 

bone,  was  contributed,  witli  the  history,  by  the  operator,  and  is  shown  in 

the  wood-cut  (FiG.  303). 

CASE  770.— Sergeant  P.  Smith,  Co.  K,  69th  New  York,  aged  30  years, 
was  wounded  at  Deep  Bottom,  August  16,  1864.  Surgeon  J.  F.  Dyer,  19th 
Massachusetts,  reported  his  admission  to  the  field  hospital  of  the  2d  divis 
ion,  Second  Corps,  with  "shot  fracture  of  both  legs."  Four  da}'s  after 
receiving  the  injury  the  wounded  man  was  admitted  to  Satterlee  Hospital 
at  Philadelphia,  where  both  limbs  were  amputated  by  Acting  Assistant 


FIG.  303.— Frac- 


Fm.  304.— Bones  of  both  ankles.  The 
astragalus  and  outer  malleolus  of  the  left 
and  the  base  of  the  tibia  of  the  right  ankle 
are  fractured.  Spec.  3644. 


tured  lower  por-  Surgeon  J.  H.  Hutehinson,  who  described  the  wound  as  follows:  "A 
tib7a°Sp<:c.3382.  conoidal  ball  entered  the  left  foot  a  little  in  front  of  the  external  malleolus, 
which  it  fractured,  thence  passing  behind  the  joint  and  making  its  exit 
below  and  posterior  to  the  internal  malleolus.  The  missile  then  entered  the  right  foot  just  in  front  of  the  internal  malleolus, 
penetrated  the  joint,  and  lodged  against  the  external  malleolus,  whence  it  was  removed  August  26th.  Considerable  difficulty 
was  experienced  in  discovering  the  position  of  the  ball,  a  large  mass  of  loose  bone  having  to  be  removed  before  it  could  be 
found.  After  the  patient's  admission  it  at  once  became  evident  that  he  would  have  to  lose  both  feet;  but  it  was  considered  more 
prudent  to  wait  for  the  establishment  of  suppuration.  About  September  3d,  both  feet  were  discharging  a  large  amount  of  healthy 
pus,  and  the  patient  was  weak  in  consequence  of  this  excessive  drain,  but  was  supported  by  means  of  quinine,  beef  essence, 
and  milk  punch.  On  September  6th  I  amputated  both  legs  by  the  circular  method,  the  left  one  above  the  ankle  joint  (at  the  junc 
tion  of  the  middle  and  lower  thirds)  and  the  right  one  and  a  half  inches  higher  up,  the  patient  being  etherized  during  the  oper 
ation.  By  September  23d  the  patient,  considering  his  situation,  was  still  doing  well.  Considerable  sloughing  had  taken  place, 
particularly  in  the  left  stump,  where  the  tibia  was  exposed.  There  was  also  two  slight  bed-sores  notwithstanding  the  very 
careful  nursing  the  patient  received."  Surgeon  I.  I.  Hays,  U.  S.  V.,  in  charge  of  the  hospital,  reported  that  the  patient  died  of 
exhaustion  October  10,  1864.  The  amputated  bones  of  the  ankles  of  both  legs  (Spec.  3644)  were  forwarded  to  the  Museum  by 
the  operator  and  are  shown  in  the  wood-cut  (FiG.  304).  In  addition  to  the  injuries  described  the  specimen  exhibits  the  left 
astragalus  to  be  fractured,  the  base  of  the  right  tibia  to  be  shattered,  and  the  right  fibula  fractured  transversely  just  above  the 
malleolus  as  if  by  the  propagated  force.  There  are  also  traces  of  periosteal  disturbance. 

TABLE   LXXIII. 

Summary  of  Three  Hundred  and  Sixty-eight  Case*  of  Intermediary  Amputations  in  the  Middle  Third 

of  the  Ley  for  Shot  Injury. 

[  Recoveries,  1  —  258  ;  Deaths.  259—3(58-1 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATKS. 

OPERATIONS,  OPERATORS,         „ 
RESULT. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Ackley,  C.,  Pt.,  I,  SJtli 

Mav  12, 

Kight  ;  circular.     Disch'd  March 

8 

Barber,  J.  M.,  Pt.,H,  21st 

Sept.  20, 

Right  ;  circular.  Discharged  Feb 

Pennsylvania,  age  21  . 

21,  '64. 

28,  1865. 

Ohio. 

Oc.10,'03. 

ruary  27,  1804. 

2 

Adams,    A.  IV,   Pt.,  C, 

Deo.  13, 

Left.     Surg.  E.  Bentley,  U.  S.  V. 

9 

Barney,   IT.   F.,   Pt.,  A, 

July  0, 

Right;  circular.     Surgeon  E.  A. 

Kith  Maine,  age  l!i. 

22,  'G2. 

Disch'dMay  20,  1803.  Spec.  590. 

8th  New  Hampshire. 

10,  '63. 

Thompson,  12th  Maine.   Disch'd 

3 

Allen,  C.,  Corp'l,  <!,  62d 

Oct.  19, 

Right;  lat.  flap.     A.  A.  Surg.  C. 

Sept.  27,  1803.    He-amp,  in  1804. 

New  York,  age  20. 

28,  '04. 

H.  Joues.     Hasmorrhage.     Dis 

10 

Beauboncher,  V.,  Pt.,  E, 

June  4, 

Left;  circular.  Surg.  K.  Bentlev, 

charged  Oct.  4,  18bT>.     Spec.  104. 

26th  Mass.,  nge  27. 

8,  '64. 

U.  S.  V.     DisoVd  Jan.  0,  1865. 

4 

Allen,  H..  Sergeant,  G, 

May  3, 

Right  ;  flap.     Surg.  J.  H.  Baxter. 

11 

Heevers,  H.  G.,  Pt.,  A,  3d 

Sept.  21, 

Left.    Surg.  —  Sleigliton,  C.  S.A. 

119th  Penn.,  age  22. 

30,  '63. 

U.  S.V.     Discharged  November 

Arkansas. 

Oo.l2,'G3. 

Recovered. 

14,  18G3.     Specs.  1184,  1185. 

12 

Bennett,  C.,  Pt.,  II,  14th 

Aug.  29, 

Left.     Discharged  Oct.  8,  1862. 

5 

Atkinson,  P.,  Pt.,G.  67th 

Jnlv  1, 

Right  ;  double  flap.     Ass't  Surg. 

N.  Y.  State  Militia. 

Sep.4,'02. 

New  York,  age  34. 

17,  ''02. 

W.  Webster,  U.  S.  A.     Disch'd 

13 

Benning,  E.,  Pt.,  I,  52d 

May  12, 

Left;  double  flap.     A.  A.  Surg. 

April  23,  1863. 

New  York,  age  28. 

19,  '04. 

J.   F.  Thompson.      Discharged 

6 

Bain,    T.,    Pt.,  G.   60th 

July  4, 

Left;  flap.     (July  4,  excision  of 

March  17,  1865. 

Illinois,  age  34. 

Aug.  1, 

4  inches  of   tibia.)     Gangrene. 

14 

Benson,  T.,  Pt.,  A,  32d 

May  12, 

Left  ;  oval  flap.    Discharged  Sep 

1864. 

Discharged  Mav  9,  1805. 

Maine,  age  20. 

20,  '04. 

tember  2,  1804. 

7 

Barbee,  J.,  Pt.,  B,  5th 

May  12,     Left;  anterior  posterior  skin  flap. 

15 

Berkley,  C.,  Pt.,  E,  1st 

June  15. 

Right;  posterior  flap.     A.  Surg. 

North  Carolina,  age  29. 

20,  '64. 

Surg.  D.  W.  Bliss,  U.  S.  V.    Ex 

Colored  Troops,  age  19. 

Julv  13, 

J.  H.  Frantz,  U.  S.  A.     Disch  d 

changed.     Spec.  2312. 

1864. 

July  12,  1805. 

SECT.  V.] 


INTERMEDIARY    AMPUTATIONS   IN    THE   LEG. 


523 


No. 

NAME,  MILITAUY 
DESCRIPTION,  AND  AC;E. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

1C 

Billman,  H.,  Pt.,  A,  40th 

Nov.  25, 

Right:  flap.   Surg.W.W.  Bridge, 

49 

Devan,  R.  P.,  Pt.,  D,  3d 

Aug.  9, 

Left;  circular.     A.  A.  Surgeon  S. 

Ohio,  age  25.                     Dec.  19, 

46th  Onio.     Discharged  March 

Wisconsin. 

17,  '62. 

E.  Fuller.     Discharged  October 

1803. 

31,  1865. 

29,  1802.     Spec.  54. 

17 

Bolen,    J.,    Pt.,    E,  6th 

April  8, 

Right  ;  anterior  posterior  skin  flap. 

50 

Dickens,   H.  S.,  Pt.,  H, 

July  3, 

Left  ;  flap.    A.  A.  Surg.  S.  R.  Skil- 

Mass.  Cavalry,  age  25. 

May  7, 

A.  A.  Surg.  H.  W.  W.  Carroll. 

126th  N.  York,  age  30. 

11,  '63. 

lern.     April  24,  1804,  ant.  post. 

18 

Bowers,  S.M.,  Pt.,  F,  1  Hh 

1864. 
July  3, 

Discharged  October  4,  1865. 
Right  ;  circ.     Exchanged  March 

flap  amput'n  thigh,  lower  third. 
Disch'd  April  28,''05.'  Spec.  2740. 

Mississippi,  age  21. 

7,  '63. 

3,  1864. 

51 

Dietz,  W.,  Serg't,  I,  29th 

May2, 

Right;  circular.     Surg.  R.  Tho- 

19 

Bowles,   G.    S.,    Pt.,   G, 

July  3, 

Right:  circ.     Exchanged  March 

New  York. 

10,  '63. 

main,   29th    New    York.      Dis 

18th  Virginia,  age  27. 

7,  '63. 

17,  1864. 

charged  June  20,  1803. 

20 

Boygon,    \\  .    (.}.,    Boat 

Mar.  29, 

Right  ;  circ.    Surg.  T.  J.  Turner, 

52 

Dillen,  F.  M.,  Pt.,  H,  7th 

May  10, 

Left;  circ.     Surg.  D.  C.  Ay  res, 

swain's    Mate,     U.    S. 

April  1, 

1).  S.  N.     Discharged  August  5, 

Wisconsin,  age  24. 

13,  '64. 

7th  Wis.     Disch'd  Oct.  8,  1864. 

Steamer  Osage,  age  39.        1865. 

1865.     Died  June  20,  1868. 

53  :  Dotts,  J.  L.,  Lieut.,  D,    Sept.  22, 

Right;  circ.     A.  A.  Surg.  B.  B. 

21 

Hrannun,  J.  J.,  Serg't,  G,    Sept.  19, 

Right  ;    anterior    posterior    flap. 

54th  Penn.,  age  22. 

Oc.15,'64. 

Miles.     Discharged  May  14,  '05. 

10th  W.  Virginia,  age  •  Oct.  14, 

Surg.  H.  F.  Garrett,  10th  W.Va. 

54     Dresser,  W.  M.,  Pt.,  G, 

Sept.  17, 

Right  :  flap.     Surg.  W.  H.  Leon 

27. 

18C4. 

Discharged  August  29,  1805. 

35th  Mass.,  age  24. 

22,  '62. 

ard,  51st  N.  Y.    Discharged. 

22 

Bressin,  C..  Pt.,  K,  4th 

May  2, 

Left.     Ass't  Surg.  T.  McMillan. 

55 

Drummond,  R.  A.,  Pt., 

April  9, 

Right  ;    circ.     Discharged  April 

Ohio  Cavalry. 

10,  'C2. 

4th  Ohio  Cavalry.     Discharged 

I,  89th  Indiana. 

12,  '64. 

30,  1865. 

July  8,  1862.                                  jj  56 

Ellis,  W.  F.,  Pt.,  B,  2d 

Aug.  30, 

Left  :  circular.     Discharged  May 

23 

Brown,  H.  G.,  Pt.,  A,  Oth 

June  27, 

.     Surgeon  —  McKinney,  C. 

Maine,  age  24. 

Sep.2,'62. 

23,  1863. 

Georgia. 

J'v  1,  '62. 

S.  A.     Recovered. 

57 

Fairfield,  S.  G.,  Pt.,  C, 

May  10, 

Left;  modificat  n  of  anterior  flap. 

24 

Brooks,  A.,  Pt.,  E,  72d 

July  2, 

Right  ;    flap.     Discharged  Feb-  ! 

1st  Mass.  Heavy  Artil 

June  8, 

Surg.  D.  P.  Smith,  1*.  S.V.    Dis 

New  York,  age  21. 

5,  '63. 

ruary  24,  1864. 

lery,  age  43. 

1864. 

charged  July  8,  '64.     Spec.  3300. 

25 

Brooks,  N.  M.,  Capt.,  C, 

May  12, 

Right';   flap.     Surg.  1).  W.  Bliss, 

58 

Farmer,   S.,  Pt.,  H,  1st 

June  5, 

Left;  circular.    Confederate  sur 

12th  N.  Jersey,  age  22. 

June  2, 

U.  S.  V.     Discharged   October 

West  Virginia,  age  22. 

J'y  2,  '64. 

geon.    Discharged  June  2,  1805. 

1864. 

4,  1804.     Spec.  2429. 

59 

Fernandez,  J.,  Serg't,  A. 

May  5, 

Right.      (Bone  removed:  haem.: 

26 

Brotts,  H.  A.,  Corp'l,  H, 

July  3, 

Left;   flap.     Surg.  N.  Hay  ward, 

2d  Florida,  age  19.            June  4, 

erysip.)    Teale's  method.    Ass  t 

8th  Ohio,  age  23. 

25,  '63. 

20th  Mass.   Bone  removed.  Dis 

1862. 

Surgeon  J.  S.  Billings,  U.  S.  A. 

charged  December  15,  1863. 

Old  Capitol  prison  July  21,  1802. 

27 

Bullock,  S.J.,  Serg't,  A, 

July  3, 

Right  :  circular.     Ass't  Surg.  F. 

60 

Finn,  E.  A.,  Corp'l,  G,    Sept.  19, 

Right  :  flap.    Discharged  Decem 

108th   New  York,  age 

6,  '63. 

Wolf,  39th  N.  Y.     Sept.  1,  rein. 

13th  Michigan,  age  28.    Oct.  -,'63. 

ber  M.  1804.    Subseq.  operation. 

20. 

necrosed  bone.  Discharged  July 

61 

Foote,  G.  A.,  Serg't,  I,     Dec.  14, 

Left  :  circular.     Discharged  July 

15,  1864.     Spec.  4370. 

14th  Conn.,  age  28. 

17,  '62. 

31,  1803.     Died  Nov.  13,  1869. 

28 

Burb  ridge,    C.,   Pt.,  A, 

May  10, 

Right  :  anterior  posterior  flap.    A.      62 

Ford,    T.,    Pt.,    K,    1st 

Jan.  2, 

Left.     A.  A.  Surg.W.  G.  Work 

88th  Pennsylvania,  age 

23,  '64. 

A.  Surg.  P.  C.  Porter.     Disch'd 

Florida,  age  17. 

5,  '63. 

man.     Discharged  June  5,  1865. 

40. 

June  27,  1805. 

63. 

Foster,  H.  S.,  Serg't,  E. 

July  1, 

Left;  flap.  Surg.C.H.  Richmond. 

29 

Burr,  H.  C.,  Pt.,  K,  8th 

Sept.  17, 

Right;  ant.  posterior  flap.    Surg. 

104th  N.  Y.,  age  "22.            8,  r03. 

104th  N.Y.    Disch'd  Mar.  23,'64. 

Connecticut,  age  35. 

Oct.  15, 

G.H.  Oliver,  Hlth  Penn.     Dis-      64 

Garlock,  D.  C.,  Pt.,  C.     July  3, 

Left  :  circular.     Ass't  Surg.  D.  C. 

1862. 

charged  April  14,  1863. 

lllth  New  York. 

27,  '03. 

Peters,   U.  S.  A.     Discharged 

30 

Butler,    J.,    1't.,    C,    3d 

May  3, 

Right.     Discharged  May  1,  1804. 

September  14,1  863.    Spec.  100C. 

Michigan. 

6,  '63. 

65 

Gibson,  E.  M.,  Serg't,  A, 

July  1, 

Right.     Surg.  J.  M.  Farley,  84th 

31 

Buttinger,  C.,  Corp'l,  B, 

June  30, 

Right.     Surgeon  M.  S.  Kittinger. 

19th  Indiana,  age  21  . 

14,  ''63. 

N.  Y.     Discharged  June  25,'64. 

20th  Massachusetts. 

July  4, 

100th  N.Y.  Disch'd  Sept.  25,  62. 

66 

Giffnrd,   J.,  Pt.,  C,   1st 

Aug.  29, 

Right.     Surg.  II.  Black,  C.  S.  A. 

1862. 

Died  Oct.  9,  '05  ;  consumption. 

Louisiana. 

Sep.  9,  '62. 

Retired  December  20,  1804. 

32 

Cadtigan,  A.,  Corp'l,  I, 

July  13, 

Right;  flap.  Surg  C.  B.  Hutchins. 

67 

Gifford,  W.  W.,  Pt.,  D, 

Sept.  19, 

Right  :  flap.    Discharged  Novem 

116th  New  York. 

Aug.  10, 

116th  N.  Y.     Discharged   Sep 

30th  Illinois. 

26,  '63. 

ber  11,  1803. 

1863. 

tember  19,  1803. 

68 

Gilmar,  J.,  Pt.,   A,  1st 

July  8, 

Left  •  flap.    Surg.  N.  R.  Moseley, 

33 

Caldwell,  J.  X.,  Pt.,  K, 

May  12, 

Right  ;    circular.       Old    Capitol 

Vermont  Cavalry,  age 

28,  "04. 

U.  S.  V.     Discharged  February 

3d  N.  C.,  age  30. 

15,'  '04. 

prison  October  14,  1864. 

20. 

17,  1865.     Spec.  2895. 

34 

Campbell.  J..  Pt.,  Stew 

Nov.  30. 

Right;  circular.     Transferred  to 

69 

Ginsenger,    J.,    Pt.,    K, 

Aug.  30, 

Right  :  double  flap.     Surar.  D.  P. 

art's  La.  Scouts,  age  32. 

Dee.7,'64. 

prison  July  22,  1805. 

58th  New  York. 

Sept.  15, 

Smith,    U.  S.  V.      Discharged 

35 

Campbell,  J.  H.,  Pt.,D, 

Aug.  2!, 

Left;  latera'l   flap.     A.  A.  Surg. 

1862. 

November  13,  1862. 

95th  Pennsylvania,  age 

28,  '04. 

W.  B.  Morrison.     Disch'd  Aug. 

70     Goodell,  F.  A..  Pt.,  B, 

July  7, 

Left  ;  anterior  post.  flap.     Surg. 

15. 

7,  1805.    Subsequent  operation. 

75th  New  York. 

28,  '03. 

S.  K.TowIe,  30th  Massachusetts. 

3G 

(,'arr.    ('..    Pt.,    E,   26th 

Aug.  29, 

Left.     Discharged  February  12, 

Discharged  November  21,  1803. 

Pennsylvania. 

Sep.0,'02. 

1803.                                                    71     Granger,  G.,  Corp'l,  D, 

'  Aug.  9. 

Right  ;  circular.    Discharged  No 

37 

Caufma'n,  C.  E.,  Pt.,  K, 

June  3(1, 

Right.    A.  A.  Surg.  J.  Swinburne, 

5th  Ohio. 

Sep.  3,  '62. 

vember  12,  1802. 

1st  Penn.  Reserves. 

J'y  3,  '62. 

Discharged  November  3,  1802.         72      Griffin,  J.   M.,    Pt.,  H, 

July3, 

Right.      Exchanged     November 

38 

Church,    G.   S.,   Pt.,   G, 

Dec.  13, 

Loft  ;  flap.   Discharged  March  19, 

loth  Miss.,  age  21. 

12,  '63. 

12,  1803. 

Oth  Penn.  Itcserves. 

25,  '62. 

1803.     Spec.  649.                             |  73 

Grir/sby,  J.  L.,  Pt.,  K, 

Sept.  20, 

Left  ;  flap.     Discharged. 

39 

Church.   M.   F.,   Pt..  B, 

June  27, 

Left.     Ass't  Surg.  R.  Bartholow, 

23d  Kentucky. 

25,  '63. 

ICthNcw  York,  age  21. 

July  22, 

U.  S.  A.     Necrosed  bone  rem'd. 

74 

Gutheridge,  J.  L.,  Corp'l, 

Aug.  9, 

Left  ;  double  flap.    Ass't  Surg. 

1802. 

Discharged  January  11,  1863. 

A,  60th  Ohio. 

15,  '62. 

J.  B.  Brinton,  U.  S.  A.     Disch  d 

40 

Cole.   J..   Pt..  D,   188th 

June  :i, 

Left  (June  3,  amp.  toes;  gang.; 

October  27,  1862.     Spec.  38. 

Pennsylvania,  age  21. 

22,  '04. 

hsem.);   anterior  post.  flap.     A. 

75  !  Haggerty,  J.,  Pt.,  I,  35th 

June  21  , 

Left:  circular.    A.  A.  Surg.  J.W. 

A.  Surg.  H.  M.  Dean.     Disch'd 

Indiana,  age  30. 

27,  '64. 

Digby.      Discharged  July  10, 

August  3.  1864.    Spec.  2635. 

1864.     Spec.  2311. 

41 

Condon,  T.,  Pt  ,  K.  42d  \   Jan.  1, 

Left;  circular.      Surgeon   T.  D. 

76 

Hall,  A.  3f.,  Serg't,  B, 

July  2, 

Left.     Paroled  September  25,  '03. 

fllinois.  age  3'J. 

15,  '03. 

Fitch,  42d  Illinois.     Discharged 

5~M  N.  C.,  age  26. 

13,  "63. 

Retired  from  service  Feb.  10,  '05. 

October  21,  1804.     Spec.  277. 

77 

Hall,  W.,  Corp'l,  I,  4th 

June  17, 

Right  ;  post.  flap.     Ass't  Surg.  J. 

42 

Cook,    if.,    Pt.,    I,   20th 

April  7, 

:  erysipelas.    Trans.  October 

Col'd  Troops,  age  23. 

July  3, 

H.  Frantz,  U.  S.  A.   Discharged 

Louisiana,  age  23. 

20,  '62. 

11,  1862,  to  military  prison. 

1804. 

November  28,  1805. 

43 

Courier.  W.  C..  Pt.,  F, 

Mar.  6, 

Left  ;  anterior  flap.     A.  A.  Surg. 

78 

Halley,    M.,   Corp'l,  E, 

Sept.  17, 

Left  :  post.  flap.     Surg.  L.  Rey 

43d  Ohio,  age  23. 

11,  '05. 

E.   L.  Mola.     Discharged  Aug. 

03d  New  York. 

23,  '02. 

nolds,   03d  N.  Y.     Discharged 

8,  1865. 

December  15,  1862. 

44 

Cover,    P.,   Pt.,  G,  14th 

Aug.  26, 

Right:  posterior  flap.      Surg.  J. 

79 

Harvey,  W.,  Pt.,  C,  88th 

Aug.  16, 

Left  ;  circular.    A.  A.  Surg.  E.  B. 

Pennsylvania  Cavalry, 

Sept.  23, 

Paddock.  22d  Virginia,  C.  S.  A. 

Penn.,  age  24. 

27,  '64. 

Woolston.    Disch'd  Nov.  22,  '04. 

age  20. 

1803. 

Discharged  May  14.  1805.    Died 

80 

Hasel,   G.,  Pt.,   E,   72d 

April  6, 

Left  :   flap.     Discharged  Febru 

May  24.  '05;  phthisis  pulmonalis. 

Ohio,  age  20. 

15,  '02. 

ary  22,  1863. 

45 

Crawford.     E.,    Pt.,    F, 

Sept.  19, 

Right  ;  ant.  post.  flap.     Surg.  W. 

81 

Healey,  R.  A.,   Pt.,  B, 

Mar.  14, 

Left:  circular.   Surg.  S.A.  Green, 

105th  Ohio,  age  20. 

Oct.  4,  '03. 

L.  Johnson,  18th  (  )hio.     Aug.  5, 

4th  R.  L,  age  21. 

21,  '62. 

24th  Mass.     Disch'd  Sept.  9,  '62. 

1804,   amp.    thigh,  lower  third. 

82 

Heitzman,    F.,    Pt.,   K, 

Sept.  17, 

Right;   anterior  post.  flap.      Dis 

HsRrn.;  ligat'n  of  profunda.  Dis 

97th  New  York,  age  31. 

21,  '02. 

charged  April  30,  1863.     Died 

charged  Mar.  18.  '05.  Spec.  3108. 

June   15,   1806;    continual   dis 

46 

Crawford,  T.,  Pt.,  I,  8th 

Sept.  14, 

Right  ;  circular.    February,  1803, 

charge  from  stump.     Spec.  1040. 

Michigan. 

17,  '62. 

operation  8  ins.  below  the  knee. 

83 

Heller,  A.  E.,Pt.,C,  49th 

Sept.  17, 

Left.      Discharged  January  24, 

Discharged  February  5,  1803. 

Pennsylvania. 

20,  '02. 

1803. 

47 

'Cullom,  G..  Pt.,  D,83d 

May  16, 

Left  ;  flap.     Aug.  25,  rem.  necro. 

84 

Herring,    C.  P.,  Lieut.  - 

Feb.  0, 

Right.     Discharged  June  1,  1865. 

Ohio,  age  20. 

June  10, 

bone.    Discharged  Oct.  1  9,  1  863. 

Colonel,  118th  Penn. 

20,  '05. 

1803. 

Died  August  27,  1872:  phthisis 

85 

Hipps.  J.  E.,  Pt.,  H,  17th 

July  2, 

Left  :  flap.     Furlonghed  Decem 

pulmonalis.     Spec.  2099. 

Mississippi,  age  21. 

26,  '63. 

ber  1,  1863. 

48 

Dallmeycr.  !•'.,  Lieut.,  C, 

May  22, 

Right.    Skey's  method.    A.  Surg. 

86 

Undue,  F.  if.,  Pt.,  D,  5th 

Sept.  20, 

.     Surgeon  G.  G.  Crawford, 

12th  Missouri,  age  24. 

26,'  '('.3. 

H.  M.  Sprague.  IT.  S.  A.     Dis 

Arkansas. 

Oct.  0,  '03. 

P.  A.  C.  S.     Recovered. 

charged  Nov.   14,   1804.      Died 

87 

Hofses,   L.  W.,  Pt.,   D, 

July  3, 

Right;  circular.    Discharged  Au 

July  18,  1871.     Xpec.  1627. 

19th  Maine,  age  28. 

11,  '03. 

gust  27.  1804. 

1  BRYAN  (J.),  Seventeen  Additional  Gates  of  Amputations  from  the  Armies  of  the  South-  West,  in  American  Medical  Times,  1863,  Vol.  VII,  p.  288 


524 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No 

NAMK,  MILITARY 

D 

Ol'K!{ATI()XS,    Ol'KUATOKS, 

x           NAME,  MII.ITAUY 

OPERATIONS,  OPERATORS, 

DESCRIPTION,  AND  AGK. 

RESULT. 

DESCRIPTION,  AND  AGE. 

RESULT. 

88 

llogan,  C.  II.,  Corp'l,  A, 

Sept.  1!', 

Left:   aiiti'i-i.  r   post.    Hap.     Ass't     124  ,  McGonigle,   H.,  Pt.,  F, 

Nov.  25, 

Right  ;  ant.  post.  flap.     Surg.  W. 

89th  Ohio,  age  26. 

Oct.  9, 

.Surgeon  C'.  .S.  Frink,  U.  S.  V. 

713d  Penn.,  age  51. 

Dec.  25, 

ll.Gunkle,  73d  Penn.     Disch'd 

1863. 

Discharged  Decembers,  1863.     '• 

1863. 

April  25,  1864.     Died  April  5, 

89 

Hootse.ll,  J.  F.,  Pt.,  A,  2d 

Fob  8, 

Right.      .Surgeon    G.   L.   Miller, 

1868;  consumption. 

Louisiana. 

15,  '62. 

C.  S.  A.     Recovered.                        125 

Mc"Griff,  J.   C.,   Pt.,   B, 

Aug.  30, 

.   Ass't  Surg.  II.  W.  Harding, 

90 

House,  I'.  A.,  Pt  ,  B,  33d 

Aug.  16, 

Left.     Recovered. 

7th  Georgia. 

Se.20,'62 

C.  S.  A.     Recovered. 

North  Carolina. 

20,  '64. 

126 

McGukiv,  W.J'.,Pt.,r, 

May  3, 

Right;    circ.      Transferred   June 

1)1 

Huntzinger,  J.  W.,  Pt., 

Aug.  5, 

Right.      Discharged    November 

2d  S.  C.  Rifles,  age  30. 

7.  '63. 

9,  1864. 

A,  21st  Indiana. 

25,  '62. 

15,  1862. 

127 

Mcllvaine,  R.  I.,  Serg't, 

Aug.  29, 

Right;   circular.     A.  A.  Surg.  J. 

93 

Hutchins,  A.  J.,  Pt.,  K, 

May  1, 

Right  :    posterior   flap.     Surg.  C. 

K,  8th  Penn.  Reserves. 

Sept.  16, 

N.Goff.    Discharged  November 

25th  Ohio. 

26,  ''63. 

L.  Wilson,  75th  Ohio.     Disch'd  i 

1862. 

29,  1862. 

March  19,  1864.     Spec.  6705. 

j  128 

McTaggart,  J.,  Pt.,  D, 

April  8, 

Right;  flap.     Surg.  J.   F.   Hess, 

93 

Jamison,  R.  E.,  Pt.,  K, 

Dec.  7, 

Left;   flap.     Discharged  Decem 

46th  Indiana,  age  35. 

12,  '64. 

96th  Ohio.     Duty  .July  8,  1864. 

19th  Iowa. 

SR,  '62. 

ber  12,  18G4. 

129 

Magee,  W.,  Pt.,  K,  81st 

De.13,'62 

Left.     Surg.  D.  W.  Bliss,  U.  S.V. 

94 

Jenkins,  D.   A.,   Pt.,  A, 

De.16,'64 

Right:  anterior  posterior  flap.    A. 

Pennsylvania. 

Jan.  1,  '63 

Disch'd  Dec.  5,  1863.    t<pec.  943. 

19th  Alabama,  age  25. 

Jan.  11, 

A.  Surg.  L.  Sinclair.     To  Pro 

130 

Maguire,   S.,  Serg't,  G, 

May  6, 

Left  ;  circular.    A.  A.  Surg.  D.  L. 

1865. 

vost  Marshal  March  7,  1865. 

llth  Penn.  Res.,  age  24. 

31,  '64. 

Ilaight.      Haemorrhage  ;    gang. 

95 

Johnson,  E.,  Pt.,  G,  54th 

Feb.  20, 

Right  ;   flap.      Discharged   July 

Discharged.     Spec.  1222. 

Massachusetts,  age  35. 

Mar.6,'64 

16,  1865. 

131 

Mnlone,  S.  S.,Pt.,K,10th 

July  23, 

Left  ;  circular.    A.  A.  Surg.  C.  H. 

96 

Johnson,  T.  G.,  Corp'l, 

April  6, 

Left.     Discharged  July  11,  1862. 

West  Virginia,  nge  20. 

Au.U,'64 

Jones.     Disch'd  June  14,  1865. 

H,  4()th  Illinois. 

14,  '62. 

132 

Manning,  'J'.,  Pt.,  11,  5th 

Aug.  9. 

Right;    flap.     Ass't  Surg.  J.  F. 

97 

Johnson,  W.,  Pt.,  1,  149th 

July  1, 

Left;  anterior  posterior  flap.    Dis 

Ohio,  uge  23. 

19,  '62. 

Day,  10th  Maine.     Discharged 

Pennsylvania,  age  23. 

7.  fo. 

charged  January  30,  1864. 

May  5,  1863.     Spec.  67C8. 

98 

Johnson,  \V.   H.,  C'apt., 

Feb.  10, 

Left;  circ.  Ass't  Surg.  .1.  G.  Mur 

133 

Marston,    B.  F.,  Serg't- 

Aug.  9, 

Left;  circular.    A.  A.  Surg.  M.  H. 

F,  144th  N.  Y.,  age  27. 

23,  '65. 

phy,  U.  S.  V.     Feb.  17,  lig.  ant. 

Major,  3d  Maryland. 

12,  '62. 

Barton.     Disch'd  Nov.  28,  1862. 

tib.  art'y.     Disch'd  May  15,  '65. 

134 

Masterson,    Jf.,   Pt,,   H, 

Nov.  27, 

.   Surg.W.  P.  Young,  C.  S.A. 

99 

Jones,    B.,   Pt.,  A,   5th 

Sept.  29, 

Right:    flap.      Discharged  June 

10th  Louisiana. 

De.12,'63 

Recovered. 

Col'd  Troops,  age  18. 

Oct.  2,  '64. 

2J.  1865. 

135 

Mauk,  S.  S..  Pt.,E,  90th 

Sept.  20, 

Right  ;  circ.      Surg.  II.  Herrick, 

100 

June,  M.  F.,  Pt.,  L,  9th 

Oct.  19, 

Right  ;  lateral  skin  flap  and  ciro. 

Ohio. 

24,  '63. 

17th  Ohio.    Disch'd  May  13,'64. 

N.  Y.  Heavy  Artillery, 

Nov.  2, 

section  of  muscles.    A.  A.  Surg. 

136 

Mays,    C.,   Pt.,    K,    1st 

June  6, 

Left;  circular  flap.     A.  A.  Surg. 

age  17. 

1864. 

J.  Neff.     Disch'd  May  13,  1865. 

Artillery,  age  19. 

24,  '64. 

T.  Carroll.    Disch'd  July  17,  '65. 

Spec.  3428. 

137 

Meagher,  D.,  Pt.,  C,  5th 

Aug.  9, 

Right:  flap.    Discharged  October 

101 

Kahl,  C.,   Serg't-Major, 

July  1, 

Left  ;    flap   (also  flesh  wound  of 

Connecticut. 

23,  '62. 

27,  1862. 

75th  Penn.,  age  29. 

4,  '63. 

shoulder).    Disch'd  Feb.  26,  '64. 

138 

Merrill,    S.,    Pt..    F,  2d 

July  2. 

Left;  flap.     Surg.  J.  M.  Merron, 

102 

Kehoe,.!.,  Serg't,  II.  39th 

April  21, 

Right;  circ.  (erysipelas).     A.  A. 

New  Ilnnip  ,  age  33. 

5,  '63. 

2dN.  H.    Disch'd  June  21,  1864. 

New  Jersey,  age  29. 

26,  '05. 

Surgeon  W.  B.  Chambers.     Dis 

139 

Miller,    C.,  Pt.,   D,  53d 

Dec.  13, 

Left.     Discharged  September  1  9, 

charged  June  8,  1865. 

Pennsylvania. 

16,  '62. 

1863. 

103 

Kelly,   T.,   Pt  ,    A,    22d 

De.29,'62, 

Right  ;  flap.     Surg.  H.  P.  Steam, 

140 

Miller,  R,  F.,Pt.,E,  123d 

Jan.  11, 

Left;  flap.     A.  A.  Surgeon  E.  L. 

Kentucky. 

Jan.  18, 

U.  S.  V.    Re-amputated.    Dis 

Illinois,  age  27. 

14,  '65. 

Jones.     Disch'd  June  4,  1  805. 

1863. 

charged  June  2,  1863. 

141 

Miller,  W.  W.,  Pt.,  G, 

Dec.  13, 

Right.    Discharged  April  2,  1863. 

104 

Kimball.V.'.,  Pt.,  K,  88th 

July  20, 

Right;  anterior  posterior  flap.    A. 

40th  New  York,  age  27. 

16,  '62. 

Illinois,  age  21'. 

Aug.  19. 

A.  Surg.  M.W.  Benjamin.    Dis 

142 

Minott,  J.  S.,  Corp'l,  F, 

May  12, 

Left  :  circular  skin  flap.    Surg.  E. 

1864. 

charged  June  9,  1865. 

1st    Michigan     Sharp 

27,'  '64. 

Bentley,  IT.  S.  V.     Discharged 

105 

Rinnan,  V.,  Pt.,  II.  147th 

June  19, 

Right  ;    flap.     Surg.  E.  Bentley, 

shooters,  age  31. 

October  17,  1864. 

New  York,  age  22. 

July  5, 

U.  S.  V.     Discharged  October 

143 

Myers,  D.,  Pt.,  K,  12th 

June  27, 

Right.  Ass't  Surg.  R.  Bartholow, 

1864. 

27,  1  865.     Specs.  25  1  7,  2833. 

Pennsylvania,  age  20. 

I'y23,'62. 

U.  S.  A.     Disch'd  Oct.  16,  1862. 

106 

Kinnoy,  V.  F.,  Pt.,  (,',  2d 

July  1, 

Left  :  circular.     Discharged  No 

144 

Newkirk,  G.  W.,  Pt.,  I, 

Oct.  8, 

Left;  flap.     Discharged  June  P.), 

Wisconsin,  age  21. 

4,  '63. 

vember  28,  1863. 

42d  Indiana,  age  22. 

22  '62. 

1863. 

107 

Knox,  U.  F.,  Pt.,C,  llth 

Aug.  31, 

Left;  anterior  post.  flap.     A.  A. 

145 

Newman,  O.,  Pt.,  K,  7th 

Mar.  31, 

Right;   circular.     Surgeon  A.  F. 

Pennsylvania,  age  28. 

Sept.  15, 

Surg.  J.  E.  Warner.     March  12, 

New  York,  age  20. 

April  8, 

Sheldon.  1T.  S.  V.     Discharged 

1862. 

1863,  removal  of  exfoliat'n  from 

1865. 

August  2,  1865.     Spec.  4877. 

tibia.     Discharged  April  24,  '63. 

146 

Nichols,  A..  Pt.,  C,  6th 

July  2, 

Left.     Surg.  —  Hawley,  C.  S.  A. 

108 

Koehler,  J.,  Pt.,  I,  151,'th 

May  5, 

Left:  circular.     A.  A.  Surg.  II. 

North  Carolina,  age  20. 

30,  ''63. 

Spic.  rem.     Retired  Mar.  14,  '65. 

Pennsylvania,  age  36. 

29,  ''64. 

Gibbons,  jr.     (May  5,  excision 

147 

Norton,  M.,  Pt.,  1,  52d 

May  9, 

Left  ;  circular.    Discharged  Octo 

4  inches  of  fibula.)     Discharged 

New  York,  age  37. 

12,  ''64. 

ber  26,  1865. 

April  19,  1865.  Specs.  3533,  2404. 

148 

Nussbaumer,  B.,  Pt.,  B, 

Mar.  23, 

Left.    Surg.  A.  D.  Gall,  13th  Ind. 

109 

Koontz,  A.,  Pt.,  H,  Ifith 

Jan.  1, 

Right  ;    flap.     Discharged   May, 

67th  Ohio,  age  27. 

April  22, 

(Also  w'nds  of  breast  and  leg.) 

Ohio. 

5,  '63. 

1863. 

1862. 

Disch'd  July  28,  1862.    Cariesof 

110 

Laird,    S.,    Pt.,    F,   4th 

De.16,'62, 

Right;  circ.    Surg.  A.M.  Wilder, 

stump.    ]  863,  amputation  thigh, 

Vermont,  age  21. 

Jan.  12, 

U.  S.  V.     Discharged   April   5, 

middle  third. 

1863. 

1864.     Spec.  4319. 

149 

O'Brien,  J.,Pt.,K,  124th 

May  3, 

Right.     Surg.  G.  P.  Oliver,  lllth 

111 

Lavorty,  E.,  Pt.,  E,  53d 

Dec.  13, 

Left;  posterior  flap.    Snrg.  O.  A. 

New  York. 

9.  r63. 

Penn.     Disch'd  April  5,  1864. 

Pennsylvania,  age  43. 

30,   62. 

Judson,   U.  S.  V.     Discharged 

150 

O'Bryan,  J.  C..  Pt,,  K, 

June  27, 

Right;   flap.     Dr.  F.   Hinkle,  of 

October  4,  1864.     Died  January 

45th  Penn.,  age  18. 

J'yl8,'64. 

Marietta,  Penn.     Discharged. 

4,  1980.    Spec.  6712. 

151 

ffDonall,    J'.,    Pt.,    B, 

July  1, 

Left.     Surgeon  —  Hunt,  C.  S.  A. 

112 

Lease,    D.,    Pt.,    E,  1st 

Sept.  19, 

Right  ;    circular.       Surg.    D.    S. 

27th  Virginia. 

21,  "'61. 

Recovered. 

Ohio   ;IL<   25. 

26   '63. 

152 

O'Donnell   .1    Corp'l  F 

July  1, 

Left      Ass't  Surg     I     R    Smith 

October?,  1864. 

81st  Pennsylvania. 

22,  ''62! 

U.  S.  A.     Disch'd  (Jet.  16,  1802.' 

113 

Leslie,    O.,  Pt.,   C,   5th 

Dec.  13, 

Right  ;    circ.     Discharged   April 

153 

O'Neal,  J.,  "Pt.,  I,  153d 

Sept.  19, 

Right  ;  flap.    Surg.  L.  P.Wagner, 

New  Hampshire. 

23,  '62. 

4,  1863. 

New  York,  age  28. 

Oct.  19, 

114th  New  York.     Discharged 

114 

Littlefield,  A.,  Pt.,  C,  2d 

May  3, 

Right;  ant.  post.  flap.  Surg.  J.  H. 

1864. 

February  11,  1865. 

Rhode  Island. 

20,  ''63. 

Baxter,   U.   S.  V.      Discharged 

154 

O'Neil,   J.,    Pt.,    A,    3d 

May  11, 

Riglit  ;  flap.     Surg.  S.  A.  Welch. 

Oct.  7.  1  863.    Died  Dec.  6,  1  877  ; 

Penn.  Reserves. 

31,  '64. 

3d  Penn.  Reserves.    Discharged 

phthisis  pulinonalis.    Spec.  1  135. 

September  23.  1864. 

115 

Lonergan,  T.,  Serg't,  B, 

Dec.  13, 

Right;  circular.    Surg.  T.  Jones, 

155 

Ortte,   H.,   Pt.,    A,   5th 

May  5, 

.     Surg.  J.  R.  Page,  C.  S.  A. 

142d  Penn.,  age  39. 

17,  '62. 

8th  Penn.  Reserves.  Discharged 

Louisiana. 

30,  '64. 

Retired   from    military   service 

March  10,  1864. 

March  (i,  1865. 

116 

Loughlin.  J.,  Pt.,A,6yth 

July  2, 

Right  :    circular.     August  5,  re- 

156 

Paine,  J.  A.,  Pt.,  E,  2d 

Nov.  30, 

Left  ;  circular.     Provost  Marshal 

New  York,  age  36. 

5,  '63. 

amputation  ;     erysipelas.      Dis 

Missouri,  nge  21. 

Dec.2,'64. 

May  6,  1865. 

charged  March  18,  1865. 

157 

Palmer,  W.,  Lieut,,   B, 

Julyl, 

Left  •'  circular.    Surg.  A.  B.  Mott, 

117 

Lowry,  II.,  Pt.,  D,  93d 

May  12, 

Right  ;    anterior    posterior    flap. 

82d  New  York,  age  29. 

31.  *63. 

I'.  S.  V.     Transferred   to   Yet. 

Pennsylvania,  age  19. 

June  6, 

Surgeon  C.  Page,  U.  S.  A.     Dis 

Res.  Corps.   Disch'd  June  30,'dO. 

1864. 

charged  March  23,  1865. 

158 

Parris,   G.  W.,    Pt.,   C, 

June  30, 

Left.     Discharged  December  11, 

118 

LubbertW.,  Pt.,  B,20th 

June  3, 

Left  :  double  flap.    Surg.  E.  Bent- 

19th  Massachusetts. 

T'v4,'62. 

1862. 

Massachusetts,  age  32. 

9,  '64. 

ley,  U.  S.V.  Disch'd  Nov.,  1865. 

1.71 

Patterson,  W.  L.,  Corp'l, 

Mar.  29, 

Left  ;  circular.    A.  A.  Surg.  M.  J. 

Died  Oct.  6,  '66;  phthisis  pulm. 

C,  198th  Penn.,  age  21. 

April  3, 

Mungcr.    Discharged  August  7, 

119 

McAulr.y.  A.,  Pt.,  H,  7tli 

June  9. 

Left.     Recovered. 

1865. 

1865.     Upec.  4037. 

Louisiana.                        i   12,  '62. 

160 

Patty,    T.    W.,    Pt.,    F., 

Nov.  25, 

Left.    March  12,  1864,  re-amputa 

120 

McCarthy,    J.,    Pt.,    D,      May  3, 

Right.     Surg.  C.  K.  Irwine,  72d 

4()tii  Indiana,  age  18. 

Dec.  6, 

tion  3  inches  above.   Discharged 

71st  New  York.                   10.  '63. 

N.  Y.  Discharged  July  30,  1864. 

1863. 

January  11,  1865. 

121 

McCarty,  W.,  Pt.,  B,  23d    July  24,    Loft  :  flap.    Ass't  Surg.  J.  8.  Tav- 

161     Paul,    L.,    Pt.,    C,   28th 

June  '.<, 

Right  ;  iiap.      Surg.  E.  Bentley, 

lllinois.  age  40.                  28,''64.        lor,  23d  111.     Discb'd  May  3,  '00. 

Massachusetts,  age  40. 

9,  '64. 

U.  S.  V.     Discharged  March  29, 

122 

McFaddeu,  D.,   Pt.,  G,    Sept.  20,    Left;   flap.     Discharged  August 

1865.     Died  July  24.  1869. 

26th  Ohio,  a-e  39.              26.  '63.   ,     26,  1864. 

162    Peart,  J..  Serg't,  A,  21st 

July  18, 

Left;  lateral  flap  of  skin  and  circ. 

123    MeGivern.  L.,  Pt..G,5th     Nov.  25,     Right:    flap.      Discharged    Sep- 

N.  Y.  Cavalry,  age  22. 

31,  '64. 

of  muscles.     A.  A.  Surg.  J.  II. 

Kentucky,  age  50.             28,  '63. 

tember  27,  1864. 

Bartholf.    Disch'd  May  23,  1865. 

SECT.  V.] 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


525 


tJf\ 

NAME,  MILITARY 

DATES. 

OPERATIONS,  OPERATORS, 

NO 

NAME,  MILITARY 

DATFS 

OPERATIONS,  OPERATORS, 

.WO. 

DESCRIPTION,  AND  ACE. 

RESULT. 

DESCRIPTION,  AND  AGE. 

RESULT. 

163 

Peck,  H.  C.,  Serg't,  B, 

Aug.  30, 

Left  ;  flap.    Surg.  R.  H.  Coolidge, 

200 

Smith,  G.,  Pt.,  K,  81st 

June  3. 

Right;  anterior  post.  flap.     Sure. 

5th  New  York,  age  26. 

Sep.2,'62. 

U.  8.  A.     Discharged  May  14, 

New  York,  age  26. 

13,  '64. 

A.  T.  Sheldon,  U.  S.  V.    Dis 

186:i. 

charged  January  6,  18C5. 

164 

Perkins,  J.  D.,   Lieut., 

July  2, 

Left  (also  amputation  left  thumb). 

201 

Smith,  G.\V.,Pt.,F,  76th 

July  1, 

Left;    circular.     Surgeon   J.  H. 

M,  2d  Florida,  age  19. 

5,  %3. 

Trans,  to  Provost  Marshal  Octo 

New  York,  age  20. 

5,  '63. 

Beach,  24th  Mich.     Discharged 

ber  22,  1863.     Exchanged. 

May  20,  1864.     Spec.  4318. 

165 

Phillips,  D.  W.,  I't,,  F. 

Dec.  16, 

Left  ;  circular.     A.  A.  Surg.  R. 

202 

Snyder,  P.,  Pt,,  E,  151st 

July  1, 

Left;  circular.     Discharged  July 

32d  Georgia,  age  32. 

19,  '64. 

L.  McClure.     To  Provost  Mar 

Pennsylvania,  age  21. 

7,  '63. 

27,  1863. 

shal  May  6,  1865. 

203 

Sparks,  M.  G.,  Serg't,  I, 

April  2, 

Right  ;  ant.  post,  skin  flap.    A.  A. 

166 

Piggott,    M.,    Capt.,    F, 

May  14, 

Right;  flap.     Ass't  Surg.  T.  A. 

10th  New  Jersey,  age 

13,  '65. 

Surg.  '/,.  P.  Denneler.     (April  2, 

66th  Illinois,  age  29. 

.June  5, 

McGraw,  U.  S.  A.     Discharged 

25. 

1865.  excis.  of  fibular  portion  of 

1864. 

January  24,  1865. 

ankle.)     Disch'd  Feb.  2,  1866. 

167 

Pitts,    R  ,   Pt.,    F,  7Cth 

July  2, 

Left  ;  anterior  posterior  flap.    Dis 

204 

Speehnan,    B.,    Pt.,    K, 

Sept.  20, 

Left  :  flap.    Confederate  surgeon. 

New  York,  age  26. 

16,  %}. 

charged  August  26,  1864. 

98th  Ohio,  age  20. 

24,  '63. 

Discharged  January  31.  1865. 

168 

Pollard,   J.,   Capt.,   H, 

June  24. 

.     Surg.  J.  G.  Dudley,  P.  A. 

205 

Sprauer,   H.,  Lieut.,  F, 

May  27. 

Right.     Surgeon  J.  B.  G.  Baxter, 

9th  Virginia  Cavalry. 

J'v4,'64. 

C.  S.     Recovered. 

2d  Louisiana. 

31,  '63. 

U.  S.  V.     Disch'd  July  3  !  ,  1  863. 

169 

Poole,  0.  H.,  Pt.,  G,  39th 

May  5, 

Left;  circular;  gangrene.     Surg. 

206 

Steenis,  P.,  Pt.,  E,  6th 

Sept.  14, 

Left  ;  anterior  post.  flap.     A.  A. 

Massachusetts,  age  18. 

26,  '64. 

D.  W.  Bliss,  U.  S.  V.     Disch'd 

Wisconsin,  age  23. 

30,  '62. 

Surg.  W.W.  Keen.    Discharged 

Dec.  17.  1864.     Spec.  2354. 

Jan.  23,  1864.     Sprcs.  791,  3833. 

170 

Porter,   H.  M.,   Pt.,   H, 

July  2, 

Left;  flap.     Ass't   Surg.  W.  R. 

207 

Steinhaus,    F.,    Pt.,    H, 

July  L, 

Right  ;    flap.      Discharged   May 

llth  Infantry. 

9,  '63. 

Ramsay,  U.  S.  A.     Transferred 

26th  Wisconsin. 

12,  ^63. 

14,  1864. 

to  regiment  Sept.  12,  1864. 

208 

Steinmetz,   W.,    Pt.,  F, 

June  8, 

Right.     Ass't  Surg.  T.  H.  l.egler. 

171 

Potts,  J.,  Pt.,  H,   123d 

Dec.  13, 

Left.     Discharged  March  9,  1863. 

8th  New  York. 

25,  '62. 

8th    New    York.       Discharged 

Pennsylvania. 

28,  '62. 

Spec.  981. 

December  12,  1863. 

172 

Price,  J.  VV.,  Corp'l,  I, 

July  3, 

Left;  post.  flap.     Surg.  H.Janes, 

209 

Sterritt,  J.,  Pt.,  C,  119th 

May  10, 

Left  ;  skin  flap  and  circ.  section  of 

20th  Conn.,  age  24. 

Aug.  1, 

U.  S.V.    Nov.  9,  re-amp,  at  June. 

Pennsylvania,  age  38. 

14,  '64. 

muse.     A.  A.  Surg.  O.  1'.  Sweet. 

1863. 

of  middle  and  upper  thirds,  flap 

Disch'd  Aug.  7.  '65.     ,<pcc.  2284. 

method.    Disch'd  June  24,  1864. 

210 

Stevens,  T.  M.,  Serg't,  B, 

July  3, 

Right.    Surgeon  J.  R.  Raine.  45th 

173 

Past,   H.,  Pt.,   K,  104th 

Dec.  7, 

Left  ;  flap.     Surgeon  R.  F.  Dyer, 

45th  N.  C.,  age  21. 

6,  '63. 

N.  C.     Erysipelas.    Exchanged 

Illinois,  age  25. 

11,  '62. 

104th  Illinois.     Anehy.  of  knee. 

November  12,  1863. 

Oct.  24,  1863,  amp.  thigh,  mid. 

211 

Stief,  P.,  Pt.,  K,   139th 

July  30, 

Right:  flap.     A.  A.  Surg.  S.  J. 

third.     Disch'd  March  4,  1864. 

New  York,  age  30. 

Aug.  14, 

Holley.     (Excision  Sins,  shaft  of 

174 

Reece,  B.,  Pt.,  K,  49th 

April  7, 

Right;    flap.      Discharged  July 

1864. 

tibia.)     Disch'd  .lime  19,  1865. 

Illinois. 

13.  '62. 

7,  1862. 

212 

Stigall,  K.,  Corp'l,  G,  1st 

Jan.  2. 

Left.     Surgeon  C.  J.  Walton,  21st 

175 

Reynolds,  J.,  Serg't,  C, 

July  14, 

Right;  flap.     June  12,  1864,  re 

Florida. 

—  ,  '63. 

Kentucky.     Recovered. 

6th  Michigan  Cavalry, 

17,"  '63. 

moval  of  necrosed  end  of  tibia. 

213 

Stilts,  A.,  Pt.,  I,  4th  New 

Sept,  14. 

Left;  circ"     Snrg.  I,.  W.  Oakley, 

age  30. 

Discharged  October  26,  1864. 

Jersey. 

21,  '62. 

2d  N.  J.     Disch'd  Jan.  3,  1863. 

176 

Richardson,  J.  M.,  Pt., 

Oct.  4, 

Right.  Surg.  S.  L.  Nidet,  C.  S.  A. 

214 

Stone,  E.  W.,  Corp'l,  A, 

Mar.  14, 

Right;    circular.      Surg.  George 

H,  35th  Mississippi. 

21,  '62. 

Recovered. 

21st  Massachusetts. 

April  6, 

Derby,  23d  Mass.     Discharged 

177 

Richardson,   (>.,    Serg't- 

July  13, 

Left  ;  circular.    A.  A.  Surg.  J.  A. 

1862. 

February  17,  1863. 

Maj.,  7th  Minn.,  age  31. 

31,  '64. 

Edmonson.  Disch'd  April  10,'65. 

215 

Storke,   L.,  Pt.,  A,  72d 

Julv  1, 

Left.     Discharged. 

178 

Rigor,  I).,  Pt.,   H,  36th 

Sept.  19, 

Left  ;  flap.     Discharged  Septem 

New  York. 

23,  '62. 

Indiana,  age  26. 

28,  '63. 

ber  21,  1864. 

216 

Strayer,   L.,  Serg't,   A, 

April  1, 

Right;  flap.    Discharged  August 

179 

Rinard,  C.  B.,  Pt.,  K,  4th 

July  15, 

Left;  circular.     A.  A.  Surg.  A. 

2!0'th  Pennsylvania. 

14,  '65. 

4,  1865. 

Iowa  Cavalry,  age  15.- 

21,  '64. 

Sterling.     Discharged  Septem 

217 

Sullivan,  J.,  Corp'l,  F, 

Aug.  30, 

Right.     Discharged    August   11, 

ber  1,  1865. 

40th  New  York. 

Sep.7,'62. 

1863. 

180 

Ritzert,  P..  Pt.,  K,  100th 

July  18, 

Right  ;  circular.  Surg.  D.  Merritt, 

218 

Sullivan,  P.  T.,  Pt,,  A, 

June  16, 

Right:  anterior  post.  flap.     A.  A. 

Now  York. 

22,"  '63. 

55th  Penn.    Discharged  Decem 

1st  Mass.  Heavy  Artil 

July  9. 

Surg.  J.  M.Boisnot.  Discharged 

ber  22,  1863. 

lery,  age  :)8. 

1864. 

June  13,  1865. 

181 

Roberts,  D.  R.,  Pt.,  B,  3d 

Nov.  30, 

Right;  anterior  posterior  flap.    A. 

219 

Swing,  H.,    Pt.,    A,  1st 

Mav  3, 

Left.    Surgeon  —  Bratton,  C.S.  A. 

South  Carolina,  age  33. 

Dec.  29, 

A.  Surg.  W.  Vance.     Trans,  to 

Louisiana. 

9,  *C3. 

Recovered. 

1864. 

Provost  Marshal  March  7.  1865. 

220 

Terry.  J.  D.,  Serg't.  E, 

Mar.  14. 

Left  :  circular.   Surg.  S.  E.  Stone, 

182 

Roberts,   M.   S.,  Pt.,   15, 

May  3, 

Left.    Confpd.  surgeon.     Disch'd 

23d"  Massachusetts. 

22,  '62. 

23d  Mass.     Disch'd  July  7,  1863. 

5th  Maine,  age  23. 

7,  '63. 

March  15,  '64.     Spec.  6694. 

221 

Texter,  G.,  Corp'i,  I,  7th 

June  16. 

Left;  circular.    Surg.  W.Watson, 

183 

Robinson.  R.   R.,  Gov't 

Feb.  20, 

Right;  circular.     Surgeon  J.  H.  ! 

New    York    Artillery, 

25,  '64. 

105th   Penn.     Discharged  July 

employe,  a<re  24. 

26,  '65. 

Phillips,  U.  S.  V.     Recovery. 

age  27. 

14.1865.     Specs.  818,  3081. 

184 

Rodenhoffer,  L.,  Pt.,  A, 

June  18, 

Left  ;  circular  ;  gangrene.     A.  A. 

222 

Thomas,  F.  M.,  Serg't,  I, 

July  30, 

Left  ;    lateral   flap.      Discharged 

1  17th  Penn.,  age  18. 

July  13, 

Surg.  T.  L.  Van  Norden.     Dis 

8th  Iowa  Cav.,  age  22. 

An.  4,  '64. 

July  14,  1865. 

185 

Ryan.    .1.,   Pt.,    H,  20th 
Connecticut,  age  39. 

1864. 
May  3, 
6,  fe. 

charged  March  24,  1865. 
Right;  anterior  post.  flap.     Con 
federate  surgeon.     Discharged 

223 

Thompson,    B.,    Pt.,  C, 
28th  Pennsylvania,  age 
33. 

Sept.  17, 
Oct.  4, 
1862. 

Right:    flap;    gang.;    erysipelas. 
April  14,  1863.  circ.  amp.  thigh, 
lower  third.     Discharged   May 

June  30.  1865. 

6,  186:!.     fyccs.  3883,  3965. 

186 

Ryan,    V.,    Pt.,    D,    1st 

Sept,  20, 

Right.     Surgeon  —  Sizemore,  C. 

224 

Todd,  J.   C.,   Capt.,   A, 

May  3, 

Right.     Ass't  Surg.  W.  C.  Good 

Arkansas. 

24,  '63. 

S.  A.     Recovered. 

14th  Alabama. 

15,  "*63. 

win,  C.  S.  A.     Discharged  Jan 

187 

Sanders.    I.   J.,    Pt.,   E,' 

Nov.  7, 

Right.     Surgeon  T.  Sim,  U.  S.  V. 

uary  14,  1865. 

31st  Illinois. 

10,  '61. 

Discharged  August  2,  1862. 

225 

Toomey,  J.  J.,  Pt.,   A, 

May  15, 

Left  ;"  circular.    Ass't  Surg.  M.  C. 

188 

Scarberry,    J.,    Pt.,    D, 

May  9, 

Left;  flap.     A.  A.  Surg.  W.  W. 

29th  Pennsylvania,  age 

31,  '64. 

Wood  worth,  U.  S.  V.     (May  1  5, 

91st  Ohio,  age  19. 

26,  '64. 

Mills.     Disch'd  July  30.  1864. 

21. 

excis.  lower  third  lib.)    Disch'd 

iey 

Seism,  J.,  It.,  L,  2d  Mis 

Oct,  25, 

Left;  anterior  posterior  flap.     A. 

July  2.  1865.     Spec.  3361. 

souri    8.    M.   Cavalry, 

Nov.  2, 

A.  Surg.  J.  II.  Page.      Necrosis. 

226 

Trapp,  D..  Pt.,  B,  125th 

June  18. 

Left  ;    circular.      Surgeon  A.   F. 

age  18. 

1864. 

Discharged  June  11,  1865. 

New  York,  age  32. 

July  2, 

Sheldon,  U.  S.  V.     Discharged 

190 

Scott.  C.  L.,  Serg't,  E, 

May  3, 

Right.      Surg.  R.  Thomain,  29th 

1864. 

JuneS,  1865. 

154th  New  York. 

19."'G3. 

New   York.     Discharged  Nov. 

227 

Trausdale,  W.  F.,  Lieut., 

May  14, 

Left.    Surg.W.  F.Westmoreland, 

4,1863.     (Spec.  1544. 

E,  7th  Alabama  Cav. 

27,"  64. 

P.  A.  C.  .S.     Recovered. 

191 

Seligar,  A.,  Pt.,  A,  43d 

April  7, 

Left;  flap.   A.  A.  Surg.O.  Blanck. 

228 

Travis,  J.  A.,  Serg't,  D, 

May  3, 

Right.     Abs't  Surg.  C.  C.  Byrne, 

Illinois,  age  27. 

17,  '62. 

Discharged  October  7,  1862. 

86th  N.  York,  age  26. 

20,  Y63. 

U.S.A.     (Haemorrhage.)     Dis 

192 

Sercey,  \V.,  Coloredfire- 

Nov.  1, 

Left;  anterior  posterior  flap.  Duty 

charged  March  28,  1864. 

man,  Steamer,  age  25. 

—  ,  '64. 

January  28.  1865. 

229 

Truekey,  P.,Pt.,  G,  14th 

Sept.  17, 

Right/  A.  A.  Surg.  J.  C.  Douglas. 

193 

Shaffer,  F..  ('apt.,  I,  73d 

Nov.  25, 

Left.     Siirg.  B.  L.  Hovcy,  136th 

Indiana. 

25,  '62. 

Discharged  March  4.  1863. 

Pennsylvania,  age  26. 

De.11,'63. 

N.  Y.    Resigned  July  5,  1864. 

230 

Tryon,  L.  J.,  Corp'l,  K, 

June  2, 

Left;  ant.  post.  flap.     Surg.  N.  R. 

194 

Shell,  it.  C.,  Serg't,  C, 

Nov.  30, 

Left;  anterior  posterior  flap.    A. 

8ist  New  York,  age  21  . 

11,  '64. 

Moselev,  U.  S.  V.     Discharged 

31st  Miss.,  age  :!2. 

Dec.  26, 

A.  Surg.  T.  Morrison.    Trans,  to 

September  30,  1864.     Spec.  203. 

1864. 

Provost  Marshal  March  7,  1865. 

231 

Tucker,  J.  G.,    Pt.,  K, 

June  18, 

Right  ;  circ.   A.  A.  Surg.  A.  F.  A. 

195 

Shewalter,  C.W.,  Pt.,  G, 

April  12, 

Left;  flap.      Discharged  August 

20th  Michigan,  age  22. 

July  8, 

King.     Disch'd    April   4,    1865. 

8th  Tenn.  Cavalry. 

16,  '65. 

11.  1865. 

1864. 

Spec.  2826. 

19ti 

Shute,W.  A.,  Pt.,  I,  13th 

Aug.  30, 

Left;    double  flap.     Surgeon  J. 

232 

Upright,  G.  T.,  PI.,  B, 

July  2. 

Right:  circ.     A.  A.  Surg.  A.  A. 

Massachusetts,  ago  31. 

Sept.  2, 

Jamison,  86th  New  York.    Dis 

8th  Ohio,  age  21. 

23.  '63. 

Hamilton.    Disch'd  May  9,  1864. 

1862. 

charged  June  4.  1863. 

°33 

Van  Gundy,  J.,  I't.,  K, 

Mar.  3, 

Right;    flap.     Discharged   Janu 

197 

Skigoll,  I.,  Pt.,  M.  2d  N. 

April  7, 

Right;    circ.      Discharged  Julv 

4th  Iowa,  age  18. 

Apr.1,'62. 

ary  28.  1863. 

Y.  U'vy  Art'v,  age  22. 

18,  '65. 

29,  1865. 

(234 

Walker,  J.,  Pt.,  Carpen 

May  25, 

Left.    Surg.W.  H.  Baldwin,  C.  S. 

198 

Slack,  li.,  Pt.,'  H,  100th 

Mav  3, 

Right  :  anterior  post.  flap.     Ass't 

ter's  Battery. 

29,"  '62. 

A.     Recovered. 

New  York,  age  27. 

13,  ''64. 

Surg.  VV.  D.  Murray.  100th  N.  Y. 

235 

Ward,  A.  S.,  Serg't.  C, 

May  3, 

Right.      Surg.   H.    K.   Goodman, 

Discharged  December  26,  1864. 

107th  N.  York,  age  22. 

8,  '63. 

28th  Penn.    Disch'd  July  27/63. 

199 

Smith.C.W.,  I't.,  D.  10th 

July  3, 

Left;    single   flap.     Surg.  F.  H. 

236 

Warn,  E.  S.,  Serg't,  C, 

July  3, 

Left,     Surgeon  C.  S.  Wood,  66th 

West  Virginia,  age  24. 

29,  ''64. 

Gross,    U.   S.   V.       Discharged 

19th  Virginia,  age  ','5. 

6,  '63. 

New  York.     Exchanged   Nov. 

March  18,  1865. 

12,  1863. 

526 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

Vn 

NAME,  MILITARY 

DATES 

OPERATIONS,  OPEKATOUS, 

NO. 

DESCRIPTION,  AND  AGE. 

DATES. 

RESULT. 

±>t  W. 

DESCRIPTION,  AND  AGE. 

RESULT. 

237 

Watson,  W.,  Pt.,  E,  7th 

May  15, 

Right  ;  flap  :  gangrene.    Disch'd 

27-2 

Bourn.  W.  L,  Pt.,  F,  12th 

July  9, 

Right:  circular.     A.  A.  Surg.  T. 

Michigan,  age  24. 

21,  '64. 

December  29,  1804.     Spec.  4540. 

Georgia,  age  30. 

13,  ^64. 

E.  Mitchell.     Died  August  12, 

238 

Weaver,  J.,  Pt.,  C,  154th 

Mar.  1, 

Left  ;  circular.    A.  A.  Surg.  E.  L. 

1864  ;  diarrhoea. 

New  York. 

12,  '65. 

Mola.     Disch'd  June  15,  18ti5. 

273 

Boylan,  A.,  Pt.,  E,  35th 

Aug.  30, 

Right.     A.  A.  Surgeon  W.  Eddy. 

239 

Webster,  E.  H.,  Pt.,  I, 

Sept.  19, 

Right;  anterior  post.  flap.    Sure;. 

New  York. 

Se.  10,'62. 

Died  October  12,  1862.    Spec.  61. 

98th  Illinois,  age  26. 

24,  '63. 

S.  B.  Hawley,   35th   111.    Dis 

274 

Bradbury,  G.W.,  Corp'l. 

Sept.  19, 

Left.     Died   November  1,  1863  ; 

charged  April  26,  1864. 

A,  98th  Illinois. 

Oc.16,'63. 

secondary  haem.  and  pyaemia. 

240 

Welker,  C.,  Pt.,  K,  9th 

July  12, 

Right;  flap.     Surgeon  C.  Smith. 

275 

Sullen,    H.    W.,   Lieut., 

Nov.  30, 

Right;  lateral  flap.     A.  A.  Surg. 

Michigan. 

15,  '62. 

9th  Michigan.    Discharged  No 

Darden's  La.  Battery. 

Dec.  30, 

R.  McNeily.     Tetanus.     Jan.  6, 

vember  29,  1862. 

1864. 

1865,  amp.  thigh,  lower  third. 

241 

Welsh,  J.,  Pt.,  H,  61st 

Sept.  17, 

Right.   Surg.  H.  S.  Hewit.U.S.V. 

Died  January  7,  1865;  tetanus. 

New  York,  age  26. 

29,  '62. 

Gangrene.    Disch'd  July  23,  '63. 

276 

Bumpus,  M.,  Pt.,  A,  5th 

Mav  10, 

Right  ;  ant.  skin   flap   and  post. 

Died  May  4,  1868.    Svec.  402. 

Maine,  age  29. 

24  ,''64. 

muse.  flap.  Surg.  A.  F.  Sheldon, 

242 

Welsh,  M.,  Ft.,  I,  154th 

May  3, 

Right.   Surg.  S.  N.  Sherman,34th 

U.  S.  V.     (May  19,  lig.  of  ant. 

New  York. 

25,  '63. 

New  York.     Discharged  March 

tibial  artery  for  secondary  haem. 

3.  1864.     Spec.  1550. 

Diarrhoea  ;  pyaemia.)    Died  May 

243 

Weston,  W.  P.,  Pt.,  H, 

De.31,'62. 

Left:  flap.     Discharged  May  11, 

29,  1864  ;  toxjemia. 

64th  Ohio. 

Ja.  12,'63. 

1863. 

277 

Burton,  J.  if.,  Serg't;  G, 

Mar.  7, 

Left  ;  anterior  post.  flap.     Surg. 

244 

Wheeler,   H.,    Ordinary 

Jan.  15, 

Left.     Dr.  H.  N.  Adams,  U.  S.  N. 

1st  Tenn.  Artillery,  age 

20,  '65. 

B.  B.  Breed,  U.  S.V.   Gangrene. 

Seamau,U.S.N.,age  23. 

30,  '65. 

Discharged  October  13,  1865. 

38. 

Died  March  26,  '65;  exhaustion. 

245 

1  Whitaker,  J.  F.,  Pt.,  K, 

Mav  16, 

Right;  circular.     June  30,  1864, 

278 

Butters,  T.  S.,  Corp'l,  I, 

July  3, 

Right.      July  21,   haemorrhage  ; 

8th  Tenn.,  age  26. 

J'el'2,'64. 

improving. 

2d  Mass.,  age  22. 

17,  ''63. 

diphtheria.     Died  July  31,  1863. 

246 

Whitesel,  J.  W.,  Serg't, 

July  3, 

Left;   circular.     Surg.  —  Chase, 

279 

Buxton,  G.  W.,  Corp'l, 

Aug.  9, 

Left.     A.  A.  Surg-.  O.  F.  Scheldt. 

B,  19th   Virginia,  age 

6,  '63. 

C.  S.  A.     Transferred  for  ex 

A,  2d  Massachusetts. 

15,  '62. 

Diarrhcea.     Died  A  ug.  31  ,  1862  ; 

25. 

change  November  12,  1863. 

pyremia.     Spec.  43. 

247 

Wieand,  J.,  Pt.,  B,  47th 

Oct.  22, 

Risrht;  posterior  flap.  Discharged 

280 

Castle,  E.  W.,  Pt.,  D,  2d 

April  6, 

Left  :  posterior  flap.    Surgeon  B. 

Pennsylvania. 

25,  '62. 

December  3,  1862.     Spec.  687. 

Conn.  Heavy  Artillery, 

18,  '65. 

A.  Vanderkieft,  U.  S.  V.      Died 

248 

Wildm'an,  E.  S.,  Lieut.. 

Julv  2, 

Right.     Surg.  —  Given,  C.  S.  A. 

age  20. 

April  23,  1865.     .Spec.  4100. 

G,  28thVirRinia,age35. 

7,  '63. 

To  Provost  Marshal  Sept.  ^5,'63. 

281 

Caughej-,  L.,  Lieut.,  C, 

July  28, 

Right  ;  circular.     Surgeon  A.  B. 

249 

Willburn,  R.,Pt.,A,  81st 

May  22, 

Right.     A.  Surg.  H.  M.  Sprague, 

1  6th  Penn  sy  1  van  ia  Cav 

AuglS, 

Mott,  U.  S.  V.    Diarrhcea.    Died 

Illinois. 

26,  '63. 

U.  S.  A.     Discharged   August 

alry,  age  23. 

1864. 

August  23,  1864. 

22,  1863.    Spec.  1628. 

282 

Cavaugh,  G.,  Pt.,  1,  10th 

Aug.  30, 

Left.     Ass't  Surgeon  B.  Howard, 

250 

Willetts,  J.  P.,  Pt.,  B, 

June  1, 

Right;  circular.    Surg.  E.  Bent- 

New  York. 

Sept.  5, 

U.  S.  A.    Died   September  13, 

1st  New  Jersey,  age  22. 

7,  '64. 

ley,  U.  S.V.  Gangrene.  Disch'd 

1862. 

1862:  pyaamia. 

June  8,  1865.     Died  Dec.  10,  '66.     283 

Cave,W.  M.,  Pt.,  E,  18th 

Oct.  19, 

Left;  lat.  skin  flap  and  circ.  sect. 

251 

William,  J.,Pt.,E,  118th 

May  16, 

Right  ;  flap.     Surg.  —  Gibbs,  C. 

Indiana,  age  22. 

Nov.  9, 

muse.     A.  A.  Surg.  C.  H.  Jones. 

New  York,  age  19. 

June  9, 
1864. 

S.  A.     Disch'd   May  27,   1865. 
Re  amp.  in  up.  third  Dec..  1865.     284 

Cearfas,  G.  W.,  Pt.,  D, 

1864. 
May  12, 

Died  Nov.  21,  '64;  exhaustion. 
Right  ;  lateral  flap.    Chills.   Died 

252 

Wilson,  G.,  Pt.,  B,  18th 

April  5, 

Left  ;  flap.     Surgeon  S.  B.  Houts, 

100th  Penn..  age  30. 

22,'  '(M. 

June  10,  1864. 

Missouri. 

26,  '62. 

18th  Mo.    Disch'd  July  15,  1862. 

285 

Chase,  C.  B.,  Pt.,  G,  7th 

Sept.  17, 

Left;  circular.     Ass't  Surg.  J.  H. 

-J..:; 

Wilson,  L.  P.,  Corp'l,  K, 

Sept.  17, 

Left;  flap.     Ass't   Surg.   W.  M. 

Maine. 

Oct.  11, 

Searle.  26th  N.  Y.     Died  Oct. 

88th  Pennsylvania. 

21,  '62. 

Notson,  U.  S.  A.     Discharged 

1862. 

30,  1862;  pyaemia.     Spec.  770. 

February  19,  1863. 

286 

Clark,  E.  J.,  Pt.,  I,  8th 

May  10, 

Left;  circular.     Surg.  A.  F.  Shel 

254 

Yost,  S.  R.,  Pt.,  A,  28th 

Sept.  17, 

Left;    anterior  post.  flap.     Ass't 

Michigan,  age  36. 

June  4, 

don,  U.  S.V.    June  6,  hajm.;  lig. 

Pennsylvania,  age  24. 

Oct.  5, 

Surgeon  C.  P.  Russell,  U.  S.  A. 

1864. 

ani.  tib.  art.   Died  J  line  16,  1864  ; 

1862. 

Disch'd  March  19,'63.  .Spec.  810. 

secondary  hemorrhage. 

255 

Young,  W.,  Pt,,  F,  7th 

Aug.  9, 

Left;  flap.     Discharged  Novem 

287 

Clock,  C.  H.,  Pt,,G,  10th 

Aug.  16, 

Right;  circular.     Ass't  Surg.  C. 

Indiana. 

12,  :62. 

ber  19.  1862. 

Connecticut,  ago  23. 

26,  '64. 

Wagner,  U.  S.  A.     Died  Sep 

256 

Zant,  J.  H.,  Pt.,  A,  37th 

Nov.  25, 

.     Surgeon  G.  M.  McDowell, 

tember    11,    1864;    exhaustion. 

Georgia. 

De.18,'63. 

C.  S.  A.     Recovered. 

.Spec.  3707. 

257 

Zergcr,  J.,  Pt.,  B,   53d 

June  1, 

Left;  circular.     Subsequent  am 

288 

Covil,  G.  B.,  Serg't,  H, 

June  3, 

Right  ;  circ.  Surg.  N.  R.  Moseley, 

Pennsylvania. 

5,  '62. 

putation.     Diseh'd  Nov.  7,  1864. 

llth  Conn.,  age  32. 

10,  '64. 

U.  S.  V.     June  13,  ham.     Died 

258 

Zook,    C.,    Pt.,    C,    8th 

Dec.  13, 

Right;  anterior  post.  flap.     A.  A. 

June  14,  1864  ;  secondary  haem 

Pennsylvania,  age  19. 

21,  '62. 

Surgeon  A.W.  Tryon.     Disch'd 

orrhage.     Spec.  2485. 

Nov.  15,  1863.     /Specs.  650,  1596. 

:289 

Craig,  W.,  Pt.,  E,  74th 

Nov.  25, 

Right;  flap;   haem.;   lig.  of  post. 

259 

Andrews,  J.,  Pt,,  C,  5th 

Dec.  13, 

Left  ;  flap.     Surgeon  E.  Bentley, 

Illinois. 

28,  '63. 

tib.  art.  Dec.  4,  re-amp,  in  upper 

Artillery,  age  19. 

20,  '62. 

U.  S.  V.     Died    December  30,  , 

third.     Died  Dec.  11,  1863. 

1862;  pyaemia.     Spec.  599. 

•290 

Crowter,  J.   D.,  Pt.,  D, 

April  2, 

Right  ;  circular.     Ass't  Surg.  W. 

260 

Apgar,  J.,  Pt.,  A,  15th 

May  2, 

Right  ;  anterior  post.  flap.     A.  A. 

4th  N.Y.  Heavy  Artil 

23,  '65. 

F.  Norris,  U.  S.  A.    Died  May  7, 

New  Jersey. 

16,  '63. 

Surg.  C.  Carvallo.     (Ball  extr.; 

lery,  age  24. 

1865;  pyaemia.     .Spec.  226. 

gangrene.  )     Died  May  20,  1863  ; 

291 

Despond,  P.,  Pt.,  A,  5th 

June  17, 

Left.     Died  June  22,  1864. 

exhaustion.     Specs.  1251,  2226. 

Michigan. 

20,  '64. 

261 

Bambauer,  J.,  Musician, 

Nov.  30, 

Right  ;  lateral  flap.     Ass't  Surg. 

292 

Detrich,  C.,  Pt.,  K,  82d 

Aug.  29, 

Left.    Ass't  Surg.  B.  A.Clements, 

H,  56th  New  York,  age 

Dec.  20, 

J.  F.  Huber,  U.  S.  V.     (Dec.  2, 

Ohio. 

Sept,  18, 

U.S.A.    Died  Oct.   28,    1862; 

22. 

1864. 

excision  tarsus.)     Died  Decem 

1862. 

pyaemia.     Spec.  62. 

ber  26,  1864  ;  pyaemia. 

293 

Dowling,  J.  T.,  Lieut,, 

May  10, 

Right  :  circular.  Med.  Insp.  F.  H. 

262 

Barber,  W.  B.,  Serg't,  I, 

May  23, 

Right;  anterior  post.  flap.     Surg. 

17th  Infantry,  age  35. 

20,  '64. 

Hamilton.     Died  June  1,  1864  ; 

93d  New  York,  age  32. 

30,  '64. 

A.  P.  Sheldon,  U.  S.  V.     Died 

pyaemia. 

June  11,  1864:  gangrene.                294 

Eastman,  C.  E.,  Pt.,  E, 

July  18, 

Left.  Surg.  D.  Merritt,  55th  Penn. 

263 

Baxter,  P.,  Pt.,  D,    1st 

Julv  2, 

Right;  flap.     Died  July  26,  1863. 

9th  Maine. 

23,  '63. 

H;em.    July  25,  lig.  of  peroneal 

Potomac  Home  Brig. 

5,  '63. 

artery.     Died  August  8,  1863. 

264 

Berry,  J.,  Pt.,   B,   39th 

Aug.  16, 

Left  ;  circular.     A.  A.  Surg.  S.  J.     295 

Evans,   A.,  Pt.,   E,   1st 

Mar.  12, 

Right."    A.  A.  Surg.  A.  Sterling. 

Illinois,  age  38. 

21,  '64. 

Holley.    Died  September  4,  '64  ; 

Illinois  Artillery,    age 

April  4, 

Died  May  6,  1864  ;  typhoid  fever 

irritative  fever.                                            27. 

1864. 

and  pyaemia. 

265 

Bigelow,  L.,  Corp'l,  B, 

Aug.  30, 

.     Died  October  18,  1862.        ;  296    Faust,  J.,  Pt.,  H,  119th 

May  2, 

Right.  'A.  Surg.  C.  C.  Lee.U.S.A. 

13th  Massachusetts. 

—  ,  '62. 

Pennsylvania,  age  24. 

17,  ''63. 

Died  May  19,  1863.     Spec.  1250. 

266 

Biggs,  M.  L.,  Corp'l,  A, 

April  30, 

Left  ;  flap.    Surg.  N.  Gay,  U.S.V.     297  ;  Frampton,  T.  H.,  Pt.,  G, 

May  22, 

Left  ;    rectangular  flap.      A.  A. 

53d  Kentucky,  age  20. 

May  12, 

Died  June  17,  1865:  exhaustion. 

22d  Mass.,  age  18. 

30,  '64. 

Surg.  R.  Ottman.     Died  June  9, 

1865. 

j 

1864  ;  exhaustion.     Spec.  2474. 

267 

Biornson,  C.,  Pt.,  C,  2d 

June  1, 

Left  ;  flap.     A.  A.  Surgeon  S.  B.     298    Fuller,  J.  P.,  Pt.,  F,  4th 

May  5, 

Left.     Died  June  21,  1864. 

Conn.  H.  Art.,  age  33. 

14,  '64. 

Ward.    Died  June  18,  '64  ;  gang. 

Michigan,  age  35. 

12,  '64. 

268 

Blanchard,  E.  W.,  Pt., 

June  3, 

Left  ;  circular.    Surg.  K.  Bcntley,     299 

Gammrl,  M.  A.,  Pt.,  G, 

Sept.  17, 

Left  ;   gangrene.     Died   Decem 

H,  45th  Penn.,  age  16. 

16,  '64. 

U.  S.  V.     Died  June  20,  1864; 

—  Arkansas,  age  23.          30,  '62. 

ber  5,  1862. 

tetanus.     Spec.  2710.                         300 

Gibney,  J.,  Pt.,  L,  2d  N.    June  1  6, 

Right.     Ass't  Surgeon  F.  Wolf, 

269 

Blodgett,  E.  J.,  Pt.,  E, 

May  6, 

Left  ;   anterior  post.  flap.     Surg.                York  Heavy  Artillery, 

—  ,  '64. 

U.  S.V.     Died  July  16,   1864. 

6th    New    Hampshire, 

26,  '64. 

A.  Delany,  U.  S.  V.    Died  May           ;     age  18. 

Spec.  2419. 

age  22. 

30,  1864  /exhaustion.                        301    Gilmore,  J.,  Pt.,  F,  144th 

Feb.  10, 

Right  ;  anterior  flap.   A.  A.  Surg. 

270 

Blois,  E.,  Lieut.,  C,  18th 

April  6, 

Left  ;  circular.    A.  A.  Surg.  J.  P. 

New  York.                          22,  '65. 

E.  L.  Mola.    (Erysipelas.)  Died 

Georgia,  age  24. 

27,  '65. 

Arthur.     (Also  w'nd  left  thigh. 

February  28,  1865. 

Erysipelas.)    Died  May  4,  1865;     302 

Grace,  E.  C.,  Lieut.,  A,      May  5, 

Right;  circular.     Med.  Inspector 

exhaustion. 

139th  Penn.,ae;e  24. 

20,  '64. 

F.  H.  Hamilton,  U.  S.  A.     Died 

271 

Bolt,    S.,    Pt.,    A,    77th 

May  22,    Right.     A.  Surg.  H.  M.  Sprague, 

June  5,  '64;  pyaemia.  Spec.  4545. 

Illinois,  age  25. 

JuneS,        U.S.A.     Died  June  21,  1863;     303    Granger,  B.,  Pt.,  K,  1st    Aug.  29, 

Left,     Died  October  2,  1862. 

1863.         pysemia.     Spec.  1633. 

Penn.  Rifles. 

1 

'62.  Int. 

Surgical  Journal,  Richmond,  1865,  Vol.  II,  p.  28. 


SECT.  V.) 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


527 


No. 

NAME,  MILITARY         DA-ITS         OPERATIONS.  OPERATORS, 

Vr\ 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

DESCRIPTION,  AND  AGK.                                   RESULT. 

A  U 

DESCRIPTION,  AND  AGE. 

DATES. 

RESULT. 

304 

Graver.  J.  C.,  Corp'l,  M, 

June  18, 

Right  :-circ.     A.  A.  Surg.  A.  J. 

335 

O'Harran,  P.,  Pt.,  A,  52(1 

June  10, 

Left  ;  posterior  flap.    A.  A.  Surg. 

1st  Massachusetts  H'w    July  10,       Smith.     Gangrene.     Died  July 

New  York,  age  40. 

July  16, 

E.  Seyffarth.    Gangrene.     Died 

Artillery,  age  20.                  1804.     '     15,  1864  ;  exhaustion. 

1864. 

July  25,  1864;  pyiemia. 

305 

Harris,  A.  F.,  Corp'l,  G,     June  16,     Right;  double  flap.     Died  June 

336 

Parry,   W.,   Pt.,  B,  5th 

May  28. 

Left.  A.A.Surg.j".  H.Thompson. 

52d  Xew  York,  age  37.  |    19,  '64.        29,  1864  ;  pyaemia. 

Mich.  Cavalry,  age  33. 

J  'lie  6,  '04 

Died  June  15,  1864;  pyaemia. 

306 

Havens,  W.,  Pt.,  K,  7th    June  25,    Right.     A.  A.  Surgeon  W.  H.  B. 

337 

Parsons,  li.  /'..'Lieut.,  G, 

July  13, 

Right.  A.  A.  Surg.  N.  A.'Robbins. 

New  York  Heavy  Ar-    July  19,       Post.     (June  25,  amp.  2d  and  3d 

4th  Georgia,  age  22. 

18,'  '64. 

Died  July  30,  1864. 

tillery,  age  29. 

lt:64.          toes;  gangrene.     July  14,  Piro- 

338 

Patterson,    A.,     Pt.,    K, 

Oct.  28, 

Left;  circular.     Ass't   Surg.   W. 

goff's  amputation.)     Died  July 

4th  Maine,  iige  35. 

Nov.  13, 

Thomson,  U.  S.  A.     Died"  Nov. 

21,1864;   exhaustion. 

1861. 

19,  1861  ;  gangrene.    Spec.  4926. 

307 

1  Heakin,  J.,  Pt.,  D,  6th 

May  31,     Right;  short  ant,  and  long  post. 

339 

Peed,    L,   Pt.,   A,    16th 

Xov.  30, 

Left  ;  circular.     Surg.  J.  R.  LuU- 

Cavalry,  age  24. 

June  8, 

flap.    Surg.  J.  A.  Lidell,  U.  S.V. 

Kentucky,  age  28. 

Dec.  15, 

low,  U.  S.  V.     Died  January  8. 

1864. 

(Ihemorrhage.)     Died  June  21, 

1864. 

1805;  pyaemia. 

1864  ;  pyaemia.     Spec.  2470. 

340 

Perkins,  A.  W.,  Pt.,  E, 

-May  8, 

Left  ;   circular.     Ass't  Surg.  W. 

308 

Jordan,  W.,  Pt.,  D,  1st 

April  12,    Left;  ant.  post.  flap.     Surg.   H. 

llth  Infantry,  age  40. 

24,  Vi. 

F.  Xorris.U.S.A.  Haemorrhage. 

Alabama  Artillery,  age 

15,  '64.   :     Wardner.  U.  S.  V.    (Also  w'nds 

Died  June  1,  1804  ;  pyaemia. 

27. 

of  head  left  humerus,  left  arm, 

341 

Piper,  E.  C.,  Serg't,  K, 

June  3, 

Left;  ant.  post.  flap.    A.  A.  Surg. 

and  right  thigh.)    Died  April  23, 

12th   New  Hampshire, 

29,  '04. 

L.  C.  Dodge.     Died  August  8, 

1864  ;  pyaemia.  Specs.  331  1  ,  331  2. 

age  28.. 

1864  ;  chr.  diarrhoea.  Spec.  2715. 

309 

Keegan,  T.  F.,  Pt.,   B,  !   July  3, 

Left.     Died  August  1,  1863;  ex 

342 

Pittman,  N.,  Pt.,  D,  1st 

May  19, 

Left:   circular.     A.  A.  Surgs.  H. 

73d  New  York,  age  20.  '   12,  ^63. 

haustion.     Spec.  1450. 

Massachusetts    Heavy 

June  10, 

B.  Knowles  and  M.  F.   Price. 

310 

Kensey,   R.    C.,  Pt.,  K, 

June  1, 

Right  ;  sloughing  ;   haemorrhage. 

Artillery,  age  32. 

1864. 

Died  June  14,  1864;  pyaemia. 

104th  Pennsylvania. 

8,  '62. 

June   14,   femoral    artery   tied. 

343 

Pit/el,   A.,  Pt.,  E,  34th 

Sept.  10, 

Left.     Died  September'lO,  1802: 

Died  June  14,  1862. 

Ohio. 

14,  '62. 

tetanus. 

311 

2Kroft,    J.,    Pt.,   D,  7th 
Xew  York,  age  33. 

Sept.  16, 
Oct.  8, 

Left  ;  circular.     A.  A.  Snr?.  J.  S. 
Waggoner.  Nov.  l':,  re-amputa- 

344    Pressr/rares,J.R.,  Lieut., 
8th  Virginia. 

July  2, 
13,  '63. 

Left.     Surgeon  C.  S.  Wood,  66th 
Xew  York.    Died  July  15,  1863; 

1864.         tion.    Died  November  16,  1864  ; 

| 

tetanus. 

312 

Lahser,  A..  Pt.,  I,  24th 

etfects  of  anaesthetic. 
May  23,     Right.     Surgeon  G.  L.  Pancoast, 

345 

Reynolds,  W.,  Corp'l,  I,     May  31, 
6th  N.Y.  H.  A.,  age  32.   J'el5,'64. 

Left.     A.  A.  Surg.  J.  H.  Thomp 
son.  Died  July  6,  1864  ;  pyaemia. 

Michigan,  age^K). 

June  9, 

U.  S.  V.     Died  June  18,  1864. 

346 

Ross,  W.  A.,  Pt.,  I,  123d    Deo.  13, 

Right.     Died  January  4,"  1863; 

313 

Lannahan.  J.,  Pt.,  H,  9th 

1804. 
Oct.  19, 

Spec.  2464. 
Left  ;  circular.    A.  A.  Surg.  R.  H. 

347 

Pennsylvania,  age  18.       18.  '62. 
Schuler,    C.,   Corp'l,  C,  1   July  2, 

diarrhoea.     Spec.  677. 
Left  ;    haemorrhage.     Died  July 

N.  Y.  Heavy  Artillery, 

Nov.  7,  1     Stirling.  (Gangrene.)  Died  De- 

71st  Xew  York,  a'ge  23!      13,  ''63. 

21,  1803;  haemorrhage. 

age  20. 

1804.         cember  5,  1804  ;  pyaemia. 

348    Scott,  E.,    Pt.,   G.  25th  '  Nov.  30, 

Left;  anterior  posterior  flap.     A. 

314 

Laveve,  D.,  Pt.,  F,  5th 

June  2, 

Right.     A.  A.  Surg.  W.  H.  Ran 

Ohio,  age  18. 

Dec.  4, 

A.  Surgeon  W.  Balser.     Died 

New  York,  age  24. 

19,  '04. 

dolph.  (Erysipelas.)  Died  June 

1864. 

December28,  1804;  hectic  fever. 

27,  1864  ;  asthenia. 

349 

Sharp,  W.,  Pt.,  I,  8th  N. 

June  3, 

Left  ;  anterior  flaps.     Surg.  F.  F. 

315 

McClellan,  J.,  Pt.,1,  40th 
Ohio,  age  19. 

May  15, 
June  4, 

Left;    circular.     A.   A.  Surgeon 
H.  C.  May.     Sloughing.     Died 

York  Heavy  Artillery, 
age  21. 

7,  '64. 

Burmeister,  09th  Penn.    (Haem.) 
Died  July  12,  1864.     Spec.  3204. 

1864. 

June  23,  1864  ;  exhaustion. 

350 

Sieker,  H.,  Pt.,  K,  35th 

Sept.  19, 

Left;   sloughing.     Died  October 

310 

McClure,  R.,  Pt.,  K,  82d 

April  1, 

Right;  circular.     A.  A   Surg.  A. 

Ohio. 

22,  '63. 

16,  1863. 

Pennsylvania,  age  37. 

17,  '65. 

V.  Cherbounier.     Died  July  3, 

351  1 

Smith,    P.,    Serg't,    K, 

Aug.  10, 

Both;   circular.     A.  A.  Surgeon 

1865;  dysentery.     Spec.  4103. 

1525 

69th  New  York,  age  30. 

Sept.  6, 

J.  H.  Hutchinson.     Sloughing; 

317 

McCoy,  G.,  Pt.,  E,  62d 

Jan.  23, 

Left;  circular.     A.  A.  Surg.  W. 

1864. 

bed-sores.      Died    October    10, 

Pennsylvania. 

Feb.  12,       F.   Peck.     Died    February  26, 

1864;  exhaustion.    Spec.  3644. 

1864.         1864  ;  pyaemia. 

353 

Spiller,  J.  F.,  Corp'l,  I, 

Feb.  11, 

Right;  lateral  flap.     A.  A.  Surg. 

318 

MoGeough,    M.,  Lieut., 

May  7.    •  Left  :  circular.    A.  A.  Surg.  J.  C. 

7th    New    Hampshire, 

Mar.  6, 

B.  B.  Miles.    Died   March   13, 

H,    1st    Sharpshooters, 

17,  '64.        McGee.     Died   May  22,    1864; 

age  21. 

1865. 

1865;  pyaemia. 

age  30. 

pyaemia.     Spec.  2275. 

354 

Steele,  G.  A.,  Serg't,  K, 

Oct.  6, 

Right;  circular.    Died  Xovember 

319 

McMillen,  J.,  Pt.,K,  86th 

July  10, 

Left  ;  circular.     Died  August  17, 

1st  New  Hamp.  (lav. 

9,  '04. 

12,  1864  ;  gangrene. 

Illinois,  asre  23. 

17,  '64. 

1864  ;  exhaustion. 

355 

Stilwell,  C.,  Pt.,  K,  57th    Sept.  17, 

Left.     Surg.  H.  S.  Hewit,  U.  R.V. 

320 

McMullen,  G.,  Lieut.,  C, 

July  9, 

Left;  circular.    A.  A.  Surg.  J.  H. 

New  York.                       Oct.  3,  '62. 

Died  October  9,  1862.    Spec.  762. 

321 

110th  Ohio,  age  34. 
Madris,   J.,  Pt.,   C,  33d 

21.  "'64. 
July  20, 

Bartholf.    Died  Aug.  21,  1864. 
Right  ;  ant.  post.  flap.  Ass't  Surg. 

356 

Temple,   A.,  Serg't,   F,  !  Aug.  21, 
1st  Missouri    Cavalry,     Sept.  6, 

Right;  circular.     A.  A.  Surgeon 
C.A.Warner.    Died  September 

Indiana,  age  35. 

Aug.  13, 

W.  B.  Trull,  U.S.  V.  Died  Aug. 

age  24.                                   1864. 

20,  1864  ;  pyaemia. 

322 

Magoon,  J.  B.,   Pt.,   A, 

1864.    . 
June  22, 

29,  1864  ;  irritative  fever. 
Left;  ant.  post.  flap.     Ass't  Surg. 

357 

3  Tillapaugh,  G.W.,Cor-    May  31, 
poral,  B,  151st  N.  Y.,     June  6. 

Right;  circular.     A.  A.  Surgeon 
C.  II.  Osborne.     Died  June  21, 

33d  Mass.,  age  42. 

July  15. 

B.  E.  Fryer,  U.S.A.    Died  July 

age  23. 

1864. 

1864  ;  pyaemia. 

1864. 

18,  1864  ;  pyaemia. 

358 

Umbarger,  J.W.,  Corp'l,      Dec.  5, 

Left,    A.  A.  Surgeon  H.  M.  Lilly. 

323 

Martin,  P.,  Pt.,  F,  18th 

April  7, 

:  erysipelas.     Died  April  25, 

I,  117th  Illinois,  ago  30. 

1864, 

(Dec.  15    1864.  Chopart's  amp. 

Louisiana,  age  32. 

16,  '62. 

1862;  mortification  of  leg. 

Jan.  12, 

foot  :  gangrene.)     Died  January 

324 

Mayne,  R.,  Pt.,  K,  6th 

May  5, 

Right.     Surg.  Z.  E.  Bliss,  U.  S.V. 

1865. 

14,  1805;  pyaemia. 

Vermont,  age  20. 

29,  ''64. 

(May  22,  rem.  of  ball  and  frag 

359 

Vangeson,  J.,  Corp'l,  F, 

Aug.  16, 

Left;  circular.     A.  A.  Surg.  S.  J. 

ments  of  bone;  erysipelas.)  Died 

4th  Artillery,  age  35. 

23,  '64. 

Holley.    Died  September  2,  '64  ; 

June  2,  1864. 

exhaustion. 

325 

Miller,  A.  L.,Pt.,D,  121st 

May  11. 

Left  •  flap.     A.  A.  Surgeon  W.  E. 

360 

Van  Scoter,  G.,  Pt.,  G, 

Aug.  29, 

Left.     Died  October  12,  1862. 

New  York,  age  23. 

17,  '64.' 

Chirk.      Died    May  23,    1864; 

5th  New  York. 

'62.  Int. 

pyaemia. 

361 

Velie,  G.  W.,  Pt.,  C,  24th 

June  3, 

Right;  circular.     Surgeon  D.  W. 

326 

Miller,  L.,  Pt.,  18th  Ohio   De.16,'64, 

Right;  flap.     A.  A.  Surg.  F.  G. 

Michigan,  age  28. 

28,  '64. 

Bliss,  U.  S.V.  (Excision  ankle.) 

Battery,  age  19.   . 

Jan.  8,  '65. 

Albright.    Died  Jan.  18,  1865. 

Gangrene.    Died  July  18,  1864. 

327 

Moore,  C.,  Pt.,  E,  1st  R. 

May  3 

Left.     Died  June  30  1863. 

362 

White,  A.  J.  Pt.  A,  8th 

June  3 

T  oft  •   rfiotin(ynlir  fl*»n       Sure*   F 

I.  Light  Art'rv,  age  38. 

12,  '63. 

New  York  Heavy  Ar 

9,  '64.' 

Bentley,U.S.V.  Flaps  sloughed. 

328 

Morrison,  D.,Pt.,  A,  llth 

May  31, 

Left.     A.  A.  Surg.  F.  H.  Brown. 

tillery. 

Died  July  10,  1804  ;  exhaustion. 

Maine. 

June  29, 

(Also  wound  of   right  femur.) 

Specs.  2497,  3340. 

1862. 

Died  July  ~">,  '62  ;  tuberculosis. 

363 

Williamson,  H.,  Pt.,  D, 

July  2, 

Right;  sloughing.     Died  Febru 

Spec.  13. 

llth  Miss.,  age  20. 

5,  '63. 

ary  18,  1864. 

329 

Mullen.  E.,  Pt..  D,  5th 

July  18, 

Left  ;  flap.  Ass't  Surg.  J.  Willard, 

364 

VVitzel,  J.,  Serg't,  I,  1st 

Aug.  19, 

Right  ;  circular  flap.    Surg.  A.  A. 

X.Y.  H'vyArt.,  age  25. 

24,  '64. 

1st  Md.     Died  July  28,  1864. 

Maryland,  age  24. 

22,  '64. 

White,    8th    Maryland.      Died 

330 

Mnsser,  W.,  Pt.,   I,  83d 

July  1, 

Right  ;  flap.    Ass'i  Surgeon  J.  S. 

September  10.  1864. 

Pennsylvania,  age  22. 

8,  '62. 

Billings,  U.  S.  A.     Gangrene  ; 

365 

Wood,  F.,  Serg't,  A,  5th 

Oct.  19, 

Right  ;  anterior  post.  flap.     Ass't 

diarrhoaa.     Died  July  15.  1862. 

Michigan  Cavalry,  age 

Nov.  7, 

Surgeon  D.  C.  Peters,  U.  S.  A. 

331 

foil,  J.  P.,  Pt.,  G,  14th 

April  2, 

Left.    A.  A.  Surg.  J.  M.  Hotaling. 

22.                                          1864. 

Died  Nov.  18,  1804;  pyaemia. 

332 

South  Carolina,  age  18. 
Nicholson,  J.,  Corp'l,  C, 

9,  '65. 
April  2, 

Dieil  April  20,  1865;  diarrhoea. 
Rijrht-  i;.'----.lar.     A.  Surgeon  F. 

36d     Woolten,  T.,  Pt.,  F,  32d    Mar.  10, 
Virginia.                               14.  '64. 

:  flap.  Surgeon  C.  B.  Gibson, 
C.  S.  A.     Died  May  19,  1864. 

40th  Penn.,  age  27. 

22,  '05. 

K.  alartindale,  U.  S.  V.     Died 

367    Wright,  B.,  Pt.,  G,  8th     May  6. 

Right  ;    iinterior  post,  skin   flap. 

April  24,  1865. 

Michigan,  age  23.              27,  '64. 

Surgeon  A.  F.  Sheldon,  If.  S.  V. 

333 

Nixon,  W.,  Pt.,  H,  20th 

June  17, 

Right.  Surg.G.  F.  French.U.S.V. 

Died  June  11,  1864;  exhaustion 

Illinois. 

July  6, 

(Haemorrhage);  diarrhoea.  Died 

and  typhoid  condition. 

1804. 

Aug.  19,  '64  ;  exh'n.    Spec.  3382. 

368    Yagle,  J.  F.,  Pt.,  E,  87th 

Sept.  20, 

Left:  circular  (gangrene).     Died 

334 

Norton,  A.  L.,  Corp'l,  D,     June  3, 

Left.     Died   June  29,  1864  ;  py 

Indiana,  age  23. 

Oct.  5, 

October  14,  1863. 

14th  Conn.,  age  29.             6,  '64. 

aemia. 

i 

1863. 

"LlDEU.  (J.  A.),  On  the  Wounds  of  Blond  Vessels,  etc.,  in  United  States  Sanitary  Commission  Memoirs,  New  York,  1870,  Surgical  Vol.  I,  p.  23. 
'PACKARD  (JOHN  H.),  Death  from  Chloroform,  in  American  Journal  Medical  Sciences,  1865,  Vol.  XLIX,  N.  S.,  p.  272. 

SLI1)KI.I.  (J.  A.)  (Secondary  Traumatic  Lesions  of  Bone,  etc.,  in  U.  S.  San.  Comm.  Mem..  Surg.  Vol.  I,  N.  Y.,  1870,  p.  408)  cites  this  case  as  an  amputation 
in  the  thigh ;  but  in  his  report  of  cases  of  pyaemia,  at  Stanton  Hospital,  for  the  second  quarter,  1864,  he  designates  the  operation  an  amputation  in  the  leg. 


528  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

Intermediary  Amputations  in  the  Lower  Third  of  the  Leg  for  Shot  Injury. — The 

number  of  the  intermediary  amputations  in  the  lower  third  of  the  leg  is  three  hundred  and 
thirty-five;  two  hundred  and  fifteen  were  successful  and  one  hundred  and  twenty  fatal — a 
mortality  of  35.8  per  cent. 

Recoveries  after  Intermediary  Amputation  in  the  Lower  Third  of  the  Leg. — The  two 
hundred  and  fifteen  operations  of  this  group  were  performed  on  two  hundred  and  fourteen 
patients — fifty  Confederate  and  one  hundred  and  sixty-four  Union  soldiers.  Of  the  latter, 
one  hundred  and  sixty-two  have  been  allowed  pensions;  the  claim  of  one  soldier  is  still 
pending,  and  the  name  of  another  has  never  appeared  on  the  Pension  Rolls.  Twelve 
have  died  since  their  discharge  from  the  service — three  of  phthisis,  one  of  softening  of 
the  brain,  one  of  ulceration  of  the  stump,  six  of  causes  not  reported;  one  pensioner  was 
accidentally  drowned. 

CASE  771. — Private  O.  Payne,  Co.  D,  20th  Colored  Troops,  aged  19  years,  was  wounded  in  the  right  foot,  near  Peters 
burg,  June  7,  1864,  and  entered  Mount  Pleasant  Hospital,  at  Washington,  three  days  afterwards.  Assistant  Surgeon  C.  A. 
McCall,  U.  S.  A.,  reported :  "Accidental  gunshot  wound  through  tendo-achillis,  passing  through  the  ankle  joint  and  emerging 
almost  at  right  angle  with  the  line  of  entrance,  literally  grinding  the  astragalus  and  part  of  the  os  calcis.  Sanguineous  fluid  was 
discharged  from  the  wounds,  and  the  foot  became  somewhat  cedematous  as  far  as  above  the  malleoli.  Two  weeks  after  the 
patient's  admission  his  pulse  grew  weaker,  more  compressible,  and  frequent,  which  was  attended  by  loss  of  "appetite  and  sleep. 
On  June  27th,  an  anaesthetic  consisting  of  equal  parts  of  ether  and  chloroform  was  administered,  and  the  leg  was  amputated  by 
the  circular  method,  by  Acting  Assistant  Surgeon  A.  Transue,  the  bone  being  divided  one  and  a  half  inches  above  the  malleoli. 
The  patient  reacted  finely,  and  after  the  operation  his  appetite  improved,  he  slept  well,  and  the  parts  looked  favorable."  On 
October  8th,  he  was  transferred  to  hospital  at  New  Albany,  where  a  second  operation  was  performed  by  Acting  Assistant  Surgeon 
W.  A.  Clapp,  who  contributed  the  following  description  of  the  case:  "The  patient  stated  that  he  contracted  syphilis  previous 
to  being  wounded.  Extensive  necrosis  of  the  shafts  of  the  tibia  and  fibula  followed  the  first  amputation,  and  the  pain  and  dis 
charge  from  the  stump  became  so  great  as  to  necessitate  a  re-amputation,  which  was  performed  by  the  circular  method,  three 
inches  below  the  knee,  on  March  18,  1865.  At  the  time  of  the  operation  firm  sequestra  had  formed  and  there  was  great  swelling 
of  the  soft  parts.  The  subsequent  progress  was  favorable."  The  patient  was  ultimately  discharged  from  service,  at  the  Joe  Holt 
Hospital,  Jeffersonville,  August  1,  1865,  and  pensioned,  and  one  year  afterwards  he  was  furnished  with  an  artificial  limb  of  the 
Palmer  patent.  The  bones  removed  at  the  second  amputation  were  subsequently  contributed  to  the  Museum  by  Dr.  T.  W.  Fry, 
late  Surgeon  U.  S.  V.,  who  at  the  same  time  stated  that  the  man  was  in  good  health  and  walking  about  on  crutches,  with  a  good 
stump,  which  had  healed  kindly.  The  specimen  is  numbered  4740  of  the  Surgical  Section,  and  is  represented  in  PLATE  LXXII, 
FIGURE  1,  opposite  page  317,  ante.  The  pensioner  was  paid  March  4,  1880. 

CASE  772. — Private  L.  Vermilyea,  Co.  K,  91st  New  York,  aged  21  years,  was  wounded  at  (iravelly 
Run,  March  31,  18(55.  He  was  conveyed  to  the  field  hospital  of  the  3d  division,  Fifth  Corps,  whence  Surgeon 
A.  S.  Coe,  147th  New  York,  reported  "a  bullet  wound  with  fracture  of  left  ankle  joint."  Surgeon  A.  F.  Shel 
don,  U.  S.  V.,  reported  the  following  description  and  result  of  the  injury:  "A  musket  ball  entered  the  lower 
extremity  of  the  tibia  anteriorly,  fracturing  it  into  the  joint  and  upwards  for  four  inches.  The  wounded  man 
was  admitted  to  Campbell  Hospital  at  Washington,  six  days  after  the  injury.  Suppuration  set  in  about  the 
wounded  foot  and  extended  to  the  muscle  of  the  calf  and  the  patient  suffered  considerable  fever  and  irritation  of 
the  system.  On  April  llth,  circular  amputation  of  the  lower  third  of  the  leg  was  performed  by  Assistant 
Surgeon  A.  Delany,  U.  S.  V.,  the  operation  being  attended  with  the  usual  amount  of  hemorrhage  and  three 
ligatures  being  applied.  Anaesthesia  was  produced  by  sulphuric  ether.  The  patient  did  well  after  the  operation, 
and  was  discharged  from  service  June  19,  1865."  Several  months  later  he  was  furnished  with  an  artificial  limb 
by  the  Salem  Leg  Company.  The  amputated  portions  of  the  bones  of  the  leg  (Spec.  4054)  were  contributed  to 
the  Museum  by  the  operator  and  are  represented  in  the  annexed  wood-cut  (FiG.  305),  showing  the  tibia  to  be 
Fir..  305.— Low-  fractured  by  a  round  ball,  which  is  lodged  just  above  the  ankle,  fissuring  into  it.  In  his  first  application  for 
^nes'ofTefrfeg •  commutation,  dated  1870,  the  pensioner  represented  the  stump  as  being  in  a  sound  condition,  but  in  subsequent 

the  ball  lodged  in  statements  he  reported  it  as  troublesome.  The  Albany  Examining  Board,  on  February  5th,  1879.  certified  to 
tibia  Spec  4054 

the  amputation,  and  stated  that  "the  stump  is  tender  and  abscesses  occasionally  form  on  the  posterior  aspect  of 

the  leg,  more  especially  if  an  artificial  limb  is  worn  for  a  few  weeks  at  a  time.  The  pensioner  also  states  that  he  has  neuralgic 
pains  and  is  now  and  then  laid  up  for  from  one  to  three  weeks."  The  pensioner  was  paid  June  4,  1880. 

CASE  773. — Private  T.  B.  Stewart,  Co.  C,  2d  Connecticut  Heavy  Artillery,  aged  31  years,  was  wounded,  at  Opequan 
Creek,  September  19,  1864,  and  admitted  to  the  Depot  Field  Hospital  at  Winchester  three  days  afterwards.  Surgeon  R. 
Sharpe,  15th  New  Jersey,  in  charge,  recorded  the  following  history:  "The  injury  consisted  of  a  shot  wound  of  both  feet  by  a 
shell,  severely  fracturing  and  comminuting  all  the  tarsal  bones.  On  September  23d  the  right  leg  was  amputated,  and  on  the 
following  day  the  left  leg  was  amputated,  both  by  circular  operation,  at  the  lower  third,  by  Assistant  Surgeon  J.  G.  Thompson, 
77th  New  York.  Severe  sloughing  of  the  stumps  followed,  and  on  October  2d  there  was  secondary  haemorrhage  from  the  inter- 
osseous  artery  of  the  left  leg,  which  was  controlled  by  taking  up  the  vessel  with  the  forceps.  The  patient  recovered  and  was 
transferred  from  Winchester  November  8th."  He  was  subsequently  admitted  to  hospital  at  Frederick,  and  lastly  he  entered 
Central  Park  Hospital  at  New  York  City,  where  he  was  furnished  with  artificial  legs  by  Dr.  E.  D.  Hudson.  On  August  13,  1865, 


SECT.  V.] 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


529 


FIG.  306.— Stump  after  flap 
amputation  in  lower  third  of 
the  left  leg.  [From  a  cast.] 
Sprc.  1025. 


the  man  was  discharged  from  service  and  pensioned.  In  his  application  for  commutation,  dated  1870,  he  described  both  stumps  as 
being  in  "  sound  condition ;"  but  five  years  later  he  reported  that  "  the  bones  stick  out."  The  pensioner  was  paid  March  4, 1880. 
CASE  774! — Private  G.  Morgan,  Co.  E,  97th  New  York,  aged  30  years,  was  wounded  in  the  left  ankle  joint,  at  Hatcher's 
Run,  February  6,  1865.  Assistant  Surgeon  D.  C.  Peters,  U.  S.  A.,  reported:  "The  wounded  man  was  admitted  to  Jarvis 
Hospital,  Baltimore,  February  lltli.  The  injury  was  caused  by  a  musket  ball  entering  the  external  malleolus,  fracturing  the 
astragalus,  and  making  its  exit  internally.  Caries  of  the  astragalus  ensued  and  the  foot  became  greatly 
inflamed.  On  March  2d,  the  leg  was  amputated  at  the  lower  third  by  Acting  Assistant  Surgeon  B.  B. 
Miles.  Ether  was  used,  and  the  operation  was  performed  by  lateral  Haps  with  circular  section  of 
muscles."  The  patient  was  subsequently  transferred  to  Ira  Harris  Hospital  at  Albany,  where  he  was 
discharged  from  service  October  13,  1865,  and  pensioned.  A  plaster  cast  of  the  stump  (Sptc.  1025), 
represented  in  the  annexed  cut  (FlG.  306),  was  contributed  to  the  Museum  by  Assistant  Surgeon  J. 
H.  Armsby,  U.  S.  V.,  in  charge  of  the  latter  hospital,  and  shows  the  ends  of  the  bone  apparently 
rounded  and  sufficiently  covered,  while  the  cicatrix  is  slightly  but  not  injuriously  drawn  on  the  pos 
terior  surface.  In  his  application  for  commutation  the  pensioner  described  the  stump  as  continuing 
in  a  "healthy  condition."  His  pension  was  paid  June  4,  1880. 

CASK  775. — E.  Robinson,  a  landsman  (colored),  aged  24  years,  while  attached  to  the  U.  S. 
Steamer  Rodolph,  was  wounded  in  the  left  leg  by  the  explosion  of  a  torpedo  in  Mobile  Bay,  April  1, 
1865.  The  injury  involved  a  dislocation  of  the  tibia  at  the  knee  and  a  compound  comminuted  frac 
ture  of  the  fibula  and  tibia  near  the  ankle  of  the  same  leg.  The  fracture  was  impacted  as  well  as 
comminuted.  When  he  was  admitted  to  the  Naval  Hospital  at  Pensacola,  thi'ee  days  afterwards,  the 
dislocation  had  been  reduced,  but  on  examination  (the  patient  being  under  the  influence  of  chloroform) 
both  the  tibia  and  fibula  were  found  to  be  severely  injured  near  the  ankle,  the  bones  protruding  from 
the  wound  and  large  and  small  fragments  being  easily  felt  by  introducing  the  finger.  It  was  then 
deemed  useless  to  attempt  to  save  the  limb,  and  amputation  was  performed  about  four  inches  above 
the  injury.  The  dislocated  bone  was  kept  in  position  by  pasteboard  splints  and  the  greatest  care  was 
used  in  dressing  the  stump.  The  case  progressed  favorably  until  April  22d,  when  the  patient  com 
plained  of  headache  and  nausea,  followed  in  a  short  time  by  a  severe  chill  and  high  fever.  Pyaemia 
being  apprehended,  the  stump,  though  nearly  healed  at  the  time,  was  carefully  examined,  and  fluctu 
ation  was  detected  at  the  under  portion  near  the  cicatrix.  After  the  escape  of  pus  by  free  incision 
into  this  part  the  patient,  who  was  a  man  of  strong  constitution,  over  six  feet  high  and  stout  in  pro 
portion,  improved  rapidly  under  the  administration  of  quinine,  and  was  soon  able  to  be  transferred  to  New  York,  where  he 
entered  the  Naval  Hospital  on  June  15th.  He  was  discharged  from  service  November  24,  1865,  with  a  good  stump,  being 
able  to  walk  easily  and  well  on  an  artificial  limb  and  suffering  no  weakness  of  the  knee  consequent  upon  the  dislocation.  The 
history  was  contributed  by  Passed  Assistant  Surgeon  J.  R.  Tryon,  U.  S.  N.,  who  also  forwarded  the  amputated  bones  of  the 
leg,  which  constitute  specimen  5662  of  the  Surgical  Section  of  the  Museum,  and  exhibit  the  seat  of  the  injury,  including  a 
longitudinal  fissure  in  the  tibia  about  three  inches  in  length.  The  man  is  a  pensioner  and  was  paid  September  4,  1880.  He 
reported  the  stump  as  continuing  in  "good  and  healthy  condition." 

CASE  776. — Private  O.  M.  Armstrong,  Co.  B,  120th  New  York,  aged  33  years,  was  wounded  at  Cold  Harbor,  June  3,  1864. 
Surgeon  F.  F.  Burmeister,  69th  Pennsylvania,  reported  his  admission  to  the  Second  Corps  Hospital,  at  White  House,  with 
"shot  wound  of  left  ankle  joint,  for  which  amputation  was  performed  by  Dr.  Henry  McLean,  of  Troy,  N.  Y.,  on  June  10th." 
Two  days  afterwards  the  patient  entered  Armory  Square  Hospital,  Washington,  where  a  subsequent  operation  was  performed 
by  Surgeon  D.  W.  Bliss.  U.  S.  V.,  who  described  the  case  as  follows:  "The  man  was  admitted  with  amputation  of  the  leg  at 
the  lower  third.  The  stump  was  very  painful  and  symptoms  of  necrosis  were  exhibited.  Simple  dressings  were  used,  and 
stimulants  and  nourishing  diet  were  prescribed.  On  October  llth,  the  patient  was  placed  upon  the  operating  table  and  put 
under  the  influence  of  chloroform,  when  the  stump  was  opened  and  a  ring  of  necrosed  bone,  which  encircled  the  tibia,  was  taken 
away  by  means  of  a  pair  of  dressing  forceps.  The  patient  did  well  after  the  operation,  and  was  transferred  to  hospital  at 
Rochester  in  February  following."  The  removed  fragment,  consisting  of  a  tubular  sequestrum  four  inches  long,  was  contrib 
uted  to  the  Museum  by  the  operator  (Cat.  Surrj.  Sect.,  1866,  p.  404,  Spec.  3284),  and  is  represented  on  PLATE  LXXI,  FIGURE  3, 
opposite  page  428,  ante.  The  patient  was  discharged  from  service  May  31,  1865,  and  pensioned,  having  been  previously  sup 
plied  with  an  artificial  limb  by  Dr.  D.  Bly,  who  described  the  amputation  as  having  been  performed  by  the  flap  method.  The 
pensioner  died  October  22,  1870.  The  cause  of  his  death  is  reported  to  have  been  softening  of  the  brain. 

Fatal  Intermediary  Amputations  in  the  Lower  Third  of  the  Leg. — One  hundred  and 
twenty  amputations — one  hundred  and  three  performed  on  Union  and  seventeen  on  Con 
federate  soldiers — belong  to  this  category.  In  two  instances  amputation  in  the  lower  third 
of  the  thigh  was  unavailingly  resorted  to.  Death  was  ascribed  to  pyaemia  in  thirty-five, 
exhaustion  in  twenty,  tetanus  in  five,  gangrene  in  three,  and  secondary  haemorrhage  in 
four  instances. 

CASE  777. — Private  L.  Mock,  Co.  I,  119th  Pennsylvania,  aged  22  years,  was  wounded  in  the  left  foot,  at  Rappahannock 
Station,  November  7,  1863,  by  a  musket  ball,  which  entered  about  one  and  a  half  inches  below  the  internal  malleolus,  passing 
upward  and  outward,  making  its  exit  anterior  and  under  the  external  malleolus  and  opening  the  ankle  joint  in  its  passage 
through  the  parts.  He  entered  Armory  Square  Hospital  at  Washington  two  days  after  receiving  the  injury.  On  December 
6th,  Surgeon  D.  W.  Bliss,  U.  S.  V.,  amputated  the  leg  above  the  ankle  by  Hap  operation,  the  patient  being  under  ether,  to 
Sl'iui.  Ill— 67 


530 


INJUKIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  307.— The 


which  a  little  chloroform  was  added  towards  the  last.  Three  vessels  were  ligated,  the  loss  of  blood  being  small.  The  patient 
reacted  well  from  the  anaesthetic.  At  the  time  of  the  operation  his  constitutional  condition  was  tolerably  good  and  the  tissues  of 
the  wounded  parts  were  in  a  healthy  state.  The  stump  grew  painful,  but  its  appearance  was  good.  Cold-water  dressing  was 
used  and  nourishing  diet  with  stimulants  were  administered.  On  December  9th  the  patient  had  three  chills,  followed  by  profuse 
perspiration.  On  the  following  day  there  was  no  chill,  the  stump  still  looked  well,  and  the  patient  suffered  no  pain.  Quinine 
and  opium  were  now  prescribed  in  addition  to  the  former  treatment.  By  December  18th  there  was  well-developed  pyaemia, 
from  the  effects  of  which  the  patient  died  December  21,  18G3.  After  deatli  yellowness,  to  an  extreme  degree,  came  on,  and,  on 
inspection,  the  shoulder  and  elbow  were  found  to  contain  pus,  the  shoulder  having  a  large  quantity  and  the  other  joints  being 
believed  to  be  in  a  like  condition.  The  tarsal  bones  of  the  amputated  limb,  contributed  with  the  history  by  the  operator,  con 
stitute  specimen  1903  of  the  Surgical  Section  of  the  Museum.  The  specimen  exhibits  no  perceptible  attempt  at  repair,  and 
shows  that  the  ball  passed  through  the  calcaneum,  which  is  necrosed,  and  grazed  the  astragalus,  opening  the  ankle  joint.  The 
appearance  of  the  entrance  and  exit  wounds  is  shown  in  PLATE  XXXIX,  FIGUHE  '2. 

CASE  778.— Corporal  G.  B.  Scott,  Co.  K,  8th  New  York  Cavalry,  aged  19  years,  was  wounded  in  the  right  lower 
extremity,  at  Beverly  Ford,  June  9, 1863.  He  was  conveyed  to  Washington  and  admitted  to  Lincoln  Hospital  on  the  following 
day,  whence  Surgeon  G.  S.  Palmer,  U.  S.  V.,  contributed  the  pathological  specimen  (No.  1347)  represented  in  the  adjoining 
wood-cut  (FlG.  307),  with  the  following  description  and  result  of  the  injury:  "The  wound  was  of  the  right 
ankle  joint,  affecting  the  internal  malleolus  and  bones  of  the  foot.  The  ball  entered  over  the  inner  malleolus 
and  was  not  extracted.  Incisions  with  the  knife  were  made  over  the  external  malleolus,  allowing  the  free  flow 
of  pus,  and  fragments  of  bone  were  daily  extracted.  The  leg  was  amputated  at  the  lower  third  on  June  20th. 
The  patient  never  recovered  from  the  shock  of  the  operation.  On  the  second  day  he  had  a  severe  chill,  followed 
by  profuse  sweating.  His  tongue  became  dry  and  he  complained  of  great  thirst;  pulse  130;  appetite  capri 
cious.  The  flaps  of  the  stump  grew  whitish  around  the  ligatures,  and  a  watery  offensive  discharge  commenced 
to  escape  from  the  stump.  On  the  third  day  the  anterior  flap  became  tawny,  having  a  decided  tendency  to 
slough,  and  the  limb  became  decidedly  erysipelatous.  On  June  24th,  profuse  diarrhoea  set  in  and  the  patient 
complained  of  pain  in  the  loins,  but  his  mind  was  yet  clear  and  he  was  in  excellent  spirits.  The  stump  now 
had  no  sensation  in  it  whatever.  The  chills  followed  each  other  in  rapid  succession,  the  patient  having  as 
manv  as  two  daily,  followed  in  each  case  by  diaphoresis.  He  rested  well  until  the  evening  of  June  29th.  On 
the  following  day  twenty-five  drops  of  laudanum  were  administered,  which  produced  a  quiet  slumber.  On 
awakening  from  this  he  became  delirious  and  very  restless;  pulse  183  and  compressible;  respiration  thirty-five 
per  minute  and  labored;  fever  intense.  He  died  on  the  morning  of  July  1,  1863.  The  wound  at  no  time  dis- 
lower  portions  ">f  charged  purulent  matter,  but  profuse,  thin,  and  offensive  fluid,  staining  the  dressings  with  a  dirty  blood  color, 
the  bones  of 'right  rpne  ^&^s  retame(i  their  proper  relations,  the  ligatures  not  loosening.  No  erysipelas  existed  beyond  tlie  knee, 
which  was  slightly  swollen.  At  the  post-mortem  examination  the  stump  was  found  to  have  become  blackened, 
the  epidermis  being  readily  detached  from  its  base,  and  a  large  bleb  full  of  brownish  serum  was  discovered  on  the  inner  side  of 
the  knee.  The  anterior  flap  was  perfectly  black,  and  the  muscles  in  the  posterior  flap  had  become  a  softened  pultaceous  mass. 
The  periosteum  of  the  fibula  was  detached  and  of  a  dark  green  color;  the  muscles  were  affected  as  far  up  as  the  union  of  the 
tibia  and  fibula.  The  anterior  portion  of  the  fibula  and  the  crest  of  the  tibia  were  dotted  with  a  reddish  color,  the  rest  of  the 
bones  being  pure  white."  The  specimen  consists  of  the  amputated  lower  extremities  of  the  bones  of  the  leg,  the  external 
malleolus  being  broken  off. 

CASE  779. — Sergeant  W.  H.  Gaslins,  Co.  K,  8th  Virginia,  aged  20  years,  was  wounded  and  captured 
at  Gettysburg,  July  3,  1863.  His  injury  was  described  by  Assistant  Surgeon  W.  F.  Richardson,  C.  S.  A., 
from  Camp  Letterman,  as  follows:  "A  mini6  ball  entered  the  centre  of  the  sole  of  the  right  foot,  passing 
through  the  tarsus  and  emerging  at  the  top  of  the  foot.  The  leg  was  amputated  at  the  lower  third  on 
August  1st.  The  patient  was  troubled  with  abscesses  which  formed  in  the  stump,  and  now  and  then  attacks 
of  diarrhoea  came  on,  which  brought  his  condition  down.  Astringents,  nourishing  diet,  tonics,  and  stimu 
lants  were  administered.  In  the  beginning  of  September  the  discharge  had  grown  very  slight;  but  about 
October  20th  the  stump  became  much  swollen  and  inflamed,  the  discharge  copious  and  unhealthy,  and  the 
tibia  protruded  one-halt'  inch,  the  bone  being  necrosed  for  six  inches  above  the  end  of  the  stump.  Diarrhoea 
was  now  profuse  .and  obstinate.  By  October  30th  the  patient  had  become  much  reduced  and  the  necrosed 
portion  of  the  tibia  was  loose.  On  November  4th  the  diseased  portion  of  the  bone,  six  inches  in  length, 
was  removed.  The  patient  died  on  the  following  day,  November  5,  1863."  A  section  of  the  bones  of  the 
stump  (Spec.  1962),  showing  very  extended  ravages  of  disease,  was  contributed  by  Acting  Assistant  Surgeon 
E.  P.  Townsend  and  is  represented  in  the  wood-cut  (FlG.  308). 

CASE  780. — Private  L.  Smith,  Co.  D,  12th  Infantry,  aged  24  years,  was  wounded  in  the  left  foot,  at 
ripottsylvania,  May  12,  1864,  and  entered  Stanton  Hospital,  Washington,  six  days  afterwards.  Surgeon  J. 
I.-JP..  noa— Sections  A.  Lidell,  U.  S.  V.,  reported:  "The  nature  of  the  injury  was  an  extensive  shell  wound  on  the  plantar  sur 
face,  all  the  tarsal  bones  except  the  cuboid  being  fractured.  The  foot  became  much  swollen  and  inflamed 
and  the  wound  was  sloughing  and  full  of  maggots.  Acting  Assistant  Surgeon  C.  H.  Osborn  amputated  the 
leg  at  the  lower  third,  on  May  21st,  by  the  circular  method,  using  sulphuric  ether  as  the  anaesthetic.  But 
little  blood  was  lost  during  the  operation.  The  patient  reacted  promptly  and  did  not  suffer  much  shock.  Tonics  and  stimulants 
were  administered.  On  May  26th,  there  was  a  pysemic  chill,  which  returned  at  intervals  for  two  weeks.  The  stump  commenced 
to  slough,  abscesses  formed  in  the  thigh,  and  large  bed-sores  came  on  over  the  sacrum.  The  patient  was  also  troubled  with 
diiirrliu-a..  Death  resulted  from  pyaemia  July  3, 1864.  At  the  autopsy  the  anterior  part  of  the  stump  was  found  to  have  sloughed 
to  within  one  inch  below  the  tubercle  of  the  tibia,  exposing  the  bone,  which  was  denuded  of  its  periosteum.  There  were  two 
large  abscesses,  one  in  the  popliteal  space  and  the  other  in  the  middle  third  of  the  thigh;  small  thrombi  in  the  veins.  The  lungs 


of  right  tibia  and  fibu 
la,  three  months  after 
amputation  in  lower 
third.  Spec.  19C2. 


SECT.  V.] 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


531 


contained  several  superficial  abscesses;  the  liver  was  enlarged,  soft,  and  fatty;  spleen  soft  and  enlarged.  All  the  other  viscera 
were  in  a  normal  condition."  *The  stump  of  the  ltjg,  showing  the  tibia  to  be  exposed  for  the  extent  of  six  inches,  was  con 
tributed  to  the  Museum  by  Assistant  Surgeon  G.  A.  Mursick,  U.  S.  V.,  and  constitutes  specimen  2739  of  the  Surgical  Section. 

TABLE  LXXIV. 

Summary  of  Three  Hundred  and  Thirty -jive  Cases  of  Intermediary  Amputations  in  the  Lower  Third 

of  the  Leg  for  Shot  Injury. 

[Recoveries,  1—215;  Deaths,  216—335.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Adams,    S.  N.,  Pt.,  D, 

April  2, 

Right  ;  flap.    A.  A.  Surg.  P.  H. 

29 

Bush,  J.,    Pt.,   B,   54th 

May  31, 

Lett  ;  flap.     A.  A.  Surgeon  M.  B. 

110th  Ohio,  age  29. 

12,  '65. 

Colton.     (Also  fracture  and  exc. 

Indiana. 

June  3, 

Graff.     Trans.   July  24,    1863. 

lefttibia.)    Disch'd  Sept.  11,  '65. 

1863. 

Died  Jan.  14,  1870;  ulceratiouof 

2 

Agan,    H.,    Pt,,    I,    7th 

Sept.  17, 

Right  ;  circular.   S.  G.  Gray,  Act 

stump.    Spec.  1629. 

Michigan,  age  17. 

24,  '62. 

ing    Medical    Cadet,    U.  S.  A. 

30 

Carver,  S.,  Pt.,  G,  45th 

May  5, 

Left.    Surg.  J.  B.  Edelin,  C.  S.  A. 

Discharged  June  6,  1863. 

North  Carolina. 

8,  '64. 

Discharged  March  4,  1865. 

3 

Anderson,    R.,   Pt.,    H, 

April  12, 

Left  ;  ant.  post,  wkin  flap  ;  circular 

31 

Clark,  R.  A.,  Pt.,  F,  14th 

July  9, 

Left;  circ.     A.  A.  Surgeon  J.  C. 

76th  Colored    Troops, 

20,  '65. 

section  muscles.    Surgeon  F.  E. 

New  Jersey,  age  21. 

Aug.  3, 

Shinier.    (Alsopenetr.  wound  of 

age  25. 

Piquette,  86th  Colored  Troops. 

1864. 

lung.)     Discharged   September 

1     Discharged  June  10,  1865. 

11,  1865.     Spec.  3922. 

4 

Armstrong,  O.  M.,Pt..  B, 

June  3, 

Left  ;  flap.  Dr.  H.  McLean,  Troy. 

32 

Cluck,   J.,   Pt.,   B,   7th 

Dec.  13, 

Left;  circular.    Surg.  H.  Bryant, 

120th  N.  York,  age  33. 

10,  '64. 

Necrosis  ;    sequestra    removed. 

Penn.     Reserves,    age 

28,  '62. 

U.  S.V.    (Also  w'nd  of  hand  and 

Disch'd   May  31,    1865.     Spec. 

30. 

buck.)     Discharged   December 

3-284.     Died  October  22,  1870; 

11,  1863.    Spec.  4548. 

softening  of  brain. 

33 

Conklin,  J.  H.,  Pt.,  A, 

May5, 

Left  ;  circular.    Discharged  May 

5 

Babcock,  E.  G.,  Pt.,  I, 

June  18, 

Left  ;  flap.    Confederate  surgeon. 

40th  New  York,  age  22. 

8,  '64. 

15,  1865. 

34th  Mass.,  age  27. 

July2,'64. 

Discharged  July  6,  1865. 

34 

Conroy,  J.,  Ptu   C,  4th 

Aug.  30, 

Right;  flap.     A.  A.  Surg.  F.  H. 

6 

Bachtell,  S.,  Pt.,  H,  7th 

Aug.  18, 

Right  ;  circular.     A.  Surg.  T.  A. 

Infantry. 

Sept.  4, 

Brown.    Aug.  9,  '63,  bone  rem.; 

Pennsylvania  Cavalry, 

Sept,  17, 

McGraw,  U.  S.V.     Disch'd  Jan. 

1862. 

gangrene.     Discharged. 

age  22. 

1864. 

30,  1866  ;  subsequently  re-amp. 

35 

Coombs,   L.  D.,  Corp  'I, 

May  5, 

Right;    anterior    posterior    flap. 

7 

Bacon,  A.,  Pt.,  B.  2d  S. 

July  2, 

Left;  circular.     Surg.  S.  Baruch, 

F,  2d   Wisconsin,  age 

15,  '64. 

Surg.  E.  Bentley,  U.  S.  V.    Dis 

Carolina,  age  21. 

26,  m 

3d  Battalion,  S.  C.     To  Provost 

28. 

charged  December  22,  1864. 

Marshal  September  17,  1863. 

36 

Corey,  R.,  Pt.,  C,  18th 

July  18, 

Left  ;  circular.     A.  A.  Surgeon  J. 

8 

Bacon,  W.,  Pt.,  D,  7th 

July  12, 

Left;  circular.     A.  A.  Surg.  T. 

Connecticut,  age  34. 

28,  '64. 

Goldsborough.     Disch'd  March 

Maine,  age  21. 

15,  '64. 

Carroll.    Necrosis.    Discharged 

23,  1865. 

June    16,    1865.      Amputation 

37 

Crocker,  N.  C.,  Pt,,  A, 

Aug.  14, 

Right;  circular.     A.  A.  Surgeon 

thigh  in  1866.     Spec.  2841. 

llth  Maine,  age  28. 

25,  '64. 

R.  O.  Sidney.   Discharged  June 

9 

Barnett,  J.    B.,  Pt.,  E, 

Mar.  31, 

Left  ;  ant.  post.  flap.    Surgeon  N. 

12,  1865. 

191st  Penn.,  age  33. 

April  8, 

R.  Moseley,  U.  S.  V.     (April  1, 

38 

Cruger,  E.,  Pt.,  E,   5th 

Aug.  30, 

Right.    Discharged  February  11, 

1865. 

Syme's  amp.  ankle  joint  ;  slough 

New  York.                       Se.20,'62. 

1863. 

ing.)     Disch'd  June  28,  1865. 

39 

Curtis,  H.  H.,Pt.,C,7th 

May  5, 

Left  ;  ciro.     Confederate  surgeon. 

10 

Bathurst,  J.  F.,  Serg't,  I, 

Dec.  13, 

Left;  circular.     A.  A.  Surg.  D. 

Wisconsin,  age  22. 

31,  64. 

Discharged  May  26,  1865. 

5th  Pennsylvania  Re 

28,  '62. 

Weisel.     Gangrene  ;  exfoliat'n. 

40 

Curtis,  J.  B.,  Pt.,  I.  8th 

June  3, 

Left  ;  circular.    A.  A.  Surg.  A.  N. 

serves,  age  23. 

Discharged  December  19,  1863. 

New    York    Artillery, 

14j  '64. 

K.  Andrews.     Sloughing.    Dis 

11 

Betty,  W.  M.,  Pt.,  K,  7th 

Sept.  19, 

Right.     Surg.  P.  F.  Eve,  C.  S.  A. 

age  21. 

charged    November    10,    1864. 

Arkansas. 

28,  '63. 

Recovery. 

Spec.  2533. 

12 

Biglow,  J.,  Pt.,   E,  8th 

Sept.  17, 

.   Union  surgeon.   Recovery. 

41 

Davidson,  S.,  Pt.,  B,  7th 

June  9, 

Right  ;  circ.     Surg.  P.  F.  W'hite- 

Louisiana. 

20,  '63. 

Indiana,  age  23. 

13,  '62. 

head,  C.  S.  A.     Discharged  Oc 

13 

Bisbee,    A.,   Corp'l,    B, 

April  16, 

Right  ;  circular.     Surgeon  R.  B. 

tober  3,  1862. 

7th  Maine,  age  25. 

May  12, 

Bontecou,  U.  S.  V.     Discharged 

42 

Davton,   B.   F.,  Pt,  B, 

May  12, 

Left;  circular.     Surg.  O.  A.  Jud- 

1862. 

February    10,    1863.      April  8, 

57th  Mass.,  age  18. 

27,  '64. 

son,  U.  S.  V.     August,  1864,  re- 

1863,  amputation  thigh. 

amp.     Discb'd  Dec.  27,  1864. 

14 

Blankenship,     W.     A., 

July  2, 

Right.     Ass't  Surg.  W.  Black,  C. 

43 

Denniston,  J.  F.,   Capt. 

Aug.  25, 

Right;  circular.     Surgeon  D.  W. 

Capt.,  F,  25th  Virginia, 

9,  '63. 

S.  A.     Exchanged  Dec.  5,  1863. 

and  Commissary,  U.  S. 

Sept.  10, 

Bliss,  U.  S.  V.     (Aug.  25,  Piro- 

age  21. 

V.,  age  24. 

1864. 

foiTs  amp.  ankle  joint.)  Disch'd 

15 

Boardwell,    I.,    Pt.,    C, 

June  6, 

Left  :  double  flap.     Ass't   Surg. 

anuary  1,  1867.    Spec.  3211. 

36th  Wisconsin,  age  18. 

19,  '64. 

S.  B.  Ward,  U.  S.  V.    Disch?d 

44 

Dersam,  F.  E.,  Pt.,  H, 

June  3, 

Right  ;  ant.  posterior  flap.     Ass't 

May  4,  1865. 

8th  New  York  Heavy 

9,  '64. 

Surg.  S.  B.Ward,  U.  S.  V.    Dis 

16 

Bowles,  R.  A.,  Pt.,   H, 

June  28, 

.    Surg.  —  Peticolas,  C.  S.  A. 

Artillery,  age  31. 

charged  Sept.  13,  '65.  Spec.  2664. 

22d  Virginia  Battery. 

July3,'62. 

Recovery. 

45 

Devlin,  J.  R.,Pt.,E,  20th 

Sept.  17. 

Left;  flap.     Discharged  Decem 

17 

Brady,  B.,  Pt.,  E,   73d 

May  15, 

Left  ;  circular.     A.  A.  Surg.  C.  S. 

Massachusetts. 

20,  '62. 

ber  12,  1862. 

Ohio,  age  21. 

June  5, 

Merrill.      Erysipelas.     Disch'd 

46 

Dodge,  T.  A.,  Lieut.,  —  , 

July  1, 

Right  :  flap.     Ass't  Surg.  G.  M. 

1864. 

February  28,  1865. 

119th  New  York. 

6,  fe. 

McGill,  U.S.  A.     To  V.  R.  C. 

18 

Brennan,  "W.  D.,  Capt., 

Sept.  29, 

Left  ;  circular.  Surg.  D.  G.  Rush, 

November  26,  1863. 

A,    I42d    New    York, 

Oct.  19, 

101st   Penn.     Discharged  May 

47 

Downey,  S.  W.,  Lieut.,G, 

Dec.  15, 

Left  ;  circular.    A.  A.  Surg.  R.  L. 

age  24. 

18C4. 

15,  1865. 

28th  Alabama,  age  39. 

18,  '64. 

McClure.     To  Provost  Marshal 

19 

Bromlev,    W.,   Pt.,    A, 

May  6, 

Left;  circular.     Discharged  May 

February  6,  1865. 

149th  N.  York,  age  33. 

13,  '64. 

25,  1865. 

48 

Driscoll,  D.  O.,  Pt.,  B, 

May  5, 

Right;    circular.      To    regiment 

20 

Brown,  A.  T.,  Pt.,  B,  43d 

Oct.  19, 

.     Surgeon   R.  T.  Baldwin, 

14th  Infantrv,  age  19. 

8,  '64. 

October  7,  1864. 

North  Carolina. 

25,  '64. 

C.  S.  A.     Recovery. 

49 

Dudley,  E.   H.,  Pt.,  K, 

Julv  3, 

Left;  circular.     (July  4.  Syme's 

21 

Brown,  C.  F.,  Pt.,  F,  1st 

June  20, 

Left;  circular.    Surg.  A.  F.  Shel 

16th  Vermont,  age  20. 

18,  ''63. 

amputut'n  foot;  sloughing);  ne 

Connecticut    Cavalry, 

July  3, 

don,  U.  S.  V.     Disch'd   March 

crosis.     Dec.  21,  re-amputation. 

age  24. 

1864. 

26,  1865.    March.  1868,  re-ampu 

Discharged  April  23,  1864. 

tation.     Specs.  2765,  4700. 

50 

Dyer,  S.  M.,  Pt.,  I,  5th 

Mav  4, 

Left.    Confederate  surgeon.    Dis 

22 

Brown,   J.    C.,   Pt.,    E, 

July  21, 

Right  ;  skin  flap.     A.  A.  Surg.  S. 

Wisconsin,  age  20. 

7,  "63. 

charged  April  25,  1864. 

5id  Ohio,  age  20. 

Aug.  6, 

W.  Blackwood.    April  22.  1865, 

51 

Emory,  J.,  Pt.,  A,  36th 

Sept.  10, 

Left  ;  flap.     Discharged  Septem 

1864. 

re-amp  leg.  Disch'd  June  3,  '65. 

Indiana,  age  28. 

22,  '63. 

ber  21,  1864. 

23 

Brown,  J.  D.,Pt.,1,  109th 

Nov.  3, 

Left;   circular.     Surgeon  D.  W. 

52 

Emory,   J.    D.,    Pt.,   B, 

Mav  5, 

Left;    flap.    Discharged   Febru 

New  York,  age  19. 

6,  '63. 

Bliss,  U.  S.  V.     Disch'd  March 

139th  Penn.,  age  24. 

1V64. 

ary  25,  1865. 

27,  1864.     Spec.  1764. 

53 

Fale,    L.,    Pt.,  G,    13th 

Oct.  ID, 

Left  ;    flap.     To   prison  June  6, 

24 

Brown,  S.,  Pt.,  I,  107th 

July  2, 

Right;  circular.  Discharged  Feb 

Mississippi,  nge  23.           28,  '64. 

1865. 

Ohio,  age  21. 

5,  '63. 

ruary  7,  1864. 

54 

Ferris,  R.  P.,  Pt.,F,  101st 

Aug.  ~>9, 

.     Discharged   November  1, 

25 

Brmvn,    W.  A.,  Pt.,  F, 

Nov.  25, 

Left  :  flap.     Surg.  J.  C.  Morgan, 

New  York. 

Sep.-,  '62 

1862. 

38th  Alabama. 

Dec.  5, 

29th  Mo.     (Also  wound  of  right 

55 

Fenpfrman,  W.C.,  Serg't,   De.13,'62, 

.     Surg.  —  Miller,  C.  S.  A. 

1863. 

leg.)     Transferred. 

F,  7th  North  Carolina.   IJan.-,'ti3. 

Recovery. 

26 

Buist,  C.  B.,  Pt.,  C,  27th 

June  Ifi, 

.     Surg.  H.  linger,  P.A.C.S. 

56 

Finnagan,    P.,    Pt.,     1), 

Sept.  17, 

Left;   flap:    exfol.      Discharged 

South  Carolina. 

23,  '62. 

Recovery. 

108th  N.  York,  age  24. 

Oe.ll.'6v>. 

November  13,  1862.     Spec  386. 

27 

Burke,  J.,  Serg't,  II,  7th 

June  16, 

Left  :  necrosis.     July  16,  re-amp. 

57 

Fleet  wood,  L.  A.,  1't.,  C,     Julv  18, 

Left  (carious).     Nov.  6,  re-amp. 

N.Y.  H'vv  Art.,age21.     28,  '64.   ;     Disch'd  Mar.  3,  '65."    Spec.  2^W). 

54th  Massachusetts  (C.     23,  '63. 

Discharged  June  8,  1864.    Died 

28 

Bush.    H.,    Pt.,   D.    85th    Aug.  '-.'9,     T.pft  •  circular.      Snr<r.  I).  Meiritt. 

T.),  age  22. 

September  3,  1866.     Spfc.  4311. 

Pennsylvania,  ago  33       Sept.  1, 

55th  Penn.     Sloughing;  erysip 

58 

Flippin,  E.,  Pt.,  F,  49th     May  30, 

Riglit  ;  circ.     Exchanged  March 

1863. 

elas.     Discharged  July  6,  1864. 

Virginia,  age  28. 

J  neo,  64. 

1,  1865. 

532 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP  x. 


Ko 

NAME,  MILITARY       '  n.TI.«.          OPERATIONS,  OPERATORS. 

No. 

NAME,  MILITARY 

DATKb. 

OPERATIONS,  OPERATORS, 

IX  \J. 

DESCRIPTION,  AND  AGK.                                     RESULT. 

DESCRIPTION,  ANI>  AGE. 

RESULT. 

59 

Forloint,  R.,  Serg't,  E.     May  16, 

.      Surg.  J.  G.  Dudley,  P.  A.  S     94  |  Lavell,  M.,  Scrg't.A,  7th 

July  3, 

Left;  flap.      Discharged  June  4, 

15th  Virginia.                      29,  '64. 

C.  S.     Discharged  Oct.  2,  J804.            !     Michigan,  age  20. 

14,  ''03. 

1864. 

60 

Friddle,  W.,  It.,  D,  21st    June  10, 

Left.     Ass't   Surg.  C.  C.  Byrne,       95  1  Lean-,  alias  Connell.D., 

June  3, 

Right  ;  circular.     Surg.  E.  Bent- 

Illinois,  age  25.               :   26,  '04.        U.  S.  A.     Disch'd  Feb.  18,  1665.                It.,  C,  28th  Massachu- 

9,  '64. 

ley,  U.  S.  V.     Discharged  May 

61 

Fuhrman,  J.,  It.,  K,  27th  !    May  3. 

Right  ;  ant.  post.  flap.  Ass  t  Surg. 

setts,  age  32. 

25.1865.     Spec.  2663.     Nov.  30, 

Indiana,  age  24.                 21,  63. 

W.  Thomson,  U.  S.  A.    Erysip 

1867,  re-amp.     Died  of  haetn.  of 

elas.     Disch'd    Sept.   16.    1803. 

lungs  February  7,  1873. 

Spec.  1851.  Died  March  31,  Ie76.       96 

Leary,   J.,  Pt.,  I,  106th 

Oct.  19, 

Right  ;  lateral  flap.     A.  A.  Surg. 

62 

Gaines,  W.  R.,  Lieut.,  B,  1  Aug.  17, 

Lel't.     Surgeon  —  Butler,  C.  S.  A. 

New  York,  age  45. 

£ov.  17, 

R.  H.  Sterling.     Disch'd   June 

14th  Virginia  Cavalry.   Se.  15/64. 

Recovery. 

1864. 

14,  1865. 

63 

Gardner,  C.  J.,  Serg't,  C, 

Aug.  11, 

Right  ;  Jong  ant.  short  pest.  flap. 

97    Leathers,  J.  A.,  Pt.,  K, 

July  3, 

Left.     Exchanged  November  12, 

1st  N.  York  Dragoons, 

26,  '64. 

A.  A.  Surgeon  G.  H.  Dare.  Dis 

19tli  Virginia,  age  24. 

17,  '63. 

1803. 

age  21. 

charged  April  28,  1865. 

98 

Leslie,   A.,  Pt.,.D,    9th 

Dec.  13, 

Left;  ant.  posterior  flap.     A.  A. 

64 

Glenn,  W.,  Ft.,  A,  10th 

June  27, 

Right  ;    sloughing.     Sept.  4,   re- 

New  York,  age  21. 

28,  '62. 

Surg.  T.  II.  Dearing.     Disch'd 

Pennsylvania,  age  25. 

July  21. 

amp,  posterior  flap.    Discharged 

July  29,  1804.    Spec.  716. 

1862. 

July  25,  1864. 

99 

Lewis,  T.  A.,  Pt.,  I,  2d 

April  8, 

Right;  circular.     A.  A.  Surg.  H. 

65 

Grindstaff,  J.  R..  Pt.,  A, 

May  12, 

Right  ;  circular.     Surgeon  I).  W. 

Illinois  Cav.,  age  25. 

22,  '64. 

Smith.     Disch'd  June  15,  1664. 

7th  West  Virginia,  age     June  4, 

Bliss,  U.  S.V.   Discliarged  April 

100 

Lindley,  T.,  It.,  L,  1st 

Sept.  13, 

Left.    Surgeon  D.  W.  Bliss,  U.  S. 

38.                                       :      1864. 

15,  1865.     Spec.  2428. 

Penn.  Cav.,  age  21. 

Oct.9,'63. 

V.     Discharged  April  J4,  J804. 

66 

Gross,  J.,  It.,  E,  200th     Mar.  25. 

Left  ;  flap.     Surgeon  E.  Bentley, 

101 

Lister,  J.,  Pt.,  M,  2d  New 

June  1, 

Left;  flap.     Surgeon  W.  Watson, 

Pennsylvania,  age  21.     Ap.24,'65.i     U.  S.  V.     Disch'd  July  15,  1607. 

York  Heavy  Artillery, 

10,  '64. 

105th  Penn.     Discharged  Nov. 

67 

Hannon,  M.,  Pt.,  A,  9th     Oct.  19, 

Left  ;  lateral  skin  flap  ;   circular 

age  26. 

22,  1864.     Spec.  3259. 

New  York  Heavy  Ar 

Nov.  9, 

section   muscles.     A.  A.  Surg. 

102 

Loggins,  N.,  Pt.,  A,  26th 

July  2, 

.     Surgeon  —  Bork,  C.  S.  A. 

tillery,  age  30. 

1864. 

B.  B.  Miles.     (Necrosis.)     Dis 

N.  Carolina,  age  23. 

23,  '63. 

Paroled  November  12,  1863. 

charged  August  2,  1865. 

103 

Lawrij,  J.  C.,  Corp'l,  F, 

Nov.  30, 

Right;  flap.     A.  A.  Surg.  J.  E. 

08 

Happe,   J.,    Pt.,  B,  4th 

July  1, 

Left  ;  circular.     Discharged  De 

38th  Tennessee,  age  26. 

Dec.  28, 

Patterson.     To  Provost  Marshal 

Artillery,  age  30. 

6,  f63. 

cember  9,  1863. 

1804. 

March  7,  1605. 

69 

Hardern,"R.,  Pt.,  C,  61st 

May  12, 

Right;  ant.  posterior  flap.     Surg. 

104 

Mathews,  B.,  Pt.,  B,  14th 

June  1, 

Right;  ant.  post.  flap.     Surg.  E. 

Pennsylvania,  age  51. 

28,  '64. 

E.  Bentley,  U.  S.  V.     Disch'd 

New  Jersey,  age  23. 

28,  '64. 

Bentley,  U.  S.  V.      Discharged 

June  8,  1865. 

April  15,  1605. 

70 

Hare.    D.,   Pt.,   I,    95th 

Mar.  12, 

Right.    A.  A.  Surg.  J.  B.  Taylor. 

!l05    Matteson.     P..     Pt..    C. 

April  2. 

Left  ;  circular.    Surg.  E.  Bentley, 

Ohio. 

15,  '63. 

Discharged  August  22,  1863. 

186th  New  York. 

29,  '65. 

U.  S.V.  (W'nds  shoulder,  back, 

71 

Harp,   A.,    Pt.,    D,    8th 

July  3, 

Right.      Exchanged    November 

and  hip.)    Disch'd  July  15,  1805. 

Alabama,  age  35. 

£8,  '63. 

12,  1863. 

106    May,  C.  H.,  It.,  B,  16th 

June  18. 

Left  :  circular.     Discharged  Feb 

72 

Harris,   W.  W.,  Pt.,  B, 

April  2, 

Left  ;  flap.    A.  A.  Surgeon  W.  F. 

Massachusetts,  age  28. 

27.  '04. 

ruary  18,  1805. 

186th  X.  York,  age  34. 

17,  '65. 

Goodwin.     Disch'd  July  20,  '05. 

107 

Mayer,  H.,  It.,  B,  12th 

Sept.  19, 

Right.    A.  A.  Surgeon  L.  Fassilt. 

73 

Hart,   J.,    It..    A,    14th 

Dec.  13, 

Left;   flap.     Discharged  August 

Maine,  age  30. 

Oc.10,'64. 

Discharged  June  J,  1865. 

Connecticut. 

17,  '62. 

1.  1863. 

108 

McCann.,    H.,    It.,    D. 

Jan.  1  1, 

Riglit  ;  JateraJ  flap.     A.  A.  Surg. 

74 

Harty,  D.,   It.,  F,  69th 

Sept.  17, 

Right;  circular.     Surgeon  H.  S. 

127th  Illinois. 

31,  '63. 

T.  T.  Smiley.     Erysipelas:  ne- 

Xew  York. 

25,  '62. 

Hewit,  U.  S.V.   Exfol.   Disch'd 

crcsis.     Disch'd  Nov.  6.  1803. 

January  2,  1803.     Spec.  210. 

109 

McGuire,  G.  F.,  Pt.,  I, 

Dec.  13, 

RigJit  ;    circular.     Ass't  Surgeon 

75 

Harvey,    G.  W.,  Pt.,  1, 

June  17, 

Right  ;  flap.      Surg.  I.  V.  Miller. 

57th  New  York,  age  21. 

24,  '02. 

G.  M.  McGill,  U.  ,«.  A.     Dis 

14th  New  York  Heavy 

20,  '64. 

14th  N.  York  Heavy  Artillery. 

charged  December  JO,  18(14. 

Artillery,  age  20. 

Discharged  June  8,  1805 

110 

McLauqlili-n,  I.   T.,  It., 

July  3, 

Left.     Surgeon  C.  S.  Wood.  OOih 

76 

Hausbeck,   A.,   Pt.,   G, 

May  5, 

Right  ;   circular  flap.     Surg.  E. 

B,  13th  Ala.,  age  48. 

6,  '615. 

New   York.     July  14,  tetanus. 

105th  Penn.,  age  19. 

June  2, 

Bentley,  U.   S.  V.     Gangrene. 

Exchanged  April  27,  1864. 

1864. 

Disch'd  May  25,  '65.     Necrosis. 

111 

McLaughlin,  M.,  It.,  H. 

May  3, 

Left  ;  circular.     Discharged  De 

Nov.  29,  1865,  re-amputation. 

1     31st  New  York. 

17,  ''63. 

cember  8,  1863. 

77 

Hawk,    J.,    Pt.,  I,  36th 

Sept.  19, 

Left  ;    flap.     Discharged   Febru 

112 

McMontry,  H.,  Corp'l,  A, 

May  28, 

Left  :  circular.    To  regiment  Sep 

Ohio. 

Oc.19,'63. 

ary  15,  1864. 

16th  Infantry,  age  34. 

J'ne3,'64. 

tember  29,  1864. 

78 

lloerr,   P..    1't.,  B,    62d 

July  2, 

Left;  circular.    Surg.  J.  Thomas, 

113 

McPherson.  A.  D.,  Serg't, 

July  2, 

Left.     A.  A.  Surgeon  J.  Dickson. 

Pennsylvania,  age  23. 

12/63. 

118th  Penn.     Discharged  July 

A,  105th  Pennsylvania. 

Aug.  1, 

Discharged  June  4,  1804.     .Spec. 

13,  1864. 

1803. 

1649. 

79 

Homln-ee,  J.,  It,,  B,  16th 

July  1, 

Right.    Recovery. 

114 

McQuilkin,  D.  L.,  Pt.,  E, 

Nov.  25, 

Left;   flap.     Discharged  August 

North  Carolina. 

22,  63. 

38th  Ohio. 

28,  '03. 

11,  1864. 

80 

flooA-*,  .7.  jR.,  Pt.,  K,  12th 

May  10, 

.     Surg.  —  Goodlett,  C.  S.  A  . 

115 

McQuinn,  J..  It.,  K,  35th 

July  30, 

Right;  double  flap.     A.  A.  Surg. 

Georgia. 

J'ne5,'64. 

Recovery. 

Massachusetts,  age  42. 

Aug.  20, 

E.  Seyffarth.     Discharged  June 

81 

Hosington,   G.,    Pt.,    E, 

June  13, 

Left.    (June  14,  amp.  ankle  joint.) 

1864. 

15,  1805. 

t'~Cd  Ohio,  age  36. 

21  ,  '63. 

Necrosis.     Sept.  17.  re-amput'n. 

116 

Mtinltard,   P.,    Pt.,    D. 

May  2, 

Right.     Surg.  W.  A.  Robertson," 

Discharged  May  1  6,  1665.    Died 

6th  Louisiana. 

5.  f63. 

P.  A.  C.  S.    Disch'd  Sept.  1,  '64. 

December  16,  1866.                        1  117 

Merrill,   J.,   Pt.,  B,  5th 

May  10, 

Right  ;    flap.      Confed.   surgeon. 

82 

l.'ork,    A.,    It.,    D,    8th 

July  2. 

Right.     For  exchange  November 

W'isconsin,  age  35. 

13,'  '64. 

Discharged  June  17.  1865. 

Mississippi. 

28,  '63. 

12,  1863. 

118 

Miller,  W.,  It.,   A,  72d 

Sept.  17, 

Left:  circular.    A.  A.  Surgeon  P.  ' 

83 

Hunter,  VV.,  Pt.,  I,  113th 

Sept.  18, 

Right  ;  circular.     A.  A.  Surgeon 

Pennsylvania. 

28,  '62. 

Middleton.    Necrosis.    April  28, 

Ohio,  age  54. 

Oct.  3, 

J.  B.  McPherson.      Gangrene. 

1864,  amp.  thigh.     Discharged 

1864. 

Feb.  27,  '65,  removed  exfoliat'n. 

September  3,  1864.     Specs.  "97, 

Discharged  July  3,  1865. 

2748,  4172. 

84 

Jaeger,    C.,    Corp'l,   G, 

May  12, 

Left  ;  circular.    A.  A.  Surg.  D.  L. 

119 

Mofflt,   W.,    Pt.,  F,  1st 

Sept.  17, 

Left;  circular.  Surgeon  B.  Beust, 

46th  New  York,  age  27. 

31,  '64. 

Haight.     Hieni.     Sept.  30,  bone 

Connecticut,  age  20. 

Oct.  10, 

U.  S.  V.     Discharged  August  5, 

removed.    1  >Uch'd  Oct.  27,  1  864. 

1862. 

1803. 

85 

Jarvis,  H.  D.,  Lieut.,  A, 

June  5, 

Left;  circ.      Surg.  S.  A.  Green, 

120 

Moore,    O.,    Pt.,   I,    5th 

June  9, 

Left  ;  flap.  Surg.  P.F.Whitehrad, 

24th  Mass.,  age  19. 

8,  '02. 

24th  Mass.  Disch'd  Sept.  9.  J  803. 

Ohio. 

13,  '62. 

P.  A.  C.  S.   Disch'd  Feb.  1,  1803.  ' 

Necrosed  bone  removed  in  1800. 

121 

Morgan,  C.  F.,  Pt.,  B,  1st 

Aug.  19, 

Right  ;  circular.     Discharged  No 

86 

Johns,  D.  S.,  Pt.,  G,  23d    Aug.  30, 

.     Surg.  —  Michel!,  C.  S.  A. 

Massachusetts. 

29   "62. 

vember  8,  1862. 

South  Carolina.               Gep.2,'62. 

Recovery. 

122 

Morgan,  G.,  It.,  E,  97th 

Feb.  6, 

Left  j  lateral  flap.    A.  A.  Surgeon 

87 

Johnson,  D.  B.,  Pt.,  H,     June  3, 

Right  ;   ant.  posterior  fliip.     Dis 

New  York,  age  30. 

Mar.  2, 

B.  B.  Miles.     Disch'd   Octolier 

8th  N.  Y.  H.  A.,  age  21.      8,  '64. 

charged  August  2,  1865. 

1865. 

13,  1805.     Spec.  1025. 

88 

Kendall,  J.,  It.,  K,  2d    Sept.  17, 

Left;  ant.  post.  flap.    A.  A.  Surg. 

123 

Morgan,    J.  M  ,  Black 

June  16, 

Left.     Surgeon  J.  II.  Baxter.  U. 

Delaware,  age  21  . 

Oct.  6, 

J.  Sweet.   Necrosis.  Discharged 

smith,   H,    13th   Penn 

July  JO 

S.  V.     Disch'd  March  6,  1665.     ; 

1862. 

January  16,  1863.     April,  1864, 

sylvania  Cav.,  age  17. 

1863. 

bone  removed.     Sprc.  2757. 

124 

Mori-ill,  ,T.  A.,Pt.,A,10th 

June  1, 

Left  ;  flap.     Surg.  E.  Bentley,  U.  i 

89 

Keys.  H.,    It.,  A,  18th 

Dec.  14, 

Right.      A.  A.   Surgeon  W.  A. 

Vermont,  age  19. 

7,  '64. 

S.  V.     Discharged   January   2, 

Massachusetts,  age  20. 

19,  '62. 

Harvey.     Discharged  June  10, 

1805.     Spec.  2548. 

1863.     Spec.  !>80. 

125 

Morris,  ^..Serg't.C,  llth 

July  3, 

Left  ;  circular.  Surg.  S.  R.  Cham 

90 

King,  A.,  Lieut.,  K,  62d 

June  27, 

Right.     (June  28,  amput'n  foot.) 

Mississippi,  ngc  23. 

7,  '63. 

bers,  P.  A.  C.  S.     Recovery. 

Pennsylvania,  age  25. 

July  —  , 

1862. 

1663,    re-amput'n.      Discharged 
March  17,  '03.   Died  July  J2.  72. 

126    Mueller,  J.,Capt.,B.  17th 
Missouri. 

Nov.  27, 
Dec.1,'63. 

Left  ;  flap.     Discharged  Septem 
ber  14,  1864. 

91 

King,    S.   S.,  Serg't,   I,    May  22,    Right;  circular.     A.  A.  Surge<  n 

127    Mulligan,  .1.,  It.,  D,  89th 

Sept.  17, 

Left.     Surg.  'I'.  H.  Squire,  89th 

190th  Pennsylvania.         June  17,      M.  F.  Price.     Discharged  June 

Pennsylvania,  age  32. 

21,  '62. 

N.  Y.     Disch'd  May  21,  1864. 

1864.         29,  J665. 

128    Murphy,  T.,  Pt.,  C,  15th 

July  21, 

Right  ;  flap.   Surg.  W.  H.  Gibbon, 

92 

Lamont,  H.,  Pt.,  B,  8th    Sept.  29, 

Right;  flap.     A.  A.  Surgeon   E. 

Iowa,  age  13. 

28,  '64. 

15th   Iowa.      Discharged   July  ! 

Connecticut,  age  40.       :  Oct.  27, 

K.  Dcemev.     Discliarged  Octo 

26,  1865. 

1864. 

ber  28.  1865. 

!  129    Myers,  S.  II.,  It.,  E,  75th 

June  20, 

Left  ;  circular.     A.  A.  Surg.  E. 

93 

Lane,    L,    Pt.,    A,    8th    Sept.  17, 

Left;  circular.     Ass't  Surgeon  J. 

Indiana,  ago  20. 

30,  '64. 

Stubbs.     (June  21,  excision  of 

Michigan,  age  24.              Oct.  14, 

Oliver,  21st  Mass.     Dischargpd 

ankle  ioint.)     Disch'd  March  7, 

1862.          April  2,  1863. 

1865.  'Died  April  12,  1872. 

INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


533 


No. 

NAMK,  MILITAKY 
DESCKIl'TION,  AND  AGK. 

DATES. 

(  H'KUATIONis.  Ol-Ki:  ATO:;S, 

RKSUI.T. 

No. 

NAMK,  MILITAUY 
DKSCIUPTION,  ASI>  AGK. 

DATEH. 

Ol'KUATIONS,   Oi'KKATOKK, 

RKSULT. 

130 

Nase,  A.,  Capt.,  Kt  L5th 

April  6, 

Right.     Surgeon    E.    S.    I'enner, 

166 

Sherman.  A.,  Pt.,D,  20th 

Oct.  20, 

Right:  circular.     Surg.  N.  Hay- 

Illinois. 

24,  "62. 

C.  S.  A.     Resigned  July  7,  1863. 

Massachusetts. 

Nov.  14, 

ward,  20th    Mass.     Discharged 

131 

Nash,  C..  Serg't,  A,  8~'d 

April  4, 

Right  ;  ant.  post,  skin  Hap  :  circ. 

1861. 

February  27,  1862. 

Col'd  Troops,  age  21. 

18,  '65. 

sect.  mus.   Surg.  F.  E.  Pianette. 

167 

Shirk,  J.G.,  PL,  F,  207th 

April  6, 

Right:  circular.     A.  A.  Surgeon 

86th  C.  T.     (April  4.  exe.  of  yd 

Pennsylvania,  age  26. 

29,  '65. 

F.  11.  Getchell.     Disch'd   Sep 

nieta.  bone.)  Disch'd  May  30,  '65. 

tember  23.  1865. 

132 

Nason,  C.  'I'.,  Pt.,  C,  1st 

May  19, 

Left  ;  ant.  post,  skin  flap.     Nov. 

168 

Simmon*,  J.   J.,  Lieut., 

Nov.  30, 

Right;  circular.     A.  A.  Surgeon 

Massachusetts    Heavy 

22,  '64. 

15.  removed  nee.  bone.    Disch'd 

A,  6th  Mississippi,  age 

Dec.  26, 

R.  McNeilly.     To  Provost  Mar 

Artillery,  age  25. 

June  30,  1865.    Specs.  47.18,  341  1  . 

24. 

1864. 

shal  March  7,  1865. 

133 

O'Connor.  J.,  l>t.,  I,  llth 

Aug.  30, 

Right:    circular.     Disch'd    April 

169 

Sitgreares,  J.,  Pt.,  C,8th 

April  6, 

Right.     (Erysipelas.)      Released 

Massachusetts,  age  44. 

Se.  11/62. 

29,  1863.    Drowned  Mar.  27,  '70. 

Virginia,  age  25. 

12,  '65. 

June  15,  1865. 

134 

Osgood.  I.,  Pt.,  B,  llth 

Dec.  13, 

Left  ;  circular  ;  necrosed.    Jan.  2, 

170 

Smith,  A.  S.,Pt..D,  104th 

Nov.  25. 

Left  :  flap.      Surg.   R.   F.   Dyer, 

N.  Hampshire,  age  ~3. 

19,  '62. 

1863,  re-amp.     Discharged  May 

Illinois. 

De.l2.'63. 

104th  HI.     Disch'd  May  6,  1864. 

3,  1864.     Spec.  268. 

171 

Smith,  R.  R.,  Pt.,  E,  3d 

Aug.  ^0, 

Left:  Hap.  A.Surg.T.A.AlcGraw, 

135 

Palmer,  U.,  Pt.,  F,  45th 

Sept.  17, 

Left;  flap.     Surgeon  H.  S.  Hewit, 

Ohio  Cavalry,  age  23. 

24,  '64. 

U.  S.  V.     Disch  d  April  8,  1865. 

Pennsylvania. 

Oct.  2, 

U.  S.  V.    Necrosis.    Discharged 

172 

Smith,  T.G.,Pt.,F,  107th 

Sept.  17, 

Right.  Surg.  S.  N.  Sherman,  34th 

1862. 

March  6,  186;!. 

New  York. 

20,  '62. 

N.  Y.     Disch'd  Dec.  6.  1862. 

13fi 

Parker,  G.  L.,  Pt.,  I,  1st 

July  :;, 

Left  ;  circular.     Ass't  Surgeon  I'. 

173 

Spearse,  G.    W.,  Pt.,  G, 

Sept.  19, 

.     Surg.  —  Roberts,  C.  S.  A. 

Virginia,  age  25. 

7,  '63. 

C.  Yates.  C.  S.  A.     Erysipelas. 

40th  Mississippi. 

29,  '63. 

Recovery. 

Recovery. 

174 

Stabenfeldt,  E.,  Pt.,  A, 

Sept.  17, 

Right  ;  flap.     Ass't  Surgeon  J.  B. 

137 

Parrott,   J.,  Serg't,  H, 

Nov.  30, 

Right;  ant.  posterior  flap.     A.  A. 

3d  Wisconsin,  age  30. 

Oct.  3, 

Brinton,  U.  S.  A.    Oct.  8,  ligat'n 

28th  Tennessee,  age  34. 

Dec.  28. 

Surg.  J.  E.  Patterson.     To  Pro 

1862. 

ant.  tibial.   Disch'd  Mar.  6,  1863. 

1864. 

vost"  Marshal  March  7,  1865. 

175 

Stamps,  J.  B.,Pt.,A,  12th 

July  9, 

Left  ;  circular.    A.  A.  Surg.  J.  H. 

138 

Parsons,   II.,   Pt.,  C,  9th 

July  20, 

Left;  anterior  posterior  skin  flap. 

Georgia,  age  21. 

Aug.  6, 

Coover.      Exchanged    October 

West  Virginia,  age  23. 

Aug.  3, 

A.   A.  Surg.  M.  M.  Townsend. 

1H64. 

17,  18U4.     Spec.  3816. 

1864. 

Discharged  May  31,  1865. 

176 

Statem,  E.  S.,  Pt.,  B,  45th 

Sept.  19, 

Right.     Surgeon  —  Hill,  C.  S.  A. 

139 

Pastorius.H.,  Pt.,E,  62d 

May  25, 

Right  ;  circular.     A.  A.  Surg.  M. 

Virginia,  age  23. 

23,  '64. 

Exchanged  November  24.  1864. 

Pennsylvania,  age  25. 

31,  '64. 

F.  Price.    Disch'd  Jan.  18,  1865. 

177 

Stealey,   J.,   Corp'l,   E, 

Sept.  19, 

Left  ;  flap.    Discharged  February 

140 

Paxton,  J.,   Pt.,   K,  23d 

April  6, 

Right  :  circular.     Released  June 

10th  W.  Va.,  age  22. 

23,  '64. 

5.  1665. 

Virginia,  age  33. 

15,  '65. 

24,  1865. 

178 

Stewart,  J.   L.,  Pt.,  D, 

April  1, 

Left  ;  circular.    A.  A.  Surg.  W.  E. 

141 

Payne,  ().,  Pt.,  D,  28th 

June  7, 

Right  ;  circular.     A.  A.  Surg.  A. 

4<Jth  N.  C.,  age  30. 

21,  '65. 

Roberts.  Released  Aug.  2,  1865. 

Col  d  Troops,  age  19. 

27,  '64. 

Transue.     Necrosis.     March  8, 

179 

Stewart,  T.  B.,  Pt,,  G, 

June  2, 

Left  ;  circular.    A.  A.  Surg.  W.  C. 

1865,  re-amp.    Discharged  Aug. 

21st  Massachusetts,  age 

24,  '64. 

Mulford.     Disch'd  Oct.  16,  1865. 

1,  1865.     Spec.  4740. 

21. 

Nov.,  1867,  re-amp,  upper  third. 

142 

Pingel,  !•'.,  Pt.,   C,  17th 

Mar.  16, 

Right  ;  circular.  Discharged  Sep 

180) 

Stewart,  T.  B.,  Pt.,  C,  2d 

Sept.  19, 

Both  ;  right.  Sept.  23d  :  left,  24th. 

Wisconsin,  age  25. 

19,  '65. 

tember  1,  1865. 

181) 

Connecticut  H'vy  Ar 

23,  '64. 

Ass't  Surgeon  J.  G.  Thompson, 

143 

Pope,  R.,  Pt.,  I,  5Jd  X. 

July  2, 

Right.      Paroled   November   12, 

tillery,  age  31. 

77th  N.  Y.    Oct.  2,  haemorrhage. 

Carolina,  age  20. 

6,  '63. 

1863. 

Discharged  August  7,  1865. 

144 

Powers,  J.  A.,  Pt.,  E,  63d 

Aug.  29, 

Left  ;  flap.     Discharged  January 

182 

Suite,  J.  M.,  Pt,  E,  23d 

May  2, 

Left.     Surgeon  —  Lott,  C.  S.  A. 

Pennsylvania. 

Sept.  3, 

19,   1863.      Died  December  5, 

N.  Carolina,  age  20. 

14,  '63. 

Retired  March  24,  1865. 

1862. 

1866  ;  consumption. 

183 

1  S  ,  L.,  Pt.,  —  ,  22d 

May  3, 

Left;  circular  flap.     Recovery. 

145 

Price,  T.,  Pt.,  I,  43d  N. 

Sept.  5, 

Left.     To  Provost  Marshal  April 

N.  Carolina,  age  21. 

25,  '63. 

Carolina,  age  18. 

19,  '64. 

1,  1865. 

184 

Terwilleger,  T.  R.,  Cor 

April  20, 

Right  ;  circular.  Confed.  surgeon. 

14H 

Raborn,  1.,  Pt.,  F,  40th 

Dec.  1, 

Right.    A.  A.  Surg.  R.  McNeilly. 

poral,  D,  85th  N.  York, 

May  11, 

Partial    anchylosis    knee  joint. 

Indiana,  age  20. 

13,  '64. 

Discharged  May  20,  1865. 

age  21. 

1864. 

Discharged  July  27,  1865. 

147 

Reagles,  E.,  Pt.,  A,  36th 

Aug.  16, 

Left;  circular.     A.  A.  Surg.  J.  1$. 

185 

Thayer,  P.  0.,  Corp'l,  F, 

July  2, 

Right.     Surgeon  —  Meoms,  1  1th 

Wisconsin,  age  30. 

Sept.  4, 

Roe.     (Gangrene.)    Discharged 

8th  Georgia,  age  23. 

5,  '63. 

Georgia.     Recovery. 

1864. 

May  23,  1865. 

186 

Thompson,    M.,  Pt.,  C, 

July  22, 

Left:  double  flap.    A.  A.  Surg.  E. 

14H 

Reden,  H.,  Pt.,  B,  llth 

June  20, 

Left  ;  flap.     Surg.  J.  D.  Mitchell, 

7th  Indiana,  age  25. 

Aug.  10, 

Seyffarth.   (Hsemorrhage.)  Dis 

New  Hamp.,  age  30. 

30,  '64. 

31  st  Maine.    Disch'd  Oct.  17,  '65. 

1864. 

charged  September  20,  1864. 

Hi) 

Reeder,  S.  B.,  Serg't,  U. 

Mar.  3, 

Left.       Discharged    August    26, 

187 

Tibbetts,  J.  G.,  Pt.,  M, 

June  3, 

Left;  circular.    Surg.  W.  Watson, 

S.  Marines,  age  21. 

21,  '65. 

1865. 

1st  Maine  Heavy  Artil 

9,  '64. 

105th  Penn.    Discharged  Jan.  6, 

150 

Richard.  J..  Pt.,  D,  5th 

July  4, 

Left.     (July  4,  exc.  4th  and  5th 

lery,  age  28. 

1865.     Died  January  6,  1871. 

Connecticut,  age  19. 

—  ,  '64. 

met)    Aug.  12,  re-amp.  Disch'd 

188 

Tibb'ler,  N.  R.,  Lieut.,  K, 

Nov.  30, 

Left;  anterior  posterior  skin  flap. 

May  12,  1865.     Died  Feb.  24,'67. 

6th  Arkansas,  age  26. 

Deo.  29, 

A.  A.  Surg.  R.  McNeilly.    To 

151 

Richardson,  G.   O  ,   Pt., 

Dec.  13, 

Left  ;   circular.      Disch'd   March 

1864. 

Provost  Marshal  Feb.  6,  1865. 

Iv,  13th  New  York. 

16,  '62. 

10,  1863. 

189 

Toothe,  I.  H.,  Pt.,  B,  61st 

July  1, 

Left.    Paroled  September  25,  '63. 

152 

Rklenour,  W.  M.,  Pt.,  B, 

June  15, 

Right  ;  circular.     Discharged. 

Georgia,  age  23. 

4,  '63. 

14th  W.  Va.,  age  20. 

HO,  '64. 

190 

Turner,  S.,  Corp'l,  H,  21st 

July  2, 

Left;  circular.     Surg.  —  Black, 

153 

Rideout,  J.   J.,    Pt.,   F, 

July  3, 

Right.     Surg.  —  Dailert,  C.  S.  A. 

Virginia,  age  20. 

10,  '63. 

C.  S.  A.    Exch'd  March  3,  1864. 

12th  Virginia,  age  21. 

12,  '63. 

Necrosis  ;    erysipelas.      Exch'd 

191 

Valentine,  C.  L.,  Pt.,  B, 

May  11, 

Right  ;  circular.     Surgeon  O.  A. 

March  17,  1864. 

5th  Wisconsin,  age  34. 

15,  '64. 

Judson,  U.  S.  V.     Discharged 

154 

Riebe,    H.,  Pt.,  F,  68th 

July  1, 

Left.     Discharged  May  2]  ,  1864. 

September  12.  1865. 

New  York,  age  40. 

4,  '63. 

192 

Vermilyea,    L.,  Pt.,  K, 

Mar.  31, 

Left  :  circular.     Ass't  Surgeon  A. 

155 

Rix,  G.  S.,  Artificer,  A, 

June  22, 

Right;  circular.     A.  A.  Surgeon 

91st  New  York,  age  21. 

April  11, 

Delany,  U.  S.  V.     Discharged 

8th  New  York  Heavy 

July  7, 

W.    C.    Mulford.      Discharged 

1865. 

June  21,  1865.     Spec.  4054. 

Artillery. 

1864. 

March  27,  1865. 

193 

Vick,  T.  W.,  Pt.,  C,  3d 

May  6, 

.     Surg.  —  Brown,  C.  S.  A. 

156 

Robinson,  E.,  Landsman, 

April  1, 

Lett.     Ass't  Surg.  J.   R.  Tryon, 

Arkansas. 

9,  '64. 

Recovery. 

U.  S.  Steamer  Rodolph, 

4,  '65. 

U.  S.  N.    Discharged  November 

194 

Wakefield,  S.  D.,  Pt.,  E, 

June  4, 

Left;  ant.  posterior  flap.     Surg. 

age  24. 

24,  1865.    Spec.  5662. 

3d  Maine,  age  24. 

7,  '64. 

A.  Garcelon,  of  Maine.    Disch  d 

157 

Rose,  E.  P.,  Pt.,  K,  6th 

July  1, 

Right  ;  circular.     Ass't  Surgeon 

March  6,  1865.     Spec.  4474. 

Wisconsin,  age  25. 

6,  '63. 

A.  D.  Andrew,  6th  Wisconsin. 

195 

Waldon,   E.,  Pt.,  E,  3d 

April  1, 

Right;  circular.     A.  A.  Surg.  F. 

Discharged  January  1  1,  1964. 

Delaware,  age  25. 

11,  '65. 

Hall.      Discharged    October  6, 

158 

.Ross,,/.,  Pt.,  F,  2d  South 

July  3, 

Left.    Surgeon  —  Barnes,  C.  S.A. 

1865.     Spec.  4055. 

Carolina. 

20,  ''63. 

Recovery  November  12,  1863. 

196 

Walsh,  R.,  Pt.,  C,  llth 

June  25, 

Right.     A.  A.  Surg.  C.  H.  Stowe. 

159 

Ross,  W.  W.,  Pt..  I,  9th 

June  21, 

Right:  circular.     Surgeon  A.  F. 

Massachusetts,  age  20. 

J'y  6,  '62. 

Discharged  June  10,  1863. 

New  Hamp.,  age  21. 

29,  '64. 

Sheldon,  U.  S.  V.     Discharged 

197 

Wanzer,  S.  O.,  Pt.,  K, 

Sept.  20, 

Left;   circular.      Disch'd   March 

November  18,  1864. 

36th  Illinois,  age  20. 

23,  '63. 

16,  1864. 

160 

Savagt,  J.  W.,  Serg't,  K, 

Sept.  30, 

Right.     Retired  March  20,  1865. 

198 

Warddle,  J.,  Pt.,  G,  16th 

Aug.  29, 

Left.      Discharged    February  4, 

13th  Alabama,  age  27. 

Oc.15,'64. 

Massachusetts. 

Sep.3,'62. 

1863. 

161 

Scullen.   M.   1'.,    Pt.,  D, 

July  :i. 

Kight  :    anterior    posterior    flap. 

199 

Warner,  J.,  Pt.,  C,    3d 

May  3, 

Left  ;  flap.     Ass't  Surg.  W.  Tow 

13th  Vermont,  age  21. 

19,  ''63. 

Ass't   Surgeon   J.   D.  Johnson, 

Wisconsin,  age  32. 

15,  '63. 

ers,  3d  Wisconsin.     Discharged 

U.  S.  V.     Spec.  1  696. 

August  25,  1863. 

162 

Sears,  O.  H.,  Pt.,  K,  6th 

Sept  19, 

Left  ;  circular.     A.  A.  Surg.  T.  J. 

200 

Weaver,  H.  Y.,  Corp'l, 

July  2, 

Right  ;  circular  skin  flap.     Surg. 

Vermont,  age  24. 

Oct.  13, 

Dunott.    (Amp.  right  great  toe.) 

B,  155th  Pennsylvania, 

5,  '63. 

J.  A.  E.  Reed,  155th  Penn.     Re- 

1H64. 

Oct.  13,  haemorrhage:  necrosis. 

age  19. 

amputation;  ha?monhage.    Dis 

Discharged  October  28.  1865. 

charged  July  21,  1865. 

163 

Selah,  T..  Serg't.  K,  96th 

May  3, 

Right:  circular.     Discharged  Au 

201 

Welsheimer,  E.  W.,  Pt., 

Oct.  29, 

Left:  anterior  posterior  flap.     A. 

Pennsylvania. 

6,  '63. 

gust  7,  1863. 

G,  73d  Ohio,  age  19. 

Nov.  16, 

A.  Surg.  C.  F.  Havnes.  Haemor 

164 

Sevael,  Ar.   B.,   Turner's 

Jan.  8, 

Left  ;  circular.    Ass't  Surg.  H.  T. 

1863. 

rhage.     Disch'd  Dec.  30,  1864. 

Brigade,  age  23. 

14,  '65. 

Leirler,  U.  S.  V.     To   Provost 

202 

Welton.  J.  A.,  Lieut.,  E, 

April  30, 

Left.    Confederate  surgeon.    Dis 

Marshal  March  2.  1865. 

51st  Indiana. 

May4,'63. 

charged  June  20.  1864. 

165 

Shappeard,    S.,    Pt.,   D, 

May  26, 

Left;   nnt.    posterior  flap.     Ass't 

203 

Wheeler,  W.  W.,  Pt.,  E, 

Dec.  13, 

Left  ;  circular.    Surg.  E.  Bentley, 

14-,'d  New  York,  age  19. 

June  9, 

Surgeon  W.  Webster.  U-  S.  A. 

16th  Maine,  age  20. 

22,  '62. 

U.  S.  V.     Discharged   May  21, 

1864. 

Discharged  April  3,  1865. 

1863.     Spec.  597. 

'SKMMES  (A.  J.),  Surgical  Notes  of  tht  late  War,  in  A't.w  Orleans  Medical  and  Surgical^ournal,  1866,  Volume  XIX,  p. 


534 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME.  MILITAUV 

D  ATFS 

OPERATIONS,  OPERATORS, 

No. 

NAME,  MILITARY 

DATES. 

OPERATIONS,  OPERATORS, 

DESCRIPTION,  AND  AGE. 

RESULT. 

DESCRIPTION,  AND  AGE. 

RESULT. 

SM 

Wheel..ck,  G.  C.,  Pt.,  K. 

July  24, 

Right  :  circular.    Surg  G.  L.  Mil 

237 

Cummings,  R.  W.,  Pt., 

Dec.  13, 

—  .     Died  January   15,    1863; 

7th  Michigan,  age  20. 

Aug.  6, 

ler,  C.  S.  A.     Discharged  Aug. 

D,  28th  X.  J.,  age  21. 

26,  '62. 

pyaemia. 

18(i4. 

29.  1865. 

238 

Defnell,  D.,  Pt.,  G,  10th 

July  2, 

—  .     Died  August  17,  1863  ;  py- 

205 

White,    J.,    Pt.,    D,   2cl 

Aug.  29, 

Right  ;  circular.  Discharged  Sep 

Georgia,  age  21. 

18,  ''03. 

icmia. 

Maryland,  age  30. 

Sep.4,'(i2. 

tember  29,  1863. 

239 

Dodge,  L.,  Pt.,  D,  10th 

Sept.  22, 

Left  ;  circular.    Surg.  Z.  E.  Bliss, 

206 

Williams,  J.  C.,  Pt.,  F, 

Sept.  17, 

Left  :  flap.     Discharged  January 

Vermont,  age  27. 

Oct.  12, 

U.  S.V.    Died  October  29,  1864  ; 

27th  Indiana. 

Oct.  5,  '62. 

5,  1863. 

1864. 

pyssmia. 

207 

Winters,  Z.,  Pt.,  C,  129th 

July  10, 

Right;  circular.    Surgeon  A.  W. 

240 

Engleman,  C.,  Ad.j't,  4th 

Mar.  30, 

Left  ;   circular.     Surgeon  D.  W. 

Illinois,  age  2IJ. 

13,''(i4. 

Reagan,  70th  Indiana.     Disch'd 

Pennsylvania  Cavalry, 

April  19, 

Bliss,  U.  S.  V.     Died  May  12, 

July  29.  1865. 

asre  26. 

1865. 

1865;  pyaemia. 

208 

Wood,  D.,  Pt.,  A,  56th 

May  16, 

Right.     Surg.  W.  X.  King,  56th 

241 

Farnham,  L.,  Pt.,  D,  5th 

June  3, 

Left;  ant.  posterior  flap.     Surg. 

Ohio. 

19,'  '63. 

Ohio.    Disch'd  August  1'J,  1863. 

New    Hampshire,    age 

9,  '64. 

E.  Bentley,  U.  S.  V.    Died  June 

209 

Woolbright,  J.  F.,  Pt.,  D, 

May  5, 

.     Surgeon  —  Fletcher,  C.  S. 

37. 

20,  1864  ;  "gangrene. 

Orr's  S.  C.  Rifles. 

12,  ''64. 

A.     Recovery. 

242 

Ford,  J.  E..  Pt.,  A,  33d 

Mar.  19, 

Left;    flap.      Ass't   Surgeon  W. 

210 

1  Wright,  A.,  —,  H,  9th 

Sept.  19, 

Right.     Surg.  P.  F.  Eve,  C.  S.  A. 

Ohio,  age  29. 

April  8, 

Webster,  U.  S.  A.     Died  May 

Kentucky. 

Oct.  1/63. 

Haemorrhage.     Recovery. 

1865. 

13,  1865. 

211 

Wright,  H.  D.,Pt.,D,  5th 

Nov.  12, 

Left  ;  circular.    A.  A.  Surg.  W.  P. 

243 

Frodine,  J.  W.,  Ptn  G, 

Sept.  17, 

Left.     Ass't  Surg.  C.  Bacon,  jr., 

Mich.  Cavalry,  age  21. 

19,  '64. 

Moon.     Disch'd  June  24,  1865. 

6th  Wisconsin. 

Oct.  6, 

U.S.A.  (Necrosis.)  Haem.  Died 

212 

2  Wright,  J.  B.,  Pt.,  H, 

Aug.  30, 

Right  ;  circular.  Ass't  Surg.  C.  A. 

1862. 

Oct.  15,  1862;  haem.     Spec.  363. 

16th  Mass.,  age  30. 

Sept.  13, 

McCall,  U.  S.  A.    (Haem.)   Nov. 

244 

4  Frost,  G.,  Pt.,  B,  57th 

Jan.  3, 

Left;  flap.     Surg.  J.  Shrady,  2d 

1862. 

3.  1862.  re-amputation.     Disch'd 

Ohio. 

22,  '63. 

Tenn.    Died  Jan.  28,  '63;  pyffitn. 

June  18,  1863.     Spec.  136. 

245 

Gallagher.    E..    Pt.,   F, 

June  3, 

Right.    A.  A.  Surgeon  A.  Ansell. 

213 

Wright,  W.  H.,  Pt.,  E, 

Aug.  30, 

Right;   necrosis.    Jan.  16,  1864, 

69th  N.  York,  age  37. 

17,  '64. 

Died  June  28,   1864;   pyaemia. 

30th  New  York,  age  23. 

Sept.  7, 

re-amputat'n.     Discharged  Sep 

Spec.  2572. 

1862. 

tember  28,  1864.     Died  May  20, 

246 

Gaskins,  W.  H.,  Serg't, 

July  2, 

Right.     Nov.  4,  removed  6  ins. 

1871  ;  consumption. 

K,  8th  Virginia,  nge  20. 

Aug.  1, 

end  of  tibia.     Died  Nov.  5,  1863  ; 

214 

Yates,  G.,  Pt.,  I,  4th  N. 

May  5, 

Right  ;  flap.     Surg.  D.  W.  Bliss, 

1863. 

diarrhoea.     Spec.  1962. 

Jersey,  age  25. 

18,  '64. 

U.  S.V.   Disch'd  March  16,  1865. 

247 

Gattan,  T.,  Pt.,  C,  64th 

Dec.  31, 

Left.     Ass't  Surg.  H.  P.  Ander 

215 

Zimmer,   D.,  Corp'l,  E, 

Sept.  20, 

Right;  circular.     Discharged. 

Ohio. 

Jan.  4, 

son,  64th  Ohio.     Died  January 

2d  Ohio. 

Oct.14,63. 

1863. 

8,  1863;  gangrene. 

216 

s  Acker,  T.,  Pt.,  A,  155th 

May  28, 

Right  ;  ant.  posterior  skin  flaps. 

248 

Gesner,   H.,   Corp'l,   G, 

Oct.  19, 

Right.     A.  A.  Surg.  B.  B.  Miles. 

New  York,  age  40. 

June  13, 

Surgeon  J.  A.  Liilell,  U.  S.V. 

176th  N.  York,  age  18. 

Nov.  7, 

Died  Nov.  26,  1864  ;  exhaustion. 

1864. 

(Haemorrhage.)     Died  June  22, 

1864. 

Spec.  3429. 

1864  ;  exhaustion. 

249 

Gilreath,  L.  P.,  Pt.,  B, 

July  2, 

Left;  circular;  necrosis  of  tibia. 

217 

Adams,  W.,  Pt.,  D,  3d 

June  27, 

Left;  circular.     Ass't  Surg.  E.  F. 

2d  S.  Carolina,  age  22. 

20,  V63. 

Died  October  2,  1863. 

New    York    Artillery, 

July  14, 

Hendrick,  15th  Conn.  Died  July 

250 

Gravenstine,  C.,  Pt.,  E, 

Aug.  2, 

Right;  circular.     Surgeon  Z.  E. 

age  24. 

1864. 

30,  1864;  irritative  fever. 

95th  Pennsylvania,  age 

29,  '64. 

Bliss,    U.  S.  V.      Gangrenous. 

218 

Auliff,  M.,  Corp'l,  G,  7th 

May  10, 

Right;  ant.  posterior  flap.    Surg. 

24. 

Died  August  31.  1864  :  pyaemia. 

Wisconsin,  age  20. 

16,'  '64. 

E.  Bentley,  U.  S.V.     Gangrene. 

251 

Guntman,    C.,    Pt.,    A, 

May  3, 

Left.    Died  June  7,  1863  ;  typhoid 

Died  June  16,  1864  ;  pyaemia. 

27th  Pennsylvania. 

—  ,  '63. 

fever.     Spec.  1548. 

219 

Barker,  L.  A.,    Pt.,  E, 

Dec.  16, 

Right;  circular.     A.  A.  Surg.  R. 

252 

Hall,  M.  J.,'  Pt.,  G,  2d 

Aug.  30, 

Right.   Died  September  16,  1862  ; 

37th  Georgia,  age  43. 

20,  '64. 

L.  McClure.    (Gangrene.)   Died 

New  Hampshire. 

Sep.8,'62. 

tetanus. 

December  28,  1864. 

253 

Hannans,  J.,  Pt.,  K,  97th 

May  20, 

Right;  circular.     A.  A.  Surgeon 

220 

Barker,   M.  H.,    Serg't, 

May  10, 

Left;  anterior  posterior  flap.     A. 

Pennsylvania,  age  23. 

June  11, 

O.  W.  Peck.     Died  September 

C,  6th    Vermont,   age 

20,  '64. 

A.  Surgeon  O.  P.  Sweet.     Died 

1864. 

20,  1864;  diarrhoea. 

2fi. 

May  24,  1864  ;  pyaemia. 

254 

Harrington,  II.,    Serg't, 

June  23, 

Left;    circular.     A.  A.  Surgeon 

221 

Belger,  W.,  Pt.,  C,  1st 

May  12, 

Right  ;  circular.     Surgeon  N.  R. 

B,  109th  N.  Y.,  age  26. 

July  20, 

A.  Ansell.     (Gangrene.)     Died 

Massachusetts    Heavy 

23,  '64. 

Moselev,  U.  S.  V.    Died  June 

1864. 

August  26,  1864.     Spec.  3125. 

Artillery,  age  30. 

16,  1864  ;  pyaemia. 

255 

Heagy,  P..    Pt.,  C,  7th 

Dec.  13, 

Left  ;  flap.    (Haemorrhage.)   Dec. 

222 

Bliss,  G.  F.,  Corp'l,  D, 

May  23, 

Left  ;  circular.     A.  A.  Surg.  M. 

Pennsylvania  Res. 

24,  '62. 

27,  hasm.;  ligation.     Jan.  1,'li!, 

30th  Maine,  age  21. 

31,  '64. 

F.  Price.     Died  July  6,  1864; 

haemorrhage.    Died  January  30. 

asthma. 

1863.    Spec.  562. 

223 

Bellinger,  B.,Pt.,C,  143d 

June  20, 

Right  ;  circular.     A.  A.  Surg.  M. 

256 

Hill,    A.,   Pt.,    F,    18th  « 

Dec.  lo, 

Right.    January  25,  haemorrhage, 

Pennsylvania,  age  32. 

July  10, 

L.  Baxter.     Died  July  15,  1864  ; 

Massaohusetts,  age  27. 

1862, 

36  oz.     Died  'January  29,  1863  ; 

1864. 

exhaustion. 

Jan.4,'63. 

haemorrhage. 

224 

Brooks.  J.  P.,  Serg't,  K, 

May  18, 

Left  ;  ant.  posterior  flap.     Surg. 

257 

Hodgkinson,  W.,  Corp'l, 

Dec.  13, 

Left.     Died    January   27,    1863; 

57th  Mass.,  age  26. 

J  une  5, 

C.  Page,  U.  S.  A.     Died  July 

A,  9th  New  York  State 

17,  '62. 

pyaemia. 

18(54. 

14,  1864  ;  typhoid  fever. 

Militia,  age  23. 

225 

Brown,  A.  A.,  Pt.,  D,  5th 

July  2, 

.     Died  July  14,  1863;  teta 

258 

Hoffstickcr,   W.,  Pt.,  B, 

Dec.  16. 

Right:  circular.     A.  A.  Surg.  E. 

Florida. 

13,  '63. 

nus. 

3d  Mississippi,  age  19. 

1864, 

Woodruff.     Carious  ;  gangrene. 

226 

Brown,  J.,  Capt.,  H,  92d 

Sept.  19, 

Right.     Sept.  28,  hrem.;  ligation 

Jan.2,'65. 

Died  Jan.  11,  1865;  exhaustion. 

Ohio. 

27,  '63. 

on  face  of  stump.    Died  October 

259 

Holt,  J.,Pt.,H,  6th  Wis 

July  1, 

Left.     Surg.  S.   P.   Bonner,  47th 

5,  1863  ;  haemorrhage. 

consin. 

—  ,  '63. 

Ohio.  Died  July  16,'63;  tetanus. 

227 

Burch,  T.  C.,  Pt.,  F,  83d 

May  8, 

Right  ;  ant.  posterior  flap.    A.  A. 

260 

Hudson,   H.  J.,   Pt.,  D, 

July  9, 

Right:  circular.      A.  A.  Surg.  T. 

New  York,  age  43. 

15,  '64. 

Surg.  A.  P.  Craft.     Died  June 

12th  Georgia  Battery, 

22,  V>4. 

E.  Mitchell.  Died  Jnly31,  1864; 

9,  1864;  exhaustion. 

age  24. 

chronic  diarrhira.     Spec.  3942. 

228 

Burns,  J.,  Pt.,  C,  147th 

Nov.  25, 

Left.    (Gangrene.)    Died  Decem 

261 

Hulle,  II.  R.,  Pt.,  A,  3d 

Dec.  5, 

Right.     Died  January  14,  1865; 

Pennsylvania. 

—  ,  '63. 

ber  3,  1863. 

Mississippi,  age  24. 

16,  '64. 

amputation  and  diarrhoea. 

229 

C  ,  L>.,  Pt.,  —  ,  —  . 

Feb.  15, 

Right  ;  circular.     Died  March  9, 

262 

Hyler,  F.  H..  Pt.,  B,  55th 

May  15, 

Left:  circular.      A.  A.  Surg.  L. 

26,  '62. 

1862;  erysipelas. 

Ohio,  age  20. 

June  6, 

Sinclair.    Died  June  8,    1864; 

230 

Cain,   J.  L.,  Pt.,  G,  1st 

June  18, 

Left:  circular.     Died  August  5, 

1864. 

exhaustion. 

Maine  H.  Art.,  age  23. 

21,  '64. 

1864  ;  pyaemia. 

263 

Iron.   F.,    Pt.,    A,   76th 

April  1, 

Right  ;  ant.  post,  skin  flap  :  circu 

231 

Campion.  J.  D.,  Pt.,  H, 

April  30, 

Right.     Died  May  13,  1864. 

Col'd  Troops,  age  20. 

26,  '65. 

lar  section  muscles.    Surg.  F.  E. 

33d  Iowa. 

M'j-3,-64. 

Piqiiette.  86th  C.  T.  (Gangrene; 

232 

Carthey,  M.  L.,  Pt.,  G, 

April  30, 

Left.     Died  May  28,  1864. 

diarrhoea.)     Died  May  11,1  865  ; 

50th  Indiana. 

May  25, 

hectic  fever  and  acute  diarrhoea. 

1864. 

264 

Johl,  W.  H.,  Pt.,  D,  52d 

May  3, 

Left.  Surg.  C.  S.  Wood,  66th  N.Y. 

233 

Childers,  L.  H.,  Corp'l, 

June  3, 

Left  ;   circular.     A.  A.  Snrg.  G. 

New  York. 

17,  '63. 

Died  May  26,  1863.     .Spec.  1173. 

G,  110th  Ohio,  age  26. 

27,  '64. 

W.  Edwards.     Died   July   14, 

265 

s  Johnson,  M.,  Pt.,  G,  23d 

Jan.  11, 

Left.     A.  A.  Surg.  T.  T.  Smiley. 

1864  ;  exhaustion. 

Wisconsin. 

31,  '63. 

Died  Feb.  5.  1863;  exhaustion. 

234 

Clark,    H.,    Pt.,  D,   8th 

Sept.  29, 

Left;  circular.    A.  A.  Surgeon  T. 

266 

Jones,  R.  B.,  Pt,,  B,  7th 

Oct.  9. 

Left  ;  circular.     A.  Surg.  J.  C.  G. 

Col'd  Troops,  age  33. 

Oct.  4, 

Hopkins.    Died  October  6,  1864  ; 

Illinois  Cavalry. 

Nov.  11, 

Happersctt,  U.  R.  A.    Died  Nov. 

1864. 

tetanus. 

1863. 

15,  1863:  congestive  chill. 

235 

Cohatci,  J.,  2d  Assistant 

June  4, 

Left  :  circular;  sloughing.     Died 

267 

Karnes.  O.  W.,   Pt.,  E, 

Oct.  19, 

Left;  lateral  flap    A.  A.  Surgeon 

Engineer,  age  24. 

29,  '64. 

July  26,  1864;  pyiemia. 

65th  New  York,  age  35. 

Nov.  18, 

R.  H.  Stirling.    Died  November 

23G 

Cowdrey,  E.  A.,  Capt., 

Mar.  31. 

liight  ;    anterior    posterior    flap. 

1864. 

20.  1864:  pyaemia. 

A,  90th  New  York,  age 

April  16, 

Surg.  H.  W.  Ducaohet,  U.  S.  V. 

268 

Keller.   W.,    Pt.,   I,    1st 

Mar.  28, 

Right  ;  ant.  pest.  flap.    A.  A.  Surg. 

31. 

1865. 

Died      May  7,    1865;   pyaemia. 

Cavalry,  age  :)9. 

April  12, 

J.  H.  Thompson.  Died  April  18, 

Spec.  4078. 

1865. 

1865;  pyaemia  and  gangrene. 

'EVE  (P.  F.),  Cases  of  Secondary  Hemorrhage,  in  If.  S.  Sanitary  Commission  Memoirs,  1870,  .Surgical  Volume  I,  pp.  210,  21 1; 

ICOUE8  (E.),  Report  of  Some  Cases  of  Amputations,  etc.,  in  Medical  and  Surgical  Reporter,  1862-63,  Volume  IX,  p.  196. 

3LlDELL  (J.  A.),  On  the  Wounds  of  Blood  Vessels,  etc..  in  U.  S.  t-anitary  Commission  Memoirs,  1870,  Surgical  Volume  I,  p.  24. 

4SHRADT  (J.,  jr.),  Gunshot  Wound — Compound  Comminuted  Fracture  of  Left  Metatarsus,  etc.,  in  Am.  Jlle.d.  Times,  1863,  Volume  VI,  p.  113. 

6SM1LET  (T.  T.),  Gunshot  Wounds  from  Arkansas  Post,  in  Boston  Medical  and  Surgical  Journal,  1863,  Volume  LX1X,  p.  159. 


SECT.  V.] 


INTERMEDIARY    AMPUTATIONS    IN    THE    LEG. 


535 


No 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPKRATOIUS, 

RESULT. 

269 

Kelly,  T.,  Corp'l,  D,  4th 

May5, 

Left  ;  antero-posterior  flap.    Surg. 

303 

Schulz,  P.,  Pt.,  K,  4th 

May  3, 

Right.     Surg.  J.  H.  Baxter,  T.  S. 

Maine,  ago  42. 

15,  '64. 

E.  Bentley,  U.  S.  V.     Died  May 

Artillery,  age  28. 

20,  '63. 

V.    Died  May  31,  1863  :  tetanus. 

21,  1864;  exhaustion. 

Spec.  113&. 

270 

King,    T.,    Pt.,  —  ,   4th 

May  31, 

Left;  circular.    A.  A.  Surg.  H.  B. 

304 

Scott.  G.B.,  Corp'l,  K,8th 

June  9, 

Right.     Died  July  1,  1863:  ery 

Michigan,  age  22. 

June  11, 

Knowles.    Died  Oct.  24,  1864. 

N.  Y.  Cavalry,  age  19. 

20,  '63. 

sipelas.     Spec.  1347. 

1864. 

305 

Shame,  J.,  Pt.,  II,  90th 

Dec.  13, 

Right.      A.  A.  Surg.  D.  Weisel. 

271 

Knowles,   A.  J.,  Corp'l, 

June  18, 

Right  ;  circular.     A.  A.  Surgeon 

Pennsylvania,  age  29. 

25,  '62. 

Died  January  12,  1863:  pyaemia. 

M,   1st   Maine    Heavy 

July  10, 

M.  L.  Baxter.     Died   July  17, 

Spec.  479. 

Artillery,  age  34. 

1864. 

1864;  exhaustion.     Spec.  2829. 

306 

Shlaffly,  C.,  Pt.,  F,  1st 

Sept.  14, 

Left.    Surg.  H.  S.  Hewit,  U.  S.  V. 

272 

Kurtz,  F.  E.,  Serg't,  G, 

Aug.  25, 

Right;   circ.     Surg.  '/,.  E.  Bliss, 

Pennsylvania  Rifles. 

Oct.  3,  '62 

Died  October  17,  1862.  Spec.  4:59. 

159th  N.  York,  age  22. 

28,  '64. 

U.  S.V.     Died  April  28,  1865. 

307 

Shoemaker,   I.,   Pt.,  H, 

Jan.  11, 

Left.    (Jan.  —  ,  amp.  ankle  joint.) 

273 

Lake,  J.,  Pt.,  D,  (ith  N. 

May  19, 

Right  ;  ant.  post,  skin  flap.     Ass't 

57th  Ohio,  age  33. 

31,  '63. 

Necrosis  ;  gangrene.     March  8, 

York  Heavy  Artillery, 

June  18, 

Surgeon  \V.  Thomson,  LI.  S.  A. 

re-amp,  leg,  middle  third.    Died 

age  40. 

1864. 

Died  July  11,  1864.    Spec.  3565. 

March  19,  1863;  gangrene. 

274 

Lance,    S.,  Pt.,    I,  29th 

De.29,'62 

Right.     Died  January  23,  1863. 

308 

Simmons,  N.  E.,  Pt.,  K, 

May  14, 

Right  ;  circular.     Ass  t  Surg.  C. 

Missouri. 

Jan.  19, 

Spec.  1031. 

3d  Tennessee,  age  26. 

June  8, 

C.  Byrne,  U.  S.  A.     Died  June 

1863. 

1864. 

16,  1864  ;  pyaemia. 

275 

Linekin,    J.    F.,  Pt,  K, 

May  5, 

Left  ;  ant.  post.  flap.     Died  June 

309 

Simpson,  C.  H.,  Pt.,  C, 

Oct.  29, 

Left.     Ass't  Surg.  C.  S.  Frink,  TJ. 

20th  Maine,  age  17. 

8,  '64. 

19,  1864;  exh'n  and  privation. 

143d  New  York. 

Nov.  18, 

S.  V.    Died  November  25,  1863  ; 

276 

Ling,  C.  B.,  Pt.,  B,  56th 

July  1, 

Right.     Died  July  18,  1863. 

1863. 

pyaemia. 

Pennsylvania. 

1C,  '63. 

310 

Smith,  H.,  Serg't,  K,  2d 

Sept.  17, 

Left.     Died  October  15,  1862. 

277 

Long,  T.,   Pt.,  H,  37th 

June  18, 

Left  ;  flap.     Surg.  T.  R.  Crosby, 

Infantry. 

Oct.  3,  '62 

Wisconsin,  age  34. 

J'y  2,  '64 

U.  S.  V.      Died  July  7,   1864; 

311 

Smith,  II.  S.,  Pt.,  F,  llth 

May  12, 

Left  ;  ant.  post.  flap.     Dr.  Lewis. 

exhaustion. 

New  Jersey,  age  21. 

21,  '64. 

Philadelphia.  Exfoliation.  Died 

278 

McCawley,  S.  E.,  Pt.,  H, 

Oct.  19, 

Right  ;  circ.     A.  A.  Surg.  E.  R. 

November  22,  1864  ;  pyaemia. 

28th  Iowa,  age  19. 

Nov.  7, 

Fell.     (Necrosis);  haemorrhage. 

312 

Smith,  L.,  Pt.,  D,  12th 

May  12, 

Left  ;  circular.    A.  A.  Surg.  C.  H. 

1864. 

Nov.  11,  ligation  anterior  tibial. 

Infantry,  age  24. 

21,  '64. 

Osborn.    Large  bed-sores.   Died 

Died  Nov.  19,  '64  ;  haemorrhage. 

June  3,  '64  ;  pyaemia.  Spec.  2739. 

279 

McCleary,  A.  P.,  Pt.,  B, 

July  2, 

Right.     Died  November  7,  1863. 

313 

Smith,  P.,  Corp'l,  C,  3d 

Aug.  16, 

Left  ;  circular.     A.  A.  Surg.  C.  F. 

63d  Perm.,  age  25. 

8,  '63. 

New   Hampshire,    age 

22,  '64. 

Bullen.   (Amp.  right  leg.)   Died 

280 

McClare,  R.  C.,  Pt.,  H, 

April  30, 

Right.     Died  May  22,  18C4. 

19. 

August  30,  1864  ;  exhaustion. 

29th  Iowa. 

May3,'64 

314 

Smith,  T.,  Pt.,  G,  28th 

June  14, 

Left.    Died  June  29,  1863. 

281 

Me  Oil  ton,  J.  F.,  Pt.,  G, 

Nov.  30, 

Right;  circular.     A.  A.  Surgeon 

Connecticut. 

—  ,  '63. 

6th  Texas,  age  18. 

Dec.  26, 

L.  Sinclair.     Died  February  6, 

315 

Snyder,   A.  W.,  Corp'l, 

Mar.  25, 

Right;  circular.     A.  A.  Surg.  H. 

1864. 

1865. 

K,  183d  Pennsylvania, 

April  5, 

E.  Woodbtiry.     Died  April  24, 

282 

'Minamom,  J.   G.,   Pt., 

May  18, 

Left  ;   double  ant.  posterior  flap. 

age  20. 

1865. 

1865  ;  pvasmia. 

L,  1st  New  York  Artil 

21,  '64. 

Ass't  Surg.  G.  A.  Mursick,  U.  S. 

316 

Starwalt,  M.,  Pt.,  K,  5th 

Oct.  19, 

Left  ;  circular.     A.  Surg.  W.  H. 

lery,  age  23. 

V.    Died  June  8,  18ii4  ;  pyaemic 

North  Carolina,  age  21. 

Nov.  1, 

Williams,  5th   North   Carolina. 

pneumonia.    Spec.  2494. 

1864. 

Died  Nov.  10,  1864;  pleuritis. 

283 

Mitchell,  T.,  Pt.,  C,  36th 

Sept.  19, 

Left  ;  flap.     A.  A.  Surgeon  J.  A. 

317 

Sterling,  G.,  Pt.,  I,  20th 

Sept.  30, 

Left.    Lenoir's  method.    Surg.  R. 

Indiana. 

Oct.  7, 

Romayne.     (Gangrene.)     Died 

Maine,  age  27. 

Oct.  11, 

B.  Bontecou,  U.  S.  V.    Erysip 

1863. 

October  15,  1863;  pyaemia. 

1864. 

elas;  gangrene.     Oct.  15,  amp. 

284 

Mock,  L.,  Pt.,   I,  119tb 

Nov.  7, 

Left  ;  flap.     Surgeon  D.  \V.  Bliss, 

thigh.     Died  October  20,  1864  ; 

Pennsylvania,  age  22. 

Dec.  6, 

U.  S.  V.    (Necrosis.)    Died  Doc. 

exhaustion.     Spec.  3285. 

1863. 

21,  1863;  pyaemia.     Spec.  1903. 

318 

Steward.  A.  R.,  Pt.,  B, 

April  6, 

Left.     Died  April  25,  1862. 

285 

Morrison,  S.,  Corp'l,  D, 

June  3, 

Left.     Died  July  26,   1864  ;   py 

34th  Illinois. 

20,  '62. 

81st  New  York,  age  24. 

27,  '64. 

aemia. 

319 

Steward.  R.,  Pt.,  I,  8th 

Dec.  13, 

Left.     Died  December  28,  1862. 

286 

MouUon,  B.,  Ft.,  H,  Gor 

Oct.  20, 

Right;  flap.     Surg.  G.  W.  Hoge- 

Penn.  Reserves. 

27   '62 

don's  Cavalry,  age  28. 

31,  '64. 

boom,  U.  S.  V.   Gangrene.  Died 

320 

Stoerzer,  H.,  Pt.,  B,  22d 

July  1, 

Left.     Died  July  28,  1862. 

Nov.  6,  1864  ;  typhoid  fever. 

Massachusetts. 

27,  '62. 

287 

Murray,  L.,  Pt.,  H,  1st 

May  27, 

Left;  circular.     Surg.  R.  B.  Bon- 

321 

Stone,   W.,    Pt.,   D,   2d 

June  1, 

Left  :  ant.  post.  flap.     Ass't  Surg. 

Maine  Heavy  Artillery, 

June  8, 

tecou,  U.  S.  V.     Died  June  8, 

Connecticut  H'vy  Ar 

27,  '64. 

W.Webster,  U.  S.A.   Died  July 

age  18. 

1864. 

'1864  ;  exhaustion. 

tillery,  age  32. 

24.  1864  ;  pyaemia. 

288 

Nailan.   P.,   Pt.,    II,   3d 

June  16, 

Right.     Died  July  27,  1862  ;  diar 

322 

Thompson,   J.,    Pt.,    A, 

April  9, 

Left  ;  flap  (erysipelas).    A.  Surg. 

Rhode  Island. 

—  ,  '62. 

rhoea. 

14th  N.  York  Cavalry, 

24,  '64. 

A.  Hartaoff,  U.  S.  A.    Died  May 

289 

Newburg,  H.,Pt.,F,  24th 

Aug.  12, 

Left;  circular.     A.  A.  Surg.  W. 

age  21. 

5,  1864  ;  pyaemia. 

Massachusetts,  age  28. 

24,  '64. 

L.   Welles.     Died   August  29, 

323 

Trumpleman,  O.,  Lieut., 

July  3, 

Right  (haemorrhage).    Died  July 

1864  ;  mortification  of  stump. 

C,  119th  New  York. 

20.  ''03. 

24,  1863.    Spec.  1459. 

290 

Nivemeyer,   J.,    Pt.,  G, 

April  30, 

Right.     Died  May  13,  1864. 

324 

Vangelder,   L.,   Pt.,  D, 

May  25, 

Left  ;  circular.    A.  A.  Surg.  H.  C. 

33d  Iowa. 

May4,'64. 

107th  N.  York,  age  21. 

June  24, 

May.     (Necrosis.)      Died  July 

291 

Norton,  M.,  Pt.,  I,  73d  N. 

July  3, 

Left.    Died  August  1,1863.    Spec. 

1864. 

29/1864;  diarrhoea.     Spec.  3496. 

York,  age  23. 

21/63. 

1453. 

325 

VermiUirm,  J.  K.,   Pt., 

July  24, 

Left  ;  circular.    A.  A.  Surg.  A.  R. 

292 

Owens,  G.  II.,  Pt.,  F,  6th 

Nov.  7, 

Right  ;  circular.     Surgeon  D.  W. 

B,   1st   Virginia   Artil 

Aug.  5, 

Gray.    (Neero.):  pysemia.    Died 

Maine,  age  18. 

11,  '63. 

Bliss,  U.  S.  V.     Died  January 

lery,  age  20. 

1864. 

August  20.  1864.    Spec.  3808. 

* 

31,  1864  ;  variola.     Spec.  1769. 

326 

Wagers,  J..  Pt.,  B,  14th 

April  2, 

Left;    circular.     Died   April   19, 

293 

Piles,  W.,  Pt.,  A,  3d  Vir 

Aug.  30, 

Right.     Died   October  21,   1862; 

South  Carolina,  age  17. 

5,  '65. 

1865;  pyaemia. 

ginia. 

Sept.  10, 

pyaemia. 

327 

Waters.  D.  J.,   Pt.,    F, 

May  11, 

Left  ;  circular.     Surg.  U.  B.  Bon 

1862. 

60th  Ohio,  age  21. 

25,  '64. 

tecou,  U.  S.  V.     Died  June  25, 

294 

Pinager,  J.,  Pt.,  H,  12th 

Dec.  15, 

Left  ;  ant.  post.  flap.     Ass't  Surg. 

1864  ;  pyaemia. 

Missouri  Cavalry,  age 

25,  '04  . 

W.  B.  Trull,  U.  S.  V.     (Gacg.; 

328 

Webber,  G.  A..  Pt.,  A, 

May  6, 

Left;  circular.   Ass't  Surg.  W.  F. 

24. 

tetanus.)     Died   December  27, 

20th  Maine,  age  19. 

29,  ''64. 

Norris,  U.  S.  A.     Died  July  10, 

1864  ;  inflammation  of  lungs. 

1864  :    exhaustion   and  chronic 

295 

Poole,  J.  H.,  Lieut.,  I, 

June  27, 

Left;  flap.     Surg.  J.  E.  Herbst, 

diarrhoea.     Spec.  3534. 

52d  Ohio,  age  33. 

July  17, 

U.  S.  V.      (Gangrene.)      Died 

329 

Wetzel,  J.,  Pt.,  C,  165th 

May  27, 

Right.    Died  June  12,  1863.   Spec. 

1864. 

July  30,  1864  ;  pyaemia. 

New  York. 

J'ne'8,'63. 

130(5. 

29(i 

Porsno,  L.,  Pt.,  B,  14th 

May  6, 

Left  ;  circular.    A.  A.  Surgeon  T. 

330 

Wilson,    H.,  Serg't,   A, 

Sept.  2, 

Left  ;  flap.     A.  A.  Surgeon  D.  II. 

New  Jersey,  age  23. 

17,  '64. 

Carroll.     Died  Sept.  24,  1864. 

71st  Ohio,  age  26. 

20,  '64. 

Bell.    (Gangrene.)     Died  Sept. 

297 

Porter,  G.  H.,  Pt.,  D,  3d 

May  5, 

Right  ;  circular.     Ass't  Surg.  W. 

24,  1864  ;  exhaustion. 

Indiana   Cavalry,    age 

17,  "'64. 

Thomson,    U.  S.  A.     (May  5, 

331 

Wood,   T-.,   Pt,,  D,   5th 

April  6, 

Right;  circular.      A.  A.  Surg.  C'. 

31. 

Syme'sarnputat'n.)     Died  June 

New   Hampshire,    age 

18,  '65. 

H.  Pegg.     Died  April  26,  1865. 

4,  1864  ;  pyaemia. 

15. 

Spec.  4098. 

298 

Redd,  J.  P.  D.,  Serg't,  E, 

Dec.  13, 

Left;    circular.      Died    January 

332 

Woodward,  H.  B.,  Serg't, 

Aug.  16, 

Left  ;  circular.    .A  .  A.  Surg.  G.  P. 

13th  Virginia. 

16,  '62. 

12,  1863. 

E,    125th    New   York, 

Sept.  10, 

Sar,cent.      (Sloughing.)      Sept. 

299 

Rclyea.  H.,  Pt.,  I,  2d  N. 

June  18, 

Left  ;  circular.  A.  A.  Surg.  W.  H. 

age  22. 

1864. 

20.  and  Oct.  5,  htemorrh.     Died 

York  Heavy  Artillery, 

July  4, 

True.    (Gangrene.)     Died  July 

December  7,  1  !?<>4  ;  pneumonia. 

age  52. 

1864. 

10,  '64  ;  exhaustion.     Spec.  2763. 

Specs.  3658.  3657. 

300 

Reynolds.  P.,  Pt.,  K,  5th 

June  17, 

Left;  circular.    Surg.  W.Watson, 

333 

U'ormsley,  L.  W.,  Pt.,  K, 

July  2, 

Left  ;  necrosis.    Dec.  29,  amput'n 

New  Jersey,  age  19. 

20,  '64. 

105th  Penn.   Died  July  30,  1864  ; 

8th  Florida,  age  35. 

6,  '63. 

thigh.     Died  Dec.  30.  '63:  exh'n. 

exhaustion.     Spec.  4578. 

334 

Wright,    M.   F.,   Major, 

Dec.  20, 

Left.     (Dec.  20.  excision  tarsus.) 

301 

Rickman,  F.,  Pt.,  K,  55th 

July  8, 

Left  ;  antero-posterior  flap.     Died 

29th  Ohio,  age  20. 

—  ,  '64. 

Died  January  7.  1865. 

Massachusetts. 

13,   64. 

July  28.  1864  :  pyaemia. 

335 

York.  M.,  Pt..  E,  120th 

July  2, 

Right.     (July"  27,  amp.  left  leg.) 

302 

RuthlPdge,  J.W.,  Serg't, 

June  15, 

Right;  circular.     A.  A.  Surg.  J. 

New  York,  age  20. 

28,  ''63. 

A.  A.  Surg.  F.  Hinkle       Died 

E,  97th  Indiana,  age  30. 

30,  '64. 

W.  Digby.     Died  July  6,  18G4. 

Aug.  8,  1863.    Specs.  1605,  1609. 

>LlDELL  (J.  A.),  On  Thrombosis  and  Embolism,  in  American  Journal  Medical  Sciences,  1872,  Volume  LXIV,  p.  354,  and  On  the  Secondary  Trau 
matic  Lesions  of  Bone,  in  U.  S.  Sanitary  Commission  Memoirs.  1870.  Surgical  Volume  1,  p.  3;JO. 


536 


INJURIES    OF    THE    LOWER    EXTREMITIES 


[CHAP.  X. 


Intermediary  Amputations  in  the  Leg,  in  which  the  Point  of  Operation  is  not  specified. 

In  forty-seven  instances  of  intermediary  amputation  in  the  leg  the  precise  point  of  ablation 
was  not  indicated.  Fifteen  operations  were  successful  and  thirty-two  fatal;  they  were  per 
formed  on  forty-six  patients,  in  a  fatal  instance  both  legs  having  been  removed.  Twenty- 
nine  were  Union  and  seventeen  Confederate  soldiers. 

CASE  781. — Corporal  W.  Dunlap,  Co.  E,  Confederate  Marine  Corps,  aged  32  years,  was  wounded  during  the  naval  engage 
ment  with  the  Confederate  Steamer  Atlanta,  June  17,  1863.  He  was  captured  and  treated  at  various  hospitals,  lastly  entering 
West's  Buildings,  Baltimore,  on  February  11,  1864.  Surgeon  T.  H.  Bache,  U.  S.  V.,  in  charge  of  the  latter,  described  the 
injury  as  a  "  shot  fracture  of  the  right  leg,  produced  by  an  iron  splinter,  for  which  amputation  of  the  leg  was  performed  on  June 
25th."  Surgeon  A.  Chapel,  U.  S.  V.,  reported  that  the  patient  recovered  and  was  sent  to  Fort  McHenry  April  10,  1864.  The 
Confederate  hospital  records  show  that  the  man  was  ultimately  retired  from  service  January  31,  1865. 

CASE  782. — Private  E.  Field,  Co.  A,  6th  Virginia,  was  wounded  in  the  leg  during  an  engagement  on  June  21,  1862.  On 
the  following  day  he  was  admitted  to  Confederate  hospital  Chimborazo  No.  2,  at  Richmond,  the  records  of  which  show  the  fol 
lowing  description  of  the  injury  and  its  result:  "There  was  a  gunshot  comminuted  fracture  of  the  tibia  and  fibula,  implicating 
the  ankle  joint,  the  point  of  entrance  being  just  above  the  external  malleolus  and  that  of  exit  three-fourths  of  an  inch  above  the 
internal  malleolus.  When  admitted  the  ankle  joint  was  swollen  and  painful,  but  there  was  no  swelling  above  the  seat  of  the 
fracture,  and  no  fever.  On  consultation  it  was  decided  to  save  the  limb,  which  was  laid  on  a  pillow,  cold-water  dressings  being 
applied  and  poultices  used  to  promote  suppuration.  By  June  26th  there  was  high  inflammatory  fever,  which  abated  on  June 
30th.  The  ankle  joint  was  now  greatly  swollen  and  red  and  suppurating  considerably;  patient  very  much  emaciated;  appetite 
poor.  Amputation  of  the  leg  was  performed  on  July  2d,  and  on  the  night  following  haemorrhage  took  place  from  the  stump. 
This  was  checked  by  elevating  the  stump  and  the  application  of  cold  water.  The  patient  continued  to  decline,  and  died  on  the 
next  day,  July  3,  1862.  An  examination  of  the  amputated  leg  revealed  extensive  injury  to  the  soft  parts  in  addition  to  the 
comminution  of  the  bone.  The  tibia  was  split  for  three  inches,  and  the  ankle  joint  was  filled  with  pus." 

TABLE  LXXV. 
Summary  of  Forty-seven.  Intermediary  Amputations  in  the  Leg,  the  Point  of  Ablation  unspecified. 

[Recoveries,  1—15;  Deaths,  16 — 47.] 


W). 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Ammons,  S.,  Pt.,  G,  23d 

Aug.  30, 

Left.     Surg.  W.  M.  Michel,  P.  A. 

24  '  Fingerle,  J.  A.,  Pt,  H, 

April  30, 

Left.     Died  May  9,  1864. 

South  Carolina. 

Sep.2,'62. 

C.  S.     Recovered 

9th  Wisconsin. 

Mav3.'64. 

o 

Branson,  J.  W..  Pt.,  G, 

Aug.  29, 

.  Surg.  —  Robertson,  C.  S.  A. 

25?    Flemming,   C.,    Pt,    A. 

De'c.  13, 

Both.     Died  December  21,  1862. 

1st  South  Carolina. 

Sep.l,'6-J. 

Recov'd.    Disch'd  Oct.  10,  1862. 

26)      35th  New  York. 

18,  '62. 

3 

Cox,  J.,  Pt.,  K,  58th  X. 

Nov.  25, 

Left.     Transferred  February  14, 

27     Foster,    S.    C.,    Pt.,   G, 

April  30, 

Right  ,  Died  May  11,  1864. 

Carolina. 

28,  '63. 

1864. 

50th  Indiana. 

Muy3,'64. 

4 

Dawson,  W.  L.,  Pt.,  G, 

April  6, 

Left.     Discharged  June  27,  1862. 

28 

Gardner,  T.,  Pt.,  G,  10th 

July  28, 

Right.      Surg.  J.  Spiegelhalter, 

28th  Tenn.,  age  30. 

—  ,  '62. 

Mississippi. 

—  ,  '64. 

12th  Mo.     Died  Aug.  11,  1864. 

5 

Dunlap,  W.,  Corp'l,  E, 

June  17, 

Right.   Retired  from  service  Jan 

29 

Grion,  11.  C.,  Serg't,  G, 

April  30, 

Left.     Died  May  14,  1864. 

Cont'ed.  Marine  Corps, 

25,  '63. 

uary  31,  18H5. 

2!)th  Iowa. 

May3,'G4. 

age  32. 

30     Hibbs,  P.  F.  Lieut.,  D, 

Dec.  13, 

Right;  gangrene.     Died  Decem 

G 

Gibson,  J.K.,  Pt.,  E,  37th 

June  28, 

.    Surg.  —  Staunton,  C.  S.  A. 

71st  Pennsylvania. 

22  '62. 

ber  30,  1862. 

7 

Virginia. 
Goodman,  D,  R.,  Pt.,  B, 

J'y  3,  '62. 
Aug  30, 

Recovered. 
.  Surgs.  W.  J.Allen  and  J.  E. 

31  ;  Hodgeboom,  W.  B.,  Pt., 
K,  5th  N.ew  York. 

A  ug.  30, 

Sep.4,'62. 

.     Ass't  Surgeon  B.  Howard, 
U.  S.  A.     Died  May  10,  1863. 

19th  Virginia. 

Se.28,'62- 

Chancellor,  C.  S.  A.  Recovered. 

32     Inman,  J.  T..  Serg't,  K, 

Sept.  1, 

Right.     Died  October  1,  1864. 

8 

Hill,  A.  C.,  Pt.,  I),  28th 

Aug.  9, 

Right.     Discharged  January  14, 

21st  Ohio. 

23,  '64. 

New  York. 

13,  'U2. 

1863. 

:!!!     Lnughery.  J.  M.,  Pt.,  B, 

Aug.  30, 

Right.     (Also  wounds  right  thigh 

9 

Holt,  J.,  Pt.,  15.  37th  Vir 

Aug.  9, 

.  Union  surgeon.  Recovered. 

ulth  Pennsylvania  Re 

Sept.  4, 

and  left  leg.)     Sept.  1,  4,  hasm. 

ginia. 

14,  '62. 

serves,  age  35. 

1862. 

Died  Sept.  8,  1862  ;  haemorrhage. 

10 

Humphries,  L.   D.,  Pt., 

Aug.  7, 

.    Surg.  A.  Atkinson,  C.  S.  A. 

34 

Madden.  R.,  Pt..  H,  29th 

April  30, 

.     Died  Aug.  16,  1864,  while 

H,  31st  Virginia. 

1V64. 

Recovered. 

Iowa. 

May  26, 

u  prisoner  of  war. 

11 

Lowre.y,  S.  B.,  Pt.,  E,  2d 

July  2, 

Left.  Transferred  to  Provost  Mar 

1864. 

Georgia,  age  39. 

—  ,  %. 

shal  September  10,  1863. 

35 

Mandel,  H.,  Pt,  D,  27th 

April  30, 

Loft.     Died  May  13,  1864. 

12 

Uight,    C.,   Pt.,   I,  48th 

April  1, 

Right  ;   ant.  post  skin   flap  and 

Wisconsin. 

May  3,  '61 

Colored  Troops,  age  23. 

12,  '65. 

ciro.  section  of  muscles.     Surg. 

36 

McCollum,    A.,    Signal 

Mav  3, 

.     Died  May  14,  1863. 

F.  E.    Piquctte,   8(ith    Colored 

Corps. 

7,  '63. 

Troops.     Disch'd  July  22,  1865. 

37 

McDaniel,   M.,   Pt.,   K, 

May  23, 

Left:  sloughing;  hasm.    June  27, 

13 

Unknown.  26th  Pennsyl 

Nov.  27, 

—  .     Ass't  Surg.  J.  T.  Calhoun, 

48th  Virginia,  age  51  . 

June  !i. 

femoral   arterv   ligated.      Died 

vania. 

—  ,  '63. 

U.  S.  A.     Recovered. 

1863. 

July  8.  1863.  ' 

14 

Utt,  L.  II.,  Capt..  A,  7th 

April  24, 

Left;  flap.     Surg.  W.  R.  Marsh. 

38 

Moselv,  J.  P.,  Serg't.,  P, 

April  30, 

Loft.'    Died  May  11,  1864. 

Kansas  Cav.,  age  22. 

27,  '63. 

2d  Iowa.    Must,  out  Sept.  2!),'65. 

13th  Kansas. 

May5,'G4. 

15 

Wood,  C.  E.,  .Musician, 

May  17, 

.    St-.rg.  R.  F.  Baldwin,  P.  A. 

39 

'Newman,  L.  C.,  Lieut. 

May  3, 

Left.     Surg.  M.  Clyinor,  U.  S.  V. 

5th  Virginia. 

25,  '62. 

C.  S.     Recovered. 

Col.,  31st  New  York. 

17,  "63. 

Tetanus;  hoem.  Died  June  7,  '63. 

16 

Anderson,  J.,  Pt.,  G,  5th 

July  —  , 

.     Died  July  11,  1863. 

40 

Richardson,  J.   H.,  Pt., 

June  20, 

Right.     Died  June  29,  1864. 

North  Carolina. 

—  ,  '63. 

D,  5th  Kentucky. 

23,  '64. 

17 

Baldwin,  G-,  Pt.,  F.fiGth 

Jan.  1, 

—  .    Jan.  2fi,  haemorrhage  from 

41 

Schooling,    J.,    Pt..    D, 

April  30, 

Loft      Died  June  4,  1864. 

Indiana,  age  35. 

11,  '63. 

ant.  tib,  art.     Died  Jan.  15,  1863. 

29th  Iowa. 

May3,'G4. 

18 

Cogin,   .J.,   Pt.,   B,  20th 

April  7, 

Right;  tubercles;   diarrh.     Died 

42 

Smith,  J.  A.,  Pt.,  C,  29th 

April  30, 

Left.     1  )iod  May  5,  1865,  while  a 

Tennessee,  age  29. 

10,  '62. 

April  25,  1862. 

Iowa. 

May3,'G4. 

prisoner  of  war  at  Tyler,  Texas. 

19 

Cookson,  A.,  Pt.,  K,  32d 

May  12, 

Right.     Died  May  19,  1864. 

43 

Taylor,   R.    C.,    Pt.,   K, 

May  10, 

.    Surg.  C.  B.  Gibson,  C.  S.A. 

Maine. 

—  ,  '64. 

19th  Virginia. 

13,  '64. 

Died  Mav  18.  1864. 

20 

Crawford,  C.  N.,  Pt.,  A, 

Sept.  17, 

Right.     Died  October  2,  1862. 

44 

Weber,   A.,  Pt.,   I,  9th 

April  30, 

Left.     Died  May  7,  1864. 

104th  Pennsylvania. 

20,  '02. 

Wisconsin. 

May.3,'64. 

21 

Farley,  J.,   Pt.,  F,  72d 

July  2, 

—  -.     Died  September  1,  1862. 

45 

Winn,  M.,  Pt,,  G,  14th 

Aug.  30, 

Left.     Died  October  1,1862;  py 

New  York. 

5,  '62. 

New  York. 

Se.21,'62. 

aemia. 

22 

Fellows,  H.  H..  Pt.,  H, 

July  2, 

.     Also  wounds  of  face  and 

46 

Wescott,  O.,  Pt.,C,  121st 

Mav  3, 

Right.     Died  May  14,  1863. 

12th  New  York. 

5,  '62. 

shoulder.    Died  July  6,  1862. 

New  York. 

—  ,  '63. 

23 

Field,   R.,   Pt.,    A,  Cth 

June  21, 

;    haemorrhage.     Died  July 

47 

Youch,  J.,  Pt.,  B,  28th 

April  6, 

Right.     Died  May  15,  1662,  py 

Virginia. 

J'y  2,  '62. 

3,  18G2. 

Illinois. 

28,  '62. 

aemia. 

1  SWINBURNE  (J.),  Unnecessary  Amputation  of  the  Leg— Tetanus— Death,  in  Medical  and  Surgical  Reporter,  Philadelphia,  1863,  Vol.  X,  p.  319. 


SECT.  V.| 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


537 


In  the  case  of  Private  M.  McDaniel,  Co.  K,  48th  Virginia  (No.  37,  TABLE  LXXV), 
the  left  femoral  artery  was  unsuccessfully  ligated  eighteen  days  after  the  amputation. 

SECONDARY  AMPUTATIONS  IN  THE  CONTINUITY  OF  THE  LEG  FOR  SHOT 
INJURY.  —  Of  the  amputations  in  the  leg  for  shot'  injury,  the  secondary  operations  give 
the  most  favorable  results.  Of  four  hundred  and  forty-four  cases,  one  hundred  and  seven 
teen  were  fatal,  a  mortality  rate  of  26.3  per  cent.,  or  4.6  per  cent,  less  than  the  fatality  of 
the  primary  operations.  One  hundred  and  thirty-three  operations  were  performed  in  the 
upper  third,  one  hundred  and  seventy-four  in  the  middle  third,  one  hundred  and  twenty- 
one  in  the  lower  third  of  the  leg,  and  in  sixteen  instances  the  reports  failed  to  indicate 
the  precise  point  of  ablation. 

Secondary  Amputations  in  the  Upper  Third  of  the  Leg  for  Shot  Injury.  —  Of  the 

one  hundred  and  thirty-three  cases  of  this  group,  thirty-seven,  or  27.8  per  cent.,  had  fatal 
terminations.  In  sixty-two  cases  the  right,  in  sixty-seven  the  left  leg  was  removed;  in 
four  this  point  was  not  recorded. 

Example?  of  Recovery  after  Secondary  Amputations  in  the  Upper  Third  of  the  Leg 
for  Shot  Injury.  —  The  ninety-six  successful  operations  were  performed  —  thirteen  on  Con 
federate  and  eighty-three  on  Union  soldiers.  Of  the  latter,  eighty-one  became  pensioners; 
ten  have  died  since  the  date  of  their  discharge  from  the  army. 

CASE  783.  —  Private  B.  Fields,  Co.  C,  27th  North  Carolina,  aged  21  years,  was  wounded  in  the  right  leg  and  taken 
prisoner  at  Autietam,  September  17,  1862.  He  entered  hospital  No.  5,  at  Frederick,  ten  weeks  afterwards,  where  Surgeon  H. 
S.  Hewit,  U.  S.  V.,  recorded  the  following  description  of  the  injury:  "A  gunshot  wound  of  the  tibia  and  fibula  by  a  minie  ball; 
continuity  of  bone  entirely  destroyed  ;  leg  very  much  swollen,  offensive,  and  filled  with  pus.  Flap  amputation  at  the  upper 
third  of  the  leg  was  performed  on  November  28th  by  Acting  Assistant  Surgeon  A.  V.  Cherbonnier.  The  stump  was  closed  with 
three  stitches  and  wet  strips  of  muslin.  Reaction  was  very  satisfactory;  patient  cheerful.  On  the  next  day  the  dressing  was 
removed  and  some  adhesive  strips  were  applied,  the  stump  looking  well  but  there  being  some  pain,  for  which  one  grain  of  mor 
phia  was  administered.  On  November  30th  the  patient  looked  and  felt  well,  having  slept  nearly  all  night  ;  appetite  good  ;  wound 
suppurating  well;  stump  dressed  with  lint  and  cold  water  and  well  supported  with  a  roller.  Secondary  haemorrhage  occurred 
on  December  1st,  when  the  popliteal  artery  was  ligated  by  Surgeon  Hewit.  One  week  afterwards  the  ligature  had  not  yet  come 
away,  but  there  was  haemorrhage  from  the  wound,  the  cause  of  which  was  not  very  obvious.  The  tourniquet 
was  then  applied  to  the  femoral  and  the  wound  filled  with  charpie  saturated  with  solution  of  persulphate 
of  iron.  By  December  llth  the  wound  in  the  popliteal  space  was  suppurating:  stump  healthy  looking  and 
dressed  with  wet  strips  of  muslin  ;  patient  pale  in  appearance,  and  ordered  to  take  three  grains  of  quinine  and 
five  grains  of  tartrate  of  iron  and  potassa  every  four  hours.  Early  on  the  morning  of  December  15th  another 
tolerably  severe  haemorrhage  took  place,  the  popliteal  ligature  not  yet  having  come  away;  continued  the  tourni 
quet  to  the  femoral  and  prescribed  quinine  and  iron,  cod-liver  oil,  and  egg-nog.  Two  days  later  the  tibia  was 
found  to  protrude  ;  tourniquet  still  kept  applied,  though  a  little  slackened.  On  December  18th  there  was 
another  hemorrhage,  the  loss  of  blood  being  about  six  ounces,  controlled  by  tightening  the  tourniquet.  By 
December  20th  reaction  was  slowly  established,  though  the  patient's  face  was  still  bloodless;  appetite  tolerably 
good  ;  treatment  continued.  An  attack  of  diarrhoea  had  been  promptly  arrested  by  the  administration  of 
rhubarb  powder,  ipecacuanha,  and  opium.  December  24th,  patient  rallying,  though  the  stump  still  gives 
evidence  of  a  low  state  of  vital  powers.  Several  days  afterwards  the  stump  looked  healthier,  and  on  Decem 
ber  20th,  when  the  patient  was  transferred  to  hospital  No.  1,  he  was  in  good  spirits  and  good  granulations 
were  springing  up."  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  in  chaige  of  the  latter  hospital,  recorded  the 
subsequent  progress  of  the  case  as  follows:  "The  stump  continued  to  look  and  suppurate  well,  the  patient 
having  but  very  little  pain  and  his  bowels  remaining  in  good  condition;  appetite  improving.  For  three  days 
previous  to  January  26th  he  complained  of  great  tenderness  along  the  inner  side  of  the  thigh,  where,  on  exam 
ination,  fluctuation  was  detected,  and  where  an  incision  was  made  which  was  followed  by  the  evacuation  of  ten 
ounces  of  pus,  the  sinus  extending  under  the  deep  muscles  of  the  posterior  and  outer  aspect.  Injections  of 
hydrochloric  acid  and  laudanum  diluted  in  water  were  then  used,  and  by  January  27th  the  ulcer  of  the 
stump  had  nearly  cicatrized  and  the  cavity  of  the  abscess  was  rapidly  filling  up;  patient  improving  in  general 
health  and  able  to  sit  up  most  of  the  time.  About  two  weeks  later  the  patient  was  in  very  good  condition  and 
going  about  on  crutches,  the  stump  cicatrizing  rapidly  and  looking  healthy.  On  February  28th  the  patient 
was  discharged  from  hospital  treatment,  his  general  condition  having  improved  very  rapidly  and  the  ulcer  of  the  stump  having 
healed."  Several  days  afterwards  the  patient  was  paroled  and  sent  south.  The  Confederate  hospital  records  show  that  the 
man  was  admitted,  on  March  18th,  to  the  General  Hospital  at  Petersburg,  and  that  he  was  permitted  to  leave  for  his  home,  on 
furlough,  April  6,  1863.  The  greater  portion  of  the  amputated  bones  of  the  injured  leg  (Spec.  751),  contributed  to  the  Museum 
SURG.  111—68 


FIG.  309.  —  Un- 


tibia  and  fibula. — 
Spec.  751. 


538 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


.  X. 


FIG.  310.— Stump  of  right  leg  thirteen 
months  after  antfro-posterior  flap  oper 
ation.  Spec.  4373. 


by  Dr.  Cherbonnier,  ar«  represented  in  the  annexed  wood-cut  (FlG.  309),  showing  an  ununited  comminuted  fracture  of  both 
bones  in  the  lower  part,  followed  by  an  effusion  of  a  large  amount  of  callus,  fragments  being  attached  to  the  fibula,  while  the 
tibia  is  carious  within. 

CASE  784. — Private  B.  F.  French,  Co.  H,  7th  New  Hampshire,  aged  21  years,  was  wounded  in  the  right  ankle  during 
flie  attack  on  Fort  Wagner,  July  18,  1863.  On  the  following  day  he  was  admitted  to  hospital  No.  9,  at  Beaufort,  where 
secondary  amputation  was  performed  by  Assistant  Surgeon  J.  F.  Weeds,  U.  S.  A.,  who  recorded  "  a  musket  ball  wound  of  the 

right  foot,  followed,  on  September  19th,  by  amputation  of  the  leg  at  the  upper  third,  Lake's 
operation  being  employed."  The  patient  was  subsequently  transferred  to  McDougall  Hos 
pital  at  Fort  Schuyler,  and  thence,  on  November  4th,  to  Lovell,  at  Portsmouth  Grove. 
Surgeon  L.  A.  Edwards,  U.  S.  A.,  in  charge  of  the  latter  hospital,  reported  that  the  slump  was 
the  result  of  an  antero-posterior  flap  amputation,  also  that  it  had  become  unhealthy  at  the  time 
of  admission  and  showed  a  disposition  to  slough,  for  which  bromine  was  applied.  On  March 
3,  1864,  the  patient  obtained  a  furlough,  and  subsequently  he  entered  Central  Park  Hospital, 
New  York  City,  where  he  was  supplied  with  a  "Hudson"  artificial  leg.  Surgeon  B.  A. 
Clements,  U.  S.  A.,  reported  the  following  recapitulation  and  result  of  the  case  :  "The  injury 
was  at  the  ankle,  the  missile  passing  from  within  outward  and  fracturing  the  bones  entering 
into  the  composition  of  the  joint.  Not  much  haemorrhage  took  place.  Water  dressings  were 
applied  at  first,  and  three  days  after  the  injury  the  ball  was  searched  for  but  could  not  be 
found.  Three  weeks  later  the  missile  was  removed,  about  which  time  erysipelas  attacked 
the  parts,  extending  up  to  the  groin,  but  soon  disappearing.  The  amputation  was  performed  on  account  of  extensive  necrosis, 
the  patient  being  under  the  influence  of  chloroform  and  ether.  Sutures  and  adhesive  strips  were  applied.  The  stump  was  very 
slow  in  healing,  but  at  the  time  of  the  patient's  admission  to  Central  Park  Hospital,  June  21st,  it  was  in  good  condition."  The 
man  was  discharged  from  service  at  his  own  request,  October  7,  1864,  and  pensioned.  He  was  paid  September  4,  1880.  In  his 
applications  for  commutation  he  continues  to  report  the  stump  as  being  i:i  good  and  healthy  condition.  A  cast  of  the  st.ump 
(Spec.  4373),  made  thirteen  months  after  the  date  of  the  amputation  and  contributed  by  Acting  Assistant  Surgeon  G.  F.  Shrady, 
is  shown  in  the  adjoining  wood-cut  (FlG.  310),  and  exhibits  the  cicatrix  extending  transversely  across  the  face  of  the  stump, 
which  is  well  formed. 

CASE  785. — Private  H.  Dimock,  Co.  K,  52d  Pennsylvania,  aged  20  years,  was  wounded  in  the  left  leg,  fracturing  the 
tibia,  at  Fair  Oaks,  May  31, 1862.  One  week  after  the  reception  of  the  injury  the  wounded  man  was  conveyed  to  Philadelphia, 
where,  after  undergoing  treatment  at  various  hospitals,  he  was  discharged  from  service  April  21,  1863,  Surgeon  I.  I.  Hayes, 
U.  S.  V.,  in  charge  of  Saterlee,  certifying  to  "the  wound  rendering  the  limb  of  no  use."  Examining  Surgeon  C.  Marr,  of 
Honesdale,  Pennsylvania,  certified,  September  25,  1863:  "He  received  a  gunshot  wound  through  the  leg  below  the  knee,  pro 
ducing  a  false  joint."  Several  years  later  Drs.  J.  D.  Lewis  and  J.  M.  Farrington,  of  Trumansburg,  New  York,  testified  that 
they  examined  the  pensioner  and  found  him  suffering  from  the  effects  of  the  wound,  also  that  they  deemed  amputation  of  said 
leg  necessary,  which  was  performed  by  the  former  on  February  12,  1867,  about  five  inches  below  the  knee'  joint.  They  further 
certified  that  after  the  amputation  they  examined  the  wound  carefully  and  found  the  tibia  one  and  a  half  inches  gone,  a  cartil 
aginous  union  having  formed  a  false  joint  in  its  stead,  and  the  fibula  being  partially  dislocated  at  the  knee  joint  in  consequence 
of  the  whole  weight  of  the  body  being  thrown  upon  it  in  walking.  Below  the  cartilaginous  union  in  the  tibia  a  number  of  pieces 
of  lead  were  discovered  in  the  substance  of  the  bone  below  the  periosteum,  all  of  which  rendered  the  leg  useless  and  a  source  of 
irritation,  causing  a  decline  of  his  general  health,  etc.  Dr.  Farrington  also  stated  that  in 
addition  to  the  condition  described  the  tibia  contained  an  oblique  irregular  fracture.  About 
a  year  after  the  date  of  the  amputation  the  pensioner  was  supplied  with  an  artificial  leg  by  the 
firm  of  B.  F.  Palmer,  of  Philadelphia,  who  described  the  operation  as  having  been  performed 
by  "flap  method."  In  his  subsequent  application  for  commutation  the  pensioner  represented 
the  condition  of  the  stump  as  ;'  sound."  He  was  paid  December  4,  1879. 

CASE  786.— Private  G.  C.  Flanders,  Co.  E,  8th  Ohio,  aged  18  years,  was  wounded 
in  the  left  leg,  at  Winchester,  March  23, 1862.  He  was  treated  at  several  hospitals  and  lastly 
at  Camp  Dennison,  where  he  was  discharged  for  disability  November  1,  1862.  Surgeon 
B.  Cloak,  U.  S.  V.,  certified  to  "gunshot  wound  in  the  upper  third  of  the  tibia,  producing 
compound  comminuted  fracture.  At  present  the  flexors  of  that  extremity  are  very  much 
contracted,  rendering  the  leg  nearly  two  inches  shorter,"  etc.  Some  months  after  being  dis 
charged  the  man  re-entered  the  service  and  joined  the  llth  Ohio  Cavalry,  in  which  organiza 
tion  he  served  until  May  26,  1865,  when  he  was  finally  mustered  out  and  pensioned.  At  the 
time  of  receiving  his  last  discharge  he  was  quite  lame,  the  wound  having  broken  out  anew 
about  two  riionths  previously  and  requiring  surgical  operations  subsequently.  Examining 
Surgeon  J.  W.  Toward,  of  Augusta,  Maine,  in  1867,  certified  to  the  injury,  and  stated  that 
"some  of  the  bone  lias  been  taken  out  and  the  ball  remains  in  the  leg.  The  wound  frequently 
breaks  out  and  is  painful.  He  wears  an  apparatus  attached  to  the  boot  and  extending  to 
the  hip,  relieving  the  leg  of  pressure  by  the  weight  being  sustained  by  the  hip  and  thigh.  I 
think  amputation  will  prove  necessary,"  etc.  Two  years  later  Dr.  J.  C.  IJeeve,  of  Dayton, 
Ohio,  certified  that  during  the  six  years  following  the  reception  of  the  wound  the  pensioner  had  seven  operations  performed  on 
the  leg  without  cure,  and  added:  "On  June  17,  1868,  I  amputated  Flanders'  wounded  limb,  and  subsequently  I  attended  him 
for  some  weeks.  Examination  of  the  bones  after  the  operation  showed  that  the  ball,  apparently  a  mini6,  had  perforated  the 
bone  in  an  upward  direction  and  remained  embedded  in  the  head  of  the  tibia  just  below  the  line  of  the  amputation."  The  ampu 
tated  bones  are  represented  in  the  wood-cuts  (FlGS.  311,  312).  The  missile  is  battered,  considerably  flattened,  and  embedded 


FIG.  311.— Por 
tions  of  left  tibia 
and  fibula— anterior 
view.  Spec.  5580. 


FIG.  312.— Pos 
terior  view  of  the 
same  specimen. — 
[Spec.  5580.] 


SECT.  V.] 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


539 


in  a  projecting  form  in  the  posterior  surface  of  the  tibia.  The  specimens  were  contributed  to  the  Museum  by  the  operator. 
About  nine  months  after  the  date  of  the  amputation  the  pensioner  was  well  enough  to  commence  using  a  "  Palmer  "  artificial  leg. 
In  the  following  year  he  described  the  stump  as  being  in  a  "sound  condition,"  but  stated  that  the  artificial  limb  did  not  prove 
satisfactory.  He  died  on  June  16,  1872.  The  immediate  cause  of  his  death  has  not  been  ascertained. 

CASE  787. — Private  F.  Mullen,  Co.  E,  43d  New  York,  aged  21  years,  was  wounded  in  the  left  leg,  at  Fredericksburg, 
May  3,  1863,  and  subsequently  underwent  secondary  amputation.  Surgeon  J.  A.  Lidell,  U.  S.  V.,  who  performed  the  operation,1 
forwarded  the  following  descriptive  history :  "The  wound  was  caused  by  a  minie"  ball,  which  passed  through  and  fractured  the 
tibia  in  the  lower  third.  The  man  was  brought  to  Stanton  Hospital,  Washington,  three  days  afterwards.  His  general  condition 
was  good,  and  it  was  judged  expedient  to  attempt  to  save  the  limb  without  operation.  It  was  accordingly  placed  in  Hodgen's 
splint  and  cold-water  dressings  were  applied;  stimulants  administered.  After  several  days  the  parts  suppurated  freely,  and  by 
June  1st  the  wounds  were  discharging  a  good  and  healthy  pus,  consolidation  taking  place,  and  appetite  and  pulse  being  normal. 
The  parts  continued  to  heal  nicely  up  to  July  28th,  when  the  patient  fell  and  re-fractured  the  limb  while  attempting  to  walk 
across  the  Ward.  On  August  2d,  several  pieces  of  bone  were  removed.  August  ICth,  parts  oedematous ;  discharge  thin  and 
fetid.  On  August  19th,  several  openings  for  the  exit  of  pus  were  made,  when  a  small  necrosed  splinter  came  away;  pulse 
weak;  general  health  suffering.  The  leg  remained  in  about  the  same  condition  until  September  1st,  when 
compression  by  bandage  was  applied.  About  October  1st  there  was  both  general  and  local  improvement,  the 
discharge  being  of  a  thick  and  healthier  character.  The  splints  were  now  removed  and  stimulants  continued. 
One  month  later  necrosis  of  the  shaft  of  the  tibia  had  become  extensive,  the  dead  bone  being  completely  encased 
in  an  involucrum;  condition  fair;  discharges  from  several  openings.  But  little  change  took  place  up  to  Decem 
ber  1st,  and  none  for  the  better  for  one  month  afterwards.  The  involucrum  was  now  large  and  the  skin  covering 
the  front  of  it  thin  and  about  to  ulcerate  extensively;  the  foot  being  considerably  twisted  inward  by  abnormal 
muscular  action  (partial  talipes  varns)  and  the  deformity  steadily  increasing ;  ankle  joint  also  becoming  stiff. 
There  being  now  no  hopes  of  preserving  a  useful  limb  it  was  deemed  advisable  to  remove  it  by  amputation. 
The  operation  was  performed  on  January  9th,  at  the  junction  of  the  upper  and  middle  thirds,  by  the  flap  method 
(double  flaps,  the  anterior  one  being  short).  The  sawn  end  of  the  tibia  was  beveled  off  as  recommended  by 
Sanson,  that  is,  by  placing  the  saw  obliquely — not  on  the  ridge,  but  on  the  internal  surface  of  the  bone.  The 
fibula  was  divided  somewhat  higher  up  than  the  tibia,  as  practised  by  Roux.  Throughout  the  operation  the 
patient  was  kept  insensible  by  sulphuric  ether.  He  did  not  exhibit  any  perceptible  shock.  The  flaps  were 
carefully  coaptated  and  secured  at  several  points  by  interrupted  sutures  and  strips  of  isinglass  plaster.  Several 
turns  of  a  roller  were  placed  around  the  leg  to  serve  as  a  supporting  bandage ;  but  no  other  dressing  was 
applied.  A  full  anodyne  was  administered  after  the  operation  and  another  at  12  P.  M.  On  the  following  day 
the  patient  was  sitting  up  in  bed  reading  a  newspaper,  the  stump  being  in  fine  condition,  free  from  heat  -and 
redness,  and  almost  devoid  of  pain  and  swelling.  On  January  13th  the  sutures  were  removed  and  the  stump 
was  dressed  for  the  first  time  and  found  to  be  uniting  by  primary  adhesion.  There  was  no  constitutional  dis 
turbance  whatever.  On  January  24th  the  last  ligature,  that  of  the  posterior  tibial  artery,  came  away.  The 
patient  had  not  at  any  time  nor  in  any  way  suffered  in  consequence  of  the  amputation,  and  the  stump  had  united 
by  first  intention.  In  short,  he  recovered  precisely  in  the  same  way  as  the  most  fortunate  cases  of  amputation 
of  the  leg  on  account  of  disease  get  well."  The  amputated  bones  of  the  leg  (Spec.  2022)  were  contributed  to 
the  Museum  by  the  operator  and  are  represented  in  the  wood-cut  (FlG.  313),  showing  the  fractured  tibia,  with 
an  abundant  involucrum  formed  to  nearly  the  point  of  section,  and  a  large  detached  but  imprisoned  sequestrum  being  exhibited 
through  the  cloacae.  A  few  points  of  osseous  deposit  are  also  seen  on  the  fibula,  which  is  uninjured.  The  patient  entirely 
recovered,  and  was  ultimately  discharged  September  5,  1864,  and  pensioned.  In  his  application  for  commutation,  dated  1870, 
he  described  the  condition  of  the  stump  as  being  "in  good  order."  He  died  March  5,  1871.  The  cause  of  his  death  has  not 
been  ascertained. 

Fatal  Cases  of  Secondary  Amputations  in  the  Upper  Third  of  the  Leg  for  Shot 
Injury. — The  thirty-seven  operations  belonging  to  this  group  were  performed — seven  on 
Confederate  and  thirty  on  Union  soldiers.  Pyaemia  was  noted  in  eight,  gangrene  in  one, 
secondary  hemorrhage  in  five,  diarrhoea  in  three,  and  exhaustion  in  twelve  instances  as 
the  immediate  cause  of  death. 

CASE  788. — Private  S.  E.  Twitchell,  Co.  G,  89th  New  York,  aged  25  years,  was  wounded  in  the  left  leg,  at  Antietam, 
September  17,  1862,  and  admitted  to  hospital  at  Chester  two  weeks  afterwards.  Surgeon  J.  L.  LeConte,  U.  S.  V.,  recorded 
the  following  history:  "The  injury  was  just  above  the  ankle  joint  and  was  followed  by  limited  necrosis  of  the  tibia  and  forma 
tion  of  pus,  which  was  evacuated  by  two  incisions,  one  on  the  anterior  aspect  about  six  inches  in  length,  and  the  other  posteriorly 
about  three  inches  long.  For  three  weeks  after  the  incisions  were  made  the  wound  progressed  favorably.  It  then  commenced 
to  slough,  and  this  went  on  until  the  external  wound  measured  six  inches  long  and  three  inches  wide.  On  February  15,  1863, 
amputation  was  performed  by  the  flap  method  at  the  upper  third  by  Acting  Assistant  Surgeon  L.  Fisher.  Tonics,  stimulants, 
perchloride  of  iron,  quinine,  whiskey,  beef-tea,  etc.,  were  administered.  The  case  progressed  satisfactorily  for  a  week  after  the 
operation,  when  signs  of  constitutional  irritation  showed  themselves  and  the  patient  gradually  became  worse.  On  February 
28th  he  had  a  rigor,  lasting  twenty-five  minutes,  and  the  case  was  diagnosed  as  one  of  pysemia.  After  this  time  the  patient 
continued  to  sink  until  March  5,  1863,  when  he  died.  The  post-mortem  examination  revealed  nothing  but  pus  in  the  knee  joint." 
The  amputated  two  lower  thirds  of  the  bones  of  the  leg  (Spec.  2067),  contributed  by  the  operator,  show  that  the  tibia  was 
partially  fractured  in  the  lowest  third,  the  injury  being  nearly  repaired  by  callus,  leaving,  however,  a  sinus  in  the  bone. 

1  LlDELL  (J.  A.),  On  the  Major  Amputations  for  Injuries  in  both  Civil  and  Military  Practice,  in  Am.  Jour.  Aled.  Sciences,  1864,  Vol.  XLVII,  p.  376. 


FIG.  31 3.— The 
lower  t birds  of 
the  bones  of  the 
left  leg,  with  in 
volucrum  of  the 
tibia.  Spec.  2022. 


540 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  314.— Por 
tions  of  fractured 
tibia  and  fibula  of 
left  leg.  Spec.748. 


CASE  789. — Private  H.  Linn,  Co.  A,  6th  Pennsylvania  Reserves,  aged  25  years,  received  a  shot  fracture  of  the  left  leg, 
at  Antietam,  September  17,  1862.  Two  weeks  afterwards  he  was  admitted  to  hospital  No.  5,  at  Frederick,  where  Surgeon  1 1. 
S.  Hewit,  U.  S.  V.,  noted  the  following  description  and  treatment  of  the  injury:  "A  minid  ball  entered  the  lower  part  of  the 
leg  inside  the  gastrocnemius  tendon,  and  emerged  on  the  outer  side  of  the  leg  near  the  crest  of  the  tibia  and  six  inches  from 
the  knee  joint.  On  October  15th  a  fragment  of  lead  was  cut  out  from  the  outer  part  of  the  leg  near  the  wound.  Subsequently 
a  sinus  formed  up  the  intermuscular  space  for  four  inches,  for  which  incisions  and  poultices  were  applied,  eight 
pieces  of  tibia  being  removed  during  the  treatment.  Towards  the  last  week  in  November  the  patient  was  doing 
well.  On  December  3d  a  small  portion  of  the  fibula  above  the  malleolus  was  excised.  The  bones  were  found 
considerably  necrosed,  and  amputation,  it  was  thought,  would  be  necessary.  On  the  next  day  the  wound 
looked  badly,  the  patient  suffered  a  great  deal,  and  amputation  at  the  upper  third  was  performed  by  flap  method 
by  Acting  Assistant  Surgeon  A.  V.  Cherbonnier.  In  the  following  night  the  stump  had  to  be  re-opened  in 
order  to  arrest  hasmorrhage  from  some  of  the  small  vessels,  persulphate  of  iron  being  used ;  and  when  the 
bleeding  ceased  dry  lint  was  applied.  By  December  17th  the  soft  parts  of  the  stump  were  much  retracted,  the 
ends  of  both  bones  exposed  and  necrosed,  and  there  was  an  apparent  effort  at  formation  of  an  involucrum. 
Ten  days  later  the  granulations  were  healthy  and  the  patient's  condition  had  improved."  On  December  29th 
the  man  was  transferred  to  hospital  No.  G,  and  subsequently  to  No.  1.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A., 
in  charge  of  the  latter,  recorded  the  following  result  of  the  case:  "Secondary  amputation  of  the  thigh  was 
performed  at  the  junction  of  the  middle  and  lower  thirds  of  the  femur  by  Surgeon  J.  B.  Lewis,  U.  S.  V.,  on 
January  15,  1863.  The  patient  progressed  favorably  until  February  4th,  when  secondary  hsemorrhage  super 
vened,  which  was  checked  only  by  ligation  of  the  femoral  at  the  point  of  election.  February  15th,  patient 
about  the  same;  pulse  135  and  rather  quick;  tongue  red  and  dry;  sloughing  condition  of  stump  disappeared 
and  healthy  granulations  commencing.  Brandy  administered  every  half  hour;  also  beef-tea  and  cod-liver  oil. 
After  this  the  patient  began  to  do  well;  appetite  better;  pulse  much  stronger;  stump  beginning  to  heal.  On 
February  21st  the  ligature  was  removed  from  the  femoral.  On  March  5th  the  patient  was  slightly  etherized, 
and  a  piece  of  dead  bone  about  one  and  a  half  inches  in  length  was  sawn  off  from  the  end  of  the  femur;  some 
small  pieces  were  taken  out  with  the  forceps;  patient  doing  well  otherwise;  stump  dressed 
with  adhesive  strips  and  cold  water.  For  about  two  weeks  after  this  the  patient  still 
improved  and  felt  quite  comfortable;  stump  assuming  a  better  appearance.  At  an  exam 
ination  on  March  19th  a  sinus  was  discovered  to  be  extending  up  on  the  posterior  aspect  to  about  the  middle 
of  the  stump,  and  the  bone  was  found  to  be  dead  when  felt  by  the  probe,  with  indications  that  the  process 
of  separation  was  going  on;  discharges  copious,  offensive,  and  of  a  dark  color.  Poultices  were  continued 
after  syringing  the  parts  with  soda  wash,  and  brandy,  with  generous  diet,  was  ordered.  By  March  23d  the 
patient's  general  health  was  quite  poor  and  he  had  hut  little  appetite;  stump  not  looking 
very  healthy,  there  being  considerable  necrosed  bone  to  come  away;  suppuration  not  as 
healthy  as  before.  Two  days  later  the  patient  was  worse  and  weaker;  tongue  coated; 
teeth  covered  with  sordes ;  appetite  poor;  stump  suppurating  pretty  freely  and  still 
having  an  offensive  odor  about  it,  hut  integuments  looking  healthy.  On  March  28th  the 
patient  complained  of  soreness  over  the  shoulder;  general  health  about  the  same;  stump 
looking  rather  better;  appetite  improving.  On  March  30th  he  was  quite  weak;  tongue 
coated  and  dry;  pulse  140;  skin  dry  and  getting  more  yellow;  stump  doing  poorly; 
discharge  unhealthy.  Extensive  necrosis  of  the  femur  was  felt  by  the  probe;  wound 
syringed  with  acid  and  soda  wash  alternately  and  poultices  applied.  The  next  day  the 
patient  failed  rapidly.  At  1  P.  M.  he  had  a  slight  haemorrhage  from  the  opening  in  the 
stump,  losing  about  one  and  a  half  ounces  of  blood.  No  bleeding  vessel  could  be  found. 
Death  occurred  at  4  P.  M.  On  examining  the  chest  eleven  hours  after  death  ihe  left 
lung  was  found  thinly  studded  with  tubercles;  lower  lobe  of  right  lung  thickly  studded 
in  upper  and  middle  portion ;  middle  lobe  a  complete  mass  of  tubercular  matter  and  filled 
here  and  there  with  abscesses  from  the  size  of  a  chestnut  to  that  of  a  pullet's  egg;  upper 
lobe  in  the  same  condition.  Heart  normal  in  size;  liver  somewhat  enlarged  and  very 
fatty;  spleen  very  much  enlarged  and  highly  congested;  kidneys  enlarged  and  fatty, 
and  pelvis  containing  a  large  amount  of  phosphatic  deposit  on  right  side,  also  renal  cal 
culi  in  upper  portion  of  urethra.  Specimen  3818  (FlG.  315),  consisting  of  the  stump  of 
the  femur,  shows  extensive  necrosis  from  the  seat  of  the  operation  to  within  an  inch  of 
the  trochanter  minor,  the  shaft  on  the  outer  &ide  being  thinly  covered  with  an  involucrum. 
On  the  posterior  surface  the  involucrum  is  bare  from  the  end  of  the  bone  to  within  three 
inches  of  the  trochanter  major,  it  having  been  broken  down  by  ulcerative  process,  while 
on  the  anterior  portion  of  the  shaft  the  sequestrum  is  exposed  at  several  points  from  the 
same  cause.  The  neck  of  the  bone  was  observed  to  be  very  short  and  its  head  quite  large.  Specimen  3983  (FlG.  31(i)  com 
prises  :i  portion  of  the  external  iliac  and  femoral  arteries,  including  the  occluded  portion  of  the  latter,  also  part  of  the  profundu 
and  anastomotica  magna,  the  end  of  which  is  covered  with  adipose  tissue."  The  amputated  portions  of  the  bones  of  the  leg 
(Spec.  748),  contributed  by  Surgeon  Hewit,  are  shown  in  wood-cut  (FlG.  314),  exhibiting  the  fibula  with  loss  of  substance  of 
one  inch  in  the  lower  third,  and  the  adjacent  portion  of  the  tibin.  which  is  superficially  necrosed,  while  the  superior  portion  of  the 
fibula  shows  increased  periosteal  action. 

CASE  790. — Private  J.  E.  Eames,  Co.  F,  112th  New  York,  aged  23  years,  was  wounded  in  the  left  leg,  during  the  assault 
on  Fort  Fisher,  January  15,  1865.     He  was  conveyed  to  New  York,  and  entered  McDougull  Hospital  at  Fort  Schuyler  ten 


FIG.  315.— Stump 
of  left  femur.  Spec. 
3818. 


Flu.  316.— Portions 

i.-f  external  iliac,  fem 
oral,  profundu.  nml 
anastom  imi'j;.:  femor 
al  ligated.  Sjjec.  U08:(. 


SECT.  V.] 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


541 


days  after  receiving  the  injury.  Assistant  Surgeon  S.  H.  Orton,  U.  S.  A.,  who  amputated  the  wounded  limb,  made  the  follow 
ing  report:  "The  wound  was  caused  by  a  minis'  ball  striking  the  outer  aspect  one  and  a  half  inches  above  the  ankle,  passing 
downward,  inward,  and  a  little  backward,  and  emerging  at  the  internal  border  of  the  tendo-achillis.  At  the  time  of  the  ampu 
tation,  February  28th,  the  muscles  were  pale  and  flabby  and  there  was  not  much  retraction.  The  operation  was  performed  by 
the  circular  method  about  three  inches  below  the  patella,  the  spine  of  the  tibia  being  sawn  off'  after  severing  the  bones.  Tlie 
soft  parts  were  cut  above  the  division  of  the  popliteal,  so  that  was  the  only  artery  requiring  ligation.  After  severing  the  limb 
the  incised  edges  of  the  integuments  were  brought  together  and  held  by  a  suitable  number  of  sutures.  Chloroform  was  used 
and  the  patient  passed  through  the  operation  very  well;  in  the  evening  his  general  appearance  was  better  than  it  had  been  for  a 
week.  Water  dressings  were  applied  and  oakum  to  catch  the  discharge.  Stimulants,  tonics,  and  a  most  nourishing  diet  were 
administered.  On  March  3d  the  ligature  came  away;  stump  looking  healthy ;  discharge  free ;  pulse  120.  The  integument  over 
the  upper  part  of  what  remained  of  the  spine  of  the  tibia  ulcerated,  exposing  a  small  portion  of  the  bone.  The  patient  died  of 
exhaustion  March  17,  186.">.  An  examination  of  the  amputated  limb  showed  that  the  ball  had  passed  through  the  base  of  the 
external  malleolus  and  grazed  the  external  border  of  the  articulating  surfaces  of  the  tibia  and  astragalus,  both  of  which  were 
apparently  necrosed.  The  whole  ankle  joint  was  filled  with  pus,  as  was  also  the  articulation  between  the  astragalus  and 
scaphoid  bone.  The  soft  parts  were  cedematous  and  filled  with  sinuses  running  in  every  direction.  The  foot  presented  the 
anatomical  curiosity — though  not  bearing  on  the  case — of  containing  six  toes,  the  supernumerary  one  being  situated  between 
the  normal  fourth  and  fifth.  On  dissection  it  was  found  that  there  were  only  five  metatarsal  bones,  but  the  fifth  was  double  the 
natural  size  in  breadth  and  had  two  phalangeal  articulations.  The  patient  stated  that  both  his  father  and  grandfather  were 
afflicted  with  the  same  deformity.  His  right  foot  was  normal." 

CASE  791. — Private  H.  Loud,  Co.  A,  183d  Pennsylvania,  aged  18  years,  was  wounded  at  the  Wilder 
ness,  May  8,  1864.  Surgeon  J.  E.  Pomfret,  7th  New  York  Artillery,  reported  his  admission  to  the  field 
hospital  of  the  1st  division,  Second  Corps,  with  '''wound  of  left  ankle  by  a  musket  ball."  Surgeon  N.  R. 
Moseley,  U.  S.  V.,  who  amputated  the  fractured  limb,  reported  the  following  result  of  the  case:  "The 
wounded  man  was  admitted  on  May  28th  to  Emory  Hospital,  Washington,  where  the  soft  parts  became 
gangrenous  and  the  bones  of  the  ankle  joint  necrosed;  tibia  and  fibula  denuded  of  periosteum  some  three 
inches  above  the  wound.  Flap  amputation  of  the  leg  at  the  junction  of  the  upper  and  middle  thirds  was 
performed  on  August  23d,  chloroform  and  ether  constituting  the  anaesthetic.  The  after-treatment  consisted 
of  cold-water  dressings,  tonics,  stimulants,  and  nourishing  diet.  Redundant  granulations  required  the 
application  of  caustics  about  three  weeks  after  the  amputation.  The  patient's  condition  varied  much  after 
the  operation,  alternately  recuperating  and  declining.  He  became  weaker,  yet,  being  young,  hopes  were 
entertained  of  his  recovery  until  within  a  couple  of  weeks  of  his  decease,  when  his  appetite  failed  and  he 
sank  rapidly.  Death  occurred  on  October  14, 1864,  from  exhaustion  and  nervous  irritability."  The  bones  of 
the  stump  (Spec.  3318),  exhibiting  but  little  healthy  action  and  showing  sequestra  which  are  about  separating 
from  each  bone,  were  contributed  to  the  Museum  by  the  operator,  and  are  represented  in  the  adjoining  wood-cut  (FlG.  317). 

TABLE   LXXVI. 

Summary  of  One  Hundred  and  Thirty-three  Secondary  Amputations  in  the  Upper  Third  of  the  Leg 

for  Shot  Injury. 

[Recoveries,  1—96;  Deaths,  97—133.] 


FIG.  317.— Bones  of 
stump  of  left  leg  seven 
weeks  after  ampnta- 
tion.  Spec.  3318. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NASIK,  MILITAHY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPEUATIOXS,  OPERATORS, 
RESULT. 

1 

Allbee,    O.   S.,   Pt.,    K, 

May  15, 

Left  ;   flap.     Discharged   March 

11 

Brown,    L.  K.,  Pt..    H, 

Au.29,'62, 

Left;   flap.     Surg.  D.  W.  Bliss, 

102d  Illinois,  age  18. 

J'yl'7,'64. 

29,  1865. 

Purnell  Legion,  Mary 

Jan.  8,'G4. 

U.  S.  V.     Discharged   August 

2 

Andrews.  S.  B.,  Ft.,  F, 

May  10. 

Right  :  flap.     A.  A.  Surg.  \V.  S. 

land  Vols.,  age  19. 

18,  1864. 

72d  New  York,  age  28. 

Sept.  27, 

Ward.     (May  1  0,  resection  of  2i 

12 

Busby,  T.,  Pt,,   F,   19th 

N'v30,'64, 

Left  ;  oval  skin  flap.     Surg.  B.  B. 

18G4. 

ins.  of  tibia;  necrosis.)    Disch'd 

South  Carolina,  age  23. 

Feb.  20, 

Breed,  U.  S.  V.     Transferred  to 

November  27,  1864. 

1865. 

Provost  Marshal  May  6,  1865. 

3 

Atkinson,  C.  T.,  Serg't, 

Sept.  17, 

Right  ;  flap.     A.  Surg.  J.  S.  Em 

13 

Chapin,    II.,   Capt.,   D, 

Sept.  20. 

Right.    A.  A.  Surg.  C.  C.  Shoyer. 

G,  llth  Ohio,  age  27. 

Oct.  21, 

erson,  9th  N.  Hampshire.     Dis 

27th  Illinois. 

Nov.  27, 

Discharged  September  20,  1864. 

1862. 

charged  January  16,  1863.   Died 

1863. 

December  3,  1870. 

14 

Chapman,  H.  E.,  Pt.,  A, 

Aug.  2!", 

Right.  Surgeon  C.  Page,  U.  S.  A. 

4 

Barraby,  M.,  Pt.,  1,  12th 

Nov.  1, 

Left  ;    circular.      Ass't  Surg.  C. 

6th  Now  Hampshire. 

Oct.  4,'62. 

Discharged  March  8,  1863. 

Vermont,  age  27. 

Dec.  20, 

Wagner,  U.  S.  A.     Discharged 

15 

Charlemaine,  A.,  Pt.,  A, 

May  31, 

Right.     Discharged  March  6,  '63. 

18G2. 

May  17,  1863. 

5jth  New  York. 

J'y21,'62. 

5 

Bartram,  A.  E.,  Corp'l, 

Sept.  2f), 

Left  ;  circular.    A.  A.  Surg.  T.  S. 

16 

Connor.   J.    0.,    Pt.,   C, 

July  22, 

Right.     Surg.  —  Cooper,  C.  S.  A. 

I,  8th  Connecticut,  age 

Dec.  15, 

Bartram.    (Haemorrhage.)    Dis 

27th  Yirginia. 

Sep.  -,"61. 

Recovered. 

21. 

1864. 

charged  August  23,  1865. 

17 

Cook,  J.,  Pt.,  H,   101st 

May  25, 

Right;  oval  flap.     A.  A.  fV.rg.  J. 

6 

Bates,    E.    G.,    Pt.,    A, 

June  14, 

Left:  circular.    Discharged  April 

Illinois,  age  19. 

Aug.  10, 

O'Connor.   Dischnr<.-vd  January 

12:!dOhin,  age  19. 

Au.14,'63. 

26,  1864. 

1864. 

24,  1865. 

7 

Becker,   11.,    Corp'l,   G, 

April  8, 

Right  :  ant.  posterior  flap.     Surg. 

18 

Copas,   W.  II.,  Pt.,  B, 

Sept.  19, 

Right  ;  circular     Surgeon  Z.  E. 

K!2dNe\v  York,  age  30. 

May  13, 

F.  Bacon,  U.  S.  V.     Discharged 

36th  Ohio,  age  28. 

Oct.  26, 

Bliss,  U.  S.  Y.     Haemorrhage. 

1864. 

August  12,  1864.     Spec.  4313. 

1864. 

Oct.  27,  ligation  of  post,  tibial 

8 

Berry,  YV.  F.,  Corp'],  G, 

.May  22, 

Loft;  flap.     Ass't  Surgeon  H.  R. 

artery.     Dis.'h'd  June  5,  1865. 

7tb  Missouri. 

Oct.  <!, 

Tilton,   U.   S.  A.      Discharged 

19 

Copeland,  M.,  Pt.,  B,  2d 

Aug.  10, 

Right;  circular  skin  flap.     Surg. 

1863. 

May  20,  1864. 

Colored   Cavalry,  age 

Oct.  24, 

F.  E.  Piquette,  86th  C.  Troops. 

9 

Brashear,  K.  H.,  Pt.,  H, 

July  2, 

Left.     Surgeon  R.  Batty.  C.  S.  A. 

28. 

1865. 

Discharged  January  16,  1866. 

3d  Arkansas,  age  20. 

Sept.  1, 

Transferred  for  exchange  Nov. 

20 

Coyle,  C.  D.,  Pt.,  D,  83d 

June  27, 

Left;  flap.     Ass't  Surg.  R.  Bar- 

1863. 

12,  1863. 

Pennsylvania. 

Aug.  1, 

tholow,  U.  S.  A.      Discharged 

10 

Brown,  W.,  Pt.,  C,  15th 

Aug.  7, 

Right  ;  ant.  posterior  flap.    Surg. 

1862. 

May  3,  1863. 

Infantry,  age  30. 

Oct.  18, 

B.  B.  Breed,  U.  S.  V.,  and  A.  A  . 

21 

Crawford,  H.  M.,  Corp'l, 

April  8. 

Left:  anterior  posterior  flap.     A. 

1864. 

Surg.  R.  McNeilly.   Discharged 

K,  116th  N.  Y.,  age  28. 

May  16, 

A.  Surg.  H.  Smilli.  Discharged 

May  23,  1865. 

1864. 

July  14,  1864. 

542 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AXD  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

22 

Crist,  A.,  Pt.,  F,  70th 

April  2, 

Right  ;  flap.    Surg.  A.  B.  Hasson, 

52 

Leighton,  B.  D.,  Pt.,  I, 

June  4, 

Left,    Dr.  O.  H.  Bradley,  of  East 

New  York. 

June  26, 

U.  S.  A.     Discharged  Septem 

9th  New  Hampshire. 

July  29, 

Jaffrey,  N.  H.   Discharged  Feb 

1862. 

ber  8,  1862. 

1864. 

ruary  11  ,  1865. 

23 

Daily,  P.,  Ft.,  E,  48th 

Oct.  —  , 

;  flap.  Surgeon  —  Holt,  16th 

53 

Lester,  J.  II.,  Pt.,  F,  1st 

June  27, 

Left;  posterior  flap.    A.  A.  Surg. 

Mississippi,  age  25. 

20,  '63. 

Miss.     Recovered. 

New  Jersey,  age  20. 

1862, 

R.  A.  Cleeman.  Gangrene.  Dis 

24 

Dawley,  1).,  Pt.,  I,  9th 

June  2, 

Right  ;  circular.  Discharged  May 

Feb.  8, 

charged  December  24,  1863. 

Indiana,  age  22. 

J'y  6,  '64. 

15,  1865. 

1863. 

25 

Dimock,  H.,  Pt.,  K,  52d 

May  31, 

Left  ;   flap.    Dr.  J.  D.  Lewis  of 

54 

Logan,  W.  J.,  Pt.,  K,  91h 

Aug.  30, 

Left.     Dr.  J.  Kirker,  of  Alleghe 

Pennsylvania,  age  20. 

1862, 

Truraansburg,    N.  Y.     Disch'd 

Penn.  Reserves. 

Dec.  23, 

ny,  Penn.    1869,  popliteal  aneur 

Feb.  12, 

April  21,  1863. 

1869. 

ism  ;  dry  gangrene.    Recovered. 

1867. 

55 

Loughlin,  J.,  Pt.,  K,  67th 

July  2, 

Left  ;  flap.     Surgeon  S.  D.  Gross, 

26 

Corn,  D.  H.,  Pt.,  E,  1st 

June  12, 

Left;  flap.     Discharged  May  15, 

New  York,  age  22. 

Sept.  16, 

U.  S.V.    (Erysipelas.    July  26, 

Cavalry,  age  23. 

Sept.  25, 

1865. 

1862. 

Pirogoff's  amp.  at  ankle  joint.) 

1864. 

Disch'd  July  -J9,  '63.     Spec.  214. 

27 

Eberhart,  A.  L.,  Pt.,  1st 

Sept.  12, 

Left.  Dr.W.L.Clemmer,  Browns 

56 

MeCarty,  C.,  Corp'l,  E, 

June  30, 

Rigbt.    Ass't  Surg.  W.  S.  Forbes, 

W.  Virginia  Cavalry. 

1862, 

ville,  Penn.    Recovered. 

1st  New  York,  age  28. 

Aug.  28, 

U.  S.V.     (Excision  of  3  ins.  of 

J'el8,'63. 

1862. 

tibia.)  Discharged  May  11,  1863. 

28 

Field,  B.,  Pt.,  C,  27th 

Sept.  17, 

Right;  flap.     A.  A.  Surg.  A.  V. 

Died  August  21,  1867. 

North  Carolina,  age  21. 

Nov.  28, 

Cherbonnier.    Dec.  1,  secondary 

57 

McLain,  D.  P.,  Pt.,  F, 

Sept.  17, 

Right;    flap.      Discharged   May 

1862. 

haem.;  lig.  of  popliteal  artery; 

4th  Cavalry,  age  21. 

Dec.  22 

26,  1865. 

recurrence.    Exch'd.    Spec.  751. 

1863. 

29 

'Finnigan,  P.,  Pt.,  F, 

June  2, 

Right;  circular.     Ass't  Surg.  W. 

58 

Macomber,  G.  W.,  Pt., 

July  2, 

Left;   ant.  posterior  flap.     (Gan 

1st  Confederate  Bat'ry. 

Aug.  20, 

F.Richardson,  C.  S.  A.     (June 

1C,    126th    New   York, 

Sept.  10, 

grene.)      Discli'd  May  3,  1864. 

1864. 

3,  Chopart'soperat'n.)   Recov'd. 

age  20. 

1863. 

Spec.  4303. 

30 

Fisher,  J.  P.,  Pt.,  A,  7th 

Aug.  16, 

Right.      Surg.  E.  P.  Smith.  7th 

59 

Masten,  D.,  Pt.,  G,  4th 

Ap.15,'64, 

Left.     Surg.  G.  R.  Bibb,  of  Jack 

Missouri  Cavalry. 

Sept.  —  , 

Slissouri.   Discharged  February 

Illinois  Cavalry. 

April  —  , 

sonville,   Illinois.     (Discharged 

1862. 

6,  1863. 

1866. 

September  17,  1864.) 

31 

Fisher,  P.  B.,Pt.,  1,  113th 

June  22, 

Right  ;  circular.     Ass't  Surg.  G. 

60 

Moran,  S.,  Pt.,  G,  26th 

July  2, 

Right  ;  flap.   A.  A.  Surgeon  J.  E. 

Ohio,  age  27. 

July  28, 

W.  Burke,  4(ith  Penn.     Disoh'd 

North  Carolina,  age  24. 

Oct.  28, 

Steele.   Nov.  8,  profuse  hemor 

1864. 

June  26,  1865. 

1863. 

rhage;  flaps  laid  open;  slough 

32 

Flanders,  G.  C.,  Pt.,  E, 

Mar.  23, 

Left;  flap.     Dr.  J.  C.  Reeves,  at 

ing.     Trans,  to  Fort  Delaware 

8th  Ohio,  age  18. 

1862, 

Dayton,  Ohio.     Recov'd.     Died 

April  19,  1864. 

J'e  17,  '68. 

June  16,  1872.    Spec.  5580. 

61 

3  Mullen,  F.,  Pt.,  E,  43d 

May  3, 

Left;  double  flap.     Surg.  J.   A. 

33 

Flynn,  M.,  Pt.,  A,  24th 

Aug.  30, 

Right.    Ass't  Surg.  J.  M.  Palmer, 

New  York,  age  23. 

1863, 

Lidell,  U.  S.  V.  Disch'd  Sept.  5, 

New  York. 

Oct.  21, 

85th  N.  Y.   Discharged  Septem 

Jan.  <>, 

1864.     Spec.  2022.    Died  March 

1862. 

ber  26,  1863. 

1864. 

5,  1871. 

34 

French,   B.  F.,  Pt.,   H, 

July  18, 

Right  ;  ant.  posterior  flap.     Ass't 

62 

Newman,  D.  J.,  Pt.,  G, 

June  27, 

Left  ;  circular.     A.  A.  Surg.  J.  C. 

7th    New    Hampshire, 

Sept.  19, 

Surgeon  J.  F.  Weeds.  U.  S.  A. 

24th  Wisconsin,  age  16. 

July  31, 

Thorp.     (Gangrene.)      Discli'd 

age  21. 

1863. 

Disch'd  Oct.  7,  1864.   Spec.  4373. 

1864. 

April  9,  1865. 

35 

Gilson,  D.,  Corp'l,  G,  2d 

Sept.  17, 

Left;  flap.    Dr.  N.  J.  Moore,  of 

63 

Newton,  J.  W.,  Pt.,  E, 

July  3, 

Right  ;  circular.     (July  16,  amp. 

U.  S.  Sharpshooters. 

1862, 

Nashua,  N.  H.    Disch'd  March 

14th  Virginia,  age  24. 

Aug.  10, 

foot,  Pirogofr's  opera.;   slough 

Sept.  17, 

2,  1863. 

1863. 

ing.)    Recovered.     Transferred 

1863. 

for  exchange  Nov.  12,  1  863. 

36 

Goldsmith,  W.H.,  Corp'l, 

June  9, 

Left  ;  circular.     A.  A.  Surg.  J.  S. 

64 

Norris,  E.,  Civilian,  age 

April  16, 

Right  ;  circular.     Ass't  Surg.  J. 

F,  2d  New  Hampshire, 

May]  5, 

Ross.     (June  0,  1804,  res.  4  ins. 

20. 

June  2, 

E.  Semple,  U.  S.  A.     Disch'd 

age  24. 

1865. 

tibia.)     Disch'd  Oct.  14,  1865. 

1864. 

July  17,  1864. 

37 

Grason,   J.   A.,  Pt.,  D, 

Aug.  28, 

Right  ;  flap.     Dr.  J.  R.  Ramsey, 

65 

Ougheltree,  G.,  Serg't., 

June  27, 

Right.     (Also  fracture  of  skull.) 

6th  West  Virginia. 

1864, 

of  Clarksburg,  West  Virginia. 

A,  12~th  Infantry. 

July  28, 

Transferred  to  Veteran  Reserve 

Au.8,  '65. 

Recovered. 

1862. 

Corps  August  14,  1863. 

38 

Green,  H.  R.,  Pt.,  F,  8  1st 

De.31,'C2. 

Left  ;   flap.     Surg.  F.  Seymour, 

66 

Perigo,  R.,  Pt.,  G,  66th 

Aug.  14, 

Left;  flap.     Discharged  June  9, 

Indiana. 

Mar.  6, 

U.  S.  V.     Discharged   August 

Ohio,  age  44. 

Se.  L'0,'64. 

JS65.     Died  September  4,  1866. 

1863. 

1,  1863. 

67 

Perrin,  F.,  Pt.,  H,  8th 

Nov.  30, 

Left  :  bi-latcral  skin  Hap  and  ciro, 

39 

Gurley,  \V.,  Pt.,C,  llth 

May  12, 

Right.     Dr.  H.  J.  Bigelow,  at  the 

Arkansas,  age  25. 

1864, 

section  of  muscles.    A.  A.  Surg. 

Infantry,  age  18. 

1864, 

Mass.  Gen'l  Hosp.     (June  1,  '64, 

Jan.  2, 

M.  L.  Herr.     Trans,  to  Provost 

Feb.  18, 

amp.  at  ankle  joint.     Necrosis.) 

1865. 

Marshal  May  6,  1865. 

1868. 

Disch'd  Feb.  7,  '65.     Spec.  2421. 

68 

Phillips,  J.  L.,  Serg't,  C, 

Sept,  17, 

Right  ;  flap.     Discharged  March 

40 

Ilaire,  1!.  11.,  Corp'l,  E, 

July  2, 

Left  ;    circular.     Surgeon   G.  L. 

104th  New  York. 

Oc.18,'62. 

23,  1863. 

31st  Illinois,  age  32. 

Aug.  10, 

Lucas,    47th    111.     (Gangrene.) 

69 

Pierce,   O.  H.,   Pt.,   H, 

June  30, 

.  Surgeon  W.  A.  Carrington, 

1864. 

Discharged  June  22,  1865. 

38th  North  Carolina. 

Au.—  ,'62. 

C.  S.  A.     Recovered. 

41 

Hale,    H.,    Pt.,  E,  84th 

May  12, 

Left.     Dr.  G.  L.  Potter,  of  Julian 

70 

Powell,  T.,  Pt.,  F,  6th 

Jan.  15, 

Left  ;  circular.     Ass't  Surg.  S.  H. 

Pennsylvania,  age  20. 

1864, 

Furnace,  Penn.     Disch'd  April 

Colored  Troops,  age  30. 

April  26, 

Orton,  U.  S.  A.     (Jan.  15,  exo. 

Jan.8,'69. 

27,  1865. 

1865. 

3ins.  tibia.)   Disch'd  Oct.  14,'65. 

42 

Harback,  31.,  Pt.,  D,  5th 

May  27, 

Right;  circular.     Ass't  Surg.  T. 

71 

Pyne,  C.  M.,  Lieut.,  I, 

Aug.  30, 

Left;  bi-lateral  flap.     Dr.  W.  II. 

Kentucky,  age  21. 

Sept.  6, 

A.  McGraw,  U.  S.  V.    Disch'd 

6th  Infantry. 

1862, 

Van  JSuren  of  New  York.     Re 

1864. 

June  9,  1865. 

M'y4,'64. 

tired  December  15,  1870. 

43 

Hatch,  D.  A.,  Pt.,  C,  2d 

July  3, 

Right  ;  ant.  posterior  flap.    Surg. 

72 

Redding,  J.,  Pt.,  K,  42d 

Sept.  20, 

Left  ;  circular  flap.     Surg.  J.  Y. 

Massachusetts,  age  23. 

Dec.  16, 

C.  W.  Jones,  U.  S.  V.     Disch  d 

Illinois,  age  28. 

1863, 

Finloy,  2d  Kentucky  Cavalry. 

1863. 

April  2,  1864.     Spec  .  2155. 

Jan.  17, 

Discharged  Sept.  29,  1864. 

44 

Hitchcock,  J.  N.,  Pt.,  F, 

Hay  15, 

Left  ;  flap.     A.  A.  Surg.  A.  Trau. 

1864. 

34th  Massachusetts. 

Sep.5,'64. 

Discharged  April  19,  1865. 

73 

Renold,  C.  D.,  Pt.,  D, 

No.25,'63, 

Left  ;  circ,  flap.    Ass't  Surg.  B.  E. 

45 

Hubbard,  J.  A.,  Corp'l, 

Sept.  5, 

Right  ;  flap.    Discharged  Decem 

37th  Ohio,  age  22. 

Feb.  26, 

Fryer,  U.  S.  A.     Disch  d  Aug. 

A,  115th  New  York. 

Oct.  9,  '62. 

ber  30,  1862. 

1864. 

24,1864.    Died  August  17,  1870. 

46 

Hyatt,   D.,    Pt.,  C,  4th 

June  18, 

Left  ;  flap.     A.  A.  Surg.  A.  Trau. 

74 

Rhodes,  J.  H.,  Pt,,   A, 

No.25,'63, 

Left  ;  flap.     Ass't  Surgeon  A.  G. 

Delaware,  age  52. 

Nov.  18, 

(Erysipelas.)    Discharged  June 

33d  Ohio,  age  30. 

Jan.  13, 

Albright,  79th  Penn.     Disch'd 

1864. 

3,  1865. 

1864. 

July  15,  1864. 

47 

Jenni,  P.,  Serg't,  C,  Jef 

Sept.  11, 

Right.    (Also  flesh  w'nd  of  chest  ; 

75 

Ross,  C.,  Lieut.,  E,  26th 

July  2, 

Left.    Discharged  June  18,  1864. 

ferson  Co.  State  Militia, 

Oct.  18, 

hsem.  from  anterior  tib.  artery.) 

Pennsylvania,  age  41. 

—  ,  ''63. 

Died  November  30,  1866. 

age  23. 

1862. 

Discharged  January  19,  1863. 

76 

Runyan,  C,A.,  Musician, 

May  3, 

Left.     Dr.  L.  Briggs  of  Auburn, 

48 

Kellerman,  31.,   Pt.,  D, 

May  2, 

Left,    Surg.  D.  W.  Bliss,  U.  S.  V. 

F,  9th    N.  Y.    Heavy 

Oct.  17, 

N.  Y.  (  May  3,  excision  of  tibia.) 

75th  Penn.,  age  48. 

June  18, 

(Haemorrhage.)     Disch'd  June 

Artillery,  age  19. 

1863. 

Discharged  July  26,  1865. 

1863. 

15,  1864.    Spec.  1273. 

77 

Sampson,  T.,  Pt.,H,  46th 

Sept.  8, 

Left  ;  flap.   Ass't  Surg.  J.  II.  Ben* 

49 

2  Kelly,  J.F.,  Pt.,A,26th 

July  28, 

Right.    Ass't  Surg.  A.H.Powell, 

Colored  Troops. 

Oct.  11, 

nett,  46th  Colored  Troops.    Dis 

Alabama,  age  25. 

Oc.18,'64. 

P.A.C.S.  (Gangrene.)  Recov'd. 

1864. 

charged  March  9,  1  865. 

50 

Keyes,  C.  W.,  Lieut.,  E, 

May  12, 

Left;  flap.  Dr.  P.  Dyer,  of  Maine. 

78 

Schmidt,  C.,  Corp'l,  K, 

May  6, 

Right  (May  23,  1864,  lig.  of  ant. 

32d  Maine,  age  33. 

June  12, 

(June  8,  amp.  foot.)     Disch'd 

39th  New  York,  age  36. 

1864, 

tibial  art'v)  ;  ant.  posterior  flap. 

1864. 

September  27,  1864. 

Feb.  18, 

Surgeon  S.  B.  Ward,  U.  S.  V. 

51 

Lay,  R.,  Serg't,  E,  1st 

Dec.  18, 

Left;  flap.     Dr.  C.  P.  West,  at 

1865. 

Re-amputation    April    18,  1865. 

Kentucky  Light  Artil 

1864, 

Louisville,  Kentucky.    Disch'd 

Discharged  July  14,  1865. 

lery. 

Feb.  13, 

August  28,  1865. 

79 

Shinn,  W.  J.,  Serg't,  I, 

J'e  18,  '64, 

Right  ;  flap.    Surg.  D.  W.  Maull, 

1866. 

5th  New  Jersey,  age  25.  Ja.18,'65. 

1st  Delaware.     Discharged. 

1  SMITH  (STEPHEN),  Analysis  of  Four  Hundred  and  Thirty-nine  Recorded  Amputations  in  the  Continuity  of  the  Lower  Extremity,  in  United 
States  Sanitary  Commission  Memoirs,  Surgical  Volume  II,  New  York,  1871,  p.  140. 

s JONES  (J.),  Investigations  upon  the  Nature,  Causes,  and  Treatment  of  Hospital  Gangrene  as  it  prevailed  in  the  Confederate  Armies,  1861-1865, 
in  United  States  Sanitary  Commission  Memoirs,  New  York,  1871,  Surgical  Volume  II,  p.  292. 

*  LIUKLL  (J.  A.),  On  the  Major  Amputation  for  Injuries  in  both  Cieil  and  Military  Practice,  in  Am.  Jour.  Med.  Sci's,  1864,  Vol.  XLV1I,  N.  S.,  p.  376. 


SECT.  V.] 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


543 


No 

NAME,  MILITARY 
DESCRIPTION,  AXL>  A(;E. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION:,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

80 

Smith,  A.  A.,  Pt.,  A,  3d 

April  8, 

Right;  circular.     A.  A.  Snrg.  J. 

108 

Heddon,   N.,  Corp'l,  F, 

Aug.  13, 

Left  ;  ant.  post.  flap.    A.  A.  Surg. 

Rhode  Jsland  Artillery. 

July  10, 

W.  Gushing.     (April  9,  flap  am 

150th  New  York,  age 

Sept.  17, 

J.  C.  Thorpe.    (Gangrene  ;  diar 

1863. 

putation  left  leg.)      Discharged 

45. 

1864. 

rhoea.)    Died  September  22,  '64  ; 

August  25,  1864.     Spec.  1  103. 

haemorrhage. 

81 

Smith,  H.,  Pt.,  H,  :i2d 

Feb.  10, 

Left;   circ.     Stirg.  A.  II.  Thurs- 

109 

Jackson,  ir.,  Pt.,  K,  2d 

May  5, 

Left.     Teale's  method.    A.  Surg. 

Colored  Troops,  age  37. 

Mar.  29, 

ton,  U.  S.  V.     Discharged  July 

Florida. 

June  28, 

J.  S.  Billings,  U.  S.  A.    (Krvsip- 

1865. 

26,  1865. 

1862. 

elas.)    Died  July  6,  '62.   Spec.!. 

82 

Synead,  A.  J.,  Pt.,  Court 

Au.  9,  '62, 

Right.     Surg.  T.  II.  Howard,  C. 

110 

Jones,  M.  M.,Pt.,D,  19th 

May  5, 

Left  ;  circular.    A.  A.  Surg.  F.  C. 

ney's  Artillery. 

Aug.  9, 

S.  A.    Recovered.    Furloughed 

Michigan,  age  25. 

July  9, 

Leber.      Died   July  20,    1864; 

1863. 

November  26,  1864. 

1804. 

pyaemia. 

83 

Spencer.  C.,  Pt.,  A,  1st 

De.13,'62, 

Right;  flap.     Recovered.     Died 

111 

Keal,  J.,  Pt.,  H,  118th 

May  14, 

Left;    haemorrhage.    12    ounces. 

K.  Island  Light  Artil 

Dec.  28, 

in  1871. 

Ohio,  age  21. 

June  27, 

Died  Aug.  20,  1804  ;  exhaustion. 

lery,  age  32. 

it-69. 

1864. 

84 

Spicer,  J.,  Pt.,  K,  14th 

Mar.  9, 

Right.     Surg.  J.  M.  Daniel,  47th 

112 

Kingsbury,  A.,  Pt.,  D, 

June  26, 

Right.     A.  A.  Surg.  S.  D.  Gross. 

K'y  Cavalry,  age  £3. 

June  30, 

Kentucky.     Discharged  March 

22d  Massachusetts,  age 

Aug.  1, 

(Aug.  12,  haemorrhage  )     Died 

1863. 

24,  1864. 

18. 

1862. 

August  31,  1862;  enteritis. 

85 

Spivey,  L.  J.,  Serg't,  F, 

May  10. 

Right  ;  posterior  flap.     Surg.  — 

113 

Levisee,  L,  Pt.,  E,  18th 

April  6, 

.     Died   May  10,   1862;   py 

51st   X.  Carolina,   nge 

June  17, 

Sutton,    P.  A.  C.   S.      Retired 

Wisconsin. 

May  9, 

aemia. 

29. 

1864. 

December  19,  1864. 

1862. 

86 

Steinbeck,    A.,    Pt.,    A, 

Aug.  16, 

Right.     Dr.  J.  A.  McArthur,  Sol 

114 

Linn,    II.,    Pt.,   A,   6th 

Sept.  17, 

Left;  flap.     A.  A.  Surgeon  A.  V. 

5!>th  New  York,  age  23. 

186-1, 

diers'  Home,  Philadelphia.  (Dis 

Penn.  Reserves,  age  25. 

Dec.  4, 

Cherbonnier.    (Excision);  harm. 

April  12, 

charged  July  20,  1865.)    Recov 

1862. 

Jan.  15,  1863,  amp.  thigh  :  nee.; 

1866. 

ered.     Died  May  6,  18G8. 

lig.  of  fern.:  haem.     Died  March 

87 

Struble,    C.  W.,  Corp'l, 

July  3, 

Left;  flap.     Surgeon  H.  Pulmer, 

31  ,  1863.    Specs.  3818,  3983,  748. 

F,  3d  Infantry,  age  23. 

Aug.  5, 

U.  S.V.    Discharged  December 

115 

Loud,  H.,  Pt.,  A,  183d 

May  8, 

Left;  flap.     Surg.  N.  R.  Moseley, 

1663. 

8,  1863. 

Pennsylvania,  age  18. 

Aug.  23, 

U.  S.  V.    (Necrosis.)    Died  Oct. 

88 

Sullivan,  A.  W.,  Pt.,  F, 

Sept.  25, 

Left  ;  lateral  flap.     Surg.  L.  Slus- 

1864. 

15,  1864  ;  exhaust'n.    Spec.  3318. 

69th  Ohio,  age  20. 

Nov.  26, 

ser,  69th  Ohio.     March  3,  1864, 

116 

Lovell,    P.,    Corp'l,    C, 

Nov.  25, 

Left;   circular.     Ass't   Surg.  R. 

1803. 

spiculse  removed.     Furloughed 

10th  Missouri,  age  41. 

1863, 

Bartholow,  U.  S.  A.     (Primary 

March  12,  1804. 

Jan.  10, 

excis.;  haem.)    Jan.  15,  slough 

89 

Swallow,  II.  R.,  Serg't, 

May  18, 

Left;    flap.     Dr.   W.  G.  Breck, 

1864. 

ing;  erysipelas;  haem.     Feb.  2, 

G,  31st  Massachusetts. 

1804, 

Springfield,  Mass.    Recovered. 

amputation   thigh.     Died  Feb 

Dec.3,'68. 

ruary  3,  1864.     Spec.  2108. 

90 

Thompson,   II.,   Pt.,  K, 

May  3, 

Left  ;  circ.    A.  A.  Surg.  J.  B.  Cut 

117 

lMabry,  S.  D.,  Pt.,  G,  6th 

Sept.  17, 

Right.   Teale's  method.    (Gang.) 

Oth  Maine,  age  24. 

Sept.  —  , 

ter.     (June  9,  diseased  bones  of 

Alabama,  age  22. 

1862, 

Erysipelas  ;  diarr.     Died  March 

1863. 

foot  rem'd.)     Discharged  May 

Mar.  16, 

22,  '63  ;  exhaustion.    Spec.  3891  . 

14,  1864.     Spec.  4316. 

1863. 

91 

Vogel,  P.,  Pt.,  I,  6th  In 

June  27, 

Right.     Act.  Surgeon  G.  H.  Mar- 

118 

Marlett,  G.,  Pt..  M,  1st 

June  5, 

Left  ;  circular.    A.  A.  Surg.  A.  D. 

fantry,  age  25. 

1802, 

mion,  Soldiers'  Home,  Hampton. 

Michigan  Cavalry,  age 

July  19, 

Hall.     (Hasmorrh.)     Died  July 

June  27, 

(Also  w'nds  of  groin  and  skull. 

19. 

1864. 

19,  1864;  exhaustion. 

1879. 

Necrosed.    Rem.  of  fragments  — 

119 

Merrill,  J.  A.,  Pt.,  G, 

Nov.  30, 

Right.     Died  January  31,  1865; 

opening  in  occipital  bone.     Dis 

51st  Tennessee. 

1864, 

exhaustion. 

charged  Aug.  21,  1863.)     Specs. 

Jan.  —  , 

429,  6941. 

1865. 

92 

Wheeler,  C.  D.,  Corp'l, 

Feb.  10, 

Left;  circ.     Surg.  A.  H.  Thurs- 

120 

Moore,   J.,   Pt.,  E,   8th 

Dec.  13, 

Left  ;  flaps  of  skin  and  circ.  sect, 

15,  32d   Col'd   Troops, 

Mar.  16, 

ton,  U.  S.  V.     Discharged  Aug. 

Penn.  Reserves,  age  20. 

24,  '02. 

of  muscles.     Ass't  Surg.  G.  M. 

age  21. 

1865. 

17,  1865.     Died  Jan.  22,  1870. 

McGill,U.  S.A.   (Haemorrhage; 

93 

Wood,C.J.,Pt.,  II,  149th 

"May  3, 

Right.     Surg.  D.W.  Bliss.U.  S.V. 

diarrhoea.)     Died  Jan.  19,  1863  : 

New  York,  age  44. 

Aug.  1, 
1863. 

Discharged  November  16,  1863. 

121 

O'Connor,  J.,  Serg't,  C, 

May  3, 

pyaemia.     Spec.  4577. 
Left.     (Necrosis.)    Died  June  23, 

94 

Woomer,  E.  M.,  Corp'l, 

May  5, 

Left  ;  flap.    A.  A.  Surg.  E.  Harts- 

llth  Massachusetts. 

June  16, 

1863.     Spec.  1237. 

A,  -93d  Penn.,  age  21. 

July  21, 

home.     Discharged  September 

1863. 

1864. 

9,  1865.     Spec.  3678. 

122 

Patten,  W.  F.,   Pt.,  C, 

NOT.  30, 

Right  ;  ant.  posterior  flap.     Ass't 

95 

Worrell,  B.  F.,  Pt.,  A, 

April  14, 

Left.     A.  A.  Surg.  O.  F.  Scheldt. 

9th  Mississippi,  age  24. 

1864, 

Surgeon  J.  C.  Thorpe,  U.  S.  V. 

1st  New  Jersey. 

Nov.  —  , 

Discharged  January  5,  1863. 

Mar.  19, 

(Gangrene;    necrosis.)     Haem., 

1862. 

1865. 

12  oz.    March  24,  amp.  thigh. 

9C 

Wurth,  L.,  Pt.,  C,  41st 

Aug.  30, 

Left;  double  flap.     A.  A.  Surg. 

Died  April  20,  1865;  pyaemia. 

New  York,  age  27. 

Dec.  1, 

T.  O.  Bannister.      Discharged 

123 

Pierson,   J.  C.,  Pt.,  D, 

July  28, 

Right  ;  circular.     A.  A.  Surg.  E. 

1862. 

September  14,  1803. 

19th  Infantry,  age  16. 

Sept.  7, 

M.  Johnston.     Died  September 

97 

Brown,  A.  C.,  Serg't,  G, 

Aug.  15, 

Right;  flap.  Surg.  N.  R.  Moseley, 

1864. 

25,  1864;  pyaemia. 

13th    Penn.    Cavalry, 

Oct.  20, 

U.  S.  V.    Died  October  29,  1804  ; 

124 

Porter,  W.  C.,  Serg't,  F, 



Right.     Died  October  10,  1862. 

age  36. 

1864. 

exhaustion.     Spec.  3316. 

66th  Ohio. 

1862. 

Sp«c.  553. 

98 

Cates,  .1.  J.,  Pt.,  I,  4th 

Sept.  20, 

Left.     Died  May  18,  1864. 

125 

2  Rudolph,  J.,  Pt.,  E,4th 

June  3. 

Left  ;  ant.  post.  flap.     Surg.  J.  A. 

Kentucky,  age  22. 

1863, 

Michigan,  age  24. 

Aug.  27, 

Lidell,  U.  S.  V.   (Haemorrhage.) 

MayG,'64. 

1864. 

Died  Sept.  16,  1864  ;  exhaust'n. 

99 

Christiana,   G.,   Pt.,   A, 

Jiilv  2, 

Right.     Sept.  2,  haem.;  amputat'n 

126 

Sands,  P.  E.,  Serg't,  B, 

May  10, 

Right  ;  circular.  Surg.  O.  A.  Jud- 

120th  New  York,  age 

Aug.  10, 

thigh.     Died  September  25,  '63  ; 

1st  Sharpshooters,  nge 

Oct.  19, 

son,  U.  S.V.    (Hsemorrh.)    Died 

36. 

1803. 

exhaustion. 

31. 

1864. 

Nov.  4,  1864  ;  exhaustion. 

lOt 

Conrad,  A.,  Pt.,  H,  26th 

May  15, 

Right  ;  circular.     A.  A.  Surg.  N. 

127 

Slusser,  C.  C.,  Pt.,  H, 

May  2, 

.      (June  15,   haemorrhage.) 

Wisconsin,  age  22. 

Aug  3, 

R.  Morris.     (Gangrene.)     Died 

107th  Ohio,  age  21. 

June  15, 

Died  June  29,  1863. 

1864. 

August  25,  1864;  diarrhoea. 

1863. 

101 

Copeland,  A.  M.,  Lieut., 

Sept.  30, 

Right.    Surg.  Z.  E.  Bliss,  U.  S.  V. 

128 

Stevens,  W.  E.,   Pt.,   E, 

July  2, 

Right.    Died  September  4,  1863. 

C,  81st  New  York,  age 

Nov.  10, 

(Haemorrhage:  ligation.)    Died 

5th  Texas,  age  18. 

Aug.  3, 

25. 

1864. 

January  4,  1865. 

1863. 

102 

Craudall,  S  ,  Pt.,  G,  17th 

July  31, 

Left  ;  circular.    Surg.  A.  F.  Shel 

129 

Tanner,  N.  A.,  Pt.,  1,  2d 

July  16, 

Right.      (Hasmorrh.;   gangrene.) 

Michigan,  age  18. 

Sept.  1, 

don,  U.  S.  V.    Died  September 

Michigan. 

Sept.  26, 

Died  October  11,  1803;  pyaemia. 

1864. 

15,  1864  ;  exhaust'n.   Spec.  3126. 

1863. 

103 

Eames,   J.    E..    Pt.,    F, 

Jan.  15, 

Left  ;   circular.      Ass't   Surg.  S. 

130 

Twitchell,  S.  R.,  Pt.,  G, 

Sept.  17, 

Left  ;  flap.  A.  A.  Surg.  L.  Fisher. 

112th   New  York,  age 

Feb.  28, 

H.  Orton,  U.  S.  A.     (Necrosis.) 

89th  New  York,  age  25. 

1862. 

(Sloughing;    necrosis.)      Died 

23. 

1865. 

Died  March  17,  1865  ;  exhaust'n. 

Feb.  15, 

March  5,  1863  ;  pyaemia.     Spec. 

104 

Eubanks,  L.  M.,  Pt  ,  I, 

Nov.  24, 

Left  ;  circular.     Surg.  H.  J.  Phil 

1863. 

2067. 

30th  Alabama,  age  33. 

1804. 

lips,  U.  S.  V.    (Gangrene.)  Died 

131 

Vogle,  F.,  Pt.,  G,  74th 

July  1, 

Right  ;  flap.    A.  A.  Surg.  A.  Hew- 

November  30,  1864. 

Pennsylvania,  age  28. 

Aug.  13, 

son.  (Gangrene;  haem.)  Sept.  7, 

105 

Frazer,  P.,    Pt.,  B,  4th 

April  30, 

Right.    Died  September  18,  1863  ; 

1863. 

haem.;  lie.   femoral.     Sept.  19, 

Artillery,  age  24. 

June  28, 

diarrhoea. 

lig.  ext.  iliac.    Died  Oct.  6,  1863; 

1803. 

haemorrhage.     Spec.  2614. 

106 

Hand,  J.  C.,  Pt.,  C,  3d 

July  20, 

Right;  circular.  Ass't  Surg.  T.  A. 

132 

Whistler,    R.,    Pt.,    H, 

June  2, 

Right,     (June  2,  excision.)    Died 

Mississippi,  age  21. 

Sept.  22, 

McGraw,  U.  S.V.     (Necrosed; 

49th  Ohio. 

July  5, 

July  14,  1864  ;  pyaemia. 

1864. 

gangrene.)    Died  Sept,  26,  1864  ; 

1864. 

exhaustion. 

133 

Wilbur,  W.,  Pt,,  B,  1st 

May  8, 

Right;  circular.     A.  A.  Surg.  H. 

107 

Harness,  J.  C.,  Pt.,  A, 

Aug.  3, 

Right;  circular.     Ass't  Surg.  T. 

N.  York  Cavalry,  age 

July  6, 

B.  Butcher.    (May  28,  Pirogoff's 

33d  Ohio,  age  21. 

Sept.  22, 

A.  McGraw,   U.   S.  V.      Died 

27. 

1864. 

amputation  :  gangrene.)      Died 

1864. 

October  4,  1864. 

July  6,  1804  ;  exhaustion. 

'NOKTH  (A.),  Report  of  Sixty  Cases  of  Hospital  Gangrene,  in  The  American  Medical  Times.  1863,  Vol.  VI,  p.  255. 

2Lll)El.L  (J.  A.),  Gunshot  Wound  of  Right  Ankle  Joint  involving  Tibia  and  Attragalus,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume 

.  x-.^^t-    i Cfrn    ,      im 


I,  New  York,  1870,  p.  191. 


544 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


In  five  of  the  one  hundred  and  thirty-three  secondary  amputations  in  the  upper  third 
of  the  leg  re-amputation  in  the  thigh  became  necessary;  one  patient  survived  and  four 
succumbed  to  the  operation. 

Secondary  Amputations  in  the  Middle  Third  of  the  Leg  for  Shot  Injury. — -One 
hundred  and  seventy-four  cases  are  included  in  this  group;  one  hundred  and  thirty-seven 
terminated  successfully  and  thirty-seven  fatally,  a  mortality  rate  of  19.7  per  cent.  In 
eighty  instances  the  right  and  in  eighty-seven  the  left  limb  was  amputated,  and  in  seven 
cases  this  point  was  not  indicated. 

Recoveries  after  Secondary  Amputations  in  the  Middle  Third  of  the  Leg  for  Shot 
Injury. — Of  the  one  hundred  and  thirty-seven  patients  who  survived  secondary  amputa 
tion  in  the  middle  third  of  the  leg  twenty-three  were  Confederate  and  one  hundred  and 
fourteen  Union  soldiers.  Of  the  latter  one  hundred  and  thirteen  became  pensioners,  but 
twelve  have  died  since  the  date  of  their  discharge  from  the  service — one  of  pysemia,  one 
of  continued  suppuration  of  the  stump,  one  of  exhaustion,  one  of  apoplexy,  one  of  chronic 
diarrhoea,  one  of  phthisis,  and  six  of  causes  not  stated. 

CASE  792. — Private  O.  L.  Bell,  Co.  D,  1st  Delaware,  aged  19  years,  was  wounded  in  the  right  leg,  at  Antietam,  Septem 
ber  17,  1862,  and  admitted  to  hospital  at  Frederick  ten  days  afterwards.  Acting  Assistant  Surgeon  W.  S.  Adams  forwarded  the 
following  history :  "An  examination  revealed  extensive  comminuted  fracture  of  both  bones  of  right  leg  at  the  upper  portion  of  the 
lower  third,  a  transverse  fracture  at  the  upper  third,  and  an  oblique  fracture  running  down  to  within  two  inches  of  the  external 
malleolus.  The  limb  was  in  Smith's  anterior  splint,  which  had  been  badly  applied;  and  a  piece  of  adhesive  plaster,  which  had 
been  placed  just  above  the  knee,  had  been  allowed  to  receive  the  weight  of  the  limb  for  six  weeks.  The  result  was  that  it  cut 
through  the  skin,  fascia,  and  to  a  considerable  extent  into  the  muscles,  the  incision  made  being  seven  inches  long  and  at  its 
middle  two  and  a  half  inches  broad.  After  taking  it  off  the  limb  was  readjusted  in  the  fame  splint,  in  which  it  remained  about 
three  weeks  longer,  when  it  was  placed  in  a  fracture  box.  After  union  the  leg  showed 
two  inches  shortening.  The  patient's  condition  had  remained  good  throughout,  but  on 
the  morning  of  December  26th  he  had  a  severe  chill,  followed  at  10  A.  M.  by  considerable 

fever.     On  the  next  day  there  was  some  evidence  of  ery 
sipelas  on  the  leg  and  thigh,  and  three  grains  of  quinine 

were  prescribed  every  three  hours,  also  fifteen  drops  of 

tincture  of  chloride  of  iron  every  four  hours.     On  the 

following  day  erysipelas  was  very  evident  and  extended 

from  the  ankle  to  the  hip ;  limb  hot  and  much  swollen  ; 

pulse  130 ;  tongue  furred  and  bowels  constipated.    Saline 

cathartics  were  now  ordered  and  lead  and  opium  wash 

was  applied.     On  December  29th  the  patient  was  no 

better  and  there  \vas  total  loss  of  appetite.     The  limb 

was  now  suspended  in  Smith's  anterior  splint  so  as  to 

allow  a  free  passage  of  air  beneath  and  to  facilitate  the 

application  of  local  remedies  to  all  parts  affected.     After 

this  the  patient  did  quite  well  until  January  10,  1863, 

when  there  was  some  evidence  of  an  abscess  on  the 

anterior  part  of  the  thigh,  but  no  distinct  fluctuation 

could  be  recognized;  patient  having  no  pain  and  feeling 

quite  well,  his  appetite  having  returned  for  some  days. 

The  quinine  was  now  stopped  and  brandy  and  tonics 

were  continued.     On  January  14th  an  extensive  abscess 

was  opened  on  the  anterior  part  of  the  thigh  and  about 

a  quart  of  pus  was  evacuated,  after  which  the  cavity 

was  syringed  'with  tepid  water   and   a  bandage  was 

applied  to  the  entire  limb.  One  week  later  a  solution 
of  zinc  was  ordered  to  be  used  for  syringing.  Subsequently  the  patient  continued  to  do  well,  requiring  no  treatment,  and  on 
February  10,  1863,  he  was  discharged,  ihe  walls  of  the  abscess  having  become  adherent  and  the  ulcer  nearly  cicatrized."  The 
man  subsequently  re-enlisted  in  the  1st  Delaware  Cavalry  and  served  for  fifteen  months,  when  the  wound  reopened.  He  then 
passed  through  various  hospitals,  being  ultimately  discharged  for  disability,  from  Jarvis  Hospital,  Baltimore,  June  15,  1H6.">, 
and  pensioned.  Examiner  I.  Jump,  of  Dover,  Delaware,  certified  July  1,  1871:  "There  is  a  large  open  sore  some  four  or  five 
inches  long  and  the  skin  or  flesh  on  most  of  the  leg  is  very  much  discolored,  the  discharge  being  very  offensive  except  when 
counteracted  by  disinfectants.  The  pensioner  had 'to  take  to  his  bed  last  February,  being  unable  to  bear  any  weight,  on  the  limb 
and  suffering  very  much  with  it.  His  physician,  who  had  served  in  the  army,  insisted  on  taking  the  leg  off.  I  am  of  the  opinion 
that  it  never  will  be  healed;  but  I  have  advised  that  the  diseased  portions  of  the  bones  be  removed ;  it  is  barely  possible  he  may 


FIG.  318. —  Posterior  and  anterior 
views  of  the  bones  of  the  right  leg. 
Spec.  65G9. 


FIG.  319. — Appearance  of  stump, 
a  photograph.] 


[From 


SECT.  V.] 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


545 


FIG.  320.— Bones  of  the 


recover."  Dr.  J.  F.  M.  Forwood,  of  Chester,  Pennsylvania,  who  subsequently,  on  August  19,  1872,  amputated  the  leg  seven 
inches  below  the  knee  joint,  communicated,  in  connection  with  the  case,  that  after  receiving  his  final  discharge  from  service  the 
man  "roamed  about  and  had  one  or  two  operations  performed  for  his  relief,  staying  some  fifty  days  in  St.  Joseph's  Hospital, 
Philadelphia,  and  finally  drifting  here,  where  I  amputated  his  limb."  At  an  examination  of  the  stump  in  August,  1879,  Examiner 
Jump  reported:  "There  has  been  ulceration  for  ten  months  continuously,  sometimes  confining  him  to  his  bed."  The  pensioner 
was  paid  March  4,  1881.  The  amputated  bones  of  the  leg  (Spec.  6569),  together  with  a  photograph  of  the  pensioner,  represented 
in  the  wood-cuts  (FlGS.  318,  319),  were  contributed  to  the  Museum  by  the  operator. 

CASK  793. — Private  W.  Holmes,  Co.  D,  18th  Massachusetts,  aged  20  years,  was  wounded  in  the  right  leg,  at  Fredericks- 
burg,  December  13,  1862.  He  passed  from  a  field  hospital  to  Campbell  Hospital,  Washington,  two  weeks  after  receiving  the 
injury,  and  six  months  afterwards  he  was  transferred  to  Mower  Hospital,  Philadelphia.  Surgeon  J.  Hop- 
kinson,  U.  S.  V.,  in  charge  of  the  latter,  recorded  the  following  history:  "The  patient  was  suffering  from 
a  compound  comminuted  fracture  of  the  tibia  and  fibula  at  the  lower  third.  He  also  complained  of  diar 
rhoea,  for  which  chulk  mixture  and  laudanum  were  administered.  Dead  bone  was  discovered  by  the 
probe.  The  leg  had  been  operated  on  and  several  pieces  of  bone  removed.  At  the  time  of  admission, 
June  20th,  it  was  very  much  enlarged  and  disfigured  by  cicatrices.  The  wound  was  dressed  with  warm- 
water  poultices  every  hour.  On  July  15th  a  large  ulcer  had  broken  out  on  the  limb  and  a  large  piece  of 
bone  was  taken  away.  Warm-water  dressings  were  still  continued,  and  the  foot  was  kept  elevated.  On 
the  following  day  the  ulcer  was  found  to  be  extending,  and  bread  and  milk  poultices  were  ordered  to  be 
applied.  Subsequently  chlorate  of  potassa  and  muriatic  disinfecting  lotion  were  used.  On  July  19th, 
creasote  was  applied  to  the  ulcer;  warm-water  dressings  continued;  bone  now  in  a  sad  state.  On  July 
22d  the  leg  was  removed  by  flap  operation  by  Assistant  Surgeon  C.  R.  Greenleaf,  U.  S,  A.,  half  way 
between  the  ankle  and  the  knee.  The  flaps  were  brought  accurately  together  and  dressed  with  water 
dressing.  On  the  following  day  the  patient  felt  easy,  having  slept  well  during  the  night  after  taking  a 
half  grain  of  morphia;  pulse  100,  full  and  soft.  On  July  26th  the  dressing  was  removed;  stump  looking 
well  and  patient  doing  well.  Extra  diet  was  given,  and  porter  daily.  The  stump  healed  rapidly  and  the 
patient's  general  health  was  excellent.  On  September  30th  the  stump  had  entirely  healed  and  the  patient 
went  home  on  furlough."  He  was  subsequently  transferred  to  Haddington  Hospital,  and  later  to  Ladies' 
Home,  New  York  City,  where  he  was  supplied  with  an  artificial  leg  of  the  "Ely"  pattern,  and  whence 
he  was  discharged  April  12,  1864,  and  pensioned.  In  his  subsequent  applications  for  commutation  he 

described  the  condition  of  the  stump  as  continuing  in  a  "healthy  state."  The  amputated  bones  of  the  right  leg" 'severT'monthi 
leg  (Spec.  2594),  contributed  by  the  operator,  are  represented  in  the  annexed  wood-cut  (FlG.  320)  and  afterfracture.  Spec.  2594. 
exhibit  the  seat  of  the  fracture,  the  fibula  being  firmly  consolidated,  and  much  callus  being  effused  about  the  tibia,  but  caries 
having  prevented  firm  union.  The  pensioner  was  paid  March  4,  1881. 

CASE  794. — Private  E.  Collins,  Co.  A,  3d  Mississippi,  aged  22  years,  was  wounded  above  the  right  ankle,  at  Peach  Tree 
Creek,  July  20,  1864.  He  was  under  treatment  at  Confederate  hospitals  until  June  7,  1865,  when  he  was  admitted  to  the 
Marine  (Union)  Hospital  at  Mobile.  Surgeon  S.  Kneeland,  U.  S.  V.,  in  charge,  contributed  the  specimen  (No.  481),  represented 
in  the  adjoining  cut  (FlG.  321),  with  the  following  description:  "The  missile,  a  mini6  ball,  perforated  the 
tibia  in  its  course  and  lodged  in  the  wounded  man's  shoe.  The  wound  had  never  healed,  and  suppuration 
and  hsemorrhaj.  had  continued  up  to  the  time  of  the  patient's  entrance  into  this  hospital.  For  the  last  few 
weeks  haemorrhage  had  been  frequent  and  profuse  and  it  was  with  difficulty  controlled  by  stuffing  the 
cavity  in  the  tibia,  which  was  large  enough  to  allow  the  finger  to  be  introduced  freely.  Suppuration  was 
also  profuse,  and  there  was  great  pain  and  ssvelling  about  the  lower  part  of  the  tibia, 
the  patient  being  considerably  exhausted  from  these  causes.  Circular  amputation  of  the 
leg  near  the  middle  was  performed  on  June  8th  by  Acting  Assistant  Surgeon  R.  W. 
Coale,  chloroform  being  used.  The  stump  at  first  was  disposed  to  slough,  but  under 
a  tonic  treatment  and  antiseptic  applications  it  soon  assumed  a  healthy  appearance.  The 
subsequent  progress  was  favorable,  and  by  June  30th  the  stump  was  nearly  well."  The 
records  of  the  hospital  show  that  the  patient  was  discharged  on  parole  July  9,  1865. 
The  specimen  comprises  the  lower  portions  of  the  bones  of  the  injured  leg,  and  exhibits 
the  cavity  in  the  tibia  as  well  as  external  deposit  of  callus. 

CASE  795. — Private  P.  Larkin,  Co.  C,  48th  New  York,  aged  24  years,  was  wounded 
during  the  assault  on  Fort  Wagner,  July  18,  1863,  by  a  canister  shot,  which  fractured 
the  right  foot.  Assistant  Surgeon  J.  E.  Semple,  U.  S.  A.,  reported  that  the  wounded 
man  was  conveyed  to  hospital  at  Hilton  Head,  where  Pirogoff's  amputation  at  the  ankle 
joint  was  performed  one  week  after  the  date  of  the  injury.  The  patient  recovered,  and 
was  discharged  from  service  December  4,  1863,  and  pensioned.  Dr.  E.  D.  Hudson,  of 
New  York  City,  who  supplied  the  pensioner  with  an  artificial  foot  several  years  after 
wards,  reported  that  he  saw  the  man  some  weeks  after  leaving  the  service  and  found  that 
the  tibia  was  extensively  necrosed,  that  numerous  pieces  had  exfoliated,  and  that  there 
was  copious  discharge  of  pus  from  the  leg,  which  was  enlarged  about  one-third  beyond 
its  normal  size,  an  iuvolucrum  being  present  corresponding  to  the  extent  of  the  necrosed  bone,  and  several  cloacae  having  formed. 
The  pensioner  subsequently  suffered  re-amputation  of  the  leg  at  the  middle  third  (near  the  junction  with  the  upper  third)  at  the 
Soldiers'  Home  in  Hampton,  whence  Dr.  G.  H.  Marmion,  surgeon  in  charge,  described  the  case  substantially  as  follows:  "After 
receiving  bis  discharge  I.nrkin  was  sent  to  his  home  in  Brooklyn,  where  he  followed  his  trade  as  stUCCO-maker,  but  was  com- 
SUIIG.  Ill— 69 


FIG.  a.1!.— Bones  of 
the  right  leg  ten  and 
a  half  months  after 
injury.  Spec.  481. 


FIG.  322. —  Bony 
stump  of  right  leg,  af 
ter  Pirogoft's  ampu 
tation  at  the  ankle 


546  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

pelled  to  desist  three  months  afterwards,  necrosis  setting  iu  and  continuing  pretty  much  up  to  the  present  time.  He  is  a  man  of 
apparently  good  constitution,  and  should  have  done  well  had  the  leg  heen  amputated  at  the  junction  of  the  middle  and  lower 
thirds.  As  it  was  he  led  a  life  of  suffering  and  mortification,  the  odor  of  his  leg  completely  ostracising  him  from  the  society  of 
his  fellows.  I  think  the  operation  of  Syme  or  Pirogoff  might  be  profitably  abandoned.  The  re-amputation  was  performed  by 
me  on  May  6,  1879,  with  the  assistance  of  hospital  nurses,  none  of  them  being  professional  men.  The  stump  was  kept  con 
stantly  wet  night  and  day  with  a  dilute  solution  of  carbolic  acid.  It  healed  entirely  by  first  intention,  and  the  patient  is  now 
(June  10,  1879)  able  to  walk  on  crutches  a  few  yards  to  the  hospital  piazza.  I  had  some  fears  of  an  extension  of  the  disease, 
but  at  present  there  is  not  nor  has  there  been  any  indication  of  the  remainder  of  the  tibia  being  involved.  The  patient  is  in 
excellent  physical  condition,  fat,  rosy,  and  good  spirits."  The  bones  of  the  leg  (Spec.  6913),  removed  at  the  re-amputation  and 
contributed  by  the  operator,  are  shown  in  the  wood-cut  (FiG.  322  on  the  preceding  page),  and  exhibit  a  large  involucrum 
embracing  a  cylindrical  sequestrum  of  the  tibia.  The  pensioner  was  paid  March  4,  1881. l 

CASE  796. — Private  L.  V.  Grant,  Co.  M,  8th  Illinois  Cavalry,  aged  23  years,  was  wounded  in  the  left  ankle,  at  Beverly 
Ford,  June  9,  1863,  and  entered  Lincoln  Hospital,  Washington,  the  following  day.  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A., 
who  amputated  the  injured  limb,  reported  as  follows:  "The  wound  was  caused  by  the  ball  entering  the  inner  malleolus  pos 
teriorly,  penetrating  the  base  of  the  tibia,  and  remaining  embedded  on  the  semi-cylindrical  face  of  the  astragalus.  Upon  taking 
charge  of  the  hospital  (December,  1863)  I  found  the  patient's  condition  as  follows:  Appetite  capricious  but  well  guarded  by 
taking  acceptable  food;  constant  pain  in  left  breast,  accompanied  by  headache;  eyes  constantly  suffused  and  face  flushed,  wake- 
fulness,  restlessness,  and  night-sweats;  also  a  strong  aortic  direct  murmur  of  the  heart,  with  considerable  hypertrophy  and  con 
sequent  labored  heart  action.  He  had  to  be  propped  up  in  bed  to  allow  him  any  rest,  his  expression  being  anxious,  appetite 
declining,  pain  of  wound  unremitting  and  excruciating,  tissues  inflamed  and  oedematous,  and  the  joint  immovable  and  firmly 
anchylosed,  rendering  it  impossible  for  the  patient  to  put  his  foot  on  the  ground.  He  begged  again  and  again  to  have  the  limb 
removed.  An  examination  by  the  probe  indicated  diseased  bone  or  foreign  substance.  The  opinion  of  Acting  Assistant  Surgeon 
W.  F.  Peck — under  whose  care  he  had  been  for  some  months — as  confirmed  by  the  statement  of  the  patient  was  that  the  ball 
had  been  extracted.  Uninfluenced  by  the  patient's  constant  and  urgent  solicitation  I  proceeded  carefully  to  examine  the  case 
further;  and  not  being  satisfied  that  I  had  sufficient  authority  to  remove  the  diseased  and  injured  joint  by  amputation,  I  delayed 
for  accumulative  evidence,  which  was  not  long  in  presenting  itself.  The  bad  symptoms  increasing,  it  became  evident  that  some 
measure  for  relief  must  be  promptly  taken  to  save  the  life  of  the  patient.  Assistant  Surgeon  R.  Bartholow,  U.  S.  A.,  under 
whose  care  the  patient  had  also  been  for  some  time,  favored  immediate  amputation,  and  stated  that  he  had  intended  to  operate 
before  my  arrival.  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  was  also  present  and  favored  the  operation.  Acting  Assistant  Surgeon 
W.  F.  Peck  insisted  upon  removing  the  limb  some  time  before  I  gave  my  consent;  other  medical  gentlemen  present  were  satisfied 
that  the  removal  of  the  limb  was  called  for  to  rid  the  patient  of  a  deformity  and  an  encumbrance.  Amputation  was  accordingly 
performed  on  December  7,  1863,  eight  inches  below  the  knee,  by  circular  operation.  Sulphuric  ether  was  used  and  the  patient 
reacted  promptly.  The  stump  was  left  laying  open  on  a  pillow  and  strapped,  when  the  healing  process  commenced.  Simple 
water  dressings  were  applied.  The  aggravated  symptoms  of  the  heart  disease  became  greatly  modified  after  the  operation.  The 
patient's  appetite  improved,  his  night-sweats  ceased,  and  he  was  delighted  to  be  able  to  sleep  and  rest,  stating  that  he  had  not 
enjoyed  any  comfort  or  relief  from  pain  for  months  before.  He  obtained  an  excellent  and  useful  stump.  The  ligatures  came 
away  two  weeks  after  the  operation.  The  patient  was  furloughed  February  llth,  and  subsequently  he  was  transferred  to 
Judiciary  Square  Hospital  to  have  an  artificial  limb  applied."  On  September  24,  1864,  his  term  of  service  expired  and  he  was 
mustered  out.  He  was  a  pensioner  until  August  21, 1865,  when  he  died.  The  cause  of  his  death  has  not  been  ascertained.  The 
amputated  part  of  the  wounded  limb,  longitudinally  bisected  and  exhibiting  the  place  of  lodgement  of  the  missile,  was  contributed 
to  the  Museum  by  the  operator  and  constitutes  specimen  1899  of  the  Surgical  Section. 

fatal  Cases  of  Secondary  Amputations  in  the  Middle  Third  of  the  Leg  for  Shot 
Injury. — Thirty-seven  operations  were  performed — six  on  Confederate  and  thirty-one  on 
Union  soldiers.  Erysipelas  was  noted  in  one,  pyaemia  in  seven,  and  gangrene  in  eleven 
cases;  in  two  instances  autopsies  were  reported. 

CASE  797. — Private  D.  Bussler,  Co.  K,  93d  Pennsylvania,  aged  19  years,  was  wounded  near  the  left  ankle  during  the 
engagement  near  Fort  Fisher,  before  Petersburg,  March  25,  1865.  Surgeon  S.  F.  Chapin,  139th  Pennsylvania,  reported  his 
admission  to  the  field  hospital  of  the  2d  division,  Sixth  Corps.  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  contributed»the  patho 
logical  specimen,  numbered  195  of  the  Surgical  Section,  A.  M.  M.,  with  the  following  description  and  result  of  the  injury:  "The 
wound  consisted  of  a  compound  comminuted  fracture  of  the  fibula;  a  conoidal  ball  had  entered  the  outer  aspect  four  inches 
above  the  external  malleolus,  and  emerged  at  the  inner  aspect  one  and  a  half  inches  above  the  internal  malleolus.  The  patient 
was  admitted  to  Mount  Pleasant  Hospital,  Washington,  one  week  after  receiving  the  injury.  Circular  amputation  of  the  leg 
was  performed  by  Acting  Assistant  Surgeon  H.  Craft,  on  May  6th,  at  the  junction  of  the  middle  and  lower  thirds.  Eight  liga 
tures  were  applied  and  sulphuric  ether  was  used.  At  the  time  of  the  operation  the  leg  presented  a  large  open  surface  on  the 
posterior  region,  extending  from  one  inch  below  the  ankle  joint  to  the  junction  of  the  middle  and  lower  thirds  of  the  limb. 
Several  spiculse  had  been  removed  previously  and  there  had  been  gangrene ;  the  patient  had  lost  his  appetite  and  was  very  weak ; 
pulse  small.  Reaction  came  on  slowly.  On  the  evening  of  May  9th  he  had  a  severe  chill;  suppurative  process  not  yet  estab 
lished;  stump  dark  looking  and  flaps  somewhat  discolored;  two  ligatures  now  came  away.  Tincture  of  chloride  of  iron,  with 
stimulants  and  nourishing  diet,  were  prescribed,  also  a  camphor  and  opium  pill  every  liquid  stool.  On  the  following  day  there 
was  another  chill,  followed  by  profuse  cold  sweat ;  previous  treatment  continued,  and  one-half  drachm  of  bi-sulphate  of  soda 
dissolved  in  water  was  given  every  two  hours.  There  was  very  little  discharge  from  the  stump,  which  was  dressed  with  solution 
of  bromine.  On  May  llth  there  were  two  chills  and  the  treatment  was  continued.  In  the  evening  the  bi-sulphate  of  soda  was 
'SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  iu  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  II,  p.  134. 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


547 


stopped,  but  resumed  the  next  morning.  Several  rigors  occurred  during  the  night  and  a  slight  chill  on  the  morning  of  May 
1.3th,  when  the  patient  had  great  pain  in  the  stomach,  and  the  bi-sulphateof  soda  was  again  stopped  and  morphia  prescribed.  In 
the  afternoon  the  doses  of  bi-sulphate  of  soda  were  again  resumed.  He  suffered  great  pain  in  the  stomach  through  the  night,  and 
the  next  day  the  remedy  was  again  stopped.  There  were  now  symptoms  of  gastritis  and  the  patient  was  gradually  sinking. 
The  slough  had  all  separated  from  the  stump,  which  looked  quite  healthy.  Poultices  of  charcoal,  flaxseed,  yeast,  and  creasote 
had  been  used  for  several  days.  On  the  morning  of  May  15th  the  patient  was  very  low  and  in  a  dying  condition,  and  all  med 
icines  except  stimulants  and  beef-essence  were  stopped.  Death,  caused  by  pyaemia,  supervened  at  3  P.  M.  on  May  15,  1865. 
At  the  autopsy  the  thoracic  viscera  were  found  to  be  normal  with  the  exception  of  old  adhesions  of  the  right  lung.  The  left 
lobe  of  the  liver  and  the  spleen  contained  metastatic  abscesses;  other  abdominal  viscera  were  normal.  The  stump  was  in  a  gan 
grenous  condition.  The  medulla  of  the  upper  third  of  the  femur  was  greatly  inflamed,  particularly  so  about  one  inch  below  the 
great  trochanter;  cancelli  of  upper  part  of  femur  very  vascular;  cancellous  structure  of  tibia  slightly  vascular."  The  specimen 
consists  of  the  amputated  portion  of  the  fibula,  showing  the  seat  of  the  injury  without  any  attempt  at  repair. 

CASE  798. — Sergeant  J.  C.  Schmid,  Co.  F,  1st  Rhode  Island  Light  Artillery,  aged  26  years,  was  wounded,  before  Peters 
burg,  August  10,  1864,  by  a  minie"  ball,  which  took  effect  above  the  malleoli  of  the  left  leg  and  implicated  the  bone.  He  was 
admitted  to  Satterlee  Hospital,  Philadelphia,  one  week  after  receiving  the  injury.  By  September  2d  the  wound 
had  become  gangrenous  and  was  sloughing  a  little,  the  muscles  and  bone  being  exposed  at  the  point  of  the 
injury.  The  patient  was  thin  looking  but  apparently  of  good  strength  and  constitution,  having  good  appetite 
and  being  in  good  spirits.  The  wound  became  very  large  and  deep,  involving  most  of  the  muscular  structure 
on  the  inner  and  posterior  surfaces  and  extending  from  the  internal  malleolus  to  within  two  inches  of  the 
point  of  election.  On  September  22d  the  leg  was  amputated  by  Acting  Assistant  Surgeon  G.  P.  Sargent  just 
above  the  point  of  election,  by  the  circular  method,  the  amesthetic  consisting  of  two  parts  of  ether  to  one  part 
of  chloroform.  One  week  after  the  operation  the  patient's  condition  was  weak  and  his  appetite  poor,  and  there 
was  unhealthy  inflammation.  On  October  6th  there  was  gangrene  of  the  stump,  the  swelling,  inflammation, 
and  discolored  spots  extending  to  the  groin.  The  patient  died  at  noon  on  October  7,  1864,  having  suffered 
much  pain  the  previous  night.  The  treatment  embraced  morphine,  quinine,  iron,  and  stimulants  according  to 
the  condition  of  the  patient.  Astringent  lotions,  caustics,  and  cataplasms  of  charcoal  and  linseed  meal  were 
used  to  the  wound  and  lead  and  opium  solution  to  the  thigh.  A  mixture  consisting  of  one  drachm  of  carbon 
ate  of  ammonia,  two  ounces  of  syrup  of  acacia,  and  six  ounces  of  brandy  was  administered  in  tabU-spoonful 
doses  every  four  hours.  The  history,  together  with  the  amputated  portion  of  the  bones  of  the  leg  (represented 
in  the  annexed  wood-cut,  FlG.  323),  was  contributed  by  the  operator.  The  specimen,  No.  3647,  shows  that 
the  tibia  was  nearly  entirely  fractured  in  the  lowest  third,'  a  deposit  of  callus  around  the  orifice,  and  an  extensive 
loss  of  substance  in  the  body  of  the  bone,  which  is  carious. 

CASK  799. — Sergeant  J.  Cannel,  Co.  I,  124th  Ohio,  aged  27  years,  was  wounded  near  Daltou,  May  9,  1864.  Surgeon 
R.  D.  Lynde,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  3d  division,  Fourth  Corps,  with  "shot  fracture  of  right 
leg  and  flesh  wound  of  left  leg."  Eighteen  days  after  receiving  the  injury  the  patient  was  transferred  to  hospital  No.  1  at  Nash 
ville,  whence  Surgeon  R.  L.  Stanford,  U.  S.  V.,  reported  the  following:  "The  wound  of  the  right  leg  was  three-fourths  of  an 
inch  above  the  external  malleolus  and  posterior  to  the  tibia,  the  ball  passing  inward  and  downward  and  emerging  three- fourths 
of  an  inch  below  the  internal  malleolus,  having  fractured  tarsal  bones  and  opened  the  ankle  joint.  Circular  amputation  of  the 
leg  at  the  middle  third  was  performed  on  June  llth  by  Acting  Assistant  Surgeon  H.  C.  May,  chloroform  and  ether  being  used. 
At  the  time  of  the  operation  the  foot  was  tumefied  and  inflamed  and  the  wounds  were  discharging  sanious  fetid  pus.  Abscesses 
existed  through  the  whole  region  of  the  joint,  with  extensive  necrosis  of  bone,  and  the  patient  was  much  emaciated  by  suppu 
ration.  Thirty-six  hours  after  the  amputation  the  integumentary  flaps  began  to  slough  so  as  to  expose  the  bones  and  face  of  the 
stump.  Charcoal  and  yeast  poultices  were  used  and  stimulants  and  supporting  diet  prescribed."  The  patient  died  of  exhaustion 
October  4,  1864.  Part  of  the  tarsal  bones  of  the  amputated  limb,  somewhat  eroded  and  showing  no  attempt  at  repair,  were 
contributed  to  the  Museum  by  the  operator  and  constitute  specimen  3359  of  the  Surgical  Section. 

TABLE  LXXVII. 

Summary  of  One  Hundred  and  Seventy-four  Secondary  Amputations  in  the  Middle  Third  of  the  Leg 

for  Shot  Injury. 

[Recoveries,  1—137;  Deaths,  138—174.1 


FIR.  323— Lower 
portions  of  boues 
of  the  left  leg  one 
mouth  und  twelve 
days  after  injury. 
Spec.  3647. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Ash.    W.,    Pt.,    I,    15th 

Sept.  20, 

Right  ;  circ.     Surg.  W.  C.  Otter- 

6 

Bassett.  A.,  PL,  II,  22d 

Oc.l8.'6:5, 

Left;   *rcular.     Dr.  W.   Green, 

Ohio,  age  li). 

Dec.  18, 

son,  U.  S.  V.     Gangrene.     Dis 

Massachusetts. 

Nov.  29, 

Pittsfield,  Mass.     Recovery. 

1863. 

charged  July  25,  1864. 

1865. 

~ 

Babb,  L.,  Pt.,  B,  5th  N. 

April  7, 

Right;  flap.  'Ass't  Surg.  G.  M. 

7 

Bell,  J.  A.,   Pt.,  I,   22d 

De.31,'(l2, 

Left  ;  flap.     Discharged  Novem 

Hampshire,  age  43. 

Aug.  12, 

McGill,  U.  S.  A.     Discharged 

Indiana. 

Dec.  17, 

ber  24,  1863. 

1865. 

October  5,  1865. 

1863. 

•> 

Baker,   J.,   Pt.,    K,   4th 

June  30, 

I^ifht  •     <MIY*        T^isfViirfrpfl    S**n 

B 

Bell,  O.   L..  Pt.,  D,  1st 

Sept.  17, 

Rigiit      Dr    J.    F.    M.   Forwood, 

Penn.  Reserves. 

Au.  2,'62. 

temb'er  26.  1863. 

Delaware,  age  19. 

1862. 

Chester,  Penn.  (Dec..  18(i2,  limb 

\ 

Ball,  T.,  Corp'l,  B.  54th 
New  York,  age  23. 

July  4, 
Sept.  26, 

Right  :  anterior  posterior  skin  flap. 
A.  A.  Surg.W.  Balser.    Disch'd 

Aug.  19. 
1872. 

united:  erysipelas.    Discharged 
Feb.  10.  1863.)    Two  subsequent 

1864. 

June  24,  1865. 

operations.     Spec.  6569. 

5 

Barnett,  B.  \V.,  Pt.,  E, 
3d    New   York    Light 

May  16, 
Aug.  15, 

Right  :  double  flap.     A.  A.  Surg. 
E.  Seyffarth.     Discharged  Feb 

9 

Bennett.  F.,  Pt.,  G,  57th 
Virginia. 

July  3, 
Aug.  18, 

.     Surg.  —  Carter.     Recov 
ery. 

Artillery,  age  19. 

1864. 

ruary  16,  1865. 

1863. 

548 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

I 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

10 

Blood  J.  N.  Pt.  C  ICth 

July  3, 

• 

39 

Goode    S.    Pt.    K   12th 

Oct.  12 

Sunc       •               9th  N  Y 

Massachusetts. 

Aug.  27,      A.  Surg.  F.   Hinkle.      Diach'd 

Virginia  Cavalry. 

Nov.  12, 

Recovery. 

1863.         May  3,  1864.     Spec.  1712. 

1863. 

11 

Boggs,  P.  F.,  Pt.,  A,  1st 

July  3.     Left.     A.  A.  Surg.  B.  H.  Wash- 

40 

Grant,  L.  V.,  Pt.,  M,  8th 

June  9, 

Left  ;  circular.     Ass't  Surg.  J.  C. 

N.  Carolina  Cavalry. 

Aug.  27,       ington,  C.  S.  A.     Recovery. 

Illinois    Cavalry,    age 

Dec.  7, 

McKee,  U.  S.  A.     Discharged 

1863. 

23. 

1863. 

Sept.   24,   1864.     Died   August 

12 

Brown,   T.  D.,   Pt.,  K, 

May  22,    Left;  circular.    Surg.  C.  T.  Alex- 

21,  1865.    Spec.  1899. 

05th  Illinois. 

June  27,  i     ander,  I!.  S.  A.     (May  2"),  nnip. 

41 

Griebe,  J.,   Pt.,   E,  9th 

Sept.  30, 

Right;  flap.     Surg.  II.  Buckmas- 

1863.     !    toes.)    Disch'd  Aug.  12,  1863. 

Wisconsin. 

Oct.  31, 

.    ter,  U.  S.  V.     Discharged  Janu- 

13 

Bugg,  W.  T.,  Serg't,  B, 

July  4,     Right.     Recovery. 

I860. 

uary  8,  1863. 

3d  Arkansas. 

Aug.8,'63. 

42 

Grieff,  C.  II.,  Pt.,A,!)6th 

June  26, 

Left  ;  circular.    A.  A.  Surg.  S.  D. 

14 

Buisch,  G.,  Pt.,  C,  160th 

Se.16,'64,   Left;  oval  flap.     A.  A.  Surg.  A. 

Pennsylvania,  age  21. 

Aug.  1, 

Gross.      Erysipelas  ;    hannorrh. 

New  York,  age  44. 

Jan.  28, 

Trau.     Disch'd  May  31,    1865. 

1862. 

Discharged  Dee.  5,  1863. 

1865. 

Died  July  31,  1876  ;  chr.  diarrh. 

43 

Grier,    W.,    Pt,,    K,    2d 

June  27, 

Left.     Discharged   November   1, 

15 

Burbank,  B.,  Pt.,  H,  95th 

Jan.  13,     Left:    flap.      Ass't  Snrg.  J.   IIo- 

Maine,  age  38. 

Aug.  21, 

1864.     Died  August  25,  1865. 

New  York,  age  22. 

April  3, 

mans,  jr.,  U.  S.  A.   Disch'd  June 

1862. 

1863. 

2,1863.     Died  Sept.  17,  1868. 

44 

Grimes,  M.,  Pt.,  A,  16th 

May  28, 

Right  ;  lateral  skin   flap.     Surg. 

16 

Campbell,  J.  N.,  Pt.,  G, 

Nov.  30, 

Left;  circular.    Ass't  S  urg.  G.  M. 

Kentucky,  age  21. 

June  29, 

C.  McDermont,  U.  S.V.  Disch'd 

2d  Michigan  Cavalry. 

1664, 

Sternberg,  IT.  S.  A.    Discharged 

1864. 

April  1,  1865. 

age  32. 

May  22, 

July  17,  1865. 

45 

Griswold,  D.  P.,  Corp'l, 

J'y  1,  '63, 

Left  ;  flap.     Dr.  J.  D.  Trips,  Vir 

1865. 

C,  76th  New  York. 

May  11, 

gil,  N.  Y.     (July  5,  excis.  tibia. 

17 

Campbell,    S.,    Pt.,   G, 

May  9, 

Left  ;  flap.     Discharged  October 

1869. 

Disch'd  Sept.  23,  1864.)     Rec. 

26th  Illinois,  age  22. 

July  10, 

13,  1662.     Died  April  17,  1870. 

46 

Growner,  H.  L.,  Serg't, 

Sept.  14, 

Left.     Exchanged  December  20, 

1862. 

A,  20th  North  Carolina, 

Oct.  18, 

1862. 

18 

Carter,  A.  L.,  Lieut.,  B, 

July  1, 

Right  ;  long  posterior  flap.     Dr. 

age  33. 

1862. 

76th  New  York. 

1863, 

F.  Hyde.  Cortland,  N.  Y.     (Dis 

47 

Hafer,  W.  II.,  Pt.,  E,  2d  De.31,'63, 

Right  ;  flap.     Surg.  S.  P.  Smith, 

April  13, 

charged  November  9.  1863.) 

Pennsylvania  Cavalry, 

Aug.  4, 

2d  Maryland  P.  II.  B.     Disch'd 

1865. 

age  24. 

1864. 

April  10,  1865. 

19 

Chellis,  J.  C.,  Pt.,  B,  41st 

Nov.  25, 

Right  ;  antero-posterior  flap.     A  .• 

43 

Hendricks,   II.,    Pt.,  D,     May  10, 

Right  ;   circular.     A.  A.  Surg.  A. 

Ohio,  age  43. 

1863, 

Surg.  G.  M.  Sternberg,  U.  S.  A. 

49th  Pennsylvania,  age       1864, 

Transue.     Discharged  May  22, 

Jan.  7, 

(Necrosis.)      Disch'd    May    18, 

18.                                     Feb.3,'65 

1865. 

1865. 

1865.     Spec.  3607. 

49 

Henry,    W.  R.,  Pt.,  H,  De.13,'62 

.    Recover}-. 

20 

Clinger,  I.  W.,  Pt.,  1,  26th 

Dec.  27, 

Right;  antero-posterior  flap.     A. 

38th  Georgia.                   Feb.3,'63. 

Ohio,  age  20. 

1862, 

A.  Surg.  J.  t).  A.  Banta.     Dis 

50 

Higinton,  J.   T.,  Pt.,  K,     July  4, 

Left  ;  circular.     To  Provost  Mar 

Dec.  18, 

charged  April  10,  1864. 

1  Oth  Tennessee,  age  1  8.    A  ug".  30, 

shal  November  16,  1864. 

»18G3. 

1864. 

21 

Collins,  E.,  Pt.,    A,  3d 

July  20, 

Right;  circular.     A.  A.  Surgeon 

51 

Holmes,  W.,  Pt,,  D,  18th    Dec.  1  3, 

Right;  flap.  A.  Surg.C.  R.Green- 

Mississippi,  age  22. 

1864, 

R.  W.  Coale.     (Haemorrhage.)  ; 

Massachusetts,  age  20.        1862. 

leaf,  U.  S.  A  .    Discharged  A  pril 

June  8, 

Paroled  July  9,  1865.   Spec.  481. 

1  J'y  2,  '63. 

12,  1864.     Spec.  2594. 

1865. 

52 

Horine,    W.  T.,  Serg't, 

July  2, 

Right;  flap.    Surg.  Z.  E.  Bliss,  IT. 

32 

Covert,   B.  C.,   Pt.,  B, 

June  1, 

Right  ;    circ.      Discharged   Sep 

K,  20th  Indiana. 

Aug'.  13, 

S.  V.    Discharged  July  29,  1864. 

67th  New  York. 

July  11, 

tember  7.  1862. 

186:!. 

1862. 

53 

House,  C.,  Pt.,  1C,  6dth 

Sept.  15, 

Left  ;  flap.     Discharged. 

23 

Cowling,  J.  R.,  Pt.,  A, 

July  2, 

Right.     Surg.  J.  Kerr,  62d  Penn. 

Ohio. 

Oct.  16, 

62d  Pennsylvania,  age 

1863, 

(Primary  excis.  tibia.     Disch'd 

1862. 

21. 

Sept.  21, 

July  13,  1864.)     Recovery. 

54 

Honser,  W.,  Pt.,  D,  5th 

June  27, 

Left;  flap.     A.  A.   Surg.   S.   D. 

1864. 

Cavalry,  age  29. 

Aug.  3, 

Gross.     Discharged  August  8, 

24 

Crawford,  L.  M.,  Corp'!, 

Aug.  14, 

Right;    circular.      Surg.    A.   F. 

1862. 

1863. 

M,  13th   Pennsylvania 

Dee.  23, 

Sheldon,  U.  S.  V.     Discharged 

55 

Howe,  S.  O.,  Pt.,  K,  57th 

Mar.  25, 

Left;  circular.   Snrg.  D.W.  Bliss, 

Cavalry,  age  25. 

1664. 

June  lit,  1865.     Spec.  3536. 

Massachusetts. 

June  8, 

U.  S.  V.     Discharged  August  4, 

25 

Currin,  O..  Pt.,   A,  63d 

Sept.  17, 

Right;  circular.  Discharged  Jan 

1865. 

1865. 

New  York,  age  OU. 

Oct.  20, 

uary  12,  1863. 

56 

Hubbard,    A..    Farrier, 

July  22, 

Left;    antero-posterior  flap.     A. 

1862. 

D,  6th  New  York  Cav 

Sept.  2, 

A.  Surg.W.  K.  Cleveland.    Jim. 

26 

Davis,  T.  F.,  Pt.,  E,  82d 

June  1, 

Left;  flap.     A.  A.  Surg.  A.  Trail. 

alry,  age  32. 

1864. 

1,    1865,   amp.   thigh.      Diseh'd 

Pennsylvania,  age  24. 

Dec.  14, 

Discharged  April  29,  1865. 

November  7,  1865.     Spec.  278. 

1864. 

57 

Hndler,.T.  M.,  Pt,,D,  4th 

July  2, 

Left;  sloughing:  exfolial'n.    Dis 

27 

Dellabella,    F.,  Pt.,   J>, 

Sept.  20, 

Right  ;  circular.    "Medical  Cadet 

Michigan,  age  31. 

Aug.  5, 

charged  May  27,  1864. 

2d  Missouri,  age  28. 

1863, 

C.  II.  Fisher.   (Gangrene  ;  haem 

1863. 

Mar.  21, 

orrhage.)     Discharged  October 

58 

Ingraham,  E.,  Pt.,  I,  21st 

Sept.  20, 

Right;    flap.     Ass't   Surg.  J.  C. 

1864. 

7,  1864.     Spec.  2-205. 

Ohio,  age  21. 

Dec.  14, 

Patterson,  85th  111.    Discharged 

28 

Dougherty,   A.,  Pt.,  D, 

April  6, 

Left;   flap.     A.   A.  Surg.  T.  B. 

1863. 

June  20,  1864.      Died   May  3, 

44tli  Indiana. 

June  25, 

Harvey.   (Erysipelas.)    Disch'd 

1871  ;  consumption. 

1862. 

September  12,  1862. 

59 

Jones,  J.  F.,  Pt,,  D,  7th 

July  3, 

Left  ;  flap.     Surg.  —  Shivers,  C. 

29 

Douglas,  A.  L.,  Pt.,  H, 

July  21, 

Right;    flap.     Discharged   Octo 

Virginia,  age  29. 

Au.  4,  '63. 

S.  A.     Exoh'd  Nov.  12,  1863. 

2d  Maine. 

Aug.  21, 

ber  5,  1861. 

60 

Jones,  J.W.,  Pt.,  L,  13th 

Oct.  28, 

Left  ;  anteriorposterior  (lap.     Dis 

1861. 

Tennessee  Cav'ry,  age 

Dec.  24, 

charged  June  10,  1865. 

30 

1  Duff)-,  T.,  Pt.,  I,  70th 

June  1, 

Left;    posterior   flap.      (Primary 

21. 

1864. 

New  Vork   flfiT6  21  . 

fii 

Knchor       T        A          Pt        P 

Dec   13 

1862. 

Disch'd  July  11,  '63.   Spec.  4312. 

Dl 

tlMlrr,     J.      A.,       1   L.,     I.T, 

145th  Penn.,  age  24. 

1862,"  ' 

March  25,  1864'. 

31 

Dunn,  T.,  Fireman,  U.S. 

April  26, 

Left.       Discharged   October  24, 

Mar.  26, 

Steamer  "Juliet,"  age 

June  —  , 

1864. 

1863. 

26. 

1864. 

62 

Kelley,  W.,  Pt,,  M,  1st 

April  8, 

Right;  lateral  flap.     Ass't  Surg. 

32 

Durau,  J.,  Corp'l,  C,  1  7th 

May  6, 

Left  ;  circular.    A.  A.  Surg.  G.  E. 

N.  York  Cavalry,  age 

May  13, 

J.  \V.  Williams,  1'.  S.  A.     Dis 

Maine,  age  38. 

Aug.  28, 

Brickett.     May  18,   1865,  amp. 

38. 

1865. 

charged  August  14,  1865. 

1864. 

thigh.     Disch'd  August  7.  1865. 

63 

King,  S.  ,S.,  Pt,,  G,  13th 

July  3. 

Right;  flap.     A.  A.  Surgeon  '!. 

33 

Duran,   J.,   Pt.,  D,    1st 

Oc.27,'64, 

Left;  circular.    Discharged  Au 

South  Carolina. 

Aug.  24, 

Martin.     Exchanged  March  17. 

Maine  Cavalry,  age  48. 

April  30, 

gust  12,  1865.     Spec.  4231. 

1863. 

1864.     Spec.  2071. 

1865. 

64 

Lackey,    G.  A.,  Serg't, 

May  12, 

Left;  flap.     (May  27,  amp.  foot.) 

34 

Fagan,  P.,  Pt.,  B,  170th 

June  18, 

Left;  flap.     A.  A.  Surg.  G.  W. 

D,  58"th  Massachusetts. 

July  27, 

Dr.  C.   E.  Swann,  Easton,  Mo. 

New  Vork,  age  41. 

Aug.  10, 

Miller.      (Primary    amp.    toes. 

1864. 

Discharged  March  16.  1865. 

1864. 

Gangrene.)      Discharged  May 

65 

Lane,  D.  C.,  Pt.,  A,20th 

June  30, 

Left.     A.  A.  Surg.  C.  J.  Morton. 

22,  1865.     Spec.  3664. 

Massachusetts,  age  37. 

1862, 

Jan.  2.  hsem.     Disch'd  August 

35 

Ferguson,  E.,  Lieut.,  A, 

Oct.  8, 

Right;   flap.     Drs.  T.   Hatcbard 

Jan.  2, 

1,   1864.      Re-amp.     Died   Jan. 

1st  Wisconsin. 

1862, 

and  K.  B.  Wolcott.  of  Milwau 

1863. 

20,  1866;  pyaemiii.     Spec.'  861. 

June  15, 

kee.    Resigned  June  17,  1864. 

66 

Larkin,  P.,  Pt.,  C.  48th 

July  18, 

Right.  Dr.  G.  H.  Marmion.  (Julv 

1863. 

New  York,  age  24. 

1863, 

25,  1863,  Pirogoff's  amp.  ankle. 

36 

Fleming,  A.  J.,  Pt.,  I,    June  27, 

Left;  flap.     A.  A.  Sura:.  A.  W. 

May  6, 

Discharged  December  4,   1863. 

83d  Pennsylvania,  age    .Tulv  28,       Calhoun.     Discharged  Deeern- 

1879. 

Necrosis.)     Spec.  6913. 

45. 

1862.          ber8,  1862.                                           67 

Laws.  G.  L.,   Serg't,  II. 

May  5, 

Left.     Ass't  Surg.  R.  Bartholow, 

37 

Gamble,  J.,  Pt.,  C,  15th 

July  24,     Right:  lateral  flup.     Ass't  Surg.  |i 

5th  Wisconsin. 

July-  4, 

U.S.A.     Discharged  July  29, 

West  Virginia,  age  23.      Oct.  12,        O.  M.  Mr-Gill,  I'.  S.  A.      Disrh'd 

1862. 

1862. 

1864.          April  Hi.  1866.     Sprr.  2415.              68 

Leigh.  G.,  Pt.,  C',  3d  Ar 

Sept.  24, 

Right  ;  double  flap.     Surg.  J.  A. 

38 

Gash,  J.  R.,  Serg't,   I,     July  1,     Left.     Surg.  Massengale,  C.  S.  A. 

tillery,  age  19. 

1863, 

Lidell,  U.S.V.   (Prim.  amp.  ank. 

16tb  North  Carolina.        Sept.  10,       Recovery. 

Mar.  2!l. 

joint.)     Disch'd  Sept.  17,  1864. 

1863. 

IP64. 

Died  Sept.  13,  1871.    Spec.  2165. 

'STKPHRN  SMITH,  Amputation*  at  tht  Anklr  .Joint  in  Military  toiratry,  in  f.  S.  San?7ar.y  Commission  Mfmmrt,  Surgical  Volume  II,  p.  138 


SECT.  V.J 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


549 


Wr» 

NAME,  MILITAKY 

OPERATIONS,  OPEHATOKS, 

Kr» 

NAME,  MILITAUY 

OPEBATIONS,  OPERATORS, 

MO. 

DESCKIPTION,  AND  AGE. 

RESULT,, 

iiU 

DESCRIPTION,  AND  AOK. 

RESULT. 

69 

Lewis.  R  D.,  Pt.,  I,  22d 

Jan.  1, 

Left  ;  circular.  Surg.  T.  D.  Fitch, 

100 

Schafer,  W.  A.,  Pt.,  H, 

Nov.  30, 

Right  :  flap.    A.  A.  Surg.  W.  An 

Illinois. 

Feb.  19, 

42d  Illinois.     Discharged  April 

65th  Ohio,  age  22. 

1864, 

derson.      Ke-amputation.     Dis 

1803. 

23,  1863. 

Jan.  4,  '65. 

charged  June  14,  1865. 

70 

Livengood,  J.  D.,  Pt.,  B, 

Sept.  17, 

Right.     Ass't  Surg.  J.  N.  Green, 

101 

Schemerhorn,  G.  C.,  Pt., 

Nov.  27, 

Left  ;  circular.    Surg.  R.  R.  Tay- 

19th  Indiana. 

Nov.  —  , 

19th   Indiana.     Disch'd    March 

D,  74th  Illinois,  age  M. 

1864, 

lor,  II.  S.  V.     Disch'd  October 

1862. 

13,  1865. 

Aug.  (i, 

30,  1865.     Died   November  18, 

71 

Lyons,   J.,    Pt.,  K,   9th 

Aug.  2li, 

Left  ;  ant.  posterior  flap.     Surg. 

1865. 

1807;  exhaustion. 

West  Virginia,  age  19. 

Oct.  26, 

N.  F.  Graham,  12th  Ohio.     Dis 

102 

Schmidt,  H.,  Corp'l,  B, 

June  9, 

Right  ;    antero-post.  flap.     Ass't 

18(34. 

charged. 

8th  New  York  Cavalry, 

July  14, 

Surg.  H.  Allen,  U.  S.  A.     Dis 

72 

McCarthy,  J.,Pt.,F,48th 

Mar.  2, 

Right;  circ.     A.  A.  Surg.  LeR. 

age  25. 

1863. 

charged  Sept.  2,  '64.    Spec.  1352. 

New  York,  age  38. 

1864, 

McLean.     (Gangrene  ;   ligation 

103 

Schmidtgrieber,  J.,  Pt., 

Mar.  —  , 

Left  ;  circular.     Discharged  May 

April  2.), 

post,  tibial  artery.     Mar.  21,  "04, 

A,  2d  Massachusetts. 

J  une  25, 

24,  1866. 

1865. 

Chopart's  amp.)     Disch'd  June 

1865. 

10,  1865.     Died   December   19, 

104 

Schweitzer,   J.,    PL,   I, 

Jan.  1, 

Right  ;  circular.     A.  Surg.  A.  C. 

1874.     Spec.  3007. 

6th  Kentucky. 

June  9, 

Rankin,  88th   111.     Discharged 

73 

McCarthy,  J..PI.,  A,  9th 

July  1, 

Left;  flap.      A.   A.  Snrg.  J.  II. 

1863. 

December  27,  1863. 

Massachusetts. 

Au.  -,  '62. 

Peabody.     Disch'd  June  26,  '63. 

105 

Scoggins,  R.  W.,  Pt.,  F, 

May  6, 

Left  ;  circular.    A.  A.  Surg.  U.W. 

74 

McCosh,  R.,  Pt.,  11,  30th 

Jan.  1, 

Right;  flap.     Discharged  July  8, 

1st  Florida  Cav'ry,  age 

Aug.  30, 

Coale.     Discharged  December 

Indiana. 

Apr.1,'63. 

1863. 

19. 

1865. 

5,  1865.     Spec.  1599. 

75 

McDowell,  J.,  Serg't,  K, 

July  2, 

Left  ;  circular.    A.  A.  Surg.  B.  B. 

106 

Scott,   F.,  Pt.,  K,  26th 

Aug.  28, 

Left  ;  circular.    A.  A.  Surg.  C.  B. 

lllth  N.  York,  age  39. 

Oct.  —  , 

Miles.      Discharged   April    16, 

Pennsylvania. 

Oct.  —  , 

King.    Disch'd  October  3,  1863. 

1803. 

1864.     Spec.  1731. 

1862. 

76 

McOill,J.  H.,Pt.,D,60th 

May  9, 

Right.     Dr.  \V.  S.  A.  Cox,  Long 

107 

Servis,  B.,  Pt.,  K,  96th 

May  9, 

Right;  fl;ip.  Surg.  M.  Goldsmith, 

Illinois,  age  24. 

1864, 

Prairie,    111.      (Caries:    ulcers; 

Illinois,  age  21. 

July  12, 

U.  S.  V.     Discharged  October 

Mar.  4, 

gangrene.     Disch'd  March  14, 

1864. 

26,  1864. 

1867. 

1865.)     Recovery. 

108 

Shannon,  W.,  Pt.,C,  llth 

July  2, 

Right.      Paroled  November   12, 

77 

McKelvey,    A.,    Pt.,  R 

June  30. 

Left;  short   anterior,   long  post. 

Georgia,  age  25. 

Au.  8,  '63. 

1863. 

169th  N.  York,  age  20. 

Aug.  9, 

flap.     A.  A.  Surg.  W.  L.  Welles. 

109 

Melton,  J.L.,  Pt.,F,llth 

July  2, 

Left,    Surg.  T.  A.  Means,  C.  S.  A. 

1864. 

Discharged  August  21,  1865. 

Georgia,  age  35. 

Aug.  3, 

Retired  December  14,  1863. 

78 

MoKeever,    D.,  Pt.,   B, 

Muy  15, 

Right  ;  posterior  flap.  Ass't  Surg. 

1863. 

99th  Pennsylvania,  age 

1864, 

S.  B.  Ward,  U.  S.  V.     Disch'd 

110 

Sherman,  M.,  Pt,  A,  1st 

Aug.  14, 

Left  ;  circular.    Snrg.  A.  F.  Shel 

40. 

Ja.24,'65. 

June  15,  18<i5. 

Minnesota,  age  42. 

Sept.  24, 

don,  U.  S.  V.     Discharged  July 

79 

McMonigal,  N.,    Corp'l, 

July  9, 

Left  ;  flap.     A.  A.  Surgeon  J.  A. 

1864. 

24,  1865.     Spec.  3258. 

F,  69th  Pennsylvania, 

1862, 

Cross.     Discharged  August  29, 

m 

Shouls,  D.  L.,  Pt,,  E,  1st 

Nov.  25, 

Left;    lateral   flap.     Discharged 

age  27. 

•Jan.  -,'63. 

1863. 

New    York     Cavalry, 

1864, 

May  28,  1805. 

80 

Miller,    N.,    Pt.,  H,   1st 

June  24, 

Left  ;  flap.  Surgeon  D.  P.  Smith, 

age  22. 

Feb.6,'65. 

Artillery,  age  34. 

1864, 

U.  S.  V.     To  regiment  June  7, 

112 

Slater,  J.  A.,  Pt.,  H,  6th 

July  2, 

Left  ;  flap.     Ass't  Surgeon  W.  T. 

M'h  1,'65. 

1865. 

Infantry,  age  23. 

Aug.  4, 

Okie,  U.  S.  A.     Discharged  Oc 

81 

Moore,  J.  E.,  Pt.,  C,  73d 

Oct.  8,  '62, 

Right  ;  flap.  Dr.  J.  C.  Cook,  New 

1863. 

tober  17,  1864. 

Illinois. 

April  4, 

port,   Ind.     Discharged  March 

113 

Smith,  A.  J.,  Serg't,  I, 

July  2, 

Right.     A.  A.  Surg.  F.  Hinkle. 

1864. 

17,  1863. 

72d  New  York,  age  33. 

Aug.  21, 

Discharged  July  3,  1864. 

82 

Moore.,    W.,  Pt.,  G,    1st 

June  26, 

Right.     Surgeon  J.  G.  Brodnax, 

1863. 

North  Carolina. 

1862, 

C.  S.  A.     Recovery. 

114 

Smith,  C.W.,Pt.,A,  10th 

Se.29,'64, 

Right  ;  flap.     A.  A.  Surg.  A.  H. 

Ja.13,'63. 

N.  Hampshire,  age  20. 

Nov.  17, 

Crosby.     Discharged  May  18, 

83 

Morris,  S.    W.,   Pt.,  G, 

July  1, 

Left  ;    antero-posterior  flap.     A. 

1865. 

1865.     Died  Nov.  11,  1870. 

55th   N.  Carolina,  age 

Oct.  2, 

A.  Snrg.  J.  Priestly.     To  prison 

115 

Smith,  B.  M.,  Pt.,  K,  13th 

May  3, 

.     Recovery. 

23. 

1863. 

April  20,  1864. 

South  Carolina. 

Au.  3/63. 

84 

Moucha,  J.,  Pt.,  C,  5th 

July  2, 

Left;  circular.    Erysipelas.    Ex 

116 

Smith,   M.,  Pt,,   H,  7th 

May  5, 

Right  ;  circular.     Surg.  E.  Bent- 

Florida. 

Au.  6,  '63. 

changed  November  12,  1863. 

Wisconsin,  age  25. 

July  12, 

ley,  U.  S.  V.     Discharged  Jan 

85 

O'Neill,  J.,  Serg't,  E,  1st 

J'y  2,  '63, 

.    Surg.  G.  A.  Nott,  P.A.C.S. 

1864. 

uary  19,  1865.     Sptr.  3341. 

Louisiana. 

M'h  -,'64. 

Retired  January  30,  18G5. 

117 

Starkey,  E.,  Serg't,  H, 

June  27, 

Left.     Ass't  Surg.  R.  Hartholow, 

86 

'O'Ueillv,    C.,    Pt.,    F, 

May  18, 

Right.     A.  A.  Surg.  W.  Robie. 

1st  Michigan,  age  21. 

July  28, 

U.  S.  A.    Necrosis.    October25, 

164th   New  York,  age 

Feb.  12, 

(Prim.  amp.  ank.  joint;  S  vine's.) 

1862. 

1863,  re-ampntat'n.    Discharged 

23. 

1865. 

Discharged  May  31,  1865". 

December  28,  1864. 

87 

Palmer,  A.,   Pt.,  G,  3d 

July  3, 

Left  ;  flap.    Sept.  2,  haemorrhage  ; 

118 

Stearns,  J.  P.,  Lieut.,  K, 

July  1, 

Left  ;  flap.     To  Veteran  Reserve 

Michigan,  age  37. 

Aug.  15, 

ligation    anterior  tibial    artery.  : 

22d  Massachusetts. 

Oct.  1,  '62. 

Corps. 

1863. 

Discharged  May  31,  1864. 

119 

Streubel,  W.,Pt,,  K,  llth 

July  21, 

Left  ;  circular.    Surg.  A.  B.  Mott, 

88 

Parker,  W.  B.,  Pt.,  G,  2d 

June  19, 

Left  ;  circular.   S'urg.  E.  Bentley,  ! 

New  York. 

1861, 

U.  S.  V.    Disch'd  April  6,  1863. 

Michigan,  age  24. 

Nov.  10, 

U.  S.  V.      To  Vet.  RPS.  Corps 

J'e20,'62. 

1864. 

February  17,  1865.     Spec.  3407. 

120 

Taft,  L.,  Pt.,  E,  34th  N. 

Se.17,'62, 

Right  ;  flap.     Surg.  W.  T.  Hum 

89 

Parkinson,  J.  R.,  Pt.,  A, 

May  13, 

Left  :  flap.      Discharged   March 

York,  age  41. 

Feb.  16, 

phrey,  149th  Penn.    Discharged 

Hlth  Illinois. 

July  13, 

28,  1865. 

1863. 

June'  30,  1863. 

1864. 

121 

Thomas,  E.  O.,  Serg't,  E, 

July  1, 

Right;  flap.     A.  A.  Surg.  J.  L. 

90 

Peet,  G.  H.,  Pt.,  E,  5th 

Aug.  9, 

Right  ;  flap.  Confederate  surgeon. 

14th  South  Carolina. 

Aug.  3, 

Whittaker.     Exchanged  March 

Ohio. 

Sept.  17, 

Discharged  February  12,  1863. 

1863. 

17,  1864.     Spec.  2054. 

1862. 

122 

Thompson,  A.  J.,  Capt., 

Nov.  30, 

Left  :  circular.     Surg.  —  Doyer, 

91 

Philpot,   G.,    Corp'l,   I, 

Deo.9,'62, 

Right.     Ass't  Surg.  F.  L.  Town, 

G,  7th  Mississippi,  age 

1864, 

C.  S.  A.     To   Provost   Marshal 

8th  Kentucky. 

Jan.  —  , 

U.  S.  A.     Discharged  April  17, 

27. 

Ja.20,'65. 

March  21,  1865. 

1863. 

1863. 

123 

Thorn,  F.,   Pt.,  D,  63d 

May5, 

Left;    flap.      Dr.   R.    Faulkner, 

92 

Potter,  J.  W.,  Corp'l,  C, 

Sept.  30, 

Left  ;  antero-posterior   flap.      A. 

Pennsylvania,  age  28. 

Aug.  17, 

Erie,  Penn.     (Gangrene.     May 

1st     Michigan    Sharp 

Nov.  4, 

A.  Surg.  J.  S.  Wheeler.     Dis 

1864. 

26,  exc.  lower  3d  fib.)     Disch'd 

shooters,  age  22. 

1864. 

charged  May  9,  1865.  £/>«:.  4229. 

March  18,  1805.     Spec.  2"02. 

93 

Kathlmrn,  C.W.,  Corp'l, 

De.  13,  '62, 

Left  ;    flap.      A.   A.  Surgeon  E. 

124 

Truel,    E.    M.,    Pt.,   E, 

July  21, 

Right  ;  circular.    Surg.  J.  G.  Mil 

B,    1st    Rhode    Island 

Sept.  16, 

Seyffarth.    Discharged  J  uue  24, 

12th  Wisconsin,  age  23. 

Sept.  8, 

ler,  llth  Iowa.    Disch'd  August 

Artillery,  age  29. 

1863. 

1864. 

1864. 

31,  1865. 

94 

Reed,  J.,   Pt.,   E,   89th 
New  York,  nge  24. 

Sept.  29, 
Nov.  5, 

Left;  antero-posterior  flap.   Surg. 
G.  S.  Palmer,  U.  S.  V.     Furl  d 

125 

Tuttle,   B.,   Pt.,    F,   1st 
Michigan,  age  24. 

Aug.  30, 
1862, 

Right;  circular.     A.  A.  Surg.  T. 
H.  Allison.     Discharged  April 

1864. 

April  10,  1865. 

Ja.22,'63. 

10,  1863. 

95 

Roberts,  H.,  Pt.,  F,  12th 

N<>.29,'64, 

Left  :  oval  flap.    Discharged  May 

126 

Walters,  M.,Pt.,K,  120th 

July  2, 

Left  :  circular.  A.  A.  Surg.  A.W. 

Kentucky,  age  2:?. 

April  20, 

6,  1865. 

New  York,  age  20. 

Oct.  26, 

Colburn.    (Hemorrhage.)    Dis 

1865. 

1863. 

charged  October  14,  1864. 

96 

Rounds,  J.  E.,  Pt.,  E,  2d 

May  6, 

Right  ;  circular.     Surgeon  D.  W. 

127 

Warmack,  J.  W.,  Pt.,  H, 

De.31,'62, 

Left.  Surg.  M.  P.  Scott,  P.A.C.S. 

U.    S.    Sharpshooters, 

June  22, 

Bliss,  U.  S.  V.    Discharged  May 

44th  Tennessee. 

Feb.  5, 

Recovery. 

age  25. 

1864. 

15,  1865. 

1863. 

97 

Ross,  J.,  Pt..  I.  2d  N.  Y. 

May  19, 

Left:  flap.     Surg.  D.  W.  Bliss, 

128 

Webb,  M.,  Pt.,  A,  114th 

June  25, 

Right:  lateral  flap.     Ass't  Surg. 

Heavy   Artillery,   age 



U.  S.V.   (Prim.  amp.  ank.  joint.) 

New  York. 

Aug.  18, 

W.  S.  Webster,  156th  N.  York. 

40.     ' 

1864. 

Disch'd  March  15,  1865.     Died 

1863. 

Recovery. 

Jan.8,'77;  apop.  andhemiplegia. 

129 

WTelsch,J.  M.,  Pt.,B,  8th 

Mav  20, 

Right  ;  flap.    Surg.  G.  Derby,  23d 

98 

Rnmbaugh,  W.,  Pt.,  D, 

April  5, 

Left.    Dr.  R.  WalUice,  ItutlerCo., 

Maine,  age  21. 

1864, 

Mass.      (Necrosis.)      Hsemorrh. 

62d  Pennsylvania. 

July  11, 

1862. 

Penn.     Discharged  Februarys, 

1863. 

Mar.  26, 

1865. 

April  12,  1865,  amputat'n  thigh. 
Discharged  August  25,  1865. 

99 

Russell,  A.    K.,  Pt.,  II, 

Mav  19, 

Left.     Surg.  C.  N.  Chamberlain, 

130 

Wells.  G.  W.,  Pt.,  K,  4th 

Aug.  16, 

Right;  ant.  posterior  flap.     A.  A. 

1st   Massachusetts  Ar 

1864. 

U.  S.  V.     (Primary  amputation 

New   Hampshire,    age 

1864, 

Surg.  J.  C.   Morton.      (Oct.  22, 

tillery,  age  43. 

ankle  joint  :   Syme's.)     Disch'd 

24. 

Jan.  16. 

1804,  Syme's  amputation  foot.) 

June  2,  1865. 

1865. 

Discharged  January  11,  1865. 

'SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  Sanitary  Commission  Memoirs,  New  York,  1871,  Surg.  Vol.  II,  p.  136. 


550 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITABY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT.     • 

131 

West,  J.  G.,  Corp'l,  H, 

July  2, 

Right  :  flap.     A.  A.  Surg.  B.  B. 

153 

Kelly,  J.  A..  Pt.,  C,  21st 

De.31,'62, 

Left.     Died  March  23,  1863. 

62d  Pennsylvania,  use 

Aug.  14, 

Miles.  (Gangrene.)   Discharged 

Michigan. 

Mar,  19, 

19. 

1§63. 

December  16,  1863.     Spec.  1669. 

1863. 

132 

Westfall.  H.,  Pt.,  D,  9th 

Sept.  17, 

Right;  anterior  post.  flap.     Surg. 

154 

Loyd.  D..  Capt.,  E,  121st 

June  27, 

Left;  flap.  A.  A.  Surg.  J.  A.  Hall. 

New  York,  age  28. 

Oct.  21, 

T.H.  Squire,  89th  N.Y.  Disch  d 

Ohio,  age  33. 

July  28, 

Died  August  7,  1864  ;  pyaemia. 

1862. 

April  8,  1863.    Spec.  275. 

1864. 

133 

WheaUrly,  J.  M.,  Pt.,  I, 

.Sept.  -, 

Right.  Surg.  —  Gilmore,  C.  S.A. 

155 

Martin,  M.    V.,  Pt.,  C. 

Nov.  25, 

Right.   A.  A.  Surg.G.  P.  Hachen- 

13th  Mississippi. 

De.W/62. 

Recovery. 

llth  Tennessee,  age  22. 

1863, 

berg.     (Necrosed.)     March  21, 

134 

Whilty.  J.,   Pt.,  A,  6th 

May5,'64, 

Left  ;  circular.    Surg.  H.  Culbert- 

Mar.  10. 

gangrene.     Died  March  25,  '64  ; 

Wisconsin,  age  22. 

Feb.  8, 

son.   I1.  S.  V.     (May  31,   1864, 

1864. 

pneumonia.     Spec.  2203. 

1865. 

Syme's  amputation  ankle  joint.) 

156 

McRae.  C..  Pt.,  A,  27th 

May  6, 

Right;  anterior  post.  flap.     Surg. 

Discharged  June  26,  1865. 

Michigan,  age  34. 

June  10, 

R.  B.  Bontecou,  U.  S.  V.     Died 

135 

White,  M.,  Pt..  I,  60th 

Sept.  19, 

Left  ;  circular.    Surg.  J.W.  Law- 

1864. 

July  18,  1864.     Spec.  3069. 

Virginia,  age  34. 

Nov.  12, 

son,  P.  A.  C.  S.      Exchanged 

157 

Mickee.  J.,   Pt.,  1,  88th 

May  18, 

Right.     Died  July  24,  1864. 

1864. 

February  16,  1865. 

Illinois. 

July  18, 

136 

White,  R.  H.,  Pt.,  D,  9th 

Dec.  13, 

Right;  circular.     May  24,   1864, 

1864. 

N.  York  State  Militia. 

1862, 

re-amputation.      Disch'd  April 

158 

Miller,  J.,  Pt.,   H,  26th 

June  27, 

Left  ;  circular.    A.  A.  Surg.  J.W. 

Feb.5,'63. 

24,  ]863. 

Ohio,  age  18. 

Aug.  7, 

Digby.     Died  August  31,  1864  ; 

137 

Wright,  J.L.,  Pt.,G,  97th 

Nov.  30, 

Left  ;  circular.    Surg.  R.  R.  Tay 

1864. 

exhaustion. 

Ohio,  age  24. 

1864, 

lor,  IT.  S.  V.     Discharged  June 

159 

Mitchell,   J..  Pt.,  I.    1st 

May  16, 

Night:  circular.     A.  A.  Surg.  J. 

Jan.8,'65. 

10,  1865. 

Maine  Heavy  Artillery, 

July  6, 

P.  Arthur.     Died  July  9,  1864. 

138 

Bennett,  C.,  Pt.,  D.  9th 

May  19, 

Right;  circular.     A.  A.  Surg.  M. 

age  45. 

1864. 

N.  Hampshire,  age  19. 

Aug.  lit, 

Lampen.     (Gang.;   sloughing.) 

160 

Morrnn,  J.   A.,    Pt.,   D, 

Feb.  3, 

Right.      Died    March   31,    1863. 

1864. 

Died  August  28.  1864  ;  pyaemia. 

4th  Alabama  Cavalry. 

Mar.  13, 

Spec.  1036. 

Spec.  3637. 

1863. 

139 

Brackett,  W.  H.,  Corp'l, 

Mar.  14, 

Left  :  circular.    A.  A.  Surg.  J.  B. 

161 

Nichols,    J.   B.,   Pt.,   A, 

June  17, 

Right  ;  circular.    A.  A.  Surg.  W. 

B,  21st  Massachusetts. 

May  5, 

Upham.     Died   May   16,   ISfW  ; 

24th  New  York  Caval 

Aug.  24, 

P.  Moon.     Died  Sept.  7,  1864. 

1862. 

exhaustion. 

ry,  age  18. 

1864. 

140 

Bussler,  D.,  Pt.,  K,  93d 

Mar.  25. 

Left;  circular.     A.  A.  Surg.   H.  I|162 

O'Brien,  J.,  Pt.,  F,  19th 

Sept.  20, 

Right.     A.  Surg.  W.  E.  White- 

Pennsylvania,  age  19. 

May  6, 

Craft.  (Spicula  rcm.;  gangrene.) 

Infantry. 

1863, 

head,  U.  S.  A.     Died  January 

1865. 

Died   May   15,   186.");    pyaemia. 

Jan.  8,  '64. 

26.  1864.     Spec.  2034. 

Spec.  195. 

163 

Penny,    W.,   Pt.,   G,  2d 

July  4, 

Right  ;  post.  flap.      A.   A.  Surg. 

141 

Cannel,   J.,    Serg't,    A, 

May  9, 

Right;  circular.     A.  A.  Surg.  H. 

Maryland,  age  ii2. 

Sep.  I,  '64. 

J.  Tyson.     Died  September  29. 

124th  Ohio,  age  27. 

June  11, 

C.  May.     Died  October  4,  1864  ; 

1864  ;  exhaustion. 

1864. 

exhaustion.     Spec.  3359. 

164 

Pero,  P.,  Pt.,  C,  2d  New 

May  5, 

Right.     A.  A.  Surg.  F.  Hassen- 

142 

Carl,  P.   S.,  Corp'l,  K, 

Aug  29, 

.     Died  October  7,  1862. 

York  Cavalry,  age  22. 

June  20, 

berg.     (May  7,  excis.  met.  and 

20th  New  York  State 

1864. 

fragm'ts  ;  hsem.)     Died  July  15, 

Militia. 

1862. 

1864;  chronic  diarrhoea. 

143 

Clellar,  J.    A.,   Pt.,    A, 

April  7, 

.     (Removal   of  fragments.) 

165 

RliofJun,}}.  £.,Pt.,  F,4th 



Right  :  circular. 

15th  Infantry. 

1862. 

Died  May  12,  1862;  pyaemia. 

North  Carolina. 

144 

Deyer,  J.,  Pt.,  Chicago 

June  21, 

Left  ;   circ.     Surg.   S.  JO.  Fuller, 

166 

Schmid.  J.  (.',.,  .Serg't,  F, 

Aug.  10, 

Left;  circular.     Died  October  7, 

Battery,  age  27. 

July  25, 

U.  S.  V.     Died  August  2,  1864  ; 

1st  Rhode  Island  Art'y, 

Sept.  22, 

1864  ;  gangrene.     Kpec.  3647. 

18fi4. 

chronic  diarrhoea. 

age  26. 

1864. 

145 

Fern,   R,   Pt.,    C,    21st 

May  17, 

Right.       Died    June    26,    1863; 

167 

Shoemaker,  H.  E.,  Pt., 

May  31, 

Left.     Ass't  Surg.  W.  Thomson. 

Iowa. 

June  23, 

chronic  diarrhoea. 

C,  52d  Pennsylvania. 

July  1, 

IT.  S.  A.     Died  October  9,  1862  ; 

1863. 

1862. 

gangrene,     Ispec.  4936. 

146 

Garland,  I.,  Pt.,  C,   1st 

June  18, 

Left.     (Gangrenous.)     Died  Au 

168 

Smith,  II.  W.,  Serg't,  K, 

July  3, 

Left.     Ass't  Surg.  1).  C.  Peters, 

Maine  Heavy  Artillery. 

Aug.  6, 

gust  10,  1864;  pyaemia. 

lllth  N.  York,  age  20. 

Aug.  4, 

U.S.A.     Died  August  8,  1863. 

1864. 

1863. 

Spec.  1607. 

147 

Gillmore,     L.,    Pt.,    K, 

June  3, 

Left  ;  anterior  post.   flap.     Surg. 

169 

Spinklcr,  J.  If.,  Pt.,  I, 

May  3, 

Right;    circular.     Died   Septem 

lllth  Pennsylvania. 

July  8, 

E.  Bentley,  IT.  S.V.    (Necrosis.) 

18th    North    Carolina, 

Aug.  31, 

ber.'!,  1863;  effects  (amputation 

1864. 

Died   July   16,  1864;    pyaemia. 

age  30. 

1863. 

last  resort). 

Spec.  3352'. 

170 

Stead,  J.  W.,  Pt.,  K,  3d 

May  15, 

Left;  flap.      A.  A.   Surg.  H.  H. 

148 

Gregg,   R.,   Pt.,   C,    1st 

June  18, 

Right;  circ.     A.  A.  Surg.  O.  W. 

N.  Hampshire,  age  24. 

June  21, 

White.      Died   July    16,    1864; 

Maine  Heavy  Artillery, 

July  28, 

Peck.     (July   12,  Syme's  amp. 

1864. 

irritative  fever. 

age  37. 

1864. 

ankle  joint.)'    Died  Sept.  30,  '64. 

171 

Stout,  I.,  Corp'l,  C,  79th 

July  20, 

Left;  circular.    A.  A.  Surg.  F.  C. 

149 

Sathaway,  W.  H.,  Pt..G, 

Nov.  29, 

Left:  circular.     A.  A.  Surg.  C.  H. 

Ohio,  age  26. 

Sept.  10, 

Leber.     Gangrene.     Died  Sep 

33d  Alabama,  age  44. 

Dec.  31, 

Fisher.     Died  January  31,  1865. 

1864. 

tember  12,  1864. 

1864. 

172 

Troxler,   G.   S.,  Pt.,   A, 

Mar.  25, 

Left;  circular.     A.  A.  Surgeon  J. 

150 

Ingram,  S.,  Pt.,  A,  161st 

April  8, 

Right  ;  flap.     A.  A.  Surg.  II.  La 

59th    North    Carolina, 

Apr!  129. 

Morris.     Died  May  5,  1865;  ery 

New  York,  age  18. 

Aug.  14, 

tham.     Died  August  29,  1864. 

age  41. 

1865. 

sipelas. 

1864. 

173 

Wiekson,  D.  D.,  Pt.,  I, 

Sept.  17, 

Left  ;   anterior  post.  flap.     Ass't 

151 

Jennings,  J.  T.,  Corp'l. 

Feb.  6, 

Left;  lat.  oval  skin  flap.     A.  A. 

59th  New  York. 

Dec.  1, 

Surgeon  J.  B.  Brinton,  U.  S.  A. 

K,  56th  Pennsylvania, 

Mar.  9, 

Surg.  E.  G.  Waters.    (Necrosis.) 

1862. 

Died  Dec.  16,  1862.     tfpec.  797. 

age  48. 

1865. 

Died  March  22,  1865;  pyaemia. 

174 

Young,  W.,  Pt.,  G,  8th 

June  9, 

Right.     Died  July  20,  1863.   Spec. 

152 

Johnston,  W.,Pt.,  E,  26th 

Aug.  29, 

Right.    Died  November  5.  1862. 

Illinois  Cavalry. 

July  10, 

1345. 

Pennsylvania. 

1862. 

1863. 

Secondary  Amputations  in  the  Lower  Third  of  the  Leg  for  Shot  Injury. — The  num 
ber  of  secondary  operations  in  the  lower  third  of  the  leg  is  one  hundred  and  twenty-one; 
eighty-six  patients  survived  the  operation  and  thirty-five,  or  28.9  per  cent.,  succumbed. 
The  right  limb  was  amputated  in  fifty-five,  and  the  left  in  sixty-two  instances;  in  four 
cases  the  side  was  not  specified. 

Recoveries  after  /Secondary  Amputations  in  the  Lower  Third  of  the  Leg. — Of  the 
eighty-six  operations  of  this  group  nine  were  performed  on  Confederate  and  seventy-seven 
on  Union  soldiers.  The  latter  were  pensioned,  and  one  only  has  died  since  the  date  of 
discharge  from  the  service. 

CASE  800. — Private  W.  Nash,  Co.  C,  187th  Pennsylvania,  aged  19  years,  was  wounded  in  the  right  foot,  before  Peters 
burg,  June  18,  1864.  Surgeon  C.  N.  Chamberlain,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  4th  division, 
Fifth  Corps,  "with  "severe  injury  to  the  bones  of  the  foot,  caused  by  a  minie'  ball."  From  the  field  hospital  the  wounded  man 
passed  to  City  Point,  thence  to  hospital  at  Alexandria,  and  subset] uently  to  Philadelphia.  Assistant  Surgeon  T.  C.  Brainerd, 
U.  S.  A.,  in  charge  of  Broad  and  Cherry  Streets  Hospital,  described  the  injury  as  ''a  compound  fracture  of  the  tarsus,  followed 


SECT,  v.l  SECONDAKY    AMPUTATIONS    IN    THE    LEG.  551 

by  necrosis  of  bone,  pain  in  the  foot,  and  free  discharge,  for  which  the  leg  was  amputated  at  the  lower  third  by  circular  method, 
on  May  8th,  by  Acting  Assistant  Surgeon  H.  M.  Bellows.  At  the  time  of  the  operation  the  patient  had  become  much  exhausted 
from  the  profuse  and  continued  discharges  from  the  wound.  He  reacted  promptly,  ether  having  been  used  as  an  anaesthetic. 
Dry  dressings  were  applied."  The  operator  subsequently  communicated  that  the  stump  only  required  three  weeks  to  heal  per 
fectly.  The  patient  afterwards  passed  through  various  hospitals,  and  was  ultimately  mustered  out  at  the  expiration  of  his  time 
of  service,  August  3,  1865,  and  pensioned.  Several  years  later,  when  seen  and  examined  by  the  operator,  the  pensioner  was 
found  in  general  good  health  and  with  a  good,  round,  and  entirely  healed  stump,  he  being  able  to  walk  satisfactorily  with  the 
aid  of  an  artificial  limb.  In  his  application  for  commutation,  in  1870,  the  pensioner  described  the  stump  as  being  "not  in  the 
best  condition;"  but  in  his  subsequent  statements,  five  and  ten  years  later,  lie  reported  its  condition  as  "good."  The  pensioner 
was  paid  September  4,  1880. 

CASE  801. — Private  D.  Dietz,  Co.  B,  48th  Pennsylvania,  aged  21  years,  was  wounded  in  the  left  ankle  joint,  at  Spott- 
sylvania,  May  12,  1864.  He  remained  at  a  field  hospital  for  two  weeks  and  was  then  conveyed  to  Washington,  where  he  was 
admitted  to  Campbell  Hospital.  Surgeon  A.  F.  Sheldon,  U.  S.  V.,  contributed  the  pathological  specimen,  No.  4032,  repre 
sented  in  the  annexed  wood-cut  (FlG.  324),  with  the  following  history  of  the  injury:  "A  musket  ball  entered 
the  left  foot  posteriorly,  passed  forward  between  the  astragalus  and  tibia,  and  emerged  anteriorly,  opposite 
the  point  of  entrance,  fracturing  the  articulating  surfaces  of  both  bones.  Circular  amputation  through  the 
inferior  third  of  the  leg  was  performed  by  Assistant  Surgeon  A.  Delany,  U.  S.  V.,  on  November  10th,  two 
ligatures  being  applied  and  anaesthesia  produced  by  chloroform.  At  the  time  of  the  operation  the  foot  and 
ankle  were  enlarged,  with  numerous  openings  discharging  sanguinolent  pus.  Hectic  irritation,  pain,  and  loss 
of  appetite  were  rapidly  overcoming  what  little  vitality  remained.  The  patient  bore  the  operation  well." 
The  patient  was  subsequently  transferred  to  Judiciary  Square  Hospital  for  the  purpose  of  being  fitted  with 
an  artificial  limb,  and  on  May  19,  1865,  he  was  discharged  from  service  and  pensioned.  In  his  application  for 
commutation,  dated  1870,  he  described  the  stump  as  "healed  and  well,"  and  subsequently  he  reported  it  as 
being  in  "good  condition."  The  pensioner  was  paid  June  4,  1880.  The  specimen  consists  of  the  bones  com-  FIG.  324. — Bones 
prising  the  ankle  of  the  amputated  leg,  and  shows  that  large  quantities  of  spongy  new  bone  were  thrown  out  momL^n 
around  the  tibia,  but  the  bodies  of  the  bones  were  destroyed  by  suppuration.  Spec.  4058. 

CASE  802  — Private  C.  W.  Fox,  Co.  I,  lllth  New  York,  aged  18  years,  was  wounded  in  the  right  foot  during  the 
engagement  at  the  South  Side  Railroad,  March  31,  1865.  He  was  admitted  to  Harewood  Hospital,  Washington,  five  days  after 
wards,  where  amputation  was  performed  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  who  made  the  following  report:  "The  metatarsal 
bone  of  the  big  toe  was  fractured  and  the  os  calcis  severely  injured.  When  admitted  the  patient  appeared  to  be  considerably 
debilitated;  the  condition  of  the  injured  parts,  however,  was  tolerably  good.  The  parts  subsequently  became  gangrenous,  with 
disorganization  of  the  ankle  joint,  sloughing  of  soft  parts,  and  necrosis  of  bone.  Sinuses  formed  and  extended  up  the  leg.  The 
limb  was  amputated  at  the  lower  third  by  the  circular  method  on  May  3d.  The  patient  did  well  after  the  operation  under  simple 
dressings,  aided  by  a  supporting  and  nourishing  diet  throughout.  The  parts  had  nearly  healed  when  he  was  transferred  to 
Armory  Square  Hospital  July  20th."  About  one  month  later  he  was  transferred  to  Stanton  Hospital,  where  a  second  operation 
became  necessary  and  was  performed  by  Surgeon  B.  B.  Wilson,  U.  S.  V.,  who  describes  it  as  follows:  "The  first  amputation 
had  been  performed  about  one  inch  above  the  ankle  joint.  At  the  time  of  the  patient's  admission  to  Stanton  Hospital  the 
stump  bnd  entirely  healed,  but  it  was  swollen  and  painful  and  presented  evidence  of  suppurative  inflammation  within.  Poultices 
were  applied  and  abscesses  soon  pointed  in  two  or  three  places,  one  in  or  near  the  cicatrix  of  the  operation  and  the  other*  along 
the  lower  part  of  the  shaft  of  the  tibia,  which,  on  rupturing,  discharged  a  bloody  and  ill-conditioned  pus  pretty  freely.  Upon 
examination  with  a  probe  the  existence  of  necrosed  bone  was  detected,  and  at  the  earnest  request  of  the  patient,  who  desired  to 
get  rid  of  his  trouble  as  quickly  and  fully  as  possible,  it  was  determined  to  re-amputate  the  stump  as  far  as  the  sequestrum 
extended.  The  operation  was  performed  on  September  6th,  three  inches  of  the  bones  being  removed  by  the  ordinary  circular 
method  and  the  sequestrum  found  to  extend  quite  up  to  the  point  severed  by  the  saw.  The  integument  was  brought  together 
laterally  and  secured  by  interrupted  sutures  and  adhesive  straps.  The  patient  did  well  and  the  healing  process  progressed 
rapidly.  At  the  closing  of  Stanton  Hospital,  on  September  19th,  he  was  sent  to  Douglas  Hospital,  where  I  saw  him  two  weeks 
afterwards,  when  the  stump  was  almost  entirely  healed  and  looked  admirably."  In  October,  1865,  the  patient  was  discharged 
from  service,  to  date  from  September  6th,  and  pensioned,  having  been  previously  supplied  with  an  artificial  leg.  In  his  appli 
cations  for  commutation  he  described  the  stump  as  being  in  "sound"  and  "good  condition."  His  pension  was  paid  September  4, 
1880.  The  bones  removed  at  the  second  amputation  were  contributed  to  the  Museum  by  the  operator  and  constitute  specimen 
2454  of  the  Surgical  Section,  exhibiting  the  fibula  in  a  state  of  caries  and  a  large  spongy  involucrum  surrounding  a  small 
sequestrum  of  the  tibia. 

fatal  Secondary  Amputations  in  the  Lower  Third  of  the  Leg  for  Shot  Injury. — 
In  the  thirty-five  cases  of  this  class  pyaemia  was  noted  in  ten,  gangrene  in  ten,  erysipelas 
in  two,  and  secondary  haemorrhage  in  one  instance.  Nine  of  the  patients  were  Confederate 
and  twenty-six  Union  soldiers: 

CASE  803. — Private  W.  J.  Craps,  Co.  D,  24th  South  Carolina,  aged  33  years,  was  wounded  at  Franklin,  November  30, 
1864,  by  a  musket  ball,  which  entered  the  external  lateral  aspect  of  the  left  ankle  immediately  over  the  malleolus,  passed 
inward,  and  emerged  at  the  internal  aspect  in  front  of  the  internal  malleolus,  fracturing  the  inferior  end  of  the  fibula  and  opening 
the  ankle  joint.  The  man  was  taken  prisoner  and  admitted  to  hospital  No.  1,  at  Nashville,  four  weeks  after  receiving  the  injury. 
The  tissues  about  the  ankle  joint  and  dorsum  of  foot  became  swollen  and  infiltrated,  which  was  followed  by  profuse  discharge 
of  carious  pus  from  three  fistulous  openings.  On  February  17, 1865,  the  leg  was  amputated  at  the  lower  third  by  Surgeon  B.  B. 
Breed,  U.  S.  V.  The  operation  was  performed  by  bi-lateral  skin  flaps  and  circular  section  of  muscles,  two  ounces  of  blood 


552 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


being  lost  and  three  ligatures  applied.  Chloroform  was  used  and  was  followed  by  prompt  reaction.  At  the  time  of  the  oper 
ation  the  patient  was  much  exhausted  and  suffering  from  obstinate  diarrhoea.  Disinfectant  dressings  were  used,  also  tonics, 
stimulants,  and  supporting  diet.  The  patient  died  of  exhaustion  March  11,  1865.  The  tarsal  and  metatarsal  bones  of  the 
amputated  limb,  contributed  with  the  history  by  the  operator,  constitute  specimen  4217  of  the  Surgical  Section  of  the  Museum. 
The  internal  and  middle  cuneiform  bones  are  wanting  in  the  specimen,  and  the  first  metatarsal  is  obliquely  fractured. 

CASK  804. — Private  S.  B.  Dudley,  Co.  B,  97th  Indiana,  aged  24  years,  was  wounded  at  Kenesaw 
Mountain,  June  27,  1864.  Surgeon  J.  M.  Woodworth,  1st  Illinois  Light  Artillery,  reported  his  admission 
to  the  field  hospital  of  the  4th  division,  Fifteenth  Corps,  with  "shot  fracture  of  right  ankle  joint."  From 
the  field  the  wounded  man  was  successively  transferred  to  hospitals  at  Rome,  Chattanooga,  and  Nashville, 
and  lastly,  on  November  29th,  he  entered  Crittendeii  Hospital  at  Louisville,  where  the  injured  limb  was 
amputated  by  Surgeon  R.  R.  Taylor,  U.  S.  V.,  who  made  the  following  report:  "The  wound  was  caused 
by  a  mini6  ball,  which  perforated  the  joint  anteriorly.  The  injury  resulted  in  anchylosis  and  inflammation 
of  the  ankle  joint,  and  fistulous  openings  formed  around  the  joint  leading  to  carious  bone.  The  disease, 
enkindled  in  the  articulation  and  adjacent  parts,  became  so  extensive  that  amputation  had  to  be  performed 
through  the  lower  third  of  the  leg  on  February  18,  1865.  Chloroform  was  used  and  the  operation  was 
done  by  the  circular  method,  the  patient  being  in  good  general  health  at  the  time.  Simple  dressings  were 
applied,  and  for  a  time  the  case  promised  well;  but  in  a  few  weeks  the  patient  was  seized  with  traumatic 
erysipelas,  which  rapidly  extended  over  the  entire  leg  and  thigh,  and  in  spite  of  an  energetic  supporting 
treatment  he  sank  rapidly.  His  deatli  occurred  February  28,  1865."  The  bones  comprising  the  injured 
ankle  joint,  Spec.  4248,  were  contributed  to  the  Museum  by  the  operator  and  are  represented  in  the  wood 
cut  (FlG.  325),  showing  the  articulation  in  a  state  of  anchylosis  and  exhibiting  marked  periosteal  disturb 
ance  in  the  shafts  of  the  tibia  and  fibula  for  several  inches.  The  specimen  also  reveals  the  outer  border  of 
the  calcaneum  to  have  been  grooved  and  the  posterior  portion  of  the  astragal  us  to  have  been  carried  away. 
CASE  805. — Private  L.  Ordway,  Co.  A,  19th  Maine,  aged  33  years,  was  wounded  before  Petersburg,  June  22,  1864,  and 
entered  Broad  and  Cherry  Streets  Hospital,  Philadelphia,  eight  days  afterwards.  Assistant  Surgeon  T.  C.  Brainerd,  II.  S.  A., 
reported:  "The  injury  consisted  of  a  gunshot  fracture  of  the  left  ankle  joint,  the  ball  entering  directly  over  the  internal  malle- 
olus,  fracturing  it  and  a  portion  of  the  upper  and  inner  articulating  edge  of  the  astragalus.  The  wound  sloughed  very  badly 
and  the  patient  became  very  much  emaciated.  Amputation  was  deemed  necessary,  and  was  performed  by  the  circular  method, 
at  the  lower  third  of  the  leg,  on  July  23d,  by  Acting  Assistant  Surgeon  F.  H.  Getchell.  Chloroform  was  used.  The  patient 
reacted  well  for  one  so  weak  as  he  was,  and  the  stump  looked  healthy  for  two  days,  after  which  sloughing  set  in.  Dry  dressings 
were  applied  and  beef-tea,  tonics,  and  stimulants  were  administered.  The  patient  continued  to  sink,  and  died  of  exhaustion 
July  28,  1864."  The  amputated  bones  of  the  ankle,  carious  and  showing  no  attempt  at  repair,  were  contributed  to  the  Museum 
by  the  operator  and  constitute  specimen  3b'63  of  the  Surgical  Section. 

TABLE  LXXVIII. 

Summary  of  One  Hundred  and  Twenty-one  Cases  of  Secondary  Amputations  in  the  Lower  Third  of  the 

Leg  for  Shot  Injury. 

(Recoveries,  1—86;  Deaths,  87— 121. J 


FIB.  325.— The  bones 
of  the  right  ankle  eight 
months  after  injury. — 
Spec.  4248. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AUE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

J 

Allhands,  F.  M.,  Lieut., 

May  11, 

Right;  flap.     A.  A.  Surg.  J.  H. 

10 

Burnett    W. 

July  4, 

Left  (necrosis).   Discharged  Feb 

E,  35th  Illinois,  age  32. 

July  18, 

Green.     (Synovitis  anderysip.) 

De.24,'63. 

ruary?,  1864. 

J864. 

Discharged  January  2,  1865. 

11 

Burns,  C.  E.,  Pt.,  D,  12th 

Aug.  29, 

Right  ;  double  flap.     Surg.  J.  H. 

2 

Arnett,    W.    W.,  Pt.,  I, 

Dec.  15, 

Right  ;  flap.      To   Provost   Mar 

Massachusetts,  age  24. 

1862, 

Baxter,  U.  S.  V.     (Sept.  13,  '62, 

14th  Miss.,  age  38. 

1864, 

shal  May  31,  1865. 

April  23, 

Syme's  amputation  ankle  joint.) 

Jan.  20, 

1863. 

Disch'd  July  11,  1863. 

1865. 

12 

Burrows,    E.,    Pt.,   19th 

May  1, 

Right;  flap.     A.  A.  Surg.  E.  L. 

3 

Bailey     D.    Pt.    G    3d 

June  10 

Riirht      Dr    T  C1    Huchcc 

X    Y.  liutterv  ficc  31 

Iowa  Cavalry,  age  26. 

1864,  ' 

(Sloughing:    ligation   plantar.) 

1864!  ' 

Discharged  September  23,  1865. 

Feb.  -,'65. 

Discuarged  Sept.  11,  1865. 

13 

Burt,  F.  P.,  Pt.,  C,  22d 

May  8, 

Right;  circular.     A.  A.  Surg.  H. 

4 

Bisbee,    N.,   Serg't,    K, 

June  18, 

Right  ;  flap.     Surg.  A.  H.  Thurs- 

Massachusetts,  age  19. 

June  8, 

B.  Knowles.     Discharged  Sep 

89th  New  York. 

1864, 

ton.  U.  S.V.     (Amputat'n  toes.) 

1864. 

tember  17,  1864. 

A  p.  3,  '65. 

Discharged  May  25,  1865. 

14 

Guilders,  F.,  Pt.,  G,  8th 

April  6, 

Right..  Surgeon   —   Fish.     Dis 

5 

1  Bralier,  II.  H.,  Pt.,  E, 

Aug.  30, 

Right  ;  Teale's  method  (circular). 

,    Illinois. 

May7.'62. 

charged  August  23,  1862. 

llth  Pennsylvania. 

Oct.  5,  '62. 

Ass't  Surg.  C.  A.  McCall,  U.S.A.!    15  *  2Connors,  J.,  Pt.,  F,  76th 

July  11, 

Right  ;   antero-post.  flap.     A.  A. 

Oct.  13,  re-amputation.    Disch'd 

Pennsylvania,  age  25. 

Sept.  27, 

Surgeon  J.  M.  Fulton.    (Syme's 

September  14,  1863.    Spec.  167. 

1863. 

amp.  ankle  joint.)     Discharged 

6 

Brinson,  J.,  Pt.,  G,  38th 

Dec.1,'62, 

Right;  flap.      Ass't   Surg.  A.  T.  I! 

August  28,  1865. 

Indiana,  age  42. 

Feb.  24, 

Barnes,  98th    Illinois.     Disch'd  !    16 

'Covell,   E.    R.,   Pt.,  C, 

May  18, 

Left;  flap.     Dr.  R.  Millar,  R.  I. 

1863. 

May  21,  1863. 

52d  New  York,  age  38. 

1864, 

Hospital.     (May  18,  '64,  Syme's 

7 

Bromley,  H.,  Pt.,  1,  14th 

May  28, 

Right:   flap.     Discharged   Janu 

May5,'69. 

amputation  ankle.)     Spec.  4369. 

Pennsylvania  Cavalry, 

July  12, 

ary  27,  1865. 

17 

Crouse,  J.,  Serg't,  I,  1st 

July  2, 

Left,     Discharged  May  21,  1864. 

age  •&. 

1864. 

New  York  Light  Artil 

Aug.  2, 

Spec.  1651. 

8 

Brouchard,   A.,  Pt.,  A, 

April  7, 

Left:  circ.     A.  A.  Surgeon  J.  M. 

lery,  age  24. 

1863. 

5th    New    Hampshire, 

May  15, 

Downs.    (April  17,  excision  met. 

18 

Detwiler,  M.  L.,  Serg't, 

Feb.  5, 

Right:  flap.     A.  A.  Surgeon  A. 

age  31. 

1865. 

bones.)     Disch'd  Aug.  12,  1865. 

A,  30th  Illinois,  age  24. 

Mar.  22, 

Sterling.      Discharged   August 

1866,  am]),  knee  j't  ;  amp.  thigh. 

1864. 

30,  1864. 

9 

Brown,  R.,  Pt.,  G,  28th 

Aug.  9, 

Right:  circular.     A.  A.  Surg.  S.      19 

Diets,  D.,   Pt.,    B,  48th 

May  12, 

Left;  circ.    Ass't  Surg.  A.  Delany, 

New  York,  age  19. 

Sept.  27, 

E.  Fuller.     Disch'd  October  23, 

Pennsylvania,  age  21. 

Nov.  10. 

U.  S.  V.     Discharged  May  19, 

• 

1862. 

1862.     Spec.  326. 

1864. 

1865.     Spec.  4052. 

1  COUES  (E.),  Report  of  some  Cases  of  Amputations  and  Rejections  from  Gunshot  Wounds,  etc.,  in  Med.  and  Surg.  Reporter,  1862-3,  Vol.  IX,  p.  196. 
3  SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  Sanitary  Commission  Memoirs,  New  York,  1871,  Surg.  Vol.  II,  p.  138. 
*  SMITH  (S.),  Loc.  tit.,  p.  136. 


SECT.  V.] 


SECONDARY    AMPUTATIONS    IN    THE    LEG. 


553 


.NO. 

NAME,  MII.ITAUV 
L)K6CUI1'T1O.N,  AND  AGE. 

DATKS. 

OPERATIONS,  OPKUATOEB, 
RESULT. 

NO. 

NAMK,  MILITARY 
DKSCUIPTIOX,  AND  AGE. 

DATES. 

Ol'KUATlOXS,  Ol'EHA  IOK8, 

RESULT. 

20 

Donahue,  M.C.,  Seaman, 

Jan.  11, 

Right.     A.  A.  Surg.  G.  Bigsby. 

49 

'Keen,  G.,   Pt.,  A,   8th 

May  23, 

Left  ;  circular.    Surg.W.Wutson, 

U.  S.  Gunboat  '•  Baron 

Feb.  11, 

Discharged  April  30,  1863. 

Indiana. 

July  9, 

U.  S.  V.     Erysipelas.     Disch'd 

DeKalb." 

1863. 

1803. 

September  15,  1863. 

21 

Eastman,  J.  E.,  Serg't, 

May  19, 

Right;  skin  flap.    A.  A.  Surg.  G. 

50 

Kelsey,  A.,  Pt.,  D,  53d 

July  12, 

Right;  flap.     Surg.  J.   T.  Ran 

L,    1st    Mass.    Heavy 

July  8, 

O.  Moody.      Discharged    July 

Illinois,  age  21. 

Sept.  19, 

dolph,  U.  S.  A.  Discharged  May 

Artillery,  age  39. 

1864. 

12,  1865. 

1863. 

25,  1865. 

22 

Egan,   ().,    I't.,   E,   17th 

Feb.  1. 

Lett;  circular.    A.  A.  Surg.  J.  B. 

51 

Kock,  W.,  Serg't,  A,  1st 

May  15, 

Right;  anterior  flap.    Ass'tSurg. 

Massachusetts,  uge  '27. 

May  14, 

Cutter.   Gangrene.    Discharged 

Virginia  Artillery,  age 

Sept.  25, 

G.  B.  Parker,  U.  S.  V.     Disch  d 

1864. 

August  3,  1864. 

28. 

1864. 

May  19,  1865. 

O'i 

Evans,  C.,  I't.,  E,  120th 

Mav  3. 

Left.     Discharged  November  16, 

52 

Lee,   D.,    Pt.,    B,    37th 

Mar.  7, 

Right  ;  flap.     Surg.  E.  A.  Clark, 

New  York. 

J'y—  ,'63. 

1863.     Spec.  1346. 

Illinois. 

June  22, 

U.  S.  V.      Discharged    August 

24 

Evans,   J.,   I't.,   1,   19th 

May  15, 

Left  ;  circular.     Discharged  Sep 

1862. 

23,  1862. 

Michigan,  age  40. 

June  15, 

tember  13,  1865. 

53 

Lillibridge,  F.  W.,  Pt., 

June  18, 

Right.     (June  18,  Chopart's  amp. 

1864. 

B,  2d  N.   Y.  Mounted 

1864. 

foot.)     Disch'd  August  10,  1865. 

25 

Farren,  B.,  Pt.,  A,  82d 

April  8, 

Right;  circular.     A.  A.  Surg.  J. 

Rifles. 

Circular  amput'n  leg  afterward. 

Pennsylvania,  age  49. 

Oct.  25, 

B.  Roe.     Recovered   February 

54 

Long,   J.,    Pt.,    F,    8th 

May  22, 

Right  ;    flap.     Dii^harged    Sep 

1865. 

22,  1866. 

Indiana. 

June  23, 

tember  8,  1863. 

26 

Finegan,  P.,  Pt.,  H,  16th 

Dec.  81, 

Right.    Dr.  J.  H.  Armsby.    (Dis 

1863. 

Infantry,  age  34. 

181)2, 

charged  Feb.  21,  1865;  chronic 

55 

Martin,    T.  B.,   Pt.,  A, 

July  3, 

Left  ;  circular.     Surg.  —  Gillett, 

Feb.  —  , 

erysipelas  of  foot.    27th,  partial 

24th  Virginia. 

Aug.  14, 

C.  S.  A.     (Haemorrhage.)    Re 

1866. 

amputation  of  foot.) 

1863. 

covery. 

27 

Foster,   T.    J.,    Pt.,    H, 

May  12, 

Left  :  circular.    A.  A.  Surg.  A.  F. 

56 

May,    M.,   Pt.,   A,    9tfi 

Sept.  17, 

Left  ;  lateral  flap.    (Primary  amp. 

140th  I'cnn.,  age  21. 

June  24, 

A.  King.     Discharged  .Septem 

New  York,  age  22. 

1862, 

ankle  joint.      Disch'd  Jan.  16, 

1864. 

ber  28,  1864. 

Ap.  -,  '63. 

1863.)     1870,  stump  sound. 

28 

Fox,  C.  W.,  Pt  ,  I,  lllth 

Mar.  31, 

Right  ;  circ.     Surg.  R.  B.  Bonte- 

57 

McDermott,  M.,  Corp'l, 

Dec.  13, 

Left.     Specimen  263,  A.  M.  M. 

New  York,  age  13. 

May  3, 

cou,  U.  S.  V.     Sept.  7,  re-amp. 

1st  Virginia  Cavalry. 

1862, 

1865. 

Disch'd  Sept.  6,  '65.    Spec.  2454. 

,  '64. 

29 

Francis.  F.,  l>t.,  C.  5th 

July  18, 

Right  ;  long  post.  flap.     Surg.  — 

58 

Nash,  W.,  Pt.,  C,  187th 

June  18, 

Right  ;  circular.     A.  A.  Surg.  H. 

New  York  Heavy  Ar 

Aug.  20, 

Miller,  C.  S.  A  .    March  30,  1865, 

Pennsylvania,  age  19. 

1864,  . 

M.  Bellows.     Discharged  Aug. 

tillery,  age  17 

1864. 

re-amp.    Discharged  August  J  1, 

Mav8,'65. 

:i,  1865. 

1865.     Specs.  4301,  4327. 

59 

Newman,    L.,    Pt.,    A, 

July  20, 

Right;   circular.      A.   A.    Surg. 

30 

Fulmer.    S.   D.,  Pt.,  F, 

July  2, 

Right  ;  circular.     A.  A.  Surg.  F. 

149th  New  York. 

Sept.  21, 

R.  McNulty.     Discharged  1865. 

105th  I'enn..  age  21. 

Aug.  21, 

Hinkle.     Discharged   Aug.  27, 

1864. 

Re-amputation  1867. 

1863. 

1864.     Spec.  1667. 

60 

Nutter,  S.  A.,  Pt.,  I,  1st 

June  7, 

Left;  flap.     Drs.  A.  Towlo  and 

31 

Gallaher,  J..Pt.,C,  10th 

July  2, 

Left.     Exchanged  October  2,  '63. 

Maine  Cavalry. 

Sept.  13, 

J.  Sawyer.    Biddeford,   Maine. 

Louisiana,  age  37. 

Aug.  24, 

Spec.  2050. 

1864. 

Discharged  July  27,  1865. 

1863. 

61 

Oyler,  A.,  Pt.,  D,  55th 

Se.29,'G4, 

Right  ;  flap.      Surg.  W.  Watson, 

32 

Gardiner,  A.,  Pt.,  D,  93d 

May  5, 

Right.     Surg.  N.  R.  Moseley,  U. 

Pennsylvania,  age  30. 

Jan.  18, 

105th  Penn.     (Gangrene.)    Dis 

New  York,  age  19. 

June  21, 

S.V.    June  26,  gangrene.    Sept. 

1865. 

charged  May  25,  1865. 

1864. 

4,  nccro.  bone  rem'd.     Disch'd 

62 

Pendleton,    K..    Pt.,    G, 

Mar.  8, 

Left;    circular.     Ass't   Surg.   E. 

May  1  1  ,  1865.     Spec.  2251  . 

27th  Mass.,  age  21. 

April  18, 

F.  Hendriok,   15th  Connecticut. 

33 

Gibbons,  J.  S.,   Pt.,  K, 

Sept.  16, 

.     Surgeon  —  Jett,  C.  S.  A. 

1865. 

Discharged  Nov.  23,  1865. 

30th  Virginia. 

1862, 

Retired  February  15,  1865. 

63 

Perkins,  H.,  Pt.,  G,  44th 

Dec.1,'64, 

Left.     A.  A.  Surg.  J.  S.  Giltner. 

June  18, 

Colored  Troops,  age  18. 

Feb.  —  , 

Discharged  January  16,  1866. 

1864. 

1865. 

34 

Good,  J.  P.,  Pt.,  K,203d 

Jan.   15, 

Left  ;    circular.       Mustered    out 

64 

Peters,  H.,  Pt.,  A,  59th 

May  17, 

Left  ;   antero-post.   flap.     March 

Pennsylvania,  age  31  . 

Feb.  15, 

May  24,  1865. 

New  York,  age  33. 

Aug.  17, 

26,  1865,  re-amputat'n.     Disch'd 

1865. 

1864. 

June  6,  1865.     Spfe.  4335. 

35 

Grantham,  J.  W.,  Corp'l, 

Nov.  30, 

Right  ;   antero-posterior  flap.    A. 

65 

Pisher,  J.  H.,  Pt.,  C,  38th 

July  12, 

Left  :  flap.    Ass't  Surg.  H.  Allen, 

A,  7th  Florida,  age  26. 

1864, 

A.  Surg.  R.  McNeilly.    Provost 

Wisconsin,  age  30. 

Aug.  15, 

U.  S.  A.     Discharged  April  8, 

Jan.  24, 

Marshal  May  6,  1865. 

1864. 

1865. 

1865. 

66 

Powers,   J.  W.,  Pt.,.C, 

Mav  16, 

Left  ;   flap.     Discharged  Decem 

36 

Grover,  L.  G.,  Corp'l,  G, 

April  23, 

Left;  flap.     Dr.  George  Collins, 

29th  Wisconsin,  age  21. 

Sept.  18, 

ber  19,  1864. 

30th  Maine.,  age  21. 

Aug.  13, 

Bethel,    Maine.      Disch'd  Jan 

1863. 

1864. 

uary  8,  1865. 

67 

Price,  S.  B.,  Serg't,  A, 

May  15, 

Left  ;  circular.     Surg.  R.  L.  Stan 

37 

Haslam.J.,  Pt.,  H,  129th 

Dec.  13, 

Right;  flap.     Dr.  A.  H.  Halber- 

2d  Ohio,  age  22. 

June  15, 

ford,  U.  S.  V.     (May  15,  Syme's 

Pennsylvania,  age  30. 

1862, 

stadt,  Pottsville.   Penn.      (Dis 

1864. 

amp.   ankle    joint;    gangrene.) 

Nov.  17, 

charged   May   18,    1863;    amp. 

Discharged  October  10,  1864. 

1867. 

toes.)      1868,    caries;   necrosis. 

68 

Pyle,   G.,   Pt.,  D,  15th 

July  3, 

Left  ;  circular.    A.  A.  Surg.  C.  H. 

June  25,  1868,  re-amputation. 

infantry,  age  19. 

Aug.  30, 

Fisher.     Disch'd  July  11,  1865. 

38 

Hawley,  W.  S.,  Corp'l, 

May  19, 

Left;  flap.     A.  A.  Surgeon  J.  H. 

1864. 

Died  March  27,  1870. 

E,  51st  New  York,  age 

Oct.  15, 

Thompson.     (May  19,  amput'n 

69 

Quinn,     J.,    Serg't,     K, 

Mav  16, 

Left  ;  circular.    A.  A.  Surg.  J.  H. 

30. 

1864. 

meta.)     Disch'd  May  21,  1865. 

169th   New  York,  age 

Aug.  19, 

Thompson.     Discharged  May  3, 

39 

Harden,  I.,  Pt.,  K,  14th 

Sept.  19, 

Left;    antero  posterior   flap.     A. 

21. 

1864. 

1865.     Spec.  3102. 

Ohio,  age  20. 

1863, 

A.  Surg.  J.  H.  Drury.     Erysip 

70 

Reizler,  C.,  Pt.,  B,  7th 

June  3, 

Left;    lateral   skin   flap.     A.  A. 

June  13, 

elas.     Disch'd  August  11,  i864. 

New  York  Heavy  Ar 

July  21, 

Surg.  F.  E.  Marsh.    Discharged 

1864. 

tillery,  age  47. 

1864. 

March  31,  1865. 

40 

Hefferman,   P.,   Pt.,   H, 

Aug.  29, 

Left  ;    antero-posterior   flap.     A. 

71 

Renfro,  U.,  Pt.,  C,   3d 

May  20, 

Right.     Ass'tSurg.  R.  B.  Maury, 

14th  Infantry,  age  22. 

1862, 

A.  Surg.  U.  J.  Levis.     (Septem 

Missouri. 

1863, 

P.  A.  C.  S.    Recovery. 

Oct.  8, 

ber  9,   1863,  Chopart's  amputa 

Feb.1,'64. 

1863. 

tion.)     Disch'd  May  17,  1864. 

72 

Robinson,    T.,    Pt.,    II, 

June  3, 

Left;  flap.    (Discharged  Novem 

41 

Henderson,  D.  H.,  Lieut., 

Oct.  4,  '62. 

Left  ;  flap.     Resigned   February 

81st  Pennsylvania. 

Dec.  7, 

ber  9,  1864.) 

C,  12th  Iowa. 

Jan.  26, 

16,  1863. 

1864. 

1863. 

73 

Schneider,   G.,   Pt.,   E, 

Sept.  14, 

Left  ;  flap.     Discharged  October 

42 

Hoffrichter,   H.,   Corp'l 

Mar.  20, 

Left  ;    flap.      Surg.   B.  N.  Fish, 

4th  Pennsylvania. 

Dec.  16, 

14,  1863. 

G,  46th  Ohio,  age  23. 

April  20, 

27th  Mass.     Discharged  August 

1862. 

1865. 

12,  1865. 

74 

Schroeder,  J.,  Pt.,  C,  2d 

Oct.  8, 

Left.     Surg.  J.  G.  Hatchitt,  U.  S. 

43 

Holden,  W.  G.,  Pt.,  B. 

Aug.  19, 

Left  ;  antero-posterior  flap.    Dis 

Missouri. 

Nov.  —  , 

V.      Discharged  February    19, 

30th  Mass.,  age  29. 

Oct.  19, 

charged  June  9,  1865. 

1862. 

1863. 

1864. 

7.~> 

Siddall.J.,  I't.,  A,  90th 

Aug.  30, 

Left  ;    flap.     Ass't  Surg.  W.  E. 

44 

Hunt,  E.  W.,  Pt.,  I,  57th 

Mav  13, 

Right.      Dr.    Gage,    Worcester. 

Pennsylvania,  age  20. 

Oct.3,'62. 

Waters,  U.  S.  A.     Discharged 

Massachusetts. 

Sep."2,'64. 

Ga)ig.    Sept.  24,  re-amputation. 

February  17,  1864. 

Discharged  June  30,  1865. 

76 

Snyder,  A.,  Pt.,  H,  75th 

May  27, 

Right  ;  circular.    Discharged  Au 

45 

Johnson.  A.  W.,  Pt.,  K, 

Dec.  13, 

Left  ;  flap.     (December  20,  1862, 

New  York. 

J'y  -,  '63. 

gust  29.  1863. 

64th  New  York,  nge  23. 

1862, 

Syme's  amputat'n.    Discharged 

77 

Spielman,   T.,    Pt.,    F, 

Aug.  30, 

Right;  circular.     A.  A.  Surg.  C. 

Oct.  9,  '63. 

January  29,  1863.) 

95th  Ohio,  age  23. 

1862, 

E.  Boyle.     (Rom.  of  os  calcis.) 

4*5 

Johnson,  S.,  Pt.,  C,  24th 

Feb.  1, 

Left;  flap  (caries).     Discharged 

July  10, 

(Discharged  February  4,  1864.) 

Missouri,  age  25. 

Mar.  17, 

May  5,  1863. 

1864. 

1863. 

78 

Stackpole.  F.  A.  H.,  Pt., 

May  3, 

Left;  circular.  Surg.  J.A.  Lidell, 

47 

Janus,    W.,   Pt.,   G.    5th 

July  2, 

Left.  Surg,  C.  H.  Mastin,  C.  S.  A. 

A,  6th  Maine,  age  21. 

Nov.  24, 

U.  S.  V.     Discharged  June  18, 

Texas,  age  22. 

Aug.  5, 

October  18,  bone  removed.     Ex 

1863. 

1864.     Spec.  1847. 

1863. 

changed  March  17,  1864. 

79 

Taylor,  J.  L.,  Pt.,  F,  7th 

May  5, 

Left  ;  circular.     Surg.  —  Tucker, 

48 

Keefer,  H..  Pt.,  K,  74th 

Feb.  23, 

Right;    flap.     Discharged    April 

Wisconsin,  age  39. 

June  5, 

C.-  S.  A.     Dec.  26,  rem.  of  seq. 

Indiana. 

Ap.  7,  '63. 

26,  1865. 

1864. 

Disch'd  May  26,  '65.   Spec.  3697. 

1  BUYAX  ( J.),  Seventeen  Additional  Cases  of  Amputations  from  the  Armies  of  the  Southwest,  in  American  Medical  Times,  1863,  Vol.  VII,  p.  287. 

SUUG.  Ill— 70 


554 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

Ol'EUATIOVS,  OPERATORS, 
RKSULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPKHATIOXS,  OPERATORS, 
RKSULT. 

80 

Thomas,  T.  M.,  Pt.,  E. 

May  24. 

Left;    lateral   skin   flap.     A.  A. 

101 

Kaufman,  C.  E.,  Pt.,  H, 

Aug.  30, 

—  .     Died  October  9,  1862. 

155th  Penn.,  age  23. 

Aug.5,'64. 

Surg.  F.  E.  Marsh.     Discharged 

1st  Pennsylvania  Res. 

—   '62. 

March  31,  1865. 

102    Keneily,  A.    V.,  Pt.,  K, 

Sept.  17,     Right;    necrosis.     Died    Decem- 

81 

Tuttle,  J.  B.,  Pt.,  F,  14th 

Sept.  19, 

Right  ;  lateral  flap.     A.  A.  Surg. 

Hampton's  South  Car 

Dec.2,'62. 

ber  13,  1862.     Spec.  1097. 

New    Hampshire,  age 

1864, 

J.  Neff.     Discharged   July    10, 

olina  Legion. 

44. 

Jan.  4,  '65. 

1865. 

103    Mcllale,  J.,  Pt.,  D,  15th 

Nov.  25,     Left  :  double  flap.     Died  March 

QO 

Verdon,  J.,  Pt.,  A,  17th 

.July  4 

Left-  flap    A  A  Surg.W  L  Hays 

Infantry,  age  21. 

1863,          6.  1864;  chronic  diarrlui'a. 

Infantry. 

Aug.6,'63. 

To  Regiment  Sept.  28,  1863. 

Feb.6,'64. 

83 

Von    Schirach,     F.    C., 

Aug.  29, 

Right;  flap.     Resigned  April  26, 

104    McMullen,   W.,   Pt.,  B, 

Aug.  29,    —  —  .     Died  October  13,  1862. 

Lieut.,    E,    54th    New 

Nov.  28, 

1863. 

24th  New  York. 

—  ,  '62. 

York. 

1862. 

105    Nevin,    G.  M.,    Pt.,    F, 

May  12,  :  Right  ;  circular.      A.  A.  Surg.W. 

84 

White,   A.  H.,   Pt.,  D. 

Oct.2,'62, 

Right  ;  flap.     A.  A.  Surg.  W.  A. 

140th  Penn.,  age  20. 

Juiie  29,        1J.  Morrison.     Died  July  11,  '64  ; 

22d  Illinois. 

Feb.  16, 

Johnson.     Discharged  May  —  , 

1864.          typhoid  fever. 

1863. 

1863. 

106    Ordway,  L.,  Pt..  A,  19th 

June  22,    Left  ;  circular.    A.  A.  Surg.  F.  H. 

85 

Williamson,  J.,  Pt.,  B, 

May  2, 

Left;  flap.     Surg.  J.  H.  Baxter, 

Maine,  age  33. 

July  23, 

Getchell.     Died  July  £8,  1864; 

26th  Pennsylvania,  age 

June  2, 

U.  S.V.     Discharged  June   18, 

Ifc64. 

exhaustion.     Spec.  3663. 

28.      • 

1863. 

1864.     Spec.  1187. 

107 

Owens,  H.  J..  Serg't,  I, 

Sept.  17,    Right.     Ass't  Surg.  C.  Bacon,  U. 

86 

Wilt,  Z.,  Pt.,  A,    166th 

April  18, 

Left;  flap.     Discharged  July  28, 

14th  Tennessee. 

Oct.  21,        S.  A.     Died   October  30,   1862. 

Pennsylvania,  age  22. 

June  11, 

1863. 

1862.          Spec.  364. 

1863. 

108 

Palmer,  S.  H.  A.,  Pt.,  I, 

July  3.     Left  (also  fracture  of  ulna);  gan- 

87 

Ambrose.    H.,    Pt.,   H. 

July  2, 

Left.     Died   September  8,  1863; 

2d  New  Hamp.,  age  35. 

Aug.  10,       grene.     Died  August   H,  1863; 

20th  Indiana,  age  24. 

Aug.  14, 

pyaemia. 

—  ,  '63. 

pyaemia. 

1863. 

109    Pangh,  J.  W.,  Pt.,  E,  3d 

April  3,     Right  ;  posterior  flap.    Died  April 

88 

Ballard,  J.  H.,  Pt.,  E, 

July  2, 

Right.    Died  September  20,  1863  ; 

W.  Virginia  Cavalry. 

J863.          16.1863.     Spec.  4276. 

28th    North     Carolina, 

Aug.  20, 

pyasnii.i.     Spec.  2062. 

110    Pepper,  G.  W.,    1't.,  C, 

June  25,  ;  Left  :  flap.     Surg.  N.  H.  Moseley,  ' 

age  30. 

1863. 

2d  Pennsylvania  H'vy 

Aug.  14.       I'.  S.  V.     Gangrene.     Died  A  u- 

89 

Barrett,  J.  15.,  Corp'l,  C, 

June  5, 

Left.     Died  July  10,  1864. 

Artillery,  age  30. 

1864. 

gust  25.  1864      Spec.  3127. 

116th  Ohio. 

J'v  8,  '64. 

Ill    Perkins,   J.  C.,   1't.,   B, 

June  3,     Left;  circ.    Surg.  R.  B.  liontecou, 

90 

Beecher,  E.,  Pt.,  E,  36th 

Oct.  8, 

Right.     Died  November  14,  1862. 

81st  New  York,  age  27. 

July  7,        IT.  S.V.   (Also  fract.  right  ankle 

Illinois,  age  20. 

—  ,  '62. 

1864.         joint;  excised.)     Died  July  17, 

91 

Blackwall,   C.  C.,  Col., 

Sept.  19, 

—  :  circular.  Surg.W.  S.  Love. 

» 

J864;  exhaustion.     Spec.  3035. 

23d    N.   Carolina,   age 

Nov.  10, 

P.  A.  C.  S.    Died  November  13, 

112    Pollard,  J.  H.,  Pt.,  F, 

Oct.  27,     Left  :  lateral  flaps.     Surg.  T.  R. 

30. 

1864. 

1864;  exhaustion. 

12th  Virginia,  age  26. 

Nov.  29,       Crosby,  U.  S.  V.     Died  Decem- 

92 

Craps,    W.   J.,   Pt.,    D, 

Nov.  30, 

Left  ;  circular.  Surg.  B.  B.  Breed, 

1864.     i    ber  2,  1864  ;  exhaustion. 

24th    South    Carolina, 

1864, 

U.  S.V.     Died  March  11,  1865; 

113    Reynolds,  IT.  G..  Pt.,  K, 

Dec.  15,     Left;  lateral  skin  flap.     Surg.  B. 

age  33. 

Fe.17,'65. 

exhaustion.    Spec.  4217. 

7th  Mississippi,  age  23. 

1864.          B.  Breed,  U.  S.  V.     Died  March 

93 

Dudley,   S.    B.,  Pt.,   I?, 

June  27, 

Right  ;  circular.  Surg.  R.  R.  Tay 

M'hl,'6f).      11,1865;  exhaust'n.    Spec.  4216. 

97th  Indiana,  age  24. 

1864. 

lor,  U.  S.  V.    Died  February  28, 

114    Kicker,    B.    J.,    Pt.,    A, 

May  18,  ,  Left.    A.  A.  Surg.W.  II.  Triplett. 

Feb.  18.        1865;  erysipelas.     Spec.  4248. 

32d  Maine. 

June  28,       July  8.  re-amp.:  gang.:  diarrh. 

1865. 

1864.          Died  July  11,  1864:  pywinia. 

94 

French,  C.  H.,  Pt.,  G,  2d 

May  9.    '  Right  :   circular.     A.  A.  Surg.  M. 

115    Seawright.  W.,    Pt.,    1, 

May  12,     Right;  double  skin  flap.     Surg. 

Indiana   Cavalry,   age 

June  14, 

L.  Hcrr.     Died   September  30, 

116th  Penn.,  age  19. 

June  14,  !     J.  A.  Lidell,  U.  S.V.    Died  July 

20. 

1864. 

1864. 

1864.         19,  1864;  pyaemia. 

95 

Geffney,  T.,  Pt.,  D.  74th 

June  3, 

Right;  circular.      A.  A.  Surg.  A. 

116    'Shroeder.  C.,  Corp'l,  I, 

May  13,  j  Right  ;     antero-post.    flaps.     Pro- 

New  York,  age  42. 

J'y  !>,  '64.      Ansell.     Died  August  2,  1864  ; 

127th  Illinois. 

June  —  , 

trading   bone   removed.      Died 

pyaemia. 

1863. 

September  26,  1863. 

96 

Gibson,  J.,  Pt,  H,  46th 

May  5, 

Left;  circular.    Surg.  A.  F.  Shel 

117    ^Street,  J.  W.,  —  ,  E,  66th 

Aug.  31,    Left  ;  circular.    Ass't  Surg.  P.  H. 

New  York,  age  22. 

June  11, 

don,  U.  S.  V.     Died   June   18, 

Georgia. 

Oct.  20,        Wright,  P.  A.  C.  S.     Died  Octo- 

1864.          1864;  exhaustion. 

1864. 

ber  28,  1864  ;  pysemia. 

97 

Goodwin,  S.  M.,  Serg't, 

May  23.     Left  ;  posterior  Hap.     A.  A.  Surg. 

118    Sullivan,  J.,  Pt.,  C,  56th 

May  6, 

Right;  circular.     A.  A.  Surg.  D. 

1,  19th  Indiana,  age  39. 

July  19.       E.  Seyffarth.     (June   8,    rem  d 

Massachusetts,  age  19. 

June  20, 

J.  Evans.    Died  August  7,  1864. 

1864.         carious  bone.)     Died  November 

1864. 

5,  1864  ;   exhaustion. 

119    Taylor,  S.  J.,  Pt.,  E,  30th 

Dec.  16, 

Left;   circular.     A.  A.  Surg.W. 

98 

Herman,  C.,  Pt.,  E.  33d 

May  25,     Right;  circular:  gangrene.    Died 

Alabama,  age  21. 

1864, 

M.  Rodman     (Necrosis.)    Died 

Massachusetts. 

June  26.       August  22,  1864;  py;emia.  Spec. 

Jan.  20, 

April  8,  1865;  chronic  diarrhoea. 

1  864.     \     3356. 

1865. 

99 

Hill,  T.  J.,  Corp'l,  I,  83d 

June  27.     Left.     Ass  t  Surg.  R.  Bartholow. 

120 

Wiards.   W.  C.,  Corp'l, 

Oct.  4. 

Left.     Died  November  13,  1862; 

Pennsylvania. 

July  30, 

U.S.A.     Died  August  6,  1862. 

D,  80th  Ohio. 

No.  7,  '62. 

pyremia.     Spec.  1034. 

1862. 

Spec.  817. 

100 

Juda,  G.,  Corp'l,  F,  8th 

May  8, 

Right  ;  circular.    A.  A.  Surg.  C. 

121 

Williams,  J..  Pt.,  E,  5th 

June  18, 

Right;  circular.     A.  A.  Surg.  F. 

Pennsylvania  Res.,  age 

June  13, 

W.  Carrier.     Died  June  25,  '64  ; 

New  Jersey,  age  27. 

July  26, 

H.  Getchell.     (Gang.:  hasmorr.) 

23. 

1864. 

pyaemia. 

1864. 

Died  Aug.  19,  1864.     Spec.  3661. 

Secondary  Amputations  in  the  Continuity  of  the  Leg,  Third  not  indicated. — In  six 
teen  of  the  secondary  amputations  in  the  leg  the  seat  of  the  operation  was  not  specified; 
eight  proved  successful  and  eight  were  fatal.  The  right  limb  was  removed  in  seven,  the 
left  in  five  cases;  in  lour  the  side  was  not  indicated. 

/Successful  /Secondary  Amputations  in  the  Leg,  Third  not  indicated. — The  eight  oper 
ations  of  this  group  were  performed  on  Confederate  soldiers.  Meagre  histories  of  the  cases 
are  found  on  the  hospital  reports: 

CASE  806. — Lieutenant  A.  Ward,  Co.  C,  9th  Tennessee,  was  wounded  in  the  right  lower  extremity  at  the  battle  of  Chap 
lin  Hills,  October  8,  1862.  He  was  taken  prisoner  and  conveyed  to  the  General  Hospital  at  Perryville,  whence  Surgeon  J.  G. 
Hatchitt,  U.  S.  V.,  reported  the  following:  "On  November  2f>th  I  amputated  the  right  leg  on  account  of  gangrene  of  the  foot 
resulting  from  gunshot  wound  of  the  ankle.  The  operation  was  performed  by  the  circular  method.  The  integuments  where 
the  incision  was  made  were  infiltrated  with  greenish  serum.  The  patient  was  much  exhausted  from  diarrhoea.  He  recovered." 
The  records  of  Perryville  Hospital  show  that  the  patient  was  transferred  to  Danville  as  a  convalescent. 

Fatal  Cases  of  Secondary  Amputations  m  the  Leg,  Third  not  indicated. — Eight  oper 
ations  performed  on  seven  patients  belong  to  this  sub-division;  five  were  Union  and  two 


'BRYAN 

'JONES  (J.) 


(J.),  Seventeen  Additional  Cases  of  Amputations  from  the  Armies  of  the  Southwest,  in  American  Medical  Times,  1863,  Vol.  VII,  p.  288. 
J.),  Pytemia  Supervening  upon  Hospital  Gangrene,  in  U.  S.  Sanitary  Commission  Memoirs,  New  York,  1871,  Surgical  Volume  II,  p.  444. 


SECT.  V.) 


AMPUTATIONS   IN    THE   LEG. 


555 


Confederate  soldiers.     Pyaemia,  secondary  haemorrhage,  exhaustion,  irritative  fever,  and 
phthisis  were  reported  as  the  causes  of  death: 

CASE  807. — Sergeant  J.  Erans,  Co.  I,  29th  Colored  Troops,  aged  33  years,  was  wounded  during  the  engagement  near 
Richmond,  October  12,  1864.  Surgeon  J.  J.  Craven,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  3d  division, 
Tenth  Corps,  with  "shot  wound  of  left  ankle."  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported  the  following  result  of  the 
injury:  "The  patient  was  admitted  to  hospital  at  Fort  Monroe  three  days  after  being  wounded.  His  injury  consisted  of  a  wound 
of  the  foot  involving  the  ankle  joint.  There  was  free  suppuration  and  copious  discharge  of  unhealthy  pus.  The  leg  was 
amputated  by  flap  method,  on  November  17th,  by  Acting  Assistant  Surgeon  H.  B.  White.  At  the  time  of  the  operation  the 
patient  was  in  a  very  weak  condition.  He  died  of  exhaustion  November  19,  1864." 

TABLE  LXXIX. 
Summary  of  Sixteen  Secondary  Amputations  in  the  Leg  for  Shot  Injury,  Point  of  Ablation  not  specified. 


[Recoveries,  1—8;  Deaths,  9—16.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  Axn  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

1  \    1$                     'lire  "M 

Nov.  25, 

Left.     Dr.  R.  H.  Taylor,  of  Mem 

8 

Wright,  J.  L.,  Corp'l,  B, 

Aug.  22, 

Right.  Ass't  Surg.E.  A.  Drewry, 

1863, 

phis.     (Nov.  —  ,  Piroguff's  amp. 

15th  Alabama. 

Nov.  21, 

C.  S.  A.     Recover  y. 

Feb.-,'(i4. 

ankle:  gang.:  caries.)    Recov'y. 

1862. 

2 

Sentley,  C.,  Pt.,   A,  8th 

June  27, 

Lett.     Recovery. 

9 

Cain,  W.  H.,  Serg't,  G. 

Aug.  16, 

Left.     Sept.  25,  haemorrh.     Died 

Louisiana. 

July  28, 

115thN.  York,  age  23. 

Sept.  17, 

Sept.  2(>,  1864;  hemorrhage. 

1862. 

1864. 

3 

Barter,  J,  E.,  Pt.,  C,  1st 

Deo.  13, 

;  flap.     Recovery. 

10 

Calhair,  J.,  Pt.,  G,  12th 



Right.     Died  September  24,  1862. 

South  Carolina,  age  2-"). 

186J, 

Mississippi. 

1862. 

April  17, 

IK 

Daniel,  J.  P.,  Corp'l,  II, 

July  —  , 

Both;  irritative  fever.    Died  Sep 

1863. 

12< 

llth  Virginia.                      

tember  30,  1863. 

4 

McDaniel,  F.  H  ,  Ft.,  C, 

July  1, 

.     A.  A.  Surg.  B.  II.  Wash 

1863. 

26th  North  Carolina. 

Oct.  2, 

ington,  C.  S.  A.     Recovery. 

13 

Evans,  J.,  Serg't,  1,29th 

Oct.  12, 

Lefti  flap.     A.  A.  Surgeon  H.  B. 

1863. 

Colored  Troops,  age  33. 

Nov.  17, 

White.    Died  November  19,  '64; 

5 

Mclntire,  B.  S..  Pt.,  K, 

Jan.  29, 

—  .     Surg.  —  Reagan,  C.  S.  A. 

1864. 

exhaustion. 

10th  Tennessee  Cav'ry. 

June  29, 

Recovery. 

14 

Ilillebraml,  M.,  Pt.,  1), 

Sept.  19, 

Right.     Died  November  2,  1863; 

1864. 

1st  Ohio. 

—  ,  '63. 

pyaemia. 

6 

Ward,  A.,  Lieut..  C,  Oth 

Oct.  8, 

Right  ;  circular.    Snrg.  J.  G.  1I.it- 

15 

Reach,  II.,  Pt.,  I,  164th 

June  3, 

Right;  flap.     A.  Surg.  —  Gibbs, 

Tennessee. 

Nov.  25, 

chitt,  U.  S.  V.    Gangrene.     Re 

New  York,  age  2'J.          J'y  5,'64. 

P.  A.  C.  S.     Died  Aug.  9,  1864. 

1862. 

covered  February  12,  1863. 

16 

Waters,  W.  W.,  Pt.,  1),  

;   erysipelas.     Died  August 

7 

Ward,  P.  If.,  Pt.,  B,  «h 

June  27. 

Right.     Recovery. 

22d  Indiana. 

Aug.  29, 

31,  1862;  phthisis  pulmonahs. 

Louisiana. 

Oct.  6,'62. 

1862. 

AMPUTATIONS  IN  THE  CONTINUITY  OF  THE  LEG  OF  UNCERTAIN  DATE. 

The  intervals  between  the  dates  of  the  injuries  and  operations  could  not  be  ascertained  in 
five  hundred  and  seventy  cases,  either  one  or  the  other  of  the  dates  and  sometimes  both 
having  been  omitted  in  the  reports.  The  operations  were  performed  in  the  upper  third 
in  fifty-one,  in  the  middle  in  forty-seven,  and  in  the  lower  third  in  fifty-one  instances;  in 
four  hundred  and  twenty-one  cases  the  point  of  ablation  was  not  recorded. 

Amputations  in  the  Upper  Third  of  the  Leg  of  Uncertain  Date. — Of  fifty-one  opera 
tions  of  this  group  thirty-three  proved  successful  and  eighteen  were  fatal;  forty-five  were 
performed  on  Confederate  and  six  on  Union  soldiers.  The  side  injured  was  not  specified 
in  fifteen  cases;  in  twenty  the  right,  and  in  sixteen  the  left  leg  was  amputated. 

TABLE  LXXX. 
Summary  of  Fifty-one  Amputations  in  the  Upper  Third  of  the  Leg,  time  of  Ablation  not  specified. 

[Recoveries,  1—33;  Deaths,  34 — 51.1 


NO 

NAME,  MILITARY 
DESCItHTIOX,  AND  AGE. 

DATKS. 

OPERATIONS,  OPERATORS. 
RESULT. 

1 
NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Allen,  D.,  Pt.,  K,  40th 

Jan.  13, 

Right.     Released  June  28,  18G5.          5 

Canady.  J.,  Pt.,  B,  24th 

Dec.  13, 

Right.     Retired  February  17,  '65. 

N.  C.  Artillerv,  age  32. 

—  ,  '05. 

North  Carolina,  nge  25. 

'62,  —  . 

liallard,   I.   N.,  Pt.,  A, 

June  22, 

Right.     Discharged   October  17. 

6 

L'oppage,  K.,  Pt.,  I,  30th 

April  —  , 

Right.     Recovery. 

Mosby's  Cavalry. 

—  .  '(13. 

1H63. 

Virginia. 

1865. 

3 

Beadle,  IT.  S.,  Lieut.,  A, 

July  9, 

T.eft.     To   prison   September  21,        7 

Cox,  H.  B.,  Serg't,    D, 

Dec.  10, 

Left.     Retired  February  17,  1865. 

12th  Ga.  Bat'v,  age  24. 

—  .  '64. 

1864. 

•    48th  North  Carolina. 

'64,—. 

4 

Brown,    M.,    Lieut.,    C, 

Aug.  16, 

Left.     To  Prov.ist   Marshal  May 

8 

Critts,  I'.L.,  Pt.,  F,21st 

Aug.  21, 

Right.    To  Prevost  Marshal  April 

Cobb's  Ga.  Legion. 

—  ,  '64. 

31,  181).-). 

Georgia,  age  34. 

—  ,  '64. 

1,  1865. 

1  HOLLOWAY  (J.  M.),  Comparative  Advantages  of  PiuouOKF's,  SVME'S,  and  CHOPART's  Amputations,  etc.,  in  Am.  Jour,  of  Med.  Sciences,  1866, 
Vol.  1.1,  p.  85,  and  SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  San.  Comm.  Mem..,  New  York,  1871,  Surg.  Vol.  II,  p.  11C. 


556 


INJURIES   OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

OPERA  Tioss,  OPERATORS,       ,  ,  ..... 
RESULT. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 

27 
28 

29 

Fletcher,  R.  J.,   Major,     July  2, 
llth  Alabama                    —  ,  '63. 
Frarel,  J.,  1't.,  F.   10th      May  2, 
Virginia,  age  til.                —  ,  '63. 
Freeman,  W.  It..  Ft.,  1C.   
46th  North  Carolina.            1862. 
Green,  W.  It.,  1't..  I,  53d     .July  14, 
North  Carolina,  age  19.     —  ,  '63. 
Harrington,  J.  It.,  Pt.,    Aug.  31, 
C.  41st  Miss.,  age  23.     •     1864. 
Howard,  I).  R.,  Pt.,  A,    Aug.  19, 
2d  Maryland.                     —  ,  '64. 
Isbell,  W'.H.,  1't.,  K,  47th     July  3, 
Virginia.                             —  ,  '63. 

Right.     Furloughed  1864. 
Right.     Retired  January  16,  1865. 
—  —  .     Recovery. 
Lett.     Exchanged  March  3,  1864. 
Right.     Retired  January  12,  1865. 

Right.     Furloughed  October  28, 
1864. 
Left.      Gangrene.       Discharged 
October  8,  1864. 
Right.      Exchanged    March   17, 
1864. 
Right:  circular.   Exchanged  Jan 
uary  2d,  1864. 
Left.     Retired. 

Right.      Furloughed    November 
26.  1864. 
Right.     Furloughed. 

Left.     Retired  March  15,  1865. 
Right.     F.xchanged  March  3,  '64. 
Left.     Furloughed. 
Eight.     Retired  March  8,  1865. 

Amputation  of   right  leg.    Dig- 
charged. 

30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
;  46 
47 
48 
49 
50 
51 

Tapp,  C.  T.,  Pt.,  C,  60th 
Georgia. 
Tay,  S.  Z,.,  Serg't,  E,  49th 
North  Carolina,  age  35. 
Watkins,  R.  U.,  Serg't, 
H,  46th  Va.,  age  23. 
Wilson,  S.,  Adj't,    ICth 
Va.  Battery,  age  26. 
Apperson,  J.  R.,  Serg't, 
D,  123d  Illinois. 
Ault,   C.,    Pt.,    B,    69th 
Ohio. 
Bailey,  R.    M.,  Pt.,  D, 
31st  Mississippi. 
Bowens,   G.  B.,  Pt.,  F, 
13th  Georgia. 
Broivn,  E.,  Pt.,  E,  49tb 
Georgia. 
Corbin,    I.    D.,   Ft.,    1st 
South  Carolina. 
Davis,  U.,  Corp'l,  K,  62d 
Virginia. 
Davis,  \V.  W.,  Pt.,  C,  1st 
Ohio  Cavalry,  nge  1  9. 
Foster,  R.   C.,'  Lieut.,  I, 
5th  Alabama,  age  40. 
Gillman,  H.  T.,  Pt.,  H, 
8th  Michigan. 
Hancock,  J.  B.,  Pt.,  C, 
61st  Georgia. 
Hoover,  W.  P.,  Pt.,  G,  1st 
Texas,  nge  2-5. 
Love,  W.,  Pt.,  G,   16th 
Maine,  age  l(i. 
Lynch,    J.,    Pt.,    A,   1st 
Louisiana. 
Oaks.  J.  A.,  Pt.,  B,  58th 
Virginia. 
Reid,  M.  J.,  Corp'l,  F, 
19th  Georgia,  age  25. 
Scales,  R.  E.,  Pt.,  C,  2d 
Mississippi,  age  21. 
Sell,  J.  M.,  Capt.,  I,  83d 
Pennsylvania. 

Nov.  27, 
1863. 
July  9, 
—  ,   64. 
June  18. 
—  ,  '64. 
April  6, 
—  ,  '65. 
Oct.  8, 
—  ,  '62. 
May  9. 
—  ,  64. 

Right.     Furloughed. 
Right.     Retired  February  21,  '65. 

Right.     To  prison  September  23, 
1864. 
Left;  anterior  skin  flap.     To  Bal 
timore  May  10,  1865. 
.     Died  October  17.,  1862. 

Left.     Died  July  7,  1864. 
Left.     Died  September  26,  1864. 
Died    July   13    186°  •   py 

3d  North  Carolina.'              1863.  ' 
Ledyard.  W.N.,  Lieut.,    July—, 
A,  3d  Alabama,  age  28.     —  ,'63. 
Lemai/,   L.    A.,   Pt.,   II,     May  22, 
40th  Alabama,  age  48.      —,'63. 
McCall.  C.  S.,  Pt.,  F,  21st    Sept.  22, 
Georgia.                                1864. 
McCarthy,  W.  E.,  Pt.,  K,    Sept.  17, 

1862. 

1862. 

aemia. 
.     Died  May  29,  1864. 

:  circular.     Died   December 
31.  1862. 

1863. 
May 
31,  '64. 
Aug.  31, 
1862. 

.     Died  March  3,  1  864  ;  small 
pox. 
;  posterior  flap.     Gangrene. 
Died  June  10,  1864. 
.     Died  September  25,  1862. 

5th  Alabama.                     —  ,  '62. 
McDaniel,  J.  J.,  1't.,  F,     Dec.  13, 
35th  Georgia,  age  32.         —  ,  '62. 
Miller,  J.  L.,  Pt.,  C,  3()th    July  —  , 
North  Carolina.               i      1863. 
Parker.  G.  W.,  Lieut.,  D,    Sept.  30, 
44th  North  Carolina.      i     1864. 
Raders,  J.   P.,  Pt.,  A,     Oct.  19, 
37th  Virginia.                       1864. 

18C2. 
June  18, 
1864. 
May  10, 
—  ,  '64. 

1862. 
;    posterior   fl:\p  ;    gangrene. 
Died  July  20,  1864. 
Left:  sloughing.     Died  May  25, 
1864;  pyaemia. 
Right.     Died  May  31,  1863. 

.     Died  July  15,  1863. 

;  circular.      Died  June    16, 
1864. 
Left  ;  erysipelas.     Died  Septem 
ber  23/1862;  diarrhoea. 
.     Died  July  —  ,  1863. 

Roberts.  J.  /».,Pt.,H,  7th    Dec.  16, 
Texas,  age  20.                     1864. 

Rossou,    jr.   B.,  Pt.,   K,      Aug.  2, 
49th  Virginia.                   ;      1864. 

C.  S.  A.     To   Provost  Marshal 
March  7,  1865. 
Left.     Retired  February  6,  1865. 

1863. 
July  3, 
—  ,  '63. 
May  16, 
1^64. 

Virginia,  age  24.                May  16, 
1664. 
Swartz,  J.  S.,  Pt.,  K.  Sth    Aug.  19, 

8,  haemorrhages.     Disch'd  Jan 
uary  16,  1865. 
Left.     Retired  January  30,  1865. 

1862. 
July  —  , 
1863. 

Virginia,  age  24.                '62,  —  . 

Amputations  in  the  Middle  Third  of  the  Leg  of  Uncertain  Date. — Forty-seven*cases 
belong  to  this  sub-division;  thirty-nine  were  successful  and  eight  fatal.  Forty-one  of  the 
patients  were  Confederate  and  six  Union  soldiers.  The  right  leg  was  amputated  in  twenty- 
six,  the  left  in  nineteen  instances;  in  two  the  side  was  not  indicated. 

TABLE  LXXXI. 
Summary  of  Forty-seven  Amputations  in  the  Middle  Third  of  the  Leg,  time  of  Operation  unspecified. 

[Recoveries,  1—39;  Deaths,  40 — 47.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

2 
3 
4 

5 
6 
7 
8 

9 
10 
11 
12 
13 

Acree,  W.  W.,  Serg't,  C, 
30th  Georgia. 
Barnett,  W.C.  D  .Corp'l, 
A,  16th  Georgia. 
Barrim,  L,  Pt.,  F,  llth 
North  Carolina,  age  22. 
Carr,  T.  A.,  Pt.,  G,  3d 
Georgia. 
Cherry,  M.  (i.  L.,  Pt.,  E, 
55th  North  Carolina. 
Cline.M.W.,  Ft.,  D,48th 
Alabama,  age  38. 
Cox,  E.,  Ft.,  I,  15th  Ala 
bama,  age  35. 
Dalton,  R.,  Ft.,  H,  38th 
Virginia. 
Downs,  L  S.,  Ft.,  G,  26th 
North  Carolina. 
Egan,  J.  A.,  Pt.,  E,  3d 
Missouri. 
Garner,  M.    C.,   Ft.,   B, 
llth  Mississippi. 
Hains,  J.  31.,  Ft.,  D,  37th 
Virginia,  age  23. 
Halliburton,  C.,  Pt.,  E, 
llth  Tennessee,  age  24. 

Left.     Furloughed  November  13, 
1863. 
Right.     Recovery. 

Left.     Exchanged  March  17,  '64. 
Right.     Furloughed. 
Right.     Furloughed. 

Left  ;    gang.     Furloughed    Sep 
tember  25,  1864. 
Left.     Released  July  17,  1865. 

Right.     Furloughed. 
Right.     Furloughed. 
.     Retired  February  6,  1865. 
Left.     Transferred  April  9,  1865. 
Right.     Exchanged  March  3,  '64. 

Left  ;  circular.    To  Provost  Mar 
shal  March  7,  1865. 

14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 

Bansbrougli,  J.  W.,  Pt., 
K,  17th  Virginia. 
Harbison,  N.  J,  Pt..  D, 
llth  North  Carolina. 
Hill,  W.,  Ft.,C,  Reeves's 
Ark.  Cavalry,  age  35. 
Hunt,  F.  N..  Ft.,  G,  47th 
North  Carolina,  age  30. 
Lipscombe,  P.  E.,  Pt.,  F, 
9th  Virginia  Cavalry. 
Mathias,  —  ,  Ft.,  C,  42d 

1863. 
Nov.  30, 
'64,  —  . 
July  3, 
—  ,  '63. 
May  10, 
'64,  —  . 
July  1, 
—  .  '63. 
Aug.  17, 
1864. 
Nov.  27, 
'63,  -. 
May  16, 
—  ,  '64. 
June  2, 
—  ,  '64. 
Oct.  5, 
—  ,  '64. 

1865. 
July  3, 
—  ,  '63. 
Nov.  30, 
—,'64. 

1861. 
June  2. 

>(j4 

Sept.  27, 
1864. 
July  3, 
—  ,  ''63. 

Recovery. 
Right.     Furloughed. 

Left;    flap.     Oath   of  allegiance 
July  7,  18(i5. 
Left.     Exchanged  March  17,  '64. 

Right.     Retired  November?,  '64. 
Right:  flap.     Recovery. 
Right.     Retired  December  30/64. 
Right.    Exchanged  March  17/64. 
Right.     Retired  December  21,  '64. 
Left.     To  prison  March  3.  1865. 
Right.     Furloughed. 
Right.    Retired  January  10,  1865. 
Left.     Retired  January  30,  1865. 

Sept.  17, 
—  ,  '62. 
June  12, 
—  ,  '64. 
July  3, 
1863. 

Virginia,  age  19. 
Mayor,  S.  E.,  Pt.,  B,  6th 
S.  C.  Cavalry,  age  25. 
McAfee,  J.  7'.,Pt.,  D,  59th 
Georgia,  age  39. 
J/c#amW,ZA,Pt.,E,  45th 
Georgia,  age  23. 
Mcllmunay,  J.,  Ft.,  

Mitchell,  F.  M.,   Serg't, 
G,  61st  N.  Carolina. 
Monzan,  L  P.,  Ft.,  I,  4th 
S.  C.  Cavalry,  age  30. 
Moore,   C.,   Pt.,    F,   Sth 
Louisiana. 

Oct.  25, 
1864. 
May  14. 
—  ,  '64. 
June  24, 
'64,  —  . 
July  —  , 
1863. 

SECT.  V.) 


AMPUTATIONS    IN    THE    LEG. 


557 


No. 

27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

0'JV«aZ,j;^.,Pt.,G,18th 
Virginia. 
Phittmore,  E.  K.,  Pt.,  A, 

27th  North  Carolina. 
Poole,  F.,  Pt.,  E,  20th  S. 
Carolina. 
Pressley,  I.,  Pt.,  I,  60th 
North  Carolina,  age  44. 
Roche,  F.  T.,  Pt.,  A,  32d 
Virginia,  age  21. 
Rodarmel,  W.  L.,  Pt.,  D, 

April  —  , 
1865. 
Oct.  —  , 
14,  '63. 
Aug.  27, 
1863. 
Nov.  30, 
1864. 
Sept.  24, 
18C4. 
Aug.  8, 
1862. 
Nov.  30, 
18C4. 

Mnv 

Right.    Recovery. 
Left.     Forlonghed. 
Right.    Retired  February  7,  1865. 

Right  ;  antero-posterior  flap.    To 
Provost  Marshal  April  6,  1865. 
Right.     Retired  March  4,  1865. 

Right.    Discharged  March  30,  '65. 

Left  :  circular.     To  Provost  Mar 
shal. 
Left.     Retired  April  1,  1865. 

;  circular.     Furloughed  Au 
gust  15,  1864. 
Left.     Kurloughed. 

Right  :  gangrene.     Recovered. 

38 
39 
40 

41 
42 
43 
44 
45 
46 
47 

Whittside,  J.  L.,  Pi.,  B, 
34th  N.  C.,  age  45. 
Williams  ^V.,Pt.,G,  60th 
North  Carolina,  age  38. 
Coupe,  /.,  Lieut.,  C,  20th 
Georgia,  age  31. 
Edmonds,  J.  W.,  Pt.,  H, 
1st  Ohio  Lt.  Artillery. 
Green,  S.  R..  Pt.,  A,  5th 
New  Hampshire. 
Honrie,  L.,  Pt.,  D,  29th 
Pennsylvania,  age  22. 
Houser,  /.,  Pt.,  H,  1st  N. 
Carolina  Cavalry. 
Stockton,   J.  R.,  Pt.,  I, 
71st  Pennsylvania. 
Storall,  J.  B.,  Serg't,  F, 
15th  Georgia. 
West.  P.,  Pt.,  K,  42d  N. 
York,  age  24. 

Mar.  25, 
—  ,  '65. 
Nov.  29, 
—  ,  '64. 

Right.    Released  June  28,  1865. 

Right  ;  antero-posterior  flap.    To 
I'rovost  Marshal  March  7,  1865. 
Left.     Died  December  31,  1864. 

Left.    Died  July  16,  1863. 

.      Surg.  C.  S.  Wood,  66th 
New  York.     Died  July  30,  1863. 
Right  :    circular.     Died   August 
23,  1864  ;  typhoid  pneumonia. 
Left.   Sing.  J.  P.  Carroll,  (  :.  S.  A. 
Died  April  2.  ]£64.     Spec.  3155. 
Left.     Died  July  12,  1863. 

Left.     Died  May  29,  1864;   py 
aemia. 
Right.     Died  July  23,  1863. 

July  2, 
—  ,  %. 
July  2, 
—  ,  '63. 
May  15, 
1864. 
July  1, 
—  ,  y63. 
July  —  , 
—  ,  '63. 

5th  Mo.  S.  M.  Cavalry. 
Shelton,  J.  A.,  Pt..A,23d 
Mississippi,  age  23. 
Smoot,  K.  W.,  Pt.,  A,  1st 

Va.  Cattery,  age  :!4. 
Talbt,rt,M.li.,  Pt.,  H,7th 
S.  C.  Battery,  age  :';>. 
Warren,  S.,  Pt.,  A,  47th 
North  Carolina. 
1  Whitaker,  J.  F.,  Pt.,  K, 
8th  Tennessee,  age  26. 

16,  '64. 
June  3, 
'64,  —  . 
June  12, 
1864. 

July  2, 
—  ,  '63. 

Amputations  in  the  Lower  Third  of  the  Leg  of  Uncertain  Date. — Fifty-one  opera 
tions — thirty-four  successful  and  seventeen  fatal — were  performed  on  forty-four  Confederate 
and  seven  Union  soldiers.  The  right  limb  was  amputated  in  twenty-two,  the  left  in 
twenty-five  cases;  in  four  instances  the  side  was  not  indicated.  Gangrene  was  noted  in 
three,  pyaemia  and  erysipelas  in  one  instance  each. 

TABLE  LXXXII. 
Summary  of  Fifty-one  Amputations  in  the  Lowe)'   Third  of  the  Leg,  time  of  Operation   unspecified. 

[Recoveries,  1—34;  Deaths,  35—51.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPEHATOKS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Beeman,  H.  C.,  Lieut.,  H, 

May  30, 

Right.     Furloughed. 

21 

Long,  J.  F.,  Corp'l,  G, 

Oct.  8,  '62. 

Right.    Transferred  February  11, 

43d  North  Carolina. 

—  ,  '64. 

41st  Georgia. 

1863. 

2 

Bland,  C.  C.,  Pt.,  K,  3(ith 

Jan.  13, 

Left  *  circulnr.     To  Provost  Mar- 

22 

Longshore  E.  C.    Pt.  B 

Left.     Furloughed  March  14  '65. 

N.  C.  Artillery',  age  18. 

—  ,  '6.J.' 

shal  April  8,  1865. 

3d  South  Carolina. 

1864. 

3 

Bradley,  J.U.,  Pt.,  H,  2d 

July  1, 

Left  ;    circ.     Exchanged  March 

03 

Mott,  D.  W.,  Pt.,  D,  13th 

Jan.  13, 

Left  ;  flap.     To  Provost  Marshal 

Mississippi,  age  29. 

-,  f<;3. 

3,  1864. 

N.  C.  Artillery,  age:!9. 

—  ,  '65. 

April  ],  1865. 

4 

Bradley,  J.  11.,  Pt.,  G, 

July], 

Left.     Exchanged  March  17,  '64. 

24 

itulley,    W.,  Pt.,  E,  2d 

Aug.  30, 

Right.    Retired  February  7,  1865. 

Kith  North  Carolina. 
Burlif    M     Pt     lireath- 

—  ,  ^63. 

of; 

Virginia  Cavalry. 

—,''62. 

^^ 

fj 

erd  s  Battery. 

H.ilfihnn       T      T>t       T'      1  n*K 

Oc.19,'63. 

Recovery. 

ttU 

etc 

Patterson,  i*.,  Pt.,  H,  1st 
Alabama,  age  27. 

Pnttn-n       7      Hf     l*t     p1     1  flfVi 

ISov.  30, 
—  ,  '64. 

S,  ,,  ,t      Oft 

Right  ;    oval   flap.      i  o   Provost 
Marshal  April  6,  1865. 

!     Louisiana. 

Left.     Exchanged  March  3,  1864.      *^vj 

ailOli,  J  .   .'/..I    t.,rv,   1OTU 

North  Carolina,  age  17. 

CJu.  (tU, 

—  .  '63. 

ig    .       e  ire       e  ruary   , 

7     Caldor,  P.,  Pt.,  E,  4th 

Left.     Furloughed  December  9,      27 

Remey,  S.,  Pt.,  H,  5T)th 

May  31, 

Right:    circular.      Disch'd  July 

North  Carolina. 
8     Cheatliam   T.  B.   Pt.  H, 

1862. 

1862. 

no 

New  York,  age  19. 

7?/vj*,7e     ^     1-1     I>fr      T~l    1  1  tVi 

—  ,  '62. 

8,  1863. 
Ivi'^lit      Transferred  Alav  1  1865 

59th  Alabama.' 

1862. 

1862. 

JltsWiS,  o.  £Z.fJtI.|  \J,  lltn 

Alabama. 

9     Clarke,  N.  U.,Pt.,I,  16th 

Sept.  14, 

.     Discharged  December  19,  '    29 

Taylor,  J.  E.,  Lieut.,  E, 

July  6, 

Right.     Furloughed. 

Georgia. 

—  ,  '6-2. 

1862. 

With  North  Carolina. 

—  ,  '64. 

10     Dyer,  S.,  Lieut.-Col.,  3d 

Nov.  30, 

Right  :    circ.     To   Provost  Mar-      30 

Thompson,  J.  M.,  Corp'l, 

Nov.  30, 

Right  ;  antero-posterior  flap.     To 

Mississippi,  age  32. 

—  ,  '64. 

shal  March  27,  1865. 

B,  55th  Ala.,  age  20. 

—  ,  '64. 

Provost  Marshal  Feb.  24,  1865. 

1  1      Finley,  J.  \V.,  Pt.,  I,  41st 

Right.     Furloughed  December  1,      31 

2  Underwood,  E.  E.  ,  Pt  .  ,  D, 

Dec.  13, 

12 

Alabama. 

n-ilrlnrt     .T     R       Pt       K 

1862. 
Sept.  28, 

1862. 

Left.    Retired  February  11.  1865.  '    32 

30th  Georgia,  nge  24. 
Wasltburne  J.  A   Pt.  H 

—  ,  '62. 

Marshal  May  4,  1863. 

I    Kith  Mississippi,  age21. 

—  ,  '64. 

llth  North  Carolina. 

ig    •       uroug  e 

13      Goods,  D.  C..  Pt.,  E,  12th 

Mar.  25. 

Left.     Released  June  28,  1865.      ,    33 

White,  J.  R.,  Pt.,  C,  3d 

Jan.  13, 

Right.     Released  June  28,  1865. 

North  Carolina,  age  18. 

—  ,  'ti5. 

N.  C.  Artillery,  age  26. 

1865. 

14 

Hannah,  S.  II.,  Pt.,  K, 

Nov.  30, 

Left  ;  circular.     To  Provost  Mar-  ,    34 

William*,  J.,  Pt.,  F,  5th 

Oct.  8, 

Left.     Transferred  March  11,  '63. 

15th  Miss.,  age  25. 

—  ,  '64. 

shal  May  2,  1865. 

Arkansas. 

—  ,  '62. 

15 

Hendcrton,  A.  R,  Pt.,  B, 

Feb.  6, 

Right.      Furloughed    March   31,      35 

Brown,   G.    W.,  Pt.,   D, 



Left.     Died  December  1.  1862. 

1'^th  North  Carolina. 

—  ,  '65. 

1865. 

10th  Georgia. 

1862. 

16 

Ireland,  K.   S.,   Pt.,   H, 

—  ,  —  .  

Left.  Surg.  S.  S.  Satchell,  C.S.A.      36 

Edison,  E.,  Pt.,  C,  39th 

De.31.'C2, 

Left.    Died  May  1C,  1864. 

7th  South  Carolina. 

J'e29,'64. 

Recovery. 

Alabama,  age  26. 

—  ,  '63. 

17 

Jones.  M.  M.,  Pt.,  G,  14th 

Sept.  17, 

Left.      Discharged    October   17,      37 

Estus,  B.  E..  Pt.,  Price's 

April  2, 

Right.     Died  May  14,  1865. 

Alabama. 

—  ,  '62. 

1863. 

Virginia  Bat'y,  age  28. 

—  ,  "65. 

:  18 

Koonce,  H.  C.,  Lieut.,  K, 

Sept.  30, 

Left.     Furloughed.                               38 

Forsi/th.  I).  .R.,Pt.,G,8th 

Mar.  31, 

Right.     Died  May  19,  1865;  py 

filst  North  Carolina. 

—  ,  '(14. 

Virginia,  age  32. 

—  ,  '65. 

aemia. 

19 

Larkins,  J.   P.,  Pt.,  B, 

Oct.  27, 

Right.     Released  July  17,  1865.        39 

Hardf/rore,    W.  IT.,  Pt.,  

Left  ;  circular.     Died   December 

Cobb's  Georgia  Legion. 

1864. 

A,  19th  Virginia.              No.18,'64. 

11,  1864;  gangrene. 

20 

Leffler.  C.,Serg  t,  D,28th 

Mar.  22, 

Right.     Released  June  28,  1865.        40 

Honre.    M.,    Corp'l,    B, 

May  27, 

Right.    Died  July  3.  1863. 

North  Carolina,  age  22. 

—  .  •(;;•>. 

131st  New  York.                —  ,  '63. 

1  O'KF.KFF,  (D.  C.),  Surgical  Cases  of  Interest  treated  at  Institute  Hospital,  Atlanta,  Georgia,  May  and  June,  1864,  in  Confederate  ^Intrx  Medical 
and  Surgical  Journal.  I?b5,  Volume  1J,  p.  28. 

"THOMSON  (W.),  Report  of  Cases  of  Hospital  Gangrene  treated  in  Douglas  Hospital,  Washington,  D.  C.,  in  American  Journal  of  Medical  Science, 
Vol.  XLVII,  p.  382. 


558 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

41 
42 
43 
44 
45 
46 

NAME,  MILITARY 
DESCRIPTION',  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 

RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

Jones,  McG.,  Pt.,  G,  67th 
North  Carolina. 
McCleary,  J.  L.,  Serg't, 
C,  25tb  S.  Carolina. 
Moore,    D.   T.,   Pt.,    H, 
100th  Illinois. 
Prince,  E.S.,  Pt.,C,45th 
Alabama,  nge  35. 
Richmond,  W.  G.,  Pt.,  D, 
57th  N   C.,  age  22. 
Smith,  W.K.,  Pt.,  B,  44th 
Alabama. 

Right.     Died  April  5,  1865. 
Left.    Died  September  5,  1862. 

Left.     Died  December  17,  1863; 
small-pox. 
Left.     Died  February  2,  1865. 

Left.     Died  January  8,  1863. 

Right;    circular.     Died   October 
21,1864;  gangrene. 

47 
48 
49 
50 
51 

Stewart,   J.,   Corp'l,  F, 
2:id  Iowa. 
Wndsworth,  W.,  Pt.,  I, 
4th  Massachusetts. 
\Vicenga,V.,  Pt.,  F,  37th 
New  York. 
Woolsey,  J.  B.,  Pt.,  A, 
7th  South  Carolina. 
Young,  G.  W.,   Pt.,   C, 
95tb  New  York. 

May  17, 
—  ,  '63. 
June  14, 
—  ,  '63. 
May  3, 
—  ,  '63. 

1862. 
May  12, 
—  ,  '64. 

1865. 

Left.    Died  July  24,  1863. 
Left.     Died  May  27,  1863. 
Right.     Died  December  1,  1862. 
Left.    Died  May  27,  1864. 

1862. 
Sept.  19, 
—  ,  '63. 
Nov.  29, 
—  ,  '64. 

Oct.  8, 
1864. 

Amputations  in  the  Continuity  of  the  Leg  of  Uncertain  Date  and  without  Indica 
tion  of  the  Seat  of  Operation. — In  lour  hundred  and  twenty-one  cases  of  amputations  in 
the  leg  neither  the  interval  between  the  injury  arid  the  operation  nor  the  precise  seat  of 
the  operation  was  reported.  The  operations  were  performed  on  four  hundred  and  eighteen 
patients,  in  three  instances  both  legs  having  been  amputated.  Ninety-six  were  Union  and 
three  hundred  and  twenty-two  Confederate  soldiers.  One  hundred  and  thirty-nine  opera 
tions  resulted  successfully,  and  one  hundred  and  ninety-seven  fatally,  while  the  termination 
of  eighty-five  cases  was  not  ascertained.  The  rate  of  mortality  of  the  cases  in  which  the 
results  were  determined  was  therefore  58.6  per  cent.  The  right  limb  was  removed  in  one 
hundred  and  forty-three,  the  left  in  one  hundred  and  fifty -three  cases;  in  one  hundred  and 
twenty -five  reports  the  side  was  not  mentioned.  As  will  be  seen  from  the  subjoined  table, 
the  reports  of  the  cases  are  very  incomplete. 

TABLE  LXXXIII. 

Summary  of  Four  Hundred  and  Twenty-one  Cases  of  Amputations  in  the  Leg  of  Uncertain  Date  and 

Seat  of  Operation. 

[Recoveries,  1—139;  Deaths,  140—336;  Results  unknown,  337—421.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AC;E. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 
2 
3 
4 
5 
6 

11 

9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 

Abernathy,  M.  J.,  Lieut., 
£,  1st  Arkansas. 
Adair,  R.,  Corp  1,  D,  8th 
Georgia. 
Akridge,  A.  W.,  Pt.,  H, 
3d  Florida. 
Allen,  W.  A.,  Pt.,  Reed's 
Bat.  Artillery. 
Angling,  A.   G.,  Pt.,  (!, 
24th  Tennessee. 
Arent,  J.  M.,  Pt.,  H,  12th 
North  Carolina. 
Barham,  W.  It.,  Pt  ,  F, 
1st  North  Carolina. 
Bellany    L    V    Pt     B 

July  —  , 
1863. 

1863. 

1864. 
Sept.  17, 
—  ,  '62. 

.     Transferred  June  2(i,  1865. 
Left.     Paroled  November  1  2,  '63. 
Right.     Furloughed  April  21.  '63. 
Right.     Retired  October  30,  1864. 
Left.     Furloughed  January  1,  '64. 
Right.     Retired  February  3,  '(55. 

Both.      Furloughed    September 
23,  1864. 
Lett.     Recovery. 

Right.     Furloughed. 
.    Discharged  October  20,  '62. 

21 
22 
23 
24 
25 
26 
**7 
28 
29 
30 
31 

*>O 

33 
34 
35 
36 
37 
38 
39 

Clayton,  W.  ti.,  I't.,  B, 
3~d  Mississippi. 
Connor,    D.   O.,   Pt.,  C. 
Cobb's  Legion. 
Cooper,  W.  V.  L.,  I't.,  G, 
5th  Texas. 
Currie,  D.  J.,  Pt.,  I),  51st 
North  Carolina. 
Davis,  J.,  Pt.,  L,  2d  S. 
Carolina. 
Davis,  J.  L.,  Serg't,  G, 
46th  North  Carolina. 
Davis,   T.,  Pt.,  11,  21st 
South  Carolina. 
Donahoe,    A.,    Pt.,    Mc 
Gregor's  Battery. 
Donavan,    J.,    It.,   10th 
Tennessee. 
Dougherty,  J.  N.,  Pt.,  D, 
8th  Alabama. 
Drum,  E.  J.,  Pt.,  C,  28th 
North  Carolina. 
Duclos,    M.,   Pt.,  C,  2d 
Louisiana. 
Dznne,  B.  L.,  Pt.,  A,  5th 
Texas. 
Ellis,  P.  F.,  Pt.,  I,  13th 
Mississippi. 
Exter,  T.  C.,  Pt.,  H,  8th 
Georgia. 
Fagan,  J.  B.,  Lieut.-Col- 
onel,  15th  Alabama. 
Farthram,  A.  S.,  Capt., 

1862. 
Sept.  23, 
1863. 

1862. 

1862. 
Aug.  25, 
—  ,  '64. 

1862. 

Left.     Furloughed  February  20, 
1863. 
Left.     Recovery. 

Left.    Discharged  October  21,  '62. 

.     Furloughed    August    16, 
1864. 
.     Discharged  August  6,  '62. 

Left.     Retired  January  20,  1865. 
Right.     Furloughed  July  27,  '62. 
Right.     Retired  October  13,  1864. 
.     Recovery. 

•Left.     Discharged    Feb»iary  2, 
1863. 
Right.     Retired  February  3,  '65. 

Right.      Discharged    November 
30,  1862. 
.    Discharged   December  7, 
1863. 
Right.    Discharged  September  9, 
1862. 
.      Discharged    October  31, 
1862. 
Right.     To  duty  March  10,  1864. 

.     Transferred    October    11, 
1864. 
Right.     To  Pro.  Marshal  March 
18,  1865. 
Lett.    Furloughed  April  28,  1863. 

19th  Virginia. 
Bleavin,  C.,  Pt.,  A,  36th 
North  Carolina. 
Bobo,  D.  P.,  Pt.,  D,  llth 
Mississippi. 
Bossier,   S.,   Pt.,   I,  9th 
Louisiana. 
Bowen,  B.,  Pt.,  G,  Orr's 
Rifles. 
Brock,  If.  C.,  Pt.,  C,  48th 
Mississippi. 
Brown,  H.  C'.,  Serg't,  B, 
Cobb's  Legion. 
Brown,  P.  \V.,Vt.,  1,  15th 

Mar.9,'63. 
Feb.  5, 
—  ,  '65. 

1862. 

1862. 
Au.25,'64, 

1862. 

1862. 
Right.      Furloughed    December 
11,  1864. 
Left.     To  be  exchanged  October 
28,  1863. 
Left.     Furloughed  February  16, 
1863. 
Left  (also  amputation  arm).     Re 
covery.  November  18,  1864. 
Left.     Recovery. 

Right.      Furloughed    December 
19,  1862. 
Right.     To  prison  April  22,  1864. 

1864. 
Julv3, 
—  ,  ''63. 

1862. 
1863. 

Sept.  —  , 
1862. 

*  1863. 
1862. 
1862. 
1863. 

1862. 

1862. 
July  1, 
—  ,  ''63. 
Sept.  19, 

Virginia. 
Brown,  W.  J.,  Serg't,  I, 
21st  South  Carolina. 
Carroll,   W.,   I't.,   I,   3d 
Pennsylvania. 
Cashan,  T.,  Pt.,  B,  21»t 
Georgia, 
Clianey,  M.  M.,  Lieut., 
Hart's  Regiment. 

Feltz,  C.  II.,  Pt.,  A,  2d 
Tennessee. 
Finley,  A.,  Serg't,  D,  5th 
Arkansas. 

Dec.7,'64, 
1863. 

SECT.  V.) 


AMPUTATIONS    IN    THE    LEG. 


559 


NO 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO 

88 
89 
90 
91 
92 
:    93 
94 
95 
96 
97 
98 
99 
100 
101 
102 
103 
104 
105 
106 
.107 
;108 
109 
'110 
111 
112 
113 
114 
115 
116 
117 
118 
119 
120 
121 
122 
123 
124 
125 
126 
127 
128 
129 
130 
131 
132 
133 
134 
135 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
54 
55 
56 
57 
58 
59 
60 
61 
62 
63 
64 
65 
66 
67 
68 
69 
70 
71 

73 
74 
75 
76 
77 
78 
79 
80 
81 
82 
83 
84 
85 
86 
87 

Fisher,  E.  D.,  Corp'l,  G, 
16th  Louisiana. 
Flavell,  R.  11.,  Serg't,  F, 
7th  Missouri,  age  22. 
Fowler,  L.,  I>t.,  I,  34th  X. 
Carolina,  age  34. 
Fulkard,  D.  A.,  Serg't, 
K,  50th  Georgia. 
Garvey,  J.,  1't.,  0,  18th 
New  York. 
Goddin,    T.,  Pt.,  H,  8th 
Florida. 
Godfrey,  J.,   Pt.,  K,  1st 
South  Carolina. 
Gooding,  «'.  .B..Capt.,  K, 
2v!d  North  Carolina. 
Goodman,  J.,  Pt.,  E,  9th 
Alabama,  age  21. 
Grant,  J.  M.,  Pt.,  I,  1st 
Louisiana. 
Griffin,   J.,    Pt.,    K,  7th 
Michigan. 
Gulick  D  r   Pt    D  8th 

Loft.    Furloughed  April  28,  1  863. 
Left.     Discharged  August  8,  '63. 
Right.     Retired  February  22,  '65. 

Left.     Furlonghed  February  21, 
1863. 
Right.     Discharged    March    24, 
1863. 
Left.     Paroled  August  22,  1863. 

Right.      Furloughed    December 
19,  1862. 
Left.     Surgeon  P.  G.  Robinson, 
C.  S.  A.     Recovery. 
;  circular.    Furloughed  Sep 
tember  25.  1862. 
.      Exchanged   January   11, 
1863. 
Right.     Discharged  February  6, 
1863.     Died  March  6,  1870. 
Right.     Recovery,  June  3,  1865. 

Right.     Retired  February  23,  '65. 

Right.     Transferred  December  5. 
1862. 
Right.     Transferred  July  31  ,  '65. 

Left.     Discharged  March  1  0,  '64. 

Right.      Exchanged    March  26, 
1863. 
Left.     Transferred  July  26,  1863. 

Right.     Furloughed. 

Right.      Paroled    November    12, 
1863. 
Left.     Retired  January  18,  1865. 

Left.     Paroled  October  24,  1863. 

Right.     Exchanged  February  14, 
1864. 
Left.     Retired  January  13,  1865. 

Right.     Transferred  on  parole. 

MinUr,  T.  F.,Pt.,  D,  26th 
Virginia. 
Myers,  J.  F.,  Pt.,  C,  38th 
North  Carolina,  age  24. 
Nichols,  M.,  Pt.,  E,  27th 
:     North  Carolina. 
Nix,    T.,    Pt.,     H,     2d 
Georgia. 
Page,  M.  W.,  Pt.,  B,  5th 
Alabama. 
Parker,  M.,  Pt.,  H,  35th 
Georgia. 
Patterson,   W.,   Pt.,   A, 
20th  South  Carolina. 
Peace,  J.  r.,  Pt.,  E,  23d 
North  Carolina. 
Perry,    W.  A.,   Pt.,  E, 
48th  Virginia. 
Pickets,  J.  P.,  Pt.,K,  5th 
Texas. 
PJeger,  J.  M.,  Pt.,  K,  9th 
Alabama. 
Plummer,  J,  B.,  Pt.,  K, 
37th  North  Carolina. 
Price,  J.  .<?.,  Pt.,  D,  52d 
Virginia. 
Proctor,  W.  H.,  Capt.,  F, 
13th  Virginia  Cavalry. 
PuckfM,  U.,  Pt.,  A,  28th 
North  Carolina. 
Ray,  J.  S.,Lieut.,K,  38th 
N.  Carolina,  age  36. 
Rhom,  R.,  Pt.,  A,  49th 

Right.     Transferred  April  9,  '65. 
Left.     Retired  January  25,  1865. 
Right.     Furloughed. 
—  .     Paroled  September  12,  '63. 

Right.     Furlonghed  February  3, 
1863. 
Left.    Paroled  September  5,  1863. 

Right.     Furloughed  January   9 
1865. 
Right.    Retired  January  28,  1865. 

1862. 

May  12, 
—  ,'  '63. 
June  13, 

—  ,  '64. 

1862. 

June  27, 
—  .  '62. 
July  2, 
1863. 

1865. 
Dec.  13, 
'62,  — 
Oct.  14, 
1863. 
July  —  , 
—  ,  '63. 

1862. 
Julv  —  , 
1863. 

1862. 
Julv  3, 
—  ,  ''63. 

1864. 
May  12, 
—  ,  '64. 

1862. 

1862. 
July  3, 
—  ,  '63. 

Right.      Transferred   September 
25,  1863. 
Right.      Furloughed    December 
19,  1862. 
Left.    Discharged   December  4, 
1863. 
Right.     Transferred  April  8,  '65. 

—     Retired. 

Right.      Discharged    September 
10,  1862. 
Right.     To  prison  September  28, 
1863. 
Left.      Furloughed    August  13, 
1862. 
Left.     Transferred  February  14, 
1863. 
Left.     Furloughed  September  29, 
1862. 
.     Discharged  December  20, 
1862. 
Left.     Retired  February  3,  1865. 

Left.     Transferred  July  18,  1863. 

Right.    Recovery,  February  19, 
1866. 

1862. 
Sept.  7, 
—  ,  '62. 

1862. 

Virginia. 
Hall,  J.,  Pt.,  H,  14th  N. 
Carolina,  age  26. 
Banks,  A.  G.,  Serg't,  F, 
1st  Texas. 
Harttuan,  L.,  Pt.,  G,  un- 
assigued,  age  23. 
Hawkins,  W.,  Landsman, 
U.  S.  Navy. 
Hegler,    C.,   Pt.,   F,    7th 
North  Carolina. 
Heim,  IF,  Pt.,  1,  7th  Vir 
ginia. 
Heister,   F.,  Pt.,   A,  2d 
Maryland. 
Henderson,  J.  T.,  Pt.,  K, 
7th  South  Carolina. 
Hendricks,  M.  S.,  Pt.,  D, 
6th  Cavalry. 
Herment,  I.  A.,  Capt.,  C, 
12th  South  Carolina. 
Hicks,  J.  V.,  Pt.,  A,  56th 
Georgia. 
Hinson,  W.,  Pt.,  F,  17th 
Tennessee. 
Humphreys,  B.  F.,  S'g't, 
G,  12th  Arkansas. 
Hunter,  J.  B.,  Corp'l,  G, 
1st  South  Carolina. 
Hutchinson,  J.   W.,  Pt., 
B,  15th  Alabama. 
Ingram,  T.,  Pt.,  D,  45th 
Alabama. 
Jackson,B.F.,P\.,  Ketch- 
am's  Ala.  Battery. 
Jackson,  E.  M.,  Pt.,  C, 
24th  Georgia. 
James,  W.  F.,  Serg't,  G, 
24th  Alabama. 
Jennings,  G.  IF.,  Pt.,  K, 
30th  North  Carolina. 
Jennings,  If.  J.,  Pt.,  B, 
14th  South  Carolina. 
Johnson,  H.  L.  W.,  Capt., 
C,  12th  Arkansas. 
Jones,  J.  J.,  Pt.,  D,  4th 
Alabama. 
Jones,  W.  C.,  Serg't,  H, 
21st  Georgia. 
Justice,  J.  G.,  Lieut,  and 
A.  D.  C. 
King,  T.  L.,  Pt.,  E,  55th 
Virginia. 
Lanier,  C.,  Serg't,  L,  2d 
Florida. 
Lemmons,  A.,  Serg't,  D, 
40th  Alabama. 
Lierun,  C.  T.,  Captain, 
Engineer  Corps. 
Lipseij,  R.C.,  Pt.,A,  llth 
Mississippi. 
Luck,  J.    W.,  Pt.,    Nel 
son's  Artillery. 
McCann,J.  F.,  Corp'l,  H, 
9th  Georgia. 
McCarthy,  T.,  Serg't,  K, 
57th  Texas,  age  29. 
Manufield,  Q.  M.,  Pt.,  F, 
4th  Texas. 
Miller,  H.  C.,  Pt.,  G,  8th 
South  Carolina. 
Milling,  J.  H.,  Pt..  K,  2d 
Louisiana. 

1865. 
May  3, 
—  ,  '63. 
Sept.  17, 
1862. 

1865. 

Mar.  14, 
1863. 

1862. 
Julv  3, 
1863. 
Sept.  13, 
—  ,  '64. 
July  —  , 
1863. 
June  11, 
—  .  '64. 
July  —  , 
1863. 
Nov.  —  , 
1863. 

May  31, 
1864. 
May  27, 
—  ,  '62. 
July  3, 
—  ,  '63. 

1862. 

North  Carolina. 
Richardson,  H.  If.,  Pt., 
F,  1st  Tennessee. 
Riley.  J.,  Pt.,   D,  56th 
North  Carolina. 
Riley,  J.  0.,  Pt.,  G,  6th 
Louisiana. 
Riuell,   H.   G.,  Pt.,  A, 
12th  North  Carolina. 
Robinson,  D.,  Pt.,  —  ,  5th 
North  Carolina. 
Roland,  J.,  Pt.,  I,  124th 
Colored  Troops,  age  35. 
Ross,  J.  M.,  Pt.,  A,  3d 
South  Carolina. 
Sample,  W.  P.,  Serg't,  F, 
9th  Louisiana. 
Summons,  W.  J.,  Pt.,  A, 
9th  Louisiana. 
Shifflett,  J.,  Pt.,  C,  4th 
Georgia,  age  29. 
Slioler,  G.  W.,  Pt.,  A,  7th 
Confed.  States  Cav'lry. 
Simmons,  A.  A.,  Pt.,  C, 
40th  Alabama,  age  31. 
Smith,  R.  H.,  Pt.,  F,  3d 
North  Carolina. 
Smith,  W.  M.,  Pt.,A,  41st 
Georgia. 
Snider,  T.  L.,  Serg't,  C, 
25th  North  Carolina. 
Stanson,  B.,  Pt.,  D,  18th 
North  Carolina. 
Starr,  J.  T.,  Pt.,  I,  llth 
Georgia. 
Stephens,  E.,  Pt,,  A,  Hoi- 
comb's  Legion. 
Stockdell,  J.,  Pt.,  F,  13th 
Virginia. 
Switzer,  B.  W.,  Pt.,  C, 
27th  Mississippi. 
Thompson,  L.,  Corp'l,  C, 
16th  North  Carolina. 
Tiveman,  D.,  Pt.,  E,  42d 
New  York,  age  36. 
Ti-ahan,  /.,  Pt.,  K,  10th 
Louisiana. 
Warford,  B.,  Pt.,  A,  7th 
Tennessee. 
Wassum,  P.  M.,  Pt.,  F, 
16th  Tennessee. 
Watson,  J.  A.,  Pt.,  A, 
4th  South  Carolina. 
Watson,  L.  S.,   Pt.,  K, 
28th  Virginia. 
Wells,  J.  J.,  Pt.,  E,  27th 
Mississippi. 

1862. 
1862. 

1862. 
Aug.  19, 
—  ,  '64. 
July  2, 
—  ,  '63. 
June  —  , 
—  ,  '65. 

1865. 
Left.     Discharged   December  2, 
1862. 

1863. 

1862. 

1862. 
1862. 

1862. 

1862. 
May  11, 
'64,  —  . 

1862. 
Left.     Discharged  November  21. 
1862. 
Left.     Furloughed  June  12,  1862. 

Right.     Furloughed  June  1  2,  '62. 
Left.     Recovery. 

Right.     Furloughed  August   19, 

1862. 

1862. 
Sept  19, 
—  ,  '63. 
1863, 

1862. 
Right.     Retired  January  9,  1865. 

Right.     Duty  May  13,  1864. 
Left.     Retired  November  19,  '64. 
Right.     Recovery. 

Left.     Furloughed  February  21, 
1863. 
Left.    Furloughed  September  19, 
1862. 

Nov.  25, 
1863. 
Sept.  17, 
—  ,  '62. 

1862. 

1862. 

1862. 

1862. 
Right.    Paroled  September  5,  '63. 

Left.     Transferred  on  parole. 

1863. 

1862. 

1863. 

1862. 

1862. 
Left.      Discharged    October    12, 
1862. 
Right.     Discharged   August  29, 
1862. 
Left.     To  Provost  Marshal  April 
1,  1863. 
Left.     Paroled  September  12,  '63. 

Left.     Discharged  March  3,  1863. 
Died  February  26,  1864. 
Left.     Transferred. 

Left.    Furloughed  April  18,  1863. 
Right.     Furloughed  April  18,  '63. 
Right.     Duty  June  20,  1863. 
Left.    Exchanged  June  5,  1865. 

.     To  Danville  February  12, 
1863. 

1861. 

1861. 
Left.     Discharged  November  30, 
1862. 
Right.     Retired  February  28,  '65. 

Left.     Retired  November  3,  1864. 

Left.     Discharged  November  14, 
1862. 
Left.     Exchanged  February  14, 

1864. 

Toft         Siinrarm            HnH     f.     K      A 

1862. 

1862. 
Aug.  16, 
1864. 

1862. 

1803. 

1862. 
Oct.  8. 
—  ,  '62. 
July  —  , 
—  ,  '63. 
Sept.  17, 
—  ,  '62. 
May  3, 
—  ,  '63. 

Mar.2,'61.1     Recovery. 

1862. 

1862. 
Left.    Retired  October  27,  1864. 

Right.    Recovery. 
Right.     Discharged  June  22,  '63. 

Right.      Discharged    November 
12,  1862. 
Left.    Furlonghed  March  16,  '65. 

Right.      Discharged    September 
18,  1862. 

July  22, 
—  ,  '64. 
May  31, 
—  ,  '62. 

1863. 

Oct.  8, 
—  ,  '62. 

1862. 

2d  Mississippi. 
Wilder,  F.   W.,  Pt.,  A, 
59th  Georgia. 
Williams,  L.,  Pt.,  B,  41st 
Alabama. 

1862. 
July  5, 
—,'63. 

Right.     Recovery,  Octobers,  '64. 
Left.    Paroled  June  17,  1865. 

1862. 

1862. 

560 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

I 

184 
185 
166 
187 
188 
189 
1<IO 
191 
192 
193 
194 
195 
1  196 
|197 
198 
199 
200 
201 
202 
203 
204 
205 
206 
207 
208 
209 
210 
211 
212 
213 
214 
215 
216 
,217 
218 
219 
220 
221 
222 
223 
224 
225 
026 
227 
228 
229 
230 
231 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

136 
137 

138 
139 
140 
141 
142 
143 
144 
145 
146 
147 
148 
149 
150 
151 
152 
153 
154 
155 
156 
157 
158 
159 
160 
161 
162 
163 
164 
165 
166 
167 
168 
169 
170 
171 
172 
173 
174 
175 
176 
177 
178 
179 
180 
181 
182 
183 

Wilson,  C.  H.,  Lieut.,  F, 
16th  Mississippi. 
Wilt,  G.  IF.,  Pt.,  Brown- 
er's  Virginia  Cavalry. 
Wood,  IF.  T.,  Pt.,D,2yth 
.Georgia. 
Yawn,  N.,  Pt.,  H,  5th 
Florida. 
Abner,   J.,  Pt.,    1,  30th 
Illinois. 
Aldtrman,  C..  Pt.,  I,  9th 
Georgia. 
Alley,  W.,  Pt.,  A,  34th 
Indiana. 
Alliger,  J.,  Pt.,  G,  102d 
New  York. 
Alloway,  S.,  Pt.,  G,  1st 
South  Carolina. 
Amos,  W.,  Pt.,  Peyton's 
Battery. 
Anderson,  I.  R.,  Pt.,  I, 
17th  Mississippi. 
Angel.  J.  Q.,  Pt.,  I,  21st 
Iowa. 

Left.    Furloughed  December  18, 
1862. 
Left.     Furloughed  July  10,  1863. 

Left.    Furloughed  April  18,  1863. 

Dodds,  J.,  Pt.,  G,  llth 
Alabama. 
Dunham,  Z.,  Serg't,  A, 
18th  Infantry. 
Earp    W  R    Pt    E  7th 

1862. 

1862. 
Dec.  31, 

'62,  —  . 

1863. 

1862. 

North  Carolina. 
Fosters,  E.,  Pt.,  D.  5th 
South  Carolina. 
Eldin,  T.,  Pt,,  K,  1st  S. 
Carolina  Rifles. 
Ellis    D    Pt    F  7th  N 

Right.     Died  October  19,  1864. 

1862. 

1862. 
Right.    Died  October  12.  1863. 

Left.     Died  July  1!>,  1863. 
Right.     Died  June  14.  1863. 
Right.     Died  November  19,  1862. 
Right.     Died  August  10,  1863. 

1863. 
July  3, 
—  ,  '63. 
May  16, 
—  ,  '63. 
Sept.  17, 
—  ,  '62. 
July  2. 
—  ,  fG3. 

1862. 

Kight.     Died  May  16,  1864. 
—  .    Died  .  I  une  5,  1864  :  tetanus. 
.     Died  March  23.  1863. 
—  .     Died. 
Right.     Died  January  13,  1863. 
Left.     Died  June  1,  1864. 
Right.     Died  August  16,  1864. 
Right.     Died  August  14,  1864. 
—  .     Died. 
—  .     Died  September  30,  1862. 
Right    Died  June  1,  1864. 

York  Cavalry,  age  24. 
Epztll,  E.  J.,  Pt.,  B,  51st 
North  Carolina. 
Etmeir,  W.,  Pt.,  G,  73d 
Indiana. 
Fair,  R.  H.,   Serg't,  B, 
10th  Penn.  Reserves. 
Fenton,    P.,   Lieut.,   B, 
19th  Georgia. 
Ferguson,  F.  F.,  Pt.,  G, 
6th  Virginia. 
Finlry.  A.  M.,  Serg't,  E, 
55th  Alabama. 
Floyd.  C.  J.,  Pt.,  11,  18th 
Alabama. 
FoosJer,   J.,   Pt.,    F,   2d 
South  Carolina. 
Fowler    H   L     Pt     E 

1864. 

Dec.  31, 

'62,  —  . 
June  27, 
1862. 

1862. 

May  17, 
—  ,  '63. 
Sept   17 

Right.     Died  June  30,  1863  ;  diar 
rhoea  and  fever. 
Left.     Died  October  24,  J8o2. 

.     Died  June  2.  1863. 
.     Died  October  20,  1864. 
Left.     Died  June  6,  1863. 
Right.     Died  August  28,  1864. 

5th  Ohio. 
Arthur,   R.,    Serg't,   15, 
22d  Iowa. 
Areritt,  A.  D.,   Pt.,   G, 
50th  Georgia. 
Baker,  J.,  Pt.,  A,  10th 
Iowa. 
Barrett,   J.  M.,  Pt.,  G, 
51st  Alabama. 
Bartholomew,  T.  K.,  Pt., 
G,  i;2d  Iowa. 
Beaver    AD     Pt     A 

—  ,  '62. 
May  22. 
—  ,  '63. 

July  3, 
'63,  —  . 

May  22, 
—  ,  '63. 

Hampton's  Legion. 
Fox,  J.  O.,  Pt..  K,  115th 
New  York. 
Frazier,  W.,  Pt.,  F,  5th 
New  Jersey. 
Garlick,  A.  J.,  Pt.,  B, 
4th  Virginia. 
Gavitt,    E.  D.,    Pt.,   D, 
4th  Rhode  Island. 
Gee,   J.,    Pt.,  G,    137th 
New  York. 
Gifford,  L.  S.,  Corp'l,  B, 
22d  Illinois. 
Greenwell,  J.  R.,  Pt.,  4th 
Virginia. 
Gregory,  J.  T.,  Serg't,  C, 
27th  Georgia. 
Good,  A.   H.,  Lieut.,  I, 
7th  Virginia,  age  19. 
Gottbrecht,  A.,  Pt.,  B, 
Kith  Iowa. 
Ilamm  J  D    Pt    C  4°d 

Aug.  31, 
—  ,  '62. 

Died  October  20  1864 

Mar.  14, 
—  ,  '62. 
July  2, 
—  ,  N63. 
Sept.  19, 
—  ,  '63. 

Right.     Died  June  11,  1862. 
Left.     Died  July  27,  1863. 
Left,     Died  October  8,  18G3. 

57th  North  Carolina. 
Kendall,  B.  F.,  Pt..  F, 
53d  Virginia. 
Benham,  J.,  Pt.,  H,  10th 
Illinois. 
Birch,  N.,  Pt.,  F,  5th  N. 
Jersey,  age  33. 
Boiling,  H.,  Capt.,  Gen. 
Chambliss"  staff. 
Bowman,   J.    T.,   Pt.,  I, 
16th  North  Carolina. 
Boyd,   J.,    Pt.,    E,    7th 
Louisiana. 
Brock,  J.  H.,  Pt.,  I,  43d 
Alabama. 
Brockett,    W.,    Pt.,    K. 
35th  Illinois. 
Brown,  R.,  Pt.,  E,  88th 
Indiana. 
Brown,    S.    H.,   Pt.,   C, 
81st  Illinois. 
Buckingham,  M.  D.,  Pt.. 
H,  1st  Virginia. 
Buttrich,  P.  W.,  Pt.,  B, 
32d  Massachusetts. 
Calvert,  W.  J.,  Pt.,  I,  1st 
South  Carolina. 
Camp,  G.  T.,  Pt.,  Gra 
ham's  Virginia  Bat'ry. 
Campbell,  J.  R.,  Serg't, 
D,  ]3th  S.  Carolina. 
Campbell,  W.  W.,  Pt.,  I, 
8th  Florida. 
Cantwell,  I.,  Pt.,  C,  7th 
Ohio. 
Carrington,  W.  W.,  Pt., 
A,  2d  Texas. 
Chaplain,  W.  E.,  Lieut., 
I,  1st  South  Carolina. 
Coe,  If.  W.,  Pt..  M,  21st 
North  Carolina. 
Connelly,  B.  C..  Corp1], 
B,  18th  Infantry. 
Coons,  A.,  Pt.,  H,  49th 
Ohio. 
Cooper,    G.,   Lieut.,    B, 
24th  Virginia. 
Coppick,  J.,  Pt.,  I),  74th 
Ohio. 
Couch,   II.,  Pt.,  F,  89th 
Illinois. 
Daum,  C.,  Pt.,  K,  25th 
Ohio. 
Davidson,  B.  R.,  Pt.,  H, 
60th  Alabama. 
Dayis.  J.  K.,  Pt.,B,  10th 
Iowa. 
Dixon,   W.,  Pt.,  G,  5th 
North  Carolina. 

July  —  . 
—  ,  '63. 
Dec.  31, 
—  ,  '62. 

Right.     (Also  amp.  left  forearm.) 
Died  August  6,  1863. 
.     Died  March  7,  1863. 

1862. 

SBinia. 
Left.     Died  October  18,  1864. 

Left.     Died  October  22,  1863. 

1862. 

gangrene  and  pyaemia. 
Left.     Died  June'  28,  1864. 

Left.     Died  August  29,  1863. 
Left.     Died  September  5,  1864. 
Died  June  16    1864  •  py 

July 

—,''63.' 

1863. 
June  15, 

—  ,  '64. 

Left.     Died  June  2,  1864. 
Right.     Died  April  14,  1862. 

Mar.  7, 
—  ,  '62. 
Dec.  31, 
—  ,  '62. 

Mississippi. 
Hammond,  J.,  Corp'l,  B, 
3d  Delaware. 
Handly,   P.,   Corp'l,   K, 
48th  Pennsylvania. 
Harris.  J.  P.  D.,  Pt.,  H, 
27th  Georgia. 
Harrold,   J.  J.,  Pt.,   A, 
59th  Georgia. 
IlawiUe.,  J.    C.,  Pt.,  K, 
13tb  North  Carolina. 
Hay,   W.,  Pt.,  E,   16th 
New  York. 
Helmick,  J.,  Pt.,G,  19th 
Iowa. 
Beyer,  W.,  Pt.,  E,  41st 
Illinois. 
Biggins,  M.  P.,  Pt.,  F, 
8th  Georgia. 
Kittle,   G.   W.,  Pt.,    G, 
75th  Illinois. 
Hodge,    R.,    Pt.,   F,  1st 
Tennessee. 
Howlett,  ./.,  Pt.,  D,  2<>th 
Virginia. 
Huggeons,    J.,     Pt.,    E, 
llth  Virginia. 
Jackson,   J.    C.,    Pt.,    I, 
47th  North  Carolina. 
James,  W.  A.,  Serg't,  K, 
14th  Alabama. 
Jenkins,  J.  S.  P.,  I't..  C, 
12th  Virginia  Cavalry. 
Jones,  G.  W.,  Pt.,  I,  13th 
N.  Carolina,  age  30. 
Jones,   R.,    Pt.,    D.    5th 
North  Carolina. 
Kelley,  E.,  Pt.,  K,  76th 
New  York. 
Ktllis,  J.,  Pt.,  E,  47th 
North  Carolina. 
Kelly,    W.   M.,    Pt.,    E, 
13th  Alabama. 
Kelioe,  J.  O.,  Pt.,  G,  1st 
Tennessee. 

June  —  , 
—  ,  '62. 

aemia. 
.     Died  June  211,  1862. 

Right.     Died  October  25,  1862. 
Loft.     Died  June  8,  1862. 
Left.     Died  September  6,  1863. 

Left.     Died  June  4,  1863. 
Right.     Died  August  1,  1863. 

1862. 

1863. 
July  2. 
—  ,  '63. 
July  2, 
—  ,  '63. 

1862. 
July  3, 
—  ,  '63. 

Died  September  23  1862 

June  27, 
-,  '62. 
Dec.  7, 
1862. 
Feb.  15. 
1862. 
July  3, 
—  ,  '63. 
Oct.  8, 
—  ,  '62. 
Oct.  8, 
)  'go_ 

Right.     Died  July  18,  1862. 
Right.     Died  January  10.  1863. 

1862. 

Left.     Died  July  16,  1863. 
Left.     Died  June  11,  1864. 
Left.     Died  November  16,  1863. 
Left.    Died  August  23,  1863. 
Right.     Died  May  13,  1862. 
Left.     Died. 

Right.    Died  September  1  7,  1863  ; 
chronic  diarrhoea. 



Left.     Died  September  9,  1863. 

1863. 
April  6, 
—  ,  '62. 

.     Died  October  25,  1862. 
Left.     Died  May  24,  1863. 
Died  September  r>    186° 

lifly 

—  ,  '63. 
Oct.  8, 
—  ,  '62. 

Right.     I;i.',l  September  2,  1862. 

Right.     Died  February  14,  1863. 
Left.     Died  July  27,  1863. 

1862. 

July 

—  ,  '63. 
Dec.  31, 
'62,  —  . 

monia. 
Left.     Died  August  22,  1863. 

Died  June   '1     1862'    py 

1863. 
May  5, 
1862. 
Aug.  30, 
—  ,  '62. 
July  2, 
—  ,  %3. 
July  3, 
—  ,  '63. 

Died  June  30   1862 

aemia. 

1862. 

Left.     Died  May  31.  186-1. 
.     Died  June  8,  1863. 
Right.      Died  July  1!'.  lHi.3. 

Died  luly  °5  1863 

May  16, 
—,''63. 
July  3. 
—  ,  T63. 

Right,     Died  July  25,  1863. 

1 

SECT.  V.J 


AMPUTATIONS    IN    THE    LEG. 


561 


No. 

NAME,  MILITARY       i  T>ATI?R          OPERATION'S,  OPERATORS, 
DESCRIPTION,  AND  AGE.                                    RESULT. 

!x          NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

232 
233 
234 
235 
236 
237 
238 
239 
240 
241 
242 
243 
244 
245 
246 
247 
248 
249 
250 
251 
252 
253 
254 
255 
256 
257 
258 
259 
260 
261 
262 

2t;;i 

264 
265 
266 
267 

•JdS 

269 
270 

271) 
272| 
273 

274 
275 
276 
277 
278 
279 
280 

Kenney,  J.,  Pt.,  I,  157th 
New  York. 
A'irfc,  W.  S.,  Pt.,  C,  4th 
Texas. 
Knecht,  A.  Al.,  Serg't,  K, 
12th  South  Carolina. 
Laffith,    J.,    Serg't,    D, 
104th  New  York. 
Lamford,  P..  Pt.,  G,  3d 
South  Carolina. 
Lemon,  W.,  Pt.,  1C,  57th 
Virginia. 
Lillibridge,  D.N.,Pt.,  F, 
12th  lowu. 
Linsley,  S.,  Pt.,  C,  100th 
Col'd  Troops,  age  24. 
Lohmann,  C.,  Lieut.,  D, 
20th  New  York. 
Lumsford,  H.  E.,  Pt.,  K, 
8th  Georgia. 
Mack,  H.,  Pt.,  B,  36th 
Wisconsin. 
Maltbie,  E.  P.,  Pt.,F,2d 
Conn.  Artil'ry,  age  57. 
Martin   If  W.    Pt     G 

April  9, 
—  ,  '65. 

Left.     Died  September  26,  1865; 
exhaustion. 

281 
282 
283 
284 
285 
286 
287 
288 
289 
290 
291 
292 
293 
294 
295 
296 
297 
298 
299 
300 
301 
302 
303 
304 
305 
306 
307 
308 
309 
310 
311 
312 
313 
314 
315 
316 
317 
318 
319 
320 
321 
322 
323 
324 
325 
326 
327 
328 

Rugg,   A.   J.,   Pt.,   Mc- 
Intosh's  Battery. 
Sanchez,  S.  J.,  Pt.,  B,  2d 
Florida. 
Sounders,  H.,  Pt.,  C,  4th 
Virginia. 
Sawyer    W.   F.,   Pt.,    B, 
37th  Tennessee. 
Scott.  J.  B.,  Pt.,  G,  4th 
Texas. 
Scott,   J.,   Pt.,    H,    47th 
North  Carolina. 
Senor,  F.  H.,  Corp'l,  B, 
79th  Pennsylvania. 
Shelter,  D.,  Pt.,  F,  46th 
Ohio. 
Sherwood,   G.  W.,  Pt., 
E.  21st  Illinois. 
Shilling,  J.,  Pt.,  B,  20th 
Massachusetts. 
Shrelas,  A.,  Pt.,  E,  26th 
North  Carolina. 
Simpson,    G.,    Pt.,   21st 
Wisconsin. 
Sims,  G.  T.,  Pt.,  I,  12th 
South  Carolina. 
Singlebush,  J.  W.,  Pt., 
G,  73d  New  York. 
Sink,    J.,    Pt.,    F,    5th 
Virginia. 
Smith,    J.,   Pt.,    H,  3d 
Delaware. 
Smith,  J.C.,Pt.,C,  112th 
Illinois. 
Smith,  J.,  Pt.,   I,   86th 
New  York. 
Smith,  L.  B.,  Pt.,  B,  llth 
Mississippi. 
Smith,    R.,    Corp'l,    B, 
30th  Virginia. 
Snider,  )V.,  Pt.,  G,  2d 
N.  C.  Battery. 
Sprarllin,    W.,   Pt.,    H, 
20tli  Alabama. 
Steele  R    C    Pt     I   7th 

July  2, 
—  ,  '63. 
July  21, 
—  ,  '61. 
Oct.  8, 
—  ,  '<i2. 

A  u  jr.  16,    Right.     Died  September  9,  1864. 
—  ,  '64. 
July  2,     Left.     Died  September  6.  18o3. 
—  ,  ''63. 

-  —  .     Died  September  8,  1861. 
—  .     Died  November  14     862. 
.     Died  July  5,  1862. 
Lett.    Died  September  19,  1862. 
Left.     Died  October  26,  1862. 

Right,     Died  April  20,  1862;  py 
aemia. 
Left.    Died  October  16,  1863. 

Righ  t  .     Died  November  1  3,  1862. 

Right.     Died  July  29,  1863;  ex 
haustion. 
.    Died  October  20,  1862. 

Left.     Died  September  6,  1864. 
.     Died  July  29,  1863. 

Inlv 

Left.     Died  August  24,  1863. 

.    Died    October    13,   1862; 
erysipelas. 
Left.      Died     March    10,    1865; 
phthisis  pulmonalis. 
Right.     Died  October  9,  1862. 

1862. 

—  ,  '63. 
April  6, 
—  ,  '62. 

Oct.  8, 
—  ,  '62. 
April  6, 
—  ,  '62. 
Sept.  19, 
—  ,  '63. 
Sept.  17, 
—  ,  '62. 
July  2, 
—  ,  '63. 
Oct.  8, 
—  ,  '62. 

Sept.  17. 
—  ,  '62. 

1861. 

Right.     Died  June  8,  1864. 
Right.     Died  July  2,  1864. 

1864. 
June  1, 
'g4 

Sept.  17, 
—  ,  '62. 
Mar.  7, 
—  ,  '62. 

7th  Virginia. 
Martinson,    C.,    Pt.,   II, 
9th  Iowa. 
Mason.    A.,   Corp'l,    K, 
93d  Illinois. 
McCaulty,  —  ,    Pt.,    E, 
47th  Alabama,  age  45. 
McClellan,  C.  H.,  Pt.,A, 
7th  Michigan. 
MoCloud,  IX,  Pt.,  I,  55th 
Pennsylvania,  age  27. 
McCuny,   G.    S.,  Pt.,  I, 
14th  South  Carolina. 
McLanghlin,  S.,  Pt.,  N, 
6th  South  Carolina. 
MoMichael,  C.,  Pt.,  II, 
17th  Iowa. 
McMurrin,  H.  S.,  Pt.,  K, 
2d  New  York. 
McMurry,  W.  B.,  Lieut.. 
K,  llth  Mississippi. 
Miller.  F.,  Serg't,  G,  3d 
Iowa  Cavalry. 
Miller,  J.  A.,  Corp'l,  F, 
93cl  Illinois. 
Moon,    R.,    Pt.,    C,   2d 
New  York. 
Morrow,  J.,  Pt.,  K,  18th 
Georgia. 
Morton,   F..  Pt.,  D,  72d 
Pennsylvania. 
Mullen,"  P.,  1't.,  E,  81st 
New  S'ork. 
Mumford,  S.,  Pt.,  E,  1st 
Delaware. 
Mu-nroe.   T.  it.,  Pt.,  K, 
18th  North  Carolina. 
Xeal,  J.  E.,  Pt.,  A,  13th 
Iowa. 
Oliver,  J.  J.,  Serg't,  K, 
61st  North  Carolina. 
Orford,  J.  M.,  Pt.,   A, 
33d  Mississippi. 
Passinger,  If.  &f.,  Pt.,  C, 
3d  South  Carolina. 
Plummer.  C.  II.,  Corp'l, 
F,  18th  Wisconsin. 
Praither,  L..  Pt.,  B,  13th 
North  Carolina. 
Price,  R.M.,  Pt.,B,34th 
North  Carolina. 
Quack,  W.,  Pt.,  E,  27th 
Mississippi. 
Rash,  R.  A.,  Pt.,  F.  52d 
North  Carolina. 
Reiche,    L.    J.,    Pt..    D, 
57th  North  Carolina. 
Rhoads,  W.,  Pt.,  A,  53d 
Pennsylvania. 
Roach,  T.  P.,  Corp'l,  K, 
6th  Maine. 
Rabbins,  J.  P.,  Pt.,  53d 
Virginia. 
Robinson  J.  W    Pt    H 

.    Died  March  15,  1862. 
Right.    Died  July  30,  1863. 
.     Died  September  8,  1864. 
Right.    Died  October  7,  1862. 
Left.     Died  July  9,  1864. 
Right.     Died  September  12,  1863. 
Left.     Died  December  28,  1864. 
.     Died  July  2,  1863. 
Right.     Died  October  26,  1862. 
Left.     Died  May  29,  1864. 
.     Died  February  25,  1865. 
Left.     Died  July  13,  1863. 
Left.     Died  November  10,  1862. 

July  2, 
—  ,  '63. 

1863. 
July  —  , 
—  ,  '63. 
Sept.  17, 
—  ,  '62. 
June  18, 
—  ,  '64. 
July  •  • 

June  —  , 
—  ,  '62. 

.     Died  June  29,  1862. 
Left.     Died  June  24,  1864. 
—  .     Died  September  10,  1862. 

1864. 
Aug.  30, 
—  ,  '62. 

—  ,  '63. 

Right.     Died  June  9,  1864. 
—  .     Died  July  17,  1863. 

May  16, 
—  ,  '63. 
Sept,  17, 
—  ,  '62. 

July  2, 
—  ,  %3. 

July  3, 
—,63. 
Dec.  31, 
'62,  —  . 

Right.     Died  August  29,  1863. 
.     Died  January  15,  1863. 
Left.     Died  June  1,  1864. 
.     Died  September  30,  1862. 
Left.    Died  September  16,  1864. 
.     Died  January  Jl,  1863. 

July  11, 
—  ,  '64. 

North  Carolina,  uge  30. 
Stevens,  A.  G.,  Pt.,  D, 
22d  Illinois. 
Stevens    B    F     Pt     K. 

1863. 
Sept.  17, 
—  ,  '62. 

38th  Virginia. 
Stever,  W.  R.,  Pt.,  E,  2d 

Aug.  31, 

—  r-62. 

Wisconsin. 
Stewart.  J.    S.,  Pt.,  G, 
1st  South  Carolina. 
Stribley,  W.,  Serg't,  A, 
30th  Indiana. 
Summers,   W.,   Pt.,    D, 
17th  Iowa. 
Tarleton,  L.  V.,  Pt.,  G, 
47th  Missouri. 
Tatf,  E.  R..  Pt,,  C,  15th 
Georgia. 
Theu>,  S.  B.,  Serg't,  F, 
llth  Georgia. 
Tliontason,  W.  A  ,  Serg't, 
E,  2d  S.  Carolina. 
Tomlinson,    D.,    Pt.,  E, 
42d  Indiana. 
Traville,  ./.,  Pt.,D,  Hoi- 
comb's  Legion. 
Trvfsdale,  J.  C.,  Pt.,  I, 
12th  South  Carolina. 
Tullis.  A..  Pt.,  G,  28th 
Iowa. 
Tyler,  H.,  Pt.,  C,  25th 
South  Carolina. 
Vanderfard,  A.  A.,  Lt., 
D,  21st  S.  Carolina. 
Van   Kuren,   J.,  Serg't, 
H,  21st  Iowa. 
Vaughn,  G.  W.,  Pt.,  B, 
1st  Tennessee. 
Walker,  J.  A.,   Pt,,   K, 
45th  Georgia. 
Walker,  N.  A.,   Pt.,   I, 

Sept.  17, 
—  ,  '62. 

Right.    Died  October  14,  1863. 

De.31,'62, 

June  26, 
—  ,  '63. 
Sept.  27, 
—  ,  '64. 

1862. 

Sept.  17, 
—  ,  '62. 

Left.     Died  October  18,  1862. 
Died  December  27  1862 

Left.     Died  November  1,  1864. 

April  6, 

Left.     Died  May  4,  1862;  haem 
orrhage. 
Died  October  °9   J  864 

—  ,  '63.' 
July  —  , 
—  ,  '63. 

.     Died  August  8,  1863. 
Right.     Died  June  1,  1863. 

1864. 

Right.     Died  August  18,  1864. 
Right.     Died  September  5,  1863. 
Right.     Died  November  29,  1862. 
.     Died  May  24,  1862. 
Left.     Died  July  5,  1862. 
Right.     Died  December  6,  1862. 
Both.     Died  January  8,  1863. 
Left.    Died  December  18,  1862. 
Left.     Died  October  9,  1862. 
Right.     Died  May  28,  1863. 
.     Died  July  20,  1863. 
Left.     Died  June  26,  1864. 
Left.     Died  May  10,  1862. 
.     Died  October  2  1862 

Oct.  8, 

July  2, 
—  ,  ''63. 
Oct.  4, 
—  ,  '62. 
May  5, 
—  ,  '62. 

Right.     Died  June  20,  1864. 

Right.     Died  July  9,  186;);  gan 
grene. 
Right.     Died  June  20,  1864. 

Left.    Died  February  28,  1863. 
Left.     Died  June  18,  1863. 

May  16, 
—  ,  '63. 

Oct.  8, 
—  ,  '62. 

May], 
—  ,  '63. 

Sept,  17, 
—  ,  '62. 
May  3, 
—  ,  '63. 
July  3, 
—  ,  %. 

Mar.  7, 
—  ,  '62. 
De.30,'62, 
,  '63. 

pyaemia. 
Left.    Died   May  26,   1864;  py 
aemia. 
Right.     Died  April  2,  1862. 

Left.     Died  January  19,  1863. 
Left.     Died  December  28,  1862. 
Right.    Died  November  2,  1862. 
Left.    Died  July  23,  1863. 
Right.     Died  October  28,  1864. 

9th  Iowa. 
Walter,  L.,  Pt.,  A,  13th 
Ohio. 
Waltz,   A.,  Pt.,  K,  7th 
New  York. 
Weber,   G.,   Pt.,  E,  3d 
Wisconsin. 
West    0   A"     Lieut     K 

10th  Ohio  Artillery. 
Robinson,  T.  K.,  Pt.,  H, 
41st  Illinois. 
Rogan,  J.  L.,  Pt.,  E,  4th 
Texas. 
Rosin,   W.,  Pt.,  C,  llth 
Mississippi. 

1864. 
April  6, 
—  ,  '62. 

1862. 
Sept.  17, 
—  ,  '62. 

40th  Virginia. 
Wheatley,  F.  M.,  Pt.,  2d 
Maryland. 

1862. 

562 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

329 
330 
331 
332 
333 
334 
335 
336 
337 
338 
339 
340 
341 
342 
343 
344 
345 
346 
347 
348 
349 
350 
351 
352 

353) 
354} 
355 

356 
357 
358 
359 
360 
361 
362 
363 
364 
365 
366 
367 
368 
369 
370 
371 
372 
373 
374 
375 

Wilkerson,   E.,   Pt.,   B. 
llth  Georgia. 
Williver,  J.,  Serg't,  H, 
44th  North  Carolina. 
Winecoff,  U.  D.,  Pt.,  H, 
7th  North  Carolina. 
Withington,  M.,  Pt.,  D 

July 

Right.     Died  July  22,  1863. 

376 
377 
378 
379 
380 
381 
382 
383 
384 
385 
386 
387 
388 
389 
390 
391 
392 
393 
394 
395 
396 
397 
398 
399 
400 
401 
402 
403 
404 
405 
4C6 
407 
408 
409 
410 
411 
412 
413 
414 
415 
416 
417 
418 
419 
420 
421 

Harris,   E.  U.,  Vt.,   F, 
7th  Georgia. 
Harrison,  N.  C.,  Pt.,  F, 
44th  Georgia. 
Ifenton,  S.  C.,  Corp'l,  F, 
4th  (ieorgia,  age  24. 
How,  M.  D.,  Pt.,  E,  20th 
Georgia. 
Jackson,  If.,  Pt.,  D,  35th 
Georgia. 
Jacobs,  It".  /.,  Pt.,  F,13th 
Georgia. 
Jones,    J.,    Pt.,    H,    6th 
Georgia. 
Jones.  W.  R.,  Serg't,  A, 
13th  South  Carolina. 
Koone,  G.  W.,  Serg't,  D, 
16th  North  Carolina. 
Langdon,  J.  J.,  Pt.,  E, 
48th  Georgia. 
Lewis,  A.,  Pt.,  I,  49th 
Georgia. 
Lewis.  J.  T.,  Pt.,  B,  7th 
South  Carolina. 
Loeb,   H.,   Pt.,    A,    22d 
Mississippi. 
Mags,  W.  J.,  Pt,,  K,  3d 
South  Carolina. 
Mallony,   M.  M.,  Pt,,  C, 
15th  Tennessee. 
McCrary  W  Pt    B  26th 

Right. 
Right. 

Right. 
Left. 
Right. 
Left. 

Left. 
High!. 
Loft. 
Left. 
Left. 
Left. 
Right. 
—  ;  flap. 
Left  ;  circular. 
Left. 
Left. 
Right. 
Lett. 
Left. 
Left. 
Right. 
Right. 

Left. 
Right. 
Left. 
Left. 

—  .  '63.' 

1864. 

chronic  diarrhoea. 
Right.     Died  February  14,  1863; 
pvjfimia  and  hectic  fever. 
Right.     Died  October  17,  1863. 

Left.     Died  September  2,  1863. 
Left.     Died  May  25,  1864. 
Left.     Died  May  24,  1864. 

1864. 

July  3, 

—  .  "(.;!. 

50th  Georgia. 
Wood,   A.,    Pt.,    K,    1st 
Mississippi. 
Woodall,  K.,  Pt.,  B,  12th 
Georgia. 
Wright,   L.  M.,  Pt.,  E, 
59th  Alabama. 
Wijnn,  P.  A.,  Corp'l,  I, 
3d  (ieorgia. 
Alkins,    H.  O.,  Pt.,   D, 
13th  Col'd  Troops. 
Andrews,  J.  P.,  Pt.,  D, 
13th  Mississippi. 
Bailey,  H.   P.,  Pt.,  1st 
Washington  Artillery. 
Beaufort,  J.  L.,  Pt.,  F, 
15th  Mississippi. 
Bell,  J,  J.,  Pt.,  C,  13th 
Mississippi. 
Bennett,   W.  F.,  Pt.,  D, 
6th  Georgia. 
Bon,  F.  L.,  Pt.,  A,  17th 
Mississippi. 
Bridges,   J.  M..    Pt.,  I, 
38th  North  Carolina. 
Brockingtm    W  J.   Pt 

1864. 

1864. 

1864. 
Aug.  It:, 
1864. 

Dec.  16,     Left. 

>g4i  •  , 

July  3,     Right. 
'63,  —  . 

1862. 

1864. 

Right. 
Right. 
Right. 
Right. 
Right. 
Right. 

1865. 
July  3, 
'63,—. 

1864. 

1865. 

1865. 
July  3, 
—  ,  ''63. 

Au.25,'64. 

1864. 

North  Carolina. 
Melton,  B.   W.,   Pt.,  H, 
llth  Georgia. 
Mercer,  M.,  Pt.,  D,  35th 
Georgia. 
Miller,  W.  N.,  Capt,,  H, 
31st  Georgia. 
Mizells,J.  fe'.,Pt.,  B.llth 
South  Carolina. 
Murray,  W.  B.,  Corp'l, 
D,  5th  S.  C.  Cavalry. 
Myers,   T.,  Pt,,  A,  45th 
Georgia. 
Neal  H.  R.   Pt.  G  Pal 

1864. 

A,  7th  S.  C.  Cavalry. 
Brown,  R.  D.,  Serg't,  H, 
45th  Georgia. 
Bruce,  J.  B.,  Pt.,  I,  1st 
Tennessee. 
Brumfield,  J.  F.,  Pt.,  C, 
4Cth  Virginia. 
Bugg,  J.,   Pt.,   C,   28th 
Georgia. 
Butts,  W.  J.,  Pt,,  B,  60th 
Georgia. 
Gamble,  T..  Pt,,  D,  7th 
Mississippi. 
Cameron,  J.  W.,  Pt.,  I, 
26th  South  Carolina. 
Carpenter,  P.  J.,  Pt.,  D, 
13th  Virginia. 
Chamberlain,  W.  D.,  Pt.. 
I,  14th  S.  Carolina. 
Chapman,  R.  F.,  Lieut,, 
E,  9th  Virginia. 
Chestnut,  F.  M,,  Pt.,  F, 
8th  Arkansas. 
Clakly,J.  T.,  Pt.,  A,)  Oth 
Georgia. 
Cone,  L.,  Serg't,  D,  8th 
Georgia. 
Conner,  J.,  Pt.,  G,  7th 
Louisiana. 
Cox,   J.    T.,    Serg't,    D, 
28th  South  Carolina. 
Craft,  J.  I.,  Pt.,  H,  33d 
North  Carolina. 
Creak,    G.  D.,   Pt.,    E, 
27th  Georgia. 
Davis,  G.  W.,  Lieut.,  H, 
6th  Virginia. 
Davis,  J.  W.,  Pt.,  K,  37th 
South  Carolina. 
Duncan,  W.  F.,  Pt.,  K, 

1864. 

1864. 

1864. 

Right. 
Right. 

Left. 

Left, 
Both. 
Left. 
Right. 
Left. 
Right. 
Right. 

1865. 

1862. 

1864. 

1864. 

1864. 

April  6, 
'62,  —  . 

1864. 

metto  S.  S.  S.  Carolina. 
Netly,    ].,    Pt.,    1),    1st 
Tennessee. 
Nc.wman,  W.  A.,  Pt.,  C, 
28th  Georgia. 
Peables,  J.   C.,    Pt.,   H, 
28th  Alabama. 
Price,    W.  K.,   Pt.,   K, 
44th  Tennessee. 
Reese,  T.  B.,  Pt.,  E,  Phil. 
Legion. 

1862. 
Oct.  8, 
'(J2,  —  . 

1862. 

1864. 

July  3, 
'63,  -. 

1865. 

Oct.  8, 
—  .  '62. 

1865. 

1864. 
Oct.  8, 
1862. 
July  2. 
—  ,  '63.' 

1864. 

Ruleau,  F.,  Pt.,  Wash 
ington  Artillery. 
Sair  A           G    "57th  N 

Left. 
Left. 
Left. 

Left. 
Right. 
Right. 
;  circular. 
Right. 
Left. 
Right. 
Left. 
Left. 
Right. 
Left. 
Right. 

1864. 

Left. 
;  circular. 
Right. 

Carolina,  age  31. 
Sawyer,  H.  A.,  Capt.,  C, 
2d  N.  Carolina,  age  24. 
Shuler.  P.  11.  B.,  Lieut., 
A,  2d  South  Carolina. 
Smith,  I.  B.,  I't.,  A,  32d 
Mississippi. 
Smith,  M.  B.,  Pt.,  F,  2d 
South  Carolina. 
Stan  till,  J.    W.,    Pt.,  A, 
20th  Georgia. 
Stewart,  A.,   I't  ,  D,   1st 
Tennessee. 
Strane.G.L.,Pt.,J),  Hoi- 
comb's  Legion  Cav'y. 
Truett,  .J.  D..  Pt.,  C,  38th 
Georgia. 
Turner,  P.    S.,  Pt.,  A, 
44th  Georgia. 
Vause,  W.  A.,  Pt.,  I,  28th 
Georgia. 
Wo.ikinx,  W.  //.,  Corp'l, 
C,  20th  Georgia. 
Welch.  J.,   Pt.,   F,  61st 
Georgia. 
WMt$eld,W,H.,Pt.,G, 
14th  Georgia. 
Willis,   R.  M.,   Pt.,   C, 
15th  Georgia. 
Winstead,  I.,  Serg't,  D, 
1st  Tennessee. 

1863. 



1862. 
July—, 
—  ,'  '63. 
Oct.  8, 
1862. 
Sept.  30, 
'64,  —  . 

1864. 

Oct.  8, 
'62,  —  . 

Left. 
Left. 
Right. 
Left. 

1864. 

44th  Tennessee. 
Edwards,  A.  D.,  Pt..  C, 
28th  North  Carolina. 
Evans,  W.  0.,  Corp'l,  E, 
18th  South  Carolina. 
Foderfteld,    JY.,    Pt.,   B. 
16th  Georgia. 
George,  IV.,  Pt.,  K,  7th 
Louisiana. 
Green,  A.  J..  Pt.,  D,  29th 
Georgia. 
Grace    L     Pt     A    20th 

1864. 

1864. 

1865. 

Sept.  19, 

1864. 

1865. 

Left. 
Left. 

Right. 

1864. 

1864. 

Georgia. 
Gunn,R.  G.,  Pt.,  A.  17th 
Mississippi. 
Harback,  C.  B.,  Pt.,  K, 
21st  Iowa. 
Harder,  T.  D.,  C'apt.,  H, 
9th  Georgia. 

1864. 
July  3, 
'63,'—. 

Right. 

1865. 
Oct.  8, 
—  ,  '62. 

1864. 

In  one  instance  (CASE  16,  p.  558)  the  arm,  and  in  a  second  instance  (No.  155,  p.  560) 
the  forearm,  was  amputated  at  the  time  of  the  removal  of  the  leg.     This  is  the  last  cate- 


SECT.  V.]  SHOT    FRACTURES    OF    THE    BONES    OF    THE    LEG.  563 

gory  of  the  five-  thousand  four  hundred  and  fifty-two  amputations  in  the  leg  for  shot  injury 
performed  during  the  American  civil  war. 

RECAPITULATION. — In  thirty-nine  instances,  with  nineteen  recoveries, .nineteen  deaths, 
and  one  unknown  result,  both  legs  were  amputated.  The  five  thousand  four  hundred  and 
fifty-two  (5452)  operations  were  therefore  performed  on  five  thousand  four  hundred  and 
thirteen  (5413)  soldiers,  of  whom  three  thousand  nine  hundred  and  seventy-four  (3974) 
belonged  to  the  Union  and  one  thousand  four  hundred  and  thirty-nine  (1439)  to  the  Con 
federate  armies.  Of  the  operations  on  the  Union  soldiers  the  results  were  recorded  in  all 
but  fifteen  cases.  Two  thousand  five  hundred  and  seventy-nine  (2579)  recovered,  and  one 
thousand  three  hundred  and  eighty  (1380),  or  34.8  per  cent.,  died.  Of  the  Confederate 
soldiers  the  results  in  one  hundred  and  twenty-two  cases  remain  undetermined;  nine  hun 
dred  and  sixty-three  survived,  and  three  hundred  and  fifty-four,  or  26.8  per  cent.,  perished. 
This  favorable  percentage  of  mortality  among  the  Confederates,  however,  would  probably 
be  materially  affected  had  it  been  practicable  to  ascertain  the  results  in  the  one  hundred 
and  twenty-two  undetermined  cases.  In  fifteen  of  the  five  thousand  four  hundred  and 
fifty-two  cases  of  amputations  in  the  leg,  the  opposite  limb  was  amputated  in  one  instance 
at  the  hip/  in  seven  in  the  thigh,2  in  two  at  the  ankle  joint,  and  in  five  through  the  foot; 
re-amputations  in  the  leg  for  diseased  stumps  or  haemorrhage  were  performed  in  one  hundred 
and  forty-four  cases.  In  six  instances  the  amputation  in  the  leg  was  followed  by  disarticu- 
lation  at  the  knee,  and  in  seventy-one  by  ablation  in  the  thigh.  The  right  leg  was  involved 
in  two  thousand  three  hundred  and  sixty-nine  cases,  the  left  in  two  thousand  five  hundred 
and  forty-four,  and  in  live  hundred  and  thirty-nine  the  side  was  not  recorded. 

CONCLUDING  OBSERVATIONS  ON  SHOT  FRACTURES  OF  THE  BONES 
OF  THE  LEG. — As  already  stated,  the  shot  fractures  of  the  bones  of  the  leg  number 
eight  thousand  nine  hundred  and  eighty-eight  (8,988).  They  form  the  most  numerous 
group  of  shot  fractures  of  the  long  bones  of  the  extremities,  comprising  nearly  one-third 
of  the  twenty-nine  thousand  and  three  (29,003)  cases  of  this  nature  recorded  during  the 
American  civil  war,  as  follows:  Shot  fractures  of  the  humerus  (Second  Surgical  Volume, 
TABLE  LV,  }>.  666)  eight  thousand  two  hundred  and  forty-five  (8,245),  or  28.4  per  cent,; 
shot  fractures  of  the  radius  and  ulna  (Second  Surgical  Volume,  TABLE  CXXIV,  p.  922) 
five  thousand  one  hundred  and  ninety-four  (5,194),  or  17.9  per  cent.;  shot  fractures  of  the 
femur  (TABLE  XX,  p.  175,  ante]  six  thousand  five  hundred  and  seventy-six  (6.576),  or  22.6 
per  cent.;  and  shot  fractures  of  the  bones  of  the  leg  (TABLE  LXI,  p.  432,  ante)  eight  thou 
sand  nine  hundred  and  eighty-eight  (8,988),  or  31.0  per  cent.  It  will  be  borne  in  mind 
that  cases  involving  the  articulations  in  the  upper  as  well  as  in  the  lower  extremities  arc 
not  included  in  these  tabular  statements. 

It  has  been  shown  in  TABLE  LXI,  page  432,  ante,  that  of  eight  thousand  nine  hun 
dred  and  eighty-eight  (8988)  cases  of  shot  fractures  of  the  bones  of  the  leg  the  bone  injured 
was  specified  in  five  thousand  and  seventy-two  (5072)  instances;  one  thousand  and  thirty- 
three  (1033)  were  fractures  of  the  fibula,  two  thousand  five  hundred  and  eighty-eight  (2588) 

1  Case  of  Private  W.  Waters,  Co.  K,  123d  New  York.     CASE  286,  page  135,  and  No.  24,  TABLE  XV,  page  138,  ant?. 

'Cases  of:  Pt.  H.  Brown,  Co.  K,  22d  Colored  Troops,  secondary  operation,  lower  third  left  thigh  ;  recovered;  TABLE  XI>.  No.  15,  page  3~>0,  ante.-- 
Pt.  C.  I,.  Johnson.  Co.  B',  1st  Tennessee,  primary  operation,  lower  third  left  thigh;  fatal ;  TABLE  XXXII,  No.  1402,  page  261.  ante.— Pt.  J.  R.  Lewis,  Co. 
H.  53d  Georgia,  primary  operation,  lower  third  left  thigh;  fatal;  TABLE  XXXII,  No.  1469,  page  262,  ante..— Pt.  S.  Banks,  Co.  C,  43d  Colored  Troops, 
primary  operation,  middle  third  right  thigh ;  fatal ;  TABLE  XXXI,  No.  706,  page  235,  ante.— Pt.  L.  O.  Lampbere,  Co.  G,  21st  Connecticut,  primary  oper 
ation,  lower  third  left  thigh;  fntal  :  TABLE  XXXT1.  No.  1445,  page  262,  ante. — Sergeant  ,T.  Fos*,  Co.  C.  5f)th  X.  V..  primary  amputation  thigh;  fatal; 
TABLE  XXXIII.  No.  1  It;,  pago  2<I9,  ante.— Cook  H.  Houseley,  Co.  F,  33d  Wisconsin,  intermediary  operation,  linii'i  third  right  thigh  :  recovery  ;  TABLE 
XXXVI,  No.  '.)],  page  294,  ante. 


564 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


of  the  tibia,  and  one  thousand  four  hundred  and  fifty-one  (1451)  of  both  tibia  and  fibula. 
Of  the  one  thousand  and  thirty-three  fractures  of  the  fibula,  fifty,  or  4.8  per  cent.,  of  the 
two  thousand  five  hundred  and  eighty-eight  cases  of  fracture  of  the  tibia,  four  hundred  and 
forty-two,  or  17.0  per  cent.,  and  of  the  one  thousand  four  hundred  and  fifty-one  fractures 
of  both  bones,  one  thousand  and  forty-two,  or  71.8  per  cent.,  were  amputated. 

Three  thousand  nine  hundred  and  thirty-eight  (3938),  or  less  than  one  half  of  the 
eight  thousand  nine  hundred  and  eighty-eight  (8988),  shot  fractures  of  the  bones  of  the 

TABLE  LXXXIV. 

Results  of  Shot  Fractures  of  the  Bones  of  the  Leg  treated  by  Conservation  on  the  Occasions  named  and 

from  the  Authorities  quoted. 


OCCASIONS  AND  AUTHORITIES. 

CASES. 

FRACTURES. 

Tibia. 

Fibula. 

Tibia  and 
Fibula. 

Bone  not 
Specified. 

"3 
o 
H 

Recoveries. 

1 
b 

Result 
Undeterm'd. 

Recoveries. 

2 
"5 
fe 

Result 
Undeterm'd. 

Recoveries. 

. 
"a 
"3 
fe 

Result 
Undeterm'd. 

Recoveries. 

"3 
1 

Result 
Undeterm'd. 

Recoveries. 

Fatal. 

~  Result^ 
Undeterm'd. 

Thirty  Yeire'  War  1618  1648  (SCHMIDT1) 

7 
5 
1 
3 

7 
33 

13 

54 

12 
47 
1 

8 

49 
58 
19 
598 
508 
3 
31 
1 

296 

1,030 

186 

5 
5 

1 
3 

,6 
33 

10 

26 
9 

28 
1 
6 

27 
52 
18 
429 
424 

31 

1 

7 
855 
125 

2 

5 

1 

2 

Franco-German  War  1671  1678  (PURMANN2) 

^ 

1 

1 

Battle  of  Molwitz   1741  (SciIMUC'KER4) 

" 

1 

Dettingen,  Fontenoy,  and  Touruay,  1743,  174."),  etc.  (RAVATON,5 
BOUCHER  6  BOUDEXAVK  '  BAGIKU")                    

1 

? 

1 

0 

1 
8 

1 
11 

Seven  Years'  War,  1756-1763  (MEHEE,9BILGUER,10  BOURIEXXE11) 
Napoleonic  Wars,   1791-1815  (LAUliEXT,  l2  LARRY,13  HUTIN,14 
GUTHRIE  l=  FEVECH  IC  HEVNEX17) 

4 

3 

11 
3 

19 

17 

2 

6 
6 

1 
3 

2 

5 

4 
1 

2 
1 

7 

Revolution  in  Paris,  1830  (ARNAL,18  JOBEBT  DE  LAMBALLE,19 
MEMERE  20  LAKRFY") 

2 

5 

2 

8 

10 

French  in  Algeria   1830  36  (BAUDENS  22  BAGRE23) 

Spanish  Peninsular  War,  1836-1837  (ALCOCK24)  

28 

19 

Mexican  War,  1845-48  (PORTER26)  ,  

1 

1 

Revolution  in  Milan   1848  (RESTELLI28) 

0 

20 
6 
1 
169 
84 

2 

1 

2 
25 

12 
20 
101 

1 

4 

1 

2 
7 
9 

1 

4 
1 

Revolution  in  Paris,  1848  (MALGAIGXE.^GOSSELIN.^HUGUIER,29 
JOBERT,30  BAUDENS31)  

1 
20 
4 

2 
3 

22 

14 

2 

Schleswig-Holstein  War,  1848-50  (STKOMEYER32)   

o 

British  in  India,  1857-58  (WILLIAMSON33)  

Crimean  War,  1854^57  (MATTHEW,34  CHEXU35) 

14       3 
62       2 

31 

28 

364 
261 
3 

12 

132  !  
74   .... 

Italian  War,  18o9  (CHEXU  i6  DEMME37) 

New  Zealand  War,  1863-65  (MOUAT38) 

Danish  War  1864  (LUECKK  3!)  HEINE  J0  OCHWADT41) 

8! 

(; 

•i 

French  in  Mexico   1864  (BlNTOT42) 

1 

Austro-Prussian  War,  1866  (BKCK,43  BlEFEL,44  FlSCHEU  (K.),45 
MAAB,46  STROMEYER47)  

37 

34 

19 
-i 

o 

4 

1 

1 

9 
1 

:i 

193 

31 

34 

U.  S.  Army,  1865-1870  (OTIS48)     ... 

Franco-German  War,  1870-71  (GERMANS49)  

114 
59 
3 

61 

2 

285 
9 
6 

26 
4 
I 

35 

1 

61 
4 
3 

6 
3 

2 

6 

188 
6 

34 

0 

20 

321 

106 

48 
50 

1 

Franco-German  War  1870-71  (FRENCH50).  .  . 

Russo-Turkish  War  1876-77  (TILING51) 

Aggregates  

2,989 

2.339   534 

116 

521 

i  

55 

v  

614 

38 

194 

23 
~23l 

14 

/ 

287 

76 

—  v  

390 

27 

' 

1,337 

*  

1 

380 

37 

Mortality  Rate  18.5  perct. 

754 

leg  treated  without  operative  interference  give  a  mortality  rate  of  13.8  per  cent.     From 
the  above  table  (TABLE  LXXXIV),  in  which  an  attempt  has  been  made  to  collect  as  f*ar  as 

1  SCHMIDT  (JOSEPH)  (Speculum  Chirurgicum  oder  Spiegel  der  Artzney.  Angspurg,  1656,  pp.  155,  el  seq.)  details  seven  cases  of  shot  fractures  of  the 
bones  of  the  leg  treated  conservatively;  five  recovered  and  two  proved  fatal:  Steffan,  shot  fracture  left  leg,  February  20,  1641>;  recovery.  H.  Bernet, 
dragoon,  shot  fracture  left  leg,  May  6,  1648  ;  pieces  of  bone  removed;  recovery.  Lieut.  Rossmann,  fracture  upper  third  left  leg,  May  21,  1648  ;  recovery. 
Lieut.  L.  Kytzinger,  aged  60,  shot  fracture  upper  third  right  leg,  May  18,  1648;  fatal.  M.  Zorn,  shot  fracture  left  leg;  recovery.  H.  J.  Buchrer,  shot 
fracture  tibia  with  great  loss  of  soft  parts;  recovery.  F.  T.  Marin,  shot  wound  of  right  leg;  fatal.  2PURMAXN  (M.  G.)  (Funfftzig  $<mde.r-und  Wunder- 
bahre  Schuxxwunde.n  Curen,  Leipzig,  1701)  details  five  successful  cases  of  shot  fractures  of  the  bones  of  the  leg:  Obs.  IV,  p.  53,  D.  Griesing,  wounded 
during  Siege  of  Stettin,  August,  1677;  fracture  of  both  bones  of  leg;  recovery.  Obs.  XIII,  p.  113,  IT.  Rother,  shot  fracture  tibia,  Ancklam,  1676;  recovery. 
Obs.  XIII,  p.  115,  C.  Wutke,  wounded  at  Stettin,  in  1677;  shot  fracture  left  tibia;  recovery.  06s.  XXIX,  p,  ~".'2,  J.  Fischer,  shot  fracture  left  legandleft 


SECT,  v.]  SHOT   FRACTURES    OF    THE    BONES    OF    THE    LEG.  565 

practicable  the  cases  of  shot  fractures  of  the  bones  of  the  leg  recorded  -by  military  surgeons 
of  other  campaigns,  it  will  be  seen  that  the  mortality  rate  of  these  cases  is  18.5  per  cent., 
or  4.7  per  cent,  in  excess  of  those  of  the  American  civil  war.  Examining  the  remote  effects 

arm  at  Stettin,  in  1676 ;  recovery.    06s.  XXXIIX,  p.  282,  H.  H ,  shot  fracture  left  fibula  and  right  tibia,  Ancklam,  1678 ;  recovery.    3CAXNAC  (Sar  une 

jambe  icrasee  par  un  obus,  ou  petite  bombe,  in  Mem.  de  VAcad.  Boy.  de  Chir.,  1753,  T.  II,  p.  494)  cites  the  case  of  an  officer  wounded  at  the  siege  of 
Douay,  in  1710;  shot  fracture  middle  third  of  tibia,  removal  of  spiculse;  recovery.  48CHMUCKEB  (J.  L.)  (Chirurgische  Wahmehmungen,  Berlin  und 
Stettin,  1774,  B.  II,  pp.  503,  et  seq.)  records  three  cases  of  recovery  after  shot  fractures  of  the  bones  of  the  leg :  Cadet  von  Sasse,  fracture  lower  third  of  tibia, 
Molwitz,  April  10,  1741 ;  spiculae  removed  ;  recovery,  with  curvature  of  leg — upper  part  of  fibula  movable  while  walking.  Captain  Graf  le  Mede,  frac 
ture  of  tibia,  Leuthen,  December  5,  1757;  recovery,  with  curvature.  Major  von  Ruitz,  fracture  of  both  legs,  one  in  middle  and  the  other  in  the  lower 
third,  Schweidnitz,  May  16,  1762;  splinters  removed;  recovery.  6RAVATON  (Chirurgie  d'armee  ou  traite  des  plaits  d'armes  d  feu,  Paris,  1768)  records 
three  cases:  Obs.  XCII,  p.  3G9,  Corp'l  La  Joie,  Regiment  Cond6,  fracture  of  middle  third  of  left  tibia  and  fibula,  July  29,  1743;  long  incisions,  removal 
of  splinters;  recovery.  Obs.  XCVI,  p.  376,  Grenadier  A.  Riant,  fracture  of  middle  third  tibia,  Nov.  20,  1759;  recovery.  Obs.  CI,  p.  387,  P.  D'Amour, 
shot  fracture  upper  third  left  tibia,  Warbourg,  August  7,  1760  ;  removal  of  splinters;  recovery,  with  shortening.  6 BOUCHER  (Sur  des  playes  d'armes  /I 
feu  compliquies  sur-tout  de  fracas  des  os,  in  Mem.  de  VAcad.  Roy.  de  Chir.,  Paris,  1753,  T.  II)  records,  at  p.  463,  the  case  of  an  English  volunteer,  wounded 
at  Foutenoy,  April  30,  1745;  shot  fractures  of  head  of  humerus  and  middle  third  of  leg;  amputation  at  shoulder  joint;  recovery;  and  at  p.  474,  the  case 
of  a  soldier  of  the  regiment  de  la  Couronne,  wounded  at  Tournay,  in  1745;  fracture  of  middle  third  of  fibula;  fatal.  'BORDENAVE  (Precis  deplusieun 
observations  sur  les  playes  d'armes  d  feu  en  diffirentes  parties,  in  Mini,  de  VAcad.  Roy.  de.  Chir.,  1753,  T.  II,  p.  528)  cites  a  case  observed  by  M.  TUUSAN 
of  shot  fracture  of  upper  third  of  tibia;  the  patient  recovered.  8BAGIEU  (Examen  de  plusieitrs parties  de  la  Chirurgie,  Paris,  1756,  p.  132):  Engineer, 
shot  fracture  middle  third  right  leg;  recovery.  9MEHEE  (J.)  (Traite  des  plaies  d'armes  a  feu,  Paris,  an  VIII,  pp.  133,  143)  records  three  cases  of  recov 
ery  following  shot  fractures  of  the  bones  of  the  leg  treated  conservatively:  Cavalier  of  the  regiment  Saint-Jal,  shot  fracture  of  both  bones  of  right  leg, 
middle  third,  Rosbach,  November  5,  1757 ;  recovered.  A  soldier  of  the  regiment  of  Cuirassiers  of  Gessler,  shot  fracture  of  bones  of  leg ;  recovery.  M.  de 
Alvensleben,  Ensign  of  the  Guards,  received  a  shot  fracture  of  the  bones  of  the  leg  at  Torgau,  in  1760 ;  recovery.  10  BlLGUER  (J.  U.)  (Chirurgische  Wahr- 
nehmungen,  etc.,  Berlin,  1763,  Abth.  IV,  pp.  4GO,  et  seq.,  Obs.  30,  31,  34,  37,  42,  44,  45, 49, 50,  55,  56,  58,  59,  61,  62,  65,  66,  67,  68,  72,  73,  75,  81,  84,  85,  90,  93, 
96,  110):  29  cases  of  recoveries  occurring  during  the  Seven  Years'  War,  1756-63;  in  4  of  the  cases  the  tibia  was  fractured,  in  17  both  tibia  and  fibula,  and 
in  8  cases  the  location  of  the  fracture  was  not  indicated.  "  BOURIENXE  ( Obs.  sur  les  grands  fracas  d'os  a  la  suite  des  plaies  d'armes  a  feu,  in  DEHOHNE'S 
Journal  de  Mid.  Mil.,  Paris,  1782,  T.  I,  p.  214):  Soldier,  wounded  July  10,  1760;  shot  fracture  of  tibia  and  fibula  in  upper  third;  recovery  in  six  weeks. 
"LAURENT  (Memoire  clinique  sur  le  te.tanos  chez  les  blessis,  Strasbourg,  an  V  [1796],  p.  61):  Lefranc,  Sergeant  of  Grenadiers,  shot  comminution  of  leg, 
1791(?),  tetanus  13  days  after  injury;  recovery.  13LARREY  (D.  J.)  (Memoires  de.  Chirurgie  Militaire  et  Campagnes,  Paris,  1812,  T.  II,  p.  261):  General 
Baudot,  shot  fracture  of  bones  of  leg,  Aboukir,  March  8,  1801;  gangrene  ;  death.  14HUTIN  (F.)  (Memoire  sur  la  nCcessite  d'extraire  les  corps  Strangers 
et  les  esquilles,  dans  le  traitement  des  plaies  par  armes  d  feu,  in  Mim.  de  VAcad.  Nat.  dt  M<'d.,  Paris,  1852,  T.  XVI,  p.  446):  Obs.  14,  15,  21,  24,  25,  28, 
relates  six  cases  of  recovery  after  shot  fractures  of  the  bones  of  the  leg  during  the  years  1793  to  1813.  In  one  case  (06s.  15)  fragments  of  bone  continued 
to  be  discharged  for  33  years.  In  one  the  tibia,  in  one  the  fibula,  and  in  four  both  bones  were  fractured.  I6  GUTHRIE  (G.  J.)  (A  Treatise  on  Gunshot 
Wounds,  London,  1827,3d  ed.,  p.  398):  Soldier,  wounded  at  the  battle  of  Rolica,  Portugal,  August  17,  1808;  both  bones  shattered  in  two  places:  recovery 
1GFENECH  (E.)  (Observations  recueillies  d  I'armee  d'Espagne  sur  les  plaies  d'armes  &  feu  aux  extn'mites,  Paris,  1813,  ThSse  No.  22,  06*.  VII,  p.  10,  and 
06.?.  XIX,  p.  16):  Soldier,  31st  Infantry,  shot  fracture  of  right  tibia,  before  Almeida,  May  5,  1811 ;  simple  fracture  of  fibula;  fatal.  Roques,  Lieutenant, 
70th  regiment,  shot  in  left  leg,  A  ugust  21,  1808,  in  Portugal ;  both  bones  were  fractured  in  the  lower  third ;  fatal.  "  HENNEN  (J.)  ( Principles  of  Military 

Surgery,  London,  1829,  3d  ed.,  pp.  131,  190):  French  soldier,  wounded  in  1814;  left  tibia  fractured,  fragment  extracted;  recovery.    Lieut.-Col.  H , 

musket  bull  partially  fractured  fibula,  Bergen-op-Zoom,  March  8,  1814  ;  recovered ;  limb  completely  varicosed.  18  ARNAL  (Memoire  sur  quelques partic 
ularities  des  plaies  par  armes  d  feu,  in  Jour.  univ.  et  hebd.  de  mid.  et  de  chir.,  Paris,  1831,  T.  Ill,  p.  35)  records  17  cases  of  shot  fractures  of  the  bones  of 
the  leg  treated  conservatively;  in  8  cases  the  h'bula,  in  2  the  tibia,  and  in  7  both  bones  were  fractured;  no  results  are  given.  19JOKERT  (DE  LAJIHALLE) 
(Plaies  d'armes  A  feu,  Paris,  1833,  pp.  285,  et  seq.)  cites  18  cases,  with  1  fatal  result ;  in  5  the  fibula  was  interested,  in  6  the  tibia,  in  5  (1  fatal)  both 
bones,  and  in  2  cases  the  bone  injured  was  not  specified.  20MENIERE  (P.)  (Li 'Hotel- Dieu  de  Paris  en  Juillet  et  Aout  1830,  Paris,  1830,  p.  312);  17  cases 
(7  recoveries,  10  fatal).  21 LARREY  (H.)  (Relation  Chirurgicale  des  evtnemens  du  Juillet  1830,  Paris,  1831,  p.  119);  2  cases ;  recoveries.  » BAl'DEXS  (L.) 
(Clinique  des  plaies  d'armes  d  feu,  Paris,  3836,  pp.  483,  et  seq.);  10  cases;  8  of  the  tibia  (5  recoveries,  3  fatal);  2  of  the  fibula  (recoveries).  23BAGRE 
(06*.  de  Chir.,  recueillies  a  Vhopital  Tare,  a  Alger;  in  Rcc.  de  Mem.  de  Med.  de  Chir.  et  de  Phar.  Mil.,  Paris,  1831,  T.  XXXI,  pp.  156,  157,  159):  Frac 
ture  of  tibia  ]  (recovery),  of  tibia  and  fibula  1  (recovery).  24  Al.cOCK  (R.)  (Notes  on  the  Med.  Hist,  and  Stat.  of  the  British  Legion  of  Spain,  London, 
1838,  p.  53);  47  cases  (28  recoveries,  19  fatal).  25PORTER  (J.  B.)  (Medical  and  Surgical  Notes  of  Campaignes  in  the  War  with  Mexico  during  the 
years  1845-46-47-48,  in  Am.  Jour.  Med.  Sci.,  1852,  Vol.  XXIII,  N.  S.,  p.  32);  1  case  of  fracture  of  tibia;  recovery.  ^RESTELLI  (A.)  (Note  et  Osserva- 
zioni  cliniche  di  chirurgia  militare,  in  Annali  Vniversali  di  Mcdicina,  1849,  Vol.  CXXX,  p.  265);  8  cases;  fractures  of  both  bones  in  2  (1  recovery,  1 
fatal),  of  fibula  in  4  (all  recovered),  of  the  tibia  in  2  (1  recovery,  1  fatal).  27 Des  plaies  d'armes  a  feu;  Communications  faites  a  VAcademie  Rationale  de 
Midecine,  Paris,  1849,  par  MM.  MALGAICXE,  p.  45,  11  cases  (5  recoveries,  C  deaths);  28GOSSRL1N,  ibid.,  p.  46,  3 cases  (1  undetermined,  2  fatal);  ^HfGUIER, 
ibid.,  p.  131,  9  cases  (7  recoveries,  2  fatal);  30  JOBEUT  (DE  LAMHALLE),  ibid.,  p.  154, 16  cases  (6  recoveries,  10  fatal);  3I  BAUDEKS,  ibid.,  p.  232,  et  seq.,  10 
cases  (9  recoveries,  1  undetermined).  S2STROMEYER  (L.)  (Maximen  der  Kriegsheilkunst,  Hannover,  1855,  p.  756),  58  cases:  Fractures  of  both  bones  in  8 
cases  (7  recoveries,  1  fatal),  of  tibia  in  27  cases  (25  recoveries.  2  fatal),  of  fibula  in  23  cases  (20  recoveries,  3  fatal).  33  WILLIAMSON  (G.)  (Military  Surgery, 
London,  18(>3,  p.  XXVI),  19  cases:  Fractures  of  both  bones  in  2  cases  (recoveries),  of  the  tibia  in  13  cases  (12  recoveries,  1  fatal),  of  the  fibula  in  4  cases 
(recoveries).  M MATTHEW  (T.  P.)  (Med.  and  Surg.  History  of  the  British  Army,  etc.,  London,  1858,  Vol.  II,  pp.  355,  et  seq.),  102  cases:  Fractures  of 
both  bones  in  59  cases  (31  recoveries,  28  fatal),  of  tibia  in  26  cases  (20  recoveries,  6  fatal),  of  fibula  in  17  cases  (14  recoveries,  3  fatal).  ^CHENU  (J.  C.) 
(Rapport  Medico  Cliirurgical  sur  la  Campagne  d' Orient,  Paris,  1865,  p.  417);  496  cases  (364  recoveries,  132  fatal).  ^CllENU  (J.  C.)  (Stat.  Meil.-Chir.  de 
la  Campagne  d'ltalie  en  1859  et  I860,  Paris,  1869,  T.  II,  p.  781),  410  cases :  Fractures  of  tibia,  109  (101  recoveries,  8  fatal);  of  fibula,  64  (62  recoveries,  2 
fatal);  bone  not  specified,  237  (184  recoveries.  53  fatal).  ^DEMME  (II.)  (Militar-Chirurgische  Studien,  WUrzburg,  1861,  Zweite  Abth.,  p.  278);  98  cases 
(77  recoveries,  21  fatal).  38MOUAT  (The  New  Zealand  War  of  1863-64-65,  in  Stat.  San.  and  Sled.  Reports,  Vol.  VII  for  the  year  1865,  London,  1867, 
p.  503);  3  recoveries.  39LUECKE  (A.)  (Kriegsclrirurgische  Aphorismen  aus  dem  zweiten  Schleswig-holsteinischen  Kriege  im  Jalire  1864,  in  Arcliiv  fur 
Klin.  Chir..  Berlin,  1806,  B.  VII,  pp.  50,  et  seq.);  5  recoveries:  Tibia  and  fibula  fractured  in  1  case,  tibia  in  3,  fibula  in  1.  «« HEINE  (C.)  (Dit  Schussver- 
letzungen  der  unteren  Extremitdten,  Berlin,  1866,  p.  294,  et  seq.);  14  recoveries:  Fracture  of  both  bones  in  4,  of  the  tibia  in  5,  of  the  fibula  in  5. 
41  OCHWADT  (A.)  (Kriegschirurgische  Erfahrungen,  Berlin,  1865,  p.  314);  12  recoveries.  42  BlNTOT  (  Observations  de  blessures  de  guerre,  in  Rec.  de  Mem. 
de  Med.  de  Chir.  de  Phar.  Mil.,  Paris,  1866,  T.  XVI,  III  s6r.,  p.  240);  1  fracture  of  fibula;  recovery.  43BECK  (B.)  (Kriegschirurgische  Erfahrungen 
wahrend  de.s  Feldzuges  18G6,  Freiburg  I.  Br.  1807,  pp.  308,  et  seq.);  4  cases:  Fracture  of  both  bones  1  recovery,  of  tibia  2  recoveries,  1  fatal.  "BlEFEL 
(R.)  (1m  Resen-e-Lazareth,  in  Archiv  fur  Klin.  Chir.,  Berlin,  1869,  pp.  461,  et  seq.);  25  cases:  Fractures  of  both  bones  in  11  (8  recoveries,  3  fatal),  of 
tibia  in  14  (13  recoveries,  1  fatal).  **  FISCHER  (K.)  (MililairUrztliche  Skizzen  ems  Suddeutschland  und  Bdhmen,  Aarau,  1867,  p.  96):  170  cases  (122 
recoveries,  14  fatal,  34  unknown  results).  46MAA8  (H.)  (Kriegschirurgische  lieitriige  aus  dem  Jahre  1866,  Breslau.  1870,  pp.  54,  et  seq.);  23  cases:  Frac 
tures  not  specified,  14  cases  (11  recoveries,  3  fatal);  of  tibia.  4  recoveries:  of  fibula,  5  cases  (4  recoveries,  1  fatal).  47STUOMEYER  .!..)  (Erfahrungen 
uber  Schusswunden  im  Jalire  1866,  Hannover,  J867.  p. 59):  74  cases  (60  recoveries,  14  fat:il).  «O'ns  (G.  A.)  (Circular  No.  3,  War  Department.  S.  G.  O., 
1871,  pp.  80-82);  7  recoveries:  Fractures  of  tibia  and  fibula,  1  case;  of  tibia,  5  cases;  of  fibula,  I  case.  ^BECK  (B.)  (Chirurgie  der  Scfiussrerletzungen, 
Freiburg,  i.  Br.  1872,  p.  717);  102  cases  (85  recoveries,  17  deaths).  BILLROTH  (T.)  (Chirurgische  Brief t  aus  den  Kriegs-Lazartthen  in  Weissenburg  und 
Mannheim  1870,  Berlin,  1872,  pp.  234,  et  seq.);  12  cases:  Fractures  of  both  bones  in  8  cases  (7  recoveries,  1  fatal),  of  the  tibia  in  4  cases  (3  recoveries,  1 


566  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

of  the  cases  treated  conservatively,  it  must  be  admitted,  with  Guthrie,1  that  the  results 
ought  to  have  been  more  successful.  The  reports  of  the  Pension  Examiners  regarding  the 
conditions  of  the  preserved  limb,  even  at  the  present  time  (1881),  are  replete  with  accounts 
of  extensive  caries  and  necrosis  with  continued  discharge,  enlargement  of  the  limb,  irritable 
ulcers,  overlapping  with  projection  of  fractured  ends,  outward  or  in\vard  curvature,  anchy 
losis  of  the  knee  or  ankle  or  of  both,  contraction  of  the  toes,  outward  turning  of  the  foot 
giving  the  ankle  the  appearance  of  being  dislocated,  extensive  and  adherent  cicatrices, 
atrophy  and  weakness,  and  inability  to  sustain  the  Aveight  of  the  body.2  Pseudarthrosis 
was  noted  only  in  seven  of  the  three  thousand  two  hundred  and  ninety-six  survivors  of 
shot  fractures  of  the  bones  of  the  leg  treated  without  operative  interference. 

The  difficulties  in  prescribing  rules  for  the  proper  mode  of  treating  shot  fractures  of 
the  bones  of  the  leg  seem  to  have  been  recognized  by  writers  on  military  surgery,  some 
advocating  immediate  operation  with  many  restrictions  in  favor  of  conservative  treatment; 
others  inclining  to  conservatism,  but  citing  many  exceptions  in  which  they  consider  imme- 

fatal).  CZEKNY  (V.)  (Bericht  iiber  die  im  College  Stanislaus  in  Weissenburg  behandeUen  VrnmindKtr.n,  in  Wiener  Med.  Wochenschrift,  1870,  p.  1357); 
3  cases:  Fractures  of  both  hones,  1  recovery ;  of  tibia,  1  recovery ;  ]  result  unknown.  KIKCIIKR  ((..)  (Dorf  Floing  und  ScJiloss  I'emailles,  in  Deutsche 
Zeitschrift  fur  Chirurgie,  Leipzig,  1872,  B.  I,  p.  250);  61  cases:  Fractures  of  both  bones  in  42  cases  (28  recoveries,  14  deaths),  of  tibia  in  JO  cases  (9 
recoveries,  1  death),  of  fibula  in  2  cases  (recoveries);  in  7  cases  with  unkno-.vn  results  the  bone  fractured  was  not  specified.  FISCHER  (H.)  (Kriegschirur- 
giache  Erfahrungen,  Krlangen,  1872,  p.  198);  33  cases  (28  recoveries,  5  fatal).  GOI.TDAMMKR  (Bericht  iiber  die  ThatigJcr.it  des  Reserve- Lazaretts  des 
Berliner  Hilfsvereins  in  der  Garde-Ulanen-Kaserne  -«  Moabit,  in  Berliner  Klin.  Wochenschrift,  1871,  V11I  Jahrg.,  p.  151);  14  cases  (recoveries).  GKAF 
(E.)  (Die  Koniglichen  Reserve-Lazarethe  zu  Diisxeldorf  n>i'ihrend  des  Krieges  1870-71,  Elberfeld,  1872,  p.  71);  20  cases  ( 1 5  recoveries,  5  fatal).  GUTK- 
KUKST  (Bericht  iiber  die  wahrend  de,s  vorigen  Jahrs  in  den  Vertinsspital  Ludwigsburg  ( Kinder heilanstalt)  avfgenommenen  Schussverletzunyen  und 
ihre  Behandliuig,  in  Zeitschrift  fiir  Wundarzte  und  Gfburtshelfrr,  StuMgart,  1871,  p.  14">);  1  fracture  of  tibia;  recovery.  KlHCHNER  (C.)  (Aerztlichr.r 
Bericht  iiber  das  Kortiglich  Preussische  Feld-Lazareth,  u.  s.  w.,  Erlnngen,  1872,  pp.  ti7.  68);  82  cases  (74  recoveries,  8  fatal).  KOCH  (\V.)  (Notizen  i'.ber 
Schussverletzungen,  nach  figenen  im  Feldzuge  1870-71  gemachten  Krfahrv.nge.ii,  in  Arch  ir  fiir  Klin,  f'hir.,  Tierlin,  1872,  p.  520);  20  cases  (19  recoveries, 
1  fatal).  KUECHLEK  (H.)  (Analecten  aus  der  Kriegsgeschichte,  in  Memorabilien,  Heilbronn,  1871,  Jahrg.  XVI,  p.  164);  1  fracture  of  tibia;  recovery. 
LOSSEN  (H.)  (Kriegschirurgisclie  Erfahrungen  aus  den  Barackeiilazarethen  :ti,  Mannheim.  Heiilelberg  und  Karlsruhe  1870  und  1871,  in  Dtutschr.  Zeil- 
schrift  fiir  Chirurgie,  Leipzig,  1873.  B.  II,  pp.  138,  et  seq.);  14  cases  (recoveries):  6  fractures  of  fibula,  8  bone  not  specified.  MAYKlt  (L.)  (Kriegschi 
rurgische  Mittheilungen  aus  den  Jahren  1870-71,  in  Deutsche  Zeitschrift  fiir  Chirurgie,  Leipzig,  18*3,  B.  Ill,  pp.  50,  52);  9  cases:  Fractures  of  both 
bones  in  5  cases  (recoveries),  of  the  tibia  in  2  cases  (1  recovery.  1  fatal),  of  the  fibula  in  2  cases  (1  recovery,  1  fatal).  MOSETIG  (Erinnerungen  aus 
dem  deutsch-franzbsischen  Kriege,  in  Der  Militaerarzt,  with  Wiener  Med.  Wochenschrift,  1872,  pp.  11,  22);  8  cases  (7  recoveries,  1  fatal).  Oil  (E.). 
OESTEULEN  und  ROMBERG  (Kriegschirurgische  Mittheitungen  nux  dem  J.udwigsburger  Rpsr.n-r.-Spital,  Stuttgart,  1871,  pp.  45,  47);  10  cases  (9  recov 
eries,  1  fatal).  RUPPRECHT  (L.)  (Militararztliche  Erfahrungen,  u.  s.  \v.,  WUrzburg,  1871,  p.  10);  13  cases:  Fractures  of  both  bones  in  9  cases  (6  recov 
eries,  3  fatal),  of  tibia  in  2  (1  recovery,  1  fatal),  of  fibula  in  2  (1  recovery,  I  fatal,.  SALZMANN  (Mittheilungen  aus  dem  Vereinsspital  in  Esslingen,  in 
Med.  Correspondenz-Blatt  des  Wiirtte.mbergischen  iirztUchen  Vereins,  1871,  B.  XLI,  p.  161);  6  recoveries:  Fractures  of  both  bones  in  3  cases,  of  tibia  in 
1,  of  fibula  in  2.  SCHINZINGER  (A.)  (Das  Reserve- Lazareth  Schwetzingen  im  Kriege  1870  und  1871,  Freiburg,  i,  Br.,  1873,  pp.  81,  et  seq.);  46  cases  (41 
recoveries,  5  fatal).  SCflOLLER  (M.)  (Kriegschirurgisclie  Skizzen  aus  dem,  deutsch-franzosischen  Kriege  1870-71,  p.  16);  1  recovery.  SEEGKH  (W.)  (Die 
Leistungen  der  Vereinsspilaler  Kleinkinderschule  und  Diakonenhaus  in  Ludwigsburg  im  Jahr  1870-71,  in  Ze.it.  fiir  Wundarzte,  und  GeburtsheJfer,  Stutt 
gart,  1870,  B.  XXIV,  pp.  113,  et  seq.);  3  cases:  Fracture  of  both  bones  (1  recovery),  of  tibia  (1  recovery,  1  fatal).  SOC1X  (A.)  (Kriegschirurgische. 
Erfahrungen,  Leipzig,  1872,  pp.  140,  et  seq.);  33  cases:  Fractures  of  both  bones  in  9  (recoveries),  of  tibia  in  14  (11  recoveries,  3  fatal),  of  fibula  in  10  (8 
recoveries,  2  fatal).  STEINBERG  (Die  Kriegslazarethe  und  Baracken  von  Berlin,  Berlin,  1872,  p.  147);  520  cases:  Fractures  of  both  bones  in  164  (128 
recoveries,  16  fatal,  20  unknown  results),  of  tibia  in  307  (255  recoveries,  18  fatal,  34  unknown  results),  of  fibula  in  49  (41  recoveries,  2  fatal,  6  unde 
termined  results).  STOLL  (Bericht  aus  dem  Koniglich.  Wiirttembergischen  4  Feldspital  von  1870-71,  in  Deutsche  Militairarztliche  Zeitschrift,  1874,  3. 
Jahrg.  p.  208);  13  cases  (9  recoveries,  4  fatal).  STUMPF  (L.)  (Bericht  iiber  das  Kriegs-Spital  des  St.  Georg- Kilter- Ordens  zu  Neubergliausen  im  Jalire 
1870-71,  in  AerMiches  Jntelligenz-Blatt,  Munchen,  1872,  No.  50,  p.  657);  5  cases  (4  recoveries,  1  fatal).  MCHIPAUI,T  (A.)  (Fractures  par  armes  a  feu, 
Paris,  1872,  pp.  7,  et  seq.);  17  cases :  Fractures  of  both  bones  in  5  cases  (3  recoveries,  2  fatal),  of  tibia  in  5  cases  (recoveries),  of  fibula  in  5  cases  (4  recov 
eries,  1  fatal),  bone  not  specified  in  2  cases  (recoveries).  CHRISTIAN  (J.)  (Relation  sur  les plaies  de  guerre  observees  &  I'ambulancedeBischwiller,  1870-71, 
in  Gaz.  Med.  de  Strasbourg,  1872,  No.  24,  p.  281);  39  cases  (33  recoveries,  6  fatal).  COUSIN  (A.)  (Histoire  chirurgicale  de  I'ambulance  de  I'ecole  des  ponts 
et  chaussies,  in  L'Union  Medicate,  1872,  T.  XIII,  p.  114);  11  cases  (3  recoveries,  8  fatal).  DESPRKS  (A.)  (Rapport  sur  les  travaux  de  la  7«  ambulance  a 
Varmee  du  Rhin,  etc.,  Paris,  1871,  pp.  46,  et  seq.);  46  cases  (£8  recoveries,  17  fatal,  1  unknown  result).  FELTZ  ET  GROLLEMUNU  (Relation  clinique  sur 
les  ambulances  de  Ilaguenau,  in  Gaz.  Med.  de  Strasbourg,  1871,  p.  202);  5  cases:  Fractures  of  both  bones  in  2  (recoveries),  of  tibia  in  3  (1  recovery,  1  fatal, 
1  result  unknown).  HEYFELDER  (O.)  (Bericht  iiber  meine  Wirksamkeit  am  Rhein  und  in  Frankreich  wahrend  des  deutsch-franzosischen  Krieges,  in  «. 
Petersburger  Medicinische  Zeitschrift,  1871,  B.  II,  N.  S.,  p.  59);  1  fracture  of  tibia;  recovery.  JOESSKI,  (Ambulances  de  Haguenau,  in  Gaz.  M  d.  de 
Strasbourg,  1871,  No.  2,  p.  21);  10  cases  (9  recoveries,  I  fatal).  MACCOKMAC  (W.)  (Notes  and  Recollections  of  an  Ambulance  Surgeon,  London,  1871, 
p.  118);  43  cases  (29  recoveries,  14  fatal).  PAXAS  (F.)  (Mcmoire  sur  le  traitement  des  blessures  de  guerre  par  la  methode  antiphlogistique,  in  Gaz.  JJebd. 
de  Med.  et  de  Chir.,  1872,  T.  IX,  p.  390):  3  cases  (1  recovery,  2  fatal).  POXCET  (F.)  (Contribution  a  la  Relation  medicale  de  la  guerre  de  1870-71,  in 
Montpellier  Medical,  1872,  T.  XXVIII,  p.  41);  3  cases  (1  recovery,  2  fatal).  VASUX  (L.)  Etude  sur  les  plaies  par  armes  a.  feu,  Paris,  1872,  pp.  136, 
etseq.);  8  cases:  Fractures  of  both  bones  in  1  (recovery),  of  tibia  in  5  (2  recoveries,  3  fatal),  of  fibula  in  2  (fatal).  B1  TILING  (G.)  (Bericht  iiber  124  im 
Serbisch-turkischen Kriege  im  Baracken-Lazareth  des  Dorpater  Sanitdts-Trainszu  Swilainatzbehandelte  Srhussverletzungeii,  Dorpnt,  1877,  pp.  63,  et  seq.); 
12  cases  (9  recoveries,  3  fatal). 

1  GUTHRIE  (G.  J.)  ( Commentaries  on  the  Surgery  of  the  War,  etc.,  London,  1855,  p.  647):  "  The  treatment  of  gun-shot  fractures  of  the  leg  ought  to 
have  been  more  successful  than  it  has  been,  even  when  both  bones  were  broken  ;  the  want  of  success  may  be  in  part  attributed  to  the  remissness  which 
has  taken  place  in  supplying  the  necessary,  nay,  the  essential  appliances,  by  means  of  which  much  suffering  might  have  been  alleviated,  perhaps  pre 
vented,  even  if  cures  could  not  have  been  effected." 

2BEUTHOLD  (Statistik  der  durch  den  Feldzug  1870-71,  invalid*,  gewordenen  Mannachaften  des  10  Armee-Corps,  in  Deutsche  Militairdrztliche 
Zeitschrift,  1872,  Jahrg.  1,  p.  505)  notices  the  frequency  of  anchylosis  of  the  knee  or  ankle  joints  in  fractures  of  the  upper  and  lower  thirds  of  the  tibia, 
and  on  page  569  remarks,  of  the  cures  of  fractures  in  both  bones,  that  "the  results  were,  in  genera!  very  unfavorable,  and  a  higher  average  of  disability 
shows  itself  than  in  fractures  of  'he  femui  " 


SECT,  v.l  SHOT    FRACTURES    OF    THE    BONES    OF    THE    LEG.  567 

diate  amputation  indispensable.  Thomson,  after  the  battle  of  Waterloo  in  1815,  gives  four 
classes1  of  injuries  of  the  leg  in  which  he  considers  amputation  proper;  but  adds  that  "it 
may  be  doubted  whether  the  practice  of  immediate  amputation  would  be  proper  or  neces 
sary  in  all  these  cases,  could  the  wounded  be  conveyed  directly  into  convenient  hospitals." 
Jobert  de  Lamballe  declares  conservative  treatment  and  excision  alike  ineffective  in  oblique 
fractures  of  both  bones  of  the  leg  in  the  lower  third.2  Beck,  after  the  European  revolutions 
in  1848,3  and  Schwartz  after  the  Schleswig-Holstein  War,  1848-50,4  advised  conservative 
measures  in  transverse  or  slightly  oblique  fractures  of  the  tibia  only,  but  counselled  the 
removal  of  the  limb  in  fractures  of  both  bones;  but  after  his  experience  in  the  Franco- 
German  War,  1870-71,  Generalarzt  Beck  greatly  restricted  the  number  of  cases  in  which 
he  considered  amputation  justifiable.5  The  conservative  views  of  Guthrie  regarding  shot 
fractures  of  the  leg  have  already  been  adverted  to  on  page  460,  ante.  Demme6  asserts 
that  Guthrie  has  "too  far  extended  the  limits  of  conservative  treatment."  Stromeyer,7 
SeMillot,8  Legouest,9  and  Hamilton10  agree  that  in  extensive  comminution  of  the  tibia,  or  of 
both  bones  of  the  leg,  especially  near  the  knee  or  ankle  joints,  it  is  prudent  to  amputate. 
Gross11  declares  that  in  shot  fractures  of  both  bones,  "unless  the  patient  is  peculiarly  fortu- 

1  THOMSON  (J.)  (Report  of  Observations  in  the  British  Military  Hospitals  in  Belgium,  after  the  Battle  of  Waterloo,  Edinburgh,  1816,  p.  240): 
"  1st,  In  cases  in  which  both  bones  of  the  leg  have  been  broken  ;  2d,  in  eases  in  which  the  bullets  h:ive  passed  through  the  ends  of  the  tibia  and  have 
fractured  this  bone  near  to  the  knee  or  ankle  joints;  3d,  in  cases  in  which  a  bullet  is  lodged  deep  in  the  tibia;  and  4thly,  in  fractures  of  the  tibia,  with 
wounds  of  the  arteries  in  the  leg." 

2  JOHERT  (UE  LAMHALLK)  (Plaies  d'armes  a  feu,  Paris,  1833,  p.  288):  "  Toutes  les  fois  qu'une  fracture  oblique  a  eu  lieu,  vers  la  region  inferieure 
du  inembre,  chez  un  homme  dont  les  forces  musculaires  sont,  puissantes,  malgre  1'appareil  le  plus  convenable,  malgr6  la  demi-flcxion,  malgr6  la  resection 
dcs  deux  extremites  de  1'os,  pratiqu6e  dans  le  but  de  ne  pas  laisser  les  parties  raolles  irritees  par  leurs  asperites,  toujours,  ou  presque  toujours,  la  mort  est 
survenue  aprds  une  serie  de  symptomes  formidables,  d'inflammation,  de  suppuration,  d'erysipele  et  de  gangrene,  et  dans  quelques  chances  que  1'on  a 
appelees  heureuses,  les  tnalades  ne  se  sont  sauv6s  qu  'apre^s  avoir  et6  cent  fois  au  bord  de  la  tombe,  et  en  conservant  un  meiabre  dfeforme." 

3 BECK  (B.)  (Die  Schusswunden,  Heidelberg,  1850,  p.  263):  "Is  the  tibia  fractured,  and  is  there  only  a  transverse  or  slightly  oblique  fracture,  the 
injury  is  to  be  treated  as  a  simple  one ;  but  when  there. is  great  splintering,  or  when  the  fracture  is  considerable,  or  the  bone  injured  in  several  parts,  or 
when  the  soft  parts  are  much  implicated,  amputation  must  be  performed;  when  both  bones  are  fractured  the  wound  generally  is  a  serious  one,  the  frac 
ture  is  more  comminuted,  and  the  limb  must  be  removed;  simple  fractures  only  give  promise  of  complete  recovery  ef  the  extremity." 

4  SCHWARTZ  (H.)  (Beitrdge  zur  Lehre  von  den  Schusswunden,  Schleswig,  1854,  p.  184):  "Extensive  comminuted  fractures  in  the  upper  or  lower 
thirds  of  the  tibia  always  require  primary  amputation.  .  .  Is  the  fracture  in  the  middle  third,  as  a  rule  primary  amputation  is  also  to  be  performed: 
very  favorable  circumstances  only,  as  good  constitution  of  the  patient,  easy  transportation,  excellent  hospital  accommodations,  large  and  free  wounds  of 
the  soft  parts,  defined  limits  of  comminution,  etc.,  can  justify  the  attempt  at  conservation;"  and  on  p.  186:  "Fractures  of  both  bones,  with  extensive 
comminution  of  both  bones  or  of  the  tibia  alone,  require  primary  amputation.  .  .  Isolated  cases  of  this  class,  it  is  true,  have  been  treated ;  yet  such 
attempts  will  only  succeed  in  a  few  instances,  and  will,  in  the  majority  of  cases,  result  in  death,  and  even  in  cases  of  recovery,  imperfectly  useful  limbs 
will  be  obtained." 

5 BECK  (B.)  (Chirurgie  der  Schussverletzungen,  Freiburg  i.  Br.,  1872,  p.  718):  "Since  the  location  of  the  bones,  particularly  the  tibia,  is  a  very 
superficial  one,  since  all  changes  can  easily  be  recognized  and  operated  for,  since  phlegmon  and  abscesses  are  accessible  to  observation  and  to  the  knife 
from  the  first  moment,  and  since  no  particular  obstacles  are  to  be  met  with  in  the  extraction  of  splinters  and  dead  pieces  of  bone, — there  is  a  large  and 
fruitful  field  opened  to  the  expectant  conservative  treatment  of  shot  fractures  of  this  limb." 

SDKMMK  (II.)  (Militir-Chirurgische  Studien,  Wilrzburg,  1861,  Abth.  II,  p.  275):  "GUTHRIE  has  too  far  extended  the  limits  of  conservative 
treatment.  The  experiences  of  the  last  wars  have  only  too  frequently  led  to  the  conviction  that  by  sacrificing  the  limb  at  the  proper  time,  life  may  be 
saved.  Here  also  holds  good  the  general  rule  according  to  which  especially  the  comminutions  and  the  extensive  lacerations  of  the  soft  parts  indicate 
primary  amputation.  The  laceration  of  the  principal  blood  vessels  of  the  leg  come  next." 

7  STROMEYEU  (L.)  (Maximen  der  Kriegsheilkunst,  Hannover,  1855,  p.  S87):  "8.  Tibia  and  fibula  are  fractured  by  a  ball,  with  extensive  splinter 
ing.     Under  favorable  circumstances  the  leg  may  here  be  preserved.     For  example,  if  only  one  of  the  bones  was  struck  by  the  ball  and  the  other  was 
broken  by  the  weight  of  the  body  in  falling,  or  when  the  fissuring  is  limited.    9.  The  tibia  alone  is  splintered  to  a  large  extent.     Here  also  the  preserva 
tion  of  the  leg  is  possible,  but  not  probable;"  and  at  p.  742:  "Shot  injuries  of  the  fibula  alone,  however  extensive,  never  indicate  amputation,  providing 
the  tibio-tarsal  joint  is  not  implicated.     .     .     Extensive  comminutions  of  the  tibia  alone,  and  of  the  tibia  and  fibula  together,  do  not  per  se  necessitate 
amputation,  as  they  do  not  destroy  the  vitality  of  the  limb.     Experience,  however,  teaches  that  in  the  attempt  to  save  the  limb,  very  readily  the  life  of 
the  patient  is  lost,  especially  through  pyaemia,  and  that  in  cases  in  which  the  limb  was  preserved  it  was  of  less  use  than  a  wooden  leg." 

8  SEliIU.OT  (Du  traitement  des  fractures  dcs  membra  par  armes  de  guerre,  in  Archiv  Gen.  de  Mid.,  I'uris,  1871,  T.  XVII,  VI"  ser.,  p.  451):  "L'am- 
putation  immediate  parait,  indiquee  lorsque  les  deux  os  sont  brises  pres  du  genou  en  fragments  volumineaux,  avec  ou  sans  complication  d'h£morrhagie 
et  de  paralysie,  circonstances  qui  ajoutent  encore  a  la  necessity  de  1'operation.     .     .     Les  fractuies  completes  des  deux  os  de  la  jambe  au  tiers  moyen  et 
au  tiers  infSrieur  guorissont  sans  doute,  mais  se  consolident  diffk-ilement  et  apr£s  beaucoup  d'accidents.     II  semble  done  prudent  quand  les  6clats  osseux 
sont  considerables,  les  pertes  de  substance  eternities,  les  parties  molles  violemment  dechirees  e  contuses,  de  se  decider  u  1'amputation,  soil  nu  tiers  supC-- 
rieur  soit  jusque  clans  les  condyles  du  tibia,  operation  moins  sure,  pensons-nous.  qu'au  lieu  dV lection,  mais  infiniment  preferable  au  sacrifice  de  la  cuisse." 

9 LEGOUEST  (L.)  (Traite  de  Chirurgie  d'Armee,  Paris,  1872,  2d  ed.,  p.  531):  "Les  amputations  sont  tres-souvent  indiquees  dans  les  blessures  de  la 
jambe:  clles  sont  indispensables  lorsque  les  deux  os  de  la  jambe  sont  fractures  dans  une  grande  Stendue ;  lorsque  le  tibia  seul  est  fracture^  avec  6clats 
\-olumineux  ex  perte  de  substance  osseuse  considerable." 

"•HAMILTON  (F.  II.)  (A  Practical  Treatise  on  Fractures  and  Dislocations,  Philadelphia,  5th  ed.,  187;>,  p.  512):  "Gunshot  fractures  of  the  shafts  of 
both  tibia  and  fibula  demand  amputation  where  the  comminution  is  extensive,  or  the  pulsation  of  the  posterior  tibial  artery  is  lost,  or  the  foot  is  cold  and 
insensible.  We  do  not  mean  to  say  that  some  limbs  thus  situated  have  not  been  saved,  but  only  that  the  attempt  to  save  such  limbs  greatly  endangers  the 
life  of  the  patient,  while  amputation  at  or  below  the  knee  is  relatively  sale." 

"GROSS  (S.  D.)  (A  System  of  Surgery,  Philadelphia,  1872,  5th  ed..  Vol.  11.  p.  1012):  •'Gunshot  fractures  of  both  bones  of  the  leg  are  also,  gen 
erally  speaking,  bad  accidents  ;  great  swelling  followed  by  diffuse  abscess  usually  rapidly  sets  in  and  unless  the  patient  is  peculiarly  fortunate  he  will 


568 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


nate  he  will  be  very  apt  to  sink  under  the  effects  of  erysipelas,  p}78emia,  osteomyelitis,  or 
hectic  irritation;"  while  Heine1  and  Ochwadt2  contend  that  by  proper  conservative  treat 
ment  happy  results  may  be  achieved  in  many  of  these  cases. 

In  conservative  treatment  of  cases  of  shot  fracture  of  one  or  of  both  bones  of  the  leg 
all  loose  spiculse  were  removed,  the  fractured  ends  coaptated,  and  the  leg  placed  in  an  easy 

position  or  secured  in  a  fracture  box  or  in 
splints.  Among  the  latter,  many  of  the  appli 
ances  referred  to  on  pp.  343—349,  ante,  as  used 
in  fractures  of  the  femur,  were  also  employed 
in  fractures  of  the  leg;  but  Smith's  anterior 
splint  and  Hodgen's  cradle  splint  seem  to 
have  been  largely  preferred  to  all  others.  Of 
the  fracture  boxes,  that  of  Petit3  (FiG.  326), 

FIG.  asti.—pBTiT'B  fracture  box.  [After  PETIT.]  so  highly  recommended  by  the  practical  Heis- 

ter,4  and  later  by  Stromeyer5  and  Esmarch,6  was  extensively  used.  In  the  register  of  the 
Nineteenth  Army  Corps  Depot  Field  Hospital  at  Winchester,  under  the  charge  of  Surgeon 
L.  P.  Wagner,  114th  New  York  Volunteers,  is  found  a  drawing  of  a  fracture  box  used  at 

that  hospital,  a  copy  of  which  is  shown  in 
the  annexed  wood-cut  (FiG.  327).  The  bot 
tom  of  the  box  was  filled  with  earth,  and  the 
heel  was  kept  somewhat  raised  by  strips  of 
adhesive  plaster  (a  a)  fastened  around  the 
foot  and  over  the  foot  board,  as  indicated  in 
the  drawing.  Extension  and  counter-exten 
sion  were  rarely  applied.  Generally  shot  frac 
tures  of  the  tibia  or  of  both  bones  healed  very 
slowly.  Of  the  nineteen  examples  cited  on 
a  pen-sketch.]  pp_  433  ^0  444^  fae  wounds  did  not  close  in 

two  until  fifteen,  and  in  one  until  twelve,  years  after  the  injury.  In  a  fourth  case  (CASE  690, 
p.  439,  ante)  a  large  sequestrum  was  removed  eight  months  after  the  injury;  the  wound 
closed  but  broke  out  again,  and  the  discharge  of  pus  continued  for  eleven  years,  and  when 
the  wound  finally  closed  the  patient's  health  declined  rapidly  and  he  died  in  about  six 
months.  It  should  be  added  that  in  two  of  these  four  cases  (CASES  680  of  Colonel  W.  F. 
Lynch  and  692  of  Major  A.  J.  Bolar)  the  missile  or  a  portion  thereof  had  never  been 
removed  from  the  leg.  The  remaining  fifteen  patients  recovered— one  in  one  month,  three 
in  three  months,  one  in  five  months,  one  in  six,  one  in  eight,  two  in  ten,  three  in  twelve, 
one  in  eighteen,  and  two  in  twenty-four  months,  or  at  an  average,  in  about  ten  months.7 

be  very  apt  to  sink  under  the  effects  of  erysipelas,  pyaemia,  osteomyelitis,  or  hectic  irritation,  not  to  say  anything  of  the  danger  of  mortification,  which  is 
often  very  great,  especially  when  the  bones  are  comminuted  at  the  same  time  that  severe  injury  has  been  sustained  by  the  soft  parts.  Gunshot  fracture 
of  the  fibula  alone  is  usually  much  less  serious  than  similar  injury  of  the  tibia." 

1  HEINE  (C.).  Die,  ftcliussverletzuiigi'.n  tier  unteren  Extremitiiten,  Berlin,  18fifi,  p.  300. 

8  OCHWADT  (A.),  Krie.gschintrgische.  Krfahrungr.n,  Berlin,  186'5,  p.  312. 

3  PETIT  (JEAN  Lotus),  Traite  des  maladies  des  os,  Paris,  1736,  T.  II,  p.  271).     The  box  is  figured  on  p.  285. 

4HEISTEU  (D.  lj.)  Institntiontis  Chimrgicx  in  quibus  qin'ctjniil  ad  rem  cltirurgicam  pertinet,  etc.,  Ainstelapdami,  1739,  T.  I,  p.  21. r).  and  Table  IX. 

6S'I'KOMEYER  (L.)  Krfahrungen  uber  Sclntsswunde.n  im  Jalire  1866,  Hannover,  1867,  p.  50. 

*E8MAUCH  (FKIKDKICH),  Handbuch  der  Kritgschirurgischm  Teclinik,  Hannover,  1877,  p.  88. 

7  Surgeon-Major  GAUJOT,  in  his  report  from  the  hospitals  at  Montcnlnaro  (J.-C.  ClIENU,  Stat.  Mid.-  Chir.  de  la  Camp,  d'ltalie  en  1859  et  1860,  Paris, 
1869,  T.  II.  p.  778),  states  that  according  to  his  experience  comminuted  fractures  of  the  leg  heal  slower  than  those  of  the  thigh  :  "  II  est  a  remarqurr  quo, 
lors  de  notre  depart,  les  fractures  de  la  jambe  ctaient  beaucoup  moins  avaneees  vers  la  gugrison  quo  celles  de  la  cuisse.  Dans  aucun  cas  'il  n'y  avail 
encore  trace  de  formation  du  cal,  mais,  au  contraire,  une  suppuration  abondante,  des  fusses  purulentes  provoqufees  par  des  esquilles  nombreuses,  s'  61imi- 
nant  diflicilctnent.  Nous  n'ogons  avaneer  que  les  d6sordres  occasionnes  dans  les  cas  de  fracture  comminutive  de  la  jambe  par  coup  de  feu,  sont  plus 


FIG.  327. — Fracture  box  used  at  the  field  hospital  at  Winchester.     [From 


SHOT.  V.I  EXCISIONS    IN    THE    BONES    OF    TttE    LEG.  569 

Of  the  three  thousand  nine  hundred  and  thirty-eight  (3938)  patients  with  fracture  of 
the  bones  of  the  leg  treated  without  operative  interference,  three  thousand  four  hundred  and 
eighty-four  (3484)  were  Union  and  four  hundred  and  fifty-four  (454)  Confederate  soldiers. 
Of  the  former,  two  thousand  nine  hundred  and  fifty-six  (2956)  recovered,  four  hundred  and 
forty-six  (446)  died,  and  eighty-two  (82)  results  were  not  ascertained,  a  fatality  of  13.1  per 
cent.  Of  the  latter,  three  hundred  and  forty  (340)  recovered,  eighty-two  (82)  died,  and  in 
thirty-two  (32)  cases  the  results  remained  undetermined,  a  mortality  rate  of  19.4  per  cent. 
One  thousand  five  hundred  and  fifty-five  (1555)  injuries,  with  one  thousand  three  hundred 
and  thirty-five  (1335)  recoveries,  one  hundred  and  eighty-nine  (189)  deaths,  and  thirty-one 
(31)  undetermined  results,  were  on  the  right  side;  one  thousand  seven  hundred  and  seventy- 
two  (1772),  with  one  thousand  five  hundred  and  twenty-nine  (1529)  recoveries,  two  hun 
dred  and  nineteen  (219)  deaths,  and  twenty-four  (24)  unknown  results,  on  the  left  side;  in 
six  hundred  and  eleven  (611)  cases  the  side  was  not  indicated. 

Detached  splinters  and  fragments  of  bone  are  reported  to  have  been  removed  in  three 
hundred  and  forty-seven  instances  with  two  hundred  and  ninety-nine  recoveries,  forty-two 
deaths,  and  six  undetermined  results.  Of  the  grave  complications,  pyaemia  was  noted  in 
eighty-one  cases,  seventy-five  of  which  terminated  fatally;  two  cases  of  recovery  from 
tetanus,  and  twenty-two  fatal  cases  are  reported.  Of  seventy  cases  of  gangrene,  thirty  had 
fatal  results.  There  were  sixty-five  cases  of  secondary  haemorrhage;  twenty-four  of  the 
patients  recovered,  the  haemorrhage  having  been  controlled  in  twelve  instances  by  compres 
sion  and  styptics,  and  in  twelve  instances  by  ligation;  forty-one  of  the  patients  died, 
twenty-seven  after  treatment  by  compression,  and  fourteen  after  ligation.  The  femoral 
artery  was  ligated  in  five  cases  with  three  deaths,  the  posterior  tibial  in  nine  with  four 
deaths,  the  anterior  tibial  in  six  with  three  deaths,  the  popliteal  in  five  with  three  deaths, 
and  the  anterior  and  posterior  tibials  in  one  instance,  which  terminated  fatally.  In  nine 
cases  -the  bleeding  vessels  were  secured  jn  the  wound,  and  in  thirteen  at  a  distance  from 
the  injury.  Four  of  the  former  and  nine  of  tne  latter  ended  in  death. 

Excisions  in  the  Continuity  of  the  Bones  of  the  Leg. — An  examination  of  the  reported 
examples  of  excision  in  the  bones  of  the  leg,  whether  in  the  tibia  or  in  the  fibula,  or  in  both 
bones,  shows  conclusively  that  in  a  large  proportion  of  the  cases  the  operation  was  inju 
dicious.  Not  only  does  the  percentage  of  fatality  after  excision  exceed  that  of  the  cases 
treated  by  conservation,  but  the  remote  results  in  the  cases  of  recovery  in  the  former  were 
even  less  satisfactory  in  regard  to  usefulness  of  the  limb  than  those  in  the  latter.  The 
fatality  of  the  conservatively  treated  fractures  of  the  tibia  was  10.3,  of  the  fibula  9.7,  and 
of  both  bones  20.2  per  cent.,  while  that  of  the  corresponding  excisions  was  25.6,  27.2,  and 
61.1  per  cent.,  respectively.  Excisions  in  both  bones  were  rarely  performed,  only  eighteen 
cases  of  this  nature  being  reported,  and  the  large  mortality  (61.1  per  cent.)  following  this 
operation  would  seem  to  justify  its  banishment  from  military  surgery.1  The  excisions  per- 

difficiles  a  conjurer  que  ceux  que  pr6sentent  les  fractures  de  la  cuisse,  et  cependant  cette  remarque  ressort  des  faits  observes  par  nous.  Le  tibia  est 
souvent  fendu  en  6cUits  dans  une  grande  partie  de  sa  longueur ;  ses  esquilles  se  d^tachent  lentement ;  son  tissu  spongieux  et  le  canal  medullaire  suppurent 
aisfement  et  la  r6paration  est  extrernement  lente."  BILLROTH  (Tn.)  (Cliirurgische  Brief e  aus  den  Kricgs-Lazarethen  in  Weissenburg  und  Mannheim 
1870,  Berlin,  1872,  p.  272)  notes  the  tedious  process  of  separation  of  sequestra  in  shot  fractures  of  the  leg.  HANNOVER  (A.)  (Die  Danischen  Ini-aliden  aus 
dtm  Kriege  1864,  Berlin,  1870,  p.  27)  observes  that  "the  separation  of  necrosed  bone  frequently  was  of  long  duration  with  persistent  fistulae." 

1  STUOMKYKR  (L.)  (Maximen  der  Kriegsheilkunst,  Hannover,  1855,  p.  743)  remarks  of  the  fractures  of  the  bones  of  the  leg  that  "the  hopes  built 
upon  excision  in  the  continuity  were  found  delusive,  as  well  in  regard  to  preservation  of  life  as  in  regard  to  usefulness  of  the  limbs  preserved  by  excision." 
DEMMK  (H.)  (Aiilitar-Chirurgische  Studien,  Wtlrzburg,  1801,  B.  II,  p.  27G):  '•  Resection  of  the  diaphysis  of  both  bones  of  the  leg  was  performed  several 
times  in  Italy.  I  have  to  mention  four  cases  of  this  kind  in  the  hospitals  of  Brescia,  which  all  proved  fatal  from  continued  suppuration  and  pyaemia. 
The  subperiosteal  method  was  here  also  tried  by  LARGHl,  but,  for  the  reasons  already  stated,  had  no  better  results.  I  believe,  therefore,  that  I  must  join 
STROMEYER  and  the  majority  of  the  military  surgeons  in  condemning  the  operation."  PlTHA  (F.  R.  VON)  (Krankheiten  der  Extremitdten,  Erlangen, 
1868):  " For  resection  the  log  offers  an  unfavorable  field:  the  operation  is.  therefore,  seldom  and  with  great  reserve  performed.''  BECK  (B.)  (Cltirurgie 
SCIIG.  Ill— 7-2 


570 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


formed  in  the  tibia  exceeded  those  in  the  fibula,  the  former  being  one  hundred  and  eighty- 
five,  the  latter  one  hundred  and  eighty-two,  with  the  percentage  of  fatality  slightly  in  favor 
of  the  excisions  in  the  tibia.  The  results  of  this  operation  in  European  war  surgery  as 
exhibited  in  the  following  table  have  been  still  less  satisfactory;  of  one  hundred  and  fifty- 
two  cases,  one  hundred  and  six,  or  69.7  per  cent.,  had  fatal  terminations: 

TABLE  LXXXV. 

Results  of  Shot  Fractures  of  the  Bones  of  the  Leg  treated  by  Excision  on  the  Occasions  named  and  from 

the  Authorities  quoted. 


OCCASIONS. 

CASES. 

TIBIA. 

FIBULA. 

TIBU 
FIB 

i 

1 

i  AND 
LJLA. 

BONE  NOT 

SPECIFIED. 

"a 
15 

1 

K    '   a 

Mortality  of 
Det.  Cases. 

Recoveries. 

Deaths. 

1     « 

_4> 

"C 

5 

1 

M 

Deaths. 

Deaths. 

Recoveries. 

Deaths. 

Revolution  in  Lombardy,  1848  (BECK1)  

1 

i 

100.0 
53.  8 

1 
2 

Schleswig-Holstein  War,  1848-50  (EsMARCH,*  STROMEYER5)  
Campagnes  de  Kabylie,  1854  (BEUTHEUAXD4)  

13 

1 

6           7 

1  i 

3 

4 

1 
1 
1 

1            1 

Crimean  War,  1854-56  (MATTHEW,5  CHEXU6)  

2 

1 

Italian  War,  1859-60  (DEMMK,7  CHEXU8)  

16 
3 

4         12 
3 

75.  0 

. 

1 

1 
1 

4 

2 

7 

Danish  War,  1864  (LANGENl)ECK,9  LUCKK,10  HEINE11)  

o 

Austro-Prussian  War,  1866  (BECK,12  FiscilEU,13  BlEFEL14)  

4 

11 
97 

0 

3           1 
1           1 
8           3 

17         80 
1           1 

25.  0  '  '        3 

i 

1 

United  States  Army,  1865-70  (OTIS15)  

50.0 
27.2: 
82.4 
50.0 

13 

1 

Franco-German  War,  1870-71  (GERMANS16)  

3  ' 
63 

1 

4 
4 
1 

1 

Franco-German  War,  1870-71  (FltEXCH17)  

17 

Turko-Russian  War,  1876  (TILING,18  K'AUE19)  

i 

Aggregates  

152 

46       106 

69.  7         25 

i 

71 

1 

14 

20 

4 

8  ! 

3 

7 

der  Schtutverhtfimgm,  Freiburg,  i.  Br.,  1872,  p.  721):  "  To  saw  through  the  diaphysis  in  its  entire  thickness  before  the  necrosed  portion  has  yet  demar 
cated  and  separated  itself  completely,  I  cannot  approve  of,  because,  on  the  one  hand,  too  much  is  often  taken  away  unnecessarily,  thereby  giving  occasion 
to  too  great  a  loss  of  substance,  to  a  colossal  defect  in  the  bone,  and,  in  consequence  thereof,  to  pseudarthrosis ;  and,  on  the  other  hand,  infectious  processes 
with  fatal  results  are  readily  caused  by  again  laying  open  the  bony  cavity.  One  may,  therefore,  quietly  wait  until  sequestrotomy  can  be  performed 
under  more  favorable  circumstances." 

Kxcision  for  shot  fracture  in  the  continuity  of  the  bones  of  the  leg,  in  military  surgery,  does  not  seem  to  have  been  practised  before  1848.  In  that 
year  '  B.  BKCK  (Die  Schuss-Wunden,  Heidelberg,  1850,  p.  338)  excised  portions  of  both  tibiffl  and  a  portion  of  the  fibula  in  an  Austrian  soldier  of  the 
Kaiser  Franz  Josef  Regiment,  wounded  in  1848,  near  Vienna,  by  a  grape  shot.  The  missile  entered  the  right  and  passed  through  the  left  leg,  fracturing 
both  tibiae  just  below  the  knee.  Amputation  of  both  thighs  was  advised  but  not  allowed  by  the  patient.  A  few  days  later  the  fractured  ends  of  both 
tibise  were  excised,  and  splints  applied;  extensive  infiltration,  fever,  and  diarrhoea  followed,  and  the  patient  died  on  the  7th  day  after  the  injury.  2  F. 
ESMARCH  (Ueber  Resectione.n  nach  Schusswunden.  Kiel,  1851,  p.  28)  and  3L.  STUOMEYKR  (Maximen  de.r  Kriegsheilkunst,  Hannover,  1855,  p.  75(i)  tabulate 
13  cases  of  excision  in  the  shafts  of  the  bones  of  the  leg,  with  6  recoveries  and  7  deaths.  Portions  of  the  tibia  were  excised  in  7  (3  recoveries,  4  fatal),  of 
the  fibula  in  3  (2  recoveries,  1  fatal),  and  of  both  bones  in  3  (1  recovery,  2  fatal).  Detailed  accounts  of  several  of  these  cases  are  found  in  ROSS  (G.) 

(Militairarztliches  aus  dem  crsten  ScMesswigschen  Feldzuge  im  fSommer  1848,  Altona,  1850,  pp.  30.  53,  60,  61,  and  62):  Prussian  volunteer  J ,  fracture 

of  head  of  right  fibula  with  grazing  of  tibia,  Bilschau,  April  24,  1848;  resection  of  upper  end  of  fibula  by  ROSS;  pyaemia,  death.     Prussian  Captain  v. 

K ,  DUppel,  JuneS,  1848;  ball  penetrated  the  upper  third  of  right  tibia;  excision  of  a  triangular  piece  of  bone  by  ROSS ;  death  June  19,  1848,  of  pyaemia. 

J.  H.  K ,  Oldenburg  Infantry,  wounded  May  28,  1848;  comminution  of  left  fibula:  excision  of  3  inches  by  KUHN,  June  11 ;  recovery.     II.  G ,  31st 

Prussian  Infantry,  Dttppel,  June  5,  1848 ;  fracture  of  right  fibula ;  June  0,  excision  of  6  inches  by  LANGKXBECK ;  June  25,  ligation  of  the  crural  artery  ; 

recovery;  no  formation  of  new  bone;  limb  useless.     Captain  J.  C ,  Hochtrup,  June  7,  1848;  comminution  of  right  tibia;  June  8,  excision  of  several 

inches  of  tibia  by  LAXGEXBECK;   June  22,  ligation  of  femoral;    June  24,  amputation  of  leg;   death  June  24,  1848.     Lieutenant  II ,   Schlesswig- 

Holsteinischen  Dragoons,  fracture  of  both  bones  of  leg  June  12,  1848;  excision  of  over  3  inches  of  both  bones  by  LAXGENUECK.  June  14  ;  death  from 
tetanus  June  2-,',  1848.  In  another  instance  a  considerable  portion  of  the  upper  third  of  the  tibia  was  excised :  recovery  with  flexed  knee ;  leg  useless. 

*BERTHKRAXl>  (A.)  (Campagnes  de  Kabylie,  Paris,  1862,  p.  109):  C ,  llth  Infantry;  comminuted  fracture  of  right  fibula;  excision  of  sharp  points  of 

fibula;  recovery  in  less  than  6  weeks.  'MATTHEW  (T.  P.)  (Med.  and  Surg.  Hist.  of  the  British  Arm;/,  etc.,  in  the  years  1854-55-56,  London,  1858,  Vol. 
II,  p.  3G8)  tabulates  a  successful  case  of  excision  of  lower  end  of  fibula,  but  gives  no  details.  "ClIKXU  (J.  C.)  (Rapport,  etc.,  de.  la  Campagne  d' Orient, 
Paris,  1865,  p.  505):  Th.  Duval,  86th  line;  shot  fracture  of  left  leg  August  16,  1855;  resection  of  tibia;  recovery  with  flexion  of  leg  upon  the  thigh. 
'DEMMK  (II.)  (Mil.-Chir.  Studien,  WUrzburg,  1861,  B.  II,  p.  278)  tabulates  7  (2  successful  and  5  fatal)  cases:  in  4  of  the  fatal  cases  both  bones  were 
excised.  "ClIEXi:  (J.-C.)  («a<.  lUed.-Cliir.  de.  la  Camp,  d'ltalie  en  1859  et  1860,  Paris,  186!>,  T.  II,  p.  8JO),  8  cases  (1  recovery  and  7  fatal).  On  pp.  PIS),  820, 
he  gives  details  of  two  <;f  the  cases:  P.  Godin,  76th  line,  aged  24,  received  at  Solferino,  June  24,  18511,  a  shot  fracture  of  the  left  fibula  in  its  upper 
third.  He  was  taken  to  the  hospital  at  St.  Mandrier,  where,  on  October  14,  Dr.  BUISSOX  excised  the  upper  third  of  the  fibula;  osteomyelitis  supervened 
and  death  ensued  October  18.  J.  Camboulives,  74th  line,  shot  fracture  of  lower  third  of  left  leg,  Montebello,  May  20,  1859;  Tesection  of  5  centimetres  of 
the  fibula;  anchylosis  of  the  tibio-tarsal  articulation,  with  rigidity  of  the  toes.  CHEXU  further  relates  (loc.  cit.,  p.  819)  that  a  resection  of  both  bones  of 
the  leg  was  successfully  performed  at  Brescia  on  a  Garibahlian  volunteer  by  A.  BERTAN1,  chief  surgeon  of  Garibaldi's  corps.  9LAXGEX1!ECK  (1!.  v.) 
(Ueber  Resect  ion  dts  Fusxgehnki  be.  Sc.hussfracturtn  desselben,  in  Jierliner  Klin.  Wochenschrift,  1865,  Jahrgang  II,  p.  31):  Corporal  Reiss,  60th  Infantry, 
shot  fracture  of  middle  third  of  left  tibia  and  fibula,  April  18,  1864 ;  extensive  infiltration ;  subperiosteal  excision  of  4  inches  of  tibia  and  1  inch  of  fibula 
by  LAXGEXhECK.  Recovery  with  1|  inches  shortening.  The  deficiency  of  bone  has  been  supplied  by  a  voluminous  new  formation  of  bone  exceeding 
in  thickness  the  normal  size  of  the  tibia.  '"LOCKK  (A.)  (Kriegschirurgische  Aphorismen  aits  dem  ziveiten  ScMesfwig-holiUinsclien  Kriege  im  Jahrt 
1864,  in  Archiv  fur  Klin  Chir.,  Berlin,  1866,  B  VII,  p.  126)-  Heerde,  25th  Infantry,  shot  comminution  of  right  tibia  and  fracture  of  fibula,  1J  inches 


SECT.  V.J  EXCISIONS    IN    THE    BONES    OF    THE    LEG.  571 

The  amount  of  bone  excised  varied  from  one-half  inch  to  twelve  inches,1  and  in  one 
instance  the  entire  fibula,  with  the  exception  of  about  one  inch  of  the  external  malleolus, 
was  removed  (CASE  720,  page  457,  ante).  Forty-nine,  or  12.6  per  cent.,  of  the  three 
hundred  and  eighty-seven  excisions  in  the  bones  of  the  leg  were  subsequently  followed 
by  ablation  of  the  limb,  viz:  twenty-one  by  amputation  in  the  leg,  five  by  exarticulation 
at  the  knee  joint,  and  twenty-three  by  amputation  in  the  thigh.  Considering  the  useful 
ness  of  the  limb,  especially  after  excision  in  the  tibia,  or  in  both  bones  of  the  leg,  the  results 
must  be  regarded  as  unsatisfactory.  In  the  case  of  Private  J.  Hogan,  127th  Pennsylvania 

above  ankle  joint,  in  April,  1864.  A  fenestrated  gypsum  bandage  was  applied.  Excision  of  2  inches  of  (lie  tibia  a  month  after  the  injury  by  Dr.  LOCKE; 
recovery.  In  November,  1864,  the  patient  walked  well,  extensive  new  formation  of  bone,  exceeding  in  thickness  the  normal  tibia.  "  HKINE  (C  )  (Dit 

Schussverletzungen  cltr  nnteren  Extremitliten,  Berlin,  1866,  p.  311):  A  Prussian  officer,  Lieut.  R ,  shot  wound  of  right  leg,  April  18,  1804,  fracturing 

tibia  and  fibula  in  the  middle  third,  and  extensively  lacerating  the  soft  parts  ;  free  incisions  and  application  of  gypsum  bandage.  June  8,  excision  of  1  inch 
of  tibia  by  Dr.  LAN'OENBKCK  ;  recovery,  with  }  inch  shortening ;  according  to  the  latest  account  no  union  of  bone  had  taken  place.  12BECK  (B.)  (Kriegs- 
chirurgixclif.  Erfahrungen  viihrend  </r.s  Feldzugrx  1866.  Freiburg,  i.  Br.,  p.  34:!)  twice  successfully  excised  portions  of  the  tibia,  retaining  as  much  as 
possible  of  the  periosteum.  Both  patients  recovered  in  a  short  time,  and  the  deficiency  in  the  bone  was  supplied  by  nature  in  a  few  weeks.  13Fl6CHEli 
(K.)  (Militairarztliche  Skizzen  aus  Sildd^utscliland  mid  Rdhmen,  Aartui,  1867,  p.  98)  states  that  lie  saw  an  excision  of  the  diaphysis  of  the  tibia  per 
formed  by  TKXTOII  for  shot  fracture  just  above  the  ankle  joint,  four  days  after  the  injury.  The  lower  extremity  of  the  tibia  was  saved ;  the  patient  did 
well.  I4BIEKKI.  (K.)  (Im  Reserve-Lazareth.  Kriegschirurgische,  Aphorismen  von  1866,  \n  Archiv  fiir  Klin.  Chir.,  Berlin,  1869,  B.  XI,  p.  468):  Joh. 
Drost,  shot  comminution  of  tibia  and  fibula  of  right  leg.  June  27,  1866,  by  canister  shot;  enormous  infiltration ;  excision  of  about  4  inches  of  both  bones 
August  7,  IPfifi;  periosteum  preserved;  death  August  27,  1866.  l&O'ns  (G.  A.)  (Circular  No.  3,  War  Department,  R.  G.  O.,  Washington,  1871,  pp.  227, 
228):  Pt.  W.  Hostler,  I),  38th  Infantry,  shot  comminution  of  left  fibula,  Fort  Bayard,  New  Mexico,  July  10,  1868;  excision  of  about  3i  inches  of  fibula 
and  ligation  of  peroneal  artery  above  and  below  wound  on  same  day  by  Acting  Assistant  Surgeon  J.  Le  Carpentier;  death  July  12,  1868.  Pt.  J.  Shaw, 
I),  .'id  Cavalry,  shot  wound  of  right  tibia,  received  in  fight  with  Indians  October  17,  1867;  necrosis;  excision  of  necrosed  portion  by  Assistant  Surgeon 
W.  M.  AUSTIN".  If.  S.  A.,  February  2.  1868;  recovered  and  returned  to  duty.  '"BECK  (B.)  (Chirurgie,  der  Sr.hussverlftzungen,  Freiburg  i.  Br.,  1872, 

p.  90')):  G ,  artSleryman,  fracture  of  left  leg  in  lower  third  from  canister  shot ;  immediately  after  the  injury  excision  of  portions  of  the  injured  bone 

was  performed ;  subsequent  amputation  of  the  leg ;  recovery.  IDEM  (Inc.  cit.,  pp.  907,  909,  910)  also  reports,  from  hospitals  at  Rastatt  and  Strassburg, 
5  instances  of  excisions  in  the  bones  of  the  leg ;  3  were  excisions  in  the  fibula  and  proved  successful  ;  2  excisions  in  the  tibia  were  fatal.  FISCHER 
(G.)  (Dorf  Fining  und  Schlos.t  Verxailks,  in  Ueutsclie  Zei/xrhrift  fiir  Chirurgie,,  Leipzig,  1872,  B.  I,  p.  253):  Unknown,  shot  fracture  of  both  bones  in 
middle  third ;  21  days  after  injury  1  inch  was  excised  from  the  upper  and  2  from  the  lower  ends ;  also  removal  of  splinter  3  inches  long;  patient  doing 
well  at  the  end  of  six  weeks.  In  another  case  in  which  the  tibia  was  extensively  splintered  a  fragment  of  the  bone  was  extracted  on  the  12th  and  1J 
inches  were  excised  on  the  2 1st  day  after  the  injury  ;  death  IS  days  after  the  operation.  RurrilECHT  (L.)  (Militiirdrztliche  Erfahrungen  wahrend  des 
deutsch-franzftsiiichen  Krieges  im  Jahre  1870-71,  Wfirzburg,  1871,  p.  86)  <rites  a  successful  secondary  excision  in  the  fibula  performed  at  the  Bavarian 
hospital  No.  VIII,  at  Antony  and  Massy.  SOCIN"  (A.)  (Kricyschirtirgisrhr.  Erfahrungen  gesammclt  in  Carlsruhe  1870  und  1871,  Leipzig,  1872,  p.  141) 
details  2  cases:  H.  Scherf,  shot  fracture  of  tibia  and  fibula  of  right  leg  in  middle  third,  Toul,  August  16,  1870;  removal  of  splinters;  resection  of  pro 
truding  portion  of  tibia  September  15,  1870;  recovery,  with  8  centimeters  shortening  ;  large  callus  but  no  union  of  bone.  Ferdinand  Schwand,  shot  frac 
ture  of  both  bones  of  right  leg,  Worth,  August  6,  1870;  excision  of  3  centimetres  of  tibia  August  17;  recovery,  with  very  little  shortening  and  consolida 
tion  of  bone.  17CHKNU  (J.-C.)  (Aper<;u  Hist.  Stat.  ft  din.,  <•<<•.,  pendant  la  Guerre  de  1870-1871,  Paris,  1874,  B.  I,  p.  493)  tabulates  97  cases  of  excisions 
in  the  continuity  of  the  bones  of  the  leg,  in  the  French  army,  of  which  76,  with  13  recoveries  and  63  deaths,  were  in  the  tibia,  and  21,  with  4  recoveries 
and  17  deaths,  in  the  fibula.  In  the  alphabetical  enumeration  of  pensioners  after  amputations,  disarticulations,  and  resections,  in  the  second  volume  of 
Dr.  CHEXU'S  work,  the  following  cases  of  excision  in  the  bones  of  the  leg  are  mentioned :  J.-B.  Bourguignon  (p.  21),  llth  Chasseurs,  shot  fracture  of  left 
fibula,  Villorceaux,  Dec.  9,  1870;  excision  of  fibula;  gangrene;  recovery  with  anchylosis  of  ankle  joint.  J.-B.  Millot,  23d  line  (p.  106),  comminuted 
fracture  of  left  leg  at  Tertre,  January  11,  1871 ;  resection  ;  recovery  with  considerable  shortening.  P.-A.  Originaire  (p.  114),  12th  Cuirassiers,  shot  com 
minution  of  leg  nt  Gravelotte;  resection  of  portion  of  tibia;  incomplete  consolidation.  C.-V.  Ridel  (p.  128),  82d  line,  comminuted  shot  fracture  of  left 
tibia,  Villorceaux,  Dec.  8,  1870;  resection  ;  atrophy  of  limb.  This  case  is  detailed  by  Cmi'AULT.  (A.)  (Fractures  par  armes  a,  feu,  Paris,  1872,  p.  157), 
who  states  that  the  operation  was  performed  on  May  22.  1871,  and  that  18  centimetres  of  the  tibia  were  excised.  There  is  regeneration  of  bone  and  no 
apparent  shortening  of  the  limb.  E.-I.  Schneider  (p.  136),  shell  wound  of  right  leg,  received  at  Villiers  sur-Marne ;  resection  of  considerable  portion  of 
tibia.  A. -J.-B.  Soviche  (p.  139),  llth  line,  comminuted  shot  fractures  of  left  forearm  and  right  leg,  Sedan ;  excision  in  lower  third  of  tibia;  atrophy  of 
leg.  L.-M.-A.  Vedel  ip.  147),  7(ith  line,  shell  fracture  of  right  leg.  Strassbourg,  September  17,  1870;  excision  of  4  centimetres  of  both  bones;  recovery- 
Besides  the  cases  mentioned  by  CHEN'U,  the  editor  has  been  able  to  gather  from  the  sources  indicated  particulars  of  the  following  instances  of 
excision  in  the  continuity  of  the  bones  of  the  leg  practised  on  French  soldiers  during  the  Franco-German  War,  1870-1871,  not  detailed  by  CHEXU:  F. 
Delalande  (CniPAUl.T)  (A.)  (Fractures par  armes  u  feu,  Paris,  187;!,  p.  173),  wounded  at  Orleans.  December  4,  1870,  in  the  lower  part  of  the  left  leg;  no 
consolidation  on  December  31,  1870 ;  resection  of  9  centimetres  of  the  fibula;  recovery  without  shortening.  The  space  between  the  sawn  ends  of  the 

bone  is  filled  with  a  firm  substance.     Joseph  G (A.  COUSIN",  Hintm'rK  Cliirurgicale  de  I'ambulance  de  I'ecole  des  ponts  et  chaussees,  in  V  Union  Midi. 

cale,  1872,  T.  XIII.  p.  158),  shell  fracture  of  left  leg.  November  29,  1870  ;  erysipelas ;  gangrene ;  excision  of  about  6  centimetres  of  tibia ;  death  December 
22,  1870.  F.  Albertini  (O.  HKYFKLDER,  llericht  iiber  meine  Wirksamkeit  am  Rhein  und  in  Frankreich  wdhrend  des  Deutsch-franzosischen  Krieges,  in 
St.  J'etersburgrr  itrd.  Ze.itschrift,  1871,  B.  II,  N.  F.,  p.  59).  3d  Voltigeurs,  shot  fracture  of  bones  of  leg,  Landonchamp,  October  7,  1870;  excision  of  the 
fractured  portion  of  ihe  tibia  November  18;  recovery  without  deformity  and  with  new  formation  of  bone.  E.  Terrier  (O.  HEYKELDER,  loc.  cit.,  p.  59). 
62d  line,  shot  fracture  of  tibia  received  at  Gravelotte;  secondary  excision  of  4  centimetres  of  the  tibia;  recovery.  M.  Maze  (T.  BlLLIlOTH,  Chirurgische 
Briefe  aus  den  Kriegs-Lazarethen  in  Weissenburg  und  Mannheim  1870.  Berlin,  1872.  p.  "234,  No.  47,  and  H.  LOSSEN",  Kriegschirurgische  Erfahrungen  aus 
den  Barackcnlazarethen,  etc.,  in  Deutsche  Zeilschrift  far  Chirurgie,  1873,  B.  II,  p.  140),  — — ,  48th  Infantry,  shot  fracture  of  both  bones  of  right  leg  August 
4,  1870;  ends  of  tibia  excised  on  the  field;  loss  of  1 J  to  2  inches  of  bone;  in  March,  1871,  the  wounds  had  healed  but  the  parts  had  not  consolidated.  "TILING 
(G.)  (Bericht  iiber  124  im  Serbisch-t&rkischen  Krifge  im  BaracJcen-Lazareth  des  Dorpater  Sanitats- Trains  zu  Swilainatz  behandelte  Schussverletzungen, 
Dorpat,  1877,  p.  72):  Simeon  liaschitseh,  aged  40,  shot  fracture  of  left  tibia,  August,  1876;  excision  of  12  centimetres  of  tibia,  September  7,  187C;  ampu 
tation  in  lower  third  of  tUigh  September  15;  death  September  1C,  1876.  19XADE  (E.)  (Das  tempo-flirt  Kriegslazareih  des  Rcssorts  der  Anstalten  der 
Xaiscrin  Maria  im  Kloster  Afariahimmelfahrt  bei  Sitstowa,  in  St.  J'etersburger  Medicimsche  Wochenschrift,  1877,  B.  II.  p.  385)  states  that  a  successful 
excision  in  the  diaphysis  of  the  fibula  was  performed  in  the  hospital  near  Sistowa  under  his  charge. 

1  In  the  185  excisions  in  the  tibia,  1 J  inches  were  removed  in  5,  2  inches  in  23,  2.V  inches  in  8,  3  inches  in  26,  3J  inches  iu  7,  4  inches  in  14,  4J  inches 
in  5,  5  inches  in  7,  5.J  inches  in  2,  6  inches  in  7,  and  7,  8,  and  8.J  inches  in  1  instance  each,  and  in  78  the  length  of  bone  removed  was  not  indicated.  Of 
the  182  fractures  of  the  fibula,  J-inch  was  removed  iu  3  instances,  1  inch  in  2,  1J  inches  in  6,  2  inches  in  22,  2J  inches  in  10,  3  inches  in  33,  3J  inches  in  7, 
4  inches  in  20,  5  inches  in  7,  6  inches  in  3,  6J  inches  in  3,  7  inches  in  1,  8  inches  in  2,  12  inches  in  1,  and  in  1  instance  nearly  the  entire  fibula  ;  in  61  fractures 
of  the  fibula  the  amount  excised  was  not  stated.  In  the  18  instances  of  excisions  in  both  bones  of  the  leg  the  amount  removed  varied,  according  to  the 
nature  of  the  injury  in  each  bone,  from  0  to  5  inches  in  tlit  tibia  und  from  2  to  8  inches  in  the  fibula  in  3  instances  neither  Ihe  bone  implicated  nor  the 
umount  excised  was  indicated 


572  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

Volunteers  (CASE  703,  page  445,  ante),  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  states  that 
"the  leg  was  perfectly  helpless,  a  hiatus  of  nine  or  ten  inches  existing  in  the  tibia,  with 
no  hope  of  any  improvement  from  the  lapse  of  time,"  and  remarks:  "no  more  useless  or 
unphilosophical  operation  could  be  devised  than  the  one  done  in  this  case."  Colonel  W.  F. 
Fitch,  29th  Ohio  Volunteers  (CASE  705,  page  446,  ante),  who  visited  the  Army  Medical 
Museum  in  1870,  six  years  after  the  operation,  greatly  regretted  that  amputation  had 
not  been  performed.  Three  inches  of  the  tibia  had  been  excised  and  the  bone  remained 
ununited;  the  calf  of  the  leg  was  atrophied,  and  the  foot  swollen  and  useless.  In  the  case 
of  Lieutenant  0.  R.  Fyler  (CASE  704,  page  446,  ante),  2d  Connecticut  Heavy  Artillery, 
Examining  Surgeon  H.  E.  Gates  reported,  in  1877,  that  "the  whole  leg  and  thigh  is  atro 
phied.  The  fibula  is  bowed  outward,  and  there  is  partial  dislocation  of  its  head.  The 
leg  bends  easily  at  the  seat  of  the  injury  and  no  weight  can  be  borne  upon  it.  I  have 
no  doubt  the  fibula  would  instantly  give  way  if  the  applicant  should  stand  upon  it.  There 
is  great  tenderness  at  the  head  of  the  fibula  from  stretching  of  the  ligaments,  the  line  of 
support  from  the  bending  of  the  leg  being  thrown  outward  toward  this  articulation.  The 
pensioner  wears  an  appliance  weighing  seven  pounds,  which  incases  the  limb  and  gives  the 
only  support.  The  disability  is  progressive  on  account  of  displacement  and  bending  of 
fibula,  etc.  I  consider  his  present  condition  worse  than  if  he  had  amputation  above  the 
knee;  locomotion  is  very  painful  indeed."  Pseudarthrosis,  rarely  noted  in  the  cases  treated 
without  operative  interference,  was  recorded  in  at  least  twenty-eight  of  the  cases  of  recov 
ery  after  excision  in  the  bones  of  the  leg.1  In  the  case  of  Private  J.  Lagro,  10th  Vermont 
Volunteers  (CASE  719,  page  457,  ante),  Examiner  0.  F.  Fassett  reports  that  "the  bones 
have  never  united  except  by  ligament,  so  that  a  false  joint  now  exists;"  and  the  same 
examiner,  in  1877,  thirteen  years  after  the  injury,  states:  "The  wound  is  still  an  open, 
suppurating,  and  discharging  sore,  the  bone  being  extensively  diseased.  The  disease  is  so 
near  the  joint  that  amputation  must  be  above  the  knee.  His  condition  now  is  worse  than 
with  loss  of  the  leg  above  the  knee.  The  leg  is  bent  into  a  curve  and  greatly  deformed." 
In  the  cases  in  which  the  excision  was  performed  in  the  continuity  of  the  fibula  useful 
lirnbs  were  preserved  in  several  instances,  but  as  a  rule  the  foot  could  not  be  planted  even, 
as  it  would  turn  outward  from  the  want  of  fibular  support. 

Amputations  in  the  Leg. — At  the  time  of  the  publication  of  the  preliminary  report 
of  1865,2  the  results  of  two  thousand  three  hundred  and  forty-eight  (2348)  amputations 
in  the  leg,  giving  a  mortality  rate  of  26.02  per  cent.,  had  been  ascertained.  Further  exam 
ination  of  the  returns  has  augmented  the  number  to  five  thousand  four  hundred  and  fifty- 
two  (5452)  and  has  increased  the  rate  of  mortality  from  26.02  per  cent,  to  32.9  per  cent.; 
yet  the  final  results,  as  reported  in  the  preceding  pages,  compare  favorably  with  the  results 
of  amputations  in  the  leg  obtained  in  other  wars,  as  exhibited  in  TABLE  LXXXVI  on  the 
opposite  page.  Of  the  seven  thousand  six  hundred  and  thirty-seven  cases  cited  in  this 
table,  the  final  results  were  ascertained  in  seven  thousand  and  thirty-eight.  One  thousand 
eight  hundred  and  thirty-nine  (]  839)  were  successful  and  five  thousand  one  hundred  and 
ninety-nine  (5199)  fatal,  giving  a  death  rate  of  73.8  per  cent.  This  excessive  rate  of 

1  HEINE  (C.)  (Die  Schussverletzungen  dtr  imteren  Extremitiiten,  Berlin,  1866,  p.  310),  who  considers  the  fracture  in  the  bones  of  the  leg  the  most 
favorable  field  for  excision,  "  as  here  the  reproductive  powers  of  the  bony  substance,  as  well  as  of  the  periosteum,  seem  to  be  especially  active  and  fruit 
ful,"  admits,  on  page  331,  that  "when  the  strength  of  the  patient  has  not  suffered  too  much,  it  is  unquestionably  preferable  to  await  the  separative  process 
to  be  performed  by  nature,  as  a  resection,  in  every  instance,  adds  a  new  wound  to  the  old  one  with  new  dangers,  and  finally  a  condition  not  too  rarely 
resulting,  but  which  we  have  as  yet  not  mentioned,  must  not  be  overlooked,  viz:  the  supervening1  of  pseudarthrosis." 

2  Circular  No.  G,  War  Department,  Surgeon  General's  Office,  Washington,  November  1,  1865,  p.  47. 


SECT.  V.] 


AMPUTATIONS    IN    THE    LEG. 


573 


mortality  is  principally  due  to  the  deplorable  fatality  attending  the  operations  among  the 
French  troops  in  the  Crimean,  Italian,  and  Franco-Prussian  Wars. 

TABLE  LXXXVI. 

Summary  of  Seven  Thousand  Six  Hundred  and  Thirty-seven  Amputations  in  the  Leg  for  Shot  Injuries 
on  the  Occasions  named  and  from  the  Authorities  quoted. 


OCCASIONS  AND  AUTHORITIES. 

CASES. 

RECOVERIES. 

DEATHS. 

UNDE 
TERMINED. 

PARE*                        -                        .               .... 

l 
4 
12 

1 
159 
2 
19 

22 
2 

5 

12 
3 
8 
4 
94 
3 
10 
2,698 
21 
466 
2 
12 
1 
93 
9 
267 
3,704 
3 

1 
o 

7 

Thirty-  Years'  War,  1G18-1C48  (SCHMIDT)2  

1 
5 
1 
33 

1 

French  Wai's   1740  1756  (BOUCHER  DK  GARENGEOT  FAURE)S 

Seven  Years'  War   1756-1763  (SCHMUCKKR)* 

Napoleonic  Wars   1791-1815  (LARREY   CHAVANE,  KLEIN   HENNKN  GUTHRIE)8 

117 
2 
8 
17 
2 
2 
11 
1 
7 
2 
57 
2 
2 

506 
21 
168 
2 
8 
1 
61 
6 
150 
654 
2 

9 

Fort  Erie  1814  (TUOWBRIDC.E)6        

Revolution  in  Paris,  1830  (LARKEY,  MENIERE,  ARNAL,  ROUX,  JOBERT)7  

8 
5 

3 

Siege  of  Antwerp  1832  (LARUET)8      

French  in  Algiers,  1830-1836  (BAUDEN8,  BAGRE)9  

Campaign  of  Constantine,  1837  (SEDILLOT)10 

3 
1 
2 
1 

2 
37 
1 
8 
1,617 

Spanish  Peninsular  War,  1837  1838  (ALCOCK)" 

War  in  Mexico   1845-1848  (PORTER)12 

Revolution  in  Paris   1848  (ROUX    MALGAIGNE,  HUGUIER   JOBERT   BAUDEN8)13 

Revolution  in  Milan   1848  (RESTELLI)14 



War  in  Schleswig-IIolstein   1848  1850  (DjORUP   STROMEYER)'* 

Revolution  in  Baden   1849  (BECK)16 

Bombardment  of  Sveaborg   1855  (HEYFELDER)17  .       .                .. 

Crimean  War,  1854-1856  (CHENU,  HUBBENET,  MATTHEW)18         

575 

British  in  India   1857  1858  (WILLIAMSON)19 

Italian  War,  1859-1860  (CnENU,  DEMME  GHEREsl)20 

278 

New  Zealand  War,  1863-1865  (MOUAT)21          .          .                                               .     . 

Danish  War,  1864  (HEINE,  OCHWADT)22            

4 

French  in  Mexico,  1864  (BlNTOT)2* 

A  ustro-  Prussian  War,  1866  (BECK,  BlEFEL  FISCHER  MAA8   STROMEYER)24 

32 

106 
3,050 

United  States  Army,  1865-1870  (OTIS)28..     .. 

Franco-German  War,  1870-1871  (GERMANS)  (BECK,  BlLLROTH  CZERNY  etc.)26 

11 

Franco-German  War,  1870-1871  (FRENCH)  (CHENU)27 

Turco-Russian  War,  1876  (KADE   STEINER  TILING)78 

Aggregates  

7,637 

1,839 

5,199 

599 

Rate  of  mortality,  73.  8  per  cent. 

As  a  rule  the  surgeons  of  the  American  civil  war  amputated  in  every  part  of  the  leg 
regardless  of  the  point  of  election,  sacrificing  as  little  as  possible  of  the  sound  portions  of 

An  early,  and  probably  the  earliest  recorded  example  of  amputation  in  the  leg  following  shot  wound  is  that  reported  by  'PARS  (A.)  ((Euvres  de, 
Paris,  1590,  p.  408,  Chap.  XXII):  Captain  Francois  Le  Clerc  had  his  foot  carried  away  just  above  the  ankle  by  a  cannon  ball.  The  wound  healed,  but 
the  leg  became  troublesome,  and  the  patient  had  the  limb  amputated  (he  width  of  five  fingers  below  the  knee.  He  recovered  with  a  serviceable  stump. — 
Four  examples  of  amputation  in  the  leg  are  recorded  by  2  SCHMIDT  (JOSEPH)  (Speculum  Chirvrgicum  oder  Spiegel  derArtzney,  Augspurg,  1656,  pp.  153, 
156,  157):  2  were  successful,  1  fatal,  and  1  result  unknown  :  B.  Lundlaw,  of  the  regiment  Wallenstein,  received,  November  22,  1663,  a  shot  fracture  of  both 
bones  of  the  left  leg;  amputation  of  leg;  death  November  16.  1663.  H.  Braunmtiller,  Oheim's  regiment,  shot  in  the  left  leg  May  23,  1663;  amputation 
of  leg;  result  not  recorded.  Cavalryman  G.  Burger,  Caselcki's  regiment;  left  leg  carried  away  above  the  ankle;  amputation  higher  up;  recovery.  A 
corporal  of  von  Oelter's  Bavarian  regiment;  left  foot  torn  away;  amputation  in  leg;  recovery. — 'BOUCHER  (Obs.  sur  des  Playes  d'armes  a  feu  com- 
pliqut.es  sur  tout  de  fracas  des  os,  in  Mem,,  de  VAcad.  de  Roy.  de  Chir.,  Paris,  1753,  T.  II,  p.  470)  cites  five  amputations  in  the  leg  for  wounds  received  at 
Fontenoy,  April  30,  1745:  A  captain  of  Hainaut'g  regiment  had  the  leg  amputated  in  the  field;  recovered  October  26, 1745.  In  the  case  of  a  lieutenant 
of  the  regiment  Clare,  the  limb  was  successfully  amputated  6  days  after  the  injury.  Of  the  remaining  three,  one  died  from  haemorrhage  11  ln-urs  after 
amputation,  and  the  other  two  survived  the  operation  16  and  CO  days  respectively.  DE  GARENGEOT  (Moyens  de  rendreplus  simple  etplus  sure  lamputa- 
tion  d,  lambeau,  in  Mtm.  de  I'Acad.  Hoy.  de  Chir.,  1753,  T.  II,  p.  262):  A  soldier  of  the  King's  regiment  received  a  shell  wound  of  the  right  foot  with 
fracture  of  both  bones  of  the  leg ;  amputation  8  days  after  the  injury ;  healed  in  27  days.  FAUIiE  (L 'amputation  etant  absolument  necessaire  dans  Its 
plaies  compliquees  de  fracas  des  os,  etc.,  in  Prix  de  VAcad.  Roy.  de  Chir.,  Paris,  1819,  T.  Ill,  pp.  339,  340)  details  3  cases  of  secondary  amputations  in 
the  leg,  the  operation  being  performed,  one  on  the  46th  and  two  on  the  47th  days  after  the  injury;  all  recovered.  BAGIEU  (Examen  de  plusieurs  parties 
de  la  Chirurgie,  Paris,  1756,  p.  97):  Shot  fracture  of  tibia  and  fibula;  primary  amputation  of  leg;  fatal.  RAVATON  (Chirurgie  d'armee  ou  traite  des 
plaies  d'armes  a  feu,  Paris,  1768,  p.  372):  Shot  wound  of  left  leg;  amputation  6  weeks  after  injury:  fatal.  IDEM  (loc.  cit.,  p.  404):  Fray,  of  Schomberg's 
regiment,  shot  fracture  of  left  foot  in  September,  1755:  primary  amputation  ;  recovery. — 4  ScHMUCKER  (J.  L.)  (  Vermischte  Chirurgische  Schriflcn,  Ber 
lin  und  Stettin,  1785,  B.  I):  Captain  von  Wedel,  shot  fracture  of  ankle  joint.  August  11,  1760;  amputation  of  leg  at  upper  third;  fatal.—  "LAKKEY  (D.  J.) 
(Mem.  de.  Chir.  Mil.  ft  Camp.,  Paris,  1812,  pp.  265,  269):  Lieut.  Bonichon,  21st  Light  Infantry,  shot  wound  of  left  foot,  October  7,  1708:  tetanus;  ampu 
tation  in  upper  third:  recovery.  Another  amputation  for  tetanus  following  shot  wound  was  performed  by  LARREY  on  March  21,  1801 ;  tetanus  subsided, 
but  the  patient  died  13  days  after  the  operation.  IDEM  (loc.  cit.,  T.  II,  p.  195):  Captain  M ,  wounded  at  the  second  battle  of  Aboukir,  in  1801 ;  ampu 
tation  immediately  below  the  knee;  recovery.  IDEM  (loc.  cit.,  T.  Ill,  pp.  56,  83,  156,  389,  391,  and  378)  refers  to  16  cases  of  amputation  in  the  leg:  Han- 


574  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

the  bones  of  the  limb.  One  thousand  five  hundred  and  nine  (1509)  of  the  five  thousand 
four  hundred  and  fifty-two  (5452)  amputations  were  performed  in  the  upper  third,  one  thou 
sand  four  hundred  and  eighty-one  (1481)  in  the  middle,  one  thousand  four  hundred  and 
seven  (1407)  in  the  lo.wer  third,  and  in  one  thousand  and  fifty-five  (1055)  instances  the  seat 

nequin,  fracture  of  leg  in  tipper  third,  Eylau,  February  8,  1807  ;  amputation  through  tuberosity  of  tibia ;  recovery.  During  the  same  campaign  LAHUKY 
performed  3  similar  operations  through  the  tuberosity  of  the  tibia;  the  patients  recovered.  At  Ulm,  iu  October,  1805,  an  officer  received  a  shot  through 
the  ankle ;  gangrene  and  fever;  amputation  below  the  point  of  election;  recovery.  In  Egypt,  in  1799,  LARKEY  twice  successfully  amputated  close  to 
the  knee  joint,  and  nearly  on  a  level  with  the  head  of  the  fibula,  and  at  Wagram  and  Esslingen,  in  1809,  9  similar  operations  were  performed  by  him; 
but  the  results  are  not  indicated.  Of  3  cases  of  amputation  of  both  legs  performed  after  Wagram,  1  performed  immediately  after  the  reception  of  the 
injury  proved  successful;  2  others  were  fatal.  IDEM  (toe.  cit.,  T.  IV,  pp.  56,  6'9,  156,  and  164)  details  4  cases  of  amputation  in  the  leg  during  the  Russian 
campaign  1812-13:  3  were  successful  and  1  proved  fatal.  LARKEY  (D.  J.)  (Clinique  Chirurgicale,  Paris,  1829,  T.  Ill,  pp.  651,  652,  662,  664,  and  (i65) 
cites  the  cases  of  Dosmenil,  wounded  at  Wagram,  in  1809;  amputation  in  middle  third;  recovery.  Lambels,  wounded  in  the  Russian  campaign,  1812, 
amputation  in  upper  third;  recovery.  General  Laferrie're,  wounded  at  Craonne  in  1814;  amputation  in  middle  third;  recovery'.  An  officer,  wounded 
at  Moscow  in  1812;  amputation  in  upper  third;  recovery.  General  Chfimineau,  wounded  at  Lutzen  in  1813;  amputation  in  upper  third;  recovery. 
Robsomen,  wounded  at  Hanau  in  1813;  amputation  in  upper  third;  recovery.  IDEM  (loc.  cit.,  T.  IV,  pp.  279,  282):  Gault,  an  officer  of  dragoons;  shot 
fracture  of  upper  third  of  right  leg;  amputation  below  the  knee;  recovery.  Colonel  d'Esclignac,  amputation  of  leg;  recovery.  ClIAVANE  (X.)  (Consid 
erations  theo.-prat.  sur  I' amputation  d  fair  e  a  la  suite  des  fractures  comminutives  de  la  jambe,  etc.,  Paris,  1814,  Thfise  No.  99,  pp.7,  9,  10)  details:! 
successful  amputations  in  the  leg.  KLEIN  (D.  C.)  (Practische  Ansichten  der  bedeutendsten  chirurgischen  Operationen,  Stuttgart,  1815,  p.  31)  relates  a 
successful  case  of  amputation  at  the  ankle  and  subsequent  ablation  iu  the  leg.  HENNEN  (J.)  (Principles  of  Military  Surgery,  3d  ed.,  London,  1829,  pp. 
275,  277):  Chatelot,  wounded  in  1815,  amputation  leg;  death.  M — -,  3d  guards,  amputation  of  leg  July  11,  1815;  death  August  3,  1815.  GliTHltlK 
(G.  J.)  (Commentaries,  etc.,  6th  ed.,  London,  1855,  p.  158)  tabulates  IK!  cases  with  23  deaths,  after  the  battle  of  Waterloo,  in  1815;  43,  with  7  deaths,  were 
primary,  and  50,  with  16  deaths,  were  secondary  operations.  GUTHUIK  (G.  ,1.)  (-4  J^reatise  on  Gunshot  Wounds,  etc.,  3d  ed.,  London,  1827,  p.  308)  reports 
28  amputations  in  the  leg  performed  near  New  Orleans,  from  January  8  to  April  24,  1815  ;  26,  with  3  deaths  and  23  recoveries,  were  primary  operations, 
and  2,  both  fatal,  were  secondary  operations. — GTROWBRIDOE  (A.)  (<!unxhot  Wounds,  in  Boston  Me.d.  and  Surg.  Jour.,  1838,  Vol.  XVIII,  p.  342)  cites  1 
case  of  amputation  of  leg  and  1  of  both  legs  from  the  siege  of  Fort  Erie,  in  1814  ;  both  patients  recovered. — 'LAKUEY  (H.)  (Re.l.  Cliir.  des  Evenemens  de 
Juillet  1830,  Paris,  1831,  p.  122):  6  amputations  in  the  leg  (3  successful,  3  fatal).  MENIERK  (P.)  (L' Hotel- Dieu  de  Paris  en  Juillet  et  Aout  1830,  p.  325): 
3  amputations  in  the  leg  ;  fatal.  ARXAL  (Mem.  sur  quelques  particular  ilex  des  pi  airs  par  arines  a  feu,  in  Jour.  Unif.  et  Hebd.  de,  M*'d.  et  de  Chir.  Prat., 
Paris,  1831,  T.  Ill,  p.  35):  I  amputation  of  leg;  recovery.  ROI'X  (Plates  d'armt.s  ti  feu.  Communications,  etc.,  Paris,  1849,  pp.  37,  38):  6  amputations  of 
leg  (4  recoveries,  2  fatal).  JOBEltT  (DK  LAMHALLE)  (P laics  d' arines  <</««,  Paris,  1833,  pp.  303-305)  cites  3  amputations  in  the  leg  (no  results). — *LAHRKY 
(II.)  (Hist.  Chir.  du  Siege  de,  la  citadel  U  d'Anvers,  Paris,  1833,  p.  334):  22  cases;  20  primary  (16  recoveries,  4  deaths),  2  secondary  (1  recovery,  1  fatal. — 
'BAUDEX8  (L.)  (Clinique  desplaies  d'armes  afeu,  Paris,  1836,  p.  540):  1  amputation  of  left  leg;  recovery.  BACiKfc  (Obs.de  Chir.,recueilUes  a  I'hopital 
Turc,  a  Alger,  in  Bee.  de  Mem.  de  Mid.  de  Chir.  et  de  Phar.  Mil.,  Paris,  1831,  T.  XXXI,  p.  168):  1  amputation;  recovery.— '"SEUll.l.OT  (O.)  (Camp,  de 
C'onstantine  de  1837,  Paris,  1838,  p.  266):  5  amputations  iu  the  leg  (2  recoveries,  3  t'atal). — "  ALCOCK  (R.)  (Notts  an  the  Mfd.  Hist,  and  Stat.  of  the  British 
Legion  in  Spain,  London,  1838,  p.  95):  12  amputations  in  the  leg  (11  recovered,  1  fatal);  3  with  2  recoveries  primary,  unil  9  recoveries  were  secondary 
operations. — '*POKTKK  (J.  B.)  (Med.  and  Surg.  Notes  of  Campaigns  in  the  War  with  Mexico,  during  the  years  1845-1848,  in  Am.  Jour.  Med.  Sci.,  1852, 
Vol.  XXIII,  N.  S.,  pp.  31,  32):  3  amputations  in  the  leg  (1  recovery,  2  fatal). — l3 l>es  plaies  d'armes  d  feu  Communications,  etc.,  Paris,  1849,  par  JIM. 
Roux  (p.  11),  2  amputations  (1  recovery,  1  fatal);  MAU;AU:NK  (p.  4ti),  2  amputations  (recoveries);  HuouiKR  (p.  143),  2  amputations  (recoveries);  JOBKin 
(p.  154),  1  amputation  (recovery);  BAUI>ENS  (p.  233),  1  amputation  (recovery). — I4RKSJKU,I  (A.)  (J\'otf.  ed  Osservaziuni  cliniche  di  chirurgia  militorc, 
in  Annali  Universali  di  Medicina,  1849,  Vol.  CXXX,  pp.  243,  244):  4  cases  (2  recoveries,  2  fatal).  151)JORUP  (Bcmaerkninger  over  de  i  Krigen  1848-50 
foretagne  Amputationer  i  Forbindelse  med  en  Statistik  over  dein,  in  Hospitals- Metldtlelxtr,  Kjobeuhavn,  1852,  B.  V,  p.  10(i):  48  cases  (29  recoveries,  19 
fatal).  STIIOMKYEK  (L.)  (Maximen  der  Kriegsheilkunxt,  Hannover,  1855,  pp.  756,  757):  46  cases  (28  recoveries,  18  fatal). — '"BECK  (B.)  (Die  Scltuss- 
wunden,  Heidelberg,  1850,  Tubellu):  3  cases  (2  recoveries,  1  fatal).— l7  HEYFE1.U1CK  (J.  F.)  (Die  Venvundungen  und  Operatioiien  in  Folge  des  Bumbarde.- 
ments  von  Sceaborg  vom  9.-1 1.  Aug.,  in  Deutsche  Klinik,  1855,  B.  VII,  pp.  4;|5  and  57.">):  10  cases  (2  recoveries,  8  fatal). — "  (MlKNU  (J.-C.)  (Rapport,  tie., 
pendant  la  Campagne  d' Orient,  en  1 854-'55-'5ti,  Paris,  1865,  p.  666):  l,30(i  cases  (368  recoveries,  938  fatal).  HttUUKNKT  (0.  v.)  (Die  Simitats-VerhdUn-isse. 
der  Russischen  Veru'undeten  wahrend  des  Krimkrieges  in  den  Jahren  1854-1856,  Berlin,  1871,  p.  182):  1,286  cases  (69  recoveries,  642  deaths,  575  unde 
termined).  MATTHEW  (T.  P.)  (Med.  and  Surg.  Hist,  of  the  British  Army,  etc.,  in  the  years  1854-'55-'56,  London,  1858,  Vol.  11,  pp.  368,  369):  106  cases 
(69  recoveries,  37  fatal).—19  WILLIAMSON  (G.)  (Military  Surgery,  London,  1863,  p.  XXVII):  21  cases  (recoveries).— *>CHEXU  (J.-CJ  (Stat.  Med.-Chir.  de 
Camp,  dltalie  en  1859  et  I860,  Paris,  1869,  T.  II,  p.  809):  347  cases  (116  recoveries,  231  fatal).  DKMMK  (II.)  (Mililar-Cliirurgische  Studien,  Wiirzburg, 
1861,  B.  II,  p.  278):  113  cases  (69  recoveries,  44  fatal).  GHEUIM  (A.)  (Rel.  chir.  dell' Ospeilale  mil.  provisorio  di  ,S'.  Filippo.  iu  Annali  Univ.  di  Mfd., 
Milano,  1860,  Vol.  CLXXIII,  pp.  419,  420):  6  cases  (3  recoveries,  3  fatal).— *'  MOUAT  (The  New  Zealand  War  of  1863-64-65,  in  Mat.  San.  and  Med. 
Reports,  Vol.  VII,  for  the  year  1865,  London,  1867,  p.  514):  2  cases  (recoveries). — w  HEINE  (C.)  (Die  Schus&verletzungen  der  unteren  Extremitaten,  Berlin, 

1866,  p.  294):  3  cases  (2  recoveries,  1  fatal).     OCHWAUT  (A.)  (Kriegschirurgische  Erfahruiigen,  Berlin,  1865,  tabular  statement):  9  cases  (6  recoveries,  3 
fatal. — 23  BIXTOT  (Obs.  de  blessures  de  guerre,  in  Rec.  de  Mem.  de  Med.  de  Chir.  et  de  Phar.  Mil.,  Paris,  1866,  T.  XVI,  p.  237):  1  case  (recovery.) — MBKCK 
(B.)  (Kriegs.-Chir.  Erfahnnigen  icdhrend  des  Feldzuges  1866,  Freiburg,  i.  Br.  1867,  p.  331):  43  cases  (26  recoveries,  17  fatal).     BlF.FEL  (R.)  (Im  Rei-crrt- 
Lazareth,  in  Archie  fur  Klin.  Chir.,  Berlin.  1869,  B.  XI,  pp.  465,  474):  4  cases  (2  recoveries,  2  fatal).     FiscilElt  (K.)  (Militairarztlicht  Skizzen,  Aarau, 

1867,  p.  97):  26  cases  (22  recoveries,  4  fatal).     MAAS  (H.)  (Kriegschirurgiichc  Beitrdge  aus  dem  Jahre  1866,  Breslau,  1870,  p.  73):  3  cases  (2  recoveries, 
1  fatal).     STROMEYEIJ  (L.)  (Erfahrungen  uber  Schusswunden  im  Jahre  1866,  Hannover,  1867,  p.  59):  17  cases  (9  recoveries,  8  fatal).— M OTIS  (G.  A.) 
(Circular  No.  3,  War  Department,  S.  G.  O.,  Washington,  1871,  pp.  196-202):  9  cases  (6  recoveries,  3  fatal).'— K BECK  (B.)  (Chirurgie  der  Schussverlet- 
ziingen,  Freiburg,  i.  Br.,  1872,  pp.  800,  et  seq.):  152  cases  (91  recoveries,  58  fatal,  3  undetermined).     BiLLltOTH  (T.)  (Chir.  Brirfe  aus  den  Kriegs-Laza- 
rethen  in  Weissenburg  und  Mannheim  1870,  Berlin,  1872,  pp.  232,  et  seq.):  7  cases  (4  recoveries,  3  fatal).     CZERNY  (V.)  (Bericht  iiber  die  im   College 
Stanislaus  in  Weissenburg  behandelten  Verwundeten,   in    Wiener  Med.   Wochenschrift,  1870,  pp.  1355-56):  3  cases  (1  recovery,   1  fatal,   1   unknown). 
FISCHER  (G.)  (Dorf  Floing  und  Schloss  Versailles,  in  Deutsche  Zeitschrift  fiir  Chirurgie,  1872,  B.  I,  p.  187):  IU  cases  (14  recoveries,  5  fatal).    FISCHER" 
(H.)  (Kriegschirurgische  Erfahrungen,  Erlangen,  1872,  p.  213):  8  cases  (5  recoveries,  3  fatal).     GOLTDAHMEK  (Bericht  i'ber  die  Thatigkeit  des  Rest  r  re- 
Lazaretts  des  Berliner  Hilfsvereins  in  der  Garde-Ulanen-Kaserne  zu  Moabit,  in  Berliner  Klin.  Wochenschrift,  1871,  .Tahrg.  VIII,  p.  152):  2  cases 
(1  recovery,  1  fatal).     GRAF  (E.)  (Die  Koniglichen  Reserve-Lazarethe  zu  Dusseldorf  wahrend  des  Krieges  1870-71,  Elberfeld,  1872,  pp.  31,  4P):  9  eases 
(4  recoveries,  5  fatal).     KlKCHNER  (C.)  (Aerztlicher  Bericht  iiber  das  KSniglich  Preussisclie  Feld-Lazareth  im  Palast  zu  Versailles.  Erlangen,  1872,  pp. 
88,  89):  9  cases  (6  recoveries,  3  fatal).     KOCH  (W.)  (Notizen  iiber  Schussverletzungen,  in  Archiv  fur  Klin.  Chir.,  Berlin,  1872,  B.  XIII,  p.  574):  12  cases 
(9  recoveries,  3  fatal).     LOS8EN  (H.)  (Kriegschirurgische  Erfahrungen  aus  den  Barackenlazarethen  zu  Mannheim,  etc.,  in  Deutsche  Zeitschrift  fur  Clrir., 

1 873,  B.  II,  pp.  138-148):  4  cases  (4  fatal).  MAYER  (L.)  ( Kriegschirurgische  Mittheilungen  avs  den  Jahren  1870-71 ,  iu  Deutsche  Zeitschrift  fur  Chirurr/ir. 
1873,  B.  HI,  pp.  50,  52):  2  recoveries.  RUPPRECHT  (L.)  (Militdrdrztliche  Erfahrungen  wahrend  des  Deutsch-Franzozischen  Krieges  im  Jahre  1870-71, 
Wurzburg,  1871,  p.  35):  5  cases  (2  recoveries,  3  fatal).  SCHINZINGEK  (A.)  (Das  Reserve-Lnzareth  Schwetzingen  im  Kriege  1870  und  1871,  Freiburg,  i. 
Br.,  187!!,  pp.  84,  88):  5  cases  (4  recoveries,  1  fatal).  SEEGER  (W.  v.)  (Die  Leistungen  der  Vereinsspitaler  Kleinkinderchule  und  Diakonenhaus  in  Lvd- 
wirjsburg  im  Jahr  1870-71,  in  Zeitschrift  fur  Wunddrzte  und  Geburtshelfer,  Stuttgart,  1871.  B.  XXIV,  p.  117):  1  case,  fatal.  SOCIN  (A.)  (Kriegschirur 
gische  Erfahrungen  gesammelt  in  Carlsruhe  1870  und  1871,  Leipzig,  1872,  pp.  144,  187):  4  cases,  fatal.  STEINBERG  (Die  Kriegslazarelhe  und  Baracken 


SECT,  v  ]  AMPUTATIONS    IN    THE    LEG.  575 

of  operation  was  not  indicated.  The  fatality  of  the  operations  in  the  upper  third  was  27.0, 
in  the  middle  third  20.6,  and  in  the  lower  third  27.6  per  cent.1  Here  as  well  as  in  the 
amputations  of  the  thigh  (see  TABLE  XXIX,  p.  213,  ante)  and  in  the  ablations  of  the  fore 
arm  and  arm  (see  TABLE  CXXXII,  p.  967),  and  of  amputations  in  the  arm  (Recapitulation, 
pp.  805,  806  of  the  Second  Surgical  Volume),  the  operations  in  the  middle  third  of  the  limb 
were  less  fatal  than  those  in  the  upper  or  lower  thirds.  It  will  also  be  noted  that  the 
mortality  of  the  amputations  in  the  lower  third  slightly  exceeded  that  in  the  upper  third,2  a 
result  which  appears  to  argue  against  the  operations  in  the  lower  third  immediately  above  the 
malleoli,  advocated  and  practised  by  Ravaton3  and  White,4  and  later  by  Lenoir,  Goyrand, 
and  others.5  Furthermore,  of  the  two  hundred  and  twenty  cases  of  re-amputations  in  the 
leg,  knee  joint,  or  thigh,  the  amputations  had  originally  been  performed  in  the  lower  third 
of  the  leg  in  one  hundred  and  two,  in  the  middle  third  in  seventy-five,  in  the  upper  third 
in  forty,  while  in  three  the  seat  of  the  first  operation  was  not  indicated;  showing  that  abla 
tions  in  the  lower  third  contributed  nearly  one-half  of  all  the  cases  of  re-amputation.  The 
considerations  of  greater  safety  of  life,  as  evinced  in  the  results  of  amputations  of  the 
middle  third,  and  the  excellent  prothetic  apparatus  furnished  at  Government  expense  to 
the  maimed  soldiers,  outweigh  the  objections  raised  by  surgeons  to  the  inconvenience  of  a 
projecting  limb,  necessitated  by  the  use  of  a  peg  leg,  as  well  as  the  question  of  the  greater 
cost  of  such  apparatus. 

From  the  returns  it  would  appear  that  of  the  modes  of  operation  the  flap  method  was 
most  frequently  employed — one  thousand  six  hundred  and  ninety-eight  (1698)  instances 
of  this  procedure  being  reported,  against  one  thousand  two  hundred  and  six  (1206)  by  the 
circular,  twenty-two  (22)  by  the  circular  flap,  and  a  few  by  Teale's6  and  Hey's7  methods; 
but  in  at  least  two  thousand  five  hundred  (2500)  cases  the  mode  of  operation  was  not  indi 
cated.  Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.,  in  his  narrative  of  service  at  the  4th 

von  Berlin,  Berlin,  1872,  p.  148):  13  cases  (3  recoveries,  ti  fatal,  4  undetermined).  STOLL  (Bericltt  avs  dem  Koniglich  Wiirttembcrgischen  4.  Feldspital 
von  1870-71,  in  Deutsche  Militairdrztliche  Zeitschrift,  1874,  3d  .lahrg.,  p.  218):  9  cases  (4  recoveries,  S  fatal).  STUMPF  (L.)  (Bericht  i:ber  das  Kriegs- 
Spital  des  St.  Georg-Ritter-Ordens  zu  Nenbergtiausen  im  Jalire.  1870-71.  in  Aerztliches  Intelligenz-BIatt,  Miinchen,  1872,  No.  50,  p.  657):  3  cases,  unde 
termined.— "CHENU  (J.-C.)  (Apercuhist.,  slat.,  et  din.,  etc.,  pendant  la  guerre  dr.  1870-71,  Paris,  1874,  T.  I,  p.  493):  3,704  cases  (654  recoveries,  3,050 
fatal).  ^KADK  (E.)  (Das  tempordre  Kriegslazareth  des  He.ssorts  de.r  Anstallen  dKr  Kaiserin  Maria  im  Kloster  Mariahimmelfahrt  bei  Sistou-a,  in  f>t. 
Petersburger  M(d.  Wochenschrift,  1877,  I?.  II,  p.  384):  1  case,  recovery.  STE1NER  (K.)  (Aus  dem  Tagebuctie  tines  deutsclien  Arztes,  in  Wiener  Med. 
Wochenschrift,  1877,  B.  XXVII,  p.  426):  1  case,  recovery.  TILIM;  (G.)  (Bericht  iiber  124  im  serbisch-tiirkischen  h'riege  im  Baracken-Lazareth  des 
Dorpater  Sanitdts- Trains  zu  St»ilainatz  behandelte  Schvssverletzungtn,  Dorpat,  1877,  p.  77,  No.  82):  1  case,  fatal. 

'The  precise  figures  are:  Upper  third  1,509  cases,  viz:  1,094  recoveries,  406  deaths,  9  unknown  results,  mortality  27  0  per  cent.  Middle  Ihird, 
1,481  cases,  viz:  1,170  recoveries,  305  deaths,  6  unknown  results,  mortality  20.6  percent.  Lower  third,  1,407  cases,  viz:  1,011  recoveries,  387  deaths,  9 
unknown  results,  mortality  27.6  per  cent.  See  TAISI.E  LXVII,  p.  4(il,  ante. 

2Staffsurgeon  GUO.SSHEI.M  (Uebe.r  die  Schusscerlctzungen  des  Fussgelenks  wdhrend  des  letzten  Kriegcs  und  die  Resultate  Hirer  Behandlung  unter 
Benutzung  officieller  QueJlen,  in  Deutsche  Militairdrztliche  Zeitscltrift.  1876,  Jahrgang  V,  p.  223,  note*)  remarks:  "The  supra-malleolar  amputation  has 
given  very  unfavorable  results  during-  the  war  1870-71 ,"  and.  on  page  252.  gives  the  ]>ercentage  of  fatality  of  the  amputations  in  the  lower  third  of  the  leg 
as  53.9  per  cent.,  and  adds:  "The  results  of  the  amputations  of  the  leg  in  the  upper  and  middle  thirds  are  incomparably  better  than  those  in  the  lower 
third,  their  percentages  of  fatality  being  only  38.5  and  36.0  per  cent,  respectively." 

3  RAVATON',  Sur  Vutilite  de  I'amputation  faite  pres  des  malleotes  dans  IKS  maladies  du  pied,  et  sur  une  bottine  de  nouvelte  invention,  in  JKecuil 
periodique  d 'observations  de  Medicine,  Chirurgie,  Pharmacie,  etc.,  Paris.  1757,  T.  VI,  p.  130. 

4  WHITE  (C.),  An  Account  of  a  new  Method  of  amputating  the  Leg  a  little,  above  the  Ankle  Joint,  with  a  Description  of  a  Machine  particularly 
adapted  to  the  Stump,  in  Medical  Obserrations  and  Inquiries  by  a  Society  of  Physicians  in  London.  London,  1771,  Vol.  IV,  p.  168. 

'LiENOIH  (A.),  Quels  sont  les  cas  et  qurls  sont  les  lie.ux,  ou  il  convient  d'amputer  la  jambe,  Paris,  1835;  ibid,  Note  sur  une  modification  de  la  methode 
circulaire  appliquee  a  Vamputation  de  la  jambe.  au  dessus  des  malleoles.  in  Archives  Generates  de  Medecine,  Paris,  1840,  3e  ser.,  T.  VIII,  p.  257.  GOY- 
itAND  (G.),  De  I'amputation  de  la  jambe,  partiquee  loin  du  genou ;  nonvel  appareil  de  sustentation,  in  Journal  Hebdomadaire  des  Progres  des  Sciences  et 
Institutions  Medicales,  Paris,  1835,  T.  II,  p.  161.  LAliliEY,  Amputation  Sus-Malleolaire,  in  Bulletin  de  V Academic  Royale  de  Medecine,  Paris,  1841-42, 
T.  VII,  p.  211.  AKNAL  et  MAKTIX,  Menioire  sur  Vamputation  sus-malleolaire,  in  Annales  de  la  Chirurgie  Franqaise  et  £trangere,  1841,  T.  Ill,  p.  129. 
ARNAL  (L.),  Memoire  sur  I'amputation  sus-malleolaire,  in  Mimoires  de  I' Academic  Royale  de  MCdecine,  1843,  T.  X,  p.  59.  KOZE  (M.  A.),  Dr.  {'amputa 
tion  sus-malli'olaire,  in  Gazette  Medicate  de  Paris,  1847,  3™*  ser.,  T.  II,  p.  987.  COOTE  (H.),  Amputation  at  the  inferior  third  of  the  Isg.  in  the  Lnndnn 
Lancet,  1847,  Vol.  I,  p.  274.  BAUXETT  (C.  V.),  Supra-malleolar  Amputation.  Its  relative  value,  in  Transactions  of  the  Medical  Society  of  the  State,  of 
New  York.  1857,  p.  169.  LAHORIE,  Communication  sur  Vamputation  sus-malleolaire,  in  Bulletin  de  la  Socifite  de  Chirurgie  de  Paris,  Paris,  1859,  T.  IX, 
p.  198;  ibid.,  in  Bulletin  de  la  Societe  impt'riale  de,  Chirurgie  de.  Paris  pendant  Varmee  1866,  Paris,  1867,  p.  63.  GUYON,  Amputation  sus-malleolairf 
par  unproced':  nouveau.  in  Bulletin  de  la  Socictt  imperiale  de  Chirurijie  de  Paris,  1869.  2°  SL'TIB,  p.  334.  CHAUVEI.,  Amputation  sus-mall  olaire,  in  Mem. 
de  la  Soc.  de  Chir.  de  Paris,  Paris.  187.3,  T.  VII,  p.  366.  GAYKAUD  (E.),  De  I'amputation  sus-malleolaire,  in  Montpellier  Medical,  1877,  T.  XXXVIII.  p.  120. 

6TKAI.E  (T.  P.),  On  amputation  by  a  long  and  short  rectangular  flap,  London,  1858. 

'HEY  (WILLIAM),  Practical  Observations  -in  Surgery,  illustrated  by  cases,  3d  ed.,  London,  1814,  p.  542. 


576  INJURIES   OF    THE    LOWER   EXTREMITIES.  [CHAi>.  X. 

division,  Second  Corps  hospital,  April  1,  1864,  prefers  the  "long  posterior  flap  with  a  small 
crescentic  anterior  flap,  and  after  sawing  the  bones  always  removes  the  sharp  projecting 
angle  of  the  spine  of  the  tibia."  Surgeon  Burt  G.  Wilder,  55th  Massachusetts  Volunteers, 
in  his  observations  of  cases  at  Judiciary  Square  Hospital,  prefers  the  circular  method  in 
amputations  in  the  lower  third.  "Here  at  least,  the  circular  method  is  superior  to  the  flap, 
that  is,  results  in  the  best  stump,  both  in  appearance  and  for  an  artificial  limb;  *  *  it  is 
evidently  the  best  method  where  the  patient  is  obliged  to  undergo  any  subsequent  trans 
portation.  The  large  inferior  flap  formed  from  the  calf  constitutes  a  very  thick  cushion  at 
the  end  of  the  stump,  but  the  superior  edge  of  the  tibia  is  always  thinly  covered." 

Protrusion  of  the  tibia  or  fibula  or  both,  frequently  noted,  especially  in  cases  in  which 
the  crest  of  the  tibia  had  not  been  removed  at  the  time  of  the  operation,  was  followed  by 
secondary  haemorrhage,  sloughing,  and  exfoliation.  Surgeon  B.  Gr.  Wilder,  55th  Massa 
chusetts  Volunteers,  remarks  of  twenty-seven  cases  of  amputations  in  the  leg,  observed  at 
the  Judiciary  Square  Hospital  at  Washington  in  1863:  "The  crest  of  the  tibia  was  removed 
at  the  time  of  the  operation  in  four  cases,  and  in  none  of  these  did  the  bone  afterwards 
protrude.  In  three  cases  sloughing  followed  a. previous  secondary  haemorrhage.  In  eleven 
cases  the  tibia  or  fibula  or  both  protruded  through  the  flap  and  exfoliation  usually  followed. 
Secondary  haemorrhage  and  sloughing  occurred  in  two,  indicating  rather  a  constitutional 
than  a  local  cause.  Omitting  these  two,  there  remains  nine  cases — five  of  them  in  the 
middle  third  of  the  leg — in  which  the  crest  of  the  tibia  exfoliated  to  a  greater  or  less  extent 
for  no  other  evident  cause  than  its  non-removal  at  the  time  of  operation.  The  exfoliations 
took  place  at  various  periods — during  the  second,  third,  fourth,  sixth,  tenth,  thirteenth 
weeks,  and  in  one  instance  during  the  fifth  month." 

To  prevent  as  much  as  possible  the  protrusion  of  the  bones,  which  the  great  weight  of 
the  soft  parts  forming  the  calf  tended  to  aggravate,  Dr.  Frank  P.  Foster,  of  the  New  York 
Hospital,  applied  with  good  advantage  an  apparatus  shown  in  the  appended  wood-cut 

(FiG.  329).     A  piece  of  adhesive  plaster  was  cut  in  the  shape  shown  in 

FIG.    328;    the 

two  limbs  were  /  \j\- —7^  ^yjj^;1;  ?* •* •  ^^-"-N^ 

cut  through  at  G 

C,  the  surfaces  of 

the  end  pieces  B 

B  reversed,  and 
FIG.  328—Adhesive  piaster  the  pieces  joined 

with  reversed  ends.  fIG.  339. — Fracture  box  with  stump  supported  by  adhesive  plaster, 

o  o 

at  C  G  with  pins.  The  adhesive  surface  of  the  middle  portion  A  was  then  applied  to  the 
posterior  surface  of  the  stump  and  the  ends  secured  to  the  outside  of  an  ordinary  fracture 
box,  as  shown  in  FIG.  329.  Traction  downward  on  the  fracture  box  was  effected  by  means 
of  a  weight  and  pulley. 


SECT.  VI.|  WOUNDS    AND    OPERATIONS    AT    THE   ANKLE   JOINT.  577 


SECTION  VI. 


WOUNDS  AND   OPERATIONS  AT  THE   ANKLE  JOINT. 


The  cases  to  be  considered  in  this  Section  are  restricted  to  injuries,  by  weapons  of  war, 
of  the  bones  forming  the  tibio-tarsal  articulation,  viz:  the  lower  extremities  of  the  tibia, 
the  fibula,  or  the  astragalus.  Injuries  of  the  os  calcis  and  other  adjoining  bones,  unless 
the  ends  of  the  tibia  and  fibula  and  the  astragalus  are  likewise  involved,  are  reserved  for 
the  next  section.  Seventeen  hundred  and  twenty-two  injuries  of  the  bones  forming  this 
articulation  were  found  on  the  field  and  hospital  returns.  All  were  caused  by  shot;  eleven 
were  contusions,  and  seventeen  hundred  and  eleven  fractures. 

SHOT  CONTUSIONS  OF  THE  ANKLE  JOINT.— Of  eleven  shot  contusions  of  the 
bones  of  the  ankle  joint  indicated  on  the  records,  seven  were  treated  throughout  without 
operative  interference;  four  were  followed  by  amputation  in  the  leg.  The  latter  cases  have 
already  been  cited  in  the  tables  of  amputations  in  the  leg,1  and  it  remains  only  to  give  brief 
details  of  the  cases  treated  by  conservation. 

Shot  Contusions  of  the  Bones  of  the  Ankle  Joint  treated  by  Conservation. — The 
injuries  in  the  seven  cases  of  this  group  were  confined  to  the  malleoli,  in  three  instances 
the  internal  and  in  four  the  external  malleoli  being  involved.  All  resulted  in  recovery. 

CASE  808. — Private  J.  G.  Clayton,  Co.  I,  24th  Eegiment  (Confederate),  aged  22  years,  was  wounded  in  the  left  ankle, 
at  Drury's  Bluff,  May  16,  1864.  The  missile,  a  ball,  impinged  upon  the  lower  end  of  the  tibia,  glanced  downward  and  passed 
through  the  anterior  aspect  of  the  ankle  joint,  lodging  under  the  skin  over  the  neck  of  the  astragalus,  whence  it  was  extracted 
two  days  afterwards.  One  week  after  the  injury  the  foot  and  ankle  were  inflamed  and  swollen  and  there  was  excruciating  pain 
upon  the  slightest  motion,  while  the  grating  of  the  inflamed  articular  surfaces  was  distinct.  After  free  incisions  to  favor  the 
escape  of  confined  pus,  which  was  freely  mingled  with  synovial  fluid,  and  the  persistent  employment  of  cold  irrigation  and 
anodynes,  the  local  inflammation  subsided.  In  the  course  of  several  weeks  it  entirely  ceased  and  the  general  condition  of  the 
patient  became  much  improved.  By  the  following  January  the  wound  had  closed  and  the  patient  was  able  to  walk  with  the 
aid  of  a  cane,  though  motion  of  the  joint  was  still  imperfect.  The  history  of  the  case  was  published2  by  Dr.  J.  M.  Hollovvay, 
late  Surgeon  P.  A.  C.  S. 

CASE  809. — Private  W.  Johnson,  Co.  B,  147th  New  York,  aged  18  years,  was  wounded  at  Hatcher's  Eun,  October  27, 
1864,  by  a  minie"  ball,  which  grazed  the  inner  malleolus  of  the  left  ankle.  He  entered  Lincoln  Hospital,  Washington,  whence 
he  reported  to  Elmira  for  muster  out  May  27,  186o.  Not  a  pensioner. 

CASE  810. — Corporal  A.  Daily,  Co.  A,  42d  Illinois,  aged  29  years,  was  wounded  in  the  right  ankle,  at  Murfreesboro', 
December  31,  1862,  by  a  musket  ball,  which 'took  effect  upon  the  external  malleolus,  touching  the  bone.  He  was  treated  at 
various  hospitals,  being  assigned  to  the  Veteran  Reserve  Corps  November  25,  1863,  and  ultimately  mustered  out  and  pensioned 
September  8,  1864.  Various  examining  surgeons  certify  to  weakness  of  the  ankle  joint,  painfulness,  and  tendency  to  inversion 
of  the  foot  in  wralking.  He  was  a  pensioner  in  June,  1880. 

CASE  811. — Private  P.  McCabe,  Co.  G,  87th  Pennsylvania,  aged  23  years,  was  wounded  in  the  left  ankle,  before  Peters 
burg,  June  23,  1864,  by  a  musket  ball,  which  contused  the  external  malleoltis.  He  was  admitted  to  Stauton  Hospital,  Washing- 

1  Cases  of  Pt.  P.  Reynolds,  K,  5th  New  Jersey,  intermediary  amputation,  lower  third  of  leg;  fatal.  Spec.  4578,  A.  M.  M.  (TABLE  LXX1V,  No. 
300,  page  535,  antt).  Pt.  W.  Sharp,  I,  8th  New  York  Heavy  Artillery,  intermediary  amputation,  middle  third  of  leg;  fatal.  Spec.  3204,  A.  M.  M. 
(TABLE  LXXIII,  No.  349,  page  527,  ante).  Pt.  J.  F.  Willetts,  B,  1st  New  Jersey,  intermediary  amputation,  middle  third  of  leg;  recovery.  (TABLE 
LXXIII,  No.  250,  page  526,  ante).  Pt.  C.  Bennett,  D,  9th  New  Hampshire,  secondary  amputation,  middle  third  of  leg:  fatal.  Spec.  3637  (TABLE 
LXXVII,  No.  138,  page  550,  ante). 

2HOLLOWAY  (J.  M.),  Comparative  Advantages  of  PlKOGOFF's,  SYME'S,  arid  CHOl'AUT's  Amputations,  and  Excision  of  the  Ankle  Joint  by  HAN 
COCK'S  Method,  after  Gunshot  Wounds  and  other  Injuries,  etc.,  in  American  Journal  of  Medical  Sciences,  1866,  Vol.  LI,  N.  S.,  p.  88. 

Sriso.  ITT— 73 


578 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


ton,  eleven  days  after  the  injury,  with  the  limb  greatly  swollen  and  intensely  painful.  An  abscess  was  opened  on  July  10th, 
and  three  weeks  later  a  thin  narrow  piece  of  bone,  about  one  inch  long,  exfoliated  from  the  external  inalleolus.  Subsequently 
another  small  necrosed  piece  \vas  removed,  after  which  rapid  and  steady  improvement  began  and  the  pain  disappeared.  About 
September  25th  the  patient  began  to  walk  on  cnrches.1  He  was  mustered  out  of  service  October  13, 18fi4,  and  pensioned.  The 
Pension  Examining  Board  in  September,  1877,  report  a  "  tender  and  adherent  cicatrix,  complete  anchylosis  of  the  ankle  joint, 
and  some  atrophy  of  the  leg.  In  walking  he  cannot  bring  the  heel  to  the  ground,  but  puts  his  weight  on  the  front  part  of  the  foot." 
He  was  paid  his  pension  in  June,  1881. 

CASE  812. — Private  J.  Staton,  Co.  G,  45th  Kentucky,  aged  17  years,  was  accidentally  wounded,  October  24.  1863,  by  a 
pistol  ball  grazing  the  external  malleolus  of  the  right  ankle.  He  was  conveyed  to  the  general  hospital  at  Ashland,  where 
simple  dressings  were  applied.  The  patient  was  returned  to  duty  December  3,  1863.  and  mustered  out  with  his  command  Feb 
ruary  4,  1865.  Subsequently  he  made  an  unsuccessful  application  for  pension. 

CASE  813. — Private  T.  Ingersoll,  Co.  E,  8th  Kansas,  aged  20  years,  was  wounded  by  a  ball  striking  the  internal  malle 
olus  of  the  left  ankle,  at  Chickamauga,  September  li),  1863.  He  passed  through  several  hospitals,  and  was  mustered  out  of 
service  September  19,  1864,  and  pensioned.  Examining  surgeons  certify  to  weakness  and  slight  enlargement  of  the  ankle  joint. 
His  pension  was  paid  to  June,  1879. 

CASE  814.— Sergeant  C.  Shade,  Co.  F,  46th  Pennsylvania,  age  23  years,  was  wounded,  at  Peach  Tree  Creek,  July  20, 
1864,  by  a  minid  ball  striking  the  external  malleolus  of  the  left  ankle.  Simple  dressings  constituted  the  treatment.  The  patient 
was  returned  to  duty  August  13,  1884,  and  was  subsequently  promoted  to  Lieutenant.  He  ultimately  resigned  July  1,  1865, 
and  afterwards  became  a  pensioner.  Examining  surgeons  certify  that  he  complains  of  pain,  weakness,  and  swelling  on  over- 
exertion.  His  pension  was  paid  to  December,  1880. 

SHOT  FRACTURES  OF  THE  BONES  OF  THE  ANKLE  JOINT.— Of  one  thou 
sand  seven  hundred  and  eleven  instances  of  shot  fractures  involving  one  or  more  of  the 
bones  of  tlie  ankle  joint,  five  hundred  and  eighteen  were  treated  without  operative  inter 
ference;  twenty-nine  were  followed  by  excision;  four  by  excision  at  the  ankle  and  subse 
quent  amputation  in  the  leg;  fifteen  by  amputation  at  the  ankle  joint;  one  by  amputation 
at  the  ankle  joint  and  subsequent  amputation  in  the  leg;  and  one  thousand  one  hundred 
and  forty-four  by  amputation  in  the  leg,  knee  joint,  or  thigh : 

TABLE  LXXXVII. 
Summary  of  One  Thousand  Seven  Hundred  and  Eleven  Shot  Fractures  of  the  Tibio-Tarsal  Articulation. 


TREATMENT. 

CASES. 

SHOT  FRACTURES  OF— 

LOWER 

EXT.  OP 

TIBIA. 

LOWER 
EXTREMITY 
OP  FIBULA. 

ASTRAG 
ALUS. 

TIBIA 

AND 

FIBULA. 

TIBIA  AND 
ASTRAGALUS. 

FIBULA  AND 
ASTRAGALUS. 

TIBIA, 
FIBULA, 

BONES  NOT 
SPECIFIED. 

3 

1 

Recoveries. 

Deaths. 

Undeterm'd. 

Ratio  of 
Mortality. 

Recoveries. 

Deaths. 

Recoveries. 
Deaths. 

•~ 
^-_ 

Recoveries. 

Deaths. 

Recoveries. 

Deaths. 

Recoveries. 

Deaths. 

Undeterm'd. 

Recoveries. 

Deaths. 

Undeterm'd. 

Recoveries. 

Deaths. 

Recoveries. 

Deaths. 
Undeterm'd. 

518 

29 
4 
15 
1 
1,083 
2 
19 
11 
29 

407 
19 
13 

772 
2 
14 
1 
7 

99 

8 
1 
1 

- 
1 

19.5 

29.6 
25.0 
7.1 
0.0 

104 
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Amputation  at  Ankle  —  Amp.  in  Leg  .  . 

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Amputation  in  Leg  —  Amp.  at  Knee.  .  . 
Amputation  in  Leg  —  Amp.  in  Thigh  .  . 

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941 

It  is  to  be  regretted  that  in  nine  hundred  and  forty-one  of  the  one  thousand  seven 
hundred  and  eleven  cases  the  bones  injured  were  not  specified.  The  internal  malleolus 
was  interested  in  two  hundred  and  seven,  the  external  in  one-  hundred  and  thirty-one,  the 

1  LlDKLL  (J.  A.),  On  Contusion  and  Contused  Wounds  of  Bone,  with  an  Account  of  Thirteen  Cases,  in  Am.  Jour.  JUcd.  Set's,  18C5,  N.  S.,  Vol.  L,  p.  36 


SECT.  VL]  SHOT   FEACTUKES    OF   THE    ANKLE   JOINT.  579 

astragalus  in  one  hundred  and  seventy-one,  the  articular  ends  of  the  libiaand  fibula  in  one 
hundred  and  two,  the  tibia  and  astragalus  in  sixty-two,  the  fibula  and  astragalus  in  twenty- 
four,  and  all  three  bones  composing  the  joint  in  seventy-three  instances. 

SHOT  FRACTURES  OF  THE  BONES  OF  THE  ANKLE  JOINT  TREATED 
BY  CONSERVATION. — The  fact  that  of  the  one  thousand  seven  hundred  and  eleven 
cases  of  shot  fractures  of  the  ankle  joint  five  hundred  and  eighteen  only,  or  less  than  one 
third,  were  treated  by  expectant  conservative  measures,  "would  indicate  that  the  surgeons  of 
the  American  civil  war  generally  adhered  to  the  teachings  of  the  masters  of  the  early  part 
of  the  present  century,  Larrey,1  Thomson,2  and  Guthrie,3  who  considered  shot  wounds  of 
the  ankle  joint  extremely  dangerous  and  generally  requiring  amputation.  It  must  be 
assumed,  therefore,  that  the  most  propitious  cases  only  were  reserved  for  conservative 
treatment.  Of  the  five  hundred  and  eighteen  cases  the  results  were  ascertained  in  all  but 
twelve;  four  hundred  and  seven  had  successful  and  ninety-nine  fatal  terminations,  giving 
a  mortality  rate  of  19.5  per  cent. 

CASE  815. — Private  J.  Dullahan,  Co.  D,  3d  Vermont,  aged  24  years,  was  wounded  in  the  right  ankle,  at  the  Wilderness, 
May  5,  1864.  Six  days  after  receiving  the  injury  he  was  admitted  to  Harewood  Hospital,  Washington,  and  one  week  later  the 
man  was  transferred  to  South  Street  Hospital,  Philadelphia.  Surgeon  S.  J.  W.  Mintzer,  U.  S.  V.,  in  charge  of  the  latter  hospital, 
recorded  a  wound  of  the  ankle  with  compound  fracture  of  the  inner  malleolus  by  a  mini6  ball, 
which  entered  at  the  inner  malleolus  and  came  out  just  behind  the  external  malleolus.  Cold- 
water  dressings  were  used.  On  May  23d  there  was  great  pain  and  swelling,  and  an  application 
oflead  water  and  laudanum  was  kept  wrapped  around  the  limb;  morphia,  milk  punch,  and  beef 
essence  being  administered.  Two  days  afterwards  the  wounds  of  exit  and  entrance  were 
enlarged,  after  which  the  foot  was  again  wrapped  up  in  the  same  application.  On  May  27th, 
the  pain  still  continuing,  equal  parts  of  tincture  of  aconite  and  water  were  applied,  and  two 
days  later  a  plaster  of  extract  of  hemlock  was  made  to  cover  the  entire  foot.  On  May  30th 
quinine  pills  were  prescribed,  and  another  lotion  consisting  of  laudanum  and  tincture  of  aconite 
was  ordered  to  be  constantly  applied.  The  entries  in  the  hospital  records  at  this  date  mention 
that  the  patient  was  evidently  sinking.  He  subsequently  mended,  however,  and  became  well 
enough  to  be  transferred  to  Brattleboro'  on  June  29th.  Several  months  later  he  was  trans 
ferred  to  Burlington,  where  he  was  assigned  to  the  Veteran  Reserve  Corps  February  21, 1865. 
The  patient  was  ultimately  discharged  from  service  at  Sloan  Hospital,  Montpelier,  July  25,  FIG  330— A  of  limb  one 

1865,  and  pensioned.  Surgeon  H.  Janes,  U.  S.  V.,  in  charge  of  the  latter,  contributed  the  year  after  shot  fracture  of  right  inner 
photograph  represented  in  the  adjacent  cut  (FlG.  330),  and  reported  that,  according  to  the  malleolus-  tFrom  a  Photograph.] 
patient's  statement,  the  lower  end  of  the  tibia  became  necrosed  and  was  gouged  out  twice  at  Brattleboro'  Hospital.  At  the  time 
of  the  man's  discharge  his  general  health  was  good  and  the  wound  was  nearly  healed,  with  ligament ous  anchylosis  of  the  joint 
and  very  slight  contraction  of  the  muscles  of  the  calf  of  the  leg.  There  was  no  appearance  of  caries  or  necrosis,  and  he  could 
walk  a  short  distance  with  a  cane,  gaining  some  motion  of  the  joint  by  exercise.  Examiner  A.  L.  Lowell,  of  Burlington,  Ver 
mont,  certified,  March  26,  1870:  "The  cicatrix  of  entrance  is  adherent  to  the  bone  and  healthy,  but  sensitive  to  pressure.  The 
inner  malleolus  is  considerably  thickened  by  bony  deposit  and  the  new  growth  is  operative  in  limiting  the  motions  of  the  foot. 
The  tibio-tarsal  articulation  is  obstructed  in  its  function  by  false  anchylosis.  In  flexion  and  extension  of  the  foot  the  toes 
describe  an  arc  of  but  two  inches.  The  foot  is  inverted  to  such  a  degree  as  to  throw  the  weight  of  the  body  on  the  outer  margin 
of  the  sole."  The  pensioner  was  paid  June  4,  1880. 

CASE  816. — Private  P.  Driscoll,  Co.  B,  13th  Infantry,  aged  26  years,  was  wounded  before  Vicksburg,  May  19,  1863. 
Surgeon  E.  O.  F.  Roler,  55th  Illinois,  noted  his  admission  to  the  field  hospital  of  the  2d  division,  Fifteenth  Corps,  with  "shot 
wound  of  right  foot."  One  week  after  the  reception  of  the  injury  the  wounded  man  was  conveyed  to  Memphis,  where  he  entered 
Jefferson  Hospital,  and  six  months  later  was  transferred  to  Marine  Hospital,  St.  Louis.  Surgeon  A.  Hammer,  U.  S.  V.,  in 
charge  of  the  latter,  described  the  iujurj'  n?  a  "shot  fracture  of  the  ankle  joint,"  and  reported  that  the  joint  being  much  enlarged 
and  quite  painful  he  lanced  the  part  on  June  18,  1864,  when  several  ounces  of  pus  escaped  and  several  sp'iculse  of  bone  were 
extracted.  The  patient  was  in  good  health  at  the  time  of  the  operation.  Warm  poultices  were  frequently  applied  and  after 
wards  tincture  of  iodine.  On  August  6,  1864,  the  patient  was  discharged  from  service  and  pensioned.  Examining  Surgeon  A. 

"LAUREY  (D.  J.)  (Mem.  de  Chir.  Mil.  et  Camp.,  Paris,  1812,  T.  II,  p.  4C8):  "Lors<iu'nn  6clat  d'obus,  un  biscayen  ou  une  balle  ont  fracassS  les 
extr6mites  articulaires,  surtout  cellcs  qui  forment  {'articulation  du  pied  on  du  genou,  et  que  les  ligamens  qui  affermissent  cette  articulation  ont  6te  arrachcs 
ou  rompus,  1'amputation  immediate  devient  indispensable.  La  mSrne  indication  se  presenterait,  si  le  corps  Granger  s'6tait  perdu  dans  I'epaisseurd'une 
dcs  cxtremites  articulaires,  ou  se  trouvait  enclavfi  dans  1'articulation,  de  maniere  H  ne  pouvoir  en  etro  extrait  par  les  proc£d6s  simples  et  ordinaires.'1 

"THOMSON  (J.)  (Report  of  Obs..  etc.,  after  the  DattU  of  Waterloo,  Edinburgh.  1816,  p.  238):  "  Wounds  in  which  musket  balls  have  passed  through, 
or  are  lodged  in  the  ankle  joint,  almost  all  require  immediate  amputation.  These  injuries,  by  giving  rise  to  high  degrees  of  inflammation  and  symptomatic 
fever,  not  unfrequently  prove  fatal.  Among  a  great  number  who  had  survived  the  fever,  we  saw  but  few  in  whom  secondary  amputation  was  not 
required;  and,  in  the  cases  requiring  it,  this  operation  was  far  from  l>eing  so  successful  as  the  primary  amputation  had  been." 

»GUTHRIE  (G.  J.)  (A  Treatise  on  Gunshot  Wounds,  etc.,  London,  1827,  3d  ed..  p.  31)8):  "  Wounds  of  the  ankle  joint  from  gun-shot  are  extremely 
dangerous,  and  in  general  require  amputation.'' 


580  INJURIES    OF    THE    LOWER    EXTREMITIES.  fCHAP.  x. 

W.  Woodhull,  of  Newark,  N. J.,  certified  April  9,  1868:  "A  conoidal  ball  fractured  the  lower  extremities  of  the  tibia  and  fibula, 
also  several  of  the  tarsal  bones.  The  joint  is  anchylosed  and  the  heel  is  kept  five  inches  from  the  ground.  The  os  calcis  and 
astragalus  were  seriously  fractured.  Several  pieces  of  bone  have  been  lost  and  there  is  extensive  deformity  of  the  parts,"  etc. 
The  Dayton,  Ohio,  Examining  Board  in  subsequent  reports  states  that  the  pensioner  "  walks  on  the  ball  of  the  toes"  and  requires 
the  use  of  a  cane.  The  pensioner  was  paid  June  4,  1881. 

In  the  following  instance  the  missile  was  firmly  wedged  into  the  articulation,  and  was 
finally  removed  by  the  aid  of  two  trephines  used  simultaneously,  one  on  each  side  of  the  ball: 

CASE  817. — Chaplain  J.  W.  W.  Bolton,  5th  West  Virginia  Cavalry,  aged  26  years,  was  wounded  at  Cloyd's  Mountain, 
May  9,  1864,  by  a  minie'  ball,  which  entered  the  right  ankle  near  the  external  malleolus  and  lodged.  He  remained  under  treat 
ment  at  a  field  hospital  for  six  weeks  and  was  then  transferred  to  the  general  hospital  at  Parkersburg,  whence  he  was  reported 
as  having  been  "returned  to  duty  November  25,  1864."  Some  weeks  afterwards  the  patient  re-entered  the  hospital,  when  his 
case  was  reported  by  Assistant  Surgeon  W.  A.  Banks,  U.  S.  V.,  as  follows :  "  From  the  time  of  the  injury  the  patient  has  been 
subject  to  formation  of  abscesses  on  either  side  of  the  ankle  joint.  The  location  of  the  ball  was  accurately  ascertained  with  a 
porcelain  pointed  probe  after  all  other  means  had  failed.  On  February  3,  1865,  chloroform  was  administered  and  the  missile 
was  extracted.  An  incision  made  below  the  external  malleolus,  one  and  a  half  inches  long,  exposed  the  ball  lodging  in  the 
articulation,  its  base  being  one  and  a  half  inches  from  the  surface.  The  missile  was  so  firmly  impacted  that  it  could  not  be 
removed  by  any  form  of  bullet  forceps,  the  metal  giving  away  before  the  teeth  of  the  forceps.  It  was  finally  dislodged  by  means 
of  two  trephine  elevators,  using  one  on  each  side  of  the  ball  at  the  same  time.  The  patient  was  in  good  general  health  at  the 
time  of  the  operation.  He  did  well  afterwards.  Simple  dressings  were  applied.  The  wound  healed  and  the  patient  recovered 
with  an  immovable  joint."  He  left  the  hospital  three  weeks  after  the  operation,  his  term  of  service  having  expired  June  14, 
1864.  Dr.  E.  D.  Safibrd,  pension  examiner,  and  formerly  Acting  Assistant  Surgeon  at  the  Pakersburg  Hospital,  in  June,  1872, 
contributed  the  following  supplementary  description  of  the  injury :  ''The  ball  entered  through  the  external  malleolus,  into  and 
nearly  through  the  astragalus,  where  it  remained  embedded  until  extracted,"  etc.  "The  injury  produced  extensive  inflamma 
tion,  and  as  a  consequence  he  has  nearly  complete  anchylosis  of  the  joint  and  one  and  a  half  inches  shortening."  In  his  original 
application  the  pensioner  alleged  that  seventeen  pieces  of  bone  were  taken  out  of  the  wound  at  different  times.  Owing  to  his 
disability  being  considered  permanent  the  pensioner  has  been  exempted  from  further  examinations.  His  pension  was  paid 
September  4,  1881. 

CASE  818. — Private  F.  Lape,  Co.  K,  34th  Massachusetts,  aged  20  years,  was  wounded  in  the  right  foot,  at  New  Market, 
May  15,  1864.  He  was  captured  by  the  enemy  and  conveyed  to  hospital  at  Harrisonburg,  where  he  was  seen  and  examined  by 
Surgeon  T.  B.  Reed,  U.  S.  V.,  who  described  the  injury  as  a  "wound  of  the  ankle  joint ;"  also,  that  an  opening  was  made  and 
the  ball  was  searched  for  and  that  poultices  were  applied.  After  remaining  a  prisoner  for  six  months  the  man  was  exchanged 
and  conveyed  to  Camp  Parole  Hospital  at  Annapolis,  whence  he  was  permitted  to  leave  for  his  home,  on  furlough,  October  31st. 
Drs.  O.  E.  Brewster  and  W.  W.  Greene,  of  Pittsfield,  Mass.,  who  attended  the  patient  at  his  home,  certified  that  they  removed 
a  detached  portion  of  the  astragalus  from  the  wounded  foot  on  February  7,  1865.  The  patient  subsequently  returned  to  Camp 
Parole,  and  was  discharged  from  service  for  disability  March  21,  1865,  Surgeon  W.  D.  Stewart,  U.  S.  V.,  certifying  to  "gun 
shot  wound  by  a  ball,  which  entered  immediately  behind  the  internal  malleolus,  passed  forward  and  outward  and  lodged,  frac 
turing  the  end  of  the  tibia  and  implicating  the  joint."  Examining  Surgeon  H.  Eastman,  of  Pittsfield,  Mass.,  reported  Novem 
ber  5,  1873:  "From  the  appearance  of  the  wound  of  exit  I  should  say  that  a  number  of  pieces  of  bone  have  been  removed. 
The  ankle  w  perfectly  anchylosed :  the  muscles  of  the  calf  of  the  leg  are  very  much  atrophied ;  the  limb  is  more  than  one-third 
smaller  than  the  other  and  is  much  lower  in  temperature.  The  muscles  in  the  calf  are  so  much  contracted  that  when  he  is 
standing  the  heel  is  one  inch  above  the  floor,  obliging  him  to  walk  on  the  anterior  portion  of  the  foot."  The  pensioner  was  paid 
September  4,  1881. 

CASE  819.— Private  S.  Vansiclen,  Co.  D,  9th  New  York  State  Militia,  aged  20  years,  was  wounded  at  Fredericksburg, 
December  13,  1862.  Surgeon  C.  J.  Nordquist,  83d  New  York,  reported  his  admission  to  the  field  hospital  of  the  2d  division, 
First  Corps,  with  "shot  wound  of  left  ankle."  Acting  Assistant  Surgeon  L.  Dorsey  contributed  the  following  description  of  the 
injury:  "A  rifle  ball  penetrated  the  ankle,  outer  surface,  fracturing  the  astragalus  and  tibia.  The  man  was  admitted  to  Hare- 
wood  Hospital,  Washington,  ten  days  after  being  wounded.  On  December  27th  he  was  etherized,  when  the  broken  bones  were 
removed  from  the  tibia  and  astragalus.  During  the  progress  of  the  case  it  became  necessary  to  make  several  counter  openings. 
Simple  dressings  were  applied  and  stimulants  and  tonics  were  freely  given  for  a  considerable  length  of  time.  In  May,  1863, 
the  wound  had  entirely  healed  and  the  patient  was  gradually  recovering  the  use  of  the  -ankle  joint.  On  June  4,  1863,  he  was 
discharged  from  service,  having  regained  considerable  motion  of  the  joint."  He  subsequently  became  a  pensioner  and  entered 
the  National  Military  Home  in  Ohio,  where  he  was  examined  at  successive  intervals  by  the  Dayton  Pension  Board,  who  certified 
to  the  ball  having  passed  through  the  ankle,  and  described  the  foot  and  ankle  as  being  in  very  good  condition,  but  the  joint  as 
partially  anchylosed  and  about  one-half  inch  shortened.  The  pensioner  was  paid  December  4,  1880. 

CASE  820. — Private  J.  H.  Noble,  Co.  A,  20th  Massachusetts,  aged  32  years,  was  wounded  and  captured  at  the  battle  of 
White  Oak  Swamp,  June  30,  1862.  lie  remained  a  prisoner  for  three  weeks,  and  was  then  exchanged  and  conveyed  to  Bnlti 
more,  where  he  entered  Camden  Street  Hospital.  Acting  Assistant  Surgeon  E.  G.  Waters  reported:  "The  injury  was  caused 
by  a  musket  ball,  which  entered  the  flexure  of  the  left  ankle  joint  in  the  median  line  of  the  leg,  passed  downward  and  backward 
and  emerged  posteriorly,  to  the  left  and  one  inch  above  the  insertion  of  the  tendo-achillis.  completely  disorganizing  the  joint. 
The  patient  was  admitted  in  a  very  prostrated  condition.  An  anterior  splint  and  water  dressings  were  applied,  it  being  deemed 
advisable  to  attempt  to  save  the  foot.  On  August  21st  the  necrosed  extremity  of  the  tibia  and  upper  surface  of  the  astragalus 
were  removed  with  a  gouge.  At  this  time  a  finger  could  be  pressed  through  the  joint  and  no  cartilage  could  be  felt  in  the  lino 
of  its  passage.  On  October  20th  the  splint  was  removed  from  the  leg  and  poultices  were  applied  to  promote  exfoliation.  On 
November  1st  a  part  of  the  calcaneum  and  astragalus  were  removed,  and  a  sinus  extending  downward  from  the  internal  malleo- 


SECT,  vi.l  SHOT   FRACTURES   OF    THE    ANKLE    JOINT.  581 

lus  was  laid  open.  The  patient  subsequently  experienced  an  attack  of  erysipelas.  There  was  much  thickening,  hut  it  rapidly 
yielded  to  camphor  and  mercurial  ointment.  By  January  22,  1863,  all  discharge  had  ceased  and  the  case  promised  to  leave  an 
anchylosed  joint  but  a  serviceable  foot.  Though  not  more  than  three  or  four  such  cases  have  been  under  treatment,  it  is  deemed 
proper  to  state  that  this  is  the  only  attempt  that  has  been  made  in  this  hospital  to  save  a  foot  after  gunshot  comminution  of  the 
joint,  and  it  is  gratifying  to  know  that  it  has  resulted  successfully."  The  removed  portions  of  the  bone,  comprising  twenty 
small  necrosed  fragments,  were  contributed  to  the  Museum  by  Surgeon  A.  B.  Hasson,  U.  S.  A.,  in  charge  of  the  hospital,  and 
constitute  specimen  424  of  the  Surgical  Section.  The  patient  was  discharged  from  service  March  23,  1863,  and  pensioned. 
Examining  Surgeon  O.  S.  Root,  of  Pittsfield,  Mass.,  certified  November  27,  1863:  "The  applicant  is  walking  on  crutches,  his 
limb  being  shortened  one  and  a  half  inches  and  the  ankle  stiff.  He  cannot  get  the  heel  to  the  ground.  The  wound  has  recently 
broken  open  and  many  pieces  of  bone  have  come  out,"  etc.  The  Hartford  Examining  Board  described  the  injury  December  1, 
1875,  and  reported:  "The  great  toe  drops  and  the  second  and  third  toes  override  it.  He  has  no  power  over  the  great  toe;  has 
a  very  perceptible  limp  in  walking,  and  is  obliged  to  use  a  cane.  The  ankle  is  completely  anchylosed,  the  leg  much  atro 
phied  and  two  inches  smaller  than  the  other.  The  leg  swells  and  is  painful  after  using  it."  In  Septembei-,  1878,  the  same  board 
reported  that  the  parts  "broke  out  again  and  discharged  last  July,  confining  him  to  his  bed  several  weeks.  The  pensioner  com 
plains  of  more  or  less  constant  pain  in  the  leg,  and  if  he  uses  it  much  it  swells  arid  becomes  painful  so  that  he  is  unable  to  sleep. 
He  still  has  to  use  a  cane.  The  leg  is  worse  than  useless."  The  pensioner  was  paid  September  4,  1880. 

CASE  821. — Private  E.  P.  Dutton,  Co.  H,  2d  U.  S.  Sharpshooters  (subsequently  transferred  to  the  4th  Vermont),  aged 
18  years,  was  wounded  in  the  left  ankle,  before  Petersburg,  October  13,  1864.  He  passed  through  various  hospitals,  lastly 
entering  Sloan  Hospital,  Montpelier,  on  April  30,  1865.  Surgeon  H.  Janes,  U.  S.  V.,  in 
charge  of  the  latter,  contributed  the  photograph  represented  in  the  annexed  cut  (FlG.  331), 
with  the  following  report :  "Gunshot  wound  of  ankle  joint  by  a  minie'  ball,  which  entered 
two  inches  posterior  to  the  internal  malleolus,  wounding  the  tendo-achillis,  passed  forward 
and  outward,  and  lodged  (as  the  field  surgeon  stated)  in  the  ankle  joint.  The  missile  was 
removed  the  next  day.  No  fragments  of  bone  came  away  then  or  subsequently.  For 
about  three  months  the  discharge  was  profuse,  offensive,  and  at  times  dark  colored,  after 
which  it  gradually  diminished.  The  original  wound  healed  in  about  four  and  a  half  months. 
Abscesses  formed  between  the  ankle  and  the  tendo-achillis  on  each  side,  which  continued  to 
discharge  after  the  wound  had  healed.  About  January  1,  1865,  the  parts  became  gangren 
ous,  which  was  checked  by  the  use  of  nitric  acid  and  bromine  in  the  course  of  a  week,  the 
ulcers  healing  about  two  months  afterwards.  When  discharged  from  service,  June  14, 1865, 
the  patient  was  in  good  health  and  able  to  fully  extend  the  foot,  but  unable  to  flex  it  beyond 

a  right  angle.  He  could  walk  a  mile  or  two  without  difficulty,  but  on  going  too  far  he  felt  Fl(}  331-_  Appearance  of  left  leg  six 
pain  in  the  joint.  There  was  also  some  tenderness  at  the  tibio-tarsal  articulation."  Exam-  months  after  shot  wound  of  ankle  joint, 
iner  L.  J.  Alleman,  of  Boone,  Iowa,  certified  to  the  injury  and  reported:  "Contraction  of  ' 

tendo-achillis  und  flexor  muscles  of  first  and  second  toes,  drawing  them  inward  and  upward  and  deforming  the  first  and  second 
joint  of  the  first  toe;  indolent  ulcer  below  the  external  malleolus,  and  another  above  the  inner  malleolus  starting  from  the  edge 
of  the  wound.  Inability  to  walk  on  injured  foot  in  consequence  of  said  condition,  and  disability  equal  to  loss  of  foot."  The 
pensioner  was  paid  June  4,  1880. 

CASE  822. — Private  G.  F.  Durkee,  Co.  B,  9th  Vermont,  aged  28  years,  was  wounded  in  the  left  ankle  during  the  engage 
ment  at  Newport  Barracks,  February  2,  1864,  and  entered  Mansfield  Hospital,  Moorehead  City,  four  days  afterwards.  Surgeon 
J.  B.  Bellangee,  U.  S.  V.,  in  charge,  reported  the  injury  and  added  that  the  internal  malleolus  was  fractured;  also  that  he  removed 
the  comminuted  bone  two  days  after  the  patient's  admission.  The  patient  subsequently  passed  through  various  hospitals,  and 
on  December  14,  1864,  he  was  assigned  to  the  Veteran  Reserve  Corps.  Surgeon  H.  Janes,  U.  S.  V.,  in  charge  of  Sloan  Hos 
pital,  Montpelier,  contributed  a  photograph  of  the  case  (Card  Photographs,  Vol.  Ill,  p.  44),  with  the  following  history:  "The 
wound  was  caused  by  a  mini6  ball,  which  entered  at  a  point  just  external  and  above  the  internal  malleolus,  passed  directly 
downward  and  emerged  at  the  inside  of  the  sole  of  the  foot,  fracturing  the  tibia  and  opening  the  ankle  joint.  The  patient  stated 
that  a  number  of  pieces  of  bone  were  removed  at  first,  and  that  several  necrosed  pieces  came  away  afterwards.  At  the  time 
of  the  injury  he  was  in  excellent  health,  and  his  appetite  continued  pretty  good  all  the  time.  At  first  suppuration  was  profuse; 
large  abscesses  formed  in  the  leg  and  he  became  much  prostrated.  Free  incisions  were  made  and  cold-water  dressings  were 
applied.  About  April  1st  the  wound  began  to  improve.  It  gradually  but  steadily  grew  better,  and  finally  closed  about  the 
middle  of  July.  He  was  not  able  to  do  without  crutches  until  the  latter  part  of  September.  After  being  transferred  to  the 
Veteran  Reserve  Corps  he  never  had  to  be  excused  from  duty  on  account  of  ill  health  or  lameness.  On  September  14,  1865, 
when  discharged  from  service,  he  could  flex  the  foot  on  the  leg  to  a  right  angle  and  extend  it  about  ten  degrees  more.  He  wan 
able  to  walk  tour  or  five  miles  a  day,  but  the  joint  would  swell  after  going  any  considerable  distance.  There  was  also  some 
tenderness  on  pressure  about  the  joint."  Various  examining  surgeons  have  certified  to  the  injury  and  have  stated  that  "the 
ankle  joint  is  restricted  in  its  motion;"  also  that  there  is  a  depression  on  the  inner  side  of  the  foot,  and  that  the  leg  is  atrophied 
and  shows  several  sears  from  abscesses.  The  pensioner  was  paid  September  4,  1880. 

CASE  823. —  W.  H.  H.  Shaw,  a  Confederate  soldier  (regiment  not  recorded),  received  a  shot  fracture  of  the  ankle  joint, 
at  Chancellorsville,  May  3, 1863.  He  was  admitted  to  the  Richmond  Confederate  general  hospital  No.  24,  from  Camp  Winder, 
August  1st.  Two  weeks  later  the  wound  was  in  a  very  bad  state  of  gangrene,  and  nitric  acid  was  used,  also  disinfectants,  tur 
pentine,  and  coal  tar,  which  were  applied  to  the  leg  every  day.  Tonics  and  stimulants  were  administered.  During  the  night  of 
August  18th  haemorrhage  took  place,  the  patient  losing  one  pint  of  blood.  On  the  following  day  the  anterior  tibial  artery  was 
ligated.  By  September  8th  the  patient  was  improving  very  fast  and  the  wound  was  healing.  On  September  15,  1863,  when 
the  patient  was  furloughed,  the  wound  was  nearly  healed  but  he  had  no  use  of  the  foot. 


582  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

CASK  824. — Private  A.  B.  McDaniel,  Co.  I,  7th  North  Carolina,  aged  34  years,  was  wounded  and  taken  prisoner  at 
Gettysburg,  July  3,  1863.  He  was  admitted  to  Chester  Hospital  two  weeks  after  the  reception  of  the  injury,  where  the  nature 
of  the  wound  was  not  recorded.  Three  months  afterwards  the  patient  was  transferred  to  Point  Lookout  Hospital,  whence  Act 
ing  Assistant  Surgeon  R.  N.  Wright  made  the  following  report:  "The  patient  was  admitted  to  this  hospital  with  gunshot  wound 
of  left  ankle  joint.  The  wound  was  inflicted  by  a  minid  ball,  which  shattered  the  joint  to  a  considerable  extent,  entering  just 
above  the  external  malleolus,  passing  obliquely  downward  and  forward  and  fracturing  the  bones.  A  number  of  bony  fragments 
have  escaped  from  the  openings  and  there  has  been  considerable  purulent  discharge.  Erysipelas  made  its  appearance  before  the 
patient  entered  this  hospital.  At  the  present  time,  March  2,  1804,  the  wounds  are  healed  and  the  patient  is  doing  well  but  has 
very  little  motion  in  the  joint."  The  man  Avas  forwarded  to  City  Point  for  exchange  the  following  day,  March  3,  1864.  The 
man  being  a  Confederate  soldier,  no  further  history  of  the  case  could  be  obtained. 

In  the  next  two  cases  the  joint  became  firmly  anchylosed,  causing,  in  each  case,  the 
heel  to  be  raised  several  inches  and  compelling  the  patient  to  walk  on  the  toes: 

CASK  825. — Sergeant  T.  B.  Sturdivant,  Co.  B,  21st  New  York  Cavalry,  aged  39  years,  was  wounded  in  a  cavalry  skirmish 
near  Halltown,  March  24,  1864.  Acting  Assistant  Surgeon  J.  H.  Bartholf  reported :  "Gunshot  fracture  of  left  ankle  joint,  by  a 
rifled  pistol  ball,  which  entered  the  inner  side  of  the  leg  five  inches  above  the  ankle,  going  downward  and  outward  and  emerging 
one  and  a  half  inches  below  the  ankle.  The  patient  was  admitted  to  Frederick  from  his  regimental  hospital  at  Halltown  two 
days  after  the  injury.  His  general  condition  was  not  good;  pulse  140.  He  had  much  pain  in  the  ankle,  which,  with  the  foot,  was 
much  swollen  and  of  a  glistening  surface.  Pus,  retained  superficially  on  the  inner  side  of  the  leg,  was  emptied  by  slitting  down 
two  inches;  and  a  few  small  bits  of  bone  about  the  size  of  peas,  which  were  felt  by  the  finger  within  the  lower  wound,  were 
removed.  Pressure  over  the  outer  ankle  evacuated  pus  mixed  with  a  yellow,  clear,  glairy  fluid  from  the  lower  opening.  Poul 
tices  were  applied  to  the  wounds  and  a  general  supporting  treatment  was  ordered;  milk  punch  and  morphia  at  night.  Two 
days  after  his  admission  the  patient  was  better  in  all  respects,  and  by  March  31st  he  had  still  further  improved,  the  treatment 
being  continued  and  good  food  given.  On  April  4th  the  limb  as  well  as  the  injured  joint  and  the  wounds  were  in  a  surprisingly 
good  condition;  redness  and  swelling  gone;  pain  and  tenderness  of  joint  nearly  gone;  suppuration  slight;  nearly  a  correspond 
ing  improvement  in  patient's  general  condition.  On  April  28th  apiece  of  bone  about  the  size  of  a  bullet,  apparently  from  one  of 
the  tarsal  bones,  was  removed,  after  which  the  condition  of  the  foot  and  ankle  improved  very  much.  The  patient  was  now  able 
to  sit  up  all  day,  and  from  this  time  he  went  on  exceedingly  well,  being  almost  without  pain  or  any  trouble  in  the  joint.  He 
walked  on  crutches  up  to  the  time  of  his  furlough  on  May  25th.  When  he  returned  from  furlough  in  July  he  walked  with  a 
cane,  the  wounds  having  closed,  leaving  the  ankle  joint  somewhat  stiffened."  He  was  subsequently  transferred  to  Camp  Parole, 
Annapolis,  whence  he  was  discharged  May  2,  1865,  and  pensioned,  Surgeon  W.  D.  Stewart,  U.  S.  V.,  certifying  to  "anchylosis 
of  the  ankle  joint  and  extension  of  the  foot"  resulting  from  the  wound.  Examining  Surgeon  L.  Darling,  of  Hammond  Creek, 
Pennsylvania,  October  7,  1874,  certified  to  contraction  of  the  gastrocnemius  muscle  and  the  tipping  of  the  foot  upon  the  toes, 
and  added:  "The  pensioner's  health  is  very  feeble;  he  is  weak  and  emaciated  and  has  disease  of  the  lungs."  Examiner  N. 
Parker,  of  Wellsborough,  Pennsylvania,  reported,  June  17,  1880:  "  The  injured  leg  at  the  calf  is  three  inches  smaller  than  the 
other;  the  weight  is  borne  on  the  anterior  part  of  the  foot;  pensioner  quite  lame.  He  states  that  nine  months  ago  an  ulcer 
formed  at  the  outer  side  of  the  ankle  and  pieces  of  bone  came  out.  There  is  slight  inflammation  and  soreness  at  the  site  of  the 
ulcer."  The  pensioner  was  paid  September  4,  1880. 

CASE  826. — Corporal  C.  B.  Davis,  Co.  F,  9th  New  Hampshire,  aged  23  years,  was  wounded  and  taken  prisoner  at 
Poplar  Grove  Church,  September  30,  1864.  He  remained  in  captivity  for  nine  days  and  was  then  paroled  and  conveyed  to 
hospital  at  Annapolis,  whence  Acting  Assistant  Surgeon  J.  S.  Fulks  made  the  following  i-eport :  "  The  patient  came  into  my 
ward  suffering  from  gunshot  wound  of  the  left  ankle  joint,  inflicted  by  a  minitS  ball  passing  transversely  across  and  producing 
compound  comminuted  fracture.  Sloughing  commenced  and  continued  until  the  integument  over  a  considerable  space  around 
the  wound  was  destroyed.  Strong  solutions  of  nitrate  of  silver  and  permanganate  of  potash  failed  to  arrest  the  sloughing,  but 
this  was  successfully  accomplished  by  the  application  of  a  concentrated  solution  of  nitric  acid.  The  wound  is  now  (December 
31st)  progressing  favorably  and  the  patient  will  recover  with  anchylosis  of  the  joint."  The  patient  was  subsequently  transferred 
to  Webster  Hospital,  Manchester,  where  he  was  discharged  from  service  May  27,  1865,  and  pensioned.  Examining  Surgeon  T. 
Sanborn,  of  Newport,  N.  H.,  certified,  August  2,  1885  :  "  The  fracture  appears  to  have  been  a  comminution.  The  tendo-achillis 
sloughed  away  and  the  ankle  is  anchylosed.  The  toes  point  downward  and  the  heel  cannot  be  brought  to  the  ground."  Exam 
iner  W.  W.  Sleeper,  of  Salisbury,  N.  H.,  reported,  September  5,  1873:  "The  ankle  joint  is  deformed  and  stiff,  causing  the  heel 
to  be  raised  about  four  inches  and  obliging  the  pensioner  to  walk  upon  his  toes.  There  is  necrosis  about  the  joint,  which  has 
discharged  several  pieces  of  bone  but  is  now  healed.  The  muscles  of  the  leg  are  much  diminished."  The  deformity  and  anchy 
losis  of  the  joint  continued  at  the  time  the  last  payment  was  made  to  the  pensioner,  on  June  4,  1881. 

Of  the  ninety-nine  fatal  cases  of  shot  fractures  of  the  ankle  joint  treated  conserv 
atively,  death  was  ascribed  to  pya3mia  in  twenty-five  and  to  tetanus  in  five  instances: 

CASK  8'27. — "Private  J.  Jiggen,  Co.  B,  10th  Wisconsin,  was  wounded  at  Chickamauga,  September  19,  1863,  by  a  mini6 
ball,  which  entered  the  inner  side  of  the  right  ankle  below  the  malleolus,  passing  through  the  joint  and  making  its  exit  on  the 
anterior  portion  of  the  instep.  He  was  taken  prisoner  and  remained  within  the  enemy's  lines  until  October  2d,  when  he  came 
through  and  was  admitted  into  the  general  field  hospital  of  the  1st  division,  Fourteenth  Corps.  The  appearance  of  the  wound 
and  limb  was  then  healihy  and  considered  favorable  to  recovery  until  October  14th,  when  the  patient  was  attacked  with  rigors 
The  limb  also  commenced  to  swell  about  this  time,  which  was  accompanied  by  a  cessation  of  discharge.  Poultices  were  applied 
to  the  wound  and  free  incisions  were  made  to  favor  the  exit  of  pus.  A  stimulant  and  tonic  treatment  was  administered  and  con 
tinued  up  to  the  time  of  the  patient's  death,  which  occurred  on  October  20,  18b3,  with  all  the  symptoms  of  pyaemia.  At  the 


SECT.  VI.] 


SHOT    FRACTURES    OF    THE    ANKLE   JOINT. 


583 


post-mortem  examination  of  the  limb  the  astragalus  was  found  to  be  fractured  and  the  three  cuneiform  bones  in  a  state  of  com 
minution.  The  articulating  surfaces  of  the  tibia  and  fibula  together  with  that  of  the  astragalus  were  blackened  and  eroded,  and 
the  cuboid  and  cuneiform  bones  with  the  articulating  portion  of  the  astragalus  were  in  a  complete  state  of  disintegration."  The 
history  was  reported  by  Surgeon  W.  M.  Wright,  79th  Pennsylvania,  in  charge  of  the  hospital. 

CASE  828. — Private  J.  Conly,  Co.  A,  90th  Illinois,  aged  18  years,  was  wounded  in 
the  right  leg,  at  Mission  Ridge,  November  25,  1863.  He  remained  under  treatment  at  a 
field  hospital  for  four  weeks,  and  subsequently  he  was  an  inmate  of  the  Chattanooga  gen 
eral  hospital  until  the  following  February,  when  he  was  transferred  to  hospital  No.  1,  at 
Nashville.  Surgeon  C.  W.  Hornor,  U.  S.  V.,  in  charge  of  the  latter,  recorded  the  follow 
ing  description  and  result  of  the  injury:  "A  gunshot  fracture  of  tibia  and  fibula  by  a 
mini6  ball,  which  entered  three  inches  above  the  external  malleolus,  fracturing  the  bone, 
and  passing  downward  and  inward.  The  missile  was  removed  at  a  point  one  inch  internal 
to  the  inner  malleolus,  its  presence  being  suspected  only  by  the  formation  of  an  abscess 
over  the  seat  of  its  lodgement  a  few  days  before  its  extraction.  The  patient  died  March 
7,  1864.  At  the  post-mortem  examination  old  and  strong  pleuritic  adhesions  were  dis 
covered  at  the  apex  of  the  right  lung,  which  contained  a  few  dormant  tubercles;  the 
remainder  of  the  lung  tissues  were  healthy.  The  bronchial  mucous  membrane  was  slightly 
inflamed.  The  heart  was  healthy  and  contained  neither  light  yellow  nor  blood  clots  in 
its  cavities,  and  the  blood  in  the  heart  as  well  as  in  the  vessels  was  remarkable  for  its 
fluidity.  The  liver  was  healthy  and  weighed  four  pounds  and  one  ounce;  spleen  very 
soft  and  puffy  and  weighing  eleven  and  a  half  ounces;  kidneys  healthy,  the  right  one 
weighing  five  and  a  half  ounces  and  the  left  one  six  ounces.  The  stomach  and  bowels 
were  in  a  healthy  condition.  On  examining  the  cranium  the  vessels  were  found  very  much 
distended  with  blood.  The  arachnoid  cavity  contained  serum;  the  organs  otherwise  were 
healthy."  The  bones  of  the  injured  ankle  (Spec.  2188)  were  contributed  to  the  Museum 
33.^ posterior  °.v  Acting  Assistant  Surgeon  H.  C.  Ma}*,  and  are  represented  in  the  wood-cuts  (FlGS.  332, 


view  of  the  bones  ot     333)  revealing  that  the  tibia  was  split  into  the  ioint  and  showing  the  fractured  portions  of 

the  right  ankle.  Spec.  J 

2188. 


FIG.  333.— Anterior 
view  of  the  bones 
of  the  right  ankle. 
Spec.  2188. 


the  bones  to  be  carious,  the  articulation  being  destroyed  by  suppuration. 
CASR  829. — Private  \V.  H.  Perry,  Co.  C,  1st  Massachusetts  Heavy  Artillery,  aged  39  years,  received  a  gunshot  fracture 
of  the  right  tibia  and  fibula,  also  flesh  wounds  of  both  lower  extremities,  and  a  wound  of  the  thorax,  at  Spottsylvania,  May  19, 
1864.  He  entered  Lincoln  Hospital,  at  Washington,  three  days  afterwards,  where  he  died  of  pyaemia  May  30,  1864.  The 
historv,  with  the  pathological  specimen  (No.  4580),  represented  in  the  accompanying  cut  (FlG.  335),  was  con 
tributed  to  the  Museum  by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.  The  specimen  consists  of  the  greater 
portion  of  the  bones  of  the  right  leg,  showing  the  fibula  to  be  transversely  fractured  in  the  lowest  fourth  and 
the  anterior  portion  of  the  tibia  shattered  into  the  ankle. 

CASE  830. — Corporal  M.  Martin,  Co.  D,  28th  Massachusetts,  aged  27  years,  was  wounded  at  Hatcher's 
Run,  March  25,  1865.  Surgeon  F.  M.  Hammond,  126th  New  York,  reported  his  admission  to  the  field  hospital 
of  the  1st  division,  Second  Corps,  with  "shot  wound  of  left  foot."  Ten  days  after  the  reception  of  the  injury 
the  patient  was  transferred  to  Douglas  Hospital,  \Vashington,  whence  Assistant  Surgeon  W. 
F.  Norris,  U.  S.  A.,  contributed  the  pathological  specimen  shown  in  the  annexed  wood-cut 
(FIG.  334),  with  the  following  history:  ''TheAvound  penetrated  the  ankle  joint.  The  ball 
entered  in  front,  about  midway  between  the  malleoli,  and  made  its  exit  posteriorly  and  a  little 
above  the  external  malleolus,  comminuting  in  its  course  the  lower  ends  of  the  tibia  and  fibula. 
There  was  marked  constitutional  disturbance,  headache,  high  fever,  rapid  pulse,  and  loss  of 
appetite.  But  little  swelling  or  inflammation  in  the  joint,  however,  took  place,  and  not  much 
discharge.  The  day  subsequent  to  the  patient's  admission  the  joint  was  carefully  examined, 
when  both  bones  were  found  to  be  much  comminuted  and  amputation  \vas  decided  as  the 
only  resort  giving  a  fair  chance  of  recovery.  The  patient,  however,  positively  declined  all 
operative  interference.  Towards  evening  he  had  a  slight  chill.  On  April  7th  there  was 
nausea  and  vomiting,  and  on  the  following  day  he  had  three  chills,  followed  by  fever  and 
profuse  sweats.  Nausea  and  vomiting  continued,  the  fluid  ejected  being  tinged  with  bile;  the 
discharge  from  both  wounds,  however,  retained  its  healthy  appearance.  On  April  9th,  10th, 
llth,  and  12th  the  patient  had  a  chill  each  day,  and  on  the  latter  day  there  was  marked  yel 
lowness  of  the  face  and  conjunctiva?;  slight  cough  and  delirium.  ..On  April  13th  there  was  another  chill;  pulse  110,  respiration 
38;  severe  pleuritic  pain  in  the  right  side  of  the  chest.  Death  occurretl  on  April  14,  1865.  Rigor  mortis  was  well  marked  at 
the  autopsy,  also  the  yellow  hue  of  the  skin  and  conjunctivae.  On  opening  the  thoracic  cavity  nearly  a  pint  of  intensely  yellow 
fluid  was  found  in  the  right  pleural  cavity.  Each  lobe  of  the  right  lung  presented  numerous  patches  varying  in  size  from  halt' 
an  inch  to  two  inches  in  diameter,  most  of  which  on  incision  gave  exit  to  pus;  the  left  lung  contained  similar  patches  in  both 
lobes.  The  spleen  was  much  softened,  being  almost  semifluid  in  consistence;  liver  enlarged  but  apparently  healthy;  other 
thoracic  and  abdominal  viscera  normal."  The  specimen  (No.  253)  consists  of  the  astragalus  and  the  lower  halves  of  the  tibia 
and  fibula  of  the  injured  limb,  the  extremities  of  both  bones  of  the  leg  being  shattered. 

CASE  831. — Private  G.  Abbott,  Co.  K,  9th  Minnesota,  aged  39  years,  was  wounded  in  the  left  foot,  at  the  battle  before 
Nashville,  December  15,  1864,  and  admitted  to  hospital  No.  8  the  same  da}-.  Two  days  afterwards  the  patient  was  placed  under 
the  influence  of  chloroform,  when  the  wound  was  examined  and  ascertained  to  have  been  caused  by  a  minic  ball,  which  entered 
at  the  outer  aspect  of  the  instep,  passed  inward  and  upward,  and  emerged  one  inch  below  the  inner  malleolus,  badly  fracturing 


FIG.  33J. -Shat 
tered  bones  of  the 
left  ankle  joint. 
Spec.  253. 


.—  Tibia 
>  the 
right  ankle  joint. — 
SJKC.  4580. 


584  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

the  cuboid,  scaphoid,  and  head  of  astragalus,  and  channelling  a  large  passage  through  these  bones.  The  patient  being  :\  robust 
man,  it  was  thought  advisable  to  attempt  to  save  the  limb  and  to  trust  to  nature  to  repair  the  injury.  Irrigation  was  found 
serviceable  to  keep  down  and  control  the  inflammation,  swelling,  and  pain.  The  discharge  was  limited  for  some  days,  but  pro 
fuse  towards  the  last.  On  December  28th  an  abscess  over  the  inner  malleolus  was  opened,  causing  a  free  evacuation  of  pus. 
Two  days  later  suppuration  was  free  from  the  posterior  part  of  the  leg  as  well  as  about  the  foot.  Lead  wash  and  tight  band 
aging  was  applied.  From  December  30th  the  patient  commenced  to  fail.  He  became  very  icteric  in  appearance,  his  pulse  rapid, 
and  the  discharge  from  the  wound  unhealthy.  On  January  2d  he  was  delirious,  and  on  the  following  day,  January  3,  1865,  he 
died.  At  the  autopsy  all  the  internal  organs  were  found  remarkably  healthy.  The  ankle  joint  was  filled  with  pus  and  there 
were  sinuses  extending  up  the  leg.  The  capsular  ligament  of  the  ankle  joint  was  found  to  be  nearly  destroyed,  and  the  articu 
lar  extremities  and  surfaces  of  the  bones  were  eroded.  The  history,  with  the  specimen  (No.  37f>5),  consisting  of  the  calcaneum, 
the  fractured  astragalus,  cuboid,  and  scaphoid  bones,  was  contributed  by  Acting  Assistant  Surgeon  H.  C.  May. 

In  one  of  the  ninety-nine  fatal  cases  of  shot  fracture  of  the  ankle  joint  the  tibial  artery 
was  ligated,  in  another  the  femoral: 

CASE  832. — Private  W.  Lazier,  Co.  M,  5th  Artillery,  aged  25  years,  was  wounded  in  the  right  ankle  joint,  at  Brandy 
Station,  August  1,  1863,  by  a  bullet,  which  entered  close  to  the  anterior  edge  of  the  internal  malleolus,  slightly  comminuting  it. 
On  the  following  day  he  was  conveyed  to  Douglas  Hospital  at  Washington.  The  missile  was  supposed  to  have  lodged,  there 
being  no  external  wound  of  exit  and  the  patient  not  being  aware  of  it  having  been  removed.  On  the  next  day  Assistant  Surgeon 
W.  Thomson,  U.  S.  A.,  in  charge  of  the  hospital,  etherized  the  patient  and  explored  for  the  missile,  but  it  could  not  be  found. 
The  comminution  was  so  slight  that  it  was  deemed  possible  to  save  the  foot  with  the  aid  of  free  incisions  should  they  become 
necessary.  A  prescription  consisting  of  two  drachms  of  fluid  extract  of  rhubarb,  one  scruple  of  quinine,  and  three  ounces  of 
whiskey  was  ordered,  on  August  5th,  to  be  given  in  teaspoonful  doses  every  four  hours.  Dead  bone  having  been  felt  with  the 
probe,  and  the  inflammation  becoming  so  extensive  and  severe  as  to  render  operative  interference  necessary,  two  large  incisions 
were  made  at  the  sides  of  the  internal  malleolus  on  August  8th,  by  Acting  Assistant  Surgeon  C.  Carvallo,  and  several  loose  frag 
ments  of  bone  were  extracted.  On  this  day  the  patient  also  had  a  chill  of  ten  minutes'  duration,  and  one-half  drachm  of  quinine 
dissolved  in  four  ounces  of  whiskey  was  prescribed  to  be  taken  in  tablespoonful  doses.  On  August  llth  the  inflammation  became 
erysipelatous,  involving  the  leg  below  the  knee,  and  there  was  another  chill.  The  quinine  and  whiskey  mixture  was  then  repeated 
and  tincture  of  iodine  was  used  to  the  limb,  after  which  a  wash  consisting  of  one-half  ounce  of  muriate  of  ammonia,  ten  grains  of 
acetate  of  morphia,  two  ounces  of  sulphuric  ether,  and  one  pint  of  water,  was  applied  over  it.  On  August  13th  there  was  still 
pain,  swelling,  and  redness,  and  another  chill  of  fifteen  minutes'  duration  took  place.  Fluctuation  was  well  marked,  and  incisions 
were  made  to  give  free  exit  to  pus.  In  addition  to  the  quinine,  tablespoonful  doses  of  a  mixture  of  two  drachms  of  muriated 
tincture  of  iron,  two  ounces  each  of  spirit  of  Mindererus  and  water,  and  half  an  ounce  of  simple  syrup,  were  administered  three 
times  a  day.  On  August  15th,  incisions  were  again  required  over  both  malleoli  and  another  on  the  calf  of  the  leg  to  allow 
accumulated  pus  to  discharge.  The  patient's  condition  was  now  too  much  depressed  to  allow  an  amputation.  Two  days  later 
pleurisy  developed,  which  was  treated  by  counter-irritation  of  turpentine  and  alcohol  fomentations  to  the  breast,  and  mustard 
poultices.  On  August  18th  the  limb  had  grown  very  red,  swollen,  and  painful  as  high  as  the  knee,  and,  fluctuation  being  felt, 
another  incision  was  made  by  Dr.  Carvallo,  after  which  the  leg  was  placed  in  a  bran-box,  and  the  wash,  with  one-half  drachm 
of  fluid  extract  of  hyosciamus  superadded,  was  re-applied.  Haemorrhage  from  one  of  the  incisions  in  the  calf  of  the  leg,  and  sup 
posed  to  proceed  from  one  of  the  muscular  branches,  came  on  one-half  hour  afterwards,  when  cold  water,  alum,  and  compres 
sion  was  applied,  and  Hoffman's  anodyne  mixed  with  brandy  and  water  was  given  every  half  hour.  Haemorrhages  recurred  in 
the  afternoon  and  evening,  being  decidedly  arterial,  and  were  checked  by  persulphate  of  iron  applied  with  charpie.  Though  active 
interference  was  demanded,  the  undoubted  disease  of  the  lungs  caused  by  metastatic  abscesses  from  pyaemia,  together  with  the 
very  rapid  and  difficult  respiration  and  the  collapse  of  the  patient  from  the  loss  of  six  or  eight  ounces  of  blood,  made  amputation 
impossible.  The  only  other  resort  being  ligation  of  the  femoral,  ether  was  carefully  administered  and  that  operation  was  per 
formed  at  9  P.  M.,  at  the  point  of  election,  by  Assistant  Surgeon  Thomson,  the  leg  being  so  distended  with  clotted  blood  as  to 
make  any  effort  to  secure  the  divided  vessels  abortive.  The  clots  of  blood  were  removed  from  the  leg  by  compression,  and  after 
the  operation  the  case  was  treated  with  the  largest  doses  of  stimulants,  including  aromatic  spirits  of  ammonia  and  fluid  extract 
of  senega.  Though  he  reacted  from  the  low  state  he  was  in  before  the  operation,  the  patient  gradually  sank  during  the  night 
and  died  at  8  A.  M.  on  August  19,  1863.  At  the  autopsy  both  lungs  were  found  to  be  filled  with  metastatic  abscesses;  there  was 
also  effusion  of  serum  in  both  thoracic  cavities.  No  injured  artery  could  be  detected,  nor  could  the  missile  be  found.  The 
detailed  notes  of  the  case  were  furnished  by  the  operators.  Dr.  Thomson  also  contributed  the  bones  of  the  injured  ankle  (Spec. 
1682),  showing  the  articular  surfaces  to  be  eroded  by  suppuration  and  the  internal  malleolus  to  be  slightly  fractured. 

CASE  833. — Private  W.  Coakley,  Co.  K,  28th  Massachusetts,  aged  37  years,  was  wounded  before  Petersburg,  June  18, 
1864,  and  admitted  to  the  field  hospital  of  the  1st  division,  ^Second  Corps,  where  Surgeon  W.  Vosburgh,  lllth  New  York, 
recorded:  "Shot  wound  of  foot."  Acting  Assistant  Surgeon  E.  C.  Manoch  reported  the  following  description  and  result  of  the 
injury  :  "The  patient  entered  the  First  Division  Hospital  at  Annapolis  June  21st.  He  was  wounded  by  a  piece  of  shell,  which 
struck  the  inner  aspect  of  the  left  ankle,  fracturing  part  of  the  bones  forming  the  joint.  When  first  admitted  the  wound  was 
doing  well.  On  June  25th  he  was  isolated,  at  which  time  he  complained  of  very  severe  pain  over  the  Avhole  foot,  which  had 
become  very  much  distended  and  increased  in  temperature.  I  ordered  the  parts  to  be  painted  with  muriatic  tincture  of  iron, 
also  the  tincture  to  be  given  internally,  and  whiskey  and  beef-tea.  The  next  day  the  pain  in  the  foot  had  grown  very  intense 
and  the  patient's  face  presented  a  very  anxious  appearance,  he  having  passed  a  very  restless  night.  On  June  27th  his  general 
condition  was  the  same ;  pulse  rapid  and  weak.  The  skin  at  the  external  front  of  the  ankle  now  presented  a,  purple  appearance, 
being  soft  and  fluctuating  on  pressure.  An  incision  gave  exit  to  several  ounces  of  foul  pus,  after  which  charcoal  and  yeast 
poultices  were  applied.  In  the  evening  the  discolored  part  assumed  a  decidedly  gangrenous  appearance.  The  patient  sank 
rapidly  notwithstanding  the  strong  stimulation  with  plenty  of  beef-essence,  and  he  died  early  in  the  morning  of  June  29,  1864." 


AT    THE    ANKLE    JOINT. 


585 


CASE  834. — Dr.  D.  A.  Hoffman,  pension  examining  surgeon  at  Oskaloosa,  Iowa,  reports  that  "  Brigadier  General  S.  A. 
Rice,  U.  S.  V.,  was  wounded  at  the  battle  of  Jenkins's  Ferry,  April  30,  1864,  a  ball  entering  the  external  malleolus  of  the  right 
ankle,  carrying  with  it  a  portion  of  his  spur  and  strap,  and  passing  through  the  ankle  joint.  I  learned  from  the  surgeon  who 
accompanied  him  that  previous  to  his  return  home  he  had  several  attacks  of  erysipelas  On  June  1st  I  examined  him  and  found 
him  suffering  with  pyaemia  and  an  unhealthy  condition  of  the  system  generally,  and  the  wound  discharging  unhealthy  pus.  On 
June  15th  the  patient  had  another  attack  of  erysipelas  in  the  wound.  During  the  treatment  of  the  case  several  pieces  of  bone 
were  removed.  Despite  all  remedies  he  gradually  grew  worse,  and  died  July  6,  1864." 

EXCISIONS  AT  THE  ANKLE  JOINT  FOR  SHOT  INJURY.— During  the  Amer 
ican  civil  war  thirty-three  excisions  at  the  ankle  joint  for  shot  injuries  were  performed.1 
The  results  in  two  cases  were  not  ascertained;  twenty-two  patients  survived  the  operation 
and  nine  died,  a  mortality  rate  of  29.0  per  cent.  As  indicated  in  the  following  table  eleven 
were  primary,  eight  intermediary,  and  nine  secondary  operations;  in  five  either  the  date  of 
injury  or  operation,  or  both,  could  not  be  ascertained. 

TABLE  LXXXVIIL 
Numerical  Statement  of  Thirty-three  Excisions  at  the  Ankle  Joint  for  Shot  Injury. 


PARTS   EXCISED. 

OPERATIONS. 

CASES. 

PRIMARY. 

INTER 
MEDIARY. 

SECONDARY       TlMK  NOT 
SECONDARY.       SpKCJFIED 

"a 
j!_ 

12 
2 
4 
•> 

i 

& 

10 
2 
2 

Death. 

;  Undeterm'd. 

Mortality  of 
determined 
cases. 

3 

% 

u 

Recovery. 

J3 

rt 

01 

O 

;  Undeterm'd. 

0 

Recovery. 

Death. 

S 
3 

O 

b 

o> 
> 

o 

8 

« 

g 

j= 

3 

A. 

1 

Recover}'. 

Uudeterm'd. 

End  of  the  Fibula                   .  .                               

2 

16.6 

5 

o 

3 

2 

2 

4 

4 

•2 

1 

1 

.... 

End  of  the  Tibia 

2 

50.0 

1 
I 

1 
1 

1 

1 

2 
1 

1 
1 

i 

3 

1 

3 

1 

2 

1 
1 
3 

1 
1 

JOO.O 
50.0 
60.0 

1 

1 

2 
5 

1 

1 
2 

2 
2 

1 

i 
•? 

I 

1 

1 

2 

1 

1 

1 

33 

22 

9 

2 

29.0 

11 

8 

2 

1 

8 

5 

3 

9 

5 

4 

5 

4 

1 

It  is  noticeable  that  although  excision  at  the  ankle  joint  had  been  performed  in  the 
latter  part  of  the  last  century  by  the  elder  Moreau,2  and  had  frequently  been  repeated,  for 
simple  and  compound  fractures  or  caries,  in  the  early  part  of  the  present  century,  the 
operation,  prior  to  the  breaking  out  of  the  War  of  the  Rebellion  in  1861,  had  only  been 
done  three  times  for  shot  injuries.3  The  first  operation  was  performed  in  the  English  army 
during  the  Crimean  War;  the  lower  end  of  the  fibula  was  excised  and  the  case  terminated 
in  recovery;  no  details  are  recorded.4  The  second  was  performed,  May  30,  1859,  by  Vori 
Langenbeck  on  a  Russian  General  wounded  at  the  Alrna,  September  20,  1854,  in  the  left 

"From  the  records  it  would  appear  that  the  first  excision  of  the  ankle  joint  during  the  American  civil  war  was  performed  by  Assistant  Surgeon  J. 
S.  HILLINGS,  U.  S.  A.,  on  January  6,  1862,  for  an  axe  wound  involving  the  external  malleolus  and  the  scaphoid  bone.  The  case  will  be  detailed  in  the 
nfixt  chapter.  The  first  total  excision  of  the  ankle  joint  for  shot  injury  was  performed  by  Surgeon  E.  BENTLEY,  U.  S.  V.,  on  October  9,  1862,  in  the 
case  of  Private  J.  Brennan,  16th  West  Virginia.  Details  of  the  case  will  be  given  hereafter. 

2JEFFUAY  (JAMES),  Cases  of  the  Excision  of  Carious  Joints  by  II.  PARK  and  P.  V.  MOREAU,  with  observations,  Glasgow,  1806,  p.  140,  Case  V. 
On  April  15,  1792,  the  elder  MOREAU  excised  the  ends  of  the  tibia  and  fibula  and  the  articulating  surface  of  the  astragalus  for  caries  in  the  case  of  M. 
Lucot,  who  walked  without  any  assistance  whatever  nine  months  after  the  operation. 

'The  case  related  by  FAUKE  (L' amputation  etant  absolument  necessaire  dans  Its  plaits  compliquces  de  fracas  des  os,  etc.,  in  Prix  <le  V  Academit 
Royale  de  Chirurgie,  Paris,  1811),  T.  Ill,  p.  352)  and  cited  by  CULIIRUTSON  (Excision  of  the  Larger  Joints  of  the  Extremities.  Prize  Essay.  Trans. 
Am.  Sled.  Assoc.,  Philadelphia,  1876,  Supplement  to  Vol.  XXVII,  p.  280)  and  others  as  the  first  instance  of  excision  at  the  ankle  joint,  can  only  be 
regarded  as  an  instance  of  expectant  conservative  surgery.  The  articular  surfaces  of  the  tibia,  fibula,  and  astragalus  were  fractured  by  shot  iit  the  battle 
of  Fontenoy,  May  11,  1745,  in  a  soldier  named  Charles  d'Amiens.  Dr.  READ  examined  the  wound  and  proposed  to  amputate  the  leg,  but  desisted  at  the 
urgent  request  of  the  patient.  He  then  removed  the  detached  portions  of  the  tibia,  fibula,  and  astragalus,  placed  the  foot  in  proper  position  and  secured 
it  by  a  suitable  apparatus.  The  patient  recovered  with  good  use  of  limb  in  about  four  months. 

'MATTHEW  (T.  P.)  Med.  and  Surg.  Hist,  of  the  British  Army  which  served  in  Turkey  and  the  Crimea,  etc.,  London,  1858,  Vol.  II,  in  tabular 
statement  on  page  368  and  brief  reference  on  p.  379. 
SORG.    Ill— 74 


586  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

ankle;  the  astragalus  and  the  internal  malleolus  were  removed  by  subperiosteal  resection; 
the  patient  recovered  without  shortening  of  the  limb;  the  joint  became  anchylosed.1  The 
third  was  performed  on  a  soldier  wounded  at  Solferino,  June  24, 1859.  J.  Neudorfer,  several 
months  utter  the  injury,  excised  the  roughened  bony  surfaces  and  several  osteophytes  that 
impeded  the  motion  of  the  joint;  the  patient  recovered  rapidly  with  a  useful  limb.2 

Primary  Excisions  at  the  Ankle  Joint. — A  complete  excision  of  the  ankle  joint,  in 
which  portions  of  all  the  bones  forming  the  articulation  were  removed,  was  performed  in 
one  only  of  the  eleven  primary  operations;  the  patient  recovered.  The  articular  end  of 
the  fibula  was  excised  in  five  cases,  of  the  tibia  in  two,  of  the  tibia  and  fibula  in  one,  and 
of  the  astragalus  in  one;  in  the  remaining  case  the  portions  removed  were  not  indicated. 
Eight  patients  recovered,  two  died;  the  result  in  one  case  could  not  be  ascertained.  Details 
of  the  cases  are  subjoined: 

CASK  385. — Private  T.  Bell,  Co.  H,  60th  Illinois,  aged  19  years,  was  wounded  in  the  left  ankle  during  the  engagement 
near  Marietta,  July  4,  1864,  by  a  minie"  ball,  which  fractured  the  lower  end  of  the  fibula.  He  was  conveyed  to  the  field  hospital 
of  the  2d  division,  Fourteenth  Corps,  where  the  excision  was  performed.  TFie  patient  passed  through  different  field  hospitals 
and  subsequently  through  various  general  hospitals.  Surgeon  B.  B.  Breed,  U.  S.  V.,  in  charge  of  hospital  No.  1,  Nashville,  in 
reporting  the  case  described  the  operation  of  excision  as  having  involved  the  removal  of  three  inches  of  bone  from  the  fibula. 
Acting  Assistant  Surgeon  W.  Sturgis  reported  that  when  the  patient  entered  Camp  Butler,  December  5th,  his  general  health 
was  bad.  Erysipelas  supervened,  which  was  treated  locally  by  linseed  poultice  and  iodine,  and  internally  by  quinine,  tincture 
of  chloride  of  iron,  etc.  The  patient  was  ultimately  discharged  from  service  June  29,  1885,  and  pensioned.  Examining  Sur 
geon  J.  Bobbins,  of  Quincy,  Illinois,  certified,  June  30,  1865:  "A  ball  passed  through  the  leg  antero- posteriorly,  just  above  the 
external  malleolus,  shattering  the  fibula  and  severing  the  tendo-achillis.  Three  inches  of  the  lower  extremity  of  the  fibula  have 
been  removed,  and  complete  anchylosis  as  well  as  the  loss  of  bone  and  tendon  render  the  limb  useless."  Numerous  subsequent 
examiners  have  corroborated  Dr.  Eobbins's  certificate.  The  pensioner  was  paid  September  4,  1880. 

CASE  836. — Private  B.  B.  Evitts,  Co.  I,  llth  Connecticut,  aged  23  years,  was  wounded  in  the  left  ankle,  before  Peters 
burg,  June  18,  1864.  He  was  conveyed  to  hospital  at  Fort  Monroe,  thence  to  McDougall,  New  York  Harbor,  and  lastly  to 
Brattleboro.'  Acting  Assistant  Surgeon  N.  G.  Brooks,  in  charge  of  the  latter  hospital,  reported  the  man's  admission,  August 
6th,  with  "  shot  fracture  of  tibia,  followed  by  excision  of  the  internal  malleolus  the  day  after  the  injury  and  favorable  progress 
subsequently."  The  patient  was  transferred  to  the  Veteran  Reserve  Corps  February  11,  1865,  and  five  months  later  he  was 
mustered  out  of  service  and  pensioned.  Examining  Surgeon  C.  B.  Maltbie,  of  Falls  Valley,  Connecticut,  June  28,  18(J8,  cer 
tified:  "The  pensioner  was  wounded  by  a  minie  ball  entering  the  ankle  joint  from  the  tibial  side  and  lodging  therein,  from  where 
it  was  extracted.  The  injury  rendered  the  joint  stiff'  and  incapacitated  the  man  for  manual  labor.  Use  of  the  limb  caused  the 
wound  to  reopen  last  season  and  to  discharge  freely."  No  changes  were  reported  at  subsequent  examinations.  This  pensioner 
was  killed  by  falling  from  a  locomotive  engine  July  19,  1875. 

CASK  837. — Private  J.  W.  Bloyd,  Co.  H,  llth  West  Virginia,  aged  18  years,  was  wounded  in  the  left  ankle  during  the 
fight  at  New  Creek,  August  4,  1864.  He  was  conveyed  to  the  Post  Hospital  at  New  Creek,  where  partial  excision  of  the  joint 
was  performed,  on  August  5th,  by  Acting  Assistant  Surgeon  W.  B.  Grain,  who  reported  the  following  description  of  the  injury: 
"A  conical  ball  penetrated  the  tissues  on  the  outer  aspect  of  the  leg,  one  and  a  half  inches  above  the  external  malleolus.  fractur 
ing  the  fibula  and  burying  itself  in  the  ankle  joint  between  the  astragalus  and  the  tibia.  The  articular  surface  of  the  astragalus 
was  considerably  comminuted,  and  that  portion  of  the  articular  surface  and  cancellated  structure  of  the  tibia  external  to  the 
groove  of  the  flexor  longus  pollicis  was  also  badly  comminuted.  The  external  surface  was  apparently  uninjured.  The  opera 
tion  was  performed  by  slightly  enlarging  the  wound  on  the  outer  aspect  of  the  leg,  where  three  large  spiculse  were  removed  from 
the  fibula.  The  ball  and  all  the  loose  fragments  were  then  extracted,  and  the  rough  spiculaB  of  the  fractured  portion  of  the  tibia 
and  astragalus  were  gouged  and  chiseled  out.  The  constitutional  state  of  the  patient  at  the  time  of  the  operation  was  in  every 
respect  favorable,  and  the  limb  was  but  little  swollen,  but  very  painful.  The  patient  did  well  until  August  27th,  at  which  time 
he  began  to  suffer  very  much  from  pain,  owing  to  a  great  accumulation  of  pus  in  the  joint.  To  relieve  this  and  to  insure  a  free 
and  constant  outlet  a  large-sized  seton  was  introduced  into  the  wound  in  the  outer  aspect  of  the  leg,  carried  obliquely  between 
the  articular  surfaces  of  the  tibia  and  astragalus  and  passed  out  in  front  of  the  external  malleolus.  An  apparatus  similar  to 
Smith's  anterior  splint  was  also  adjusted  to  the  limb  in  order  to  insure  greater  comfort."  After  he  became  convalescent  the 
patient  was  transferred  to  hospital  at  Cumberland,  where  he  was  discharged  from  service  May  6,  1865,  and  pensioned.  Dr.  J. 
C.  Hupp,  of  Wheeling,  and  other  examining  surgeons  have,  at  successive  periods,  certified  to  the  injury.  In  1873,  the  injured 
ankle  and  also  the  lower  third  of  the  leg  was  reported  as  being  enlarged,  the  extensors  of  the  foot  as  acting  imperfectly,  etc. 
Subsequently  the  mobility  of  the  ankle  joint  was  described  as  impaired.  The  pensioner  was  paid  June  4,  1880. 

CASE  838. -Captain  A.  F.  Miller,  Co.  K.  48th  New  York,  aged  38  years,  was  wounded  in  the  right  ankle,  at  Cold  Har 
bor,  June  2,  1864.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Sixth  Corps,  and  thence,  several  days  afterwards, 
to  the  Seminary  Hospital  at  Georgetown.  Surgeon  H.  W.  Ducachet,  U.  S.  V.,  in  charge  of  the  latter  hospital,  reported  that 
the  patient  obtained  leave  of  absence  on  June  13th  and  proceeded  to  his  home.  On  January  13,  1865,  the  patient  was  discharged 

'VON  LANGENBECK  (13.),  Utber  die  Schustfracturen  der  Gelenke  und  Hire  Behandlung,  Berlin,  1868,  p.  46,  and  GUKLT  (E.),  Die  Gelenk-Resec- 
tionen  nach  Schussverletzungen,  Berlin,  1879,  p.  133. 

2NKUD5UFKR  (J.),  Die  Endresultate  der  Gelenkresectionen,  in  Wiener  Jlfedicinische  Presse,  1871,  Jahrganff  XII,  p.  405. 


SEcrr.  vi.J  PRIMAEY    EXCISIONS    AT   THE    ANKLE   JOINT.  587 

from  service  and  pensioned.  Dr.  G.  T.  Stevens,  formerly  Surgeon  77th  New  York  Volunteers,  subsequently  contributed  the 
following  description  of  the  injury  and  resection  of  the  ankle,  which  he  performed:  "The  wouud  was  caused  by  a  mini6  bull, 
which  penetrated  the  ankle,  entering  just  behind  the  outer  malleolus,  passing  nearly  through  the  bones,  and  lodging  in  the  inner 
side  of  the  tarsus.  The  os  calcis  and  astragalus  were  badly  shattered.  Two  days  after  the  reception  of  the  injury  the  patient 
was  brought  Jiuler  the  influence  of  chloroform  with  intent  to  amputate;  but  after  carefully  inspecting  the  wound  it  was  decided 
to  attempt  to  save  the  foot.  The  wound  was  then  enlarged  by  crucial  incision,  splinters  of  bone  were  removed,  and  the  ball, 
which  laid  in  the  inner  side  of  the  ankle,  was  extracted.  The  shattered  fragments  of  the  os  calcis  and  astragalus  were  then 
removed  by  a  gouge  and  bone  nippers,  the  wound  was  drawn  together  and  water  dressings  were  applied.  On  June  6th  the 
patient  was  transferred  to  White  House  Landing  in  an  army  wagon,  where  he  remained  three  days.  Thence  he  was  taken  to 
Washington,  and  a  Aveek  afterwards  he  went  to  his  home  in  Brooklyn.  Water  dressings  were  continued.  Extensive  suppura 
tion  took  place,  and  several  deep  incisions  were  made  near  the  ankle.  In  about  four  weeks  a  considerable  piece  of  dead  bone 
came  away,  after  which  improvement  was  rapid.  In  injecting  fluids  into  the  original  wound  they  passed  freely  through  the 
ankle,  coming  out  at  an  opening  on  the  opposite  side.  In  the  course  of  eight  weeks  the  patient  was  able  to  walk  with  crutches 
and  from  that  time  his  recovery  was  rapid.  He  now  (March  9,  1808)  walks  with  little  difficulty  and  there  is  no  anchylosis." 
The  Brooklyn  and  Boston  Examining  Boards  in  1874,  1875,  and  1877,  respectively,  certified  to  "anchylosis  of  the  ankle  joint, 
tendons  bound  down/'  etc.  The  pensioner  was  paid  June  4,  1880. 

CASE  839. — Private  I.  Ostheimer,  Co.  F,  66th  New  York,  aged  31  years,  was  wounded  in  the  right  leg,  at  Antietam, 
September  16, 1862,  and  admitted  to  a  Second  Corps  field  hospital.  Surgeon  C.  S.  Wood,  66th  New  York,  reported:  "A  miin'6 
ball  struck  the  tibia  anteriorly  about  four  inches  above  the  malleoli,  shattering  the  bone.  The  fibula  and  bones  of  the  foot  were 
uninjured.  I  performed  resection  of  the  lower  four  inches  of  the  tibia,  removing  the  bone  from  the  articulation,  after  which 
splints  were  applied  to  the  leg;  case  sent  to  General  Hospital."  Acting  Assistant  Surgeon  A.  V.  Cherbonnier  recorded  the 
patient's  admission  to  hospital  No.  5,  at  Frederick,  where  a  large  sequestrum  was  removed  on  November  22d,  also  that  a  large 
portion  of  the  diseased  tibia  was  resected  on  December  2d.  About  two  weeks- afterwards  the  wound  assumed  a  healthy  appear 
ance,  and  by  December  28th  it  was  filling  up  with  healthy  granulations,  the  patient  being  cheerful  and  feeling  well.  On  the  next 
day  he  was  transferred  to  hospital  No.  1,  where  he  remained  until  the  following  June,  when  he  was  sent  to  Patterson  Park  (Con 
valescent)  Hospital  at  Baltimore.  On  August  10, 1863,  the  patient  was  returned  to  his  command  for  duty,  and  while  in  the  field 
he  again  came  under  the  notice  of  Surgeon  Wood,  who  made  the  following  supplementary  report:  "The  man  laid  in  hospital  for 
seven  months  before  he  could  move  his  leg.  Being  possessed  of  a  good  constitution  and  no  untoward  symptoms  appearing,  at 
the  end  of  that  time  he  began  to  Avalk  a  little,  and  now — eleven  months  after  the  reception  of  the  injury — he  has  just  been 
returned  to  duty.  On  examination  a  large  cicatrix  is  found,  the  bone  having  refilled  its  entire  length  and  uniting  with  the 
astragalus  with  a  moveable  articulation.  Although  less  than  usual,  the  bone  is  not  quite  so  long  as  its  fellow,  allowing  the  foot 
to  turn  slightly  inward.  Otherwise  he  has  a  very  useful  limb.  He  cannot  endure  hard  marches  as  well  as  formerly,  and  prob 
ably  never  will.  Still  the  case  is  one  of  interest,  as  not  one  in  twenty  saves  his  limb  after  the  receipt  of  a  like  injury."  Accord 
ing  to  information  from  the  Adjutant  General,  U.  S.  A.,  this  man  has  been  reported  as  "missing  in  action"  since  the  battle  of 
Todd's  Tavern,  May  8,  1864. 

CASE  840.— Private  A.  C.  Rose,  Co.  H,  10th  Illinois,  aged  22  years,  was  wounded  at  Bentonville,  March  21,  1865. 
Assistant  Surgeon  J.  W.  Brewer,  U.  S.  A.,  reported  his  admission  to  the  Seventeenth  Corps  Field  Hospital  with  "  shot  fracture 
of  left  ankle,"  for  which  resection  of  fibula  was  performed  by  Surgeon  W.  A.  Gott,  25th  Wisconsin.  From  the  field  the 
wounded  man  was  sent  to  Foster  Hospital  at  New  Berne,  thence  to  McDougall  Hospital  at  Fort  Schuyler,  and  lastly,  on  August 
18th,  to  DeCamp  Hospital,  David's  Island.  On  September  23,  1865,  the  patient  was  discharged  from  service  and  pensioned, 
Assistant  Surgeon  W.  Webster,  U.  S.  A.,  in  charge  of  the  latter  hospital,  certifying  to  the  disability  resulting  from  fracture  of 
the  fibula.  Examining  Surgeon  I.  H.  Ruden,  of  Lacon,  Illinois,  who  examined  the  pensioner  periodically,  in  1866  described 
the  injury  as  having  been  "followed  by  gangrene  in  the  wound,  which  caused  necrosis  of  one-third  of  the  bone.  Ankle  nearly 
immovable  and  painful."  Some  years  later  he  stated  that  "about  two  inches  of  the  bone  had  been  removed.  The  cicatrix  is 
large  and  firm,  so  much  so  that  the  circulation  of  the  foot  is  impeded,  causing  varicose  veins;  it  is  also  so  tender  that  he  cannot 
wear  a  boot  or  high  shoe.  The  ankle  joint  is  not  free  in  its  movements,  owing  to  adhesions  of  the  tendo-achillis  to  the  heavy 
cicatrix,  and  becomes  swollen  and  painful  when  used  to  any  considerable  extent.''  The  pensioner  was  paid  June  4,  1880. 

In  the  following  three  cases  the  limb  was  subsequently  amputated,  in  two  in  the 
middle,  in  one  in  the  lower  third  of  the  leg.  Two  of  the  patients  recovered,  one  died: 

CASE  841. — Sergeant  M.  G.  Sparks,  Co.  I,  10th  New  Jersey,  aged  25  years,  was  wounded  in  the  right  ankle,  before 
Petersburg,  April  2,  1865.  He  entered  the  field  hospital  of  the  1st  division,  Sixth  Corps,  where  Surgeon  R.  Sharpe,  15th  New 
Jersey,  recorded  the  injury  as  a  "shot  fracture  of  the  fibula  and  tarsus,"  also  that  "resection  of  the  fibula"  was  performed. 
The  patient  was  subsequently  transferred  to  the  Depot  Hospital  at  City  Point,  and  from  there,  on  April  12th,  to  Judiciary  Square 
Hospital  at  Washington.  Surgeon  E.  Griswold,  U.  S.  V.,  in  charge  of  the  latter,  reported  that  when  the  patient  was  admitted 
his  constitutional  state  was  not  good  and  the  injured  parts  were  in  a  bad  condition,  necessitating  amputation,  which  was  per 
formed  by  antero-posterior  skin  flaps  at  the  middle  third  of  the  leg,  on  April  13th,  by  Acting  Assistant  Surgeon  Z.  P.  Dennler. 
Chloroform  and  ether  constituted  the  anaesthetic.  After  the  amputation  simple  dressings  were  used  and  stimulants,  etc.,  were 
administered.  Subsequently  the  patient  passed  through  various  hospitals,  and  on  February  2,  1886,  he  was  discharged  from 
service  and  pensioned.  He  was  paid  June  4,  1874,  since  when  he  has  not  been  heard  from. 

CASE  842. — Private  S.  H.  Myers,  Co.  E,  75th  Indiana,  aged  20  years,  was  wounded,  before  Kenesaw  Mountain,  June  21, 
1864.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  Fourteenth  Corps,  where  Surgeon  F.  Lloyd,  U.  S.  V.,  recorded: 
"Shot  fracture  of  left  ankle;  resection  of  two  inches  of  tibia  and  fibula."  One  week  afterwards  the  wounded  man  was  sent  to 
the  General  Field  Hospital  at  Chattanooga,  whence  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A.,  reported  that  amputation  became 
necessary,  and  was  performed  by  the  circular  method  at  the  lower  third  of  the  leg  by  Acting  Assistant  Surgeon  G.  E.  Stubbs, 


588  INJURIES    OF   THE    LOWEK    EXTREMITIES.  CHAP.  X. 

on  June  30th.  The  patient's  subsequent  progress  was  fair,  the  treatment  consisting  of  water  dressings,  tonics,  and  stimulants. 
About  two  weeks  after  the  amputation  he  was  transferred  to  hospital  at  Nashville,  and  lastly  he  was  admitted  to  Ekin  Barracks, 
Indianapolis,  where  he  was  discharged  from  service  March  7,  1865,  and  pensioned.  In  his  application  for  commutation  he 
stated  that  the  first  operation  (meaning  that  of  resection)  was  performed  by  Surgeon  C.  N.  Fowler,  105th  Ohio,  five  hours  after 
the  reception  of  the  injury.  The  pensioner  died  April  12,  1872. 

CASE  843. — Private  G.  W.  Velic,  Co.  C,  24th  Michigan,  aged  28  years,  was  wounded  at  Cold  Harbor,  June  3,  1864. 
He  entered  the  field  hospital  of  the  4th  division,  Fifth  Corps,  where  Surgeon  C.  N.  Chamberlain,  U.  S.  V.,  recorded:  "Severe 
shell  wound  of  ankle  joint;  excision  of  lower  end  of  fibula."  Ten  days  after  the  date  of  the  injury  the  wounded  man  was 
transferred  to  Armory  Square  Hospital,  Washington,  where  Surgeon  D.  W.  Bliss,  U.  S.  V.,  subsequently  amputated  the  limb 
and  recorded  the  result  of  the  case  as  follows:  ''The  injury  was  a  lacerated  wound  of  the  right  ankle,  the  outer  xualleolus  being 
shattered  and  the  joint  opened.  On  June  28th  the  leg  was  amputated  at  the  middle  third.  The  circular  flap  operation  was 
performed,  the  patient  being  under  the  influence  of  chloroform.  On  July  3d  there  was  sloughing  and  sanious  discharge  from 
the  stump.  By  July  12th  there  was  hospital  gangrene,  which  rapidly  extended  to  the  knee  and  was  treated  with  nitric  acid  and 
yeast  poultices.  The  patient  died  July  18,  1864." 

CASE  844. — Private  J.  Durst,  Co.  D,  148th  Pennsylvania,  aged  24  years,  was  wounded  in  the  left  lower  extremity,  at 
Gettysburg,  July  2,  1863,  and  admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps.  Surgeon  C.  S.  Wood,  66th  New 
York,  reported:  "The  lower  portion  of  the  fibula  was  shattered  by  a  mini6  ball,  and  resection  was  performed  of  the  articulation 
of  the  bone  about  four  inches  in  length.  The  tibia  remained  sound.  A  splint  was  applied  to  the  outer  portion  of  the  leg,  and 
cold-water  dressings.  The  case  continued  to  do  well,  with  a  fair  prospect  of  getting  ultimately  a  very  good  limb."  Three  weeks 
after  being  wounded  the  patient  was  transferred  to  the  Cotton  Factory  Hospital  at  Harrisburg,  where  Acting  Assistant  Surgeon 
W.  S.  Woods  noted  the  case  as  one  of  "  exsection  of  the  left  ankle  joint,"  and  recorded  the  following  termination  :  "  The  patient, 
a  man  of  irritable  and  nervous  temperament,  was  suffering  severely  from  the  wound  when  admitted.  There  was  considerable 
sloughing  of  the  wound  at  the  time,  attended  with  deep-seated  suppuration.  Several  spiculse  of  bone  were  taken  out.  For  a 
time  the  leg  was  placed  in  a  cushioned  box  splint  and  the  usual  simple  cerate  and  cold-water  dressings  were  applied  twice  each 
day.  The  weather  becoming  unusually  warm  it  was  found  necessary  to  suspend  the  leg  in  a  cot  splint,  which  proved  to  be  far 
more  comfortable.  The  same  treatment  was  continued,  a  tonic  course  and  liberal  diet  being  allowed.  By  August  13th  the 
wound  granulated  nicely  and  the  patient  was  considered  as  doing  well.  He  improved  slowly  until  September  19th,  when  he 
had  a  severe  chill,  also  pain  in  the  inguinal  glands,  followed  by  traumatic  erysipelas.  For  the  first  two  days  antiphlogistic 
remedies  were  advised,  which  were  followed  by  quinine  and  whiskey.  The  leg  was  washed  with  glycerine  and  iodine.  The 
case  resulted  fatally  on  October  6,  1863." 

CASE  845. — Private  J.  Eadford,  Co.  F,  14th  Virginia,  received  a  gunshot  wound  of  the  ankle  joint  May  9,  1864.  Excis 
ion  of  the  joint  was  performed  on  the  following  day,  and  the  patient  was  subsequently  transferred  to  General  Hospital.  The 
report  of  the  case  was  contributed  by  Dr.  H.  L.  Thomas,  late  Surgeon  P.  A.  C.  S.,  who  obtained  the  record  of  the  injury  and 
operation  from  the  notes  of  Confederate  Surgeon  J.  S.  Pride,  Battle  Hospital,  Dublin  Depot. 

Intermediary  Excisions  at  the  Ankle  Joint. — Of  the  eight  excisions  of  this  group  five 
were  successful,  three -fatal.  In  one  case  portions  of  the  astragalus  were  excised,  in  one 
the  extremities  of  the  tibia  and  fibula,  in  four  the  extremities  of  the  fibula,  and  in  two  the 
surfaces  of  the  three  bones  forming  the  articulation  were  removed: 

CASE  846. — "Private  J.  Brennan,  Co.  K,  16th  West  Virginia,  aged  18  years,  was  admitted  to  hospital  at  Alexandria  on 
October  6,  18S2,  with  a  wound  of  the  right  ankle  joint,  received  accidentally  the  night  previous.  On  examination  it  was  found 
that  a  pistol  ball  had  entered  the  ankle  three-fourths  of  an  inch  posterior  and  inferior  to  the  internal  malleolus,  passed  forward 
and  upward,  rupturing  the  capsular  ligaments  and  cutting  its  way  between  the  articular  surfaces  of  the  tibia  and  astragalus  and 
lodging  within  the  joint.  He  was  in  good  health  at  the  time  of  the  injury  and  evidently  suffered  no  great  amount  of  pain.  He 
was  freely  purged  and  a  light  and  nutritious  diet  enjoined.  The  question  of  procedure  was  exceedingly  perplexing.  The  single 
small  bullet  hole  and  the  slight  local  and  constitutional  symptoms  presented  a  case  apparently  well  adapted  to  the  performance 
of  resection,  while  the  want  of  success  attending  this  operation  was  a  serious  argument  against  its  performance.  It  was  decided, 
however,  to  resect  the  joint,  which  was  done  on  October  9th.  The  patient  being  under  the  influence  of  chloroform,  two  lateral 
incisions  were  made  about  four  inches  in  length,  terminating  three-fourths  of  an  inch  below  the  malleoli.  The  lips  being  drawn 
asunder,  a  chain  saw  was  then  applied  to  the  tibia  and  about  one-third  of  an  inch  of  the  extremity  removed;  the  extremity  of 
the  fibula,  on  a  level  with  the  tibia,  was  removed  through  the  opposite  opening,  and  through  the  same  aperture  a  portion  of  the 
articular  surface  of  the  astragalus  was  taken  away.  By  this  method  the  division  of  the  extensor  tendons  and  of  the  anterior 
tibial  artery  was  avoided.  The  posterior  tibial  was  uninjured.  The  incisions  were  closed  with  silver  wire  sutures,  and  the 
bones  were  held  in  apposition  by  means  of  adhesive  strips  extending  down  the  sides  of  the  leg  and  embracing  the  sole  of  the 
foot.  Lateral  splints  of  binders'  board  were  applied.  The  hemorrhage  was  trifling,  no  vessels  having  to  be  tied.  On  the  fol 
lowing  day  there  was  considerable  febrile  excitement;  pulse  100;  skin  hot  and  dry.  Small  doses  of  antimony  and  morphia 
were  administered.  On  the  next  day  the  patient  appeared  more  comfortable  but  complained  of  slight  pain;  pulse  diminished  in 
force  and  frequency.  On  October  12th  the  patient  was  comfortable;  skin  cool  and  moist;  pulse  80  per  minute.  Discontinued 
the  medicine.  On  October  13th  suppuration  was  established  and  the  patient  was  comfortable ;  limb  suspended  by  means  of 
Smith's  anterior  splint ;  lateral  splints  retained.  From  this  time  the  dressings  were  daily  removed.  By  October  16th  the  patient 
was  doing  well  and  the  wound  was  discharging  freely;  diet  light,  though  nutritious.  Four  days  later  he  began  to  take  solid 
food.  On  October  27th  the  incisions  were  filled  with  granulations.  The  dressings  were  continued  to  November  25th,  when 
Smith's  splint  was  removed,  the  lateral  splint  being  still  applied.  The  patient  remained  in  bed  until  December  20th,  when  he 


SECT,  vi.]  INTERMEDIARY    EXCISIONS    AT    THE    ANKLE   JOINT.  589 

began  to  move  about  on  crutches.  The  lateral  splints  were  removed  in  the  early  part  of  February,  at  which  time  he  moved 
about  freely  and  with  little  embarrassment.  In  dressing,  the  toes  of  the  injured  side  were  extended  so  as  to  be  on  a  line  with 
those  of  the  sound  side.  The  advantage  of  this  is  apparent  when  a  shoe  with  a  high  heel  is  worn.  The  elasticity  of  the  instep 
thus  brought  into  play  compensates  in  a  great  measure  for  the  anchylosis."  The  case  is  reported  by  Surgeon  E.  Bentley,  II.  S.  V. 
The  subsequent  records  in  the  case  show  the  patient  was  mustered  out  at  the  expiration  of  his  term  of  service,  June  16,  1863. 
There  is  no  record  of  his  ever  having  applied  for  pension. 

CASE  847. — Private  N.  Lloyd,  Co.  I,  29th  Pennsylvania,  aged  38  years,  was  wounded  in  the  left  ankle,  at  Gettysburg, 
July  1,  1863.  He  was  admitted  to  the  Twelfth  Corps  field  hospital,  where  Surgeon  H.  E.  Goodman,  28th  Pennsylvania,  noted 
that  an  excision  at  the  lower  third  of  the  fibula  was  performed  on  July  12th  by  Surgeon  J.  A.  Wolf,  29th  Pennsylvania.  Three 
weeks  after  being  wounded  the  patient  was  transferred  to  Camp  Letterman,  several  months  later  to  hospital  at  Baltimore,  and 
subsequently  to  Philadelphia.  Acting  Assistant  Surgeon  W.  V.  Keating  reported  his  admission  to  Broad  and  Cherry  Streets 
Hospital,  December  llth,  and  described  the  injury  as  "a  compound  gunshot  fracture  of  the  external  malleolus  opening  the 
ankle  joint,  followed,  apparently,  by  resection  of  a  very  small  portion  of  the  malleolus.  The  patient  apparently  did  not  get 
along  very  well.  On  his  admission  the  tissues  around  the  ankle  joint  were  considerably  swollen  and  there  were  symptoms  of 
chronic  arthritis.  A  sinus  on  both  the  inner  and  outer  side  of  the  ankle  connected  with  the  joint,  where  the  cartilages  were 
found  eroded  and  from  which  a  sanious  discharge  issued.  On  January  23,  1864,  when  the  patient  was  transferred  to  Mower 
Hospital,  the  swelling  around  the  joint  had  somewhat  diminished  and  the  sinus  on  the  inner  side  of  the  ankle  had  healed,  while 
the  one  on  the  external  side  still  discharged  a  slight  amount  of  sanious  pus."  Surgeon  J.  Hopkinson,  U.  S.  V.,  in  charge  of 
Mower  Hospital,  reported  the  result  of  the  case  as  follows:  "At  the  time  of  the  patient's  admission  the  wound  was  nearly  closed, 
the  joint  stiff,  the  parts  swollen,  and  circulation  in  the  foot  very  feeble.  The  cold  douche  was  used  to  the  foot  with  marked 
benefit.  By  February  16th  the  foot  was  much  better,  the  patient  being  able  to  place  it  on  the  floor  and  bear  some  weight  on  it. 
One  month  later  the  foot  was  rapidly  improving  and  the  treatment  was  discontinued."  On  April  20,  1864,  the  patient  was  dis 
charged  from  service.  Examining  Surgeon  T.  B.  Reed,  of  Philadelphia,  February  5,  1866,  certified  to  "  compound  fracture  of 
left  ankle,  shattering  the  outer  malleolus  and  requiring  exsection  of  the  same.  Permanent  anchylosis  of  ankle.  The  greatly 
impaired  use  of  the  foot  has  produced  subsequent  irritation  of  the  knee  joint,  with  rheumatism.  Is  obliged  to  use  a  cane  or 
crutch  constantly.  Amputation  of  the  foot  and  the  use  of  an  artificial  limb  would  be  a  great  improvement  to  his  present  con 
dition."  Subsequent  examiners  substantially  confirm  Dr.  Reed's  report.  The  pensioner  was  paid  September  4,  1880. 

CASE  848. — Private  D.  Stottlemeyer,  Co.  K,  66th  Ohio,  aged  17  years,  was  wounded  in  the  right  ankle  joint,  at  Cedar 
Mountain,  August  9,  1862,  and  entered  Fairfax  Seminary  Hospital  several  days  afterwards.  Surgeon  D.  P.  Smith,  U.  S.  V., 
reported  that  the  patient  was  discharged  from  service  October  9,  1862,  by  reason  of  "exsection  of  lower  third  of  fibula,  anchy 
losis  of  ankle  joint,"  etc.  Examiner  S.  M.  Smith,  of  Columbus,  Ohio,  certified,  December  22,  1862:  "He  received  a  wound  in 
the  right  ankle,  a  musket  ball  entering  the  outer  portion  of  the  joint,  embedding  itself  in  the  bones  of  the  joint  and  fracturing 
them.  Eleven  days  afterwards  the  missile  and  portions  of  bone  were  removed.  At  present  there  is  great  enlargement  of  the 
joint  and  foot,  complete  anchylosis  of  the  joint,  an  open  wound  and  necrosis  of  bone."  Examining  Surgeon  W.  S.  Constant,  of 
Delaware,  Ohio,  November  4,  1880,  certified  to  the  injury  and  reported  as  its  result  "an  occasional  suppurating  wound  of  the 
ankle,  partial  anchylosis  of  ankle  joint,  and  shortening  of  limb  from  contraction,  so  that  he  can  walk  only  on  the  ball  of  the 
foot.  The  pensioner  cannot  walk  any  distance  or  do  much  manual  labor." 

CASE  849. — Sergeant  A.  M.  Wright,  Co.  C,  80th  Indiana,  aged  23  years,  was  wounded  in  the  left  ankle,  at  Resaca,  May 
14,  1864.  Surgeon  E.  Shippen,  U.  S.  V.,  reported  his  admission  to  the  Twenty-third  Corps  field  hospital,  whence  the  wounded 
man  WKS  transferred  to  hospital  at  Chattanooga  and  afterwards  to  hospital  No.  15,  Nashville.  Surgeon  W.  M.  Chambers,  U.  S.  V., 
in  charge  of  the  latter  hospital,  described  the  injury  and  reported  that  "the  bone  was  fractured  and  necrosed,"  necessitating 
"  excision  of  two  and  a  half  inches  of  the  lower  end  of  the  fibula,  which  was  performed  on  June  13th  by  Acting  Assistant  Sur 
geon  J.  J.  O'Riley.  Gangrene  ensued  the  day  after  the  operation,  but  was  stopped  by  applying  bromine.  Simple  dressings 
were  used  and  nutritious  diet  and  stimulants  were  administered."  The  patient  subsequently  was  transferred  to  Joe  Holt  Hos 
pital,  and  later  to  Lincoln  Hospital,  Washington.  In  the  following  March  he  was  returned  to  duty,  and  on  June  22,  1865,  he 
was  mustered  out  of  service.  Examining  Surgeon  H.  M.  Smith,  of  Vincennes,  Indiana,  March  31,  1877,  certified:  "I  find  on 
examination  that  the  applicant  received  a  wound  in  the  ankle  joint.  The  ball  penetrated  the  lower  part  of  the  external  malleo 
lus  and  passed  through  the  head  of  the  tibia,  making  its  exit  on  the  front  part  of  the  ankle,  at  which  point  a  large  cicatrix 
exists — as  if  caused  by  sloughing — resulting  in  adhesions  of  the  soft  parts  and  partial  anchylosis  of  the  joint,"  etc.  The  pen 
sioner  was  paid  June  4,  1880. 

In  the  following  instance  gangrene  appeared  three  months  after  the  excision,  and 
amputation  was  performed  in  the  middle  of  the  leg: 

CASE  850. — Private  F.  Thorn,  Co.  D,  63d  Pennsylvania,  aged  28  years,  was  wounded  in  the  left  lower  extremity,  at  the 
Wilderness,  May  5,  1864.  Surgeon  O.  Evarts,  20th  Indiana,  reported  his  admission  to  the  field  hospital  of  the  3d  division, 
Second  Corps.  Three  weeks  after  the  reception  of  the  injury  the  wounded  man  entered  Emory  Hospital,  Washington,  where 
he  underwent  the  operation  of  excision  at  the  hands  of  Surgeon  N.  R.  Moseley,  U.  S.  V.,  who  reported  that  "the  injury  con 
sisted  of  a  gunshot  wound  of  the  left  ankle,  the  bones  being  comminuted  and  the  soft  parts  lacerated,  but  in  a  favorable  condition. 
On  May  26th  chloroform  and  ether  was  administered,  and  resection  of  the  lower  third  of  the  fibula  was  performed.  The  parts 
were  kept  in  coaptation  by  adhesive  straps,  and  cold-water  dressings  were  used."  According  to  a  subsequent  report  the  patient 
obtained  a  furlough  on  July  16th  and  left  the  hospital  for  his  home  in  Erie,  Pennsylvania,  where  "Dr.  R.  Faulkner  amputated 
the  leg  at  the  middle  third,  on  August  17th,  by  reason  of  gangrene."  Several  months  later  the  patient,  who  had  in  the  mean 
time  been  assigned  to  the  105th  Pennsylvania  Volunteers,  returned,  and  was  transferred  to  Judiciary  Square  Hospital.  After 
being  supplied  with  an  artificial  leg  he  was  discharged  from  service  March  18,  1865,  and  pensioned.  He  was  paid  March  4, 


590  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP  x. 

1880.     Five  small  fragments  of  the  fibula,  removed  at  the  first  operation  by  Surgeon  Moseley,  and  contributed  by  him  to  the 
Museum,  constitute  specimen  2362  of  the  Surgical  Section. 

Three  of  the  eight  intermediary  excisions  at  the  ankle  joint  proved  fatal — two  from 
pyaemia  and  one  from  exhaustion : 

CASE  851. — Private  J.  Davis,  Co.  L,  1st  Michigan  Cavalry,  aged  18  years,  was  wounded  at  Salem  Church,  May  28, 
1864.  Surgeon  W.  H.  Rulison,  9th  New  York  Cavalry,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Cavalry 
Corps,  "with  shot  wound  of  left  foot  and  hip."  Surgeon  J.  A.  Lidell,  U.  S.  V.,  who  operated  in  the  case,  made  the  following 
report:  "The  patient  was  admitted  to  Stanton  Hospital,  Washington,  June  4th,  with  a  gunshot  wound  of  the  left  tarsus,  inflicted 
by  a  mini6  ball,  which  struck  the  foot  a  little  below  the  external  malleolus  and  passed  through  the  tarsus  horizontally  inward 
and  somewhat  backward,  escaping  a  little  below  and  behind  the  internal  malleolus.  It  occasioned  compound  comminuted  frac 
ture  of  the  calcaneum,  astragalus,  and  posterior  edge  of  the  external  malleolns.  At  the  time  of  the  operation,  June  10th,  the 
ankle  and  foot  were  much  swollen,  inflamed,  and  very  painful;  the  leg  was  also  swollen.  The  edges  of  the  orifices  of  both 
entrance  and  exit  were  pouting  and  exhibited  no  tendency  to  close ;  discharge  thin  and  scanty.  Since  the  patient  came  to 
Stanton  Hospital  the  wound  had  been  treated  with  ice  dressings,  but  was  manifestly  growing  worse.  He  now  had  a  good  deal 
of  constitutional  disturbance;  pulse  quick  and  ranging  from  110  to  120;  skin  dry  and  too  warm;  countenance  pinched  and 
anxious;  tongue  coated,  and  appetite  poor.  He  was  also  restless,  got  but  little  sleep,  and  his  general  condition  was  daily  getting 
worse.  Wishing  to  avoid  secondary  amputation  of  the  leg  if  possible  on  account  of  the  great  fatality  which  had  lately  attended 
it,  resection  was  performed  of  the  anterior  extremity  and  part  of  the  external  side  of  the  caloaneum.  Some  fragments  of  the 
astragalus  were  also  extracted,  and  a  splinter  from  the  posterior  edge  of  the  external  malleolus.  The  incisions  were  made  on 
the  external  side  of  the  foot,  from  the  orifice  of  entrance,  first,  to  the  base  of  the  metatarsal  bone  of  the  little  toe;  second,  to 
the  base  of  the  external  malleolus;  third,  to  the  point  of  the  heel;  and  fourth,  to  the  dorsum  of  the  foot,  two  and  a  half  inches. 
Sulphuric  ether  constituted  the  anaesthetic.  There  was  no  shock.  Ice-water  dressings  were  continued.  On  June  llth  the 
patient  was  cheerful  and  free  from  pain  and  the  swelling  and  irritative  fever  had  abated.  He  died  of  pyaemia  on  June  20,  1864. 
Autopsy:  The  ankle  joint  contained  pus;  the  bones  were  partially  denuded  of  their  cartilage;  muscles  of  leg  infiltrated  with 
pus.  The  left  pleural  cavity  contained  a  large  quantity  of  dark-colored  effusion,  and  the  left  lung  was  compressed  against  the 
vertebral  column  ;  the  inferior  lobe  contained  an  abscess  about  the  size  of  an  egg,  which  was  filled  with  dark-colored  and  offen 
sive  pus.  The  right  lung  contained  several  superficial  abscesses  and  some  patches  of  lobular  pneumonia.  Thrombi  existed  in 
the  femoral  vein.''  In  his  publication1  of  the  operation  the  operator  furnished  the  following  supplementary  details  of  the  patient's 
progress,  as  well  as  of  the  autopsy,  in  addition  to  his  comments  on  the  case:  After  the  operation  "the  limb  was  placed  upon  a 
wire  splint  (Smith's)  bent  to  a  right  angle,  which  was  well  padded  and  npplied  to  the  posterior  part  of  the  leg  and  sole  of  the 
foot,  where  it  was  properly  secured  by  roller  bandages  for  the  purpose  of  keeping  the  ankle  joint  in  a  fixed  position.  The  wound 
was  plugged  with  lint  and  a  full  opiate  was  given.  The  constitutional  treatment  consisted  in  the  administration  of  nutrients, 
tonics,  and  stimulants.  On  June  12th  the  patient  had  a  severe  pyaemic  chill  and  sweat,  and  quinine  in  full  doses  was  added  to 
the  treatment.  On  the  next  day  he  was  much  worse;  wound  discharging  a  thin  dark-colored  pus;  chills  and  sweats  increasing 
in  frequency  and  severity;  complexion  assumed  a  bronzed  hue;  breath  bovine;  body  exhaling  a  sweet  mawkish  smell ;  anorexia; 
debility;  diarrhoea  set  in.  Pneumonic  symptoms  also  appeared,  and  a  large  proportion  of  blood  was  mingled  with  the  sputa. 
He  sank  rapidly.  «At  the  autopsy  the  calcaneum  was  found  to  be  fractured  entirely  through  and  its  cancfllous  structure  was 
gangrenous.  The  astragalo-scaphoid  articulation  contained  pus  and  the  articulating  surface  of  its  bones  was  entirely  denuded 
of  its  cartilage.  The  connective  tissue  on  the  front  of  the  leg  was  infiltrated  with  pus  from  the  ankle  joint  upward  to  the  extent 
of  three  inches,  and  the  tibia  and  fibula  were  denuded  of  periosteum  to  the  extent  of  two  inches.  The  liver  and  spleen  were 
both  enlarged  and  softened,  but  the  kidneys  presented  a  normal  appearance.  There  were  clots  in  both  ventricles  of  the  heart. 
Comments:  In  this  case  also  osteomyelitis  supervened,  which  was  conclusively  shown  by  the  gangrenous  condition  of  the  can- 
cellous  tissue  belonging  to  the  calcaneum,  or,  rather,  the  gangrenous  condition  of  the  medullary  tissue  whiph  filled  the  cancelli 
of  that  bone.  Besides,  it  is  probable  that  if  the  interior  of  the  tibia  and  fibula  had  been  examined  the  marrow  would  have 
been  found  inflamed  at  and  above  the  place  where  those  bones  were  seen  to  be  denuded  of  periosteum  at  the  post-mortem 
examination.  It  is  also  probable  that  the  medullary  tissue  of  the  denuded  portion  of  the  tibia  contained  collections  of  purulent 
matter  which  were  produced  by  the  suppurative  character  of  the  inflammatory  process  involving  that  tissue.  Furthermore,  it  is 
probable  that  the  inflammatory  process  had  extended  to  the  medullary  tissue  of  the  tibia  prior  to  the  performance  of  the  resec 
tion  of  the  tarsus,  and  if  its  presence  there  had  then  been  recognized,  it  would  have  contra-indicated  that  operation  and  called 
for  amputation  far  up  the  limb.  The  thrombosis  of  the  femoral  vein  was  of  recent  occurrence.  The  coagulated  blood  which 
filled  that  vein  presented  a  fresh  appearance  and  had  not  yet  undergone  the  puriform  transformation,  nor  even  become  at  all 
softened.  It  was  therefore  obvious  that  the  thrombosis  had  not  occasioned  the  visceral  abscesses  nor  the  inflammation  of  the 
lungs,  since  the  morbid  process  in  those  organs  was  considerably  older  than  the  thrombus  of  the  femoral  vein.  The  thrombosis 
was  a  more  rtcent  event  than  the  pyaemia.  This  circumstance  is  important,  because  it  shows  that  the  pyocmic  process  in  this 
case  could  not  have  had  its  origin  in  the  thrombosis,  and  that  if  any  relationship  or  necessary  connection  existed  between  them, 
the  pyaemic  process  induced  the  formation  of  the  thrombi.  The  symptoms  of  irritative  fever  (or,  speaking  properly,  the  surgical 
fever  of  an  irritative  type),  which  where  so  strikingly  relieved  by  the  operation,  had  been  produced  entirely  by  local  causes, 
namely,  the  inflammation  of  the  various  structures  bordering  upon  and  connected  with  the  gunshot  wound,  such  as  the  connect 
ive,  the  fibrous,  the  osseous,  and  the  medullary  tissues.  The  symptoms  of  the  purulent  infection  did  not  make  their  appear 
ance  till  two  days  after  the  operation.  They  presented  a  marked  contrast  to  those  of  the  surgical  fever  which  preceded  the 
operation.  They  denoted  the  occurrence  of  a  poisoned  condition  of  the  blood  and  the  whole  system,  under  which  the  patient 
sank  rapidly,  and  died  on  the  eighth  day  after  its  advent." 

1  LIDELL  (JOHN  A),  in  V.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  pp.  524-C,  and  CULHEUTSON  (H.),  Excision  of  the  Larger  Joints 
of  the  Extremities,  in  Transactions  of  the  American  Med.  Association,  Philadelphia,  1876,  Supplement  to  Vol.  XXVII,  p.  314. 


SECT.  VI.] 


SECONDARY    EXCISIONS    AT    THE    ANKLE    JOINT. 


591 


CASE  852. — Private  J.  F.  Geer,  Co.  F,  112th  New  York,  aged  22  years,  was  wounded  at  Cold  Harbor,  June  2,  1864. 
Surgeon  S.  A.  Richardson,  13th  New  Hampshire,  recorded  his  admission  to  the  Eighteenth  Corps  field  hospital  with  "shot 
wound  of  left  ankle."  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  contributed  the  following  description  of  the  injury  and  operation  in 
the  case,  which  he  performed:  "The  patient  was  admitted  to  Harewood  Hospital,  Washington,  June  15th,  suffering  from  a 
wound  of  the  left  ankle,  the  ball  passing  from  the  inner  to  the  outer  sin  face,  opening  the  joint.  On  admission  the  condition 
of  the  injured  parts  and  the  constitutional  state  of  the  patient  was  good.  On  June  25th  resection  of  the  injured  joint  was  per 
formed  by  lateral  vertical  incisions  over  the  malleoli,  exposing  the  articulation.  The  ends  of  the  tibia  and  fibula  were  cut  off 
bv  the  chain  saw,  and  the  tipper  portion  of  the  astragalus  was  removed  by  the  cutting  forceps.  Sulphuric  ether  was  used. 
Two  days  after  the  operation  the  patient  had  slight  febrile  movement  and  his  pulse  was  a  little  accelerated.  The  treatment 
was  supporting;  simple  dressings  were  used.  Death  occurred  on  July  24,  1864." 

CASE  853. — Sergeant  W.  Roberts,  Co  I,  7th  New  York  Artillery,  aged  35  years,  was  wounded  in  the  left  ankle,  at  Cold 
Harbor,  June  10,  1864,  by  a  conoidal  ball,  which  passed  from  before  backward,  fracturing  the  external  malleolus  and  opening 
the  ankle  joint.  He  entered  Harewood  Hospital,  Washington,  five  days  afterwards,  at  which  time  his  constitutional  state 
was  very  poor,  the  injured  parts  were  in  a  very  bad  condition,  and  the  wound  discharged  fetid  pus.  Resection  of  the  ankle 
joint  was  performed  on  June  24th  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  who  exposed  the  articulation  by  incisions  over  the 
malleoli  and  excised  the  lower  articular  extremities  of  the  tibia  and  fibula.  Sulphuric  ether  was  used.  The  patient  did  well  up 
to  July  1st.  From  that  period  diarrhoea  set  in  and  he  gradually  sank.  There  were  no  pyaemic  symptoms.  He  died  July  6, 
1864,  from  exhaustion.  The  history  was  reported  by  the  operator. 

Secondary  Excisions  at  the  Ankle  Joint. — Of  nine  secondary  operations  the  articular 
surfaces  of  the  fibula  were  excised  in  two,  of  the  tibia  and  fibula  in  two,  of  the  astragalus 
in  one,  of  the  tibia  and  astragalus  in  two,  and  of  the  tibia,  fibula,  and  astragalus  in  two 
instances.  Five  patients  recovered,  four  died. 

CASE  854. — Sergeant  C.  Barber,  Co.  E,  86th  Pennsylvania,  aged  30  years,  received  a  shot  fracture  of  the  fibula  of  the 
left  leg,  at  Gettysburg,  July  1,  1863.  From  a  First  Corps  field  hospital  he  passed  to  York  and  subsequently  to  Philadelphia. 
Acting  Assistant  Surgeon  M.  K.  Knorr  recorded  the  following  description  of  the  case  at  the  South  Street  Hospital,  where  the 
patient  was  admitted  August  14th:  "The  wound  was  caused  by  a  mini6  ball  passing  in  above  the  external  malleolus,  fracturing 
the  bone,  and  passing  through  the  interosseous  space.  About  August  20th  hospital  gangrene  set  in  and  the  wound  filled  with 
large  sloughs;  patient  became  very  weak.  Stimulating  poultices  of  yeast  and  flaxseed  were  then  used,  and  pulverized  persul 
phate  of  iron  was  applied  to  the  slough.  After  three  applications  the  patient  appeared  much  better  and  the  slough  came  off. 
Poultices  were  now  continued  for  a  while,  and  afterwards  stimulating  applications.  Still  the  wound  was  not  healing,  the  dis 
charge  being  yet  great  and  the  patient's  constitutional  state  extremely  low  and  weak.  On  examination  Surgeon  C.  N.  Cham 
berlain,  U.  S.  V.,  found  the  bone  to  be  necrosed  and  denuded  of  perios 
teum,  and  concluded  to  excise  the  fibula.  This  operation  was  accord 
ingly  performed  on  December  19th,  it  being  deemed  necessary  to  remove 
three-fourths  of  the  length  of  the  bone,  including  the  external  malleolus. 
The  patient  rallied  from  the  operation  and  made  rapid  improvement. 
Tonics  and  stimulants  were  given  and  simple  dressings  used."  Surgeon 
H.  Janes,  U.  S.  V.,  subsequently  in  charge  of  South  Street  Hospital, 
reported,  in  April,  1864,  that  the  wound  had  healed  with  the  exception 
of  the  upper  part,  where  a  small  sinus  still  existed.  The  patient  was 
afterwards  transferred  to  Filbert  Street  Hospital,  and  on  September  17, 
1884,  he  was  discharged  from  service  and  pensioned.  Examining 
Surgeon  H.  L.  Hodge,  of  Philadelphia,  certified,  December  21,  1864 : 
''The  limb  is  now  much  swollen,  the  ankle  is  painful  and  the  foot  turned 
outward.  He  is  very  lame  and  the  limb  is  useless."  The  Philadelphia 
Examining  Board,  April  10,  1872,  certified  to  the  injury  and  operation 
and  described  the  result  as  follows:  ''A  long  cicatrix  with  musculo- 
fascial  adhesions;  a  slight  varicose  condition  with  tenderness  about  the 
ankle  joint,  and  anchylosis  of  the  ankle  joint  with  atrophy  of  muscles 
on  posterior  portion  of  leg.  Increase  of  pension  is  recommended  on 
account  of  increased  pain  and  firmness  of  anchylosis  of  the  ankle  joint." 
In  a  communication  dated  April  18,  1881,  accompanying  the  photographs  represented  in  the  annexed  wood-cuts  (FlGS.  336, 
337),  the  pensioner  stated  that  "  the  ankle  is  very  painful  at  present,"  and  added  that  his  disability  had  obliged  him  to  give  up 
working  at  his  trade  of  stone  cutter. 

CASE  855. — Private  W.  A.  Gavett,  Co.  K,  141st  Pennsylvania,  aged  43  years,  was  wounded  in  the  right  ankle  during 
the  engagement  near  Bristoe  Station,  October  13,  1863,  and  entered  Judiciary  Square  Hospital,  Washington,  three  days  after 
wards.  Assistant  Surgeon  A.  Ingram,  U.  S.  A.,  made  the  following  report:  "The  wound  was  caused  by  a  minie  ball,  which 
entered  at  the  internal  malleolus,  passed  into  the  ankle  joint  and  lodged.  The  missile  was  extracted  the  next  day  through  the 
wound  of  entrance.  Partial  excision  of  the  ankle  joint  was  performed  on  February  1,  1864,  by  Acting  Assistant  Surgeon  J.  F. 
Thompson.  An  incision  two  and  a  half  inches  in  size  was  made  on  the  outer  side  of  the  ankle  and  several  pieces  of  bone  were 
taken  out.  Part  of  the  internal  malleolus  was  dissected  from  the  integument  and  removed  through  the  enlarged  wound  of 
entrance,  and  a  portion  of  the  astragalus  was  taken  away  with  the  bone  forceps.  At  the  time  of  the  operation  the  patient's 
general  health  was  excellent,  but  considerable  inflammation  existed  around  the  ankle  joint  and  there  was  great  discharge  of  pus 


FIG.  33fi.— Outer  view  of  left  leg  18 
years  after  excision  of  the  lower  three- 
fourths  of  fibula.  [From  a  photograph.] 


FIG.  337.  — Anterior 
view  of  the  same.  [From 
a  photograph.] 


592 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP. 


FIG.  338.  —  Excision  of 
right  ankle  joint.  Outer 
view  17  years  after  opera 
tion.  [From  a  photograph.] 


from  the  wound.  A  collection  of  pus  had  also  formed  on  the  outer  side  at  the  point  of  the  internal  incision.  The  patient  did 
well  for  about  a  month  after  the  operation,  at  which  time  both  sides  had  healed.  A  day  or  two  afterwards  an  abscess  was 
detected  in  front  of  the  joint,  which,  on  being  opened,  discharged  considerable  pus.  Carious  bone  could  be  felt  by  the  probe, 
indicating  the  necessity  of  another  operation."  The  patient  was  subsequently  transferred  to  Philadelphia,  where  he  was  admitted 
to  Summit  House  and  afterwards  to  Satterlee  Hospital.  On  May  6,  1885,  he  was  discharged  from  service  and  pensioned. 
Examining  Surgeon  C.  M.  Turner,  of  Towanda,  Pennsylvania,  December  27,  1865,  certified  to  the  injury  and  added :  "  Of 
course  anchylosis  has  taken  place  and  the  tendons  of  the  foot  and  toes  are  in  a  degree  contracted  and  rigid."  On  August  16, 
1869,  he  reported  that  the  pensioner  "walks  with  difficulty  and  lias  much  pain  after  exercise.  The  joint  is  often  inflamed,  and 
abscesses  form  in  the  integuments,  which  discharge  pus  for  many  days.  I  do  not  think  the  joint  is  carious,"  etc.  At  sub 
sequent  dates  the  same  examiner  certified  to  the  heel  bone  being  diminished  in  size,  and  to  the  leg  being  atrophied  up  to  the 
knee  and  shortened  two  inches.  Examiner  C.  F.  Paine,  of  Troy,  Pennsylvania,  September  22,  1879,  reported  "fistulous  open 
ings,  constantly  discharging  portions  of  bone.  The  pensioner  is  compelled  to  use  a  crutch  or  cane  for  locomotion."  The  pen 
sioner  was  paid  June  4,  1880. 

CASE  856. — Sergeant  W.  H.  Gaylord,  Co.  B,  6th  U.  S.  Colored  Artillery,  aged  26  years,  was  wounded  at  Fort  Pillow,  April 
12,  1864,  by  a  minte  ball,  which  fractured  the  fibula  of  the  right  leg  at  the  lower  third.  The  missile  entered  above  the  external 
malleolus,  passed  obliquely  downward  and  backward,  and  emerged  below  and  behind  the  internal  mal- 
leolus.  Four  days  after  the  reception  of  the  injury  the  wounded  man  was  admitted  to  Adams  Hospital 
at  Memphis,  where  Surgeon  J.  G.  Keenon,  U.  S.  V.,  on  May  21st,  excised  the 
external  malleolus,  the  comminuted  fragments  of  the  fibula,  and  the  end  of  the 
tibia  through  a  semilunar  incision  two  inches  long.  Chloroform  was  used  and 
the  haemorrhage  was  slight.  The  patient's  physical  condition  at  the  time  of  the 
operation,  though  somewhat  emaciated,  was  fair  and  his  spirits  were  buoyant. 
The  wound,  which  had  been  suppurating  freely,  was  closing  by  healthy  granula 
tions,  but  necrosed  bone  could  be  distinctly  felt.  The  patient  did  well  after  the 
operation.  He  was  permitted  to  leave  the  hospital  and  go  to  his  regiment  on 
June  7th,  before  his  cure  was  complete.  The  history  was  reported  by  the  operator. 
Sergeant  Gaylord  was  subsequently  promoted  to  Lieutenant,  and  remained  in  the 
service  until  March  28,  1865,  when  he  was  discharged,  Surgeon  G.  Perin,  U.  S.  A., 
as  a  member  of  an  examining  board  certifying  to  the  injury,  and  adding  that  the 
"wound  is  healed  and  ankle  joint  partially  anchylosed.  Cannot  walk  without  a 
crutch."  The  Cleveland  Pension  Examining  Board,  Drs.  G.  C.  Ashmun  and  P. 
Roeder,  in  1877,  add  that  there  is  "  slight  lateral  motion  of  ankle,  constant  enlarge 
ment,"  etc.  The  pensioner  was  paid  September  4,  1880. 
CASE  857. — Private  E.  Roberts,  7th  Wisconsin  Battery,  aged  26  years,  was  wounded  in  the  right  foot,  at  Parker's  Cross 
Roads,  December  30,  1862.  Surgeon  E.  D.  Kittoe,  U.  S.  V.,  recorded  his  admission  to  hospital  at  Jackson,  and  several  months 
afterwards  the  wounded  man  was  transferred  to  Jefferson  Barracks,  whence  he  was  discharged  October  6,  1863,  and  pensioned. 
Surgeon  J.  C.  Whitehill,  U.  S.  V.,  subsequently  contributed  the  following  report  of  the  case:  "Understanding  from  Surgeon 
H.  W.  Davis,  18th  Illinois,  who  was  in  charge  of  the  General  Hospital  at  Jackson  for  some  time  in  the  early  part  of  18615, 
that  some  doubts  had  been  expressed  concerning  the  removal  of  the  os  calcis  and  astragalus  from  a  patient  in  that  institution, 
and  his  recovery  with  a  foot  of  comparatively  good  conformation  and  use  of  the  ankle  joint,  I  desire  to  set  the  matter  at  rest  by 
furnishing  a  detailed  report  of  the  case.  In  the  latter  part  of  March,  1863,  while  passing  through  the  wards  of  the  General 
Hospital  at  Jackson  in  the  discharge  of  my  duties  as  Medical  Director  of  the  district,  my  attention  was  called  to  a  case — that 
of  Private  Roberts,  7th  Wisconsin  Battery — supposed  to  require  amputation.  He  had  been  wounded  in  the  heel  by  a  rifle  ball, 
which  grazed  the  posterior  tuberosity  of  the  os  calcis  and  passed  out  through  the  sole  of  the  foot  about  two  inches  forward. 
Under  the  usual  treatment  the  wound  soon  healed.  The  heel,  however,  remained  tender,  and  the  tenderness  gradually  increased ; 
the  integuments  became  oedematous  and  glazed;  the  pain  more  acute  and  deep  seated;  constitutional  symptoms  supervened;  the 
wound  re-opened,  and  in  spite  of  all  treatment  the  patient's  condition  gradually  grew  worse.  He  had  now  hectic  fever,  some 
bronchial  irritation,  diarrho3a,  and  impaired  appetite;  the  foot  and  ankle  were  swollen ;  the  integument  of  the  heel  was  an  intense 
dusky  or  purplish  red,  tense,  and  glistening,  and  three  sinuses  over  the  posterior  part  of  the  os  calcis,  with  everted  edges,  were 
discharging  fetid  sanious  pus.  Through  the  sinuses  the  probe  readily  detected  carious  or  necrosed  bone.  After  a  careful  exam 
ination  I  determined  to  make  an  effort  to  save  the  foot  by  removing  the  os  calcis,  to  which,  judging  from  the  location  of  the 
sinuses,  I  was  in  hopes  the  disease  was  yet  confined.  On  April  1st,  in  the  presence  of  Surgeon  Davis  in  charge  of  the  hospital, 
Surgeon  H.  E.  Foote,  22d  Ohio,  the  ward  surgeons  of  the  hospital,  and  several  other  medical  gentlemen,  the  patient  was  placed 
comfortably  on  his  side  arid  anaesthesia  was  induced,  after  which  I  commenced  an  incision  at  the  margin  of  the  sole  immediately 
behind  the  plantar  artery,  carrying  it  around  the  heel  and  along  the  outer  margin  of  the  foot  to  the  tarso-metatarsal  articulation, 
and  then  keeping  the  knife  close  to  the  bone  dissected  up  the  flap  thus  made  and  exposed  the  under  surface  of  the  os  calcis. 
There  was  slight  haemorrhage  from  a  posterior  perforating  branch  of  the  plantar,  but  this  was  readily  arrested  by  torsion  of  the 
vessel.  A  perpendicular  incision  of  about  two  inches  was  next  made  over  the  heel  and  along  the  tendo-achillis,  the  tendon 
detached  from  the  os  calcis,  and  the  lateral  flaps  and  soft  parts  carefully  dissected  up  so  far  as  the  calcaneo-astragaloid  articula 
tion,  keeping  the  edge  of  the  knife  close  upon  the  bone  to  avoid  wounding  the  vessels,  and,  if  possible,  to  preserve  a  portion  of 
the  periosteum,  which  was  much  thickened  and  in  some  places  thickly  studded  with  minute  spiculae  of  bone.  The  articulation 
was  then  opened,  the  interosseous  ligaments  were  divided,  and  the  bone  readily  removed.  The  articular  surface  of  the  astragalus 
being  diseased,  the  gouge  was  used  for  its  removal  until,  finding  the  greater  portion  of  its  structure  involved,  I  decided  to  remove 
the  entire  bone.  Keeping  the  knife  close  upon  the  posterior  surface  of  the  bone  the  dissection  was  continued  to  the  ankle  joint, 
which  was  opened,  when  by  using  the  point  of  the  finger  as  a  lever  and  at  the  same  time  as  a  guide  and  sheath  for  the  knife,  the 


FIG.  33!).— Inner  view 
of  the  same  injury. 


SECT.  VI.] 


SECONDARY    EXCISIONS   AT    THE    ANKLE    JOINT. 


593 


FIG.  340.  —  Excision  of  os  calcis 
and  astragalus.  [From  a  photograph 
taken  18  years  after  the  operation.] 


bones  were  sufficiently  separated  to  allow  the  ligamentous  attachments  to  be  divided  by  a  careful  application  of  the  point  of  the 
knife.  The  greatest  caution  was  used  on  the  inner  side  to  avoid  wounding  the  plantar  vessels  and  to  preserve  the  periosteum, 
which,  at  this  point,  like  that  of  portions  of  the  os  calcis,  was  thickly  studded  with  minute  spiculse  or  corpuscles  of  bone.  After 
making  a  careful  dissection  to  free  the  bone  from  its  remaining  attachments  the  entire  astragalus  was  removed.  Finding  the 
other  articular  surfaces  healthy  the  wound  was  carefully  cleansed,  the  parts  coaptated,  light  water  dressings  applied,  and  the  foot 
and  leg  fixed  in  a  position  by  a  suitable  splint  so  arranged  as  to  retain  them  firmly  without  interfering  with  the  dressings  of  the 
wound.  No  part  of  the  integument  was  removed,  nor  did  a  single  vessel  require  ligation.  Surgeons  Davis,  Foote,  and  several 
other  medical  gentlemen,  by  attending  to  the  administration  of  the  anaesthetic  and  affording  other  assistance,  rendered  efficient 
aid  during  the  progress  of  the  operation,  which,  from  the  large  amount  of  careful  dissection 
required,  was  necessarily  somewhat  tedious.  The  subsequent  treatment  consisted  in  the  main 
of  a  careful  retention  of  the  parts  in  position,  simple  water  dressings  and  a  generous  diet,  with 
wine,  ale,  and  porter.  A  free  suppuration  of  healthy  pus  was  established;  the  redness  and 
tumefaction  of  the  integuments  subsided ;  the  cavity  of  the  wound  gradually  filled  with  healthy 
florid  granulations;  and  when  I  last  saw  the  patient,  two  months  afterwards,  the  wound  was 
healed  except  at  its  most  dependent  portion,  from  which  there  was  a  discharge  of  laudable  pus. 
The  conformation  of  the  foot  was  well  preserved  and  bore  but  little  evidence  that  so  large  a 
portion  of  its  bony  structure  had  been  removed.  The  following  extract  from  a  note  concerning 
the  case,  and  received  from  Assistant  Surgeon  T.  D.  Washburn,  126th  Illinois — in  charge  of 
one  of  the  wards  of  the  hospital — described  the  appearance  of  the  foot  about  that  time  (June 
1st):  'The  patient  was  not  in  my  ward,  but  as  this  was  an  unusual  operation  I  visited  him  the 
more  frequently  to  witness  its  progress.  The  parts  healed  kindly  and  by  June  1st  were  almost 
completely  closed,  and  no  one  would  have  imagined  that  so  formidable  an  operation  had  taken 
place.  The  appearance  of  the  foot  was  natural,  a  new  formation  having  apparently  taken  the 
place  of  the  removed  bone,  leaving  the  configuration  good;  besides,  he  had  some  motion  of  the 
ankle,  and  it  certainly  promised  to  make  a  very  useful  as  well  as  ornamental  member  of  the 
body  corporate.'  I  regret  that  I  had  no  opportunity  of  seeing  the  case  at  a  later  date,  to  ascertain 
the  amount  of  mobility  of  the  joint  retained  or  the  character  of  the  'new  formation,'  whether 
fibrous,  osteoid,  or  osseous.  I  had  hoped  by  preserving  a  portion  of  the  periosteum  to  secure 
a  re-formation — in  part  at  least — of  the  bony  structure,  and  I  have  but  little  doubt,  judging  from  the  amount  of  reparative  effort 
evinced  by  the  ossific  formation  found  in  portions  of  the  thickened  periosteum,  that  such  a  result  was  actually  obtained.  The 
case  presents  several  points  of  practical  and  pathological  interest.  There  can  be  no  doubt  that  the  success  of  the  operation 
was  to  some  extent  dependent  on  the  small  amount  of  interference  with  the  circulation  of  the  part,  as  already  stated,  not  a  single 
vessel  requiring  ligation.  The  granulations  by  which  the  cavity  of  the  wound  was  filled  presented  a  striking  resemblance  to  the 
medulla  of  young  bone.  To  what  extent  was  the  preserved  periosteum  concerned  in  the  new  formation  and  what  was  its 
ultimate  character?  The  thickening  proliferation  of  the  periosteum  was  by  far  the  greatest  in  the  vicinity  of  the  larger  vessels, 
and  the  osseous  spiculse  were  most  abundant  in  the  same  vicinity.  The  ossific  deposits  or  formation  in  several  places  extended 
some  distance  into  the  adjacent  soft  parts  and  were  sufficiently  abundant  to  produce  a  grating  sensation  under  the  knife.  With 
out  entering  upon  a  discussion  of  the  method  or  methods  of  the  'pathological  new  formation  of  bone,'  I  will  merely  add  that  it 
does  not  seem  unreasonable  to  suppose  that  the  'new  formation'  in  this  case  was  of  an  ossific  character, 
and  that  the  success  attending  the  case  is  a  strong  argument  in  favor  of  '  conservative  surgery.'  In  similar 
cases  I  should  certainly  look  upon  excision  as  the  rational  treatment,  and  amputation  as  the  dernier 
resort."  Various  examining  surgeons  have  from  time  to  time  certified  to  the  injury  and  to  the  disability 
resulting  therefrom.  The  photograph,  represented  in  the  adjacent  wood-cut  (FlG.  340),  was  contributed 
by  the  pensioner  in  May,  1881.  He  states  that  "the  os  calcis  and  astragalus  were  both  removed,  which 
makes  the  limb  two  and  a  half  inches  shorter.  The  articulations  are  now  with  the  tibia,  about  two 
inches  above  the  joint." 

CASE  858. — Private  R.  Fuller,  Co.  I,  45th  Illinois,  aged  19  years,  was  wounded  during  the  siege 
of  Vicksburg,  June  20,  1863.  Surgeon  G.  R.  Weeks,  U.  S.  V.,  recorded  his  admission  to  the  Seven 
teenth  Corps  hospital  with  "shot  wound  of  left  ankle."  Six  weeks  after  the  reception  of  the  injury  the 
wounded  man  was  transferred  to  Jefferson  Barracks  Hospital,  whence  Surgeon  J.  F.  Randolph,  U.  S.  A., 
reported  that  "gangrene  appeared  on  August  16th,  and  was  treated  by  application  of  nitric  acid  with 
favorable  result,"  also  that  "resection  of  the  external  malleolus"  was  performed.  The  patient  was  dis 
charged  from  service  April  3,  1864,  and  pensioned.  In  the  following  month  Examining  Surgeon  C. 
Hershe,  of  Muscatine,  Iowa,  certified  to  the  injury  involving  the  loss  of  the  external  malleolus,  causing 
anchylosis  of  the  ankle  joint  and  leaving  the  leg  "so  painful  that  he  cannot  put  the  foot  on  the  ground 
without  enduring  pain."  The  pensioner  subsequently  re-enlisted  in  the  army  and  was  assigned  to  the 
42d  Infantry,  from  which  organization  he  was  discharged  March  31,  1869,  when  he  again  resumed  his 
place  on  the  Pension  Rolls.  Examining  Surgeon  F.  Hooper,  of  Fall  River,  certified,  November  13, 
1869  :  "  The  external  malleolus  is  gone,  and  the  astragalus  and  os  ealcis  are  anchylosed  to  the  tibia.  A  large  cicatrix  covers  the 
outside  of  the  ankle.  There  is  some  motion  between  the  scaphoid  and  astragalus,  but  it  produces  pain  in  walking."  In  Sep 
tember,  1877,  the  Cleveland  Examining  Board  reported  "partial  lateral  displacement  of  foot  outward,  with  anchylosis  of  ankle 
joint  and  deformity  of  foot,"  etc.  The  pensioner  was  paid  June  4,  1880.  The  photograph  from  which  the  wood-cut  (FlG.  341) 
is  copied  was  furnished  by  the  pensioner  in  1881.' 


FIG. 
ankle  1 
ion  of  external  mulleolus. 
[From  a  photograph.] 


1  CULUKUTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities,  in  Trans.  Am.  Mcd.  Asfociation,  1876,  Supplement  to  Vol.  XXVII,  p.  314 

SURG.  Ill— 75 


594  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

Four  cases  of  secondary  excisions  at  the  ankle  joint  proved  fatal — one  from  pyaemia, 
one  from  gangrene,  and  two  from  exhaustion. 

CASE  859. — Private  T.  Lister,  Co.  B,  20th  Michigan,  aged  20  years,  was  wounded  at  Spottsylvania,  May  12,  1864. 
Surgeon  J.  E.  Pomfret,  7th  New  York  Artillery,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Second  Corps, 
with  "wound  of  foot  caused  by  a  musket  ball."  Surgeon  K.  B.  Bontecou,  U.  S.  V.,  who  operated  in  the  case,  described  the 
injury  as  a  gunshot  wound  of  the  left  leg,  lower  third,  the  missile  fracturing  the  tibia,  entering  about  one  inch  above  the  ankle 
joint,  and  lodging  in  the  head  of  the  astragalus.  The  wounded  man  was  admitted  to  Harewood  Hospital,  Washington,  May  26th. 
On  July  5th  sulphuric  ether  was  administered,  and  the  lower  end  of  the  tibia  as  well  as  the  head  of  the  astragalus,  which  had 
become  necrosed,  were  excised.  The  constitutional  state  of  the  patient  at  the  time  of  the  operation  was  very  poor;  the  tissues 
had  become  infiltrated  with  pus.  Five  days  after  the  operation  the  fibula  protruded  and  was  somewhat  necrosed,  the  parts  other 
wise  progressing  favorably.  The  treatment  was  supporting.  The  result  was  unfavorable.  Death  occurred  on  August  7,  1864." 

CASE  860. — Private  A.  B.  McCool,  Co.  E,  188th  Pennsylvania,  aged  21  years,  was  wounded  in  both  lower  extremities, 
at  Cold  Harbor,  June  3,  1864.  Surgeon  S.  A.  Richardson,  13th  New  Hampshire,  recorded  his  entrance  into  the  Eighteenth 
Corps  field  hospital.  Secondary  resection  was  subsequently  performed  at  Harewood  Hospital,  Washington,  by  Surgeon  R.  B. 
Bontecou,  U.  S.  V.,  who  reported  that  "  the  patient  was  admitted  June  15th,  suffering  from  gunshot  wound  of  the  right  thigh 
and  of  the  left  leg  at  the  ankle  joint,  fracturing  the  external  and  internal  malleolus.  At  the  time  of  admission  the  condition  of 
the  injured  parts  was  not  good,  being  oedematous  and  somewhat  infiltrated  with  pus.  Subsequently  the  parts  sloughed  exten 
sively  and  the  bone  became  necrosed,  the  patient's  strength  failing  day  by  day.  On  July  12th  sulphuric  ether  was  administered 
and  the  ankle  joint  was  resected,  one  inch  each  of  the  lower  end  of  the  tibia  and  fibula  being  removed.  A  severe  and  prostrating 
diarrhoea  complicated  the  case,  from  the  consequent  exhaustion  of  which,  together  with  the  excessive  suppuration,  the  patient 
died  July  21,  1864.  The  treatment  consisted  of  stimulants,  sedatives,  narcotics,  and  supporting  diet."  The  excised  portions  of 
the  tibia  and  fibula  were  contributed  to  the  Museum  by  the  operator  and  constitute  specimen  3045  of  the  Surgical  Section? 

CASE  861. — Private  J.  T.  McGuiffin,  Co.  B,  24th  Regiment  (Confederate),  aged  23  years,  received  a  gunshot  wound  of 
the  right  ankle  joint,  at  Drury's  Bluff,  May  16,  1864.  The  missile,  a  mini6  ball,  entered  in  front  and  on  a  line  with  the  internal 
malleolus,  passed  through  the  astragalus,  and  made  its  exit  through  the  external  malleolus,  carrying  with  it  a  number  of  frag 
ments.  The  injury  was  followed  by  the  escape  of  synovia.  There  was  also  another  wound  of  the  right  foot,  fracturing  the 
fourth  metatarsal  bone.  Some  days  after  the  reception  of  the  wounds  the  patient  came  under  the  care  of  Surgeon  J.  M.  Hollo- 
way,  P.  A.  C.  S.,  who  thought  that  amputation  of  the  limb,  though  advisable  as  a  primary  operation,  was  not  then  admissible. 
Smith's  anterior  splint  was  applied  and  cold  irrigation.  Subsequently  poultices,  cerate  dressings,  and  bandaging  was  used. 
Several  abscesses  formed  and  numbers  of  small  fragments  of  bone  were  removed  on  different  days.  Anodynes,  stimulants,  and 
nutritious  diet  were  administered  as  required.  After  consultation  Dr.  Holloway  excised  the  ankle  joint  by  Hancock's  method, 
on  June  21st,  completing  the  operation  without  injury  to  nerve,  vein,  artery,  or  tendon.  The  patient  was  not  removed  from  the 
operating  table  to  his  bed  until  the  following  day.  By  the  second  day  the  wounds  had  become  unhealthy  and  gangrene  of  the 
toes  was  in  progress.  The  patient  died  suddenly  and  unexpectedly  on  the  morning  of  June  25,  1864,  after  his  condition  had 
encouraged  the  hope  that  in  a  few  days  it  would  be  favorable  for  amputation  of  the  limb.3 

CASE  862. — Private  J.  C.  Perkins,  Co.  B,  81st  New  York,  aged  27  years,  was  wounded  at  Cold  Harbor,  June  3,  1864. 
Surgeon  W.  H.  Rice,  81st  New  York,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Eighteenth  Corps,  with 
"wound  of  ankles  by  a  minie"  ball."  Twelve  days  after  the  reception  of  the  injury  the  wounded  man  was  admitted  to  Harewood 
Hospital,  Washington,  where  both  limbs  were  operated  upon  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  who  made  the  following 
report:  "The  patient  was  suffering  from  wounds  of  the  right  and  left  ankle  joints,  the  ball  entering  above  the  external  malleolua 
of  the  right  ankle,  passing  directly  through,  and  entering  the  internal  malleolus  of  the  left  ankle.  On  admission  and  at  the  time 
of  the  operation  the  condition  of  the  injured  parts  was  not  good.  The  wounds  suppurated  freely.  There  were  detached  por 
tions  of  bone  in  each  joint,  and  necrosed  fragments  came  away  from  time  to  time.  The  constitutional  state  of  the  patient  was 
poor.  Resection  of  the  right  ankle  joint  and  circular  amputation  of  the  left  leg  at  the  lower  third  was  performed  on  July  7th, 
the  anesthetic  consisting  of  sulphuric  ether  and  chloroform.  The  result  of  the  operation  was  unfavorable.  The  stump  sloughed 
and  profuse  unhealthy  suppuration  followed  the  resection,  extending  in  every  direction  and  burrowing  up  the  leg  nearly  to  its 
middle.  The  patient  became  very  weak  and  sank  gradually.  He  died  of  exhaustion  July  17,  1864.  The  treatment  was  tonic 
and  supporting  throughout."  The  tarsal  bones  of  the  right  foot,  together  with  the  lower  extremity  of  the  tibia,  were  con 
tributed  to  the  Museum  by  Surgeon  Bontecou  and  constitute  specimen  3035  of  the  Surgical  Section. 

Excisions  at  the  Ankle  Joint,  Time  between  the  Injury  and  Operation  unknown. — The 
five  cases  of  this  group  would  appear  to  have  terminated  in  recovery,  but  it  has  been 
impracticable  to  get  accurate  details  of  the  cases.  Two  of  the  operations  were  performed 
on  Confederate  and  three  on  Union  soldiers;  the  names  of  the  latter  do  not  appear  on  the 
Pension  Rolls.  The  right  ankle  joint  was  excised  in  two,  the  left  in  one  instance;  in  two 
cases  the  side  was  not  indicated: 

CASE  863.— Private  T.  Haley,  Co.  D,  91st  .New  York,  was  wounded  at  Port  Hudson,  May  27,  1863.  Surgeon  T.  B. 
Reed,  U.  S.  V.,  reported  his  admission  to  a  Nineteenth  Corps  field  hospital  with  "  wound  of  foot."  Two  days  after  the  recep- 

'CULBERTSOX  (H.),  Excision  of  the.  Larger  Joints  of  the  Extremities,  in  Trans.  Am.  Aled.  Association,  1876,  Supplement  to  Vol.  XXVII,  p.  312. 

"CULBEKTSON  (H.),  Excision  of  the  Larger  Joints  of  the  Extremities,  in   Trans.  Am.  Med.  Association,  1876,  Supplement  to  Vol.  XXVII,  p.  312. 

3  HALLOW  AY  (J.  M.),  Comparative  advantages  of  PlUOGOFF's,  SYME'S,  and  CHOPAKT'S  Amputations,  and  Excision  of  the  AnkU  Joint  by  HAN 
COCK'S  Method,  after  Gunshot  Wound*  and  other  Injuries ;  with  Reports  of  Cases  and  the  Results ;  and  proposing  another  Method  for  Excision  of  the 
Ankle  Joint,  in  American  Journal  Medical  Science,  1866,  Volume  LI,  p.  90. 


SECT.  VI.] 


AMPUTATIONS    AT    THE    ANKLE    JOINT. 


595 


tion  of  the  injury  the  wounded  man  was  transferred  to  University  Hospital,  New  Orleans,  where  Assistant  Surgeon  P.  S.  Conner, 
U.  S.  A.,  recorded:  "Gunshot  wound  of  right  foot;  resection  of  astragalus.  Patient  absent  without  leave  from  September  7, 
1863."  There  is  no  record  of  this  man  ever  having  applied  for  pension. 

CASE  864. — Surgeon  E.  Andrews,  1st  Illinois  Artillery,  publishes  that  "J.  K ,  40th  Illinois,"  in  one  of  the  Western' 

campaigns  received  a  compound  shot  fracture  of  the  os  calcis  and  astragalus,  and  that  both  these  bones  were  excised,  the  opera 
tion  being  followed  by  recovery. 

CASE  86.">. — Colonel  Y.  M.  Moody,  43d  Alabama,  received  a  gunshot  wound  through  the  right  ankle  joint  on  June  16, 
1864.  He  entered  Confederate  hospital  No.  4,  at  Richmond,  whence  he  was  furloughed  August  11,  1834.  Excision  of  the  lower 
end  of  the  fibula  was  performed ;  the  date  of  the  operation  was  not  recorded.  The  record  of  the  case  was  found  on  the  Confed 
erate  hospital  registers. 

CASE  866. — Private  H.  Gregory,  Co.  B,  35th  U.  S.  Colored  Troops,  aged  18  years,  was  wounded  at  Olustee,  February 
20, 1864.  He  passed  through  various  hospitals  at  Beaufort,  one  of  which  was  under  charge  of  Surgeon  J.  Trenor,  jr.,  U.  S.  V., 
who  reported  the  patient's  admission,  August  27th,  with  "gunshot  wound  of  left  ankle;  astragalus  excised  before  admission." 
Assistant  Surgeon  J.  G.  Murphy,  U.  S.  V.,  reported  that  the  patient  was  discharged  from  service  June  5,  1865,  by  reason  of 
"  anchylosis  of  ankle  joint"  resulting  from  the  wound.  There  is  no  record  of  this  man  ever  having  applied  for  pension. 

CASE  867. — "Sergeant  P.  R.  Wright,  Co.  K,  13th  North  Carolina,  was  wounded  in  the  engagement  near  Williamsburg, 
May  5,  1862.  A  conical  pistol  ball  entered  on  the  outside  of  the  os  calcis  near  the  sole  of  the  foot,  and  passed  up  through  the 
outer  portion  of  this  bone  and  through  the  astragalus,  comminuting  the  lower  end  of  the  fibula  and  lodging  between  the  tibia 
and  fibula,  three  inches  from  their  lower  extremities.  The  missile  was  traced  to  its  lodgement  with  difficulty.  A  crescentic 
incision  along  the  course  of  the  peroneus  longus  and  behind  the  external  malleolus  was  intersected  by  a  straight  incision  coming 
up  from  the  heel,  and  another  crescentic  incision  was  found  necessary  to  be  made  anterior  to  the  external  malleolus.  By  work 
ing  under  the  ligaments  the  loose  fragments  of  bone  were  removed  from  the  calcaneum  and  astragalus;  the  lower  comminuted 
end  of  the  fibula  was  cut  and  pulled  away  by  means  of  the  forceps,  and  the  bullet  was  found  in  its  lodgement  between  the  two 
bones,  about  three  inches  from  the  joint.  While  the  lateral  ligaments  were  left  in  position  with  their  superficial  connections, 
their  bony  attachments  were  of  course  disturbed.  The  granulation  and  consolidation,  which  will  probably  result,  must  give  the 
joint  greater  strength  against  inversion  of  the  foot  than  it  could  acquire  without  them.  The  opening  into  the  joint  was  made 
very  free  by  this  operation,  which  is  an  advantage.  It  is  now  well  enough  settled  that  an  inflamed  and  suppurating  joint  is 
more  likely  to  result  well  with  a  free  and  external  opening  than  with  a  limited  one.''  The  »ase  was  reported  by  Surgeon  D. 
Prince,  U.  S.  V.;  the  result  was  not  ascertained. 

AMPUTATIONS  AT  THE  ANKLE  JOINT. — The  number  of  exarticulations  at 
the  ankle  recorded  during  the  American  civil  war  is  one  hundred  and  sixty-one;  one  hun 
dred  and  three  were  primary,  thirty-nine  intermediary,  and  thirteen  secondary  operations; 
in  six  instances  the  time  between  the  injury  and  the  operation  was  not  indicated. 

TABLE  LXXXIX. 
Numerical  Table  of  One  Hundred  and  Sixty-one  Amputations  at  tlie  Ankle  Joint  for  Shot  Injury. 


OPERATIONS. 

o 

Recovery. 

Death. 

Undetermined. 

Ratio  of  Mortality. 

METHOD  OF  OPERATION. 

PIROGOFF'S. 

SYME'S. 

VAKIOUS  METHODS. 

1 

o 

Recovery. 

Death. 

8 

a 

Recovery. 

"S 
1 

Undeterm'd. 

a 
O 

Recovery. 

Death. 

Undeterm'd. 

Primary  Operations  

103 
39 

6 

78 
25 

4 

23 

14 
1 
o 

2 

22.  7 
35.9 
7.7 
33.3 

26 
18 
4 
1 

20 
10 
4 
1 

6 
8 
... 

57 
19 

7 

42 
13 

6 

14 
6 
1 

1 

20 
2 

0 

16 

3 

1 

Period  of  Operation  not  specified  

5 

3 

2 



161       119 

1 

40 

3 

25.  1 

49 
Mortj 

35 
ility^S 

14 
5%. 

83 

61 

21 

1 

29 

23 

5 

1 

Mortality  25.  6  %. 

Mortality  17.  8  %. 

The  results  were  ascertained  in  one  hundred  and  fifty-nine  instances;  one  hundred  and 
nineteen  had  successful,  and  forty  fatal  terminations,  a  mortality  rate  of  25.1  per  cent.,  or 
7.8  per  cent,  less  than  the  death  ratio  after  amputation  in  the  leg. 

Primary  Amputations  at  the  Ankle  Joint. — In  one  instance  both  feet  were  removed. 
The  one  hundred  and  three  operations  were  therefore  performed  on  one  hundred  and  two 


596 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


FIG.  342.-Stump 
after  PIKOGOFF'B 
amputation  at  left 
ankle  joint.  Spec. 
373-2. 


PIG.  343.— Stump 
after  Syme's  am 
putation  at  unkle. 
[From  a  cast.] 


patients;   seventy-eight  recovered,  twenty -three  died,  and  in  two  cases  the  results  were  not 
ascertained. 

Successful  Primary  Amputations  at  the  Ankle  Joint. — Seventy-eight  operations  per 
formed  on  seventy-seven  patients  belong  to  this  group;  sixteen  were  Confederate  and 
sixty-one  Union  soldiers;  the  names  of  the  latter  were  all  on  the  Pension  Roll;  but  six 
have  died  since  the  close  of  the  war  in  1865 — two  of  diarrhoea  and  dysentery,  one  of 
apoplexy;  in  three  cases  the  immediate  cause  of  death  is  not  reported. 

CASE  888. — Private  O.  Leblanc,  Co.  E,  2d  New  Hampshire,  aged  20  years,  was  wounded  in  the  right  foot,  at  Cold 
Harbor,  June  1,  1664,  by  a  shell,  which  fractured  the  ftvrsal  and  metatarsal  bones.     Assistant  Surgeon  J.  C.  McKee,  U.  S.  A., 
reported  that  the  man  was  admitted  to  Lincoln  Hospital,  Washington,  ten  days  after  receiving  the  injury,  also  that  tbe  wounded 
foot  had  been  removed  by  Pirogoffs  method,  on  the  field,  by  Surgeon  J.  M.  Merrow,  2d  New  Hampshire.     The 
patient  subsequently  passed  through  various  hospitals,  and  was  ultimately  discharged  from 
service  June  16,  1865,  and  pensioned,  having  been  previously  fitted  with  a  "  Palmer"  artificial 
foot.     The  cast  (Spec.  3732),  contributed  by  Acting  Assistant  Surgeon  L.  C.  Dodge  and  rep 
resented  in  the  adjoining  cut  (FlG.  342),  shows  an  apparently  firm  cicatrix,  but  reveals  the 
stump  to  be  a  little  irregular  and  without  the  appearance  of  being  able  to  sustain  decided 
weight.     The  pensioner  was  paid  December  4,  1880.' 

CASE  869. — Private  J.  E.  Ayers,  Co.  E,  8th  New  York  Cavalry,  aged  19  years,  was 
wounded  in  the  left  foot,  at  Funkstown,  July  10,  1863,  and  entered  the  General  Hospital  at 
Frederick  eight  days  afterwards.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  reported:  "The 
injury  consisted  of  a  compound  fracture  of  the  tarsus.  Syme's  amputation  at  the  ankle  joint 
was  performed  on  the  field.  During  the  progress  of  the  case  sloughing  opened  the  stump,  for 
which  nitric  acid  wash  was  applied  by  injecting.  Adhesive  straps  were  used  to  support  the 
posterior  flap,  and  tonics  were  given  internally;  generous  diet  was  allowed.  The  patient 
recovered  with  an  excellent  stump,  and  was  discharged  from  service  October  5,  1863."  After 
leaving  the  service  he  became  a  pensioner,  and  subsequently  he  was  an  employ^  in  the  Quar 
termaster  General's  Office,  U.  S.  A.,  for  a  number  of  years.  In  1879  lie  received  an  appointment  in  the  U.  S.  Treasury  Depart 
ment.  On  July  8,  1868,  when  visiting  the  Army  Medical  Museum,  the  pensioner  walked  remarkably  well  on  an  apparatus 
furnished  by  Dr.  E.  D.  Hudson,  of  New  York  City,  and  the  stump  was  found  to  be  in  good  condition.  Since  then  the  pensioner 
has  contracted  and  suffered  for  a  time  from  frost  bite  in  the  stump,  but  in  1881  the  stump  was  in  excellent  condition.  The  Army 
Medical  Museum  possesses  a  cast  of  the  stump  (Spec.  6056),  represented  in  FIG.  343.  A  copy  of  a  photograph  of  the  pensioner, 
taken  in  January,  1881,  is  shown  in  FIGURE  II  of  PLATE  LXXV,2  on  the  opposite  page. 

CASE  870. — Private  H.  W.  Clark,  Co.  H,  100th  New  York,  aged  30  years,-  was  wounded  by  a  shell  in  both  feet,  at 
Drury's  Bluff,  May  13,  1864.  He  was  admitted  to  a  Tenth  Corps  field  hospital,  where  the  injured  limbs  were  removed.  Assist 
ant  Surgeon  E.  McClellan,  U.  S.  A.;  reported  that  the  wounded  man  was  brought  to  hospital  at  Fort  Monroe 
six  days  after  the  injury,  and  that  "both  feet  were  amputated"  before  his  admission.  About  two  months  after 
wards  the  patient  was  transferred  to  McDougall  Hospital,  and  subsequently  to  Central  Park  Hospital,  New 
York  City.  Surgeon  B.  A.  Clements,  U.  S.  A.,  in  charge  of  the  latter,  reported  that  "  the  right  foot  was  shat 
tered  up  to  the  metatarsal  articulation,  and  the  left  heel  with  most  of  the  tendo-achillis  was  carried  away. 
There  was  no  great  amount  of  haemorrhage.  The  amputations  were  performed  flu  the  field,  while  the  man  was 
under  the  influence  of  chloroform,  by  Surgeon  M.  S.  Kittinger,  100th  New  York,  the  right  foot  being  taken  ofF 
by  Chopart's  method.  His  general  condition  at  the  time  of  the  operation  was  good.  At  first  sutures,  bandages, 
and  cold-water  dressings  were  applied,  and  when  the  patient  arrived  at  Fort  Monroe,  adhesive  strips  and  band 
ages  were  used.  Both  stumps  healed  kindly,  the  right  one  in  eight  weeks  and  the  left  one  in  six  weeks.  At 
the  time  of  his  admission  here,  on  July  26th,  both  were  entirely  well,  the  tendo-achillis  of  the  right  stump  being 
considerably  contracted."  The  patient  was  discharged  from  service  December  13,  1864,  and  pensioned,  and 
subsequently  he  was  supplied  with  artificial  feet  by  Dr.  E.  D.  Hudson  of  New  York  City.  Plaster  casts  of 
the  stumps  of  the  legs,  contributed  by  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  constitute  specimen  28.">7 
of  the  Surgical  Section  of  the  Museum.  That  of  the  left  limb,  showing  an  excellent  Syme's  stump,  is  repre 
sented  in  the  annexed  wood-cut  (FlG.  344).  In  his  first  application  for  commutation,  in  August,  1870,  the 
pensioner  described  the  stumps  as  being  "sound  and  healthy;"  but  later,  in  1880,  he  reported  their  condition  as  "poorly." 
His  pension  was  paid  December  4,  1880. 3 

CASK  871. — Private  A.  K.  Russell,  Co.  H,  1st  Massachusetts  Heavy  Artillery,  aged  43  years,  was  wounded  at  Spottsyl- 
vania,  May  19,  1864,  and  admitted  to  Emory  Hospital,  Washington,  three  days  afterwards.  Acting  Assistant  Surgeon  J.  E. 
Janvrin  reported:  "Gunshot  wound  of  left  foot,  the  ball  entering  the  heel  posteriorly,  passing  forward  through  the  os  calcis 
and  astragalus,  and  making  its  exit  anteriorly  on  the  dorsal  surface  of  the  foot.  The  os  calcis  and  astragalus  together  with  the 
metatarsal  bones  were  comminuted,  and,  according  to  the  patient's  statement,  the  soft  parts  were  very  much  lacerated.  Chloro 
form  was  administered,  and  Syme's  operation  was  performed  on  the  day  of  the  injury.  When  admitted  to  Emory  Hospital  the 
sutures  had  given  way  and  the  flap  was  pendant,  with  unhealthy  discharges  and  tendency  to  slough.  Adhesive  straps  and 

'SMITH  (S.),  Amputations  at  the,  Ankle  Joint  in  A{i!itary  Surgery,  in  U.  S.  San.  Com.  Memoirs,  New  York,  1871,  Surgical  Volume  II,  p.  132. 
2  SMITH  (S.),  Amputations  at  the  Ankle.  Joint  in  Military  Surgery,  in  U.  S.  Kan.  Com.  Memoirs,  New  York,  1874,  Surgical  Volume  II,  p.  138. 
3SMlTil  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  San.  Com.  Memoirs^  New  York,  1871,  Surg.  Volume  II,  pp.  110.  140. 


FIG.  344.— Stump 
after  SYME'S  ampu 
tation  at  ankle  joint. 
Spec.  2«57.  [From 
a  cast.  I 


M<-d .»  Sur».  Hist,  of  the  War  of  the  Rebellion.  Fart  ll[.Vol.IU'lm|i.X. 


Ki.y  I      <';isc  of    l.i.-ul    \V  ( '  \\Vrk 

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SECT.  VI. J 


AMPUTATIONS    AT    THE    ANKLE    JOINT. 


597 


cold-water  dressings  were  applied,  and  subsequently  linseed,  charcoal,  and  yeast  poultices  were  used.  Alteratives,  tunics,  uud 
stimulants  were  administered,  the  patient  being  much  exhausted  and  suffering  from  loss  of  appetite,  with  derangement  of  the 
system  generally.  On  June  3d  the  parts  were  thoroughly  cleansed,  and  a  flat  padded  splint  was  applied  to  the  anterior  surface 
of  the  leg,  extending  beyond  the  stump,  after  which  adhesive  straps  were  passed  from  beneath  the  leg  across  the  flap  and  carried 
over  the  end  of  the  splint  and  fastened.  These  were  gradually  shortened  as  the  healing  process  went  on,  thus  removing  the 
tension  and  weight  of  the  flap  from  the  anterior  edge  of  the  wound.  By  July  12th  the  patient  was  doing  well  and  the  granula 
tions  were  covering  the  bone.  About  August  18th  the  stump  had  nearly  closed  and  the  patient's  general  health  was  good  Two 
weeks  afterwards  he  left  for  his  home  on  furlough.  The  success  attending  this  case  is  attributed  in  a  large  measure  to  the 
method  adopted  for  supporting  the  flap."  The  patient  subsequently  entered  the  general  hospital  at  Readville,  whence  he  was 
discharged  from  service  June  2,  1865,  and  pensioned.  After  leaving  the  service  he  was  furnished  with  an  artificial  foot.  A 
photograph  of  the  stump,  taken  three  months  after  the  date  of  the  amputation,  and  contributed  by  Surgeon  N.  R.  Mosely,  U.  S.  V., 
is  represented  in  FIGURE  4  of  PLATE  LXXV,  opposite  page  596.  The  man  subsequently  underwent  a  second  operation,  which 
was  certified  to  by  the  Surgeon  General  of  the  State  of  Massachusetts,  who  communicated  the  following  on  January  '26,  1871 : 
"The  pensioner  lias  sustained  re-amputation  six  inches  below  the  knee,  which  was  performed  by  Dr.  C.  N.  Chamberlain,  of 
Lawrence,  late  surgeon  U.  S.  Vv  assisted  by  Dr.  G.  W.  Garland,  the  case  being  at  the  time  under  my  observation."  In  his  sub 
sequent  application  for  commutation  the  pensioner  described  the  stump  as  being  in  a  good  condition.  His  pension  was  paid 
December  4,  1880. 

CASE  872.— Private  E.  R.  Covell,  Co.  C,  52d  New  York,  aged  38  years,  was  wounded  in  the  left  foot,  at  Spottsylvania, 
May  18,  1864,  and  admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps.  Surgeon  J.  W.  Wishart,  140th  Pennsyl 
vania,  described  the  injury  as  a  "shell  wound  of  the  tarsal  and  metatarsal  bones,"  for  which  he  performed 
"Syme's  amputation  at  the  ankle  joint."  Ten  days  after  being  wounded  the  patient  entered  Emory  Hospital 
at  Washington,  and  subsequently  he  was  transferred  to  Central  Park  Hospital,  New  York  City.  Surgeon 
B.  A.  Clements,  U.  S.  A.,  in  charge  of  the  latter,  reported  the  following  history  of  the  case:  "Considerable 
haemorrhage  took  place  at  the  time  of  the  injury,  and  the  man's  general  condition  was  not  very  good  in  conse 
quence  of  his  suffering  from  diaiThoea.  Amputation  at  the  ankle  joint  was  performed  under  chloroform  six 
hours  after  the  reception  of  the  injury,  the  ends  of  the  tibia  and  fibula  also  being  removed.  Sutures,  adhesive 
strips,  and  cold-water  dressings  were  applied.  The  parts  did  not  unite  by  first  intention,  though  there  was 
no  sloughing  nor  necrosis.  When  the  patient  \vas  admitted  to  Central  Park  Hospital,  August  17th,  the  stump 
had  healed  with  the  exception  of  a  small  ulcer  in  the  cicatrix  near  the  external  angle  of  the  flaps,  and  his  general 
condition  was  pretty  good,  though  he  still  had  diarrhoea.  By  October  2d  the  stump  was  entirely  healed 
and  the  diarrhoea  was  much  improved."  The  patient  was  discharged  from  service  November  3,  1864,  and 
pensioned,  having  been  previously  furnished  with  an  artificial  foot.  A  cast  of  the  stump  (Spec.  4369)  was 
contributed  to  the  Museum  by  Surgeon  J.  J.  Milhau,  U.  S.  A.,  and  is  represented  in  the  adjoining  wood-cut 
(FiG.  345).  After  leaving  the  service  the  stump  was  re-amputated  at  the  lower  third  of  the  leg  on  May  5, 
1869.  In  his  subsequent  applications  for  commutation  the  pensioner  described  the  condition  of  the  stump  as 
"sound  and  healthy."  His  pension  was  paid  September  4,  1881. l 

CASE  873. — Lieutenant  W.  C.  Weeks,2  Co.  I,  5th  Michigan  Cavalry,  aged  28  years,  was  wounded  at  Five  Forks,  April 
1,  1865,  by  a  conoidal  musket  ball,  which  passed  through  the  left  ankle  joint.  Assistant  Surgeon  C.  A.  Leale,  U.  S.  V.,  reported: 
"He  was  immediately  conveyed  to  hospital  at  City  Point,  where  Surgeon  A.  K.  St.  Clair,  5th  Michigan  Cavalry,  performed 
PirogofFs  amputation  at  the  ankle  joint  the  samejlay,  removing  the  articulating  surfaces  of  the  tibia  and  calcaneum  and  bringing 
the  cut  extremities^  into  apposition.  On  April  16th  the  patient  was  transferred  to  Armory  Square  Hospital  at  Washington, 
where  he  was  admitted  in  a  very  feeble  condition.  Erysipelatous  inflammation  extended  from  the  stump  several  inches  above  the 
knee  joint.  Extensive  suppuration  had  taken  place,  and,  although  fifteen  days  had  elapsed  since  the  operation,  the  rough  edges 
of  the  calcaneum  could  be  rubbed  against  the  denuded  end  of  the  tibia,  proving  that  no  union  existed.  The 
integumentary  Hap  had  partially  united,  thus  confining  a  large  quantity  of  pus  in  the  stump,  which  prevented 
the  bones  from  being  kept  in  apposition.  Metastatic  abscesses  had  commenced  to  form  along  the  course  of  the 
anterior  tibial  lymphatic  glands,  and  every  symptom  prognosticated  an  unfavorable  termination,  the  only  hope 
being  based  on  the  remarkable  strong  constitution  of  the  patient.  The  abscess  at  the  stump  was  freely  evac 
uated,  and  the  metastatic  abscesses  were  freely  opened  as  soon  as  fluctuation  could  be  detected;  the  calca 
neum  and  tibia  were  held  in  proper  position  by  means  of  adhesive  straps  after  the  limb  had  been  thoroughly 
cleansed  with  liquor  of  chloride  of  zinc.  Large  linseed  poultices  were  applied  over  the  lower  third  of  the 
tibia  and  lead  and  opium  wash  over  the  remaining  part  of  the  limb  as  far  as  the  erysipelas  extended;  stimu 
lants  and  beef  tea  were  administered.  The  patient  gradually  improved  until  April  28th,  when  he  had  a  chill, 
which  was  soon  followed  by  others.  Quinine  and  tincture  of  chloride  of  iron  was  then  prescribed  and  an 
ounce  of  brandy  was  given  every  two  hours.  By  May  2d  the  patient  had  the  peculiar  sweet  odor  of  breath 
and  the  well-marked  icteroid  hue,  especially  in  the  conjunctivas,  which  were  exceedingly  yellow.  Several 
chills  occurred  each  day  and  were  followed  by  considerable  febrile  movement  and  great  prostration;  but  by 
the  frequent  administration  of  stimulants  and  the  constant  application  of  artificial  heat  the  patient  rallied,  after 
which  beef  tea  was  given  in  quantities  as  large  as  could  be  tolerated.  From  May  6th  he  improved,  the  chills  occurring  at  longer 
intervals  and  with  less  severity  until  May  12th,  when  they  ceased.  A  slight  diarrhoea  at  this  time  was  checked  by  starch  and 
opium  injections,  after  which  the  patient  convalesced  rapidly.  By  June  26th  he  had  entirely  recovered,  the  os  calcis  having 
united  to  the  tibia  and  the  wound  having  closed,  leaving  a  solid,  firm  stump."  A  plaster  cast  of  the  stump,  Specimen  2298  of 

'SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  San.  Com.  Memoirs,  New  York,  1871,  Surgical  Volume  II,  p.  136. 
J  Circular  No.  6,  War  Department,  S.  G.  O.,  1865,  p.  47.     SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  Sanitary 
Commission  Memoirs,  New  York,  1871,  Surgical  Volume  II,  pp.  116, 132. 


FIG.  345. — Stump 
after  SYME'S  am 
putation  at  ankle 
joint.  Spec.  4369. 
[From  a  cast.] 


FIG.  346.— Stump 
after  PIKOGOFF'S 
amputation  at  an 
kle  joint.  [From  a 
plaster  cast.] 


598 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAT.  X. 


FIG.  :i47.-Stump 
of  left  leg  after 
PlUOGOFF'S  am 
putation  at  ankle 
joint.  [From  a 
«ast.] 


the  Army  Medical  Museum,  is  shown  in  FIG.  346,  and  a  photograph  of  the  patient  is  copied  in  FIGURE  I  of  PLATE  LXXV, 
opposite  page  59o.  Lieutenant  Weeks  was  mustered  out  of  service  July  20.  1865,  and  pensioned,  after  which  time  he  com 
menced  to  wear  the  "Palmer"  artificial  foot.  In  a  subsequent  report,  dated  June  28,  1866,  Dr.  Leale  furnished  the  following 
information  in  regard  to  the  case:  "I  have  just  received  a  communication  from  Lieutenant  Weeks  (residing  at  Allegan,  Mich 
igan),  in  which  he  states :  '  I  am  able  to  do  anything  that  most  men  can  do;  my  patent  foot  works  like  a  charm.  I  am  at  present 
engaged  in  a  large  flour  mill,  and  my  stump  has  never  troubled  me  but  once  since  I  left  the  hospital,  and  then  it  was  caused  by 
an  accident,  which  loosened  a  small  splinter  of  bone.  This  I  had  removed  at  Chicago,  since  which  time  it  has  done  well.  I 
adjusted  my  false  foot  on  October  1,  1865,  and  never  take  it  off  except  when  I  go  to  sleep.  I  can  easily  walk  without  a  cane.'" 
The  pensioner  was  paid  September  4,  1881. 

CASE  874. — Private  II.  Bell,  Co.  A,  2d  New  York  Artillery,  aged  45  years,  was  wounded  in  the  left  foot,  at  the  battle  of 
White  Oak  Swamp,  June  30,  1862.  He  was  conveyed  to  hospital  at  Fort  Monroe,  whence  he  was  transferred  to  DeCamp  Hos 
pital,  David's  Island,  three  weeks  afterwards.  Surgeon  J.  Simons,  U.  S.  A.,  in  charge  of  the  latter,  recorded 
the  patient's  admission  with  "amputation  of  foot."  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  in  charge  of 
Central  Park  Hospital,  New  York  City,  contributed  the  cast  (Spec.  4218),  represented  in  the  annexed  wood-cut 
(FlG.  347),  with  the  following  description:  "This  interesting  wax  specimen,  a  cast  of  Pirogoff's  operation,  I 
regret  to  say  has  an  incomplete  history.  According  to  the  patient's  statement  he  was  wounded  by  a  shell,  which 
tore  oft"  the  outside  of  the  foot  nearly  up  to  the  ankle.  He  was  etherized  on  the  field,  and  when  he  awoke  he 
found  that  he  had  no  foot.  When  admitted  to  this  hospital,  on  October  28th,  the  stump  was  healed  and  in  the 
condition  represented  in  the  cast.  The  parts  were  perfectly  consolidated,  and  the  heel  was  firm  and  capable  of 
sustaining  the  weight  of  his  whole  body  without  giving  rise  to  pain  or  tenderness.  The  limb  was  about  three- 
fourths  of  an  inch  shorter  than  its  fellow.  The  patient  was  furnished  with  an  apparatus  by  Dr.  Hudson,  which 
answered  admirably,  the  heel  of  the  artificial  limb  being  made  three-fourths  of  an  inch  higher,  while  the  ankle 
joint  was  lowered.  On  the  whole  it  was  as  shapely  as  the  width  of  the  ankle  would  allow.  The  patient  was 
discharged  from  service  July  7,  1863.  Before  he  left  the  hospital  he  was  able  to  walk  without  the  assistance 
of  a  cane  and  without  causing  any  irritation  to  the  stump."  Examining  Surgeon  W.  M.  Chamberlain,  of  New 
York  City,  certified  to  "loss  of  most  of  the  left  foot.  Pirogoff's  operation  has  been  successfully  performed.  A 
small  fragment  of  the  heel  only  is  left,  and  the  pensioner  wears  an  artificial  foot."  The  pensioner  was  paid 
March  4,  1871,  since  when  he  has  not  been  heard  from.1 

CASE  875. — Captain  J.  F.  Denniston,  Commissary  of  Subsistence,  U.  S.  V.,  aged  24  years,  was  wounded  in  the  right 
foot,  during  the  engagement  at  the  Weldon  Railroad,  August  25,  1864.  Surgeon  N.  Hayward,  20th  Massachusetts,  reported  his 
admission  to  the  field  hospital  of  the  2d  division,  Second  Corps,  with  "fracture  of  ankle,1'  followed  by  "Piro 
gofFs  operation,  performed  by  Surgeon  G.  Chaddock,  7th  Michigan,"  Surgeon  D.  W.  Bliss,  U.  S.  V.,  who 
subsequently  re-amputated  the  limb,  reported  that  "the  patient  entered  Armory  Square  Hospital,  Washington. 
August  28th.  On  September  6th  haemorrhage  ensued,  which  was  controlled  by  styptics  and  a  compress,  but 
commenced  again  two  days  afterwards,  when  the  femoral  was  held  by  the  attendants  for  several  hours.  On 
September  10th  a  fresh  and  copious  haemorrhage  set  in,  when,  after  a  thorough  examination  of  the  parts,  it  was 
deemed  proper  to  amputate  at  a  point  about  three  inches  above  the  ankle,  the  patient  being  in  good  condition 
at  the  time.  The  entire  loss  of  blood  probably  amounted  to  a  pint,  its  source  being  first  the  anterior  tibial  and 
afterwards  the  femoral  artery.  The  amputation  was  performed  by  the  circular  method  and  without  much  shock 
to  the  patient's  system.  The  treatment  included  tonics,  stimulants,  and  nourishing  diet.  Simple  dressings 
were  used.  Three  weeks  after  the  operation  the  patient  was  doing  well."  The  re-amputated  stump,  showing 
the  soft  tissues  and  the  cut  surfaces  of  the  tibia  and  os  calcis  softened  by  suppuration,  was  forwarded  to  the 
Museum  by  the  operator  and  constitutes  specimen  3211  of  the  Surgical  Section.  In  1881  the  soft  tissues  were 
removed  from  the  specimen,  when  it  was  found  that  the  tibia  was  fissured  to  the  extent  of  four  inches  (FlG. 
348).  The  patient  wras  subsequently  transferred  to  the  Seminary  Hospital,  Georgetown,  where  he  obtained 
leave  of  absence  November  25th,  when  he  started  for  his  home.  He  was  ultimately  mustered  out  of  service 
January  1,  1867,  and  pensioned.  While  serving  as  an  officer  of  the  70th  New  York,  at  the  battle  of  Williams- 
burg,  May  5, 1832,  Captain  Denniston  had  also  been  wounded  in  the  right  forearm,  for  which  injury  he  underwent  the  operation 
of  resection  of  the  continuity  of  the  bones.2  After  leaving  the  service  he  obtained  an  artificial  leg  from  the  Pittsburgh  Artificial 
Limb  Manufacturing  Co.,  and  since  then  he  has  continued  to  report  the  stump  of  his  amputated  leg  as  being  in  a  "healthy 
condition."  The  pensioner  was  paid  September  4,  1881. 

Fatal  Primary  Amputations  at  the  Ankle  Joint — The  results  in  twenty-three  primary 
amputations  at  the  ankle  joint  were  fatal.  Syme's  operation  was  performed  in  fourteen, 
and  PirogofF's  in  six  instances;  in  three  the  mode  of  operation  was  not  indicated.  Seven 
teen  of  the  patients  were  Union  and  six  Confederate  soldiers.  In  four  instances  the 
exarticulations  at  the  joint  were  followed  by  amputations  in  the  leg: 

CASE  876. — Private  H.  E.  Boynton,  Co.  L,  1st  Massachusetts  Heavy  Artillery,  aged  18  years,  received  a  shot  fracture 
of  the  left  foot  and  of  the  right  arm,  at  Spottsylvania,  May  19,  1864,  and  was  admitted  to  the  field  hospital  of  the  1st  division, 
Second  Corps.  Susgeon  J.  W.  Wishart,  140th  Pennsylvania,  reported  that  he  amputated  the  foot  by  Syme's  method  on  the  day 
of  the  injury.  Three  days  afterwards  the  wounded  man  entered  Emory  Hospital  at  Washington,  where  Surgeon  N.  R.  Moseley, 

'SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  San.  Com.  Memoirs,  New  York,  1871,  Surgical  Vol.  II,  pp.  117,  134. 
2 See  Medical  and  Surgical  History  of  the  Mar  of  the  Rebellion,  Part  II,  Volume  II,  TABLE  CXXVIII,  p.  957,  No.  23. 


FIG.  348.— Bones 
of  the  right  ankle 
joint  alter  PlKO- 
GOFF  8  amputa 
tion.  Spec.  3211. 


SECT.   VI.] 


PRIMARY    AMPUTATIONS    AT    THE    ANKLE    JOINT. 


599 


U.  S.  V.,  excised  two  inches  of  the  middle  third  of  the  fractured  humerus.  The  case  resulted  fatally  on  June  22,  1864.  The 
excised  portion  of  the  humerus  (Spec.  2322)  and  most  of  the  bone  of  the  amputated  foot  (Spec.  828)  have  been  contributed  to 
the  Museum  by  the  respective  operators.  The  latter  specimen  consists  of  the  metatarsus,  scaphoid,  cuboid,  and  outer  two  cunei 
form  bones,  and  shows  a  large,  battered,  conoidal  bullet  occupying  the  place  of  the  inner  cuneiform,  the  bones  adjacent  to  it 
being  fractured. 

CASE  877. — Private  E.  P.  Hale,  Co.  I,  1st  Minnesota,  aged  24  years,  was  wounded  through  the  left  lung  and  in  the  left 
foot,  at  Gettysburg,  July. 2,  1883.  He  was  admitted  to  the  field  hospital  of  the  1st  division,  Second  Corps,  where  amputation 
was  performed  by  Surgeon  C.  S.  Wood,  66th  New  York,  who  described  the  injury  of  the  foot  as  follows:  "A  mini6  ball  entered 
at  the  internal  malleolus,  passed  obliquely  downward  and  outward,  and  emerged  about  two  inches  below  the  external  malleolus, 
comminuting  the  astragalus  and  involving  the  ankle  joint.  Syme's  operation  was  performed."  Five  weeks  after  the  reception 
of  the  injuries  the  patient  was  transferred  to  Camp  Letterman,  whence  Acting  Assistant  Surgeon  A.  B.  Shekell  reported  that 
the  wounds  discharged  freely  and  that  the  patient  continued  in  a  weak  state,  his  condition  and  the  stump  of  the  leg  improving 
but  slightly,  though  stimulants,  quinine,  and  iron  were  freely  administered.  Simple  dressings  were  applied.  On  September  2d 
an  abscess  was  opened  on  the  inner  side  of  the  right  thigh,  which  discharged  about  a  pint  of  pus.  The  case  terminated  fatally 
on  September  12,  1863.  The  leaver  extremities  of  the  bones  ef  the  stump  (Spec.  1949),  showing  the  articular  surfaces  to  be 
destroyed  by  uFceration,  were  contributed  to  the  Museum. 

CASE  878. — Private  G.  Harfeter,  Co.  D,  104th  Pennsylvania,  aged  22  years,  was  wounded  at  Morris  Island,  September 
27,  1863,  and  was  conveyed  to  hospital  No.  5,  at  Beaufort,  the  following  day.  Assistant  Surgeon  J.  S.  Smith,  U.  S.  A.,  reported: 
"The  wound  was  by  a  fragment  of  shell  in  the  left  foot,  which  was  amputated  the  next  day  by  Surgeon  E.  B.  Bontecou,  U.  S.  V., 
on  board  of  the  hospital  transport  Cosmopolitan.  Syme's  operation  was  performed.  There  was  also  a  slight  flesh  wound  of  the 
right  hip  and  right  arm.  Simple  dressings  were  used  and  anodynes  were  given  at  night.  On  October  1st  slight  haemorrhage 
occurred,  which  was  easily  controlled  by  slight  pressure,  about  an  ounce  of  blood  being  lost.  Two  days  afterwards  a  profuse 
haemorrhage  took  place,  reducing  the  patient's  vitality  to  an  alarming  extent.  The  stump  was  then  opened  for  the  purpose  of 
securing  the  bleeding  vessel,  but  it  could  not  be  found,  and  the  anterior  tibial  was  ligated  two  inches  above  the  seat  of  the  haem 
orrhage.  The  bleeding  did  not  recur,  but  the  patient  gradually  sank.  He  died  October  12,  1863." 

CASE  879. — Private  F.  M.  Bland,  Co.  D,  23d  Iowa,  aged  22  years,  was  wounded  in  the  left  foot  during  the  engagement 
at  the  Black  River,  May  19,  1863,  and  entered  Adams  Hospital,  Memphis,  several  weeks  afterwards.  Acting  Assistant  Surgeon 
B.  J.  Bristol  reported:  "Syme's  operation  at  the  ankle  had  been  performed  the  same  evening  the  injury  was  received.  At  the 
time  of  the  patient's  admission  to  Adams  Hospital,  June  13th,  nearly  the  entire  flap  had  sloughed  off  and  the  bones  were  exposed 
to  view.  An  abscess  had  also  formed  at  the  middle  of  the  lower  third  of  the  leg,  and  there  was  periostitis  of  the  tibia  and  fibula 
at  the  same  point.  The  general  condition  of  the  patient  was  low,  he  having  had  diarrhoea  for  four  months.  He  was  put  upon 
iron,  quinine,  stimulants,  and  astringents.  On  June  17th  his  general  condition  was  somewhat  improved,  the  diarrhoea  checked, 
and  it  was  decided  to  operate.  Amputation  of  the  leg  was  accordingly  performed  at  the  junction  of  the  middle  and  upper  third 
by  Acting  Assistant  Surgeon  J.  Thompson.  I  saw  the  patient  for  the  first  time  the  next  day,  when,  though  in  a  low  condition, 
he  seemed  to  be  rallying  from  the  shock  of  the  operation.  I  administered  tonics,  stimulants,  and  beef  tea  freely,  and  had  water 
dressings  applied  to  the  stump,  under  which  course  the  general  condition  of  the  patient  gradually  improved.  The  stump  then 
appeared  to  do  well,  but  before  many  days  it  began  to  discharge  a  thin  ichorous-looking  pus.  About  June  26th  the  flaps  gaped 
open,  no  adhesions  having  formed  in  any  part  of  the  stump.  The  flaps  soon  commenced  sloughing,  and  it  was  decided  that  the 
only  chance  for  the  patient  laid  in  another  amputation.  Accordingly  on  July  2d  the  thigh  was  taken  off'  at  the  middle  of  the 
lower  third,  which  operation  the  patient  seemed  to  bear  well.  The  tonic  and  supporting  treatment  was  continued,  and  as  before 
the  patient  seemed  at  first  to  be  doing  well ;  but  the  stump  soon  became  gangrenous.  An  abscess  also  formed  below  the  clavicle, 
the  edges  of  which  sloughed  away,  laying  bare  the  thyroid  axis,  the  branches  of  it  too  sloughing  off.  On  July  13th  the  patient 
was  removed  to  my  ward  in  a  rapidly  sinking  condition.  He  died  three  days  afterwards — on  July  16, 1863."  The  Syme  stump 
(Spec.  1706),  removed  at  the  first  re-amputation  and  contributed  to  the  Museum  by  Surgeon  J.  G.  Keenon,  U.  S.  V.,  shows  the 
extremities  to  be  necrosed  and  an  absence  of  reparative  action. 

TABLE  XC. 
Summary  of  One  Hundred  and  Three  Cases  of  Primary  Amputation  at  the  Ankle  Joint  for  Shot  Injury. 

[Recoveries,  1—78;  Deaths,  79—101;  Results  undetermined,  102-103.] 


NO. 

NAME,  MILITARY 
DESCKIPTIOX,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION"  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

1  Ayres,  J.  E.,  Pt.,  E,  8th  N. 

July  10, 

Conoidal  ball  comminuted  left 

July  10, 

Syme's  amputat'n  at  left  ankle 

Sloughing.     Discharged  October 

York  Cavalry,  age  19. 

1863. 

tarsus. 

18C3. 

joint. 

5,  1863  ;  pensioned.     Spec.  6056, 

A.  M.  M.     Stump  in  good  con 

dition  in  1881. 

o 

Baal,  M.,  Pt.,  E,  21st  Iowa. 

May  17, 

Shot  fracture  of  right  foot. 

Mnv  17, 

Pirogoff's  amputation  at  right 

Discharged  Sept  26,  1863;  pen* 

age  20. 

18(13. 

1863. 

ankle  joint. 

sioned.  Stump  perfectly  healed. 

3 

Barnett,  J.  B.,  Pt.,  E,  191st 

Mar.  31, 

Conoidal  ball  comminuted  tar- 

April  1, 

Syme's  amputation  at  left  ankle 

April  8,  amputation  in  low.  third 

Pennsylvania,  age  33. 

1865. 

sal   and  metatarsal   bones  of 

1865. 

joint.    Surg.  A.  A.  White,  8th 

of  leg.    Discharged  June  28, 

left  foot. 

Maryland. 

1865.  and  pensioned. 

4 

''Bell,  H.,  Pt.,  Battery  A,  2d 

June  30, 

Shell  fracture  of  tarso-metatar- 

June  30, 

Pirogoff's   amputation   at   left 

Discharged  July  7,  1863:  stump 

New  York  Artillery,  age  45. 

1862. 

sal  bones  of  left  foot. 

1862. 

ankle  joint;  lower  portion  of 

finely  formed  ;  'pensioned.  Able 

tibia  and  anterior  portion  of 

to  walk  without  aid  of  cane; 

(•alcaneiim  exsected. 

portion   of  calcaneum    useless. 

1 

Spec.  4218,  A.  M.  M. 

SMITH  (S.),  Amp  at  the  Ankle  Joint  in  Mil.  Sury.,  in  U.  S.  San.  Com.  Mem.,  N.  Y.,  1871,  Surg.  Vol.  II,  p.  138.  "SMITH  (S.),  loc.  rit.,  pp.  117,  134. 


600 


INJURIES   OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCIUPTION,  AND  AGE. 

DATK 

OF 
INJURY. 

NATURE  OF  IXJUKY. 

DAIK 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RKSI  -].T  AND  REMARKS. 

5 

Blake,  H.,  Pt.,  I,  37th  Mass., 

June  13,    Shot  fracture  of  right  tarsus.  .  .  June  13 

Pirogoff's  amputation  at  right 

Discharged  December  16,  1864; 

age  36. 

1864.                                                                1864. 

ankle  joint. 

pensioned.    Stump  well  healed. 

6 

Blakeman,   M.    A.,   1't.,    D, 

Sept.  22,   Conoidal    ball    fractured    the  Sept.  22, 

Amputnt'n  at  right  ankle  joint 

Discharged  May  8,  1865,  and  pen 

3<:th  Ohio,  age  36. 

1864.         right  ankle  joint.                             1864. 

by  Symc's  method. 

sioned.  Stump  perfectly  healed. 

7 

Blanlcenbecker,  G.  R.,  Pt.,  C,  June  24,   Cnnoidal  ball  fractured  meta-    June  24, 

Syme's    amputation   at  ankle 

Sloughing   of    flaps;    a'bscesses. 

4th  Va.  Cavalry,  age  20.          1864.         tarsal  bones  of  left  foot.                1864. 

joint. 

Furloughed  October  30.  1864. 

8 

Bourkney,  N..  1't  .  K,  155th  June  16,   Shell  fracture  of  right  tarsus  ..  June  17, 

Amputation  at  ankje  joint  by 

Discharged  March  15,  1865,  and 

New  York,  age  32. 

1864.                                                                1864. 

circular  incision.    Surgeon  N. 

pensioned. 

Hayward,  20th  Mass. 

9 

Brewster.    J.,   Pt.,    I,    29th 

Sept.  29,  Grapeshot  wound  of  left  foot,  Sept.  29, 

Syme's    amputation  at   ankle 

Discharged  July   22,    1865,  and 

Conn,  (colored),  age  22. 

1864.         fracturing  metatarsal  bones. 

1864. 

joint. 

pensioned.     Sound  stump. 

10 

Brink.   S.   S.,   Pt.,    B,  3Cth 

June  18,   Conoidal  ball  fractured  left  foot.  June  18. 

Flap  amputation  at  ankle  joint. 

Discharged  April  25,  1865;  pen 

Wisconsin,  age  28. 

1864. 

1864. 

Surgeon   N.    Hayward,  20th 

sioned.     Stump  unsound  ;  bone 

Massachusetts. 

diseased. 

11 

Bunting,  J.  K.,  Corp'l,  I,  8th 

April  16, 

Shot  comminution  of  astragalus  April  18, 

Syme's  amputation  at  left  ankle 

Discharged  June  27,  1862;  pen 

Michigan,  age  28. 

1862. 

and  calcaneum.                              1862. 

joint.     Ass't   Surgeon   C.  A. 

sioned.      Stump    healthy    and 

McCall,  U.  S.  A. 

useful. 

12 

'Clark,  H.  W.,  Pt.,  H,  100th 

May  13, 

Solid   shot   fractured  bones  of   May  13, 

Syme's  amputation  at  left  ankle 

Discharged  December  13,  1864. 

New  York,  age  :!0. 

1864. 

both  feet. 

1864. 

joint;    Chopart's  amputation 

Spec.  2857,  A.  M.  M. 

right  foot.     Surg.  M.  S.  Kit- 

tinger,  100th  New  York. 

13 

CoUins,  W.,  Pt.,  F,  3d  Mis 

July  22, 

Conoidal  ball  fractured  the  arch    July  23, 

Syme's    amputation   at   ankle 

Recovered. 

sissippi  Battery,  age  28. 

1864. 

of  the  left  foot.                               1864. 

joint. 

14 

2  Connors,    J.,    Pt,   F,   76th 

July  11, 

Musket   ball  comminuted  the    July  12, 

Syme's  antero-post.  flap  ampu 

Necrosis  of  tibia.     Sept.  27,  amp. 

Pennsylvania,  age  25. 

1863. 

right  tarsus.                                   1863. 

tation  at  right  ankle  joint. 

lower  third  leg.     Disch'd  Aug. 

• 

28,  1865;  pensioned. 

15 

3Covell,  E.  R.,  Pt.,  C,  52d 

May  18, 

Shell  wound,  carrying  away  a    May  18, 

Syme's  amput'n  at  ankle  joint, 

Discharged  Nov.   3.  1864;  pen 

New  York,  age  38. 

1864. 

large  portion  of  left  foot  ;  con-      1864. 

end  of  tibia  and  fibula  rem'd. 

sioned.     May  5,  1869,  amput'n 

siderable  haemorrhage. 

Surgeon  J.  W.  Wishart,  140th 

lower  third  leg.     Spec.  4:«J9,  A. 

Pennsylvania. 

M.  M. 

16 

4Denniston,  J.  F.,  Commis 

Aug.  25, 

Conoidal  ball  fractur'dl  he  right  Aug.  25, 

Pirogoff's  amputation  at  ankle 

Haem.  from  ant.  tib.  and  femoral 

sary  of  Subsistence,  U.  S. 

1864. 

ankle. 

1864. 

joint. 

arteries.     Sept.  10,  amp.  lower 

V.,  age  24. 

third  leg.     Disch'd  Jan.  1,  1867, 

and  pensioned.     >Spec.  3211. 

17 

6  Dresser,  E.  E.,  Pt.,  A,  20th 

June  24, 

Shell  fragm't  extensively  laoer-   June  24, 

Syme's  amp.  at  ankle.    Surg. 

Fragments  of  necrosed  bone  re 

Massachusetts,  age  21. 

1864. 

ated  foot  and  injured'  tarsal 

1864. 

N.  Hayward,  20th  Mass.   Soft 

moved.     Discharged   Dec.   12, 

and  metatarsal  bones. 

parts  so  much  destroyed  that 

1864.     Died  Nov.  14.  1870,  from 

flaps  wero  made  from  sides  of 

ulceration  of  bowels. 

ankle  and  foot  and  extcr.  sole. 

18 

Dudley,  E.  H.,  Pt.,  K,  16th 

July  3, 

Shell  fracture  and  laceration  of 

July  4, 

Syme's  amputation  at  ankle. 

Inflammation  :   sloughing.     July 

Vermont,  age  20. 

1863. 

tarsal  bones  of  left  foot. 

1863. 

Ass't    Surgeon    (!.   H.   Rich 

J  8,  amp.  lower  third  leg.     M.  O. 

mond,  104th  New  York. 

Aug.  10,  1863.     Amp.  up.  third 

leg  Dec.  21,  186:t;  pensioned. 

19 

6  Duffy,  T.,  Pt.,  I,  70th  New 

June  1, 

Musket  ball   fractured    tarsal 

June  2, 

Syme's  amputat'n  at  left  ankle 

Sloughing  of  flaps.    Nov.  6,  amp. 

York,  age  21. 

1862. 

and  metatarsal  bones  of  left 

1862. 

joint. 

middle  third  leg.     Nov.  28,  se 

foot. 

questra  removed.    Disch'd  July 

11,   1863;  pensioned.     Healthy 

stump.     Spec.  4312. 

20 

Foreman,  J.  Af.,  Pt.,  B,  7th 

May  4, 

Gunshot  wound  

May  5, 

Amput'n  at  ankle  joint.     Surg. 

Furloughed  June  23,  1863. 

Louisiana. 

1863. 

18&3. 

J.  B.  Davis,  C.  S.  A. 

21 

Freeman,  J.  C..  Pt.,  A,  9th 

Sept.  17. 

Shot  fracture  of  left  foot  

Sept.  18, 

Syme'samp.at  leftankle.  Surg. 

Discharged  December  30,  1862; 

New  York,  age  2ii. 

1862. 

18G2. 

G.  C.  Humphreys,  9th  N.  Y. 

pensioned.     Stump  healed. 

22) 

Hicks,  II.  F.,  Pt.,  A,  1st  R. 

Dec.  13, 

Shot  wound  of  both  feet  Dec.  1  4. 

Syme's  amput'n  at  right  ankle, 

Discharged  September  14,  1863; 

93j 

Island  Artillery. 

1862. 

1862. 

and  Pirogoff's  at  left  ankle. 

pensioned. 

24 

7  Holland,  K.  B.,  Corp'l   B, 

May  3, 

Shot  fracture  of  tarsus 

May  4, 

Pirogoff's  amputation  at  ankle 

Recovery.     1864,  unable  to  walk 

44th  Virginia. 

1863. 

1863. 

joint.  Surg.  B.  F.  Whitehead, 

without  crutches.      Parts   still 

C.  S.  A. 

swollen  and  cedematous  ;   heel 

drawn  upward. 

25 

Holmes,  A.  H'.,  Pt.,  K,  20th 

June  19, 

Shot  wound  of  right  foot  

June  19, 

Amputat'n  at  right  ankle  joint. 

Discharged  August  25,  1864. 

Georgia. 

1864. 

1864. 

Surgeon  C.  Cord,  C.  S.  A.    . 

26 

Hosington,  G.,  Pt.,  A,  123d 

June  13, 

Wound  of  left  foot  by  conoidal 

June  14, 

Amputation  at  ankle  joint  by 

June  21,  amp.  leg  3  ins.  above 

Ohio,  age  36. 

1863. 

ball. 

1863. 

Confederate  surgeon. 

ankle  joint.  Sept.  17,  re-amp,  in 

middle  third  leg.     Disch'd  May 

16,  1  865  ;  stump  entirely  healed  ; 

pensioned.     Died  Dec.  16,  1866. 

27 

Humble,    T.,    Pt.,    G,    24th 

May  13, 

Shot  wound  of  right  foot 

Mav  13 

Amputat'n  at  right  ankle  joint. 

Retired  March  2,  1865. 

Texas. 

1864. 

1864. 

Surg.  G.W.  Lawrence,C.S.A. 

28 

Hunt,  J.,  Pt.,  C.  19th  Indiana, 

June  18, 

Conoidal  ball  injured  right  foot. 

June  18, 

Syme's  amput'n  at  right  ankle 

Discharged  May  20,   1865,  and 

age  38. 

1864. 

1864. 

joint.     Surgeon  J.  Ebersole, 

pens'd.  Stump  perfectly  healed. 

19th  Indiana. 

Declares,  in  1875,  that  his  leg  is 

slowly  getting  weaker. 

29 

Hunter,    A.,    Pt.,    F,    140th 

May8, 

Shell  fracture  of  all  metatarsal 

May  9, 

Syme's  flap  amputation  at  right 

Discharged  June  1  4,  1  865  ;  pen 

Pennsylvania,  age  33. 

'1864. 

bones  in  right  foot. 

1864. 

ankle  joint.     Surgeon  J.  W. 

sioned. 

Wishart,  140th  Pennsylvania. 

30 

Ishain,  D.  E.,  Pt.,  E,  154th 

May  3, 

Shell   wound,    shattering  and 

Mav  4, 

Chopart's  amp.  attempted,  but 

Discharged  January  22,  1864,  and 

New  York,  age  19. 

1863. 

carrying   away   most   of  left 

1863. 

finding  astragalus  and  cunei 

pensioned. 

foot. 

form  injured,  Syme's  operat'n 

was  performed.     Surg.  C.  S. 

Wood,  66th  New  York. 

31 

Jackson,    F.,    Pt.,    E,    86th 
Colored  Troops,  age  32. 

April  3, 
1865. 

Compound  fracture  right  foot 
by  fragment  of  shell. 

April  3, 
1865. 

Syme's  amput'n  at  right  ankle 
joint.     Surgeon  H.  Osborne, 

Discharged  Aug.  7,  1865.    Stump 
perfectly  healed. 

51st  Colored  Troops. 

32 

•Johnson,  F.,  Capt.,  K,  26th 

May  12, 

Conoidal  ball  comminuted  left 

May  12, 

Syme's  amputation,  left  ankle 

Discharged  Nov.  30,  1864  ;  pen 

Michigan,  age  2ii. 

18'64. 

tarsus. 

1864. 

joint.     Surg.  J.  W.  Wishart, 

sioned.   3J  ins.  shortening;  flaps 

140th  Pennsylvania. 

retracted.    Not  heard  from  since 

• 

September  4,  1870. 

33 

Johnson,  J.  M.,  Pt.,  C,  3d 

June  3, 

Shell  wounds  of  left  foot  and 

June  3, 

Syme's  amputation  at  leftankle 

Discharged   June   8,  1865  ;  pen 

Delaware,  age  31. 

1864. 

right  leg. 

1864. 

joint  :  also  amp.  in  mid.  third 

sioned.     Small  ulcer  on  stump 

right  leg.     Surg.  G.  W.  Met- 

in  1874. 

calf,  76th  New  York. 

1  SMITH  (S.),  loc.  tit.,  pp.  110,  140.  »  SMITH  (S.),  loc.  cit.,  p.  138.  3  SMITH  (S.),  loc.  tit.,  p.  136. 

*Capt.  Denniston  had  received  a  shot  fracture  of  the  bones  of  the  forearm,  at  Williamsburg,  May  5,  1862,  for  which  excision  was  performed.  See 
Second  Surgical  Volume,  TABLE  CXXVIII,  p.  957.  No.  23.  B  SMITH  (S.),  loc.  tit.,  pp.  109,  140.  6  SMITH  (S.),  loc.  til.,  p.  138. 

7 HOLLOWAY  (J.  M.),  Comp.  Advantages  of  PIUOGOFF'S,  SYME'S,  and  CHOPART'S  Amp.,  etc.,  in  Am.  Jour.  JUed.  Sri,,  1866,  N.  S.,  Vol.  LI,  p.  85,  and 
SMITH  (S.),  Amp.  at  the  Ankle  Joint  in  Mil.  Surg.,  in  U.  S.  San.  Co  i.  Mem.,  New  York,  1871,  Surg.  Vol.  II,  p.  134.  'SMITH  (S.),  loc.  tit.,  p.  138. 


SECT.  VI.] 


PRIMARY    AMPUTATIONS    AT    THE    ANKLE    JOINT. 


601 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATK 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS 

34 

June,  J.,  Pt.,  E,  43d  New 

May  10, 

Conoidal  ball  fractured  tarsal 

May  12,   Flap  amputation  at  anklejoint 

Discharged  March  15,  1865;  good 

York,  nge  25. 

1864. 

bones,  left  foot. 

1864.         by  Confederate  surgeon. 

stump.     Pensioned. 

35 

Kilborn,  M.,  Pt,,  F,  14th  In 

Nov.  3, 

Shell  wound  right  foot     

Nov.  3.     Svme's  amrmtation.  ritrht  nnklp 

Discharged  September  16,  1863; 

fantry,  age  29. 

1862. 

1862. 

joint. 

pensioned. 

36 

King,  'C.,  Pt.,  B,  82d  Ohio, 

Mar.  19, 

Left  foot   badly  shattered  bv 

Mar.  19, 

Syme's  nmputnt'n  at  left  ankle 

Discharged  August  15,  1865,  and 

age  19. 

1865. 

shot. 

1865. 

joint.     Surgeon  J.  Chapman. 

pensioned. 

12Cd  New  York. 

37 

1  Le  Blanc,  L.  D.,  Pt,,  Don- 

-  —  .  

Shot  wound  of  left  foot  

On  field. 

Disartioulation  at  anklejoint.. 

Recovery. 

aldsonville  Artillery. 

1862. 

38 

2I,e  Blanc,  ().,  Pt,,  E,  2d  N. 

June  1, 

Shell  fracture  tarsal  and  meta- 

June  1, 

Pirogoff's  amputation  at  ankle 

Discharged   June   16,  1865.  and 

Hampshire,  age  20. 

1864. 

tarsal  bones,  right  foot  ;  great 

1864. 

joint.    Surgeon  J.  M.  Merron, 

pensioned.     Stump  healed. 

laceration. 

2d  New  Hampshire. 

39 

Leigh,  G.,  Pt.,  C,  3d  Artil 

Sept.  24, 

Shell  carried  away  portion  of 

Sept.  24, 

Syme's  amputation  at  right  an 

Flaps  sloughed  :  March  20,  1864, 

lery,  age  19. 

1863. 

right  foot. 

1863. 

kle  joint. 

amp.  lower  third  leg.     Disch'd 

Sept.  17,  1864.     Died  Sept.  13, 

1871.    Spec.  2105,  A.  M.  M. 

40 

Luyster,  T.,  Pt.,  B,  10th  N. 

May  10, 

Conoidal  ball  comminuted  the 

May  10, 

Circular  amputation   at  right 

Discharged  April  24,  1865;  pen 

York,  age  19. 

1864. 

right  os  calcis. 

1864. 

ankle  joint.     Surg.  M.  Rizer. 

sioned. 

72d  Pennsylvania. 

41 

Lynn,    S.,   Serg't,  C,   104th 

Nov.  25, 

Conoidal  ball  fracturing  right 

Nov.  25, 

Pirogoff  'smodificat'n  of  Syme's 

Discharged    February  23,  1864, 

Illinois,  nge  28. 

1863.- 

foot. 

1863. 

amputat'n  at  right  anklejoint. 

and  .  pensioned.       Fine    round 

Surg.  C.  H.  Miller,  125th  111. 

stump. 

42 

3Lyon,  B.,  Pt,,  C,  12th  Mas 
sachusetts,  age  19. 

Sept.  17, 
1862. 

Solid  shot  shattered  left  tarsus 
and  carried  away  phalanges 

Sept.  17, 
1862. 

Syme's  amputat'n  at  left  ankle 
joint.     Surgeon  J.  McL.  Hay- 

Discharged  Oct.  23.  1803.  Stump 
highly    serviceable  ;    3    inches 

and  metatarsus. 

ward,  12th  Massachusetts. 

shortening. 

43 

McConihe,  L.  A.,  Pt.,  F,  3d 

Aug.  26 

Shell  wound  of  left  foot 

A  ug.  20, 

Svme's  amp.,  left  ankle  joint. 

Discharged   Nov.  5,  1863  ;   pen 

New  Hampshire,  age  20. 

1863. 

1863. 

Surg.A.  J.  H.  Buzzell,3d'N.H. 

sioned.     Stump  healed. 

44 

Mclntire,  E.  P..  Pt.,  K,  2d 

May  1, 

Conoidal  ball  injured  left  foot.  . 

May  2, 

Amputation  at  left  ankle  joint. 

Discharged  July  24,  1863;  pen 

Infantry,  age  30. 

1863. 

1803. 

Surg.  G.  R.  C.  Todd.  C.  S.  A. 

sioned. 

45 

Mclntyre,   N.,   Pt.,   F,    10th 

May  14, 

Conoidal  ball  comminuted  the 

May  15, 

Syme's  amputation  at  left  ankle 

Discharged     January   21,    1864, 

Missouri,  age  22. 

1863. 

left  tarsus  and  splintered  the 

1863. 

joint,     Surgeon  H.  S.  Hewit, 

and  pensioned. 

astragalus. 

U.  S.  V. 

46 

Maddox.    T.,    Pt.,   E,    19th 

May  22, 

Wound  of  left  foot  bv  conoidal 

May  23, 

Amp.  at  left  ankle  joint.    Surg. 

Discharged  October  5,  1863;  pen 

Kentucky,  age  23. 

1863. 

ball. 

1803. 

W.  K.  Sadler,  19th  Ky. 

sioned. 

47 

Marsh,  B.   F.,  Pt,,  K,  12th 

Oct.  19 

Gunshot  wound. 

Oct.  19, 

Amputation  at  ankle  joint  by 

Discharged  February  1,  1865. 

Alabama. 

1864. 

1864. 

Surgeon  —  Scott. 

48 

May,  M.,    I't.,  H,  9th   New 

Sept,  17, 

Solid  shot  comminuted  the  left 

Sept.  18, 

Syme's  amputat'n  at  left  ankle 

Discb'd  January  10,  1863;  pen 

York,  age  22. 

1862. 

foot. 

1862. 

joint,     Surgeon  G.  C.  Hum 

sioned.   April,  "1863,  amputation 

phreys.  9th  New  York. 

lower  third  leg. 

49 

Mentaldo,    P.,    Pt.,   K,    6th 

Jan.  2, 

Conoidal  ball  fractured  meta- 

Jan.  2, 

Pirogoff's    amputation  at  the 

Discharged  June  22,   1864,  and 

Ohio,  age  33. 

1863. 

tarsal  bones,  right  foot. 

1863. 

right  anklejoint. 

pensioned.     Stump  healed. 

50 

Munger,    M.,     Pt.,    H,    8th 

May  6, 

Comp.  fracture   left  foot,  just 

Mav  6, 

Syme's  amp.  at  left  ankle  joint. 

Discharged  January  27,  1865.  and 

Michigan,  age  19. 

1864. 

below  joint,  by  conoidal  ball. 

1864. 

Surg.  B.  Rohrer,  10th  Pa!  Res. 

pensioned. 

51 

Newell,    T.    F.,    Lieut.,    G, 

July  2, 

Fracture  of  right  foot  by  a  frag 

July  2, 

Pirogoff's  amputation  at  right 

Transferred  for  exchange  Sept. 

45th  Georgia,  age  24. 

1863. 

ment  of  shell. 

1863. 

anklejoint. 

27,  1863.     Spec.  6688,  A.  M.  M. 

52 

•"O'Reilly,  C.,  Pt,,  F,  164th 

May  18, 

Shell  wound  of  right  foot  

May  18, 

Syme's  amputat'n,  right  ankle. 

February  12,  1865,  amp.  of  leg  at 

New  York,  age  23. 

1864. 

1864. 

Surg.  G.  W.  Briggs,  C.  S.  A. 

junc.   of  lower  third.     Disch'd 

Mav  31,  1865,  and  pensioned. 

53 

Patton,  A.  G.,  Pt.,  I,  139th 

May  12, 

Wound  of  left  foot  by  conoidal 

May  13, 

Pirogoff's  amputation  at  ankle 

Disch'd  March  ]6,  1865.  and  pen 

Pennsylvania,  age  23. 

1864. 

ball. 

18~64. 

joint,     Surgeon  S.  F.Chapin, 

sioned.    Stump  healed  soundly. 

139th  Pennsylvania. 

54 

Policy,  J.  B.,  Corp'l,  F,  4th 

Oct.  7, 

Shot  wound  of  right  foot  

Oct.  7, 

Syme's  amputation  at  right  an 

Retired  January  25,  1865. 

Texas,  age  24. 

1864. 

1804. 

kle  joint. 

55 

Porter,    A.,    Pt.,    K,    106th 

July  6. 

Shot  wound  left  foot,  destroy 

July  7, 

Pirogoff's   amputation  at  left 

Discharged   September  5,  1862; 

Pennsylvania,  age  22. 

1862. 

ing  tarsus. 

1802. 

ankle  joint.    Ass't  Surgeon  P. 

pensioned.     Died  July  10,  1864. 

Leidy,  106th  Penn. 

56 

Price,  S.  B.,   Serg't,  A,  2d 

MavlS, 

Conoidal  ball  fractured  left  foot. 

May  15, 

Syme's  amputat'n  at  left  ankle. 

Gangrene  of  stump.     June  15. 

Ohio,  nge  22. 

1864. 

1864. 

Surgeon  B.  F.  Miller,  2d  Ohio. 

amp.  leg  at  lower  third.     Dis 

charged  Oct.  10,  1864  ;  pens'd. 

57 

Ross,  J..  Pt.,  I,  2d  New  York 

Mav  19, 

Conoidal  ball  passed  through 

May  19. 

Syme's    amputation  at  ankle 

Secondary  amput'n  of  leg.  upper 

Heavy  Artillery,  age  34. 

1864. 

metatarsus    from    dorsal    to 

1864. 

joint.     Surg.  J.  W.  Wishart, 

third.     Disch'd  March  15,  1865. 

plantar  surface. 

140th  Pennsylvania. 

Died  Jan.   8.    1877;    apoplexy 

and  hemiplegia. 

58 

Russell,   A.   K.,  Pt.,  H,  1st 

May  19, 

Conoid,  ball  lacerated  soft  parts 

May  19, 

Syme's    amputation   at  ankle 

Discharged  June  2,  1865.  Ampu 

Massachusetts  Heavy  Artil 

1864. 

of  left  foot  and  com.  os  calcis, 

1864. 

joint;  sloughing. 

tation  leg  at  mid.  third.     Card 

lery,  age  43. 

astragalus,  and  metatarsals. 

Photo's,  Vol.  1,  p.  45. 

59 

Smith,   G.  W.,   Pt.,   H,   6th 

Sept.  15, 

Shot  wound  of  right  foot  

Sept,  15, 

Pirogoff's  amputation  at  right 

Discharged    October    17,   1864  ; 

Illinois  Cavalry,  age  21. 

1864. 

1864. 

ankle  joint  ;  portion  of  heel 

pensioned. 

bone  retained.     Surg.  G.  P. 

Christy,  9th  Illinois  Cavalry. 

60 

Smith.  S.  B.,  Lieut.,  D,  3d 

May  2, 

Four  of  left  tarsal  bones  shat 

May  2. 

Syme's  amputation  at  left  ankle 

Transferred  to  V.  R.  C.  July  2, 

Michigan,  age  26. 

1863. 

tered  and  soft  parts  extensive 

1863. 

joint.    Surgeon  C.  S.  Wood, 

1863.    Disch'd  January  1,  1868; 

ly  destroyed. 

66th  New  York. 

pensioned.     Stump  sound  and 

healthy. 

61 

Smith,   T.  A.,  Pt.,  H,  llth 
Penn.  Reserves,  age  18. 

Dec.  13, 
1862. 

Wound  of  right  foot  by  conoid 
al  ball. 

Dec.  15, 
1862. 

Pirogoff's  amputation  at  right 
anklejoint. 

March  14,  1803,  gangrene.     Dis 
charged   Sept.   11,   1863:   pen 

sioned.     1878,    stump    tender; 

cannot  wear  artificial  limb. 

62 

Smyser,  J.  W.,  Pt,,  A,  27th 

June  24, 

Shot  wound  of  right  foot  

June  24, 

S3-me's    amputation    at    right 

Furlough  ed  August  6,  1864. 

South  Carolina,  age  25. 

1804. 

1864. 

ankle  joint. 

63 

Snyder,   L.,  Corp'l,  F,  71st 
Penn.,  age  24. 

Dec.  15, 
1862. 

Fracture  of  left  foot  by  conoidal 
ball. 

Dec.  16, 

1862. 

Pirogoff's  amputation  at  left 
anklejoint. 

Discharged  May  17,  1864  ;  pen 
sioned.  Stump  perfectly  healed. 

64 

Spearman.    R.    F.,   Pt.,  D, 

May  30, 

Conoidal  ball  fractured  tarsus. 

Mav  31, 

Amput'n  at  ankle  joint.     Surg. 

Transferred. 

25th  South  Carolina. 

1864. 

1864. 

C.  B.  Gibson,  C.  S.  A. 

65 

5  Stetson,  A.  L.,  Pt.,  G,  20th 

Mav  2, 

Spiral  case  shot  perforated  left 

Mav  2, 

Double  lat.  flap  amp.  (Syme's 

Discharged  Dec.  29,  1863;  pen 

Massachusetts,  age  26. 

1863. 

ank.  joint,  destroying  articula 

1863. 

modified)  at  left  ankle.   Surg. 

sioned.      Cicatrization   perfect; 

tion  and  soft  parts  about  heel. 

N.  Hayward,  20th  Mass. 

2J  inches  shortening. 

66 

6  Stockwell,  W.  S.,  Serg't,  B, 
57th  New  York,  age  23. 

May  3, 
1863. 

Unexploded  shell  comminuted 
phalanges,  metatarsal  bones, 

Mav  4, 
1863. 

Syme's  amput'n  at  right  ankle 
joint.     Sureeon  C.  S.  Wood, 

Discharged  Aug.  24,  1863  ;  pen 
sioned.    Very  creditable  stump. 

andport'n  of  tarsus,  rigfht  foot. 

66th  New  York. 

67 

Thornton,  F.  C'.,  Pt,,  K,  34th 
Virginia. 

July  30, 
1864. 

Greater  port'n  of  right  foot  torn 
away  by  fragment  of  shell. 

July  30, 
1864. 

Pirogoff's  amputation  at  right 
anklejoint. 

Healed  bv  first  intention.    Fur- 
loughed'October  23,  1864. 

1  FOR.MENTO  (P.,  jr.),  Notes  and  Observations  on  Army  Surgery,  etc.,  New  Orleans,  1863,  p.  27. 
•SMITH  (8.),  loc.  cit.,  p.  138.          «SMITH  (S.),  loc.  cit.,  p.  136.          'SMITH  (S.),  lac.  tit.,  pp.  110, 140. 

SURG.  Ill— 76. 


*SMIT(I  (S.),  loc.  cit.,  p.  132. 
*  SMITH  (S.),  loc.  tit.,  p.  138. 


602 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITAUY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 
IXJUBY. 

NATURE  OF  INJUUY. 

DATK 

OF 
OPERA 
TION. 

OPERATION-  AND  OI-KUATOR. 

RESULT  AND  REMARKS. 

GS 

Townsend,  W.,    Pt.,  I,  92d 

Sept.  1, 

Conoidal  ball  fractured  left  foot. 

Sept.  1, 

Pirogoff's  modificat'n  of  Syme's 

Discharged  June  16,   1865;  pen 

Ohio  age  21. 

1864. 

1864. 

amputation  at  left  ankle  joint. 

sioned.     In    1867,  alleged   that 

retained  portion  of  heel  was  an 

annoying  encumbrance. 

69 

Treadway,  W.,  Pt.,  H,  13th 

April  4, 

Wound  of  left  foot  by  conoidal 

April  5. 

Svme's  amput'n  at  ankle  joint. 

Discharged    October    23,    1865; 

Tennessee  Cavalry,  age  20. 

1865. 

ball. 

186."). 

Surg  R.D.Hamilton.  P.  A.C.S. 

pensioned.     Sound  stump. 

70 

Unknown,  Pt.,  

Nov.  26, 

Shot  wound  ,  involving  tarsus.  .  Nov.  28, 

Pirogoff  s  amp.  at  ankle  joint. 

1865,  recovery:  apparently  little 

1863. 

1863. 

Surg.  R.  K.  Taylor,  P.A.C.S. 

inconvenienced  bv  loss  of  foot. 

71 

Wallace,   T.  C..  Pt.,  B.  1st 

Aug.  7, 

Conoidal  ball  perforated  tarsal    Aug.  !>, 

Pirogolf  s  modincat'n  of  Syme's 

Discharged  May  29,    1865;  pen 

West  Virginia  Cavalry,  age 

1864. 

bones,  left  foot. 

1864. 

ainputat'nat  left  ankle.  Surg. 

sioned.  An  open  ulcer  extended 

20. 

P.  Gardner,  1st  W.  Va.  Cav. 

to  the  rear  of  the  ext.  malleolus. 

7* 

1  Weeks,  W.  C.,  Lieut,,  I,  5th 

April  1, 

Conoidal   ball    perforated   left 

April  1, 

Pirogoff  s  amput'n  at  left  ankle 

Discharged  July  '20,  1865.    Good 

Michigan  Cavalry,  age  28. 

1865. 

ankle  joint. 

1865. 

joint.     Surg.  A.  1C.  St.  Glair, 

solid  stump.    18;i(i,  small  portion 

5th  Michigan  Cavalry. 

of  bono  removed.     Spec.  2298. 

73 

Welsh,  M.,  Pt.,  H,  47th  New 

Oct.  7, 

Fracture  of  left  ankle  joint  by 

Oct.  8, 

Syme's  amputat'n  at  left  ankle 

Disch'd  May  31  .  1865  ;  pensioned. 

York,  age  26. 

1864. 

conoidal  ball. 

1864. 

joint. 

Died  Jan.  17.  '7(i  ;  chr.  dysentery 

74 

Wilson,  U.,  Pt.,  E,  72d  Penn 

June  3, 

Shell  wound  of  left  foot  

June  3. 

Disarticulat'n  at  left  ankle  joint. 

Discharged    May   5,    1865,    and 

sylvania,  age  22. 

1864. 

1864. 

Surg.  M.  Ilizer,  72d  Penn. 

pensioned. 

75 

Wince1.,  P.,  Pt.,  B,  36th  Wis 

June  2, 

Conoidal  ball   fractured  bones 

June  3. 

Antero-posterior  flap  amputat'n 

Gangrene.     Discharged  October 

consin,  age  22. 

1864. 

of  left  foot. 

1864. 

at  left  ankle  joint. 

7.  1864.  and  pensioned. 

76 

Winters,   C.   11.,   Corp'l,    F. 

May  12, 

Wound  of  right  foot  by  frag 

May  12, 

Syme's    amputation    at    right 

Discharged  December  14,  1864, 

110th  Ohio,  age  30. 

1864. 

ment  of  shell. 

1864. 

ankle  joint. 

and  pensioned. 

77 

Womack.  J.  K.,  Pt.,  II,  14th 

July  3, 

Shot  fracture  of  left  foot  

Julv4, 

Syme's  amputat'n  at  left  ankle 

Paroled  Sept.  25.  1863.     Stump 

Virginia,  age  21. 

18ti3. 

1863. 

joint. 

sound  and  good. 

78 

Yount.   J.    J/.,    Pt.,   G,  52d 

June  8, 

Shot  wound  

June  8,* 

Amputation  at  ankle  joint  bv 

Recovered. 

Virginia. 

1862. 

1862. 

Surg.  J.  M.  Hayes,  C.  S.  A.  ' 

79 

Birmingham.  A..   Lieut.,  A, 

Dec.  13, 

Wound  of  left  foot  by  conoidal 

Dec.  13. 

Pirogoff  s  amp.  at  left  ankle  j't  ; 

Died  December  17,  1862. 

69th  New  York!  age  20. 

1862. 

ball  ;  also  wound  right  thigh. 

1862. 

also  amputat'n  of  right  thigh. 

80 

Bland,    F.  M.,    Pt.,   D,   23d 

Mav  19, 

Shot  fracture  of  left  toot  

Mav  H», 

Syme's  amput'n  at  ankle  joint  : 

Gangrene  of  thigh  stump.     Died 

Iowa,  age  22. 

1863. 

1863. 

sloughing.    June  17,  amp.  leg 

Julv  16,   I86:i.     Spec.  1706,  A. 

at  junc.  upper  thirds.     July  2, 

M.  M. 

amp.  thigh,  lower  third. 

81 

Boynton,  II.  K.,  Pt.,  L,  1st 

May  19, 

Conoidal  ball  fractured  left  tar- 

May  1!), 

Symo's  amp.  at  left  ankle  joint. 

Two  inches  of  middlethirdof  hu- 

Mass.  Artillery,  age  18. 

1864. 

sal  and  metatarsal  bones  ;  also 

1864. 

Surgeon  J.  W.  Wishart,  140th 

merus  excised  May  22d.     Died 

fracture  of  right  humerus. 

Pennsylvania. 

June  22,  18(i4.  Spec.828,  A.M.M. 

82 

Bradshaw,  G.,  Pt.,  D,  19th 

Jan.  I, 

Shot  wound  of  left  foot. 

Jan.  1, 

Pirogoff's   amputation   at   left 

Died  February  4,  1863. 

Ohio. 

1863. 

1863. 

ankle  joint. 

83 

Cecil,  11..  Lieut.,  1C,  1st  Vir 

May  24 

Shot  wound  of  left  tarsus 

Mav  24, 

Pirogoff's  modificat'n  of  S  vine  s 

Sphacelus,  necessitating  interme 

ginia  Cavalry. 

1864. 

1864. 

amputation  at  left  ankle  joint. 

diary  amp.  log  in   upper  third. 

Died  June  23.  1864. 

84 

Colbert,  E.,  Pt..  1C,  170th  N. 

Mav  23, 

Conoidal  ball  fractured  left  foot. 

May  25. 

Pirogoff's    amputation   at   left 

Died  June  9,  1864,  of  tetanus. 

York,  age  34. 

186-1. 

1864. 

ankle  joint.     Surgeon  M.   F. 

Regan',  164th  New  York. 

85 

Davis,  J.,  Steamer  Memphis. 

Nov.  7, 

Shot  wound  of  right  foot  

Nov.  9, 

Syme's  amput'n  at  ankle  joint. 

Died  February  26,  1862,  of  pneu 

18til, 

1861. 

monia. 

,-.; 

Frank,  A.  B.,  Pt.,  L,  2d  N. 

June  16. 

Conoidal  ball  fractured  tarsal    June  16. 

Syme's  amput'n  at  right  ankle 

Sloughing  of  flaps.     Died  July 

York  Artillery,  age  30. 

1864. 

and  metatarsal  bones  of  right 

1864. 

joint.     Surg.  J.  W.  Wishart, 

28,  1864. 

foot. 

140th  Pennsylvania. 

87 

Hale,  E.  P..  Pt.,  I,  1st  Min 

July  2, 

Conoid,  ball  entered  at  internal 

Julv  2, 

Syme's  amputat'n  at  left  ankle 

Died  September  12,  1863.     Spec. 

nesota,  age  24. 

1863. 

mallenlus  and  emerged  2  ins. 

1863. 

joint.     Surgeon  C.  S.  Wood, 

1949,  A.  M.  M. 

below  ext.  malleolus  ;  astrag 

66th  New  York. 

alus  comminuted. 

88 

Harfeter,   G..    Pt.,   D,  104th 

Sept.  27, 

Shell  wound  of  left  foot  :  also 

Sept.  28. 

Syme's  amputat'n  at  left  ankle 

Oct.  1,  3.  haemorrhage  ;  ligation 

Pennsylvania,  age  22. 

1863. 

slight  wounds  of  hip  and  arm. 

1863. 

joint.     Surg.  R.  B.  Bontecou, 

of  anterior  tibial.    Died  October 

U.  S.  V. 

12,  18G3. 

89 

Lour,   B.  F.,   Pt.,   A,  140th 

July  2, 

Conoidal  ball  shattered  bones 

July  2, 

Syme's  amput'n  at  right  ankle 

Died  August  2,  1863. 

Pennsylvania. 

1863. 

of  right  foot. 

1863. 

joint.     Surgeon  C.  S.  Wood. 

66th  New  York. 

90 

Morgan,  T.,  Pt.,  I,  29th  Penn 

July  20, 

Shell  fracture  of  right  foot  

July  20, 

Amputat'n  at  right  ankle  joint. 

Died  September  11,  1864. 

sylvania. 

1864. 

1864. 

Surg.  J.V.Kendall,  14!»thN.Y. 

91 

Oppelt,  M.,  Pt..  1C,  36th  Wis 

June  6. 

Conoidal    ball     fractured    the 

June  6, 

Amputat'n  at  right  ankle  joint 

Died  July  11,  1864. 

consin,  age  30. 

1864. 

right  foot. 

1864. 

Surg.  S.  H.  Plumb,  59th  N.  Y. 

92 

Pope,  J..  Pt,,  C,  37th  Missis 

Oct.  8, 

Shot  fracture  of  bones  of  right 

Oct.  —  , 

Primary  amput'n  at  right  ankle 

Died  Nov.  6,  1862,  of  pyaemia. 

sippi,  ago  22. 

1862. 

foot. 

1862. 

joint  by  Syme's  method. 

93 

Porter,  G.  H.,  Pt.,  D,  3d  In 

May  5, 

Conoidal    ball    fractured    the 

Mav  5, 

Syme's  amput'n  at  right  ankle 

May  17,  amput'n  lower  third  leg. 

diana  Cavalry,  ago  31. 

1864. 

right  foot. 

1864. 

joint. 

Died  Junc  4,  1864,  of  pyaemia. 

94 

Shoemaker,  J.,  Pt,,  II,  57th 

Jan.  11, 

Conoidal  ball  fractured  tarsal 

Jan.  11, 

Syme's  amputat'n  at  left  ankle 

Jan.   31,  amp.  leg,  lower  third. 

Ohio,  age  33. 

1863. 

bones  of  left  foot. 

1863. 

joint.     Surgeon  J.  B.  Sparks, 

March  8,  re-amp,  leg,  mid.  third. 

19th  Kentucky. 

Died  Mar.19,'63:  gang,  of  stump. 

95 

Smith,  H.,  Pt.,  G,  12th  Mis 

Nov.  9, 

Shot  fracture  of  left  foot 



Primary  amputation  at  ankle 

Died  December  1,  1863. 

souri. 

1863. 

joint  by  Syme's  method. 

96 

Smith,  —,  —,  E,  5:M  Georgia, 



All  the  bones  of  left  foot  badly 

On  field. 

Svme's  amput'n  at  ankle  joint. 

He-amputation.     Died. 

age  27. 

com'nuted  by  shell  fragment. 

Surg.  J.  J.  Knott,  53d  Ga. 

97 

Thurston,   L.,  Pt.,  H,  2d  N. 

June  16, 

Conoidal  ball  shattered  the  tar 

June  17, 

Svme's  amputat'n  at  left  ankle 

Died  June  28,  1864,  of  hospital 

York  Heavy  Artillery,  age 

1864. 

sal  bones  of  left  foot. 

1864. 

joint.     Surg.  J.  W.  Wishart, 

gangrene. 

25. 

140th  Pennsylvania. 

98 

2  Unknown  



Shot  wound  .  . 

On  field. 

PirogofT's  amp.  at  ankle  joint. 

Also  amputation  of  other  leg  by 

Surg.  J.  T.  Gilmore,  C.  S.  A. 

Lenoir's  method.     Died. 

99 

Unknown    (A.   .#.),  Confed 

Feb.  16. 

Tarsal  bones  of  left  foot  com 

Feb.  18, 

PirogofT's  amputation   at   loft 

Died    Feb.   22,    1864,  of  double 

erate. 

1862. 

minuted  ;  soft  parts  lacerated. 

186-J. 

ankle  joint. 

pneumonia. 

100 

Watts,     W.    T..    Pt.,    G,   4th 

July  3, 

Shot  fracture  left  foot,  opening 

July  3, 

Svme's  ampntation  at  left  ankle 

Aug.  20,  sloughing  of  right  foot. 

Virginia,  age  27. 

1863. 

ankle  joint  ;  also  fracture  of 

1863.    |    joint.     Surgeon  J.  M.  Hayes, 

Died  Aug.  29,  1863,  of  pyaamia. 

right  os  calcis. 

C.  S.  A. 

101 

Webb,  J.  D.,  Corp'l,  F,  87th 

Sept.  19, 

Shot  wound  of  right  foot  

Sept.  10,    Amputat'n  at  right  ankle  joint. 

Died  Oct.  18,  1863,  of  wounds. 

Indiana. 

1863. 

1863. 

102 

3  1  ,  M.,—  .  45th  Georgia. 

Mar.  25, 

Rifle  ball  perforated  the  ankle 

Mar.  26,   Syme's    amputation    at   ankle 

Forty  days  after  operation  dis- 

1865. 

joint. 

1865. 

joint. 

chargingsinuses  indicating  dead 

bone.     Result  doubtful. 

103 

Marshall,  W.  E  .,  eol'd  cook, 

June  8, 

Wound  of  right  foot  by  solid   — 

Primary   amputation    in   right 

Result  undetermined.  Not  a  pen 

K,  2d  Michigan. 

1864. 

shot. 

foot  at  ankle  joint.     Surg.  II. 

sioner. 

E.  Smith,  27th  Michigan. 

1  An  abstract  of  this  case  was  published  in  Circular  No.  6,  S.  G.  O.,  Washington,  1865,  p.  47.  See  Photographs  of  Surgical  Cases,  A.  M.  M.,  Vol. 
II,  p.  25,  and  SMITH  (S.),  Amputations  at  the  Anklt.  Joint  in  Military  Surgery,  in  U.  S.  San.  Com.  Memoirs,  Surgical  Volume  II.  pp.  116,  132. 

2HOLLOWAY  (J.  M.),  Comparative  Advantages  of  PIROGOFF'S,  SYME'S,  and  CuOl'ART's  Amputations,  etc.,  in  Am.  Jour.  Med.  Sci.,  1866,  N.  S., 
Vol.  LI,  pp.  85,  86.  3  SMITH  (S.),  loc.  cit.,  pp.  122,  136. 


SECT.  VT.l  INTERMEDIARY    AMPUTATIONS    AT    THE    ANKLE    JOINT.  603 

Intermediary  Amputations  at  the  Ankle  Joint — This  group  comprises  thirty-nine 
cases;  twenty-five  terminated  in  recovery  and  fourteen  in  death,  a  mortality  rate  of  35.9 
per  cent.  Thirty-four  were  Union,  and  five  Confederate  soldiers. 

Recoveries  after  Intermediary  Amputations  at  the  Ankle  Joint. — Of  the  twenty-five 
successful  intermediary  amputations  at  the  ankle  joint,  ten  were  performed  after  Pirogoff's 
and  thirteen  after  Byrne's  method;  in  two  cases  the  mode  of  operation  was  not  indicated. 
Of  the  patients,  five  were  Confederate  and  twenty  Union  soldiers.  The  latter  were  all 
pensioned;  hut  one  has  since  died  of  phthisis.  In  seven  instances  re-amputations  in  the 
leg  became  necessary — in  two  in  the  lower,  in  two  in  the  middle,  and  in  two  in  the  upper 
third;  in  one  the  point  of  re-amputation  was  not  specified. 

CASE  880.—  Private  P.  Carter,  Co.  I,  7th  Michigan,  aged  22  years,  was  wounded  at  Fmlericksburg,  December  11, 1862. 
Surgeon  G.  S.  Palmer,  U.  S.  V.,  recorded  his  admission  to  the  field  hospital  of  the  2d  division,  Second  Corps,  with  "shot  frac 
ture  of  right  foot.  Treatment  of  simple  dressings."  Two  weeks  after  the  reception  of  the  injury  the  wounded  man  was  trans 
ferred  to  Lincoln  Hospital,  Washington,  where  Syme's  amputation  at  the  ankle  joint  was  performed,  on  December  26th,  by 
Assistant  Surgeon  G.  M.  McGill,  IT.  S.  A.  The  patient  recovered,  and  was  discharged  from  service  March  2,  1863,  and  pensioned. 
Several  years  afterwards  he  was  fitted  with  :m  artificial  foot  by  Dr.  E.  D.  Hudson,  of  New  York  City.  Dr.  A.  B.  Ranney,  of 
Bronson,  Michigan,  testified.  June  25, 1875  :  "I  have  been  Carter's  family  physician  for  the  past  three  years  and  have  examined 
him  to-day.  His  right  leg  from  the  knee  down  is  withered  to  the  bone.  The  foot,  was  taken  off  at  the  ankle  joint,  and  there 
was  no  cushion  left  for  the  end  of  the  bone  to  rest  upon.  At  times  the  end  of  the  bone  is  exposed  and  very  painful,  and  much 
of  the  time  there  is  discharge  from  the  stump.  I  have  treated  him  with  poor  success  at  various  times  during  the  years  1872, 
1873,  and  1874,  and  have  advised  an  amputation  of  the  limb  at  the  knee,  as  it  would,  in  my  opinion,  give  him  less  trouble  than 
at  present,"  etc.  The  pensioner  was  paid  March  4,  1881.  A  part  of  the  amputated  foot  (Spec.  4859),  showing  fracture  of  the 
calcaneum  and  cuboid  bone  by  a  conoidal  ball,  was  contributed  to  the  Museum  by  the  operator. 

CASK  881. — Private  W.  A.  Elderkin,  Co.  C,  (ith  Maine,  aged  24  years,  was  wounded  at  Eappahannock  Station,  November 
7,  1863,  by  a  minie"  ball,  which  entered  the  dorsum  of  the  right  foot,  fracturing  the  metntarsal  bones,  and  making  its  exit  at  the 
plantar  surface.  Two  days  afterwards  he  was  admitted  to  Harewood  Hospital  at  Washington,  where  the  wound  became  gan 
grenous  about  November  23d.  For  this  a  local  treatment  of  nitric  acid  and  oakum  dressing  was 
applied  and  a  constitutional  treatment  of  tonics,  stimulants,  and  beef  tea  diet  was  administered.  The 
disease,  however,  not  being  arrested  and  the  patient  growing  weaker,  operative  interference  became 
necessary,  and  Pirogoff's  amputation  w:is  performed  on  December  6th  by  Surgeon  R.  B.  Bontecou, 
U.  S.  V.  After  the  operation  the  parts  were  kept  properly  adjusted  and  the  supporting  treatment 
was  continued.  About  January  4,  1884,  the  progress  of  the  case  was  interrupted  by  erysipelas 
making  its  appearance,  followed  by  sloughing  of  the  soft  parts  to  some  extent.  Tincture  of  chloride 
of  iron  was  then  prescribed  and  wheat  flour  was  applied  locally.  The  inflammation  was  arrested  in 
about  two  weeks,  after  which  the  patient's  health  improved  daily  and  the  wound  healed  rapidly.  He 
was  discharged  from  service  with  a  useful  stump  April  23, 1864,  and  pensioned.  The  amputated  part 
of  the  foot  (Spec.  2028),  contributed  with  the  history  by  the  operator,  is  represented  in  the  annexed 
cut  (FiG.  349),  and  shows  the  metatarsus  to  have  been  badly  shattered,  some  of  the  fragments  being 
necrosed  and  a  slight  effusion  of  callus  having  occurred  in  the  neighboring  parts.  After  receiving  his 
discharge  the  patient  was  supplied  with  a  "Palmer"  artificial  foot,  which,  however,  did  not  prove 
satisfactory,  and  is  reported  to  have  become  entirely  useless  in  about  two  months.  The  pensioner 
died  December  14,  1866,  his  physician,  Dr.  A.  G.  Peabody,  of  Machias,  Maine,  certifying  that  "death 
was  caused  by  consumption  arising  from  hardship,  exposure,  and  the  loss  of  the  foot,  the  amputated 

foot  leaving  a  stump  which  never  thoroughly  healed,  but  remained  a  constant  drain  upon-  the  vital     ,  ^IG-  3'  -—Portion  of  right 

'     •  toot,  metatarsus  shattered. — 

powers  or  the  man  s  constitution.  Spec.  2028. 

CASE  882. — Private  J.  H.  Short,  Co.  F,  140th  Pennsylvania,  aged  19  years,  was  wounded  at  Spottsylvania,  May  12, 
1864.  Surgeon  J.  E.  Pomfret,  7th  New  York  Artillery,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Second 
Corps,  with  "shot  wound  of  left  foot."  Several  days  after  receiving  the  injury  the  wounded  man  was  sent  to  Washington, 
where  he  entered  Harewood  Hospital  and  suffered  amputation  of  the  foot.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  who  performed 
the  operation,  made  the  following  report:  "The  wound  was  caused  by  a  ball  entering  in  front  of  the  ankle  joint,  opening  the 
same,  and  lodging  against  the  astragalus.  On  his  admission  to  Harewood  Hospital  the  patient  was  suffering  from  irritative  fever 
and  the  parts  above  the  joint  were  considerably  swollen.  Syme's  operation  was  performed  on  May  25th  with  favorable  result, 
the  patient  improving  rapidly  and  making  a  good  recovery.  Sulphuric  ether  constituted  the  anaesthetic  used  in  the  case.  Sim 
ple  dressings  were  used,  and  the  treatment  was  supporting."  The  patient  was  subsequently  transferred  to  hospital  at  Phila 
delphia  and  later  to  Pittsburgh,  whence  he  was  discharged  from  service  November  4,  1864,  and  pensioned.  His  photograph, 
taken  at  Harewood  Hospital  and  contributed  by  the  operator,  is  copied  in  FIGURE  3  of  PLATE  LXXV,  opposite  page  596.  In 
his  applications  for  commutation  the  pensioner  continues  to  describe  the  condition  of  the  stump  as  "very  good  and  sound." 
He  was  paid  September  4,  1880. 

CASE  883. — Private  W.  Darling,  Co.  E,  6th  Wisconsin,  aged  41  years,  was  wounded  in  the  left  foot,  at  Antietam,  Sep 
tember  17,  1862.  He  was  admitted  to  hospital  at  Smoketown,  where  the  limb  was  amputated  three  weeks  after  the  date  of  the 


604 


INJURIES    OF    THE    LOWF.R    EXTftF.MTTTKS. 


[CHAP.  X. 


FIG.  350.— Stump  of 
left  leg  after  BAUDKN'.S 
amputation  at  the  an 
kle.  Spec.  4957. 


FIG.  351  .—Bones 
of  left  le£  after  Pi- 
UOGOFF's  amputa 
tion.  Spec.  214. 


injury.  Surgeon  B.  A.  Vanderkieft,  U.  S.  V.,  who  performed  the  operation,  reported  that  the  patient  recovered  and  was  dis 
charged  from  service  January  13,  1863.  The  man  became  a  pensioner,  and  was  subsequently  furnished  with  an  artificial  foot 
by  Dr.  E.  D.  Hudson,  of  New  York  City,  who  contributed  a  cast  of  the  stump  (Spec.  4957),  represented  in  the  adjoining  cut 
(FlG.  350),  with  the  following  description  of  the  case:  "The  injury  consisted  of  a  comminution  of  the  tarsus  and  calcaneum, 
and  the  amputation  was  performed  at  the  ankle  joint  by  Bauden's  dorsal  flap,  the  tibia  and  fibula  being  left  in  their  entire  length 
with  the  exception  of  the  malleoli."  In  his  applications  for  commutation  the  pensioner 
continued  to  report  the  stump  as  being  in  "good  condition."  He  was  paid  September  4, 
1880. 

CASK  884.-  Private  J.  Loughlin,  Co.  K,  67th  New  York,  age  22  years,  was  wounded 
in  the  left  foot.  :it  Malvern  Hill,  July  2,  1832.  He  entered  Fourth  and  George  Streets 
Hospital,  Philadelphia,  several  weeks  afterwards,  whence  Acting  Assistant  Surgeon  J.  B. 
Bowen  reported  the  following  history:  "The  injury  was  caused  by  a  minie"  ball,  which 
entered  the  external  portion  of  the  ankle,  passing  through,  fracturing  and  comminuting 
the  tarsal  bones.  The  man  was  tak<tfi  prisoner  and  sent  to  Richmond,  where  he  remained 
about  two  weeks.  Twelve  days  after  the  receipt  of  the  wound  a  portion  of  stocking  and 
shoe  sloughed  out.  He  suffered  great  pain  and  the  wound  discharged  large  quantities  of 
purulent  matter,  also  several  pieces  of  bone.  When  released  by  the  enemy  he  was  trans 
ferred  to  a  hospital  transport,  where  Pirogoff's  operation  was  performed  on  July  26th. 
The  patient  was  received  into  this  hospital  the  same  day.  Erysipelas  invaded  the  stump 
and  extended  to  the  knee,  and  abscesses  and  sloughing  appeared  on  the  posterior  surface. 
Amputation  at  the  upper  third  of  the  leg  was  performed  by  flap  operation  on  September 
16th,  by  Acting  Assistant  Surgeon  S.  D.  Gross.  Sinc*e  then  the  man  has  improved  and 
the  stump  has  united.  The  treatment  embraced  muriatic  tincture  of  iron,  quinine,  whis 
key,  and  morphine."  The  patient  was  subsequently  transferred  to  Hacldington  Hospital, 
whence  he  was  discharged  from  service  July  29,  1863,  and  pensioned.  About  one  year 
afterwards  he  was  supplied  with  an  artificial  leg  by  L>r.  E.  D.  Hudson,  of  New  York  City.  The  pensioner  was  last  paid  March 
4,  1869,  since  when  he  lias  not  been  heard  from.  The  bones,  forming  the  Pirogoff  stump  and  including  the  lower  half  of  the 
shafts  of  the  tibia  and  fibula  (Spec.  214),  were  contributed  to  the  Museum  by  the  second  operator,  and  are  represented  in  the 
annexed  cut  (FlG.  351),  showing  the  cut  extremities  of  the  tibia  and  calcis  to  be  carious.  No  union  whatever  had  occurred. 
The  lower  extremity  of  the  fibula  is  also  carious,  and  the  upper  portion  of  the  shaft  is  necrosed  and  enlarged  by  attempts  at  an 
involucrum  from  the  periosteum. 

Fatal  Intermediary  Amputations  at  the  Ankle  Joint.  —  Fourteen  of  these  operations 
were  recorded,  eight  by  Pirogoff's  and  six  by  Syme's  method.  In  one  instance  exarticula- 
tion  at  the  ankle  joint  was  followed  by  re-amputation  in  the  middle,  and  in  two  by  ablation 
in  the  upper  thirds  of  the  leg.  The  fatal  issue  was  ascribed  to  pneumonia  in  one,  pyaemia 
in  three,  tetanus  in  one,  erysipelas  in  two,  exhaustion  in  four,  and  typhoid  fever  in  one 
instance.  In  one  case  the  right  arm  had  been  amputated  in  the  upper  third.1 

CASE  885. — Private  S.  Smith,  Co.  K,  86th  New  York,  aged  47  years,  was  wounded  at  the  Wilderness,  May  10,  1864,  by 
two  mini6  balls,  one  of  which  passed  through  the  left  foot  and  fractured  the  tarsal  bones ;  the  other  produced  a  flesh  wound  of 
the  dorsal  region  near  the  spine.  Several  days  after  receiving  the  injury  the  wounded  man  was  admitted  to  Harewood  Hospital, 
Washington,  where  he  did  well  up  to  May  23d.  From  that  date  his  mind  became  wandering  and  delirious,  his  left  arm  and 
right  leg  keeping  up  constant  motion.  Irritation  from  the  wound  was  suspected  as  the  cause  of  this  unusual  action,  and  ampu 
tation  was  deemed  necessary  on  May  25th.  when  Surgeon  R  B.  Bontecou,  U.  S.  V.,  performed  the  operation  by  his  modification 
of  PirogofF's  method  at  the  ankle  joint.  The  patient  improved  after  the  amputation,  all  symptoms  of  derangement  of  mind  dis 
appeared,  and  he  became  perfectly  conscious.  Ether  was  used  as  the  anaesthetic.  The  patient  continued  to  do  well  up  to  June 
1st,  when  pysemic  symptoms  appeared,  the  wound  ceased  to  suppurate,  and  rigors  set  in ;  skin  hot  and  dry.  In  spite  of  a  sup 
porting  treatment  the  patient  gradually  grew  weaker.  He  died  July  19,  1864.  The  tarsal  bones,  together  with  the  malleoli  and 
a  thin  section  of  the  tibia,  removed  at  the  amputation  (Spec.  3054),  with  the  history,  were  contributed  to  the  Museum  by  the 
operator. 

CASE  886. — Private  D.  C.  Hayes,  Co.  A,  4th  New  Hampshire,  was  wounded  at  the  battle  of  Pocotaligo,  October  22,  1862, 
by  a  mini6  ball,  which  struck  the  dorsum  and  penetrated  to  the  sole  j^f  the  left  foot,  passing  out  nearly  opposite  the  point  of 
entrance  without  having  caused  much  apparent  comminution  or  splintering  of  the  bone.  He  was  admitted  to  hospital  at  Hilton 
Head  the  following  day,  whence  Assistant  Surgeon  J.  E.  Semple,  U.  S.  A.,  contributed  the  pathological  specimen  (No.  691)  with 
the  following  report:  "We  endeavored  to  save  the  foot,  but  the  patient  became  much  reduced  and  mortification  set  in.  Syme's 
operation  was  performed  on  November  llth,  and  death  occurred  on  the  following  day  from  exhaustion."  Acting  Assistant  Sur 
geon  T.  T.  Smiley,  who  performed  the  amputation,  states  in  his  publication  of  the  caseQ  that  the  patient  died  with  all  the  symp 
toms  of  pyaemia,  also  that  the  injury  produced  violent  pain  and  high  inflammation,  which  he  ascribed  to  a  longitudinal  fracture 
of  one  of  the  metatarsal  bones,  opening  the  tarso-metatarsal  articulation.  The  specimen  consists  of  a  ligamentous  preparation  of 
the  scaphoid,  cuboid,  cuneiform,  and  metatarsal  bones  of  the  amputated  foot,  the  bases  of  the  second  and  third  of  the  latter 
exhibiting  the  seat  of  the  fracture  by  the  bullet. 

'CASE  of  F.  Schoneckles,  Private,  C,  -M  Delaware.     See  CASE  77,  TAULE  LXXVII,  p.  700  of  the  Second  Surgical  Volume. 
'SMILEY  (T.  T.),  Twenty  Cases  of  Gunshot  Wounds,  in  Roston  Med.'cal  anil  Suryical  Journal,  1803,  Vol.  LXVIII,  p.  419. 


SECT.  VI. J 


INTERMEDIARY    AMPUTATIONS    AT    THE    ANKLE    JOINT. 


605 


TABLE  XCI. 
Summary  of  Thirty-nine  Cases  of  Intermediary  Amputations  at  the  Ankle  Joint  for  Shot  Injury. 


[  Recoveries,  1—25 ;  Deaths,  26—39.] 


No. 

NAME,  MILITARY 
DESCRD?TION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Atwell,  J.  J.,  Pt.,  A,  8th  Vir 

July  3, 

Conoidal   ball    entered   instep 

July  17, 

Syme's  amputation  at  left  an 

Paroled  Nov.   12,   1863;   stump 

ginia,  age  20. 

1863. 

and  lodged  among  the  tarsal 

1863. 

kle  joint.    A.  A.  Surgeon  T. 

healed. 

bones  of  left  foot. 

T.  Smiley. 

2 

'Bayard,  J..  Pt.,  B,  28th  N. 

July  6, 

Musket  ball  passed  through  in 

July  11, 

Syme's  amp.  left  ankle  joint. 

Discharged  July  24,  1861  ;  pen 

York,  age  28. 

1861. 

step,  fracturing  tarsal  bones  of 

1861. 

Ass't  Surgs.  J.  W.  S.  Goulev 

sioned.    Serviceable  extremity. 

left  foot. 

andW.J.  White,  U.  S.  A. 

3 

Burns,   C.  E.,   Pt.,  D,   12th 

Aug.  29, 

Fracture  of  right  foot,  involv'g 

Sept.  13, 

Syme's    amputation    at   right 

Cushion  one  inch  thick,  well  uni 

Massachusetts,  age  24. 

1862. 

ankle  joint,  by  musket  ball. 

1862. 

ankle  joint.     Surgeon  D.  I'. 

ted  to  tibia,  and  quite  tender. 

Smith,  U.  S.  V. 

April  22.  1863,  amp.  lower  third 

leg.    Discharged  July  11,  1863; 

pensioned. 

4 

'  Butler,    W.  M.,  —,  K,  7th 

Sept.  20, 

Ball  passed  through  right  foot. 

Oct.  3, 

Pirogoff's  amputation  at  right 

Haemorrhage  from  plantar  arch. 

Arkansas. 

1863. 

1863. 

ankle  joint. 

Doing  well. 

5 

Carter,  P.,  Ft.,  I,  7th  Mich 

Dec.  11, 

Conoidal  ball  comminuted  os 

Dec.  26, 

Syme's  amputation  at  right  an 

Discharged  March  2,  1863;  pen 

igan,  age  22. 

1862. 

calcis  and  cuboi0bones,  right 

1862. 

kle  joint,  posterior  flap.    Ass't 

sioned.     Leg  withered  to  knee  ; 

foot. 

Surg.  G.  M.  McGill,  U.  S.  A. 

troublesome    stump;    at   times 

bones  exposed  and  painful.  Spec. 

4859,  A.  M.  M. 

6 

3  Clark,  F.  \V.,  Pt.,  B,  12th 

May  10, 

Conoidal   ball  fractured  astra 

May  28, 

Pirogoff's  amputation  at  ankle 

Recovered.     Heel  drawn  up  ;  a 

Georgia. 

1864. 

galus  and  third  .and  fourth 

1864. 

joint.     Surgeon  C.  B.  Gibson, 

tender  cicatrix  formed  part  of 

metatarsal  bones. 

C.  S.  A. 

sole  o4  stump. 

7 

«Cook,   G.   L.,    Pt..    B,    1st 
Pennsylvania,  age  22. 

June  30, 
1862. 

Conoidal  ball  passed  through 
right  instep,  fracturing  tarsal 

July  23, 
1862. 

Syme's    amputation    at    right 
ankle. 

Aug.  1,  straps  tostump.    Disch'd 
Dec.  7,   1862;  pens'd.     Stump 

and  metatarsal  bones. 

healed  perfectly. 

8 

Darling,  W.,  Pt.,  E,  6th  Wis 

Sept.  17, 

Conoidal    ball    fractured    left 

Oct.  8, 

Syme's  modified  amputation  at 

Discharged    January    13,    1863; 

consin,  age  41. 

1862. 

tarsus  and  calcaneum. 

1862. 

ankle  joint,  dorsal  flap.  Surg. 

pensioned.   Spec.  4907,  A.  M.  M. 

B.  A.  Vanderkieft,  U.  S.  V. 

9 

Dickey.  W.   H.,   Serg't,  A, 

Dec.  13, 

Conoidal  ball  fractured  the  left 

Dec.  24, 

Syme's  amputation  at  left  an 

Abscess.     Discharged  Dec.   10, 

8th  Pennsylvania  Reserves, 

1862. 

foot. 

1862. 

kle  joint.     Surg.  II.  Bryant, 

1863;  pensioned.     Stump   per- 

age  28. 

U.  S.  V. 

fectlyhealed.  Spec.  575,  A.M.M. 

10 

Elderkin,  W.  A.,  Pt.,  C,  6th 

Nov.  7, 

Musket  ball  entered  dorsum  of 

Dec.  6, 

Pirogoff's  amputat'n  with  Bon- 

Erysipelas  ;  sloughing.     Disch'd 

Maine,  age  24. 

1863. 

right  foot,  fracturing  metatar 

1863. 

tecou's  modification.     Surg. 

April  23,  1864.     Stump  never 

sal  bones. 

R.  B.  Bontecou,  U.  S.  V. 

healed  thoroughly,  and  was  a 

constant  drain   upon   the  vital 

powers.    Died  Dec.  14,  1866,  of 

consumpt'n.  Spec.  2028,  A.M.M. 

11 

Forsyth,  G.,  Pt.,  E,  14th  N. 

May  13, 

Conoidal  ball  injured  left  foot. 

May  18, 

Pirogoff's   amputation  at  left 

Discharged  April   6,  1865,   and 

Jersey,  age  25. 

1864. 

1864. 

ankle  joint. 

pensioned. 

12 

«  Gross,   D.  N.,  Pt,,   E,  8th 

June  29, 

Canister  shot  comminuted  the 

July  22, 

Syme's  amput'n  at  right  ankle 

Necrosis.    Discharged  December 

Illinois  Cavalry,  age  24. 

1862. 

right  astragalus  and  carried 

1862. 

joint.     Ass't  Surg.  K.  Bartho- 

7,  1863  ;  pens'd.     Good  stump. 

away  ends  of  both  malleoli. 

low,  U.  S.  A. 

13 

Gurley,  W..  Pt,,  C,  llth  In 

May  12, 

Conoidal  ball  entered  below  ex 

June  1, 

Amputat'n  at  right  ankle  joint. 

Necrosed  sequestra  removed  at 

fantry,  age  18. 

1864. 

ternal  malleolus  and  crushed 

1864. 

Surgeon  D.  W.  Bliss,  U.  S.  V. 

different  times.     Disch'd  Feb. 

posterior  tuberosity  of  os  cal 

7,  1865.     Amp.  upper  third  leg 

cis. 

Feb.  18,  '68.   Spec.  2421,  A.M.M. 

14 

Johnson.  A.  W.,  Pt.,  E,  64th 

Dec.  13, 

Ball  entered  between  extensor 

Dec.  20, 

Syme's  amputation  at  left  an 

Discharged  Jan.  29,  1863;  pen 

New  York,  age  23. 

1862. 

longuspollicis  and  calcaneum. 

1862. 

kle  joint.     Surgeon  C.  Gray, 

sioned.     Oct.  9,  1863,  amput'n 

fracturing  bones  of  foot. 

7th  New  York. 

lower  third  leg. 

15 

«Larkin,  P.,  Pt.,  C,  48th  N. 

July  18, 

Piece  of  shell  comminuted  tar- 

July  25. 

Pirogoff's  amputation  at  right 

Discharged  Dec.  4,  1863.     Amp. 

York,  age  24. 

1863. 

so-  metatarsus   except  calcis, 

1863. 

ankle  joint.   Ass't  Surg.  J.W. 

leg  at  middle  third  May  6,  1879, 

right  foot. 

Apple'gate,  U.  S.  V. 

for  necrosis.  Spec.  6913,  A.M.M. 

16 

Loughlin,    J.,    Pt.,    K,   67th 

July  2, 

Conoidal   ball    perforated  left 

July  26, 

Pirogoff's  amputation   at  left 

Erysipelas.    Sept.  16,  amput'n  of 

New  York,  age  22. 

1862. 

ankle,  commin^f  tarsal  bones. 

1862. 

ankle  joint. 

leg,  upper  third.     Disch'd  July 

29,  1863  ;  pensioned.    Not  heard 

from  since  March  4,  1869.    Spec. 

214,  A.  M.  M. 

17 

Morse,  G.  F.,  Pt.,  K,  16th 

May  1 

Shot  fracture  of  left  foot. 

May  16 

Pirogoff's  amputation  at  left 

Discharged  August  4   1862  and 

Massachusetts,  age  19. 

1862.  ' 

1862.  ' 

ankle  joint.     Surgeon  C.  C. 

pensioned.     Good  stump;   can 

Jewett,  16th  Massachusetts. 

bear  his  weight  upon  it. 

18 

Newton,  J.  W.,  Pt.,  E,  14th 

July  2, 

Conoidal  ball  fractured  tarsal 

July  16, 

Pirogoff's  amputation  at  right 

July  25,  sloughing.     August  10, 

Virginia,  age  26. 

1863. 

bones  of  right  foot. 

1863. 

ankle  joint. 

amp.  at  junction  of  upper  thirds 

of  leg  ;  stump  healed.     Exch'd 

November  12,  1863. 

19 

'Ramsdell,  J.  H.,  Pt.,C,8th 

Dec.  7, 

Conoidal  ball  passed  through 

Dec.  16, 

Amputation  at  left  ankle  joint 

Discharged  June  4,  1865;  pen 

Minnesota,  age  30. 

1864. 

tarsus  from  dorsum  to  heel. 

1864. 

by  Syme's  method.    Surgeon 

sioned.     Stump  sound  and  reli 

S.  D.'Turney,  U.  S.  V. 

able  for  support. 

20 

Sanford,  A.  C.,  Pt.,  E,  6th 

Aug.  16, 

Conoidal  ball  fractured  tarsal 

Sept.  14, 

Circular  amputation  at  left  an 

Discharged  April  27,   1865,  and 

Connecticut,  age  27. 

1864. 

bones  of  left  foot. 

1864. 

kle  joint  by  Svme's  method. 

pensioned.     Stump  healed. 

A.  A.  Surg.'  E.'B.  Woolston. 

21 

Short,  J.  H.,  Pt.,  F,    140th 

May  12, 

Ball  lodged  against  astragalus. 

May  25, 

Syme's  amp.  at  left  ankle  joint. 

Discharged  Nov.  4,  1864  ;  pens'd. 

Pennsylvania,  age  19. 

1864. 

left  foot;  tarsus  comminuted. 

1864. 

Surg.  R.  B.  Bontecou,  U.  S.V. 

Card  Phot.,  Vol.  I,  p.  45. 

22 

Strout,  S.,Capt.After  Guard, 

April  1, 

Pistol  shot  wound  of  right  foot. 

A  prillS. 

Amputat'n  at  right  ankle  joint. 

Discharged   June  5,   1865;  pen 

U.  S.  Navy,  age  38. 

1865. 

1865. 

Surgeon  —  Smith,  U.  S.  N. 

sioned.     Sound  stump. 

23 

8  Unknown,  age  24  

Nov.  25 

Shot  fracture  of  left  tarsus  ... 

_r-i^^ 

Intermediary  amp.  at  left  ankle 

January,  1864,  complete  disinte- 

1863. 

joint  by    Pirogoff's   method. 

f  ration  of  calcis  and  endof  tibia. 

Prof.  P.  F.  Eve. 

'eb.,  1864,  amp.  leg.  Recov'ry. 

24 

Whitney,  P.  P.,  Pt.,  A,  6th 

Aug.  5, 

Shot  wound  of  right  foot  

Aug.  16, 

Pirogoff's  amp.  at  ankle  joint, 

Discharged  Octi.ber4,  1862;  pen 

Michigan,  age  24. 

1862. 

1862. 

leaving  portion  of  os  calcis. 

sioned. 

Surg.  E.  F.  Sangcr,  V.  S.  V. 

1  SMITH  (S.),  Amputations  at  the  Ankle  Joint  in  Military  Surgery,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  II,  p.  136. 

2EVK  (P.  F.),  Cases  of  Secondary  Hemorrhage  occurring  in  the  Gate  City  Hospital  (Confederate)  after  the  battle  of  Chickamavya,  etc.,  in  U.  S- 
Sanitary  Commission  Memoirs,  New  York,  1870,  Surgical  Volume  I,  p.  210. 

3HOU.OWAY  (J.  M.).  Comparative  Advantages  of  PlHOGOFF's,  SYMK'S,  and  CHOPART'S  Amputations,  etc.,  in  Am.  Jour.  Med.  Sci.,  1866,  N.  S., 
Vol.  LI,  p.  85,  and  SMITH  (S.),  Inc.  cit.,  p.  134.  4 SMITH  (S.),  loc.  cit.,  p.  140.  5 SMITH  (S.),  loc.  cit.,  p.  140. 

«SMITH  (S.),  loc.  cit.,  p.  134.  'SMITH  (S.),  loc.  cit.,  p.  136. 

"ITOT.T.OWAV  (T.  M.)  rnrnparatirf  Advantages  of  PIROGOFF'S,  SYME'S,  and  CHOPART'S  Amputations,  etc.,  in  Am.  Jour.  Sled.  Set'.,  1866,  N.  S., 
Vol.  LI,  p.  85,  and  SMITH  (.S.),  loc.  cit.,  pp.  116,  132. 


606 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

25 

Whitty,  J.,  Pt.,  A,  6th  Wis 
consin,  age  22. 

May5, 
1864. 

Conoidal  ball  fractured  left  cal- 
caneum. 

May  31, 
1864. 

Syme's  amputat'n  at  left  ankle 
joint.     Surgeon  E.  Donnelly, 
2d  Pennsylvania  Reserves. 

Gangrene  in  stump.  Feb.  8,  1865, 
amputation  at  junction  of  lower 
third  of  leg.     Discharged  June 

26,  1865;  pensioned. 

26 

Alley  J                          

July  2, 

Conoidal  ball  fractured  left  tar 

July  15, 

Syme's  amputat'n  at  left  ankle 

Died  July  16,  1863,  of  tetanus. 

1863. 

sal  bones  ;  also  flesh  wounds 

1863. 

joint. 

of  thigh  and  shoulder. 

27 

Bager,  A.,  Pt.,  K,  2d  Mary- 
l&ncL 

Dec.  13, 

1862. 

Shot  fracture  of  right  foot  

Jan.  9, 
1863. 

Pirogoff  'samp,  at  right  ank.  j't. 
A.  A.  Surg.  J.  R.  Ludlow. 

Stump  done  well.     Died  Feb.  21, 
1863,  of  pneumonia. 

28 

Gregg,  R.,  Pt.,  C,  1st  Maine 
Artillery,  age  37. 

June  18, 
1864. 

Shot  wound  of  right  foot,  with 
great  injury  to  tarsus. 

July  12, 

1864. 

Syme's  amput'n  at  right  ankle 
joint.     A.  A.  Surgeon  O.  W. 
Peck. 

Sloughing.    July  18,  1864,  amp. 
of  leg  at  junction  of  upper  third. 
Died  Sept.  30,  1864. 

29 

Havens.  W.,  Pt.,  K,  17th  N. 

June  25, 
1864. 

Conoidal  ball  injured  2d  and  3d 
toes,  right  foot.    June  25.  '64, 
amp.  of  injured  toes:  gang. 

July  14, 
1864. 

Pirogoff's  amp.  at  right  ankle 
joint.     Surg.  R.  B.  Bontecou, 
U.  S.  V.     Sloughing  ;  gang. 

July  19,  amputation  leg,  middle 
third.     Died  July  21,  1864,  of 
exhaustion. 

York  Heavy  Artillery,  age 
29. 

30 

'Hayes,  D.  C.,  Pt.,  A,  4th 

Oct.  22, 

Conoidal  ball  fractured  2d  meS 

Nov.  11, 

Syme's  amput'n  at  ankle  joint. 

Died  Nov.  12,   1862,  of  pyaemia. 

New  Hampshire. 

1862. 

atarsal  bone  and  injured  tarsal 

1862. 

A.  A.  Surgeon  T.  T.  Smiley. 

Spec.  691,  A.  M.  M. 

articulation,  left  foot. 

31 

Haynes,  G.,  Pt.,  F,  12th  N. 

June  3, 

Shot  wound  left  foot  near  mal- 

June  .'30, 

Joint  diseased  and  cedematous. 

Died,  from  typhoid  fever,  July  9, 

Hampshire,  age  22. 

1864. 

leolus,  fractur'g  tarsal  bones; 

1864. 

Syme's  amp.  at  left  ankle  j'nt. 

1864. 

exit  near  little  toe. 

Surg.  R.  B.  Bontecou,  U.  S.V. 

32 

Johnson,  H.  H.,  Pt.,  A,  9th 

July  9, 
1864. 

Shell  fracture  4th  and  5tli  met 
atarsal  bones  ;  extensive  lacer 
ation  of  soft  parts. 

July  12, 

1864. 

SvSe's  amp.  at  right  ankle  j'nt. 
Ass'tSurg.  R.  F.Weir,U.S.A. 
Malleoli  sawn  off;    articular 

July  18,  extensive  erysipelas,  ex 
tending  to  abdomen.    Died  July 
28,  1864,  of  erysipelas.     Spec. 

N.  York  Heavy  Artillery, 
age  18. 

surface  of  tibia  left  intact. 

2281,  A.  M.  M. 

33 

Lincoln,  G.,  Pt.,  9th  Illinois, 

Feb.  15, 

Rifle  ball  fractured  tarsal  and 

Feb.  25, 

Pirogoff's  amputation  at  ankle 

Feb.   25,    erysipelas;    March   2, 

age  27. 

1862. 

metatarsal  bones. 

1862. 

joint.     Dr.  T.  L.  Maddin,  of 

whole    body  involved.      Died 

Nashville. 

March  8,  1862,  of  erysipelas. 

34 

Phillips,  J.,  Pt.,  I,  5th  Mich 

May  10, 

Couoidal  ball  fract'd  left  tarsal 

May  17, 

Pirogoff's  amp.  at  left  ankle  j't. 

Died  May  28,  1864,  of  exhaus 

igan,  age  31. 

1864. 

bones,  leaving  os  calcis  intact. 

1864. 

Surgeon  K.  Bentley,  U.  S.  V. 

tion. 

35 

Schoneckles,  F.,  Pt.,  G,  2d 

Dec.  13, 

Shot  fracture  of  bones  of  right 

Dec.  19, 

Pirogoff's  amp.  at  right  ankle 

Died. 

Delaware. 

1862. 

foot;   also   fracture   of   right 

1862. 

joint  ;  also  amp.  arm  at  upper 

humerus. 

third.    Surgs.C.  S.  Wood.  66th 

N.  Y.,  and  C.  Gray,  7tli  N.  Y. 

36 

Shook,  G.  L.,  Corp'l,  C,  37th 

Sept.  19, 

Conoidal  ball  fracturedleft  foot. 

Sept.  26, 

Pirogoff's  amp.  at   left  ankle 

Died  October  14,  1864. 

Massachusetts,  age  25. 

1864. 

1864. 

joint,  leaving  a  portion  of  os 

calcis.    A.  A.  Surg.  J.  Young- 

love. 

37 

Smith,  S.,  Pt.,  K,  86th  New 

May  10, 

Conoidal  ball   fractured  tarsal 

Ma}-  25, 

Pirogoff's  amp.  at  left  ankle  j't 

Died  June  19,  1864,  of  pyiemia. 

York,  age  47. 

1864. 

bones,    left   foot  ;    also    flesh 

1864. 

with  Bontecou's  modification. 

Spec.  3054,  A.  M.  M. 

wound  of  back. 

Surg.  R.  15.  Bontecou,  U.  S.V. 

38 

*Sutton,  E.  L.,  Pt.,  H,  77th 

Jan.  11, 

Conoidal  ball  fractured  2d  and 

Jan.  24, 

Syme's  amputat'n  at  left  ankle 

Died  Feb.  3,  1863,  of  pyaemia. 

Illinois. 

1S63. 

'.id  metatarsal  bones,  left  foot. 

IHlili. 

joint.     A.  A.  Surgeon  T.  T. 

involving  tarsal  articulation. 

Smiley. 

39 

Wilbur,  W.,  Pt.,  13,1st  New 

May  8, 

Shot  fracture  of  2d  and  3d  met 

May  28,   Pirogoff's  method  with  Bonte- 

July  6,  amputation  of  leg,  upper 

York  Cavalry,  age  27. 

1864. 

atarsal  bones  of  right  foot. 

1864.         con's  modification.     Surgeon 

third.     Died   July   6,   1864,    of 

R.  B.  Bontecou,  U.  S.  V. 

exhaustion. 

Secondary  Amputations  at  the  Ankle  Joint.  —  Thirteen  secondary  amputations  at 
the  ankle  joint  were  recorded;  the  mortality  rate  was  7.7  per  cent.,  only  one  of  the  cases 
having  a  fatal  termination.  Of  the  twelve  successful  operations  four  were  performed  after 
PirogofF's  and  six  after  Syme's  method  ;  in  two  cases  the  mode  of  ablation  was  not  indicated. 
Eight  of  the  patients  were  Union  and  four  Confederate  soldiers.  In  one  instance  the  leg 
was  subsequently  amputated  in  the  middle  third.  Of  the  eight  Union  soldiers  the  names 
of  seven  were  found  on  the  Pension  Rolls;  two  have  died  since  their  discharge  from  the 
service.  In  the  fatal  secondary  amputation  at  the  ankle  Syme's  operation  had  been  per 
formed;  the  patient  died  of  exhaustion. 

CASE  887.  —  Private  O.  C.  Crandall,  Co.  B,  ?th  Wisconsin,  aged  19  years,  was  wounded  in  the  right  foot,  at  Gettysburg, 
July  1,  1863.  lie  remained  at  a  First  Corps  field  hospital  for  nearly  two  weeks  and  was  then  removed  to  Broad  and  Cherry 
Streets  Hospital,  Philadelphia,  whence  Acting  Assistant  Surgeon  W.  V.  Keating  contributed  the  follow 
ing  history:  "The  wound  was  caused  by  a  minie"  ball,  which  entered  on  the  outer  side  just  in  advance 
of  the  ankle  joint  and  passed  directly  across,  fracturing  the  astragalus  and  lodging  beneath  the  skin 
on  the  inner  side  of  the  foot,  whence  it  was  removed  four  hours  after  the  reception  of  the  injury.  At 
the  time  of  admission  his  general  condition  was  broken  down,  and  the  foot  and  ankle  were  much 
inflamed,  swollen,  and  painful;  the  wounds  discharging  sanious  pus.  The  patient  was  ordered  extra. 
diet,  with  tonics,  milk  punch,  and  beef-essence,  and  the  foot  was  enveloped  in  a  fomenting  poultice. 
Five  days  after  admission  the  wounds  commenced  to  slough  and  -a  large  abscess  formed  on  the  outer 
side  of  the  foot  above  the  wound,  in  its  course  burrowing  the  tendo-achillis.  At  the  same  time  the 
patient  was  rapidly  growing  weaker.  On  August  1st  it  was  decided,  in  consultation,  that  to  operate 
was  the  only  means  of  saving  life,  and  on  the  following  day,  while  the  patient  was  under  the  influence 
°f  ether,  PirogofF's  amputation  was  performed  by  Acting  Assistant  Surgeon  A.  Hewson.  The  edges 

()f  tne  flaps  were  brought  together  by  means  of  lead-wire  sutures,  and  an  opening  was  made  along  the 

%  °  .      .  .    ..  .    , 

side  of  the  tendo-achillis  to  prevent  the  collection  of  pus.     ihe  stump  was  covered  with  lint  saturated 


fibula'  astragalus  and  cal- 
caneum,  from  a  PiiioooFF 
amputation.  Spec.  2783. 


(T.  T.),  Tioenty  Casts  of  Gunshot  Wounds,  in  Boston  Med.  and  Surg.  Jour..  1863,  Vol.  LXVITI,  p.  419. 
"SMILEY  (T.  T.),  Gunshot  Wounds  from  Arkansas  Post,  in  Boston  Med.  and  Surg.  Jour.,  1863,  Vol.  LXIX,  p.  159. 


SECT.  VI.] 


SECONDARY    AMPUTATIONS    AT    THE    ANKLE    JOINT. 


607 


with  a  mixture  of  laudanum  and  whiskey,  and  the  limb  was  kept  at  perfect  rest  in  a  fracture-box.  On  the  third  day  after  the 
operation  sloughing  took  place  to  a  slight  extent  on  the  outer  side  of  the  stump  in  the  line  of  tin?  first  incision,  exposing  the 
lower  extremity  of  the  fibula.  The  stump  was  then  washed  with  a  solution  of  permanganate  of  potassa  and  a  fomenting  poul 
tice  was  applied.  The  discharge  from  the  stump  was  very  profuse  for  a  few  days,  but  it  gradually  subsided  and  healthy  granu 
lations  established  themselves.  The  patient  continued  to  do  well  afterwards,  bony  union  taking  place  and  the  case  promising  a 
good  and  useful  stump,  with  the  limb  one  inch  shorter  than  the  other.  The  patient's  general  condition  now  was  very  good. 
The  advantages  claimed  for  the  operation  in  this  case  were,  firstly,  that  it  was  less  extensive  than  an  amputation  higher  up  in 
the  leg  and  thereby  produced  less  shock  ;  secondly,  that  less  blood  would  in  all  probability  be  lost,  and  the  patient  would  have  a 
greater  length  of  limb  for  actual  use  after  recovery."  The  specimen  (No.  2783)  represented  in  the  adjoining  wood-cut  (FiG.  352) 
was  contributed  by  the  operator,  and  consists  of  the  lower  borders  of  the  tibia  and  fibula,  the  astragalus,  and  a  slice  of  the 
upper  portion  of  the  calcaneum,  all  which  were  removed  at  the  amputation.  The  astragalus  is  shown  to  be  fractured  and 
carious,  and  the  tibial  articulation  is  eroded.  The  patient  was  subsequently  transferred  to  Mower  Hospital,  whence  he  was  dis 
charged  June  11,  18>'i4,  and  pensioned.  He  formerly  represented  the  stump  as  being  in  a  good  state,  but  at  a  special  examina 
tion  on  March  16,  1880,  its  condition  was  described  by  Dr.  T.  B.  Mansfield,  pension  examiner  at  Sac  City,  Iowa,  as  follows: 
"  I  find  the  claimant  suffering  from  necrosis  of  the  end  of  the  stump  of  the  tibia,  also  atrophy  of  the  muscles  of  the  lower  leg. 
There  is  some  discharge  at  present  from  the  wound,  and  the  cicatrices  present  an  unhealthy  condition,  assimilating  senile  or  dry 
gangrene.  The  general  appearance  and  appetite  of  the  pensioner  is  good.  He  states  that  he  has  constant  pain  in  the  wound 
and  constant  pain  in  the  knee,  and  that  he  is  unable  to  walk  but  a  short  distance  without  experiencing  great  pain  in  the  stump 
and  entire  limb.  I  think  his  wound  will  necessitate  another  amputation."  This  pensioner  was  paid  June  4,  1880.' 

CASE  833. — Private  I.  T.  Mossup,  Co.  D,  100th  New  York,  aged  30  years,  was  wounded  in  the  left  foot, 
during  the  assault  on  Fort  Wagner,  July  18,  1863.  He  was  admitted  to  hospital  at  Beaufort  on  the  following 
day,  and  several  months  later  he  was  transferred  to  McDougall  Hospital,  at  Fort  Schuyler,  where  amputation 
was  performed  but  not  recorded.  Subsequently  the  patient  passed  to  De  Camp  Hospital,  and  lastly,  on  Feb 
ruary  18,  18o4,  he  entered  Central  Park  Hospital,  New  York  City.  Surgeon  B.  A.  Clements,  U.  S.  A.,  in 
charge  of  the  latter,  made  the  following  report :  "  The  patient  had  been  wounded  by  a  conical  ball,  which  passed 
just  under  the  malleoli,  fracturing  the  astragalus  and  calcaneum.  Amputation  at  the  ankle  joint  was  performed 
at  McDougall  Hospital,  on  November  llth,  by  Syme's  method,  and  the  result  has  not  been  retarded  by  any 
accident  whatever  since  the  operation,  the  cicatrix  being  completely  formed  when  the  patient  was  admitted  to 
Central  Park  Hospital.  He  has  an  artificial  foot  (from  Hudson),  and  at  his  own  request  his  discharge  has  been 
recommended."  A  cast  of  the  leg  (Spec.  726),  made  nine  months  after  the  amputation,  and  showing  a  well- 
formed  and  apparently  useful  Syme's  stump,  was  contributed  to  the  Museum  by  Assistant  Surgeon  J.  W.  S. 
Gouley,  U.  S.  A.,  and  is  represented  in  the  annexed  wood-cut  (FiG.  353).  The  patient  was  discharged  from 
service  June  1,  1834,  and  pensioned.  In  his  applications  for  commutations,  dated  1870  and  1875,  he  described  after  .SYME'S  any 
the  stump  as  being  in  "good  condition,"  but  five  years  later  he  reported  it  as  "painful  all  the  time."  The  ankle.  Spec. 726. 
pensioner  was  paid  December  4,  1880.- 

TABLE  XOII. 
Summary  of  Thirteen  Cases  of  Secondary  Amputations  at  the  Ankle  Joint  for  Shot  Injury. 

[Recoveries,  1—12;  Deaths,  13.] 


FIG.  353.— Stump 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

3  Connolly,  P.,  Corp'l,  K,  70th 

Aug.  27, 

Conoidal  ball  comminuted  left 

Nov.  19, 

Foot  a  large  shapeless  mass. 

Discharged  Aug.  13,  1863;  pen 

New  York. 

1862. 

tarsus. 

1864. 

Syme's  amp.  at  left  ankle  j't  ; 

sioned.     In  1870,  stump  sound  ; 

tibia  sawn  through  above  mal- 

receives  entire  weight  of  body 

leoli.     A.  A.  Surg.  S.  Smith. 

on  stump  ;  2J  ins.  shortening. 

2 

«  Crandall,  O.  0.,  Ft,,  15,  7th 

July  1, 

Conoidal  ball  fractured  astrag 

Aug.  2, 

Foot  and  ankle  much  inflamed; 

Limb    kept    in    a   fracture-box  ; 

Wisconsin,  age  19. 

1863. 

alus  and  was  removed  from 

1863. 

slough  'g  ;  Pirogoff  s  amput'n. 

sloughing.      Disch'd  June  11, 

inner  side  of  foot. 

A.  A.  Surg.  A.  Ilewson. 

1864;  pensioned.     Spec.  2783. 

3 

Ewing,  A.  G.,  Ft.,  Forrest's 

July-, 

Shell  fracture  of  right  foot  ;  ca 

Aug.  —  , 

Pirogoff  's  amputation  at  right 

Also  partial  paralysis  from  pistol 

Cavalry. 

1864. 

ries  of  ends  of  tibia  and  fibula. 

1865.        ankle  ioint.     Prof.  P.  F.  Eve. 

ball  in  spine.  Recovered  ;  caries 

of  ends  of  tibia  and  fibula. 

4 

Griffin,  J.  B..  Lieut.,  C,  10th 

Dec.  31, 

Shot  wound  of  left  ankle  joint. 

Mar.  9, 

Amp.  at  left  ankle  joint.    Surg. 

Recovery. 

Texas  Cavalry. 

1862. 

1863. 

F.  Hawthorne,  P.  A.  C.  S. 

5 

'Johnes,  A.,  Corp'l.  E,  5th 

June  27, 

Conoidal  ball   passed  through 

Aug.  4, 

Syme's  amputation  at  right  an 

Erysipelas;  stump  healed.     Dis 

New  York,  aged  27. 

1862. 

tarsal  bones  of  tlie  right  foot; 

1802. 

kle  joint.    Ass'tSurg.  K.  Bar- 

charged   Dec.   6.    1862.     Died 

sloughing. 

thoiow,  U.  S.  A. 

March  28,  1880,  of  consumption. 

6 

6  Mossup,  I.  T.,  Ft.,  D,  100th 

July  18, 

Conoidal  ball  fractured  left  as 

Nov.  11, 

Syme's  posterior  flap  amputa 

Disch'd  June  1,  1864  ;  pensioned. 

New  York,  age  30. 

18B3. 

tragalus  and  calcaneum. 

1863. 

tion.     A.  A.  Surgeon  J.  B. 

Two  ins.  shortening  ;  limbsome- 

Cutter. 

what  atrophied,  tissue  healthy, 

compact  and  symmetrical.  Spec. 

726,  A.  M.  M. 

7 

O'Donahue,  M..  Pt.,  D,  124th  i  Mav  4, 

Musket  ball  injured  right  foot. 

Nov.  —  , 

Pirogoff  's  amputation  at  right 

Discharged   Dec.  27,   1864,  and 

Ohio,  age  3G.                              18fi4. 

Primary  amptit'n  3d  and  4th 

1866. 

ankle  joint.  Prof.C.  B.  Weber, 

pcns'd.     Stump  healed.     Died 

toes  with  metatarsal  bones  ; 

of  Cleveland. 

April  13,  1873. 

re-amputation. 

8 

Porter,   I,.  S.,  Pt.,   F,   49th    Dec.  31,   Shell  fracture  of  left  ankle  

Feb.  25,   Syme's  amputation  at  left  ankle 

Disch'd  Dec.  6,  1863,  and  pens'd. 

Ohio,  age  32. 

1862. 

1863. 

joint. 

Stump  healed,  but  is  trouble 

some  and  causes  pain. 

0 

7H  ,  F  Dec.  9,    Musket    ball    passed  through 

Jan.  20, 

Svme's  amput'n  at  ankle  joint. 

Stump  firm   and    useful.     Two 

1864.        tarsus. 

1865.         Dr.  G.  Buck,  New  York  city. 

inches  shortening. 

'SMITH  (S.),  Amputations 
2 SMITH  (S.),  loc.  cit.,  p.  140. 
"SMITH  (S.),  loc.  cit.,  p.  136 


at  the  Ankle  Joint  in  Military  Surgery,  in  TT.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  II,  p.  119. 

s  SMITH  (S.),  loc.  cit.,  pp.  Ill,  136.  4  SMITH  (S.),  loc.  cit.,  p.  119. 

6  SMITH  (S.),  loc.  cit.,  p.  140.  7  SMITH  (S.),  loc.  cit.,  p.  136. 


60S 


IN.TUETES    OF   THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

JX.JURY. 

NATURK  OF  INJURY. 

DATE 

OF 
Ol'ERA- 
TION. 

OPERATION  AND   OPERATOR. 

RESULT  AND  REMARKS. 

10 
11 

Rooney,  J.  S.,  Pt.,  D,  37th 
Georgia. 
Taylor  J.  W  I.    Pt     A    3d 

Sept.  20, 
1863. 
Sept  '20 

Shot  wound  in  front  of  foot.  .  .  . 

Oct.  26, 
1863. 
A  prill  3, 

Pirogoff'samputat'n  ;  resection 
of  tibia  and  calcis. 
Disarticulation  right  foot  at  the 

Doing  well  November  1,  1863. 
Retired  November  30,  1864. 

12 
13 

Arkansas,  ag-e  23. 
Wells,   G.  W..    Pt.,   K.   4th 
New  Hampshire,  age  24. 

Frost,     E.    It.,    Pt.,    I.    32d 

18ti3. 
Aug.  Hi. 
1864. 

J  une  15, 

Conoidal  ball  fract'd  metatarsal 
bones,  right  foot.    Necrosis  of 
tarsus  and  metatarsus. 
Ball  entered  inner  side  of  right 

1664. 
Oct.  22, 
1864. 

July  18, 

ankle  joint. 
Syme's  amputation  at  right  an 
kle  joint.     A.  A.  Surg.  G.  A. 
Chesley. 
S  vine's  amputation  at  right  an 

Sloughing.     Discharged  Jan.  11, 
1865;  pensioned.    Jan.  16,  1865, 
amp.  of  leg  at  middle  third. 
Gangrene  ;    haemorrhage.      Died 

Maine,  age  44. 

1864. 

toot  at  mid.  of  first  metatarsal 
bone  ;  exit  at  base  of  2d  and  3d 
toes;  prim.  amp.2dand3dtoes. 

1864. 

kle  joint.     Surg.  R.  B.  Bonte- 
coui  U.  S.  V. 

July  23,    1864,  of  exhaustion. 
Spec.  3068,  A.  M.  M. 

Of  three  of  the  cases  cited  in  the  preceding  table  specimens  are  preserved  in  the  Army 
Medical  Museum. 

Amputations  at  the  Ankle  Joint  of  Uncertain  Date. — In  six  instances  the  date  of 
the  injury,  or  of  the  operation,  or  both  were  not  recorded.  Four,  it  would  appear,  recovered 
and  two  proved  fatal.  All  were  Confederate  soldiers: 

TABLE  XCIII. 
Summary  of  Six  Cases  of  Amputations  at  the  Ankle  Joint  for  Shot  Injury  of  Uncertain  Date. 

[Recoveries,  1 — 4;  Deaths,  5-6.] 


NO. 
1 

0 

3 

4 
5 

li 

N'AMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

Crenshaw.   J.    W.,    Pt.,    A, 
4,")ih  Georgia. 
Lawson,  M.,  Serg't,  F.  21st 
North  Carolina. 
Lloyd,    J.    T..    Pt..    K,    8th 
(ieorgia. 
Oqburn,   C.  J.,  Pt.,  D,  57th 

June  2, 
1864. 
Feb.  6, 
1865. 
Aug.  13, 
1864. 
May  4, 
1863. 

Shot  wound  
Shot  fracture  of  right  foot  
Shot  wound  of  right  foot  

Amputation  at  ankle  joint  
Amputation  at  right  ankle  joint. 
Amputation  at  right  ankle  joint. 

Pirogoff's  amputation  at  ankle 
joint. 
Amputation  at  ankle  joint  

Amputation  at  ankle  joint  

Furloughed  July  12,  1864. 
Furloughed  March  —  ,  1865. 
Furloughed  October  14,  1864. 
Furloughed  June  12,  1863. 
Died  June  27,  1864. 
Died  September  15,  1862. 



North  Carolina. 
Clark.  A.,  Pt.,  D,  6th  South 
Carolina. 
Rogers,  J.  M.,  Pt.,  G,  48th 
Georgia. 

Shot  wound  of  foot  

1862. 

1862. 

Sixty-two  of  the  one  hundred  and  sixty-one  cases  of  amputations  at  the  ankle  joint 
recorded  in  the  preceding  pages  were  performed  on  the  right,  eighty-two  on  the  left  sido; 
in  seventeen  instances  the  side  was  not  indicated. 

CONCLUDING  OBSERVATIONS  ON  SHOT  INJURIES  OF  THE  ANKLE 
JOINT. — As  far  as  the  records  of  military  surgery  indicate,  attempts  at  conservation  of 
the  limb  in  severe  shot  wounds  of  the  ankle  joint  were  rarely  made  during  the  first  half  of 
the  present  century.  In  cases  in  which  the  joint  was  opened,  or  in  which  the  lesion  of  the 
bones  forming  the  joint  was  extensive,  amputation  in  the  leg,  or,  if  practicable,  exartieula- 
tion  at  the  ankle,  were  resorted  to,  in  conformity  with  the  teachings  of  Desport,  Thomson, 
Hennen,  and  Williamson.1  The  experience  of  the  surgeons  of  the  American  civil  war 
would  seem  to  have  led  to  similar  conclusions.  Surgeon  T.  H.  Squire,2  89th  New  York 
Volunteers,  from  his  experience  in  the  hospitals  after  the  battle  of  Antietam,  asserts  that 
"every  ankle  joint  opened  by  a  ball,  with  any  considerable  injury  of  articular  bones,  should 

1  DESPORT  (Traite  desplaies  d'armes  a  feu,  Paris,  1749,  p.  232):  "Si  la  balle  passe  dans  1'articulation  et  fracasse  les  os,  I'amputation  cst  n6cessaire, 
et  ne  pent  etre  trop  tot  faite."  THOMSON  (J.)  (Report  of  Observations  made  in  the  British  Military  Hospitals  in  Belgium  after  the  Battle  of  Waterloo, 
etc.,  Edinburgh,  1816,  p.  143):  "  The  injuries  of  the  ankle  joint  might  be  said  to  be  almost  equally  severe  with  those  of  the  knee  joint.  .  .  The  swell 
ing  of  this  joint  was  proportionally  greater  than  even  that  of  the  knee.  Fungous  granulations  protruding  through  the  wounds  were  more  common,  but 
the  constitutional  symptoms,  though  in  particular  instances  severe,  were,  in  general,  far  less  so  than  in  gunshot  wounds  of  the  knee  joint."  HENNEN  (J.) 
(Principles  of  Military  Surgery,  London,  182'J.  p.  157):  "However  desirable  it  may  be  to  save  a  hand  or  a  foot,  yet,  in  severe  and  complicated  lacera 
tions  of  the  wrist  and  ankle  joints,  the  frequency  of  tetanic  affections  should  at  once  lead  us  to  adopt  immediate  amputation."  WILLIAMSON  (G.)  (Military 
Surgery,  London,  1863,  p.  159):  '•  When  the  fracture  takes  place  near  the  ankle  and  a  fissure  extends  into  the  joint,  it  is  rarely  that  the  patient  recovers." 

2SQU1UE  (T.  H.),  Field  Note  Book,-   Case  Book  No.  16,  Division  of  Surgical  P.ecords,  Surgeon  General's  Office,  p.  59. 


SECT,  vi.]  SHOT    FEACTURES   OF   THE    ANKLE   JOINT.  609 

be  amputated,  and  the  quicker  the  better."  Surgeon  A.  J.  Phelps,1  U.  S.  V.,  Medical  Direc 
tor  of  the  Fourth  Army  Corps,  declared,  after  the  battle  of  Chickamauga:  "In  my  mind 
there  is  no  question  upon  the  necessity  of  amputation  in  cases  of  knee  joint  injury  (gun 
shot);  and  it  is  also  my  opinion  that  the  same  treatment  is  scarcely  less  necessary  in  wounds 
of  the  tarsus  and  ankle  joint."  Surgeon  J.  T.  Woods,2  99th  Ohio  Volunteers,  after  the 
battle  of  Chickamauga  "found  the  early  history  of  these  cases  exceedingly  flattering,  and 
affording  ample  reason  to  warrant  an  effort  to  save  the  limb  in  injuries  of  this  class;  but 
at  a  later  date  the  incapability  of  nature's  power  of  reparation  became  apparent,  *  *  the 
unwarrantableness  of  conservatism  (?)  in  these  cases  is  most  obvious,  every  indication  pre 
sented  by  them  warranting  the  conclusion  that,  after  much  suffering  and  great  exhaustion, 
the  choice  is  still  between  death  and  loss  of  foot."  Surgeon  H.  S.  Hewit,3  U.  S.  V.,  in 
charge  of  the  hospitals  at  Frederick  after  the  battle  of  Antietam,  expressed  the  opinion 
that  "amputation  of  the  leg  ought  to  be  performed  in  every  case  of  gunshot  penetration  and 
fracture  of  the  ankle  joint."  A  year  later,  Surgeon  Hewit,4  then  Medical  Director  of  the 
Department  of  the  Ohio,  counseled  the  medical  officers  under  his  charge  that  "amputation 
was  to  be  employed  in  almost  every  penetrating  injury  of  the  ankle  joint,"  and  made  con 
sultation  obligatory  in  all  doubtful  cases  of  this  injury.  It  is  therefore  not  surprising  that 
the  number  of  amputations  following  injuries  of  the  ankle  joint,  recorded  during  the  war,  is 
proportionally  very  large.  Of  one  thousand  seven  hundred  and  eleven  instances  of  shot 
injuries  of  the  bones  of  the  tibio-tarsal  articulation,  five  hundred  and  eighteen  were  treated 
by  expectant  conservative  measures,  in  thirty-three  instances  excision  was  practised,  and  in 
one  thousand  one  hundred  and  sixty  recourse  was  had  to  ablation  of  the  limb  either  at  the 
ankle  joint,  in  the  leg,  or  in  the  thigh.  It  may  be  assumed  that  the  five  hundred  and 
eighteen  cases  treated  by  conservation  were,  as  a  rule,  instances  in  which  the  injury  was 
comparatively  slight,  and  in  which  the  articulation  originally  was  not  seriously  involved. 
Of  these  five  hundred  and  eighteen  patients  four  hundred  and  seven  recovered  and  ninety- 
nine,  or  19.5  per  cent. ,  died ;  in  twelve  the  ultimate  result  was  not  ascertained.  Free  incisions 
into  the  joint  were  frequently  made,  and  in  forty-one  instances  fragments  of  bone  were  elim 
inated;  pyaemia  was  noted  in  twenty-eight,  gangrene  in  twenty-two,  erysipelas  in  twelve, 
and  tetanus  in  five  instances. 

Examining  the  cases  of  recovery  after  conservative  treatment  of  shot  fractures  of  the 
bones  of  the  ankle  joint  adduced  at  pp.  579  to  582,  ante,  it  will  be  seen  that  the  remote 
results  in  many  instances  were  less  satisfactory  than  the  early  progress  of  the  cases  had 
promised.  In  the  case  of  Private  J.  H.  Noble  (CASE  820,  p.  580,  ante),  in  January,  1863, 
six  months  after  the  injury,  the  wound  had  healed  and  an  anchylosed  and  serviceable  limb 
was  reported ;  but  nearly  a  year  later  the  patient  was  walking  on  crutches ;  the  wound  had 
reopened.  In  1878,  sixteen  years  after  the  injury,  the  pension  examining  board  reported 
that  the  "parts  broke  out  again  and  again,  and  discharged;  the  pensioner  complains  of 
more  or  less  constant  pain  in  the  leg,  and  if  he  uses  it  much  it  swells  and  becomes  painful, 
so  that  he  is  unable  to  sleep.  He  still  has  to  use  a  cane;  the  leg  is  worse  than  useless." 
In  the  case  of  Sergeant  T.  B.  Sturdivant  (CASE  825,  p.  582,  ante),  who  was  discharged  in 

1  PllELPS  (A.  J.),  Tlit  Battle  of  Chickamauga,  Observations  by,  in  Bound  Manuscript  No.  11,  Div.  of  Surg.  Records,  Surgeon  General's  Office. 

2  WOODS  (J.  T.),  Observations  of  the  Surgery  of  the  Battle  of  Chickamauga,  in  Bound  Manuscript  No.  11,  Division  of  Surgical  Records,  Surgeon 
General's  Office. 

3  IlKWIT  (H.  S.),  Report  of  the  Surgery  of  the  U.  S.  A.  General  Hospital  No.  5,  at  Frederick,  3fd.,  in  Bound  Manuscript,  No.  33,  Surgeon  General's 
Office,  Division  of  Surgical  Records. 

4  HEWIT  (H.  S.),  Report  on  the  Military  Medicine,  Surgery,  and  General  Conduct  of  the  Medical  Department  of  the  Army  of  the  Ohio,  etc.,  in 
Appended  Document*,  Medical  and  Surgical  History  of  the  War  of  the  Rebellion,  Part  I,  Volume  I,  p.  311. 

SCUG.  m— ?r 


610 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


1865,  with  "anchylosis  of  the  ankle  joint  and  extension  of  the  foot,"  an  ulcer  formed  on 
the  outer  side  of  the  ankle  and  pieces  of  bone  were  discharged  as  late  as  1880.  Private 
Dutton  (CASE  821,  p.  581),  when  mustered  out  in  June,  1865,  was  able  "to  walk  a  mile  or 
two  without  difficulty,"  but  several  years  later  there  were  indolent  ulcers  at  the  inner  as 
well  as  the  outer  side  of  the  joint,  and  the  patient  was  unable  to  walk;  his  disability  was 
then  reported  as  equal  to  loss  of  foot. 

Excision  at  the  Ankle  Joint  for  Shot  Injury. — The  substitution  of  excision  at  the 
ankle  joint  for  amputation  effected  no  saving  of  life.  Of  the  thirty-three  cases  in  which 
this  operation  was  practised,  the  results  are  known  in  thirty-one,  of  which  nine,  or  29.0 
per  cent.,  proved  fatal,  while  the  mortality  of  the  cases  treated  by  expectation  was  only 
19.5  per  cent,  and  that  of  the  amputations  25.1.  The  results  of  this  operation  performed 
in  the  European  wars  were  even  less  satisfactory,  as  will  be  seen  from  the  appended  table: 

TABLE  XCIV. 
Results  of  Excisions  at  the  Ankle  Joint  on  the  Occasions  named  and  from  the  Authorities  quoted. 


•d 

"3 

• 

a 

S 

£~ 

**>£' 

ACTION,  ETC. 

a 

an 

S"f 

8 

o 

a 

"S  <5 

g| 

g 

8 

§ 

•O  pj 

t.  ^ 

O 

« 

0 

S 

PH 

Crimean  War,  1854-'57  (MATTHEW,1  LANGENBECK1)  

2 

2 

Italian  War,  1859  (NEUDORFER3)  

1 

1 

Schleswig-Holstein  War,  1864  (LANGENBECK,4  NEUDORFER5)  

6 

5 

1 

16  6 

Mexican  War,  1805  (NEUI)6'UFERC)  

1 

Austro-Prussian  War,  1866  (BECK,7  LAUFFS,8  STROMEYER,9  LANGENBECK,10  GURLT") 

26 

22 

4 

15  3 

Franco-German  War,  1870-71,  (GURLT,12  BECK,13  KRATZ,14  GOLTDAMMER  IS  COUSIN16) 

104 

60 

40 

4 

40  0 

Russo-Turkish  War,  1876-'78  (Soc.  Otto.du  Croissant  Rouge,  I7STEIXER,I8REYHER,19  TILING,20  WAHL21) 

10 

5 

4 

1 

44.4 

Aggregates  

150 

96 

49 

r 

33  7 

Considering  the  remote  results  in  the  twenty-two  cases  of  recovery  after  excision  at 
the  ankle  of  the  American  civil  war,  we  find  that  in  three  instances  the  operation  was  fol- 

1  MATTHEW  (T.  P.)  (Med.  and  Surg.  Hist,  of  the  British  Army  which  served  in  Turkey  and  the  Crimea,  etc.,  London,  1858,  Vol.  II,  pp.  368,  379): 
successful  excision  of  lower  end  of  fibula.  2 LANGENBECK  (B.  V.)  (Ueber  die  Schussfractvren  der  Gelenke  und  ihre  Behandlung,  Berlin,  1868,  p.  40): 
v.  Kwicinsky,  Russian  Lieutenant  General,  wounded  at  the  Alma,  Sept.  20,  1854,  in  left  ankle;  subperiosteal  excision  of  internal  malleolus  and  astraga 
lus,  May  30,  1859,  by  VOX  LAXGENBECK  ;  recovery  without  shortening ;  anchylosis  of  joint.  3  NEUDORFER  ( J.)  ( Die  Endresultate  der  GeUnkresektiimtn, 
in  Wiener  Med.  Presse,  1871,  S.  405):  A.  Winkler,  shot  fracture  of  right  ankle  joint,  Solferino,  June  24,  1859;  secondary  excision  of  the  ankle  joint  by 
NEUDORFER;  excellent  recovery.  4LANGENBECK  (B.  v.)  (Ueber  Resection  des  Fussgelenks  lei  Schussfracturen  desselben,  nebst  Vorstellung  eines  FaJles 
von  subperiostaler  Resection  der  Diaphyse  der  Tibia  und  Fibula,  in  Berliner  Klinische  Wochcnschrift,  1865,  S.  30)  performed  5  excisions  of  the  ankle 
joint  in  the  Schleswig-Holstein  War  of  1864  :  Werkmeister,  Tambour,  Dtlppel,  March  28,  1864  ;  fracture  of  left  internal  malleolus  and  astragalus;  May 
1,  1864,  subperiosteal  excision  of  ankle  joint;  recovery,  with  useful  limb;  joint  anchylosed.  F.  Holcke,  7th  Brandenburg  Reg't,  No.  60,  April  18,  18(14, 
before  Dflppel ;  shot  fracture  of  lower  portions  of  tibia  and  fibula;  excision  May  3,  1864  ;  death  May  14,  of  pyaemia.  Lieut.  C.  F.  Leth,  3d  Infantry, 
Alsen,  June  29,  1864.  shot  fracture  of  both  malleoli  of  right  foot ;  excision  July  29 ;  recovery,  with  useful  liinb.  Lieut.  Wedell- Jarlsberg,  Alsen,  June 
29,  1804  ;  shot  fracture  right  ankle  joint ;  A  ug.  19,  subperiosteal  excision  of  lower  portion  of  tibia  and  part  of  astragalus ;  recovery.  Groen,  5th  Danish 
Regiment,  Alsen,  June  29,  1864 ;  shot  fracture  of  left  ankle  joint ;  July  15,  subperiosteal  excision  of  tibia,  fibula,  and  astragalus ;  recovery,  with  useful 
limb.  &  NEUDORFKU  (J.)  (Aus  dem  feldarztlichen  Berichte  iiber  die  Verwundeten  in  Sclileswig,  in  Archivfiir  Klinische  Chirurgie,  Berlin,  1805,  B.  VI, 
p.  559)  excised  the  lower. portions  of  the  tibia  and  fibula  and  the  head  of  the  astragalus ;  the  patient  recovered  with  one  inch  shortening  and  good  use 
of  the  limb.  (See  also  Berliner  Klinische  Wochenschrift,  1865,  S.  31.)  s NEUDORFER  (J.)  (Die  Endresultate  der  Gelenkresektionen,  in  Wiener  Med. 
Presse,  1871,  p.  406)  excised  the  ankle  joint  on  May  15,  1865,  in  the  case  of  J.  Kuzelik,  wounded  at  Sayaltepek,  April  25,  1865;  recovery  in  five  months, 
with  good  use  of  foot.  Dr.  NEUDORFER  (Handbuch  der  Kriegschirurgie  und  der  Operationsle.hre,  Leipzig,  1872,  Zweite  Halfte,  Spec.  Theil,  Zweite  Abth! 
S.  1003)  remarks:  "I  have  performed  this  resection  after  shot  wounds  14  times,  and  of  these  14  cases  I  have  lost  only  2;  nil  the  rest  recovered  with  perfectly 
useful  feet."  With  the  exception  of  the  3  cases  referred  to  above,  the  editor  has  not  been  able  to  identify  the  operations  claimed  to  have  been  performed 
by  Dr.  NEUu5ilFER.  7BECK  (B.)  (Kriegs-Chirurgische  Erfahrungen  wahrend  des  Feldzuges  1806,  in  Siidcleutschland,  Freiburg,  I.  Br.,  1807,  S.  354): 
L.  Finkbeiner,  2d  WUrtemberg  Infantry,  Tauberbischoffsheim,  July  24,  1866,  through  both  ankle  joints;  July  28,  excision,  by  Professor  v.  Bituxs,  of 
right  ankle  joint;  both  joint  surfaces  were  removed;  fatal.  8 LAUFFS  (LAUREXZ)  (Zur  Statistik  der  Fussgelenkresektionen,  Inaug.  Diss.,  Halle,  1872, 
p.  36):  C.  Rochhardt,  Lieut.,  1st  Austrian  Inf.,  Trautenau,  June  27,  1866,  shot  wound  left  ankle  joint;  August  16,  resection  of  ends  of  tibia  and  fibula 
and  upper  surface  of  astragalus  by  Prof.  VOI.KMAXN;  recovery;  shortening  1J  inches;  walks  well  with  a  cane.  9STROMEYER  (L.)  (Erfahrungen  iiber 
Schusswunden  im  Jahre  1866,  Hannover,  1867,  p.  60):  C.  Weidemann,  3d  Hannoverian  Infantry,  shot  in  left  ankle  joint ;  July  10,  excision  of  1 J  inches  of 
tibia  and  fibula  and  upper  part  of  astragalus  by  Dr.  STROMEYER  ;  ball  extracted ;  July  18,  removal  of  remaining  portion  of  astragalus ;  May  21,  1807, 
amputation  upper  third  of  leg;  recovery  in  4  weeks.  10 LAXGEXBECK  (B.  v.)  (Ueber  die  Schusxfracturen  der  Gelenke,  etc.,  Berlin,  1868,  p.  47,  No.  10): 
C.  Staudinger,  1st  Thtlringen  Inf..  No.  31,  Koniggratz,  July  3,  1866;  shell  wound  of  right  ankle  joint;  July  31,  excision  of  internal  malleolus  and  joint 
surface  of  astragalus  by  Prof.  v.  LANGEXBECK;  recovery,  with  2  centimetres  shortening;  walks  well  with  an  ordinary  shoe.  LAXGEXBECK  (B.  v.)  (loc. 
cit.,  p.  47,  No.  11):  J.  E.  H.  Pfitzner,  1st  Silesian,  No.  46,  Naehod,  June  27,  1866;  shell  fracture  of  lower  third  of  leg;  resection  of  internal  malleolus 


SECT.  VI.]  EXCISIONS    AT    THE    ANKLE    JOINT.  611 

lowed  by  secondary  amputation,  and  that  in  at  least  nine  instances  the  joint  remained  pain 
ful  and  swollen,  compelling  the  patients  to  use  crutches  or  canes  for  support,  and  unfitting 
them  for  manual  labor;  in  several  instances  the  wounds  reopened,  abscesses  formed  many 
years  after  the  injury,  deficient  circulation  and  varicose  veins  followed,  and  in  one  case 
the  continued  irritation  finally  extended  into  the  knee  joint.  In  regard  to  this  operation 

August  7,  by  v.  LAXGEXBECK;  shortening  8-9  centimetres;  uses  a  crutch.  (See  also  GUUI.T  (E.),  Die  Gelenk-Resectionen  nach  Scliussverletzungen; 
ihre  Geschichte,  Statistik,  End-Resultate,  Berlin,  1879,  p.  404.)  LAXGEXBECK  (B.  v.)  (loc.cit.,  p.  47,  No.  7):  A.  Thiel,  1st  Austrian  Infantry,  Koniggratz, 
July  3,  18(56,  right  ankle  joint;  July  26,  excision  of  external  malleolus  and  the  upper  joint  surface  of  the  astragalus  by  Prof.  v.  LAXGEXBECK;  recovery, 
with  anchylosis.  GURLT  (E.)  (toe.  cit.,  p.  489).  LAXGEXBECK  (B.  v.)  (loc.  cit.,  p.  47,  No.  8):  M.  Wagner,  Austrian  Infantry  Regiment  No.  0,  Konig 
gratz,  July  3,  1866 ;  shot  fracture  left  ankle  joint ;  July  26,  subperiosteal  resection  of  tibia,  fibula,  and  upper  surface  of  astragalus  by  Prof.  VOX  LAXGEX 
BECK;  death  August  6.  GUHLT  (E.)  (loc.  cit.,  p.  493).  LAXGEXBECK  (B.  v.)  (loc.  cit.,  p.  47,  No.  9):  Bissig,  train-captain,  Austrian  Infantry  No.  55, 
Koniggratz,  July  3,  1866;  shot  in  right  astragalus;  July  26,  excision  of  lower  portion  of  internal  malleolus  and  of  astragalus  by  VOX  LAXGEXBECK; 
gangrene ;  death.  GUULT  (E.)  (loc.  cit.,  p.  493).  "  GUKLT  (E.)  (Die  Gelenk-Resectionen  nach  Schussverletzungen,  u.  s.  w.,  Berlin,  1879,  p.  400):  R.  Witt. 
Kaiser  Alexander  Garde-Gren.  Reg't,  Koniggratz,  July  3,  1866 ;  shot  fracture  left  ankle  joint ;  August  20,  excision  of  external  malleolus  and  portion  of 
astragalus  by  Dr.  WAGXER;  bony  anchylosis ;  6  centimetres  shortening;  walks  short  distances  comfortably,  sometimes  even  without  a  cane.  GUULT  (E.) 
(loc.  cit.,  p.  401):  A.  Streese,  Kaiser  Alexander  Garde-Gren.  Reg't,  Koniggratz,  July  3,  1866 ;  shot  fracture  of  right  ankle  joint ;  August  31,  excision  of 
both  malleoli  and  talus  by  Dr.  WAGXEU;  recovery,  with  2J  inches  shortening;  new  formation  of  bone;  able  to  walk  a  mile  with  the  use  of  a  cane. 
GURLT  (E.)  (loc.  cit.,  p.  402):  Jacob  Raecke,  1st  Magdeburg  Reg't,  No.  26,  Koniggratz,  July  3,  1866;  left  ankle  joint;  August  17,  excision  of  1  inch  of 
tibia  and  fibula  and  joint  surface  of  astragalus  by  Dr.  SriEUIXG ;  recovery ;  walks  with  apparatus.  GUELT  (E.)  (loc.  cit.,  p.  405):  A.  Griczka,  7  Pormn. 
No.  54,  Trautenau,  June  27;  shell  wound  of  left  ankle  joint;  September  19,  joint  surface  of  tibia  excised  and  necrosed  portions  of  astragalus  removed; 
recovered ;  walks  on  crutches  and  with  a  high  heel ;  shortening  6 centimetres.  GUKLT  (E.)  (loc.  cit.,  p.  406):  A.  Bauske,  8th  Pommeranian  Reg't,  No.  61 ; 
shrapnel  shot,  July  3,  1866,  at  Koniggratz,  in  left  ankle;  July  29,  excision  of  lower  extremities  of  tibia  and  fibula  and  upper  part  of  astragalus  by  Dr. 
BUSCH ;  recovery,  with  9  centimetres  shortening  ;  anchylosis ;  walks  with  a  crutch.  GURLT  (E.)  (loc.  cit.,  p.  445):  H.  Morgenstern,  6th  Saxon  Infantry, 
Koniggratz,  July  3,  1866;  shot  wound  of  left  ankle  joint;  July  28,  excision  of  lower  ends  of  tibia  and  fibula  and  the  whole  astragalus  by  Prof.  BUSCH; 
Nov.  21,  amputation  of  leg;  recovery.  GURLT  (E.)  (toe.  cit.,  p.  445):  G.  H.  Seifert,  13th  Saxon  Infantry,  Koniggratz,  July  3,  1866;  shot  through  right 
ankle  joint;  July  29,  resection  of  ends  of  tibia  and  fibula  by  Dr.  DlEHL;  shortening  10  centimetres;  little  use  of  ankle  and  foot.  GURLT  (E.)  (toe.  cit., 
p.  447):  A.  Seidel,  12th  Saxon  Infantry,  Koniggratz,  July  3,  1866;  shot  fracture  of  right  leg  at  the  ankle  joint;  July  26,  excision  of  lower  end  of  tibia 
and  of  the  astragalus  by  Dr.  BUSCH;  death  July  31,  1866.  GURLT  (E.)  (loc.  cit.,  p.  489):  A.  Jano,  2d  Austrian  Infantry,  Koniggratz,  July  3,  1866; 
shell  wound  of  left  ankle;  August  4,  excision  of  left  ankle  joint  with  extirpation  of  astragalus;  recovery.  GURLT  (E.)  toe.  cit.,  p.  490):  F.  Mistelbauer, 
6th  Austrian  Reg't;  shot  wound  of  left  ankle  joint ;  resection  of  left  tibia  and  fibula  ;  Nov.  27,  amputation  leg;  recovery.  GURLT  (E.)  (loc.  cit.,  p.  490): 
A.  Leitgeb,  Austrian  Infantry  Regiment  No.  15;  KSniggratz,  July  3,  1866;  right  ankle  joint ;  July  27,  excision  of  ends  of  tibia  and  fibula  and  astragalus 
by  Professor  BUSCH;  recovery,  with  good  use  of  limb.  GURLT  (E.)  (toe.  cit.,  p.  490):  G.  Bulsoni,  Austrian  Inf.  Reg't,  No.  26,  July  3,  1866,  Konig 
gratz  ;  right  ankle  joint ;  August  8,  excision  of  the  fractured  joint  surface  of  the  tibia  and  removal  of  the  fractured  external  malleolus  by  Dr.  FIXCKE  ; 
recovery;  walks  with  a  cane.  GURLT  (E.)  (toe.  cit.,  p.  490):  P.  Kanta,  34th  Austrian  Infantry,  Koniggratz,  July  3,  1866;  left  ankle  joint;  August  3, 
excision  of  joint  by  Dr.  HAHX;  recovery.  GURLT  (E.)  (toe.  cit.,  p.  490):  W.  Stelzig,  Austrian  Infantry  No.  42,  Koniggratz,  July  3,  1866;  shot  fracture 
of  right  ankle  joint;  July  25,  excision  of  ankle  joint  by  VOX  LAXGEXBECK;  good  recovery.  GURLT  (E.)  (toe.  cit.,  p.  491):  J.  Bresonelli,  47th  Austrian 
Infantry,  Koniggratz,  July  3,  1866 ;  comminution  of  right  external  malleolus  ;  August  8,  excision  of  end  of  tibia  and  upper  portion  of  astragalus  by 
Surgeon  FIXCKE;  Sept.  3,  amputation  of  leg  in  upper  third;  recovery.  GURLT  (E.)  (toe.  cit.,  p.  491):  A.  Diener,  73d  Austrian  Infantry,  Kor.iggratz, 
July  3,  1866 ;  ankle  joint  fractured  ;  Oct.  20,  inner  surface  of  external  malleolus,  portion  of  astragalus,  and  part  of  os  calcis  removed  by  Surgeon  HECK 
recovery,  with  4  centimetres  shortening;  able  to  walk  several  miles  without  pain.  GURLT  (E.)  (toe.  cit.-,  p.  492):  F.  Dubsky,  Austrian  Jaeger  Batt.  No. 
17;  shell  wound  of  outer  malleolus  of  left  foot;  August  21,  excision  of  2J  inches  of  end  of  tibia  by  Surgeon  GAEHDE;  recovery.  GURLT  (E.)  (loc.  cit.. 
p.  492):  N.  Prymak,  Austrian  Lancers  Reg't  No.  11,  Koniggratz,  July  3,  1866;  shot  fracture  lower  end  of  right  tibia  and  fibula ;  July  28,  excision  of  2 
inches  of  tibia  and  fibula  by  Prof.  BUSCU ;  recovery,  with  varus  position.  12GUKLT  (E.)  (toe.  cit.,  pp.  611,  et.  seq.)  details  99  cases  of  excisions  at  the 
ankle  joint  from  the  Franco-Prussian  War  of  1870-71 ;  the  results  in  4  cases  are  not  stated;  57  were  successful  and  38  fatal,  a  mortality  rate  of  40  percent. 
The  operation  involved  the  tibia  in  7  (4  recoveries,  2  deaths,  1  unknown  result),  the  fibula  in  5  (3  recoveries,  2  deaths),  the  tibia  and  astragalus  in  7  (2 
recoveries,  5  deaths),  the  fibula  and  astragalus  in  4  (4  recoveries),  the  tibia  and  fibula  in  22  (14  recoveries,  8  deaths),  the  tibia,  fibula,  and  astragalus  in  38 
(24  recoveries,  13  deaths,  1  unknown  result),  and  in  16  instances  (6  recoveries,  8  deaths,  2  unknown  results)  the  portions  of  bone  excised  were  not  indicated. 
In  13  instances,  with  11  deaths,  amputation  was  subsequently  resorted  to.  To  the  99  cases  reported  at  length  by  Professor  GURLT  in  his  exhaustive 

work  must  be  added  the  following  5  cases:  13BECK  (B.)  (Chirurgie  der  Schussverletzungen,  Freiburg,  i.  Br.,  1872,  p.  881):    F ,  1  Baden  L.-Gr — . 

Reg't,  No.  109;  comminuted  shot  fracture  of  ankle  joint;  primary  excision  ;  recovery,  with  anchylosis.  BECK  (B.)  (toe.  cit.,  p.  909):  1  case  of  resection 
of  internal  malleolus;  fatal.  14KKATZ  (Besultate  der  wahrend  des  letzten  Feldzuges  ausgef&hrten  Gelfnkresektionen,  in  Deutsche  Militai:-;;'-?tliche 
Ze.itsch.rift,  Berlin,  1871,  Jahrg.  I,  p.  596):  Saeckel,  Jaeger  Bat.  No.  11  (Prussians);  shot  fracture  left  ankle  joint;  excision  of  lower  portions  of  DO.  =  <it 
leg ;  shortening  2J  inches,  with  oedematous  swelling ;  atrophy  of  muscles  from  knee  downwards ;  active  movements  of  foot  weak.  I5  GOLTDAJIMEK  (Be.richt 
uber  die  Thiitigkeit  des  Reserve- Lazar  efts  df.s  Berliner  Hilfsvereins  in  der  Garde-Ulanen-Kaserne  zu  Moabit,  in  Berliner  IClinische  IV'ocJtenschrift,  1871, 
Jahrg.  VIII,  p.  151):  Leclerc,  1st  French  Engineers,  wounded  at  Worth,  August  6,  1870,  in  left  ankle;  Sept.  13,  excision  of  astragalus,  os  calcis,  and  os 
navicnlare;  recovery,  with  good  use  of  foot.  I6COUSIX  (A.)  (Histoire  ChirurgicaU  de  Vambulance  de  I'Ecole  des  Fonts  et  Chaussees,  in  L' Union  Mtd- 
icale,  1872,  T.  XIII,  p.  159):  Soldier,  110th  French  line,  shot  fracture  of  lower  ends  of  tibia  and  fibula,  November  29,  1870;  December,  haemorrhage  from 
peroneal,  which  was  ligated ;  excision  of  lower  ends  of  tibia  and  fibula ;  pyaemia ;  death  December  25,  1870.  (GORDOX,  Lessons  on  Hygitne  and  Surgery 
from  the  Franco-Prussian  War,  London,  1873,  p.  167.)  " Societe  Ottomans  de  secours  aux  blesses  et  malades  militaires  constitute  d'apres  la  Convention  Je 
Geneve.  Vol.  Ill,  Ambulances  fixes  et  mobiles  du  Croissant  rouge,  Constantinople,  1878,  p.  39,  and  GUULT  (E.)  (toe.  cit.,  p.  1153):  At  the  hospital  at  Beyler- 
bey,  under  the  charge  of  Dr.  BALDUIAN  ;  Mehmet,  shot  wound  of  ankle  joint ;  resection ;  death  from  anaemia.  18STEINER  (F.)  (Aus  dem  Tagebuclie  eines 
deutschen  Arztes  wuhrend  der  Zeit  des  Krieges  im  Oriente  1876,  in  Wiener  Med.  Wochrnschrift,  1877,  No.  18,  p.  426):  K.  N.,  aged  29,  shell  fracture  left  ankle 
joint,  middle  of  August,  1876;  September  1,  excision  of  4  inches  of  fibula;  doing  well  in  three  weeks.  19REYHER  (CARL)  (Dieantiseptische  Wundbehand- 
lung  in  der  Kriegschirurgie,  in  R.  "VOLKMAXX's  Sammlung  Klinischer  Vortrdge,  Nos.  142,  143,  Leipzig,  1878,  pp.  1219  and  1234)  tabulates  6  cases  (4 
recoveries,  2  deaths)  of  excisions  at  the  ankle  joint  treated  at  the  Barrack  hospital  at  Swilainatz,  but  gives  no  details.  The  2  fatal  cases  are  related  by  G. 
TlLlXG  in  his  Bericht  uber  124  im  serbisch-tiirkiscfien  Kriege  im  Bar  acken- Lazar  eth  des  Dorpater  Sanitdts- Trains  zu  Swilainatz  behandelte  ScJiussrerlet- 
zungen,  Dorpat,  1877,  pp.  76  and  81:  St.  Petkowitsch,  aged  18,  shot  fracture  of  right  internal  malleolus  August  20,  1876;  excision  of  ends  of  tibia  and 
fibula;  September  2,  amputation  at  knee  joint ;  September  7,  secondary  haemorrhage  and  death.  O.  Uroschewitsch,  aged  28,  shot  fracture  of  astragalus 
and  os  calcis;  ankle  joint  opened;  wound  received  a  few  days  before  September  21,  1876;  September  21,  excision  of  the  astragalus  and  entire  os  calcis; 
September  25,  amputation  at  ankle  joint;  gangrene ;  death  September  30,  1876.  zoDr.  TlLIXG  (toe.  cit.,  p.  80)  reports  a  third  fatal  case,  not  included  in 
Dr.  REYHER'S  statistics:  G.  Konstantinowitsch,  aged  56,  shot  wound  of  left  ankle  joint,  received  in  the  early  part  of  September,  1876;  October  11, 
excision  of  articular  extremities  of  tibia  and  fibula  and  astragalus:  death  October  20,  1876.  21  GURLT  (E.)  (loc.  cit..  p.  11. "4)  tabulates  a  successful  case 
of  excision  at  the  ankle  joint  observed  by  Dr.  WAUL  at  the  hospital  at  Sistowa ;  no  particulars  are  given. 


INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

it  is  therefore  only  necessary  to  reiterate  the  opinion  expressed  in  the  preliminary  report,1 
that  while  the  "judicious  use  of  the  gouge  and  bone  forceps  are  admissible  in  gunshot 
wounds  of  the  ankle  joint,  the  formal  excisions  are  rarely  successful."2  Recoveries  with 
useful  limbs  have  been  claimed  for  this  operation  in  some  instances  during  the  Franco- 
Prussian  War,  1870-71,  and  later,  under  antiseptic  treatment,  in  the  Russo-Turkish  War, 
1876-77,3  but  hardly  sufficient  time  has  elapsed  to  judge  of  the  remote  effects  of  the  opera 
tions  performed  during  these  campaigns. 

Amputations  at  the  Ankle  Joint.  —  Amputation  at  the  ankle  joint  for  disease  had 
been  frequently  performed  since  the  middle  of  the  last  century4  in  civil  practice,  but  the 
operation  seems  not  to  have  been  performed  for  shot  injury  until  about  the  middle  of  the 
present  century,  during  the  Schleswig-Holstein  War,  1848-1850,  in  which  four  exarticu- 
lations  at  the  ankle  are  recorded  by  Professor  Stromeyer.  That  it  was  not  regarded  with 
favor  by  surgeons  of  the  late  civil  war  is  evident  from  the  limited  number  of  cases  in  which 
it  was  performed;  and,  although  the  number  of  operations  recorded  has  increased  from 
sixty-seven  cases  reported  in  the  preliminary  report  from  the  Surgeon  General's  Office  in 
1865, 5  to  one  hundred  and  sixty-one  cases  reported  here,  yet  the  proportion  of  exarticula- 
tions  at  the  ankle  joint  to  the  cases  of  fractures  remains  very  small  when  compared  with 
the  number  of  amputations  in  the  leg  following  similar  injuries.  Of  the  seven  thousand 
five  hundred  and  forty-three  shot  fractures  of  the  bones  of  the  foot  and  ankle  joint  recorded 
during  the  war,  one  thousand  six  hundred  and  twelve,  or  21.3  per  cent.,  were  followed  by 
amputation  in  the  leg,  while  only  one  hundred  and  sixty-one,  or  2.1  per  cent.,  were  disartic 
ulated  at  the  ankle  joint.  The  operation  seems  to  have  been  selected  by  the  few  surgeons 
who  performed  it  as  an  "operation  of  expediency,"  with  a  view  of  falling  back,  in  case  of 
necessity,  upon  amputation  in  the  leg  as  a  "dernier  ressort."6  It  may  be  assumed,  there 
fore,  that  only  the  cases  most  favorable  to  such  an  operation  were  selected  for  its  perform 
ance.  As  far  as  the  mortality  rate  is  concerned,  the  exarticulation  at  the  joint  would  seem 
to  have  been  followed  by  less  loss  of  life  than  the  amputations  in  the  leg — the  fatality  rate 
of  the  former  being  25. 1,7  of  the  latter  32.9  per  cent.;  but  of  the  one  hundred  and  sixty- 
one  exarticulations  at  the  ankle,  twenty-nine,  or  18.0  per  cent.,  required  reamputation, 
while  of  five  thousand  four  hundred  and  fifty-two  amputations  in  the  leg,  in  only  two 
hundred  and  twenty-one,  or  4.0  per  cent.,  reamputation  became  necessary. 

1  Circular  No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  Nov.  1,  1865.     Report!  on  the  Extent  and  Mature  of  the  Materials 
available  far  the  preparation  of  a  Medical  and  Surgical  History  of  the  Rebellion. 

2  Surgeon  D.  PKIN'CE,  U.  S.  V.,  in  his  Notes  on  Surgical  Cases  and  operations  at  Harrison's  Landing,  Fa.,  August  12,  1862,  Surg.  General's  Office, 
Div.  of  Surg.  Rec.,  File  A,  No.  132,  remarks:  "Any  injury  requiring  n  complete  exsection  of  the  tibio-astragalean  articulation  would  be  almost  certain 
to  make  amputation  a  more  suitable  remedy  on  account  of  the  thinness  of  the  stratum  of  soft  parts  covering  the  bones."     HAMILTON  (F.  II.)  (A  Practical 
Treatise  on  Fractures  and  Dislocations,  5th  ed.,  Philadelphia,  1875,  p.  513):  "  Resections  at  the  ankle  joint  are  much  more  hazardous  than  amputations, 
and  scarcely  to  be  preferred,  in  army  practice,  to  attempts  to  save  the  foot  without  surgical  interference."     AOXEW  (D.  H.)  (The  Principles  and  Practice 
of  Surgery,  Philadelphia,  Ifc78,  Vol.  I,  p.  254):  "Amputation  either  through  the  joint,  or  above  in  the  continuity  of  the  limb,  is  a  much  more  successful 
operation  than  excision,  which  fact  of  itself  should  determine  our  course  where  the  articulating  extremities  of  the  bones  are  comminuted."     SEUILI.OT 
(Du  traitement  des  fractures  des  membres  par  armes  de  guerre,  in  Arch.  Gen.  de  M<:d.,  1871,  T.  XVII,  p.  457):  "Nous  la  croyons  contre  indiqu6e  par 
1'etendue  des  surfaces  osseuses  la  presence  dcs  nombreux  tendons  periarticulaires,  le  volume  et  la  position  superflcielle  des  os,  la  difficulte  de  la  contention 
de  la  jambe  et  du  pied,  et  le  danger  des  complications.     Nous  maintenons  cependant  nos  appreciations  sur  les  avantages  de  la  resection  des  malleoles." 

3GROSSHEIM,  Ueber  die  Scliussverletzungen  des  Fussgelenks  wdhrend  des  letzten  Krieges  und  die  Resultate  Hirer  Behandlung  unter  Benutzunrj 
ofTicifUer  Quellen,  in  Deutsche  Militairiirztliche  Zfitschrift,  1876,  Jahrgang  V,  p.  2i7,  et  seq. 

4  The  first  authentic  example  of  this  operation  is  recorded  by  BHASDOU  (Essai  sur  les  Amputations  dans  les  Articles,  in  Mm.  de  I'  A  cad.  Rny.  rlf 
Cfiir.,  Paris,  1774,  T.  V,  p.  771):  The  foot  of  a  child,  10  years  of  age,  became  mortified  from  some  external  cause.  M.  SEIIILIEH.  surgeon  at  Laval, 
amputated  through  the  ankle  joint.  The  patient  apparently  suffered  little  from  the  operation;  there  was  little  inflammation  or  suppuration;  a  sound 
stump  ensued,  which  never  reopened  during  the  twelve  years  which  the  patient  survived  the  operation. 

6  Circular  No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  November  1,  1865.  Reports  on  the  Extent  and  Nature  of  the  Materials 
available  for  the  preparation  of  i  Medical  and  Surgical  History  of  the  Rebellion. 

6  SMITH  (S.),  Amputations  at  tht  Ankle  Joint  in  Military  Surgery,  in  V.  S.  Sanitary  Com.  Memoirs,  Surgical  Volume  II,  New  York,  1871,  p.  10'J. 

7  In  Circular  No.  6,  War  Dep't,  Surg.  General's  Office,  November  1,  1865,  p.  45,  the  number  of  exarticulations  at  the  ankle  joint  was  stated  as  67  ; 
58  recovered  and  9  were  fatal,  a  fatality  of  13.4  per  cent.     This  mortality  rate  was  ascertained  from  partial  returns,  and  it  was  stated  at  the  timo  that 
the  records  were  far  from  complete.     The  full  returns  have  augmented  the  mortality  rate  to  25.1  per  cent.,  as  shown  in  TABLE  LXXX1X,  p.  595,  ante. 


SECT.  VI.J 


AMPUTATIONS    AT    THE    ANKLE    JOINT. 


613 


FIG.  354 
amputation    at    the 
ankle.      [After  Es- 

MAItCH.J 


FIG.  355.  —  PIROGOFF  B   amputation  at  the  ankle. 

E8MABCH-l 


The  operations  most  generally  preferred  were  those  of  Syme  and  Pirogoff,  but  in  a 
few  instances  the  malleoli  and  the  articular  surface  of  the  tibia  were  retained,  and  in  others 
the  malleoli  were  removed  while  the  articular  surface  of  the  tibia  was  left  intact  and  the 
bone  covered  with  a  dorsal  flap.  In  Syme's  operation  (FiG.  354)  the  malleoli  and  from 
one-half  to  one  and  a  half  inches  of  the  surface  of  the  tibia  were  removed;  in  PirogofT's 

operation  (Fio.  355)  the  os  calcis  was  sawn  through  and  its  cut  surface  placed 

in  apposition  to  the  sawn  ends  of  the  tibia  and  fibula.     In  both  operations 

the  heel  flap  was  used.     The  advantages  claimed  for  the  Pirogoff  operation 

would  seem  to  be  a  gain  in  the  length  of  the  stump  and  the  preservation  of 

the  heel   cushion  in  its  natural   condition    attached   to   the  os  calcis,  thus 

insuring  a  stump  capable  of  readily  sustain 

ing  the  weight  of  the  body.     The  latter  ad 

vantage  cannot  be  denied,  provided  a  firm 

union  of  the  cut  surfaces  of  the  os  calcis  and 

the  tibia  and   fibula  can   be  obtained;  the 

additional  length  of  the  limb  may  be  con- 

sidered  a  substantial  gain  in  unaided  loco- 

motion,  but  in  the  application  of  an  artificial 

limb  the  Syme  stump  offers  the  best  facili- 

J 

ties,  the  base  of  support  being  on  the  same  [After 
plane  us  the  natural  ankle  joint,  while,  in  the  PirogofF  stump,  the  base  is  necessarily  on  a 
much  lower  plane  than  that  of  the  sound  limb,  allowing  no  space  for  the  play  of  an  arti 
ficial  joint.  The  few  surgeons  who  recorded  their  views  on  the  relative  value  of  the  Syme 
and  Pirogoff  operations  have  expressed  themselves  in  favor  of  Syme's  operation.  Surgeon 
J.  Wilson  Wishart,  in  a  letter  to  the  Surgeon  General  dated  May  1,  1866,  states:  "If  called 
upon  to  choose  in  a  given  case,  I  should  prefer  Syme's  to  Pirogoff's."  In*  a  letter  to  this 
Office,  in  1869,  Surgeon  0.  S.  Wood,  who  had  performed  Pirogoff's  operation  on  several 
occasions,  states  that  he  had  so  much  trouble  in  preventing  displacement  of  the  parts  to  be 
united  that  afterwards  he  always  gave  Syme's  operation  the  preference. 

To  what  extent  union  of  the  cut  surfaces  of  the  os  calcis  and  of  the  tibia  and  fibula 
has  taken  place  in  the  cases  of  recovery  after  Pirogoff's  operation,  and  whether  the  union 
was  osseous  or  only  ligamentous,  could  not  be  positively  ascertained.  Of  three  cases  in 
which  the  limb  was  subsequently  amputated  in  the  leg,  the  bony  portions  removed  at  the 
second  operations  are  preserved  in  the  Army  Medical  Museum.  In  two  of  these  cases 
(Captain  Denniston,  CASE  875,  p.  598,  ante,  and  Private  Loughlin,  CASE  884,  p.  604,  ante) 
there  were  no  indications  whatever  of  union  after  two  and  three  weeks;  in  the  third  case 
(Private  Larkin,  48th  New  York,  CASE  795,  p.  545,  ante)  the  patient  was  discharged  cured 
on  December  4,  1863,  four  months  and  nine  days  after  the  operation;  but  when  seen  some 
weeks  after  his  discharge  by  Dr.  E.  D.  Hudson,  to  whom  he  had  applied  for  an  artificial 
limb,  the  tibia  was  already  extensively  necrosed  and  the  leg  was  enlarged  one-third  beyond 
the  normal  size.  The  patient  led  a  life  of  suffering  for  fifteen  and  a  half  years,  until 
re-amputation  was  performed  in  May,  1879.  In  this  case  union  of  bone  had  taken  place, 
as  shown  in  the  specimen  (No.  6913  Surg.  Sect.,  A.  M.  M.)  represented  in  the  wood-cut, 
FIG.  32,  on  page  545.  As  far  as  is  indicated  by  the  recorded  cases,  cure  followed  more 
speedily  after  Pirogoff's  than  after  Syme's  operation;  in  twenty-five  cases  of  the  former  the 
average  time  was  2.8,  in  forty-seven  of  the  latter  3.7  months. 


614 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP    X. 


Judging  from  the  cases  before  us,  the  risk  of  life,  in  military  surgery  at  least,  is  some 
what  greater  in  Pirogoff's  than  in  S vine's  operation.  Of  the  eighty-three  operations  after 
Syme  in  the  American  civil  war,  the  result  was  not  determined  in  one  case,  sixty-one  were 
followed  by  recovery,  twenty-one  by  death,  a  mortality  of  25.6  per  cent.;  while  of  forty- 
nine  operations  after  Pirogoff,  thirty-five  were  successful  and  fourteen  fatal,  a  fatality  of 
28.5  per  cent.  A  similar  result  has  been  obtained  from  the  cases  collected  in  European 
and  other  campaigns,  grouped  in  the  following  table: 

TABLE  XOIV. 
Results  of  Amputations  at  the  Ankle  Joint  on  the  Occasions  named  and  from  the  Authorities  quoted. 


ACTION,  ETC. 

CA6ES. 

OPERATION. 

SYME'S. 

PlKOGOFF'8. 

VARIOUS 
OPERATIONS. 

"3 
o 

(H 

7 
120 
o 

01  Recovery. 

C,i  £t 

3 
"3 

\n 

Undetermin'd. 

FH 

i  . 

•M    >> 

°5 
.2  5 
"3 

* 

§ 

K 

2 

o 

S 
"5 
h 

2 

Undetermin'd. 

Ratio  of  mor 
tality. 

Recover}-. 

3 
'S 

&H 

Undetermin'd. 

Ratio  of  mor 
tality. 

Recovery. 

"3 
a 
t. 

Undetermin'd. 

3 
21 

0 

2 
53 

1 
20 
1 

44 

Crimean  War,  1854-.~>7  (MATTHEW,*  CHENU,4  HUBBKXET5)  
Bombardment  of  Sveabor"  1855  (HEYFELDER6) 

44 

1 

1 

British  in  India   1857  58  (Wll  1  1  \MSON7) 

1 
o 

1 
2 

1 

Accidents    1858  59  (GRAY  8  CORVAZ') 

o 

Italian  War   1859  CO  (CHENU10) 

9 
4 

4 
2 

5 
1 

4 

5 

Danish  War  1864  (HEI\EU) 

1 
5 

1 

1 

1 

1 
3 

\ustro-  Prussian  War  186C  (FISCHER1*) 

o 

United  States  Army   1865  70  (OTIS") 

2 
105 

14 

o 

17 

11 

1 

1 

Franco-German  War  1870  71    French  (CHEN'U14) 

88 

3 

3 

14 

88 

Franco-German  War,  1870-71,  Germans  (BKCK,  FISHER,  GRAF, 

KlllDMER    RUPPRECHT    SCHLXZlVGEli    STOI  L1SJ 

«; 

6 

3 

Aggregates  .  ,  

271 

98 

123 

50 

55.6 

11 

3 

2 

21.4 

13 

5 

4 

27.7 

74 

115 

44 

Of  fourteen  operations  after  Syme  with  determined  results,  three,  or  21.4  per  cent., 
were  fatal,  and  of  eighteen  after  Pirogoff,  five,  or  27.7  per  cent.,  had  fatal  terminations. 

1  STUOMEYER  (L.)  (Maximen  der  Kriegstheilkunst,  Hannover,  1855,  p.  756)  tabulates  4  amputations  at  the  ankle  joint  by  SYME'S  method  during 
the  Schleswig-Holstein  War,  1848-50;  2  were  successful  and  2  fatal.  'DJORUP  (Bem&rkninger  over  tie  i  Krigen  1848-50  foretagne  Amputationer  i  For- 
bindelse  med  en  Statistik  over  dem,  in  Hospital 's-Mcddtlclser.  Kjobenhavn.  1852.  B.  V,  p.  107)  reports  3  exarticulations  at  the  ankle  joint  in  the  Danish  army 
during  the  war  of  1848-50 ;  2  were  successful,  1  fatal ;  no  details  are  given.  3  MATTHEW  (T.  P.)  (Med.  and  Surg.  Hist,  of  the  British  Army  in  the  years 
1854-55-56,  London,  1858,  Vol.  II,  pp.  372,  373)  tabulates  13  cases  of  exarticulation  at  the  ankle  joint;  11  of  the  patients  survived  and  2  died.  Details  of 
two  of  the  cases  are  given  by  GUTHRIE  and  STANLEY.  GUTHKIE  (G.  J.)  (Commentaries  on  the  Surgery  of  the  Peninsular  War,  London,  sixth  ed., 
1855,  p.  99):  British  soldier  in  the  Crimea  ;  round  ball  lodged  against  the  astragalus  but  was  not  removed  ;  inflammation  extended  into  the  ankle  joint : 
flap  amputation  at  the  ankle  joint  and  subsequent  amputation  in  thigh ;  recovery.  STANLEY  (Result  of  Syme's  Operation  of  Amputation  at  the  Anlch 
Joint,  in  Tlie  Lancet,  London,  1857,  Vol.  II,  p.  472):  A  sailor  had  his  foot  shattered  by  an  explosion  of  a  shell  before  Sebastopol,  in  April,  1857;  SYME'S 
amputation  at  the  ankle  joint  by  a  Russian  surgeon;  October  31,  amputation  in  lower  third  of  leg  for  painful  stump;  probably  recovered.  4CHEXU  (J.-C.) 
(Rapport,  etc.,  de  Campagne  d' Orient  en  1854-55-56.  Paris,  1865,  p.  473)  records  50  cases  of  exarticulation  at  the  ankle  joint;  35  terminated  successfully 
and  15  fatally;  and  on  pp.  474,  475,  gives  brief  details  of  the  successful  operations.  Two  fatal  cases  are  cited  by  AROXSSHOX  and  SALLKUOX.  Auoxs- 
6HO\  (Obs.  d'un  cos  d'amputation  tibio-tarsienne  procede  PIROGOFF,  in  Eec.  de  Mem.  de  MM.  de  Chir.  et  de  Phar.  Mil.,  Paris.  185C,  2me  ser.,  T.  XVII,  p. 
36(1):  J.  Sch — ;  shot  wound  of  right  metatarsus  June  13,  1855,  at  Sebastopol;  PIROGOFF'S  operation  by  AuoxssilON  June  18;  gangrene;  death  July  2. 
SALLERON  ( Compte.-Rendu  des  Amputations  Primitives  et  des  Amputations  consecutive*,  in  Bee.  de  Mem.  de  Med.  de  Chir.  et  de  Phar.  Mil.,  Paris,  1858,  2m» 
s6r.,  T.  XXII.  p.  317):  Cornand,  20th  line  regiment,  received  July  10,  1855,  a  shot  fracture  of  the  three  first  metatarsal  bones  of  left  foot;  amputation  at 
the  ankle  joint  July  30. 1855;  gangrene;  death.  SHUBBEXET(C.  v.)  (Die  Sanitdts-Verh'dltnisse  derRussischen  Verwundeten,  etc..  in  den  Jahren  1854-56,' 
Berlin,  1871,  p.  182)  tabulates  57  amputations  at  the  ankle  joint ;  the  results  were  ascertained  in  only  13  cases;  9  were  successful,  4  fatal.  One  of  the  suc 
cessful  cases  is  detailed  by  LEGOUEST  (Amp.  de  Ja  partie  infcrieure  de  lajambe  dans  la  region  intra-malleolaire.  in  Gaz.  des  Flop.,  1855,  No.  150,  p.  597): 
Russian  prisoner  G.  Gardey,  6th  Infantry;  shot  fracture  of  right  tarsal  bones  at  the  Alma,  September  20,  1854  ;  SYME'S  operation  October  3, 1854;  nearly 
healed  in  one  month :  marched  well  in  3  months.  c  HEYFELDER  (J.  F.)  (Die  Vtrwundungen  und  Operationen  in  Folge.  des  TSomlardements  von  Sveaborg 
font  9-11  Aug.,  in  Deutsche  Klinik,  1855,  15.  VII,  p.  531):  Officer's  servant  of  the  ship  "Russland;"  shot  wounds  of  right  shoulder  and  left  foot  and  con 
tusion  of  chest ;  exarticulation  of  right  arm  and  left  foot,  the  latter  by  BAUDEX'S  method ;  died  one  hour  after  the  operation.  IDEM  (loc.  tit.,  p.  554): 
W.  Xolomagin,  sailor,  aged  22;  shell  wound  of  right  foot  August  9,  1855;  August  25,  amputation  at  ankle  joint  by  a  modification  of  SYME'S  operation ; 
pyajmia.  and  death  September  1,  1855.  'WILLIAMSON  (G.)  (Military  Surgery,  London,  1863,  p.  214)  relates  a  successful  case  of  amputation  at  the  ankle 
joint  during  the  mutiny  in  India  in  1857,  in  a  man  of  the  75th  regiment;  a  very  good  stump  resulted.  8E.  P— — ,  aged  29,  accidental  shot  wound  of  left 
fbot  May  16, 1858 ;  integuments  and  muscles  of  the  sole  of  the  foot  ploughed  up  except  at  the  heel ;  the  metatarsals  fractured ;  PlROr.OFF's  amputation  at 
the  ankle  performed  by  Dr.  MASH  on  the  same  day:  recovery,  with  a  useful  stump  (J.  F.  GRAY,  in  the  Medical  Times  and  Gazette,  London,  1860,  Vol. 


SECT,  vi.]  AMPUTATIONS    AT    THE    ANKLE   JOINT.  615 

Considering  the  number  of  re-amputations  after  Syme's  and  Pirogoff's  operations, 
Pirogoff's  method  would  seem  to  be  the  more  successful.  Of  eighty-three  cases  of  Syme's 
amputation,  twenty,  or  24.0  per  cent.,  submitted  to  re-amputation;  of  forty-nine  PirogofFs 
operations,  eight,  or  16.3  per  cent.,  were  subjected  to  re-amputation.  Sloughing  of  the  flaps 
seems  to  have  been  the  most  frequent  cause  of  the  re-amputation  after  Syme's  operation, 
this  complication  having  been  given  as  the  cause  in  twelve  of  the  twenty  re-amputations; 
tender  stump  is  given  in  one  case,  and  necrosis  in  another;  in  six  the  cause  was  not  stated. 
In  the  eight  re-amputations  after  Pirogoff's  operation  necrosis  and  caries  are  stated  as  the 
cause  in  two,  sloughing  in  four,  gangrene  in  one,  and  secondary  haemorrhage  in  one  instance. 
Deducting  the  cases  in  which  re-amputations  were  performed  there  remain  forty-six  recov 
eries  after  Syme's  and  thirty  after  Pirogoff's  operation.  In  sixteen  of  the  forty-six  opera- 

11,  p.  9).    9CORNAZ  (Amputation  tibio-tarsienne  d'apres  le  precede  de  PlKOGOFF,  in  Echo  Midical,  Sept.  10,  1861,  p.  428):  J.  F.  D ;  accidental  shot 

wound  of  left  foot,  involving  tarsus  and  metatarsus ;  PlROFOFF's  amputation  performed  the  same  day  by  Dr.  CORXAZ ;  recovery  in  about  2  months,  with 
union  of  sawn  surfaces  and  good  use  of  stump.     '"CHENU  (J.-C.)  (Statistique  Mid.  Chir.  de.  la  Campagne  d'ltaiie  en  1859  et  1860,  Vol.  II,  p.  823)  tabu 
lates  9  disarticulations  at  the  ankle  joint,  4  successful,  5  fatal,  and  gives  some  details  of  the  4  successful  operations:  L.  J.  Boyer,  sergeant,  55th  line;  shot 
fracture  of  right  metatarsus,  Solferino,  June  24,  1859;  amputation  at  ankle  joint  by  Dr.  ARLAUD,  after  September  28;  the  malleoli  were  removed  Octo 
ber  8;  December  10,  recovery.     J.  Gros,  86th  Infantry;  shot  fracture  of  left  tarsus,  Solferino,  June  24,  1859;  amputation  at  the  ankle  joint  by  Dr.  J. 
ROUX,  Aug.  18,  1859;  recovery.     X.  Hecht,  9th  Artillery  ;  shot  fracture  of  right  foot,  at  Solferino ;  disarticulation  at  ankle  joint ;  recovery.     L.  J.  Paviot, 
86th  Infantry;  shot  fracture  of  right  calcaneurn,  Solferino,  June  24,  1859;  amputation  at  the  joint;  recovery.     "HEINE  (C.)  (Die  Schussverletzungen  der 
Unteren  Extremitdten,  Berlin,  1866,  p.  338)  and  OCHWADT  (A.)  (Kriegschirurgische  Erfahrungen,  Berlin,  1865,  Appended  Table  of  Operations,  p.  XIII. 

Case  54):  Private  Chr.  L ,  3d  Danish  Infantry ;  shot  fracture  of  right  astragalus  and  os  calcis,  April  18,  1864  ;  PIROGOFF'S  operation  was  attempted 

on  May  4,  but  the  os  calcis  being  found  fissured  the  operation  was  finished  according  to  SYME'S  method  by  Dr.  FISCHER;  J  inch  of  the  epiphysis  of  the 
tibia  was  removed;  several  necrosed  fragments  of  the  tibia  came  away;  recovery,  with  a  poor  stump.    In  a  case  at  a  hospital  at  Ulderup,  Staffsurgeon 
AHKL  performed  PlltOGOFF's  operation  (HEINE,  loc.  cit.,  p.  339,  and  LUCKE  (A.)  (Kriegschir.  Aphorismen  in  LAXGEXBECK'S  Archiv  fur  Klin.  Chir., 
Berlin,  1866,  B.  VII,  p.  19):  P.  Schlott,  3d  Danish  Infantry,  wounded  at  Dflppell,  April  18, 1864  ;  shot  fracture  of  tarsal  and  metatarsal  bones ;  PlROGOFK's 
amputation  at  ankle  joint  by  Dr.  ABKL;  pyaemia  and  gangrene;  death  May  10,  1864.     NEUDORFER  (J.)  (Aus  denifelddrztlichen  Berichte  fiber  die  Ver- 
wundeten  in  Schleswig,  in  LAXGEXBECK'S  Archiv  fur  Klin.  Chir.,  1865,  B.  VI,  p.  544):  J.  Brandner,  9th  Chasseurs,  at  Oeversee,  Feb.  6,  1864,  received 
a  shot  fracture  of  the  right  astralagus  and  internal  malleolus;  February  24,  PIROGOFF'S  amputation  at  the  ankle  performed  by  Dr.  NEUDORFER;  April 

12,  union  of  os  calcis  and  tibia;  May  20,  stump  healed ;  patient  able  to  walk  on  the  stump  without  pain.     NEUDORFER  (loc.  cit.,  p.  558)  tabulates  a  second 
case  of  amputation  after  PIUOGOFF,  but  gives  no  details  or  result.     12FISCHER  (K.)  (Militairdrztliche  Skizzen  aus  Suddeutschland  und  Bohmen,  Aarau, 
1867,  p.  99)  refers  to  2  operations  after  SYME  and  3  after  PIROGOFF,  performed  during  the  Austro-Prussian  War,  1866;  the  results  are  doubtful.     I3OTIS 
(G.  A.)  ( Circular  No.  3,  War  Dep't,  S.  G.  O.,  Washington,  1871 :  A  Report  of  Surgical  Cases  treated  in  the  Army  of  the  United  States  from  1865  to  187J ; 
pp.  193,  194):  H.  G.  Nims,  additional  paymaster,  admitted  into  post  hospital,  Fort  Vancouver,  Washington  Territory,  Dec.  25,  1866,  with  shot  fracture  and 
comminution  of  external  and  middle  cuneiform  bones  of  right  foot;  Dec.  28,  PIROGOFF'S  amputation  at  ankle  joint  by  Assistant  Surgeon  J.  E.  SEMl'LE, 
U.  S.  A.;  recovered.     Private  P.  Vandel.  A.  3d  Infantry,  accidentally  wounded  Nov.  5, 1867 ;  conoidal  ball  shattered  left  os  calcis  and  injured  astragalus ; 
SYME'S  amputation  at  ankle  joint  by  Assistant  Surgeon  A.  D.  WlLSOX,  U.  S.  A.;  recovered.     14CHEXU  J.-C.)  (Apercu  hist.  stat.  et  din.,  etc.,pendant  la 
guerre  de  1870-71,  T.  I,  p.  493)  tabulates  105  instances  of  amputation  at  the  ankle  joint;  17  recovered  and  88  proved  fatal;  and  gives  details  of  a  few 
cases  of  recovery:  T.  II,  p.  31,  P.  P.  F.  Chambon,  aged  20,  14th  Provisionary  regiment;  shot  fracture  of  left  foot.  May  26,  Paris;  amputation  at  ankle 
joint;  pensioner;  p.  55,  L.  L.  Faivre,  7th  Artillery,  aged  36;  shell  fracture  of  left  foot,  Montb§liard,  January  15,  1871;  amputation  at  ankle  joint ;  pen 
sioner;  p.  74,  Havart  (C.  J.  M.),  12th  Infantry,  aged  27;  comminuted  shot  fracture  of  left  foot,  received  at  Saint-Privat ;  amputation  at  ankle  joint;  pen 
sioner;  p.  75,  Hermier  (C.  A.),  3d  Zouaves,  aged  33;  shell  fracture  of  left  foot;  amputation  at  ankle  joint;  pensioner;  p.  99,  Mangin  (P.  G.  A.),  Captain, 
24th  Infantry,  aged  31 ;  shell  wound  of  left  tarsal  bones,  received  at  Bapaume;  amputation  at  ankle  joint;  pensioner;  p.  100,  A.  Marchand-Liffoz,  64th 
Infantry,  aged  28;  shot  wound  of  left  foot,  Sedan  ;  exarticulation  at  ankle  joint;  pensioner.    Other  cases  are  given  in  detail  by  SEDILLOT  (Dn  traitement 
des  fractures  des  membres  par  armes  de  guerre,  in  Arch.  Gen.  de  M6d.,  1871,  VI*  ser.,  T.  XVII,  p.  458):  Louis  Charlier,  48th  Infantr3r.  aged  21 ;  shell 
wound  of  foot.  Woerth,  August  6;  PIROGOFF'S  amputation  on  the  day  after  the  injury  by  M.  SARAZIX;  partial  gangrene  of  stump;  recovery;  walks 
well ;  no  consolidation  (CHEXU,  Apercu  hist.  stat.  et  din.,  etc.,  Paris.  1874,  T.  II,  p.  32);  Jean  Barjet.  9th  Cuirassiers,  aged  26 ;  shot  fracture  of  right  tarsus 
and  metatarsus,  Reichshofen,  August  6,  1870;  PIROGOFF'S  operation,  August  19,  1870,  by  M.  JOESSEL;  abscess;  doing  well  at  the  end  of  September;  os 
calcis  movable  (CHEXU,  Joe.  cit.,  p.  8);  Fran9ois  Berga,  sergeant,  50tb  Infantry,  aged  33  ;  fracture  of  left  tarsal  bones,  Woerth,  Aug.  6, 1870;  PIROGOFF'S 
amputation  performed  August  7,  by  M.  JOESSEL;  abscess;  wound  healed  September  27;  os  calcis  movable  (CHEXU,  loc.  cit.,  p.  13).     ISBECK  (B.)  (Chir. 

der  Schussverletz.,  1872,  p.  838,  et  seq.)  details  five  cases  of  amputation  at  the  ankle  joint ;  one  by  SYME'S  and  four  by  PIROGOFF'S  method:  F ,  14th 

Prussian  L.  W.  regiment;  shell  wound  of  right  tarsal  bones;  SYME'S  amputation  at  the  ankle  joint;  recovery.     D ,  14th  L.  W.  regiment;  severe  shot 

injury  of  foot,  at  Strassbtirg;  PIROGOFF'S  amputation;  good  recovery.     P ,  14th  L.  W.  regiment;  shell  comminution  of  tarsal  bones;  PIROGOFF'S 

operation;  gangrene;  septicaemia;  death.     S ,  Baden  Artillery  regiment  No.  14;  shot  wound  of  tarsal  bones,  January  1C,  1871;  PIROGOFF'S  opera 
tion;  patient  discharged  in  September,  1871 ;  result  of  operation  very  favorable.     G ,  7th  L.  W.  regiment ;  wounded  February  9,  1871  ;  PIROGOFF'B 

amputation  at  ankle;  pyasmia;  death  8  days  after  the  operation.    FISCHER  (G.)  (Dorf  Floing  und  Schloss  Versailles,  in  Deutsche  Zeitschrift  fiir  Chir- 
urgie.  Leipzig,  1872.  B.  I,  p.  262),  in  a  case  of  PlKOGOFF's  amputation  performed  19  days  after  ilie  injury,  received  September  1, 1870,  the  remaining  por 
tion  of  the  os  calcis  became  necrosed  and  was  removed  two  months  after  the  operation ;  the  patient  then  recovered  in  3J  months.    In  a  case  of  SYMF.'S 
operation  extensive  granulations  and  pus  formations  retarded  the  recovery  2J  months.     GRAF  (B.)  (Die  Konigl  Reservelazarethe  zu  Dussddorf,  Elberfeld, 
J872,  p.  50):  II.  Riemann,  46th  Prussian  Infantry;  comminution  of  ankle  joint,  especially  astragalus,  August  6,  1870;  PIROGOFF'S  amputation  Aug.  17; 
death  September  11,  1870,  from  pyaemia.     KIRCIIXER  (C.)  (Aerztlichcr  Bericht  iiber  das  Koniglich  Preussische  Feld-Lazareth  im  Palast  zu  Versailles, 
Erlangen,  1872,  p.  89)  tabulates  a  successful  amputation  after  PIROGOFF  for  shell  wound  of  the  tarsal  bones,  and  a  successful  SYME'S  operation  for  shot 
fracture  of  the  ankle  joint.     RUPPRECHT  (L.)  (Militairdrztliche  Erfalirungen  wdhrend  des  deutscJt-franzosischen  Krieges  im  Jahre  1870-71,  Wiirzburg, 
1871,  p.  86)  observed  a  successful  operation  by  NEUDORFER  after  SYME'S  method,  at  the  Bavarian  field  hospital  No.  VIII.    SCHIXZIXGER  (A.)  (Das 
Reserve- Lazareth  Schwetzingen  im  Kriege  1870  und  1871,  Freiburg,  i.  Br.,  1873,  p.  91):  Diemenct;  shot  fracture  of  left  foot,  August  18,  1871 ;  comminu 
tion  of  metatarsals;  September  2,  PIROGOFF'S  amputation  by  Dr.  SCHIXZIXGER;  good  recovery.     A.  Gluck,  64th  Infantry;  shot  fracture  of  right  ankle 
joint  August  18,  1870 ;  September  14,  PIROGOFF'S  operation  ;  union  of  the  tibia  and  os  calcis,  the  latter  projecting  downward  like  a  shovel ;  patient  cannot 
walk;  February  22,  1871,  the  remaining  portion  of  the  os  calcis  removed,  and  ends  of  tibia  and  fibula  resected;  recovery,  with  useful  stump.     STOLL. 
(Bericht  aus  dem  Koniglich  Wiirttembergischen  4  Feldspital  von  1870-71,  in  Deutsche  Militairdrztliche  Zeitschrift,  1874,  Jahrgang  III,  p.  215):  Fahnert, 
107th  Infantry,  shell  wound  of  foot,  October  30.  1870  ;  PIROGOFF'S  amputation  on  the  day  of  injury ;  necrosis  of  part  of  the  remaining  portion  of  the  os 
caleis;  necrosed  portions  removed;  in  the  summer  of  1871  the  patient  had  good  use  of  his  leg. 


616  INJURIES    OF   THE    LOWER    EXTREMITIES.  [CHAP.  x. 

tions  after  Syme's  method  the  stumps  are  reported  as  sound  and  useful,  in  ten  as  simply 
"healed;"  in  one  case  the  flaps  retracted,  in  two  necrosis  is  diagnosed,  and  in  three  the 
wounds  never  healed,  abscesses  continuing  for  years;  in  fourteen  the  remote  conditions  are 
not  reported.  Of  the  thirty  Pirogoff  operations  nine  are  stated  to  have  given  good  and 
serviceable  limbs,  four  are  reported  as  "healed,"  in  two  the  remaining  portion  of  the  os 
calcis  is  drawn  upward,  in  one  caries  is  reported,  in  two  the  retained  portions  of  the  os  calcis 
are  considered  hindrances,  in  three  abscesses  continued  to  form.  The  conditions  of  nine  of 
the  patients  could  not  be  traced  beyond  the  time  of  their  discharge  from  the  service.1 

To  relieve  the  tension  caused  by  the  weight  of  the  flap  and  the  consequent  tendency 
to  sloughing  so  frequently  noted,  Acting  Assistant  Surgeon  J.  E.  Janvrin  applied  a  flat 
padded  splint  to  the  anterior  surface  of  the  leg,  which  extended  beyond  the  end  of  the 
stump.  Adhesive  straps  were  then  passed  from  beneath  the  leg  across  the  flap  and  carried 
over  the  end  of  the  splint  and  fastened.  These  were  gradually  shortened  as  the  healing 
process  went  on. 

There  seems  to  have  been  no  foundation  for  the  statement  made  in  the  preliminary 
report,2  on  the  authority  of  Baron  von  Haurowitz,3  Surgeon-in-Chief  of  the  Russian  Navy 
(during  a  visit  to  this  Office  in  1865),  that  Pirogoff  had  himself  abandoned  his  operation, 
finding  the  segment  of  the  os  calcis  likely  to  become  necrosed.  In  a  letter  dated  Berlin, 
March  28,  1866,  Professor  Pirogoff4  emphatically  denies  that  he  has  ever  given  up  this 
operation,  and  states  that  he  had  not  a  single  case  of  necrosis  of  the  segment  of  the  os 
calcis,  although  he  had  performed  the  operation  more  than  sixty  times. 

'SCHEDE  (Ueber  partielle  Fussamputationen,  in  VOLKMANN's  Sammlung  Klinischer  Vortrdge,  Leipzig,  1874,  Nos.  72,  73,  pp.  515,  516)  remarks: 
"  The  difference  of  the  length  of  the  stumps,  further,  is  a  very  considerable  one,  and  upon  this,  other  authors  to  the  contrary  notwithstanding,  I  would 
not  place  too  little  weight.  PIROGOFF  himself  estimates  the  length  gained  by  his  method  at  least  1J  inches.  According  to  O.  WEBER,  the  shortening 
of  the  leg  after  PlROGOFF'8  operation  amounts  to  2.8  ctm.  in  the  average,  while  in  SYME'S  method  the  limb  loses  from  6  to  8  or  9  ctm.  Yet  the  former 
figure  can  certainly  be  still  considerably  reduced  by  sawing  off  the  bone  obliquely,  whereby  much  more  may  be  preserved,  and  rotation  is  rendered  easier. 
Among  our  patients  operated  upon  there  are  several  on  whom  no  measurable  shortening  could  be  shown:  as  a  rule  it  amounted  to  about  1  ctm.,  some 
times  to  2,  and  only  once  did  it  rise  to  3  ctm.  So  little  shortening,  of  course,  is  very  easily  counterbalanced  by  a  slight  dropping  of  the  pelvis.  With  a 
PIROGOFF  stump  the  patient  can  therefore  not  only  walk  very  well  without  an  artificial  apparatus  and  simply  with  a  somewhat  cushioned  lace-boot — as 
our  patients  learned  to  do  without  exception  very  readily ;  but  in  favorable  cases  not  even  an  elevated  shoe  was  required.  But  when  an  American  surgeon 
and  inventor  of  an  artificial  leg.  Dr.  IIUDSOX,  rejects  PIKOGOFF'S  operation  for  the  reason  that  his  method  results  in  too  long  a  stump  to  admit  of  apply 
ing  a  complicated  prothetic  apparatus  with  an  artificial  ankle  joint,  and  therefore  prefers  SYME'S  cut,  one  will  be  inclined,  on  the  same  principle,  to  the 
views  of  another  American,  Dr.  BLY,  for  whom  in  turn  the  SYME  stump  is  too  long  because  it  is  not  adaptable  to  his  artificial  apparatus,  nnd  who,  there 
fore,  advises  amputations  of  the  leg  throughout.  We  would,  therefore,  return  again  lo  amputation  at  the  point  of  election  as  the  only  alternative,  only 
with  this  difference,  that  in  this  case  a  greater  portion  of  his  limb  be  sacrificed  and  his  life  be  put  in  greater  jeopardy,  not  in  his  own  interest,  but  in  that 
of  the  instrument  maker."  That  the  patient's  life  is  not  put  in  greater  jeopardy  by  the  PIROGOFF  than  by  the  SYME'S  operation  has  been  shown  in  the 
statistics  of  the  American  as  well  as  the  European  campaigns  above  cited.  Great  stress  is  laid  by  SCHEUF.  upon  the  increased  length  of  stump,  enabling 
the  patient  to  walk  very  well  with  a  "  somewhat  cushioned  lace-boot "  without  the  addition  of  a  complicated  artificial  ankle  joint,  as  required  after  SYME'B 
amputation.  But  in  the  former  case  the  surface  of  the  stump,  acting  as  a  pivot  on  the  cushioned  shoe,  is  exposed  to  the  danger  of  continued  attrition 
similar  to  the  irritating  friction  caused  by  the  heel  cap  of  an  ill-fitting  boot  or  shoe.  In  the  artificial  apparatus  the  friction  is  in  the  joint,  and  not  on  the 
tender  surface  of  the  stump,  which  is  securely  encased  in  the  parts  fitting  to  the  leg.  Moreover,  the  artificial  joint  will  allow  an  easier  and  more  graceful 
movement,  which,  in  point  of  appearance,  is  quite  a  desideratum  with  the  young  soldier,  and  which  causes  no  extra  expenditure,  as  the  United  States 
government  furnishes  him,  at  reasonable  periods  (every  fifth  year),  with  an  excellent  apparatus.  The  writer  has  seen  instances  in  which  it  was  almost 
impossible  to  detect  the  use  of  an  artificial  foot  with  an  articulated  joint,  even  after  attention  had  been  called  to  that  fact. 

''Circular  No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  November  1,  1865.  Reports  on  the  Extent  and  feature  of  the  Materials 
available  for  the  preparation  of  a  Medical  and  Surgical  History  of  the  Rebellion,  page  46. 

3  Not  Harronwitz,  as  erroneously  printed  in  Circular  No.  6. 

4  "  Berlin,  28  March,  1866.     Sir :  Having  read  in  the  Circular  No.  6,  Surgeon  General's  Office,  dated  November  1, 1865,  page  40,  that  the  Baron  von 
Haurowitz,  Surgeon-in-Chief  of  the  Russian  Marine,  in  his  recent  visit  to  your  office  has  mentioned  that  I  had  myself  abandoned  my  osteoplastic  operation 
of  the  foot,  finding  the  segment  of  the  os  calcis  likely  to  become  necrosed,  I  have  the  honor  to  state  that  I  have  never  given  up  this  operation.    I  had 
not  one  single  case  of  necrosed  segment  of  the  os  calcis,  though  I  have  made  this  operation  more  than  sixty  times,  the  results  of  which  I  published  in  my 
Outlines  of  General  Military  Surgery  (Grundzugt  der  Kriegs  Chirurgie,  Leipzig,  1864).     With  the  urgent  request  that  my  protest  may  be  made  public, 
I  have  the  honor  to  be,  very  respectfully,  your  obedient  servant.     N.  PlROOOFF." 


SECT.  VILJ  WOUNDS   AND    OPERATIONS    IN    THE    FOOT.  617 


SECTION  VII. 


WOUNDS  AND  OPERATIONS  IN  THE  FOOT. 


According  to  the  plan  pursued  in  the  previous  sections  of  this  Chapter,  the  consider 
ation  of  the  wounds  of  the  bones  of  the  foot  in  this  section  will  be  restricted  to  those 
inflicted  by  weapons  of  war.  The  cases  number  five  thousand  eight  hundred  and  sixty ; 
viz:  one  bayonet  and  five  thousand  eight  hundred  and  fifty-nine  shot  wounds. 

BAYONET  WOUNDS  OF  THE  BONES  OF  THE  FOOT.— A  solitary  case  of  bay 
onet  injury  of  the  metatarsal  bones  is  reported  from  the  Fairfax  Seminary  Hospital: 

CASE  889. — Corporal  J.  Hough,  Co.  I,  120th  New  York,  aged  26  years,  received  a  bayonet  wound  of  the  left  foot  on 
October  10,  1864.  He  was  treated  at  the  Depot  Hospital  of  the  Second  Corps,  at  City  Point,  and  subsequently  at  Fairfax  Sem 
inary  Hospital.  Surgeon  D.  P.  Smith,  U.  S.  V.,  in  charge  of  the  latter,  certified,  that  the  metatarsal  bones  were  injured  and 
that  the  patient  was  returned  to  duty  June  20, 1865,  to  be  mustered  out  of  service.  The  man  has  not  applied  for  a  pension. 

SHOT  WOUNDS  OF  THE  BONES  OF  THE  FOOT.— Twenty-seven  shot  contusions 
and  five  thousand  eight  hundred  and  thirty-two  shot  fractures  are  recorded.  Of  the  former 
one,  and  of  the  latter  four  hundred  and  fifty-one  proved  fatal,  a  mortality  rate  of  8.3  per 
cent.  In  four  hundred  and  forty  cases  the  results  were  not  ascertained. 

SHOT  CONTUSIONS  OF  THE  BONES  OF  THE  FOOT.— Of  the  twenty  seven 
cases  of  this  group,  seventeen  are  designated  as  contusions  of  the  tarsals,  four  of  the  meta- 
tarsals,  one  of  the  metatarso-phalangeal  articulation,  and  two  of  the  phalangeal  bones.  In 
three  instances  the  part  injured  was  not  indicated.  Twenty-six  of  the  patients  recovered 
and  one  died  of  tetanus. 

CASE  890. — Lieutenant  W.  Stribler,  Co.  B,  G3d  Colored  Troops,  aged  27  years,  was  wounded  in  the  right  foot  by  the 
accidental  discharge  of  his  pistol,  on  President's  Island,  January  14,  1865.  He  was  admitted  to  the  Officer's  Hospital  at  Mem 
phis  the  following  day,  when  the  ball,  which  had  lodged  against  the  scaphoid  bone,  was  extracted  through  an  incision  one  and 
a  half  inches  in  length  by  Assistant  Surgeon  S.  S.  Jessop,  U.  S.  V.  Partial  anaesthesia  was  produced  by  chloroform.  At  the 
time  of  the  operation  the  foot  had  become  somewhat  swollen  and  was  very  painful,  but  the  patient's  physical  condition  was  good. 
Profuse  suppuration  followed  during  the  first  month,  and  an  abscess  formed  over  the  internal  malleolus  without  involving  the 
ankle  joint.  Cold  and  warm-water  dressings  and  poultices  were  used  and  stimulants  were  administered.  The  patient  recovered 
and  was  mustered  out  of  service  May  5,  18S5.  The  history  was  reported  by  the  operator.  Lieutenant  Stribler  subsequently 
became  a  pensioner.  On  January  26,  1870,  he  was  examined  by  Dr.  W.  Jones,  of  St.  Joseph,  Missouri,  who  reported  as  the 
results  of  the  injury:  "Anchylosis  of  the  ankle  joint,  with  an  atrophied  and  partially  contracted  condition  of  the  muscles  of  the 
foot,  causing  deformity  of  a  character  sufficient  to  render  it  very  difficult  to  secure  proper  appearing  covering  that  can  be  worn 
with  any  degree  of  comfort.  The  loss  of  the  use  of  the  ankle  joint  also  greatly  interferes  with  walking  and  causes  his  move 
ments  to  be  imperfect  and  laborious."  The  pensioner  was  paid  December  4,  1881. 

CASE  891. — Lieutenant  W.  C.  Hall,  Co.  K,  136th  New  York,  aged  28  years,  was  wounded  in  the  right  foot,  at  Resaca, 
May  15,  1864.  From  a  field  hospital  of  the  Twentieth  Corps  he  passed  to  Nashville,  where  he  entered  the  Officer's  Hospital 
one  week  after  the  reception  of  the  injury.  Surgeon  J.  E.  Herbst,  U.  S.  V.,  described  the  wound  and  its  result  as  follows:  "The 
ball  passed  transversely  through  the  tissues  on  the  plantar  aspect,  immediately  beneath  and  grazing  the  under  surface  of  the  os 
calcis.  The  internal  or  external  plantar  nerves,  or  both,  were  injured,  and  no  doubt  the  patient  suffered  exposure  to  draughts 
during  his  transportation  hither.  Tetanus  in  the  form  of  trismus  and  emprosthotonos  ensued  on  May  24th.  The  wound  was 
freely  incised  and  cleansed.  Purgatives  of  croton  oil  were  administered,  seconded  by  the  use  of  calomel  and  opium,  the  latter 
SURG.  111—78 


618 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


in  lar^e  quantities  with  little  effect.  Chloroform  had  the  effect  of  relaxing  the  spasms;  but  notwithstanding  all  our  endeavors 
rigidity  increased  and  spasms  became  more  violent  until  the  patient  was  at  last  overcome  by  their  intensity.  Death  occurred  on 
May  26,  1864." 

SHOT  FRACTURES  OF  THE  BONES  OF  THE  FOOT. — The  cases  included 
in  this  group  number  five  thousand  eight  hundred  and  thirty-two  (5,832),  or  only  about 
one-half  of  the  number  of  shot  fractures  of  the  bones  of  the  hand  recorded  on  page  1019 
of  the  Second  Surgical  Volume.  In  the  following  table  it  has  been  attempted  to  group  the 
shot  injuries  of  the  foot,  as  far  as  possible,  according  to  the  different  bones  implicated. 

TABLE  XCV. 
Summary  of  Five  Thousand  Eight  Hundred  and  Thirty-two  Shot  Fractures  of  the  Bones  of  the  Foot. 


TREATMENT. 

CASES. 

TAKSAL 
BONKS. 

TAHSO- 
MKTATAKSAL 
AUTICULA- 

TION. 

METATAUSAL 
BONES. 

PHALANGES. 

BONES  NOT 
SPECIFIED. 

Total  Cases. 

Recoveries. 

Deaths. 

Undetermined. 

h 

O 

«"£• 

c  ~ 

o3 

<a 

K 

Recoveries. 

Deaths. 

Undetermined. 

Recoveries. 

Deaths. 

Undetermined. 

Recoveries. 

Deaths. 

Undetermined. 

Recoveries. 

Deaths. 

Undetermined. 

Recoveries. 

Deaths. 

Undetermined. 

3,560 
83 

1 
7 

1 
1,216 
2 
1 

3,111 
69 
1 
4 

1 
1,088 

1 

135 
15 

314 

4 

4.1 

17.8 

671 
24 

40 
3 

59 
1 

38 
3 

3 
2 

1 

1,238 
41 

33 
7 

118 
3 

725 

1 
1 

10 
3 

16 

439 

49 

120 

Exc.  of  Bones  of  Foot  and  Part.  Amp.  Foot. 
Exc.  of  Bones  of  Foot  and  Amp.  Leg  
Exc.  of  Bones  of  Foot,  Amp.  Leg,  Amp.  at 

3 

42.8 

1 

2 

3 

1 

1 

23 

1 
1 

105 

2.0 
50.0 

1,088 
1 

23 

1 
1 

105 

Amp.  of  Toes  and  Partial  Amp.  Foot  

100.0 
100.0 

Amp.  of  Toes,  Amp.  Ankle  Joint,  and 

1 

1 

1 

Amputation  of  Toes  and  Amp.  of  Leg.  .  . 
Amp.  of  Toes  and  Amp.  at  Knee  Joint.  .  . 

6 
1 

4 

2 
1 

33.3 
100.0 

| 

4 

2 
1 

|, 

275 
1 
12 
116 
25 

498 
10 
4 

209 
1 
11 
84 
20 

50 

1C 

19.3 
100.0 

9 

3 

8 

1 

1 

83 

17 

3 

55 
1 
3 

1 

4 

54 

28 

8 

Part.  Amp.  Foot  and  Amp.  at  Ankle  Joint 
Partial  Amp.  Foot  and  Amp.  of  Leg  

1 
31 
5 
1 

1 

8.5 
26.9 
20.  0 
100.0 

1 

1 

4 
5 

2 

3 

26 
9 

7 
3 

6 
4 

6 

1 

] 

47 

17 
1 

1 

Amp.  at  Ankle  Joint  and  Amp.  of  Leg... 
Amp.  at  Ankle  J't,  Amp.  Leg,  Amp.Thigh 

1 

329 
5 
1 
3 

169 
5 
3 
3 

33.9 

m 

17 

Ti 

lf> 

27 

29 

0 

1 

152 

66 

Amputation  of  Leg  and  Amp.  of  Thigh  .  . 

50  0 

,T 

2 

o 

75.0 

o 

1 

1 

| 

50.0 

3 

1 

1 

1 

5,832 

4,942 

450 

440 

8.3 

859 

V™  

121 
1,04( 

PO 

98 

29 

v  — 

129 

2 

1,404 

i 

90 
~s  — 
618 

124 

1,881 

V  

44 
050 

125 

700    Ki6 
1)95 

129 

The  tarsal  bones  were  implicated  in  one  thousand  and  forty,  the  tarso-metatarsal 
articulation  in  one  hundred  and  twenty-nine,  the  metatarsal  bones  in  one  thousand  six 
hundred  and  eighteen,  and  the  phalanges  in  two  thousand  and  fifty  cases;  in  nine  hundred 
and  ninety-five  instances  the  parts  injured  were  not  indicated.  Three  thousand  five  hun 
dred  and  sixty  were  throughout  treated  by  expectation,  ninety-seven  were  followed  by 
excision,  and  two  thousand  one  hundred  and  seventy-five  by  amputation. 

SHOT  FRACTURES  OF  THE  BONES  OF  THE  FOOT  TREATED  BY  CONSERVATION.  --  Tll6  shot 


of  the  foot  treated  without  operative  interference  numbered  three  thousand  five  hundred 
and  sixty;  the  results  in  three  hundred  and  fourteen  cases  were  not  ascertained.  Of  the 
remaining  three  thousand  two  hundred  and  forty-six  cases,  three  thousand  one  hundred  and 
eleven  had  successful,  and  one  hundred  and  thirty-five  fatal  terminations,  a  mortality  rate 


SECT.  VII.]  SHOT    FRACTURES    OF    THE    BONES    OF    THE    FOOT.  619 

of  4.1  per  cent.  A  few  cases  will  be  detailed  to  indicate  the  manner  of  treatment  gen 
erally  pursued,  which  was  similar  to  that  of  wounds  of  the  hand  discussed  on  page  1020 
of  the  Second  Surgical  Volume.  Shot  fractures  of  the  os  calcis  even  when  quite  extensive 
healed,  as  a  rule,  without  difficulty: 

CASE  892. — Shot  fracture  of  the  os  calcis. — Sergeant  D.  M.  Tarrance,  Co.  B,  1st  Pennsylvania  Cavalry,  aged  24  yean?,  was 
wounded  in  the  right  foot,  at  United  States  Ford,  May  25,  1863,  and  entered  Harewood  Hospital,  Washington,  three  weeks  after 
wards.  On  September  29th  the  patient  was  transferred  to  Mower  Hospital,  Philadelphia.  Surgeon  J.  Hopkinson,  U.  S  V., 
reported:  "The  patient  was  wounded  by  a  ball  entering  outside  of  the  tendo-achillis,  passing  downward,  forward  and  inward 
through  the  os  calcis,  fracturing  the  bone,  and  emerging  at  the  inner  margin  of  the  sole  of  the  foot.  The  heel  became  very  much 
swollen  and  painful  and  pus  continued  to  discharge  from  both  the  wound  of  entrance  and  exit,  all  the  symptoms  of  necrosed  bone 
being  present.  Flaxseed  poultices  were  applied;  iron  and  quinine  with  wine  was  administered.  On  December  1st,  another 
examination  having  been  made,  it  was  decided  to  cut  down  and  remove  the  diseased  bone,  and  a  crucial  incision  was  made  along 
the  internal  aspect  of  the  bone,  its  length  parallel  with  the  axis  of  the  bone  being  three  and  a  half  inches,  in  the  opposite  direction 
two  and  a  half  inches.  The  loose  pieces  were  then  removed  and  the  necrosed  bone  was  scraped  with  the  gouge,  after  which  the 
wound  was  closed  with  sutures  and  cold-water  dressings  were  applied.  The  operation  was  performed  by  Acting  Assistant  Sur 
geon  J.  H.  Jamar,  the  patient  being  in  good  general  condition  at  the  time.  He  did  well  afterwards.  Small  fragments  of  bone 
exfoliated  and  were  removed  at  different  intervals.  By  January  20,  1864,  the  wound  was  healing  kindly  and  the  patient  was 
allowed  to  go  to  his  home.  About  the  end  of  February  the  wound  had  healed  with  the  exception  of  a  small  point,  and  the 
patient  dispensed  with  his  crutches  and  used  a  cane.  He  was  discharged  from  service  July  8,  1864."  Examining  Surgeon  W. 
Jewell,  of  Philadelphia,  certified  to  the  injury  April  7,  1866,  and  described  the  wound  as  still  suppurating.  The  pensioner  was 
paid  March  4,  1871. 

CASE  893. — Shot  fractures  of  scaphoid  and  cuneiform  bones. — Lieutenant  J.  Miller,  Co.  A,  5th  Ohio,  aged  26  years,  was 
wounded  in  the  left  foot,  at  Cedar  Mountain,  August  9,  1862.  Acting  Assistant  Surgeon  J.  A.  Murphy,  in  charge  of  Third  Street 
Hospital,  Cincinnati,  reported:  "The  ball  entered  between  the  scaphoid  and  internal  cuneiform  bones  and  passed  out  one  inch 
below  the  external  malleolus.  The  patient  was  sent  to  Cliffburn  Hospital,  at  Washington,  where  Assistant  Surgeon  J.  S. 
Billings,  U.  S.  A.,  on  August  14th  enlarged  the  wound  of  exit  and  removed  several  pieces  of  bone.  The  patient  remained  in 
said  hospital  for  three  months,  when  he  obtained  a  leave  of  absence  and  came  to  his  home  (in  Cincinnati).  He  applied  for  treat 
ment  in  this  hospital  in  December,  1862,  when  there  was  still  considerable  inflammation  in  the  foot.  Poultices  and  cold-water 
dressings  were  ordered  until  the  wounds  healed.  Five  small  pieces  of  bone  were  removed  from  both  the  wound  of  entrance  and 
exit.  He  is  now  (April,  1863)  able  to  flex  the  foot  on  the  leg  and  walks  with  a  slight  halt."  Lieutenant  Miller  was  discharged 
from  service  June  11,  1863,  and  pensioned.  The  Cincinnati  Examining  Surgeons  have  certified  to  the  injury  from  time  to  time. 
In  1877  they  added  that  "the  cicatrix  is  small,  healthy,  and  adherent.  There  is  some  flattening  of  the  plantar  arch;  middle 
tarsal  joint  very  much  impaired;  motion  of  ankle  good  but  limited  in  range."  The  pensioner  was  paid  March  4,  1881. 

CASE  894. — Private  J.  A.  Lunderman,  East  Missouri  Militia,  was  wounded  in  the  left  foot  during  a  skirmish  on  March 
9,  1863.  Acting  Assistant  Surgeon  F.  A.  Bushey  reported:  "The  wound  was  caused  by  a  conical  pistol  ball,  which  entered  at 
the  astragalo-cuboid  articulation,  comminuted  the  cuneiform  and  scaphoid  bones,  and  lodged  in  the  foot.  The  man  entered  the 
General  Hospital  at  Springfield  eleven  months  after  the  injury,  at  which  time  the  external  wound  had  healed,  but  the  foot  was 
much  swollen;  constitutional  condition  good.  On  February  10,  1864,  Dr.  B.  A.  Barette  attempted  to  extract  the  ball  and  made 
an  incision  three  inches  in  length  along  the  tibialis  anticus  muscle,  when  a  quantity  of  necrosed  bone  was  taken  out,  but  the 
missile  could  not  be  found.  Simple  dressings  were  applied  after  the  operation.  The  patient  recovered  and  was  returned  to  duty 
March  26,  1864."  He  is  not  a  pensioner. 

CASE  895. — Shot  fracture  of  os  calcis  and  tarsal  bones. — Private  J.  Chew,  Co.  C,  58th  Indiana,  was  wounded  in  the  left 
foot,  at  Chickamauga,  September  20,  1863.  He  was  conveyed  to  hospital  at  Chattanooga,  where  Surgeon  J.  T.  Woods,  99th 
Ohio,  recorded  the  following  history:  "A  m'mi6  ball  entered  one  inch  below  the  outer  malleolus,  ranging  slightly  forward  and 
comminuting  the  head  of  the  os  calcis  and  tarsal  bones.  Careful  exploration  failed  to  detect  the  missile.  Several  spiculae  and 
one  small  fragment  of  lead  were  removed.  On  September  26th  inflammatory  action  in  the  parts  had  increased  and  the  pain  was 
severe  and  attended  with  great  restlessness.  Irrigation  was  then  applied  to  the  parts  and  anodynes  were  freely  administered. 
By  September  30th  the  inflammation  was  increasing,  the  pain  intense,  and  several  more  spiculae  were  removed.  On  October  2d 
an  incision  was  made  from  the  entrance  wound  forward  and  inward,  opening  into  the  discolored  mass  freely,  after  which  several 
pieces  of  tarsal  bone  were  removed,  also  a  Belgian  musket  ball  from  near  the  internal  cuneiform  bone.  Irrigation  to  the  foot  was 
continued.  Three  days  afterwards  the  appearance  of  the  parts  was  better,  the  pain  had  decreased,  and  an  anterior  splint  was 
applied,  elevating  the  foot.  On  November  2d  part  of  the  tarsal  bone  from  the  inner  side  of  the  foot  was  removed."  Several 
days  afterwards  the  patient  was  transferred  to  hospital  at  Murfreesboro'  and  subsequently  to  Evansville,  where  he  was  dis 
charged  from  service  November  9.  1864,  Acting  Assistant  Surgeon  J.  A.  Jearicon  certifying  to  the  use  of  the  foot  being  com 
pletely  destroyed  by  the  wound.  There  is  no  record  of  the  man  ever  having  applied  for  pension. 

CASE  896. — Shot  fracture  of  tarsal  bones. — Private  J.  Campbell,  Co.  F,  llth  New  York,  aged  36  years,  was  wounded 
and  captured  at  Bull  Run  July  21,  1861.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  reported:  "He  was  admitted  to  Hygeia  Hospital 
at  Fort  Monroe,  from  Richmond,  October  21,  1861,  with  gunshot  wound  of  right  tarsus.  A  ball  had  passed  into  the  foot  in 
front  of  the  ankle  joint  and  came  out  at  the  tip  of  the  heel.  The  patient  was  in  bad  condition  when  he  arrived,  and  the  foot  was 
very  much  swollen  and  painful,  with  profRse  discharge  from  several  sinuses.  The  fistulas  were  dilated  with  sponge  tents  and 
carious  bone  was  removed.  He  recovered  the  use  of  his  foot  and  went  to  his  home  in  New  York  City."  The  patient  was  dis 
charged  from  service  February  16,  1862,  and  pensioned.  The  New  York  City  Examining  Board  certified,  November  4,  1874  : 


620  INJURIES   OF   THE    LOWER    EXTREMITIES.  [CHAP.  x. 

"The  wounds  are  still  open  and  connect  with  dead  bone;  the  cicatrices  and  surrounding  tissues  are  thin,  inflamed,  and  tender; 
movements  of  joint  limited."  In  the  following  year  the  same  board  reported  that  "a  portion  of  the  astragalus  has  been  removed. 
Cicatrices  are  deep  and  adherent;  wound  of  exit  still  open  and  connecting  with  dead  bone."  The  pensioner  was  paid  September 
4,  1880. 

CASE  897. — Shot  fractures  of  tarsal  and  metatarsal  bones. — Private  J.  E.  Chase,  Co.  F,  1st  U.  S.  Sharpshooters,  aged  25 
years,  was  wounded  in  the  right  foot,  fracturing  the  bones,  at  Spottsylvania,  May  12, 1864.  He  passed  through  several  hospitals 
and  was  ultimately  transferred  to  the  Veteran  Reserve  Corps,  December  4,  1864,  by  reason  of  the  results  of  the  injury.  On 
August  31,  1866,  the  man  was  mustered  out  and  pensioned.  Dr.  E.  D.  Hudson  furnished  the  following  description  of  the  case: 
"Compound  comminuted  fractures  of  the  metatarsus  and  tarsus  were  caused  by  three  rifle  shots,  and  were  followed  by  extensive 
necrosis  and  exfoliation  of  the  metatarsus.  The  insertion  and  function  of  the  tibialis  aulicus,  peroneus  longus,  and  extensor 
muscles  are  destroyed,  the  plantar  aspect  of  the  foot  is  turned  inward  and  upward,  and  the  patient  rests  his  leg  on  the  outside 
of  the  foot,  which  is  turned  down,  the  extensor  muscles  failing  to  make  the  great  toe  and  other  parts  hug  the  ground.  The  limb 
is  not  shortened,  but  there  is  soreness  and  stiffness  of  the  foot  and  considerable  anchylosis  of  the  tarsus.  An  apparatus  was 
applied  to  antagonize  the  flexor  muscles  of  the  foot  and  the  extensors  of  the  toes,  and  to  reduce  the  heel  and  the  foot  to  a  normal 
position."  Examining  Surgeon  L.  Richmond,  of  Troy,  Vermont,  certified  to  the  injury  as  follows:  "One  ball  entered  between 
the  lower  extremity  of  the  tibia  and  tendo-achillis  on  the  inner  aspect,  passed  outward  and  downward,  and  made  its  exit  near 
the  sole  of  the  foot,  severely  injuring  the  os  calcis.  Another  ball  passed  through  the  foot,  severely  injuring  the  three  outer 
metatarsal  bones  and  the  tendons;  extensive  sloughing  followed.  The  third  ball  entered  on  the  inner  side  just  about  the  union 
of  the  great  toe  with  its  metatarsal  bone.  '  The  pensioner  walks  partly  upon  the  side  of  the  foot,"  etc.  Examiner  J.  C. 

Rutherford  subsequently  reported  that  "the  foot  and  leg  are  atrophied  and  there  is  but  very  little  muscle  left  upon  the  limb. 
There  is  no  strength  in  the  ankle.  He  is  obliged  to  use  a  mechanical  support  on  the  foot  and  leg  to  enable  him  to  walk  at  all.'' 

CASE  898. — Captain  M.  D.  Bearden,  Co.  D,  6th  Tennessee,  aged  34  years,  was  wounded  in  the  left  foot,  at  the  Cliatta- 
hoochee  River,  July  1, 1864,  and  was  admitted  to  Lookout  Mountain  Hospital  near  Chattanooga  eight  days  afterwards.  Surgeon 
L.  D.  Harlow,  U.  S.  V.,  reported :  "A  conical  ball  fractured  the  cuboid  bone  and  lodged  in  the  centre  of  the  foot  under  the  scaphoid 
bone.  The  foot  became  greatly  swollen  and  inflamed,  particularly  on  the  inner  side,  and  the  patient,  who  had  been  a  strong  and 
robust  man  previous  to  the  injury,  grew  weak,  feverish,  and  irritable.  On  August  27th  an  abscess  which  had  formed  on  the 
internal  surface  was  opened,  and  the  ball  was  extracted  through  the  opening.  Chloroform  was  used  during  the  operation.  Rapid 
improvement  followed."  The  patient  subsequently  entered  the  Officers'  Hospital  at  Knoxville,  where  he  was  mustered  out  of 
service  April  27,  1865,  and  pensioned.  The  Knoxville  Examining  Board  certified  to  anchylosis  resulting  from  the  injury.  The 
Pension  Office  Examining  Board,  Washington,  D.  C.,  reported  the  pensioner's  condition  March  11,  1881,  as  follows:  "This  man 
can  do  no  manual  labor.  The  ankle  and  leg  to  the  knee  are  much  enlarged,  and  the  lower  two-thirds  of  the  tibia  and  soft  parts 
are  much  diseased.  He  has  to  use  crutches  at  times  to  walk,  and  a  stout  cane  at  all  times.  He  is  very  lame,  and  from  the  great 
ulceration  of  the  bone  and  soft  parts  must  suffer  constant  pain." 

CASE  899. — Private  H.  West,  Co.  L,  7th  Illinois  Cavalry,  aged  22  years,  was  wounded  in  the  left  foot,  at  Colliersville, 
October  11, 1863.  He  remained  at  a  field  hospital  for  some  weeks  and  was  then  conveyed  to  Memphis,  where  he  entered  Adams 
Hospital  November  17th.  Surgeon  J.  G.  Keenon,  U.  S.  V.,  in  charge  of  the  latter,  reported:  "The  patient  had  been  wounded 
by  a  ball  penetrating  the  scaphoid  bone  and  carrying  with  it  the  tongue  of  the  buckle  of  a  spur,  which  lodged.  After  a  time  a 
sinus  formed  in  the  injured  foot,  connecting  with  what  appeared  to  be  necrosed  bone,  but  which  proved  to  be  perfectly  healthy. 
On  March  10,  1864,  chloroform  was  administered,  and  a  vertical  incision  was  made  about  one  and  a  half  inches  in  length  and 
continued  along  the  track  of  the  ball  from  within  outward,  after  which  the  tongue  of  the  buckle  was  found  and  removed.  The 
operation  was  performed  by  Acting  Assistant  Surgeon  S.  S.  Jessop,  the  patient  being  in  good  physical  condition  at  the  time. 
He  did  well  until  March  30th,  when  hospital  gangrene  supervened,  which  was  checked  by  one  application  of  pure  bromine." 
The  patient  was  ultimately  discharged  from  service  May  13,  1865,  and  pensioned.  Examining  surgeons  have  certified  to  "anchy 
losis  and  deformity  of  the  foot,"  etc.  The  pensioner  was  paid  March  4,  1881. 

CASE  900. — Shot  fractures  of  metatarsal  bones. — Private  C.  S.  Wheelwright,  Co.  M,  1st  New  Jersey  Cavalry,  aged  26 
years,  was  wounded  on  picket  duty  near  Warrenton,  January  31,  1864,  and  admitted  to  Douglas  Hospital,  Washington,  the 
following  day.  Acting  Assistant  Surgeon  C.  Carvallo,  reported:  "The  ball  entered  the  external  dorsal  aspect  of  the  right  foot 
anterior  to  the  fourth  tarso-metatarsal  articulation,  and  emerged  posteriorly  to  the  metatarso-phalangeal  articulation  of  the  big 
toe,  having  fractured  the  fourth  metatarsal  bone  obliquely  and  passed  beneath  the  others.  Water  dressings  had  been  applied 
before  admission  and  were  continued.  The  foot  became  red,  swollen,  and  painful,  and  the  patient  had  considerable  fever,  anorexia, 
and  pain.  Epsom  salts,  weak  diaphoretics,  and  the  dressings  soothed  the  symptoms  considerably.  On  February  8th  the  distal 
fragment  of  the  fourth  metatarsal  bone  was  found  to  be  movable,  but  still  attached  by  its  phalangeal  articulation,  and  an  effort 
to  remove  it  proved  impossible  without  injuring  that  joint.  It  was  therefore  decided  to  leave  its  removal  to  nature,  and  a  seton 
was  conducted  through  both  wounds  in  order  to  keep  them  open  and  promote  suppuration.  Subsequently  an  exacerbation  of 
the  symptoms  manifested  itself,  after  which  the  foot  showed  an  erysipelatous  tendency  by  swelling,  redness,  heat,  and  puffiness. 
A  solution  of  nitrate  of  silver  with  acacia,  constantly  applied  for  forty-eight  hours,  finally  subdued  the  inflammation,  when  a 
profuse  discharge  of  healthy  pus  followed  and  gave  great  relief  to  the  patient.  Thenceforward  the  stimulants  were  substituted 
by  tonics,  and  water  dressings  took  the  place  of  all  former  local  applications.  In  a  very  short  time  all  the  swelling  and  redness 
had  left  the  foot,  and  the  wound  showed  such  a  healthy  appearance  and  discharged  such  small  quantities  of  pus  that  I  enter 
tained  hopes  the  fractured  bone  would  heal  without  being  removed.  I  then  applied  Sentin's  starch  bandage,  which  the  patient 
still  had  on  when  he  went  home  on  furlough  on  March  15th.  I  afterwards  heard  that  he  was  attacked  with  erysipelas  and  had 
entered  Central  Park  Hospital,  New  York  City."  The  patient  was  discharged  at  tne  latter  hospital  May  20,  1864,  and  pen 
sioned.  Examining  Surgeon  J.  T.  Burdick,  of  Brooklyn,  N.  Y.,  certified  that  "the  flexor  tendons  of  the  middle  toes  and  some 
of  the  ligaments  of  the  pedal  arch  were  injured."  The  pensioner  was  paid  September  4,  1880. 


SECT,  vn.]  SHOT    FKACTURES    OF    THE    BONES    OF    THE    FOOT.  621 

CASE  901. — Private  I.  Parso,  Co.  F,  21st  Wisconsin,  aged  25  years,  was  wounded  in  both  lower  extremities,  at  Chick- 
amauga,  September  19,  1863.  The  injuries  were  produced  by  two  musket  balls,  one  of  which  fractured  the  first  and  second 
metatarsal  bones  of  the  right  foot,  the  other  fracturing  the  fibula  of  the  left  leg  near  its  lower  extremity.  The  wounded  man 
passed  through  various  hospitals  and  lastly  entered  Harvey  Hospital,  Madison,  on  July  12,  1864.  Surgeon  H.  Culbertson, 
U.  S.  V.,  who  operated  in  the  case  at  the  latter  hospital,  reported  the  following  result  of  the  injuries:  "The  patient  was  assigned 
to  the  Veteran  Reserve  Corps  October  7th.  The  fracture  of  the  metatarsal  bone  had  united  with  a  very  large  provisional  callus, 
which  interfered  with  the  action  of  the  extensor  tendons  and  compressed  the  tarsus.  This  growth  was  mainly  developed  from 
the  first  metatarsal  bone,  which  jutted  over  the  second,  the  parts  being  tender  and  the  patient  unable  to  walk  without  pain.  In 
order  to  accomplish  the  chiseling  off  of  the  exostosis,  if  possible,  or  failing  in  this,  to  remove  a  portion  of  the  first  metatarsal 
together  with  the  diseased  bone,  an  incision  was  made  down  to  the  bone,  commencing  one-half  inch  from  the  metatarso-phalan- 
geal  articulation  and  extending  two  and  three-quarter  inches  along  the  inner  border  of  the  first  metatarsal.  Another  incision  of 
two  inches  was  then  carried  over  the  dorsum  of  the  foot  down  to  the  superficial  fasciae  and  at  right  angles  with  the  first  cut, 
care  being  taken  not  to  divide  the  extensor  tendons.  The  soft  parts  were  now  separated  with  the  handle  of  a  scalpel,  preserving 
the  periosteum  as  much  as  possible,  and  the  bone  was  sawn  through  with  a  metacarpal  saw  about  one  inch  from  the  metatarso- 
phalangeal  joint.  The  old  line  of  the  fracture,  three-fourths  of  an  inch  from  the  tarso-metatarsal  joint,  was  next  separated  with 
a  strong  narrow  knife  and  removed  with  the  diseased  structure.  A  portion  of  the  exostosis,  projecting  from  the  upper  fragment 
and  jutting  over  the  second  metatarsal  bone,  was  removed  with  the  forceps.  No  vessels  required  ligating.  The  wound  was  left 
open  for  two  hours  until  all  bleeding  had  ceased,  after  which  the  edges  were  brought  together  and  secured  with  sutures  and 
adhesive  plaster.  A  compress  secured  by  bandages  was  applied  over  the  seat  of  the  wound  for  twelve  Jiours ;  the  foot  was 
elevated  and  cold-water  dressings  were  used.  The  external  wound  healed  by  first  intention  and  the  patient  progressed  well. 
He  was  returned  to  duty  February  20,  1865."  The  removed  exostosis,  one  inch  in  length,  and  contributed  to  the  Museum  by 
the  operator,  constitutes  specimen  3694  of  the  Surgical  Section.  The  patient  was  mustered  out  of  service  August  19,  1865.  and 
pensioned.  Dr.  J.  F.  Force,  pension  examining  surgeon  at  Heron  Lake,  Minnesota,  states  that  "the  great  toe  was  left,  but  it  is 
so  tender  that  he  can  use  it  but  little  in  walking.  The  left  ankle  joint  is  considerably  weakened.  His  bodily  health  is  good." 
The  pensioner  was  paid  June  4,  1881. 

CASE  902.— Surgeon  T.  H.  Squire,  89th  New  York,  records  that  "Private  C.  M.  Yarnes,  Co.  F,  89th  New  York,  aged  24 
years,  was  wounded  at  the  storming  of  a  fort  on  the  Nansemond  River,  April  19, 1863,  by  a  musket  ball,  which  entered  the  outer 
margin  of  the  right  foot  at  the  root  of  the  little  toe  and  came  out  on  the  inner  margin  of  the  foot  just  below  the  ankle,  traversing 
the  whole  sole  of  the  foot  diagonally  and  below  the  bones.  I  think  the  phalangeal  extremity  of  the  metatarsal  bone  of  the  little  toe 
was  injured,  but  not  the  rest  of  the  bones,  and  whether  any  of  the  vessels  were  injured  or  not  was  more  than  I  could  tell,  though 
there  had  been  no  haemorrhage.  The  wound  of  entrance  was  small,  while  that  of  exit  was  large,  ragged,  and  pouting.  The 
first  day  after  the  injury  the  foot  was  hot  and  painful.  I  placed  it  in  an  easy  elevated  position,  applied  wet  dressings,  and  drew 
blood  liberally  from  the  patient's  arm,  from  which  time  the  pain  grew  less.  By  April  25th  the  foot  had  a  good  appearance.  On 
June  6,  1863,  the  patient  went  home  on  furlough.  He  had  done  well.  The  wound  of  entrance  had  suppurated  freely  and  bone 
was  apparently  yet  to  come  out  of  this  opening."  He  was  ultimately  mustered  out  of  service  August  3,  1865,  and  pensioned. 
Examining  Surgeon  J.  G.  Orton,  of  Binghamton,  N.  Y.,  December  14,  1872,  stated  that  "the  action  of  the  ankle  joint  is  much 
impah-ed,  obliging  the  patient  to  walk  almost  entirely  on  the  heel  and  always  giving  him  a  limping  motion.  The  disability  is 
permanent  in  its  present  degree."  The  pensioner  was  paid  December  4,  1880. 

CASE  903.— Private  J.  Johnson,  Co.  D,  4th  U.  S.  Artillery,  aged  36  years,  was  wounded  in  the  right  foot,  at  Drury's 
Bluff,  May  14,  1864.  He  was  admitted  to  Point  Lookout  Hospital  three  days  afterwards,  where  Acting  Assistant  Surgeon  J. 
Oilman  recorded  the  following:  "The  wound  was  from  a  minie'  ball,  which  entered  at  the  dorsal  surface  and  was  taken  out  at 
the  plantar  aspect,  having  fractured  the  metatarsal  bone  of  the  great  toe.  Gangrene  set  in,  destroying  the  continuity  of  the 
dorsalis  pedis  artery  and  necessitating  ligation,  which  was  performed  on  July  20th  by  Surgeon  A.  Heger,  U.  S.  A.,  in  charge  of 
the  hospital,  who  enlarged  the  wound  and  tied  the  artery  above  and  below.  The  case  progressed  favorably,  the  gangrene  being 
cured  and  the  wound  granulating,  when  the  patient  was  transferred  to  Judiciary  Square  Hospital  at  Washington  on  August  6th." 
He  was  subsequently  transferred  to  Fort  Washington,  and  on  July  16,  1865,  he  was  discharged  from  service  and  pensioned  by 
reason  of  "difficulty  in  walking  in  consequence  of  the  wound."  Examining  Surgeon  J.  O.  Stanton,  of  Washington,  D.  C., 
reported,  September  10,  1873:  "The  cicatrix  is  large,  now  open,  and  discharging.  He  has  no  motion  of  the  great  toe."  The 
pensioner  died  at  the  Soldiers'  Home,  Washington,  D.  C.,  November  6,  1878. 

CASE  904.— Private  J.  T.  Bartley,  Co.  B,  38th  Indiana,  aged  20  years,  was  accidentally  shot  in  the  left  foot,  at  Nashville, 
March  3,  1864,  the  ball  passing  in  at  the  arch,  fracturing  the  third  metatarsal  bone,  and  coming  out  at  the  plantar  surface.  On 
the  following  day  he  was  admitted  to  hospital  No.  1,  whence  he  was  transferred  to  Jeffersonville  two  months  afterwards,  and 
subsequently  to  No.  6,  at  New  Albany.  Acting  Assistant  Surgeon  E.  S.  Crosier,  in  charge  of  the  latter  hospital,  reported  that 
owing  to  troublesome  haemorrhage  the  anterior  and  posterior  tibial  arteries  were  ligated  by  Acting  Assistant  Surgeon  J.  Grant 
six  days  after  the  reception  of  the  injury,  also  that  the  parts  were  attacked  with  gangrene  during  the  early  stage  of  the  case. 
The  patient  recovered  and  was  discharged  from  service  April  10,  1865.  He  is  not  a  pensioner. 

CASE  905.— Shot  fracture  of  toe.— Corporal  R.  Steele,  Co.  F,  27th  Massachusetts,  aged  23  years,  was  wounded  in  the 
left  foot,  during  the  skirmish  at  Gum  Swamp,  May  22,  1863.  Surgeon  E.  P.  Morong,  2d  Maryland,  recorded  his  admission  to 
Foster  Hospital,  New  Berne,  and  his  return  to  duty  one  month  afterwards.  Surgeon  G.  A.  Otis,  27th  Massachusetts,  made 
the  following  report:  "Corporal  Steele  was  sent  to  me  from  Foster  Hospital  June  25th.  He  had  been  under  treatment  for  a 
wound  at  the  phalangeal  articulation  of  the  left  great  toe,  caused  by  an  Enfield  rifle  ball.  Dead  and  detached  fragments  of  tin- 
distal  phalanx  could  be  felt  and  the  wound  showed  no  disposition  to  cicatrize  either  on  the  dorsal  or  palmar  aspect.  I  laid 
open  the  toe  and  removed  the  loose  fragments,  including  the  entire  distal  phalanx  and  part  of  the  proximal  phalanx."  The 
man  recovered  and  subsequently  continued  with  his  regiment  until  mustered  out  September  27,  1864.  In  1880  he  became  an 
applicant  for  pension  by  reason  of  alleged  painfulness  in  walking. 


622 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


CASE  906. — Shot  fracture  of  tarsal  bones;  death. — Captain  C.  E.  Jennings,  Co.  G,  26th  New  York,  was  wounded  in  the 
foot,  at  Bull  Run,  August  30,  1862,  and  was  conveyed  to  Washington.  Surgeon  C.  L.  Allen,  U.  S.  V.,  reported  :  "The  patient 
was  a  man  about  thirty  years  of  age,  of  a  sanguine  temperament,  and  apparently  of  good  constitution  and  fair  health  previous 
to  being  wounded;  while  he  was  at  Alexandria,  on  his  way  to  Washington,  a  surgeon  had  declared  the  necessity  of  amputa 
tion;  but  before  the  operation  could  be  performed  the  patient  was  taken  to  Washington.  The  ball  had  entered  on  the  inner 
side  of  the  foot  and  passed  through  the  three  cuneiform  bones  and  the  cuboid,  the  wound  of  exit  being  upon  the  external  and 
upper  surface  of  the  foot.  On  September  27th  the  foot  was  enormously  swollen,  and  there  were  five  or  six  openings  besides  the 
original  wounds  discharging  large  quantities  of  unhealthy  sanious  pus.  The  leg  and  even  the  thigh  were  very  much  swollen  and 
oedematous,  and  the  lower  third  of  the  leg  was  marked  by  several  long  cicatrices,  said  to  be  the  results  of  incisions  made  early 
in  the  case  for  erysipelatous  inflammation.  His  general  condition  was  that  of  marked  hectic  and  his  emaciation  was  great. 
He  had  also  considerable  dyspnrea  and  complained  of  pain  in  his  chest,  for  which  sinapisms  were  being  applied.  Compound 
tincture  of  cinchona  and  tincture  of  cantharides,  with  brandy  and  liberal  allowance  of  beef-essence,  etc.,  were  now  immediately 
ordered  for  the  patient,  hoping  but  not  expecting  to  raise  him  to  a  condition  to  sustain  amputation  of  the  leg.  Although 
crowding  the  nourishment  and  stimulants  to  the  utmost  he  continued  to  sink,  and  died  on  October  1,  1862.  No  post-mortem 
examination  wras  held.'' 

CASE  907  .—Shot  fracture  of  first  metatarsal  bone;  death. — Private  W.  S.  Hodgkins,  Co.  A,  14th  New  York  Artillery, 
aged  27  years,  was  wounded  at  Spottsylvania,  May  10,  1864,  and  entered  Emory  Hospital,  Washington,  two  weeks  afterwards. 
Surgeon  N.  R.  Moseley,  U.  S.  V.,  reported:  "The  patient  was  received  with  gunshot  wound  of  left  foot,  fracturing  the  first 
metatarsal  bone.  Cold-water  dressings  were  applied  to  the  wound  and  alteratives  were  given  internally.  This  treatment  was 
continued  for  some  weeks,  the  wound  doing  well,  although  the  patient's  constitutional  health  was  very  poor.  On  June  29th 
Btimulants  with  alteratives  were  ordered,  and  warm  applications  were  made  to  the  wound,  which  appeared  to  be  obstinate  in 
healing.  On  July  20th  simple  cerate  dressings  were  commenced,  the  wound  appearing  healthy  in  some  parts,  though  peculiarly 
unhealthy  around  the  edges;  internal  treatment  continued.  One  month  later  the  wound  was  erysipelatous  in  appearance  and 
warm  poultices  were  again  applied;  patient's  appetite  still  good.  By  September  9th  erysipelas  and  gangrene  had  invaded  the 
wound  and  creasote  was  added  to  the  poultice;  stimulants  given  internally.  In  about  ten  days  cold-water  dressings  were 
resumed,  gangrene  having  disappeared,  but  the  parts  still  being  unhealthy.  On  September  27th  the  patient  was  attacked  with 
chills  followed  by  high  fever,  when  antiperiodics  and  tonics  were  prescribed  and  warm  applications  were  again  used.  Several 
days  afterwards  the  patient  began  to  sink  rapidly.  He  died  October  3,  1864,  from  the  effects  of  irritative  fever  produced  by  the 
unhealthy  wound." 

EXCISIONS  IN  THE  BONES  OF  THE  FOOT.— Ablations  of  one  or  more  of  the 
metatarsals  with  their  corresponding  toes  have  been  classified  with  partial  amputations  of 
the  foot  and  will  be  cited  hereafter.  The  cases  to  be  considered  in  this  group  will  be 
confined  to  excisions  of  the  tarsal  bones  or  of  the  metatarsal  bones  without  removal  of  the 
corresponding  toes.  Ninety-seven  cases  of  this  nature  have  been  recorded.  The  results 
in  four  cases  were  not  determined.  Seventy-five  were  successful  and  eighteen  proved  fatal, 
a  mortality  rate  of  19.3  per  cent.  Of  the  ninety-seven  operations,  thirty-one  involved  the 
tarsal  bones,  five  the  tarso-metatarsal  articulation,  fifty-seven  the  metatarsal  bones,  and 
four  the  metatarso-phalangeal  articulation,  as  indicated  in  the  following  table: 

TABLE  XGVI. 
Numerical  Statement  of  Ninety-seven  Cases  of  Excisions  in  the  Bones  of  the  Foot. 


CASES. 

Pi-iMvuY               INTER- 

MEDIAKY. 

SECm-DAHY.      TIME  XOT  SI'ECI- 

PARTS  EXCISED. 

"3 
"S 

H 

i 

•c 

1 

25 
3 
46 

1 

Deaths. 

Undeterm'd 

Percentage 

of  Mortality. 

1 

y 

K 

Deaths. 

'I 

~>-,t.  Recoveries. 

Deaths. 

Recoveries. 

.1 

1     i      % 

1         8 

O           K 

Deaths. 

Undeterm'd. 

1 

Excision  in  the  Tarsal  Bones  31 

5 

a 

J8 

1 
13 

1C.  C 
40.0 
14.8 

10 

1 

28 

1 

40 

3 

i 

2 

1 

1     i 
2     ' 

1 
5 

9 
1 
ti 

1            , 

Excisiuu  in  the  Turso-Metatarsal  Articulat'n.         5 
Excision  in  the  Metatarsal  Bones                           57 

2 

! 
ii 

i 
1     :       ~> 

Excision  in  the  Metatarso-Phalangcal  Artie-  ' 
illation  4 

Aggregates  97 

4 

"•" 

U 

2          15 

1C 

,           4 

1 

2 

Fifty-three  of  the  ninety-seven  operations  were  primary,  twenty  intermediary,  seven 
teen  secondary,  and  in  seven  the  intervals  between  the  injury  and  the  operation  could  not 


SECT.  vn. |  EXCISIONS    IN    THE    BONES    OF    THE    FOOT.  623 

be  ascertained.     A  few  examples  of  each  of  these  groups  will  be  detailed,  and  a  brief 
account  of  all  cases  given  in  a  condensed  tabular  statement. 

PRIMARY  EXCISIONS  ix  THE  BONES  OF  THE  FOOT. — The  results  VfeTe  ascertained  in  fifty-one 
of  the  fifty-three  primary  excisions;  forty  were  successful,  eleven  fatal.  In  five  instances, 
two  successful  and  three  fatal,  the  limb  was  subsequently  amputated  in  the  leg. 

CASE  908. — Captain  A.  Badeau,  Aide-de  Camp  on  Brigadier  General  T.  W.  Sherman's  Staff,  was  wounded  in  the  left  foot, 
fracturing  the  tarsal  bones,  before  Port  Hudson,  May  27,  1863.  He  was  admitted  to  the  field  hospital  of  the  2d  division,  Nine 
teenth  Corps,  where  he  was  treated  by  Surgeon  E.  F.  Sanger,  U.  S.  V.,  who  contributed  the  following  description  of  the  case: 
"The  ball  penetrated  at  the  instep  and  came  out  below  the  internal  malleolus.  I  resected  the  middle  cuneiform  bone,  portions 
of  the  internal  and  external  cuneiform,  and  the  proximal  end  of  the  second  metatarsal,  on  account  of  which  operation  he  was  sent 
to  New  Orleans  permanently  disabled.  I  met  him  during  the  following  fall  at  Newport,  R.  I.  He  was  then  still  lame  and  went 
on  crutches."  About  ten  months  after  being  wounded,  Captain  Badeau  was  promoted  and  appointed  on  the  Staff  of  General  Grant, 
in  which  position  he  continued  up  to  a  short  time  before  being  retired  from  active  service  on  May  18,  1869.  In  addition  to  the 
history  of  the  case,  forwarded  by  Dr.  Sanger  on  February  26,  1878,  the  operator  makes  the  following  mention  of  the  result  of  the 
injury:  "  I  learn  that  the  arch  of  the  foot  is  somewhat  depressed  by  the  wound  and  operation,  tending  slightly  to  valgus." 

CASE  909. — Lieutenant  L.  A.  Dubois,  Co.  E,  120th  New  York,  aged  24  years,  was  wounded  in  the  right  foot,  before 
Petersburg,  September  20,  1864.  Surgeon  O.  Everts,  20th  Indiana,  reported  his  admission  to  the  field  hospital  of  the  3d 
division,  Second  Corps,  with  "shot  fracture  of  metatarsus,  followed  by  resection."  Surgeon  H.  F.  Lyster,  5th  Michigan,  who 
performed  the  operation,  reported  that  the  second  metatarsal  bone  was  fractured  and  the  posterior  tibial  artery  lacerated,  also  that 
the  operation  consisted  of  the  excision  of  the  distal  extremity  of  the  fractured  bone  and  of  the  ligation  of  the  lacerated  artery, 
and  was  followed  by  "recovery  with  a  useful  foot."  The  patient  was  transferred  from  the  field  to  the  Depot  Hospital  at  City 
Point,  where  he  obtained  a  leave  of  absence  on  October  8th.  On  January  10,  1865,  he  was  discharged  from  service  and  pen 
sioned.  Various  examining  surgeons  have  certified  to  the  injury  resulting  in  considerable  "  lameness,  much  pain  and  difficulty 
in  walking."  The  pensioner  was  paid  September  4,  1880. 

CASE  910. — Private  B.  J.  Smith,  Co.  G,  21st  Kentucky,  aged  22  years,  was  accidentally  wounded  in  the  left  foot,  and 
was  conveyed  to  Cumberland  Hospital,  Nashville,  November  28,  1864.  Surgeon  B.  Cloak,  U.  S.  V.,  reported:  "The  metatarsal 
bone  of  the  second  toe  was  fractured,  and  the  adjacent  parts  were  much  swollen  by  irritation  from  the  comminuted  bone.  Acting 
Assistant  Surgeon  T.  C.  Eakin  made  an  incision  on  November  28th,  two  and  a  half  inches  in  length  on  the  dorsal  surface  of  the 
foot,  and  excised  two-thirds  of  the  fractured  metatarsal  bone.  Chloroform  was  the  anaesthetic  used;  the  patient  was  in  good 
health  at  the  time  of  the  operation.  Several  days  afterwards  erysipelas  of  a  simple  cutaneous  character  attacked  the  foot  but 
was  easily  arrested.  About  one  month  after  the  operation  tire  patient  was  progressing  favorably."  He  was  subsequently  trans 
ferred  to  hospital  at  Louisville,  and  lastly  to  Camp  Dennison,  where  he  was  mustered  out  of  service  September  11, 1865.  There 
is  no  record  of  his  ever  having  applied  for  pension. 

CASE  911. — Private  J.  Leunze,  Co.  C,  71st  Ohio,  aged  37  years,  was  wounded  in  the  right  foot,  at  Campbellsville,  Novem 
ber  26,  1864,  and  entered  hospital  No.  1,  at  Nashville,  the  following  day.  Surgeon  B.  B.  Breed,  U.  S.  V.,  reported:  "Gunshot 
fracture  of  first  metatarsal  bone;  foot  much  inflamed  and  tumefied;  tarso-metatarsal  articulation  opened;  patient's  constitutional 
condition  good ;  secretions  natural.  Excision  of  the  first  metatarsal  bone  was  performed  on  November  28th,  by  Acting  Assistant 
Surgeon  C.  H.  Fisher,  Avhile  the  patient  was  under  the  influence  of  chloroform.  The  treatment  consisted  of  water  dressings  and 
nutritious  diet.  Wound  healing  kindly  when  the  patient  was  transferred  to  Louisville,  December  20th."  Subsequently  the 
patient  was  transferred  to  Camp  Dennison,  where  he  was  discharged  from  service  May  16,  1865,  by  reason  of  "paralysis  of  foot 
and  toes  resulting  from  the  wound."  Several  years  afterwards  the  man  became  an  applicant  for  pension  and  was  examined  by 
Surgeon  L.  Whiting,  of  Canton,  Ohio,  who  certified,  April  29,  1868,  as  follows:  "There  is  great  deformity  and  disability  of  the 
injured  foot.  A  large  part  of  the  metatarsal  bone  of  the  great  toe  is  lost,  and  the  toe  itself  is  so  distorted  that  it  now  lies  at  least 
an  inch  posterior  to  its  original  locality.  *  *  *  The  weight  of  the  body  in  walking  is  sustained  by  the  heel  and  a  portion  of  the 
external  border  of  the  foot." 

CASE  912. — Private  J.  C.  Troutman,  Co.  K,  3d  Tennessee,  aged  29  years,  was  wounded  accidentally  in  the  left  foot,  at  Kings 
ton,  June  19,  1864.  After  remaining  at  a  field  hospital  for  over  two  months  he  was  transferred  to  Chattanooga,  whence  Assistant 
Surgeon  C.  C.  Byrne,  U.  S.  A.,  described  the  injury  as  "a  shot  fracture  of  the  second  and  third  metatarsal  bones.  Excision  of 
the  fractured  bones  was  performed  on  the  field  through  an  incision  three  inches  in  length,  chloroform  being  used.  At  the  time 
of  the  operation  the  parts  were  inflamed  and  swollen,  but  the  patient  was  in  good  constitutional  condition.  Cold-water  dressings 
constituted  the  treatment  and  favorable  progress  followed."  The  patient  subsequently  passed  through  other  hospitals,  and  was 
ultimately  discharged  from  Brownlow,  Knoxville,  July  8,  1865,  by  reason  of  "much  impairment  of  the  usefulness  of  the  foot." 
Two  years  afterwards  he  made  application  for  pension  and  was  examined  by  Surgeon  A.  B.  Tadlock,  of  Knoxville,  who  certified 
to  the  injury  and  stated:  "The  second  and  third  metatarsal  bones  have  been  exsected,  which  permanently  damages  the  arch  of 
the  foot  and  materially  obstructs  locomotion."  Owing  to  subsequent  failures  to  respond  the  man's  claim  was  suspended  by  the 
Pension  Office  in  1873. 

CASE  913. — Private  P.  Pero,  Co.  C,  2d  New  York  Cavalry,  aged  22  yeai-s,  was  wounded  in  the  right  foot,  while  on  picket 
duty  near  Alexandria,  May  5,  1864.  Surgeon  C.  Powers,  160th  New  York,  in  charge  of  the  Alexandria  Hospital,  made  the 
following  report :  "The  ball  entered  at  the  inner  side  of  the  middle  of  the  metatarsal  bone  of  the  great  toe  and  emerged  over  that 
of  the  little  toe.  The  first,  second,  third,  and  fourth  metatarsal  bones  were  shattered.  The  patient  suffered  considerable  pain. 
Two  days  after  the  injury  excision  of  the  first  metatarsal  bone  was  performed  and  the  shattered  fragments  of  the  second,  third, 
and  fourth  Avere  removed  by  Assistant  Surgeon  C.  H.  Andrus,  128th  New  York.  Chloroform  was  used,  and  the  patient  reacted 


624  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  X. 

promptly.  He  did  well  afterwards.  Five  days  after  the  operation  considerable  haemorrhage  occurred,  but  was  completely 
arrested  by  light  pressure  on  the  dorsal  artery.  Simple  water  dressings  were  used.  The  case  was  still  doing  well  when  the 
patient  was,  on  May  22d,  transferred  to  University  Hospital  at  New  Orleans."  Surgeon  S.  Kneeland,  U.  S.  V.,  in  charge  of  the 
latter  hospital,  reported  the  result  of  the  case  as  follows :  "  The  whole  foot  became  greatly  swollen,  purulent  inflammation  having 
occurred  on  the  dorsal  and  plantar  surfaces ;  several  of  the  bones  became  disorganized  and  the  tibio-tarsal  articulation  completely 
anchylosed;  patient  greatly  reduced  by  the  excessive  suppuration;  pulse  78;  appetite  tolerably  good.  He  also  suffered  from 
chronic  diarrhoea  and  intermittent  fever,  from  which  he  had  recovered  on  June  20th,  when  the  leg  was  amputated  at  the  middle 
third  by  Acting  Assistant  Surgeon  F.  Hassenburg.  Chloroform  was  used,  and  the  haemorrhage  attending  the  operation  was 
Blight.  Under  a  supporting  diet  and  cool  dressings  the  patient  did  well  up  to  June  30th.  He  died  from  the  effects  of  chronic 
diarrhoea  July  15,  1864." 

CASE  914. — Private  J.  G.  Fowler,  Co.  K,  42d  Illinois,  was  wounded  in  the  left  foot,  at  the  battle  before  Nashville, 
December  15,  1864.  He  was  admitted  to  Cumberland  Hospital  at  Nashville,  whence  Surgeon  B.  Cloak,  U.  S.  V.,  reported  :  "The 
metatarsal  bone  of  the  second  toe  was  fractured  and  two-thirds  of  its  tarsal  extremity  was  excised  the  day  after  the  injury.  One 
week  after  the  operation  trismus  set  in,  the  patient  complaining  of  stiffness  of  the  jaws,  and  on  the  following  day  the  muscles  of 
the  neck  and  shoulders  were  in  a  state  of  tonic  spasm.  The  patient  was  placed  under  the  influence  of  chloroform  and  the  wound 
was  thoroughly  cleaned  out  with  the  knife,  after  which  concentrated  nitric  acid  was  applied.  Large  quantities  of  opium  were 
administered  internally,  but  without  effect.  On  December  25th  opisthotonos  ensued,  in  which  condition  the  patient  died  at  8  A.  M." 

INTERMEDIARY  EXCISIONS  IN  THE  BONES  OF  THE  FOOT. — Twenty  cases  with  fifteen  recoveries 
and  five  deaths,  a  mortality  rate  of  25.0  per  cent.,  belong  to  this  group.  In  two  of  the 
fifteen  cases  of  recoveries  the  patients  subsequently  submitted  to  amputations  in  the  leg : 

CASE  915. — Private  J.  M.  Cole,  Co.  G,  8th  Michigan  Cavalry,  aged  22  years,  was  accidentally  wounded  in  the  right  foot, 
at  Waynesboro',  November  20,  1864,  and  entered  hospital  No.  1,  Nashville,  eight  days  afterwards.  Surgeon  B.  B.  Breed, 
U.  S.  V.,  who  operated  in  the  case,  made  the  following  report:  "The  wound  was  caused  by  a  ball  entering  the  dorsal  surface, 
fracturing  the  third  and  fourth  metatarsal  bones,  and  emerging  directly  opposite  on  the  plantar  aspect.  The  foot  became  highly 
inflamed  and  tumefied;  tarso-metatarsal  articulation  opened;  patient  suffering  much  from  pain;  appetite  impaired;  bowels 
constipated.  The  third  and  fourth  metatarsal  bones  were  excised  on  November  30th  through  an  incision  two  and  a  half  inches 
long  ou  the  dorsal  surface.  Chloroform  was  used.  Hospital  gangrene  appeared  in  the  wound  five  days  after  the  operation  and 
was  promptly  arrested  by  one  application  of  undiluted  bromine.  After  this  the  wound  healed  rapidly.  Cold-water  dressings 
were  used  and  nourishing  diet  was  furnished.  On  December  21st  the  patient  was  transferred  to  Louisville."  He  was  ultimately 
discharged  from  Harper  Hospital,  Detroit,  May  12,  1865,  by  reason  of  permanent  lameness  resulting  from  the  wound.  Examiner 
D.  A.  West,  of  Lexington,  Michigan,  June  13,  1877,  certified  to  the  wound,  loss  of  metatarsal  bones,  etc.,  and  added  that  "the 
cicatrix  is  very  sensitive  to  the  touch.  There  appears  to  be  bulbous  extremities  of  some  of  the  nerves,"  etc.  "A  spicula  of  bone 
is  now  troubling  the  plantar  surface  and  may  necessitate  removal."  The  man's  application  for  pension  was  rejected  owing  to 
his  inability  to  produce  corroborative  evidence  as  to  the  cause  of  the  reception  of  the  injury. 

CASE  916. — Private  M.  H.  Hargrave,  8th  Indiana  Battery,  aged  42  years,  was  wounded  at  Chickamauga,  September  20, 
1863.  He  was  admitted  to  the  field  hospital  at  Crawfish  Springs,  where  Surgeon  A.  Ewing,  13th  Michigan,  recorded  the  injury 
as  "a  wound  of  the  left  foot,  the  ball  entering  the  centre  of  the  metatarsal  bone,  going  inward  and  backward  through  the  tarsus, 
fracturing  all  the  bones  in  its  passage.  Resection  of  the  os  calcis  and  portion  of  the  astragalus  was  performed  on  September  29th." 
After  passing  through  other  hospitals  subsequently  the  patient  Avas  transferred  to  Evansville,  March  8,  1864,  the  wound  having 
healed  previous  to  that  date.  Ou  December  30,  1864,  he  was  mustered  out  of  service  and  pensioned.  Various  examining  sur 
geons  certified  to  his  inability  to  walk  without  crutches.  The  pensioner  died  November  16,  1871.  His  attending  physician, 
Dr.  F.  W.  Billert,  testified:  "He  came  under  my  personal  observation  when  he  was  discharged  from  the  army;  was  then  very 
much  prostrated,  and  prostration  was  succeeded  by  violent  reaction  and  fever,  terminating  in  general  nervous  exhaustion.  This 
left  him  partially  paralyzed  in  the  lower  extremities,  broke  down  his  constitution,  and  finally  generally  paralysis,  it  is  supposed, 
took  place,  resulting  in  death." 

CASE  917.— Private  M.  Goffney,  Co.  A,  114th  New  York,  aged  27  years,  was  wounded  at  Cedar  Creek,  October  19, 1864. 
Assistant  Surgeon  J.  Homans,  jr.,  U.  S.  A.,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Nineteenth  Corps, 
with  a  "severe  bullet  wound  of  the  bones  of  the  left  foot."  Surgeon  T.  B.  Reed,  U.  S.  V.,  reported  the  following  result  of  the 
injury  :  "  The  patient  was  admitted  to  Filbert  Street  Hospital,  Philadelphia,  five  days  after  receiving  the  wound.  The  missile 
had  entered  at  the  insertion  of  the  tendo-achillis  and  remained  hidden  among  the  bones  of  the  foot.  Theos  calcis  and  the  astrag 
alus  were  fractured.  After  admission  the  pans  commenced  to  slough  ;  circulation  became  feeble ;  appetite  depraved,  and  general 
condition  bad.  Haemorrhage  from  the  posterior  tibial  artery  to  the  amount  of  eight  ounces  occurred  on  October  31st,  when 
Acting  Assistant  Surgeon  E.  L.  Duer  ligated  the  vessel  in  the  continuity  behind  the  malleolus,  removed  a  portion  of  the  os  calcis 
and  extracted  the  ball.  Ether  was  used  as  the  anaesthetic.  The  patient  did  not  recover  from  its  influence  for  several  hours,  then 
suffered  from  nausea  constantly,  became  jaundiced,  and  presented  decided  pyaemic  symptoms.  The  treatment  consisted  of  mer 
curials,  tonics,  stimulants,  and  nutritious  diet.  Cups  were  applied  over  the  liver  and  nitric  acid  to  the  wound,  followed  by  per 
manganate  of  potash.  Death  resulted  on  November  9,  1864.  At  the  post-mortem  examination  no  metastatic  abscesses  were  found, 
nor  any  pus  except  in  the  joints  of  the  foot ;  liver  greatly  engorged;  blood  fluid  and  dark ;  stomach  softened  ;  gall  bladder  empty." 

CASE  918. — Private  W.  W.  McKeran,  Co.  H,  3d  Michigan,  was  wounded  in  the  foot,  at  Fair  Oaks,  May  31,  1862,  by  a 
musket  ball,  which  entered  the  outer  side  of  the  fifth  metatarsal  bone  and  made  its  exit  at  the  first  metatarsal  just  behind  the 
great  toe.  He  was  admitted  to  Judiciary  Square  Hospital,  Washington,  four  days  afterwards,  where  the  wound  went  on  slowly 
for  some  days.  The  foot  was  probed  and  portions  of  the  metatarsal  bones  were  found  to  be  bare  and  broken.  There  being  no 
apparent  natural  effort  to  throw  off  the  fragments,  the  upper  wound  was  enlarged  and  one-half  the  second  metatarsal  bone, 


SECT.  VII.]  EXCISIONS    IN    THE    BONES    OF    THE    FOOT.  625 

including  the  phalangeal  articulation,  was  removed,  together  with  considerable  fragments  of  the  third  and  fourth  metatarsals. 
On  the  following  day  there  was  some  pain,  but  no  haemorrhage.  On  June  26th  the  patient  was  much  better ;  foot  a  little  red  ; 
poultices  applied.  June  28th,  severe  chills;  quinine  administered.  June  29th  and  30th,  patient  the  same;  foot  inflamed  a  little. 
July  1st,  very  severe  chills  and  fever;  skin  and  conjunctivas  yellow;  tongue  brown,  dry,  and  horny.  July  2d,  bad  symptoms 
increased.  July  3d,  continuous  vomiting;  jaundice  worse;  tongue  more  moist.  July  4th,  patient  apparently  a  little  better. 
July  5th,  fool  improved,  but  general  aspect  bad.  Patient  died  July  6,  1862.  The  history  was  contributed  by  Acting  Assistant 
Surgeon  D.  W.  Cheever,  who  also  forwarded  the  removed  portions  of  the  metatarsal  bones.  (Cat.  Surg.  Sect.,  1866,  p.  420, 
Spec.  506.) 

SECONDARY  EXCISIONS  IN  THE  BONES  OF  THE  FOOT. — One  of  the  seventeen  secondary  excis 
ions  in  the  bones  of  the  foot  was  followed  by  death.  Of  the  sixteen  patients  who  survived 
the  operation  one  subsequently  suffered  amputation  in  the  leg.  The  names  of  twelve  are 
found  on  the  Pension  Kolls;  one  has  died  since  his  discharge  from  the  service  of  Bright's 
disease  of  the  kidneys. 

CASE  919. — Sergeant  T.  Barbin,  Co.  C,  81st  Pennsylvania,  aged  18  years,  was  wounded  in  the  right  foot,  at  Fredericks- 
burg,  December  13,  1862.  Assistant  Surgeon  C.  R.  Greenleaf,  U.  S.  A.,  contributed  the  following  report  of  the  injury:  "He 
received  the  wound  from  a  conoidal  ball,  which  passed  directly  through  the  boot  and  entered  the  heel,  passing  through  the  os 
calcis  in  an  oblique  direction  from  behind  forward  and  from  above  slightly  downward.  Considerable  haemorrhage  attended  the 
wound,  and  after  an  attempt  at  walking  the  man  was  carried  to  a  house  near  by,  where  a  bandage  was  applied.  Two  days  after 
wards  he  was  taken  to  Washington  and  admitted  to  Mount  Pleasant  Hospital,  where  cold-water  dressings  were  applied.  Eight 
days  later  he  was  transferred  to  Mower  Hospital,  Philadelphia,  where,  on  examination,  the  bone  was  found  to  be  carious,  and 
poultices  were  ordered.  From  this  date  until  the  time  of  the  operation  several  pieces  of  bone  were  discharged  and  some  small 
abscesses  were  opened.  As  no  improvement  was  observed  and  the  probe  could  be  passed  entirely  through  the  bone,  showing  a 
considerable  loss  of  substance,  it  was  finally  determined  to  remove  the  os  calcis.  On  May  16th  I  proceeded  with  the  operation, 
being  assisted  by  Drs.  J.  H.  B.  McClellan  and  C.  R.  McLean  (Acting  Assistant  Surgeons),  and  the  patient  being  freely  under 
the  influence  of  chloroform.  An  incision  was  commenced  a  little  in  front  of  the  articulation  between  the  cuboid  and  calcis  and 
carried  around  the  heel,  parallel  with  the  long  axis  of  the  calcis,  to  a  point  just  posterior  to  the  posterior  tibial  artery;  another 
was  made  at  right  angles  to  this,  about  two  and  a  half  inches  in  length,  through  the  tendo-achillis.  The  flaps  Avere  then 
dissected  back  and  disarticulation  was  effected  in  the  manner  recommended  by  Mr.  Erichsen,  the  operation  being  completed  in 
thirty  minutes  and  no  artery  requiring  ligation  being  cut.  Morisell's  solution  was  used  to  control  the  haemorrhage  from  the 
smaller  arterial  twigs  and  veins.  The  flaps  were  accurately  brought  together  and  retained  in  position  by  silver-wire  sutures, 
an  opening  being  left  posteriorly  for  the  escape  of  fluids.  Cold-water  dressings  were  used.  One-half  grain  of  morphia  was 
given,  and  some  little  febrile  action  during  the  next  two  days  was  controlled  by  spirits  mindereri.  On  May  18th,  Smith's  ante 
rior  splint  was  applied  to  the  leg  and  adhesive  strips  from  the  toes  to  a  point  near  the  incision.  The  incisions  on  the  inner  side 
of  the  foot  healed  by  first  intention  and  the  sutures  were  withdrawn  on  May  20th,  and  a  sponge  tent  was  ordered  to  keep' open 
the  posterior  point  of  exit,  which  had  closed  by  granulations.  On  May  22d  all  the  sutures  were  removed  and  adhesive  strips 
re-applied.  Large  quantities  of  grumous  pus  were  being  discharged.  The  patient  continued  to  improve,  and  on  the  24th,  the 
splint  was  removed,  a  sling  made  from  a  sheet  being  substituted.  After  this  the  patient  improved  rapidly  and  left  his  bed  on 
June  12th,  the  wound  having  healed  with  the  exception  of  a  slight  track  at  the  junction  of  the  two  incisions,  from  which  a  little 
healthy  pus  was  being  discharged.  By  June  17th  tlie  patient  could  bear  his  weight  on  the  foot,  the  sinus  having  closed.  The 
contour  of  the  foot  was  not  materially  altered,  the  sole  being  a  little  flatter  than  its  fellow.  He  was  in  excellent  health  and  fine 
spirits,  and  felt  no  pain  when  bearing  his  weight  on  the  foot,  but  said  that  it  felt  very  springy."  In  addition  to  the  history,  Dr. 
Greenleaf  also  stated  that  as  soon  as  the  parts  had  become  a  little  hardened  and  accustomed  to  their  new  position,  a  shoe  filled 
with  hair  at  the  heel  was  to  be  furnished  to  the  patient.  The  subsequent  records  of  the  hospital  show  that  the  patient  was  able 
to  wear  his  shoe  by  July  loth,  and  could  walk  without  crutch.  Afterwards  he  was  allowed  to  stay  at  his  home  in  Philadelphia 
on  furlough,  getting  stronger  every  day  and  his  foot  being  entirely  healed.  On  November  30,  1863,  he  was  discharged  from 
service  and  pensioned.  Examining  Surgeon  W.  Jewell,  of  Philadelphia,  September  14,  1866,  certified  that  "the  removal  of  the 
os  calcis  has  left  the  pensioner  lame  in  his  gait  but  not  otherwise  injured.  Other  examiners  report  nothing  additionally  import 
ant.  The  pensioner  was  paid  September  4,  1880.  The  excised  calcaneum,  contributed  to  the  Museum  by  the  operator,  and 
exhibiting  general  caries,  constitutes  specimen  1286  of  the  Surgical  Section.1 

CASE  920. — Private  M.  Dean,  Co.  F,  4th  Kentucky,  aged  24  years,  was  wounded  in  the  right  foot,  at  Chickamauga, 
September  19,  18G3.  He  was  sent  to  hospital  at  Chattanooga,  and  thence  one  month  afterwards  to  hospital  No  1,  at  Nashville. 
Surgeon  C.  W.  Horner,  U.  S.  V.,  in  charge  of  the  latter,  reported:  "The  wound  penetrated  the  structure  of  the  tarsus  and 
metatarsus.  The  parts  became  considerably  swollen,  painful,  and  involved  in  suppurative  inflammation.  The  patient's  system 
was  much  reduced  from  irritative  fever  and  nervous  disturbance.  On  December  7th  Acting  Assistant  Surgeon  G.  P.  Hachenberg 
made  an  incision  about  three  inches  in  size  and  excised  the  cuboid  bone,  using  two  parts  of  chloroform  and  one  of  sulphuric  ether 
as  an  anaesthetic.  The  patient  improved  very  slowlv.  Tonics  and  stimulants  were  administered,  and  warm-water  dressings,  and  a 
weak  solution  of  bromine  was  applied  to  the  wound  about  two  weeks  after  the  operation."  Three  months  after  the  date  of  the 
operation  the  patient  was  transferred  to  hospital  No.  7,  at  Louisville,  whence  he  was  returned  to  duty  June,  1864.  At  the 
expiration  of  his  term  of  service,  October  25,  1864,  he  was  mustered  out  of  service  and  pensioned.  Various  examining  surgeons 
have  certified  to  the  injury  and  to  the  use  of  the  foot  and  ankle  as  being  very  much  impaired.  The  pensioner  was  paid  Sep 
tember  4,  1880. 

1  A  detailed  account  of  this  case  by  Surgeon  C.  R.  GREEXLEAF,  U.  S.  A.,  will  be  found  on  page  389  of  Vol.  XLVI  of  the  American  Journal  of  the 
Medical  Sciences,  Philadelphia,  1863. 

SURG.  Ill— 79 


626 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.X. 


TABLE  XOVII. 
Summary  of  Ninety-seven  Cases  of  Excisions  in  the  Bones  of  the  Foot. 

Primary  operations,  1—53;  Intermediary  operations,  54—73;  Secondary  operations,  74—90;  Time  of  operation  not  specified,  91—97. 


No 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPEHATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Aldrich,  W.  S.,  Pt.,  B, 

May  12, 

c  •  
Right;  part  of  os  calcis.    Disch'd 

35 

Troutman,    P.,    Pt.,    A, 

May  27, 

Right  ;    os   calcis.     Surg.   S.  II. 

14th  Intantry,  age  21. 

12,  '04. 

May  20,  1805  ;  pensioned.    ' 

77th  Penn.,  age  18. 

27,  '04. 

Kersey,  30th  Ind.     Discharged 

2 

Anderson,  F.,Pt.,H,  28th 

May  25, 

Left;  third  metatarsal.     June  9, 

April  1,  1805;  pensioned. 

Pennsylvania,  age  40. 

25,  '64. 

amputation  toe.     Vet.  Reserve 
Corps  March  29,  1805. 

36 

'Turner,  H.   A.,  Lieut, 
and  Q.  M.,  43d  Mass. 

Nov.  —  , 

1862, 

Right:  3d  metatarsal.     Surg.  A. 
C.   Webber,  43d  Mass.     Duty 

3 

Anderson,  J.,Pt.,  F,  70th 

May  5, 

Left.    Duty  December  9,  1864. 

Primary. 

December  21,  1802. 

New  York,  age  19. 

5,  '04. 

37 

Vandcrgriff,  J"..Capt.,  F, 

—  !  Right;  two  metatarsals.    Surg.  J. 

4 

Badeau,  A.,  Captain  and 

May  27, 

Left  ;  mid.  and  parts  of  int.  and 

53d  Georgia,  age  28. 

1     J.  Knott,  53d  Ga.     Recovery. 

Aide-de-Camp. 

27,  63. 

ext.  cuneiform  ;  end  of  2d  met. 

<  38 

Van  Gorder,  C.,  Serg't, 

Oct.  5, 

Left:  internal  cuneiform.    Surg, 

Surgeon  10.  F.  Sanger,  U.  S.  V.   i 

B,  3!)th  Iowa,  age  27. 

0,  '04. 

J.  H.  /earing,  57th  111.     Disch'd 

Retired  May  18,  I860. 

June  5,  180.'). 

5 

Chapman,    P.,    Pt.,   H, 

May  19, 

Right;   2d  metatarsal.     Disch'd 

39 

Weaver,   G.,  Teamster, 

July  13, 

Left  ;  2d  and  3d  metatarsals.    Re 

38th  Illinois,  age  36. 

19,  '04. 

January  25,  1865;  pensioned. 

97th  New  York. 

—  ,  '64. 

covery. 

6 

1  C  ,  G.,  —  ,  —  ,  age  23. 

May  12, 

Right  ;  whole   calcaneum  ;  amp. 

40 

Whittier,  C.,  Pt.,  C,  12th 

Sept.  17, 

Left  ;  large  portion  os  calcis.  Dis 

12,  '64. 

left  leg.     Surf  .  —Strait,  C.S.A. 

Massachusetts,  age  19. 

—  ,  'iy. 

charged  Jan.  13,  '03;  since  died. 

Recovery.                                             41 

Baumberger,    J.,   Musi 

Nov.  30, 

Right;  ext.  mid.  cuneiform  and 

7 

Donohue,  M.,  Pt.,  G,  7th 

Dec.  5, 

Left  ;  metatarsal.     Surg.  L.  W. 

cian,  H,  50th  N.  York, 

Dec.  •>, 

scaphoid.     Ass't  Surgeon  J.  F. 

Rhode  Island,  age  23. 

5,  '04. 

Bliss,  57th  N.  Y.    Duty  April 

age  22. 

1804. 

II  uber,  U.  S.  V.     Died  Dec.  26, 

28,  1865. 

1804  ;  pya-mia. 

8 

Drummond,  A.  H.,  Pt., 

Dec.  13, 

Right  :  3d   and   4th   metatarsals.  i    42 

Fowler,  J.  G.,    Pt.,   K, 

Dec.  15, 

Left  ;    two-thirds   tarsal   and    2d 

II,  3d  Maine,  age  IS. 

13,  '02. 

Disch'd  June  4,  '04;  pensioned. 

42d  Illinois. 

10,  '04. 

metatarsal.   Died  Dec.  25,  1804  ; 

9 

Dubois,  L.  A.,  Lieut.,  I, 

Sept.  20, 

Right  ;  end  of  2d  mot.     Surg.  H. 

tetanus. 

12Uth  New  York,  age 

20,  '64. 

F.  Lyster,  5th  Mich.     Disch'd!    43 

Hall,  A.  A.,  Corp'l,  M, 

April  2, 

Left;    metatarsal.     Surg.   J.   H. 

24. 

January  10,  1805. 

31st  Maine,  age  18. 

2,  '65. 

Kimball,  31st  Me.     Died  April 

10 

Eggleston,  F.,   Pt.,   D, 

Nov.  12, 

Right;  liead  1st  phal.  great  toe;  I 

15,  1865. 

8th  New  York  Cavalry, 

12,  '64. 

head  1st  met.     Surg.  N.  D.  Fer 

44 

Hanson,  N.,  Pt.,  C,  38th 

June  17, 

Left;  metatarsal.     Surg.  W.  B. 

age  21. 

guson,  8th  N.  Y.  Cavalry.    Mus 

Wisconsin,  age  34. 

17,  '04. 

Fox,  8th  Mich.    Died  June  25, 

tered  out  June  19,  1865. 

1864;  wound. 

11 

Freeman,  D.  R.,  Pt.,  D, 

May  5, 

Left  ;   4th   metatarsal.     Disch'd 

45 

Hunt,  P.,  Lieut.,  A,  1st 

May  30, 

Right;   os  calcis.     Surg.   G.   L. 

7th  Wisconsin,  age  21. 

5,  '04. 

May  22,  1805  :  pensioned. 

Rhode  Island  Artillery. 

30,"  '64. 

Potter,  145th  Penn.     Died  June 

12 

Garrtty,  P.  H.,  Corp'l,  H, 

June  14, 

Right;  2d  metatarsal.     A.  Surg. 

14,  1804  ;   pyoemia. 

91st  New  York,  age  24. 

14,  '63. 

J.  T.  Myers,  91st  N.  Y.     Duty 

46 

Jones,  J.,  Serg't,  H,  21st 

May  3, 

;  os  calcis. 

Septembers,  1805;  pensioned,    i 

Georgia. 

3,  r03. 

13 

Goodwin,  J.   L.,  Lieut., 

July  22, 

Right  ;  2d  and  3d    metatarsals.      47 

Judkins,  A.,  Pt.,  B,  10th 

May  2, 

Left;  metatar.  and  phal.  of  three 

H,  57th  Mass.,  age  24. 

22,  '64. 

Disch'd  Nov.   29,    1804.     Died 

Maine. 

2,  '63. 

mid.  toes.     Died  June  14,  1803  ; 

Nov.  "J2,  1809  ;  consumption. 

gangrene  of  leg. 

14 

Greenleaf,  B.  F.,  Pt.,  E, 

Aug.  15, 

Left;  2d  metatarsal.     To  Provost 

48 

Locke,   J.,   Pt.,    G,    5th 

July  —  , 

Left:  tarsal  and  metatarsal.  Died 

5th  Tenn.  Cav.,  age  31. 

10,  '04. 

Marshal  Nov.  Hi,  1864. 

North  Carolina. 

1803. 

July  18,  1803. 

15 

Harrington,  W.  C.,  Pt., 

April  2, 

Left  ;    5th   metatarsal.      Disch'd 

49 

Norton,  W.  A.,  Capt.,  I, 

June  18, 

Left  :  5th  metatarsal.    Died  July 

C,  1st  Vt  H.  A.,  age  19. 

2,  '05. 

July  0,  1865;  pensioned. 

100th  Penn.,  age  23. 

18,  '64.  . 

21,  1804;  exhaustion. 

16 

Henry,  A.  R.,  Pt.,  1,12th 

May  12, 

Right  ;  2d  metatarsal.     V.  R.  C.      50 

Pero,  P.,  Pt.,  C,  2d  New 

May  5, 

Right;  1st  metatarsal.     A.  Surg. 

i  .Massachusetts,  age  30. 

12,  '04. 

April  28,  1805;  pensioned. 

York  Cavalry,  age  22. 

7,  '04. 

C.  H.  Andrus,  128th  N.  Y.    June 

17  i  rfitehcuck.  15.  F.,  Serg't, 

May  25, 

Left  ;  2d  metatarsal.    Surg.  J.  V. 

20,   amp.    leg.     Died  July  15, 

F.  14'Jth  N.  York,  age 

25,  '04. 

Kendall,  149th  N.  Y.     Disch'd 

1804;  chronic  diarrhoea. 

24. 

June  12,  180.");  pensioned. 

51 

Williams.  J.  M.,  Capt., 

June  3, 

Right,     Died  June  15,   1804,  of 

18. 

Jock,  D.  B.  W.,  Pt.,  H, 

July  1, 

Left;  portion  os  calcis.     Disch'd 

C,  31st  Maine,  age  47. 

3,  '04. 

wound. 

104th  N.  York,  age  23. 

—  ,  '63. 

May  10,  1804;  pensioned. 

52 

Wright.    M.   F.,   Major, 

Dec.  20, 

Left  :  tarsal  ,•  amputation  of  leg. 

19 

Leunze,  J.,  Pt.,  C,  71st 

Nov.  20, 

Right;    1st   metatarsal.      A.    A. 

29th  Ohio,  age  20. 

2(1,  '04. 

Died  January  7,  1805. 

Ohio,  age  37. 

28,  '63. 

Surg.    C.   II.    Fisher.      Disch'd 

53 

Young,  —  ,  Pt.,  G,  8th 

May  5. 

;   distal  end  4th  metatarsal. 

May  10,  1605  ;  pensioned. 

Ohio. 

—  ,  V>4. 

Surg.  C.  Bowen,  (5th  Penn.  Res. 

20 

McGlinn,  J.,  Corp'l,  F, 

July  28, 

Right;  1st  metatarsal.     V.  R.  C. 

54 

Arnot,    T.,   Pt.,    E,  7th 

Sept.  17, 

Left:  2d  metatarsal.    A.  A.  Surg. 

60th  Ohio,  age  29. 

28,  '64. 

November  19,  1804. 

Michigan,  age  28. 

Oct.  4, 

J.   Dickson.     Discharged  Nov. 

21? 

Murray,  M.,  Pt.,  F,  19th 

July  30, 

Left  ;  lower  half  os  calcis.  Right  ; 

1802. 

3,  1802  :  pensioned. 

22$ 

Colored  Troops. 

Aug.  2, 

5th  metatarsal.     Surg.  D.  Mac-      5.") 

Bailey,   D.,   Pt.,  G,  3d 

June  10, 

Right  ;  3d  and   4th   metatarsals. 

1804. 

Kay,  29th  C.  T.;  recovery. 

Iowa  Cavalry,  age  20. 

14,  '64. 

A.  A.  Surg.  J.  N.  Sharp,     Feb. 

23 

Nash,  C..  Serg't,  A,  82d 

April  4, 

Right  ;  3d  metatarsal.     Surg.  N. 

—  .  1805,  amp.  leg.     Discharged 

Colored  Troops,  age  21. 

4,  '05. 

N.  Hoi-ton,  47th  C.  T.     Disch'd 

Sept.  11,  1805. 

May  30,  1865. 

56 

Bowen,    M.,    Corp'l,  H, 

May  18, 

Left;    portion   os   calcis.     A.  A. 

24 

Phalen,  P.,Pt.,  B,  117th 

Sept.  29, 

Left;  portion  of  os  calcis.     Dis 

57th  Mass.,  age  22. 

28,  '04. 

Surg.  F.  G.  II.  Bradford.     Dis 

New  York,  age  40. 

29,  '64. 

charged  July  0,  '65;  pensioned. 

charged  May  13,  1803  ;  pens'd. 

25 

Pickctt,  G.,  Pt.,  B,  51st 

Sept.  19, 

Right;  portion  cuboid.    To  prison 

57 

Brouchard,  A.,  Pt.,   A, 

April  7, 

Left  ;  2d  and  4th  metatarsals.     A  . 

Virginia,  age  20. 

20,  '64. 

February  Hi,  1865. 

5th    New    Hampshire, 

17,  '65. 

Staff  Surg.  J.  Aiken,  U.  S.  A. 

26 

'Richards,  J..  Pt,,  D,  5th 

July  4, 

Left;    4th  and  5th   metatarsals. 

age  34. 

Disch'd  Aug.  12,   1865.     Amp. 

Connecticut. 

4,  '64. 

July  —  ,   amp.    leg;   Aug.   12, 

leg.     Feb.  —  ,  1860,  amp.  knee 

re-amp,  leg.     Disch'd  May  12, 

.joint  ;  subsequent  amp.  thigh. 

1805.     Died  Feb.  24,  1807. 

58 

Cole.  J.  M.,  Pt.,  G,  8th 

Nov.  20, 

Right;  3d  and  4th   m.etatarsals. 

27 

Rowell,  P.,  Pt.,   A.  1st 

June  23, 

Left  ;  4th  metatarsal.   Duty  June 

Michigan  Cavalry,  age 

30,  '64. 

Surg.  15.  15.  Breed,  U.  S.  V.  Dis 

Maine  H'vy  Artillery. 

23,  '04. 

7,  1805. 

22. 

charged  May  12,  1805. 

28 

Ryan,  J..  Serg't.  G,  4th 

Nov.  24, 

Right  ;  4th  and  5th  metatarsals. 

59 

Hargrave,  M.  II.,  Pt.,  8th 

Sept.  19, 

Left  :  portion  of  os  calcis  and  as- 

West  Va.,  age  25. 

24,  '63. 

Surg.  I.  N.   Barnes,  116th  111. 

Indiana    Battery,    age 

29,  '03. 

tragalus.   Disch'd  December  30, 

Disch'd  July  6.  '64  ;  pensioned. 

42. 

1804.    Died  November  Hi.  1871  : 

29 

Scanlon,  B.,  Pt.,  K,  103d 

Nov.  25, 

Right  ;  1st  metatarsal.      Disch'd 

paralysis. 

Illinois,  age  27. 

25,  '63. 

July  5.  1804;  pensioned.                   do 

Jackson.  R.  G.,  Pt..  A, 

June  3, 

Rijrht;   li  in.  3d  metatarsal  (ery- 

30 

Shriver,    G.  A.,   Lieut., 

April  2, 

Right;    1st  metatarsal.     Disch'd  !| 

8th   New  York  Heavy 

9,  '04.         sipelatous).     Ass't  Surg.  S.  J5. 

B,  119th  Penn.,  age  23. 

2,  '65. 

June  19,  1805;  pensioned. 

Artillery,  age  23. 

Ward.  IT.  S.  V.     Disch'd  Oct.  6. 

31 

Smith,  R.  J.,  Pt..  G,  21st 

Nov.  28, 

Left;  two-thirds  2d  metatarsal. 

• 

1804  ;  pensioned. 

Kentucky,  age  22. 

28,  '64. 

A.  A.  Surg.  T.  C.  Eakin.     Kry-      61 

Jacobs,  W.  G.,  civilian, 

Sept.  11. 

;  third  of  os  calcis.     Disch'd 

sijielas.     Disch'd  Sept.  11,  1805.   • 

age  30. 

Hi,  '02. 

Dec.  1,  1802;  pensioned. 

32 

Smith,  W.  A.,  Serg't,  C, 

Feb.  21, 

Right;  1st  and   2d   metatarsals.      6:.' 

Kinscll,  G.  W.,  Pt,,  D, 

June  3, 

Left  ;    4th   and   5th  metatarsals. 

7th  Infantry,  age  39. 

22,  '62. 

Disch'd  Aug.  23,  '02  ;  pensioned. 

184th  Penn.,  age  19. 

2".  '04. 

A.  A.  Surg.  E.  L.  Bliss.  Disch'd 

33 

Trennor,  J.,  Lieut.,  H, 

June  3, 

Left;  os  calcis.     Surg.  P.  E.  Hu- 

May  IS,  1805:  pensioned. 

28th  Mass.,  age  23. 

3,  '64. 

bon,  28th  Mass.    Disch'd  Oct. 

63 

McDougal,  J.,  Pt,,  E,2d 

May  20, 

Right;  3d  metatarsal.  A.  A.  Surg. 

13,  1804.     Died  Feb.  8,   1670;   1 

N.  Y.  Cavalry,  age  23. 

30,  '64. 

R.  W.  W.  Carroll.     Discharged 

consumption. 

May  22,  1805;  pensioned. 

34 

Troutman,  J.  C.,  Pt.,  K, 

June  19, 

Left  ;  2d  and  3d  metatarsals.    Dis 

64 

Myerson,G.,  Pt.,  G,  14th 

Oct.  14, 

Left  ;  os  calcis.  Surg.  E.  Bentley, 

3d  Teun.,  age  29. 

22,  '64. 

charged  July  8,  '05  ;  pensioned. 

Connecticut,  nge  24. 

18,  '63. 

U.  S.  V.     Disch'd  Aug.  18,  '05. 

I 

•McGuiRE  (H.),  Excision  of  the  Os  Calcis,  in  The  Philadelphia  Medical  Times,  1870-71,  Vol.  I,  p.  6. 

*  WEBBER  (A.  C.),  Army  Medical  Intelligence,  in  Boston  Medical  and  Surgical  Journal,  Vol.  LXVIII,  1863,  p.  164. 


SECT.  VII.] 


AMPUTATIONS    IN    THE    FOOT. 


627 


Vr» 

NAME,  MILITARY 

DATFS 

OPERATIONS,  OPEUATOKS, 

NO. 

NAME,  MILITARY 

OPERATIONS,  OPERATORS, 

iXU. 

DESCRIPTION,  AND  AGE. 

RESULT. 

DESCRIPTION,  AND  AGE. 

DATKS. 

RESULT. 

65 

Sherd,   W.,   Corp'l,    G, 

Aug.  16, 

Left  ;  2d  metatarsal.    A.  A.  Surg. 

80 

Fritchman,  J.,  Serg't,  E, 

July  2, 

Right;  os  calcis.    A.  A.  Surg.  T. 

llth  Maine. 

—  ,  '64. 

F.   Ganntt.      Discharged   May 

105th  Penn.,  age  31. 

Nov.  1, 

G.  Morton.     Discharged   Sept. 

24,  1865;  pensioned. 

1803. 

4,  1804. 

06 

Sweeney,  B.,  Pt.,  B,  7th 

July  2, 

Left.  A.  A.  Surg.  A.  E.Carothers. 

81 

Gage,    C.,    Pt..    D,   8th 

May  20, 

Left;  two  metatarsal  bones.     A. 

Infantry,  age  30. 

22,  V63. 

Disch'd  May  14,  '64  ;  pensioned. 

Maine,  age  20. 

1804, 

Surg.  J.  Vansant.     Disch'd  May 

67 

Young,  W.  C.,   Corp'l, 

Nov.  27, 

Left  ;  3d  and  4th  metatar.    Surg. 

Feb.8,'05. 

15,  J865;  pensioned. 

H,  24th  Mich.,  age  29. 

Dec.  9, 

E.  Bentley,  U.  S.V.     Duty  July 

82 

Haws,  C.  B.,  Pt.,  B,  7th 

Se.l7.'02, 

Left;  portion  of  cs  calcis  (necro 

1803. 

13,  1804. 

Maine,  age  21. 

Ja.24,'03. 

sis).     Duty  June  !'.  1803. 

68 

Zimmerman,  B.,  Pt.,  B, 

June  15, 

Left  :  3d  and  4th  metatarsals.     A. 

83 

Hodges,  G.,  Pt.,  K,  13th 

Sept.  20, 

Right;    almost   entire  os    calcis 

lllth  Penn.,  uge  33. 

21,  '04. 

Surg.  J.  D.  Johnson,  U.  S.  V. 

Michigan,  age  19. 

Dec.  20, 

(necrosis).     A.  A.  Surg.  D.  O. 

Disch'd  April  11,  1865;  pens'd. 

1803. 

Farrand.     Discharged  April  25, 

C9 

Carl,  A.  J.,  Pt.,  C,  5th 

July  3, 

Right  ;  upper  half  metatarsal  of 

1804  ;  pensioned. 

Michigan,  age  27. 

13,  V64. 

great  toe.     A.  A.  Surg.  T.  T. 

84 

Irwin,   T.,  Pt.,  H,  llth 

Se.17,'63, 

Left  ;  portion  of  os  calcis.     Ass't 

Devan.     Died  July  22,   1864; 

Pennsylvania,  age  26. 

Nov.  3, 

Surgeon  C.  H.  Alden,  U.  S.  A. 

pyaemia. 

1803. 

Discharged  June  1>.  1804. 

70 

Gaffnev,  M.,  Pt.,  A,  114th 

Oct,  19, 

;  portion  of  os  calcis.     A.  A. 

85 

Shinquin,  E.,  Pt.,  E,  63d 

Se.  17,  '02, 

Right  ;   base  of  os  calcis.    Vet. 

New  York,  age  27. 

31,  '64. 

Surg.  E.  L.  Duer.    Died  Nov.  9, 

New  York. 

Ja.  10/63. 

Kes.  Corps  June  25.  1803. 

1864  :  pyaemia. 

86 

Spielman,    T.,    Pt.,    F, 

Aug.  29, 

Rifflit  :  os  calcis.     Surg.  J.  G.  F. 

71 

Green,    T.,   Pt.,   I,   9th 

May  5, 

Left  ;  1st.  4th,  and  5th  metatarsals 

95th  Ohio,  age  23. 

1802, 

Holston,  U.  S.  V.    July  10,  '64, 

Massachusetts. 

—  ,  '64. 

and  mid.  cuneiform.  A.  A.  Surg. 

Se.21,'63. 

amputation  leg;  recovery. 

C.  H.  Van  Tagen.    Died  May 

R7 

Stroud,   D.,   Pt.,  B,  3d 

Nov.  30, 

Left  ;  3d  metatarsal.    A.  A".  Surg. 

28,  1804. 

Mississippi,  age  41. 

1864, 

W.  J.  R.  Holmes.     To  Provost 

72 

King,  E.,Pt.,B,  1st  Ver 

Aug.  25, 

Right;    1st   metatarsal.      A.  A. 

Jan.  1,  '65. 

Marshal  May  6,  1865. 

mont  Cavalry,  age  18. 

30,  '64. 

Surg.   M.  J.  McHench.    Died 

88 

Tvrigg,  0.,  Pt.,  C,  46th 

Au.  3,'64, 

Right;    5th   metatarsal.      A.  A. 

Sept.  11,  1864;  pytemia. 

Ohio,  age  23. 

Feb.  7, 

Surg.  W.  H.  Drury.     Disch'd 

73 

McKenian,  W.  \V.,  Pt., 

May  31, 

;  half2d  metatarsal  and  parts 

1865. 

June  30,  1865;  pensioned. 

H,  3d  Michigan. 

June  24, 

of  3d  and  4th.     A.  A.  Surg.  D. 

80 

Yax,    O.,    Pt.,    C,   22d 

Se.  20,  '63, 

Right  ;    almost  entire  os  calcis. 

1862. 

\V.  Cheever.  Died  July  6,  1862. 

Michigan,  age  23. 

Jan.  20, 

Surgeon  C.  S.  Tripler,  U.  S.  A. 

Spec.  506. 

1804. 

Disch'd  May  2,  '04  ;  pensioned. 

74 

Albert,  J.  B.,  Corp'1,  K, 

Mar.  23, 

Left  ;  1  st  metatarsal.   A.  A.  Surg. 

90 

Freese.  J.  B.,  Pt.,  I,  1st 

July  2, 

Left  ;  os  calcis.     Died  August  15, 

110th  Penn.,  age  32. 

May  2, 

J.  Gibbons,     Disch'd   Oct.  14, 

Minnesota,  age  25. 

Au.  2,  '63. 

1863  ;  trau.  fever  and  pytvmia. 

1862. 

1862  ;  pensioned. 

91 

Ferguson.  A.,  Pt.,  C,  22d 

July  12, 

Left  ;  part  of  os  calcis.     Disch  d 

75 

!Barbin,  T.,  Serg't,  C, 

De.13,'62, 

Right  ;    entire  os  calcis.      Ass't 

Kentucky,  age  42. 

—  ,  '63. 

Nov.  21,  1804;  pensioned. 

81st  Penn.,  age  18. 

May  16, 

Surg.  C.  R.  Greenleaf.  U.  S.  A. 

92 

O'Leary,  C.,  Pt.,  F,  3d 

July  —  , 

Left  ;  portion  1st  metatarsal.   Dis 

1863. 

Disch'd  Nov.  30,  '63.  Spe.c.  1286. 

Infantry,  age  22. 

2,  '03. 

charged  Aug.  20,  '04  ;  pensioned. 

76 

Bennett,  T.,  Pt.,  E,  5th 

July  2, 

Right  ;  4th  and  5th  metatarsals 

93 

Whitefie'ld,   N.,    Pt.,  B, 

June  27, 

Right  ;  portion  of  os  calcis.    Dis 

Michigan,  age  28. 

Oct.  27, 

(necrosis).    Disch'd  Dec.  18,  '63. 

16th  Michigan,  age  18. 

—  ,  '02. 

charged  Dec.  18,  1862  ;  pens'd. 

1863. 

Died  May  12,'G4  ;  Bright's  dis. 

94 

Wendell,  D.  F.,  Pt,,  D, 

June  17, 

Left;    2d    metatarr.al.      Disch'd 

77 

Dean,  M.,  Corp'l,  F,  4th 

Sept.  19, 

Right  ;  cuboid.     A.  A.  Surg.  G. 

60th  Ohio,  age  20. 

—  ,  '64. 

Feb.  27,  1865.     Died  August  8, 

Kentucky,  age  24. 

Dec.  7, 

P.  Hachenburg.     Disch'd  Oct. 

1870;  consumption. 

1863. 

25,  1864  ;  pensioned. 

95 

Wood,  G.F.,Pt.,E,  24th 

May  23, 

Right  ;    metatarsal.     Died  June 

7- 

Button,  L.  N.,  Serg't,  C, 

De.13,'62, 

Left;   int.  cuneiform,   portion  of 

Massachusetts,  age  19. 

—  ,  '64. 

24,  1864  ;  pysemia. 

•  3d  Vermont,  age  20. 

Jan.  16, 

metatarsal.      Disch'd   April   1, 

96 

.  Cross,   T.,  Pt.,   D,  21st 

Oct.  8, 

;  3d  metatarsal  ;  gangrene. 

1863. 

1863;  pensioned. 

South  Carolina. 

—  ,  '64. 

79 

Fender,  B.  F.,  Corp'l,  B, 

May  19, 

Right  ;  1J  in.  2d  and  3d  metatar 

97 

Smith,  L.  S.,  Pt.,  —  ,  2d 

Aug.  14, 

Left;  metatarsal. 

113th  Illinois,  age  30. 

Nov.  29, 

sals  (gangrene).     Discharged; 

South  Carolina. 

—,'64. 

1863. 

pensioned. 

The  operations  were  performed  in  the  right  foot  in  forty-four,  in  the  left  in  forty-eight 
instances;  in  five  cases  the  side  was  not  indicated.  Eighty-eight  patients  were  Union, 
seven  Confederates,  and  two  unknown  soldiers.  In  seven  instances  the  excision  in  the 
foot  was  followed  by  re-amputation  in  the  leg,  and  in  one  instance  re-amputations  were  per 
formed  in  the  leg,  at  the  knee  joint,  and  finally  in  the  thigh.  Gangrene  was  noted  in  eight 
cases  (five  recoveries,  two  deaths,  and  one  unknown  result);  pyaemia  in  eight  (all  fatal); 
erysipelas  in  one  (recovery);  and  tetanus  in  one  (fatal)  instance. 

AMPUTATIONS  IN  THE  FOOT.  — One  thousand  five  hundred  and  eighteen 
amputations  in  the  foot  were  recorded:  in  eighty-seven  the  operation  was  through  the 
tarsal  bones;  in  forty-one  through  the  tarso-metatarsal  articulation;  in  one  hundred  and 
thirteen  from  one  to  four  metatarsals  and  the  corresponding  toes  were  amputated;  in  fifty 
cases  the  operation  was  simply  denoted  as  "amputation  of  the  foot;"  and  in  one  thousand 
two  hundred  and  twenty-seven  instances  the  operation  was  confined  to  the  toes — embracing 
the  ablation  of  one  toe  in  one  thousand  and  one  instances;  of  two  toes  in  one  hundred  and 
forty-five,  of  three  toes  in  thirty-one,  of  four  toes  in  eight,  and  of  all  five  toes  in  eighteen 
instances;  in  twenty-four  cases  the  number  of  toes  removed  was  not  stated. 

Seven  hundred  and  fifty  were  primary,  two  hundred  and  sixty-seven  intermediary, 
and  ninety-four  secondary  operations ;  in  four  hundred  and  seven  the  time  of  the  operation 
was  not  indicated. 

1  GREENLEAF  (C.  R.),  Excision  of  the  Os  Calcis,  in  American  Journal  Medical  Sciences,  Vol.  XLVI,  p.  389. 


628 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.    X. 


TABLE  XCVIII. 
Numerical  Statement  of  One  Thousand  Five  Hundred  and  Eighteen  Cases  of  Amputation  in  the  Foot. 


METHOD  OF  OPERATION. 

CASES. 

PRIMARY. 

INTER-         j  SECOXU- 
MED1AUY.      1       .A  BY. 

TIME  NOT 
SPECIFIED. 

5 
'S 
H 

Kecoveries. 

Deaths. 

Undetermin'd. 

Percentage  of 
Mortality. 

Recoveries. 

Deaths. 

Undetermin'd. 

Recoveries. 

Deaths. 

Undetermin'd. 

Recoveries. 

Deaths. 

Recoveries. 

Deaths. 

Undetermin'd. 

85 

24 
17 
113 
1,227 
50 

72 
1 
22 
11 
99 
1,093 
18 

11 
1 
1 
6 
9 
29 
24 

81 

2 

13.2 
50.0 

57 

5 

1 

1 

5 
1 

6 

1 

1 

q 

Amputation  through  tarso-metatarsal  articulation  (LlSFRANC's)  .  . 
Amputation  through  tarso-metatarsal  articulation  (HEY's)  
Amputation  of  from  one  to  four  metatarsal  bones  and  toes  

1 

5 

105 
8 

4.3 
35.2 
8.3 
2.5 

57.1 

16 
9 
52 
512 
5 

1 
4 
3 

18 
4 

1 
59 

4 

1 
24 
207 

1 

1 

j 

6 
5 
3 

1 
19 

2 

11 

3 
43 

8 

54 

3 

76 
1 

92 

•  , 
9 

.... 

298       6 
11      17 

1,518 

1,316 

121 

5.7 

651 

*  

3(1 
750 

63    243 

20 

'S  — 

267 

4 

2 

,  • 
4 

330     03 
407 

PKIMARY  AMPUTATIONS  IN  THE  FOOT. — Of  the  seven  hundred  and  fifty  primary  opera 
tions  the  results  were  not  ascertained  in  sixty-three;  six  hundred  and  fifty-one  patients 
survived  and  thirty-six  died,  a  mortality  rate  of  5.2  per  cent.  One  hundred  and  sixty-one 
operations  were  through  the  tarsal  or  metatarsal  bones;  five  hundred  and  eighty-nine  were 
amputations  of  the  toes. 

CASK  921. — Private  M.  C.  Fitxpatrick,  Co.  H,  2d  New  York  Mounted  Rifles,  aged  50  years,  was  wounded  before  Petersburg, 
Juue  30, 1864.     He  was  admitted  to  the  field  hospital  of  the  2d 
division,  Ninth  Corps,  where  Surgeon  J.  Harris,  7th  Rhode 
Island,  recorded :  '•'  Fracture  of  right  foot  by  mini6  ball,  followed 

\,  "  -  s?M 

by  Chopart's  amputation."     Several  days  after  the  operation  I 

the  patient  was  transferred  to  Washington,  where  he  entered  \  f:, 

Stanton  and  subsequently  Judiciary  Square  Hospital.     The  ! 

wound  was  reported  ns  healing  mostly  by  first  intention,  leav 
ing  an  excellent  stump.  On  April  1,  1865,  the  patient  was  j 
discharged  from  service  and  pensioned,  having  been  previously 
furnished  with  an  artificial  foot  by  the  Jewett  Patent  Leg  Co. 
Examiner  H.  N.  Loomis,  of  Buffalo,  N.  Y.,  September  4,  1869, 
certified  to  the  loss  of  the  foot  and  stated  :  "  Wound  healed, 
leaving  the  ankle  nearly  powerless  and  the  end  of  the  stump 
and  heel  very  tender.  His  general  health  is  very  feeble,  with 
harassing  cough  and  night  sweats."  The  history  of  the  case 
was  accompanied  by  drawings  copied  in  the  adjoining  wood 
cuts  (FlGS.  356,  357).  .The  pensioner  died  of  consumption 
December  28,  1869. 

CASK  922. — Private  J.  Armstrong.  Co.  H,  39th  Illinois,  aged  41  years,  was  wounded  in  the  left  foot,  at  Morris  Island, 
August  15,  1863.  Assistant  Surgeon  J.  Trenor,  jr.,  reported  the  following  history:  "A  shell  struck  the  phalanges  and  carried 
off  all  the  toes  except  the  fifth.  Amputation  was  performed  through  the  metatarsal  bones  at  the  centre  of  their  continuity, 
immediately  after  the  wound  was  received,  by  Surgeon  C.  M.  Clark,  39th  Illinois.  Six  days  after  the  operation  the  wounded 
man  was  admitted  to  hospital  No.  4,  at  Beaufort.  The  wound  was  then  in  a  sloughy  condition,  with  an  exceedingly  offensive 
discharge  and  every  symptom  of  constitutional  irritation.  Cold-water  dressings  were  used.  The  patient  continuing  to  grow 
worse,  a  consultation  of  surgeons  was  held  five  days  after  his  admission,  when  a  second  operation  was  deemed  the  best  plan  for 
saving  his  life,  and  Chopart's  amputation  was  resolved  upon  for  the  next  day.  As  a  last  resort,  however,  to  avoid  another 
operation,  the  dressings  were  changed  to  oakum,  and  in  about  sixteen  hours  a  change  for  the  better  was  evident  in  the  aspect  of 
the  wound.  It  steadily  continued  to  improve  until  the  date  of  the  report,  August  31st,  when  there  was  every  prospect  that  the 
foot,  would  have  a  good  cicatrix  and  a  fair  support  sufficient  for  the  weight  of  the  body."  In  the  following  month  the  patient 
was  transferred  to  McDougall  Hospital,  New  York,  and  subsequently  he  was  admitted  to  Marine  Hospital.  Chicago,  where  he 
was  discharged  from  service  November  3, 1864,  and  pensioned.  In  March,  1871,  the  stump  was  tender,  swelling  after  exercise. 
CASK  923. — Private  M.  Shauprhnepsv.  Co.  H.  2d  Pennsylvania  Artillery,  aged  28  years,  received  a  shot  fracture  of  the  bones 
of  the  left  foot,  before  Petersburg,  June  1H.  1864.  He  was  admitted  to  the  field  hospital  of  the  2d  division,  Sixth  Corps,  where 
primary  amputation  by  Chopart's  method  was  performed.  Surgeon  G.  T.  Stevens,  77th  New  York,  who  performed  the  operation. 


Fio.  356.  —  CIIOPART'S 
amputation ;  anterior  view, 
f  After  a  drawing.] 


FIG.  357. — CllOl'AKT's  amputation; 
view.     [After  a  drawing1.] 


SECT.  VII.J  AMPUTATIONS    IN    THE    FOOT.  629 

reported  that  "the  flap  was  made  from  the  inner  side  of  the  foot,  the  sole  being  too  much  mutilated  for  Chopart's  operation." 
Two  days  after  the  date  of  the  injury  the  wounded  man  was  transferred  to  Hampton  Hospital,  and  several  weeks  later  he  was 
transferred  to  Philadelphia.  He  was  discharged  December  10,  1864,  and  pensioned.  In  his  subsequent  application  for  commuta 
tion  the  pensioner  reported  the  stump  of  the  foot  as  being  in  ''good  and  healthy  condition."  His  pension  was  paid  June  4,  1880. 
CASE  924. — Private  J.  Miller,  Co.  E,  6th  Pennsylvania  Reserves,  aged  20  years,  was  wounded  in  the  right  foot,  fracturing 
the  bone,  at  Fredericksburg,  Uect  mber  13,  1862.  He  was  admitted  to  the  field  hospital  of  the  3d  division,  First  Corps.  Surgeon 
C.  Bower,  6th  Pennsylvania  Reserves,  reported  that  he  performed  "amputation  at  the  tarsus"  on  the  day  of  the  injury.  Acting 
Assistant  Surgeon  H.  Hirschfield  reported  the  progress  of  the  case  as  follows :  "The  patient  was  admitted  to  Harewood  Hospital 
at  Washington  ten  days  after  being  wounded.  Chopart's  amputation  had  been  performed  on  the  field.  On  December  27th, 
when  the  case  was  first  seen  by  me,  there  was  much  suppuration  and  the  wound  seemed  to  be  drawn  open,  by  the  teudo-achillis. 
1  applied  a  splint  to  correct  the  tension  and  at  first  used  cold  wator  and  afterwards  warm  dressings ;  tonics  and  stimulants  were 
administered.  By  January  20,  1863,  the  wound  had  nearly  healed  and  dry  lint  and  bandages  were  used.  A  small  abscess  hud 
appeared  at  the  ankle  and  had  been  opened.  About  February  15th  this  opening  became  gangrenous  and  the  leg  in  this  locality 
swelled  up  to  an  enormous  size — the  abscess,  which  originally  was  only  two  inches  long,  growing  into  a  large  sore  of  circular 
shape  three  and  a  half  inches  in  diameter.  All  the  tissues  and  even  the  periosteum  were  destroyed.  Healthy  granulations, 
however,  were  finally  brought  out,  and  the  part  was  healing  but  could  not  close  up  on  account  of  necrosis  in  part  of  the  tibia- 
While  the  healing  process  of  the  neighboring  parts  was  progressing  favorably,  erysipelas  set  in  and  spread  from  the  foot  to 
nearly  up  to  the  knee,  being  attended  by  excessive  sloughing  of  the  original  abscess.  This  soon  passed  off,  however,  and  after 
a  few  days  the  wound  again  became  healthy  in  appearance,  decreased  in  extent,  and  the  leg  resumed  its  natural  size  rapidly. 
Things  now  went  on  favorably  again  for  a  time,  when  severe  pain  indicated  another  collection  of  matter  above  the  line  of  the 
affected  tibia  and  towards  the  middle  of  the  leg,  which  was  relieved  by  an  incision  two  inches  in  length  into  the  periosteum, 
giving  free  exit  to  the  confined  pus.  This  last  opening  healed  up  readily,  and  by  June  1st  nature  had  completed  the  exfoliation 
of  the  cortical  substance  of  the  tibia,  which  I  removed  four  inches  in  length.  The  wound  now  healed  up  very  rapidly,  but  several 
days  afterwards  gangrene  re-appeared  and  continued  up  to  June  10th.  Poultices  were  continued  in  the  mean  time  and  the  treat 
ment  was  adapted  to  the  exigencies  of  the  case.  During  the  progress  of  the  case  the  patient's  general  condition,  which  was  very 
good  now,  had  varied  according  to  the  several  complications,  being  sometimes  very  low  and  prostrated  from  hectic  and  diarrhoea, 
but  always  reacting  rapidly.  On  June  14th  healthy  granulations  once  more  showed  themselves,  and  by 
July  8th  the  wound  had  closed  up  to  the  size  of  a  two-shilling  piece.  Ten  days  later  it  was  healed  entirely, 
the  patient's  general  condition  being  excellent."  He  was  discharged  from  service  September  4,  1863,  and 
pensioned,  and  one  year  afterwards  he  was  supplied  with  an  artificial  foot  by  the  Palmer  Arm  and  Leg  Co. 
of  Philadelphia.  The  pensioner  was  paid  June  4,  1880. 

CASE  925. — Private  T.  H.  Hodgson,  Co.  F,  67th  Ohio,  aged  32  years,  was  accidentally  wounded, 
at  Folly  Island,  June  22,  1863,  by  a  musket  ball  fracturing  the  left  foot.  Amputation  by  Chopart's  method 
was  performed  the  following  day  by  Surgeon  S.  F.  Forbes,  67th  Ohio.  The  wounded  man  passed  through 
various  hospitals  and  was  lastly  transferred  to  Central  Park,  New  York  City,  where,  as  soon  as  the  stump 
had  entirely  healed,  he  was  supplied  with  a  "  Hudson  "  artificial  foot.  Four  months  later,  on  August  9, 
1864,  the  patient  was  discharged  from  sen-ice  and  pensioned.  The  Dayton,  Ohio,  Examining  Board  on 
January  16,  1871,  reported  a  "  well  healed  and  very  useful  stump,"  and  described  the  operation  as  very 
creditable  to  the  operator  and  to  the  author  of  it.  A  cast  of  the  stump  (Spec.  1530),  made  about  a  year 
aftgf  the  date  of  the  operation  and  showing  a  firm  and  smoothly  united  cicatrix  well  up  on  the  anterior 
face,  was  contributed  to  the  Museum  by  Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  and  is  represented  amputant'n^of  "hfhsft 
in  the  adjoining  wood-cut  (FlG.  358).  foot.  [Prom  a  cast.] 

In  the  succeeding  three  cases  three  or  more  of  the  metatarsal  bones  with  the  cor 
responding  toes  were  removed.  The  remaining  toes  were  a  constant  source  of  annoyance: 

CASE  926. — Private  R.  P.  Saint,  Co.  F,  123d  Indiana,  aged  22  years,  was  wounded  in  the  right  foot  by  a  shell,  during  the 
siege  of  Atlanta,  August  4,  1864.  Partial  amputation  of  the  foot  by  removing  the  four  outer  toes,  including  the  distal  extremities 
of  their  metatarsal  bones,  and  leaving  the  great  toe  intact,  was  performed  on  the  day  of  the  injury.  The  wounded  man  continued 
under  treatment  in  various  successive  hospitals  until  June  11,  1865,  when  he  was  discharged  from  service  and  pensioned. 
Examiner  G.  W.  Hears,  of  Indianapolis,  certified,  August  23, 1865 :  "  The  wound  is  now  healed,  but  the  foot  and  ankle  are  weak. 
As  yet  but  little  weight  can  be  sustained  on  the  foot  and  crutches  are  therefore  still  in  requisition.  It  is,  however,  improving  in 
strength  and  will  soon  be  used  in  walking."  On  November  17,  1866,  the  same  examiner  stated  :  "What  disables  the  pensioner 
most  seriously  is  the  pain  suffered  when  the  foot  is  much  used,  the  .eschar  being  yet  tender  to  the  touch  from  imperfect  healing 
and  liable  to  inflammation,"  etc.  Examining  Surgeon  G.  A.  Haise,  of  Russell,  Kansas,  October  12, 1877,  described  the  great  toe 
of  the  injured  foot  as  being  drawn  or  lapped  across  the  cicatrix.  The  pensioner  was  paid  March  4,  1881. 

CASE  927. — Private  J.  T.  Lewis,  Co.  B,  38th  Illinois,  aged  21  years,  was  wounded  in  the  right  foot,  before  Atlanta, 
August  16,  1834.  Surgeon  M.  G.  Sherman,  9th  Indiana,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Fourth 
Corps,  and  described  the  injury  as  a  "fracture  of  the  metatarsus,  followed  by  amputation  of  three  toes  by  Surgeon  S.  H.  Kersey, 
36th  Indiana."  The  wounded  man  subsequently  passed  through  various  hospitals  and  was,  lastly,  transferred  to  Jeffersonville. 
Assistant  Surgeon  A.  B.  Prescott,  U.  S.  V.,  in  charge  of  the  latter,  described  the  operation  as  a  "flap-amputation  of  the  three 
lesser  toes  at  the  tarso-metatarsal  articulation."  On  June  1,  1865,  the  patient  was  discharged  from  service  and  pensioned. 
Examining  Surgeon  J.  Portness,  of  Xenia,  Illinois,  certified,  April  6,  1866 :  "  The  third,  fourth,  and  last  toes  with  their  metatarsal 
bones  have  been  removed,  leaving  only  the  great  and  second  toe.  This  renders  the  sole  of  the  foot  very  narrow  and  destroys 
the  elasticity  of  the  arch  of  the  foot  in  a  great  measure."  The  reports  of  subsequent  examinations  show  no  additional  information. 
The  pensioner  was  paid  December  4,  1878,  since  when  he  has  not  been  heard  from. 


630 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


CASE  928.—  Sergeant  H.  S.  Carroll,  Co.  D,  33d  Missouri,  aged  20  years,  was  wounded  in  the  left  foot,  at  the  battle  of 
Lake  Chicot,  June  6,  1864,  by  a  shell  which  destroyed  the  second,  third,  and  fourth  toes.  He  was  admitted  to  the  Sixteenth 
Corps  Field  Hospital,  where  partial  amputation  of  the  injured  foot  was  resorted  to  by  Surgeon  A.  T.  Bartlett,  33d  Missouri,  who 
described  the  operation  as  having  been  performed  through  the  second,  third,  and  fourth  metatarsal  bones.  From  the  field  the 
patient  was  sent  to  Adams  Hospital,  at  Memphis,  where  he  remained  under  treatment  for  four  months,  when  he  was  returned 
to  duty.  He  was  discharged  August  10,  18b'o,  and  pensioned.  Various  examiners  have  from  time  to  time  certified  to  "irritation 
and  swelling  of  the  foot  when  much  used;"  and  Dr.  H.  E.  Jones,  of  Louisiana,  Missouri,  added,  January  12,  1878,  that  "  the 
big  toe  is  drawn  nearly  at  right  angle  with  the  foot  and  rests  on  the  little  toe."  The  pensioner  was  paid  June  4,  1881. 

CASE  929.  —  Private  C.  L.  Daniels,  Co.  K,  57th  Massachusetts,  aged  18  years,  was  wounded  before  Petersburg,  July  20, 
1864.  Surgeon  M.  K.  Hogan,  U.  S.  V.,  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Ninth  Corps,  with  "  shot 
fracture  of  the  bones  of  the  right  foot,  treated  by  Chopart's  amputation." 
Acting  Assistant  Surgeon  F.  F.  Maury  reported  the  result  of  the  case  as 
follows:  "The  patient  was  admitted  to  South  Street  Hospital,  Philadelphia, 
July  26th.  He  stated  that  he  was  wounded  by  a  mini6  ball  entering  the 
right  side  of  the  foot  and  fracturing  the  bones  to  such  an  extent  as  to  demand 
amputation  on  the  field.  He  was  sent  to  City  Point  and  thence  by  hospital 
boat  to  this  city.  At  the  time  of  his  admission  to  this  hospital  the  patient 
was  in  a  typhoid  condition,  fretful,  irritable,  and  at  times  delirious.  The  stump 
was  in  a  very  good  condition,  with  but  a  slight  tendency  to  inflammation  in 
the  leg.  This  condition  yielded  readily  to  applications  of  laudanum  and 
leadwater,  after  which  the  stump  and  leg  both  improved.  Compound 
tincture  of  cinchonas  and  afterwards  quinine  was  prescribed;  beef  tea  and 
milk  punch  were  given.  The  typhoid  fever  did  not  yield  to  the  treatment, 
the  patient  continuing  to  sink  until  July  29th,  when  death  supervened."  The 
amputated  metatarsal  and  part  of  the  tarsal  bones  (Spec.  6531),  with  the 
bullet  attached  and  showing  the  seat  of  the  fracture,  were  contributed  to  the 
Museum  by  Surgeon  H.  Ludington,  100th  Pennsylvania,  who  performed  the  operation.  A  representation  of  the  specimen 
appears  in  the  wood-cuts  (FiGS.  359,  360). 

CASE  930.  —  Private  W.  H.  Jamison,  Co.  G,  24th  Michigan,  was  wounded  in  the  left  foot,  at  Fredericksburg,  April  29, 
1863.  Surgeon  J.  H.  Beach,  24th  Michigan,  described  the  injury  as  follows  :  "A  mini6  ball  passed  through  the  foot  from  right 
to  left.  All  the  metatarsal  bones  were  injured  and  all  but  that  of  the  second  were  comminuted  fractures.  The  fractures  extended 
to  the  tarso-metatarsal  articulation  in  the  first  and  in  the  fourth.  Amputation  was  performed  on  May  1st,  by  Surgeon  E.  Shippen, 
U.  S.  V.,  at  the  tarso-metatarsal  articulation  by  Lisfranc's  method,  a  good  covering  being  obtained  from  the  plantar  flap.  Perfect 
amesthesia  was  preserved  during  the  operation  by  chloroform.  The  case  was  left  at  the  First  Army  Corps  Hospital  and  was 
doing  well  at  last  advices."  Surgeon  A.  W.  Whitney,  13th  Massachusetts,  reported  that  the  patient  died  at  the  Fitzhugh  House 
Field  Hospital,  May  24,  1863,  from  the  result  of  the  injury.  The  amputated  bones  of  the  foot  (Spec,  1121)  were  contributed  to  the 
Museum  by  the  operator. 

In  the  following  table  one  hundred  and  sixty-one  primary  amputations  in  the  tarsal  or 
metatarsal  bones  are  enumerated;  space  will  not  permit  to  cite  the  amputations  of  the  toes 
in  this  and  the  succeeding  three  tables: 

TABLE  XCIX. 

Summary  of  One  Hundred  and  Sixty-one  Primary  Amputations  in  the  Tarsal  and  Metatarsal  Bones 

for  Shot  Injury. 

[Recoveries,  1—139;  Deaths,  140—157;  Unknown,  158—  163.  | 


F  ,  T9  -F     tureofuie 
tarsai  bones;   dorsal  view, 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Adams,   J.   N.,   Pt.,  K, 

Sept.  17, 

Left  ;  Chopart's.     Surgeon  P.  S. 

8 

Brown,  C.   W.,  Pt,,  B, 

Oct.  19, 

Right  ;    Lisfranc's.      Discharged 

31st  Wisconsin,  age  27. 

17,  'G4. 

Arndt.    31st   Wis.     Discharged 

3d  Vermont,  age  23. 

20,  '64. 

May  8,  1865. 

May  13,  18C5;  nee.  of  os  calcis. 

9 

Brown,    L.    C.,    Pt.,  E, 

Oct.  27, 

Left  ;    Chopart's.     Disch'd   June 

2 

Armstrong,   J.,    Pt.,  H, 

Aug.  15, 

Left  ;  Hey's  ;  through  the  centre  of 

30th   Colored    Troops, 

28,  '64. 

22,    1P65;     ''stump    not   good; 

39th  Illinois,  age  37. 

17,  '63. 

continuity  of  metatarsals.  Surg. 

age  29. 

heel  drawn  up." 

C.  M.  Clark,  U.  S.  V.     Disch'd 

10 

Bumgardner,  S.,  Serg't, 

Sept.  22, 

Right;  Choparfs;  also  amp.  left 

November  3,  1864. 

F,  14th  West  Va.,  age 

22,  '64. 

leg.     Disch'd    March    4,    1865. 

3 

Army.  A.  P..  Pt.,  H,  52d 

April  2 

Right  :  Chopart's.   Released  July 

34. 

'*  No  better  thiui  if  amputated  in 

North  Carolina,  age  24. 

3,  '(i5. 

10,  1865. 

lower  third  leg." 

4 

Avery,  J.  R.,  Lieut.,   B, 

Oct.  20, 

Left;  Chopart's.     Surgeon  J.  J. 

11 

Burnside,  G.  M.,  Pt.,  E, 

June  18, 

Lett;  Chopart's,     Surgeon  G.  T. 

53d  Georgia,  nge  30. 

—  ,  '63. 

Knott,  53d  Georgia.     Recovery. 

89th  N.  York,  age  21. 

18,  '61. 

Stevens,   "th   X.  Y.     Disch'd; 

5 

Bean,  G.  H.,  Lieut..  H, 

July  20, 

Right:  3d  and  4th  toes  and  meta 

stump  healod. 

2  1st  Mass.,  age  20. 

20,  '64. 

tarsal  bones.     Discharged  Aug. 

12 

Butner.  A.,  Pt.,  E,  35th 

Deo.  6, 

Right:  Chopart's.    A.  A.  Surg.  J. 

30,  1864  ;  pensioned. 

Kansas  Cav.,  age  18. 

7,  '63. 

Thome.     Disch'd  May  18,  1864. 

6 

Dowers,   A.   M.,  Lieut., 

July  1, 

Left  :  Chopart's.     To  prison  Oct. 

13. 

Buzzard,  A.  W.,  Pt.,  E, 

April  6, 

Left;  Chopart's.     Released  June 

D.  15th  S.  C.,  age  25. 

2,  '63. 

2C,  18f>3;  healed. 

31st  Virginia,  age  43. 

7,  '65. 

2'.',  18(>5;  "muscles  contracted, 

7 

Bovan,    J.,    Pt.,   F,  fith 

June  18, 

Left  ;  5th  toe  and  metatarsal  ;  ne 

elevating  heel." 

N.  Y.  Heavy  Artillery, 

18,  '64. 

crosis.     Discharged  January  20, 

14 

Campbell,  J.,  Corp'l,  8th 

May  18, 

Right  ;   5th   toe  and   metatarsal. 

age  28. 

1865;  pensioned. 

Co.,N.  Y.  S.  S.,  age  24. 

—  ,  '64. 

JJuty  September  12,  1864. 

SECT.  VII.] 


AMPUTATIONS    IN    THE    FOOT. 


631 


No. 

'     NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

XO. 

NAME,  MILITARY 
DESCRIPTION,  AXI>  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

15 

Carlisle,  J.,  Pt.,  H,  16th 

July  3, 

Left;   great  toe   and  metatarsal. 

51 

Hart,  J.  W.,  Pt,,  H,  22d 

Mar.  19, 

Right;  Chopart's.    Disch'd  June 

Vermont,  age  22. 

3,  '63. 

Discharged  August  11,  1863. 

Indiana,  age  18. 

19,  '65. 

i     30,  1865. 

16 

Carroll,  H.  S.,  Serg't,  D, 

June  6, 

Left;  2d,  3d,  and  4th  toes  thro' 

52 

Hawley,  W.  S.,  Corp'l. 

May  19, 

Left  ;  Hey's.     June  9,  gangrene. 

33d  Missouri,  age  20. 

6,  '64. 

raetatarsals.     Surg.  A.  T.  Bart- 

E,  51st  New  York,  age 

19,  '64. 

Oct.  15.  amp.  leg.     Disch'd  May 

lett,  33d  Missouri.     Duty  Octo 

30. 

21,  1865. 

ber  6,  1864;  pensioned. 

53 

Hazel,   P.,   Pt.,   G,    9th 

May  15, 

Left;    3d  toe  at  tarso-metatarsal 

17 

Christian,    W.    T.,   Pt., 

Mar.  25, 

Lett  ;    Lisfranc's.       To    Provost 

New  Jersey,  age  18. 

15,'  '64. 

articuUit'n.    Disch'd  May23,'65. 

G,  25th  Ala.,  age  25. 

25.  '65. 

Marshal  June  13,  1865. 

54 

Herman,  L.,  Pt.,  M,  7th 

June  8. 

Left  ;  Hap  ;  2d  toe  at  tarso  meta. 

18 

Clark,   H.   W..    Pt.,  H, 

May  13, 

Right;  Chopart's;  also  amp.  left 

N.  Y.  Art'y.  age  18. 

8,  '64. 

artic.     V.  R.  C.  Feb.  21,  1865. 

100th   New  York,  age 

13,'  '64. 

ankle  joint.     Surg.  M.  S.  Kittin- 

55 

Higgins,  T.,  Corp'l,  H, 

April  2. 

Left;    Chopart's.     Disoh'd   June 

30. 

gir,  100th  New  York.     Disch'd 

liWd  Ohio,  age  33. 

2.  'fi5. 

23,  1865. 

ec.  1  3,  '64.     Spec.  2857. 

56 

Hodgson,  T.  H.,  Pt.,  F, 

June  22, 

Left;  Chopart's.     Surgeon   S.  I". 

19 

Coan.   N.,   Pt.,  H,  12th 

May  5, 

Left  ;  4th  toe.  mid.  of  metatarsal. 

67th  Ohio,  age  27. 

23,  '63. 

Forbes,  67th  Ohio.     Discharged 

New  Jersey,  age  27. 

5,  '64. 

Vet.  Res.  Corps  June  19,  1865. 

August   9,    1864;    well  healed. 

20 

Coffin,    I.,    R,  D,  69th 

June  22, 

Left,    Chopart's.     Confcd.    sur 

useful  stump.     Spec.  1530. 

Pennsylvania,  age  21. 

22.  '64. 

geon.     Disch'd  June  27.  1865. 

57 

Horr,  D.  P.,  Corp'l,  H, 

Dec.  13, 

Left;    Chopart's.     Disch'd   May 

21 

Collins,   J.,   Pt.,  1,  20th 

Aug.  14, 

Left;   1st,  2d,   3d,  and  4th  toes, 

17th  Maine,  age  23. 

13,  '62. 

11,  1863:  ".-tump    will   always 

Massachusetts,  age  26. 

15,  '64. 

portion   of   metatarsals.     Surg. 

be  troublesome." 

N.  Hayward,  20th  Mass.     Dis 

58 

Rowland,  H.,  Pt.,  A,  3d 

June  (J, 

Left:  1st  toe  at  middle  of  meta 

charged  April  1,  1865. 

Missouri  Cav.,  age  17. 

9.  '65. 

tarsal.     Recovery. 

22 

Cornwall,  N.  S.,  Pt.,  C, 

May  5, 

Left:  Chopart's.     Disch'd  Janu 

59 

Hnmbarger,  A.,  Pt.,  E. 

Nov.  30, 

Left  ;  triangular  of  2d  toe  at  tarsal 

10th  Mass.,  age  26. 

5,  '64. 

ary  7,  1865. 

30th  Indiana,  age  31. 

Dec.  2, 

joint.     A.  A.  Surg.  M.  1'.  \Voolf. 

23 

Cunningham,  D.  C.,  Pt., 

May  4, 

Left  ;  Chopart's.    Surg.  —  Strick- 

1864. 

Soldiers'  Home  April  27,  1865. 

A,  5th  Louisiana. 

5,  fo. 

len,  C.  S.  A.   Disch'd  Nov.  6,'63. 

60 

Ireland,  J.,  Pt.,  H.  8th 

Aug.  17, 

Right  ;  3d  toe,  portion  metatarsal. 

24 

Davis,  J..  Serg't,  A,  12th 

Dec.  13, 

Left  ;  small  toe  and  portion  meta 

N.  Y.  II.  Art'y.  age  24. 

18,  '64. 

Disch'd  May  30,  1865. 

Massachusetts. 

13,  '62. 

tarsal.     Disch'd  March  27,  1863. 

61 

Jenks.   T.   B.,   Pt.,    A, 

July  3, 

Right  ;  Chopart's.     Surg.  C.  F. 

2u 

Davis,    J.    B.,    Pt..    B, 

June  7, 

Left:  3d  toe  and  portion  of  meta 

37th  Mass.,  age  45. 

3,  '63. 

Crehore,   37th   Mass.      Disch'd 

105th  Illinois,  age  27. 

9,  '64. 

tarsal.     A.  Surg.  A.  Waterman, 

Jan.  20,  '64  ;  serviceable  stump. 

105th  Illinois.     Disch'd  October 

62 

Johnson,    S.  J.,  Pt.,  B, 

Dec.  13, 

Left  ;    Hey's.     Discharged  May 

29,  1864  ;  pensioned. 

31st  C.  T.,  age  19. 

14,  '64. 

16,  1865. 

26 

Dunn.    B.,   Pt.,   E,    3d 

July  3, 

Left.    Paroled  September  23,  '63. 

63 

Kendig,    D.  E.,  Pt.,  C, 

April  2, 

Right  ;  3d,  4th,  and  5th  toes  and 

North  Carolina. 

—  ,  ''63. 

5th  Tennessee,  age  25. 

2,  '65. 

metatarsals.     Discharged  June 

OT 

Dyer.  F.  A.  M.,  Pt..  F, 

April  9, 

Right  ;  4th  toe  and  1  inch  meta 

18,  1865. 

1st  West  Va.,  age  35. 

10,  '64. 

tarsal.     Surg.  P.   Gardner.   1st 

64 

King,  A.,  Lieut.,  K.  62d 

June  27, 

Right;  mortification;  July,  186!>, 

Va.  Cav.     D'uty  Sept.  9,  1864. 

Pennsylvania,  age  25. 

28,  '62. 

amp.  leg;   18G3,  re-amputation. 

28 

Eddy,  W.  P.,  Pt..  E.  1st 

May  19. 

Right  ;  Chopart's  ;  no  motion  of  os 

Disch'd  March  17,  1863.     Died 

Mass.  H.  Art'y.  age  29. 

19,'  '64. 

calcis.    Disch'd  July  22.  1864. 

July  12.  1872. 

29 

Elliff,   W.  W.)  Pt.,   G, 

May  6, 

Left;  great  toe  and  metatarsal. 

65 

King,  J.,  Serg't.  K,  50th 

Aug.  21, 

Right  ;  Chopart's.     Provost  Mar 

117th  Illinois,  age  24. 

6,  '64. 

Duty  July  14,  1864:  pensioned. 

Georgia,  age  41. 

—  ,  '64. 

shal  March  8,  1865. 

30 

lFinnigan,I>.,  Pt.,  F,  1st 

June  2, 

;  Chopart's.     Surgeon  C.  B. 

66 

Kingsley,  G.  H.,  Pt.,  A. 

June  17, 

Right  :    Lisfranc's.      Discharged 

Battery. 

3,  '64. 

Gibson,   C.  S.  A.     August  20, 

1st  D.'C.  Cav.,  age  27. 

—  ,  '64. 

Dec.  14,  1864;  serviceable  limb. 

amp.  leg.     Transferred. 

67 

Koon.    C.,   Pt.,   G,   41st 

Nov.  5, 

Left  ;  Lisfranc's.     Surgeon  A.  G. 

31 

Fitzpatrick.  M.  C.  (alias 

June  30, 

Right;  Chopart's.    Disch'd  April 

Ohio,  age  24. 

5,  '62. 

Hart,   41st    Ohio.      Discharged 

Coots  ,  Pt.,  H,  2d  N.  Y. 

30,  '64. 

1,  1865;  "an  excellent  stump." 

December  31,  1862. 

M.  Rifles,  age  44. 

Died  Dec.  28,  1869:  consumpt'n. 

68 

Lamb,  H.,  Pt.,  C,  125th 

June  27, 

Left  ;  2d  toe  and  portion  metatar 

32 

Forbes,  W.  E.,  Pt.,  H, 

Aug.  18, 

Right  ;    oval  ;    3d  and  4th  toes, 

Ohio,  age  19. 

27,  '64. 

sal.     Surg.  J.  B.  Burns,  :!d  Ky. 

14th    Indiana  Battery, 

18,  '64. 

portions  of  metatarsals.    Recov 

Discharged  Feb.  20,  1865. 

age  40. 

ery  Nov.  4,  1864. 

69 

Langford,  J.  C..  Serg't, 

Julv  9, 

;  great  toe  and  its  metatarsal. 

33 

Franklin,  J.  W..  Pt.,  B, 

June  18, 

I/eft  ;    Lisfranc's.     Disch'd  Dec. 

B,    38th   Georgia,   age 

11,  '64. 

Surgeon  C.  H.  Todd,  C.  S.  A. 

8th  New  York  Cavalry, 

18,  '63. 

12,  1863;   "painful  and  difficult 

23. 

Transferred  August  25,  1864. 

age  30. 

use  of  limb.'' 

70 

Lare,  D.,  Corp'l,  A,  51st 

Dec.  2, 

Right  ;    2d  toe  and   metatarsal. 

34 

Fuller,    H.    D.,   Pt.,   F, 

Oct.  19, 

Left:  Chopart's.     Surg.  J.  W.  H. 

Pennsylvania,  age  23. 

2,  '63. 

Disch'd  Sept.  11,  1864. 

28th  Iowa,  age  16. 

20,  '64. 

Vest,  28th   Iowa.     (Also  amp. 

71 

Lewis,  'j.,  Pt,,  B,  38th 

Aug.  16, 

Right  ;  flap  ;  3  lesser  toes  at  tarso- 

arm.)     Disch'd  June  21,  1865; 

Illinois,  age  21. 

16,  '64. 

metatarsal  articulat'n.     Disch'd 

"  better  to  have  removed  entire 

June  1,  1865. 

foot."     Spe.c.  4226. 

72 

Lewis,  J.,  Lieut.,  C,  1st 

Sept.  17, 

Right  :       Chopart's      (modified). 

35 

Galvin,    D.   G.,  Pt.,  G, 

May  5, 

Left  :  2d  toe  and  metatarsal.    Dis 

Delaware. 

17,  '62. 

Discharged  February  23,  1866  ; 

32d  Mass.,  age  26. 

5,  '64. 

charged  April  1,  1865. 

"cicatrix   under  heel;  pressure 

36 

Garvey,    P.,  Pt.,  E,  3d 

Dec.  13, 

Right  ;  4th  and  5th  toes  and  meta 

painful.'' 

Infantry,  age  21. 

13,  '62. 

tarsals.     Disch'd  April  2,  1863; 

73 

Lewis,  L.,  Lieut.,  A,  5th 

De.31,'62, 

Left  :  Chopart's.    Surgeon  W.  A. 

pensioned. 

Confederate  States. 

Jan.  1,  '63. 

Gentry.  17th  Tenn.     Recovery. 

37 

Gay,  8.  J.  J..  Corp'l,  II, 

May  1, 

Left;  Chopart's. 

74 

Lillibridge,  F.  W..  Pt., 

June  18, 

Right;  Chopart's.     Disch'd  Aug. 

51st  Georgia,  age  21. 

2,  '63. 

B.  2d  New  York  M.  R., 

18,  '64. 

10,  1865  ;  amputation  leg. 

38 

Gillespie,     C.,     Pt.,    F, 

Mar.  13, 

Left;    Chopart's.      Surgs.   Hum 

age  18. 

94th  New  York. 

13,  '65. 

phrey  and    Ramsay.      Disch'd 

75 

Little,  L.  B.,  Capt.,  A, 

July  2. 

Right  :    3d   toe  and    metatarsal. 

May29.'65  ;  stnmpbadly  formed. 

9th  N.  Hamp.,  age  24. 

—  ,  !64. 

Disch'd  Oct.  24,  '64  ;  pensioned. 

39 

Gillon,   J.,  Pt.,  F,  27th 

Aug.  4, 

Lett;  Hey's.    Discharged  July  5, 

76 

Lyford,G.  A.,  Corp'l,  D, 

Dec.  13, 

Left:   Chopart's.      Surg.   A.   W. 

Ohio,  age  22. 

4,  '64. 

1865.     " 

13th  Mass.,  age  24. 

13,  '62. 

Whitney,  13th  Mass.     Disch'd 

40 

Givens,   W.  W.,  Pt.,  D, 

July  3, 

Right  ;    Chopart's.      Discharged 

January  7,  1863. 

1st  West  Virginia  Cav. 

3,  '63. 

December  3.  1863. 

McCarty.  T.,  Pt..  B,  4th 

Feb.  5, 

Left:  2cl  toe  at  middle  of  meta 

41 

Gohl,    F.,    Pt.,    K,   8th 

April  5, 

Right:  Hey's;  thro"  metatarsals. 

N.  Y.  Art'y,  age  32. 

5,  '65. 

tarsal.     Disch'd  June  8,  1865. 

Pennsylvania  Cavalry, 

5,  '65. 

neartarsal  articulation.  Disch'd 

78 

McGinley.  R.,  Serg't.  II, 

Sept.  5, 

Right.     Surg.  R.  W.  Hazlett,  2d 

age  27. 

September  23.  1865. 

2d  West  Va.,  age  41. 

—  ,  '61. 

W.  Va.    Disch'd  Nov.  29,  1861. 

42 

Graham,  J.,  Pt.,  E,  2d 

June  18, 

Left  ;   2d  toe  and  portion  meta 

Died  Dec.  15,  1866;  "absorption 

Pa.  Art'y,  age  22. 

18,  '64. 

tarsal.     Surg.   G.   T.   Stevens, 

of  pus  from  necrosed  bone.'" 

77th  N.  Y.     Disch  'd  Mar.  20,  '65. 

79 

Mann,  W.,  Pt.,  A,  llth 

May  22, 

Right;  Chopart's.     Disch'd  Aug. 

43 

Greyer,    J.,    Serg't,   G, 

June  1. 

:  preat  toe  at  tarso-metatar- 

Illinois,  age  32. 

—  ,  '63. 

7.  1863;  ankle  anchylosed. 

52d  Virginia. 

—  ,  '64. 

sal  articulation.     Surgeon  C.  B. 

80 

Matthews,  J..  Pt,,  II,  2d 

Sept.  23, 

Right  ;  Chopart's.      Transferred. 

Gibson.  C.  S.  A.     Transferred. 

North  Carolina,  age  20. 

—  ,  '03. 

44 

Gumlerman,  S.,  Pt.,  F, 

June  20, 

Right:  Chopart's.  Surg.  —  Payne. 

81 

Manson.  J.  S.,  Corp'l,  G, 

May  5, 

Left;  2d  toe  at  middle  of  metatar 

4(Jth  Pennsylvania,  age 

20,  '64. 

Disch'd  March  6,  1865:  "condi 

17th  Maine,  age  21. 

5,  '64. 

sal.     Duty  July  12,  '64  ;  pens'd. 

21. 

tion  worse  than  if  amp.  in  leg.'' 

82 

Marsh,  F.  M.,  Corp'l,  B, 

June  2, 

Left,    4th    toe    and    metatarsal. 

45 

Hall,  J.  L.,  Lieut.,  L, 

June  16, 

Lett  ;  4th  and  5th  toes  and  meta 

118th  Ohio,  age  22. 

3.  '64. 

Duty  December  3,  1864. 

1st  Mass.   H.  A.,  age 

16,  '64. 

tarsals.     Disch'd  October  3,  '64  ; 

83 

Martin,  J.,  Pt..  L,  2d  N. 

June  16. 

Left  ;  four  smaller  toes  and  por 

24. 

pensioned. 

York  Heavy  Artillery, 

16,  '64. 

tion  of  metatarsal.     Discharged 

46 

Ball,  J.  T.,  Pt.,  D,  1st 

Nov.  28, 

Left  ;    Chopart's.      To     Provost 

age  21  . 

Nov.  11,  1864.     Also  amputat'n 

Georgia,  age  27. 

29,  '64. 

Marshal  March  7,  1865. 

right  leg;  re-amputation  1865. 

47 

Hand,    E.,     Pt.,    K,   2d 

June  3, 

Right  :  great  toe  and  metatarsal. 

84 

Miller,  J.,    Pt.,    E.   6th 

Dec.  13, 

Right;    Chopart's.      Surgeon  C. 

Michigan,  age  18. 

—  ,  '64. 

Vet.  Res.  Corps  March  4,  1865. 

Penn.  Reserves,  age  22. 

13,  '62. 

Bowers,  6th  Penn.  Res.     Exfo 

48 

Harris,  L.,  Pt.,  A,  100th 

Mar.  25. 

Right  :  Lisfranc's.  Surg.  —  Davis. 

liation  ;  gangrene.     Discharged 

Pennsylvania,  age  18. 

25,  '65. 

Discharged  June  19,  1865. 

September  14.  1863. 

49 

Harxe.ii,  IF.,  Pt.,  G,  27th 

Aug.  21, 

Left;  Chopart's.     Furl'd   March 

85 

Mitchell,  C.,Pt.,  E,  149th 

May  3, 

Left  ;  1st  toe  and  metatarsal.  Vet. 

South  Carolina,  age  27. 

21,  '64. 

17,  1865. 

New  York,  affe  19. 

3,  '63. 

Res.  Corps  Dec.  15,'63;  pens'd. 

50 

Hart,    E.,    Pt.,    C,    8th 

June  22, 

Left  ;  Chopart's.  Surg.  J.  L.  Bren- 

86 

Mizen,  H.,  Pt.,  A,  145th 

June  18, 

Left  ;  5th  toe  and  metatarsal.  Sur 

Ohio,  age  34. 

23,  '64. 

ton,    8th    Ohio.     Disch'd  Janu 

Pennsylvania. 

18,  '64. 

geon  J.  W.Wishart,  140th  Penn. 

ary  25,  1865. 

Disch'd  Jan.  14,  '65;  pensioned. 

'SMITH  (S.),  Amputations  at  the  AnkU  Joint  in  Military  Surgery,  iu  U.  S.  San.  Com.  Mems.,  Surgical  Volume  II,  p.  140. 


632 


INJUEIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

KO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AC;E. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

87 

Myers,  S.,  Pt.,  D,  2d  N. 

June  3, 

Right  :  mid.  toe  at  mid.  of  meta 

123 

Stabler,  E.,  Pt.,  K,  12th 

June  18, 

Left  ;  Key's.     Ass't  Surg.  S.  T. 

York  Heavy  Artillery, 

3,  '64. 

tarsal.    Furloughed  June  9,  '64; 

Ohio,  age  26. 

20,  '64. 

Buck,  12th   Ohio.     Discharged 

age  24. 

pensioned. 

August  18,  1864. 

88 

Neal,  T.,Pt.,  I,  6th  Mich 

Oct.  18, 

Left  ;   Hey's.     Discharged  June 

|124 

Stead,   I.  B.,  Serg't,  I, 

Dec.  13. 

Right;  Chopart's.     Disch'd  Feb. 

igan  Cavalry,  age  29. 

18,  '62. 

29,  1864." 

136th  Penn.,  age  20. 

14,  '62. 

28,    1863;   "no  power  to   move 

89 

Neile,  E.  C.,  Serg't,  C, 

May  23, 

—  ;  Chopart's.  Surg.  C.  B.  Gib 

ankle  except  with  the  hand." 

1st  Maryland  Cavalry. 

23,  '64. 

son,  C.  S.  A.     Syme's  amp.  re 

'125 

Strait,  O.,  Capt.,  E,  41st 

June  25, 

Right  ;    Chopart's.      Discharged 

commended  by  returning  board. 

Illinois,  age  30. 

25,  '63. 

August  20,  1864. 

90 

Nicholson,  J.W.,  Pt,,  B, 

April  2, 

Right;  Hey's;  "at  middle  of  met 

126 

Swain,  S.  F.,Pt..B,  65th 

July  20, 

Left;  2d  toe  and  metatar.;  hseiu. 

97th  Illinois,  age  30. 

—  ,  '65. 

atarsal  bones."    Surg.  C.  Davis, 

Indiana,  age  32. 

21,  '64. 

Discharged  April  1,  1865. 

77th  111.     Disch'd  May  26,  1865. 

127 

Swartz,   W.  S.,   Pt.,  F, 

Aug.  £8, 

Left  :  2d  toe  and  metatarsal.    Dis 

91 

Nicholson,   W.,  Pt..  K, 

June  22, 

Right  ;  2d  and   3d  toes,  and  1st 

107th  Penn.,  age  31. 

28,  '62. 

charged  Dec.  10,  1864  ;  pens'd. 

191st  Penn.,  age  18. 

23,  '64. 

toe  and  portion  of  metatarsal. 

1128 

Taylor,  W.  J.,Pt.,Norfolk 

April  2, 

Right  ;  Chopart's.    Released  May 

Discharged  March  2,  1865. 

Blues  Lt.  Art'y,  age  21. 

2,  '65. 

30,  1865. 

92 

Noyes,  D.  K.,  Capt.,  A, 

Sept.  17, 

Right  ;    Chopart's.     Surg.   A.  J. 

il29 

Thomas,  A.  P.,  Lieut.,C, 

May  11, 

Left  ;  4th  toe  and  half  of  meta. 

6th  \Visconsin,  age  42. 

17,  '62. 

Ward,  2d  Wisconsin.     Disch'd 

1st  Mich.   Sharpshoot 

11,  '64. 

Surg.  A.  F.  Whelan,  1st  Mich. 

July  27,  1864. 

ers,  age  27. 

S.S.  Disch'd  Sept.  13,'64;  pen'a. 

93 

Oakley,  P.,  Pt.,   A,  2d 

April  20, 

Left  ;  2d  toe  and  metatarsal.     A. 

130 

2  Turd:,  E.,  Pt.,  E,  7th 

May  3, 

;  Chopart's.     Surg.  F.  For- 

Artillery,  age  17. 

21,-  '64. 

A.  Surg.  J.  A.  Romayne.    Duty 
5uly  3,  1864  ;  pensioned. 

131 

Louisiana. 
Vanwagoner,  J.  H.,  Pt., 

—  ,  ''63. 
Aug.  10, 

meato,  jr.,  C.  S.  A.     Recovery. 
Left  ;    Lisfranc's.     Disch'd   May 

94 

O'Connor,  D.,  Pt.,  I.  66th 

June  22, 

Right  ;    Lisfranc's.     Confederate 

B,  31st  WTis.,  age  24. 

10,  '64. 

30,  1865;  "better  to  have  re 

New  York,  age  22. 

23,  '64. 

surgeon.     Disch'd  June  16,  '65. 

moved  whole  foot  ;  cannot  wear 

95 

O'Donahue,  M.,  Pt.,  D, 

May  14, 

Right  ;  3d  and  4th  toes  and  meta 

boot  or  shoe,  etc." 

124th  Ohio,  age  36. 

14,  '64. 

tarsal  bones.     Disch'd  Dec.  27, 

132 

Walker,  D.,  Pt.,  G,  2d 

Mar.  31, 

Right;  Hey's.     Disch'd   July  6, 

1864.      Nov.,    1866,    Pirogoff's 

New  York  H'vy  Artil 

April  1, 

1865;  stump  unhealed. 

amputation  ;  recovered.      Died 

lery,  age  20. 

1865. 

April  13.  1873. 

133 

Walters,  M.,  Lieut.,  A, 

Dec.  13, 

Left  ;    Chopart's.     Disch'd   June 

96 

Oliver,   A.,    Lieut.,   K, 

Nov.  30, 

Right;    Chopart's.     To   Provost 

3d  Penn.  Res.,  age  22. 

—  ,  '62. 

30,  1866.     Died  Dec.  23,  1879; 

18th  Miss.,  age  23. 

30,  '64. 

Marshal  March  27,  1865. 

consumption. 

97 

Parkinson,  J.,Pt.,  1,  103d 

Feb.  15, 

Left;  Lisfranc's.    Surg.  B.  Bond, 

134 

Welling,  D.  C.,  Lieut., 

July  19, 

Left:  Lisfranc's.     Surg.  E.  Bat- 

Illinois,  age  29. 

15,  '65. 

25th  Mo.     Disch'd  June  15,  '65. 

A,  10th  Mich.,  age  24. 

19,  '64. 

well,  14th  Michigan.  Gangrene. 

98 

Parmelee,  E.A.,  Pt,,  F, 

Mar.  25, 

Left;    Chopart's.     Disch'd  June 

Discharged  Feb!  22,  1865. 

5th  Xew  Hamp.,age  24. 

25,  '65. 

26,  1865. 

135 

Williams,    H.,    Pt.,   K, 

April  9, 

Right  ;  Lisfranc's  (also  amp.  left 

99 

Quick,  S.,  Pt.,   F,  28th 

June  18, 

Right;  4th   toe  and  metatarsal. 

198th  Penn.,  age  23. 

9,  '65. 

leg).     Surg.  H.  A.  Grim,  198th 

Kentucky,  age  45. 

19,  '64. 

Disch'd  Feb.  8,  1865  ;  pension  'd. 

Penn.     Disch'd  Oct.  6.  1865. 

100 

Reid,  G.,  Pt.,L,2dConn. 

June  1, 

Right  ;  4th  and  5th  toes  at  tarso- 

136 

Williams,  J.  H.,  Lieut., 

July  2, 

Right;  Chopart's.     Surg.   T.  A. 

Artillery,  age  25. 

1,  '64. 

metatarsal  articulat'n.     Disch'd 

F,  14th  S.  C.,  age  30. 

3.   (13. 

Means,  C.  S.  A.     Exchanged. 

January  5,  1865:  pensioned. 

137 

Williamson,  J.,  Pt.,  D, 

July  19, 

Right;    Lisfranc's.      Surgeon   — 

101 

Reilley,  C.  J.,  Serg't,  K, 

July  10, 

Left;  Chopart's.  Surg.J.A.Wolfe,  i 

86th  Illinois,  age  24. 

19,  '64. 

Houghton.     Disch'd  March   5, 

29th  'Penn.,  age  23. 

11,  '64. 

29th  Penn.     Furl'd;  killed  in  a 

1865;  good  stump. 

railroad  accident  Sept.  20,  1864. 

138 

Wilson,   T.  H.,  Pt.,   F, 

Oct.  7, 

Left;  5th  toe  and  meta.     Disch'd 

102 

Reynolds,    D.,    Pt.,    M, 

July  24, 

Left  ;  3d  toe  and  rnetatar.     Surg. 

4th  Mass.  Cav.,  age  19. 

8,  '64. 

July  30,  1865. 

27th  Michigan,  age  19. 

24,  '64. 

—  Sherlock.  Disc'd  June  13.  '65.  ' 

139 

Zimmet,  T.,   Serg't.  K, 

June  21, 

Right  ;  Lisfranc's.      Surg.   J.   L. 

103 

Reynolds,  S.  T.,  Pt.,  G, 

Sept.  3, 

Right  ;  three  mid.  toes  near  met. 

lllth  Penn.,  age  26. 

21,  '64. 

Dunn,  109th  Penn.    Discharged 

4th   Indiana    Cavalry, 

3,  '64. 

phal.  artic.     A.  A.  Surg.  M.  L. 

June  29,  1865. 

age  20. 

Herr.     Duty  June  14,  1865. 

140 

Beck,  R.  C.,  Pt.,  H,  15th 

June  2, 

Right;  Hey's.     Surg.  C.  B.  Gib 

104 

Robb,    G.,   Pt.,    D,    2d 

July  21, 

Right  ;    Chopart's.      Discharged 

South  Carolina. 

3,  '64. 

son,  C.  S.  A.     Died  July  23.  '64. 

Artillery,  age  19. 

21,  '61. 

November  17,  1861. 

141 

Btmiell,  L.  S.,  Corp'l,  D, 

May  27, 

Right;    Chopart's.      Died   June 

105 

Roberts,  O.  O.,  Serg't.D, 

Oct.  19, 

Left  ;  Chopart's.     Surgeon  G.  T. 

43d  New  York. 

27,  '64. 

26,  1864. 

1st  Maine,  age  22. 

20,  'l»4. 

Stevens,  77th   N.    Y.      Disch'd 

142( 

Carpenter.  J.W.,  Serg't, 

June  3, 

Right  :  1st  metatarsal  (Hey's  am 

February  11,  1865. 

1435 

I,  10th  Vermont. 

3,  '64. 

putation  left  foot).     Died  June 

106 

Rohm,   G.  W.,   Pt.,   H, 

May], 

Left  ;    Lisfranc's.      Disch'd   Oct. 

15,  1864. 

llth  Indiana. 

1,  '63. 

22,  1863;  uses  crutch. 

144 

Daniel,   C.  L.,   Pt.,    K, 

July  20, 

Right  ;  Chopart's.    Surg.  II.  Lud- 

107 

Rosewell,  J.,  Pt.,E,  102d 

Sept.  19, 

Right;   Chopart's.      Surg.   S.  F. 

57th  Mass.,  age  18. 

20,  '('A. 

ington,  100th  Penn.     Died  July 

Penn.,  age  21. 

19,  '64. 

Chapin.    139th   Penn.     Disch'd 

29.  '64  ;  typh.  fever.     £pKC.  6531. 

April  15,  1865  ;  sound  stump. 

145 

Darrow,   H.  C.,   Pt.,  G, 

May  18, 

Left  ;  Chopart's  (also  exc.  elbow; 

108 

Sadler,  A.  D..  Serg't,  G, 

Dec.  11, 

Left  (also  amp.  right  log).    Surg. 

77th  New  York,  age  24. 

18,  '64. 

luem.).      Died  June  23,   1864, 

21st  Mississippi. 

11,  '62. 

—  Hill.  C.  S.  A.     Recovery. 

gangrene  of  arm. 

109 

Saint,  R.  P.,  Pt.,  F,  123d 

Aug.  4, 

Right  ;    four   small   toes,    taking 

146 

Edgcrton,  G.  E.,  Pt.,  E, 

May  9, 

Left.     Died  June  3,  'd'4;  pyaemia. 

Indiana,  age  22. 

4/64. 

metatarsals  obliquely.     Disch'd 

169th  N.  Y.,  age  33. 

10,''64. 

June  11,  1865. 

147 

Folsom,  T.  T.,  Pt.,   E, 

May  3, 

Left;  Hey's.     Died  May  26,  '63. 

110 

Sands,  J.,  Lieut.,  C,  36th 

May  15, 

Left;   Lisfranc's.     Surg.   W.   P. 

5th  Xew  Hampshire. 

3,  \13. 

Illinois,  age  26. 

15,  '64. 

Pierce.  88th  111.     Disch'd  Feb. 

148 

Uarrinqtov,  G.  M.,  Pt., 

Aug.  31, 

Right  ;    Chopart's.      Confederate 

17,  1865. 

A,  66th  On.,  age  20. 

31,  '64. 

surgeon.     Died  Xov.  10,  1864. 

111 

Schoop,  S.  I.,  Capt.,  I, 

Oct.  —  , 

Left  ;  two  toes  with  metatarsals. 

149 

Heigans,  H.,  Pt.,  G,  1st 

Dec  1  3, 

;  Chopart's  ;  tetanus.     Died 

31st  Colored  Troops. 

—  ,  '64. 

Surg.  E.  Jackson.  30th  Colored 

Delaware. 

14,  '62. 

December  25,  1862. 

Troops.     Disch'd  Dec.  15,  1864. 

150 

Hintz,  C.,  Pt.,  K,  35th 

July  30, 

Right  ;  5th  toe  and  meta.     Died 

112 

Schroeder,    H..    Pt.,   H, 

Oct.  8, 

.     Recovery  Feb.  11,  1863. 

Massachusetts. 

30,  '64. 

Aug.  5,  18G4;  congestion  lungs. 

28th  Louisiana. 

—  ,  '62. 

151 

Jameson,  W.  H.,  Pt.,  C, 

April  29, 

Left;  Lisfranc's.     Surg.  E.  Ship- 

113 

Sciter,    B.,   Pt.,   C,   9th 

Sept.  17, 

Right  ;  three  lesser  toes  and  outer 

24th  Michigan. 

May  1, 

pen,    U.  S.  V.     Died  May  24, 

New  York,  age  25. 

17,  '62. 

side  foot.    Surg.  —  Humphreys, 

1863. 

1863.     Spec.  1121. 

Recovery. 

152 

Lapham,  I.  B.,  Pt.,   C, 

June  4, 

Left  ;  great  toe  and  meta.     Died 

114 

Shaughnessy,  M.,  Pt.,H, 

June  18, 

Left;  Chopart's  (flap  from  inside). 

9th  X.  Y.  Artillery. 

4,  '64. 

June  17,  1864;  acute  diarrhoea. 

2d  Penn.  H'vy  Artil'ry, 

18,  '64. 

Surg.  G.  T.  Stevens,  77th  N.  Y. 

153 

Monroe  If.  B.  —  

June  1, 

Right.     Died  August   10,   1864  ; 

age  26. 

Discharged  Dec.  12,  1864. 

1,  '64. 

exhaustion. 

115 

'  Sliea,  J.,  Letcher's  Bat 

Dec.  13. 

Left;  Cbopart'tt.     Recovery. 

154 

Randall,  .1.,  Pt.,  F,  29th 

Oct.  27, 

Left.     Surg.    A.   (,'.   Barlow.  62cl  ! 

tery,  ago  45. 

—  ,  '62. 

Connecticut. 

27,  '64. 

Ohio.     Died  Nov.  11,  18C4. 

116 

Sheffield.  B.,  Corp'l,  B, 

July  14, 

Left  ;  three  outer  toes  and  meta 

155 

Umberger,  J.W.,  Corp'l, 

Dec.  15, 

Left;  tarsal  bones  sawn  through. 

61st  C.  Troops,  age  39. 

14,  '64. 

tarsals.  Duty  Dec.  7,  '64  ;  pens'd. 

1,  117th  Illinois,  age  30. 

15,  '64. 

Surg.  M.  Wiley,  117th  Illinois. 

117 

Shelly,  M.,  Pt.,  C,  28th 

Oct.  19, 

Right;  Chopart's.     Surg.  W.   A. 

Gangrene;  Jan.   12,  1865,  amp. 

Iowa,  age  21. 

19,  '64. 

Daniels,   28th    Iowa.      Disch'd 

leg.    Died  Jan.  14,  1865;  pysBm. 

April  14,  1865. 

156 

Whitaker,  A.  J.,  Corp'l, 

June  16, 

Right;   Hey's;   gangrene.     Died 

118 

Shipley,   T.,  Corp'l,  F, 

Aug.  22, 

Left  ;  2d  toe,  half  of  metatarsal. 

A.  66th  X.  C.,  age  24. 

16,  '64. 

July  18,  1864;  gangrene. 

1st  Maryland,  age  29. 

22,  '64. 

Surgeon  A.  A.  White,  8th  Md. 

157 

Whitehead,  H.,  Pt.,  L, 

June  10, 

Left.    Died  July  2,  '64  ;  wounds. 

Disch'd  June  14,  '65;  pensioned. 

16th  Michigan,  age  32. 

—  ,  '64. 

119 

Smith,  B.  H.,  Capt.,  1st 

Oct.  16, 

Left  ;  Chopart's.  Surg.  —  Mason, 

158 

s  Everett,  W.  P.,  Corp'l, 

May  5, 

;  Lisfranc's  ;  excision  of  tar- 

Virginia  Artillery. 

16,  '62. 

C.  S.  A.     Discharged. 

H,  9th  Alabama. 

5,  '64. 

sal  bones  and  malleoli.     Surg. 

120 

Smith,    A.,    Serg't,    G, 

Dec.  11, 

Right  ;    Lisfranc's.     Surg.  C.  S. 

D.  Prince,  U.  S.  V. 

66th  New  York,  age  47. 

11,  '62. 

Wood,  66th  N.  York.    Disch'd 

159 

Mitchell,  J..  Pt..  A,  90th 

May  1-1, 

Left;  4th  toe  and  metatarsal.    — 

May  1,  1863. 

Ohio. 

14,  '64. 

Gastner. 

121 

Smith,  N.  R.,  Lieut.,  F, 

July  1, 

Left  ;  Chopart's.     Disch'd   Sept. 

160 

Pride.  IT.,  Pt.,   F,  61st 

July  31, 

Right;  great  toe  and  metatarsnl. 

157th  X.  Y.,  Hge  25. 

2,  '63. 

23,  1863  ;  stump  good. 

Virginia,  age  36. 

31,  '64. 

122 

Spencer,  D.  M.,  Pt.,  B, 

Nov.  8, 

Left;  Chopart's.  Surg.  N.  Barnes, 

161 

Stillwell,   W.  K.,   Pt.,  I, 

Oct.  19, 

Left;  Chopart's.     Surgeon  J.  J. 

184th  X.  Y.,  age  21. 

8,  '64. 

J84thN.  Y.    Disch'd  June  2,  '65. 

53d  Georgia,  age  21. 

19,  '64. 

Knott,  53d  Georgia. 

'HOLLOW  AY  (J.  M.),  Comparative  Advantages  of  PIROGOFF'S,  SYME'S,  and  CHOPART'S  Amputations,  etc.,  in  Am.  Jour.  Med.  Sci's,  Vol.  LI,  p.  86. 

2FORMENTO  (F.,  jr.),  Notes  and  Observations  on  Army  Surgery,  Xew  Orleans,  1863,  p.  27. 

'SMITH  (S.),  Amputations  at  the  Ankle  Joint,  etc.,  in  United  State*  Sanitary  Commission  Memoirs,  Surgical  Volume  II,  New  York,  1871,  p.  123. 


SECT.  VII.] 


INTERMEDIARY    AMPUTATIONS    IN    THE    FOOT. 


633 


INTERMEDIARY  AMPUTATIONS  IN  THE  FOOT. — Two  hundred  and  sixty-seven  operations 
were  followed  by  recovery  in  two  hundred  and  forty-three,  by  death  in  twenty  instances; 
the  result  in  four  cases  was  not  recorded;  the  mortality  rate  therefore  was  7.6  per  cent. 
Fifty-two  were  amputations  through  the  tarsal  or  metatarsal  bones  and  two  hundred  and 
fifteen  were  ablations  of  the  toes. 

CASE  931.— Private  C.  Craudall,  Co.  K,  2d  New  York  Artillery,  aged  18  years,  was  wounded  in  the  left  foot,  at  Spott- 
sylvania,  May  18,  1864,  and  entered  Carver  Hospital  at  Washington  six  days  afterwards.  Surgeon  O.  A.  Judson,  U.  S.  V., 
reported:  "Gunshot  fracture  of  metatarsus.  The  injury  was  caused  by  a  musket  ball,  which  entered  the  space  of  the  fifth 
metatarsal  bone  and  emerged  at  the  corresponding  point  of  the  second  metatarsal  bone.  On  May  29th  partial  amputation  of  the 
foot  by  Lisfranc's  method  was  performed  by  Assistant  Surgeon  H.  Allen,  U.  S.  A.  The  case  did  remarkably  well.  By 
September  30th  the  stump  had  entirely  healed  but  was  still  very  tender,  the  patient  being  unable  to  stand  on  it."  He  was 
dischai'ged  from  service  December  12,  1864,  and  pensioned.  He  died  May  12,  1867. 

CASK  932. — Private  G.  W.  Leslie,  Co.  E,  2d  South  Carolina  Rifles,  aged  23  years,  was  wounded  July  8,  1863,  by  a 
conoidal  ball,  which  fractured  the  first  and  second  metatarsal  bones  of  the  left  foot  and  produced  great  laceration  of  the  soft 
parts.  He  was  conveyed  to  Confederate  hospital  No.  9,  at  Richmond,  where  amputation  by  Chopart's  method  was  performed  on 
August  3d  by  Assistant  Surgeon  C.  W.  P.  Brock,  C.  S.  A.  At  the  time  of  the  operation  the  tissues  were  infiltrated  and  in  a 
sloughing  condition,  and  the  patient  was  in  a  debilitated  state,  having  suffered  from  angeioleucitis  and  erysipelas.  Slight 
sloughing  of  the  flaps  followed,  but  by  September  1st  the  stump  was  nearly  healed.  The  patient  recovered  with  a  useful  limb. 

CASE  933. — Private  S.  Hacket,  Co.  F,  llth  Pennsylvania  Reserves,  aged  25  years,  was  wounded  in  the  right  foot,  at 
Fredericksburg,  December  13,  1862,  by  a  round  ball,  which  entered  the  sole  near  the  third  metatarsal  bone,  passed  through  the 
tarsus,  and  was  extracted  just  anterior  to  the  internal  malleolus.  He  was  admitted  to  Lincoln  Hospital,  Washington,  ten  days 
after  receiving  the  injury,  and  Chopart's  amputation  was  performed  the  following  day.  The  patient's  complexion  was  yellowish, 
his  pulse  rapid,  and  the  color  of  his  tongue  light  red  and  smooth.  On  December  29th  he  had  a  chill  and  complained  of  pain  in 
his  hips.  There  had  been  a  few  discharges  of  laudable  pus  and  the  stump  looked  well.  On  January  3d  an  abscess,  which  had 
been  forming  for  three  days,  was  lanced  and  bled  profusely.  During  this  time  the  patient  had  been  costive  and  continued 
icteroid,  the  conjunctiva  being  of  a  pearly  whiteness  and  his  pulse  moderately  rapid,  full,  and  regular.  The  granulations  of  the 
sore  were  more  eminent  and  were  bathed  in  a  not  unhealthy  pus.  His  tongue  on  this  day  was  furrowed,  and  during  the  morning 
he  had  a  slight  chill.  On  January  6th  he  had  three  chills,  and  the  stump  was  inactive,  the  pus  being  white  and  cheesy.  The 
abscess  over  the  malleolus  was  now  better,  but  the  patient's  skin  was  very  yellow,  with  a  brown  tinge;  tongue  pale;  coun 
tenance  anxious.  During  the  next  three  days  he  had  one  or  two  chills  each  day,  and  by  this  time  he  had  become  very  feeble 
and  his  mind  was  wandering  somewhat;  pulse  very  rapid.  The  stump  did  not  look  very  badly,  but  some  hardness  was  noticed 
along  the  track  of  the  vessels.  By  January  llth  he  was  wholly  delirious,  which  continued  for  two  days,  when  he  recovered 
his  consciousness.  The  left  pupil  was  now  more  dilated  than  the  right;  the  stump  was  looking  well,  but  was  more  swollen  than 
at  first.  After  this  he  became  extremely  exhausted  and  died  January  15,  1863.  The  autopsy  showed  much  emaciation.  On 
opening  the  chest  a  large  cavity  was  found  just  above  the  right  lung,  the  top  of  it  being  lined  with  a  greyish  pus.  Pleurisy  with 
firm  attachments  existed  on  the  right  side,  and  there  was  partial  pneumonia  in  the  posterior  lobe.  A  mass  of  separating  dead 
tissue  partially  occupied  the  excavated  space  in  the  upper  and  anterior  portion.  The  walls  were  lined  with  a  thick  and  cheesy 
pus.  Partial  pneumonia  with  small  circumscribed  collections  of  pus  existed  in  the  lower  lobe  of  the  left  lung  posteriorly,  while 
in  the  upper  lobe  anteriorly  and  at  the  middle  there  was  a  sharp-edged  and  deep  excavation  having  separated  dead  tissue  in  it. 
The  spleen  was  attached  by  fibrinous  adhesions  to  the  surface  of  the  diaphragm  and  contained  small  circumscribed  collections  of 
pus.  The  liver  was  large,  heavy,  and  mottled,  with  a  distinct  rough  feel;  kidneys  natural  and  a  little  pale;  inguinal  glands 
greatly  swollen.  Thtre  was  also  a  deep  abscess  below  the  popliteal  space  and  unconnected  with  the  stump.  The  amputated 
portion  of  the  foot  (Cat.  Surg.  Sect.,  1866,  p.  421,  Spec.  4493)  was  contributed  to  the  Museum  by  Assistant  Surgeon  G.  M. 
McGill,  U.  S.  A.,  who  also  recorded  the  history  of  the  case. 

TABLE  C. 
Summary  of  Fifty-two  Intermediary  Amputations  in  the  Tarsal  or  Metatarsal  Bones  for  Shot  Injury. 

[Recoveries,  1—36;  Deaths,  37 — 51;  Unknown,  52.] 


NO. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATKS. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Albright,  P.  J.,  Corp'l, 
B,  110th  Ohio,  age  19. 

July  9, 
22,  '64. 

Right  ;  great  toe  and  half  of  met 
atarsal.     Surg.  G.  S.  Palmer,  U. 

5 

Boger,  J.,  Pt.,  A,  17tb 
Infantry. 

June  24, 
July  9, 

Left     (phagadenic);    great    toe 
middle  of  metatar.    A.  A.  Surg 

S.  V.     Disch'd  Feb.  19,  1865. 

1864. 

J.  T.  Logan.   Duty  Mar.  9,  186r> 

•2 

Anderson,    F.,    Pt.,    11, 

May  25, 

Left  (exc.  portion  3d  met.  bone); 

6 

Burt,  C.M.,Pt.,E,  141st 

Aug.  5, 

Left  ;  great  toe  thro'  metatarsal 

28th  Penn.,  age  40. 

June  9, 

amp.  3d  toe  and  metatar.     A.  A. 

New  York,  age  21. 

17,  '64. 

A.  A.  Surg.  —  Ward.     V.  R.  C 

1864. 

Surgeon  J.  G.  Harvey.   V.  R.  C. 

March  10,  1865. 

March  29,  1865. 

7 

Chalton,  X.,  Pt.,  E,  2d 

May  31, 

Right  ;  2d  toe  at  tarso-met.  nrtic 

3 

Baskett,  J.,  Pt.,  G,  146th 

May  8, 

Left  ;  4th  toe  and  half  of  metatar- 

Cavalry,  age  25. 

June  4, 

Surgeon  A.  F.  Sheldon,  U.  S.  V 

New  York,  age  37. 

25,  '64. 

sal.     A.  A.  Surg.  O.  P.  Sweet, 

18C4. 

Duty  January  25,  1865. 

4 

Bender,  J.,Serg't,  1,  15th 
Mass.,  age  23. 

Sept.  17, 
20,  '62. 

Discharged  July  6,  1865. 
Right  ;    Chopart  s.      Discharged 
February  28,  1863. 

8 

Clarkson,  J.  N.,  Pt.,  E, 
93d  Indiana,  age  18. 

June  10, 
14,  '64. 

Right  ;  2d  toe  and  metatar.  Surg. 
J.  G.  Keenon,  U.  S.  V.     Duty 
March  22,  1865  ;  pensioned. 

SURG.  Ill— 80 


634 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OTKICATOUS, 
RESULT. 

No. 

NAME,  MILITAUV 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

Q 

Cox,  S.,  Lieut.,  G,  4th 

Aug.  25, 

Left;  little  toe  and   metatarsal. 

30 

Marshall.  J.  S.,  Pt.,  B, 

July  2, 

Right  ;  toe  at  middle  of  metatar 

N.  Y.  Heavy  Artillery, 

29,  '64. 

Surgeon  N.  R.  Moseley,  U.  S.  V. 

131st  Co..  2d  Bat.  V.  R. 

20,  '63. 

sal.  A.  A.  Surg.  J.A.  Buchanan. 

age  23. 

Discharged  January  18,  1865. 

Corps,  age  29. 

Duty  May  21,  1864. 

10 

Cmndall,  C.,  Pt.,  K,  2d 

May  18, 

Left  ;  Listranc's.     Ass't  Surg.  H. 

31 

Mendenhall.  A.,  Corp'l, 

Aug.  14, 

Lett  ;  toe  and  metatarsal.     A.  A. 

N.  Y.  Heavy  Artillery, 

29,'  '64. 

Allen,  U.S.  A.     Disch'd    Dec. 

H,  391h  Illinois,  age  38. 

24,  '64. 

Surg.   R.  ().   Sidney.     Disch'd 

age  18. 

12.  1864.     Died  May  12,  1867. 

April  4.  1865. 

11 

Dotson.  D.  N.,  Serg't,  K, 

Nov.  30, 

Right  ;  Chopart's.      Snrg.  D.  J. 

32 

Quade,  C.  H..  Pt.,  F,  8th 

June  22, 

Left  (erysip.;  gang.);  4th  and  5th 

37th  Tenn.,  age  24. 

Dec.  5, 

Roberts.  20th  Tenn.     To  Provo. 

N.  Y.  Heavy  Artillery, 

July  16, 

toes  and  metatar.      A.  A.  Surg. 

1864. 

Marshal  May  6,  1865. 

age  17. 

1864. 

A.  Trau.  Disch'd  Feb.  18,  1865; 

12 

Gelvair,  W.,  Pt.,  C,  16th 

Oct.  27. 

Right;  3d  toe  and  lower  third  of 

pensioned. 

Penn.  Cav.,  age  26. 

Nov.  15, 

metatarsal.     Surg.  N.  R.  Mose 

33 

Rooney,  A.,  Pt.,  F,  40th 

Aug.  29, 

Right  ;  Lisfranc's.     Surg.  D.  W. 

1864. 

ley,  U.  S.  V.    Duty  April  20,  '65. 

New  York,  age  29. 

Sept.  —  , 

Bliss,  U.S.  V.    Disch'd  May  20, 

.:: 

George,  J.  H.,Pt.,1,  49th 

Jan.  13, 

Right  (gangrene);  2d  and  3d  toes 

1862. 

1863.    1879,  stump  healthy. 

Illinois,  age  20. 

25,  '64. 

and  metatarsals.    A.  A.  Surg.  S. 

34 

Shearer,  A.,  Pt.,  A,  6th 

De.—  ,'64, 

Left  ;  thro'  ant.  part  cuboid  and 

S.  Jessop.     Duty  June  8,  1804. 

Colored   Cavalry,  age 

Jan.  8,  '65. 

cuneiform   bones.      Discharged 

14 

Grimstead,  R.  T.,  Pt.,  I, 

June  11, 

Left  ;  i!d  toe  and  metatarsal.    Dis 

25. 

June  12,  1865. 

93d  Indiana. 

J'y  -,  '63. 

charged  Dec.  28,  1863. 

35 

Snyder,  B.,  Pt.,  F,  129th 

May  7, 

Left  (gang.);  4th  toe  at  middle  of 

15 

Green,   A.,  Pt.,  D,  8th 

June  23, 

Right;  Lisfranc's.     A.  A.  Surg. 

Pennsylvania,  age  24. 

15,  ''64. 

metatar.     Surg.  A.  F.  Sheldon, 

N.  Y.  Artillery,  age  30. 

July  18, 

D.  G.  Caldwell.     Disoh'd  Sept. 

U.  S.  V.     Disch'd  May  26,  1865. 

1864. 

27,  1864. 

36 

Watson,  J.  H.,  Serg't,  G, 

May  10, 

Left  ;  2d  and  lid  toes  and  metatar 

16 

Hansmeier,  A.,  Pt.,  A, 

June  10, 

Right  ;    Lisfranc's.      Discharged 

12  1st  Penn.,  age  22. 

21,  '64. 

sals.     Surg.  E.  Rentier,  U.  S.V. 

114th  Illinois,  age  19. 

13,  '64. 

June  20,  1865;   painful,  tender 

Duty  January  30,  1865. 

cioatrix. 

37 

Barnes,  M.,  Pt.,  D,  28th 

June  4, 

Right  ;  3d  toe  and  metatarsal.    A. 

17 

Hefferman,   P.,   Pt.,   F, 

Aug.  30, 

Left  ;  Chopart's.  Confed.  surgeon. 

Mass.,  age  34. 

—  ,  '64. 

A.  Surg.  J.   G.   Nelson.     Died 

14th  Infantry,  age  20. 

Sept.  9, 

Heel  drawn  up.     Oct.  8.   1863, 

July  6,  1864  ;  dysen.  and  w  nd. 

1862. 

amp.  leg.     Disch'd  May  17,  '64. 

C8 

Bell,  B.  A.,  Pt.,  A,  14th 

May  10, 

Left  ;  Chopart's.     Surgeon  C.  B. 

18 

Kelton,   W.,  Pt.,  H,  3d 

May  6, 

Right  ;    1st  toe  and   metatarsal. 

Virginia. 

19,  '64. 

Gibson.  C.S.A.  Died  May  27.'64. 

Vermont,  age  23. 

13,  !64. 

Vet.  Res.  Corps  Nov.  25,  1864. 

39 

Brooks,   T.  M.,  Pt.,  C, 

Nov.  27, 

Left  ;  3d  and  4Mi  toes  and  meta 

19 

Keyes,  C.  W.,  Lieut.,  K, 

May  12, 

Left  (gang;.     Dr.  P.  Dyer,  Wil 

124th  N.  York,  age  19. 

Dec.  8. 

tarsals.    Surg.  E.  Bentley,  U.  S. 

32d  Maine,  age  33. 

June  8, 

ton,  Me.     Gang.  .June'l2,  3864, 

1863. 

V.     Died  Dec.  20,  '63;  pyasrnia. 

1864. 

amput'n  leg.     App't  in  U.  S.  A. 

40 

Decay,    S.,    Corp'l,    A, 

June  11, 

Right  ;  1st  toe  and  metatarsal.    A. 

Retired  December  31,  1870. 

179th  New  Y'ork,  age 

30,  '64. 

A.  Surg.  J.  G.  F.  Strowbridge. 

20 

Knowlton,  D.,  Serg't,  M, 

June  18. 

Left  ;  4th  toe  and  half  of  meta 

35. 

Pyaemia.     Died  July  29,  1864  ; 

1st  Maine  H'vy  Artil 

July  5, 

tarsal.    A.  A.  Surg.  F.  H.  Green- 

excessive  suppuration. 

lery,  age  19. 

1864. 

ough.     Disch'd  March  27,  1SC5. 

,  41 

Graham,  P.,  Corp'l,  K, 

Sept.  19, 

Right  :  Chopart's  (also  ex.  elbow). 

21 

Lackey,  G.  H.,   Serg't, 

May  12, 

Left;  1st  toe  and  metalarsal.     A. 

26th  Ohio. 

25,  '63. 

Died  Oct.  8,  1863. 

D,  58th  Mass.,  age  24. 

27,  '64. 

A.  Surg.  J.  C.  Nelson.     Erysip.; 

42 

Hackett,  S.,  Pt.,  F,  lllth 

Dec.  13, 

Right  ;    Chopart's.     Ass't   Surg. 

gangrene.     July  27,   amp.   leg. 

Penn.  Reserves. 

24,  '62. 

G.  M.  McGill.U.S.A.   Died  Jan. 

Disch'd  March  16,  1865. 

15,  1863  ;  pyaemia.     Spec.  4493. 

22 

Landenberger,  F.D.,Pt.. 

Mar.  18, 

Right  ;  2d  toe  and  metatar.    Ass't 

43 

King,    E.,   Pt,,    B,    1st 

Aug.  2."), 

Right  ;  1st  toe  and  metatarsal  and 

B,  6th  Penn.  Cavalry. 

24,  '64. 

Surg.  J.  W.  Williams,  U.  S.  A. 

Vermont  Cavalry,  age 

30,  '64. 

3d  toe  thro'  3d  phalanx.     A.  A. 

age  57. 

Discharged  Sept.  3,  1864. 

18. 

Surg.   W.  J.  McIIenoh.      Died 

23 

Leslie,  G.  W.,  Pt.,  E,  2d 

July  8, 

Left;  Chopart's.     Ass't  Surg.  C. 

Sept.  11.  1864;  pyaemia. 

S.  Carolina,  age  23. 

Au.  3,  '63. 

W.  P.  Brock,  C.S.A.  Recovery. 

44 

King,  S..  Serg't,  C,  9th 

July  20, 

Right  ;  2d  toe  and  part  of  meta 

24 

Little,    D.    H.,   Pt.,    G, 

Nov.  27, 

Right  ;  great  toe  and  metatarsal. 

West  Va.,  age  23. 

25,  '64. 

tarsal.     Died  Aug.  3,  1864. 

138th  1'enn.,  age  20. 

Dec.  9, 

Surg.  E.  Bentley,  U.  K.  V.    Dis 

45 

Linville,  A.  J.,  Pt.,   G, 

Oct.  30, 

Left;  Chopart's.     A.  A.  Surg.  — 

1863. 

charged  Feb.  27,  '64  ;  pensioned. 

44th  Illinois,  age  18. 

Nov.  12, 

Bell.     Died  Feb.  10,  1865  ;  ex 

25 

London,    J.  C.,   Pt.,   C, 

Nov.  27, 

Left  ;    4th    toe    and    metatarsal. 

1864. 

haustion. 

90th  Penn.,  age  28. 

De.15,'63. 

Transferred  May  30.  1864. 

40 

Lumbard,   M.,    Pt.,    D, 

Sept.  20, 

Left;   Chopart's.     Died  Novem 

26 

Lovelady,    A.,    Pt..    A. 

June  10, 

Right  (gangrene);  great  toe  and 

15th  Ohio. 

Oc.10,'63. 

ber  24.  1863. 

4th  Iowa  Cav.,  age  22. 

July  —  , 

metatarsal.  A.  A.  Surg.  Slmrpe. 

47 

Mockler,W.,  Pt.,  G,  81st 

Dec.  13, 

Right  ;  Chopart's.    Dec.  31,  hrem. 

1864. 

Disch'd  March  29,  1865. 

Pennsylvania,  age  47. 

26,  '62. 

Died  January  10.  1863. 

27 

Lynch,  A.,  Pt.,  C,  29th 

May  25. 

Right;  Hey's.     Confed.  surgeon. 

48 

Xash,  J.,  Pt.,  C,  Mary 

July  3, 

Left  :    tetanus.     Died    July   16, 

Pennsylvania,  age  39. 

June  1, 

Disoh'd  March  16,    1863;  good 

land  Battalion. 

14,  ''63. 

1863. 

]862. 

stump. 

49 

Schmidt,  J..  Pt.,  C,  102d 

June  5, 

Left  ;  great   toe  and  metatarsal. 

28 

McCarty,  J..  Pt.,  F,  48th 

Mar.  2, 

Right;  Chopart's.     A.  A.  Surg. 

Penn..  age  29. 

25,  '64. 

Surg.  H.  Palmer,  U.  S.V.    Died 

New  York,  age  38. 

21,  '64. 

C.  T.  Reber.     (Mar.  2,  lig.  post. 

June  27.  1864:  inflam.  liver. 

tibial;  gang.)     Mar.  23,    bones 

50 

Smith,  B.J.,  Pt..I,  14th 

June  1, 

Right.     Died,  in    Libby    Prison, 

removed  ;  April  25,  1865,  amp. 

N.  Y.  H.  Art'v,  age  28. 

12,  '64. 

July  3,  1864. 

leg.      Disch'd    June   10,    1865. 

51 

Whistler,  A.  W.,  Pt.,  I, 

June  5, 

Left.     Ass't  Surg.  H.  Grumbine, 

Died  Dec.  19,  1874.     Spec.  3007. 

54th  Pennsylvania. 

22  '64. 

20th  Penn.  Cav.     Died  August 

29 

Madison,  J.,  Pt.,  C,  9th 

July  16, 

Right  ;  2d  toe  and  part  of  meta 

16,  1864  ;  gangrene  and  hagm. 

Minn.,  age  48. 

23,  '64. 

tarsal.     Surg.  J.  G.  Keenon,  U« 

52 

Monrt,  G.  11.,  Pt.,  —  ,  28th 

Aug.  25, 

Left  •    Chopart'"       Surg    D     F. 

S.  V.     Disch'd  May  26,  1865. 

N.  Carolina,  age  17. 

31,  '64. 

Wright,  C.  S.  A. 

SECONDARY  AMPUTATIONS  IN  THE  FOOT. — Of  ninety-four  secondary  operations  ninety-two 
were  successful  and  two  fatal,  a  mortality  rate  of  2.1  per  cent.  Seventy-six  were  ablations 
of  the  toes,  eighteen  amputations  in  the  tarsal  or  metatarsal  bones. 

CASE  934. — Private  E.  McEntee,  Co.  B,  73d  New  York,  aged  23  years,  was  wounded  in  the  right  foot,  at  Gettysburg, 
July  2,  1863.  and  entered  Jarvis  Hospital,  Baltimore,  eight  days  afterwards.  Upon  examination  a  compound  comminuted 
fracture  of  the  tarsal  articulation  was  found,  with  a  musket  ball  lodging  in  the  foot.  Efforts  were  made  to  save  the  limb;  but  a 
high  degree  of  suppurative  inflammation  set  in,  when  it  was  decided  to  amputate,  and  Chopart's  operation  was  performed  on 
August  4th  by  Assistant  Surgeon  D.  C.  Peters,  U.  S.  A.  The  patient  recovered,  and  was  discharged  from  service  December  16, 
1863,  and  pensioned,  the  stump,  though  healed,  remaining  tender  and  giving  indications  of  remaining  unserviceable  for  a  long 
time,  thereby  unfitting  him  for  duty  in  the  Invalid  Corps.  Part  of  the  amputated  foot,  exhibiting  a  great  effusion  of  callus  and 
showing  necrosis  in  the  track  of  the  missile,  was  contributed  to  the  Museum,  with  the  history  of  the  case,  by  the  operator,  and 
constitutes  specimen  1650  of  the  Surgical  Section.  The  pensioner  was  paid  September  4,  1880.  In  his  application  for  commu 
tation,  dated  1870,  he  described  the  condition  of  the  stump  as  still  "very  tender;"  but  in  subsequent  statements  he  reported  it  as 
"pretty  good"  and  "healthy." 

CASE  935. — Lieutenant  H.  Holt,  Co.  F,  30th  New  York,  aged  20  years,  was  wounded  in  the  right  foot,  at  Bull  Run, 
August  30,  1862.  Surgeon  C.  L.  Allen,  U.  S.  V.,  described  the  injury  as  follows:  "The  ball  entered  at  the  top  of  the  foot, 
fracturing  the  fifth  metatarsal  bone,  and  was  cut  out  on  the  field  from  the  sole  of  the  foot.  He  went  on  horseback  to  Centreville, 
where  during  the  afternoon  of  the  following  day  he  was  placed  in  an  ambulance.  The  next  day  he  came  to  Washington,  Baking 


SECT.  VII.] 


SECONDARY    AMPUTATIONS    IN    THE    FOOT. 


635 


the  cars  at  Fairfax  Station  and  entering  Emory.  Hospital  for  a  day  or  two,  when  he  removed  to  a  private  boarding-house  and 
was  attended  by  a  private  physician.  On  September  28th,  foot  was  swollen;  abscesses  opened,  and  the  original  wounds  were 
all  discharging  freely.  The  patient  was  much  emaciated,  his  countenance  expressing  suffering  and  showing  the  strongly  marked 
hectic  Hush;  appetite  gone;  thirst  considerable;  pulse  1150,  feeble  and  fluttering;  pain  and  stiffness  in  the  jaws,  with  inability 
to  open  the  mouth  more  than  to  admit  the  tip  of  the  little  finger  between  the  teeth.  This  condition  (trismus),  he  stated,  had  been 
coming  on  for  two  or  three  days.  Huxham's  tincture,  brandy,  beef-essence,  etc.,  with  an  occasional  full  dose  of  morphia  was 
prescribed.  On  October  5th  another  abscess  opened.  October  9th  :  The  patient  has  slowly  and  steadily  improved  in  general 
appearance  since  my  first  attendance;  pulse  110  to  116  with  more  strength.  It  was  thought  advisable  to  put  the  patient  under 
the  influence  of  ether  and  examine  and  perform  any  operation  considered  necessary,  Surgeons  M.  Clymer  and  J.  H.  Brinton, 
U.  S.  V.,  being  requested  to  see  the  case.  The  foot  was  still  enormously  swollen,  and  the  probe  passed  readily  from  the  wound 
of  entrance  to  the  opening  below  the  external  malleolus.  In  the  upper  opening  four  inches  above  the  inner  malleolus  the  probe 
rapped  distinctly  upon  the  denuded  tibia.  Surgeon  Clymer  made  an  incision  nearly  the  whole  length  of  the  external  side  of  the 
foot,  and  removed  the  fragments  of  the  fifth  metatarsal  bone  together  with  the  little  toe.  Since  it  appeared  at  this  stage  that  all 
or  nearly  all  the  tarsal  and  metatarsal  bones  were  diseased,  as  well  as  the  lower  third  of  the  tibia,  it  was  decided  that  amputation 
was  necessary,  but  that  the  patient  at  this  time  could  not  endure  any  further  operation.  The  tonics,  stimulants,  and  nourish 
ments  were  now  crowded  as  much  as  possible.  On  October  12th  the  patient  had  somewhat  improved.  On  the  following  day  tinc 
ture  of  cantharicles,  in  doses  of  twenty  drops  every  four  hours  and  to  be  increased  if  necessary,  was  prescribed  in  addition  to 
his  other  treatment.  For  three  or  four  days  the  patient  steadily  but  very  slightly  improved,  after  which  he  evidently  failed  for  a 
few  days.  He  had  taken  nearly  two  ounces  of  tincture  of  cantharides  and  suffered  a  little  of  strangury.  All  remedies  except  his 
nourishment  and  a  little  brandy  were  now  omitted,  and  on  the  following  day  compound  syrup  of  phosphate  of  lime  and  iron  was 
ordered.  On  October  23d  the  patient  was  still  very  feeble,  but  looked  a  little  brighter  and  had  a  little  appetite ;  pulse  120  to 
130.  After  this  he  steadily  improved,  and  by  November  1st  he  had  a  good  appetite,  his  pulse  having  gradually  lessened  to  from 
HO  to  90  pt-r  minute.  On  November  8th  he  was  dressed  and  able  to  sit  in  a  chair,  and  about  two  weeks  later  he  first  went  down 
stairs  on  crutches.  The  wounds  on  the  external  side  of  the  foot  had  completely  healed  by  December  21st,  while  the  openings 
on  the  other  side,  both  above  and  below  the  malleolus,  were  still  discharging.  All  the  openings  healed  up  about  December  31st, 
but  several  days  after  more  swelling  appeared  toward  the  toes,  and  on  January  3d  an  opening  occurred  over  the  second  meta 
tarsal  bone,  near  the  distal  extremity.  This  discharged  freely  for  several  weeks,  denuded  bone  being  detected  by  the  probe. 
On  January  29th  the  patient  was  able  to  wear  his  boot  all  day,  and  one  week  afterwards  he  walked  with  a  cane.  By  February 
15th  the  last  opening  had  closed.  On  March  13,  1863,  the  patient  was  mustered  out  of  service,  walking  with  ease  by  the  aid 
of  a  cane  and  without  much  difficulty  without  one.  He  subsequently  informed  me  by  letter  that  he  was  holding  a  position  on  the 
staff  of  Brigadier  General  Pierce  in  Massachusetts."  Lieutenant  Holt  is  a  pensioner,  and  was  paid  February,  1879. 

TABLE  01. 
Summary  of  Eighteen1  Cases  of  Secondary  Amputations  in  the  Tarsal  or  Metatarsal  Bones  for  Shot  Injury. 

[Recoveries,  1—16;  Deaths,  17—18.1 


NO. 

NAME,  MILITARY 
DESCIUI-TIOX,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

1 

Carey,  J.,  Pt.,  E,  149th 

May  5, 

Right  ;  4th  toe  and  metatarsal. 

10 

Noll,  E.,  Pt.,  G,  147th 

May  25, 

Right  ;  2d  toe  and  portion  of  met 

Penn.,  age  23. 

June  11, 

Surg.  H.  Palmer,  U.  S.  V.    Dis 

Penn.,  age  22. 

Aug.  13, 

atarsal.    A.  A.  Surg.  J.  O.  Con- 

1864. 

charged  July  24,  1865. 

1864. 

nell.     Disch'd  Sept.  22,  1865. 

2 

Finnegan,  P.,Pt..H,  16th 

De.31,'62, 

Right.     Dr.  J.  E.  Pomfret.    (Dis 

11 

Palmer,  A.  G.,  Pt.,  D, 

May  23, 

Left  (May  29,  3d  and  4th  toes; 

Infantry,  age  34. 

Feb.  27, 

charged  Feb.  21,  1865;  eh.  ery 

4th  New  York  Heavy 

1864, 

amp.;  necrosis)  ;  part  of  4th  and 

1865. 

sipelas  of  foot.)     Feb.  —  ,  1866  ; 

Artillery,  age  21  . 

Jan.  10, 

5th  metatarsals.    A.  A.  Surg.  D. 

amputation  lower  third  leg. 

1865. 

F.  Etter.     Disch'd  May  30,  '65. 

3 

Foss,  G.  P.,Serg't,  K,  1st 

June  18, 

Left  ;  4th  toe  and  metatarsal.    A. 

12 

Strong,  A.,  Pt.,  E,  24th 

J'y  2.  '63, 

Left:  1st  toe  and  part  of  metatar 

Mass.  He:ivy  Artillery, 

Sept.  14, 

A.  Surg.  J.  H.  Gushing.  Disch'd 

Wisconsin,  age  24. 

Jan.  20, 

sal.     Surg.  E.  13.  Wolcot,  Wis 

age  4i>. 

1864. 

June  2li,  1865. 

1864. 

consin.     Disch'd  Oct.  14,  1864. 

4 

Haslam,  J.,  Pt.,  H,  129th 

Dc.l3,'<;2, 

Right  :  great  toe  and  part  of  met- 

13 

Titus,  A.,  Serg't,  E,  3d 

Aug.  9, 

Left  :   Lisfranc's.     Disch'd  Nov. 

Penn.,  age  30. 

Feb.  18, 

atursal  (gangrene;  March,  1863, 

Wisconsin,  age  28. 

De.  6,  '62. 

14,  1862;  necrosis. 

1864. 

excis.  2d  toe);    Nov.  17,  1867, 

14 

Tooley,  P.,  Pt,,  D,  103d 

De.16,'62, 

Right  :  2d  and  3d  toes  and  meta 

. 

amp.  leg;  June,  1868,  amputat'n 

New  York,  age  22. 

Mav  30, 

tarsals  ;  hjEinorrhage.     Disch'd 

upper  third  leg. 

1863. 

Sept.  12,  1863. 

5 

Lcimond.  H.,Pt.,E,  28th 

J'v30,'64, 

Right  :  4th  toe  and  part  of  meta 

15 

•Williams,  S.W.,  Pt.,  An 

Sept.  17, 

Left  ;  Hey's  ;  through  metatarsals 

Mass.,  age  37. 

Feb.  28, 

tarsal.  A.  A.  Surg.  J.  H.  Cutler. 

drew's   S.    S.   (Mass.), 

1862, 

just  ant.  to  tarsal  articulation. 

1865. 

Disch'd  July  31,  1865. 

age  31. 

Jan.  17, 

Surg.  J.  Niell.  U.  S.  V.    Disrh'd 

6 

McEntee,  E.,  Pt.,  H,  73d 

July  2, 

Right;    Chopart's.     Ass't    Surg. 

1863. 

April    17,  1863;   depending  on 

New  York,  age  23. 

Aug.  4, 

D.  C.  Peters,  U.  S.  A.     Disch'd 

crutches. 

1863. 

Dec.  16,  1863.     Spec.  1650. 

16     Wither,  C.  E.,  Corp'l,  B, 

May  4. 

Left  ;  1st  toe  and  inetatar.     Duty. 

7 

MeMorran,  S.  T.,  Capt., 

Aug.  i>, 

Left  ;  3d  and  4th  toes  and  meta- 

7th  Maine,  age  23. 

J'e21,'63. 

C,  66th  Ohio,  age  32. 

Oct.  —  , 

tarsals.     Disch'd  Jan.  27,  1863  ; 

17 

Gilman,  C.  P.,  Pt.,  E,  3d 

May  8, 

Right  ;  Hey's.     A.  A.  Surg.  G.  E. 

1862. 

pensioned. 

Maine,  age  24. 

June  22, 

Brickett.     (Amp.  toe;  gangren 

8 

Merrill,  M.,  Pt.,  K,  12th 

Oct.  19, 

Right  ;  3d   toe   thro'  metatarsal. 

1864. 

ous.)    Died  June  30,  '64:  dipthe. 

iliiiuc,  tt(Tc  33. 

Dec.  19, 

A    A     Sura*    Tr-in       T)ntv     Inlv 

18 

Ryan    A.    Pt.    C   114th 

Left  ;  Hey's.     Surg.  C.  T.  Simp 

1864.  ' 

27,  1865.  "' 

New  York,  age  28. 

Nov.  5, 

ers,'  6th  Md!    Died  Nov.  9,  1864  ; 

9 

Meyers,  J.  J.,Pt.,K,  102d 

June  22, 

Right;  1st  and  2d  toes  and  por 

1864. 

pneumonia. 

Illinois,  age  33. 

Sept.  7, 

tions  of  metatarsals.     Disch'd 

1864. 

April  4,  1865. 

AMPUTATIONS  IN  THE  FOOT  OF  UNCERTAIN  DATES. — In  four  hundred  and  seven  instances  of 
amputations  in  the  foot  the  time  between  the  injury  and  the  operation  was  not  indicated. 


1  As  in  the  preceding  two  tables,  amputations  of  the  toes  are  not  included  in  this  table. 


636 


INJURIES    OF    THE    LOWER    EXTREMITIES. 


[CHAP.  X. 


The  results  in  fifty-four  cases  were  not  ascertained;  three  hundred  and  twenty  ended  in 
recovery  and  twenty-three  in  death,  a  mortality  rate  of  6.5  per  cent.  Sixty  cases  were 
amputations  in  the  tarsal  or  metatarsal  bones;  three  hundred  and  forty-seven  were  ampu 
tations  of  the  toes.  Few  details  of  the  cases  were  reported. 

CASE  933. — Corporal  G.  Marsh,  Co.  G,  17th  Iowa,  aged  25  years,  received  a  shot  wound  of  the  right  foot,  at  Champion 
Hills,  May  16,  1863,  and  was  conveyed  to  Gayoso  Hospital,  Memphis,  two  weeks  afterwards.  After  some  time  had  elapsed  in 
an  attempt  to  save  the  whole  foot  an  operation  was  resorted  to  which  involved  the  four  small  toes  and  metatarsal  bones.  The 
wound  healed  kindly,  and  the  patient  recovered  with  a  comparatively  useful  foot.  The  case  was  reported  by  Surgeon  J.  Bryan, 
U.  S.  V.1  The  patient  was  subsequently  transferred  to  Jefferson  Barracks,  where  he  was  discharged  from  service  October  6, 
1863,  and  pensioned.  Examining  Surgeon  J.  Windle,  of  Des  Moines,  Iowa,  certified  to  the  loss  of  the  four  small  toes  and  meta 
tarsal  bones,  "leaving  the  big  toe  greatly  deformed,  the  ankle-joint  stiff,  and  the  muscles  on  the  sole  of  the  foot  contracted  so 
that  the  toe  touches  the  ground  first  and  causes  him  to  walk  with  difficulty.  The  limb  is  considerably  wasted  and  weak."  The 
pensioner  was  paid  September  4,  1881. 

TABLE  GIL 

Summary  of  Sixty  Cases  of  Amputations  in  the  Tarsal  or  Metatarsal  Bones  of  Uncertain  Date  for 

Gunshot  Injury. 

[Recoveries,  1—32;  Deaths,  33 — 49;  Results  unknown,  50—60.] 


No. 

1 

2 

3 

4 

5 
6 

7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 

23 
24 
25 

26 
27 
28 
29 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RESULT. 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATES. 

OPERATIONS,  OPERATORS, 
RKSULT. 

Aikins,   J.    T.,   Pt.,    A, 
Phillip's  Legion. 
Barnes,   J.   G.,    Pt.,  B, 
38th  Va.  Art'y,  age  19. 
Berry,   H.    T.,   Pt.,    H, 
(iCth  Alabama. 
Bisbee,    N.,    Serg't,    K, 
89th  New  York,  age  43. 

Blevins,  F.,  Pt.,  A,  26th 
North  Carolina. 
Buck,  C.  jV.,  Pt.,  B,  17th 
Virginia,  age  19. 
Burnett,   W.  li.,  Lieut., 
G,  10th  Arkansas. 
Collins,  W.  A.,  Pt.,  F, 
63d  Tenn.,  age  31. 
Denham,  G.  D.,  Corp'l, 
B,  15th  Alabama. 
Caspar,  J.,  Pt.,  H,  8th 
Louisiana. 
Gleason,  J.,  Pt.,  D,  7th 
N.  C.,  age  42. 
Hardy,   K.  F.,   Pt.,    C, 
38th  Va.,  age  24. 
Harvey,  S.,  Pt.,   A,   2d 
.South  Carolina. 
Hickman,  J.  W.,  Pt.,  B, 
2d  Louisiana. 
Holmes,  G.  W.,  Pt.,  F, 
73d  Ohio,  age  36. 
Ingle,  W.  F.,  Serg't,  A, 
2d  Ind.  Cav.,  age  21. 
Johnson,  G.  N.,  Serg't, 
B,  154th  New  York. 
Johnson,    T.  T.,  Pt.,  K, 
59th  Georgia. 
McDonnell,    C.,   Pt.,   C, 
Cth  North  Carolina. 
Marsh,   G.,    Corp'l,    G, 
17th  Iowa,  nge25. 
Miller,  M.,  Pt.,  G,  10th 
Louisiana. 
Morrison,  J,  G^Aide-de- 
Camp  to  General  T.  J. 
Jackson. 
Patrick,  W.  A.,  Pt.,  F, 

May  3, 

—  ,  '63. 
April  18, 
—  ,  '64. 

;  Chopart's.     Furloughed. 
Left.    Retired  March  22,  1865. 

Right  ;  great  toe  and  metatarsal. 
Furloughed  August,  1864. 
Right  ;  toes  and  3d  metatarsal  ; 
April,  1865,  amput'n  leg.     Dis 
charged  May  25,  1865. 
Right;  Chopart's.    Retired  Feb 
ruary  3,  1865. 
;  Chopart's.  Furlough'd  Sep 
tember  15,  1862. 
.      To    custody   of   Provost 
Marshal. 
;    4th  toe  and    metatarsal  ; 
necrosis.     Recovery. 
Left.     Furloughed  Oct.  3,  1864. 

Left.     Discharged  November  19, 
1863. 
Right;    Chopart's.      Duty  Nov. 
4,  1863. 
Left;  Chopart's;  gangrene.    Ex 
changed  March  17,  1864. 
Left.     Sent  to  Nashville. 

Left.      Discharged  January  23, 
1863. 
Left  ;  great  toe  and  half  of  meta 
tarsal.     Disch'd  May  9,  1865. 
Left:   Lisfranc's.     Disch'd  Octo 
ber  4,  1864. 
Right  ;  great  toe  and  metatarsal. 
Recovery. 
Right.      Paroled   September  23, 
1863. 
.    Paroled  September  12,  '63. 

Right  ;  four  small  toes  and  meta- 
tarsals.     Disch'd  Oct.  6,  1864. 
Lett;  Chopart's.     Furloughed. 

;  Chopart's.     Recovery. 

—  T—  .     Paroled  August  22,  1863. 

Left;    Chopart's.     Retired   Feb 
ruary  14,  1865. 
Right  ;  1st  toe  at  scaphoid,  2d  toe 
and  metatarsal.     Disch'd  Aug. 
11,  1865;  pensioned. 
Right  ;    2d  too    and  metatarsal. 
Transferred  Oct.  27,  1864. 
Right.     Discharged  December  1, 
1862. 
Right;  great  toe,  excision  1  st  and 
2d  metatarsals.     Recovery. 
;   5th  metatar.     Ass't  Surg. 
J.  Murphy.  37th  111.    Duty  May 
5,  1863.     Died  September,  1864. 

30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 

45> 
40* 
47 

48 
49 
50 

52 
53 
54 

56 
57 
58 
59 
60 

Tedrick,  W.  L.,  Pt.,  F, 
149th  Penn.,  age  21. 
Tilty,  J.,  Lieut.,  E,  34th 
North  Carolina. 
Weinlcler,  F.  E.,  Pt,,  C, 
6th  Louisiana. 
Becker,  F.,  Pt.,  G,  32d 
Indiana. 
Colgan.  J.  A.,  Corp'l,  D, 
14th  South  Carolina. 
Crockett,    VV.,    Pt.,    B, 
19th  Maine. 
Davis,  B.  M.,  Pt.,  B,  20th 
Georgia. 
Esley,  J.  A.,  Pt.,  C,  18th 
Georgia. 
Freeman,  C.  D.,  Pt.,  F, 
4th  Massachusetts. 
Furry,  E.  M.,  Serg't,  G, 
73d  Ohio. 
Gordon,    V.,  Corp'l,  K, 
55th  Virginia. 
Greenwood,  E.  W.,  Pt.. 
G.  53d  Mass. 
Hoffman,   A.,    Aide-de- 
Camp  to  Gen.  Trimble. 
Bunnicutt,  J.  B.,  Pt.,  G, 
12th  South  Carolina. 
Mitchell,  W.,  Pt.,  E,  25th 
Virginia. 
Rowland,  S.,  Serg't,  A, 
78th  New  York. 
Stuart,  J.  W.,  Pt.,  I,  9th 
Iowa. 
Wooden,  A.,  Pt.,  E,  21st 
Virginia. 
Wooding,  H.,  Serg't,  I, 
24th  Connecticut. 
Cannady,  J.  W.,  Pt,,  I, 
3d  South  Carolina. 
Colley,  T.  W.,  Serg't,  D, 
1st  Virginia  Cavalry. 
Garrison,  F.  tl.,  Pt.,  I, 
J3th  Alabama. 
Greenwood,   A.,   Pt.,  C, 
55th  Virginia. 
Hendrix,  G.  A.,  Pt.,  E, 
2d  South  Carolina. 
Herniii.  l>.  /:.,  Pt.,  I,  42d 
Georgia. 
Knight,  K.   H.,  Pt,,  K, 
45th  Georgia. 
Landing,  J.  F.,  Pt.,  A, 
38th  North  Carolina. 
Lindsay,  A.  T.,  Pt.,  F, 
6th  South  Carolina. 
Linsbay,  A,  L.,  Pt.,  E, 
60th  Alabama. 
Powell,  R.  B.,  Lieut.,  C, 
2d  South  Carolina. 

M'y  5,  '64, 

July  3, 
—  ,  ''63. 
July 

Left;  toe  and  2d  metatar.     Dis 
charged  February  10,  1865. 
Right  ;  Chopart's.     Paroled  Oct. 
24,  18<i3  ;  exchanged. 

June  18, 

1864, 

—  ,  '63. 
De.31,'62, 

.     Died  January  21,  1863. 
Right.     Died  September  13,  1864. 
Right.     Died  June  8,  1864. 
.     Died  September  12,  1862. 

J'y  3,  'C3, 

Aug.  3, 
—  ,  '62. 

1863. 

J'y31,'64. 
Sept.  20, 
—  ,  '63. 
J'y  3,  '63, 

1864. 
May  6, 
—  ,  *64. 

1862. 

1862. 
June  14, 
—  ,  '63. 
Aug.  31, 
—  ,  '62. 

Left.     Died  July  17,  1863. 
—  .     Died  September  23,  1862. 

Right    (gangrenous);    erysipelas. 
Died  August  4,  1862. 
.     Died  July  6,  1863. 

.     Died  August  10,  1863. 
Left.     Died  June  27,  1864. 
Right.     Died  July  24,  1862. 
Both.     Died  June  6,  1863. 
Left.     Died  May  G,  1862. 
.     Died  July  1,  1863. 

.     Died  July  23,  1863;  diar- 
rho3a. 

Left. 

Left  ;  grout  toe  at  tarso-metatarsal 
articulation. 
Right  ;  two  toes  and  portions  of 
metatarsals. 
Right. 

Right. 
Left. 

Dec.  14, 
—  ,  '62. 
July  3, 
—,''63. 

1863. 

J'y31,'62. 
June  14, 
—  ,  '63. 

1863. 

1864. 

1862. 
May  3, 
—  ,  ^63. 
Mar.  7, 
—  ,  '62. 

1863. 
May  24, 
—  ,  '63. 
July  3V 
—  ,  TO. 

1864. 

De.28,'64, 

Jan.  27, 
—  ,  '64. 

Aug.9,'63. 
July  3, 
—  ,  "'63. 
July  3, 
—  ,  ^63. 
M'ylG.'fiS. 

July  2, 
''63 

July  3, 
—  ,  Y63. 
Oct.  14. 
—  ,  '03. 
April  2, 
1865, 

1864. 

ICth  Georgia. 
Rogers,  J.,  Pt..  B.  44th 
North  Carolina,  ago  ilJ. 
Shaw,  L.,   Pt.,    K,   6th 
Vermont,  age  41. 

Simms,    W.  E.,    Serg't- 
Maj  ,24th  Miss.,  age  22. 
Slaiightfr,r>.W.,Vt.,K, 
18th  Georgia. 
Smithers.  B.  G.,  Corp'l, 
C,  llth  Mass. 
Sowle,  H.,  Pt.,  F,  37th 
Illinois. 

1865. 

1865. 

Se.13,'64, 

1863. 

Left. 

Right;  2d  tue  and  part  of  meta 
tarsal. 
Left. 

1862. 
Au.  2,  '63. 

1864. 

Oct.  3, 
—  ,  '64. 

'BRYAN  (JAMES),  Seventeen  Additional  Cases  of  Amputations  from  the  Armies  of  the,  S"nth-We.ttt,  in  Am.  Me.rl.  Times,  Volume  VII,  p.  287. 


SKCT.  VII.]  SHOT    WOUNDS    OF    THE    BONES    OF    THE    FOOT.  637 

Concluding  Observations. — Less  frequent  than  the  shot  lesions  of  the  bones  of  the 
hand,  the  shot  fractures  of  the  bones  of  the  foot  were  found  more  vexatious,1  not  rarely 
leading  to  extensive  inflammation  and  accumulations  of  pus  under  fascia  and  tendons,  and 
to  tedious  exfoliations  of  fractured  bones;  and  the  percentage  of  fatality  of  the  injuries  of 
the  foot  considerably  exceeds  that  of  the  injuries  of  the  hand,  the  former  being  8.3,  the 
latter  only  3.1  per  cent.  In  many  of  the  cases  of  fractures  of  the  tarsal  bones  detailed  on 
pages  619  to  622,  the  wounds  suppurated  for  months  and  even  years.  In  the  case  of  Gamp- 
bell  (CASE  896,  page  619,  ante),  who  was  shot  through  the  tarsal  bones  in  July,  1861,  the 
pension  examiners  testified  in  1874  that  the  wound  was  still  open  and  connected  with  dead 
bone;  and,  in  1875,  that  a  portion  of  the  astragalus  had  been  removed.  In  the  case  of 
Tarrance  (CASE  892,  page  619,  ante),  who  received  a  shot  fracture  of  the  os  calcis  in  1863, 
necrosed  bone  was  removed  with  the  gouge  six  months  after  the  injury,  and  the  wound  was 
yet  suppurating  in  1866.  In  other  cases,  although  the  wounds  closed,  the  limbs  remained 
of  little  service.  In  Chase's  case  (CASE  897,  page  620,  ante)  the  foot  is  turned  inward 
and  upward,  the  leg  resting  on  the  outside  of  the  foot,  and  the  patient  cannot  get  along 
without  an  artificial  apparatus.  Flattening  of  the  plantar  arch  was  recorded  in  the  case  of 
Miller  (CASE  893,  page  619,  ante),  anchylosis  of  the  ankle  joint  in  the  case  of  West 
(CASE  899,  page  620,  ante),  and  swelling  of  the  ankle  and  leg  to  the  knee  with  disease  of 
the  tibia  and  soft  parts  in  the  case  of  Captain  Bearden  (CASE  898,  page  620,  ante),  who 
either  has  to  use  crutches  or  a  stout  cane  at  all  times  to  walk. 

The  treatment  generally  consisted  in  the  application  of  cold-water  dressings  or  of 
poultices.2  Of  the  grave  surgical  complications,  pyaemia  was  noted  in  fifteen  cases,  all 
fatal;  tetanus  in  fourteen,  with  two  recoveries,  twelve  deaths;  gangrene  in  thirty-seven, 
with  thirty  recoveries,  six  deaths,  one  unknown  result;  erysipelas  in  twenty-three,  with 
twenty  recoveries,  three  deaths;  and  hemorrhage  in  twenty-three  cases,  with  nineteen 
recoveries,  three  deaths,  and  one  unknown  result. 

^Excisions  in  the  bones  of  the  foot  for  shot  injuries  are  of  very  recent  date.  The  opera 
tions  ascribed  by  Velpeau3  and  Heyfelder4  to  Formey5  in  the  sixteenth  century  and  to 

1  RA.VATON  (Chirurgie  d'armee  ou  traite  des  plaits  d'armes d,feu,  etc.,  Paris,  1768,  p.  389):  "Les  coups  de  feu  qui  fracturent  les  os  du  pied  sont 
tres  facheux  :  on  pent  les  distinguer  en  ceux  qui  percent  le  pied  suivant  sa  longueur  d'arriere  en  avant,  ou  de  devant  en  arriere ;  en  cenx  qui  le  percent 
de  cot6.  plus  ou  raoine  obliquement :  en  ceux  qui  ont  leur  entr6e  sur  le  col  du  pied,  et  leur  sortie  au  talon,  et  par  la  route  la  plus  courte  au  tarse,  an 
m^tatarse  en  fracturant  les  os  des  doigts.  Toutes  ces  difTerentes  fractures  sont  toujours  accompagnfies  de  lesion  de  tendons,  et  c'est  la  multitude  de  ces 
memes  tendons  qui  aggrave  la  maladie.'1  NKALE  (H.  ST.  JOHN)  (Chirurgical  Institutes,  etc.,  London,  1805,  2nd  ed.,  p.  256) :  "Gunshot  wounds  of  the 
tarsus,  when  the  bullet  remains  in  its  substance,  or  when  it  has  pierced  quite  through,  are  much  more  dangerous  than  those  of  the  wrist ;  and  many  reasons 
mil}1  be  given  for  this.  First,  the  bones  of  the  tarsus  are  larger  than  those  of  the  wrist,  and  of  consequence  a  greater  havock  is  occasioned  here ;  secondly, 
the  tendinous  parts  that  cover  these  bones  and  tie  them  together  are  larger  and  more  numerous.  Thus  the  nervous  system  suffers  more  in  the  injury. 
Thirdly,  the  conjoined  group  of  bones  in  the  tarsus  form  a  much  thicker  body,  and  therefore  we  cannot  reach  them  with  our  incisions  to  the  bottom  of  the 
wound,  as  in  the  soft  fleshy  parts.  These  wounds  should  therefore  be  regarded  as  being  of  very  great  consequence,  and  even  it  may  be  said  of  as  great 
importance  as  those  that  pierce  a  joint  quite  through.'1  PORTER  (J.  B.)  (Medical  and  Surgical  Notes  of  Campaigns  in  the  War  with  Mexico,  etc.,  in 
A  m.  Jour.  Med.  Set.,  1852,  Vol.  X XIII,  p.  30) :  "  Wounds  of  the  foot  and  leg  do  not,  by  any  means,  recover  so  readily  or  so  perfectly  as  wounds  of  the 
hnnd  and  forearm."  PlROGOFF  (X.)  ( Grundziige  der  Allgemeinen  Kriegschirurgie,  Leipzig,  1864,  p.  823) :  "  With  a  wound  of  the  foot  the  case  is  different 
from  a  wound  of  the  hand.  The  patient  with  a  wounded  hand  can  stand  and  go  about,  and  during  fair  weather  can  remain  in  the  fresh  air  the  whole  day. 
In  shot  wounds  of  the  foot  on  the  contrary  the  patient  is  confined  for  half  a  year  or  a  year  to  his  bed  at  the  hospital,  and,  in  the  end,  the  foot  preserved  is 
so  crippled  that  he  must  have  recourse  to  crutches.''  THOMSON  (J.)  {Report  of  Observations,  etc.,  after  the  Battle  of  Waterloo.  Edinburgh,  1816,  p. 
144) :  "Various  instances  presented  themselves  of  gunshot  wounds  of  the  foot.  In  some  of  these  the  balls  had  passed  between  the  soft  parts  and  the  bones 
on  the  under  as  well  as  upper  part  of  the  foot.  In  other  instances  the  balls  had  passed  through  the  foot  in  every  direction  and  had  fractured  the  tarsal 
and  metatarsal  bones.  These  fractures  were  always  accompanied  with  great  swelling,  which  depended  on  the  communication  of  inflammation  from  the 
wound  to  the  contiguous  ligaments  and  articulating  surfaces."  GUTHUIE  (G.  J.)  (Treatise  on  Gunshot  Wounds,  London,  1827,  p.  412):  "The  feet  pen 
•'rally  suffer  from  wounds  of  musket  balls;  and  as  the  parts  in  the  foot,  although  bearing  a  general  resemblance  to  the  hand,  are  more  complex  and 
difficult  of  management,  so  are  wounds  of  the  foot  more  dangerous  and  more  generally  followed  by  defective  cures  from  apparently  slighter  causes." 

2>STKOMEYEK  (L.)  (Maximen  der  KriegsJieilkunst,  Hannover,  1855,  p.  748)  warns  against  the  too  early  application  of  cataplasms  in  fractures  of  the 
titrsal  bones;  but  advises  their  application  in  fractures  of  the  metatarsal  and  phalangeal  bones,  as  the  cold  applications  are  apt  to  become  harassing. 

3  VELPEAU  (A.-A.-L.  M.),  Nouveaux  dements  de  medecine  operatoire,  Paris,  1839,  T.  II,  p.  660. 

4HEYFEt,DEU  (O.),  Lf.hrbuch  der  Resectiontn,  Zweiter  Abdruck,  Wien,  1863.  p.  194. 

SRIVEKIU8  (L.)  (Opera  Medico,  Unirersa,  Lugduni,  1679,  p.  571,  Obs.  XIII)  cites  a  case  of  shot  -wound  of  the  calcaneum:  the  ball  had  lodged  in 
the  calcaneum  and  was  removed  by  FORMKY  with  the  aid  of  a  trephine:  "trepano  calcaneum  aperui,  et  in  «o  latentem  globulum  inveni  et  extraxi." 


638  INJURIES    OF    THE    LOWER    EXTREMITIES.  [CHAP.  x. 

Morand1  in  the  seventeenth,  were  certainly  not  excisions,  but  simply  extractions,  by  the  aid 
of  the  trephine,  of  missiles  lodged  in  the  calcaneum.  An  excision  of  four  metatarsals  and 
the  cuneiform  bone,  performed  by  Langenbeck  in  1848,  in  the  Schleawig  Holstein  war,  seems 
to  have  been  the  first  operation  of  this  nature  for  shot  injury;  and  since  then  only  a  few 
cases  of  excisions  of  the  tarsal  or  metatarsal  bones  can  be  traced,2  as  the  surgical  histories 
of  the  late  great  European  wars  barely  mention  these  cases,  or  include  them,  without  com 
ment,  in  the  .tabular  statements  of  operations  of  the  foot  and  toes. 

As  indicated  in  Table  XCVT,  page  622,  the  excisions  in  the  tarsal  bones  had  a  fatality 
of  16.6  per  cent.,  in  the  tarso-metatarsal  articulation  of  40.0  per  cent.,  in  the  metatarsal 
bones  of  14.8  per  cent.,  and  in  the  metatarso-phalangeal  articulation  of  75.0  per  cent., 
making  in  the  aggregate  number  of  cases  a  mortality  of  19.3  per  cent.,  which  slightly 
exceeds  that  of  the  partial  amputations  of  the  foot,  viz:  18.9.  The  unfavorable  results, 
especially  in  the  cases  in  which  the  tarso-metatarsal  or  the  metatarso-phalangeal  articula 
tions  were  involved,  were  found  to  be  due  to  inflammation  of  the  synovial  membranes  and 
the  ease  with  which  purulent  suppuration  extended  through  the  spaces  between  the  adjacent 
bones.  The  usefulness  of  the  limb  remained  largely  impaired  in  nearly  all  the  patients  who 
submitted  to  this  operation.  In  the  case  of  General  Badeau,  in  which  the  middle  and 
portion  of  the  internal  and  external  cuneiforms  were  removed,  the  arch  of  the  foot  remained 
depressed,3  and  the  operation  tended  slightly  to  valgus.  In  Dubois'  case  (CASE  909,  page 
623,  ante),  the  pension  examining  surgeons  testify  to  lameness,  and  much  pain  and  diffi 
culty  in  walking;  and  in  Hargrave's  case  (CASE  916,  page  624,  ante)  it  is  reported  that  he 
was  never  able  to  walk  without  crutches.  In  the  case  of  Leunze  (CASE  911,  ante),  in  which 
the  first  metatarsal  was  removed  in  1864,  the  great  toe  had  become  distorted  in  1868  and 
was  pushed  at  least  one  inch  posterior  to  its  original  locality;  the  weight  of  the  body  in 
walking  was  sustained  by  the  heel  and  a  portion  of  the  external  border  of  the  foot. 

Amputations  in  the  Foot. — Amputations  were  performed  in  every  part  of  the  foot  as 
was  deemed  necessary  from  the  nature  of  the  injury,  thus  causing  a  series  of  operations 

1  MORAXD  (Opuscules  de  Chirurgie,  Paris,  Secomle  Partie,  177:2,  p.  248):  "  J'ai  vu  des  balles  enclav6es  daus  les  os,  et  entr6  autres  une  dans  le 
calcaneum  qui  ne  put  ctre  tir6e  que  par  1'application  du  trepan,  en  1'embrassant  dans  le  cercle  de  la  comonne." 

2  Ross  (G.)  (Militairarztliches  aus  dem  ersten  Schleswigschen  Feldzuge  im  Sommer,  1848,  Altona,  1850,  p.  56):  L ,  shot  at  Diippel,  June  5, 

1848;  ball  entered  the  dorsum  of  the  foot,  fractured  the  metatarsals,  and  escaped  at  the  sole  of  the  foot;  June  15,  excision  of  the  four  inner  metatarsals 
by  LAXGEXliKCK;  gangrene ;  June  10,  amputation  in  the  leg  ;  also  amputation  of  left  leg  for  shot  wound  of  ankle ;  death.     MATTHEW  (T.  P.)  (Medical 
and  Surgical  History  of  the  British  Army,  etc.,  in  the  years  1854-'55-'56,  London,  1858,  p.  36)  tabulates  from  the  Crimean  War  a  case  of  excision  of  the 
os  calcis  and  part  of  the  astragalus;  the  patient  was  invalided.     OCHWADT  (A.)  (Kriegschirurgisclie  Erfahrungen,  Berlin,  1865,  Appended  Table,  p. 

XVI,  Case  No.  65):  Private  C.  L ,  C-lth  Prussian  Regiment,  was  shot  in  the  calcaneum,  April  18,  1864;  excision  of  calcaneum  was  performed  by 

L/AKGENBECK  on  Muy  24 ;  recovery.     LOCKE  (A.)  (Kriegschirurgische  Apliorismen  aus  dem  zweiten  schleswig-holsteinsclicn  Kriege,  im  Jahrc  1804,  in 
Archiv  fur  Klinische  Chirurgie,  Berlin,  1806,  15.  VII,  p.  12'J):  A.  Uiep.  24th  Prussian  Regiment,  shot  June  29,  1804,  through  the  calcaneum;  removal 
of  fragments  at  various  periods;  August  2,  subperiosteal  excision  of  calcaneum  by  LfJCKE;  August  15,  gypsum  bandage;  recovery";  in  December,  1804, 
there  was  a  moderate  amount  of  new  osseous  formation.     OTIS  (G.  A.)  (Circular  No.  3,  War  Department,  Surgeon  General's  Office,  Washington,  1871, 

p.  227):  C.  L ,  1st  U.  S.  Cavalry,  shot  wound  of  calcaneum,  at  Camp  Bidwell,  Nov.  3,  1866;  caries;  excision  of  portion  of  calcaneum  February  26, 

1867  ;  good  recovery.    J.  E ,  10th  U.  S.  Cavalry,  shot  through  metatarso-phalangeal  articulation  of  left  great  toe,  January  21,  1868,  at  Fort  Riley ; 

March  1,  1808,  excision  of  phalanx  and  head  of  metatarsal  bone;   periosteum  preserved;  healed  with  profuse  suppuration;    recovery.     BECK  (B.) 
(Chirurgie  der  Schussrcrletzungen,  Freiburg,!.  Br.,  1872,  p.  900):  Soldier,  3d  Baden  Infantry,  shot  through  the  metatarsals;  extensive  suppuration; 
excision  of  the  metatarsal  bone  of  the  5th  toe  in  the  third  week  ;  favorable  result.    IDEM  (loc.  cit.,  pp.  907  arid  910)  tabulates  a  fatal  case  of  excision  in 
the  metatarsal  and  another  of  the  oaloanetim  from  the  hospitals  at  Ttasstatt  and  Strassbnrg.     CHIPAUJ.T  (A.)  (Fracturf.t p<tr  nrnic/s   '  fnt,  Paris,  1&70.  p. 

176):  J.  S ,  41st  French  Infantry,  aged  44;  shot  wound  of  left  foot;  Beaugency,  Dec.  8,  1870;  February,  1871,  extensive  suppuration;  excision  of 

part  of  astragalus  and  the  entire  os  calcis  two  months  after  injury;  wounds  cicatrized  and  patient  walked  well  in  June,  1871 ;  in  July  a  fistulous  opening 
discharged  fetid  pus;  death  Aug.  18.  1871,  of  phthisis.     IlEYFELDEH  (O.)  (Bcricht  uber  meine  Wirksamkeit  am  Iihein,etc.,  in  1'etcrsburg  Med.  Zeitschrift, 
1871,  B.  II,  p.  61):  Bazze,  67th  Infantry  ;  shot  wound  of  os  caicis  and  calcaneum  Aug.  16,  1870;  December  0,  excision  of  part  of  calcaneum  ;  reproduction 
of  bone  followed  in  a  few  weeks.     IDEM  (p.  80):  French  officer,  shot  through  (he  os  calcis  at  Sedan(?) ;  partial  excision  of  calcaneum  by  HEYFELDKU  ; 
good  recovery.     TILING  (G.)  (Bericht  uber  124  im  serbisch-tiirkischen  Kriege  im  Barar.ken-Lazareth  des  Dorpater  Sanitats- Trains  zu  Swilainats  bclian- 

deltc  Schussverletzungen,  Dorpat,  1877,  p.  81):  M.  G ,  aged  21;  shot  fracture  of  calcaneum  in  September,  1876;  excision  of  the  os  calcis;' wound 

nearly  healed  in  October. 

'HAMILTON  (F.  H.)  (A  Treatise  on  Military  Surgery  and  Hygiene,  New  York,  1865,  p.  508):  "  The  tarsal  bones  constitute  a  large  portion  of  that 
important  arch  upon  which  the  entire  bony  superstructure  rests.  The  several  portions  of  which  it  is  composed  are  all  alike  essential  to  its  perfection,  and 
the  removal  of  any  single  bone  necessarily  gives  a  certain  degree  of  instability  to  the  gait.  What,  therefore,  might  be  regarded  as  a  success  in  any 
other  portion  of  the  body  must  often  be  regarded  as  a  failure  here." 


SECT.  VII.] 


AMPUTATIONS    IN    THE    FOOT. 


639 


differing  materially  from  each  other.  The  medio-tarsal  operation  of  Chopart,1  between  the 
astragalus  and  scaphoid  bone  (FiG.  361),  was  performed  in  eighty-five  instances.  In  two 
the  results  were  not  determined;  seventy-two  were  successful  and  eleven  fatal.  In  two 
instances,  with  one  recovery  and  one  death,  the  reports  merely  indicate  that  the  ablation 
was  performed  through  the  tarsal  bones;  these  operations  were  probably  also  after  Chopart. 
Lisfranc's8  amputation  through  the  tarso-metatarsal  articulation  (FiG.  362)  was  performed 
on  twenty-four  patients;  twenty-two  recovered,  one  died,  and  one  result  was  not  determined. 

Hey's  operation,3 

in  which  the  four 

outer  metatarsal 

bones    are   exar- 

ticulated  at  their 

junction  with  the 

tarsals,    and    the 

projecting  part  of 

the  first  cuneiform 

l.-CHOl-AKT'B  amputation  of  the  foot.     [After     bone    which     Slip-         ^    362._LI8FRAKC,S  amputation  in   the  foot.     [After 

ports  the  great  toe  ESMAUCH- J 
is  removed,  was  performed  in  seventeen  cases;  eleven  were  successful  and  six  fatal.  In 
one  hundred  and  thirteen  instances  from  one  to  four  toes,  with  the  corresponding  metatar- 
sals,  were  amputated,4  and  in  one  thousand  two  hundred  and  twenty-seven  cases  one  or 
more  toes  were  removed.5  Of  the  two  hundred  and  ninety-one  patients  with  amputations 
in  the  foot,  thirteen  submitted  to  subsequent  operations,  viz:  one  to  amputation  at  the 
ankle  joint  and  twelve  to  amputations  in  the  leg;  one  of  the  latter  died.  The  twelve 
hundred  and  twenty-seven  amputations  of  toes  were  followed  by  amputations  in  the  foot  in 
two,  at  the  ankle  joint  in  two,  in  the  leg  in  six,  at  the  knee  joint  in  one  instance,  making 
a  total  of  eleven  re-amputations  following  amputations  of  the  toes.  In  five  hundred  and 
fifty  cases  the  amputation  involved  the  right  limb,  in  eight  hundred  and  forty-seven  the 
left  limb,  and 'in  one  hundred  and  twenty-one  the  side  was  not  indicated. 

It  is  difficult  to  attain  a  common  standard  of  the  usefulness  of  the  foot  after  amputa 
tion,  as  the  patient,  according  to  his  individuality,  personal  vanity,  or  the  necessities  of  his 
condition,  will  insist  on  diverse  requirements;  but  it  is  evident  that  a  well-rounded  stump 
is  of  the  utmost  importance.  A  remaining  portion  of  a  finger  or  thumb  may  be  very  useful; 
but  a  remaining  toe  will  frequently  be  a  source  of  annoyance  and  even  an  inconvenience; 
will  add  nothing  to  the  patient's  power  of  locomotion  and  prove  a  hindrance  to  the  proper 
fitting  of  a  shoe. 


1  LAFITEAU,  Observation  sur  une  amputation  pariielle  tin  pied,  in  La  Mldecine  eclairee  par  les  sciences  physiques  ou  Journal  des  decouvertes, 
Paris,  171)2,  Vol.  IV,  p.  8.5. 

2LlSFRA.XC  (.!.),  Noucelle  methode  operatoire  pour  V 'amputation  partielle  dupied  dans  son  articulation  tarso-metatarsiennf,  Paris,  1815,  p.  17. 

3Hl£Y  (W.),  Practical  Observations  in  Surgery  illustrated  by  cases,  London,  3d  ed.,  1814,  p.  054. 

4  Four  metatarsals  with  their  corresponding  toes  were  amputated  in  3  instances  ;  three  in  7  instances,  two  in  19  iustances,  and  one  metatarsal  and 
the  corresponding  toe  in  84  iustances.  Of  the  113  cases,  5  were  not  terminated,  99  recovered,  9  were  fatal.' 

5 The  operation  involved  one  toe  in  1,001  cases,  two  in  145,  three  in  31,  four  in  8,  and  all  toes  in  18  instances;  in  24  cases  the  numbei  of  toes 
removed  was  not  indicated. 


640 


MISCELLANEOUS    INJURIES. 


[CHAP.  II. 


CHAPTER    XI. 


MISCELLANEOUS    INJURIES, 


In  the  beginning  of  this  work,  in  the  first  chapter  on  injuries  of  the  head,  and  to  some 
extent  in  the  second,  third,  and  fourth  chapters  on  injuries  of  the  face,  neck,  and  spine, 
the  miscellaneous  injuries,  as  well  as  the  injuries  by  weapons  of  war,  were  discussed.  But 
as  the  work  progressed  it  was  found  advantageous  for  the  compiler  as  well  as  the  reader  to 
examine  the  injuries  caused  by  direct  impact  of  weapons  of  war  by  themselves,  and  to 
reserve  the  injuries  from  other  causes  for  a  separate  chapter.  In  this  chapter  will,  there 
fore,  be  considered  the  numerous  accidents  similar  to  those  daily  occurring  in  civil  life, 
and  to  which  the  soldier  is  likewise  exposed,  such  as  burns,  scalds,  contusions,  sprains,  dis 
locations,  frostbites,  simple  and  compound  fractures,  punctured  and  incised  wounds — not 
including  sabre  and  bayonet  wounds — and  lacerated  wounds.  As  will  be  seen  from  the 
following  tabular  statement  the  number  of  these  injuries  was  by  no  means  insignificant: 

TABLE  GUI. 
Summary  of  One  Hundred  and  Seventy-one  Thousand  Five  Hundred  and  Sixty -five  Miscellaneous  Injuries, 


CLASSIFICATION. 

TOTAL. 

Percentage 
of 
Mortality. 

WHITE  TROOPS. 

COLORED  Tnoors. 

Cases. 

Deaths. 

Cases. 

Deaths. 

Cases. 

Deaths. 

1 

3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 

Jiurns  and  Scalds  

10,  100 
46,  972 

98 
172 
215 
17 
3 
10 
53 
76 
397 
163 
467 
169 
110 
1,075 

0.97 
0.36 
23.31 
27.86 
.00 
0.33 
4.11 
1.74 
28.95 
0.73 
3.16 
3.13 
3.48 
7.03 

9,487 
44,  323 
873 
61 
38,387 
2,908 
1,  287 
4,215 
1,316 
20,  932 
14,  153 
4,902 
3,087 
13,  099 

94 
161 
193 
17 
3 

9  ; 

53 
61 
378 
161 
459 
162 
93 
1,003 

613 
2,649 
49 

4 
11 

Contusions  

Concussion  of  Brain   

922 
61 
42,  704 
3,016 
1,287 
4,  340 
1,  371 
22,  227 
14,748 
5,  384 
3,154 
15,  -J73 

Compression  of  Brain  

Sprains  

4,317 
108 

Dislocations  

1 

Fractures  

Simple  Fractures  

131 

55 
1,295 
595 
482 
67 
2,174 

15 
19 
2 
8 

7 
17 

72 

Compound  Fractures  

Incised  AVounds1  

Lacerated  Wounds  

Punctured  Wounds2  

Poisoning  

Other  Accidents  and  Injuries  

Aggregates  

171,  565 

3,025 

1.76 

159,  030 

2,847 

12,535 

178 

1  The  entire  number  of  incised  wounds  as  indicated  on  page  XXV  of  the  First  Surgical  Volume  was  22.749.     From  these  have  hofn  deducted  522 
sabro  wounds  referred  to  in  the  preceding  ten  chapters. 

2  The  entire  number  of  punctured  wounds  as  indicated  on  page  XXV  of  the  First  Surgical  Volume  was  5,784.     From  these  have  been  deducted 
400  bayonet  wounds  referred  to  in  the  preceding  ten  chapters. 


SECT.  I.I 


BURNS   AND    SCALDS. 


641 


Besides  the  number  of  accidents  recorded  in  the  preceding  table  there  were  a  number 
of  deaths  from  violence,  such  as  drowning,  suicide,  homicide,  and  execution  of  sentence: 

TABLE  CIV. 
Summary  of  One  Thousand  Three  Hundred  and  Thirty-six  Deaths  from  Various  Causes. 


WHITE 

Tuoors. 

COLOUED 

TKOOl'S. 

t 

Deaths. 

Percentage. 

Deaths. 

Percentage. 

^ 

Drowning  

797 

672 

84.  32 

125 

15.68 

9 

Suicide  

278 

270 

97.12 

8 

°  88 

3 

Homicide  

126 

114 

90.48 

12 

9.52 

4 

Execution  of  Sentence  

135 

103 

76.30 

32 

23.70 

Total 

1  336 

1,159 

177 

The  total  number  of  troops  engaged  during  the  war  is  estimated  (see  introduction  to 
First  Medical  Volume,  p.  XXXIX)  at  2,335,942  men;  of  these  2,157,047,  or  92.34  per 
cent.,  were  white  and  178,895,  or  7.66  per  cent.,  colored.  It  will  thus  be  seen  that  the 
percentage  of  suicides  among  the  colored  troops  was  very  small,  while  the  percentages  of 
deaths  from  accidental  drowning  and  execution  of  sentence  were  large. 

The  injuries  recorded  in  the  preceding  tables  are  of  such  frequent  occurrence,  in  daily 
life,  and  their  treatment  is  so  fully  discussed  in  surgical  journals  and  text-books  and  in 
the  reports  of  civil  hospitals,  that  it  will  only  be  necessary  here  to  introduce,  without  com 
ment,  a  few  of  the  more  serious  examples  of  the  different  accidents,  and  to  give,  in  tabular 
form,  a  summary  of  the  operations  subsequent  to  these  injuries. 

Burns  and  Scalds. — Injuries  caused  by  the  exposure  of  living  tissue  to  a  high  degree 
of  temperature  are  called  burns;  when  the  burn  is  produced  by  hot  or  boiling  liquid  it  is 
called  a  scald.  The  pathological  conditions  and  the  treatment  of  burns  and  scalds  are 
fully  described  by  Dupuytren,  Long,  Erichsen,  Crompton,  Ashhurst,  Follin,  and  Legouest 
and  others.1  The  large  majority  of  the  ten  thousand  one  hundred  injuries  of  this  nature 
during  the  war  were  of  an  exceedingly  trivial  nature,  only  ninety-eight,  or  0.9  per  cent., 
proving  fatal.  Those  caused  by  the  action  of  powder,2  from  explosions  of  cartridges, 
caissons,  or  magazines,  were  the  most  serious,  and  a  few  instances  will  be  cited. 

CASE  937. — Private  G.  Witter,  1st  Ohio  Battery,  aged  29  years,  was  injured  by  the  explosion  of  a  caisson  during  the 
action  near  Winchester,  July  20,  1864,  and  entered  the  Cumberland  General  Hospital  three  days  afterwards.  Acting  Assistant 
Surgeon  M.  M.  Townseml  recorded  the  following  description  of  the  case:  "The  patient  was  suffering  from  burns  of  his  face, 
arms,  and  hands.  When  admitted  his  appearance  was  dreadful,  the  burns  involving  the  whole  of  the  face,  the  anterior  surface 
of  the  neck,  and  parts  of  the  external  surfaces  of  the  forearms.  On  the  hands  the  skin  was  destroyed  in  several  places  at  the 
dorsal  surface  and  ulnar  edge.  The  patient's  face  was  covered  with  a  complete  mask  of  dried  pus,  oil,  and  cotton,  causing  him 
to  look  like  a  negro  in  the  suppurating  stage  of  confluent  small-pox.  Warm  emollient  poultices  and  assiduous  washing  soon 

1  DUPUYTKKX,  Des  Brulures,  in  Lemons  Orales  de  Clinique  ChirurgicaU,  Paris,  1839,  T.  IV,  p.  503.     LONG  (JAMES),  On  the  Post-Mortcm  Appearances 
found  after  Bum*,  in  London  Medical  Gazette,  London,  1640,  Vol.  XXV,  p.  743.     ERICHSEN  (J.  E.),  On  the  Pathology  of  Burns,  in  L<mdon  Medical 

Gazette.,  London  184:i,  Vol.  XXXI,  p.  544.  CHOM1TON  (SAMUEL),  Report  on  Burns  and  Scalds,  in  The  Transactions  of  the  Provincial  Medical  and  Surgical 
Association,  London.  1851,  Vol.  XVIII,  p.  1.  AsiilluusT  (JOHN,  JR.),  On  Burns,  in  Am.  Jour.  Med.  Sciences,  Philadelphia,  1862,  Vol.  XLIV,  p.  82. 
FOLUN  (E.),  Brulures.  in  Trait':  Elementaire  de.  Pathologie  Extcrne,  Paris,  1869,  T.  I,  page  521.  LEOOUEST,  Brulure,  in  Dictionnaire  Encyclopedia/lie 
des  Sciences  Medicates,  Paris,  1870,  T.  XI,  p.  184.  MONTGOMERY  (J.  F.),  Burns  and  Scalds;  their  treatment,  with  casrs,  San  Francisco,  1872,  and  Pacific 
Med.  and  Surg.  Journal,  San  Francisco,  1872,  N.  8.,  Vol.  VI,  p.  157. 

2  Burns  by  gunpowder  have  been  treated  by  LOXSDALE  (E.  F.),  in  London  Med.  Gazette,  183:i,  XI,  p.  69(> ;  SCHNEIDER,  Verletzungen  durch  Scliicss- 
pulver,  Gewehre,  Zi'.ndhutchen  und  Zunclhiilzchni,  in  Zeitschrift  fur  die  Staatsarzneikunde,  Erlungen,  1851,  B.  LXI,  p.  461 ;  DUSCH  (W.),  Mittel grgctt 
Schiesspulvcr-  Verbrennu-ng,  in  Arch,  fur  path.  Anat.,  Berlin,  1858,  B.  XIV,  p.  379 :  CAHAS8E,  Des  brulurcs  multiples  an  1",  2"  et  3«  degr's.  produites  par 
la  deflagration  d'une  grande  quantite  de  poudre,  in  Gaz.  des  Bop.,  Paris, '1867,  T.  XL,  p.  516;  HOLLER  (A.  W.),  Ueber  Pulver-Verbrennung  mit  letalcm 
Ansgartg,  Leipzig,  1870;  GlLLIAM  (D.  T.),  Extensive  powder  burn,  in  Clinic,  Cincinnati,  1875,  Vol.  VIII,  p.  30 ;  MAISSIN  (L.-E.),  Quelques  cas  de  brulures 
causees  par  la  deflagration  de  la  poudre,  Paris,  1875;  SMART,  On  Burns  by  Gunpowder  and  Scalds  by  Steam,  in  Lancet,  London,  1876,  Vol.  II,  p.  4'J1 ; 
DOWNS  (S.),  Severe  Injury  from  Discharge  of  Gunpowder,  in  Toledo  Med.  and  Surg.  Journal,  1880,  Vol.  IV,  p.  507;  FAIRiiROTHEK,  Disfigurement  from 
gunpowder,  in  St.  Louis  Med.  and  Surg.  Jour.,  1880,  Vol.  XXXV11I,  p.  491.     LONGMORK  (T.),  Gunshot  Injuries,  London,  1877,  p.  171. 

Srno.  Ill— 81 


642  MISCELLANEOUS    INJURIES.  [CHAP.  xi. 

removed  the  offensive  incrustations,  when  a  saturated  solution  of  alum  was  applied  with  good  effect.  To  the  deepest  burns  on 
the  hands  poultices  of  slippery  elm  were  found  to  be  more  grateful  and  beneficial  than  the  alum  and  were  therefore  substituted, 
being  followed  three  daj-s  later  by  simple  cerate.  This  was  continued  until  cure  was  complete."  On  September  5th  the  patient 
was  transferred  to  Camdun  Street  Hospital  at  Baltimore,  where  he  remained  until  May  16,  1865,  when  he  was  mustered  out  of 
service  and  pensioned.  Examining  Surgeon  J.  G.  Orton  certified  to  the  existence  of  ''several  extensive  scars,  the  result  of  burns. 
One  over  the  posterior  part  of  the  left  elbow  impairs  the  action  of  the  extensor  muscles  and  renders  the  joint  defective.  He  also 
complains  of  pain  in  the  back  and  over  the  bowels,  resulting  from  a  fall  at  the  time  of  the  explosion."  Subsequent  examiners 
report  no  additional  information.  The  pensioner  was  paid  September  4,  1881. 

CASE  938. — Private  C.  H.  Shields,  6th  Maine  Battery,  aged  21  years,  was  injured  by  the  explosion  of  some  cartridges 
during  the  battle  of  the  Wilderness,  May  6,  1864.  Surgeon  H.  C.  Tompkins,  4th  New  York  Artillery,  reported  his  admissisn 
to  the  Artillery  Brigade  Hospital,  Second  Corps,  with  "severe  burn  of  face  and  hands  by  powder."  From  the  field  the  injured 
man  passed  to  Armory  Square  Hospital  at  Washington,  and  thence  to  Cony  Hospital  at  Augusta,  where  he  was  discharged  from 
service  for  disability  June  13,  1865,  and  pensioned.  Examining  Surgeon  J.  B.  Bell  reported,  July  8,  1865,  that  "  the  disability 
results  clriefly  from  disfigurement.  Both  ears  were  disagreeably  deformed  and  partially  destroyed.  The  left  side  of  the  face  is 
scarred  and  blackened,  and  the  use  of  the  left  hand  is  somewhat  impaired  by  the  scar  of  the  burn."  Examiner  G.  W.  Burket,  of 
Tyrone,  Penn.,  certified  September  4,  1873:  "Both  ears  were  burnt,  causing  partial  deafness  from  closure  of  the  external  meatus 
of  the  left  ear."  Examiner  I.  E.  Oatman,  of  Sacramento,  Cal.,  September  4,  1879,  confirmed  the  existence  of  partial  deafness, 
also  that  the  upper  and  greater  portion  of  both  ears  were  burned  off  by  the  explosion. 

CASE  939.— Private  C.  Withee,  1st  Wisconsin  Battery,  was  severely  injured  by  the  explosion  of  a  caisson  during  the 
battle  of  Big  Black  River,  May  18,  1863.  He  was  admitted  to  Union  Hospital,  Memphis,  three  weeks  afterwards,  where  Surgeon 
J.  D.  Brumley,  U.  S.  V.,  recorded  the  following  result:  "  He  had  been  very  badly  burned  over  his  face,  both  hands  and  both 
arms,  by  the  accident,  and  when  he  entered  this  hospital  he  was  a  most  pitiful  and  repulsive  looking  object>  His  face  was  covered 
with  scabs  so  that  the  eyes  could  not  be  opened.  A  bullous  eruption  covered  the  •body  and  arms,  and  tetanus  caused  the  left 
hand  and  wrist  to  be  so  contracted  that  the  finger  nails  were  embedded  into  the  wrist,  while  the  wrist  was  flexed  on  the  arm  to 
such  an  extent  as  to  bring  its  dorsal  aspect  further  down  than  any  part  of  the  hand.  Trismus  existed,  so  that  a  spoon  could 
hardly  be  introduced  between  the  teeth.  By  tonics,  anodynes,  and  supporting  treatment  the  patient  was  relieved  sufficiently  to 
enable  him  to  converse  and  to  take  food  by  means  of  a  spoon.  His  mind,  which  had  been  delirious,  now  became  sane,  and  his 
left  arm  was  straightened  by  gradual  force,  after  which  splints  were  applied.  On  June  15th,  however,  when  taking  some 
drink — after  having  taken  hi&.uourishment  in  the  morning  as  usual — he  appeared  to  have  difficulty  in  swallowing,  and  in  half 
an  hour  afterwards  he  died,  apparently  from  suffocation  caused  by  spasm  of  the  epiglottis." 

CASE  940. — Private  R.  A.  Runion,  Co.  I,  68th  Indiana,  aged  24  years,  had  his  feet  scalded  by  accident,  and  was  admitted 
to  Hospital  No.  13  at  Nashville  on  February  26,  1863.  Surgeon  E.  Swift,  U.  S.  A.,  contributed  the  following  report  of  the  case: 
"The  injury  was  caused  by  the  upsetting  of  a  pot  of  hot  coffee,  involving  the  right  foot  at  the  heel  and  toes  and  affecting  the  left 
foot  but  slightly.  No  unfavorable  symptoms  were  presented  when  the  patient  was  admitted.  His  pulse  and  respiration  were 
natural ;  tongue  lightly  furred  ;  bowels  rather  loose,  with  a  tendency  to  diarrhrea.  The  wound  was  dressed  with  simple  cerate. 
On  February  28th  his  bowels  became  more  loose,  accompanied  by  slight  pain,  when  pills  of  blue  mass,  ipecacuanha,  and  opium 
were  prescribed.  The  effect  of  this  seemed  to  be  favorable  and  indications  were  generally  promising  until  March  5th,  when  the 
bowels  became  costive,  the  urine  scanty  and  very  highly  colored,  and  the  skin  yellow,  showing  all  the  symptoms  of  an  aggravated 
case  of  jaundice.  With  a  view  of  gently  moving  the  bowels,  two  compound  cathartic  pills  were  then  given,  followed  four  hours 
afterwards  by  doses  consisting  of  two  grains  of  quinine,  three  grains  of  nitrate  of  potassa,  and  one-twelfth  of  a  grain  of  morphia. 
On  March  7th  the  bowels  were  still  costive  and  the  urine  scanty.  Indeed  all  the  symptoms  were  aggravated  and  the  patient  had 
a  severe  spasm  followed  by  delirium  approaching  mania.  Three  pills,  each  containing  five  grains  of  blue  mass  and  one  drop  of 
croton  oil,  were  now  prescribed,  one  to  be  given  every  three  hours  until  the  patient  had  an  operation.  He  Avas  bathed,  and 
warm  water  was  given  freely,  and  corn-meal  gruel.  On  March  8,  1863,  the  patient  died,  having  been  comatose  and  perfectly 
unconscious  since  the  spasm  of  .the  previous  day.  Perspiration  and  urine  became  profuse  before  death.  Sectio  cadaveris :  An 
incision  was  made  from  the  ensiform  cartilage  to  the  symphysis  pubis  and  transversely  to  the  crest  of  the  ilium.  The  general 
appearance  of  the  liver  was  not  marked,  though  of  a  rather  pale  color  and  tough  in  texture.  The  gall  bladder  contained  the  usual 
amount  of  bile,  the  hepatic  and  cystic  ducts  being  perfectly  pervious  and  free.  The  ileum  and  jejunum  were  natural  in  appearance, 
but  the  duodenum  gave  evidence  of  being  the  seat  of  the  disease.  It  had  a  soft,  doughy  feeling,  its  inner  coats  being  softened  down 
and  entirely  disorganized;  perforation  had  taken  place  at  a  number  of  places  in  this  part  of  the  intestinal  canal.  The  outer  coat 
was  perforated,  with  sharp  well-defined  edges,  while  the  inner  coats  were  softened  and  beveled,  and  indeed  affected  in  their 
entire  surface.  A  marked  peculiarity  was  that  the  disease  involved  only  the  duodenum,  the  other  parts  of  the  alimentary  canal 
being  in  a  perfectly  normal  condition."  • 

Contusions  and  Sprains. — Less  serious  even  than  the  preceding  group  of  injuries  were 
the  numerous  contusions  and  sprains.  Forty-six  thousand  nine  hundred  and  seventy-two 
of  the  former  had  one  hundred  and  seventy-two,  and  forty-two  thousand  seven  hundred  and 
four  of  the  latter  had  three  deaths, — a  total  of  eighty-nine  thousand  six  hundred  and  seventy- 
six  cases,  with  one  hundred  and  seventy-five  deaths,  or  a  mortality  of  0.19  per  cent.  As 
a  rule  the  patients  were  returned  to  duty,  no  lasting  disabilities  having  followed  the  injuries. 
A  few  of  the  graver  cases  will  here  be  cited: 

CASE  941. — Contusion  of  tJic  spine. — Private  J.  Sanford,  Co.  I,  32d  Massachusetts,  aged  37  years,  was  accidentally  hurt 
in  the  back  on  September  12,  1862.  He  was  admitted  to  Fairfax  Seminary  Hospital  the  following  day,  where  he  was  discharged 


SECT.  l.J  CONTUSIONS    AND    SPRAINS.  643 

from  service  on  December  8,  1862.  Surgeon  D.  P.  Smith,  U.  S.  V.,  certified  to  the  following  disability:  "An  injury  of  the 
lumbar  vertebrae  which  has  resulted  in  inflammation  of  the  kidneys  and  of  the  tissues  of  the  lumbar  region,  rendering  it  difficult 
for  him  to  stand."  The  Boston  Examining  Board  reported,  November  27,  1862:  "Partial  paralysis  of  the  superior  and  inferior 
extremities,  bowels,  and  bladder  frum  injury  to  spine.  The  paralysis  of  the  inferior  extremities  is  no  worse  than  a  year  ago, 
perhaps  the  legs  are  a  trifle  smaller.  The  paralysis  of  the  arms  has  increased  somewhat.  The  disability  is  permanent  and 
incapacitates  him  for  all  manual  labor."  Dr.  \V.  H.  Wallace,  of  East  Boston,  testified,  March  29,  1880:  "The  pensioner  is 
suffering  from  an  injury  of  the  spine,  partial  paralysis  of  the  upper  and  lower  extremities,  great  irregularity  of  the  bowels — 
sometimes  obstinate  constipation,  at  others  diarrhoea;  also  inability  to  retain  the  urine  and  at  times  inability  to  pass  it.  He 
requires  the  passing  of  a  catheter  once  and  often  twice  a  week,  and  is  unable  to  feed,  dress,  or  undress  himself  fully  two-thirds 
of  the  time.  There  is  emaciation  and  loss  of  sleep  from  pain  in  back  and  legs .  He  will  never  be  any  better." 

CASK  942. — Contusion  of  the  spine. — Private  R.  Clark,  Co.  D,  6th  Ohio  Cavalry,  aged  54  years,  received  an  injury  of 
the  spine  during  the  battle  of  Bull  Run,  August  29,  1862,  and  was  treated  at  St.  Aloysius  Hospital,  Washington.  Assistant 
Surgeon  A.  Ingram,  U.  S.  A.,  in  charge,  reported  the  man's  discharge  from  service  December  18,  1862,  by  reason  of  "  slight 
anterior  curvature,  with  much  tenderness  resulting  from  the  injury."  The  Chicago  Examining  Board,  September  5,  1873, 
reported  that  the  man  was  hurt  by  falling  from  his  horse,  and  that  "the  horse  stepped  upon  his  loins,  injuring  the  structure  of 
the  spine  in  the  muscular  and  fibrous  portions.  There  is  apparent  permanent  rigidity  of  the  spinal  muscles  and  great  pain  on 
pressure  or  movement."  Examining  Surgeon  J.  F.  Daggett,  of  Lockport,  Illinois,  May  22,  1877,  certified  to  an  injury  of  the 
spine,  etc.,  and  stated  that  it  is  difficult  to  determine  what  structural  impairment  there  is,  but  that  the  functional  derangement  is 
severe  and  continued,  and  that  there  is  "anchylosis  of  the  lumbar  vertebrae ;  brain  affected  from  spinal  irritation  or  other  causes; 
tendency  to  mental  derangement;  general  health  bad."  The  pensioner  died  August  24, 1881,  from  the  results  of  his  injuries. 

CASK  943. — Sprain  of  the  back. — Private  J.  B.  Saunders,  Co.  K,  143d  New  York,  aged  47  years,  entered  Satterlee  Hos 
pital,  Philadelphia,  December  23, 1862.  He  had  several  months  previously  received  a  fall  against  the  arm  of  a  seat  in  a  railroad 
car,  straining  the  small  of  his  back.  Since  then  he  had  suffered  from  occasional  retention  of  urine,  and  his  bowels  were  never 
moved  except  by  the  most  powerful  cathartics.  Pressure  upon  any  of  the  lumbar  vertebrae  appeared  to  give  pain,  but  there  was 
no  fracture  or  displacement  to  be  detected.  While  the  patient  remained  in  Satterlee  Hospital  large  doses  of  castor  oil,  with  one 
drop  of  croton  oil  added,  were  administered,  and  pills  of  compound  extract  of  colocynth,  with  one-sixteenth  grain  of  strychnine 
added,  were  given.  Friction  to  the  spine,  with  stimulating  liniments,  was  applied.  No  change  took  place  in  the  condition  of 
the  patient,  who  was  discharged  from  service  January  29,  1863,  and  subsequently  became  a  pensioner.  Surgeon  I.  I.  Hayes, 
U.  S.  V.,  who  reported  the  case,  described  that  there  seemed  to  be  a  complete  paralysis  of  the  muscular  coats  of  the  large  intes 
tine  and  also  of  the  sphincter  ani,  from  which  cause  an  evacuation  would  take  place  only  when  the  mass  of  faeces  became  so  great 
from  natural  accumulation  or  from  the  action  of  the  cathartics  as  to  no  longer  leave  room  in  the  bowels  to  contain  it,  when  the 
fecal  matter  appeared  to  pass  off  by  force  of  gravity  and  unmolested  by  the  sphincter  as  soon  as  it  reached  the  rectum.  Exam 
ining  Surgeon  A.  Otis,  of  Ellinsville,  N.  Y.,  December  8,  1872,  certified:  "There  is  great  tenderness  of  the  spine,  especially  of 
the  lumbar  vertebrae.  His  lower  limbs  are  very  weak  and  at  times  almost  paralyzed.  He  trembles  almost  continually,  has  an 
anxious,  waxy,  and  cadaverous  expression  of  countenance,  difficulty  in  micturition,  and  is  excessively  constipated."  The  pen 
sioner  died  from  the  effects  of  his  injuries  December  2,  1875. 

CASE  944. — Contusion  of  the  abdomen. — Private  A.  Bickel,  Co.  K,  142d  Pennsylvania,  aged  29  years,  entered  Satterlee 
Hospital  July  10,  1863,  having  received  a  severe  injury  during  the  march  to  Gettysburg.  The  accident  was  incurred  while  a 
fence  was  being  knocked  down  for  the  purpose  of  facilitating  the  passage  of  troops,  when  he  was  struck  with  the  butt  end  of  a 
musket  in  the  lower  part  of  the  abdomen,  causing  a  severe  contusion  of  the  bowels  and  forcing  the  right  testicle  back  into  the 
abdomen.  The  patient  suffered  much  from  pain  in  the  bowels,  which  were  also  quite  inactive,  and  his  general  health  as  well  as 
his  appetite  was  poor.  His  treatment  consisted  of  the  administration  of  compound  cinchona  tincture  and  of  rhubarb,  to  which 
subsequently  aloes  and  small  quantities  of  extract  of  nux  vomica  and  hyosciamus  were  added.  On  November  1st,  the  patient's 
bowels  being  still  very  painful  and  inactive,  the  medicines  were  discontinued  and  injections  of  warm  salt  water  were  substituted. 
Very  little  change  in  the  condition  of  the  patient  occurred  up  to  December  16,  1863,  when  he  was  discharged  from  service  and 
pensioned.  The  history  of  the  case  was  contributed  by  Acting  Assistant  Surgeon  D.  Kennedy.  Examining  Surgeon  S.  L.  Beck, 
of  Mifflinburg,  Pennsylvania,  September  17, 1873,  certified  that  "  the  stroke  produced  an  injury  of  the  bladder  and  an  abdominal 
rupture,  which  causes  some  pain  and  other  inconvenience,  so  that  he  is  somewhat  disabled  in  performing  manual  labor.  He 
will  be  no  better,  but  may  get  worse."  Examiner  T.  H.  Wilson,  of  Lewisburg,  Pennsylvania,  reported,  November  14,  1881 : 
"I  find  the  pensioner  has  a  reducible  inguinal  hernia  in  the  right  side  and  has  been  wearing  a  truss,  which,  he  alleges,  does  not 
retain  the  bowel  completely,  so  that  it  frequently  escapes  in  spite  of  the  truss,"  etc. 

CASE  945. — Contusion  of  the  shoulder. — Private  J.  M.  Granger,  Co.  F,  141st  New  York,  aged  26  years,  entered  Central 
Park  Hospital,  New  York  City,  December  17,  1862.  Surgeon  B.  A.  Clements,  U.  S.  A.,  forwarded  the  following  report :  "  In 
October,  18G2,  the  patient  was  injured  at  Annapolis  by  the  falling  of  a  heavy  piece  of  timber  on  his  right  shoulder,  striking 
upon  the  superior  and  posterior  aspect  over  the  spine  of  the  scapula.  The  blow  was  so  severe  as  to  knock  him  down.  He  was 
immediately  taken  to  hospital,  where  the  hand  and  arm  swelled  largely  and  he  became  unable  to  use  them  without  great  suffering. 
Five  weeks  afterwards  he  entered  Trinity  Hospital  at  Washington,  whence  he  was  transferred  here  two  weeks  later.  On 
examination  the  patient  was  found  to  be  well  nourished  and  in  general  good  condition,  but  his  face  had  an  anxious  expression, 
or  that  of  suffering.  The  right  shoulder  was  swollen,  the  greatest  amount  of  tumefaction  being  directly  over  the  supra-spinous 
region.  The  whole  arm  and  hand  were  also  swollen  and  of  a  purplish  color,  and  the  patient  was  unable  to  raise  them  except  to 
a  limited  degree.  By  an  assistant  the  arm  could  be  moved  with  difficulty  and  the  hand  might  be  placed  on  the  top  of  the  head. 
The  patient  underwent  a  variety  of  treatment,  including  colchicum,  iodide  of  potassa,  liniments,  etc.,  without  any  appreciable 
benefit,  the  condition  of  the  shoulder  and  arm  remaining  unchanged,  the  hand  swollen  and  cold,  and  the  arm  quite  stiff  and  useless. 
When  he  received  his  discharge  from  service  December  23,  1863,  his  general  health  was  not  as  good  as  formerly."  He  subse- 


644  MISCELLANEOUS    INJURIES.  [CHAP.  XI. 

quently  made  application  for  pension,  and  received  the  following  certificate  from  Examining  Surgeon  W.  M.  Chamberlain,  of 
New  York  City :  "There  has  been  a  general  contusion  of  the  shoulder,  followed  by  inflammatory  action  about  the  joint.  Depres 
sion  of  the  shoulder  and  almost  total  inability  to  use  the  arm  is  dependent  perhaps  upon  rupture  of  the  musculo-spiral  nerve." 
Owing  to  the  applicant's  inability  to  prove  the  origin  of  the  injury  in  the  line  of  duty  his  claim  for  pension  was  rejected. 

CASE  946.— Sprain  of  both  ankles.— Private  A.  Leehaus,  Co.  K,  4th  Ohio  Cavalry,  aged  39  years,  accidentally  sprained 
both  ankles  severely  at  Stone  Mountain,  October  23,  1864.  After  passing  through  various  hospitals  he  was  transferred  to 
Madison,  where  he  was  mustered  out  of  service  May  25,  1865.  Subsequently  his  name  was  admitted  on  the  Pension  Rolls. 
Examining  Surgeon  J.  S.  McNeeley,  of  Hamilton,  Ohio,  certified  July  2, 1873 :  "  Both  ankles  are  partially  anchylosed,  the  right 
one  to  a  greater  extent,  and  both  are  painful  when  walking,  especially  at  night  after  having  walked  much  during  the  day. 
The  pains  are  influenced  by  atmospheric  changes.  The  right  ankle  is  always  swollen,  the  left  one  at  times."  Other  exam 
iners  substantially  report  the  same  condition.  The  pensioner  was  paid  December  4,  1880. 

Concussion  and  Compression  of  the  Brain. — The  nine  hundred  and  eighty-three  cases 
of  this  group  have  been  considered  in  detail  in  the  chapter  on  injuries  of  the  head,  and 
the  reader  is  therefore  referred  to  pp.  35-68  of  the  Mrst  Surgical  Volume. 

Dislocations. — The  percentage  of  mortality  of  the  three  thousand  and  sixteen  cases 
of  dislocations  was  0.33,  death  having  followed  the  injury  in  ten  cases;  but  the  records  of 
the  Pension  Office  show  that  the  results  of  many  of  these  injuries  were  severe  and  of  long 
continuance,  the  disabilities  frequently  increasing  with  time. 

The  great  number  of  bones,  with  their  projecting  processes,  which  form  the  vertebral 
column,  the  narrow  limits  to  which  mobility  in  the  column  is  confined,  the  manner  in 
which  the  articular  surfaces  are  joined,  the  number  and  strength  of  ligaments  which  hold 
them  together,  and  of  the  muscles  which  enclose  them,  would  seem  to  preclude  the  possi 
bility  of  displacing  any  portion  of  the  column  without  at  the  same  time  causing  a  fracture 
of  the  body  of  the  vertebra  or  of  its  many  processes.  A  few  cases  of  dislocation  of  the 
dorsal  or  lumbar  vertebrae  without  fracture  were  recorded,  but  the  correctness  of  the  diagnosis 
in  some  of  the  cases  may  well  be  questioned.  A  case  of  luxation  of  the  lumbar  vertebra 
is  reported  by  Surgeon  E.  Bentley,  U.  S.  V.:1 

CASE  947. — Dislocation  of  first  lumbar  vertebra. — Private  A.  Hoffman,  Co.  E,  101st  New  York,  sustained  a  dislocation  of 
the  superior  lumbar  vertebra  by  the  falling  of  the  brick  wall  of  a  building  at  Port  Republic,  June  1,  1862.  He  was  admitted  to 
Washington  Street  Hospital,  at  Alexandria,  sixteen  days  after  the  occurrence  of  the  accident,  there  being  perfect  paralysis  of  all 

'Instances  of  dislocation  of  the  lumbar  vertebrae  are  not  frequent.  HAMILTON  (F.  H.)  (A  Practical  Treatise  on  Fractures  and  Dislocations,  Phil 
adelphia,  1875,  p. 541)  cites  two  cases:  one  from  CLOQUET  (Obs.  d'une  luxation  de  la  colonne  vertebrate comp.  de  fracture,  et  suivie  de  guirism,  in  Orlhop. 
Win.  sur  les  Diffbrmitts,  parC.  A.  MAISOXAIJE,  Paris,  1834,  T.  I,  p.  453,  a  second  from  DUPUYTREN  (Lecons  Oralesde  Clin.  Chir.,  Paris,  1839,  T.I,  p.  464); 
both  cages  were  accompanied  by  fracture.  To  these  may  be  added  instances  cited  by:  PABKICIU8  HlLDANUS  (Opera  quae  extant  omnia,  Franeofurti  ad 
Moenum,  1646,  Cent.  V,  Obs.  68,  p.  459):  A  farmer,  falling  from  a  tree,  had  one  of  the  lumbar  vertebrae  forced  inward;  paralysis  of  the  lower  extremities; 
he  survived  several  years.  AUKKAN  (Luxation  incomplete  des  vtrtebres,  in  Jour,  de  Mid.  Chir.  Phar.,  etc.,  Paris,  Decembre,  1771,  T.  XXXVI,  p.  522): 
A  man  was  forcibly  thrown  on  his  seat ;  the  spinal  apophyses  of  the  2d  and  3d  lumbar  vertebrae  became  very  prominent ;  diastasis  of  the  vertebrae ;  body 
bent  forward;  unable  to  straighten  out ;  amelioration  in  two  months.  SCHMUCKElt  (J.  L.)  ( Von  einer  Verrenkung  des  letzten  Riiclcen-  und  erslen  Lendtn- 
wirbelbeins,  vom  Htrren  RCDIGElt,  in  Vermischte  Chirurgisclie  Schriften,  Berlin  und  Stettin,  1776,  B.  I,  p.  286):  A  wall  falling1  on  a  soldier  caused  dislo 
cation  of  last  dorsal  and  first  lumbar  vertebrae,  the  former  being  forced  outward  and  to  the  right  to  the  width  of  three  fingers;  recovery.  BuCcKMAXN 
(Btobachtung  einer  Verrenkung  des  zweiten  Lendenwirbels,  in  Arch,  fur  Me,d.  Erfahrung.  im  Gebiete  der  prakt.  Med.  CJiir.  Geburtsh.  und  Staatsarz- 
neikunde,  Jahrgang  1825,  Berlin,  1825,  p.  469):  Young  man,  aged  30,  jumped  from  third-story  window  ;  dislocation  of  second  lumbar;  paralysis  of  blad 
der;  survived  the  injury  eighteen  months.  LAUKEY  (D.  J.)  (Clinique  Ckirurgicale,  Paris,  1809,  T.  Ill,  pp.  271-272):  A  young  soldier  received  a  com 
plete  luxation  of  the  first  lumbar  from  a  contusion  by  a  cannon  ball ;  recovery.  A  young  Swiss  soldier  fell  from  a  third  story  window ;  complete  luxation 
of  first  lumbar;  leg  fractured  and  amputated;  recovery.  A  soldier  named  Samson  received  a  complete  luxation  inward  of  the  first  lumbar  by  a  fall 
from  a  parapet ;  spine  curved  till  the  head  touched  the  knee ;  lower  extremities  paralyzed ;  paralysis  gradually  diminished ;  patient  survived.  LEBEKT 
(Luxation  simple  et  incomplete  par  cause  externe  de  la  douzilme  vertebre  dorsale,  en  avant  de  la  premiere  lombaire,  etc.,  in  Hull,  de  la  Soc.  Anat.  de  Paris, 
Paris,  1836-'37,  T.  II,  p.  238):  Deloge,  aged  50,  received  a  dislocation  of  the  first  lumbar  by  the  fall  of  a  scaffolding ;  paralysis  of  lower  extremities ; 
death  in  46  days;  at  the  autopsy  the  first  lumbar  was  found  dislocated  downward  and  inward;  there  was  fracture  of  the  body  of  the  vertebra.  MEP.TENS 
( General- Bericht  des  Konigl.  liheinischen  Med.  ColUgii  liber  das  Jahr  1840,  Koblenz,  1841,  p.  97)  successfully  reduced  a-dislocntion  of  the  third  lumbar 
which  projected  half  an  inch.  KEU  (F6rha»dlingar  vid  Svenska  Lakare-Sallskapets  sammankomster,  1857-1858,  in  Hygiea,  Stockholm,  1858,  B.  XX, 
p.  116) :  Sailor,  aged  23,  January  7,  1858,  second  lumbar  dislocated  7  lines  backward,  fracture  of  articular  and  transverse  processes ;  death.  KUNKLER 
(G.  A.)  (Case  of  Dislocation  of  Third  Lumbar  Vertebra,  in  Cincinnati  Lancet  and  Obs.,  1858,  Vol.  I,  p.  212):  In  1856,  a  young  man,  aged  19,  was  thrown 
from  a  swing ;  large  depression,  fully  admitting  a  pigeon's  egg,  in  region  of  third  lumbar  vertebra ;  recovery  ;  depression  remaining.  VlXCEXT  (liulletinx 
de  la  SociCtc  Anatomique  de  Paris,  Paris.  1850,  T.  XXV,  p.  85),  in  March,  1850,  presented  to  the  Anatomical  Society  of  Paris  a  specimen  of  fracture  and 
dislocation  of  the  first  lumbar  vertebra.  Patient  had  been  injured  8  months  previously;  the  fracture  had  consolidated ;  there  had  been  paralysis  of  the 
lower  extremities  and  of  the  bladder  and  rectum.  HOLMES  (T.)  (Dislocation  of  tlie  Spine  in  the  Dor  si- Lumbar  Region,  in  Transact,  of  the  J'alh.  Soc. 
of  London,  1859,  Vol.  X,  p.  219):  Man,  aged  19,  struck  across  the  loius  by  a  heavy  piece  of  timber  on  October  30,  1858;  paralysis  of  lower  extremities 
and  bladder;  died  Nov.  22;  preparation  in  St.  George's  Museum ;  the  transverse  processes  of  the  lumbar  vertebra  are  fractured.  RAXKE  (H.  R.)  (Ueber 
Beugungsluxation  der  Lendenwirbil.  Inaug.  diss.,  Halle,  1873,  p.  14):  Man,  aged  30,  fell  about  30  feet  from  a  platform ;  luxation  backward  of  first  lumbar  ; 
paralysis  of  lower  extremities  and  bladder;  compression  of  spinal  cord ;  death  after  2  months  and  11  days.  The  autopsy  showed  that  there  was  no  frac 
ture.  PORTA  (L.)  (Delle  luisazioni  delle  vertebre,  etc.,  Oss  7,  p.  6):  A  soldier  fell  from  his  horse  and  dislocated  the  fourth  lumbar  forward  the  width  of  a 


SECT.  l.J  DISLOCATIONS.  645 

« 

the  parts  below  the  seat  of  injury.  His  stools  passed  off  involuntarily,  and  the  urine  was  drawn  off  by  the  catheter.  On  July  5th 
he  passed  his  urine  freely  and  some  slight  sensation  was  felt  in  both  feet  and  legs.  Erysipelatous  inflammation  attacked  the 
inguinal  region  of  the  right  side  and  resulted  in  gangrene,  terminating  in  death  on  August  29,  1862.  No  autopsy  was  recorded. 

In  the  next  case  the  ninth  dorsal  vertebra  was  displaced,  allowing  two  fingers  to  be 
inserted  between  the  eighth  and  the  tenth  vertebra. 

CASE  918. — Surgeon  G.  Jewett,  51st  Massachusetts,  describes  a  case  of  dislocation,  which  occurred  at  Newberne,  May  20, 
1863,  as  follows :  "  The  case  was  an  injury  of  the  spine,  not  positively  diagnosticated.  The  patient  was  in  a  sitting  posture  when 
he  was  crushed  to  the  ground  by  a  great  weight  from  behind  applied  to  his  back  and  shoulders,  bending  the  back  nearly  double. 
Within  three  minutes  I  examined  the  back  and  found  a  fluctuating  tumor  occupying  the  site  of  the  ninth  dorsal  vertebra.  The 
tenth  was  very  prominent.  Two  fingers  could  be  inserted  between  the  eighth  and  tenth.  Perfect  loss  of  sensation  and  motion 
existed  below  the  injury,  with  paralysis  of  the  sphincters,  and  there  was  considerable  shock  and  violent  pain  in  the  epigastrium. 
The  treatment  was  by  rest  and  opium.  Three  days  after  the  accident  a  digital  examination  showed  a  reappearance  of  the  lost 
vertebra,  a  great  difference  between  the  spinous  processes  still  remaining.  No  crepitus  could  be  discerned  at  any  time.  At  this 
date  (the  eleventh  day  after  the  injury)  the  patient  is  in  General  Hospital  and  the  paralysis  still  continues.  My  opinion  is  that 
there  was  a  luxation  anteriorly  of  the  ninth  dorsal  vertebra."  No  positive  identification  of  this  case  has  been  practicable  from  the 
registers  of  the  New  Berne  hospitals.  Corporal  J.  F.  Simpson,  Co.  I,  51st  Massachusetts,  is  the  only  member  of  that  regiment 
who  is  recorded  as  having  been  treated  for  "  paralysis  "  at  the  Stanley  Hospital  from  May  25th  to  July  6,  1863.  Three  weeks 
later  he  was  mustered  out  by  expiration  of  service.  He  is  not  a  pensioner. 

Displacement  of  the  eighth  dorsal  vertebra  was  accompanied  by  fracture  of  the  pro 
cesses  in  the  following  case: 

CASE  949. — Private  R.  L.  Root,  Co.  D,  32d  Wisconsin,  aged  33  years,  was  severely  hurt  in  the  back  while  engaged  in 
building  fortifications  at  Decatur,  June  20, 1864.  About  five  weeks  afterwards  he  was  transferred  to  Nashville,  whence  Surgeon 
R.  R.  Taylor,  U.  S.  V.,  reported  his  admission  to  hospital  No.  8,  and  described  the  injury  as  a  "dislocation  of  the  spine." 
Several  months  later  the  patient  was  transferred  to  Brown  Hospital,  at  Louisville,  where  he  was  discharged  for  disability 
November  10,  1864,  Assistant  Surgeon  B.  E.  Fryer,  U.  S.  A.,  certifying  to  "  fracture  of  dorsal  vertebra,  producing  paralysis  of 
the  right  inferior  extremity."  Examining  Surgeon  W.  H.Walker,  of  Fond  du  Lac,  Wisconsin,  reported,  June  10.  1865:  "He 
was  injured  by  being  crushed  down  under  a  stick  of  timber.  Fracture  of  the  process  of  the  eighth  dorsal  vertebra  seems  to 
have  been  produced,  which  has  resulted  in  extensive  forward  curvature  of  the  spine.  The  ligaments  of  the  right  hip  joint  were 
strained  so  that  they  are  now  relaxed,  weakening  the  joint."  Examiner  H.  Roberts,  of  Providence,  Pennsylvania,  December 
28,  1868,  made  a  corroborating  report  of  the  injury  and  its  results,  stating  that  "a  gradual  and  increasing  curvature  of  the 
spinal  bones  in  the  portion  known  as  the  dorsal  has  been  going  on  for  three  years.  The  curve  is  about  eight  inches  in  length 
and  the  deviation  is  now  two  inches  to  the  right,  with  a  very  short  convex  curve  also.  For  the  past  year  he  has  had  to  almost 
entirely  abandon  any  work  which  required  him  to  stoop  forward  and  lift  an}*  light  weight."  The  Philadelphia  Examining 
Board,  June  8,  1881,  referred  to  curvature  and  deformity  as  being  very  marked,  and  added  that  the  pensioner  "states  that  he 
suffers  from  numbness  in  the  lower  extremities.  There  is  atrophy  of  the  muscles  over  the  buttock.  He  would  have  been  bene 
fited  by  a  spinal  support,  but  owing  to  the  want  of  this  he  has  become  so  disabled  that  he  can  do  no  labor." 

As  an  example  of  sub-luxation  of  one  of  the  cervical  vertebrae  Surgeon  J.  Tunnicliff, 
1st  Michigan,  has  furnished  the  following  notes  of  an  accident  which  occurred  on  the  Balti 
more  and  Ohio  Railroad  during  the  month  of  November,  1861: 

CASE  950. — "  The  man  was  standing  guard  during  a  gale  on  an  embankment  while  a  lumber  train  was  passing.  The 
wind  blew  him  off  the  bank  down  into  the  cut,  by  the  passing  train,  and  at  the  same  time  lifted  a  quantity  of  lumber  from  the  cars 
and  piled  jt  on  him.  It  was  about  two  minutes  before  the  lumber  could  be  removed  sufficiently  to  relieve  him.  The  main  injury 
seemed  to  be  in  the  cervical  vertebrae.  Indeed,  the  force  of  the  blow  as  well  as  the  weight  of  the  lumber  was  on  the  neck.  As 
he  was  lifted  up  he  said  '  he  thought  his  neck  was  broken.'  His  head  was  inclined  to  one  of  the  shoulders,  and  for  a  number  of 
minutes  he  was  utterly  unable  to  raise  it  up.  The  pain  he  represents  as  having  been  most  excruciating.  He  persisted,  however, 
in  his  efforts,  with  the  assistance  of  one  of  his  comrades,  who  performed  traction  by  grasping  his  head,  when  a  sudden  snap 
was  felt  and  heard  distinctly  by  himself  and  those  about  him,  and  his  head  had  resumed  its  normal  position.  This  was  followed 
by  acute  pain  at  the  point  of  the  injury  to  the  cervical  column,  with  a  most  distressing  tingling  sensation  and  pain  down  the 
brachial  plexus,  which  continued  more  or  less  for  four  weeks  after  the  injury.  He  was  unable  to  rotate  his  head  one-half  inch 
even  after  five  weeks,  and,  although  improving,  he  cannot  now  (December  31,  1661)  do  it  more  than  two  inches,  marking  at 
this  time  about  four  inches  of  a  segment  of  a  circle  with  the  end  of  his  nose."  The  name  of  the  soldier  could  not  be  learned. 

finger;  no  fracture;  ligament  destroyed.  FOWLEK  (R.  S.)  (Dislocation  of  the  Lumbar  spirit,  in  The  British  Mtd.  Jour.,  1863,  Vol.  II,  p.  280):  Laborer, 
aged  25,  in  18G3;  dislocation  between  1st  and  2d  lumbar,  the  lower  vertebra  being  thrown  behind  and  to  the  left  of  that  above  it ;  lower  extremities  not 
paralyzed ;  death  on  the  following  day ;  at  the  autopsy  no  fracture  of  the  vertebrae  was  discovered.  Clinical  Lectures  and  Reports  of  the  London  Hos 
pital,  London,  1866,  Vol.  Ill,  pp.  348,  354:  At  the  Museum  of  the  London  Hospital  are  3  specimens  of  luxated  lumbar  vertebra?;  in  one  the  body  of  the 
first  lumbar  lias  slipped  forward  for  about  half  an  inch  on  the  surface  of  the  second,  crushing  the  latter.  In  the  second  specimen  the  third  lumbar  is 
nearly  half  an  inch  in  front  of  the  fourth,  with  only  very  slight  splintering  of  the  edges  of  the  bones.  The  third  specimen  shows  a  clean  dislocation  of 
the  third  lumbar  forward  without  fracture.  The  articular  processes  of  the  third  lumbar  have  completely  left  those  of  the  fourth  and  passed  forward  a 
third  of  an  inch.  There  is  no  important  fracture.  EULKNBERO  (A.)  (Luxation  und  Fractur  dei  ersten  Lumbalwirbels,  mit  tSdtlicliem  Ausgange  durch 
Riickenmarkscompression  und  secunddre  Cystitis  und  Pyelonephritis,  in  Archivfiir  Klin.  Cliir.,  Berlin,  1866,  B.  VII,  p.  507):  A  printer,  on  May  1, 1865, 
fell  a  distance  of  twenty  feet;  first  lumbar  dislocated  backward  J  inch  :  dpath  on  the  following  day ;  splintering  of  body  of  vertebra. 


646  MISCELLANEOUS    INJURIES.  [CHAP.  xi. 

In  the  following,  the  sternal  end  of  the  clavicle  was  dislocated  upward.  As  in  similar 
cases  cited  by  Malgaigne  and  Hamilton,1  the  dislocation  could  readily  be  reduced,  but  it 
was  impossible  to  retain  the  bone  in  its  place. 

CASE  951. — Private  E.  D.  Halleiibeck,  Co.  B,  1st  Wisconsin  Cavalry,  aged  26  years,  entered  Hospital  No.  2  at  Nashville 
on  August  12,  1863,  having  sustained  a  dislocation  of  the  sternal  end  of  the  right  clavicle  by  falling  from  his  horse.  Acting 
Assistant  Surgeon  E.  Jennings,  who  reported  the  case,  stated  that  the  attempt  was  made  to  reduce  the  luxation,  but  the  bone 
could  not  be  retained  in  its  place.  In  the  following  month  the  patient  was  detailed  for  light  duty  about  the  hospital,  and  on 
February  6,  1864,  he  was  assigned  to  the  Veteran  Reserve  Corps.  He  was  ultimately  mustered  out  and  pensioned.  Examining 
Surgeon  W.  A.  Knox,  of  Chicago,  Illinois,  May  18,  1867,  reported  the  "dislocation  still  unreduced.  The  injury  being  upon  the 
right  side  materially  interferes  with  his  capacity  for  manual  labor."  The  Chicago  Examining  Board  certified,  March,  1879: 
"  He  has  permanent  dislocation  of  the  right  clavicle  from  its  sternal  articulation  upward.  The  end  of  the  bone  lias  affixed  above 
its  natural  position,  weakening  the  part  and  limiting  the  power  in  the  right  arm." 

Examples  of  dislocations  of  the  various  joints  of  the  upper  and  lower  extremities  will 
next  be  adduced.  Dislocations  at  the  shoulder  and  elbow  joints  were  the  most  frequent: 

CASE  952. — Dislocation  at  the  shoulder. — Farrier  L.  Swafford,  Co.  G,  9th  Indiana  Cavalry,  aged  36  years,  Avas  severely 
hurt  at  Pulaski,  November  8,  1864,  by  his  horse  falling  and  throwing  him  upon  his  left  shoulder,  dislocating  the  joint.  For 
some  weeks  he  was  at  the  regimental  hospital,  where  ineffectual  attempts  were  made  to  reduce  the  luxation,  and  subsequently 
he  entered  Gayoso  Hospital,  at  Memphis.  Surgeon  F.  N.  Burke,  U.  S.  V.,  in  charge  of  the  latter,  reported  that  the  patient 
was  transferred  to  the  Veteran  Reserve  Corps  May  11,  1865,  by  reason  of  disability  from  ''chronic  dislocation  of  left  shoulder 
joint."  The  man  was  mustered  out  of  service  September  4,  1865,  and  subsequently  became  a  pensioner.  Examiner  J.  Menden- 
hall,  of  New  Castle,  Indiana,  reported  May  17,  1866:  "I  suppose  the  joint  has  been  dislocated;  it  is  now  partially  anchylosed. 
He  cannot  put  his  hand  on  top  of  his  head,  nor  raise  the  elbow  up  from  the  body  more  than  about  twelve  inches,  but  can  move 
it  better  forward  than  backward.  But  this  motion  is  limited,  though  I  think  it  will  improve."  Examining  Surgeon  W.  H. 
Boor  certified,  December  9,  1875:  "I  find  the  left  shoulder  joint  anchylosed  so  that  the  arm  cannot  be  raised  only  as  the 
scapula  gives  it  motion.  The  muscles  of  the  arm  and  forearm  are  soft.  He  says  his  shoulder  is  painful."  This  pensioner  was 
paid  December  4,  1880. 

CASE  953. — Dislocation  at  the  elbow. — Private  H.  Mewes,  Co.  E,  63d  Illinois,  aged  28  years,  had  his  elbow  joint  dislo 
cated  by  falling  from  a  wagon  during  the  march  near  Holly  Springs,  October  20,  1863.  He  was  treated  at  the  regimental 
hospital,  subsequently  in  Nashville,  and  lastly  in  Clay  Hospital,  Louisville.  Surgeon  A.  F.  Watson,  U.  S.  V.,  in  charge  of 
the  latter,  described  the  injury  as  an  unreduced  "  dislocation  of  the  radius."  The  man  was  mustered  out  of  service  April  11, 
1865,  and  subsequently  made  application  for  pension.  Examining  Surgeon  L.  W.  Low,  of  Albion,  Illinois,  reported  June  4, 
1868:  ''The  injury  is  such  that  the  head  of  the  radius  is  luxated  and  again  adjusted  by  rotary  motion  of  the  hand  and  forearm, 
rendering  tire  hand  and  arm  yearly  useless  for  labor  and  weak  at  all  times."  Examiner  H.  C.  Reed  certified,  July  4,  1879: 
"  The  ulna  is  displaced  inward,  the  olecranon  resting  on  the  internal  condyle.  The  forearm  is  quadriflexed  and  about  one-half 
pronated,  there  being  very  little  rotary  motion  retained.  The  head  of  the  radius  could  not  be  located,  but  a  distinct  '  snap'  could 
be  felt  on  forcible  rotation  outward  over  the  normal  site." 

CASE  954. — Dislocation  at  the  elbow. — Private  H.  Finley,  Co.  H,  5th  Connecticut,  aged  29  years,  suffered  a  dislocation 
of  the  right  elbow  while  going  to  Stevenson,  Alabama,  October  5,  1864,  on  a  railroad  train,  which  was  attacked  by  the  enemy 
and  brought  to  a  sudden  stop,  causing  him  to  be  violently  thrown  to  the  ground.  He  was  treated  in  the  field  hospitals  of  the 
Twentieth  Corps  until  the  arrival  of  the  troops  at  Savannah,  when  he  was  placed  on  board  of  a  hospital  steamer  and  conveyed 
to  McDougall  Hospital,  Fort  Schuyler,  New  York  Harbor.  Assistant  Surgeon  S.  H.  Orton,  U.  S.  A.,  certified  to  the  patient's 
discharge  from  service  March  13,  186,~>,  by  reason  of  uselessness  of  the  right  arm  from  an  "unreduced  luxation  of  the  ulna 
backward  upon  the  humerus."  Examining  Surgeon  W.  W.  Potter,  of  Washington,  D.  C.,  March  29,  1869,  certified  to  the 
following  disability:  "A  fall  upon  the  right  elbow  while  in  a  semi-flexed  position  has  driven  the  olecranon  process  of  the  ulna 
upward  between  the  condyles  of  the  humerus,  at  the  same  time  forcing  them  apart.  Considerable  deformity  is  the  result,  with 
inability  to  flex  the  forearm  beyond  a  right  angle  or  to  extend  it  perfectly.  He  has  very  little  strength  in  the  arm;  its  motions 
are  circumscribed  and  general  usefulness  seriously  impaired."  Examiner  M.  Burton,  of  Richmond,  Virginia,  reported,  Septem 
ber  23,  1873,  that  "the  dislocation  still  exists,  the  joint  is  inflexible  and  the  limb  useless  for  manual  labor.  The  fingers  have 
some  power  of  flexion  and  extension."  This  pensioner  was  paid  June  4,  1881. 

CASE  955. — Dislocation  at  the  wrist. — Private  C.  Mesi-rvey,  Co.  G,  69th  Indiana,  aged  47  years,  received  a  severe  injury 
of  the  left  forearm  and  wrist  during  the  battle  of  Richmond,  August  30,  1862.  Surgeon  M.  K.  Taylor,  U.  S.  V.,  reported  his 
discharge  from  service  at  the  Keokuk  General  Hospital,  March  5,  1863,  by  reason  of  the  following  disability:  "Much  deformity 
from  an  unreduced  fracture  of  the  radius  and  dislocation  of  the  lower  end  of  the  ulna."  The  man  subsequently  became  an 
applicant  for  pension,  and  received  the  following  certificate  from  Examining  Surgeon  S.  W.  Vance,  of  Connersville,  Indiana, 
on  June  18,  1867:  "The  injury  consisted  of  a  fracture  of  the  lower  end  of  the  radius  about  an  inch  and  a  half  from  its  articu 
lation  \vitli  the  semihmar  and  scaphoid  bones,  together  with  a  dislocation  of  the  lower  end  of  the  ulna.  This  dislocation  and 
the  fracture  of  the  radius  just  above  caused  the  hand  to  assume  a  rather  pronated  condition,  carrying  forward  with  it  the  lower 
fragment  of  tin-  radius,  which  has  united  to  the  superior  fragment,  leaving  the  bone,  however,  very  crooked  at  the  site  of  the 
fracture  and  the  end  of  the  ulna  still  dislocated.  The  condition  of  the  bones  necessarily  renders  rotation  impracticable,  and 

1  MAU-AIGXE  ( J.  F.),  Traiti  des  fracture*  et  des  luxations,  Paris,  1855,  T.  II,  p.  426.     HAMILTON  (FRANK  H.),  A  Practical  Treatise  on  Fracture* 
and  Dislocations,  Philadelphia,  1875,  p.  561. 


SECT.  I.]  DISLOCATIONS.  647 

moreover  greatly  weakens  and  debilitates  the  muscles  and  tendons  of  the  surrounding  parts,"  etc.     Examiner  A.  C.  Fosdick, 
of  Brownsville,  Indiana,  in  July,  1875  and  1881,  reported  no  change  in  the  condition  of  the  injured  parts. 

The  following  is  an  example  of  successful  reduction  of  a  dislocation  of  the  head  of  the 
femur  upward  and  backward  into  the  great  ischiatic  notch.  The  thigh  had  become  flexed 
on  the  pelvis  at  nearly  right  angles,  and  the  limb  was  well  thrown  across  its  fellow : 

CASE  956. — Dislocation  at  the  hip. — Lieutenant  Colonel  W.  A.  Bullitt,  3d  Kentucky,  aged  24  years,  was  wounded  at  the 
battle  of  Rocky  Face  Eidge,  May  9,  1864.  He  was  wounded  in  two  places.  The  first  shot  entered  at  a  point  five  inches 
below  the  anterior  superior  spinous  process  of  the  ilium,  left  side,  and  did  not  emerge;  the  second  ball  struck  the  right  side 
between  the  seventh  and  eighth  ribs  and  came  out  about  four  inches  below  the  point  of  entrance  and  two  inches  posteriorly.  An 
ambulance  was  obtained  and  the  patient  was  transported  five  miles  to  a  field  hospital,  whence  he  was  taken  to  Chattanooga'the 
following  day.  On  the  ninth  day  erysipelas  commenced  in  the  wound  of  the  right  side,  which  extended  all  over  the  body  and 
up  to  the  head,  resulting  in  numerous  abscesses  in  the  areolar  tissue.  On  June  3d  the  patient  was  transferred  to  Louisville, 
where  an  attack  of  dysentery  came  on  and  reduced  him  very  much.  This  was  in  turn  succeeded  by  another  attack  of  erysipelas, 
extending  all  over  the  body  as  the  former  had  done.  About  August  7th  he  began  to  have  a  great  deal  of  pain  in  the  left  iliac 
fossa,  which  at  first  was  paroxysmal  and  continued  a  month  before  the  abscess  that  gave  rise  to  it  was  detected.  This  abscess 
was  opened  by  a  deep  cut  one-half  inch  to  the  inside  of  the  anterior  superior  spinous  process  and  above  Poupart's  ligament, 
when  a  large  quantity  of  pus — estimated  by  the  surgeons  present  at  half  a  gallon — escaped.  The  abscess  continued  to  discharge 
for  about  three  months.  When  the  pain  first  commenced  the  patient,  in  order  to  feel  relief,  would  flex  his  thigh  on  the  pelvis 
during  the  paroxysms,  which  came  on  about  5  o'clock  daily;  but  afterwards  he  kept  the  knee  closely  approximated  to  the  chest 
and  any  attempt  to  extend  the  limb  caused  severe  pain.  About  October  20th,  while  in  the  act  of  turning  over  from  his  back  to 
his  right  side,  he  felt  the  head  of  the  right  femur  slip  from  its  position  with  a  severely  painful  jolt.  This  occurred  almost  daily 
for  two  weeks,  when  the  attention  of  the  surgeon  was  called  to  it  and  a  dislocation  was  recognized.  The  patient  was  etherized 
and  an  unsuccessful  attempt  made  to  replace  the  bone.  The  abscess  closed  up  shortly  afterwards.  A  second  attempt  at  reduction 
in  February,  1865,  again  failed.  A  few  days  later  the  patient  got  out  of  his  bed  and  began  to  walk  about  on  his  crutches.  He 
came  to  New  York  City  May  24th,  where  he  was  admitted  to  the  Central  Park  Hospital,  under  the  care  of  Dr.  L.  A.  Sayre,  who 
reports  the  following:  "When  I  saw  him  in  June  his  general  health  was  good  and  he  was  able  to  walk  about  very  well  on  crutches. 
His  left  thigh  was  flexed  on  the  pelvis  at  nearly  right  angles  and  strongly  adducted  across  its  fellow,  lying  on  its  upper  third 
and  compressing  the  genital  organ.  The  difficulty  of  urinating  was  a  most  serious  annoyance.  The  whole  limb  was  much  colder 
than  the  other,  bathed  in  perspiration,  and  much  shrunken  in  size.  There  was  some  slight  mobility  of  the  hip  and  of  the  knee, 
which  was  stiffened  by  a  firm  contraction  of  the  hamstring  muscles.  Motion,  however,  gave  pain.  On  July  20th  I  determined 
to  attempt  reduction  by  manipulation  after  the  method  so  well  described  by  Dr.  Reed  and  Surgeons  W.  J.  Sloan,  J.  J.  Milhau, 
U.  S.  A.  Several  bed-quilts  were  folded  and  laid  upon  the  floor;  the  patient  was  placed  thereon  and  thoroughly  anaesthetized 
by  chloroform.  After  removing  my  boots  I  placed  one  heel  on  the  crest  of  each  ilium,  thus  holding  the  pelvis  by  the  weight  of 
my  own  body,  when  with  some  considerable  force  I  succeeded  in  breaking  up  the  adhesions  and  obtained  tolerable  free  motion 
of  the  limb.  The  finger  was  then  passed  into  the  rectum  as  far  as  the  ischiatic  notch,  and  when  the  limb  was  moved  by  an  assist 
ant  the  head  of  the  femur  could  be  distinctly  felt  gliding  on  the  finger.  This  examination  was  also  made  by  Professor  Hamilton, 
and  the  diagnosis  as  to  the  position  of  the  head  of  the  bone  was  confirmed.  I  thereupon  stated  my  intention  that,  should  the 
attempt  by  manipulation  prove  unsuccessful,  I  would  wait  some  days  for  the  inflammation  necessarily  produced  to  subside,  then 
subcutuneously  divide  the  contracted  adductor  muscles  and  restore  the  limb  to  parallelism  with  the  other,  leaving  the  head  of 
the  bone  in  its  abnormal  position.  By  considerable  effort  I  finally  succeeded  in  reducing  the  limb  to  parallelism  with  the  other, 
retaining  it  there  by  means  of  extension  with  weight  and  pulley  over  the  foot  of  the  bed  and  secured  to  the  thigh  by  means  of 
adhesive  plaster  and  a  roller.  On  account  of  the  long-continued  contraction  of  the  hamstring  muscles  the  leg  could  not  be  extended 
from  the  thigh  ;  but  as  the  tension  had  given  way  somewhat  while  the  patient  was  under  the  influence  of  chloroform,  I  concluded 
to  try  and  bring  it  straight  by  constant  extension,  and  consequently  applied  another  plaster  below  the  knee,  with  weight  and 
pulley  on  the  foot  of  the  bed,  a  little  lower  than  the  former  one,  the  thigh  being  slightly  elevated  every  day  until  the  limb  was 
straightened  and  the  two  extending  forces  acted  in  the  same  line.  Another  weight  and  pulley  was  applied  at  a  right  angle  to 
the  limb,  opposite  the  knee  joint,  for  the  purpose  of  adducting  the  limb.  An  irrigating  apparatus,  from  which  cold  water  was 
constantly  dripping,  was  arranged  over  the  hip  joint,  and  a  rubber  cloth  placed  under  to  protect  the  bed.  For  three  days  the 
patient  suffered  great  pain  and  had  to  use  morphine  to  allay  it;  but  after  the  third  day  no  anodyne  was  necessary.  No  reac 
tionary  fever  or  constitutional  disturbance  set  in,  and  at  the  end  of  the  third  week  the  limb  was  parallel  with  the  other  and  of  the 
same  length.  A  line  drawn,  however,  from  the  center  of  the  pubis  to  the  trochanter  major  of  that  side  proved  to  be  nearly  half 
an  inch  longer  than  measurement  on  the  opposite  side,  and  firm  pressure  from  the  foot  caused  it  to  ride  upon  the  ilium  and 
become  more  than  an  inch  shorter  than  the  other.  It  became  necessary,  therefore,  to  devise  some  plan  by  which  the  limb  could 
be  extended  during  walking  and  the  weight  of  the  body  borne  upon  it.  I  therefore  took  a  plaster  cast  of  the  hip  in  its  improved 
position  and  on  this  cast  fitted  a  crutch  passing  under  the  pubis  and  around  the  gluteo-femoral  fold,  with  a  wing  hammered  out 
so  as  to  accurately  fit  the  buttock,  in  which  he  could  comfortably  sit.  Opposite  the  tuberosity  of  the  ischium  I  made  a  ball  and 
socket  joint,  from  which  an  iron  rod  ran  down  the  limb  to  the  ankle  joint,  being  bifurcated  at  its  lower  extremity  and  terminating 
in  rounded  knobs,  and  the  main  shaft  being  capable  of  extension  by  means  of  a  racket  and  cog-wheel.  A  neatly  fitting  shoe, 
well  padded  on  the  instep  to  bear  pressure,  had  an  iron  band  secured  under  the  sole,  which  terminated  opposite  each  side  of  the 
ankle  in  cups  or  sockets  to  receive  the  rounded  ends  of  the  rod.  With  this  instrument  adjusted  and  the  extension  applied  the 
limb  was  brought  to  the  same  length  as  the  other,  and  the  patient  could  bear  his  entire  weight  upon  it  without  pain.  The  limb, 
which  before  the  operation  had  been  cold  and  very  much  atrophied,  now  grew  rapidly  in  normal  temperature  and  in  October 
had  nearly  resumed  its  natural  size."  Photographs  of  the  patient,  showing  the  position  of  the  limb  before  and  after  the  operation, 
and  of  the  apparatus,  applied  and  unapplied,  were  forwarded  with  the  history  of  the  case  by  the  operator,  who  also  contributed 


648  MISCELLANEOUS    INJURIES.  [CHAP.  xi. 

two  plaster  casts,  one  representing  the  hip  eight  months  after  the  luxation  and  the  other  the  condition  of  the  reduced  parts.  The 
caste  constitute  specimen  4033  of  the  Surgical  Section  of  the  Museum.  Lieutenant  Colonel  Bullitt  was  mustered  out  of  service 
October  7,  1865. 

CASE  957. — Dislocation  at  the  hip. — Private  J.  B.  Holroyd,  Co.  C,  15th  Illinois,  aged  28  years,  was  captured  by  the 
enemy  during  the  Atlanta  campaign,  October  4,  1864,  and  for  months  underwent  the  hardships  of  the  Anderson  ville  Prison, 
where  his  left  hip  joint  became  affected  from  the  exposure  and  privation.  After  being  released  from  captivity  lie  was  conveyed 
to  Cumberland  Hospital  at  Nashville,  thence  to  Jeffersonville,  and  lastly,  on  July  21,  1865,  to  Camp  Butler.  Surgeon  A.  B. 
Campbell.  U.  S.  V.,  in  charge  of  the  latter,  reported  that  the  patient  was  suffering  from  "dislocation  of  the  left  hip  joint,"  and 
that  he  was  mustered  out  of  service  August  9,  1865.  Examining  Surgeon  J.  G.  Hostetter,  of  Mt.  Carroll,  Illinois,  certified, 
June  19,  1866:  "The  ligaments  and  head  of  the  left  thigh  bone  are  diseased,  allowing  displacement  of  said  bone  on  making  a 
misstep.  He  cannot  raise  his  left  leg  to  the  height  of  a  stair-step,  and  drags,  as  it  were,  rather  than  moves  his  limb  in  walking." 
Examiner  B.  T.  Buckley,  of  Freeport,  Illinois,  reported,  April  7,  1871:  "The  disability  consists  in  the  imperfect  use  of  the  left 
leg,  produced  by  partial  dislocation  of  the  hip  joint  and  causing  pain  and  lameness  on  exercise.  The  displacement  has  increased 
and  consequently  there  is  increased  inability  to  use  the  limb."  Examiner  II.  N.  Bradshaw,  of  Monroe,  Wisconsin,  stated,  Jan 
uary  10,  1875,  that  "the  region  of  the  joint  is  flatter  than  it  should  be,  showing  considerable  atrophy  of  the  muscular  structure; 
the  leg  below  the  hip  is  smaller  than  the  right  one,  and  the  muscles  are  flabby.  The  leg  cannot  be  flexed  upon  the  abdomen, 
and  any  attempt  to  place  it  in  that  position  is  evidently  attended  with  much  pain."  This  pensioner  was  paid  September  4, 1881. 

CASK  958. — Dislocation  at  the  knee. — S.  Chiquoine,  a  fireman  attached  to  the  U.  S.  Steamer  Rudolph,  21  years  of  age, 
and  of  a  strong  constitution,  sustained  a  dislocation  of  the  left  tibia  backward  during  the  action  in  Mobile  Bay,  April  1,  1865. 
He  was  admitted  to  the  Naval  Hospital  at  Pensacola  three  days  afterwards.  The  luxation  was  reduced,  but  there  was  consid 
erable  swelling  of  the  limb,  accompanied  by  inflammation.  The  treatment  consisted  in  moulding  pasteboard  splints  to  the  limb, 
in  keeping  the  extremities  at  perfect  rest  on  a  double-inclined  plane,  and  in  applying  water  dressings.  Ten  weeks  after  his 
admission  the  patient  was  transferred  to  hospital  at  New  York,  where  he  was  discharged  for  disability  June  30,  1865,  with 
probabilities  of  regaining  full  use  of  the  limb.  The  notes  of  the  case  were  furnished  by  Passed  Assistant  Surgeon  J.  R.  Tryon, 
U.  S.  N.,  who  supplemented  the  history  with  the  following  remarks:  "From  the  severity  of  this  and  other  cases  I  think  the 
dislocation  of  the  tibia  in  each  must  have  been  complete.  Considerable  deformity  about  the  knee  existed  for  months  after  the 
injuries,  and  the  joints  in  most  of  them  were  impaired  in  some  degree  by  the  inflammation,  adhesion,  etc.,  which  invariably 
follow."  Examining  Surgeon  L.  Jemison,  of  Bordentown,  New  Jersey,  reported,  August  23,  1870:  "The  bones  of  the  leg  now 
stand  a  little  back  from  their  normal  position  and  the  joint  seems  movable  upon  the  cartilages.  He  complains  when  standing 
any  length  of  time  upon  his  feet,  and  falls  from  a  slight  touch  to  the  limb,"  etc.  The  Philadelphia  Examining  Board  in  October, 
1873,  certified  to  "grating  in  the  knee  joint  when  moved;  ligaments  relaxed  and  knee  falls  back  unless  supported  when  his 
weight  is  borne  upon  it,"  etc.  At  subsequent  dates  the  same  board  reported  that  "  the  patella  projects  forward  and  the  internal 
tuberosity  projects  inward,"  also  that  there  is  decided  crepitus,  and  that  deformity  is  caused  by  dislocation  of  the  internal  semi- 
lunar  cartilage  of  the  knee.  The  pensioner  was  paid  June  4,  1881. 

CASE  959. — Dislocation  at  the  ankle. — Private  J.  Reich,  Co.  K,  21st  Illinois,  aged  33  years,  was  severely  hurt  in  the  left 
foot  while  doing  guard  duty  on  the  Louisville  and  Lexington  Railroad,  June  15,  1864.  The  accident  occurred  while  he  was 
riding  on  the  cowcatcher  of  the  locomotive,  which  struck  an  obstruction  on  the  track  and  threw  him  off.  He  was  picked  up  in 
a  senseless  condition  and  was  conveyed  to  Clay  Hospital,  at  Louisville,  where  his  left  ankle  joint  was  found  to  be  much  injured. 
Several  weeks  afterwards  he  was  transferred  to  Jefferson  Barracks,  and  lastly  he  entered  the  General  Hospital  at  Quincy,  where 
he  was  discharged  December  20,  1864,  and  pensioned.  Surgeon  D.  G.  Brinton,  U.  S.  V.,  in  charge  of  the  latter  hospital,  reported 
that  the  patient  was  "crippled  for  life,"  and  described  the  disability  as  a  "  dislocation  of  the  left  ankle  joint  (Pott's  fracture)  with 
consequent  permanent  uselessness  of  the  limb."  Examining  Surgeon  J.  H.  Maxwell,  of  Newton,  Illinois,  September  4,  1873, 
certified  to  the  disability  and  stated  that  "there  is  great  deformity  of  the  foot  and  ankle  in  consequence  of  the  dislocation  never 
having  been  reduced.  Walking  is  very  difficult,  and  if  continued  becomes  painful."  Four  years  later  the  same  examiner  reported 
no  improvement  in  the  condition  of  the  limb,  stating  that  "the  astragalus  is  forced  below  the  outer  malleolus,"  that  the  foot  is 
nearly  flat,  etc.  The  pensioner  was  paid  June  4,  1878,  since  when  he  has  not  been  heard  from. 

CASE  960. — Dislocation  of  tarsal  lones. — Private  J.  Beers,  Co.  F,  84th  Illinois,  aged  27  years,  while  on  duty  as  assist 
ant  teamster,  December  23,  1862,  was  accidentally  precipitated  to  the  ground  by  the  slipping  of  his  left  foot.  He  stated  that 
he  heard  a  cracking  sound  in  the  foot  .and  felt  something  give  way  about  the  middle  of  it.  This  was  attended  with  intense 
pain,  which  subsided  in  the  course  of  a  few  weeks.  The  foot  remained  swelled  about  a  month,  when  that  also  partially  subsided, 
and  from  that  time  he  has  not  had  pain  except  when  he  has  attempted  to  use  it  in  walking.  He  was  present  at  the  battle  of 
Murfreesboro'  (December  31st),  but  was  unable  to  participate  in  that  action  on  account  of  lameness.  After  the  battle  the  surgeon 
applied  a  roller  bandage,  but  it  produced  so  much  pain  that  lie  soon  had  to  remove  it.  No  other  application  was  used.  On 
January  30th  the  man  was  brought  to  Nashville,  where  he  was  sent  to  Convalescent  Barracks,  and  several  days  afterwards  to 
hospital  No.  22.  At  that  time  he  was  in  good  general  health.  There  was  slight  tumefaction  below  the  external  malleolus  and 
the  foot  was  everted,  its  inner  border  being  nearly  thrown  in  contact  with  the  ground,  giving  the  foot  a  splay  appearance. 
Below  the  internal  malleolus  a  prominence  existed  corresponding  to  the  rounded  head  of  the  astragalus,  and  great  and  deep- 
seated  tenderness  was  experienced  on  pressure  upon  the  astragalo-scaphoid  articulation.  The  most  remarkable  circumstance  of 
the  case  was  the  very  slight  inflammation  in  and  around  the  joint.  The  case  was  diagnosed  as  a  luxation  of  the  astragalo- 
scaphoid  articulation,  and  no  treatment  was  deemed  advisable  nor  reduction  attempted  for  the  reason  that,  having  been  so  long 
delayed,  it  would  have  been  necessary  to  break  up  the  new  adhesions,  it  being  feared  that  the  resulting  inflammation  would  prove 
uncontrollable.  Locomotion  remained  much  impeded  and  the  patient's  condition  continued  unchanged  up  to  March  10,  1863, 
when  he  was  discharged  as  unfit  for  further  service  and  returned  to  his  home.  The  history  of  the  case  was  contributed  by 
Surgeon  L.  W.  Beckwith,  38th  Indiana.  There  is  no  record  of  the  man  ever  having  applied  for  pension. 


SECT.  L]  SIMPLE    AND    COMPOUND    FRACTURES.  649 

Simple  and  Compound  Fractures. — The  total  number  of  injuries  of  this  group  was 
seven  thousand  and  four,  of  which  five  hundred  and  twenty-six,  or  7.5  per  cent.,  were  fatal. 
Four  thousand  three  hundred  and  forty-six,  with  seventy-six  deaths,  were  specified  as  simple 
fractures;  one  thousand  three  hundred  and  seventy-one,  with  three  hundred  and  ninety- 
seven  deaths,  as  compound  fractures;  and  one  thousand  two  hundred  and  eighty-seven,  with 
fifty-three  deaths,  as  fractures  merely.  Instances  of  fractures  of  the  cranium  and  of  the 
vertebrae  have  been  cited  on  pages  42  to  68  and  pages  426  to  429  of  the  First  Surgical 
Volume.  Examples  of  fractures  of  the  bones  of  the  face,  of  the  ribs,  the  sternum,  the  clavicle, 
the  scapula,  the  ilium,  and  the  bones  of  the  extremities  will  here  be  detailed. 

CASE  961. — Fracture  of  the  lower  jaw  from  the  kick  of  a  horse. — Assistant  Surgeon  S.  C.  Sanger,  6th  New  York  Cavalry, 
reported  the  following  history  of  the  case  of  "  a  contused  and  lacerated  wound  in  connection  with  fracture,  which  was  incurred 
accidentally.  The  patient  was  kicked  by  a  horse.  The  'heel  cork '  or  iron  projection  of  the  shoe  impinged  the  anterior  aspect  of 
the  lower  jaw  a  little  to  the  right  of  the  symphysis,  and  drove  inward  a  large  portion  of  the  alveolar  process  to  which  six  teeth 
were  attached.  It  was  determined  to  place  the  fragment  in  situ.  This  was  difficult  because  the  fracture  was  impacted  at  the 
point  where  the  blow  was  received  and  the  separated  bone  was  drawn  inward  by  the  upper  fibres  of  the  genio-hyo-glossus  muscles. 
But  the  object  was  finally  accomplished  by  extracting  a  tooth  from  the  sound  portion  of  the  jaw,  when  the  fragment  was  secured 
in  its  place  by  silk  cord  and  silver  wire,  two  small  braces  made  of  cork  being  placed  between  the  movable  teeth  and  the  cor 
responding  ones  of  the  upper  jaw.  The  patient  was  sent  to  General  Hospital.  The  accident  happened  June  19,  1863,  and  on 
August  18th  the  patient  arrived  back  in  camp  and  reported  for  duty.  An  examination  made  showed  that  the  bone  had  united 
perfectly  and  without  any  perceptible  deformity,  but  little  trace  of  the  severe  laceration  of  the  soft  parts  being  discerned  in  the 
well-shaped  and  scarcely  apparent  cicatrix."  This  case  has  been  identified  as  that  of  Farrier  J.  O.  Bivins,  Co.  B,  Gth  New  York 
Cavalry,  aged  32  years,  who  entered  Emory  Hospital,  Washington,  three  days  after  the  date  of  the  injury,  and  was  returned  to 
duty  August  13,  1863.  He  was  mustered  out  of  service  September  19,  1864,  and  has  since  then  filed  an  application  for  pension. 

CASE  962. — Fracture  of  the  lower  jaw  by  a  fall  from  a  horse. — Private  L.  P.  Towers,  Co.  F,  3d  Ohio  Cavalry,  aged  48 
years,  sustained  a  simple  oblique  fracture  of  the  lower  jaw  by  falling  from  his  horse  December  1,  1864.  The  injury  was  located 
about  an  inch  to  the  right  of  the  symphysis,  its  track  being  from  above  downward  and  forward.  Two  days  after  the  accident 
the  injured  man  was  admitted  to  Crittenden  Hospital  at  Louisville.  He  had  lost  nearly  all  his  teeth  except  the  incisors,  and 
various  surgical  dressings  were  applied  to  retain  the  fractured  parts  in  position,  but  without  success.  On  December  18th  Acting 
Assistant  Surgeon  A.  H.  Hoy  administered  chloroform  and  made  an  incision  two  inches  long  over  the  seat  of  the  injury,  after 
which  holes  were  drilled  through  the  fractured  ends  of  the  bone  and  a  small  iron  wire  was  passed  through.  The  fracture  was 
then  reduced  and  retained  in  place  by  twisting  the  wire,  an  ordinary  retentive  apparatus  being  placed  under  the  chin  and 
fastened  over  the  top  of  the  head.  With  the  help  of  some  little  traction  the  wire  came  away,  bringing  with  it  two  small  necrosed 
fragments,  on  January  7th,  at  which  time  not  a  particle  of  union  had  taken  place  between  the  parts.  Two  weeks  afterwards 
the  patient  was  granted  permission  to  leave  the  hospital  for  a  short  time  and  came  back  intoxicated.  Violent  gastritis  then 
supervened,  and  death  resulted  on  January  24,  1865.  At  the  post-mortem  examination  a  second  fracture  was  discovered,  being 
situated  in  the  left  condyle  and  extending  obliquely  downward  and  inward.  The  mucous  coat  of  the  stomach  was  in  a  state 
of  intense  acute  inflammation  and  some  inflammation  existed  in  the  duodenum  and  jejunum.  The  injured  maxilla,  contributed 
to  the  Museum,  with  the  history  of  the  case,  by  Surgeon  E.  R.  Taylor,  U.  S.  V.,  is  numbered  4246  of  the  Surgical  Section.  The 
specimen  shows  a  portion  of  the  body  of  the  bone  at  the  seat  of  the  fracture  to  be  wanting,  both  ends  of  the  fragments  being 
carious  and  necrosed  and  both  condyles  carious. 

CASE  963. — Fracture  of  the  sternum;  railroad  accident. — Private  R.  Boyle,  Co.  A,  3d  New  Jersey,  met  with  a  railroad 
accident  on  April  3,  1862,  and  was  admitted  to  hospital  at  Alexandria  several  days  afterwards.  Surgeon  J.  E.  Summers, 
U.  S.  A.,  described  the  injury  as  a  "transverse  fracture  of  the  sternum  between  the  articulations  of  the  third  and  fourth  ribs, 
with  displacement,  the  fractured  ends  sliding  upon  each  other  and  shortening  the  bone  one  and  a  half  inches.  From  the  pos 
teriorly  curved  condition  of  the  spinal  column  there  is  reason  to  think  that  there  was  crushing  of  the  first  and  second  dorsal 
vertebrae,  although  there  was  no  paralysis  of  any  of  the  limbs  or  organs.  The  patient  is  much  crippled  in  appearance,  but  is 
evidently  recovering,  although  slowly,  with  considerable  deformity."  The  patient  was  discharged  for  disability  resulting  from 
his  injury  June  16,  1862.  He  is  not  a  pensioner. 

CASE  964. — Fracture  of  ribs  by  a  fall  from  a  horse. — Lieutenant  E.  Whitfield,  Co.  I,  22d  New  York  Cavalry,  aged  29 
years,  was  injured  in  the  right  side  by  falling  from  his  horse  near  Leesburg,  July  12,  1864.  Acting  Assistant  Surgeon  A. 
Edelin,  who  attended  him  at  Washington,  reported  that  the  injury  involved  a  "fracture  of  ribs,  which  had  not  yet  united  on 
October  19."  Several  weeks  later  the  patient  obtained  a  leave  of  absence,  and  on  December  19,  1864,  he  was  discharged  from 
service  and  pensioned.  Examiner  J.  D.  Button,  of  Auburn,  N.  Y.,  certified,  February  9, 1870 :  "  The  sixth  and  seventh  ribs  on 
the  right  side  were  fractured  and  dislocated  from  the  sternum,  and  not  being  properly  adjusted  an  imperfect  cure  was  the  result. 
There  is  a  projection  of  two  inches  outward  from  the  chest  at  the  ends  of  those  two  fractured  ribs,  which  are  not  joined  to  the 
sternum.  The  muscles  which  move  the  arm  are  weakened  and  exercise  causes  pain."  Subsequent  examiners  report  the  exist 
ence  of  an  ulcer  on  the  left  thigh,  alleged  to  be  the  result  of  a  wound  of  the  knee  by  a  spent  ball,  which  was  also  corroborated 
by  the  Auburn  Examining  Board.  The  latter,  on  December  5,  1877,  described  the  projection  caused  by  the  fractured  ribs, 
and  added  that  the  pensioner  "has  an  anxious  expression  of  countenance;  distended  nasal  alas;  respiration  easily  disturbed; 
loud  resonance  and  weak  respiration  in  right  lung,  indicating  emphysematous  condition  of  the  lung."  The  pensioner  was  paid 
September  4,  1881. 

SURG.  Ill— 82 


650 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


FlG.363.-Bones 
of  the  right  fore 
arm.  Spec.  1784. 


FIG.  364. — The  left   scapula  trans- 


CASE  965. — Fracture  of  ilium  from  a  fall  under  a,  liorse. — Major  W.  E.  Bryan,  3d  New  Jersey,  aged  41  years,  was  injured 
in  the  right  hip  by  his  horse  falling  upon  him,  near  Brandy  Station,  February  22,  1864.  Two  days  after  the  accident  he  was 
conveyed  to  Washington,  where  he  entered  Armory  Square  Hospital  and  afterwards  Georgetown  Seminary. 
Surgeon  D.  W.  Bliss,  U.  S.  V.,  in  charge  of  the  former,  and  Surgeon  H.  W.  Ducachet,  U.  S.  V.,  in  charge  of 
the  latter,  both  described  the  injury  as  a  "fracture  of  the  right  ilium/'  Subsequently  the  patient  was  treated 
for  a  time  in  private  quarters,  and  on  June  23,  1864,  he  was  discharged  from  service,  since  when  he  has 
become  a  pensioner.  The  Philadelphia  Examining  Board,  consisting  of  Drs.  J.  Collins.  T.  S.  Harper,  J.  H. 
Sherwood,  and  E.  A.  Smith,  certified,  February  7,  1872:  "The  pensioner  sustained  a  fracture  of  the  crest  of  the 
right  ilium.  He  complains  of  constant  pain  and  inability  to  follow  any  occupation,  looks  delicate,  and  carries 
the  right  hip  somewhat  higher  than  the  left."  Subsequent  examining  boards  reported,  in  1875  and  1877,  that 
"the  hip  is  flattened  and  the  leg  slightly  shorter  than  its  fellow.  He  alleges 
pain  and  fatigue  in  the  hip,  and  has  oblique  inguinal  hernia  of  right  side,  well 
supported  by  a  truss."  The  pensioner  was  paid  June  4,  1881. 

CASE  966. — Fracture  of  scapula,  humerus,  and  forearm;  railroad  accident. 
John  Gazell,  a  laborer  of  the  Commissary  Department,  U.  S.  A.,  aged  36 
years,  was  run  over  by  a  city  passenger  railroad  car  at  Washington,  August 
10,  1863,  and  died  at  Douglas  Hospital  one  hour  after  the  accident.  Acting 
Assistant  Surgeon  J.  E.  Smith  made  the  following  report  of  the  injury: 
"Everything  to  alleviate  his  sufferings  was  done  that  could  be,  but  the  man 
did  not  react  from  the  shock  in  the  least.  At  the  autopsy  a  tumor  was 
observed  on  the  right  side  of  the  throat  which  was  supposed  to  have  resulted 
from  the  injury,  but  on  cutting  down  upon  it  I  discovered  it  to  be  a  pre-exist 
ing  enlargement  of  the  thyroid  gland.  A  section  of  the  tumor  displayed  fatty 
degeneration  of  the  greater  part  with  two  sacs,  each  containing  about  one-half 

ounce  of  sero-sanguinolent  fluid.     The  left  inferior  portion  of  the  tumor  was 

.«,       T,       .  ,1-i^ixi  x-iij  iiij          •  i  •  i       verselv  fractured.     Spec.  ItiCl. 

ossified.     Previous  to  his  death  the  patient  had  passed  bloody  urine  which 

could  not  be  satisfactorily  accounted  for,  the  kidneys,  ureter,  and  bladder  being  found  apparently  uninjured.  The  right 
humerus  was  comminuted,  as  were  also  the  radius  and  ulna  of  each  forearm.  On  the  left  anterior  side  the  ribs  were  all  broken 
except  the  twelfth,  and  the  lung  was  considerably  lacerated;  posteriorly  the  same  ribs  were  fractured  except  the  first,  second, 
and  twelfth.  The  left  scapula  was  transversely  fractured  below  its  spine  and  the  left  clavicle  at  its  acromial  extremity."  The 
injured  scapula  (FiG.  364,  Spec.  1631),  humerus  (Spec.  1786),  and  both  bones  of  both  forearms  (FlGS.  363,  365,  Spec.  1784  of  the 
Suryical  Section  of  the  Museum),  were  contributed  by  Assistant  Surgeon  W.  Thomson,  U.  S-  A., 
and  are  represented  in  the  adjoining  wood-cuts.  The  left  radius  and  ulna  show  an  oblique 
fracture  at  the  junction  of  the  upper  thirds,  the  superior  fragments  being  wanting,  while  in  the 
right  radius  a  nearly  transverse  fracture  exists  in  the  lower  part  of  the  middle  third  and  longi 
tudinal  fractures  occupy  the  lower  fragment.  The  lowest  third  of  the  right  ulna  is  comminuted. 

CASE  967. — Fracture  of  humerus  from  the  blow  of  a  club. — Private  W.  Jordan,  1st  Alabama 
Colored  Artillery,  aged  27  years,  was  wounded  at  the  battle  of  Fort  Pillow,  April  12,  1864,  and 
entered  Mound  City  Hospital  two  days  afterwards.  His  injuries  consisted  of  a  comminuted 
shot  fracture  of  the  left  ankle,  flesh  wounds  of  the  left  arm  and  right  thigh,  and  a  comminuted 
fracture  of  the  superior  portion  and  head  of  the  left  humerus,  inflicted  by  a  club.  The  wound 
of  the  ankle  became  very  painful  and  the  soft  parts  much  inflamed.  Amputation  at  the  middle 
third  of  the  leg  was  performed  by  Surgeon  II.  Wardner,  U.  S.  V.,  on  April  15th,  chloroform 
and  ether  being  used  and  three  ligatures  applied.  The  patient  was  in  good  condition  at  the  time 
of  the  operation  and  seemed  to  do  well  for  several  days,  when  haemorrhage  took  place  from  the 
tibial  artery,  which  was  checked  by  the  application  of  persulphate  of  iron.  Death,  from  pya3mia, 
took  place  on  April  23,  1864.  The  upper  portion  of  the  injured  humerus  and  the  amputated 
bones  of  the  leg,  contributed  with  the  history  of  the  case  by  the  operator,  constitute  specimens 
3311  and  3312  of  the  Surgical  Section  of  the  Museum.  A  representation  of  the  former  appears 
in  the  annexed  wood-cut  (FJG.  366). 

CASE  968. — Fracture  of  the  bones  of  the  elbow;  railroad  accident. — Private  P.  Stutz,  Co.  A,  91st  Pennsylvania,  met  with 
a  railroad  accident  on  April  9,  1864,  and  entered  South  Street  Hospital  at  Philadelphia,  whence  Acting  Assistant  Surgeon  J.  F. 
Koerper  reported  the  case  as  a  "compound  fracture  of  the  right  elbow,  cured  with  partial  mobility  of  the  joint.  The  patient 
stated  that  while  on  his  way  from  Chester  to  Philadelphia  he  attempted  to  alight  from  a  railroad  car,  when  the  sudden  starting 
of  the  train  caused  him  to  fall  and  the  wheel  to  strike  his  elbow.  He  was  brought  to  this  hospital  soon  after  the  accident.  The 
parts  were  much  swollen  and  contused,  and  crepitation  could  be  felt  around  the  joint.  The  wound  on  the  inner  side,  a  little 
above  the  joint,  communicated  with  a  detached  piece  of  the  internal  condyle.  Haemorrhage,  though  not  very  profuse,  was 
controllable  only  by  pressure  on  the  brachial  artery.  Cold-water  applications  were  used  to  the  joint,  and  angular  splints  were 
applied  to  the  posterior  surface  of  the  arm.  Ten  days  after  the  accident  the  swelling  had  become  reduced,  and  by  May  15th  the 
wound  was  healed  and  slight  movements  of  the  arm  had  been  restored.  Only  simple  bandages  were  now  used,  and  the  patient 
was  detailed  for  light  duty.  By  September  1st  the  patient  had  almost  recovered  the  entire  use  of  the  arm.  He  deserted  from 
the  hospital  on  October  11,  1864.'' 

CASE  969. — Fracture  of  the  bones  of  the  forearm;  railroad  accident. — Private  W.  Call,  a  substitute,  aged  19  years,  was 
severely  injured  in  the  right  forearm  by  a  railroad  collision  at  Madison,  Wisconsin,  December  30,  1864,  and  entered  Harvey 


FIG.  365.-Boneg 
of  left  forearm, 
obliquely  frac 
tured.  Spec.  1784. 


Fin.  360.— Up 
per  portion  of 
left  humerus. 
Spec.  3311. 


SECT.  I.]  SIMPLE    AND    COMPOUND    FRACTURES.  651 

Hospital  the  following  day.  The  limb  was  found  to  have  suffered  a  compound  comminuted  fracture  of  the  radius  aud  ulna  at 
the  lower  fourth  and  a  simple  fracture  of  the  radius  at  the  upper  third.  The  radial  and  uluar  arteries  and  large  nerves  were 
intact.  In  the  course  of  several  weeks  inflammation  resulted,  the  arm,  forearm,  and  hand  becoming  greatly  swollen  from  effusion 
of  serum  and  blood  into  the  cellular  tissue,  bullse  existing  on  the  dorsum  of  the  wrist,  and  the  skin  being  very  sensitive. 
Healthy  pus  was  freely  discharged  from  the  openings.  The  patient,  though  in  possession  of  medium  strength  and  appetite  and 
having  a  naturally  good  constitution,  was  suffering  from  intermittent  fever,  deranged  secretions,  aud  much  emaciation.  On 
February  11,  1865,  Surgeon  H.  Culbertson,  U.  S.  V.,  made  an  incision  four  inches  long  over  the  radius,  extending  upward  from 
the  wrist  on  the  dorsum  of  the  forearm,  separated  the  soft  parts  down  to  the  ulna  and  removed  five  loose  pieces  of  radius  and 
ulna,  together  with  one-quarter  of  an  inch  of  the  lower  end  of  the  latter,  from  the  seat  of  the  fracture.  An  incision  was  also 
made  through  the  integuments  of  the  radial  and  ulnar  borders  of  the  dorsum  of  the  hand  to  liberate  the  effusion  of  blood  and 
serum.  The  lips  of  the  upper  wound  were  then  approximated  with  sutures  and  plaster,  being  left  open  at  the  seat  of  the  frac 
ture  below  and  filled  with  lint,  and  light  poultices  were  applied  over  the  seat  of  the  fracture  as  well  as  over  the  dorsum  of  the 
hand;  arm  placed  in  a  fracture  box  filled  with  tow.  One  grain  of  morphia  was  given  immediately  after  the  operation,  to  be 
followed  with  such  doses  as  the  patient  might  need.  Whiskey,  quinine,  and  muriated  tincture  of  iron  were  prescribed,  with  good 
diet.  About  one  month  after  the  operation  the  external  wounds  were  healing  up,  the  swelling  having  subsided  and  the  patient's 
constitutional  state  continuing  good.  On  April  21,  1865,  he  was  returned  to  the  Post  Commander,  having  entirely  recovered. 
The  history  of  the  case  was  reported  by  the  operator.  There  is  no  record  of  Private  Call  ever  having  applied  for  pension. 

CASE  970. — Fracture  of  the  femur  from  a  fall  under  a  horse. — Sergeant  D.  F.  Mansfield,  Co.  F,  91st  Pennsylvania,  aged 
37  years,  was  admitted  to  Harewood  Hospital,  Washington,  January  18, 1865,  suffering  from  great  deformity  of  the  right  thigh, 
the  result  of  a  simple  fracture  of  the  femur  at  the  middle  third,  the  injured  parts  not  having  been  properly  adjusted.  The  injury 
occurred  near  the  Weldon  Eailroad  November  29,  1864,  by  a  horse  falling  upon  the  man.  At  the  time  of  admission  the  deformed 
limb  was  of  no  use  whatever  to  the  patient  and  locomotion  was  impeded,  although  the  fractured  parts  were  firmly  united.  The 
constitutional  state  of  the  patient  otherwise  was  good.  On  January  28th  Surgeon  K.  B.  Bontecou,  U.  S.  V.,  refractured  the  limb, 
after  which  a  straight  splint  and  counter-extension  were  applied.  An  anaesthetic  consisting  of  chloroform  and  sulphuric  ether  was 
used.  The  patient  did  well  after  the  operation,  the  parts  uniting  symmetrically.  On  March  13th  the  splint  and  extension  were 
removed,  when  the  fractured  parts  were  found  to  be  firmly  united  and  the  limb  was  placed  in  a  plastic  bandage.  The  patient 
continued  to  do  well.  On  April  -6th  the  plastic  bandage  was  removed  and  the  patient  was  allowed  to  be  up  on  crutches,  the 
fractured  limb  being  one  aud  a  half  inches  shorter  than  the  other,  but  firm  and  of  perfect  use.  The  history  was  reported  by  the 
operator.  The  patient  was  discharged  from  service  June  24,  1865,  and  pensioned.  Examining  Surgeon  O.  I.  Beach,  of  Parker- 
ville,  Kansas,  May  19,  1873,  certified  to  the  injury  resulting  in  shortening  of  the  limb,  and  added  that  there  is  "displacement 
of  the  patella  downward,  causing  much  weakness  in  the  leg ;  muscles  placid.  Complains  of  constant  numbness  and  occasional 
severe  pain  in  the  leg,  restricting  locomotion,"  etc.  The  pensioner  died  of  consumption  April  17,  1875. 

CASE  971. — Fracture  of  the  femur  caused  by  a  fall  from  a  bridge. — Private  F.  Buob,  Co.  C,  108th  Ohio,  aged  36  years,  was 
admitted  to  the  Government  Hospital  for  the  Insane  near  Washington  on  May  16,  1865,  his  condition  being  described  by  the  super 
intendent,  Dr.  C.  H.  Nichols,  as  follows:  "  The  patient's  mental  condition  was  that  of  slight  chronic  dementia.  He  was  not  able 
to  walk  up  stairs  to  the  ward  on  account  of  a  lameness  of  the  left  hip,  the  sergeant  in  charge  of  him  stating  that  tin's  was  caused 
by  a  fall  from  a  bridge,  which  had  occurred  between  two  and  three  weeks  previous  to  his  admission.  His  own  statement  was 
that  in  marching  across  the  bridge  at  night  he  was  accidentally  crowded  off  the  side  and  fell  down  some  distance,  striking  upon 
his  left  hip.  As  he  laid  upon  his  back  the  injured  limb  appeared  shortened  and  the  toes,  turned  toward  the  other  foot.  By 
measurement  the  shortening  was  found  to  be  three-fourths  of  an  inch.  The  trochanter  was  flattened  and  approximated  to  the 
anterior  superior  spinous  process  of  the  ilium.  On  rotating  the  limb  no  point  of  false  motion  was  discovered  and  no  crepitation. 
The  arc  of  the  movement  of  the  trochanter  was  less  than  that  of  the  sound  side.  WThen  the  patient  stood  erect  there  was  the 
same  shortening  and  the  same  in  version  of  the  foot.  He  could  limp  about  a  little  by  the  aid  of  a  chair,  bearing  considerable  of  his 
weight  upon  the  injured  limb.  The  diagnosis  of  the  case  was  that  of  an  impacted  fracture  of  the  neck  of  the  femur.  The  limb 
improved  rapidly,  and  in  a  few  weeks  the  patient  walked  without  inconvenience  excepting  what  arose  from  the  shortening. 
The  general  appearance  of  the  man,  however,  led  to  the  suspicion  of  pulmonary  tuberculosis,  and  a  physical  examination  of  the 
chest  confirmed  this  suspicion.  The  tuberculosis  advanced  with  the  ordinary  phenomena  of  cough,  expectoration,  some 
hemoptysis,  and  occasional  pleuritic  and  pneumonic  inflammation.  From  this  disease  the  patient  died  January  28,  1866.  The 
post-mortem  examination  of  the  bod}'  proved  the  correctness  of  the  diagnosis  respecting  the  lung  disease.  Nothing  peculiar  was 
noticed  about  the  acetabulum  of  the  injured  side  except  that  the  ligamentum  teres  and  the  cushion  of  fat  at  the  bottom  were  more 
vascular  than  on  the  sound  side.  The  femur  presented  unmistakable  evidence  that  the  injury  was  an  impacted  fracture  of  the 
neck  of  the  bone,  the  line  of  it  being  partly  within  and  partly  without  the  capsular  ligament.  By  comparison  with  the  sound 
femur  a  shortening  of  three-fourths  of  an  inch  was  shown,  and  the  impaction  was  found  to  be  greater  anteriorly  than  posteriorly, 
thus  causing  the  inversion  of  the  foot.  The  union  of  the  bone  appeared  to  be  firm  and  sound."  Both  the  injured  and  the  sound 
femur  were  contributed  to  the  Museum  by  the  reporter  of  the  case  and  constitute  specimen  2376  of  the  Surgical  Section. 

CASE  972. — Fracture  of  the  patella. — Lieutenant  J.  H.  Sullivan,  Co.  G,  1st  Regiment  Potomac  Home  Brigade,  aged  27 
years,  was  thrown  out  of  a  wagon  on  July  24,  1864,  striking  his  knee  on  the  stone  pavement  and  fracturing  the  patella.  The 
bone  was  split  into  three  fragments,  there  being  one  outer  lower,  one  inner  lower,  and  one  larger  upper  piece.  The  patient  was 
admitted  to  the  General  Hospital  at  Frederick  on  the  day  of  the  injury.  Anti-inflammatory  treatment,  such  as  ice  and  evapo 
rating  lotion,  was  used  to  the  joint,  and  a  straight  splint  was  applied  to  the  back  of  the  limb,  coaptation  being  made  by  compress 
above  and  below  the  bone,  drawn  and  pressed  together  by  adhesive  plaster.  The  limb  was  kept  elevated  during  part  of  the 
treatment  on  an  inclined  plane.  After  union  had  taken  place  a  plaster  of  Paris  splint  was  applied  to  enable  the  patient  to  go 
about.  On  October  20,  1864,  he  returned  to  his  regiment  to  be  mustered  out,  his  term  of  service  having  expired.  At  the  time 
of  leaving  the  hospital  the  patient  had  recovered  from  his  injury  with  short  ligamentoua  union.  The  case  was  reported  by 
Acting  Assistant  Surgeon  J.  H.  Bartholf.  The  patient  has  never  applied  for  a  pension. 


652  MISCELLANEOUS   INJURIES.  [CHAP.  xi. 

CASK  973.— Fracture  of  the  tibia. — Sergeant-Major  J.  L.  Keys,  18th  Pennsylvania  Cavalry,  was  admitted  to  Frederick 
Hospital  July  13,  1804,  with  a  chronjc  indolent  ulcer  of  the  right  leg,  the  result  of  an  old  fracture  of  the  tibia.  Assistant  Sur 
geon  II.  F.  Weir,  U.  S.  A.,  recorded  that  the  ulcer  was  treated  by  strap;  and  stimulant  applications  and  became  much  diminished 
in  size.  On  September  25th  the  patient  received  a  furlough  for  thirty  days,  and  when  he  returned  he  showed  evidence  of  pro 
tracted  intoxication.  Symptoms  of  mania  apotu  soon  after  prevailed,  and,  though  subdued  for  periods  by  treatment,  resulted 
fatally  on  October  26,  1864.  At  the  autopsy  the  body  was  found  to  be  well  nourished,  the  lungs  healthy,  and  a  large  deposit  of 
fat  on  the  outer  surface  of  the  heart.  The  liver  was  much  enlarged  and  decidedly  fatty;  kidneys  fatty;  spleen  and  intestines 
healtliy;  omeutum  very  large;  stomach  very  much  contracted,  its  coats  being  intensely  thickened,  the  rugae  remarkably  prom 
inent,  and  the  mucous  membrane  much  congested.  On  removing  the  calvarium  the  membranes  were  found  to  be  much  congested, 
with  slight  effusion  between  the  arachnoid  and  pia  mater,  slight  deposit  of  lymph  on  the  pia  mater  and  consid 
erable  effusion  beneath.  The  substance  of  the  brain  was  quite  firm.  A  section  of  the  injured  tibia  was  presented 
to  the  Museum  and  forms  specimen  3932  of  the  Surgical  Section,  showing  the  old  consolidated  fracture  followed 
by  a  spongy  and  carious  condition  of  the  anterior  portion  of  the  bone. 

CASE  974. —  United  fracture  of  the  tibia. — Specimen  1057  (FlG.  367)  was  contributed  to  the  Surgical  Section 
of  the  Army  Medical  Museum  by  Assistant  Surgeon  E.  Coues,  U.  S.  A.,  and  consists  of  a  portion  of  the  shaft  of 
the  tibia,  exhibiting  a  simple  oblique  fracture  firmly  consolidated.  Death  occurred  from  an  independent  cause. 

CASK  975. — Fracture  at  the  ankle  joint. — Captain  T.  M.  Howrigan,  Co.  H,  1st  Michigan  Cavalry,  aged  37 
years,  suffered  a  fracture  at  the  left  ankle  joint  while  passing  through  Washington,  November  11,  1862.  The 
accident  was  occasioned  by  his  horse  becoming  frightened  and  falling  with  him,  causing  his  left  foot  to  be  caught 
under  the  horse  and  to  be  fractured.  He  was  discharged  for  disability  June  30,  1863,  but  re-entered  his  regiment 
as  Major  several  months  afterwards,  and  remained  in  service  until  ultimately  mustered  out  June  19,  1865,  since 
which  date  he  has  become  a  pensioner.  Examining  Surgeon  J.  A.  Brown,  of  Detroit,  Michigan,  August  11,  1869, 
FIG  307  Con  edified  to  the  fracture  and  to  the  tibia  being  partially  dislocated  at  the  ankle,  and  added  that  "motion  and 
solidated  frac-  strength  of  the  foot  and  ankle  are  considerably  impaired."  The  Kansas  City  Examining  Board  reported,  Septem- 
£p«°i057  "  her  4,  1873:  "Upon  careful  examination  we  find  fracture  of  the  tibia  and  fibula  and  dislocation  of  the  internal 
malleolus,  it  being  projected  inward  and  dowmvard,  with  tumefaction  and  pain.  Close  to  the  femur  and  femoral 
vessels  at  the  upper  third  of  the  thigh  there  is  found  an  osseous  deposit  about  six  and  a  half  or  seven  inches  long,  one  and  a  half 
inches  wide  above  and  tapering  off  in  a  wedge-shape  below,  and  one-half  inch  thick,  and  just  above  this  there  is  a  smaller 
deposit,  being  two  inches  long  and  one  inch  wide.  These  deposits  interfere  materially  with  the  circulation  and  mobility  of  the 
limb,  which  is  atrophied  and  partially  paralyzed.  General  health  bad."  The  same  board  on  September  8,  1877,  reported  the 
existence  of  "  large  varicose  veins  of  the  entire  limb.  He  is  feeble,  very  nervous,  and  quite  lame,  being  compelled  to  support 
himself  by  a  cane  in  walking.  He  is  much  more  feeble  now  than  two  years  ago,  and  unable  to  do  manual  labor."  One  year  later 
the  board  reported  that  the  pensioner  "  is  now  confined  to  his  bed  and  has  not  been  able  to  walk  for  several  months.  He  has  to 
have  constant  attendance  and  is  not  able  to  help  himself."  The  pensioner  died  May  2,  1879.  His  attending  physician,  Dr.  A. 
B.  Sloan,  of  Kansas  City,  testified  that  death  was  'caused  by  "exhaustion  induced  by  ossification  of  the  arteries  in  the  lower 
limbs  and  the  deposit  of  bony  masses  in  his  left  thigh,  resulting  from  the  injury  and  exposure  in  the  army." 

Punctured,  Incised,  and  Lacerated  Wounds. — Thirty-six  thousand  nine  hundred  and 
seventy-five  punctured  and  incised  wounds,  not  including  those  caused  by  sabre  or  bayonet, 
were  reported;  five  hundred  and  thirty  had  fatal  terminations,  a  mortality  rate  of  1.4  per 
cent.  The  number  of  lacerated  wounds  is  recorded  as  five  thousand  three  hundred  and 
eighty-four,  of  which  one  hundred  and  ten,  or  2.0  per  cent.,  ended  in  death. 

CASK  976. — Punctured  wound  of  chest. — Private  B.  McGinnis,  Co.  H,  7th  Kansas,  aged  31  years,  was  discharged  from 
service  at  the  General  Hospital  at  Leavenworth  City,  December  29,  1863,  Acting  Assistant  Surgeon  S.  F.  Few  certifying  to  the 
following  disability:  "He  has  been  under  treatment  in  this  hospital  since  August  18,  1862,  for  a  punctured  wound  of  the  right 
side  below  the  axilla,  caused  by  a  knife  in  the  hands  of  a  comrade  during  a  drunken  quarrel.  Chronic  pleurisy  exists,  accom 
panied  by  empyema.  The  thoracic  walls  on  the  right  side  are  much  compressed,  and  there  is  dullness  on  percussion  and  almost 
entire  absence  of  respiratory  murmur  in  the  right  lung.  There  is  discharge  of  fetid  matter  from  a  fistulous  opening  in  front  of  the 
right  axilla,  and  the  patient's  general  health  is  much  impaired."  There  is  no  record  of  this  man  ever  having  applied  for  pension. 

CASK  977. — Punctured  wound  of  urethra. — Passed  Assistant  Surgeon  J.  K.  Tryon,  U.  S.  N.,  reports  that  "  J.  Welsh,  a 
seaman,  aged  43  years,  and  of  strong  constitution,  was  admitted  into  the  Naval  Hospital  at  Pensacola  June  29,  1864.  He  had 
been  admitted  on  the  sick  list  eight  days  previously  with  difficulty  of  micturition  accompanied  by  inflammation  of  the  spermatic; 
cord  and  tunica  vaginalis,  and  on  June  28th  he  had  ruptured  the  urethra  by  passing  a  sail  needle  for  a  bougie.  At  the  time  of 
the  patient's  admission  to  hospital  the  scrotum  and  perinaeum  were  gangrenous,  consequent  upon  extravasation  and  infiltration  of 
urine  in  the  surrounding  cellular  tissue,  caused  by  the  laceration  of  the  urethra.  The  buttocks  were  swollen  and  inflamed,  large 
quantities  of  pus  escaping  on  incision.  He  was  weak  and  faint,  unable  to  void  urine,  and  laboring  under  all  the  effects  of  a  severe 
shock.  Upon  consultation  it  was  decided  that  no  operation  could  possibly  be  of  benefit  to  the  patient.  A  catheter  was  accord 
ing!}'  passed  into  the  bladder  after  considerable  difficulty;  tonics  and  stimulants  were  freely  administered,  and  the  affected  parts 
were  dressed  with  liquor  sodae  chlorinatis.  On  June  30th  the  patient  was  no  better,  being  hectic  and  comatose,  from  which  he 
could  be  easily  aroused.  Urine  passed  freely  through  the  catheter.  On  July  1st  there  was  no  change.  During  the  following 
night  the  patient  removed  the  catheter;  the  scrotum  sloughed  away  entirely  and  the  testicles  became  exposed,  with  an  ulcerated 
surface  extending  over  the  perineum,  and  the  buttocks  filled  with  maggots,  which  seemed  unavoidable  from  the  extreme  difficulty 
in  keeping  the  parts  clean  and  from  the  heat  of  the  weather.  On  July  3d  a  gum-elastic  catheter  was  again  passed  into  the 


SECT,  i.]  PUNCTURED,    INCISED,    AND    LACERATED    WOUNDS.  653 

bladder.  The  patient,  however,  failed  rapidly,  became  fully  comatose  under  all  the  depressing  circumstances,  and  died  in  a 
pitiable  condition  on  the  morning  of  July  15,  1864.  The  autopsy  revealed  the  stricture  and  point  of  rupture  just  external  to  the 
triangular  ligaments.  The  severe  symptoms  of  the  case  at  the  time  of  reception  into  the  hospital  render  it  highly  doubtful  whether 
the  laceration  of  the  urethra  and  extravasation  of  urine  could  have  taken  place  only  the  day  previous  to  admission,  but  under  any 
circumstances  should  not  the  treatment  in  the  first  instance  have  been  decisive,  puncturing  the  bladder  through  the  rectum  (if 
the  catheter  could  not  be  introduced)  and  making  numerous  and  deep  incisions  into  the  affected  parts?" 

CASE  978. — Punctured  wound  of  knee  joint. — Private  B.  F.  Carr,  Co.  G,  2d  Minnesota  Cavalry,  aged  19  years,  was 
wounded  in  the  left  knee  during  the  engagement  with  the  Indians  near  the  Little  Missouri  River,  August  8,  1864.  He  remained  at 
a  field  hospital  for  two  months  and  was  then  transferred  to  Fort  Ridgely.  Acting  Assistant  Surgeon  A.  Muller,  in  charge  of  the 
latter,  certified  to  his  discharge  from  service,  February  1,  1865,  by  reason  of  "  an  arrow  wound  through  the  knee  immediately 
below  the  patella,  causing  stiffness  of  the  knea  joint  and  considerable  limping."  Examining  Surgeon  B.  R.  Palmer,  of  Sauk 
Centre,  Minnesota,  reported,  June  17,  1868:  "An  Indian  arrow  passed  into  the  knee  joint  under  the  knee  pan.  There  are 
evidences  of  extensive  inflammation  of  the  joint  in  numerous  cicatrices  around  the  joint.  There  is  no  anchylosis,  but  great 
irritability  in  the  joint  after  exercise,  and  difficulty  in  walking  far  or  standing  long."  Examiner  J.  M.  McMasters  on  Septem 
ber  6,  1877,  made  a  corroborating  report  of  the  nature  of  the  injury,  and  stated  that  "an  iron  or  steel  arrow  penetrated  the 
knee  joint.  At  present  there  is  partial  anchylosis  of  the  joint,  with  dryness  of  the  syuovial  membranes,  indicated  by  cracking 
upon  motion,  and  considerable  tumefaction  in  the  popliteal  region."  The  pensioner  was  paid  December  4,  1881. 

CASE  979. — Punctured  wound  of  knee  joint. — Private  T.  A.  Jackson,  Co.  H,  1st  Rhode  Island  Cavalry,  aged  23  years,  is 
recorded  by  Assistant  Surgeon  E.  J.  Marsh,  U.  S.  A.,  as  having  been  admitted  to  Judiciary  Square  Hospital,  Washington,  April 
29,  1863,  with  a  "perforating  wound  of  the  left  knee,"  and  as  having  been  transferred  to  Philadelphia  one  week  afterwards. 
Acting  Assistant  Surgeon  W.  W.  Keen,  jr.,  reported  the  case  as  a  "punctured  wound  of  the  knee  joint"  and  described  the  injury 
as  follows:  "The  patient  was  admitted  to  Satterlee  Ho&pital  May  7th.  He  stated  that  in  the  previous  December  he  met  with  a 
fall  from  his  horse,  during  which  a  pair  of  scissors  from  his  knapsack  punctured  the  knee  joint  and  broke  off;  that  the  points 
were  removed  three  days  after  the  accident,  being  three  inches  deep  according  to  the  statement  of  his  surgeon,  and  that  severe 
inflammation  followed  and  a  large  number  of  abscesses  formed  about  the  joint.  At  the  time  of  the  patient's  admission  the  injured 
joint  was  smaller  than  the  sound  one,  the  hamstrings  were  contracted,  and  motion  was  limited  from  complete  flexion  to  an  angle 
of  135°  with  the  thigh.  Crepitation  was  very  marked  and  motion  of  the  patella  much  restricted.  Just  to  the  inside  and  above 
the  tubercle  of  the  tibia  there  was  a  cicatrix  from  a  wound,  and  all  about  the  joint  old  cicatrices  from  abscesses  were  found. 
The  evidence  was  rather  in  favor  of  penetration  of  the  joint,  both  by  the  position  of  the  cicatrix  mentioned  and  the  escape  of 
synovia,  which  seems  probable  from  his  statement,  though  of  this  he  is  not  quite  confident.  The  scissors  were  rusty  when  he 
was  wounded.  He  walks  about  on  crutches  but  is  unable  to  bear  weight  on  the  limb."  Surgeon  I.  I.  Hayes,  U.  S.  V.,  reported 
that  the  patient  was  discharged  from  service  June  1,  1863,  by  reason  of  anchylosis  of  the  left  knee  joint  resulting  from  an  injury  by 
scissors  penetrating  the  knee  joint."  The  man  is  not  a  pensioner. 

CASE  980. — Incised  wound  of  neck. — Assistant  Surgeon  G.  W.  Hogeboom,  8th  Kansas,  reports  that  "Private  S.  Noyes,  Co.  K, 
13th  Wisconsin,  was  admitted  to  hospital  at  Leavenworth,  May  28,  1862,  with  a  partially  healed  incised  wound  across  the  throat, 
running  diagonally  from  left  to  right  and  crossing  the  trachea  just  below  the  pomum  adami.  He  was  sent  here  from  the  Law 
rence  Hospital  and  no  account  came  with  him  of  the  injury,  which  is  said  to  have  been  inflicted  by  himself  with  a  bovvie  knife 
while  laboring  under  a  temporary  aberration  of  mind  some  time  in  March.  When  I  first  saw  him  the  wound  was  discharging 
healthy  matter  and  there  was  some  hoarseness  of  voice  and  expectoration  of  considerable  quantities  of  pus  at  times;  pulse  70,  full, 
soft  and  regular ;  general  condition  of  system  very  good ;  mind  sound.  There  was  no  apparent  opening  from  the  external  wound 
into  the  trachea.  It  soon,  however,  became  evident  that  there  existed  some  obstruction  to  the  closing  up  of  the  wound  by  granu 
lation,  and  from  time  to  time  thorough  search  was  made  for  any  deep-seated  abscess  and  for  sinuses  connecting  therewith.  From 
the  character  of  the  sputa  at  times  I  feared  that  there  might  exist  such  connections  with  the  trachea  internally,  but  failed  in  every 
attempt  to  find  any  leading  from  the  external  wound.  The  patient's  general  condition,  though  every  effort  was  made  to  find  the 
true  seat  of  the  difficulty,  continued  much  the  same  until  the  morning  of  June  29th,  when  his  hoarseness  was  a  great  deal  worse 
and  accompanied  with  great  difficulty  of  respiration  and  increased  frequency  of  pulse  attended  with  considerable  hardness.  I 
immediately  put  him  on  calomel  and  tartar  emetic  in  pretty  liberal  doses.  By  6  P.  M.  the  symptoms  were  in  a  measure  relieved. 
The  treatment  was  continued  through  the  night.  At  8  P.  M.  on  the  following  day  the  dyspnoea  was  still  aggravated  and  the 
patient's  blood  greatly  in  need  of  oxj'genation.  I  then  sent  for  instruments  for  the  purpose  of  performing  tracheotomy,  but  before 
the  operation  could  be  done  the  patient  expired  asphyxiated.  At  the  post-mortem  examination  I  found  an  old  sinus  communicat 
ing  with  the  trachea  from  behind,  just  below  the  chordae  vocales,  leading  to  an  abscess  below  and  immediately  behind  the  opening 
into  the  trachea.  The  trachea  was  contracted  from  behind  to  less  than  one-third  its  normal  size,  and  following  it  closely  a  very 
tortuous  and  small  sinus  connected  the  abscess  also  with  the  external  wound.  Sub-acute  inflammation  extended  in  a  limited 
degree  to  the  larger  bronchia,  and  patches  of  false  membrane  were  found  on  the  right  side  of  the  trachea.  Other  organs  healthy." 

CASE  981. — Incised  wound  of  abdomen. — Private  J.  Mooney,  Co.  G,  1st  California  Cavalry,  was  stabbed  with  a  knife  by 
a  fellow  soldier  May  18,  1863.  He  was  conveyed  to  Camp  Stanford  Hospital  at  Stockton,  whence  Surgeon  W.  W.  Hays,  6th 
California,  made  the  following  report:  "When  first  seen,  about  three-quarters  of  an  hour  after  the  injury,  I  found  a  wound  in 
the  left  side  of  the  abdomen  extending  from  about  the  centre  of  the  seventh  rib  three  inches  diagonally  toward  the  umbilicus,  and 
another  in  the  back,  on  the  left  side  of  the  second  lumbar  vertebra,  extending  upward  and  across  the  vertebral  column  for  about 
two  and  a  half  inches.  About  three  feet  of  the  small  intestine,  with  some  omentum,  was  lying  upon  the  external  surface  of  the 
abdomen,  being  partly  cold  from  exposure  to  the  air  and  distended  with  gas.  By  gentle  manipulation  all  was  reduced  in  about 
half  an  hour,  and  the  wound  was  closed  by  interrupted  sutures.  The  wound  in  the  back  bled  freely  and  was  only  controlled  by 
an  injection  of  sulphate  of  iron.  The  treatment  consisted  of  the  free  use  of  opium,  half  a  grain  being  given  every  hour  during 
the  first  twenty-four  hours,  and  low  diet.  On  the  third  day  the  bowels  were  opened  by  an  enema  and  afterward  by  a  full  dose 
of  castor  oil.  Very  little  inflammation  occurred,  and  that  was  controlled  by  opium  and  cold  water.  The  patient  improved  rapidly, 


654  MISCELLANEOUS    INJURIES.  [CHAP.  XT. 

and  to  day  (May  31st)  he  is  walking  about  the  camp,  although  the  wound  in  the  back  is  still  discharging  slightly."  About  two 
months  after  the  occurrence  of  the  accident  the  patient  was  admitted  to  hospital  at  Camp  Drum,  whence  Surgeon  S.  S.  Todd,  4th 
California,  reported  his  discharge  from  service  September  6,  1863,  by  reason  of  "ventral  hernia." 

CASE  982. — Incised  wound  of  knee. — Private  R.  Moody,  Co.  G,  118th  New  York,  aged  24  years,  entered  Turner's  Lane 
Hospital,  Philadelphia,  May  23,  1864,  and  was  discharged  for  disability  seven  months  afterwards.  Acting  Assistant  Surgeon 
W.  W.  Keen,  jr.,  contributed  the  following  history  of  the  case:  "The  patient  had  been  struck  by  an  axe  in  the  right  leg,  just 
below  the  patella,  during  the  fall  of  1862.  The  axe  severed  the  ligamentum  patella,  but  he  states  that  no  synovia  escaped  and 
but  very  little  blood.  He  was  sick  in  bed  for  five  months  and  then  got  up,  having  no  anchylosis  and  the  great  primary  swelling 
having  disappeared.  In  December,  1863,  he  enlisted  in  the  army,  having  good  use  of  the  limb,  though  he  could  not  run  nor  walk 
rapidly  without  care.  He  states  that  within  the  last  six  weeks  the  patella  has  been  drawn  upward,  and  that  before  then  it 
had  almost  kept  its  normal  position.  He  now  constantly  requires  a  cane  and  cannot  extend  the  limb  by  the  quadriceps  muscle. 
No  anchylosis  exists."  The  cast  (Spec.  6692,  A.  M.  M.)  was  taken  by  Dr.  Keen  at  the  time  of  the  patient's  admission  to 
Tumer's  Lane  Hospital,  and  shows  the  position  of  the  patella,  also  the  scar  and  resulting  deformity,  the  limb  being  flexed.  Some 
years  after  his  discharge  the  man  claimed  a  pension  for  disability  from  diarrhoea,  etc.,  alleged  to  have  originated  in  the  service, 
and  was  inspected  by  Examining  Surgeon  T.  C.  Noyes,  of  Oshkosh,  Wisconsin,  who  in  connection  with  the  case  mentioned  the 
condition  of  the  injured  limb  on  August  19,  1880,  as  follows:  "I  find  the  right  thigh  atrophied  from  hip  to  knee,  with  slight 
paralysis.  Its  size  above  the  knee  is  three  inches  smaller  than  the  left,  somewhat  weaker,  and  uncertain  in  movement." 

CASE  983. — Lacerated  wound  of  leg. — Private  J.  Farrell,  Co.  B,  132d  New  York,  aged  21  years,  was  severely  injured  by 
an  explosion  at  Bachelor's  Creek,  May  26,  1864.  Surgeon  C.  A.  Cowgill,  U.  S.  V.,  reported  his  admission  to  Foster  Hospital 
at  New  Berne  with  "extensive  laceration  of  the  popliteal  space  of  the  left  lower  extremity."  Four  months  after  receiving  his 
injury  the  patient  was  well  enough  to  leave  for  his  home  on  furlough.  He  subsequently  entered  Ladies'  Home  Hospital,  New 
York  City,  and  lastly  McDougall  Hospital,  whence  he  was  discharged  from  service  June  16,  1865,  and  pensioned.  The  New 
York  City  Examining  Board  certified  to  the  injury  on  November  23,  1870,  and  stated  that  "the  outer  hamstring  muscles  were 
carried  away,  causing  partial  paralysis  of  the  left  foot.  The  cicatrix  is  eight  inches  in  length  by  three  in  width."  Five  years 
afterwards  the  same  board  reported  that  "the  strength  of  the  knee  joint  is  greatly  impaired;  complete  paralysis  of  foot  at  the 
ankle  joint  and  also  of  the  toes;  foot  cold  and  badly  nourished."  The  pensioner  was  paid  September  4,  1881. 

CASE  984. — Lacerated  wound  of  leg. — Private  P.  Berrer,  Co.  I,  3d  New  Jersey  Cavalry,  aged  26  years,  was  kicked  in  the 
left  leg  by  a  horse  on  March  14,  1864.  He  was  admitted  to  hospital  at  Philadelphia,  where  simple  dressings  were  applied  and 
where  he  remained  until  June  19th,  when  he  was  transferred  to  Ward  Hospital  at  Newark.  At  the  latter  place  the  injured  limb 
was  operated  upon  by  Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.,  who  made  the  following  report  of  the  case:  "The  site  of  the 
limb  kicked  by  the  horse  was  on  the  anterior  aspect,  at  the  junction  of  the  middle  and  upper  thirds  of  the  tibia.  A  lacerated 
wound  was  produced  and  the  bone  was  laid  bare.  In  the  course  of  some  months  a  large  and  unhealthy  ulcer  developed  itself, 
covering  the  whole  face  of  the  lower  upper  third  and  upper  part  of  the  middle  third  of  the  tibia  and  causing  profuse  suppuration. 
On  November  8th  an  anesthetic  of  ether  and  chloroform  was  administered  and  an  incision  three  inches  long  was  made,  after 
which  a  sequestrum  four  inches  long  was  extracted  with  a  bone  forceps  and  carious  bone  was  removed  by  means  of  a  gouge. 
The  patient's  general  health  at  the  time  of  the  operation  was  in  a  fair  state.  His  subsequent  treatment  consisted  of  simple  dress 
ings,  stimulants,  and  full  diet.  The  wound  did  well  for  a  time,  but  prospects  of  complete  recovery  remained  remote  and  indifferent 
at  the  time  of  the  patient's  discharge  from  service  on  April  8,  1865."  The  Philadelphia  Examining  Board  reported,  September 
4.  1875:  "On  the  inner  side  of  the  injured  leg  there  is  an  extensive  scar,  which  involves  fully  one-half  of  the  surface.  The 
tibia  is  enlarged  and  the  scar  is  hard  and  discolored.  It  has  been  open  recently,  but  is  now  nearly  healed."  Two  years  later 
the  same  board  described  the  scar  as  discharging  pus  and  the  limb  as  greatly  discolored  and  hypertrophied.  The  pensioner 
was  paid  June  4,  1881. 

Other  Accidents  and  Injuries. — Of  fifteen  thousand  two  hundred  and  seventy-three 
injuries  of  various  kinds,  grouped  in  this  class,  one  thousand  and  seventy-five  were  fatal, 
a  mortality  of  7.03  per  cent.  A  large  number  of  these  cases  were  injuries  from  frostbite. 

CASK  985. — Private  A.  Zufall,  Co.  C,  142d  Pennsylvania,  aged  21  years,  had  his  feet  frost-bitten  in  the  field  during  the 
month  of  January,  1863.  After  undergoing  treatment  in  field  hospitals  for  several  months,  he  was  transferred  to  Washington 
and  subsequently  to  Philadelphia.  Acting  Assistant  Surgeon  K.  M.  Girvin  reported  that  at  the  time  of  the  patient's  admission 
to  Satterlee  Hospital,  June  23d,  his  feet  were  swollen  and  purplish  looking  and  he  had  not  been  able  to  wear  his  shoes  for  five 
months.  He  was  doing  well  and  no  treatment  was  required.  The  patient  was  returned  to  his  regiment  for  duty  on  December 
2,  1863.  At  the  battle  of  the  Wilderness,  May  5,  1864,  he  received  a  gunshot  flesh  wound  in  the  left  thigh,  for  which  injury  he 
was  again  treated  in  various  hospitals.  He  was  ultimately  mustered  out  of  service  May  29,  1865,  and  pensioned.  Examining 
Surgeon  II.  Brubaker,  of  Somerset,  Pennsylvania,  reported,  November  4,  1874:  "The  toes  of  both  feet  are  stiff  and  the  feet  are 
very  tender  from  the  presence  of  chilblains,  which  become  very  troublesome  during  the  winter,  when  he  is  unable  to  wear  shoes 
most  of  the  time."  Examiner  S.  L.  Good,  of  Meyersdale,  Pennsylvania,  March  15, 1880,  certified  to  "loss  of  motion  of  the  toes 
of  both  feet;  cold  and  imperfect  circulation.  He  states  that  the  feet  are  numb  and  get  cold  easily.  He  cannot  walk  much." 
The  pensioner  was  paid  December  4,  1881. 

CASE  986. — Frostbite  of  both  feet. — Private  L.  S.  Cronkhite,  Co.  I,  40th  Indiana,  aged  46  years,  was  taken  prisoner  at 
the  battle  of  Franklin,  November  30,  1864,  and  had  his  lower  limbs  frozen  by  exposure  during  his  captivity,  which  lasted  for 
several  months.  Assistant  Surgeon  J.  A.  White,  U.  S.  V.,  reported  that  he  was  admitted  as  a  paroled  prisoner  to  McPherson 
Hospital  at  Vicksburg,  April  2,  1865,  suffering  from  "frostbite  of  both  feet,"  subsequent  to  which  date  the  patient  passed 
through  various  hospitals  until  August  31,  1865,  when  he  was  mustered  out  of  service.  Having  made  an  application  for  pension, 
he  was  examined  on  December  31,  1880,  by  Examining  Surgeon  J.  T.  French,  of  Knoxville,  Iowa,  who  described  his  condition 


SECT.  I.]  LIGHTNING   STROKE.  655 

as  follows:  "He  has  suffered  from  frozen  feet.  The  flesh  has  sloughed  off  both  the  great  toes  and  inner  side  and  bottom  of  the 
feet,  causing  extensive  contraction  of  the  tendons.  He  is  unable  to  walk  or  attend  to  ordinary  farm  labor,  rendering  his  dis 
ability  equal  to  one-half  of  total." 

CASE  987.'—  Struck  by  lightning. — Private  S.  Millard,  Co.  K,  52d  Pennsylvania,  aged  20  years,  was  struck  by  lightning 
while  doing  guard  duty  near  Port  Royal,  May  13,  1864.  He  was  treated  at  the  regimental  hospital  and  subsequently  at  the 
General  Hospital  at  Hilton  Head,  whence  Assistant  Surgeon  J.  F.  Huber,  U.  S.  V.,  reported  the  case,  stating  that  "  the  electric 
fluid  passed  down  the  man's  body  in  a  zigzag  direction  and  burned  the  body  in  its  course."  The  patient  is  recorded  as  having 
been  returned  to  duty  three  months  after  the  occurrence  of  the  accident.  He  was  ultimately  mustered  out  of  service  July  12, 
1865,  and  afterwards  allowed  a  pension.  The  following  detailed  account  of  the  case  was  subsequently  contributed  by  Dr.  J.  B. 
Crawford,  of  Wilkesbarre,  Pennsylvania,  who  at  the  time  of  the  accident  held  the  rank  of  regimental  surgeon  of  the  52d  Penn 
sylvania  volunteers:  "I  saw  the  man  about  ten  minutes  after  the  reception  of  his  injury.  He  laid  upon  the  ground  apparently 
dead.  No  pulsation  of  the  heart  could  be  felt,  no  respiration  could  be  observed,  nor  could  any  symptoms  of  life  be  discovered. 
There  was  complete  relaxation  of  the  muscles  and  the  pupils  were  much  dilated.  The  electric  fluid  seemed  to  have  first  touched 
the  point  of  the  bayonet,  about  one  inch  of  which  was  melted.  The  brass  buckle  of  his  belt,  his  steel  watch-chain,  and  the 
larger  portion  of  the  silver  casing  of  the  watch  were  also  melted.  The  hair  was  burned  from  his  chest  and  pubes,  and  the  skin 
of  nearly  the  whole  anterior  portion  of  his  body  was  more  or  less  deeply  burned.  The  injury  to  the  skin  was  most  severe  about 
the  pubic  region,  where  some  sloughing  subsequently  took  place.  Passing  down  the  legs  the  fluid  singed  the  hair  and  slightly 
burned  the  skin  on  the  anterior  surface  of  each  limb.  The  soles  of  his  boots  were  completely  torn  off,  and  no  trace  of  them, 
with  the  exception  of  a  few  small  portions  left  attached,  could  be  found.  No  marks  of  the  electric  fluid  were  made  upon  either 
of  the  upper  extremities  nor  upon  the  head  or  the  neck.  It  seemed  to  have  first  touched  him  below  the  clavicle  .and  to  have 
descended  over  the  anterior  portion  of  the  body,  where  it  left  its  visible  traces.  The  woolen  shirt  which  he  wore  at  the  time 
was  also  much  burned  and  was  still  smoking  when  I  reached  him.  At  first  I  had  no  thought  of  making  any  attempt  at  resusci 
tation,  but  while  awaiting  the  arrival  of  a  stretcher  for  the  purpose  of  removing  the  body  I  decided  to  try  the  effect  of  artificial 
respiration.  No  appliances  for  this  purpose,  however,  wrere  at  hand,  and  my  only  resource  was  to  compress  and  expand  the 
chest,  depending  on  the  elasticity  of  its  walls  and  on  the  forcible  elevation  of  the  arms  for  means  of  expansion  and  inflation,  and 
on  direct  compression  of  the  chest  with  the  hands  for  expiration.  Being  aided  by  my  assistant,  Dr.  J.  Flowers,  I  proceeded  to 
carry  out  my  purpose,  the  relaxed  state  of  the  muscular  system  seeming  to  facilitate  the  proceeding  greatly.  Ammonia  was 
applied  to  the  mouth  and  nose  while  the  forced  respiration  was  being  carried  on.  After  continuing  this  procedure  for  a  quarter 
of  an  hour  or  more,  and  when  about  despairing  of  success,  we  were  rewarded  by  what  seemed  to  be  a  faint  gasp  in  our  patient — 
so  slight,  indeed,  that  we  were  not  quite  sure  of  its  reality,  yet  enough  to  induce  us  to  persevere  in  our  efforts.  We  soon  saw 
more  unequivocal  signs  of  life,  and  at  the  expiration  of  half  an  hour  we  could  detect  positive  evidence  of  the  heart's  action, 
which  was  feeble  and  exceedingly  slow,  not  amounting  to  more  than  thirty-five  beats  per  minute.  After  continuing  the  treat 
ment  for  another  half  hour  our  patient  was  so  far  restored  that  we  had  him  conveyed  to  the  regimental  hospital.  As  he  was  yet 
unable  to  swallow,  ammonia  was  given  by  inhalation,  and  whiskey  was  freely  applied  to  the  surface  of  the  body.  After  the 
expiration  of  some  hours  the  patient  became  able  to  swallow  small  quantities  of  liquid ;  the  limbs  and  organs  of  speech,  however, 
remained  paralyzed.  He  continued  in  a  similar  condition  for  about  five  days,  the  bowels  being  constipated  and  the  urine  passing 
involuntarily.  Sensibility  seemed  to  have  been  lost.  On  the  sixth  day  after  the  injury  a  slight  improvement  in  all  the  suspended 
functions  was  apparent.  The  voice  gradually  returned;  movements  of  the  limbs  again  became  possible;  the  bladder  and  bowels 
gradually  resumed  their  wonted  action,  and  sensibility  and  motion  returned  by  slow  and  uniform  degrees.  At  the  expiration  of 
three  weeks  I  left  for  the  north  and  lost  sight  of  the  patient,  who  was  then  able  to  walk  a  few  rods  with  the  aid  of  crutches. 
Some  three  years  afterwards  he  applied  to  me  for  a  certificate  on  which  to  found  a  claim  for  a  pension.  At  that  time  he  had  not 
fully  recovered,  sensibility  and  motion  being  still  impaired.  His  gait  was  unsteady  and  his  movements  tremulous  and  feeble; 
his  pulse  had  regained  its  normal  frequency  and  force.  His  condition  still  continued  to  improve,  and  at  the  expiration  of  another 
year  he  was  able  to  attend  to  some  light  labor.  I  again  saw  the  man  in  July,  1873,  when  he  told  me  that  he  had  nearly  recov 
ered  from  his  injury  and  had  resumed  his  trade  as  wagon-maker.  He  also  stated  that  he  enjoyed  tolerable  health,  and  expe 
rienced  none  of  the  511  effects  of  his  injury  except  on  the  approach  of  and  during  a  thunder  storm,  at  which  time  he  would  feel 
excruciating  pains  throughout  his  system,"  etc.  In  consequence  of  adverse  reports  by  the  examining  surgeons  the  pensioner's 
name  was  dropped  from  the  rolls  on  March  4,  1869,  since  when  he  has  made  ineffectual  attempts  to  be  restored.  The  Scranton, 
Pennsylvania,  Examining  Board  certified,  on  March  7,  1877,  to  "reflex  paraplegia  consequent  on  the  general  electric  shock  of 
such  intensity  as  to  disturb  the  co-relation  of  the  nerve  centres.  While  it  did  not  utterly  destroy,  it  has  so  far  impaired  the 
neural  force  as  to  give  rise  to  loss  of  power  by  exhaustion  more  or  less  complete  and  to  consequent  occurring  nutritive  changes." 

CASK  988. — Struck  l>y  lightning. — Sergeant  W.  Roberts,  Co.  C,  56th  Ohio,  aged  24  years,  was  struck  by  lightning  while 
on  the  march  from  Jackson  to  Vicksburg,  July  22, 1863.  He  was  conveyed  to  hospital  at  Vicksburg,  where  he  was  under  treat 
ment  for  several  weeks,  after  which  he  received  a  furlough  and  was  allowed  to  proceed  to  his  home.  Surgeon  L.  R.  Stone, 
U.  S.  V.,  reported  that  "the  man  was  admitted  from  his  home  to  the  General  Hospital  at  Gallipolis  on  February  9,  1864.  At 
the  time  of  his  admission  he  could  not  walk,  only  shuffle  along  a  few  inches  at  a  time,  and  could  stand  only  when  supported 
on  crutches  or  canes.  He  showed  considerable  emaciation;  appetite  poor;  pulse  120  and  feeble;  skin  dry  and  cool.  His  mind 
was  not  at  all  affected.  According  to  his  account  of  the  accident  he  had  sought  shelter  in  the  woods  during  a  heavy  thunder 
storm  and  was  standing  under  and  against  a  tree,  when  he  was  struck  senseless  to  the  ground,  one  or  two  other  soldiers  being 
killed  at  the  same  time.  He  remained  unconscious  for  some  hours,  but  was  at  last  resuscitated  by  the  dashing  of  cold  water 
and  by  friction,  and  was  then  removed  to  a  hospital  as  soon  as  possible.  The  physician  under  whose  care  he  was  while  staying 
at  his  home  stated  that  at  first  he  was  nearly  helpless,  and  in  December  there  was  yet  no  perceptible  improvement  in  the  case,  • 
his  pulse  being  125  and  feeble,  his  emaciation  considerable,  and  the  use  of  his  lower  extremities  being  greatly  impaired.  Nothing 
was  mentioned  about  the  treatment  employed.  On  examination  of  the  patient  after  his  admission  here,  well  marked  general 
paralysis  of  the  motor  system  was  found,  particularly  of  the  lower  extremities,  with  some  slight  insensibility,  and  a  sluggish- 


656  MISCELLANEOUS    INJURIES.  [CHAP.  xi. 

ness  of  the  capillary  circulation.  There  was  no  oedema  nor  subsultus  tendinum.  He  could  move  his  toes  and  partially  flex  his 
legs  or  his  thighs,  but  could  not  walk.  The  upper  extremities  were  somewhat  affected,  but  in  a  much  less  degree;  bowels  very 
sluggish ;  no  affection  of  the  urinary  organs.  Though  occasionally  there  were  severe  paroxysms  of  pain  just  below  the  scapulas, 
no  pressure  at  any  particular  point  along  the  spine  caused  pain.  Atmospheric  changes  affected  the  patient  very  much,  and  when 
the  air  was  charged  with  electricity  he  showed  considerable  constitutional  irritation,  with  fever,  pain  in  the  head  and  limbs,  and 
nausea.  This  was  followed  by  two  or  three  days  of  depression  before  he  would  recover  his  usual  condition.  The  treatment 
was  principally  chalybeate,  with  milk  diet.  The  patient  is  slowly  improving  now  (May  12th)  and  able  to  walk  more  easily 
with  crutches,  but  is  still  quite  feeble."  At  a  subsequent  date  the  patient  was  transferred  to  Columbus,  where  he  was  dis 
charged  by  expiration  of  service  on  October  27, 1864.  On  making  an  application  for  pension  he  received  the  following  certificate 
from  Examining  Surgeon  W.  G.  Gill,  of  Decatur,  Alabama,  dated  April  23,  1881 :  "I  have  carefully  examined. the  applicant. 
He  appears  quite  nervous,  and  says  his  left  side  gives  him  great  pain  when  he  exercises  in  attempting  to  do  manual  labor;  that 
he  has  never  been  able  to  do  a  regular  day's  work  since  the  war,  and  although  partially  recovered  from  paralysis  caused  by 
lightning,  he  still  suffers  very  much.  I  rate  his  disability  total." 

CASE  989. — Fatal  case  of  sunstroke. — Private  C.  Vaughn,  Co.  B,  1st  Louisiana,  aged  30  years,  was  sunstruck  at  New 
Orleans,  and  admitted  to  St.  James'  Hospital  on  September  16,  1863.  Acting  Assistant  Surgeon  J.  V.  C.  Smith  reported  that 
"  the  patient  was  brought  to  the  hospital  in  a  state  of  unconsciousness.  He  could  swallow  nothing  and  occasionally  had  spasms 
of  the  lumbar  muscles.  He  was  carefully  watched.  Cold-water  applications  were  made  to  the  head,  and  mustard  was  applied 
to  the  back  of  the  neck  and  to  the  soles  of  the  feet.  On  the  following  day  the  patient's  jaws  were  still  spasmodically  closed  and 
nothing  could  be  forced  into  his  mouth.  At  2  P.  M.  the  ice  was  taken  from  his  head  and  his  whole  body  was  washed  in  mustard 
water.  His  pulse  was  not  much  different  from  that  of  one  in  ordinary  health.  At  3  P.  M.,  by  some  singular  movement  which 
no  one  saw — although  he  was  in  a  ward  of  forty-three  beds,  mostly  occupied,  and  the  nurses  were  but  a  few  feet  off — he  seemed 
to  have  rolled  over  and  broken  awash-basin,  a  sharp  edge  of  which  cut  a  gash  three  inches  in  length  across  the  masseter  muscle 
of  the  left  side  of  his  face,  nearly  dividing  it,  and  cutting  in  twain  a  branch  of  the  transversalis  faciei  artery,  which  bled  pretty 
freely.  The  artery  was  secured  by  a  ligature  and  the  wound  was  stitched  and  secured  by  adhesive  strips.  The  patient  groaned 
several  times  during  the  operation,  but  never  recovered  his  consciousness  nor  took  either  nourishment  or  medicine  while  in  the 
hospital.  He  died  at  10  p.  M.  on  September  17,  18G3." 

CASE  990. — Injury  from  a  scorpion  bite. — Private  J.  Sculley,  Co.  H,  6th  New  York  Cavalry,  aged  25  years,  was  stung 
by  a  scorpion  on  the  back  of  the  neck,  between  the  third  and  fourth  cervical  vertebrae,  while  in  camp  at  Fair  Oaks,  June  27, 
18G2.  Surgeon  A.  P.  Clark,  6th  New  York  Cavalry,  who  treated  the  case,  made  the  following  report:  "The  patient  was  a  man 
of  robust  constitution  and  of  good  health.  I  saw  him  a  few  minutes  after  the  reception  of  the  wound,  which  occurred  at  10  A.  M. 
There  was  no  swelling  of  the  part,  but  he  complained  of  intense  pain  in  the  back  and  lower  extremities.  I  cauterized  freely. 
Severe  spasms  soon  came  on,  producing  in  quick  succession  complete  emprosthotonos  and  opisthotonos ;  pulse  55  and  weak; 
pupils  dilated;  voice  feeble;  face  livid;  surface  cold  and  bathed  in  clammy  perspiration.  He  remained  in  this  condition  for  two 
and  a  half  hours,  when  he  gradually  became  insensible,  the  action  of  his  heart  becoming  more  feeble  and  irregular.  Ten  minims 
of  Bibron's  antidotal  mixture  and  a  tablespoonful  of  brandy  diluted  with  the  same  quantity  of  warm  water  was  administered 
and  repeated  every  half  hour  until  two  and  a  half  ounces  of  the  brandy  had  been  given.  During  this  time  hot  sinapisms,  with 
diluted  acetic  acid,  were  kept  applied  along  the  spine  and  lower  extremities.  At  12  o'clock  his  face  and  hands  began  to  swell, 
the  skin  of  these  parts  resembling  an  attack  of  phlegmonous  erysipelas,  though  of  a  duskier  hue.  The  swelling  continued  to 
increase  until  about  6  p.  M.,  at  which  time  his  head  was  of  an  enormous  size  and  his  eyes  very  glassy,  appearing  as  if  they  would 
burst  from  their  sockets.  The  swelling  also  extended  down  the  neck  and  chest  as  far  as  the  lower  part  of  the  pectoral  muscles, 
down  the  arms  as  far  as  the  insertion  of  the  deltoid,  and  over  the  shoulder  on  either  side  of  the  wound;  but  there  was  none  in 
its  immediate  vicinity  or  below  it  on  the  back.  The  patient  still  remaining  unconscious,  I  took  twelve  ounces  of  blood  from  the 
left  median  cephalic  vein  and  cupped  him  along  the  spine  and  lower  part  of  the  thorax,  put  two  minims  of  croton  oil  upon  his 
tongue,  and  administered  an  enema  of  warm  water  and  olive  oil.  Sinapisms  were  still  continued.  About  2  A.  M.  on  the  follow 
ing  morning  signs  of  returning  consciousness  appeared,  when  another  enema  was  given  and  his  feet  were  put  into  warm  water. 
In  about  a  quarter  of  an  hour  afterwards  he  had  a  copious  discharge  from  his  bowels,  very  offensive  and  of  a  dark  gelatinous 
character,  which  AVRS  soon  followed  by  the  vomiting  of  a  large  quantity  of  matter  of  a  similar  but  not  so  offensive  nature. 
After  this  consciousness  returned  and  the  swelling  gradually  subsided.  At  3  P.  M.  the  patient  was  able  to  sit  and  ride  in  an 
ambulance.  He  reached  Harrison's  Landing  on  July  1st,  when  he  reported  to  his  company  for  duty.  No  untoward  symptoms 
afterwards  appeared.  During  the  course  of  the  first  day  some  ten  different  medical  officers  saw  the  patient  and  none  of  them 
entertained  any  hope  of  his  recovery.  I  am  of  the  opinion  that  it  was  through  the  action  of  Bibron's  antidote  conveyed  into  the 
circulation  that  the  virus  of  the  scorpion  was  neutralized  or  eliminated  from  the  system,  and  that  the  action  of  the  medicine  was 
promoted  by  the  other  measures  employed." 


SECT.  11.  J 


OPERATIONS    FOR    MISCELLANEOUS    INJURIES. 


657 


SECTION  II. 


OPERATIONS   FOR  MISCELLANEOUS  INJURIES. 


Numerous  operations  for  miscellaneous  injuries  or  diseases,  such  as  excisions,  amputa 
tions,  ligations,  operations  on  the  eye,  the  mouth  and  its  dependencies,  the  air  passages,  the 
chest,  the  genito-urinary  organs,  etc.,  were  reported  during  the  war.  Detailed  reports  will 
be  given  of  the  more  important  cases,  and  all  will  be  cited  in  condensed  tabular  statements. 

EXCISIONS. — Forty-five  cases  of  excisions  for  miscellaneous  injuries  or  diseases  were 
reported.  Twenty-five  were  excisions  of  the  bones  of  the  head,  five  of  the  upper  extrem 
ities,  and  fifteen  of  the  lower  extremities.  The  results  are  indicated  in  the  following  table: 

TABLE  CV. 
Numerical  Statement  of  Forty-Jive  Cases  of  Excisions  following  Miscellaneous  Injuries  or  Diseases. 


EXCISIONS. 

CASES. 

FOR  INJURY.          ji  FOR  DISEASE. 

"3 

~C 

EH 

Recoveries. 

Deaths. 

Undetermin'd 
Results. 

Recoveries. 

'a 
1 

Undetermin'd 
Results. 

Recoveries. 

Deaths. 

1 
1 
1 
1 
1 
1 
9 
1 
1 
1 

0 

12 
1 

12 

1 

12 

1 

12 

1 

1 

1 

1 

1 

1 

1 

1 

1 

1 

1 

9 

5 

4- 

1 

1 

Excision  in  hones  of  Leg  and  amputation  of  Leg  

1 
I 
9 

1 

1 
1 

Excisions  at  the  Ankle  Joint    ...                       ... 

1 

16 

45 

28 

16 

1 

23 

1 

5 

The  twenty-five  cases  of  excisions  of  the  cranial  bones  for  injuries  from  miscellaneous 
causes  have  been  detailed  in  the  First  Surgical  Volume.1  A  few  examples  of  excisions  in 
the  extremities  will  here  be  cited,  and  all  will  be  given  in  tabular  form. 

CASK  991. — Excision  in  the.  bones  of  the  leg. — Private  C.  Peasley,  Co.  A,  10th  Massachusetts,  was  kicked  by  a  mule  in  the 
left  leg,  fracturing  both  bones,  while  driving  ambulance  at  Camp  Brightwood,  August  31,  1861.  He  was  admitted  to  the  Washing 
ton  Infirmary  Hospital  on  the  day  of  the  injury.  One  month  after  the  accident  no  attempt  at  union  of  the  bgne  had  yet  taken  place, 
but  much  suppuration  had  occurred  and  the  bone  had  become  bare  in  its  whole  circumference  for  the  space  of  two  inches.  Free 

1  Cases  of:  Citizen  J.  Berry,  p.  316' ;  Pt.  J.  Burns,  C.  4th  Kentucky  Cav.,  p.  57 ;  Pt.  W.  H.  Edwards,  D,  3d  Jowa  Cav.,  p.  317  ;  Corp'l  A.  Gasslein, 
B,  6th  Penn.  Cav.,  p.  51;  Pt.  P.  H.  Greene,  II,  J2f>th  X.  V.,  p.  57;  Pt.  C.  Horahan,  G,  61st  Ohio,  p.  57;  Pt.  J.  T.  Jenkins,  5th  Alabama,  p.  ">8 ;  Pt.  W. 
H.  Lowery,  C,  6th  Tenn.  Cav.,  p.  58 ;  Pt.  J.  McTye,  G,  6th  Tenn.,  p.  317 ;  Pt.  E.  Miller,  G,  6th  Va.  Cav.,  p.  58 ;  Pt.  N.  II.  Neodhairi,  I,  tith  Mass.,  p.  58 ; 

A.  B.  Parish,  employe  Q.  M.  Dep't.,  p.  58;  Pt.  G.  W.  Phillips,  G,  6th  Iowa  Cav.,  p.  317;  Pt.  P .  14th  Tenn.,  p.  59;  Pt.  J.  Rogers,  L,  4th  Ohio  Art'y, 

p.  59;  Pt.  J.  Ruytz,  H,  2d  Mich.,  p.  59;  Pt.  J.  C.  Shedd,  D,  llth  N.  Y.  Cav.,  p.  59;  Freedmau  J.  Smith,  p.  59;  Pt.  W.  H.  South,  H,  168th  Penn.,  p.  60; 
Pt.  C.  E.  Towns,  I,  9th  N.  H.,  p.  60;  Unknown,  4th  II.  S.  C.  H.  A.,  p.  316;  Unknown  German  soldier,  p.  316;  Unknown  negro,  p.  58;  Pt.  C.  Vorrist, 
Signal  Corps;  and  Pt.  C.  Williams,  B,  161st  N.  Y.,  p.  60. 

SURG.   111—83 


658 


MISCELLANEOUS    INJURIES. 


(CHAP.  XI. 


incisions  were  made  anteriorly  and  posteriorly  and  resection  of  the  tibia  and  fibula  was  performed.  Firm  union  resulted  three 
months  after  the  operation,  a  gypsum  apparatus  being  used  during  the  last  month.  The  patient  was  discharged  from  service 
December  17,  1861,  and  sent  home.  He  had  urgently  requested  that  amputation  be  performed,  but  on  careful  examination  it  was 
deemed  more  prudent  to  saw  off'  the  dead  bone  which  had  not  yet  been  cast  off  and  to  resort  to  amputation  only  in  case  of  failure 
of  the  resection.  The  excised  portion  of  the  tibia  (Spec.  340).  represented  in  the  adjacent  cut  (FiG.  368),  and 
measuring  one  and  one-fourth  inches  in  length,  was  contributed  with  the  history  of  the  case  by  Assistant  Surgeon 
J.  W.  S.  Gouley,  U.  S.  A.  The  patient  became  a  pensioner  after  receiving  his  discharge.  Examining  Surgeon  II. 
D.  Train,  of  Sheffield,  Massachusetts.  September  7,  1872,  certified  to  the  injury  and  resection,  "shortening  the  limb 
three  inches.  There  is  a  perfect  solidification  at  the.  place  of  fracture;  no  motion  of  ankle  and  instep  After  slight 
exertion  or  during  damp  weather  he  has  often  severe  pain,  which  prevents  any  labor.  Since  his  discharge  he  has 
been  obliged  to  lead  a  sedentary  life  from  inability  to  walk.  His  general  health  is  fair,  but  his  system  is  generally 
weakened  and  sensitive  to  cold  weather.  The  foot  is  gradually  perishing,  and  the  pensioner  would  have  been 
infinitely  better  off  to-day  if  amputation  had  been  performed."  Five  years  later  the  same  examiner  reported  that 
',i<m  °fjlbula'  "eince  last  examination  spiculrc  of  bone  were  frequently  discharged,  the  wound  breaking  out  afresh.  He  cannot 

walk  any  distance  without  crutch  or  cane.  General  health  poor."  The  pensioner  was  paid  December  4,  1881. 
CASE  992. — Partial  excision  at  the  ankle  joint. — Private  L.  Ettinger,1  Co.  K,  58th  New  York,  aged  52  years,  was 
accidentally  injured,  near  Hunter's  Chapel,  December  6,  18(51,  by  the  blow  of  an  axe,  which  struck  his  right  foot  just  below  the 
external  malleolus,  penetrating  the  ankle  joint.  Assistant  Surgeon  J.  S.  Billings,  U.  S.  A.,  who  operated  in  the  case,  made  the 
following  report:  ''The  man  was  admitted  to  the  Union  Hotel  Hospital,  Georgetown,  January  1,  1862,  being  very  feeble  and 
emaciated  and  complaining  of  great  pain  in  the  foot.  A  large  gaping  wound  existed  at  the  site  of  the  injury,  from  which  sanious 
fetid  pus  was  escaping  and  at  the  bottom  of  which  dead  bone  could  be  felt.  Sinuses  also  ran  down  each  side  of  the  tendo-achillis, 
and  the  whole  integument  about  the  ankle  joint  was  livid  and  undermined.  On  January  6th  partial  excision  of  the  ankle  joint 
was  performed  by  a  curved  incision  three  inches  long,  made  just  below  the  external  malleolus  and  including  the  original  wound. 
The  external  malleolus,  the  whole  of  the  astragalus,  and  a  small  portion  of  the  scaphoid  were  found  to  be  carious  and  were 
removed  by  means  of  the  bone  gouge  and  Liston's  forceps.  The  haemorrhage  was  slight.  Simple  dressings  were  applied,  and 
ale  and  good  diet  were  furnished.  By  March  1st  the  wound  had  entirely  healed,  the  skin  had  resumed  its  natural  appearance, 
and  the  patient  could  walk  with  a  cane.  He  was  then  sent  to  Philadelphia,  where  he  was  discharged  from  service.  I  saw  him 
eight  months  aftenvards,  walking  with  a  cane  and  with  but  a  very  slightly  perceptible  limp.  The  age  and  debilitated  condition 
of  this  patient  rendered  the  expediency  of  excision  very  doubtful ;  but  the  result  proved  entirely  satisfactory."  The  records 
of  South  Street  Hospital,  Philadelphia,  show  that  the  patient  was  discharged  September  17,  18(i2,  by  reason  of  "anchylosis  of 
the  right  ankle  joint "  resulting  from  the  wound.  The  man  subsequently  became  a  pensioner.  The  nature  of  his  injury  and 
disability  has  since  then  been  corroborated  by  successive  certificates  of  various  examining  surgeons.  The  pensioner  has  been 
for  some  years  an  inmate  of  the  hospital  for  the  insane  at  Randall's  Island,  New  York  Harbor. 

TABLE  OVJ. 
Summary  of  Twenty  Cases  of  Excisions  of  the  Bones  of  the  Extremities. 

[ Upper  Extremities,  1 — 5;  Lower  Extremities,  6 — 20.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  OF 
INJURY 

OH 

DISEASE. 

NATURE  OF  INJURY  OK 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RKSULT  AND  REMARKS. 

1 

Ormsby,  M.  S..  Pt.,  D,  8th 

Abscess  on  right  shoulder  from 

Aug.  15, 

Portion  ol'acr.  proc.  of  scapula 

Discharged  Nov.  1,  1862.     Claim 

Infantry,  age  20. 

1862. 

pressure  of  knapsack  and  ac 

1662. 

excised  ;  August  22,  spine  and 

for  pension  rejected.     Spec.  415, 

coutrements.  Another  abscess 

balance  of  acr.  proc.  remov'd. 

A.   M.   M.     &e  First  Surgical 

in  leg;  ulceration. 

A.  Surg.  R.  Bartholow.U.S.A. 

Volume,  p.  564. 

2 

Bliss,  O.  M.,  Capt..  H.   9th 

Got.  8, 

Compound  fracture  of  the  left 

Oct.  9, 

Excision  of  upper  part  left  hu 

Erysipelas  appeared  ;  had  nearly 

Iowa,  age  41. 

1864. 

hiunerus.    caused   by  fall   of 

1864. 

merus  thro'  a  single  incision. 

passed  away  on  Oct.  31,  1864. 

horse. 

Surg.  A.  Goslin,  48th  Illinois. 

Died  March  24.  1865. 

:t 

Reynolds.    T..    Pt..    Perma 

May  1  1  , 

Right  arm  run  over  by  a  street 



Resection  of  2  inches  of  shaft 

Disch'd  Mar.  26.  1864.    Necrosis; 

nent  Party  at  Carlisle  Bar 

1863. 

car.  fracturing  humerus. 

of  right  humerus. 

wound    re-opened;    discharged 

racks,  Peiin.,  age  27. 

pus;  pensioned;  arm  impaired. 

4 

West,  \V.,  It.,  F,  78th  Ohio. 

Oct.  20, 

Compound    comminuted   frac 

Oct.  22, 

Excision  of  condyles  of  right 

Erysipelatous  inflammat  n,  which 

age  39. 

1863. 

ture  of  the  right  elbow  joint. 

1863. 

humerus.  head  of  radius,  and 

appeared  on  the  8th  day.  was 

Condyles  of  humerus,  head  of 

point  of  olecranon  through  an 

readily  subdued.      Died   June 

radius,  and   portion   of   ulna 

incision   5   ins.    long.     A.  A. 

20,  1864,  of  mortification  of  tho 

crushed  by  a  car  wheel. 

Surg.  J.  S.  Bailv. 

arm. 

!t 

Revnaud,  C.,  Pt.,  H,  2d  Ken 

May  5, 

(tight  ulna  fractured  at  upper 

June  •). 

Resection  of  both  ends  of  bone, 

Disch'd  June  13,  '65  :   pensioned  ; 

tucky  Cavalry,  age  26. 

1864. 

part  by  blow  from  a  musket  ; 

1864. 

about  3  ins.  of  shaft  removed. 

anchylosis  elbow;  good  motion 

both  ends  of  bone  denuded. 

Surg.  R.  K.  Taylor,  U.  S.  V. 

of  fingers.     Died  Dec.  28.  1870. 

6 

Taylor.  J.,  Pt.,  C,  38th  Col 



A  log  fell  upon  him,  fracturing 

Oct.  17, 

Resection  of  4  inches  of  lower 

Wound  sloughing.     Died  Octo 

ored  Troops,  age  Hi. 

1864. 

lower  third  of  right  femur; 

1864. 

third  of  shaft  of  right  femur. 

ber  29,  1864.  of  exhaustion. 

necrosis  and  sloughing. 

A.  A.  Surg.  O.  Shiftier. 

7 

Burnett,   A.   J.,   Pt.,  (1.  6th 

Aug.  7, 

Compound  comminut'd  fracture 

Aug.  21, 

Excision  of  the  left  tibia  

Discharged  June  27,  '64  :  anchy 

East  Tennessee,  age  'Mi. 

1863. 

of  left  leg  and  dislocation  of 

1863. 

losis  of  the  ankle  joint.     Claim 

ankle  :  run  over  by  a  wagon. 

for  a  pension  rejected. 

H 

Coburn.  S.,  Pt..  G,  3d  Illinois 



Ulcer  of  the  right  leg;  perios 

Second 

Excision   of  3.V  inches  of   the 

Mustered  out  July  (>,  '66;  tissues 

Cavalry,  age  38. 

titis  of  tibia  and  inflammation 

ary. 

right  tibia. 

inflamed  and  indurated;  ankle  : 

of  leg  from  knee  to  ankle. 

partially  stiffened. 

9 

Disney,  T.  W.,  It.,  B.  36th 



Accidental  fracture  of  the  right 

Sept.  2, 

Excision  of  5  inches  of  the  right 

Discharged  March  8.  1865;  pen 

Massachusetts,  age  33. 

tibia:    3   inches   of   necrosed 

1864. 

tibia. 

sioned:  two  inches  shortening; 

bone  exposed. 

lameness.     Died  Jan.  31.  1873. 

10 

Harper.   H.  S.,  Pt..  E.  137th 

Aug.  -. 

Scurvv  and  ulcer  of  left  leg: 

Jan.  21, 

Excision  of  ](>i   inches  of  left 

Mustered  out  Sept.  15,  1865:  pen 

New  York,  age  35. 

1864. 

tibia  extensively  necrosed. 

1865. 

tibia  through   an  incision   12 

sioned.  1877,parts  still  discharg 

inches  long.     Surg.  O.  Grant. 

ing  extensively;  walks  with  dif 

U.  S.  V. 

ficulty;  limb  nearly  worthless. 

'CULBERTSON  (H.),  Excision  of  the  Larger  Joints  of  tlie  Extremities,  in  Trar 
XXVII,  p.  344.     Prize  Essay. 


Medical  Association,  1876.  Supplement  to  Vol. 


SECT.  II.] 


AMPUTATIONS    FOR    MISCELLANEOUS    INJURIES. 


659 


DATE  OF 

- 

DATE 

- 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

INJURY 

OR 

NATURE  OF  INJURY  OR 
DISEASE. 

OF 

OPERA 

OPERATION  AND  OPERATOR. 

RKSULT  AND  RT.MAHKS. 

DISEASE. 

TION. 

11 

Hickey,   T.,    Corp'],    E,    3d 

Jan.  21, 

Fracture  of  bones  of  right  leg  ; 

Mar.  10, 

Fractured  ends  of  tibia  remov'd 

March  19,  ligation  of  post,  tibial  ; 

Michigan  Cavalry. 

1864. 

kick  by  a  mule;  fractured  ends      1864. 

by  chain  saw.     A.  A.  Surg. 

metastatic  abscess.     March  29, 

overlapped  ;  gangrene. 

S.  S.  Jessop.                                     amp.  thigh.   Died  Mar.  HI   186-1. 

12 

Hughes,  J.,  Contraband,  age 



Comminuted    fracture   of   the  '  Mar.  3, 

Excision  of  about  2  inches  of    March  31,  1865;  recov'd.     Walk- 

52.               " 

tibia  :  necrosis  about  middle.      1865. 

tibia  at  middle  third.     A.  A.       ing  on  injured  leg. 

Surg.  H.  H.  Watts. 

13 

Mickey,  B.  F.,  Unassigned 

April  6, 

Comp'd  comminut'd  fracture  of  April  20, 

Excision   of   2   inches  of   left 

Absented  himself  without  leave. 

recruit,  age  25. 

1865. 

the  lower  third  of  left  tibia  and  '    1865. 

tibia  through  incision  3  inches  :     Not  pensioned. 

fibula,  caused  by  leaping  from 

long.     Surgeon  T.  W.  Fry, 

railroad  car  while  in  motion. 

U.  S.  V. 

14 

Moulton,   A.  S.,  Pt.,  A,  (5th 



Disease  of  left  leg,  caused  by    July  31, 

Excision  of  a  portion  of  tibia.  .  i  Discharged  Sept.  27,  1862;  pen- 

New  Hampshire. 

fever  ;  necrosis  of  tibia.                1862. 

|    sioned.     1871.  leg  swollen  and 

painful  ;  varicose  veins. 

15 

Olds,   J.  K.,  Serg't,  B,  10th 

Mav29, 

Compound  fracture  of  middle    Feb.  7, 

Ends  of  tibia  remo'd  with  chain     Discharged  June  14,  1865;  tibia 

New  York  Artillery,  age  29. 

1864. 

third  of  right  tibia  and  fibula;      1865. 

saw;  holes  drilled  to  facilitate  ;     ununited:  limb  totally  useless. 

fibula  firmly  united;   no   at 

formation  of  callus.     Surg.  O.  '     May,  1877,  amputation  of  leg 

tempt  at  union  in  tibia. 

A.  Judson.  U.  S.  V.                      below  the  knee. 

16 

Peaseley,   C.,   Pt.,   A,    10th 

Aug.  31, 

Comminuted    fracture  of   the    Second- 

Excision  of  2  inches  of  shafts  :  Discharged  Dec.  16,  1861  ;  pens'd. 

Massachusetts. 

1861. 

left  tibia  and  fibula  by  kick  of  i     ary. 

of   tibia  and  fibula  through       1877,  no  flexion  or  motion  at  an- 

a  horse  ;  no  attempt  at  union  ;  i 

anterior  and  posterior  incis'ns.       kle  ;  wound  breaking  out  afresh. 

bone  bare  for  space  of  2  inches. 

Spec.  346,  A.M.  M. 

17 

White,   H.  C.,   Pt,.  C,  40th 



Necrosis    of   the    right    tibia,    Second- 

Excision  of  (i  inches  of  the  right     Discharged  Oct.  3.  18G5.      1869, 

New  York,  age  23. 

caused  by  syphilis.                        ary. 

tibia,  middle  third.                     !     ulcerated  surface  of  limb  with 

•     indurated  and  adherent  border. 

18 

!Ettinger.    L.,   Pt.,   K,  58th 

Dec.  6, 

Right  foot  struck  with  an  axe     Jan.  6, 

Curved  incision  3  inches  long    March   1.  entirely  healed.     Dis- 

New  York,  age  52. 

1861. 

jnst  below   malleolus,    pene 

1862. 

juat  below  external  malleolus;       charged    September   17,   1662; 

trating  ankle  .joint  ;  large  gap 

malleolus.   astragalus,  and  a       anchylosis  of  ankle  joint  ;  pen- 

ing  wound,  at  the  bottom  of 

small  portion  of  scaphoid  bone       sioned.      February,    1881,    has 

which  dead  bone  could  be  felt. 

removed  by  bone  gouge  and       been  for  the  past  eight  years  au 

Listen's  forceps.     Ass't  Surg. 

inmate  of  Hospital  for  the  In- 

J.  S.  Billings,  U.  S.  A.                  sane  at  Randall's  Island. 

19 

Danbury,   E.,    Pt.,    K,   14th 

Oct.  3, 

Comminuted    fracture    of   the    Oct.  10, 

Excision   of   entire  os    calcis. 

Wound  healed  but  opened  again 

New  Jersey,  age  22. 

1863. 

right  os  calcis  by  a  railroad 

1863. 

Surg.   A.  Treganowau,  14th 

during    march   in    Wilderness. 

accident. 

New  Jersey. 

Transferred  for  muster  out  May 

23.  1865;  not  a  pensioner. 

20 

Pettie,  H.,  Pt.,  K,  Tilth  New 

May  —  , 

Ulcer,  causing  caries  July  2(1, 

Excision  of  the  first  metatarsal 

Discharged  Dec.  19.  1863  :  pens'd. 

York,  age  22. 

1863. 

1863. 

bone  of  right  foot.     Assistant 

1877,   foot   partly  everted,   toe 

Surg.  W.  Thomson,  U.  S.  A. 

retracted,  foot  weakened. 

AMPUTATIONS. — Seven  hundred  ami  seventy-six  cases  of  amputations  in  the  bones 
of  the  extremities  are  found  on  the  records.  One  hundred  and  ninety-rive  were  in  the  upper, 
and  live  hundred  and  eighty-one  in  the  lower  extremities.  Of  the  former  twenty,  or  10.5 
per  cent.,  and  of  the  latter  one  hundred  and  forty-six,  or  25.5  per  cent.,  were  fatal. 

AMPUTATIONS  IN  THE  UPPER  EXTREMITIES.— Si x  were  amputations  at  the  shoulder  joint, 
forty-four  in  the  arm,  thirty-four  in  the  i'orea*rm,  seventeen  of  the  hand,  and  ninety-four  of 
the  fingers;  in  one  of  the  latter  re-amputation  in  the  forearm  became  necessary: 

TABLE  OVII. 

Numerical  Statement  of  One  Hundred  and  Ninety-five  Cases  of  Amputations  in  the  Upper  Extremities 
for  Disease  or  for  Injury  not  inflicted  by  Weapons  of  War. 


AMPUTATIONS. 

CASE8.                             Foit  INJURY. 

Foil 
DISEASE. 

3 

"5 

H 

Recovery. 

73 
ta 

Undetermin'd 
Results. 

Percentage 
Fatality. 

llecovery. 

3 

T-3 

£ij 

Undetertnin'd 

Results. 

Recovery. 

~3 

3 
fa 

Amputations  at  the  Shoulder  Joint  

6 

44 
34 
17 
93 

1 

3 

34 

28 
17 

87 

3 
10 
6 

50.0 
22.  7 
17  6 

3 
33 

00 

9 

Amputations  in  the  Upper  Arm  

1 
6 

1 

1 

Amputations  in  the  Forearm  

Partial  Amputations  of  the  Hand  

12 

Amputations  of  Fingers  

fi 

75 

6 

12 

1 

3 

Amputation  of  Fingers  followed  by  Amputation  in  Forearm  

1 

TOO  0 

Aggregates  

195 

169 

20 

* 

10.5 

145 

17 

6 

24 

'CULBERTSON  (H.),  Excision  <if  the.  Larger  Joints  of  the  Extremities,  in   Transactions  of  the.  American  Medical  Association,  1876,  Prize  Essay, 
Supplement  to  Volume  XXVII,  p.  344. 


660 


MISCELLANEOUS    INJUKIES. 


[CHAP.  XI. 


CASK  993. — Amputation  in  the  arm. — A.  J.  Ross,  a  civilian,  was  hurt  in  the  left  forearm  by  a  railroad  accident  at  Mound 
City,  April  18,  1863.  The  injury  and  its  results  were  described  by  Surgeon  H.  Wardner,  U.  S.  V. ,  as  follows :  "The  radius  and 
ulna  were  fractured  in  several  places  and  the  superficial  muscles  of  the  palmar  side  of  the  arm  were  terrible  lacerated,  besides 
which  the  arm  was  bruised  about  the  elbow  joint.  The  patient  was  considerably  prostrated  from  loss  of  blood,  so  much  so  as 
to  cause  me  to  desist  from  operating  when  counseled  by  his  attending  physicians.  Adhesive  strips  and  cold-water  dressings 
were  used  and  the  patient  was  put  upon  stimulants  and  tonics.  By  May  1st  much  of  the  superficial  muscular  substance  of 
the  forearm  had  sloughed  away  and  the  olecranon  process  was  exposed  and  denuded.  Flaxseed  poultices 
with  charcoal  and  cinchona  were  now  applied.  On  June  3d  I  again  visited  the  patient  and  urged  him  to 
have  the  limb  amputated.  The  treatment  was  continued  until  June  18th,  when  it  was  found  that  the  bones 
would  not  unite  and  the  patient  was  on  the  decline,  and  I  was  called  by  the  attending  physician  for  the  pur 
pose  of  operating.  I  found  the  patient  quite  weak  and  showing  symptoms  of  epilepsy.  I  performed  the 
amputation  at  the  middle  third  of  the  humerus  by  circular  operation  and  dressed  the  stump  with  simple 
dressings,  which  were  continued  until  June  24th,  when  a  portion  of  the  ligatures  came  away.  Two  days 
afterwards  the  patient  was  able  to  walk  about  the  room,  and  the  next  day  the  remaining  ligatures  came  away. 
On  July  4th  the  patient  was  attacked  with  fever  and  dian-hcca,  which  continued  over  two  weeks,  reducing 
him  very  low  and  seriously  retarding  the  progress  of  the  case.  By  July  25th,  however,  he  was  regaining 
his  strength  rapidly  and  the  stump  was  again  improving.  In  the  following  month  he  was  able  to  walk  about 
town  and  was  gaining  flesh  very  fast.  On  October  13th  he  was  considered  cured."  The  amputated  portion 
of  the  humerus  and  the  bones  of  the  forearm  (Spec.  1770)  were  contributed  to  the  Museum  by  the  operator 
and  are  represented  in  the  cut  (FlG.  369).  The  specimen  shows  the  bones  of  the  forearm  to  be  fractm-ed 
near  the  middle  and  again  at  their  upper  extremities,  the  greater  portion  of  the  shafts  being  necrosed  and 
having  slight  and  imperfect  involucra.  The  fragments  of  the  lower  extremity  of  the  humerus  are  attached 
to  it  in  irregular  positions  by  callus. 

CASE  994. — Amputation  in  the  forearm. — Private  N.  W.  Pelton,  2cl  Wisconsin  Cavalry,  aged  40  years, 
was  admitted  to  Harvey  Hospital  at  Madison  on  November  15,  1864,  with  disease  of  the  right  hand,  for 
which  amputation  was  performed  by  Surgeon  H.  Culbertson,  U.  S.  V.,  who  reported  the  following  history: 
"The  patient  had  lost  the  thumb  and  index  finger  of  his  right  hand,  which  were  removed  by  Dr.  K.  L. 
Tolfore,  of  Lone  Rock,  Wisconsin,  on  April  20,  1864,  the  operation  being  the  result  of  a  felon  contracted 
the  previous  month.  On  December  30th,  when  the  forearm  vVas  amputated,  the  wrist  joint  had  become  par 
tially  anchylosed  from  ostitis  and  necrosis  of  several  of  the  carpal  bones,  and  there  was  an  open  sinus  on 
the  dorsum  of  the  hand;  plastic  organized  material  in  the  cellular  tissues  of  the  fingers,  hand,  wrist,  and 
along  the  extensor  and  flexor  tendons;  cellular  tissues  indurated  and  of  a  yellow  color;  periostitis  extend 
ing  up  the  radius  and  ulna  three  inches  above  the  wrist  joint;  structure  of  ulna  somewhat  softened  and 
darkened  for  two  inches  above  its  lower  extremity;  loss  of  motion  in  the  remaining  fingers  induced  by  the 
organized  effusion  about  the  tendons.  The  patient's  system  had  become  impaired  from  continued  pain  and 
discharge.  He  had  recently  had  an  attack  of  erysipelas  in  the  hand  and  arm.  but  had  entirely  recovered 
and  earnestly  desired  to  have  the  hand  removed.  The  amputation  was  performed  by  the  circular  method 
at  the  lower  fourth  of  the  forearm,  above  the  diseased  bone,  three  vessels,  the  radial,  ulnar,  and  interosseous  arteries,  being 
taken  up.  Chloroform  was  used  with  good  effect.  One  grain  of  morphia  was  given  after  the  operation,  and  the  wound  was 
closed  with  sutures,  adhesive  plaster,  and  bandage.  Fifteen  hours  afterwards  the  bandage  was  removed  and  cold-water  dress 
ings  were  applied.  The  patient  died  January  7,  1865,  of  erysipelas,  which  extended  to  other  parts  of  the  body  and  was  arrested 
in  the  arm  and  stump."  The  bones  of  the  amputated  limb,  comprising  the  lower  portion  of  the  forearm,  the  carpus,  and  three 
metacarpal  bones,  were  contributed  to  the  Museum  by  the  operator  and  constitute  specimen  3695  of  the  Surgical  Section.  The 
carpus  shows  the  semilunar  bone  to  be  partly  necrosed  and  caries  exists  in  the  adjacent  bones. 

CASE  995.— Amputation  in  the  forearm. — Private  F.  Schubnel,  Co.  A,  23d  Indiana,  aged  37  years,  had  his  right  hand 
poisoned  in  May,  1864,  while  engaged  in  pulling  and  gathering  leaves  for  bedding  for  a  field  hospital  during  the  Atlanta  campaign. 
Surgeon  M.  Brucker  of  the  regiment  certified  to  the  injury,  and  reported  that  it  produced  malignant  ulceration,  affecting  the  whole 
arm.  At  the  expiration  of  his  service,  July  28,  1864,  the  man  was  mustered  out  and  returned  to  his  home,  where  amputation 
subsequently  became  necessary  and  was  performed  four  inches  below  the  elbow  on  September  2,  1864.  Dr.  D.  H.  Combs,  of 
Charlestown,  Indiana,  who  performed  the  operation,  certified  that  when  the  man  came  to  him  "ho  was  suffering  from  poison 
which  had  affected  his  system.  Gangrene  had  ensued,  the  arm  was  greatly  swollen,  and  there  was  no  remedy  but  amputation, 
which  was  performed.  After  a  time  the  stump  healed  well  and  the  patient  was  in  a  fair  way  to  recovery,  though  his  system 
was  Aveakened  from  the  effects  of  the  poison;  his  gums  were  spongy,  tongue  flabby,"  etc.  The  operator  further  added  that  he 
saw  but  little  of  the  patient  after  the  stump  had  entirely  healed.  In  his  application  for  commutation,  dated  1870,  the  pensioner 
described  the  stump  as  being  in  a  "sound  condition."  No  definite  cause  of  his  death,  which  occurred  on  April  5,  1873,  has  been 
reported  to  the  Pension  Office. 

Ninety-three  of  the  one  hundred  and  ninety-five  amputations  in  the  upper  extremities 
were  ablations  of  fingers.  In  the  following  tabular  statement  are  given  condensed  accounts 
of  the  remaining  one  hundred  and  two  cases  of  amputations  at  the  shoulder,  in  the  arm,  in 
the  forearm,  and  in  the  hand;  sixty-seven  were  for  fractures  caused  by  falls,  railroad  acci 
dents,  etc.,  six  for  punctured  and  incised  wounds,  eight  for  burns  or  scalds,  four  for  poisoning, 
and  seventeen  for  diseases. 


FIG.  309.— Bones  of 
the  forearm,  with  por 
tion  of  humerus.  Spfc. 
1770. 


SECT.  II.] 


AMPUTATIONS    IN    THE    UPPER    EXTREMITIES. 


661 


TABLE  GVIII. 

Summary  of  One  Hundred  and  Two  (hses  of  Amputations  in  the  Upper  Extremities  for  Miscellaneous 

Injuries  or  Disease. 

[Amputations  at  the  shoulder,  1 — 6;  [imputations  iu  the  arm,  7 — 50;  amputations  in  the  forearm,  51 — 85;  amputations  in  tbe  hand,  86 — 102.] 


DATE  OF                                                             DATE 

Vn            NAME,  MILITARY 
•     DESCRIPTION,  AND  AOK. 

INJURY       NATURE  OF  IXJUKY  OK            OF        Ol>ERATlox  ANI)  QI-ERATOH.          RESULT  AND  REMARKS. 

OU                                     Ulfcr.ASJi.                            !   Vrl.KA- 

DlSEASF.. 

TION. 

1      Armes,  A..  Pt.,  D.  TOd  New 

Sept.  20,   Right  arm  crushed  bv  railroad 

Sept.  20,   Amputation    at    the    shoulder    Discharged  February  17,   1865; 

York,  age  22. 

1804.    j     cars. 

1864.        joint;  flaps  from  deltoid  mus-  :     pensioned;  good  stump. 

cle  and  axilla.     A.  A.  Surg. 

M.  Baldwin. 

2     Corragin.  J..  IJt..  13th  Mich 

June  19,   Right   arm   carried   away    by 

June  20,   Ainputat'n  at  the  shoulder  joint    Discharged  September  19,  1865  ; 

igan  Battery,  age  23. 

1865. 

railroad  cars. 

1865.         by  external  and  internal  flaps.       pensioned. 

A.  A.  Surg.  F.  P.  Foster. 

3     Wimderlieh,  M..  Pt.,  H,  1st 

June  30, 

Comminuted  fracture  of  right 

June  30,   Antero-posterior  flap  amputa- 

Discharged  October  27,  1865;  not 

Michigan  Artillery,  age  20. 

1855. 

arm,  caused  by  a  railroad  ac 

1865.     ,     tion  at  shoulder  joint.     A.  A. 

a  pensioner. 

cident. 

Surg.  M.  L.  Herr. 

4     Bowers,  (1.  W.,  1't.,   A,  3d 

Oct.  4, 

Right  forearm  and  arm  crushed 

Oct.  4,     Flap  amputation   at  shoulder 

Died  October9,  1863,  of  pyaemia. 

Maryland,  age  25. 

1863. 

by  railroad  cars. 

1863.        joint   by   Lisfranc's    process. 

:     A.  A.  Surg.  J.  Kirker. 

5     Hill,  I.  B.  (Rev.).  U.  S.  San- 

June  15, 

Left  arm  crushed  by  railroad 

June  15,    Amputation    at  the    shoulder 

Died  June  16,  1864,  of  shock. 

itary  Commission,  age  68. 

1864. 

cars. 

1864.    !     joint.  Ass't  Surg.  C.C.Byrne, 

U.  S.  A  . 

6     Whalen,  M.,  Corp'l,  G,  32d 

Sept.  15, 

Right  arm  severed  and  scapula 

Sept.  15.   Amputat'n  at  the  shoulder  joint 

Died  September  16,  1864.  of  in 

Massachusetts,  age  38. 

1864.         fractured  by  railroad  cars. 

1864.         and  removal  of  fragments  and 

juries.     Autopsy  revealed  also 

head  of  scapula.     Ass't  Surg. 

fracture  of   first,   second,    and 

C.  Bacon,  jr.,  U.  S.  A. 

third  ribs,  etc. 

7     Baker,    J.,    Serg't,    A,    4Mh 

Feb.  3, 

Comp'ml  comminuted  fracture 

Feb.  3,     Circular  amputat'u  of  arm  near 

Transferred  to  Veteran  Reserve 

Pennsylvania. 

1864. 

of  left  arm  and  laceration  mid 

1864.         shoulder  joint.     A.  A.  Surg. 

Corps  March  3,  1865. 

dle  finger,  right  hand;   rail 

A.  H.  Hal'berstadt, 

road  accident. 

8     Carpenter.  J.  X.,  Pt.,  A,  Uth 

Sept.  24, 

Railroad  injury  of  right  arm.  .  . 

Sept.  24,'  Circular  amputation  of  arm  4 

Discharged  September  30.  1864. 

Michigan. 

1864. 

1864. 

inches  from  fold  of  pectoralis 

major. 

9     Carrigan,  F.   S.,  Pt.,  F,  5th 

Cavalry. 

Nov.  21, 
1865. 

Right  forearm  crushed  by  being 
run  over  by  a  locomotive. 

Nov.  21, 
1865. 

Circular  amputation   of   right 
arm  at   lower    third.     Ass't 

Discharged   March  2,   i866;   re 
jected  as  a  pensioner. 

Surg.  D.  Bache,  U.  S.  A. 

10     Coleman.    J..    Pt.,     D,    6th 

Mir  —  , 

Incised   wound   of  left   elbow 

April  9,    Circular  amputation  at  middle 

Discharged  June  6,  1865. 

Tennessee  Mounted  Infan- 

1865. 

joint  ;  gangrene. 

1865.     1     third  of  left  arm.    A.  A.  Surg. 

;     try,  age  18. 

J.  W.  Taylor. 

11      Dilley.  A.,  Gov't  employe. 

June  12. 

While  attempting  to  get  on  a 

Prim'ry.    Amputation  of  left  arm,  3  ins. 

Recovery.     Wound  of  left  shoul 

Nashville  and  Chattanooga 

1863. 

moving  train  had  both  arms 

of  bone  allowed  to  remain  in 

der  has  never  healed.     May  20, 

Railroad,  age  20. 

crushed  by  car  wheels  ;   left 

stump;  also  of  right  forearm 

1866,  three  sinuses  in  front  and 

humerus  crushed  to  its  head. 

at  middle  third.     Dr.  Brand 

one  behind  shoulder  leading  to 

ish.  Nashville. 

necrosed  bone.     Oct.,  1866,  his 

health  is  very  good. 

12     Downey,    J.,   Pt.,   D,   145th 

Oct.  28, 

Comminuted  fract.  of  forearm 

Oct.  29, 

Flap  amputation  at  upper  third 

Much  sloughing.     Disch'd  Nov. 

New  York,  age  40. 

1863. 

and  arm,  great  laceration  of 

1863. 

of  left  arm.     Surg.  K.  S.  Ken- 

3,  1864;  stump  healed. 

soft  parts;  railroad  accident. 

derdine,  V.  S.  V.,  and  A.  A. 

Surg.  D.  \V.  Hunt. 

13     Feigley,  J.   C..   Serg't  Maj. 

Feb.  24, 

Compound  fracture  of  left  arm; 

Feb.  24, 

Amputat'n  of  left  arm  at  upper 

Discharged  June  1,  1864. 

31st  Ohio,  age  25. 

1864. 

railroad  accident. 

1864. 

third.     Pension  Exam.  Surg. 

Hamlin,  Newark,  Ohio. 

14 

Freeman,   H.,    Pt.,   D,   60th 



Unfavorable    result   of   vacci 

Sept.  28, 

Circular  amputation  of  left  arm 

Mustered  out  July  31,  1865. 

Illinois,  age  21. 

nation  in  rebel   prison  ;  gan 

1864. 

near  shoulder  joint.     Confed 

grenous. 

erate  surgeon. 

15 

Fuller,   A.,  Serg't,  G,   14th 

June  30, 

Left  arm  crushed  by  railroad 

June  30, 

Arm  amputated  5  inches  from 

Discharged  September  11,  1865  ; 

Maine,  age  24. 

1864. 

cars. 

1864. 

shoulder.  Surg.  T.  F.  Perley, 

stump  healed. 

U.  S.  V. 

16 

Funking,  H.,  Pt.,  D,  5th  N. 

Oct.  25, 

Comminuted  fracture  of  right 

Oct.  25, 

Circular  amputation  at  middle 

Doing  well.      Discharged   May 

Y,.  11  'vy  Artillery,  age  23. 

1864. 

arm   and   left  foot;    railroad 

1864. 

third  of  right  arm  and  at  low 

31,  1865. 

accident. 

er  third  of  left  leg.     Surg.  Z. 

E.  Bliss,  U.  S.  V. 

17 

Loveridge,  J.,   Pt.,  G,  14th 

Dec.  18, 

Injury  of  the  right  arm  by  rail 

Dec.  18, 

Flap  amputation  of  right  arm, 

Discharged  May  19,  1864. 

N.  Y.  Heavy  Artillery. 

1862. 

road  cars. 

1862. 

upper  third.     Surg.  S.  Morse, 

14th  N.  Y.  Heavy  Artillery. 

18 

Lowry.  P.,  Pt.,  C.  21st  New 

June  14, 

Comminuted  fracture  of  right 

June  15, 

Flap  amputation  of  right  arm, 

Discharged  November  22,  1865. 

York  Cavalry,  age  27. 

1865.  . 

humerus,    radius,    and    ulna, 

1865. 

upper  third,   also  of  second 

also  of  second  and  third  toes 

and  third  toes.     A.  A.  Surg. 

• 

of  right  foot. 

H.  S.  Streeter. 

19 

Marcy,   G.  F.,    Pt.,    F,   21st 

Aug.  29, 

Left  arm  injured  above  elbow; 

Aug.  30, 

Amputation  of  arm  at  upper 

Discharged    January  13,   1862; 

Massachusetts. 

1861. 

railroad  accident. 

1861. 

third. 

stump  good. 

20 

Meeks,  J.  C.,  Serg't.,  A,  24th 

July  16, 

Comminuted  fracture  of  right 

July  19, 

Circular  amputation  at  middle 

Sent  to  prison  February  16,  1865. 

Georgia,  age  22. 

1864. 

elbow  joint. 

1864. 

third  of  right  arm. 

21 

Megans.  T.,  Hospital  Stew 

July  4, 

Railroad  cars  completely  crush 

July  4, 

Circular  amputation   of  right 

Gangrene.     July  10,   secondary 

ard,  90th  Penn.,  age  41. 

1864. 

ed  and  comminuted  right  hu 

1864. 

arm  at  upper  third.     A.  A. 

haemorrhage.     Discharged  De 

merus  in  lower  third. 

Surg.  E.  L.  Duer. 

cember  12.  1864. 

22 

Mitchell,  E.,  Pt.,  E,  6th  In 

Oct.  30, 

Right  arm  crushed  and  almost 

Oct.  30, 

Circular  amputation  at  upper 

Transferred  December  1,   1864  ; 

diana  Cavalry,  age  28. 

1864. 

severed;  railroad  accident. 

1864. 

third  of  arm.     Ass't  Surg.  W. 

not  a  pensioner. 

H.  Jones,  115th  Ohio. 

23      Murphy.     B.,     Pt.,     11,     1st 

May  14, 

Fell  from  caisson  and  sustained 

May  14, 

Flap  amputation  of  arm  at  up 

Discharged  September  17,  1863; 

Rhode  Island  Anil  rv.  age 

1863. 

compound  comminuted  frac 

1863. 

per  third. 

stump  healed  but  tender. 

46. 

ture  of  left  arm. 

24 

Navins,  J.,  citizen   

July  23, 

Compound  fracture  of  right  ra 

July  26, 

Oval   skin-flap  amputation   of 

Discharged   from   hospital  Nov. 

1863. 

dius  and  ulna  and  simple  frac 

1863. 

right  arm  at  surgical  neck  of 

15,  1863,  perfectly  well.     Spec. 

ture  of  humerus;  fall  from  a 

humerus,  with  circular  section 

1849,  A.M.  M. 

| 

bridge  ;  sphacelus. 

of  muscles.     Ass't  Surg.  W. 

Thomson.  U.  S.  A. 

25     Ncer,  M..  Pt.,  II.  14th  West 

A  prill  4. 

Left  forearm  crushed  from  wrist 

A  prill  4, 

Antero-posterior   flap  amputa 

Haemorrhage  on  17th  day;  no  re 

Virginia,  age  29. 

1864. 

to  elbow,  also  fracture  of  in 

1864. 

tion   at   lower  third  of  arm. 

currence.     Discharged  Septem 

ferior  maxilla;  railroad  acci 

Surg.  S.  N.  Sherman,  U.  S.  V. 

ber  10,  1864  :  not  pensioned. 

dent. 

26 

Newcomb,    N.    L.,     Pt.,    G, 

May  12, 

Right  arm   injured  above  the 

May  13, 

Circular  amputation  at  lower 

Discharged  June  28,  1865  ;  stump 

174th  Ohio. 

1865. 

elbow  ;  railroad  accident. 

1865. 

third  of  arm.     Surg.  G.  W. 

sound. 

Kizer,  C.  S.  A. 

662 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  OF 
INJURY 

OR 

DISEASE. 

NATURE  OK  INJURY  OR 
DISEASK. 

PATK. 

OPFK\-     OPERATION  AND  OI-KRATOR. 

TION. 

RESULT  AND  REMARKS. 

27 

Osborne,  C.,  Pt.,  28tli  New 

Feb.  24, 

Compound    comminuted   frac-    Feb.  24,   Flap  amputation  of  arm  9  ins.     Discharged  June  14,  1865. 

York  Battery. 

18fi5.         Hire  of  right  humerus  ;  rail-       1865.         from  shoulder. 

road  accident. 

28 

Rieman,    II.,    Pt.,    C,    12th 

Jan.  16.    Injury   of   left   arm:    railroad    Jan.  HI    Flap  amputat  n  at  middle  third    Jan.  31  .  ligation  of  axillary.  Feb. 

Maine,  age  23.                            1P64.        accident.                                         1884.         of  arm.     Surg.  O.  M.  Hum-       17,  ligation  of  subclavian.  Gan- 

plireyB,  U.  S.  v  .                             grenc;  necrosis.     Disch'd  July 

31,  1865. 

29 

Romine     J       Pt       F     12°d   Sent.  M.    Kiffht  arm  crushed  under  car     Nov.  1.     Flap  amputation  of  arm  near 

Discharged  June  20,  1865;  good 

Ohio,  age  20. 

18(54. 

wheel.                                                1864.         insertion  of  deltoid.    Surg.  T. 

stump. 

A.  Dargan,  P.  A.  C.  S. 

30 

Ross   A.  J     civilian.                  AnrillP.    Fracture  of  left  radius  and  ulna,    June  18.   Circular  amputation  at  middle    October   18.   18(i3,  cured.     Spec. 

1863. 

involving   elbow   joint;   rail-      1863.         third  of  arm.   Surg.  II.  Ward- 

1770,  A.  M.  M. 

road  accident.                                                       ner.  I".  S.  V. 

31 

Searv.  J.,   Pt.,  H,   1st  Mis-    May  26,    Fracture  of  left  arm  by  being    May  2(1,    Flap  amputation  at  upper  third    Discharged  .  I  uly  31,  1864.    Died 

gouri  Cavalry,  age  26. 

1864.         thrown  from  his  horse.                   1864.         of  left  arm. 

July  15,  1S68. 

oo 

Secor,   D.,   Corp'l,    A.   56th 

Julv  12,    Comp'nd  comminuted  fracture    July  12,   Circular  amputation  of  left  arm 

Discharged  November  4,  1865. 

New  York,  age  32.                      18(55.         of  left  arm  .•  railroad  accident.       186.">.         at  lower  third. 

33 

Se.it    F.,  Pt.,   F,  68th   New   Sept.  !.">,    Right  arm  crushed  by  railroad   Sept.  15,    Amputation  of  right  arm  about     Discharged  June  17,  1865;  sound 

York. 

1864.         accident.                                     i    1864.         3.  ins.  from  shoulder.     Surg.      stump. 

L.  Sehultz.  68th  N.  Y. 

34 

Sunnier,  L.  G.,  Pt.,  1),  78th    Julv  10,    Injury  of  right  arm;   railroad    Twelve    Amputation   of  arm   '.!   inches 

Discharged    January    17,    1863; 

New  York.                                   185:2.         accident.                                           hours        from  shoulder.     Surg.  E.  P. 

sound  stump. 

i    after.    !     Gray,  78th  N.  Y. 

35 

Thompson,  M.,    1't.,   C,    1st  1  Jan.  22,    Railroad  injury  of  left  arm  ....  Aroputat'n  of  arm  below  shoul- 

Deserted  July  2,  1865;  no  pension 

Penn.  Light  Art.,  age  30.      i     in;5. 

1865.         der  joint. 

record. 

36 

Tucker,  W.  J.,  Pt.,  G,  llth    July  15.    Injury  <>f  right  arm  above  el-    July  Hi,    Flap  amputat'n  at  middle  third 

Discharged  Nov.  2,  1864;  stump 

Veteran  Reserve  Corps.             lsi>4.         bow  and  dislocation  of  thigh  ;  '     1864.         of  right  arm. 

healed. 

railroad  accident. 

37 

Tuttle.   J.  H..   Pt.,  E,   3Kth    Mar.  28.    Injury  of  left  arm  by  railroad    Mar.  28,    Flap  amputation  of  left  arm  9 

Stump   wasted    and    weak,   but 

Massachusetts.                             186.~>.     ,     accident.                                            1865.         inches  from  shoulder.     Surg. 

healed.     Disch'd  June  30,  186.'i. 

H.  Fearn,  175th  N.  Y. 

;jj3 

Van  Vleck,  W.,  Pt..  II,  125th    Oct.  ]!',    Injury  of  right  arm  and  right    Oct.  H),     Flap  amputation  at  upper  third 

Discharged   November  21,  1862. 

New  York,  age  37. 

1862. 

knee;  railroad  accident.               1862.         of  arm.     Surg.  AY.  S.  Cooper, 

Died  July  28,  1868,  of  pyiemia. 

125th  N.  Y. 

39 

Wade.  S.,  Pt.,  TO,  177th  Ohio, 

Oct.  13,    Compound  fracture  at  middle    Out.  13,    Circular  amputation  at  upper 

Discharged  April  13,  1865;  stump 

age  21. 

1864.          third   of    left  humerus;    rail- 

1864.         third  of  arm.     A.  A.  Surg.  S. 

healed. 

road  accident. 

L.  Merrill. 

40 

Wait,  H.  I,.,  Pt.,  C,  3d  Iowa. 

May  9.     Right  elbow  joint  crushed  by     May  9,     Flap  amputation  2  inches  above 

Mustered  out  August  26,  1865. 

age  25. 

1864.         railroad  car  wheel.                     >    1864.         elbow. 

41 

Clark,   J.,   employe    in   the 

Jan.  4,  ;  Compound    comminuted   frac-  '  Jan.  4.     Amputation  of  arm  by  antero- 

January  22.   pyamiic  symptoms 

Quartermaster's  Departm't, 

1865.         ture  of  left  humerus,  radius, 

186.r>.         post,  semi-circular  flaps.     A. 

set  in.     Died  February  11,  1865, 

age  30. 

and  ulna  ;  railroad  accident. 

A.  Surg.  W.  Ualser. 

of  pyaemia. 

42) 

Coker,  J.,  Pt..  C,  f,th  Ten     Jan.  '-'•>,    Comp'nd  comminuted  fracture    Jan.  27,    Flap  amputation  of  botb  arms 

In   a  semi-moribund    condition. 

43( 

nessee,  age  34.                             1865.         at  upper  third  of  left  radius       1865.         at  middle  third.     A.  A.  Surg. 

Died  January  27,  1865. 

and    ulna,  also   fracture   and  i                      II.  S.  Streeter. 

dislocation  of  right  elbow. 

44 

Conway,  J.  A.,  Pt.,  A,  55th    May  24.    Railroad  carscompletely  crush- 

May  24,    Circular  amputat'n.lower  third, 

Died  May  28,  1865,  of  internal 

Pennsylvania,  age  22. 

1865.         ed  left  radius  and  ulna  and 

1865.    i     left  arm.     A.  A.  Surg.  R.  M. 

injuries. 

right  tibia  and  fibula. 

!     Kirk.     Amp.  of  right  thigh. 

45 

Dougherty,  J.,  Pt.,  A,  90th 

Nov.  11.   Compound  fracture  left  radius 

Nov.  15,    Antero-pusterior  flap  amputa- 

Died  November  18,  1863,  of  in 

Pennsylvania. 

1863.         and  ulna,  laceration  of  scalp 

1863. 

tiou  at  middle  third  of  arm. 

juries;  autopsy. 

and  cone,  of  brain,   fracture 

A.  A.  Surg.  S.  C.  King. 

of  2d  and  3d  ribs  ;  gangrene. 

46 

Enyart,  H.  D.,   Pt.,   G,  23d 

Oct.  13,    Compound    fracture    of    right 

Oct.  24,    Amputation  at  upper  third  of 

Died  November  11,  1864,  of  py 

Veteran  Reserve  Corps,  age 

1864. 

radius   and   ulna  ;    accident  ; 

1864. 

right   arm.     Surg.  A.  Ham 

aemia;  autopsy. 

28. 

gangrene. 

mer,  U.  S.  V. 

47 

Hitehens,  C.,  Pt.,  C,  2d  Ma 

April  3, 

Right  arm  crushed  from  wrist 

April  3, 

Amputation  of  arm  near  shoul 

No  reaction.     Died  April  5,  1863. 

ryland  P.  II.  B. 

1803. 

to  middle  of  humerus  ;  rail 

1863. 

der  joint. 

road  accident. 

48 

Ready.  P.,  Pt.,  E,  13th  New 

June  9, 

Compound    comminuted   frac 

June  9, 

Flap  amputat'n  at  middle  third 

June  13.  pva?m.  symptoms.   Died 

York  Cavalry,  age  48. 

1864. 

ture  of  middle  and  up.  thirds 

1864. 

of  arm.     Ass't   Surg.  J.    II. 

June  29  ,'1864,  of  pyaemia  ;  an- 

of  right  radius  and  ulna,  joint 

Frantz,  U.  S.  A. 

topsy. 

destroyed  ;  railroad  accident. 

« 

49 

Rouse,  M.,  colored  woman, 



Ulcer  of  left  arm  and  neck  re 

A  prill  5, 

Circular  amputation  at   upper 

Died  April  27.  1865,  of  diarrhoea. 

age  23. 

sulting  from  frequent  attacks 

1865. 

third  of  arm.     Surgeon  T.  J. 

of  malarial  fever;  gangrene. 

Wright,  64th  U.  S.  C.  T. 

50 

Sweeny,  J.,  Pt.,  E,  70th  N. 

Mar.  28, 

Comp'nd  comminuted  fracture 

Mar.  29, 

Circular  amputation   of   right 

Rallied  to  some  extent.     Died 

York. 

1864. 

of  right  humerus,  lower  third, 

1864. 

arm.  A.  A.  Surg.W.  S.Ward. 

March  31,  1864,  from  nervous 

extensive   laceration  of  fore 

shock. 

arm  ;  also  compound  fracture 

of  left   metatarsus  and   pha 

langes:  railroad  accident. 

51 

Adams,    T.  B.,   Pt.,  A,  6th    Scrofula  •  inrlamma'n  involving 

Xmnnt'ttinn  rif  rio*lit  ff  reirm 

Discharged  August  12   1863. 

Kansas  Cavalry,  age  39.                             ligaments,  carpal  bones,  and 

low.  thirds  of  radius  and  ulna. 

52 

Campbell,  S.,  Pt..  II,  2d  Ma-   -           —   Palmar  abscess  of  left   hand; 

Feb  19, 

Antero-posterior  flap  amputa 

Feb.  23,  sec.  haem.,  lig.  of  radial 

ryland,  age  22.                                             erysipelas. 

1863. 

tion  at  middle  third  of  forearm. 

artery.     Trans,  to  V.  R.  Corps 

July  10,  1863;  stump  perfectly 

healed.  Specs.}  184,  1185.A.M.M. 

53 

Dilley,  A.,  Oov't  employe1,   June  1C1.    Both    arms    crushed     by    car 

Prim'ry. 

Amputation  of  right  forearm, 

Recovered.     May  20,  1866,  three 

Nashville  and  Chattenooga 

1863. 

wheels;  attempting  to  get  on 

middle  third,  and  of  left  arm, 

sinuses  in  front  and  one  behind 

Railroad,  age  20.                                          moving  train. 

upper  third.     Dr.    Brandish, 

shoulder  leading  to  neero.  bone. 

Nashville. 

Oct.,  1866,  health  very  good. 

54 

Dunlap,   O.,    Capt.,    I,  26th    Deo.  28,   Injury  of  right  hand  and  right 

Dec.  28, 

Amputation  forearm  just  above 

Discharged  May  15,  1865. 

Illinois.                                      r    1864.         foot';  railroad  accident. 

1864. 

wrist  and  of  leg  just  above 

ankle.     Surg.  O.  Hoyt,  30th 

Wisconsin. 

55 

Fleming,  J..  Corp'l,  F,  Cole's    June  20,   Left  hand  mangled  and  forearm 
Maryland  Cavalry.                 j    18G4.         fractured,  also  thumb  and  first 

June  21, 
1864. 

Circular  flap  amputat'n  at  low 
er  third  of  left  forearm   and 

Discharged  March  11,  1865. 

linger   right    hand  ;     railroad 

thumb  and  finger  right  hand. 

accident. 

56 

Fosgate,    O.,    Pt.,    C,    ,r>7th    -         —   Felon   on   right    index  finger; 

June  16. 

Circular  amputation  at   lower 

Transferred  to  Veteran   Reserve 

Massachusetts,  age  43.                              fissures  of  hand   sloughing  ; 

1864. 

third  of  forearm.    A.  A.  Surg. 

Corps  January  18,  1865;  sound 

Inemorrh.  from  palmar  arch. 

M.  M.  Jarratt. 

stump. 

57 

Gardner,  C.  A.,  Pt.,  B,  10th    Mar.—,   Fever  sore    

Aug.  28, 

Flap  amputation  at  lower  third 

Transferred  to  Veteran  Reserve 

New  York  Artillery.             ,    1864. 

18C4. 

of  left  forearm.     Dr.   Trow- 

Corps. 

bridge,  Watertown,  N.  Y. 

SECT.  IT.1] 


AMPUTATIONS    IN    THE    UPPER    KXTRKMITIES. 


663 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  or 
INJURY 

OR 

DISEASE. 

NATURE  OF  INJURY  OR 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

58 

Gardner,  St.,  It.,  I,  12th  Col 

Aug.  26. 

Injury  of  right  hand  and  foot 

Aug.  27, 

Amput'n  of  forearm  and  leg  at 

Discharged  July  18,  1865. 

ored  Troops. 

1864. 

by  railroad  cars. 

1864. 

lower  thirds.     Surg.  G.  Steg- 

man,  12th  Colored  Troops. 

50) 

Garrett,  E.,  Pt.,  A,  43d  Col 



Both  limbs  injured  by  falling 



Circular  amputation  at  middle 

Discharged  August  22,  1865. 

60| 

ored  Troops,  age  20. 

into  fire. 

third  of  both  forearms. 

61 

Glavin,  J.,  Ft.,  G,  21st  New- 

Jan.  18, 

Right  hand  burned,  destroying 

Jan.  18, 

Amputation  at  middle  third  of 

Discharged  March  8,  1866. 

York  Cavalry. 

1865. 

bone  and  muscles. 

1865. 

forearm.     Acting  Staff  Surg. 

N.  F.  Graham. 

62 

Graeser,  W.,  Pt.,  I,  42d  New 



Left   hand    poisoned    while  a 

Feb.  —  , 

Amputation  below  elbow  joint. 

Discharged  Aug.  16,  1865;  good 

York. 

1864. 

prisoner  of  wa» 

1865. 

stump;  died  since. 

G3 

Gridley,  J.,  Pt.,  —  ,  9th  Mich 

Sept.  16, 

Contusion   of  left   forearm  by 

Sept.  17, 

Flap  amputat'n  at  middle  third 

Discharged  February  4,  1865. 

igan,  age  3d. 

1864. 

cars. 

1864. 

of  forearm. 

64 

Halbert.   J.    S.,    Pt.,    I,  8th 

June  24, 

Injury  of  left  forearm  ;  railroad 

June  24, 

Amputation  2  inches  below  el 

Discharged  ;  stump  painful. 

Illinois  Cavalrv. 

1865. 

accident. 

1865. 

bow  joint. 

65 

Hawkins,  S.,  Pt.",  A,  9th  New 

Jan.  20, 

Axe  wound  in  left  wrist  joint.  . 

Jan.  20, 

Circular  flap  amput'n  at  lower 

Discharged. 

York  Cavalry,  age  35. 

1865. 

1865. 

third  of  forearm.     Surg.  R. 

Curran,  9th  N.  Y.  Cavalry. 

66 

Hughes,  T.,  Pt.,  H,  49th  N. 

Aug.  30, 

Comp'ud  comminuted  fracture 

Aug.  30, 

Circular  amputation  at  upper 

Transferred  to  Veteran  Reserve 

York,  age  44. 

1864. 

of  right  radius  and  ulna  ;  rail 

1864. 

third  of  forearm.     Ass't  Surg. 

Corps  November  27,  1864. 

road  accident. 

P.  C.  Davis,  U.  S.  A. 

67 

Jones,  N.,  Pt.,  D,  4th  Engi 



Cut  by  an  axe  across  forearm 



Double  flap  amputation  at  mid 

Discharged  March  10,  1864;  ex 

neers,  Colored  Troops. 

and  face. 

dle  third  of  forearm. 

cellent  stump. 

68 

Kennedy,   1'.  A.  13.,  Pt.,  B, 

April  —  , 

Scrofula.      Right    wrist   joint, 

Aug.  16, 

Circular  amp.  5  inches  below 

Mustered  out  September  21,  1864. 

3Gth  Indiana. 

1863. 

knee,  and  ankle  affected  by 

1864. 

elbow.      Dr.   J.    M.    Youal, 

• 

tuberculosis;  exten.  destruc 

Indianapolis.     (Feb.  25,  1864, 

tion  of  bony  and  soft  parts. 

amp.  right  thigh,  low.  third.) 

69 

Killgore,  J.  A.,  Pt.,  B,  97th 

Nov.  1, 

Lower  two-thirds  of  right  fore 

Nov.  1, 

Circular  amputation  at  upper 

Rapid  recovery  ;  discharged  De 

Illinois,  age  19. 

1863. 

arm   bady  crushed  :   railroad 

1863. 

third  of  forearm.     Ass't  Surg. 

cember  9,  1863. 

accident  ;  also  scalp  wound. 

S.  H.  Orton,  U.  S.  A. 

70 

Laviers    M   II     Pt    F  26th 

Tniurpd  bv  '\  tlir'tsliino-  tmehinp 

A  mnntition  it  middle  third  of 

Discharged  October  29,  1864. 

Michigan,  age  30. 

previous  to  enlistment. 

left  forearm. 

71 

Moreland,  J.,  Pt.,  G,  9th  Ohio 

Mar.  14. 

Fracture  of   the   right    hand  : 

Aug.  15, 

Amputat'n  between  elbow  and 

Discharged  April  21,  1865. 

Cavalry. 

1865. 

accident  ;  mollifies  of  carpal 

1865. 

wrist.     Dr.  J.  Tingle,  Cam 

bones. 

bridge,  Ohio. 

72 

Osborne,  W.  L..  Pt.,  H,  12th 

C'lncpr  of  left  foreirin 

A  TTiDutition  foreirm   it    ui>itpr 

Discharged  April  20,  1864. 

West  Virginia. 

1864. 

third. 

73 

Pampell,  J.  E.,  Serg't,  B,  3d 

Nov.  9, 

Comp'nd  comminuted  fracture 

Nov.  9, 

Circular  amputation  at  middle 

Healed  kindly  ;  discharged  April 

Maryland,  age  23. 

1863. 

left  forearm  and  right  middle 

1863. 

third  of  forearm.    Surg.  R.  U. 

11,  1864. 

finger  ;  railroad  accident. 

Clark,  34th  Mass.    Amputat'n 

right  middle  finger  and  por 

tion  metacarpal  bone. 

74 

Payne,  W.  T.,  Serg't,  M,  6th 

May  3, 

Right  hand  and  wrist  crushed 

May  3, 

Flap  amputat'n  at  middle  third 

Flaps  united  by  first  intention  ; 

Kentucky  Cavalry,  age  22. 

1864. 

by  railroad  cars. 

1864. 

of  forearm. 

discharged  September  15,  1864. 

75 

Price,  H.,  Pt.,  II,  66th  New 

Feb.  6, 

Fell  into  fire  and  burned  right 

Feb.  27, 

Flap  amputation  about  middle 

Discharged  April  14,  1863  ;  excel 

York. 

1863. 

forearm  from  elbow  to  fingers  ; 

1863. 

of  forearm. 

lent  stump. 

gangrene. 

76 

Roller,  J.,  Bugler,  13th  New 

July  13, 

Right  hand  crushed;  railroad 

July  13, 

Antero-posterior  flap  amputat'n 

Discharged  August  4,  1865. 

York  Battery. 

1865. 

accident. 

1865. 

at  lower  third  of  forearm. 

77 

Sehubnel,    F.,    Pt.,    A,    23d 

May  14, 

Right  hand  poisoned  by  weeds  ; 

Sept.  2, 

Amputation  at  upper  third  of 

Discharged  July  28,  1864. 

Indiana. 

1864. 

malignant  uleeration,  threat 

1864. 

forearm.     Dr.  D.  H.  Combs, 

ening  mortification. 

Charlestown,  Ind. 

78 

Woodfolk,   H..   Pt.,  B.   28th 

Sept.  1, 

T?io-]it   li'iml    ininrpfl    bv  f-illino- 

Flin'minntntinn  'it  miner  third 

Discharged  December  30,  1865. 

Colored  Troops,  age  22. 

1864.  ' 

into  fire. 

of  forearm. 

79 

Aylmer,    E.    1'.,    Lieut.,    1st 

June  25, 

Comminution  of  right  forearm  ; 

June  27, 

Flap  amputation  at  lower  third 

Died  July  13,  1864,  of  pneumonia. 

Wisconsin  Battery. 

1864. 

run  over  by  a  horse-car. 

1864. 

of  forearm.     A.  A.  Surg.  J.  C. 

Lee. 

80 

Ball,  T.  E.,  Pt.,  9th  Indiana 

Jan.  27, 

Burn  and  scald  of  left  forearm  ; 

Feb.  15, 

Circular  amputation   at  upper 

Sloughing;  secondary  hsemorrh. 

Battery,  age  40. 

1865. 

explosion  of  Steamer  Eclipse. 

1865. 

third  of  forearm.     Surg.  W. 

Died  March  24,  1865,  of  exhaus 

Varian,  U.  S.  V. 

tion  and  pvsemia. 

81 

Hede,  C.,  Corp'l,   E,  32d  In 

June  21, 

Right   radius    comminuted   at 

July  15, 

Circular  amput'n  at  the  upper 

Died  July  '29,   1864,   of  chronic 

diana,  age  28. 

1864. 

lower  third  by  car  wheel. 

1864. 

third  of  forearm.    A.  A.  Surg. 

diarrhoea. 

E.  Kramer. 

82 

Norton,  M.,  employe  Quarter 

Mar.  26, 

Compound  frac.  lower  third  of 

Mar.  26, 

Circular  amputat'n  of  forearm. 

Mar.  29,  erysipelas.  April  2,  hiem. 

master's    Department,   age 

1864. 

left  radius  and  ulna  ;  caught 

1864. 

from  radial  art.:  lig.  at  middle 

20. 

in  an  engine;  skin  and  muscles 

third  of  brachial.     Died  April 

torn  from  hand  and  forearm. 

4,  1864,  of  haemorrhage. 

83 

Pelton,  N.  F.,  Serg't,  2d  Wis 

Mar.  —  , 

Felon  of  thumb  and  index  fin 

Dec.  30, 

Circular  amputation  at  lower 

Died  January  7,  1865,  of  ervsip- 

consin  Cavalry,  age  46. 

1864. 

ger  of  right  hand.     April  20, 

1864. 

third  forearm  ;  radial,   ulnar, 

elas.     Spec'  3695.  A.  M.  M.' 

thumb  and  index   finger  re 

and  interosseous  arteries  tied 

moved  :  ostitis  and  necrosis  of 

Surg.  H.  Culbertson,  U.  S.  V. 

carpal  bones  ;  erysipelas. 

84 

Shields,  J.,  Pt.,  G,  83d  Penn 



Extensive  burn  of  right  fore 

Oct.  31, 

Circular  amputation   2  inches 

Typhoid  pneumonia  and  diarrh. 

sylvania. 

1864. 

arm  ;  extensive  slough'g  and 

1864. 

below  elbow.     Ass't  Surg.  H. 

Died  November  4,  1864.  of  ex 

suppuration. 

Allen,  U.S.  A. 

haustion  :  autopsy. 

85 

Tomlison.  J.,   Pt.,   A,  120th 

Dec.  5, 

Erysipelas  of  right   hand   fol 

Jan.  21, 

Circular  amputation  at  upper 

March  3.  gang,  in  stump.     Died 

Indiana,  age  4-J. 

1864. 

lowed  by  gangrene;  slough 

1865. 

third  of  forearm.     Ass't  Surg. 

May  23,  '65,  of  acute  dysentery. 

ing. 

B.  Knickerbocker,  U.  S.  A. 

86 

Davidson,  S.  H..  Pt.,  2dlowa 

Mar.  22, 

Bowie  knife  dividing  right  ul- 

A  prill  2. 

Amputation   of   fourth    finger 

Returned  to  duty  June  8,   1864. 

Battery,  age  19. 

1864. 

nar  aitery  and  opening  ulna- 

1864. 

with  head  of  metacarpal  bone. 

See  Second  Suryiral  Volume,  p. 

carpal  articulation.     Mar.  22, 

Surg.  J.  G.  Keenon,  U.  S.  V. 

436. 

1864,  ligation  of  ulnar  artery  ; 

dry  gangrene. 

87 

Denmark,  J.  H.,  Pt.,  H,  14th 

Jan.  12, 

Punctured  wound  of  right  hand. 

Feb.  20,  !  Amputation  of  little  finger  and 

Furloughed  Mar.  25,  1865  ;  nearly 

New  York  H'vy  Artillery, 

1865. 

1865. 

head  of  metacarpal  bone;  an- 

healed. 

age  19. 

tero-posterior  flaps. 

88 

Dickey,  C.  B.,  Pt.,  C,  104th 

July-  —  ,    Right  hand  injured  bv  railroad 

July  12, 

All  Hie  bone  of  little  finger  and 

Recovered. 

Ohio,  age  22. 

1864. 

accident  :  little  finger  cut  off, 

1864. 

its  metacarpal  bone  removed. 

«q 

D,  ,.ir>       f1         T>t         f       '},!      T>n,n-i 

third  and  fourth  flng'rs  broken. 

• 

1-   - 

CJ 

<>an,  ij.,  i  i.,  \j,   .m   i  enn.    ..'vpni  o, 
Res.  Corps,  age  30.                     1864. 

Railroad  car  passing  over  left 
hand  and  crushing  it. 

April  5, 
1864. 

Amputat  n  of  fingers,  lett  hand, 
through  the  metacarpus. 

° 

90 

Doyle,   J.   15..    1't.,    1C,    18th   Nov.  23,.  Bitten    in  the  middle  of  third    Dec.  7. 

Oval  amputatioaof  finger  and     Recovery. 

Iowa. 

1864. 

left  finger  by  a  comrade  ;  bone      1864. 

head    of    metscarpal     bone. 

denuded  and  exposed.                                     Sunr.  C.  E.  Swasev,  IT.  S.  V. 

91 

Ellison,  D.,  colored  seaman,    Nov.  11,   Metacarpal  bone  of  mid.  finger    Nov.  21.    Aiii]>utation   of  middle  finger    Ree-ivery. 

U.S.  Steam  'r  Gen.  Thomas,      1864.         crushed  bv  machinery.                 1864.         and  metacarpal  bone.     Ass't 

age  16.                                                                                                                                        Surg.  II.  T.  Legler,  U.  S.  V. 

MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


DATEHK 

DATE 

NO. 

NAMK,  MILITARY 
DESCRIPTION,  AND  AGE. 

INJI;KY 

OR 

NATURE  OF  INJURY  OR 
DISEASE. 

OF 

OPERA 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

DISEASE. 

TION. 

92 

Harris,  A.  W.,  Corp'l,  D,  5th 

Mar.  10, 

Gangrene  of  index  finger,  right 

April  13, 

Amputat'n  of  index  finger  with 

Returned  to  duty  Aug.  25,  1864. 

Kentucky. 

1864. 

hand. 

1864. 

head    of    metacarpal     bone. 

Confederate  surgeon. 

93 

Keeler,  J.,  Pt.,  JOSth  Co.  8d 



Gangrenous   sloughing  of  left 

Sept.  18. 

Amputation  left  second  finger 

Discharged  April  28,  1865. 

Veteran  Reserve  Corps,  age 

second  finger. 

1864. 

with  head  of  metacnrpal  bone. 

;;o 

A.  A.  Surg.  J.  \V.  Hull. 

94 

Loveland,  A.  A.,  Pt.,  H,  Jst 



Tumor  first  finger  of  left  hand, 

Mar.  26. 

Amputat'n  of  finger  with  head 

Recovery. 

Conn.  Cavalry,  age  21. 

supposed  to  be  fungus  h:em- 

1864. 

of  metacarpal   bone.      A.   A. 

atodes. 

Surg.  J,  Neff. 

95 

Luecke,  A.,  Pt.,  G,  llth  In 

June  10, 

Axe  wound  of  left  index  finger; 

June  8, 

Arnjutat'n  of  index  finger  with 

Returned  to  duty  Sept.  11,  1863. 

fantry. 

1862. 

anchylosis  and  deformity. 

1863. 

greater  portion  of  metacarpal 

bone.     Ass't  Surg.   P.  Adol- 

phus,  U.  S.  A. 

90 

Mansur,  J.,  Pt.,  H,  8tli  Xew 



Left  mid.  finger  affected  with  an 

Oct.  17, 

Amputation   of  middle   finger 

Returned  to  duty  Dec.  4,  1804. 

Hampshire,  age  41. 

ill-oonditioned  sore,  probabl}- 

1864. 

above    head    of    metacarpal 

from  absorption  of  unhealthy 

bone.     A.  A.  Surg.  F.   Has- 

pus;  erysipelas;  sloughing. 

senburg. 

97 

Martz,    J.,    Corp'l.    K,    5th 

Jan.  1, 

Comp'nd  dislocation  of  second 

April  10, 

Amputation   of   second  finger 

Useful  hand.     Returned  to  duly 

Michigan,  age  85. 

18(i4. 

finger,   left   hand  ;   extensive 

1864. 

with  head  of  metacarpal  bone. 

July  5,  1H04. 

necrosis. 

A.  A.  Surg.  1).  O.  Farrand. 

98 

Peoples.  It.,  Pt.,  B.  151st  Illi 

Mar.  —  , 

Lllcerof  phalangeal  bone  of  left 

April  14. 

Flap  amputat'n  of  index  finger 

Discharged  June  7,  180."). 

nois,  age  45. 

1865. 

index  finger,  result  of  a  felon  ; 

1865. 

and  one  half  of  metacar.  bone. 

extensive  slough.:  erysipelas. 

A.  A.  Surg.  W.  J.  It.  Holmes. 

99 

Taylor,  J.   T..   Pt..   C,  83d 

Deo.  —  , 

Severe  burn  of  right  and  left 

Mar.  18, 

Amputation  of  fifth  finger  with 

Discharged   September  9,  1864; 

Pennsylvania,  age  24. 

1803. 

hands;  necrosis. 

1864. 

entire  metacarpal  bone.   A.  A. 

stump  healed. 

Surg.  J.  O.  French.    (Jan.  —  , 

1864,   amputation   left    index 

and  middle  fingers.) 

100 

Tracey.  T.,  Pt.,  M.  1st  Lou 

Got.  5, 

Left  thumb  severely  bitten  in  a 

Nov.  5, 

Amp.  of  thumb  and  metacarpal 

Healed.       Returned    to    Provost 

isiana  Cavalry,  age  27. 

1864. 

fight  :  necrosis  ;  sloughing. 

1864. 

bone  at  its   trapezial   attach 

Marshal  November  23,  1804. 

ment.     A.  A.  Surg.  J.  C.  Lee. 

101 

Wadley,  M.,  Pt.,  11,  9tli   X. 

Nov.  22, 

Poisoned    second    finger  from 

Nov.  22, 

Amputation  second  finger  with 

Discharged  May  29.  1805. 

Ilami)sliire.  age  35. 

1864. 

dressing  wounds. 

18G4. 

head  of  metacarpal  bone. 

102 

Wren.  J.,  employe  Military 

Jan.  9, 

Left  thumb  cont.  and  crushed; 

Jan.  9, 

Amputat'n  of  thumb  with  met 

Discharged  from  hospital  Janu 

Railroad,  age  18. 

1865. 

accident. 

1865. 

acarpal  bone  at  carpal  articu 

ary  26,  1805. 

lation.     A.  A.  Surgeon  S.  T. 

Buck. 

AMPUTATIONS  IN  THE  LOWER  EXTREMITIES. — They  comprise  five  hundred  and  ninety-seven 
operations  performed  on  five  hundred  and  eighty-three  patients,  as  follows: 

TABLE  OIX. 

Table  of  Five  Hundred  and  Eighty-three  Cases  of  Amputations  in  the  Lower  Extremities  for  Disease,  or 

for  Injury  not  inflicted  by  Weapons  of  War. 


AMPUTATIONS. 

CASES. 

FOR  INJURY. 

FOI 

£ 
o> 

i  DlSE 

ISE. 

Gj 

ej 

—  S 

§£ 

c"3 

$T 

si 

*•  P 

Si 

a 
H 

2 
« 

3 
•3 

b 

1-2 
«3 

££ 
«r 

PH   o 

§ 

K 

3 
& 

a  E 

tO    O 
M    « 

KTS 

o 

S 

K 

a 
a 

fa 

2      '~ 

l| 

Amputations  at  the  Hip  Joint     .  .    . 

1 
142 
3 

1 

249 
5 
5 
48 
1 
122 
o 

i 

80 

1 
17 
1 

Amputations  in  the  Thigh  

56 

T 

1 

39.  4 
33.3 

50.0 

6!) 
1 

53 

3 

Amputations  at  the  Knee  Joint  

Amputations  at  the  Knee  Joint,  Re-amputation  in  Thigh 

1 

Amputations  in  the  Leg  

174 
3 

« 

1 

10!) 

74 
2 

I 

1 

29.8 
40.0 
20.0 
8.3 

152 
3 
4 
42 
1 
97 
o 

" 
1 
4 

22 

13 

1 

Amputations  in  the  Leg  and  Re-amputations  in  Thigh.      .  .   . 

Amputations  at  tho  Ankle  Joint  

Partial  Amputations  of  the  Foot.  . 

2 

Partial  Amputations  of  Foot  and  Re-amputation  in  Leg 

Amputations  of  the  Toes  

6 

7 

5.2 

6 

7 

12 

Amputations  of  Toes  and  Re-amputations  in  Foot 

Amputations  of  Toes  and  Re-amputations  in  Leg  

:i 

1 

2 

00.6 

; 

2 

Amputation  of  Toes  and  Re-amputation  in  Leg  and  Thigh 

Aggregates   

583 

428 

147           8     25.5 

373 

130 

7 

55 

17 

1 

One  hundred  and  twenty-eight  were  amputations  of  the  toes,  followed  in  two  instances 
by  re-amputations  in  the  foot,  in  four  by  amputations  in  the  leg,  and  in  one  byre-amputa 
tion  in  the  thigh.  Forty-nine  were  ablations  in  the  foot  with  one  re-amputation  in  the  leg; 
five  were  disarticulations  at  the  ankle  joint;  two  hundred  and  fifty-four  were  amputations 


AMPUTATIONS    IN    THE    LOWER    EXTREMITIES. 


665 


in  the  leg  with  five  re-amputations  in  the  thigh;  four  exarticulations  at  the  knee  joint  with 
one  re-amputation  in  the  thigh;  one  hundred  and  forty-two  were  ablations  in  the  thigh,  and 
one  an  exarticulation  at  the  hip  joint. 

CASE  996. — Amputation  at  the  hip  joint. — Private  ,1.  W.  Spradling,  Co.  A,  33d  Illinois,  was  wounded  in  the  right  side 
and  back  by  a  shell  at  Black  River  Bridge,  May  17,  1863.  He  passed  through  various  hospitals  and  was  lastly  admitted  to 
Mound  Citv  on  January  25,  1864.  Surgeon  II.  Wardner,  U.  S.  V.,  in  charge  of  the  latter,  recorded  the  following  description 
of  the  injury:1  ''The  missile  struck  the  right  side  between  the  ilium  and  lower  rib.  inflicting  a  wound  six  by  nine  inches.  Cold- 
water  dressings  were  applied  for  four  weeks,  and  afterwards  simple  cerate.  The  wound  healed  kindly  in  about  three  months. 
About  five  or  six  days  after  the  reception  of  the  wound  a  bedsore  commenced  forming  on  the  left  hip,  which  was  attacked  witli 
gangrene,  causing  sloughing  of  the  soft  parts  and  exposure  of  bone.  This  continued  sore  for  ten  months.  By  March  22d  the 
sore  had  entirely  healed  up,  but  the  patient  had  no  use  as  yet  of  the  leg,  the  integuments  being  adherent  to  the  bone.  Feeling 
in  the  leg  and  foot  was  almost  normal;  but  feeling  in  the  thigh  was  rather  dead,  though  improving.  The  patient  was  able  to 
walk' about  on  crutches."  He  was  discharged  from  service  for  disability  April  3,  1864,  and  pensioned  in  pursuance  of  a  certificate 
by  Examining  Surgeon  A.  H.  Kellogg,  of  Clinton,  Illinois,  who  stated  that  "the  applicant  now  has  partial  paralysis  of  both  lower 
extremities,  resulting  from  the  effects  of  the  wound,  and  incapacitating  him  for  obtaining  his  subsistence  by  labor."  Examiner 
J.  Wright,  of  Clinton,  reported  March  25,  1867:  ''  The  original  wound  was  in  the  right  lumbar  region,  which  lias  healed,  leaving 
a  large  cicatrix.  While  being  treated  in  hospital  a  bedsore  formed  on  the  left  hip  which  was  attacked  by  hospital  gangrene, 
destroying  the  muscles,  cellular  tissues,  periosteum,  and  injuring  the  bone.  This  wound  partially  healed,  leaving  four  and  some 
times  five  fistulous  openings  communicating  with  the  femur,  there  being  also  anchylosis  of  the  hip  and  knee  joints.  He  has  been 
laying  on  his  right  side  for  over  three  years,  being  unable  to  be  turned  over  or  to  sit  up,  and  requiring  a  nurse  all  the  time.  I 
amputated  the  left  leg  at  the  hip  joint  on  the  20th  day  of  February,  1867.  The  wound  is  nearly  healed  and  will  get  well,  I  think. 
How  much  the  other  limb  will  be  worth  is  more  than  I  can  tell  now."  One  year  later  the  same  examiner  reported  that  "the 
right  leg  is  perfectly  useless ;  he  cannot  bear  his  weight  on  it  nor  use  it  with  the  aid  of  crutches,  and  requires  an  attendant  con 
stantly.''  At  a  subsequent  date  Dr.  Wright  certified  that  he  continued  as  the  attending  physician  of  the  pensioner,  who  was 
taken  with  diarrhoea,  and  then  "dropsy  followed  and  continued  off  and  on  until  the  date  of  his  death  on  September  28,  1872." 

CASE  997. — Amputation  in  the  thiyh. — Private  C.  W.  Barnes,  Co.  I,  95th  New  York,  aged  23  years,  was  admitted  to 
Mower  Hospital,  Philadelphia,  May  6,  1863,  suffering  from  osteo-cephalomatous  tumor  of  the  right  tibia.  Surgeon  J.  Hopkinson, 
U.  S.  V.,  reported  :  "The  history  of  this  patient's  case  is  as  follows :  While  he  was  assisting  in  building  a  wharf  at  Aquia  Creek 
.  about  June  20,  1862,  he  fell  and  bruised  himself  over  the  spine  of  the  right  tibia.  He  was  soon  able  to  resume  duty,  but  in  about 
ten  days  after  the  accident  he  noticed  a  small  lump  growing  on  his  leg.  This  gave  him  no  annoyance  and  he  remained  witli  his 
regiment  until  the  battle  of  Bull  Run,  August  29, 1862,  when  he  was  taken  prisoner.  He  remained  in  captivity  until  the  following 
December,  when  he  was  paroled,  sent  to  Annapolis,  and  thence  back  to  his  command.  He  now  continued  to  perform  the  duties 
of  a  soldier  until  February  20,  1863,  when  he  was  again  excused  on  account  of  the  swelling,  and  one  month  later  he  was  sent  to 
Douglas  Hospital,  whence  he  was  transferred  here.  The  tumor  in  the  mean  time  had  gradually  grown 
larger,  attaining  the  size  of  a  goose  egg  by  July  29th,  when  it  was  decided  to  remove  it,  which  was  accord 
ingly  done  by  Assistant  Surgeon  C.  R.  Greenleaf,  U.  S.  A.  In  a  few  days,  however,  it  began  to  reappear 
in  the  wound,  and  large  portions  of  it  were  removed  on  August  20th  by  the  same  operator,  after  which  it 
was  not  long  before  it  again  showed  signs  of  returning,  and  amputation  was  decided  upon.  The  limb  was 
taken  off,  after  gaining  the  patient's  consent,  on  October  17th,  at  the  lower  third  of  the  thigh,  by  Acting 
Assistant  Surgeon  J.  H.  Jamar.  But  little  haemorrhage  attended  the  operation,  which  was  performed 
by  the  antero-posterior  flap  method,  four  ligatures  being  applied.  Chloroform  constituted  the  anaesthetic 
ami  the  patient  reacted  promptly.  The  wound  united  by  first  intention,  and  by  November  8th  the  stump 
had  almost  entirely  healed,  there  being  no  indication  of  reappearance  of  any  tumor.  The  tumor,  when 
removed,  had  been  examined  by  Dr.  J.  M.  Da  Costa,  of  Philadelphia,  and  pronounced  to  be  undoubtedly 
carcinomatous."  The  patient  was  subsequently  transferred  to  Haddington  Hospital,  where  he  was  sup 
plied  with  a  "Palmer"  artificial  limb.  He  was  ultimately  discharged  from  service,  at  Broad  Street  Hos 
pital,  December  16.  1864,  and  pensioned.  A  wet  preparation  of  the  shaft  of  the  tibia  of  the  amputated 
limb,  exhibiting  the  tumor  at  the  upper  third  of  the  bone,  was  contributed  to  the  Museum  by  the  opera 
tor,  and  constitutes  specimen  2779  of  the  Surgical  Section.  The  pensioner  was  inspected  on  February  1, 
1882,  by  Examining  Surgeon  O.  Warner,  of  Paterson,  New  Jersey,  who  reported  that  he  found  the 
''stump  small,  shrunken,  painful,  tender,  and  sore  on  the  end,  so  that  it  is  impossible  for  an  artificial  limb 
to  be  worn  with  any  comfort  or  benefit." 

CASE  998. — Amputation  in  the  thiyh. — Dr.  D.  Stanton,  late  Surgeon  U.  S.  V.,  reports  that  "John 

Meyer,  who  represented  himself  as  a  discharged  soldier  of  a  Minnesota  regiment,  on  his  way  to  his  home,  37Q  _c 

was  left  by  reason  of  an  attack  of  remittent  fever  at  New  Brighton,  Pennsylvania,  where,  during  a  fit  of  comminuted  fracture  of 
delirium  on  January  9.  1866,  he  jumped  from  a  second-story  window  to  the  ground,  a  distance  of  twenty 

feet.  When  called  to  see  him  I  found  a  compound  comminuted  fracture  of  the  left  femur  extending  about  four  inches  above  the 
condyles,  the  upper  end  of  the  bone  protruding  through  the  skin  and  pantaloons.  The  condyles  were  split  apart  and  the  patella 
was  slightly  fractured.  I  amputated  at  the  junction  of  lower  and  middle  thirds  of  the  bone,  making  anterior  and  posterior 
flaps.  Two  arteries  were  ligated.  Union  through  almost  the  entire  extent  took  place  by  first  intention,  and  in  six  weeks  the 
stump  was  entirely  healed  and  of  very  good  shape."  The  amputated  portion  of  the  femur  and  the  patella  (Spec.  2455),  contributed 
to  the  Museum  by  the  operator,  are  represented  in  the  adjoining  wood-cut.  (FlG.  370),  showing  the  line  of  the  operation  to  have 


1  WRIGHT  (JOHN),  Amputation  at  the  Hip  Joint,  in  Cincinnati  Lancet  and  Observer,  1868,  VoL  XI,  p.  257. 
SURG.   Ill— 84 


Circular  No.  2,  S.  G.  O.,  p.  109. 


666 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


passed  through  a  small  exostosis.     No  subsequent  history  of  the  patient  has  been  ascertained.     There  is  HO  record  of  his  ever 
having  applied  for  pension. 

CASE  999. — Amputation  in  the  thiijft. — Private  P.  O'Reilly,  Co.  F,  5th  New  York  Heavy  Artillery,  aged  40  years,  had 
both  his  legs  horribly  mutilated  by  the  car  wheels  of  a  railroad  train  near  Baltimore,  November  5,  18G4.  He  was  conveyed  to 
Patterson  Park  Hospital,  where  the  right  thigh  was  amputated  at  the  middle  third  by  Surgeon  T.  Sim,  U.  S.  V.  The  patient 
then  was  so  rapidly  failing  that  it  was  considered  useless  to  proceed  with  any  further  operation  on  the  other  limb.  He  was 
insensible  at  the  time  of  admission  and  remained  so  up  to  his  death,  which  occurred  four  hours  afterwards.  The  amputated 
portions  of  the  leg  were  forwarded,  with  the  history,  by  the  operator,  and  form  specimen  3470  of  the  Surg.  Sect,  of  the  Museum. 

TABLE  (JX. 

Condensed  Summary  of  One  Hundred  and  Forty-nine  Amputations  in  the  Thigh  for  Miscellaneous 

Injuries  or  Diseases. 

[Recoveries,  1— HO;  Deaths,  91—149.] 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGK. 

DATE  OF 
INJURY 

OR 

DISEASE. 

NATURE  OK  INJURY  ou 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

Oi'KKATiox  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Anders.  J.  J..   Pt.,  K,  (i5th 

Oct.  19, 

Frac.  right  leg;  fall  from  horse; 

June  20, 

Flap  amputation  at  lower  third 

Recovery.    (Disch'd  June  5,  '65.) 

New  York,  uge  20. 

1864. 

leg  shortened  and  atrophied  ; 

1868. 

of  thigh.     Dr.  A.  Marsh,  Al 

Died  March  3],  1870;  absorption 

toes  paralyzed;  exostosis. 

bany,  N.  Y. 

of  pus. 

o 

Anderson.   M.,  I't..  K,  115th 

Oct.  5, 

Right     leg    injured  ;    railroad 

Oct.  5, 

Flap  amputation  at  lower  third 

Discharged. 

Illinois. 

1862. 

accident. 

1862. 

of  thigh. 

3 

Barnes,  C.,  Pt.,  I,  95th  New- 

June  —  , 

Injury  of  the  right  leg  :  osteo- 

Oct.  17, 

Antcro-posterior  flap  amputat'n 

Discharged    November  5,    1864. 

York,  age  23. 

1862. 

cephalomutoustuinorof  tibia  ; 

1863. 

at  lower  third  of  right  thigh. 

Spue.  2779,  A.  M.  M. 

tumor  removed. 

A.  A.  Surg.  J.  H.  Janmr. 

Sept.  1 

Navy,  age  31. 

1864.  ' 

board  steamer  Alabama. 

below  trochanter"  major. 

puckered  and  tender. 

5 

Bergman.  J.,  Pt.,  7th  New 

April  30. 

Comp'nd  fract.  of  lower  thirds 

Julv  6, 

Circular  amputation   at  lower 

Wound   healed,   leaving  a  good 

York  Battery,  age  38. 

1864. 

of  right  tibia  and  fibula  by  a 

1864. 

third  of  thigh.     A.  A.  Surg. 

stump.     Discharged  December 

caisson  wheel. 

E.  Curtis. 

2,  1864. 

6 

Bice,  J.  A.,  Pt.,  C,  95th  New  i  Dec.—, 

Phlegmonous  erysipelas,  right 

May  23. 

Amputation  at  middle  third  of 

Discharged  October  5,  1865. 

York.                                           1864  to 

foot  and  leg,  caused  by  ex 

1865. 

thigh.      Dr.   H.   B.    Salmon, 

1865. 

posure  to  wet  and  cold. 

Stuyvesant,  N.  Y. 

7 

Blackburn.  J.,   I't.,   B,  19th 

Sept.  17, 

Right  leg  mashed  from  knee  to 

Sept.  17, 

Amp.  at  lower  third  of  thigh. 

Discharged  October  4,  1861. 

Illinois. 

1861. 

ankle;  accident. 

1861. 

Dr.  R.  G.  Bogue.  Chicago. 

8 

Boderker.    G.,     Pt.,    C.    6th 

Nov.  6, 

Run  over  by  ammunit'n  wagon, 

Jan.  4, 

Circular  amputation   at  upper 

Discharged. 

Missouri,  age  39.                         1863. 

fract  ur'g  right  tibia  at  middle. 

1864. 

third  of  thigh.    Surg.  N.  Gay, 

Extensive  supp.  and  necrosis. 

U.  S.  V. 

Jan.  3.4,  liajm.  fr.  post.  lib.  art. 

9     Bolton,    P.,    Serg't,    F.   51st 

June  7, 

Left  limb  injured  by  railroad 

Juno  10, 

Flap  amput'n  at  middle  third 

Discharged. 

New  York. 

1863. 

accident. 

1863. 

of  thigh.    Surg.  J.  T.  Carpen 

ter,  U.  S.  V. 

10 

Bowen.  T.,  Pt.,  E,  13th  New 

Sept.  8, 

Fracture  of  the  left  leg;  rail 

Sept.  29, 

Amputation  at  middle  third  of 

Discharged  Feb.  16,  1863.    Piece 

York. 

1862. 

road  accident. 

1862. 

thigh.     A.  A.  Surg.  W.  Sar 

of  bone  subsequently  removed 

gent. 

from  stump. 

11 

Bruce,  C.,  Pt..  K,  95th  Illi 

Dec.  19, 

Compound  comminuted  frac.  at 

Dec.  19, 

Circular  amputation  at  middle 

Discharged. 

nois,  age  37. 

1864. 

upper  third  of  left  leg;  rail 

1864. 

third  of  thigh.     Surg.  S.  E. 

road  accident. 

Fuller.  U.  S.  V. 

12 

Buekridge.  J.  N.,  Pt..  C,  6th 



Axe  wound  of  right  foot,  sever 

Mav  27, 

Antero-posterior  flap  amputat'n 

May  30,  slight  haemorrhages  ;  re 

New  York  Artillery. 

1864. 

ing  tarsus    and   metatarsus; 

1864. 

of  thigh  nearjunct.  of  middle 

covered. 

erysipelas  ;  gangrene. 

and  lower  thirds.     Surg.  D. 

W.  liliss,  U.  S.  V. 

13 

Burgess,  O.  S.,  Pt.,  L,  8th 



Scrofulous  inflammat'n  of  right 

Nov.  20, 

Circular  amputation  at  lower 

Necrosis  of  stump.     Discharged 

New  York  Artillery,  age  18. 

knee  joint;  anchylosis;  cartil 

18(14. 

third  of  thigh.     Surg.  R.  W. 

May  31.  J865. 

ages  disorganized:  haemorrh. 

Pease,  U.  S.  V. 

14 

Burns.  J.,  Pt.,  A,  17th  New 

June  20, 

Right   foot   and    left   thigh  at 

June  20, 

Circular  amputation  at  upper 

Stumps   ulcerated.      Discharged 

York,  age  21. 

1865. 

middle  third  fractured;  rail 

1865. 

third  of  left  thigh.  A.  A.  Snrg. 

November  14,  1865. 

road  accident. 

R.  P.  Johnson.     Amputation 

right  leg,  lower  third. 

15 

Carlisle.  J.  L.,  Recruit,  10th 

Feb.  29, 

Injury  of  right  knee  and  frac 

June  26, 

Amputation  at  middle  third  of 

Discharged  August  5,  1865;  re 

Michigan  Cavalry,  age  21. 

1865. 

ture  of  tibia  ;  railroad  aecid't  ; 

1868. 

right  thigh.    Dr.  D.W.  Flora, 

covered. 

inflammation  in  knee  joint. 

Chicago,  Illinois. 

16 

'Cator.  A.,  Pt.,  G,  48th  New 



Wrenched  his  right  leg;  osteo- 

July  21, 

Flap  amputation  at  junction  of 

Discharged  July  8,  1863. 

York,  age  21. 

1861. 

sarcoma  of  fibula;  leg  much 

1862. 

middle  and  lower  thirds.    Dr. 

swollen,  red.  and  tender. 

W.  Parker,  New  York. 

17 

Chapman,  O.W.,  Pt.,  E,  76th 



Scurvy;    extensive   ulceration 

Aug.  20, 

Amputation  at  lower  third  of 

Discharged  July  29.  1865;  recov 

Pennsylvania. 

of  right  leg.  exposing  (i  inches 

1865. 

thigh.    Dr.  A.  Strong,  Hones- 

ered,  with  sound  stump. 

of  tibia. 

dale,  Penn. 

18 

Clarke,  T.W.,  Chaplain,  99th 

May  10, 

Injury  of  left  second  toe  ;   de 

Feb.  7, 

Amputation  at  lower  third  of 

Disch'd  Feb.  1  1,  1863.     (Nov.  26, 

New  York,  age  42. 

1862. 

formity  and  partial  dislocat'n. 

1872. 

thigh.     Dr.  J.   Momans,  late 

1862,  amputation  toe:  Jan.  21, 

Ass't  Surg.  U.  S.  A. 

1863,  amputat'n  low.  third  leg.)  , 

19 

Coe,  S.,  Col'd  Pioneer  Corps. 

Aug.  11. 

Falling  tree  crushed   the  left 

Aug.  11, 

Flap  amputat'n  at  middle  third 

Returned  to  regiment  September 

1863. 

leg. 

1863. 

of  thigh. 

22.  1863. 

20 

Collier,  L..  Pt..   I,  Oth  Mis 

Sept.  25, 

Right    thigh     crushed     by   a 

Oct.  4, 

Flap  amputat'n  at  middle  third 

Transferred  to  Veteran  Reserve 

souri,  age  17. 

1861. 

wagon. 

1861. 

of  thigh. 

Corps. 

21 

Concannon.  E.  C.,  Corp'l.  H, 

May  4, 

Fracture  left  tibia  and  fibula  ; 

May  4, 

Antero-post.  flap  amputat'n  at 

Discharged    January   27,    1865; 

9th  Veteran  Reserve  Corps. 

1864. 

laceration  lower  third  of  right 

1864. 

junct.  of  mid.  and  lower  thirds 

stump  very  well  shaped.     Spec. 

age  24. 

thigh  ;  railroad  accident. 

of  left  thigh.     Surg.  E.  15ont- 

2550,  A.  M.  M. 

ley,  U.  S.  V. 

22 

Dillon,  K.,  Pt..  !•',  5lh  New 

Nov.  23, 

Injury  of  right  knee  by  fall  of  !  Second 

Flap  amp.  at  upper  third  thigh. 

Discharged  December  13,  1862. 

York. 

1861. 

a  fence. 

ary. 

Surg.  G.  Taylor,  II.  S.  A. 

23     Drysdell.    H..    I't.,    E,    71st 

Sept.  28, 

Railroad  cars  crushed  the  right 

Sept.  28, 

Antero-posterior  flap  amputa'n 

Discharged. 

I     Pennsylvania. 

1863. 

leg. 

1863. 

at  lower  third  of  thigh. 

'M     Duncin*    O   W     I't     I*1    °h't 

Pennsylvania  Cav..  ago  10.                        large  amount  of  pus  deeply 

JUD6  i.*, 

1864. 

Circular  amputation  at   lower 
third  of  thigh.     Ass't   Surg. 

iteeovereo. 

seated   in  the  joint;   necrosis 

C.  Wagner,  1'.  S.  A. 

of  external  condyle. 

25 

Dunn,   \V.  F.,   I't..    I,    192d 

Ana.  12.   Right  leg  crushed:  railroad  ac- 

Jan.  1. 

Amp.  of  thigh  at   lower  third. 

Discharged. 

Pennsylvania,  age  -,'0. 

1864.     i     cident.     Aug.  12.  amputation 

1865.         A.'A.Siir-r.'F.  F.  Maurv. 

Icy  ;  stump  diseased. 

1  KENNEDY  (J.  T  ),  Amputations  of  Thigh,  etc.,  in  American  Mtdical  Wmes,  Volume  V,  186J,  p.  JUJ 


SECT.   II.  1 


AMPUTATIONS    IN    THE    THIGH. 


667 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  ACE. 

DATE  OF  . 
INJURY        NATURE  OF  INJURY  OR 
OR                        DISEASE. 
DISEASE. 

BATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

Ofi 

Fl^n'irv    T    Pt    13   5th  VCTV                     Hydnrthru*-'  of  left  knee  joint 

Anril  9fi 

Flap  amput'n  at  middle  third  of 

Dischar  ed 

*JO 

York  Heavy  Artillery.                                                                                 !     1865.  ' 

thigh.     Medical  Cadet  Stille. 

large 

27 

Gallagher,   L..    Pt..  A.  69th  :  Jan.  31,    Comp'nd  comminuted  fract.  of 

Jan.  31, 

Flap  amp.  at  lower  third  thigh. 

Disch'd  March  2.  1866.     (Ampu 

Ohio  a"e  18.                                1865.         right  leg;  railroad  accident. 

1865. 

Surg.  C.  McDermont,  U.  S.V. 

tation  left  arm  Sept.  2,  1864.) 

-co     l_rleeson,    ri.,    i  i.,    -\.    1'iuin 
New  York,  age  '-.'7. 

1864.         in  mortification. 

1865.   '      thigh.     Dr.   A.  M.  Leonard, 

August  29,  1865;  stump  healed 

Lockport,  N.Y.   June  7,  1865, 

but  tender. 

amputation  left  leg. 

2!)     Godfrey.  T..  1't.,  II.  22d  Ken- 

Feb.  26, 

Fract.  of  leg  ext.  into  knee  j'nt 

Mar.  29, 

Circular  amputation   at  lower 

Discharged  June  11.  1864. 

tucky  Artillery,  age  35. 

1864. 

and  comp'nd  fract.  ankle  j't  ; 

1864. 

third  of  thigh.     A.  A.  Surg. 

crush,  bet.  ferryboat  and  dock. 

N.  F.  Marsh. 

on    :  n  /"»    i.^      r  :„..*      T-*    l  K*K 

Tninrv  of  ri<rht  "  leo1   bv  ft  f'lll 

Oct.  7, 

A  mr>ntMtion  ot   thiirh   6  inches 

Recovered  •    bone   tilted   nnward 

West  Virginia,  age  43. 

lameness.    Must,  out  June  10, 

1863.' 

from  hip.     Dr.  J.  Suinburn. 

and  forward  by  action  of  mus 

1863.     Enlargement  of  artery 

Albany,  N.  Y. 

cles  in  stump. 

behind  knee  ;  gangrene. 

31     H'i"pcll   F     Pt     1)   3'Hh  llli 

Oct.  17, 

Discharged  Dec.  22,  1863.     Re 

•     nois,  age  39. 

necrosis  of  femur  and  tibia  ; 

1867.  ' 

thigh.     Dr.  J.  II.  Thompson. 

covered. 

diseased  bones  fractured  by 

surgeon    at    Soldiers'    Home. 

accident. 

Milwaukee.  Wis. 

32     Hooks,   H.  A..   1't..  <;,  78th    Sept.  Oil, 

Right  tibia,  fibula,  and  patella 

Sept.  29,   Circular  amputation  at  lower 

Discharged  February  15,  1865. 

Pennsylvania. 

1864. 

fractured;  railroad  accident. 

1864. 

third  of  thigh.     A.   A.   Surg. 

S.  T.  Williams. 

33     Hornbeek.  S.  S.,  Pt..  F,  -,>8tli    Aug.  15, 

Injury  of    left    limb;    railroad 

Aug.  Hi,   Amp.  at  middle  third  of  thigh. 

Discharged  September  25,  1863. 

Kentucky. 

1862. 

accident. 

1862,         Surg.  G.W.  Ronald,  34th  Ky. 

34  '.  Mutcliinsoii.  A.,  contraband. 

Mar.  5, 

Thigh  crushed  by  a  falling  tree. 

Mar.  10,    Post,  flap  amp.  at  upper  third 

Discharged  from   hospital  Nov. 

ape  5."). 

1864. 

1864.         thigh.     Surg.  K.  K.  Piquette, 

27.  1861. 

86th  Colored  Troops. 

35     Jacks.m,  K.  II..  Serg't,  I),  2<1 

Sept.  1, 

Left  tibia  injured  by  chafe  of 

Jan.  14,    Amp.  at  lower  third  thigh.    Dr. 

Mustered   out   August  17,  1865. 

Michigan  Cavalry,  age  31. 

1864. 

stirrup:  disease  inv.  knee  j'nt. 

1869.         'A.  K.  Bliss,  late  Surg.  U.  S.V. 

Recovered. 

36     Kalbfleish.  .1..  I't.'  A.  116th 

Feb.  24, 

Compound  tract,  of  right  tibia. 

Feb.  24,    Antero-posteriorflapamputat'n 

Discharged  May  15,  1865. 

Ohio,  age  27. 

1864. 

fibula,  and  ankle;  crushed  by 

1864.         lower  third  thigh.     Surg.  T. 

car  wheel.                                                       J.  Shannon.  lltith  Ohio. 

37     Keller,  F..  I't..  E.  18th  Ohio.    Jan.  24, 

Fracture  middle  third  of  right  :  Feb.  25,   Circular  amputat'n  upper  third 

Discharged  September  29,  1865; 

age  21.                                              1865. 

femur;  railroad  acoid't  ;  morti        1865.         of  thigh.      Dr.    H.    Tappan, 

stump   healthy.     (Also   a  shot 

fieation.                                                               Steubeuvillc.  Ohio. 

wound  of  right  leg  Dec.,  1864.) 

38     Kennedy,   I'.  A.   I?.,  1't..   I!, 
36th  Indiana. 

Scrofula;  r't  ankle,  knee,  and    Feb.  2."",    Amputation  at   lower  third  of 
wrist  affected  by  tuberculosis.       1864.         right  thigh.   Di  J.  M.Youant, 

August   16,  1864,  amputation  of 
right   forearm.      Mustered   out 

Destruct.  bony  and  soft  parts.                        Indianapolis. 

September  21,  1864. 

39     Kennedy,  W..    I't.,  (',    37th     Jan.  5, 

Leg  broken  by  accident   Mar.  i>,     Flap  amputat'n  at  upper  third 

Discharged  June  14,  1864. 

Illinois.                                             1863. 

1863.          of  thigh.     Ass't   Surg.  S.  D. 

Carpenter,  I'.  S.  V. 

40     Lambert.  H.  M.,   Serg't,  D, 

Oct.  10, 

Comminuted  fracture  of  right    Nov.  10,   Double  flap  amputat'n  at  lower 

Disch'd  July  30,  '64.    Specs.  1744, 

12th  Illinois  Cav.,  age  29. 

1863. 

leg  at  middle  third  by  fall  of 

1863.         third.     A.  A.  Surgeon  W.  II. 

1879,  A.  M.  M.     (Oct.  25,  1863, 

horse. 

Ensign. 

amp.  leg  :  Nov.  8,  26,  hasinorrh.) 

41  |  Lewis.  P..  Musician,  G,  183d 

July  20, 

Fracture  of  right  leg;  railroad    July  20,    Flap  amputat'n  at  middle  third 

Recovery. 

Ohio. 

1865. 

accident.                                            1865.         of  thigh. 

42  :  Lindsay,  W.,  Corp'l,  I,  81st 

Mar.  20, 

Accid'tal  injury  left  knee  joint  ;    Aug.  12,   Circular  aniput'n  at  lower  third 

Discharged  December  4,  1865. 

Colored  Troops,  age  35. 

1865. 

pus  in  and  around  joint  ;  in-      1865.     1     thigh.     Surg.  F.  E.  Piquette, 

rtammatien.                                                   '     86th  Colored  Troops. 

43     Little,   T.  W..   Pt.,   L,   10th 

May  5, 

Compound  fracture  of  left  tibia    May  26,  ,  Flap  amputation  at  lower  third 

Discharged  October  16,  1864. 

Indiana  Cavalry. 

1864. 

and  fibula  :  railroad  accident.       1864.         of  thigh.     Surg.  C.  N.  Hoag- 

land,  71st  Ohio. 

44 

Long.   S..   Pt..   E,  5th  Ken 

June  24.   Left  leg  fractured:  fall  of  horse; 

Oct.  27,    Circular  amput'n  middle  third 

Discharged  July  11,  1864. 

tucky  Cavalry,  age  40. 

1863. 

erysipelas  ;  gangrene. 

1863. 

thigh.  Ass  t  Surg.  J.  E.  Link, 

21st  Illinois. 

45 

Lynch,  H.,  Pt.,  G,  15th  Con 

Aug.  28, 

Injury  of  left  knee  by  a  fall; 

Jan.  24,    Amputat'n  at  lower  third  thigh. 

(Discharged  September  13,  1863.) 

necticut,  age  35. 

1862. 

periostitis  and  ostitis;  enlarge 

1865.         Dr.   F.  Bacon,  of  the  Conn. 

Recovered. 

ment  of  head  of  tibia. 

State  Hospital. 

46 

McCabe.  J..  Pt..  A,  23d  Illi 

Sept.  20, 

Left  limb  injured  by  railroad 

Sept.  20,    Flap  amputation  at  upper  third 

Discharged  September  30,  1863. 

nois,  age  33. 

1862. 

accident. 

1862. 

of  ihigh. 

47 

McLay,    \V.,    Pt.     G,    12th 

Bones  of  right  le°°  fractured  by 

Jtin.  15 

Lateral  flap  amputat'n  at  lower 

Discharged  July  5,  1864.     (Nov. 

Illinois. 

1856. 

machinery  ;  necrosis  and  dis 

1864.  ' 

third  of  thigh.     Surg.  J.  G. 

3,  1863,  amputation  leg;  gang.) 

placement  of  fractured  ends. 

Keenon,  U.  S.  V. 

48 

Marcellus    L.     Pt.    15    94th 

Gangrene  of  right  leg  and  foot 

April  30, 

Circular  amputation  at  lower 

Discharged  November  3,  1805. 

New  York. 

from  exposure. 

1865: 

third  of  thigh. 

49 

Marshall.   W.,   Pt.,    A,   55th 

Aug.  4, 

Sprain   of  right   ankle  ;  disor 

Mar.  4, 

Circular  amputat'n  lower  third 

Mustered  out   August  26,   1863. 

Pennsylvania. 

1863. 

ganization  of  tibia  and  astrag 

1865. 

of  thigh.     Dr.   T.   St.  Clair, 

Recovered. 

alus. 

Blairsville,  Penn. 

50 

Martindale,  L.,  Pt..  K,  54th 

Nov.  1, 

Leg    crushed,   extending   into 

Nov.  1, 

Circular  amputation  at  lower 

Discharged  December  15,  1863. 

Indiana,  age  25. 

1863. 

knee  joint;   femur  obliquely 

1863. 

third   of    right  thigh.     Ass't 

fractured  :  railroad  accident. 

Surg.  J.  Homans,  jr.,  U.  S.  A. 

51 

M'lV 

New  York. 

tibia;  inflamm.  of  knee  joint. 

1865. 

of  lower  thirds  of  thigh.     Dr. 

' 

Todd,  Tarrytown,  N.  Y. 

52 

Meyer,  J.,  discharged  soldier, 

Jan.  9, 

Compound  comm.  fract.  lower 

Jan.  9, 

Antero-post.  flap  amp.  at  June. 

Stump    entirely    healed    in   six 

Minnesota  regiment. 

1866. 

third  left  femur  into  knee  j'nt  ; 

1866. 

of  lower  thirds  of  thigh.     Dr. 

weeks.    Recovered.    Spec.  2455, 

jumped  from  2d  story  window. 

D.  Stanton,  late  Surg.  1'.  S.V. 

A.  M.  M. 

53 

Morton,   C.   L.,    Pt.,    I,    4th 

Oct.  14, 

Right  knee:  kicked  by  a  horse. 

Oct.  14, 

Flap  amp.  low.  third  thigh.  Dr. 

Discharged  February  27,  1863. 

Michigan  Cavalry. 

1862. 

1862. 

E.  Thorn,  Constantine,  Mich. 

54 

Mill-dock,    G.,    Pt.",    A,    23d 

May  16. 

Severe  contus.  left  leg  ;  accid't;     June  6, 

Circular  amputation  at   lower 

Progress  steady  but  slow.     Mus 

Illinois,  age  "ft. 

1864. 

sloughing;  gang,  of  foot;  pus  ;    1864. 

third  of  thigh.     A.  A.  Surg. 

tered  out  June  24,  1865. 

burrowed  along  popliteal  vein  ; 

R.  N.  Isham. 

and  in  it. 

55     Myers,  J..  Pt..   L,  4th  Ohio    June  6, 

Injured  by  railroad  accident    .  . 

June  6, 

Amputation  at  lower  third  of 

Discharged  January  7.  1865. 

Cavalry. 

1863.    I 

1863. 

right  thigh. 

56 

O'Brien,  F.,  Pt..  A,  4th  New 

Feb.  —  , 

Axe  wound  of  the  left  knee; 

Second 

Amputat'n  at   middle  third  of 

Discharged  April  28,  1863.   Spc.c. 

York. 

1862. 

necrosis. 

ary. 

thigh,  lateral  flaps.     Surg.  G. 

!>19,   A.  M.  M.     (CASE  524,  p. 

Taylor,  V.  S.  A. 

362,  ante.) 

57 

Pflueger,  F.,  Pt..  H,  8th  N.    July  21,  Injury  of  left  knee  joint  by  fall  ;    July  7, 

Circular  amputat'n  at  middle 

Discharged    September  5,   1861. 

York,  age  37.                           !     1861.         caries  of  cartilage  of  knee.           1863. 

third  left  thigh.     A.  A.  Surg. 

Recovered  July,  1865. 

C.  F.  Heuser. 

58     Phillips.  J.,  Pt..  A.  1st  Mich-   April  10,   Contusion,  result  'gin  synovitis  Nov.  20, 

Circular  amput'n  middle  third 

Recovered.    (Discharged  Jan.  11, 

igan  Cavalry.                          ;     1864. 

left  knee. 

1866. 

of  thigh.     Dr.  D.  O.  Farrand, 

1866.) 

Detroit.  Mich. 

59 

Pierce,  A.,  Pt.,  C.  S.  Engi-    Aug.  2,    Injury  of  right  leg;  boiler  ex- 

On  field. 

Amputation  at  middle  third  of 

Discharged  from  hospital  Novem 

ueers,  age  45.                                1864.         plosion,  Steamer  Anna  Lyon. 

thigh. 

ber  2,  1864. 

668 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


DATE  OF 

DATE 

No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

INJURY 

OK 

NATURE  OF  INJURY  OK 
DISF.ASE. 

OF 

OPERA 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

DISEASE. 

TION. 

60 

Pittmau    W\  H     Pt    E    4th 

f 

Allir    °7 

Amputation  lo\ver  third  of  left 

Discharged  June  16,  1865;  bad 

Teiin.  Cavalry,  age  38. 

1864. 

resulting  from  imprisonment. 

rtllg.  *.!, 

1865. 

thigh.  Dr.  J.  D.  Ketchcrside, 

stump;   bone  protruding.     Re 

Ducktown,  Tenn. 

covered. 

61 

Powell,  .1.,  I't.,  K,  28th  Penn-     Jan.  5, 

Fell  from  horse  and  injured  r't 

July  6, 

Teale's  rectangular  flap  amp. 

Discharged  December  12,  1862. 

sylvania.                                     1862. 

leg:  caries  of  tarsus,  tibia,  and 

1862. 

at  middle  third  thigh.     Ass't 

fibula  :  erysipelas  ;  abscesses. 

Surg.  R.  Bartholow,  U.  S.  A. 

62 

Putmm     C     A     Pt     F    k\l 

\iichvl    sis'lct'l    knee-   chronic 

Mar  17 

Klup  nmputntion  jit  lower  third. 

Discharged   February   13,   1864. 

Colorado  Cavalry,  age  24. 

enlargement  of  knee  joint. 

1867.  ' 

of  thigh.   Dr.  T.  B.  Dearborn, 

Recovered. 

Hillsborough,  N.  H. 

63 

f)t  '     i      T*     '             t        f  ^    !  1'or*' 

^rn  fill        •    infll  nmltinn  Hisnr 

Sept.  3 

AtnrHit'n  it  lower  third  tlii/^h 

Healed   by   first   intention.     Re 

Home,  age  54. 

1862. 

ganizitig  right  knee  ;  abscess. 

1804.  ' 

Surg.R.  B.  Bonteeou,  U.  S.V. 

turned  to  Soldiers'  Home  cured. 

64 

Randolph,    W.   M.,    Pt.,    A, 

July;?, 

Right  lower  limb  kicked  by  a 

April  8, 

Double  flap  amput'n  at  middle 

Discharged  May  27,  1865. 

10th  Missouri  Cav..  age  21.       1864. 

horse  ;  extensive  suppuration; 

1865. 

third  of  thigh.     Surg.  J.  R. 

knee  joint  disorganized,  with 

McClurg,  U.  S.  V. 

ulceration  of  bones. 

65 

Roberts.  10.,  Pt.,  G,  13th  Wis 

May  2, 

Right  leg  injured;  railroad  ac 

May  2, 

Flap  amput'n  low.  third  thigh. 

Discharged  Mar.  24,  1865.  Specs. 

consin,  age  24. 

1864. 

cident. 

1804. 

June  18.  3  ins.  bone  removed. 

2990,  3098.  A.  M.  M. 

06 

Robinett.  M.  B.,  Musician,  11. 

April  11. 

Railroad  cars  crushed  the  left 

A  prill!. 

Amputation  at   lower  third  of 

Discharged  August  19,  1864. 

2d  Maryland  P.  H.  B. 

1863. 

leg- 

1863. 

thigh.     Surg.  S.  P.  Smith,  2d 

Maryland  P.  H.  B. 

67 

Scoville,  I-:.,  Pt.,  E.  123d  N. 

Dec.  20, 

Contusion  from  full  of  tree  ;  ne 

Feb.  18, 

Circular  amput'n  at  lower  third 

Discharged  August  5,  1865. 

York,  age  20. 

1864. 

crosis  left  tibia. 

1805. 

of  left  thigh.     Surg.  J.  Reily, 

33d  N.  J. 

68 

Sealey.  I).  K..  Pt.,  C.  74th 

Oct.  7, 

Fracture  both  legs  ;  bad  conun. 

Oct.  25, 

Circular  amputation  at  lower 

Discharged  February  28,  1865. 

Illinois. 

1864. 

of  right  leg;  railroad  accid't. 

1804. 

third  of  right  thigh. 

69 

Sheuermaii.  J..  Pt.,  1C,  10th 

May  1, 

Right   femur  crushed  by  rail 

May  11, 

Flap  amputat'n  at  middle  third 

Discharged  August  22,  1805. 

Ohio  Cavalry,  age  :!4. 

1805. 

road  accident. 

1805. 

of  thigh. 

70 

Smith.  R.  H.,'Pt.,  D,  3d  W. 

July  24, 

Compound  comminuted  fract. 

July  25, 

Antero-post.  flap  amputation  at 

August  1,  haemorrhage;  ligation 

Virginia,  age  38. 

1864. 

right  leg  ;  railroad  accident. 

1804. 

lower  third  of  thigh.     Surg. 

of  popliteal  artery.     Mustered 

S.  N.  Sherman,  U.  S.  V. 

out  September  3,  1864. 

71 

Oct    r) 

age  14. 

part  of  right  thigh  and  knee. 

1864.' 

of  thigh.     Surg.  H.  Wardner, 

femur  removed.     July  31,  1865, 

U.  S.  V. 

stump  healed.     Left  for  home. 

72 

Sowle     H    A      Pt      G     .r>th 

Oct  18 

I  )i^<'h'tr<red  Oct   2   186^'  unible 

Michigan  Cav.,  age  28. 

defective  circulation  and  in- 

1862.  ' 

third.     Dr.  C.   w!  Topping, 

to  wear  artificial  limb. 

nervation. 

DeWitt,  Mich. 

73 

Spragg,  Or.,  I't.,  G,  1st  Kan 

Mar.  12. 

Left  knee  cut  just  above  joint 

About 

Amputation  at  middle  third  of 

Discharged  April  19,  1863.    1870, 

sas,  age  33. 

1862. 

by  an  axe. 

April  12, 

thigh.    Surg.  H.Nauman,  9th 

stump  sound  and  healthy. 

1862. 

Wis.;  subsequent  operation. 

74 

Stauber,    W.,    Pt.,    L,    14th 

Feb.  20, 

Erysipelas  resulting  from  cold. 

April  4, 

Amp.  at  middle  third  left  thigh. 

Discharged    December  4,   1863. 

Illinois  Cavalry. 

1863. 

1803. 

A.  A.  Surg.  E.  Andrews. 

Died  September  10,  1872. 

75 

Straw,  P.,  Pt.,  (',.  203d  Penn 

Mar.  3. 

Left  leg,  kicked  by  a  horse.  .  .  . 

Mar.  20, 

Flap  amputation  at  lower  third 

Mustered  out  June  23,  1865. 

sylvania. 

1865. 

1805. 

of  thigh. 

76 

Sullivan,  E.  O..   Serg't.  K. 

Oct.  14, 

Fract.  middle  right  femur;  ac 

July  1, 

Flap  amputation  at  mid.  third 

(Mustered  out  February  27,  '65.) 

18th  Missouri  Mounted  Vol 

1803. 

cident  ;    limb  shortened  and 

1805. 

of  thigh. 

Recovered. 

unteers,  age  38. 

flexed  at  knee. 

77 

Tanner.  D.  B..  Pt..  1).  1st  R. 

Oct.  0. 

Right  leg  fractured  by  a  kick 

Second 

Amputation  at  middle  third  of 

Discharged  April  7,  1862.     Spec. 

Island  Light  Art.,  age  26. 

1861. 

from  a  horse  ;  erysipelas. 

ary. 

thigh.     Ass't  Surg.  J.  W.  S. 

21,  A.  M.  M. 

in  j 

Gouley,  U.S.A. 

78 

Tanvater,  H.  C.,  Pt.,  C,  Gist 

Jan.  20, 

Injury  of  left  ankle  joint,  fract. 

Feb.  6, 

Circular  amputation  at  lower 

Discharged  May  16,  1865. 

Tennessee,  age  24. 

1805. 

external  malleolus  ;  contusion 

1865. 

third  of  thigh.     Ass't  Surg. 

of  foot;  erysipelas. 

C.  Bacon,  jr.,  U.  S.  A. 

'i  • 

Trowbridge,  L.  M.,   Corp'l, 

Oct.  24, 

Left   leg    entirely  severed   at 

Oct.  24, 

Flap  amputation  at  mid.  third 

Gangrene.     December   11,  1864, 

F,  6th  West  Virginia,  age 

1864. 

knee,  severe  burn  over  sacrum, 

1864. 

of   left  thigh.     Snrg.  S.  N. 

2  inches  of  protruding  bone  sawn 

28. 

. 

nates,  and  both  thighs  ;  rail 

Sherman,  U.  S.  V. 

off;  recovered. 

road  accident. 

80 

Tscholl,  J.,  Pt..  D,  12th  Mis 

Oct.  1, 

Fracture  of  left  femur  ;  railroad 

Oct.  1, 

Circular  amputation  at  upper 

Mustered  out  August  15,   1864. 

souri,  age  28. 

1803. 

accident. 

1863. 

third  of  thigh. 

Died  Jan.  25,  1808,  of  phthisis 

pulmonalis. 

81 

Utter,  J.,  Drummer.  F.,  5th 

Oct.  0. 

Injured  by  a  railroad  accident. 

Oct.  6, 

Amputation  at  upper  third  of 

Discharged  January  30,  1804. 

Ohio. 

1863. 

1803. 

left  thigh. 

82 

Van    Inwagen,    A.,    Pt.,    B, 

Oct.  12, 

Left  tibia  and  fibula  fractured 

Oct.  23, 

Antero-posterior  flap  amputat'n 

Carious  bone  remov'd  from  stump. 

lllth  New  York,  age  37. 

1864. 

at  lower  third  ;  railroad  acci 

1864. 

at  lower  third  of  thigh.    Surg. 

Discharged  September  4,  1865. 

dent. 

W.  O'Meagher,  9th  N.  Y. 

83 

Van  Nordstrand.  1).,  Wagon 

Oct.  9, 

Injury  of  left  lower  extremity; 

Jan.  24, 

Flap  amputation  at  mid.  third 

Discharged  May  25,  1865. 

er,  H,  12th  Indiana  Cav. 

1804. 

railroad  accident. 

1865. 

of   thigh.     Dr.  J.  N.  Green, 

South  Bend,  Indiana. 

84 

Webber,  C.,  Pt.,  8th  Co.  X. 

Axe  wound  2  inches  above  pa 

Oct.  4, 

Amputat'n  at  junction  of  lower 

Discharged.  Spec.  2004,  A.  M.  M. 

York  Ind.  Vols. 

1863. 

tella,  suppuration  extending 

1863. 

thirds  of  left  thigh.     Surg.  D. 

(CASE  8,  p.  8,  ante.) 

into  knee  joint. 

P.  Smith,  U.  S.  V. 

85 

Weiser,  A.,  Pt.,  A,  65th  Illi- 

Aug.  17. 

Foot  fractured  and  tibia  split 

Aug.  17, 

Circular  amputation  at  lower 

Discharged  April  23,  1804. 

11O1S. 

1803. 

into  knee  joint;  railroad  acci 

1863. 

third  of  thigh.     Ass't   Surg. 

dent. 

T.  Brown,  65th  Illinois. 

86     Welch.  .1.  M.,  Serg't.  A  ,24th 

Feb.  8, 

Sprain  of  left  leg;  ulceration 

Aug.  1, 

Circular  amp.  low.  third  thigh. 

Discharged  Marcli  20,  1803;  re 

Massachusetts. 

1802. 

of  knoe  joint. 

1803. 

Dr.  H.  J.  Bigelow,  Boston. 

covered. 

87  i  Wheeler,  C.,  Pt.,  I,  2d  Ohio 
!     Heavy  Artillery,  age  18. 

Jan.  29, 
1805. 

Comp'd  comm.  fract.  mid.  third 
left  thigh  :  railroad  accident. 

Jan.  30, 
1865. 

Flap  amp.  at  upper  third  thigh. 
A.  A.  Surg.  T.  \7.  Baugh. 

Feb.  8  and  14,  haemorrhage.    Dis 
charged  June  2.  1805. 

88 

W  ilkmson,  J.  W.,  Pt.,  1),  6th 
New  Hampshire. 

May  29, 
1802. 

Accidental  injury  right  leg  and 
knee  ;  i  n  flam.  and  sup.  kneej't. 

Sept.  29. 
1863. 

Flap  amp.  at  upper  third  thigh. 
Dr.  T.  Haynes,  Concord,  N.H. 

Discharged  September  22.  1862; 
recovered. 

89 

Williams,     K.    A.,    Pt.,    V, 
184th  Pennsylvania,  age  19. 

Typhoid  fever,  resulting  in  ul 
ceration  of  right  leg  and  dis 

June  16, 
1864. 

Flap  amputation  at  mid.  third 
of  thigh.     Dr.  J.  B.  Mitchell, 

Discharged  October  9,  1866. 

ease  of  bone. 

l.ellefonte,  Penn. 

90 

Zachman,   S.,   Pt.,    I),    82d 

Oct.  2, 

Left  thigh   crushed  ;    railroad 

Oct.  2, 

Flap  amputation  at  junction  of 

Discharged. 

Ohio. 

1863. 

accident. 

1803. 

uppcrand  mid.  thirds  of  thigh. 

Dr.  .1.0.  Reeve,  Dayton,  Ohio. 

91 

Allee,  M.  J.,  Corp'l,  I,  33d 

June  17, 

Punctured  wound  of  right  knee 

July  31  , 

Amputation  at  middle  third  of 

Died  Aug.  11.  1865,  of  diarrhoea. 

Indiana,  age  22. 

1805. 

joint  by  the  point  of  an  axe  ; 

1865. 

right  thigh.     A.  A.  Surg.  D. 

See  p.  302,  ante. 

synovitis. 

J.  Griffiths. 

92)  •  Allen,  —  ,  contraband,  age  23. 

Nov.  10. 

Comminuted  fracture  of  both 

Nov.  11.   Circ.  amp.  at  middle  third  left 

Died  November   11,   1864.   from 

93  f 

1804. 

knee  joints  by  railroad  acci 

1864.         thigh;  flap  amp.  right  thigh 

shock,  four  hours  after  operat'n. 

dent. 

at  low.  third.     Ass't.  Surg.  H. 

T.  Legler,  U.  S.  V. 

94 

Anderson,  D.,  Conductor  U. 

May  28. 

Comp'd  com.  fract.  of  left  tibia 

May  28, 

Circular  amputation  at  middle 

Died  June  25,  1865,  of  exhaust'n. 

S.  Mil.  Railroad,  age  25. 

1805.         and  fibula;  railroad  accident. 

1865.         third  of  left  thic-h. 

95 

Ashenhnrst,  J.  D.,  Pt.,  H,  8th 

Sept.  —  ,   Axe  wound  of  left  thigh  and 

Sept.  22, 

Circular  amp.  at  middle  third 

Died  September  30,  1864,  of  ex 

Kansas,  age  22. 

1864. 

knee,  opening  joint;  gangrene. 

1864. 

of  thigh.     Ass't  Surg.  T.  A. 

haustion. 

McGraw,  U.  S.  V. 

SECT.  II.] 


AMPUTATIONS    IS    THE    THIGH. 


669 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  OF 
INJURY 
on 
DISEASE. 

NATURE  OF  INJURY  OR 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RKSULT  ANI>  RKMARKS. 

96 

Bowns,  \V.  A.,  Quartermas 

May  21,  '  Comp'd  comm.  fracture  middle 

May  21, 

Circ.  amp.  at  upper  third  of  left 

Died  May  21,  1865. 

ter,  15th  Conn.,  age  26. 

1865. 

third  left  femur  and  mid.  third      1865. 

thigh  ;  amp.  right  leg.  Surgs. 

right  tibia  and  fibula  ;  railroad 

C.  A.  Cowgill,  U.  S.  V.,  and 

accident. 

N.  Meyer,  16th  Conn. 

97 

Brown,  G.,  Pt.,  C,  34th  Illi 

Sept.  24, 

Fracture  of  right  leg;  railroad 



Amputation  at  middle  third  of 

Died  December  4,  1864. 

nois. 

1864. 

accident. 

1864. 

thigh. 

98 

Caringer  J  L    Pt    G   141st 

Accidental  incised  wound  left 

.Tnn    94 

Circular  amp.  at  low.  third  left 

Died  January  25,  18f>5. 

New  York,  age  43. 

foot  ;  gangrene  ;  sloughing.          1865. 

thigh.  Surg.  G.  Grant.U.S.V. 

99 

Cavanry.  W.,  Pt,,  —  ,   10x!d 

June  14, 

Fracture  of  right  femur  by  fall  ; 

June  15, 

Autero-posterior  flap  amputat'n 

Died  June  15,  1864,  of  concussion. 

Pennsylvania. 

1864. 

knee  joint  involved. 

1864.         at  middle  third  of  thigh.     A. 

A.  Surg.  S.  G.  Minassian. 

100 

Cochnin,  M.  F.,  Teamster,  H, 

Nov.  15, 

Fracture  of  right   knee  joint  ;    Nov.  15, 

Amputation  at  middle  third  of 

Died  Dec.  8,  1863.  of  pyaemia. 

70th  New  York,  age  34. 

1863. 

run  over  by  a  wagon. 

1863. 

thigh. 

101 

Conway,  J.  A..  Pt.,  A,  55th 

May  24, 

Comp  dcomminut'dfract.  right 

May  24, 

Circular  amp.  at  lower  third  of 

Died  May  28,  1865.   From   effects 

Pennsylvania,  age  22. 

1865. 

tibia  and  fibula  and  left  radius 

1865. 

right  thigh  and  of  left  arm. 

of  internal  injuries. 

and  ulna;  railroad  accident. 

A.  A.  Surg.  H.  S.  Streeter. 

102 

Curgill,    W..    Pt..   —  .    90th 

Oct.  29, 

1864. 

Left  foot,  leg.  and  lower  third    Oct.  29, 
of  right  thigh  crushed;  rail-  ;     1864. 

Amp.  right  thigh  at  lower  third 
and  left  leg.     Ass't  Surg.  C. 

Died  October  29,  It64. 

New  York. 

road  accident. 

Bacon,  jr.,  U.  S.  A. 

103 

Draper.  B.  F..  Serg't.  F,  1st 

Mar.  30. 

Both  bones  of  left  leg  fractured 

May  8, 

Circular  amputation  at  lower 

Died  May  27,  18<c'. 

Rhode  Island  Artillery. 

1862. 

by  kick  of  a  horse. 

1862. 

third  thigh. 

104 

Dunn.  J  .  Pt.,  G,  20th"Con- 

Nov.  4,  j  Comp'd  comm.  tract,  left  thigh 

Nov.  4, 

Amputation  at  lower  third  of 

Died  November  5.  1863. 

nectieut. 

1863.         into  knee  :  railroad  accident.        1863. 

thigh. 

105 

Ely,  J.  R.,   Corp'l,  11.   12th 

Fall   upon   right   knee  caused    Sept.  8, 

Antero-posterior  flap  amputat'n 

Died  September  14.  1864. 

Infantry,  age  24. 

scrofulous  disease  of  joint.            1864. 

at  upper  third  of  thigh.     A. 

A.  Surg.  O.  D.  Norton. 

106 

English.  P..  U.  S.  Railroad 

April  11. 

Right    leg    crushed  ;    railroad 

April  12, 

Amput'n  at  lower  third  thigh. 

Died  April  20,  1865. 

employe,  age  25. 

1865. 

accident. 

1865. 

A.  A.  Surg.  S.  T.  Buck. 

107 

Foley.   M.,    Pt.,    G,    Marine 

Sept.  6, 

Loft  tarsus  lacerated  ;  explos'u 

Sept.  14, 

Circular  amputation  of  thigh 

Died  October  3,  1862,  of  tetanus. 

Artillery,  age  28. 

1862. 

of  gunboat  Picket  ;  gang. 

1862. 

immediately  above  knee. 

108 

Frazer,  H.  C.,  Pt..  A.  40th 

June  20. 

Axe  injury  of  left  knee  joint; 

Aug.  14,    Antero-post.  flap  amputat'n  of 

Rapidly  sinking.     Died  Aug.  14, 

New  York. 

1862. 

gangrene. 

1862. 

thigh  6  inches  below  trochant- 

1862."  Ante.  p.  362. 

ers.     Brig.  Surg.  J.  C.  Dorr. 

109 

Furgerson,M.  A.,  contraband. 

Nov.  —  . 

Injured   bv   a   fall  ;    gangrene 

Feb.  15. 

Circular  amputation  at  lower 

Gang,  again  set  in;  gangrenous 

1863.         from  below  knee  to  foot  ;  tibia 

1864. 

third  of  thigh.     Surg.  D.  O. 

inflammation   of  throat.     Died 

exposed  and  partly  destroyed. 

McCord,  9th  Louisiana  C.  T. 

March  4,  1864. 

110 

Good.  H.  J.,  Serg't,  L.  10th 

May  5. 

Comp'd  fracture  of  lower  third 

June  24. 

Flap  amp.  middle  third  thigh. 

Died  June  27,  1864,  of  pya'mia. 

Indiana  Cavalry,  age  29. 

1864. 

of  femur;  pytemia;  gangrene. 

1864. 

Surg.  C.  N.  Hoagland,  71st  O. 

111 

Harmer.     S..     Pt..    0,    98th 

May  —  , 

Fracture  of  right  leg  ;  run  over 

June  —  . 

Amp.  of  thigh  just  above  knee. 

Abscesses  forming.     Died  Aug. 

Pennsvlvania,  age  18. 

1864. 

by  cars. 

1864. 

(May  —  ,  1864,  amp.  of  leg.) 

30,  1864,  of  epilepsy. 

112 

Hartz.  T.,  Pt..  G,  7th  Iowa, 

Nov.  4, 

Comm.  of  right  femur  at  mid. 

Nov.  10, 

Flap  amputation  of  thigh.     A. 

Died  December  12,  1864,  of  gan 

age  41. 

1864. 

third  by  railroad  accident. 

1864. 

A.  Surg.  A.  Robillard. 

grene. 

113 

Hickey.    T.,    Corp'l.    K.    3d 

.Ian.  21, 

Bones  of  right  leg  broken  by 

Mar.  29, 

Lateral  flap  amputation  lower 

(March  10.  excis.  tibia;  Mar.  19, 

Michigan  Cavalry. 

1864. 

kick   of  a  mule  ;  gangrene  ; 

1864. 

third  thigh.    A.  A.  Surg.  S.  S. 

ligation  posterior  tibial  artery. 

fractured  ends  overlapping. 

Jessop. 

Died  Mar.  31,  '64,  of  exhanst'n.) 

114 

Hofer  F.  Hospital  Steward 



CumnoiiTid  r'ncture  of  knee  i't- 



•\mputation  of  thigh  . 

Died  NoA'ember  22,  1865. 

U.  S.  A.' 

accident. 

115 

Hume.    C.    M..    Pt.,    A,    3d 

Dec.  11, 

Fract.  both  legs,  dislo.  r't  ankle, 

Dec.  14, 

Flap  amputation  at  junction  of 

Died  December  24,  1  864. 

Iowa  Cavalry. 

1864. 

injury  face  and  chest  :  explo. 

1864. 

lower  thirds  right  thigh.     A. 

steamer  Maria  ;  mortifi.  r't  leg. 

A.  Surg.  T.  F.  Rumbold. 

116 

Irmer,  C.,  Pt.,  —  ,  86th  Ohio, 

Sept.  23. 

Third  and  4th  met.  bones  and 

Oct.  10, 

Antero-posterior  flap  amputat'n 

Oct.  19,  haem.;  ligation  of  artery. 

age  2:!. 

1864. 

little  toe  r't  foot  crushed  and 

1664. 

at  lower  third  right  thigh.    A. 

Died  Oct.  29,  1864,  of  py;emia. 

heel  lacerated  :  railr  daccid  t; 

A.  Surg.  C.  E.  Boyle. 

Autopsy  :  saphenousand  femor 

slough'g  of  foot  and  leg  ;  in 

al  veins  full  of  pus. 

flammation  of  thigh. 

117 

Jennings.    D..    Pt.,    C,    37th 

Aug.  13, 

Fracture  of  left  tibia  ;  railroad 

Aug.  25, 

Circular  amputation  at  upper 

Gangrene  of  stump.     Died  Sept. 

Iowa,  age  52. 

1864. 

accident  ;   abscesses  ;  mortifi 

1864. 

third  of  thigh.     A.  A.  Surg. 

2,  1864,  of  pyaemia. 

cation. 

R.  W.  Coale. 

118 

Jones,  H.,  Pt.,  D,   1st  New 

Mar.  13, 

Left  leg  crushed  and  right  foot 

Mar.  13, 

Double  flap  amputation  lower 

Died  March  28,  1865. 

York  Cavalry,  age  17. 

1865. 

contused  ;  railroad  accident. 

1865. 

third  of  left  thigh.     Act.  Staff 

Surg.  N.  F.  Graham. 

119 

Kellins,    D.    II.,    .Serg't,    G, 

Sept.  24, 

Fracture  of  left  leg,  including 

Sept.  28, 

Double  flap  amputation  middle 

Died  October  1,  1864. 

81st  Indiana,  age  30. 

1864. 

ankle  joint  :  railroad  accident. 

1864. 

third  of  thigh.     A.  A.  Surg. 

J.  B.  McPherson. 

120 

King,  F.  J.,  Pt.,  C,  6th  Ten 

Jan.  26, 

Comp'd   comminuted   fracture 

Jan.  27, 

Circular  amp.  at  middle  third 

Semi-moribund.      Died  January 

nessee,  age  22. 

1865. 

right  tibia,  fibula,  and  lower 

1865. 

of  thigh.     A.  A.  Surg.  H.  S. 

27,  1865. 

third  femur;  railroad  accid't. 

Streeter. 

121 

Iving  J     freedman 

Mar.  —  , 

Right  leg  run  over  by  a  dray  ; 

May  28, 

Circularamp.  lowerthird  thigh. 

Died  June  4,  1864. 

1864. 

gangrene. 

1864. 

A.  A.  Surg.  B.  E.  Dodson. 

122 

Kitteredge,   A.,   Pt.,  H,   4th 

Jan.  —  , 

Subcutaneous  cellular  inttam. 

Mar.  18, 

Circularamp.  lowerthird  thigh. 

Died   March  19,  1864,   of  shock 

Vermont,  age  56. 

1864. 

left  foot  and  leg  ;  gangrene. 

1864. 

Ass't  Surg.  A.  Ingram,  U.S.  A. 

and  exhaustion. 

123 

Leeds,    A.    P.,   Pt.,  H,  10th 

May  5, 

Laceration  of  foot  around  heel 

May  10, 

Flapamputation  thigh  at  lower 

Died  May  12,  1864,  from  effects 

Indiana  Cavalry,  age  24. 

1864. 

and  up  tendo-achilles:  railr'd 

1864. 

third.    Surg.  C.  N.  Hoagland, 

of  gangrene. 

-   accident  :  gangrene  in  leg. 

71st  Ohio. 

124 

Lindsley,  E.  D.,  Pt.,  D,  114th 



Scrofulous    abscess    involving 

Mar.  16, 

Lateral  flap  amp  at  lower  third 

Died  March  20,  1864,  of  exhaus 

Illinois. 

left  knee  joint. 

1864. 

thigh.  A.  A.  Surg.J.  E.Wilson. 

tion. 

125 

Lucas,  S.,  colored  employe 

May  9, 

Comp'd  comminuted  fracture  of 

May  9, 

Antero-posterior   flap   amp.  at 

Sloughing.     Died  July  1,   1864, 

Quartermaster's  Dep't. 

1864. 

right  tibia  and  fibula  ;  railroad 

1864. 

lower  third  of  thigh.     A.  A. 

of  diarrhoea. 

accident. 

Surg.  B.  P.  Brown. 

126 

Matthews,  A..  Serg't,  82d  Co. 

May  22.    Comp'd  fracture  of  left  leg  near 

June  4. 

Circularamp.  lower  third  thigh. 

Haemorrhage.  '  Died  June  1  9,  '64, 

2d  Vet.  Res.  Corps,  age  31. 

1864. 

ankle  bv  railroad  cars. 

1864. 

A.  A.  Surg.  G.  P.  Norris. 

of  pysemia. 

127 

Miller.  M.  G.,  Pt.,  F,  87th  N. 

Aug.  16,   Contusion  resulting  in  slough- 

Sept.  1, 

Amputation  at  middle  third  of 

Oct.  fi,  hsem.     Died  Oct.  11,  1862, 

York,  age  23. 

1862.         ing  ulcer. 

1862. 

thigh. 

of  marasmus. 

128 

Moore.    M.  B..    Pt.,    B,   6th 

Dec.  3,     Injured  by  railroad  accident.  . 

Dec.  25, 

Amputation  at  juncture  lower 

Died  Dec.  30.  1864,  of  pyremia. 

Maryland,  age  22. 

1864. 

1864. 

thirds  of  right  thigh. 

129 

O'nei'llv,  P..  Pt..  F,  5th  N. 

Nov.  5. 

Both  lec-s  mutilated  by  railroad 

Nov.  5. 

liiCflit  thigh  amput'dat  middle 

Died   November  5.  1864.     Spec. 

York  H'vy  Art.,  age  40. 

1864.             nn  rft 

1864           third      Sur".  T.  Sim,  1'.  S.  V. 

3470.  A.  M.  M. 

130 

Providence,  T.,  Pt,,  B,  55th 

July  4, 

Fract.  r't  femur  and  extensive 

July  5.  i  Circularamp.  at  up.  third  thigh. 

Died  July  (i,  1805.  from  effects  of 

Ohio,  age  25. 

1865. 

lacerat'nthiffh  :  railr'd  accid't. 

1865     |     A.  A.  Surg.  I).  J.  Griffiths.        i     shock. 

131 

Reams,  (>.  F..  Pt..  15,  U.  S. 

Mnr.  12,    Axe  wound  of  right  knee  joint. 

April  24.    Lateral  flap  amputation  upper    Died    May   1.   1S6-I.    of  pyaemia. 

Engineers,  age  23. 

1864. 

1864.         third  thigh.     Surg.  E.  Bent- 

Spec*.  2234,  22o3,A.M.M.   CASE 

ley,  IT.  S.V. 

529.  p.  363.  ante. 

132 

Robinson,    S..    I>t.,    C,    15th 

Nov.  —  ,    Necrosis  of  tibia  from  a  bruise  ; 

Jan.  0:1,    Circular  amputation  at  lower 

Died    February    13,    18155,    from 

Pennsylvania  Cav.,  age  22. 

1864.         periosteal   inflam.      Jan.    13. 

1865.         third  of   right    thigh.     Ass't 

exhaustion. 

1865,  portion  of  tibia  removed. 

Surg.  J.  C.  Thorpe,  U.  S.  V. 

133 

Rose,  J.,  Pt.,  B,  119th  Illi 

Simple  fracture  of  lower  third 

Sept.  5,    Circ.  amp.  at  lower  third  thiffh. 

Died  September  7,  1864. 

nois,  age  35. 

1864.    1     of  right  tibia  ;  gangrene. 

1864.         Surg.  J.  F.  Randolph,  U.  S.A. 

!                                                                    i 

670 


MISCELLANEOUS    INJURIES. 


[CHAP.  XT. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  or 
INJURY 

OR 

DISEASE. 

NATURE  OF  INJURY  OK     • 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  ANI>  REMARKS. 

134 
135 

136 

137 
138 
139 

140 
141 

142 
143 

144 
145 

146 
147 
148 
149 

Searle,  T.  E..  Lieut.,  G,  1st 
New  York  Artillerv. 
Smith,   M.  V.,    Ft.,   A.    llth 
West  Virginia,  age  24. 

Smith,  O.  F.,  Serg't,  F,  69th 
Ohio,  age  ~'8. 

Storey,   R.  G.,  Pt.,  K,  95th 
Illinois,  age  44. 
Strouse.    A.,    Pt.,    G,    174th 

Oct.  31, 
1864. 
Sept.  19, 

1864. 

June  11, 
1865. 

Dec.  19, 

1864. 

Nov.  24. 
1863. 

A  32-pounder  gun  crushed  right 
thigh. 
Contusion  of  left  knee  joint  and 
fracture  of  patella;  fall  from 
a  horse. 
Comp'd  comin.  fnict.  heads  of 
right  tibia  and  fibula  and  obi. 
fract.  of  int.  condy  le  of  femur; 
r't  hand  injured  ;  railr'dacoid. 
Comp'd  comminuted  fract.  of 
right  leg:  railroad  accident. 
Abscess  of  right  thigh  ;  gan 
grene. 
Axe  wound  of  right  knee  joint  ; 
sloughing;  joint  extensively 
opened. 
Contusion  left  foot,  fracture  os 
calcis.  and  injury  of  ank.  joint 
by  a  fall  ;  gangrene. 
Fract.  left  leg,  rupture  femoral 
artery;  limb  tumefied;   rail 
road  accident. 
Accidental  injury  

Oct.  31, 

1864. 
Nov.  7, 
1864. 

June  11, 
1865. 

Dec.  lit, 
1864. 
Feb.  6, 
1865. 
Jan.  !5, 
1864. 

May  13, 

1864. 

Nov.  3, 
1864. 

Mar.  8, 
1864. 

Oct.  18, 
1864. 

Jan.  4, 
1865. 

Oct.  13, 
1864. 

April  26, 

18ii4. 

Nov.  !>. 
1863. 

Dec.  2.1, 
1  863. 

Amputation  at  upper  third  of 
thigh. 
Amp.  middle  third  thigh  by  lat. 
oval  skin  flaps,  circ.  sec.  muse. 
A.  A.  Surg.  J.  Xeff. 
A  ntero-  posterior  flap  amp.  of 
right  thigh  by  transfixion. 

Flap  amp.  at  lower  third  thigh. 
Surg.  S.  E.  Fuller,  U.  S.  V. 
Amputation  at  middle  third  of 
thigh. 
Circular  amputat'n  at  junction 
of  lower  thirds.     Surg.  S.  T>. 
Turney,  U.  S.  V. 
Antero-posterior  flap   amputa 
tion  of  thigh.     A.  A.  Surg.  F. 
F.  Maury. 
Flap  amputation  at  junction  of 
middle  and  lower  thirds. 

Amputation  of  left  thigh  

Lateral  flap  amputation  lower 
third  of  thigh.     Surg.  H.  W. 
Owiugs,  2d  E.  S.  Maryland. 
Circular  amp.  at  middle  third 
of  thigh.     Ass't  Surg.  R.  F. 
Weir.  U.  S.  A. 
Circular  amputation  at  middle 
third  of  thigh.     A.  A.  Surg. 
J.  C.  Morton. 
Circular  amputation  at   upper 
third  of  thigh.     Surg.  J.    C. 
Whitehall,  1!.  S.  V. 
Lateral  Hap  amputation  lower 
third   of  thigh.     Surg.  .1.    I!. 
McClurg,  U.  S.  V. 
Flap  amputation  at  upper  third 
of  thigh.     A.   A.  Surgeon  I). 
Cummins. 
Flap  amputation  at  lower  third 
of  thigh.     A.   A.  Surg.  J.  C. 
Marr. 

Died  November  1.  1864. 

Died  December  4.    186-1.   of  ex 
haustion. 

Died  June  30,  !S6:>,  of  pyaemia. 

Died  December  20,  1864,  of  shock. 
Died  Feb.  16,  1865,  of  pyaemia. 

Died  January  7,  1864,  of  exhaus 
tion.     CASE  527,  p.  360,  ante.. 

Died  May  13,  1864,  from  shock. 

Died  November  3,  1864,  of  ex 
haustion. 

Died  July  9.  1863. 

Secondary  haamorrage  from  fem 
oral   artery.    Died   March    28, 
1864,  of  haemorrhage. 
Died  October  24,  1864,  of  pyaemia. 
CASE  528,  p.  363,  ante. 

(Dec,.  25,  '64,  amp.  at  knee.)    Jan. 
6,  '65,  liaem.;  lig.  femoral  artery. 

Ohio,  age  20. 
Swift,  K.'B.,  Pt.,  H.  1st  Mich 
igan,  age  23. 

Taylor.  T..  Pt.,  D,  5th  Penn 
sylvania  Res.,  age  36. 

Thomas.  J.  I,.,  Pt..  E,  12th 
Missouri,  age  25. 

Tinkler,  F..  Pt.,  A,  18th  Illi 

1864. 

Nov.  1, 

1864. 

nois. 
Towne,  W.  H.,  Pt.,  A,  18th 
Connecticut,  nge  30. 

Turner.  R.  H..  Corp'l.  E,  1st 
Maryland,  age  23. 

Urban,    H.,  Serg't,   F,  20th 
Massachusetts,  age  2J. 

Vigor,   J.  H.,  Pt.,  I),  n.lth 
Ohio,  age  18. 

Walton,  J..  Pt.,  C,  72d  Ohio, 
age  43. 

Wilkins.  K.,  Pt..  H.  8th  Iowa, 
age  24. 

Wilson.  T..  Pt..  C.  7th  Yet. 
Reserve  Corps,  age  41. 

Nov.  17. 
1863. 

Oct.  3. 
1864. 

Feb.  —  . 
1864. 

Oct.  13, 
1864. 

April  7, 
1864. 

Oct.  20, 
1863. 

Right  ankle  crushed  by  railr'd 
accident.    Nov.  18,  1863,  amp. 
leg:  necrosis  of  tibia. 
Incised  \v'nd,  adze  penetrating 
left  knee  joint. 

Chronic  ulcers  of  left  leg  ;  gan 
grene;     flaps    sloughed    and 
condy  les  protruded. 
Comp'd  coinm.  fract.  right  tibia, 
fibula,  and  femur:  knee  joint 
involved:  railroad  accident. 
Compound  fracture  right  ankle 
joint;  railroad  accident  :  ery 
sipelas. 
Right  leg  crushed:  railroad  ac 
cident:    gangrene    involving 
knee  joint. 
Contusion  of  leg  :  ant.  surface  a 
Mack   slough    from   ankle  to 

Died  October  14.  1864,  of  shock. 
Died  May  I','.  lti(14,  of  pyiemia. 

1  >ied  January  24,  1865,  of  chronic 
diarrlitea  and  bronchitis. 

Varioloid  and  pleuro-pneumonia. 
Died   March  13,  1864,  of  pneu 
monia. 

Exarticulations  at  the  Knee  Joint. — Four  amputations  at  the  knee  joint  for  miscel 
laneous  causes  were  reported;  two  proved  successful,  two  fatal.  In  one  instance  amputation 
in  the  thigh  was  subsequently  performed: 

CASES  1000-1003. — Private  G.  Brown,  K,  34th  Illinois,  aged  54,  had  his  right  leg  crushed  in  a  railroad  accident,  .Septem 
ber  24,  1864;  circular  amputation  at  the  knee  joint  was  performed  on  the  same  day,  the  condyles  of  the  femur  being  sawn  off; 
gangrene  appeared  hut  was  checked  by  the  application  of  bromine;  the  patient  recovered. — Private  H.  Gertjahr,  D,  82d  Penn 
sylvania,  aged  45,  had  the  left  leg  removed  at  the  knee  joint  by  Surgeon  E.  Bentley,  U.  S.  V.,  on  March  7,  18G5,  for  necrosis  of 
the  middle  third  of  the  left  tibia.  He  was  discharged  the  service  June  4,  1805. — Sergeant  J.  Shearer,  A,  llth  Maryland,  aged 
28,  received,  on  May  20,  1805,  several  kicks  from  a  horse  which  caused  compound  comminuted  fractures  of  both  legs:  excessive 
haemorrhage  followed.  On  May  21st  the  left  leg  was  amputated  through  the  knee  joint,  retaining  the  patella  and  condy  les  of 
femur;  the  right  leg  was  removed  at  the  upper  third  by  the  an  tero- poster!  or  Hap  method;  Assistant  Surgeon  G.  M.  McGill, 
U.  S.  A.,  performed  both  operations.  The  patient  died  May  22.  18i>5. — Sergeant  H.  Urban,  F,  20th  Massachusetts,  aged  22, 
suffered  from  chronic  ulcers  of  the  left  leg ;  gangrene  set  in  and  the  lower  part  of  the  tibia  became  exposed  and  necrosed.  Act 
ing  Assistant  Surgeon  J.  H.  Parkard,  on  December  25,  18G4,  amputated  the  limb  at  the  knee  joint,  removing  the  patella;  the 
flaps  sloughed  and  the  condyles  protruded,  and  on  January  4,  1865.  circular  amputation  of  the  thigh  at  the  middle  third  was 
performed  by  Acting  Assistant  Surgeon  J.  C.  Morton ;  haemorrhage  subsequently  occurred,  and  on  January  6th  the  femoral 
artery  was  ligated  in  continuity.  The  patient  died  on  January  7th,  of  recurring  haemorrhage. 

Amputations  in  the  Leg. — Of  two  hundred  and  fifty-nine  amputations  in  the  leg 
the  results  were  determined  in  all  but  one  case;  one  hundred  and  eighty  were  followed  by 
recovery  and  seventy-eight  by  death,  a  mortality  rate  of  30.2  per  cent.  One  hundred  and 
forty-seven  were  for  fractures,  forty-four  for  frostbites,  seventeen  for  gangrene,  and  the 
remainder  for  various  accidents  and  diseases. 

CASE  1004. — Amputation  in  the  ley. — Private  C.  0.  F.  Clark,  Co.  G,  1st  Oregon,  aged  35  years,  was  frost-bitten  in  his  feet 
and  hands  while  on  march  between  Owyhee  and  Malheur  rivers,  Idaho,  December  17,  1865.  He  was  conveyed  to  Camp  Auburn, 
where  portions  of  the  lower  limbs  were  amputated  by  Acting  Assistant  Surgeon  M.  V.  Amen  on  January  17,  1866.  The  patient 
recovered,  and  was  mustered  outof  service  April  14,  1866,  and  pensioned.  Having  been  sent  East,  after  receiving  his  discharge  from 
service,  for  the  purpose  of  being  provided  with  artificial  limbs,  he  was  admitted  to  the  Post  Hospital  at  Washington  on  February  2, 


SECT.  II.J 


AMPUTATIONS    IN    THE    LEG. 


671 


1867,  whence  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  described  the  case  as  follows:    "The  operation  seems  to  have  been 

Chopart's,  on  the  right  foot,  which  had  entirely  healed  when  the  patient  was  admitted.     The  stump  was 

firm  and  well  formed,  but  so  sensitive  for  the  space  of  one  and  a  half  inches  from  the  cicatrix  that  the 

man  desired  the  limb  to  be  removed  at  a  point  above  the  ankle.     The  amputation  of  the  left  leg  had  been 

performed   about  six  inches  above  the  ankle  and  had  failed  to  close  from  the  presence  of  a  ligature. 

After  this  was  removed  the  stump  healed  entirely.     The  patient  had  also  lost  portions  of  the  phalanges 

of  both  hands  from  the  same  cause.     On  May  22,  18(57,  lie  was  furnished  transportation  to  New  York 

City  to  be  fitted  with  artificial  limbs."       These  were  supplied  by  the  firm  of  Monroe  and  Gardiner. 

Ke-amputation  of  the  stump  of  the  left  leg  subsequently  became  necessary  and  was  performed  by  Professor 

F.  H.  Hamilton,  at  Bellevue  Hospital,  on  November  9, 18b'8.     Several  years  later,  when  the  pensioner  was 

supplied  with  artificial  limbs  by  D.  W.  Kolbe,  of  Philadelphia,  both  stumps  were  reported  as  being  in  a 

sound  condition.     The  pensioner  was  paid  December  4,  1881.     Casts  of  the  stump  of  the  foot  and  of  the 

leg  were  prepared  at  the  Arrny  Medical  Museum,  and  constitute  specimens  4128  and  4191,  respectively,        FlG   37i._stmnp  after 

of  the  Surgical  Section.     The  latter  is  represented  in  the  annexed  wood-cut  (FiG.  371)  and  apparently     posterior  flap  amputation 

shows  the  amputation  to  have  been  performed  by  the  posterior  flap-method.1 

TABLE  CXI. 

Condensed  Summary  of  Two  Hundred  and  Fifty-nine  Amputations  in  the  Leg  for  Disease  or 

Miscellaneous  Injuries. 

[Recoveries,  1—180;  Deaths,  181—258;  Result  undetermined,  259.] 


No. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  OF 
INJURY 

OR 

DISEASE. 

NATURE  OF  INJURV  OR 
DISEASE. 

DATE 

OF 
Ol'ERA- 
TIO.V. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Aylesworth,  F.  P.,  Serg't,  E, 

Oct.  —  , 

Typhoid  fever,  resulting  in  hos 

Jan.  4, 

Amp.  right  leg,  middle  third, 

Discharged  February  27,  1862. 

5th  Vermont. 

1861. 

pital  gangrene. 

1862. 

circular,  and  all  toes  left  foot. 

2 

Baker,    C.  R..    Pt.,   E,  llth 

May  —  , 

Scrofulous  ulcers  from  chafing 

Den.  —  , 

Amp.  left  leg,  lower  third,  flap. 

Discharged  April  18,  1865. 

Massachusetts. 

J'ne,'64. 

of  boot  during  marching. 

1866. 

Dr.  J.  H.  Bigelow,  of  Boston. 

3 

Banks,   A.  M.,  Pt.,  H,  13th 

Running  sores  of  leers,  the  re- 

June  3. 

Amp.  left  leg,  upper  third.    Dr. 

Must'd  out  Aug.  6,  1861.    Stump 

Pennsylvania,  age  32. 

1861. 

suit  of  fever;  necrosis  of  both 

1869. 

J.  VV.  King,  Covington,  Ky. 

healed;  right  leg  improved  af 

tibias. 

ter  amputation  of  left. 

4* 

Bates,   C..   Corp'l.    E,   20th 

Jan.  —  , 

Frostbite  and  gangrene  in  both 

April  25, 

Amp.  both  legs,  lower  thirds, 

Discharged  Oct.  21,  1865:  sound 

5j 

Maine,  age  31. 

1865. 

feet,  contracted  in  rebel  prison. 

1865. 

antcro-posterior   flap.     A.  A. 

stumps. 

Surg.  A.  J.  Smith. 

6 

Bell,   W.    H.,    Pt.,    I),    3!!d 

July  20, 

Comp'd  fracture  lower  third  by 

Aug.  8, 

Amput'n  right  leg,  upper  third, 

Discharged  December  15,  1863. 

Kentucky. 

1863. 

wagon  wheel;  severe  injury 

1863. 

flap.    Dr.  Moore,  Greensburg, 

to  ankle  joint  ;  mortification. 

Kentucky. 

7 

Best,  R.,  Pt..  D,  1st  N.   Y. 

Dec.  1, 

Disorganization   of   right   foot 

May  1, 

Amp.  right  leg,  upper  third,  bi 

Discharged  October  14,  1865. 

Mounted  Rifles,  age  41. 

1864. 

and  ankle  joint  from  burn. 

1865. 

lateral  flap.     A.  A.  Surg.  L. 

McLean. 

8 

Bishop,  R..  Government  em 

Aiiff.  17, 

Right  ankle  joint  crushed  by 

Aug.  17, 

Amput'n  right  leg,  lower  third, 

Recovered  September  25,  1864; 

ploye,  age  28. 

1864. 

railroad  accident. 

1864. 

posterior  flap.     Snrg.   J.   L. 

stump  entirely  healed. 

Roe,  137th  Indiana. 

9 

Bond,  J.,  Pt.,  A,   149th  Illi 

Feb.  26, 

Right  leg  crushed  by  railroad 

Feb.  26, 

Amp.  right  leg,  middle  third, 

Discharged  July  25,  1865. 

nois,  age  20. 

1865. 

accident. 

1865. 

circular.  Surg.  J.  H.Phillips, 

U.  S.  V. 

10 

Bond,  J.,  Pt,,  K,   150th  Illi 

May  5, 

Hight  leg  injured  by  railroad 



Amputation  right  leg,  middle 

Discharged  July  25,  1865. 

nois. 

1865. 

accident. 

third. 

11 

Boon,  N.,  Pt.,  E,  2d  Colored 



Scrofulous    disease,  involving 

Dec.  11, 

Amp.  right  leg,  junction  upper 

Discharged  July  14,  1866;  sore 

Cavalry. 

bones  of  right  leg. 

1865. 

and  mid.  thirds.     A.  A.  Surg. 

stump. 

A.  McLetchie. 

12 

Bouchsein,    T.    E..    Pt..    A, 

May  2, 

Com.  fracture  of  left  foot  and 

May  3, 

Amp.  left  leg.  upper  third,  flap. 

Discharged  October  12,  1864. 

68th  New  York. 

1864. 

ankle  joint  by  railroad  aceid't. 

1864. 

Surg.  L.  Schultz,  68th  N.  Y. 

13 

Branson,  D.  A..  Pt..  C.  73d 

Afar.  —  , 

Erysipelas,    gang.,   abscesses, 

Jan.  10, 

Amp.   right   leg,  lower  third. 

Discharged  July  19.  1865:  stump 

Illinois,  age  25. 

1805. 

and  diseased  bone  from  abra 

1866. 

post.  flap.     Dr.  R.  H.  Buck. 

healed. 

sion  of  foot. 

late  surgeon  13th  Ind.  Cav. 

14 

Brazier,  J.,  unassigned   Re 

Mar.  28, 

Injury  to  right  leg  by  railroad 

Mar.  28, 

Amp.  right  leg,  middle  third, 

Discharged  July  19,  1865. 

cruit,  Vet.  Vols.,  age  22. 

1865. 

accident. 

1865. 

flap.     Dr.  W.  \V.  Rutherford, 

Harrisburg,  Penn. 

15 

Brockwav,  M.,  Pt  ,  I.    47th 

June  22, 

Comminuted  fracture  right  leg 

June  22, 

Amp.  right  leg.  middle  third. 

Discharged  May  8,  1864. 

Ohio. 

1863. 

by  falling  tree. 

1863. 

Surg.  S.  P.  Bonner,47th  Ohio. 

16 

Brown,   A.    R.,    Pt,,    I),    3d 

Dec.  5, 

Opening   in   right  ankle  joint 

Jan.  3, 

Amp.  right  leg,  junct.  middle 

Must'd  out  July  27,  1865;  stump 

Vermont,  age  20. 

1863. 

and  ill-conditioned  leg  from 

1866. 

and  lower  thirds,  circ.    Dr.  L. 

healed.     Died  April  10,  1867. 

a  misstep. 

Richmond,  Derby,  Vermont. 

17 

Brown,  C.,  Pt.,  H.  9th   Mis 

April  15, 

Left  leg  fractured  by  railroad 

April  15, 

Amputation    left     leg,    upper 

Discharged  November  17,  1865. 

souri. 

1865. 

accident. 

1865. 

third,  flap. 

18 

Brown,    C.    E.,    Pt..    G,    1st 

Jan.  3, 

Frostbite  of  left  foot  followed 

Mar.  15, 

Amp.  left  leg,  lateral  skin  flaps 

Discharged  May  16,  1865. 

Massachusetts  Heavy  Artil 

1865. 

by  ulceration. 

1865. 

and  circular  section  muscles. 

lery,  age  22. 

A.  A.  Surg.  B.  B.  Miles. 

19 

Brown,  R..  Pt.,  G,  31st  Ohio. 

Feb.  1. 

Left   leg  crushed  by  railroad 

Feb.  1, 

Amp.  left  leg,  upper  third,  ant. 

Discharged  September  24,  1864. 

1864. 

accident. 

1864. 

posterior  flap. 

20 

Buckner,  A.  J.,   Pt.,  E,  4th 

July  19, 

Axe  wound,  fraet'g  phalanges 

Dec.  10, 

Amp.  right   leg,    lower  third, 

Discharged  August  7,  1865. 

Iowa  Cavalry,  age  27. 

1864.         and  met.  bones  3d  toe,  r't  to  jt  : 

1864. 

flap.      Surg.   M.  K.  Taylor, 

ulceration  .and  sloughing. 

U.  S.  V. 

21 

Burns,  J.,  Pt.,  A,  17th  New 

June  20,   Coinp'd   tract,  right  foot  with 

June  20, 

Amp.   right   leg.   lower  third, 

Discharged  November  14,  1865. 

- 

York,  age  21. 

1865.         great  destruction  of  soft  parts, 

1865. 

circular,  and  left  thigh  in  up 

and  comp.  fracture  left  thigh, 

per  third.     A.  A.  Surg.  R.  P. 

mid.  third,  by  railr'd  accid't. 

Johnson. 

22 

Burns,  J.,  Pt.,  (',.  30th  Penn.     Jan.  28, 

Right  leg  injured  by  railroad 

Jan.  2?, 

Amputation   right   leg,    upper 

Discharged. 

Cavalry,  age  18. 

1864. 

accident. 

1864. 

third,  flap. 

23 

Callaway,  A.  K..  Pt..  A,  115th 

Sept.  9, 

Fracture  of  left  leg  above  an 

Sept.  9, 

Amp.  left  leg,  upper  third,  flap. 

Discharged  March  25,  lP6.r>. 

Illinois,  age  22. 

1863. 

kle  by  railroad  accident. 

1863. 

Ass't  Surg.  J.  A.  Jones,  115th 

Illinois. 

24 

Carson,  E.,  Pt.,  1st  Kentucky 

Sept.  12, 

Right  leg  crushed  by  cannon 

Sept.  12, 

Amp.  right  leg,  flap,  mid.  third. 

Discharged  December  2.  1862. 

Battery.                                         ISC.1.         wheel. 

1862. 

Ass't  Surg.  R.F.Weir.U.S.A. 

672 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


DATE  OK                                                         i    DATK 

NO. 

NAME,  MILITARY 

iNjt-RY        NATURE  OF  INJURY  OR            or 

OPERATION    AMI   Ol'KRATOU.               RESULT  ANIt   REMARKS. 

DESCRIPTION,  AND  AGE. 

OR                       DISEASE.                    OIT.IJA- 

DlSEASE., 

TION. 

23 

Caton,  G.  W..  Pt..  M,  2d  E. 

July  25,   Left  foot  and  ankle  crushed  by 

July  25, 

Amp.  left  leg  3  inches  above 

Gangrene.    Discharged  April  24, 

Tennessee  Cavalry. 

1863.         railroad  cars. 

1863. 

ankle,    circular.      Surg.  W. 

1865. 

Hobbs,  85th  Indiana, 

26 

Christoflerson.  J.,Pt..  E,  10th 

July  10,   Left  leg  torn  off  and  left  thigh 

July  11. 

Amp.  left  leg.  upper  third,  circ. 

Discharged. 

Veteran  Reserve  Corps. 

1864. 

fractured  by  railroad  accid't. 

1864. 

Dr..).  Evans,  Havre-de-Grace, 

Maryland. 

27 

Clark,  C.  O.  I-'.,  Pt.,  G,   1st 

Dec    17     Frostbite  of  both  feet 

Jan.  17, 

Amp.  left  leg,  mid.  third,  and 

Disch'd   April   14,   1866.     1870, 

Oregon. 

1865. 

1866. 

right  foot.     A.  A.  Surg.  M.V. 

sound  stumps.     Specs.  4128  and 

Aman.    Nov.  9,  1868,  re-amp. 

4191,  A.M.  M. 

in  upper  third. 

28 

Clark,  T.  W.,  Chaplain,  99th 

May  10, 

Injury  of  left  2d  toe,  resulting    Jan.  21, 

Amputation  left  leg,  low.  third, 

Disch'd  Feb.  11,  18(53.     (Nov.  26, 

New  York,  age  42. 

1862. 

in  painful  deformity  and  par-       1863. 

flap. 

1862,  amp.  left  2d  too.)     Feb.  7, 

tial  dislocation. 

1872,  amp.  thigh,  lower  third; 

recovered. 

29     Collins.    P..    Pt.,    I.  29th  In 

July  2. 

Left  leg  injured  by  railroad  un 

July  2, 

Amp.  left  leg,  low.  third.  Surg. 

Recovered  Aug.  13,  1865.     (Dis 

diana,  age  28. 

1865.          cident. 

1865. 

F.  B.  Kimball,  3d  N.  H. 

charged  soldier.) 

:io 

Conn,  S..   Pt.,  G,   18th   Mis 

Jan.  17,    Comp'd  fracture  left  leg  by  a 

Feb.  1, 

Amput'n  left  leg,  middle  third. 

Discharged  April  10,  1862. 

souri,  agO  2-.'. 

1862. 

fa  11  from  a  wagon. 

1862. 

Surg.  W.  Varian,  U.  S.  V. 

:; 

Connell,  J..  Pt..  A.  51st  Illi- 

Oct.  31, 

Left  leg  injured  l>v  railroad  ac- 

Oct.  31. 

Amp.  left  leg.  mid.  third,  flap. 

Discharged  Mar.  23.  1865.     (Also 

inns,  ago  135.                                    1664.         cident. 

1864. 

Dr.  J.  Northrup,  Woodstock, 

wound  right  thigh.) 

Illinois. 

:K 

Cranc.   !£.,  Pt.,  E,  89th   Illi 

Jan.  Hi,     Axe  wound  of  right  foot  :  ery- 

Mar.  5. 

Amput'n  right  leg,  lower  third, 

Discharged  June  14,  1864. 

nois,  age  30. 

1864.         sipelas  ;  necro.  of  tarsal  bones. 

1864. 

antero-post.  skin  flap.     Surg. 

H.  T.  Legler.  U.  S.  V. 

33 

Cummins,  J.  W..  Pt.,  L,  5th 

Feb.  —  ,   Slough  'g  and  unhealthy  condi- 

May  10    Amputation  of  both  legs,  lower 

Discharged  Aug.  2,  1865.    (Fob.. 

34) 

Michigan  Cavalry,  age  22. 

1865.         tion  of  stumps  following  amp. 

1865. 

thirds,   flap.     A.  A.  Surg.  E. 

1865,  amputation   both   feet  at 

of  both  feet  at  ank.  j't  on  ace. 

Seyffarth. 

ankle  joint.) 

of  scurvy  contracted  in  prison. 

331 

Dougherty.  B.T.,  Pt.,  K,  31st  Gangrene  of  both  feet  follow- 

April  17,    Amp.  both  legs,  lower  thirds, 

Discharged  October  13,  1865. 

36} 

Illinois,  age  22.                                             ing  frostbite  while  prisoner  of 

1865. 

circular.     A.  A.  Surg.  F.  E. 

war. 

Martindale. 

37 

Davis.  J..  Pt.,  B,  31st  Wis 

Mar.  2, 

Left    leg  injured    by   railroad 

Mar.  2, 

Amput'n  left  leg,  upper  third. 

Discharged  August  29,  1863. 

consin. 

1863. 

accident. 

1863. 

:$8 

Dees,    G.    W..    Pt.,   E,    13th    Doe.  13.     Frostbite  of  both  lees  

Dec.  16, 

Amp.  both  legs,  lower  thirds. 

Discharged  June  2,  1866. 

39 

Missouri  Cavalry,  age  23. 

1865. 

18,  1865. 

Ass't  Surg.  D.  G.  Wilson,  1st 

Michigan  Cavalry. 

40 

Do  Long.   U.  1..,  Pt.,  15,  5th 

Mar.  24,    Comp'd  fract.  both  bones  right 

Mar.  24, 

Amp.  right  leg,  junct.  middle 

Discharged  November  4,  1865. 

Vermont,  age  20. 

1864.         leg  by  railroad  accident. 

1864. 

and  lower  thirds,  flap. 

41 

Dor.nis,  F..  Pt..  K.  98th  Illi-    Sept.  8,    Left   leg   injured    by  railroad 

Sept.  8, 

Amput'n  left  leg,  upper  third. 

Discharged  July  30,  1863. 

imis.                                           |    1862.         accident. 

1862. 

i  -' 
J.J 

Devine.  P.,  citizen,  age  17...  Sept.  14.   Comp'd   comminuted   fracture 

Sept.  14. 

Circ.  amp.  both  legs,  low.  th'ds. 

Gangrene.     Recovered  June  24, 

4.}  . 

1863. 

of  bones  of  both  legs. 

1868. 

A.  A.  Surg.  T.  H.  Stillwell. 

1864.     Spec.  1844,  A.  M.  M. 

44 

Dohertv.  E.,  Pt.,  D,  9th  Mas 

Feh    0 

('omn'd  coin,  t'nie.ture  of  bones 

Feb.  24, 

Amput'n  right  leg,  upper  third. 

Mustered  out  June  21,  1864. 

sachusetts,  age  40.                     1864.         right  leg  by  kick  of  a  mule. 

1864. 

Surg.  J.  F.  Sullivan.  Oth  Mass. 

45 

Dolaway,    11.,    Pt..   D,   50th    Aug.  15.   Comp'd   coin,   fracture   of  left 

Aug.  15. 

Antero-posterior  flap  amp.  left 

Discharged  June  28,  1865.    Spec. 

Pennsylvania,  age  17. 

1864. 

foot  by  railroad  accident. 

1864. 

leg,  lower  third.     A.  A.  Surg. 

251,  A.  M.  M. 

W.  C.  Merrillat. 

4M 

Douglas.  S.,  Governrn't  em- 

Dec.  20 

Frostbite  of  both  feet   

FeD.  — 

Circular  amput'n  of  both  limbs 

Recovery  slow. 

47) 

plove.  age  3:i. 

1863. 

1864. 

1  inch  above  ankle  joint. 

48 

Doyle,  T.,  Pt.,  G,  14th  Con 

April  24, 

Comp'd  com.  fracture  left  leg 

April  24, 

Flap  amp.  left  leg  2  ins.  below 

Discharged  August  1.  1865. 

necticut,  age  28. 

1864. 

by  railroad  accident. 

1864. 

knee.  Surg.Z.E.  Bliss,  U.S.V. 

49 

Dunlap,   O.',   Capt.,   I,    26th 

Dec.  28, 

Injury  of  right  foot  and  right 

Dec.  28, 

Amput'n  of  right  leg  at  lower 

Discharged  May  1  5,  1  665.     (  A  Iso 

Illinois. 

1864. 

hand  by  railroad  accident. 

1864. 

third.      Surg.  O.  Hoyt,  30th 

nmput'n  right  forearm.)    Stump 

Wisconsin. 

well  healed. 

50 

Dunn.   W.   F  .    Pt..    I,   192d    Aug.  12, 

Fracture  mid.  third  right  tibia 

Aug.  12, 

Circular  amputation  mid.  third 

Jan.  1,  1865,  amp.  in  right  thigh, 

Pennsylvania,  age  20. 

1864. 

and  fibula  by  fall  from  a  rail 

1864. 

right  leg. 

lower  third.     Feb.  22,  ligatiou 

way  ear. 

femoral  artery;  recovery. 

51 

English,  C..  Pt.,  C,  12th  N. 

Nov.  30, 

Compound    fracture    of   right 

Nov.  30, 

Flap  amputation  of  leg  at  junc 

Discharged  June  7,  1865. 

Y.  Cavalrv,  age  33. 

1864. 

leg. 

1864. 

tion  of  upper  and  mid.  thirds. 

52 

Faulkner,    j.,    Pt.,    B,    13th 

April  21, 

Compound  fracture  right  foot- 

May  19, 

Flap  amputat  n  of  leg  at  lower 

Discharged  May  30,  1  866. 

Infantry. 

1865. 

by  railroad  accident. 

1865. 

third. 

53 

Feelv,  M..  Pt,,  C,  38th  New 

May  27, 

Left  leg  fractured  by  a  falling 

May  27, 

Amputat'n  in  middle  third  leg. 

Discharged  December  29,  1862. 

-.A  I 

Yofk. 

1862. 

tree. 

1862. 

Surg.  A.  J.  Berry,  38th  N.  Y. 

55 

Ferguson,  J.  C.,  citizen  

Nov.  18. 

Comp'd  com.  fract.  both  legs. 

Nov.  18. 

Circ.  amp.  both  legs,  low.  third. 

Transferred. 

•'•') 

1863. 

lower  third,  by  railr'd  accid't. 

1863. 

A.  A.  Surg.  T.  11.  Stillwell. 

56 

Fink,  J.,   Pt.,  G,   1st  Mary 

Aug.  30, 

Right  leg  and  left  foot  man 

Aug.  31, 

Amputation   right   leg  1J  ins. 

Discharged  Oct.  24,  1864.     (Also 

land  P.  11.  B.,  age  30. 

1862. 

gled  by  railroad  accident. 

1862. 

below  tuberositv  of  tibia.     A. 

loss  of  great  and  2d  toes  <;f  left 

A.  Surg.  J.  II.  Bartholf. 

foot.) 

57 

Fitzgerald,  W.,  Pt.,  A,  103d 

,  — 

Frostbite  of  left  leg  in  rebel 



Amputation  of  leg  at   middle 

Mustered  out  August  15,  1865. 

Illinois,  age  29. 

1865. 

prison. 

1865. 

third. 

58 

Fitzmier,  F.,Pt.,  D,  3d  New 

Dec.  13, 

Frostbite  of  both  feet  



Amputation  of  right  leg,  lower 

Amp.  of  right  foot  at  met.  phal. 

Jersey  Cavalry. 

18G4. 

third,  after  discharge. 

art.,  andgreattoe.  left  foot,  Dec. 

20,  1864.    Disch'd  July  5,  1865. 

59) 

Flack,  M.,  Pt.,  B,  135th  Penn 

Jan.  28, 

Injury  to  both  legs  by  railroad 

Jan.  28, 

Amputation  right  leg  5  inches 

Discharged  ;  sound  stumps. 

60) 

sylvania. 

1863. 

accident. 

1863. 

below  knee,  and  left  leg  4  ins. 

below  knee. 

(11 

Ford,  T.,  Corp'l,  F.  1st  Ala-   

Scrofulous  disease  of  right  foot, 

June  30, 

Antero-post.  flap  amp.  of  leg  at 

Discharged  November  4,  1865. 

bania  Cavalry. 

contracted    in    Andersonville 

1865. 

upper  third.     A.  A.  Surg.  J. 

prison. 

D.  Skeer. 

62 

Freeland.  J.  J..  Corp'l,  I,  74th    Oct.  18, 

Right  foot  crushed  

Oct.  18, 

Flap  amputation  of  leg,  lower 

Discharged  February  1,  1865. 

Indiana.                                      1864. 

1864. 

third.     Dr.  B.  Larrimer,  Mil- 

lersburg.  Indiana. 

63 

Funking,   11.,  Pt,,  D,  Oth  N.    Oct.  25,    Comp'd  fracture  left  foot  and 

Oct.  25, 

Circular  amp.  of  leg.  low.  third. 

Disch'dMay31.  1865.    (Alsoeire. 

Y.  Artillery,  age  23.                   1864.         right  arm  by  railroad  accid't. 

1864. 

Surg.  Z.  E.  Bliss,  U.  S.  V. 

amputation  arm.  middle  third.) 

64 

Gainey,  J.,  Pt.,  C,  ISth  New 

May  10.    P.ight   leg  fractured  by  fall  of 

May  10, 

Flap  amputation  of  leg.  middle 

Mustered  out  in  1865. 

York  Cavalry. 

1865. 

horse. 

1865. 

third.      Surg.  A.  C.  Walker, 

18th  N.  Y.  Cavalry. 

65 

Gardner.     M.,     Pt.,    I.     12th    Aug.  26.    Injury  «.f  right  foot  and  hand 

Aug.  27. 

Flap  amput'n  right  leg,  lower 

Disch'd    July    18,    1865.     (Also 

Colored  Troops.                         1864.    j     by  railroad  accident. 

1864. 

third.  Surg.  G.  Stegman,12th 

amputation  right  forearm,  lower 

Colored  Troops. 

third.)     Stumps  healed. 

66 

Garrett,  J.  W.,    Pt..    B.   1st     Sept.  4,  ,  Comp'd  tract,  of  bones  of  right 

Sept.  4, 

Circular  amputation  leg  in  up 

Discharged. 

Ohio  Artillery,  age  27.          :     1864.         leg  by  railroad  accident. 

1864. 

per  third. 

67 

Gates,   I,.,  Capt.,  H,  7th  In-   Sept.  15.   Left    leg   crushed  by  railroad 

Sept.  15. 

Flap  amp.  of  leg.  upper  third. 

Haemorrhage;    gangrene.      Dis 

diana.  age  24.                              1864.         accident. 

1864. 

Surg.  W.  M.  Wright,  79th  Pa. 

charged  May  15,  1865. 

68 

Geary,  J.,  Pt..  K,  liilst  New   _          _    Extensive  necrosis  of  tibia  and 

Mar  23, 

Circular  amp.  upper  third  leg. 

Disch'd  October  9,  1863.     Spec. 

York,  age  53.                                                large   sloughing    ulcer  from 

1863. 

Surg.  J.  J.  Reese,  U.  S.  V. 

2793,  A.  M.  M. 

injury  by  falling. 

SECT.  II  ] 


AMPUTATIONS    IN    THE    LEG. 


673 


I  NO. 

NAME,  MILITARY 
DEBCUIl'TION,  AND  AGE. 

DATE  OF 
INJURY 

OR 

DISEASE. 

NATURE  OF  INJURY  ou 
DISEASE. 

DATE 

OF 

OPERA 
TION  . 

OPERATION  AND  OPEKATOI;. 

RESULT  AND  REMARKS. 

69 

Gilbert,  J.  X..  Serg't,  B,  4th 

Feb.  4, 

Fracture  of  right  leg  by  kick 

April  5, 

Amputat'n  of  leg,  middle  third. 

Discharged  August  3,  1863. 

Michigan  Cavalry. 

1863. 

of  a  mule. 

1663. 

Ass't  Surg.  C.C.Gray,  U.S.A. 

70 

Glecson,    H.,    Pt.,  A,   140th 



Scurvy,  resulting  in  mortifica 

June  7, 

Amputat'n  upper  third  left  leg. 

(April  25,  1865,  amp.  right  thigh, 

New  York,  age  27. 

tion,  contracted  while  a  pris 

1865. 

Dr.  A.  M.  Leonard,  Lockport, 

mid.  third.)     Disch'd  Aug.  29, 

oner  of  war. 

New  York. 

1865;  stumps  healed. 

71 

Glover,  W.  A.,  1't.,  B.  18th 



Tubercular    synovitis    of    left 

May  5, 

Flap  amp.  leg  at  lower  third. 

Discharged  June  17,  1865;  stump 

Indiana. 

ankle  joint. 

1865. 

A.  A.  Surg.  S.  A.  Cummins. 

entirely  healed. 

12 

Grady,  M.,  Pt.,  A,  48th  Ohio. 

A  tiff.  9, 

Left  ankle   joint  fractured  by 

June  13 

Flap  amp.  leg,  lower  third.  Dr. 

Discharged  ;  good  stump. 

1863. 

explosion  of  steamboat. 

1867. 

W.  H.  Mussey.  Cincinnati. 

73 

Griffin,   K.    D..  Pt.,  B,  40th 

Oct.  26, 

Right  leg  crushed  by  cannon 

Oct.  26, 

Flap  amput'n  leg,  upper  third. 

Discharged  February  23.  1862. 

Illinois. 

1861. 

falling  on  it. 

1861. 

Surg.  S.  W.  Thompson,  40th 

Illinois. 

74 

Griswold,  F.  N.,  Saddler.  G, 

May  1, 

Sprain  of  right  ankle;  inflam- 

Dec.  26, 

Flap  amputation  of  leg  at  up 

Mustered  out  \ov.8,  1865.     Died 

2d  New  York  Cavalry,  age 

1665. 

mat'n  of  synovial  membrane  ; 

1867. 

per  third. 

June  18,  1870,  of  consumption. 

21. 

carious  bone. 

75 

Hassett,  J.,  Pt.,  1,  13th  Mary 

Mar.  25, 

Comminuted  fract.  of  os  calcis 

April  9, 

Amp.  of  leg,  upper  third,  lateral 

Discharged  August  5,  1865. 

land  P.  H.  B. 

1865. 

android,  cuneiform  bone.right 

1865. 

flap  of  skin,  circ.  sect,  of  muse. 

foot,  by  railroad  accident. 

A.  A.  Surg.M  B.  McCausland. 

76 

Hatch,  G.,  Pt.,  M,  14th  Col'd 

May  22, 

Lower  third  right  leg  crushed 

May  24, 

Circularamp.  leg  at  junction  of 

Discharged;  gtump  healed. 

Heavy  Artillery,  age  23. 

1865. 

b}'  railroad  accident. 

1865. 

upper  and  middle  thirds.     A. 

A.  Surg.  D.  Shephard. 

77 

Hearn,  J.  M.,  Pt.,  A,  7th  Ten 

May—, 

Burn  of  left  leg,  at  Anderson- 

Sept.  9, 

Flap  amp.  of  leg,  lower  third. 

Discharged  July  13,  1865. 

nessee  Cavalrj'. 

1664. 

ville  prison. 

1864. 

Drs.  Elon  and  Pelat,  C.  S.  A. 

78 

Hockathorn,  —  ,  Pt.,  E,  100th 



(Edema    of    right    foot    from 

May  2, 

Amp.  of  leg  at  mid.  third.    Dr. 

Must'd  out  July  19,  '65;  healthy 

Pennsylvania. 

sprain  :  mortification. 

1866. 

M.  P.  Barker,  Newcastle,  Pa. 

stump. 

79 

Hoblitt.W.  S.,  Pt.,  82d  Ohio, 

Nov.  7, 

Comp'd  fracture  of  left  ankle 

Nov.  8, 

Antero  posterior  flap  amput'n 

Mustered  out  June  9,  1865. 

ag-e  35. 

1864. 

by  railroad  accident. 

1864. 

leg  at  middle  third. 

80 

Houghtaling,  H.,  Pt.,  B,  8th 

Sept.  20, 

Necrosis  following  sprain  right 

April  20, 

Ant.  flap  amp.  of  leg.  low.  third. 

Discharged  August  12.  1865. 

Michigan,  age  22. 

1864. 

ankle.  joint. 

1865. 

Surg.  R.  B.  Bontecou,  U.  S.V. 

81 

Housefelter,  J.,  Pt.,  M,  6th 

Nov.  15, 

Diffused  aneurism  left  post.  tib. 

Dec.  7, 

Amputation  leg  at  junct.  lower 

Discharged  March  3,  1863. 

New  York  Artillery. 

1862. 

artery  near  int.  mal.,  inj.  to 

1862. 

and  middle  thirds.     Surg.  J. 

artery  by  broken  glass  ;  haem. 

G.  Wood,  6th  N.  Y.  Artillery. 

82} 

Hurley,  T.,  Pt,,  K,  8th  Ten 

Mar.  7, 

Injury  of  both  legs  by  railroad 

Mar.  7, 

Amp.  right   leg,  upper  third, 

Mustered  out  July  17,  1865. 

83  J 

nessee  Cavalry. 

1865. 

accident. 

1865. 

left  leg,   middle  third.    Drs. 

L.  C.  Brown  and  E.  B.  Root, 

Painesville,  Ohio. 

84)    Hnv.ird.  A..Pt..f!.l22d  Penn- 

Feb.  10, 

Frostbite  of  both  feet  

Mar.  10, 

Amp.  of  both  legs.  mid.  third. 

Discharged  August  11,  1863. 

*"        I 

85] 

sylvania. 

1863. 

1863. 

A.  Surg.  E.  Marshall,  124th 

New  York. 

86 

James,  H.,  Pt.,  G,  6th  Penn. 

May  28, 

Bones  of  right  leg  comminuted 

May  28, 

Antero-posterior  flap  amp.  leg, 

Discharged  September  7,  1865.  • 

Cavalry,  age  25. 

1865. 

at   middle  third  by  railroad 

1865. 

upper  third.     A.  A.  Surg.  H. 

accident. 

M.  Bellows. 

87 

Johnson,O.,  Pt.,  B,  44th  Wis 

Mar.  28, 

Left  inter,  malleolus  and  pos 

Mar.  28, 

Flap  amput'n  leg,  lower  third. 

Mustered  out  July  29,  1865. 

consin,  age  44. 

1865. 

terior  tibial  artery  severed  by 

1865. 

A.  A.  Surg.  J.  K.  Simmons. 

an  axe. 

88  ( 

Jones,  J.,  Pt.,  H,  llth  Penn. 



Typhoid  fever  ;  disease  of  both 

Mar.  22, 

Left  leg  at  up.  third,  right  leg 

Disoh'd  May  27,   1865.     (Sabre 

89$ 

Cavalry,  age  30. 

limbs,  resulting  in  gangrene. 

1865. 

at  lower  third,  circular.    A.  A. 

cut  in  lumbar  region  October  1  7, 

Surg.  A.  Claude. 

1864.) 

SO 

Jones,  S.,  1't.,  I,  30th  Iowa, 



Disease  of  both  feet,  ending  in 

Oct.  16, 

Flap  amputation    of   left   leg 

Nov.  6.  Chopart's  amp.  right  foot. 

age  21. 

1863. 

gangrene. 

1863. 

near  upper  third.     Surg.  N. 

Nov.  11,  int.  plantar  artery  tied. 

Gay,  U.  S.  V. 

Discharged  June  3,  1865. 

91 

Josephus,   M.,    Government 

July  23, 

Left  foot  crushed  by  a  wheel  ; 

Oct.  20, 

Oval  amp.  leg  at  junct.  middle 

December  31,  1864;  nearly  well. 

teamster,  age  25. 

1863. 

gangrene. 

1864. 

and  lower  thirds.    Surg.  T.  J. 

Wright,  G4th  Col'd  Troops. 

92 

Keffe,  J.,  Pt.,  D,  12th  Massa 

Aug.  14, 

Compound  fracture  right  ankle 

Aug.  14, 

Posterior  flap  amp.  of  leg  at 

Discharged  October  19,  1863. 

chusetts. 

1863. 

joint  by  railroad  accident. 

1863. 

junction  mid.  and  lower  thirds. 

93 

Keller,   J.   C.,    Pt.,   I,   49th 

Mar.  —  , 

Frostbite  toes  of  left  foot;  gan 

Nov.  —  , 

Flap  amput'n  leg,  lower  third. 

Discharged  May  15,  1865. 

Pennsylvania. 

1864. 

grene. 

1864. 

Dr.  B.  F.Wagonseller,  Selin's 

Grove,  Pennsylvania. 

94 

Kelly,  U.  F.,  Serg't,  B,  28th 

June  10, 

Right  foot  and  leg  crushed  by 

June  10, 

Amp.  leg  in  upper  third.   Surg. 

Discharged  July  10,  1862. 

Kentucky,  age  19. 

1862. 

railroad  accident. 

1862. 

A.  H.  Thurston,  U.  S.  V. 

95 

Kelsey,    j'..    Pt.,  I,  18th  In 

Nov.  15, 

Axe  wound  of  right  foot  ;  caries 

Sept.  26, 

Amputation  at  middle  third  of 

Discharged  Dec.  10,  1863;  stump 

diana,  ago  24. 

J862. 

extending  to  tarsus. 

1863. 

leg. 

healed. 

96 

Kenyon,  G.  \V.,  Pt.,  H,  46th 

Aug.  18, 

Right  foot  fractured  byrailroad 

Aug.  18, 

Flap  amp.  of  leg  at  lower  third. 

Mustered  out  July  16,  1665. 

Penn.,  age  25. 

1864. 

accident. 

1864. 

Surg.  S.  Hart,  U.  S.  V. 

97 

Kier,  I.,  Pt.,  A,  99th  Colored 

July  14. 

Right  foot  injured  by  railroad 

July  15, 

Flap  amp.  of  leg,  lower  third. 

Discharged. 

Troops. 

1864. 

accident. 

1864. 

Surg.  H.  E.  Huberich,  99th 

Colored  Troops. 

98 

Lambert.  II.  M.,  Serg't,  D, 

Oct.  10, 

Comp'nd  comminuted  fracture 

Oct.  25, 

Double  flap  amputation  of  leg 

HiRin.    Nov.  10.  amp.  thigh,  low. 

12th  Illinois  Cav'ry,  ago  30. 

1863. 

right  leg  by  fall  of  a  horse. 

1863. 

in  upper  third.     A.  A.  Surg. 

third.     Disch'd  July  30.    1864. 

W.  H.  Ensign. 

Specs.  1744  and  1879,  A.  M.  M. 

99 

Lasbander.  J.  B.,  Pt.,  L.  4th 

June  3, 

Loft  ankle  run  over  by  wagon  ; 

June  3, 

Amput'n  of  leg  at  lower  third, 

Discharged  November  3,  Ib65. 

New  York  Heavy  Artillery, 

1865. 

tibia  dislocated  and  low.  third 

1865. 

skin  flaps  and  circ.  section  of 

«ge  19. 

of  fibula  and  internal  malle 

muscles.     A.  A.  Surg.  A.  W. 

olus  broken. 

Merrill. 

100 

Leonard,  J.  S.,  Pt.,  B,  1st  N. 

May  28, 

Loft  leg  run  over  by  a  wagon  ; 

Mar.  15, 

Antero-post.  flap  amp.  of  leg  at 

Mustered  out,  Spec.2403,A.M.M. 

Jersey  Light  Artillery,  age 

1864. 

sloughing  and  necro.  of  tibia. 

1865. 

junct.  upper  and  mid.  thirds. 

45. 

A.  A.  Surg.  U.  B.  Watson. 

101 

Lewis.  C.,  Pt.,  B,  llfith  Col 

June  —  , 

Sprain  in  right  instep  

Feb.  1, 

Flapamp.  of  log  at  lower  third. 

Discharged  May  5,  1866. 

ored  Troops,  age  22. 

1865. 

1866. 

,A.  Surg.G.  M.  McGill,U.S.A. 

102( 

Lowe,    G.   S.,    1't.     F,   35th 

Ilosiut'il  vinfr   of  both  limb1? 

Jan.  12 

Cironl'ir    ininiit'ition    of    both 

Dischar"ed  May  2,  1863.     Died 

103J 

Massachusetts. 

1863.  ' 

legs  at  lower  third. 

August  5,  1867. 

104     Md'ann.  1!..  1't..  D,  92d  Illi- 

June  2, 

Comp'd  fracture  right  tibia  and 

June  2, 

Antero-posterior  flapamputat'n 

Discharged  June  28,  1865. 

nois,  age  43. 

1864. 

fibula  by  falling  timber. 

1864. 

leg.     Surg.  C.  Helm,  92d  Ills. 

105 

McDonald,    \V.   11.,   Pt.,    F, 

Dec.  1  1,    Right  foot  and  leg  crushed  by 

Dec.  11, 

Amputation  of  leg   in    middle 

Discharged  February  5,  1864. 

60th  New  York. 

1862.         railroad  accident. 

1862. 

third. 

100 

Mclntyre.     J.,    Pt.,    A,     3d 

Mar.  18, 

Left   foot   injured  by  railroad    Mar.  18. 

Flap  amp.  of  leg.  lower  third. 

Discharged. 

Pennsylvania. 

1865. 

accident. 

1865. 

Dr.  A.  B.  Carr,  St.Clnir.Penn. 

107 

McLnv!    W.,   Pt.,     G,    12th 



Comp'nd  comminuted  fracture 

Nov.  3, 

Antero-post.  flap  amp.  right  log, 

Gangrene  of  stump.    Jan.  15,  '64. 

Illinois. 

of  bones  of  right  log  by  ma-      1863. 

junct.  upper  and  middle  thirds. 

amputation  of  thigh,  low.  third. 

chinery. 

A.  A.  Surg.  W.  P.  Sweetl.iml. 

Discharged  July  5,  1864. 

108'  McQnade,  T.,   I't..   F,   69th 

July  26, 

Comminuted  fracture  left  ankle 

July2(i, 

Circular  amputation  of  leg  at 

Mustered  out  August  3,  1861. 

New  Yi.rk. 

1861. 

.joint  by  railroad  accident.             1861. 

middle  third. 

109 

Magly.  A.,  J't.,  F.  66th  Ohio. 

Oct.  29, 

Comminuted  fract.  both  bones 

Oct.  30, 

Antero-posterior   flap  amput'n     Discharged  May  17,  1865. 

age  37. 

1664.    i     of  loft  leg:  railroad  accident. 

1864. 

of  log  in  upper  third. 

110    Mahafley,    S.,   Pt.,   H,   30tli 

June  8,  ,  Right  leg  crushed  by  railroad    Juno  H, 

Flap  amp.  of  leg.  middle  third.  |  Mustered  out. 

Iowa. 

1865.        accident.                                         1865 

Surff.  S.  G.  U<urers.30th  Iowa,  i 

111—8,-) 


674 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AXU  AGE. 

DATE  OF 
INJURY 

OR 

DISEASE. 

NATUKE  OF  INJURY  OR 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

Ill 

Manson,    M.,    Pt.,   F,    21st 

Periosteal  inflam.  of  left  ankle 

June  15, 

Flap  amputation  of  leg,  lower 

Disch'd  January  12,  1863.     Died 

Maine. 

and  caries  of  tarsal  bones. 

1867. 

third.     Dr.  G.  E.  Brickett, 

Jan.  4,  1874,  of  typhoid  fever. 

112 

Manuel,  J.,  Contraband,  age 

Feb.  4, 

Comp'd  com.  fracture  of  leg  4 

Feb.  5, 

Posterior  flap  amputat'n  of  leg. 

Feb.  20,  ligation  of  anterior  tibial 

10. 

1864. 

inches  below   knee  joint  by 

1864. 

A.  A.  Surg.  C.  Pelaez. 

artery  for  haemorrhage.     Dis 

railway  cars. 

charged  December  15,  1864. 

113 

Marshall,  J.,  Corp'l,  B,  4th 

Jan.  1, 

Fracture  of  both  bones  of  left 

Feb.  10, 

Flap  amputation  of  leg,  middle 

Discharged  May  23,  1865. 

114 

Ky.  Cavalry,  age  25. 
Mason,  G.,  Pt..  C,  12th  Vet. 

1864. 
May  10, 

leg  by  fall. 
Left  foot  crushed  by  railroad 

1864. 
May  15, 

third. 
Circular  amp.  of  leg  at  junct.  of 

Discharged  July  19,  1865.     Re- 

Reserve  Corps. 

1864. 

accident. 

1864. 

middle  and  lower  thirds.     A. 

amputation  4  ins.  higher  Sept. 

A.  Surg.  J.  B.  Cutter. 

26,  1865.     Died  Dec.  24,  1868. 

115 

Mern-ii),  D.  G.,  Pt.,  B,  44th 



Phagedenic  ulcer  of  right  leg  ; 

Jan.  7, 

Antero-post.  flap  amp.  of  leg, 

Jan.  9,  haemorrhage.  Discharged 

Wisconsin,  age  40. 

sloughing  of  soft  parts. 

1865. 

upper  third.    Ass't  Surg.  J.  C. 

May  31,  1865. 

Thorpe,  U.  S.  V. 

116) 

Miller,  D.  W.,  Pt.,  A,  13th 

Dec.  —  , 

Loss  of  both  feet  from  frostbite. 

May  13, 

Amp.  left  leg  at  junct.  mid.  and 

Discharged  January  14,  1865. 

117} 

Kentucky  Cavalry,  age  18. 

1863. 

1865, 

lower  thirds  ;  amp.  right  leg 

• 

Feb.  1, 

at  junct.  of  middle  and  lower 

1866. 

thirds.     Dr.  H.  Owens. 

"    •   -    i 

Monran    M    Pt    H  3d  Col 

Jan.  1 

Frostbite  of  both  feet         .    .  . 

Jan.  25, 

Amput'n  of  left  and  right  legs 

Discharged  May  9,  1865. 

111*  [ 

ll'Jl 

ored  H'vy  Art.,  age  19. 

1864.' 

29,  '64. 

at  middle  thirds.    Surg.  H.  11. 

Hood,  3d  Colored  H'vy  Art. 

120 

Mullally,    J.,    Pt.,   C,    49th 

Dec.  8, 

Right  leg  injured  by  railroad 

Dec.  9, 

Amputat'n  of  leg  at  mid.  third. 

Discharged  June  18,  1865. 

Mass.,  age  18. 

1862. 

accident. 

1862. 

Dr.  W.  J.  Gilfillan,  Brooklyn 

College  Hospital. 

1O1 

Nash    J.   Pt.    H    5th  Penn. 

Scrofulous  caries   right  tibia, 

Jan.  8, 

Circular  amputation  of  leg  at 

Discharged  June  18,  1864. 

l-wl 

Cavalry,  age  31. 

the  result  of  an  old  fracture. 

1864. 

middle  third.     Ass't  Surg.  C. 
A.  McCall,  U.  S.  A. 

122 

Ohring,    C.,    Corp'l,   F,  42d 



Dry  gangrene  of  left  leg  

Sept.  9, 

Flap  amp.  of  leg,  upper  third. 

Discharged  May  10,  1864.     Spec. 

I  llililUl.'l.    ilfifG   2L. 

1863. 

A.  A.  Surg.  H.  M.  Lilly. 

1921,  A.  M.  M. 

123 

Older,  B.,  Pt.,  I,  68th  Ohio, 

Fob.  —  , 

Camp  fever  and  disease  right 

April  1, 

Amp.  of  leg  in  middle  third. 

Discharged  August  19,  1862. 

age  22. 

1862. 

foot  ;  excessive  ulceration. 

1862. 

A.  A.  Surg.  W.  R.  Burke. 

124 

Olds,  J.  K.,  Serg't,  B,  10th 

May  29, 

Coinp'ndfract.  mid.  third  right 

May  —  , 

Amputation  of  leg  below  knee. 

Discharged  June  14,  1865.  (Feb., 

N.  Y.  Artillery,  age  29. 

1864. 

tibia  and   fibula  by  a  blow 

1877. 

1865,  ends  of  tibia  removed.) 

from  a  cable. 

125 

Orne,  W.  H.,  Corp'l,  D,  16th 



Sore  on   left  leg,  followed  by 

Mar.  —  , 

Amputation  leg  in  mid.  third. 

Discharged  Aug.  20,  1863.    Died 

New  Hampshire. 

disease  of  bones  of  foot  after 

1870. 

Dr.  T.  Haynes,  Concord,  N.H. 

Jan.  5,  1874,  of  chr.  diarrhoea. 

debility  and  intermittent  fev. 

126 

Peaceley,   C.,   Pt,,   B,   49tb 

May  1  5, 

Compound  fracture  left  ankle 

May  15, 

Circular  amputat'n  of  leg,  low. 

Extensive  sloughing.     Mustered 

Indiana,  age  26. 

1865. 

by  railroad  accident. 

1865. 

third.     Surg.  J.  G.  Hatchitt, 

out  August  7,  1865. 

U.  S.  V. 

127 

Peck,  S.,  Pt..  C,  184th  New 

Sept.  17, 

Lacerated  wound    left  ankle, 

Sept,  17, 

Flap  amp.  of  leg,  lower  third. 

Discharged  July  18,  1865. 

York,  age  37. 

1864. 

opening  joint,  by  railr'd  acci 

1864. 

Dr.  D.  T.  Krebs,  Watsontown, 

dent. 

Penn. 

128 

Penny,  L.,  Pt.,  E,  llth  Ohio, 

Mar.  —  , 

Right  foot  and  leg  crushed  by 

Mar.  —  , 

Flap  amp.  of  leg  at  mid.  third. 

Discharged  June  26,  1865. 

age  22. 

1864. 

railroad  accident. 

1864. 

A.  A.  Surg.  R.  Wirth. 

129 

Perrigo,  C.  M.,  Pt,,  I,  143d 

Oct.  20, 

Necro.  of  left  ank.  j't  and  wast 

Sept.  24, 

Flap  amp.  of  leg,  middle  third. 

Discharged  September  17,  1863. 

New  York. 

1862. 

ing  of  leg,  the  result  of  sprain. 

1863. 

Dr.  F.  Hyde,  Courtland,  N.Y. 

130) 

Pcttibone,    S.,   Pt.,    D,   33d 

Mar.  2, 

Both  legs  injured  by  railroad 

Mar.  2, 

Flap  amp.  of  both  legs  in  mid. 

Discharged  August  4,  1865. 

131  j 

Illinois. 

1865. 

accident. 

1865. 

third.  Surg.G.P.Rex,  Ski  111. 

132 

Peuschke,    A.,    Corp'l,    K, 

Sept.  30, 

Right  leg  injured  by  railroad 

Sept.  30, 

Flap  amputation  of  leg,  middle 

Discharged  June  7,  1865. 

145th  New  York. 

1863. 

accident. 

1863. 

third. 

133 

Pike,  P.,  Pt.,  D,  1st  Colorado 

Nov.  21, 

Compound  fracture  of  left  leg 

Jan.  29, 

Amput'n  of  leg  in  upper  third. 

Discharged. 

Cavalry. 

1864. 

by  a  fall  from  a  horse. 

1867. 

Dr.  J.  W.  Hamilton,  Colum 

bus,  Ohio. 

134 

Poole,R.  \V.,  Pt.,  15th  Ohio, 

June  3, 

Left   leg  injured  by  railroad 

June  4, 

Double  flap  amp.  of  leg,  mid. 

Mustered  out  June  8,  1865. 

age  ]  9. 

1865. 

accident. 

1865. 

third.    A.A.Surg.C.  E.Boyle. 

135 

Quaid,  W.  II.,  Pt.,   L,   5th 

July  29, 

Left  leg  injured  by  horse  fall 

July  29. 

Flap  amputation  of  leg  in  mid 

Discharged  September  21,  1865. 

Pennsylvania  Cavalry. 

1865. 

ing  on  it. 

1865. 

dle  third. 

:'.u 

Redfuot,  G.,  Corp'l.  K,"  106th 

Feb.  20, 

Frostbite  of  left  foot  in  rebel 

Aug.  11, 

Circular  amp.  of  leg,  low.  third. 

Discharged  December  12,  1865. 

Pennsylvania,  age  29. 

1865. 

prison. 

1865. 

A.  A.  Surg.  E.  DeWitt. 

137 

Row,  M.  D.,  Corp'l,  E,  5th 

Aug.  15, 

Amp.  of  leg,  mid.  third.     Dr. 

Discharged  June  29,  1865. 

New  York  Cavalry. 

vy  contracted  in  rebel  prison. 

D.  Prince,  Jacksonville,  111. 

138 

Richardson,  J.,  Contraband. 

Dec.  2, 

Necrosis  of  lower  end  of  tibia 

Mar.  15, 

Posterior  flap  amp.  of  leg,  upper 

Good  result. 

1864. 

and  sloughing  ulcer  involving 

1865. 

third.     Surg.  F.  E.  Piquette, 

foot,  after  injury. 

86th  Colored  Troops. 

139) 

Robinson,  A.,  Pt.,  I,  8th  Col 

Dec.  18, 

Frostbite  of  both  limbs 

Feb.  — 

Amput'n  of  both  legs  in  lower 

Discharged  Juno  7,  1865  ;  sound 

140J 

ored  Troops,  age  26. 

1864. 

1865. 

third. 

stumps. 

141 

Rumpf,   J.,   Serg't,  B,  75th 

Mar.  15, 

Injury  to  right  leg  by  railroad 

Mar.  15, 

Flap  amputation  of  leg  at  mid 

Discharged  June  19,  1865. 

Pennsylvania. 

1865. 

accident. 

1865. 

dle  third. 

142 

Scott,  M.,  Pt.,  I,  14th  Ohio. 



Irritative  fever,  debility,  and 

April  19, 

Flap  amput'n  of  leg  in  middle 

Mustered  out  March  8,  1865. 

gangrene  of  right  foot,  result 

1865. 

third.     Dr.  S.  F.  Forbes,  To 

ing  from  imprisonment. 

ledo,  Ohio. 

143 

Severy,   W.  F.,    Pt.,   I,   3d 

Dec.  25, 

Left  leg  jammed  by  boat  against 

Dec.  25, 

Circular  amp.  of  leg,  mid.  third. 

Discharged  October  31,  1862. 

Vermont,  age  25. 

1861. 

wharf;  bones  of  foot  crushed. 

1861. 

Dr.  S.  Cabot.  Boston. 

144 

Shanger,    R.,   Pt.,  4th  New 

Julv27, 

Left   leg  crushed  by  wagon; 

Oct.  27 

Flap  amp.  of  leg,  upper  third. 

Discharged  October  21,  1865. 

Jersey  Lt.  Battery,  age  20. 

1864. 

gangrene  ;  necrosis  of  tibia. 

1864. 

A.  Surg.  T.  Calhoun,  U.S.A. 

145 

Simmons,    W.,     Substitute, 

Mar.  4, 

Right  foot  and  ankle  crushed 

Mar.  4, 

Circular  amp.  of  leg,  mid.  third. 

Discharged  July  8,  1665. 

age  32. 

1865. 

by  railroad  accident. 

1865. 

A.  A.  Surg.  J.  C.  Morton. 

146 

Skillin,  W.  E.,  Pt.,  H,  15th 

Jan.  17, 

Left  leg  cut  off  by  railroad  ac 

Jan.  17, 

Circular  amput'n  of  leg.     Ass't 

Discharged. 

Maine. 

1865. 

cident. 

1865. 

Surg.  G.  Z.  Higgins,  15th  Me. 

147 

Slater.   C.  H.,   Pt.,  D,  27th 

Dec.  28, 

Axe  cut  of  left  foot  

Jan.  8, 

Circ.  amp.  of  leg,  middle  third. 

Mustered  out  May  25,  1863.  Died 

New  York. 

1862. 

1863. 

Surg.  H.  Bryant,  U.  S.  V. 

January  8,  1872. 

148 

Smith,   J.   D.,    Pt.,   C,  74th 

Nov.  7, 

Left  leg  injured  by  railway  ac 

Nov.  7, 

Flap  amputation  of  leg  in  mid 

Discharged  April  25,  1865. 

Illinois. 

1864. 

cident. 

1664. 

dle  third. 

149 

Smith,  R.,  Pt.,  E,  100th  N. 

Sept.  13, 

Fracture  of  right  foot  by  rail- 

Sept.  13. 

Flap  amp.  of  leg,  lower  third. 

Discharged  December  4,  1864. 

York. 

1864. 

•road  accident. 

1864. 

Surg.  —  Hiland,  C.  S.  A. 

150 

Smith,  T.,  Contraband,  age 

Nov.  —  , 

Comminuted  fracture  of  leg  ; 

Jan.  25, 

Circular  amp.  of  leg  in  upper 

Recovered  in  30  days. 

33. 

1864. 

railway  collision. 

1865. 

third.     Ass't  Surg.  T.  A.  Mc- 

Graw,  U.  S.  V. 

151 

Snyder,  J.,  Pt.,  B,  51st  New 

Oct.  4, 

Comp'nd  fract.  left  ankle  and 

Oct.  4, 

Circ.  amp.  left  leg,  lower  third. 

Discharged  July  2G,  1865.    Spec. 

York,  age  27. 

1864. 

foot  by  railroad  accident. 

1864. 

A.  A.  Surg.  L.  Curtis. 

3676,  A.M.  M'. 

152 

Stacy,  A.,  Pt.,  H,  12th  Kan 

Mar.  20, 

Axe  wound  of  left  foot  ;  necro 

Aug.  15. 

Amput'n  at  lower  third  left  leg 

Discharged  December  31,  1864. 

sas,  age  51. 

1864. 

sis  of  bone. 

1864. 

by  Dr.  Clark. 

153 

Stevens,   J.  A.,   Pt.,  E,  1st 

,  

Erysipelas  of  right  foot 

Tnlv  °7 

T'ost  fl'irt  imt>ut'ilion  ri^ht  Iftr 

Discharged  September  8,  1865. 

Wisconsin  Cavalry. 

a  «*i.)    *-  *  , 

1865. 

A.  A.  Surg.  .1.  D.  Skeer. 

154 

Stone,  I.  M.,  Pt.,  M,  1st  Illi 

Oct.  21, 

Commin  ution  of  lower  end  right 

May  22. 

Short  ant.  and  long  post,  flap 

Discharged  December  28,  1864. 

nois  Artillery,  age  24.               1863. 

tibia  and  astragalus  by  fall-  !    1864. 

amp.  of  leg,  up.  third.     Surg. 

Spec.  2422,  A.  M.  M. 

ing  timber. 

H.  Culbrrtson,  V.  S.  V. 

SECT.  II.] 


AMPUTATIONS    IN    THE    LEG. 


675 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  OF 
INJURY 

OR 

DISEASE 

NATURH  OF  INJURY  OR 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMAKKS. 

155 

Stoner,  F.,  Pt.,  K,  57th  Penn 

Dec.  22, 

Right  foot  fractured  by  railroad 

Dec.  22, 

Circular  amputation   left  leg, 

Discharged  July  7,  1865. 

sylvania. 

1864.    ,     accident. 

1864. 

middle  third. 

156 

St.  Ong,  M.,  Pt.,  B,  7th  Ohio, 
age  34. 

Sept.  20,   Left  foot  and  ankle  crushed  by 
1863.         railroad  accident. 

Sept.  20, 
1863. 

Antero-post,  muse,  flap  ampu 
tation  of  leg,  middle  third. 

Discharged  January  23,  1864. 

1571 

Storer,  L.,  Pt.,  F,  105th  Illi 

Sept.  24,   Both  legs  injured  by  railroad 

Sept.  24, 

Flap  amp.  right  leg.     Surg.  J. 

Discharged  December  15,  1863. 

158J 

nois. 

1863. 

accident. 

1863. 

Bennett,    19th   Mich.     Circ., 

left  leg.     Ass't   Surg.  J.    K. 

Link,  21st  Illinois. 

159 

Taylor,    G.  H.,  Pt.,  H,   1st 

Sept.  23,   Fracture  of  left  tibia  and  fibula 

Sept.  23, 

Amputation  of  leg  

Transferred  to  prison  December 

N.  C.  Cavalry,  age  22. 

1863.        by  fall  of  horse. 

1863. 

15,  1863. 

160 

1  Taylor,  H.,  Serg  t,  B,  30th 

May  2,    Fract.  of  left  leg,  lower  third; 

May  18, 

Double  flap  amp.   leg,  upper 

Discharged  August  9,  1863. 

Illinois. 

1863.         basin.;  lig.  ant.  tibial  artery,     j    1863. 

third.     A.  A.  Surg.  L.  Dyer. 

161 

Thomas,  J.  C..  Pt.,  I,  8th  N. 

Dry  gangrene  of  right  leg  from 

April  5, 

Flap  amp.  leg,  up.  third.     Dr. 

Discharged  October  3,  1865. 

Y.  H'vy  Artillery,  age  19. 

exposure  in  rebel  prison. 

1865. 

M.  W.Townseml,  Byron,  N.Y. 

162 

Thompson,  H.,  Corp'l,  G,  5th 

Mar.  20,   Comp'd  dislocation  right  ankle  \  April  13, 

Flap  amp.  leg,  middle  third. 

Discharged  June  2,  1865. 

Tenn.  M't'd  Inf..  age  20. 

1865. 

outward  by  railroad  accident. 

1865. 

A.  A.  Surg.  A.  S.  Austin. 

163 

Thompson,  W.,  Boatswain's 

Oct.  27, 

Right  foot  contused  by  recoil 

Oct.  28, 

Amputat'n  of  leg,  middle  third. 

Discharged  Jan.  19,  1865.    Died 

Mate,  U.  S.  N. 

1864. 

of  gun. 

1864. 

May  I,  1874. 

164 

Troutman.  J.  W.,  Corp'l,  F, 

Sept.  16,  Fracture  of  right  leg  by  acci- 

Sept.  16, 

Flap  amp.  of  leg,  mid.  third. 

Discharged  April  1,  1863. 

40th  Indiana. 

1862. 

dent. 

1862. 

Dr.  D.  Funkhouber,  Indian 

apolis. 

165 

Trueheart,   G.  W.,   Pt.,    F, 

June  15, 

Fracture  of  right  leg  by  rail 

June  15, 

Circular  amp.  of  leg,  mid.  third. 

Discharged  May  30,  1865.    (May 

67th  New  York,  age  20. 

1864. 

road  accident. 

1864. 

A.  A.  Surg.  W.  C.  Merrillat. 

12,  '64,  amp.  arm,  lower  third.) 

166 

Underwood,  J.,  Pt.,  I,  103d 

June  6, 

Compound  fracture  of  left  leg 

July  2, 

Amputation  of  leg  below  knee. 

Haemorrhage.     Discharged  Nov. 

Illinois,  age  24. 

1863. 

by  railroad  accident. 

1863. 

A.  A.  Surg.  J.  Thompson. 

18,  1863.     Spec.  1704,  A.  M.  M. 

167 

Wallace,  B.,  Freedman,  age 



Old  ulcer  of  right  heel,  extend 

July  14, 

Oval  amptat'n  leg.  upper  third. 

Did  well. 

35. 

ing  up  leg  ;  gangrene. 

1864. 

Surg.  T.  J.Wright,  64th  C.  T. 

168 

Ward,  W.,  Pt.,  B,  60th  New 

May  10, 

Left  leg  injured   by  railroad 

May  10, 

Flap  ampt'n  leg,  middle  third. 

Discharged  September  16,  1862. 

York. 

1862. 

accident. 

1862. 

Surg.  J.  S.  Gale,  60th  N.  Y. 

169 

Watkins,  E.  D.,  Pt.,  H,  5th 

Feb.  21, 

Frostbite  of  both  feet  ;  amput'n 

Mar.  18, 

Amputation  right  leg  6  inches 

Recovered. 

Kentucky  Cavalry,  age  30. 

1864. 

both  feet  April,  1865. 

1866. 

below  knee. 

170 

Watson,    R.,    Pt.,    E,    10th 

Oct.  24, 

Left  leg  fractured  by  railroad 

Oct.  24, 

Amputation  of  leg,  mid.  third. 

Discharged. 

Tennessee,  age  23. 

1864. 

accident. 

1864. 

171 

Watt,  P.,  Pt.,  A,  28th  Mas 

Jan.  11, 

Left  leg  injured   by  railroad 

Jan.  11, 

Flap  amp.  of  leg,  lower  third. 

Discharged. 

sachusetts. 

1862. 

accident. 

1862. 

Jan.  14,  1864,  re-amputation. 

172 

Watts,  A.,  Pt.,  E,  73d  Illi 



Erysipelas  and  disease  of  bone 

Nov.  20, 

Circular  amp.  leg.  lower  third. 

Gangrene.      Discharged    March 

nois. 

1863. 

from  a  sprain. 

1863. 

Ass't  Surg.B.E.Fryer,U.S.A. 

15,  1865. 

173 

Way,  C.,  Pt.,  H,  47th  Iowa. 

Sept.  18, 

Left  foot  injured  by  railroad 

Sept.  18, 

Circ.  amp.  leg  at  low.  third.  Dr. 

Discharged. 

1864. 

accident. 

1864. 

Cherry,  Bloomington,  111. 

174 

Weed,  E.  D.,  Pt.,  I,  128th 

Oct.  11, 

Right  leg  crushed  by  railroad 

Oct.  11, 

Amp.  leg,  middle  third.   Dr.  T. 

Mustered  out  May  24,  1865. 

Indiana. 

1864. 

accident, 

1864. 

Higday,  Rolling  Prairie,  Ind. 

175 

Weidle,  J.  P.,  Pt.,  G,  29th 

Feb.  13, 

Right  ankle  dislocated  and  tib. 

Feb.  13, 

Teale's  rect.  flap  amp.     A.  A. 

Discharged  September  29,  1864. 

Ohio,  age  40. 

1864. 

and  fibula  fractured  by  falling 

1864. 

Surg.  A.  F.  Johnson  ;  gang.; 

building. 

re-amputated  May  7. 

176 

Wellirs,  W.,    Pt.,    K,    60th 

Illinois. 

June  15, 
1865. 

Fracture  of  bones  of  left  leg  by 
railroad  accident. 

July  30, 
1865. 

Amp.  leg,  junct.  upper  thirds. 
Dr.  Owens,  St.  Luke's  Hos 

Mustered  out  July  31,  '65.     Died 
Nov.  29,  1874,  of  consumption. 

pital,  Chicago. 

177 

Werner,  A.,  Pt.,  101st  Penn 

Mar.  11, 

Right  leg  injured  by  railroad 

Mar.  11. 

Amputation  leg  in  middle  third. 

Discharged  June  27,  1865. 

sylvania. 

1865. 

accident. 

1865. 

Surg.  S.  J.  Mintzer,  U.  S.  V. 

178) 

Williams,  B.,  Pt.,  I,  3d  Col 

Jan.  1, 

Both  legs  frostbitten 

Jan.  25, 

Oval  amp.  of  both  legs  at  junc 

Discharged  May  9  1865  *  stumps 

179/ 

ored  Heavy  Artillery,  age 

1864. 

1864. 

tion  lower  thirds.  Surg.  H.  H. 

healed. 

14. 

Hood,  3d  Col'd  H'vy  Art, 

180 

Wilson,  J.,  Government  em 



Necrosis  of  right  tibia  of  four 

Aug.  20, 

Flap  amput'n  leg,  upper  third. 

Convalescent. 

ploye,  age  23. 

years'  standing. 

1864. 

Surg.  E.  A.  Clark,  U.  S.  V. 

181 

Aenishield,    L.,   Corp'l,    H, 

Mar.  30, 

Right  foot  cut  by  an  axe  ;  swell 

April  19, 

Flap  amput'n  leg,  upper  third. 

Died  April  20,  1865. 

66th  Illinois,  age  19. 

1865. 

ing  and  inflammation. 

1865. 

A.  A.  Surg.  R.  J.  Lulder. 

182 

Black   H     Pt    D  3d  Maine 

Disease  of  left  foot  '  necrosis  of 

July  3 

CircuUir  Jimp,  leer  lower  third. 

Died  July  8,  1864. 

age  20. 

metatarsus. 

1864.  ' 

A.  A.  Surg.  W.  B.  Carey. 

183 

Buchanan,  D.,  Pt.,  F,   12th 

July  13, 

Contusion  of  left  foot  by  fall 

Aug.  6, 

Circularamp.  leg,  middle  third. 

Died  Aug.  6,  '64  ;  shock  and  loss 

Penn.  Cavalry,  age  17. 

1864. 

from  horse  ;  necrosis. 

1864. 

A.  A.  Surg.  A.  R.  Gray. 

of  blood.     Spec.  1839,  A.M.  M. 

184) 

Black,  J.,  Pt.,  I,  16th  Conn., 

April  24 

Died  April  27  1865  of  pxhiust'n 

O-VJ^    F 

185  j 

age  33.  ' 

captivity. 

1865. 

third'.  A.  A.  Surg.  E.  DeWitt. 

186 

Bowns,   W.  A.,  Lieut,   and 

May  21, 

Comp'd  com.  fract.  right  tibia 

May  21, 

Circ.  amp.  mid.  third  right  leg 

Died  May  21,  1865. 

Quartermaster,  15th  Conn., 

1865. 

and  fibula,  middle  third,  and 

1865. 

and  up.  third  left  thigh.  Surgs. 

age  26. 

left  femur,   middle  third,  by 

C.  A.  Cowgill,  U.  S.  V.,  and 

railroad  accident. 

Surg.  N.  Meyer,  16th  Conn. 

187 

Bryant,  B.,  Pt.,  B,  2d  East 

Sept.  1, 

Right  leg  inj.  by  falling  down 

June  8, 

Amputation   of  leg  at   upper 

June  11,  hamorrh.     Died  June 

Tennessee  Cavalry. 

1862. 

an  embankment  :  necrosis. 

1863. 

third. 

16,  1863,  of  pyaemia. 

188 

Bucke,  N.  F.,  Serg't  U.  S. 

Dec.  17, 

Left  leg  fractured  by  railroad 

Dec.  17, 

Amputation   of   leg   in   upper 

Died  December  17,  1861.     Spec. 

Marines. 

1861. 

accident. 

1861. 

third. 

20,  A.  M.  M. 

189) 

Coleman,   R.,    Pt.     B     83d 

Nnv 

Frostbitft  of  both  fppt  •  mortifi 

A  mnntltinn  ttf  V»r»th  Ipcrfi  }iAlmv 

Died  January  2  1  865 

190J 

Pennsylvania. 

1864. 

cation. 

knee. 

191 

Column,    M.,   Pt.,   F,    103d 



Senile  gangrene,  left  foot,  from 

Nov.  9, 

Antero-post.  flap  amp.  leg  at 

Died  November  12,  1803,  of  ex 

Illinois,  aged  42. 

1863. 

scorbutus. 

1863. 

middle  third.     A.  A.  Surg.  R. 

haustion. 

H.  Brown. 

192 

Creek,  J.  W.,  Pt.,  D,  91st 

T^lopr  of  Ipft  Ipr^  PYrtOfiinir  ti  Vtii 

June  29 

Arrmiititum  nf  Ion1   nnnprthirfl 

Died  July  5  1864. 

Indiana,  age  21. 

1862. 

from  injury  by  fall. 

1864. 

193 

Curgill,  W.,  Pt.,  90th  New 

Oct.  29, 

Left  leg  and  foot  and  right  thigh 

Oct.  29, 

Amp.  left  leg  at  tuber,  of  tibia 

Died  three  hours  after  operation. 

York. 

1864. 

crushed  by  railroad  accident. 

1864. 

and  right  thigh  at  low.  third. 

Ass't  Surg.  C.  Bacon,  U.  S.  A. 

194 

Davis,  D.,  Pt.,  L,  2d  N.  Y. 

Scald  of  left  ankle  by  boiling    T^OO  17 

Died  December  17  1864. 

Heavy  Artillery,  age  23. 

1864. 

coffee;  gangrene;  ha»morrh. 

1864.  ' 

Ass't    Surg.  J.  T.  Calhoun, 

U.  S.  A. 

195) 

Dawson.  W.,  Serg't,  B,  1st 

April  14, 

Fractured  bones  of  both  legs  ; 

April  16, 

Amputation  both  legs  in  upper 

(Also  disl.  left  shoulder  and  other 

196| 

Kentucky  Cavalry. 

1863. 

dislocation  both  ankles.                1863. 

third. 

injuries.)     Died  April  18,  1863. 

197  !  Dennis.  J.,  Pt.,  Signal  Corps, 

April  20, 

Gangrene;  ulccrat'n  following  Sept.  26, 

Circular  amp.  leg  at  up.  third. 

Died  Oct.  1,  1804,  of  exhaustion. 

1     age  19. 

1864. 

injury  by  kick  of  a  mule. 

1864. 

A.  A.  Surg.  C.  Bausch. 

198 

Dunham,  M..  Pt.,  D,  U.  S. 

Jan.  24, 

Necrosis  following  axe  wound    June  6, 

Amputation  of  leg,  upper  third. 

Died  June  18,  1864,  of  pyoDmia. 

Engineers,  age  23. 

1864. 

of  left  ankle.                                    1864. 

Surg.  E.  Bentley,  U.  S.  V. 

199 

Flenner,   L.  G.,  Pt.,  I,  ]61st 

July  10, 

Accidental  contusion  right  foot; 

Avig.  3, 

Circular  amp.  of  leg.  up.  third. 

Died  Aug.  8,  1864,  of  exhaustion. 

Ohio,  nge  45. 

1864. 

extensive  sloughing. 

1864. 

A.  A.  Surg.  M.B.McCausland. 

200 

Garrett.  G.,  Pt.,  F,  16th  Col 

Sept.  26, 

Comp'd  fract.  tibia  and  lacera-  j  Oft.  1, 

Circ.  amp.  leg  at  lower  third.    Died  December  4,  18G4. 

ored  Troops,  age  28. 

1864. 

tion  foot  by  railroad  accident.      18li4. 

Surg.  II.  B.  Johnson,  115th  O. 

201 

Gellison.    G.,    Pt.,    E,    65th 

Fr'iptiirp    of  bones    of   \cff    b\r                        A  mr,nt'-iiirm  ^f  lo«r 

Died  August  12,  1863. 

Illinois. 

railroad  accident. 

1  BRYAN  (J.),  A  *W/  account  of  the  "3/ary  Ann"  Hospital,  Grand  Gulf,  Miss.,  in  Am.  Med.  Times,  1863,  Vol.  VII,  p.  5. 


676 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AMD  AGE. 

DATE  OF 
INJURY 

OH 

DISEASE. 

NATURK  OF  INJURY  OR 
DISEASE. 

DATE 

OF 

OPEBA- 

TION. 

OPERATION  AND  OPKRATOH. 

RESULT  AND  REMARKS. 

202 

Gilchrist,  J.,  Pt.,  I,  31st  In 



Chronic  ulcer  of  left  leg  becom 

April  20, 

Amputation  left  leg.     Surg.  F. 

Died  April  26,  1863,  of  gangrene. 

diana. 

ing  gangrenous. 

1863. 

Irish,  77th  Pennsylvania. 

203 

Gilchrist,  W.,  Corp'l,  H,  2d 

May  16, 

Left  leg  kicked  by  horse;  ex 

Julv  10, 

Circ.  amput'n  leg,  junction  of 

Chills  and  fever  and  diarrhoea. 

Maine  Cavalry,  age  24. 

1864. 

tensive  gangrene  overdorsuin 

1864. 

upper  thirds.     A.  A.  Surg.  G. 

Died  July  22,  1864. 

of  foot. 

E.  Bricket. 

204 

Glasgow,  G.,  colored  conk, 

Dec.  —  , 

Feet  frostbitten  ;  sloughing  of 

Feb.  3, 

Amput'n  left  leg,  middle  third. 

(Jan.  11,  1865,  amp.  of  toes,  both 

F,  3d  New  Jersey  Cavalry. 

1864. 

toes,  exposing  bones. 

1865. 

A.  A.  Surg.  S.  T.  Buck. 

feet  sloughing.)     Died  Feb.  7. 

1865,  of  traumatic  pneumonia. 

205 

Graham,  D.,   Pt..  I.  51st  N. 

July  17 

Comp'd  com.  fract.  of  bones  of 

July  20, 

\mputation  of  leg 

Died  July  24,  1864.  of  nervous 

Carolina. 

1864.  ' 

leg  by  railroad  accident. 

1864.  ' 

shock  and  pyaemia. 

206 

Hurmer,    S.,    Pt.,    E,    98th 

Muy  — 

Compound  fracture  right  leg 

May  — 

Amputation  of  right  leg.  . 

June.  1864,  auiput  n  thi^h  above 

Pennsylvania,  age  18. 

1864. 

by  car  running  over  it. 

1864. 

knee.     Died  August  30,    1864, 

of  epilepsy. 

207  ( 

Hart,  J.,  Pt.,  E,  140th  New 



Mortification  of  both  feet  from 

Jan.  4, 

Circ.  amp.  both  legs,  low.  third. 

Died  January  16,  1863. 

208  i 

York,  age  IP. 

exposure  to  cold. 

1863. 

Surg.  J.  H.  Baxter,  U.  S.  V. 

209 

Henry,  W.,   frccdinan,   age 

May  8, 

Left  ankle  crushed  by  railroad 

May  8, 

Amputation  of  leg,  lower  third. 

Died  May  19,  1864,  of  gangr.-ne. 

22. 

1864. 

accident. 

1864. 

A.  A.  Surg.  B.  E.  Dodson. 

2101 

Holloran,   J.,  Pt.,  D,  140th 

Mortification  of  both  feet,  ex 

Jan.  7, 

(Jirc.  ump.  l)otli  It*  ""s  low.  third. 

Died  Feb.  18,  1863.  of  pysemia. 

*,*.\j  i 
211  1 

New  York. 

tending  above  ankle  joint. 

13,  '63. 

Surg.  .).  H.  Baxter,  U.  S.  V. 

212 

Hutchison,   S.,   Pt.,    A,  5th 

Mar.  JO, 

Lett  leg  crushed  by  railroad 

Mar.  11, 

Amp.  leg.  upper  third,  lateral 

Died  March  15,  1864. 

Maryland,  age  27. 

1864. 

accident. 

1864. 

skin  flaps  and  circ.  sect.  muse. 

Surg.  Z.  E.  Bliss,  U.  S.  V. 

2131 
214/ 

Ivory,  J.,  Pt.,  D,  2d  Tenn. 
Cavalry. 



Frostbite   of  both    feet;   gan 
grene. 

April  2, 

1864. 

Flap  amp.  both  legs,  low.  third. 
A.  A.  Surg.  F>.  Herwig. 

Died  AprilSO,  1864,  of  congestive 
fever. 

215 

Jackson,  J.,  Pt.,  K,  9th  Mas 

Oct.  15, 

Left  leg  injured  by  railroad  ac 

Cvi,  17, 

Flap  amputation  of  leg.     A  .  A  . 

Died  October  19,  1864. 

sachusetts. 

1864. 

cident. 

1864. 

Surg.  T.  B.  Townsend. 

216 

Kappelman,  W.,  Pt.,  G,  17th 

Nov.  8, 

Left  leg  fractured  by  wagon 

Nov.  8, 

Amputation  of  leg,  low.  third. 

Died  May  14,  1864,  of  acute  plen- 

Missouri. 

1863. 

wheel. 

1863. 

ritis. 

217 

Kennioott,  E.  S.,  Pt.,  D,  31st 

Oct.  27, 

Accidental  compound  fracture 

Oct.  27, 

Circular  amputation  of  leg,  up 

Gangrene.     Died  Dec.  1,  1864,  of 

Iowa,  age  28. 

1864. 

of  bones  left  leg. 

1864. 

per  third. 

typhoid  fever. 

218 

King,  J.,    Pt.,  2d  Battalion 

April  27. 

Right  foot  and  leg  comminuted 

April  27, 

Circular  amp.  of  leg.     Surg.  R. 

Died  May  5,  1864,  of  tetanus. 

Yet.  Res.  Corps,  age  55. 

1864. 

by  railroad  accident. 

1864. 

S.  Kenderdine,  U.  S.  V. 

219) 

Kirk,  M.,  Pt.,  E,  10th  Vpt. 

May  20, 

Both  legs  badly  crushed  by 

May  20, 

Circular  amp.  of  both  legs,  mid. 

Died  May  21,  1865,  of  shock. 

aao; 

Keserve  Corps. 

1865. 

railroad  accident. 

1865. 

third.     Dr.  W.  H.  White. 

221 

Kries,  F.,  Pt.,  H,  1st  Missouri 

Jan.  6, 

Frostbite  of  left  foot  

Jan.  12, 

Circ.  amp.  leg  4  inches  above 

Died  January  18,  1864,  of  tetanus. 

State  Militia,  age  41. 

1864. 

1864. 

ankle.      A.  A.    Surg.  L.   H. 

Callaway. 

222 

Lahay,  J.,  Pt.,  K,  46th  Illi 

Feb.  3, 

Right  leg  injured  by  railroad 

Feb.  2, 

Amputation  of  right  leg  

Gangrene.     Died  Feb.  19,  1865. 

nois,  age  16. 

1865. 

accident. 

1865. 

223) 

Lee,  L.,  Pt.,  A.  12th  Colored 



Dry  gangrene  both  legs  

Nov.  25, 

Circ.  amp.  both  legs.  up.  third. 

Died  Jan.  13,  1865,  of  gangrene. 

224, 

Troops,  age  11). 

1864. 

A.  A.  Surg.  J.  S.  Giltner. 

225 

Level  1,  L.,  Pt.,  —  ,  1st  Mich. 



Necrosis  of  right  tibia  ;  gang. 

Sept,  25, 

Flap  amp.  of  right  leg  below 

Died  September  26,  1864,  of  ex 

Lt.  Artillery,  age  52. 

caused  by  injudicious  appli'n 

1EG4, 

tuberosity  of  tibia.     Surg.  S. 

haustion. 

of  tourniquet  to  suppress  hasm. 

D.  Turney,  U.  S.  V. 

226 

Loyd,  E.,  Pt.,  E,  2d  Mary 



Idiopathicphlegmonous  erysip 

Dec.  28, 

Amputation  of  leg,  lower  third. 

Gangrene;   tetanus.     Died   Fnb- 

land,  age  2.5. 

elas  of  right  foot. 

1864. 

Surg.  D.  W.  Bliss,  IT.  S.  V. 

niary  3,  1865. 

227 

McAllister,  J.,  Pt.,  I,  3d  Illi 

May  20, 

Fract.  of  right  leg  and  os  calcis 

May  21, 

Amp.  right  leg,  mid  third,  and 

Chronic  bronchitis.      Died   May 

nois  Cavalry. 

1863. 

of  both  feet  by  a  fall. 

1863. 

Syme's  amput'n  at  left  ankle. 

23,  1863. 

•^c 

McElroy,  D.,  —  ,  age  27  

June  19, 

Comm'n  met.  bones  ri»;ht  foot  ; 

June  24, 

Lat.  skin  flap  amp.  leg.    Dr.  T. 

Diarrhoea.     Died  Aug.  28,  1862. 

1862. 

gangrene;  railroad  accident. 

1862. 

M.  Markoe.  New  York. 

229 

McQuaid,  R.  D.,  Lieut.,  K, 

Jan.  11, 

Comp'd  com.  fract.  right  tibia, 

Jan.  11, 

Flap  ampnt'n  leg.  upper  third. 

Died  Jan.  19.  1865,  of  exhaustion. 

29th  Michigan,  age  30. 

1865. 

upper  third,  with  dislocation. 

1865. 

Surg.  J.  E.  Herbst,  F.  S.  V. 

230 

Marks,   J.  H.,    Pt.,    G,   fith 

Dec.  24, 

Compound  fracture  left  leg  by 

Amputation  of  leg 

Died  January  6   1  863. 

Pennsylvania  Cavalry. 

1862. 

wagon  wheel. 

231 

May,  W.  A.,  Pt.,  H,  7th  N. 

Oct.  17, 

Compound  com.   fracture  left 

Oct.  18, 

Circ.  amp.  of  leg,  upper  third. 

Sloughing.     Died  Oct.  25,  18(54. 

Carolina,  age  23. 

1864. 

leg  by  railroad  accident. 

1864. 

Surg.  W.  D.  Baylor,  C.  S.  A. 

232 

Meador,    F.,   Pt,,    K,    2Cth 

Mar.  18, 

Frostbite  left  foot  and  two  mid 

April  16, 

Amp.  left  leg,  junct.  up.  thirds. 

Died  June  23,  1864,  of  pyaemia. 

Colored  Troops,  age  40. 

1864. 

dle  toes  right  foot. 

1864. 

and  Cd  middle  toes,  right  foot. 

A.  A.Surg.  E.  DeWitt. 

233 

Miller,   D.,   Pt.,  145th  New 

Oct.  17, 

Right  foot  fractured  by  railroad 

Oct.  19, 

Amputation  of  leg,  lower  third. 

Died  October  24  ,  1  862.   Spec.  781  , 

York. 

1862. 

accident. 

1862. 

A.  M.  M. 

2341 

Mulhatlan,  P.,  Pt.,  B,  150th 

Oct.  8, 

Both  legs  crushed  by  railroad 

Oct.  8, 

Doub.  flap  amp.  left  leg,  junct. 

Died  October  8,  18(54,  of  shock 

235} 

Pennsylvania. 

1864. 

accident. 

1864. 

up.  thirds,  and  right  leg  just 

and  loss  of  blood. 

below  tub.  of  tibia,  skin  flap 

and  circ.  sect,  of  muse      Ass  t 

Snrg.  H.  S.  Sehell,  U.  S.  A. 

236 

Murphy,  E.,  Pt.,  D,  143d  N. 

Oct.  12, 

Right  tarsal  bones  comminuted 

Oct.  17, 

Lateral  flap  amp.  leg  at  middle 

Gangrene:  diarrhoea.     Died  De 

York,  age  21. 

1862. 

in  attempt  to  jump  from  rail 

1862. 

third.     Dr.  G.  A.  Pe.ters,  New 

cember  1,  1862. 

way  car  :  gangrene. 

York  City  Hospital. 

6 

237 

Newton   O.,  Pt.,  K,  10th  N.  ;  

Erysip.  inflam.  of  right  leg  and  !  July  15, 

Circ.  amp.  of  leg,  lower  third. 

Died  Aug.  24,  1864.  of  dysentery. 

York  H'vy  Art.,  nge  40. 

foot,  resulting  in  gangrene. 

1864. 

A.  A.  Surg.  A.  Van  Cortlandt. 

238 

Pale,  J.  H.'  N.,  Pt.,  C,  97th 

Nov.  1, 

Compound  fracture  right  leg, 

Nov.  16, 

Flap  amputation  of  leg,  upper 

Nov.  18,  haem  ;  lig.  post.  tib.  art. 

Illinois,  nge  36. 

1863. 

mid.  third,  by  railroad  accid  t. 

1863. 

third.   Surg.  F.Bacon,  U.S.V. 

on  face  of  stump.   Died  Nov.  25, 

1863,  of  pyaemia. 

23°) 

End"'?   L  H    Corp'l   H   1st    July 

Tirifli     Ifirra    inin,«ii^     Vnr    voilYV-ioil 

A  mnnt'ition  if  both  leo*<* 

Died  July  17,  1863. 

240) 

New  York  Artillery.                 1863.        accident. 

i                                           -o 

241) 

Sanders,  B.,  Corp'l.  3d  Md.  —          -  Mortification   of  both   legs  to 

Feb.  1  6,   Amput'n  through  middle  third. 

Died  March  12,  1865.     (May  13, 

242J 

Battery,  ago  37.                                         junction  of  middle  and  lower 

1865. 

both  legs.    Surg.  B.  B.  Breed, 

1864,  shot  fracture  upper  third 

thirds. 

U.  S.V.,  and  A.  A.  Surg.  L. 

femur.) 

Sinclair. 

243 

Shearer,  J.,  Serg't,  A,  llth    May  20,  Comp'd  com.  fracture  middle 

May  21,   Ant.  post,  skin  flap  amp.  right 

Feeble  reaction  after  prolonged 

Maryland,  age  28.                 ;    1865.        third  right   leg,  and  double 

1865.         leg  and  amp.  thro'  left  knee 

primary  shock.     Died  May  22, 

ciiinpimnd  fracture  left  leg  in 

joint,  leaving  patella  and  con- 

1865. 

middle  and  upper  thirds,  by 

;     dyles,  by  Ass't  Surg.  G.  M. 

horse  kicks. 

McGill,  U.  S.  A. 

244 

Sligh,   J.  W.,  Capt.,  F,  1st 

Oct.  23,    Com.   fractur:    right   leg  and    Nov.-  —  ,    Amp.  right  leg  4  inches  below 

Died  November  15,  1863.    Spec. 

Michigan  Engineers.                  1863.         simple  fracture  "left   leg   by      1863.         knee.     Surg.  B.  Woodward, 

2077,  A.  M.  M. 

railroad  accident. 

22d  Illinois. 

245 

Smith,    J.,    Lieut.,    I,    65th    June  2,    Comp'd  com.  fracture  left  ankle 

June  2,     Amputat'n  of  leg.  lower  third. 

Acute  meningitis.    Died  June  10, 

Ohio.                                              1865.    '     joint  and  injury  of  spine.               1S65.         Sursr.  E.  B.  Click.  40th  1ml. 

1865. 

•24G  I  Smith.    W.    W..    I't..    I.     17th     Dec.  1.      KrostbitP  of  tops  i,f  buth    feet  •      "\T;ir.  <>      Finn  ninnntntion    rio-ht    IPO-   in 

(Feb.  11,  1865,  1st  4  toes  right  foot 

Alabama,  age  19.                       1864.    :     mortification  of  parts.               ,    18(i5.        middle  third.     Ass't  Surg.  J. 

and  1st  3  toes  left  foot  nmput'd.) 

C.  Thorpe,  IT.  S.  V. 

Died  June  16,  1865,  of  exhaus. 

247 

Sorter.    J.    D..    Pt,,  E,   16th  —         —  Abscess  of  foot;  gangrene  and    July  18,   Oval   flap  amp.  of  log,   lower 

Gangrene.      Died  Aug.  11,  1HM. 

Vet.  Kr.s.  Corps,  age  31  .                              ropputpil  lui-iunni                             isiil.         third.  A.  A.  Surg.W.  C.Wey. 

248 

Thirlway,  J.,  I't.,  I,  60th  N.    Dec.  26,    Frostbite  of  right  foot:  gang.  . 

Feb.  17,  Circ.  amp.  of  leg.  lower  third. 

Died  February  25,  1865,  of  ex 

York,  age  18.                          ;    1  864. 

1865.         A.  A.  Surg.  C.  F.  Trautman. 

haustion. 

SECT.   fl.J 


AMPUTATIONS    IN    THE    LEG. 


677 


NO. 

NAME,  MILITARY 
DESCRIPTION,  AND  A«E. 

DATE  or 
INJURY 

OB 

DISEASE. 

NATURE  OF  INJURY  OR 
DISEASE. 

DATE 

OP 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

249 

Thompson,  J.W.,  Pt.,  A,  5th 

Jan.  —  , 

Frostbite  of  feet  ;  gangrene  

Feb.  17, 

Amp.  left  leg,  lower  third,  semi- 

Died  February  20,  1864,  of  ex 

Colored  Troops,  age  22. 

1864. 

1864. 

circ.  method  above,  flap  from 

haustion. 

below.     A.  A.  Surg.  B.   T. 

Crooker. 

250 

Towue,  W.  H.,  Pt.,  A,  18th 

Nov.  17. 

Comp'd  ci  >m.  fract.  right  ankle  ; 

Nov.  18, 

Flap  amputat'n  lower  third  leg. 

March  8,  1864,  amp.  !  -wr  third 

Conn.,  age  30. 

1863. 

crushed  by  railroad  care. 

1863. 

Surg.  H.  W.  Owings,  2d  E.  S. 

thigh.     Died    March   28,   1804, 

Maryland  Vols. 

of  secondary  haemorrhage. 

251  ( 

Weber.  J..  Pt.,  E,  7th  New 

Jan.  —  , 

Frostbite  of  both  feet  ;  tetanus. 

Feb.  10, 

Amp.  both   legs,   lower  third.     Died  February  11,  1865. 

2o2$ 

York,  age  60. 

1865. 

1865. 

with  lateral  closure  of  stumps. 

Ass't  Surg.  H.  Allen,  IT.  S.  A. 

253 

Westfall   L.   Pt.   M  24th  N. 

Jan.  19 

York  Cavalry,  age  17. 

left  leg,  exposing  tibia. 

1865.  ' 

Surg.  R.  B.  Bontecou,  U.  S.V. 

haustion. 

254 

\Vilmot.    W..    Musician,    E, 



Gangrene  of  right  foot  to  ankle 

Feb.  8, 

Ant.  post,  flap  amp.  right  leg. 

Died  March  11,  1865,  of  exhaus 

Nth  Illinois  Cav'ry,  age  51. 

and  of  toes  of  left  foot,  from 

1865. 

lower  third,  and  all  toes  of  left 

tion. 

exposure. 

foot.     Ass't  Surg.  W.  S.  Tre- 

maine,  U.  S.  V. 

2551    Wood.  W..  Pt.,  A,  102d  N.  Sept.  14, 

Both  legs  injured  by  railroad 

Prim'ry. 

Amp.  of  both  legs,  mid.  third. 

Died  September  17,  1864. 

256j!     York. 

1864. 

accident. 

A.  A.  Surg.  C.  C.  Lee  and  Dr. 

W.  C.  Way,  of  Elmira. 

2:.? 

Woody,   B.   C.,  Pt.,  E,   14th 

July  15, 

Right  leg  crushed  from  ankle   July  15, 

Ant.  post,  flap  ump.  of  leg  at     Died  July  26,  1864,  of  traumatic 

Penn.  Cavalry,  age  18. 

1864. 

to  middle  by  railroad  accid't.      1864. 

iunct.  of  upper  thirds.     Surg.       gangrene. 

S.  N.  Sherman.  U.  S.  V. 

258     Vai.crum,    F.,    Pt,,    E,    9:id 

May  10, 

Fracture  bones  of  right  leg  at   June  13, 

Amputation  of  leg  at  up.  third.    Died  June  27,  1865,  of  pyaemih. 

Pennsylvania,  age  34. 

1864. 

junction   of   lower  thirds  by 

1865. 

A.  A.  Surg.  G.  K.  Smith.               Spec.  4242.  A.  M.  M. 

mule  kick;  gangrene. 

259 

Michel,  —  ,  Lieut.,  14th  La.. 

Gangrene 

Airiputiition  of  l6ff 

Result  unknown. 

Of  fifty-one  partial  amputations  of  the  foot  for  miscellaneous  injuries  or  disease,  forty- 
seven  were  followed  by  recovery  and  four  by  death : 

TABLE  OXII. 
Condensed  Summary  of  Fifty-one  Partial  Amputations  of  the  Foot  for  Miscellaneous  Injuries  or  Disease. 

[Recoveries,  lr-47;  Deaths,  48 — 51.] 


,0. 

NAME.  MILITARY 
DESCRIPTION,  AND  AGE. 

DATE  OP 
INJURY 
ou 
DISEASE. 

NATURE  OF  INJURY  OH 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

i1 

4 

5( 
65 

7 

8 

9 
10 
11 
12 

13) 
14/ 

15 

16J 
W 

18 

19) 

201 
21 

22  ( 
23' 
24  ( 
25$ 

26 

Earner,  J.,  Pt.,  G,  178th  New 
York. 
Banihart.  M..  Pt.,  H,  50th 
Pennsylvania,  age  28. 

Bickel,  J.,  Pt.,  H,  22d  Ohio. 

Butler,  J.  R.,  Pt..  H,    10th 
Kansas,  age  13. 

Charles,  M.,  Pt,,  B,  10th  N. 
Jersey. 

Clark,   C.  O.  F.,  Pt.,  G,  1st 
Oregon. 

Conklin,  J.,  Pt.,  F,  1st  Ohio 
Cavalry,  age  18. 
Corcoran,  C.,  Pt.,  G,  1st  Mas 
sachusetts,  age  22. 
Counter.   O.  R.,  Pt..  —  ,  4th 
New  Hampshire. 
Dennison.  C.  W.,  Pt.,  B,  2d 
Rhode  Island,  age  18. 

Downey,  J.,  Pt.,  B,  12th  Illi 
nois  Cavalry,  age  34. 

Dukes,  J.  It.,  Serg't,  E,  87th 
Indiana. 
Fletcher.  J.,  Pt.,  D,  1st  Col 
ored  Troops,  age  25. 
Gardner,  J.,  Pt.,  F,  65th  In 
diana. 

Harris,  T.,  Pt.,  C,  27th  Col 
ored  Troops,  age  25. 
Hawkins.  E..  Pt.,  B,  9th  In 

Partial  amputat'n  of  both  feet. 

Amputation  great  toe  and  met 
atarsal    bone.      Surg.  G.  L. 
Pancoast,  U.  S.  V. 
Chopart's  amputation  left  foot. 

Amp.  1st,  2d.  and  part  3d  met. 
bones  left  foot,  and  great  toe 
and  head  met,  bones  right  foot. 
Surg.  A.  C.Van  Duyn,  U.S.V. 
Lisfranc's  amputat'n  right  foot. 
A.  Surg.  B.  E.  Fryer,  U.  S.  A. 

Chopart's  amp.  right  foot  and 
amp.  left  leg  at  middle  third. 
A.  A.  Surg.  M.  V.  Amen. 
Amputat'n  through  metatarsal 
bones,  flap  from  sole  of  foot. 
Oval  amp.  of  great  toe  and  met. 
bone.    A.  A.  Surg.  J.  Murray. 
Amp.  left  foot  thro'  met.  bones 
and  of  right  fifth  toe. 
Disarticulatiori   of  met.  bones 
of  left  foot.     Surg.  St.  J.W. 
Mintzer,  U.  S.  V. 
Amp.  of  both  feet  thro'  tarso- 
metatar.  articulation.     A.  A. 
Surg.  R.  N.  Isham. 
Chopart's  amput'n  of  left  foot. 
A.  A.  Surg.  F.  Rectanus. 
Amp.  both  foet  thro'  met.  bones. 
A.  A.  Surg.  C.  B.  Fry. 
Modification  of  Chopart's  amp.; 
the  proximate  half  scaphoid 
bone  allowed  to  remain.     A. 
A.  Surg.  J.  G.  Harvey. 
Amp.  at  tarso-met.  articulat'n. 
Surg.  E.  Bentley,  U.  S.  V. 
Amputation  at  tarso-metatarsal 
articulation. 
Amputation  of  both  feet  thro' 
metatarsal  bones. 
Flap  amp.  right  foot  at  mid.  of 
metatarsus,  and  of  toes  and 
heads  of  met.  bones  left  foot. 
Ass't  Surg.  A.  Ingram,  U.S.  A. 
Circular  flap  amp.  4th  and  5th 
toes  at  tarso-metatarsal  artic 
ulation. 

Left  foot  frozen  ;  slough,  of  toes. 
Nov.  22,  '64,  amp.  of  toes  ;  ne 
crosis  of  met.  bone  of  great  toe. 
Injury  of  left  foot  ;  railroad  ac 
cident. 
Feet  frozen  ;  toes  slough'd  from 
left  foot  except  5th  and  one 
phalanx  of  4th. 

Frostbite  both  feet  ;  gangrene. 
April  28,  '62,  Syme's  amputa 
tion  at  left  ankle  joint. 
Frostbite  both  feet 

Mar.  27. 
1865. 

Sept.  15. 
1864. 
Mar.  20, 
1864. 

May  4. 
1862. 

Jan.  17, 
1866. 

1864. 

Sept.  15, 
1864. 
Jan.  7, 
1864. 

Dec.  17, 
1865. 

July  10, 
1864. 
Nov.  13, 
1864. 
Feb.  10, 
1865.- 
Deo.  —  , 
Ie63. 

Jan.  1, 
1864. 

Nov.  1, 
1862. 
Dec.  —  , 
1863. 
April  2, 
1864. 

Oct.  —  , 
1864. 
Mar.  17, 

Fract.  of  metatarsal  bones  of 
right  foot  ;  railroad  accident. 
Phalanges  of  great  toe  cut  by 
an  axe  ;  necrosis. 

Feb.  14, 

1865. 
Mar.  4. 
1865. 
Sept.  17. 
1864. 

April  15, 
1864. 

Feb.  —  , 
1863. 
Jan.  22, 
1864. 
June  5, 
1864. 

Jan.  19, 
1865. 
Mar.  17. 
1865. 
Mar.  3. 
13,  '6:i. 
Feb.  9, 
1864. 

July  21, 
1864. 

Frostbite  of  both  feet  ;  loss  of 
all  toes.     Sept.,  1864,  left  foot 
contused. 
Severe  frostbite  both  feet  ;  ca 
ries  of  metatarsal  bones. 

Freezing   of    both   feet;    gan 
grene. 
Laceration  of  left   tarsus  and 
fracture  of  metatarsus;   rail 
road  accident. 

Gangrene  both  feet  from  wear'g 
tight  shoes:  toes  dry  and  hard. 
Com.  met.  bones  and  lac.  soft 
parts  left  foot  ;  railr'd  accid't. 
Frostbite  of  both  feet;  gang, 
and  mortification. 
Both  feet  frozen  ;  line  of  demar 
cation  well  defined. 

Comp'd  com.  fract.  4th  and  5th 
metatarsal  bones   right  foot  ; 
railroad  accident. 

diana,  nge  21. 
Hayes,  J.  S.,  Pt.,  I,  21st  N. 
Jersev. 
Hirsch^  P..  Pt..  D,  98th  Penn 
sylvania,  age  38. 

Human.    W.,    Pt..    H,    18th 
Kentucky,  age  45. 

1865. 
Jan.  —  , 
1863. 
Jan.  1, 
1864. 

July  21, 
1864. 

RESULT  AND  RKAIAKKS. 


Discharged  Oct.  16,  1865:   feet 

blue  and  cold. 
Discharged  Aug.  10, 1865.    Amp. 

left  ring  finger  for  shot  fracture. 

Discharged  Nov.  15,  1864  ;  stump 

remaining  sore. 
Discharged  March  7,  1865. 


Discharged  August  11,  1862. 


Disch'd  April  14,  '66.  Nov.  9, '68, 
re-amp,  left  leg.  1870,  stump 
sound.  Sprcs.  4128,4191.  A. M.M. 

Discharged  March  25.  1865. 

Mustered  out  June  27,  1865;  do 
ing  well. 
Discharged  July  11,  1865. 

Discharged  July  5,  1865. 


Discharged  June  20,  1864  ;  good 
stump. 

Discharged  February  15,  1863. 
Discharged  February  7,  1865. 

Mustered  out  June  22,  1865,  with 
excellent  stump. 


Discharged  September  2,  1865: 

ends  of  bone  well  covered. 
Mustered  out  September  28, 18fir>. 

One  foot  healed,  small  ulcer  on 
the  other.  Discharged. 

Stump  healed  and  promised  to  be 
useful.  Discharged  September 
22,  1864. 

Transferred  to  Veteran  Reserve 
Corps  May  4,  18ti.">. 


678 


MISCELLANEOUS    INJUEIES. 


[CHAP.  XI. 


No. 

NAME,  MILJTAKT 
DESCRIPTION,  AND  AGE. 

DATE  OF 
INJURY 

OR 

DISEASE. 

NATURE  OF  INJURY  OH 
DISEASE. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

27 
28 

29 

30  ( 
3lf 
32 

33  1 
34j 
35 

36{ 
375 

38 
39 

40 
41 

42 
43 

44? 
45$ 

46> 
47$ 

48? 
49J 

50 
51 

Jones,  S.,  Pt.,  I,  30th  Iowa, 
age  23. 

Langan,  J.,  civilian,  Quarter 
master's  Dep't,  age  25. 

Leichley,  S.,  H.,  I,  178th  N. 
York,  age  IP. 
Messer,  G..  Pt.,  B,  7th  New 
York,  age  27. 
Metzger,   A.,    Pt.,    B,    19th 
Penn.  Cavalry,  age  17. 
Mitchell,  D.,  Pt.,  C,  7th  N. 
York,  age  25. 
Norcross,  J.  H..  Pt.,  H,  2d 
New  Jersey  Cavalry. 

Pollard,  R.,  Pt.,  D,  21st  Ken 
tucky,  age  27. 

Quillain,  J.  W.,  Pt.,  I,  27th 
Pennsylvania,  age  31. 
Shadel,  J.,  Pt.,  G,  llth  Wis 
consin. 

Shauley,  W.  F.,  Pt.,  K,  37th 

Sept,  30, 
1863. 

July  18, 
1865. 

Dec.  30, 
1864. 
Dec.  —  , 
1864. 
Dec.  31, 
1863. 
Jan.  —  , 
1864. 
Dec.  —  , 
1863. 

Jan.  24, 
1865. 

Sept.  5, 
1863. 
May  2, 
1864. 

April  30, 
1863. 
Feb.  28, 

Bone  scurvy  and  hospital  gan 
grene,  causing  loss  of  use  of 
both  feet. 
Incised  wound  thro'  metatarso- 
phalangeal  joint  left  5th  toe, 
extending  to  tarsalarticulat'n. 
Frostbite  of  left  foot  ;  necrosis. 

Frostbite  of  both  feet  

Nov.  6, 
1863. 

July  18, 
1865. 

April  30, 
1865. 
Jan.  1, 
1865. 
Jan.  25, 
1864. 
Feb.  1, 
1864. 

Chopart's  amp.  of  right  foot. 
Surg.  J.  Andrews,  yd  Mich 
igan  Cavalry. 
Amp.  of  5th  toe  at  tarso-met. 
artic.    A.  A.  Surg.W.  Balser. 

Flap  amputation  at  tarso-meta- 
tarsal  articulation. 
Chopart's  antero-posterior  flap 
amputation  of  both  feet. 
Flap  amp.  at  tarso-met.  artic. 
Surg.  H.  Wardner,  U.  S.  V. 
Chopart's  amp.  both  feet.  Surg. 
J.  E.  Pomfret,7th  N.Y.H.Art. 
Amp.  left  foot  thro'  met.  bones, 
also  right  great  toe.    A.  Surg. 
D.  G.  Hetzell,  34th  N.  J. 
Flap  amp.  both  great  toes  and 
metatarsal  bones,  also  of  left 
third  metatarsal  bone. 
Amp.  1st,  2d,  and  3d  toes  with 
portion  1st  and  2d  met.  bones. 
Amputation  of  2d  toe  and  re 
moval  of  2d,  3d,  4th,  and  5th 
metatars'l  bones  in  continuity. 
A.  A.  Surg.  S.  S.  Jessop. 
Chopart's  amputation  of  right 
foot. 
First  met.  bone  and  phal.  of  3d 
toe  exart.,  middle  of  2d  mat- 
atarsal  bone  sawed  through. 
Chopart's    amputation   of  the 
left  foot. 
Amp.  1st,  2d,  3d,  and  4th  toes 
left  foot  at  2d  joint,  and  5th 
toe  at  tarso-met.  artic. 
Amp.  both  feet  through  meta 
tarsal  bones.     Surg.  Geo.  C. 
Underbill,  llth  Ohio  Cavalry. 
Hey's  amp.  both  feet,  tuberos- 
ity  right  os  calcis  removed. 
A.  A.  Surg.  H.  McElderry. 
Amputation  of  both  feet  across 
instep.     Dr.    N.    L.    Folsom, 
Portsmouth,  N.  H. 
Amput'n  of  right  foot  at  tarso- 
metatarsal  articulation. 
Circular  amp.  of  foot  through 
metatarsal  bones. 

Oct.  16,  amp.  left  leg.     Nov.  10, 
1.1,  hsem.;  inter,  plantar  artery 
tied.     Disch'd  June  3,  1805. 
Returned  to  duty  Aug.  27,  1865. 

Discharged  February  15,  1866. 

Discharged  May  22,  1865;  stumps 
healed. 
Disch'd  June  4,  '65  :  good  stump, 
excellent  motion  of  ankle  joint. 
Discharged  October  14,  1865. 

Discharged  June  29,  1864.     Died 
January  9,  1871,  of  disease. 

Discharged  July  2,  1865;  almost 
entirely  healed. 

Discharged  August  16,  1864;  per 
manent  lameness. 
Discharged    October    20,    1864. 
1877,  foot  contracted  to  a  point  ; 
walks  quite  lame. 

Discharged  Aug.  24,  1863.     Died 
Oct.  20.  1865;  clironic  diarrhoaa. 
Discharged  October  25,  1864. 

Discharged  February  25,  1865. 

Parts    healed    kindly.     Sent  to 
military  prison  May  18,  1864. 

Left  for  his  home  September  5, 
1865. 

Discharged  Dec.  6,  1865.     March 
18,  1866,  amp.  right  leg.     1877, 
stump  of  foot  still  ulcerating. 
Discharged   February  24,  1863. 
Died  February  27,"  1863;  con 
gestion  of  bowels. 
Died  Sept.  30,  1864,  of  chronic 
diarrhoea. 
Died  August  26,  1864,  of  general 
debility. 

Toes  of  left  foot  frozen  ;  gang, 
and  sloughing. 

Both  feet  frost-bitten  ;  mortifi 
cation. 

Both  feet  frost-bitten  ;  slough 
ing. 

Compound  fracture  of  toes  of 
right  foot  by  street  cars. 
Contusion  of  left  foot  and  comp. 
fract.  of  4th  toe;  railr'daccid't. 
May  3/64,  amp.  4th  toe  ;  gang. 
May  15,  amp.  3d  and  5th  toes. 
Wound  of  right  tarsus  and  met 
atarsus  by  wheel  of  a  wagon. 
1st,  2d,  and  3d  toes  of  left  foot 
crushed  and  sole  lacerated  ; 
railroad  accident. 
Left  foot  injured  by  railroad 
accident. 
Hospital  gangrene  of  both  feet 
from  erysipelas. 

Both  feet  frost-bitten  ;  slough 
ing. 

Frostbite  of  both  feet    

Jan.  24, 
1865. 

1863. 
May  30, 
1864.  _ 

May  13, 
1863. 
Feb.  28, 
1864. 

Massachusetts,  age  42. 
Sickler,  J.,  Pt.,  H,  8th  Illi 

nois  Cavalry,  age  35. 

Stephens,  J.,  Serg't,  G,  10th 
Indiana  Cavalry. 
Stone,  W.,  Pt.,  E,  10th  Ten 
nessee,  age  40. 

Sutton.  F.,  Pt.,  H,  llth  Ohio 
Cavalry   (disch'd  soldier), 
age  27. 
Watkins.  E.  D.,  Pt.,  H,  5th 
Kentucky  Cavalry,  age  30. 

Parks    T    B     Pt     K    13th 

1864. 

Mar.  31, 
1864. 

Mar.  1, 
1864. 

Mar.  28, 
1865. 

April  —  , 
1865. 

Feb.  26, 
1863. 

Feb.  —  , 

1864. 
April  2, 
1864. 

Jan.  7, 
1864. 

Feb.  21, 
1864. 

Frostbite  of   both   feet;    gan 
grene. 

Both  feet  frost-bitten  

New  Hampshire. 

Tucker,  A.,  Pt.,  B,  7th  In 
diana  Cavalry. 
Williams,    H.,  Pt.,   B,  59th 
Colored  Troops. 

Feb.  —  , 
1864. 

Frostbite  of  light  foot  ;   gan 
grene  of  toes. 

One  hundred  and  twenty-two  amputations  of  the  toes  for  miscellaneous  injuries  were 
recorded;  the  results  in  seven  cases  were  not  ascertained;  one  hundred  and  nine  recovered, 
six  died.  An  instance  of  amputation  for  dry  gangrene  is  here  cited: 

CASE  1005. — Amputation  of  toes. — Hospital  Steward  R.  Schofield.  69th  Pennsylvania,  aged  49  years,  had  both  his  feet 
frost-bitten  while  with  his  regiment  in  the  field  near  Stevensburg,  January  1,  1864.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  in  charge 
of  Harewood  Hospital,  Washington,  gives  the  following  history:  "The  patient  was  a  man  of  temperate  habits  and  of  good 
constitution.  The  tent  in  which  he  was  sleeping  in  the  field  was  blown  down  during  the  night,  when  his  feet  became  exposed, 
the  other  parts  of  his  body  remaining  well  protected.  Although  the  weather  was  intensely  cold,  he  slept  well  during  the  night, 
and  on  waking  up  in  the  morning  found  the  forepart  of  botli  his  feet  frozen.  He  received  no  treatment  until  admitted  to  this 
hospital  on  February  1st.  At  the  time  of  his  admission 
the  patient  was  found  to  be  suffering  from  dry  gangrene 
of  the  toes  of  both  feet,  resulting  from  the  freezing,  and 
extending  to  the  metatarsal  bones  of  the  left  foot,  with 
destruction  of  the  soft  parts.  The  patient  was  in  good 

spirits,  and  although  he  was  doing  well  it  was  deemed  ^^pBP  .  \ 

advisable  to  disarticulate  the  toes.  Nourishing  diet  and 
stimulants  were  administered  and  simple  dressings  were 
used."  The  amputated  toes,  contributed  to  the  Museum 
with  the  description  of  the  case  by  Surgeon  Bontecou, 
constitute  specimen  '2163  of  the  Swrgical  Section,  and  a 
representation  of  the  diseased  feet  appears  in  the  adjoining 
wood-cut  (FlG.  372).  The  patient  was  discharged  from 
service  for  disability  January  27,  1865,  and  pensioned. 

The  Philadelphia  Examining  Board  on  November  7,  1877, 

.,.     ,  A     ,,  .  ,  ,...  „  ,,  FIG.  372. — Dry  gangrene  of  both  feet  after  frostbite. 

certified  to  the  pensioners  condition  as  follows:      He  lias 

had  all  the  toes  of  the  right  foot  amputated  through  the  metatarso-phalangeal  articulation  except  the  little  toe,  which  is  drawn 
into  the  cica.trix.     The  foot  is  defective  in  circulation  and  there  are  chronic  ulcers  of  the  leg  extending  from  the  ankle  to  within 


Spec.  2163. 


SECT.  II.]  LTGATIONS.  679 

four  and  a  half  inches  below  the  knee,  being  very  offensive  and  requiring  constant  care  and  attention.  This  condition  no  doubt  is 
due  to  anaesthesia  of  the  foot  and  leg.  The  cicatrices  extend  around  the  leg  and  are  constantly  scaling.  There  is  also  varix 
above  to  a  slight  extent.  The  toes  of  the  left  foot  were  amputated  at  the  tarso-metatarsal  articulation,  the  stump  showing  a  good 
horny  cicatrix ;  hypersesthesia  of  foot  or  stump;  atrophy  of  leg;  stump  alleged  to  be  painful  during  changes  of  weather,"  etc. 
The  pensioner  was  paid  September  4,  1881. 

LIGATIONS. — Eighteen  instances  of  ligations  of  the  larger  vessels  were  reported. 
The  injuries  in  eight  cases  were  incised  wounds,  in  two  punctured  wounds,  and  in  five 
aneurisms;  in  three  cases  the  nature  of  the  injury  was  not  specified.  Four  of  the  opera 
tions  were  on  arteries  of  the  neck  and  trunk,  four  on  vessels  of  the  upper  and  ten  on 
arteries  of  the  lower  extremities.  Seven  were  fatal,  viz:  a  ligation  of  the  primitive  carotid, 
of  the  external  and  common  carotids,  of  a  branch  of  the  mesenteric.  of  the  radial,  two  of  the 
femoral  with  subsequent  ligations  of  the  external  iliac,  and  one  of  an  artery  of  the  dorsum 
of  the  foot.  Ten  of  the  cases  are  here  detailed : 

CASE  1006. — Amputation  in  the  arm.  Ligation  of  the  axillary  and  subsequently  of  the  subclavian  artery. — Private  H.  Rieman, 
Co.  A,  12th  Maine,  aged  21  years,  had  his  left  arm  crushed  by  a  railroad  accident  near  New  Orleans,  January  1C,  18G4,  and 
suffered  amputation  at  the  middle  third  of  the  humerus.  Surgeon  J.  B.  G.  Baxter,  U.  S.  V.,  reported  that  the  man  was  conveyed 
to  Barnicks  General  Hospital,  where  "the  axillery  artery  was  ligated,  by  reason  of  secondary  haemorrhage  from  the  brachial 
artery,  on  January  31st.  On  February  7th  another  haemorrhage  supervened  and  the  subclavian  was  ligated  in  the  third  portion, 
at  its  point  of  exit  from  behind  the  scalenus  anticus  muscle.  The  probable  loss  of  blood  amounted  to  two  quarts.  The  subsequent 
treatment  included  tonics,  stimulants,  and  diet  as  nourishing  as  possible.  Some  pyaemia  did  supervene,  but  haemorrhage  did  not 
again  recur.  By  February  29th  the  ligature  had  come  away  and  the  wounds  were  healing  rapidly,  the  patient's  appetite  being 
good  and  his  condition  presenting  every  prospect  of  recovery.  The  operations  were  performed  by  Surgeon  O.  M.  Humphrey, 
U.  S.  V."  The  patient  was  subsequently  admitted  to  Central  Park  Hospital,  New  York  City,  where  he  was  discharged  from 
service  July  31,  18G5,  and  pensioned.  Several  months  after  receiving  his  discharge  he  was  furnished  with  an  artificial  arm  by 
the  firm  of  M.  Lincoln,  of  Boston.  The  pensioner  was  paid  September  4,  1881.  Stump  in  good  condition. 

CASE  1007. — Ligation  of  primitive  carotid  for  aneurismal  tumor. — Acting  Assistant  Surgeon  W.  P.  Moon  reports  the  follow 
ing  history  of  "Private  H.  Cater,  Co.  C,  106th  New  York,  aged  37  years,  who  was  admitted  to  Mower  Hospital,  Philadelphia. 
September  12,  18G4,  on  account  of  a  tumor  of  the  neck,  situated  in  the  upper  portion  of  the  right  great  anterior  triangle  and  being 
about  an  inch  and  a  quarter  in  diameter.  The  tumor  had  first  been  noticed  about  a  year  before,  growing  slowly,  and  for  two  or 
three  months  the  patient  was  subject  to  paroxysms  resembling  asthma,  relief  being  obtained  by  inhalations  of  ether.  His  general 
health  was  good,  but  the  mass  was  evidently  encroaching  upon  the  larynx  and  oesophagus  latterly,  and  after  consultation  it  was 
decided  to  attempt  the  removal  of  the  tumor.  The  patient  was  first  allowed  a  furlough  to  go  home  and  consult  his  friends,  after 
which,  finding  his  case  growing  rapidly  worse,  he  finally  consented  to  submit  to  an  operation.  Accordingly,  on  December  13th, 
he  was  thoroughly  etherized,  and  I  made  an  incision  over  the  centre  of  the  tumor  down  to  the  cyst.  The  enveloping  membrane 
was  found  to  be  very  vascular  and  the  tumor  had  the  feeling  of  the  fibroid  class.  While  we  were  examining  the  mass,  having 
partly  enucleated  it  and  getting  down  to  its  attachment,  the  patient  was  seized  with  vomiting  and  two  superficial  veins  were 
ruptured  by  the  retching.  As  soon  as  these  were  tied  another  seemed  to  give  way,  the  retching  increased,  and  the  hfemoi-rhage 
became  so  profuse  that  we  were  compelled  to  desist  from  all  further  efforts  for  the  time  being  and  decided  to  close  up  the  wound 
after  ligating  the  open  vein,  hoping  for  a  favorable  termination  by  suppuration.  For  some  days  the  case  did  so  well  that  we  had 
strong  hopes  of  a  favorable  result.  Drs.  D.  H.  Agnew,  E.  R.  Fell,  and  others  were  present  at  the  operation,  and  the  patient 
was  carefully  attended  by  Dr.  Fell.  Two  days  afterwards  the  case  had  become  complicated  by  erysipelas,  involving  the  chest 
and  right  side  of  neck,  but  being  readily  controlled  by  tincture  of  iodine  externally,  and  tincture  of  chloride  of  iron,  Dover's 
powder,  etc..  internally.  On  December  18th  the  wound  had  closed  except  at  the  upper  and  lower  points  of  the  incision,  from 
which  openings  healthy  pus  was  discharged;  but  there  was  an  unpleasant  odor  which  excited  suspicion;  patient's  tongue  white 
in  centre,  but  moist.  No  untoward  symptoms  exhibited  themselves  until  December  26th,  when  secondary  haemorrhage  suddenly 
set  in  to  the  amount  of  some  thirty  ounces,  being  arrested  by  charpie  and  compress.  After  the  wound  was  opened  and  a  careful 
examination  had  been  made  by  Dr.  T.  G.  Morton  and  myself,  we  could  not  determine  distinctly  from  what  vessel  the  haemorrhage 
came,  owing  to  the  altered  condition  of  the  tissues,  and  therefore  concluded  to  ligate  the  right  primitive  carotid  as  the  most  likely 
means  to  prevent  a  recurrence  of  the  haemorrhage.  The  ligature  was  applied  about  an  inch  and  a  quarter  above  its  origin  from 
the  innominata.  The  tumor  was  found  to  have  nearly  disappeared,  and  what  remained  consisted  of  a  calcareous  deposit  attached 
to  the  thyroid  cartilage — the  veins  covering  it,  with  the  entire  cyst,  having  sloughed  away.  On  the  next  day  the  patient  was 
apparently  doing  well;  wound  dry  but  disposed  to  slough;  very  little  pus  forming.  The  parts  were  dressed  with  diluted 
chlorinate  of  soda.  On  December  29th  there  was  partial  paralysis  of  the  left  side;  wound  showing  some  disposition  to  clean 
out;  pulse  108;  tongue  dry  and  coated;  nausea,  with  some  vomiting;  slight  delirium,  with  some  tendency  to  diarrhoea,  which 
was  controlled  by  an  enema.  Wound  dressed  with  solution  of  permanganate  of  potassa.  On  December  30th  the  patient  seemed 
to  improve — taking  his  cream,  beef-essence,  and  brandy  without  difficulty,  and  having  no  vomiting  nor  diarrhoea ;  pulse  90 ; 
wound  cleaning  out.  On  the  following  morning  the  wound  presented  healthy  granulations,  but  the  patient  had  a  rigor,  followed 
by  fever  and  perspiration,  precursors  of  pyaemia.  From  this  time  a  decided  change  for  the  worse  became  evident  and  the  patient 
continued  to  sink  until  the  morning  of  January  5,  1865,  when  he  died.  The  wound  was  healthy  at  the  time  of  death.  The  post 
mortem  examination  revealed  the  ordinary  condition  of  a  pyaemic  patient,  and  showed  that  pus  had  dissected  down  the  sheaths 
of  the  vessels  nearly  to  the  pericardium.  An  organized  clot  was  found  above  as  well  as  below  the  ligature.  The  former 


680  MISCELLANEOUS    INJURIES.  [CHAP.  xi. 

extended  down  to  the  point  of  the  ligation,  and  the  latter  was  found  occupying  the  carotid  to  within  a  few  lines  of  the  innoininnta 
and  extending  up  an  inch  and  a  half  above  the  bifurcation.  The  ligature  had  ulcerated  through  the  carotid." 

CASK  1008. — Ligation  of  brachial  for  aneurism. — Corporal  R.  L.  Phillips,  Co.  M,  1st  Wisconsin  Cavalry,  aged  44  years, 
admitted  into  City  Hospital,  St.  Louis,  September  15,  1862,  with  an  aneurism  of  the  brachial  artery,  caused  by  a  sprain;  had 
been  increasing  gradually.  October  2cl,  ligation  of  artery  by  Surgeon  J.  T.  Hodgen,  U.  S.  V.  October  24th,  coldness  in  hand ; 
ligature  removed.  Returned  to  regiment  November  20,  1862,  quite  well;  aneurism  nearly  same  size,  but  no  pulsation. 

CASE  1009. — Ligation  of  brachial  for  incised  wound. — Private  W.  Stewart,  Co.  G,  1st  Connecticut  Cavalry,  aged  23  years- 
admitted  to  Douglas  Hospital,  Washington,  July  31, 1865,  with  an  incised  wound  of  the  internal  aspect  of  the  lower  third  of  the 
left  arm.  inflicted  with  a  penknife.  July  31st,  ligation  of  the  brachial  artery  (supposed)  at  its  bifurcation  in  continuity  by  Sur 
geon  R.  B.  Bontecou,  U.  S.  V.  The  radial  pulse  was  almost  if  not  quite  as  full  as  on  the  right  side,  leading  to  the  conclusion 
that  either  the  brachial  had  not  been  tied  e»r  that  the  bifurcation  was  high  up  in  the  arm.  August  6th  and  8th,  ligatures  came 
away.  August  25th.  wound  entirely  healed;  slight  pain  in  forearm.  Transferred  to  New  Haven  August  31,  1865. 

CASE  1010. — Ligation  of  femoral  followed  by  ligation  of  external  iliac;  death. — Private  W.  P.  Webb,  Co.  H,  4th  Maine, 
ageu1  21  years,  was  admitted  to  Master  Street  Hospital,  Philadelphia,  August  12,  1862,  suffering  from  an  abscess  resulting  from 
a  contusion.  Acting  Assistant  Surgeon  P.  B.  Goddard  reported  that  "the  injury  was  located  at  the  outer  and  anterior  part  of 
lower  third  of  the  right  thigh,  and  was  inflicted  by  a  blow  with  the  butt  end  of  a  musket.  The  abscess  was  followed  by  caries 
of  the  femur,  and  the  patient  was  much  debilitated  when  admitted,  but  improved  until  secondary  haemorrhage  set  in  at  the  seat 
of  the  abscess.  In  order  to  control  this  Acting  Assistant  Surgeon  D.  Gilbert  was  obliged  to  ligate  the  femoral  artery  above  the 
profunda  on  September  21st.  The  patient  did  well  until  the  ligature  cut  through  on  September  25th,  when  from  the  aplastic 
condition  of  the  blood  no  coagulation  had  taken  place  in  the  calibre  of  the  vessel  and  violent  haemorrhage  from  the  divided 
femoral  artery  was  the  consequence.  This  was  controlled  by  the  ligation  of  the  external  iliac  below  the  origin  of  the  deep 
epigastric  by  Acting  Assistant  Surgeon  W.  H.  Pancoast  on  September  25th.  The  haemorrhage,  however,  reappeared  at  the  seat 
of  the  first  ligation  on  September  30th,  when  Dr.  Pancoast  was  obliged  to  enlarge  the  former  incision,  and  finding  that  the  lifting 
up  of  the  external  iliac  on  the  groove  director  just  below  the  bifurcation  controlled  the  bleeding  entirely,  he  ligated  the  artery  at 
that  point.  The  patient  lived  several  days  after  the  operation;  but  he  could  not  recover  from  the  effects  of  the  haemorrhages 
and  sank  away  gradually  till  October  3,  1862,  when  he  died.  The  temperature  of  the  leg  continued  good  after  the  operation." 

CASE  1011. — Ligation  of  femoral  followed  by  ligation  of  external  iliac. — Private  D.  Brittou,  Co.  C,  5th  Indiana  Cavalry, 
aged  34  years,  entered  hospital  No.  2,  at  Nashville,  on  September  19,  1864.  He  was  admitted  on  account  of  femoral  aneurism, 
located  in  Scarpa's  triangle,  for  which  pressure  had  been  applied,  producing  an  extensive  gangrenous  slough  below  Poupart's 
ligament.  Surgeon  J.  E.  Herbst,  U.  S.  V.,  who  described  the  case,  reported  that  he  ligated  the  femoral  artery  three-fourths  of 
an  inch  below  Poupart's  ligament  on  October  2d,  and  that  haemorrhage  to  the  amount  of  forty-eight  ounces  occurred  four  days 
afterwards,  when  the  external  iliac  artery  was  ligated  by  Acting  Assistant  Surgeon  M.  N.  Benjamin.  Death  occurred  on  Octo 
ber  7,  1864,  from  exhaustion  resulting  from  the  haemorrhage. 

CASE  1012. — Ligation  of  femoral  artery  for  popliteal  aneurism. — Private  J.  Fleming,  Co.  C,  157th  Pennsylvania,  aged  47 
years,  was  admitted  to  Cuyler  Hospital,  Philadelphia,  June  6,  1864,  with  aneurism  of  the  popliteal  artery  of  the  right  leg. 
Assistant  Surgeon  H.  S.  Schell,  U.  S.  A.,  reported  that  "when  first  seen  the  tumor  was  about  the  size  of  a  duck's  egg;  pulsa 
tion  strong  and  diffused;  bruit  loud,  but  thrill  not  very  well  defined.  The  patient  kept  his  leg  in  a  semi-flexed  position  and 
complained  of  constant  pain  proceeding  from  the  tumor  and  ankle  of  the  same  side.  Below  the  seat  of  the  aneurism  the  limb 
was  somewhat  cedematous,  dusky,  and  slightly  pitting  on  pressure.  He  stated  that  he  first  observed  the  tumor  some  months 
previously,  after  a  severe  exertion  in  lifting  heavy  stones,  that  it  gradually  though  slowly  increased  in  size,  and  that  latterly  the 
pain  in  the  limb  had  increased  in  intensity.  According  to  his  statement  the  only  treatment  to  which  he  had  been  subjected  before 
his  admission  to  Cuyler  Hospital  consisted  of  the  application  of  an  ointment  and  of  a  liquid,  which  from  his  description  was  tin- 
tincture  of  iodine.  Physical  examination  showed  the  heart  to  be  perfectly  healthy  and  there  appeared  to  be  no  disposition  to 
disease  of  the  arteries  in  any  other  part  of  the  body.  Bearing  in  mind  Mr.  Syme's  case  in  which  coagulation  and  a  spontaneous 
cure  was  effected  by  the  simple  application  of  a  bandage  to  the  limb,  this  plan  was  tried  and  the  patient  was  strictly  confined  to 
his  bed.  No  success  followed  this  method,  and  forced  flexions  were  next  employed,  the  leg  being  bent  upon  the  thigh  and  firmly 
fixed  by  numerous  turns  of  a  figure  of  eight  bandage.  This  mode  of  treatment  likewise  proving  unavailing,  pressure  by  means 
of  an  instrument  resembling  Signorini's  tourniquet  was  resorted  to,  but  was  found  equally  as  ineffective  as  the  means  previously 
employed.  Meanwhile  the  aneurism  was  steadily  enlarging  and  the  risk  of  venous  obstruction  became  more  imminent  daily. 
It  was  accordingly  resolved  to  tie  the  femoral  artery  at  the  lower  angle  of  Scarpa's  space,  which  was  done  in  the  usual  manner 
on  June  16th  by  Acting  Assistant  Surgeon  J.  Ashhurst,  jr.  Anaesthesia  was  induced  by  the  use  of  ether,  and  the  vessel  was 
reached  by  an  incision  abtjut  three  inches  in  length.  The  haemorrhage  during  the  operation  scarcely  exceeded  a  fluid  drachm  ; 
pulsation  ceased  instantly  upon  the  tightening  of  the  ligature.  The  edges  of  the  wound  were  then  brought  together  by  hare-lip 
pins  and  several  points  of  the  interrupted  suture  (lead  wire  being  the  material  employed),  after  which  a  light  dressing  of  dry 
shdfct  lint  was  applied  and  the  entire  limb  below  the  wound  was  enveloped  in  carded  cotton.  The  temperature  of  the  limb  was 
at  first  slightly  above  that  of  the  other,  but  it  soon  became  normal  and  remained  so.  When  the  state  of  anaesthesia  passed  off 
the  patient  complained  of  a  burning  pain  in  the  heel  and  ankle.  The  tumor  (which  in  a  few  days  became  hard,  showing  that  a 
clot  had  been  formed)  gradually  diminished  in  size,  no  recurrent  pulsation  taking  place  at  any  time.  The  wound  healed  almost 
throughout  by  adhesion.  The  application  of  cotton  to  the  limb  was  discontinued  on  the  fifth  day;  the  ligature  came  away  on 
the  seventeenth  day,  and  the  progress  of  the  patient  afterwards  to  recovery  was  uninterrupted."  The  patient  was  subsequently 
transferred  to  Mower  Hospital,  whence  he  was  discharged  July  5,  1865,  and  pensioned.  The  Philadelphia  Examining  Board 
reported,  December  7,  1S70:  "We  find  the  aneurism  entirely  cured  by  a  ligation  of  the  right  femoral  artery  at  Scarpa's  space; 
limb  somewhat  atrophied  and  numb;  use  and  power  of  limb  impeded."  Several  years  later  the  same  board  certified  that  the 
pensioner  "  complains  of  numbness  down  the  whole  surface  of  the  thigh  and  leg.  There  is,  however,  no  evidence  of  want  of 


SECT.  II. 


OPERATTOXS    ON    THE    EYE    OR    ITS    APPENDAGES. 


681 


bJood-supplv  in  the  leg;  nor  is  there  nny  atrophy  of  the  limb.  There  is  no  pulsation  in  the  artery  below  the  seat  of  the  liga- 
tion."  The  pensioner  was  paid  December  4,  1879. 

CASE  1013. — Ligation  of  femoral  artery. — Private  Jerry  Hart,  Co.  B,  2d  Kentucky,  was  admitted  into  hospital  No.  9, 
Nashville,  with  an  injury  received  in  a  quarrel  at  Shiloh,  Tennessee.  Femoral  artery  Hinted.  Discharged  January  30.  1863. 

CASE  1014. — Liyation  of  superior  profumla  for  incised  wound. — Private  J.  Shaw,  Co.  D,  4th  Minnesota,  aged  23  years, 
was  admitted  into  Crittenden  Hospital,  Louisville,  June  26,  1865,  with  an  incised  wound  of  left  arm,  inflicted  with  a  knife.  The 
superior  profunda  was  ligated  in  the  wound.  He  was  mustered  out  July  19,  1865. 

CASE  1015. — Liyation  of  an  artery  of  tJic  foot. — Surgeon  T.  H.  Squire,  89th  New  York,  reports:  "Private  T.  P.  Barrows, 
Co.  G,  35th  Massachusetts,  aged  18  years,  accidentally  wounded  by  an  axe,  which  slipped  from  the  handle  while  he  was  using 
it,  making  a  transverse  cut  across  the  dorsum  of  the  left  foot,  injuring  the  metatarsal  bones,  dividing  the  tendons  and  one  artery, 
which  required  a  ligature.  The  wound  has  been  painful,  the  foot  is  badly  swelled,  the  wound  is  ugly,  and,  for  aught  I  know, 
the  boy  will  eventually  lose  his  limb  or  life  from  it;  now  being  poulticed.  Died  November  1,  1862." 

Details  of  the  remaining  eight  cases  of  ligation  belonging  to  this  group  have  already 
been  given  in  the  preceding  chapters.1 

OPERATIONS  ON  THE  EYE  OR  ITS  APPENDAGES.— Seventy-six  operations  for 
diseases  or  injuries  of  the  eye  were  reported.  They  include  operations  on  the  conjunctiva, 
for  pterygium,  symblepharori,  anchyloblepharon,  gonorrhoea!  ophthalmia;  on  the  cornea,  for 
staphyloma  and  leucoma;  operations  on  the  iris  and  the  ciliary  body;  operations  for  cata 
ract,  for  strabismus,  for  lacrymal  fistula,  and,  on  the  eyelids,  for  blepharitis,  entropion, 
ectropion,  etc.  In  seven  instances  the  eyeball  was  extirpated.  Brief  abstracts  of  all  the 
cases  are  given  in  the  appended  table: 

TABLE  OXIII. 
Condensed  Summary  of  Seventy-six  Operations  on  the  Eye  or  its  Appendages. 


NAME,  MILITARY  DESCRIP 
TION,  AND  AGE. 


INJURY  on  DISEASE. 


1  Adams,  J.,Pt.,B,  1st  Louisiana, 

age  :i5. 

2  i  Anderson,  G.  II.,  Pt.,  D,  15th 
.     Vet.  Reserve  Corps,  age  22. 

3  !  Barry,  C.,  Pt.,  H.  58th  Illinois, 
j     »g<=  -'• 


4  I  Beach,  J.  W.,  citizen,  age  47.. 


5  i  Bemlon,   T.,   Serg't,  D.   170th 

Now  York,  age  26. 
G     Blakeman,    A.,    Pt.,    A,    10th 

j     Wisconsin,  age  2K. 
7     Boas,  H.,   Pt.,  B,  8th  Veteran 

Reserve  Corps,  age  20. 


•  8  j  Brandy,  F.  M.,  Corp'1,  C,  42d 

Indiana,  age  31. 

9     Brown,  B.  L.,  Pt.,  II,  84th  Illi 
nois,  age  25. 

10  :  Butler,  H.,  Seaman,  Gunboat 
j     Mound  City,  nge  23. 

11  Callaghan,  j.,  Pt.,  C,  45th  Illi- 
1     nois.  nge  21 . 

12  Chandler,  T.,  Ft..  E.  7th  Illi 

nois  Cavalry,  age  33. 

Cornell,    R.    A..  Pt..   H,   103d 
Illinois,  age  25. 


14     Crippen.  J.  H.,  Pt..  E,    161st 
New  York,  age  26. 


15  !  De  Areey,  J.,  Pt.,  I,  1st  Michi 
gan  Engineers,  age  30. 


186!),  inflammation  right  iris,  encepha- 
loid  tumor  size  of  horse-chestnut. 

August,  1864,  staphyloma  involving 
entire  cornea  of  right  eye,  result  of 
variolous  postules. 

Attachment  of  fold  of  conjunctiva  to 
cornea,  right  eye;  nebulous  and  im 
perfect  condition  left  cornea,  result 
of  ophthalmia,  March,  1863. 

Lenticular  cataract  on  both  eyes,  pro 
ducing  total  blindness. 


May,  1864,  injury  left  side  of  head ; 

staphyloma  of  left  cornea. 
November,  1863,  staphyloma  of  left 

cornea. 
Central  leucoma  of  left  eye,  result  of 

gonorrhoea! ophthalmia;  vision  null. 


Pterygium  of  right  eye 

Large  pterygium  of  both  eyes 

Penetrating  wound  of  left  eyeball ; 

large  protrusion  of  humor. 
Severe  strabismus,  sing,  convergence. 

result  of  cereb.  aft'ect.  in  childhood. 
Leucoma  of  both  eyes  from  purulent 

ophthalmia. 

18(>3.  entropion  left  eye,  result  of  gran- 
ularophtlinlinia  :  lashes  in  perpetual 
contact  with  the  globe. 

Cornea  right  eye  ulcerated;  slightly 
panniform  and  somewhat  anaesthetic; 
.neuralgic  pains. 

Cornea  of  both  eyes  ulcerated  ;  pan 
niform  and  anaesthetic ;  repeated 
paracentesis  on  both  eyes  without 
relieving  pain. 


OPERATION  AND  OPERATOR. 


June  8,  1863,  removal  of  eyeball  and 
contents  of  socket  by  knife. 

Rapidly  increasing-  in  size.  Nov.  20, 
excision  of  staphyloma.  Surg.  J.  S. 
Hildreth,  U.  S.  V. 

Oct.  13,  1864,  flap  dissected.  Staphy 
loma  involved  whole  cornea.  Dec. 
31,  excision  staphyloma  right  eye. 
Feb.  16,  iridec.tomy.  Surg.  J.  S. 
Hildreth,  U.  S.  V. 

Oct.  19,  1864,  incis'n  thro'  left  cornea, 
forming  semi-lunar  flap  ;  capsule  of 
lens  opened  and  lens  extracted.  A. 
A.  Surg.  F.  Strube. 

Jan.  10,  '65,  removal  of  whole  cornea; 
a  portion  of  humor  evacuated. 

Aug.  10,  1864,  operation  for  staphy- 
lorna.  Surg.  A.  Hammer,  U.  S.  V. 

June  3,  1865,  artificial  pupil  at  upper 
and  int.  margin  of  cornea.  Surg.  J. 
S.  Hildreth.  U.  S.  V. 

Dec.  24,  1864.  Desmarres's  process. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

March  4,  1865,  Desmarres's  method. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

Sept.  15,  1862,  extirpation  of  ball  of 
eye.  Surg.  E.  C.  Franklin,  U.  S.  V. 

Dec.  19,  1863.  strabotomy.  Surg.  M. 
K.  Taylor,  U.  S.  V. 

March  11.  1865.  iridectomy  by  pro 
cess  of  deehirement ;  both  eyes. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

May  6,  1865,  elliptical  section  of  ex 
ternal  integument  of  upper  lid;  new 
position  maintained  bv  three  sutures. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

April  17.  1865,  division  of  ciliary  mus 
cle.  Surg.  J.  S.  Hildreth,  U.  S.  V. 

May  19,  division  of  ciliary  muscles  of 
both  eyes  between  external  and  in 
ferior  recti-muscles.  Surg.  J.  S.  Hil 
dreth.  U.  S.  V. 


RESULT  AND  REMARKS. 


Recovery  in  three  months.     Disch'd 

Jan.  2,' 1864.     Died  in  1866. 
Discharged  July  22,  1865;  pens  d. 


Discharged  April  13,  1865;  pens'd. 
Total  loss  of  sight  of  right  eye; 
disease  of  left  eye,  resulting  in  al 
most  total  loss  of  sight. 

Eyes  closed  with  plaster  and  band 
age.  Oct.  25,  able  to  read  with  a 
bicornons  lens.  Recovery  Novem 
ber  2,  1864. 

Discharged  May  17,  1865 ;  received 
artificial  eye. 

Disch'd  Oct.  13,  1864;  loss  of  sight 
left  eye.  threatened  loss  right  eye. 

Recoverv  of  vision  of  large  objects. 
Discharged  July  2,  1865. 

Adherent  in  a  few  days.  Disch'd 
August  7,  1865. 

Flap  united,  pterygium  disappeared. 
Disch'd  April  13,  1865:  pensioned. 

Duty  Dec.  7,  1862 ;  pens'd.  "  Sym 
pathetic  affection  of  right  eye." 

Accord  of  optics  nearly  normal. 
Discharged  November  ID,  1864. 

Can  see  large  objects.  Discharged 
June  17,  1865;  totally  blind;  pen 
sioned. 

Complete  remedy,  eyelashes  all  pre 
served  and  in  their  proper  position  ; 
eyes  weakened.  Disch'd  June  6, 
1865;  pensioned. 

Pain  relieved,  ulceration  speedily 
modifying.  Discharged  June  19, 
1865. 

Disch'd  Sept-  I,  1865;  pain  relieved, 
condition  of  eyes  improved  ;  right 
eye  permanently  destroyed  ;  pen 
sioned. 


1  l''or  a  ligation  of  the  thoraciea  longa  for  an  incised  wound  see  First  Surgical  Volume.,  page  556,  case  of  D.  Hughes,  13th  N.  Y.  Artillery.  The 
instance  of  ligation  of  the  branches  of  the  mesenteric  artery  for  a  punctured  wound  will  be  found  on  page  62,  CASE  206,  of  the  Second  Surgical  Volume. 
Details  of  a  case  of  ligation  of  the  radial  and  also  one  of  the  ulnar  artery,  for  incised  wounds,  are  given  on  page  436  of  the  same  volume ;  and  three 
cases  of  ligation  of  the  tibial  artery  are  cited  on  page  7,  CASES  5,  6,  7  of  this  volume.  For  ligation  of  iliac  see  CASE  978,  p.  336,  Second  Surgical  Vol. 

SURG.  Ill— 86 


682 


MISCELLANEOUS    INJURIES. 


[CHAP.  XI. 


NAME,  MILITARY  DESCRIP 
TION,  AND  AGE. 


Doran,  J.  E.,  Pt.,  E,  3d  Illinois 
Artillery,  age  17. 


Dunlap,  G.  S.,  Pt.,  B,  1st  Mis 
souri  Cavalry,  age  21. 


Edward,   J.,   contraband,  age 
25. 

Elliott,  J.  M.,  Pt.,  H,  30th  Ken 
tucky,  age  29. 


Ellsworth,  J.,  Pt.,  A,  1st  Mich 
igan  Artillery,  age  24. 

Essing,  R.,  Pt.,  B,  58th  New 
York,  age  40. 

Finn,  A.,  Pt.,  A,  8th  Veteran 
Reserve  Corps,  age  23. 

Flint,  J.  D.,  Pt.,  K,  13th  Wis 
consin,  age  20. 


Frank.  P.,  Pt.,  E,  58th  Illinois, 
age  33. 


French,  D.  S.,  Pt.,  A,  70th 
New  York,  age  39. 

Furrow,  W.  P.,  Pt.,  E,  51st 
Illinois,  age  29. 

Garrett,  D.  J.,  Serg't,  C,  9th 

Iowa,  age  24. 
Getz.  B.,  Pt.,  L,  4th  Cavalry, 

age  24. 

Grieshaber,  U.,  late  Pt,,  K,  30th 

Missouri,  age  37. 
Haight,  F.  G.,  Corp'l,  K,  15th 

Vet.  Reg.  Corps,  age  26. 

Hamilton.  W.  W.,  Pt,  A,  95th 
Illinois,  age  21.  (Discharged 
soldier.) 

Hayne,  P.,  Serg't,  C,  60th  New 
York,  age  33. 

Hicks,  W.,  Pt.,  1, 107th Illinois, 

age  30. 
Hixon,  H.  A.,  Corp'l,  H,  18th 

Massachusetts,  age  23. 


Hoffstetter,   J.,  Pt.,  48th    Co. 

Vet.  Reserve  Corps,  age  34. 
Howard,  M.  H.,  Serg't,  C,  1st 

Missouri  Cavalry. 

Hughes,  J.  C.,  Pt.,  C,  1st  Mis 
souri  Engineers,  age  23. 

Johnson,  H.  J.  N.,.  Pt.,  K,  14th 
Illinois  Cavalry,  age  19. 


Kennedy,  J.  M..  Pt.,  K,  119th 
Illinois,  age  23. 

Kenner,  J.,   civilian  prisoner, 

age  19. 
Knapp,  C.,  Pt,  K,  65th  Illinois, 

age  56. 

Lamont,  J.,  Pt.,  K,  8th  Veteran 
Reserve  Corps,  age  49. 

Long,  Z.  V.,  Pt,,  D,  9th  Illinois 
Cavalry,  age  22. 

Mernin,  J.,  Pt.,  F,  7th  Minne 
sota,  age  43. 

Merritt,  J.  A.  J.,  Corp'l,  I,  6th 

Florida. 
Morris.  O.,  Pt,.  F,  5th  Maine, 

age  26. 


INJURY  OR  DISEASE. 


Purulent  ophthalmia  witli  moderate 
chemosis  of  both  eyes. 

Central  leucoma  of  both  eyes,  caused 
by  ophthalmia;  right  eye  quite  use 
less. 


Protrusion  and  destruction  of  eyeball 
by  sharp  edge  of  hoe. 

Pannus  covering  cornea  of  right  eye; 
total  obscurity  of  vision. 


Gonorrhoeal   ophthalmia  with   large 
chemosis  of  both  eyes. 

Entropion ;  both  low.  lids  well  marked. 


Purulent  ophthalmia  with   chemosis 
of  both  eyes. 

Entropion  caused  by  superabundance 
of  integument. 


Trichiasis  right  upper  lid,  caused  by 
blepharitis  andgranularophthalmia. 


Double  entropion,  caused  by  catarrhal 
inflammation  of  eyes. 

Cornea  panniform  and  superficially 
ulcerated. 

Staphyloma 

Staphyloma  left  eye,  result  of  gonor- 
rhceal  ophthalmia;  leucoma  of  right, 
result  of  purulent  ophthalmia. 

Artificial  pupil  of  right  eye;  com 
plete  blindness. 

Aug.,  1864,  purulent  ophthalmia  with 
chemosis  of  both  eyes. 

August,  1865.  central  hernia  iris,  left 
eye,  from  sloughing  of  cornea,  re 
sult  of  purulent  ophthalmia. 

Defective  vision  right  eye  from  cen 
tral  albugo,  result  of  ulceration  fol 
lowing  fever. 

Large  pterygium  left  eye 

Strabismus  interims  (double);  bleph 
aritis,  granular  lids. 


Glaucoma  of  both  eyes 

Small  vascular  tumor,  upper  eyelid. 


Irido-cboroiditis  right  eye ;  permanent 

contraction  of  pupil. 
Partial  Staphyloma  of  right  cornea 

from  ulceration  following  erysipelas 

of  face. 

January,  1864,  panniform  cornea,  sur 
face  covered  with  exudations. 


Disorganization  of  right  eye 

Moderate  sized  pterygium  returned 
after  previous  operation. 

Cornea  of  left  eye ;  ulceration;  pain, 
which  was  not  relieved  by  repeated 
paracentesis,  etc. 

Ant.  chamber  both  eyes  nearly  oblit 
erated  ;  irides  attached  to  capsules, 
result  of  ophthalmia. 

Spurious  cataract  and  occlusion  of 
pupil  right  eye;  total  blindness. 

Complete  Staphyloma  of  cornea,  result 

of  confluent  small-pox. 
November  4, 1863,  splinter  perforated 

cornea  and  wounded  lens,  left  eye ; 

splinter  extracted. 


OPERATION  AND  OPERATOR. 


Aug.  29,  1864,  division  of  ciliary  mus 
cle,  righteye.  Surg.  J.  S.  Hildreth, 
U.  S.  V. 

Dec.  31,  1864,  operation  for  artificial 
pupil.  Feb.  25,  1865,  iridectomy  of 
both  eyes.  Operator:  Surg.  J.  S. 
Hildreth,  U.  S.  V. 

Feb.  2,  1864,  excis.  eye  ball,  edges  of 
palpebral  wound  brought  together 
by  sutures.  A.  A.  Surg.  C.  Pelaez. 

Aug.  25,  syndectomy.  Pannus  con 
necting  necessitated  re-operation. 
Sept.  9,  disease  reproducing  itself. 
Hancock's  operation  performed  Oct. 
7.  Surg.  J.  S.  Hildreth,  U.  S.  V. 

Jan.  21,  1865,  division  of  ciliary  mus 
cles  of  both  eyes.  Surg.  J.  S.  Hil 
dreth,  U.  S.  V. 

Feb.  4,  1865,  excision  of  triangular 
flap  on  both  eyes.  Surg.  J.  S.  Hil 
dreth,  U.  S.  V. 

Oct.  19,  division  of  ciliary  muscle. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

April  18, 1865,  removal  of  integument 
beneath  lower  lid  right  eye.  A.  A. 
Surg.  M.  L.  Herr. 

Sept.  9,'65,  transposit'n  "  by  a  new  pro 
cess  adopted  for  the  first  time,  so  far 
as  known,  in  this  case."  Snrg.  J.  S. 
Hildreth, U.S. V.  Trichiasis  left  up. 
lid ;  same  operation,  same  operator. 

Oct.  4,  1863,  Janson's  operation,  Des- 
marres's  modification.  Surg.  J.  S. 
Hildreth,  IT.  S.  V. 

April  13, 1865,  division  of  ciliary  mus 
cle  left  eye.  Surg.  J.  S.  Hildreth, 
U.  S.  V. 

May  1,  operated  on  by  A.  A.  Surg.  — 
Biickhalm. 

July  25, 1864.  exc.  of  Staphyloma,  left 
eye.  Jan.  7,  '65,  iridectomy  of  right 
eye,  Desmarres's  method  ofdechire- 
ment.  Surg.  J.  S.  Hildreth,  U.  S.  V. 

July  12,  1864,  operation  for  artificial 
pupil.  Surg.  A.  Hammer,  U.  S.  V. 

Oct.  2,  1864,  division  of  ciliary  mus 
cle  of  right  eye.  Surg.  J.  S.  Hil 
dreth,  U.  S.  V. 

Sept.  16,  1865,  iridectomy  by  d6chire- 
ment.  Oct.  11 .  Hancock's  operation. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

Feb.  11,  1864,  excision  of  portion  of 
iris.  Surg.  J.  S.  Hildreth,  U.  S.  V. 

Jan.  14,  1865,  Desmarres's  operation. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

Sept.  16,  1863,  Graefe's  operation  on 
rectus  internus  dexter.  Dec.  1,  '63, 
same  operation  on  sinister.  Surg.  J. 
S.  Hildreth,  U.  S.  V. 

Iridectomy  both  eyes.  Surg.  J.  E. 
McDonald.  U.  S.  V. 

May,  1863,  tumor  exc.,  its  bed  plugged 
with  lint  saturated  with  liq.  ferri  per- 
sulp.  Surg.  H.  Culbertson,  U.  S.V. 

March  11,  1865,  division  of  ciliary 
muscle.  Surg.  J.  S.  Hildreth, U.S.V. 

Oct.  15, 1864,  excision  of  Staphyloma, 
leucoma  followed.  March  4,  1865, 
iridectomy  by  process  of  dechire- 
ment.  Surg.  J.  S.  Hildreth,  U.  S.V. 

April  13, 1865,  divis.  of  ciliary  muscle. 
Surg.  J.  S.  Hildreth,  U.  S.V. 


Feb.  5,  1864,  extirpation  of  right  eye. 

Surg.  . I.  H.  Curry,  U.  S.V. 
Feb.  4,  "65,  Destnarres's  meth.  on  left 

eye.     Surg.  J.  S.  Hildreth,  U.  S.  V. 

April  26,  1865,  divis.  of  ciliary  muscle. 

May  13.  operation  repeated.     Surg. 

J.  S.  Hildreth,  U.  S.  V. 
May  6,   1865,  attempted  excision  of 

irides;    division   of  ciliary   ring   of 

each   eye ;    excision   impracticable. 

Surg.  J".  S.  Hildreth.  U.  S.  V. 
Nov.  10,  1864,  operation  for  artificial 

pupil  by  Surg.  A.  Hammer,  U.  S.V. 

May  11,  1864,  removal  of  eye 


RESULT  AND  UKMARKS. 


Nov.  21.  fragments  of  crystalline  ex 
tracted,  protruding  parts  of  iris  ex 
cised.  Surg.  .7.  S.  Hildreth,  U.  S.V. 


Cornea  improved  for  a  few  days  and 
then  sloughed  away;  cornea  of 
other  eye  also  destroyed;  blind. 
Discharged  Aug28,  1865. 

Disch'd  April  13,  1865;  has  good 
vision. 


Recovery  March  6,  1864. 


Left  hospital  Oct.  16,  1865;  pens'd. 
Totally  blind ;  complete  opacity 
and  Staphyloma  of  both  cornea. 


Discharged  July  28,  1865 ;  vision  of 

right  eye  good,  left  eye  lost  from 

central  leucoma. 
Discharged  May  17, 1865;  defective 

vision ;    lids    entirely    recovered, 

natural  condition. 
Cornea  sloughed  away.  Discharged 

Jan.  23,  1865;  total  loss  of  sight 

left  eye ;  pensioned. 
Discharged  Nov.  28,   1865 ;  claims 

pension  for  moon-blindness  and  loss 

of  sight  of  right  eye. 
Disch  d  Nov.  11,  1865;  pensioned. 

Deformity  and  induration  of  both 

upper  lids. 


Disch'd  March  14,  1864;  pensioned. 
Structural  changes  left  eye,  caus 
ing  almost  total  loss  of  vision. 

Disch'd  June  19,  1865;  eye  greatly 
improved ;  pens'd.  Loss  of  sight 
of  left  eye. 

Discharged  Feb.  28.  1866;  pens'd. 
''  Total  blindness  left  eye." 

Discharged  Aug.  10,  1865;  pens'd. 
Total  loss  of  left  eye,  imperfect 
vision  of  right  eye. 

Sight  partially  restored. 

Cornea  destroyed  by  ulceration. 
Disch'd  June  4,  '65;  sight  ot  right 
eye  lost,  left  eye  impaired. 

Nov.  8,  1865,  extent  of  opacity  of 
cornea  disappearing;  pens'd.  To 
tal  loss  of  left  eye. 

March  15,  1864,  vision  improving, 


Pterygium  entirely  displaced.  Dis 
charged  May  22]  1865. 

Strabismus  not  completely  corrected. 
Transferred  March  9,  1864. 


July  27,  1865;  doing  well. 
Duty  June  7, 1863. 


Discharged  June  19, 1865;  claim  for 
pension  rejected. 

Disch'd  May  25,  1865;  sight  very 
imperfect,  owing  to  atrophy  of  optic 
nerve;  pensioned.  Blind  in  right 
eye.  left  impaired. 

Disch'd  June  27.  1865;  panniform 
condition  to  a  great  extent  disap 
peared  ;  pens  d.  Defective  vision. 

Escaped  Feb.  24,  1864.  Movement 
of  muscles  of  eyeball  preserved. 

Pterygium  entirely  displaced.  Dis 
ch'd  Mar.  1 5,  '65,  cornea  nebulous  ; 
pensioned.  Impairment  of  sight. 

Cornea  clean  and  in  good  condition  ; 
an  artificial  pupil  will  give  him  an 
excellent  vision. 

Discharged  June 2,  '65;  total  blind 
ness  both  eyes ;  pensioned. 


Disch'd  June  2,  1865;  complete  and 
permanent  loss  of  vision  from  oph 
thalmia  and  iritis;  pensioned. 

Recovery,  with  good  stump  for  arti 
ficial  eye. 

Transferred  March  15,  ]864;  form 
of  eye  well  preserved  but  vision 
lost. 


SECT.  71. ] 


OPERATIONS    ON    THE    EYE    OR    ITS    APPENDAGES. 


683 


65 
66 

67 
68 

69 
70 

71 
72 
73 

74 

75 
76 


NAME,  MILITARY  DESCRIP 
TION,  AND  AGE. 


Myers,  F. .!.,  Pt.,  K,  llth  N.  Y. 
Cavalry,  age  22. 

Neville,  C.  W.,    Pt.,    E,   21st 
Missouri,  age  17. 

Nichols,  A.,  Pt.,  L,  3d  Michi 
gan  Cavalry,  age  30. 

O'Brien,   1).   J.,   Pt.,    C,    2Stu 

Massachusetts. 
Oliphant,  W.  J.,  Pt.,  B,  132d 

New  York,  age  16. 
Oppelcust.  G.,   Pt.,    K,   112th 

Illinois,  age  35. 

Patterson,    S.  B.,  Pt.,  G,  8tU 
Vet.  Reserve  Corps,  age  34. 


Pemberton,  J.,  Pt.,  A,  5th  Ken 
tucky  Cavalry,  age  29. 

Plowman,    A.  J.,  Pt.,  A,  6th 
Maryland,  age  27. 


Scheming,  A.,  Pt.,  G,  8th  Vet. 
Reserve  Corps,  age  20. 


Shafer,  W.,  Pt.,  F,  123d  Illi 
nois,  age  39. 

Smith,  A.,  Pt.,  F,  8th  Veteran 
Reserve  Corps,  age  25. 

Street,  G.  S.,  Pt..  M,  1st  Conn. 
Artillery,  age  34. 

Sullivan,  J.,  Pt.,  G,  2d  Mass. 
Cavalry,  age  21. 

Tibbitts.  \V.,  Pt.,  H,  147th  X. 
York,  ago  25. 

Toomey,  J.,  Pt.,  G,  18th  Mis 
souri,  age  21.  _ 


Ulrich,  H.,  Pt.,  K,  63d  Illinois, 
age  25. 


INJURY  OR  DISEASE. 


Unknown . 


Unknown . 


Van   Curen,    C..    Pt.,  E,    17th 
Wisconsin,  age  46. 


Van  Tassel,  E.,  Pt.,  A,  120th 
New  York,  age  19. 

Vosbnrp.  J..  Pt.,  K,  3d  Minne 
sota,  age  43. 

\Velch.  J..  Pt.,  B.  17th  Mich 
igan,  age  43. 

Welsh,  P.,  Pt.,  D.  28th  Ken 
tucky,  age  35. 

Whipple.  H.  L.,  Pt.,  E.  77th 
New  York,  age  30. 

Williamson,  J..  Pt.,  D,  174th 
New  York,  age  20. 

Wycoff.  D.  E.,  Serg't,  F.  108th 
Now  York,  age  20. 


Young.  A.  W.,  Serg't,  L.  12th 
Tennessee  Cavalry,  age  29. 


Curtis,  J.,  Pt.,  E,  12th  Indiana, 
age  42. 

Wolf,  J.  H.,  Musician,  E,  12th 
Penn.  Reserve*,  age  26. 


Gonorrhoeal  ophthalmia  of  both  eyes, 
uleeration,  chemosis. 


Staphyloma 

March,  1864,  ectropion  of  right  eye. 


OPERATION  AND  OPERATOR. 


RESULT  AND  REMARKS. 


Congenital  convergent  strabismus  of 

right  eye. 
Double  divergent  strabismus 


Staphyloma  both  cornea,  and  iris  of 
right  eye,  from  ophthalmia. 

Chronic  choroiditis  of  both  eyes 


Irido-choroiditis  of  right  eye. 


Pterygium,  double  at  internal  angle 
of  either  eye. 


Purulent  ophthal  mia  with  chemosis  of 
both  eyes. 


Purulent  ophthalmia,  large  chemosis 
of  both  eyes. 

Nebulous  condition  of  cornea  of  both 
eyes. 

Excessive  myopia  of  both  eyes 


Staphyloma  of  cornea  and  iris,  result 
of  uleeration. 

Staphyloma  of  cornea  of  left  eye; 

catarrhal  ophthalmia. 
Internal  strabismus  . . . 


Purulent  ophthalmia ;  large  chemosis 
of  both  eyes. 


Chronic  inflammation   of  lachrymal 
sac,  with  mucous  discharge. 


Chronic   inflammation   of  lachrymal 

sac  attended  with  mucous  discharge. 

Staphyloma  cornea ;  sight  obliterated. 


Fistula  of  lachrymaTIs  left  eye  ;  ab 
scess  at  internal  canthus. 

April  6,  1864,  purulent  ophthalmia; 
large  chemosis  of  both  eyes. 

Large  uleeration  of  cornea  following 

chronic  ophthalmia;  sloughing. 
Entropion  left  eye,  upper  lid 


Cataractous  lens  dislocated  into  ant. 
chamber  of  left  eye;  blow,  Septem 
ber,  1862. 

Symblepharon  left  lower  lid  with 
cornea. 

Anehyloblepharon  both  eyes  from  in 
flammation  of  lids. 


Large  central  leucoma  both  eyes,  re 
sult  of  purulent  ophthalmia;  only  a 
small  part  of  each  cornea  remained 
transparent. 

Sarcoma,  right  eye  entirely  destroyed, 
inflamed,  ulcerated,  and  protruding 
from  orbit. 

Pterygium,  double. 


July  25,  Hancock's  operation ;  divis. 

of  ciliary  muscle.     Surg.  J.  S.  Hil- 

dreth,  U.  S.  V. 
Extirpation  left  eye 


July  12,  operation  by  Surg.  A.  Ham 
mer,  U.  S.  V. 

June  8, 1863,  operation  by  A.  A.  Surg. 
J.  W.  Gushing. 

Division  of  both  extern!  recti.  A.  A. 
Surg.  J.  H.  Hinton. 

Sept.  10,  '65,  exc.  of  Staphyloma,  right 
eye,  Desmarres's  process.  Surg.  J. 
S.  Hildreth.  U.  S.  V. 

April  26, 1365,  division  of  ciliary  mus 
cle,  right  eye.  June  17,  same  oper 
ation  on  left  eye.  Surg.  J.  S.  Hil 
dreth,  U.  S.  V. 

March  8,  1865,  division  of  ciliary  mus 
cle,  right  eye.  Surg.  J.  S.  Hildreth, 
U.  S. V. 

Deo.  11, 1863,  displacement  rigrht  eye 
by  Desmarres's  process.  Feb.  11, 
1864,  same  operat'n  on  left  eye,  using 
one  stitch  only  to  maintain  position. 
Surg.  J.  S.  Hildreth,  U.  S.  V. 

Aug.  29,  1864,  division  of  ciliary  mus 
cle,  left  eye ;  abscess ;  cornea  finally 
sloughed  away.  Jan.  7,  '05,  staphy- 
loma  excised.  Aug.  23,  '65,  iridec- 
tomy  of  right  eye.  Surg.  J.  S.  Hil 
dreth,  U.  S.  V. 

Sept.  2,  division  of  ciliary  muscle  of 
right  eye.  Surg.  J.  S.  Hildreth, 
U.  S.  V. 

March  8,  1865,  iridectomy  of  both 
cornea.  Surg.  J.  S.  Hildreth,  U.S.  V. 

June  15,  Hancock's  operation,  right 
eye.  Surg.  J.  S.  Hildreth,  U.  S.  V. 

Feb.  2,  1864,  excision  of  tumor  with 
Staphyloma.  Surg.  J.  S.  Hildreth, 
U.  S.  V. 

June  1,  cornea  removed  by  Surg.  J. 
E.  McDonald,  U.  S.  V. 

May  6,  1865,  Graefe's  operation,  sep 
arating  digitations  of  tendons  from 
sclerotic.  Two-thirds  of  error  cor 
rected.  Surg.  J.  S.  Hildreth,U.S.V. 

Sept.  25.  1864,  division  of  ciliary  mus 
cles  of  both  eyes.  Feb.  11,  '65,  ex 
cision  Staphyloma,  left  eye.  Surg. 
J.  S.  Hildreth,  U.  S.  V. 

May,  1863,  sac  opened  and  tent  intro 
duced  to  obliterate  sac  and  set  up 
new  action  in  lining  membrane. 
Surg.  II.  Culbertson,  U.  S.  V. 

May  — ,  same  operation  as  in  case  64. 
Surg.  J.  H.  Culbertson. 

June  27,  division  of  cornea  with  cat 
aract  knife,  removal  of  lower  section 
with  scissors.  Surg.  H.  C.  Culbert 
son,  U.  S.  V. 

Feb.  5,  ISM.  introduction  of  style  by 
the  usual  method.  A.  A.  Surg.  J. 
M.  McGrath. 

Oct.  7,  division  ciliary  muscle,  right 
eye.  Surg.  J.  S.  Hildreth,  U.  S.  V. 

Dec.  31,  '64,  divis.  ciliary  muscle,  left 
eye.  Surg.  J.  S.  Hildreth,  U.  S.  V. 

Dec.  30.  1863.  excision  of  oval  piece 
of  integument  sutures.  A.  A.  Surg. 
G.  P.  Hackenburg-. 

Dec.  29,  1862,  lens  extracted  by  supe 
rior  section  of  cornea.  Surg.  D.  P. 
Smith.  U.  S.  V. 

Nov.  2,  '63,  symblepharon  dissect,  up, 
conjunctiva  of  globe  drawn  together 
bysutures  A. A. Surg.  J. IF.  Hinton. 

Jan.  25,  1864,  separation  of  iids  from 
globe  of  right  eye  with  probe-pointed 
scissors.  Feb.  24,  same  operation  on 
left  eye.  Surg.  J.  S. Hildreth, U.S.V. 

July  27,  1865,  iridectomy  both  eyes 
by  profess  of  d6ehirement.  Aug. 
25,  operation  on  left  eye  to  enlarge 
pupil.  Surg.  J.  S.  Hildreth,  U.  S.V. 

May  15.  1865,  whole  diseased  eye  re 
moved  with  bistoury.  A.  A.  Surg. 
E.  Seyffarth. 

Dec.  11,  1863,  displacement  of  ptery-  i 
gium.  right  eye.  Desmarres's  meth-  \ 
od.  Surg.  J.  S.  Hildreth.  U.  S.  V. 


Discharged  Feb.  6,  1864.  Pen.  Er. 
1881,  sight  greatly  impaired,  etc. 

Contracted  small-pox ;  remain'g  eye 
ulcerated,  sloughed  away.  Disch'd 
Jan.  26, '64;  pens'd;  totally  blind. 

Duty  Sept.  12,  1864 ;  claims  pension 
for  disease  of  eyes  resulting  from 
measles. 

Result  good;  Veteran  Res.  Corps. 
Discharged  December  13,  1864. 

No  change  by  operation  ;  Veteran 
Reserve  Corps  January  31, 1864. 

Disch'd  Oct.  16,  1805 ;  pens'd.  Oper 
ation  of  no  benefit ;  can  distinguish 
nothing.  Died  Sept.  11, '76;  ch.  diar. 

Discharged  July  3,  1865:  defective 
vision;  pensioned. 


Discharged  June  17,  1865;  affected 
with  granular  ophthalmia ;  pens'd; 
blind  in  left  eye. 

March  15,  1864,  recovery;  about  J 
disappeared  from  right  eye ;  left 
eye  much  more  satisfactory  owing 
to  absence  of  second  stich. 

Discharged  Aug.  26,  1866,  and  pen 
sioned;  no  vision  in  left  eye;  right 
eye  affords  enough  sight  to  enable 
him  to  go  about  alone. 


Discharged  March  6,  1865;  pens'd. 

Right  eye  totally  blind,  left  eye 

can  only  discern  light. 
Disch'd  May  24, '65.  Sight  improv'g, 

bids  fair  to  become  good  enough 

to  enable  him  to  read  fine  print. 
Myopia  disappeared.     Disch'd  Dec. 

13,  1863;  pensioned.     Amblyopia; 

right  eye  useless,  sight  feeble. 
Disch'd  August  12,   1864.     Loss  of 

vision  of  left  eye ;   sight  of  right 

eye  impaired:  pensioned. 
Discharged  July  19,   1865;  pens'd. 

Loss  of  sight  o'f  left  eye. 
Operation  on  other  eye  will  correct 

deformity.     Discharged  July  24, 

1865. 

Discharged  April  27,  1865.  Loss  of 
sight  left  eye,  cornea  of  right  eye 
nebulous;  pensioned. 

Doing  well. 


Doing  well. 

Active  conjunctivitis  and  comeitis 

resulted.      Duty   Nov.  28,    1 864  ; 

pensioned.     Loss  of  left  eye  and 

chronic  ophthalmia  right. 
March  6.  active  inflam.  set  in;  style 

removed,  tinct.  chlor.  iron  injected. 

Discharged  July  31,  1865. 
Cornea  sloughed  away.   Discharged 

June  13,  '65:  sight  of  right  eye  lost, 

central  nebulosity  of  left :  pens'd. 
Discharged  June  28,  1865 ;  pens'd. 

Sight  of  left  eye  lost. 
Duty,  and  discharged  Feb.  8,  1865; 

pensioned  for  wounds. 

Disch'd  March  23,  1863.  Very  tol 
erable  vision ;  pension  claim  reject 
ed.  Spec.  1195. 

Duty  January  6,  1865. 


Recovery,  with  ability  to  use  eyes 
and  read  some.  Disch'd  Aug.  12, 
1864:  pensioned.  Died  April  9, 
1866:  phthisis  pulmonalis. 

Vision  of  both  eyes  improving.  Dis 
charged  October  20,  1865;  pens'd. 
Nearly  blind. 

No  pain  after  operation.  June  30, 
eye  healed.  Died  July  5,  1865; 
debility. 

Doing  well ;  injured  in  a  street  affray 
and  died  December  27.  1863. 


684  MISCELLANEOUS    INJUEIES.  [CHAP.  XI. 

OPERATIONS  ON  THE  MOUTH  AND  ITS  APPENDAGES.— Three  plastic  opera 
tions  for  disease  have  been  detailed  in  the  First  Surgical  Volume.1  One  operation  for 
hare-lip  will  be  added: 

CASE  1016. — Private  Morell  Seely,  Co.  F,  103d  Ohio,  aged  21  years,  was  admitted  into  Cumberland  Hospital,  Nashville, 
March  7,  18b'4,  with  gunshot  wound  of  left  leg,  middle  third,  with  injury  to  tibia.  Patient  also  had  congenital  hare-lip.  On 
March  15,  18G4,  Surgeon  C.  McDermotit,  U.  S.  V.,  operated  for  hare-lip,  without  anaesthesia.  Two  interrupted  sutures,  one 
uniting  mucous  membrane  on  inner  border  of  lip,  used  with  dressings  of  adhesive  plaster.  Union  by  first  intention  within  five 
days;  patient  fed  on  liquid  food.  The  wound  of  the  leg  did  well.  The  patient  recovered  and  was  furloughed  April  13,  1804. 

OPERATIONS  ON  THE  AIR  PASSAGES.— To  the  six  cases  of  laryngotorny  for 
disease,  recorded  on  page  417  of  the  First  Surgical  Volume,  should  be  added  a  fatal  opera 
tion  performed  for  sore  throat  following  typhoid  fever,  making  seven  cases  of  this  operation 
with  only  one  recovery: 

CASE  1017.— Private  Samuel  Mitchell,  Co.  C,  12th  Infantry,  was  admitted  into  hospital  No.  1,  Frederick,  September  19, 
1862.  Acting  Assistant  Surgeon  W.  W.  Keen,  jr.,  reported:  "Had  had  typhoid  fever  followed  by  sore  throat.  On  October  5th, 
3  P.  M.,  the  respiration  became  somewhat  embarrassed  and  grew  rapidly  worse,  till  at  4  P.  M.  Dr.  G.  L.  Potter,  the  officer  of  the 
day,  was  hurriedly  summoned.  The  neck  was  observed  to  be  swollen,  especially  on  the  right  side;  there  was  great  dyspnoea, 
botli  in  inspiration  and  expiration,  coldness  of  the  extremities,  and  insensibility.  Laryngotomy,  on  examination  of  the  epiglottis, 
was  immediately  resolved  upon,  but  the  patient  revived  scarcely  at  all,  although  the  respiration  through  the  artificial  opening 
was  free,  and  in  about  fifteen  minutes  ceased  to  breathe.  Post-mortem  twenty- four  .hours  after  death:  The  tonsils  are  deeply 
eroded,  the  epiglottis  erect  and  firm,  not  from  oedema  but  from  effusion  of  lymph  about  the  vocal  cords.  There  is  a  marked 
plastic  eft'usion,  especially  on  the  right  side.  The  lungs  are  congested  and  somewhat  filled  with  oedema;  other  organs  healthy, 
save  Peyer's  patches,  which  are  ulcerated  to  some  extent." 

'OPERATIONS  ON  THE  CHEST  AND  ABDOMEN.— For  the  cases  of  thoracentesis, 
herniotomy,  and  paracentesis,  the  reader  is  referred  to  pp.  573-598  of  the  First,  and  pp. 
187-191  of  the  Second  Surgical  Volume. 

OPERATIONS  ON  THE  GENITO-URINARY  ORGANS.— With  the  exception  of 
ten  instances  of  removal  of  testes,  the  operations  on  these  parts  have  been  fully  discussed 
in  the  Second  Surgical  Volume!2  Two  of  the  ten  cases  proved  fatal: 

CASES  1018-1027. — Removals  of  the  testes. — Private  J.  B — ,  Co.  F,  77th  New  York,  age  '23;  bruise  oT  right  testicle  against 
pommel  of  saddle,  September  1,  1864.  Testicle  and  spermatic  cord  greatly  enlarged;  three  fistulous  openings  through  scrotum 
discharging  pus.  December  10th,  right  testicle  removed  by  Acting  Assistant  Surgeon  H.  Pearce.  Returned  to  duty  March  19, 
1865. — Private  ./.  S.  D — ,  conscript,  C.  S.  A.,  age  33.  October  28,  1863,  incision  at  superior  portion  of  scrotum,  testicle  forced 
through  the  aperture  and  exscinded  by  himself.  November  2d,  serious  haemorrhage,  which  recurred  on  November  Gtli,  when 
artery  was  ligated.  Furloughed  November  23,  18(53  — Private  E.  G — ,  Co.  H,  30th  Illinois,  age  24.  January  H,  1864,  excision 
of  left  testicle  by  Assistant  Surgeon  W.  Feland,  30th  Illinois,  on  account  of  scirrhus.  Gangrene,  secondary  haemorrhage  from 
spermatic  artery.  June  30th,  wound  nearly  healed  and  doing  well.  Mustered  out  September  8,  1864. — Lieutenant  G.  W.  H — . 
173d  Ohio,  age  28;  sarcocele  of  right  testicle  of  nine  months'  duration;  tumor  a  little  larger  than  an  ordinary  goose  egg.  Feb 
ruary  6,  1865,  testicle  removed  by  Acting  Assistant  Surgeon  J.  A.  Hall.  Mustered  out  May  15,  1865. — Private  D.  P.  H — ,  Co. 
E,  30th  Colored  Troops,  age  20;  chronic  orchitis;  right  testicle  much  enlarged  and  painful.  Testicle  removed  and  spermatic 
artery  tied  by  Acting  Assistant  Surgeon  O.  Shittler.  Dischai'ged  July  31,  1865. — Private  J.  M.  J — ,  Co.  D,  146th  New  York, 
age  24;  injury  to  right  testicle  by  fall  from  horse.  Excision  of  right  testicle.  Discharged  September  25,1865. — Captain  G. 
McP — ,  8th  Tennessee  Cavalry,  age  36;  cystic  sarcocele:  right  testicle  enlarged  to  the  size  of  a  goose  egg.  July  7,  1864, 
right  testicle  removed  by  Surgeon  J.  E.  Herbst,  U.  S.  V.  Returned  to  duty  August  10,  1864. — W.  S — ,  colored  civilian,  age 
50;  left  testicle  enlarged  to  the  size  of  a  small  cocoanut;  dragging  pain  when  walking.  November,  1864,  removal  of  left  tes 
ticle  by  Assistant  Surgeon  S.  J.  Bumstead,  29th  Illinois.  The  organ  when  removed  weighed  two  and  a  quarter  pounds.  It  was 
contributed  to  the  Army  Medical  Museum  by  the  operator,  and  is  numbered  3(554  of  the  Suryical  Section.  The  patient  recovered.— 
Private  J.  C — ,  Co.  B,  3d  East  Tennessee  Vols.;  cystic  enlargement  of  left  testis.  March  29,  1864.  extirpation  of  left  testicle 
by  Assistant  Surgeon  B.  E.  Fryer,  U.  S.  A.  Erysipelas  attacked  the  parts,  extending  to  the  abdomen.  Died  May  31,  1864,  of 
peritonitis.— Captain  E.  D.  L — ,  43d  Wisconsin,  age  32;  sarcocele  of  right  testicle,  the  result  of  injury.  March  16,  1865, 
removal  of  right  testicle  by  Surgeon  J.  E.  Herbst,  U.  S.  V.  Furloughed  April  9,  1865.  Died  June  2,  1865,  cause  not  stated. 

'Cases  of  E.  E.  Sadler,  Co.  C,  9th  Iowa  Cavalry,  p.  3u'J ;   H.  Kennedy,  citizen,  p.  370;  and  Pt.  C.  Burgan.  Co.  B,  Purnell  Legion,  p.  375. 

''  Cases  of  lithotomy,  pag-e  282  ;  operations  for  fistula  ani,  page  3:21 ;  operations  for  removal  of  piles,  page  3:>2;  operations  for  phymosis,  page  343; 
external  perineal  nrothrotoiny,  page  400  ;  operations  for  hydrocele,  page  4iM.  Two  cases  of  extirpation  of  the  testes  on  account  of  contused  wounds  have 
been  cited:  P.  W.  Lucas.  1st  Virginia  Battalion,  page  414,  and  Recruit  H.  D.  Tuner,  page  418. 


CHAP.  XII.] 


SABRE    AND    BAYONET    AND    SHOT    WOUNDS. 


685 


CHAPTER    XII. 


WOUNDS    AND    COMPLICATIONS. 


The  subject  of  injuries  affecting  the  several  regions  of  the  body  having  been  thoroughly 
discussed  throughout  the  preceding  portions  of  this  history,  the  present  chapter  will  be 
devoted  to  a  general  consideration  of  wounds  and  complications,  in  the  course  of  which  the 
endeavor  will  be  made  to  use,  to  the  best  advantage,  the  large  amount  of  material  accumu 
lated  during  the  late  war,  illustrative  of  facts  of  general  interest  and  of  statistical  value 
relating  to  wounds;  of  the  nature,  peculiarities,  and  effects  of  missiles  and  projectiles  used 
in  warfare;  of  the  conditions  affecting  the  course  and  result  of  wounds,  with  especial  refer 
ence  to  the  graver  complications  of  secondary  haemorrhage,  erysipelas,  pysemia,  gangrene, 
and  tetanus. 

During  the  late  war  there  were  treated  two  hundred  and  forty-six  thousand  seven 
hundred  and  twelve  (246,712)  cases  of  wounds  by  weapons  of  war.  Of  these,  two  hundred 
and  forty-five  thousand  seven  hundred  and  ninety  (245,790)  were  shot  wounds,  and  nine 
hundred  and  twenty-two  (922),  or  0.37  per  cent.,  were  sabre  and  bayonet  wounds.  The 
average  percentage  of  sabre  and  bayonet  wounds  in  the  European  Wars  during  the  last 
twenty  years  was  2.4,  as  shown  in  the  following  table: 

TABLE  CXIV. 
Frequency  of  Sabre  and  Bayonet  and  Shot  Wounds  on  Occasions  named  and  from  Authorities  quoted. 


OCCASIONS. 

INJURIES. 

Percentage  of 
Sabre  and  Bay 
onet  Wounds. 

Total. 

Sabre  and 
Bayonet. 

Shot. 

Knfrlish  in  the  Crimean  War  1854  57  (MATTHEW1) 

10,129 
26,  811 
15,  966 
18,  521 
281 
3,232 
85 
1,697 
2,903 
8,527 
54,  268 

158 
818 
565 
543 
54 
61 
19 
56 
92 
333 
786 

9,971 
25,  993 
15,  401 
17,  978 
227 
3,171 
66 
1,  641 
2,811 
8,  194 
53,  482 

1.5 
3.0 
3.5 
2.9 
19.2 
1.8 
22.  3 
3.3 
3.1 
3.9 
1.4 

French  in  the  Crimean  War  1854  57  (CHENU2)                      .-                        

French  in  the  Italian  War   1859  (ClIENU3)           

A  ust  nans  at  Verona  1850  (RicHTF.it4)                                                              

Austrian's  at  Montebello    IPS')  (RlCHTFH6) 

Germans  in  Schleswig-Holstein  W:ir  1804  (LOKFFLEK6)                          

French  in  Mexico  1804  (BiXTOT7)                                                  .                     .... 

Six  Weeks'  War  in  Germany   I860  Bavarians  (RlCHTER8) 

Six  Weeks'  War   18(!G  Italians  (COItTKSE9) 

Franco-Prussian  War  1870  71   Germans  (FISCHEK11) 

142,  420 

3,  485 

138,  935 

2.  4 

In  comparison   with  the   large  number  of  shot  wounds,   the   number  of   sabre  and 
bayonet  wounds  seems  insignificant,  offering  a  striking  commentary  upon  the  advance  of 

1  MATTHEW  (T.  P.),  Medical  and  Surgical  History  of  the  British  Army  which  served  in  Turkey  and  the  Crimea,  etc.,  London,  1858,  Vol.  II.  pp. 
257,  259.  2  CIIENU  (J.-C.),  Rapport  auConseil  de  Sant>'  des  Armecs,  etc...  pendant  la  Campagne  d' Orient  en  1854-18-35-1856,  Paris,  1865,  p.  627.  3CllENU 
(J.-C-),  Statistiffue  M6d,  Chir,  de  la  Campagne  d'Jtalie  en  1859  et  18CQ,  Paris,  1869,  T.  11;  the  figures  here  given  were  obtained  from  a  compilation  of  the 


686 


WOUNDS    AND    COMPLICATIONS. 


(CHAP.  XTT. 


modern  military  science,  and  showing  that  with  the  general  adoption  of  long-range  repeat 
ing  fire-arms  the  sabre  and  bayonet  are  rapidly  falling  into  disuse,  and  that  the  time  is 
coming,  if  it  has  not  already  arrived,  when  these  old  and  honored  weapons  will  become 
obsolete;1  and  when  such  wounds  from  these  sources  will  be  regarded  rather  as  incidents  of 
battle  than  as  the  results  of  regular  tactical  manoeuvres. 

SABRE  AND  BAYONET  WOUNDS.— Of  the  nine  hundred  and  twenty-two  (922) 
cases  of  these  injuries  reported  in  detail  throughout  the  history,  and  grouped  together  in 
the  following  table,  a  large  proportion  had  their  origin  in  private  quarrels  or  broils,  or  were 
inflicted  by  sentinels  in  the  discharge  of  their  duty: 

TABLE  CXV. 

Summary  of  Nine  Hundred  and  Twenty-two  Sabre  and  Bayonet  Wounds  recorded  during  the  American 

War,  1861-65. 


SEAT  OF  INJURY. 

TOTAL  NUMBER 
OF  CASES. 

SABRE. 

BAYONET. 

o 

Recoveries. 

"3 
~a 
PM 

Undetermined 

Results. 

Mortality. 

| 

c: 
O 

Recoveries. 

"5 

03 

PH 

Undetermined 
Results. 

Mortality. 

300 
55 
64 
9 
38 
18 
10 
7 
9 
34 
149 
7 
9 
7 
198 
7 
1 

282 
49 
37 
5 
9 
o 

1 
4 
1 
13 

80 
4 
6 
7 
22 

276 
36 

3:S 
4 

8 

0 

6 
13 

1 

2.  1 
2fi.  5 
2.9 

18 
6 
27 
4 
29 
16 
9 
3 
8 
21 

16 
1 
22 
3 
18 
16 
G 

6 

21 

o 
5 
1 
1 
9 

11.1 

83.3 
43.4 
25.0 
33.3 

3 

1 

4 

1 

11.1 

2 

1 

100.0 
50.0 

3 

1 
2 

33.3 
33.3 

25.0 

0 

1 

13 

75 
4 
6 
6 

1 

4         1.3 

69 
3 
3 

61 
3 
3 

1 

7 

1.6 

Sabre  and  Bayonet  Wounds  of  Elbow  Joint  

Sabre  Wounds  of  Bones  of  Forearm  

1 

14.2 

176 

7 
1 

171 
7 
1 

5 

2.8 

13 

922 

522 

488 

20 

8 

5.0 

400 

357 

30 

7.7 

The  fatality  of  these  wounds  as  indicated  in  the  table  is  small,  perhaps  exceedingly 
so  when  it  is  considered  that  these  injuries  derive  their  importance  from  their  tendency  to 
excite  inflammatory  action  in  deep-seated  tissues  and  cavities,  with  the  danger  of  forma- 

tabular  statements  on  pp.  424  to  836  of  the  second  volume  of  Dr.  CHEXU'S  work;  the  summary  on  p.  849  of  his  work  includes  the  injuries  of  a  miscel 
laneous  character,  which  have  been  eliminated  in  this  calculation.  4RICHTER  (E.),  Chirurgie.  dt,r  Schussverletzungcn  im  Kriege,  etc.,  Breslau,  1874,  I, 
Theil,  I  Abth.,  p.  905.  5RICHTER,  Inc.  cit.,  p.  905.  6LOEFFLER  (F.),  General- Veridit  ilber  den  Gesundheitsdienst  im  Feldzttge  gegen  Danemarli,  1864, 
Erster  Theil,  Berlin,  1867,  p.  36.  7 BlNTOT,  Observations  de  BUssures  de  Guerre,  in  Rec.  de  Mem.  de  Sled,  de  Chir.  et  de  1'har.  Mil.,  1866,  3"  s6r.,  T.  XVI, 
p.  42.  8RlCHTER  (E.),  Inc.  cit.,  p.  905.  9 COKTKSE  (F.),  UJtfrinri  ragrjuagli  siilJe  perdite  delV escreito  italiann  snffe.rte.  nrUa  rampagna  del  1866,  in 
Annali  Unive.rsa.li  di  Mcdicina,  Milano,  1868,  Vol.  CCV,  p.  506.  10RlCHTEli,  loc.  cit.,  p.  905.  n  FiscilEU  (G.),  Statistik  der  in  dem  Kriege  1870-71, 
vnrgeknmmenen  Verivundungen  itnd  Todtungen,  etc.,  Berlin,  1876,  p.  7.  The  total  number  of  sabre  and  bayonet  and  shot  wounds  cited  by  FISCHER  is 
61,959  ;  but  this  number  includes  7,691  killed  on  the  battlefield,  which  have  been  dropped  in  this  tabulation,  as  the  killed  are  not  included  in  any  of  tho 
authorities  quoted. 

1  The  following  is  an  extract  from  a  letter  on  file  in  this  office  from  General  ROBERT  WILLIAMS,  Assistant  Adjutant  General,  in  reply  to  inquiries 
made  by  the  late  Surgeon  G.  A.  OTIS,  U.  S.  A.: 

"ADJUTANT  GENERAL'S  OFFICE,  WASHINGTON,  March 24, 1868. 

"DEAR  DOCTOR:  Yours  of  the  18th  instant,  containing  certain  queries,  has  been  received  ;  in  reply  to  your  questions  I  would  say  .  .  .  hand 
to  hand  skirmishes  between  cavalry  during  the  late  rebellion  were  not  at  all  infrequent;  but  the  pistol  and  carbine  were  more  commonly  relied  upon. 
Sabre  wounds  were  slight  and  generally  harmless,  as  the  sabre  was  in  few  instances  sharpened,  and  the  men  were  almost  totally  uninstructed  in  its  use. 
Hand  to  hand  combats  between  cavalry  mounted  and  infantry  were,  1  believe,  of  rare  occurrence ;  in  almost  every  case  the  cavalry  was  dismounted 
and  fought  as  infantry.  .  .  .  Owing  to  the  present  long-range  and  repeating  weapons,  with  which  both  cavalry  and  infantry  are  now  armed,  it  is  my 
belief  that  the  lance  may  be  regarded  as  obsolete  and  that  the  sabre  will  soon  become  so.  Yours  truly,  ROBERT  WILLIAMS,  Ass't  Adjutant  General," 


CHAP,  xn.]  SHOT    WOUNDS.  687 

tion  and  confinement  of  pus;  from  the  chances  of  injury  to  blood-vessels,  nerves,  and  viscera, 
and  the  possibility  of  pyaemia,  gangrene,  and  tetanus. 

As  might  be  anticipated,  wounds  by  the  sabre  involve  chiefly  such  parts  of  the  body 
as  are  especially  exposed  to  blows  in  the  ordinary  use  of  this  weapon;  thus  injuries  of  the 
head  and  upper  extremities  are  more  largely  represented,  while  wounds  from  the  bayonet 
show  a  decided  preponderance  in  the  lower  extremities.1 

Wounds  from  sabre  blows2  were  not  of  a  grave  character,  except  in  cases  involving  the 
cranial  cavity,  where  the  mortality  attained  its  highest  percentage.  Seven  cases  recorded 
in  previous  chapters  of  the  history  show  fractures  of  one  or  both  bones  of  the  forearm  by 
sabre  blows;  in  one  case  primary,  and  in  another  secondary  amputation  became  necessary.3 
One  fatal  case  of  tetanus  is  reported  as  following  an  incised  sabre  fracture  of  the  cranium; 
also  one  case  of  pyaemia  from  a  similar  cause.  Epilepsy,  insanity,  loss  of  vision  and  hear 
ing,  and  impairment  of  mental  faculties  seem  to  have  been  among  the  remoter  effects  of 
injuries  of  the  cranium  from  this  cause. 

The  fatality  of  bayonet  wounds  exceeds  that  of  sabre  wounds  by  2.7  per  cent.,  and  is 
chiefly  due  to  injuries  of  viscera  and  large  blood-vessels.  The  heart,  lungs,  diaphragm, 
liver,  stomach,  jejunum,  and  spleen  are  noted  as  having  been  punctured;  and  of  the  blood 
vessels,  the  common  iliac,  femoral,  internal  pudic,  and  brachial  were  involved. 

The  fatal  cases  of  bayonet  wounds  of  the  lower  extremities,  five  in  number,  resulted 
from  gangrene  in  three  cases,  and  from  primary  haemorrhage  and  pyaemia  in  one  instance 
each.  The  median  and  sciatic  nerves  were  lacerated  in  two  cases,  and  the  penis  punctured 
in  one.  No  case  of  tetanus  is  reported  as  following  a  bayonet  wound. 

SHOT  WOUNDS. — The  consideration  of  generalities  on  shot  wounds,  their  nature, 
frequency,  fatality,  and  principal  complications  will  be  preceded  by  a  tabular  summary  of 
all  shot  wounds  of  which  records  are  found  in  this  Office.  In  the  introductory  memoran 
dum  of  the  Second  Surgical  Volume  and  in  the  various  sections  throughout  the  work  the 
total  number  of  wounds  of  the  portions  of  the  body  under  consideration,  so  far  as  known  at 
the  time,  were  indicated.  Since  then  additional  reports  and  records  of  hospitals,  especially 
field  hospitals,  frequently  subjected  to  the  varying  fortunes  of  a  successful  or  unsuccessful 
campaign,  records  which  in  some  instances  were  supposed  to  have  been  lost  or  destroyed, 
have  been  received  at  this  Office,  as  the  work  on  the  surgical  history  progressed,  increasing 
somewhat  the  total  number  of  injuries.  There  undoubtedly  remain,  even  at  the  present 
time,  quite  a  number  of  casualties  of  which  there  are  no  histories  on  file,  especially  of  the 
early  part  of  the  war  in  1861,  when  each  regiment  and  sometimes  each  detachment  of  troops, 
before  the  establishment  of  base  and  general  hospitals,  continued  to  find  shelter  for  its  more 
seriously  injured  patients  in  tents  or  buildings  temporarily  occupied  which  offered  no  facil 
ities  for  keeping  records,  and  when  volunteer  officers  and  also  enlisted  men  were  allowed  to 
proceed  from  the  battle-fields  to  their  homes  to  be  treated  by  their  family  physicians.  A 
few  special  reports  of  some  of  the  most  interesting  of  these  cases  have  been  received  at 
this  Office;  but  undoubtedly  quite  a  large  proportion  failed  to  be  recorded  at  all.  Further 
more,  after  general  engagements  many  circumstances  interfered  with  the  efforts  of  medical 

1  Of  522  sabre  wounds,  368  were  wounds  of  the  head  and  97  of  the  upper  extremities,  making  a  total  of  465,  or  89  per  cent,  of  the  whole  number. 
Of  400  bayonet  wounds,  184,  or  46  per  cent.,  were  in  the  lower  extremities. 

2  Examples  have  been  cited  in  the  First  Surgical  Volume,  on  pp.  1  to  30,  of  sabre  wounds  of  the  head ;  on  p.  322,  of  the  face  ;  on  p.  399,  of  the  neck ; 
in  the  Second  Surgical  Volume,  on  pp.  3,  4,  of  the  abdominal  parietes ;  on  p.  32,  of  simple  perforations  of  the  abdominal  cavity  without  visceral  injury ;  on 
pp.  61,  62.  of  the  small  intestines  ;  on  p.  76,  of  the  large  intestines  ;  on  p.  129,  of  the  liver;  on  p.  429,  of  the  back;  on  pp.  435,  436,  of  the  upper  extremities  ;  on 
p.  473,  of  the  clavicle  and  scapula;  on  pp.  828,  829,  of  the  elbow  joint ;  and  in  the  Third  Surgical  Volume,  on  p.  7,  of  sabre  flesh  wounds  of  the  lowel 
extremities.  3 CASES:  1845,  1846,  on  page  919,  Second  Surgical  Volume,  of  Privates  William  Billows  and  Corwin  Davis. 


688 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XIL 


officers  to  obtain  accurate  details  of  the  number  of  wounded,  and  no  record  could  be  made 
of  the  wounded  among  those  reported  as  captured  and  missing.  The  shot  wounds  now 
recorded  number  two  hundred  and  forty-five  thousand  seven  hundred  and  ninety  (245,790). 
They  have  been  grouped  in  three  tables,  the  first  containing  shot  wounds  of  the  head,  face, 
and  neck,  the  second  those  of  the  trunk,  and  the  third  those  of  the  extremities: 

TABLE  CXVI. 

Tabular  Statement  of  the  Shot  Wounds  of  the  Head,  Face,  and  Neck  recorded  during  the  American 

Civil  War. 


NATURE  AND  SEAT  OF  INJURY. 

. 

Totals. 

RESULTS.                 £ 

8 

K              0 

;d               o>  >> 

J>3     i     c~ 
11        | 

SHOT  INJURIES  OF  THE  HEAD.*  < 
SHOT  INJURIES  OF  THE  FACE.2  « 
SHOT  INJURIES  OF  THE  NECK.S  < 

r  Flesh  Wounds  of  the  Scalp 

7,739 

328 

4,  865           162 
273            55 

2,712           3.2 
Hi.  7 

138 
20 
19 
2,911 
3G4 
486 
73 
9 

128             10 
1             19 
12              7 
9GO       1,  82(5 
232           129 
84           402 
17             5fi 

1)5.  0 

.%'.  7 

Fractures  without  known  depression  
Fractures  with  depression  

1-25         (15.  5 
3  :       35.7 

7li.  7 

!     100.0 

1               1 

50.  0 

Total  Shot  Injuries  of  the  Head 

12,  089 

4,914 
4,  502 

9,  4  Hi 

(i,  573       2,  r,7tJ 

3,  7()ti             58 
3,  700           404 

7,  40(i           4(i2 

2,  840         28.  9 

1,150            1.5 
398           9.  8 

1,5-18           5.8 

Total  Shot  Injuries  of  the  Face 

4,789 
41 
30 
13 
10 
4 

2 

1 

1 

4,  895 

3,  450           570 
19             21 
10              10 
5              7 
4               (i 
4    

7»J9          M.I 
1          5-.'.  5 
10         50.0 
1           5H.  3 
(il).  0 

Wounds  inju  ing  Trachea  and  Larynx  

„ 

MIO.O 

1    

1    

•T 

100.0 

Total  Shot  Injuries  of  the  Neck.  .  . 

3,  49fi           til" 

781           15.  n 

Aside  from  flesh  wounds  of  the  scalp,  and  slighter  forms  of  contusion  and  fracture, 
shot  wounds  of  the  head  were  of  a  very  fatal  character,  the  ratio  of  mortality  following 
closely  upon  the  degree  of  injury  inflicted  upon  the  brain  and  its  appendages.  Fractures  of 
the  inner  table  of  the  cranial  bones  were  of  difficult  diagnosis,  and  could  in  general  be 
substantiated  only  after  post-mortem  inspection.  Perforating  gave  slightly  more  favorable 
results  than  penetrating  fractures;  this  may  have  been  clue  to  the  fact  that  less  vital  por 
tions  were  involved,  or  that  these  wounds  were  more  satisfactorily  treated,  being  freed  from 
the  complications  attending  the  lodgement  of  foreign  bodies.  The  results  of  shot  injuries 
of  the  face  confirm  the  opinion  that  these  wounds  commonly  do  well,  notwithstanding  the 
amount  of  destruction  apparent  at  the  time  of  injury.  The  records  have  furnished  sufficient 

I  See  First  Surgical  Volume,  p.  308,  TAULJJ  V1J.    2See  first  Surgical  Volume,  p.  382,  TABLE  XIV.    3See  First  Surgical  Volume,  p.  414,  TAliLB  XVIJ. 


CHAP.  XII. ] 


SHOT    WOUNDS. 


689 


material,  already  alluded  to  in  a  previous  chapter,  to  show  a  remarkable  degree  of  success 
in  the  treatment  of  such  cases.  The  high  mortality  of  shot  wounds  of  the  neck  is  almost 
necessarily  to  be  expected  from  lesions  of  parts  of  great  vital  importance,  placed  in  close 
relation  with  the  great  nervous  and  vascular  trunks  found  in  this  region. 

TABLE  CXVII. 

Tabular  Statement  of  the  Shot  Wounds  of  the  Spine,  Chest,  Abdomen,  Pelvis,  and  Back  recorded  during 

the  American  Oivil  War. 


NATUHE  AND  SEAT  OF  1NJUHY. 

Totals. 

RF.6U1.T6. 

Percentage  of  Ka- 
talitv. 

8 

• 

%                    J3 

1           1 

tindeterm'd 
Results. 

SllOf   WOI'XHS  OV  THE   Sl'INK    

SHOT  WOUNDS  OF  THE  CHKBT...     .   < 

91 
137 
149 

3 

27 
50 
79 
1 

63 

ft"* 

66 

1 

• 

129 

1 

70.0 
63.5 

45.5 
50.0 
100.0 
51.3 

4 

260 

122 

<i 

14 

642 

279 

349 

55.5 

11,549 
446 
8,  269 

20,  264 

10,778 
362 
2,781 

13,  921 

113 

68 
5,192 

5,373 

658 

16 
296 

970 

1.0 

15.8 
65.  1 

27.8 

SHOT  WOUNDS  OF  THE  AUDOMKN   ... 

SHOT  WOUNHB  OF  THE  PELVIS  •, 
SHOT  WOUNDS  OF  THE  BACK  

Total  Shot  Injuries  of  the  Chest         

4,469 
238 
41 
19 
79 
653 
173 
29 
5 
78 
54 
1 
2,599 

2,881 
120 
21 
12 
19 
118 
62 
o 

1 
26 
7 

253 
5 
20 
7 
60 
484 
108 
27 
4 
51 
47 
1 

1,3:!5 
113 

8.0 
4.0 
48.8 
36.8 
75.9 
89.4 
63.5 

9ai 

80.0 
66.2 
87.0 
100.0 
92.2 

Wounds  of  the  Stomach 

51 
3 

1 

Wounds  of  the  Blood-vessels,  Omentum,  and  Mesentery  

186 

2,226 

187 

8,438 

3,455 

3,  293 

1,  6i»0         48.7 

1,494 
38 
185 
8 
103 
179 
309 
105 
586 
32 
120 

:!,  i5<) 

3,  486 
990 
098 
7,507 

12,681 

918 
25 
89 
4 
59 
94 
268 
83 
520 
30 
104 

',',  194 

544 
13 
96 
4 
44 
85 
41 

66 
13 
930 

32 

.37.2 
34.2 
51.8 
50.0 
42.7 
47.4 
13.2 
21.9 
11.2 
6.6 
11.  1 

29.7 

Wounds  of  the  I'rothni 

Wounds  of  tho  Spermatic  Cord 
Wounds  of  the  Genital  Organs  indefinitely  described  

Total  Shot  Injuries  of  the  Pelvis    

3 

35 

Reported  as  Shot  Wounds  of  tlio  Back 

3,024 

886 
620 
6,353 

172 
51 
51 
526 

290 
53 
27 
628 

5.3 
5.4 
7.6 
7.6 

Specified  as  over  the  Posterior  Tlionirii'  Region    -    .    . 
1  Specified  as  over  the  Posterior  Alidoininal  Uegion     . 

Total  Shot  Injuries  of  the  Back 

10,  883 

800          998 

6.9 

SURG.  Ill— 87 


690 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


The  great  fatality  of  undoubted  shot  penetrations  of  the  abdomen  alluded  to  on  page 
204  of  the  Second  Surgical  Volume  is  apparent  in  the  preceding  table;  of  three  thousand 
four  hundred  and  eighty-nine  (3,489)  determined  instances  of  such  lesions,  three  thousand 
and  thirty-five  (3,035)  had  fatal  terminations,  a  mortality  rate  of  86.9  per  cent.,  exceeding 
that  of  the  shot  fractures  of  the  cranium  with  penetration  of  the  brain,  which,  as  indicated 
in  TABLE  CXVI,  was  82.7  per  cent.;  even  the  large  fatality  of  shot  fractures  of  the  hip, 
84.7,  in  the  succeeding  table,  is  in  some  measure  due  to  complications  with  injuries  of  the 
viscera  of  the  abdominal  cavity. 

TABLE  CXVIII. 

Tabular  Statement  of  the  Shot  Wounds  of  the  Upper  and  Lower  Extremities  recorded  during  the 

American  Civil  War. 


NATURE  AND  SEAT  OF  INJURY. 

3 
1 

RESULTS. 

Percentage  of  Fa 
tality. 

Recoveries. 

Deaths. 

Undeterm'd 
Results. 

SHOT  WOCXDS  OF  THE 
UPPER  EXTREMITIES. 

SHOT  WOUNDS  OF  THE* 
LOWKK  EXTKKMITIKS. 

54,  801 

2,280 
1,378 
201 
8,245 
2,678 
138 
5,194 
1,496 
13 
11,369 

J  53,  095 
t         66 
1,936 
916 
32 
6,249 
2,  130 
81 
4,  636 
1,292 
13 
9,644 

1,634 
6 
314 
449 
43 
1,  639 
513 
19 
482 
193 

2.9 
8.3 
13.  9 
32.8 
57.3 
20.7 
19.4 
19.0 
9.4 
12.9 

30 
13 

126 
357 
35 

38 

76 
11 

Fractures  of  the  Bones  of  the  Shoulder  Joint  in  Confederate  Army  (excisions)6 

Fractures  of  the  Bones  of  the  Elbow  Joint  in  the  Confederate  Army  (excisions)8 

Fractures  of  the  Bones  of  the  Wrist  Joint  in  the  Confederate  Army  (excisions)11 

316 

1,  409 

3.1 

87,  793 

80,  090 

5,  608 

2,  095 

6.5 

59,  139 

386 
162 

6,  57G 
43 
3.  355 
183 
8,988 

f  55,  914 
1       305 
59 
120 
2,995 
24 
1,542 
157 
6,334 
8 
1,239 
26 
4,942 

2,788 
132 
327 
42 
3,392 
19 
1,800 
26 
2,.  376 
3 
457 
1 
450 

4.7 
30.2 
84.7 
25.9 
53.1 
44.1 
53.8 
14.2 
27.2 
27.  2 
26.9 
3.7 
8.3 

Fractures  of  the  Shaft  of  the  Femur'7  

189 

13 

278 
15 
440 

11 
1,711 

O*7 

5,832 

86,  413 

73,  665 

11,813 

935 

13.8 

With  two  exceptions  the  generally  accepted  rule  in  fractures  of  the  extremities,  that 
the  ratio   of  fatality  diminishes  with   increased  distance  of  the  injury  from   the  trunk,  is 

'Aote  1,  page  435,  Second  Surgical  Volume..  2Page  502,  Second  Surgical  Volume.  3TAliLE  XVI,  page  474,  Second  Surgical  Volume.  4On  page 
503,  Second  Surgical  Volume,  505  shot  fractures  of  the  shoulder  joint  treated  conservatively  are  accounted  for.  To  these  should  be  added  640  cases  <>f 
excisions  after  fractures  of  the  shoulder  joint  (not  670.  as  erroneously  stated  on  page  519,  as  245,  not  215,  were  for  fractures  involving  the  humen 
the  shoulder  joint)  and  203  instances  of  amputation  following  fractures  of  the  shoulder  joint.  The  total  number  of  amputations  at  the  shoulder  \v; 
but  of  this  number  only  203  were  for  fractures  of  the  bones  of  the  joint.  The  remaining  649  cases  were :  621  for  fractures  of  the  arm  (TABLE  I  A',  p. 
17  for  fractures  of  the  elbow  (TABLE  CV,  p.  829),  6  for  fractures  of  the  forearm  (TAHLK  CXXIV,  p.  922),  3  for  fractures  of  the  wrist  (TABLE  CXI. I.  p 
and  2  for  fractures  of  the  hand  (TABLE  CXL1V,  p.  1019).  "Page  601,  Second  Surgical  Volume.  "TABLE  LV,  p.  666,  Second  Surgical  Volume,.  7TABl.K 
CV,  page  829,  Second  Surgical  Volume.  8TAliLE  CXIX,  pp.  898-9,  Second  Surgical  Volume..  "TABLE  CXXIV,  page  922,  Second  Surgical  Volume. 
10  TABLE  CXIJ.  page  996,  Second  Surgical  Volume.  "  Pages  1012-13.  Second  Surgical  Volume.  "TABLE  CXUV,  page  1019,  Second  Surgical  Volume. 
1 3 Pages  8-60,  a nte.  ""Pages  24-32,  ante.  "TAISLK  IX.  page  65,  ante.  '6 TABLE  XIX.  page  170,  ante.  "  TABLE  XX,  page  175,  ante.  >»  Pages  363-3G7, 
ante.  l9  TABLE  LII,  page  367,  ante.  w  Pages  427-432,  ante.  2I  TAWLK  LXT,  page  432,  ante.  « Pages  577-578,  ante.  23  TABLE  I^XXXVII,  page  578, 
ante.  "Pages  617-619,  ante.  » TABLE  XCV,  page  619,  ante. 


CHAP    XT!.] 


SHOT   WOUNDS. 


691 


verified  in  this  table.  In  the  upper  extremities  the  fractures  of  the  wrist  had  a  greater 
fatality  than  those  of  the  forearm  (12.9  and  9.4  per  cent,  respectively),  and  in  the  lower 
extremities  the  results  of  the  injuries  of  the  knee  joint  were  slightly  less  favorable  than 
those  of  the  femur,  the  fatality  rate  being  in  the  former  53.8,  in  the  latter  53.1  per  cent., 
although  the  difference  0.7  per  cent,  is  very  trifling.  That  the  wounds  of  the  joints  are  of 
a  more  serious  nature  than  those  of  the  long  bones  immediately  above  them  has  been 
shown  in  numerous  tabular  statements  throughout  the  preceding  volumes,  yet  the  percent 
ages  of  fatality  do  not  seem  to  have  been  proportionally  increased.  But  the  joint  wounds 
were  far  more  frequently  followed  by  excision  and  amputation,  and  it  would  seem  therefore 
that  the  increased  ratio  of  operation  had  tended  to  reduce  the  percentage  of  fatality. 

Longmore1  cites  from  Albinus,  Liharzik,  Marshall,  and  from  measurements  of  the 
Pythian  Apollo  and  Farnesian  Hercules,  the  relative  amounts  of  superficial  area  presented 
by  the  principal  divisions  of  the  human  body,  and  gives  as  the  mean  of  these  measure 
ments  the  following  percentage  of  the  whole  target  area  of  the  body:  For  the  head,  face, 
and  neck,  8.51  per  cent.;  for  the  trunk,  28.91;  for  the  upper  extremities,  21.14;  for  the 
lower  extremities,  41.41.  If  battles  were  fought  and  decided  on  level  and  unobstructed 
ground  we  might  find  that  the  percentages  of  the  injuries  inflicted  on  the  various  sections 
of  the  human  body  would  correspond  with  the  proportional  percentage  of  the  area;  but  it 
is  evident  that  the  nature  of  the  field  of  operations,  whether  fortified  places  or  the  open 
plain  or  rolling  wooded  districts,  must  necessarily  change  the  relative  regional  frequency  of 
injuries.  Of  the  wounds  that  came  under  treatment  in  the  American  civil  war,  as  shown 
in  the  following  table,  10.77  per  cent,  were  injuries  of  the  head,  face,  and  neck,  18.37  of 
the  trunk,  35.71  of  the  upper  extremities,  and  35.15  of  the  lower  extremities. 

TABLE  OXIX. 

Table  indicating  Percentage  of  Fatality  and  Relative  Frequency  of  Shot  Wounds  recorded  during  the 

War  of  the  Rebellion. 


o 

8 

RKSUI.TS. 

|£ 

.  Is 

Relative  Fre 

'S 

£ 

Recoveries. 

Deaths. 

Undeterm'd 
Results. 

o,* 
K 

quency. 

12  089 

6,573 

2,676 

2,840 

28.9 

ri4.91 

9,416 

7,406 

462 

1,548 

5.8 

10.77-;    3.87 

4,895 

3,496 

618 

781 

15.0 

(   1.99 

642 

°79 

349 

14 

55.5 

0.26 

20,  264 

13,  921 

5,373 

970 

27.8 

8.24 

8.438 

3,  455 

3,293 

1,690 

48.7 

18.37-,    3.43 

Shot  Injuries  of  the  Pelvis 

3,159 

2,  194 

930 

35 

29.7 

| 

1    1.28 

12  681 

10,  883 

800 

998 

6.9 

I   5.16 

87  793 

80  090 

5,  608 

2,  095    : 

6.5 

35.71 

86  413 

73,  6f>5 

11,813 

935 

13.8 

35.15 

245,  790 

201,  962 

31,  922 

11,906 

13.6 

00.00 

1 

According  to  this  tabular  statement  the  injuries  of  the  extremities  form  70.86  per 
cent,  of  the  total  number  of  wounded,  and  the  proportion  of  the  wounds  ot  these  parts 
would  therefore  appear  disproportionately  large.  But  it  must  be  borne  in  mind  that  the 
figures  here  given  only  constitute  a  portion  of  the  injuries  received,  as  the  large  number  ol 
killed  are  not  included  in  these  calculations.  The  records  in  this  Office  show  the  seat  of 


'LOMi.MOi;i:  t'l  '•). 


liijiinen,  London,  1877,  page  595. 


692  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

injury  in  only  one  thousand  one  hundred  and  seventy-three  cases  of  soldiers  killed  on  the 
battle- field.  Of  these,  four  hundred  and  eighty-seven  (487)  were  of  the  head  and  neck,  six 
hundred  and  three  (603)  of  the  trunk,  thirty  (30)  of  the  upper  extremities,  and  fifty-three 
(53)  of  the  lower  extremities.  In  the  Introductory  to  the  First  Surgical  Volume,  at  page 
XXVI,  it  has  been  stated  that  the  total  number  of  killed,  according  to  the  Adjutant  Gen 
erals  Report,  w.as  not  less  than  forty-four  thousand  two  hundred  and  thirty-eight  (44,238). 
Applying  the  proportions  of  the  one  thousand  one  hundred  and  seventy-three  (1,173)  cases, 
viz:  four  hundred  and  eighty-seven  (487)  of  the  head,  six  hundred  and  three  (603)  of  the 
trunk,  thirty  (30)  of  the  upper  extremities,  fifty-three  (53)  of  the  lower  extremities,  to  this 
total  of  forty-four  thousand  two  hundred  and  thirty-eight  killed,  we  would  have  eighteen 
thousand  three  hundred  and  sixty-seven  (18,367)  killed  from  wounds  of  the  head,  twenty- 
two  thousand  seven  hundred  and  forty-one  (22,741)  from  injuries  of  the  trunk,  one 
thousand  one  hundred  and  thirty-one  (1,131)  from  wounds  of  the  upper  extremities,  one 
thousand  nine  hundred  and  ninety-nine  (1,999)  from  casualties  in  the  lower  extremities. 
Adding  to  these  the  cases  of  wounded  according  to  the  above  table,  viz:  twenty-six  thou 
sand  four  hundred  (26,400)  of  the  head,  forty-five  thousand  one  hundred  and  eighty-four 
(45,184)  of  the  trunk,  eighty-seven  thousand  seven  hundred  and  ninety-three  (87,793)  of 
the  upper  extremities,  eighty-six  thousand  four  hundred  and  thirteen  (86,413)  of  the  lower 
extremities,  we  have  a  total  of  injuries  according  to  regions  of  body,  including  killed  and 
wounded,  of  forty-four  thousand  seven  hundred  and  sixty-seven  (44,767)  head,  sixty-seven 
thousand  nine  hundred  and  twenty-five  (67,925)  trunk,  eighty-eight  thousand  nine  hun 
dred  and  twenty-four  (88,924)  upper  extremities,  eighty -eight  thousand  four  hundred  and 
twelve  (88,412)  lower  extremities;  or,  according  to  percentages,  of  15.44  per  cent,  injuries 
of  the  head,  23.42  per  cent,  injuries  of  the  trunk,  30.66  per  cent,  injuries  of  the  upper 
extremities,  30.48  per  cent,  injuries  of  the  lower  extremities,  making  a  total  of  61.14  per 
cent,  of  injuries  of  the  extremities. 

Whether  we  take  into  consideration  the  percentage  of  the  injuries  of  the  upper  extrem 
ities  derived  from  the  total  wounded  and  killed,  30.66  per  cent.,  or  that  obtained  from  the 
number  of  soldiers  treated  for  wounds  only,  35.71,  the  regional  proportion  of  these  injuries 
is  very  large.  The  same  is  to  be  said  of  the  relative  frequency  of  the  wounds  of  the  head, 
face,  and  neck,  amounting  to  10.77  per  cent,  of  the  wounded  and  15.44  per  cent,  of  the 
wounded  and  killed.  But  the  protection  afforded  to  the  lower  extremities  and  the  trunk 
in  the  many  siege  operations,  by  parapets,  and  in  field  operations,  especially  during  the 
severe  and  extended  campaign  beginning  with  the  battles  of  the  Wilderness,  Spottsyl- 
vania,  Cold  Harbor,  and  ending  with  the  siege  of  Petersburg,  by  trenches,  ditches,  behind 
trees,  etc.,  screened  those  parts  to  a  large  extent  from  injury,  while  the  head  and  upper 
extremities  were  continually  exposed  to  the  practised  eye  of  a  vigilant  foe. 

The  influence  exerted  by  the  nature  of  the  military  operations  on  the  regional  per 
centage  of  injuries  is  well  illustrated  in  the  next  table,  in  which  it  has  been  attempted  to 
give  the  proportions  of  the  injuries  of  the  head,  face,  and  neck,  the  trunk,  and  the  extrem 
ities,  from  the  most  reliable  accounts  of  European  and  other  campaigns.  The  percentages 
of  the  injuries  of  the  head  varies  from  20.2  per  cent,  among  the  French  in  the  Crimean 
campaign  in  1854-57,  to  6.4  per  cent,  in  the  Revolution  in  Paris  in  1830;  the  percentage 
of  the  trunk  from  31.2  in  the  New  Zealand  Campaign  in  1863-65,  to  9.3  in  the  Mutiny  in 
India  in  1859;  the  percentages  of  the  upper  extremities  from  39.3  per  cent,  in  the  Russo- 
Turkish  War,  1876-77,  to  18.8  in  the  campaign  in  the  Kabylie  in  1854-57;  and  the 


CHAP    XII. 1 


SHOT    WOUNDS. 


693 


percentages  of  the  lower  extremities  from  48.2  in  the  same  campaign,  to  27.1  in  the  New 
Zealand  War  in  1863-65,  and  it  will  be  noted  that  the  fluctuations  are  the  largest  in  cam 
paigns  confined  to  a  limited  territory.  But  of  the  entire  number  of  two  hundred  and 
sixteen  thousand  three  hundred  and  forty-eight  (216,348)  cases  here  referred  to,  thirty-one 
thousand  one  hundred  and  eighty-four  (31,184),  or  14.4  per  cent.,  were  injuries  of  the  head, 
face,  and  neck;  forty-five  thousand  five  hundred  and  eighty-three  (45,583),  or  21.1  per  cent., 
injuries  of  the  trunk;  sixty-six  thousand  four  hundred  and  seventy-five  (66,475),  or  30.7 
per  cent.,  injuries  of  the  upper,  and  seventy-three  thousand  one  hundred  and  six  (73,106), 
or  33.8  per  cent.,  injuries  of  the  lower  extremities,  nearly  approaching  the  percentages 
derived  from  the  injuries  of  the  American  civil  war. 

TABLE  CXX. 
Tubular  Statement  of  the  Relative  Frequency  of  Shot  Wounds  of  the  Different  Regions  of  the  Body. 


OCCASIONS  AND  AUTHORITIES. 

g 

3J 

o 

HEAD,  FACE,  !      T 
AND  NECK.    , 

UPPEH 

EXTREMITIES. 

LOWER 
EXTREMITIES. 

Cases. 

Percentage. 

Cases. 

Percentage. 

Cases. 

Percentage. 

Cases. 

Percentage. 

Revolution  in  Pari<   18'30  (MKXIERF  '  JOHERT  (DE  LAMB  U.LE2) 

627 
413 
6,355 
9,971 
25,  993 
1,422 
558 
17,095 
15,  401 
48 
66 
3,  171 

2,282 
2,811 
108 
387 
53,  482 

40 
46 
949 
2,000 
5,263 
220 
60 
2,050 
1,  514 
8 
11 
458 

218 
333 
17 
63 
7,880 
611 
9,376 
47 

6.4 
11.  1 
14.9 
20.1 
20.2 
15.5 
10.8 
12.0 
9.8 
16.7 
16.7 
14.4 

9.5 
11.8 
15.8 
21.4 
14.7 
14.1 
13.1 
12.7 

117 
77 
1,006 
1,500 
4,  937 
249 
52 
3,750 
2,265 
15 
10 
614 

410 
529 
16 
145 
8,835 
772 
20,  243 
41 

18.7 
18.7 
15.8 
15.0 
19.0 
37.5 
«0.  3 
21.9 
14.7 
31.2 
15.1 
19.4 

18.0 
18.8 
14.8 
37.5 
16.5 
17.8 
28.4 
11.1 

193 
116 
1,804 
3,089 
8,238 
267 
212 
6,047 
5,378 
12 
20 
925 

591 
761 
40 
79 
17,  795 
1,174 
19,  588 
146 

30.8 
28.1 
28.4 
31.0 
31.7 
18.6 
38.0 
35.4 
34.9 
25.0 
30.3 
29.2 

25.9 

27.1 
37.0 
20.4 
33.3 
27.0 
27.  4 
39.3 

277 
174 
2,596 
3,382 
7,555 
686 
234 
5,248 
6,244 
13 
25 
1,174 

1,063 
1,188 
35 
80 
18,  972 
1,787 
22,  236 
137 

44.1 
42.1 
40.9 
33.  9 
29.1 
48.2 
41.9 
30.7 
40.6 
27.1 
37.9 
37.0 

46.6 
42.3 
32.4 
20.7 
35.5 
41.1 
31.1 
36.9 

Revolution  in  Paris,  1848  (BAUDKXS,  HUOUIEI:.  JOBEKT  (DE  LAMBALLE3)... 
Schleswig-Holstein  War  1848  51  (SIMON  *  DJORUP6)                          

Crimean  War   1854-57  English  (MATTIIKW6) 

Campaign  in  the  Kabylif'    1854  57  (BKRTHEliA\li)s                                         

Mutiny  in  India,  1858-59  (WILLIAMSON9)  
Campaign  in  Italy   185l>  Austrian  (DEMME10)                                                 

Campaign  in  Italy,  1859,  French  (CHENU11)             .          

Campaign  in  New  Zealand    1863  65  (MOUAT12) 

French  in  Mexico  1864  (BlNTOT'3)   .                                 .                      .           

Schleswig-Holstein  War  1864  (LOEFFLER14)        

Austro-Prussian  War,   1866,   Germans   (MAAS.15,  BlKFEL,16   STROMEYEK,17 
BECK18) 

Austro-Prussian  War,  1866,  Italians  (CORTESE19)   

Revolt  in  Montenegro   1869  (RlEDL  and  EliNER20) 

U.  S.  Army  1865-70  (OTIS21)           ..                  

Franco-German  War,  1870-71,  Prussians  (FISCHER22)  

Franco-German  War,  1870  71,  Bavarians  (BECK23)  

4,  344 

Franco-German  War,  1870-71,  French  (CHENU24)   

71,  443 
371 

Russo-Turkish  War   1876  77  (TILING  2S  KADE26) 

Totals  

216,  348 
245,  739 

31,184 
26,400 

14.4 
10.7 

45,  583 
45,  184 

21.1 
18.4 

66,  475 
87,  793 

30.7 
35.7 

73,106 
86,  413 

33.8 
35.1 

War  of  the  Rebellion  in  United  States  of  America  1861-65 

462,  087 

57,584 

12.5 

90,767 

19.6 

154,  268 

33.3 

159,519 

34.5 

The  excessively  large  percentage  of  wounds  of  the  hands  and  fingers,  frequently  noticed 
by  writers  on  military  surgery,  was  also  observed  in  the  American  civil  war.     Of  thirty- 

1  MENMERE  (P.)  (V Hotel-Dim  de  Paris  en  JuilUt  et  Aout,  1830,  Paris,  1830,  pp.  273  to  339)  records  272  cases ;  33  of  head  and  neck,  80  of  trunk,  51 
of  upper  and  108  of  lower  extremities.  * JonEUT  (A.-J.  DE  LAMDALLE)  (Plaies  d'Armes  J  Feu,  Paris,  1833)  records,  according  to  the  tabular  statement 
of  L.  SKUHIER  (Traite  de  la  nature,  des  complications  et  tin  traitement,  des  plaies  d'armes  ufeu,  Paris,  1844,  p.  30),  7  cases  of  head  and  neck,  37  of  trunk, 
142  of  upper  and  169  of  lower  extremities;  total  355.  3Ves  plaies  d'armes  d  feu.  Communications  faites  a  V  Academie  Rationale  de  M  'tlecine,  Paris, 
1849:  lUL'DEXS  (pp.  224  et  seq.),  head  and  neck  15,  trunk  26,  upper  extremities  40,  lower  extremities  51 ;  total,  132.  HUGUIKK  (p.  131).  head  and  neck  24, 
trunk  31,  upper  extremities  36,  lower  extremities  41 ;  total  132.  JOBEKT  (A.-J.  DE  LAMBALLE)  (p.  150),  head  and  neck  7.  trunk  20,  upper  extremities  40, 
lower  extremities  82  ;  total  149.  4  SIMON  (G.)  ( Ueber  Schussivunden,  G iessen,  1851,  p.  3),  wounds  of  head  and  neck  15,  of  trunk  24,  of  upper  extremities 
37.  of  lower  extremities  80  ;  total  156.  8DjOlJUP  (M.)  (Om  den  relative  Hyppighed  af  deforskjellige  Skudsaar  efter  deres  Sxdf,  og  om  dere.s  Dodelinlieds- 
Fnrliold,  in  Hofpitals-Meddelelser,  Kjobenhavn,  1850,  Bind  V,  pp.  360-363),  head  and  neck  934,  trunk  982,  upper  extremities  1,7(:7,  lower  extremities 
2.516 ;  total  6,109.  6  AlATTHKW  (T.  P.)  (Medical  and  Surgical  Hist,  of  the  British  Army,  etc.,  in  the  years  1854-55-5C),  London,  1858.  Vol.  II.  pp.  257, 
etc.),  and  McLEOD  (G.  H.  B.)  (Jfote.it  on  the  Surgery  of  the  War  in  the  Crimea,  London,  18."8.  p.  414).  'CllKXU  (,I.-C.)  (Rapport,  etc..  pendant  la. 
Campaign*  d' Orient  en  18.j4-5."i-."6,  Paris.  1865.  p.  0:7).  LOXGMOUE  (Gunshot  Injuries.  London,  1877.  p.  607)  erroneously  cites  the  number  of  shot 
injuries  of  the  lower  extremities  among  the  French  in  the  Crimean  War  as  11,413,  and  of  the  upper  extremities  as  8,803;  these  numbers  include  shot 


694  WOUNDS  AND  COMPLICATIONS.  (CHAP.  xii. 

throe  thousand  and  sixty-four  (33,064)  instances  of  fracture  and  contusion  of  the  upper 
extremities,  including  the  articular  portions  of  clavicle  and  scapula,  eleven  thousand  three 
hundred  and  sixty-nine  (11,369),  or  above  one-third,  were  fractures  of  the  bones  of  the 
hands  and  fingers.  It  has  already  been  stated  in  Note  4,  on  page  435  of  the  Second 
Surgical  Volume,  that  27.8  per  cent.,  or  over  one-fourth  of  the  fifty-four  thousand  seven 
hundred  and  twenty-nine  (54,729)  shot  flesh  wounds  of  the  upper  extremities,  were  flesh 
wounds  of  the  hand.  It  is  possible  that  this  large  percentage1  is  due  to  the  increased 
exposure  of  the  hand  from  almost  constant  movements  over  a  considerable  area,  thus 
increasing  the  chances  of  intercepting  missiles  in  their  flight. 

DEFINITION  OF  SHOT  INJURIES. — All  injuries  caused  directly  or  indirectly  by  missiles  and 
projectiles  impelled  by  the  force  of  gunpowder  or  other  explosive  compounds  have  been 
included  in  the  term  '"shot"  injuries.  They  differ  from  the  accidents  common  to  ordinary 
life  not  so  much  in  their  essential  character  as  in  the  peculiarity  of  the  conditions  and  cir 
cumstances  attending  them,  and  on  this  account  invite  especial  attention  to  the  producing 
causes,  to  the  dangers  and  complications  liable  to  arise  -in  their  course,  and  to  their  man 
agement  and  treatment  under  conditions  generally  less  favorable  than  are  found  in  the 
practice  of  civil  surgery. 

A  gunshot  wound  is  essentially  a  contused  wound,  yet  the  character  of  the  missile  and 
the  circumstances  relating  to  the  individual  at  the  time  of  injury  may  impress  upon  it  the 
additional  features  belonging  to  incised,  lacerated,  and  penetrating  wounds.  In  degree,  it 
may  range  from  trivial  simplicity  to  all  the  terrible  gravity  of  injury  seldom  seen  but  on  the 
battle-field,  yet  in  all  its  phases,  simple  or  complicated,  the  application  of  the  sound  prin 
ciples  of  general  surgery  forms  the  basis  for  treatment  and  marks  the  advance  in  the 
surgical  science  of  the  present  day. 

The  great  superiority  of  the  rifled  arm  and  cylindro-conoidal  projectile,  as  compared 
with  the  smooth-bore  arm  and  round  ball,  had  been  fully  established  by  the  experience  of 
foreign  nations  in  the  great  wars  of  Europe  between  the  years  1'848  and  1860.  An  inter 
esting  field  of  inquiry  had  thus  been  opened  to  the  military  surgeon  regarding  the  modifica 
tion  of  the  nature  of  wounds  resulting  from  the  use  of  the  improved  firearms,  and  quite  an 
extensive  bibliography1  on  this  subject  had  already  been  presented  to  the  European  pro 
as  well  as  miscellaneous  injuries.  8P>EUTHEUAXD  (A.)  (Campagnes  de  Kabylie,  Paris,  1862.  p.  314).  9  WILLIAMSON"  (G.)  (Military  Surgery,  London, 
1863,  pp.  XXIV-XXVI).  ">DEMMK  (II.)  (Militdr-Chirurgische.  Studien,  Wiirzburg,  1861,  pp.  19,  20).  " CHKXU  (J.-C.)  (Statislique  Med.-Ckir.  de  la 
C'ampagne  d'ltalie  en  1859  et  18(10,  Paris,  1869,  T.  II).  The  figures  here  given  were  obtained  from  a  compilation  of  the  tabular  statements  on  pp.  424 
to  836  of  the  second  volume  of  Dr.  CHEXU's  work;  the  summary  <in  p.  849  of  his  work  includes  the  injuries  of  a  miscellaneous  character,  which  have 
been  eliminated  in  this  calculation.  '-MOUAT  (The  New  Zealand  War  of  J863-G4-f5,  in  Stat.  San.  and  Med.  Reports,  fur  the  year  18(i5,  London,  1867, 
Vol.  VII,  p.  477).  13BIN*TOT  (Observations  de  blessures  de  guerre,  etc.,  in  Recueil  de,  Memoires  de  Mede.cine  de  Chiruryie  et  de  Pharmacie  Militair^s, 
Paris,  1866,  T.  XVI.  p.  42).  I4LOEFFLEH  (F.)  (General  Bericht  iiber  den  Gesundheitsdievst  im  Feldzuge  grgen  Ddnemark  1864,  Berlin,  1867,  Krster 
Theil,  p.  54).  1SMAA8  (H.)  (Kriey&chirurgische  Beitrdge  atts  dem  Jalire  1866,  Breslau,  1870,  p.  72),  head  and  neck  12,  trunk  41,  upper  extremities 
50,  luwer  extremities  109;  total  212.  10  BIEFEI,  (R.)  (Im  Kf.xf.rve- Lazaretk.  Kriegschirurgische  Aphorismen  von  1866,  in  L,AXGEXl!ECK'S  Archie  fur 
Klin.  Chir.,  Berlin,  1869,  P..  XI,  p.  371 ),  head  and  neck  38.  trunk  'i7,  upper  extremities  82,  lower  extremities  185 ;  total  382.  l7  STKOMEYEH  (L.)  (Erfalt- 
rungen  iiber  Schitsswunden  im  Jalire  1866,  Hannover,  1867,  pp.  10.  11).  head  and  neck  139,  trunk  £50,  upper  extremities  392,  lower  extremities  f>10;  total 
1,391.  18BECK  (B.)  (Kriegschirurgische  Erfahrungen  wiihrend  des  Feldzvges  1866  in  Siiddeutschland ,  Freiburg  I.  Br.,  1867,  pp.  25,  26).  "COUTESK 
(F.)  (Ulleriori  ragguagli  sulle  perdite  deliescreito  italiano  sofferte.  nclla  campagna  del  1866.  in  Annali  fnir.  di  filed.,  Milano,  1868,  Vol.  CCV,  p.  506). 
20PvIEUL  und  EBXEU  (Aus  dem.  K.  K.  Truppen-Sjntal  in  Cattaro,  in  Wiener  Med.  Wochenschrift,  1870,  p.  155).  2IOTIH  (G.  A.)  (Circular  No.  3,  War 
Department,  Surgeon  General's  Office,  Washington,  1671,  p.  86).  TlSCIlEK  (G.)  (Statistik  der  inde.m  Kriege  1870-71,  etc.,  Berlin,  187(5.  p.  64)  tabulates 
the  seat  of  injury  in  61,146  killed  and  wounded.  To  make  a  fair  comparison  with  the  statistics  here  cited  it  will  be  necessary  to  deduct  the  number  of 
killed,  7,664,  leaving  53,482  cases  to  be  considered  here.  23BECK  (B.)  (Cliirurgie  der  Schussrerletzungen,  Freiburg  i.  Br.,  1872,  p.  160).  MCHEXU 
(J.-C.)  (Apercu  hist.  stat.  et  din.,  etc.,  pendant  la  guerre  de  1870-71,  T.  I,  pp.  XX  VII,  XXVIII,  XXIX,  XXX).  2STll,IXG  (G.)  (Bericht  iibe.'  124  im 
Serbisch-tiirkischen  Kriege  im  Baracl;en-Lazare,th  des  Dorpater  Sanitats- Trains  zu  Stvilainatz  behandeltf  Scliussuerletzungen,  Dorpat,  1877,  pp.  18-97). 
head  and  neck  10,  trunk  21,  upper  extremities  31,  lower  extiemities  62;  total  124.  26KAI)E  (E.)  (Das  temporZre  Knegslazareth  der  Anstalten  der 
Kaiserin  Maria  im  Kloster  iiariahimmelfahrt  bei  Sistowa,  in  fit.  1'etersburger  Medicinische  Wochcnsclirift,  1877,  No.  45,  p.  ,'i83),  head  and  neck  37 
trunk  20,  upper  extremities  115,  lower  extremities  75 ;  total  247. 

1  Des  plaies  d  armes  a.  feu.  Communications  faites  a  V Academic  Nationale  de  Affdecine,  Paris,  1649.  This  volume  contains  articles  by  BAUUE.NS, 
Koux,  MALGAIGXE,  AMUSSAT,  BLANUIX,  PIOUHY,  VELPEAU,  HUGUIEU,  JOBERT  (DE  LAMBALLE),  BEGIN,  Rocnoux,  and  DEVKUGIE.  SIMON,  Utber 
Schusswunden  verbunden  mil  einem  Berichte  iiber  die  im  grossherz.  Militair-Lazaretli  zu  Darmstadt  behandelten  Verwundeten  vom  Sommer  1849. 


CHAP.  XII.]  FIREARMS    AND    THEIR    PROJECTILES.  695 

fession.  American  surgeons  had  had  but  little  opportunity  to  familiarize  themselves  with 
the  active  practice  of  military  surgery,  and  were  obliged  to  draw  upon  the  authorities 
abroad  for  their  early  information,  upon  which  was  largely  based  the  practice  of  the  later 
surgery  of  the  vf'dr. 

FIREARMS  AND  THEIR  PROJECTILES. — The  reports  of  medical  officers  on  the  early  engage 
ments  of  the  rebellion  allude  to  the  great  diversity  of  missiles,1  showing  that  every  avail 
able  weapon  had  been  seized  upon  to  arm  the  troops  hastily  thrown  into  the  field;  this  was 
especially  true  of  the  Confederate  troops.  The  northern  forces  were,  perhaps,  from  the 
beginning,  better,  or  at  least  more  uniformly  armed.  Previous  to  the  war  a  rifled  musket 
adapted  to  the  use  of  the  minid  projectile  had  been  issued  to  the  troops  of  the  regular  army, 
and  distributed  among  the  arsenals  in  the  several  sections  of  the  country.  Many  of  these 
fell  into  the  hands  of  the  Confederate  government  on  the  commencement  of  hostilities,  and 
were  appropriated  to  the  use  of  their  troops.  Large  numbers  of  arms  of  modern  manufac 
ture  were  purchased  from  abroad,  principally  of  the  Austrian,  Belgian,  and  Enh'eld  pattern, 
but  inventive  ingenuity,  roused  by  the  exigencies  of  war,  soon  superseded  these  by  arms 
of  domestic  manufacture  of  great  power  and  precision,  among  which  breech-loading  and 
magazine  guns  occupied  prominent  positions.2 

Giessen,  1851.  KESTKLLI  (ANTONIO),  Note  ed  Osservazioni  cliniche  di  chirurgia- Militare,  in  Annali  Universali  di  Medicina,  1849,  Vol.  CXXX,  Faso. 
389,  p.  2->5.  WATERS  (E. ),  Observations  on  Gunshot  Wounds,  made  in  Paris  during  the  Summer  of  1848,  in  Monthly  Journal  of  Medical  Science,  Edin 
burgh  and  London,  1849,  Vol.  IX  (N.  S.,  Vol.  Ill,  pp.  251,  309,  353).  ALQUI£  (A.),  Chirurgie.  Conservatrice,  et  mnyens  de  restreindre  I'utilil'  des  opera- 
tions,  Montpellier,  1850.  BECK  (B.),  Die  Schuss-Wunden,  Heidelberg1,  1850.  Ross  (G.),  Militairirztliches  aus  dem  ersten  Schleswigschen  Feldzuge  im 
Sommer  1848.  Altona,  1850.  BKUTHEUAND  (A.).  Des  panseme.nts  des  plaies,  Paris.  1851.  IDEM.  Des  plates  d'armes  a  feu  de  I'orbite,  Paris,  1851. 
ESMAUCH  (F.),  tlber  Resectionen  nach  Schussivunden,  Kiel,  1851.  DJiiuur  (M.),  Oin  de.n  relative  Bypighed  af  de  forskjellige  Skudsaar  efter  deres 
Ssede,  og  om  deres  Dodeligheds-Forhold,  in  Hospital s-Meddelelser,  1852.  Bind  V,  p.  349.  IDEM,  Bemxrkninger  over  de  i  Krigen  1848-50  foretagne  Ampu- 
tationer  i  forbindelse  med  en  Statistik  over  dem,  in  Bospitals-Medddelser,  1852,  B.  V,  p.  99.  HuTTX  (M.  F.),  Memoire  sur  la  necessit'.  d'extraire  les  corps 
etrangers  et  les  esquilles,  dans  le  traitement  des  plaies  par  armes  u  feu,  in  Mem.  de  V  Academie  Nationale  de  Medecine,  1852,  T.  XVI,  p.  407.  BAUDKN8, 
M 'moire  sur  le  traitement  des  plaies  d'armes  ^  feu,  in  Recueil  de  Memoires  de  Medecine,  de  Chirurgie.  et  del'harmacie  Militaires,  1853,  2ml!  ser.,  T.  X,p.  98. 
SCHWAUTZ  (H.),  Be.itrage  zur  Lelire  von  den  Schusswunden,  Schleswig.  1854.  BALI.INGAU.  (Sir  GEOEGE),  Outlines  of  Military  Surgery,  5th  ed.,  Edin 
burgh  ami  London,  1855.  GUTllUIE  (G.  J.),  Comment,  on  the  Surgery  of  the  War  in  J'ortugal,  France,  and  the  Netherlands,  etc.,  6th  ed  ,  London,  1855. 
HKYFELDEit  (J.  F.),  Die  Verwundungen  und  Operationen  in  Folge  des  Bombardements  von  Sv'aborg  vom  9-11  Aug.,  in  Deutsche  Klinik,  1855,  B.  VII, 
p.  553.  STUOMEYKU  (L.),  Maximen  tier  Kriegslieilkunst,Ha.nnn\er,  1855.  VALETS  K,  Documents  pour  servir  a  la  solution  de  plusieurs  questions  relatives 
au  traitement  des  plaies  par  projectiles  de  guerre,  in  Jie.rue.il  de  Mem.  de  M  d.  de  Chir.  et  de  1'har.  Mil.,  1855,  2me  se>.,  T.  XV,  p.  204.  QUESXOY  (M.  F.), 
Notice  Medico- Chirurgicale  sur  I'armee  d  Orient,  iu  Recueil  de.  Mem.  de  Mid.  de  Chir.  et  de  1'har.  Mil.,  1857,  T.  XX,  2""  ser.,  p.  241.  SCIUVE  (G.), 
Relation  medico  chirurgicale  de  la  Campagne  d' Orient,  etc.,  Paris,  1857.  AltMAND  (A.),  Histoire  Medico-cliirurgicale  de  la  guerre  de  Crimee,  etc., 
Paris,  18.~i8.  BAUDEXS  (L.).  La  Guerre  de  Crimee,  etc.,  2d  ed.,  I'aris,  1858.  MATTHEW  (T.  P.)  Medical  and  Surgical  History  of  the  British  Army 
which  se.rred  in  Turkey  and  the  Crimea  during  the  War  against  Russia  in  the  years  1854-55-5*),  2  volumes,  London,  1858.  MACLEOD  (G.  H.  B.), 
Notes  on  the  Surgery  of  the  War  in  the  Crimea,  etc.,  London,  1858.  SALLEKON,  Compte- Rendu  des  Amputations  1'rimitives  et  des  Amputations  Consec- 
utives  in  Recueil  de  Mem.  de  Med.  de  Cliir.,  et  de  I'har.  SHI.,  1858,  'J'.  XXI,  p.  283,  ct  T.  XXII,  p.  239.  Ari'lA  (L.),  Le  Chirurgien  a  V Ambulance,  etc., 
Paris,  1859.  BlLLKOTll  (T.),  Historische  t-tudie.n  iiber  die  Jleurlheilung  und  Behandluvg  der  Schusswunden  vom  XV  Ja.hr undert  bis  auf  die  neueste 
Zeit,  Berlin,  1859.  FltASEU  (P.),  A  Treatise  upon  Penetrating  Wounds  of  the  Chest,  London.  1859.  LKCOUEST  (L  ),  La  chirurgie  militaire  contem- 
pornine,  in  Archives  gen 'rales  de  Medecine,  Paris.  1859,  V  ser.,  T.  XIII.  pp.  78,  201,  462.  LOEFFLEll  (F.),  Grundsdtze  und  Regeln  fur  die  Behandlung 
der  Schusswunden  im  Kriege,  Berlin.  1859.  LOIIMEYEU  (C.  F.),  Die  Schusswunden  und  Hire  Be.handlung,  Gottingen,  1859.  WILLIAMSON  (G.),  Notes 
on  the  Wounded  from  the  Mutiny  in  India,  etc  .  London,  1859.  BEUTHEUAND  (A.),  Campagne  d' Italic  de  1859,  Paris.  I860.  LANUA  (N.),  La  Campana 
d<:  Man-items  Memorias  de  nn  medico-mil.,  Madrid,  18(iO.  I'AKAVICINI,  L'ospitale  Militare  a  Santa  Maria  di  Loreto,  etc.,  in  Annali  Universalidi  Medicina, 
Milano,  1800.  Vol.  CLXXI,  p.  36'5,  and  Vol.  CLXXII,  p.  191.  liOl'X  (J.),  De  Vosteomy  'lite  ft  des  amputations  secondaircs  «  la  suite  des  coups  defeu,  etc., 
Paris,  1800.  IDEM,  Desarticulation  de  la  cuisse  d'apres  des  observations  recueillies  a  iiaint  Mandrier,  in  M'm.  lu  ,1  I'Acad.  des  Sciences,  le  16  Avril,  18(10. 

1  Appended  Documents,  Part  I,  Vol.  I,  p.  7;  Assistant  Surgeon  C.  C.  Gray,  U.  S.  A.,  in  report  of  services  at  the  first  battle  of  Bull  Run,  Va..  July 
18,  1861,  says :  "The  greater  number  of  our  wounded  were  injured  by  round  musket  balls :  the  wounds  indicted  on  the  Confederates  were  of  a  graver 
character,  a  large  proportion  of  them  being  caused  by  conoidal  rifle  balls  and  canister  shot."  At  p.  10,  Surgeon  C.  F.  II.  Campbell,  U.  S.  A.,  iu  record 
of  services  at  Falling  Waters,  Va.,  July  2,  18(il.  says:  '"Wounds  were  all  from  gunshot  and  prineipally'of  the  lower  extremities,  produced  by  round 
musket  balls,  buckshot,  and  in  one  or  two  instances  by  sphero-conoidal  balls."  At  p.  15,  Assistant  Surgeon  Philip  C.  Davis,  U.  S.  A.,  in  report  relative 
to  the  battle  of  Wilson's  Creek.  Mo.,  August  9,  18(il,says:  "The  fire  to  which  our  men  was  exposed  was  principally  from  musketry  at  short  range. 
The  Confederates  used  the  mini6  rifle,  while  the  Missouri  State  Guards  and  the  irregular  troops  were  armed  with  smooth-bore  muskets,  western  rifles,  and 
double-barreled  shot-guns — the  last  being  very  effective  at  short  range."  At  p.  12,  Surgeon  A.  B.  Crosby,  U.  S.  V..  in  report  of  the  engagement  at  Ball's 
Bluff.  Oct.  21,  18o'l,  says:  •'  Their  [Confederate]  can  ridges  generally  contained  a  round  ball  and  three  buckshot."  At  p.  12.  Surgeon  J.  A.  Lidell,  U.  S.  V., 
in  a  report  of  the  same  engagement,  says:  "  The  enemy  had  no  artillery,  and  most  of  the  wounds  of  our  men  were  inflicted  by  round  musket  balls."  At 
p.  '_'•-',  Surgeon  H.  P.  Stearns,  U.  S.  V.,  iu  a  report  of  the  battle  of  Belmont,  Mo.,  Nov.  7.  1861,  says:  "  The  enemy  used  both  the  smooth  bore  muskets 
with  round  ball,  shot  guns  with  ball  and  buck,  and  also  rifles  with  conoidal  ball.  '  At  p.  31,  Surgeon  J.  H.  lirinton.  U.  S.  V.,  in  an  account  of  the  cam 
paign  of  the  Army  of  the  Tennessee  from  February  to  June.  1801,  including  the  battle  of  Shiloh,  says  :  "  The  nature  of  the  wounds  caused  by  the  fire  to 
which  the  troops  were  exposed  at  the  battle  of  Shilnh  was  of  the  most  varied  kind:  at  times  they  were  exposed  to  that  of  artillery  both  light  and  heavy, 
from  which  almost  every  species  of  projectile  was  thrown— solid  shot,  round  and  conical,  grape  and  canister,  spherical  case  and  shell;  at  other  times  the 
fire  was  from  musketry.  The  small  arms  used  by  the  enemy  were  the  improved  rifle  throwing  conical  balls,  the  western  rifle,  and  the  old  fashioned 
smooth  bore  musket :.  the  cartridges  for  the  latter  were  generally  composed  of  ball  and  buckshot." 

"The  collection  of  missiles  in  the  Army  Medical  Museum  at  Washington  indicates  the  progress  made  in  th«  United  States  duirng  the  years  of  the 
war  iu  the  improvement  of  firearms.  Though  by  no  means  complete,  the  series  of  unused  missiles  and  projectiles  on  exhibition  affords  an  interesting  and 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


For  the  purpose  of  this  history,  projectiles  common  to  warfare  may  be  divided  into 
thoso.  used  with  small  arms,  as  rifles,  muskets,  pistols,  etc.;  those  discharged  from  heavy 
ordnance,  as  cannon,  both  rifled  and  smooth-bore,  mortars,  torpedoes,  etc.;  those  which  acted 
indirectly  in  the  causation  of  injury,  as  splinters,  stones,  and  fragments,  detached  or  set  in 
motion  by  projectiles  in  their  flight,  and  missiles  of  an  unusual  or  eccentric  character. 
By  far  the  larger  number  of  shot  injuries  were  inflicted  by  missiles  from  small  arms,  as 
indicated  in  the  following  table: 

TABLE  GXXI. 

Table  indicating  the  Seat  of  the  Injury  and  Nature  of  the  Projectile  in  the  Cases  of  Shot   Wounds 

reported  during  the  War. 


SEAT  OF  INJURY- 

Solid  Shot. 

Fragments  of 
Shell. 

Grape,  Canister, 
etc. 

Conoidal  Ball. 

Round  or  Musket 
Ball. 

M 

3 
O 

o  £ 
"o 

s 

Explosive  Mus 
ket  Balls. 

Nature  of  Missile 
not  ascertained. 

'I'otal  Cases. 

Shot  Flesh  Wounds  of  Scalp                                        

3 

867 

15 

2  612 

5°1 

119 

o 

3  600 

7  73") 

q 

567 

27 

1  437 

506 

66 

3 

I  735 

4  350 

5 

572 

19 

2  632 

2% 

160 

31 

1  19() 

4  914 

1 

190 

"0 

1  845 

309 

65 

q 

2  063 

4  502 

Shot  Flesh  Wounds  of  Neok 

•5 

171 

Tl 

1  982 

343 

84 

2  301 

4  845 

1 

59 

5 

380 

108 

16 

J 

72 

64" 

7 

1  034 

11 

0  163 

911 

106 

1 

6  486 

11   549 

4 

35 

i 

250 

(IS 

3 

70 

446 

10 

148 

23 

2  873 

1  789 

134 

•5 

3  °89 

8  °69 

10 

270 

21 

1   836 

375 

51 

2  185 

•)  748 

•3 

G4 

g 

1  °17 

"17 

67 

1 

0  113 

3  690 

4 

78 

15 

7;i8 

269 

13 

377 

1   494 

Shot  Flesh  Wounds  of  Oenito-Urinary  Organs  

47 

6 

589 

144 

37 

842 

1,  665 

Shot  Flesh  Wounds  of  Back           *  

5 

1  798 

50 

7  260 

1  080 

140 

o 

2  346 

12  681 

18 

1  660 

180 

2°  023 

•'  868 

625 

27 

27  400 

54  801 

5 

160 

19 

1  236 

18 

569 

2  280 

6 

79 

17 

822 

131 

12 

1 

511 

1  579 

°8 

40] 

83 

4   156 

599 

56 

9 

2  913 

8  °45 

g 

101 

12 

930 

175 

12 

1  578 

2  816 

Shot  Injuries  of  the  Itadius  and  Ulna  

14 

206 

25 

1  803 

391 

32 

7 

2  656 

5,  194 

4 

29 

12 

285 

61 

g 

1  110 

1   509 

g 

079 

47 

2  699 

549 

74 

2 

7  711 

11  369 

Shot  Flesh  Wounds  of  the  Lower  Kxtremities      

0.) 

2  150 

215 

33  301 

2  474 

880 

20 

21  077 

59  13!) 

1 

°0 

4 

185 

104 

6 

66 

386 

Shot  Injuries  of  the  Shaft  of  the  Femur  

28 

1(14 

63 

2  4')6 

567 

19 

4 

3  397 

6,  738 

27 

201 

54 

1  725 

48° 

°5 

1 

883 

3  398 

79 

593 

86 

4  968 

634 

81 

2  730 

9  171 

Shot  Injuries  of  the  Bones  of  the  Ankle  Joint  

26 

177 

32 

570 

152 

13 

3 

749 

1  722 

20 

400 

36 

3  167 

346 

89 

1  801 

5  859 

Aggregates  

359 

12  5°0 

1  153 

108  049 

16  742 

3  008 

130 

103  829 

245  790 

The  nature  of  the  missile  was  ascertained  in  one  hundred  and  forty-one  thousand  nine 
hundred  and  sixty  one  (141,961)  cases,  of  which  one  hundred  and  twenty-seven  thousand 
nine  hundred  and  twenty-nine  (127,929),  or  90.1  per  cent.,  were  caused  by  missiles  from 
small  arms.  The  projectiles  or  missiles  used  with  small  arms  resolved  themselves  into 
spherical  balls,  usually  discharged  from  smooth-bore  muskets,  and  those  of  an  elongated 
form,  adapted  to  rifled  arms;  the  latter  were  either  conical,  cylindro-conoidal,  or  ovoid,  vary 
ing  in  size,  weight,  and  volume.  The  materials  composing  the  missiles  were  usually  lead 

instructive  study  us  to  their  varying  forms,  size,  weight,  and  volume:  this  in  connection  with  a  series  of  over  500  projectiles  extracted  from  wounds, 
together  with  the  numerous  preparations  of  fractures  and  wounded  viscera  in  which  the  missiles  producing  the  injuries  have  been  preserved,  affords  oppor 
tunity  f..r  a  comparison  <>f  the  effects  of  the  several  missiles  as  well  as  for  the  study  of  the  modification  in  gunshot  wounds  resulting  from  modern 
Improvement*  in  ordnance. 


CHAP.  XII. 


FIREARMS    AND    THEIR    PROJECTILES. 


697 


or  lead  hardened  by  an  alloy  of  tin  or  antimony.  The  superiority  of  the  elongated  missile 
thrown  from  the  rifled  barrel  over  the  spherical  ball  rests  upon  the  Tact  that  the  elongated 
bullets  usually  have  an  expansive  base,  either  plain  or  hollowed,  which  by  the  explosion 
of  the  charge  is  intended  to  rill  the  grooves  of  the  rifle  and-give  the  projectile,  as  it  is  driven 
forward,  rotation  on  its  long  axis,  thus  increasing  its  range  and  precision. 

The  cuts  appended  (FiG.  373)  are  designed  to  illustrate  the  general  appearance  of  the 
more  common  and  typical  varieties  of  small-arm  missiles  used  during  the  war  by  both 
contending  parties;1 


,  weight  3,«7  grains;  1.  Buck  and  ball,  calibre  .69,  weight  of  ball  387  grains  :  c.  Springfield  rifled 


The  large  projectiles  used  with  ordnance  may  also  be 
classified  under  the  headings  spherical  and  elongated,  the 
former  being  generally  used  with  smooth-bore,  the  latter  with 
rifled  guns.  Round  shot  are  solid  spheres  of  cast-iron  vary 
ing  in  size  and  weight.  A  grape-shot  (FiG.  374)  is  composed 
of  a  number  of  cast-iron  balls  (in  the  U.  S.  service  generally 
nine)  arranged  in  layers  of  three  each  and  kept  in  position 
by  a  series  of  tables  or  plates  which  are  held  together  by  a 
vertical  rod  secured  by  nuts  on  each  end;  these  missiles  vary 
in  calibre  to  fit  guns  of  various  sizes;  at  the  discharge  the 
several  parts  become  separated  and  each  part  acts  as  a  dis 
tinct  projectile.  Thev  have  a  considerable  range. 

A  canister  shot  is  a  projectile  made  by  enclosing  a  large 
number  of  iron  or  leaden  balls  of  less  size  than  grape  in  a 
cylinder  of  tin,  which  is  torn  asunder  at  the  discharge  of  the 
gun;  the  contents  are  scattered,  assuming  in  their  onward 
course  something  of  the  area  of  a  cone;  when  used  against  masses  of  troops  and  at  short 
range  the  canister  shot  is  very  destructive.  Shrapnel  shots  are  spherical  or  elongated. 

1  The  number  of  varieties  of  missiles  and  projectiles  on  exhibition  in  the  Army  Medical  Museum  exceeds  one  hundred,  embracing  specimens  of 
nearly  all  the  latest  inventions.  Some  of  these  were  tested  in  actual  warfare,  while  others,  although  constructed  upon  theoretical  principles,  were  laid 
aside  after  a  few  trials  ;  a  detailed  description  of  all  these  would  be  impracticable. 

SURG.  Ill— 88 


374.— Grape  shot.     fyec.  450*!. 


698 


WOUNDS    AND    AMPUTATIONS. 


[CHAP    XII. 


Fl(.    :mi._The  simi(,  s;nvu  n,  |,.llf  showing  the  bullets 

^composition.   Spec. 


according  to  the  character  of  the  gun  in  which  they  are  used,  and  when  adapted  to  smooth 
bores  they  are  designated  spherical  case  shots.  They  are  shells  of  considerable  thickness, 
filled  with  nmskft  balls  consolidated  into  mass  by  a  composition  of  sulphur  and  resin 

(Fios.  375,376.  377), 

and  are  exploded  by 

a  charge   of  powder 

fitted  into  their  inte 

rior.  which  is  ignited, 

as    may    be    desired. 

• 

by  a  time  or  percus 
sion  fu/<'.  They  have 
a  long  effective  range 
and  are  calculated  to 
inflict  serious  injury 
by  the  great  number 

Fl<;.  37.x—  A  l-J-pouml-r  sph.-ri.-al  case-shot.  outer  ami    °*  mlgmentS  Set  lOOSe 

at  their  explosion. 

The  projectiles  used  in  rifled  guns  exclusively  combine  with  the  properties  and  char 
acter  of  the  projectiles  just  described  those  which  pertain  particularly  to  guns  constructed 
on  the  rifled  principle;  they  differ  greatly  in  size  and  weight;  their  velocity  varies  with 
the  calibre  from  1,100  to  1,550  feet  per  second,  and  their  range  has  exceeded  five  miles. 
The  10-pounder  percussion  Parrot  case-shot  illustrated  in  FIG.  378  is  a  missile  of  this  nature. 
By  the  explosion  the  shell  is  rent  into  many  fragments,  varying  in 

*  •/  O  v  O 

weight  from  a  few  grains  to  many  pounds;  these  fragments  are  driven 
in  all  directions  with  great  force  and  inflict  injuries  of  the  gravest 
character.  The  Museum  collection  is  particularly  rich  in  specimens 
of  fragments  of  exploded  shells  of  all  sizes  and  descriptions,  showing 
the  great  diversity  of  shape  and  form  which  these  fragments  may  take. 

Rifled  projectiles  are  also  cast  solid,  and  are 
used  for  breaching  or  battering  purposes. 

Bolts,  so  called,  are  solid  metal  projectiles 
of  elongated  form,  with  surfaces  so  cut  as  to  fit 
corresponding  surfaces  in  the  barrel  of  the  gun  : 
they  are  made  to  fit  with  great  exactness,  so 
that  a  greater  proportional  effect  is  attained 
with  a  smaller  charge  of  explosive  compound. 
The  Whitworth  gun  and  projectile  may  be 
taken  as  the  type  of  this  class.  Its  projectile 
has  been  thrown  nearly  six  miles.  It  is  prob- 
case.Shot  atn,,..  ;l''1(>  tll:lt  tll(1  fxtremo  care  necessary  to  pre- 

,]  r>  ,•    ,1  i         •       -i          i 

serve  the  surfaces  ol  the  gun  and  missile  clean 
and  smooth  will  render  it  practically  less  effective  than  many  of  the  ordinary  patterns  of 
rifled  ordnance  which  possess  almost  equal  power,  range,  and  precision. 

AVith  this  general  knowledge  of  the  more  common  forms  of  ordnance  projectiles  it  will 
be  unnecessary  to  enter  more  fully  into  a  detailed  account  of  the  improvements  made  from 
time  to  time  with  the  object  ot  perfecting  these  agents  of  destruction. 


F,,;.;!77.-A 

ped  for  howitzer  or  <f  tin.     Siifc.  4W2. 


l-'Ii;.  I57H.— A  1(1  poiimh'i- 
cussion  I'aiTot  ruse-shot  , 
4587. 


FIREARMS    AND    THEIR    PROJECTILES. 


699 


Shells  thrown  from  mortars  differ  little  if  any  from  ordinary  spherical  shells  except 
in  size  and  in  the  manner  of  projection.  Their  use  is  generally  restricted  to  sieges.  Under 
the  same  circumstances  hot  solid  shot  were  used  during  the  war,  but  with  the  intention  of 
destroying  property  rather  than  human  life. 

Hand  grenades  (Fio.  379)  are  small  iron  shells  tilled  with  powder  and 
discharged  by  percussion ;  they  were  used  in  sieges  and  assaults  at  close 
quarter,  and  their  effects  are  similar  to  ordinary  shells;  as  their  name  indi 
cates,  they  are  carried  and  thrown  from  the  hand. 

Torpedoes,  or  more  properly  fougasses,  were  largely  used  as  a 
means  of  defence  during  the  late  war;  they  were,  as  a  rule,  simplv 
large  shells  arranged  with  levers  connected  with  a  percussion  fuze 
and  sunk  below  the  surface  of  the  ground  in  the  supposed  path 
of  an  assailing  party.  A  pressure  of  the  foot  upon  the  concealed 
lever  was  sufficient  to  explode  the  shell,  resulting  in  effects  similar 
to  the  bursting  of  a  like  projectile  under  ordinary  circumstances. 
Torpedoes  of  more  complicated  construction  and  of  far  greater 
power  were  employed  in  the  defence  of  rivers  and  harbors  and 
proved  important  and  effective  agents  of  destruction.  In  an 
article  on  torpedo  wounds,  Dr.  S.  W.  Gross1  describes  a  formidable 
engine  of  this  character,  containing  about  sixty  pounds  of  gunpow 
der  and  capable  of  being  exploded  by  a  pressure  of  four  pounds 
only.  Dr.  Gross  adds  that  ''its  effects  can  readily  be  imagined.'' 
Surgeon  J.  B.  Brown,  U.  S.  A..~  Medical  Director  of  the  Fourth 
Army  Corps,  in  an  extract  from  a  narrative  of  his  service  at  Wil- 
liamsburg,  Virginia,  reports  that  the  enemy  "had  planted  torpe 
does  in  the  works  and  along  the  road  leading  to  Williamsburg, 
designing  that  they  should  explode  by  the  pressure  of  the  foot  of  those  passing  over  them. 
A  casualty  occurred  in  General  Casey's  division  from  the  explosion  of  one  of  these  torpe 
does  and  one  man  was  killed  and  five  wounded.  The  wagon  track  and  the  side  paths  for  a 
mile  were  studded  with  these  buried  shells;  but  they  were  guarded,  as  soon  as  discovered, 
by  men  detailed  to  remain  near  them  to  point  them  out  to  passing  troops.  I  passed  near 
several  of  them  and  observed  the  ingenuity  with  which  they  were  concealed.  '  Surgeon  D 

J  J  o 

W.  Hand,  U.  S.  V.,:!  in  an  extract  from  a  report  relative  to  operations  in  North  Carolina, 
relates  that  on  ''June  4,  1864,  two  large  torpedoes  were  accidentally  exploded  at  Bachelor's 
Creek,  an  outpost  of  New  Berne,  instantly  killing  thirty-six  soldiers  and  eight,  negroes  and 
seriously  wounding  twenty-nine  men  attached  to  the  132d  New  York  Volunteers." 

A  bridge  torpedo,  devised  by  McCallum,  designed  to  be  placed  in  an  auger  hole  in 
the  beam  of  a  bridge,  is  represented  in  FIGURE  380.  The  two  sections  are  joined  by  a 
percussion  cap  connected  with  a  lever  placed  under  one  of  the  planks  of  the  bridge;  slight 
pressure  is  sufficient  to  explode  the  torpedo. 

In  a  third  division  of  missiles  and  projectiles  are  included  such  as  cause  wounds  and 
injuries  indirectly:  splinters,  stones,  fragments,  or  foreign  bodies  set  in  motion  or  driven  by 
the  force  of  projectiles  in  their  course,  and  which  frequently  by  their  action  or  lodgement 


Fin.  37!).— Krtclanu's 
1 -pound  hand  grenade. 
Spec.  4593. 


'GKO88  (S.  AV.),  On  Torpedo  Wounds,  in  American  Journal  Medical  Science,  1866,  Volume  LI,  page  370. 
*  APPKSIIIX  to  1'urt  I,  Vol.  I,  Medical  and  Surgical  History  of  the  War  of  the  Rebellion,  page  67. 
"  APFKMUX  to  1'art  I,  Vol.  1:  Medical  and  Surgical  History  of  the   War  of  the  Rebellion,  page  239. 


700 


WOUNDS    AND    COMPLICATIONS. 


(OHA1>.  XJI. 


complicate  direct  shot  wounds,  and  which  are  themselves  sources  of  danger  and  of  uncer 
tainty  in  diagnosis.  The  most  common  examples  of  this  class  are  fragments  of  stone  and 
splinters  of  wood  torn  from  the  earth  or  from  trees,  and  from  structures  forming  defensive 
works,  scraps  of  iron  or  metal  from  ordnance,  firearms,  or  from  articles  of  equipment;  or 
indeed  from  any  object  with  which  projectiles  come  in  contact. 

In  the  class  of  unusual  or  eccentric  projectiles  the  missile  illustrated  in  FIGURE  381 
may  be  placed;  it  is  a  conoidal  leaden  shell  two  inches  in  length,  one  and  a  half  in  calibro, 
weighing  nine  and  three-quarter  ounces.  The  missile  was  cut  out  of  a 
horse  killed  while  the  rider  was  reconnoitering  with  General  Kearney  on 
the  day  of  the  second  battle  of  Bull  Run.  No  report  was  heard  from  the 
direction  in  which  it  came.  It  was  subsequently  learned  that  such  mis 
siles  were  fired  from  globe-sighted  rifle-guns  of 
some  thickness.  FIGURE  382  represents  what 
is  known  as  a  ricochet  shell,  picked  up  on  the 
battle-field  of  the  Wilderness  in  1865  by  Gap- 
tain  James  M.  Moore,  U.  8.  A.,  and  presented 
to  the  Army  Medical  Museum ;  it  is  of  peculiar 
form,  weighing  nine  and  one-half  pounds;  it  has 
a  shallow  narrow  excavation  at  the  head,  ap 
parently  designed  for  a  charge  and  percussion 
cap,  which  charge  seems  to  have  proved  insuf 
ficient  to  burst  the  missile.  They  are  said  to 
have  been  commonly  used  by  the  Confederates 
at  the  battle  of  Fredericksburg,  at  the  battle 
of  the  Wilderness,  and  on  other  occasions. 
It  is  stated  that  railroad  iron  cut  into  suitable  lengths,  spikes,  and  scrap-iron  \\viv 
used  by  the  Confederates  in  lieu  of  regular  projectiles.  No  specimens  of  such  missiles  are 
in  the  Museum  collection  to  substantiate  this  statement. 

Shaler's  sectional  bullet,  represented  in  FIGURE  383,  is  drawn  of  natural  size  and  weighs 
608  grains;  it  is  designed  to  part  in  its  flight,  forming  three  separate  missiles;  whether  it 
was  over  used  on  the  field  is  not  known. 

The  ordinary  "buck  and  ball,"  FIGURE  373,  b,  p.  697,  a  compound  missile, 
was  very  extensively  used  during  the  early  part  of  the  war;  it  consists  simply 
of  the  ordinary  round  ball,  calibre  .69,  and  three  buckshot  enclosed  in  the  same 
cartridge.  Cartridges  made  up  en 
tirely  of  buckshot  were  common  and 
at  close  range  made  very  effective 
missiles.  Slugs  and  fowling-piece 
ammunition  are  also  noted  as  having 
been  occasionally  used. 

A  peculiar  missile,  said  to  have 

1  •      ,        ,i  ,      FIR.  384. — Bullet  with  a-niding  (?)  attachment :  actual  size. 

been  thrown  into  the  prison  camp  at 
Johnson's  Island  with  a  message  attached,  is  shown  in  FIGURE  384.  It  is  a  conoidal  bullet 
with  a  spade-shaped  appendage  twice  its  length,  designed  to  render  the  course  of  the  projec 
tile  more  accurate.  It  is  believed  to  be  a  pattern  rejected  by  the  Ordnance  Department 
about  the  year  I860;  its  history  is  not  positively  known. 


''If!.  381.—  Leaden  • 
li  incheiilil.re.  wei<rh 
3C>94.  l\"atiiral  size.) 


FIG.  383.— Sha- 
ler's  sect  i DII al 
ball.  Spec.  4621. 
No.  36. 


CHAP.  XII.)  EXPLOSIVE    BALLS.  .  701 

"Greek  fire"  for  incendiary  purposes  was  employed,  probably  by  both  sides  in  a  few 
instances.  It  was  used  at  the  siege  of  Charleston,  in  1863;1  but  its  employment  led  to 
such  representations  respecting  its  barbarity  that  the  use  of  it  was  but  little  resorted  to,  if 
at  all,  during  the  remainder  of  the  war. 

A  small  quantity  of  composition,  a  portion  of  the  contents  of  a  fire-ball  used  by  the 
Confederates  and  captured  at  Morris  Island,  was  contributed  to  the  Army  Medical  Museum 
by  Acting  Assistant  Surgeon  H.  K.  Neff.  It  is  specimen  572  of  the  Surgical  Section,  and 
is  described  as  "a  mixture  of  nitre,  sulphur,  and  antimony,  and  when  used  is  made  into  a 
paste  with  sand  and  rosin.  The  missile  was  wrapped  on  the  outside  with  three  layers  of 
heavy  canvas,  tarred  and  pitched  without,  with  a  network  of  twine  over  it.  The  bottom 
was  cast-iron  covered  only  with  pitch.  Within  the  ball  was  a  tin  cup  to  which  the  canvas 
and  twine  were  fastened,  and  which  contained  the  composition,  and  near  the  base  was 
embedded  a  6-pounder  shell.  Three  pins  in  the  top  are  withdrawn  before  loading  in  the 
gun  to  allow  ignition  previous  to  its  exit  from  the  muzzle.  The  composition  burns  slowly 
with  intense  heat.  The  missile  was  designed  to  be  thrown  from  a  mortar."  Except  in  the 
instances  quoted  it  is  doubtful  if  the  use  of  this  agent  was  at  all  common. 

EXPLOSIVE  BAIXS. — The  subject  of  the  employment  of  explosive  missiles  in  warfare 
between  civilized  nations  has  been  largely  discussed  from  an  ethical  point  of  view,  partic 
ularly  since  the  civil  war  in  the  United  States.  While  their  use  is  acknowledged  to  savor 
of  barbaric  warfare,  there  is  still  a  manifest  reluctance  to  place  them  entirely  beyond  the 
pale  of  legitimate  employment. 

By  an  agreement  between  the  principal  nations  of  Europe,  signed  by  their  representa 
tives  at  an  international  military  conference  held  at  Saint  Petersburg  in  October,  1868,  it 
was  resolved  to  abstain  from  the  use  of  explosive  projectiles  under  the  weight  of  four 
hundred  grammes.  In  commenting  on  this  agreement,  Dr.  Longmore2  remarks  that  "not 
withstanding  the  International  agreement  just  referred  to,  there  is  great  misgiving  on  the 
part  of  many  as  to  the  abandonment  of  explosive  bullets  in  time  of  war.  The  government 
of  the  United  States  has  not  joined  the  convention,  and  the  treaty  is  only  obligatory  upon 
the  contracting  parties  when  at  war  between  themselves;  it  also  ceases  to  be  obligatory  in 
case  of  a  power  which  has  not  joined  the  convention  allying  itself  to  either  one  or  other  of 
the  belligerents.  The  English  government  of  the  day  was  greatly  blamed  by  the  press  and 
by  many  military  men  for  joining  the  treaty."3 

One  hundred  and  thirty  cases  of  wounds  attributed  to  explosive  missiles  were  recorded 
on  the  returns  (TABLE  CXXII,  page  696,  ante).  The  records  of  the  Ordnance  Office,  U.  S. 
Army,  show  that  thirty-three  thousand  three  hundred  and  fifty  (33,350)  Gardner's  "  explo 
sive  bullets"  or  "musket  shells"  were  issued  to  the  troops  in  the  early  part  of  the  war;  that 

•I.OXfiMOKE  (T.),  Trratiseon  Gunshot   n'nvnds,  tlieir  history  ami  treatment,  London,  1877,  page')  I.  2  Ibid,  page  48. 

3  For  the  information  of  those  who  have  never  seen  the  treaty  alluded  to  above  the  text  is  here  reproduced  from  the  work  just  quoted :  "Consider 
ing  that  the  progress  of  civilization  ought  to  have  the  effect  <  f  lessening  as  much  as  possible  the  calamities  of  war:  That  the  only  legitimate  object  that 
states  ought  to  propose  to  themselves  during  war  is  to  weaken  the  military  strength  of  their  enemies:  That  for  this  purpose  it  is  sufficient  to  put  hors-de 
combat  the  greatest  number  of  men  possible:  That  this  end  would  be  overpassed  by  the  employment  of  arms  which  would  uselessly  aggravate  the 
wounds  of  men  placed  hors-ile-combat  or  that  would  render  their  death  inevitable:  That  the  employment  of  such  arms  would  be  consequently  contrary 
to  the  laws  of  humanity  :  The  undersigned  having  received  the  orders  of  their  governments  in  this  respect  are  authorized  to  declare  as  follows :  §  1.  The 
contracting  powers  mutually  bind  themselves  to  renounce,  in  ease  of  war  among  themselves,  the  employment  by  their  land  or  sea  forces  of  all  projectiles 
charged  with  explosive  or  intlammable  matters  «.f  a  less  weight  than  400  grammes  §'?.  They  will  invite  all  the  states  which  have  not  sent  delegates  to 


the  mil 


5.4.   It 
to  the  c 
every  t 


ary  international  commission  at  St.  Petersburg  to  accede  to  the  present  engagement.  §:t.  This  engagement  is  only  obligatory  upon  the  contract- 
•.ceding  parties  in  case  of  war  between  two  or  more  of  themselves  :  it  is  not  binding  in  regard  to  parties  who  have  not  joined  the  convention. 
•ill  equally  cease  to  be  obligatory  from  the  moment  when  in  a  war  between  powers  which  have  joined  the  convention,  another  power,  not  a  party 
nvention,  shall  join  one  of  the  belligerents.  §  5.  The  contracting  and  acceding  parties  will  come  to  a  further  understanding  among  themselves 
ne  that  a  precise  proposition  shall  be  made  on  the  subject  as  regards  future  improvements  that  science  may  make  in  the  arms  of  troops,  so  that 


the  principles  which  they  have  laid  down  for  reconciling  the  necessities  of  war  with  the  laws  of  humanity  may  be  maintained." 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


.  3P5.— Gard 
ner's  explosive 
ball.  /?/«•<-'.  4621. 


ri<;.  38(5.— Explosive 
bull  extracted  from 
thigh.  ,Vp<r.  4561. 


of  these  over  ten  thousand  (10,000)  were  abandoned  on  the  field  for  want  of  transportation. 
It  is  probable  that  the  latter  fell  into  the  hands  of  the  Confederates,  accounting  in  a  measure, 
for  the  wounded  before  alluded  to;  but  many  reports  of  wounds  attributed  to  explosive  balls 
were  made  in  which  it  is  doubtful  if  the  missile  was  really  of  this  nature,  as  under  certain 
circumstances  the  ordinary  ball  is  capable  of  great  distortion  and  of  inflicting  severe  injury. 
The  extent  of  the  damage  from  explosive  missiles  is  greater  than  that  ordinarily  caused 
by  the  simple  projectile;  bony  structures  are  more  extensively  shattered  and  the  area  of 
destruction  in  soft  parts  is  larger;  hemorrhage,  both  primary  and  secondary,  is  more  com 
mon;  extensive  sloughing  follows,  and  the  course  of  repair  is  slow  and  tedious. 

The  Gardner  "explosive  bullet"  or  "musket  shell"  (FiG.  385),  referred  to  as  having 
been  issued  to  the  United  States  troops,  is  a  cylindro-conoidal  projectile  of  lead,  made  in 
two  sizes;  the  larger  of  calibre  .58,  weighing  451  grains,  the  smaller  of  cali 
bre  .54,  weighing  363  grains.  Within  the  interior  is  placed  an  accurately 
fitting  acorn-shaped  chamber  filled  with  fulminate,  and  commu 
nicating  with  a  one  and  one-quarter  time-fuze,  which  is  exposed  to 
the  charge  at  the  rear  of  the  missile;  the  fuze  is  ignited  by  the  dis 
charge  of  the  piece.  The  bursting  charge  is  sufficient  to  rend  the 
bullet  and  transform  it  into  a  jagged  dangerous  missile.  Should 
it  have  penetrated  the  body  before  exploding  its  effects  are  still 
more  destructive.  It  is  claimed  that  other  forms  of  projectiles  of 
this  nature  were  used  provided  with  a  percussion  cap  which  would 
explode  upon  contact  with  even  soft  tissues.  No  specimens  of  tins 
kind  are  found  in  the  collection  of  the  Army  Medical  Museum.1  The  appearance  of  an 
exploded  musket  shell  extracted  from  the  thigh  of  a  private  of  the  120th  New  York  Vol 
unteers  is  shown  in  FIGURE  386.  The  wound  resulting  was  a  flesh  wound  of  the  muscles 
of  the  thigh,  and  the  bullet  was  removed  by  enlarging  the  opening  of  entrance.'"' 

Six  well  authenticated  cases  of  injuries  from  explosive  balls  have  already  been  cited;3 
accounts  of  sixteen  cases  of  alleged  injuries  from  similar  cause  are  here  appended: 

CASES  1028-1043.— Private  .Tos«pli  Baker.  Co.  B.  29tli  New  York,  \vounded  at  Bull  Kim,  August  ->S».  lsf>t>.     Acting 
Assistant  Surgeon  AV.  L.  Hammond  reported  tlie  patient's  admission  into  Baptist  ( 'lnm-li  1  lospital,  Alexandria,  September  1 ,  1H(5\J, 

1  There  aic,  however,  on  exhibition  several  specimens  of  centre-tire  metallic  cartridges  for  a  breech  loading  ritte  .:!.">  calibre,  loaded  with  explosive 
bullets,  contributed  by  Major-General  M.  C.  MKICS,  Quartermaster  General  V .  S.  A.,  and  Surgeon  H.  H.  Tll.TON.  U.  S.  A.,  and  found  in  the  camp  of 
Chief  Joseph's  band  of  Nez  Perces,  in  1877,  after  their  surrender  to  General  Miles.  The  projectile  is  represented  in  Kl<;.  :is7.  A  copper 
shell  nearly  three  fourths  of  an  inch  in  length,  loaded  with  fulminate,  is  enclosed  in  a  boring  at  the  head  of  the  bullet  :  the  end  of  the 
shell  projects  sufficiently  to  act  as  a  percussion  cap  by  which  the  missile  is  exploded.  Tin'  following  extracts  from  a  letter  from  Surgeon 
II.  1!.  Tll.TON.  V.  S.  A.,  give  sonm  interesting  facts  in  connection  with  this  and  another  form  of  explosive  missile  :  "  Fort  Kiley,  Kansas, 
April  3,  11-81.  Surgeon  1).  I,.  Hl'N  I  IX(;TOX,  I'.  S.  A.,  Washington.  I).  C.  DKAIt  DocKii;  :  In  reply  to  your  note  of  enquiry  about 
explosive  balls  used  by  the  Nez  Perces,  I  will  give  you  such  information  as  I  have.  During  the  siege,  which  lasted  five  days.  I  \s 
disposed  to  doubt  that  the  Nez  Perces  had  any  explosive  balls,  although  several  men  insisted  that  they  had  been  struck  by  them,  as 
they  distinctly  heard  the  explosion.  One  man  of  the  9th  Cavalry  was  shot  through  the  thigh  in  front  of  the  femur:  the  skin  was  dis 
colored,  and  the  hole  was  large  enough  to  admit  the  thumb:  there  was  only  a  bridge  of  skin.  After  the  surrender  and  discovery  of 
explosive  balls  in  the  village.  I  was  convinced  that  a  number  of  the  wounds  had  been  caused  by  explosive  balls.  .  .  I  was  curious 
to  know  how  the  Indians  had  obtained  these  explosive  balls,  and  heard  upon  enquiry  that  in  passing  through  Idaho  they  had  made  a 
raid  upon  a  'ranch  of  an  Englishman  who  had  hunted  in  all  parts  of  the  world,  and  who  was  well  supplied  with  rifles  and  ammunition 
including  explosive  balls,  and  the  Nez  Perces  had  captured  his  outfit  although  he  escaped.  ...  I  have  an  impression  that  explosive  balls,  like  other 
balls,  cause  a  larger  wound  at  the  point  of  exit  than  at  the  point  of  entrance,  although  explosive  balls  and  'Express'  rifle  balls  greatly  lacerate  the  tissue 
before  their  exit.  My  attention  having  been  drawn  tffthe  subject.  I  found  that  a  citizen  employe  with  the  7th  Cavalry  had  explosive  balls  for  use  in 
hunting.  The  Winchester  rifle  ball  was  cast  with  a  cavity  of  proper  size  to  receive  a  .22  calibre  cartridge  in  its  apex  ;  the  .22  calibre  cartridge  required 
a  portion  of  its  ball  to  be  removed  in  order  to  fit  into  the  .44  calibre  ball.  I  saw  the  effect  of  these  on  antelope,  and  the  laceration  was  beyond  the  point 
of  entrance.  Very  respectfully,  H.  It.  Tll.TOX,  Surgeon  I".  S.  A." 

.*The  case  has  already  been  referred  to,  as  a  case  of  flesh  wound  of  the  lower  extremities,  in  jYote  1  of  page  24,  ante. 

3See  Cases  of:  Pt.  W.  Gritzmacher,  C.  5th  Wisconsin;  Spotlsylvania,  May  la,  1804  ;  explosive  musket  ball  struck  frontal  bone  and  fractured  outer 
table  ;  recovery  :  First  Surgical  Volume,  p.  129.  Pt.  J.  F.  Singer.  K,  24th  Wisconsin ;  Dallas.  Ga.,  May  27,  1864  :  explosive  bullet  fractured  external  table 
of  the  occipital  bone :  recovery  ;  idem,  p.  217.  Lieut.  T.  E.  Maley,  Tith  Cavalry;  Deep  Bottom,  July  28,  18(>4  :  ball  exploded  in  left  antrum  of  Highmore  : 
recovery  ;  idem,  p.  352.  Pt.  P.  T.  White.  I,  7th  Michigan  ;  Antietam,  Sept.  17,  1862 ;  ball  exploded  in  belly  of  pectoral  muscle  :  recovery  :  •idem.  p.  4'J4. 
Corp'l  A.  Burlingame.  64th  New  York;  Fair  Oaks.  June  1.  1862:  missile  exploded  in  left  forearm;  recovery:  ftfrrmil  Surfiical  Vnlttme,  p.  !)23.  Corp'l 
S.  P.  Keller,  1st  Maryland;  Weldon  Railroad,  August  18,  le'64  ;  missile  completely  shattered  right  knee;  recovery;  Third  liuryical  Volume,  i>.  250. 


CHAP.  XH.J  EXPLOSIVE    BALLS.  703 

with  n  wound  of  the  right  thigh,  inflicted  by  an  explosive  ball,  which  entered  the  intem;vl  femoral  region,  centre  of  the  middle 
third,  fracturing  and  comminuting  the  femur;  ball  extracted  on  the  battle-field,  under  the  fascia  lata.  between  the  rectus  and  the 
vustus  externus,  almost  in  the  line  of  its  direction.  Treated  in  Smith's  anterior  splint ;  union  of  bones  with  considerable  curvature 
externally;  limb  shortened  2$  inches  and  foot  inverted.  Discharged  February  29,  186:5. — Lieutenant  C.  M.  Ball,  Co.  G,  14lst 
Pennsylvania,  aged  35,  wounded  at  Chancellorsville,  May  3,  1833,  by  what  lie  thought  was  an  explosive  ball,  which  entered  the 
left  leg  in  the  upper  portion  of  its  lower  third,  inner  and  posterior  aspect,  and  produced  two  wounds  in  its  exit,  one  on  the 
posterior  and  the  other  on  the  anterior  aspect  of  the  leg ;  fragments  of  bone  discharged.  This  officer  was  discharged  from  service 
December  9,  1863,  and  pensioned,  and  paid  in  September,  1866,  since  which  time  he  has  not  been  heard  from. — Private  M.  Con 
ner,  Co.  D,  102d  Pennsylvania,  aged  30,  wounded  at  Cold  Harbor,  June  3,  186-1,  by  an  explosive  ball,  which  injured  the  right 
malleolus;  extraction  of  missile;  admitted  into  Third  Division  Hospital,  Alexandria.  Discharged  from  service  Jan.  7,  1835. — 
Private  W.  Bohmer,  Co.  D,  26th  Wisconsin,  wounded  at  Resaca,  June  22,  1864,  by  an  explosive  ball,  causing  transverse  frac 
ture  of  alveolar  process  of  superior  maxilla,  removing  teeth  of  left  side  to  molar  and  on  right  to  bicuspids;  fistulous  opening 
into  nose.  Treated  at  Harvey  Hospital,  Madison,  and  returned  to  duty  November  19,  1864. — Sergeant  D.  S.  Durell,  Co.  E,  3d 
New  Jersey,  was  admitted  into  Turner's  Lane  Hospital.  Philadelphia,  August  28,  1833,  with  a  wound  of  the  right  leg,  caused 
by  an  explosive  conical  ball,  at  Chancellorsville,  May  3,  1833.  The  ball  struck  the  upper  third  of  the  right  tibia  anteriorly, 
making  but  one  orifice.  Portions  of  the  missile  were  said  to  have  been  extracted  in  camp  at  Washington  and  at  West  Philadel 
phia  hospital.  Discharged  from  service  January  23,  1864.  Reported  by  Acting  Assistant  Surgeon  George  Hutton. — Sergeant 
J.  L.  Fenton,  9th  Massachusetts  Battery,  aged  28,  was  admitted  into  Jarvis  Hospital,  Baltimore,  July  10,  1863,  with  a  wound 
of  the  right  leg,  inflicted  by  an  explosive  ball  at  Gettysburg.  Acting  Assistant  Surgeon  B.  B.  Miles  reported  that  when  admitted 
the  patient  had  typhoid  symptoms,  and  on  the  night  of  July  27th  had  a  slight  haemorrhage.  He  died  on  July  28,  1833,  with 
supposed  pyaemia.  An  autopsy  revealed  the  knee  joint  and  thigh  infiltrated  with  pus,  and  a  compound  comminuted  fracture  of 
the  tibia.  The  specimen  of  the  upper  third  of  the  right  tibia,  showing  superficial  necrosis  around  the  injury  on  its  posterior 
aspect,  was  contributed  to  the  Army  Medical  Museum  by  Assistant  Surgeon  D.  C.  Peters,  U.  S.  A.,  and  is  numbered  1613  of  the 
Suryical  Scrtifjii. — Sergeant  0.  V.  Gingrass,  Co.  A,  29th  Missouri,  wounded  at  Ringgold,  Georgia,  November  24,  1863.  At  the 
general  field  hospital  at  Chattanooga  the  wound  was  recorded  as  a  gunshot  fracture  of  left  malar  bone  and  superior  nasal  bone 
by  a  conoidal  ball.  lie  was  subsequently  treated  at  hospitals  in  Nashville  and  Louisville,  and  on  June  25,  1864,  was' admitted 
into  the  hospital  at  Jefferson  Barracks,  Missouri.  Surgeon  J.  F.  Randolph,  U.  S.  A.,  reported  that  an  explosive  ball  entered 
two  inches  forward  and  one  and  a  half  inches  above  angle  of  inferior  maxilla,  emerging  at  nose,  exploding  as  it  passed  out, 
tearing  away  body  of  superior  maxilla  and  entire  nose  and  destroying  left  eye.  The  patient  was  transferred  to  St.  Louis  and 
discharged  July  14.  1835. — Private  Charles  G.  Hall,  Co.  G,  5th  Maine,  aged  36,  was  wounded  at  the  Wilderness,  May  10, 1864. 
On  May  14th  he  enteied  Carver  Hospital,  Washington.  Surgeon  ().  A.  Judson,  U.  S.  V..  reported:  "Gunshot  wound  of  left 
side  of  pelvic  region,  flesh.  Explosive  ball  entered  body  near  anterior  inferior  spinous  process  of  ilium  and  lodged  in  the  same 
side  near  the  sacrum.  May  10th,  extraction  of  ball  on  field ;  simple  dressings.  Doing  well  June  26,  1864,  when  he  was  returned 
to  regiment  to  be  mustered  out." — Acting  Assistant  Surgeon  D.  C.  Owen  reported  that  Private  James  Kenney,  Co.  I,  100th 
Illinois,  aged  18,  was  admitted  into  the  hospital  at  Quincy,  Illinois,  December  26,  1863,  with  a  gunshot  wound  of  the  right 
shoulder  by  explosive  ball,  received  at  Missionary  Ridge,  November  25,  186  >.  Ball  entered  half  way  between  the  shoulder 
joint  and  neck  and  penetrate!  the  flesh  two  and  a  half  inches;  extracted  from  place  of  entrance;  wound  healed.  Returned  to 
duty  February  16,  1864. — Private  T.  P.  McElroy,  Co.  F,  Hist  Pennsylvania,  aged  46,  wounded  at  Spottsylvania.  Ma}-  12,  1864. 
Treated  in  Washington  and  Annapolis  hospitals,  and  admitted,  on  August  18,  1834,  into  hospital  at  York,  Pennsylvania.  The 
following  record  of  the  case  appears  upon  an  unsigned  case-book:  "An  explosive  ball  struck  the  lower  jaw  on  the  left  side 
of  the  chin,  bursting  and  comminuting  the  bone.  The  ball  was  removed  by  Dr.  Vanderkief't,  surgeon-in-charge  of  the  Naval 
Academy  Hospital,  on  May  21,  1864.  Several  fragments  of  bone  were  removed  at  the  same  time  and  several  had  come  away 
before.  The  wound  is  now  healed  externally  but  discharges  slightly  into  the  mouth."  McElroy  deserted  from  hospital 
October  14,  1834. — Private  P.  F.  Moore,  Co.  B,  83d  New  York,  aged  40,  wounded  at  Tolopotomy  Creek,  Virginia,  May  30, 
1864.  On  June  4.  1834,  he  was  admitted  into  Mt.  Pleasant  Hospital,  Washington,  where  the  injury  was  diagnosed  as  "arm 
poisoned  by  explosive  ball."  He  was  afterwards  treated  in  hospital  at  Bristol  and  Philadelphia,  but  no  subsequent  allusion  is 
made  to  the  character  of  the  missile. — Medical  Cadet  E.  D.  Mitchell  reports:  "Bugler  Jack  Robinson,  1st  U.  S.  Cavalry, 
was  killed  at  Brandy  Station.  August  1,  1863,  and  by  order  of  General  Buford  his  body  was  sent  to  Washington  for  interment. 
Autopsy  August  2d,  one  hour  after  admission  into  Douglas  Hospital.  The  ball  entered  over  inner  third  of  right  clavicle, 
fracturing  it,  wounding  the  apex  of  the  right  lung,  and  passed  out  obliquely,  striking  the  seventh  cervical  vertebra,  and  was  cut 
out  underneath  the  skin  near  the  inferior  angle  of  the  scapula.  The  lung  was  too  much  decomposed  to  make  a  preparation  of. 
The  ball  had  evidently  exploded  after  it  struck  him.  There  was  a  great  amount  of  haemorrhage,  but  the  body  was  too  much 
disorganized  to  allow  of  finding  its  seat.  The  specimens  are  the  clavicle  and  ball."  The  specimens  were  received  at  the  Army 
Medical  Museum,  and  the  clavicle  is  numbered  1644  of  the  Suryical  Section,  but  the  missile  is  not  attached  and  a  carefid  search 
failed  to  discover  any  tracv  of  it.— Private  John  Ryan,  Co.  E,  114th  Illinois,  aged  21,  wounded  at  Guntovvn,  Mississippi,  June 
10,  1864,  and  admitted  into  Adams  Hospital,  Memphis,  June  13th.  Surgeon  J.  G.  Keenon,  U.  S.  V.,  reported:  ''A  lacerated 
wound,  from  explosive  shot,  of  calf  of  right  leg.  June  17th,  extraction  of  ball  through  extension  of  opening;  calf  of  leg  appeared 
as  if  peppered  by  buckshot.  Ball  had  exploded  after  entering  limb.  June  30th,  gangrene  attacked  the  wound  and  was  checked 
with  bromine.  On  August  25th  the  patient  was  transferred  to  Quincy,  Illinois,  and  discharged  June  22,  1835." — Private  W.  II. 
Stanley.  Co.  C,  1st  Maine,  aged  21,  was'admitted  into  Chestnut  Hill  Hospital,  Philadelphia,  June  7, 1864,  with  a  gunshot  wound 
of  left  foot,  received  at  Spottsylvania  May  19,  1864,  said  to  have  been  inflicted  by  an  explosive  ball.  Simple  dressings  were 
applied,  and  the  patient  was  returned  to  duty  July  11,  1864. — Acting  Assistant  Surgeon  Louis  Fassitt  reports:  "R.  C.  Wright, 
1st  U.  S.  Chasseurs,  was  wounded  on  the  skirmish  line  at  Malvern  Hill,  July  1,  1862,  by  an  explosive  ball,  which  entered  about 
the  middle  of  the  right  clavicle,  fracturing  the  bone,  passed  through  the  cavity  of  the  thorax,  and  was  extracted  four  days  after 
below  the  spine  of  the  right  scapula.  Large  amount  of  haemorrhage  from  the  lungs.  Sensation  at  the  time  of  receiving  the 


704  WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


wound  was  like  tliat  of  a  '  blow  from  a  man's  fist.'  Admitted  into  hospital  at  Chester,  Pennsylvania,  July  '29th.  Several  pieces 
of  brass  were  extracted  by  me  from  the  anterior  wound  near  the  clavicle,  and  others  from  the  posterior  wound  near  the  scapula. 
(He  had  no  scales  on  his  shoulders  or  any  metal  about  his  person  )  These  form  a  portion  of  an  explosive  cap  attached  to  a 
conical  ball,  which  I  have  no  doubt  ignited  at.  'the  moment  it  struck  the  clavicle,  and  these  fragments  were  driven  through  the 
lung."  Wright  was  discharged  from  service  November  30,  186:2. — Private  A.  Farcy,  Co.  C,  183d  Pennsylvania,  aged  3f>, 
wounded  at  Cold  Harbor,  June  3,  1864.  Acting  Assistant  Surgeon  J.  A.  McArthur  reported  from  South  Street  Hospital.  Phil 
adelphia:  '•'  Wounded  by  an  explosive  ball,  which  entered  the  right  side  of  the  thorax  one  and  a  half  inches  from  the  acromion. 
On  June  12th  a  large  abscess  which  had  formed  over  the  biceps  muscle  was  opened  and  the  ball  extracted."  Erysipelas  attacked 
the  wound  and  the  patient  died  July  22,  1864.  At  the  autopsy  the  ball  was  found  to  have  passed  through  the  glenoid  cavity  of 
the  scapula,  partially  fracturing  the  head  of  the  humerus,  and  passing  around  the  bone  lodged  beneath  the  fascia  covering  the 
biceps  muscle.  The  upper  half  of  the  right  humerus  was  forwarded  to  the  Army  Medical  Museum  by  Dr.  McArthur,  and  con 
stitutes  specimen  3669  of  the  Surgical  Section.  There  is  a  double  longitudinal  partial  fracture  of  five  inches  on  the  inner  side  of 
the  shaft.  The  head  is  carious,  and  necrosed  bone  borders  the  lines  of  separation  in  the  shaft. 

EFFECTS  OF  LARGE  PROJECTILES. — The  effects  of  these  projectiles  depend  on  their  weight, 
size,  and  momentum.  At  high  velocities  they  virtually  encounter  no  resistance  from  a 
single  human  body  and  their  force  is  but  slowly  expended  on  masses  of  soldiery.  Their 
form  is  of  little  importance,  as  similar  results  follow  the  use  of  spherical  and  elongated  solid 
shot  and  shell;  their  impact  is  followed  by  instant  death  or  by  wounds  of  great  severity. 

When  the  injury  is  not  immediately  fatal,  as  is  not  rarely  the  case  when  a  limb  is 
carried  away  by  a  projectile  of  considerable  size  striking  directly,  the  surface  of  the  stump 
will  be  found  to  be  somewhat  "cleanly  cut,"  the  skin  and  muscular  tissues  contused  and 
dark  with  but  little  retraction;  the  bone  fractured  with  not  much  splintering  or  comminu 
tion  above  the  seat  of  injury;  the  arteries  retracted  and  the  haemorrhage  slight.  If  the 
projectile  strikes  obliquely  or  with  somewhat  diminished  force,  the  resulting  wound  resembles 
a  deeply  grooved  furrow  corresponding  to  the  size  of  the  projectile  and  influenced  by  its 
direction;  the  skin,  fasciae,  and  deeper  soft  parts  are  extensively  lacerated  or  removed 
entire,  the  surface  is  covered  with  blood  clots  and  shreds  of  connective,  muscular,  and 
aponeurotic  tissue ;  if  penetrating  cavities,  disorganization  and  destruction  of  the  parts  will 
follow,  resulting  in  death  either  immediately  or  in  a  very  short  time.  Should  a  large,  pro 
jectile  come  in  contact  with  a  limb  under  these  circumstances,  it  may  carry  it  away  entire 
or  leave  it  partially  attached  by  fragments  of  skin  and  muscular  tissue;  in  its  midst  will 
be  found  fragments  of  shattered  bone,  the  whole  forming  a  mass  devoid  of  form  and  life. 
An  illustration  of  a  laceration  of  the  leg  from  a  cannon  ball  is  given  in  PLATE  LXXVI, 
opposite  page  478,  ante.  The  lithograph  is  copied  from  a  sketch  made  on  the  field. 

A  solid  projectile  whose  velocity  is  so  greatly  diminished  as  to  seem  harmless  is  still 
capable  of  doing  great  damage  through  its  acquired  momentum;  it  may  not  possess  the 
force  necessary  to  carry  away  any  part  of  the  body,  but  a  contusion  or  wound  resulting  from 
its  impact  is  generally  serious  and  not  infrequently  fatal.  It  may  be  that  no  outward 
evidences  of  injury  are  manifest  beyond  some  discoloration,  but  subsequent  symptoms 
indicate  the  existence  of  grave  internal  lesions,  rupture  of  viscera,  concussion  of  the  brain 
or  spinal  cord,  and  sometimes  fracture  of  bones  with  extensive  comminution  and  disorgan 
ization  of  the  surrounding  soft  parts.  The  following  case  of  fracture  of  the  humerus  in 
three  places,  leaving  the  skin  intact,  taken  from  a  report  of  his  personal  service  at  the 
battle  of  Bull  Kun,  is  related  by  Assistant  Surgeon  B.  E.  Fryer,  U.  S.  A.: 

CASE  1044. — "A  Sergeant  of  Eickett's  Battery  walked  from  the  field  to  the  hospital  after  having  been  struck  by  a  round 
shot,  en  ricochet,  on  the  arm,  fracturing  the  humerus  in  three  places  and  producing  great  contusion  without  breaking  the  skin. 
The  case  is  interesting  from  two  facts — the  great  injury  to  the  bone  without  laceration  of  the  surrounding  soft  parts,  and  from 
the  fact  that  disorganization  of  the  tissues  did  not  take  place  in  this,  as  it,  nearly  always  does  in  all  parallel  cases.  The  result  of 
the  treatment  of  this  man  was  doubtful,  and  the  question  of  amputation  was  raised  by  the  other  medical  officers  of  the  hospital, 
but  I  strenuously  opposed  it,  and  had  the  satisfaction  of  seeing  this  useful  soldier  recover  and  return  to  duty  with  no  other 
deformity  than  a  slight  shortening,  and  with  a  perfect  use  of  the  arm.  The  treatment  in  this  case  was  to  lay  the  arm  on  a 
pillow;  cold  water  until  all  swelling  had  subsided,  after  which  I  ordered  a  plaster  of  Paris  splint." 


CHAP.  XII.]  EFFECTS    OF    LARGE    PROJECTILES.  705 

In  the  next  case  the  femur  was  fractured  at  the  neck  and  the  soft  parts  were  severely 
bruised,  but  the  skin  was  not  broken: 

CASK  1045. — Surgeon  James  T.  Stewart,  64th  Illinois,  aged  40  years,  was  wounded  at  Decatur,  Georgia,  July  19,  1864. 
The  following  history  of  his  case  was  kindly  furnished  hy  this  officer:  "While  acting  in  the  capacity  of  Surgeon-in-Chief  of 
the  4th  division,  Sixteenth  Army  Corps,  near  Decatur,  I  was  struck  hy  a  spent  shell  on  the  right  hip.  The  shell  came  from  the 
side,  struck  me  fairly  on  the  hip  and  fell  down,  not  exploding.  It  crushed  the  soft  parts  dreadfully  and  broke  the  thigh  bone  in 
the  neck.  The  skin  was  not  broken,  but  everything  underneath  it  was  bruised  into  a  jelly.  I  was  laid  on  my  left  side  as  I  could 
not  lie  on  my  back,  the  wounded  leg  resting  on  the  sound  one  with  a  pad  between  them.  In  this  position  I  lay  for  two  or  three 
months,  with  no  extension  or  counter  extension  or  apparatus  whatever,  as  I  could  not  bear  any.  I  remained  on  the  field  for 
three  days  and  was  sent  in  an  ambulance  to  the  field  hospital  a  distance  of  about  four  miles.  I  lay  then?  three  or  four  days,  and 
had  to  be  moved  about  four  miles  further  to  the  right.  Tin*  time  four  men  carried  me  on  my  cot,  and  while  on  the  way  the  end 
of  the  cot  came  oft'  suddenly  and  threw  me  off  in  the  road.  I  survived  the  shock,  but  it  was  all  I  could  do ;  I  lay  in  this  field 
hospital  perhaps  about  ten  days,  when  I  was  put  in  an  ambulance  and  carried  back  to  Marietta,  some  twenty-two  miles.  Here 
I  lay,  I  think,  about  a  month.  At  the  end  of  this  time,  there  being  no  union  of  the  bone  whatever,  I  prevailed  on  them  to  start 
me  for  St.  Louis  for  the  purpose  of  getting  under  the  care  of  Professor  Pope.  I  went  as  far  as  Nashville,  but  could  ride  no 
firther,  hence  I  was  put  in  the  hospital  there.  After  a  week  they  put  me  on  a  train  for  Louisville.  In  consequence  of  exhaus 
tion  I  was  obliged  to  stay  in  Louisville,  in  hospital,  probably  ten  days,  when  I  was  put  on  a  steamboat  for  Cairo,  but  the  boat 
was  stopped  at  Evansville  in  consequence  of  a  raid  the  Rebels  had  made  on  the  river  below;  but  after  a  week  or  so  went  on,  and 
finally  arrived  safely  at  Cairo,  was  transferred  to  another  boat,  and  eventually  reached  St.  Louis.  Professor  Pope  examined  the 
leg,  and  told  me  the  bone  was  uniting  and  that  he  would  not  advise  any  change  in  the  treatment.  On  this  advice  I  came  to 
Peoria.  As  to  the  result,  the  leg  is  shortened  one  inch.  There  is  quite  a  hollow  where  the  trochanter  major  should  be.  The 
leg  is  weak  and  most  of  the  time  sore  and  tender  in  the  hip.  It  does  not  often  give  me  pain.  I  can  walk  with  a  cane  pretty 
well,  but  without  a  cane  it  gives  out  in  a  few  squares.  For  six  or  seven  years  after  the  injury  it  improved,  since  then  it  has 
rather  grown  worse  and  gives  me  more  trouble  now  than  it  did  ten  years  ago."  Dr.  Stewart  was  mustered  out  December  22, 
1864,  and  pensioned.  Examiner  G.  L.  Lucas,  of  Peoria,  reported  September  4,  1877:  "That  no  improvement  had  taken  place 
since  last  examination.'' 

Slighter  contusions  very  generally  destroyed  the  vitality  of  the  skin  and  soft  tissues  and 
resulted  in  extensive  sloughing  and  slow  repair.  The  occurrence  of  simple  fracture  and 
dislocation  was  noted,  but  these  complications  were  infrequent. 

Probably  the  largest  class  of  injuries  attributable  to  heavy  projectiles  is  that  resulting 
from  fragments  of  exploded  shells.  The  nature  and  character  of  these  wounds  are  largely 
influenced  by  the  weight,  form,  and  velocity  of  the  fragments.  Pieces  of  great  weight 
moving  with  high  velocities  inflict  injuries  similar  to  and  not  less  severe  than  those  caused 
by  the  large  projectiles  already  mentioned.  As  their  velocity  diminishes,  which  is  rapidly 
the  case,  owing  to  the  great  resistance  offered  by  the  air  to  the  passage  of  irregularly  shaped 
bodies  as  well  as  to  gravitation  and  modification  of  the  original  impetus,  the  factor  of  weight 
alone  assumes  importance,  as  even  with  slow  motion  the  momentum  of  such  masses  is 
almost  irresistible.  Form  may  determine  the  severity  of  a  wound — especially  when  the 
fragment  is  of  a  small  size,  the  sharply  outlined  edges  becoming  sources  of  danger  to  blood 
vessels,  nerves,  and  viscera. 

Wounds  from  large  shell  fragments  are  attended  with  great  laceration  and  destruction. 
When  the  force  has  been  insufficient  to  carry  away  a  portion  of  the  trunk  or  an  extremity, 
the  resulting  wound  is  deeply  contused  with  ragged  and  irregular  edges;  there  may  be  a 
loss  of  more  or  less  substance;  bony  structure  exposed  to  the  force  of  the  blow  is  shattered 
and  comminuted;  not  infrequently  the  missile  will  be  found  lodged  in  the  wound.  In 
other  cases  a  large  fragment  will  pierce  the  skin  without  destroying  the  vitality  and  sink 
deep  into  the  cavities  or  soft  parts;  the  skin  retracting  will  present  so  small  an  opening  as 
to  obscure  the  diagnosis  until  subsequent  symptoms  disclose  the  true  nature  of  the  injury. 
As  in  cases  of  solid  shot,  contusions  of  little  or  no  outward  significance  beyond  slight 
bruising,  but  attended  with  extreme  internal  disorganization,  are  met  with.  Shell  fragments 
striking  obliquely,  as  often  happens  when  the  missile  explodes  on  the  ground,  generally 
produce  superficial  wounds  only,  though  covering  an  extensive  area.  A  curious  case  ot 

SCRG.  111—89 


706  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

lodgement  of  a  12-pound  unexploded  shell  in  the  gluteal  muscles  appears  upon  the  records 
of  the  field  hospital  of  the  Eighteenth  Army  Corps:1 

CASE  1046. — Private  B.  D.  Thayer,  Co.  D,  xioth  Massachusetts,  aged  21  years,  was  wounded  at  Petersburg,  June  30, 
1864,  and  was  taken  to  a  field  hospital  of  the  Eighteenth  Corps,  where  it  was  reported  that  Surgeon  H.  N.  Small,  10th  New 
Hampshire,  removed  a  12-pound  round  shell  from  the  left  gluteal  region,  the  patient  surviving  the  operation  some  forty-eight 
hours.  The  missile,  which  was  retained  by  the  operator,  was  entirely  concealed  behind  the  gluteal  muscles. 

Wounds  by  grape-shot  partake  of  the  general  nature  of  injuries  from  cannon  balls. 
The  velocity  of  these  projectiles  is,  however,  generally  lower,  and  their  weight  less,  so  that 
their  destructive  power  is  somewhat  limited.  Case  and  canister  shot,  as  well  as  small  frag 
ments  of  shell,  produce  effects  not  materially  differing  from  those  of  small-arm  missiles. 

The  effects  resulting  from  the  explosion  of  torpedoes,  though  somewhat  dependent  upon 
their  size,  nature,  and  proximity,  are  extremely  terrible.  Not  only  is  the  violent  action 
of  fragments  and  splinters  hurled  at  their  initial  velocity  to  be  considered,  but  also  the  con 
sequences  of  exposure  to  the  flame  and  gas  of  the  exploding  charge.  Should  life  be  not 
immediately  extinguished,  fearful  mangling  and  mutilation  results,  and  limbs  may  be 
entirely  torn  away  or  shattered  almost  beyond  recognition,  while  the  presence  of  burns  and 
the  effects  of  the  inhalation  of  gases  serve  to  complicate  and  obscure  the  condition. 

Although  it  has  been  previously  stated  in  this  history  (see  Second  Surgical  Volume, 
page  28)  and  elsewhere  that  "reports  of  alleged  traumatic  effects  from  the  wind  of  balls 
*  *  *  do  not  seem  to  merit  serious  consideration,"  it  would  appear  by  the  number  of 
reports  of  cases  of  this  character  during  the  late  war,  that  there  is  still  a  lingering  belief  that 
injuries  from  this  source  are  not  of  infrequent  occurrence.  After  a  careful  consideration  of 
these  reports  the  evidence  unmistakably  points  to  effects  produced  by  actual  contact  of  the 
missile  causing  severe  concussion,  or  to  the  accident  known  as  the  "  brush  of  a  ball,"  in  which 
the  missile  passes  so  near  as  to  actually  touch  the  clothing  or  skin  without  tearing  the  one  or 
the  other,  and  producing  apparent  paralysis,  swelling,  inflammation,  and  sloughing. 

The  several  theories  of  vacuum,2  of  foreign  bodies  carried  along  with  the  ball,3  and 
of  electricity,4  which  have  from  time  to  time  been  suggested  to  support  the  idea  of  injuries 

'Descriptions  in  detail  of  injuries  caused  by  solid  projectiles  or  large  fragments  of  shell,  together  with  illustrations,  have  been  given  in  the  preced 
ing  parts  of  the  history.  On  page  91  of  the  First  Surgical  Volume  it  was  pointed  out  that,  "  without  any  attendant  injury  to  the  skull  or  concussion  of 
the  brain,  the  scalp  may  be  wounded  by  the  largest  projectiles  from  artillery,"  and  that  "cleanly-cut  furrows  were  made  ...  by  fragments  of  shell 
in  rapid  flight."  A  case  of  contusion  of  the  occipital  by  a  6-pound  iron  cannon  ball  is  cited  on  page  99,  and  instances  of  crash  or  smash  produced  by 
cannon  balls  or  explosion  of  large  shells  are  given  on  pp.  212-214.  On  pp.  476-477,  remarks  on  and  cases  of  injuries  to  the  contents  of  the  chest  by  large 

spent  shot  and  fragments  of  shell  will  be  found  ;  see  also  case  of  II.  B ,  on  p.  487,  and  on  p.  486  the  case  of  C.  P.  Belts,  injured  \>y  grape-shot.  In 

the  Second  Surgical  Volume  visceral  injuries  without  external  wounds  are  referred  to  on  pp.  15-S8.  The  cases  of  Howard,  p.  1C ;  Charles  G ,  p.  18  ; 

Lioveland  and  Dulepohn,  p.  20;  five  cases  on  p.  21;  cases  of  Bishop,  Bence,  Brown,  Rand,  and  Bowditch,  on  p.  23;  of  Williams,  on  p.  24;  and  the 
cases  on  pp.  25,  26,  were  all  from  solid  shot  or  shell  fragments.  Case  649,  p.  223,  of  fracture  of  the  os  innominatum  by  a  shell  fragment,  is  illustrated  by 
a  plate.  Specimen  4457,  a  fragment  of  shell  extracted  from  the  ischiatic  region,  is  illustrated  by  a  wood-cut  and  referred  to  at  p.  240.  An  illustration 
of  a  shell  fragment  extracted  from  the  sacrum  is  given  on  p.  250,  CASE  732.  A  portion  of  hand  grenade,  extracted  from  bladder  by  lithotomy,  is 
illustrated  in  PLATE  VII. 

2FORBK8  (P.)  (Observations  on  the  Cause  of  Death  from  what  is  called  the  Wind  of  a  Ball,  in  The  Edinburgh  Medical  and  Surgical  Journal, 
1812,  Vol.  VIII,  p.  310)  is  of  the  opinion  "that  there  is  a  mechanical  cause  for  the  effects  produced  by  a  ball  passing  close  to  the  human  body  which  will 
sufficiently  account  for  them.  This  is  the  vacuum  produced  by  the  rapid  motion  of  the  ball  through  the  air,  which  though  of  itself  partial,  yet  when  we 
combine  with  it  the  condensation  of  air  taking  place  immediately  before  the  ball,  may,  I  suppose,  have  fully  the  same  effect  as  if  the  vacuum  behind  it 
were  complete.  When  a  ball  then  passes  close  to  the  stomach,  there  is,  in  the  first  place,  a  great  addition  to  the  pressure  on  that  viscus  from  the  condensa 
tion  of  the  air  ;  as  soon  as  the  ball  is  passed,  this  pressure,  with  a  great  part  of  that  of  the  atmosphere,  is  taken  off;  the  consequence  of  which  is  a  sudden 
expansion  of  all  the  fluids  in  the  stomach  and  the  blood  in  its  blood-vessels,  and  the  rupture  of  both.  The  rupture  of  the  stomach  is  the  cause  of  death, 
and  the  extravasation  of  the  blood,  of  the  black  appearance,  externally,  ...  on  the  same  grounds  an  easy  answer  is  afforded  to  the  question  pro 
posed  by  Dr.  SPEXCE,  why  the  passage  of  ball  has  not  always  the  same  effect  in  battle  ?  This  arises  from  want  of  the  necessary  velocity  to  produce  the 
condensation  and  vacuum  which  has  been  considered  as  the  cause  of  the  effects  produced,  as  great  velocities  we  know  from  the  experiments  made  with 
cannon  balls  are  rapidly  destroyed  by  the  resistance  of  the  air." 

3  SPENCE  (J.)  (Observations  on  those  Accidents  commonly  ascribed  to  Hie  Wind  of  a  Ball,  in  London  Medical  and  Physical  Journal,  1812,  Vol. 
XXVIII,  p.  142)  states  that  "there  are  many  substances,  comparatively  light  of  themselves,  on  board  ship,  such  as  canvas,  rope-yarns,  part  of  the  bedding, 
etc.,  which,  when  carried  along  with  the  velocity  of  a  ball,  or  even  driven  but  a  short  way  with  that  force,  are  apt  to  do  considerable  injury  by  hitting 
the  body,  and,  by  occupying  a  large  or  small  bulk,  may  or  may  not  produce  external  marks  of  injury.'' 

4  El.l-18  (D.)  (Observation*  on  the  Mature  and  Cause  of  certain  Accidents  which  sometimes  occur  in  battle  and  hare  been  usually  ascribed  to  Hie, 
wind  of  a  Ball,  in  Edinburgh  Medical  and  Surgical  Journal,  1812,  Vol.  VIII,  p.  I)  says  that  it  is  sufficiently  proven  that  the  peculiar  facts  ascribed  to 
the  wind  of  n  ball  ''are  likewise  occasioned  by  the  varied  operation  nf  atmospheric  electricity,  for,  in  both  cases  persons  are  suddenly  struck  down  with 
loss  of  sense  and  motion,  vision  is  impaired  or  irreparably  injured,  the  body  is  discolored,  the  nerves  paralyzed,  the  bones  broken,  and  even  life  destroyed 
without  any  visible  external  injury  or  breach  of  parts,  or  any  appearance  of  the  body  from  whence  the  injury  proceeded." 


CHAP,  xii.)  EFFECTS    OF    LARGE    PROJECTILES.  707 

from  the  "windage  of  balls,"  have  all  been  disproved,  and  it  is  now  conceded  by  modern 
surgeons  that  without  the  .actual  contact  of  the  projectile  injuries  cannot  occur;  on  the 
other  hand  it  is  admitted  that  slight  contact  from  the  "grazing"  or  "brushing"  of  a  projec 
tile,  or  the  rolling  motion  of  a  cannon  ball  over  the  surface  of  the  body,  may,  by  the  weight 
and  momentum,  aided  by  the  elasticity  of  the  skin,  effect  most  serious  results,  while  little 
or  no  external  evidence  of  such  contact  is  left.1  Instances  of  injuries  attributable  to  the 
explosion  of  shells  near  at  hand,  without  wound  or  contusion, -are  numerous,  and  generally 
well  authenticated.  They  are,2  for  the  most  part,  cases  of  partial  or  complete  paralysis,  deaf 
ness,  blindness,  loss  of  voice,  rupture  of  superficial  blood-vessels,  and  mental  prostration.3 

CASE  1047. — Private  William  C.  Goodell,  Co.  A,  6th  Vermont,  aged  37  years,  was  admitted  into  Satterlee  Hospital, 
Philadelphia,  August  12,  1862,  suffering  from  shock  resulting  from  the  explosion  of  a  shell  at  White  Oak  Swamp,  Virginia, 
June  30,  1862.  The  missile  exploded  a  few  feet  behind  the  patient,  the  fragments  tearing  off  his  knapsack  and  the  clothing  from 
the  upper  part  of  his  body,  but  producing  no  visible  wound.  The  shock  was  very  severe,  producing  a  sensation  of  "sinking 
into  the  earth,"  followed  immediately  by  total  loss  of  power  and  consciousness,  which,  however,  lasted  but  for  a  short  time. 
Upon  their  return  he  found  himself  unable  either  to  hear  or  speak.  Immediately  after  the  reception  of  the  injury  he  was  sent  to 
Harrison's  Landing,  and  thence  to  Satterlee  Hospital,  where  he  came  under  the  care  of  Acting  Assistant  Surgeon  Francis  West, 
who  reports:  "On  examination  no  external  lesion  of  the  head  or  spine  was  discoverable,  and  he  had  no  paralysis  anywhere  of 
ordinary  motion  or  sensation.  He  could  move  his  tongue  perfectly  in  every  way,  but  he  could  not  speak,  and  he  was  totally 
insensible  to  all  sound ;  he  was,  in  a  word,  simply  deaf  and  dumb.  He  complained  of  some  uneasiness  in  his  head,  which  was 
hot  and  his  face  flushed.  His  pulse  was  active  but  not  very  full.  Respiration  very  little  if  at  all  disturbed  ;  no  vomiting,  bowels 
regular.  The  case  was  regarded  as  one  of  probable  congestion  of  the  brain  at  or  about  the  point  from  which  the  proper  nerves 
of  speech  and  hearing  arise,  or,  if  more  general  in  its  character,  manifesting  itself  by  particular  pressure  at  the  deep  origin  of 
these  nerves;  in  other  words,  that  the  part  of  the  fourth  ventricle  giving  rise  to  the  glosso-pharyngeal  and  auditory  nerves  was 
compressed,  and  thus  the  functions  of  speech  and  hearing  destroyed.  The  treatment  employed  was  depletory  and  revulsive. 
Blood  was  taken  by  cups  applied  to  the  nucha  and  behind  the  ears,  and  active  purgation  was  kept  up  by  calomel  and  other 
cathartics.  Cold  applications  were  made  to  the  head  with  derivatives  to  the  feet,  and  a  low  diet  was  enjoined.  This  plan  of 
treatment  was  pursued  for  several  days,  and  until  all  evidence  of  local  or  general  excitement  had  disappeared.  The  only  mani 
festation  of  disease  which  then  remained  was  the  deaf-dumbness,  which  did  not  in  any  degree  diminish.  A  blister  was  now 
applied  to  the  nucha  and  a  discharge  kept  up  for  several  days.  No  change  was  observable  in  the  deaf-dumbness,  but  the  patient 
was  otherwise  doing  well.  Still  viewing  his  disease  as  dependent  upon  local  hypersemia,  or  perhaps  non-inflammation  of  the 
brain  at  the  point  already  indicated,  which  after  some  weeks  of  primary  treatment  had  refused  to  yield,  it  was  determined  to  try 
the  alterative  effect  of  small  doses  of  calomel.  This  was  given  in  quantities  of  an  eighth  of  a  grain  every  three  or  four  hours 
and  continued  for  several  days.  No  better  success  was  the  result.  After  a  short  time  the  calomel  was  repeated  and  pushed  to  a 
slight  ptyalism,  but  still  without  any  favorable  effect.  The  strength  of  the  patient  in  a  short  time  began  to  decline,  but  without 
any  change  in  his  intelligence  or  spirits,  which  all  along  had  been  remarkably  good.  Communication  with  him  was  kept  up  by 
means  of  a  slate.  Quinine  in  moderate  quantities  was  given,  and  his  general  health  seemed  to  improve,  but  still  the  deaf-dumb 
ness  remained.  On  mentioning  his  case  to  some  of  my  colleagues  it  was  suggested  that,  as  the  patient  might  possibly  be  feigning 
an  inability  to  hear  or  speak,  it  would  be  well  to  render  him  unconscious  by  etherization  and  then  test  his  powers  in  these 
respects.  The  operation  only  confirmed  the  reality  of  the  symptoms.  Electricity  was  also  tried,  but  without  any  good  effect. 
On  December  10th,  just  four  months  after  admission,  it  was  noticed  that  the  left  leg  had  not  full  power  of  motion,  and  that  the 
face  was  somewhat  drawn  to  the  right  side.  On  the  12th  of  the  same  month  he  was  seized  with  a  convulsion  which  lasted  for 

1  In  Note  2,  on  page  28  of  the  Second  Surgical  Volume.,  a  supposed  case  of  the  "capability  of  compressed  air  or  wind  from  a  missile  to  bruise  or 
iufliot  visible  injury"  is  referred  to.     The  case  is  reported  by  Surgeon  B.  Rhett  in  the  Am.  Jour.  Sled.  Sci.,  N.  S.,  1873,  Vol.  LXV,  p.  92:  "After a 
skirmish  upon  John's  Island,  in  which  the  besieging  gunboats  took  part,  a  private  entered  the  Marine  Hospital  of  Charleston,  of  which  I  was  then  surgeon, 
to  be  treated  for  discoloration  of  the  skin,  a  purple,  yellow,  and  green  bruise,  extending  from  the  mamma  to  ilium  of  right  side  and  from  the  umbilicus  to 
the  dorsum.     The  discoloration  precisely  resembled  such  as  I  have  seen  in  scorbutic  patients  among  the  Andersonville  prisoners,  an  ecchymosis.    But 
the  man  was  in  perfect  health,  no  signs  of  scurvy.     I  give  his  account  of  the  cause  of  the  injury :  He  was  standing  with  his  rifle  held  by  the  ban-el  at 
arm's  length  and  the  butt  resting  on  the  ground,  when  a  large  shot  or  shell  passed  between  himself  and  his  rifle  without  touching  either  or  moving  him 
from  his  position.    Immediately  after  he  observed  the  discoloration,  and  was  sent  to  the  hospital  for  fear  of  internal  injury.     The  case  rests  upon  my 
evidence  of  the  injury  and  upon  the  soldier's  account  of  the  cause." 

2  Three  Cases  of  Injuries  of  the  Nervous  Centres  from  Explosion  of  Shells,  without  Wound  or  Contusion,  are  given  by  G.  BUUR,  in  New  York 
Med.  Jour.,  1865,  Vol.  I,  p.  428,  and  Five  Cases  of  Injury  to  the  Nervous  System,  by  the  Explosion  of  Shell,  by  B.  RHETT,  in  Am.  Jour.  Med.  Sci.,  1873, 
Vol.  LXV,  p.  90.     Dr.  Rhett's  fifth  case,  with  his  comments  thereon,  are  as  follows:  "CASE  V.  The  private  injured  in  the  gun  chamber  with  Lieut.  Poor 
was  brought  into  the  hospital  a  frightful  object,  bleeding  at  mouth,  nose,  and  ears,  his  eyes  protruding  from  their  sockets.     The  sutures  of  the  cranium 
parted,  ono  parietal  bone  overlapping  the  other,  and  the  sutures  with  the  occipital  and  frontal  bones  loosened.     The  head  dislocated  from  the  neck,  the 
latitude  of  motion  showing  either  a  parting  of  the  ligaments  or  that  the  base  of  the  occiput  was  broken  up.     The  thoracic  and  cervical  regions  were 
bloated,  blown  up  with  an  escape  of  air  into  the  cellular  tissue;  emphysema;  yet  there  was  no  external  wound  or  injury.     The  place  and  time  did  not 
admit  of  a  post-mortem  examination.    Now  the  question  arises  whence  this  extensive  disorganization  ?     I  offer  the  following  suggestion,  not  professing  to 
affirm  its  correctness  :  I  think  the  man  was  driven  by  the  force  of  the  explosion  head  foremost  into  the  earthwall  of  the  gun  chamber;  that  the  cervical 
verfebne  were  driven  through  the  fractured  occiput,  and  the  sutures  were  forced  asunder  from  within  by  pressure  upon  the  cranial  contents." 

3  One  hundred  and  thirty  cases  appear  upon  the  field  casualty  lists  of  compression  of  the  brain  stated  to  have  been  caused  by  the  explosion  of  shells. 
Twenty-three  were  discharged.    Of  this  number  deafness  is  alleged  in  one  case,  irritability  in  one,  meningitis  in  one,  paralysis  of  limbs  in  one,  paralysis 
of  optic  nerve  in  one,  insanity  in  two,  and  spinal  affection  and  nervous  prostration  in  one  case  each.     Seventy-one  patients  returned  to  duty.     Among 
these  cases  the  early  symptoms  were  temporary  deafness  in  five  cases,  momentary  loss  of  sight  and  hearing  in  one,  loss  of  speech  in  one,  and  cephalalgia 
in  one.     Ono  patient  deserted,  and  in  thirty-five  cases  the  results  could  not  be  ascertained. 


708  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

nearly  half  an  hour,  and  was  followed  by  stupor,  accompanied  at  short  intervals  by  startlings  of  an  indistinct  gutteral  sound. 
On  the  next  day  these  symptoms  had  entirely  disappeared  and  his  intelligence  was  found  to  be  perfectly  rational,  as  it  had 
always  been  during  the  whole  course  of  his  disease,  although  he  retained  no  recollection  of  what  had  occurred  during  the  previous 
twenty-four  hours.  He  could  only  protrude  his  tongue  with  great  difficulty,  and  it  was  drawn,  in  a  marked  degree,  to  the 
right  side.  The  occurrence  of  this  latter  train  of  symptoms  was  sufficient  to  satisfy  me  of  the  correctness  of  my  early  views  of 
tlie  pathology  of  his  affection.  The  indications  were  clear  that  the  original  hyperfemia  and  inflammatory  conditions  had  resulted 
in  softening  of  the  cerebral  tissue  at  about  the  origins  of  the  proper  nerves  of  audition  and  speech  in  the  floor  of  the  fourth  ven 
tricle.  From  the  period  of  the  subsidence  of  the  graver  symptoms  just  enumerated  his  condition  has  been  variant  from  day  to 
day.  Sometimes  he  seems  to  be  better,  and  then  suddenly  his  symptoms  become  aggravated,  with  complaint  of  severe  pain  in 
his  head.  During  the  last  month  he  has  recovered  sufficiently  to  be  able  to  occupy  himself  in  some  trifling  mechanical  work, 
but  still  he  remains  perfectly  deaf  and  dumb.  The  only  other  manifestation  of  paralysis  is  a  slight  loss  of  power,  with  stiffness 
in  his  right  leg.  His  intelligence,  spirits,  and  general  health  are  quite  good."  Goodell  was  discharged  for  disability,  February 
4,  1863,  and  pensioned.  Examiner  0.  G.  Dyer,  of  Brandon,  Vermont,  reported,  January  '.M,  1870:  "The  pensioner  has  com 
plete  loss  of  speech  and  hearing,  the  result  of  an  injury  sustained  upon  the  upper  middle  third  of  the  spinal  column.  At  this 
point  there  is  an  angular  curvature  of  the  spine,  and  to  the  right/ on  a  line  with  the  spine  of  the  scapula,  between  it  and  the 
vertebral  column,  a  large  circumscribed  tumefied  swelling,  tender  and  painful  on  pressure,  but  without  heat  or  redness.  The 
tenderness  and  pain  also  extends  to  and  involves  the  angle  of  curvature.  Pensioner  also  has  partial  loss  of  sensation  of  both 
hands  and  feet.  He  has  also  hectical  symptoms  and  is  now  totally  incapacitated  from  all  labor,  requiring  the  aid  of  an  attendant  to 
supply  his  daily  wants.  On  September  4, 1877,  Dr.  Dyer  reported  that  the  patient  "  is  quite  lame  and  gets  about  with  difficulty.'' 

The  proportion  of  cases  of  deafness  among  officers  of  the  artillery  arm,  as  well  as  among 
the  carmoniers,  has  been,  since  the  war,  a  frequent  subject  of  remark,1  and  on  page  385 
of  the  First  Surgical  Volume  allusion  is  made  to  the  frequency  of  rupture  of  the  membrane 
of  the  tympanum  from  "propinquity  to  artillery  fire." 

An  illustration  of  the  serious  injuries  sometimes  inflicted  by  the  discharge  of  heavy 
artillery  on  soldiers  in  the  near  vicinity  is  given  in  the  following  case: 

CASE  1048. — Corporal  John  S.  Terhune,  Co.  K,  32d  Illinois,  was  admitted  into  the  hospital  at  Evansville,  Indiana,  in 
August,  1862.  Assistant  Surgeon  W.  D.  Turner,  1st  Illinois  Artillery,  reported :  "  Case  of  aneurism  of  abdominal  aorta.  Traces 
his  injury  to  the  1st  of  March,  1862.  While  on  the  gunboat  Lexington  he  was  leaning  over  the  side  of  the  boat  immediately 
above  an  84-pound  gun,  when  it  was  discharged.  Another  man  was  standing  behind  him  and  leaning  most  of  his  weight  on 
htm.  The  shock  from  the  discharge  caused  them  both  to  fall,  or  threw  them  back  about  seven  or  eight  feet.  It  felt  like  an 
electric  shock.  On  the  same  night  he  commenced  discharging  arterial  blood  from  the  bowels,  which  continued  about  four  weeks. 
He  was  treated  by  Dr.  Christy,  32d  Illinois;  took  pills  of  opium.  The  discharges  ceased  in  the  beginning  of  April,  when  he 
first  perceived  a  fluttering  above  the  umbilicus,  which  has  been  increasing  in  extent  and  severity.  It  extends  at  present  from 
four  inches  above  the  umbilicus  to  the  bifurcation  of  the  aorta  below.  He  was  dizzy  part  of  the  night  when  hurt,  but  was  on 
picket  duty  part  of  the  same  night  at  Savannah,  Tennessee.  Present  appearances:  Anxious,  uneasy;  is  a  tall  man,  six  feet 
three-fourths  inch  high;  is  losing  flesh.  Has,  as  he  sajs,  a  sinking  in  his  stomach.  Appetite  is  very  poor.  Has  orthopncea, 
dyspnoea,  tinnitis  aurium,  and  throbbing  in  right  side  of  head  and  neck  and  in  right  hypochondrium.  Has  considerable  tender 
ness  over  spine  at  lower  dorsal  vertebra  and  to  the  right  side  a  space  of  about  the  size  of  the  palm  of  the  hand.  Bowels  at  times 
are  costive,  at  present  lax.  The  last  blood  he  passed  was  very  black.  Has  sensations  of  numbness  when  he  lies  on  his  back. 
Feet  do  not  swell.  Sleeps  at  night  but  two  or  three  hours.  Has  bad  dreams  at  night  of  falling  off  precipices  and  into  water. 
In  the  supine  position  the  abdominal  aorta  is  felt  to  the  left  and  partly  over  the  spine,  and  is  much  increased  in  size.  The  pul 
sations  at  and  immediately  below  the  umbilicus  for  one-half  inch  are  much  stronger  than  at  the  apex  of  the  heart.  The  same 
extends  to  about  one  and  one-half  inch  above  in  the  mesial  line.  One-half  an  inch  above  the  umbilicus  is  the  most  powerful 
pulsation.  Pulse  80,  and  very  weak,  feeble,  and  compressible.  Extremities  cold  and  numb.  Circulation  very  defective ;  least 
noise  causes  violent  excitement  and  palpitation.  Has  paralysis  agitans  almost  constantly;  sometimes  cannot  hold  a  pen  from 
trembling  in  his  hand.  There  is  general  numbness  in  right  side;  in  stepping  on  any  elevation  always  puts  the  left  foot  forward, 
as  the  right  is  deficient  in  power.  Treatment :  Purgatives,  rest,  anodynes."  This  man  was  discharged  October  2,  1862,  for 
"aneurism  of  the  abdominal  aorta;  by  compressing  the  aorta  above,  the  tumor  becomes  soft  and  also  is  reduced  in  size."  He 
was  pensioned.  Examiner  J.  W.  Lee,  of  Majority  Point,  Illinois,  August  9,  1871,  certified  to  diaphragmatic  hernia  with  con 
siderable  tenderness  on  pressure,  with  slight  rupture  of  the  abdominal  artery,  causing  an  enlargement  of  the  capillary  blood 
vessels  of  the  right  leg.  He  is  very  much  emaciated,  presenting  the  appearance  of  one  whose  nervous  system  Avas  gradually 
giving  way,  rendering  him  unfit  for  manual  labor."  Dr.  W.  H.  Edson,  of  Willow  Hill,  Jasper  County,  Illinois,  states  that, 
Terhnne  died  June  24,  1877,  from  inflammation  of  the  lungs  superinduced  by  his  internal  injuries.  No  autopsy. 

EFFECTS  OF  MISSILES  AND   PROJECTILES   FROM  SMALL  ARMS. By  reference  to    TABLE    GXXT. 

p.  696,  it  will  be  seen  that  of  the  aggregate  of  shot  wounds  reported  during  the  war.  by 
far  the  greater  number  was  due  to  projectiles  from  small  arms.  In  considering  the  effects 
of  large  projectiles,  size,  weight,  and  velocity  constituted  the  principal  factors;  in  the 
case  of  missiles  and  projectiles  from  small  arms,  form,  both  original  and  that  acquired  by 

1  LONCMOHE,  in  his  treatise  upon  Gunshot  Injuries,  etc.,  London,  1877,  p.  118  e.l  seq.,  graphically  describes  the  effects  produced  by  a  terrific,  explo 
sion  of  the  French  and  Knglish  magazines  of  gunpowder  and  munitions  of  war  during  the  Crimean  campaign  in  1855. 


CHAP    xii  ]  EFFECTS    OF    PROJECTILES    FROM    SMALL    ARMS.  709 

accidental  causes,  assumes  importance,  as  well  as  the  relation  of  the  individual  injured  to 
the  impinging  projectile,  the  direction  of  the  ball,  position,  structure,  and  power  of  resist 
ance  of  the  parts,  and  course  of  missile  through  the  tissues.  With  reference  to  the  projec 
tile  itself,  form  and  velocity  are  of  principal  importance;  size,  weight,  and  volume  modify 
the  character  and  extent  of  the  wound,  while  the  remaining  factors  have  an  especial  sub 
jective  relation.  The  great  disparity  in  the  number  of  wounds  by  round  balls  as  compared 
with  those  by  conoidal  balls,  indicated  in  TABLE  CXXI,  on  page  696,  shows  that  the 
greater  effectiveness  of  the  latter  was  early  recognized  by  the  combatants  in  the  late  war. 

Aside  from  the  influence  which  the  improvements  in  modern  small  arms  may  have 
had  in  increasing  the  general  effectiveness  of  projectiles,  the  adaptation  of  the  conoidal 
missile  to  the  rifled  gun  has  unquestionably  wrought  a  change  in  the  surgical  relations  of 
wounds,  the  opinion  being  generally  expressed  by  surgeons  that  wounds  caused  by  the  elon 
gated  missile  are  more  severe  and  dangerous  than  those  resulting  from  the  spherical  ball. 

The  cylindro-conoidal  projectile  attains  a  great  range  with  effective  power;  it  opposes 
less  frontage  to  the  resistance  of  the  air  and  its  velocity  suffers. less  retardation  than  that 
of  the  spherical  ball.  Rotation  upon  its  long  axis  tends  to  give  it  a  steadier  flight  and  a  more 
direct  course.  Its  pointed  apex,  aided  by  its  rotation,  gives  it  the  mechanical  advantages 
of  the  wedge  and  screw,  enabling  it  to  pierce  more  easily  the  structures  of  opposing  bodies 
while  it  suffers  a  proportionately  less  diminution  of  force;  adding  the  factor  velocity,  we 
have  a  missile  endowed  with  tremendous  force,  maintaining  for  a  long  time  and  over  great 
distances  a  steady  flight,  not  easily  deflected,  piercing  and  rending  opposing  obstacles,  and 
preserving,  even  at  immense  range,  a  momentum  sufficient  to  render  it  deadly  in  its  effects. 

It  is  probable  that  the  effects  produced  by  round  bullets  at  very  close  quarters  are 
equally  if  not  more  destructive  than  those  produced  by  elongated  missiles;  the  initial 
velocity  in  the  two  cases  does  not  vary  greatly,  and,  in  short  distances,  the  advantage  of 
form  as  a  destructive  element  is  on  the  side  of  the  round  ball;  but  as  the  peculiar  power 
of  the  rifled  bullet  mainly  lies  in  its  destructive  effects  at  long  range,  the  change  of  military 
tactics,  based  on  this  fact,  has  compelled  the  general  use  of  weapons  of  greater  power  and 
has  thus  lessened  the  opportunities  for  comparison  on  any  extended  scale. 

The  size  and  weight  of  small-arm  missiles  vary  within  such  narrow  limits  as  to  make 
practically  but  little  difference  in  the  effects  produced  by  them,  though,  in  the  question  of 
the  extraction  of  a  ball  from  between  bones  or  in  joints,  dimension  may  be  of  importance, 
as  well  as  in  the  consideration  of  the  gravity  of  penetrating  wounds  of  the  chest,  as  pointed 
out  on  page  615  of  the  First  Surgical  Volume. 

Missiles  from  carbines,  pistols,  and  from  fowling  pieces,  when  used  as  weapons  of  war, 
produce  injuries  very  analogous  to  those  of  the  ordinary  small  arms;  but,  being  of  smaller 
size  and  impelled  with  less  force,  their  wounding  power  is  generally  less: 

CASK  1049. — "Sergeant  Stephen  M.  Harper,  Co.  D,  4th  Ohio  Cavalry,  aged  25  years,  while  acting  as  a  picket  guard, 
uirie  miles  from  Nashville,  February  28.  1862,  was  wounded  by  seven  different  bullets,  fired  simultaneously  from  a  rebel  ambush. 
The  missiles  were  buckshot  qf  the  largest  size.  One  shot  passed  through  the  biceps  muscle  of  the  right  arm,  entering  the  skin 
three  lines  outside  of  the  cephalic  vein,  passing  upward  and  inward,  and  emerging  just  anteriorly  to  the  nerves  and  to  the 
bi  achial  artery.  Another  entered  the  right  deltoid  muscle,  passing  backward,  and  emerging  at  a  point  over  the  scapula  two- 
thirds  of  the  distance  between  the  acromion  process  and  the  inferior  angle  of  the  bone.  Another  grazed  the  skin  two  inches 
above  the  insertion  of  the  left. /fearer  biceps  cubiti.  Another  entered  the  flesh  over  the  seventh  intercostal  space,  on  a  line  perpen 
dicular  from  the  left  nipple,  and,  passing  backward  and  outward  three  inches  and  three-fourths,  emerged  through  the  skin  over 
the  ninth  intercostal  space.  Another  entered  over  the  ninth  rib  at  a  point  on  a  line  drawn  from. the  right  nipple  to  the  right 
anterior  superior  spinous  process  of  the  ilium.  This  ball  glanced  around  the  body  under  the  integuments,  and  was  arrested  by 
contact  with  the  right  lateral  surface  of  the  spinous  process  of  the  second  lumbar  vertebra,  from  which  place  it  was  afterwards 
removed  through  an  incision  made  for  the  purpose.  Another  entered  the  right  thigh  two  inches  below  Poupart's  ligament,  at  the 


WOUNDS    AND    COMPLICATIONS.  [CHAP.  xii. 

outer  margin  of  the  quadriceps  extensor  muscle,  and  emerged  over  the  posterior  superior  spinous  process  of  the  ilium  upon  the 
same  side.  The  seventh  grazed  the  skin  over  the  body  of  the  hyoid  bone.  The  quantity  of  blood  lost  was  inconsiderable. 
Only  water  dressings  were  applied  to  the  wounds.  There  was  very  little  ecchymosis  and  swelling.  Suppuration  was  slight. 
The  wounds  were  all  healed  by  the  1st  of  April;  but  an  attack  of  diarrhoea,  which  supervened  while  in  the  hospital,  so 
depressed  the  general  health  of  the  patient  that  he  was  unable  to  resume  active  service  after  i-ecovery  from  his  wounds." 
Surgeon  E.  Swift,  U.  S.  A.,  reported  the  case.  The  patient  died  in  hospital  No.  8,  Nashville,  on  April  6,  1862. 

At  close  range  the  "buck  and  ball,"  used  extensively  in  the  late  war,  was  considered 
very  effective,  for,  besides  the  effect  of  the  round  ball,  the  buckshot  had  sufficient  force  to 
place  a  man,  temporarily  at  least,  hors  du  combat. 

The  accidental  forms  and  distortions  which  leaden  projectiles  are  liable  to  assume  by 
contact  with  opposing  obstacles  both  within  and  without  the  body  form  a  curious  and  inter 
esting  feature  in  the  study  of  inissiles  and  their  effects.  The  illustrations  given  in  PLATE 
LXXVIII,  opp.,  are  taken  from  the  collection  of  missiles  in  the  Army  Medical  Museum.1 

If  the  distortions  of  bullets  were  of  all  imaginable  forms,  their  courses  were  frequently 
no  less  erratic,  as  shown  in  the  following  example: 

CASE  1050. — Private  John  R.  Smith,  Co.  G,  22d  Illinois,  was  wounded  at  Belmont,  November  7,  1861.  Surgeon  J.  H. 
Brinton,  U.  S.  V.,  who  saw  this  soldier  at  the  time  of  being  wounded  on  the  field,  describes  the  erratic  course  of  the  missile  as 
follows:  "A  small  conical  ball  entered  behind  the  left  shoulder  and  passed  underneath  the  skin  across  lower  part  of  left  side  of 
neck,  across  median  line,  and  then  upward  immediately  beneath  the  base  of  jaw  of  right  side,  emerging  just  below  the  angle  of 
the  maxilla.  The  man  was  shot  in  front  of  a  fence,  and  the  ball  lodged  in  the' fence  and  was  removed  and  returned  by  his 
comrade.  It  was  probably  a  small  rifle  projectile,  or  possibly,  although  unlikely  from  the  time  and  circumstances,  a  revolver 
projectile.  The  track  was  superficial,  for  days  discolored  olive  and  yellow,  as  if  painted  by  a  camel's-hair  pencil ;  there  was 
little  extravasation  and  almost  no  pain;  no  injury  to  either  clavicle  or  maxilla.  On  the  26th  of  November,  nineteen  days  after 
the  injury,  the  patient  was  discharged  from  the  hospital  well.  I  could  not  obtain  the  ball.  I  watched  this  case  almost  from  the 
moment  of  wounding."  Smith  was  promoted  sergeant  and  lieutenant,  and  mustered  out  July  7,  1864,  at  the  expiration  of  his 
term  of  service,  and  pensioned.  Examiner  T.  S.  Hening,  of  Springfield,  reported,  July  8,  1864:  "Smith  received  a  gunshot 
missile  beneath  the  jaw  on  the  right  side;  it  crossed  the  median  line  to  the  left  side  and  then  down  the  neck  and  outward  to 
the  acromial  extremity  of  the  vertebral  portion  of  the  spine  of  scapula.  Considerable  injury  was  done  to  the  tissues  of  the  left 
shoulder,  the  motion  and  power  of  which,  together  with  those  of  the  elbow  joint,  are  much  impaired.  The  left  arm  is  somewhat 
wasted  and  its  circulation  defective."  Examiner  J.  Bowman,  of  Flora,  Illinois,  certified,  March  31,  1880:  "Physical  signs  of 
disability  are  loss  of  hearing  in  left  ear,  paralysis  of  left  arm  and  hand,  extreme  tenderness  of  left  scapula  and  clavicle — in  fact 
the  whole  left  shoulder  is  disabled.  Applicant  states  that  the  whole  left  shoulder  and  left  arm  have  no  power  of  feeling  except 
a  constant  tingling  and  numbness  of  the  muscles  of  left  shoulder  and  arm,  and  that  he  is  not  able  to  perform  any  kind  of  manual 
labor."  This  pensioner  was  paid  to  March  6,  1881,  and  since  reported  "dropped  from  Roll  because  of  death." 

1  Ot  the  20  missiles  in  PLATE  LXXVI1I,  15  are  cunoidal  and  5  round  balls.  Brief  abstracts  of  the  conditions  under  which  the  missiles  were  found 
will  be  given ;  fuller  details  of  the  cases  will  be  found  in  the  Catalogue  of  the  Surgical  Section  of  the  U.  S.  Army  Medical  Museum,  Washington,  186'li : 
Spec,.  45:37  (Cat.,  p.  607),  a  couoidal  ball  split  and  flattened  by  the  inferior  maxilla;  nearly  one-third  of  the  body  is  smoothly  and  obliquely  split  off  from 
the  upex  and  turned  back,  forming  a  plane  surface  with  ragged  edges. — Spec.  209  (Cat.,  p.  614),  a  couoidal  ball  with  the  base  split  on  the  tibia  into  three 
equal  parts,  two  of  which  arc  curled  outwardly  upon  themselves.  The  second  groove  is  almost  obliterated. — Spec.  427!)  (Cat.,  p.  614),  a  conoidal  ball 
split  on  the  tibia  from  the  apex  to  the  second  rim,  with  the  two  halves  turned  backward.  The  bullet  lodged  astride  of  the  middle  third  of  the  tibia,  and 
was  discovered  by  the  X61atou  probe  after  an  unavailing  search  by  ordinary  means. — Spec.  4403  (Cat.,  p.  612),  the  greater  part  of  a  conoidal  ball  which 
entered  the  meatus  auditorius  externus  of  the  left  ear  to  the  depth  of  an  inch  and  lodged  in  the  mastoid  process,  whence  it  was  extracted  nearly  three 
months  after  the  injury. — Spec.  4483  (Cat.,  p.  605),  a  conoidal  ball  much  distorted  and  curved  against  a  vertebra:  the  apex  is  obliquely  flattened;  a  piece 
of  bone  is  held  in  the  base. — Spec.  4411  (Cat.,  p.  611),  a  conoidal  ball  flattened  by  contact  with  the  femur.  The  apex  is  undisturbed  in  shape;  impact 
evidently  occurred  when  the  ball  was  revolving  on  its  short  axis,  and  probably  at  a  low  velocity. — Spec.  4400  ( Cat.,  p.  604),  a  conoidal  ball,  slightly  rounded 
at  the  apex,  with  a  deep  longitudinal  groove  its  entire  length,  from  contact  with  a  clavicle. — Spec.  2645  (Cat.,  p.  610),  a  conoidal  ball  extracted  from  the 
sole  of  the  foot,  laterally  ami  smoothly  flattened  somewhat  like  a  fan.  The  smooth  surface  has  a  multitude  of  shallow  parallel  grooves. — Spec.  69'!  (Cat., 
p.  606),  a  conoidal  ball  flattened  from  the  apex  backward,  with  b<.dy  curved  over  the  base  to  a  diameter  of  nearly  an  inch  and  one-fourth  ;  ball  entered 
the  front  of  the  knee  below  the  patella  and  passed  upward  and  inward  through  the  inner  condyle  of  the  femur. — Spec.  1236  ( Cat.,  p.  609),  a  conoidal  ball 
removed  from  the  knee  joint,  apparently  split  longitudinally  and  expanded  and  flattened  laterally  ;  the  missile  probably  struck  in  the  act  of  longitudinal 
rotation. — Spec.  4558  (Cat.,  p.  606),  a  conoidal  ball  detected  by  NEI.ATON's  probe  and  extracted,  20  months  after  injury,  from  the  sternum.  The  missile  is 
flattened  upon  itself  from  the  apex  to  the  second  ring,  with  jagged  borders. — Spec.  4151  (Cat.,  p.  593),  an  elongated  rifle  ball,  very  little  disfigured,  with 
an  ordinary  military  coat  button  inverted,  together  with  the  cloth  to  which  it  was  sewn  ;  the  missile  had  passed  through  the  liver  and  lodged  beneath  tho 
diaphragm. — Spec.  2241  ( Cat.,  p.  615),  a  conoidal  ball  with  the  apex  somewhat  driven  into  the  body,  and  the  whole  laterally  compressed  with  a  flattened 
fragment  projecting  from  one  side.  The  missile  was  found  lodged  against  the  femur  behind  the  trochanter  major. — Spec.  3028  (Cat.,  p.  595),  a  conoidal 
ball,  beaten  into  nearly  a  triangular  pyramid  with  very  sharp  edges,  extracted  from  the  lower  third  of  the  thigh.  It  probably  ricochetted  from  a  stone 
before  wounding. — Spec.  44'_3  (Cat.,  p.  612),  a  conoidal  ball  smoothly  flattened  over  a  surface  of  one  by  one  and  a  hall  inches  by  contact  with  femur,  with 
out  producing  fracture.  The  flattening  is  lateral,  us  if  by  being  rolled  out  after  splitting. — Spec.  2813  ( Cat.,  p.  (iOO).  a  spherical  bullet  flattened  and  half 
way  split,  with  ragged  edges,  removed  from  near  the  fifth  lumbar  vertebra. — Spec.  4564  (Cat.,  p.  600),  a  spherical  ball,  somewhat  flattened  and  smoothly 
split  Dear  the  centre,  with  the  smaller  portion  bent  down  at  right  angles;  extracted  from  above  the  coudyle  of  the  humerus. — Spec.  4533  (Cat.,  p.  591),  a 
flattened  round  ball,  which  passed  subcutaneously  from  one  thigh  to  the  other. — Spec.  4435  ( Cat.,  p.  600),  a  round  ball,  grooved  in  one  side  to  the  depth 
of  a  quarter  of  an  inch,  wilh  a  fragment  bent  outwardly,  removed  from  the  superior  maxilla.  It  had  penetrated  the  brain  through  the  opposite  temple. — 
Spec.  4565  (Cat.,  p.  600 1,  n  spherical  ball,  irregularly  flattened  on  one  side,  in  which  is  embedded  a  fragment  of  an  iron  n:iil  ;ts  though  from  the  heel  of 
the  shoe:  missile  was  extracted  from  against  the  bone  near  the  centre  of  the  plantar  surface  of  the  loot. 


ui-j.  lli.-l.ol'  the  War  of  the  Keln'Iiioii.  Part  III, Vol. II  CluipXII 


Spec  4537 


Spsc    209 


Spec    4403 


Spec    4+83 


Spec    4+11 


Spec    4400. 


Spec   26+5 


;pec   693. 


Spec.  1236 


Spec    4558 


Spec.  4151. 


Spec    2241 


Spec.  2813 


Spec    443S 


Spec    4565 


PLATE    LXXVIII  .  DISTORTED     BULLETS 

S|>»'ciin«'iis   in  Ilic  Army  McclK.'il   Musrtitii. 


T  >imhur  a  roii  .lilli    Philu. 


CHAP,  xir.]  ENTRANCE    AND    EXIT    WOUNDS.  711 

Entrance  and  Exit  Wounds. — Small  projectiles  impinging  upon  the  human  body  and 
penetrating  the  skin  inflict  what  is  known  as  the  wound  of  entrance;  if  preserving  sufficient 
force  to  perforate,  the  opening  last  made  is  called  the  wound  of  exit. 

These  wounds  of  entrance  and  exit,  which  have  for  years  been  the  subject  of  lengthy 
discussions,  are  believed  to  possess  certain  diagnostic  values,  as  indicating  in  a  general  way 
the  form  and  variety  of  missile,  its  velocity,  its  probable  course  through  the  tissues,  and,  to 
some  extent,  the  nature  and  character  of  the  wound.  Under  the  force  of  ever  varying 
conditions  they  are  very  diverse  in  appearance  and  extent,  and  their  significance  is  largely 
dependant  upon  the  experience  and  acuteness  of  the  observer. 

In  general,  a  bullet  preserving  its  integrity,  impinging  at  ordinary  range  and  at  a 
right  angle  upon  a  portion  of  the  body  well  covered  with  soft  tissues  and  not  unnaturally 
put  upon  the  stretch,  leaves,  as  it  passes  through  the  skin,  an  opening  more  or  less  regu 
larly  rounded  in  form,  often  perhaps  a  little  less  in  diameter  than  the  missile,  with  the 
edges  inverted  and  livid  in  hue,  due  to  the  contusion  and  to  the  discoloration  from  the 
burned  powder  carried  upon  the  missile.  In  the  case  of  a  spherical  ball. there  is  generally 
some  loss  of  substance,  a  portion  of  the  integument  being  carried  away  before  its  obtuse 
surface.  A  cylindro-conoidal  bullet  will  probably  cause  a  more  irregularly  outlined  open 
ing,  ejther  stellate  or  slit-like,  with  serrated  edges. 

The  wound  of  exit  may  closely  resemble  that  of  entrance,  but  is  usually  larger  and 
more  irregular,  with  everted  edges,  bearing  fewer  evidences  of  contusion,  but  often  showing 
a  greater  loss  of  substance. 

From  this  simple  uncomplicated  form  of -wound  we  find  an  almost  infinite  variation, 
dependent  upon  the  peculiar  circumstances  which  impress  their  characteristics  upon  each  case. 

If  the  missile  has  carried  before  it  a  foreign  body,  or  has  become  distorted  before 
impact,  or  has  suffered  a  diminution  of  velocity  and  force,  the  wound  of  entrance  will  be 
modified  accordingly.  The  resistance  offered  by  the  tissues  to  the  passage  of  a  missile 
through  any  part  of  the  body  and  the  reciprocal  effect  of  the  tissues  upon  the  missile  will 
largely  influence  the  character  of  both  entrance  and  exit  wounds.  Obliquity  of  the  course 
of  a  projectile  to  the  plane  of  the  surface  of  the  body  will  result  in  merely  a  superficial 
grazing  of  the  skin  or  penetration  and  perforation,  in  which  case  the  appearance  of  the 
wounds  of  entrance  and  exit  will  depend  on  the  angle  of  impact.  Fragments  of  shell  pro 
duce  irregularly  shaped  wounds,  with  contusion  and  considerable  loss  of  substance;  should 
their  force  be  sufficient  to  perforate  a  part,  the  wound  of  exit  is  lacerated  and  ragged,  with 
portions  of  muscular  and  connective  tissue  thrust  out  of  the  opening.  The  differential 
diagnosis  between  these  and  bullet  wounds  is  usually  not  difficult. 

A  single  wound  of  entrance  may  have  two  or  more  wounds  of  exit;  as,  for  example, 
when  a  missile  is  divided  upon  a  bone.  A  projectile  may  be  split  into  fragments  before 
striking  the  body,  in  which  case  the  fragments  may  each  enter  and  leave  separately,  or  one 
or  more  fragments  may  lodge.  Multiple  wounds  of  entrance  and  exit  are  common,  resulting 
from  a  missile  perforating  two  or  more  parts  of  the  body  successively,  as  two  arms,  two  legs, 
the  body  and  one  or  more  extremities,  or  parts  of  the  same  extremity  when  flexed.  Cases 
are  recorded  in  which  the  projectile  has  entered  and  made  its  exit  by  the  same  opening. 

Plate  XXXIX,  opposite  p.  712,  and  PLATE  XL,  opposite  p.  714,  give  typical  repre 
sentations  of  wounds  of  entrance  and  of  exit  made  by  spherical  and  conoidal  balls  and 
small  fragments  of  shells  under  varying  circumstances.  The  drawings  were  made  from 


712  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

recent  wounds,  at  field  hospitals,  during  the  war,  by  the  late  Hospital  Steward  E.  Stanch, 
U.  S.  A.,  and  present  faithful  delineations  of  the  early  appearances  of  these  wounds.1 

EFFECTS  OF  PROJECTILES  ON  MuscTiLAR  TISSUE  AND  TENDONS. — The  differences  of  structure 
and  density  of  the  muscular  tissues  of  the  body  encountered  by  a  missile  in  its  passage  are 
found  to  influence  the  directness  of  its  course,  unless  its  velocity,  i.  e.,  force,  is  sufficiently 
great  to  overcome  the  resistance  offered,  as  in  the  case  of  conoidal  missiles  at  high  velocities, 
the  course  of  which  is  generally  direct. 

Bound  balls  presenting  an  obtuse  frontage  part  more  easily  with  their  force,  and  are 
readily  deflected  by  fasciae  and  aponeurotic  expansion,  pursuing  curious  and  devious  courses 
until  they  either  find  exit  or  make  lodgement: 

CASE  1051. — Corporal  S.  S.  Walker,  Co.  F,  51st  Illinois,  aged  26  years,  was  wounded  at  Chickamauga,  September  19, 
1863.  He  was  treated  in  hospitals  in  Nashville  and  Louisville,  and  on  December  2d  was  admitted  into  the  hospital  at  Quiucy, 
Illinois.  Acting  Assistant  Surgeon  F.  K.  Bailey  reported:  "A  round  leaden  bullet  entered  one  inch  to  the  right  of  the  third 
dorsal  vertebra  and  gives  no  indication  of  having  passed  out,  but  seems  to  have  passed  round  the  body  and  lodged  in  the  pector- 
alis  muscle;  wound  healed."  He  was  returned  to  duty  March  9,  1864,  and  discharged  from  service  June  16,  1865,  and  pensioned. 
Pension  Examiner  T.  S.  Hening,  of  Springfield,  Illinois,  reported,  August  22,  1865 :  "  Applicant  received  a  ball  on  the  right  side 
of  the  second  dorsal  vertfbra,  which  entered  the  back,  lodged,  and  is  concealed  in  the  tissues,  probably  on  the  inner  side  of  the 
front  portion  of  the  right  third  rib,  where  there  is  tenderness,  though  the  ball  did  not,  I  think,  pass  through  the  lung;  complains 
of  pain  in  chest  and  difficult  breathing  on  exertion  and  in  damp  weather;  also  weakness  of  the  right  arm  and  muscles  between 
the  shoulders.  Has  also  a  buckshot  lodged  over  the  right  parotid  gland,  and  one  on  the  outside  of  the  left  shoulder  which  only 
produces  slight  soreness."  The  pension  examining  board  at  Springfield  report,  under  date  of  February  18, 1880:  "Ball  remains 
unextracted."  His  pension  was  paid  June  4,  1881. 

The  effects  of  missiles  of  different  character  upon  muscular  structures  are  not  dissim 
ilar;  the  track  of  a  small  conoidal  ball  passing  swiftly  through  a  muscle  is  generally  more 
cleanly  cut  than  that  made  by  a  large  or  round  ball;  but  in  all  shot  wounds  there  is  usually 
found  an  irregular  channel  with  contused  and  lacerated  walls,  more  or  less  devitalized  by 
contact  with  the  missile,  the  area  of  injury  gradually  shading  off  by  concentric  layers  until 
lost  in  healthy  tissue;  there  is  always  more  or  less  loss  of  substance  dependent  somewhat 
upon  muscular  tension  or  relaxation,  also  upon  the  direction  of  the  missile  through  the 
muscle,  whether  transversely  or  obliquely  to  its  long  axis.  Fascia?  and  aponeurotic  tissues 
are  torn  and  lacerated  or  simply  perforated,  according  to  their  condition  of  tension  at  the 
time;  their  openings  seldom  correspond  with  the  openings  in  muscular  tissue,  owing  to  the 
ever  constant  change  in  the  relations  of  parts  due  to  movement  and  muscular  action.  Hence 
it  is  frequently  difficult,  to  follow  the  course  of  the  missile  with  accuracy;  when,  for  the  pur- 

1  The  drawings  in  1'LATE  XXXIX  represent :  Flos.  1  :ind  3,  the  entrance  and  exit  wounds  of  the  left  foot  and  the  right  thigh  in  the  same  subject 
by  a  conoidal  bullet.  The  soldier  at  the  time  of  the  injury  was  in  a  sitting  posture  on  the  ground,  with  the  left  leg  well  flexed.  The  left  drawing  of 
Vic,.  3  shows  the  wound  of  entrance  just  behind  the  joint  of  the  great  -toe;  the  right  drawing  the  wound  of  exit  diagonally  below ;  the  upper  sketch  of 
FlG.  1  shows  tin-  entrance  wound  of  the  right  thigh,  in  which  the  ball  lodged ;  the  missile  after  inflicting  the  wound  of  the  foot  had  probably  lost  part  of 
its  force  and  hart  possibly  suffered  some  change  in  rotation,  not  striking  the  thigh  directly  with  its  apex.  The  lower  drawing  of  FlG.  1  shows  the  entrance 
wound  inflicted  by  a  conoidal  ball  that  flattened  on  the  right  clavicle  and  lodged  beneath  the  scapula.  FlG.  i  represents  the  wounds  of  entrance  and 
exit  in  a  shot  fracture  of  the  ankle  joint  by  a  conoidal  ball ;  entrance  wound  to  the  left,  exit  to  the  right.  Fin.  4.  a  penetrating  wound  of  the  abdomen 
by  a.  conoidal  ball ;  the  upper  drawing  shows  the  wound  of  entrance,  the  lower  the  wound  of  exit.  FIG.  5,  simple  flesh  wound  of  thigh  by  spherical 
ball;  upper  drawing  represents  the  wound  of  entrance,  lower,  that  of  exit.  FIG.  (i.  a  simple  flesh  wound  of  lower  third  of  arm  by  a  conoidal  ball ; 
wound  of  entrance  to  the  left,  exit  to  the  right.  FIG.  7.  flesh  wound  of  arm  by  a  small  fragment  of  shell ;  wound  of  entrance  to  the  left,  exit  to  the  right. 
FIG.  8,  shot  wound  of  neck  by  a  conoidal  ball ;  wound  of  entrance  to  the  left,  exit  to  the  right,  by  a  missile  travelling  with  high  velocity.  FIG.  9,  shot 
wound  of  thigh  by  a  minie  ball,  large  calibre;  entrance  wound  to  the  left,  exit  to  the  right.  FIG.  10,  flesh  wound  of  hand  by  fragment  of  shell.  FIG. 
11,  flesh  wound  of  shoulder  by  a  fragment  of  shell.  FIG.  U>,  slight  flesh  wound  <.f  leg  by  fragment  of  shell.  FIG.  13,  gunshot  wound  through  body 
from  right  to  left,  between  ninth  and  tenth  ribs,  by  a  conoidal  ball ;  the  figure  represents  the  wound  of  entrance.  Fin.  14,  shot  wound  of  left  thigh,  frac 
turing  trochanter.  from  a  spherical  musket  ball.  The  wounds  on  PLATE  XL  represent :  FIG.  1,  shot  wound  of  left  hand,  fracturing  bone,  by  a  conoidal 
ball ;  wound  of  entrance  to  left,  of  exit  to  right— both  very  characteristic.  FIG.  2,  shot  wound  of  foot,  fracturing  bone,  by  a  conoidal  ball ;  wound  of 
entrance  to  left,  i.f  exit  to  right.  FIG.  3,  flesh  wound  of  right  arm,  making  exit  from  forearm,  by  conoidal  ball ;  left  drawing  represents  wound  of  entrance, 
right,  wound  of  exit — somewhat  oblique.  FIG.  4,  flesh  wound  of  shoulder  by  a  conoidal  ball  ;  upper  figure  shows  wound  of  entrance,  lower  of  exit. 
Fir..  5,  shot  wound  of  leg,  involving  bone,  by  conoidal  ball;  here  the  right  figure  represents  the  wound  of  entrance  and  the  left  the  exit  wound.  FIG.  (i, 
shot  wound  of  foot  by  conoidal  ball ;  left  figure  wound  of  entrance,  right,  of  exit.  Fin.  7,  shot  wound  of  left  shoulder,  fatal,  by  conoidal  ball ;  entrance 
to  left,  exit  to  right.  FIG.  8,  shot  fracture  of  ilium  by  conoidal  ball ;  entrance  wound  to  left,  exit  to  right.  FIG.  0,  flesh  wound  of  leg  by  conoidal  ball ; 
entrance  wound  above,  exit  below.  Fin.  10,  shot  wound  of  arm,  involving  bones,  by  u  conoidal  ball;  entrance  to  left,  exit  to  right.  FIG.  11,  shot  wound 
of  left  leg,  fatal,  by  a  conoidal  ball  ;  entrance  to  left,  exit  to  right.  FIG.  12,  shot  flesh  wound  of  foot  by  conoidal  ball ;  entrance  wound  to  left,  exit  '•• 
right — a  typical  representation  of  the  effects  of  a  conoidal  ball  at  high  velocity. 


•05 


t 


V 


CHAP,  xil.l  EFFECTS    OF    MISSILES    ON    BONY    STRUCTURE.  713 

pose  of  diagnosis,  it  becomes  necessary  to  do  so,  the  relation  of  the  individual  to  the  imping 
ing  projectile  becomes  of  great  importance. 

Contusions  of  muscular  tissue  are  found  as  the  result  of  the  impact  of  "spent  balls," 
or  where  the  force  of  the  missile  has  been  retarded  upon  some  obstacle,  as  on  a  part  of  the 
equipment,  or  on  objects  upon  the  person,  as  books,  money,  buttons,  etc.  The  contusion  may 
present  all  degrees  of  severity  from  simple  ecchymosis  to  the  loss  of  vitality  of  the  part  struck ; 
this  may  be  limited  to  the  skin,  in  which  case  an  eschar  of  rounded  form  and  of  about  the 
size  of  the  missile  is  thrown  off,  or  it  may  affect  deeper  structures,  as  the  contents  of  the 
great  cavities.1  Contusions  result  more  frequently  from  round  than  from  conoidal  balls. 

Wounds  by  distorted  bullets,  by  fragments  of  shell,  by  foreign  bodies,  or  by  elongated 
bullets  revolving  on  their  lesser  axis,  are  more  destructive  in  their  nature  than  the  usual 
wounds  from  intact  balls;  the  irregularity  of  a  bullet  track,  due  to  the  causes  mentioned, 
constitutes  one  great  source  of  danger  in  flesh  wounds.  The  cavities  and  irregular  pouches 
formed  along  the  track  give  lodgement  to  foreign  matters  driven  in  with  trie  missile,  as 
shreds  of  clothing,  etc.,  causing  irritation,  inflammation,  and  abscess,  with  the  retention 
and  burrowing  of  purulent  accumulations,  and  exposing  the  patient  to  the  danger  of  septi- 
csemia,  or,  at  least,  prolonging  convalescence  and  retarding  cicatrization. 

Many  cases  attended  with  extensive  destruction  of  skin,  muscular  tissue,  tendons,  and 
ligaments  resulted  fatally  or  in  very  serious  disability  from  contraction  and  rigidity  of 
parts,  and  from  the  formation  of  extensive  cicatrices  impairing  motion  and  becoming  the 
seat  of  pain  and  inconvenience. 

Gangrene,  tetanus,  and  pyaemia  were  not  infrequent  complications,  and  in  a  number 
of  lesions  of  the  muscular  structure  of  the  extremities  life  was  only  preserved  by  recourse 
to  amputation.  Instances  of  this  nature  have  been  cited  among  the  flesh  wounds  of  the 
extremities. 

A  few  instances  of  repair  of  shot  wounds  of  muscles  by  first  intention  have  been  noticed, 
but  they  were  very  rare  and  presuppose  a  cleanly  cut  wound,  a  sound  constitution,  and  a 
temperate  habit  of  life. 

EFFECT    OF    MISSILES    AND    PROJECTILES    ON    BONY   STRUCTURE. Tll6    effects    ot     llllSSlleS   aild 

projectiles  upon  the  bony  structure  of  the  human  body  have  been  so  thoroughly  illustrated 
in  their  practical  relations  that  little  more  than  a  brief  general  consideration  of  the  subject 
is  here  necessary. 

Gunshot  injuries  of  bones  may  be  classified  as  contusions,  simple  fractures,  partial 
fractures,  penetrations,  perforations,  and  complete  fractures,  with  varying  degrees  of  com 
minution  and  destruction  of  substance.  Nearly  every  form  of  gunshot  missile  and  projectile 
used  in  warfare  is  liable  to  cause  these  various  injuries.  The  properties  inherent  to  the 
missile,  as  velocity,  size,  form,  and  weight,  and  the  conditions  pertaining  to  the  individual  at 
the  time,  as  posture,  part  wounded,  etc.,  will  determine  the  nature,  extent,  and  severity  of  the 
injury.  Slight  forms  of  injury  'may  result  from  the  impact  of  a  solid  shot,  a  fragment  of  shell, 
or  from  a  leaden  bullet;  injuries  of  the  gravest  character  may  equally  be  inflicted  by  these 
missiles.  Between  the  extremes  are  found  wounds  of  all  degrees  arid  grades,  but  they  are 
all  simply  the  manifestation  of  mechanical  force  acting  in  accordance  with  established  laws. 

'A  soldier  found  nn  iron  breast-plate,  probably  thrown  aside  by  some  Confederate,  on  the  field  at  Kingston,  N.  C.,  and  put  it  on.  I  In  was  struck 
by  aminifi  ball  >n  the  breast-plate  over  the  region  of  the  third  rib  and  severely  contused.  He  expectorated  a  full  pint  of  blood  and  suffered  from  dyspnoea; 
the  next  day  he  was  able  to  walk  about.  Since  the  reception  <  f  the  wound  a  round  excavation  about  the  size  of  a  Relgian  minie  bullet  has  sloughed 
out  at  the  point  where  he  was  hit,  laying  bare  the  rib.  The  same  breast-plate  was  worn  by  another  soldier  at  Whitehall,  with  less  fortunate  result.  A 
mini6  ball  struck  it  near  its  lower  border  and  passed  through  it,  carrying  fragments  of  it  into  his  abdomen,  causing  death. 
SURG.  111—90 


714  WOUNPS    AND    COMPLICATIONS.  [CHAP.  XII. 

Discussion  upon  the  comparative  effects  of  round  and  conoidal  missiles  has  been 
virtually  put  at  rest  by  the  general  adoption  of  arms  of  precision  and  some  form  of  elon 
gated  conoidal  bullet.  Writers  on  modern  military  surgery  agree  in  conceding  to  the 
conoidal  missile  greater  force  and  more  destructive  power.1 

There  is  no  doubt  that  at  very  close  range  the  damage  inflicted  by  the  round  ball  is 
hardly  less  than  that  resulting  from  the  conoidal  bullet,  but  beyond  this  point,  and  to 
extreme  ranges,  the  conoidal  missile  is  by  far  the  more  efficient  engine  of  destruction: 

CASE  1052.— Private  G.  R.  Packard,  Co.  F,  3d  Maine,  aged  21  years,  was  wounded  at  Fair  Oaks,  May  31,  1862.  Acting 
Assistant  Surgeon  S.  Teats  contributed  the  following  history:  "The  patient,  a  farmer  l>y  occupation,  of  temperate  habits,  having 
no  strumous  or  other  hereditary  disease,  was  wounded  by  a  round  ball  and  buckshot,  both  coming  from  the  same  musket  at 
close  range,  the  ball  fracturing  the  left  humerus  and  the  buckshot  wounding  the  left  shoulder.  The  arm  was  amputated  about 
the  middle,  a  few  hours  after  the  injury,  on  the  field.  On  admission  to  DeCamp  Hospital,  June  8,  1862,  the  whole  stump*was 
swollen  and  painful;  the  end  was  nearly  cicatrized.  Anteriorly,  just  below  the  left  clavicle  and  at  its  external  third,  there  was  a 
small  opening  from  which  thin  bloody  pus  was  discharging ;  posteriorly,  on  the  same  side,  at  about  the  lower  angle  of  the  scapula, 
there  was  a  circular  cicatrix  the  size  of  a  buckshot.  About  the  cicatrix  there  was  a  fluctuating  tumor,  with  heat  and  pain  of 
the  part.  No  aneurismal  thrill  or  bruit.  He  was  much  debilitated  and  anaemic.  On  passing  an  exploring  needle  into  this  tumor 
no  pus  could  be  detected.  July  1st,  arterial  haemorrhage  to  the  amount  of  one  pint  from  the  anterior  wound,  which  ceased 
spontaneously,  after  which  pus  was  again  discharged.  July  20th,  haemorrhage  again  about  the  same  amount  as  before,  again 
followed  bv  discharge  of  pus.  July  28th,  haemorrhage  again  amounting  to  one  and  a  half  pints,  but  this  time  it  did  not  cease 
spontaneously  as  in  the  two  previous  cases.  On  consultation  it  was  decided  to  ligate  the  axillary  artery.  This  was  done  by 
enlarging  the  wound  and  passing  the  ligature  around  it  near  its  origin,  without,  however,  seeing  the  artery,  the  pulsation  of  the 
vessel  beinff  the  guide.  The  haemorrhage  ceased  as  soon  as  the  ligature  was  tightened.  With  eacli  occurrence  of  haemorrhage 
the  tumor  posteriorly  diminished  in  size  somewhat.  Some  two  or  three  days  after  the  operation  an  organized  clot  was  discharged 
from  the  wound  about  the  size  of  a  hickory  nut.  Two  days  after  this  another  clot  of  like  size  and  appearance  was  discharged. 
Subsequent  to  this  laudable  pus  was  discharged  until  August  5th,  when  the  patient  died  from  another  recurrence  of  haemorrhage. 
The  ligature  could  not  be  found;  it  was  supposed  that  during  sleep  he  had  pulled  it  away.  Autopsy  sixteen  hours  alter  death : 
On  tracing  up  the  axillary  artery  it  was  found  that  about  two  inches  of  it  had  almost  entirely  disappeared.  Commencing  just 
below  the  first  rib  a  cavity,  containing  several  ounces  of  more  or  less  organized  clot,  existed  around  this  deficiency  of  the  artery, 
which  cavity  extended  downward  into  the  axilla  and  backward  under  the  scapula.  No  pus  was  found  in  the  shoulder  joint. 
The  head  of  the  humerus  was  very  soft,  and  on  cutting  through  the  softened  articular  cartilage  a  pasty  substance  was  found 
beneath  it.  taking  the  place.of  much  of  the  spongy  extremity  of  the  bone.  This  pasty  substance  was  the  broken  down  spongy 
structure.  Other  organs  normal.  In  the  specimen  it  will  be  seen  that  about  one-third  of  the  border  of  the  cartilage  of  incrus 
tation  is  detached  from  the  bone.  This  is  due  to  manipulation  and  maceration."  The  specimens  were  forwarded  by  Dr.  Teats, 
together  with  a  wet  preparation,  hi  two  portions,  of  parts  of  the  aorta,  innominata,  left  common  carotid,  subclavian  and  axillary 
arteries.  (See  Ca'.  Kury.  Sect.,  1866,  p.  459,  Spec.  4339.) 

Contusions  of  bone  more  commonly  result  from  the  impact  of  missiles  under  low 
velocity,  as  a  spent  ball  or  fragment  of  shell,  or  when  the  force  of  the  missile  has  been 
nearly'expended  in  overcoming  the  resistance  of  overlying  tissues,  or  when  the  line  of 
direction  has  been  oblique  to  the  bone,  causing  a  glancing  or  grazing  blow.  Round  balls, 
parting  rapidly  with  their  force  after  their  initial  velocity  is  diminished,  will  generally  con 
tuse  rather  than  fracture;  the  same  is  true  of  shell  fragments,  unless  their  weight  is  sufficient 
to  cause  fracture  by  crushing.  Contusions  of  bone  may  be  followed  by  no  very  serious 
results;  such  cases  undoubtedly  occurred  during  the  late  war,  and  recovery  followed  with 
out  bad  symptoms.  Instances  of  this  nature  have  been  reported  on  pp.  817  and  920  of  the 
Second  Surgical  Volume. 

In  many  cases  the  contusion  was  at  first  unrecognized,  until  tardy  and  faulty  cicatriza 
tion  and  discharge  of  bone  proved  the  existence  of  caries  and  necrosis: 

CASE  1053. — Private  C.  C.  Mulford,  Co.  K,  6th  New  York  Artillery,  aged  42  years,  was  wounded  in  the  right  thigh,  at 
Spottsylvania,  May  19, 1864,  and  entered  Fairfax  Seminary  Hospital  six  days  afterwards.  Assistant  Surgeon  H.  Allen,  U.  S.  A., 


conico-cylindrical  ballet  produces  the  most  destructive  effects;  not  only  comminuting  the  part  struck,  but  often  splitting1  up  the  shaft  of  the  bone  by  its 
wedge-like  action,  in  fissures  many  inches  long  leading  into  contiguous  parts.'  MACLEOD  (G.  II.  B.)  (Notes  on  the  Surgery  of  the  War  in  the  Crimea, 
London.  1838,  p.  i)8)  asserts  that :  "The  greater  precision  in  aim.  the  immensely  increased  range,  the  peculiar  shape,  great  force,  and  unwonted  motion 
imparted  by  the  new  rifles  to  their  conical  balls,  have  introduced  into  the  prognosis  of  gunshot  wounds  an  element  of  the  utmost  importance."  Asil- 
IIUKST  (J.,  jr.)  (The  Principles  and  Practice  of  Surgery,  Philadelphia,  1871,  p.  158)  finds  that :  •'  Bullet  wounds  have  increased  greatly  in  severity  since 
the  introduction  of  rifled  muskets  and  of  conoidal  balls.  The  old  round  musket  ball,  fired  from  a  smooth-bore,  produced  a  comparatively  slight  wound.' 


CHAP,  xn.]  EFFECTS   OF   MISSILES    ON    BONY   STRUCTURE.  715 

described  the  injury  as  follows:  "The  wound  was  caused  by  a  musket  ball,  which  entered  at  the  upper  part  of  the  middle  third 
of  the  thigh  and  lodged.  The  case  was  treated  as  a  simple  flesh  wound ;  patient  doing  well.  On  June  14th  the  missile  was 
found  and  extracted.  A  severe  diarrhoea  came  on  June  19th  and  continued  till  June  25th,  when  it  was  controlled.  Four  days 
afterwards  diarrhoea  again  appeared,  and  brandy  and  opium  were  prescribed.  During  the  night  of  June  30th  the  patient  had  a 
severe  chill,  followed  by  fever,  dry  tongue,  and  collections  of  sordes  upon  the  teeth.  I  saw  the  patient  for  the  first  time  on  July 
1st,  when  he  was  in  a  dying  condition,  being  bathed  in  a  copious  clammy  sweat,  though  his  mind  was  quite  clear,  and  he  com 
plained  of  no  pain.  There  was  discoloration  of  the  skin.  He  died  on  the  following  day,  July  2, 1804.  Autopsy:  Emaciation 
extreme;  afi'ected  thigh  very  little  swollen:  wound  open,  and  the  integuments  for  some  distance  above  and  below  it  of  a  purplish 
red  color;  femoral  vein  entirely  healthy;  internal  organs  healthy.  The  bone  was  found  to  have  been  grazed  by  the  ball.  Upon 
removing  the  femur  its  walls  immediately  opposite  the  track  of  the  ball  were  found  to  be  stripped  entirely  of  periosteum,  and 
that  covering  the  bone  above  and  below  this  region  was  thickened  and  stained  of  a  grayish  hue  from  contact  with  a  dark  colored 
offensive  pus,  which  laid  both  in  the  wound  and  around  the  bone.  At  the  great  trochanter  an  abscess  of  about  the  size  of  a  hen's 
egg  was  discovered.  This  was  entirely  distinct  from  the  collection  before  mentioned,  being  separated  from  it  by  a  track  of  com 
paratively  healthy  tissue.  The  pus  contained  therein  was  more  laudable  than  that  found  elsewhere.  When  the  bone  was  sawed 
open,  which  was  accomplished  with  some  difficulty  on  account  of  the  increased  thickness  and  density  of  its  walls,  its  entire 
interior  was  found  filled  with  pus,  the  fluid  being  of  an  ochre-yellow,  with  large  oily  globules  floating  upon  the  surface.  No 
trace  of  the  original  structure  could  be  seen  anywhere.  The  spongy  tissue  at  the  head  of  the  bone  Avas  completely  discolored 
with  a  uniform  grayish  yellow  stain,  while  that  of  the  condyles  was  perfectly  healthy.  The  walls  of  the  bone  were  of  great 
thickness  and  the  sawn  surface  presented  a  white,  glistening,  ebnrnated  appearance.  No  vascularity  was  seen,  and  the  haversian 
canals  were  found  not  to  be  enlarged."  The  greater  portion  of  the  injured  femur,  contributed  to  the  Museum  by  Surgeon  D.  P. 
Smith,  U.  S.  V'.,  constitutes  specimen  2675  of  the  Surgical  Section,  showing  necrosis  at  the  point  of  contusion  on  the  inner  surface 
in  the  middle  third,  above  and  below  which  the  bone  is  greatly  roughened  by  suppuration  in  nearly  its  whole  extent. 

Unhappily  a  very  considerable  percentage  of  cases  of  contusions  of  bone  proved  to  be 
far  from  innocent,  and  were  followed  by  a  train  of  most  serious  complications.  In  discussing 
shot  contusions  of  the  cranial  bones  in  the  First  Surgical  Volume,  at  page  101,  haemorrhage, 
gangrene,  periostitis,  and  exfoliation  were  mentioned  as  early  complications,  and  among 
the  later  results  vertigo,  chronic  irritation  of  the  brain,  mental  imbecility,  and  impairment 
of  the  special  senses.  Surgeon  John  A.  Lidell,  U.  S.  V.,  in  an  article  on  shot  contusions 
of  bones1  enumerates  ecchymosis  of  the  osseous  tissue,  ecchymosis  of  the  medullary  tissue, 
osteomyelitis  of  a  simple  character,  necrotic  osteitis,  and  suppurative  osteomyelitis,  as  con 
sequences  of  contusion  of  bone,  and  says:  "Any  injury  of  bone  in  the  nature  of  a  bruise, 
however  trivial  it  may  appear  to  be  at  the  time  of  infliction,  may  be  followed  by  serious 
consequences,  which  it  is  the  duty  of  the  surgeon  to  anticipate  and  ward  off  if  possible." 

Stromeyer2  describes  contusions  of  bones  as  follows:  "They  [bullets]  strike  the  bone 
without  breaking  it  and  flatten  themselves  against  its  surface;  the  bone  struck  becomes 
necrotic  from  the  destruction  of  its  periosteum.  In  crowded  hospitals  such  injuries  of  the 
larger  long  bones  cause  suppuration  of  the  medullary  canal,  which  extending  itself,  at  last 
by  the  passage  of  pus  into  the  veins,  gives  a  fatal  termination.  In  the  autopsy  (the  bone 
being  sawn  in  its  long  axis)  the  marrow  is  found  filled  with  pus  from  the  wounded  part 
upward,  and  the  same  morbid  product  in  the  neighboring  large  veins;  as  in  the  femoral 
vein  after  contusion  of  the  femur.  The  spot  struck  by  the  ball  is  colorless  and  exsanguine; 
in  its  circumference  appears  the  commencement  of  a  line  of  demarcation.  Contusions  of 
this  kind,  which  up  to  the  present  time  have  been  little  attended  to  in  the  long  bones,  are 
well  known  in  the  bones  of  the  skull,  where  caused  by  a  blow  or  fall  they  have  the  same 
dangerous  consequences  if  not  properly  treated,  as  suppuration  occurs  in  the  diploe  and 
purulent  inflammation  in  the  sinus,  with  its  usual  results."  Dr.  Lidell3  is  of  the  opinion 
that,  owing  to  their  better  blood-supply  and  consequent  greater  vitality,  shot  contusions  of 
upper  portions  of  the  body  give  more  favorable  results  than  similar  lesions  of  the  lower 
extremities.  The  results  as  tabulated  on  the  next  page  from  the  records  of  this  Office 
seem  to  favor  this  conclusion. 

1  LlUlit.L  (J.  A  ),  On  Contusion  and  Contused  Wounds  of  BOM,  with  an  Account  of  Thirteen  Cases,  in  Am.  Jour.  Mcd.  <Sci.,  1865,  Vol.  L,  p.  17. 

2S"ll'.OMKVF.li  (L.),  On  the  Fractures  of  Bones  occurring  in  Gunshot  Injuries,  STATHAM'S  translation,  London,  1856,  page  2. 

3  I,ID  '.!.!.  (.1.  A.),  On  Contusion  and  Contused  ]\'uunds  of  Hone,  etc.,  in  American  Journal  of  Medical  Sciences,  18G5,  Volume  L,  page  20. 


'16 


WOUNDS    AND    COMPLICATIONS. 


[CHAT.  XII. 


TABLK  CXXTI. 
Numerical  Statement  of  Shot  Contusions  of  the  Jlones  of  the  Head,  Trunk,  and  Extremities. 


SEAT  OF  INJURY. 

CASKS. 

Unknown. 

Percentage  of  Fa 
tality. 

TKEATKH  HY  Cox-     TUEATEIJ  HY 

6EHVAT1OX.                 EXCISION. 

TltEATEU  BY 

AMPUTATION. 

C* 
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5     •     8          5 

C       1        0       '        3 

fri     1     PS      1     fc 

Recovery. 

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ca 
fe 

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& 

c             « 

P            « 

j3 

^5 

Recovery. 

03 
i. 

328       '-'73         55 
30         25           3 

22         18           4 
10           8           2 
205       144         61 

I'M       Kio         2<J 

i    Hi.  7 

261 
25 
18 
7 
140 
157 
26 

6154 

51 
3 

4 

1 
46 

15 
1 

12 

4 

2    :     10.7 

18.1 

o 

20.0 

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14 

29.  7 

4 

8 

:  17.5 

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27         26           J 

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2      19.  0 

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2    !        13             4            12 

:<o 

Structure  has  undoubtedly  a  great  influence  in  determining  the  severity  ol  the  effects 
of  contusion.  Such  lesions  in  the  spongy  bones  or  cancellated  portions  of  long  bones, 
attended  with  extravasation  of  blood,  are  very  liable  to  result  in  extensive  and  dangerous 
necrosis,  inasmuch  as  the  blood  confined  within  the  unyielding  structure  interferes  by  com 
pression  with  the  nutrient  blood-vessels,  or  acting  as  a  foreign  body  destroys  the  .vitality 
of  the  bone  by  setting  up  inflammatory  action. 

CASK  1054. — Private  J.  Tetlow,  Co.  F,  23d  New  Jersey,  was  wounded  at  Fredericks  burg,  December  13,  1862.  Surgeon 
G.  Burr,  U.  S.  V..  reported  his  admission  to  the  field  hospital  of  the  1st  division,  Sixth  Corps,  with  ''shot  wound  of  leg." 
Acting  Assistant  Surgeon  G.  F.  French  reported  the  following  result  of  the  injury :  "The  patient  was  admitted  to  hospital  at 
Alexandria  on  December  19th.  lie  had  been  wounded  by  a  ball  entering  on  the  outer  side  of  the  right  popliteal  space  and  not 
emerging.  He  was  a  strong  and  healthy  man,  his  pulse  being  90  and  full;  appetite  fair;  knee  tender,  very  little  inflamed,  and 
slightly  swollen  By  December  22d  the  inflammation  about  the  knee  was  increasing:  pulse  98;  appetite  flagging.  On  the  next 
day  there  was  high  constitutional  fever  with  great  swelling  and  pain  about  the  knee;  patient  hectic  and  had  a  chill.  On  Decem 
ber  '24th  a  round  ball  was  found  lying  loose  in  the  wound  and  was  extracted  without  incision ;  under  portion  of  internal  condyle 
felt  to  be  bare.  December  fc9th.  knee  more  inflamed  and  swelled;  constitutional  fever  about  the  same;  pulse  ICO  and  weak. 
Pus  was  detected  and  let  out  by  a  free  incision,  giving  much  relief.  Egg-nog  ordered  for  the  patient.  On  the  following  day  he 
was  more  comfortable  but  seemed  exhausted,  and  was  delirious  at  times;  pulse  weak.  On  December  31st  he  had  a  chill  with 
pain  in  the  stomach,  and  two  days  afterwards  he  was  delirious;  pulse  very  feeble  and  slow.  His  death  occurred  at  5  1'.  M.  on 
January  2,  1863.  Autopsy  :  External  condyle  bared  of  periosteum;  joint  full  of  pus;  external  portion  of  articular  surface  of 
tibia  bared  also;  lower  third  of  femur  dissected  up  with  pus;  periosteum  gone  on  the  inner  side  and  end  of  internal  coudyle; 
bone  beginning  to  necrose.  The  missile  had  impinged  upon  the  under  side  of  the  internal  condyle,  doing  no  further  injury  to 
the  bone  than  killing  the  periosteum  over  a  space  the  size  of  a  half  dime."1 

CASE  1055. — Private  S.  F.  Blanchard,  Co.  D,  17th  Michigan,  aged  25  years,  was  wounded  in  the  left  knee,  at  the  battle 
of  Antietam,  September  17,  1862.  He  was  conveyed  to  the  Big  Spring  field  hospital,  near  Sharpsburg,  where  Surgeon  T.  H. 
Squire,  89th  New  York,  recorded  the  following  description  and  result  of  the  injury:  "The  wound  was  caused  by  a  musket  ball 
which  struck  just  at  the  inner  side  of  the  triceps  extensor  of  the  left  knee,  passed  backward,  grazing  the  side  of  the  inner  con 
dyle  in  its  course,  and  came  out  between  the  tendons  of  the  inner  hamstring.  In  an  early  examination  of  the  joint  it  would 
have  been  possible  for  a  good  surgeon  to  conclude  that  the  cavity  of  the  joint  had  just  escaped;  but  at  this  date  (October  16th) 
there  are  all  the  bad  symptoms  of  such  cases — pus  in  the  joint  and  up  the  thigh,  hectic,  diarrhoea,  etc.  The  case  presented  but 
little  encouragement  for  the  knife  since  the  time  I  first  saw  the  patient,  though  he  had  scarcely  failed  any  for  some  days.  His 
death  occurred  on  November  1,  1862."  The  bones  of  the  wounded  knee,  contributed  by  Surgeon  Squire,  and  exhibiting  destruc 
tion  of  the  joint  by  ulceration,  constitute  specimen  3580  of  the  Surgical  Section  of  the  Museum. 

The  following  case  of  simple  osteomyelitis  affords  an  illustration  of  one  of  the  frequent 
and  grave  results  of  bone  contusions  observed  during  the  late  war: 

CASE  1056. — Private  John  Anderson,  Co.  G,  76th  New  York,  aged  30  years,  was  wounded  at  Cold  Harbor,  June  6,  1H64. 
He  was  at  once  conveyed  to  the  depot  field  hospital  of  the  Fifth  Army  Corps,  and  on  June  12th  was  transferred  to  Stanton  Hos 
pital,  Washington.  Surgeon  John  A.  Lidell,  U.  S.  V.,  reported:  "Was  admitted  for  a  gunshot  wound  of  the  left  thigh  in  the 

1  An  abstract  of  this  case  was  published  by  J.  15.  BKI.LANOKK  (Itrptirt  of  Jive  cases  of  Gunshot  Injury  qf  lite  Knee  Joint)  in  American  Journal 
Medical  Sciences,  New  Series,  1863,  Vol.  XLVI,  p.  44. 


CHAP,  xii.]  EFFECTS    OF    MISSILES    ON    BOXY    FTRrCTUUF.  717 

upper  third,  inflicted  by  ;\  conical  musket  ball,  which  penetrated  the  front  of  the  limb  at  the  inner  side  of  the  femoral  vessels, 
and,  passing  backward  and  outward  through  the  limb,  lodged  beneath  the  skin.  It  WHS  extracted  by  an  incision  from  behind. 
When  he  came  to  the  hospital,  six  days  after  the  injury,  it  was  thought  that  the  wound  was  only  a  flesh  one.  His  general  con 
dition  was  fair,  or  rather  below  par  at  that  time.  Simple  dressings  to  wound  were  ordered,  and  nutrients  and  stimulants  were 
allowed.  Subsequently  the  wound  did  well,  and  he  appeared  in  a  fair  way  to  recover  for  a  time.  July  1st,  it  was  observed  that 
he  was  failing  in  strength  and  emaciating.  Stimulants  and  the  supporting  treatment  were  continued  with  tinct.  ferri  muriat. 
Afterwards  he  sank  into  a  typhoid  condition,  the  skin  becoming  warmer  than  natural,  but  without  sweats,  the  pulse  frequent 
iind  feeble,  the  tongue  dry  and  red,  with  almost  entire  loss  of  appetite.  He  also  became  somnolent,  and  toward  the  last  it  was 
difficult  to  rouse  him.  He  did  not  have  any  chills.  He  died  July  18th.  The  amount  of  discharge  from  the  wound  was  at  no 
time  great,  but  the  thigh  remained  swelled  and  inflamed  all  the  while.  On  making  an  autopsy  it  was  found  that  the  bullet,  had 
struck  the  shaft  of  the  femur  on  its  postero-inner  side,  two  or  three  inches  below  the  trochanter,  grazimj  and  bruishifj  it.  The 
aperture  of  exit  had  healed.  There  was  an  abscess  about  the  place  of  injury  of  the  bone  as  large  as  an  orange,  and  pus  had 
also  burrowed  among  the  muscles  of  the  thigh.  There  was  a  large  deposit  of  new  bone  about  the  contused  portion  of  the  femur. 
A  longitudinal  section  was  made  with  a  saw.  New  osseous  tissue  was  also  found  deposited  in  the  medullary  canal.  The  marrow 
presented  the  'red  inflammatory'  appearance  described  by  Virchow.  There  was  no  thrombosis,  nor  any  lesion  whatever  of  the 
veins  and  arteries.  The  cadaver  was  considerably  emaciated  and  resembled  in  its  general  appearance  that  produced  by  typhoid 
fever.  There  was  no  lesion  of  the  intestines  or  any  other  of  the  internal  organs.  For  an  account  of  the  autopsy  and  for  much 
other  interesting  information  concerning  this  case,  the  writer1  is  indebted  to  Assistant  Surgeon  George  A.  Mursick,  II.  S.  V." 

A.  case  of  gangrenous  osteomyelitis  following  shot  contusion  of  the  femur  has  been 
riteri  on  page  171.  ante,  and  a  similar  case  is  here  detailed: 

CASE  10't7. — Private  G.  Cole,  Co.  A,  91st  New  York,  aged  35  years,  was  wounded  in  the  right  thigh,  at  Petersburg, 
March  31,  1865.  From  a  field  hospital  he  passed,  on  April  3d,  to  the  Fifth  Corps  Depot  Hospital  at  City  Point,  and  two  days 
later  lie  was  transferred  to  Washington.  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A.,  contributed  the  following  history:  "The 
patient  was  admitted  to  Douglas  Hospital,  April  6th,  with  a  wound  inflicted  by  a  minie  ball,  which  caused  a  severe  contusion  of 
the  femur  at  the  middle  third  without  producing  fracture.  His  constitutional  condition  at  the  time  of  Us  admission  was  good 
and  the  wound  looked  healthy.  On  April  12th  a  very  much  flattened  bullet  was  extracted  by  Acting  Assistant  Surgeon  H. 
Gibbons.  On  the  17th,  erysipelatous  inflammation  appeared  about  the  wound,  which  increased  on  the  following  day  in  spite  of 
the  application  of  poultices  and  tincture  of  iodine.  On  the  20th  there  was  a  slight  attack  of  erysipelas  of  the  nose,  and  the 
following  day  the  patient  had  two  severe  chills,  which  were  repeated  on  the  22d,  23d,  and  24th.  On  the  25th  he  again  had  two 
chills,  and  one  on  the  next  day.  The  conjunctiva;  now  had  assumed  a  yellow  tinge,  and  he  had  pain  in  the  chest;  pulse  132. 
On  the  27th  there  was  another  chill,  the  constitutional  condition  remaining  as  before,  and  on  the  following  day  there  was  one 
more  repetition,  and  secondary  involvement  of  the  knee  joint  manifested  itself.  The  skin  and  conjunctivas  were  now  deeply 
jaundiced,  and  the  discharge  from  the  wound  unhealthy,  fetid,  and  bloody.  On  the  29th  there  was  hiccough,  delirium,  and 
vomiting,  and  the  patient  sank  rapidly.  He  died  on  the  following  day — April  30, 1865.  At  the  autopsy,  both  lungs  were  found 
to  be  covered  posteriorly  with  an  offensive  greenish  flak}'  lymph  and  to  contain  a  number  of  small  py«:mic  abscesses.  There 
was  about  five  ounces  of  effusion  in  the  thoracic  cavities.  The  other  organs  were  but  slightly  affected.  On  removing  the  femur 
the  periosteum  was  found  to  be  wanting  for  five  inches  in  length  and  one-third  of  the  circumference  of  the  bone,  the  part  so 
bared  showing  evidence  of  absorption  of  its  tissue  except  at  the  point  struck  by  the  bullet.  On  sawing  open  the  shaft  of  the 
femur  longitudinally  the  lower  half  was  discovered  to  be  in  a  gangrenous  condition,  the  medulla  being  greenish,  soft,  and  offen 
sive,  and  the  cancellated  structure  of  the  condyles  presenting  the  same  appearance.  There  was  about  two  ounces  of  thin 
brownish-yellow  fluid  in  the  knee  joint,  and  the  femoral  vein  near  the  joint  as  well  as  the  small  articular  veins  were  filled  with 
clots,  their  inner  coats  in  some  places  being  reddened  and  in  others  of  a  greenish  hue." 

A  leaden  bullet  coming  in  contact  with  a  bone  presenting  a  smooth  flat  surface,  as  one 
of  the  faces  of  the  tibia,  may  flatten  itself  against  it,  contusing  without  fracturing  the  bone: 

CASK  1058. — Private  W.  B.  Donkersley,  Co.  I,  2d  New  Jersey,  was  wounded  at  Chancellorsville,  May  2, 1863.  He  was 
admitted,  on  May  8th,  into  Douglas  Hospital,  Washington.  Acting  Assistant  Surgeon  Carlos  Carvallo  reported:  "This  patient 
received  a  flesh  wound  of  the  right  inguinal  region;  ball  extracted  on  field;  doing  well,  wound  suppurating."  At  the  end  of  a 
week  Donkersley  was  transferred  to  Satterlee  Hospital,  Philadelphia,  whence  Acting  Assistant  Surgeon  J.  H.  Hutchinson 
reported:  "This  man  received  a  wound  from  a  conical  ball  which  entered  the  right  groin  and  flattened  itself  on  the  bone  without 
producing  fracture.  He  lay  upon  the  field  all  night,  and  was  removed  Sunday  morning  and  the  ball  extracted.  From  the  time 
of  the  wound  on  Saturday  afternoon  until  Sunday  morning  he  was  entirely  insensible,  and  remembered  nothing  from  the  time 
of  receiving  the  shot  until  he  roused  to  consciousness  in  an  ambulance  on  Sunday.  After  reaching  this  hospital  on  May  17th,  he 
did  well,  and  went  on  duty  as  clerk  in  the  Commissary  Department  on  June  1,  1863."  The  patient  was  transferred  to  the  Veteran 
Reserve  Corps  in  September,  1863,  and  discharged  from  service  May  31,  1864.  He  is  not  a  pensioner. 

In  the  next  case  a  conoidal  ball  struck  the  angular  surface  of  the  tibia  with  full  force. 
The  missile  split  to  within  a  few  lines  of  its  base  without  seriously  contusing  the  bone: 

CASE  1059. — Private  Henry  C.  Mallory,  Co.  G,  36th  Indiana,  aged  20  years,  was  wounded  at  Murfreesboro',  Tennessee, 
December  31,  1862.  He  was  admitted,  on  January  3,  1803,  into  hospital  No.  3,  Nashville.  Surgeon  Alexander  Ewing,  13th 
Michigan,  reported:  "Was  struck  by  a  large  conical  leaden  bullet,  at  about  the  distance  of  two  hundred  yards,  at  the  battle  of 
Stone  River,  on  the  31st  day  of  December,  1862.  He  was  standing  in  an  open  plain  in  the  act  of  loading  his  trun.  The  interest 
in  the  case  is  that  the  centre  of  the  apex  of  the  bullet  struck  directly  on  the  spine  of  the  right  tibia,  between  the  middle  and 

T,IL>H  1.  (.!    A.),   On  Contusion  and  C'lntusul  \Younrlsof  Bonr,  etc.,  in  Am.  Jnur.  Med,  Sci.,  ItttM,  Vol.  L,  p.  20. 


'718  WOUNDS    AND    COMPLICATIONS.  [CH,\r.  xii. 

lower  thirds,  and  split  the  missile  to  within  a  few  lines  of  its  base,  overlapping  the  bone,  where  it  was  firmly  held  by  the  tissues. 
Kemarkable  as  it  may  appear,  the  bone  was  not  injured,  and  in  a  very  short  time  the  wound  healed  up.  It  was  evident,  as  well 
from  the  distance  as  the  injury  done  to  the  bullet,  that  it  struck  with  full  force."  Mai  lory  was  discharged  from  service  September 
21,  1864,  and  pensioned.  Examiner  H.  H.  Deming,  of  Pana,  Illinois,  reported,  June  23,  1879:  "Call  struck  tibia  on  anterior 
surface,  splintering  it  so  that  quite  a  large  piece  of  bone  came  out.  There  is  left  quite  a  depression  and  a  very  large  tender 
cicatrix.  If  he  walks  too  much  the  leg  swells  up.  The  pain  at,  times  is  severe." 

Instances  in  which  the  missiles  split  upon  the  bones  of  the  forearm  and  on  the  zygoma 
are  here  adduced : 

CASE  1060. — Private  A.  Wilson,  Co.  L,  1st  Minnesota,  aged  30  years,  was  wounded  at  Antietam.  September  17,  1862. 
He  was  treated  in  Carver  Hospital,  Washington,  and  on  December  12th  was  admitted  into  Satterlee  Hospital,  Philadelphia. 
Surgeon  I.  I.  Hayes,  U.  S.  V.,  reported:  "The  ball,  the  precise  character  of  which  is  unknown,  struck  at  the  outer  side  of  the 
lower  part  of  the  left  arm;  part  of  it  passed  through  the  member  and  came  out  at  the  posterior  surface.  Next  day  a  portion  of 
the  ball,  about  the  size  of  a  dime,  was  cut  out  from  the  front  part  of  the  arm  toward  the  inner  side.  On  his  admission  into  this 
hospital  his  arm  seemed  nearly  well,  but  a  small  ulcer,  scabbed  over,  marked  the  point  of  entrance  of  the  ball,  and  a  probe 
passed  into  this  discovered  a  sinus  extending  several  inches  upward,  a  piece  of  metal  being  discovered  and  clearly  felt  at  its 
upper  extremity.  His  general  condition  was  perfectly  good.  January  3d,  having  administered  chloroform,  I  laid  open  the 
sinus  before  mentioned  for  about  three  inches  and  readily  extracted  a  piece  of  ball.  Its  concave  surface  was  closely  applied  to 
the  outer  edge  of  the  lower  flat  portion  of  the  humerus;  the  bone  beneath  was  roughened  and  apparently  bare  of  periosteum. 
On  several  subsequent  occasions  I  convinced  myself  that  the  bone  was  dead  and  looked  for  a  tedious  process  of  exfoliation ;  but 
on  January  15, 1863,  thinking  to  pass  a  probe,  I  found  the  wound  firmly  united,  and  the  healing  process  has  gone  on  most  favor 
ably.  There  is  no  swelling,  no  tenderness,  no  orifice  through  which  the  smallest  probe  could  be  inserted,  and  the  wound  has 
the  aspect  of  a  healthy  and  rapidly  healing  ulcer."  Wilson  was  returned  to  duty  April  22,  1863,  and  discharged  from  service 
November  24,  1865,  and  pensioned.  The  Williamsport  Examining  Board  reported,  July  6,  1881:  "The  projectile  penetrated 
the  left  arm  at  the  insertion  of  the  triceps  and  passed  inward  and  upward.  Fragments  were  extracted  from  two  places  in  the 
belly  of  the  biceps.  Some  fragments  of  bone  were  removed.  The  arm  has  every  motion  free  except  tensile  strength."  His 
pension  was  paid  December  4,  1881. 

CASE  1061. — Corporal  Julius  Relham,  Co.  K,  1st  Kansas,  aged  21  years,  was  wounded  at  Wilson's  Creek,  August  10, 
1861,  and  entered  the  "House  of  Refuge"  Hospital,  St.  Louis,  on  August  16th.  Assistant  Surgeon  S.  M.  Horton,  II.  S.  A., 
reported  :  "The  following  is  an  interesting  case  of  a  mini6  ball  splitting  in  two  by  the  resistance  offered  by  the  zygoma  of  the 
left  side  of  the  face.  One-half  of  the  ball  was  found  embedded  in  the  corresponding  cheek  beneath  the  middle  portion  of  the 
masseter  muscle;  the  other  half  was  found  and  extracted  from  beneath  the  outer  portion  of  the  platysma  myoides  of  the  same 
side.  The  zygoma  was  not  broken.  The  case  was  that  of  Corporal  Julius  Relham,  of  Co.  K,  of  the  1st  Kansas  regiment,  who 
was  wounded  at  the  battle  of  Wilson's  Creek,  August  10,  1861.  He  left  the  hospital  for  his  regiment,  well,  November  15,  18(51. 
The  inertia  of  a  spongy  zygoma  splitting  a  minie  ball  of  lead  is  similar  to  that  of  a  tallow  candle  resisting  the  woody  fibres  of 
a  pine  board  when  shot  through  it  from  a  gun."  Relham  was  mustered  out  May  31,  1864,  and  pensioned.  Examiner  W.  Jewell, 
of  Philadelphia,  reported,  December  27,  1864  :  "  Ball  passed  through  his  left  cheek,  lodging  near  the  angle  of  the  lower  jaw. 
The  ball  was  extracted.  The  wound  continues  to  discharge  and  is  probably  connected  with  the  duct  of  Steno.  The  jaw  is  con 
tracted,  preventing  the  opening  of  the  mouth  more  than  half  an  inch."  The  Philadelphia  Examining  Board,  January  3,  1872, 
certified  :  "Ball  entered  through  middle  of  superior  maxillary  bone  of  right  side;  a  part  of  it  was  extracted  in  the  mouth  and 
another  part  in  the  neck  below  the  angle  of  the  lower  jaw.  All  the  back  teeth  of  upper  jaw  of  right  side  decayed 
in  consequence.  He  has  occasional  discharge  from  wound  through  mouth  and  nose.  Motions  of  jaw  limited  and 
painful;  can  chew  on  one  side  only."  The  same  board  reported,  September,  7,  1877:  "Scar  of  entrance  is  puck 
ered  to  a  point  and  adherent.  Exit  is  fast  to  muscles  of  neck  and  drags  badly." 

CASE  1062. — Captain  James  Ferguson,  Co.  I,  4th  Ohio,  was  admitted  into  Seminary  Hospital,  Georgetown, 
December  20,  1862,  with  a  shot  wound  of  the  left  forearm,  received  at  Fredcricksburg.     Surgeon  J.  H.  Brinton, 
U.  S.  V.,  who  examined  this   officer's  injury,  reported:   "A  conical    ball   entered   below  the  inner  condyle  of  the 
humerus,  traversed  the  forearm  obliquely  downward  and  outward  and  split  on  the  radius,  one  portion  emerging  on 
either  side."     Four  and  one-half  inches  of  the   left    ulna   were   removed   by  A.  A.  Surgeon    II.  W.  Ducachet. 
FIG. 388.—     Captain  Ferguson  was  attacked  with  confluent  small-pox  and  removed  to  Kalorama  Hospital,  Washington,  Feb- 
bruken  upon     ruary  8,  1863.     Acting  Assistant  Surgeon   R.  J.  Thomas,  U.  S.  A  .  reported:   "The  condition  of  the  arm  when 
! After "BIHX-     adn»tte<l  was  bad;  no  disposition  to  heal,  with  strong  gangrenous  tendency.     He  died  February  15,  1863."     Sur- 
TON.]  geon  Brinton  furnished  a  drawing  of  the  divided  missile,  which  is  copied  in  the  wood-cut  (FiG.  388). 

Tn  other  cases  bullets  wore  found  wedgod  between  bones  without  serious  injury. 

Simple  Fractures,  following  shot  injuries,  are  infrequent,  and  generally  result  from 
the  impact  of  projectiles  of  the  larger  class,  as  solid  shot,  grape-shot,  or  large  shell  frag 
ments  of  which  the  momentum  is  nearly  expended.  The  examination  of  the  cases  of  shot 
injuries  of  the  lower  extremities  has  confirmed  the  opinion  expressed  on  page  815  of  tlu> 
Second  Surgical  Volume,  "that  shot  fractures  of  the  long  bones  without  injury  of  the  soft 
parts  are  more  infrequent  than  visceral  ruptures  without  external  wounds." 

Hamilton1  observes:    ':When  the  bones  of  a  limb  are  broken  by  a  solid  shot  and  the 

'HAMILTON  (F.  II.),  Treatise  <m  Military  Surgery,  Philadelphia,  16K),  p.  194. 


CHAT    XH.J 


PARTIAL    FRACTURES PENETRATIONS. 


710 


integuments  are  not  torn  the  fracture  is  seldom  simple,  but  almost  always  the  comminution 
is  excessive.  Five  cases  of  simple  fractures  have  been  reported  on  pp.  815,  816  of  the 
Second  Surgical  Volume,  and  three  cases  are  given  on  p.  440  (CASE  693)  and  pp.  704,  705 
(CASES  1044,  1045)  of  this  volume.  To  these  may  be  added  the  following: 

CASE  1063. — Private  H.  Emerson,  Co.  I,  88th  Illinois,  aged  34  years,  was  wounded  at  the  battle  of  Franklin,  Novemlx-r 
30,  1864,  and  was  admitted  to  Cumberland  Hospital  at  Nashville  the  following  day.  Surgeon  B.  Cloak,  U.  S.  V.,  recorded 
that  "the  patient  stated  that  he  was  struck  by  a  spent  cannon  ball.  There  was  no  external  indication  of  the  injury  except  a 
small  bruise  on  the  left  knee  and  a  general  ecchymosed  condition  of  the  surrounding  part.  The  skin  was  not  broken,  but  the 
limb  was  very  much  swollen,  with  pulsation  in  the  popliteal  region.  The  patient's  general  health  was  good.  The  limb  was 
amputated  on  December  1st,  at  the  lower  third  of  the  thigh,  by  the  circular  method,  by  Acting  Assistant  Surgeon  J.  C.  Thorpe, 
when  it  was  found  that  the  popliteal  artery  had  been  ruptured  at  its  lower  portion  and  that  the  condyles  of  the  femur,  tibia,  and 
fibula  were  fractured.  The  patient  seemed  to  do  well  for  twenty-four  hours  after  the  operation,  when  the  wound  became 
unhealthy  and  gangrenous  irritative  fever  set  in  ;  pulse  130,  skin  dry  and  jaundiced.  He  continued  to  sink,  and  died  on  Decem 
ber  13,  1834." 

Partial  Fractures. — Several  instances  of  partial  fracture  of  bone  in  which  a  portion  of 
its  substance  had  been  cut  without  complete  solution  of  the  continuity  were  met  with.  This 
lesion  is  more  commonly  seen  in  spongy  bones  or  in  the  parts  of  long  bones 
well  supplied  with  cancellated  structure.  In  Specimen  1998  (FiG.  389)  the 
external  portion  of  the  surgical  neck  of  the  left  humerus  is  partially  fractured, 
but  the  continuity  of  the  bone  is  not  destroyed.  The  patient, 
Private  John  Gr.  Levering,  Co.  A,  5th  Michigan,  was  wounded  at 
Mine  Run,  November  27,  1863.  On  account  of  the  extremely 
unhealthy  condition  of  the  soft  parts,  the  head  of  the  humerus 
was  excised  December  14th  by  Surgeon  D.  P.  Smith.  U.  S.  V. 
Profuse  suppuration  followed;  the  patient  died  of  pneumonia 
January  3,  1864.  Specimen  1991  (FiG.  390)  shows  a  compara- 
Spec.  tively  clean-cut  passage  in  the  outer  and  upper  portion  of  the  in 
ternal  condyle  of  the  right  femur.  Private  F.  Johnson,  Co.  A, 
10th  New  York,  aged  -15,  wounded  at  Reams's  Station,  August  25,  1864.  On  August  30th 
symptoms  of  inflammation  of  the  knee  joint  presented  themselves,  and  the  limb  was  ampu 
tated  at  the  lower  third  by  Surgeon  iN.  R.  Moseley,  U.  S.  V.;  death  from  exhaustion  and 
diarrhoea  occurred  on  January  23,  1865.  In  the  following  case  a  conoidal  ball  had  gouged 
out  the  anterior  surface  of  the  left  tibia: 

CASE  1064. — Private  Joseph  Stacey,  Co.  I,  27th  North  Carolina,  was  wounded  at  Antietam.  September 
17,  1862,  receiving  a  compound  fracture  of  the  left  tibia;  conoidal  ball  entered  inner  side  of  s]  ine  of  tibia 
and  emerged  one  and  a  half  inches  below  on  the  outer  side.  Patient  had  double  pneumonia  and  pericarditis. 
Stimulants  and  supporting  treatment;  large  bedsore.  Died  of  exhaustion  November  13,  1862.  lost-mortcm: 
Left  lung  almost  altogether  involved,  the  lower  and  middle  lobes  returning  to  the  first  stage;  lower  lobe  of 
right  lung  congested.  The  specimen,  consisting  of  the  upper  portions  of  the  bones 
of  the  left  leg,  was  contributed  to  the  Army  Medical  Museum,  with  the  notes  of  the 
case,  by  Assistant  Surgeon  Philip  Adolphus,  U.  S.  A.  The  missile  has  gouged  out 
the  anterior  surface  of  the  tibia  just  below  the  tubercle.  The  specimen  is  numbered 
815  of  the  Surgical  Section,  and  is  figured  in  the  wood-cut  (FlG.  391). 

Penetrations  of  Pone. — Small  missiles,  as  bullets  and 
small  fragments  of  shell,  often  penetrate  a  bone  and  ivmain 
fixed,  with  little  splintering  and  h'ssurino;.  Instances  of  KIG.  392.-Hrmiofnffiiti.u- 

merus  with  symmetrical  bul- 

tliis  nature  are  met  with  in  spongy  bones  or  in  parts  of  bones    '<•' gri>(ive-  si>fe-  •-'•"' 
whose  structure  is  cancellated.      A  unique  illustration  of  such  an  injury  is  found  in  Specimen 
2590  (  FIG.  392).     An  excavation  at  the  base  of  the  great  tuberosity  of  the  humerus.  the  shape 
and  a  little  greater  than  the  size  of  a  conoidal  ball,  one  inch  deep,  extends  into  the  head  ot  the 
boiH-.      The  walls  of  the  cavity  are  perfectly  smooth,  as  if  formed  by  design,  and  there  is  no 


Fir,.  3S9.— Head 
and  1J  ins.  of_left 
humerus. 
1998. 


FIG.  390.  —  Lower 
rd  of  right  femur. 
tc.  1991. 


Soec  813 


720 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


FIG.  394. — View  of  Spec.  3540,  after  bisection. 


fissuring  or  comminution  connected  with  the  injury.  The  case  has  been  detailed  on  page 
543  of  the  Second  Surgical  Volume  (CASE  1513),  accompanied  by  a  cut  which  only  imperfectly 
indicates  the  nature  of  the  penetration.  In  FIGURE  392  the  nature  and  depth  of  the 
excavation  are  more  clearly  illustrated.  In  the  following  case  the  missile  lodged  in  the 
cancellated  structure  of  the  femur,  but  no  fissuring  or  splintering  were  observable: 

CASK  1055. — Private  J.  Gleason,  Co.  13,  5Jd  New  Hampshire  Heavy  Artillery,  aged  18  years,  was  accidentally  wounded 

at  Washington,  May  10,  1864,  by  a  pistol 
ball,  which  entered  the  upper  third  of  the 
left  thigh  anteriorly.  He  was  conveyed  to 
Douglas  Hospital,  where  pya-mia  subse 
quently  appeared,  the  first  chill  occurring 
on  MaySGtl),  uid  being  preceded  by  marked 
icterus  Tin  ball  could  not  lie  discovered. 
Secondary  haemorrhage  from  the  femoral 
artery  to  the  amount  of  fourteen  ounces 
occurred  on  May  31st.  and  to  the  amount  of 
fifteen  ounces  on  the  next  day,  still  further 
adding  to  the  patient's  depression.  His 
death  occurred  on  June  1,  1864.  At  the 
autopsy  the  whole  body  was  found  to  be 

Fifi.  393.-Onter  view  of  upper  third  of  left     ^P'j  tinged   with    bile.     No    metastatic 
femur.    Spec.  3.14U.  abscesses  were  discovered.     The  knee  joint 

was  found  to  be  disorganized,  as  was  also  the  hip  joint  on  the  wounded  side,  and  a  large  dark-colored  cavity  existed  in  the 
injured  thigh,  which  had  been  an  immense  abscess.  No  secondary  deposits  were  seen  in  the  lungs.  On  dividing  the  femur  longi 
tudinally,  the  medullary  canal  and  cancellated  portion  of  the  bone  were  found  in  a  diseased  condition. 
The  medulla  was  softened,  of  a  dark  red  color,  and  in  the  early  stage  of  that  change  which  is  seen  in  well- 
marked  cases  of  pyaemia  after  amputation,  when  this  material  is  found  of  a  dark  green  color  and  iti  a 
state  of  advanced  decomposition.  Before  death  the  patient  had  wandering  delirium  for 
days,  profuse  perspiration,  chills,  a  rapid  feeble  pulse,  and  icteroid  hue.  The  upper 
third  of  the  injured  thigh,  longitudinally  bisected,  and  showing  an  impacted  pistol  ball, 
which  penetrated  the  base  of  the  neck  and  lodged  in  the  cancellated  portion,  consti 
tutes  specimen  3540  of  the  Surgical  Section  of  the  Museum  (FiGS.  393,  394),  and  were 
contributed,  with  the  history  of  the  case,  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A. 

More  frequently  penetrations  were  accompanied  by  fissur 
ing  and  splintering.     Specimen  406  (FiG.  395)  represents  the 
lower  third  of  the  left  femur  with  a  conoidal  ball  embedded 
just  above  the  patella.      A  fissure  extends  upward  three  and  a 
I'm.  3'js.-Lower  third    half  inches,  and  another  and  independent  fissure  occupies  the 

of  left  femur.  Spec.  406.  ~.  ~         „     ,  ,,.  r    TV  r  Spec.  403. 

outer  surface.  Ihe  patient,  a  Confederate  soldier  of  Mor 
gan's  Cavalry,  had  been  wounded  in  a  skirmish  in  front  of  Winchester  by  a  minie!  ball, 
which  perforated  the  quadriceps  femoris  close  above  the  left  patella  and  lodged  one  inch 
above  the  articular  surface  of  the  knee  joint.  The  limb  was  amputated  by 
Dr.  V.  B.  Thornton.  The  patient  recovered.  Specimen  405  (FiG.  396)  shows 
the  lower  third  of  the  right  femur  with  a  conoidal  ball  embedded,  point  down 
ward,  in  the  anterior  surface,  just  above  the  articulation;  a 
fissure  extends  upward  the  length  of  the  specimen.  Pri 
vate  Joseph  J.  Shelley,  2d  Tennessee  (Confederate),  was 
wounded  at  the  battle  of  Middle  Creek,  Kentucky,  January 
10,  1862;  the  limb  was  amputated  by  Dr.  G.  H.  Higgins, 
in  the  lower  third  of  the  thigh.  The  patient  died  a  few 
7.  i.nver  hours  after  the  operation  from  loss  of  blood.  In  those  two  Fw.m_Lowere]rtrein. 

instances  as  well  as  in    specimens  4179  and  3228  (FiGS.    i<y°fle«"-ur-  *~ 
397,  398),  received  without  history,  the  former  from   the  battle-fields  of  the  Wilderness, 
the  latter  from  in  front  of  Petersburg,  the  fissures  do  not  extend  into  the  knee  joint,  although 


(HAP.  XII.] 


PERFORATIONS    OF    BONE. 


721 


Fl<;.   399.—  Section  of 
left  lemur.     Sjifc.  70ti9. 


FIG.  400.— Upper 

portion  of  left    tibia 
perforated.    Spec. 

1662. 


t.lie  point  of  impact  was  close  to  the  articulation.      Illustrations  of  similar  injuries  in  the 
humeru>  will  be  found  on  page  584  of  the  Second  Surgical  Volume,  FIGURES  461  and  462. 

Perforations  of  Bone. —  The  illustrations  show  the  manner  in  which 
bones  may  be  more  or  less  cleanly  pierced.  When  shafts  of  long  bones 
are  perforated  there  is  commonly  much  splintering,  as  illustrated  in  Specimen 
7069  (FiG.  399*).  A  Colt's  revolver  ball  passed  through  the 
upper  third  of  the  femur  from  behind  forward,  comminuting 
the  femur;  amputation  was  performed  about  twelve  hours 
after  the  injury;  death  three  hours  alter  the  operation.  In 
Specimen  1662  (FiG.  400),  the  tibia  had  been  perforated 
below  the  head,  causing  longitudinal  fissures:  Private  Frank 
B.  Robinson,  Co.  II,  7th  New  Hampshire,  wounded  at  Fort 
Wagner,  Morris  Island,  July  11,  1863.  The  posterior  tibial 
artery  was  injured.  Secondary  haemorrhage  ensued,  and  on 
August  1  st  the  limb  was  amputated  in  the  lower  third  by  Surg. 
K.  B.  Bontecou  by  the  circular  method.  The  patient  died  August  11,  1863.  In  the  follow 
ing  case  the  perforation  was  in  the  lower  third  of  the  femur,  with  fissures  extending  upward: 

CASE  1066. — Private  S.  S.  Kopp,  Co.  E,  10th  Pennsylvania  Reserves,  aged  21 
years,  received  a  shot  fracture  of  the  right  femur,  at  Bull  Run,  August  28,  1862. 
He  was  admitted,  one  week  after  the  injury,  to  Judiciary  Square  Hospital  at  Wash 
ington,  where,  the  thigh  was  amputated  at  the  middle  third  by  Surgeon  C.  Page, 
IT.  S.  A.,  on  September  20th.  The  patient  survived  the  operation  two  days.  The 
amputated  portion  of  the  femur,  perforated  just  above  the  patella  by  a  musket  hall, 
was  contributed  by  tlw  operator,  and  forms  specimen  76  of  the  Suryical  Section.  It 
is  represented  in  the  wood-cuts  (FlGS.  401,  402);  two  longitudinal  fissures  extend 
upward  and  a  slight  one  enters  the  joint. 

In  the  next  case  the  shaft  of  the  femur  is  perforated  in 
its  centre.  A  longitudinal  fissure  on  the  anterior  surface 
extends  into  the  joint  and  for  four  inches  upward,  ending 
in  a  slight  transverse  fissure;  on  the  posterior  surface  an 

FIG.  401  .—Lower  third  °  i 

Tfsg*c  7o'm'r  ''erf"rated-    oblique  fracture  runs  upward  for  nearly  four  inches.  I11CI1. 

CASK  1067. — Private  Reuben  Donnelly,  Co.  A,  25th  Ohio,  was  wounded  at  Bull  Run,  August  30,  1862.  Acting  Assistant 
Surgeon  Thomas  C.  Barker  reported:  ''  H«  entered  King  Street  Hospital,  Alexandria,  on  September  3d,  suffering  with  a  wound 
of  the  right  thigh.  A  round  ball  entered  the  front  part  of  the  thigh  just  above  the  patella  and  passed  directly  through  the  limb 
from  front  to  rear,  dividing  the  condyles  and  splitting  the  bone  up  the  shaft  several  inches.  On  September  f>th  Surgeon  J.  E. 
Summers,  T.  S.  A.,  amputated  the  thigh  at  the  junction  of  the  lower  and  middle  thirds  by  the  antero-posterior  flap  operation. 
The  case  progressed  favorably.  Union  had  taken  place  throughout  the  whole  of  the 
Haps,  with  the  exception  of  one  point,  about  one-eighth  of  an  inch  in  diameter,  over 
the  end  of  the  bone,  which  lay  at  a  depth  of  three-fourths  of  an  inch  below  the  orifice 
of  the  aperture.  Patient's  health,  appetite,  and  general  vigor  had  been  good  up  to 
the  night  of  October  3d.  when,  during  a  cold  rain,  he  was  attacked  with  a  severe  chill. 
The  next  day.  in  the  afternoon,  he  had  another  chill,  and  although  tonics  and  stimu 
lants  were  sedulously  used  with  him,  he  sank  in  general  vigor  and  his  appetite  failed. 
Absorption  of  the  new  granulations  took  place  around  the  aperture  which  had  remained 
nnunited,  and  the  opening  increased  to  nearly  an  inch  in  diameter,  the  integuments 
retracting  and  leaving  the  end  of  the  bone  nearly  on  a  level  with  the  external  surface. 
Suppuration  occurred  in  the  medullary  canal  of  the  bone.  Emaciation  was  extreme; 
debility  was  rapidly  increasing,  with  indisposition  and  incapacity  of  taking  and  retain 
ing  food,  or  even  stimulants  to  any  appreciable  amount;  and  the  patient  gradually 

KH,.  40:1.— Shot  per      sank,  and  died  of  exhaustion  and  debility  October  20,  1^62."      The  specimen,  consist- 
flTeriorvLwg1lt^n3ll<)!      '"--  "t't1"'  1('Wl'st  tllil'(1  (lt'  t1"'  ri.-nt  *'''»'""•  perforated  by  a  round  ball  directly  through      „„-,, 

the  centre  of  the   shaft,  just  below  the  upper  margin  of  the  patella,  was  forwan  td  to 

the  .Museum  by  Dr.  Barker,  and  is  represented  in  the  wood-cuts  (Kios.  40:?,  -40-1).     The  shaft  is  split  longitudinally  in  its  ante 
rior  surface  for  four  indies,  and  posteriorly  obliquely  for  the  same  distance.      The  condyles  are  also  separated  by  a  fissure. 

SURG.  Ill— 91 


FIG.    402.  —  Posterior 
view  of  the  same  sped 


FIG.  404.  —  Posterior 
view  of  the  same  speei- 


722 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


TlG.  405. — Posterior 
view  of  upper  portion 
right  tibia.  Spec.  1444. 


FIG.   406. —  The 

same  specimen ;  lat 
eral  view. 


In  a  case  of  transverse  perforation  of  the  tibia  just  below  the  head  no  fissuring  was 

noticeable  six  months  after  the  injury,  when  the  patient  died  from  exhaustion: 

CASK  10(38. — Private  J.  W.  Sailor,  Co.  K,  48th  North  Carolina,  aged  23  years,  was  wounded  in  the  right  leg,  at  Hatcher's 
Run,  March  13,  18f).~>.  lie  was  treated  in  Confederate  hospitals  until  May  6th,  when  he  was  admitted  into  hospital  at  Point 
Lookout.  Subsequently  he  was  transferred  to  Armory  Square,  and  lastly  to  Douglas 
Hospital,  Washington.  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A.,  in  charge  of  the  latter, 
made  the  following  report:  "The  wound  was  caused  hy  a  ball  perforating  the  tibia  at 
the  upper  third  without  involving  the  knee  joint.  The  patient  was  cachectic  and  much 
emaciated,  the  wound  indolent  and  discharging  a  thin  unhealthy  pus.  Stimulants,  tonics, 
and  good  nutritious  diet  were  freely  exhibited.  On  September  3d  the  wound  was  care 
fully  examined  and  a  considerable  quantity  of  carious  bone  was  removed.  On  the  next 
day  the  patient  had  a  severe  chill  which  recurred  on  the  (5th.  He  had  been  subject  to 
periodical  chills  and  fever,  and  this  attack  of  intermittent  yielded  readily  to  a  full  dose 
of  quinine.  On  September  10th  slight  diarrhoea  came  on  and  continued  for  nine  days, 
the  patient  growing  much  weaker.  The  wound,  which  had  improved  in  appearance  after 
the  removal  of  the  dead  bone,  again  looked  unhealthy,  small  abscesses  having  formed 
along  the  line  of  the  tibia,  which,  when  opened  and  examined  by  the  probe,  showed 
extensive  necrosis  of  the  bone.  Subsequently  the  patient  had  a  slight  chill,  which  was 
followed  by  an  attack  of  erysipelas  of  the  leg,  and  from  this  period  he  steadily  declined. 
He  died,  apparently  of  exhaustion,  on  October  1,  1865.  The  autopsy  showed  a  dirty 
yellowish  clay  color  of  the  skin.  The  thoracic  and  abdominal  organs  were  apparently 
healthy,  except  the  liver  and  the  spleen,  the  former  being  enlarged  and  the  latter  much 
softened  and  weighing  fourteen  ounces."  The  perforated  tibia,  contributed  with  the  his 
tory  by  Assistant  Surgeon  Norris,  and  constituting  Specimen  1444  of  the  Surgical  Section 
of  the  Museum,  exhibits  the  deposit  of  a  large  quantity  of  callus  on  the  outside  of  the 
bone,  and  shows  the  cavity  of  the  passage  of  the  ball  to  be  enlarged  by  ulceration,  the  lower  portion  of  the  shaft  being  super 
ficially  necrosed.  Posterior  and  lateral  views  of  the  specimen  are  copied  in  the  wwod-cuts  (FlGS.  40,">,  40G). 

Complete  Fractures.  —  In  by  far  the  greater  number  of  shot  fractures  of  bones  the 
solution  of  continuity  is  complete,  the  degree  of  comminution  depending  upon  the  attend 
ing  circumstances.  In  rare  instances  fractures,  transverse  or  oblique,  but 
simple  as  regards  comminution,  occur.  They  are  commonly 
due  to  the  impact  of  partly  spent  missiles  or  to  glancing  or 
grazing  blows.  Specimen  ]  148  (FiG.  407)  shows  an  oblique 
fracture  in  the  upper  third  of  the  left  femur,  with  a  minute 
fissure  extending  to  the  lesser  trochanter  and  a  small  portion 
chipped  from  the  anterior  surface  at  the  point  of  impact.  The 
case  has  been  fully  detailed  on  page  131  of  this  volume.  Speci 
men  1210  (illustrated  in  the  Second  Surgical  Volume  on  page 
475,  and  a  history  recorded,  in  detail,  on  page  482  of  the  First 
Surgical  Volume]  shows  the  left  clavicle  transversely  fractured 

r  lu.  -iu<. — r  raoture  ol        -,  •  -,  ,  •  i  11  •  •  •  rrn 

the  upper  third  of  the    chrQctly  m  the  middle   without    comminution.     The    missile, 

left  femur  by  a  conoidal  *  .  „  ..  , 

which  is  attached,  was  a  conoidal  ball  which  entered  near  the  Spec-u 
third  dorsal  vertebra,  fractured  the  corresponding  rib  at  its  angle,  and  was  found  after  death 
encysted  immediately  beneath  the  fractured  point  of  the  clavicle.  Another  illustration  of 
this  rare  fracture  is  given  in  FIGURE  408.  The  Specimen,  number  1412,  shows  the  lower 
half  of  the  right  humerus  apparently  amputated  for  a  nearly  transverse  fracture  through 
both  condyles;  it  was  received  without  history  from  Surgeon  G.  S.  Wood,  66th  New  York. 
In  these  cases  the  missile  is  usually  found  in  close  apposition  to  the  fractures. 

A  form  of  injury  is  referred  to  in  Circular  No.  6,1  in  which  the  bones  are  fractured 
and  comminuted,  though  less  than  common  at  the  point  where  the  ball  impinged,  while  at 
a  short  distance  above  or  below  this  point  an  oblique  or  transverse  fracture  is  produced. 
When  point  of  impact  is  above  the  middle  of  the  bone,  the  fracture  is  below;  when  below 

'OTIS  (G.  A.),  Circular  A'o,  6,  War  Department,  Surgeon  General's  Office,  Washington,  November  1,  1865. 


FIG.  408.- Trans 
verse  fracture  in 
lower  luimerus. 


CHAP.  XII.] 


COMPLETE    FRACTURES. 


723 


Fin.  410.— Lon-er 
half  of  left  femur. 
Spec.  1064. 


the  middle,  the  oblique  fracture  is  found  above.  Specimen  4703  (FiG.  409)  shows  a  nearly 
transverse  fracture  in  the  middle  of  the  left  tibia,  communicating  with  the  point  of  impact 
by  a  longitudinal  fissure.  Specimen  1064  (FiG.  410)  exhibits  the  lower  portion  of  the  left 
femur,  amputated  in  the  middle  third  for  a  perforation  with  oblique  fracture 
above  the  seat  of  injury:  Lieutenant  F.  M.  Wells,  Co.  D,  132d  Pennsylvania, 
received,  at  Chancellorsville,  May  2,  1863,  a  comminuted  fracture  of  the  left 
femur  just  above  the  condyles.  He  was  at  once  removed  to  the  field  hospital, 
and  on  May  6th  was  transferred  to  Washington  and  admitted  into 
Armory  Square  Hospital.  Shortly  after  admission  he  was  placed 
under  the  influence  of  chloroform  and  the  injured  limb  examined. 
It  was  decided  to  amputate  the  thigh  at  the  middle,  which  opera 
tion  was  performed  by  the  antero-posterior  flap  method,  by  Assist 
ant  Surgeon  C.  C.  Byrne,  U.  S.  A.  The  patient  gradually  sank, 
and  died  June  2,  1863. 

In  the  following  case  the  transverse  fracture  is  connected  with  the  point 
of  impact  by  several  fissures.  Fractures  of  this  nature  are  principally  found  in 
the  long  bones  of  the  lower  extremities,  and  are  probably  the 
result  of  the  direct  impact  of  a  missile  at  high  velocity  upon  the 
bones  somewhat  firmly  fixed  by  the  weight  of  the  body: 

CASK  lUijy.  —  Private  J.  Scanton,  Co.  A,  3d  Maryland,  was  wounded  at  Cedar  Mouu- 
Utin,  August  9,  18b'2,  by  a  musket  ball,  which  entered  above  the  external  condyle  of  the 
left  femur  and  passed  directly  through  from  front  to  rear,  badly  comminuting  the  shaft  to 
the  extent  of  tour  inches.  He  was  admitted  into  the  Mansion  House  Hospital  at  Alex 
andria  several  days  afterwards.  Infiltration  of  the  soft  parts  from  the  anterior  superior 
spinous  process  of  the  ilium  to  the  spine  of  the  tibia,  followed  the  injury.  Amputation  of 
the  thigh  at  the  middle  third  by  the  circular  method  was  performed  by  Assistant  Surgeon 
P.  Adolphus,  U.  8.  A.,  on  August  15th.  and  the  case  resulted  fatally  on  August  '20,  1862.  The  history  of  the 
case,  with  the  amputated  portion  of  the  femur,  was  contributed  by  Surgeon  J.  E.  Summers,  U.  S.  A.  The 

bone  is  numbered  specimen  42  of  the  Suriiiral  Section  of  the  Museum,  and  exhibits  an  extensive  longitudinal 
.....  .     .  ,.  .  ,  ,  ,,. 

fracture  implicating  the  joint,  and  being  complicated  with  an  oblique  fracture  in  the  lowest  third  (riG.  411). 

Commonly  a  bone  is  broken  into  many  fragments,  some  of  which  are  entirely  detached 
and  driven  into  the  surrounding  tissues,  while  others  remain  connected  with 
one  or  more  of  the  fragments  by  shreds  of  periosteum.  Over 
and  above  this  shattering  and  comminution,  effects  common 
to  all  forms  and  varieties  of  missiles,  the  extensive  splinter 
ing  and  fissuring  so  often  found  is  unquestionably  due  to  the 
wedgelike  form  and  great  force  of  the  conoidal  bullet: 

CASE  1070.  —  Corporal  S.  Forrester,  Co.  E,  67th  New  York,  aged  37  years,  was 
wounded  in  the  left  leg,  at  the  battle  near  Winchester,  September  19,  1864.  He  was 
admitted  into  the  Sixth  Corps  hospital  several  days  afterwards,  whence  Assistant 
Surgeon  J.  G.  Thompson,  77th  New  York,  described  the  injury  as  follows  :  "A  minie" 
ball  entered  the  posterior  edge  of  the  outer  tuberosity  of  the  tibia,  taking  a  down 
ward  direction  through  the  medullary  canal,  comminuting  the  bone  and  becoming 
impacted  beneath  its  anterior  surface,  at  the  junction  of  the  middle  and  upper  thirds. 
On  the  morning  of  September  24th  I  performed  amputation  through  the  lower  third 
of  the  thigh,  being  assisted  by  Acting  Assistant  Surgeons  W.  L.  Hammond  and  W. 
I).  Henderson.  The  operation  was  done  by  a  modification  of  the  ordinary  flap 
method,  making  the  incision  the  same  as  for  skin  flaps,  as  described  in  Smith's 
Operative  Surf/cry,  which  obviates  the  redundancy  of  muscle  characteristic  of  the 
ordinary  Hap  method,  and  still  gives  enough  to  preserve  the  even  contour  of  the 
stump.  The  patient  suffered  considerable  pain  previous  to  the  operation,  which  was  subsequently  relieved,  and  by  September 
28th  he  was  doing  well,  the  stump  healing  by  first  intention.  Toward  October  8th,  however,  traces  of  phlebitis  appeared  in 
the  stump,  thrombosis  in  the  femoral  and  internal  saphenous  vein,  and  the  patient  was  troubled  with  hiccough  and  vomiting. 
Stimulants,  tonics,  and  nutritious  diet  were  administered.  Death  resulted  from  pyaemia  on  October  13,  1864.  At  the  autopsy 


Upper 
half  of  left  tibia.— 
Spec.  4T():i. 


F1G-  411-  —  Lower 
half  of  left  femur. 
spec.  42. 


Fl<;.  412. —  Hones  of 
left  leg  shattered  by  a 
coiioidal  ball.  .Spec.  3L'7:i. 


FiG.  413. — Same  speci 
men  ;  posterior  view. 


'24 


WOUNDS    ASD    COMPLICATIONS. 


[CHAP.  XII. 


FIG,  414.— Uppe 
portion  of  left  humer 
us.  Spec.  1726. 


the  face  of  the  stump  was  found  to  be  granulating  and  surrounded  with  provisional  callus;  femoral  vein  filled  with  thrombus: 
pus  oozing  from  both  the  femoral  and  iliac  veins;  metastatic  abscesses  under  the  integument  covering  the  lower  portion  of  the 
pectoralis  major  muscle;  fatty  degeneration  of  the  liver.  In  the  left  ventricle  of  the  heart  an  embolism  was  found  adherent  1<> 
the  valves."  The  bones  of  the  amputated  leg.  contributed  to  the  Museum  by  the  operator  and  shown  in  the  wood-cuts  (FiGS. 
412.  413),  constitute  specimen  H27!>  of  the  Suryical  Section. 

When  the  shaft  of  a  long  bone  is  fractured  about  equidistant  from  the  epiphyses  the 
fissures  extend  upward  and  downward  in  about  equal  proportion;  but  as  the  point  of  frac 
ture  approaches  the  ends  the  tendency  is  to  split  in  the  direc 
tion  of  the  longer  fragment.     This  is  particularly  noticed  in 

o  O  I  J 

fractures  of  the  humerus  near  the  head,  where  the  general 
tendency  of  fissuring  is  downward.  Specimen  1726  (FiG.  414) 
is  the  excised  portion  of  the  left  humerus,  including  tlie  head 
and  four  inches  of  the  shaft.  The  fracture  is  at  the  surgical 
neck,  and  extends  with  comminution  obliquely  down  the  shaft. 
Excision  of  the  head  and  four  inches  of  the  shaft  was  per 
formed  and  the  specimen  contributed  by  Assistant  Surgeon 
George  M.  McGill,  U,S.  A.  Specimen  2160  (FiG.  415)  shows 
the  upper  half  of  the  right  femur;  the  missile  struck  the  ante 
rior  surface  of  the  bone  a  little  below  the  trochanter  minor 
and  shattered  and  fissured  the  femur  downwards.  In  Speci 
men  2176  (FiG.  416)  the  comminution  extends  upward  and  portio'n  of  right  femur. 

Spec.  2160. 

downward  in  about  equal  proportion.  The  weapon  was  dis 
charged  at  close  range.  The  soldier,  John  Watson,  Co.  F,  83d  Indiana,  while  on  duty  at 
Convalescent  Camp,  Nashville,  became  enraged  from  some  cause,  threw  his  musket  from 
him,  causing  its  discharge.  The  missile,  a  mini^  ball,  entered  the  right 
thigh,  greatly  lacerating  the  soft  parts  and  extensively  comminuting  the 
femur.  He  died  on  the  same  clay.  The  specimen  is  a  fair  illustration  of 
the  effects  of  a  conoidal  ball  at  short  range. 

From  a  careful  examination  of  a  large  number  of 
specimens  of  long  bones  in  the  collection  of  the  Army 
Medical  Museum  it  would  seem  that  the  statement  made 
by  Esmarch  is  correct,  that  "in  comminution  of  along 
bone  the  fissures  almost  never  extend  into  the  epiphyses; 
in  the  same  manner  injuries  of  the  epiphyses.  only  in 
rare  cases,  extend  into  the  shaft,  unless  the  bullet  strikes 
the  adjoining  border  of  both  parts,  in  which  case  both 
are  usually  more  or  less  severely  comminuted.".  This  is 
probably  due,  in  the  greater  number  of  cases,  as  Esmarch 
says,  "to  the  soldier  being  generally  young  and  the  parts 
not  consolidated."  The  Museum  possesses  several  speci 
mens  showing  this  kind  of  injury,  some  of  which  have 
been  illustrated  on  the  preceding  pages  (see  FIGURES  409,  410).  The  few 
exceptions  to  this  rule  seem  to  be  cases  in  which  the  consolidation  is  complete,  or  in  which 
the  direction  of  the  missile  was  such  as  to  necessarily  cause  this  effect,  as  in  Specimen  2564 
(FiG.  417),  where  fissures  extend  through  the  head  and  into  the  shaft. 

It  has  been  shown  that  cases  of  penetration  and  perforation  of  bones  may  occur  with 
out  complete  fracture;  but  the  contrary  is  the  more  general  rule,  and  even  in  spongy  bones, 


KJ(;.   417.— Upper  third  of 


CHAP.  XII]  EFFECTS    OF    MISSILES    ON    NERVES.  725 

where  we  naturally  look  for  such  lesions,  it  will  usually  be  found  that  complete  destruction 
of  the  bone  has  resulted. 

EFFECTS  OF  MISSILES  AND  PKOJECTLLES  ON  NERVES. —  Shot  wounds  and  injuries  of  nerves 
afforded  a  wide  field  for  study  and  observation  during  the  late  war. 

Wounds  of  this  class,  not  implicating  the  great  nerve  centres  and  not  complicated  by 
severe  lesions  of  other  tissues  and  parts,  show  a  very  small  percentage  of  mortality,  but 
comprise  a  class  of  injuries  which  result  too  often  in  great  and  permanent  disability,  attended 
with  intense  suffering  and  misery,  and  are  often  but  little  amenable  to  treatment. 

In  May,  1863,  under  the  direction  of  the  Surgeon  General,  U.  S.  A.,  a  hospital  for 
the  treatment  of  diseases  and  injuries  of  the  nervous  system  was  organized  in  Philadelphia, 
under  the  charge  of  Acting  Assistant  Surgeons  S.  Weir  Mitchell,  George  R.  Morehouse, 
and  W.  W.  Keen,  jr.,  U.  S^A.1 

The  results  of  the  experience  of  these  gentlemen  in  the  study  and  treatment  of  the 
large  number  of  cases  under  their  charge  have  been  incorporated  by  them  in  several  pub 
lications  which  form  most  valuable  contributions  to  the  literature  of  a  much  neglected 
subject,  and  constitute  an  admirable  digest  of  the  typical  forms  of  nervous  lesions  resulting 
from  shot  injuries.2 

The  immediate  effects  of  shot  injuries  of  nerves  were  pain — not  generally  felt  locally, 
but  at  some  point  in  the  distribution  of  the  nerve — in  completely  divided  nerves;  total  loss 
of  sensation  in  the  parts  supplied  by  it;  shock  more  or  less  profound,  proportionate  to  the 
reflex  disturbance;  and  paralysis  of  motion  and  sensation,  complete  or  partial.  Of  forty- 
eight  cases  of  severe  gunshot  injuries  of  nerves  selected  with  a  reference  to  the  study  of 
the  immediate  effects  of  injuries,  Drs.  Mitchell,  Morehouse,  and  Keen  (loc.  cit.,  p.  14) 
found  that  "by  far  the  larger  number  felt,  when  shot,  as  though  some  one  had  struck  them 
sharply  with  a  stick,"  and  that  "about  one-third  experienced  no  pain  nor  local  shock  when 
the  ball  entered.  *  :':  More  rarely,  the  pain  of  the  wound  was  dagger-like  and  intense, 
while  a  few,  one  in  ten,  were  convinced  for  a  moment  that  the  injured  limb  had  been  shot 
away;  *  *  in  two  instances  of  neck  wounds  the  pain  at  the  moment  of  wounding  was 
intense,  and  was  referred  to  the  insertion  of  the  deltoid  muscle." 

In  a  case  of  shot  wound  of  the  leg  the  patient  felt  no  pain,  but  had  so  vivid  an  "impres 
sion  "  of  a  wound  in  the  other  leg  that  he  found  it  difficult  at  first  to  get  rid  of  the  erroneous 
idea.  With  reference  to  the  shock  from  wounds  of  nerves  the  same  authorities  (loc.  cit., 
p.  15)  say:  "Every  case  of  wound  of  nerve  trunks  in  the  legs  fell  instantly,  and  not  one  of 
the  whole  twelve  lost  consciousness;  yet  in  gravity  and  in  the  size  of  the  nerves  injured  these 
were  among  our  worst  cases.  Of  the  remaining  thirty-one,  seven  fell  instantly,  uncon 
scious;  one  only  of  these  bled  very  largely.  All  of  the  seven  were  wounded  in  the  neck, 
face,  or  arms.  Of  the  total  number  of  arm  cases  (eighteen  in  all)  two  were  of  the  class 
described  above  as  falling;  senseless.  Of  the  remainder,  two  onlv  fell,  but  with  entire  con- 

o  •/ 

1  The  following  is  a  copy  of  the  order  organizing  this  hospital:  "  SUKGEON  GENEUAI/8  OFFICE,  May  23,  1863.  Surgeon  W.  S.  KDCG,  U.  S.  A., 
Medical  Director,  Philadelphia.  Sill:  The  Surgeon  General  directs  that  a  ward  be  set  apart  in  either  the  South  or  Christian  Street  Hospital  for  the 
exclusive  treatment  of  diseases  of  the  nervous  system,  and  that  contracts  be  made  with  Doctors  S.  \V.  MITCIIKI.L  and  MOUEHOUSE,  and  that  they  be 
assigned  to  the  charge  thereof.  .  .  .  Very  respectfully,  your  obed't  serv't.  By  order  of  the  Surgeon  General.  J.  K.  SMITH,  Surgeon  U.S.A.' 
Acting  Assistant  Surgeon  W.  W.  KEEN,  jr.,  U.  S.  A.,  was  subsequently  assigned  to  duty  at  this  hospital  as  resident  physician,  and  the  scope  of  the 
hospital  enlarged  to  include  patients  suffering  from  injuries  of  the  nerves. 

'MITCHELL  (S.  W.),  MOUEHOUSE  (G.  U.),  and  KEEN  (W.  W.)  (Gunshot  Wounds  and  other  Injuries  of  Xcrres.  Philadelphia,  1864,  p.  9)  remark 
upon  the  number  and  variety  of  the  cases  presented  for  treatment  in  the  Philadelphia  hospital  as  follows  :  "  Among  them  were  representatives  of  every 
conceivable  form  of  nerve  injury — from  shot  and  shell,  from  sabre  cuts,  contusions,  and  dislocations.  So  complete  was  the  field  of  study  that  it  was  not 
uncommon  to  find  at  one  time  in  the  wards  four  or  five  cases  of  gunshot  injuries  of  any  single  large  nerve.  It  thus  happened  that  phenomena,  which  one 
day  seemed  rare  and  curious,  were  seen  anew  in  other  eases  the  next  day,  and  grew  commonplace  as  our  patients  became  numerous." 


726  WOUNDS  AND  COMPLICATIONS.  [CHAP.  xn. 

sciousness  and  in  full  possession  of  their  senses;  fourteen  continued  standing,  or  walked 
away.  *  *  Of  the  wounds  of  the  lower  neck  and  axilla,  brachial  plexus,  or  axillary 
nerves,  one  fell  senseless,  four  fell  conscious,  and  the  remaining  eight  suffered  no  imme 
diate  fall.  *  *  If,  then,  we  regard  the  fall  with  loss  of  consciousness  as  the  most  marked 
expression  of  the  condition  known  as  shock,  we  shall  have  some  right  to  infer  that  it  is 
most  likely  to  be  severely  felt  in  wounds  about  the  upper  third  of  the  body." 

In  paralysis  of  nerves,  motion  is  more  frequently  impaired  than  sensation.  Mitchell, 
Morehouse,  and  Keen  remark  (loc.  cit.,  p.  18):  "It  would  be  natural  to  suppose  that  a  ball 
striking  a  nerve,  or  passing  near  it,  would  equally  damage  its  motor  and  sensory  fibres. 
Practically,  it  is  the  motor  filaments  which  suffer  most  severely,  most  often,  and  most 
extensively.  Nor  is  this  less  true  of  the  case  in  all  stages,  for  we  find  that  the  lesions  of 
motion  are  always  the  least  readily  relieved  and  the  last  to  improve." 

Of  the  forty-eight  cases  studied  by  these  gentlemen  (loc.  cit.,  p.  17)  with  reference  to 
paralysis,  five  were  rejected  as  being  wounds  affecting  nerves  of  single  function;  of  the 
remaining  forty-three,  "thirty-two  exhibited  total  loss  of  motion  with  defective  sensation 
or  entire  loss  of  that  function.  In  the  remaining  eleven  there  were  partial  loss  of  motion 
and  usually  slight  loss  of  sensation."  In  defining  total  loss  of  motion  "it  is  to  be  under 
stood  that  the  whole  limb  became  powerless  at  once." 

Of  injuries  resulting  from  shot  wounds  of  the  great  centres,  those  of  the  cranium  have 
been  fully  considered  in  the  previous  parts  of  the  history;  it  may  bo  stated  in  general 
terms  that  the  greater  percentage  of  such  injuries  proved  fatal  at  once  or  within  a  short 
period.  Those  who  survived  the  original  injury  most  generally  became  the  victims  of 
insanity,  epilepsy,  or  chorea.1 

CASE  1071. — Private  W.  T.  White,  Co.  D,  84th  Indiana,  aged  20  years,  was  wounded  at  Chickamauga,  September  19, 
1863.  Surgeon  W.  M.  Chambers,  U.  S.  V.,  noted  his  admission  into  hospital  No.  15,  Nashville,  with  "gunshot  wound  of  upper 
jaw,  with  injury  of  infra-orbital  nerve;  simple  dressings  applied."  The  patient  was  discharged  from  service  at  Madison,  Indiana, 
May  1G,  1864,  and  pensioned.  Examiner  George  W.  Mears,  of  Indianapolis,  reported,  June  21,  1864:  "Ball  entered  left  side 
of  nose  one-half  inch  below  the  inner  corner  of  the  eye,  and  ranging  backward  and  outward  escaped  on  the  posterior  and  outer 
or  left  side  of  the  neck  two  inches  from  the  ear.  The  wound  is  healed  except  at  a  point  forward  of  the  ear,  where  an  abscess 
formed.  The  sight  of  the  left  eye  is  nearly  extinct.  The  under  lid  is  somewhat  deformed  and  the  cheek  much  swollen.  There 
is  also  a  constant  discharge  of  saliva  from  the  left  corner  of  the  mouth,  which  is  also  slightly  deformed."  Examiner  J.  C.  Helm, 
of  Muncie,  Indiana,  reported,  November  10,  1868  :  "The  sight  of  the  left  eye  is  much  injured,  and  what  there  is,  is  in  my  opinion 
worse  than  useless,  as  the  eyeball  is  so  much  turned  outward  as  to  destroy  the  axis  of  vision  and  confuse  the  mind  with  other 
objects.  The  ball  passed  through  the  base  of  the  skull,  evidently  injuring  the  cerebellum,  and  as  a  consequence  he  suffers  from 
vertigo,  dizziness,  blindness,  faintness,  etc.,  and  has  frequent  spells  of  severe  pain  in  the  head,  which  are  increased  by  exercise 
or  excitement.  These  symptoms  are  growing  worse,  and  he  is  in  great  danger  of  insanity,  which  I  fear  will  ultimately  be  his 
lot.  The  deformity  is  also  growing  worse;  the  eyeball  is  turned  out  and  is  constantly  red,  part  of  the  face  is  paralyzed  and 
twisted  over  so  as  to  be  quite  hideous,  and  is  getting  worse,  as  are  all  these  symptoms,  so  that  altogether  his  disability  is  equal 
to  or  worse  than  the  loss  of  a  limb."  Later  reports  do  not  show  any  improvement  in  the  condition  of  the  pensioner.  The  pen 
sioner  was  paid  December,  1881. 

A  reference  to  TABLE  CXVII,  page  689,  ante,  will  indicate  the  large  number  of  wounds 
recorded  as  affecting  in  some  manner  the  spinal  column  and  its  contents.  The  percentage 
of  mortality  will  afford  some  evidence  as  to  the  varying  extent  and  gravity  of  these  wounds. 
Where  the  spinal  cord  was  severed  or  involved,  a  fatal  issue  seems  to  have  ensued  more  or 
less  remotely. 

Aside  from  these  there  were  innumerable  cases  of  lesions  in  which  it  was  evident  that 
there  had  been  damage  done  to  the  nervous  centres  by  concussion,  compression,  or  contu 
sion,  or  in  which  were  presented  the  phenomena  of  reflex  paralysis. 

'Instances  of  epilepsy  following  injuries  of  the  skull  will  be  found  in  the  First  Surgical  Volume,  at  pp.  02,  48,  50,  54,  55,  59,  118,  119,  176,  177, 
187,  193,  194,  196,  198,  215,  218,  221,  228,  230,  235,  237,  238,  257,  270,  282,  284,  287,  288.  289,  293,  319,  and  341,  and  of  impairment  of  tbe  mental  faculties 
at  pp.  12,  30,  53,  117,  118,  119,  120,  164,  166,  171,  172,  173,  174,  175,  176,  181,  185,  193,  194,217,  221,  226,  228,  231,  232,  234,  230,  237,  238,  244,  253,  294, 
310,  340,  350. 


CHAP.  XTI.]  EFFECTS    OF    MISSILES    ON    NERVES.  727 

The  following  oases  will  serve  to  illustrate  these  lesions  and  injuries  of  the  spine: 

CASE  1072.  — Private  C.  C.  Thomas,  Co.  A,  2d  Wisconsin,  aged  23  years,  was  wounded  at  Gettysburg,  July  1,  1863. 
He  was  admitted  into  the  hospital  at  York,  Pennsylvania,  on  July  17th.  Surgeon  H.  Palmer,  U.  S.  V.,  reported:  "Mini6  ball 
entered  the  back  at  the  point  of  the  right  shoulder  blade,  passed  across,  and  was  extracted  three  inches  below  the  left  shoulder 
blade,  deeply  situated.  Patient  complains  of  numbness  and  loss  of  power  of  the  legs.  There  is  no  displacement  or  tenderness  of 
the  spinal  column.  Cold-water  dressings;  orifice  of  entrance  filled  with  granulations,  that  of  exit  discharging  some  pus."  He 
was  discharged  from  service  January  6,  18G4,  on  account  of  partial  paralysis  of  the  lower  extremities,  the  result  of  the  injury,  and 
pensioned.  Examiner  L.  8.  Thompson,  of  Shackopee,  Minnesota,  reported,  September  23,  1875 :  "Ball  entered  just  below  inferior 
angle  of  right  scapula,  and  passing  across  the  back  lodged  about  two  inches  below  the  inferior  angle  of  the  left  scapula,  from 
whence  it  was  removed.  The  missile  injured  the  spine  to  such  an  extent  that  the  patient  has  but  a  limited  control  over  the 
inferior  extremities,  and  from  this  cause,  together  with  the  consequent  weakness  of  the  spine,  he  is  incapacitated  for  all  manual 
labor.'1  Examiner  H.  H.  Kimball,  of  Minneapolis,  reported  in  September,  1877,  that  the  pensioner  "has  only  partial  control 
over  the  bladder  and  rectum." 

CASK  1073. — Lieutenant  J.  F.  Moreland,  Co.  C,  17th  Indiana,  was  wounded  at  Hoover's  Gap,  Tennessee,  June  23, 1863. 
Assistant  Surgeon  S.  J.  F.  Miller,  5th  Kentucky,  reported,  from  the  Officer's  Hospital,  Murfreesboro',  Tennessee:  "The  patient 
entered  this  hospital  June  27th,  wounded  by  a  mini6  ball.  It  struck  him  two  inches  to  the  left  of  the  spinal  column,  opposite 
the  first  lumbar  vertebra,  and  followed  up  the  spinal  column  until  it  reached  the  spinous  process  of  the  first  cervical  vertebra, 
when  it  turned  to  the  left,  and  was  cut  out  just  beneath  the  skin  over  the  middle  third  of  the  sterno-cleido  mastoideus  muscle; 
the  lower  half  of  his  body  was  paralyzed.  He  passed  his  feces  unconsciously  and  we  had  to  draw  his  urine  with  a  catheter.  He 
died  July  12,  1863;  for  want  of  time  no  autopsy  was  performed." 

CASE  1074. — Color  Sergeant  James  S.  Schermerhorn,  Co.  F,  127th  Illinois,  aged  33  years,  was  wounded  at  Vicksburg, 
May  19, 1863.  He  was  treated  in  the  field  and  at  Webster  Hospital,  Memphis,  and  Marine  Hospital,  Chicago,  and  discharged  from 
service  December  9,  1863,  for  "gunshot  wound  of  spine  with  fracture  of  the  spinous  and  transverse  processes  of  the  ninth,  tenth, 
and  eleventh  dorsal  vertebne.  There  is  partial  paralysis,  but  also  severe  pain  of  the  whole  column,  producing  severe  nervous 
spasms."  Examiner  J.  P.  Lynn,  of  Chicago,  reported,  January  23,  1864:  "The  ball  struck  the  crest  of  the  left  ilium  three 
inches  back  of  the  anterior  superior  spinous  process,  passed  through  near  the  sacrum  and  lumbar  vertebral  articulation,  and  was 
cut  out  two  inches  to  the  right.  The  wound  of  entrance  is  discharging,  the  other  is  healed,  but  an  opening  over  the  spine  is 
discharging  pieces  of  vertebra  and  pus.  There  is  nearly  complete  paraplegia."  On  July  24,  1865,  Dr.  Lynn  reported  :  "  Since 
he  received  his  wound  he  has  been  and  is  now  wholly  deprived  of  the  use  of  his  legs.  His  bladder  is  paralyzed  and  his  urine  has 
to  be  drawn  by  a  catheter.  He  has  also  only  partial  use  of  his  arms,  and  is  unable  to  sit  upright."  Being  an  applicant  for  a  chair 
in  which  to  propel  himself,  he  was  examined  at  Chicago  by  Assistant  Surgeon  Thomas  J.  Asch,  U.  S.  A.,  January  17,  1871, 
who  states:  "There  is  complete  paralysis  of  the  lower  extremities  below  the  seat  of  the  injury;  locomotion  is  utterly  impossible, 
and  the  trunk  cannot  be  maintained  in  an  upright  position  except  with  the  aid  of  a  supporting  apparatus  consisting  of  two  steel 
rods  with  crutch-shaped  extremities  to  support  the  arms,  fastened  to  a  belt  buckled  around  the  body.  *  He  was  confined 

to  his  bed  from  the  date  of  his  wound  until  the  Spring  of  1870,  during  which  time  portions  of  the  vertebrae  were  removed  by 
Dr.  Isham  of  this  city.''  Examiner  L.  H.  Kobbins,  of  Lincoln,  Nebraska,  reported,  August  5,  1874 :  "The  pensioner  is  wearing 
an  apparatus  to  support  the  upper  part  of  the  body,  without  which  he  has  no  power  to  sit  erect.  The  legs  are  wholly  useless. 
He  requires  the  regular  personal  aid  and  attendance  of  another  person."  The  pensioner  was  paid  December  4,  1880. 

In  the  next  case1  it  is  supposed  that  the  spine  was  wounded  or  that  the  missile  lodged 
within  the  vertebral  column  in  such  close  proximity  to  the  nerve  centres  as  to  cause  com 
pression  of  the  anterior  branches: 

CASE  1075. — "Private  S.  Johnson,  Co.  I,  8th  Pennsylvania  Cavalry,  aged  18  years,  enlisted  in  August,  1861.  Health 
good  previous  to  enlistment,  except  a  typhoid  fever  four  years  before.  Six  months  after  enlisting  he  had  a  fever,  probably  of  a 
malarious  character.  Three  weeks  before  he  was  wounded  lie  suffered  with  pain  in  the  right  leg,  made  worse  by  movement, 
but  unaccompanied  with  any  rheumatic  swelling  of  the  joints.  May  3,  1863,  he  was  wounded  by  a  small  ball  in  the  left  cheek 
while  riding  at  a  trot.  It  entered  at  the  middle  of  the  ramus  of  the  jaw  a  little  below  the  level  of  the  teeth.  From  his  position 
as  well  as  the  after  evidence,  it  seems  that  the  ball  passed  backward  and  inward  and  finally  lodged  in  the  spinal  column.  The 
edge  of  the  jaw  was  somewhat  injured,  and  probably  was  the  source  of  the  small  fragments  of  bone  which  afterward  escaped 
from  the  neck.  When  shot  the  man  fell  forward  on  his  horse's  neck;  says  he  was  confused  though  conscious,  and  felt  as  if  he 
had  been  struck  in  the  ear  and  then  lifted  up  in  the  air.  He  also  felt  instant  pain  in  the  back  of  his  neck  and  in  all  of  his 
limbs.  There  were  no  spasms.  He  was  removed  from  his  horse  and  carried  to  ahou.se  near  by.  The  motion  increased  his  pain, 
especially  any  movement  of  the  neck.  He  now  became  aware  of  the  total  motor  paralysis  of  the  arms  and  legs.  He  is  not  sure 
whether  sensibility  was  also  extinct  or  not.  Two  days  after  being  wounded  he  became  delirious,  but  gradually  recovered  his 
senses  after  three  or  four  days.  He  was  finally  sent  to  Douglas  Hospital.  Washington,  then  under  charge  of  Assistant  Surgeon 
W.  Thomson,  U.  S.  A.,  and  was  transferred  to  our  own  wards  July  1!>.  18(53.  The  wound  healed  in  nine  weeks,  after  the  dis 
charge  of  a  few  small  fragments  of  the  jaw.  Meanwhile  his  left  ley  improved  slightly.  July  19,  1863;  present  state:  A  more 
wretched  spectacle  than  this  man  presents  can  hardly  be  imagined,  lie  lies  in  bed  motionless,  emaciated  to  the  last  degree,  and 
with  bedsores  on  both  elbows  and  both  hips.  His  hands  lie  crossed  on  his  chest,  perfectly  rigid,  the  fingers  extended,  the  skin 
congested  ;md  thin,  the  nails  curved,  false  anchylosis  of  all  the  joints  of  the  upper  limbs,  the  head  and  neck  rigid,  with  acute 
pain  in  these  parts  on  movement.  The  right  leg  has  motion  of  a  feeble  nature  in  all  of  the  joints;  the  left  only  very  slight  vol 
untary  movement.  The  hands,  the  appearance  of  which  has  been  already  alluded  to,  present  certain  characteristics  which  belong 


'MITCHELL,  MORE11OU8E,  nud  KEEN,  Gunshot  Wounds  and  Other  Injuries  of  Nerves,  Philadelphia,  1864,  p.  22 


728  WOUNDS    AND    COMPLICATIONS.  [CHAP.  XII. 

usually  to  cases  in  which  there  have  been  wounds  of  the  brachial  nerves.  In  the  present  instance,  as  in  many  others,  these 
peculiarities  have  been  modified  by  the  long  continued  rest  of  the  limbs  in  one  posture.  The  results  of  the  nerve  injury  and  its 
consequent  effects  on  the  nutrition  of  the  part  may,  however,  be  partially  discriminated,  so  that  what  is  due  to  them  and  what  is 
due  to  mere  rest  may  be  discerned  to  some  extent.  Thus,  the  shining  palm,  the  slight  eczema,  the  burning  pain,  the  atrophy, 
and  the  swollen  joints,  whose  appearance  simulates  subacute  rheumatism, — these,  with  the  contraction  of  certain  muscles,  are  all 
owing  to  the  nerve  lesion;  while  the  anchylosis  and  the  peculiar  flattening  of  the  hand  are  perhaps  owing  to  this  and  to  the  long 
rest  and  disuse,  the  arms  meanwhile  lying  crossed  on  the  chest,  the  fingers  in  extension.  The  disuse  alone  would  have  caused 
anchylosis,  but  never  to  such  a  degree  as  occurs  when  the  joints  have  been  subacutely  inflamed  at  the  same  time.  The  loss  of 
the  lateral  palmar  arch  is  owing  to  both  causes,  and  the  monkey-like  appearance  of  the  hand,  the  thumb  rotated  outward,  and 
its  nail  looking  upward  and  even  toward  the  forefinger,  is  caused  first  by  the  subluxation  of  the  metacarpo-phalangeal  articula 
tion,  and  secondly  by  the  weakening  and  atrophy  of  the  adductor  and  short  flexors  of  the  thumb.  The  nerve  lesion,  affecting 
the  muscles  and  the  general  nutrition  of  the  part,  has  so  relaxed  the  unused  tissues  of  the  limb  as  to  make  the  pressure  of  its 
own  weight  an  effective  aid  in  thus  altering  its  form.  Specimen  6693  of  the  Army  Medical  Museum  represents  casts  of  both 
arms,  and  exhibits  admirably  their  condition  soon  after  they  began  to  improve.  Sensation:  Tactile  sense  enfeebled  equally  in 
both  arms,  worse  in  the  left.  Feeble  in  both  legs,  worse  in  the  left.  Confused  power  of  localizing  sensation  in  the  legs.  Mis 
takes  right  for  left,  but  not  left  for  right.  There  is  muscular  hypenesthesia  of  the  upper  members,  shoulders,  and  neck;  none  in 
the  legs.  The  left  brachial  plexus  is  sensitive  to  pressure  and  this  causes  pain  in  the  left  arm  and  hand.  The  palms  prickle 
and  burn  a  little,  the  feet  not  at  all.  Every  attempt  at  passive  motion  causes  exquisite  pain  in  the  arms,  hands,  and  shoulders; 
but  most  of  all  the  back  of  the  neck,  about  the  first  and  second  vertebne.  This  is  due,  first,  to  the  hyperaesthesia  of  the  muscles, 
and  secondly,  to  the  state  of  false  anchylosis,  owing  to  rest  in  one  fixed  posture.  He  either  is  too  weak  to  move  the  body  or  is 
really  paralyzed  in  the  spinal  muscles.  The  biceps  flexors  and  wrist  muscles  are  very  rigid  as  well  as  the  trapezius,  and  the 
atrophy  of  the  muscles  throughout  the  upper  limbs  is  singularly  well  marked.  His  condition  was  too  grave  to  allow  of  an 
electric  examination.  There  was  no  inflammatory  swelling  about  the  neck,  and  it  was  therefore  resolved  to  treat  him  with  free 
passive  motion,  breaking  the  adhesion  and  forcing  him  to  exert  himself  as  far  as  he  could.  Tonics,  porter,  and  liberal  diet  were 
ordered,  and  the  shampooing  and  passive  movement  was  vigorously  carried  out,  despite  his  pain  and  most  earnest  supplications 
to  be  let  alone.  The  bedsores  were  treated  with  alternate  applications  of  iced  water  for  ten  minutes,  followed  by  a  poultice  as 
hot  as  could  be  borne.  This  local  means,  recommended  by  Brown -Sdquard,  succeeded  marvelously,  as  it  always  does,  the  bed 
sores  healing  easily  within  ten  days.  August  25th,  still  losing  flesh;  great  pain  in  the  neck ;  moves  head  and  legs  a  little  better; 
no  change  in  the  arms.  Despite  his  prayers  and  protestations  the  shampooing  was  continued,  and  on  October  15th  he  was 
greatly  improved.  He  is  fatter;  the  legs  can  be  voluntarily  crossed ;  appetite  voracious.  December  7th,  great  gain  ;  can  move 
right  arm  freely;  can  raise  his  head,  bend  and  turn  the  neck;  sits  up  daily.  December  29th,  motion  returning  iu  right  hand; 
no  gain  in  left;  but  in  both  the  malpositions  have  been  relieved  and  the  hypera;sthesia  reduced.  From  this  time  the  improve 
ment  was  manifest  and  rapid.  On  January  7,  1864.  the  case  was  carefully  reviewed  with  the  following  results :  Nutrition:  Much 
fatter;  atrophy  lessened.  The  hands  have  lost  their  smooth,  shining  look,  so  expressive  to  us  of  a  nerve  lesion.  The  nails  are 
less  curved.  The  temperature  is  better.  Sensation:  Eight  arm  and  hand,  tactility  and  localizing  sense  good;  left  arm  rather 
less  perfect;  tactility  and  localizing  sense  in  legs  normal  or  nearly  so.  Sense  of  pain  more  perfect  than  at  first,  but  even  now  u 
pinch  causes  a  feeling  of  prickling  only,  rather  than  the  usual  sensation.  There  has  been  some  burning  of  the  right  face,  neck, 
and  arm  within  the  past  week.  Voluntary  motion:  Left  leg  normal  in  extent  of  action,  but  still  feeble;  right  leg  healthy.  The 
right  iirm  has  regained  all  the  shoulder  and  elbow  motions  except  that,  owing  to  a  remnant  of  contraction  in  the  biceps,  exten 
sion  is  not  quite  entire.  Flexion,  pronation,  and  supination  are  perfect.  Extension  of  wrist  incomplete,  owing  to  contracted 
state  of  flexors.  Flexion  of  wrist  perfect.  The  thumb  has  lost  abduction,  owing  to  contraction  of  the  abductor.  Fingers, 
extension  perfect,  as  also  flexion  of  first  phalanges;  the  joints  being  still  stiff  and  swollen,  the  second  and  third  joints  possess 
but  two-thirds  of  their  healthy  extent  of  flexion.  Left  arm:  For  ten  days  past  the  shoulder  has  begun  to  exhibit  voluntary 
power;  elbow,  no  movement;  pronation  and  supination  slight;  flexion  and  extension  of  wrist  also  slight;  fingers,  feeble,  trem 
ulous  movements.  For  the  first  time  we  now  examined  the  electric  state  of  the  muscles.  The  electro-muscular  contractility 
was  good  in  the  right  biceps,  feeble  in  the  left;  good  in  the  right  supiuator  longus,  feeble  in  the  left;  good  in  the  extensors 
of  both  hands ;  good  in  the  flexors  of  the  right  hand,  feeble  in  the  left.  The  interossei  on  both  sides  showed  great  loss  of  this 
property.  The  abductor  policis  on  the  left  had  no  electro-muscular  contractility.  As  a  rule,  this  property  was  lessened  in  the 
left  arm  and  shoulder,  while  the  electro-muscular  sensibility  was  scarcely  altered  in  the  two  members,  except,  perhaps,  some 
diminution  in  the  thumb  muscles  of  the  left  hand  and  in  the  flexor  group  of  the  left  forearm.  The  whole  left  arm  was  still  very 
stiff.  Ordered  the  patient  to  be  etherized  daily,  and  the  adhesions  to  be  forcibly  broken.  Passive  motion  to  be  continued,  and 
the  limbs  to  be  faradized  daily.  The  future  progress  was  inconceivably  rapid.  On  January  20th  he  could  rise  to  his  feet,  and 
by  February  20th  could  walk  a  few  steps.  March  20th,  walks  well  without  a  cane  or  any  aid;  the  left  hand  alone  has  not 
gained  to  any  great  extent,  although  the  malposition  of  the  hand  has  been  much  relieved.  The  patient  was  discharged  in  March, 
slightly  shuffling  in  his  walk,  but  with  nearly  entire  use  of  all  his  limbs  except  the  left  hand  and  forearm."  Johnson  was  pen 
sioned.  The  Philadelphia  Board  of  Pension  Examiners  reported,  October  23,  1873:  "Total  paralysis  of  left  leg  so  as  to  cause 
foot  to  trip  at  times."  In  November,  1877,  the  same  board  reported:  "Suffers  no  pain  in  arm,  but  has  to  move  arm  in  different 
positions.  Is  anchylosed  at  shoulder  and  partially  so  at  elbow.  Toes  are  drawn  up  and  use  impaired;  paralyzed.  Has  evi 
dently  progressive  nerve  trouble  from  ball,  no  doubt,  lodged  near  spine  in  cervical  region.  Has  weakness  of  hand,  right  side, 
and  is  cold  almost  all  the  time.  There  is  atrophy  of  arm,  forearm,  and  leg,  left  side." 

The  following  case  illustrates  what  is  known  as  concussion  or  "commotion"  of  the 
spine;   it  is  not  supposed  that  any  large  nerve  could  have  been  touched: 

CASE  1076.— Thomas  Carroll,  aged  21  years,  plumber,  of  New  Jersey.     Enlisted  November,  1863,  in  Co.  D,  3d  New  Jersevy 
Cavalry.     Healthy  to  date  of  wound.     December  15,  1863:  While  seated  on  a  fence  rail,  a  pistol  ball,  accidentally  fired,  took 


CHAP,  xii.)  REFLEX    PARALYSIS.    THE    RESULT    OF    SHOT    WOUNDS.  729 

effect  on  the  back  of  his  neck.  It  entered  at  the  middle  line,  exactly  over  the  interspace  between  the  spinus  of  the  sixth  and 
seventh  cervical  vertebrae,  and  was  cut  out  on  the  left  side  of  the  neck  one  inch  below  the  angle  of  the  jaw.  No  bone  escaped 
at  any  time,  and  the  surgeon  who  explored  the  wound  at  the  time  of  the  injury  felt  assured  that  there  was  no  fracture.  The 
patient  thinks  that  he  was  looking  to  the  left  when  hit,  but  is  not  sure.  If  lie  be  correct  as  to  his  position,  the  ball  could  have 
come  near  to  no  part  of  importance  except  the  spine,  and,  in  any  case,  it  would  be  difficult  to  assert  that  it  could  have  wounded 
the  cervical  and  still  less  the  brachial  plexus.  He  fell  senseless,  was  removed  to  a  hospital  tent,  and  finally  recovered  his  reason 
within  two  hours.  As  he  became  aware  of  his  condition  he  found  that  although  he  could  talk,  see,  and  hear,  he  had  neither 
motion  nor  feeling  in  any  of  his  limbs.  The  trunk  was  equally  powerless.  He  describes  himself  as  at  first  unable  to  feel  the 
bed  upon  which  he  lay,  but  as  having  good  feeling  in  the  head  and  face.  About  the  second  day  he  had  severe  pain  and  tender 
ness  in  the  right  shoulder  and  neck.  Gradually,  sensation  first,  and  then  voluntary  power,  returned  to  the  whole  right  side. 
Within  a  month  the  left  side  also  improved,  with  the  exception  of  the  left  arm.  Within  two  months  the  right  side  was  well  and 
the  left  leg  nearly  so.  About  May  1,  1864,  he  began  to  be  able  to  stir  the  left  thumb.  Present  state,  May  14,  18G4  (admitted 
May  1'2, 1864):  General  loss  of  flesh.  Left  arm  exhibits  marked  atrophy.  Measurements  :  Left  biceps,  8J  inches;  right  biceps, 
9£  inches.  Forearm,  left,  8-J-  inches;  right,  9f  inches.  Legs,  no  notable  difference.  The  left  shoulder  muscles  are  fearfully 
atrophied,  especially  the  deltoid.  The  arm  has  dropped,  owing  to  want  of  support,  so  that  a  thumb  may  be  laid  in  the  furrow 
between  the  head  of  the  humerus  and  the  acromion  process.  This  subluxation  of  the  bone  increases  the  apparent  length  of  the 
left  arm  nearly  half  an  inch.  Casts  of  both  shoulders,  which  exhibit  well  the  deformities,  were  sent  to  the  Army  Medical  Museum 
at  Washington.  There  are  no  contracted  muscles.  The  hand  is  swollen  and  congested,  the  cuticle  thickened  and  hanging  in 
yellow  scales.  Nails  not  curved.  No  acid  sweat.  Slight  burning  of  the  left  palm  a  recent  symptom.  Tactile  sensation  and 
sense  of  pain  absent  in  left  ulnar  distribution,  and  defective  everywhere  else  in  the  arm  below  the  shoulder.  Normal  in  right 
arm.  Sensation  alike  in  the  legs,  and  normal  in  both.  The  right  arm  is  weak  ;  the  left  arm  powerless,  except  slight  ability  to 
abduct  the  thumb.  The  left  leg  is  weaker  than  the  right,  and  his  gait  is  awkward,  from  his  swinging  his  right  leg  outward 
and  forward. 

As  the  subject  of  reflex  paralysis  is  one  of  great  interest  in  tlie  study  of  spinal  injuries, 
and  lias  been  thoroughly  and  exhaustively  treated  in  Circular  6,  B.  G.  0.,  March  10,  1864, 
it  is  deemed  proper  to  reproduce  the  Circular  at  this  point: 

"CIRCULAR  No.  G. 

"SURGEON  GENERAL'S  OFFICE, 

"WASHINGTON,   I).  C.,  MdTfh  10,  1864. 

"The  following1  paper  on  Reflex  Paralysis,  the  result  of  gunshot  wounds,  founded  chiefly 
upon  cases  observed  in  the  U.  S.  General  Hospital,  Christian  Street,  Philadelphia,  by  S.  Weir 
Mitchell,  M.  D.,  George  R.  Morehonse,  M.  D.,  and  William  W.  Keen,  jr.,  M.  D.,  is  published  for 
the  information  of  Medical  Officers,  in  the  belief  thai  immediate  and  practical  benefit  may  be 
derived  from  it: 

"JOS.  K.  BARNES, 

"Acting  Surgeon  General." 

•'Since  the  establishment,  in  May,  18G3,  of  a  Special  Hospital  for  the  treatment  of  diseases 
and  injuries  of  the  nervous  system,  a  vast  number  of  cases  of  gunshot  and  other  injuries  of  nerves 
have  been  studied  by  the  authors  of  this  paper. 

"The  great  mass  of  these  will  be  considered  in  a  future  essay,  upon  the  history,  results,  and 
treatment  of  gunshot  wounds  of  nerves.  We  have  judged  it  wise,  however,  to  report  separately 
a  class  of  very  infrequent  cases,  in  which  paralysis  of  a  remote  part  or  parts  has  been  occasioned 
by  a  gunshot  wound  of  some  prominent  nerve,  or  of  some  part  of  the  body  which  is  richly  supplied 
with  nerve  branches  of  secondary  size  and  importance. 

"  So  far  as  we  are  aware,  the  Medical  Histories  which  we  are  about  to  record  stand  alone  as 
the  tirst  reports  of  sudden  reflex  paralysis  from  mechanical  injuries.  How  they  differ  from  the 
paralytic  affections  which  result  from  disease  of  organs,  and  which  have  been  so  ably  treated  of  by 
numerous  authors,  we  shall  presently  consider.  That  they  have  thus  far  escaped  notice  may  be 
easily  accounted  for.  In  the  first  place  they  are  rare;  among  some  sixty  or  more  carefully  studied 
instances  of  wounds  of  nerves,  we  have  met  with  only  seven  cases  of  reflex  paralysis  of  remote 
organs,  in  which  the  influence  was  prolonged  or  severe.  In  the  majority  of  cases  the  reflex  effect 
is  either  very  slight  or  very  transient,  and  for  one  or  both  of  these  reasons  unlikely  to  attract 
notice  from  surgeons  on  the  battle-field,  or  in  division  or  Corps  hospitals,  where  their  brains  and 
hands  are  taxed  to  the  utmost  by  the  palpable  misery  of  wounds  in  the  early  stages  of  treatment. 
Had  it  been  otherwise,  we  do  not  doubt  that  numerous  cases  of  reflex  paralysis  from  injuries  to 
nerves  would  have  been  recorded. 
SURQ.  Ill— 92 


730  WOUNDS    AND    COMPLICATIONS.  [CHAP.  XII. 

"The  various  effects  produced  upon  the  nervous  system  by  gunshot  wounds  have  received,  it 
seems  to  us,  far  less  attention  and  far  less  study  than  their  interest  and  importance  appear  to  call 
for.  Among  them  are  some  which  must  clearly  be  classified  with  the  results  illustrated  by  the 
cases  reported  in  this  paper;  but  there  are  also  others  which  are  far  more  numerous,  in  tact  very 
common,  and  which  are  signally  exemplified  on  every  battle-field.  These  have  been  more  or  less 
vaguely  treated  of  as  shock,  commotion,  stupor,  etc.  The  larger  part  of  those,  who  receive  flesh 
wounds  involving  no  important  organ,  are  but  little  affected  at  the  time,  or  may  even  be  uncon 
scious  of  having  been  hit,  and  at  all  events  exhibit  no  well-marked  immediate  constitutional  dis 
turbance.  In  other  cases,  and  particularly  in  wounds  of  graver  nature,  the  patient  instantly  falls 
senseless,  and  so  remains  during  a  few  minutes,  or  many  hours,  reviving  again  either  completely, 
or  suffering  from  a  continued  state  of  depression  known  as  the  result  of  shock,  and  marked  by 
the  usual  features  of  great  weakness,  feeble  circulation,  pallor,  etc.  In  other  cases  these  last- 
named  symptoms  come  on  at  once,  and  without  the  intervention  or  accompaniment  of  unconscious 
ness.  These  very  interesting  states  of  system  may  be  due,  it  seems  to  us,  either  to  an  arrest  or 
enfeeblement  of  the  heart's  action  through  the  mediation  of  the  medulla  oblongata  and  the  pneu- 
mogastric  nerves,  or  to  a  general  functional  paralysis  of  the  nerve  centres,  both  spinal  and  cere 
bral,  or  finally  to  a  combination  of  both  causes.  Arrest  of  the  heart  movements  is  producible,  as 
is  now  well  known,  by  any  violent  irritant  directly  addressed  to  the  trunks  of  the  pneumogastric 
nerves,  or  to  the  medulla  oblongata,  and  it  is  conceivable  that  such  an  effect  may  be  brought  about 
by  any.  very  severe  injury  of  an  external  part. 

"In  fact,  it  has  long  been  known  that  the  sudden  crushing  of  a  limb  in  inferior  animals  will 
stop  the  heart  or  make  it  act  slowly  for  a  greater  or  less  length  of  time.  Now  if  we  add  to  this 
M.  Bernard's  experiments,  in  which  he  showed  that  irritation  of  the  posterior  roots  of  spinal 
nerves  suddenly  checks  the  cardiac  motions  for  a  time,  and  that  like  irritation  of  the  anterior  or 
motor  roots  gives  rise  to  no  such  result,  we  shall  be  able  to  see  how  it  is  possible  that  a  gunshot 
wound  of  a  large  limb  may  be  competent  to  effect  a  like  result.  We  should  remember,  too,  that 
in  nearly  all  of  these  cases  the  hasinorrhage  from  large  vessels,  such  as  are  usually  opened  by 
accidents  of  this  nature,  is  sufficient,  even  during  syncope,  to  add  to  or  deepen,  so  to  speak,  the 
effects  of  the  reflected  nerve  impression.  Where  small  vessels  only  have  been  wounded  this  might 
not  occur,  but  it  is  proper  to  state  that  men  who  have  fallen  senseless  at  the  instant  of  the  wound, 
frequently  awaken  after  a  time  to  find  themselves  drenched  with  blood.  Supposing  such  an  arrest 
of  the  heart  movements  to  have  taken  place,  a  continuance  of  their  stoppage,  even  for  a  brief 
period,  would  naturally  give  rise  to  cerebral  anaemia,  pallor,  unconsciousness,  and  the  remaining 
phenomena  of  shock. 

".Again,  as  we  have  said,  a  severe  injury,  as  a  gunshot  wound  of  a  limb  or  the  neck,  may 
produce  its  effects  of  unconsciousness  and  loss  of  power  by  greatly  weakening  or  for  a  time 
destroying,  with  various  degrees  of  completeness,  the  functions  of  all  the  nerve  centres  and  of 
their  conducting  cords. 

"The  influence  of  shock  in  thus  causing  temporary  paralysis  of  nerve  trunks  is  very  well 
known  to  every  experimenting  biologist.  Thus,  after  opening  the  spinal  cavity,  it  is  very  common 
to  discover  that  the  sensitive  nerves  are  for  a  time  unimpressible  by  stimuli.  But,  as  a  general 
thing,  this  is  not  so  as  regards  the  nerve  centres  within  the  skull,  which  are  rarely  so  disturbed  by 
the  operation  of  uncovering  them  as  to  refuse  all  reply  to  irritations. 

"The  majority  of  physicians  will  no  doubt  be  disposed  to  attribute  the  chief  share  in  the 
phenomena  of  shock  in  its  various  forms  to  the  indirect  influence  exerted  upon  and  through  the 
heart.  There  are,  however,  certain  facts,  which,  duly  considered,  will,  we  think,  lead  us  to  sup 
pose  that  in  many  cases  the  phenomena  in  question  may  be  due  to  a  temporary  paralysis  of  the 
whole  range  of  nerve  centres,  and  that  among  these  phenomena  the  cardiac  feebleness  may  play  a 
large  part,  and  be  itself  induced  by  the  state  of  the  regulating  nerve  centres  of  the  great  circu 
latory  organ. 

"The  loss  of  consciousness,  and  the  appearance  of  a  state  outwardly  resembling  syncope, 
prevent  us  in  most  cases  from  feeling  sure  that  the  great  nerve  centres  suffer  loss  of  function  pri 
marily  and  not  through  want  of  nutrition  from  feeble  or  arrested  heart  action.  But  there  do  exist 
certain  cases,  more  rare,  it  is  true,  in  which  singular  affections  of  the  nerve  centres,  other  than 
those  of  the  heart,  occur  as  a  consequence  of  wounds.  These  are  well  described  by  Legouest  in 


CHAP,  xil.]  REFLEX    PARALYSIS,    THE    RESULT    OF    SHOT    WOUNDS.  731 

his  Svrgcn/  of  the  Crimean  War,  page  219,  and  in  somewhat  varied  shapes  must  have  been  seen 
by  all  who  are  familiar  with  the  early  history  of  gunshot  wounds.  The  patients  to  whom  we  refer 
do  not  fall  when  struck,  but  become  insanely  excited  or  almost  hysterical.  The  author  above 
alluded  to  supposes  that  this  form  of  nervous  excitement  occurs  chiefly  among  those  who  are 
already  excited  by  immediate  conflict  and  who  are  actively  engaged. 

"One  well  known  instance  has  been  related  to  one  of  the  authors  of  this  paper  as  having 
taken  place  in  the  Mexican  War,  in  1846.  An  officer  of  well  known  courage  was  wounded  in  the 
heel,  and  was  thrown  at  once  into  a  state  of  alarm,  which  caused  him  to  exhibit  signs  of  the  utmost 
trepidation.  His  character  for  courage  was  such  that  the  favorable  verdict  of  a  subsequent  Court 
of  Inquiry  was  scarcely  needed.  No  cases,  such  as  the  above,  or  such  as  Legouest  has  related, 
have  been  met  with  by  us,  so  that  they  must  be  of  very  exceptional  occurrence;  yet  as  they  show 
the  possibility  of  cerebral  disturbance  without  precedent  or  accompanying  feebleness  of  the  heart, 
it  is  enough  to  prove  that  they  do  now  and  then  take  place.  We  are  tempted  to  add  the  following 
case  as  a  still  better  proof  that  cerebral  disturbance,  the  result  of  a  shock  other  than  traumatic, 
may  give  rise  to  the  most  profound  prostration,  without  any  prolonged  continuance  of  cardiac 
weakness:  A  well  known  apothecary  in  Philadelphia  was  making  a  mixture  of  certain  medicines 
in  a  large  mortar,  when  they  exploded  with  such  violence  as  to  break  the  windows  of  the  store, 
crack  bottles  and  jars,  and  deeply  indent  the  board  on  which  stood  the  mortar.  Both  he  and  his 
assistant  were  thrown  down.  Both  suffered  rupture  of  the  tympana  I  membrane  of  the  right  and 
left  ear.  The  assistant  felt  no  marked  constitutional  effects,  and  got  well  with  good  hearing,  but 
with  a  constant  buzzing  in  the  left  oar.  Tho  apothecary  himself,  of  a  more  nervous  temperament, 
and  perhaps,  also,  because  he  was  standing  nearer  to  the  point  of  explosion,  was,  he  thinks,  insen 
sible  for  a  moment.  When  seen  by  one  of  ns  a  few  minutes  later  he  was  lying  on  a  bed,  with  a 
pulse  of  rather  remarkable  strength,  but  now  and  then  losing  a  pulsation,  and  altogether  irregular 
as  to  rhythm,  beating  seventy  one  minute  and  eighty  the  next.  His  manner  was  excited  and 
hysterical.  He  talked  incessantly,  and  his  limbs  were  in  continual  agitation,  with  occasional 
twitching  of  the  facial  muscles.  Tho  tympanal  membrane  was  split  across  in  his  left  ear,  and  on 
the  right  side  presented  a  triangular  opening.  He  had  no  headache,  but  complained  of  the  roar 
ing,  hissing,  etc.,  which  seemed  to  be  sources  of  the  utmost  annoyance.  Despite  his  desire  to 
move  about,  his  muscles  were  extremely  feeble,  and  for  twenty-four  hours  he  was  unable  to  walk 
without  aid.  He  recovered  readily,  both  membranes  healing  completely,  and  his  hearing  none 
the  worse  for  the  accident.  The  patient,  it  should  be  noted,  was  not  injured  by  his  fall,  and  as  we 
have  seen,  showed  no  signs  of  concussion.  He,  as  well  as  his  medical  attendant,  attributed  the 
phenomena  which  he  exhibited  to  the  shock  given  to  the  auditory  nerve.  This  opinion  has  since 
been  confirmed  by  the  cases  reported  by  M.  Browu-Sequard  and  others. 

"Further  on  we  shall  show  that  in  rare  cases  gunshot  wounds  cause  partial  or  very  general 
paralysis  of  gr.ive  type  and  prolonged  duration  in  parts  not  directly  injured;  we  shall  also  show 
that  these  protracted  paralyses  must  be  due  to  an  equally  permanent  affection  of  the  nerve  centres. 
Now,  if  this  be  possible,  there  is  every  reason  to  believe  that  a  temporary,  though  general,  paraly 
sis  may  take  place  in  a  large  number  of  gunshot  wounds.  When  the  cardiac  centres  feel  the  shock 
most  severely  the  feebleness  will  of  course  be  greater;  but  there  is  much  reason  to  suppose  that 
the  cerebral  and  spinal  centres  in  general  suffer  en  masse  in  every  case  of  loss  of  consciousness 
from  shock. 

"As  we  proceed  we  shall  have  occasion  to  discuss  the  mechanism  of  the  more  permanent 
forms  of  reflex  paralysis.  Here  we  desire  only  to  show  that  the  effect  of  grave  wounds  is  to  cause 
a  condition  of  the  centres  which  gives  rise  to  a  general  and  profound  feebleness,  and  that  in  rare 
cases  the  central  effect  is  so  intense  as  in  some  way  to  cause  paralysis,  which  may  last  for  hours, 
days,  or  months. 

"Another  class  of  nerve  affections  demands  some  notice  before  we  discuss  the  undoubted 
instances  of  reflex  paralysis  from  wounds  which  have  fallen  under  our  notice.  These  are  what 
the  French  writers  call  cases  of  injury  from  commotion.  They  differ  from  those  we  have  described 
in  being  due  to  the  mere  mechanical  effect  produced  upon  the  neighboring  parts.  If,  for  example, 
a  ball  passes  near  the  spinal  column,  it  is  conceivable  that  the  roll  of  its  motion  and  the  resist 
ance  of  the  tissues  may  determine  in  the  spine  a  brusque  and  sudden  oscillation  of  the  contents 
sufficient  to  cause  very  grave  results. 


732  WOUNDS    AND    COMPLICATIONS.  [CHAI>.  xii. 

"We  have  sometimes  seen  this  illustrated  in  a  very  interesting  shape  and  in  a  less  danger 
ous  form.  Thus,  in  the  case  of  a  soldier  who  was  shot  at  Gettysburg,  July  3, 1363,  the  ball  entered 
the  cheek,  and  passing  outside  of  the  ramus  of  the  jaw  was  cut  out  of  the  trapezius  muscle.  It 
struck  the  ramus,  but  did  not  fracture  it  or  interfere  with  the  act  of  mastication.  In  October, 
one  or  two  very  minute  morsels  of  bone  escaped  from  the  neck  in  front  of  and  four  inches  below 
the  jaw.  The  only  injury  to  the  jaw  bone  must  have  been  on  its  exterior  surface,  from  which  the 
pieces  of  bone  alluded  to  worked  down  the  tissues  of  the  neck.  The  shock  caused  complete 
paralysis  of  the  inferior  dental  nerve,  with  absolute  anesthesia,  analgesia,  and  loss  of  sense  of 
temperature  in  the  lower  lip  and  chin  of  the  injured  side.  The  sensation  was  for  the  most  part 
rapidly  restored  by  the  use  of  cutaneous  faradization  after  the  nerve  had  been  allowed  time  to 
recover  from  the  results  of  the  shock  it  had  sustained.  A  portion  of  the  lip.  the  skin  below  it, 
and  the  mucous  membrane  within  still  remain  rebellious  to  treatment. 

"The  other  case  of  mechanical  shock  to  a  nervous  structure  we  shall  report  more  at  length. 
It  is  one  as  to  which  there  may  reasonably  exist  some  doubt  whether  to  call  it  an  instance  of  com 
motion  of  the  spinal  cord  from  injury  of  neighboring  parts,  or  to  regard  it  as  an  impression  made 
upon  the  spinal  centre  through  the  injured  nerves,  and  resulting  in  a  paralysis,  as  the  reflected 
result  of  the  state  into  which  the  centres  were  thus  thrown.  It  is  impossible  to  be  sure  that  both 
sets  of  causes  may  not  have  been  at  work. 

"  Flesh  Wound  of  Back  of  Neck  ;  entire  Aphonia  and  Paralysis  of  all  four  liinbs  ;  speedy  recovery,  t/te  r'vjhi  arm  remaining  weak. 

"Morgan  Emory,  aged  20,  farmer,  born  in  New  York,  enlisted  September,  1861,  in  company  'C,'  9th  New  York  Cavalry, 
a  healthy  man.  August,  1862.  had  typhoid  fever,  but  recovered  perfectly.  On  the  seventh  of  July,  1863,  he  was  wounded  at 
Williamsport.  The  ball  passed  through  the  neck  from  side  to  side,  posterior  to  the  vertebra?,  entering  the  left  side  one-half  inch 
below  the  level  of  the  angle  of  the  jaw  and  two  inches  from  the  posterior  middle  line  of  the  neck,  and  emerging  on  the  right 
side  at  one-fourth  of  an  inch  lower  down  and  two  and  a  half  inches  from  the  same  middle  line.  No  bone  has  been  discharged 
from  the  wound,  nor  is  there  any  evidence  of  injury  of  the  spinous  processes  of  the  vertebrae.  Effect  of  wound. — He  fell  from 
his  horse,  striking  upon  his  right  shoulder  and  bruising  it  slightly.  He  was  speechless  for  fifteen  minutes,  and  could  neither 
stand  nor  move  either  arm.  He  acquired  partial  use  of  his  left  arm  and  of  his  legs  in  three  or  four  days,  and  in  a  week  could 
walk;  his  right  arm  improved  very  little.  September  21,  1863;  present  condition. — With  the  exception  of  slight  numbness  of  the 
left  hand,  his  right  arm  is  his  only  trouble.  He  has  no  power  to  move  the  right  shoulder  and  elbow  joints;  the  wrist  and  fingers 
he  can  move  slightly.  He  has  a  burning  pain  in  the  fingers,  most  marked  when  the  hand  is  cold.  Sensation  of  touch  is  generally 
good.  The  circulation  in  both  hands  is  bad — the  right  is  colder  than  the  left — the  right  biceps  and  pectoralis  major  are  hyper- 
iesthetic.  Caleanic  test. — Electro-muscular  contractility  and  electro-muscular  sensibility  slightly  diminished  in  all  the  muscles 
of  the  right  arm.  The  shoulder  joint  is  susceptible  of  passive  movement,  and  seems  not  to  have  been  injured  permanently  by 
the  full;  the  shoulder  muscles  are  not  wasted.  It  seems  that  for  some  days  after  the  wound  his  skin  was  hyperassthetic  from 
the  level  of  the  wound  down  to  the  waist,  so  that  a  fly  on  the  skin  gave  pain,  although  deep  pressure  did  not.  The  muscular 
hyperaesthesia  is  of  later  date.  Treatment. — Douche  to  arms;  passive  motion  and  electricity  to  right  arm  and  shoulder.  Three 
weeks  later  the  electro-muscular  contractility  of  the  shoulder  muscles  was  as  good  as  on  the  other  side.  In  the  triceps  the  electro- 
muscular  properties  were  lessened;  in  the  forearm  and  hand  both  were  as  usual.  Continued  to  faradize  daily.  The  faradization 
was  used  up  to  November  1st,  when  he  was  furlonghed.  At  this  time  the  electro-muscular  contractility  and  sensibility  of  the 
muscles  were  as  good  on  the  right  side  as  on  the  left.  He  has  recovered  all  the  motions  of  the  elbow,  wrist,  shoulder,  and  hand, 
but  all  are  more  feeble  than  those  of  the  left  arm,  which  is  still  a  little  numb,  although  far  less  so  than  when  admitted.  The 
burning  pain  which  at  first  annoyed  him  is  now  rarely  felt,  and  the  hyperaosthesia  of  the  muscles  is  nearly  gone.  On  his  return  from 
fin-lough  he  was  still  better,  and  within  a  month  was  returned  to  duty.  The  fall  upon  the  shoulder  was  incompetent  to  cause  all 
of  the  symptoms  here  described,  and  since,  in  other  cases  where  this  element  of  doubt  was  absent,  we  have  seen  paralysis  caused 
by  commotion,  therefore  we  see  little  reason  to  hesitate  in  assigning  it  as  the  producing  cause  of  the  paralysis  in  the  present  case ; 
moreover,  there  was  no  paralysis  of  cerebral  nerves,  and  the  loss  of  power  lay  chiefly  in  the  range  of  those  nerves  over  whose 
spinal  origin  the  ball  passed. 

"In  many  of  the  cases  of  injuries  of  the  brachial  plexus  which  we  have  observed  it  was  quite 
impossible  that  the  nerve  tissue  could  have  been  directly  injured  by  the  ball,  and  in  some  of  these 
at  least  the  resultant  paralysis  must  have  be*en  due  to  brief  compression  of  their  trunks  during 
the  movement  of  the  missile  or  to  agitation  of  the  nerves  through  the  tearing  of  tissues  more  or 
less  remote. 

"As  we  shall  return  to  this  subject  in  a  future  essay,  it  is  only  necessary  here  to  describe  cases 
of  commotion  so  as  to  separate  them  from  those  of  true  reflex  paralysis,  with  which  they  might 
easily  be  confounded.  We  have  met  with  another  and  very  interesting  form  of  paralysis  which 
might  possibly  be  mistaken  for  reflex  paralysis  by  a  superficial  observer.  Men  who  are  forced  to 
use  crutches,  and  to  bear  heavily  upon  them,  are  sometimes  affected  with  numbness  of  one  or  both 
hands,  and  even  with  loss  of  motion  in  these  members.  This  result  is  due  to  pressure  upon  the 
axillary  nerves.  It  is  most  apt  to  occur  in  emaciated  persons  and  those  of  large  frame.  Where 
it  presented  itself  early  in  the  case,  as  it  may  do,  it  might  readily  be  attributed  to  reflected  irrita 
tion.  It  is  then  easily  relieved  by  laying  aside  the  crutches,  or  by  padding  them  and  adding  a 
handle  by  which  to  support  the  weight  of  the  body  on  the  hands.  When  the  cure  is  delayed, 
faradization  always  affords  prompt  relief. 


CHAP,  xil.}  REFLEX    PARALYSIS,    THE    RESULT    OF    SHOT    WOUNDS.  "733 

"We  have  seen  that  in  all  probability  the  state  of  shock  from  gunshot  injuries  is  a  state  of 
general  paralysis.  We  have  also  seen  that  in  the  great  mass  of  cases  it  is  temporary.  We  have 
now  to  show  that  in  rare  instances  the  paralysis  continues  as  a  more  or  less  permanent  evil  after 
the  general  depression  has  passed  away.  When,  therefore,  a  wound  occurs,  and  the  patient  sur 
viving  the  first  effect  is  found  to  have  paralysis  of  a  distant  limb  or  limbs,  it  is  impossible  to  deny 
to  such  cases  the  title  of  reflex  paralysis.  All  of  the  following  instances  seem  to  us  to  have  ful 
filled  every  condition  which  would  entitle  them  to  be  so  considered: 

"CASE  I. — Ball  Wound  of  Eight  Side  of  the  Neck,  probably  involving  no  important  nerve  directly ;  fracture  of  hyoid  bone ;  wound 
of  throat.  Reflex  paralysis  of  left  arm;  probable  reflex  paralysis  of  right  arm;  early  recovery  of  left  arm;  partial  and 
remote  recovery  of  right  arm. 

"Captain  R.  N.  Stemble,  U.  S.  N.,  aged  49.  While  commanding  the  ram  Cincinnati,  May  10,  1862,  the  ship  was  attacked 
by  two  rebel  rams.  Captain  8.  was  aiming  a  pistol  when  a  hall  entered  his  right  neck,  broke  the  hyoid  bone,  and  traversing  the 
neck  emerged  three  and  a  half  inches  from  the  middle  line,  above,  and  to  the  right  of  the  superior  angle  of  the  scapula,  through 
the  edge  of  the  trapezius  muscle.  He  fell  half  conscious  and  confused,  but,  soon  reviving,  felt  that  both  arms  were  paralyzed. 
Mis  first  impression  was  that  he  was  shot  through  both  arms.  He  was  carried  below  in  great  pain  and  spitting  blood  freely. 
The  pain  in  the  arms  was  made  wrorse  by  movement  and  by  passive  motion.  Pressure  gave  him  pain  in  the  right  arm  and 
shoulder  only,  and  in  the  right  chest.  Sensation  was  never  entirely  absent  from  either  arm,  but  was  dull  in  both.  His  medical 
attendant,  Dr.  Judkins,  of  Cincinnati,  who  took  charge  of  his  case  on  the  19th  of  May,  1<%:J,  writes  as  follows:  'When  first- 
seen  by  me  the  anterior  wound  was  discharging  mucus  and  pus  with  saliva.  His  voice  was  hoarse;  deglutition,  which  returned 
in  part  on  the  third  day,  was  still  difficult  and  painful.  He  experienced  severe  pain  in  the  supra-hyoidean  group  uf  muscles  and 
in  the  pharynx.  His  left  arm  was  still  slightly  paralyzed,  having  rapidly  improved.  On  the  right  side  the  deltoid,  biceps, 
triceps,  and  brachialis  anticus  were  completely  paralyzed,  and  up  to  the  date  of  this  account,  July  9,  1862,  have  improved  very 
little.  The  muscles  of  the  right  forearm  are  nearly  as  much  paralyzed  as  those  of  the  arm,  and  the  sensibility  of  the  right  arm 
has  become  painfully  acute.  Captain  S.  seems  also  to  have  lost  to  a  great  degree  the  use  of  most  of  the  shoulder  muscles  on 
the  right  side.'  The  left  arm  was  nearly  well  in  four  weeks,  the  sensibility  and  movements  of  both  improving  equally,  so  that 
now,  July  18,  1863,  he  has  no  loss  of  function  in  the  member  except  slight  want  of  tactile  sensation  in  the  ultimate  distribution 
of  the  ulnar  nerve.  The  right  arm  was  but  little  better  at  this  date,  but  the  forearm  had  acquired  every  movement  except 
supination,  which  seemed  to  be  limited  about  one-half,  not  by  paralysis,  but  by  contraction  of  the  opponent  group  of  pronating 
muscles.  At  this  period  sensation  was  entire  in  the  right  limb,  but  there  was  soreness  on  pressure  in  all  the  anterior  arm  muscles, 
and  neuralgia  in  the  arm  and  forearm.  The  nutrition  of  both  arms  was  good,  but  the  right  was  the  smaller,  measuring  nt  the 
biceps  9f  inches,  while  the  left  measured  lOf  inches.  During  the  slow  progress  of  his  case  Captain  Stemble  lost  several  small 
pieces  of  the  hyoid  bone,  and  although  hoarse  for  many  months  has  recovered  his  voice  without  serious  change  in  its  tone  or 
power.  His  convalescence,  interrupted  by  many  accidents  and  by  an  attack  of  pneumonia,  continued  up  to  the  summer  of  18B3, 
and  was  largely  due  to  the  skill  and  care  of  his  able  medical  attendant,  Dr.  Judkins.  When  placed  under  treatment,  in  Phil 
adelphia,  by  Dr.  Mitchell.  July  18,  1863,  Captain  S.  was  still  suffering  from  constant  pain  in  the  right  arm.  The  left  was  well 
except  as  to  the  trifling  loss  of  sensation  mentioned  above.  The  right  forearm,  though  weak,  possessed  every  movement  except 
supination.  as  did  also  the  hand,  but  the  arm  hung  at  the  side  useless,  because  there  was  scarce  any  abducting  power  and  very 
little  flexion  at  the  elbow,  both  the  biceps  and  long  supinator  being  greatly  enfeebled,  and  the  former  muscle,  as  well  as  the 
brachialis  anticus,  almost  entirely  atrophied  and  lost  to  view.  Excepting  the  trapezius  and  rhomboid  muscles,  all  the  shoulder 
group  was  nearly  useless  and  partially  wasted.  From  July  18th  to  September  9th  he  was  faradized,  at  first  every  day,  and 
then  every  third  day.  Active  and  passive  movements  which  had  already  been  employed  being  of  course  continued  The  result 
was  a  steady  gain,  ending  in  a  cure  as  complete  as  could  be  hoped  for  in  a  case  so  severe.  He  regained  every  lost  motion,  .and 
could  raise  his  hand  to  his  chin  and  abduct  the  arm  about  fifty  degrees.  The  pronators  alone  remained  intractable,  despite  every 
effort,  but  as  the  supinators  and  biceps  developed  themselves  largely,  even  pronation  gained  somewhat,  though  not  to  such  an 
extent  as  the  other  movements.  The  pain  and  hyperscsthesia  diminished,  but  the  former  still  exists.  It  is  believed  that  a  second 
course  of  similar  treatment,  about  to  be  instituted,  will  further  amend  this  case,  in  which  all  other  means  had  utterly  failed. 
Dr.  Judkins  is  of  opinion  that  the  entire  paralysis  was  due  to  reflected  irritation.  We  incline  to  this  belief  for  anatomical 
reasons,  but  even  though  we  admit  that  the  paralj-sis  of  the  I'ight  arm  may  have  been  caused  by  commotion  of  the  brachial 
plexus,  it  is  impossible  to  suppose  that  the  loss  of  power  in  the  left  member  could  have  been  similarly  produced.  The  only 
permanent  lesion  on  that  side  was  the  loss  of  feeling  on  the  ulnar  side  of  the  palm  und  fourth  finger.  With  this  exception  it 
regained  its  normal  functions  within  three  or  four  weeks.  Whatever  may  have  been  the  cause  of  injury  to  the  right  arm,  it 
appears  to  have  involved  more  or  less  nearly  all  the  strands  of  th«  plexus,  which  is  unusual  in  cases  of  traumatic  injury  from  a 
ball.  Its  results  were  also  more  lasting  than  in  the  other  arm.  A  year  and  two  months  after  the  accident  the  right  arm  was  a 
useless  member.  Farardization  of  the  muscles  affected  restored  their  power  very  rapidly,  so  that  the  patient  regained  every 
movement  of  the  limb,  which  is  still  improving, — electricity  having  been  temporarily  laid  aside  in  September,  1863. 

"CASE  II. — Flesh  Wound  of  Right  Thigh,  without  wound  of  any  large  nerve.;  complete  paralysis  of  all  four  limbs  ;  speedy  recovery 
of  the  left  arm,  tardy  recovery  of  the  other  limbs,  subsequent  analgesia  of  the  right  side. 

"Jacob  Demmuth,  aged  21,  Swiss,  enlisted  July,  1861,  company  'D,'  108th  New  York  Vols.,  a  man  somewhat  below 
the  average  standard  of  height,  of  lymphatic  temperament  and  moderate  intelligence.  Reports  himself  as  healthy  up  to  the  date 
of  his  wound,  which  took  place  at  Fredericksburg,  December  13,  1862.  He  was  marching  at  double-quick,  when  a  fragment  of 
shell  as  large  as  a  musket  ball  struck  his  right  thigh  at  the  junction  of  the  upper  and  middle  thirds,  directly  over  the  femoral 
artery.  The  fragment  did  not  enter  deeply,  but  merely  lodged  in  the  leg,  and  was  removed  a  day  later  without  injury  to  the 
vessel.  Effect  of  wound. — lie  fell  half  conscious,  and  although  aware  that  he  was  wounded,  he  could  not  fix  on  the  sitt^  of  the 
injury  until  he  had  examined  the  limb.  He  felt  instantly  a  burning  pain  in  both  feet,  in  front  of  the  right  chest  and  in  the  right 
arm,  and  in  the  right  thigh  about  the  wound.  At  first  he  was  entirely  powerless,  but  after  a  few  minutes  the  power  of  the  left 
arm  returned,  leaving  him  paralyzed  as  to  motion  in  the  right  arm  and  in  both  legs.  He  lay  on  the  field  twenty-four  hours,  the 
weather  being  very  cold.  Sensation  was  defective  in  all  the  parts  paralyzed  as  to  motion.  He  had  no  pain  in  the  back,  but  the 
burning  pains  alluded  to  above  continued  for  a  long  time,  and  were  always  eased  by  cold  applied  to  the  wound.  While  the 
wound  was  healing  he  had  headache  and  difficult,  painful  micturition.  The  wound  closed  in  four  weeks.  During  this  period  he 
regained  the  power  to  move  the  right  arm,  feebly  and  slowly,  although  perfectly  as  to  extent.  The  pain  in  the  side  and  feet  also 
diminished,  and  the  former  disappeared  altogether  at  a  later  period.  He  could  not  stand,  however,  or  lift  his  legs  from  the  bed 
at  the  time  the  wound  healed,  but  there  was  then  no  headache  or  difficulty  with  the  bladder  or  rectum.  January  .28,  1863,  he 
was  sent  to  Washington,  where  he  improved  so  as  to  be  able  to  walk  with  the  help  of  a  cane.  His  subsequent  transfer  to  West 
Philadelphia  caused  a  relapse;  the  pains  returned,  the  paralysis  increased,  and  he  walked  with  difficulty  on  crutches.  June  4, 
entered  Christian  Street  Hospital.  Present  state  :  Movement. — The  patient  is  partially  paraplegic.  He  has  some  power  to  move 
the  thighs  when  lying  down,  but  cannot  lift  the  legs  from  the  bed.  Below  the  knee  all  motion  is  lost,  except  a  slight  power  of 


WOUNDS    AND    COMPLICATIONS.  [CHAP.  xu. 

flexing  the  smaller  toes  in  both  feet.  Pressure  upon  the  cicatrix  causes  feeble  twitching  of  the  anterior  muscles  of  the  right  thigh ; 
both  legs  are  subject  to  cramp  and  twitchings,  which  increase  at  night.  The  left  arm  is  strong,  the  right  arm  has  all  the  normal 
movements,  but  all  are  slowly  and  feebly  executed.  Sensation. —  He  has  shooting  pains,  which  start  from  the  seat  of  the  wound 
and  dart  down  the  thigh  to  the  knee.  No  other  pain  exists  at,  present,  but  there  is  still  a  good  deal  of  burning  sensation  in  both 
feet  alike.  Localizing  sensibility  perfect  everywhere.  Tactile  sensation  normal,  or  very  nearly  so,  in  all  parts  of  his  body;  no 
loss  of  sense  of  pain  in  the  skin.  Pressure  or  pinching  of  the  muscles  gives  him  more  than  the  usual  pain,  so  the  muscles  (of  both 
legs,  especially  below  the  knees)  may  be  regarded  as  affected  with  hyperiesthesia  of  common  sensation.  The  left  arm  is  in  all 
respects  normal;  the  right  arm  is  also  free  from  lesions  of  sensibility.  Nutrition. — There  is  no  special  atrophy  of  individual 
groups  of  muscles,  but  both  legs  are  slightly  wasted,  the  right  arm  not  at  all  so.  The  legs  below  the  knees  are  relaxed  and  cold; 
the  feet  are  congested,  but  not  swollen  to  any  marked  extent.  Along  the  edges  of  both  soles  there  are  singular  purple  and  blue 
anottled  spots,  which  he  says  existed  from  the  time  his  boots  were  first  taken  off,  twenty-four  hours  after  he  was  wounded.  It  is 
possible  that  these  marks  are  due  to  frostbite.  The  muscles  of  the  legs  are  about  equally  irritable  to  induced  electric  currents. 
Unfortunately,  no  very  perfect  electric  examination  of  their  condition  was  made  at  this  period.  Treatment. — Regarding  the  case 
as  one  of  reflex  paralysis  chiefly,  he  was  ordered  to  have  rough  frictions,  with  cold  to  the  spine,  and  to  take  the  twentieth  of  a 
grain  of  strychnia  three  times  a  day.  Under  this  treatment  the  cramps  and  twitchings  increased,  so  that  after  three  weeks  the 
strychnia  was  abandoned.  Every  future  attempt  to  repeat  its  employment  caused  the  same  increase  of  annoyance,  without 
correspondent  benefit,  so  that  it  was  finally  laid  aside  as  useless  or  worse.  About  the  middle  of  August  a  blister  was  placed  on 
the  cicatrix,  with  the  effect  of  greatly  relieving  the  burning  in  both  feet.  At  the  same  time  he  was  ordered  to  use  the  hot  and  cold 
douche  to  the  spine  alternately,  and  faradized  daily.  The  electricity  was  persistently  employed  during  two  months,  and  a  month 
later  he  was  also  treated  with  iron  and  quinine,  porter  and  liberal  diet.  The  electric  treatment  caused  a  rapid  amelioration  of 
his  case,  so  that  he  soon  left  his  bed  and  began  to  walk  on  crutches.  Early  in  November  he  ceased  to  improve,  and  the  treatment 
was  abandoned.  At  this  time  he  could  use  his  right  arm  well  and  quickly,  and  walked  unaided,  although  with  a  little  unsteadi 
ness  of  gait.  No  close  examination  was  made  as  to  his  sensibility  until  December  3,  1863,  because  during  this  time  he  had  been 
able  to  give  aid  in  the  wards,  and  made  no  complaint,  except  of  more  or  less  constant  aching  in  the  dorsal  and  lumbar  regions  of 
the  spine.  About  December  3d  he  was  closely  inspected  for  discharge,  when  the  following  notes  were  taken :  Motion. — Good  in 
left  arm;  not  so  perfect  in  right  arm.  Both  legs  somewhat  weak,  so  that  lie  shuffles  a  little  in  walking,  the  worst  movement 
being  that  of  extension  in  the  toes  of  the  right  foot.  Sensation. — Tactile  sensibility  feeble  in  the  right  leg  and  right  arm,  but 
nowhere  entirely  lost;  it  is  normal  in  the  left  leg  and  left  arm.  The  sense  of  touch  is  first  found  to  be  feeble  below  the  navel  on 
the  right  side.  It  lessens  in  perfection  to  the  knee,  and  is  better  below  that  part,  especially  on  the  inside  of  the  calf,  being  worse 
in  the  foot.  Tickling  the  sole  causes  no  sensation  of  tickling  on  either  side.  1'ain. — There  is  absolute  loss  of  sense  of  pain  in  the 
right  leg,  belly,  chest  and  arm,  with  somewhat  lessened  sensibility  to  pain  on  the  left  side  also.  In  many  localities  he  was  able 
instantly  to  tell  by  the  altered  sensibility  when  the  needle  point  crossed  the  median  line;  in  others,  this  was  more  difficult.  So 
complete  was  this  analgesia  that  the  most  intense  faradization  of  the  nails  of  the  right  hand  or  of  the  right  nipple  caused  not  the 
least  sensation.  The  penis  remained  sensitive,  but  all  over  the  right  side  he  could  be  cut  or  stuck  full  of  needles  without  evincing 
the  least  consciousness  of  anything  but  a  touch.  The  sense  of  temperature  was  good  in  the  left  leg,  confused  and  uncertain  at  the 
upper  third  of  the  right  thigh,  and  lost  below  the  knee,  where  a  heat  of  110°  Fahrenheit  was  felt  as  a  touch  only  when  the  sponge 
wetted  with  hot  water  was  applied.  On  the  foot  of  the  right  side  this  degree  of  heat  was  unfelt  in  any  form.  Higher  heat 
caused  reflex  movements,  which  did  not  tend  to  remove  the  limb  from  the  irritant,  but  were  merely  convulsive  in  their  character. 
Intense  cold  also  gave  rise  to  these  irregular  movements.  Electric  examination, — There  was  some  difficulty  in  determining  the 
state  of  the  muscles  as  to  their  electric  sensibility,  owing  chiefly  to  the  want  of  intelligence  in  the  patient  and  to  the  fact  that  he 
spoke  an  impure  German  patois,  which  made  it  no  easy  task  to  obtain  from  him  a  clear  statement  of  his  feelings.  The  electro- 
muscular  contractility  is  slightly  diminished  in  the  right  leg  and  arm;  it  is  much  impaired  in  the  extensors  of  the  toes  on  both 
sides;  everywhere  the  muscles  respond  slowly.  The  patient  wu.s  discharged  December  14,  1863. 

"CASK  III. —  Wound  of  Right  Thiyh,  with  yrol>al>le  commotion  of  right  sciatic  nerve  ;  partial  paralysis  of  r'ujht  ley  ;  reflex  paralysis 

of  rigid  arm ;  speedy  recover >j  of  arm  ;  history  unfinished. 

"William  W.  Armliu,  aged  23,  born  in  New  York,  farmer,  enlisted  August,  1862,  in  company  'D,'  134th  New  York  Yols. 
Healthy  before  enlisting,  and,  except  a  slight  typhoid  fever  in  the  fall  of  1802,  healthy  up  to  the  date  of  the  wound,  July  1,  18b'3. 
at  Gettysburg.  While  kneeling  on  the  left  knee,  the  right  knee  bent  at  a  right  angle,  he  was  shot  in  the  right  thigh  on  a  line 
with  the  internal  condyle  of  the  femur,  ten  inches  above  it,  and  a  little  anterior  to  the  artery.  The  ball  passed  upward,  backward, 
and  outward,  and  emerged  two  inches  below  the  tuber  ischii,  and  one  and  a  quarter  inches  external  to  it,  just  above  the  fold  of  the 
nates.  Dropping  his  musket  lie  fell  on  his  face,  weak,  but  not  insensible;  the  right  leg  violently  flexed  for  a  moment.  He  felt 
very  feeble,  but  especially  so  in  the  right  arm,  with  which  he  vainly  tried  to  aid  himself.  After  a  half  hour  the  bleeding,  which 
was  not  excessive,  ceased,  and  he  was  able  to  stand  on  the  left  leg,  but  not  on  the  right  leg,  and  had  scarcely  any  use  of  the  right 
arm,  which,  it  should  be  noted,  was  in  no  way  hurt  when  befell.  He  managed  to  bind  up  the  wound  with  a  water  dressing,  and, 
occasionally  renewing  it,  lay  two  days  on  the  field.  When  hit  he  perceived  no  pain,  but  within  an  hour  a  burning  attacked  his 
instep,  and  has  never  left  it,  remaining  neither  worse  nor  better.  Sensation,  he  is  sure,  was  unaltered  except  on  the  sole;  motion 
improved  slowly,  except  in  the  flexors  and  extensors  of  the  foot  and  toes.  To  his  surprise  the  feebleness  of  the  right  arm 
increased  after  he  was  put  in  bed,  and  indeed  notably  after  the  second  day.  Up  to  October  28th  it  improved  slowly,  but  at  this 
time  he  went  home  on  furlough,  and  began  to  use  a  crutch,  which  again  so  weakened  the  arm  as  to  alarm  him  and  deprive  him, 
as  at  first  had  happened,  of  the  power  to  feed  himself.  Rejecting  a  crutch  on  this  side,  he  used  a  liniment  on  the  arm,  and  it  has 
now  gained  so  much  as  to  have  about  one-fourth  the  force  of  the  left  arm.  It  did  not  lose  sensation  at  any  time.  Present  state. 
December  14,  1863. — General  health  good.  Nutrition. — Wounds  healed.  Leg  below  knee  wasted,  foot  swollen,  toes  blue. 
Contraction  of  great  toe  in  flexion.  Measurements,  8f  inches  above  internal  condyle  the  thigh  measures,  right  16,  left  17|  inches; 
middle  calf,  right  11J,  left  13  inches.  Voluntary  motion. — He  lifts  the  right  thigh  well,  but  complains  of  its  weight.  Knee 
motions  very  fair;  has  no  extension  or  flexion  of  the  foot  or  toes.  Sensation. — Tactility  absent  in  sole  of  right  foot,  feeble  in 
second  toe  on  its  dorsal  face,  absent  on  top  of  third  toe,  but  elsewhere  complete.  Localization  extremely  confused,  so  that  a  touch 
on  the  toes  is  felt,  but  is  referred  to  the  instep.  Surface  analgesia  of  the  sole,  but  deep  pricking  with  a  needle  is  felt  in  the  sole. 
Hypersesthesia  of  the  posterior  thigh  muscles  to  a  slight  degree;  marked  soreness  on  pressure  in  the  calf  muscles,  the  short 
extensors  of  the  foot,  and  its  whole  dorsal  surface  as  well  as  the  inside  of  the  sole.  Pain. — The  pain  lies  deep  in  the  calf  and 
extends  outside,  under  and  in  the  peroneal  muscles,  down  the  front  of  the  leg,  and  over  the  dorsum  of  the  foot,  and  to  the 
external  side.  It  is  intense  in  the  dorsum,  but  nearly  absent  in  the  sole.  Water  does  not  seem  to  ease  the  pain,  which  is  of  a 
burning  character  Mike  mustard.'  Hitherto  nothing  has  aided  it.  Electric  test. — The  thigh  muscles  respond  well.  The  right 
tibfalis  anticus  has  no  electro-muscular  contractility,  but  its  electro  sensibility  is  highly  exalted,  as  is  the  case  in  all  the  muscles 
down  to  the  foot.  In  the  foot  the  electro-muscular  contractility  and  sensibility  are  both  lost,  except  that  in  some  parts  of  the 
dorsum  the  sensibility  cannot  be  tested  readily  for  various  reasons.  It  is  certainly  lessened.  The  right  arm  is  still  very  feeble, 
especially  below  the  elbow,  and  has  lost  in  size.  It  measures  comparatively  as  follows:  Dec.  20th,  right  forearm  8f  inches,  right, 
arm  9  inches;  left  forearm  9£  inches,  left  arm  9f  inches.  He  is  not  left  handed.  The  arm  is  improving;  the  leg  has  remained 
unchanged  during  some  time  past.  Ordered,  first,  a  blister  over  the  whole  dorsum  pedis.  Dec.  23d. — This  has  caused  great 
relief  and  is  to  be  repeated.  The  complete  history  of  this  case  will  be  detailed  elsewhere.  Up  to  this  present  date,  February  1, 
1864,  the  burning  pain  in  the  foot  has  been  relieved,  and  the  hand  and  arm  have  entirely  recovered  under  the  use  of  the  douche, 
active  exercise,  and  electricity. 


CHAP.  XII.J  EEFLEX    PARALYSIS,    THE    EESULT    OF    SHOT    WOUNS.  735 

"The  following  cases  are  equally  instances  of  reflex  paralysis.  We  regret  that,  owing  to 
circumstances  not  under  our  control,  they  are  less  complete  as  to  their  symptoms  and  history  than 
we  should  have  desired: 

''CASE  IV. — A  Sergeant  was  shot,  during  the  battle  of  Malvorn  Hill,  in  the  right  testicle.  This  organ  was  nearly  entirely 
destroyed  by  the  ball.  He  fell  without  pain,  believing  himself  wounded  in  the  back.  A  few  moments  later  he  became  senseless. 
Recovering  after  a  few  minutes  he  discovered  that  he  could  walk,  but  that  the  right  foot  dragged  when  he  attempted  to  lift  it 
during  the  effort  to  get  to  the  rear.  This  weakness  remained  permanent  for  several  months,  and  was  relieved  by  faradization,  and 
shampooing  soon  after  the  testicle  healed.  The  flexors  of  the  foot  on  the  left  leg  were  completely  paralyzed  to  voluntary  control, 
but  responded  to  the  irritation  of  the  induced  electro-magnetic  currents.  There  was  no  loss  of  sensibility. 

"  The  next  case  was  observed  by  one  of  us  in  the  U.  S.  A.  General  Hospital,  Sixteenth  and 
Filbert  Streets.  Unfortunately  no  notes  were  taken  at  the  time,  which  will  account  for  the  brevity 
of  the  details: 

"CASE  V. — An  officer  wras  struck  by  a  small  fragment  of  shell  upon  the  external  side  of  the  left  thigh.  He  felt  pains  of 
a  smarting  character  in  both  thighs  at  or  about  the  same  spot,  and  was  impressed  for  a  time  with  the  conviction  that  he  had 
been  shot  through  both  thighs.  The  shell  wound  healed  in  the  course  of  three  or  four  months.  During  this  time  he  had  occasional 
smarting  on  the  outside  of  the  sound  thigh.  This  gradually  disappeared,  and  at  length  he  noticed  accidentally  that  there  was  a 
space  of  skin  about  five  inches  square,  on  the  outer  part  of  the  sound  thigh,  in  which  there  was  neither  sense  of  touch  nor  of  pain. 
When  examined  by  us,  he  could  indicate  the  boundaries  of  the  anaesthetic  space  very  readily  by  the  loss  of  tactile  sensations 
when  a  body,  moved  while  in  contact  with  his  skin,  was  made  to  cross  the  line  on  to  the  numb  parts.  These  bounds  were  always 
very  accurately  the  same.  He  returned  to  his  regiment  without  any  improvement  having  taken  place  in  regard  to  anresthesia. 
It  is  difficult,  as  it  appears  to  us,  to  refer  either  this  case  or  the  last  to  any  cause  except  a  reflex  effect.  The  interest  of  the  case 
just  now  recorded  lies  partly  in  the  fact  that  at  the  time  of  the  wound  the  patient  felt  a  sensation  which  he  referred  to  the  part 
which  afterward  became  deprived  of  sensation. 

"  The  following  case  is  a  still  more  remarkable  instance  of  the  same  peculiarity,  and  is  also 
instructive  from  its  resemblance  to  Case  III,  that  of  Armlin,  in  whom  a  gunshot  wound  of  the 
right  leg  also  caused  reflex  paralysis  of  motion  only  in  the  arm  of  the  same  side : 

"CASE  VI. — Gunshot  Wound  of  Right  Thigh;  lesions  of  motion  and  sensation;  reflex  paralysis  of  right  arm  as  to  motion. 

"Daniel  Kent,  aged  24;  Pennsylvania!!;  farmer.  Enlisted  August,  1862,  company  'B,'  145th  Pennsylvania  Volunteers. 
Healthy  until  wounded.  At  Gettysburg,  July  2,  1863,  while  charging  at  a  full  run,  the  leg  raised  up,  he  was  shot  in  the  right 
thigh  10|  inches  above  the  edge  of  the  patella,  directly  over  the  rectus.  The  ball  made  its  exit  on  the  postero-internal  surface 
of  the  thigh  one  inch  below  the  fold  of  the  nates.  It  seems  to  have  passed  inside  of  the  bone  and  could  not  have  hit  the  sciatic 
nerve.  He  fell  at  once,  quite  conscious,  and  feeling  an  instant  stinging  pain  all  over  the  right  side  of  his  body,  and  especially 
ii!  the  arm.  He  lost  a  great  deal  of  blood,  and  found  that  he  could  not  sit  up  without  giddiness.  His  wound  was  dressed  in 
six  hours,  and  he  was  on  the  field  thirty-six  hours.  The  leg  lost  all  motion  and  some  sensation,  and  the  tingling  pain  in  the 
arm  left  him  within  twelve  hours.  He  remained  in  bed  six  weeks,  and  then  was  able  to  walk  on  crutches.  The  sense  of  touch 
changed  but  little  during  the  time  which  has  since  elapsed,  and  the  power  of  movement  in  the  leg  has  remained  unaltered  since 
August  1,  1863.  The  wound  healed  in  October,  with  some  previous  loss  of  bone.  Since  October  the  wounds  have  twice 
reopened  to  give  exit  to  small  pieces  of  bone.  Except  an  attack  of  ague  in  October,  his  general  health  has  been  good.  Present 
condition,  December  26,  1863:  Nutrition. — The  leg  is  healthy  in  color;  the  foot  swells  when  hanging  down.  The  right  thigh, 
eight  inches  above  the  patella,  measures  19  inches  in  circumference;  the  left  measures  19£  inches.  The  right  calf  measures  14£ 
inches;  the  left  calf  measures  15  inches.  Sensation. — No  pain  anywhere;  tactile  sensibility  entire;  sense  of  locality  healthy. 
Motion. — The  thigh  is  voluntarily  flexed  very  slightly,  and  only  through  the  agency  of  the  psoas  muscle,  the  anterior  thigh 
muscles  refusing  to  obey  the  will;  abduction  and  adduction  of  the  thigh  normal;  extension  of  the  thigh  is  normal;  extension 
of  leg  noue.  The  foot  is  almost  moveless,  except  that  the  will  can  cause  feeble  flexion  of  the  toes  and  slight  eversion  and 
inversion  of  the  foot.  Electric  examination. — The  rectus  muscle  has  its  electro-muscular  contractility  somewhat  lessened;  that 
of  the  two  vasti  muscles  is  lost  until  the  wet  conductors  reach  the  upper  parts  of  the  muscles  (three  inches  above  the  wound), 
where  this  properly  becomes  normal.  The  sartorius  has  its  electric  contractility  diminished.  Below  the  knee  the  peroneus 
longus  responds  very  well,  but,  with  this  exception,  none  of  the  leg  muscles  stir  under  the  most  powerful  induced  currents.  The 
short  extensor  of  the  toes  and  the  interossi  still  possess  some  power  to  contract  under  electrical  stimulus.  Throughout,  the 
electro-muscular  sensibility  is  diminished  in  all  the  muscles  which  have  suffered  in  their  contractile  power,  and  the  sense  of  pain 
seems  also  to  be  materially  lessened  since  dry  electric  conductors,  with  strong  currents,  cause  no  pain  when  applied  to  the  bones 
or  nails  of  the  foot.  The  history  of  the  arm,  which  was  reflectively  paralyzed,  has  been  reserved  for  separate  detail  here. 
After  three  days  from  the  date  of  the  wound  the  right  arm,  which  had  remained  feeble,  became  so  completely  paralyzed  that  the 
patient  could  no  longer  raise  it  to  his  lips;  under  the  use  of  a  stimulating  liniment  it  grew  better  until  he  used  crutches.  Prob 
ably  owing  to  their  employment  he  became  much  worse,  but  gradually  improved  again  up  to  this  present  date  of  January  6, 1864. 
The  right  and  left  arms  measure  nearly  the  same;  power  of  right  arm  one-fourth  that  of  left.  Electric  examination. — Electro- 
muscular  contractility  normal ;  electro-muscular  sensibility  somewhat  lessened.  Treatment. — Faradization  of  arm  daily ;  alternate 
hot  arid  cold  douche,  and  active  motion.  On  close  examination,  soon  after  admission,  some  evidence  of  tubercle  was  found  in 
the  right  lung,  and  the  patient  was  therefore  ordered  to  be  discharged  January  20,  1864. 

"CASE  VII. —  Wound  of  Eight  Deltoid;  sensory  altd  slight  motor  paralysis  of  right  arm;  speedy  recoreri/. 
"Michael  Farrell,  aged  28;  farmer;  born  in  New  York;  enlisted  September,  1861,  company  'I,'  20th  New  York  Vols.;  a 
vigorous,  healthy  looking  man — was  well  up  to  date  of  enlistment.  At  Fredericksburg,  December  13,  1862,  he  was  shot  in  the 
left  shoulder  while  lying  down.  *  The  ball  entered  the  erector  spinse  mass  of  muscles  on  the  left  side  on  a  level  with  the  lower 
angle  of  the  scapula,  and  passing  upward  and  outward,  lodged  under  that  bone ;  the  wound  healed  readily,  the  ball  remaining. 
February  3d,  went  to  duty.  July  1,  1863,  a  small  ball  passed  through  the  right  deltoid  muscle  three  inches  above  its  insertion 
into  the  humerus.  The  ramrod  fell  from  his  hand  and  the  arm  dropped.  He  retired  to  a  hospital,  and  on  examination  found 
that  although  he  had  all  the  movements  of  the  arm  he  had  no  sensation.  During  the  next  four  days  he  was  exposed  to  the  sun 
a  good  deal,  and  the  arm,  being  bare,  was  blistered,  which,  he  says,  to  a  great  extent  restored  its  feeling,  which  has  since  gone 
on  improving.  There  is  now,  July  25,  1863,  some  slight  paralysis  of  motion,  but  all  the  movements  are  feeble,  and  those  of  the 
arm  painful,  owing  to  the  contractions  about  the  ball  track  ;  the  arm  improved,  and  the  man  was  returned  to  duty  Oct.  22, 1863. 

"Before  proceeding  to  discuss  the  causes  which  give  rise  to  reflex  paralysis,  it  will  be  useful 
to  analyze  the  symptoms  of  the  preceding  cases  so  as  to  learn  how  they  differ  and  in  what  respect 
thev  resemble  one  another. 


736  WOUNDS    AND    COMPLICATIONS.  K-IIAF.  XII. 

"Relation  of  the  seat  of  the  icound  to  the  part  or  parts  paralyzed. 

"CASE  1. — The  wound  involved  the  muscles  of  the  neck  or  throat,  and  the  hyoid  bone. 
Result:  Paralysis  of  both  arms  and  of  the  neck.  CASE  II. — Fragment  of  shell ;  wound  of  mus 
cles  over  and  external  to  the  right  femoral  artery.  The  injury  may  have  caused  concussion  of  the 
crural  nerves,  and  thus  much  of  traumatic  paralysis.  Result:  Reflected  paralysis  of  the  right 
arm  and  leg  and  the  left  leg.  "CASE  III. — Probable  injury  of  the  sciatic  nerve — (commotion). 
Result:  Reflex  paralysis  of  the  right  arm.  CASE  IV. — Ball  wound  of  right  testicle;  paralysis  of 
right  anterior  tibial  muscles  and  peroneus  longus.  CASE  V. — Wound  by  fragment  of  shell  in 
external  side  of  left  thigh;  paralysis  of  tact  on  a  corresponding  part  of  right  thigh.  CASE  Vf. — 
Ball  wound,  probably  involving  the  crural  nerves.  Result:  Paralysis  of  right  arm.  CASE  VII.— 
Ball  wound  of  deltoid  muscle;  sensory  and  slight  motor  paralysis  of  same  arm.  There  is  no 
evidence  in  this  case  that  the  ball  struck  the  bone  or  directly  injured  any  large  nerves,  since  even 
the  deltoid  itself  had  nearly  full  power  when  the  patient  was  first  examined  by  us.  In  three  of 
these  cases  the  leg  was  hit,  and  the  arm  of  the  same  side  was  paralyzed.  In  three  cases  the 
paralysis  affected  the  opposite  side  of  the  body;  and  in  one  the  paralysis  of  tact  and  pain  was 
observed  to  have  fallen  upon  a  space  symmetrically  related  to  the  wounded  spot  as  regards  posi 
tion.  No  general  law,  therefore,  can  be  deduced  from  these  records,  nor,  from  what  we  see  in  the 
causation  of  reflex  paralysis  from  disease,  should  we  expect  to  find  any  inevitable  relation  between 
the  part  injured  and  the  consequent  paralysis.  The  constitutional  condition  at  the  time  of  the 
wounding,  as  to  excitement,  mental  and  physical,  may  possibly  have  to  do  with  causing  the 
resultant  paralysis. 

uOf  the  seven  cases  above  reported,  two  were  in  active  movement,  two  were  standing  about 
taking  aim,  one  was  kneeling,  and  of  two  we  have  no  information  as  to  this  point.  It  may  prove, 
upon  examining  a  larger  number  of  cases,  that  a  man  wounded  when  moving  violently,  or  when 
excited,  is  more  than  another  liable  to  reflex  paralysis,  but  as  yet  we  are  not  entitled  to  such  an 
inference.  In  most  of  our  cases  the  constitutional  effects  were  instant  and  severe,  and  could  not 
therefore  have  been  due  to  the  loss  of  blood,  which  in  some  of  them  was  copious.  Four  of  f  he 
seven  cases  had  stinging,  smarting,  or  burning  pain  in  the  part  paralyzed  reflectively.  The  pain 
was  an  early  symptom,  which  disappeared  in  all  of  them  after  a  time.  In  three  cases  no  such 
pains  were  complained  of. 

"The  after  history  of  these  cases  is  extremely  curious.  However  grave  the  lesion  of  motion 
or  sensation,  it  grew  better  early  in  the  case,  and  continued  to  improve  until  the  part  had  nearly 
recovered  all  its  normal  powers.  In  almost  every  instance  some  relic  of  the  paralysis  remained, 
even  after  eighteen  months  or  more  from  the  date  of  wounding.  In  some  the  part  remained  weak, 
in  others  there  was  still  left  some  slight  loss  of  sensibility,  and  in  two  the  loss  of  power  and  of 
sensory  appreciation  was  very  considerable.  In  a  case  of  reflex  paralysis  from  a  wound  we  have, 
therefore,  some  right  to  expect  that  the  patient  will  recover  rapidly  up  to  a  certain  point;  then  in 
most  cases  a  small  amount  of  loss  of  power  or  sensation  may  remain.  The  future  history  of  our 
own  or  other  cases  may  determine  hereafter  whether  the  recovery  is  ever  quite  complete.  In  CASE 
I,  the  more  prominent  results  were  only  the  continued  lesions  which  had  been  noted  early  in  the 
case.  In  CASE  II,  the  permanent  lesions  were  chiefly  of  secondary  character,  and  were  at  all 
events  additions  to  those  which  were  first  observed.  In  no  other  case  were  similar  phenomena 
noticed.  In  two  of  the  seven  cases  there  were  lesions  of  sensation  and  motion;  in  three,  motion 
alone  was  lost;  and  in  two  the  sense  of  tact  and  pf  pain  were  affected  without  other  loss  of  func 
tion.  The  extent  and  duration  of  the  induced  paralysis  have  already  been  considered. 

"Of  the  treatment  we  have  very  little  to  say.  In  Captain  Stembel's  case  the  left  arm  recov 
ered  without  treatment  in  four  weeks,  leaving  only  a  slight  loss  of  touch  in  the  terminal  distribu 
tion  of  the  ulnar  nerve.  The  right  arm,  which  we  also  regard  as  reflectively  paralyzed,  recovered 
sensation  early,  but  was  useless  as  to  motion,  until  it  was  treated  and  cured  by  faradization 
eighteen  months  after  it  was  first  injured. 

"Demmuth,  CASE  II,  came  under  our  care  seven  months  after  he  was  wounded;  as  to  his  pre 
vious  treatment  we  know  nothing.  In  our  hands  strychnia  not  only  failed  to  aid  him,  but  did 
harm.  He  was  rapidly  relieved  by  faradization,  active  and  passive  movement,  and  the  douche, 
with  iron,  quinine,  and  liberal  diet. 


CHAP.  Xll.]  REFLEX    PARALYSIS,    THE    RESULT    OF    SHOT    WOUNDS.  737 

"  Arinlin,  CASE  III,  used  a  liniment  on  the  paralyzed  arm  with  some  improvement.  Faradiza 
tion  has  restored  it  completely.  CASE  IV. — Relieved  by  faradization.  CASE  V. — Xo  treatment; 
lesion  of  sensation  only.  CASE  VI. — Kent.  A  stimulating  liniment  applied  upon  the  arm  seems  to 
have  been  of  use.  As  in  Case  III,  the  employment  of  crutches  caused  a  relapse.  CASE  VII  seems 
to  have  been  accidentally  benefited  through  the  blistering  to  which  the  arm  was  subjected  after 
exposure  to  the  sun — a  useful  hint  in  like  cases.  No  other  treatment  was  employed.  Although 
long  periods  had  elapsed  in  every  case  before  we  examined  them,  in  only  one,  that  of  Arinlin,  Case 
III,  was  there  any  very  notable  wasting.  And  even  in  this  patient  the  loss  was  generally  through 
out  the  member,  and  may  be  readily  ascribed  to  mere  lack  of  use.  In  none  was  there  atrophy, 
such  as  characterizes  lesions  of  nerves,  and  certain  rheumatic  and  other  palsies,  save,  perhaps,  in 
the  doubtful  instance  of  the  right  arm  in  CASE  I. 

"The  electric  examination  was  made  at  periods  so  variable  in  the  several  cases  as  not  to 
permit  of  any  useful  comparison  of  results,  and  has  been  stated  in  each  case  merely  for  future  use 
and  reference  when  more  cases  have  been  reported.  In  only  one  case  did  the  muscles  display 
great  loss  of  contractility  when  faradized,  and  in  this,  No.  1  of  the  series,  the  limb  in  question  was 
the  right  arm,  as  to  which  alone  some  doubt  may  exist  concerning  the  cause  of  the  paralysis. 
The  ultimate  causation  of  these  very  singular  and  hitherto  undescribed  affections  is  the  last  point 
which  we  shall  consider.  The  problem  before  us  may  be  simply  and  briefly  stated;  its  solution  is 
a  task  less  easy. 

"A  gunshot  wound  occurs,  involving  large  nerves  or  not,  and  we  have  instantly  a  paralysis 
of  motion  and  sensation,  or  of  either  alone,  in  some  part  of  the  body  more  or  less  remote.  How 
shall  we  explain  this?  Although  we  have  long  been  aware  that  certain  forms  of  disease  are  capa 
ble  of  causing  paralysis  of  distant  organs,  of  altering  secretions  and  affecting  nutrition,  we  have 
had  no  plausible  theory  of  the  causation  of  these  effects  until  M.  Brown-Se"quard  attempted  to 
account  for  them  in  a  manner  equally  simple  and  ingenious.  Recalling  the  fact  that  irritation  of 
the  vaso-inotor  nerves  is  capable  of  producing  contraction  of  the  blood-vessels,  he  inferred  that 
when  an  external  nerve  is  violently  or  permanent^  excited  it  may  be  able  to  produce  contraction 
of  the  capillary  vessels  of  the  nerve  centres  and  thus  give  rise  to  paralysis.  It  seems  unlikely, 
even  if  we  admit  his  explanation,  that  the  capillaries  could  remain  contracted  for  any  great  length 
of  time.  But  it  is  possible  that  the  alteration  of  nutrition,  which  this  temporary  anaemia  causes, 
may  give  rise  to  one  of  two  results — either  a  continued  disturbance  of  nutrition,  which,  however 
slight,  would  occasion  grave  results  if  it  existed  in  a  nerve  centre,  or  secondly,  to  a  paralysis  of  the 
capillaries  of  the  nerve  centre  involved. 

"We  suppose,  first,  the  existence  of  an  exterior  nerve  lesion;  secondly,  a  consequent  irrita 
tion  of  the  vase-motor  nerves  in  a  limited  part  of  the  spine;  contraction  of  its  capillaries,  anaemia, 
nutritive  changes,  and  finally,  a  relaxation  of  these  vessels,  which  would  be  more  apt  to  be  a  last 
ing  condition,  and  would  in  fact  constitute  congestion.  Such  a  series  of  consequences  may  very 
possibly  occur,  and  would  no  doubt  be  competent  to  cause  a  paralysis  whose  site,  extent,  and 
character  would  depend  upon  the  part  of  the  nerve  centres  affected  by  the  excitation.  With  so 
satisfactory  an  hypothesis  before  us  in  this  modified  shape,  it  would  seem  needless  even  to  suggest 
any  other  explanation.  But  in  a  region  of  research  so  little  explored,  it  may  be  allowable  to  point 
out  the  fact  that  another  mode  of  explanation  is  at  least  possible,  and  the  more  so,  since  there  exist 
certain  objections  to  M.  Browu-Stiquard's  manner  of  viewing  the  subject.  It  is  to  our  minds 
improbable  that  contraction  of  the  capillaries  can  continue  for  any  great  length  of  time.  There  is 
no  experiment  on  record  to  show  that  this  can  be,  or  that  it  ever  occurs  in  a  nerve  centre.  We 
have  therefore  added  the  suggestion  of  consequent,  and  why  may  we  not  say  primary,  paralysis  of 
these  vessels.  Here  we  have  firmer  ground  for  opinion,  since  it  has  been  most  distinctly  shown 
that  in  section  of  the  sympathetic  nerve  this  result  does  take  place,  and  is  singularly  persistent. 
But  whether  the  blood-vessels  remain  contracted  or  dilated,  nutritive  changes  would  occur,  and 
these  the  pathologist  has  failed  to  find.  If  now  we  ask  ourselves  the  question  whether  it  may  be 
possible  to  blight  or  exhaust  utterly  the  power  of  a  nerve  centre,  without  the  intervening  mechanism 
of  contracted  or  dilated  blood-vessels,  we  are  tempted  to  think  that  such  a  result  may  be  producible. 

"It  appears  to  us  possible  that  a  very  severe  injury  of  a  part  may  be  competent  so  to 
exhaust  the  irritability  of  the  nerve  centres  as  to  give  rise  to  loss  of  function,  which  might  pi-ove 
SUHG.  Ill— 93 


738  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xii. 

more  or  less  permanent.  A  strong  electric  current,  frequently  interrupted,  is  certainly  able  to 
cause  such  a  result  in  a  nerve  trunk,  while  a  general  electric  shock,  as  a  stroke  of  lightning,  is,  as 
we  well  know,  quite  competent  to  destroy  the  irritability  of  every  excitable  tissue  in  the  economy. 
Now  if  the  former  of  these  results  can  occur  in  a  nerve  so  insulated  as  practically  to  have  no  cir 
culation,  the  loss  of  irritability  cannot  be  set  down  as  due  in  such  a  case  to  a  defect  of  circulation. 
Eeflecting  then  upon  the  close  correlation  of  the  electrical  and  neural  force,  it  does  not  seem 
improbable  that  a  violent  excitement  of  a  nerve  trunk  should  be  able  to  exhaust  completely  the 
power  of  its  connected  nerve  centre.  The  central  change  thus  brought  about  would  no  doubt 
involve  the  consequent  or  immediate  occurrence  of  chemical  nutritive  changes,  which  would  grad 
ually  yield  as  time  went  on.  While  this  view  seems  to  us  adequate  to  explain  the  facts,  the  notion 
of  vaso-motor  irritation  and  capillary  contraction  (Brown-Se"quard)  does  not  appear  to  be  compe 
tent  to  cover  all  the  facts.  We  have  pointed  out  that  no  one  has  ever  shown  that  capillary  con 
traction  can  exist  as  a  permanent  state  in  a  nerve  centre;  while,  on  the  other  hand,  it  has  been 
proven  that  section  of  a  sympathetic  nerve  involves  permanent  dilatation  of  blood-vessels;  but  in 
the  brain,  which  is  supplied  by  the  sympathetic  of  the  neck,  division  of  this  nerve  gives  rise  to  no 
disturbance,  although  the  side  of  the  brain  on  which  the  section  occurs  grows  warmer.  However, 
it  is  probable  that  the  whole  supply  of  vaso-motor  nerves  to  the  brain  does  not  come  from  the 
neck,  while  other  organs,  whose  whole  supply  we  can  cut  off,  as  the  kidneys,  do  certainly  suffer 
nutritive  changes  as  a  consequence  of  such  sections. 

"  One  or  other  of  the  two  theories  we  have  offered  must  therefore  be  called  011  to  explain  the 
central  changes  which  give  rise  to  reflex  paralysis.  Either  the  shock  of  a  wound  destroys  directly 
the  vital  power  of  a  nerve  centre,  or  it  causes  paralysis  of  the  vaso-moter  nerves  of  the  centre, 
with  consequent  congestion  and  secondary  alterations.  But  there  is  no  reason  why,  if  shock  be 
competent  to  destroy  vitality  in  vaso-motor  nerves  or  centres,  it  should  be  incompetent  so  to  affect 
the  centres  of  motion  or  sensation.  Until  the  causation  of  these  cases  is  better  understood,  it  is 
vain  to  speak  confidently  as  to  treatment  founded  on  a  conception  of  the  mode  of  their  production. 
Experience  has  shown  that  the  removal  of  the  first  cause,  and  in  some  instances  The  application 
of  alteratives,  as  blisters  to  the  cicatrix,  prove  valuable  in  relieving  such  induced  pain  as  may 
exist.  Further,  that  stimulating  liniments  or  blisters  to  the  affected  member  are  useful,  and  that 
the  local  application  of  induced  electric  currents  to  the  muscles  is  of  the  utmost  service.  The 
question  of  the  use  of  internal  remedies  has  yet  to  be  decided  by  larger  clinical  experience.  We, 
ourselves,  have  been  unfortunate  in  that  no  chances  have  presented  themselves  of  treating  these 
cases  in  their  early  stages,  when  the  causes  which  first  produce  the  paralysis  are  present  and  before 
those  later  nutritive  changes  occur  which,  as  we  presume,  are  essential  to  the  continued  existence 
of  the  state  of  palsy.  We  have  endeavored  to  show  in  this  report  that  the  condition  called  shock 
is  of  the  nature  of  a  paralysis  from  exhaustion  of  nerve  force;  that  it  may  affect  one  or  many  nerve 
centres,  and  finally,  that  it  may  be  so  severe  as  to  give  rise  in  certain  cases  to  permanent  central 
nerve  changes,  productive  of  paralysis  of  sensation  and  motion,  or  of  either  alone. 

"S.  WTEIR  MITCHELL, 

uGrEO.   E.   MOREHOUSE, 

"  W.  W.  KEEN,  jr., 

"Act.  Ass't  Surgeons,  U.  S.  Army." 

The  number  of  recorded  cases  of  wounds  of  nerves  of  special  sense  caused  by  missiles 
is  small.  The  following  case  of  shot  wound  of  the  neck  is  interesting,  and  is  regarded  as 
a  case  of  injury  of  the  sympathetic  nerve:1 

CASE  1077. — Edward  Mooney,  aged  24  years,  enlisted  July,  1861,  Co.  C,  110th  Pennsylvania.  He  was  perfectly  healthy 
before  and  after  enlisting,  until  wounded  at  Chancellorsville,  May  3,  1863.  He  was  standing  erect  and  was  looking  toward 
the  left  side,  when  a  ball  entered  his  right  neck  one  and  a  half  inches  behind  the  ram  us  of  the  jaw,  at  the  anterior  edge  of  the 
Bterno-cleido  mastoid  muscle.  The  ball  passed  across  the  neck,  rising  a  little,  and  emerged  immediately  below  and  a  half  inch 
in  front  of  the  angle  of  the  jaw  on  the  left  side.  He  fell  senseless,  and,  judging  from  the  movements  of  his  regiment,  may  have 
so  remained  during  half  an  hour.  On  awaking,  he  found  his  mouth  full  of  clotted  blood,  which  he  pulled  out.  The  bleeding 
did  not  continue.  After  a  short  rest  he  was  able  lo  walk  nearly  three  miles  to  the  rear,  where  his  wounds  were  dressed  with 
cold  water.  On  his  way  he  discovered  that  his  speech  had  become  hoarse,  difficult,  and  painful,  and  that  deglutition  gave  rise 

1  MlTCHEU.,  MOUEIIOUBE,  and  KKEN  (loc.  cit.,  p.  44)  are  of  the  opinion  that  this  is  a  "case  of  injury  of  the  sympathetic  nerve,  and  if  so,  that  it 
\s  the  only  one  on  record." 


CHAP,  xii.]  SHOT    "WOUNDS    OF    NERVES.  739 

to  great  uneasiness  and  to  burning  pains.  He  says  the  sensation  of  pain  was  felt  as  though  behind  the  pomum  adami.  After 
five  days  of  great  suffering  and  utter  inability  to  swallow,  he  obtained  some  relief,  but,  for  a  month  or  more,  was  forced  to 
swallow  a  mouthful  of  water  after  every  mouthful  of  solid  food.  The  power  to  swallow  gradually  improved,  and  is  now  as  good 
as  it  ever  was.  A  week  after  he  was  wounded  he  became  able  to  articulate  without  pain,  although  still  hoarsely.  This  difficulty 
also  lessened  by  small  degrees.  At  present,  July,  1863,  his  voice  is  still  a  little  hoarse.  During  his  recovery,  which  was  rapid, 
the  wounds  healing  within  six  weeks,  he  had  a  good  deal  of  pain  in  the  back  of  the  neck.  He  says  that  he  had  headache  when 
ever,  after  the  injury,  he  attempted  to  walk  far  or  exert  himself;  but  he  describes  the  headache  as  chiefly  behind  the  ear  and  in 
the  back  of  the  head,  with  some  frontal  pain.  About  one  month  after  he  was  hurt  a  comrade  noticed  the  peculiar  appearance  of 
his  right  eye  and  called  his  attention  to  it.  A  little  later  it  began  to  be  troublesome  in  bright  lights,  and  has  remained  so  ever 
since,  with  of  late  some  change  for  the  better.  July  15,  1863:  The  pupil  of  the  right  eye  is  very  small,  that  of  the  left  eye 
unusually  large.  There  is  slight  but  very  distinct  ptosis  of  the  right  eye,  and  its  outer  angle  appears  as  though  it  were  dropped 
a  little  lower  than  the  inner  angle.  The  ball  of  the  right  eye  looks  smaller  than  that  of  the  left.  These  appearances  existed 
whether  the  eye  was  opened  or  closed,  and  gave  to  that  organ  the  look  of  being  tilted  out  of  the  usual  position.  The  conjunctiva 
of  the  right  eye  is  somewhat  redder  than  that  of  the  left,  and  the  pupil  of  the  right  eye  is  a  little  deformed,  oval  rather  than  round. 
In  a  dark  place,  or  in  half-lights,  the  difference  in  the  pupils  was  best  seen ;  but  in  very  bright  light,  as  sunlight,  the  two  pupils 
became  nearly  of  equal  size.  The  left  eye  waters  a  good  deal,  but  has  the  better  vision,  the  right  eye  having  become  myopic. 
In  sunlight  he  sees  well  at  first,  but,  after  a  time,  observes  red  flashes  of  light  in  the  right  eye,  and  finally,  after  long  exposure, 
sees  the  same  appearances  with  the  left  eye  also.  He  complains  a  good  deal  of  frontal  headache  at  present,  and  thinks  that  since 
the  injury  his  memory  has  been  failing,  although  of  late  it  has  improved.  Has  lost  flesh  and  strength  since  he  was  wounded. 
About  the  30th  of  August  the  patient  rode  to  the  office  of  Dr.  Dyer,  who  examined  his  eyes  with  the  ophthalmoscope,  but  found 
no  abnormal  retinal  appearances.  Mooney  walked  from  Dr.  Dyer's  office  to  the  hospital,  an  unusual  exertion,  as  he  was  weak, 
and  avoided  exercise  on  account  of  the  headache  it  caused.  An  orderly  who  was  with  him  on  this  occasion  remarked  to  one 
of  the  hospital  staff  upon  the  singular  appearance  which  his  face  presented  after  walking  in  the  heat.  It  became  distinctly  flushed 
on  the  right  side  only,  and  pale  on  the  left.  This  fact  was  afterward  observed  anew  by  one  of  us.  The  patient  had  used  exercise 
and  had  just  come  in.  The  right  half  of  the  face  was  very  red.  The  flush  extended  to  the  middle  line,  but  was  less  definite  as 
to  its  limit  on  the  chin  and  lips  than  above  these  points.  He  complained  of  pain  over  the  right  eye  and  of  red  flashes  in  that 
organ.  A  careful  thermometric  examination,  made  during  repose,  showed  no  difference  in  the  heat  of  the  two  sides  within  the 
mouth  or  the  ear.  We  regret  that  it  did  not  occur  to  us  to  repeat  this  wben  the  face  was  flushed  by  exertion.  Under  a  tonic 
course  of  treatment  he  gained  ground  rapidly.  The  eyes  became  less  sensitive,  the  pupils  more  nearly  alike,  the  line  of  the  lid 
straighter.  He  had  several  attacks  of  fainting  after  exposure  to  the  sun,  and  these,  with  occasional  diarrhoea,  retarded  his 
recovery.  He  was  at  last  able  to  return  to  duty,  and  left  for  that  purpose  in  October,  1863,  nearly  all  of  his  peculiar  symptoms 
having  disappeared  and  his  general  health  having  been  altogether  recovered. 

A  case  of  neurosis,  involving  different  brandies  of  the  sympathetic  nerve,  is  reported 
by  Acting  Assistant  Surgeon  L.  K.  Baldwin: 

CASE  1078. — Private  Hiram  Voight,  Co.  E,  13th  Massachusetts,  was  admitted  into  ward  O  of  the  West  Philadelphia 
Hospital  on  December  16,  1862,  with  a  cicatrized  shot  wound  of  the  right  arm,  producing  paralysis  of  the  ulnar  nerve.  Soon 
after  admission  he  had  congestion  of  the  kidneys,  with  scanty  acid  urine,  which  he  passed  with  difficulty.  Of  this  he  was  soon 
relieved  by  acetate  of  potassa  with  sweet  spirit  of  nitre,  conjoined  by  demulcent  drinks  and  fomentations  to  the  spine.  On 
January  16,  1863,  he  was  attacked  with  palpitation  of  the  heart  and  violent  dyspnoea,  coming  on  in  paroxysms,  chiefly  during 
the  night.  He  was  of  German  birth,  medium  sized,  with  dark  complexion  and  good  physical  organization,  about  24  years 
old.  After  the  exhibition  of  a  mild  laxative  he  was  put  upon  the  use  of  tincture  of  assafoetida,  with  the  application  of  a  bella 
donna  plaster  to  the  cardiac  regions.  No  tenderness  of  the  spine  was  manifested  upon  pressure.  Tincture  of  valerian  was  given 
along  with  the  assafcetida  upon  the  recurrence  of  the  dyspnoea,  which  resembled  spasmodic  asthma,  and  this  plan  of  treatment 
was  pursued  for  several  days.  On  February  14th  the  impulse  of  the  heart  was  so  considerable  that  five  drops  of  tincture  of 
veratrum  viride"  were  given;  but  its  discontinuance  was  soon  demanded,  and  the  antispasmodic  treatment,  with  tincture  of 
valerian  in  addition,  was  resumed.  On  February  17th  the  dyspnoea  was  less  violent  and  of  shorter  duration;  but  he  began  to 
complain  of  general  tremulousness  with  great  nervous  irritability.  The  tongue  became  furred  and  yellowish,  with  slight  head 
ache  and  feverishness,  which  were  relieved  bv  the  use  of  five  grains  of  blue  mass  at  night  and  slight  laxatives  in  the  morning. 
On  the  20th  he  had  great  cardiac  agitations  with  some  dyspnoea  and  general  nervous  tremulousness.  His  strength  was  also 
failing.  Pills  containing  one  grain  of  sulphate  of  quinine  and  two  grains  of  extract  of  hyoscyamus  were  given  four  times  daily, 
with  a  teaspoonful  of  compound  spirit  of  sulphuric  ether  at  times  of  paroxysms.  On  the  24th  he  felt  better,  but  a  repetition  of 
the  mercurial  was  demanded  by  the  state  of  the  tongue,  etc.  Still  had  paroxysms  of  dyspnoea  at  night,  with  twitchings  of  facial 
muscles  and  great  nervous  agitation.  Mental  functions  were  also  somewhat  disturbed.  On  the  27th  he  was  attacked  with 
vomiting,  which  caused  him  great  distress.  He  had  no  appetite  and  his  stomach  rejected  everything.  His  pulse  was  moderately 
full  and  regular,  but  his  countenance  and  general  movement  indicated  great  malaise,  and  he  seemed  almost  as  if  insanity  were 
impending.  His  face  became  flushed,  with  general  heat  of  skin,  and  thirst,  and  a  recurrence  of  the  furred  tongue,  with  constant 
vomiting.  He  was  again  put  upon  the  use"  of  blue  mass  with  aromatic  syrup  of  rhubarb,  which  soon  produced  a  favorable 
change  of  the  gastric  symptoms  as  well  as  his  general  condition.  Paroxysms  of  dyspnoea  had  now  in  a  great  measure  passed 
away.  The  pulse  had  become  regular  and  firmer ;  but  still  his  stomach  remained  irritable  and  non-retentive.  On  March  5th 
his  symptoms  had  a  little  improved,  but  he  was  very  restless  at  night,  and  still  gave  evidence  of  great  nervous  irritability,  which 
were  thought  to  be  clearly  traceable  to  an  affection  of  the  ganglionic  centres  of  the  sympathetic  nerve.  Endermic  applications 
of  morphia  to  the  epigastrium  was  tried  for  the  relief  of  gastric  irritability,  but  without  apparent  benefit.  The  stomach  remained 
rebellious  to  the  reception  of  everything  which  was  taken  into  it,  and  could  not  be  subdued  by  any  medicinal  or  dietetic  measures 
which  were  prescribed.  Notwithstanding  the  obstacle  to  proper  nutrition,  his  strength  was  quite  well  maintained  and  no 


740  WOUNDS   AND    COMPLICATIONS.  [CHAP,  xn 

particular  emaciation  was  observed.  Being  a  German,  lager  beer  and  bock  wine  were  temptingly  offered  bim;  but  witb  no 
successful  result.  In  this  way  be  continued  for  several  days  longer,  being  fortunately,  however,  now  relieved  of  all  pulmonary 
aud  cardiac  symptoms.  All  medicine  was  suspended,  and  on  March  30th  be  first  expressed  a  desire  to  be  discharged  and  sent 
home.  This  wish  was  acquiesced  in,  and  he  was  discharged  from  service  April  18, 1863,  and  pensioned.  Examiner  G.  S.  Jones, 
of  Boston,  reported,  December  21,  18G7:  "He  now  has  partial  paralysis  of  his  left  hand,  which  impairs  its  power  and  usefulness. 
There  is  no  evidence  of  nervous  debility  or  softening  of  the  brain." 

The  following  two  cases  of  shot  wounds  of  the  portio  dura  nerve,  seventh  pair,  are 
copied  from  Mitchell,  Morehouse,  and  Keen,  pp.  47,  51 : 

CASE  1079. — Private  John  C.  Dyre,  Co.  E,  71st  Pennsylvania,  aged  19  years,  was  wounded  at  Gettysburg,  July  3,  1863. 
While  aiming,  a  ball  entered  just  behind  the  left  ear  at  the  level  of  the  meatus.  It  broke  the  mastoid  process  slightly,  and  was 
said  to  have  gone  forward  and  downward.  It  has  not  been  found.  He  fell  unconscious,  and  reviving  within  about  two  hours 
at  a  hospital,  where  he  had  been  carried,  he  found  that  he  could  not  use  the  jaw,  owing  to  pain  in  the  ear.  There  was  also  pain 
in  the  left  cheek  and  brow,  left  neck,  shoulder,  arm,  and  hand,  together  with  the  left  chest.  The  left  arm  was  weak  for  several 
days.  He  may  have  fallen  upon  it.  The  pain  was  a  neuralgic  ache,  not  the  pain  of  a  bruise.  Water  dressings  were  used  after 
a  vain  search  for  the  ball.  Within  two  days  he  had  pain  in  the  lower  teeth  and  jaw  on  the  left  side.  After  five  weeks  all  the 
pains  grew  better  rapidly,  and  at  the  same  time  the  motions  of  the  jaw  returned.  The  ear  was  deaf  from  the  first;  but  he  does 
not  know  whether  blood  flowed  from  it  or  not,  or  when  pus  first  came  from  it.  Present  state,  February  14,  1864,  ciyht  months 
after  reception  of  wound :  The  features  are  slightly  drawn  to  the  right  in  repose,  and  excessively  so  during  laughter  and  speech. 
Specimen  1567,  in  the  Army  Medical  Museum,  is  a  cast  of  his  face  in  repose.  The  left  side  is  absolutely  paralyzed.  The  inner 
canthus  of  the  left  eye  is  a  little  rounder  than  that  of  the  right  eye.  The  tears  overrun  the  lid  at  times.  Inability  to  close  the 
lids  on  the  left  side,  owing  to  which  he  has  formed  the  habit  of  rolling  the  eyeball  upward  so  as  to  cover  it  with  the  passive  lid. 
He  then  supposes  that  he  has  closed  the  eye.  Chewing  on  the  left  side  causes  pain  in  the  teeth,  which  endures  for  some  time. 
Sensation  is  perfectly  normal  on  the  paralyzed  side.  Motion  is  of  course  utterly  lost  in  all  the  muscles  of  expression.  Electric 
test :  Not  the  slightest  contractility  exists  in  any  of  the  muscles  of  expression  on  the  left  side,  with  a  curious  exception.  The 
muscular  layer  of  the  orbicularis  oris  in  the  upper  and  lower  lips  still  responds  to  the  current,  but  more  remarkably  below 
than  above.  There,  is,  however,  no  voluntary  control  over  these  parts.  The  buccinator  alone  of  the  masticating  muscles 
seemed  to  have  its  electric  contractility  enfeebled  but  not  wholly  lost.  Examination  of  Special  Senses — Tonyuc — Motions :  The 
upward  and  backward  motion  of  the  base  of  the  tongue  is  awkwardly  performed.  In  most  of  its  movements  the  tongue  inclines 
slightly  to  the  right  side,  and  is  capable  of  being  drawn  to  the  left  side.  The  palate  hangs  a  little  to  the  right  and  acts  imper 
fectly,  so  that/oo(Z  is  apt  to  enter  the  nose.  There  is  some  further  loss  of  power  in  the  other  muscles  of  deglutition,  for  he  is  often 
troubled  by  food  entering  the  glottis,  while  at  times  it  is  thrust  back  again  into  the  mouth.  Speech  :  He  pronounces  many  letters 
with  difficulty  or  imperfectly,  so  that  his  speech  may  be  said  to  be  a  little  thick,  and  he  so  describes  it,  referring  the  trouble  to 
his  lips  and  tongue.  The  labials  are  of  course  affected,  but  the  guttural  sounds  arc  also  imperfectly  executed.  Taste  is  appa 
rently  impaired  over  the  entire  left  tongue.  It  was  examined  by  comparing  its  appreciations  with  those  of  the  other  side. 
Electric  state  of  Tongue  :  No  loss  of  its  electric  properties  was  detected.  Hearing  on  the  left  side  was  destroyed.  The  back 
part  of  the  bony  meatus  was  carious  and  the  membrane  absent,  perhaps  from  inflammation  consequent  upon  the  wound.  Treat 
ment  :  The  patient  was  industriously  faradized  for  several  months  without  the  least  gain  in  any  respect.  The  nerve  may  have 
undergone  such  changes  as  might  make  it  impossible  to  restore  to  the  muscles  their  lo.st  properties.  Dyre  was  discharged  from 
service  July  2,  1864,  and  pensioned.  Examiner  T.  F.  Harper,  of  Philadelphia,  reported,  January  30,  1869:  "A  gunshot  wound 
in -petrous  portion  of  temporal  bone  of  left  side  of  head,  causing  superficial  fracture  followed  by  some  exfoliation  of  bone.  Tlftre 
has  resulted  a  paralysis  of  seventh  nerve,  occasioning  an  impairment  of  vision  of  left  eye;  also  a  great  deformity  of  the  face,  it 
being  much  contorted  and  twisted  to  the  right  by  loss  of  power  in  the  muscles  of  the  left  side  of  the  face."  The  Philadelphia 
Examining  Board  reported,  September  13,  1877:  "Paralysis  of  left  side  of  face,  with  loss  of  hearing,  left  oar,  and  defective 
sight  in  left  eye.  Deformity,  overflow  of  tears,  and  inability  to  close  eyelids.  Ball  sup'posed  to  be  in  temporal  bone." 

CASE  1080. — J.  Gager,  Co.  M,  14th  New  York  Heavy  Artillery,  aged  4:2  years,  wounded  at  Spottsylvania,  May  12,  1864. 
The  ball  entered  the  left  posterior  neck  one  and  three-quarter  inches  from  the  spine  of  the  third  cervical  vertebra,  and  was  cut 
out  immediately  behind  and  below  the  left  ear,  about  two  and  a  half  inches  below  meatus  and  a  quarter  of  an  inch  behind  the 
jaw.  Its  track  is  unknown,  except  that  it  injured  the  ear  and  paralyzed  the  portio  dura  of  the  seventh  nerve  and  splintered 
the  edge  of  the  ramns  of  the  jaw.  His  head,  at  the  time  he  was  shot,  was  thrown  forward  and  downward  He  fell,  conscious, 
bleeding  freely  from  the  ear  only.  After  two  minutes  he  arose  and  walked  away,  the  blood  still  spoutiny  out  from  the  ear,  until 
it  was  checked  by  a  bandage  over  that  organ.  He  had  no  pain  until  the  next  day,  when  he  had  the  usual  inflammatory  pains. 
His  eyesight  is  said  to  have  become  affected  on  the  second  day,  when  there  was,  according  to  his  account,  a  distinct  difference 
against  the  left  eye.  Things  appeared  hazy  to  the  left  eye.  This  remains  the  same.  The  paralysis  of  the  muscles  was  imme 
diate,  and  his  speech  was  made  difficult.  This  seemed  to  him  to  come  from  a  defect  in  the  tongue  and  lips.  Hearing  was  lost 
at  once  in  the  left  ear.  Present  state,  June  8,  1864  :  The  pains  in  the  face  and  the  swelling,  which  was  never  great,  arc  now 
better.  The  wounds  are  open  but  healing.  The  nutrition  is  unaltered.  The  lines 'of  the  face  are  lost,  the  tip  of  the  nose  and 
the  lower  mobile  portions  of  the  face  are  drawn  to  the  right.  The  left  eyebrow  has  fallen  a  little.  The  tears  run  over  the  edge 
of  the  lid.  The  tongue  is  perfectly  movable  and  under  entire  control  of  the  will.  Speech  perfect,  except  a  slight  difficulty  in 
articulating  the  gutturals,  and  still  more  as  to  the  labiale.  Special  Senses :  The  left  eye  sees  only  one-third  as  well  as  the  right. 
Hearing  is  lost  in  the  left  ear.  On  washing  out  the  pus  a  mass  of  granulations  was  seen  at  the  bottom  of  the  ear.  Possibly  the 
bony  meatus  may  have  been  fractured  by  the  ball,  but  no  bone  escaped  except  pieces  of  the  jaw,  which  came  out  with  the  ball. 
Taste  :  There  seems  to  be  no  marked  loss  of  gustation.  Taste  is  dulled  a  little  on  the  left  side.  Tactility  is  equally  good  on 
the  two  sides,  both  in  the  tongue  and  face.  June  20th,  the  sight  is  becoming  worse.  Dr.  Dyer  is  of  opinion  that  it  was  affected 
before  he  received  his  wound.  Induced  electric  currents  give  rise  to  slight  movement  in  the  left  eyelid  and  the  elevator  of  the 


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CHAP,  xn.]  SHOT   WOUNDS   OF    NERVES.  741 

angle  of  the  mouth.     A  rapid  recovery  was  predicted,  and,  in  fact,  within  three  days  later  voluntary  power  returned  in  the 
orbicular  muscle  of  the  eye.     By  July  27th,  every  motion  had  been  re-acquired. 

An  illustration  of  paralysis  of  the  facial  nerve  with  distortion  of  the  face  is  given  in 
PLATE  XXXVIII,  opposite.  The  patient  suffered  from  loss  of  sight  in  the  left  eye  and 
of  hearing  in  the  left  ear. 

Nerve  trunks  may  be  completely  severed  by  a  missile,  or  they  may  be  partially  divided 
and  lacerated.  They  may  be  injured  by  the  near  passage  of  a  missile  causing  concussion 
or  "commotion,"  or  they  may  be  contused  by  a  missile  which  has  insufficient  power  to  divide 
or  lacerate,  or  which  has  expended  its  force  on  neighboring  tissues.  As  in  the  case  of  arte 
ries,  their  position  and  surroundings  tend  to  protect  them,  and  it  is  probable  that  their 
mobility  and  form  may  enable  them  to  slip  aside  and  escape  damage  from  a  passing  missile. 

Mitchell,  Morehouse,  and  Keen  (op.  cit.,  chap.  5,  p.  55)  add  to  the  above  more  com 
mon  forms  of  shot  injury — those  from  cicatricial  pressure,  and  those  from  the  extension  of 
diseased  processes  from  wounded  nerves  to  those  which  are  healthy.  The  same  authors 
consider  injuries  by  contusion  of  a  nerve  to  be  those  "most  apt  to  be  permanent  and  serious." 
The  following  case,  taken  from  their  work,  illustrates  the  result  of  a  contusion: 

CASE  1081. — James  Walton,  aged  47  years,  Ireland,  sailor;  enlisted  June,  1862,  Co.  A,  115th  Pennsylvania.  At  the 
second  Bull  Run  battle,  August  30,  1862,  while  lying  on  his  belly  in  the  woods,  a  shell,  exploding  in  the  air,  cut  off  a  large 
branch,  which,  falling,  struck  him  on  the  left  shoulder,  or  rather  across  the  base  of  the  neck.  He  grew  dizzy,  felt  stunned,  and 
lost  consciousness.  When  he  revived  he  had  sharp  pains  down  the  arm  to  the  hand.  It  was  totally  paralyzed  as  to  sense  and 
motion.  Up  to  September  15,  1862,  he  was  a  prisoner.  At  this  date,  when  exchanged,  sensation  was  still  absent,  but  motion 
was  improving  slowly.  It  gained,  however,  at  the  same  time  that  atrophy  was  taking  place  in  the  very  muscle  whose  power 
was  returning.  From  September,  1862,  to  September,  1863,  the  motions  grew  better,  with  one  exception;  sensation  returned  to 
a  perfect  extent,  and  the  muscles  ceased  to  waste.  January,  1864:  The  arms  measure  alike.  The  right  forearm  measures  10 J 
inches,  the  left  9-f  inches.  The  supinator  longus  and  the  extensor  mass  of  muscles  in  the  forearm  are  wasted,  having  lost  about 
one-third  of  their  bulk.  The  flexor  group  is  still  more  wasted,  and  is  hard  and  contracted  Tact  and  localization  normal. 
All  the  movements  of  the  fingers  normal,  except  extension,  which  is  incomplete,  owing  to  the  contraction  of  the  flexors  and 
also  to  partial  paralysis  of  their  extensors.  The  wrist  has  loss  of  extension  and  of  lateral  movements,  and  the  thumb  has  also 
defective  extension.  The  patient  was  discharged  from  service  October  3,  1865,  and  pensioned.  Examiner  W.  Jewell  reported, 
August  16,  18G6 :  "  Paralysis  of  left  hand  ;  it  is  entirely  useless,  and,  at  his  age,  irrecoverable." 

A  case  illustrating  an  injury  of  nerve  trunks  owing  to  their  being  involved  in  a  cica- 
trix  has  been  detailed  at  page  462  of  the  /Second  /Surgical  Volume,  and  an  example  of  the 
extension  of  disease  along  a  nerve  trunk  to  others,  with  consequent  paralysis  and  atrophy 
appearing  at  points  of  distribution  remote  from  the  original  injury,  is  here  adduced: 

CASE  1082. — Stephen  Warner,  Co.  A,  151st  New  York,1  aged  33  years,  farmer,  New  York ;  enlisted  August,  1862. 
Healthy  to  day  of  wounding.  At  Locust  Grove,  November  27,  1F63,  a  ball  entered  the  left  chest  below  the  first  rib,  half  an  inch 
below  the  clavicle  and  two  and  a  half  inches  from  its  sternal  end.  Passing  probably  under  the  arch  of  the  snbclavian  artery,  it 
went  backward  and  downward  and  made  its  exit  two  inches  below  the  inferior  angle  of  the  left  scapula,  three  and  a  quarter 
inches  from  the  spine.  The  ball  was  fired  by  a  skirmisher  not  twenty  yards  distant,  and  was  received  while  the  patient  was  in 
the  act  of  bending  forward  to  aim.  He  fell,  giddy  but  conscious;  ti'ied  to  move,  but  failed,  and  fainted  from  IOPS  of  blood. 
After  several  hours  he  revived  and  discovered  that  the  left  arm  and  hand  were  sensitive  throughout.  On  the  radial  side  of  the 
forearm  there  was  slight  numbness,  a  condition  compatible  with  perfect  tactile  sensibility ;  motion  appears  to  have  been  lost,  or 
greatly  lessened  during  some  hours,  and  within  a  day  to  have  become  restored  entirely.  No  doubt  exists  as  to  this  point.  No 
dressing  was  used  until  the  third  day,  when  water  was  applied.  At  this  date  the  arm  motions  were  complete  below  the  shoulder, 
and  there  had  been  no  pain.  Soon  after  the  cold  dressing,  to  which  he  attributed  the  segment  symptoms,  he  was  seized  with 
neuralgic  pain,  which  was  principally  in  the  median  nerve  distribution,  but  also  on  the  outside  of  the  arm  and  shoulder,  with  a 
spot  of  intense  pain  at  the  deltoid  insertion.  The  pain  was  darting  and  prickling  in  its  nature.  Coincidently  with  the  pain  the 
joints  of  fingers  swelled  and  became  sore,  and  this  was  especially  the  case  with  the  thumb  and  the  fore  and  second  fingers.  At 
the  same  time  the  shoulder  muscles  grew  weak,  flexion  of  the  fingers  grew  feeble,  and  the  flexion  of  the  forearm  was  affected. 
All  of  those  defects  increased  for  several  months,  and  the  flexor  group  in  the  foreaitn  wasted  so  much  as  to  attract  attention. 
The  biceps,  brachialis  anticus,  and  coraco-brachialis  were  in  like  manner  atrophied.  The  pectoralis  major  was  'also  thus 
altered  at  a  still  earlier  period.  Up  to  the  eighth  day  the  patient  spat  blood  freely.  Then  it  ceased,  and  he  has  had  no  pulmon 
ary  difficulties  of  any  kind  since  his  admittance  on  February  19,  1864.  Nutrition :  Atrophy  of  pectoralis  major  great,  of  shoulder 
muscles  slight,  wasting  of  biceps  and  other  anterior  and  internal  arm-muscles  considerable.  Arm  at  biceps  measures — left,  10 
inches;  right,  11 J  inches.  Foream — left,  10  inches;  right,  11  inches.  Left  hand  congested,  dark,  and  cold.  It  grows  cold 
easily.  Sensation  perfect.  The  neuralgia  has  nearly  disappeared,  except  in  bad  weather,  and  about  the  insertion  of  the  deltoid, 
1  Not  18th  Pennsylvania  Volunteers,  as  reported  by  MITCHELL.  MOREHOUSE,  and  KEEN,  lac.  cit.,  p.  64. 


WOUNDS    AND    COMPLICATIONS.  fCll.\p   XH. 

where  there  is  great  tenderness,  and  ;v  good  deal  of  hardening  and  deposit  in  the  subcuticular  tissues  and  over  the  bone.  The 
only  muscle  which  is  hypersesthetic  to  any  marked  degree  is  the  biceps.  The  course  of  the  musculo-cutaneous  and  the  median 
nerves  is  acutely  tender  upon  pressure.  Motion:  None  in  the  pectoralis  major,  scarcely  perceptible  in  the  biceps,  the  supinator 
longus  alone  Hexing  the  forearm.  Extension  of  forearm  perfect.  The  fingers  act  in  flexion  feebly,  but  are  improving.  The 
thumb  motions  are  also  weak  but  not  lost.  Motion  is  now  most  limited  by  the  state  of  the  linger  joints,  which,  although  no 
longer  tender,  are  stifl'  and  enlarged.  So  much  improvement  has  taken  place  very  recently  that  we  cannot  be  sure  as  to  what 
motions  were  lost.  Probably  the  principal  nerves  of  the  external  cord  of  the  plexus,  namely,  the  musculo-cutaneous  and  the 
median,  were  those  chiefly  affected ;  certain  filaments  of  the  posterior  strand,  as  the  circumflex,  also  sharing  in  the  diseased 
condition.  *  The  case  was  improving  when  admitted,  and  it  gained  ground  with  increased  speed  under  a  course  of 

baths,  gymnastics,  and  faradization.  Examiner  D.  Clarke,  of  Flint,  Michigan,  reported,  September,  4,  1877:  "Suffers  most  from 
an  affection  of  the  nerves,  causing  partial  paralysis  of  the  arm,  and  of  late  extending  to  the  leg,  with  'darting'  pains.  Pressure 
on  the  front  cicatrix  produces  numbness,  with  a  prickly  sensation  down  the  arm.  Same  effect  produced  by  rubbing  the  spine." 
lu  March,  1882,  the  pensioner  was  an  applicant  for  increase. 

The  immediate  effects  of  injuries  by  gunshot  missiles  upon  nerve  trunks  are  charac 
terized  by  shock,  pain,  and  partial  or  complete  loss  of  motion  or  sensation,  the  latter  symp 
toms  being  peculiar  and  diagnostic  of  such  lesions.  The  persistence  and  severity  of  these 
symptoms  and  the  extent  of  loss  of  function  vary  within  very  wide  limits,  and  seem  to 
indicate,  in  some  degree,  the  remote  effects  generally  to  be  expected. 

CASK  1083. — Captain  Charles  P.  Johnson,  17th  Iowa,  aged  21  years,  was  wounded,  on  May  14,  18G3,  at  Jackson,  Miss., 
by  a  spherical  musket  ball,  which  entered  the  buttock  at  the  left  side  on  a  level  with  the  great  trochanter,  passed  through  the 
great  sacro-ischiatic  notch,  traversed  the  sacrum,  and  made  its  exit  on  the  right  side  through  the  right  great  sacro-ischiatic  notch 
one  inch  above  the  right  great  trochanter,  cutting  the  rectum,  together  with  many  blood-vessels,  nerves,  and  muscles  which  supply 
the  pelvis  and  lower  extremities.  At  the  time  of  the  injury  he  was  in  perfect  good  health,  weighing  200  pounds,  and  measuring 
six  feet  one  inch  in  height.  He  fell  and  was  earned  to  a  house  near  by,  where  he  was  taken  prisoner,  and  sent,  a  month  later, 
to  Atlanta.  He  remained  a  prisoner  for  seventeen  months,  until  liberated  by  General  Sherman  in  18C4.  He  was  then  sent  to 
Beuton  Barracks,  and  mustered  out  of  service  in  1865.  He  then  moved  to  Alton,  Illinois,  and  finally  came  to  Garden  Grove, 
Iowa.  During  all  this  time  he  was  never  able  to  stand  erect  or  turn  upon  his  back  or  either  side ;  but  lay  prone  upon  his  face, 
passing  his  life  upon  a  couch,  from  which  he  could  never  by  any  voluntary  effort  move.  Assistant  Surgeon  John  V.  R.  Hoff, 
II.  S.  A.,  who  made  a  careful  examination  of  the  patient  in  February,  187(5,  reported :  "  The  following  tissues  must  have  been 
involved  to  a  greater  or  less  extent,  either  in  the  wound  itself  or  in  the  inflammation  consequent  upon  it :  most  of  the  muscles 
arising  from  posterior  aspect  of  pelvis,  external  and  internal ;  several  branches  of  external  iliac  artery;  great  sciatic  nerve  and 
numerous  smaller  nerves  arising  from  it,  and  the  sacral  plexus;  also  some  of  those  of  the  sympathetic  system,  and  finally  the 
rectum.  I  could  not  discover  that  any  osseous  tissue  had  been  primarily  involved.  The  patient  remarked  that  small  pieces  of 
what  appeared  to  be  dead  bone  had  occasionally  been  discharged  while  the  wound  was  open,  and  from  the  fact  that  it  re-opened 
several  times  it  is  reasonable  to  suppose  that  there  was  a  certain  amount  of  necrosis  ;  but  from  the  direction  of  the  wound,  and 
the  fact  that  no  history  of  bone  trouble  is  given  by  his  medical  attendants,  I  take  it  that,  if  there  was  necrosis,  it  was  due  to 
inflammation,  and  not  to  the  primary  effects  of  the  wound.  For  six  weeks  immediately  following  the  injury  the  faeces  v^ure  passed 
through  both  orifices  of  the  wound,  and  not  at  all  by  the  natural  opening.  After  that  they  were  evacuated  both  by  wound  and 
anus  ;  then  by  anus  alone  ;  then  from  time  to  time,  as  the  wound  re-opened,  again  by  wound ;  till  finally,  in  1672,  the  fistulae 
healed  entirely  and  spontaneously.  The  treatment  of  this  case  consisted  solely  in  the  administration  of  anodynes,  tonics,  and 
laxatives.  No  surgical  procedure  has  been  attempted  further  than  to  keep  the  wound  in  the  most  favorable  condition  for  healing. 
Much  of  the  time  patient  has  been  without  professional  advice,  and  while  a  prisoner  often  wanted  for  the  bare  necessities  of  life. 
Present  condition  :  Mr.  Johnson  informs  me  that  since  being  wounded  his  health  was  best  two  years  ago,  from  which  time  it 
has  gradually  failed.  The  face  is  pale  and  emaciated,  body  shrunken  till  little  is  left  but  skin  and  bones;  the  muscles  of  the 
gluteal  region  have  almost  entirely  disappeared,  giving  a  peculiar  flattened  appearance  to  the  buttock.  The  lower  extremities 
are  almost  entirely  devoid  of  motion,  and,  except  anterior  of  the  thighs,  of  sensation;  they  are  cold  to  the  touch,  and  have  little 
muscular  or  adipose  tissue;  leg  at  lower  third  measures  six  inches  in  circumference;  thigh,  middle  third,  twelve  inches;  joints  all 
stiff  (doubtless  from  want  of  use).  Upper  extremities  comparatively  well  developed,  due  to  constant  exercise:  I  judge  the:  weight 
of  body  would  not  exceed  seventy  pounds.  Patient  rests  alternately  on  breast  and  elbow  (the  body  as  stated  being  horizontal,  face 
downward),  sleeping  in  the  former  position,  eating,  reading,  etc.,  in  the  latter.  Spinal  cord  is  very  sensitive  to  pressure  throughout 
its  whole  extent ;  pain  is  constant,  referred  to  sacral  region,  and  is  only  rendered  bearable  by  the  habitual  use  of  anodynes. 
Patient  is  generally  neuralgic.  Skin  pale  but  natural  in  appearance  and  feeling  (at  upper  portion  of  the  body) ;  perspiration  free, 
sometimes  copious;  pulse  weak  and  irregular ;  heart  action  irregular,  with  ansomic  murmur;  respiration  normal ;  tongue  coated 
and  fissured  ;  appetite  for  both  solids  and  fluids  capricious  ;  bowels  constipated.  This  has  been  the  case  since  18G7,  necessitating 
the  habitual  use  of  laxatives  (probably  in  a  measure  due  to  the  opium  habit) ;  previous  to  that  time,  more  especially  while  a  pris 
oner,  there  wan  constant  diarrhoea,  the  dejections  often  passing  involuntarily;  now,  under  the  influence  of  cathartics,  the  move 
ment*  are  regular,  but  always  accompanied  by  moi*e  or  less  pain  referred  to  the  rectum,  especially  when  the  fteces  are  in  the  least 
degree  hard,  at  which  time  the  rectum  seems  without  expulsive  power.  The  rectum  has  partially  recovered  its  integrity,  the  wounds 
(about  five  inches  above  the  anus)  have  closed,  leaving  a  slight  cicatricial  contraction  and  a  certain  amount  of  torpidity,  which  may 
be  an  additional  cause  of  constipation.  The  sphincter  ani  muscle  is  normal.  Bladder  is  somewhat  irritable,  but  when  not  allowed 
to  become  over  distended  is  entirely  under  control.  Other  viscera  than  those  mentioned  were  not  examined,  for  the  reason  that 
any  movement  caused  suffering.  The  patient  has  several  times,  with  assistance,  attempted  to  stand  erect  and  to  change  his 
position  to  the  back  and  sides ;  but  never  succeeded,  and  has  given  up  all  hope  of  ever  recovering  the  use  of  his  lower  extremities. 


CHAP,  xir.]  SHOT    WOUNDS    OF   NERVES.  743 

He  has  consulted  eminent  surgical  authority,  and  was  advised  against  resorting  to  any  operative  interference,  as  such  offered 
little  promise  of  successful  results."  Captain  Johnson  died  in  1879.  In  a  subsequent  report,  dated  December,  1879,  Dr.  Hotf 
states  :  "The  general  clinical  features  of  this  case,  so  far  as  I  could  ascertain,  remained  unchanged  from  date  of  examination  up 
to  the  autumn  of  1877,  when,  while  out  driving,  Captain  Johnson  was  overtaken  by  a  severe  rain  storm,  from  the  effects  of  which, 
his  wife  says,  'he  never  fully  recovered.'  The  exact  immediate  condition  obtaining  after  this  exposure,  I  regret  to  say,  could  not 
be  learned,  as  the  case  at  that  time  did  not  fall  under  observation  of  a  physician,  and  the  attendants'  descriptions  were  vague 
and  general.  I  infer  that  there  was  no  pulmonary  complication ;  in  fact,  it  was  stated  that  the  lungs  remained  remarkably 
healthy.  The  exposure  to  storm  seemed  to  precipitate  a  condition  of  general  asthenia;  patient  lost  all  ambition  and  hope,  refused 
to  take  accustomed  exercise  (in  carriage),  and  failed  perceptibly.  The  circulation  in  lower  extremities,  heretofore  weak,  now 
became  deficient ;  the  limbs  were  benumbed,  and  the  toes,  to  borrow  the  patient's  own  expression,  'seemed  as  though  they  were 
breaking  off.'  Pain  was  always  present,  and  in  greater  degree  after  the  exposure  of  1877.  From  this  time  his  appetite  became 
more  capricious,  though  digestion  was  apparently  good,  'there  being  nothing,'  his  attendant  said,  that  he  could  not  eat  at  times. 
The  bowels  were  constipated,  the  result  of  causes  already  described.  Micturition  frequent' and  painful,  the  quantity  of  secretion 
estimated  as  less  than  normal  (no  chemical  examination  of  urine  was  made).  There  was  marked  change  in  the  patient's  psychi 
cal  condition:  memory  failed,  he  became  exacting,  demanded  constant  attention,  though  not  irritable,  and  suffered  continuously 
from  insomnia.  In  July,  1878,  an  eczematous  eruption  appeared  on  the  genitals,  spreading  upward  and  downward  to  epigastrium 
and  knees,  covering  the  entire  abdomen.  This  lesion  discharged  a  copious  and  exceedingly  offensive  secretion,  continued  acutely 
for  nine  weeks,  and  never  entirely  disappeared.  The  greatest  difficulty  was  experienced  in  treating  the  cutaneous  lesion,  on 
account  of  the  necessarily  prone  position  of  the  patient.  A  physician,  Dr.  Todd,  was  called  and  attempted  to  remove  pressure 
by  propping  the  patient  on  his  side  with  pillows.  This  posture  very  soon  became  unbearable,  and  the  patient  urgently  demanded 
to  be  returned  to  what  he  called  his  '  natural '  position,  which  was  done.  The  eczema,  joint  offspring  of  the  general  asthenia  and 
local  nervous  conditions,  probably  excited  by  the  difficulty  of  absolute  cleanliness,  added  impetus  to  causes  already  hastening  the 
final  result.  'After  the  appearance  of  the  eruption,'  says  Dr.  Todd,  'there  was  a  gradual  though  well-marked  decline  of  powers, 
the  digestive  organs  losing  tone,  and  vomiting  was  not  infrequent.'  The  wound  never  re-opened;  there  was  no  abscess  and  no 
observable  fever.  Pain  in  sacral  region,  as  always,  was  severe,  and  in  the  latter  months  of  life  this  extended  to  the  lumbar 
region,  causing  intense  suffering.  Alcohol  and  anodynes  were  used  extensively  throughout  the  whole  course  of  the  case — morphia 
being  taken  to  the  average  extent  of  8  J  grains  per  diem.  No  post-mortem  examination  was  made." 

Instances  of  immediate  death  from  injuries  of  nerve  trunks  are  probably  rare,  though 
it  is  not  difficult  to  conceive  of  such  disturbance  of  central  ganglia  as  may  induce  a  fatal 
result.  The  records  of  this  office  indicate  the  frequency  with  which  tetanus  developed 
itself  in  the  early  progress  of  wounds  of  nerve  trunks,  and  how  generally  fatal  it  proved. 
Nervous  spasms  were  of  frequent  occurrence,  but  were,  as  a  rule,  easily  controlled. 

The  important  labors  of  Mitchell,  Morehouse,  and  Keen  in  the  vast  field  presented  by 
the  organization  of  a  hospital  for  diseases  and  injuries  of  nerves  cannot  be  seen  to  better 
advantage  or  be  better  appreciated  than  in  their  clinical  observations  upon  the  remote 
effects  of  nerve  injuries.1  "Most  of  the  cases  presented  phenomena  which  are  rarely  seen 
and  which  were  naturally  foreign  to  the  observation  even  of  those  surgeons  whose  expe 
rience  was  the  most  extensive  and  complete.  Nowhere  were  these  cases  described  at  length 
in  text-books,  and,  except  in  a  single  untranslated  French  book,  their  treatment  was  passed 
over  in  silence,  while  even  in  the  volume  in  question  but  a  limited  class  of  nerve  lesions 
was  discussed.  In  the  great  monographs  on  military  surgery  this  defect  is  still  so  complete 
that  wounds  of  nerves  are  there  related  rather  as  curiosities,  and  as  matters  for  despair, 
than  with  any  view  to  their  full  clinical  study  and  systematic  treatment." 

In  cases  of  nerve  injury,  immediate  symptoms,  when  not  severe,  may  pass  away, 
leaving  the  patient  uninjured,  but  by  far  the  more  common  result  is  that,  while  there  may 
be  a  temporary  improvement,  there  is  a  permanency  of  certain  symptoms,  especially  those 
of  paralysis  of  movement  and  sensation.  As  time  progresses  others  are  added  which  give 
the  case  a  hopeless  aspect,  viz:  altered  nutrition,  changes  in  calorification,  persistent  pain, 
and  other  sensory  phenomena. 

On  the  subject  of  altered  nutrition,  Mitchell,  Morehouse,  and  Keen  (loc.  cit.,  p.  69) 
remark:  "Atrophy  of  the  muscles  of  an  entire  member  is  sure  to  follow  complete  division 
of  its  nerves  when  there  is  no  subsequent  repair.  In  this  case  the  muscles  waste  alike, 
the  areolar  tissue  shrinks,  the  vessels  fade  from  view,  and  the  pulse  becomes  feeble  and 

'MITCHELL,  MOIUCUOUSE,  and  KEEN,  Gunshot  Wounds  and  Other  Injuries  of  Nerves,  Philadelphia,  18(J4,  page  10. 


744  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

small.  The  rate  at  which  this  process  goes  on  varies  greatly,  but  it  begins  very  early  in 
extreme  cases,  and  continues  until  nothing  is  left  but  bone  and  degenerated  areolar  structures, 
covered  with  skin,  whose  altered  surface  tells  of  the  singular  blight  which  has  fallen  upon 
the  member.  *  *  *  Partial  atrophy  is  due,  of  course,  to  partial  nerve  lesions.  The 
filaments  which  supply  a  group  of  muscles  may  have  suffered,  or  only  those  of  one  or 
more  muscles,  or,  finally,  a  part  only  of  the  nerve  fibres  of  one  muscle.  In  some  cases 
the  loss  is  equal  throughout  a  muscle;  in  others  it  affects  a  lateral  or  longitudinal  part  of 
a  muscle.  Among  the  injuries  which  fail  to  palsy  a  limb  at  once  and  completely,  those  which 
bruise  a  nerve  have  seemed  to  us  to  be  the  most  likely  in  the  end  to  cause  atrophies."  The 
effects  of  altered  nutrition  upon  the  skin  and  appendages  are  thus  described  by  Mitchell, 
Morehouse,  and  Keen  (loc.  cit.,  p.  77):  "Early  in  the  case  it  is  found  associated  in  most 
instances  with  oedema  of  the  part,  and  is  one  of  the  remotest  effects  of  the  loss  of  nervous 
influence.  The  skin  becomes  thickened  and  dry,  the  epithelium  hangs  in  patches  here  and 
there  and  is  yellow  or  even  pale  brown  in  tint.  These  peculiarities  are  in  part  owing  to  mere 
disuse;  but  this  in  no  way  applies  to  the  changed  form  of  the  nails,  which  become  curved 
as  in  tubercular  disease,  although  to  a  less  degree  than  in  the  other  form  of  cutaneous 
affection,  which  is  caused  by  partial  injuries  of  the  nerves.  In  fact,  it  may  be  stated  as  a 
rule,  that  the  skin  and  subcuticular  tissues  are  less  strikingly  altered  in  entire  paralysis 
than  in  cases  of  lighter  nature." 

A  second  form  of  altered  nutrition  of  the  skin  was  not  infrequently  seen;  it  has  been 
noticed  by  Paget:1  "Glossy  fingers  appear  to  be  a  sign  of  peculiarly  impaired  nutrition  and 
circulation  due  to  injury  of  nerves.  They  are  not  observed  in  all  cases  of  injured  nerves, 
and  I  cannot  tell  what  are  the  peculiar  conditions  of  the  cases  in  which  they  are  found; 
but  they  are  a  very  notable  sign,  and  are  always  associated,  I  think,  with  distressing  and 
hardly  manageable  pain  and  disability.  In  well-marked  cases,  the  fingers  which  are  affected 
(for  this  appearance  may  be  confined  to  one  or  two  of  them)  are  usually  tapering,  smooth, 
hairless,  almost  void  of  wrinkles,  glossy,  pink  or  ruddy,  or  blotched  as  if  with  permanent 
chilblains.  They  are  commonly  also  very  painful,  especially  on  motion,  and  pain  often 
extends  from  them  up  the  arm.  In  most  of  the  cases  this  condition  of  the  fingers  is 
attended  with  very  distinct  neuralgia  both  in  them  and  in  the  whole  arm,  and  its  relation 
to  disturbance  of  the  nervous  condition  of  the  part  is,  moreover,  indicated  by  its  occasional 
occurrence  in  cases  where  neuralgia  continues  after  an  attack  of  shingles  affecting  the  arm. 
In  two  such  cases  I  have  seen  this  same  condition  of  the  fingers  well  marked,  and  only  very 
slowly  subsiding,  and  seeming  unaffected  by  the  ordinary  treatment  of  neuralgia."  Mitchell, 
Morehouse,  and  Keen  state  that  out  of  fifty  partial  nerve  lesions  under  their  charge,  this 
condition  existed  in  nineteen,  and  their  description  of  the  symptoms  agrees  with  that  of 
Paget  just  given.  An  instance  has  been  cited  on  page  1020  of  the  Second  Surgical 
Volume  (CASE  2046),  and  the  appearance  of  the  hand  and  fingers  is  faithfully  shown  in 
PLATE  LII,  opposite  page  1020  of  the  same  volume.  This  condition  seems  to  have  occurred 
in  cases  of  injury  in  which  there  was  not  complete  destruction  of  the  nerve  and  during 
healing.  Its  duration  was  variable,  in  favorable  cases  disappearing  after  a  few  weeks.  Pain 
was  an  invariable  attendant  upon  these  cases.  Eczematous  eruptions  were  a  frequent  accom 
paniment  of  this  condition  of  the  skin.  In  many  cases  of  altered  nutrition  the  hair  was 
observed  to  disappear  from  the  affected  region,  and  a  remarkable  alteration  in  the  nails  was 
noticed,  which  is  thus  described  by  Mitchell,  Morehouse,  and  Keen  (loc.  cit.,  p.  81):  "They 

1  I'AGKT,  Clinical  Lecture  on  Some  Cases  uf  Local  I'aralysis.  in  Medical  Timts  and  Guz/tte,  London,  March  x.'b,  1BG4,  Vol.  I,  p.  U32. 


CHAP.  XII.]  SHOT    WOUNDS    OF   NERVES.  745 

[the  nails]  suffer  only  in  the  fingers  the  neural  supply  of  which  has  been  interfered  with,  so 
that  the  nails  in  the  median  distribution  may  be  contorted  and  those  in  the  little  finger  be 
unaffected.  The  alteration  in  the  nail  consists  of  a  curve  in  its  long  axis,  an  extreme 
lateral  arching,  and  sometimes  a  thickening  of  the  cutis  beneath  its  extremity.  In  other 
instances  a  change  takes  place  which  is  quite  peculiar,  and  which,  to  us  at  least,  was  new. 
The  skin  at  that  end  of  the  nail  next  to  the  third  finger  joint  becomes  retracted,  leaving 
the  sensitive  matrix  partly  exposed.  At  the  same  time  the  upper  line  of  union  of  skin  and 
nail  retreats  into  or  under  the  latter  part,  and,  in  place  of  a  smooth  edge,  is  seen  through 
the  nail  as  a  ragged  and  notched  border.  The  patient  who  presented  these  changes  in  the 
most  striking  form  had  also  lateral  arching  of  the  nail,  but  no  longitudinal  curving.  It  was 
a  case  of  the  most  terrible  suffering,  from  a  combination  of  burning  pain  in  the  hand  and 
neuralgic  pain  in  the  forearm.  *  *  *  When  the  nails  of  the  toes  have  been  attacked, 
and  they  are  very  rarely  so,  the  curving  is  less  marked,  but  a  distressing  ulceration  is  apt  to 
occur  at  their  angles,  and  to  break  out  again  and  again,  despite  of  every  care  and  attention." 

Of  altered  nutrition  of  joints,  Mitchell,  Morehouse,  and  Keen  (loc.  cit.,  p.  84)  observe.: 
"It  consists  essentially  in  a  painful  swelling  of  the  joints,  which  may  attack  any  or  all  of 
the  ar.ticulations  of  a  member.  It  is  distinct  from  the  early  swelling  due  to  the  inflamma 
tion  about  the  wound  itself,  although  it  may  be  masked  by  it  for  a  time;  nor  is  it  merely  a 
part  of  the  general  cedema  which  is  a  common  consequence  of  wounds.  It  is  more  than 
these, — more  important,  more  persistent.  Once  fully  established,  it  keeps  the  joints  stiff 
and  sore  for  weeks  or  months.  When  the  acute  stage  has  departed,  the  tissues  about  the 
articulations  become  hard,  and  partial  anchylosis  results,  so  that  in  many  cases  the  only 
final  cause  of  loss  of  motion  is  due  to  this  state  of  the  joints.  Of  all  the  agencies  which 
impede  movement  it  is  the  most  difficult  to  relieve." 

It  was  found  in  the  cases  of  wounded  limbs  that  after  complete  division  of  nerves  the 
secretions  of  the  skin  were  generally  absent,  while  incomplete  division  led  to  variable  con 
ditions  of  this  function.  In  some  cases  there  was  excessive  sweating,  which  was  limited  to 
the  area  of  the  surface  affected.  There  were  also  noted  cases  of  perverted  secretion,  as  acid 
sweating  and  perspiration  of  a  disgusting  odor.  The  following  cases  well  illustrate  the  con 
dition  above  described: 

CASK  1034. — Kilian  Grim,  aged  about  20  years.  German,  enlisted  August,  1861,  Co.  B,  121st  Pennsylvania.  Healthy 
until  wounded,  but  exhausted  and  ill-fed  for  three  days  before  being  hurt.  At  Fredericksburg,  December  13,  1862,  a  ball 
passed  through  the  lower  third  of  the  thigh,  entering  externally  four  inches  above  the  upper  border  of  the  patella,  and  emerg 
ing  two  inches  lower  on  the  inside.  It  went  behind  the  bone,  entered  the  right  leg  below  and  behind  the  knee,  and,  traversing 
the  calf  obliquely  downward,  made  its  exit  on  the  other  side.  In  the  right  leg  no  large  nerves  were  injured.  In  the  left  the 
sciatic  must  have  been  slightly  affected.  He  was  able  to  walk  several  miles  with  his  limbs  thus  wounded.  The  chief  difficulties 
in  his  case,  when  we  examined  him  in  July,  1863,  were  severe  burning  on  top  of  the  left  foot,  congestion  and  eczema,  without 
marked  redness  or  thinning  of  the  skin,  but  accompanied  with  ulceration  on  the  edges  of  the  nails.  This  existed  also  in  the 
great  toe  of  the  right  foot,  which  had  defective  sensibility.  He  had  complete  paralysis  of  all  the  flexors  of  the  foot,  partial  of 
the/ecr.  com.  dig.  pedis  and  of  the  calf  muscles.  He  could  walk,  but  dragged  the  foot,  or  else  carried  it  in  a  long  sling.  All 
of  these  muscles  improved  under  treatment ;  the  burning  grew  better,  and  the  eczema  left  his  foot,  but  the  ulcers  proved  unman 
ageable.  After  five  months'  treatment  he  was  discharged,  with  more  or  less  volitional  control  over  all  the  muscles  affected.  At 
no  time  had  he  any  marked  atrophy. 

CASE  1085. — Admitted  about  the  same  time  as  the  last  was  another  instance  of  ball  wound  close  to  the  sciatic  nerve. 
Here  also  was  burning  on  top  of  foot.  Defective  sensation  of  touch  on  the  outside  of  the  foot  and  the  leg,  in  the  sole  and  the 
toes,  and  part  of  the  instep.  Loss  of  power  in  the  flexors  of  the  foot  complete.  Eczema  coming  in  crops  about  every  two  weeks 
as  high  up  as  to  the  knee,  and  with  relief  to  the  burning.  Foot  swelled  when  dependent,  and  this  increased  the  pain  to  an 
unbearable  degree.  Nearly  total  relief  of  all  the  symptoms  in  five  months,  when  he  was  transferred  to  the  West.  Cessation  of 
the  electricity  at  this  time.  Partial  relapse  as  to  movement.  No  further  history. 

CASK  1086. — Austin  Lawton,  machinist,  aged  20  years,  enlisted  April,  1861,  Co.  A.  4th  Ohio.  Wounded  at  Chaneellors- 
ville,  May  3,  1863,  by  a  piece  of  shell,  which  fell  on  the  inside  of  the  arm  just  below  the  axilla.  The  skin  waa  torn  slightly  and 
the  parts  severely  bruised.  His  fingers  clutched  the  ramrod,  which  he  was  using,  and  required  force  to  unlock  the  grip.  Pain 
SURG.  Ill— 94 


746  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

in  the  hand,  of  a  burning  character,  came  on,  he  says,  within  a  few  minutes,  and  has  remained  ever  since.  So  severe  was  it 
that  he  was  in  bed  on  account  of  the  paiii  alone  for  nine  weeks.  The  hand  is  now  kept  in  a  sling  and  constantly  covered  with 
wet  cloths.  Sensation  impaired  in  the  back  of  the  forefinger  and  thumb  and  in  the  radial  half  of  the  palm.  The  tlexor  profun- 
dtis  digitorum  and  the  flexor  subl.  d'uj.  were  both  very  feeble,  but  they  soon  regained  power  when  faradized,  during  a  few  weeks. 
It  was  then  perceived  that  the  real  difficulty  lay  in  the  stiffened  and  painful  state  of  the  joints  at  the  second  and  third  digital 
articulations.  Passive  motion  and  the  usual  treatment  of  the  burning  were  ordered,  with  almost  total  return  of  normal  move 
ment,  but  without  any  ease  to  the  burning.  After  two  months  he  preferred  to  return  to  his  regiment  for  light  duty  as  orderly  to 
the  colonel. 

Besides  illustrating  the  phenomenon  of  excessive  skin  secretion,  the  following  case 
presents  with  unusual  clearness  the  group  of  symptoms  which  may  attend  lesions  of  nerve 
trunks;  in  many  cases  one  or  two  of  these  symptoms  may  predominate;  but  here  they  all 
seem  to  be  strongly  marked,  as  pain  and  burning  hyperaesthesia  of  the  skin,  partial  paraly 
sis  of  sensation  and  motion,  excessive  skin  secretion  and  commencing  impairment  of 
nutrition.  In  addition  reflex  action  is  well  shown. 

CASE  1087. — Private  William  A.  Sturdy,  Co.  I,  18th  Massachusetts,  aged  22  years,  was  wounded  at  Bull  Run,  August  30, 
1862,  receiving  an  injury  of  the  right  arm.  He  was  admitted,  on  September  2d,  into  Camdeu  Street  Hospital,  Baltimore,  and 
on  September  19th  was  transferred  to  West's  Buildings  Hospital.  Here  he  remained  until  April  29,  18(53,  suffering  from  neural 
gia.  He  was  afterwards  treated  in  Lovell  Hospital,  Portsmouth  Grove,  and  on  May  23,  1863,  was  admitted  into  Central  Park 
Hospital,  New  York.  Acting  Assistant  Surgeon  M.  G.  Echeverrio  reported:  "The  ball  entered  the  posterior  and  superior  part 
of  the  outer  face  of  the  right  arm  and  came  out  through  the  union  of  the  two  inferior  with  the  superior  thirds  of  the  inner  border 
of  the  biceps  brachialis.  There  was  scarcely  any  inflammation  of  the  wound  upon  its  infliction;  the  arm  became  numb,  and  the 
first  night  after  he  was  wounded  he  had  severe  pain  in  the  hand  which  has  continued  ever  since,  existing  principally  in  the  thumb, 
index  and  middle  fingers.  Sensibility  has  been  impaired  in  the  forearm  and  hand.  Electricity  was  applied  in  the  beginning  for 
a  period  of  three  or  four  weeks,  with  very  little  success.  August  16,  1863 :  There  is  now  hyperaesthesia,  and  the  skin  of  the  hand 
is  constantly  wet  with  perspiration.  Pressure  of  the  wound  produces  a  burning  pain  in  the  three  fingers  affected ;  their  movement 
is  likewise  very  much  impeded  and  the  nutrition  of  their  muscles  has  been  diminished;  they  exhibit  a  beginning  of  atrophy 
The  temperature  of  the  hand  is  not  different  from  that  of  the  other  hand,  nor  does  the  pulse  in  the  right  forearm  exhibit  any  marked 
difference  to  that  of  the  left.  The  touch  of  a  rough  surface  with  the  left  hand  produces,  by  reflex  action,  a  more  or  less  severe 
pain  in  the  paralyzed  fingers  of  the  right  hand.  This  phenomenon  may  be  repeated  several  times,  and  when  discontinued  a  great 
deal  of  the  left  hand  is  wet.  An  ointment  composed  of  four  grains  each  of  aconitine  and  atropine  to  an  ounce  of  cerate  has  brought 
about  great  relief  of  the  neuralgic  pain,  but  the  paralytic  condition  of  the  fingers  remains  always  the  same."  This  soldier  was 
discharged  from  service  August  16,  1863,  for  "neuralgia  of  right  hand,  the  result  of  gunshot  injury,"  and  pensioned.  Examiner 
J.  13.  Chase,  of  Taunton,  Massachusetts,  reported,  May  16,  1877 :  "  The  bullet  struck  the  right  arm  near  the  junction  of  the  upper 
and  middle  thirds  of  the  humerus,  on  the  outer  and  posterior  surface  of  the  arm  (it  being  raised  at  the  time),  and  passed  directly 
through  on  the  inner  side  of  the  humerus  without  injuring  the  bone,  and  emerged  near  the  head  of  the  biceps  muscle,  injuring  the 
brachial  nerve.  The  circumference  of  the  right  arm  is  10|  inches,  of  the  left  arm  11  inches;  of  the  right  forearm  10  inches,  of 
the  left  10J  inches.  The  radial  nerve  is  partially  paralyzed.  The  muscles  of  the  right  thumb,  particularly  the  abductor,  are 
very  much  smaller  than  those  of  the  left,  and  the  forefinger  is  smaller  than  the  left.  He  cannot  fully  rotate  the  forearm  nor  fully 
extend  the  elbow.  He  says  his  right  forefinger  and  thumb  are  very  weak,  and  alleges  pain  in  the  thumb,  index,  and  side  of  mid 
dle  finger  next  the  index,  and  that  they  are  cold.  Pressure  at  place  of  exit  of  bullet  causes  pain  along  the  course  of  the  radial 
nerve." 

Lesions  of  sensation  were  always  present  in  some  degree.  Hyperaesthesia  and  anaes 
thesia  were  commonly  observed.  The  following  case  shows  how  sensation  may  be  pre 
served  while  motion  is  largely  impaired : 

CASE  1088. — Corporal  B.  Graham,  aged  22  years,  enlisted  September,  1861,  Massachusetts  Artillery,  5th  Battery.  Pre 
viously  healthy.  On  May  12,  1864,  he  was  struck  on  the  back  and  outside  of  the  right  arm  by  a  piece  of  shell  which  denuded 
but  did  not  break  the  humerus.  The  wound  lay  immediately  below  the  deltoid  insertion,  and  was  five  inches  wide  as  it  stretched 
across  the  arm,  and  three  inches  in  diameter  from  above  downward.  The  arm  dropped  and  he  had  sharp  pain  in  the  wound,  se 
that  he  cried  aloud.  The  after  pain  was  trifling.  As  he  went  to  the  rear  he  examined  the  limb  and  found  that  he  could  move 
his  fingers  a  little,  but  that  there  was  no  notable  loss  of  feeling.  The  wound  healed  rapidly,  and  is  now,  June  10,  1864,  level 
with  the  skin.  Nutrition  is  unimpaired.  The  right  forearm  measures  9|  inches,  the  left  9|  inches.  Outside  of  the  elbow,  for 
a  short  space,  tactility  is  enfeebled.  In  the  radial  distribution  touch  is  slightly  less  perfect  than  usual;  elsewhere  there  is  no 
lesion  of  sensation.  The  supinator  longus  muscle,  supplied  by  the  musculo-spiral,  acts  pretty  well.  The  extensors  of  the  wrist 
and  thumb  and  the  extensor  communis  are  completely  paralyzed.  The  interossei  act  well.  The  triceps  extensor  is  healthy. 
The  muscles  above  named  as  paralyzed  have  no  electric  contractility,  the  currents  applied  to  them  always  causing  contraction  of 
the  flexor  group.  He  was  discharged  September  14,  1864. 

Neuralgia  was  of  great  frequency  and  of  great  persistence,  stubbornly  resisting  treat 
ment.  Its  favorite  seat  seems  to  have  been  the  hand  and  foot;  other  parts  of  the  body 
were  rarely  attacked.  Severe  neuralgia  was  in  some  instances  due  to  the  presence  of 


CHAP,  xn.)  SHOT    WOUNDS   OF    NERVES.  747 

foreign  bodies,  such  as  fragments  of  lead  from  a  bullet,  splinters  of  wood,  iron,  or  bone 
pressing  upon  or  embedded  in  a  nerve  trunk;  the  pain  resulting  from  such  causes  were 
always  more  acute -and  persistent.  "The  intensity  of  neuralgia  varies  from  the  most  trivial 
burning  to  a  state  of  torture  which  can  hardly  be  credited,  but  which  reacts  on  the  whole 
economy,  until  the  general  health  is  seriously  affected."  (Mitchell,  Morehouse,  and  Keen, 
op.  cit.,  p.  102.)  The  temperature  of  affected  parts  was  found  to  be  higher  than  that  of 
surrounding  or  corresponding  portions  of  the  body.  The  following  case  illustrates  this 
painful  condition: 

CASE  1089. — J.  H.  Corliss,  late  private,  Co.  B,  14th  N.  Y.  S.  M.,  aged  27  years,  shingle  dresser,  enlisted  April,  18G1,  in 
good  health.  At  the  second  Bull  Run  battle,  August  29,  1862,  he  was  shot  in  the  left  arm  three  inches  directly  above  the 
internal  condyle.  The  ball  emerged  one  and  a  quarter  inches  higher,  through  the  belly  of  the  biceps,  without  touching  the  artery, 
but  with  injury  to  the  median  and  ulnar  nerves.  He  was  ramming  a  cartridge  when  hit,  and  "thought  he  was  struck  on  the 
crazy-bone  by  some  of  the  boys  for  a  joke."  The  fingers  of  both  hands  flexed  and  grasped  the  ramrod  and  gun  tightly. 
Bringing  the  right  hand,  still  clutching  the  ramrod,  to  the  left  elbow,  he  felt  the  blood  and  knew  he  was  wounded.  He  then 
shook  the  ramrod  from  his  grasp  with  a  strong  effort,  and  unloosened  with  the  freed  hand  the  tight  grip  of  the  left  hand  on  the 
gun.  After  walking  some  twenty  paces  he  fell  from  loss  of  blood,  but,  still  conscious,  attempted  to  walk  several  times  and  as 
often  failed.  He  was  finally  helped  to  the  rear,  taken  prisoner,  lay  three  days  on  the  field  without  food,  but  with  enough  water 
to  drink,  and  had  his  wounds  dressed  for  the  first  time  on  the  fourth  day,  at  Fairfax  Court  House.  On  the  second  day  the  pain 
began.  It  was  burning  and  darting.  He  states  that  at  this  time  sensation  was  lost  or  lessened  in  the  limb,  and  that  paralysis  of 
motion  came  on  in  the  hand  and  forearm.  His  statement  is  unsatisfactory  and  indistinct.  Admitted  to  the  Douglas  Hospital, 
Washington,  D.  C.,  September  7,  1862.  The  pain  was  so  severe  that  a  touch  anywhere,  or  shaking  the  bed,  or  a  heavy  step, 
caused  it  to  increase.  The  suffering  was  in  the  median  and  ulnar  distribution,  especially  at  the  palmar  face  of  the  knuckles  and 
the  ball  of  the  thumb.  Motion  has  varied  little  since  the  wound,  and  as  to  sensation  he  is  not  clear.  Peter  Pineo,  Surgeon, 
U.  S.  V.,  now  Medical  Inspector  U.  S.  A.,  exsected  two  or  three  inches  of  the  median  nerve  at  the  wound.  ( See  Army  Medical 
Museum  Specimen  No.  959.)  The  man  states,  very  positively,  that  the  pain  in  the  median  distribution  did  not  cease  nor  imme 
diately  lessen,  but  that  he  became  more  sensitive,  so  that  even  the  rattling  of  a  paper  caused  extreme  suffering.  He  "thinks  he 
was  not  himself"  for  a  day  or  two  after  the  operation.  It  seems  quite  certain  that  the  pain  afterward  gradually  grew  better, 
both  in  the  ulnar  and  median  tracts.  Meanwhile  the  hand  lay  over  his  chest,  and  the  fingers,  flexing,  became  stiff  in  this  posi 
tion.  About  a  week  after  he  was  shot  the  right  arm  grew  weak,  and  finally  so  feeble  that  he  could  not  feed  himself.  He  can 
now,  April,  1864,  use  it  pretty  well,  but  it  is  manifestly  less  strong  than  the  other.  The  left  leg  also  was  weakened,  but  when 
this  began  he  cannot  tell.  He  gives  the  usual  account  of  the  pain,  and  of  the  use  of  water  on  the  hands  and  in  his  boots,  as  a 
means  of  easing  it.  Present  condition,  April,  1864:  Wound  healed;  cicatrix  of  the  operation  two  and  a  half  inches  long  over 
median  nerve.  The  forearm  muscles  do  not  seem  to  be  greatly  wasted.  The  interosseal  muscles  and  hypothenar  group  are 
much  atrophied,  and  the  hand  is  thin  and  bony.  The  thenar  muscles  are  partially  wasted.  The  skin  of  the  palm  is  eczematous, 
thin,  red,  and  shining.  The  second  and  third  phalanges  of  the  fingers  are  flexed  and  stiff;  the  first  is  extended.  Nails  extra 
ordinarily  curved,  laterally  and  longitudinally,  except^  that  of  the  thumb.  Pain  is  stated  to  exist  still  in  the  median  distribu 
tion,  but  much  less  than  in  the  ulnar  tract,  where  it  is  excessively  great.  He  keeps  his  hand  wrapped  in  rags  wetted  with 
cold  water  and  covered  with  oiled  silk,  and  even  tucks  the  rag  carefully  under  the  flexed  finger-tips.  Moisture  is  more  essen 
tial  than  cold.  Friction  outside  of  the  clothes,  at  any  point  of  the  entire  surface,  "shoots"  into  the  hand,  increasing  the  burning 
in  the  median  sometimes,  and  more  commonly  in  the  ulnar  distribution.  Deep  pressure  on  the  muscles  has  a  like  effect,  and 
he  will  allow  no  one  to  touch  his  skin  with  a  dry  hand,  and  even  then  is  careful  to  exact  a  tender  manipulation.  He  keeps  a 
bottle  of  water  about  him  and  carries  a  wet  sponge  in  the  right  hand.  This  hand  he  wets  always  before  he  handles  anything; 
used  dry,  it  hurts  the  other  limb.  At  one  time,  when  the  suffering  was  severe,  he  poured  water  into  his  boots,  he  says,  to  lessen 
the  pain  which  dry  touch  or  friction  causes  in  the  injured  hand.  So  cautious  was  he  about  exposing  the  sore  hand  that  it  was 
impossible  thoroughly  to  examine  it;  but  it  was  clear  to  us  that  there  was  sensibility  to  touch  in  the  ultimate  median  distribu 
tion,  although  he  describes  sensation  as  somewhat  lessened  in  this  region,  and  states  that  he  has  numbness  on  the  inner  side  of 
the  palm  and  in  the  third  and  fourth  fingers  (ulnar  tract).  When  the  balls  of  the  first  and  second  fingers  were  touched  he  said 
lie  felt  it;  but,  on  touching  those  of  the  third  and  fourth  fingers,  he  refused  to  permit  us  to  experiment  further,  and  insisted  on 
wrapping  up  and  wetting  the  hand.  He  thus  describes  the  pain  at  its  height:  "It  is  as  if  a  rough  bar  of  iron  were  thrust  to 
and  fro  through  the  knuckles,  a  red-hot  iron  placed  at  the  junction  of  the  palm  and  thenar  eminence,  with  a  heavy  weight  on  it, 
and  the  skin  was  being  rasped  off  his  finger  ends."  (Mitchell,  Morehouse,  and  Keen,  loc.  cit,,  p.  109.)  The  following  informa 
tion  was  received  from  Douglas  Hospital,  under  charge  of  Surgeon  Peter  Pineo,  U.  S.  Vols.:  "The  ball  passed  through  the 
inner  and  anterior  part  of  the  arm  at  the  junction  of  the  middle  and  upper  thirds,  apparently  involving  the  median  nerve.  He 
entered  this  hospital  September  1,  1862,  suffering  excruciating  neuralgia  of  the  palmar  portion  of  the  hand  and  fingers.  The 
wound  healed  kindly,  but  the  pain  in  the  hand  continued  in  its  intensity,  yielding  to  no  treatment,  though  nervous  remedies, 
both  local  and  constitutional,  were  resorted  to.  The  extreme  suffering  produced  an  exalted  sensibility  of  the  entire  nervous 
system  which  manifested  itself  in  an  extraordinary  excitability  of  the  patient,  he  complaining  bitterly  at  the  least  jar  or  noise  in 
the  ward.  This  sad  condition  increased  in  severity  until  December  9,  1862,  when  the  operation  of  resection  of  the  median  nerve 
was  performed  by  Dr.  Peter  Pineo,  in  charge  of  the  hospital.  The  patient  being  etherized,  about  two  inches  of  the  nerve  was 
removed  and  the  wound  closed  by  adhesive  strips.  After  the  effect  of  the  ether  passed  off  the  patient  still  complained  of  much 
pain  in  the  hand,  but  seemed  to  think  it  was  not  so  intense  as  before  the  operation.  The  patient's  appetite  continued  good  through 
all  this  suffering,  and  he  was  allowed  a  liberal  diet,  For  several  days  after  the  operation  the  patient  was  allowed  sulphate  of 


748  WOUNDS   AND    COMPLICATIONS.  [CHAP.  xn. 

morphia ; .  but  it  was  soon  entirely  withdrawn.  The  wound  healed  by  first  intention,  but  there  seemed  to  be  no  positive  improve 
ment  in  regard  to  the  neuralgia  until  December  14th,  five  days  after  the  operation,  when  he  was  moved  to  a  separate  room; 
after  which  the  hypersesthesia  seemed  perceptibly  to  subside.  February  14,  1863,  the  patient  was  discharged  from  the  service 
at  his  own  earnest  solicitation.  At  this  time  he  was  able  to  walk  about  the  room  at  night,  but  still  suffered  very  much  from  the 
slightest  excitement."  Examiner  J.  T.  Burdick,  of  Brooklyn,  reported,  October  23,  1866:  "A  ball  perforated  the  arm  three  and 
a  half  inches  above  the  condyles,  injuring  the  median  and  ulnar  nerve  trunks.  He  alleges  that  two  inches  of  the  median  nerve 
were  excised  by  the  surgeon;  the  existence  of  a  longitudinal  eschar  three  inches  in  length  tends  to  confirm  the  statement.  The 
fingers  are  rigid^-  flexed  into  the  palm.  The  arm  and  hand  are  atrophied.  In  my  opinion  the  disability  is  equal  to  the  loss  of 
the  arm.''  The  Brooklyn  Examining  Board,  Drs.  McCollom  and  Leighton,  reported,  September  18,  1873:  "Contraction  of 
thumb  and  fingers  into  palm  of  hand.  Extreme  sensitiveness  of  the  fingers.  Arm  and  hand  useless." 

Paralysis  of  motor  nerves  from  gunshot  injury  was  found  to  vary  in  all  degrees  of 
severity  and  completeness,  resulting  from  blows,  wounds,  concussions,  arid  from  transferred 
irritation.  In  the  following  instance  a  slug  remained  in  the  left  shoulder  for  twenty  years, 
when  it  was  accidentally  disturbed  in  its  resting  place  by  a  fall  of  the  patient.  Paralysis 
of  the  left  arm  and  left  leg  ensued,  but  was  completely  relieved  by  the  removal  of  the  slug: 

CASE  1090. — Sergeant  C.  A.  Norton,  1st  Maine  Cavalry,  aged  22  years,  while  out  with  a  scouting  party  was  wounded, 
August  7,  1862,  by  a  rebel  hid  in  a  cellar,  by  three  leaden  slugs,  one  striking  the  right  hip,  another  the  right  arm,  and  the  third 
lodging  in  the  left  shoulder.  The  wounds  in  the  hip  and  arm  were  slight  and  occasioned  but  little  pain  and  healed  in  twenty 
days;  the  wound  in  the  left  breast  and  shoulder  was  deep  and  produced  peculiar  sensation.  The  slug  entered  just  over  the  third 
left  rib  about  on  a  line  with  the  middle  of  the  clavicle,  and  passed  upward  and  backward,  lodging  in  the  deep  muscles.  When 
hit  the  patient  instantly  fell  forward  but  did  not  become  unconscious,  although  it  was  some  moments  before  he  could  speak.  The 
mind  was  unusually  active  and  incidents  of  his  childhood,  long  forgotten,  passed  rapidly  in  review.  The  pain  at  first  was  of  a 
sharp  tingling  kind,  accompanied  by  a  beating,  throbbing  sound  in  the  left  ear,  and  the  eyes  became  very  sensitive  to  the  sun 
light.  All  these  symptoms  gradually  disappeared,  and  in  two  months  he  rejoined  his  command.  In  about  a  year  his  eyesight 
had  so  failed  that  he  was  compelled  to  use  positive  glasses,  and  he  also  had  frequent  attacks  of  neuralgia  of  the  heart.  These 
conditions  remained  unchanged  for  twenty  years;  the  wound  in  the  shoulder  occasioned  no  further  inconvenience  until  May, 
1882.  But  he  could  at  any  time,  by  simply  striking  the  heel  of  the  left  foot  smartly  on  the  ground,  produce  a  numb  feeling 
on  the  left  side  of  the  body,  including  the  arm  and  head.  In  May,  1882,  he  fell  down  a  flight  of  steep  stairs,  striking  the  left 
shoulder  in  the  fall.  At  first  he  had  a  faint  deathly  feeling  at  the  stomach,  and  a  sharp  smarting  pain  in  the  left  hand  and  arm 
and  down  the  spine.  These  symptoms  gradually  wore  off,  and  the  next  morning  he  only  felt  a  slight  soreness  from  the  bruise. 
About  noon  the  day  after  the  fall,  while  writing,  he  found  he  had  suddenly  lost  the  power  to  move  the  fingers  of  the  left  hand, 
and  in  a  moment  the  arm  became  useless.  He  was  writing  at  the  time  with  the  left  hand,  having  lost  the  right  arm  at  Fort 
Fisher  in  18u5.  He  could  not  rise  from  his  chair,  for  the  left  leg  was  also  powerless.  lie  was  at  once  removed  to  his  home, 
where  it  was  found  that  he  had  paralysis  of  the  whole  left  side,  with  complete  loss  of  sensation,  not  being  able  to  feel  the  deep 
prick  of  a  pin.  The  eyes  were  very  sensitive  to  the  light,  and  the  voice  was  weak  and  tremulus.  In  four  days  he  so  far 
recovered  as  to  be  able  to  walk,  but  the  arm  and  hand  remained  almost  useless.  Feeling  that  the  slug  in  the  lefy  shoulder  was 
the  cause  of  this  trouble,  he  had  it  remove*!  in  June,  1882,  twenty  years  after  receiving  the  wound.  It  was  about  as  large  as 
a  common  lead  pencil,  three  quarters  of  an  inch  long,  flattened  at  both  ends,  and  weighed  at  the  time  of  removal  129  grains. 
After  the  removal  of  the  slug  the  numbness  and  coldness  gradually  disappeared  from  the  hand  and  arm,  and  in  three  weeks  he 
could  hold  a  pen  and  write  a  few  moments  at  a  time,  and  in  six  weeks,  with  the  exception  of  a  slight  weakness,  the  hand  and 
arm  were  as  well  as  ever.  The  eyesight,  which  for  nineteen  years  had  compelled  the  use  of  glasses,  improved  so  much  that  the 
glasses  were  not  needed  or  used,  and  the  neuralgia  of  the  heart,  of  which  he  had  so  long  suffered,  had  not  made  its  appearance 
in  September. 

In  the  work  of  Drs.  Mitchell,  Morehouse,  and  Keen,  so  freely  quoted,  the  diagnosis 
and  prognosis  of  this  class  of  injuries  are  succinctly  stated  (op.  cit.,  p.  120):  ''The  diagnosis 
of  this  paralysis  is  of  course  easy.  A  ball  cuts  a  nerve,  or,  as  is  more  common,  stuns  or 
contuses  it,  and  we  have  certain  muscles  made  powerless.  In  a  few  days,  if  the  nerve 
injury  has  been  partial,  some  of  these  muscles  improve  or  recover  entirely.  In  other  cases, 
weeks  or  months  go  by  without  change  for  the  better,  and  the  muscles  fall  victims  to  atrophy 
and  contraction."  As  to  prognosis:  "Of  course  every  case  of  partial  loss  of  function  is  more 
likely  to  recover  than  one  of  total  loss,  and  if  the  will  has  any  control  over  the  muscle  after 
the  injury  we  may  reasonably  look  for  an  increasing  gain.  But  there  are  varieties  of  mus 
cular  injury  outside  of  the  mere  palsy  of  volitional  control.  Early  loss  of  tone  in  the 
muscle  is  a  bad  sign;  rapid  shrinking  in  size  is  another;  and  contraction,  when  this  is  a 
nutrient  change  and  not  pure  spasm,  is  worse  still.  They  are  all  due  to  lesions  of  nutritive 
fibres,  and  are  ominous  of  ultimate  deformities  and  of  permanent  loss  of  power.  But  these 
signs,  already  fully  discussed,  arrive  late  in  the  case.  It  is  possible,  at  a  very  early  date, 


CHAP.  XII.]  SHOT    WOUNDS    OF    NERVES.  749 

usually  within  two  weeks  of  the  injury,  to  make  a  very  complete  prognosis,  by  means  of 
electricity,  as  to  the  extent  of  the  motor  palsy  and  the  probability  of  its  remaining  intract 
able  to  treatment  or  not.'' 

As  results  of  motor  paralysis  are  found  loss  of  motion  from  alterations  of  joints,  con 
tracted  muscles,  spasmodic  affections  and  tremors.  The  following  cases  show  the  condi 
tion  and  phases  of  injuries  affecting  motor  nerves: 

CASE  1091. — Private  Patrick  H.  Mahoney,  Co.  H,  13th  Iowa,  aged  38  years,  was  wounded  at  Shiloh,  April  6,  1862.  On 
May  7th  he  was  admitted  into  the  hospital  at  Quincy,  Illinois.  Surgeon  R.  Niccolls,  U.  S.  Vols.,  reported:  "Wounded  in  the 
left  arm;  the  ball  entered  near  the  insertion  of  the  pectoralis  major,  traversed  the  axilla^and  came  out  at  the  lower  angle  of  the 
scapula,  evidently  dividing  some  of  the  branches  of  the  axillary  plexus.  Ever  since  admission  he  has  complained  of  violent  neu 
ralgia  of  the  wounded  arm,  and  especially  of  the  hand,  together  with  exalted  sensibility  of  the  whole  surface,  so  that  he  starts 
and  complains  of  pain  when  touched  anywhere.  His  face  is  Hushed.  Narcotics  seem  to  make  but  little  impression  upon  him. 
September  3d  :  Neuralgia  now  confined  to  the  hand.  Flush  and  sensibility  of  surface  nearly  gone.  Bowels  regular;  sleeps  well. 
Pulse  112,  full  and  strong.  Muscles  of  forearm  somewhat  atrophied,  of  hand  completely  so.  Flexors  and  extensors  of  fingers 
contracted  so  as  to  bend  the  fingers  like  the  letter  S.  Skin  of  hand  bright  red,  partially  from  the  constant  use  of  water  dressings. 
Has  very  little  motion  of  the  fingers.  The  galvanic  battery  was  tried  at  one  time,  without  effect.  September  15th :  The  pains 
appearing  to  be  somewhat  periodical,  a  mixture  containing  quinine  30  grains,  tincture  of  aconite  40  drops,  strychnia  £  grain,  aro 
matic  sulphuric  acid  q.  s.,  and  water  4  ounces,  was  given  in  tablespoonful  doses  every  six  hours.  This  prescription  seemed  to 
aggravate  his  pain  and  was  discontinued  on  the  17th."  Mahoney  was  discharged  September  22,  18G2,  and  pensioned.  Exam 
iner  W.  H.  Walker,  of  Fond  du  Lac,  Wisconsin,  reported,  March  15,  1867  :  "  He  was  wounded  through  the  upper  third  of  the  left 
arm,  injuring  the  axillary  nerve  and  artery.  Hand  and  arm  atrophied  and  entirely  useless  for  practical  purposes.  He  can  use 
the  hand  as  a  dead  weight  to  hold  a  paper  when  writing.  Cannot  hold  his  fork  to  cut  his  meat.  Cannot  take  his  hat  off  with 
the  hand  ;  it  is  absolutely  useless  for  manual  labor."  He  was  paid  December  4,  1876. 

CASE  1092.— J.  S.  L.  Scott,  aged  31-  years,  farmer,  New  York,  enlisted  August,  1862,  Co.  F,  121st  New  York.  Wounded 
May  3,  1863,  at  Chancellorsville.  The  ball  entered  the  right  leg  a  little  below  its  middle,  in  front  of  the  fibula  three-fourths  of 
an  inch,  and  emerged  one  inch  and  a  fourth  behind  the  tibia,  on  the  same  level,  without  injury  to  the  bones.  Total  loss  of  motion 
below  knee;  slight  of  sensation.  Pain  only  on  the  second  day,  from  inflammation.  The  after  history  doubtful,  except  that  sen 
sation  improved.  Present  condition,  September  12,  1863 :  The  patient  walks  with  a  crutch,  the  foot  being  suspended  in  a  long 
sling,  in  extension,  and  quite  useless.  Attempts  at  flexion  resisted  by  the  pinning  of  the  cicatrix  and  by  shortening  of  the  soleus 
chiefly.  (See  Specimen  No.  6682,  in  the  Army  Medical  Museum,  a  cast  of  the  foot  and  ankle.)  Sensation  impaired  slightly  in  the 
foot,  but  nowhere  lost.  The  leg  and  thigh  muscles  slightly  tender  on  pressure.  The  foot  feels  warm,  the  toes  are  cold  and  purple. 
No  burning.  Treatment :  Alternate  cold  and  hot  douches ;  splint  to  correct  malposition ;  faradization  daily.  October  26,  1863, 
re-examined:  Tactility  and  localization  nearly  perfect;  cold  and  heat  are  appreciated  correctly,  although  slowly;  sensibility  to 
pain  much  impaired  below  the  knee,  but  lost  at  the  outer  head  of  the  gastrocnemius  and  on  the  outside  of  the  foot ;  volitional 
control  lost  from  the  knee  downward  ;  electric  contractility  feeble  in  the  tibialis  anticus,  extensor  longus  digitorum  com.,  and 
extensor  proprius  pollicis ;  it  is  best,  though  weak,  in  the  peroneus  lougus.  In  none  of  these,  nor  elsewhere,  are  the  contractions 
sufficient  to  stir  the  parts.  None  of  the  calf  muscles  respond  at  all,  and  electro-muscular  sensibility  is  absent  in  all  except  at  the 
upper  end  of  the  external  origin  of  the  gastrocnemius.  Withal,  there  is  no  atrophy.  The  electric  brush  gives  little  or  no  pain 
on  the  dried  skin.  The  muscles,  or,  at  all  events,  the  subcuticular  tissues,  are  sore  when  firmly  pressed,  especially  the  great 
toe  and  the  inside  of  the  plantar  arch.  It  is  difficult  to  reconcile  this  with  the  analgesia  so  evident  where  a  needle  is  used.  It 
is  remarkable,  but  in  accordance  with  M.  Duchenue's  experience,  that  above  the  wound  the  muscles  in  general  have  lost  electric 
contractility  as  well  as  below  it.  December  20,  1863 :  The  anterior  muscles  have  regained  sensibility  to  electricity.  A  club- 
foot  apparatus  was  used  to  flex  the  foot.  January  1,  1864  :  Contractility  under  electricity  returning  in  anterior  muscles  and  calf. 
No  voluntary  power.  January  20,  1864  :  Calf  muscles  begin  to  respond  to  will.  Electro-muscular  contractility  well  marked 
in  tibialis  anticus,  peroueus  longus,  common  extensor,  and  interossei.  Volition  good  as  to  calf  muscles ;  none  as  to  anterior 
group  ;  but  the  foot  is  now  flexed  to  over  a  right  angle,  and  when  it  is  cased  iu  a  stout  gaiter  he  can  walk  well  with  a  cane ;  for, 
although  he  has  no  volitional  flexion,  the  weight  of  the  body  on  the  toes  and  ball  of  the  foot  serves  to  antagonize  the  calf.  The 
man  is  anxious  to  be  discharged,  although,  from  the  return  of  electric  properties  in  the  tibial  group,  we  feel  sure  of  ultimate  cure 
with  the  aid  of  electricity.  Under  the  circumstances  we  do  not  feel  that  it  is  proper  to  retain  him.  Discharged  February  12, 
1864,  and  pensioned.  Pension  Examiner  Lanning  reported,  February  4,  1874,  that  paralysis  of  the  foot  and  toes  was  nearly 
complete.  The  pensioner's  condition  was  unchanged  in  1876. 

Carefully  conducted  experiments  on  the  condition  of  calorification  in  injuries  of  the 
nerves  were  made  by  Drs.  Mitchell,  Morehouse,  and  Keen.  The  results  in  a  number  of 
grave  cases  are  summed  up  as  follows  (op.  cit.,  p.  135) :  "  It  was  observed  that  the  member 
the  nerves  of  which  were  affected  was  nearly  always  colder  than  the  other,  whether  the 
nerve  lesion  was  extensive  or  trifling.  In  two  cases  there  was  no  difference.  One  of  these 
was  an  instance  of  total  motor  palsy  below  the  knee,  with  good  tactile  feeling  preserved 
and  without  atrophies.  The  other  was  a  wound  of  the  portio  dura  of  the  seventh  nerve  ; 
the  motor  palsy  complete,  sensation  perfect.  Five  cases  had  a  higher  temperature  in  the 


750  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xil. 

wounded  limb  than  in  the  sound  member.  Of  these,  one  was  an  ordinary  nerve  wound, 
with  slight  loss  of  sensation  and  with  a  good  deal  of  motor  paralysis.  All  of  the  others 
were  cases  of  the  burning  pain  so  often  alluded  to.  The  examination  in  these  was  limited 
to  the  spot  affected.  At  the  time  of  these  observations  we  had  no  wounds  in  which  com 
plete  division  of  all  the  nerves  of  a  part  had  occurred  ;  and  in  fact  this  is  a  rare  accident. 
The  sole  exceptions  were  wounds  of  the  seventh  pair.  One  of  these  we  examined  as  to 
temperature,  but  with  no  notable  result.  There  was  no  difference  between  the  two  sides." 

EFFECTS  OF  MISSILES  AND  PBOJECTLLES   ON  BLOOD-VESSELS. WoUllds     of    blood-VCSSCls,    the 

effect  of  missiles  and  projectiles,  were  few  in  comparison  with  the  total  number  of  shot 
wounds  recorded  during  the  war. 

In  the  general  consideration  of  these  injuries  the  question  as  to  the  particular  character 
of  the  missile  does  not  appear  to  assume  much  practical  importance ;  in  fact,  it  is  difficult 
to  distinguish  the  effects  of  injuries  inflicted  by  one  or  the  other  form  of  more  common 
forms  of  bullets. 

It  is  probable,  from  the  general  nature  and  conditions  pertaining  to  missiles,  that  a 
round  ball  will  more  frequently  contuse  than  divide  a  blood-vessel,  while  the  contrary  may 
be  expected  to  result  from  an  injury  by  a  conoidal  bullet ;  but  perforations  by  round  balls 
have  also  been  noted,  as  in  the  following  case : 

CASE  1093. — Private  Henry  Owens,  Battery  A,  5th  U.  S.  Artillery,  aged  23  years,  was  wounded  at  Suffolk,  Virginia, 
April  15,  1863,  by  the  bursting  of  a  shell  over  his  head.  Surgeon  T.  H.  Squire,  89th  New  York,  reported  :  "A  flesh  wound, 
a  mere  graze  across  the  right  ramus  of  the  lower  jaw,  near  the  chin ;  a  second  wound,  penetrating,  a  slit  three-fourths  of  an 
inch  across  the  side  of  the  neck,  over  the  middle  of  the  sterno-cleido-mastoid  muscle,  the  opening  being  near  three  inches  from 
the  median  line  in  front.  April  18,  1863,  the  right  side  of  the  neck,  extending  down  toward  the  subclavicular  region,  is  swelled 
and  somewhat  emphysematous  to  the  touch.  There  is  some  pain  in  the  chest  in  the  region  of  the  mediastinum  ;  some  dyspnoea 
and  cough,  and  a  little  spitting  of  blood  on  one  occasion.  Respiratory  murmur  very  distinct,  and  percussion  resonant  over  the 
front  of  both  lungs.  He  died  on  April  19,  1863.  Post-mortem  examination  at  1  o'clock  P.  M.  on  April  19th  :  Countenance 
livid ;  mottled  appearance  of  skin  on  the  right  shoulder,  arm,  and  chest;  frothing  at  the  lips ;  all  of  the  right  chest,  save  a 
hand's  breadth  immediately  beneath  the  clavicle,  dull  on  percussion  ;  left  chest  resonant  on  percussion  in  front.  Made  one 
incision  through  the  skin  and  areolar  tissue  from  the  point  of  the  thyroid  cartilage  down  to  the  umbilicus  ;  one  from  the  point 
of  commencement,  about  four  inches  long,  just  below  the  ramus  of  the  under  jaw  ;  and  a  third  at  right  angles  with  the  first, 
from  the  umbilicus,  about  six  inches  to  the  right.  Dissected  back  this  whole  flap,  including  skin,  superficial  fascia,  and  pla- 
tysma  myoides.  Areolar  tissue  of  the  whole  right  side  of  the  neck  injected  with  dark  blood.  Discovered  the  opening  caused  by 
the  missile  to  be  nearly  in  the  centre  of  the  sterno-cleido-mastoid  muscle  ;  the  omo-hyoid  muscle  was  also  injured  by  the  ball. 
Sterno-hyoid  and  sterno-thyroid  uninjured,  being  toward  the  median  line  from  the  wound.  Thyroid  gland  quite  large.  Arrived 
at  this  point,  discovered  that  the  ball  had  passed  through  the  internal  jugular  vein  about  two  inches  above  the  clavicle,  the 
wounds  of  entrance  and  exit  being  on  the  anterior  and  posterior  walls  of  the  vein,  the  outer  and  inner  third  being  entire.  The 
vessel  from  this  wound,  upwards  in  the  neck,  was  occupied  with  a  large  clot  of  blood ;  par  vagum  and  carotid  uninjured  ; 
scalenus  anticus  perforated,  the  direction  of  the  ball  being  downward  and  toward  the  spine.  On  opening  the  chest  a  great 
deal  of  scrum  escaped  from  the  right  pleural  cavity.  There  was  extensive  adhesions  of  recent  false  membrane  over  the  whole 
of  the  right  lung,  or  the  greater  portion  of  it.  The  ball,  after  going  through  all  the  soft  parts,  as  narrated,  struck  and  fractured 
the  neck  of  the  first  rib,  also  the  neck  of  the  second  rib,  and  finally  found  a  lodgement  by  the  right  side  of  the  body  of  the  third 
dorsal  vertebra,  in  the  posterior  mediastinum.  From  the  right  cavity  of  the  chest,  after  the  lungs  were  removed,  the  ball  could 
easily  be  felt  with  the  fingers,  lying  in  the  place  where  its  motion  was  arrested,  with  nothing  but  the  costal  or  mediastinal  pleura 
intervening  between  it  and  the  cavity  of  the  chest.  The  ball  evidently  bruised  the  mediastinal  pleura,  injured  it,  but  did  not  make 
an  opening  in  it.  The  lung  was  not  inflamed.  The  ball  was  round,  the  size  of  a  common  musket  ball,  and  battered  on  one  side. 
It  may  be  well  enough  to  remark  that  there  was  never  any  bleeding  to  speak  of  in  this  case.  By  a  further  and  more  careful 
examination  of  the  injury  to  the  vein  I  find  that  the  ball  actually  perforated  the  vessel  instead  of  biting  out  a  piece  on  one  side/' 
The  wounded  portion  of  the  right  internal  jugular  vein  was  forwarded  to  the  Army  Medical  Museum  by  Dr.  Squire,  and  is 
numbered  Specimen  1055  of  the  Surgical  Section.  A  part  of  the  parietes'of  the  vein  is  carried  away,  and  in  the  posterior  portion 
an  orifice  is  seen,  through  which  the  contributor  considers  the  missile  passed. 

Distorted  balls,  pieces  of  shell,  fragments  of  stone  and  iron,  and  splinters  follow  the 
general  rule  common  to  all  missiles,  by  contusing,  cutting,  and  puncturing  blood-vessels. 

The  graver  lesions  due  to  the  impact  of  large  projectiles  are  so  manifest  in  their  charac 
ter  as  to  need  no  comment. 

The  position  of  the  larger  trunks  of  the  principal  blood-vessels  tends  to  give  them 


CHAP   XII.]  EFFECTS    OF    MISSILES    ON    BLOOD-VESSELS.  751 

immunity  from  accident.  They  are  deeply  placed,  sheltered  by  the  bony  frame-work, 
protected  by  soft  parts  and  by  fasciae  capable  of  deflecting  the  course  of  a  missile ;  their 
investing  sheaths  and  coats  are  strong  and  tough ;  having  a  certain  degree  of  freedom  of 
motion  they  are  enabled  to  slip  aside  and  elude  a  passing  missile ;  their  tubular  form  and 
easily  compressed  fluid  contents  are  also  elements  of  safety.  All  of  these  conditions  may 
have  their  influence  in  contributing  to  the  many  fortunate  escapes  from  severe,  perhaps 
fatal,  injury  common  to  the  experience  of  every  military  surgeon. 

CASE  1094. — Private  Michael  Hussey,  Co.  D,  37th  New  York,  aged  32  years,  was  wounded,  while  on  picket,  at  Occoquan, 
Virginia,  February  24,  1862.  Surgeon  W.  O'Meagher,  37th  New  York,  reported: 1  "  The  hall  entered  the  right  thigh  near  the 
lower  angle  of  Scarpa's  space,  eluded  or  pushed  aside  the  femoral  vessels,  passed  upward,  and  escaped  posteriorly  in  the  gluteal 
furrow.  Very  little  haemorrhage  occurred,  though  he  walked  a  considerable  distance  back  to  the  picket  station.  A  plug  of 
scraped  lint  was  inserted  into  each  opening  and  a  roller  bandage  applied,  this  being  kept  wet  with  an  evaporating  lotion.  Next 
day  he  was  removed  to  the  regimental  hospital,  and  for  two  weeks  following  little  more  was  done  except  to  apply  a  poultice. 
By  this  time  he  was  able  to  walk  about,  no  bad  symptom  having  occurred  to  rnar  his  speedy  convalescence."  On  March  5,  1862, 
he  was  transferred  to  the  Mansion  House  Hospital,  Alexandria,  whence  he  was  returned  to  duty  August  7, 1862.  He  continued 
in  service  until  June  8,  1865,  receiving  at  Petersburg,  on  May  9,  1864,  a  shot  wound  of  the  forehead.  In  February,  1882, 
Hussey  was  an  applicant  for  pension. 

In  the  case  of  Private  William  McDonald  (First  Surgical  Volume,  page  39^7),  Go.  F, 
51st  New  York,  a  musket  ball  lodged  between  the  carotid  artery  and  the  jugular  vein, 
pressing  the  vein  forward  to  such  an  extent  that  the  vessel  was  collapsed  and  little  or  no 
blood  passed  through  it.  In  the  case  of  Captain  J.  N.  Lake  (First  Surgical  Volume,  page 
412),  a  musket  ball  passed  on  a  level  with  the  pomum  Adami,  between  the  jugular  vein  and 
the  carotid  artery,  without  injuring  either  vessel. 

Aside  from  the  injuries  of  large  trunks  which  are  immediately  fatal,  it  would  appear 
that  the  number  of  cases  of  wounds  of  important  blood-vessels  is  small.  In  the  preliminary 
report  (Circular  No.  6,  Surgeon  Generals  Office,  1865,  page  38)  it  was  stated  that  "  in  the 
campaign  of  the  Army  of  the  Potomac  from  the  Hapidan  to  the  James,  in  May,  June,  and 
July,  1864,  of  a  total  of  36,508  gunshot  wounds  only  27  belonged  to  this  category."  Dr. 
Longmore2  says:  "  Out  of  4,434  wounds  detailed  in  the  British  returns  of  the  Crimean  War, 
only  15  wounds  of  arteries  were  registered."  Surgeon  M.  Goldsmith,  U.  S.  V.,  "desiring  to 
learn  whether  external  primary  haemorrhage  often  occurs  as  the  instant  result  of  shot 
wounds,"  placed  himself  "near  the  line  of  battle,  and  observed  only  one  case,  a  soldier 
struck  in  the  neck,  severing  the  carotid,"  and  fatal  before  he  could  reach  him. 

In  the  following  case  the  common  carotid  artery  was  perforated  from  before  back 
ward  ;  death  ensued  very  rapidly : 

CASE  1095. — Lieutenant  Colonel  E.  A.  Kimball,  9th  New  York,  aged  about  40  years,  of  well-knit  frame  and  in  good  health, 
was  shot  at  Suffolk,  Virginia,  at  about  4  o'clock  A.  M.  on  April  12,  1863.  Surgeon  T.  H.  Squire,  89th  New  York,  reported :  "It 
is  said  that  Lieut.  Colonel  Kimball  uttered  a  brief  ejaculation  after  he  was  shot  and  died  almost  instantly.  A  pistol  was  the  arm 
used ;  the  person  firing  was  on  horseback,  the  person  shot  standing  on  the  ground  very  near  him.  I  examined  the  body  at  3 
o'clock  P.  M.  Blood  was  dried  on  the  clothes  on  the  front  of  his  person  from  the  throat  to  the  boots.  An  opening  half  an  inch 
in  diameter  existed  in  the  front  of  the  neck,  the  edge  of  it  only  about  a  quarter  of  an  inch  to  the  right  of  the  median  line,  and  the 
centre  of  the  opening  being  about  three-quarters  of  an  inch  below  the  prominent  point  of  the  thyroid  cartilage.  No  other  open 
ing  existed;  but  the  ball  was  felt  beneath  the  skin  just  over  the  posterior  border  of  the  scapula.  Here  I  made  an  incision  and 
removed  it  with  forceps.  Putting  my  finger  in  the  opening  I  found  that  the  ball  had  just  made  a  notch  in  the  border  of  the  blade 
at  the  point  corresponding  to  the  termination  of  the  spine  of  the  scapula.  From  the  point  of  entrance  the  ball  took  its  course 
downward  and  backward,  but  nearly  in  a  direct  antero-posterior  direction.  I  made  one  incision  in  the  medium  line  from  the 
thyroid  cartilage  to  the  top  of  the  sternum,  another  from  the  point  of  commencement  toward  the  angle  of  the  jaw  about  two  and 
a  half  inches,  and  a  third  from  the  bottom  of  the  first  in  the  direction  of  the  clavicle  about  two  inches.  1st,  Laid  back  the  skin 
and  superficial  fascia;  2d,  the  platysma  myoides  muscle  (the  areolar  tissue  was  dark  with  suffused  blood  near  the  wound) ;  3d, 
divided  the  lower  attachment  of  the  sterno-cleido-mastoid  and  carried  the  muscle  up  and  laid  it  on  the  reflected  skin  ;  the  ball 
went  just  to  the  inner  edge  of  this  muscle ;  4th,  divided  the  omo-hyoid  and  turned  it  away ;  5th.  cut  the  upper  attachment  of  the 


EH  (W.),  Cases  in  Military  Surgery;   Gunshot  Wound  of  Thirjh,  narrow  escape  of  Femoral  Vessels,  in  American  Medical  Times,  18fi2, 
Vol.  IV,  p.  205.  2LONGMOUE  (T.),  Gunshot  Injuries,  etc.,  London,  1877,  page  150. 


752 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


sterno-hyoid  and  turned  it  down  (the  ball  hole  was  right  through  the  middle  of  the  muscle),  and  also  cut  the  lower  attachment 
and  then  the  muscle  away;  6th,  did  the  same  thing  with  the  sterno-thyroid ;  7th,  discovered  that  the  ball  had  made  a  notch 
in  the  edge  of  the  thyroid  gland ;  8th,  cleared  away  areolar  tissue  dark  with  suffused  blood ;  9th,  found  the  common  carotid 
artery  absolutely  perforated  from  before  backward,  there  being  a  roundish  opening  in  the  anterior  and  a  somewhat  longitudinal 
one  in  the  posterior  wall,  the  two  lateral  portions  of  the  tube  being  entire;  10th,  the  par  vagum  and  the  vein  uninjured  ;  llth, 
this  ball  hole  in  the  carotid  was  used,  without  any  alteration,  to  insert  the  syringe  pipe  to  inject  arsenic  to  preserve  the  body; 
12th,  the  ball  was  conical  and  quite  a  size  larger  in  diameter  than  the  diameter  of  the  artery." 

The  passage  of  a  missile  through  any  part  of  the  body  will  necessarily  divide  and  lac 
erate  many  small  blood-vessels,  but  serious  results  seldom  follow,  as  permanent  retraction 
of  the  injured  vessels  takes  place  at  once. 

When  an  artery  of  size  is  completely  divided  by  the  impact  of  a  large  or  small  pro 
jectile  at  high  velocity  there  may  be  a  gush  of  blood;  but  the  immediate  retraction  of  the 
inner  and  middle  coats  and  the  formation  of  a  coagulum  will  generally  prevent  further 
haemorrhage  and  secure  the  patient  for  the  time  at  least. 

In  eighty-four  of  one  hundred  and  eighteen  cases  of  complete  division  of  the  larger 
arteries  no  primary  bleeding  was  observed,  while  in  thirty-four  cases,  or  28.8  per  cent.,  the 

injury  was  followed  by  primary  hemorrhage. 

i 

TABLE   OXXIII. 

Summary  of  One  Hundred  and  Eighteen  Cases  of  Complete  Division  of  the  larger  Blood-vessels }  indi 
cating  the  number  of  cases  in  which  primary  bleeding  occurred. 


ARTERIES. 

CASKS. 

RESULTS. 

PKIMARY 

BLEEDINGS. 

NO  PUIMAKT 
BLEEDING. 

8 

I            1 

tf            & 

Recoveries. 

1 

r- 

Recoveries. 

i 
A 

Complete  division  of  Common  Carotid.  

„ 

2 

1 

i 
i 

5 

4 
2 
13 
12 
15 
1 

1 
6 
15 

10 
fi 

:n 

20 
24 
3 

1 

Complete  division  of  Axillary  

6 

1 

o 

10              5 

<;          4 

4               2 
5             26 
f,             14 
(i             18 
1               2 

3 
3 

1 
1 
3 

7 
3 
3 
4 
3 
6 
1 

Complete  division  of  Radial  

Complete  division  of  Ulnar  

Complete  division  of  Femoral  

13 
o 

3 

1 

Complete  division  of  Popliteal  

Complete  division  of  Tibials  

Complete  division  of  Peroneal  

Aggregates  .... 

118 

:J8             80 

11 

23 

27 

57 

The  proportion  of  primary  bleedings  to  the  number  of  cases  in  which  the  blood-vessels 
were  completely  divided  is  rather  larger  than  that  observed  by  Dr.  Lidell,1  who  found  that 
in  twenty  cases  the  bleeding  ceased  spontaneously  in  all  but  three. 

In  the  following  case,  in  which  the  posterior  tibial  was  severed,  haemorrhage  did  not 
occur  until  thirteen  days  after  the  injury: 

CASE  1096. — Sergeant  Z.  H.  Mather,  Co.  M,  5th  Michigan  Cavalry,  aged  27  years,  was  wounded  near  Funkstown,  July 
8,  1863.  He  was  treated  in  a  field  hospital,  and  was  admitted  on  July  17th  to  hospital  No.  1,  Frederick,  Maryland.  Acting 

1  Dr.  JOHX  A.  LlPELL  (Surgical  Memoirs  of  the.  War  of  the  Rebellion,  collected  and  published  by  the  United  States  Sanitary  Commission,  Surgical 
Volume  I,  p.  2ti),  in  commenting-  upon  twenty  cases  in  which  important  arteries  were  completely  divided,  says:  "In  all  but  three  of  these  twenty  cases 
the  primary  bleeding  ceased  spontaneously.  .  .  Of  the  twenty  cases  wherein  the  wounded  vessel  was  completely  divided  by  the  bullet,  the  femora! 
artery  was  the  seat  of  the  injury  in  five  instances,  of  which  all  died;  the  popliteal  in  four  instances,  »f  which  two  died  and  two  recovered;  the  posterior 
tibial  in  twoi  nstances,  of  which  both  died  ;  the  axillary  in  four  instances,  of  which  two  died  and  two  recovered  ;  the  brachial  also  in  throo  instances,  of 
which  one  died  and  two  recovered ;  the  internal  mammary  in  one  instance,  which  proved  fatal ;  and  the  external  carotid  in  one  instance,  which  recovered. 
Of  the  thirteen  fatal  cases  in  which  the  artery  was  severed,  two  died  of  primary  haemorrhage,  two  of  secondary  haemorrhage,  five  of  gangrene,  one  of 
gangrene  and  secondary  haemorrhage,  one  of  pyaemia,  and  two  of  exhaustion.  .  .  The  analysis  of  these  twenty  cases  shows  that  gunshot  wounds 
dividing  large  arteries  are  not  only  very  dangerous  to  life,  but  that  they  occasion  death  in  certain  determinate  ways,  the  most  important  of  which  are 
primary  htemorrhagp,  secondary  hemorrhage,  and  conserutive  gangrene.'' 


CHAP.  XII.]  EFFECTS    OF    MISSILES    ON    BLOOD-VESSELS.  753 

Assistant  Surgeon  W.  S.  Adams  reported :  "Wounded  by  a  minid  ball,  which  entered  the  outer  and  lower  border  of  the  popliteal 
space,  passed  inward  and  downward,  and  lodged  beneath  the  skin  on  the  opposite  side,  from  which  point  it  was  cut  out  upon  the 
field.  Patient's  condition  fair,  and  wounds  present  a  healthy  appearance.  Ordered  full  diet.  July  21st,  6  P.  M.,  haemorrhagf 
has  just  taken  place  from  the  wound  of  entrance  to  the  extent  of  about  eight  ounces.  Compression  of  the  femoral  was  instituted 
bv  the  patient,  and  when  I  reached  there  the  haemorrhage  had  ceased.  A  compress  of  dry  lint  was  placed  over  the  wound  an«l 
a  nurse  directed  to  watch  it.  At  1  A.  M.  slight  oozing  commenced  at  wound  of  exit,  and  at  4  A.  M.  it  gushed  out  in  a  consi;! 
erable  stream,  but  was  again  controlled  by  compression  of  the  femoral  artery.  At  this  time  about  four  ounces  were  lost,  and,  us 
no  bleeding  vessel  could  be  observed,  a  tourniquet  was  placed  over  the  femoral  artery,  but  not  tightened.  July  24th,  the  com 
presses  have  been  removed  from  day  to  day  and  the  wounds  dressed,  but  there  has  been  no  recurrence  of  haemorrhage.  Tin- 
patient  is  taking  tonics  and  generous  diet.  July  2(5th,  haemorrhage  has  just  recurred.  Compression  of  the  femoral  controls  ii. 
This  time  the* patient  lost  about  six  ounces.  He  was  etherized,  and  upon  thorough  examination  it  was  found  th.it  the  ball  h;id 
severed  the  popliteal  artery  and  also  wounded  the  posterior  portion  of  the  tibia  near  its  articular  surface.  Taking  into  consid 
eration  the  wound  of  the  bone  so  near  the  joint,  if  not  actually  involving  it,  together  with  the  destruction  of  the  soft  parts  along 
the  track  of  the  ball,  it  was  deemed  advisable  to  amputate  rather  than  ligate  the  femoral,  which  would  be  more  than  equivalent 
to  a  second  ligation  of  the  artery.  Amputation  of  the  thigh  at  its  lower  third  was  done  by  flaps  of  skin  and  circular  of  muscles. 
The  patient  being  quite  weak  was  ordered  brandy  and  beef  tea  every  half  hour.  July  27th,  slept  well  last  night,  pulse  120  and 
quite  nervous;  has  but  little  disposition  to  take  nourishment;  ordered  milk  punch,  iron,  and  quinine.  July  28th,  had  a  slight 
chill  last  evening;  pulse  125  this  A.  M.;  discharge  from  stump  somewhat  unhealthy;  syringed  it  out  with  acid  wash  (muriatic 
acid,  one-half  ounce  to  pint  of  water).  July  31st,  healthy  granulations  are  being  thrown  out.  The  acid  has  very  much  improved 
the  appearance  of  the  stump ;  general  condition  improving;  is  very  despondent.  August  5th,  pulse  120  and  feeble.  Has  trouble 
some  diarrhoea;  appetite  poor;  stump  discharges  quite  profusely.  Ordered  opiate  injections  after  each  evacuation,  and  a  wine- 
glassful  of  milk  punch  every  hour.  August  8th,  diarrhoea  still  obstinate  and  is  running  the  patient  down.  Ordered  Monsel's 
solution,  fifteen  drops  four  times  per  day.  Continued  injections  and  other  treatment.  August  10th,  diarrhoea  slightly  improved. 
August  15th,  patient  has  had  a  troublesome  hacking  cough  for  some  days;  skin  is  becoming  sallow.  Has  evidence  of  pyaemia, 
but  has  had  no  chills.  August  17th,  evidently  failing  fast;  raises  pneumonic  sputa;  countenance  anxious,  mind  wandering. 
Died  August  19,  18G3.  As  the  friends  wished  to  embalm  the  body  no  post-mortem  could  be  obtained."  Portions  of  the  femoral, 
popliteal,  anterior  and  posterior  tibial  arteries  and  popliteal  vein  constitute  Specimen  3963  of  the  Army  Medical  Museum,  and 
were  contributed  by  Dr.  Adams.  The  specimen  shows  a  large  well-organized  clot  near  the  orifice  of  the  posterior  tibial,  which 
is  severed  at  its  origin. 

In  the  cases  in  which  the  division  of  the  blood-vessel  is  followed  by  primary  haemor 
rhage  it  is  possible  that  some  foreign  body  may  be  thrust  into  the  open  lumen  of  the  artery 
which  will  prevent  retraction  while  insufficient  to  act  as  a  plug;  or  that  there  may  be 
paralysis  of  the  nerves  of  the  arterial  coats,  preventing  their  retraction : 

CASE  1097. — Major  W.  F.  Smith,  1st  Delaware,  received  a  shot  flesh  wound  of  the  right  thigh,  at  Hatcher's  Kun,  Vir 
ginia,  October  27,  1864.  Surgeon  A.  N.  Dougherty,  Medical  Director  Second  Army  Corps,  reported :  "Among  the  wounded 
I  noticed  Major  Smith  being  conveyed  on  a  stretcher  to  the  rear,  evidently,  from  his  ghastly  pallor,  severely  hurt,  and  probably 
suffering  much  from  loss  of  blood.  I  accompanied  him  as  far  as  the  ambulances,  where,  with  the  assistance  of  Surgeon  J.  M. 
McNulty,  U.  S.  V.,  and  Assistant  Surgeon  C.  Smart,  U.  S.  A.,  Medical  Inspector,  I  examined  the  wound  and  did  what  seemed 
necessary.  The  ball  (minie")  passed  through  the  right  thigh  behind  the  os  femoris,  a  little  below  the  middle,  severing  the  femoral 
artery  but  not  injuring  the  bone.  Haemorrhage  had  already  been  profuse,  but  was  partially  restrained  by  a  handkerchief  and  a 
leather  strap  which  some  one  had  applied.  On  consultation  it  was  thought  imperatively  necessary  to  cut  down  upon  and  tie  the 
vessel  in  the  wound,  which  I  accordingly  tied  with  the  assistance  above  mentioned  and  that  furnished  by  regimental  medical 
officers  in  compressing  the  artery  at  the  groin.  The  enlarging  of  the  wound  quickly  brought  the  upper  cut  end  into  view  and 
enabled  me  to  cast  a  ligature  around  it;  but  in  order  to  secure  the  lower  end  it  was  necessary  to  cut  across  the  sartorius  muscle. 
The  femoral  vein  also  required  tying.  There  was  still  considerable  haemorrhage  of  a  dark  venous  character,  which,  as  its  source 
could  not  be  brought  into  view,  it  was  judged  best  to  arrest  by  sponge  compresses,  the  lowest  one  dipped  in  solution  of  per 
sulphate  of  iron,  after  which  it  ceased  completely.  A  bandage  was  applied  and  he  was  sent  in  an  ambulance  to  the  Gurley  House, 
which  he  reached  without  molestation.  Up  to  this  time  (October  30)  there  has  been  no  return  of  the  haemorrhage.  The  pulse, 
which  was  scarcely  perceptible  at  the  wrist,  was  quite  good  yesterday.  The  leg  and  foot  are  pale  and  cold,  with  some  mottling 
about  the  instep,  and  sensibility  is  quite  wanting  below  the  calf.  I  directed  artificial  heat,  wrapping  in  flannel  and  cotton  bat 
ting,  frictions,  etc."  An  entry  on  the  register  of  the  hospital  shows  that  amputation  in  the  middle  third  of  the  thigh  was  after 
wards  performed,  and  that  the  patient  died  November  6,  1864. 

In  the  following  case  the  complete  division  of  the  femoral  artery  was  followed  by 
severe  primary  hemorrhage,  but  the  bleeding  ceased  spontaneously: 

CASE  1098. — Private  E.  H.  Clarendon,  Co.  I,  26th  Massachusetts,  aged  22  years,  was  wounded  in  action  at  Opequan 
Creek,  September  19,  1864,  by  a  mini6  ball,  which  passed  through  the  fleshy  part  of  the  left  thigh  and  slightly  wounded  the  right 
thigh.  The  wounded  man  was  brought  to  hospital  at  Winchester  on  September  22d.  Severe  haemorrhage  occurred  at  the  time 
of  receiving  the  wound,  which  ceased  spontaneously.  About  eight  days  after  the  date  of  the  injury  serious  haemorrhage  took 
place,  wholly  venous  in  character.  After  that  time  there  was  no  recurrence,  but  a  constant  and  free  discharge  of  dark  bloody 
|>us.  The  patient  became  anaemic,  feverish,  and  at  times  delirious,  until  he  sank  at  length  with  evident  manifestations  of  pyaemin. 
He  died  October  17,  1864.  The  post-mortem  examination  disclosed  a  large  dissecting  abscess  beneath  the  fascia  and  among  the 
muscles  of  the  anterior  portion  of  the  thigh.  The  missile  had  entered  about  the  junction  of  the  upper  and  middle  third  of  the 
Ill — 95 


754 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


limb,  severing  the  femoral  artery  and  wounding  the  femoral  vein.  Both  the  proximal  and  distal  portions  of  the  artery  were 
filled  with  firm  coagnla.  and  for  about  half  an  inch  from  the  torn  extremity  of  each  there  was  a  hard  cartilaginous  formation 
surrounding  the  vessel,  which  was  indeed  nearly  osseous  in  character.  The  crural  nerve  was  inflamed  in  the  track  of  the  ball, 
but  not  otherwise  injured.  The  femoral  vein  was  filled  with  a  very  thick  pus,  reaching  from  the  wound  to  a  point  sonic  two 
inches  above  Poupart's  ligament.  Above  this  and  to  within  about  an  inch  of  its  junction  with  the  internal  iliac  the  vein  w;is 
filled  with  a  firm  coagulum  of  lymph.  The  distal  portion  of  the  vein  contained  very  little  pus.  Purulent  or  lymphatic  deposits 
were  found  on  the  peritoneum,  covering  the  hepatic  vessels  ;  also  on  the  anterior  edge  of  the  right  lobe  of  the  liver.  Purulent 
deposits  were  also  found  in  the  spleen,  and  a  small  abscess  existed  at  its  superior  edge  containing  bloody  pus.  The  treatment 
of  the  patient  had  been  of  a  tonic  and  stimulating  character.  The  history  of  the  case,  together  with  portions  of  the  injured  femoral 
artery  and  vein,  was  contributed  to  the  Museum  by  Surgeon  C.  H.  Andrus,  176th  New  York.  A  wet  preparation  of  the  vessels 
constitutes  Specimen.  3794  of  the  Surgical  Section. 

Cases  of  partial  division  of  vessels  more  frequently  came  under 
the  observation  of  the  surgeon.  In  these  cases  it 
was  usually  found  that  only  a  portion  of  the  calibre 
of  the  vessel  was  carried  away  or  that  perforation 
of  the  vessel  had  taken  place.  Under  such  condi 
tions  the  retraction  of  the  vessel  is  rendered  impos 
sible,  and  haemorrhage  ensues  proportionately  to  the 
size  of  the  artery  and  of  the  wound.  A  case  of  shot 
perforation  of  the  carotid  has  been  cited  on  page 
751,  ante  (case  of  Kimball) ;  and  a  perforation  of 
the  right  primitive  iliac  by  a  pistol  ball  is  shown 
in  FIG.  418.  The  injured  man  died  in  twelve  min 
utes.  A  partial  division  of  the  femoral  vein  is 
shown  in  FIG.  419.  Profuse  haemorrhage  followed 
immediately  after  the  injury,  which  was  with  diffi 
culty  arrested  by  compression.  Details  of  this  case 
are  given  on  page  304  of  the  Second  Surgical  Vol-  FIG.  419.— shot 

/r\  OfO\          Tr  j.1  •      1  il'        1  tion  of  right  femoral  vein. 

ume  (L/ASE  obo).      It  the  artery  is  large  the  hsemor-    spec.  2094. 
rhage  will  be  profuse,  and  attended  with  speedily  fatal  results  unless  help  is  near  at  hand, 
as  in  the  case  of  Assistant  Surgeon  R.  S.  Vickery,  detailed  on  page  16,  ante.     The  follow 
ing  additional  data,  furnished  by  Dr.  Vickery  in  a  letter  to  the  editor,  dated  April  5,  1882, 
will  be  found  of  interest : 

CASE  25  (Cont.  from  p.  16). — "A  partially  spent  rifle  bullet  struck  me  on  the  front  of  the  left  thigh.  Profuse  luemorrhage 
ensued  and  I  fell  fainting.  Recovering  consciousness  I  found  myself  lying  on  a  stretcher,  with  the  artery  secured  by  a  tourniquet. 
It  must  have  been  done  promptly,  as  several  surgeons  of  the  brigade  and  the  hospital  steward  of  the  regiment  were  within  a  few 
feet  of  me  when  I  fell,  and  but  for  that  prompt  and  timely  assistance  the  haemorrhage  would  probably  have  been  fatal.  1  was 
then  carried  by  stretcher  and  ambulance  to  the  division  hospital,  about  three  miles  to  the  rear.  There,  as  the  operating  surgeons 
were  all  very  busy,  I  was  placed  in  charge  of  one  of  the  assistants,  to  watch  that  the  haemorrhage  was  kept  in  control,  until  the 
afternoon,  when,  having  placed  me  under  the  influence  of  chloroform,  Surgeon  W.  B.  Fox,  of  the  8th  Michigan  Volunteers, 
cut  down  in  the  opening,  enlarging  it,  and  ligated  the  femoral  artery  above  and  below  the  injured  part.  The  wound,  fortunately, 
was  well  situated  for  ligation  of  the  artery,  being  about  four  inches  below  Poupart's  ligament  and  about  an  inch  below  the  pro- 
funda,  the  ball  entering  in  front,  passing  back  close  to  the  bone  but  not  injuring  it,  and  lodging  in  the  muscles  of  the  posterior 
part  of  the  thigh  about  an  inch  below  the  surface,  from  which  it  was  extracted  at  the  time.  The  ligatures  came  away  on  the 
thirteenth  day.  On  the. eighteenth  day,  while  at  stool,  a  secondary  haemorrhage  came  on  to  the  amount  of  eight  ounces.  It 
ceased  with  the  aid  of  compression  and  quiet,  and  there  was  no  return  of  it.  The  wound  was  completely  healed  by  November 
:<<!.  On  the  fifteenth  day  I  was  moved  from  field  hospital  to  City  Point  by  ambulance,  and  eight  days  afterwards  placed  on 
board  steamer  and  carried  to  a  northern  hospital.  Some  branch  of  the  anterior  crural  nerve,  probably  the  internal  saphe- 
nous,  must  have  been  injured  by  the  ball,  as  I  suffered  severe  pain  in  the  wound  and  along  the  leg  for  some  days.  This  caused 
a  want  of  sensation  of  the  skin  of  the  inner  side  of  the  leg  from  the  knee  down,  which  was  greatest  in  the  foot,  and  from  the 
deficient  innervation  and  bad  nutrition  of  the  skin  gave  me  much  trouble  for  years,  and  though  it  has  now  much  improved  it 
is  the  chief  cause  of  the  lameness  which  still  continues.  On  March  11,  1865,  seeing  that  I  would  not  be  able  to  resume  my 
duties,  I  was  honorably  mustered  out  of  the  service  at  my  own  request,  and  returned  to  Ireland  to  visit  friends  there.  When 
the  wound  healed  the  muscles  of  the  knee  remained  contracted,  so  that  when  standing  erect  I  could  only  touch  the  toes  to  the 
ground,  and  had  to  use  crutches.  As  this  condition  did  not  improve  by  the  modes  of  extension  employed,  on  June  15,  1865, 


FIG.  418.— Shot   perforation  of 
right  primitive  iliac.     Spec.  6336. 


CHAP,  xil.j  EFFECTS    OF    MISSILES    OIS*    BLOOD-VESSELS. 

Drs.  Daniel  Donovan  and  David  Hadden  divided  the  hamstring  tendons  of  the  leg  subcutaneoualy  and  forcibly  extended  the 
limb.  In  a  few  months  I  was  able  to  get  about  without  crutches.  The  leg  now  remains  weak,  and  hats  not  regained  its  former 
size  or  strength ;  but  it  has  never,  during  my  service  in  the  army,  kept  me  a  day  off  duty." 

Ill  the  case  of  Booth,  7th  Indiana  Cavalry  (CASE  21,  page  14,  ante),  the  femoral  artery 
was  perforated.  Copious  haemorrhage  ensued  at  once,  which  was  arrested  by  the  applica 
tion  of  a  tourniquet.  Haemorrhage  recurred  on  the  sixth  day,  which  was  again  arrested  by 
pressure;  the  wound  became  unhealthy,  and  the  patient  died  on  the  tenth  day  after  the 
injury.  Prompt  operative  interference  would  undoubtedly  have  afforded  a  chance  of  life. 

Sometimes  haemorrhage  will  continue  though  it  may  be  retarded  by  the  formation  of  a 
coagulum  in  the  track  of  the  wound,  but  the  tendency  is  to  form  a,  diffuse  traumatic  aneurism, 
which,  untreated,  will  exhaust  the  patient  by  frequently  recurring  haemorrhage.  In  the  case 
of  Melley,  2d  West  Virginia  (CASE  13,  page  555,Jtf,rst  Surgical  Volume),  the  axillary  had 
been  almost  entirely  divided;  an  enormous  tumor  of  coagulum  formed  in  the  axilla.  Hem 
orrhages  recurring,  the  axillary  was  ligated;  but  during  the  operation  the  subclavian  vein 
was  accidently  opened  and  death  ensued  in  less  than  ten  minutes. 

The  greater  number  of  cases  of  injury  to  blood-vessels  were  caused  by  contusion. 
Missiles  with  low  velocities,  or  those  whose  force  is  partially  expended  upon  tissues  previous 
to  striking  the  artery,  seldom  divide  or  penetrate,  but  contuse  the  arterial  coats,  destroying 
or  impairing  their  vitality,  and  establishing  inflammatory  action  which  results  in  the  removal 
of  a  slough  at  definite  periods,  accompanied  by  profuse  secondary  haemorrhage.  In  some 
cases  the  resulting  inflammation  or  the  injury  to  the  vasa-vasorum  effects  a  partial  or  com 
plete  occlusion  of  the  arterial  tube ;  if  the  collateral  circulation  becomes  well  established 
recovery  may  take  place ;  but  fatal  gangrene  of  the  extremity,  deprived  of  its  blood  supply, 
very  commonly  supervenes. 

CASE  1099. — Private  Henry  Knoble,  Co.  D,  149th  New  York,  was  wounded  at  Ringgold,  November  27, 1863.  Assistant 
Surgeon  Norman  Teal,  88th  Indiana,  reported:  ''Wounded  in  superior  regions  of  both  thighs  and  posterior  part  of  neck;  mini6 
ball  entered  left  thigh  on  outer  anterior  aspect  six  inches  below  superior  spinous  process  of  ilium,  dipped  beneath  the  integu 
ment  and  deep  fascia,  and  emerged  on  inner  surface  of  thigh  four  inches  below  pubis;  the  wound  of  the  right  thigh  was  sup 
posed  to  have  been  made  by  the  same  ball  after  passing  through  the  left.  I  saw  the  case  for  the  first  time  on  December  11, 18(53; 
removed  the  ball  from  the  wound  of  the  neck.  On  examination  found  the  left  foot  in  a  state  of  humid  gangrene,  with  aline  of  demar 
cation  encircling  the  ankle  at  the  malleoli.  On  inquiry  learned  that  this  soldier  had  been  brought  hither  from  the  battle-field  after 
suffering  considerable  exposure  to  cold  on  the  battle  ground  and  during  transition ;  that  the  foot  was  cold  and  insensible  at  the  time 
of  the  patient's  admission  into  hospital ;  that  he  arrived  here  hungry  and  cold  on  the  morning  of  November  28th,  the  next  day  after 
the  injury;  that  he  had  diarrhoea  at  the  time  the  wounds  were  received,  and  that  he  had  suffered  from  this  disease  more  or  less 
during  his  sojourn  in  hospital.  Know  nothing  of  the  treatment  previous  to  December  llth.  After  this  time  opiates  were  exhib 
ited  to  control  the  bowels  and  tonics  and  stimulants  to  invigorate  and  support  the  system.  Amputation  of  the  leg  at  the  junction 
of  the  middle  with  the  lower  third  was  performed  on  December  14th;  artery  controlled  by  thumb  alone.  Very  little  haemor 
rhage  ;  parts  at  point  of  section  flabby.  Treatment  mentioned  above  continued ;  alcohol,  full  strength,  applied  to  stump  freely  from 
the  first ;  but  little  inflammation  occurred,  and  but  feeble  efforts  at  reparation  were  made.  Granulation  sparse  and  flaccid  through 
out  ;  appetite  pretty  good.  My  connection  with  this  case  ceased  about  the  last  of  December.  Dr.  Kilbotirne  then  assumed  charge. 
Death  took  place  January  14, 18(i4,  on  the  48th  day  after  the  injury  and  the  31st  after  amputation.  Autopsy :  Wound  in  left  thigh 
closed;  track  of  ball  occupied  by  an  abscess  containing  thin  fetid  pus.  The  course  of  the  ball  appears  to  have  been  posterior  to 
the  artery,  impinging  upon  its  sheath,  for  the  wall  of  the  artery  at  this  point  is  thickened,  of  a  brownish  color,  and  its  calibre 
diminished  one-half.  A  firm  coagulum  fills  the  sheath  for  one  inch  below  the  track  of  the  ball.  Bones  protruded  between  the 
'  flaps,  which  were  lined  with  an  ash-gray  slough.  The  elaborate  post-mortem  examination  in  this  case  is  omitted  as  unnecessary 
to  the  description  of  the  specimen,  illustrating  as  it  does  death  by  pyaemia.  The  gangrene  in  this  case  was  clearly  due  to  the 
diminution  of  the  calibre  of  the  artery  and  to  the  cold  and  exposure  to  which  the  man  was  subjected ;  neither  cause  sufficient  of 
itself  to  have  produced  the  result."  Specimen  2114,  Section  I,  Army  Medical  Museum,  consists  of  a  wet  preparation  of  the  upper 
portion  of  the  left  femoral  artery,  with  the  walls  much  thickened  by  a  coagulum  in  the  sheath.  It  was  contributed  by  Dr.  Teal.1 

Not  unfrequently  spiculse  of  bone  driven  before  a  missile  puncture  blood-vessels,  and 
though  jdiey  may  not  be  productive  of  instant  trouble,  they  set  up  inflammatory  action, 
resulting  in  ulceration  and  sloughing  attended  with  secondary  haemorrhage. 

An  example  of  division  of  the  intercostal  artery  by  the  fractured  end  of  a  rib  has  been 

1  An  abstract  of  this  case  was  published  by  Dr.  JOHN  A.  LlUELL  in  U.  S.  Sanitary  Commission  Memoirs,  New  York,  1870,  Surgical  Vol.  I,  p.  27, 


756  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

cited  on  page  551  (Case  of  Butterfield)  of  the  First  Surgical  Volume,  and  an  instance  of 
rupture  of  the  popliteal  by  a  fragment  of  bone  is  here  adduced : 

CASE  1100. — Private  Jonathan  Wining,  Co.  A,  125th  Ohio,  aged  25  years,  was  wounded  at  Kesaca,  Georgia,  May  14, 
1864.  He  was  at  once  admitted  into  the  field  hospital  of  the  2d  division,  Fourth  Corps,  where  the  injury  was  recorded  as  a 
flesh  wound  of  the  left  thigh.  He  was  subsequently  treated  in  hospital  at  Nashville,  and  on  August  25,  1864,  was  transferred 
to  "Joe  Holt"  Hospital,  Jetfersonville,  Indiana.  Surgeon  H.  P.  Stearns,  U.  S.  V.,  reported:  "Compound  fracture  of  lower 
third  of  femur  by  conoidal  ball.  October  12th  :  Patient  enfeebled  and  anaemic  by  constant  discharge  of  pus.  Pulse  frequent  and 
soft,  tongue  moist  and  clean,  appetite  good,  bowels  regular.  Femur  much  shattered;  ends  overlapped  and  partially  united. 
Soft  parts  destroyed  by  gangrene,  exposing  blood-vessels;  rupture  of  popliteal  artery  by  a  fragment  of  bone.  Chloroform  admin 
istered  and  antero-posterior  flap  amputation  of  the  middle  third  of  the  thigh  performed  by  Dr.  Stearns.  The  flaps  subsequently 
sloughed,  exposing  an  inch  of  the  femur ;  repeated  haemorrhages  also  occurred.  Quinine,  opium,  and  whiskey  administered  and 
cold-water  dressings  applied.  December  17th  :  Every  indication  of  recovery ;  flaps  nearly  healed.  The  man  is  in  fine  health 
and  spirits;  all  medicines  have  been  suspended  and  nourishing  diet  alone  depended  upon."  Wining  was  transferred  to  Cleve 
land,  Ohio,  March  24,  1865,  and  discharged  from  service  May  20,  1865.  He  is  a  pensioner. 

Wounds  closely  resembling  incised  wounds  frequently  are  caused  by  sharp-edged  shell 
fragments  flying  with  great  velocity;  but  a  certain  amount  of  contusion  and  laceration, 
always  present,  separates  them  from  the  class  of  purely  incised  wounds. 

Missiles  and  foreign  bodies  lodging  sometimes  act  as  plugs,  restraining  for  a  time 
hemorrhage  from  a  wounded  blood-vessel.  An  interesting  case  of  occlusion  of  the  common 
carotid  by  an  impacted  ball  is  related  by  Surgeon  John  A.  Lidell:1 

CASE  1101. — "At  the  Washington  Infirmary,  August  15, 1861,  through  the  kindness  of  Dr.  J.  W.  S.  Gouley,  then  attached 
to  the  medical  service  of  the  U.  S.  Army,  the  author  had  an  opportunity  to  examine  a  very  interesting  preparation  of  the  left 
common  carotid  artery  and  the  parts  adjacent  to  it,  which  had  been  obtained  on  the  previous  day  at  the  autopsy  of  u  soldier 
who  had  died  from  secondary  haemorrhage  following  a  gunshot  wound  of  the  left  side  of  the  face  and  neck.  The  ball,  which, 
by  the  way,  was  nearly  spent,  struck  the  lower  jaw  well  forward  and  was  deflected  downward,  backward,  and  a  little  outward 
in  such  a  manner  as  to  pass  obliquely  through  the  left  common  carotid  artery,  and  to  lodge  in  the  tunics  and  sheath  of  that  ves 
sel  underneath  the  omo-hyoid  muscle,  pressing  somewhat  upon  the  par  vagum,  and  occluding  completely  the  proximal  end  of  the 
divided  artery.  It  was  a  round  ball.  The  haemorrhage  occurred  fourteen  days  after  the  wound  was  inflicted  and  two  or  three 
days  after  his  admission  into  the  infirmary.  It  came  on  suddenly,  without  warning,  and  was  very  profuse.  The  patient  lost 
more  than  a  quart  of  blood,  which  flowed  in  a  great  stream  from  his  mouth.  On  the  supposition  that  the  haemorrhage  proceeded 
from  a  lesion  of  some  of  the  carotid  vessels,  an  effort  was  made  to  tie  the  common  carotid  above  the  omo-hyoid  muscle,  but  it 
had  to  be  abandoned  on  account  of  the  great  profuseness  of  a  flow  of  blood  which  took  place  in  the  wound  of  operation,  and 
did  not  permit  the  search  to  be  continued  in  order  to  secure  the  bleeding  vessel  by  ligature  at  the  place  of  injury.  It  was  believed 
by  all  the  surgeons  present  that  the  patient  was  now  so  much  exhausted  by  the  loss  of  blood  as  to  make  it  useless  to  attempt  to 
tie  the  common  carotid  artery  below  the  omo-hyoid  muscle,  and  the  next  morning  he  died.  Moreover,  the  source  of  the  haem 
orrhage  was  very  obscure  until  it  was  revealed  at  the  autopsy.  It  was  then  found  that  the  divided  carotid  artery  was  still  occluded 
on  the  side  of  the  wound  toward  the  heart  (proximal)  by  the  impacted  ball ;  that  a  false  aneurism  as  large  as  a  filbert  and  elongated 
in  shape  had  been  formed  at  the  distal  extremity  and  on  the  inner  side  of  the  wounded  artery  just  above  the  omo-hyoid  muscle  ;  that 
the  hcemorrhage  occurred  from  rupture  or  spontaneous  opening  of  the  sac  of  this  traumatic  aneurism;  that  the  hemorrhage  was  not 
direct,  but  recurrent  in  character;  and  that  it  could  not  have  been  arrested  without  the  application  of  a  ligature  to  the  vessel  on  the 
distal  side  of  the  wound  in  it.  The  ligation  of  the  common  carotid  below  the  omo-hyoid  muscle  would,  therefore,  not  have  done 
any  good,  unless  the  vessel  had  been  tied  at  the  same  time  at  some  point  beyond  the  spot  where  it  was  wounded  and  where  the 
traumatic  aneurism  was  situated.  A  remarkable  and,  so  far  as  the  writer  knows,  an  unique  feature  of  this  case  was,  that  the  trau 
matic  aneurism  was  formed  in  connection  with  the  distal  end  of  the  divided  common  carotid  artery,  the  occurrence  of  which 
appears  to  have  been  favored  by  the  free  anastomosis  which  exists  between  the  terminal  branches  of  both  the  external  and  inter 
nal  carotid  arteries  of  the  two  sides  of  the  body."  The  above  has  been  identified  as  the  case  of  Corporal  Jonathan  Calef,  2d  New 
Hampshire.  An  abstract  of  this  case  has  been  published  by  Medical  Cadet  L.  H.  Bodman,  U.  S.  A.,2  who  states  that  the  man 
was  injured  by  a  sentry,  August  7,  1861.  There  was  considerable  haemorrhage  at  the  time  of  the  accident,  but  when  admitted 
to  the  hospital  a  few  hours  afterwards  he  was  in  a  comfortable  condition,  bleeding  having  entirely  ceased.  No  search  was  made 
for  the  ball,  but  the  edges  of  the  fractured  bone  were  retained  in  apposition  by  means  of  a  suitable  bandage,  and  quiet  enjoined. 
Diet  consisted  of  nutritious  soups  and  beef  tea.  The  patient  continued  in  good  condition  until  the  afternoon  of  the  13th,  nearly 
a  week  after  the  reception  of  the  injury,  when,  lying  quietly  in  bed,  he  was  seized  with  violent  arterial  haemorrhage.  The  blood 
poured  from  his  mouth,  welling  up  with  each  pulsation  of  the  heart.  Compression  over  the  carotid  was  instantly  resorted  to, 
but  a  quart  of  blood  had  escaped  before  the  haemorrhage  was  controlled.  The  patient  being  now  very  weak,  stimulants  were 
administered  and  directed  to  be  given  frequently  through  the  night.  Continuous  compression  was  kept  up  over  the  artery.  Bleed 
ing  recurred  twice  during  the  night  and  was  controlled  with  great  difficulty.  He  sank  rapidly,  and  died  on  the  morning  of  August  1 4 . 
1861,  by  syncope,  in  another  and  terrible  attack  of  haemorrhage. 

CASE  1102. — Private  John  Jones,  187th  New  York,  aged  27  years,  was  admitted  into  Jarvis  Hospital,  Baltimore,  Feb 
ruary  11,  1865,  with  a  gunshot  wound  of  the  mouth  and  throat,  received  at  Hatcher's  Run,  Virginia,  on  February  6th.  The 

1  Surgical  Memoirs  of  the  War  of  the  Rebellion,  collected  and  published  by  the  U.  S.  San.  Comm..  New  York,  1870,  Surgical  Volume  I,  page  172. 
5  BOPMAM  (L.  H.),  Gtmshot  Wound  of  Carotid  Artery — Secondary  Hemorrhage,  in  American  Medical  Times,  New  York,  1862,  Vol.  IV,  p.  67. 


LODGEMENT    OF    MISSILES.  757 

patient,  at  the  time  of  admission  into  the  hospital,  was  able  to  walk  about,  and  a  casual  observer  would  have  thought  him  to  be 
in  nowise  a  dangerous  condition.  The  musket  ball  had  entered  directly  the  mouth  and  in  its  progress  carried  away  the  upper 
and  lower  incisors  and  canine  teeth,  and  passing  backward  lodged,  but  where  was  not  discovered  until  the  post-mortem  revealed  the 
fact.  The  index  finger  inserted  into  the  mouth  found  that  it  had  wounded  the  right  side  of  the  tongue,  and  from  thence  the  track 
ran  to  the  right  side  of  the  neck  and  backward  through  the  pillars  of  the  fauces  and  then  could  not  be  further  traced.  The  patient 
himself  thought  that  he  had  swallowed  the  ball.  The  only  inconvenience  he  suffered  was  in  either  talking  or  swallowing,  and 
when  resting  on  his  back ;  and  being  so  apparently  comfortable  it  was  not  thought  best  to  trouble  him,  but  orders  were  given  to  the 
nurses  to  watch  him  closely.  An  examination  externally  revealed  no  signs  of  injury,  and  the  only  symptom  there  marked  was 
tenderness  over  the  upper  vertebra  and  general  soreness  of  the  muscles  of  the  neck.  He  had  not  the  least  sign  of  paralysis,  and 
the  day  previous  to  his  death  he  was  walking  about  his  ward,  and  even  requested  his  medical  attendant  to  extract  for  him  a  tooth 
which  was  almost  detached  by  the  ball  and  was  giving  him  some  annoyance.  On  February  12th  (six  days  after  the  injury  was 
received),  at  5.30  P.  M.,  a  most  furious  arterial  secondary  haemorrhage  occurred  through  and  out  of  his  mouth.  Before  assist 
ance  could  reach  him  (although  close  at  hand)  he  had  bled  so  copiously  as  to  be  in  a  state  of  syncope,  and  while  bleeding  he  had 
two  convulsions,  one  of  which  was  quite  violent.  During  the  active  haemorrhage  pressure  was  made  over  the  common  carotids, 
yet  it  did  not  seem  to  control  it  to  any  great  extent,  and  notwithstanding  various  expedients  were  employed  it  only  stopped 
when  syncope  came  on.  It  is  proper  to  state,  also,  in  this  connection,  that  pressure  from  within  by  the  fingers  did  not  stay  the 
haemorrhage,  but  to  his  detriment  increased  the  suffering  of  the  patient.  The  exhausted  condition  of  the  patient  at  this  time 
rendered  it  inexpedient  to  resort  to  any  operative  interference.  The  haemorrhage  having  entirely  ceased  through  this  effort  of 
nature,  it  was  ordered  that  diffusible  stimulants  be  freely  given  in  such  quantities  as  the  stomach  could  bear,  and  that  ice  should 
be  constantly  kept  applied  to  the  parts,  and  under  this  treatment  he  slowly  rallied  and  rested  quietly  until  5  o'clock  on  the  fol 
lowing  morning,  when  a  gush  of  blood  took  place  from  the  patient's  mouth  and  he  expired.  An  autopsy  was  made  twenty-four 
hours  after  death,  and  the  track  of  the  wound  was  thoroughly  explored,  after  both  common  carotids  had  been  injected  with  a  suitable 
material,  which,  on  cooling,  hardened  and  distended  the  principal  arteries  of  the  head  and  neck.  On  the  plan  of  operating  recom 
mended  by  Mr.  Guthrie  on  the  living  subject,  an  angular  flap  of  the  integuments  was  made  corresponding  with  the  ramus  and 
body  of  the  lower  maxillary  bone,  and  this  integument  was  turned  back,  and  by  the  saw  the  bone  was  divided  near  the  first 
lower  molar  tooth  and  the  upper  fragment  raised.  By  a  little  dissection  the  wound  was  fully  exposed  and  the  first  vessel 
wounded  was  ascertained  to  have  been  the  right  internal  carotid,  which  was  converted  into  a  traumatic  aneurism  for  near  its 
entire  length,  and  its  position  was  occupied  by  an  extensive  clot  of  blood.  On  introducing  the  finger  into  the  track  of  the  wound 
at  this  point  and  carrying  it  almost  directly  backward  and  inward,  the  ball  was  found  loosely  resting  against  the  transverse 
process  of  the  first  cervical  vertebra,  and  was  easily  extracted  without  the  aid  of  forceps.  By  further  careful  exploration  of  the 
parts  adjacent  to  where  the  ball  was  arrested  in  its  progress  it  was  ascertained  that  the  right  vertebral  artery  had  been  exten 
sively  lacerated  at  the  point  where  it  passes  through  the  foramen  of  the  transverse  process  of  the  atlas,  and  that  the  ball  resting 
there  had  probably  acted  as  a  plug  in  preventing  haemorrhage  from  that  artery,  and  in  proof  of  this  assertion  no  clots  of  blood 
were  discovered  here.  The  right  transverse  process  of  the  atlas  was  completely  fractured  and  comminuted,  and  the  fragments 
were  readily  removed  en  masse  simply  with  the  fingers  and  without  any  force.  This  fracturing  of  this  process  of  the  atlas  was, 
on  further  investigation,  found  to  extend  through  the  ring  down  to  the  spinal  cord,  yet  the  fragments  were  not  driven  in  upon, 
or  were  they  apparently  causing  any  pressure  on  the  cord.  On  examining  the  brain,  heart,  and  lungs  they  were  found  healthy 
and  in  a  normal  condition,  but  were  exsanguinated.  Assistant  Surgeon  D.  C  Peters,  U.  S.  A.,1  who  transmitted  the  above  report, 
remarks  :  "It  is  somewhat  remarkable  that  this  soldier  was  not  killed  outright,  or  having  lived  so  long  he  should  not  have  suf 
fered  from  paralysis  in  some  form,  and,  in  fine,  that  his  terrible  wound  should  have  given  him  so  little  trouble  up  to  the  time  of 
his  first  haemorrhage.  In  my  humble  opinion  operative  interference  at  any  stage  of  the  treatment  would  not  have  saved  nor  even 
prolonged  his  life." 

In  many  cases  where  both  artery  and  vein  are  divided  the  injury  of  the  vein  assumes 
less  practical  importance  at  the  time  from  the  more  serious  lesion  of  the  artery;  but  cases 
of  secondary  haemorrhage  from  veins  which  have  been  contused  and  subsequently  slough 
are  found  to  be  not  infrequent,  as  will  be  seen  hereafter. 

LODGEMENT  OF  MISSILES  AND  PRO jECTiLEs. — Cases  of  lodgement  of  missiles,  projectiles,  and 
foreign  bodies  in  the  persons  of  the  wounded  were  of  extremely  frequent  occurrence  during 
the  late  war.  Although  it  is  not  possible  to  give  with  any  accuracy  the  frequency  of  such 
lodgements,  it  can  be  confidently  stated  that  the  percentage  was  very  large. 

Round  balls  are  more  prone  to  lodge  than  those  of  a  conoidal  form,  as  would  naturally  be 
inferred  from  the  rapidity  with  which  the  former  lose  their  initial  velocity  and  the  resistance 
offered  to  their  passage  through  the  tissues  of  the  body.  Conoidal  balls  at  ordinary  range 
preserve  sufficient  force  to  perforate  the  body;  but  at  long  range,  or  with  velocity  diminished 
by  contact  with  intervening  objects  before  reaching  the  body,  or  when  the  posture  is  such 
as  to  compel  a  long  course  through  the  tissues,  lodgement  very  commonly  occurs.  As  a 
general  rule  the  lodgement  of  conoidal  missiles  is  deeper  than  that  of  round  balls. 

1  An  abstract  of  this  case  was  also  published  in  the  A  merican  Journal  of  Medical  Sciences,  1805,  Vol.  XLIX,  p.  373. 


758  WOUNDS    AND    COMPLICATIONS.  [CHAP.  XII. 

Instances  of  the  lodgement  of  the  larger  class  of  projectiles,  as  solid  cannon  halls, 
grape-shot,  and  fragments  of  exploded  shell,  have  been  cited  on  pages  240'  of  the  Second 
Surgical  Volume,  on  page  746  (CASK  1040)  of  the  present  volume,  and  elsewhere. 

The  collection  of  the  Army  Medical  Museum  furnishes  many  specimens,  not  only  of 
missiles  and  projectiles  proper  removed  from  the  persons  of  soldiers,  but  also  of  foreign 
bodies,  as  buttons,  coins,  pieces  of  pocket-knives,  shreds  of  clothing,  portions  of  the  accou 
trements  of  the  soldier,  and  fragments  from  objects  torn  off  by  a  missile  in  its  course,  as 
iron  wire  from  the  bail  of  a  tin  bucket,  a  portion  of  a  ramrod,  a  tompion  nearly  entire,  etc. 
Not  infrequently  pieces  of  bone  or  teeth  from  a  wounded  comrade  driven  before  a  missile 
became  themselves  wounding  missiles.  Splinters  of  wood  and  iron,  stones,  and  debris  from 
artillery  caissons  and  carriages,  from  breastworks  and  defenses,  acted  in  a  similar  manner. 
All  parts  of  the  body  share  the  liability  to  lodgement. 

The  direct  effects  of  lodgement  are  those  common  to  the  presence  of  foreign  bodies 
generally  in  the  tissues  of  the  human  structure;  they  become  the  centres  and  sources  of 
irritation,  liable  to  be  followed  by  symptoms  of  every  degree  of  severity  in  nature's  effort  to 
rid  herself  of  the  offending  matter.  These  symptoms  largely  depend  upon  the  size,  nature, 
and  form  of  the  intruding  body;  also  upon  the  region  of  the  body  involved. 

The  most  serious  results  follow  the  lodgement  of  missiles  and  foreign  bodies  in  joints 
and  cavities  of  the  body,  or  in  organs  necessary  to  life;  even  small  missiles,  with  qualities 
the  least  irritating,  may  be  the  cause  of  great  mischief  by  the  production  of  tetanus  and 
haemorrhage,  when  lodged  where  they  may  cause  pressure  upon  nerves  or  blood-vessels. 

Passing  from  the  more  immediate  or  primary  effects  of  irritation  and  inflammation 
resulting  from  the  lodgement  of  foreign  bodies,  we  find  that  the  usual  tendency  of  their 

o  o  o  */ 

continued  presence  is  to  prevent  or  retard  the  course  of  healing.  Cicatrization  is  slow  and 
liable  to  be  interfered  with  by  any  aggravation  of  the  primary  irritation ;  the  wound  takes 
on  a  condition  of  chronic  inflammation,  sinuses  form  with  purulent  discharges,  sapping  and 
undermining  the  strength  and  vigor  of  the  patient,  opening  the  way  for  the  invasion  of  any 
of  the  surgical  complications  which  may  be  near  at  hand.  Especially  does  this  seem  to  be 
true  of  substances  of  organic  nature,  as  shreds  of  wool  or  cotton,  or  splinters  of  wood.  Until 
such  substances  are  removed  by  nature  or  art  the  progress  of  the  case  toward  health  is 
usually  entirely  held  in  abeyance.  Foreign  bodies  of  a  metallic  nature,  particularly  those 
with  smooth  surfaces,  seern  to  act  more  kindly;  they  frequently  permit  the  closure  of  the 
wound;  but  if  their  location  is  subject  to  frequent  movements  the  wound  is  liable  to  reopen; 
this  process  may  be  repeated  until  the  offending  body  is  removed  or  discharged. 

In  many  cases  of  lodged  missiles  the  tendency  to  move  or  change  place  is  observed  ; 
slowly  and  gradually  the  substance  will  work  to  the  surface  of  the  body,  where  it  will  often 
form  an  abscess  and  be  discharged,  or  it  may  tend  toward  the  internal  surfaces  of  the  great 
cavities,  where  its  presence  may  be  productive  of  great  harm  ;  or,  on  the  other  hand,  it 
may  be  harmlessly  ejected  from  the  body.  Thus  balls  lodged  in  or  about  the  abdominal 
region  and  of  which  the  exact  position  had  not  been  ascertained  have  finally  been  passed 
by  stool  per  via*  naturales.  Scraps  of  iron  and  lead  have  been  known  to  work  their  way 
through  the  coats  of  the  bladder,  where  they  became  the  nuclei  of  vesical  calculi  which  were 
subsequently  removed  by  lithotomy.  The  collection  of  the  Army  Medical  Museum  contains 
several  specimens  of  this  nature  ;  also  of  portions  of  bullets  and  shell  fragments  which  have 
been  similarly  lodged  in  the  bladder  and  removed  by  operation.  Cases  of  this  nature  have 
been  recorded  on  pages  269—276  of  the  8cc<>n<l  ftu.ryical  Volume.  The  Museum  collection 


CHAP,  xii.]  PRIMARY    SYMPTOMS    OF    SHOT    WOUNDS. 

also  contains  missiles  which  had  for  years  lodged  within  the  cranial  bones.  The  least 
harmful  effects  of  lodgement  are  seen  in  the  cases  of  balls  lodged  in  the  muscular  or  cellu 
lar  tissues  of  the  body  and  in  regions  of  little  vital  importance.  Musket  balls  have  remained, 
encysted  for  years,  causing  but  little  trouble  or  inconvenience.  At  the  Soldiers'  Home,  near 
Washington,  it  is  not  uncommon  to  find  old  soldiers  who  have  carried  encysted  bullets  for 
long  periods  in  their  persons  with  little  more  inconvenience  than  slight  neuralgic  pains  during 
damp  and  unpleasant  weather.  The  writer  has  in  mind  the  cases  of  two  soldiers,  one 
wounded  in  the  lower  maxillary  region  during  the  Mexican  war,  the  other  in  the  gluteal 
region  during  the  late  war,  in  both  of  whom  the  balls  are  firmly  encysted;  the  missiles  give 
so  little  trouble  that  the  suggestion  of  removal  is  not  received  with  favor.  A  most  remark 
able  instance  of  the  encysting  of  a  ball  is  that  of  Lieutenant  E.  B.  Blake  (CASE  552,  on 
p.  372,  ante),  who  carried  for  fifteen  years  a  full-sized  conoidal  bullet  in  the  cancellated 
structure  of  the  condyles  of  the  femur,  experiencing  but  little  trouble. 

PRIMARY  SYMPTOMS  COMMON  TO  GUNSHOT  WOUNDS. — The  immediate  symptoms  common  to 
shot  injuries  are  pain,  shock,  and  haemorrhage.  To  be  duly  appreciated  in  their  primary 
state  they  must  be  seen  on  the  battle-field,  as  they  are  speedily  evanescent,  fatal,  or  merge 
themselves  into  conditions  pertaining  to  the  later  stages  of  shot  injuries. 

Shock. — Severe  shot  injuries,  particularly  those  involving  the  larger  bones  and  the 
more  important  organs  and  cavities,  are  followed  by  a  train  of  phenomena  known  as 
"  shock,"  or  a  general  perturbation  of  the  nervous  system.  Upon  the  reception  of  such 
injuries  the  person  affected  turns  suddenly  pallid,  trembles,  and,  may  perhaps  fall  to  the 
ground;  the  surface  of  the  body  is  cool  and  bathed  in  profuse  perspiration;  the  features 
indicate  anxiety  and  distress,  the  respiration  is  labored  and  sighing,  the  circulation  is 
feeble,  the  mental  condition  is  often  one  of  agitation  resembling  fear,  or  there  may  be  an 
entire  loss  of  self-control ;  at  times,  in  severe  cases,  consciousness  is  lost,  and  finally  death 
may  ensue  without  reaction. 

The  degree  of  shock  seems  to  bear  some  relation  to  temperament,  to  physical  condi 
tion,  and  to  the  region  of  body  affected.  Equal  degrees  of  injury  seem  to  affect  individuals 
differently.  While  some  are  apparently  overwhelmed  by  the  shock,  others  maintain  their 
self-control  and  composure  ;  m  some,  shock  seems  to  heighten  the  excitement  under  which 
the  individual  is  laboring  during  a  battle  ;  in  others,  the  effect  is  to  produce  a  sense  of  fear 
and  panic.  As  a  rule,  the  more  severe  the  injury  the  greater  will  be  the  degree  of  shock. 
Injuries  caused  by  the  larger  projectiles,  as  the  loss  of  a  limb  near  the  trunk,  is  generally 
followed  by  depressing  shock,  and  this  independent  of  any  loss  of  blood.  Generally,  shock  is 
more  profound  and  persistent  in  grave  wounds  of  the  abdomen  than  in  wounds  of  any  other 
part  of  the  body.  Profound  and  even  fatal  shock  has  been  the  occasional  consequence  of 
shot  contusion  of  the  parietes  of  the  abdomen,  as  in  the  case  of  Major  King,  British  Fusi- 
leers,1  who  was  killed  at  the  battle  of  New  Orleans,  January  8,  1815,  by  a  musket-ball, 
"which  struck  him  on  the  pit  of  the  stomach,  leaving  only  the  appearance  of  a  contusion, 
apparently  in  the  same  manner  as  a  blow  from  the  hands  of  a  pugilist  in  the  same  part." 

Wounds  producing  great  splintering  and  comminution  of  long  bones  are  generally 
followed  by  a  severe  degree  of  shock.  The  duration  of  shock  is  very  variable,  sometimes 
lasting  but  a  few  minutes;  at  other  times  showing  great  persistence,  and  continuing  for 
hours  or  days.  Here,  too,  individual  temperament  and  idiosyncracy  seem  to  exert  a  large 

Ll.  .1   7';v«/i>  i,n  f.-uiifliot  Wounds,  etc.,  London,  'M  edition,  1847.  j..  5. 


760  WOUNDS    AND    COMPLICATIONS.  (CHAP.  xn. 

influence.  When  shock  is  very  persistent  the  prognosis  is  to  be  very  guarded,  as  its  persist 
ence  may  depend  upon  some  severe  or  fatal  injury,  as  was  probably  the  case  in  the  following- 
instance,  reported  by  Surgeon  E.  Swift,  U.  S.  Army: 

CASE  1103.— Private  A.  P.  Pringle,  Co  A,  25th  Louisiana,  aged  24  years,  temperament  bilious,  occupation  farmer: 
wounded  at  the  battle  of  Stone's  Eiver,  near  Murfreesboro',  Tennessee,  December  31, 1862,  by  a  minie"  ball  under  the  left  shoulder, 
through  pectoralis  major.  The  shock  knocked  him  down  and  he  fell  across  the  railroad  track  on  his  left  hip.  He  complained 
more  of  this  than  of  the  wound;  suffered  intensely  from  pains  in  his  hip,  back,  and  leg;  quieted  pains  with  morphine,  and  was 
obliged  to  use  a  catheter  twice  daily  as  long  as  he  lived.  The  wound  healed  very  well,  but  he  never  recovered  from  the  shock 
of 'the  fall.  He  had  no  appetite  from  the  first.  All  the  nervous  symptoms  increased  in  intensity;  he  had  no  rest  except  from 
morphine,  and  for  two  or  three  days  before  his  death  he  could  not  move  at  all.  Died  January  11,  1863. 

Shock  may  be  the  actual  cause  of  death  of  many  cases  on  the  battle-field,  especially  in 
severe  injuries  of  the  abdomen.  Of  twenty-seven  fatal  cases  of  shock  fourteen  were  found 
to  be  shot  wounds  of  the  abdomen  and  eight  of  the  femur.  Fatal  shock  is  more  frequently 
a  sequel  of  wounds  by  large  projectiles  than  by  bullets.  Longmore1  found  that  out  of  twenty- 
two  deaths  from  shock  only  eight  were  caused  by  bullets,  and  in  all  of  these  the  cavity  of 
the  abdomen  had  been  penetrated  by  the  projectile.  In  the  remainder  the  injuries  were 
from  gunshot,  shell,  or  grape. 

Pain. — Pain  as  a  primary  symptom  of  shot  injury  is  rarely  absent.  In  degree  it  may 
be  slight  or  severe  according  to  the  locality  of  the  wound,  its  nature,  and  the  mental  condition 
of  the  individual.  In  simple  flesh  wounds  it  is  commonly  described  as  stinging  or  cutting. 
as  from  a  blow  by  a  cane ;  it  is  sometimes  likened  to  the  passage  of  a  hot  wire  through  the 
part;  by  others  it  is  described  as  dull,  like  the  blow  from  some  heavy  body.  When  nerves 
are  injured  or  contused  the  pain  is  usually  severe,  but  is  commonly  referred  to  parts  sup 
plied  by  the  nerve.  In  some  cases  the  pain  is  referred  to  parts  distant  from  the  seat  of 
injury,  as  in  the  case  of  Lieutenant  William  F.  Goodwin,  16th  U.  S.  Infantry,  who  was 
wounded  at  Chickamauga,  September  19,  1863,  by  a  conoidal  ball,  which  caused  a  severe 
flesh  wound  of  the  left  thigh.  He  felt  no  pain  of  moment  in  the  wounded  limb,  but  had 
a  firm  impression  that  the  wound  was  in  the  right  limb.  The  case  is  referred  to  by 
Mitchell,  Morehouse,  and  Keen  (loo.  cit.,  page  14).  When  large  nerve  trunks  are  divided 
there  is  momentarily  intense  pain,  immediately  succeeded  by  loss  of  sensation  in  parts 
depending  upon  the  nerve  trunk.  In  severe  wounds  generally  the  pain  which  accompanies 
them  is  lost  in  the  anaesthesia  of  the  shock  which  soon  follows. 

Pain  resulting  from  shot  contusions  of  bone  is  often  severe  and  widespread,  especially 
if  the  injury  is  insufficient  to  cause  unconsciousness. 

CASE  1104. — Captain  A.  L.  Dearing,  Co.  H,  5th  Maine,  aged  28  years,  was  wounded  at  Chancellorsville,  May  3,  1863. 
He  was  admitted  into  Seminary  Hospital,  Georgetown,  on  May  8th.  Surgeon  H.  W.  Ducachet,  U.  S.  V.,  reported  :  "Gunshot 
wound  of  left  thigh  bone."  The  following  account  of  the  case  was  furnished  by  the  patient:  "I  was  wounded,''  says  this  officer, 
"on  Sunday,  May  3d,  by  a  round  musket  ball  in  my  left  thigh,  very  near  the  hip  joint,  the  enemy  being  fifty  or  sixty  yards 
distant.  The  sensation  produced  when  the  ball  struck  me  was  as  though  a  ball  of  glass  had  been  thrown  with  irresistible  force 
and  shivered  to  atoms  against  the  bone  of  my  thigh.  This  sensation  was  very  distinct,  and  no  other  was  felt  for  the  instant.  1 
have  no  recollection  of  falling;  but  found  myself  lying  on  my  left  side,  with  a  strange  feeling  of  numbness  rushing  through  the 
entire  leg.  This  lasted  but  a  few  moments;  the  blood  flowing  freely,  this  active  numbness  soon  died  away.  I  believed  myself 
mortally  wounded,  as  I  had  no  doubt  the  bone  was  shattered  to  the  hip  joint.  Dreading  to  fall  into  the  hands  of  the  enemy  I 
dragged  myself  from  the  battle-field  about  two  hundred  yards,  when  some  of  our  men  carried  me  to  a  place  of  safety.  Taken 
to  the  hospital  at  Falmouth  on  the  4th,  my  wound  was  probed  by  Surgeon  N.  S.  Barnes,  27th  New  York,  on  the  morning  of  the 
5th.  The  probe  struck  the  bone  and  followed  the  wound  a  short  distance  around  it  on  the  inside,  without  feeling  the  ball.  Sur 
geon  Barnes  decided  that  the  ball  struck  the  bone,  and,  without  injuring  it,  glanced  to  the  right,  passing  around  to  the  opposite 
side  from  which  it  entered,  and  probably  lay  deep  in  the  groin;  but  my  thigh  was  so  much  swollen  that  the  ball  could  not  "be 
found.  On  May  8th  I  reached  Seminary  Hospital,  Georgetown.  At  length,  after  the  swelling  had  subsided  considerably,  the 
ball  was  found  near  the  groin  and  near  the  surface.  It  was  extracted  by  Surgeon  Ducachet  on  May  18th,  but  this  ragged,  mis 
shapen  piece  of  lead  was  so  light  that  doubts  were  expressed  as  to  its  being  a  whole  ball.  The  wound  seemed  to  be  doing  well; 
there  was  considerable  yet  no  very  severe  pain,  the  severest  and  most  continuous  being  in  that  region  where  the  ball  entered  and 
'I.OXGMOUE  (T  )  Gunshot  Injuries:  their  history,  etc.,  London,  1877,  p.  150. 


CHAP   yi 1. 1  PRIMARY    SYMPTOMS    OF    SHOT    WOUNDS.  701 

struck  the  bone.  On  May  27th  a  small  piece  of  bone  was  discharged  from  the  wound,  indicating  that  the  bone  was  more  or 
less  injured.  On  May  28th  I  was  attacked  with  a  most  intense  pain  on  the  inside  of  the  thigh,  midway  between  the  wound  and 
the  opening  where  the  ball  had  been  extracted.  This  pain  brought  on  fever  and  a  severe  headache.  Chloroform  liniment  was 
freely  applied  and  alleviated  the  pain.  On  May  31st  a  piece  of  lead  made  its  appearance  at  the  opening  where  the  ball  had 
entered,  and  was  extracted  by  Dr.  Miller,  and  proved  to  be  very  nearly  as  large  as  that  extracted  on  the  18th.  This  second 
piece  of  lead  is  very  ragged,  and  holds  a  portion  of  the  cloth  which  it  had  carried  into  the  wound.  About  the  first  of  June  the 
nerves  of  my  left  foot,  mostly  in  the  toes,  commenced  troubling  me,  causing  many  sleepless  nights  and  restless  days  for  two 
weeks.  It  was  like  a  continuous  nervous  toothache.  A  powerful  chloroform  liniment  was  freely  applied,  but  it  proved  less 
effectual  than  cold  water  in  easing  the  pain.  This  pain  was  not  constant,  but  would  burn  my  toes  as  with  boiling  water  for  ten 
or  fifteen  minutes,  then  ease  away  somewhat  for  a  few  minutes,  and  then  return  in  full  force.  On  June  12th  a  course  of  vigorous 
rubbing  with  a  coarse  towel  was  commenced  on  the  foot  and  leg  to  the  knee.  On  the  third  day  the  pain  began  to  yield,  and  has 
now,  June  24,  1863,  almost  ceased.  My  leg  remains  as  yet  almost  perfectly  helpless.  It  cannot  support  its  own  weight.  My 
general  health  is  very  good."  The  patient  was  discharged  from  service  September  15,  1863,  and  pensioned.  The  Hartford 
examining  board  reported,  August  7,  1872:  "Ball  entered  at  middle  of  left  nates  and  passed  forward;  part  of  the  ball  was 
removed  at  the  junction  of  the  upper  and  middle  thirds  of  the  left  thigh  at  the  outer  border  of  the  sartorius  muscle.  In  its  passage 
the  ball  struck  the  inner  side  of  the  femur,  and  in  consequence  of  which  portions  of  bone,  with  the  remainder  of  the  ball,  were 
discharged  through  the  point  of  entrance  in  the  nates.  The  knee  becomes  swollen  and  painful  from  slight  use." 

Under  the  stimulus  of  great  excitement,  as  that  prevailing  during  an  active  engage 
ment,  men  may  receive  wounds  without  being  aware  of  the  fact  until  their  attention  is 
drawn  to  the  blood  flowing  from  the  wound,  or  until  they  are  affected  by  faintness  from  the 
loss  of  blood.  Race  and  temperament  undoubtedly  exert  a  modifying  influence  on  the 
degree  of  suffering.  The  white  races,  as  a  rule,  seem  to  be  more  susceptible  to  pain  and 
to  suffer  more  acutely.  The  negro  soldiers  engaged  in  the  late  civil  war  bore  their  suffer 
ings  with  great  fortitude  and  patience  ;  but  it  is  questionable  if  the  actual  degree  of  suffering 
was  as  great  as  that  of  the  white  soldiers.  The  nervous  and  sanguine  temperaments  show 
a  greater  capacity  for  suffering  than  the  lymphatic  or  lethargic  temperaments. 

Primary  Hcemorrhac/e. — Primary  haemorrhage,  or  the  loss  of  blood  immediately  upon 
the  receipt  of  an  injury  severing  or  wounding  a  blood-vessel,  has  been  alluded  to  as  causing 
speedily  fatal  results,  or  as  ceasing  spontaneously  by  the  retraction  of  the  coats  of  the 
bleeding  vessels,  by  syncope,  or  followed  by  such  retardation  of  the  flow  of  blood  as  to  allow 
assistance  to  reach  the  wounded  man,  rendering  him  secure  for  a  time  at  least. 

As  a  result  of  the  experience  of  the  late  war  it  may  be  stated  that  primary  haemor 
rhage,  within  the  bounds  of  possible  succor,  was  infrequent ;  yet  without  doubt  many 
wounded  men  perished  through  lack  of  self-possession,  want  of  coolness,  or  of  sufficient 
knowledge  to  save  themselves. 

It  is  probable  that  a  large  percentage  of  the  "killed  in  battle"  were  cases  where 
primary  haemorrhage  followed  the  division  of  important  vessels,  death  ensuing  instantly 
or  before  help  could  be  procured.  Surgeon  John  A.  Lidell,  U.  S.  V.,1  was  convinced,  from 
his  own  observation,  "that  a  large  proportion  of  the  persons  killed  in  battle  perish  directly 
from  loss  of  blood:  On  the  25th  of  March,  1865,  I  examined  the  bodies  of  forty-three 
soldiers  as  they  lay  dead  where  they  had  fallen  on  the  field  of  combat  at  Fort  Steadman,  in 
the  lines  before  Petersburg.  Of  them  23  were  wounded  in  the  cranium,  15  were  wounded 
in  the  thorax,  5  were  wounded  in  the  abdomen.  The  blanched  and  exsanguinated  appear 
ance  of  the  cadaver  in  every  case  wounded  in  the  abdomen  denoted  clearly  that  death  had 
been  produced  by  haemorrhage,  and  the  extreme  rapidity  with  which  that  result  had  taken 
place  implied  that  some  large  blood-vessel  had  been  injured.  In  all  but  two  or  three  of 
the  cases  wounded  in  the  thorax  the  body  presented  a  blanched  and  exsanguinated  appear 
ance,  occasioned  by  hemorrhage.  There  was  much  blood  in  the  clothing  and  on  the  ground 
where  they  had  fallen  in  most  of  the  cases  wounded  in  the  trunk.  This  fact  shows  that  the 
fatal  haemorrhage  generally  took  place  externally.  There  were,  however,  some  cases  wherein 

1  LIDELL  (J.  A.),  On  the  Wounds  of  Blood-vessels,  Traumatic  Hemorrhage,  etc.,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  p.  12. 
SUKG.    Ill— 96 


WOUNDS    AND    COMPLICATIONS.  !<'HAP.  xn. 

death  had  boon  produced  by  internal  haemorrhage.  While  the  bodies  of  those  were  pallid 
and  wax-like,  there  was  but  little  blood  in  their  clothing  and  on  the  ground  where  they  lay. 
All  the  wounds  appeared  to  have  been  inflicted  by  cylindro-conoidal  bullets." 

Primary  haemorrhage  from  wounded  veins  is  generally  regarded  as  of  less  imminent 
importance  than  that  from  wounded  arteries.  It  was  stated  in  the  preliminary  report 
(Circular  No.  6,  1865,  p.  39)  that  "no  cases  have  been  reported  in  which  the  bleeding 
could  not  be  controlled  by  pressure."  A  further  examination  of  the  material  at  hand  makes 
it  necessary  to  somewhat  modify  this  statement.  Primary  haemorrhage  from  large  trunk 
veins  lying  in  cavities  and  beyond  the  roach  of  ligatures  appear  to  be  as  fatal  as  that  from 
arteries.  A  case  of  this  nature  is  reported  on  page  71  of  the  Second  Surgical  Volume. 
A  colored  teamster  shot  in  the  abdomen  died  forty-two  hours  after  the  injury.  At  the 
autopsy  the  abdomen  was  found  distended  with  clotted  blood  from  one  of  the  mesenteric 
veins  which  had  been  cut. 

Primary  haemorrhage  from  the  jugular  and  femoral  veins  would  appear  to  be  less 
amenable  to  treatment  than  that  from  others  which  yield  to  pressure  or  cease  spontaneously. 
A  case  illustrating  primary  haemorrhage  from  the  femoral  vein  is  reported  on  page  338  of  the 
Second  Surgical  Volume  (CASE  981):  a  private  of  the  110th  Ohio  was  wounded  at  Fort 
Steadman,  March  25,  1865;  the  ball  entered  the  right  thigh,  cutting  across  the  femoral 
vein,  and  lodged  in  the  gluteal  muscles;  haemorrhages  followed  continuously,  which  were  at 
times  checked  by  styptics.  Death  occurred  April  11,  1865. 

Early  in  the  war  it  was  recommended  that  each  soldier  should  have  in  his  possession 
some  simple  form  of  tourniquet,  and  in  many  instances  the  recommendation  was  carried 
out ;  how  far  they  were  of  use  is  not  known,  as  no  cases  are  recorded  of  life  being  saved 
by  them;  but  it  is  probable  that  they  were  little  used,  and  it  is  very  doubtful  if,  in  the 
excitement  and  confusion  of  battle,  they  could  have  been  applied  with  any  efficacy.  Later 
in  the  war  experience  taught  the  older  and  more  experienced  troops  to  do  all  that  could  be 
done  in  cases  of  emergency. 

HAEMORRHAGES  AND  LIGATIONS. 

Of  the  many  complications  of  shot  wounds,  perhaps  none  plays  a  more  important  part 
than  haemorrhage.  Injuries,  apparently  trivial,  prove  fatal  in  the  most  unexpected  manner, 
as  the  lesion  to  the  artery  causes  at  first  little  or  no  disturbance;  or  haemorrhages  occur  in 
cases  in  which,  judging  from  the  direction  of  the  ball,  no  injury  to  a  blood-vessel  could 
have  been  surmised.  Thus  the  prognosis  of  the  shot  wound  becomes  exceedingly  proble 
matical,  and  the  surgeon  not  infrequently  is  suddenly  roused  from  a  feeling  of  security  and 
brought  face  to  face  with  an  unexpected  and  serious  complication,  which,  under  the  peculiar 
necessities  of  war,  is  of  difficult  treatment;  and  the  results  thus  far  have  been  by  no  means 
as  satisfactory  as  could  be  wished.  Too  often  the  surgeon  is  induced  to  await  develop 
ments  rather  than  to  resort  to  prompt  action. 

It  has  therefore  been  thought  desirable  to  give  in  the  following  pages  as  complete  a 
summary  of  the  cases  of  haemorrhage,  whether  primary  or  secondary,  as  space  would  allow. 
Details  of  many  cases  have  appeared  in  this  and  the  preceding  volumes,  and  in  a  few 
instances  partial  tabular  statements  of  ligations  of  the  more  important,  blood-vessels  have 
been  adduced.  But  during  the  progress  of  the  work  many  additional  cases  were  ascertained 
and  additional  data  were  found  of  cases  already  reported ;  all  will  here  be  grouped  together 
in  as  concise  a  manner  as  possible  to  aid  the  student  interested  in  the  investigation  of  this 


CHAP.  XII.] 


HEMORRHAGES    AND    LTGATIONS. 


763 


important  branch  of  military  surgery  in  his  researches  in  this  direction.  As  already  stated 
in  the  consideration  of  the  effects  of  missiles  and  projectiles  on  blood-vessels,  it  is  difficult 
to  distinguish  the  injuries  inflicted  by  one  or  another  of  the  more  common  forms  of  bullets; 
but  it  would  seem,  nevertheless,  from  the  large  series  of  bleedings  reported  during  the 
war,  that  the  introduction  of  the  elongated  bullet,  thrown  from  a  rifled  weapon,  has  largely 
increased  the  number  as  well  as  the  gravity  of  the  injuries  to  blood-vessels.  The  injuries 
of  the  arteries  will  be  first  considered,  and  those  of  the  veins  unattended  by  lesions  of  the 
accompanying  arteries  are  reserved  for  a  special  subsection. 

.  ARTERIES. — The  number  of  arterial  haemorrhages  found  on  the  records  of  the  field 
and  general  hospitals  was  three  thousand  two  hundred  and  forty-five  (3,245).  One  thou 
sand  six  hundred  and  forty-nine  of  these  bleedings  occurred  in  the  lower  extremities,  eight 
hundred  and  seventy-eight  in  the  upper  extremities,  two  hundred  and  ninety-one  were  haem 
orrhages  of  the  head,  face,  and  neck,  and  four  hundred  and  twenty-seven  of  the  trunk.  Of 
the  three  thousand  two  hundred  and  forty-five  cases  recorded,  the  blood-vessels  involved 
were  not  named  in  one  thousand  and  ten  instances;  and  as  the  details  of  these  cases  are 
not  as  complete  as  those  of  the  remaining  two  thousand  two  hundred  and  thirty-five,  in 
which  the  bleeding  vessels  were  definitely  ascertained,  the  former  will  be  dropped  in  the 
further  discussion  of  the  subject. 

The  cases  have  been  grouped  in  a  tabular  statement,  adducing  :  First,  the  bleedings  of 
the  ramifications  of  the  ascending  aorta  in  the  chest,  neck,  head,  and  upper  extremities  ; 
and  next,  those  of  the  descending  aorta  in  the  abdomen,  pelvis,  and  lower  extremities;  and 
lastly,  the  few  examples  of  pulmonary  haemorrhages.  The  tables  also  indicate  the  number 
of  cases  in  which  pyaemia,  erysipelas,  tetanus,  and  gangrene  were  recorded  as  complications, 
the  number  of  cases  in  which  death  was  ascribed  directly  to  haemorrhage,  and  the  propor 
tion  of  cases  in  which  primary  injury  to  vessels  and  primary  bleedings  were  observed: 


TABLE   CXXIV. 

Summary  of  Two  Thousand  Two  Hundred  and  Thirty-five  Cases  of  Arterial  Haemorrhages  of  the 
Head,  Neck,  Chest,  Trunk,  and  Upper  and  Lower  Extremities,  in  which  the  bleeding  vessels  were 
indicated  by  name. 


ARTERIES. 

CASES. 

IlKSl  LTS. 

PHIMAKY 
INJI:RY. 

I'KIMAKY 

BLEKDI.NG. 

PYAEMIA. 

CrANGUENK. 

EUYKH'KLAS. 

TETANUS. 

DEATH 

FHOM  11  JEM. 

Reo. 

Fat. 

Rec. 

Fat. 

Rec. 

Fat. 

Rec. 

Fat. 

Rec. 

Fat. 

0 

0 

41 

(i 

; 

3 
1 
1 
5 

9<; 

12 
3 
7 
13 
3 
30 

21 

4 

4 
24 

ia 

o 

75 
8 
1 
3 
5 
1 
fi 
9 

31 

fi 

o 

1 

o 

1 

5 

4 
1 

6 
4 

1 

! 

1 

1 

Occipital  

1 

3 
1 
1 
1 

3 

1 

0 

1 

Facial  

1 

1 

14 

8 
11 

1 

223 

r> 

4 

1  - 

02 

8 
4 
9 

8 
5 

Middle  Menlngeal 

Internal  Carotid   

1 

Frontal  

131 

17 

Zl 

3 

1 

(ii 

1          2 

3  , 

4 

7(5 

WOUNDS    AND    COMPLICATIONS. 


tCHAi'.  XII. 


ARTERIES. 

00 

£ 

•«! 
O 

RKSULTS. 

PRIMARY 
INJURY. 

PRIMARY 
BLEEDING. 

PYAEMIA. 

GANGHKNE. 

ERYSIPELAS. 

TETANUS. 

*1 
W  S 

fi§ 
fe 

76 
32 
2 
1 
5 
1 
13 

Rec. 

Fat. 

Rec. 

Fat. 

Ren. 

».| 

RPO. 

4 
1 

Fat. 

Rec. 

Fat. 

223 
62 
2 
1 
9 
2 
37 
3 
1 

12 

87 
10 
13 
32 

r> 

92 
10 

131 
52 
2 
1 
7 
2 
86 
1 
1 
1 
7 
76 
9 
9 
12 
2 
99 
o 

6 
8 
35 
3 

12 
9 
7 

61 
12 
1 

17 
1 

1 

0 

6 

3 

3 
4 

1 

•                      8 

3 

T 

0 

1 

1 

11 

O 

1 
1 

4 

o 

1 

1 

J 

1 

5 

11 
1 
4 

20 

1 
26 

3 

56 
6 
5 
7 
2 
33 
1 
5 
6 
8 

4 

1 

6 

1 
1 

y 

2 
2 

Cir     tnflex 

1 

1 

1 

1 

1 

1 

201 

4 
14 
9 
111 
4 
49 
42 
23 
2 
1 
1 
10 
2 
1 

0 

lew 

0 

8 
1 
76 
1 
37 
33 
16 
2 
1 
1 
8 

73 

22 

25 
1 

18 

11 

7 

4 

1 
7 
2 
1 
1 
2 

32 
1 
7 
5 

5 

6 

4 

3 

1 

Ulnar 

1 

1 

6 
5 

1 
1 

7 
5 
2 

PI 

. 

0 

2 
1 
2 
o 

2 
1 
1 
7 
7 
1 
18 
8 
3 
1 
23 

1 

2 

2 
1 
2 

2 

ff    • 

2 
1 
1 
1 

2 
2 
1 
2 
7 
7 
1 
22 
8 
4 
1 
2G 

13 
551 
1 
60 
10 
7 
6 
54 
105 
8 
270 

6 

:i 

8 

17 

3 

1 

1 

1 

2 

1 

1 

1 

1 

3 

6 
1 
12 
4 
3 
1 
7 

Gluteal 

4 

2 
1 

1 

3 

1 

1 

3 

2 

119 
1 
18 
2 
4 

6 
1 

2 

2 

3 
43:> 

3 

194 

103 

27 

2 

48 

11 

53 

2 

1 

2 

42 

3 

(j 
39 
79 
5 
142 
o 

1 

1 

6 
o 

2 

2 

25 
4 

1 
2 
1-2 

32 

4 

46 

1 

1 

1 
13 
12 

15 
26 
;i 

128 

r 

3 

6 

7 

o 
46 
1 
7ii 

1 
5 

o 
24 
1 

28 

1 
2 

Popliteal       .               ...   .           

9 

1 

Tibial 

14 

29 

19 

3 

3 

3 
1 

1 

2 

10 
3 

1 

1 

1 

4 

5 

1 

1 
1 

2 

1 

1 

148 

23 

11 

Affereirates  .  .  . 

2.235 

855 

1.380 

485 

110 

5 

177 

80 

16 

653 

CHAP    XII. 1 


H.EMOBKHAGES    ANP    LIGATIONS. 


765 


The  number  of  cases  of  primary  lesions  of  blood-vessels  was  quite  large,  comprising 
four  hundred  and  eighty-five,  or  nearly  one-fourth  of  the  two  thousand  two  hundred  and 
thirty-five  cases.  Of  these,  one  hundred  and  ten  were  immediately  followed  by  haemorrhage. 
To  what  extent  the  injuries  to  arteries  influenced  the  mortality  rate  among  the  wounded 
will  be  seen  from  the  fact  that  of  the  two  thousand  two  hundred  and  thirty-five  instances 
in  which  bleedings  formed  an  important  element,  one  thousand  three  hundred  and  eighty, 
or  61.7  per  cent.,  proved  fatal,  while,  of  the  total  number  of  shot  wounds,  as  indicated 
in  TABLE  CXIX,  page  691,  ante,  only  13.6  per  cent,  ended  in  death.  Nor  can  this  high  rate 
of  mortality  be  attributed  to  the  presence  of  other  complications,  such  as  pya3mia,  gangrene, 
erysipelas,  tetanus,  etc.,  as  the  fatality  of  the  cases  in  which  these  diseases  occurred  com 
prised  only  20.5  per  cent,  of  the  whole  number  of  deaths,  while  in  six  hundred  and  fifty- 
three  instances,  or  47.3  per  cent.,  death  was  ascribed  directly  to  haemorrhages,  and  in  22.2 
per  cent,  to  exhaustion  following  severe  or  continued  loss  of  blood. 

Of  the  two  thousand  two  hundred  and  thirty-five  cases  of  haemorrhage  in  which  the 
bleeding  vessels  were  specified,  one  thousand  one  hundred  and  fifty-five  were  followed  by 
ligation.  Many  of  these  instances  of  ligation,  especially  of  the  larger  arteries,  have  already 
been  cited  in  this  and  the  preceding  volumes,  sometimes  in  detail,  sometimes  in  partial 
tabular  statements.  For  the  convenience  of  the  reader  all  have  here  been  grouped  together 
in  a  numerical  statement,  which  will  be  followed  by  nominal  lists  arranged  according  to 
the  various  blood-vessels  operated  upon. 

TABLE  CXXV. 
Tabular  Statement  of  One  Thousand  One  Hundred  and  Fifty-five  Legations  for  Shot  Injuries. 


ARTERIES  LIGATED. 

CASES. 

'RESULTS. 

ARTERIES  LIGATED. 

RESULTS. 

Rec. 

Fat. 

J       Eec. 

Fat 

Common  Carotid  

82 
7 
1 
1 
5 
1 
18 
8 
1 
51 
2 

19 
4 
1 
1 
4 
1 
14 
5 
1 
10 

63 
3 

1 

4 
3 

41 
2 
4 

Brought  forward  

529       281 
4           4 
2           2 
1           1 
1           1 
4           3 
5l  
3    
6           2 
2    
26           3 

374         93 
1           1 
22           5 
6    
24           6 
36           « 
3            1 
7            4 
40         22 
1            1 
2           1 
48         -'0 
3           2 
4            1 

1,  155       471 

248 

1 
5 
3 
4 
2 
23 
1 
281 

17 
(i 
18 
28 
o 

3 

18 

1 
19 
1 
3 

External  Carotid            

Arch  Vol  Profundi 

Temporal  .  .1  

Common  Iliac                     

Facial           

Gluteal 

Intercostals  

6           2 
1           1 
1           1 

2           2 
49           7 
1    

Superficial  Cervical  

42 
1 

1 

1 
51 
2 
2 
1 
14 
2 
3 

External  Pudic            

A  xillary  

Perforating  Arteries  

Acromial  Thoracic  (Branch)  

2       .    1 
IS         11 
1 

Popliteal 

Circumflex  

Mn«r.iila.r  T?r»jirh 

Brae-trial  

170 

3 

7 
1 

119 
1 
5 

£47  J 
Anterior  Tibial.              ...     .          )      ( 

Muscular  Branch   

Profunda  

Anastomotica  Magna  

Posterior  Tibial       

Radial    

59 
22 
9 

45 
20 
6 

TTlnar  

Aggregates  

Forward  .  .  . 

684 

529 

281 

248 

766  WOUNDS    AND    COMPLICATIONS.  [CHAP.  XH. 

Four  hundred  and  seventy-one  eases  terminated  in  recovery,  and  six  hundred  and 
eighty-four  in  death,  a  mortality  rate  of  59.2  per  cent. 

legations  of  the  Common  Carotid. — Eighty-two  cases1  of  ligation  of  the  common  carotid 
were  reported;  nineteen  recovered  and  sixty-three  proved  fatal,  a  mortality  of  76.8  per 
cent.  The  operations  were  performed  for  haemorrhages  from  the  common  carotid  in  four 
cases — two  recoveries,  two  fatal ;  for  haemorrhages  from  the  internal  carotid  in  four  cases- 
all  fatal;  for  injuries  of  the  external  carotid  in  eleven  cases — one  recovery,  ten  fatal;  and 
in  twenty-eight  instances,  with  eight  recoveries,  for  haemorrhages  from  branches  of  the 
carotids — the  lingual  in  seven,  the  auricular  in  one,  the  temporal  in  two,  the  facial  in  five, 
the  maxillary  in  eleven,  the  middle  meningeal  in  two  cases.  In  one  case  it  was  found  at 
the  autopsy  that  the  haemorrhage  had  occurred  from  the  vertebral  artery.  In  the  following 
the  bleeding  occurred  from  the  internal  carotid  on  the  eighth  day: 

CASK  1105. — Sergeant  P.  I?.  Messenger,  Co.  A,  lllth  Pennsylvania,  aged  33  years,  was  wounded  at  Lookout  Mountain, 
November  '24,  1863.  He  was  admitted  to  a  field  hospital  of  the  Twelfth  Corps  and  transferred  to  the  General  Hospital  at  Tulla- 
lioma  five  days  afterwards.  Surgeon  B.  Woodward,  22d  Illinois,  in  charge  of  the  latter,  described  the  case  as  follows:  "The 
injury  consisted  of  a  compound  comminuted  fracture  of  the  right  lower  jaw,  the  ball  passing  in  at  the  angle  of  the  mouth,  going 
backward  through  the  neck,  and  making  its  exit  close  by  the  cervical  column.  Water  dressings  were  applied  and  opiates  were 
administered.  By  December  2d  the  wound  was  discharging  freely,  no  attempt  having  been  made  to  remove  any  portion  of  the 
fractured  bone  by  reason  of  the  great  amount  of  swelling.  At  noon  the  patient  fed  himself  with  soup;  but  at  1.30  P.  M.  I  was 
called  to  him  and  found  four  quarts  of  blood  collected  in  a  large  tin  basin.  Arterial  blood  was  also  pouring  in  torrents  from  his 
mouth.  On  introducing  the  finger  it  was  found  that  the  internal  carotid  had  sloughed,  when  I  pressed  lint  soaked  with  solution 
of  persulphate  of  iron  firmly  back  against  the  bleeding  artery,  and,  holding  it  there  with  my  finger,  directed  Assistant  Surgeon 
II.  Pearce,  150th  New  York,  to  cut  down  and  take  up  the  common  trunk,  which  he  did.  Before  the  artery  was  taken  up  the 
patient  had  a  severe  convulsion  from  the  loss  of  blood,  rendering  the  operation  very  difficult.  The  lint  was  left  in  situ,  though 
the  blood  ceased  to  pour  from  the  artery  immediately  after  the  operation;  pulse  at  the  wrist  imperceptible;  breathing  gasping. 
The  patient  was  allowed  to  lie  on  the  table  for  four  hours,  being  wrapped  in  hot  blankets.  At  9  P.  M.  the  pulse  was  perceptible 
but  very  weak;  patient  made  to  swallow  pure  extract  of  beef  in  teaspoonful  doses  every  fifteen  minutes  and  through  the  night. 
After  he  was  removed  to  his  bed  extreme  vigilance  was  kept  up,  and  at  11  P.  M.  I  gave  him  one-fourth  of  a  grain 
of  morphia.  The  following  morning  his  pulse  was  160  and  very  feeble.  He  had  not  slept  any,  but  his  bowels  had 
moved  well  and  he  had  urinated.  There  had  been  no  bleeding,  and  at  10  A.  M.  the  lint  was  removed  and  his  mouth 
cleaned  out.  By  8  P.  M.  he  had  slept  two  hours,  his  pulse  was  130  and  fuller,  and  he  was  given  one  drachm  of 
wine  with  two  drachms  of  extract  of  beef  every  two  hours.  During  the  next  night  he  slept  well;  pulse  120  and 
growing  fuller;  no  haemorrhage;  wound  in  neck  suppurating  well ;  patient  sitting  raised  in  bed  and  takes  nour 
ishment  freely;  feels  well  but  weak  ;  no  cerebral  symptoms;  bowels  moved;  urinates  freely.  At  2  P.  M.  his  pulse 
was  110  and  he  felt  well  enough  to  dictate  a  letter  to  his  wife.  At  8  P.  M.  on  December  Gth  he  was  still  doing  well, 
his  head  feeling  clear;  pulse  98  and  growing  full;  appetite  good;  craves  oysters,  which  are  given  as  freely  as  he 
wishes.  No  change  took  place  until  the  night  preceding  December  8th,  when  his  pulse  become  120  and  very  soft ; 
evidences  of  cerebral  symptoms  beginninir  to  show  themselves,  such  as  hebetude  and  listlessness;  breathing  very 
feeble;  slight  but  perceptible  divergence  of  the  right  eye.  His  appetite,  which  had  been  good,  was  now  failing. 
At  5  P.  M.  there  was  great  hebetude  and  he  could  hardly  be  roused,  though  rational  when  roused;  eyes  winking; 
pulse  120,  very  soft  and  feeble.  Coma  came  on  at  8  P.  M.  and  complete  paralysis  of  the  left  side.  Death  occurred 
at  1  A.  M.  on  December  {),  18(53.  The  autopsy  showed  every  part  of  the  brain  to  be  covered  with  lymph.  The 
right  side  seemed  to  be  more  pallid  than  the  left,  though  this  might  be  imaginary.  Dissecting  out  the  carotid  from 
its  origin  at  the  innominata  to  its  entrance  into  the  skull  we  found  a  firm  clot  at  the  point  of  the  ligation,  extending 
Fn;  4-^if  —  one-half  inch  below  and  one  and  three-fourths  inches  above  the  ligature.  The  internal  carotid  was  completely 
Right  common  filled  with  a  firm  fibrinous  clot  as  far  as  the  entrance  of  the  skull,  so  that  in  no  event  could  haemorrhage  have 
I  £  inches  below  taken  place.  The  jaw  was  a  mass  of  putrilage  and  pus  had  followed  down  the  sheath  of  the  common  trunk, 
c"UfH)fo'on'  hathing  all  the  parts  to  a  full  inch  below  the  ligation  and  dissecting  out  the  descendens  noni  nerve."  In  addition 
to  the  history  of  the  case  Surgeon  Woodward  has  contributed  a  wet  preparation  of  the  ligated  artery  (tiprc.  2018), 
a  representation  of  which  appears  in  the  adjoining  wood-cut  (FlG.  420). 

Reviewing  the  above  case  Surgeon  Woodward  remarks:  "Here  was  a  case  in  which, 
according  to  Guthrie,2  the  internal  carotid  should  have  been  ligated  in  the  back  of  the 
throat.  If  allowed  to  differ  from  so  great  an  authority,  I  say  it  could  not  have  been  done. 

1  Professor  D-  HAYES  AGXKW  (The  Principles  and  Practice  of  Surgery,  Philadelphia,  1878,  Vol.  I.  p.  6:iO)  states  that  "(luring  the  War  of  the 
Rebellion  there  were  llfi  ligations  of  the  common  carotid  for  wounds  of  the  face  and  the  neck,  81  of  which  died,''  and  gives  as  his  authority  the  Surgical 
Hixtory  <if  iht.  War.  Part  1.  The  eminent  professor  evidently  overlooked  the  fact  that  the  cases  given  in  detail  are  also  included  in  the  tabular  statements. 
On  page  4JU  of  the  fir.it  ijargical  Volume  the  number  of  ligations  of  the  common  carotid,  as  then  ascertained,  was  stated  to  be  75.  On  page  45(>  of  the 
same  volume  another  case  was  subsequently  added,  making  a  total  of  7<i  cases.  Since  then  (i  additional  cases  have  been  found,  making  a  total  of  82. 

''  CiUTllltIK,  (<!.  J.).  Commentaries,  London,  18r>5,  Sixth  Edition,  p.  U53. 


LIGATIONS    OF    THE    COMMON    CAROTID    ARTERY. 


767 


In  the  first  place,  the  jaw  was  shattered,  pieces  of  which  had  been  removed  before  he  came 
to  this  hospital  [Tullahoma].  The  face  and  neck  were  enormously  swelled,  and  a  large 
quantity  of  flowing  pus  from  a  great  suppurating  surface  blinded  every  view  of  the  parts. 
Again,  when  the  haemorrhage  came  on,  it  was  in  such  a  torrent  that  there  was  no  time  for 
a  nice  dissection,  such  as  Guthrie  advises  in  his  theoretical  operation." 

CASK  1103. — Corporal  J.  Quick,  Co.  G,  38th  New  York,  aged  21  }rears,  was  wounded  in  the  face,  at  the,  battle  of  Fred- 
erieksburg,  December  K>.  18;>2.  a  ball  passing  behind  the  left,  condyle  of  the  lower  jaw  and  making  its  exit  on  the  left  side  of 
the  nose.  The  wounded  man  was  admitted  to  Eckington  Hospital,  at,  Washington,  five  days  after  receiving  his  injury,  his  fact; 
being  very  much  swollen  on  the  left  side  and  the  left  eye  being  closed  but  uninjured.  The  treatment  consisted  of  rest,  aperients, 
low  diet,  and  lead-wash  locally.  No  fever  ensued,  the.  swelling  abated,  and  the  patient  did  very  well  until  December  25th,  when 
secondary  1  feinorrhage  occurred  at  4  r.  M.  The  blood  gushed  from  his  mouth  and  left  nostril,  amounting  to  a  quart  in  a  few 
minutes.  Acting  Assistant  Surgeon  H.  N.  Fisher,  assisted  by  Acting  Assistant  Surgeon  A.  Edelin,  quickly  plugged  the  nares 
with  bits  of  muslin  strung  on  threads  and  thrust  into  the  nostiil,  which  promptly  stopped  the  haemorrhage.  It  occurred  again, 
however,  and  was  controlled  by  thrusting  in  more  of  the  tampon.  The  patient  slept  pretty  well  all  night,  being  carefully 
watched  and  having  his  head  well  elevated.  At  10  A.  M.  on  December  26th  he  commenced  bleeding  again,  the  blood  spouting 
from  the  wound  at  the  side  of  the  nose.  A  compress  then  applied  over  the  orifice,  and  snugly  bandaged,  controlled  the  haemor 
rhage.  On  the  morning  of  the  following  day  the  patient  had  another  free  attack  of  haemorrhage,  but  it  was  promptly 
checked  by  increased  pressure  on  the  compress,  after  which,  on  consultation,  it  was  determined  to  tie  the  common 
carotid  artery.  Acting  Assistant  Surgeon  Fisher  accordingly  ligated  that  vessel  just  above  the  omo-hyoid  muscle,  the 
patient  not  being  etherized.  The  plugs  were  then  removed  from  the  nostril  and  the  compress  from  the  face,  and  no 
haemorrhage  recurred.  The  patient  was  put  to  bed,  and  the  face  and  fresh  wound  were  dressed  with  cold  water. 
With  the  aid  of  an  anodyne  the  patient  slept  well  during  the  following  night.  The  next  morning  his  pulse  was  120, 
a  very  slight  pulsation  being  detected  in  the  left  temporal  artery  and  that  side  of  the  head  preserving  its  warmth. 
He  was  now  also  afflicted  with  diarrhoea,  the  discharges  being  thin  and  light  colored.  Beef  tea  and  stimulants  were 
ordered.  On  December  30th  the  pulse  had  increased  to  150;  patient's  mind  wandering;  very  restless;  diarrhoea  still 
continuing.  Opium  pills  were  now  prescribed  and  the  stimulants  continued.  On  January  2,  1863,  the  patient  was 
quite  insensible,  but  gave  answers  when  aroused;  diarrhoea  still  continuing;  stools  frequent  and  involuntary;  skin 
cold;  pidse  140  and  weak;  wound  looking  sunken  and  glassy.  In  addition  to  opiates  vegetable  astringents  were 
now  ordered.  Being  unable  to  swallow  solids  and  feeling  choked  by  swallowing  liquids,  he  Avas  ordered  oysters, 

which  he  ate  greedily  and  swallowed  readily.     On  January  4th  the  patient  was  still  in  a  stupor;  skin  cold;  pulse     p]G  421 

146;  some  little  redness  about  wound  of  face;  wound  of  neck  suppurating.     In  the  afternoon  a  <anious  discharge     Left    com- 
!•  ...  .  c  i  TIM  p  i  i       mon    euro- 

came  on  from  the  place  of  operation,  giving  reason  to  rear  haemorrhage  from  the  artery.  Ihe  oozing  from  the  neck  tid;  ulcer- 
continued,  and  the  patient's  condition  was  about  the  same  on  the  following  dav  until  2.30  P.  M.,  when  the  attending  "tionornrt- 

B        J  •      ery     witli- 

surgeon  was  called  in  haste  and  found  that  the  carotid  had  given  way  and  the  blood  was  gushing  per  saltum  from     out  forma- 

the  wound.  Death  supervened  in  a  few  minutes.  At  the  post-mortem  examination  the  artery  was  found  to  have  spec* K)8  ' 
ulcerated  through  anteriorly  where  the  ligature  was  applied.  No  attempt  at  union  of  the  inner  coats  of  the  vessel 
was  discovered,  and  no  fibrinous  deposit  was  found  on  the  cardiac  side,  it  having  doubtless  been  forced  out  by  the  haemorrhage. 
The  distal  side  was,  however,  occupied  by  a  plug  extending  up  to  the  bifurcation  of  the  vessel.  The  history  of  the  case, 
together  with  the  injured  portion  of  the  ligated  artery  (tfper.  898),  represented  in  the  annexed  cut  (FlG.  421),  was  contributed  to 
the  Museum  by  the  operator. 

TABLE  CXXVI. 
Condensed  Summary  of  Eighty-two  Cases  of  Ligations  of  the  Common  Carotid  for  Shot  Injuries. 

[Recoveries,  1— H):  Deaths,  20—82.] 


No. 

NAME, 
AUK,  ANI>  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
H.KMOU- 
KHAQE. 

PROBABLE  SOURCE 

OF 

HJEMOIUUIAGE. 

DATE 

OF 

OPERA- 

TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Ames,  J.  F.,  Pt.,  G, 

Mar.  31, 

Fracture  left    nasal 

Apr.  5,     Branch  of  internal 

Apr.  5, 

Left  ;  in  upper  3d,  in 

Discharged  July  3, 

91st  N.  Y.,  ago  24. 

1865. 

and   superior  max- 

1865.         maxillary  artery. 

1865. 

cont.      Surg.  T.  R. 

1865. 

illary  bones. 

Crosby,  TT.S.V. 

2     Andrews,  W.  C.,  Pt., 

Dec.  28,    Shell  wound  left  tern-    Jan.  18,    Middle  meningeal 

Jan.  18, 

Left;  in  continuity. 

Discharged  May  28, 

A,30thIo\va,agelO. 

1862.          poral  region. 

1863.         arterv. 

1863. 

Ass't    Surp.   C.  T. 

1803. 

Alexander,  F.  S.  A. 

3     Beamenderfer.C.W., 

May  C, 

Fracture   left  lower  .  May  12,     Carotid  artery  May  12, 

Left;  in  continuity,    Discharged  Nov.  29, 

Pt.,    A,   84th    Pa., 

1864.         maxilla;  excision. 

1861. 

1861. 

just  above  clavicle.  !    1864. 

ago  20. 

4     Heard,  ./.  J.,  Lieut., 

Aug.  13,    Fracture  of  inferior 

Aug.  21.    Common  carotid  ...   Sept.  4. 

;  in  continuity.    Recovered. 

B.    19th  Va.   Cav., 

1804.     i    maxilla.                        Sept.  4, 

1864. 

Surg.  W.  S.  Lov'o,  ; 

ape  28. 

1864. 

1'.  A.  U.  S. 

5    Brooko,  J.,Pt.,1,  57th 

May  6,  ,  Fracture  left  tempo-    June  —  , 

Temporal    artery  ;    June  20, 

Left;  in  continuity.    Discharged  June  8, 

Pa.,  age  17. 

1864. 

rnl  bone.                          1864. 

June  18,  lig.  temp. 

1864. 

Sure.  T.  K.  Crosby,      1865. 

U.S.  V.  Aug.  15,  re-  . 

» 

, 

ligation  below  omo- 

hyoid. 

0     Cox,  I).,  Pt.,  F,  15th 

Nov.  25,    Fracture  left  lower 

Nov.  25, 

Subliugual  artery  . 

Nov.  29, 

Left;  in  continuity.    December  3,  left  ca- 

Indiana,  age  25. 

1863.          maxilla. 

1863. 

1863. 

Surz.  A.McMahon,       rotid  ligated.    Dis- 

U.  S.  V.                            charg.  June  2.'.,  1804. 

WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

NAME, 
AGE,  XXD  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OK  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

7 
8 

Fugleson,  C.,  Serg't, 
E,  4th  Ohio,  age  35. 

Hayden  J  S   Pt   D 

Mav  12, 
1864. 

Feb  li 

Flesh  woundoflower 
jaw. 

June  25, 
1864. 

Mar.  8 

ligation  facial 
artery. 

Julv  l, 

1864. 

Mar  22 

Right;  in  continuity. 
Surer.  D.  W.  Bliss, 
U.S.V. 

Discharged  October 
27,  1864. 

Discharged  July  23, 

9 
10 
11 
12 
11 

2(1  Iowa. 
Hisgins,  P.,  Pt.,  K, 
56th  New  York 

Klingenberg.C.,  Pt., 
F.  7th  New  York 
Artillery. 
Malev,  T.  E.,  Lieut., 
5th  Cavalry,  age  29. 

Merchant,     G.     B., 
Serg't,  K,  4th  Ohio, 
age  33. 
Murrav  J.  L.  Pt.  B 

186-'. 
May  31, 
1862. 

Juno  3, 

1864. 

July  28, 
1864. 

Mav  10, 
1864. 

Oct.  14 

bone. 
Fracture  lower  jaw.  . 

Fracture  lower  jaw.  . 
Fract  bones  of  face  . 

Fract  inferior  max 
illa. 

1862. 
May  31, 
1862. 

June  9, 

1864. 

Aug.  18, 
1864. 

Mav  15, 
1864. 

Oct.  25 

Sublingual  artery  . 

Internal  maxillary 
artery. 

Internal  maxillary 
artery. 

1862. 
May  31, 
1862. 

June  9, 
1864. 

Aug.  24, 
1864. 

May  15, 
1864. 

Oct.  25 

J.  Moore,  U.  S.  A. 
Right;  in  continuity. 
Surg.Z.E.  Bliss,  U. 

s.v! 

Right;  in  continuity. 
Surg.  D.  P.  Smith, 

u.sTv. 

Right;  in  continuity. 
Surg.  A.  B.  Mbtt, 
U.  S.  V. 
Right;  in  continuity. 
Ass't  Surgeon  W. 
Thomson,  U.  S.  A. 

1862. 
Discharged  Sept.  21  , 
1862. 

Discharged  Feb.  20, 
1805. 

Retired     December 
15,  1870. 

Returned    to    duty 
June  19,  18G4. 

Discharged  Feb.  13, 

14 

42d  N.  Y.,  age  32. 
Flasket    J.    Pt.,  A, 

1863. 
Sept.  9 

ilia. 
Fracture  of  bones  of 

1863. 
Sept.  9 

1863. 
Sept.  9 

Surg.  E.  Bentley,  U. 
S.V. 
Carotid  ;  in  continu 

1864. 
Transfer'dtoV.  B.C. 

15 

120th  New  York. 
Reed  J  K  F  Ser^'t 

1864. 
Sept  17 

face. 

1864. 

1864. 
Sept  28 

ity.  Surg.W.B.Rev- 
iiolds,  2d.U.  S.  S.  S. 

May  4,  1865. 

16 

IT 

Ifl 
19 

D,  13th  Mass. 
Salmon.  G.E.,Pt,  I, 
207th  Pa.,  age  26. 
Sandv.N.B.,  Ft.,  G, 
.'id  W.  Va,,  age  19. 

Shockey,  D.,  Pt.,  I, 
101st  Jnd.,  age  22. 

1862. 
Apr.  2, 
1805. 
Aug.  30, 
1862. 

Sept.  19, 
1863. 
Mav  27 

face,  right  side. 
Fracture  right  infe 
rior  maxilla. 
Fracture  left  inferior 
maxilla. 

Fracture  left  lower 
jaw 

Apr.  10, 
lf-65. 
Sept.  6, 
1862. 

Sept.  25, 
1863. 
May  31 

Right  common  ca 
rotid. 
Through  mouth  .. 

Haem.  recur.  Sept. 
30,  Oct.  6,  9,  10. 

1862. 
Apr.  11, 
3865. 
Sept  6, 
1862. 

Oct.  14, 
1863. 

Right;  in  continuity. 

Right;  in  continuity. 
A  ss't  Surg.  P.  Adol- 
phus,  U.  S.  A. 
Left;  in  continuity. 
Confederate  surg. 

1862. 
Discharged  May  18, 
1865. 
Discharged  October 
10,  1862. 

Discharged  June  24, 
1865. 
Recovered. 

20 
?1 

49th  Mass. 

Ashley,  J.  J.,  citizen, 
age  63. 
Backus,  J.   W.,   Pt., 

1863. 

Oct.  16, 
1864. 
July  9, 

bones. 

Wound  of  left  ear, 
sloughing. 
Fracture  right  infe 

1863. 

Oct.  29, 
1864. 
July  20 

Temporal  artery  .  . 
Facial  artery  

1863. 

Oct.  29, 
1864. 
July  25, 

Surg.  F.C.Greene, 
30th  Mass. 
Left  ;  in  cont.    A.  A. 
Surg.  N.  A.  Robbing. 
Right;  in  cont.  Ass't 

Died   November   2, 
1864. 
Died    September    1, 

22 
23 
*>4 

A,  12th  Ga.  Batt'y, 
age  20. 

Baine,    H.,    Pt.,    C, 

188th  Pa.,  age  19. 

Beare,  J.,  Pt.,G,  llth 
Pa.,  age  34. 

Bowles,  G.W.,  Serg't, 

1864. 

June  3, 
1864. 

Mav  10, 

1864. 

July  3 

rior  maxilla. 

Wound  left  side  of 
face. 

Injury  com.  carotid 
artery  and  external 
jugular  vein. 

1864. 

June  15, 
1864. 

May  10, 
1864. 

July  9 

Internal  maxillary 
artery. 

Common  carotid  .  . 

1864. 

June  16, 
1864. 

May  15, 

1864. 

July  10 

Surg.  R.  F.  Weir,  U. 
S.A.  Aneurism  ;re- 
lig.  above  and  below 
aneurism,  Aug.  30. 
Left;  in  continuity. 
Surg.  N.  R,  Mose- 
ley.TJ.  S.  V. 
Left  ;  in  cont  and  ext. 
jug.  vein.    Surg.  E. 
Bentley,  U.  S.  V. 

1864. 

Died  June  26,  18(54; 
exhaustion. 

Died  May  21,  1864; 
pysemia. 

Died  July  13,  1863. 

25 
26 

?7 

I,  42d  Fa,,  age  25. 
Bovts,    H.,    Ft.,   A, 
142d  Pa.,  age  18. 
Brown,  G,  Ft.,  I,  25th 
Mass.,  age  41. 
Burns,  R.,  Ft.,  10th 

1863. 
Aug.  21, 
1864. 
Dec.  14, 
1862. 
May  31 

ilia. 
Fracture  left  tempo 
ral  region. 
Fract.  malar,  temp., 
and  max.  bones. 

18S3. 
Aug.  26, 
27,  1864. 
Jan.  7, 
9,  1863. 

External  carotid.  .  . 

1863. 
Aug.  27, 
1864. 
Jan.  9, 
1863. 

Left;  in  continuity.. 
Right;  in  continuity 
In    continuity  ;    lin 

Specs.  3969,  3902. 
Died  Sept.   2,    1864. 
Spec.  3179. 
Died   Jan.  18,  1863; 
exhaustion. 
Died  Juno  19,  1862; 

28 

?ft 

Massachusetts. 
Clark,    J.,    Pt.,    H, 
57th  Pa.,  age  21. 

Copeland,  W.  Ji.,  Pt, 

1862. 
Sept.  30, 
1864. 

Sept.  19 

neck. 
Fracture  right  upper 
jaw. 

Wound  left  side   of 

Oct.  13, 
1864. 

Oct.  7 

External  carotid.  .  . 

1862. 
Oct.  13, 

1864. 

Oct.  7 

gual  also  tied. 
Right;  in  continuity. 
A.  A.  Surg.  J.  H. 
Packard. 
Riirht-  in  continuity. 

exhaustion. 
Died  Oct.  22,  1864,  of 
haemorrhage. 

Ha3m.  recurred;  died 

30 

B,  61st  Ala.,  age  34. 
Oreecy,  B.,  Pt.,  F,42d 

1864. 
May  3, 

face. 
Shot  wound  of  lar 

1864. 
May  12 

1864. 
Mav  12, 

Surg.  W.  S.   Love, 
F.  A  C.  S. 
Ri^ht  •  in  continuity. 

Oct.  8,  1864. 
May  15,  left;  in  cont. 

31 

rt? 

Va. 

Cronin,   M.,  Pt.,  F, 
95th  N.  Y.,  age  19. 
Darnabv,  E.,  Ft,  H 

1863. 

June  19, 
1864. 
Apr.  12 

ynx. 

Wound  right  side  of 
face. 

1863. 

July  1, 
1864. 

Internal  maxillary 
artery. 

1863. 

Julv  4, 
1864. 

Surg.  R.  Murdock, 
P.  A.  C.  S. 
Right  ;  in  continuity  ; 
religated  July  6. 

Died  May  20,  1863. 

Died   July    6,  1864; 
haemorrhage. 
Died  May  5,  1805,  of 

33 
34 
35 

1st  Maine  Cav.,  age 
19. 
Deibold,   C.,  Lieut., 
D,  82d  Ohio. 

Dougherty,   J.,  Ser 
geant,  B,'69th  N.Y., 
age  23. 
Felix.  W.,Pt,H,  9th 
W.  Va.,  age  18. 

1865. 

May  8, 
1862. 

May  13, 

1864. 

Aug.  25, 
1861. 

ang.   jaw  ;    carotid 
artery  wound. 
Shot  wound  of  neck 

Fracture    right   pa 
rietal. 

Fracture  right  lower 
jaw. 

May  23, 
1862. 

May  16, 

1864. 

Sept.  3, 
1864. 

External  carotid 
sloughed. 

Middle  meningeal 
artery. 

Lingual  artery  

Mav  24, 
1862. 

May  16, 
1864. 

Sept.  3, 
1864. 

ing    Staff  Surgeon 
N.  F.  Graham. 
In  continuity.   Surg. 
J.  Y.  Cantwell,  8*1 
Ohio 
Right;  in  continuity. 
Surg.    E.    Bentley, 
U.  S.  V. 
Left;  in  continuity. 
Ass't  Surg.   R.  F. 
Weir,  U.S.  A. 

haemorrhage. 
Died  June  19,  1862. 

Died  May  26,  1864,  of 
exhaustion. 

Died  Sept.  4,  1864,  of 
haemorrhage. 

36 

Fisher,  "W.,   Lieut., 

Oct.  7, 

Facial   and    carotid 

Facial  and  carotid 

Oct.  9, 

Left;  in  continuity. 

Died  Oct.  10,  1864. 

37 

H,  99th  Pa. 
Fonderan,  A.,Serg  t, 

1864. 
June  24, 

arteries  severed. 
Fracture  lower  jaw 

July  7 

arteries. 

1864. 
July  8 

Surg.  W.    B.    Rey 
nolds.  2d  U.  S.  S.  S. 
Right  -in  continuity  ; 

Died  July  10,  1863, 

38 

39 
40 

D,  llth  Indiana,  age 
25. 

Gardner,  J.  B.,  Pt, 
F,  5th  Louisiana. 

Guthi-ie,   W.  T.,  Pt, 
F,  38th  Va.,  age  30. 
Harrington,  M.,  Ft., 

1863. 

Feb.  7, 
1865. 

Mav  16, 
1864. 
Julv  24, 

right  side. 

Ball  entered  anterior 
to  left  ear. 

Wound  of  face  
Wound  through  neck 

1863. 

Feb.  17, 
1865. 

June  19, 

22,  1864. 
Aug.  9 

Recur.   20th,  21st, 
and  22d. 

Superior  maxillary 

1863. 

Feb.  22, 
1865. 

June  23, 
1864. 
Aug.  10, 

religated  at  bifurc. 
ext.  and  int.  car.  ; 
inc.  in  ligature. 
Left;  in  continuity. 
Surg.  W.  F.  Rich 
ardson,  P.  A.  C.  S. 
Left;  in  continuity.. 

Left  •  in  continuity, 

from    exhaustion. 
Specs.  1635,1636. 

Died  Feb.  22,  1865. 

Died  June  25,  18f.4  ; 
exhaustion. 
Died  Aug.  ft),  1864. 

41 

L,  21st  N.  Y.  Cav., 
age  19. 

Reiser,  J.,  Oorp'l,  1, 
53d  Fa.,  age  27. 

1864. 

Aug.  14, 
1864. 

Shot  wound  of  face.  . 

1864. 

Aug.  24, 
25,  1864. 

Inferior  maxillary 
artery. 

1864. 

Aug.  25, 
1864. 

Surg.  J.  B.   Lewis, 
U.  S.  V.     Aug.  14, 
lig.  right  com.  car. 
In  cont    Surg.  N.  R. 
Moseley,  U.  S.  V. 

Died  Aug.  30,  1864; 
exhaustion. 

C1IAP.    XII.] 


LIGATIONS    OF    THE    COMMON    CAROTID    ARTERY. 


769 


No. 

NAME, 
AGE,  AND  MILITARY 

DATE 

OF 

NATURE  OF  INJURY. 

DATE 

OF 

1  IjKMOU 

PROBABLE  SOURCE     DA™      OPEUATIOX    OrEUA. 

RESULT. 

DESCRIPTION. 

INJURY. 

RHAGK. 

HEMORRHAGE.          ^JQ!^" 

42 

Herman,  H.,  Pt.,  I, 

Sept.  17, 

Wound  of  neck  ;  ball 

Sept.  29, 

Carotid  artery  ;  an-  i  Sept.  30,  '  Right  ;  both  ends  in 

Died  Oct.  1,  1802. 

12th  Pa.  Res.,  ago 

1862. 

lodged     in     spinal       1862.         curism.                        1862.         wound.      A.  Suiir. 

23. 

•cord.                                                                                                          R.  F.Wcir,  T.  S.  A. 

43 

Houston,  J.  C.,  Pt., 

Apr.  9, 

Fracture  tight  malar     May  6, 

Branches  external     May  7,     Left;  in  continuity. 

II&iu.  recurred;  died 

I),  2(1  Ala,,  age  18.          1865.         bone.                                7,1865. 

carotid.                        1865.         Surg.  A.  McMaho'u, 

May  26,  1865. 

U.  S.  V. 

44 

Hughes,    D.    C.,    Pt..     M:iy—  .      Woun.l  nt  neck 

Left*  in  cout.    May 

Died  May  17,  1862. 

F,  llth  Virginia. 

1802. 

17,  lig.  ofrightcom. 

carotid. 

45 

Uutchins,  H.,  Pt.,  I, 

Dec.  9, 

Fracture    inf.    max-    Dec.  18. 

Lingual  artery  Dec.  18,  '  In  cont.    A.  A.  Surg. 

Died  Dec.  27,   1864  ; 

2oth  Ohio,  ago  25. 

1864.          ilia.                                    1864.  ' 

1     1864.         S.  Hendrickson. 

haemorrhage. 

46 

Huttx,  J/.,  Pt.,  C.  S. 

Fractuie  lower  jaw     '  June  7 

Juno  7   '  Ixi4fl)t  '  in  continuity 

Died  J  une  8,  1863. 

A.  ,  ago  35. 

1863. 

1863. 

47 

Jones,  E.,  Pt,,D,29th 

July  4,     Fracture  left  inferior    July  18, 

Brach.,  facial,  and    July  18, 

Left;  in  continuity  .  . 

Haem.  recurred  ;  died 

Iowa. 

1863          maxilla.                           -1863. 

lingual  arteries.         1863. 

July  26,186:;. 

48 

Junes,  J.  P.,  Pt.,  E, 

May  3,     Fracture   left  supe- 

June  3, 

Slough,  rcc.  5,  6,  7. 

June  7,    In  continuity  

Died  Juno  7,  1863;  ex 

21st  Miss.,  ago  30.     [     1863.          rior  maxilla. 

1863. 

1863. 

haustion. 

49 

Juugk,  J.  G.,  Serg't,    Sept.  3'),    Fracture  right  upper  |   Oct.  7,    |  External  carotid 

Oct.  7,     Right  :incont.  A.  A. 

Died  Oct.  12,  1864,  of 

F,46thX.Y.,age30. 

1864.         jaw.                                 18C4.         artery.                        1864*         Surg.G.  A.Chcsley. 

haemorrhage. 

50 

Keiflin,  V.  L.,  Serg't, 

July  2,     Fracture  right  arch    July  12,    Internal  carotid  ...  July  13,    Right,  in  continuity. 

Died  July  14,  1863. 

K,  105th  Pa. 

1863.         of  atlas.                      i     1863. 

1863.        Surg.  H.  Palmer,  U. 

S.  V. 

51 

Kenrick,  A.  F.,  Pt,, 

June  2, 

Wound  of  face   ....    June  17, 

Recurred  18th  and   June  19, 

Left  ;  in  continuity  .  . 

Died  June  22,  1864. 

A,  16th  Kv.,  age  24. 

1864. 

1864. 

19th.                            1864. 

52 

Kilburu.D.'W.,Pt,,I,     May  19, 

Wound  of  face  and    May  29, 

Facial  and  exterior 

May  29, 

Right  ;  in  cont.    A. 

Died  June  2  1864,  of 

1st  Maine,  ago  22. 

1864. 

neck.                          ,     1864. 

carotid  arteries. 

1864.          A.  Surg.  J.  C.  Nel 

asphyxia. 

j 

son. 

53 

Klink,N.,  Pt.,K,95th 

M;iv  3 

Wound  ri<rht  side  of    May  14, 

.    .       .                            TVT:iv1fi    !  Hir^ht..  in  coiitimiitv 

Died  May  20,  1863. 

Pa.,  ago  26.                      1863. 

face.                                1863. 

1863.     I 

54 

Lilley,  E.  F.,  Pt.,  G,     Max-  9 

Wound  of  face              M.ivifi 

M:i  v  Ifi 

Right;  in  continuity  . 

Died  May  16,  1864. 

8th  Texas,  age  24. 

1864. 

1864. 

1864".  ' 

55 

McGuire,  J.  H.,  Pt., 

Sept,  26, 

Fracture   left    inas- 

Oct,  10 

Left;  in  continuity.  - 

Died  Oct.  24,  1863. 

K,  24th  Miss. 

1863. 

toid  process. 

1863. 

56 

Mcllroy,  J.  P.,  Pt., 

June  3 

Fract.  inf.  maxilla  • 

...                                     I.Tiinttlft      Tn  cunt.     A    A    Snr<r 

Died  Juno  19,  1864; 

C,  4otii  Pa. 

1864. 

int.  max.  art.  ini. 

1864.  '  j     J.  H.  York. 

haemorrhage. 

57 

Melunis,  S.,  Pt.,  A, 

May  22,  !  Fracture  lower  jaw  ; 

May  31, 

External  carotid  .  .  <  May  31,  '  In  cont,    Surg.  E.  M. 

Died  Juno  7,  1863. 

llth  Illinois,  age  27. 

1863.     i    right  side. 

1863. 

1863.         Powers,  7th  Mo. 

58 

McIntoah,T.,  Pt.,A, 

Nov.  25   1  Fract.  frontal  l>mn< 

Tiff  Ifi 

Dec.  16       Rio'lit,-  in  <*,nnt,inuitv 

Died    Dec.  19,  1863  ; 

40th  Ind.,  age  18. 

1863. 

17,1863. 

1863. 

exhaustion. 

59 

McKenney,   E.,  Pt., 

Jan.  1, 

Wound  through  left     Jan.  1, 

Aneurism  Feb.  26,    Left  ;  in  cont.    Ass't 

Died  April  6,  1863. 

6th  Pa.  Cav.,  age  26. 

1863. 

side  neck.                       1863. 

1863.         Sui  g.  R.  F.Weir.U. 

S.  A. 

60 

Martin,  T.B.,Pt.,E, 

Sept.  20,    Fract.  orbital  plate 

Oct.  8, 

Ophthalmic  artery  ;    Nov.  11, 

Riuht;  in  cont.    A. 

Died  Dec.  19,  1863. 

96th  111. 

1863.         and  nasal  bones. 

1863. 

haemorrhages  Oct.       1863. 

A.  Surg.  J.  H.  Coo- 

23  and  Nov.  7,  10. 

ver. 

61 

Messenger,  P.  B.,  Ser 

Nov.  24, 

Fracture  right  lower 

Dec.  3, 

Internal  carotid  .  .  . 

Dec.  3, 

Right;  both  ends  in 

Died  Dec.  8,  '63.  Spec. 

geant,  A,  lllth  Pa. 

1863. 

jaw. 

1863. 

i     1863. 

wound.     Assistant 

2018,  A.  M.  M, 

Surgeon  H.  Pearce, 

150th  N.  Y. 

62 

Moore,  J.  G.,  Corp'l. 

Feb.  6, 

Wound  left  side  of  |  Feb.  15, 

Internal  carotid.  .  .    Feb.  15, 

Left;   in  continuity. 

Died  Feb.  25,  1865. 

B.  110th  Pa.,  age  20. 

1865. 

head. 

1865. 

1865. 

Feb.  21,  religated. 

63 

O'Connor,  P.,  Pt,,  H, 

Sept.  20, 

Fracture  left  inferior     Oct.  2, 

Facial  art.;  Oct.  4,     Oct.  23. 

Right;  in  continuity. 

Died  Oct.  25,  1863,  of 

18th  Inf. 

1863. 

maxilla.                          1863. 

ligature  ext.  caro 

1863.          Surg.  L  Moses,  TJ. 

exhaustion.     Spec. 

tid.     Surg.  P.  H. 

S.V. 

2133. 

Cleary,  U.  S.  V. 

64 

Peckham,  A.  J.,  Cor 

Jllllt^   ** 

Fracture  cranium 

.Tnn«  8 

Right;  in  continuity. 

Died  Juno  13,  1864; 

poral,!,  115th  N.Y., 

1864.'' 

1864. 

Surg.   E.    Bentley, 

exhaustion     from 

age  30. 

U.  S.  V. 

continued  haem.     * 

65 

Phillips,  G.,  Corp'l, 

Oct.  27, 

Left  inferior  maxilla.    Nov.  4, 

Lingual  

Nov.  6, 

Left;  in  continuity. 

Died  Nov.  18,  1864,  of 

H,  91st  Pa.,  ago  28. 

1864. 

6,  1864. 

1864. 

Surg.  N.  R,  Mose- 

exhaustion.     Spec. 

ley,  U.  S.  V. 

3409. 

66 

Pvle,  L.  A.,  Serg't, 

Aug.  25, 

Ball     impinged     on 

Sept  7, 

Post,  auricular  ar 

Sept.  9, 

Right;    in    continu 

Died  Sept.  20,  1864  ; 

A,  8th  N.  Y.  Art., 

1864. 

temporal  bone. 

9,  1864. 

tery. 

1864. 

ity.    A.  A.  Surgeon 

haemorrhage.  Spec. 

ago  21. 

"W.  W.  Valk. 

3252. 

67 

Quick.  J..  Corp'l,  G, 

Dec.  13,     Fracture  left  lower 

Dec.  25, 

Recurred  26th  and    Dec.  27, 

Left;  in  cont,    A.  A. 

Died  January  6,  1863. 

38th  N.Y.,  age  21. 

1862.        jaw. 

1862. 

27th. 

1862. 

Surg".  H.  N.  Fisher. 

Spec.  8G8,  A".  M.  M. 

68 

Reeves,  W.,  Pt.,  C, 

May  6,     Fracture  of  inferior    May  12, 

Lingual    and    inf.     May  12, 

Left  ;    in  cont.     A. 

Died   May   13,   1864; 

761  h  N.  Y.,  age  22. 

1864.         maxilla.                          1864. 

dental  arteries.          1864.         Surg.  G.   A.   Mur- 

exhaustion. 

sick,  U.  S.  V. 

69 

Ritisran,  J.,   Pt.,  B, 

May  6, 

Fracture  of  inferior    May  14, 

Carotid  artery  ...     May  31, 

Right;  in  continuity. 

Died  June    1,  1864  ; 

C3d  N.  Y.,  age  30. 

1864. 

maxilla. 

1864. 

1864.         Surg.   G.    L.    Pan- 

prostration.   Specs. 

coast,  U.  S.  V. 

2481,  2482,  A.  M.  M. 

70 

Robinson,  J.  W.,  Cap 

June  19,    Wound  left  side  of 

June  19, 

Internal  carotid.  .  . 

Juno  19,  :  Left;  in  cont.    July 

Died  July  5,  1861. 

tain,  C,  27th  Geor- 

1864.         neck. 

1864. 

1864. 

3,  relig.  below  omo- 

eia,  age  21. 

hyoid. 

71 

lioUin,  J.  N.,  Pt.,  I, 

Oct.  19,     Ball  entered   hack  of 

Oct.  — 

Nov.  9, 

Tn  cont,     A.  A.  Surf. 

Died    Nov.   9,  1864  ; 

1st  N.  Carolina,  age 

1864. 

neck  ;  fracture  ver 

1864. 

1864.         G.  G.  Brewer. 

exhaustion. 

2K. 

tebra. 

72 

Schcnck,  W.,  Pt,,  F, 

June.  15, 

Fracture  sup.  max 

July  6,     Superior  maxillary 

July  10, 

In  cont.    A.  A.  Surg. 

Died  July  24,  1864; 

119th  N.York,  age 
18. 

1864. 

illa. 

1864.         artery.                        1864. 

D.J.  Griffiths. 

exhaustion. 

7.'J     Schlicher,  J.,  Corp'l,     July  1, 

Fracture  left    supe- 

July  8, 

Recurred  lOtli  and    July  16,    Left;  in  cont.    A.  A. 

Died   Aug.  23,   1863. 

C,  20th  Mass..  age  33.       1863.         rior  maxilla.                   1863. 

16th.                              1863.          Surg.  W.  W.  Keen. 

Spec.  4428.  A.M.  M. 

74     Sheppard,  P.,  Pt.,  K,    Aug.  1,     Fracture  nasal,  ma-    Aug.  29,  !  Internal  maxillary    A  us.  30.    Right;  in  continuity. 

Died   Aug.  30,  18C4  ; 

42d  Indiana,  age  34.  !     1864.         1  :ir,   and  inf.  max- 

1864.         artery.                    ;    1864. 

Surg.  13.  B.  Breed,  '' 

haemorrhage. 

illary  bones. 

TJ.  S.  V. 

75     Smith,  W.   W..  C.  S.     May  5,     Wound  of  head  and 

May  12, 

May  21, 

In  continuity  .  . 

Died  May  22,  18H4. 

A.                                    1864.         neck. 

1864. 

i     1864. 

76     Spacht,   M.,  Pt.,  D,     May  31,    Fracture  sup.  in;\\- 

Juno  13.   . 

June  14, 

Left  ;  in  cont.    A.  A. 

Died  June  24.   1862. 

52d  Pennsylvania. 

1862.     i    ilia.                               14.1862. 

1862. 

Surg.  D.  W.  Chee- 

Spec.  508,  A.  M.  M. 

ver. 

77    Stie-nberger,  S.,  Pt., 

May  5,     Fracture  lower  iaw 

MavlS,     Vertebral    artery.     Mav  16,    In  cont,    Surg.  R.  B. 

Died    May  23,  1862; 

1st  Cavalry.               \     1862.         and  3d  cervical  ver 

1862.                                             1862.          Bontecon,  U.  S.  V. 

haemorrhage. 

tebra, 

78    Theilman,  II.,  Pt.,  K,   Juno  19,    Wound  left  side  face; 

July  6,     Left  ;  in  cont.    A.  A. 

Died  July  12.  1864; 

15th  New  York  Ar- 

1864.         fracture. 

1864.          Sura.  O.  W.  Peck. 

exhaustion. 

tillury.  age  37. 

SURG.  111—97 


770 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII 


No. 
79 

80 
81 

82 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OP 

INJURY. 

XATURE  OF  I.VJUUY. 

DATE 

OF 

HJEMOR- 

KHAGIi. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 
Ol'ERA- 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Thomas,  G.,  Pt.,  C, 
82d  Pa.,  age  22. 

Trabey,  H.,  Pt.,   L, 
5tb.Pa.Cav.,  ace  26. 
Ward,  P.  H.,  Pt.,  B, 
24th  Wisconsin. 
Winter,  F.,Pt.,A,3d 
Illinois  Cav.,  age  24. 

May  10, 
1864. 

May  8, 
1804. 
Dec.  30, 
1862. 
Aug.  21, 
18G4. 

Fracture  infer'r  and 
superior  maxillae. 

Shot-  wound  of  face. 

Fracture   inf.    max 
illa. 
Fracture  upper  and 
lower  jaws. 

June  2, 
1864. 

June  26, 
1864. 

Internal  maxillary 

June  2, 
1864. 

June  27, 
18G4. 
Jan.  —  , 
186.'!. 
Sept.  6, 
1864. 

Left  ;  in  cont.      A. 
Sure.  W.  Thomson, 
U.  S.  A.    Int.  jug. 
vein  also  tied. 
In   cont.      A.  Surg. 
W.Webster,TJ.S.A. 
Right  ;    in    continu 
ity. 
Lei't  ;  in  cout.    A.  A. 
Surg.  J.  Z.  Hall. 

Died   June    3,  1864. 
Spec.  3542,  A.  M.  M. 

Died  July  5,  1864. 
Died  Jan.  15,  1863. 

Died    Sept.  7,  1864; 
exhaustion. 

Inferior  maxillary 
artery. 
Internal  maxillary 
artery. 

Sept.  4, 
1864. 

legations  of  the  Internal  Carotid  Artery. — Instances  of  this  operation  are  rare,1  and 
no  cases  were  reported  by  the  medical  officers  of  the  Union  army. 

Jjigations  of  the  External  Carotid. — Of  seven  cases,  four  recovered  and  three  were 
fatal.  The  bleedings  were  from  the  internal  maxillary  in  two,  from  the  carotid  in  four 
instances ;  in  one  case  the  source  of  the  haemorrhage  was  not  indicated. 

TABLE  OXXVII. 
Condensed  Summary  of  Seven  Cases  of  Jjigations  of  the  External  Carotid  Artery  for  Shot  Injuries. 

[Recoveries,  1 — 4;  Deaths,  5 — 7.1 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

DATF, 
NATURE  OF  INJURY.    Hj£*OK. 

KIIAGE. 

PROBABLE  SOURCE     ^Q^& 
HEMORRHAGE.     ,  °,™^' 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

2 
3 
4 
5 

6 

7 

Bryant,  W.,  Pt.,  B, 
17th  Indiana. 
Diss,  C.  A.,  Pt.,  D, 
30th  Ohio. 
Henderson,  G.,Serg., 
F,  7th  Wisconsin. 
Thompson,  L.  0.,1't., 
S,  1st  Texas,  age  20. 
Godfrey,  A.,  Pt.,  U, 

June  25, 
1803. 
Sept,  14, 
1802. 
Sept.  14, 
186.'. 
Dec,  14, 
1864. 
Juno  18, 
Ife64. 

June  6, 
1864. 
June  3, 
1864. 

Fract.  left  malar  and 
maxillary  bones. 
Fract,  superior  max 
illa. 
Fract.  inferior  max 
illa. 
Fract.  inferior  max 
illa. 
Wound   of  external 
carotid. 

Fracture  of  zygoma. 

Fract.  right  orb.  and 
zygomatic  arch. 

July  5, 
8,  '63. 
Sept.  22, 
1862. 
Sept,  15, 
1862. 
Dec.  14, 
1864. 
June  27, 
18G4. 

June  7, 
1864. 
June  15, 
1864. 

External  carotid  .  . 

Internal  maxillary 
and  carotid. 
External  carotid  .  . 

Internal  maxillary. 
External  carotid  .  . 

Internal  maxillary. 

July  8, 
1863. 
Sept.  22, 
1802. 
Sept,  15, 
1802. 
Dec.  14, 
1804. 
June  27, 
1864. 

June  7, 
1864. 
June  16, 
1864. 

One  end  in  wound  .  .  . 

In  cont.    Surg.  H.  S. 
Howit.TJ.  S.  V. 
In  continuity     

Returned    to     duty 
June  11,  1864. 
Discharged  Nov.  24, 
1862. 
Discharged  Oct.  25, 
1802. 
Recovered  Juno  14, 
1865. 
Died  Juno  30,  1864. 

Died  June  10,  1864. 

Died  June  16,  1864,  of 
exhaustion. 

In  cont.    Surg.  J.  C. 
Jones,  4th  Texas. 
Both  ends  in  wouud. 
Surgeon  G.  L.  Pan- 
coast,  U.  S.  V. 

14th   X.   Y.  Art'y, 
ago  16. 
Nelson,  G.  TF.,  Pt.,K, 
12th  Georgia. 
Whitney,  F.  L.,  Pt., 
D,  3Uth  Massachu 
setts,  age  24. 

In  continuity.    A.  A. 
Surg.  W.  H".  Ensign. 

Thirty-five  examples  of  ligations  of  minor  branches  of  the  external  carotid  were  reported. 
They  comprise  one  ligation  of  the  superior  thyroid,  one  of  the  lingual,  five  of  the  occipital, 

1  On  the  Confederate  side  a  case  is  related  by  Dr.  W.  H.  BRAMLETTE.    It  will  be  found  on  page  194  of  the  Medical  Record,  New  York,  1869-70' 

Vol.  IV :  Captain  H ,  5th  Georgia  State  Reserves,  aged  47,  was  wounded  December  10,  1864,  by  a  mini6  ball,  which  comminuted  the  malar  bone,  and 

ranging-  backward,  impinged  against  the  base  and  inner  border  of  the  mastoid  process,  passing  out  at  back  of  neck.  lie  was  sent  to  a  hospital  at 
Macon,  where  the  fractured  bone  was  removed;  secondary  haemorrhage  occurred  on  the  tenth  day  from  wound  of  entrance,  which  was  controlled  by 
pressure  on  common  carotid  until  the  arrival  of  the  surgeons.  The  ordinary  incision  was  made  and  the  internal  carotid  ligated,  as  was  believed,  about 
three-fourths  of  an  inch  above  the  bifurcation ;  haemorrhage  from  wound  ceased  ;  ligature  came  away  on  14th  day  without  haemorrhage.  On  the  follow 
ing  day  an  alarming  haemorrhage  recurred  from  a  small  opening  in  the  line  of  the  incision  of  the  neck  ;  the  common  carotid  was  then  ligated  below  the 
omo-hyoid  muscle ;  haemorrhage  continuing  through  the  reflow  of  the  blood  through  the  external  carotid,  the  latter  was  ligated,  as  also  the  superior  thyroid. 
The  ligatures  separated  and  came  away  without  haemorrhage — that  of  the  common  carotid  about  the  18th  day  ;  but  a  few  hours  afterwards  haemorrhage 
recurred  while  straining  at  stool.  This  time  the  haemorrhage  was  arrested  by  styptics  and  pressure.  No  further  luemorrhages  occurred.  The  wounds 
healed  ia  three  weeks,  and  the  patient  was  furloughed  and  went  home.  Since  the  war  a  case  in  which  ligatures  were  placed  around  the  internal  as  well 
as  the  external  and  common  carotid  for  shot  injury  is  reported  by  W.  U.  BYKD  (Ligation.  of  the  Common,  External,  and  Internal  Carotid  Arteries  for 
Gunshot  Injury— Death,  in  New  York  Medical  Journal,  1876,  Vol.  XXIV,  p.  174):  A  policeman,  shot  by  thieves  at  Quincy,  Illinois,  May  29,  1876.  Wounds 
of  lip,  chin,  and  fracture  of  jaw  ;  ball  split  in  three  pieces,  one  of  which  split  the  external  cnrotid  artery,  with  the  point  impinging  upon  and  entering  the 
left  internal  carotid  a  half  inch  above  the  division  of  the  left  common  carotid.  Profuse  haemorrhage.  May  30,  1876,  common  carotid  ligated  just  below 
bifurcation,  and  internal  and  external  carotids  just  above  points  of  injury ;  died  20  minutes  after  operation.  The  first  ligation  of  the  internal  carotid  seems 
to  have  been  performed  by  KEITH,  in  1850,  who,  while  removing  a  foreign  body,  accidentally  cut  the  internal  carotid :  KEITH  ( W.)  (Case  of  Wound  of  the. 
Internal  Carotid  Artery,  inflicted  while  operating  from  within  the  Mouth  for  the,  removal  of  a  foreign  body  deep  in  the  Neck— Ligature,  of  the  Internal 
Carotid— Hxmorrhage  controlUd  by  a  Single  Ligature,  and  Cure,  in  The  Monthly  Journal  of  Uedical  Science,  Edinburgh,  1851,  Vol.  XII,  p.  435).  Two 
operations  fi.r  punctured  wounds,  and  one  after  disarticulation  of  the  lower  jaw  for  malignant  tumor,  have  been  reported  by  :  LEWIS  (M.),  Double  Ligation 
of  the  Internal  Carotid  Artery  in  1869,  by  Dr.  A.  T.  LEE,  deceased,  formerly  of  Kingston,  Temt.,  in  Am.  Jour.  Med.  Sci.,  1879,  Vol.  LXX.VII,  p.  142. 
BRIGGS  ( W.  T.),  Traumatic  Aneurism  of  the  Internal  Carotid  Artery,  the  remit  of  a  Puncture— Ligation  of  the.  Internal  Carotid  at  the  seat  of  the 
Injury,  in  Nashrillc  Journal  of  Sled,  and  Surgery,  1874,  Vol.  XIII.  p.  119.  SANDS  (H.  B.),  A  Case  of  Ilxmorrhage  from  the  Internal  Carotid  Artery 
treated  successfully  by  the  Ligature,  in  New  York  Medical  Journal,  1871,  Vol.  XIX,  p.  34. 


CHAP.  XII.] 


LIGATIONS    OF    THE    TEMPORAL    ARTERY. 


771 


one  of  the  auricular,  eighteen  of  the  temporal,  eight  of  the  facial,  and  one  of  the  submental 
arteries.     The  results  are  indicated  in  TABLE  CXXV,  on  page  765. 

Liyation  of  Superior  Thyroid. — CASE  1107. — Private  G.  Atwoocl,  Co.  H,  142d  New  York ;  shot  injury  of  inferior  maxillary 
region,  October  27,  1864.  Haemorrhage  occurred  from  branch  of  superior  thyroid  November  7,  18G4.  Ligation  of  both  ends  in 
wound  November  7,  1864.  Discharged  April  19,  1865. 

Liyation  of  Lingual  Artery. — CASK  1103. — Private  P.  Everson,  B,  1st  Minnesota;  shot  through  base  of  tongue;  jaw 
fractured,  July  2,  18G3.  Haemorrhage  from  both  linguals  occurred  July  14th;  both  arteries  tied  en  masse  in  wound  on  the  same 
day.  Discharged  June  12,  18G4  ;  unable  to  eat  other  than  liquid  food. 

Lirjations  of  Occipital  Artery. — CASES  1109-1113. — Private  L.  C.  Adzcr,  K,  9th  Louisiana,  aged  20,  wounded  atMonocacy 
Junction  July  9,  1864;  shot  penetration  of  neck;  occipital  artery  severed;  July  19,  haemorrhage,  16  ounces,  from  occipital; 
both  ends  of  artery  ligated  in  wound  by  Surgeon  C.  H.  Todd,  C.  S.  A.;  recovery. — Sergeant  D.  Holliday,  B,  26th  Pennsylvania; 
flesh  wound  of  neck.  July  2,  1863;  haemorrhage,  32  ounces,  occurred  July  25;  both  ends  ligated  in  wound  011  the  same  'lay; 
haemorrhage  recurred  on  the  2?th,  but  ceased  spontaneously;  duty  May  3,  1834. — Private  R.  Norris,  C,  1st  Cavalry,  wound  of 
right  side  of  head  and  neck,  May  8,  1864 ;  May  19,  haemorrhage  from  occipital ;  May  25,  1864,  ligation  by  A.  A.  Surgeon  F. 
G.  H.  Bradford;  discharged  July  25,  1864.— Private  D.  H.  Roberts,  E,  118th  New  York;  wounded  October  17,  1864;  fracture 
of  external  table  of  occipital  bone;  November  7,  haemorrhage  from  occipital;  ligation,  both  ends  in  wound,  on  same  day;  dis 
charged  April  20, 1865. — Private  J.  Horton,  D,  57th  Massachusetts ;  wounded  May  18, 1864 ;  ball  lodged  in  first  dorsal  vertebra; 
May  31,  haemorrhage  from  occipital;  artery  ligated  in  wound  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.;  haemorrhage  recurred; 
artery  re-ligated  June  2;  death  June  2,  1864.  • 

Liyation  of  Auricular  Artery. — CASE  1114. — Private  C.  Wagner,  L,  1st  New  York  Cavalry,  aged  25  years;  fracture  of 
temporal  bone  by  pistol  ball  June  26,  1865 ;  ligation  of  posterior  auricular  on  the  same  day  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 
Discharged  October  12,  1865. 

Ligations  of  the  Temporal  Artery. — There  were  eighteen  cases  of  ligations  of  the 
temporal  artery ;  fourteen  were  successful  and  four  were  fatal ;  the  haemorrhages  in  fifteen 
instances  were  from  the  temporal,  and  in  three  from  branches  of  this  artery. 

TABLE  OXXVIII. 
Condensed  Summary  of  Eighteen  Cases  of  Ligations  of  the  Temporal  Artery  for  Shot  Injuries. 

[Recoveries,  1—14;  Deaths,  15—18.] 


No. 

1 

2 
3 
4 

5 
C 

7 
8 
9 

10 
11 
12 

13 
14 
13 
1G 

17 
18 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OP 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OK 

HJEMORRIIAGE. 

DATE 

OI<" 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Faucett,  E.,  Pt.,  B, 
feth  Michigan,  ago 
45. 
Fobes,  J.,  Pt.,  L,  1st 
Vt.  Cavalry,  age  19. 
Fuller,  B.,  PL,  H,  7tli 
Iowa. 
Gilrnore,  H.,  Lieut., 
A,    17th  Vermont, 

Hartly'F.  C.,Vt.,G, 
4'Jth  Virginia. 
Jones,  D.,  Pt.,B,  1st 
Massachusetts,  ago 
26. 
Kullman,  IT.,  Corp'l, 
I,  37th  Wis.,age  24. 
Miller,  L.,Pt,D,4Gth 
New  York,  age  34. 
Mullen,   J.,    Pt,  A, 
lUOth  Pennsylvania. 

Reese,  H.,  Pt.,I,  53d 
Pa.,  age,  18. 
Smith,  A.  U.  C.,  Lt, 
E,  12th  X.  H. 
Talmadge,      A.     S., 
Corp'l,  E,  llth  New 
Jersey,  age.  32. 
Taylor,  J.  C.,  Corp'l, 
1),  5th  N.  J.,  age  44. 
Wheeler,  W.,  Pt.  B, 
91st  N.  Y.,  age  37. 
Dimbar,  II.,  Serg't. 
B,  19th  Mas*. 
Jones,    L.,     Pt,    C, 
115th  X.  Y.,  age  23. 
Newcomb,  J.  S.,  Pt., 
E,  50th  New  York. 
Taylor,  K.  I.,  Pt,,  F, 
1st  Maine  H.  Art, 
age  25. 

Mav  6, 
1804. 

June  24, 
1864. 
Oct.  3, 
1862. 
Mav  12, 
1864. 

May  31, 
1864. 
Mav  G, 
1864. 

July  30, 
1864. 
June  30, 
1864. 
Nov.  30, 
1863. 

July  2, 
1803. 
June  3, 
1864. 
July  3, 
1863. 

June  1, 
1862. 
April  1, 
1865. 
Oct.  14, 
1863. 
Feb.  20, 
1864. 
Sept.  18, 
1861. 
Mav  19, 
1864. 

Fract.  of  right  mas- 
toid  process. 

Scalp  wound  of  fore 
head. 
Flesh  wound  ;  tempo 
ral  artery  severed. 
Flesh  wound  of  scalp  . 

May  19, 
18C4. 

Small    branch    of 
right  temporal. 

Mav  19, 
1864. 

Pros,  end  in  wound. 
Surg.  I.   I.  Hayes, 
TJ.  S.  V. 
Hi  "lit 

Transferred  to  V.  R. 
C.  Jan.  23,  1865. 

Retur'd  to  dutv  Sep 
tember  2s),  1864. 
Discharged  January 
i:»,  1863. 
Retur'd  to  duty  Sep 
tember  6,  1864. 

Recovered  
Recovered  

Ri"'it-  li^ated 

May  21, 
1864. 

Temporal  artery  .  . 

Branch  of  tempo 
ral. 
Temporal  artery  .  . 

Temporal  artery  .  . 

Mav  21, 
1864. 

Juno  5, 
1864. 
May  24, 
1864. 

Aug.  14, 
18G4. 
July  28, 
1864. 
Nov.  30, 
1863. 

July  13, 

In  continuity,  by  A  . 
A.  Surgeon  F.  AV. 
Kelly. 
Ligated  

Left;  in  cent.,  by  A. 
A.  Surg.  S.  D.  Mar 
shall. 
In  cont.,  by  Surg.  R. 
l!.Bontee'ou,U.S.V. 
Left;  ligated  

In  cont.,  by  Surg.  G. 
B.  Coggswell,  29th 
Massachusetts. 
One  end  in  wound-  .  . 

Wound  of  scalp  

Wound  of  scalp  and 
right  ear. 
Fracture  of  parietal, 
temp.,  and  frontal. 
Wound  of  scalp;  tem 
poral  art'y  severed. 

Flesh  wound  of  scalp; 
right. 
Scalp  wound  ;  tempo 
ral  artery  severed. 
Flesh  wound  of  left 
temple. 

Shot  wound  of  scalp 

Fracture  of  temporal 
bone;  right  side. 
Fracture  of  left  fron 
tal  eminence. 
Flesh  wound  of  scalp 

Scalpwouud;  tempo 
ral  artery  torn. 
Fracture  of  loft  tem 
poral  bone. 

May  24, 
1864. 

Aug.  14, 
1864. 
July  28, 
1864. 
Nov.  30, 
1863. 

July  13, 
1863. 
Juno  3, 
1864. 
July  14, 
18G3. 

Juno  4, 
1862. 
Apr.  22, 
1865. 
Nov.  6, 
1863. 
Feb.  27, 
1864. 
Sept.  18, 
1801. 
June  3, 
1864. 

Mustered    out  May 
30,  1865. 
Discharged  July  25, 
1865. 
Returned  to  duty. 

Retur'd  to  duty  Dec. 
7,  1863. 
Discharged  June  21, 
1865. 
Retur'd  to  duty  Mar. 
24,  1864. 

Retur'd  to  duty  Aug. 
19,  1862. 
Discharged  June  29, 
1865. 
Died    November  29, 
1863.     Spfe.  1951. 
Died  Oct.  15,  1864. 

Died  September  21, 
1861. 

Died  June  5,  18G4. 

1863. 
June  3, 
1864. 
July  14, 
1863. 

Juno  4, 
1862. 
Apr.  22, 
1865. 
Nov.  0, 
1863. 
Feb.  27, 
1864. 
Sept.  18, 
1861. 
June  3, 
1804. 

Ligated.    Sursr.  I.  I. 
Hayes,  U.  S.  V. 

In  continuity  

Temporal  and  pos 
terior  auricular. 
Temporal  

Anterior  temporal 

Ono  end  in  wound.  .. 
In  wound  
In  wound  

In  continuity  

Temporal  

772 


WOUNDS    AND    COMPLICATIONS. 


(CHAP.  XII. 


Ligations  of  the  Facial  Artery. — Eight  cases  were  reported;  five  of  the  patients  recov 
ered  and  three  died — one  from  haemorrhage,  one  from  tetanus,  and  one  from  the  severity 
of  the  injuries  to  the  bones  of  the  lower  portion  of  the  face. 

TABLE  CXXIX. 
Condensed  Summary  of  Eight  legations  of  the  Facial  Artery  for  Shot  Injuries. 

(Recoveries,  1 — 5;  Deaths,  f — 8.] 


NAME,  DATE  D^T       PROBABLE  SOURCE 

No.  AGE,  A*Z>  MILITARY  |      OF        NATURE  OF  INJURY.  :„  r.  OF  '  OPFP»  TOP' 

DESCRIPTION,       i  INJURY.  I  HEMORRHAGE.     : 


KIIAGE. 


TIOX. 


RESULT. 


Bessel.  A.  J.,  Serg't 
14th  Michigan. 
Corwell,  J.,  Pt.,  D, 
4th  Pa.  Cavalry. 
Gaincs,  W.,   Pt.,  C, 
5th  Colored  Troops, 
age  20. 
McOray,  J.  A.,  Pt., 
14otU  Pennsylvania. 
AVoodward.C.  L.,Pt., 
I,2d  Vt-.,age  19. 
Button,   A.  H.,  Col. 
21st,  Conn.,  ago  25. 
Foot.  ]<.,  Pt.,  I.  4th 
C.  Troops,  agi*  22. 
Parks,  J.  D.,  Pt.,  A, 
29th  Conn.,  age  30. 

July  5, 
1864. 
Oct.  18, 
1861. 
June  18, 
1864. 

May  12, 

Mav  3, 
1863. 

Mav  ^0, 
1804. 
June  15, 
1804. 
Oct.  27, 
1864. 

Fracture  of  inferior 
maxilla. 
Fracture  of  left  in 
ferior  maxilla. 
Fracture  of  superior 
and   inferior  max 
illa. 
Fracture    of    lower 
jaw. 
Fracture    of    lower 
maxilla. 
Fracture    of    lower 
maxilla. 
Fracture  of  superior 
maxilla. 
Fracture  of  body  of 
inf/maxilla. 

Oct.  19, 
1861. 
June  25. 
1864. 

June  4, 
1864. 

Facial 

Oct.  19, 

1861. 
Juno  25, 
1864. 

June  4, 
1864. 

Facial  artery  

May  31, 
1864. 
June]  5, 
22,  '64. 

Facial 

June  2, 
1864. 
June  23, 
1864. 

Ascending   pala 
tine  artery. 

Facial  ligated in  con-    Discharged  January 

tinuity.  j    4, 1865. 

Ligated Discharged  January 

9, 1862. 
In  continuity.    A.  A.    Recovered. 

Surg.  C.  C.'Ela. 

One  end  in  wound. . .   Recovered. 

Left;     ligated    in    Returned    to    duty 


wound. 


Feb.  19,  18C4. 


One  end  in  wound...   Died   June  4,  1864; 

tetanic  symptoms. 

In  continuity.    A.  A.    Dud  Jmm  2;i,  18G4, 

Surg.  C.  C.  Ela.          |    from  haemorrhage. 

Ligation  of  facial  ...  I  Died    November   6, 

1804. 


Liyqtion  of  Submental  Artery. — CASE  1115. — Private  J.  Ketcham,  Co.  F,  5th  Michigan,  received  at  Gettysburg,  July  2, 
1863,  a  shot  wound  of  left  cheek,  severing  the  submental  artery.  The  vessel  was  tied  on  the  field.  The  patient  was  returned 
to  duty  on  December  5,  1863. 

Ligations  of  the  /Subclavian  Artery. — Fifty-one  cases  of  ligations  of  the  subclavian 
artery  for  shot  injuries  were  reported,  of  which  ten  terminated  in  recovery.  In  ten  cases 
the  operations  were  performed  for  aneurism,  either  diffused  or  circumscribed.  In  seventeen 
instances  amputation  had  been  performed  prior  to  the  ligation  —  in  seven  cases  at  the  shoul 
der  joint,  in  ten  in  the  arm.  In  the  remaining  twenty-four  cases  the  bleeding  was  from  the 
brachial  in  three,  the  posterior  circumflex  in  one,  the  axillary  in  eight,  the  subscapular  in 
one,  and  the  subclavian  in  five  instances;  and  in  six  cases  the  source  of  hemorrhage  was 
not  indicated.  •  In  the  following  case,  of  which  the  specimen  is  preserved  in  the  Army  Modi- 
cal  Museum,  the  subclavian  was  ligated  in  its  third  portion  after  the  arm  had  been  ampu 
tated  in  the  upper  third: 

CASE  1116. — Private  S.  R.  Peterson,  60.  D,  14th  Infantry,  aged  27  years,  was  wounded  at  Chancellorsville,  May  3,  1863, 
and  received  into  Second  Division  Hospital,  Fifth  Army  Corps.    Assistant  Surgeon  C.  Wagner,  U.  S.  A.,  noted:  "Gunshot  wound 
of  arm.     Amputation  by  B.  Howard,  Assistant  Surgeon,  U.  S.  A."     From  the  field  hospital  the  patient  was,  on  June  14th, 
admitted  to  Douglas  Hospital  at  Washington,  and  several  days  afterwards  he  was  transferred  to 
Satterlee  Hospital  at  Philadelphia.     Acting  Assistant  Surgeon  D.  Kennidy  contributed  the  speci 
men  (Cat.  Surf/.  Sect.,  1866,  p.  458,  Spec.  2607)  with  the  following  minutes  of  the  case:  "Patient 
was  wounded  by  a  shell  in  the  left  arm,  rendering  amputation  near  the  shoulder  necessary.     The 
operation  was  performed  upon  the  battle-field,  about  fifteen  minutes  after  he  received  the  wound, 
without  the  administration  of  anaesthetics.     At  the  time  he  was  transferred  to  this  hospital  he  had 
erysipelas  of  left  side  of  thorax  and  back.     He  was  immediately  placed  on  tinctura  fcrri  chlor.  <jlts 
xx  every  three  hours,  and  unyucnt.  fcrri. sulpk.  used  locally.     The  stump,  which  suppurated  freely , 
was  dressed  with  a  poultice.     He  began  to  improve,  and  by  June  30th  the  erysipelas  had  disap 
peared  and  he  was  fast  gaining  strength.     July  5th :  Had  slight  diarrhoea ;  prescribed  astringents. 
July  6th  :  Not  so  well ;  very  weak.     Ordered  beef  essence  and  wine  whey.     July  8th  :  Bled  about 
a  pint  from  the  stump;  ice-water  and  compress  applied.     July  Dili:  Had  another  haemorrhage 
early  in  the  morning;  subclavian  artery  ligated  at  its  third  part.     Present  at  the  operation  :  Drs. 
Hayes,  Schell,  Baldwin,  and  Roe.     Prescribed  brandy,  one-half  ounce  every  two  hours.     July 
10th  :  Feels  stronger  and  pulse  good ;  ordered  sulphate  of  quinine,  yrs.  ii,  three  times  a  day.     He 
FIG.  4H. — Portions  of  the  aorta,     continued  to  do  well  until  the  16th,  when  he  had  a  haemorrhage  from  the  artery  where  it  had 
Lr±'ciaviantt"S°^So7:     bet'n  "8***  >  bled  about  a  pint ;  digital  pressure  applied.     July  17th  :  No  bleeding.     Early  in 
the  morning  of  the  18th  he  lost  some  blood  while  changing  the  fingers.     His  pulse  had  bc<  n  very 
weak  since  the  16th,  and  he  was  fast  losing  strength.     About  10  o'clock  on  the  morning  of  the  18th  of  July  he  died.''     The  sj  uciinen 


CHAP.  XH.) 


LIGATIONS    OF    THE    SUBCLAVIAN    ARTERY. 


773 


consists  of  a,  wet  preparation  of  the  arch  of  the  aorta,  the  innoiniuata,  left  common  carotid,  and  aubclavian  rfrteries,  terminating 
at  the  point  of  ineffectual  ligntion  of  the  left  subclavian  in  its  third  portion,  showing  the  separation  of  the  coats  with  no  forma, 
tion  of  clot. 

TABLE  CXXX. 
Condensed  Summary  of  Fifty-one  Cases  of  legations  of  the  Aubclavian  Artery  for  Shot  Injuries. 

[Recoveries,  1—10;  Deaths,  11—51.] 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

HJ.MOR- 

RHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 
2 
3 

4 
5 
6 

7 
8 
9 
10 
Jl 
12 
13 
14 
15 

1C 
17 
18 
19 
20 

tol 

22 
23 

24 

25 

26 
27 
28 
29 
30 
31 
32 

33 

34 
35 

Cauqkman,  O.  M.,  K, 

Jnly  3, 

Shot  through  chest  ; 

0 

July, 
1863. 
July  17, 
1863. 
Sept.  5, 
1864. 

Sept.  19, 
1864. 

Jan.  11, 

1863. 

Aug.  8, 
1864. 

Aug.  2, 
1803. 
Apr.  14, 
1862. 
Sept.  26, 
1864. 
Mav  7, 
1865. 
July  27, 
1«04. 

May  29, 
1864. 
May  30, 
1865. 
June  17, 
1804. 

Dec.  16, 
1803. 

May  26, 
1864. 

May  31, 
1864. 

Sept.  1, 
1864. 

Nov.  5, 
1864. 

Aug.  10, 
1864. 
Apr.  20. 
18C2. 
Julyl, 
1804. 

Dec.  16, 
1804. 

June  30, 
1864. 
Aug.  18, 
1863. 
June  23, 
1862. 
Oct.  22, 
1862. 
Feb.  27, 
1864. 
Juno  7, 
1862. 
June  18, 
1864. 
July  14, 
1863. 

Julv  23, 
1864. 

Oct.  11, 
1803. 
Oct.  13, 

1804. 

Ligated  in  third  por 
tion  in  continuity. 
In  cont.  in  third  por 
tion;  lig.  subscap. 
In  cont.  in  t  bird  por 
tion     Surg.   A.  B. 

Recovered  ;  arm  par 
alyzed. 
Furloughed  August 
31,  1803. 
Discharged  October 
4,  1864. 

IStli  S.  C.,  age  25. 
Endy,  J.  T.,  Ft,  F, 
5th  N.  C.,  age  23. 
Herman,   A.,  Pt.,  C, 
•18th  N.  Y.,  age  42. 

Hiclcey,  J.,  Serg't,  M, 
1st  N.  Y.  Cav.,  age 

Hurst,C.,  Pt.,C,  16th 
Ohio. 

Kellogg,  E.  8.,  Pt., 
A,  89th,  N.  Y.,  age 
21. 
Kitrell,  J.  H.,Pt.,D, 
3d  Tennessee. 
Palmer,  D.  J.,Corp'l, 
C,  8th  Iowa,  age  20. 
Plielps,  J.  T..  Pt.,  D, 
24th  Mass.,  age  32. 
Wiggins,  C.,  Ft.,  G, 
9th  N.  Y.  A.,  ago  21. 
Andrews,  M.,  Ft.,  E, 
17th  Vt,ago22. 
Averitt,    W.  '  S.,  Pt., 
11,  14th  Tennessee. 
Brannon,  B.,  Pt.,  B, 
Olst  N.  Y.,age  22. 
Broderick,W.,  Cor'l, 
C,  199th  Pa.,  age  39. 
Buzzell,   H.,  Serg't, 
D,  12th  N.  H.,  age 
21. 
Click,  J.  B.,  Pt,,  G, 
5th  Virginia  Cav. 

Conant,    A.    E.,  Pt., 
K,  8th  Maine,  age 
22. 
Contorman,     T.    J., 
Pt,  G,  48th  X.  Y., 
age  21. 
Denton,  F.  M.,   Ft., 
H,  4th  S.  U.  Cav., 
age  34. 
Dow,    S.    E.,  Color 
Sorg't,  4th  N.   Y., 
age  21. 
Downing,  S.,  Pt,,  C, 
9th  111.  Cav.,  age  21. 
Everly.K.  M.,  Pt.,G, 
17th  Kentucky. 
Gates,  E.  O.,  Serg't, 
M,4thN.  Y.  H.  A.. 
ago  22. 
Graves,   IL,  Pt.,  B, 
5th  Pa.  Cav.,  age  25. 

Grimm,   A.,  Pt,  D, 
7th  Conn.,  age,  21. 
Grothenn,  H.,  Serg't. 
K,  5th  Cav.,  age  28. 
Henderson,    J.     H., 
Pt,*\  57th  Pa. 
Kites,  J.,  Pt,  C,  7th 
Iowa,  agt;  19. 
Holshowes,     W.    W., 
Serg't,  3dS.  C.Bat. 
Howard,  A.  O.,  Con 
federate. 
Ingalls,  D.  W.,  Pt, 
B,  6th  Conn.,  age  35. 
Jordan,  J.  F.,  Ca.pt., 
B,  13th  Va.  Cavalry, 
ago  31. 
Eahea,  E.  P.,  Pt,  B, 
Jeff.  Davis'  Legion, 
age  29. 
King,  J.  TT.,  Pt.,  C, 
29th  N.  Carolina. 
Klechner,  G.  M.,  Cor. 
D,  93d  111.,  age  23. 

1803. 
July  2, 
1863. 
Feb.  20, 
1864. 

June  5, 
1864. 

Dec.  29, 
1862. 

June  18, 
1864. 

Julv  12, 
1863. 
Apr.  7, 
1862. 
Aug.  16, 
1864. 
Mar.  25, 
18G5. 
May  12, 
1864. 
Aug.  9, 
1862. 
May  8, 
1864. 
Apr.  2, 
1865. 
June  3, 
1864. 

Nov.  8, 
1863. 

May  20, 
1864. 

May  9, 
1864. 

May  28, 
1864. 

Oct.  27, 
1864. 

Julv  14, 
1804. 
Apr.  7, 
1862. 
Juno  4, 
1864. 

Oct.  7, 
1864. 

June  9, 
1864. 
Juno  9, 
1863. 
May  31, 
1862. 
Oct.  3, 
1862. 
Nov.  30, 
1863. 
May  31, 
1862. 
Mar  20, 
1864. 
June  21, 
1863. 

June  14, 
1864. 

Sept.  19, 
1863. 
Oct.  5, 
1804. 

subclav'n  wounded. 
Ball    entered   below 
scapnla  and  lodged. 
Shot  fracture  of  right 
humerus  ;  excision. 

Ball  entered    below 
right  clavicle. 

Fract.    right   hutne- 
rus;  amputation. 

Fract.  left  hnmerus; 
amputation  arm. 

Fract.   right  hume- 
rus;  amp.  arm. 
Wound  of  left  axil 
lary  artery. 
Fract.  left  shoulder  ; 
amputation. 
Ball  perforated  be 
low  right  clavicle. 
Fract.  right   hume- 
rus;  amp.  at  sh. 
Fract.  left  arm;  am 
putation. 
W  o  u  i)  d    of   right 
shoulder  and  arm. 
Left  shoulder  below 
clavicle. 
Wound  right  shoul 
der. 

Wound  in  right  ax 
illa  ;  lesion  axillary 
artery. 
Fracture    head  left 
humerus  ;   amp.  at 
shoulder  joint. 
Wound  in  right  ax 
illa. 

Flesh  wound  shoul 
der  and  chest. 

Shot  wound  of  chest. 

Fracture  right  arm  ; 
amputation. 
Fract.  right  humor 
us;  amp.  at  sh.  jt. 
Flesh  wound  of  right 
.arm. 

Wound  left  side  of 
neck. 

Fracture  right  clavi 
cle. 
Right  shoulder  ;  axil 
lary  artery  •wound. 
Flesh  wound  left  arm 

Wound  in  right  axilla 
Wound  left  lung  

Left  shoulder;    inj. 
spine. 
Wound  of  chest 

July  16, 
17,  '63. 
Sept,  5, 
1864. 

Jan.  11, 

1863. 

July  25, 
1804. 

Julv  26, 
28,'  '63. 
April  8, 
1862. 
Sept.  26, 
1864. 
Mav  7, 
1865. 
Julv  23, 
1864. 

Mav29, 
1864. 
Apr.  17, 
1865. 

Posterior   circum 
flex. 

Axillary  aneurism  . 

Brachial  on  face  of 
stump. 

Axillary  ligated  in 
stump. 

Haemorrhage  from 
stump,  Aug.  2. 
Aneurism    

Mott,  U.  S.  V. 
Ligated  in  continu 
ity  by  Surgeon  F. 
H.  Gross,  TLS.V. 
In    cout.    by   Asst. 
Surg.W.  D.Turner, 
1st  Illinois  Art. 
In  continuity  in  third 
portion    by  A.   A. 
Surg.  R.  J.  Kevis. 
In  continuity  in  third 
portion. 
In  cont.  by  Surg.  T. 
F.  Azpell,  U.  S.  V. 
In   cont.  by  A.   A. 
Surg.  J.  C.  Morton. 
Both  ends  in  wound  . 

Lig.  by  A.  A.  Surg. 
J.  B.  Crandall. 
Ligation  of   subcla 
vian. 
In  cout.  by  Surg.  A. 
V.  Sheldon,  U.  S.  V. 
In  continuity  in  outer 
third. 
Right  ;  in  continuity. 
Surg.  N.  R.  Mose- 
loy,  U.  S.  V. 
Right;  in  continuity. 
Asst.  Surgeon  J.  C. 
Baylor,  C.  S.  A. 
Left;  in  continuity. 
A.  A.  Surgeon  T. 
Liebold. 
Right;  in  c  jntinuity. 
A.  A.  Surgeon  G. 
F.  Shrady. 
Left  ;  in  continuity. 
A.  Surg.  J.  C.  Mc- 
Kee,  D.  S.  A. 
Right;  in  continuity. 
Assistant  Surgeon 
H.  Allen,  U.  S.  A. 
Right;  in  cout.  A.  A. 
Siirg.  J.  N.  Sharp. 
Right;  in  continuity. 

Right;  in  continuity. 
A.  A.  Surgeon   T. 
G.  Morton. 
Left;  in  continuity. 
Asst.  Snrg.  VV.  E. 
Day,  117th  N.  Y. 
Right;  in  continuity. 

Right;  in  cont.  Surg. 
It.  H.  Coolidge. 
Left;  in  continuity.  . 

R't  ;  in  cont.  Surg.  J. 
S.Hodgden.U.S.V. 
Loft  ;  in  cont.    Surg. 
B.  B.  Breed,  U.S.  V. 
Left;  in  continuity.. 

Ligation;  in  continu 
ity. 
Left;  in  cont.   Surg. 
J.A.Lidell.U.S.V. 

Left  ;  in  continuity. 
Surg.  W.  Seldon,  C. 
S.A. 
Right;  in  continuity 

Left  ;  in  cont.   Surg. 
J.  H.  Grove,  U.S.  V. 

Discharged  May  30, 
1865. 

Discharged  March  7, 
1863. 

Hjern.  Aug.  15.     Din- 
charged    April    6, 
1865. 
Furloughed  Septem 
ber  3,  1863. 
Discharged  Septem 
ber  6,  1802. 
Discharged    Decem 
ber  13,  1864. 
Discharged   August 
3,  1865. 
Died  July  28,  1864. 

Died   January    26, 
1863. 
Died  June  19,  1864; 
bnem.  rec'd. 
Died  Juno  11,  1865. 

Died  Juno  29,  1804, 
ofhaem.   Spec.  2812, 
A.  M.M. 
Died  Dec.  17,  1863. 

Died   May  29,  1804  ; 
exhaustion. 

June  2,  br.  ax.  plex. 
veiuslig.  DiedJune 
2,1804.    Spec.  4331. 
Amp.  at  shoulder.  jt. 
Died  September  2, 
1864. 
Died  November  18, 
1864;  haemorrhage. 

Died  August  30,  1864. 

Axillary  artery  
Axillary  (?)  
Subclavian 

Axillary  aneurism  . 

Large   aneurismal 
tumor. 

Axillary  

May  24, 
25,  ''64. 

May  27, 
30,''C4. 

Aug.  28, 
1864. 

Nov.  5, 
1864. 

Aug.  8, 
JO,  '64. 
Apr.  20, 
1862. 
June  25, 
1864. 

Dec.  14, 
1804. 

June  28, 
1864. 
Aug.  18, 
1863. 
June  19, 
1862. 
Oct.  22, 
1862. 
Fob.  27, 
1864. 

Subscapular  arter  y 
and  axillary  vein. 

Axillary  aneurism  . 
Subclavian  

Spec.  2508. 
Died  April  20,  1862  ; 
exhanstiou. 
Died   July    1,    1864. 
Spec.  2545. 

Died    December  18, 
1804. 

Died  July  9,  1804. 

Died  Aug.  18,  1803. 
Spec.  2009,  A.  M.  M. 
Died  June  27,  1802; 
pva3tnia. 
Died  Oct.  31,  1802. 

Died  March  11,1865; 
pyjemia. 
Died  June  8,  1802. 

Died  June  24,  1804; 
pyaemia.  Spec.  4089. 
Died   Aug.   29,  1863. 
Spec.    1684,   A.    M. 
M. 
Died  July  31,  1864. 

Died  Oct.  21,  1863. 
Died  Oct.  13,  1864. 

Brachial  ;  axillary 
ligated. 

Subclavian  artery. 

Aneurism  

Axillary  artery  

Branches  axillary. 

Left  axillary  artery 
divided. 

Through  left  axilla, 
sov.  axillary  artery. 

Fracture  head  ;  right 
humerus. 
Loft  arm  and  chest.  . 

July  12, 
1863. 

Julv  10, 
1864. 

Oct.  10, 
11,  '63. 

Aneurism   

^•^  4 

/  74 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

•  NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OP 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
II.EMOR- 
UHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

36 

L'Aimee  A.  B.   Pt. 

Mar.  14 

Fracture   riirht   hu- 

Mar.  29 

Stump 

Mar.  29, 

Right;  incont.  Surg. 

Died  April  5,  1862; 

G,51stN.Y.,age2i'. 

1802. 

merus  ;  amp.  arm. 

18G2.  ' 

1862. 

G.Derby,  23d  Maes. 

pvicmia. 

37 

McMichael,  H.,  Pt., 

Nov.  30, 

Wound    chest,    inj. 

Dec.  11, 

Axillary  artery  

Dec.  11, 

Right;  in  rout.  Surg. 

Died  Dec.  16,  3804. 

A  57th  Iiid.  <i<re  19. 

1804. 

axillary  artery. 

1864. 

18(i4. 

SfE.  Fuller,  TJ.S.V. 

38 

Maiort,E.,Pt.,K,62d 

April2, 

Fracture    right    hu- 

April  18, 

Brachial  artery  

April  18, 

Right;  in  continuity. 

Died  April  20,  1865. 

Ohio,  age  28. 

1865. 

merus;  excision. 

1865. 

1805. 

39 

Moore,  W.  E.,Pt,,Ev 

Oct.  8, 

Fracture   right    hu- 

Nov.  21, 

Axillary  artery    .  . 

Nov.  21, 

Right;    in  continui 

Died  November  27, 

57th  Mass.,  aye  '23. 

1864. 

merus;  amputat'n 

1864. 

1864. 

ty.    Asst.  Surg.  C. 

1804. 

at  shoulder  .joint. 

Waguer,  U.  S.  A. 

40 

M^owrcv  TT,  B.   Oor- 

Sept.  17, 

Fracture  left  humer- 

Sept.  26, 

Sept.  20, 

Left;  in  continuity. 

Amputat'n  at  shoul 

poral,  'B,   Cth   Pa. 

1862. 

U8. 

1862. 

1862. 

Surg,  A.  B.  Hasson, 

der  i't.     Died  Sep 

lies.,  age.  20. 

U.  S.  A. 

tember  27,  1802. 

41 

Peterson    S   E    Pt 

May  3, 

Left  arm  shattered; 

July  8 

Stump 

July  9, 

Left;  in  continuity. 

Died   July   18,   1863. 

D,  14th  Inf.  '' 

1863.  ' 

amputation  arm. 

*9,  '63. 

1863. 

A.  A.Sutg.D.Ken- 

Spec.  2607,  A.M.  M. 

iiidy. 

42     Pfluzi-r,  E.,  P(.,  H, 

June  27, 

Fracture  right  scap 

July  14, 

;  lig.   axillary 

July  25, 

Eight;  in  continuity. 

Died  August  10,  1864. 

2d  Pa.  Art.,  age  28. 

1864. 

ula. 

1864. 

artery. 

1864. 

43  j  Reed,  A..  Pt.,  B,  6th 

Jan.  30, 

Fracture  right  arm  ; 

Feb.  6, 

Axillary  artery  .  .  . 

Feb.  7, 

Eight;  incont.  Asst. 

Died    February    27, 

Massachusetts. 

1803. 

ainputat'n  at  shoul 

1863. 

1863. 

Surg.  O.  M.  Hum 

1803. 

der  ioint. 

phrey,  6th  Mass. 

41       Sli'icf^pll    \V      Spnuf. 

Nov.  15,     T<V;int,nrp  i-irrlit.  pljivi- 

Dec.  14, 

Right;    in  continui 

Died    December  14, 

1864. 

cle  and  rib. 

1864. 

ty.     A.sst.  Surtr.  S. 

1804.      Spec.   4729, 

C.  Ayres,  U.  S.'V. 

A.  M.  M. 

45 

Smith,  A.  H.,  Pt..F, 

Jan.  11, 

Fracture    right    el 

April  4, 

Brachial  artery  

April  6, 

Right;    iu   continui 

Died  April  14,  1863. 

25th  Iowa,  age  30. 

1803. 

bow  joint;    ompa- 

6,  '63. 

1863. 

ty.       Surg.    O.    T. 

talion  arm. 

Alexander,  IT.  S.  A. 

46 

Smith,  P.,Sergt.,E., 

Sept.  30,  |  Flesh  wound    right 

Oct.  12, 

Brachial     artery  ; 

Oct.  21, 

Eight;   in  continui 

Died   November  22, 

84th  Pa.,  age  33. 

1864. 

arm. 

1864. 

artery  ligated. 

1804. 

ty.    A.  A.  Surg.  J. 

1804;  pyaemia. 

C.  Morton. 

47 

Stainca,  S.,  Pt,,  C., 

July  2, 

Flesh  wound   right 

July  23, 

Brach.  artery  lig.  ; 

Aug.  23, 

Right;  in  continuity. 

Died    September   2, 

53d  Pa.,  age  25. 

1863. 

arm. 

1863. 

Aug.  2,  amp.  arm. 

1863. 

1863. 

48 

Stihvell,  J.,'  Pt.,    I, 

Aug.  16, 

Fracture  head;   left 

Sept.  21, 

Axillary  artery.  .  .  . 

Sept  21, 

Left;  in  continuity. 

Died  September  23, 

1st  Maryland  Cav 

1864. 

hninorus;  Sept.  21, 

1864. 

1864. 

A.  A.  Surg.  J.  C. 

1864. 

alry,  age  21. 

excision. 

Morton. 

49 

Ward,  T.,  Corp'l,  C, 

June  25, 

Wound  in  left  axilla 

Mar.  14, 

Aneurism  

Mar.  15, 

Left;  in  continuity. 

Died  March  17,  1863. 

2d  Pa.  Res. 

1862. 

1863. 

1863. 

Prof.  S.  D.  Gross. 

50 

Wisser,  H.  H.,  Cor 

June  15, 

Left  arm  shattered; 

July  13, 

Stump  ;      axillary 

Aug.  6, 

Left;  in  continuity.. 

Died  August  17,  1804. 

poral,  F,  27th  Mas 

1864. 

amputat'n  at  shoul 

1864. 

ligated. 

1864. 

sachusetts,  age  34. 

der  joint.     • 

51 

Wright,  S.  A.,Capt., 

April  6, 

Fracture  left  humer- 

May  9, 

Axillary  artery  

May  9, 

Loft;  in  continuity.. 

Died  May  12,  1862. 

F,  55th  Illinois. 

1862. 

us;  wound  of  hip. 

1862. 

1862. 

Twelve  cases  of  ligations  of  branches  of  the  subclavian  were  reported.  Two  were 
ligations  of  the  internal  mammary,  six  of  the  intercostals,  one  of  the  thyroid  axis,  one  of 
the  superficial  cervical,  and  two  of  the  suprascapular  arteries.  The  two  operations  on  the 
internal  mammary  and  two  of  the  ligations  of  the  intercostal  artery  were  fatal: 

Lvjatlons  of  the  Internal  Mammary. — CASES  1117-1118. — Private  A.  Campbell,  Co.  A,  2d  Pennsylvania  Heavy  Artillery, 
wounded  near  Petersburg,  June  29, 18G4;  penetration  of  chest  near  second  rib;  haemorrhage  July  13;  ligation  of  internal  mam 
mary  by  Surgeon  O.  A.  Judson,  U.  S.  V.;  death  July  19,  1864.  (First  Surg.  Vol.,  p.  548.)— Private  J.  Gallin.  F,  65th  New 
York,  aged  30;  wounded  at  Spottsylvania  May  8,  18G4;  penetration  of  chest  and  wound  of  internal  mammary;  haemorrhages; 
ligation  of  artery  May  19,  1864.  by  Surgeon  E.  B.  Boutecou,  U.  S.  Vols.;  death  May  24,  from  recurring  haemorrhage.  (First 
Sury.  Vol.,  p.  548.) 

Ligations  of  Intercostals. — CASES  1119-1124. — Private  R.  Morris,  K,  142d  Pennsylvania,  aged  25;  shot  wound  of  chest, 
Fredericksburg,  Dec.  12,  18i)2;  haemorrhage  January  20,  1883;  ligation  of  intercostal,  one  end  in  wound;  discharged  from  service 
June  13,  1863.  (First.  Surg.  Vol.,  p.  550.) — Private  S.  Scofield,  D,  Gth  Connecticut,  age  21;  shot  wound  of  chest.  Drury's  Bluff, 
May  14,  1864;  haemorrhage  May  27;  ligation  of  intercostal  artery  by  Asst.  Surg.  W.  H.  Gardner,  U.  S.  A.;  ligature  passed 
around  rib;  no  recurrence  of  haemorrhage;  discharged  September  3,  1864.  (First  Surg.  Vol.,  p.  550.) — Private  J.  B.  Bruce,  C, 
31st  Alabama,  aged  17;  shot  fracture  of  ninth  rib,  at  Shiloh,  April  G,  1862;  April  29,  haemorrhage  from  intercostal;  both  ends 
ligated  in  wound  by  Asst.  Surg.  B.  Howard,  U.  S.  A.:  ligature  included  rib;  death  April  29.  from  haemorrhage.  (First  Surg. 
Vol.,  p.  550.) — Private  J.  H.  Butterfield,  F,  3d  Vermont,  wounded  in  chest,  at  Lee's  Mill's,  April  16,  1862;  haemorrhage  April 
25;  ligation  of  intercostal  artery;  haemorrhage  recurred  April  27;  artery  religated;  death  May  4,  1862.  (First  Surg.  Vol.,  p. 
551.) — Private  J.  Mahew,  D,  100th  Pennsylvania;  shot  fracture  of  rib  May  24,  1864;  ligation  of  intercostal;  death  May  26, 
1864.  (First  Sury.  Vol.,  p.  551). — Private  P.  F.  Wilson,  A,  33d  Ohio;  penetrating  wound  of  chest,  Chickamauga,  September 
20.  1833;  haemorrhage  October  4;  ligation  of  intercostal  October  5;  death  October  30,  1863.  (First  Sury.  Vol.,  p.  551.) 

Ligation  of  Thyroid  Axis. — CASE  1125. — Private  A.  P.  Dunem,  Co.  H,  1st  New  Jersey  Cavalry,  aged  46;  shot  wound  of 
right  shoulder,  ball  passing  over  clavicle,  June  3,  1864;  June  30th,  haemorrhage  of  thirty  ounces  from  thyroid  axis;  artery 
ligated  on  the  same  day,  one  end  in  wound;  returned  to  duty  December  7,  1864. 

Ligation  of  Superficial  Cervical  Artery. — CASE  1126. — Private  J.  H.  Potter,  F,  15th  Massachusetts;  shot  wound  of  left 
posterior  triangle  of  neck  June  18,  1864;  July  13,  haemorrhage  from  superficial  cervical;  one  end  ligated  in  wound  on  the 
same  day;  transferred  to  V.  R.  C.  May  16,  1865. 

Ligations  of  Suprascapular  Arteries. — CASES  1127-1128. — Corporal  T.  Barrick,  44th  New  York,  age  25;  shot  wound  of 
side  of  neck  July  2,  1863;  haemorrhage  from  suprascapular  July  21st;  artery  ligated  on  same  day  by  A  A.  Surgeon  D.  Kennidy; 
discharged  March  26,  1864.  (First  Surgical  Volume,  p.  422.) — Private  S.  Sickles,  H,  14th  New  Jersey,  age  27;  shot  penetration 
of  chest  and  fracture  of  scapula  July  9,  1864;  haemorrhage,  probably  from  diffuse  aneurism,  August  1,  1864;  both  ends  of 
suprascapular  artery  ligated;  no  recurrence;  discharged  July  G,  1865.  (First  Surgical  Volume,  p.  541). ) 


CHAP.  XII.] 


LIGATIONS    OF    THE    AXILLARY    ARTERY. 


775 


a  rnor- 


Ligations  of  the  Axillary  Artery. — The  total  number  of  ligations  of  the  axillary 
artery  reported  is  forty-nine;  of  these  seven  recovered  and  forty-two  proved  fatal, 
tality  rate  of  85.7  per  cent.  The  operation  was  on  the  right  side  in  seventeen,  on 
the  left  in  twenty-five  instances;  in  seven  the  side  was  not  stated.  In  fifteen 
instances  amputation  of  the  arm  had  been  performed.  In  four  of  these  fifteen 
cases  re-ligation  of  the  artery  was  performed  on  the  face  of  the  stump,  and  in  eleven 
in  the  continuity.  In  one  instance  only  was  the  artery  ligated  on  the  field  immedi 
ately  after  the  injury,  for  primary  bleeding.  Of  the  forty-nine  operations,  haemor 
rhages  recurred  in  twenty-one,  only  one  of  which  terminated  in  recovery  after  ampu 
tation  of  the  arm.  Four  operations  were  performed  for  aneurism.  The  specimen 
(No.  3630,  Surg.  Sect.}  of  one  of  these  cases  is  preserved  in  the  Army  Medical 
Museum  and  is  shown  in  FIG.  423.  It  is  a  wet  preparation  of  the  axillary  artery, 
and  shows  loss  of  substance  by  sloughing;  slight  haemorrhage  occurred  on  the  seven 
teenth  day,  which  was  controlled  by  pressure;  severe  haemorrhage  followed  on  the 
nineteenth  day;  an  immense  aneurism  formed,  which  was  opened,  and  ligatures 
placed  on  both  sides  of  the  injury;  mortification  supervened;  the  arm  was  ampu 
tated  at  the  shoulder,  but  death  ensued  several  hours  after  the  operation.  The 
reported  in  detail  on  page  443  of  the  Second  Surgical  Volume  (CASE  1255). 


case  is 


TABLE  CXXXI. 
Condensed  Summary  of  Forty -nine  cases  of  Ligation  of  the  Ax'dlery  Artery  for  Shot  Injuries. 

[Recoveries,  1—7;  Deaths,  8—49.] 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJUKY. 

NATURE  OF  INJURY. 

DATE 

OF 
H^MOR- 
RIIAGE. 

PEOBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 
Ol'ERA- 
TIOX. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Coolream,  P.,  Ft.,  B, 

Mav  8, 

Fract    head     right 

May  24, 

May  24, 

Eight;  in  continuity- 

Discharged  October 

?, 

Cist  N.  Y.,  age  45. 
Cutler,  F.K.,  Ft,,  K, 

1864. 
Sept.  17, 

hum.;  excision. 
Fract.   right  hum.  • 

1864 
Oct.  19, 

Axillary  

1864. 
Oct.  20, 

Eight;  in  cont.  Surg. 

13,  1865. 
Disch.  Aug.  10,  1864. 

3 

72d  Pennsylvania. 
Flics,  A.,  Corp'l,  E, 

18G2. 
Sept  19 

ampt'nat  sh'd'r  j't. 
Fract.   ri"ht    hum.  ; 

1862. 
Nov.  8, 

1862. 
Nov.  9, 

II.  S.Hewit.U.  S.V. 
Right;  in  cont.  Surg. 

Died  May  11,  1873. 
Discharged  April  18, 

4 

100th  111.,  ago  26. 
James,  W.,  —  ,  D,  83d 

1863. 
July  2 

amputation  arm. 

9,  1863. 
July  14 

1863. 
Julv  14 

A.  McMahen,  64th 
Ohio. 

1864. 

5 
6 

7 

PH.,  age,  20. 
Sobbey,  W.,  Pt,,  G, 
51st  J'a.,nge  29. 
Vancellette,  T.,  Pt., 
L»,  3d  Vt,ago21. 

Williams,  A.  E.,  Pt, 

1863. 

Julv  12, 
1804. 
Apr.  16, 
1862. 

Julv  2, 

border  axilla. 
Flesh  wound    right 
arm. 
Fk-sh     wound     left 
arm. 

1863. 
Julv  23, 
24,  1864. 
Apr.  18, 
23,  1862. 

Brachial  
Brachial  

1863. 
Julv  24, 
1864. 
April  23, 
1862. 

Aug.  4 

Right;  in  continuity 

Left;  in  cont.    Surg. 
R.  B.  Bontecou,  U. 
S.V. 

Recovered. 

Apr.  25;  ampt'narm. 
Disch.  Jan.  13,  1863. 

8 
9 

B,  7th  Mich.,  age  27. 

Aldrich,  A.,  Pt.,  F, 
25th  Mass.,  age  25. 
liaqgs,  W.  A.,  Pt.,  E, 

1803. 
June  3, 
18G4. 

arm. 
Wound  in  left  axilla 

1863. 
June  15, 
1864. 
June  23 

Small  artery  liga 
ted. 

1803. 
June  17, 
1864. 
June  25, 

wound. 
Left  ;  in  continuity.  . 

Artery  Heated  

25,  1864. 
Died  June   17,  1864. 
Spec.  2576,  A.  M.  M. 
Died  June  28,  18C4. 

10 
1] 

2uth  Geo)  gia  Cav. 
Corrio,  J.  is.,  Serg't, 
A,  llth  Mo.,  aye  25. 

Davis.  H.  J.,  Pt.,  G, 

May  22, 
1863. 

June  21 

shoulder. 
Fracture  left  hum.  ; 
anipt'u  at  sh'd'r  j't 

24,  1864. 
Juno  6, 
7,  1863. 

June  22 

Posterior   circum 
flex. 

1864. 
Juno  7, 
1803. 

Juno  22 

Left;  in  continuity; 
recurred. 

June  8,  br.-.  acrom. 
thor.lig.  Died  June 
9,  1863. 
Hseru.  July  3     Died 

12 
13 
14 

5th  N.  C.,  age  41. 
Daw-son,  M.  M.,  Lt. 
Col.,  100th  Pennsyl 
vania.  a<:e  38. 
Downing,  W.E.,Pt., 
J,  loth  Pennsylva 
nia  Cavalry,  ago  19. 
Dnuu,N.,Pt  ,11,  38th 

18Gi. 
Juno  17, 
1804. 

May  28, 
1864. 

Apr.  2, 

IT18. 

Flesh     wound     left 
shoulder. 

Wound  through  left 
axillary  space. 

1864. 
Juno  27, 
1864. 

June  12, 
1864. 

Axillary  artery  .  .  . 
Axillary  artery  .  . 

1864. 
Juno  27, 
1864. 

June  15, 
1864. 

Mav  4, 

amputation  arm. 
Left;  both  ends   in 
wound. 

Left;   both  ends   in 
wound;    vein  also 
tied. 
Loft;  in  cont.    Ass't 

July  G,  18G4. 
Efem  recur'd.  Died 
June  30,  1864. 

Died  June  28,  1804. 
Died  May  8,  1865;  ex 

15 
16 

Wisconsin,  ago  19. 

Folev,    M.,    Pt.,    K, 
llth  111.  Cav.,  ago  20. 
Friedeboldt,  F.,  Pt, 

1865. 

Mar.  3, 
1864. 
Mav  31, 

ru  s. 

Wound  right  arm; 
cutting  axillary. 
Flesh  wound  arm  •  in 

Mar.  3, 
1804. 

Axillary  
Brachial  

1865. 

Mar.  5, 
1864. 
Juno  10, 

Surg.  O.  P.  Sweet, 
U.  SV. 
One  end  in  wound.  A. 
A.Surg.W.B.Trull. 
In  cont.    A.  A.  Surg. 

haustion. 

Religated.     Died 
March  10,  1864. 
Died  July  14,  1802. 

17 

K,  5th  Michigan. 
Gillies,    P.,    Pt,    H, 

1862. 
Oct.  19, 

jury  brachial  ait. 
Fracture   head   left 

Oct.  26 

1862. 
Oct.  31, 

C.  C.  Page;  subscap. 
artery  also  tied. 
Loft;  on  face  stump 

Died  Nov.  1,  1864,  of 

18 

131st  N.  Y.,  age  25. 
Goodheart,  J  .  F.,  Pt, 

1864. 
May  10, 

humerua. 
Fracture    left  arm  • 

1864. 

tation  sh'cl'r  j't. 

1864. 
Juno  4, 

Left;  in  continuity.  . 

rec.  haemorrhage. 
Died  June  5,  1864. 

19 

F,  88th  Pa,,  age  29. 
Ilall.W.,  Pt  ,  H,  15th 

1864. 
Jan  11, 

amputation  arm. 

Jan  11 

1864. 
Jan.  22 

Ki"ht.    A.  A.  Surg. 

Died  Jan'ry  22,  1866. 

20 

Infantry,  age  19. 
Ilankin,  'J.,  Pt,  IT, 
lstMich.S.S.,agel7. 

1866. 
June  17, 
1864. 

fractured  rib. 
Fract.  head  of  right 
humerus;  excision. 

20,  1866. 
July  23, 
1864. 

Axillary  

186(5. 
July  23, 
1864. 

R.  W.  Coale. 
Right  axillary  art'y 
ligated. 

Spec.  2674. 
Died  July  24,   1864; 
hffimorrhage. 

h»^"/"« 

/  76 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


NAME, 
No.   AGE,  AND  MILITAKV 
DESCRIPTION. 


Herpst,   H.,   Serg't, 

H.  119th  Pa.,  age  25. 
Hills,  J.  W.,  Ft.,  A, 

145th  Pa.,  age  24. 
Hongard,  J.,  Pt,  E, 

137th  Ills.,  ago  20. 
Hollingshead,  A., 

Corp'l,  H,  12th  Ky. 

Hurd,  F.,  Corp'l,  F, 
8th  Maiue,  age  24. 

Leddie,  J.,  Pt.,  E, 
118th  New  York. 

Lightfoot,  J.,  Pt.,E, 
25th  Mass.,  ago  28. 

McTonrjh,  J.  H.,  Pt., 

1, 45th  Ga.,  age  23. 
Maokey.J.,  Serg't,  I, 

50th  Pa.,  ago  23. 
Marquis,  W.  II.,  Pt., 

K,  85th  Pa.,  age  20. 
Mclle.v,  E  (;.,  Pt.,K, 

2cl  West  Virginia. 
Miller.  K.  IX,  Pt.,  F, 

90th  Pennsylvania. 
Moore,  H.  O.,  Pt,,  A, 

2Cth  Georgia. 

Morgan,  W.,  Pt.,  F, 
l.'Otli  N.  Y.,  ago  22. 

Morgan,  W.  B.,  Pt., 
F,  17th  Connecti 
cut,  ago  24. 

Moser,  J.,  Pt.,  B, 
51st  111.,  age  18. 

Oldfield,  T.,    Sergt., 

D,  10th  Michigan, 
age  33. 

Oni  ish.  P..  Sergeant, 

E,  32d   Massachu 
setts,  age  11). 

Packard,  G.  R.,  Pt., 

F,  3d  Mo.,  age  21. 
Paper,    Ur.,   Pt.,   G, 

5th  N.  C. 

Richards,  S.,  Corp., 
M,  llth  Pa.,  age.  25. 


DATE 
OF 

INJURY. 


NATURE  OF  Ix.n  KY. 


May  5, 

1864. 
Dec.  13, 

1802. 
Au<r.  21, 

1804. 
June  21, 

1864. 

May  16, 
1804. 


Aug.  10, 
1804. 

May  3, 
18d3. 

May  25, 

1864. 
Aug.  27, 

1863. 
Nov.  6, 

1863. 
Auar.  SO, 

1862. 
May  12, 

1804. 

July  2. 

1803. 

July   3, 

1863. 

Nov.  30, 

1804. 
July  20, 

1864. 

May  30, 
1864. 

May  31, 
1862. 

May  5, 
1802. 


DATE 
OF 

,  HAEMOR 
RHAGE. 


PliOBABLE  SOURCE 

OF 
HAEMORRHAGE. 


Fract.  r't  huinerus; 

amputation  arm. 
Wound  through  left 

axilla. 

F:act.   right   huine 
rus  :  amp.  sh.  joint- 
Wound  in  upper  3d 
right  arm. 

Flesh  wound  of  left 
arm. 

Flesh  wound  of  left 
arm.  * 

Flesh  wound  of  left 
shoulder. 

Fracture  hnmerus: 
amp.  at  sh.  joint. 

Wound  left  arm,  div. 
axillary  artery. 

Fracture  right  arm ; 
amp.  at  sh.  joint. 

Wound  of  chest 

Flesh  wound  of  arm. 

inj.brachial  art. 
Flesh    wound,     left 

arm. 


June  13, 

1864. 
Dec.  23. 

1862. 
Sept.  9, 

3864. 
June — , 

1864. 

May  21, 
1864. 

June  30, 
1864. 

Aug.  27, 
29, 1864. 

May  27, 
1863. 


Sept,  12, 

1863. 
Nov.  18, 

1863. 
Sept.  5, 

1862. 
May  19, 

1864. 


Axillary 

Subscapular  art'y. 

Brachial  

Braehial  aneurism 


Brachial;  art.  tied ; 

ha3in .  rec.  May  25, 

June  1. 
Brachial 


DAII: 

OF 

OPERA 
TION. 


Juno  13, 

'     1864. 
Dec,  23, 

1862. 
!  Sept.  9, 
'     1864. 
:  June  24, 


Fracture  huinerus ;  July  19, 
amputation  sh.jt.  j  18G3. 

Fracture  left  arm;!  July  20, 
amputation  arm.  ]  1803. 

Fracture  right  stap-    Dec.  12, 

ula.  i    180 1. 

Flesh  wound  left  arm  . . 


Fract,  left  huinerus   !  May  31,- 
;     1864. 

Fract.  left  humerus;  July  1, 
amputation  arm.  1862. 

Flesh  wound  right  Juno  13, 
arm.  !  1862. 


1864. 

June  1. 
1864. 

June  30, 
1864. 

Sept.  17, 
1864. 

May  27, 

1863. 
June  5, 

1864. 
Sept.  12, 

1863. 
Nov.  19. 

1803. 
Sept.  6, 

1862. 
May  19, 

1804. 

July  19, 
1803. 

July  20, 
1863. 


Enlarged  vessel,  !  Dec.  14, 
collateral  circula.  I    1864. 
Aug.  10, 
1864. 

Axillary May  31, 

|     1864. 

..[July  28, 

18G2. 

June  13, 

1862. 


Axillary  ;  diffused 
aneurism. 

Axillary  artery  . . . 

Axillary 

Brachial 

Aneurism 

Brachial ._. 

Axillary 


Axillary 


Aug.  25, ;  Flesh  wound  left  arm  Sept,  6,    Brachial 
1864. 


1804. 


Sawyer.  D..  Pt.,  D,  July  30, 
31st  Mo.,  ago  33.  1804. 

Sheppnrd,  J.  F.,  Pt.,  July  2, 
A,  18th  Mass.,  age  j  1803. 


Fracture  head  left!. Aug.  8, 
hum.;  amp.  sh.jt.  I  9,1864. 

Wound  through  left  !  July  14, 
axillary  space.  i  1863. 


44  :  Smith.    D.,    Pt,    E, 


6th  Penn.  Cavalry, 
age  29. 

Stetson,  S.  M.,  Pt., 
15,  32d  Me.,  age  19. 


June  12, :  Flesh  wound  left  arm 

1804. 

May  31,    Fracture  right  arm;    June 22, 
1804.          amputation  arm.       j     1804. 


Tighe,    C.,    Pt.,    F,    JunelG, 
50th  J Mass  ,  age  18.   i     1864. 

I 

VanGaslinck,W.  A.,    June  G, 
Pt,,  llth  Xcw  York  :     1864. 
Battery,  age  23. 

Walsh, 'D.,   Pt.,  D,  ,  Oct.  19, 
106th  N.  Y.,  age  23.   ;     1864. 

Yoho,  P.,  Corpl.,  F,  '  Sept,  19, 
116thOhio,age37.    ]     1804. 


Aneurism ;  brach. ; 
lig.  twice ;  amp. 
at  shoulder  joint. 


Wound  left  chest  and  !  July  1,  i  Axillary 
arm.  1804.     , 


Fiact.  left  humerus ;  •  June  12, 
amputation   at  sh.  :    1864. 
joint. 

wound  left  shoulder.  Nov.  3, 
1804. 


Flesh  wound  left  arm  Oct.    4, 
I    1864. 


Sept,  G, 
1864. 

Aug.  8,  9, 

1864. 
July  14. 

1863. 

Aug.  7, 
8, 1864. 

June  22, 
1864. 

July  2, 
1864. 

June  18, 
1864. 


Axillary  art.   and  !  Nov.  3, 
vein.  I     1864. 

Brachial |  Oct.    7, 

;    1864. 


OPERATION,  OPERA 
TOR. 


RESULT. 


Right;  incont.  A. A. 

Surg.  J.  C.  Nelson. 
Left;  in  continuity.. 

Right;  in  cont  inuity : 

relig.  Sept,  11. 
Right;  both  ends  in 

wound.      Surg.    E. 

Shippen,  U.  S.  V. 
Loft;  incont.    A.  A. 

Surg.  J.  H.  Jamar. 

Left;  iu  cont.    Surg. 

T.  H.  Squire,  89th 

New  York. 
Left;  both  ends   in 

wound.  A.  A.  Snrg. 

L.  K.  Baldwin. 
Ligated  on    face  of 

stump. 
Left  axillary.   A.  A. 

Surg.  H.  Craft. 
Right:    on    face    of 

stump. 
Right  axillary  tied. 

Surg.  S.  N.  Sherman. 
Axillary  tied  in  con 
tinuity. 
Left  axillary  tied 


Axillary  tied  in  con 
tinuity. 

Left ;  in  continuity. 
Aug.  3,  religated. 

Right ;  in  continuity 

Left;  in  continuity. 

A.  A.  Surg.  J.   C. 

Thorpe. 
Left;  incont,,  June.7, 

relig.  A. Surg. G.  A. 

Mursick,  U.  S.  V. 
Left;  incont.    A.  A.  < 

Surg.  S.  Teal. 
Right;  in  continuity. 

Surg.  R.  B.  Bonte-  j 

con.  U.  S.  V. 
Left:  incont,    A.  A.  ! 

Surg.  W.  P.  Moon. 

Relig.  Sept.  11. 
Left;  tied  3  times  on 

face  of  stump. 
Left;  in  continuity; 

religated   July  19,  ' 

23. 
Left;  in  cont.    Asst. 

Surg.  H.  S.  Schell, 

U.S.A.  Religated. 
Right ;  in  cout.    A. 

A.    Surgeon   J.    K. 

Thompson. 
Axillary  tied.    Surg. 

R.  B.  Bontecou,  U. 

S.V. 
Left;  in  continuity  ; 

religatccKTuuo  23. 


Died  Juue  15,    1804. 
Spec.  2463,  A.  M.  M. 
Died  Dec.  29,  1862. 

Hsem.   Died  Sept.  12, 

1804, 
Died  June  26, 1864. 


Died  June  1. 1864. 
Died  July  2,  1804. 

Sept,  19,  amp.  atsh.  j. 

Died  Sept.  19.  1864. 

Spec.  3030. 
Died  Juno  3, 1863. 

Died  JuneS,  1864. 
Died  Sept,  12, 1863. 
Died  Nov.  19,  1863. 
Died  Sept.  12, 1802. 

May  23,  amputation 
at  shoulder  joint. 
Died  May  23.  1864. 

Died  July' 19, 1863. 

Died  Aug.  16,  1863. 


Hsem.  rec.  Dec.  19.  i 
Died  Dec.  21, 1804. 

Died  Aug.  10,  1864; 
irritative  fever. 

June  8,  amputation 
shoulder  it.  Died 
June  8,  ]  804. 

Died  Aug.  5, 1862;  re 
current  hcL'm. 

Died  Juno  14, 1862. 


Died  Sept.  18, 1804. 


Died   Aug.   9,    1804; 

asthenia. 
Died  July  24,  1863. 


Died  Aug.  8, 1804. 


Died  Juno  22,  1864; 
exhaustion. 

Died  July  4, 1804;  cx- 
haustiou. 

Died  Juno  23,  1864; 
exhaustion. 


Left;  axillary  artery    Hrem.  recurred  Nov. 

andvein'ied.  A.  A. ;    K,  15.     Died  Nov. 

Surg.  E:  L.  Duer.       |    15  1804. 
Left;  in  cont.    A.  A.  1  Died  Oct.   22,   1864; 

Surg.  W.  L.  Wells.       pyremia.  Spec.  3079. 


Twenty-two  ligations  of  branches  of  the  axillary  were  reported :  one  (fatal)  of  a  branch 
of  the  acromial  thoracic  artery  ;  two  (one  recovery,  one  fatal)  of  the  subscapular ;  eighteen 
(eleven  recoveries,  seven  fatal)  of  the  circumflex;  and  one  (fatal)  pf  the  muscular  branch. 

Liyation  of  Branch  of  the  Acromial  Thoracic  Artery. — CASE  11'29. — Lieutenant  A.  Stephens,  C.  121st  Ohio,  wounded  at 
Chickamauga  September  19, 1863,  in  right  chest ;  haemorrhage  October  6th  ;  October  10th,  ligation  of  branch  of  acromial  thoracic 
in  wound;  haemorrhage. recurred;  death  October  22,  18G3. 

Liyations  of  Sulscapular  Artery. — CASES  1130-1131. — Private  E.  Burk,  I,  81st  Pennsylvania,  age  20;  fracture  of  head 
of  left  humerus  May  12,  1864;  May  20,  excision;  May  23,  haemorrhage  from  subscapular;  ligation  in  wound  on  the  same  day; 
hremorrhage  recurred  May  28;  death  from  pyaemia  June  28,  1864. — Private  J.  Stottlemeyer,  C,  Cole's  Maryland  Cavalry; 
fracture  of  spine  of  left  scapula  Juue  6,  1864;  June  19,  20,  haemorrhages ;  July  24,  ligation  of  subscapular  in  continuity;  returned 
to  duty  December  3,  1864. 


CHAP. 


LTOATIONS    OF    THE    BRACHIAL    ARTERY. 


I  i 


Ligations  of  Circumflex. — Of  eighteen  cases,  eleven'  recovered  and  seven  were  fatal. 

TABLE  OXXXII. 
Condensed  Summary  of  Eighteen  Ligations  of  the  Circumflex  Artery  for  Shot  Injury. 

[  Recoveries,  1—11 ;  Deaths,  12—18.] 


No. 

NAME, 

AGE,  AN1>  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
ILEMOK- 
UIIAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Boothman,  W.,  Pt., 

Jnnel4, 

Fracture  right  shoul 

June  25,    Circumflex  artery  .  June25, 

Right  ;  both  ends  in 

Discharged  Jan.  31, 

B,17;ki;s"-.Y.,a£ol8. 

1863. 

der  :  excision. 

1863.                                             1863. 

wound. 

1864. 

2 

Detweiler,  —  ,Corp'l, 

Mar.  20,     Wound  right  arm  .  .  . 

Apr.  —  /Posterior    circum-    Apr.  —  ,    Posterior  circumflex 

Discharged  June  10, 

G.  198th  Pa.,  ago  18.       18G5. 

1865.         flex. 

1805.         ligated. 

1865. 

3 

Gear,  S.,  Corp'l.  IT,    Dec.  16,     Fracture    right  hu- 

Dec.  26,    Posterior   circum-    Dec.  26,    Right  ;    one  end  in 

Discharged  June-  29, 

•19th  Ohio,  ago  IS. 

1864. 

merus;  excision. 

1864.         Ilex. 

1864. 

wound.  A.  A.  Surg. 

1865. 

S.  M.  Blackwood. 

4 

Howard,  J.R.,Pt.,B, 

Xov.  7, 

Fracture   humerus  ;    Xov.  24,    Anterior    circum-    Nov.  24, 

Ligated  on    face    of 

Discharged      June, 

7th  Iowa. 

1861.         amputation  arm.            1861. 

flex. 

1861. 

stump. 

1863. 

5 

1  Irvine,  S.,  Corp'l,  I, 

Sept.  22,   Right  arm,   injured    Oct.  28,    Anterior    circum-    Oct.  28, 

Right  anterior  circ. 

Amp.atsh.it.    Dis. 

67th  Pa.,  age  23. 

1864.          huiucrus. 

1804.         flex  artery.                  1864. 

artery  ligated. 

Sept.  9,  1865. 

6 

Sharp,  H.  J.,  Serg't, 

Aug.  29,    Flesh  wound  of  left 

Sept.  8.    Posterior  circura-    Sept.  8, 

Left  ;  both  ends  in 

Vet.  Reserve  Corps 

F,  6th  N.  Y.  Car., 

1864.         shoulder.                        1864.     :    flex  artery.                  1864. 

wound. 

Feb.  10,  1865. 

ago  21. 

7 

Smith,    S.,    Pt.,    H, 

MavlO,     Fracture   right   lui-    Mav26,    Posterior   circum-    May  28,    Right;  in  wound.... 

Discharged   Jan.   7, 

150th  Pa.,  age  36. 

1864.         ruerus  ;  excision.        28,1864.      flex  artery.                  1864. 

1865. 

8 

Sprav,  J.  C.,  Pt.,  G, 

Dec.  16      "Frnrtnrn     ridit,    lin-     .Tnn   10 

Jan.  10,     TH«rht-      nnst.     r.ire. 

Jan.   22,   amputated 

71st  Ohio,  age  22. 

18C4. 

merus  ;  excision.           1865. 

1865. 

Surg.  J.  H.  Grove, 

arm.      Discharged 

U.  S.  V. 

May  16,  1805. 

9 

'Wager,  S.,  Pt.,  B,  1st    June  3,    Fracture   light  hit-    June  10, 

Circumflex 

June  10,    Right;    on    face    of 

Disch.  Mar,  16,1865. 

Art.                                 1864.         merns;  amp.  sh.it.  i     1864. 

1864.         stump. 

Died  Dec.  31,  1868. 

10 

Ward,  A.  D.,  Corp'),  '•  July   2,     Flesh  wound  of  left    Julvl3, 

Posterior   circum 

July  13,    Left;    one    end    in 

Discharged  July  28, 

F.I  5th  Mass.,  age~25.       1863.         shoulder.                          1863. 

flex  artery. 

1863.         wound. 

1804. 

It    Yarick,   R.,   Pt.,  G, 

June  3,    Flesh  wound.  left  arm  July  14, 

Anterior    circuiu- 

July  14, 

Left;     one    end    in 

Vet.  Reserve  Corps 

1st  Mich.,  age  27. 

18C4.                                                   1864.         flex  artery. 

1864. 

wound. 

Feb.  10,  1865. 

12    Beekwith,  R.J.,Pt., 

Mar.  9,    Fracture  head  right    May  8, 

Posterior   circum-    May  8, 

Right  ;  in  continuity 

Died  May  12,  1865  ; 

j    B,  12th  Xew  York 

1863. 

humerus  j  excision.       1865. 

flex  artery.                  l8"65. 

pyaemia* 

!    Cav.,  ago  28. 

13    Lvon,  Z.  S.,  Pt.,  I,  ;  Apr.  2,    Fract.    r't   scapula  ;    Apr.  14, 

Brs.  circumflex  ar-    Apr.  16, 

Several    small    brs. 

Died  April  21,  1865. 

17th  Vt.,  age  20.            18(55.         ball  lodged  in  lung.       1863. 

tery. 

1865. 

circumflex  ligated. 

14    Moiiahan,  J.,  Corp'l,    May  5,    Frait.rt.  hum.;  exc.  ;   Sept.  19, 

Anterior    circum-    Sept.  19,    Right  ;  in  continuity 

Amp.  sh.   jt.     Died 

E,  22dMass.,age38. 

1864. 

amputation  arm. 

1864. 

flex. 

1864. 

Sept.  26,  1864.  Xpec. 

3331,  A.  M.  M. 

15    Sanford,  J.  E.,Ft.,D, 

May  6, 

Fracture   right    hu-    June  7, 

Circumflex  artery. 

June  7, 

Right  ;  one    end    in 

Haein.  recnr'd.   Died 

7th  Mass.,  age  24. 

18'  04. 

merus  ;  excision.           1864. 

1864. 

wound. 

June  16,  1864. 

1C    Stoutenberg,"      M., 

May  5, 

Fracture  left  hnme-    Juno  15,  i  Posterior   circum-   June  16, 

Left.    Surg.  H.  Pal 

Died  June  18,  1804. 

Scrg't,  C,  148th  X. 

1864. 

rus.                                  1864.         flex  artery.                  1864. 

mer,  U.  S.  V. 

Y.,  age  24. 

17    Welch^E.  A.,  Scrg't, 

An"-.  25 

Fract.  left  hum.  ;  ex-   Sept.  24, 

Stump 

Sent.  <U 

Anterior  and  poste 

Died    Oct.    11,  1864. 

H.  1st  D.  0.  Cav., 

1864. 

cision  ;  amputation  :     1864. 

1864. 

rior  circumflex  on 

Spec.  3675,  A.  M.  M. 

age  20. 

at  shoulder  .joint. 

face  of  stump. 

18 

Zwick,  G.  T.,  Scrg't, 

May  12, 

Flesh  wd.  left  shoul-    July  2,    Posterior   circum- 

July  2, 

Left  ;  in  wound  

Died  July  15,  1864; 

I,27thMich.,age27. 

1864. 

der.                                  1864. 

flex  artery. 

1864. 

exhaustion. 

Ligation  of  Muscular  Branch  of  Axillary. — CASK  113'2. — Private  E.  Draper,  A,  3d  Delaware,  aged  23;  shot  flesh  -wound 
of  axilla;  axillary  artery  divided  March  31,  1665;  amputation  at  shoulder  April  9.  1865;  haemorrhage  from  muscular  branch 
April  16th,  ligation  on  face  of  stump;  no  recurrence  of  haemorrhage;  death  from  exhaustion  April  16,  1865. 

Ligations  of  the  BracMal  Artery. — One  hundred  and  seventy  cases  of  ligation  of  the 
brachial  artery  were  reported;  one  hundred  and  nineteen  were  successful  and  fifty-one  were 
fatal,  a  mortality  rate  of  30.0  per  cent. 

TABLE  CXXXIII. 
Summary  of  One  Hundred  and  Seventy  Cases  of  Ligations  of  the  Brachial  Artery. 

[Recoveries,  1—119 ;  Deaths,  120—170.1 


NAME, 
No.  I  AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

HJEMOR- 

RIIAGK. 

PROBABLE  SOURCE 

OF 

HJBMOKRHAGK. 

DATK 

OF 

OPEHA- 

TION. 

OPERATION.  OPEHA- 

TOK. 

RESULT. 

1     B;ibcock,  F..  Serg't, 
M,  fith  111.  Cav. 
2     Bal)COck,O.P.,Sers't, 
U,  207th  Pa.,  age  25. 

Becker,  "W.,  Serg't,  B, 
98th  Pennsylvania. 

4     Bergner,  F.,  Pt,,  B, 

Feb.  21, 
1864. 
April  2, 
1865. 

July  2, 
1863. 

May  25, 

JTlesh  ;  left  hand  .  . 

Fracture  left  radius, 
upper  third. 

Fracture  left  wrist  .  . 
Flesh  ;  left  arm,  mid 

1864. 
Apr.  12, 
1865. 

July  14, 
Aug.  30, 
31,  1863. 
Juno  13 

Palmar  arch  
Rec.  branch  radial. 

Ulnar  radial  
Brachial    

Mar.  14, 
1864. 
Apr.  12, 
1865. 

After 

Aug.  31, 
1863. 
June  11, 

In  continuity.  A.  A. 
Surg.  A.  Sterling. 
In  continuity,  lower 
fourth.  A.  Surg.  H. 
Allen,  U.  S.  A. 
In  continuity  

Both  ends  in  wound. 

Duty,  July  13,  1864. 

Discharged  June  2, 
1865. 

Discharged   August 
17,  If  64. 

Duty. 

121st  Pa.,  age  21. 
">     Berry,  P.,  Corp'l,  G, 

1864. 
June21, 

dle. 
Fract.  left  hnmerus- 

1864. 
July   1, 

13,  1854. 
July  1 

A.  A.  Surg.  E.  Do 
Witt. 
On  face  of  stump  .  . 

Discharged   Decem 

23d  Illinois,  age  27. 

1864. 

elbow  joint  amp. 

1861. 

1864. 

ber  5,  1864. 

'  MOON  (W.  P.),  Amputation  of  Right  Shoulder  Joint,  in  Am.  Jour.  Med.  Set.,  1866,  Vol.  LI,  p.  143. 

SURG.  Ill— 98 


WOUND?    AND    COMPLICATIONS. 


[CTIAP.  XII 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

• 
DATE 

OF 

INJURY. 

NATUKE  OF  INJURY. 

^nvS     PROBABLE  SOURCE 

OF 

?^^f"        HEMORRHAGE. 
KoAulS. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

6 

7 

8 
9 
10 
11 
1-2 
13 
14 
15 
10 
17 
18 
19 

20 
21 
22 
23 
24 
25 
26 
27 

28 

29 
30 
31 
32 
33 
34 
35 

36 

:.-, 

38 
^9 
40 
41 

42 
43 

44 

45 
4G 

Bettenhauser.C.,  Pt,, 
I,  GlstX.  Y.,  age  22. 
Bird,  W.  A.,  Pr,..  G, 
68th  Ind.,  age32. 

Bowman.  G,  W.,Pt, 
C,  107th  Illinois. 
Bovuton.  A.  J.,  Ft,, 
II,  13th  Wis.,  age  23. 
BrannagRn,  T.,  Pt., 
B,22dMa88.,agel9. 
Brooks,   J.,    Pt,,   E, 
22d  Mass.,  ago  18. 
lJiroom,  J'.,  Serg't  , 
A.  48th  X.  C. 
Budd,  J.,Pt.,F,  100th 
Pa.,  age  22. 
Carton,  L.,  Pt.,  C,  8th 

July  2, 

1803. 
Aug.  14, 
1864. 

Aug.  6, 
1864. 
Nov.  21, 
1864. 
Juno  18, 
1861. 
July  2, 
1863. 
Aug.  25, 
1864. 
Mar.  25, 
1865. 
Juno  16, 
1864. 
Aus.  16, 
1864. 
Feb.    6, 
1865. 
July  2, 
1863. 
June  20, 
1864. 
May   6, 
1864. 

July  9, 

1864. 
May  22, 
1863. 
Dec.   7, 
1862. 
Oct  16, 
1864. 
Aug.  18, 
1864. 
July  30, 
1864. 
Feb.  20, 
1864. 
May  12, 
1864. 

June  18, 
1864. 

June  3, 
1864. 
Mav  3, 
1863. 
Aug.   1, 
1863. 
June  9, 
1863. 
June22, 
1864. 
Apr.   6, 
1862. 
Feb.  25, 
1864. 

Dec.  16, 
1864. 
Mar.  21, 
1865. 

Dec.  13, 
1862. 
Jan.   29, 
1864. 
Aug.  24, 
1864. 
June  25, 
1864. 

Mav  16, 
1864. 
JuiselG, 
1864. 

July    1, 
1862. 

Aup.  :?0, 
1862. 
Jan.    1, 
1862. 

Aug.  12,  :  Brachial  

Aug.  12, 
1863. 
Sept,  9, 
1864. 

Aug.  6, 
1864. 
Dec.  —  , 
1864. 
July  24, 
1864. 
July  15, 
1863. 
A  us.  30, 
1864. 
Apr.  3, 
1865. 
July  2, 
1864. 
Aug.  16, 
1864. 

One  end  in  wound.  .  . 

In  continuity  ;  haem. 
Sept  15. 

Both  ends  in  wound  . 
In  continuity  

One  endin  wound.  A. 

A.  Surg.H.  Sanders. 
In  continuity  

In  continuity.    Stirg. 
P.Wright'P.A.C.S. 
In  cont    Surg.  N.  11. 
Moseley,  U.  S.  V. 
One  end  in  wound.  A. 
A.  Surg.  W.  Hooper. 
In  continuity;  Sept. 
1,  13,  religated. 
In  continuity,   mid 
dle  third. 
In  continuity,   mid 
dle  third. 
In  cont.  A.  A.  Surg. 
D.  J.  Griffith. 
One  end  in  cont    A  . 
A.  Surg.  F.  G.  H. 
Bradford. 
In  cont.    A.  A.  Surg. 
A.  H.  Hoy. 
On  face  of  stump  

In  continuity  

In  cont,,  mid.  Surg. 
P.  Harvey,  U.  S.  V  . 
Both  ends  in  wound 

In  continuity,  upper 
third. 
In  cont.,  mid.    A.  A. 
Surg.  J.T.  Kennedy. 
Both  ends  in  wound. 
A.  A.  Surgeon  E.  G. 
Waters. 
In  cont.    A.  A.  Surg. 
G.  E.  Brickett. 

V.  R.  C.  May  13,  1864. 

Sept  15,  amp.;    dis 
charged  November 
26,  1864. 
Discharged  April  11, 
1865. 
Discharged  April  8, 
1865. 
V.  It.  C.  May  2,  1865. 

Recovery. 
Recovery. 

Discharged  June  27, 
1865. 
Duty    January     15, 
1865. 
Discharged  October 
31,  1865. 
Discharged  Septem 
ber  9,  1865. 
V.  It.  C.Feb.  24,  18C4. 

July  13,  amp.;  disch. 

Sept.  23,  1864. 
Discharged  July  28, 
1864. 

Discharged. 

Discharged  Sept.  19, 
1863. 
Discharged  Feb.  27, 
1863. 
Discharged  May  31, 
1865. 
Discharged  July  2, 
1865. 
Recovered  Jan.    19, 
1865. 
Duty  Apr.  24,  1864. 

Discharged  Jan.  10, 
18G5. 

Discharged  June  3, 
1865. 

July  21,  amputated  ; 
disch.  Oct.  11,1864. 
Discharged  Aug.  29, 
1863. 
Duty  Oct.  10,  1863. 

Discharged  Jan.  16, 
1864. 
Discharged  Dec.  23, 
1864. 
Discharged  July   2, 
1862. 
Discharged   Dec.   7, 
1864. 

Duty  Sept.  5,  1865. 

Hocm.  rec.  ;  May  14, 
amputated  ;    disch. 
Juno  27,  1865. 
Furloughed. 

Discharged  Nov.  14, 
1864. 
To  prison  Feb.  5,  1865. 

Discharged  May  16, 
1865. 

Discharged  Sept.  23, 
1864. 
Discharged    Feb.    6, 
1865. 

Discharged    Dec.    9, 
1862. 

Discharged  Nov.  10, 
1862. 
Recovered  March  —  . 
1862. 

Fract.  left  humerus, 
lower  third. 

Left  elbow,  cut  brach- 
ial  artery. 
Fract  left  humerus  ; 
Nov.  22,  amp.  arm. 

1863. 
Sept,  9, 
15,  1864. 

Aug.  6, 
1864. 
Dec.   4, 
7,  1864. 
July  20, 

Humeral  

Brachial  
Brachial  

Fract.  left  humerus  ; 
amp.  arm. 
Mid.  finger  left  hand 

Fract.righ  t  humerus, 
lower  third. 
Fleshjright  arm,  mid 
dle. 
Brachial  artery,  right 
arm. 
Fract.  left  radius,  up. 
third,  wd.  radial. 

24/64. 
July  15, 
1863. 

Brachial  
Palmar  arch  

Apr.  2, 
1865. 
July  2, 
1864. 

Superior  prof  unda 
Minor  profunda  .  .  . 

Now  Jersey,  age  19. 
Callahan,  P.,  4th  N. 
J.  Battery,  age  26. 
Canning,  \V.  J.,  Pt, 
D,  95th  Pa,,  age  24. 
Carnaghan,  J.,  Pt.,C, 
29th  Pa.,  age  21. 
Carr,  S.  H.,  Pt,,  C, 
90th  Ohio,  age  21. 
Carroll.   J.,   Pt,  E, 
39th  X.  Y,  age  28. 

Clark,  O.  A.,  Serg't, 
D,  21st  Ohio,  ago  31. 
2  Cloud,  A.,  Pt,   H, 
22d  Iowa,  ago  41. 
Cole,  N.,  Lieut,  20th 
Wisconsin. 
Daniels,  I).,  Pt.,C,  3d 
Wis.  Car.,  age  30. 
David,  W.,  Pt,   D, 
107th  Illinois. 
Davis.  J.  H.,  Pt,  E, 
39th  C.  T.,  age  21. 
Davis,  W.,  Pt,E,  3d 
Artillery,  age  24. 
Donnelly,  J.,  Pt,  D, 
16th  Mass.,  age  41. 

Downey,  J.  N.,  Pt, 
Cth  Maine  Battery, 
age  21. 
Dutfv,  II..  Lieut,  D, 
155tii  N.  Y.,  age  46. 
Ellis,  D.,  Pt..  A,  12th 
N.  U..  age  34. 
Eils,  W..  Pt,  K,  9th 

Radial 

July  21, 
1863. 
July  12, 
13,  1864. 
May  12, 
1864. 

July  24, 
1864. 
Aug.  17, 
1863. 

Repeat 
ed. 

Superficial  palmar 
arch. 
Brachial  

July  21, 
1863. 
July  12, 
1804. 
May  12, 
1864. 

July  24, 
1864. 
Aug.  17, 
1863. 
Dec.  16, 
1862. 
Oct.  28, 
1864. 

July  31, 
1864. 
Mar.   7, 
1864. 
Mav  12, 
24,'  '64. 

July   6, 
1864. 

July  13, 
1864. 
June29, 
1863. 
Aug.  12, 
1863. 
June  19, 
1863. 
On  tield 

Apr.  21, 
1862. 
Apr.  21, 
1861. 

Dec.  23, 
1864. 
Apr.  23, 
1865. 

Jan.  13, 
1863. 
Feb.  11, 
1864. 
Sept.  7, 
1864. 
Sept,  15, 
1864. 

June  21, 
1864. 
July  4, 
1864. 

July   9, 
1862. 

Sept,  26, 
1862. 
Jan.  23, 
Mar.   1, 
1862. 

Flesh  ;  left  arm,  low. 
third. 
Right    brachial    ar 
tery,  high  up. 

Flesh  ;  left  arm.  mid 
dle. 
Fract.  left  humerus, 
lower  third,  amp. 
Bracbial  artery,  left 
arm. 
Flesh  ;  right  forearm 

Brachial  artery,  bend 
of  left  elbow. 

Brachial  
Diffused  aneurism  . 
Brachial  

Flesh  ;  left  forearm  .  . 

Flesh  ;  left  arm,  up 
per  brachial  artery. 

Mar.   7, 
1864. 
May  24, 
1864. 

TJlnar  and  interos- 
seous. 

Brachial  artery,  left 
arm. 
Right  elbow  ;    amp. 
arm. 
Flesh  ;  left  arm,  low 
er  third. 
Flesh;  right  hand.  .. 

Flesh  ;  right  arm  
Flesh;  left  hand  
Fracture  left  carpus 

Left  arm,  upper  third. 

Flesh  ;  left  arm,  mid 
dle  third. 

Fracture   left  wrist 
joint. 

June  29, 
18B3. 

Aug.ll, 
12,  '63. 
Junel3, 
1863. 
On  field 

Apr.  20, 
1862. 
Mar.  25, 
1864. 

Apr.  23, 
1865. 

Jan.  13, 
1863. 

Brachial  
Branch  brachial  .  . 

Palmar  arch  ;   lig. 
radial  Juno  13. 

In  continuity,  high 
up. 
In  cont.   A.  A.  Surg. 
J.  E.  Smith. 

N.  Y.  Cav.,  age  20. 
Estes,    11.,    Pt,    H, 
llth  Ky.,  age  18. 
Fisher,  A.,  Corp'l,  G, 
30th  Mass. 
Flewellen,  A.,Pt,  I, 
29th  Ind.,  ago  20. 
Ford,  I.  C.,   Pt,  C, 
10th  Mich.,  age  21. 

Frnnk,P.,Pt,D,5th 
Minnesota,  ago  27. 
Fritschey,  W.,  S'gt, 
M,  12th   Pa.  Cav., 
age  24. 
Gates,  It.,  Pt  ,  1,  4th 
N.Y.,  age  19. 
Grilboa,A.,Pt.,C,8th 
Mich.  Cav..,  age  27. 
Giltaril,  M.,  Pt,,  K, 
16th  Miss.,  age  27. 
Girrbaeb,  A.,Pt,,B, 
5th  Penn.  Cav.,  age 
26. 
Goodwin,  A.K.,Pt. 
I,  4th  N.  H.,  age  23. 
Gradv,J.,Pt.,C,lC4th 
N.  Y.,  age  47. 

Graham,  It.,  Pt,  B, 
81st  Penn.,  age  43. 

Griggs,  E.  P.,Pt,  F, 
14th  Inf.,  ago  21. 
3  Hamilton,  J.,Pt,  I, 
51st  Penn.,  ago  22. 

Ligation  

April  20,  21,  recur 
red. 

In  continuity,  lower 
third.     A.  A.  Surg. 
D.  O.  Farraud. 
Ligation  

In  cont.    Surg.  J.  B. 
Lewis,  TJ.  S.  V. 

In  cont.  at  bend  of 
elbow. 
Both  ends  in  cont.  A. 
A.  Surg.  H.  C.  May. 
Both  ends  in  wound. 
A.  A.  Surg.  J.  Morris. 
In  continuity,   mid. 
A.  Surgeon   J.  H. 
Merriam,  U.  S.  V. 
Both  ends  in  conti 
nuity. 
Both  ends  in  wound. 
Assist.  Surgeon  II. 
S.  Schfll,  U.  S.  A. 
In  continuity,  lower 
third. 

Radial,  ulnar,  and 
brachial  in  cont. 
In  continuity  

Ulnar  

Flesh  ;    through    bi 
ceps. 
Flesh;  right  wrist.. 

Right  arm  fractured 
amp. 

Sept.  5,     Ulnar  ligated  Sept. 
14,  '64.        5. 

June  21,    Brachial  
1864. 

Radial    artery,     left 
forearm,  up." 

Fractured    metacar- 
pal,  right  hand. 
Left  hand,  fract  met. 
Jan.  1,  excision. 

4,  1864. 

P  r  i  m.     Radial  
and  re-  ! 
currinz. 
Sept.26,  

1862. 
Jan.  10,     Palmar  arch  ;   lig. 
15,  Mar.      radial  Jan.  10. 
1,  1862. 

'WRIGHT  (D.  F.),  The  Effects  of  the  Hunterian  Method  of  Ligation  on  Inflammation,  in  Confederate  States  Medical  and  Surgical  Journal, 
1864,  Volume  I,  p.  178. 

2  LLOYD  (D.  C.),  Report  of  Five  Cases  of  Hospital  Gangrene,  in  Am.  Hied.  Times,  1863,  Vol.  VII,  p.  267. 

3  SQUIRE  (T.  H.),  Report  of  Stiryical  Cases  at  Roanoke  Island,  in  Boston  2Ii-d.  and  Surf/.  Jour.,  1862,  Vol.  LXVI,  p.  176. 


CHAP.  XIT.l 


LTGATION8    OF    THE    BRACHIAL    ARTERY. 


779 


Itfo 

NAME, 
AfiE,  AND  MILITARY 

DATE 

OF 

NATURE  OF  INJURY. 

DATE 

OF 

PROBAHLE  SOURCE 

OF 

DATE 

OP 

OPERATION,  OPERA- 

RESULT. 

DESCRIPTION. 

INJURY. 

RHAGE. 

HEMORRHAGE. 

TION. 

47 

Hammond  R  Pt    G 

Dec.  7 

Brachial  art'y,  tipper 

Dec.   7 

Brachial  

Dec.   7 

48 

8th  Minu. 
Hardv  M    II    "en"! 

1864. 

third,  right  arm. 
Fractured   right  ra 

1864. 

1864. 

Surgeonll.  B.John 
son,  15th  Ohio. 
Ligation  

18G5. 
Discharged  Feb    96 

49 

service. 
Hastings   C.  S.   Tt. 

Is62. 
May   2, 

dius,  mid. 
Fractured  right  carp. 

June  29 

Palmar  arch  

June  29, 

In   cont.    at   elbow. 

1863. 

50 

E,  2dU.  S.  S.  S.,age 
21. 
Hatmaker,  J.,Cnpt., 

1863. 
Nov.  24, 

and  met.;  excision. 
Right  arm  

1863. 
Nov.  24, 

1863. 
Nov.  24, 

Surg.  D.  P.  Smith, 
U.  S.  V. 

discharged    Oct.  9, 
1863. 
Discharged    Oct.    4, 

51 

B,  51st  Obio. 
Hawkins,  A.  P.,Lt., 

18C3. 
Aug.  25, 

Fractured  left  hum., 

1863. 
Sept.  1, 

Brachial  

1863. 
Sept.  10, 

In  continuity  

1864. 
Discharged  Jan.  26 

5^ 

E,  8th   New   York 
Artillery,  age  20. 

1804. 
Dec.  13 

elbow;  exc.,  amp. 

10,  '64. 
Dec  31 

Brachial 

18G4. 
Jan.    1 

Ligated 

1865.    Spec.  2010. 
Discharged   Oct    30 

53 

Corporal,B,4thVt,, 
age  19. 
Uolokor    R.    Pt.    G 

18G2. 
Nov.  25, 

Brachial  tirtery  left 

18G2. 

Brachial 

1863. 
Dec.   6 

Both  ends  in  wound 

1863.  Died  Aug.  10,' 
1869. 

M 

65th  Ohio,  a;:e  25. 
Henby,  J.  R.,'Pt.,F, 

1863. 
Au".  14 

arm. 
Rio'ht  huruerus    el 

Au"'  29 

Brachial  .... 

1863. 
Aug.  29 

In  continuity    . 

1864. 
Discharged  April  25 

55 

51st  ind.,  age  22. 
Henderson,    D.    D., 

1864. 
Feb.  12, 

bow. 
Flesh-  left  brachial 

Sept.  3, 
1864. 
Feb.  24 

Brachial 

Sept.  3, 

1864. 
Feb.  24, 

Both  ends  in  wound. 

L865 

56 
57 

Pt.,   I,   15(h  Miss., 
aso  21. 
1  Heiidorson,"W.,Pt., 
E,  115th  Poiin.,  age 
37. 
Henninfer,  J.,Pt.  H. 

1865. 

Julv  2, 
1863. 

May  20, 

artery. 
Fracture  left  ulna  .  .  . 

Flesh  ;    ri<rht     arm 

1865. 

Aug.  8, 
1863. 

July  24 

Ulnar  branches  
Brachial      

1865. 

Aug.  8, 
1863. 

July  24, 

Surg.  B.  B.  Breed, 
U.  S.  V. 
In  continuity.  A.  A. 
Surg.  J.  Ashhurst, 
jr. 
Both  ends  in  wound. 

Veteran  Res.  Corps 
May  12,  18G4. 

Discharged  Juno  28 

•>;• 

G7th  Ohio,  age  18. 
Hereford,  J.,  Pt.,  L, 

18G4. 
Oct.  22, 

lower  third. 
Ri^ht  arm,  brachial 

1864. 

Aneurism  . 

1864. 
Nov.  27 

Surgeon  A.  Heger, 
•  U.S.A. 
Both  ends  in  wound. 

1865.    r 
Discharged  June  23 

59 

Gth  Kansas  Cav'ry, 
ago  18. 
?  Herring,  Isaac,  Pt., 

1864. 
Nov.  25, 

artery. 
Flesh  •  left  hand 

Palmar  arch    

1864. 
Nov.  29 

Surg.  A.   C.    Van- 
duyn,  U.  S.  V. 
In  continuity  

1865. 
April  24  1864   haem 

no 

C,  53d  C.  S.  A. 
Hinckman,  W.,  C'pl, 

18G3. 
Aug.  19, 

Fractured  left  ulna 

18G3. 
Sept.  24, 

In    continuitv.      A. 

orrhage;  recovery. 
Sept.    14    '64    amp.  • 

01 

B,5thN.T.,age25. 
Hubn  11.,  Lit-uf.  K 

18li4. 
Tune  27 

mid. 

June  27 

1864. 
June  97 

A.  Surg.  A.  Ansell. 
In  continuitv 

disch.May  11,  1865. 

62 

63 

64 

44th  111.,  age  24. 
Huntlev,  W."  F.,  Pt., 
F,  5th  Vt.,  age  26. 

Hurley,  It.,  Pt.,  H, 
159th  New  York. 
^Kennedy,  M.  J.,  Pt., 

1864. 
Mav  5, 
1864. 

Sept.  19, 
18C4. 
Au<r.  29, 

artery. 
Flesh  ;'  right  brachial 

Right  arm,  middle.  .  . 
Flesh  ;    ri^ht     arm, 

18G4. 
May  5, 
1864. 

Sept.  27, 
28,  1864. 

Brachial  

Brachial  
Aneurism    

1864. 
Mav  5, 
1864. 

Sept.  28, 
1864. 
Apr.  7, 

Both  ends  in  wound. 
Surg.  A.  N.  Dough 
erty,  U.  S.  V. 
In  continuitv,  upper 
third. 
In  continuity.  Surg. 

18G4. 
Discharged  Feb.  22, 
1865. 

Oct.  9,  amp.  forearm. 
Disch'dMar.  27,  '65. 
Recovery. 

65 
fifi 

U,  Gth  La,,  age  24. 
Lastofka,  \V.,  Pt.,I, 
•JGth  Wia.,  ago  19. 
Leichfield,  J.  N..  B 

18G2. 
Mav  3, 
1863. 
Mav  !•> 

middle. 
Fract.  r't  humerus  ; 
May  15,  amp.  sh.  jt. 

June  1, 
1863. 
May  24 

Brachial  
Radial 

1863. 
June  1, 
1863. 

F.  For  men  to,  jr. 
On  face  of  stump  .  .  . 

In  continuity  

Discharged  Aug.  13, 
1863. 

67 

20th  Ind.,  age  21. 
LcttiTman,    II.,    K 

1864. 

31,  June 
7,  1864. 
July  13 

Radial 

18G4. 
Julv  14 

In  continuity  

1864.    " 

68 

67th  I'enu.,  age  36. 
Little,  .1.  H.,  Serg't. 

1864. 
.Tune  3, 

Fracture  rinht  ulna, 

1864. 

18G4. 
June  14, 

In  cont.    A.  A.  Surg. 

18G5. 
Duty  Jan.  26,  1865. 

69 
70 

72 
73 

I,  32d  Maine. 
Lusc,  J.   15.,  Pt.,  C, 
125th  Ohio. 
Malier.    T.,    Pt.,   E, 
5(jth  Mass.,  age  17. 

Martin,  T.  A.,Pt,,G, 
91st  N.  Y.,  ii!_re  22. 
Mav,  A.  L>.,  Corp'l. 
Hi  33d  Ind.,  age  22. 

McAllister,  "W.,  S'gt, 

1864. 
Julv  18, 
1864. 
June  17, 
1864. 

Mar.  31, 
1865. 
Mav  15, 
1864. 

Mav  10, 

lower;  excision. 
Fract.   radius;  July 
23,  excision. 
Left  hnmerus,  mid 
dle. 

Fracture  right  fore 
arm. 
Fracture  right  ulna, 
middle. 

Aug.  1, 
4,  1864. 
Julv  G, 
1864. 

Apr.  16, 
1865. 
Mav  24, 
26,27/64. 

May  21 

Radial  ;     brachial. 
Aug.  2,  amp.  arm. 
Brachial  

Radial  

Ulnar  or  interosse- 
ous. 

Brachial 

1864. 
Aug.  4, 
(1864. 
July  6, 
1864. 

Apr.  16, 
1865. 
Mav  27, 
1864. 

May  21, 

J.  A.  McArthur. 
On  face  of  stump  

In  cont.  ,  upper  third. 
A.  A.  Surg.  H.  M. 
Dean. 
In  cont.,  flower  third. 

In  cout.,    at  elbow. 
A.  Surg.  H.  T.  Leg- 
ler,  U.  S.  V. 
One  end  in  wound  ; 

Discharged  Apr.  11, 
1865. 
Recovered  Sept.  24, 
1864. 

April  18,  amputated. 
Disc'hAug.  17,  1865. 
Discharged  Mar.  6, 
1865. 

74 
75 

F,  9Gth  Pa.,  age  30. 

McClinty.  G.,  Pt.,  F. 
17th  S.  O.  C.,  age  17. 
McGraw,  T.  n..C'p], 

18G4. 

Aug.  27, 
1864. 
July  21, 

lower. 
Right  elbow  joint  ... 
Left  arm,  fracture; 

1864. 

Sept.  20, 
18G4. 
Au".  30, 

Brachial  
Brachial    

1864. 

Sept.  20, 
1664. 
Au".  30. 

relig.  June  6.  Surg. 
E.Bentley,  U.  S.V. 
Both  ends  in  wound. 

In  cont.,  upper  third, 

1864. 

Exchanged  Oct.  17, 
1864. 
Discharged  Sept.  27 

7fi 

A,  9th  Me.,  age  18. 
Mclntire.  A.,Pt.,M, 

18G4. 
Juno  3, 

primary  amp. 
Ri°  lit  forearm  

1864. 

1864. 
June  15, 

near  stump. 
In  cont.    Surg.  T.  R. 

1864. 
Discharged  Dec.  —  , 

77 
78 

2d  N.  Y.  Art.,  age  22. 
McMillan,  S.  L.,  Pt., 
C,  40th  Ohio,  age  21. 
Moore,  A.  A.,  Pt.,  C, 

1864. 
Sept.  20, 
1863. 
Julv  21, 

Fracture  right  ulna  . 

Nov.  5, 
1863. 

Brachial  

1864. 
Nov.  5, 
1863. 
Oct  1 

Crosby,  U.  S.  V. 

1864. 
Duty  May  26,  1864. 

79 
80 
81 
82 
83 

53d  Ind.,  age  21. 
Morris,    R.,'  Pt,,   A. 
149th  Penn.,  aee25. 
Mullen,  11.,   Pt.,  E, 
36th  Illinois. 
Myers,  H.,  Serg't,  A, 
23tl  Illinois. 
Noyes,  E.,  Corp.,  C, 
ll'th  Maine,  airo  21. 
O'Covle,  1).,  Pt.,  K, 

1864. 
Oct.  27, 
1864. 
Dee.  31, 
1862. 
Mav   3, 
1803. 
Aus.  16, 
18G4. 
July  27, 

Flesh;  right  forearm, 
upper. 
Lett  arm  ;  March  12, 
amputation. 
Brachial  artery  near 
elbow,  left. 
Right  arm  

Interosscous  artery 

Nov.  13, 
1864. 
Mar.  26, 
31,  1863. 
Mav  3, 
1863. 
Sept.  3, 
1864. 

Radial  
Brachial  

1864. 
Nov.  14, 
1864. 
Mar.  31, 
1803. 
Mav   3, 
1863. 
Sept,  3, 
1864. 

Morgan,  29th  Mo. 
In  cout.    Surg.  N.  R. 
Moseley,  U.  S.V. 
In  cont.;  slight  hem 
orrhage. 
Ligation.       A.      A. 
Surg.  J.  Kirker. 
In  cont.    A.  A.  Surg. 
E.  B.  Woolston. 
In    continuity,  near 

1865. 
Discharged  April  26, 
1865. 
Discharged  June  27, 
1863. 
Discharged  July  24, 
1865. 
Amputated  Sept.  10; 
disch.  Jan.  27,  1865. 

84 
85 

1st  Wis.  U.,  !!!_'021. 

Owens,  E.  G.,  Pt,,U, 
13th  \V~.Va.,  age  19. 
Parrett,W.B.,Pt.,D, 
5th  Iowa,  age  20. 

18Gi 
Oct.  19, 
1864. 
Sept,  19, 
1862. 

right  forearm. 
Left  arm,  lower  third. 

Left  arm  

Oct.  27, 
1864. 
Oct.    3, 
1862. 

Brachial  

Oct.  27, 
1864. 
Oct.    3, 
1862. 

elbow. 
Both  ends  in  wound 

Ligation  

25,  1862. 
Vet.  R.  C.  May  26, 
1865. 
Discharged  January 
7,  1863. 

Asiiiit'R&T  (J.),  Surgical  Cases,  in  Am.  Jour.  Med.  Sci.,  1864,  Vol.  XL VII,  p.  144. 
2  HOLI.OWAY  (J.  M.),  Consecutive  and  Indeterminate  Hcemorrhage  from  Large  Arterien  after  Gunshot  Wounds,  etc.,  in  Am.  Jour.  Med. 
Sci.,  18G5,  Vol.  L,  p.  :U2. 

sFou.MENTO  (F.),  Xotcs  and  Observations  on  Army  Surgery,  New  Orleans,  1863,  p.  56. 


WOUNDS    AND    COMPLICATIONS. 


rcHAP.  xn. 


No. 

86 
87 

88 
89 
00 

91 

92 
93 
94 

95 
96 

97 
98 

99 

100 
101 
102 
103 
104 
103 

106 
107 

108 

109 
110 

111 
112 

113 
114 

115 
116 

117 
118 
119 

120 
jl21 
122 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 
INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

H.S:MOR- 

KIIAGE. 

PKOBAHLE  SOUKCE 

OF 
RfiMOBBHAGB. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

'Pepper,  E.,  Pt.,  B, 
18th  Inf.,  age  35. 
Pel-man,  M.,  Pt,.  V, 
2d  N.  J.  C.,  age  33. 

Philbrick,  C.W  ,  Pt, 
F,3dN.  H.,  age  22. 
Pierce,  G.  W.,  Corp., 
D,  20th  Ind.,  age  22. 
Potter.  E.,   Pt,,   H, 
86th  N.  Y.,  age  29. 

Powers,  C.  C.,  Pt.,  A, 
40th  Iowa. 

Price.,  E.,  Corp'l,  B, 
39th  N.  Y.,age  22. 
Quinn,  J.,Pt,,C,  18th 
Infantry. 
Reede,    £.,    Pt,,    C. 
18ith     Pennsylva 
nia,  age  21. 
Reese,     0.,     substi 
tute,  age  20. 
Reese,   R.,    Pt.,    H, 
1115th  Ohio. 

Rice,  J.  H.,  Pt,  A, 

20th  Conn.,  age  22. 
Root,  E.  C.,  Lieut, 
D,   2d  New  York 
Artillery,  age  29. 

Schrichfield,  J.  H., 
Pt,  B,  20th  Indi 
ana,  age  21. 
Shook,    J.,    Pt,    G, 
27th  Ohio,  ago  21. 
Sipes,  J.,  Serg't,  K, 
32d  Ohio,  age  24. 
Smith.  T..  I.,  Pt,  E, 
6th  Iowa,  ago  22. 
Smith.  U.  A.,  Pt,C, 

Dec.  31, 

1862. 
Mav  2, 
1864. 

May  15, 
1864. 
Aug.29, 
1862. 
Mav   6, 
1864. 

Juno  13, 
1865. 

April  2, 
1865. 
Dec.  31, 
1862. 
Aug.  14, 
1864. 

Oct.  17, 
1863. 
Oct.  8, 
1862. 

Mar.  19, 
1865. 
Mav  19, 
lt'64. 

May  12, 
1864. 

July  4, 
1864. 
Julv  16, 
1865. 
April  6, 
1862. 
Au  g.  14, 

Fracture  right  ulna, 
upper  third. 
Fract  right  radius, 
middle. 

Fract.  left  hnnierus  ; 
May  15,  amputation. 
Lacerated  wound  of 
left  hand. 
Flesh;  left  arm;  in 
jured  artery. 

Fracture  left  radius, 
middle. 

Elbow;  iu  jury  to  bra- 
cbial  artery. 
Flesh  ;   middle  third 
aim. 
Left,  forearm,    near 
elbow. 

Fracture  left  radius 
and  artery. 
Fracture  ulna  

Right   bracbial    ar 
tery. 
Fracture   left    fore 
arm,    upper  third; 
excision. 

Jan.    8, 
10,  1863. 
June21, 
1864. 

June  1, 
1864. 
Sept  9, 
10,  1864. 
May  17, 
1864. 

Jan.  10, 
1863. 
June21, 
1864. 

June  1, 
1864. 
Sept.  10, 
1802. 
May  17, 
1864. 

June  17, 
1865. 

April  6, 
1865. 
Jan.  23, 
1863. 
Sept  7, 
1864. 

Oct.  17, 
1863. 
Oct.  22, 

1862. 

Mar  19 

In  continuity;  Feb. 
10,  hffimor.  rec. 
In  cont,  mid.  third. 
Ass't  Surg.  J.  C.  G. 
Happersett,  U.S.A. 
On  face  of  stump  

In  continuity    .  . 

Feb.  12  ,  amputated. 
.  Dis.  April  21,  1863. 
Discharged  Septem 
ber  5,  1864. 

Discharged   August 
18,  1864. 
Discharged     Febru 
ary  11,  1863. 
Discharged     March 
12,  1865. 

Recovery. 

Discharged  July  27, 
1865. 
V.  R.  C.  July  8,  1863. 

Discharged  Dec.  26, 
1864. 

Jan.    7,    1864,    amp. 
Disc.  Nov.  28,  1864. 
Hem.  cont  by  exci 
sion.     Discharged 
Jan.  27,  1863. 
May  7,  amp.     Disc. 
Oct.  18,  1865. 
Dismissed    Jan.    25, 
1865. 

Discharged  July  29, 
1864. 

Discharged  May  25, 
1865. 
Discharged  Sept.  27, 
1865. 
Discharged  Mar.  19, 
1863. 
Discharged  Dec.   6, 
1864.     " 
Discharged  Jan.  23, 
1863. 
Hffim.  September  29. 
Discharged  Fob.  3, 
1865. 
Discharged  June  28, 
1864. 
April  25,  1865,  hrem. 
Recovery. 

Discharged  May  23, 
1865. 

Discharged  Feb.  28, 
1865. 
July  26,  slight  hrem. 
Recovery. 

Discharged  1862. 

Discharged  Septem 
ber  19,  1864. 

Discharged    Decem 
ber  29,  1864. 

Discharged  June  29, 
1865. 
Duty  Octobcrl6,  1862. 

Duty  April  26,  1865. 

Discharged  Januarv 
11,1864. 

Discharged  January 
13,  1865. 

Died  Juno  1,  1804. 

Died  September  17, 
1862. 
Died  July  2,  1864,  py- 
remic  pneumonia. 

Radial           

Brachial             .   .  . 

In  continuity,   mid. 
Assistant  Surg.  W. 
Thomson,  U.  S.  A. 
In  continuity.  Ass't 
Surg.  J.  C.  Miles, 
U.  S.  V. 
Ligat'u  brachial  and 
ulnar. 
Ligation  in  continu 
ity,  upper  third. 
Both  ends  in  wound. 
A.  A.  Surg.  W.  H. 
Ensign. 
In  continuity.  A.  A. 
Surg.  A.  Hewson. 
In  contiuuitv.  Surg. 
W.  Varian,  U.   S. 
V.;  ineffectual. 

April  6, 
1865. 
Jan.  10, 
22,  1803. 
Sept,  2, 
7,  1864. 

Uluar,  recurrent  . 

Ulnar  ligated  Sep 
tember  2. 

Oct.  38, 
1862. 

Mar.  19, 
1865. 
June  1, 
15,  1864. 

Mav  24, 

Radial  and  branch 
profunda. 

Radial 

1S6:>. 
Juno  1, 
15,1864. 

June  7, 
1864. 

July  18, 
1864. 
Julv  17, 
1865. 
Apr.  24, 
1862. 
Aug.  14, 
1864. 
Dec,  18, 
1862. 
Sept.  17, 
1864. 

In  cont.    1st  Surg.  H. 
W.  Ducachet,  U.  S. 
V.,  and  2d  A.  A.  S. 
J.  O.  Stanton. 
In  continuity,  lower 
third. 

Ineont'n'ty.  Surg.  J. 
H.  Grove,  U.  S.  V. 
Ligation.     Surg.    R. 
R.Taylor,  U.  S.  V. 
Ligation  ;    in    conti 
nuity. 
Ligation    in    upper 
third. 
In  continuity    near 
elbow. 
Ligat'n.    Surg.N.  R. 
Moseley,  U.  S.  V. 

Left  forearm,  upper 
third. 
Right  humerus,  inv. 
brachial  artery. 
Fract   right  radius 

Ri^ht     arm,     upper 

31,  June 
7,  1864. 

Apr.  24, 
1862. 

Radial  
Brachial  
Brachial  

Brachial  

15th  Iowa,  age  29. 
Stevenson,  T.  J'.,  Pt., 
G,.  02d  Ohio,  age  30. 
Sweeny,  P.,  Pt,D,  2d 
New  York  Heavy 
Artillery,  age  40. 
Thompson,    W.    M., 
Serg't,  E,  99th  Ohio. 
Tobert,  L.  C.,  Serg't, 
C,  2d  Alabama,  ago 
18. 
Trask,  T.,  Pt,  F,  2d 
New  York  M.  R., 
ago  16. 
Tmtle,  F.M.,  Pt,B, 
44th  111.,  age  23. 
2  Ward,  C.  O.,  Pt  ,  G, 
66th    North  Caro 
lina,  age  25. 
Warren,  S.,  Pt.,  A, 
llth  Maine. 
Welch,   E.    F.,   Pt, 
57th    New     York, 
age  20. 
Whaley,    I.,    Corp., 
II,  54th  Alabama, 
White,   A.    B.,    Pt., 
D,  1st  D.  C.  Caval 
ry,  age  22. 
White,  E.  B.,  Pt.,  F, 
19th  Maine,  age  21. 
Williams,  J.,  Pt.,  A, 
6th     Pennsylvania 
Cavalry,  age  26. 
Wilkinson,    E.    W., 
Serg.,  G,  42d  New 
York. 
Wiltse,  M.  II.,  Pt, 
G,  1st  U.  S.  Signal 
Service,  age  25. 
Winnemore,E.,Mu8., 
K,    88th    Pennsyl 
vania,  ago  21. 
Barker,  J.  H.,Corp., 
E.14'2dPenn.,n{re25. 
Beaver.  T  ,  Pt,  II,  2d 
Wisconsin,  age  30. 
Bcvei!y,W.J.,i't,C, 
17th  Maine,  age  27. 

1864. 
Dec-.  10, 
1862. 
Aug.  14, 
1864. 

Nov.  25, 
1863. 
April  9, 
1865. 

June  3, 
1864. 

June  27, 
1864. 
June  30, 
1864. 

Mav  31, 
1862. 
June  16, 
1864. 

Julv  28, 
1864. 
Juno  16, 
1864. 

Mar.  31, 
18G5. 
Sept.  20, 
1862. 

May  10, 
1864. 

Mav   3, 

1863. 

June  26, 
1864. 

Mav  12, 
1864. 
Aug.  27, 
180i>. 
May    5, 
1864. 

third  brachial  art. 

Dec.  18 

Left  arm  

1862. 
Sept.  17, 

Brachial  

Fracture  elbow,  sev. 
brachial  artery. 
Flesh  ;  left  arm,   el 
bow. 

Left  forearm,  radial 
and  ulnar  arteries. 

Flesh  ;  left  forearm 

Fracture   left  meta- 
carp. 

Flesh;  leftarm,  near 
elbow. 
Left  arm  ;  fracture  ; 
amputated. 

Fracture    right   sh. 
joint;  excision. 
Flesh  ;  upper  third, 
right  aim. 

Flesh  ;     right    arm, 
inj.  brachial  artery. 
Lei't  arm  ;  div.  bra 
chial  artery. 

Fract.  ulna  ;  lacera'd 
brachial  artery. 

Fracture  right  ulna, 
upper  third  ;  exc. 

Right   forearm,    up 
per  third. 

Fraet.  left  humerus  ; 
amputated. 
Fract  right  humer 
us;  excision. 
Flesh,  elbow  ;  brach. 
artery  severed. 

1864. 

Brachial 

Apr.  17, 
1865. 

June  20, 
1864. 

Julv  17, 
1864. 

Julv   6, 
1864. 

Aug.  11, 
12,1864. 
Julv  6, 
1864. 

Apr.  12, 
1855. 
Sept.20, 
1862. 

Mav  10, 
1864. 

Mav  15, 
1863. 

Aug.  8, 
1864. 

June  1, 
1864. 
Sept.  1, 
18G2. 
Mav  2.1, 
24,  iS(J4. 

Brachial  

Apr.  17, 
1865. 

June  20, 
1864. 

Julv  19, 

1864. 
Julv  16, 
1864. 

In  continuity,  lower 
portion.    Surg.  A. 
McMahon,  U.  S.  V. 
In  cont.    Surg.  X.  R. 
Moseley,  U.  S.  V. 

In  continuity,  lower 
third. 
In  cont    Asst  Surg. 
O'Leary,  C.  S.  A. 

Radial 

Ulnar  ligated  
Sloughing  

Brachial  .... 

Julv  6, 
1864. 

Aug.  12, 
1864. 
July  6, 
1864. 

Apr.  12, 
1865. 
Sept.20, 
1862. 

May  10, 
1864. 

May  26, 
1863. 

Aug.  8, 
1864. 

June  1, 
1864. 
Sept.l, 
1862. 
May  24, 
1864. 

On    face  of    stump. 
Surg.  R.  B.  Bonte- 
cou,'  U.  S.  V. 
In  wound  

Both  ends  in  wound. 
A.  A.  Surg.  J.  M. 
McGrath. 
In  cont.,  mid.    A.  A. 
Surg.W.  H.  Ensign. 
In  wound,  both  ends. 
Asst,  Surg.  J.  W.  S. 
Gouley,  U.  S.  A. 
In  cont.  (ulnar  also). 
Surg.  J.    M.    Burr, 
4'Jd  New  York. 
In   continuity,  near 
elbow. 

In  cont  ,   mid.  third. 
A.  A.  Surg.  W.  P. 
Moou. 
In  continuity  .  . 

In  wound  

Both  ends  in  wound. 
Asst.   Surg.  G.  A. 
Mursick,  U.  S.  V. 

Deltoid  branch  .... 

Brachial 

Post,  interosseous. 
Ulnar  

Braehiul  
Brachial  
Brachial  

'SIIRADY  (J.),  Ligature  of  lirachial  Artery,  in  American  Medical  Times,  1863,  Vol.  VI,  p.  173. 

2  WRIGHT  (D.  F.),  The  Effects  of  the  Hunter-ion  Method  of  Ligation  on  Inflammation,  in  Confederate  States  Medical  and  Surgical  Jour 
nal,  1864,  Vol.  I,  p.  177. 


CHAP.  XII.J 


LIGATIONS    OF    THE    BRACHIAL    ARTERY. 


781 


Xo. 

NAME, 

AGE,  AXI)  MlLlTAUY 

•DESCRIPTION. 

DATE 

OF 

IXJUUY. 

NATURE  OF  INJURY. 

DATE 

OP 

ILEJIOR- 
KHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 
Ol'F.  RA 
TION. 

OPERATION,  OPERA- 

TOB. 

RESULT. 

123 
V>4 

Blakeloy,  A.,  Pt.,  I, 
3d   Michigan   Cav 
alry. 
Bohiicr   W    Pt    TI 

June  16, 
1803. 

An"  19 

Left  arm  

July  8,  9, 
10, 
1863. 
Sept,  5 

Brachial  

July  10, 
1803. 

Sept.  5 

Incont;  ineffectual. 
Surg.  B.  A.  Vander- 
kieft,  U.  S.  V. 

Amp.  arm,  sh.  joint; 
hacm.  recur'd,  amp. 
Died  July  26,  1863. 
Died  October  3  1861 

125 

3dOhioCav.,ago20. 
Brick  ett   E.  .T.    Pt. 

1804. 
July  2 

lower  third. 

1864. 
July  23 

Brachial  

7,  8,  10, 
1804. 
July  23, 

J.  L.  Eaton. 
In  continuity  . 

Died  Au"    10    1863- 

126 

A,    7th     Michigan 
Cavalry,  ace  19. 
Print    J  ,  Corp.,  F, 

1863. 
Au".  5 

per  third  ;  amp. 

1863. 
Sept.  13 

Brachial    

1863. 
Sept.13, 

Both  ends  in  cont.  • 

pyajrnia. 
Sept.  23    amp.  •  died 

127 
128 

120 
130 

14th  Ohio,  ago  27. 
Broolis,G.,  Pt.,I,9th 
\V.  Virginia,  age  20. 

Burnham,     L.     M., 
Corp.,D,132dPenn- 
svlvunia,  iigo  22. 
CliiH-,  C.  11.,  Pt.,  D, 
71  h  W.  Va.,  age  2K 

1804. 
Aug.  26, 
1804. 

Sept,  17, 
1802. 

June  1, 
1864. 
May  6 

bow;  gangrene. 
Flesh  ;  middle  right 
arm  ;  part,  severed 
brachial  artery. 
Fract.    left   radius; 
amp.  forearm. 

Flesh;   right  brach. 
artery  injured. 

1804. 
Sept.  5, 
9864. 

Oct.  30, 
1862. 

JtinelS, 
1864. 
May  16 

Brachial  
Slough,  stump  

Brachial  .......'.. 
Radial 

1864. 
Sept,  5, 
1804. 

Xov.  4, 
1862. 

June  15, 
1801. 
May  19, 

Sept.  16,  relig. 
Both  ends  in  wound. 
A.   A.   Surg.  T.  J. 
Dunott, 
In  continuity  

Lig.   A.  A  Surg.  H. 
D.  Vosburgh. 

Oct.  12,  1864;  pv. 
Died  Sept.  10,  1864; 
gangrene. 

Died  Xov.  15,  1862. 

June  23,  amp.  ;  died 
June  25,  1864. 
Died   May  31    1664- 

131 

148thPenu.,  age  27. 

1854. 
May  12 

turo;  excision. 

1!>,  1864. 

Brachial 

1864. 
June  1, 

per  third. 

pyasmia. 
Died  June  2  1864. 

13° 

10th  La.,  age  27. 
Donnelly   E    Pt   C 

1804. 
Sept  17 

amputation. 
Flesh  •  left  arm 

1864. 
Oct  3  5 

18G4. 
Oct.  6 

Died   Xov    7    186°  • 

m 

SlstX.  Y.,  age  29. 
Evors,  W.  —  ,  E,  9th 

1802. 

6,  1862. 

1802. 
Xov., 

Oct.  7,  amputation. 
In  continuity  

pyaemia. 

134 

Wisconsin. 
Fitzgerald  .T  P    Pt 

May  18 

May  22 

1862. 
May  2'~> 

lig.  of  aneurism. 
Died  June  4    1864  • 

133 

G,  52dX.Y.,age37. 
Greaf  A    Corp'l  P 

1804. 

amputation. 

1864. 
July  23 

Radial 

1864. 
July  23 

Ass't  Surg.  G.  A. 
Mursick,  IT.  S.  V. 

pyrcrnia. 
Died  July  25    18/54  • 

136 

40th  X.  Y.,  age  37. 
llamlin    F    X.    Lt 

1864. 
May  5 

right  forearm. 

1804. 

1864. 

lig.  radial). 

exhaustion. 
Died  June  25    1864- 

137 
138 

K,  147th  X.  Y.,  ago 
32. 
^Hardy,F.S.,'Pt.,'B, 

30tli  X.  U.,  age  22. 
Ileatheilv     .T.,   Pt., 

1864. 

July  12, 
1864. 
Oct  28 

arm,   uluar   artery 
divided. 
Fracture    left    ulna 
and  light  radius. 

1804. 

Aug.  13, 
1804. 
Dec   10 

Right  brachial  .... 

1864. 

Aug.  13, 
1864. 
Dec.  19 

ulnar.  Surg.  II.  W. 
Dncachet,  U.  S.  V. 
In  cont'ty;  slough.; 
hann.  recurred. 

exhaustion. 

Died  Aug.  14,  1864; 
exhaustion. 

139 

E,  llth  W.Va,,  age 
35. 
Heudrix  A  ,  P(  ,  C 

1804. 
July  2 

arm,  upper   third; 
Oct.  29,  excision. 

10,  19, 
1864. 
July  26 

1864. 
Au".  4, 

bifurcation;    liitm. 
recurred. 

tion.    Died  Jan.  24; 
pyaemia. 
Died  Au".  18   1863 

140 

140th  X.  Y. 
Howard    G.,  Pt.,  H 

18U3. 

joint. 

Aug.  2, 
1803. 
June  29 

1863. 
Juue  29 

rhage    recurred 
Aug.  14,  16. 
Both  ends  iu  wound 

Died   July    1     1864- 

141 

8th    X.   Y.   Heavy 
Artillery,  age  20. 
Her,  \V.  S.,  Easier, 

1864. 
May  27 

arm. 

1804. 
Sept.  6 

1864. 
Sept.  6, 

On  face  of  stump  .  .  . 

exhaustion. 
Died  Sept.  16   1864 

14° 

D,  10th  Ohio,  age  22. 

1804. 
July  4 

elbow;  amp. 

1864. 
July  30 

1864. 
An"  5 

Died  Au"  13   1863 

1-1't 

33d  Iowa. 
Jones,    J.,    Pt,    A, 

1863. 
Jiiiy  1 

arm. 
Frac.    ri"ht    wrist; 

Alice.  5, 
1803. 
July  17 

1803. 
July  17, 

In  continuity     

Died  July  18  1863. 

144 
145 

143d  I'enii.,  ago  28. 
Kane,  J.  F.,  Pt.,  D, 
27th  Georgia. 

1803. 
Juno  1, 
1864. 

Xov  27 

amputation. 
Fracture    hunierus, 
upper  third;  ampu- 
tion. 

1863. 
Juno  13, 
16,  1864. 

Brachial  

1863. 
June  15, 
10,  1864. 

Dec.  15 

In  continuity  

Died  June  16,  1864. 
Died  .Dec  V5  1863 

146 

M7 

A,  14thX.J.,age44. 
Laniareaux,  A...  Cor 
poral,   E,   14th    X. 
Y.,  age  20. 
Lanoui,   C.     Pt.    I 

181)3. 
April  1, 
1805. 

Sept  13 

rus;  amp. 
Fracture  left  radial, 
upper  third  ;  radial 
artery  severed. 

1863. 
Apr.  9, 
12,  15, 
1865. 
Oct  10 

1863. 
Apr.  15, 
1805. 

Oct.  10 

24,  lig.  sup.  prof. 
In  continuity  

Died  April  16,  1863  ; 
exhaustion.     Spec. 
4186. 
Died  Xov    13    1864  • 

148 
141 

9th  X.  H.,  ago  23. 
Marshall,  H.,  Pt.,  E, 
1st  Mich.  C.,  age  20. 

MrCridcn  B.  Pt  ,D 

1864. 
May  28, 
1804. 

June  16 

Flesh  ;  right  arm  

1804. 
June  19, 
1864. 

June  29 

Radial  and  ulnar  .  . 

1864. 
June  19, 
1864. 

June  29, 

A.  Surg.  G.  Sweet. 
In  continuity;  haem 
orrhage  recurred. 

Li"ation  

chronic  diarrhoea. 
June  24,  1864,  amp. 
Died  July  11,  1864  ; 
pyaemia. 
Died  July  8  1804 

150 
151 

1V> 

03d  X.  Y.,  age  30. 
Morgan.  L.,  Pt,  D, 
14th  Mich,  ago  22. 
Mullau,    P.,   diseh'd 
soldier,  a^e  30. 
Xash.  J.  E.,  Pt,,  B, 

1864. 
Mar.  25, 
1863. 
J;m.  29, 
1862. 
July  9 

rus;  23d,  exc.  sh.  jt. 
Flesh  ;  left  arm,  mid 
dle  third. 
Inj.    humerus    and 
thoracic  parietes. 

1804. 
April  8, 
1805. 
Oct.  20, 
186-'. 
Ail".  2 

Brachial  
Brachial  

1864. 
April  8, 
1865. 
Oct.  20, 
1802. 
Aug.  2, 

Both  ends  in  wound. 
Ligation  

On  face  of  stump  .  . 

Died  April  13,  1803; 
pyaemia. 
Oct.  21,  amputated  ; 
died  Xov.  5,  1862. 
Died  Au".   7    1864- 

153 
154 

9th  N.Y.  A.,  age  23. 
A'tinn,  T.  P.,  Pt.,  F, 
12th  Ga. 
Palmer,   U.,  Pt.,  B, 

1864. 
July  1, 

putation. 
Right  elbow,  cutting 
brachial. 
Left  arm  

1864. 
July  12 

Brachial;  July  12, 

1804. 
July  16, 

In  continuity  
On  face  of  stump  .... 

pneumonia. 
Died  June  20,  1864. 

Died  July  21  1864. 

155 

4th  Art. 
1'armenter,  II.  B.  ,  Pt., 

1803. 
Dec.  10, 

Left  hand    

16,  1864. 

amp.  arm. 

1804. 
Dec.  —  , 

In    continuity   near 

Died    Jan.   1,    1863; 

100 
157 

A,2lBtMich.,age32. 

llea.  J.  H.,   Pt,7  II, 
102d  I'enn.,  age  17. 

Reagles,  L.,  Pt.,  A, 

1802. 
May   5, 
1864. 

Oct.  14, 

Leftarm,  upperthird. 

Oct    18 

Brachial  

1802. 
May—, 
1864. 

Oct.  18, 

elbow. 
Ligatiou  

In  continuity  at  ax 

mortification. 
May  17,  amputated  ; 
died  Dec.    1,    1864; 
phth.  and  diar. 
Died  Oct.   20    1864  • 

ir.s 

C4th  X.  Y.,  age  20. 
Rees,  G.  W.,  Pt,  G, 

1804. 
April  1, 

at   middle;   ampu 
tated  in  u  piper  third 

Fracture  left  radius, 

1864. 
Apr.  12 

Radial  .          

1804. 
Apr.  12, 

illa.   A.  A.  Surg.  C. 
P.  Bigelow. 
In  cont.  A,  A.  Surg. 

recur,  of  haeni. 
Died  April  26   1S05; 

i,-ft 

20th  Pa.  C.,  ago  22. 
Richardson,    O.    B., 

1805. 
June  3, 

middle  third. 
Fracture    right    ra 

1805. 
July  1 

1865. 
July  5, 

J.  Morris. 
Both  ends  in  cont. 

pneumonia. 
July  15,  amputated; 

100 
1(51 

Serg't,  E,  32d  Me., 
age  21. 
Roberts,  J.,  Corp'l, 
H,  24th  X.  Y.  Cav. 
Satterfield,    K.,   Pt., 
F,  12  tli  W.  Va. 

1864. 

June  3, 
1864. 
Apr.  2, 
1804. 

dius. 

Right,     arm,    lower 
third. 
Left  elbow  joint;  am 
putation  arm. 

1864. 

Aug.  6. 
1804. 

Brachial  

1SC4. 

June  28, 
1864. 
Aug.  6, 
1864. 

Surg.    E.    Russell, 
Farmington,  Me. 
Ligated  

On  face  of  stump.  .  .  . 

died  Aug.  23,  1804. 

Died   July  8,   1864; 
pyaemia. 

Died  August?,  1S64;  '. 
pyaemia. 

1  LEAVITT  (T.  L.),  Tenacity  of  Iluman  Life  as  seen  in  Gunshot  Injuries,  in  Medical  and  Surgical  Reporter,  Philadelphia,  1865,  p.  299. 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  xn. 


No. 

1C2 

163 
164 
165 

166 
167 

168 
169 

170 

NAME, 

AGE,  AND  MlUTAKY 
DESCRIPTION. 

DATE 

OK 

IXJUKY. 

NATURE  OF  INJURY. 

DATE 

OF 
H^EMOU. 
It  HACK. 

PUOBAIU.E  SOUKCE 
OF 

HJBMOBBHAGE. 

DATE 

OF 
Ol'EHA- 
TION. 

OPERATION,  OPEUA- 

TOK. 

EESULT. 

Slater,  J.,  Corp'l,  K, 
7tli  Now  York  Ar 
tillery,  ago  20. 
Tipton,    J.,   Pt.,   C, 
78th  Illinois,  ago  30. 
Urmston,  J.,  Pt.,  K, 
8Cth  Indiana. 
Vander.slico,  J.,  Pt., 
D,  9Ctli  Ponnsylva- 
nia,  age  49. 
Waite,   \V.,  Ft.,   E, 
53d  Ohio. 

'Walker,  H.  H.,  Pt., 
A,  27th  New  York, 
age  29. 
WaUeer,  W.,  Pt.,  C, 
18th  Georgia. 
"Williamson.  J.,  Cor 
poral,  F,  lllth  Illi 
nois,  age  26. 
Wolfe,    F.,   Pt.,   N, 
9th  Now  York  Ar 
tillery,  age  28. 

Juno  16, 
1864. 

Sept.  —  , 
1862. 
Sept.  19, 
1863. 
June  3, 
18(54. 

May  31, 
1864. 

Juno27, 
1862. 

1863. 
Dec.  13, 
1864. 

Oct.  19, 
1864. 

Fracture  right  radi 
us  and  ulna,  mid.  ; 
amputation. 

June  30, 
1864. 

Oct.  15 

Radial  and  ulnar  .  . 

June  30, 
1864. 

Oct.  15, 
1862. 
Out.  20, 
1863. 
June  14, 
1864. 

May  31, 
1804. 

Alirr     3 

In  continuity     .   . 

Died   July    8,    1864. 
Spec.  2700. 

Disch'g'd  :  died  Nov. 
30,  1802;  lung  foyer. 
Died  Uctober21,  1863. 

Died  July  16,  1864; 
pyaemia. 

Died  May  31,   1864; 
efl'ect  of  ehlorof  'm. 

Died  August  3,  1862. 

Died   December   11, 
1863. 
January  7,   amputa 
tion.     Died  Febru 
ary  1,  1805  ;  pyaemia. 
Died  November  14, 
1864,  of  pyinmia. 

In  continuity;  Oct. 
17,  amputation. 
In  continuity  at  low 
er  third. 
One  end  in  wound. 
A.  A.  Surg.  D.  Keu- 
edy. 
Ligatod.   Surg.  J.  N. 
liarues,   116th  Illi 
nois. 

Thro'  carpus  right 
hand  ;  amputation. 

1862. 

Juno  14, 
1864. 

May  31, 
1864. 

Aug.  3, 
1862. 

Brachial  
Brachial  

Flesh;    right  arm, 
upper  third;  brach- 
ial  artery  cut. 
Flesh;  middle  third 
arm. 

18(52. 

Ligation  ;  hsern.  rec. 
December  10. 
In  continuity.  A.  A. 
Surg.   H.  Leaman. 
Jan.  6,  re-ligated. 
Both  ends  in  wound. 
A.  A.  Surg.  11.  L. 
Suyder. 

Right  forearm,  in 
juring  ulnar  artery. 

Flesh  ;  injuring  bra- 
chial  artery. 

Dec.  30, 
1864. 

Oct.  29, 
1864. 

Ulnar 

Jan    2, 

1863. 

Oct.  29, 

1864. 

Brachial  

Of  the  one  hundred  and  seventy  cases  amputation  of  the  arm  had  been  performed  in 
twenty-nine,  and  the  subsequent  ligations  were  on  the  face  of  the  stump  in  ten  and  in  the 
continuity  in  nineteen  instances.  Haemorrhages  recurred  after  ligations  in  thirty-eight 
instances,  causing  fatal  terminations  in  sixteen  cases. 

Ligations  of  Branches  of  the  Brachial  Artery. — These  include  three  cases  of  liga 
tions  of  muscular  branches  (one  recovery,  two  fatal),  seven  ligations  of  the  profunda  (five 
recoveries,  two  deaths),  and  a  fatal  case  of  ligation  of  the  anastomotica  rnagna: 

Ligations  of  Muscular  Branch  of  BracJiial  Artery. — CASES  1133-1135. — Private  R.  Eichards,  G,  4th  New  Hampshire,  aged 
29;  shell  wound  of  right  elbow  February  21,  1865;  amputation  of  arm  on  same  day;  haemorrhage  March  27;  muscular  branch 
ligated  on  face  of  stump;  discharged  June  11,  1865. — Private  W.  Fitzgerald,  B,  1st  U.  S.  Sharpshooters,  age  19;  shot  fracture 
of  elbow  joint  November  7, 1863;  excision  November  8,  1863;  amputation  of  arm  November  12th;  haemorrhage  November  24th 
from  muscular  branch;  ligation  on  face  of  stump  by  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A.;  death  from  pyaemia  November 
29,  18(53. — Lieut.  D.  A.  Walbridge,  A,  llth  Vermont,  age  31;  shot  fracture  of  right  humerus  June  4,  1864;  amputation  of  arm 
on  same  day;  haemorrhage  June  18th;  ligation  of  muscular  branch  on  face  of  stump;  haemorrhage  recurred ;  artery  re-ligated; 
death  June  19,  1864,  from  exhaustion. 

Lifjatiovs  of  Profunda  Arteries. — CASES  1136-1142.— Private  G.  C.  Figgens,  8th  Illinois,  age  25;  right  shoulder  joint  April 
9,  1865 ;  excision  of  neck  of  humerus  same  day ;  haemorrhage  from  profunda  May  9th ;  ligation  in  wound  May  9th  ;  no  recurrence ; 
discharged  July  22,  1865. — Private  E.  Getchell,  C,  3d  Maine,  age  29;  shot  fracture  of  left  arm  May  5,  1864;  amputation  of  arm 
May  6th;  haemorrhage  from  profunda  May  9th;  ligation  on  face  of  stump;  discharged  December  13,  1864. — Private  G.  Johnson, 
I,  9th  U.  S.  Colored  Troops;  shot  fracture  of  right  humerus  September  29,  1864;  haemorrhages  October  16-20;  excision  of 
head  of  humerus  and  ligation  of  profunda;  discharged  December  9,  1865. — Corporal  A.  C.  Vantiue,  B,  123d  Ohio,  age  23;  shot 
wound  of  right  elbow  September  22, 1864;  amputation  of  arm  October  12th ;  haemorrhage  from  profunda  October  16th;  ligation 
on  face  of  stump;  no  recurrence;  discharged  February  21,  1865. — Private  L.  G.  Williams,  II,  84th  Illinois,  age  30;  llesh  wound 
of  arm  September  19,  1863;  haemorrhage  from  profunda  October  8th;  ligation  of  cardiac  end  in  wound  October  8th;  no  recur 
rence;  discharged  February  28,  1865. — Private  J.  P.  Wells,  E,  104th  New  York,  age  19;  flesh  wound  of  arm  July  1,  1863; 
haemorrhage  from  profunda  July  7th;  ligation  July  9th;  death  July  20,  1863. — Private  J.  Woods,  C,  85th  Pennsylvania,  age 
23;  fracture  of  left  humerus  September  2,  1863;  amputation  of  arm  September  9,  1803;  haemorrhage  from  profunda  September 
12th;  artery  ligated  on  face  of  stump;  death  September  17,  1863,  from  exhaustion. 

Ligation  of  Anastomotica  Magma. — CASK  1143. — Corporal  J.  Foster,  K,  38th  Illinois;  flesh  wound  of  arm  September  19, 
1863;  haemorrhage  from  anastomotica  magna  September  29th;  wound  enlarged  and  artery  ligated  same  day;  gangrene  October 
7th;  death  from  exhaustion  October  9,  1863. 

Ligations  of  the  Radial  Artery. — Fifty-nine  cases  with  forty-five  recoveries  and  four 
teen  deaths  were  reported,  a  fatality  rate  of  23.7  per  cent.  In  four  cases,  of  which  one 
proved  successful  and  three  fatal,  the  ulnar  artery  was  also  ligated.  The  ligation  was  per 
formed  after  amputation  in  the  forearm  in  seven  instances  ;  in  three  cases  of  recovery  on 
the  face  of  the  stump;  and  in  four  cases,  with  two  recoveries  and  two  deaths,  in  the  con 
tinuity.  In  four  instances  primary  ligation  was  performed  on  the  field;  all  recovered, 


CHAP,  xil.]  LIGATIONS    OF    THE    RADIAL    ARTERY. 

TABLE  GXXXIV. 
Condensed  Summary  of  Fifty-nine  Ligations  of  the  Radial  Artery  for  Shot  Injury. 

[Recoveries,  1 — 45;  Deaths,  46 — 59.] 


783 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HjEMOR- 
KHAGB. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

2 
3 

4 
5 
6 

7 
8 

9 
10 
11 
12 
13 
14 

15 
16 
17 
18 

19 
20 
21 

!J  J 

23 
24 

25 

2G 

27 

L.1" 
29 
30 

31 
32 

33 
34 
35 
36 

37 

Blackney,  J.,Pt.,  G, 
63d  Penn.,  age40. 

Brown,  P.,  Pt,I,7th 
"West  Va.  Cavalry. 
Clongh,  A.,  Pt.,  C, 
31st  Maine,  age  IS. 

Cottrell,  C.H.,  Pt.,  I, 
7th  X.J.,agol8. 
Dieffenbach,  H.,Lt, 
I,  lllth  Pa.,  age  30. 
Engle.G.  D.,Pt.,A, 
28th  Mich.,  age  18. 
Fair  field,    E.   F., 
Corp'l,  D,74thN.Y. 
Fisher,    R.,    Pt.,  K, 
121st  N.  Y.,  age  18. 

Gaunt,    B.,   Pt.,  A, 
12thN.  J.,  age  26. 
Gracev,   A.,  Pt.,  E, 
52d  Ohio,  age  40. 
Greenly,  H.,  Pt,,  K, 
34th  New  York. 
Hakes,   A.,   Pt.,  A, 
32d  >,'.  Y.,  ago  23. 
Hull,  J.   M.,  'Pt.,  E, 
20th  Illinois. 
Hannaherry,  W.  A., 
Pt.,  A,  26th  Penn., 
age  20. 
Harding,  H.S.,Capt., 
A,  122d  Ohio,  ago42. 
Hart  15.,  Pt.,  D,'28th 
Mrs?.,  age  38. 
Hathiway,  L.,  C'p'l, 
I,  25th  Mass.,  age  25. 
Ilavden,  J.,   Corp'l, 
H,17thWis.,age25. 

Hnlse,  S.,Pt.,I,  84th 
Penn.,  ago  27. 

Lamper,  C..  Pt.  F, 
82d  Peun.,age21. 

Lewis,  E.H.,Pt.,E, 

June  16, 
1864. 

Nov., 
1864. 
June  3, 
1864. 

May  12, 
18(54. 
July  20, 
1804. 
Mar.  10, 
1865. 
Aug.  29, 
1862. 
Mav  10, 
1864. 

June  5, 
1864. 
July  1, 
1864. 
June  30, 
1862. 
Sept,  17, 
1862. 
April  6, 
18G2. 
July  2, 
1863. 

June  3, 
1864. 
July  3, 
1863. 
June  2, 
1864. 
Aug.  22, 
1864. 

May  15, 

1804. 

June  1 
1864. 

Dec.  13, 

1862. 
May  10, 
18(54. 

Sept.  18, 
1864. 

May  20, 
1864. 

July  11, 
1864. 

June  30, 
18(54. 

July  3, 
1863. 
Aug.  19, 

18(54 

Fracture    right   ra 
dius. 

June  28, 
1864. 

Radial  artery. 

June  28, 
1864. 

Nov., 
1864. 
June  8, 
1864. 

July  20, 
1864. 
Mar.  18, 
1865. 

June  7, 
1864. 

June  30, 
1864. 
July  20, 
1864. 
July  18, 
1862. 
Oct.  9, 
1862. 

Right;  both  ends  in 
wound.    Act.  Asst 
Surg.C.  Eberhardt 
Left  ;  radial  ligated. 

Right  ;  both  ends  in 
cont.      Act.    Asst. 
Surg.C.  Eberhardt. 
Left     A.    Surg.    H. 
M.  Sprague,U.S.A. 
Right.    Surg.  A.  K. 
Fifield,  29th  Ohio. 
Left  ;  radial  ligated  .  . 

Rad.  and  ulnar  art. 
in  cont.  ,  lower  third. 
Right  ;  both  ends  in 
wound.    Act.  Asst 
Surg.  A.  A.  Smith. 
Right  ;  on  face  stump. 

Left;    both  ends  in 
wound. 
Right;  in  continuity. 

Right;    one  end  in 
wound. 
Right;  radial  ligated. 

Left;     one    end   in 
wound. 

Left  ;  on  field. 

Right  ;    in    continu 
ity. 
Left  ;  in  cont.   Surg. 
E.  Bentley,  U.  S.  V. 
Left;  in  cont.   Surg. 
J.  G.   Miller,   llth 
Iowa. 
Right;  in  cont.;  both 
ends.      Act   Asst. 
Surg.  J.  Evans. 
Left;  both  ends    in 
wound.  Act.  Asst. 
Surg.  \V.  F.  Atlee. 
Left;  in  continuity.  . 

Radial  ;  both  ends  in 
wound.    Act.  Asst. 
Surg.W.  R.  Dunton 
Right;  both  ends  in 
wound.   A.  A.  Surg. 
J.  M.  McGrath. 
Left  ;  both  ends  in 
wound.   A.  A.  Surg. 
T.  Liebold. 
Right  ;  in  continuity. 
Aug.  1,  2,    haern.  , 
palm.  arch. 
Left;   both  ends  in 
wound.   Asst.Surg. 
E.Curtis,  U.S.  A. 
Left;  in  continuity.. 

Left;  in  continuity.. 

Left;   both  ends  in 
wound. 
Left  ;  on  face  of  stump 

Right;     in    wound; 
one  end. 

One  end  in  wound. 
A.  A.  Surg.  W.  P. 
"VVolhaupter. 
Right  ;  in  cont.     A. 
A.  Surg.  J.  Stearns. 
Left,     A.  A.  Surg.  J. 
Grant. 
Left  radial  artery  lig 

Right;  in  wound  

Right;  both  ends  in 
wound. 

Discharged  July  7, 
1865. 

Mustered  out  Aug., 
1865. 
Veteran  Reserve  C. 
Feb.  18,  1865. 

Duty  Oct.  17,  1864. 

Discharged  Nov.  3, 
1864. 
Discharged  July  20, 
1865. 
Discharged  Oct.  31, 
1862. 
Discharged  Dec.  10, 
1864. 

Discharged  Oct.   26, 
1864. 
July  22,   amp.   arm. 
Disch'd  May  2,  1865. 
Discharged  Jan.  10, 
1863. 
Duty  Feb.  13,  1863. 

Discharged  Aug.  28, 
1862. 
Discharged    Feb.  9, 
1864. 

Discharged   Oct.  27, 
1864. 
Discharged  Feb.  28, 
1864. 
Discharged  Oct.  27, 
1864. 
Discharged    May  5, 
1865. 

Deserted  October  16, 
1864. 

Discharged  May  17, 
1865. 

Discharged  Juno  13, 
1864. 
Duty  Aug.  12,  1864. 

Oct.  91,   amputation 
forearm.       Disch'd 
Aug.  21,  1865. 
Vet.  R.  Corps  April 
12,  1865. 

Aug.  2,    amputation 
forearm.      Disch'd 
May  18,  1865. 
Aug.   2,  amputation 
arm.       Discharged 
Feb.  11,  1865. 
Discharged  May  16, 
lt-64. 
Discharged  Jan.  17, 
1865. 
Duty  Jan.  26,  1865. 

Discharged  Sept.  9, 
1865. 

Discharged  July  2, 
1865. 

Duty  July  12,  1864. 

Discharged. 
Duty  Sept  7,  1864. 

Discharged  June  6, 
1S65. 
Duty  Nov.  1),  1862. 

Discharged    Dec.  7, 
1862. 

Fracture    right   ra 
dius. 

Fracture  left  radius  . 

Fracture    right   ra 
dius  ;  excision. 
Fracture  left  radius  ; 
excision. 
Fracture  loft  hand; 
amputation  finger. 
Flesh  wounds  right 
forearm  and  arm. 

Fracture  right  fore 
arm  ;  amputation. 
Flesh     wound    left 
forearm. 
Shell   wound    right 
wrist. 
Fracture    right   ra 
dius. 
Fracture    right   ra 
dius. 
Fracture  left  ulna.  .  . 

Fracture  left  radius. 

Fracture  bones  right 
hand. 
Flesh     wound    left 
forearm. 
Fracture   left  hand 
and  wrist. 

Flesh  wound,  injur 
ing  right  rad.  art 

Fracture  left  ulna.  .  . 

Frac.  left  carpus,  j't  ; 
excis.  ;  amp.  forearm. 
Flesh     wound    left 
forearm. 

Fracture  right  carp, 
bones. 

Flesh     wound    left 
forearm. 

Wound  right  wrist, 
rad.  art  severed. 

Flesh     wound     left 
forearm. 

Fracture  left  ulna.  .  . 
Fracture  left  wrist; 

June  8, 
1864. 

July  20, 
1864. 
Mar.  18, 
1865. 

June  7, 
1864. 

June  30, 
1864. 
July  20, 
1864. 
July  15, 
1862. 
Oct.  9, 
1862. 

Radial  artery  . 

Radial  

Radial  :. 
Radial  

Radial.. 

Radial  

Radial  artery  

July  19, 
1863. 

June  3, 
1864. 
July  4, 
18(53. 
June  6, 
1864. 
Sept.  9, 
1864. 

May  26, 
1864. 

July  27, 
1864. 

Mar.  7, 
1863. 
May  24, 
1864. 

Oct.  18, 
1864. 

Radial  artery  . 

July  19, 
1863. 

June  3, 
1864. 
July  4, 
1863. 
Juno  13, 
1864. 
Sept.  9, 
1864. 

Mav  26, 
1864. 

July  27, 
1864. 

Mar.  7, 
1863. 
Mav  24, 
1864. 

Oct.  18, 
1864. 

June  12, 
1864. 

July  11, 

1864. 

July  15, 
1864. 

July21, 
1863. 
Oct.    9, 
1864. 
July  22, 
1S64. 
Junel6, 
1865. 

Sept  10, 

18G4. 

Apr.  7, 
1864. 

Nov.  20* 
1863. 
Oct.  26, 
1863. 
Mar.  20, 
1865. 
Oct.    4, 
1862. 
Get  20, 
1862. 

Radial  artery  

Radial  artery  

Radial  artery  
Radial  artery  . 

Radial  artery  -  

Radial  artery  
Radial  artery  

145th  Peiin.,  age  18. 
Melsaars,  J.,  Corp'l, 
G,  5th  Mich.,  age  21. 

MeMullin,  S.,  Serg't, 
A,  14tli  Penn.  Cav 
alry,  age  43. 
Miller.    I.,   Pt.,    K, 
97th  Penn.,  age  25. 

Kevins,  H.  M.,  Serg't 
E,  25th  Xew  York 
Cavalry,  age  23. 
O'Brien,   M.,  Pt.,  I, 
l(59th  N.  Y.,  age  24. 

O'I)onnel],E.,Pt.,C, 
3d  Pa.  Art,  ago  20. 
Perkins,  G.  W.,  Pt., 
G,  8tnMich.,age25. 
Ray,   D.,  Pt.,  I,  5th 
Conn  ,  age  22. 
Reielmeider,  P.,  Pt, 
H,  28th  IV-nii.,  a:ro 
24. 
Richards,  G-TV^Pt., 
A,  Vet.  Res.  Corps. 

Rose,  G.  M.,  Pt.,  G, 

Oth  Cavalry,  age  22. 

Smith,    J.,    Pt.,    K, 
ll'Jth  Pa.,  ago  22. 
Smith,    S.,    Pt.    II, 
74th  Ohio,  ago  3(5. 
Swords.  J.  W.,  Serg't, 
H,  2lith  Iowa, 
Tate,  W.  C.,  Pt,  B, 
With  Illinois. 
Tli-.ina.s.   J.,  Pt.,  G, 
7.")tli  Illinois,  age  22. 

Radial  artery  

July  11, 
1804. 

July  14, 
18(54. 

July21, 
18(53. 
Oct.    !), 
1801. 
July  2  2, 
18(54. 
June  16, 
1865. 

Sept,  10, 
1804. 

Apr.  2, 
1864. 

Nov.  20, 
18(53. 
Oct.  26, 
1803. 

Oct.    4, 
1862. 
Oct.  20, 
1862. 

Radial  artery  
Radial  artery  

Radial  artery  
Radial  artery  

Muse,  branch   ra 
dial  artery. 
Radial  artery  .  

Radial  artery  
Radial  artery  

Radial  artery  
Radial  artery  

Radial  artery  
Radial  artery  

May  25, 
180*. 

July  20, 
1864. 

Sept,  3, 
1804. 

Mar.  29, 
1864. 

Nov.  7, 
1>63. 
Oct.    2, 
1863. 
Mar.  20, 
18(55. 
Oct.    4, 
1862. 
Oct.    8, 
1862. 

Flesh     wound     left 
forearm. 
Fracture  left    wrist 
.joint;  amputation; 
forearm  re-amp. 
Fracture  right  wrist 
and   hand  ;    ampu 
tation  forearm. 
Fracture    ulna,    ra 
dial  artery  injured. 

Fracture  right  rad. 
at  wrist. 
Fracture  left  radius. 

Fracture  left  radius; 
resection. 
Flesh    wound    right 
foro'm,  rad.  art.  sev. 
Flesh  ;  right  forearm. 

734 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

NAME, 

AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

XATUBE  OF  INJURY. 

DATE 
OF 

ILEMOR- 
K11AUE. 

PUOliABLK  SOL'KCE 
OF 

HJEHORBHAGK. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA- 

TOB. 

RESULT. 

38 

39 
40 

41 
42 
43 

44 

45 
46 

47 
48 

49 
50 
51 
52 
53 

54 

55 
56 

57 

58 

59 

Thompson,    W.    M., 
I't.,   E,   1st  Mary 
land,  age  24. 
Van  Kirk,  P.,  Pt.,  A, 
26th  Penn.,  a»e  21. 
Washington,  M.,Pt., 
K,    8th    Co  lore  il 
Troops,  a  ire  30. 
White.   P.',    Pt.,   B, 
22d  Mass.,  airo  42. 
Wiseius,  H.,  Pt.,  I, 
20th  Mass.,  age  31. 
Woodruff,  J.,  Pt.,  A, 
27th  Mich.,  age  33. 
Wright      W.     C 

June  3, 
1864. 

Julv  2, 
1863. 
Aug.  16, 
1804. 

Julv  2, 
1863. 
Feb.  26, 
1863. 
Juno  18, 
1864. 
Julv  20 

Flesh  ;  left  forearm, 
inj.  rad.  art. 

Fracture  left  ulna  .  . 
Fracture  left  wrist.. 

Flesh      wound     left 
hand. 
Fracture  left  carpus; 
exeis. 
Fracture  lingers  left 
hand;  amputation. 
Flesh    wound    riuht 

June  11, 
1864. 

July  22, 
1863. 
Sept.  9, 
1864. 

Julv  10, 
1863. 
Mar.  9, 
1863. 
Julv  3, 
1864. 

Radial          

June  12, 
1864. 

Julv  22, 
1863. 
Sept.  9, 
1864. 

July  10, 
1863. 
Mar.  12, 
1863. 
Julv   3, 
1864. 
Auir.  5, 
1864. 

June  28, 
1864. 

Jan.  10, 
1865. 

Left;    both  ends  in 
wound.      Surg.   E. 
Bentley,  U.  S:  V. 
Left;     one    end    in 
wound. 
Rad.  tied  in  wound 

Left  ;  in  continuity  .  . 
Left  ;  in  continuity  .  . 
Left;  on  face  stump 

Right  ;  iu  wound.  A. 
A.    Surg.     S.     W. 
Blackwood. 
Left;     one    end    in 
wound. 

Right  :  rad.  and  uln. 
arteries    tied,    one 
end  in  wound.     A. 
A.  Surg.  J.  Sloan. 
Left;  both    ends   in 
wound. 
Left;  rad.    art.  and 
muse.  branch.  A.  A. 
Snrg.  A.  A.  Smith. 
Left;    one    end     in 
wound. 

Left  ;  in  continuity  . 
Left  ;  in  continuity  .  . 

Left;     0110     end     in 
wound. 

Left;    both   ends  in 
wound. 

Left  ;    both   ends  in 
wound.    Surg.N.R. 
Moseley,  U.  S.  V. 

Left;  in  continuity.. 

One      end     tied      in 
wound. 

Right  ;  radial  ligated 

Left;  radial  and  ul 
nar  arteries  in  con 
tinuity. 
Right;  radial  and  ul- 
iiar  arteries  ligated. 

Duty  Sept.  19,  1864. 

Duty  May  3,  1864. 

Discharged  May  26, 
1865. 

Recovered.      Killed 
June  3,  1804. 
Discharged  Dec.  29, 
1863. 
Transferred  Julv  2^, 
1804. 
Duty  July  13,  1865. 

Furloughed  Aug.  19, 
1864.  ' 

Died  Jan.  27,    1865; 
jaundice,  etc. 

Died  April  12,  1865, 
of  asthma. 
Died  Sept,   3,   1864; 
pharyngitis. 

Died  Oct.  26,  1864. 
Died  June  8,  1804. 

Feb.   21,    amp.    fore 
arm.    Died  Aprils, 
1865;  pyasmia. 
Julv   24,  amp.  arm. 
Died  (Jet.  11,1861; 
diarrhcoa. 
July  29,  amp.  fore 
arm.    Died  August 
19,    1863;    pyasmia. 
Specs.     2615',     2610, 
2773,  A.  M.  M. 
July  0,  amp.  forearm. 
Died  Sept.  7,   1864; 
pyaemia.  Spec.  2810. 
A*.  M.  M. 
Xov.   6,    amp.    arm. 
Died  Xov.  15,  1864  ; 
exhaustion. 
July  29,    am]),    fore 
arm.    Died  July  31, 
1863. 
Died  July  21,  1863. 

Died    Dec.   3,    1862; 
pviemia.    Spec.  217, 
A".  M.  M. 
Oct.   26,    amp.    fore 
arm.     Died  Oct.  29, 
1863;  pyaemia. 

Radial  artery  
Radial  artery  

Dorsal  artery  

Recurred     March 
10,  11,  12. 
Radial  

Radial  

Corp'l,  F,   107th  X. 
York,  age  21. 
Wrightman.G.,Sgt,, 
L,  6th  Mich.  Cav., 
age  23. 
Beach,  H.  M.,  Serg't, 
0,   51  h  Minn.,  age 
31. 

Daniels,  L.,   Pt.,  B, 
09th  X.  Y.,  age  26. 
Fiantz,    P.,    Corp'l, 
H.,     148th     Peim, 
age  21. 
Grundv.  J.X.,Corp., 
F,    98th    X.  York, 
age  21. 
Humphrey,    J.     M., 
I't.,  B,  183d  Pcnu., 
age  32. 
Jackson,  T.,  Pt,,  B, 
95th  X.  Y.,  age  19. 

Knock,  A.,  Serg't,  B, 
84th  111.,  age  26. 

Kuhn,  .T.  G.,  Pt..  G, 
75th  Pa.,  ago  42. 

McCready,     J.     S., 
Captain,    H,    126th 
Ohio,  age  35. 

Morrick.  T.,  Sorg't, 
F,  10M  111.,  age  35. 

Palmer,  A.,  Pt.,  K, 
73d  Ohio,  age  '40. 

Pohlman,  W.  11.,  Ad 
jutant,  59th  X.  Y. 
Strickland,  M.  L'.,  —  , 

1864. 

May  28, 
1864. 

Dec.  16, 

1864.    * 

Mar.  25, 
1865. 
Mav  10, 
1864. 

Sept,  29, 
1864. 

Mav  18, 
1864. 

Feb.    7, 

1865. 

June  27, 
1864. 

July  U, 
1863. 

Mav  10, 
1864. 

Oct.  20, 
1864. 

Julv   3, 
1863. 

Julv  3, 
1863. 

Sept.  14, 
1802. 

Sept  19, 
1863. 

forearm,  rupturing 
radial  artery. 
Flesh    wounds    left 
hand  and  thigh. 

Flesh   wound  right 
arm,  inj.  rad.  and 
uln.  arteries. 

Flesh     wound     left 
forearm  and  chest. 
Fracture   left    fore 
arm. 

Flesh     wound     left 
arm. 

Wound    left   hand; 
amp.  fingers. 

Fracture  left  radius  ; 
wounds  both  hands. 

Flesh     wound     left 
forearm. 

Fracture  left  hand  ; 
amp.  fiiig. 

Fracture   left   ulna; 
exc.  ulna  May  20. 

Fracture  left  radius  ; 
wound  left  hip. 

Flesh  wound  forearm 

Wounds  r't  foreaain 
and  left  shoulder. 
Fracture  left  radius  ; 
amp.  forearm. 

Fracture  met.  bone 
right  thumb;  amp. 

June  27, 
28,  '64. 

Jan.  10, 
1865. 

Radial  artery  .... 

Radial   and    ulnar 
arteries. 

Radial  artery 

Radial  artery  

Radial   and  inter, 
arteries. 

Radial  artery 

May  30, 
1864. 

Oct.  16, 
1864. 

Mav  23, 
1864. 

Feb.  21, 
1865. 

Julv  22, 
1864. 

July  24, 
1863. 

May  20, 
1864. 

Xov.  6, 
1864. 

Julv  29, 
1863. 

July—  , 
1863. 
Oct.  20, 
1802. 

Oct.    3, 
1863. 

Oct.    9, 
13,  'C4. 

May  23, 
1864. 

Feb.  21, 
1865. 

Julv  22, 
1864. 

July  24, 
1863. 

Mav  19, 
1864. 

Xov.  6, 
1864. 

Julv  29, 
1863. 

Radial  artery  
Radial  artery  

Radial  artery..  .. 

Radial  artery  
Radial  

Oct.  20, 
1862. 

Oct.     3. 
1863. 

Radial  and    uluar 
arteries. 

G,  50th  Ga.,  age  22. 

Washburn,   J.,   Pt., 
H,  38th  Ind. 

Ligations  of  the  Ulnar  Artery. — There  were  twenty-two  cases  of  ligation  of  this  artery 
with  two  deaths,  the  fatal  issue  being  ascribed  to  haemorrhage  in  one  instance  and  to 
exhaustion  following  haemorrhage  in  the  other.  In  a  case  of  aneurism  of  the  ulnar  artery 
both  ends  of  the  vessel  were  ligated  in  the  wound  ;  the  bleeding  did  not  recur,  and  the 
patient  recovered  without  further  untoward  accident. 

TABLE  CXXXV. 
Condensed  Summary  of  Twenty-two  Ligations  of  the  Uhnr  Artery  for  Shot  Tnjiii'icx. 

[Recoveries,  1—20:  Deaths,  21— ->:.'.] 


STO. 

NAME, 

AGE,  AND  MILITARY 
DESCRIPTION. 

DATE                   * 
OF      :  NATURE  OF  IXJUIIY. 

INJURY. 

DATE 

OF 
ILKMOU- 

PROBABLE  SOUHCK 

OF 
rLEMOUBHAGE. 

DATE 

OF 

OPERA- 

OPERATION,  OPEKA 

TOR. 

RESULT. 

1 

Black,  J.  A.,  Capt, 

1 
Mav  23,    Fracture  left   ulna; 

M;iv—  , 

Mav  28, 

Discharged    Julv   1 

B.  50th  Pa.,  age  36. 

1864.     i     excision. 

1804. 

1804. 

1805. 

2 

Booth.  G.  W.,  I't,.  F, 

AU-.  21,    Flesh   wound;    left 

Sept,  6, 

Aneurism  of  ulnar 

Sept.  7, 

Left;    both   ends   in 

Discharged  Feb.  25, 

1st  Mich.,  age  26. 

1804.     !     foreami. 

7,  '64. 

artery. 

1804. 

wound.     A.    Surg. 

1805. 

II.Allen.U.S.  A. 

CHAP.  XII.) 


LIGATIONS    OF    ARTERIES    OF    THE    HAND. 


785 


No. 

NAME, 

A(JK,  AND  MlLITAKT 

DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
H-KMOR- 
RHAGE. 

PROHAUI.E  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

3 
4 

Bruso.    T.,    Ft,    A, 

121st  N.  Y.,  age  21. 
Cirter    J      Pt      D 

Apr.  6, 
1865. 
May  16 

Fracture  left  radius. 

May  14, 
1865. 

Ulnar  artery  

May  14, 
1805. 
June  2 

Left;    both  ends  in 
wound. 

Discharged  Aug.  1, 
1865. 

5 
6 

llth  Conn  ,  age  22. 
Copley,  J.  G.,  Capt., 
E,  86th  N.  Y. 
Ci'anshaw  S    PI    ~B 

1804. 
.May   6, 
1864. 
May  31, 

forearm. 
Fract.  left  forearm: 
excision. 
Fracture  left  radius 

1864. 
May  22, 
1864. 

Ulnar  artery  

1864. 
May  22, 
1?64. 

A.  Smg.O.W.Peck. 
Left  ;  in  wound    

1864. 
May  23,   amp.  arm. 
Disch.  Sept.  19,1864. 

7 

70thN.  Y.,age,45 
Eiger  J  H    Pt    F 

1864. 
May   6 

and  ulna  ;  excision. 
Fracture  left  baud. 

May  21, 

1864. 
May  21 

same  day. 

1864. 

8 
9 

28th  Mass.,  ago  20. 

Fallen,    P.,    Pt.,    I, 
146th  N.  Y.,  age  22. 
Foid  M    Pt.  G  51st 

1864. 

Dec.  13, 

1862. 
Sept.  17, 

Wound  of  wrist  joint  . 
Fracture  of  ulna  .... 

1864. 

Dec.  24, 
1862. 
Oct.    2, 

Ulnar  artery  
Ulnar  artery  

1864. 

Dec  24, 
1862. 
Oct.    3, 

cision. 
Left;  in  continuity.  . 

Disch.  Apr.  16.  1865. 
Spec.  2477,  A.M.M. 
Discharged  Apr.  23, 
1863 
Discharged   Feb.   2 

10 

N.Y..aM28. 

Fox  W.  H.,  Pt     F 

1862. 
Aug.  20, 

Fracture  of  left  ulna  - 

1862. 

1862. 

wound. 
Ligation  of  ulnar 

1863. 
Discharged  Mar.  22, 

11 

161  h  Wis.,as:ol8. 

1864. 
Sept  19 

Sept.  19 

Ulnar 

Sept  19 

1865. 

12 

H,  58th  V  a.,  age  36. 
Harbison  G    Pt    L 

1864. 
Sept  29 

arm,  ulnar  severed. 

1864. 
Nov.  1 

1864. 

C.W.Todd,13thv7i. 

1864. 
Duty  Dec  22  1864 

13 

14 

15 

2dPa.  H.  A.,  age  32. 

Harrison,  "W.  II..  Pt., 
M,  1st  U.  S.  Art, 
age  22. 
Howell,S.  TF.,Pt.,E, 
6th  N.  C.,  age  20. 
Kripps  J  B    Pt    E 

1864. 

Feb.  20, 
1864. 

July  3, 

1863. 
Sept.  29 

arm. 
Fracture  of  left  ulna 

Fracture  of  ulna  .  .  . 
Fracture  of  ulna 

1864. 

Mar.  1, 
1864. 

July  13, 
1863. 
Oct.    8 

Distal  end  of  ulnar  . 
Ulnar  artery 

3,  '64. 

Mar.  1, 
1864. 

July  13, 
1863. 
Oct.    8 

cont.    A.  Surg.  W. 
S  G.Elliott,U.S.V. 
Both  ends  in  wound. 
Sure.  C.  L.  Allen, 
U.  S.  A. 
Left  ;  nlnar  ligated  .  . 

Duty  July  12,  1864. 

Recovery. 
Returned    to    duty 

16 
17 
18 

2<1  Pa,  Art.,  age  40. 
McColliff,  J.,  Pt.,  B, 
2d  111.  Cav.,  age  28. 
Price,  L.  II.,  Pt.,  G, 
86th  N.  Y. 
Shaw  G.  W  ,  Pt.  H 

1864. 
Aug.  11, 
1864. 
Aug.  30, 
1862. 
May  20 

Fracture  of  radius.  .  . 
Fracture  of  ulna  
Wound  of  left  arm  • 

1S64. 
Aug.  24, 
1864. 
Sept.  15, 
1862. 
June  12, 

Ulnar  artery;  40  oz 
Ulnar  artery;  18oz. 

1864. 
Aug.  24, 
1864. 
Sept.  15, 
1862. 
June  12, 

wonnd. 
One  end  in  w'd.  Surg. 
D.C.  Jones,  2dIll.U. 
In  continuity  

Ligation.  Act.  Asst. 

Mar.  31,  18G5. 
Returned    to    duty 
Nov.  25,  1864. 
Discharged  Dec.  29, 
1862. 
Discharged  Nov.  12, 

19 
20 
21 

85th  Pa.,  age  42. 
Waitenbee,    W.   D., 
Pt.,  100th  O.,  ago  23. 

Wood,  D.  E.,  Pt.,K, 
64th  N.  Y.,  age  33. 
Bell,  G.  L.,  Ser""'t,  E 

1864. 
Feb.  20, 
1865. 
July  3, 
1863. 
Dec.  15, 

gangrene. 
Flesh    wound    right 
forearm. 
Fract.  of  right  ulna.  . 

Flesh   wound    ri^ht 

1864. 
Mar.  26, 
1865. 
July  24, 
1803. 
Dec.  27, 

Ulnarartery  ;  20  oz  . 
Ulnar  artery  ;  8  oz  . 
16  oz    

1864. 
Mar.  26, 
1865. 
July  24, 
1863. 
Dec.  27, 

Snrg.  W.C.  Fryer. 
Both  ends  in  wound. 
A.A.Stirg.G.Byers. 
Both  ends  in  wound  . 

In  continuity;    also 

1864. 
Discharged   July  5, 
1865. 
July  29,  exc.    Disch. 
Dec.  31,  1863. 
Died  March  11,  1863. 

f> 

10th  Conn.,  age  34. 
Clapper,  J.  D.,  Pt. 

1862. 
July  12, 

forearm. 
Left  forearm  

1862. 
Aug.  8, 

Ulnar  artery  ;  6  oz. 

1862. 
Aug.  8, 

amp.  arm. 
Both  ends  in  wound 

Died  Sept.  14,  1864. 

G,43dN.  Y.,  age  22. 

1864. 

1864. 

A.  A.   Surg.   W. 
F.  Atlee. 

1864. 

Of  the  branches  of  the  ulnar  artery  the  interosseous  was  ligated  in  nine  instances,  of 
which  three,  or  33.3  per  cent.,  proved  fatal: 

Ligations  of  the  Interosseous  Artery  of  Forearm. — CASES  1144-1152. — Private  J.  J.  Boden,  B,  45th  Pennsylrania;  shot 
fracture  of  lower  extremity  of  radius  September  14,  1862;  October  17th,  excision  of  pieces  of  radius;  haemorrhage;  ligation 
of  anterior  interosseous  in  wound  by  Assistant  Surgeon  E.  W.  Brennermann,  U.  S.  A.;  discharged,  April  18,  1863. — Private 
I.  B.  Flint,  K,  1st  Massachusetts  Artillery,  age  21;  shot  fracture  right  radius  May  18,  1864;  removal  of  ball  and  section  of 
radius  on  May  28;  haemorrhages  May  28,  30,  June  1st;  ligation  of  interosseous,  June  1,  in  the  wound;  no  recurrence ;  duty 
February  16,  1865. — Private  T.  Hart,  C,  145th  Pennsylvania,  age  25 ;  shot  wound  of  third  finger  of  left  hand  June,  1864 ; 
amputation  of  finger;  gangrene;  interosseous  tied  to  prevent  haemorrhage;  duty  March  14, 1865. — Private  S.  W.  Howell,  E,  6th 
North  Carolina,  age  20 ;  minie"  ball  entered  posterior  part  of  left  forearm  two  and  a  half  inches  from  wrist  joint,  fractured  the 
ulna  and  passed  through,  July  2, 1863;  haemorrhage  July  13,  1863;  ligation  by  A.  A.  Surgeon  J.  H.  Bartholf;  no  recurrence  of 
haemorrhage ;  transferred  August  10, 1863.  — Private  D.  McKemu'liy,  G,  10th  Kentucky;  shot  fracture  metacarpal  bones  of  right 
hand  September  19, 1863;  September  28th,  amputation,  three  fingers ;  October  29th,  amputation  forearm;  November  4th,  haemor 
rhage  from  interosseous;  ligated  on  face  of  stump;  transferred  to  V.  R.  Corps  August  20,  1864. — Corporal  I.  Martz,  B,  184th 
Pennsylvania,  age  39;  shot  fracture  of  middle  finger  of  right  hand  June  3, 1864;  amputation  of  finger  June  3;  gangrene;  flap 
amputation  of  forearm  at  lower  third;  whole  stump  became  diseased  June  30,  1864;  haemorrhage  from  interosseous  in  July ; 
ligation  of  artery  on  face  of  stump;  circular  amputation  of  arm  at  lower  third  April  9,  1865;  discharged  July  26, 1865. — Private 
J.  Archibald,  33d  New  York,  age  50;  comminuted  fracture  of  lower  extremity  of  left  radius  and  carpal  bones  December  13, 
1862;  amputation  of  forearm  at  upper  third  January  8,  1863;  haemorrhage  from  interosseous  January  10th;  artery  ligated  on 
face  of  stump  same  day;  haemorrhage  recurred  January  13,  artery  re-ligated;  death  from  pyaemia  January  29,  1833. — Private 
J.  Bowman,  K,  20th  Indiana,  age  25;  shot  fracture  of  forearm;  haemorrhages  July  16th,  August  4th;  ligation  ;  September  5th, 
amputtition  of  arm;  death  of  diphtheria  and  gangrene  September  6,  1863. — Private  J.  A.  Forsyth,  G,  9th  Maine,  age  21;  flesh 
wound  of  left  wrist  June  30,  1864;  July  19th,  haemorrhage  from  branch  of  interosseous;  July  20th,  ligation  of  both  ends  in 
wound  by  Assistant  Surgeon  E.  Curtis,  U.  S.  A.;  August  13th,  haemorrhage  recurred;  death  ensued  on  August  13,  1864,  from 
secondary  haemorrhage. 

Ligations  of  Arteries  of  the  Hand. — Of  twelve  cases,  four  were  ligations  of  the  palmar 
arch,  two  of  the  dorsalis  and  radiaUs  indicis,  one  of  the  dorsalis  carpi,  one  of  the  arcus 
volaris  profundi,  and  four  of  the  digital  arteries.  One  only  terminated  in  death,  from 

pyasmic  irritation  of  the  system. 
SURG.  Ill— 99 


786 


WOUNDS    AND    COMPLICATIONS. 


[CHAP   XII. 


TABLE  OXXXVI. 
Condensed  Summary  of  Twelve  Cases  of  legations  of  Arteries  of  the  Hand. 

[Recoveries,  1—11 ;  Death,  12.] 


No. 

NAME. 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 
INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

HJEMOU 

RHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

l 

A  chuff,    H.    N.,  Pt., 

May    3, 

Fracture    3d    finger 

June  4, 

Deep  palmar  arch  . 

June  4, 

Branch  deep  palmar 

Recovered. 

K,  27th  Pa.,  age  20 

1863. 

right  hand. 

1863. 

1863. 

arch  ligated. 

2 

Gantt,  Z.,Tt.,G,  27th 

June  15, 

Wound  right  hand.  . 

July  20, 

Digital  artery  

July  20, 

One  end  3d  digital 

Recovered. 

S.  C.,  age  30. 

1864. 

1864. 

1864. 

in  wound.    A.  Surg. 

E.  Curtis,  U.  S.  A. 

3 

Gripping,  I.  G..Pt., 

July    3, 

Fracture     2d    met. 

July  30, 

Superficial  palmar 

July  30, 

Branch  superfi.  pal- 

Discharged  January 

Oneida  N.  T.  Cav., 

1863. 

boue  right  hand. 

1863. 

arch. 

1863. 

mararch  in  wound. 

4,  1804. 

age  45. 

4 

Holdridge,    H.,  Pt., 

May  12, 

TVound   both  hands; 

May  21, 

May  21, 

Both  ends  arch  vol. 

Discharged  Septem 

A,  6th  O.'  Cav'    age 

1864. 

fracture  fingers. 

1864. 

1864. 

prof,  tied  in  wd.  A. 

ber  9,  1864. 

28. 

A'.Surg.  T.Liebold. 

5 

Loland,  J.,Pt..4thN. 

June  16, 

Fracture  right  met 

July  17, 

Dorsalis  indicis  ar 

July  19, 

Dorsalis  carpi,  both 

Discharged  June  16, 

Y.  Art,,  age  17. 

1864. 

acarpus. 

1804. 

tery  ligated. 

1864. 

ends  in  wound. 

1865. 

6 

McNaraara,  P.,  Pt., 

June  16, 

Fracture  met  .a  c  a  r- 

July    1, 

Digital  artery  

July    1, 

One  end  dig.  art.  tied 

Aug.   11,  amp.  fore 

A,  2d  N.    Y.  Art,, 

1864. 

pus  bone  left  little 

1864. 

1864. 

in  wound.      Haetn. 

arm.  Disch.  Mar.  27, 

ago  30. 

finger;  amputation. 

rec.  July  6,  8,  Aug.  5. 

1865.    Spec.  2450,  A. 

M.  M. 

7 

Mullin,    D.,  Pt.,  K, 

May   8, 

Fract.  1st  3  met.  bones 

May  29, 

May  29, 

Right  dorsal  indices 

Duty  September  3, 

16th  Mass',  age  24.' 

1804. 

right  hand  ;  amp. 

1864. 

1864. 

on  face  stump. 

1864. 

8 

Roberts,  R.  D.,  Pt. 

Mar.    !), 

Flesh   wound    right 

Mar.  22, 

Superficial  palmar 

Mar.  27, 

Right;    snperfi.  pal 

Discharged  January 

F,  72d  111.,  ago  49. 

1864. 

forearm  and  hand. 

1£64. 

arch. 

1861. 

mar  arch  tied. 

26,  1865. 

9 

Sylvester.    H.,    Pt., 

May    4, 

Fract.  2d  phal.  right 

May  17, 

May  18, 

Right  radialis  indi 

Trans.    Provo   Mar 

G,91stN.Y..ag('23. 

1803. 

iud.  finger  ;  amp. 

1863. 

1863. 

cis  on  face  stump. 

shal  May  27,1863. 

10 

Tucker,  N.   J.,  Pt., 

Sept.  2, 

Fracture  fingers  left 

Sept,  25, 

Superficial  palmar 

Sept,  25, 

Left;  superfi.  palmar 

Duty     December  7, 

E,  17th  Ky.,  age  23. 

Ifc64. 

hand;  amputation. 

1861. 

arch. 

1861. 

arch,  both  ends  in 

1864. 

wound. 

11 

Turner,  J.  W.,  Pt., 

May  12, 

Flesh  wound    right 

May  21, 

Digital  artery  

May  22, 

Both  ends  dig.  art. 

Veteran    Reserve 

A,  126th  Ohio,  age 

1864. 

hand. 

1864. 

1864. 

t'd  in  wound.  Surg. 

Corps  January  17, 

24. 

N.  R.  Moseley,  U. 

1865. 

S.V. 

12 

Moynehan,  W.,  Pt., 

July   9, 

Fracture    bone  left 

July  18, 

Digital  artery  

July  18, 

Digital  artery    tied 

Amp.  fing.  Au.  1  hae. 

F,  122dOhio,age40. 

1864. 

hand. 

1864. 

1864. 

in  wound. 

Died  Aug.  15,  1864. 

Ligations  of  the  Common  Iliac  Artery. — Four  cases  of  ligations  of  the  common  iliac 
artery  following  shot  injuries,  and  one  following  a  bayonet  stab,  were  reported  during  the  war.1 

TABLE  OXXXVII. 
Summary  of  Five  unsuccessful  Cases  of  Ligation  of  the  Common  Iliac  Artery. 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
H^MOR- 
RHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Boner,  J.,  Pt.,I,  48th 

May  31, 

Flesh  wound  of  both 

June  10, 

From    small    ves 

June  22, 

Ligation  of  common 

Death  June  22,  1804. 

Pennsylvania,   age 

1864. 

thighs. 

15,  1864. 

sels;  ligation   of 

1864. 

iliac. 

Seep.3i',an<e,  CASE 

19. 

femoral  June  15; 

82. 

haemorrhage  Jun. 

22. 

2 

Hardy,  John,  Pt,  H, 
95th  N.  Y.,  age  25. 

Aug.  20, 
1864. 

Shot  wound  of  left 
gluteal  region;  ball 
lodged  against  right 

Sept,  5, 
1864. 

Gluteal    artery; 
haemorrhages  re 
curred  Sept.  6,  8, 

Sept.  12, 
1864. 

Ligation  of  common 
iliac  by  Asst.  Surg. 
J.  Cooper  McKee, 

Death  Sept,  14,  1864. 
See  Sec.  Surf].  Vol., 
p.  334,  CASE  976. 

•wall  of  pelvis. 

11  ;  Sept.  12,  liga 

U.  S.  A. 

tion    of  internal 

iliac. 

3 

Preston,  J.  E.,  Cor 

May  4, 

Shot  injury  of  ant. 

May  5 

May  14 

Dr.  F.  H.  Hamilton. 

Death  M'y  14,  '64.  See 

poral,  G,  119th  Penn. 

1864. 

sup.  spin,  processof 

1864. 

1864. 

p.  39,  ante,  NOTE  1. 

left  ilium. 

4 

Scott,    J.    R.,    Col., 
19th  Illinois. 

Dec.  31, 
1862. 

Shot  wound  of  groin, 
ball  grazing  inside 

Apr.  9, 
10,  1863. 

Arrested  by  com 
press  over  femo 

Apr.  10, 
1863. 

Ligation  of  common 
iliac  by  Dr.  Brain- 

Death  July  8,  1863. 
See  CASE  975,  Sec. 

of  femur. 

ral;  haemorrhage 

ard. 

Surg.  Vol.,  p.  333. 

recurred  ;      liga 

tion  of  external 

iliac    April     10; 

bleeding    contin 

ued. 

5 

Tapka,  A.,   Pt.,   H, 
35th  Wisconsin,  age 

Mar.  18, 
1864. 

Bayonet  stab  in  glu 
teal  region. 

Oct.    2, 
1864. 

Diffuse  aneurism.  . 

Oct.    7, 
1864. 

Ligation  of  common 
iliac  by  A.  A.  Surg. 

Death  Oct.  11,  1864. 
See  CASE  977,  p.  3:io 

25. 

R.  N.  Isham. 

of  the  Sec.  Surg.  Vol. 

In  one  of  the  five  cases  the  external  and  in  another  the  internal  iliac  artery  had  been 
ligated  without  arresting  the  bleeding. 

Ligations  of  the  Internal  Iliac  Artery. — Three  cases  were  reported  ;  all  terminated 
fatally,  from  recurring  haemorrhage. 

1  A  sixth  case  of  ligation  of  the  common  iliac  (case  of  Private  G.  W.  Clark,  I,  4th  New  Jersey)  for  aneurismal  varix  has  been  referred  to  in  the 
preceding  chapter,  iu  the  foot-note  on  page  681,  and  has  been  detailed  on  page  336  of  the  Second  Surgical  Volume. 


CHAP.  XII.] 


LIGATIONS    OF    THE    INTERNAL    ILTAC    ARTERY. 


787 


TABLE  OXXXVITT. 
Condensed  Summary  of  Three  Ligatiom  of  the  Internal  Iliac  Artery. 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATUKE  OF  INJURY. 

OF 

HJEMOU- 

HHAGE. 

PROBAIILE  SOURCE 

OF 

HJSMORBHAGE. 

I_)  ATK 
OF 
OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Fonda,  E.  R.,Serg> 

Mav    7, 

Shot  through   right 

June  12, 

Sciatic  artery  

June  17, 

Int.  iliac  above,  I'ou- 

Died  July   2?.   1W4. 

Major,  115th  N.Y., 

1804. 

gluteal  region. 

]5,  17, 

18154. 

pai  t's  lig't.    Surg. 

Sec.  Surg.   Vol..  p. 

age  28. 

1864. 

A.  15.  Mott,  U.  S.V. 

332,  CASK  <J7:t. 

2 

Hardy,  John,  Pt.,  H, 

Aug.  20, 

Shot  wound  of  left 

Sept.  5, 

Gluteal  artery  .  .  . 

Sept.  12, 

Lig.  of  internal  iliac. 

Sept.   12,  ligaiion  of 

95th  N.  Y.,  age  25. 

1864. 

gluteal  region;  ball 

6,  8.  11, 

1864. 

Surg.  J.Coo  per  Mc- 

com'n  iliac.  Death 

lodged  against  right 

12,  '.864. 

Kee,  U.  S.  A. 

Sept.  14,  1X04.    See. 

wall  of  pelvis. 

Surrf.  Vol.,  p.  3i!4, 

CAbE  970. 

3 

P  ,  Thomas,  Pt., 

July  10, 

Shot  penetration  of 

July  26, 

Gluteal  artery  .... 

July  26, 

Ligation  of  internal 

Aug.  1,  sudden  ha?m- 

16th  Tenn.  Cav. 

1864. 

left  buttock. 

1864. 

1864. 

iliac.  Dr.  S.  N.  Den- 

orrhagi;  follow'd  by 

ham. 

death  in  a  few  rain 

utea.      Sec.    Surg. 

Vol.,  p.  33.',  CASE 

972. 

Eight  cases  of  ligations  of  branches  of  the  internal  iliac  comprised  six  ligations  of  the 
gluteal  and  two  of  the  sciatic  arteries  ;  four  of  the  former  and  one  of  the  latter  were  fatal. 

Ligations  of  the  Gluteal  Artery. — In  four  of  the  six  cases  the  bleeding  was  the  result 
of  the  shot  injuries.  In  two  instances  the  gluteal  was  accidently  cut — in  one  while  search 
ing  for  the  missile,  in  another  while  excising  the  head  of  the  femur. 

TABLE  OXXXIX. 
Summary  of  Six  Ligations  of  the  Gluteal  Artery. 

[Recoveries,  1—2;  Deaths,  3—6.] 


No. 

NAME. 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
ILEMOR- 
KHAGE. 

PROBABLE  SOURCE 

OF 

HJEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Warner,  A.  J.,  Col., 

Sept,  17, 

Shot   perforation   of 

Feb  6, 

Gluteal  cut  while 

Feb.  6, 

Lig.  cardiac  end  in 

Discharged  and  pen 

10th  Penn.  Res. 

1802. 

right  ilium. 

1863. 

searching  for  ball. 

1863. 

wound.  Surg.  J.  H. 

sioned.     Sec.  Surg. 

Brinton,  U.  S.  V. 

Vol.,  pp.    232,   329, 

CASE  678. 

2 

West,    R.,    Pt..    B, 

Au».  7, 

Flesh  wound  of  right 

Sept.  19, 

Gluteal  artery  

Sept,  19, 

Cardiac  end  ligated 

Discharged    Feb.  7, 

104th  111.,  age  31. 

1864. 

buttock. 

1864. 

1864. 

in  wound. 

1865.  Sec.  Surg.  Vol., 

p.  329,  CASE  961. 

3 

Davidson,  Ti.C.,  Pt., 

April  2, 

Shot  wound  of  right 

Apr.  13, 

Gluteal  artery  

Apr.  16, 

In  continuity.   Surg. 

Death  April  19,  1865. 

K,  6th  Md.,  ago  16. 

1865. 

hip,  fract.  of  ilium. 

15,  16, 

1865. 

E.  Bentley,    U.   S. 

Sec.  Surg.   Vol.,  p. 

1865. 

Vols. 

330,  CASE  964. 

4 

Johnson,  O.  M.   W., 

Feb.  15, 

Shot  wound  of  left 

Mar.  12 

Gluteal  artery  ;  25 

Mar.  12, 

Ligated    

Death  March  24,  1862. 

Pt.,   I,   32d  Tenn., 

1862. 

hip. 

1862. 

ounces. 

1862. 

Sec.  Surg.   Vol.,   p. 

ago  20. 

329,  CASE  962. 

5 

Melcar,  I.,  Pt.,   8th 

Nov.  16, 

Shot  fracture  of  head 

Nov.  16, 

Gluteal  cut  while 

Nov.  16, 

Cardiac  end  ligated. 

Died    Dec.   2,   1863. 

Michigan,  age  18. 

1863. 

and  neck  of  femur. 

1863. 

excising  head  of 

1863. 

Surg.  J.  S.  D.  Cul- 

See  CASE  232,  p.  97, 

femur 

len,  P.  A.  C.  S. 

ante. 

6 

Morrison,  J.,  Serg't, 

May  15, 

Shot  wound  of  both 

June  17, 

Gluteal       artery; 

Juno  17, 

Ligation  of  gluteal. 

Death  from  pyaemia 

A,  102d  111.,  age  27. 

1864. 

buttocks. 

1864. 

left. 

1864. 

Ass't  Surgeon  B.  E. 

July  3,  '64.  Sec.  Surg. 

Fryer,  U.  S.  A. 

Vol.  p.  329,  CASE  963. 

Ligations  of  /Sciatic  Artery. — The  two  cases  of  ligations  of  the  sciatic  artery  proved 
fatal,  one  on  the  first  the  other  on  the  third  day  after  the  operation. 

CASES  1153-1154. —  W.  E.  Carrington,  H,  2d  South  Carolina,  wounded  at  Cedar  Creek  October  19,  1864;  comminution 
of  transverse  portion  of  sacrum;  admitted  on  the  next  day  into  Prisoner's  Hospital  at  Winchester;  haemorrhage  from  sciatic 
artery  occurred  on  November  3d;  artery  ligated  and  missile  extracted  by  Dr.  Duval  (Confederate);  death  November  4,  1864. — 
Private  H.  C.  Leslie,  M,  7th  New  York  Artillery,  aged  18  years,  received  a  shot  wound  of  nates,  injuring  the  sciatic  artery, 
by  a  mini6  ball,  at  Cold  Harbor,  June  3,  1864.  The  patient  was  removed  to  a  field  hospital  of  the  Second  Corps,  and  on  June  8th 
was  sent  to  Washington  and  admitted  into  Columbia  Hospital;  haemorrhage  to  the  extent  of  twenty-five  ounces  from  the  sciatic 
artery  occurred  on  June  16th ;  ligation  of  the  artery  on  the  same  day  ;  death  from  gangrene  June  19,  1864. 

Ligations  of  the  External  Iliac  Artery. — Of  twenty-six  cases  of  ligation  of  the  external 
iliac  artery  twenty-three  had  fatal  terminations,  a  mortality  rate  of  88.4  per  cent.  Six 
were  ligations  after  amputations — one  on  the  face  of  the  stump,  five  in  the  continuity 
(four  after  amputations  in  the  thigh  and  two  after  amputations  at  the  hip)  ;  haemorrhage 
recurred  in  six  cases,  and  in  one  instance  the  common  iliac  was  afterwards  ligated. 


788 


WOUNDS    AND    COMPLICATIONS. 

TABLE  CXL. 
Summary  of  Twenty-six  legations  of  the  External  Iliac  Artery. 

[Recoveries,  1—3;  Deaths,  4—26.] 


[CHAP.  XII. 


No. 

1 
2 

3 
4 

5 
G 

7 
8 

9 
10 
11 
12 

13 

14 
15 
16 
17 

18 

19 
20 
21 
22 

23 

24 
25 

26 

NAME, 
AGE,  ANL)  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURK  OF  INJURY. 

DATE 

OF 
ILEMOR- 
KHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Locke,  H.,Pt,n,Gth 

Vermont,  age  23. 
Smith,  E.  E  ,  Pt.,  A, 
llth  Maine,  age  19. 

Zeiders,J.K.,Serg't, 
I.  53dPeim.,agel9. 

iBrown,  B.  B.,  Pt., 
C,9th  Va.  Cav.,age 

2  Corn  well,  R.  B.,Pt, 
25t  h  Ohio,  age  2:i. 
Dsgolia,  J.  S.,Pt.,A, 
76th  Penn.,  age  32. 

Dougherty,  M.,  Pt., 
E,  49th  Pa,,  age  35. 
3Gatewood,J.H.,Vt., 
F,  21st  Ga.,  age  32. 

Gentle,  G.  "W.,  Pt., 
E,  5th  Ohio. 
Hambrecht,  C.,  Pt., 
E,  4th  New  Jers1  v. 
Hearv,     P.,   Pt.,  E, 
73d  'Ohio,  age  25. 
Husk,  G.  W.,  Pt,,  F, 
1st  Maryland  Cav- 
alrv,  age  49. 
*Langford,J.lt.,Pt., 
F,  10th  Ga.,  age  19. 
McQuilbn.J.A.,  Lt., 
I,  38th  Ohio,  ago  25. 
Mm  shall.  W.  L.,Pt,, 
E,  llth  Pa.,  age  20. 
O'Neil,  M,    Pt.,    E, 
58th  Mfiss..  age  W. 
Ridge,  J.,  Lieut.,  B, 
13th  Iowa. 
5Scott,   J.    R.,  Col., 
19th  Illinois. 

Seaburn,  A.,  Pt,,  G, 
97th  Peuns\  Ivania. 
Sears,  L.   C.,  Sergt. 
maj.,5thN.H.,age22. 
Shields,    P.  J.,  Pt,, 
D,  GlhWis.,  age  20. 
Smith,  H.  F.,  Corp., 
1st  \Vis.,  age  25. 

6Spaulding,   J.    R., 
Pt.,  F,  112th  New- 
York,  age  23. 
Teel.   M.,Pt.,  C,  73d 
Indiana. 
Vogel,   F.,   Pt.,     G, 
74th  Penn.,  age  28. 

Tockev,  P.,  Pt.,  D, 
29th  Ohio,  age  29. 

Mav    5, 

1864. 
Ang.16, 
1864. 

July   3, 

1863. 

June  24, 

1864. 

Sept.  14, 
1862. 
May  16, 
1864. 

Sept.  19, 
1804. 
Aug.  28, 
1862. 

Sept.  17, 
1862. 
Sept,  14, 
1862. 
Mar.  11, 
1862. 
Aug.  16, 
1864. 

Sept..  17, 
1862. 
Aug.  17, 
1804. 
June  27, 
1862 
June  :!, 
1804. 
July  21, 
1864. 
Dec.  31, 
1862. 

July  30, 
1864. 
Dec.  13, 
1802. 
Apr.  29, 
1863. 
Mar.  24, 
1802. 

Jan.  15, 
1865. 

Dec.  31, 

1802. 
Julv  3, 
1863. 

July  22, 
1864. 

Flesh  -wound    right 
thigh. 
Fract.  head  rt.  tib.; 
amp.  thigh. 

Flesh  wd.  rt.  thigh  ; 
Aug.  4,  fern.  art.  lig.; 
Aug.  11,  religated. 
Fract.  ramus  pubis.. 

"Wound  right  thigh, 
inj.  femoral  art. 
Flesh  wounds  right 
hip  and  left  t  high 

Fracture  left  knee  ; 
amputation  thigh. 
Flesh    wounds    left 
hip  and  right  thigh  . 

Fracture    right    fe 
mur. 
Fract,  os  pubis  and 
neck  femur. 
"Wound    in  iliac  re 
gion. 
Flesh   wound    right 
thigh. 

"Wound  in  rt.  groin, 
injuring  fern.  art. 
Flesh    wound   right 
thigh. 
Flesh,    right  thigh, 
inj.  fern.  art. 
Fract.  right  femur; 
amp.  at  hip  joint. 
Wound  in  left  iliac 
region. 
Wound  in  thigh,  inj. 
fern,  artery. 

Fract.    left    femur; 
amp.  thigh. 
Flesh   wound    right 
thigh;  profundainj. 
Fract.  left  knee  jt.; 
amp.  thigh. 
Fracture  left  femur.  . 

Flesh     wound     left 
thigh. 

Fract.  ri<rht  thigh 

May  32, 
1864. 
Oct.  17, 
1864. 

Oct.     8, 
1863. 

July  14, 
1864. 

Sept,  21, 
1862. 
Mav  24, 
lt-64. 

Nov.   4, 
1864. 

Femoral  art.  liga- 
ted  ;  lia  'in.  rec. 
Femoral  lig.    Jan. 
19,  1865;  amp.  at 
hip  joint  ;  hasm. 

Mav  16, 

1864. 
Jan.  27, 
1865. 

Oct.     8, 
1863. 

July  18, 
1864. 

Oct.  30, 

1862. 
May  29, 
1864. 

Mar.  26, 
1805. 
Jan.  31, 
1864. 

Oct.  27, 

1862. 
Oct.   18, 
1862. 
Mar.  27, 
1862. 
Nov.  10, 
1864. 

Nov.  6, 
1862. 
Sept.  26, 
1804. 
Sept,  5. 
1862. 
Aug.  20, 
1864. 
Aug.  30, 
1864. 
April  10, 
1863. 

Sept,  25, 
1864. 
Jan.    8, 
1863. 
June  9, 
1864. 
Mar.  30, 
1862. 

April  2, 
1865. 

Jan   —  , 

1863. 
Sept,  19, 
1863. 

Right;  in  continuity. 

Ext.  iliac  tied.   A.  A. 
Surg.  J.  C.  Morton. 

Right  ;  in  continuity. 

Leftjincont.    Ass't 
Surg.  J.  C.  Baylor, 
C.  S  A. 
Right;  in  continuity. 

Left;incont.    Surg. 
J.  H.Thompson,  U. 
S.V. 
Left;  in  continuity; 
haern.  recurred. 
Right;    in  continui 
ty.    Surg.  J.  Cham- 
bliss,  P.  A.  C.  S. 
Right  ext.  iliac  tied.  . 

Ext.  iliac  and  fern, 
arts.  tied. 
Ext.    iliac    tied    in 
continuity. 
Right;  in  cont.     A. 
A.  Surg.  J.  C.  Mor 
ton. 
Right;  in  continuity. 

Right  ;  in  continuity. 
Right  ;  in  continuity. 
Right  ;  in  continuity. 
Left;  in  continuity  .  . 

Ext.  iliac  tied.     Dr. 
D.  Brainard. 

L«ft  ;  in  cont.   Surg. 
E.  Bentley,  U.  S.  V. 
Right  ;  in  cont.  Surg. 
T.  Antisell,  TJ.  S.  V. 
Left;  in  continuity.. 

Left  ;  in  cont.   Surg. 
A.  H.  Thurston,  U. 
S.V. 
Left;  in  cont.    Ass't 
Snrg.  S.  H.  Orton, 
U.  S.  A. 
Right  ;  in  continuity. 

Right;   iu  cont.    A. 
A.  Surg.  A.  Hew- 
son. 
Right  ;  in  cont.;  fern, 
art.  prev.  tied. 

V.R.C.  Decembers, 

1864. 
Discharged  May  27, 
1865.    Spec.  3709,  A. 
M,  M. 
Discharged  May  14, 
1864. 

Died   Aug.  22,1864; 
exhaustion. 

Died  Nov.  3,  1862. 

Died  June    1,  1864; 
gangrene. 

Died  April  8,  1865. 
Died  Feh.  17,  1864. 

DiedOot.28,'62.  Sp'« 
758,  894,  A.M.  M. 
Died  Oct.  18,  1862. 

Died  April  26,  1862  ; 
pyaemia. 
Died  Nov.   17,  1864; 
haemorrhage. 

Died  Mar.  15,  1863. 
Spec.  3986. 
Died  Oct.  2,  1864. 

Died  Sept,  16,  1862. 

Died    Sept,   2,    1864. 
Spec.  3098. 
Died   Oct.    4,    1864  ; 
pyaemia. 
Common   iliac   tied. 
Died  July  8,   1863  ; 
diarrhoea. 
Died    Oct.    9,    1864. 
Spec.  3282. 
Died  Jan  11,  1863. 

Died  June  19,   1864. 
Spec.  1143. 
Died  Mar.  30,  1862. 

Died  June  15,  1865. 

Died  Jan.  19,  1863. 

Died    Oct.    4,    1863  ; 
haemorrhage. 

Died  April  23,  1805  ; 
diarrhoea. 

Femoral  aneurism 

r 

Aneurism  ;     femo 
ral  artery  ligated. 
Fern  oral    artery 
tied. 

Femoral   artery 
ligated  3  times.  ' 
Femoral  aneurism  . 

Oct  2,  3, 
1862. 
Oct.  18, 
1862. 
Mar.  27, 
1862. 
Nov.  10, 
1864. 

Nov.  6, 

1862. 
Sept.  20, 
1804. 
Aug.  23, 
1862. 
Aug.  20, 
1864. 
Aug.  26. 
29,  '64. 
April  5, 
9,  1863. 

Sept,  22, 
1864. 
Dec.  22, 
1862. 
June  1, 
1863. 
Mar.  30, 
1862. 

Mar.  23, 
31,  1865. 

Femoral  artery  .... 

Femoral  aneurism. 

Femoral  art.   tied 
September  20. 
False     aneurism  ; 
femoral  tied. 
Femoral  artery  

Epigastric  artery.. 
Profunda  artery.  .  . 

femoral  artery 
tied. 
Stump  ;    fern.   art. 
tied  and  relig. 
Femoral  arttry  .  .  .  . 

Fract.  rt.  fib.;  h»m.; 
amp.  leg. 

Fract.  right  femur  ; 
amp.  thigh;  reamp. 

Sept.  8, 
1863. 

Stump  ;    fern.   art. 
tied  Sept.  8. 

Ligation  of  the  Spermatic  Artery. — The  only  instance  of  ligation  of  this  artery  has 
been  detailed  on  page  337  of  the  Second  Surgical  Volume: 

CASE  1155. — Color-Sergeant  E.  W.  Crippen,  C,  27th  Illinois,  aged  29,  was  wounded  at  Missionary  Ridge  November 
25,  1863;  the  left  testicle  was  shot  away,  leaving  a  ragged  wound  of  the  scrotum,  also  wound  of  ankle.  On  November  28  the 
spermatic  artery  was  ligated  and  the  debris  of  the  testicle  removed.  Hemorrhage,  which  ceased  spontaneously,  occurred  on 
December  14;  on  December  19  haemorrhage  from  wound  of  ankle,  arrested  by  persulphate  of  iron;  death  on  the  same  day. 

Ligatwns  of  the  Femoral  Artery. — Three  hundred  and  seventy-four  cases,  including 
ninety-three  recoveries  and  two  hundred  and  eighty-one  deaths,  are  comprised  in  this  group, 
giving  a  mortality  rate  of  75.1  per  cent.  In  one  hundred  and  seventy-nine  cases  amputation 

'BROWNF,  (P.  F.),  Ligation  of  the  External  Iliac  for  Traumatic  Aneurism  of  the  Femoral  Artery,  in  Confed.  States  Med.  and  Surg.  Jour., 
1804,  Vol.  I,  p.  163.  "HEARD  (L.),  Wound  of  the  Femoral  Artery,  in  Am.  Med.  Times,  1862,  Vol.  V,  p.  337. 

3CHAMi3Liss  (J.),  Case  of  Traumatic  Femoral  Aneurism,  etc.,  in  Confederate  States  Med.  and  Surg.  Jour.,  1864,  Vol.  I,  p.  97. 

4Noi4TH  (A.),  Report  of  Sixty  Cases  of  Hospital  Gangrene,  in  American  Medical  Times,  1863,  Vol.  VI,  p.  256. 

sBl{AlNARt)  (D.),  Ligature  of  the  Common  Iliac  Artery,  in  Chicago  MedicalJournal,  1864,  Vol.  XXI,  p.  97. 

"LinELL  (J.  A.),  Gunshot  wound  of  thigh;  Secondary  Harmorrhage  ,•  Ligation  of  External  Iliac  Artery,  in  United  States  Sanitary  Commis 
sion  Memoirs,  Surgical  Vol.  I,  p.  231. 


CHAP.  XII.] 


LIGATIONS    OF    THE    FEMORAL    ARTERY. 


789 


in  the  thigh  had  been  performed  prior  to  the  ligation;  in  eighty-two  of  these  cases  the  vessel 
was  ligated  on  the  face,  and  in  ninety-seven  in  the  continuity  of  the  stump.  In  nineteen 
cases,  with  five  recoveries  and  fourteen  deaths,  the  ligations  were  followed  by  amputation. 

TABLE  GXLI. 
Summary  of  Three  hundred  and  Seventy-four  Liyalions  of  the  Femoral  Artery. 


[Recoveries,  1—  H3;  Deaths,  94—374.] 


No. 

NAME, 
AUK,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

HJEMOR- 

RHAGK. 

PKOHAUI.E  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Askey,   J.,    Pt.,   F, 

Mar  25, 

Fract.  r't  knee  joint; 

Apr.  11, 

Femoral  artery.  .  .. 

Apr.  11, 

Right;  in  continuity. 

Disch'd  July  28,  1865. 

200th  Peun.,age  18. 

1865. 

March  28,  amputa 

1865. 

1865. 

Act.  Assist.  Surg.'j. 

Specimen  3997,   A. 

tion  thigh. 

Tyson. 

M.M. 

•j 

Alcbison,  J.  N.,Pt, 

Aug.  27 

Fract.    left     femur; 

Sept.  3, 

Femoral  artery 

Right;  in  continuity. 

Discharged  June  3, 

F,  2d  N.  J.,age.  28. 

1802. 

primary      amputa 

1862. 

Surg.'E.  Bentley.U. 

1863. 

tion  thigh. 

S.  V. 

3 

Austin,  A.H.,Pt.,B, 

Apr.  20, 

Kract.  left  leg;  amp. 

Juno  7, 

Femoral  artery  .  .  . 

June  7, 

Left;  in  continuity; 

Discharged   August 

lOtith  K.  Y. 

1863. 

thigh  May  22. 

1863. 

1863. 

hsein.  rec.  Juno  11. 

23,  1863. 

4 

Barkftloo.J.T  ,Pt  ,M, 

July  19, 

Flesh    wound    right 

July  19, 

Popliteal  artei  j*.  .  . 

July  19. 

Right;  in  continuity. 

Amp.  thigh.  Disch'd 

2<1  Ohio  Cav.,  age  2£ 

1863. 

thigh. 

1863. 

1863. 

March  17,  1865. 

5 

Bluke,  G.,  Pt.,  I,  3d 

Aug.  27, 

Flesh     wound     left 

Sept.  9 

Sept.  9 

Left;  in  continuity. 

Discharged  Novem- 

W.  V.i.  Mtd.  Inf. 

1863. 

thigh,  severing  pop- 

1863. 

1863. 

Surg.  W.  D.  Stew- 

her  12,  1863. 

lit  eal  artery. 

ait,  U.S.  V. 

6 

Brannan,  J.,  Pt.,  C, 

July  2, 

Fracture  right  leg; 

July  12, 

Post.  lib.  art.  ;  art. 

July  15, 

Right;  in  continuity; 

Recovered. 

44tb  X.  Y.,  age  26. 

1863. 

prim.  amp.  leg. 

1863. 

tied. 

1863. 

in  Scarpa's  space. 

7 

Brown,    J.,    Pt.,  D, 

May   28, 

Flesh   left  leg    .  .  . 

June  9 

June  10 

Left  -in  cent.  bur.  J. 

Fui  lou  "bed  July  31 

120th  Ohio. 

1863. 

10,  '63. 

1863. 

D.  Brumley.  U.S.V. 

1863. 

8 

Brown,    W.,    Serg't, 

Dec.  10, 

Flesh     wound     left 

Femoral  artery  tied. 

Detailed  Mar.16.1864. 

1st  Mil.  Art. 

186.'!. 

thigh. 

9 

Btigbee,  S.,  Corp.,  E, 

Oct.  27, 

Wound    right    knee 

Nov.  8 

Stump  . 

Nov.  12, 

Right;  on  face  stump. 

Discharged    August 

14th  Conn.,  ago  24. 

1864. 

joint;    prim.    amp. 

1864. 

1864. 

Surg.  W.  L.  Baylor, 

23,  1865. 

thigh,  lower  third. 

C.  S.  A. 

10 

Cheany,  W.  W.,  Lt, 

July  4, 

Wound  right  knee; 

An<r.  17, 

Femoral  artery  

Ausr.  17, 

Right;  in  continuity. 

Transferred  to  pri^- 

B,  3()t  h  Ark. 

1863. 

prim.  amp.  thigh. 

1863. 

1863. 

on  April  21,  1864. 

11 

'Check,  J/.,Pt.,I,  61st 

July  30, 

Flesh  wound  thigh. 

Aug.  3, 

Femoral  artery  

Aug.  3, 

Femora]  tied,  in  con 

Furloughed  August 

N.  C. 

1864. 

1864. 

1864. 

tinuity.    Sur.  D.  F. 

—  ,  1864. 

Wright,  P.A.C.  S. 

12 

Cleggett,  T.,  Pt,  D, 

Apr.  ?, 

Fracture  right  knee 

May   2, 

Femoral  artery  

May  2, 

Ligation    in   contin 

Discharged  July  22, 

76fh  C  olored  troops, 

1865. 

joint;  amp.   thigh, 

1865. 

1865. 

uity,  iu  upper  third. 

1865. 

ago  45 

lower  3d,  April  24. 

13 

Clover,   B.,   civilian, 

Aug.—, 

Flesh  wound  thigh, 

Sept,  1, 

Aneurism  of  femo 

Sept.  1. 

Ligation  in  cout.  just. 

Recovered. 

age  16. 

1864. 

femoral  injured. 

1864. 

ral. 

1864. 

above  profuuda. 

14 

Coble,  J.  A.,  Pt.,  F, 

Nov.  27, 

Flesh  wound  of  left 

Jan.  23, 

Aneurism  of  femo 

Jan.  23, 

Both  ends  in  wound. 

Recovery. 

45th  N.  C.,  ago  20. 

1863. 

thigh,  lesion  of  fem 

1864. 

ral. 

1864. 

Surg.  J.  G.  Dudley, 

oral. 

C.  S.A. 

15 

Cockburn,  W.  ,  Serg't. 

Dec.  28, 

Shot    fracture     left 

Jan.    7, 

Femoral  artery.  .  .  . 

Jan.    7, 

Three      consecutive 

Mustered   out    May 

ii,  2d  New  Jersey 

1864. 

knee     joint;     amp. 

1865. 

18,  23, 

ligations   in  conti 

11,  1865. 

Cav.,  nge  38. 

Dec.  29. 

1865. 

nuity. 

16 

Collins,  if.,  Pt.,  K, 

Dec.   7, 

Left  knee  joint;  amp. 

Dec  25, 

Femoral  artery.  .  .  . 

Dec,  25, 

In  cent,  in  middle.. 

Discharged  May  13, 

1  3th  Kansas,  age  27. 

1802. 

thigh  Dtc.  10 

ISiii 

1862. 

1864. 

17 

Cnthbort,  T.,  Serg't, 

Oct.  27, 

Leftkneejoint  ;  prim. 

Nov.  21, 

Femoral  artery  .  . 

Nov.  21, 

In    continuity,    just 

Discharged  July  18, 

G,  8th   New  York 

1864. 

amp.    thigh;    gan 

1864. 

1864. 

above     profuuda. 

1865. 

H.  Art  ,  age  44. 

grene. 

Surg.  Gibus,  C.S.A. 

IS 

Danlbrtli,      H.      J., 

May  18, 

Right     knee  joint; 

May  26, 

Femoral  artery.  .  .  . 

May  26, 

On  face  of  stump.  .  . 

Discharged  Aug.  11, 

Coip'l,  A,  8th  New 

1864. 

prim,     amputation 

1864. 

1864. 

1865. 

York  H.  Art, 

thigh,  lower  third. 

19 

Darling:,  It.  A.,  Pt., 

MavSl 

Fracture  right  thigh; 

June  14, 

Femoral 

Junel4 

Femoral  ligated  .... 

Discharged   Aug.  9, 

11,  67th  New  York. 

1862. 

amp.  low.  3d  Juuc3. 

1862. 

1862. 

1862. 

20 

Dassel,    T.,    Pt.,    G, 

Jan.  11, 

Right  leg:  tibia  and 

Feb.  20, 

Anterior  tibial  ar 

Feb.  20, 

Femoral,  in  cont;  in 

Discharged       Dec., 

60th  Indiana,  age  25. 

1863. 

arteries  injured. 

1863. 

tery. 

1863. 

Scarpa's  triangle. 

1863. 

21 

Davis,  A.  A.,Pt,K, 

Mar.  31, 

Right    knee  joint; 

Apr.  4, 

Profunda  feinoris  . 

Apr.  4, 

In  cont.   Surg.  N.  R. 

Discharged  Sept.  14, 

6th  Wis..  age  32. 

18C5 

prim.  amp.  thigh. 

1865. 

1865. 

Moscley,  U.  S  V. 

1865. 

22 

Dow,  G.  E.,  Pt.,  G, 

Juno  3, 

Left  leg  amputated 

June23, 

Popliteal  artery.  .. 

Juue24, 

Femoral  artery.    A. 

Discharged  Nov.  18, 

12th  N.  H.,  ago  22. 

1864. 

at  knee  joint  June 

18C4. 

1864. 

A.     Surg.    W.     H. 

1864. 

3. 

Ensign. 

23 

Downs,    T.,    Pt.,    F, 

Sept.17, 

Fracture  knee  joint  ; 

Sept.29, 

Femoral  artery  .... 

Sept.29, 

Femoral,  in  continu 

Discharged  Mar.  13, 

88th  N.  Y.,  age  38. 

1862. 

amputation  thigh. 

1862. 

1862. 

ity.      Surg,    H.   S. 

1863. 

Hewit,  U.  S.  V. 

24 

Dunn.  G.  K.,  Serg't, 

May  16, 

Upper  third  of  right 

May  29, 

Femoral  artery  .... 

May  29, 

Femoral  above  origin 

Furloughed  July  23, 

E,  2:>th  S  C.,  age  20. 

1864. 

thigh. 

1864. 

1864. 

of  profunda;  in  cont, 

1864. 

25 

Ellis,  II.  H.,  Cuip'l, 

May    3, 

Left  knee  joint  ;  amp. 

May  20, 

Profuuda  

May  21, 

Femoral,  in  continu 

Discharged   Oct  26, 

I,  16th  N.  Y.,  age  23. 

1863. 

thigh. 

1863. 

1863. 

ity;  hffim.  recurred. 

1863. 

26 

Ferguson,  D.,  Lieut., 

Jan.  11, 

Left  Knee  joint-,  amp. 

Feb.  20, 

Femoral  artery.  .  . 

Feb.  20, 

Femoral,  in  continu 

Discharged  Sept.  13, 

A,  113th  111  ,  age  27. 

1863 

thigh.     ' 

1863. 

1863. 

ity;  hceni.  recurred. 

1863. 

27 

GardinT,  Ii.,Capt.,  I, 

Nov  24 

Ri^ht    knee  joint; 

Ligation  in  cont.  ;  in 

Discharged  Aug.  18, 

100th  111.,  ago  S3. 

1863. 

amp.  thigh,  middle 

Scarpa's  triangle. 

1864. 

third. 

•28 

Gardner,  R.  F.,  Pt, 

July  2, 

Tin  ough  both  thighs; 

July  23 

Femoral  

July  23, 

In  continuity  .   

Exchanged  Oct.  28, 

A,     1st     Maryland 

1863. 

gangrene. 

1863. 

1863. 

1863. 

Battery,  age  19. 

29 

Goodman,    W.,    Pt., 

May   5, 

Left  thigh  and  le<* 

June  5 

June  5, 

In  cont.  ;  below  Pou- 

Recovered. 

Clark's  X.  C.  Art. 

18C4. 

1864. 

1864. 

part's  ligament 

30 

Graham,  R.  P.,  Pt, 

Oct.    5, 

Right    knee  joii.t  ; 

Nov.  17, 

Femoral;  16ounces 

No  v.l  7, 

Femoral,  on   face  of 

Discharged  May  22, 

ll,7ih  111.  .ago  23. 

1861. 

amp.  thigh  Nov.  9. 

1864. 

1864. 

stump,  lower  3d. 

1865. 

31 

Ha  ihaiiL'h,  H.,  Serg't, 

July   2, 

Left  thigh;    slough 

Sept.  12, 

Profunda  

Sept.  13, 

Femoral;  gangrene.. 

Discharged  July  21, 

i 

K,  7th  Wis.,  age  22. 

1863. 

ing. 

1863. 

1863. 

1864. 

32 

IlHi-tiunn,  J.,  Pt,  A, 

June  19 

Upper   third    tibia  ; 

June  26, 

Femoral 

June  27 

In    cont.,    in   upper 

Discharged  Aug.  14, 

37th  Wis.,  age  10. 

18H4. 

prim.  amp.  thiirh. 

27,  1864.' 

1864. 

third.    Surg.  N.  R. 

1865. 

Moseley,  U.  S.  V. 

31 

Harvey,   R.,  Pt,  E, 

July  1, 

Fract.  of  left  femur; 

Aug.  12, 

Femoral  ......  

Aug.  12, 

Femoral,    in   contin 

Discharged    Oct.    <j, 

3lst  Penn.,  ago  20. 

1862. 

Aug.  1,  amputation. 

1862. 

1862. 

uity. 

1863. 

34 

Houser,!'.,  Serg't,  II, 

All"  10 

Flesh  wound  of  left 

Sept.  10 

Femoral 

Sept.  10 

In  continuity.   A.  A. 

Discharged  May  20, 

76th  Penu.,  age  27. 

U64. 

thigh. 

18C4. 

1864. 

Surg.J.n.  Packaul. 

1865. 

1  W  RIGHT  (D.  F.),  The  Effects  of  lite  Uunterian  Method  of  Liyation  on  Inflammation,  in  Confed.  States  Med.  and  Surg.  Jour.,  Vol.  I,  p.  177. 


790 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XH. 


No. 

NAME, 
AGE.  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURT. 

DATE 

OF 

H;EMOU- 

RHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

35 
36 

Hubner,  J.,  Pt,  K, 
5th  Mich.,  ago  29. 
Hunt   J  L    Pt    G 

May  31, 
1802. 
May  5 

Flesh  wd.  of  thigh.. 

June  27, 
1862. 
July  9 

Copious  haemor 
rhage. 

June  27, 
1862. 
July  9 

In  continuity.   Snrg. 
T.  M.  Markoe. 

-Discharged    Oct.   1, 
1862. 

37 

57th  N.  Y.,  ago  41. 

1864. 
Sept.  17 

thigh. 

1864. 
Nov.  24 

1864. 
Nov  24 

grene  of  toes  ;  amp. 
toes. 

1865. 

98 

Pt.,D,7thS.C. 
Jordan  W  H  Capt 

18G2. 

prim.  amp.  thigh. 

1862. 
June  28 

1862. 
June  28 

stump. 

April  27,  1863. 

W 

9th  Infantry. 
Knrlinver  F    Pt.  K, 

3.862. 
June  1, 

Flesh  wd.  of  thigh 

1862. 
June  9 

1862. 

triangle. 
In  cent.     Surg.    E. 

Discharged  May  20 

40 

48th  N.  Y.,  age  37. 
Kelly  F    Pt    0  10th 

1864. 

Phalanx  of  left  foot 

1864. 

1864. 

Bentley,  U.  S.  V. 

1865. 

41 

Louisiana. 
Klein  I)    Pt  C  64th 

July  22 

Fract  of  left  femur  • 

Aug  3 

Auf  3 

4? 

Illinois,  age  26. 
Lahany,   P.,  Corp'l, 

1861. 
April  2, 

prim,  amputation. 
Fract.  of  left  fibula 

1864. 
April  9, 

1864. 
April  9, 

Surg.  "W.  C.  Jacobs, 
81st  Ohio. 
In  Scarpa's  triangle. 

1866. 
Discharged  Aug.  14 

43 
44 

G,    5th    Vermont, 
age  21. 
Lee,   J.   A.,  Pt.,    I, 
17th  Miss.,  age  25. 
Lenne|Than,  P.,  S'g't, 

1865. 

July  2, 
1863. 
April  6, 

Upper  third  of  left 
leg. 

1865. 

July  18, 
20,  1863. 
Apr  20 

Posterior  tibial  ar 
tery. 
Femoral 

1865. 

July  21, 
1863. 
Apr  20 

Surg.  D.  P.  Smith, 
U.  S.  Vola. 
Femoral,    at    upper 
third. 

1865. 
Recovery. 
Discharged  July  26 

4f> 

B,  88th  New  York, 
age  30. 
Lesler,    J.,    Pt.,    H, 

1865. 
June  3, 

thigh. 
Flesh  wound  of  left 

1865. 
July  24 

Femoral 

1865. 
July  24 

ing   Staff  Surg.  J. 
Aiken. 
In  continuity.   A.  A. 

1865. 
HaBm.rec.  •  reli^ated. 

46 

148th  X.Y.,  age  48. 
Linehan,  T.,  Pt  ,  D, 

1861. 
May  31, 

thigh. 

1864. 
June  27 

Femoral 

1864. 
June  27 

Surg.  W.  P.  Moon. 
On  lace    of  stump. 

Disch.  Jan.  117  1865. 
Discharged  Sept.  26 

47 

37th  X.  Y.,  age  19. 
Lyon,  A.  E.,  Pt.,  E, 

1862. 
Ang.  8, 

femur:    June    27, 
amp.  thigh. 
Fracture  of  right  os 

1862. 
Aug.  17 

Femoral        ... 

1862. 
Au"  .  17 

Surg.     R.    Bartho- 
low,  U.  S.  A. 
In  continuity       

1862. 
Discharged  Au'r.  13 

48 

37th  Iowa,  age  23. 
McGonagle,C.,C'p'l, 

1864. 
Oct.  19, 

calcis;  amp.  thigh. 
Fract.  condyle  ri^ht 

1864. 
Oct.  23 

Femoral  

1864. 
Oct.  23 

On  face  of  stump   .  .  . 

1865. 
Discharged  Mar.  31 

49 

C,  36th  Ohio,  age  24. 
McLin,  V.,   Pt.,  H, 

1864. 
July  1, 

femur;  prim.  amp. 
Fracture  right  knee 

1864. 
Aug.  16, 

Femoral  

1864. 
Aug  20 

On  face  of    stump. 

1865. 
Discharged  Sept.  6 

S!) 

7th  Wis.,  age  24. 
McMullen,  B.  T.,  Pt., 

1863. 
May  3, 

joint;  Aug.  3,  amp. 
thigh. 
Fract.  of  leg  ;  Mav  5, 

20,  '63. 
June  5, 

Femoral  

1863. 
June  7 

Asst.   Surg.  J.   1). 
Johnson,  U.  S.  V. 
Femoral,  in  cont.  ;  in 

1864. 
Furloughed  Aug.  4 

51 

I,  4th  Ga.,  age  20. 
McNallv,  J.,  Pt.,  G, 

1863. 
Juno  16, 

amp.  at  knee  ;  27th, 
re-amp,  in  thigh. 
Middle    third,  right 

1863. 
July  4, 

Femoral     

1863. 
July  4 

Scarpa's  triangle. 
In  continuity.  A.  A. 

1863. 
Furloughed  Nov.  1, 

m 

09th  N"  Y.,  age  24. 
Malloy    M..  Pt.    fl, 

1864. 
Sept.  17, 

thigh. 

1864. 
Oct     4 

1864. 
Oct     4 

Surg.  O.  P.'  Sweet. 

1864. 

53 

69th  "New  York. 
Meildo    D.,   Pt.,   B, 

1862. 
Aug.  30, 

Sept.  27,  amp.  thigh. 

1862. 
Oct     4 

1862. 
Oct     7 

Surg.  A.  EL  Smith. 

1863. 

54 

llth  Massachusetts. 
Miller,  C.,Pt.,G,  9th 

1862. 
June  30, 

at  knee  Sept.  28. 
Fracture  of  left  le"- 

1862. 
Auf  14 

recurred  Oct.  7. 

1862. 
Au"-  14 

Femoral  in  continu 

1862. 

55 

Penn.,  age  19. 
Minehau,  A.,  Corp'l, 

1862. 
Aug.  21, 

Sept.  30,  amp.  leg. 
Fract.  ri"ht.  knee  j't  • 

1862. 

Femoral 

1862. 
Sept  25 

ity. 
In  continuity;  thigh 

18G3. 

Sfi 

F,27thMich.,age31. 
Monroe,  H.,  Pt.,  I, 

1864. 
June  22, 

prim.  amp.  thigh. 
Right  leg  ;  amp.  leg, 

1861. 
July  10, 

From  stump  

Ir64. 
July  10, 

re-amp.  Oct.  19,1864. 
In  cont.  ;  July  17,  in 

1805. 
Discharged  January 

57 

20th  Maine,  age  25. 
Moor,  IF.,  Pt.,  G,  5th 

1864. 
Oct.  19, 

upper  third. 
Wound    of   femoral 

1864. 
Oct.  20 

Femoral 

1864. 
Oct.  20 

Scarpa's  triangle. 
In    wound.       Surg. 

13.  1865.    Died  1870. 
Exchanged  Feb.  10 

58 
59 

on 

N.C.,  age  27. 
Moore,  J.  W.,  Pt.,  I, 
13th  Miss.,  ago  23. 
Moore,  L.  J.,  Lieut., 
10th    Penn.    Res., 
age  26. 
Morris,  J.,   Pt.,   H, 

1864. 
July   3, 
1863. 
June27, 

1862. 

Aug.  30, 

artery. 
Middle  third,   right 
leg. 
Fract.  of  left  femur; 
July  24,  amp.  lower 
third. 
Left  femoral  injured 

1864. 
July  13, 
17,  . 
July  31, 
1862. 

Aug.  30, 

Ant.  tibial  artery.  . 

Branch  of  femoral  ; 
recurred  Aug.  2. 

1864. 
July  17, 
1863. 
Aug.  2, 
1862. 

Aug.  30 

Pearson,  5th  N.  C. 
Femoral,  in  continu 
ity. 
In  Scarpa's  triangle. 
Surg.  R.  B.  Bonte- 
cou,  U.  S.  V. 
Ligated  on  field  

1805. 
Transferred   for  ex 
change  Oct.  5,  '63. 
Resigned  January  21, 
1863. 

Discharged   Novem 

61 

14th  U.  S.  Inf. 
Moss,  B.  F.,  B.  101st 

1862. 
July  20, 

Flesh  wound  of  left 

1862. 
Dec.  15 

Femoral  

1862. 
Dec.  15 

Left;  in  continuity, 

ber  7,  1862. 
Discharged  June  26, 

6?, 

Illinois,  age  43. 
Palmer,  J.  C.,  Pt.,  G, 

1864. 
April  2, 

leg  ;    gang.  ;    amp. 
leg;  amp.  thigh. 
Flesh  wound  of  righ  t 

1864. 
Apr.  10, 

Femoral  

1864. 
Apr.  10, 

high  up. 
Both  ends  in  wound  . 

1865. 
Mustered  out    July 

63 

10th  Conn.,  age  18. 
Paschal,  J.,  Pt,,  I,  2d 

1665. 
Auc.  16 

thigh. 

1865. 
Aug  27 

1865. 
Au"  27 

In  Scarpa's  triangle. 

5,  1865. 
Retired  February  22, 

64 

N.  C.  Cav. 
Perkins,  L.  A.,  Corp'l, 

1864. 
Sept.  19, 

thigh;  gangrene. 
Fract.  ri<*ht  femur  • 

1864. 

1864. 

Surg.  D.  F.Wright, 
C.  S.  A. 
Femoral  li<rated  

1865. 
Recoveiy     April    1, 

65 

D,  50th  Va.,  age  19. 
Picket,  J.,  Pt.,  F,  8th 

1864. 
June  20, 

prim.  amp.  thigh. 

June  20 

from  sloug.  stu'p. 

Femoral  ligated  

1865.     ' 
Discharged  June  9, 

66 

Illinois  Cav.,  age  21. 
Robert  son,  T.\V,,Lt., 

1863. 
June  16, 

Left  knee  joint    

1863. 
July  8 

Anterior  tibial 

1863. 
July  8 

Femoral,  in  continu 

18C4. 
Resigned    March    6, 

67 

7thN.Y.,:igc26. 
Poss,  A.  G.,  Corp'l.  I, 

1862. 
Oct.  19, 

Ri^ht  femoral  artery 

1862. 

1862. 

ity. 
Fern,  ligated;   amp. 

1863. 
Retired    March    14, 

68 

13th  Miss.,  age  21. 
Rowe,  J.  B.,  Pt.,  G, 

1864. 
May  14, 

wounded. 
Middle   third   right 

June  12, 

Femoral    

June  12 

right  leg  Nov.  8. 
Both  ends  in  wound. 

1805. 
Discharged  June  5, 

69 

70 

71 
72 

12th  N.  H.,  age  22. 

Sassaman,  L.  H.,  Pt., 
E,  12th  Penn.  Kes., 
ago  24. 
Scott.  A.  J.,  Pt.,  A, 
9th  Maine,  age  24. 

Sharren,  J.,  Pt.,  E, 
170th  N.  Y.,  ago  46. 
Sboffer,  G.  W.,  Pt., 

1864. 

May  8, 
Ib64. 

Aug.  16, 
1864. 

May  24, 
1864. 
May  24, 

thigh. 

Upper  third  of  leg; 
injury  of  ant.  tibial. 

Head  of  right  tibia.  . 

Right  femur,  middle; 
Oct.  1,  amp.  thigh 
Flesh  wound  of  left 

1864. 

June  2, 
1864. 

Dec.  17, 
1864. 

Oct.    8, 

1864. 
May  24, 

Anterior  tibial  
Anterior  tibial  .... 
Femoral  

1864. 

June  4, 
1864. 

Dec.  17, 
1864. 

Oct.  13, 
1864. 
May  24, 

Surg.  A.  Heger,  U. 
S.A. 
Femoral,  in  Scarpa's 
triangle.  A.  A.  Surg. 
J.  S.  Cohen. 
Femoral,  in  continu 
ity.    A.  A.  Surg.  J. 
C.  Morton. 
In  cont.,  in  Scarpa's 
triangle. 
Femoral  ligated  

1865. 

Mustered  out  June 
28,  1865. 

Discharged  Juue  6, 
1865. 

Discharged    August 
15,  1865. 
Discharged  January 

73 

C,  5th  U.S.  Art. 
Short,  S.  A.,  Serg't, 

1864. 
July  20, 

thigh. 
Fract.  kneej't;  .amp. 

1864. 
Aug.  14, 

Femoral  

1864. 
Aug.  14, 

Right  femoral  liga 

30,  1865. 
Discharged  January 

74 
75 

A,  73d  111.,  age  26. 
Simmons,     H.     H., 
Capt.,  F,  21st  Miss., 
ago  24. 
Smith,  F.  A.,  Pt.,G, 

1864. 
July  2, 
1863. 

July   2, 

thigh;  sloughing. 
Fracture  right  leg; 
prim.  amp.  leg,  up. 
third. 
Fracture  lower  third 

1864. 
July  28, 
1863. 

July  2, 

From  stump  

1864. 
July  30, 
1863. 

July  2 

ted  in  continuity. 
Femoral,  in  continu 
ity. 

Femoral  ligated  on 

18,  1865. 
Sent  to  Provost  Mar 
shal  March  17,  1864. 

Transferred  for  ex 

4th  Ala.,  age  24. 

1863. 

of  femur. 

1863. 

1863. 

field. 

change  Apr.  27,  '64. 

CHAP.  XII.] 


LIGATIONS    OF    THE    FEMORAL    ARTERY. 


791 


No. 

NAME. 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATK 

OP 
HAEMOR 
RHAGE. 

PROBABLE  SOUIJCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

76 

Smith  E   E    Pt    A 

Aug.16 

Fracture  right  tibia; 

Oct.  17, 

Femoral    

Oct.  17, 

77 
78 

llth  Maine,  age  19. 

Smith,  H.,    Pt.,    F, 
21st  Va.,age41. 
Sock-well   C  L    Pt 

1864. 

Oct.  19, 
1864. 
May  6 

Sept.  12,  amp.  thigh. 

Both    thighs;    right 
femoral  severed. 

1864. 
May  6 

1864. 
Mav   6 

hip  joint  "Jan.   19; 
lig.     of    ext.    iliac 
Jan.  27,  1865. 
Femoral  ligated  

1865.    Spec.  3709,  A. 
M.M. 

Returned  March  14, 
1865. 

79 
80 

K,  12thN.J.,age22. 
Spivey,  D.,  Pt.,   5th 
N.  C.,  age  46. 

Surface  W.  J.    Pt. 

1864. 
May,  —  , 
1863. 

Au<*.  9 

Left  thigh,   femoral 
wounded. 

1864. 
June  11, 
1863. 

Nov.  19 

Aneurism  from  fe 
moral. 

Femoral 

1864 
July  8, 
1863. 

Nov.  19 

ha3in.  rec'd  May  31. 
In  Scarpa's  triangle. 
Surg.   E.    15.   Hay- 
wood,  C.  S.  A. 
In  continuity.   ..   . 

1865. 
Recovered. 

81 

F,  7th  Indiana. 

1862. 
Mav  5 

15,  amp.  at  thigh. 
Right  thiwh;   femo 

1862. 
Mav  19 

Femoral          .  

1802. 
May  19 

In  continuity  

27,  1862. 

m 

St>rg't,D,  12th  Mass. 

1864. 
July  14, 

ral  artery  injured. 
Fracture   of  upper 

1864. 

Femoral  

1864. 

Femoral  ligated    .  .  . 

1864. 

83 

Van  Lear  A.  Q.  L., 

1864. 
Mav   3, 

third  of  femur. 
Right  knee  ;    prim. 

Mav  15, 

Femoral  

May  15, 

In  continuity  

Removed. 

84 

Pt.tK,  5th  Virginia. 
Vearin",  W.,  Pt  ,  G, 

1803. 
Mav  22, 

amp.  at  thigh. 
Wound    of     right 

It  63. 
June  22, 

Femoral  .  .  . 

1863. 
June  22, 

Femoral  li<rated  

July  1  venous  ha-ni. 

85 

12th  Mo.,  age  30. 
Vickery,  R.  S.,  Ass't 

1863. 
July  30, 

thigh. 
Flesh     wound     left 

1863. 
July  30, 

Femoral  

1863. 
JulvSO, 

Both  ends  in  wound. 

Duty  Dec.  16,  1863. 
Discharged     March 

86 

87 

Surg.,  2d  Michigan. 

Wilder,   E.,   Corp'l, 
A,100thN.Y.,agel9. 

Williams,   B.    F., 

1864. 

Aug.16, 
1864. 

June  20, 

thigh,  upper  third. 
Left  leg;  sloughing  . 

Fracture  left  thigh  ; 

1864. 

Sept.  21, 
1864. 

July  4, 

Posterior  tibial  ar 
tery. 

1864. 

Sept.21, 
1864. 

July  4, 

Surg.   W.   B.  Fox, 
8th  Mich. 
Fern.,  in  continuity. 
A.   A.  Surg.  J.  C. 
Morton. 
Femoral,  in  contiuu- 

11,  1865. 
Recovered. 

Discharged  May  29, 

88 

Serg't,E:,40thOhio, 
age  23. 
Wilson,  J.,Pt.,  27th 

1864. 
May  26, 

prim,  amputation. 
Left   thigh,   middle 

1864. 
July  16, 

Aneurism  

1864. 
July  16, 

ity. 
Both  ends  in  wound. 

1865. 
Returned  to  duty. 

89 
90 

N.  T.  Batt.,  age  26. 

Winchell,  C.  D.,  Pt., 
K,  38th  W  is.,  age  19. 
Winchester   D.  W. 

1863. 

Apr.  2, 
1865. 
May  19 

third. 

Upper  third  of  left 
thigh. 
Middle  third  of  left 

1863. 

Apr.  11, 
1865. 
Mav  28 

Branch  of  femoral. 
Femoral. 

1863. 

Apr.  12, 
1865. 
May  28 

A.  A.  Surg.  G.  B. 
Hammond. 
Femoral,    H    inches 
below  Poup'art's  lig. 
In  Scarpa's  trian"le. 

Discharged  July  3, 
1865. 

91 

Pt.,  I,  1st  Me.  Ar 
tillery,  age  21. 
Winston    D  S     Pt. 

1864. 
Sept.  29, 

thigh. 
Right    knee    joint  • 

1864. 
Sept.  26 

1864. 
Sept.  26 

Surg.  T.  R.  Crosby, 
U.  S.  V. 
On    fico  of   stump. 

1865. 

92 

F,  117th  N.  Y.,  age 
23. 
Wood  W.  Corp'l  H 

1864. 
Dec.  31 

prim.  amp.  at  thigh  . 
Rio-fat  thi^h 

1865. 
1863. 

1865. 

A&s't  Surg.    J.    U. 
Armsby,  U.  S.  V. 
Femoral,  in  continu 

93 

81st  Indiana. 
Wrio-ht  M.    Pt.   F, 

1862. 
Dec.  11 

Jan.    2 

Jan.   9 

ity- 
In  Scarpa's  triangle. 

June  22,  1863. 
Discharged  July  8 

94 

95 
96 

25th  Ind.,  age  18. 

Ackland,  G.,  Corp'l, 
H,  21st  Mo.,  age  25. 

Allen,  E.  S.,  Serg't, 
D,  3d  Me.,  age  36. 
Ambrose  J.G.  Chap. 

1864. 

April  4, 
1865. 

July  2, 
1863. 
July  25 

femur. 

Fracture  left  ankle 
joint  ;  Apr.  24,  amp. 
leg. 
Fracture   left   log; 
prim.  amp.  thigh. 
Upper  part  rt.  (hiirh 

1865. 

April  27, 
1865. 

July  21, 

1863. 
Aug.  15 

Posterior  tibial  .  . 

Femoral  
Femoral  .  .  . 

1865. 

April  27, 
1865. 

July  21, 
1863. 
Aug.  15 

A.  A.  Surg.  E.  L. 
Mola. 
In  cont.,  Scarpa's  sp. 
A.  Surg.  E.  McClin- 
tock,  U.  S.  V. 
Ligatiou  

In   cont.,   one   end; 

1865. 
Died  May  1,  1865. 

Died  August  7,  1863  ; 
hsern. 
Died  August  20,  1864. 

97 

12th  N.  H.,  age  35. 

1864. 
Sept  14 

inj.  femoral,  &c. 

1864. 

1864. 
Sept  29 

Aug.  2V,  lig.  of  prof. 

Died  Sept  30  1862 

98 
99 

Georgia. 
Archibald,  T.,  Pt.,G, 
24th  Mass.,  age  18. 
Armstrong,  F.,  S'g  t, 

1862. 
April  2, 
1805. 
June  3 

Flesh,    right    thigh, 
injured  femoral 
Fract.  left  knee  j't; 

April  12, 
1865. 
June  26 

Femoral  

1862. 
April  12, 
1865. 
June  26 

In  wound,  one  end  .  .  . 
In  continuity,  upper 

Died  April  26,  1865. 
Julv  17,   lui'in.   pro 

1(10 

A,  58th  Massachu 
setts,  age  30. 
Atkins,  W.  H.,  Pt., 

1864. 
July  1, 

prim.  amp.  thigh. 
Fract.    lower    third 

1864. 
Au"-.  10 

Femoral  

1864. 
Aug.  11, 

third. 
In   continuity,   near 

funda.     Died  July 
18,  1864. 
Died  Aug.  12,    1862; 

101 

1,  10th  Mass.,  age  20. 
Atkinson,  J.  M.,  Pt., 

1862. 
Mav  12, 

right  femur  ;  amp. 
Fracture     femur, 

1862. 

1862. 
May  25, 

It-moral  ring. 
In  continuity.  A.  A. 

exhaustion. 
Juno  2,  amp.     Died 

10? 

A,  3d  Indiana  Cav- 
ali  v,  age  23. 
Atw'ood,  L.  D..  Pt., 

1864. 
Sept.  30, 

right. 
Flesh,    middle,    left 

Oct.  31 

Femoral  

1864. 
Oct.  31, 

Surg.  T.  Liebold. 
Both  ends  in  wound. 

June  7,  1864;  pya> 
rnia. 
Died  Nov.9,  1864;  ar 

103 

B,  32(1  Mass. 
Ayres,    B.,   Pt.,   A, 

1864. 
May  19, 

thigh. 
Flesh,    left    thigh, 

1864. 
May  31, 

1864. 
June  1, 

In  continuity. 

tery  had  sloughed. 
Died  Juno    1,    1863. 

104 

5th  Iowa,  ago  40. 
Bailey,   J.,    Pt.,    I, 

1863. 
June  18, 

femoral  vein  inj'd. 
Flesh,  left  thigh  .. 

June  1, 
1863. 
July  9 

Femoral  

1863. 
July  9, 

In  continuity  below 

Spec.  2085. 
Died  July  10,  1864. 

105 

55th  Pa.,  age  20. 
Ball,  C.  E.,  Pt.,  F, 

1864. 

1864. 
Juno  23 

1864. 
Juno  23 

profunda. 
On  face  of  stump. 

Died  June  29,  1863. 

li  0 

53d  Mass.,  age  20. 
Banfill,  T.,  Serg't,  C, 

1863. 
Mav  12 

lower  third  amp. 

1863. 

1863. 
Juno  12 

In  cont.,  in  Scarpa's 

Died  June  12,  1864; 

107 

19th  Ind.,  age  20. 
Barnes,   C.,   Pt,  D, 

1864. 
Mav  5 

left  thigh. 
Fract.    right    knee  • 

June  16 

1864. 
June  17 

triangle.    Surg.  T. 
R.  Crosby,  U.  S.  V. 
On  face  of  stump. 

pyaemia. 
Hammer,  rec.     Died 

108 

40th  N.  Y.,  age  21. 
Bauer,  P.,  Pt.,  B,  9th 

1864. 
Feb.  14, 

prim,  amputation. 
Fracture    ri<rht   pa 

17,  '64. 
Mar  23 

Femoral 

1864. 
Mar.  23 

On  face  of  stump. 

June  19,  1864. 
Died  Mav  5,  1862;  ex 

109 
110 

Illinois. 
Baxter,  S.,  Serg't,  C, 
68th  <J.  T.,  age  39. 
Bearly.J.  H.,  Serg't, 

1862. 
April  1, 
1865. 
Sept.  1, 

tella  ;  Mar.  15,  amp. 
Fract.    tibia,     inv. 
kneejt.;  Apr.  12,  am. 
Fracture    right    fe 

1862. 
April22, 
1865. 
Sept.  17, 

Femoral  
Femoral  

1862. 
April  22, 
1865. 
Sept.  17, 

lu  continuitv,  upper 
third. 
On  face  of  stump. 

haustion. 
DiedJune2,  1865;  ex 
haustion. 
Died  Oct.  31,  1864. 

111 

1,  101st  Ohio. 
Bedingfleld,    J.    1'., 

1864. 
Mar.  25 

mur;  Sept.  8,  amp. 

1864. 

1864. 

In  cont.,  Scarpa's  sp. 

22(1,  ha?m.  Died  Apr. 

112 
113 

Capt.,  G,  60th  Ga., 
age  25. 
Bell,   T.  C.,  Pt.,  E, 
34th  Iowa,  age  23. 

Bell,  R.  H.,Capt.,  F, 

1865. 

April  6, 
1865. 

May  7, 

third. 

Left   post,  tibial  ar 
tery. 

Left  knoe  j't  ;  prim. 

1865. 

April  15, 
1865. 

June  10, 

Left  post,  tibial.  .  . 
Femoral  ... 

1865. 

April  17, 
1865. 

June  10, 

A.  A.  Surg.  N.  A. 
Robbins. 
In  cont.,  Scarpa's. 
Surg.  A.McMahou, 
U.  S.  V. 
On  face  of  stump. 

25,  1865. 

Ham.  ;  amp.      Died 
April  23,  1865;  ex 
haustion. 
Died  June  20,  1864; 

114 

7th   N.  Y.  H.   A., 
ago  37. 
Benn,  J.  H.,  Pt.,  E, 

1864. 
May  6, 

amputation  thigh. 
Flesh,  both  thighs. 

1864. 
May  28 

1864. 
May  28 

One  end  in  wound    . 

exhaustion. 
June  14,  ha.'in.    Died 

45th  Pa. 

1864. 

1864. 

1864. 

June  14,  1864. 

792 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  xu. 


No. 

XAMK, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
II-iEMOB- 
KHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

115 

116 
117 
118 

119 
120 
121 
122 

123 
124 

125 

12G 

127 
128 
129 

130 

131 

132 

133 
134 
135 

136 
137 

138 
139 

140 
141 

142 
143 

111 

145 

146 
147 

148 
149 
150 
151 

Borkev,   C..  Pt.,  A, 
10th  'Pa.   lies.,  age 
24. 
Bibb,  W.  J.,  Pt..  G, 
32d  Tennessee. 
Bicklev,  II.,  Pt.,  E, 
10  th  N.  J.,  ago  21. 
Bills.  C.,Pt.  K,  17th 
N.  Y. 

Bloomer,  J.,  Pt.,  K. 
170th  N".  Y.,  .12041. 
Buozer,  F.  S.,  Pt.,  K, 
5thS.C.,age37 
Bout  on,  H.  S.,  Pt.,  K, 
5Uth  Va. 
Bowser,  J.F.,Pt.,  B, 
llth  Pa.,  age  18. 

Brandon,  E.E.,  Pt., 
K,  14th  Va,.,  ago  23. 
Brassiir.;ton,  J.,  Pt., 
H,  9oth  Pa.,  age  32. 

Briscoe,  M.,  Pt.,   G 
l.joth  N.  Y.,  age  42. 
Brittou,  M.,  Corp'l, 
F,  7th  Pa.  Res.,  age 
21. 
Brooks,  A.M.,  Lieut  , 
A,  26th  Va. 
Brooks,  J.  H.,Pt,  E, 
IstMd.Cav.,  age  37. 
Brown,    S.,    Pt.,    G, 
131th  N.  Y.,age  Iti. 

Brown.W.  C.,  Serg't, 
G,  51st  N.  Y.,  age 
21. 
Burke,   P.,    Pt.,   G, 
10th  Infantry. 
Cain,  W.  H.,  Serg't, 
I,  115th  N.  Y.,  age 
23. 
"Cameron,  D.  H.,Pt., 
C,4lhR.  I.,  age  24. 
Campbell.  J.  lV.,Sgt, 
A,  17thVa,,age23. 
Campbell,  S.,  Pt.,  H, 
140th  Pa.,  age  30. 

Campbell,  S.  G.,  Pt,, 
F,  58th  Va.,  age  31. 

Carroll,  R.  A.,I>t.,F, 
3d  Ala.,  ago  19. 

Carter,  C.  S.,  Pt,  D, 
50th  Pa.,  age  22. 
Chase,  J.  B.,  Pt.,K, 
24th  N.Y.  Cavalry, 
ago  49. 
Clark,  W.  L  ,  Pt.,K, 
25th  N.  C.,  age  20. 

Clavpole.  S.,  Pt.,  I), 
62d  Pa.,  age  27. 

Clelland,  W.,  Pt.,  H, 
8th  N.  Y.,  ago  18. 
Cleveland,  J.  L.,Pt, 
G,  ICthMe.,  age  25. 
Clymer,  J.,   Ft,   B, 
i04th  Pa. 

Coder,  D.,  Corp'l,  F, 
10th   Pa.  Cavalry, 
ago  23. 
Coleman,  G.,  Pt,  F, 
91th  N.Y.,  ago  19. 
Colgau,  W.,    Pt,  C, 
2a  Mass.  Cavalry, 
age  21. 
Conliu,  J.  S.,  Pt.,  I, 
5th  Michigan. 

Council,  M.,  Pt,  K, 
2d  K.   Y.    H.   A., 
age  34. 
Coultes,  W.  II.,  L't, 
C,  Gist  N.  Y. 

Councell,  E.  G.,  Col., 
IGth  Miss.,  ago  32. 

Aim.  30, 
1862. 

MavlS, 

1804. 
May  14, 
1864. 
Aug.  UO, 

IS,  2. 

Aug.  25, 
1864. 
May  28, 
1864. 

Mar.  30, 
1865. 

May  10, 
1864. 
May  13, 
1864. 

June  3, 
18G4. 
Doc.  13, 
1862. 

Apr.  0, 
186'). 
Aug.  16, 
18W. 
Aug.  30, 
1862. 

May  11, 
1864. 

Aug.  30, 
1862. 
Ausr.  16, 
1864. 

Mar.  14, 
1802. 
Aug.  4, 
1864. 
May  29, 
1864. 

May  31, 
1864. 

July  2, 
1863. 

May  12, 
1864. 
June  16, 
18b4. 

April  1, 

18U5. 

May  30, 
1864. 

Juno  1, 
18'J4. 
Dec.  13, 
1802. 
May  31, 
1862. 

Mav  28, 
1864. 

Aug.  29, 
1862. 
Sept,  14, 
18G4. 

Mav  31, 
1862. 

April  7, 
1865. 

June  1, 
1862. 

Aug.  21, 
1864. 

Dividing  of  left  pop 
liteal. 

Riiiht  knee.j't  fraet; 
prim,  amputation. 
Flesh,  mid.,  left  leg; 
Aug.  3,  ampt'n  leg. 
Right  lh:gh,  iuv.  pro- 
fuuda  artery. 

Fracture  upper  3d  of 
right  leg. 
Flesh,  near  groin.  .  .  . 

Sept  11, 
13,  14, 
1862. 

Sept.  14, 
1862. 

Aug.  14, 

In  continuity,  Scar- 
pa's  space. 

On  face  of  stump.  .  .  . 

September  15,  hsem.  ; 
18,  amp.    Died  Sep 
tember  18,  1862. 
Died    September  23, 

Aug.  23, 
1864. 
Sept.  13, 
15,  22, 
1862. 
Sept  17, 
1864. 

Femoral 

1861. 
Aui;.  23, 
1864. 
Sept.  20, 
1862. 

Sept.  17, 
1864 
July   3, 

Oil  f.iee  of  stump   .  .  . 

Incont;  ()e.  3,  ha-m.; 
unsuccessful  att'pt 
to  relig. 
In  contain  Searpa's 
triangle. 
In  cout.   A.  Surg.  J. 
C.  McKee,  U.  S.  A. 
Ligation  

On  face  of  stump.  A. 
Surg.  W.  F.  Norris, 

u.  s:  A. 

On  face  of  stump   .  .  . 

On  face  of  stum  p.  A. 
Sui'g.  W.  F.  Norris, 
U.  S.  A. 
In  cont.    Surg.  N.  II. 
Moseley,  D.  S.  V. 
In  continuity.    Surg, 
E.  Bentley,'  U.  S.  V. 

In  continuity,  below 
profuuua. 
lu  cont.   A.  A.  Surg. 
E.  B.  Woolston. 
In  cont,  low.  3d.    A. 
Surg.    \V~.    A.  Con- 
over,  U.  S.  V. 
On  face  of  stump  .  .  . 

In  continuity  
In  continuity  

In  continuity  

In  continuity,  Scar- 
pa's  space. 
In  continuity.   Asst. 
Surg.  W.Thomson, 

u.s:  A. 

On  face  of  stump.  .. 
In  continuity  .   

On  face  of  stump  .  .  . 

In  continuity,   Sear- 
pa's.     A.  A.  Sing. 
W.  H.  Ensign. 
In  continuity,  above 
profunda.     A.    A. 
Surg.  J.  Morris. 
In  continuity,  Scar- 
pa's.     A.  Surg.  W. 
P.  Norris,  U.  S.  A. 
One  end  in  wound, 
mid. 
On  face  of  stump  .  .  . 

In  continuity,  Scar- 
pa's.    A.  A.  Surg. 
NV.  K.  Cleveland. 
In  continuity.    A«st 
Surg.  W.  Thomson, 
U.  S  A. 
In  continuity  

1864. 
Died  August  21!,  1864; 
exhaustion. 
Died  October  -i.  1862. 

September  IS,  amp. 
Died  Sept,  21.  1864. 
Died  July  20,  1864. 

Died  June  lit,   1864  ; 
exhaustion. 
Died   May   21,  1865; 
pyaemia. 

Died  June  24,   1864; 
exhaustion. 
Died   June   7,    1804; 
exhaustion. 

Ilwm.  recur.     1)  i  e  d 
June  17,  1864. 
Died  Jan.  12,   1863. 

Died  April  20,  1865. 

Sept  28,  amp.     Died 
Oct.  17,  1864;  exh'n. 
Died    Dec.    7,    1862; 
pvjcmia.  Spec.  1024, 
A.  M.  M. 
Died  July  11,  1864. 

Died  Sept.  14,  1862  ; 
exhaustion. 
Died  September  26, 
1864. 

Died  April  6,  1862. 

Died  August  13,  1864; 
exhaustion. 
Died  Juno   13,  1864; 
exhaustion.      Spec. 
3557,  A.  M.  M. 
Died  Juno  23,   1864; 
pyicmia. 

Died    February    17, 
1864;  pysemia. 

Died  Juno  2,  1864. 
Died  July  9,  1864. 

Gangrene.  Died  Apr. 
19,1865. 

Hccm.  recur'd.    Died 
August  4,  1864;  as 
thenia. 
Died  July  24,  1864. 

Died    December   31, 
1862;  exhaustion. 
Died  Juno  16,  1862. 

Died  Juno  10,  1864  ; 
asthenia. 

Died    December    3, 
1862;  pyaemia. 
Hiinnor.       recurrent. 
Died  September  28, 
1864. 
Relig.       profunda. 
Died  Juno  17,  1862. 

Died  Juno  16,  1865; 
exhaustion. 

Died  June  23,  1862. 

September  10,  luem. 
Died  Sept.  10,  1864. 

Post.  tiuial  

Groin  and  testicles.  . 

Right   tibia,    head; 
Apr.  11,  amp.  thigh. 

Frac.  up.  3d  right  tib. 
May  1!),  amp.  thigh. 
Right  tibia,  Uneej't; 
May  30,  ainp. 

Loft  knee  joint  ;  June 
28,  amputation. 
Bones,  v'tfoot;  Dec. 
26,  amp.  knee.j't. 

Fract    right  femur, 
inj.  pop.  artery. 
Fracture  left  fibula.  . 

Post,  tibial  artery.  .  . 

Fract.  r't  thigh,  low. 
;jd  ;  primary  amp. 

Right  knee.j't;  Sept 
11,  amp.  thigh. 
Injuring  right  tibia; 
Sept.  17,  amp.  leg. 

Condyles  r't  femur; 
prim,  amputation. 

Apr.  17, 
28,1865. 

May  25, 
1864. 
June  5, 
1864. 

June  15, 
16,  1864. 
Jan.    7, 
1863. 

Sept  11, 
1864. 
Nov.  14, 
28,  18n2. 

May  21, 

1864. 

Sept.  13, 
1862. 
Sept.  25, 
1864. 

Apr.   5, 
1862. 
Au«-.  13, 

Femoral 

1864. 
June  19, 
18G4. 
Apr.  28, 
1865. 

May  25, 
1864. 
Juno  5, 
1864. 

June  16, 
1864. 
Jan.    7, 
1863. 

Apr.  17, 
1865. 
Sept,  11, 
1864. 
Nov.  28, 
1862. 

Mav  21, 
1864. 

Sept  13, 
1862. 
Sept,  25, 
1864. 

Apr.  5, 
1862. 
Aug.  13, 
1864. 
June  13, 
1864. 

June  21, 
1864. 

Dec.  23, 
1863. 

May  28, 
1864. 
Julv  7, 
1864. 

April  10, 
1865. 

June  8, 
1864. 

July  24, 

1864. 
Dee.  30, 
1862. 
June  16, 
1862. 

Juno  9, 
1864. 

Dec.  3, 

1862. 
Sept,  27, 
1864. 

June  10, 
1862. 

Juno  15, 
1865. 

June  18, 
1862. 

Sept.  3, 
1864. 

Femoral 

Femoral  

Stump  

Popliteal  
Femoral  

Post,  tibial  

Femoral  
Femoral  

Fract.  middle  third 
right  femur. 

Left  knee  joint;  pri 
mary    amputation 
thigh. 
Flesh,  right  leg;  sec 
ondary  amputation 

thigh: 

Right  leg;   amputa 
tion  thigh. 
Fracture    left   tibia 
and  lib.;  prim.  amp. 
knee  joint. 
Flesh,    right    thigh, 
femoral  artery. 

Flesh,  right  leg  

Flesh.left  thigh,  uiid- 
dlrt. 
Primary  amp.  thigh, 
lower  t  bird. 
Popliteal  space.  

Trochanter     minor, 
right  thigh. 

Upper  third  femur  .  . 
Flesh  leftthi-'h     .. 

1864. 
Juno  10, 
13,  '64. 

June  20, 
18b4. 

Dec.  9, 
23,  "63. 

Mav  28, 
1864. 
July  6, 
1864. 

April  10, 
1865. 

June  8, 
1864. 

July  24, 
1864. 
Dee.  30, 
1862. 
Juno  15, 
16,  '62. 

Juno  8, 
9,  '64. 

Dec.  3, 

1862. 

Profunda  ligated  .  . 

Femo'l  and  branch 
profuuda. 

Anterior  tibial    .  . 

Femoral  
Popliteal       

Femoral    

In  continuity,    four 
inches  below  pro 
funda. 
In    cont.  ;     also    lig. 
profunda.    Surg.  R. 
B.  Bontecoii,  U.S.V. 
In     continuity,    one 
end.     A.  A.  Surg. 
0    P.  Sweet. 
Both  ends  in  wound. 
A.  Asst.  Surg.  W. 
Hunt. 
On  face  of  stump.  .  .  . 

Right    femoral    art 
ery,  middle. 

Flesh,  middle,  right 
thigh. 

Middle  of  thigh,  in 
jury     femoral    ar 
tery. 
Fracture    right   leg 
near  knee;  Aug.  21, 
amp.  knee  joint. 

Juno  10, 
1862. 

Femoral  sloughed 
Femoral  

Juno  18, 
1862. 

Sept.  2, 
1864. 

Femoral  

1  THOMPSON  (J.  II.),  Report  of  the  wounded  at  the  battle  of  Xew- Berne,  in  American  Medical  Time*,  Vol.  5,  p.  6 


CHAP.  XII. | 


LIQATION.S    OF    THE    FEMORAL    ARTERY. 


793 


No. 

15_> 
153 
154 

155 

156 
157 
158 

159 

160 

161 

162 
163 
164 

165 
1G6 

167 
168 
169 

170 
171 

172 
173 
174 
175 
176 

177 

178 
179 
180 
181 
182 
183 

184 

185 

186 
187 
18S 
189 
190 
191 

NAME. 
A<;E.  AND  MIUTAUY 
DESCKU'TION. 

DATK 

OF 
INJUKV. 

NATUUE  OF  IXJUKY. 

DATE 

OF 
H.EMOK- 
HHAGE. 

PliOKAllLK  SOUKCK 
OF 
HEMORRHAGE. 

L)ATK 
OF 

OFKUA- 

TIOX. 

OPERATION,    Ol'F.KA- 
TOtt. 

EKSULT. 

Cox,  T.   C  ,   Pt.,  G, 
88th  Now  York. 
Coy,  J.,  Serg't,  K,6th 
Maine,  age  28. 
Crews,  M.  A.,  Pt,  F, 
2dS.C.,age36. 

Crowder   D.  J.,  Pt., 

Dec.  13, 

1862. 
Nov.  7, 
1863. 
June  J, 
1864. 

Dec.  10, 

Fr.  left  fern.,  up.  th'd, 
femoral  injured. 
Left  thi°rh  middle 

Jan.  9, 
10,   '63. 

Jan.  10, 
1863. 
Nov.  24, 
1863. 
June  19, 
1864. 

Jan.  9, 
1865. 

Mav  25, 

1864. 

Died  Janua'y  10,1863. 

Died  Dec.  23,  1863; 
recurring  haini's. 
Died  October  25,  1864; 
tuberculosis. 

Died  Feb.  3,  1865. 

Died  May  29,  1864. 

Jan.    12,    gangrene. 
Died  Jan.  29,  1863. 
Died  Jan.  25,   1863; 
exhaustion. 

Dec.  22,  haem.    Died 
Jan.  26,  1865. 

Died  July  31,  1864. 

Recurring      haemor 
rhages.    Died  June 
3,  1864;  exhaust'n. 
Amputation     thigh. 
Died  May  26,  1864. 
Gaug'ne.    Died  June 
5,  1863. 
Amputation     thigh. 
Died  Aug.  7,  1864; 
pyaemia. 
Died  July  10,   1864; 
exhaust'u,  pyaemia. 

Died  Oct.  21,  1863. 

Died  March  10,1865; 
exhaustion. 
Died  March  4,  1863; 
pyaemia. 
Died  June  29,  186  I; 
pyaemia. 

Died  April  8,  1865. 

Amputation     thigh. 
Died  June  6,  1864; 
exhaustion. 
Sept  8,  haem.    Died 
April  13,  1864. 
Died  Sept.  13,  1862. 

Died  May  26,  1864. 
Died  July  11,  1863. 
Died  April  2r<,  1865. 

Died  June  21,  1864. 

Died  Oct.  2,  1864. 

Died  Jan.    29,    1863. 
Spec.  1140,  A.  M.  M. 
Died  Dec.    '.9,  1864; 
pya'inia. 
Died  Oct.  18,  1862. 

Died  Sept.  24,  1862. 

U;em.  ree.  Died  June 
25,  1864. 

Died  Nov.  24,  1862. 

Hu'inor.  recurred. 
Died  A  prill  8,  1865. 

Died  June  8,  1864. 

Died   May  27,  1864; 
pyaemia. 
Died  Aug.  9,  1863. 

Died  Aug.  8,  1863. 
Died  June  15,  1864. 
Died  July  12,  1864. 

In  continuity  ;   reli- 
gated  Dec.  'land  13. 
Oil  face  of  stump.  .  .  . 

In   continuity,   mid 
dle.    A.  A.  Stirg.  D. 
D.  Talbot 
In  continuity,  above 
profunda. 
In  cont,  in  Scarpa's 

Fracture  right   leg; 
primary    amputa 
tion  thigh. 
Fleah,    lower    third 

1863. 
June  19, 
1864. 

Popliteal  

Stanuard's  Batt'ry, 
age  23. 
Ciimmings,    H.,     A, 
7th  W.Va.,  age21. 
Cummings,    f.     M.. 
Pr.,  D,  49th  Ind. 
Cummins,  A.  H..Pt., 
K,  34th  New  York, 
age  25. 
Cunningham,  S.,  Pt., 
D,  13th    Ind.  Cav 
alry,  age  29. 
Curtis,  J.  J.,  Serg'r, 
A,  13th  New  Hamp 
shire,  age  20. 

Dal*,   J.,  Serg't,  K, 
82d  N.  Y.,  ago  27. 

Darling,  S.  G.,  Pt., 
D,  32<1  Me.,  age  19. 
Day,  If  .  Corp'l,  A, 
6th  Alabama. 
Delamater,  M.,  Cor 
poral,  G,  7th  Mich. 
Cav.,  age  20. 
Delanev,  J  ,  Pt.,  G, 
C7th   'New    York, 
age  20. 
Deminsr.  J.C.,  Corp'l, 
A,  11  1th  XewYork, 
age  20. 
Detweiler,  C.,Pt.,C, 
47th  Pa.,  age  24. 
Dier,  \V.,  Corp'l,  A, 
129th  Pa.,  age  23. 
Dougherty,    J.    H., 
Pt.,  G,   t6th    New 
York,  age  35 
Dougherty,  M.,  Pt., 
E,  49th  Pa.,  age  35. 

Doyle,  L.,  Pt.,  K,  8th 
Maine,  age  34. 

Dunn,  15.  M.,  Pt.,  D, 

1st  Louisiana. 
Eddy,  G.,  Pt.,  E,  7th 
Wisconsin,  age  24. 
Edson,  lF.,Pt.,I,  5th 
K.  C.,  age  22. 
Edwards,  R.,  Pt.,  G, 
98th  Illinois. 
Edwards,  J.  W.,  Pt., 
B,  28th  III.,  age  18. 

Elliot,    E.,    Pt.,   H, 
118th  Pa.,  age  21. 

Faust,  P.  L  ,  Pt.  A, 
7llth  Pa.,  age  26. 
Ferguson,  J.,  Pt.,  G, 
142d  Pennsylvania. 
Firth,  11.  E.,'  Pt.,  A, 
157th  N.  Y.,  age  23. 
Fliege,    II.,    Corp'l., 
F.  7th  Michigan. 
Flowers,  M.,  Pt,  II, 
HUstN.  Y.,  age  26. 
Floyd,  J.,  Sergeant, 
13th  Pa.  Cavalry. 

Freeman,  A.,  Pt,  H, 
61st  New  York. 
Freeman,      C.      A., 
Sergeant,    B,    37th 
Mass.,  ant-  '.'2. 
Geitz,     H.,     Pt,    C, 
l.'.th  N.  Y.,  age  20. 
Gilley,  M.,Pt.,G,9th 
N.  Y.  Vols.,a<re  27. 
Goodman,  E.,  Pt.,  D. 
27th  Pa.,  age  17. 
Goodwin,  A.   B.,  2d 
New  Hampshire. 
Graham,  J.  A.,  Ser 
geant,  11,  116th  Pa. 
Gray,  J.,  Pt,  D,  2d 
Pa.  H.  Art,  age  17. 

1864. 

May  8, 
1864. 
Dee.  28, 
1862. 
Dec.  13, 
1862. 

Dec.  4, 

1864. 

June  15, 
1864. 

May  6, 
1864, 

May  5, 
1864. 
May  3, 
1803. 
Mav  28, 
1864. 

May  6, 
1864. 

Oct.  12, 
1863. 

Oct.  19, 
18C4. 
Dec.  13, 
1862. 
June  3, 
1864. 

Sept  19, 
1864. 

May  20, 
1864. 

July  2, 
1863. 
Aug.  30, 
1862. 
Mav  12, 
1864. 
June  25, 
1863. 
Mar.  26, 
18G5. 

June  3, 
1864. 

Aus.  10, 
1864. 
Dee.  !3, 
1802. 
Dec.  6, 
1864. 
Sept.  17, 
1802. 
A  u  iz.30, 
1862. 
May  28, 
1864. 

Sept.  17, 
186.'. 
Apr.  6, 
1865. 

Mav  18, 
1864. 
May    5, 
1864. 
May   2, 
1863. 
July  2, 
1863. 
June  1, 
1864. 
June  17, 
1864. 

thigh. 
Ei'fht  thi"-h 

May  95 

Eight  thigh,  cutting 
femoral  artery. 
Left  tibia,  np.  third; 
Dec.  26,  amp.  thigh. 

Eight    knee    joint; 
primary  amputat'n 
thigh. 

1864. 

Femoral  

Jan.  3, 
1863. 

Dec.  9, 

1864. 

Femoral  

Jan.  3, 
1863. 

Dec.  9, 

13,  20, 
1864. 
Julv  31, 
1864. 

May  20, 
1864. 

Mav, 

1864. 
May  28, 
1863. 
July  10, 
1864. 

July  4, 
1864. 

Oct.  21, 
1863. 

Mar.  10, 

1865. 
Feb.  22, 

space. 
In   continuity,  high 
up. 

On  face  of  stump,  in 
continuity. 

Both  ends  in  wound  ; 
also  int.    cir.      A. 
Surg.  E.  Curtis,  U. 
S.  A. 
In   cont.,    Scarpa's. 
A.  Surg.  W.  F.  Nor- 
ris,  U.  S.  V. 
In  co  tinuity,  below 
profunda. 
lu  continuity    

In    cont;    July    12, 
hrem.  popliteal. 

On    face    of   stump. 
Surg.  E.  B.  Bonte- 
cou,  U.  S.  V. 
Li'ratiou        ...   . 

Femoral 

Fracture  left  fibula  .  . 

Severing  femoral,  rt. 
thigh,  lower  third. 
Eight   leg,    fracture 
fibula. 
Richt    thigh,    lower 
third. 

Fracture    head   left 
tibia  ;  May  J7,  amp. 
thigh. 
Left  pelvic  bone,  fe 
moral  artery. 

Fracture  left  femur, 
middle  third. 
Left  popliteal  space. 

Fracture   left    knee 
joint  ;  June  9,  amp. 
thigh. 
Fracture  left  knee; 
amputation  thigh. 

Flesh,  middle,  right 
thigh. 

Fract.  right  femur, 
severing  femoral. 
Fracture  right  leg; 
prim.  amp.  thish. 
Fract.  low.  third  left 
femur:  amp.  thigh. 
Flesh,    both  thighs. 

Right    leg,      upper 
fin.,  third. 

Flesh    wound    mid 
dle  third  right  th. 

Fracture    left  knee; 
prim.  amp.  thigh. 
Upper    third    right 
leg. 
Left      knee     joint; 
Dec.  10,  amp  thiL'h. 
Eight       knee  joint; 
Oct.  9.  sunn.  tbii;h. 
Wound     of    thigh  ; 
Aug.  30.  amputated. 
Fracture  ot'lef  t  femur 

Fracture  of  left  femur 

Flesh  wound  of  left 
thigh. 

Fracture    of     right 
femur. 
Wound  of  thigh... 

May  20, 
1864. 

May, 
1864. 
May  26, 
28/63. 

Post  tibial  

Post,  tibial  

July  3, 
Itf64. 

Oct.  21, 
1863. 

Mar.  5, 
9,  '65. 
Feb.  22, 
1863. 
Juno  20, 
21,  '64. 

Nov.  4, 
1864. 

Ext.     circumflex  ; 
lig.  profuuda. 

Both  ends  in  wound, 
Scarpa's  triangle. 
Li<*ation  .  . 

1863. 
June  21      On  face  of  st.nnin    . 

Femoral 

1864. 

Nov.  4, 
1864. 

June  1, 
1864. 

July  2, 
1863. 
Sept  13, 
1862. 
May  24, 
1864. 
July   8, 
1863. 
Apr.  20, 
1865. 

June  13, 
1864 

Sept  15, 
1864. 
Jan.  25, 
1863. 
Dec.  19, 
1864. 

Oct.  n, 

1862. 
Sept.  20, 
1862. 
June  19, 
1864. 

Nov.   3, 
1862. 
Apr.  15, 
1865. 

Mav  30, 
1864. 
May  —  , 
1864. 
June  18, 
1863. 
July  20, 
186:!. 
June  8, 
1864. 
Juuo30, 
1864. 

Femoral;  March  26, 
1865,  external  iliac 
ligated. 
Both  ends  in  wound. 
Surg.  A.  Heger,  U. 
S.  A. 
In  cont.,  in  Scarpa's 
space. 
In  continuity  

July  2, 
1863. 
Sept.  10, 
13.  '62. 
Mav  24, 
1864. 
July  6,  8, 
1863. 
Apr.  15, 
20,  '65. 

June  13, 
1864. 

Sept.  15, 
1864. 
Jan.  23, 
24,25/63 
Dee.  17, 
19,  '64. 
Oct.  11, 
Ir62. 

S,-pt.20, 
1802. 
June  19, 
1864. 

Nov.  3, 
1862. 
Apr.  15, 
1865. 

Mav  29, 
30,'  '64. 
Mav  — 

Femoral    

Femoral  

Femora  1  

In    continuity,    one 
end. 
Lower  portion  Scar- 
§a's  space.    A.  A. 
urg.   H.  B.  Cole. 
Femoial,  one  end  in 
wound.     A.    Snrg. 
A.  Allen.  U.  S.  A. 
On  face  of  stump 

Femoral,  in  Scarpa's 
triangle. 
Femoral,  in  continu 
ity. 
Femoral  ligated 

Femoral    ligated,   in 
cont. 
Fern,  above  origin  of 
profuuda.       A.    A. 
Surg.J.Newi'omb'!. 
Femoral  ligated     . 

In  Scarpa's  triangle. 
Surg.  B.  A.  Vaiidcr- 
kieft,  U.  S.  V. 
In  continuity.    Surg. 
D.W.  Bliss,  IT.  S.  V. 
Femoral  ligated  .    . 

Femoral  ligated  ... 
Both  ends  in  wound 

Femoral,  two  inches 
above  the  profunda. 
In  cout.    Snrg.  N.  E. 
Moseley,  U.  S.  V. 

Posterior  tibial  ar 
tery. 

Femoral  
Popliteal     
Branch  of  fi-moral. 
Femoral    

From  stump  

Femoral  

Profuuda  

Femoral  

Shot  wound  ;  ampu 
tated  thigh. 
Left  thigh  

Eight  thigh  

Upper  third  of  left 
thigh. 

1864. 
June  18, 
1863. 
July  20. 
1863. 
June  8, 
1864. 
June  30, 
1864. 

Femoral  

Profuuda;       pro- 
funda  ligated. 

SURG.  Ill— 100 


794 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

192 

193 
194 
195 
196 

197 
198 
199 
200 

201 

202 

203 
204 

205 
206 
207 
208 
209 
210 
211 
212 
213 

214 
215 
216 
217 
218 
219 
220 

221 
222 
223 

224 
225 
226 
227 
228 

229 
230 
231 

232 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OP  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Griffitbs,  H.,  Ft,  E, 
8th  N.  Y.  Cav. 

Gross,   C.,    Pt.,   6th 
Penn.  Cavalry. 
Hagan,    J.,   Pt.,   G, 
76th  Pa. 
Ham,   J.  C.,  Serg't, 
B,  87th  Pa. 
Hamilton,  E.,  Capt, 
G,15thN.  J.,  ago  19. 

Harper,  J.,   Pt.,   B, 
ICth  Inf. 
HaiTiman,  R.  C.,Pt, 
F,  llth  Me.,  ace  39. 
Harrington,    W.   J., 
Pt.,C,  16th  Wis. 
Harris,  J.M.,Corp'l, 
C,  14th  Iowa,  age  20. 

Harrison,  E.,  Color- 
Serg't,  B,  lOthN.  Y. 
Haskoll,   A.    M., 
Corp'l,  K,  12th  Me., 
age  23. 
Haskins,  "W.  H.,  Pt., 
K,  39th  Massachu 
setts,  ago  23. 
Hayden,  G-,  Pt.,  B, 
1st  Maryland  Bat., 
age  22. 
Heath,  L.,  Serg't,  D, 
2d  Mich.,  age  22. 
Hershay,  C.,  Serg't, 
F,  25th  Iowa,age21. 
Hickey,   T.   G.,  73d 
Pa.,  a  go  53. 
Horn,  S.,Pt.,H,  53d 
North  Carolina. 
Horton,    A.,    Pt,    I, 
48th  N.  T.,agc  19. 
Hubbs,J.  B.,  Pt.,  B, 
142d  Pa  ,  age  20. 
Huggins,  W.,  Serg't, 
G,  COth  Illinois. 
Hulbert,  G.  D.,  Pt., 
G,  109thN.Y.,ago37. 
Hyatt,  J.,  Pt.,  E,  2d 
Ohio,  age  30. 

Johns,  J.  M.,  Pt.,  G, 
5th  Florida. 
Johnson,  F.  B.,  Pt, 
E,  16th  Maine. 
Johnson,  P.  L..  Pt., 
U,  25th  Va.,  age  22. 
Johnson,  V.,  Pt,  I, 
13th  Iiid.,  age  22. 
Johnston,  J.,  Pt.,B, 
27th  Connecticut. 
Jones,  W.  U.,  Pt,,  C, 
14thN.Y.A.,age24. 
Jones,  W.  W.,  Ensign, 
Thomas's     Legion, 
age  25. 
Judrt,  J.  E  ,  Lieut, 
K,  49th  Mass.,  age  25. 

Kane.  W.  H.,  Serg't, 
1,  115th  New  York, 
ago  23. 
Keaton,  J.  M.,Pt,D, 
19th  Ind.,  age  19. 

Keeler,  J.,Pt.,D,5th 
Ohio  Cavalry. 
Keese,W..Co'rp'l,  G, 
74th  N.  Y.,  age  31. 
Keller,  H.H.,Pt.,B, 
7th  Michigan  Cav. 
Kelley,  J.  A.,  Lieut  , 
C,  9th  Missouri. 
Kennedy,  J.  J.,  Ser 
geant,  G,   155th  N. 
Y.,  age  29. 
Kimler.  W.  O.,  Pt,, 
D,  3Gth  111.,  age  33. 
Kiusev,   R.   C.,  Pt., 
K,  104th  Pa. 
Kitzing,  A.,  Pt.,  H, 
57th  N.  Y.,  age  40. 

Knapp,  C.  A.,  Pt,  B, 
6th  Vt,  age  20. 

Sept.  17, 
1862. 

May  30, 
1804. 
July  17, 
1864. 
Oct.  19. 
1864. 
May  6, 
1864. 

Dec.  31, 
1862. 
Aug.  16, 
1864. 
July  5, 
1864. 
July  15, 
1864. 

May  10, 
1864. 
Oct.  19, 
1864. 

May  10, 

1864. 

July  3, 
1863. 

June  18, 
1804. 
Mar.  19, 
1865. 
Aug.  30, 
1802. 
Mar.  25, 
1865. 
June  3, 
1864. 
Dec.  13, 
1862. 
Mar.  16, 
1865. 
May  17, 
1864. 
May  15, 
1864. 

Sept.  17, 
1862. 
Dec.  13, 
1862. 
May   3, 
1863. 
May  10, 
1864. 
Dec.  13, 
1862. 
June  9, 
1864. 
Sept.  19, 
1864. 

May  27, 
1864. 

Aug.16, 
1864. 

May  12, 
1864. 

Apr.  —  , 
1802. 
July  23, 
1863. 
May  6, 
1864. 
July  4, 
1863. 
Aug.14, 
1864. 

Nov.  29, 
1864. 
Juno  1, 
1862. 
Dec.  13, 
1862. 

May  10, 
1864. 

Left    femur,    knee; 
Nov.  —  ,  amp.  thigh. 

Left  thigh,    femoral 
divided. 
Right  thigh,  femoral 
divided. 
Left  knee  joint;  Oct. 
29,  amp.  thigh. 
Right  thigh,  femoral 
divided. 

Fracture  of  thigh  

Head  of  left  tibia; 
Sept.  16,  amp.  thigh. 
Flesh  wound  of  left 
thigh. 
Lower    third    right 
thigh. 

Right  thigh,  femoral 
artery  severed. 
Right  knee  ;  Nov.  15, 
amp.  thigh. 

Left    ankle    joint; 
May  18,  amp.  thigh. 

Left  knee  joint;  July 
8,  amp.  thigh. 

Right  tibia;  July  7, 
amp.  thigh. 
Rigut  femur;    Mar. 
20,  amp.  thigh. 
Middle  third  of  right 
thigh. 
Flesh  wound  of  left 
thigh. 
Right  knee  j't  ;  prim, 
amp.  thigh. 
Fracture  right  leg; 
Dec.  26,  amp.  thigh. 
Right  thigh  

Flesh  w'ds  of  both 
thighs. 
R'ttuigh;balllodg'd 
in  pelvic  cavity. 

Left     knee;     prim, 
amp.  thigh. 
Right   knee;    prim, 
amp.  thigh 
Right  leg;  May.   23, 
amp.  thigh. 
Wounds    of    both 
thighs,  frac.  of  left 
Right  tib.  and  fib.  ; 
Dec.  23,  amp.  thigh. 
Flesh  wound  of  right 
thigh. 
Flesh  wound  of  thigh, 
femoral  injured. 

Injury  to  coats  of  fe 
moral  artery. 

Left  tibia;  Sept.  17, 
amp.  at  knee  joint. 

Left  knee  j'nt;  prim, 
amp.  thigh. 

Wound  of  left  thigh. 

Left  knee,  j'nt;  prim, 
amp.  thigh. 
Right  femur  ;   prim, 
amp.  thigh. 
Fracture  of  left  fe 
mur. 
Right  thigh  and  left 
groin. 

Flesh  wound  of  right 
thigh;  gangrene. 
Right  leg;   Juno  8, 
amp.  leg. 
Through      popliteal 
hpace,    arteries 
wounded. 
Left  knee  joint;  May 
29,  amp.  thigh. 

Nov.  19, 
1862. 

May  31, 
1864. 
July  23, 
1864. 
Oct.  28, 
1864. 
May  15, 
1864. 

Sept.  23, 
1864. 
July  16, 
1864. 
July  27, 
1864. 

May  10, 
1864. 
Nov.  21, 
1864. 

May  24, 
31,'  '64. 

July  13, 
1863. 

July  12, 
1864. 
April  14, 
1865. 
Sept  27, 
1862. 
July6,9, 
1865. 
June  12, 
1864. 
Dec.  29, 
1862. 
April  3, 
1865. 
June  8, 
1864. 
May  28, 
1864. 

Oct.    3, 

1862. 
Dec.  25, 
1862. 
May  26, 
1863. 
May  19, 
1864. 
Dec.  31, 
1862. 
July  5, 
1864. 

Branch  of  femoral  . 

Nov.  19, 
1862. 

May  31, 
1864. 
July  23, 
1864. 
Oct.  28, 
1864. 
May  15, 
1864. 

Sept.  23, 
1864. 
July  16, 
1864. 
July  27, 
1864. 

May  10, 
1864. 
Nov.  21, 
1864. 

May  31, 
1864. 

July  13, 
1863. 

July  12, 
1864. 
April  14, 
1865. 
Sept.  27, 
1862. 
July  9, 
1865. 
Juno  12, 
1864. 
Jan.  9, 
1863. 
April  5, 
1865. 
June  8, 
1864. 
May  28, 
1864. 

Oct.    3, 

1862. 
Dec.  25, 
1862. 
May  26, 
1863. 
May  22, 
1864. 
Dec.  31, 
1862. 
July  5, 
18u4. 
Oct.    2, 

In  Scarpa's  triangle. 
Surg.  H.  S.  Hewit, 
U.  S.  V. 
Bothends  in  wound  ; 
haem.  recurred. 
One  oud  in  wound  .  . 

On  face  of  stump  ... 

In  Scarpa's  triangle. 
Surg.  H.  W.  Duca- 
chet,  U.  S.  V. 
Femoral  ligated  

In  continuity.    A.  A. 
Surg.  J.  C.  Morton. 
In  continuity.   Surg. 
G.F.Frenc'h.TJ.S.V. 
Both  ends  in  wound. 
Surg.  J.  G.  Keenon, 
U.  S.  V. 
Femoral  ligated    on 
field. 
Femoral,  ou  face  of 
stump. 

Femoral,  on  face  of 
stump. 

Femoral  ligated    in 
continuity. 

In  Scarpa's  triangle. 

Femoral,  on  face  of 
stump. 
Femoral,  in  continu 
ity. 
In  cont.    A.  A.  Surg. 
J.  Morris. 
Femoral,  on  face  of 
stump. 
In  Scarpa's  triangle 

Femoral,  just  below 
Poupart's  ligament. 
Femoral,  in  continu 
ity. 
Femoral,  in  Scarpa's 
triangle.  A.  A.  Surg. 
H.  C.  May. 
Femoral,  in  Scarpa's 
triangle. 
On  face  of  stump  .  . 

On  face  of  stuiup  .  . 

Femoral  above  pro- 
fuuda,  in  cont. 
Femoral,  iii  Scarpa's 
triangle. 
Femoral,  above  pro- 
f  umla.  iu  wound. 
Femoral  ligaled    ... 

Died  Nov.  19,  1862. 

Died  June  8,  1864. 

Died  of  gangr.  July 
27,  1864. 
Died  Oct.  28,  1864. 

Died  May  16,  1864. 

Died  Feb.  14,  1863. 
Died  Sept.  26,  1864. 

Died  July  21,   1864; 
gangrene. 
July  27,  amp.    Died 
Augusts,  1864;  py 
aemia. 
Died  May  22,  1864. 

Hsem.  Nov.  27,  28,  30. 
Died  Dec.  1,  1864. 

Died  May  31,  1864. 
Died  Sept.  23,  1863. 

Died  July  28,  1864; 
pyaemia. 
Died  April  15,  1865. 

Died  Sept  27,  1862. 

Died  July  14,   1865; 
haemorrhage. 
Hffim.  rec.  June  16. 
Died  June  23,  1864 
Died  Jan.    12,    1863. 
Spec.  652. 
Died  April  8,  1865. 

Died  June  8,  1864. 
Died  Juue  2,  1864. 

Died  Oct.  5,  1862. 
Died  Dec.  25,  1862. 
Died  June  2,  1863. 
Died  May  26,  1864. 

Died    Jan.    5,    1863. 
Spec.  982,  A.  M.  M. 
Died  Sept.  25,  1864. 

Died  Oct.  6,  1864. 

Died  June  13,   1864. 
(Vein  also  tied.) 

Died  Sept.  26,  1864. 

Died  June  12,  1864; 
pyaemia. 

Died  May  4,  1802. 
Died  May  8,  1864. 

Died  June  25,  1864; 
pyaimia. 
Died  July  13,  1863. 

Died  Aug.22,  1864. 

Died  June  26,  1865. 
Died  June  14,  1862. 

Amp.  thigh  Dec.  23. 
Died  Jan.  12,  1863. 

Died  June  4,  1864. 

Femoral,  32  oz  
Br'ch  of  profunda 

Femoral  

Traumatic   aneur 
ism. 

Femoral 

From  stump  

Femoral  ;  lig.  muse, 
branch  May  24. 

Femoral  artery  
Femoral  artery  .  . 
Femoral  artery  
From  stump  

Femoral;  haem.  re 
curred. 
Prof  'da;  prof,  lig- 
ated. 
Profunda  

Profunda  

From  .stump  
From  stump  
From  stump  

Profunda;    prof, 
lig'din  continuity. 
From  stump  

Femoral  artery  

June  12, 
1864. 

Sept.  25, 
1864. 

May  25, 
1864. 

May   1, 

1862. 
Aug.14, 
25,1863. 
May  20, 
1864. 
July  12, 
13,  ''63. 
Aug.22, 
1864. 

Jan.  20, 
1865. 
June  14, 
1862. 
Dec.  20, 
1862. 

May  31, 
1864. 

Femoral    

1864. 

June  12, 
1864. 

Sept,  25, 
1864. 

June  2, 
1864. 

May   1, 

1862. 
Aug.25, 
18S3. 
May  28, 
1864. 
July  13, 
1863. 
Aug.22, 
1861. 

Jan.  20, 
1865. 
June  14, 
1862. 
Dec.  20, 
1862. 

May  31, 

1864. 

Both  ends  iu  wound. 
Medical    Inspector 
P.  Pineo,  U.  S.  A. 
Femoral,  in  continu 
ity.     A.  A.  Surg.  J. 
C.  Morton. 
On  face   of  stump  ; 
relig.     in    Scarpa's 
triangle.     Surg.  T. 
R.  Crosby,  U.  S.  V. 
Femoral,  in  continu 
ity. 
Femoral,  in  continu 
ity;  rearnp. 
Femoral,  iu  continu 
ity. 
Femoral,  in  continu 
ity. 
Femoral,  below  Pou- 
part'slig.  A.  Sursr. 
A.  Delany,  U.  S.  V. 
Both  ends  in  continu 
ity. 
Femoral,  in  continu 
ity. 
Femoral,  in  continu 
ity.      Surg.    J.    P. 
Prince,  36th  Mass. 
In  continuity;    suc 
cessive  ligations. 

Femoral  artery  .  . 

Femoral    

From   stump  ;    re 
curred  May  28. 
Profunda  

Femoral  artery  

Femoral    

CHAP.  XII.) 


LTGATTONS    OF    THE    FEMORAL    ARTERY. 


795 


No. 

NAME, 

AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROIIABLK  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OK 
Ol'F-RA- 
TION". 

OPERATION,  OPERA 
TOR. 

RESULT. 

233 

224 

235 
236 
237 

238 
23!) 
240 
241 
242 
243 
244 

245 
246 
247 
248 

249 
2oO 

251 

252 
253 
254 
255 
256 
257 

258 

259 
•260 
261 
262 
203 
264 
•J05 
2C6 

267 
268 

-.09 

•270 
271 
•272 
273 
274 

Kuecht,  M.,  Pt.,  K, 

July  10, 
1863. 

June  16, 
1864. 

Mar.  31, 
1865. 
Julv  10, 

Fraet,  of  left  femur, 
popliteal      artery 
wounded. 
Left  knee  ;  amputa 
tion  at  knee  joint. 

Right  leg  ;   amputa 
tion  at  knee  joint. 
Right  thigh;   prim, 
amputation. 
Left    thigh,    middle 
third. 

Head  of  tibia  ;  Mar.  2, 
1863,  amp.  thigh. 
Right  thigh;  ampu 
tation. 
Right  leg,  inner  side 

Left  thigh,  femoral 
artery  cut. 
Left  leg;  amputation 
of  leg. 
Left  knee  j'nt;  Sept. 
26,  amp.  thigh. 
Flesh,    lower   third 
right  thigh. 

Fracture  right  ankle 

Julv  28, 
1863. 

Julv  3, 
4,  '64. 

June  18, 
1865. 
July  21, 
1863. 
Oct.  9, 
1864. 

Mar.  4, 
1863. 
Mav25, 
1864. 
April  12, 
13,  '65. 
Aug.  11, 
1864. 
Julv  18, 
20,  ''63. 
Oct.  1, 
1864. 

Aug.  17, 
18,  '63. 

Popliteal  ;      hsem. 
Aug.  3,  popliteal 
lig.;  rec.  5,  9,  10. 
Femoral 

Aug.10, 
1863. 

July  4, 
1864. 

June  18, 
1865. 
Julv  21. 
1863. 
Oct.  9, 
1864. 

Mar.  4, 
1863. 
Mav  26, 
1864. 
April  13, 
1865. 
Aug.  11, 
1864. 
Julv21, 
1863. 
Oct.  1, 
1864. 
April  25, 
1865. 

Aug.  18, 
1863. 

Femoral    above    an- 
astomotica  magua. 

On    face   of  stump. 
Surg.  R.  B.  Bonte- 
con,  CT.  S.  V. 
On  face  of  stump  ;  re- 
lig.  June  23. 
On  face  of  stump.  .  .  . 

Both  ends  in  wound  . 

On  face  of  stump  .... 
Ligation  femoral  

Femoral,  in  Scarpa's 
triangle. 
Femoral.  A.  A.  Surg. 
J.  M.  Browne. 
Femoral,  in  contiuu 
ity. 
On  face  of  stump  

Artery  and  vein.    A. 
A.  Surg.  J.  Morris. 

In  cent.   A.Surg."W 
Thomson,  U.  S.  A. 

Died  Aug.  12,  1863. 
Died  July  12,  1864. 

Died  June  24,  1865; 
gangrene. 
Ha3m.  rec.   Died  Oct. 
22,  1863. 
Died   Oct.    '28,    1864; 
pyaemia. 

Died  March  6,  186!. 
Died  May  26,  1864. 
Died  April  15,  1865. 
Died  August  11,  1864. 
Died  August  20,  186.1 
Died  October  4,  1864. 

May    6,    lig.     above 
profuu.     Died  May 
7,1805;  exhaustion. 
Died  Aug.   19,  1863; 
pynsmia. 
Died  May  20,  1862. 

Died    Dec.   5,    1864; 
haemorrhage. 
Died  March  31,  1863. 
Specs.  748,  3818,  3983. 

Died  Jan.    31,  1863; 
rec.  haemorrhage. 
Died  May  26,  1865. 

Died  Aug.    23,  1864; 
pyaemia.  Spec.  3592, 
A.  M.  M. 
Died    December  22, 
1862. 
Died  June   7,    1865; 
exhaustion. 
Hsem.      recurred. 
Died  Nov.  13.  1864. 
Died  July  8,  1863. 

Died  Jan  3,  '63;  gan 
grene. 
Died  Oct.  16,  1862. 

Htcui.      recurred. 
Died  Sept.  17,  1864; 
hasm. 
Died  Oct.  28,  1862;  ex 
haustion. 
Died  Sept.  28,  1862. 

Hajm  recur'd.   Died 
Oct.  9,'62;exha'st'n. 
Died  Sept.  28,  1862. 

Died  Oct.  27,  1864. 
Died  Oct.  28,  1862. 

Hsem.      recurred. 
Died  Sept.  12,  1862. 
Died  May  29,  '65;  ex 
haustion. 

Died  May  15,  1864  ;  ex 
haustion. 
Died  Juno   6,    1863; 
pyaemia. 

Haem.     recurred. 
Died  Juno  10,  1863. 
Died  Feb.  17,  1864. 

Died  May  2?.,  1863. 
Died  June  19,  1862. 

Died  July  25,  1864; 
gangrene. 
Died  July  2,  1864. 

4th  Ohio  Cavalry. 

Koch,  J.  R.,  Serg't, 
F,  69th  Pa.,  age  22. 

Krowlow,  H.,Pt.,  A, 
With  N.  Y.,  ago  18 
Lackev    M.,  Pt.   K 

Femoral 

6th  Vermont. 
Landon,   L.,  Lieut., 
H,  6th  Col.  Troops, 
age  20. 
Lane,  W.,  Pt.,  I,  1st 
East  Tcmi.,  age  20. 
Lautair,  S.  P.,Pt.,  A, 

1863. 
Sept.  29, 
1804. 

Dec.  31, 

1862. 
May  5, 
1864. 
April  2, 
1865. 
July  20, 
1864. 
July   1, 
1863. 
Sept,  19, 
1864. 
April  6, 
1865. 

Aug.  1, 
1863. 
May  5, 
1862. 
Nov.  30, 
1864. 
Sept.  17, 
1862. 

Dec.  14, 
1862. 
April  2, 
1865. 

July  30, 
1864. 

Dec.  13, 
1862. 
April  9, 
1865. 
Oct.     1, 
1864. 
May  23, 
1863. 
Dec.  13, 
1862. 
Sept,  17, 
1862. 

Aug.19, 
1864. 

Sept,  14, 
1862. 
Sept.  14, 
1862. 
Sept.  14, 
1862. 
Aug.30, 
1862. 
Sept.  17, 
1864. 
Sept,14, 
1862. 
Aug.29, 
1862. 
May    3, 
1865. 

Apr.  23, 
1864. 
May    3, 
1803. 

May  18, 
1863. 
Jan.  16, 
1864. 
May    3, 
1863. 
June  1, 
18S2. 
June  17, 
1864. 
May  19, 
1864. 

Aneurismal  tumor  . 
Femoral 

From  stump  

Posterior  tibial  ar 
tery. 
Femoral 

37th  Mass.,  a<re  40. 
Lang,  W.  M.,  Pt,,  C, 
40;  h  N.  T..  age  34. 
Lapp,  C.,  Pt.,  I,  22d 
Wisconsin,  age  21. 
LaraV>ee,  J.,  Pt.,  E, 
75th  Ohio,  age  19. 
Liiwson,   L.  B.,  Pt., 
F,  128th  New  York. 
Layne,  J.  H.,  Pt.,  B, 
19th  Virginia,   age 
18. 
Lazier,  W.,  Pt.,  M, 
5th  Cav.,  age  25. 
Leake,W.G.,Pt,,K. 
6th  New  Jersey. 
Leline,  G.,  Serg't,  C, 
8th  Mich.,  age  27. 
Liuii,  H.,  Pt..  A,  6th 
Pennsylvania    Re 
serves,  age  25. 
Loetsch,  H.,  Pt..  G, 
9th  N.  J.,  age  56. 
Loutz,    J.,    Pt.,    D, 
94th     New     York, 
age  17. 
Lund,  E.  F.,  Pt.,  C, 
4ih     New     Hamp 
shire,  age  20. 
Lutz,  J.,  Pt.,  B,  1st 
Pa.  R.,  age  17. 
Lvun,J.  B.,  83d  Ohio, 
age  19. 
McCarthy.  J.,Corp'l, 
E,  76thN.  Y.,age31. 
Me  Daniel  If.,  Pi.,  K, 
48th  Virginia. 
McGuire.  T.,  Pt.,  D, 
53d  Perm.,  age  19. 
McMahon,  J.,Pt.,  A, 
61st  New  York. 

McReynolds,  J.,  Cor 
poral,  9th  Co.,  60th 
Ohio,  age  20. 
Madden,   C.  B.,  Pt., 
3dS.  C.  Bat.,  age  17. 
Martin,  ,  C,  16th 
Ga. 
Mask.  M.,  Pt.,  A,  23d 
N.  C..  age  24. 
Mason,  J.  W.,  Pt.,  I, 
12th  N.  Y.,  age  21. 
Maxlielil.  D.,  Pt.,  E, 
!)7i  hN.  Y.,  age  20. 
Mellott.F.  L.,  Pt,,K, 
l'2lh  Penn. 
Meranville.R.E.,  Cor 
poral,  F,  2d  N.  Y.  C. 

Posterior  tibial  ar 
tery. 
From  stump 

Femoral  vein  
Tibial 

Flesh,    right   thigh, 
femoral  artery. 
Left  fibula;  Dec.  3, 
exc.;  4th,  amp.;  Jan. 
15,  amp.  thigh. 
Fracture  right  knee  ; 
14th,  amp.  thigh. 
Fracture  lower  third 
left  femur;  amp. 

Flesh,     left    thigh, 
right  knee  joint. 

Fracture  left  femur; 
20th,  amp.  thigh. 
Fracture  righttibia, 
knee  ;  May  30,  amp. 
Neck  of  right  femur 

Fractured  leg  ;  June 
9,  amputation  leg. 
Fractured    left  leg, 
upper  third. 
Fractured  left  knee 
ioint;  Sept.,  ampu 
tation  thigh. 
Both  thi<Ths 

Dec.  5, 
1864. 
Feb.  4, 
1863. 

Jan.  17, 
1863. 
May  19, 
1865. 

Aug.  12, 
1864. 

Dec.  22, 
1862. 
June  5, 
1865. 
Nov.   5, 
1864. 
June  27, 
1863. 
Dec.  31, 
1862. 
Oct.    3, 
1862. 

Sept.  5, 
1864. 

Oct.  15 

In  cont.    A.  A.  Surg. 
S.T.Williams. 

Jan.  14, 
17,  '63. 

In  cont.    Snrg.C.A. 
Cowgill,  U.  S.  V. 
On  stump;   May  25, 
relig.  in  cout.  A.  A. 
Surg.  H.M.  Bellows. 
Both  ends  in  wound. 
A.  Surg.  W.  Thom 
son,  U.  S.  A. 
On  face  of  stump  

Aug.  12, 
1864. 

Dec.  22, 
1862. 
June  5, 
1865. 
Nov.   5, 
1864. 

Femoral 

Femoral 

Profunda 

In  continuity,  below 
Poupart's  lig. 
In  continuity 

Dec.  31, 
1862. 

Post,  tihial 

In  continuity  ;     two 
ligatures;  excision. 
Ligation  

In  continuity.     A.  A. 
Snrg.  H.  B.'  Mabeu  ; 
Sept,  11,  relig. 
In  continuity  

Fract'd  right  knee; 
Oct.  2,  amputation. 
Upper  part  of  thigh. 

Right  thigh;    Sept. 
20,  amputation. 
Shot  wound  

Head  left  tibia  ;  Oct. 
22,  amputat'n  thigh. 
Fractured  left  knee 
joint. 
Thigh  ;  primary  am 
putation. 
Left  knee  joint  ;  4th, 
amputation. 

Left  thigh  ;  Apr.  29, 
amputation. 
Fract'd  cond.   right 
femur  ;  14th,  ampu 
tation. 
Right  thigh,  profun- 
da  artery. 
Left  femoral  artery. 

Right  knee  joint;  14, 
amputation  thigh. 
Fract'd  left   femur; 
June  9,  amp.  thigh. 
Fractured    left  leg  ; 
17,  amputation  leg. 
Fracture  right  leg  ; 
primary     amputa 
tion  thigh. 

Oct.   15, 
1862. 

Femoral  

1862. 
Sept.  28, 
1862. 
Oct.     6 

In  wound,  both  ends 
On  face  of  stump   .  . 

Oct.     6, 

1862. 

Oct.  25, 

1864. 

Femoral  

1862. 

Oct.  25, 
1864. 
Sept.  16, 
1862. 
Sept.  7, 
1862. 
May    4, 
1865. 

Mav  15, 
1864. 

May  28, 
1863. 

June  3, 
1863. 

Ligation  of  femoral  .  . 
In  continuity  

In  continuity,  to  pro- 
vent  inflammation. 
In  continuity,  above 
profuuda. 
On  face  stump  ;  two 
muscular  branches 
also  tied. 
In  continuity,  Scar- 
pa's  space. 
In  continuity    

Sept.  5, 
6,  1862. 
May    4, 
1865. 

May  25, 
1863. 

June  3, 
1863. 
Feb.  7, 
1864. 
Mav  16, 
18,  186:5. 
June  15, 
1862. 
Julv  20, 
1864. 
June  12, 
1864. 

Meiriott,  E.,  Pt.,  D, 
6th   Mo    C.   S.   M., 
ago  23. 
Metzer,W.,  Serg't,  E, 
1st  La.,  ago  26. 
Miller,A.,l't,,E,95th 
Penn.,  age  18. 

Miller,  G.  H.,  Pt.,  F, 
3d  Iowa,  age  23. 
Mills,  J.,  Pt.,  D,  4th 
Missouri  Cav. 
Moan,  F.  H.,  Corp'l, 
F,  6th  Me.,  age  22. 
Mohre,    A.,    Pt.,    K, 
104th  Penn. 
Monaghan,M.,Pt.,C, 
2d  Mich.,  age  43. 
Morris,   W.  G.,  Pt., 

Femoral  

In  continuity,  above 
profunda. 
Ligation  

Stump  
Tibial.   

May  18, 
1863. 
June  15, 
1862. 
Julv  20, 
1864. 
June  29, 
1864. 

In  continuity  
Ligation  

In  continuity.   A.  A. 
Surg.W.  H.  Ensign. 
On  face  of  stump  

E,  4th  Alabama, 
age  24. 

796 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.   XII. 


No. 

NAME, 
AGK,  A-VD  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY 

DATE 

OF 

HJEMOR- 

UHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

275 

270 

277 
278 
279 
280 

281 
282 
283 

284 

2iO> 

286 

287 

288 

289 

290 

291 
292 
293 
294 

295 
296 

297 
298 
299 
300 
301 
302 
303 
304 
305 
306 
307 
308 

309 
310 
311 

312 
313 

314 

Moscrip,      W.     S., 
Serg't,  19th   Wis 
consin,  agi<  33. 
Mullin,  F.   U.,  Pt,, 
F,  3d  Penn.,  age  17. 
Muiphv,  I).,  Pt.,  F, 
62(1  Penn.,  age  18. 
Ml/era,  0.  K.,  Pt,  E, 
Cth  Va.  Cavalry. 
O'Keefo.    J.,    M'aj., 
2dN.  Y.  C.,  age  24. 
Osgood,  T.  J.,  Pt., 
A,  39th  111.,  ago  20. 

Pack,  J.  R.,  Pt,  D, 
39th  N  C  ,  age  17. 

Paddock,  D.  G.,Pt, 
G,  83d  Penn.,  age 
21). 
Padcn,    W.,  Corp'l, 
G,  10th  Penn.  He- 
serves,  age  22. 
Parker,  J.,  Corp'l,  II, 
58th  Mass.,  age  'AS. 
1  Parker,  N.,  Corp'l, 
B,  51at  (?) 

Parks,   J.,    Pt,    E, 

91st  Penu.,ase38. 
Parrv,  T.,  Serg't,  D, 
16th  Mich.,  age  30. 

Payne,  D.,Pt,H,  2d 
Conn.  H.  A.,  age  25. 
Payne,  G.   II.,  Pt,, 
K,64th  New  York, 
age  18. 
Pencil,    E.,   Pt,  H, 
93d  Pennsylvania. 

"  Peters,  "W.  C.,  Pt., 
C,  68th  Penn. 
Pope,  P.  P.,  Pt.,  M, 
67th  Ohio,  ago  22. 
Pope.  W.,  Pt,  I,  2d 
N.  Y.  A.,  age  19. 
Pulheiiius,  J.,  Pt.,  E. 
1st  Mich.,  age  20. 

Rairdon,  "W.,  Pt.,  I, 
40th  Ind.,age,35. 
Rapp,  D.,  Pt.,K,  7th 
Indiana,  age  20. 

Kayncr,   G.    W.,  Pt., 
G,  12th  Alabama. 
Reed,.!.,  Pt.,C,  15th 
W.  Va.,  age  20. 
Keed,  J.  P.,  Pt,,  B, 
L9th  Ala  .ago  20. 
Reed,  W.  H.,  Pt.,  H, 
10th  Vt.ageSl. 
Reigle,   J.,    Pt,    A, 
88th  Penn.,  ago  23. 
Riley,  E.,  Pt.,G,  98th 
Illinois. 
Ringer,   O,   Pt.,   C, 
60th  Ohio,  ago  21. 
Roberts,  J.,    Serg't, 
9th  W.  Va.,ago31. 
Roberts,  A.,  Pt,   I, 
127th  111.,  age  20. 
Robinson,  J.,Pt,  D, 
12th  Conn.,  ago  34. 
Robinson,  S.,  Sorg't, 
3d  N.  U.,  age  23. 
Rodgors.   S.  J.,  Pt.,* 
A,  2d  Mich.,  age  21. 

Roe,  J.,  Pt.,  B,  42d 

New  York. 
Root,  .1.  L.,  Pt,  H, 
77th  New  York. 
Rope,  S.,  Pt,  A,  140th 
Penii.,  age  43. 

RoseniVlt,  N.,  Serg't, 
D,  26th  1'a.,  ago  22. 
Ruhlinz,  F.  J.,  S'g't, 
E,  llJth  New  York, 
ago  29. 
Sager,"W.,  Serg't,  E., 
188th  N.  Y.,  age  19. 

Aug.22, 
1864. 

Nov  14, 

1863. 
Dec.  13, 
1862. 

1864. 
Apr.    1, 
1865. 
Aug.  16, 
1864. 

Apr.    8, 

18G5. 

May    8, 
1864. 

May  23, 
1864. 

June  3, 
1804. 
May  16, 
1864. 

June  18, 
J864. 
Sept,  30, 
1864. 

Oct.   19, 

1864. 
Oct.   12, 
1864. 

May  31, 

1862. 

July    2, 
1863. 
May    9, 
1864. 
June   3, 
1864. 
Dec.  13, 
1862. 

June  27, 
1864. 
Nov.  30, 
1863. 

Apr.  6, 
1865. 
June  18, 
1864. 
Apr.  6, 
1862. 
Oct.  19, 
1804. 
Mav  8, 
Ifc64. 
June  25, 
1863. 
July  6, 
1864. 
July  20. 
1864. 
Mav  19, 
1863. 
Oct.  19, 
1804. 
May  12, 
1864. 
Juno  17, 
1864. 

Sept.  17, 
1862. 
Oct.  19, 
1864. 
June  16, 
1864. 

July  2, 
1863. 
June  1, 
1864. 

Apr.  1, 
1865. 

Flesh,  middle  third 
left  thigh. 

Muscles  of  r't  thigh, 
severing  femoral. 
Right       knee-joint; 
int.  amp.  thigh. 
Left  knee  joint;  amp. 
thigh. 
Flesh,    right    popli 
teal  space. 
Fracture  head  right 
tibia;  Sept.  15,  am 
putation  thigh. 
Flesh,   right    thigh, 
lower  third,  injur 
ing  artery. 
Fracture  right  kneo 
j't  ;  16th,  amp.  ;  lig. 
muscular  branches. 
Popliteal  space,  right 
thigh. 

Fracture      middle 
third  left  femur. 
Fracture  left  tibia; 
May  29,  lig.   post, 
tibial. 
Fracture,  and  amp. 
up.  third  loft  leg. 
Flesh,  right  thigh  .  . 

Left  knee  jt;  Nov.  2, 
amputation  thigh. 
Fracture  lei't  fibula; 
21st,  lig.  popliteal. 

Femoral  artery  

Aug.  27, 
1864. 

Jan.    4, 
1863. 

Apr.    1, 

1865. 
Sept.  23, 
1864. 

Apr.  20, 
27,  1865. 

May  23, 

1864. 

May  29, 
31,  1864. 

June  —  , 
1864. 
June  1, 
1864. 

June  30, 
1864. 
Nov.  19, 
1864. 

Nov.  13, 
1864. 
Oct.   28, 
1864. 

Femoral 

Aug.  27, 
1864. 

Nov.  14, 
1863. 
Jan.     4, 
1863. 
Oct.     8, 
1864. 
Apr.    1, 
1865. 
Sept.  23, 
1864. 

Apr.  27, 
1865. 

May  24, 
1864. 

May  31, 
1864. 

June  27, 
1864. 
Juno  1, 
1864. 

June  30, 
1864. 
Nov.  19, 
1864. 

Nov.  13, 
1864. 
Oct.   29, 
1864. 

June  16, 
1862. 

July  15, 
1863. 
May  21, 
1864. 
June  20, 
1864. 
Dec.  30, 
1862. 

July  23, 
1864. 
Dec.  9, 
1863. 

Apr.  27, 
1865. 
NoV.  1, 
1864. 
May  29, 
1862. 
Oct.  24, 
1864. 
Juno  12, 
1864. 
July  8, 
1863. 
Aug.  22, 
1864. 
July  29, 
1864. 
June  5, 
1863. 
Nov.  11, 
1864. 
May  29, 
1864. 
July  26, 
1864. 

Oct.  30, 
1862. 
Oct.  19, 
1864. 
July  26, 
1864. 

Aug.  14, 
1863. 
Juno  14, 
1864. 

Apr.  22, 
1865. 

In  continuity,  Scar- 
pa's  triangle. 

Ligatiou  
On  face  of  stump  .... 
Ligatiou 

Sept,  8,  h»m.    Died 
Sept.  14,  1864;   ex 
haustion. 
Died  Nov.  14,  1863; 
nervous  depression. 
Died  January  4,  1863  ; 
exhaustion. 
Oct.  9,  ham.     Died 
October  10,  1864. 
Died  May  31,  1865. 

Died  September  28, 
1864  ;  exhaustion. 

Died  April  27,  1865  ; 
congestive  chill. 

Died  May  24,  1864; 
exhaustion. 

Gangrene  ;    amputa 
tion  leg.  Died  Juno 
26,  1864. 
Died  Jul>  12,  1864. 

Ha5m.  ;   amputation. 
Died  June  2,  1864. 

Died  July  12,  1864. 

Died  November  21, 
1864;  exhaustion. 

Died  Nov.  17,  1864. 

October  29,  amputa 
tion.    Died  Dec.  4, 
1864  ;  exhaustion. 
Died    July  5,    1802; 
pyaemia. 

Died  July  13,  1863. 

Died    May  22,  1864; 
exhaustion. 
Died  June  24,  1864. 

Died  Jan.   15,   1863; 
nervous  prostration. 

Died  July  23,  1864; 
exhaustion. 
Femoral  vein  also  li- 
gated.     Died  Dec. 
13,  1863  ;  gangrene. 
Died    May   6,    1865  ; 
exhaustion. 
Died  Nov.  14,  1864  ; 
exhaustion. 
Died  June  30,  1862. 

Died  Nov.  21,  1864  ; 
pyaemia. 
24th,  religatfd.    Died 
.1  uno  24,  1864. 
Died  July  11,  1864. 

23d,  hseiu.   Died  Aug. 
25,  1864. 
Aug.  4,  haem.     Died 
August  24,  1864. 
Died  Juno  7,  1863. 

Died  Nov.  23,  1864. 

June  1,  hasin.     Died 
June  2,  1864;  htem. 
Died  July  30,  1864  ; 

lliBIU. 

Died    Oct.   30,   1862; 
exhaustion. 
Died  Nov.  1,  1864. 

Died  Aug.  10,  1864  ; 
exhaustion. 

Died  Oct.  2,  1863. 

Died   July  8,   1864; 
gangrene. 

Died  April  29,  1865; 
pyaemia. 

Femoral    .  .  . 

Femoral  
Femoral    

"Within        adductor 
mag.  ;  i  elig.  in  cont. 
Ligaled   by    A.    A. 
Surg.  J.  C.  Morton. 

In  cont,  in  Scarpa's 
space.   A.  A.  Surg. 
H.  B.  Cole. 
In  continuity,  below 
Poupart's  ligament. 

In  continuity.    Surg. 
G.  L.  Pancoast,  U. 
S.V. 
Ligation  

In  continuity  whoro 
it  passes  under  sar- 
torious. 
In    continuity  ;    re- 
ligated  July  6. 
Both  ends  in  wound. 
A.  A.Sirrg.  G.  R.B. 
Robinson. 
On  face  of  stump  

In    continuity,    low 
down. 

In   continuity,   four 
inches  below  Pou 
part's  ligament. 
Ligation  

Femoral 

Popliteal  

Sloughing  

Stump  

Femoral  
Femoral  

Flesh,     left     thigh, 
lower  third. 
Flesh,  right  thigh... 

Flesh,    lower   third 
left  thigh. 
Fract.  tib.  ant.  tibial 
artery;  26th,  hrein.; 
amp.  thigh. 
Fracture  right  foot  ; 
July  9,  amp.  thigh. 
Flesh,     left     thigh, 
fom.  art.  and  vein. 

Fracture  left  femur; 
April  17th,  amp. 
Left  kneoj'nt;  20th, 
amp.  thigh. 
Right  thigh  

Right  knee  j'nt;  21st, 
amp.  thigh. 
Right    knee  ;    28th, 
amp.  thigh. 
Flesh,  both  thighs. 

Right  thigh  ;  flesh. 
Upper  third  femur 

July  15, 
1863. 
May  21, 
1864. 
June  20, 
1864. 
Dec.  30, 
1862. 

July  23, 
1864. 
Dec.  9, 
1863. 

Apr.  27, 
1865. 
Nor.  1, 
1864. 
May  29, 
1862. 
Oct.  24, 
1864. 
June  8, 
12,  1864. 
July  6, 
8,  1863. 
Aug.  22, 
1864. 
July  29 

Femoral  
Femoral  
Femoral 

One  end  in  wound  .  . 
On  face  of  stump.  .  . 

Femoral 

Both  ends  in  wound. 
A.  Surg.  W.  Thom 
son,  U.  S.  A. 
On  face  of  stump.  .  .  . 

On  face  of  stump; 
Nov.  8,  hsem.;  amp. 
Ligation  

Ligation  ;   hceni.    re 
cur.  Oct.  29. 
In  cont.;  h;em.  June 
16,  24. 
In    continuity,     oue 
end. 
In  cont  ,  one  end.   A. 
A.  Surg.  J.  F.  Holt, 
Ligation.    Surg.  J.  B. 
Lewis,  U.  S.  V. 
In  continuity,  upper 
third. 
On  face  of  stump  .  . 

In    cont.  J    inch  be 
low  Poupart's  lig. 
In  cont,  both  ends. 
A   A.  Surg.  O    W. 
Peck. 
Ligation      

Femoral 

Femoral     .  .  . 

Flesh,  left  popliteal 
space. 
Right    knee    joint.  ; 
Jsov.  4,  amp. 
Left  hip  and  root  of 
penis. 
Mid.  right  thigh  

1864. 
June  3, 
1863. 
Nov.  11, 
1864. 
May  28, 
29,  1864. 

Popliteal  

Femoral  
Profunda,  or  pudii; 
Aneurism   

Fract.  low.  left  fern.; 
October  27,  amp. 
Fracture  left  femur 

Frac.  left  leg  ;  17th, 
amp.  thigh. 

Head  of  flbala  ;  19th, 
amp. 
Left  tibia  knee  joint  ; 
llth,  amp.  thigh. 

Flesh,  middle,  right 
thigh. 

Oct.  29, 
30,  1862. 

Ligatiou  

July  20, 
1864. 

Aug.  13, 
14,  1863. 
Juno  1  1  , 

14,  1864. 

Apr.  15, 

20.  21, 
22,  1865. 

In  cont.,  in  Scarpa's 
space.     Surg.  II.  B. 
Bontecoii,  U.  S.  V. 
On  face  of  stump  .  . 

On   face  of   stump  ; 
June  17,  religation 
in  continuity. 
Both   ends,  in   cout. 
A.  Surg.W.  F.  Nor- 
ris,  U.  S.  A. 

Femoral     

Mus.  branch    and 
femoral. 

Femoral  

344. 


'Hoi.LOWAY  (J.  M.),  Consent  live  and  Indeterminate  Ilcemorrhage  from  Large  Arteries,  etc.,  in  American  Jour.  Med.  Sci.,  1865,  Vol.  L.  p. 
See  also  U.  S.  Sanitary  Commission  Memoirs,  Surg.  Vol.  I,  p.  188. 


CHAP.  XII.) 


LIQATIONS    OF    THE    FEMORAL    ARTERY. 


797 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

XATUBE  OF  INJURY. 

DATE 

OP 

HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 

HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

315 

Salzm.in,  C.,  Pt.,  K, 

Dec.  27, 

Tract,  left  leg;  Jan. 

Jan.  10, 

Femoral  branch  .  .  . 

Jan.  12, 

In  continuity  

Died  Jan  13  1866 

310 

2(1  Inf.,  age  31. 
Scanlan    P.    Pt.,  G 

1865. 
Dec.  14, 

3,  1866,  amp.  thigh. 
Lodged   in  r't  knee 

12,  1866. 
Jan.  1, 

1866. 
Jan.  6 

317 

63d  X.  Y..  age  34. 
Scott  J    Pt.    F,  1st 

1862. 
May  31, 

joint  ;  26th,  amp.  th. 
Fract.  left  leg;  June 

6,  1863. 
Juno  16, 

1863. 

triangle. 

Jan.  14,  1803. 
Died  June  16    1864  • 

318 

X.  Y.  Diag,  age33. 
Scott  J.,  Pt.,  F  69th 

1864. 
July  24, 

1,  amp.  knee  joint. 
Injury   lower   third 

1864. 
Aug.  6, 

Femoral  

1864. 
Aug.  6 

Moseley,  U.  S.  V. 

collapse. 
Died  Au"    21    1864  • 

319 

X.  Y.,  age  30. 
1  Seever,  A.,  Serg't, 

1864. 
Sept.  1, 

left  thigh. 
Grazing  middle  left 

1864. 
Sept.  11, 

1864. 
Sept.  14 

H.  M.  Dean. 
Lig.   in  mid.  third 

pyaemia. 
Died  September  18 

320 

C,  16th  Illinois. 
Self  I    Pt.  H    llth 

1864. 

femur. 
Upper  third  thigh. 

14,  1864. 
July  9 

1864. 
July  11 

Surg.   E.    Batwell, 
14th  Michigan. 

1864. 
Died  July  11    1862- 

T>1 

Alabama. 
Sexton,  J.,  Pt.,  A,  4th 

1862. 
July  9, 

Fracture  right  fern., 

11,  1862. 
Aug.  5, 

Femoral  

1862. 
Aug.  5, 

In  cont.  ;  An1'.  6  re- 

exhaustion. 
Died  August  6  1864- 

iw 

Va.  Cav.,  age  22. 
Shaffer,T.W.,Pt,,  F, 

1864. 
Sept.  2, 

middle  third. 
Frac.  left,  flesh  right 

1864. 

1864. 

lig.profunda.    A.  A. 
Surg.  J.  H.  Coover. 
Ligation  right  femo 

exhaustion. 
Died  Oct.  20  1863. 

323 

324 

22d  Mich. 
Sharpe,   A.,    Pt,  D, 
llth  Pa. 
2Sbaw     M.,   Pt.     I 

1863. 
June  21, 
1864. 
Sept.  1 

thigh. 
Flesh,  thigh  

Flesh,  right  thigh  . 



June  21, 
1864. 
Sept  12 

ral. 
Both  ends  in  wound  .  . 

Died  June  26,  1864. 

325 

17th  N.  Y. 
Shav  M.,  Pt.  B  61st 

1864. 
Sept.  17, 

Low.  third  r't  fern.  ; 

1864. 
Xov.  20 

Surg.   E.    Batwell, 
14th  Michigan. 

1864. 

326 

N.  Y.,ajre'JO. 
Sheafter  C.    Pt.    D 

1862. 
June  5, 

Xov.  15,  amp. 
Ri"ht  thigh,  inv.  fe 

1862. 
July  8 

1864.    Sp's  1096.  853. 
Died  July  21  1864 

3°7 

1st  X.  Y.  Cavalry. 
Shields,  P.  J.,  Pt.  D 

1864. 
Apr.  29 

moral  artery. 
Left  knee  jt.  ;  amp. 

June  1, 

1864. 

pa's.      Surg.   Bald 
win,  C.  S.  A. 

Died  June  19  1863 

T>8 

6th  Wis.,age20. 
Shock,  W.  Corp'l  K 

1863. 
Aug.  9, 

thigh  April  29. 
Head  left  tib.  ;  16th, 

1863. 
Aug.  29. 

1863. 
Aug.  29 

stump  ;  June  9,  lig. 
of  ext.  iliac. 

Died  Sept.  2    1864 

46th  Pa. 

1864. 

amp.  thigh. 

1864. 

1864. 

A.  Surg.  J.  B.  Brin- 

Spec.  50,  A.  M.  M. 

T'Q 

Sbugert  J.L  Corp'l 

Apr.  1, 

Flesh,    right    knee  ; 

May  24, 

Femoral 

May  24 

ton,  U.  S.  A. 
On  face  of  stump 

Died  May  25    1865- 

330 

I!,  49th  Pa.,  age  20. 
Simmons,  T.,  Pt.    F 

1865. 
Juno  18, 

May  20,  amp. 
Flesh,    upper   third 

1865. 
July  27, 

1865. 
July  27 

In  wound 

exhaustion. 
Died  Augusts  1864- 

331 

971  h  N.  Y.,  age  20. 
Singer,    L,    Pt.     F, 

1864. 
July  11, 

left  thigh. 
Fracture  left  femur; 

1864. 
July  17, 

Femoral      

1864. 
July  17 

In  continuity 

gangrene. 
Died  July  17  1863. 

332 

174th  X.  Y. 
Six,  I.,  Pt.,  K,  14th 

1863. 
July  20, 

13th,  amp. 
Fract.  1't  knee  joint  ; 

1863. 
Aug.  3, 

Femoral 

1863. 
Aug.  3 

On  face  of  stump 

DiedAugustI4  1864- 

,t;<3 

W.  Va.,age  16. 
Smith,  D.  U.,  Pt.,  I, 

1864. 
Xov.  25, 

July  26,  amp.  thigh. 
Fract.  right  femur  .  . 

1864. 

1864. 
On  field. 

Li  gated.    Surg.  J.  L. 

haemorrhage. 
Died  Dec.  5,  1863. 

334 

93d  Illinois. 
Smith,  J.  —  ,  D,  97tb 

1863. 
May  18, 

Flesh,   right   thigh, 

May  30, 

Circumflex 

June  2 

Prout,  26th  Illinois. 
In  cont.  |  inch  be 

Hfem.  recur'd.    Died 

335 

Pa.,  ago  22. 
Smith,  It.  W.,Lt..F. 
5th  Pa,  Res.,  age  24. 

1804. 
Aug.  30, 
1862. 

upper  third. 
Flesh,   thigh,    femo 
ral  artery. 

1864. 
Sept.  7, 
1862. 

Femoral  ;      aneur 
ism. 

1864. 
Sept,  7, 
1862. 

low  Ponpart's  lig. 
lu    continuity;    un 
successfully. 

June  5,  1864. 
Died   Sept.  7,  1862. 
Spec.  509,  A.  M.  M. 

Tlfi 

Smith,  W.  F.,  Maj., 

Oct.  27, 

Sev.  femoral  artery, 

Oct.  27, 

Femoral    

Oct.  27 

Both  ends  in  wound  ; 

Ha3tn.;    amp.     Died 

T17 

1st  Delaware. 
Stark,  O.  11.,  Serg't 

1864. 
Sept,  29, 

middle. 
Right  leg;  Dec.  25, 

1864. 
Jan.    3, 

Femoral  

1864. 
Jan.    3 

vein  also  tied. 
On  face  of  stump  .... 

Xov.  6,  1864. 
Died   Jan.  13,  1865; 

338 
T>Q 

11,  13th   N.  K.,  ago 
30. 
Steele,  G.  S.,  Pt.,  P, 
126th  N.  Y.,  age  23. 
Story,     F.,    Pt.,    E, 

1804. 

June  22, 
1864. 
July  23, 

amp.   leg;   Jan.    3, 
186.i,  amp.  knee. 
Fracture    left    knee 
j't;  23d,  amp.  thigh. 
Flesh,    in    Scarpa's 

1865. 

Julv23, 
1864. 
Sep.  8,9, 

Femoral  
Femoral  

1865. 

July  23, 
1864. 
Sept.  9 

On  face  of  stump.  .  . 
Both  ends  in  wound 

pyremia. 

Hsetn.  recur'd.    Died 
July29,  1864;  exh'n. 
Died*  Sept.  10,  1864. 

340 
341 
342 
341 

38th  Ohio,  ace  22. 
Stowell,   F.  M.,  Pt., 
D,70thN.Y.,agfi28. 
3£  ,  A.,  i>t.,  37th 
X.  C  ,  age  33. 
Tafr,  G.  K.,  Oapt.,  A, 
53d  Mass. 
Thorn,  H.  C.,  Pt.,  I, 

1864. 
July  2, 
1803. 
May   3, 
1863. 
June  14, 
1863. 
July20, 

space,  right. 
Fracture  left  tib.  and 
fib.;  31,  amp.  thigh. 
Lac.  femoral  artery, 
middle  third. 
Right  leg;  June  14, 
am  p.  leg. 
Flesh   wound    right 

1864. 
Aug.  1, 
1863. 
May  10, 
1863. 
June  21, 
1863. 
Aug.  7, 

Muscu.  branch  of 
femoral. 
Femoral  

Femoral  

1864. 
Aug.  1, 
1863. 
May  10, 
1863. 
June  21, 
1863. 
Aug.  7 

On  face  of  stump.  .  .  . 
Lig.  in  middle  third.  . 

Lig.;  bsem.  recurred  ; 

Died  Aug.  3,  1863. 
Died  June  5,  1863. 

Died   July   2,   1863; 
pyaemia. 
Died  Aug.  12,  1864. 

344 

14th  W.V.i.,  age  19. 
Thorp,  E.,  Pt.,  G,  1st 

1864. 
Aug.  4, 

thigh. 
Left  knee  j't;  Aug. 

1864. 
Aug.  9, 

• 

1804. 
Aug.  9 

amp.  thigh. 
In  cont.  below  prof. 

Died  Aug.  12,  '64.  Sp. 

34  ri 

Penn.  Art.,  age  20 
TompkLs,    G.,   Pt., 

1864. 
July  3, 

5th,  amputated. 
Tib.  and  fib.;  July  4, 

1864. 
July21, 



Femoral    

1864. 
July  21 

J.H.  Coover,  A.A.S. 
On  face  of  stump  .  .  . 

3929,  3960,  A.  M.  M. 
Died  July  26,  1863; 

346 

K,  1st   New   York 
Art.,  age  40. 
Tompkins    J.,    sub- 

1863. 
July  28, 

amp.  leg;  17th,  amp. 
thigh,  upper  third. 
Right  leg  

1863. 

1863. 
July99 

pyjemia. 
Died    Au«-.   4,  1863; 

347 
348 
3-1  9 

sti  nte,  atre  21. 
Tracy,  A.  L.,  Pt.,K, 
141st  Penn.,  aue  35. 
Truex,  J.  B.,  Corp., 
F..14thX.  J.,  age  22. 
Unknown  

1863. 
July  2, 
1803. 
May  31. 
18(54. 
Sept.  17, 

Right  knee  ;  July  5, 
amp.  thigh. 
Fracture  right  knee 
joint;  Juno  14,  amp. 
Femoral  artery    ... 

July  12, 
1863. 
June  19, 
1864. 
Sept,  22, 

Femoral    
Femoral  
Femoral 

1863. 
July  12, 
1803. 
June  19, 
1864. 
Sept.  22 

On  face  of  stump  .  .  . 
On  face  of  stump  .  . 
One  end  in  wound 

tetanus. 
Died  July  22,  1863  ; 
exhaustion. 
Died  June  20,  1864  ; 
pyiemia. 
Died  Sept.  22,  1862. 

350 
3..1 

352 
353 

Van  Wie,  S.,  Sen:., 
B,  C2d  Ohio,  age  25. 
Vcrmillve,  J.  C..  Pt., 
K,  124th  New  York, 
age  24. 
Wakeham,     J.     E.  . 
Corp.,  E,  19th  Vir 
ginia,  age  27. 
Walter,   V.,    Pt  ,  E, 

18C2. 
Aug.  16, 
1804. 
May  12, 
1864. 

Mar.  31, 
1865. 

May  10, 

Frac.  left  femur    

Left   leg;    May   20, 
amp.  thigh. 

Flesh,    inj.    femoral 
artery. 

Fract.   upper    third 

1862. 
Sept.  28, 
1864. 
May  25, 
1864. 

Apr.  15, 
21,25, 
1865. 
June  7, 

Femoral  
Femoral  

1862. 
Sept.  28, 
1864. 
May  25, 
1864. 

Apr.  10, 
25, 
1865. 

In  cont.    A.  A.  Surg. 
J.  C.  Mot  ton. 
On  face  of  stump  .... 

Scarpa's  space,  in 
cont.  A.  A.  Surg.  J. 

Morris.     Relig. 

Died  Sept.  29,  1864; 
exhaustion. 
Died   May  28,  1864; 
exhaustion. 

Hseiu.  recur'd.    Died 
Apr.  28,  1865. 

Died  June  17,  1864. 

354 

8  ill  Ohio,  age  24. 
Wells,  L.  D,Pt.,D., 

1804. 
Sept.  20, 

femur. 
Right  knee  

1864. 

1864. 
Xov.  17, 

funda. 
lu    cunt..    Scarpa's. 

Died  Dec.  1,1863;  re 

35:> 

74th  I  ml.,  age  22. 

Wendt.    C.,    Pt.,    E, 
15;d  Xi-w  York. 

1M3. 

Oct..  19, 
1864. 

Shattering      right 
knee  ;  20th,  amp. 

Oct.  27, 
1864. 

1863. 

Oct.  27, 
1864. 

Surg.  \V.  C.  Otter- 
son,  U.  S.  V. 
Ligation  

mittent  haera.   ant. 
tibial. 
Died    Xov.   5,    1864; 
exhaustion. 

' BATWELL  (E.),  Secondary  Hcein  or  rharje  following  Gunshot  Wound  of  Thigh,  in  U.  S.  San.  Com.  Hem's,  Surg.  Vol.  I,  p.  186. 
2  BATWELL  (E.).  Cane*  from  the  A'ote  Book  of  an  Artny  Surgeon,  in  Med.  and  Swy.  Rep.,  1865,  Vol.  13,  p.  50. 
3 New  Orleans  Medical  and  Surgical  Journal,  Vol.  9,  p.  71. 


798 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

356 
357 

3C8 
B5fl 

360 
361 

362 

363 
364 
365 
366 
367 

369 

370 
371 
372 
373 

374 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 

HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Wesley,  D.  T.,Corp., 
K,  128th  New  York. 
Wetherall,     J.     H., 
Capt.,C,10th  Mass.. 
age  39. 
Whallon,  W.  M.,Pt., 
C.  129th  Pa  ,  ase  21. 
Whitaker.  D.,  Serg't, 
A,  88th  Pa.,  age  20. 
Wilbur.  J.  F.,Corp  , 
I,  29:  h  Ohio,  age  24. 
Williams,  C.,  Pt.,  F, 
5th  C.  T.,  ago  23. 

Williams,  G.,  Corp., 
E,  9th  N.  Y.  H.  A., 
age  30. 
Williams.  L.,  Pt,,  C, 
26th  Mich.,  age  23. 
Willis.    A.,    Pt.,    I, 
7th  II.  I.,  age  25. 
Wilson,  C.  "M.,  Pt., 
F,  4lhN.  Y.,  age  35. 
Wilson,  G.  S.,  Adj. 
17th  N.  Y.,age  24. 
Wilson,   J  ,   Pt,,    B, 
5th  Texas,  age  32. 
Wipfclder,    F.,    Pt  , 
C,  52d  N.  Y. 
Withani.  A.,  Pt.,  A, 
1  st    Maine    Heavy 
Artillery,  age  20. 
Woolsey,  A.,  Pt.,  H, 
20th  N.  Y.  S.M. 
Worlev.  S.,  Pt,,  A, 
139th  Penu.,  age  20. 
Wynne.  W.  G..  Pt., 
F,  661  h  New  York. 
Yockev,  P.,  Pt,,  D, 
29th  Ohio,  age  29. 

Young,  A.,Pt.,F,  1st 

Oct.  19, 
1864. 
May  5, 
1864. 

Dec.  13, 
1862. 
Apr.   1, 
1*65. 
Mav   3, 
1863. 
Sept.  29, 
1864. 

July  9, 
1864. 

Mav  12, 
1864. 
Dec.  13, 
1862. 
May   5, 
1864. 
Dec.  13, 
1862. 
July   2, 
1863. 
June  1, 
1862. 
Mav  19, 
1864. 

Aug.  30, 
1862. 
Mav  5, 
1864. 
Sept.  17, 
1862. 
July  22, 
1864. 

Apr.  26, 
1863. 

Right    knee  joint  ; 
20th,  amp.  lo.  third. 
Right    knee;     19th, 
amp.  thigh. 

Left  knee  joint;  18th, 
amp.  lower  third. 
Right    knee  joint; 
prim.  amp. 
Fracture    left    knee 
joint;  8th,  amp.  th. 
Flesh,  left  thigh,  up 
per  third. 

Left     thigh,    upper 
third,  flesh. 

Left  knee;  June  13, 
amp.  thigh,  middle. 
Femoral  artery  

Lower  3d  left  femur  ; 
June  2,  amputation. 
Right    knee    joint  ; 
Jan.  3,  amputation. 
Fracture  right  fern.; 
July  4,  amp.  thigh. 
Fracture  right  fern.; 
2d,  amp.  middle. 
Flesh,  left  thigh,  up 
per  third. 

Left    knee;    Oct.   1, 
amputation  thigh. 
Ri"ht  thigh 

Oct.  28, 
1864. 
May  24, 
1864. 

Dec.  24, 
1862. 

Oct.  28, 
1864. 
Mav  24, 
1864. 

Dec.  24, 
1862. 

Mav  15, 
1863. 
Oct.  15, 
1864. 

Aug,  3, 
1864. 

July  19, 
1864. 
Dec.  25, 
1862. 
Juno  5, 
1864. 
Jan.  12, 
17,  1863. 
July  15, 
1863. 

On  face  of  stump  

In  continuity,  Scar- 
pa's  triangle. 

In  continuity,  Scar- 
pa's  space. 
In  continuity  

On  stump;   May  17, 
lig.  profuuda. 
Both  ends  in  wound. 
A.  A.  Surg.  0.  War 
ner. 
In  cont,  below  prof. 
A.  A.  Surgeon  J.  C. 
Shimer. 
On  face  of  stunip.  .  .  . 

Died    Nov.   1,  1864; 
exhaustion. 
Died  June  20,  1864; 
pyasmia. 

Died    Jan.   4,    1863; 
pysemia. 
Died  Apr.  20,  1865; 
pyaemia. 
Died  May  17,  1863. 

Hajm.  recur'd.    Died 
Oct.  21,  1864;  phle 
bitis. 
Died  Aug.   4,    1864; 
exhaustion. 

Died  July  19,  1864. 
Died  Dec.  28,  1862. 

Died  Juno    5,  1864; 
exhaustion. 
Died   Feb.  17,  1863; 
pyremia. 
HiBii).  recur'd.    Died 
July  23,  186  1. 
Died'  June  17.  1862. 

Died  July  2,  1864. 

Died  Oct.  5,  1862  ;  ex 
haustion. 
Died  June  2,  1864. 

Died  Nov.  3,  1862. 
Spec.  746,  A.  M.  M. 

Femoral  
Femoral  

Femoral  

May  15, 
1863. 
Oct.  15, 

1864. 

Aug.  3, 
1864. 

July  18, 
1864. 
Dec.  22, 
25,  1862. 
June  5, 
1864. 
Jan.  12, 
1863. 
July  15, 
1863. 
Juno  9, 
1862. 
June  29, 
1864. 

Oct.    2, 

1862. 

Femoral 

Femoral;  recurred 
Femoral  

In  continuity  above 
profunda. 
On  face  of  stump  ... 

In   continuity,  Scar- 
pa's  space. 

Femoral  

1862. 
June  29, 
1864. 

Oct.    2, 

1862. 
May  20, 
1864. 
Oct.  25, 
1862. 

May  17, 
1863. 

In  cont.  just  below 
Poupart's  lig.  A.  A. 
Surg.  J.  Newcombe. 
In  continuity,  Scar- 
pa's  triangle. 
Ligatiou  

FVacture  left  knee  ; 
Oct.  16,  amp.  thigh. 
Fract.  right  femur; 
prim.  amp.  thigh; 
reamp.  middle. 
Lower  3d,  left  thigh, 
flesh. 

May  11, 
1863. 

In  continuity,  Scar- 
pa's  triangle. 
Ligation  of  femoral  ; 
subsequent  lig.   of 
external  iliac. 
Both  ends  in  wound  . 

From  stump  

Died  April  23,  1865. 
Died  May  20,  1863. 

Missouri  Cavalry. 

.Of  the  branches  of  the  femoral  artery  the  external  pudic  was  ligated   in  one,  the  pro 
funda  in  twenty-two,  and  the  perforating  artery  in  six  instances. 

Liyation  of  the  External  Pudic  Artery. — CASE  1156. — Sergeant  J.  H.  Warford,  A,  124th  New  York,  age  23,  was  wounded 
at  Sailor's  Creek,  Virginia,  April  6,  1865,  in  the  right  thigh  about  two-inches  below  Poupart's  ligament;  June  12th,  hremorrlmge 
from  external  pudic  artery ;  ligation  of  artery  in  wound ;  no  recurrence  of  hsemorrhage.  Patient  was  discharged  August  26, 
1865.  (Second  Surg.  Vol.,  page  326,  CASE  940.) 

Ligation  of  the  Profunda  Femoris.—  Twenty-two  cases,  with  five  recoveries  and  seven 
teen  deaths  were  reported.  Fourteen  were  ligations,  after  amputations,  on  the  face  of  the 
stump. 

TABLE  OXLII. 
Summary  of  Twenty-two  Cases  of  Ligations  of  the  Profunda  Femoris. 

[Recoveries,  1—5;  Deaths,  6—22.] 


NO. 

NAME, 

AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 
2 
3 
4 

Bedinn  field.    R.    W., 
Serg  t,  I,  60th  G;i., 
age  18. 
Casey,  P.,  Pt.,  H,  1st 
Col.  Troops. 

Crawford,  E.,Pt.,  F, 
10011]  Ohio,  age  20. 

Michaelis  T.  Corp'l 

July  9, 

1864. 

July  10, 
1863. 

Sept.  19, 
1803. 

Mav  8 

Flesh  wounds  of  both 
thighs. 

Fracture  of  right  fe 
mur;  prim.  amp. 

Right  ankle  jt.;  Oct., 
amp.  leg;    Aug.  5, 
1864,  amp.  thigh. 
Ril'ht  thi"h    upper 

Aug.  16, 
1864. 

July  16, 

21,25,26, 
1863. 
Aug.  14, 
15. 
1864. 
July  4 

False  aneurism  r't 
thigh. 

From  stump  
From  stump  
Profunda 

Aug.  10, 
1864. 

July  26, 
1863. 

Aug.  15, 
1864. 

July  4, 

Profunda,  both  ends 
in  wound.     A.  A. 
Surg.J.U.Bartholf. 
Ou   face    of   stump. 
A.  A.  Surgeon  J.  C. 
Shinier. 
Profunda  on  face  of 
stump. 

Profunda,    proximal 

Exchanged   October 
25,  1804! 

Discharged    Decem 
her  10,  1863. 

Discharged  Mar.  18, 
1865. 

Discharged  May  31 

"> 

3,  140th  New  York, 
age  27. 
Shaw  go   G     Pt    A 

1864. 
Apr  1 

third. 

1864. 
Apr.  7 

1804. 
Apr.  7 

end  in  wound. 

1865. 

6 

7 

121stPenn.,age21. 
Bodley.  E.,  Pt..39th 
Indiana,  age  28. 
Carlton.C.  C.,  Pt.,  B, 
1st    Massachusetts 
Artillery,  age  35. 

1865. 
Sept,  19, 
1863. 
May  19, 
1864. 

amp.  thigh. 
Left  leg;  amputation 
thigh  September  21. 
Left  knee  joint  ;  am 
putation  t  high  May 
22. 

1865. 
Sept.  28, 
1863. 
Mav  26, 

1864. 

Profunda  
Anastomotic  

1865. 
Sept.  28, 
1863. 
May  27, 
1864. 

Profunda  on  face  of 
stump. 
Profunda  on  face  of 
stump. 

1865. 
Died  September  28, 
1863. 
Died  May  30,  1864. 

(  HAP.  XII.] 


LIGATIONS    OF    BRANCHES    OF    THE    FEMORAL    ARTERY. 


799 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

g 

Clark  J    Pt    H  7th 

June  27 

June  27 

Died  October  9  1864 

Q 

N.  Y.  Heavy  Artil 
lery,  age  24. 

18C4. 
Oct   19 

primary  amp.  thigh. 

1864. 
Oct  26 

Profuuda 

1864. 
Oct  26 

stump. 

10 

11 

12 

I,  1st  Cavalry,  age 
24. 
Doty,N.,  Pt.,  E,  102d 
Penn.,  age  33. 
Folensbee.C.  M.,Pt., 
B,  157th  New  York, 
age  16. 
Galiger    M     Serg't 

1864. 

Sept,  19, 
1HC4. 
Dec.  6, 
1864. 

July  2 

joint  ;  Get.  22,  amp. 
thigh. 
Condyle  of  left  fern.  ; 
Sept.  28,  amp.  thigh. 
Right  knee  joint; 
Dec.  9,  amp.  thigh. 

1864. 

Sept.  30, 
1864. 
Dec.  19, 
1864. 

July  6 

Branch  of  profunda 
Branch  of  profunda 

1864. 

Sept.  30, 
1864. 
Dec.  19. 
1864. 

July  6 

stump. 

Ligated  on    face  of 
stump. 
Artery  tied  on  faco 
of  stump. 

1864. 

Died   November    7, 
1864.  . 
Died  December  26, 
1864. 

Died  July  8  1863 

13 

14 

G,  73d  N.Y.,  age  22. 
Gibson,  E.  H.,Pt.,  A, 
14th  New  jersey, 
age  15. 

Gilkey,   E.,   Pt.,   C, 

1863. 
July  8, 
1864. 

June  19, 

July  5,  amp.  thigh. 
Fracture  of  right  fe 
mur,  upper  third. 

Right  thigh,   upper 

1863. 
July  19, 
1864. 

JulyS 

Circumflex  

18U3. 
July  19, 
1864. 

July  5 

stump. 
Circumflex  branch  of 
prof.,  both  ends  in 
wound.  A.  A.  Surg. 
T.  J.  Dunott. 

Died  July  20,  1864. 
Vein  also  lig.    Died 

T> 

17th  Maine,  age  27. 
Jenkins,  J.H.,  Serg't, 

1864. 
Feb.  25, 

third. 
Left  knee  j't;  amp. 

1864. 
Mar.  12 

Profunda    

1864. 
Mar.  12 

Ass't  Surg.  A.  De- 
lauy,  U.  S.  V. 

July  7,  1864  ;  recur 
rence  of  haem. 
Died  March  16,  1864  ; 

16 

17 

B,  89th  Ohio,  ago  24. 
Labrie,   O.,   Pt.,    H, 
126th  Ohio,  age  23. 
Lowe,  J.  T.,  Lieut  , 

1864. 
July  9, 
1864. 
Oct.  14, 

thigh  February  29. 
Left  thigh  ;  amputa 
tion  July  12. 
Wound  of  left  thigh 

1864. 
July  15, 
1864. 

Branch  of  profunda 

1864. 
July  15, 
1864. 

stump. 
On  face  of  stump  .  . 

Profunda,  both  ends 

pytemia. 
Died  July  22,  1864. 

Died  October  30,  1863. 

18 

D,  12th  N.  Jersey. 
Murphy    M.    Pt.  G 

1863. 
Nov.  25 

Left    thigh      flesh 

Jan  26 

Jan  26 

in  wound. 

Died  Jail  27   1864 

19 
?0 

5th  Kentucky. 

Pattison,  T.,  Corp'l, 
D,5thMich.,age32. 
Sturgis.  J.,  Corp'J,  G, 

1863. 

May  5, 
1864. 
Aug.  16, 

gangrene. 

Flesh  wound  of  left 
thigh. 
Both    thighs,    right 

1864. 

July  13, 
1864. 
Nov.  1, 

Branch  of  profuuda 
Profunda  

1864. 

July  13, 
1864. 
Nov.  1, 

A.  H.  Stephens,  6th 
Ohio. 
One  end  in  wound  ; 
hrem.  recurred. 
Profunda,  in   conti 

Died  July  20,  1864. 
Died    November    6, 

21 

flfl 

85th  Pennsylvania. 

Weiler,  J.,  Corp'l,  K, 
40th  N.  Y.,  age  20. 
Wells,  E.,Pt.,  1,  12th 

1864. 

May  24, 
1864. 
Dec.  16, 

femur  injured. 

Fracture  right  thigh  ; 
prim,  amputation. 
Right  knee  ;  amp. 

1864. 

MavSl, 
1864. 
Dec.  21 

Branch  of  profunda 

1864. 

May  31, 
1864. 
Dec.  21, 

nuity.    A.  A.  Surg. 
J.  C.  Morton. 
On  face  of  stump  .  .  . 

On  face  of  stump  .  .  . 

1864. 
Died  May  31,  1864. 
Died   December  21, 

Iowa. 

1864. 

thigh  Dec.  16. 

1864. 

1864. 

1864. 

Of  the  branches  of  the  profunda  the  perforating  arteries  were  ligated  in  six  instances; 
all  the  cases  terminated  in  death: 

CASES  1157-1162. — Private  T.  B.  Benedict,  D,  7th  Connecticut,  age  32;  received  a  shot  flesh  wound  of  right  thigh  May 
10,  1864;  haemorrhage  occurred  from  one  of  the  posterior  perforating  arteries  on  June  9th,  which  was  ligated;  no  recurrence 
of  haemorrhage;  death  May  3,  1865,  of  pneumonia, — Lieutenant  J.  Coote,  F,  10th  Alabama;  wounded  May  5,  1862,  through  left 
knee  joint;  May  20th,  amputation  of  thigh;  May  23d,  haemorrhage  from  branch  of  inferior  perforating  artery;  vessel  ligated; 
death  May  25,  1862. — Private  T.  Hagleman,  D,  41st  Ohio,  age  49;  wound  of  right  thigh  December  16,  1864 ;  haemorrhage  from 
superior  perforating  artery  December  29,  1864;  vessel  ligated  at  proximal  end  by  A.  A.  Surg.  S.  W.  Black  wood;  died  January 
15,  1865.— Private  J.  J.  Smith,  F,  llth  Virginia;  fracture  of  left  femur  October  19,  1864;  amputation  of  thigh  October  20th; 
November  1st,  secondary  haemorrhage;  perforating  artery  ligated  on  face  of  the  stump  on  the  same  day;  death  November  9, 
1864. — Surg.  H.  S.  Wheeler,  B,  2d  Connecticut  H.  Artillery,  age  29;  fracture  of  condyle  of  femur  October  19,  1864  ;  amputation 
October  26th;  haemorrhage  November  1st  from  perforating  artery,  which  was  ligated  on  face  of  the  stump;  death  November  11, 
1864. — Private  W.  F.  Young,  A,  114th  New  York,  age  26;  wound  of  left  knee  October  19,  1864;  amputation  on  same  day; 
October  30th,  haemorrhage  from  inferior  perforating  artery ;  October  31st,  ligated  on  face  of  stump  ;  died  November  27,  1864. 

Twenty-four  cases  of  ligations  of  muscular  and  other  minor  branches  of  the  femoral 
artery  were  reported  ;  twenty-two  were  ligations  on  the  face  of  the  stump. 

TABLE  GXLIII. 
Summary  of  Twenty-four  Ligations  of  Muscular  and  other  small  Branches  of  the  Femoral  Artery. 

[Recoveries,  1 — 6;  Deaths,  7 — 24.] 


No. 


NAME, 
;E,  AND  Mn 
DESCRIPTION. 


Iowa,  ago  '20. 
Schrabasliie. 
B.  183d  Pen 
nia,  ago  46. 


LITARY 
ION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
H.EMOK- 
RHAGE. 

PROBABLE  SOURCE 

OF 
HAEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Serg't, 

July  27, 

Right  knee  j't;  prim. 

Ang.  2, 

Muscular  branch  .  . 

Aug.  2. 

Muscular        branch 

Discharged  in  1865. 

as,  age 

1864. 

amputation  thigh. 

1864. 

1864. 

tied     on    face     of 

stump. 

F,  120th 

July  2, 

Right  leg  :  prim,  am 

July  11, 

Muscular  branch  .  . 

July  11, 

Muscular  branch  on 

Discharged  April  20, 

age  24 

1861!. 

putation  leg. 

1803. 

18(13. 

face  of  stump. 

1864. 

Pt,,  I, 

July  30, 

Right   thigh  ;   prim. 

Nov.  22, 

Branch  of  femoral  . 

Nov.  2i, 

Branch  of  femoral  ou 

Discharged  May  15, 

ge  24. 

1864. 

amputation. 

1864. 

180  4. 

face  of  stump. 

1865. 

t.,  I,  2d 

Nov.  19, 

Through  left  knee; 

Lee.   3, 

Dec.  3, 

Branch  of  femoral  .  . 

Discharged  April  20, 

1804. 

Nov.  28,  amp.  thigh. 

1864. 

1864. 

18G5. 

M.,Pt., 

Apr.   1, 

Through  right  patel 

June  7, 

June  7, 

Muscular  artery  tied. 

Recovered. 

nsylva- 

1865. 

la;   April  8,  ampu 

1866. 

1866. 

tation  thigh. 

800 


WOUNDS   AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OK 

HJEMORRHAOK. 

DATE 

OF 
OPKRA- 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

6 

Swavne.W.,  Colonel, 

Feb.  2, 

Right  knee;  prim. 

Feb.  13, 

Branch  of  femoral 

Feb.  13, 

On  face  of  stump  

Recovered. 

43(t  Ohio,  acre  30. 

1865. 

amputation  thigh. 

1865. 

1865. 

7 

Anderson,  W.  G.,  Pt., 

Dec.  13, 

Right  knee  j't;  Jan 

Jan.  13, 

From  stump  

Jan.  17, 

Muscular  branch  on 

Died  Jan.  17,  1863. 

G,  114th  IVnnsylva- 

1862. 

uary  11,  amp.  thigh. 

15,17, 

1863. 

face  of  stump. 

nia,  ago  16. 

1863. 

g 

Carroll,    L  ,    Serg't. 

Oct  27, 

Fracture  femur,  up 

Branches  of  femoral  ; 

November  11,  amp. 

H,    1st    Delaware, 

1864. 

per  third. 

ba-morrhage. 

at  hip.     Died  Nov. 

age  3:! 

19,  18B4. 

9 

Davis,  H.  C.,  Pt.,  I, 

May   1, 

Fract  of  femur,  pro- 

Mav  17, 

From  stump  

May  17, 

Small  branch  on  face 

Died  May  18,  1863. 

46th  Indiana. 

1803. 

funda  injured  ;  amp. 

1863. 

1863. 

of  stump. 

10 

Fisher.  G.  A.,Pt.,  A, 

June  2, 

Right  knee  j't  ;  June 

June  22, 

Muscular  branch.. 

June  22, 

On    face  of  stump. 

Died  June  23,  1864; 

8th  New  York  Ar 

1864. 

15,  amputa'n  thigh. 

1*64. 

1864. 

A.   A.  Surg.  D.  L. 

pyremia. 

tillery,  age  19. 

Haight. 

11 

Foster,  R.,  Cant,  K, 

Mav  10, 

Left  knee  joint;  May 

June  4, 

Muscular  branch  .  . 

June  4, 

On    lace  of   stump. 

Died  Juno  14,  1864. 

1st    New    Jersey, 

1864. 

27,  amputa'n  thigh. 

1864. 

1864. 

A.  A.  Surg.  F.  H. 

age  39. 

Colton. 

12 

Faust,  J.,  Pt,  N.  C. 

Mar.  27, 

Left  knee;  -rune  17, 

June  17, 

From  stump  

June  17, 

Small  branch  on  face 

Died  July  25,  1865. 

Artillerv,  age  37. 

1805. 

amputation  thigh. 

1865. 

1865. 

of  stump. 

13 

Geller,    M.,   Pt.,  D, 

June  30, 

Left  knee  j't;  July  4, 

Aug.  5, 

Muscular  branch  .  . 

Aug.  5, 

Muscular  branch  on 

Died  August  29,  1864. 

48th  N.  Y.,  age  37. 

1864. 

amputation  thigh. 

1864. 

1864. 

face  of  stump. 

14 

Hammond,  A.,   Pt  , 

Apr.   2, 

Left  knee  joint;  Apr. 

Apr.  11, 

Muscular  branch.. 

Apr.  11, 

Muscular  branch  on 

Died  April  16,  1865; 

H,  lllth  New  York, 

1865. 

6,  amputat'n  thigh. 

1865. 

1865. 

face  of  stump. 

pysemia. 

age  47. 

15 

Hayer.G.,  Pt,,  K,  6tb 

May  19, 

Left  knee  j't  ;  June 

June28, 

Muscular  branch  .  . 

June  28, 

Muscular  branch  on 

Died  June  29,  1864; 

New   York   Heavy 

1864. 

16,  amputa'u  thigh. 

1864. 

1861. 

face  of  stump. 

pytcmia. 

Artillery,  age  27. 

1C 

Havs,  A.  H  ,  Pt.,  B, 

Dec.  13, 

Fracture  left  tibia; 

Jan.    7, 

Branch  of  femoral  . 

Jan.    7, 

Small  branch  on  face 

Died    January     10, 

142dPenn.,age23. 

1862. 

Dec.  25,  amp.  thigh. 

1863. 

1863. 

of  stump. 

1863. 

17 

Knowlton,A.W.,Pt, 

Mav   5, 

Left  knee  joint;  May 

June  1, 

Muscular  branch.  . 

June  1, 

Ou    f.ice  of   stump. 

Died  June   4,    1864; 

F,93dN.Y.,  age  22. 

1864. 

14,  amputa'n  thigh. 

1864. 

1864. 

Ass't  Surg.  W.  F. 

pyajmia. 

Nori  is,  U.  S.  A. 

18 

Mars.H.,  PI.,G,5th 

Mar.  31, 

Right    knee    joint; 

Apr.  10, 

Muscular  branch.  . 

Apr.  10, 

Muscular  branch  on 

Died  April  22,  1865  ; 

New  York,  age  24. 

1865. 

Apr.  9,  amp.  thigh. 

1865. 

1865. 

face  of  stump. 

pvaimia. 

19 

Michaelis,  S.,  Pt,  E, 

June  25, 

Flesh  wound  of  both 

July  30, 

Branch  of  femoral  . 

July  30, 

Both  ends  in  wound. 

Died  August  4,  1864. 

9th  Maine,  ago  21. 

1864. 

thighs. 

1864. 

1864. 

Ass't  Surg.  E.  Cur 

tis,  U.S.  A. 

20 

Spencer,  J.,  Pt.,  G, 

Mav   9, 

Right  knee  j't  ;  May 

May  24, 

From  stump  

Mav  24, 

Branches  ligated  on 

Died  May  31,  1864. 

48th  Penn.,age  19. 

1804. 

16,  amputa'n  thigh. 

1864. 

1864. 

face  of  stump. 

21 

Sterling,  E.E.,Corp'l, 

May   9, 

Right  leg;    May  10, 

Mav  22, 

Branch  of  femoral. 

Mav  22, 

Small  branch  on  face 

Died  Aug.  12,  1864  ; 

E,    143d     Pennsyl 

1864. 

amputation  thigh. 

1864. 

1864. 

of  stump. 

pyseinia. 

vania,  age  32. 

22 

Townsend.E.,  Pt,  F, 

June  2, 

Left  knee  j't;  June 

June  4, 

Small    branch    of 

June  4, 

On  face  of  stump  .  .  . 

Died  July  1,1864. 

5th  N.  H.,  age  35. 

1864. 

21,  amputa'n  thigh. 

1861. 

femoral. 

1804. 

23 

Weisrailler,  C.,  Pt., 

Dec.  13, 

Head  of  left  tibia; 

Dec.  26, 

Branches  of  fem 

Dec.  26, 

Branches  ligated  on 

Died    December  27, 

B,  12th  Peun.  Res., 

18B2. 

Dec.  25,  amp.  thigh. 

1862. 

oral. 

1862. 

face  of  stump. 

1862. 

age  22. 

24 

Yeagher.  F.,  Corp'l, 

June  17, 

Right    knee   joint; 

July   2, 

Muscular  branch.  . 

July  3, 

On  face  of  stump  

Died  July  5,  1864. 

C,26thMich.,age44. 

1864. 

prim.  arnp.  thigh. 

1864. 

1864. 

legations  of  the  Popliteal  Artery. — Thirty-six  cases,  with  eight  recoveries  and  twenty- 
eight  deaths,  a  mortality  rate  of  77.7  per  cent.,  were  reported.  Six  of  the  operations  were 
performed,  after  amputations,  on  the  face  of  the  stump. 

TABLE  CXLIV. 
Summary  of  Thirty-six  Ligations  of  the  Popliteal  Artery. 

[  Recoveries,  1— € ;  Deaths,  9—36.] 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

HJSMOR- 

BHAGR. 

PKOBAHLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

1 

Ditters.  "W.,  Pt.,  H, 

May  14 

Right  popliteal  space 

June  6, 

Popliteal 

June  6 

Both  ends  in  wound. 

Discharged   August 

42d  Illinois,  age  27. 

1864. 

1864. 

1864. 

Asst    Surg.  B.    E. 

16,  1865. 

Fryer,  U.  S.  A. 

2 

Fields.    B.,   Pt.    C, 
27th  N.  C.,  age  21. 

Sept.  17, 
1862. 

Fracture  right  leg  ; 
Nov.  28,  amp.  leg. 

Dec.    1, 

1862. 

Popliteal 

Dec.    1, 
1862 

On  stump.     Surg.  11. 
S.  Il.-witU.  S.V. 

H.Bni.  recur'd.  Exch. 
February  28,  1863. 

3 

Kansche.  G.  D.,  20th 

Sept.  17, 

Shot    laceration    of 

Sept.  17 

Popliteal  ... 

Sept.  17, 

Card,  end  in  wound  ;     Discharged   August 

New  York,  age  35. 

1862. 

popliteal  space. 

1862. 

1862. 

hajms.  rec'd.                    13,  1  863. 

4 

Kracher,  J.  P.,  Pt., 

Juno  1, 

Grapeshot,  left  thigh, 

July  24 

Popliteal  

July  24, 

One  end   ligated    in    Discharged     March 

D,6thN.Y.H.  Art, 

1804. 

near  knee. 

1864. 

1864. 

wound;    no  recur-      15,  186.~>. 

age  35. 

Fence. 

5 

Lofz,  J.,Pt,  1,  105th 

Mar  25,    Fracture  of  left  fibu- 

Apr.  7, 

Posterior  tibial  and 

Apr,  12, 

Pop.  above  its  bifur 

Discharged    August 

Pa.,  age  26. 

1865. 

la. 

10.11,12, 

poroneal. 

1865. 

cation.    Surg.  15.  15 

4,  1865. 

1865. 

Wilson,  U.  S.  V. 

6 

Maher,   C.,    Pt,    A, 

Mar.  25, 

Upper  third  of  tibia, 

Apr.   5, 

Posterior  tibial  .  . 

Apr.   5, 

Popliteal,     in     cont.     Discharged   October 

64th  N.  Y.,age  20. 

1865. 

post,  tibiiil  injured. 

1865. 

1865.           Surg.  T.  R.  Crosby,       4,  1865. 

U.  S.  V. 

7 

Smith,  P.  D.,  Pt,  C, 

Mai-.  19, 

Right    ankle;    gan-    May  6,  '  Posterior  tibial  

Mav  6,    In  lower  portion  pop-    Discharged     March 

8th  Iowa. 

1864. 

greue  iu  wound. 

1864. 

1SU4.          liteal,  iu  cont.      A.       21,1865. 

A.  Surg.  D.  McLean. 

8 

Taft,  E.  P.,  Lt  Col., 

July  9,     Tibia  and  fibula,  mid-    July  24,    Popliteal  

Julv  24,    Popliteal,  on  face  of 

Mustered     out    No 

9th  N.  Y.  H.  Art, 

1864.          die  third;  July  22,       1864. 

1864. 

stump. 

vember  28,  1864. 

age  32. 

amputation  leg. 

9 

B(irtlioloin6W   J.  C. 

May   16       ESflrttnvn  of  Iwff.  lotr         \fn\r  Ifi       PnY^lit^al 

May  16 

Popliteal 

Died   May   29,    1864; 

Lieut,  K,2utuind', 

1864. 

1864. 

1864.  ' 

tetanus. 

age  30. 

CHAP 


LIGATIONS    OF    THE    ANTERIOR    TIBIAL    ARTERY. 


801 


No. 

NAME, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJUKT. 

NATURE  OF  INJURY. 

DATE 

OF 
ILEMOR- 
RHAOE. 

PKOBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

10 
11 

JBernhard,  A.,  Pt.,K, 
4thOhioCav.,age35. 

Feb.  25, 
1864. 

Oct.  27, 

Fracture  right  leg; 
ptim  amp.  leg. 

Cond.  of  femur  and 

Mar.   5, 
1864. 

Nov.  10 

Anterior  tibial  
Popliteal  .  .  . 

Mar.  5, 
1864. 

Nov.  14 

Popliteal,  in  middle. 
A.  Surg.  J.  G.  Bu 
chanan,  125th  Ohio. 

Died  March  22,1864; 
pyaemia. 

Died  Nov     25    !>>f>4 

12 

A,  10th  Va.,  ago  29. 
Burnham,  IF.,  G,  8th 

1864. 
Oct.  19, 

right  pop.  artery. 
Right  tibia  

1864. 
Oct.  19 

Popliteal  

1864. 
Oct  19 

A.  A.  Surg.  C.  Ebcr- 
hardt. 

during  amp.  thigh. 

13 

Louisiana,  ago  33. 
Cornwall,    11.  McQ., 

1864. 
May  12, 

Right  tibia,  anterior 

1864. 
May  18, 

Popl  iteal  

1864. 
MaylS 

amp.  thigh. 
On  face  stump.  Surg. 

1864. 
Died  Mav  28  1W4 

14 
15 

Major,  9tli   N.    Y. 
Cav.,  ago  27. 
Elliott,  J.  E.,  Coip'l, 
E,  I'a.  Cav.,  age  24. 
Fletcher,  J.M.,C'p'l. 

1864. 

Apr.   2, 
1863. 
June  18, 

tibial  injured  ;  amp. 
at  knee,  prim. 
Through  left  leg  ... 

Flesh  wound  of  right 

1864. 

Apr.  19, 
1863. 
Aug.  14, 

Recurred  5  times. 
Popliteal  

1864. 

Apr.  29, 
1863. 
Aug.  14, 

A.  Heger,  U.  S.  A. 

Popliteal  ;   hsem.  re 
curred  ;  amp.  thigh. 
Both  ends  in  wound. 

Died  May  5,  1863. 
Died  An".   14,  18C4 

16 
17 

C,  39th  Mass.,  age  28. 

Gmy,W.,E,  18th  In 
fantry,  age  26. 
Gwinn    E  ,    Pt,  B, 

1864. 

Dec.  30, 
1802. 
July  9 

knee. 
Popliteal  region  .... 

1864. 

Jan.  12, 
1863. 
Julv  22 

Popliteal  artery   .  . 

1864. 

Jan.  12, 
1863. 
July  22 

A.  A.  Surg.  J.   M. 
McGrath. 
Both  ends  in  wound 

typhoid  fever. 
Died  January  22,  1863. 
Died  Julv  '-"''    J8G4- 

IS 

138th  Pa.,  ago  21. 
Knight,  A.  Pt,  L,2d 

1864. 
May  4, 

12,  amputation. 
Left     femur,      pop 

1864. 
Sept   6 

1864. 
Sept  10 

stump. 
Popliteal  both  emls 

pyasnria." 

19 
20 

*>1 

111.  Cav.,  age  24. 
Lee,  A.  F.,  Corp'l,  A, 
24th  Ohio,  ago  22. 
Leonard,  J.,  Pt..  L, 
7th  N.  T.  H.  Art., 
ago  21. 
Lynch.  J.,  Corp'l,  K, 

1862. 
Feb.  25, 
1864. 
May  30, 
1864. 

May  10, 

liteal  wounded. 
Upper    third    right 
tibula. 
Flesh  wound  upper 
portion  of  left  leg. 

Flesh  w'd  popliteal 

1862. 
Mar.    1, 
2,  1864. 
July   3, 
1864. 

May  17, 

Peroneal  artery  .  .  . 
Posterior  tibial  .  .  . 

1862. 
Mar.  2, 
1S64. 
Julv   3, 
1864. 

Mav  17 

in  wound. 
Pop.  ligated.  A.S'rg. 
T.  A.  McGraw. 
Popliteal  ;     haemor 
rhage  recurred. 

Poplit'l  lif'd.    ^ss't 

1862. 
Ri'lig.  Mar.  5.    Died 
Mar.  8,  1864;  gang. 
Amputation     thigh. 
Died  July  23,  1864. 

Died  May  23    1864- 

23 

i46th  N.  Y.,  age  34. 
McNnlty,  J.,  Pt,  E, 

1864. 
Sept  20, 

region  left  leg. 
Both  knee  joints  .... 

1864. 

1864. 
October 

Surg.  C.  A.  McCall, 
U.SA. 
Poplit'l  and  branch, 

pyaemia. 
Died  October  15  1863. 

23 

94 

22d  Michigan. 
Mathews.  S.,  Pt.,  A, 
93d  Pa,,  age  28. 
Powers.  T.,  Pt,  G, 

1863. 
Mav  15, 
1864. 
May, 

Left  leg;  prim.  amp. 
at  knee  joint 
Right  leg   and   left 

Mav  30, 
1864. 
May, 

Repeated  hsem.  to 
June  12. 

1863. 
Juno  12, 
1864. 
Mav 

with  popliteal  vein. 
Popliteal  ligated  on 
base  of  stump. 
Popliteal  ligated    in 

Died  June  17,  1864; 
pyaemia. 
Died  May  14  1864. 

?•» 

140th  New  York. 
Reynolds.  H.  H.,  Pt., 

1864. 
Sept  4, 

foot, 
Left  knee  j'nt  ;  Sept. 

1864. 
Sept  19, 

Popliteal  

1864. 
Sept  19, 

cont. 
Popliteal  on  face  of 

Died  September  30 

26 

27 
?8 

P,  1st  Mich.  Cav., 
age  25. 
Seldon,  U.,Pt.H,  9th 
Virg.  Cav.,  age  23. 

Sharon,  P.,  Pt,I,153d 
New  York. 
Smith,  A.  M.,Serg't, 

1864. 

July  8, 
1863. 

Sept  19, 
1864. 
May, 

18,  amp.  thigh. 

Popliteal  space,  pop 
liteal    artery   divi 
ded;  left     " 
Fracture  of  head  of 
tibia. 
Popliteal  art'y  w'ded 

1864. 

July  17, 
27,  1863. 

Oct.  1,5, 
12,  '64. 
May, 

Popliteal  artery... 

Anterior  tibial  .... 
Popliteal  . 

1864. 

July  27, 
1863. 

Oct.  12, 
1864. 
May, 

stump. 

Proximal  end  iu  w'd. 
A.  A.  Surg.  W.  S. 
Adams. 
Popliteal;  hii-in.   re 
curred. 
Popliteal  ligated  on 

1864  ;  pyaemia. 

Died  August  2,  1863  ; 
pyaemia. 

Oct  18,  amp.  thigh. 
Died  Oct.  18,  1864. 
Died  May  22  1864. 

29 
30 

<n 

F,  20th  Maine. 
Smith.  F.,  Pt.,  B,  1st 
Mass.  Art.,  age  28. 

Taber,  J.  A.,  Pt,  E, 
5th  Mich.,  age  23. 

Thompson,    J.     A., 

1864. 
May  23, 
1864. 

Mar.  31, 
1865. 

Aug.  3 

Right   leg  and   left 
thigh. 

Right  leg  in  middle 
third. 

Left    \&f-    Sept.    3 

1864. 
June  17, 
1864. 

Apr.  10, 
1865. 

Oct.    4 

Post,  tib.;  art'y  li 
gated;   haem.  re 
curred. 
Post.  tib.  or  inter- 
osseous. 

1864. 
June  29, 
1864. 

Apr.  12, 
1865. 

Oct     4 

field. 
Poplit'l.  A.  A.  Surg. 
H.  M.  Dean. 

Poplit'l  lig'd  ;   haem. 
recur'd.   Surg.  J.  C. 
McK.ee,  F.  S.  A. 

Died  June  29,  1864. 
Died  April  18,  1865. 
Died  Oct  4   1864 

39 

Corp'l,  K,  10th  In 
diana,  age  27. 
Vaun.    D.,    Pt,    B, 

1864. 
June  3, 

amp.  upper  third. 
Left  knee,   popliteal 

1864.    . 

1864. 
June  16, 

nuity. 
Popliteal.    Surg.  R. 

June  20,  amp.  thigh. 

33 

8th  N.  Y.  H.  Art., 
age  18. 
"Walker,  M.  K.,  col 

1864. 
June  3 

artery  injured. 

June  25 

1864. 
June  26 

B.  Bontecou,  U.  S. 
V. 

Died  June  22,  1864. 
Died  July  3  1864 

34 

ored  servant,    58th 
Pa.,  age  13. 
Wick,  J.  C.,  Pt.,  C, 

1864. 
Mar.  25, 

liteal  art.  wounded. 
Flesh  wounds  of  both 

26,  '64. 
May  23, 

Popliteal  

1864. 
Mav  23, 

wound.     Surg.    R. 
B.  Bontecou,  U.S.V. 
Both  ends  iu  wound. 

June  14,  amp.  thigh. 

31 

155th  Penn.,  age  22. 
Wild,  C.  B.,  Corp'l, 

1865. 
Sept.  19 

thighs. 

1865. 
Oct     I 

1865. 
Oct.    1 

Ass't  Surg.  A.  De- 
lany,  TJ.  S.  V. 
Popliteal;  haem.  rec. 

Died  June  20,  1865. 
Oct.  12   amp.  thigh 

3G 

E.  114th  New  York. 
Wilkins,  T.  E.,  Corp'l, 
A,  49th  Virginia. 

1864. 
Oct.  19, 
1864. 

Fracture    of  fibula, 
tibial  arteries  iuj'd. 

1864. 

Ant  tibial;  tibial 
ligated. 

1864. 

Oct  12. 
Popliteal  lig.  ;  amp. 
thigh  Oct.  23. 

Died  Oct.  13,1864. 
Died  Nov.  12,  1864. 

Of  the  branches  of  the  popliteal  the  articular  artery  was  ligated  in  three  instances;  two 
of  the  cases  terminated  in  death: 

Liyations  of  the  Articular  Branch. — CASES  1163-1165. — Private  A.  Shaw,  I,  16th  Massachusetts,  aged  19,  wounded  May 
3,  1863;  ball  entered  external  condyle  of  right  femur  and  was  cut  out  at  a  point  three  inches  above;  haemorrhage ;  June  11, 
ligation  of  articular  branch;  admitted  into  Armory  Square  Hospital,  Washington;  discharged  December  14,  1863. — Sergeant  J. 
W.  Long,  I,  8th  Kansas,  aged  23;  shot  fracture  right  leg,  December  16,  1884;  Dec.  17,  amputation  at  knee  joint;  Dec.  18, 
haemorrhage  from  internal  articular  artery ;  ligation  on  face  of  stump  on  same  day;  Dec.  25,  haemorrhage  external  articular;  death 
Dec.  26, 1864. — Private  S.  Lyon,  C,  84th  Indiana,  age  23;  shot  fracture  of  right  tibia,  Chickamauga.  September  19,  1883;  haemor 
rhages  October  2d,  3d,  probably  from  popliteal  artery;  ligation  of  articular  branch  October  3;  great  prostration  from  extensive 
loss  of  blood;  gangrene;  October  6,  amputation  of  thigh  at  junction  of  middle  and  lower  thirds;  death  October  8,  1863. 

Ligatwns  of  the  Anterior  Tibial  Artery. — Forty-seven  cases  come  under  this  group; 
twenty-six  patients  survived  the  operation,  twenty-one  perished,  a  mortality  rate  of  44.6  per 
cent.  In  seven  cases  with  four  recoveries  and  three  deaths  the  posterior  tibial  artery  was 

likewise  tied.     Fifteen  were  operations  on  the  face  of  the  stump  after  amputation  in  the  leg. 
SURG.  Ill— 101 


802 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


TABLE  CXLV. 
Summary  of  Forty-seven  TAgations  of  the  Anterior  Tibial  Artery. 


I  Recoveries,  1—26;  Deaths,  27—47.] 


No. 

1 

2 
3 

4 
5 

6 

7 
8 

!i 
10 
11 

12 
13 

14 
15 
16 
17 
18 
19 

20 
21 

22 
23 
24 

25 

26 
27 

28 
29 
30 

31 
32 

33 

04 
35 

36 

37 

NAME, 

AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJUKY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATF. 

OF 
O  I'  K  RA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Bartley,J.P.,Pt,B, 
38th  Ind.,  age  20. 
Boelmie,  C.,  Pt.,  E, 
52d  N.  Y.,  age  33. 
Brewster,      C.      C., 
Capt,,      D.      10th 
Conn.,  age  45. 
1  Bullet,  R.  W.,  Pt., 
H,  22d  N.  C. 

Condon,  T.,  Corp'l, 
C,   2d  New  York 
Artillery,  age  21. 
Elmer,    A.,    Pt  ,    I, 
6!)th  Pa.,  ape  21. 
Furrow,  G.,  K,  10th 
Mass.,  age  20. 
Galliger.  M.,  Ft,  L, 
1st  W.Va.  Cav.,age 
31. 
Goodrich,  L.  H.,  Pt., 
B,  6th  Vt.,  age  30. 
Gould,    J.,    Pt.,    C, 
105th  Pa. 
Hoar,    J.,    Pt.,    G, 
144th  N.  Y.,  age  17. 

Johnson,      "W.     H., 
Capt.,     F,      144th 
New  York,  age  27. 
McCracken,  R.  W., 
Serg't,     C,     170th 
New  York,  age  32. 
Mangan,  J.,  Pt.,  F, 
Olst  Ohio,  age  28. 
Matters,  B..  Pt.,  A, 
108thN.  Y.,  age  18. 
Palmer,  A.,  Pt.,  G, 
3d  Mich.,  age  34. 
Renshaw,  J.  L.,  Pt., 
H,  2dPa.R.,age28. 
Rilev,  S.,  H,  92d  Pa., 
age  19. 
Sampson.  I.,  Corp'l, 
F.  1st  Mass.  Cav., 
age  35. 
Sargent,  C.,  Pt,  B, 
4th  Vt.,  age  24. 
Saulsbury.  W.,  Pt., 
K,  3«JthC.  T.,  age  36. 

Schmidt,  C.,  Corp'l, 
K,  39th  N.  Y.,  age  36. 
Smith,    H.,    Pt,   E, 
llth  Vt..  age  19. 
Stabeufe'd,   J.,   Pt, 
A,  3d  Wis.,  age  30. 
Suiumeis,  P.,  Pt.,  A, 
2d  Vermont,  age  29. 

Weaver,  L.,   Pt,  G, 
4th  Virginia,  age  23. 
Babcock,  E  ,  Pt.,  K, 
1st  Mich.  C.,  age  39. 

Boobar,   J.,  Pt,    K, 
8th  Maine,  age  49. 
Bromnn:l,W..E,  15th 
N.  Y.  Art,,  age  3D. 
Bumpus,  M.,  Pt.,  A, 
5th  Alaine,  ago  29. 

Clark,  E.  J.,  Pt.  I, 
8tl)  Mich.,  ago  30. 
Clark.  J.  \V.,  St-rg't, 
J,  129th  Ind.,  age  37. 

Dener,  C.,Pf.,  B.Oth 
Connecticut,  age32. 

Gla.ss,M.C.,Serg't.F, 
Kith  Mich.,  age  24. 
Hardf.-lter.    G.,  Pt, 
D,  104th  Pa. 
Jom-H  J.,  Pt.,  I,  27th 
Ind. 

.Kane,  J.  A.,  Corp'l, 
C,6thC.  T.,  age  33. 

Mar.  3, 
1864, 
Apr.  2, 
1865. 
May  16, 
1864. 

May  23, 
1864. 

Aug.16, 
1864. 

June  18, 
1862. 
May   5, 
1804. 
Apr.  6, 
1865. 

May  4, 
1863. 
July  30, 
1864. 
July  24, 
1863. 

Feb.  10, 
1865. 

June  17, 
1864. 

July  20, 
186*. 
July  3, 
1863. 
July  3, 
1803. 
June  24, 
1864. 
June  1, 
1864. 
May  11, 
1864. 

Dec.  13, 
1862. 
July  30, 
1864. 

May   5, 

1864. 
Sept.  13, 
1864. 
Sept,  17, 
1862. 
May   5, 
1864. 

July  2, 
1863. 
July  3, 
1863. 

May  20, 
1864. 
Mar.  31, 
18G5. 
May  10, 
1864. 

May  10, 
1804. 
July  19, 
1864. 

Juno  3, 
1864. 

Feb.  17, 
1865. 
Sept.27, 
1803. 
Aug.  9, 
1862. 

Sept.  29, 

1804. 

Fracture  bones  left 
foot. 
Fracture  left  aukle  ; 
4th,  amp.  leg. 
Flesh,  left  leg  

Fracture  right  foot  ; 
gangrene. 

Flesh,  right  leg,  mid 
dle  third. 

Fract.  tibia,  ant.  tib- 
ial  artery  divided. 
Fracture  right  tibia, 
middle  third. 
Right  ankle 

Mar.  9, 
1864. 
Apr.  11, 
1865. 
May  21, 
1864. 

June  3, 

1864. 

Aug.  26, 
1864. 

Ant.  and  post,  tibial. 
A.  A.Surg.  J.  Grant. 
Both  tibials,  on  face 
of  stump. 
Anterior  tibia],  one 
end  in  wound. 

Ant  tibial  in  wound. 
A.Surjf.R.  O'Leary, 
P.  A.  C.  S. 
Anterior  tibial,  both 
ends  iu  wound.    A. 
A.Surg.W.F.Atlee. 
Anterior  tibial     . 

Discharged  Apr.  11, 
1865. 
Discharged  Nov.  14, 
1865. 
Discharged  Sept.  19, 
1864. 

Recovered  July  23, 
1864. 

Discharged  July  26, 
1865. 

Discharged   Jan.   7, 
1865. 
Discharged  Dec.    6, 
1864. 
Discharged  Aug.  25, 
1865. 

Discharged  Mar.  19, 
1864. 
Discharged  Mar.  18, 
1865. 
Duty  Apr.  11,  1864. 

Haemorrhages  recur 
red  ;   Feb.  23,  amp. 
Disch.Mayl5,  1865. 
Discharged  Jan.  20, 
1865. 

Discharged  1865;  re- 
amputation  1806. 
Discharged  Nov.  3, 
1864. 
Discharged  May  31, 
1864. 
Discharged  May  18, 
1865. 
Discharged   Feb.   9, 
1865. 
Discharged  Oct.  16, 
1864. 

Discharged  Aug.  25, 
1863. 
Haim.;  Jan.  9,  1865, 
amputation.      Dis- 
ch'ged  May  26,  1865. 
1865,  amputation  leg. 
Disch.  July  14,  1865. 
Gangrene.    Disch'ed 
Sept,  14,  1865. 
Discharged  March  6, 
186;!. 
Discharged  May  13, 
1865. 

Paroled  Nov.  12,  1863. 

Died  Oct.    19,    1863. 
Spec.  2611,  A.M.  M. 

Died  Aug.  28,  1864. 

Died     May    2,1865; 
haemorrhage. 
May  24.  amputation. 
Died  May  -9,  1864  ; 
toxajmia. 
HOMII.   Died  June  16, 
1864;  luem.;  gang. 
Gangrene,       Died 
Sept.  1'J,  1864. 

H;t  m.;  am  p.  of  thigh. 
Died  June  18,1864; 
exhaustion. 
Died   Feb.  28,   1865; 
haemorrhage. 
Died  Oct.  12,  1863. 

Died  Aug.  20,  1862. 
Died  Oct.  13,1864. 

Apr.  10, 
11,1865. 
May  21, 
1864. 

June  —  , 

Anterior  tibial  
Amterior  tibial  .  .  . 

June  8, 
9,  1864. 

Anterior  tibial  — 

June  9, 
1864. 
Apr.  20, 
1865. 

May  10, 
1863. 
On  field. 

July  31, 
1863. 

Feb.  17, 
1865. 

June  22, 
1864. 

Aug.  15, 
1864. 
July  10, 
1863. 
Sept.  2, 
1863. 
Aug.  2, 
1864. 
July  8, 
1864. 
June  28, 
1864. 

Feb.   7, 
1863. 

Anterior  tibial,  both 
ends  in  wound. 
Ant.  tib.,  one  end  in 
wound.    A.  A.Surg. 
J.  Sweet. 
Ant.  tibial,  on  face  of 
stump. 

Fract.  left  leg,  mid 
dle  ;  7th,  amp. 

May  10, 
1863. 

Fracture  right  foot.  . 

Left  external  malle- 
olus. 

Right  fibula,  lacera 
tion  anterior  tibial 
artery;  excision. 
Flesh,  left  leg;  22d, 
amputation. 
Fracture  right  ankle 
joint;  4th,  amp. 
Fracture  left  ankle  ; 
Aug.  15,  amp. 
Flesh,  left  leg  

Left  leg,  upper  third. 
Right  leg;  gangrene 

Fracture  middle  third 
tibia;  Dec.  14,  amp. 
Flesh,    lower    third 
right  leg. 

Right  tibia,    middle 
third. 
Left  leg;  prim.  amp. 

Fracture  right  foot; 
Oct.  3,  amp.  leg. 
Fracture  tibia,  right. 

Both  legs  (also  face)  . 

Fract.    fibula,    left; 
excision;  gangrene. 

Middlethird,  leftfib- 
ula. 
Left  leg,  flesh,  lower 
third. 
Right  ankle  joint.  .  .  . 

Fracture    left    foot; 
June  4,  amp.  leg. 
Fracture     left     leg; 
prim.    amp.    upper 
third. 
Fracture  right  leg.  .  . 

Right  anterior  tibial 
artery. 
Foot;  prim.;  Syme's 
amputation. 
Fracture     left     leg; 
Aug.  13,  amp. 

Lower    third,    right 
fibula. 

July  31, 
1863. 

Feb.  17, 
1865. 

Both  tibials.    Ass't 
Surg.  "W.  Thomson, 
U.  S.  A. 
Ant.  tib.,  in  continu 
ity.    Asst.  Surg.  J. 
G.  Murphy.  T7.S.V. 
Anterior  tibial  liga- 
ted  ;  July  25,  slight 
haemorrhage. 
Ant.  tibial,  on  face  of 
stump. 
Ant.  tibial,  on  face  of 
stump. 
Ant.  tibial,  on  face  of 
stump. 
Both  ends  in  wound. 

Ant.  tibial,  in  wound  . 

Both  ends  in  wound. 
A.  A.  Surg.  T.  Lie- 
bold. 
On  face  of  stump  .  .  . 

One  end  iu  wound; 
religation. 

Anteriortibial.  Surg. 
E.  Bentle.v,  TJ.  S.  V. 
Anterior    tibial,    on 
face  of  stump. 
On  face  of  stump  .  .  . 

One  end  in  wound. 
A.   A.  Surg.  J.  F. 
Strawbridge. 
Both  ends  in  wound. 

Both  ends  in  wound. 
A.  A.  Surg.  J.  H. 
Jamar. 
Both  ends  in  w'd.   A. 
A.  Surg.  T.  Liebold. 
Anterior  tibial.  A.  A. 
Surg.  S.  \V.  Brigg.s. 
Ono  end  in  wound  .  .  . 

On  face  of  stump  .  .  . 

Anterior    tibial,    on 
faceot'  stump.  Surg. 
A.M.TVilder.U.S  V. 
One   end  in  wound. 
A.  A.  Surg.  S.  Co- 
loosdian. 
In  continuity  

In    continuity,   two 
inches  above  stump. 
Anterior  tib.,  and  iu- 
terosseous,  on  face 
of  stum  p. 
Both     tibials,    both 
ends  in  wound.     A. 
A.  Surg.  O.Warner. 

Anterior  tibial  

July  8, 
1863. 
Sept.  2, 
1863. 
Aug.  2, 
1864. 
July  8, 
1864. 
June  28, 
1864. 

Feb.   7, 
1863. 
Sept.  10, 
1804. 

Anterior  tibial  
Anterior  tibial  
Anterior  tibial  

Both  tibials 

Anterior  tibial  .  . 

May  23, 
1864. 
Sopt,26, 
1864. 
Oct.    8, 
1862. 
June  26, 
1864. 

July  14, 
1863. 
Oct.  19, 
1863. 

July  10, 
1864. 

Sept.26, 
1864. 
Oct.    8, 
1862. 
June  26, 
1864. 

July  14, 
1863. 
Oct.  19, 
1863. 

July  10, 
1864. 

Anterior  tibial  
Anterior  tibial    .  . 

Anterior  tibial  .... 

Anterior  tibial; 
sloughed. 

Anterior  tibial  
Anterior  tibial   .. 

May  19, 
1864. 

June  6, 
1864. 
July  19, 
1864. 

June  12, 
1864. 

Feb.  20, 
1865. 
Oct.    3, 
1863. 
Aug.  18, 
1862. 

Oct.    8- 

12,  1864. 

Branch  tibial  
Anterior  tibial  

May  19, 
Ie64. 

Junel6, 
1864. 
July  19, 
1864. 

Junel2, 
1864. 

Fob.  20, 
1865. 
Oct.    3, 
1863. 
Aug.18, 
1862. 

Oct.  12, 
1864. 

Anterior  tibial  

Ulceration  anterior 
tibial. 
Anterior  tibial 

Anterior  tibial;  in- 
terosseous. 

Anterior  and  pos 
terior  tibials. 

1  Confederate  States  Mudical  and  Surgical  Journal,  Volume  I,  p.  177. 


CHAP.  X1I.J 


LIGATION    OF    THE    POSTERIOR    TIBIAL    ARTERY. 


803 


No. 

NAME, 

AGK,  AND  MlLITAKY 

DESCRIPTION. 

BATE 

OF 

INJURY. 

NATURE  OF  INJUKY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

?fl 

Kercher   J.,  D    7th 

July  2, 

Right  leg,  wound  of 

July  29 

Until  tibial  arteries 

39 

40 

41 

Mich.  Cav. 
McCauley,  S.  E.,  Pt., 
n,  28th  Iowa,  age  19. 
Partridge,      G.     V., 
Saddler,  B,  4th  Mas 
sachusetts       Cav., 
age  21. 
Poctcn,  W.  F.,  Pt.,  C, 

1863. 
Oct  19, 
18G4. 
April  2, 
18G4. 

Nov.  30, 

both  tibial  arteries. 
Fracture   right  tar 
sus;  Nov.  7,amp.leg. 
Fracture  left  tibia, 
and     injury     ant. 
tibial  artery. 

Eight  tibia,  middle 

Nov.  11, 
1864. 
April  9, 
1864. 

Mar.  23, 

Anterior  tibial  ar 
tery. 
Anterior  tibial  

Anterior  tibial  .... 

1663. 
Nov.  11, 
1864. 
April  9, 
1864. 

Mar.  23, 

ligated. 
On  lace  of  stump  

In  wound,  one  end: 
April   27,    haemor 
rhage  recurred. 

On  face  of  stump  .  . 

Died  Ang  10,  1803. 
Du-d  Nov.   19,  1804; 
haetno-  rhage. 
Died    May  2,   1864; 
haemorrhage;     py 
aemia. 

March  -4  1805  amp 

42 
4T 

9th  Miss.,  age  24. 

Robhins,  E.  H.,  Cor 
poral,  F,  15th  Mass 
achusetts,  age  29. 
Scbreiber,  A.,  Pt.,  A, 

1864. 

May  6, 
18C4. 

Mav  10, 

third;  Mar.  19,  '65, 
amputation. 
Fracture  fibula,  inj. 
ant.  tibial  artery. 

Fracture  right  tibia. 

18C5. 

Mav  31, 

1804. 

Mav  19, 

Anterior  tibial  

1865. 

May  31, 
1864. 

May  19 

In  continuity.  A.  A. 
Surg.  J.  Ransom. 

thigh.    Died  April 
20,  1865. 
June    2,   amputated 
thigh.     Died  July 
15,1864. 

44 

45 

50th  Peun.,  age  17. 
Skiffington,    J.,  Pt., 
I,    2d    New    York 
H.  A.,  age  28. 
Wilkins,  T.  -E.,Corp'l, 

1804. 
June  10, 
1864. 

Oct.  19, 

Flesh,  right  leg  
Fract.  fib.,  sev.  ant. 

1864. 
July  28, 
1864. 

Anterior  tibial  .  .  . 

1864. 
Julv  28, 
1864. 

Both  ends  in  wound. 
A.  A.  Surg.  W.  F. 
Atlce. 
Both  tibials-  Oct  31 

Died  June  9,  1864  ; 
pyaemia. 
Died  Aug.  29,  1864; 
pyaemia. 
Died  Nov   I1'    1804- 

46 
47 

A,  49th  Virginia. 
Williams,  E.,  Pt.  F, 
136th  Penn.,  age  45. 
Williams,  II.  H.,  Pt., 
D,  19th  Maine. 

1864. 
Dec.  13, 
1862. 
July  2, 
1863. 

and  post.  lib.  arts. 
Ant.  tibial  art.;  Dec. 
28,  haem.;  amp. 
Fracture   tibia   and 
lib.,  lower  third. 

Jan.  1, 
1863. 
July  12, 
1863. 

Anterior  tibial  
Anterior  tibial  

Jan.  1, 
1803. 
July  12, 
1863. 

amputated  thigh. 
On  face  of  stump  

In  continiiitv.  A.  A. 
Surg.F.  T.ilaury. 

haemorrhage. 
Died    Jan.   1,   1803; 
pyaemia. 
Died  July  18,  1863. 

Ligations  of  the  branches  of  the  anterior  tibial  artery  were  reported — one  of  the  dorsalis 
pedis  and  two  of  the  interosseous ;  one  of  the  latter  was  fatal: 

CASES  1166-1168. — Private  J.  Johnson,  D,  4th  U.  S.  Artillery,  age  36;  fracture  of  metatareal  bone  of  great  toe  May  14, 
1864  ;  gangrene ;  July  20th,  ligation  of  dorsalis  pedis,  both  ends  being  tied  in  wound  by  Surgeon  A.  Hegner,  U.  S.  A. — Sergeant 
H.  S.  Foster,  E,  104th  New  York,  age  22;  fracture  of  left  os  calcis  July  1,  1863;  amputation  of  leg  July  8th  ;  haemorrhage 
from  interosseous  July  10th;  interosseous  ligated  on  face  of  stump;  discharged  March  22,  1864. — Captain  J.  Brown,  H,  92d 
Ohio ;  shot  wound  of  right  foot  September  19,  1863 ;  amputation  of  leg  September  27th ;  haemorrhage  from  interosseous  Septem 
ber  29th;  artery  ligated  on  face  of  stump  on  the  same  day;  died  October  5,  1863,  from  effects  of  haemorrhage. 

Ligations  of  the  Posterior  Tibial  Artery . — Forty-eight  cases  were  reported  in  which  the 
posterior  tibial  artery  alone  was  ligated;  twenty-nine  ended  in  recovery,  nineteen  in  death, 
a  fatality  rate  of  39.5  per  cent.  Ten  were  operations  on  the  face  of  the  stump  after  ampu 
tation  of  the  leg. 

TABLE  CXLVI. 
Summary  of  Forty-eight  Ligations  of  the  Posterior  Tibial  Artery. 

[Recoveries,  1—29 ;  Deaths,  30 — 48.] 


No. 

1 
2 
3 

4 

5 

6 

7 

8 
9 

10 
11 

NAME, 

AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
HEMORRHAGE. 

DATS 

OF 

OPERA 
TION. 

OPERATION,  OPERA 
TOR. 

RESULT. 

Ball,  J.   D.,  Corp'l, 
A,    125th    N.    Y., 
age  24. 
Bowers.   G.,  Pt.,   B, 
77th  N.  Y.,  age  31. 

Brazzle,  J.,  Pt.,  G, 
23d  Mo.,  age  18. 

Buckner,   J.  F.,  1st 
C.  S.  A.,  age  21. 
Cashdollar,    L.   W., 
Pt.,  C,  128th  N.  Y., 
age  21. 
Clark,    P.,    Pt.,    D, 
140th  X.  Y.,  age  28. 
Collins.    O.,   Pt,,   D, 
151st  N.  Y.,  age  32. 

Copas,  W.  A.,  Serg., 
B,  30th  Ohio,  nge  28. 
Dorr,  J.  A.,  Pt..   E, 
136th  X.  Y.,age  20. 

Du  Bow,  L.  A.,  Lt., 
1.  120th  X.  Y.,  age 
21. 
Emorv,    R.,    Pt.,   D, 
5th  Vt.,  age  33. 

May  18, 
1864. 

Sept.19, 
1864. 

Sept.  1, 
1804. 

Apr.    6, 
1862. 
Sept.  19, 
1864. 

July    2, 

1863. 
Nov.  27, 
1863. 

Sept.  19, 

1864. 
May  20, 
1864. 

Sept.20, 
1861. 

Mav  5, 
1864. 

Flesh,  right  leg,  di 
viding  post,  tibial. 

Fract.  right  fibula; 
excision. 

Fractured  left  fibula. 
Ri^ht  le"1 

Mav  28, 
1864. 

Nov.  13, 
1864. 

Jan.  1,3, 
9,  1865. 

Apr.  16 

Post,  tibial  

Mav  28, 
1864. 

Both  ends  in  wound. 
Asst.  Surg.  A.  IL- 
gram,  U.  S.  A. 
Ligation    bv    Asst. 
Surg.R.F.'Wier.U. 
S.  A. 
One  end  in  wound. 
A.  A.  Sing.  A.  A. 
Greene. 
Li"utiou      

Discharged  Dec.  29, 
1864. 

Discharged  June  5, 
1805. 

Discharged  July  26, 
1865. 

Recovery. 

Discharged  May  30, 
1865. 

Recovery. 

Discharged  Feb.  25, 
1865. 

Discharged  Juiio  5, 
1865 
Discharged  Juno  13, 
1865. 

Discharged  Jan.  10, 
1865. 

Discharged   Dec.  16, 
1804;    Aug.,    1865, 
uiup. 

Jan.    9, 
1805. 

Apr.  10, 
1802. 
Oct.  27, 
1864. 

Jnlv  10, 
1863. 
Dec.    9, 
1863. 

Oct.  27, 
1864. 
Mav  20, 
1864. 

Sept.20, 
1864. 

Aug.  4, 
1804. 

Fract'd  right  tibia; 
20th,  amputated. 

Right  ankle  ;  3d,  am 
putated. 
Fracturd  left  fibula; 
excision. 

Fract.  middle,  right 
leg  ;  Oct.  26,  amp.- 
Right  ankle,  sever 
ing  post,  tibial  art. 

Right  foot,   lacerat 
ing  post,  tibial. 

Left  leg;  gangrene.. 

1862. 
Oct.  27, 
1864. 

July  10, 
1863. 
Dec.    9, 
1863. 

Oct.  27, 

1804. 

On  face  of  stump  

On  face  of  stump  

In  wound,  both  ends. 
Surg.   E.    Bent  ley, 
TJ.  S.  V. 
On  face  of  stump  .. 

Below  int.  mallolus. 
Surg  I.  N.  Himos, 
73d  Ohio. 
Ligation.  Stuj.H.F. 
Lyster,  5th  Mich. 

Both  ends  in  wound. 
A.  A.  Surg.  J.  B. 
i  niudnll. 

Post,  tibial  
Post,  tibial  

Post  tibial 

Post,  tibial  
Post,  tibial  

Aug.  4, 
1864. 

Post  tibial 

804 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

12 
13 

14 
15 

16 
17 

18 
19 

20 

21 
22 

23 
24 
25 
26 

27 
28 
29 
30 
31 
32 

33 
34 
35 

36 
37 

38 

39 
40 
41 
42 

43 
44 
45 
46 
47 
48 

NAMB, 
AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 
HAEMOR 
RHAGE. 

PROBABLE  SOURCE 

OF 
H-KMOKRHAOE. 

DATE 

OF 

OPERA 
TION. 

OI-E  RATION,  OPERA 
TOR. 

RESULT. 

Gilmore,  M  ,  Pt.,  B, 
96th  111.,  age  22. 
Hagoy,  J.  D.,  Pt,,  I, 
138th  Pa.,  ago  24. 

Ingalls.  H.  B.,  L,  1st 
Me.  Oav.,  age  25. 
Johnson,  A.  J..  Corp., 
A,  19th  Intl.,  age  25. 

Johnson,  H.  C.,  Sgt, 
C,  28th  Ky.,  age  25. 
Jones,  S.  W.,  Corp., 
A,  4th  Del.,  age  29. 

Leichty,  J.,  Pt,  F, 
8th  Pa.  C.,  age  21. 
Lowth,  J..  Sgt,,  M, 
4th  Wis.  C.,  age  26. 

McCartv,  J.,  Pt.,  F, 
48th  N.  Y.,  age  38. 

Moran,  M.,  Pt.,  A, 
2dN.  J.  C.,  age  20. 
Poole    E  E.    Pt.,E, 

Aug.  3, 
1864. 
Apr.   2, 
1865. 

Mar.  31, 
1865. 
July  1, 
1863. 

Feb.   4, 
1864. 
Oct.     8, 
1864. 

May  11, 
1864. 
Ausr.24, 
1864. 

Mar.  2, 
1864. 

Feh.  11, 

1864. 
Nov.  30, 

Flesh,  left  leg,   inv. 
post,  tibia). 
Flesh,  left  leg,  artery 
opened. 

Middle,    right     leg, 
flesh. 
Fr.  left  fibula,  mid.: 
gangrene. 

Left  ankle  ;  Feb.  25, 
amp.  leg,  lower  3d. 
Fract.  left  fibula  .... 

Aug.  3, 
1864. 
Apr.  21- 
28,  1865. 

Apr.  7, 
9,  1865. 
Nov.  23, 
1863. 

Feb.  25, 
1864. 

Aug.  3, 
1864. 
May  8, 
1865. 

Apr.  9, 
1865. 
Nov.  23, 
1863. 

Feb.  25, 
1864. 
In  field. 

Ligation.  Surg.  S.  H. 
Kersey,  36th  Ind. 
One  end   in  wound. 
A.  A.  Surg.  H.  M. 
Bellows. 
Ligation.     Surg.    E. 
Griswold,  U.  S.  V. 
One  end  in  wound. 
A.  A.  Surg.  J.  H. 
Janiar. 
Oii  face,  in  stump  .  .  . 

Post,  tibial  and  pero- 
neal.    Surg.  A.  A. 
White,  8th  Md. 

Discharged  Jan.  10, 
1S65. 
May  9,  1865,  amp.  leg. 
Discharg'd  July  26, 
1865. 
Discharged  Aug.  12, 
1865. 
Discharged  Mar.  30, 
1864. 

Discharged  Dec.  16, 
1864. 
Discharged  June  22, 
1865. 

Discharged  Jan.  11, 
1865. 
Gang.  ;  amp.    thigh. 
Discharg'd  July  17, 
1865. 
Amp.  foot  ;  amp.  leg. 
Discharg'd  June  10, 
1865.    Died  in  1874. 
Discharged  Oct  21, 
1865. 
To  Provost  Marshal. 

Furloughed  Aug.  11, 
1864. 
Discharged  July  27, 
1866. 
Discharged   Feb.   6, 
1865. 
Duty  March  30,  1865. 

Discharged  Aug.  4, 
1865. 
Discharged  Nov.  17, 
1863. 
Discharged  Oct.  27, 
1863. 
Died  July  28,  1862. 

Died   July    7,  1864  ; 
pyaemia. 
Died  Feb.  14,  1865. 

Died  June  15,  1865; 
erysipelas. 

Disch.  Aug.  31.  Died 
Nov.  17,  1863. 

Died  June  17,  1864  ; 
exhaustion. 

Died  June  13,  1864. 
Died  Nov.  9,  1864. 

Died  Aug.  8,  1864. 
Died  Nov.  23,  1864. 
Died  April  19,  1865. 
Died  Jan.  11,  1863. 

Died  October  1,1862; 
exhaustion. 

Died  June  30,  1864. 

Haem'ge  ;  gangrene. 
Died  Sept.  25,  1803. 
Died  March  23,  1865  , 
exhaustion. 
Died  Nov.  22,  1864. 

Died  Aug.  30,  1865  ; 
exhaustion. 
Amp.  leg.   Died  May 
28,  '64;  ex  'n  and  py. 

Post,  tibial  

Branch  post,  tibial 
Post,  tibial  

Fract.  left  fibula;  ex 
cision. 
Fr.   up.  third  right 
fibula;  May  27/65, 
rxcis. 
Fr.  foot,  dorsal  pedis 
and  int.  plant,  ar 
teries. 
Right   leg,    middle, 
flesh;  gangrene. 
Frac.  middle,   right 
femur. 

Flesh,  left  leg  

Flesh,  left  leg,  upper 
third. 
Flesh,  right  leg  

Right  leg,  middle  

Severing  post,  tibial 
artery,  right  leg. 
Flesh,  right  leg  

Left  leg,  fract  lower 
third;  5tb.  amp. 
Fract  left  fibula  .... 

Flesh,  right  leg  

Fract.  right  tib.,  lac. 
post.  tib.  artery. 

Left  leg,  lower  third, 
inj.  post.  tib.  artery. 

Fr.  tib.  and  fiUbla; 
prim.  amp.  right  leg. 

Fr.  low.  third  rtfib.; 
June  9,  exc. 

Fract.  tibia  

Post,  tibial 

May  27, 
1865. 

Mar.  2, 
1864. 

Feb.  27, 
1864. 
Mar.  1, 
1865. 

July  3, 
1864. 
April  6, 
1865. 
July  25, 
1863. 
Oct  14, 
17,  19,  '64. 

May  27, 
1865. 

Mar.  2, 
1864. 

Fob.  27, 
1864. 
Mar.  1, 
1865. 

July  3, 
1864. 
April  7, 
1865. 
July  25, 
1863. 
Oct.  19, 
1864. 

On  field. 

Sept  23, 
1863. 
May  12, 
1863. 
July  10, 
1862. 
June  10, 
1864. 
Dec.  27, 
1864. 

In  continuity,  upper 
third. 

In  cont.  behind  int. 
malleolus. 

In    wound.     A.  A. 
Surg.  S.  S.  Jessop. 
In  wound,  both  ends. 
Surg.  B.  B.  Breed, 
T7.S  V. 
Ligation  

Ligated  by  Surg.  G. 
L.  Pancoast,  U.  S.  V. 
Both  ends  in  wound. 

Both  ends  in  wound. 
A.  A.  Surg.  J.  W. 
Kerr. 
Ligation    

Post,  tibial 

Post,  tibial  

17th  Ala.,  age  18. 

Rigsbv,   T.,  Pt,  C, 
9th  N.  H.,  age  23. 
'Ritter,  D.  T.,Corp'l, 
F,  208th  Pa.,  age  19. 
Sheridan,  J.,  D,  68th 
Pa.,  age  31. 
Thompson,   S.,   Pt., 
E,  4th  N.  J.,  age  23. 

Trask.H.V.,  Ft,  G, 
120th  N.T.,  age  27. 
Trowbvidge,  D.  A., 
L,  5th  III.  Cav. 
Valentino,    L.    W., 
Pt.,  K,  6th  Maine. 
Adams,  M.J.,Pt.,D, 
20th  Indiana. 
Brown,  W.H.,  5th  N. 
J.  Battery,  age  25. 
Cramp,  T.,'Pt,G,  5th 
Minn.,  age  33. 

Flannigan,    H.    A., 
Scrg't  H,  16th  Pa. 
Cav.,  age  25. 
Fogle.  M.  P.,  Corp'l, 
A,  133d  N.  Y.,  age 
3L 
Freeman,  G.  B.,  Pt, 
F,  58th  Mass.,  age 
32. 
Fuller  C.  E.   Pt.  D 

1864. 

June  20, 
1864. 
Mar.  25, 
1865.  . 
July  3, 
1863. 
Sept.  22, 
1864. 

Mar.  25, 
1865. 
July   8, 
1863. 
May  3, 
1863. 
June  25, 
1862. 
May  24, 
1864. 
Dec.  16, 
1864. 

April  7, 
1865. 

June  14, 
1863. 

June  3, 

1864. 

June  3, 

1864. 
Oct.  19, 
1864. 

July  9, 
1864. 
Oct.  1, 
1864. 
Mar.  25. 
1865. 
Dec.  13, 
1862. 
Sept.  14, 
1862. 

May  27, 
1864. 
July  2, 
1863. 
Mar.  8, 
1865. 
Aug.  3. 
1864. 
Apr.  1, 
1865. 
May  5, 
1864. 

Post,  tibial  

Post  tibial 

Sept.  23, 
1863. 
May  12, 
1863. 
July  10, 
1S62. 
June  10, 
1864. 
Dec.  27, 
1864. 

May  14, 
1865. 

June  23, 
1863. 

June  9, 
1864. 

Post  tibial 

In  wound    

On  face  of  stump  
Ligation 

Ligation  

Both  ends  in  wound. 
A.  A.  Surg.  S.  W. 
Blackwood. 
In  cont,  mid.  third  .  . 

On  face  of  stump  
Ligated    

Post,  tibial  

Post  tibial  

June  23, 
1863. 

On  field. 

Oct.  31, 
1864. 

Aug.  5, 
1864. 
Oct.  29, 
1864. 
Apr.  5, 
1865. 
Jan.  2, 
1863. 
Oct.  2, 
1862. 

June  22, 
1864. 
July  24, 
1863. 
Mar.  8, 
1865. 
Oilfield. 

Apr.  26, 
1865. 
May  23, 
1864. 

36th  Wisconsin. 
Gaffnev.  M.,  Pt.,  A, 
H4th'N.Y.,  age  27. 

Hoasch,  G.,  Pt,   E, 
110th  Ohio,  age  45. 
Hodgkius,  F.,  G,  1st 
Mass.  C.,  ago  29. 
-  Jones,  W.  H.,  Pt., 
E,G5th.V.Y.,age26. 
McCluskev,  P.,  Sgt, 
F,26thN'.Y.,age27. 
3Matht-rson,  R.,Col.. 
32d  New  York. 

Miller,  H.  L.,  Pt.,B, 
9i!d  Ohio,  ago  27. 
Moore,  C.,  Serg't,  D, 
42d  N.  Y.,  age  40. 
Oakley,  C.N.,Pt,A, 
85th  N.  Y.,age  32. 
Tyler,  C.,  Lieut.,  D, 
1291  h  Indiana. 
Vaughn,  N.,  Pt,  H, 
1st  Va.,  age  30. 
Wright.  E.,  Pt,   F, 
119th  Pa.,  age  18. 

Bones  left  foot 

Oct.  31, 
1864. 

Aug.  4,  5, 
1864, 
Oct.  29, 
1864. 
Apr.  3, 
1865. 
Jaii.  2, 
1863. 
Sept  20, 
Oct.  1, 
1862. 

July  19, 
24,'  '63. 

In  cont.,  low.  third. 
A.  A.  Surg.  E.  L. 
Duer. 
On  face  of  stump  .  .  . 

One  end  in  wound  .  .  . 
Both  ends  in  wound  . 
On  face  of  stump  

Both  ends  in  wound. 
Surg.   G.  Burr,   U. 

s.v! 

Ligation  

Ligat'n.    Aug.  1,  '63, 
amp.  leg. 
Lig.  post,  tibial  and 
peroneal  arteries. 
Both  ends  in  wound 

On  face  of  stump.  .  . 

In  wound;  May  25, 
haem.  rec'd. 

Both  bones  left  leg; 
llth,  amp.  leg. 

Post  tibial 

Left  fibula,  post,  tib 
ial  artery  cut. 
Fract.  left  leg  ;  prim, 
amp.  upper  third. 
Fr.  right  fibula  and 
inj.  post,  tibial. 

Fract.  middle   third 
right  fibula. 
Fracture  left  ankle  .  . 

Lac.  flesh  left  leg  .    . 

Post,  tibial  
Post,  tibial  
Post,  tibial  

Post,  tibial  

Os  calcis  and  post, 
tib.  artery. 
Fr.  left  aiikle  joint, 
April  20,  amp.  leg. 
Post,  tibial  artery  of 
right  leg. 

Apr.  26, 
1865. 
May  22, 
23,  '64. 

Post  tibial  ........ 
Post,  tibial   

The  plantar  branch  of  the  posterior  tibial  was  ligated,  in  three  cases,  on  the  face  of  the 
slump  after  partial  amputations  of  the  foot;  one  case  resulted  in  death: 

1  LIDELL  (J.  A.),  On  the  Wounds  of  Blood-vessels,  etc.,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  p.  262. 
"LiDELL  (J.  A.),  On  the  Wounds  of  Blood-vessels,  etc.,  in  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  p.  223. 
3  American  Medical  Times,  Vol.  VI,  p.  101.  U.  S.  Sanitary  Commission  Memoirs,  Surgical  Volume  I,  p.  46. 


CHAP.  XII.J 


HAEMORRHAGES    AND    LIGATIONS — CONCLUDING    OBSP^RVATIONS. 


805 


Lifjations  of  Plantar  Arteries. — CASES  1169-1171. — Private  D.  Bailey,  G,  3d  Iowa  Cavalry,  age  26;  shell  wound  of  right 
foot  June  10,  1864 ;  June  14th,  removal  of  metatarsal  bones;  external  plantar  ligated  by  A.  A.  Surgeon  J.  N.  Sharp;  February, 
1865,  amputation  of  leg  at  lower  third ;  discharged  September  11, 1865. — Private  J.  Belts,  K,  2d  New  Hampshire,  age  25 ;  wound 
of  toes  of  left  foot  May  27,  1864 ;  May  28,  amputation  of  three  toes ;  June  9,  haemorrhage  from  plantar ;  vessel  ligated  on  face  of 
stump ;  returned  to  duty  July  4,  1864. — Private  W.  Mockler,  G,  81st  Pennsylvania,  age  47;  shot  fractune  of  right  foot  Decem 
ber  13, 1862  ;  December  26,  Chopart's  amputation  ;  December  31,  haemorrhage  from  external  and  internal  planter  arteries;  liga- 
tion  on  face  of  stump  on  the  same  day;  death  January  10,  1863. 

Of  four  ligations  of  the  peroneal  artery  three  had  fatal  terminations;  the  operation 
was  on  the  face  of  the  stump  after  amputation  in  the  leg  in  one  case. 

Ligations  of  the  Peroneal  Artery. — CASES  1172-1175. — Private  O.  F.  Nash,  K,  12th  Wisconsin,  age  21 ;  shot  wound  of 
leg  August  23,  1864;  August  27,  resection  of  four  inches  of  middle  third  of  left  fibula;  artery  ligated  by  Surgeon  A.  J.  Miller, 
13th  Iowa;  discharged  June  30,  1865. — Private  J.  E.  DeWitt,  A,  9th  New  York  Cavalry,  age  23;  shot  fracture  of  fibula  June 
21,  1864;  bleedings  from  peroneal  June  24,  25;  June  25,  fractured  portion  of  fibula  excised  and  peroneal  artery  ligated  by  A.  A. 
Surgeon  O.  P.  Sweet;  death  June  25,  1864. — Private  C.  E.  Eastman,  F,  9th  Maine;  shot  fracture  of  left  leg  July  18th;  ampu 
tation  of  leg  July  23d;  sloughing;  haemorrhage  from  peroneal;  artery  ligated  on  face  of  stump  by  Surgeon  D.  Merritt,  55th 
Pennsylvania. — Private  S.  Mitchell,  D,  188th  Penn.,  age  23 ;  shot  fracture  of  left  fibula  June  3,  1864  ;  haemorrhage  from  peroneal 
June  27th;  ligation  of  peroneal  and  removal  of  two  inches  of  fibula  by  A.  A.  Surgeon  A.  W.  Merrill;  death  August  17,  1864. 

General  Remarks  on  Haemorrhages  and  Ligations. — It  has  been  found  most  con 
venient  in  dealing  with  the  cases  of  hemorrhage  to  classify  them  simply  as  primary  and 
secondary.  While  undoubtedly  some  of  these  bleedings  occurred  a  short  time  after  the 
injury  and  before  the  period  of  suppuration  had  commenced,  it  was  found  impossible,  from  the 
nature  of  the  records,  to  eliminate  these  cases  with  certainty  and  accuracy;  and  inasmuch 
as  such  haemorrhages  partook  more  or  less  of  a  primary  or  secondary  character  they  have 
been  assi'gned  to  one  or  the  other  of  these  groups.  In  the  following  table  are  indicated  the 
days  on  which  ha3morrhage  first  occurred : 

TABLE  OXLVII. 
Table  indicating  the  days  on  which  the  first  haemorrhage  occurred. 


Day  after  injury  on  which 
the  haemorrhage  occur 
red. 

V 

§ 
0 

Head,  chest,  and  up 
per  extremities. 

Abdomen,  pelvis,  and 
lower  extremities. 

Day  after  injury  ou  which 
the  haemorrhage  occur 
red. 

O 

Head,  chest,  and  up-' 
per  extremities. 

Abdomen,  pelvis,  and 
lower  extremities. 

Day  after  injury  on  which 
the  htemorrhage  occur 
red. 

« 
o 

3 

ty 

Head,  chest,  and  up 
per  cxtromities. 

Abdomen,  pelvis,  and 
lower  extremities. 

1st  day  

153 

68 

85 

Forward  

788 

425 

363 

Forward  

1,166 

644 

522 

2d  day 

17 

5 

12 

15th  day 

51 

36 

15 

27th  day 

13 

8 

5 

3d  day  .  -  - 

17 

6 

11 

16th  day  

40 

21 

19 

28th  day  

17 

12 

5 

4th  day 

26 

n 

9 

17th  day 

41 

20 

91 

29th  day 

13 

8 

5 

5th  day  

24 

15 

9 

18th  day  

39 

24 

15 

30th  day     ... 

5 

3 

2 

6th  day 

37 

90 

15 

19th  day 

33 

19 

14 

31  to  40  days 

102 

51 

51 

7th  day  

62 

36 

26 

20th  day  

20 

9 

11 

41  to  50  days  .              

57 

25 

32 

8th  day  . 

58 

34 

24 

21st  day 

35 

23 

12 

51  to  60  days 

40 

15 

25 

9th  day  

68 

35 

33 

22d  day 

34 

16 

18 

61  to  70  days    

21 

6 

15 

10th  day  

71 

37 

34 

23d  day 

28 

17 

11 

71  to  80  days 

10 

1 

9 

llth  day   

44 

27 

24th  day    

23 

15 

g 

81  to  90  days     

8 

3 

5 

12th  day  

C8 

43 

25 

25th  day 

14 

(5 

8 

91  to  100  days      -  ... 

6 

G 

13th  day  

64 

33 

31 

26th  day 

20 

13 

7 

4 

18 

1,166 

644 

522 

1,480 

780 

700 

The  number  of  bleedings  on  the  first  day  was  one  hundred  and  fifty-three  (153),  of 
which  one  hundred  and  ten  (110)  were  haemorrhages  immediately  following  the  injury 
(strictly  primary,  see  TABLE  CXXIV,  p.  763),  while  forty-three  (43)  occurred  at  some  period 
within  the  first  twenty-four  hours  succeeding  the  injury.  Should  it  be  deemed  desirable 
to  make  a  group  of  intermediary  cases,  these  forty-three  cases  with  those  occurring  on  the 
second  and  third  days  should  probably  be  so  classified.  Those  of  the  first  day  undoubtedly 


806  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

partook  of  the  character  of  primary  haemorrhage  and  were  results  of  reaction ;  as  to  those 
of  the  second  and  third  days  the  data  are  insufficient  to  determine  their  proper  classification. 
By  the  fourth  day  sufficient  time  had  elapsed  to  allow  such  changes  as  result  from  inflamma 
tory  action  and  which  are  recognized  as  productive  of  secondary  haemorrhage,  and  it  will 
be  noticed  that  from  this  day  the  bleedings  perceptibly  increase  and  steadily  maintain  an 
upward  tendency  until  the  tenth  and  eleventh  days,  when  the  greatest  number  of  haem 
orrhages  occurred.  From  this  point  their  frequency  gradually  and  somewhat  regularly 
diminishes  until  the  thirtieth  day;  after  this  time  they  lose  their  regularity  and  occur  at 
various  intervals,  subject  to  infectious  diseases  or  other  peculiar  conditions  attending  each 
case.  Examples  of  long-deferred  hsemorrhages  were  not  rare.  In  the  case  of  Mullan,  cited 
in  TABLE  XLIX,  on  page  650  of  the  Second  Surgical  Volume,  haamorrhage  did  not  occur 
until  the  264th  day,  and  in  the  following  case  the  first  bleeding  took  place  on  the  122d  day: 

CASE  117G. — J.  Brazzle,  Co.  G,  23d  Missouri,  aged  18  years,  was  wounded  in  both  legs,  at  the  battle  of  Jonesboro',  Sep 
tember  1,  1864.  He  passed  through  several  hospitals,  lastly  entering  No.  8,  at  New  Albany,  on  December  2d.  Assistant  Sur 
geon  S.  M.  Horton,  U.  S.  A.,  in  charge  of  the  latter,  reported:  "The  wound  was  caused  by  a  minie  ball,  which  entered  the 
left  leg  at  the  inner  edge  of  the  gastrocnemius  muscle,  three  inches  below  the  knee  joint,  and  passed  out  at  the  opposite  side  of 
the  leg,  splintering  the  fibula  in  its  course.  No  haemorrhage  took  place  at  the  time  the  wound  was  received,  but  three  attacks 
occurred  in  this  hospital,  the  first  on  January  1st,  the  second  on  January  3d,  and  the  third  six  days  later.  The  entire  loss  of 
blood  amounted  to  about  a  quart,  and  its  source  was  the  posterior  tibial  artery,  the  cardiac  extremity  of  which  was  ligated  at 
the  bottom  of  the  wound,  on  January  9th,  by  Acting  Assistant  Surgeon  A.  S.  Greene.  Chloroform  constituted  the  anajsthetic. 
At  the  time  of  the  operation  the  wound  was  in  a  healthy  condition  and  the  patient  was  in  good  health,  but  looked  exsanguineous 
from  the  repeated  losses  of  blood.  No  recurrence  of  haemorrhage  followed  after  the  operation.  Erysipelas,  in  a  mild  degree, 
subsequently  attacked  the  leg,  leaving  it  wdematous.  By  March  31st  the  wound  had  not  yet  healed,  but  was* discharging 
unhealthy  pus,  giving  evidence  of  caries  of  fibula  at  the  site  of  the  wound."  The  patient  was  subsequently  transferred  as  a 
convalescent  to  Joe  Holt  Hospital,  and  on  July  26,  1865,  he  was  discharged  from  service  and  pensioned.  Examiner  G.  W 
Newman,  of  Bethany,  Mo.,  May  8,  1867,  certified  to  the  injury,  and  added:  "From  appearance  there  is  yet  some  detached 
pieces  of  the  fibula  in  the  wound.  The  wound  is  running,  the  leg  is  considerably  enlarged,  and  the  gastrocnemius  muscle  con 
tracted  so  that  he  cannot  bend  the  foot  forward,  and  walks  with  difficulty."  Two  years  later  the  same  examiner  stated:  "The 
wound  has  not  discharged  for  ten  or  twelve  months.  I  think  the  leg  will  gradually  improve,"  &c.  Examining  Surgeon  J. 
Walker,  at  subsequent  dates,  reported  the  wound  of  the  right  leg,  made  by  the  missile  passing  through  the  calf  of  that  limb 
before  entering  the  left  leg,  produced  no  disability,  but  that  the  left  leg  is  wasted  and  its  motion  much  impaired,  flexure  being 
confined  to  a  right  angle,  and  the  limb  requiring  to  be  bandaged  to  prevent  swelling.  In  May,  1877,  the  exit  wound  was 
reported  to  be  suppurating  occasionally.  The  pensioner  was  paid  September  4,  1880. 

In  another  instance — a  case  of  fracture  of  the  humerus — haemorrhage  from  sloughing 
did  not  occur  until  the  one  hundred  and  twenty-ninth  day,  necessitating,  at  that  late  period, 
amputation  of  the  arm: 

CASE  1177. — Sergeant  M.  Bumgardner,  Co.  B,  9th  Iowa,  was  wounded  in  the  right  arm  during  the  assault  on  Vicksburg, 
May  22,  186:5.  He  was  treated  at  a  field  hospital  for  some  weeks,  and  subsequently  at  JeS'ersou  Barracks.  Surgeon  J.  F. 
Randolph,  U.  S.  A.,  in  charge  of  the  latter  hospital,  made  the  following  report:  "The  injury  consisted  of  a  fracture  of  the 
humerus,  lower  third,  and  was  caused  by  a  round  ball.  The  wound  became  gangrenous  and  sloughing,  causing  haemorrhage 
from  the  biachial  artery  to  the  amount  of  thretj  pints  on  September  28th.  The  bleeding  was  checked,  but  recurred  on  October 
9.<\,  when  circular  amputation  of  the  arm  was  performed  at  the  upper  third  by  Assistant  Surgeon  II.  E.  Tilton,  U.  S.  A.  Equal 
parts  of  ether  and  chloroform  were  used  as  an  anaesthetic,  from  which  the  patient  reacted  tardily.  At  the  conclusion  of  the 
operation  hut  little  hope  was  entertained  of  his  recovery,  and  for  several  days  afterwards  he  continued  very  weak.  Under  a 
treatment,  however,  of  tonics  and  stimulants,  and  cold  water  applications  to  the  stump,  the  patient  subsequently  rapidly 
improved."  On  December  3,  1863,  he  was  discharged  from  service  and  pensioned,  and  subsequently  he  was  supplied  with  an 
artificial  arm  of  the  "Lincoln"  pattern.  In  his  application  for  commutation  the  pensioner  described  the  stump  as  being  in  a 
sound  condition.  The  pensioner  was  paid  June  4,  1881. 

Not  unfrequently  the  haemorrhage  following  immediately  upon  the  injury  ceased  spon 
taneously  only  to  return  at  a  later  period,  generally  in  the  evening  or  during  the  night,  at 
times  when  the  reactionary  process,  or  the  wound  fever,  were  most  pronounced : 

CASE  1178. — Sergeant  Christian  Geisel,  Co.  II,  6th  Pennsylvania  Cavalry,  aged  25  years,  was  wounded  at  Spottsylvania, 
May  12,  1864.  On  May  16th  he  was  admitted  into  Hammond  General  Hospital,  Point  Lookout,  Maryland,  whence  Surgeon  A. 
Heger,  U.  S.  A.,  reported:  "  Gunshot  wound  right  side  of  chest;  ball  entered  in  front  near  the  armpit,  fracturing  the  right 
shoulder  blfi  de  at  the  middle ;  the  missile  was  cut  out  on  May  16th.  Secondary  haemorrhage  occurred  on  May  27th,  to  the  extent 
of  eight  ounces,  from  the  axillary  artery.  The  fractured  lower  angle  of  the  shoulder  blade  was  removed.  The  htemorrliage  did 
not  come  from  the  subscapular  artery;  the  operation  to  ligate  the  axillary  artery  was  therefore  commenced  May  27th,  but  he 


CHAP,  xii.]  HEMORRHAGES    AND    LTGATIONS.  807 

died  before  it  was  finished.  His  comrade  said  that  hemorrhage  to  the  amount  of  a  gallon  occurred  immediately  after  being 
wounded,  but  that  it  ceased  spontaneously ;  the  pulse  was  very  low  before  the  operation  was  commenced ;  he  lost  no  blood  during 
the  operation.  Though  lie  was  very  carefully  and  slightly  put  under  the  influence  of  chloroform,  the  same  may  have  hastened 
hie  end.  No  post-mortem  examination  was  made;  the  body  was  given  to  his  father." 

In  several  instances  one  or  more  slight  bleedings — "warning  bleeding"- —preceded  the 
actual  haemorrhage,  as  in  the  case  of  J.  Lightfoot,  25th  Massachusetts,  detailed  on  page 
443  of  the  Second  Surgical  Volume,  and  in  the  example  here  adduced: 

CASE  1179. — Private  A.  M.  Buzhardt,  Co.  K,  14th  South  Carolina,  aged  23  years,  received  a  shot  fracture  of  the  upper 
third  of  the  right  femur  at  the  battle  of  Malvern  Hill,  July  28.  1864.  He  was  captured  and  conveyed  to  hospital  at  City  Point, 
whence  he  was  transferred  to  hospital  at  Alexandria  on  August  10th.  Surgeon  E.  Bentley.  U.  S.  V.,  recorded  the  following 
result  of  the  injury:  "The  fracture  was  very  high  up  and  the  femur  was  much  shattered.  The  limb  was  placed  upon  a  double- 
inclined  plane  and  the  fragments  were  placed  in  apposition  as  nearly  as  possible.  The  patient  was  worn  out  with  exposure  and 
anxiety  and  had  some  diarrhoea.  Slight  haemorrhages  occurred  on  September  4th  and  7th,  which  readily  yielded  to  pressure. 
On  September  8th  a  severe  haemorrhage  took  place,  exhausting  iu  amount,  from  which  the  patient  sank  rapidly,  and  died  the 
same  day.  The  post-mortem  examination  showed  the  heart  to  be  exsanguineous  and  without  clot;  pus  in  body  of  the  sternum; 
lungs  sound;  liver  pale  and  anaemic;  other  organs  sound.  Evidences  of  haemorrhage  from  branches  of  the  profunda  artery 
were  found." 

Instances  of  haemorrhage  from  the  distal  ends  of  arteries  after  ligations  of  the  cardiac 
end  are  reported  and  will  be  referred  to  hereafter;  but  there  were  also  a  few  instances  in 
which  the  bleeding  occurred  from  the  farther  extremity  of  the  wounded  blood-vessel,  either 
as  primary  or  secondary  haemorrhage,  before  operative  interference.  In  the  case  of  Harrison 
(Second  Surgical  Volume,  p.  926,  CASE  1869),  haemorrhage  from  the  distal  end  of  the  ulnar 
artery  was  noted 'on  the  tenth  day  after  the  injury.  In  the  following  case  bleeding  from 
the  distal  end  of  the  anterior  tibial  artery  occurred  on  the  seventh  day  after  the  injury: 

CASE  1180. — Saddler  G.  V.  Partridge,  Co.  B,  4th  Massachusetts  Cavalry,  aged  21  years,  was  wounded  iu  the  left  leg 
during  a  skirmish  near  Jacksonville,  April  2,  1864.  The  missile,  a  ball,  passed  directly  through  from  back  to  front,  fracturing 
the  tibia,  comminuting  a  portion  of  the  internal  surface  of  the  bone,  and  cutting  the  anterior  tibial  artery  at  the  middle  of  the 
limb.  Five  days  after  being  wounded  the  man  was  admitted  to  hospital  No.  3,  at  Beaufort,  where  haemorrhage  occurred  to  the 
amount  of  four  ounces  from  the  distal  end  of  the  injured  vessel  on  April  9th,  on  which  day  the  fractured  bone  was  excised  and 
the  artery  was  ligated.  The  operation  was  performed  by  Acting  Assistant  Surgeon  W.  A.  Greenleaf,  who  made  an  incision  five 
inches  in  length  along  the  line  of  the  internal  surface  of  the  tibia  and  removed  eleven  pieces  of  bone,  cutting  off  the  points  with 
the  chain-saw.  At  the  time  of  the  operation  the  edges  of  the  wound  looked  dry  and  red,  and  the  parts  were  swollen,  very 
painful,  and  discharging  some.  The  patient  Avas  in  good  spirits  and  had  a  good  appetite,  but  was  exhausted  from  previous  loss 
of  blood;  pulse  65.  Only  the  lower  extremity  of  the  anterior  tibial  artery  was  ligated,  the  vessel  having  been  so  extensively 
destroyed  that  it  was  impossible  to  reach  the  upper  end.  Chloroform  was  used  during  the  operation,  from  which  the  patient 
reacted  well.  He  did  well  for  three  days,  when  chills  came  on  and  the  wound  sloughed.  On  December  17th  sloughing  ceased, 
healthy  granulations  appeared,  and  pus  discharged  freely.  Stimulants  were  duly  administered.  On  April  20th  chills  were 
more  frequent  and  at  times  severe.  Decided  symptoms  of  pyaemia  developed  on  April  27th,  when  a  slight  haemorrhage  also 
recurred  from  the  superficial  arteries,  which  was  easily  controlled  by  pressure  and  the  application  of  persulphate  of  iron.  Death 
resulted  from  pyasmia  May  2,  1864.  The  history  of  the  case  was  reported  by  Assistant  Surgeon  J.  F.  Huber,  U.  S.  V. 

In  the  case  of  Calef,  2d  New  Hampshire  (see  CASE  1101,  page  756,  ante),  in  which  a 
round  ball  had  occluded  the  proximal  end  of  the  divided  carotid  artery,  a  false  aneurism 
formed  at  the  distal  extremity. 

The  form  of  haemorrhage  known  as  capillary  or  parenchymatous  was  occasionally  seen, 
and  was  marked  by  a  steady  leakage  of  blood  from  the  capillary  vessels,  often  great  in 
amount  and  frequently  resulting  in  syncope  or  exhaustion.  The  discharge  had  neither  the 
bright  scarlet  of  arterial  nor  the  darker  hue  of  venous  blood;  it  flowed  without  jets  and 
was  often  difficult  to  arrest.  When  observed  as  a  primary  condition,  or  after  a  primary 
operation,  it  was  generally  the  result  of  what  is  known  as  haemorrhagic  diathesis.  In 
other  cases  it  was  due  to  paralysis  of  the  capillary  vessels  from  inflammatory  action.  It 
was  most  frequently  noticed  as  an  accompaniment  of  pyaemia  and  osteomyelitis,  and  was 
caused  by  interrupted  venous  circulation,  assisted  by  the  leucothycemic  condition  of  the 
blood  in  such  cases. 

Fifteen  cases  of  this  form  of  haemorrhage  were  reported.     In  the  cases  of  recovery 


808 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


the  bleeding  was  comparatively  slight,  and  easily  controlled  by  cold,  compression,  or 
styptics.  Of  the  nine  fatal  cases  death  occurred  either  as  a  direct  result  of  the  haemorrhage 
or  from  the  complications  which  probably  gave  rise  to  the  bleeding,  as  pyaemia,  gangrene, 
erysipelas,  and  diarrhoea.  Of  the  fifteen  cases,  capillary  haemorrhage  followed  amputation 
in  seven  instances — with  three  .recoveries  and  four  deaths;  and  excision  in  six  cases — rwith 
one  recovery  and  five  deaths. 

Four  cases  of  medullary  hemorrhage  were  noted.  Two,  occurring  from  medullary 
arteries  of  stumps  in  pysemic  cases,  resulted  in  death.  One  appears  to  have  been  a  case  of 
recurring  haemorrhage  from  medullary  artery  of  tibia  of  a  patient  much  debilitated — who 
finally  recovered.  The  fourth  was  a  case  of  osteomyelitis  of  tibia  and  fibula  further  com 
plicated  by  diarrhoea;  it  ultimately  terminated  in  recovery. 

Traumatic,  A?ieurism. — In  seventy-four  cases  the  injuries  were  followed  by  traumatic 
aneurism.  Twenty-three  cases  terminated  in  recovery  and  fifty-one  in  death,  a  mortality 
rate  of  68.9  per  cent.  Thirty-four,  or  nearly  one-half  of  all  the  cases,  were  aneurisms  of  the 
femoral  or  axillary  arteries — twenty  of  the  former  and  fourteen  of  the  latter. 

TABLE  CXLVIII. 
Summary  of  Seventy-four  Cases  of  Traumatic  Aneurism.     • 


ARTERIES. 

O 

Recoveries. 

Deaths. 

TREATMENT. 

ARTERIES. 

1 

• 

u 

Recoveries. 

,0  Deaths. 

oo 

TREATMENT. 

Ligation. 

No  ligation. 

Ligatiou.    ,  No  legation. 

Recoveries. 

Deaths. 

Recoveries. 

Deaths. 

00                                      ff. 

_o.                            _t       : 
®              OD                             a* 

\-      a       fc      .3 

O              *J               C              *; 

£    :    g       £       2 
K      a      «   ,  « 

6         17           4         11 

!     i 

5 
1 
3 

1 

4 
1 

3 

1 

1 
1 
3 

Carried  forward  ... 

38 
1 
1 
j 

10 
1 

External  Carotid 

Subclavinn  

3 

Internal  Iliac   . 

] 

i    i  

Suprascapular  

.     2 
14 
1 

1 
3 

1 
11 
1 

1 
2 

1 
10 

Sciatic 

i 

1 

1 
] 

20 
] 
2 

5 
1 

15           5          11    4 
1 

Acromial  Thoracic    .  .  . 

Pudic  

1 
7 
1 

1 

2 

1 

Brachial  

5 
1 
1 

2 

3 

2 
1 
1 

Popliteal               .   . 

1 
7 
2 

1                                               1 

Tibials 

: 

5 

2           5 

Radial  and  Uluar  
Forward  

3 

2 

1 



1 

Peroneal 

•>    .  . 

Aggregates 

38 

10 

28 

6 

17 

4 

11 

74 

2.'i 

51         l.'i         20         10         22 

The  aneurisms  were  either  diffuse  or  circumscribed,  and  in  one  instance,  the  case  of 
Click,  detailed  on  page  541  of  the  First  Surgical  Volume,  time  had  been  given  for  anas- 
torn  otic  communication.  In  the  case  of  Hickey  (First  Surgical  Volume,  page  539),  in 
which  ligation  of  the  subclavian  was  performed  for  aneurism  of  the  axillary,  an  aneurism 
again  developed  after  his  discharge  from  the  service;  the  man  is  a  pensioner  and  was  living 
in  April,  1882;  the  last  report  of  the  pension  examiners,  in  September,  1877,  states  that 
he  has  now  "aneurism,  involving  the  innominate  artery;  the  thrill  is  very  distinct;  radial 
pulse  cannot  be  felt;  he  suffers  from  pain  in  the  chest  and  can  do  no  labor." 

Forty-two  of  the  seventy-four  cases  were  treated  by  ligation,  of  which  thirteen  recovered 
and  twenty-nine  died.  In  the  following  interesting  case  of  shot  wound  in  the  axillary 
region  unattended  by  fracture,  an  aneurism  appeared  three  months  after  the  injury,  which 
increased  very  rapidly.  The  subclavian  was  ligated,  but  on  opening  the  sac  the  tissues 
were  found  infiltrated  with  blood  and  disorganized,  and  the  arm  was  amputated  at  the 


Tl 


x 

T.         < 


J. 

A 


-        C 


-  -I 

-  o 

_  > 

r  Z 

x  m 

~-_  c 


CHAP,  xil.]  CAUSES    OF    HEMORRHAGE.  809 

shoulder  joint.  In  PLATE  LXXVII,  opposite  page  808,  the  anterior  as  well  as  the  posterior 
appearance  of  the  tumor  is  illustrated  after  a  photograph  contributed  bj  the  operator,  Assist 
ant  Surgeon  J.  C.  McKee,  U.  S.  A. 

CASE  1181. — Private  F.  M.  Denton,  Co.  H,  4th  South  Carolina  Cavalry,  aged  34  years,  was  wounded  at  Hanovertown,  May 
28,  1864.  Surgeon  L.  W.  Read,  U.  S.  V.,  reported  the  patient's  admission  into  the  field  hospital  of  the  3d  division,  Fifth  Corps, 
with  "gunshot  wounds  of  abdomen  and  arm;  sent  to  general  hospital."  On  June  5th  he  was  admitted  into  Lincoln  Hospital, 
Washington.  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  reported:  "Minie'  ball  entered  three  inches  below  left  shoulder  joint 
anteriorly,  passed  through  the  axilla  under  the  scapula,  and  emerged  one  inch  to  the  right  of  the  vertebral  margin.  July  1st, 
suffers  much  pain  in  the  hand  and  region  of  the  wound.  July  4th,  arm  easy;  hand  very  painful.  The  daily  use  of  hypodermic 
injections  of  morphia,  etc.,  relieved  the  pain  a  little.  August  28th,  swelling  in  region  of  wound,  extending  over  pectoral  and 
axillary  regions,  to  vertebral  border  of  scapula,  left  side,  continuing  to  increase  from  day  to  day.  Upon  consultation  it  was 
determined  to  be  an  aneurismal  tumor,  and  pressure  by  spiral  bandage  advised,  which  was  continued  until  September  1st,  when 
the  tumor  increased  very  rapidly.  The  patient  was  quite  irritable  and  weak.  Chloroform  was  administered  and  ligation  of  the 
isubclavian  artery  was  performed.  On  opening  the  sac  the  tissues  were  found  so  diffused  with  blood  and  disorganized  that 
amputation  at  the  shoulder  joint  was  advised  and  performed.  Two  ligatures  were  placed  on  the  external  jugular  vein  and  three 
at  the  shoulder.  About  eighty  ounces  of  blood,  mostly  coagulated,  were  removed  from  the  aneurism.  After  the  operation  the 
patient  rallied  considerably.  He  died  September  2,  1864,  at  10  o'clock  A.  M.,  from  exhaustion."  The  operator,  Dr.  McKee, 
contributed  to  the  Army  Medical  Museum  photographs  of  the  anterior  and  posterior  appearances  of  the  aneurismal  swelling, 
which  have  been  accurately  copied  in  PLATE  LXXVII. 

Causes  of  Haemorrhage. — The  earlier  cases  of  hemorrhage  were  due  to  the  force  of 
the  blood  current  in  the  returning  circulation  during  reaction;  to  commencing  inflammatory 
action  in  which  the  swelling  had  been  sufficient  to  force  out  the  protective  coagulum;  to 
weakened  arterial  walls,  and  to  a  depraved  condition  of  the  blood  in  persons  suffering  from 
exhn listing  or  depressing  diseases.  Not  unfrequently  the  hemorrhage  of  the  earlier  days 
had  its  source  in  the  injury  of  some  vessel  of  considerable  size  unnoticed  in  the  primary 
examination  of  the  wound.  Cases  have  been  cited  in  which  no  excessive  hemorrhage  was 
noticed  until  attempts  were  made  to  effect  the  removal  of  a  lodged  missile  or  foreign  body 
which  had  prevented  bleeding  by  acting  as  a  plug  or  tampon. 

Regarding  secondary  hemorrhage  in  its  usual  acceptation,  as  embracing  all  cases  of 
bleeding  from  wounded  vessels  occurring  after  the  establishment  of  suppuration,  including 
cases  of  rupture  of  the  sacs  of  traumatic  aneurisms,  we  find  that  by  far  the  greater  num 
ber  are  due  to  the  separation  of  a  slough,  the  result  of  a  contusion  of  the  walls  of  the 
vessel  and  the  inflammatory  action  consequent  upon  it.  The  time  required  for  this  process 
varies  within  very  wide  limits,  as  shown  in  TABLE  CXLVII,  p.  805,  and  appears  to  be 
dependent  upon  the  size  of  the  artery,  the  extent  of  the  contusion,  and  somewhat  upon  its 
proximity  to  the  heart.  Ulcerative  action  extending  from  neighboring  parts  may  attack  a 
vessel  with  similar  results. 

Scorbutic  diathesis,  fevers,  gangrene,  pyemia,  osteomyelitis,  and  all  conditions  which 
lower  the  vital  forces  or  alter  the  elements  of  the  blood  as  well  as  the  general  condition  of 
the  patient  and  his  physical  health  largely  influence  this  complication.  Hygienic  surround 
ings  must  also  be  taken  into  consideration  as  playing  an  important  part  in  the  maintenance 
of  a  good  physical  status  and  enabling  the  wounded  man  to  successfully  resist  the  insidious 
attacks  of  disease. 

Thrombosis  of  veins  will  cause  great  pressure  on  the  arteries  of  wounded  parts  and 
re-open  vessels  temporarily  closed: 

CASE  1182. — Private  J.  A.  Campbell,  Co.  H,  81st  Illinois,  was  wounded  during  the  Vicksburg  campaign,  May  22,  1863, 
receiving  a  gunshot  wound  of  the  left  hand.  He  was  admitted  into  Church  Hospital,  Memphis,  whence  Acting  Assistant  Sur 
geon  C.  II.  Cleaveland  reported:  "Patient  of  a  nervous,  bilious  temperament;  had  gangrene  of  left  hand  and  arm.  He  was 
very  deaf,  and  no  particulars  could  be  obtained  from  him  except  that  his  hand  was  '  bruised  by  a  cannon  shot.'  An  ulcer  had 
formed  at  the  wrist  just  above  the  annular  ligament;  another  in  the  palm  of  the  hand,  commencing  one  inch  below  the  wrist, 
laying  opeil  almost  the  entire  palmar  surface  of  the  hand  and  fingers;  the  first  and  second  fingers  hung  only  by  shreds  from  their 
articular  surfaces,  the  whole  surface  being  covered  with  foetid  sloughs,  which  were  removed  as  effectually  as  possible  and 
111—102 


810 


WOUNDS    AND    COMPLICATIONS. 


I  CHAP.  Xfl 


bromine  applied  at  once.  A  subcutaneous  cavity  was  also  found  extending  from  the  wound  to  near  the  elbow;  the  integument 
was  divided  upon  a  director  and  bromine  freely  applied.  August  10th,  wound  cleaning  rapidly  at  both  extremities;  patient 
troubled  with  anorexia  and  diarrhoea.  At  two  A.  M.,  August  14th,  haemorrhage  to  the  extent  of  thirty  ounces  occurred  from  the 
radial  artery  while  the  patient  was  asleep,  and  soon  resulted  fatally.  The  autopsy  revealed  thrombi  of  various  sizes  in  the 
circulating  vessels  leading  both  to  and  from  the  heart." 

Diseases  of  the  coats  of  the  arteries,  as  atheroma,  etc.,  will  hasten  haemorrhage,  and  in 
such  cases  the  conditions  will  render  operative  interference  doubtful  or  uncertain. 

Transportation  of  the  wounded  during  the  process  of  suppuration  has  been  mentioned 
as  a  not  infrequent  cause  of  haemorrhage  by  surgical  writers,  and  cases  recorded  in  the  late 
war  justify  its  enumeration  as  an  exciting  cause: 

CASE  1183. — Private  W.  F.  Lepper,  Co.  H,  148th  Pennsylvania,  was  wounded  at  the  Wilderness,  May  6,  1864,  receiving 
a  gunshot  compound  fracture  of  the  right  knee  joint.  Surgeon  J.  "H.  Brinton,  U.  S.  V.,  referring  to  this  case,1  remarks: 
"I  amputated  at  the  knee  joint,  at  a  hospital  in  Fredericksburg.  This  man  did  well  for  three  days.  At  the  expiration  of  this 
time  orders  were  received  to  remove  all  patients  from  the  temporary  hospitals  and  to  vacate  Fredericksburg.  I  was  subsequently 
informed  that  as  this  soldier  was  being  lifted  into  the  ambulance  for  transportation  to  the  boat  a  sudden  and  uncontrollable 
haemorrhage  occurred,  which  proved  almost  immediately  fatal.  Owing  to  the  pressing  exigencies  of  the  occasion,  opportunity 
was  not  aflbrded  for  an  examination  of  the  stump  after  death." 

Accidental  causes  will  be  found  to  be  not  uncommon,  as  falling  out  of  bed,  the  pulling 
off  of  ligatures  during  delirium,  falling  upon  stumps,  and  spasmodic  twitchings  of  muscles: 

CASE  1184. — Sergeant  Foster  Hudson,  Co.  B,  132d  New  York,  aged  24  years,  was  wounded  near  Kinston,  North  Caro 
lina,  March  7,  1865.  Surgeon  C.  A.  Cowgill,  U.  S.  V.,  reported  from  Foster  Hospital,  New  Berne:  "Admitted  March  8,  1865, 
with  a  gunshot  wound,  shattering  the  tibia  of  the  left  leg  and  opening  the  knee  joint.  On  March  9th  Assistant  Surgeon  E.  F. 
Hendricks,  15th  Connecticut,  amputated  the  thigh  at  the  lower  third.  There  was  extensive  shattering  of  the  head  of  the  tibia, 
and  the  soft  parts  were  much  infiltrated  with  blood  and  serum.  The  pulse  was  weak  at  the  time  of  the  operation.  Simple 
dressings  were  applied  to  the  wound  and  stimulants  administered.  The  posterior  flap  sloughed  away  on  the  eighth  day,  but  the 
interior  was  healthy  and  covered  the  stump.  On  the  tenth  day  the  ligature  came  away,  but  the  stump  looked  well.  Pulse  weak, 
appetite  poor.  Twelfth  day,  severe  chill,  followed  by  delirium,  drowsiness,  and  spasmodic  twitching  of  muscles.  On  March 
21st,  haemorrhage,  amounting  to  one  quart,  occurred  from  the  femoral  artery.  He  died  March  23,  1865,  from  secondary  haem 
orrhage,  probably  induced  by  convulsive  movements  of  patient  and  stump." 

The  records  of  the  war  show  a  large  number  of  haemorrhages  subsequent  to  excisions, 
probably  due  to  the  engorged  condition  of  the  vessels  in  the  neighborhood  of  the  injury 
which  were  cut  or  injured  during  such  operation. 

Treatment. — Of  the  two  thousand  two  hundred  and  thirty -five  cases  of  haemorrhage, 
two  hundred  and  ninety-four  were  followed  by  amputation;  seven  hundred  and  eighty-six 
were  treated  by  compression,  styptics,  etc.,  or  ceased  spontaneously;  and  in  one  thousand 
one  hundred  and  fifty-five  cases  the  bleeding  vessels  were  ligated. 

TABLE  CXLIX. 

Summary  of  Two   Thousand  Two  Hundred  and  Thirty-five  Cases  of  Haemorrhage,  indicating  Mode 

of  Treatment. 


TREATMENT. 

CASES. 

RECOVERY. 

FATAL. 

PEUCEXT- 

AGE  OF 

FATALITY. 

Haemorrhage  followed  by  Amputation  

294 

122 

172 

58.5 

Haemorrhage  ceased  spontaneously  or  was  arrested  by  Compression  and  Styptics  

786 

262 

524 

66.6 

Haemorrhage  followed  by  Legations  

720 

328 

392 

54.4 

Haemorrhage  followed  by  Ligations  and  subsequent  Amputation  

87 

34 

53 

60.9 

Haemorrhage  from  Stump  after  Amputation  (ligated)  

348 

109 

239 

68.6 

AgTog^ites  

2  235 

855 

1  380 

61.7 

Amputation  was  resorted  to  for  the  purpose  of  saving  life  in  cases  of  uncontrollable 
haemorrhage,  both  primary  and  secondary:  In  primary  bleeding,  where  the  original  injury 

1  IJRrNTO.\  (J.  H.),  On  Amputation  at  Hit  Knee  Joint  and  at  the  Knee.,  in  Am.  Jour.  Med.  Set.,  1868,  Vol.  LV,  p.  316. 


CHAP.  XII.)  TREATMENT    OF    HEMORRHAGES.  811 

was  so  far  destructive  to  the  parts  as  to  render  ligation  unavailing;  in  secondary  bleeding, 
in  cases  of  traumatic  aneurism,  with  great  infiltration  of  tissue;  in  gangrene  following 
division  or  ligation  of  the  principal  artery;  and  in  cases  where  ligation  had  failed  to  arrest 
bleeding,  and  where  more  radical  measures  were  demanded  to  prevent  a  further  loss  of 
blood.  Of  two  hundred  and  ninety-four  cases  thus  treated  by  amputation,  one  hundred 
and  twenty-two  recovered  and  one  hundred  and  seventy-two  died,  a  fatality  of  58.5  per  cent. 
Of  the  remaining  one  thousand  nine  hundred  and  forty-one  cases  of  haemorrhage,  seven 
hundred  and  eighty-six  were  treated  by  compression,  styptics,  etc.  The  fatality  of  these 
cases,  as  indicated  in  TABLE  CXLIX,  on  the  preceding  page,  was  large,  exceeding  that  of 
ligations  12.2  and  that  of  ligations  and  subsequent  amputations  5.7  per  cent.  In  a  number 
of  cases  digital  compression  was  employed  as  a  temporary  measure,  and  in  a  few  instances 
steadily  continued  compression  appears  to  have  been  rewarded  with  favorable  results.  Gen 
erally  the  tourniquet  v:as  carefully  and  judiciously  used,  although,  in  a  few  instances,  a 
resort  to  operative  procedure  would  have  been  much  better  for  the  patient: 

CASE  1185. — Sergeant  T.  A.  Polleys,  Co.  H,  6th  Wisconsin,  aged  25  years,  was  wounded  before  Petersburg,  June  18, 
1864,  by  a  musket  ball,  which  fractured  the  right  thigh.  He  was  admitted  to  the  field  hospital  of  the  4th  division.  Fifth 
Corps,  where  amputation  at  the  lower  third  of  the  femur  was  performed  by  Surgeon  J.  H.  Beach,  24th  Michigan,  on  the  follow 
ing  day.  Acting  Assistant  Surgeon  H.  E.  McCartin  reported  the  following  result  of  the  case:  "The  patient  entered  Baptist 
Church  Hospital,  at  Alexandria,  on  June  28th.  The  amputation  had  been  performed  by  the  posterior  flap  method.  When 
received  into  hospital  the  stump  was  found  strangulated  by  a  tourniquet  placed  around  it  to  compress  the  femoral,  and  the  flap 
was  gangrenous  and  sloughing  extensively;  patient's  condition  very  low.  Tonics,  stimulants,  and  nutritious  diet  failed  to  pro 
duce  any  improvement.  Haemorrhage  to  the  amount  of  thirty-two  ounces  from  the  femoral  artery  occurred  on  June  28th  ;  the 
patient  died  on  June  29,  1864." 

Cases  of  troublesome  bleeding  from  the  posterior  auricular,  occipital,  or  temporal 
arteries,  or  their  branches,  are  reported  where  the  haemorrhage  was  controlled  by  compres 
sion  by  a  clamp  tourniquet,  or  by  bandage  and  compress,  or  by  a  compress  consisting  of  a 
metallic  disk.  In  one  such  instance  transverse  division  of  the  wounded  artery  was  suffi 
cient  to  secure  complete  retraction  of  the  coats. 

No  cases  of  acupressure,  after  the  method  of  Sir  James  Y.  Simpson,  appear  on  the 
records,  though  it  would  seem  probable  that  many  wounds  must  have  presented  themselves 
where  this  measure  would  have  been  found  convenient,  speedy,  and  effectual. 

Torsion  was  employed  to  secure  arteries,  a  few  cases  of  this  procedure  being  reported ; 
and  Surgeon  H.  S.  Hewit,  U.  S.  V.,  mentions  a  case  where  the  actual  cautery  was  resorted 
to  for  the  arrest  of  troublesome  bleeding. 

Two  cases  of  transfusion  of  blood  are  found  on  the  records;  one,  a  successful  operation, 
was  performed  by  Surgeon  E.  Bentley,  U.  S.  V.;  the  other,  a  fatal  case,  by  Assistant 
Surgeon  B.  E.  Fryer,  U.  S.  A.  Both  are  here  detailed: 

CASE  1186. — Private  G.  P.  Cross,  Co.  F,  1st  Massachusetts  Heavy  Artillery,  aged  19  years,  was  wounded  in  the  right 
leg,  before  Petersburg,  June  16, 1864,  and  entered  the  Grosvenor  Branch  Hospital,  Alexandria,  two  weeks  afterwards.  Surgeon 
E.  Bentley,  U.  S.  V.,  who  operated  in  the  case,  made  the  following  report:  "The  injury  consisted  of  a  flesh  wound  on  the 
posterior  aspect  of  the  leg.  At  the  date  of  the  patient's  admission  he  was  exsanguineous  from  previous  loss  of  blood.  Owing 
to  his  condition  no  operative  measures  were  adopted,  but  his  languishing  vital  powers  were  sustained  by  stimulating  treatment 
combined  with  highly  nutritious  diet.  Under  this  method  he  slightly  improved  in  strength,  but  the  circulating  fluid  was  so 
impoverished  in  quality  and  reduced  in  quantity  that  the  face  of  the  wound  looked  pnle  and  bad,  and  ultimately,  on  August 
12th,  it  assumed  a  gangrenous  aspect.  Local  applications,  such  as  creasote,  charcoal  poultices,  nitric  acid,  etc.,  were  applied  to 
combat  this  condition.  These  means  failed  to  arrest  its  onward  progress,  the  leg  presenting  in  a  short  space  of  time  a  mass  of  gan 
grenous  sloughs,  horribly  fetid.  Hasmorrhage  from  the  posterior  tibial  artery  again  commenced  on  the  afternoon  of  August  15th, 
when  it  was  deemed  advisable  to  amputate  to  prevent  further  loss  of  blood.  The  operation  was  accordingly  performed  just  at 
the  tubercle  of  the  tibia,  the  condition  of  the  parts  not  allowing  a  flap  to  be  made  below  that  point.  Not  more  than  two  table- 
spoonsful  of  blood  was  lost ;  but  the  patient  not  seeming  to  rally,  it  was  determined  to  test  the  method  of  transfusion  of  blood  as 
recommended  by  Brown-Scquard.  Blood  having  been  obtained  from  the  temporal  artery  of  a  strong  healthy  German,  an 
attempt  was  made  to  penetrate  the  internal  saphenous  vein,  but  was  unsuccessful  on  account  of  its  small  size;  after  which  au 


812  WOUNDS    AND    COMPLICATIONS.  [CHAP,  xn 

opening  was  made  into  the  median  basilic,  and  about  two  ounces  were  transfused  by  meansofaTiemann's  syringe.  Immediately 
after  the  injection  a  marked  difference  was  noticed  in  the  patient's  pulse,  which  became  stronger  and  firmer.  He  was  then 
removed  to  his  bed  and  generous  diet  was  administered,  together  with  stimulants  and  tonics,  under  which  treatment  he  gradually 
improved,  his  appetite  became  better,  his  strength  increased,  and  the  stump  assumed  a  healthy  aspect.  On  October  20th  the 
stump  had  healed  and  the  patient  had  so  far  improved  as  to  be  able  to  be  furloughed.  At  its  expiration  he  returned,  and,  finally, 
he  was  transferred  to  Webster  Hospital,  Manchester,  January  13,  1865,  cured."  The  patient  was  ultimately  discharged  from 
Central  Park  Hospital  at  New  York  City,  June  9,  1865,  and  pensioned,  and  afterwards  he  was  supplied  with  a  "Hudson"  arti 
ficial  limb.  This  pensioner  died  August  24,  1867. 

CASE  1187. — Private  J.  Mott,  Co.  E,  105th  Illinois,  aged  37  years,  received  a  flesh  wound  in  the  upper  third  of  the  left 
leg,  at  Kenesaw  Mountain,  June  26,  1864,  by  a  musket  ball,  which  lodged  between  the  tibia  and  fibula.  He  entered  Brown 
Hospital,  at  Louisville,  nine  days  after  receiving  the  injury,  the  missile  having  been  extracted  and  the  wound  looking  unhealthy 
and  sloughing.  During  the  night  of  July  24th  the  patient  had  a  copious  haemorrhage  from  what  was  supposed  to  be  the  anterior 
tibial  artery,  which  was  arrested.  On  July  26th  bleeding  again  commenced,  the  blood  welling  up  from  between  the  bones  and 
from  the  tissues  posterior  to  them.  It  was  then  deemed  necessary,  in  order  to  save  life,  to  amputate,  which  was  done  through 
the  upper  third  of  the  leg  by  the  circular  method,  by  Assistant  Surgeon  B.  E.  Fryer,  U.  S.  A.  Ether  was  used  as  an  anaes 
thetic,  and  three  ligatures  were  applied,  the  patient  reacting  very  slowly.  On  the  following  day  it  was  determined  to  transfuse 
some  blood  into  the  patient,  for  which  purpose,  in  the  absence  of  any  other  suitable  apparatus,  an  ordinary  gutta-percha  syringe 
was  used,  the  nozzle  of  which  was  filed  to  fit  a  small  tube  having  a  stop-cock  through  its  centre.  The  right  cephalic  vein  having 
been  selected,  an  opening  was  made  carefully  into  it,  and  the  syringe  having  been  warmed  and  filled  with  blood  from  a  healthy 
man,  a  little  of  which  was  allowed  to  flow  from  the  syringe  before  forcing  its  nozzle  tightly  into  the  tube  in  order  that  any  air 
might  be  driven  out,  the  tube  was  introduced  and  the  stream  of  blood  was  slowly  and  carefully  forced  in.  About  sixteen  ounces 
were  thus  transfused.  The  first  effect  upon  the  patient  was  to  increase  respiration  from  about  fifteen  to  twenty-eight  per  minute, 
though  it  soon  returned  to  its  normal  number  of  about  sixteen.  The  pulse  ran  up  from  one  hundred  to  one  hundred  and  thirty, 
which,  however,  also  soon  returned  to  what  it  had  been.  The  man's  general  condition  was  greatly  improved.  His  pulse  became 
fuller  and  slower;  he  slept  well;  his  stomach  retained  food,  and  altogether  the  prognosis  became  more  favorable.  On  August 
4th  haemorrhage  commenced  from  the  face  of  the  stump,  the  whole  surface  of  which  appeared  to  be  involved.  From  the  effects 
of  this,  and  from  chronic  dysentery,  the  patient  died  on  the  following  day,  August  5,  1864;  although  his  condition,  from  the 
effects  of  chronic  dysentery  and  of  the  haemorrhage  at  the  time  of  the  transfusion,  was  such  as  hardly  to  expect  his  recovery,  the 
improvement  was  such  as  to  show  that  the  operation  was  not  only  justifiable,  but  that  it  was  to  all  intents  a  success.  The  history 
of  the  case  was  reported  by  the  operator. 

Styptics  were  very  commonly  used.  The  persulphate  of  iron  in  powder  or  in  solution 
was  placed  in  every  knapsack  and  pannier,  and  was  found  at  every  hospital.  In  addition 
to  these  we  find  mention  of  the  nitrate  of  silver,  gallic  and  tannic  acids,  alum,  and  turpen 
tine  as  having  been  employed.  While  it  is  possible  that  in  many  cases  the  use  of  styptics 
may  have  been  ill-advised,  and  while  it  may  be  admitted  that  in  the  hands  of  the  timid 
or  ignorant  surgeon  they  may  furnish  an  excuse  for  procrastination  or  for  deferring  opera 
tions  imperatively  demanded,  still  the  evidence  as' to  their  usefulness  during  the  late  war 
is  not  altogether  unfavorable,  and  should  lead  to  some  modification  of  the  views  previously 
expressed  in  this  history.  The  experience  of  surgeons  in  the  Confederate  Army  was  much 
to  the  same  point,  and  Dr.  Ohisolm  observes  that  "iron  styptics  will  control  the  most 
annoying  haemorrhage."  Instances  in  which  this  class  of  haemostatics  was  successfully 
used,  even  in  bleeding  from  larger  vessels,  are  not  wanting: 

CASE  1188. — Captain  E.  H.  Davis,  Inspector  General,  aged  32  years,  was  wounded  at  Fort  Steadmau,  March  25,  1865,  by 
shrapnel,  which  fractured  and  comminuted  the  bones  of  the  right  arm  and  forearm.  Surgeon  J.  M.  Holloway  states l  that  ampu 
tation  of  the  arm  was  done  on  the  morning  of  the  26th,  supposed  to  be  at  the  anatomical  neck.  Repair  of  the  wound  was  very 
rapid  and  unaccompanied  by  unpleasant  symtoms  other  than  occasional  nervous  twitching  in  stump.  On  April  19th  he  took  a 
long  walk ;  at  that  time  the  wound  was  nearly  closed  externally.  On  April  20th  he  experienced  a  tingling  sensation  in  the  arm, 
which  was  immediately  followed  by  a  gush  of  blood.  Medical  aid  was  speedily  obtained,  the  dressings  removed  ;  a  small  clot 
near  the  lower  edge  of  the  incision  was  removed,  and,  after  exposing  the  parts  for  a  short  time  to  the  air,  a  compress  was  secured 
in  the  axilla  by  means  of  a  roller.  The  patient  informed  me  subsequently  that  for  three  days  before  the  haemorrhage  the  dis 
charge,  which  before  that  had  almost  entirely  ceased,  increased  in  quantity  and  was  darker,  and  accompanied  by  a  constant 
aching  pain  in  stump.  From  this  it  was  concluded  that  ulcerative  destruction  of  the  tissues  was  going  on,  which  in  the  end 
invaded  the  artery.  Haemorrhage  recurred  at  8  and  again  at  6  o'clock  of  April  21st.  Upon  removing  the  dressings,  extensive 
extravasation  of  blood  was  discovered  in  the  axilla  and  anterior  thoracic  region.  Diaynosis :  Indeterminate  haemorrhage  from 
an  aperture  in  the  axillary  artery,  occasioned  by  ulcerative  destruction  of  the  coats  of  the  artery  and  the  newly  formed  tissues 
surrounding.  April  21st,  10  A.  M.,  pulse  frequent  and  feeble;  cheeks  blanched  from  loss  of  blood;  mind  clear  and  calm;  fully 
aware  of  the  danger  of  his  condition.  He  was  placed  upon  the  operating  table,  a  full  stimulant  was  given,  compression  with 
the  finger  and  key  was  made  in  the  subclavian  triangle,  aud  the  careful  administration  of  chloroform  was  commenced.  Before 

'Hor.LOWAY  (J.  M.),  Consecutire  and  Indeterminate  Haemorrhage  from  Laryr.  Arteries  after  Guiifhot  Wounds,  etc.,  in  American  Journal  Medical 
Sciences,  1865.  Vol.  L,  p.  348. 


CHAP.  XII.]  LICfATIONS.  813 

he  became  fully  anaesthetized  the  dressings  were  removed  and  the  cicatrix  laid  freely  open.  The  opening  was  then  enlarged  hy 
an  incision  at  right  angles  to  this,  extending  obliquely  downward  and  inward  through  the  skin  and  great  pectoral  muscle.  A 
number  of  large  clots  were  turned  out,  and,  the  cavity  being  empty,  pressure  upon  the  subclavian  was  removed  to  secure  a  jet 
of  blood  to  guide  to  the  bleeding  point;  the  jet  was  easily  obtained,  and  the  blood  welled  up  from  the  bottom  of  the  cavity,  which 
extended  high  up  under  the  clavicle.  Such  was  the  disorganized  condition  of  the  surrounding  tissues  that  no  artery  could  be 
seen,  and  it  was  decided,  without  delay,  that  the  search  should  not  be  prolonged,  and  that  the  best  chance  for  the  patient  would  be 
to  plug  the  cavity  with  successive  layers  of  lint  saturated  with  a  strong  solution  of  persulphate  of  iron,  well  packed  in,  and 
secured  by  a  figure-of-eight  bandage.  This  was  done.  Prescribed  two  grains  of  opium  and  ten  grains  of  quinine  to  be  taken  at 
once.  April  22d :  Has  reacted  fully;  shows  loss  of  blood;  slight  increase  of  heat  in  stump;  slept  well  all  yesterday  and  a* 
night  under  the  influence  of  the  opium  and  quinine.  April  24th,  attacked  with  colic  last  evening,  which  was  soon  relieved  by  a 
large  enema;  annoyed  also  by  uneasiness  in  the  stump.  Disorganized  blood  still  exuding.  On  April  26th  the  sponge  that  was 
placed  over  the  plugs  was  removed  by  saturating  it  with  water,  after  which  slight  capillary  oozing  occurred.  On  April  27th  he 
was  seized  with  a  slight  rigor,  followed  by  fever,  which  broke  up  in  a  short  time,  leaving  him  with  a  moist  skin.  On  April 
29th  the  largest  and  most  superficial  plug  came  away  without  force,  in  the  evening;  another  at  12  P.  M.  The  patient  gradually 
and  steadily  improved  until  the  morning  of  May  5th,  when  he  was  seized  with  severe  lancinating  pain  in  the  right  side,  which 
persisted,  with  distressing  nervous  symptoms,  throughout  the  day.  Physical  exploration  of  the  chest  could  detect  no  lesion  of 
the  lung;  strong  suspicion  of  pyaemia  was  entertained;  had  suffered  with  severe  pain  in  the  muscles  of  the  jaw  during  mastica 
tion  for  several  days.  The  patient  subsequently  suffered  from  colliquative  sweats;  the  pain  and  stiffness  of  the  muscles  of  the 
jaw  increased  and  interfered  with  his  relish  for  food.  On  May  loth  the  last  wad  was  removed,  and  the  channel  soon  after  closed. 

The  use  of  ice  and  cold  was  very  general  and  was  very  favorably  regarded.  Internal 
hsemastatics  were  used  to  some  extent,  but  little  can  be  said  decisively  in  their  favor  from 
the  records  of  cases  in  which  they  were  used.  Of  those  most  frequently  used  may  be  men 
tioned  tannic  and  gallic  acids  and  ergot,  generally  in  the  form  of  the  fluid  extract.  These 
remedies  were  especially  employed  in  cases  where  the  vital  powers  were  much  depressed 
and  where  the  coagulative  elerneats  of  the  blood  were  deficient. 

Ligatio7is. — In  one  thousand  one  hundred  and  fifty-five  cases  of  haemorrhage  recourse 
was  had  to  ligations,  embracing  nearly  all  the  principal  arterial  trunks  and  their  branches. 
Of  these,  four  hundred  and  seventy-one  recovered  and  six  hundred  and  eighty-four  died. 
The  fatality  in  these  cases,  as  well  as  in  the  cases  of  haemorrhage  followed  by  amputation, 
was  principally  due  to  exhaustion  following  excessive  loss  of  blood  previous  to  the  opera 
tions,  to  recurring  haemorrhages  after  operations,  or  to  complications,  such  as  gangrene, 
erysipelas,  and  especially  pyaemia,  as  indicated  in  TABLE  OXXIV,  pp.  763,  764. 

Five  hundred  and  forty-one  of  these  operations,  with  two  hundred  and  ninety-two 
recoveries  and  two  hundred  and  forty-nine  deaths,  a -mortality  of  46.0  per  cent.,  were  per 
formed  in  the  upper  circulatory  system,  and  six  hundred  and  fourteen,  with  four  hundred 
and  thirty-five  deaths,  a  fatality  of  70.8  per  cent.,  in  the  lower  circulation,  thus  confirming 
the  general  opinion  that  proximity  to  centre  of  circulation  favorably  influences  the  final  issue. 

Three  hundred  and  forty-eight  were  ligations  after  amputations;  of  these,  one  hundred 
and  fifty-seven,  with  fifty -two  recoveries  and  one  hundred  and  five  deaths,  were  ligations  in 
the  continuity  of  the  stump,  and  one  hundred  and  ninety-one,  with  one  hundred  and  thirty- 
four  deaths,  ligations  on  the  face  of  the  stump.  It  is  probable  that  the  ligation  in  con 
tinuity  was  frequently  the  only  alternative,  and  perhaps  a  greater  saving  of  life  would  have 
resulted  had  the  operation  been  more  generally  performed  in  the  continuity,  as  bleedings 
from  the  stump  were  generally  found  in  patients  of  low  vitality  and  where  but  little  was 
to  be  expected  from  any  operation  in  the  immediate  proximity  to  diseased  tissue.  Of  the 
remaining  eight  hundred  and  seven  cases,  two  hundred  and  thirty-six  were  ligations  in  the 
wound,  five  ligations  above  and  below  the  wound,  and  four  hundred  and  thirteen  ligations 
in  the  continuity;  in  one  hundred  and  fifty-three  instances  the  mode  of  ligation  was  not 
indicated.  It  is  probable  that  the  large  majority  of  ligations  of  the  last  group  were  opera 
tions  in  the  coatinuity.  The  various  modes  of  ligations  with  their  respective  mortalities 
are  indicated  in  the  following  table: 


814 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


TABLE  GL. 
Table  indicating  the  various  Modes  of  legations  and  their  Fatality. 


ARTERIES. 

TOTAL  CASES. 

LlGA- 
|  T1ONS  IN 

CONTI 
NUITY. 

LlG.  BE- 
LOW  AND 
A1JOVE 

WOUND. 

LIGATIONS  IN  Wouxu. 

MODE 

OF  LlG. 
NOT  INDI 
CATED. 

AFTEK  AMPUT'N. 

ONB  END. 

BOTH  ENDS 

!   NOT  INDl- 
CATEI1. 

IN  CONTI 
NUITY. 

O»  FACE 

or  STUMP. 

& 

> 

29 
5 
5 
66 
11 
2 
28 
3 
3 

1 

Recovery. 

I 

Recovery. 

1 

Recovery. 

"n 

4J 

« 
* 

£ 

9 

O 
U 

1 

3 

CB 
P* 

Recovery. 

I 

Recovery. 

I 

Recovery. 

3 

at 

to 

124 
63 
71 
181 
102 
43 
427 
39 
101 
4 

66 
29 
17 
17 
2 
24 
91 
10 
5 

5 
4 
3 
5 
9 
2 
1 
2 
7 

1 
4 
2 
o 

4 
1 
10 
2 
4 

5 
2 
3 
17 
22 

3 
1 
4 
6 
5 

3 

2 
3 

12 

3 

3 
3 
1 

8 
1 
3 
15 
14 

1 

1 
9 
10 
4 
8 

4 
2 
9 
4 

12 
10 
10 
3 
5 
64 

1 

9 

7 

•1 

21 
2 
16 

7 
7 

I 

101 
5 
12 
1 

134 

*m 

1 
3 

1 

6 
1 
11 

23 
4 
8 

2 
6 

5 
2 
2 

14 
1 
16 
1 

28 
7 
10 
2 

33 

1,155 

152 

*  * 
63. 

261 

"l% 

4 

'  v 

20 

1 

"0% 

38 

1  v 

44 

30 
1% 

67 

'  . 
44 

54 
6% 

28 

'  v 

40 

19 
4% 

73  I    80 
52.2% 

52 
66 

105 
8% 

57 

'  * 
70 

The  fatality  after  ligations  in  the  continuity  was  63.1  per  cent.,  after  ligations  in  the 
wound  43.6  per  cent.  The  necessity  of  ligating  both  ends  has  been  shown  in  numerous 
instances  in  the  preceding  volumes.  In  the  case  of  Lieutenant  Colonel  M.  M.  Dawson, 
100th  Pennsylvania  Volunteers  (CASE  1251,  page  442,  /Second  /Surgical  Volume),  the 
cardiac  end  only  of  the  axillary  was  tied  for  haemorrhage  occurring  on  the  tenth  day  after 
the  injury;  the  haemorrhage  continued,  and  the  distal  end  was  secured  by  tying  the  brachial. 
In  Private  G.  Harbison's  case  (Second  Surgical  Volume,  page  451)  a  ligature  was  placed 
on  the  proximal  end  of  the  ulnar  artery;  but  haemorrhage  recurring  on  the  next  day,  the 
distal  end  was  ligated,  and  no  further  bleeding  occurred.  In  the  following  instances  of 
ligation  of  the  femoral  artery  haemorrhages  from  the  distal  ends  occurred  on  the  second, 
fourth,  and  sixth  days  after  the  ligation: 

CASE  1189. — Private  J.  Sesler,  Co.  H,  148th  New  York,  aged  28  years,  was  wounded  in  the  left  thigh,  at  Cold  Harbor, 
June  3,  1864.  From  the  field  he  passed  to  Mount  Pleasant  Hospital,  at  Washington,  and  thence,  on  June  15th,  to  Mower, 
Philadelphia.  Surgeon  J.  Hopkinson,  U.  S.  V.,  in  charge  of  the  latter,  made  the  following  report:  "The  injury  was  caused 
by  a  musket  ball  passing  through  the  inner  aspect  of  the  lower  third  of  the  limb.  There  was  profuse  discharge  and  extensive 
sloughing,  extending  down  to  and  ulcerating  through  the  femoral  artery,  and  causing  haemorrhage  to  the  amount  of  from  four 
to  six  ounces  on  July  24th,  when  the  vessel  was  ligated  in  its  continuity,  at  the  middle  third  of  the  thigh,  one  inch  above  the 
wound.  Bleeding  recurred  to  the  extent  of  from  six  to  eight  ounces  from  the  lower  end  of  the  artery  on  July  28th,  when  the 
distal  end  of  the  vessel  was  ligated  in  the  wound.  The  operations  were  performed  by  Acting  Assistant  Surgeon  W.  P.  Moon, 
chloroform  being  used  in  the  first  and  ether  in  the  last,  and  both  being  followed  by  prompt  reaction.  The  patient  did  well  after 
wards.  The  subsequent  treatment  consisted  of  simple  dressings,  tonics,  and  stimulants."  The  patient  was  discharged  from  service 
on  January  11,  1865,  and  pensioned.  Examiner  R.  C.  Dunham,  of  Seneca  Falls,  New  York,  certified,  August  7,  1877,  to  the 
injury,  and  added  that  the  muscular  structures  and  integuments  on  the  inner  side  of  the  limb  have  sloughed  out,  and  that  the 
remaining  structures  have  healed  to  the  bone ;  also  that  "  the  leg  is  swelled  below  the  knee  and  is  sore  and  tender  to  the  touch; 
knee  partially  anchylosed.  Some  important  nerves  must  have  been  wounded  and  are  healed  in  the  structure  with  the  cicatrix, 
as  the  leg  below  the  wound  is  very  numb  and  weak.  He  cannot  walk  but  a  very  little  distance  at  a  time,"  etc.  The  pensioner 
was  paid  March  4,  1882. 

CASE  1190. — Private  C.  Berkey,  Co.  A,  10th  Pennsylvania  Reserves,  aged  24  years,  was  wounded  at  the  bat  tie  of  Manassas, 
August  30,  1862,  and  entered  Filbert  Street  Hospital,  Philadelphia,  four  days  afterwards.  Acting  Assistant  Surgeon  A.  D.  Hall 
reported  the  injury  as  a  "wound  of  the  popliteal  artery,"  and  described  the  case  as  follows:  "A  round  ball  passed  through  the 
lower  third  of  the  left  thigh,  entering  on  the  inner  side  one  inch  or  so  above  the  condyles,  and  making  its  exit  at  the  opposite  side 
in  the  direct  course  of  the  popliteal  artery.  The  case  was  treated  by  simple  dressings  until  the  occurrence  of  arterial  haemorrhage 
on  September  llth  from  both  wounds,  which  amounted  to  about  sixteen  ounces,  and  was  checked  by  compression  with  tourniquets 
until  September  13th,  when  it  recurred  twice  to  the  extent  of  eight  ounces.  Compression  by  means  of  Petit's  tourniquet  over  the 


CHAP,  xii.)  LIGATIONS.  815 

femoral,  Skey's  below  the  wound,  and  graduated  compresses  over  the  course  of  the  vessel  proving  unsuccessful,  and  several  attacks 
of  haemorrhage,  though  small  in  amount,  occurring  on  the  next  day,  the  femoral  artery  was  ligated  at  10  p.  M.,  at  the  middle 
third  of  the  thigh,  after  the  method  of  Hunter.  The  ligature  controlling  the  Weeding,  all  compresses  were  removed  after  the 
operation.  On  September  15th  there  was  slight  oozing  of  bloody  serum  from  the  old  wounds,  and  at  11  P.  M.  another  haemor 
rhage  occurred  from  the  inner  wound  to  the  amount  of  three  ounces,  which  ceased  after  the  application  of  the  tourniquet  to  the 
femoral  where  it  crosses  the  brim  of  the  pelvis.  There  was  no  return  of  haemorrhage  until  the  morning  of  September  17th,  when 
it  recurred  to  the  amount  of  six  ounces.  The  question  of  ligating  the  popliteal  was  now  discussed,  and  after  consultation  it  was 
decided  to  cut  down  upon  the  artery,  upon  doing  which  the  whole  popliteal  space  beneath  the  external  muscles  was  found  to  be 
in  a  sloughing  state  and  filled  with  broken  down  masses  of  clot  and  grumous  matter.  A  cavity  was  formed  by  the  sloughing 
tissue  that  dissected  up  the  muscles  of  the  thigh  and  laid  bare  the  lower  part  of  the  femur.  The  bullet  appeared  to  have  grooved 
the  under  surface  of  the  femur  in  its  passage,  producing  some  comminution  and  opening  the  cancellated  structure  of  the  bone. 
Under  these  circumstances  it  was  considered  that  amputation,  although  almost  certainly  fatal,  would  afford  the  only  chance  for 
the  patient.  Ether  was  accordingly  given,  and  the  operation  was  performed  by  the  circular  method  at  the  upper  part  of  the 
middle  third  of  the  thigh.  There  was  no  reaction,  the  patient  continuing  to  sink,  and  dying  at  1  A.  M.  on  September  18,  1862. 
At  .the  post-mortem  examination  the  popliteal  artery  was  found  to  be  opened  for  about  one-sixth  of  an  inch  at  the  middle  of  the 
popliteal  space,  in  a  direction  parallel  to  the  axis  of  the  artery.  The  popliteal  vein  was  filled  to  distension  by  a  firm  clot.  The 
track  of  the  wound  was  found  to  have  entered  through  the  external  hamstring  tendon,  channelling  the  under  surface  of  the  femur 
and  emerging  through  the  inner  hamstring  tendon.  The  popliteal  artery  was  not  obliterated,  and  the  haemorrhage  must  have 
occurred,  after  the  ligation,  from  the  lower  end  of  the  vessel  through  the  recurrent  circulation.  The  femoral  artery  was  found 
to  be  ligated  about  four  inches  below  the  origin  of  the  profunda,  a  clot  extending  from  the  point  of  the  ligature  about  one-fourth 
of  an  inch  up  to  the  first  small  artery  above." 

CASE  1191. — Private  M.  Knecht,  Co.  K,  4th  Ohio  Cavalry,  was  wounded  in  the  left  thigh,  July  1,  1863,  by  a  musket 
ball,  which  entered  at  the  lower  and  external  side  above  the  condyle  of  the  femur,  and  made  its  exit  at  the  inner  condyle  near 
the  attachment  of  the  hamstring  muscle.  He  was  admitted  to  hospital  at  Murfreesboro'  nine  days  after  the  injury,  where  Assist 
ant  Surgeon  W.  P.  McCullough,  78th  Pennsylvania,  recorded  the  following  treatment:  "The  limb  was  bandaged  from  foot  to 
hip  and  ice  was  applied  to  the  knee.  Haemorrhage  occurred  on  July  28th  and  31st  to  the  amount  of  about  twenty  ounces,  and 
was  controlled  by  compression.  On  August  3d  there  was  another  haemorrhage,  amounting  to  twelve  ounces,  and  ligation  of  the 
popliteal  artery  was  performed  by  enlarging  the  opening  of  exit.  Two  days  later  haemorrhage  again  occurred  from  the  wound, 
and  a  large  anastomotic  branch  was  tied.  No  further  attack  followed  until  August  9th,  when  profuse  bleeding  set  in  from  the 
lower  end  of  the  wounded  artery,  and  the  femoral  was  ligated  in  the  middle  third.  Stimulants  were  given  freely  and  artificial 
heat  was  applied  to  the  foot  and  leg.  The  patient  died  of  exhaustion  August  14,  1863."  The  lower  third  of  the  shaft  of  the 
femur  of  tlie  injured  thigh,  showing  the  outer  and  posterior  border  of  the  bone  to  be  perforated  above  the  condyle  by  the  missile, 
the  seat  of  injury  being  carious,  was  contributed  to  the  Museum  by  Surgeon  I.  Moses,  U.  S.  V.,  and  constitutes  specimen  1757 
of  the  Surgical  Section. 

Two  hundred  and  sixty-one  of  four  hundred  and  thirteen  ligations  in  the  continuity 
had  fatal  terminations,  a  mortality  rate  of  63.1  per  cent.,  exceeding  the  fatality  of  ligations 
in  the  wound  nearly  20  per  cent. ;  but  it  will  be  observed  that,  with  the  exception  of  the 
femoral,  the  large  vessels,  as  the  carotid,  subclavian,  axillary,  iliac,  and  popliteal  arteries 
were,  as  a  rule,  tied  in  the  continuity.  It  is  to  be  regretted  that  ligations  of  both  ends  in 
the  wound  were  not  more  generally  practiced. 

Lidell  records,1  as  his  personal  observation  after  several  severe  battles,  that  he  had 
not  met  "with  a  single  case  of  primary  hemorrhage  which  required  a  surgical  operation, 
such  as  the  application  of  a  ligature  for  its  suppression."  Neudorfer  and  Richter,2  expe 
rienced  European  military  surgeons,  have  never  been  called  upon  to  control  primary  haemor 
rhage  after  injuries  of  blood-vessels  by  ligature  on  the  battle-field  or  the  first  place  of  dressing. 
But  a  number  of  such  operations  were  performed  during  the  war  of  the  rebellion,  and  the 
results  of  these  operations  seem  to  have  been  quite  successful.  Thus,  for  instance,  of  thir 
teen  ligations  of  the  femoral  performed  on  the  battle-field,  seven  proved  successful ;  of  ten 
ligations  of  the  tibial  arteries,  seven  terminated  in  recovery;  and  of  fourteen  ligations  of 
the  brachial  only  one  had  a  fatal  termination,  although  several  of  these  cases  were  compli 
cated  by  fractures.  In  the  case  of  A.  Elmer,  69th  Pennsylvania  (CASE  679,  page  435, 
ante),  the  tibia  was  fractured  and  the  anterior  tibial  artery  divided;  the  latter  was  secured 
by  a  ligature  on  the  field;  the  patient  recovered.  A  case  of  shot  fracture  of  the  lower  third 

1  LIPEI.L  (J.  A.).  On  the  Wounds  of  Blood-vessels,  Traumatic  Hxnwrrhage,  Traumatic  Aneurism,  and  Traumatic  Gangrene,  etc..,  in  United  Slate* 
Sanitary  Commission  Memoirs,  Surgical  Vol.  1,  New  York.  1870,  p.  12. 

"HiCHTKK  (B.),  Chirurgie  der  Schussverlttzungen  im  Kriege  mit  besonderer  Btriicksiclitigung  Kriegschirurgischer  Statistik,  Breslau,  1877,  p.  346, 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


of  the  left  femur,  in  which  the  femoral  artery  was  severed  and  successfully  ligated  on  the 
field,  is  cited  in  TABLE  XLIX,  on  page  353,  ante,  CASE  2. 

VEINS. — Haemorrhage  from  wounded  veins  is  generally  regarded  as  of  less  practical 
importance  than  that  from  wounded  arteries.  It  is  stated  in  a  previous  portion  of  the  history 
that  "no  cases  have  been  reported  in  which  the  bleeding  could  not  be  controlled  by  pres 
sure."  An  examination  of  the  cases  in  the  following  table  shows  that  in  five  instances 
at  least  ligation  of  veins  was  resorted  to : 

TABLE  OLI. 
Summary  of  One  Hundred  and  Six  Cases  of  Hcemmorrhage  from  Veins. 


VEINS. 

<e 

M 

01 

0 

RESULTS. 

CAUSES  OF  DEATH.              LIGATION. 

REMARKS. 

Recovery. 

Death. 

3 

a 

8 

£ 

to 

a 

a 
a 
O 

Erysipelas. 

Haemorrhage. 

Not  stated. 

Kecovery. 

•3 
1 

Parietal        .  .            

1 
1 
2 
15 
6 
3 
2 

2 
1 

7 
1 
2 
1 
2 
15 
C 
2 
1 
7 
5 
17 
7 

1 
1 
1 
I 
3 
1 
0 
1 
1 

Longitudinal  Sinus  ...          

1 
14 
3 
2 
2 
1 

i 



8 
2 

5 

1  typhoid  pneumonia. 

i 

2 



Brachial 

2 

1 

1 

. 

Vena  Cava  .  . 

7 
1 
1 
1 
2 
13 
5 
2 

5 

51  peritonitis. 
1  perf.  liver  and  asc.  vena  cava. 

1 

Gluieal  •...     .. 

1 

1 

Hffimorrhoidal 

i 

Intemal  Iliac  

2 

Femoral    .  .  . 

2 

1 

3 
1 

4 
1 

5 

1 

1 

1 

1 

Profunda  . 

2 

Popliteal  

1 
3 
1 
1 

1 



Subsequent  amputation. 

Upper  extremities,  vessel  not  named. 
Trunk,  vessel  not  named  

4 
4 
16 

7 

1 

1 
8 

3 

3 

Lower  extremities,  vessel  not  named. 
From  Stump  

6 
4 

1 

2 

1  dysentery. 
1  diarrhoea. 

1 

Totals  

106 

20 

86 

17 

5 

1 

47 

9 

3 

2 

Among  the  instances  of  wounds  of  the  arteries  considered  in  the  preceding  pages  were 
quite  a  number  in  which  the  veins  were  likewise  injured.  These  cases  have  not  been 
included  in  this  statement  of  one  hundred  and  six  (106)  venous  haemorrhages,  of  which 
eighty-six  (86),  or  81.1  per  cent.,  proved  fatal. 

From  the  number  of  venous  vessels,  and  from  the  fact  that  they  are  less  liable  to 
evade  a  projectile  in  its  course  than  the  arteries,  it  would  seem  that  injuries  and  haemor 
rhages  of  the  veins  should  have  been  more  frequently  noted.  Statistics  on  the  relative 
frequency  of  injuries  of  the  arteries  and  veins  are  nowhere  found  in  military  surgery. 
Richter1  suspects  that  many  soldiers  perish  on  the  battle-field  from  injuries  of  these  vessels. 
It  remains  a  fact,  however,  that  hemorrhages  from  veins  come  far  more  rarely  under  the 
observation  of  the  surgeon  than  those  of  arteries  ;  but  that  their  fatality  is  equally  as  great, 
if  not  greater,  than  that  of  arteries,  is  clearly  proven  in  the  above  tabular  statement. 

Wounds  of  large  veins  lying  in  cavities  and  beyond  the  reach  of  ligation  seem  to  be  as 

1  RlCHTBlt  (E.),  Chir.  tier  Schussverlclzungen  tm  Kriege  mit  besnnderer  Beriicksichtiguny  Krirrjschir.  Statistik,  Breslau,  1877,  1  Theil,  p.  357. 


VENOUS    HAEMORRHAGES.  817 

fatal  as  those  of  arteries.  The  femoral  and  jugular  veins  would  appear  to  be  less  amenable 
to  treatment  than  others  which  yield  to  pressure  or  cease  spontaneously.  In  forty-seven 
(54.6  per  cent.)  of  the  eighty-six  fatal  cases,  death  was  ascribed  to  secondary  haemorrhage 
occurring  at  various  dates  ;  next  in  order  we  find  pyaemia  and  gangrene  as  causes  of  death, 
especially  in  wounds  of  the  lower  extremities. 

Among  the  one  hundred  and  six  cases  of  haemorrhage  from  veins  were  twenty  cases 
of  primary  injury.  Of  these  fifteen,  or  75  per  cent.,  were  followed  by  primary  bleeding, 
while  in  the  arteries  only  one  hundred  and  ten  of  four  hundred  and  eighty-five,  or  22.7 
per  cent.,  were  succeeded  by  immediate  haemorrhage.  Secondary  haemorrhage  from  veins 
occurred  at  irregular  intervals  from  one  to  seventy  days ;  in  one  instance  the  bleeding  did 
not  take  place  until  the  one  hundred  and  thirty-seventh  day;  and  in  another,  a  case  of 
shot  wound  of  the  buttock,  uncontrollable  venous  haemorrhage  occurred  from  a  persistent 
fistula  three  years  after  the  injury: 

CASE  1192. — Private  W.  H.  Marsh,  Co.  K,  13th  Illinois,  aged  23  years,  was  wounded  at  Chickasaw  Bayou,  December 
29,  1862,  by  two  musket  balls,  one  entering  the  upper  part  of  the  left  thigh  and  the  other  passing  into  the  hip.  He  was  taken 
prisoner  and  remained  for  a  time  in  the  hands  of  the  enemy.  In  May,  following,  he  was  conveyed  to  Memphis,  where  he  entered 
Overtoil  Hospital,  and  remained  for  four  weeks,  after  which  he  was  transferred  to  Lawson  Hospital,  at  St.  Louis.  Surgeon  C. 
T.  Alexander,  U.  S.  A.,  in  charge  of  the  latter,  reported  that  "the  wound  of  the  thigh,  which  is  now  quite  healed,  was  treated 
by  a  Confederate  physician  as  a  fracture  of  the  femur,  which  does  not  seem  to  have  existed.  The  patient  avers  that  the  other 
ball,  which  entered  the  gluteal  region  close  to  the  tuberosity  of  the  ischium,  is  still  there,  though  it  cannot  be  felt  by  the  probe. 
There  is  a  sinus,  however,  extending  six  inches  into  the  muscles  of  the  buttock,  and  from  the  nature  of  the  discharge  it  is 
probable  that  there  is  a  foreign  body  of  some  kind  in  the  wound."  Acting  Assistant  Surgeon  F.  K.  Bailey  reported  the  subse 
quent  history  of  the  case,  as  follows:  "The  patient  was  admitted  to  hospital  at  Quincy  on  July  17th,  being  very  feeble  and  pale 
and  appearing  to  have  lost  a  great  deal  of  blood.  He  could  not  stand  on  his  left  lower  extremity,  and  pus  was  still  escaping 
from  the  orifice,  which  was  near  the  coccyx.  Good  nourishment  and  laxatives,  when  necessary,  were  given,  witli  morphia  pro 
re  nata.  Solution  of  morphia  was  also  used  in  poultices  and  dressing.  Two  months  after  his  admission  he  complained  of  pain 
in  the  hypogastric  when  passing  urine,  in  connection  with  which  he  stated  that  while  he  was  at  Vicksburg  it  was  necessary  to 
use  the  catheter.  In  October  he  had  neuralgic  pains  in  the  left  side  of  the  pelvis  and  in  the  thigh,  and  there  were  indications  of 
miasmatic  chills;  wound  still  discharging  freely.  Quinine  was  then  prescribed,  and  subsequently  small  doses  of  strychnine 
were  added.  On  October  27th  a  probe  was  passed  into  the  opening  at  the  ischiatic  region  to  the  depth  of  three  inches  toward 
a  point  one  inch  above  the  crest  of  the  ilium.  There  was  still  free  discharge  of  pus,  but  the  patient  felt  much  better  than  he  did 
a  month  previously.  On  October  29th  tincture  of  iodine  was  injected  into  the  wound,  subsequent  to  which  he  complained  of 
severe  pain  along  the  track  of  the  fistulous  opening,  accompanied  by  spasmodic  jerking  of  the  wounded  extremity.  On  Novem 
ber  1st  a  small  piece  of  woollen  cloth  came  out  of  the  opening,  which  was  followed  by  another,  one  and  one-half  inches  square, 
the  next  day.  By  November  15th  the  wound  had  nearly  healed,  very  little  pus  was  escaping,  and  the  patient  was  improving 
in  strength  but  could  not  yet  step  upon  the  injured  limb.  On  November  24th  he  had  some  fever,  with  dysuria,  when  sweet 
spirits  of  nitre  was  ordered  in  addition  to  the  quinine.  About  December  1st  the  patient  was  able  to  st»p  a  little  and  was 
improving  finely.  During  the  next  month  no  change  occurred  in  the  condition  of  the  patient,  who  still  complained  of  pain  in 
the  affected  side  from  the  orifice  through  to  the  crest  of  the  ilium,  and  also  in  the  inguinal  region ;  pus  still  escaping,  and  occasion- 
all}'  a  shred  of  clothing.  By  March  18,  1864,  a  probe  could  still  be  passed  in  the  direction  of  the  crest  of  the  ilium.  On  June 
6,  1864,  the  patient  was  discharged  from  service  for  disability,  being  barely  able  to  walk  with  the  aid  of  a  cane,  and  his  wound 
not  having  healed."  The  ultimate  result  of  the  case  was  communicated  by  Dr.  Bailey  several  years  later:  "  In  November,  1865. 
I  returned  to  11131  former  home  in  Joliet,  Illinois,  where  I  was  called  upon  to  examine  the  patient,  who  had  returned  there  after 
receiving  his  discharge.  The  fistulous  opening  of  his  wound,  which  for  a  long  time  had  been  an  exit  for  pus,  had  become  gan 
grenous  during  the  previous  month,  and  about  November  10th  inflammation  began  to  extend  to  the  peritoneum,  involving  the 
bladder  and  causing  characteristic  symptoms  of  peritoneal  inflammation  through  the  lower  part  of  the  abdomen.  Extensive 
venous  haemorrhage  occurred  about  twenty-four  hours  before  death.  There  was  no  post-mortem  examination  held."  The  records 
of  the  Pension  Office  show  that  death  took  place  on  November  20,  1865. 

In  the  next  two  cases  death  was  ascribed  to  the  sudden  entrance  of  air  into  the  veins: 

CASE  1193.— Corporal  A.  M.  Delano,  Co.  E,  1st  Maine  Heavy  Artillery,  aged21  years,  was  wounded  at  Spottsylvania,  May 
12,  1864,  by  a  minic"  ball,  which  entered  just  back  of  the  left  ear,  fracturing  the  mastoid  process  of  the  left  temporal  bone,  passed 
downward  and  forward  and  lodged  just  anterior  to  the  artery  at  the  angle  of  the  lower  jaw.  On  May  22d  he  was  admitted  into 
Emory  Hospital,  Washington,  where,  on  the  same  day,  the  missile  and  a  fragment  of  the  cranium  were  removed.  On  May  25th 
haemorrhage  to  the  extent  of  twenty  ounces  occurred  from  the  internal  jugular  vein.  He  died  suddenly  on  May  25,  1834.  Air 
was  supposed  to  have  passed  into  the  vein.  The  autopsy  revealed  the  jugular  vein  to  be  in  process  of  ulceration  two  inches  of 
its  length,  with  its  tissues  severed  from  before  backward,  except  a  few  fibres  on  its  posterior  surface.  Surgeon  N.  E.  Moseley, 
U.  S.  V.,  reports  the  case. 

CASE  1194. — Private  B.  Y.  Brown,  Co.  C,  22d  Massachusetts,  aged  23  years,  was  admitted  into  Kmory  Hospital, 
Washington.  May  13.  18i>4,  with  gunshot  wounds  of  the  thigh,  leg,  and  neck,  received  at  the  battle  of  the  Wilderness,  May  7, 
SUHG.  ill— 103 


818  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

1864.  The  thigh  had  been  amputated  on  the  field  on  May  7th,  in  the  lower  third,  hy  lateral  flaps.  A  ball  had  entered  the  neck 
below  the  angle  of  the  jaw,  passed  through  the  larynx,  and  lodged  near  where  the  carotid  crosses  the  omo-hyoid  muscles.  On 
May  Kith  the  hall  was  extracted  from  its  position  against  the  carotid  by  an  incision  one  and  a  half  incites  long,  one  inch  below 
the  mastoid  process  of  the  temporal  bone,  by  Acting  Assistant  Surgeon  W.  H.  Ensign,  U.  S.  A.  At  this  date  the  thigh  was 
healing  kindly  hy  first  intention.  The  wound  of  the  neck  had  an  extraordinary  appearance.  The  patient's  constitution  was 
slender  but  not  much  impaired.  Some  trouble  in  swallowing  and  breathing  ;  cheerful,  sleeps  well,  shows  little  signs  of  distress  ; 
pulse  90,  bowels  regular.  No  medicine  given;  but  good  liquid  diet  with  local  water  dressings.  Food  has  to  be  administered 
with  a  stomach  pump.  On  May  17th  haemorrhage  to  the  amount  of  one  quart  occurred  from  the  internal  jugular  vein.  Air 
was  supposed  to  have  passed  through  the  vein  into  the  heart.  A  post-mortem  examination  showed  the  cause  of  haemorrhage  to 
be  ulceration  of  the  anterior  surface  of  the  internal  jugular  vein.  The  case  is  reported  by  Surgeon  N.  R.  Moseley,  U.  S.  V. 

In  a  third  instance  (Case  of  E.  C.  Melley,  page  555,  First  Surgical  Volume]  the  sub- 
clavian  vein  was  accidentally  cut  while  searching  for  the  axillary  artery.  The  .entrance  of 
air  caused  syncope,  and  death  ensued  in  less  than  ten  minutes. 

In  the  accompanying  chromo-lithograph  (PLATE  LXXIX,  FIG.  I)  the  appearance  of  the 
femoral  vein  removed  from  a  stump  twelve  hours  after  death  from  pyaemia  (Case  of  Sailor, 
No.  469.  page  289,  ante)  is  faithfully  represented.  The  end  of  the  vein,  well  sealed  up  in 
the  stump,  was  empty,  and  collapsed  from  the  end  up  to  the  valve  of  the  first  anastomosing 
branch,  a  distance  of  about  six  inches.  The  vein  in  this  situation  was  about  as  large  as 
the  artery,  the  walls  being  much  thickened  and  about  the  thickness  of  those  of  the  artery; 
the  lining  membrane  looked  velvety,  wrinkled,  and  dirty-gray  in  color;  there  was  no  pus 
in  the  vein.  From  the  valve  above  mentioned  up  to  the  mouth  of  the  vena  profurida,  a 
distance  of  about  two  and  a  half  inches,  the  femoral  vein  was  filled  to  distension  with  fetid 
broken-down  liquefied  blood,  its  lining  membrane  dirty-gray  colored  in  this  situation,  and 
its  walls  somewhat  thicker  than  natural;  no  pus  was  found  in  this  locality  by  the  microscope. 
At  the  mouth  of  the  vena  profunda  the  femoral  vein  was  plugged  up  with  yellowish-white 
fibrine;  the  vena  profunda  and  many  of  its  branches  were  filled  and  knotted  with  recent 
coagulum;  the  femoral  vein  was  also  filled  with  recent  coagulum  above  the  mouth  of  the  pro 
funda  to  a  distance  of  about  two  and  a  half  inches;  the  lining  membrane  of  the  profunda  and 
of  the  part  of  the  femoral  vein  last  mentioned  were  stained  dark  red,  and  the  walls  of  the 
vessels  somewhat  thickened  in  the  same  locality.  A  thin  dark  colored  recent  coagulum, 
not  filling  the  calibre,  extended  the  whole  length  of  the  external  iliac  vein. 

TETANUS. 

Considering  the  number  of  injuries,  the  proportion  of  cases  of  tetanus  is  not  large;  of 
the  two  hundred  and  forty-six  thousand  seven  hundred  and  twelve  (246,712)  injuries  by 
weapons  of  war,  five  hundred  and  five  (0.20  per  cent.,  or  a  little  over  two  in  a  thousand) 
were  followed  by  tetanus.  In  the  cases  in  which  this  complication  was  observed  the  seat 
of  the  injury  was:  in  the  head,  face,  and  neck  in  twenty-one  instances,  in  the  trunk  in 
fifty-five,  in  the  upper  extremities  in  one  hundred  and  thirty-seven,  in  the  lower  extremi 
ties  in  two  hundred  and  ninety-two  instances.  The  preponderating  frequency  of  tetanus  in 
the  lower  extremities,  observed  by  Beck1  and  others,  was  very  marked,  over  one-half  of  all  the 
cases  having  occurred  after  injuries  in  this  portion  of  the  human  structure,  due  undoubtedly 
to  the  massive  layers  of  muscles  and  soft  tissue,  which  prevent  the  surgeon  frequently  from 
clearing  the  track  of  the  wound  of  foreign  bodies  and  other  obnoxious  influences.  Of  the  two 
hundred  and  ninety-two  cases  of  tetanus  in  the  lower  extremities,  the  injuries  were  in  the 
hip  in  two  instances,  in  the  thigh  in  ninety- nine,  in  the  knee  in  seventeen,  in  the  leg  in 
ninety-five,  in  the  ankle  in  twenty-two,  and  in  the  foot  in  fifty-seven  instances;  of  the  one 
hundred  and  thirty-seven  instances  in  the  upper  extremities  the  injuries  were  in  the  hand 

1  BECK  (R.),  Chirurgie  der  Schussverletzungen,  Freiburg,  i.  Br.,  1872,  p.  331. 


CHAP.  XII.) 


TETANUS. 


819 


in  thirty-seven,  in  the  arm  in  thirty-four,  in  the  shoulder  in  thirty- one,  in  the  forearm  in 
twenty-four,  in  the  elbow  in  seven,  and  in  the  wrist  in  four  instances.  The  belief  that  shot 
wounds  of  the  foot  and  hand  are  particularly  apt  to  cause  tetanus  is  not  confirmed  by  the 
rases  recorded  during  the  war.  In  the  lower  extremity,  especially,  this  complication  is 
found  most  frequently  in  injuries  of  the  thigh  and  the  leg.  In  one  hundred  and  thirty-one 
instances  tetanus  followed  closely  upon  operations  in  the  extremities,  viz,  in  one  hundred 
and  sixteen  cases  after  amputations  and  in  fifteen  cases  after  excisions.  The  rarity  of  tetanus 
as  a  complication  of  chest  wounds  has  been  noted  on  page  635  of  the  First  /Surgical  Volume, 
and  it  may  here  be  added  that  in  all  but  one  of  the  seventeen  cases  there  referred  to  the 
complication  was  due  to  simultaneous  injuries  of  the  scapula,  shoulder  joint,  or  arm. 

Of  the  five  hundred  and  five  cases,  four  hundred  and  fifty-one,  or  89.3  per  cent.,  ended 
in  death,  as  follows  : 

TABLE  CLII. 

Summary  of  Five  Hundred  and  Five  Cases  of  Tetanus,  indicating  Seat  of  Injury  and  Result. 


SEAT  OF  INJUEY. 

TOTAL  CASES. 

RECOVERIES. 

DEATHS. 

RATIO  OF 
MORTALITY. 

Head  Face,  Neck                                       -  -      -      

21 

1 

20 

95.2 

Trunk                                                                          -  

55 

5 

50 

90.9 

137 

18 

119 

86.8 

292 

30 

262 

89.7 

505 

54 

451 

89.3 

The  recoveries  after  tetanus  appear  to  have  chiefly  occurred  in  the  cases  of  slighter  or 
tetanoid  forms,  or  in  those  in  which  the  disease  took  a  chronic  course,  and  it  is  possible 
that  the  early  application  of  powerful  narcotics  interrupted  the  progress  of  the  malady 
in  a  few  cases  of  acute  form.  From  an  examination  of  these  cases  it  may  be  concluded  that 
the  later  the  occurrence  of  the  disease  after  an  injury,  the  better  was  the  chance  of  recovery; 
arid  also,  that  the  longer  the  duration  of  the  affection  after  its  inception,  the  greater  was 
the  chance  of  life.  (See  TABLE  CLIV,  on  page  820.) 

In  the  following  table  are  indicated  the  days  after  the  injury  or  after  amputation  on 
which  tetanus  made  its  first  appearance: 

TABLE  GLIII. 
Statement  indicating  the  day  after  Injury  or  Amputation  on  which  Tetanus  appeared. 


a 

a 

3 
o 

367 


Days  after  the  Injury  or  Amputation  on  -which  Tetanus  appeared. 

2!°;< 

5 

fi    '    7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26  to  30 

Above  30 

i 

899 

19 

30     23 

37 

24 

27 

25 

20 

17 

12 

6 

7 

11 

5 

4 

4 

3 

1 

3 

3 

3 

7 

23 

In  twenty-seven  cases  tetanus  appeared  on  the  first  day;  but  twenty-one  of  these 
were  cases  of  tetanus  following  amputations,  so  that  in  reality  it  only  appeared  in  six  cases 
within  the  first  twenty-four  hours  after  the  original  injury,  and  it  may  here  be  stated  that, 
with  the  exception  of  a  small  number  of  cases,  tetanus  in  cases  of  amputations  invariably 
followed  within  a  few  days  after  the  operation.  Few  cases  occurred  on  the  second,  third, 
and  fourth  days  after  the  injury;  but  from  the  fifth  day,  when  sufficient  time  had  elapsed 
for  inflammatory  action  to  establish  itself,  the  number  of  cases  rapidly  increases  until  the 


820 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


eighth,  when  it  gradually  diminishes  again  until  the  fourteenth,  after  which  period  tetanus 
appear  irregularly,  in  one  instance  the  malady  not  making  its  appearance  until  seven  months 
after  the  injury. 

As  the  causes  of  this  fatal  malady  are  cited :  excessive  heat,  exposure  to  cold  and  damp 
air,  draughts,  neglect  of  thorough  and  early  cleaning  of  the  wound  channel,  pressure  of 
missiles  and  bone  splinters  and  of  bandages  on  nerves,  injuries  to  nerves  while  searching 
for  foreign  bodies  or  while  performing  ligations  and  excisions. 

The  duration  of  the  disease  is  indicated  in  three  hundred  and  fifty-eight  cases,  of  which 
twenty-one  ended  in  recovery  and  three  hundred  and  thirty-seven  in  death,  as  follows: 

TABLE  CLIV. 

Numerical  Statement  of  Results  of  Three  Hundred  and  Fifty-eight  Cases  of  Tetanus  in  which  the  dura 
tion  of  the  disease  was  reported. 


EKSULT. 

Totals. 

Days  of  Duration  of  Tetanus. 

1 
1 

eg 

2 

3 

4 

5 

6     7 

8 

0 

10 

1! 

12 

13 

It 

15 

16 

18 

19 

20 

21 

23 

24 

20 

27   29 

33 

37   39 

48 

49 

21 
337 

1 

,-:; 

1 

r. 

i 

6 

1 

? 

1 

1 
3 

3 
1 

•  i 

* 

1 

2 

1 

1 

1 

1 

> 

1 

Deaths 

19 

:;i 

22 

L9 

1  1 

7 

•  t 

2 

3 

•1 

•1 

1 

1 

j 

358 

7U 

84 

•I'.' 

:n 

22 

1:1 

M 

7 

0 

7 

0 

3 

2 

5 

2 

1 

1 

1 

1 

1 

In  two  hundred  and  three,  or  more  than  one-half  of  the  cases  in  which  this  point  was 
ascertained,  the  duration  of  the  malady  did  not  exceed  three  days,  and  of  these  only  two 
recovered;  in  the  remaining  nineteen  cases  of  recovery  the  disease  lasted  from  nine  to  forty- 
nine  days,  while  the  longest  duration  in  the  fatal  cases  was  only  twenty-seven  days. 

In  several  cases  the  removal  of  the  missile  or  of  foreign  bodies,  as  pieces  of  bone,  seem 
to  have  quieted  the  threatening  symptoms;  in  one  instance  they  were  relieved  by  the  loosen 
ing  of  a  bandage  pressing  on  the  brachial  plexus,  and  in  another  by  the  removal  of  a  neuroma  : 

CASE  1195. — Private  Oscar  C.  Romaine,  Co.  I,  145th  New  York,  aged  20  years,  was  wounded  in  the  right  index  finger 
October  25,  1862.  The  finger  was  amputated  near  the  base  of  the  first  phalanx  on  October  30th.  The  part  healed  readily,  but 
was  very  tender  and  often  painful.  In  this  condition  he  was  admitted  into  Lincoln  Hospital,  Washington,  January  18,  18b'3. 
Acting  Assistant  Surgeon  B.  P.  Brown  reported  :  "Nothing  special  transpired  until  March  20th,  when,  on  attempting  to  swal 
low,  he  was  seized  with  pain  and  stiffness  in  the  neck  and  was  unable  to  speak.  Soon  there  was  a  heaving  up  of  the  chest  and 
the  head  was  rapidly  thrown  from  side  to  side;  the  jaws  closed,  the  angles  of  the  mouth  were  drawn  back,  the  eyebrows  knit, 
and  the  countenance  of  a  ghastly  appearance.  For  a  moment  there  would  be  partial  remission,  when  the  patient  would  complain 
that  he  could  not  bear  to  have  any  one  touch  him,  as  it  caused  the  most  severe  suffering.  Suddenly  another  paroxysm  would 
come  on  more  severe  than  the  former,  and  then  an  interval,  which,  however,  would  be  very  short.  This  state  of  things  continued 
from  four  o'clock  P.  M.  till  one  o'clock  A.  M.,  when  it  was  decided  upon  to  open  the  wound  and  search  for  the  cause.  The  part 
being  laid  open,  a  neuroma  somewhat  larger  than  a  buckshot  was  found  intimately  incorporated  with  the  hard  cicatrix  and 
tightly  adherent  to  a  spiculum  of  bone  beneath.  The  tumor  was  removed,  also  the  bony  portion  to  which  it  had  been  attached. 
The  parts  were  then  brought  together  by  adhesive  straps,  and  the  patient  rested  well,  having  but  one  more  spasm  about  four 
o'clock  A.  M.,  and  that  very  light.  He  is  now  quite  recovered  and  enjoying  better  health  than  for  some  months  past."  He  was 
discharged  from  service  June  19,  1863.  He  is  not  a  pensioner. 

In  the  following  case  an  incision  down  to  the  nerve  temporarily  relieved  the  symp 
toms  of  trismus,  caused  by  the  contraction  of  the  cicatrix.  As  the  symptoms  reappeared 
with  increased  vehemence,  a  portion  of  the  nerve  was  dissected  out,  and,  no  relief  being 
afforded,  amputation  remained  the  only  alternative  : 

CASE  1196. — Private  John  C.  Marks,  Co.  D,  149th  Pennsylvania,  aged  28  years,  was  wounded  at  the  Wilderness,  May  10, 
1864.  On  May  13th  he  was  admitted  into  Stanton  Hospital,  Washington,  whence  Surgeon  John  A.  Lidell,  U.  S.  V.,  reported: 
"Flesh  wounds  of  both  arms  by  a  musket  ball,  which,  after  passing  through  the  left  arm,  entered  the  right  near  the  inner  edge 
of  the  biceps  muscle,  and  passed  through  obliquely,  outward  and  downward.  At  the  end  of  about  six  weeks  both  wounds 
had  healed;  the  cicatrix  was  firm.  The  medial  nerve  was  evidently  included  in  the  cicatrix  of  the  wound  of  the  right  arm,  as 
he  suffered  intense  pain  in  the  course  of  it,  especially  in  the  fingers,  which  were  stiff  and  extended.  The  nutrition  of  the  arm 


CHAP.  XII.]  TETANUS.  821 

was  also  impaired.  He  suffered  great  nervous  irritation.  September  16th,  the  pain  in  the  forearm  and  hand  is  very  severe;  lie 
has  also  partial  trismus;  his  jaws  are  stiff,  but  he  can  open  them  to  the  extent  of  about  an  inch.  He  has  failed  in  strength  and 
appetite  and  is  emaciated."  Dr.  Lidell  made  an  incision  about  two  inches  in  length  through  the  cicatrix  down  to  the  nerve,  which 
was  loosened  and  laid  bare  to  the  extent  of  the  incision.  The  old  cicatrix  was  also  removed.  The  nerve  did  not  appear  to  be 
injured  in  any  way.  The  pain  was  apparently  caused  by  compression  of  it — by  the  contraction  of  the  cicatrix.  The  wound 
was  left  open  to  heal  by  granulation.  He  had  been  treated  to  date  of  operation  by  subcutaneous  injections  of  morphia,  which 
relieved  the  pain  temporarily.  September  17th,  pain  is  slight,  trismus  lessened;  passed  a  comfortable  night.  September  18th, 
pain  continues,  trismus  subsided.  The  injections  of  morphia  were  continued  at  night,  and  a  grain  of  sulphate  of  zinc  ordered 
thrice  daily.  September  30th,  treatment  continued  to  date.  The  operation  has  only  afforded  partial  relief.  The  pain  continues 
quite  severe.  October  Gth,  the  wound  of  the  previous  operation  has  entirely  healed,  but  he  cannot  use  the  hand  in  consequence 
of  the  exalted  sensibility  of  it;  the  pain  in  it  is  very  severe,  and  he  is  suffering  much  from  want  of  sleep.  He  has  had  several 
paroxysms  of  severe  tetanic  irritation,  with  some  stiffness  of  the  jaws,  one  of  which  occurred  this  morning.  Assistant  Surgeon 
George  A.  Mursick,  U.  S.  V..  made  an  incision  through  the  cicatrix  of  the  previous  operation  and  dissected  out  the  median  and 
excutaneous  nerves,  which  were  found  lying  in  close  apposition,  and  resected  three- fourths  of  an  inch  of  each  of  them.  They 
were  both  involved  in  the  new  cicatrix.  October  19th,  the  operation  of  resection  did  not  avail  anything,  and  his  condition  is  as 
bad  as  ever.  The  pain  is  now  so  severe  as  to  deprive  him  (if  all  rest,  and  the  sensibility  of  the  hand  is  so  great  that  he  will  not 
allow  anything  to  touch  it.  His  general  health  is  suffering  severely.  His  countenance  expresses  great  anxiety  and  his  appetite 
has  failed.  Surgeon  John  A.  Lidell,  U.  S.  V.,  administered  chloroform  and  amputated  the  right  arm  at  the  junction  of  the  upper 
with  the  middle  third  by  anteror  posterior  flaps.  Marks  recovered,  and  was  discharged  May  27,  1865,  and  pensioned. 

Including  the  case  just  detailed,  amputation  was  resorted  to  in  twenty-nine  instances 
after  incipient  tetanic  symptoms;  ten  of  the  cases  resulted  favorably,  and  in  several 
instances  it  is  noted  that  the  symptoms  ceased  after  the  operation.  A  few  of  these  cases 
are  here  cited  in  detail: 

CASE  1197. — Private  D.  E.  Isham,  Co.  E,  154th  New  York,  aged  19  years,  was  wounded  in  the  left  foot,  at  Chancellors- 
ville,  May  3, 1863,  and  was  admitted  to  a  field  hospital  of  the  Second  Corps.  Surgeon  C.  S.  Wood,  66th  New  York,  made  the  follow 
ing  report:  "The  injury  was  caused  by  the  explosion  of  a  shell,  which  carried  away  most  of  the  foot  and  shattered  the  cuneiform 
bone  and  the  astragalus,  leaving  the  foot  hanging  by  the  integument  of  the  plantar  surface.  There  was  but  little  haemorrhage, 
but  the  shock  was  excessive  and  tetanic  symptoms  were  present;  in  other  words  the  case  admitted  of  no  delay.  If  I  remember 
right  the  patient  had  lain  out  all  night.  Not  knowing  the  extent  of  the  injury  I  performed  Chopart's  amputation,  but  discover 
ing  the  cuneiform  and  astragalus  bones  to  be  so  much  injured  I  proceeded,  while  the  patient  was  still  under  chloroform,  to  perform 
Syme's  operation."  The  patient  was  subsequently  transferred  to  hospital  at  Alexandria,  and  later  to  Washington,  where  he  was 
discharged  from  service  January  22,  1864,  and  pensioned. 

CASE  1198. — Sergeant  T.  Lewis,  Co.  E,  5th  Michigan,  aged  26  years,  was  wounded  in  the  right  forearm,  at  Gettysburg, 
July  2,  1863,  by  around  ball,  which  entered  on  the  ulmar  side  just  above  the  styloid  process,  passed  obliquely  across,  and  came 
out  on  the  radial  side  about  two  inches  above  the  joint,  comminuting  both  bones  in  its  course.  He  was  admitted  to  Broad  and 
Cherry  Streets  Hospital,  Philadelphia,  July  13th,  at  which  time  his  general  health  was  not  very  good,  the  wound  being  inflamed 
and  very  painful.  Several  fragments  of  bone  were  removed,  flaxseed  poultice  was  applied,  and  the  forearm  was  placed  in  Bond's 
splint.  Under  a  treatment  of  tonics,  with  opium  at  night,  the  patient  slowly  improved  until  August  25th,  when  he  was  sud 
denly  seized  with  a  chill  followed  by  threatening  tetanus.  In  consultation  the  next  day  it  was  decided  to  amputate  the  fore 
arm  as  a  means  of  saving  life.  The  operation  was  performed  by  Teal's  method,  at  the  middle  third,  by  Acting  Assistant  Surgeon 
A.  Hewson,  while  the  patient  was  under  the  influence  of  ether.  He  reacted  readily.  The  stump  was  dressed  with  solution  of 
lead  and  laudanum,  being  slightly  elevated  on  a  pillow.  The  wound  granulated  rapidly,  and  by  September  20th  cicatrization 
was  almost  complete,  leaving  a  good  stump  without  adhesion  of  flaps  to  the  bones.  A  slight  exfoliation  from  the  end  of  the 
radius  occurred  during  the  progress  of  the  case.  The  carpus  and  amputated  portions  of  the  bones  of  the  forearm  were  forwarded 
to  the  Museum,  with  the  history  of  the  case,  by  Acting  Assistant  Surgeon  W.  F.  Keating,  and  constitute  specimen  2794  of  the 
Suryical  Section.  The  patient  was  subsequently  transferred  to  Mower  Hospital,  where  he  was  discharged  from  service  April 
20,  1864,  and  pensioned. 

CASK  1199. — Corporal  P.  Nelson,  Co.  K,  139th  Pennsylvania,  aged  19  years,  was  wounded  at  the  Wilderness,  May  5, 
1864,  by  a  muskst  ball,  which  shattered  the  radius  and  ulna  of  the  right  forearm  for  two  inches  at  the  junction  of  the  middle 
and  lower  thirds,  also  wounding  the  ulnar  nerve.  One  week  after  receiving  the  injury  the  man  entered  Finley  Hospital, 
Washington,  where  he  did  well  until  June  9th,  when  the  arm  became  much  swollen  and  symptoms  of  tetanus  ensued,  including 
stiffening  of  the  jaws,  great  pain  and  restlessness,  and  irritable  pulse.  On  June  llth  circular  amputation  of  the  arm  at  the  middle 
third  was  performed  under  chloroform  by  Acting  Assistant  Surgeon  D.  P.  Wolhaupter.  All  symptoms  of  tetanus  disappeared 
after  the  operation  and  the  patient  rapidly  recovered.  He  was  ultimately  discharged  from  service  July  27,  1865,  and  pensioned. 
The  two  lower  thirds  of  the  bones  of  the  fractured  forearm  were  contributed,  with  the  history  of  the  case,  to  the  Museum  by 
Surgeon  G.  L.  Pancoast,  U.  S.  V.,  and  constitute  specimen  2586  of  the  Surgical  Section. 

CASK  12CO. — Sergeant  A.  Smith,  Co.  G,  66th  New  York,  aged  47  years,  was  wounded  at  Fredericksburg.  December  11, 
1862,  by  a  shell  which  carried  away  a  large  portion  of  the  right  foot.  Partial  amputation  of  the  foot  was  performed  in  the  field 
by  Surgeon  C.  S.  Wood,  63th  New  York.  The  peculiarities  in  the  case  were  that  symptoms  of  tetanus  were  quite  marked,  with 
great  exhaustion,  and  that  relief  was  afforded  temporarily  by  chloroform,  and  permanently  by  the  amputation.  The  patient 
continued  to  do  well  afterwards.  He  was  discharged  from  service  May  1,  1863,  and  pensioned.  The  history  of  the  case  was 
reported  by  the  operator. 


y22  WOUNDS    AND    COMPLICATIONS.  I  CHAP,  xn 

CASK  1201. — Captain  F.  Schaefer,  Co.  I,  73d  Pennsylvania,  aged  28  years,  was  wounded  at  Mission  Ridge,  November 
25,  1863,  by  a  musket  ball,  which  fractured  the  left  foot  and  lodged.  The  missile  was  extracted  the  fifth  day  after  the  injury, 
which  was  followed  by  extensive  inflammation.  On  December  9th  symptoms  of  tetanus  ensued,  which  were  relieved  by  active 
purgatives,  calomel,  etc.  Three  days  later  the  symptoms  returned,  and  on  December  13th  tetanus  supervened  in  its  usual  form. 
On  December  18th  the  leg  was  amputated  at  the  middle  third,  after  which  the  tetanus  subsided  and  the  patient  made  a  rapid  and 
good  recoverv.  Surgeon  13.  L.  Hovey,  136th  New  York,  who  performed  the  operation,  reported:  "I  believe,  with  other  sur 
geons,  that  amputation  cured  this  man  of  tetanus."  Captain  Schaefer  resigned  the  service  July  5,  1864,  and  subsequently 
became  a  pensioner. 

CASK  120J. — Sergeant  J.  Henderson,  Co.  A,  12lith  New  York,  aged  29  years,  was  wounded  in  the  right  knee,  at  Spottsyl- 
vania,  May  10,  Ido4,  by  a  musket  ball,  which  shattered  the  head  of  the  fibula  and  the  posterior  surface  of  the  tibia,  lodging 
between  the  gastrocnemins  and  soleus  muscles.  lie  was  admitted  to  Finley  Hospital,  Washington,  two  weeks  after  the  injury. 
the  wound  appearing  healthy  and  his  general  condition  being  good.  A  day  or  two  afterwards  the  patient  complained  of  soreness 
in  the  throat,  and  on  May  29th  marked  symptoms  of  tetanus,  such  as  rigidity  of  the  muscles  of  the  jaw  and  difficulty  of  masti 
cation  and  deglutition,  existed.  On  May  30th  circular  amputation  at  the  lower  third  of  the  thigh  was  performed  by  Acting 
Assistant  Surgeon  F.  G.  H.  Bradford,  immediate  relief  seeming  to  be  afforded  by  the  operation.  The  following  day  the  rigidity 
of  the  muscles  had  partly  disappeared  and  improvement  continued  until  the  patient  was  entirely  relieved.  Further  progress  in 
every  respect  continued  favorable  and  the  stump  healed.  The  probable  cause  of  the  appearance  of  tetanus  was  owing  to  a  slight 
laceration  of  the  external  popliteal  nerve,  produced  by  the  ball  in  its  passage  through  the  limb.  On  August  1,  1865,  the  patient 
was  discharged  from  service  and  pensioned,  having  been  previously  fitted  with  a  "  Jewett"  artificial  limb.  The  upper  portion 
of  the  bones  of  the  amputated  leg,  showing  the  seat  and  extent  of  the  injury,  were  contributed  to  the  Museum,  with  the  history 
of  the  case,  by  the  operator. 

CASK  120.5. — Corporal  II.  Kampp,  Co.  A,  113th  Illinois,  aged  20  years,  was  wounded  in  the  right  forearm,  before  Vicks- 
burg,  May  19,  18(53.  lie  was  conveyed  to  hospital  at  Memphis,  and  subsequently  to  St.  Louis,  where  he  entered  Lawson  Hos 
pital  one  month  after  the  date  of  the  injury.  Surgeon  C.  T.  Alexander,  II.  S.  A.,  in  charge  of  the  latter,  made  the  following 
report:  "The  injury  consisted  of  a  compound  fracture  of  the  radius  and  ulna  near  the  wrist,  and  was  produced  by  u  conical 
ball.  Both  bones  were  necrosed,  and  the  wound  was  in  a  very  bad  condition  at  the  time  of  the  patient's  admission.  Numerous 
pieces  of  bone  were  impacted  into  the  surrounding  fleshy  tissue,  and  pus  of  a  fetid  and  unhealthy  character  was  flowing  from 
both  wounds  very  abundantly.  According  to  the  patient's  statement  he  was  first  taken  with  trismus  about  a  week  before  his 
admission  here,  while  he  was  in  hospital  at  Memphis,  though  it  did  not  appear  that  lie  had  been  exposed  to  anything  unusual. 
As  he  was  certainly  getting  worse  every  day  it  was  decided  to  amputate  as  a  last  resort.  Accordingly,  on  June  28th,  the  opera 
tion  was  performed  about  four  inches  below  the  elbow  joint,  the  patient  seeming  to  stand  the  shock  very  well  and  to  gradually 
improve  from  that  time.  The  treatment  at  first  had  consisted  of  a  narrow  blister  applied  along  the  whole  length  of  the  spine  on 
each  side,  brandy  and  chloroform  being  administered  every  two  hours.  These  last  two  remedies  not  appearing  to  do  any  good, 
one-half  drachm  of  tincture  of  cannabis  indica  was  tried  every  two  hours,  under  which  the  patient  slowly  improved.  An  enema 
of  beef  tea  and  quinine  had  also  been  given  three  times  a  day  from  the  first."  The  patient  entirely  recovered,  and  was  dis 
charged  from  service  September  1,  1853,  and  pensioned. 

The  treatment  of  this  affection  was  empirical  to  the  last  degree,  and  the  formidable 
list  of  remedial  agents  employed  in  combating  it  presents  a  curious  study  of  the  diverse 
pathological  and  therapeutical  views  entertained  by  the  medical  profession  on  this  subject. 
In  the  cases  of  recovery  it  is  impossible  to  say  how  far  any  individual  or  class  of  thera 
peutical  remedies  was  of  avail.  Chloroform,  ether,  opiates,  stimulants,  and  external 
irritants,  embrocations  and  fomentations,  were  mainly  relied  upon.  In  some  instances  the 
symptoms  disappeared  so  speedily  and  permanently  as  to  raise  the  question  whether  the 
same  result  might  not  have  occurred  spontaneously.  In  the  fully  developed  cases  all 
remedial  measures  failed  and  the  cases  ran  on  unchecked  to  a  fatal  termination.  The 
following  are  the  remedies  which  are  recorded  to  have  been  used  by  the  medical  officers: 
Tincture  of  valerian,  bromide  of  potassium,  extract  of  cannabis  indica,  yellow  jasmine, 
woorara,  extract  of  nux  vomica,  tincture  of  aconite,  assafoetida,  belladonna,  chlorodyn,  conium, 
strychnia,  solution  of  permanganate  of  potassa,  hyoscyarnus,  chlorate  of  potassa,  tartrate  of 
antimony,  Hoffmann's  anodyne,  chloric  ether,  chloroform,  camphor,  quinine,  hyposulphites 
of  soda  and  lime,  nitric  acid,  mercurialization,  castor  oil,  turpentine,  and  croton  oil;  stimu 
lants  and  opiates  were  given  with  all  of  these  preparations.  Of  external  applications  the 
following  were  used:  Blisters,  emollient  poultices,  warm  fomentations,  turpentine,  ice, 
olive  oil,  creasote,  warm  baths,  electric  currents,  chloroform  liniment,  powdered  lime  and 
opium  poultice,  vapor  baths,  powdered  morphia  locally,  snow  and  salt  bagged  and  applied  to 
seat  of  injury,  hyoscyarnus  ointment,  and  saturated  solution  of  chlorate  of  potassa  in  wound. 


CHAP.  XII.]  GANGRENE.  823 

Injections  were  given  of  sulphate  of  atropia  and  sulphate  of  morphia  hypodermically,  opiates, 
tobacco,  turpentine,  castor  oil,  soap  and  water,  milk  of  assafcetida,  vinegar,  and  brandy. 

In  the  Army  Medical  Museum  is  preserved  a  specimen  (No.  3538,  Surgical  Section) 
showing  a  shot  laceration  of  the  crural  nerve  in  a  patient  who  survived  the  injury  twenty- 
five  days  and  died  of  tetanus.  The  specimen  and  its  history  were  contributed  by  Dr. 
William  Thomson.  On  page  339  of  the  Second  Surgical  Volume  a  drawing  illustrating 
its  pathological  histology  was  promised,  but  a  careful  microscopical  examination  of  the 
specimen  failed  to  indicate  any  abnormal  conditions: 

CASE  1*^04. — Private  Alexander  Fletcher,  Co.  F,  31st  Maine,  aged  21  years,  was  wounded  at  the  Wilderness  May  6, 1864. 
He  was  removed  to  the  field  hospital  of  the  2d  division,  Ninth  Army  Corps,  and  was  transferred  on  May  12th  to  Douglas  Hos 
pital,  Washington.  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  reported:  "Gunshot  flesh  wounds  of  left  arm,  and  side  over 
lower  ribs.  On  May  20th  tetanus  in  the  form  both  of  trismus  and  opisthotonos  appeared.  Equal  quantities  of  laudanum  and 
tincture  of  valerian  were  given  in  teaspoonful  doses  every  two  hours,  which  alleviated  the  symptoms  somewhat.  Death  resulted 
on  May  31,  1864,  from  tetanus.  At  the  autopsy  it  was  found  that  the  ball  had  entered  over  the  lower  ribs  and  passed  down 
between  the  muscles  of  the  abdomen  over  Poupart's  ligament  and  under  the  femoral  vessels,  wounded  the  crural  nerve,  and 
lodged  near  the  middle  third  of  the  femur."  The  specimen  of  the  lacerated  crural  nerve  was  contributed  to  the  Army  Medical 
Museum  by  Dr.  Thomson,  and  is  numbered  3538  of  the  Suryical  Section. 

In  crowded  field  and  general  hospitals  neither  time  nor  opportunity  was  found  for 
microscopical  examination  of  minute  structural  changes,  and  the  post-mortem  examinations 
are  therefore  incomplete  and  give  only  negative  results;  no  anatomical  lesions  of  the  medulla 
oblongata,  the  cerebellum,  or  the  spinal  cord  in  such  cases  were  noted. 

Sixteen,  or  3.1  per  cent.,  of  the  five  hundred  and  five  instances  of  tetanus  were  found 
among  the  colored  troops,  who  furnished  2.7  per  cent,  of  the  total  number  of  shot  injuries. 

GANGRENE. 

"The  necessity  of  the  careful  definition  of  such  terms  as  mortification,  gangrene, 
sphacelus,  dry  gangrene,  moist  gangrene,  hospital  gangrene,  and  gangrenous  phagedsena," 
urged  by  Joseph  Jones  in  his  article  on  hospital  gangrene,1  has  become  apparent  from  the 
examination  of  the  reports  of  cases  of  gangrene  recorded  during  the  war.  According  to 
the  conception  or  predilection  of  the  surgeon,  these  terms,  in  many  instances,  seem  to  have 
been  used  indiscriminately,  and  it  has  been  found  utterly  impossible  to  determine  with 
accuracy  the  cases  of  traumatic  gangrene,  hospital  gangrene,  dry  gangrene,  etc.  For 
instance,  there  were  reported,  as  will  be  shown  hereafter,  eight  hundred  and  forty-six  (846) 
cases  of  gangrene  during  the  years  1862  and  1863,  of  which,  on  the  hospital  records,  only 
one  hundred  (100)  were  designated  as  hospital  gangrene,  and  yet  Surgeon  M.  Goldsmith, 
U.  S.  V.,  in  his  special  report  on  the  subject,  in  the  spring  of  1863,  gives  a  tabular  state 
ment  of  three  hundred  and  forty-three  (343)  cases  of  hospital  gangrene  observed  in  the 
hospitals  of  Louisville  alone  during  only  parts  of  the  years  1862  and  1863.  An  attempt 
to  separate  the  various  forms  of  this  disease  according  to  the  descriptions  of  symptoms  and 
treatment  noted  in  each  case  failed,  and  it  has  therefore  been  deemed  advisable  to  include 
in  one  tabular  statement  all  cases  of  gangrene  observed  after  shot  wounds  and  to  illustrate 
the  various  forms  by  examples  or  special  reports. 

The  total  number  of  cases  of  gangrene  reported  was  two  thousand  six  hundred  and  forty- 
two  (2,642).  Of  these,  sixty  (60)  were  observed  after  wounds  of  the  head,  two  hundred 
and  sixteen  (216)  after  wounds  of  the  trunk,  and  two  thousand  three  hundred  and  sixty-six 
(2,366)  after  wounds  of  the  extremities,  as  follows: 


'JO.VES  (JOSEPH),  Investigations  upon  the  Xature,  Causes,  and  Treatment  of  Boxpital  (Sanr/rene.  as  it  prevailed  in  the  Confederate  Armies,  1861- 
18G5,  in  (fnite.d  States  Sanitary  Commission  Memoirs,  New  York.  1871,  Second  Surgical  Yulumu,  !>•  1"4. 


824  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

TABLE  CLV. 

Summary  of  Two  Thousand  Six  Hundred  and  Forty-two  Cases  of  Gangrene,  indicating  the  Result  and 

Relative  Frequency. 


SEAT  OF  INJURY. 

RECOVERY. 

FATAL. 

UNDETERMINED. 

TOTAL. 

Cti 

PER  CENT.  OF  RELA 
TIVE  FREQUENCY. 

5 

7 

12 

58.3 

1 

32 

16 

48 

33.3 

I    .  .  60=2.  2% 

Flesh  Wounds  of  Trunk                                                     

36 

32 

7 

75 

47.0 

J 

) 

44 

97 

141 

68.7 

I...  216=8.  2% 
J 

47 

50 

12 

109 

51.5 

1 

476 

245 

14 

735 

33.9 

125 

127 

92 

344 

50.3 

1  2,  366=89.6% 

596 

568 

U 

1,178 

48.7 

Aggregates                           ... 

1  361 

1,142 

139 

2,642 

45.6 

Thus  it  will  appear  that  89.6  per  cent,  of  all  the  cases  of  gangrene  were  observed  in 
wounds  of  the  extremities,  8.2  per  cent,  in  wounds  of  the  trunk,  and  only  2.2  per  cent,  in 
wounds  of  the  head,  face,  and  neck,  although  the  proportion  of  injuries  of  the  three  regions, 
as  shown  in  TABLE  CXIX,  page  691,  ante,  is  70.86  per  cent,  for  the  extremities,  18.37  per 
cent,  for  the  trunk,  and  10.77  per  cent,  for  the  head,  face,  and  neck.  Nearly  two-thirds — 
one  thousand  five  hundred  and  twenty-two  (1,522) — of  two  thousand  three  hundred  and 
sixty-six  (2,366)  cases  of  gangrene  in  the  extremities  occurred  in  the  lower  extremities, 
while,  as  has  been  shown  before,  the  total  number  of  injuries  of  the  upper  extremities 
slightly  exceeded  that  of  the  lower  extremities. 

The  results  in  one  hundred  and  thirty-nine  (139)  of  the  two  thousand  six  hundred  and 
forty-two  (2,642)  cases  of  gangrene  were  not  ascertained;  one  thousand  three  hundred  and 
sixty-one  (1,361)  terminated  in  recovery,  and  one  thousand  one  hundred  and  forty-two 
(1,142)  in  death,  a  mortality  rate  of  45.6  per  cent.;  but  in  a  large  number  of  these  cases 
death  was  ascribed  either  to  the  injury  itself  or  to  other  complications — such  as  pyaBmia  in 
one  hundred  and  fifty-two  (152),  hemorrhage  in  forty-seven  (47),  exhaustion  in  one  hun 
dred  and  eight  (108),  tetanus  in  eleven  (11),  erysipelas  in  two  (2),  and  pneumonia,  typhoid 
fever,  diarrhoea,  and  other  diseases  in  seventy-seven  (77)  instances.  In  three  hundred  and 
thirty-nine  (339)  cases  the  immediate  cause  of  death  was  not  stated.  In  four  hundred  and 
six  (406)  of  the  one  thousand  one  hundred  and  forty-two  (1,142)  deaths  the  fatal  issue 
was  directly  ascribed  to  gangrene.  A  peculiar  feature  in  the  above  table  is  the  fact  that 
with  the  exception  of  the  penetrating  wounds  of  the  trunk  the  percentage  of  fatality  of  the 
cases  of  gangrene  after  flesh  wounds  is  larger  than  that  after  fractures.  The  death  rate  of 
the  cases  of  flesh  wounds  of  the  head,  face,  and  neck  complicated  by  gangrene  is  58.3  per 
cent.,  while  that  of  the  fractures  is  only  33.3  per  cent.;  likewise  the  death  rate  of  the  flesh 
wounds  of  the  upper  extremities  attacked  with  gangrene  is  51.5  per  cent.,  while  that  of 
the  fractures  complicated  with  gangrene  is  only  33.9  per  cent.  In  the  lower  extremities 
the  mortality  after  gangrenous  flesh  wounds  is  50.3,  while  that  of  the  fractures  is  48.7  per 
cent.  In  wounds  of  the  trunk  alone  the  mortality  of  the  fractures  and  penetrations  exceeds 
that  of  the  flesh  wounds,  the  former  being  68.7,  the  latter  47.0  per  cent. 


CHAP.  XII.) 


GANGRENE. 


825 


Of  the  two  thousand  three  hundred  and  sixty-six  (2,366)  instances  of  gangrene  in  the 
extremities,  one  hundred  and  eighty-five  (185)  were  cases  of  gangrene  following  excisions, 
and  in  forty-six  (46)  of  these  cases  amputation  of  the  limb  had  to  be  resorted  to.  The 
great  liability  of  excisions  to  this  complication  will  be  referred  to  hereafter. 

In  eight  hundred  and  ninety-eight  (898)  instances  gangrene  was  noted  on  the  face  of 
the  stump.  In  a  few  of  these  cases  the  complication  was  caused  by  strangulation  of  the 
stump  by  tourniquet.  In  the  following  instance  the  gangrenous  condition  of  the  limb  was 
ascribed  to  the  tight  application  of  bandages: 

CASK  1^05. — Captain  J.  Phinney,  Co.  K,  86th  New  York,  aged  28  years,  received  a  gunshot  fracture  of  the  left  forearm, 
lower  third,  at  Spottsylvania,  May  10,  1864.  When  he  was  admitted  to  Seminary  Hospital,  Georgetown,  four  days  afterwards, 
he  was  in  a  rapidly  sinking  condition,  and  the  injured  limb  was  gangrenous  from  the  elbow  down,  owing  to  the  circulation 
having  been  stopped  by  applying  bandages  too  tight  on  the  field.  On  May  15th  the  arm  was  amputated  above  the  elbow  joint 
by  Surgeon  H.  W.  Ducachet,  U.  S.  V.,  who  performed  the  operation  by  skin  flaps  and  circular  section  of  muscles.  Chloroform 
constituted  the  anaesthetic.  The  patient  began  to  improve  within  forty-eight  hours  after  the  amputation,  and,  with  the  exception 
of  .the  formation  of  two  abscesses  in  the  stump,  his  improvement  continued  slowly  afterwards.  About  June  30th  he  was  able  to 
walk  about,  and  three  weeks  later  he  left  the  hospital  on  leave  of  absence.  The  history  of  the  case  was  reported  by  the  operator. 
The  Adjutant  General,  U.  S.  A.,  reports  that  Captain  Phinney  died  August  10,  1864. 

But  the  large  majority  of  the  cases  were  instances  of  hospital  gangrene  caused  by  the 
crowded  condition  of  the  hospitals  and  the  bringing  together  of  many  cases  of  extensive 
fractures  and  large  operation  wounds. 

How  far  the  frequency  of  the  occurrence  of  gangrene  was  influenced  by  the  season  of 
the  year  cannot  be  ascertained  from  the  nature  of  the  reports;  it  can  only  be  stated  that 
in  nine  hundred  and  eighty-three  (983)  of  the  two  thousand  six  hundred  and  forty-two 
(2,642)  cases  the  month  was  not  indicated;  that  eighty-seven  (87)  cases  were  recorded  as 
having  occurred  in  January,  forty-eight  (48)  in  February,  forty-three  (43)  in  March,  sixty- 
four  (64)  in  April,  one  hundred  and  seventy-five  (175)  in  May,  three  hundred  and  one 
(301)  in  June,  two  hundred  and  ninety-four  (294)  in  July,  two  hundred  and  twenty-five 
(225)  in  August,  one  hundred  and  ten  (110)  in  September,  ninety-eight  (98)  in  October, 
eighty-nine  (89)  in  November,  and  one  hundred  and  twenty-five  (125)  in  December;  the 
highest  number  having  been  observed  in  June,  July,  August,  May,  and  December;  the 
lowest  in  March  and  February. 

The  frequency  of  gangrene  according  to  the  different  years  of  the  war  is  indicated  iri 


the  following  table: 


TABLE  CLVI. 

Indicating  the  Years  in  which  the  Gangrene  occurred. 


SEAT  OF  INJURY. 

TOTAL. 

1861. 

1862. 

1863.            1864. 

1865. 

NOT 
STATED. 

12 

3  |                9 

Fractures  and  Penetratin'r  Wounds  of  Head,  Face,  and  Neck 

48 

3 

13                31 

1 

75 

5 

23  1              34 

8 

5 

141 

13 

42                78 

G 

•> 

109 

3 

27                69 

r, 

4 

735 

2 

37 

144              510 

32 

10 

Flush  Wounds  of  the  Lower  Extremities    

344 

35 

117  '            163 

16 

13 

1  178 

2 

127 

254              717 

07 

11 

AgTefates     ... 

2  642 

4 

223 

623           1  611 

135 

46 

Only  four  cases  of  gangrene  were  recorded  for  the  first  eight  months  of  the  war  in  1861 ; 
but  it  must  be  remembered  that  the  medical  reports  for  this  period  are  very  incomplete. 
In  the  following  year,  1862,  the  number  of  cases  of  gangrene  increased  to  two  hundred  and 
twenty-three.  A  few  sporadic  cases  occurred  in  the  hospital  at  Fort  Hamilton,  New  York, 

SURG.  Ill— 104 


826  WOUNDS    AND    COMPLICATIONS.  (CHAK  xii. 

in  the  early  part  of  September,  among  men  wounded  in  McClellan's  Peninsular  Campaign 
in  June  and  July,  1862.  Of  the  three  cases  reported  at  that  hospital  by  Surgeon  B.  Randall, 
U.  S.  A.,  one,  at  least,  was  that  of  a  prisoner  who  had  been  carried  to  Richmond  and  had 
then  been  paroled.  It  was  after  the  battles  of  South  Mountain  and  Antietam,  in  September, 
1862,  that  serious  outbreaks  of  hospital  gangrene  occurred  at  the  hospitals  at  Frederick  and 
at  West  Philadelphia.  The  cases  were  carefully  observed  by  Acting  Assistant  Surgeon  W. 
W.  Keen,  whose  report  is  here  given: 

"After  the  battles  of  South  Mountain  aud  Autietain,  September  14th  and  17th,  1802,  an  immense 
number  of  patients  was  accumulated  in  the  hospitals  at  Frederick,  Maryland.  The  old  general  hos 
pital  (No.  1),  which  had  contained  six  hundred  beds,  was  so  crowded  with  patients  that  one  thou 
sand  were  of  necessity  placed  in  the  wards,  and  one  thousand  eight  hundred  men  were  fed  at  its 
tables  aud  slept  somewhere.  The  hospital  consisted  of  five  old  barracks  of  inferior  character,  a 
tine  new  one  (built  very  much  after  the  style  of  our  wards  at  this  place  [West  Philadelphia],  with 
ventilation  at  the  ridge-pole,  either  continuous  or  interrupted),  together  with  a  large,  substantial 
old  stone  building  of  Revolutionary  times,  better  ventilated  by  its  fire-places  than  by  its  windows. 
To  these  were  soon  added  two  large  new  barracks,  finely  ventilated.  Each  of  these  buildings  was 
entirely  detached  from  the  others,  and  would  accommodate  some  eighty  patients,  with  about  six 
hundred  and  forty  cubic  feet,  of  space  to  each  in  the  old  barracks  and  one  thousand  two  hundred 
aud  fifty  cubic  leet  in  the  new.  Besides  these,  about  thirty  hospital  tents,  with  eight  beds  in  each, 
were  pitched  at  various  points.  Here  the  allowance  of  air  was  only  about  one  hundred  and  seventy- 
five  cubic  feet.  The  hospital  was  situated  on  a  hill  on  the  outskirts  of  the  town  and  in  a  mountain 
ous  region.  This,  with  the  distribution  of  the  buildings,  procured  the  amplest  circulation  of  pure 
fresh  air. 

"About  the  middle  of  October  the  number  of  cases  in  Barrack  E,  of  which  1  had  charge,  was 
diminished  from  one  hundred  to  seventy-eight.  Excepting  four  or  five,  they  were  all  severe  surgi 
cal  cases,  a  number  of  them  being  amputations,  resections,  or  compound  fractures  of  the  thigh,  and 
the  wounds  were  suppurating  freely.  Every  means  to  insure  cleanliness  and  pure  air  was  taken. 
Each  patient  had  his  own  sponge.  Oakum  was  largely  used  as  a  dressing,  and  chlorinated  soda 
freely  used  on  the  dressings  and  the  floor. 

"  Preceding  October  19, 1862,  three  or  four  days  of  cold  rainy  weather  set  in,  which  occasioned 
the  closing  of  the  doors  aud  windows  to  keep  both  warm  and  dry.  On  the  second  or  third  day  I 
noticed  three  cases  of  decided  hospital  gangrene,  all  in  the  lower  extremity;  about  twelve  or  fifteen 
wounds  also,  which  had  been  progressing  finely,  stopped  cicatrizing  and  assumed  an  unhealthy 
appearance.  They  were  red  and  punctated;  in  some  small  new  vessels  were  seen;  they  bled 
freely  on  removing  the  dressings;  the  parts  already  cicatrized  became  bluish  red,  and,  in  the  worst 
looking  cases,  an  areola  of  an  inflammatory  nature,  red  color,  and  with  a  hard  base,  was  observed. 
The  cases  of  decided  gangrene  were  removed  to  a  tent,  with  six  beds  and  an  allowance  of  space  of 
two  hundred  and  thirty-two  cubic  feet,  where,  under  treatment,  they  rapidly  recovered.  Sixteen 
beds  were  removed  and  the  barrack  still  more  carefully  ventilated.  The  weather  became  tine,  and 
in  two  days  the  unhealthy  sores  recovered  their  original  healthy  appearance,  and  no  more  cases 
occurred.  Two  other  outbreaks  of  the  disease  occurred  in  this  barrack,  one  on  November  8th  and 
another  early  in  December,  running  precisely  a  similar  course.  During  the  last  an  attempt  was 
made  to  treat  the  cases  in  the  ward  without  isolation,  but  it  only  ended  in  an  utter  failure,  and  they 
were  again  removed.  Four  days  before  it  made  its  appearance  in  Barrack  E  the  disease  appeared 
in  Barrack  B,  where  its  history  was  an  exact  counterpart  of  the  one  already  related.  From  these 
two  barracks,  the  most  overcrowded  and,  by  the  way,  the  only  ones  in  which  erysipelas  had  appeared, 
the  disease  spread  to  all  the  others,  in  most  cases,  apparently,  by  contagion,  in  some  clearly  by 
infection,  through  the  careless  use  of  sponges,  etc.;  and  yet,  strange  as  it  may  seem,  but  one  case 
appeared  among  the  patients  in  the  tents.  They  were,  it  is  true,  far  lighter  cases  of  wounds;  but 
they  were,  apparently,  much  more  exposed  by  the  small  allowance  of  space  and  by  their  greater 
proximity  to  the  gangrene  tents.  When  1  left  Frederick,  December  llth,  about  fifty  cases  in  all 
had  occurred,  of  which  some  eight  or  ten  were  still  under  treatment  and  progressing  favorably. 
Two  cases  had  proved  fatal,  but  by  reason,  it  seemed,  of  other  organic  complications. 


CHAP.  XII.]  HOSPITAL    GANGRENE.  827 

"On  December  23,  1862,  fifty  patients  were  admitted  to  Ward  No.  1,  and  one  hundred  each 
to  Wards  Nos.  2  and  3,  U.  S.  A.  General  Hospital,  West  Philadelphia.  Of  these,  twenty-five  in 
Ward  No.  1,  eighty  in  Ward  No.  2,  and  fifteen  in  Ward  No.  3,  one  hundred  and  twenty  in  all, 
were  gunshot  wounds.  There  were  at  the  same  time  two  thousand  three  hundred  and  eighty-four 
patients  in  the  hospital,  of  whom  rather  more  than  two  hundred  were  wounded.  The  allowance 
of  space  in  these  three  wards,  which  are  contiguous,  is  nearly  twelve  hundred  cubic  feet  to  each 
man.  But  few  of  these  new  wounds  were  discharging  freely,  and  scarcely  any  were  more  than  flesh 
wounds  of  no  great  severity.  '  At  the  time  and  after  the  admission  of  these  patients,  who  were  the 
first  occupants  of  the  wards,'  says  Dr.  Lewis  in  his  report  for  Ward  1  for  January,  1863,  kindly 
placed  at  my  disposal  by  Mr.  Knorr,  '  the  weather  had  been  for  some  days  unusually  cold  and  blus 
tering,  and  this  portion  of  the  hospital  was  so  arranged  as  to  afford  no  protection  against  draughts 
of  air  proceeding  directly  from  the  outside  through  open  doors  communicating  with  the  passage 
way  leading  to  the  ward.' 

"One  week  after  their  admission,  L  e.,  December  30,  1862,  I  observed  two  cases  of  decided 
hospital  gangrene,  both  of  the  thigh,  in  my  own  ward,  and  at  the  same  time  eight  or  ten  of  the 
other  wounds  began  to  look  unhealthy.  The  cases  of  decided  gangrene  were  immediately  vigor 
ously  treated  by  nitric  acid,  but  were  not  removed  from  the  ward,  and  the  fullest  precautionary 
measures  were  taken  to  prevent  the  further  progress  of  the  disease.  Since  the  patients  could  not 
be  removed,  I  resolved  to  put  the  ward  in  as  favorable  a  condition  as  possible.  I  ordered  every  other 
window  on  both  sides  to  be  lowered  both  day  and  night,  and  put  a  reliable  patient  in  charge  of  the 
matter;  I  obtained  a  sponge  for  each  man,  directed  the  nurses  to  dress  the  gangrenous  and 
unhealthy  sores  last  of  all,  and  to  wash  their  hands  carefully  in  dilute  chlorinated  soda  afterward ; 
used  no  dressing  or  bandage  a  second  lime,  and  had  the  soda  freely  used  on  the  floor  near  those 
suffering  from  the  disease.  On  the  31st  no  new  cases  appeared.  On  January  1st  four  more  were 
observed,  and  from  the  2d  to  the  18th  nine  more.  In  Ward  3  no  cases  whatever  have  appeared ; 
in  Ward  1  three  cases  appeared  respectively  on  the  4th,  5th,  and  8th  of  January.  In  Ward  L,  far 
removed  from  Wards  1,  2,  and  3,  one  case  broke  out  on  January  17th.  These,  as  far  as  I  know, 
are  all  the  cases  that  have  occurred.  They  number  nineteen  in  all :  ten  in  the  lower  extremities, 
five  in  the  upper,  and  four  in  the  trunk. 

''A  marked  contrast  is  thus  seen  to  exist  between  the  disease  as  seen  at  Frederick  and  at 
West  Philadelphia.  At  Frederick  it  was  notably  contagious  and  spread  widely  and  to  every  bar 
rack;  in  West  Philadelphia,  although  probably  contagious,  it  did  not  invade  many  wounds  in  the 
same  wards,  nor  did  it  spread  widely  to  adjoining  wards.  There  the  patients  were  isolated,  here 
they  were  retained  in  the  wards ;  there  all  attempts  to  treat  them  successfully  in  the  barracks  failed, 
here  it  has  been  perfectly  successful ;  there  nitric  acid  was  used  as  an  escbarotic,  here  both  that 
and  the  acid  nitrate  of  mercury.  It  should  also  be  noted  that  both  attacks  followed  a  few  days  of 
bleak,  cold,  and  rainy  weather;  that  both  occurred  where  a  number  of  wounds  were  collected 
together;  that  in  individual  symptoms  both  were  precisely  alike,  and  that  they  improved  imme 
diately  on  the  setting  in  of  fine  weather  and  under  appropriate  treatment;  that  simultaneously 
with  the  outbreak  of  the  disease  a  number  of  wounds  assumed  an  unhealthy  appearance,  which 
quickly  disappeared  under  proper  hygienic  treatment  and  good  weather. 

"The  disease,  as  I  have  observed  it,  is  ushered  in  by  from  one  to  three  days  of  unhealthy 
action  such  as  already  described,  accompanied  in  some  cases  with  marked  fever,  coated  tongue, 
and  prostration,  but  in  by  far  the  majority  of  cases  with  simply  sleeplessness  and  general  malaise. 
The  patient  complains  of  sharp,  burning,  pricking  or  stinging  pain  in  the  wound,  sometimes  so 
severe  as  to  make  him  cry  out,  the  suffering  being  intense ;  at  others  feeling  rather  as  if  the  part  had 
been  'asleep.'  If  the  surgeon  now  examine  the  wound  he  will  find  a  layer  of  ash-colored  matter, 
which,  as  Guthrie  describes  it,  'covers  the  face  of  the  ulcer  and  adhers  so  firmly  as  not  to  be  readily 
removed;  or,  if  separated,  shows  that  it  is  a  substance  found  upon  the  surface  and  constituting  a 
part  of  the  granulations  themselves;'  the  edges  rugged,  everted,  or,  more  commonly,  undermined, 
or  violet  or  livid  in  color;  a  marked  areola,  almost  erysipelatous,  surrounding  the  wound,  an  indu 
rated  base  feeling  very  like  that  of  a  hard  chancre;  the  discharge  thin,  watery,  bloody,  ash-colored 
or  darker,  and  the  wound  considerably  enlarged,  and  enlarging  with  aggravated  symptoms,  day  by 
day,  regardless  of  Nature's  best  efforts;  and  benevolent  Art  now  interferes  to  relieve  the  oft-time 
wretched  sufferer.  The  smarting  pain  and  the  extension  of  the  wound  (usually  conjointly,  but 


828  WOUNDS    AND    COMPLICATIONS.  (CHAP.  xn. 

sometimes  separately)  I  have  found  to  be  the  most  distinctive  characteristics  of  the  disease.  The 
enlargement  is  usually  confined  to  the  skin  and  superficial  fascia;  occasionally,  however,  it  extends 
to  the  intennuscular  cellular  tissues,  and,  in  rare  instances,  to  the  muscles  themselves;  arteries, 
large  nerves,  and  bones  resist  its  destructive  tendency  with  great  perseverance.  The  following 
case  will  illustrate  the  disease : 

"CASE  120G.— Corporal  H.  H.  Kuhn,  Co.  A,  10th  Pennsylvania  Reserves,  aged  23,  was  admitted  to  Ward  No.  2,  West 
Philadelphia  Hospital,  December  23,  1862.  lie  had  been  wounded  ten  days  before  at  Fredericksburg,  by  a  ball  which  had 
passed  through  the  right  thigh  postero-anteriorly  and  inflicted  a  superficial  wound,  the  openings  being  about  two  and  a  half 
inches  apart.  The  wounds  looked  well.  Ordered  cold-water  dressings.  December  30th  :  The  wound  has  done  well  up  to  this 
date, 
and 

sulph  _ 

ing  the  wound  hard,  the  areofa  marked  both  in  color  and  size;  the  pain  sticking  or  pricking,  and  quite  severe;  the  surface  ashy 
gray  and  punctated;  it  bleeds  freely  on  removing  the  dressings;  the  two  openings  are  coalescing,  and  the  intervening  sound 
Hesh  is  unhealthy  and  partially  destroyed.  I  opened  it  thoroughly,  cut  away  the  intervening  unhealthy  flesh  and  applied  strong 
nitric  acid  to  the' entire  surface,  the  patient  being  under  ether;  ordered  flaxseed  and  laudanum  poultice  covered  witli  oiled  silk, 


times  a  day :  still  no  constitutional  symptoms  are  seen.  January  9th :  The  slough  is  all  gone,  and  fine  healthy  granulations  are 
found  covered  with  thick  yellow  pus;  ordered  the  acid  wash  to  be  reapplied.  January  llth:  Again  slightly  unhealthy; 
ordered  acid  wash  continued,  adding  five  drops  of  nitric  acid  to  the  ounce.  He  now  did  finely,  and  the  acid  wash  was  gradually 
diluted  and  then  simple  cnrate  substituted  until  January  23d.  Two  or  three  days  of  stormy  weather  having  occurred,  the  wound 
again  looks  unhealthy.  The  cicatrix  is  invaded  at  one  point  and  looks  bluish,  and  the  discharge  is  less  in  amount  and  rather 
unhealthy  in  character.  There  is,  however,  no  pain  nor  ashy  surface;  no  areola,  and  no  extension  other  than  that  noticed. 
Ordered  tin  foil  to  be  applied.  January  25th :  The  wound  is  vastly  improved,  so  that  I  ordered  the  foil  discontinued.  January 
30th  :  Left  on  thirty  days  furlough,  doing  finely. 

"The  question  has  almost  uniformly  been  raised  by  authors,  whether  the  disease  is  consti 
tutional  or  local.  Without  quoting  particular  authorities,  suffice  it  to  say  that  rather  the  larger 
number  regard  it  as  a  local  disease, '  sometimes,'  in  the  language  of  Guthrie, '  preceded  by  and  accom 
panied  with  constitutional  symptoms.'  But  the  concurrent  constitutional  symptoms  are  no  proof 
of  a  similar  character  in  the  disease,  for  the  removal  of  a  benign  tumor,  an  amputation,  or  a  gun- 
shot  wound  is  followed  by  the  same.  No  one  as  yet  has  ever  seen  the  disease  originate  constitu 
tionally,  but  always  locally.  Wounds  may  become  gangrenous;  but  hospital  gangrene  never  gives 
rise  to  ulcers.  Even  where  the  constitutional  symptoms  are  present,  as  I  have  seen  the  disease, 
they  have  been  very  slight,  and  rarely  exceeded  anorexia,  sleeplessness,  and  a  slight  irritative 
fever.  Of  the  fifty  cases  in  Frederick  I  have  statistics  of  twenty -five.  In  these  the  constitutional 
symptoms  preceded  the  disease  in  but  five  cases,  accompanied  it  in  four,  leaving  sixteen  unaffected 
constitutionally.  Of  the  nineteen  cases  here  seen  there  were  two  in  which  they  preceded  and  four 
in  which  they  accompanied  the  disease,  leaving  thirteen  with  no  constitutional  disturbance.  The 
following  is  a  case  in  which  the  constitutional  symptoms  were  first  manifested  and  then  the  local: 

"CASE  T307. — Private  William  P.  Trump,  Co.  D,  8th  Pennsylvania  Reserves,  miner,  aged  22,  was  admitted  to  Ward  No. 
2,  West  Philadelphia  Hospital,  December  23,  1862,  having  been  wounded  on  the  13th  at  Fredericksburg.  The  ball  grazed 
slightly  the  right  shoulder,  and  the  wound  did  finely  under  cold-water  dressings.  January  2d:  An  active  fever  has  set  in,  with 
loss  of  appetite,  coated  tongue,  and  costiveness;  ordered  three  compound  cathartic  pills,  and  tartar  emetic  one-eighth  of  a  grain 
three  times  a  day.  January  Gth  :  The  constitutional  disturbance  is  about  the  same,  but  local  trouble  has  manifested  itself.  The 
usual  symptoms  of  hospital  gangrene  have  become  developed,  the  wound  is  enlarging,  and  the  pain  is  so  great  as  to  deprive  him 
of  all  rest  and  to  cause  him  to  disturb  the  whole  ward  with  his  outcries.  I  cauterized  the  wound  freely  with  nitric  acid  and 
ordered  a  poultice  with  morphia  sulph.  gr.  one-quarter  h.  s.  The  pain  ceased  from  that  moment;  he  slept  well;  in  three  days 
the  slough  separated.  I  applied  the  acid  wash,  and  he  soon  recovered  sufficiently  to  desert." 

"The  offensive  odor  I  have  observed  but  in  four  cases,  two  at  Frederick  and  two  here.  In 
cases  so  severe  as  those  observed  by  Macleod  and  others,  in  which  death  occurred  in  sixteen  hours, 
it  was,  no  doubt,  one  of  the  most  marked  and  disgusting  symptoms.  The  case  in  Ward  L,  bed  7, 
was  so  offensive  that  its  odor  could  readily  be  observed  in  the  corridor,  and  one  of  those  in  Ward 
1  was  no  less  so.  The  experience  of  Dr.  Lewis  in  Ward  1,  as  detailed  in  his  cases,  gives  the  most 
marked  efficiency  to  the  permanganate  of  potash  in  ten  grains  to  the  ounce  as  a  deodorant.  It 
controlled  the  odor  when  charcoal  and  fomenting  poultices  of  porter  and  corn  meal  seemed  to 
have  not  the  least  effect.  It  deserves  further  trial. 

"The  circular  form,  also  alluded  to  by  other  writers,  is  by  no  means  so  frequent  in  these 
lighter  cases;  nor  have  I  yet  seen  a  case  of  secondary  haemorrhage,  although  I  have  seen  the  ante 
rior  tibial  and  the  femoral  itself  pulsating  at  the  base  of  such  gangrenous  sores,  and  in  one  case 
at  Frederick,  of  ligation  of  the  external  iliac,  the  disease  being  communicated  by  a  sponge,  attacked 
the  wound ;  and  yet  the  artery  resisted  both  the  disease  and  the  remedy.  Should  such  a  misfortune 
occur,  I  should  unhesitatingly  ligate  higher  up,  and  with  the  greatest  precaution  against,  infection. 
1  should,  if  disease  attacked  the  new  wound,  apply  the  escharotic  immediately.  But  it  will  not 


CHAP.  XII.J  HOSPITAL    GANGRENE.  829 

always  attack  every  sore,  and  this  is  a  serious  argument  in  favor  of  its  local  character.  I  have 
often  seen  it  attack  a  wound  of  entrance  or  of  exit,  and  leave  the  other  free;  I  have  seen  it  attack 
an  abrasion  over  the  head  of  the  fibula  and  leave  untouched  a  compound  fracture  of  the  same 
thigh  ;  attack  an  ulcer  on  a  leg,  and  pass  by  the  granulating  stump,  three  inches  lower  down.  I 
have  yet  to  learn  of  a  single  case  occurring  among  patients  in  the  field — a  fact  fully  corroborated  by 
other  surgeons  who  have  had  greater  opportunities  in  the  field  than  myself,  and  which  I  can  only 
explain  by  the  reason  that  the  patients  are  usually  placed  in  houses,  or  on  the  field  itself,  where 
free  ventilation  is  attained,  and  are  speedily  removed  into  hospitals. 

"As  to  the  treatment  it  has  been  pretty  fully  illustrated  in  the  cases  cited.  As  soon  as  the 
disease  is  recognized  I  have  applied  either  nitric  acid  or  the  acid  nitrate  of  mercury.  The  former, 
alone,  was  used  at  Frederick;  but  here  I  have  used  the  acid  nitrate  of  mercury  in  six  cases,  and 
with  the  most  favorable  results.  I  prefer  it,  now,  to  the  nitric  acid,  since  it  causes  less  pain — indeed, 
often  it  saves  time  vastly  by  requiring  no  anaesthetic  to  be  used;  the  pain  continues  for  a  shorter 
time,  the  slough  appears  to  be  more  thoroughly  destroyed  and  disintegrated,  and  it  separates  in 
from  twelve  to  thirty-six  hours  sooner  than  that  from  the  acid.  I  have  not  yet  met  with  a  case  of 
ptyalism  from  its  use.  The  relief  obtained  from  the  severe  stinging  pain  is  often  almost  instan 
taneous,  and  if  the  disease  has  been  thoroughly  checked  it  does  not  recur.  Should  I  have  any 
other  cases,  I  should  also  desire  to  make  trial  of  a  forty-grain  solution  of  corrosive  sublimate  to  an 
ounce  of  glycerine.  But  whatever  escharotic  be  used,  I  cannot  insist  too  strongly  upon  the  neces 
sity  of  its  thorough  application.  The  disease,  especially  in  the  milder  form  noticed  here,  can  be 
eradicated  by  this,  and  by  this  only.  It  must  be  unsparingly  applied  to  every  spot  and  surface 
involved.  Stumps  must  be  laid  bare  and  apparently  ruined ;  sinuses  must  be  fully  exposed,  and 
the  disease  relentlessly  pursued  to  its  furthest  refuge.  The  timid  hand,  according  to  DeQuincey 
the  opprobrium  of  our  profession,  will  not  do  here.  The  work  must  be  thorough  and  complete  and 
the  remedy  applied  everywhere— not  only  to  the  surfaces  diseased,  but  also  to  those  laid  bare  by 
the  knife,  and  even  somewhat  to  the  sound  parts  beyond,  or  the  disease  will  spread  inevitably, 
and  kindness  well  meant  will  be  really  unintentional  cruelty.  I  generally  used,  as  a  means  of 
application,  a  stick  rather  than  a  mop,  since,  if  sharp  pointed,  it  penetrates  to  places  which  will 
remain  untouched  if  a  mop  is  used.  I  have  then  usually  applied  a  flaxseed  poultice  with  one 
drachm  to  a  half-ounce  of  laudanum  till  the  slough  has  separated.  Poultices  of  meal  and  yeast  or 
porter  are  also  good.  Then,  if  any  unhealthy  spots  were  still  seen,  and  especially  if  the  stinging 
pain  had  not  subsided,  I  again  made  use  of  the  escharotic,  followed  by  a  poultice.  As  soon  as  a 
healthy  surface  is  obtained  I  began  with  a  stimulating  lotion  such  as  the  'acid  wash'  already 
alluded  to,  varying  its  strength  to  the  necessities  of  the  case.  Under  this  they  have  usually  made 
a  rapid  recovery.  In  five  cases  I  have  used  tin-foil  applied  directly  to  the  wound,  surrounded  with 
charpie,  for  purposes  of  cleanliness,  and  have  found  it  a  most  excellent  remedy  where  wounds 
have  refused  to  respond  to  other  stimulants. 

UI  have  scarcely  ever  used  the  escharotic  unless  the  two  principal  symptoms,  viz,  the  peculiar 
pain  and  the  enlargement  of  the  wound,  were  both  present,  along  with  the  unhealthy  condition  of 
the  sore.  On  inspection  I  have  often  been  tempted  in  several  cases  to  apply  the  acid  ;  but  finding 
the  one  or  the  other  absent  I  have  refrained  and  applied  vigorous  stimulation,  as,  e,  #.,  the  l  acid 
wash,'  sometimes  further  fortified  by  some  little  nitric  acid,  and  I  have  been  gratified  to  find  a 
successful  result.  Tin-foil  itself  will  sometimes  alone  change  their  character  vastly  for  the  better. 

"  The  constitutional  treatment  is,  I  take  it,  of  far  less  importance  than  the  local,  just  as  the 
constitutional  symptoms  are  less  grave  than  the  local.  Frequently  they  will  subside  entirely  after 
the  vigorous  local  treatment  advocated.  The  fever  will  abate,  the  patient  will  sleep  well,  the 
tongue  clean,  the  bowels  relax,  and  he  will  tell  you  the  next  morning  that  he  has  eaten  an  excel 
lent  breakfast  and  'feels  first  rate.'  If  fever  sets  in,  I  treat  it  as  usual  in  any  irritative  fever;  if 
the  appetite  and  strength  fail,  by  tonics  and  stimulant's  and  good  diet.  The  tincture  of  iron,  quinine, 
milk  punch,  and  beef  tea  are  the  most  valuable  auxiliaries  in  such  cases. 

"'Hospital  gangrene,  the  typhus  of  wounds,' is,  in  its  most  marked  form,  a  fearful  and 
unwelcome  guest  in  any  hospital,  most  of  all  in  a  military  hospital.  It  claims  many  victims  in  its 
fierce  attacks,  and  often  puts  to  naught  all  the  resources  of  the  most  skilful  surgeon.  But  in  its 
milder  forms,  such  as  I  have  seen  it,  and  such  as  I  have  attempted  to  describe,  the  means  already 
indicated  will,  I  feel  confident,  arrest  its  progress  and  baffle  its  worst  endeavors." 


830  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

The  next  appearance  of  hospital  gangrene,  more  serious  in  its  character  than  that 
observed  at  Frederick  and  West  Philadelphia,  was  at  Annapolis.  It  appears  from  the 
report  of  Surgeon  J.  H.  Brinton,  U.  S.  V.,  who  had  been  sent  there  to  "inquire  into  the 
origin  of  the  affection  and  the  means  which  had  been  adopted  for  its  treatment  and  for 
checking  its  progress,"  that  on  January  11,  1863,  one  hundred  and  fifty-three  (153)  patients 
were  brought  to  Annapolis  from  Richmond.  Very  many  of  these  men  were  wounded,  and 
all  had  been  closely  confined  in  the  prisons  and  prison  hospitals  of  that  city.  Of  these  one 
hundred  and  fifty-three  men,  four  had  hospital  gangrene  at  the  time  of  admission  and  thirty- 
one  contracted  the  disease  within  a  short  time.  On  January  29th  four  hundred  and  twenty- 
one  additional  patients  were  admitted  from  the  same  place  and  under  the  same  circum 
stances;  of  these,  gangrene  existed  in  fourteen  at  the  time  of  their  admission.  By  February 
7th  the  number  of  affected  patients  amounted  to  sixty.  All  cases  in  which  the  process  of 
destruction  was  advancing,  or  in  which  reparation  and  cicatrization  had  not  fairly  set  in, 
were  collected  in  special  wards  isolated  from  all  other  buildings,  and  special  bedding,  blan 
kets,  utensils,  sponges,  surgical  dressings,  and  instruments  were  provided  for  them.  In  this 
manner  the  disease  remained  almost  entirely  confined  to  the  paroled  prisoners.  All  agreed 
that  the  origin  of  their  sores  must  be  referred  to  their  confinement  in  the  Libby  Prison  at 
Richmond  and  the  adjacent  hospitals.  In  the  prison  they  were  much  crowded,  and  the 
majority  were  unprovided  with  beds  or  cots,  sleeping  on  straw  which  was  foul  and  affected 
with  vermin.  Their  diet,  although  sufficient,  was  of  poor  quality.  In  the  hospital  they 
received  better  care  and  every  medical  attention  possible  under  the  circumstances.  In  both 
prison  and  hospital  gangrene  was  prevalent;  many  cases  were  said  to  have  died,  and 
others  were  stated  to  be  in  such  condition  from  their  sores  as  to  forbid  removal.  The 
paroled  prisoners  who  had  been  taken  on  western  battle-fields  referred  the  development  of 
their  gangrenous  ulcers  to  tedious  and  painful  transportation  from  the  West  to  Richmond. 
The  cars  used  were  closely  boxed;  the  food  on  the  road  was  deficient  and  miserable;  many 
of  them  had  been  altogether  deprived  of  food  for  two  or  three  days. 

The  treatment  adopted  in  the  Annapolis  Hospital  seems  to  have  been  judicious  and 
successful.  It  consisted  chiefly  in  the  limitation  of  the  ulcerative  process  by  the  applica 
tion  of  fuming  nitric  acid  to  the  edges  of  the  sore,  to  its  surface,  and  especially  to  the 
healthy  integument  beyond  the  line  of  diseased  action.  In  some  cases  nitrate  of  silver  had 
been  successfully  applied.  The  cleansing  means  employed  during  the  separation  of  the 
slough  were  chiefly  Labarraque's  solution,  creasote  and  vinegar  washes,  yeast,  cinchona,  and 
charcoal  poultices,  etc.  The  patient's  constitution  at  the  same  time  had  been  supported 
by  the  internal  administration  of  muriate  tincture  of  iron  and  quinine,  and  by  the  free  use 
of  stimulants,  malt  liquor,  beef  tea,  and  a  general  nutritious  diet. 

A  few  weeks  after  the  appearance  of  the  disease  at  Annapolis,  Assistant  Surgeon 
.1.  J.  Woodward,  United  States  Army,  was  sent  there  for  the  purpose  of  examining  into  the 
microscopical  appearances  of  hospital  gangrene.  His  observations  are  embodied  in  the 
following  report: 

"Arriving  at  Annapolis  I  visited  thej)atients  affected  with  hospital  gangrene  on  the  morning 
of  February  18,  1803.  I  found  that  the  progress  of  the  disease  was  not  yet  arrested,  and  that  one 
or  two  new  cases  were  occurring  almost  daily.  No  one  had,  however,  suffered  from  it  except 
returned  prisoners  from  Richmond,  and  the  affection  was  proving  much  less  fatal  than  European 
experience  would  cause  us  to  anticipate.  The  patients  were  isolated  from  the  rest  of  the  hospital, 
in  separate  buildings.  The  number  of  cases  in  which  the  characteristic  appearances  of  the  earlier 


CHAP.  XII.]  HOSPITAL    GANGEENE.  831 

stages  of  the  disease  could  be  observed  was  only  three  or  four,  and  about  the  same  number  pre 
sented  vast  sloughing  excavations,  which  were  still  enlarging  in  spite  of  treatment.  In  all  the 
other  cases  granulating  surfaces  of  various  sizes,  and  in  various  stages  of  the  reparative  process, 
indicated  the  former  extent  of  the  disease.  As  the  description,  history,  and  treatment  of  these 
cases  has  been  made  the  subject  of  special  observations  which  will  be  duly  reported  to  the  depart 
ment  by  Surgeon  J.  H.  Brintou,  U.  S.  V.,  I  shall  limit  myself  as  much  as  possible  in  this  report  to 
pathologico-histological  considerations. 

"  In  its  destructive  progress  hospital  gangrene,  as  observed  by  me  in  these  cases,  appears  to 
follow  at  least  two  diverse  modes  of  extension,  which,  however,  are  frequently  combined  in  differ 
ent  portions  of  the  same  excavation. 

"  I.  On  the  one  hand  the  tissues  immediately  adjacent  to  the  slough,  which  have  been  slightly 
reddened  without  being  increased  in  thickness,  become  greenish-brown,  or  black ;  the  slough 
steadily  progressing  in  this  manner  into  the  sound  tissues,  from  which  it  is  not  separate!  so  long 
as  it  continues  to  extend  by  any  pus-producing  or  ulcerative  action  or  any  true. line  of  demarcation.. 

"  II.  On  the  other  hand  the  tissues  about  to  be  invaded  become  not  only  reddened,  but  hard 
and  swollen,  elevating  the  edges  considerably,  and  causing,  therefore,  the  cavity  to  appear  deeper 
than  it  really  is.  This  thickened  mass  breaks  down  rapidly  into  a  fetid  yellowish  ichor  and  is  thus 
quickly  eroded,  but  in  such  a  manner  that  the  subcutaneous  connective  tissue  is  more  speedily 
destroyed  than  the  skin  which  overhangs,  therefore,  the  jagged,  irregular  underminings  of  the 
morbid  process.  The  sloughs  in  this  case  are  ash-colored,  yellowish,  or  greenish-yellow,  occasionally 
brownish  or  blackish,  in  which  latter  case  it  will  generally  be  found  that  the  dark  color  is  due  to 
the  putrid  mass  drying  into  a  species  of  scab. 

"  In  both  these  varieties  the  slough  attacks  chiefly  the  skin  and  subcutaneous  connective 
tissue  and  adipose  layer.  The  second  variety,  however,  more  frequently  than  the  first,  may 
penetrate  beneath  the  deep  fascia  of  the  part,  still  affecting  especially  the  connective  tissue  septa, 
dissecting  thus  profoundly  between  the  muscles  and  tendons,  which  resist  longer  the  destructive 
process,  and  retain  often  their  general  form  and  appearance  even  after  they  have  been  completely 
undermined  and  separated,  except  at  their  extremities,  from  their  normal  connections. 

"  In  the  first  variety  an  examination  of  the  slough  as  close  as  possible  to  the  living  tissues 
showed  nothing  but  the  normal  form  elements  of  the  affected  part  in  various  stages  of  putrefactive 
decomposition.  None  of  the  lymph  or  pus-forms  which  usually  result  from  inflammatory  action 
could  be  observed.  The  small  vessels  and  capillaries  of  the  living  tissues  near  the  slough  were 
gorged  with  blood,  which,  in  the  vessels  immediately  adjacent  to  the  dead  parts,  was  completely 
stagnant.  In  proceeding  in  the  investigation  of  the  sloughs  of  this  character  from  the  living 
tissues  through  the  slough  to  the  central  cavity  exposed  by  the  disease,  the  elementary  forms  were 
found  to  be  more  and  more  completely  obscured  by  the  putrefactive  changes  until  a  granular 
opaque  mass  remained  in  which  no  form  elements  could  be  observed,  except  perhaps  a  few  yellow 
elastic  fibres  which  had  resisted  decomposition.  Associated  with  these  changes  was  a  tendency  to 
break  down  into  a  fetid,  diffluent  semi-liquid,  and  thus  to  leave  a  cavity  which  in  this  class  of  cases 
was  usually  bounded  below  by  the  superficial  surface  of  the  muscles  of  the  part.  In  these  cases  it 
was  generally  observed  that  while  the  disease  continued  to  spread  peripherally,  a  line  of  demarca 
tion  was  formed  by  a  true  ulcerative  action  with  pus-formation  between  the  superficial  slough  and 
the  subjacent  muscles,  the  pus  being  formed  in  at  least  some  of  the  cases  at  the  expense  of  the 
muscular  tissue,  as  will  be  seen  in  the  sequel. 

"In  the  second  variety  an  examination  of  the  thickened  and  hardened  edges  into  which  the 
eroding  process  was  extending  showed  the  tissues  to  be  transformed  into  a  mass  of  cell  forms,  of 
which  the  most  numerous  were  spherical  granular  cells,  quite  identical  in  individual  aspect  to  ordi 
nary  pus  corpuscles,  but  embedded  in  a  granular  mass,  and  thus  constituting  what  has  been 
variously  called  croupous  fibrine,  croupous  lymph,  and  corpuscular  lymph.  This  is  the  condition 
described  by  Rokitansky  as  the  'death  of  textures  replete  with  fibrin o-croupous  exudates,'  to 
which  category  he  refers  hospital  gangrene.  Embedded  in  the  same  mass  can  also  be  seen  occasion 
ally  connective  tissue  cells  in  various  stages  of  enlargement  and  multiplication  by  division.  By 
the  liquefaction  of  the  granular  mass  in  which  these  elements  are  embedded  they  float  out  free, 
forming  a  scanty  ichorous  pus.  The  process,  therefore,  in  this  variety  consists  of  two  stages:  In 


832  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xii. 

the  first  there  is  an  extremely  rapid  cell  multiplicatiou,  resulting  in  the  formation  of  the  innumerable 
cells  of  croupous  lymph  with  which  the  tissues  are  crammed;  in  the  second  the  death  of  the 
infarcted  tissues  occurs  either  gradatim  as  an  eroding  ulcer  or  in  mass  as  a  bulky  slough. 

"In  cases  of  either  variety  in  which  a  favorable  termination  is  attained  after  the  sloughs  are 
thrown  off,  granulations  sprout  from  the  bottom  and  sides  of  the  cavity  and  gradually  fill  it  up. 
In  one  or  two  cases  in  which  this  process  had  advanced  to  commencing  cicatrization  nothing  was 
observed  different  from  what  may  be  seen  in  the  healing  of  ordinary  ulcers  of  considerable  size. 
In  many  favorable  cases,  however,  granulations  sprout  from  the  exposed  muscles  at  the  bottom  of 
the  excavation  even  before  the  extension  of  the  sloughing  at  the  margin  is  arrested.  I  found  in 
these  cases,  as  well  as  in  the  ulcerative  process  previously  mentioned,  by  which  the  black  sloughs 
of  the  first  variety  are  separated  from  the  subjacent  muscles,  a  good  opportunity  to  study  the  pro 
cess  of  pus-formation  iu  the  muscular  tissue.  The  observations  made  here  confirm  precisely,  as  do 
many  others  made  by  me  heretofore,  the  opinion  that  the  muscular  tiJbre,  when  involved  in  the 
inflammatory  process,  contributes  its  share  to  the  formation  of  the  products  of  inflammation.  The 
form  elements  involved  especially  are  the  so-called  nuclei  of  the  sarcolemma,  concerning  which 
there  is  a  difference  of  opinion  as  to  whether  they  are  to  be  regarded  as  an  anatomical  portion  of 
the  muscular  fibre  or  as  belonging  to  delicate  connective  tissue  cells  wound  spirally  around  it. 
These,  whatever  their  nature,  enlarge,  elongate,  multiply  by  division,  and  produce  broods  which 
encroach  on  the  proper  substance  of  the  fibre.  The  transverse  striae  become  pale,  indistinct,  and  at 
length  are  replaced  by  a  granular  appearance.  Finally  the  whole  substance  of  the  fibre  is  occupied 
by  spherical  granular  cells,  the  destiny  of  which  may  be  on  the  one  hand  to  develop  into  granulations, 
or,  on  the  other,  to  be  set  free  as  pus  by  the  liquefaction  of  the  matrix  in  which  they  are  embedded. 

"With  regard  to  the  constitutional  conditions  present  in  these  cases  of  hospital  gangrene 
the  patients  were  pale,  the  countenance  anxious,  the  pulse  frequent,  small,  feeble,  the  bowels  some 
times  affected  with  diarrhoea  but  in  other  cases  constipated.  The  appearance  of  the  patients  in 
some  cases  indicated  the  presence  of  a  scorbutic  taint.  In  other  cases  the  yellow  complexion  and 
the  enlarged  spleen  indicated  constitutional  disturbances  due  to  malarial  poisoning.  In  all  it  was 
observed  that  a  needle  inserted  into  the  finger  to  obtain  a  drop  of  blood  lor  examination  required 
to  be  carried  deeper  than  usual  to  obtain  it.  The  blood  thus  obtained  presented  in  every  case  a 
noticeable  increase  in  the  proportional  number  of  white  blood  corpuscles,  which  were  also,  as  a 
rule,  larger  than  normal  (^-8V^  to  ^STJT  °f  an  iucu  i11  diameter).  This  condition  was  developed  in 
some  cases  much  more  than  in  others,  but  in  none  attained  to  an  exquisite  degree.  The  red  blood 
corpuscles  were  scanty,  pale,  and  showed  less  tendency  than  iu  healthy  blood  to  aggregate  into 
nummular  rolls. 

"If  now,  in  appreciating  the  foregoing  observations,  an  attempt  be  made  to  recognize  the 
etiology  of  the  affection,  we  shall  seek  for  the  efficient  causes  in  the  exposures,  the  privation,  the 
want  and  depressing  agencies  to  which  these  men  had  been  exposed  in  the  crowded  prison  hos 
pitals  of  Richmond.  It  was  there  that  the  affection  originated,  and  although  new  cases  still  from 
time  to  time  occur  in  Annapolis,  it  will  be  borne  in  mind  that,  as  previously  stated,  these  cases 
occur  only  among  the  wounded  of  the  returned  Richmond  prisoners.  The  escape  of  these  unfor 
tunates  to  the  open  wards,  the  generous  treatment  and  good  diet  of  the  United  States  General 
Hospital,  will  account  for  the  small  mortality  that  has  occurred. 

"In  conclusion,  an  allusion  may  be  made  to  the  idea  that  the  peculiar  characteristics  of  this 
disease  are  due  to  the  local  presence  of  microscopical  fungi.  This  idea  is  not  borne  out  by  facts. 
Accurate  examination  with  a  high  magnifying  power  of  cases  in  every  stage,  both  where  nothing 
but  an  ordinary  water  dressing  as  well  as  iu  cases  in  which  various  forms  of  antiseptic  and  caustic 
washes  had  been  employed,  utterly  failed  to  demonstrate  any  cryptogarnic  organisms  except  the 
ordinary  bacteria  which  are  to  be  observed  in  every  decomposing  animal  substance." 

While,  at  Annapolis,  the  cases  of  hospital  gangrene  had  been  produced  by  infection,  the 
disease  at  Nashville,  where  it  appeared  a  month  or  two  later,  in  April,  1863,  was  undoubt 
edly  of  an  indigenous  origin.  Thirty-eight  cases  occurred  at  hospital  No.  8  within  a  few 
days,  and  Surgeon  M.  Goldsmith,  U.  S.  V.,  who  had  been  sent  there  to  look  into  the  origin 
and  progress  of  the  disease,  found  that— 

"1.  All  of  the  cases  occurred  in  Ward  No.  1.     II.  All  the  cases  occurred  in  the  row  of  beds 


CHAP.  xil.J  HOSPITAL    GANGRENE.  833 

next  the  windows  opening  upon  an  alley.  III.  All  the  cases  occurred  prior  to  the  24th  of  April, 
or  during  the  time  when  the  external  atmosphere  was  colder  than  that  of  occupied  houses,  enclosed 
cellars,  or  underground  drains.  IV.  The  cellar  under  the  hospital  had  passing  under  and  opening 
into  it  by  several  apertures  the  common  sewer  of  that  part  of  the  city.  V.  The  soil  pipes  from  the 
privies  of  the  several  wards  traversed  this  cellar  and  emptied  without  a  trap  into  the  common  sewer. 
VI.  This  soil  pipe  was  made  of  tin  and  leaked  badly.  VII.  In  wet  weather  the  cellar  bottom  was 
overflowed  by  the  contents  of  the  soil  pipes  and  sewer.  VIII.  This  cellar  had  but  two  openings, 
one  in  the  front  of  the  building  and  one  on  the  alley.  IX.  The  alley  was  long,  narrow,  and  high 
(five  stories).  X.  The  area  of  the  adjacent  building  received  the  drainings  of  the  garbage  of  the 
kitchen,  and  this  area  formed  a  part  of  the  alley.  XI.  Ward  No.  1  derived  its  ventilation  almost 
entirely  from  windows  opening  on  the  alley.  On  the  opposite  side  there  was  but  one  opening,  a 
door,  leading  to  a  hall  which  had  no  window.  On  the  end  next  the  street  there  were  but  three  win 
dows.  XII.  The  prevailing  winds  during  cold  weather  sweep  the  street  on  the  front  of  the  build 
ing,  leaving  the  atmosphere  in  the  alley  almost  still.  XIII.  The  emanations  from  the  area  of  the 
adjoining  building,  as  well  as  those  from  the  cellar,  were  most  offensive  at  all  times,  and  were  dis 
gustingly  perceptible  in  the  evening  when  the  external  atmosphere  began  to  grow  cool.  XIV.  No 
cases  of  hospital  gangrene  occurred  after  the  weather  grew  so  warm  that  the  outer  air  was  warmer 
than  the  air  in  the  cellar  and  sewer  (after  April  24th).  XV.  The  building  on  the  opposite  side  of 
the  street  (the  alley  running  through  only  one  square)  prevented  any  wind  from  sweeping  it  below 
the  second  story. 

"  In  the  early  part  of  the  season  one  patient  was  brought  into  the  ward  with  hospital  gan 
grene.  In  a  few  hours  six  other  cases  were  developed  in  wounded  men  laying  adjacent  to  him. 
The  disease  did  not  spread,  and  with  the  termination  of  these  cases  disappeared  for  a  season. 
When  it  broke  out  again  it  attacked  those  who  came  into  the  ward  without  any  appearance  of  a 
gangrenous  condition  in  their  wounds  at  the  time  of  their  admission.  It  will  appear  from  the  fact 
related  that  the  miasm  generated  by  putrefying  animal  matters  in  the  cellar,  and  perhaps  in  the 
area,  are  given  off  at  all  seasons,  and  that  just  during  that  season  when,  from  the  relations  of 
temperature,  the  atmosphere  of  the  cellar  would  ascend  in  the  alley  and  the  currents  would  enter 
the  wards  most  constantly — i.  e.,  when  it  was  necessary  to  heat  the  ward  with  stoves,  the  cases  of 
gangrene  occurred;  and  that  they  occurred  in  just  that  locality  in  which  the  gases  would  impinge 
upon  the  patients  in  most  concentration;  and  that  when  the  uiiasin  of  the  cellar  would  How  down 
ward,  i.  e.j  when  the  external  air  was  warmer  than  the  air  of  the  cellar,  and  when  from  the  extinc 
tion  of  fires  no  air  was  drawn  in  at  the  windows,  the  disease  ceased. 

"The  testimony  of  the  surgeon  having  the  ward  and  cases  in  charge  is  all  the  more  valuable 
that  he  did  not  anticipate  or  interpret  the  facts.  He  noticed,  without  peculiar  interest,  the  occur 
rence,  and,  as  he  expressed  himself  to  me,  supposed  that  by  some  singular  accident  the  patients 
having  the  'lowest  vitality'  were  placed  in  that  row  of  beds;  and  he  marveled  greatly  that  the 
cases  should  occur  when  the  ventilation  was  best,  because  the  windows  in  the  alley  were  the  only 
available  outlets  for  air  in  the  whole  ward,  and  were  opened  fully  and  diligently  four  times  a  day 
in  even  the  coldest  weather,  and  some  part  of  the  windows  were  kept  open  all  the  while. 

"I  think  that  the  records  of  surgery  do  not  afford  a  more  unique  or  striking  example  of  one 
of  the  methods  of  the  production  of  hospital  gangrene,  or  afford  a  more  pertinent  commentary  upon 
the  use  of  buildings  constructed  in  utter  disregard  of  all  hygienic  rules.  It  is  due  to  the  Medical 
Director  at  Nashville  to  state  that  he  had  closed  this  hospital,  and  reopened  it  only  when  the 
crowd  of  patients  coming  from  the  front  was  so  great  that  they  could  not  be  accommodated  other 
wise,  either  in  Nashville  or  at  Louisville,  and  also  to  state  that  the  attention  of  the  Quartermas 
ter's  Department  had  been  called  to  the  condition  of  the  building. 

"I  found  some  cases  of  hospital  gangrene  in  process  at  the  field  hospital  at  Murfreesboro', 
Tenn.  The  wounds  in  the  same  and  adjoining  tents  had  an  unhealthy  look,  and  some  were  attended 
with  profuse  and  unhealthy  suppuration.  A  few  of  the  cases  were  already  laboring  under  the 
ichorous  infection  (pyaemia).  The  general  police  and  attention  to  sanitary  regulations  were  good 
except  in  one  particular — a  particular  to  which,  I  fear,  but  little  attention  is  commonly  paid — 1 
refer  to  the  privies.  The  tents  are  arranged  on  two  sides  of  the  square,  end  to  end,  along  parallel 
streets  laid  out  in  squares,  each  row,  I  believe,  being  regarded  as  a  ward.  The  privies  are  placed 
along  a  middle  line  bisecting  a  square,  and  distant,  as  near  as  my  memory  serves,  about  twenty  or 
SUBG  III— 105 


834  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

thirty  yards  from  the  tents.  These  privies  are  opeu  sheds  placed  over  shallow  sinks,  nowhere 
deeper  than  aii  ordinary  field  latrine.  The  flooring1  is  so  loose  that  the  whole  arrangement  is  the 
equivalent  of  three  square,  large  tield  latrines,  with  only  this  difference,  that  in  the  field  they  can 
be  policed  by  throwing  in  earth,  while,  in  the  present  case,  they  were  broad  and  shallow  pits  filled 
almost  to  the  surface  with  a  pestilent  semi-fluid  mass,  the  excrement  of  men  affected  with  typhus, 
dysentery,  diarrhoea,  etc.,  etc.,  and  incapable  of  the  ordinary  treatment  of  field  latrines.  At  the 
time  of  my  visit  the  streets  surrounding  the  square  were  filled  with  the  odor  of  these  sinks — an 
odor  such  as  is  only  to  be  perceived  in  the  neighborhood  of  such  collections — a  nauseous  odor,  not 
mere  ammoniacal  odors,  but  a  sickening  phosphorescent  odor.  For  some  days  prior  to  the  appear 
ance  of  the  hospital  gangrene  the  atmosphere  had  been  remarkably  still  and  damp  and  the  weather 
warm  and  cloudy;  what  little  wind  there  was  had  been  from  the'  east.  The  tents  holding  the 
wounded  were  at  the  westward  of  the  privies.  I  state  these  facts  not  for  the  purpose  of  intruding 
upon  the  province  of  the  medical  inspectors,  or  as  a  text  for  any  comment  other  than  that  in  them 
I  can  see  clearly  the  operation  of  causes  proverbially  potent  in  giving  rise  to  hospital  gangrene, 
erysipelas,  and  congeners. 

"In  Nashville  I  found  a  few  sporadic  cases  of  hospital  gangrene,  some  of  which  had  been 
treated  with  bromine  unsuccessfully.  In  examining,  the  methods  of  applying  the  remedy  I  found 
that  the  applications  had  not  been  properly  made.  I  requested  permission  to  show  the  surgeons 
my  methods  on  one  of  the  cases.  I  dressed  the  first  case  in  the  presence  of  a  number  of  medical 
officers.  This  method  was  applied  to  all  the  other  cases  in  the  city  on  the  same  afternoon,  and  I 
had  the  satisfaction  of  seeing  that  every  one  of  them  yielded  to  a  single  application  of  bromine, 
aud  in  less  than  forty-eight  hours  were  granulating  throughout  the  whole  extent  of  the  diseased 
surface.  The  affair  of  these  cases,  I  am  informed,  has  settled  all  doubts  lingering  in  the  minds  of 
some  of  the  surgeons  on  duty  at  that  place  in  regard  to  the  efficacy  of  the  bromine  treatment  of 
hospital  gangrene." 

As  a  prophylactic  against  this  disease,  Medical  Director  M.  Goldsmith,  U.  S.  V.,  ordered 
the  following  compound  solution:  "Bromine,  one  Troy  ounce;  bromide  of  potassium,  one 
hundred  and  sixty  grains;  distilled  water,  enough  to  make  four  fluid  ounces  of  the  entire 
mixture.  At  the  same  time  printed  directions  for  its  use  were  issued  as  follows: 

"1.  For  Fumigation: — Place  vessels  containing  one  ounce  of  the  solution  at  different  points  of 
the  ward,  and  in  number  sufficient  to  secure  in  the  latter  the  constant  presence  of  the,  odor  of 
bromine.  It  should  be  borne  in  mind  that  if  the  vapor  of  bromine  comes  in  contact  with  the  vapor 
of  water,  hydro-bromic  acid  is  formed;  therefore,  when  there  is  much  of  the  vapor  of  water  dis 
engaged  in  the  apartment  the  quantity  of  the  vapor  of  bromine  must  be  correspondingly  increased. 

"  2.  Topical  application  of  the  vapor : — A  piece  of  dry  lint  is  to  be  placed  over  the  diseased  j  >art ; 
over  this  is  to  be  placed  another  piece  of  lint  moistened  with  the  solution  of  bromine;  over  this,  a, 
third  piece  spread  with  simple  cerate;  the  whole  to  be  covered  with  oiled  silk  and  bandage,  so 
arranged  as  to  retain  the  vapor  in  contact  with  the  diseased  surface  as  long  as  possible.  The  solu 
tion  is  to  be  renewed  as  often  as  it  becomes  exhausted  by  evaporation. 

"3.  The  solution,  in  substance,  as  a  direct  application  in  Hospital  Gangrene,  Diphtheria,  Gangrene 
of  the  Tongue,  and  other  diseases  of  this  nature: — The  parts  are  first  to  be  dried  by  the-  application 
of  charpie;  then  the  sloughs,  if  thick,  should  be  trimmed  out  with  forceps  and  scissors  as  much  as 
possible,  for  the  thinner  the  slough  the  more  effective  is  the  remedy.  The  parts  having  again  been 
dried,  the  solution  is  applied  by  means  of  a  mop,  or  a  pointed  stick  of  wood,  in  quantity  sufficient 
to  saturate  the  sloughs.  If  the  sloughs  undermine  the  skin,  or  dip  down  into  intermuscular  spaces, 
the  solution  must  be  made  to  follow,  with  the  pointed  stick  or  by  means  of  a  glass  syringe  with  a 
long  nozzle.  If  the  application  has  been  effectual,  all  odor  from  the  diseased  surface  ceases  and 
the  sloughs  become  somewhat  hardened.  The  remedy  should  be  reapplied  every  second  hour  as 
long  as  any  odor  of  putrefaction  is  present,  or  as  long  as  the  sloughs  appear  to  be  diffluent.  It  is 
not  always  necessary,  especially  when  the  sloughs  are  diffluent  and  thin,  to  use  the  solution  in  its 
full  strength;  it  may  be  weakened  by  the  addition  of  water  as  the  disease  subsides. 

"The  points  to  be  especially  attended  to,  in  the  use  of  the  solution  of  bromine,  are  two: 
1.  The  solution  should  be  applied  in  strength  and  frequency  sufficient  for  the  impregnation  of  the 
whole  of  the  sloughs.  2.  To  secure  this  end,  the  application  should  be  made  by  the  surgeon  himself') 


CHAP.  xn. |  HOSPITAL    GANGRENE.  835 

and  never  be  trusted  to  a  nurse.  If  the  sloughs  are  thick  and  cauuot  well  be  trimmed,  the  bromine 
may  be  introduced  into  the  thickness  of  the  slough  by  means  of  a  hypodermic  syringe.  After  the 
topical  application  of  the  solution  the  parts,  when  so  situated  as  to  render  it  practicable,  should 
be  subjected  to  the  influence  of  the  vapor.  (See  par.  1.)  Surgeons  will  do  well  to  bear  in  mind 
that  bromine  is  a  new  remedy  for  the  purposes  indicated  above.  The  directions  for  its  use,  given 
here,  are  those  followed  in  the  military  hospitals  of  this  city;  it  may  be  found  advisable  to  modify 
them  as  experience  with  the  remedy  accumulates.  It  is,  therefore,  earnestly  recommended  that 
the  subject  be  studied  diligently,  that  the  effects  of  the  remedy  be  carefully  watched,  and  that  the 
application  be  varied  as  new  facts  are  developed  in  its  use." 

The  action  and  influence  of  bromine  thus  employed  will  be  best  understood  from  the 
reports  made  to  Surgeon  Goldsmith  by  several  surgeons  in  charge  of  hospitals  under  his 
direction  in  which  the  disease  occurred.  Surgeon  B.  Woodward,  in  charge  of  the  Park 
Barracks  Hospital,  Louisville,  Kentucky,  reported: 

u  In  hospital  gangrene  the  most  remarkable  effects  of  the  use  of  bromine  have  been  seen. 
At  hospital  No.  7  there  is  one  case  of  gunshot  wound  of  the  foot  in  which  the  gangrene  included 
the  whole  upper  part  of  the  foot  from  the  toes  to  the  tarsus.  The  integuments  and  muscles  had 
all  sloughed  away,  leaving  the  extensor  tendons  bare  and  isolated.  The  local  use  of  the  bromine 
had  arrested  the  slough,  and  the  line  of  demarcation  was  well  marked.  Another  was  at  the  same 
hospital  of  wound  of  the  leg  by  a  piece  of  shell ;  the  gastrocnemius  and  soleus  were  bared  for  a 
space  of  eight  inches  by  three  inches ;  after  the  direct  application  of  bromine  the  line  was  well 
marked,  and  the  wound  took  on  healthy  action.  In  a  third  case  at  the  same  hospital  the  tibia  was 
bared  and  denuded  of  periosteum,  but  the  same  good  results  were  had  from  the  use  of  bromine. 
At  hospital  No.  3  I  was  shown  two  cases  of  gangrene  ;  in  one  the  slough  had  destroyed  not  only 
the  muscles  of  the  right  arm,  but  the  humeral  artery  had  sloughed  and  had  been  ligated.  Another 
and  perhaps  the  worst  case  at  the  same  hospital,  where  the  slough  had  carried  away  integument, 
obliquus  externus  and  obliquus  internns,  so  that  for  a  space  of  eight  by  five  inches  there  was 
nothing  left  but  the  tendons  of  the  obliquus  interims  and  the  peritoneum,  the  sloughing  had  been 
arrested,  and  the  whole  wound  was  covered  with  healthy  granulations.  In  all  these  cases  the 
peculiar  fetor  of  gangrene  had  disappeared.  All  these  cases  were  mixed  in  with  sick  and  badly 
wounded  men,  and  yet  there  had  not  been  an  instance  in  which  others  had  taken  the  disease.  All 
of  these  cases  were  gangrenous  when  they  were  brought  from  the  front  to  this  city,  and  I  cannot 
find  an  instance  in  which  it  has  originated  here.  This,  as  Dr.  Goldsmith,  in  charge  of  hospital 
No.  7,  said,  '  can  only  be  attributed  to  the  prophylactic  power  of  the  vapor  of  bromine  in  the  wards,' 
and,  to  use  his  own  words,  '  we  are  doing  with  the  greatest  impunity  what,  a  year  ago,  we  should 
not  have  dared  to  do,  viz,  putting  these  cases  in  the  wards  with  other  wounded  men.' " 

Surgeon  Thomas  H.  Mercer,  U.  S.  V.,  records  in  detail  in  the  following  case  the  man 
ner  in  which  bromine  was  employed  at  hospital  No.  13,  Louisville: 

"CASE  1208. — Corporal  Jesse  Havens,  Co.  F,  69th  Regiment  Ohio  Volunteers,  was  admitted  to  hospital  No.  13,  Louis 
ville,  Kentucky,  January  14,  1863,  having  been  wounded  at  the  battle  of  Murfreesboro',  December  31,  1862,  by  a  conical  ball  in 
the  anterior  tibial  region,  lower  third  of  leg;  flesh  wound.  The  wound  did  not  bh?ed  at  all  at  the  time  of  the  injury,  but  appeared 
to  remain  from  that  time  until  January  13th  in  about  the  same  condition,  with  no  disposition  to  granulate  or  heal.  At  that  time, 
or  very  soon  after,  the  edges  of  the  wound  and  flesh  in  the  vicinity  began  to  assume  a  purplish  hue  and  unhealthy  look.  Water 
dressings  used  up  to  February  1st;  wound  and  surroundings  growing  worse  daily.  The  wound  then  commenced  sloughing  and 
extending,  with  a  dark  gray  and  blackish  appearance.  At  this  stage  of  the  disease  was  commenced  the  antiseptic  treatment, 
the  yeast  poultice  with  cinchona  and  charcoal;  after  a  few  days  nitric  acid,  diluted  one-half,  applied  directly  to  the  wounded 
surface  and  gangrenous  surroundings,  with  some  slight  improvement.  This  was  continued  for  several  days.  Bromine  was  then 
commenced,  twenty  drops  to  one  ounce  of  alcohol,  as  a  substitute  for  the  acid,  with  the  cinchona  and  yeast  poultice  applied  imme 
diately  after  the  use  of  the  bromine.  Up  to  this  time,  February  20th,  Acting  Assistant  Surgeon  John  Logan  had  the  care  of  the 
case;  the  treatment  constitutionally  was  sustaining.  The  gangrenous  sloughs  were  becoming  detached  and  the  surface  of  the 
wound  was  looking  well,  but  very  pale  after  removal  of  the  sloughs.  February  21st :  Wound  cleaning;  some  soft,  pultaceous 
sloughs  remaining  on  the  inferior  third  of  the  ulcerated  surface.  This  wound,  not  exceeding  a  twenty-five-cent  piece  in  si/e 
when  the  patient  was  admitted,  now  extends  some  seven  inches  inferiorly  and  superiorly,  and  about  five  inches — two  and  a  half 
on  either  side  of  the  leg;  applied  the  bromine  twice  a  day  over  the  surface  of  the  wound  and  around  the  edges  for  an  inch  or 
more.  Ale.  sulph.  ferri  gr.  1  every  four  hours;  diet  generous.  February  22d:  Soft  pultaceous  masses  of  slough  removed  with 
forceps  and  scissors.  Bromine,  ale,  and  iron  continued.  Appetite  improving.  Yeast  and  cinchona  poultice  as  usual.  February 
23d:  Pearly  edge  developing  around  the  nicer;  pulse  92;  general  surface  of  the  wound  looking  well,  and  some  disposition  to 
granulation.  Tongue  slightly  furred,  appetite  pretty  good;  patient  more  cheerful.  Ale,  iron,  etc.,  continued.  February  24th: 
Tongue  improved,  pulse  90;  improvement  in  general  appearance.  Skin  clear,  mind  tranquil,  granulations  appearing  over  the 
entire  surface  of  the  wound,  except  a  irangrenous  spot  about  the  size  of  a  dime  on  the  inner  surface  of  the  tibia,  about  the  cen 
tral  portion  of  the  wound,  involving  the  periosteum.  Appetite  improving.  Bromine,  ten  drops  to  the  ounce  of  alcohol,  proves 
as  much  as  he  can  bear.  Continue  treatment  as  before.  Generous  diet.  February  25th :  Tongue  clean,  pulse  90,  appetite  good: 


836 


WOUNDS    AND    COMPLICATIONS. 


[CHAT.  XII. 


gangrenous  spot  lessening;  granulations  increasing;  surface  ulceration  improving  in  color;  treatment  the  same  as  before.  Feb 
fuary  26th :  Tongue  clean,  pulse  96,  appetite  good;  gangrenous  spot  lessening  in  width,  slightly  increasing  in  length;  wound 
still  improving  and  filling  up  with  fine  healthy  granulations.  February  27th  :  Feels  better;  tongue  clean,  pulse  88,  appetite  good ; 
gangrenous  spot  about  the  same;  granulations  improving  all  the  time;  feels  cheerful  and  hopeful.  February  28th  :  Pulse  84, 
tongue  slightly  furred;  application  of  bromine  quite  painful  for  an  hour  or  so  after  its  use.  March  1st:  Pulse  84,  tcngue  cleaner, 
wound  looking  well;  bowels  in  good  order  throughout  since  February  20th,  previous  to  which  time  he  had  frequently  suffered 
from  sharp  attacks  of  diarrhoea.  March  2d:  Tongue  clean,  pulse  86,  wound  filling  with  fine  healthy  granulations;  bowels  not 
so  easy;  some  griping  pains  in  epigastrium  ;  countenance,  however,  cheerful.  Gangrenous  spot  entirely  devoid  of  the  soft  pulta- 
ceous  mass,  leaving  the  periosteum  exposed  about  the  size  of  a  five-cent  piece  and  black  as  ink.  Appetite  not  so  good;  ordered 
wine  to  substitute  the  ale ;  diet  generous.  March  3d :  Pulse  88,  tongue  slightly  furred,  wound  improving,  bowels  better ;  cheerful 
and  hopeful:  appetite  good ;  treatment  continued.  March  4th  :  Pulse  86,  wound  about  the  same;  tongue  clean,  bowels  in  good 
condition  ;  gangrenous  spot  still  the  same.  Diet  generous  and  full.  March  5th  :  Pulse  88.  tongue  slightly  furred,  appetite  good, 
wound  gradually  and  steadily  improving.  Application  of  the  bandage  to  the  foot  up  to  the  edge  of  the  wound  to  prevent  burrow 
ing.  March  6th :  Pulse  88.  Complains  of  some  pains  in  the  right  side  of  the  chest  on  taking  a  long  breath.  Wound  still 
improving,  appetite  good..  Ordered  mustard  sinapism  to  chest,  and  Dover's  powder,  grains  15,  at  night.  March  7th:  Pulse  90. 
tongue  clean;  pain  in  chest  relieved;  appetite  good  as  usual;  wound  still  improving.  March  8th:  Pulse  108,  tongue  coated; 
pain  returned  to  the  right  side;  not  as  well  to-day;  spirits  depressed,  appetite  still  good,  bowels  regular.  Mustard  sinapism  to 
chest ;  pulv.  Dover!,  grains  25,  in  four  powders,  one  every  three  hours;  same  treatment  of  wound.  March  9th :  Pulse  96,  tongue 
about  the  same;  general  condition  much  improved;  pain  inside  relieved,  appetite  good,  and  in  good  spirits;  wound  healing. 
March  10th:  Pulse  88,  tongue  cleaning,  wound  painful,  but  improving  in  appearance;  appetite  good.  Treatment  the  same. 
March  llth:  Pulse  96;  condition  about  the  same  as  yesterday.  Treatment  and  diet  continued;  wound  healing  rapidly  and  pret 
tily.  Bromine  has  acted  like  a  charm,  and  still  possesses  a  biting  character  when  applied,  from  which  he  suffers  for  an  hour  or 
so  after  its  use." 

Surgeon  Goldsmith  gives  a  statistical  summary  of  three  hundred  and  thirty-four  (334) 
well  authenticated  cases  of  hospital  gangrene  treated  at  the  military  hospitals  at  Louisville, 
Kentucky,  Nashville  and  Murfreesboro',  Tennessee,  and  New  Albany,  Indiana,  and  remarks 
that  the  testimony  of  these  cases  will  establish  the  value  of  bromine  in  hospital  gangrene 
sufficiently  at  least  for  the  purpose  of  challenging  investigation. 

TABLE  OLVII. 
Summary  of  Three  Hundred  and  Thirty-four  Cases  of  Hospital  Gangrene,  giving  Treatment  and  Results. 


TREATMENT. 

TOTAL  CASKS. 

RECOVERED. 

a 

I 

AMPUTATIONS. 

AVERAGE   DURATION  j 
OF  TREATMENT. 

PERCENTAGE  OF 
Moi  IALITY.  , 

Treated  with  Bromine  in  different  ways  

152 

148 

4 

Treated  with  Pure  Bromine  exclusively 

27 

25 

2 

Treated  with  Pure  Bromine  in  solution  exclusively  ....          

86 

84 

2 

Treated  with  Pure  Bromine  after  the  solution  failed 

8 

8 

2.6 

Treated  with  Pure  Bromine  after  Nitric  Acid  failed     

23 

22 

1 

Treated  with  Bromine  after  other  remedies  failed 

g 

8 

Treated  with  Nitric  Acid  exclusively 

13 

5 

g 

3  davs  14g  hours 

61  5 

Treated  with  other  remedies  exclusively  

13 

7 

5 

1 

38  4 

Treated  with  other  remedies  after  Bromine  failed  

4 

4 

Aggregates  

334 

311 

21 

9 

C  2 

Surgeon  J.  H.  Brinton,  U.  S.  V.,  who  had  examined  the  outbreak  of  hospital  gangrene 
at  Annapolis,  reports  of  the  cases  at  Nashville  that— 

"Although  of  an  analogous  form  the  disease  did  not  appear  to  me  to  be  of  so  virulent  a 
grade;  whether  this  was  due  to  the  original  character  of  the  affection,  or  to  the  effect  of  the  reme 
dial  measures  employed,  I  am  not  prepared  positively  to  decide.  Nearly  all  the  cases  observed  by 
me  were  in  the  stage  of  reparation,  and  but  very  few  iu  the  period  of  progress.  The  shape  of  the 
ulcers  was  characteristic,  as  was  also  the  appearance  of  the  gray  slough,  but  the  tendency  of  the 
sores  to  burrow  deeply  and  to  extend  rapidly  was  not  well  marked  at  the  time  J  examined  the 
cases,  some  thirty  in  number.  The  treatment  almost  universally  adopted  in  the  Louisville  hos 
pitals  is  that  origiuated  and  introduced  by  Surgeon  Goldsmith,  TJ.  S.  V.  It  consists  in  the  direct 
local  application  of  bromine,  either  pure  or  in  solution,  to  the  surface  of  the  sloughing  sore.  Due 
care  is  always  first  taken  to  remove  as  thoroughly  as  possible  the  sloughs,  so  that  the  agent  may 
act  on  the  living  tissues  and  permeate  them  to  some  extent.  In  cases  in  which  the  burrowing  is 
so  extensive  and  deep  seated  as  to  render  the  application  of  bromine  difficult  or  incomplete,  Dr. 
Goldsmith  resorted  to  hypodermic  injections  of  bromine  at  the  circumference  of  the  sore.  The 


CHAP,  xii.]  HOSPITAL    GANGRENE.  837 

punctures  with  the  point  of  the  syringe  are  made  at  intervals  of  from  one-half  to  three-fourths  of 
an  inch,  and  one  drop  of  the  pure  bromine  is  thrown  into  the  tissues  at  each  application.  The 
mode  of  dressing  the  surfaces  of  the  sores  with  the  bromine  was  exhibited  to  me  by  Dr.  Goldsmith. 
From  my  observation  of  the  immediate  effect  of  the  reagent  upon  the  diseased  tissues,  and  of  the 
condition  of  the  sores  upon  which  it  had  been  previously  applied,  I  am  inclined  to  look  upon  the 
remedy  as  one  of  great  value  and  well  deserving  of  a  fair  and  extended  trial.  *  *  I  would  here 
remark  that  in  the  Louisville  hospitals  but  little  tendency  has  been  observed  in  the  disease  to 
spread  from  bed  to  bed,  although  isolation  of  the  gangrenous  patients  has  not  been  enforced.  In 
my  own  judgment  the  absence  of  this  tendency  to  infection  tells  strongly  against  the  supposed 
virulence  of  the  affection,  and  would  ever  throw  doubts  on  its  true  nature — at  all  events  in  some 
instances.  Assuming  the  disease,  however,  to  be  the  veritable  hospital  gangrene,  the  facts  con 
nected  with  its  origin  were  peculiar.  The  disease  occurred  almost  always  in  patients  who  had  been 
wounded  at  the  battle  of  Murfreesboro',  and  who  had  been  retained  for  some  time  in  crowded  hos 
pitals  previous  to  their  transportation  to  Louisville.  I  am  informed  by  Surgeon  Thurston,  U.  S.V., 
Medical  Director  of  the  Nashville  hospitals,  that  no  one  upon  whom  the  gangrene  had  already 
appeared  was  ever  sent  from  Nashville,  and  yet  many  were  so  infected  when  admitted  to  the  Louis 
ville  hospitals.  The  development  of  this  disease  on  the  route  seems  to  have  been  owing  to  the 
fact  that  the  transportation  of  the  wounded  was  effected  by  means  of  crowded  and  illy  ventilated 
boats,  and  that  the  trip  by  the  Cumberland  and  Ohio  rivers  frequently  occupied  several  days. 
During  this  time  these  patients,  who  had  already  undergone  much  suffering,  were  exposed  to  all 
the  influence.'  most  apt  to  engender  this  disease.  In  contrast  with  this  fact  it  was  found  that  as 
soon  as  the  Louisville  and  Nashville  Kailroad  was  opened  so  that  the  wounded  could  be  conveyed 
from  city  to  city  in  hospital  trains  in  one  day,  all  importations  of  gangrenous  sores  into  Louisville 
ceased.  The  development  of  hospital  gangrene  during  the  boat  transportation  is  a  noticeable 
fact,  and  is  strikingly  analogous  with  the  same  phenomena  observed  among  our  paroled  wounded 
prisoners  from  Richmond  received  into  the  Annapolis  general  hospitals  some  months  since." 

It  is  well  to  state  here  that  a  few  at  least  of  the  surgeons  at  Louisville  and  elsewhere 
did  not  entertain  the  favorable  opinion  in  regard  to  the  use  of  bromine  in  cases  of  hospital 
gangrene  expressed  by  Drs.  B.  Woodward  and  M.  Goldsmith.  Acting  Assistant  Surgeon 
John  E.  Crowe,  in  charge  of  General  Hospital  No.  4,  Louisville,  reports  in  July,  1863,  that 
it  was  efficacious  in  "very  superficial  wounds  attacked  with  hospital  gangrene;  but  when 
the  disease  attacks  a  large  or  deep-seated  wound  it  has  failed,  after  repeated  trials,  to  exert 
any  beneficial  influence.  Greasote  is  superior  to  it  in  this  class  of  cases;  yet  creasote  has 
failed  in  several  instances."  Dr.  W.  W.  Keen  considered  bromine  a  poor  agent,  painful, 
inconvenient;  the  suffocating  fumes  preventing  a  close  inspection  of  the  wound.  Surgeon 
J.  E.  Summers,  Medical  Inspector,  Department  of  Tennessee,  believed  that  there  was  a 
"tendency  on  the  part  of  surgeons  interested  in  the  bromine  treatment  to  regard  every 
slough  as  gangrene." 

In  February,  1863,  a  number  of  cases  of  hospital  gangrene  occurred  at  the  Douglas 
Hospital,  Washington,  D.  G.,  and  were  observed  by  Assistant  Surgeon  William  Thomson, 
U.  S.  A.,  who,  in  a  special  report  to  the  Surgeon  General,  gives  the  following  interesting 
account  of  the  pathology  and  treatment  of  the  cases.  In  several  instances  later  information 
has  been  added  to  the  cases  cited  by  Dr.  Thomson :  l 

"The  victims  of  this  disease  were  wounded  at  Fredericksburg,  December  13,  1802.  For 
several  weeks  previous  to  this  battle  the  army  had  been  resting  on  the  Kappahanuock  and  had 
been  exposed  to  no  great  hardships.  It  had  been  amply  supplied  with  good  and  varied  food,  mid 
the  men  were  free  from  any  scorbutic  or  other  cachectic  taint. 

"It  is  well  known  that  the  fullest  preparations  had  been  made  by  Surgeon  Letterman  for  that 
engagement.  The  operations  were  performed  promptly,  and  the  wounded  probably  received  better 
care  than  ever  before  in  the  historv  of  the  war. 


1  The  report  has  been  published  in  the  American  Journal  Medical  Science*  for  April,  1864.  Vol.  XLV1I,  p.  378. 


838  WOUNDS    AND    COMPLICATIONS.  [CHAP.  XII. 

"Ou  the  26th  of  December,  1862,  about  two  hundred  wounded  from  the  battle  of  Fredericks- 
burg  were  received  into  the  Douglas  Hospital. 

"I  cannot  speak  of  their  treatment,  medical,  surgical,  or  hygienic,  as  at  that  time  I  was  not 
connected  Avith  the  hospital.  I  am,  however,  aware  that  the  building  in  which  the  gangrene 
appeared  contained  fifty  badly  wounded  and  recent  cases;  that  there  was  a  deficiency  of  medical 
officers  and  dressers  to  insure  the  necessary  cleanliness,  and  that  the  sanitary  condition  of  the  ward 
was  far  from  perfect. 

"This  hospital  consists  of  the  three  brick  houses  known  as  'Minnesota  Row,'  and  two  large 
wooden  pavilions,  each  divided  into  two  wards.  The  ward  in  which  this  disease  originated  is  one 
hundred  and  forty-three  feet  in  length,  twenty-three  feet  in  breadth,  and  sixteen  feet  in  height 
(eighteen  feet  at  the  cone  and  fourteen  at  the  eaves  of  the  roof),  and  contains  beds  for  fifty  patients, 
thus  giving  1,050  cubic  feet  of  space  for  each  bed.  There  are  two  rows  of  windows,  the  lower  of 
which  contains  two-,  the  upper  one  sash  each;  the  upper  windows  so  constructed  as  to  be  opened 
by  means  of  a  cord,  but  when  opened  directing  a  current  of  cold  air  immediately  downward  upon 
the  beds  beneath. 

"On  the  16th  of  Feburary,  1863,  I  took  charge  of  the  hospital,  and  found  the  ward  mentioned 
in  the  following  condition:  There  was  no  ridge  ventilation,  nor  was  there  any  egress  for  foul  air 
except  through  two  large  wooden  shafts  connected  with  two  of  the  stoves,  which  had  been  placed 
there  only  a  few  days  previously.  The  ward  was  heated  by  ordinary  sheet-iron  radiating  coal 
stoves,  and  no  provision  had  been  made,  until  a  few  days  before,  to  introduce  any  supply  of  fresh 
air.  It  contained  from  forty  to  fifty  patients,  all  wounded,  many  of  them  very  severely.  The 
police  was  not  unexceptionable,  too  little  attention  having  been  paid  to  the  removal  of  offensive 
discharges.  The  medical  officer  in  charge  preferred  to  water  as  a  dressing  either  simple  cerate  or 
mutton  tallow,  which  had  been  issued  to  the  hospital,  and  which  had  become  rancid.  The  attend 
ants  were,  from  a  want  of  strict  discipline,  careless  and  inattentive.  There  was  a  perceptible  and 
offensive  odor  in  the  ward,  which  felt  close  and  badly  ventilated;  and  this  condition  of  the 
atmosphere  seemed  to  have  a  marked  effect  on  the  spirits  of  the  men;  they  were  all  gloomy,  des 
pondent,  and  homesick. 

"On  February  17th,  when  making  my  first  visit  with  the  officer  in  charge  of  the  ward,  I 
discovered : 

"CASE  I. — Sergeant  Otto  Kosaek,  Co.  K,  2d  Maryland,  who  had  been  struck  by  a  shell,  December  13, 1862,  which  made 
it  necessary  to  amputate  his  left  leg  at  the  middle.  The  operation  was  done  ten  minutes  after  the  injury.  He  was  received  here  on 
tin-  2!>th  of  December.  The  stump  closed  by  granulation,  a  small  portion  of  the  tibia  having  been  removed  by  exfoliation.  The 
cicatrization  had  been  almost  complete,  when,  a  few  days  previous  to  the  17th,  the  still  open  wound  commenced  to  slough.  He 
was  anaemic,  very  pallid,  haggard,  and  with  an  expression  of  great  depression  in  his  features ;  his  pulse  was  very  feeble  and 
rapid ;  he  had  been  'feeling  very  badly'  for  several  days,  and  complained  of  a  burning  pain  in  the  stump.  -On  the  outer  side  of 
the  tibia  there  was  an  ulcer  one  inch  in  diameter,  covered  with  a  yellowish-gray  pultaceous  slough,  and  a  serous  and  very  fetid 
discharge ;  the  edges  were  thickened  and  everted,  and  an  areola  of  purple  livid  congestion  extended  for  half  an  inch  from  the 
margin,  which  was  undermined.  This  sore  was  at  once  treated  with  pure  nitric  acid,  applied  both  to  the  ulcer  and  to  the  areola ; 
the  ulcer  was  dressed  with  an  antiseptic  solution  of  creasote,  and  citrate  of  iron  and  quinine,  with  stimulants  and  nutrients,  were 
freely  given.  On  the  18th  the  sloughing  had  extended  to  the  border  of  yesterday's  livid  areola,  but  was  now  more  superficial, 
and  the  areola,  which  had  likewise  invaded  the  surrounding  skin,  was  more  florid.  The  ulcer  was  now  two  inches  in  diameter. 
As  there  was  some  doubt  as  to  its  specific  character,  the  patient  was  not  removed  from  the  ward  until  the  23d,  when  he  was  trans 
ferred,  with  several  others,  to  a  small  ward  prepared  in  the  brick  building,  and  completely  isolated  from  the  other  wounded  men. 
The  iron  and  quinine  were  found  to  disturb  his  stomach  and  destroy  his  appetite,  and  was  replaced  by  a  mixture  of  nitro- 
muriatic  acid  and  tincture  of  opium.  March  3d :  The  sore  was  now  perfectly  healthy  and  was  granulating  rapidly.  [The  patient 
was  discharged  June  15,  18(54,  and  was  a  pensioner  in  1882.  A  plaster  cast  of  the  stump  is  preserved  in  the  Army  Medical 
Museum  and  is  numbered  6706  of  the  Sunjicul  Section.'] 

"This  was  a  mild  case,  treated  in  its  iucipieucy  with  nitric  acid  most  thoroughly.  The  ulcer- 
ation  had  not  extended  so  deeply,  nor  so  far  beneath  the  margin  of  the  skin,  as  to  make  it  almost 
impossible  to  reach  every  portion  of  the  diseased  surface.  There  was  no  scorbutis.  The  gums  were 
firm  and  hard.  The  patient  was  very  pallid,  his  heart  feeble,  and  his  pupils  dilated.  The  mucous 
membranes  were  very  pale,  and  the  expression  of  the  face  haggard  and  anxious.  He  recovered 
rapidly  with  a  good  stump,  and  was  seen,  several  months  after,  walking  with  great  ease  on  an 
artificial  leg. 

"CASE  II.— L.  D.  Thurston,  Private,  Co.  A,  IGtli  New  Hampshire,  aged  42  years,  was  struck-  by  a  fragment  of  shell  on 
December  13, 1862,  at  Fredericksburg,  which  caused  a  severe  but  superficial  wound  of  the  integuments  on  the  outer  side  of  the  left 
thigh.  When  seen,  February  17,  1863,  there  was  a  wound  at  the  middle  of  the  thigh,  on  its  outer  aspect,  three  and  a  half  inches 
long  by  two  and  a  half  wide,  expos-ing  the  muscular  tissue  slightly,  the  surface  of  which  was  glazed  and  dry.  On  the  10th  of 
February  it  had  been  found  desirable  to  open  an  abscess  three  inches  below  the  left  greater  trochanter.  On  the  13th  this  had 
assumed  an  unhealthy  look,  and  when  I  saw  it  on  the  17th  the  incision  made  by  the  lancet,  half  an  inch  in  length,  was  sur 
rounded  by  a  border  of  spbacelus  one  inch  in  width,  and  by  an  areola  of  purple  congestion,  in  which  there  seemed  to  have 
occurred  a  complete  stasis  of  the  circulation.  There  was  no  pus,  but  a  discharge  of  very  fetid  dark-colored  serum.  There  was 


CHAP,  xn  ]  HOSPITAL    GANGRENE  839 

no  swelling,  ulceration,  or  aversion  of  edges  of  the  incision,  which,  although  mortified,  remained  as  sharp  as  when  first  made. 
There  was  profound  nervous  prostration,  which  was  indicated  by  his  rapid,  feeble,  and  irritable  pulse:  by  his  sallow  hue;  his 
haggard  and  anxious  expression  of  countenance;  his  weary  and  helpless  decubitus  and  great  mental  despondency.  He  was  treated 
internally  with  stimulants,  the  most  condensed  and  nourishing  food,  and  citrate  of  iron  and  quinine;  nitric  acid  was  applied 
locally,  followed  by  a  weak  solution  of  creasote,  three  drops  to  the  ounce  of  water,  as  an  antiseptic  dressing.  The  sphacelus 
extended  in  all  directions  rapidly,  unchecked  by  this  treatment,  from  which  I  hoped  little,  since  it  was  impossible  to  bring  the 
acid  into  contact  with  the  diseased  tissues,  although  it  was  injected  into  the  incision.  The  constitutional  symptoms  also  became 
more  grave.  On  the  night  of  the  '20th  there  was  quite  a  severe  haemorrhage  from  the  incision,  oozing  slowly,  and  very  difficult 
to  restrain,  since  it  was  caused  by  the  erosion  of  vessels  at  a  distance  from  the  small  incision.  There  was  now  a  circular  patch 
of  sphacelus  surrounding  this  small  incision,  three  inches  in  diameter.  On  February  23d  he  was  removed  to  the  ward  in  the 
brick  building.  The  original  wound,  hitherto  unaffected,  now  began  to  be  black  and  offensive.  The  sphacelus  extended  from 
these  two  centres  at  the  rate  of  one  inch  daily,  preceded  by  the  above-mentioned  areola  of  purple  stasis.  No  treatment,  local  or 
constitutional,  produced  the  least  effect.  Stimulants  were  given  in  every  possible  form,  until  the  stomach  refused  to  retain  them. 
Pure  nitric  acid  was  freely  applied  to  the  diseased  surfaces  with  no  benefit.  He  fell  into  a  typhoid  condition,  with  muttering 
delirium,  subsultus  tendinum,  etc.,  and  finally  expired  February  28th.  The  sphacelus  then  extended  from  the  trochanter  major 
to  three  inches  above  the  outer  condyle,  and  from  the  median  line  in  front  to  a  corresponding  point  behind.  There  had  never 
been  any  ulceration,  but  the  tissues  seemed  to  perish  en  masse.  The  incision  made  by  the  lancet  was  yet  plainly  seen  in  the  cen 
tre  of  any  extensive  surface  of  mortification.  This  man  was  42  years  old,  had  had  chronic  diarrhoea,  and  was  in  a  feeble  state  of 
health  when  wounded.  No  benefit  was  observed  from  any  treatment.  He  took  in  addition  to  the  nutrients  and  tonics  the 
acid  mixture  with  tincture  of  opium.  [A  wet  preparation  of  the  thigh,  exhibiting  the  ravages  of  hospital  gangrene,  is  Specimen 
1001  of  lln- 8urr/ical  Section,  A.  M.  M.]  *  *  * 

"CASK  V.1 — Isadore  Wick,  Co.  D,  1st  New  York  Artillery,  aged  32  years,  had  his  right  thigh  amputated  on  the  field,  for 
comminuted  fracture  of  the  tibia,  received  December  13,  1862,  at  Fredericksburg,  caused  by  a  minU:  ball.  He  was  admitted 
December  26th.  I  regret  that  I  can  give  no  account  of  his  progress,  but  I  learn  that  the  flaps  had  been  insufficient,  and  that  the 
stump  had  been  closing  by  tedious  granulation.  There  had  been  a  free  discharge,  and  his  general  condition  was,  therefore, 
unfitted  to  withstand  the  depressing  influence  of  hospital  gangrene.  His  bed  was  on  the  same  side  of  the  ward,  and  in  close 
proximity  to  the  first  case  reported.  The  operation  had  been  a  circular  one;  the  granulation  had  entirely  covered  the  end  of  the 
bone,  and  there  was,  when  seen  on  the  18th  of  February,  only  a  narrow  strip,  not  yet  cicatrized  between  the  margins  of  skin. 
This  was  now  covered  with  a  gray  slough  and  had  the  characteristic  fetid  odor.  It  was  dressed  simply  with  the  creasote  solu 
tion,  my  faith  in  the  acid  treatment  having  been  shaken  by  the  reports  of  medical  officers  who  had  visited  the  cases  at  Annapolis. 
February  23d  :  The  case  was  now  considered  an  unequivocal  one  of  hospital  gangrene,  and  was  removed  to  the  ward  selected  for 
such  cases.  The  cicatricial  tissue  had  all  yielded  to  the  sloughing,  and  the  subcutaneous  connective  tissue  had  been  destroyed 
for  two  inches  beneath  the  skin  at  the  outer  angle  of  the  original  incisions.  No  change  was  made  in  the  local  treatment,  as  the 
creasote  was  a  perfect  deodorant,  and  as  good  results  were  hoped  for  from  its  local  use,  as  had  been  reported  from  Annapolis. 
The  destruction  was  limited  to  the  connective  tissue  until  March  9th,  when  there  was  a  margin  of  sphacelus  half  an  inch  wide 
in  the  true  skin.  The  constitutional  symptoms  had  been  growing  more  grave.  His  mental  despondency  was  most  marked,  his 
face  pale  and  anxious,  his  pupils  dilated,  his  pulse  100  per  minute  and  feeble,  and  his  skin  very  moist;  a  free  diarrhoea  had  also 
commenced.  The  tonics  and  stimulants,  having  produced  anorexia  and  nausea,  were  replaced  by  a  mixture  of  tincture  of  opium 
and  hydrochloric  acid  in  such  proportions  that  he  took  gtt.  xvi  of  tr.  opii  and  git.  iv  of  acid,  hydrochlor.  every  fourth  hour. 
Beef  essence  and  milk  punch  were  given  as  freely  as  his  stomach  would  tolerate  them,  llth  :  As  his  general  condition  became 
less  favorable  the  local  action  was  changed  from  molecular  death  to  sphacelus.  The  whole  face  of  the  stump  has  now  a  margin 
of  black  mortification  of  the  skin,  outside  of  which  was  the  usual  areola  of  purple  congestion — the  complete  stasis  of  to-day 
becoming  the  sphacelus  of  to-morrow.  The  end  of  the  femur,  protected  by  rosy  granulations,  now  protrudes  from  the  black 
mass  of  sphacelus.  the  integument  having  become  loosened  by  the  destruction  of  the  subcutaneous  connective  tissue  and  retracted. 
The  presence  of  this  mass  of  putrefaction  seems  to  add  to  the  nervous  prostration,  if  indeed  the  absorption  of  such  peccant 
material  is  not  its  sole  cause.  Pure  nitric  acid  had  been  applied  several  times,  but  it  had  been  found  impossible  to  convey  it  into 
the  depths  of  the  ulcer.  21st :  No  change  except  for  the  worse  had  occurred.  Stimulating  poultices  of  cinchona,  ginger,  and 
flaxseed  had  been  used  locally,  but  with  no  benefit.  Antiseptics,  such  as  the  solutions  of  chloride  of  soda,  creasote,  and  per 
manganate  of  potash,  were  necessary  to  purity  the  ward  and  render  it  endurable  for  his  attendants.  Nutrients  and  stimulants 
had  been  pushed  to  the  last  extent,  and  opium  had  been  largely  given  for  its  supposed  specific  effect  in  the  disease  as  well  as  to 
allay  suffering.  The  symptoms  had  been  typhoid  for  several  days;  emaciation  had  gone  on  rapidly ;  there  had  been  subsultus 
tendinum  and  muttering  delirium  with  extreme  prostration  until  this  date,  when  death  occurred.  The  limb  was  removed  after 
death  and  the  specimen  sent  to  the  Army  Medical  Museum.  [Specimen  1000,  >S'/m/.  Sect  ]  The  sphacelus  had  involved  all  the 
tissues  for  five  inches  above  the  divided  bone,  and  there  seems  to  have  been  a  faint  effort  to  form  a  line  of  demarcation. 

"This  was,  at  first,  a  very  mild  case,  with  no  very  decided  constitutional  depression  until  the 
system  seemed  to  be  poisoned  by  the  absorption  of  the  products  of  the  gangrene,  when  the  ulcer- 
ation  became  more  rapid,  and  was  finally,  as  the  strength  succumbed,  converted  into  uncontrollable 
and  rapidly  extending  sphacelus,  accounting  satisfactorily  for  the  unfortunate  result.  The  treat 
ment  locally  had  been,  first,  weak  solution  of  creasote,  made  soluble  by  one  drachm  of  alcohol,  four 
drops  to  one  ounce  of  water;  and  second,  strong  nitric  acid,  never  fully  applied,  however,  to  the 
depths  of  the  diseased  tissues.  The  constitutional  treatment  was  stimulating,  sustaining,  and  tonic. 

"  CASK  VIII. — John  Jordan,  Private,  Co.  H,  2d  Maine,  aged  20  years,  was  struck  at  Fredericksburg,  December  13,  1852, 
by  a  fragment  of  shell,  which  passed  across  the  right  thigh  below  Poupart's  ligament,  through  the  scrotum,  destroying  the  right 
testicle,  and  behind  the  left  thigh,  producing  in  its  course  very  extensive  but  superficial  wounds  of  the  anterior  portion  of  right 
and  posterior  portion  of  left  thigh.  He  was  admitted  December  26,  1882,  and  placed  in  ward  No.  f>.  February  27,  1863, 
he  had  febrile  disturbance  and  anorexia,  a  yellow,  furred  tongue,  an  anxious,  restless  expression  of  countenance,  and  a  burning 
pain  in  his  left  thigh.  There  was  on  the  right  thigh  a  granulating  surface  three  by  two  inches  in  dimensions,  level  with  the 
integument,  and  cicatrizing  rapidly.  A  smaller,  equally  healthy  surface  remained  unheuled  on  the  scrotum,  while  on  the  pos 
terior  portion  of  the  upper  part  of  the  left  thigh  an  ulcer  three  by  two  inches  in  extent  was  found,  oval  in  shape,  covered  with 
an  ashy  gray  slough,  with  its  margin  thickened  and  everted,  surrounded  by  a  livid  areola,  and,  instead  of  normal  pus,  dis 
charging  a  thin  fetid  serum  mixed  with  debris.  He  was  at  once  removed  to  the  house  ;  the  whole  diseased  surface  was  touched 
with  pure  nitric  acid  and  dressed  with  the  creasote  lotion  ;  stimulants  and  the  best  extra  diet,  with  beef  essence  and  milk  punch 
at  short  intervals,  and  citrate  of  iron  and  quinine  three  times  daily,  were  ordered.  March  ">th:  The  attempt  to  push  the  nutrients 
and  stimulants  produced,  as  it  generally  does,  anorexia,  nausea,  vomiting,  and  diarrluEa.  The  tongue  became  thickly  coated 
with  a  yellow  fur  and  dry  and  red  at  the  tip;  and  so  great  was  the  gastric  disturbance  that  all  medicines  were  discontinued  ami 
the  stomach  allowed  to  recover  its  tone  by  rest,  no  longer  being  teased  either  by  drugs  or  excessive  and  undesired  nutriment.  No 
benefit  followed  the  local  application,  and  the  ulceration  had  extended  in  every  direction.  There  was  the  characteristic  margin, 

'Spare  will  not  permit  to  introdure  all  oases  rited  l>y  Or.  THOMSON'.     CASKS  III.  IV,  VI.  and  VII  have  boon  omitted  here. 


840  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

preceded  by  the  areoln  of  livid  stasis,  preparing  the  tissues  for  their  rapid  destruction.  The  connective  tissue  beneath  the  skin 
had  been  destroyed,  so  that  the  skin  for  one  inch  from  its  margin  was  perfectly  movable.  The  muscles  separated  from  each 
other  by  the  death  of  their  connective  tissue  lay  in  the  wound  bathed  in  its  discharge,  but  rosy  and  florid,  and  resisting  the 
advance  of  the  disease.  This  sore  was  so  unmistakably  hospital  gangrene  that  several  pictures  of  it  were  taken  by  direction 
of  Surgeon  Brinton,  which  represent  well  the  surface  of  the  ulcer  dripping  with  its  thin  serous  discharge,  mingled  with  threads 
of  dead  connective  tissue,  its  '  piled-up,'  thickened,  and  everted  margin  surmounted  by  a  thin  line  of  vivid  redness,  and  its  broad 
zone  of  purple  congestion  shading  away  into  a  bronze  hue,  the  depth  of  color  in  the  areola  indicating  the  engorgement  of  the  small 
vessels  and  its  line  the  feebleness  and  slowness  of  the  movement  of  the  blood.  It  was  determined  to  try  the  opium  treatment, 
with  hydrochloric  acid  as  a  tonic,  and  this  mixture  was  given  in  the  proportion  of  16  drops  of  tincture  of  opium  with  four  drops 
hydrochloric  acid  every  three  hours.  The  sore  was  dressed  with  a  stimulating  poultice  composed  of  Ilaxseed,  cinchona,  and 
g'iiiirer  mixed  with  porter.  Under  the  use  of  the  acid  internally  the  tongue  has  become  clean  and  moist,  the  tone  of  the  digest 
ive  Apparatus  improved,  and  a  fair  quantity  of  food  had  been  taken.  Porter  and  ale  had  been  given  as  the  stomach  would 
retain  them.  But  little  change  had  taken  place  in  the  character  of  the  ulcer,  which  was  eight  inches  in  length  by  seven  in 
breadth,  extending  to  the  perineum,  and  irregularly  oval  in  shape.  The  muscles  exposed  (the  semi-membranosus  and  biceps) 
had  yielded  and  were  now  almost  divided.  The  sores  on  the  right  thigh  and  scrotum  had  not  been  in  the  least  affected,  but 
were  cicatrizing  rapidly.  The  entire  surface  of  the  gangrenous  sore  was  now  thoroughly  cleaned,  all  sloughs  and  shreds 
removed  with  forceps  and  scissors,  was  well  dried  with  lint  and  carefully  painted  with  pure  nitric  acid.  The  brush,  charged 
with  acid,  was  passed  beneath  the  excavated  margin  in  some  places  more  than  an  inch.  The  patient  was  etherized,  and  this  acid 
application  was  made  most  carefully  and  completely.  This  was  considered  a  dernier  resort,  for  although  the  capacity  for  taking 
and  assimilating  food  seemed  to  have  been  increased  by  the  acid  treatment  internally,  yet  his  strength  was  daily  diminishing 
from  the  exhausting  discharge  and  from  the  absorption  of  the  products  of  the  gangrene.  On  the  succeeding  day  an  entire  change 
in  the  sore  was  observed;  there  had  been  no  extension  of  the  gangrene,  the  fetid  odor  was  gone,  and  the  discharge  was  more 
consistent  and  less  serous.  In  a  few  days  more  all  the  shreds  of  dead  fascia  were  removed,  and  the  surface  was  found  to  be 
perfectly  healthy.  The  contrast  between  the  ragged,  offensive,  yellow-colored  ulcer  before  the  last  application  of  acid,  and  the 
florid,  perfectly  normal  granulating  surface  which  replaced  it,  was  as  gratifying  as  it  was  surprising.  With  the  local  there  was 
also  a  constitutional  improvement.  The  appetite  became  voracious,  the  patient  slept  well ;  there  was  no  pain,  and  the  process 
of  repair  was  very  rapid.  The  acid  was  continued  internally.  April  1st:  The  sore  was  now  two  by  three  inches  in  extent  and 
cicatrizing  rapidly ;  but  a  small  surface  yet  remained  annealed.  The  patient  was  in  perfect  health,  had  gained  flesh  very 
rapidly,  and  was  now  on  crutches.  There  was  some  contraction  of  the  flexors,  as  the  biceps  and  semi-membranosus  were  both 
involved  in  the  destruction.  [Jordan  was  dircharged  June  9,  1863,  and  pensioned.  Examiner  J.  C.  Weston  reported,  Septem 
ber  11,  186U  :  "At  the  biennial  examination  in  1865  atrophy  and  increased  weakness  of  right  thigh  and  leg  had  occurred.  His 
gait  is  always  affected ;  he  has  severe  pain  in  region  of  cicatrix  of  left  thigh ;  this  cicatrix  is  six  by  tln-ee  inches,  is  depressed, 
indurated,  adherent  to  muscles,  and  sensitive  on  account  of  rigidity  and  emaciation  ;  he  cannot  fully  extend  the  leg."  His  con 
dition  had  not  improved  when  examined  in  1873.] 

"The  most  remarkable  circumstance  in  this  typical  case  is  the  fact  that  when  the  gangrene 
attacked  the  granulating  surface  of  the  left  thigh  the  equally  large  granulating  surface  of  the  right 
thigli  was  unaffected;  and  that  while  the  gangrene  was  ravaging  the  left  thigh  the  rapid  cicatriza 
tion  of  the  right  proceeded  uninterruptedly.  The  discharge  from  the  left  thigh  was  so  profuse 
that  no  precaution  would  have  prevented  the  virus  from  coming  in  contact  with  the  excoriated 
surfaces  of  the  scrotum  and  right  thigh.  If,  therefore,  the  disease  be  propagated  by  inoculation, 
all  the  circumstances  were  favorable;  since  the  proximity  of  the  thighs  at  their  upper  part,  and  a 
denuded  surface  on  the  scrotum,  that  might  act  as  a  link,  render  it  certain  that  a  portion  of  the 
great  discharge  from  the  left  must  frequently  have  been  placed  in  contact  with  both  of  the  other 
sores.  If,  on  the  other  hand,  the  gangrene  be  not  a  local  but  a  constitutional  disease,  why  should 
it  spend  itself  on  one  granulating  surface  when  there  were  two  others  equally  obnoxious  ?  The  con 
trast  between  these  sores  was  marked ;  for  while  the  tissues  of  the  left  thigh  were  melting  away 
under  one's  very  gaze,  the  process  of  repair  in  the  scrotum  and  right  thigh  was  progressing  as 
rapidly  as  under  the  most  favorable  circumstances.  In  its  earlier  stages  this  case  was  twice  treated 
with  nitric  acid,  and  perhaps  imperfectly,  from  its  not  having  been  carried  into  the  recesses  of  the 
ulcer.  The  system  of  urging  nutrients,  stimulants,  and  tonics  irrespective  of  the  natural  desires 
of  the  patient  is,  I  am  satisfied,  pernicious.  The  vital  energy  being  depressed,  the  digestive 
organs  are  enfeebled;  and  the  introduction  of  milk  punch,  beef  essence,  eggnog,  and  with  stimu 
lants  porter,  ale,  etc.,  into  an  unwilling  stomach,  simply  produces  anorexia,  nausea,  vomiting,  and 
diarrhoea.  The  tongue  became  furred  and  dry,  and  there  was  a  perfect  disgust  for  all  food.  The 
hydrochloric  acid  was  given  to  correct  this  condition ;  and  whether  its  action  was  confined  to  the 
stomach  in  rendering  soluble  the  aliment  given  in  very  small  quantities,  or  whether  its  action  was 
catalytic  or  eliminative,  I  shall  not  pretend  to  state,  but  under  its  influence  the  tongue  became 
moist  and  clean  and  tlie  patient  made  known  his  desire  for  food.  Nutrients  were  then  given  more 
freely  as  his  appetite  returned.  The  recovery  of  this  man  is  due,  firstly,  to  the  thorough  applica 
tion  of  nitrid  acid  to  every  portion  of  the  ulcer,  which  changed  its  specific  nature  immediately; 
and,  secondly,  to  the  combined  effect  of  acid  and  opium  internally.  After  the  last  complete  appli 
cation  of  acid  the  sore  was  changed  in  character,  the  areola  disappeared,  the  surface  became  clean, 
the  margins  lost  their  elevated  appearance,  the  serous  discharge  became  purulent,  and  the  offensive 
odor  was  entirely  destroyed.  An  equally  marked  improvement  occurred  in  his  general  condition. 

•'  CASE  IX. — George  Zilch  (Zuelch).  Sergeant,  Co.  K,  7th  New  York,  aged  25  years,  had  his  left  leg  amputated  at  its  upper 
third  for  a  bullet  wound  received  at  Fredericksburg,  December  13,  1862.  He  was  admitted  to  Douglas  Hospital  December  26th, 


CHAP.  XIT.]  HOSPITAL    GANGRENE.  841 

and  placed  in  ward  No.  5.  The  stump  had  closed  slowly  by  granulation  until  there  remained  an  ulcer  as  large  as  a  half  dime 
on  its  face.  April  14,  1863,  this  ulcer  was  inflamed  around  its  edges  and  covered  with  a  white  pultaceous  slough;  there  was  no 
constitutional  disturbance,  and  the  patient  was  allowed  to  remain  on  his  crutches.  The  ulcer  was  cauterized  with  nitric  acid 
and  dressed  with  solution  sodre  chlorinatse.  18th  :  The  ulceration  and  areolaare  both  enlarged,  and  the  slough,  yet  very  tough, 
is  thicker.  Acid  was  again  used  locally.  21st:  He  is  feverish  and  inclined  to  nausea;  his  pulse  120,  skin  hot.  and  tongue 
thickly  coated.  The  ulcer  is  extending  in  depth,  and  he  was  removed  to  the  gangrene  ward.  22d:  The  solution  of  bromine  was 
applied  to  the  sore  after  cleansing  the  surface  as  much  as  possible  of  the  tenacious  slough.  His  general  condition  was  unfavor 
able,  and  there  was  a  tendency  to  diarrhoea  and  perspiration.  Internally  he  took  muriatic  acid,  with  extra  diet  and  stimulants. 
24th:  Bromine  was  again  applied  to  the  surface  and  used  in  the  form  of  vapor.  The  ulcer  was  now  three  inches  in  diameter, 
irregularly  circular  in  form,  with  ragged,  everted,  and  thickened  edges,  and  surrounded  by  a  purple  areola.  The  slough  was 
one  inch  in  thickness,  and  resisted  the  action  of  the  bromine.  2Gth:  The  sore  is  looking  better;  it  has  been  disinfected  since  the 
first  application  of  bromine,  and  the  constitutional  symptoms  are  better.  2?th  :  A  pointing  in  oil  was  made  to-day  by  Surgeon 
Brinton's  direction,  which  would  be  pronounced  a  good  representation  of  hospital  gangrene.  28th:  The  slough  is  much  thinner 
to-day,  and  the  granulations  are  showing  the  thin  gray  covering.  29th:  The  sore  is  much  better,  is  becoming  covered  with 
granulations,  and  has  lost  almost  entirely  its  specific  appearance.  There  is  no  constitutional  disturbance,  no  fever,  no  headache, 
the  tongue  is  cleaning  oft',  and  there  is  a  return  of  the  appetite.  The  bromine  vapor  was  discontinued,  and  sol.  sod.  chlorinat. 
substituted.  30th  :  The  livid  areola  has  been  changing  daily  in  hue  under  the  bromine  treatment,  has  now  entirely  disappeared, 
and  the  sore  is  perfectly  healthy.  May  6th  :  He  is  still  improving,  and  is  taking  tonics  and  nutrients.  20th  :  The  sore  is  reduced 
to  half  its  original  size  and  is  now  cicatrizing  rapidly.  24th :  There  is  now  a  surface  as  large  as  a  penny  unhealed  ;  health  is 
very  good;  he  is  about  the  ward  on  crutches,  and  is  no  longer  considered  an  interesting  case.  This  man  steadily  improved; 
recovered  with  a  good  stump,  and  was  finally  sent  to  New  York  to  be  mustered  out  of  service.  He  was  discharged  May  b,  1863, 
and  died  July  2,  1878,  of  valvular  disease  of  the  heart  and  cardiac  asthma. 

''We  Lave  in  this  case  another  instance  in  which  the  acid,  locally  used,  proved  useless,  and 
in  which  the  solution  of  bromine  caused  an  immediate  improvement.  It  was  found  necessary  to 
apply  the  caustic  solution  to  the  ulcer  three  times,  owing  to  the  thickness  of  the  slough,  which  was 
too  closely  attached  to  be  removed  by  spatula  or  forceps.  Its  action  here  seemed  to  correct 
the  fetor  at  once,  to  check  the  molecular  death,  and  to  change  the  hue  of  the  areola,  by  causing  a 
more  healthy  action  in  the  capillaries.  The  gnawing  burning  pain  was  relieved,  and  the  patient 
was  able  to  sleep  in  comfort.  The  absorption  of  the  virus  produced  in  the  ulcer  was  prevented  by 
its  destruction,  and  the  nervous  system  quickly  regained  its  tone.  I  will  conclude  this  brief  his 
tory  by  a  short  summary. 

u  Etiology. — This  disease  made  its  appearance  in  a  wooden  pavilion  containing  fifty  beds,  most 
of  them  occupied  by  very  seriously  wounded  men  unable  to  leave  the  building,  with  a  cubic  capa 
city  of  1050  feet  to  each  bed,  heated  by  ordinary  radiating  coal-stoves,  devoid  of  any  system  of  ven 
tilation,  and  having  no  ingress  for  pure  air  nor  egress  for  foul,  except  through  the  windows  and 
doors.  This  want  of  pure  air  was  combined  with  a  want  of  strict  police  and  a  careless  and  unscien 
tific  method  of  dressing  the  wounds,  rancid  ointments  being  largely  used  instead  of  the  ordinary 
water  dressing.  No  case  of  gangrene  was  received  as  such  into  the  hospital,  nor  is  it  probable 
that  it  was  otherwise  introduced.  Although  a  majority  of  the  cases  in  this  ward  escaped  gangrene, 
yet  there  was  evidently  some  depressing  agent  at  work,  since  but  few  wounds  healed  rapidly. 
The  patients  seemed  also  dispirited,  homesick,  and  moody.  Those  who  were  attacked  were  removed 
to  a  ward  in  the  brick  house,  where  they  were  isolated  and  at  the  same  time  placed  under  better 
hygienic  influences.  Two  shafts  for  foul  air,  connected  with  the  stoves,  which  withdrew  the  foul 
air  from  near  the  floor,  had  recently  been  placed  in  the  ward  by  order  of  the  Surgeon  General. 
This  was  not  considered  sufficient,  and  the  long  doors  of  these  foul-air  shafts  were  kept  constantly 
open.  Strict  attention  to  cleanliness  and  careful  dressing  was  enforced,  and  what  might  have  been 
a  very  severe  epidemic  was  confined  to  few  cases.  The  upper  row  of  windows  were  rehuug  in  such 
a  manner  as  to  direct  the  currents  of  cold  air  admitted  in  a  line  with  the  roof,  and,  to  crown  all, 
the  ridge  ventilation  was  applied  to  the  pavilion.  These  precautions,  and  an  improvement  in  the 
diet  of  the  house,  giving  more  vegetables  and  antiscorbutics,  enabled  me  to  prevent  any  further 
serious  manifestations. 

"There  were  three  other  wards  of  like  construction  with  Ward  No.  5,  but  two  of  them  were 
unoccupied  and  the  third  one  contained  fewer  and  less  serious  cases.  The  table  on  the  next  page 
indicates  that  of  the  nine  unmistakable  cases  reported,  eight  appeared  in  Ward  No.  5;  and  that  of 
these  eight,  five  occurred  on  the  west  and  three  on  the  east  side  of  the  ward.  Although  these  facts 
would  suggest  the  probability  of  inoculation,  yet  I  cannot  but  remember  that  there  were  at  least 
thirty-five  other  wounded  men  in  this  ward  who  escaped,  although  the  disease  had  been  in  exist 
ence  several  days  before  February  17th,  when  I  took  charge,  and  no  precautions  against  contagion 
had  been  employed.  I  shall  not  attempt  to  argue  here  the  long-disputed  point  of  contagion  or  non- 
contagion,  but  simply  state  it  as  the  result  of  my  observation  that  I  saw  no  well-marked  instance 
of  inoculation,  while  I  did  see  many  wounds  escape  this  influence  where  inoculation  was  not  only 
possible  but  probable.  Nor  was  it  necessary  to  invoke  the  aid  of  any  specific  virus,  since  the 

SURG.    Ill— 106 


842 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.   XII. 


TABLK  OLVJTT. 
Summary  of  Nine  Cases  of  Hospital  Gangrene,  showing  Date  of  Attack  and  Grade  of  Disease- 


NAMES.                                   WAKD.  '     SIDE. 

DATE  OF  ATTACK.     GKAUE  OK  DISEASE.     RESULT. 

TREATMENT. 

1     Otto  Kossack  

5 
o 
5 
3 
5 
5 
5 
1 
5 

West  
West  
"West  
East  

February  15,  1863. 
February  15,  1863. 
February  18,  1863. 
February  20,  1863. 
February  28,  1863. 
March  6,  1863  
February  27,  1863 
March  9,  1863  
April  14,  1863  

Ulceration  C  ured  . 
Sphocelus  Death    . 
Ulceration  Cured  .  . 
Ulceration,  mild  Cared  .  . 
Sphaeelus  Death  .  . 

Nitric  Acid. 
Nitric.  Acid. 
Nitric  Acid. 
Nitric  Acid. 
Nitric  Acid. 
Nitric  Acid. 
Nitric  Acid. 
Bromine. 
Bromine. 

5     J  f.T  1  Wick                                   

West  
West  
East  

Ulceiation  Cured  .  . 
Ulceration  Cured  .  . 

8     R  W  I'lummer      

Building  .  . 
East  

Ulceration  !  Cured  .  . 
Ulceration  •.  Cured  . 

9     Georire  Zilch 

NOTE. — Space  would  not  permit  to  give  the  details  cited  by  Dr.  Thomson  of  the  cases  of  Thurston,  Fossett,  Morrissey,  and  Plumuier, 
referred  to  in  this  table. 

unfavorable  hygienic  influences  which  had  surrounded  these  men  from  the  date  of  injury,  Decem 
ber  13th,  and  the  date  of  admission  into  hospital,  December  26th,  1862,  to  February  15th,  1863, 
were  sufficient  to  produce,  in  all  the  cases  treated  in  Ward  5,  a  well-marked  cachexia — neither 
scorbutus  nor  anaemia,  but  more  unmanageable  than  either,  and  due,  most  probably,  to  the  absence 
simply  of  fresh  pure  air  in  sufficient  quantities.  With  no  further  improvements  than  those  men 
tioned,  a  marked  change  for  the  better  took  place  in  the  other  inmates  of  this  ward.  Their 
wounds  became  healthy  and  healed  rapidly,  and  their  spirits  became  cheerful.  It  will  be  observed 
from  the  table  that  I  have  described  two  grades  of  hospital  gangrene,  the  one  mild,  generally  man 
ageable,  and  characterized  by  ulceration  or  molecular  death  of  the  tissues,  spending  itself  gen 
erally  in  the  subcutaneous  and  intermuscular  connective  tissue;  the  other,  more  rapid  in  its  course, 
more  fatal,  less  amenable  to  treatment,  and  distinguished  by  sphacelus  or  mortification  en  masse 
of  the  invaded  tissues.  It  will  be  seen  that,  of  the  nine  cases,  seven  are  described  as  ulceration 
and  two  sphacelus,  and  the  latter  both  fatal.  These  two  cases  last  mentioned  were  entirely  unin 
fluenced  by  the  treatment  employed.  The  rapid  invasion  and  advance  of  the  mortification,  and 
the  impossibility  of  reaching  it  with  nitric  acid  to  influence  it  locally,  left  but  little  to  do  but  to 
observe  its  profoundly  depressing  effect  on  the  vital  forces.  Bromine  may  prove  the  antidote  in 
such  cases,  but  its  virtues  were  then  unknown  to  me.  Treatment:  Recognizing  the  depressed 
condition  of  the  first  few  cases,  I  endeavored  to  remedy  it  by  giving,  at  short  intervals,  nutrients 
and  stimulants,  with  such  tonics  as  seemed  proper;  and  milk  punch,  alternating  with  beef  essence, 
porter  or  ale,  and  eggnog  was  at  first  given,  regardless  of  the  desires  of  the  patient.  The  citrate 
of  iron  and  quinine  with  sherry  wine  was  given  in  doses  of  6  to  10  grains  three  times  daily.  This 
system  was  found  injudicious,  since  it  overpowered  the  feeble  digestive  organs  and  caused  nausea, 
vomiting,  and  diarrhoea;  it  was  suspended,  and  four  drops  of  hydrochloric,  acid,  in  combination 
with  16  drops  of  tincture  of  opium,  were  given  every  three  hours.  Under  this  treatment  the  tongue 
became  moist  and  clean,  and  the  appetite  returned  sufficiently  to  cause  the  patient  to  ask  for  and 
enjoy  a  reasonable  quantity  of  food.  The  opium  was  given  to  allay  the  gnawing  pain  and  to  give 
rest  and  sleep,  as  well  as  to  obtain  any  specific  influence  over  the  disease  which  it  might  possess  as 
claimed  for  it  by  the  older  writers.  The  local  treatment  consisted  at  first  in  the  use  of  undiluted 
nitric  acid  freely  applied  to  the  entire  surface  of  the  ulcer.  The  table  indicates  the  success  of  that 
treatment.  Of  the  nine  cases,  all  were  treated  with  the  acid  in  the  early  stages..  Of  these,  two  were 
fatal  and  two  resisted  the  acid — or,  in  other  words,  in  four  cases  it  was  useless.  Of  these  four,  the 
two  fatal  cases  were  not  treated  otherwise,  while  the  other  two  were  treated  with  success  with 
bromine.  The  five  cases  treated  successfully  with  acid  are  marked  ulceratiou,  and  were  milder  than 
those  that  proved  fatal  or  those  that  were  treated  with  bromine  successfully.  The  dressing,  after 
the  use  of  the  acid,  was  an  antiseptic  wash,  either  creasote  or  liq.  sod.  chlor.  in  a  dilute  solution 
of  bromine  in  water  and  bromide  of  potassium,  proposed  by  Surgeon  Goldsmith,  U.  S.  V.  Two 
cases  were  treated  with  this  agent,  in  both  of  which  nitric  acid  had  failed.  One  of  these  would, 
doubtless,  have  proved  fatal,  while  the  other  was  progressing  rapidly,  although  the  acid  had  been 
used  several  times  without  benefit. 

"The  action  of  the  bromine  is  that  of  a  caustic,;    all  the  necrosed  tissues  are  converted  into 


CHAP.  XII.]  HOSPITAL    GANGRENE.  843 

tough  yellow  shreds  and  are  perfectly  deodorized.  The  ulceration  seems  to  be  checked  at  once, 
while  the  nervous  system,  no  longer  depressed  by  the  absorption  of  the  fetid  products  of  the  mor 
tification,  soon  recovers  from  its  depression.  The  areola  loses  its  livid  hue,  becomes  more  crimson, 
and  finally  disappears ;  the  sloughs  are  rapidly  thrown  off  and  a  rosy,  florid  surface  appears  beneath. 
The  bromine  was  also  used  in  the  form  of  vapor,  confined  to  the  surface  by  oiled  silk.  Its  antiseptic 
influence  is  very  powerful,  since  not  the  least  odor  could  be  perceived  oij  dressing  these  gangre 
nous  sores,  even  when  they  had  been  covered  closely  with  oiled  silk  for  twelve  hours.  From  its 
antidotal  efficacy  in  these  two  cases  I  have  formed  a  high  opinion  of  its  value  in  the  local  treatment 
of  this  disease. 

"  Microscopy. — The  discharges  from  several  of  these  cases  were  examined  to  ascertain  whether 
some  of  the  speculative  views  in  regard  to  the  presence  of  fungi  and  their  influence  in  producing 
the  disease  could  be  sustained,  but  no  fungi  were  found.  The  discharge  consisted  of  fluid,  granular 
matter,  and  debris.  The  connective  tissue  seemed  to  have  been  broken  down  into  unrecognizable 
granular  material.  The  fibrous  tissue  was  softened  and  easily  teazed  out,  and  in  the  muscular 
tissue  the  striated  appearance  was  lost  before  the  fibrous. 

"jSTo  evidence  of  textural  growth  was  found  in  the  discharges,  although  the  'piled  up'  and 
thickened  margins  of  the  ulcers  would  probably  reveal,  on  examination,  a  multiplication  of  the  con 
nective  tissue-corpuscles,  as  reported  in  a  similar  group  of  cases  at  Annapolis  by  Assistant  Sur 
geon  Woodward,  U.  S.  A.  Since  the  preceding  report  was  drawn  up  four  other  cases  of  hospital 
gangrene  have  been  observed,  occurring  sporadically,  and  treated  with  success  with  bromine. 
Their  clinical  histories  are  very  briefly  offered  for  consideration,  in  addition  to  those  already  sub 
mitted.  No  other  cases  have  occurred  in  this  hospital.  It  will  be  observed  that  three  of  these  four 
cases  were  fully  treated  with  pure  nitric  acid  without  benefit,  and  that  the  four  did  yield  event 
ually  to  the  local  application  of  bromine.  Where  that  remedy  has  required  heretofore  several 
repetitions,  it  would  now  be  used  more  energetically.  The  diseased  surface  would  be  thoroughly 
cleansed  of  all  sloughs  by  removing  those  portions  dead,  yet  tenaciously  adherent,  with  the  forceps 
and  scissors,  and  pure  bromine  would  be  freely  used  by  means  of  a  glass  pipette  or  a  syringe.  A. 
number  of  the  cases  reported  I  am  now  satisfied  would  have  proved  fatal  but  for  this  local  treat 
ment,  and  it  will  be  a  proud  satisfaction  to  Surgeon  Goldsmith  to  know  that  he  has  not  only  already 
been  instrumental  in  preserving  so  many  valuable  lives,  but  that  he  has  provided  the  military  sur 
geons  with  a  defence  against  one  of  the  most  deadly  and  obdurate  of  his  antagonists." 

Sporadic  cases  of  gangrene  had  occurred  in  the  hospitals  at  Memphis,  Tenn.,  in  May, 
1863,  and  during  the  latter  part  of  this  month  the  number  of  cases  increased  so  rapidly 
that,  on  June  19th,  an  order  was  issued  for  the  organization  of  Church  Hospital  for  the 
special  care  of  patients  afflicted  with  this  complication.  The  hospital  was  placed  under 
the  charge  of  Acting  Assistant  Surgeon  C.  H.  Cleveland,  whose  detailed  report  of  the  pro 
gress  and  treatment  of  the  disease  is  here  appended: 

"General  History :  Although  1  have  been  at  no  inconsiderable  pains  to  obtain  a  history  of 
hospital  gangrene  as  it  has  appeared  in  the  military  hospitals  of  this  city,  I  am  convinced  that  I 
have  been  unable  to  collect  all  the  facts  necessary  for  a  complete  history,  and  therefore  shall  con- 
tine  myself  mainly  to  such  as  fell  under  my  own  observation. 

"The  first  cases  of  this  disease  which  came  under  my  notice  were  those  of  Lieutenants  Albau, 
Dallmyer,  Letner,  and  Davis,  who  were  brought  to  Officers'  Hospital,  of  which  I  then  had  charge. 
They  were  received  from  the  hospital  boat  on  the  evening  of  May  27,  18G3,  and  each  had  gan 
grene  of  several  days'  standing  when  admitted,  and  were  expected  to  survive  but  a  few  hours.  In 
fact,  Lieutenant  Letner,  who  had  gangrene  of  the  stump  of  the  left  leg,  died  on  the  29th,  the  second 
day  after  admission.  Although  the  flaps  sloughed  away  from  the  stump  of  Lieutenant  Dallmyer 
so  as  to  leave  the  bone  uncovered  for  at  least  two  inches,  still,  the  periosteum  remained  vitalized. 
The  gangrene  was  quickly  arrested  by  the  application  of  Labarraque's  chlorinated  soda  solution, 
under  the  vigilant  care  of  Cadet  Randall,  who  attended  to  the  dressing  of  the  patient.  Granula 
tions  sprang  up  all  over  the  surface  of  the  bone,  a  tine  conical  stump  was  formed,  and  on  the  12th 
of  June,  about  a  fortnight  after  admission,  he  was  dismissed  on  leave  of  absence,  and  went  to  his 
Lome.  About  this  time,  and  later,  a  number  of  cases  occurred  in  the  different  hospitals,  but  their 


844  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

nature  was  not  always  understood  by  attendant  surgeons.  When  attention  was  especially  called 
to  this  disease  by  Surgeon  Irwiu,  Superintendent  of  Military  Hospitals  here,  cases  were  found  in 
the  Union  Hospital  to  the  number  of  twelve  (12)  June  25th;  and  soon  thereafter  at  the  Jackson, 
Gayoso,  and  Overtoil  hospitals.  The  surgeon  in  charge  of  Adams  Hospital  reports  the  case  of  a 
man  who  came  from  the  vicinity  of  Vicksburg  on  the  18th  of  February.  He  says  that  is  the  only 
case  which  has  occurred  in  that  hospital  this  year — a  statement  evidently  erroneous,  as  Corporal 
Fuller  was  sent  here,  from  there,  with  gangrene  of  right  ankle,  on  the  9th  of  August.  A  similar 
error  occurred  in  the  report  of  the  surgeon  in  charge  of  the  Webster  Hospital,  who  says  but  one 
case  has  occurred  in  his  hospital;  and  yet  he  has  sent  to  us  Privates  Alt,  McEvoy,  Cloud,  McClure, 
and  Butler,  all  with  unmistakable  gangrene.  From  the  Overtoil  Hospital  we  have  received  fif 
teen  (15)  patients,  and  how  many  more  have  had  the  disease  in  that  hospital  I  am  unable  to 
determine,  as  I  get  no  response  to  my  applications  for  information.  From  the  Jackson  Hospital 
we  have  received  eleven  (11)  patients;  but  from  that  hospital  also  have  been  unable  to  obtain  any 
further  information. 

"  Up  to  the  first  of  September  forty-six  (46)  patients  have  been  sent  to  us,  from  other  hospitals, 
having  gangrene,  which  I  have  reason  for  supposing  are  not  more  than  half  the  cases  that  have 
occurred  in  the  hospitals.  I  know  of  seven  (7)  cases  occurring  at  the  Officers'  Hospital  which  were 
retained  there  for  treatment,  as  we  have  no  special  accommodations  for  officers. 

"Not  only  have  there  been  manifest  errors  in  the  reports  from  different  hospitals  in  regard  to 
the  number  of  patients  who  have  had  gangrene,  but  the  date  of  its  appearance  has  been  incor 
rectly  reported.  Early  in  the  mouths  of  June  the  wards  of  Union  Hospital  were  filled  with  patients 
from  down  the  river,  and  immediately  Cadet  liandall  reported  to  me  that  gangrene  was  among 
them.  Surgeon  Irwin  states  that,  according  to  information  in  his  possession,  gangrene  appeared 
first  in  the  Union,  then  in  the  Jackson,  the  Gayoso,  and  the  Overton  hospitals;  and  his  order  for 
organizing  and  opening  Church  Hospital  was  issued  on  the  19th  of  June,  one  week  before  the 
disease  was  reported  to  have  appeared  in  Union  Hospital.  The  order  for  establishing  and  opening 
this  hospital  was  issued  on  the  19th  of  June;  yet,  owing  to  delays  in  the  Quartermaster's  Depart 
ment,  no  patient  was  received  until  the  30th  of  July,  and  the  two  days  of  that  month  are  included 
in  the  report  for  the  month  of  August.  During  its  organization  and  until  the  7th  of  August  I 
was  in  charge  of  this  hospital,  when  Surgeon  George  K.  Weeks  was  assigned  to  its  temporary 
charge  for  the  special  purpose  of  testing  the  use  of  bromine  in  the  treatment  of  gangrene.  Until 
Surgeon  Weeks  came  we  had  no  bromine;  one  ounce  had  been  furnished  to  the  hospital,  but  after 
the  dressers  had  used  it  once  it  unaccountably  disappeared.  After  that  time  reliance  was  placed 
mainly  on  the  local  use  of  Labarraque's  solution  of  chlorinated  soda  applied  in  its  full  strength, 
although  nitric  acid,  acetic  acid,  sulphate  of  zinc,  and  muriated  tincture  of  iron  were  used  in 
some  cases. 

"  The  favorable  result  which  followed  the  chlorinated  soda  preparation  in  the  case  of  Lieu 
tenant  Dallmyer  at  Officers'  Hospital  gave  me  considerable  confidence  in  it,  both  in  gangrene  and 
erysipelas,  which  confidence  is  shown  by  the  hospital  records  not  to  have  been  misplaced,  as  every 
case  of  erysipelas  sent  to  us  was  cured  by  it  alone  in  from  three  to  five  days.  Private  Samuel 
Arbothnot  was  sent  here  from  Jackson  Hospital,  with  gangrene  in  the  palm  of  the  left  hand,  July 
3()th,  and  was  returned  cured  of  the  gangrene  August  8th.  Robert  Graham  was  admitted  from 
Union  Hospital  on  the  31st  of  July,  with  gangrene  of  the  right  arm,  and  returned  with  no  vestige 
of  gangrene  remaining  on  the  4th  of  August.  Private  William  Goff  was  admitted  from  Union 
Hospital,  August  1st,  with  gangrene  of  the  right  leg,  and  returned  cured  August  4th.  Private 
T.  L.  Twiman  was  sent  here  from  the  Overton  Hospital  on  the  31st  of  July,  with  gangrene  of  the 
right  thigh,  and  returned  cured  of  gangrene  on  the  5th  of  August,  Private  Fred.  Louis  came  from 
Jackson  Hospital,  with  gangrene  of  the  right  hand,  on  the  30th  of  July,  and  was  returned  cured 
on  the  4th  of  August.  Other  similar  cures  have  followed  the  persistent  use  of  this  remedy  since 
that  date. 

"On  the  8th  of  August,  when  Surgeon  Weeks  took  charge  of  the  treatment,  he  brought  from. 
Surgeon  Irwin  five  ounces  of  pure  bromine,  which  supply  was  exhausted  on  the  16th  of  August, 
and  no  more  has  been  had  since.  On  the  20th  of  August,  Dr.  Warriuer,  agent  U.  S.  Sanitary 
Commission,  gave  to  the  hospital  five  bottles  of  Professor  J.  Lawrence  Smith's  compound  solution 


CHAP   xil.!  HOSPITAL    GANGRENE.  845 

of  bromine,  which  is  now  used  in  place  of  the  pure  article,  but  not  to  the  satisfaction  of  any  one 
connected  with  the  hospital,  it  evidently  being  by  no  means  equal  in  efficiency  to  the  bromine  in 
full  strength.  During  the  week  that  pure  bromine  was  applied  it  was  found,  as  the  records  show, 
that  usually  a  single  application  sufficed  to  completely  eradicate  the  gangrene.  In  cases  of  appar 
ent  failure  it  was  afterwards  found  that  there  were  some  parts,  deep  between  muscles,  under  the 
integuments,  or  in  sulci  or  sinuses,  which  the  bromine  did  not  reach.  While  we  had  no  bromine, 
and  also  when  we  had  only  the  Smith's  compound  solution,  we  found  it  mucli  more  difficult,  and  in 
some  cases  quite  impossible,  to  eradicate  the  disease,  mainly  from  the  impossibility  of  bringing  the 
remedies  directly  in  contact  with  the  entire  affected  surface.  Up  to  the  1st  of  September  forty-six 
(4G)  cases  of  genuine  hospital  gangrene  have  been  treated  in  this  hospital.  Of  that  number  thir 
teen  (13)  died,  but  none  directly  from  the  gangrene.  During  the  month  fifteen  (15)  have  been  cured 
and  transferred  to  the  hospitals  from  which  they  came.  Eighteen  (18)  still  remain  under  treatment, 
most  of  whom  are  entirely  free  from  gangrene,  but  are  not  restored  in  health  sufficiently  to  leave 
the  hospital.  Some  of  these  will  die  from  the  effects  of  gangrene  on  the  system. 

"Diagnosis. — Hospital  gangrene,  as  it  has  been  presented  to  us  at  this  hospital,  has  assumed  a 
great  variety  of  appearances.  In  the  earlier  stages  it  has  appeared  as  a  dusky,  almost  black,  mass 
of  dead  and  rotten  flesh,  occupying  the  seat  of  the  disease,  surrounded  by  a  reddish  ring  of  slightly 
swollen  integuments,  which  ring  varies  from  one  to  five  lines  in  breadth,  while  the  adjacent  tissues 
do  not  appear  to  be  affected  by  the  disease,  except  that  they,  as  well  as  the  whole  body,  contain 
less  heat  than  is  natural  in  healthy  structures.  Often  the  disease  has  burrowed  under  the  integu 
ments  bordering  a  wound,  and  when  the  skin  dies  it  loses  its  epidermis,  the  true  skin  becomes  red 
dish,  greenish,  purplish,  or  black.  When  a  surface  already  divested  of  its  skin  is  affected  with 
the  disease  (and  most  of  the  cases  at  this  hospital  are  truly  traumatic),  the  first  invasion  appears 
by  giving  to  the  surface  an  ashy-gray  color,  with  a  pultaceous  consistency,  and  the  peculiar  odor  of 
spoiled  meat,  by  which  the  disease  is  readily  recognized.  This  pultaceous  ashy  appearance  of  the 
surface  wounds  presents  itself  when  the  areolar  tissue  alone  is  attacked.  When  the  muscular  tissue 
becomes  affected,  and  when  small  blood-vessels  have  become  ruptured,  a  dark,  grumous,  almost 
black,  dirty  appearance  of  the  diseased  surface  is  presented,  accompanied  by  a  powerful  fetid 
odor,  and,  usually,  with  an  invasion  of  the  disease  under  the  skin,  and  between  muscles  and  ten 
dons  in  the  connective  tissues  much  beyond  the  boundary  of  the  disease  as  it  appears  on  a  superficial 
examination.  In  the  case  of  Private  Milseps,  who  was  wounded  at  Port  Hudson,  on  the  27th  of  May, 
with  a  inini6  ball  in  the  right  thigh  (the  ball  not  being  extracted  till  he  came  here),  the  disease 
burrowed  in  the  fascia  of  the  thigh  until  his  whole  thigh  appeared  gangrenous  in  the  deep-seated 
parts,  and  he  died  suddenly  from  arrest  of  circulation.  Post-mortem  examination  revealed  a  detached 
thrombus  in  the  left  auricle  of  the  heart,  plugging  up  the  artery,  which  weighed  four  hundred  and 
eighty-two  (482)  grains.  One  patient,  Private  T.  D.  Eiggs,  who  was  wounded  high  up  in  the  right 
calf  by  a  musket  ball,  at  Helena,  on  the  4th  of  July,  and  brought  here  on  the  31st,  had  the  disease 
following  down  the  tendon  to  the  os  calcis,  which  was  necrosed.  Although  the  entire  extent  of  the 
leg  was  laid  open  it  was  too  late  to  save  the  patient,  who  has  since  died  (Sept.  2d)  from  the  absorp 
tion  of  gangrenous  matter.  I  removed  from  his  thoracic  duct  a  thrombus  nearly  six  inches  in 
length.  These  two  cases  are  but  extreme  illustrations  of  the  tendency  of  the  disease  to  extend 
itself  in  the  areola  tissue,  along  plains,  and  between  more  solid  organs  and  structures.  But  muscles, 
vessels,  nerves,  tendons,  periosteum,  and  bone  are  often  invaded,  when  the  part  affected  turns  dark, 
emits  a  peculiar  (gangrenous)  odor,  dies,  softens,  and  finally  liquefies  when  not  removed  in  the 
form  of  slough  or  by  the  dresser's  instruments. 

"Preparation  of  Wound. — I  am  convinced  that  many  surgeons  have  failed  in  the  treatment 
of  hospital  gangrene  because  they  have  not  fully  perceived  the  necessity  of  thoroughly  cleansing 
the  wound  of  all  dead  and  diseased  matter  previous  to  the  use  of  any  local  application.  Private 
James  McEvoy.  who  was  wounded  at  Raymond,  on  the  12th  of  May,  and  had  his  right  arm  ampu 
tated  near  the  elbow,  had  gangrene  of  the  stump  about  the  20th  of  June,  and  was  sent  here  on  the 
10th  of  August,  with  a  statement  that  bromine  had  been  applied,  daily,  for  eight  days.  On  exami 
nation  it  was  found  that  there  were  at  least  two  -inches  in  extent  of  dead  structure  on  the  end  of 
the  stump,  and  the  bromine  had  been  applied  to  that,  and  not  to  the  live  tissue.  All  the  dead  and 
dying  structures  were  carefully  dissected  from  the  surface  of  the  stump,  removing  a  large  quantity 


846  WOUNDS   AND    COMPLICATIONS.  (CHAP.  xn. 

of  putrescent  matter,  and  then  bromine  in  full  strength  was  cautiously  applied  to  the  entire  surface, 
and  the  disease  was  at  once  arrested.  He  remained  ten  days,  and  then  was  returned  to  Webster 
Hospital. 

"When  patients  are  first  brought  here  it  is  often  necessary  to  place  them  under  the  influence 
of  chloroform  while  their  wounds  are  being  prepared,  and  obtund  the  pain  caused  by  the  remedies 
applied;  aud  afterward  it  is  not  refused  them  if  the  dressing  is  likely  to  be  very  painful.  The 
wound  is  washed  by  means  of  a  stream  of  water  projected  from  a  syringe;  all  the  pultaceous  and 
gangrenous  matter  removed  with  soft  cloths;  the  more  tenacious  diseased  portions  taken  away 
with  forceps,  the  scissors,  and  scalpel ;  and  finally,  all  blood,  water,  moisture,  aud  semi-fluid  mat 
ters  under  the  skin,  or  between  muscles  or  tendons,  are  removed  with  a  little  swab  made  by 
winding  a  strip  of  soft  cloth  around  a  stick.  .  If  the  disease  has  burrowed  under  the  skin  it  is  better 
to  at  once  open  up  all  such  retreats,  as  well  as  to  carefully  pare  off  the  diseased  portions  of  the 
skin  on  the  edges  of  the  wound,  that  the  agent  applied  may  come  directly  in  contact  with  the 
vitalized  structures  in  the  parts  affected.  If,  through  carelessness  or  oversight,  this  thorough 
preparation  of  the  wound  is  not  attended  to,  the  progress  of  gangrene  is  not  likely  to  be  stayed 
whatever  the  remedy  applied. 

"Soapsuds  as  a  wash  does  not  answer  for  gangrenous  ulcers  as  well  as  pure  warm  water.  It 
appears  to  combine  with  the  fluids  of  the  surface,  producing  a  slimy  mixture  which  it  is  difficult  to 
remove.  A  diluted  solution  of  Labarraque's  chlorinated  soda  has  been  found  to  answer  admirably 
in  these  cases,  for  when  applied  in  a  gentle  stream  from  a  syringe  it  can  be  made  to  penetrate  into 
all  the  recesses  of  the  disease,  destroying  all  odor  and  dissolving  aud  removing  some  of  the  dead 
matter  attached  to  the  surface  of  the  ulcer.  At  about  the  strength  of  sea  water  it  seems  to  prop 
erly  stimulate  the  structures  as  well  as  cleanse  them.  An  ordinary  hard-rubber  syringe  with  the 
little  swabs  (already  described)  have  been  found  preferable  to  sponges  or  cloths  for  cleansing  ten 
der  and  delicate  surfaces. 

"Local  Applications. — Any  substance  which  has  the  chemical  power  of  decomposing  the  specific 
virus  of  gangrene  so  that  it  no  longer  exists  as  gangrene  must  possess  the  property  of  a  curative 
agent  in  this  disease,  provided  it  can  be  brought  in  sufficient  quantities  in  direct  contact  with  every 
atom  of  gangrene  matter;  and  provided  also  that  it  does  not  possess  sufficient  power  to  overcome 
and  destroy  the  vitality  of  such  still  vitalized  structures  and  tissues  as  we  wish  to  preserve.  We 
have  made  trial  of  nitric  acid  until  we  have  become  satisfied  of  three  things  iu  regard  to  it:  It 
will  destroy  all  gangrenous  matter  with  which  it  is  brought  in  contact  in  its  full  strength.  It  is, 
however,  extremely  difficult  in  many  cases  to  apply  it  in  full  strength,  as  in  sinuses  and  sulci,  where 
the  moisture  in  those  parts  may  so  dilute  it  as  to  render  it  inefficient.  It  is  unsafe,  as,  if  brought 
in  contact  with  the  fine  tissues,  nerves,  vessels,  periosteum,  or  bone,  it  is  almost  certain  to  cause 
destruction  to  the  parts  and  produce  irreparable  injury. 

"Sulphate  of  zinc  in  solution  does  not  appear  powerful  enough  to  arrest  the  disease  in  many 
instances.  Acetic  acid  has  not  been  applied  in  a  sufficient  number  of  cases  to  have  led  to  any  posi 
tive  conclusion.  The  same  may  be  said  of  the  solution  of  the  chloride  of  zinc.  The  muriated 
tincture,  as  well  as  the  solution  of  the  persulphate  of  iron,  have  both  been  used,  but  principally 
on  bleeding  surfaces  and  to  check  haemorrhage  from  ruptured  vessels;  and  while  they  may  have  a 
curative  power,  such  property  has  not  been  so  manifest  as  to  give  us  much  confidence  in  them  as 
arresters  of  gangrene. 

"Labarraque's  chlorinated  soda  solution  has  proved  quite  efficient,  applied  in  its  full 
strength,  as  an  arrester  of  gangrene.  In  all  cases  where  the  liquid  could  be  thoroughly  applied 
to  all  of  the  affected  parts,  one,  or  at  most  two  or  three,  applications  appeared  to  eradicate  the 
disease.  But  it  could  not  always  be  applied  to  deep-seated  parts,  or  within  sulci,  without  becom 
ing  diluted  with  the  fluids  already  there,  aud  so  much  of  the  solution  seemed  to  be  demanded  that 
it  was  liable  to  flow  beyond  the  ulcer  and  the  healthy  skin  be  blistered  by  it.  But,  during  nearly 
one-half  the  time  this  hospital  has  been  open,  we  have  placed  our  main  reliance  on  this  agent,  and 
our  confidence  has  not  been  shaken.  In  all  cases  of  ulceration,  where  no  gangrene  remains,  we 
wash  the  surface  once  or  twice  a  day  with  this  solution,  diluted,  and  saturate  the  dressings  with  it 
as  often  as  they  get  dry,  or  once  in  two  hours,  and  are  well  pleased  with  the  result. 

"Bromine  in  its  full  strength,  however,  is  the  agent  which  has  given  us  the  most  satisfaction. 
This  does  not  appear  caustic  enough  to  destroy  healthy  tissues,  but  is  of  sufficient  strength  to 


CHAP,  xii.]  HOSPITAL    GANGRENE.  847 

unite  with  arid  change  all  the  parts  affected  with  disease.  Of  course  a  few  drops  will  uot  unite 
with  or  change  a  large  amount  of  gangrenous  material,  but  in  all  cases  under  my  observation 
where  the  dead  matter  had  been  properly  dissected  away  and  the  wound  cleansed  of  its  pultaceous 
and  other  dead  matter  with  the  syringe,  the  forceps,  and  the  swabs,  and  the  surface  dried  with 
soft  cloths,  one  application,  or  at  most  two  or  three,  has  obliterated  all  traces  of  gangrene  and 
left  the  wound  a  simple  ulcer.  As  has  been  observed,  the  wound  must  be  thoroughly  and  carefully 
prepared  before  the  bromine  is  applied.  Even  if  all  other  necessary  conditions  are  complied  with, 
should  moisture  be  allowed  to  remain  in  the  deeper  parts  of  the  sore,  that  moisture  may  so  dilute 
the  bromine  as  to  render  it  inefficient,  or  it  may  protect  the  subjacent  parts  from  the  remedy,  and 
a  point  of  gangrene  will  remain  to  infect  the  whole  sore.  Bromine  can  be  conveniently  applied  by 
means  of  little  swabs,  like  those  used  in  cleansing  the  wound.  First,  there  should  be  prepared  and 
at  hand  a  cloth  spread  with  simple  cerate,  large  enough  to  more  than  cover  the  affected  surface. 
The  ulcer  should  be  cleansed  and  dried,  and  then  an  attendant,  standing  near  the  patient,  holds 
the  phial  of  bromine,  from  which  he  removes  the  stopper  just  long  enough  to  allow  the  surgeon  to 
insert  into  it  a  little  swab,  saturating  it  with  the  bromine,  which  is  at  once  applied  to  the  ulcer. 
This  operation  is  to  be  repeated  until  all  parts  of  the  sore  are  touched  with  the  bromine;  and  to 
parts  beyond  the  reach  of  the  swab  bromine  should  be  injected  by  means  of  a  glass  P.  P.  syringe, 
when  the  sore  should  be  immediately  covered  with  the  cerated  cloth  to  prevent  evaporation  of 
bromine  and  to  protect  the  ulcer  from  the  atmosphere.  Then  the  part  may  be  dressed  with  cloths 
and  bandages  the  same  as  for  simple  sores. 

"The  pain  which  attends  and  follows  the  application  of  bromine  is  quite  severe,  but  not  more 
severe  nor  of  longer  continuance  than  follows  the  application  of  milder  agents.  The  sense  of  pain 
appears  even  somewhat  obtunded  by  the  action  of  it,  and  after  a  short  time  patients  express  them 
selves  as  being  much  easier  than  they  have  been  for  days. 

"To  surgeons  and  attendants  bromine,  when  incautiously  used,  proves  very  disagreeable,  and 
this  fact,  doubtless,  has  prevented  its  use  in  many  cases.  If  the  vapor  of  bromine  is  allowed  to 
come  in  contact  with  the  eyes  and  air  passages  such  parts  suffer  severely  from  irritation  for  several 
minutes,  then  all  unpleasant  effects  pass  away.  But,  with  proper  precaution,  these  parts  need  not 
be  exposed  to  the  vapor,  and  ten  or  twenty  patients  may  have  bromine  applied  to  them  in  a  morning 
without  much  discomfort  to  the  surgeon. 

"Whatever  agent  is  applied  to  a  gangrenous  surface  it  does  not  appear  desirable  to  disturb 
the  dressing  more  than  once  a  day.  When  bromine  is  used  it  is  usually  necessary  to  wait  two  or 
three  days  for  the  surface  of  the  sore  to  become  thoroughly  cleansed  before  it  is  again  resorted  to; 
but  if  there  remains  a  decidedly  gangrenous  odor  on  the  second  day,  or  if  it  appears  at  any  future 
time,  the  parts  should  be  carefully  examined  and  bromine  applied  to  all  affected  surfaces.  Gan 
grene  can  be  detected  by  the  trained  sense  of  smell  more  readily  than  in  any  other  way,  and  for 
several  days  after  the  disease  has  disappeared  wounds  should  be  examined  in  this  manner,  as  well 
as  by  the  eye,  and  all  appearance  of  taint  followed  to  its  source  and  the  disease  eradicated. 

"On  the  second  day,  usually,  after  bromine  has  been  applied  the  surface  of  the  ulcer  looks 
dark  and  charred;  on  the  third  day  the  dead  portions  begin  to  liquefy;  and  the  fourth  day  the 
surface  appears  studded  with  healthy  granulations.  After  the  gangrene  is  subdued  the  wounds 
are  dressed  as  simple  ulcers,  but  in  most  cases  the  dilute  chlorinated  soda  solution  is  constantly 
applied,  both  as  a  slight  stimulant  to  the  newly  formed  tissues  and  to  protect  it  from  the  virus 
which  may  be  in  the  atmosphere  of  the  hospital.  I  have  made  considerable  use  of  oakum,  wet 
with  a  solution  of  chlorinated  soda  or  of  the  chloride  of  lime,  to  gangrenous  ulcers  the  day  after  the 
application  of  bromine,  and  to  the  ulcer  after  the  wound  is  freed  from  gangrene,  and  am  satisfied 
that,  in  general,  it  is  preferable  to  lint.  It  is  easy  of  application,  readily  absorbs  the  excretions, 
and  is  easily  removed  when  the  wound  again  requires  dressing.  A  very  convenient  way  of  apply 
ing  moisture  to  the  sore  is  by  means  of  a  hard-rubber  syringe.  The  solution  may  be  drawn  into  the 
syringe,  the  pipe  of  which  can  readily  be  inserted  under  the  bandage  and  the  liquid  applied 
directly  to  the  oakum,  filling  and  covering  the  ulcer  and  moistening  the  entire  dressing.  The  com 
pound  solution  of  bromine  has  been  extensively  used  by  us  since  our  stock  of  pure  bromine  became 
exhausted,  but  we  do  not  consider  it  a  good  substitute.  It  does  not  appear  to  be  active  enough  to 
readily  destroy  the  gangrene.  It  has  been  applied  day  after  day  carefully,  thoroughly,  and  faith 
fully,  with  the  swab  and  the  syringe,  into  parts  where  the  gangrene  has  burrowed  under  fascia  and 


848  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

along  tendons,  as  it  is  very  apt  to  do,  and  directly  to  the  walls  of  such  extensions,  when  they  have 
been  laid  open,  by  means  of  pledgets  of  lint  saturated  with  it,  as  well  as  in  the  same  manner  to  the 
original  ulcer,  and  yet  we  have  sometimes  failed  for  days  to  arrest  the  disease.  I  have  made  careful 
trial  of  both  the  compound  solution  of  bromine  and  Labarraque's  solution  of  chlorinated  soda,  and 
cannot  discover  that  the  bromine  preparation  possesses  any  valuable  properties  which  the  chlori 
nated  soda  has  not.  Both  destroy  the  disease  when  applied  to  it,  but  the  compound  solution  of 
bromine  causes  more  pain,  does  not  appear  to  be  any  more  active  than  the  chlorinated  solution  in 
full  strength,  and  very  readily  loses  its  bromine  by  evaporation  if  not  quickly  and  cautiously 
covered  with  a  cerated  cloth. 

"Pure  unadulterated  bromine  seems  to  possess  special  properties  which  entitle  it  to  more 
confidence  than  any  other  agent  with  which  we  are  acquainted.  The  liquid  readily  vaporizes  in 
the  atmosphere  and  the  vapor  is  easily  absorbed  by  fluids.  The  vapor  when  brought  in  contact 
with  the  odoriferous  emanations  of  gangrene  at  once  destroys  their  odor,  and  probably  their  spe 
cific  gangrenous  character.  When  thoroughly  applied  in  sufficient  quantity  to  a  gangrenous  sore 
it  at  once  obliterates  all  gangrenous  odor,  and  no  gangrene  appears  afterward,  unless  the  wound 
receives  new  infection.  Its  ready  vaporization  permits  its  application  to  the  bottom  of  sinuses  and 
sulci  which  cannot  safely  be  laid  open  with  the  knife,  and  which  are  very  common  in  the  patients 
of  this  hospital;  its  prompt,  almost  instantaneous,  action  precludes  the  necessity  for  a  prolonged 
use  of  the  remedy;  while  sufficient  experience  in  its  use  shows  that  it  may  be  applied  directly  to 
the  covering  of  a  nerve,  or  the  periosteum,  without  destroying  their  vital  integrity. 

"  Contagiousness. — Hospital  gangrene  is  produced  by  infection  upon  an  exposed  surface. 
Several  cases  have  come  to  us  with  the  disease  following  the  application  of  a  blister.  It  has  also 
appeared  in  bed-sores.  One  case,  where  the  arm  had  been  broken,  badly  adjusted,  and  splints 
caused  abrasion,  gangrene  followed.  A  man  acting  as  nurse  to  his  captain  who  had  gangrene, 
had  small  spots  of  inflammation  on  his  ankle,  caused  possibly  by  mosquito  bites,  which  he  had 
rubbed  the  skin  from;  he  also  had  little  scratches  on  his  fingers;  gangrene  set  in  at  all  these  points, 
and  he  may  yet  lose  his  life  as  the  result.  In  Officers'  Hospital,  an  officer  with  gangrene  occupied 
a  room  alone;  the  carpenters  wished  to  put  a  water-pipe  in  it,  and  he  was  removed  to  a  room  in 
which  were  three  other  officers  with  wounds  not  then  gangrenous;  all  four  had  their  wounds 
exposed  and  dressed,  and  the  gangrenous  odor  pervaded  the  apartment.  Although  the  officer  was 
returned  to  his  own  room  in  an  hour,  the  next  day  gangrene  appeared  in  the  wounds  of  the  three 
others  who  had  been  exposed  to  the  infection. 

"Instances  have  occurred  in  this  hospital  where  wounds  which  had  been  free  from  gangrene 
for  several  days  became  again  diseased,  and  doubtless  from  renewed  infection  received  from  others 
laboring  under  the  disease.  To  guard  against  infection  we  have  made  free  use  of  chlorinated  soda, 
chloride  of  lime,  a  solution  of  the  permanganate  of  potassa,  chlorinum,  and  bromine,  and  the  most 
scrupulous  cleanliness  and  free  ventilation.  Each  patient  is  supplied  with  his  own  drinkiug-cup 
and  other  utensils,  and  his  own  sponges ;  if  he  has  two  wounds  and  only  one  is  gangrenous,  each 
wound  has  its  sponge,  and  all  are  kept  as  clean  as  possible.  If  the  nurses,  dressers,  or  surgeons 
have  wounds  or  abrasions  on  their  hands,  bromine  is  applied  and  their  hands  exposed  to  the  virus 
without  fear.  In  cleaning  a  very  bad  gangrenous  sore  the  scissors  were  found  to  be  dull,  and  while 
sharpening  them  I  cut  out  the  ball  of  my  left  fore-finger;  I  applied  bromine,  and  the  wound  healed 
kindly  and  readily.  Nearly  every  day  I  have  had  either  cuts,  pricks,  scratches,  or  other  abrasions 
on  my  hands,  which  are  freely  exposed  in  dressing  the  wounds  and  in  the  dead-house,  with  no 
unpleasant  consequences.  I  have  always  applied  bromine  to  the  denuded  surface  before  exposure, 
and  am  convinced  that  the  virus  of  the  dead-house,  as  well  as  other  animal  poisons,  is  entirely 
destroyed  by  the  action  of  bromine. 

"General  Treatment. — The  constitution  seems  to  require  much  more  than  the  ordinary  amount 
of  nutriment  in  this  disease,  and  it  is  only  after  considerable  poison  has  been  absorbed,  and  the 
heart  and  lungs  have  become  affected,  that  digestion  and  assimilation  are  deranged.  It  is  true 
that  the  temperature  of  the  entire  body  is,  almost  invariably,  below  the  normal  standard.  During 
the  mouth  of  August  the  thermometer  ranged,  in  the  wards  of  this  hospital,  at  2  o'clock  P.  M.,  at 
from  98°  to  103°,  and  yet  the  average  temperature  of  the  patients  at  the  same  hour,  as  indicated 
by  the  thermometer  in  their  axillae,  was  but  89°.  The  average  daily  temperature  of  Sergeant 


CHAP.  XII.]  HOSPITAL    QANQEENE.  849 

Wilkie,  who  died  from  pyaemia  after  secondary  haemorrhage,  was  only  74°;  and  that  of  Private  T. 
D.  Riggs,  who  had  gangrene  of  the  right  calf  extending  down  the  tendon  to  the  heel  bone,  was 
only  84°.  The  pulse  of  the  former  averaged  114.  the  latter  88  beats  in  a  minute.  This  low  state 
of  temperature  led  us  to  very  free  use  of  alcohol  in  the  various  forms  of  ale,  porter,  whiskey,  and 
brandy,  usually  given  once  in  two  hours,  and  as  much  nutriment,  beef,  eggs,  etc.,  as  the  patient 
would  take.  A  very  marked  desire  for  acids  prevailed,  which  was  gratified  by  giving  pickles, 
citric  acid  drinks,  and  acid  fruits.  After  the  disease  had  progressed  to  the  serious  invasion  of  the 
general  system  (and  most  of  our  patients  were  old  cases,  brought  from  other  hospitals)  a  very  per 
sistent  diarrhoea  was  common,  and  that  was  about  the  only  condition  that  demanded  active  medica 
tion.  We  carefully  avoided  the  use  of  cathartics  and  opium,  and  as  a  soother  to  nervous  and  febrile 
excitement  used  Hoffman's  anodyne.  In  some  cases,  distinctly  complicated  with  miasma,  (and 
many  of  the  patients  came  from  the  vicinity  of  Vicksburg,  where  they  had  been  exposed  for 
months),  we  gave  sulphate  of  quiniae — one  or  two  doses  of  ten  grains  each  were  usually  sufficient. 

"  Conditions  favoring  the  appearance  of  Gangrene. — While  no  certain  cause  for  the  disease 
except  contagion  has  been  determined,  it  is  evident  that  a  depression  of  the  vital  forces  has  been 
favorable  to  its  accession.  Fourteen  (14)  out  of  forty-six  (46)  cases  of  our  patients  were  secession 
prisoners,  and  I  think  that  all  the  seven  at  Officers'  Hospital  were  also  prisoners — a  much  larger 
number  than  a  fair  proportion,  proving  that  exposure,  privation,  and  a  consequent  depression  of 
vital  forces  is  a  condition  favoring  the  appearance  of  the  disease. 

"Post-mortem  Appearances. — The  tables  compiled  from  the  hospital  records,  and  the  reports 
of  individual  cases  furnished  by  Cadets  Gunn  and  Lloyd,  together  with  the  learned  and  able  report 
on  the  pathology  of  the  disease  by  Surgeon  Weeks,  who  has  had  unusual  opportunities  for  the 
study  of  gangrene  at  Louisville,  Vicksburg,  and  this  place,  obviate  the  necessity  of  extended 
remarks  on  this  branch  of  the  subject.  With  one  or  two  exceptions  we  have  made  examinations 
in  every  fatal  case  and  have  observed  a  very  uniform  set  of  conditions.  In  all  we  have  found 
thrombi  in  the  heart,  some  of  which  have  been  very  large.  In  one  we  found  a  thrombus  in  the 
thoracic  duct,  and  I  regret  that  we  did  not  examine  that  passage  in  the  preceding  cases.  In  one 
case  of  long  standing  the  heart  thrombus  was  softening,  and  the  walls  of  the  heart  were  tainted 
with  gangrene.  In  another  case,  where  the  disease  was  of  still  longer  duration,  the  heart  thrombus 
was  considerably  broken  down  and  liquefied,  and  the  walls  of  the  heart  very  much  softened,  flabby, 
and  decidedly  gangrenous.  The  lungs  in  every  case  were  spotted  with  dark  specks,  and,  being  cut 
into,  it  was  found  that  the  smaller  arteries  were  often  filled  with  thrombi  and  dark  matter,  evidently 
the  debris  which  had  been  washed  away  from  a  thrombus  in  the  heart  and  become  lodged  in  the 
smaller  vessels.  The  disease  in  this  case  was  unusually  malignant  and  rapid.  In  no  case  have  I 
perceived  any  collection  of  pus  or  softening  of  matter,  such  as  is  said  to  have  been  observed  in  the 
lungs  of  those  who  have  died  of  gangrene  elsewhere. 

"Curability  of  Gangrene. — This  disease,  like  syphilis  in  its  earlier  stages,  seems  to  be  entirely 
local,  and  completely  curable  when  the  parts  affected  are  not  vital  organs,  which  has  never  been, 
primarily,  in  any  case  coming  under  my  observation,  and  when  all  the  parts  affected  can  be  reached 
by  direct  application  of  the  remedy.  But  the  secondary  affections,  as  the  thrombi  in  the  heart,  the 
pulmonary  complications,  and  the  change  in  the  fluids,  which  is  sometimes  called  pyaemia,  are  con 
ditions  which  do  not  seem  controllable  by  remedies.  We  have  often  had  cases  recover  after  the 
heart,  the  lungs,  and  the  blood  had  become  seriously  implicated.  But  gangrene  can  be  considered 
certainly  curable  only  in  cases  where  the  system  has  not  become  seriously  affected  by  disease.  In 
all  simple  cases  gangrene  seems  as  curable  as  a  burn,  scald,  or  any  other  serious  wound. 

"General  Treatment. — No  remedy  has  yet  been  presented  to  us  that  has  apparently  any  marked 
or  positive  curative  power  over  the  constitutional  and  organic  derangements  produced  by  the 
absorption  of  the  poison  of  gangrene.  We  saturate  the  air  of  the  wards  of  this  hospital  with 
chlorine,  and  we  have  given  bromine  internally  for  days  and  weeks;  and  while  we  do  not  know  of 
a  certainty  that  this  course  has  proved  beneficial  to  our  patients,  we  should  hesitate  to  deprive 
them  of  even  the  possible  benefits  arising  therefrom.  Pure  air,  full  nutrition,  alcoholic  prepara 
tions  repeated  as  often  as  once  in  two  hours,  hope,  cheerfulness,  and  immediate  removal  of  all 
causes  of  distress  and  fretfuluess  (for  gangrenous  patients  are  very  childish),  with  perfect  cleanli 
ness  of  the  bed  and  the  person,  seem  preferable  to  any  form  of  perturbative  medication." 
SURG.  Ill— 107 


850  WOUNDS    AND    COMPLICATIONS.  [CHAP.  XII. 

The  largest  number  of  cases  of  gangrene  (1,611)  occurred  in  1864,  when  the  terrible 
battles  of  Grant  in  Virginia,  and  of  Sherman  in  Georgia,  filled  the  hospitals  to  overflow- 
ino--  but  the  disease  seems  to  have  lost  its  terror  to  the  medical  officers.  The  cases  were 

o  ' 

quickly  isolated  in  hospitals  or  wards  specially  assigned  to  this  purpose,  and  under  the 
various  treatments  described  in  the  preceding  pages  the  larger  proportion  of  the  cases  were 
brought  to  successful  terminations.  The  proportion  of  cases  of  gangrene  to  the  number  of 
troops  engaged  or  to  the  wounded  treated  in  hospitals  during  the  six  months  of  1865  was 
very  small,  only  one  hundred  and  thirty-five  (135)  being  found  recorded  on  the  registers. 
Illustrations  of  hospital  gangrene  will  be  found  on  the  plates  opposite  pp.  739  and  928  of 
the  Second,  and  on  PLATE  XXVII,  opposite  p.  53,  of  the  Third  Surgical  Volume. 

Instances  of  Dry  Gangrene,  the  result  of  shot  injuries,  were  rare.  A  case  of  this 
nature  has  been  detailed  on  page  310  of  this  volume  (Case  of  E.  Green),  and  another  (Case 
of  H.  Strauss)  has  been  referred  to  in  Note  2,  on  page  351  of  the  Second  Surgical  Volume. 
The  appearance  of  the  feet  in  the  latter  case  is  shown  in  the  chromo-lithograph  opposite. 
In  these,  as  well  as  in  the  following  seven  instances,  the  gangrene  was  due  to  impaired 
arterial  circulation : 

CASE  1209. — Private  W.  Steel,  Co.  G,  70th  New  York,  aged  26  years,  was  wounded  in  the  left  leg,  at  Manassas  Gap, 
July  23,  1863,  and  entered  Lincoln  Hospital,  Washington,  one  week  afterwards.  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  recorded 
the  following  description  of  the  injury :  "  The  ball  struck  on  the  outer  side  of  the  leg,  passing  in  a  straight  line  inward  through 
the  upper  part  of  the  belly  of  the  gastrocnemina,  and  coming  out  on  the  inner  side  of  the  calf.  The  bleeding  was  copious. 
Immediately  after  the  reception  of  the  wound  the  man  experienced  a  severe  pain  in  the  ankle  and  was  totally  unable  to  walk, 
only  dragging  the  limb  after  him.  When  admitted  into  Lincoln  Hospital  the  foot  had  become  bluish,  which  appearance  the 
patient  stated  had  come  on  two  days  previously.  The  pain  in  the  ankle  passed  off  the  first  evening,  but  when  the  blueness  com 
menced  the  pain  reappeared  and  continued  to  increase  in  severity  until  the  date  of  amputation.  The  color  of  the  foot  was  that  of 
bluish  stone,  but  not  shrivelled,  the  toes  being  of  a  deeper  hue  than  the  rest.  This  appearance  gradually  increased  up  to  the 
ankle,  and  then  ran  up  posteriorly  to  the  lower  third  of  the  leg.  Amputation  through  the  wound  was  performed  by  flap  method 
on  August  3d.  After  the  operation  the  constitutional  symptoms,  such  as  pale  and  tremulous  tongue,  quick  and  feeble  pulse,  con 
tinued  about  the  same.  The  flaps  were  pale  and  rather  flabby,  but  not  gangrenous.  A  diarrhoea  set  in,  which  was  checked  by 
August  25th ;  appetite  capricious.  By  October  20th  had  entirely  recovered,  the  stump  having  healed  without  exfoliating  any 
bone."  On  January  30,  1884,  the  patient  was  discharged  from  service  and  pensioned,  and  subsequently  he  was  furnished  with  a 
"Palmer"  artificial  leg.  In  his  application  for  commutation  the  pensioner  describes  the  stump  as  being  in  a  healthy  condition. 
He  was  paid  December  4,  1880.  A  representation  of  the  gangrenous  limb  is  given  in  PLATE  LXXIX,  opposite  p.  818. 

CASE  1210. — M.  A.  Gammel,  Co.  G,  Arkansas  Kegiment,  aged  23  years,  wounded  at  Antietam,  September  17,  1862,  by  a 
fragment  of  shell  just  above  left  ankle.  Leg  was  amputated  about  two  weeks  afterwards.  On  October  28th  he  was  admitted 
into  hospital  at  Frederick,  Maryland.  Patient  suffered  from  a  large  bed-sore,  and  sloughing  of  the  flaps  allowing  the  bones  to 
protrude;  he  had  also  a  violent  diarrhoea.  These  complications  were  alleviated  by  treatment,  but  his  general  condition  continued 
very  poor;  the  discharge  from  the  stump  became  thin,  watery,  and  dark  colored.  On  December  2d  dry  gangrene  set  in,  in  the 
great  toe  of  the  right  foot  and  also  in  the  second  toe.  Pulse  very  feeble  and  rapid.  General  condition  bad.  December  4th : 
Gangrene  involved  all  the  toes ;  no  constitutional  symptoms  developed ;  strength  vei-y  feeble.  The  patient  died  December  5,  1862. 

CASE  1211. — Private  Charles  Hanford,  Co.  I,  14th  Ohio,  was  wounded  at  Chickamauga,  September  19,  1863.  The  mis 
sile  entered  over  the  anterior  border  of  the  sterno-mastoid  of  the  right  side  opposite  the  larynx,  passed  backward  and  inward, 
striking  the  spine  and  comminuting  its  processes  at  that  point.  Another  ball  passed  through  the  right  hand  at  the  middle  of  the 
carpo-metacarpal  articulation.  A  few  spicula3  were  removed  from  the  wound  in  the  neck.  He  was  admitted  on  September  30th 
into  the  hospital  at  Chattanooga,  Tennessee.  There  was  complete  paralysis  of  the  lower  extremities  and  of  the  right  arm ; 
unpromising  case.  Simple  dressings  were  applied  and  anodynes  given.  October  3d  :  Large  slough  of  skin  on  dorsal  aspect  of 
left  foot;  dry  gangrene  of  toes  of  same  side.  No  other  change.  Right  carotid  seen  pulsating  through  wound ;  little  reduction 
of  general  heat  of  body.  No  trace  of  motion  in  extremities  and  right  arm  ;  slight  in  leg,  but  being  pricked  with  a  pin  said  it 
was  water  falling  on  the  part.  October  6th  :  Motion  slight  in  both  extremities  and  right  arm  ;  sensibility  increased  ;  can  detect 
pricking  in  leg  and  feet.  Gangrene  of  toes  progressing  slowly;  ball  of  right  toe  involved;  right  hand  and  arm  swollen. 
Patient  died  October  6,  1863,  with  tetanic  symptoms. 

CASE  1212. — Walter  Hill,  freedman,  was  admitted  into  Freedmen's  Hospital,  Vicksburg,  Mississippi,  April  26,  1865,  with 
a  gunshot  wound  of  the  left  leg,  accidentally  inflicted  on  April  15th.  A  conical  ball  entered  the  left  popliteal  space  and  lodged 
in  the  deep-seated  tissues  of  the  joint.  Simple  dressings  were  applied.  The  bullet  was  cut  out  on  April  26th.  Patient  died  May 
20,  1865,  of  chronic  diarrhoea  and  dry  gangrene  of  the  leg. 

CASE  1213. — Private  W.  J.  Logan,  Co.  K,  9th  Pennsylvania  Reserves,  aged  23  years,  received  a  shot  wound  of  the  left 
foot,  at  Bull  Run,  August  30,  1862.  The  bullet  entered  the  front  of  the  heel  and  passed  directly  upward  through  the  top  of  the 
foot.  Many  pieces  of  bone  were  extracted.  The  patient  was  discharged  from  service  at  Carver  Hospital,  Washington,  November 
5;  1862,  and  pensioned.  Dr.  John  Kirker,  of  Pittsburg,  reported,  April  15,  1870,  that  on  December  23,  1869,  he  "amputated  the 


DRY     GANGRENE      OF     THE      FEET 


CHAP,  xil.l  TEAUMATIO    ERYSIPELAS.  851 

V 

left  leg  at  the  junction  of  the  upper  and  middle  thirds  because  of  dry  gangrene  of  the  foot  produced  under  the  following  circum 
stances  :  He  received  a  gunshot  wound  of  the  foot  which  so  injured  it  as  to  compel  him  to  rest  chiefly  on  the  heel  in  walking, 
causing,  in  my  judgment,  aneurism,  which  gradually  developed  during  the  summer  of  1869.  Dr.  A.  M.  Pollock  operated  for 
aneurism  in  my  presence.  Dry  gangrene  resulted  from  impaired  arterial  circulation,  it  commencing  in  the  original  wound,  and 
had  involved  the  whole  foot  at  the  time  the  operation  of  amputation  was  performed."  The  pensioner  was  paid  in  June,  1876. 

CASE  1214. — Private  Peter  Mon,  Co.  E,  2d  Massachusetts,  aged  27  years,  Avas  wounded  at  Chancellorsville,  May  3, 1863. 
On  May  7th  he  was  admitted  into  Douglas  Hospital,  Washington.  A  minitS  ball  had  entered  the  internal  portion  of  the  calf  of  the 
right  leg,  lacerated  the  posterior  tibial  vessels,  comminuted  both  bones,  and  lodged  in  the  gastrocnemius  muscle.  When  admit 
ted  to  the'hospital  his  general  condition  was  tolerable,  and  the  injury  to  the  vessels  Avas  not  detected,  as  the  heat  and  appearance 
of  the  foot  Avere  good.  On  May  9th  it  Avas  noticed  that  dry  gangrene  Avas  beginning  in  the  foot,  and,  after  free  stimulation  during 
that  day,  a  circular  amputation  Avas  done  in  the  lo\ver  third  of  the  thigh  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.  The 
patient  reacted  Avell  and  had  no  bad  symptoms  from  the  moment  of  the  amputation.  The  ligature  around  the  femoral  artery 
separated  on  the  tenth  day,  and  by  May  22d  nearly  one-half  of  the  flap  had  united.  A  slight  tendency  to  diarrhoea  Avas  readily 
checked  by  laudanum  enemata.  The  patient  Avas  discharged  August  26,  1863;  stump  quite  Avell;  patient  strong  and  hearty. 

CASE  1215. — Private  W.  Thompson,  Co.  H,  69th  NBAV  York,  aged  19  years,  was  admitted  into  Armory  Square  •Hospital, 
Washington,  April  1,  1865,  with  a  shot  wound  of  the  posterior  aspect  of  the  right  leg,  receiA'ed  at  Hatcher's  Run,  March  25, 1865. 
The  ball  passed  upward  and  made  its  exit  over  the  tibia  five  inches  beloAV  the  knee  joint.  Dry  gangrene  existed  at  the  time  of 
admission,  oAving  to  the  circulation  to  the  foot  being  cut  off.  On  April  2d  Surgeon  D.  W.  Bliss,  U.  S.  V.,  amputated  the  limb 
at  the  lower  third  of  the  thigh.  Pyaemia  supervened  on  April  12th,  and  the  patient  died  from  exhaustion  April  15,  1865. 

In  all  these  cases  the  feet  or  the  toes  were  the  parts  affected.  As  already  stated, 
interference  with  the  arterial  circulation  was  the  cause  of  the  gangrene,  although  the  man 
ner  of  this  interference  may  not  be  so  clear  in  one  or  two  of  the  cases.  In  the  cases  of 
Steel,  Thompson,  Mon,  Hill,  and  Green,  the  arteries  of  the  affected  limb  had  been  injured. 
In  the  case  of  Logan  (CASE  1213),  dry  gangrene  developed  upon  the  formation  of  an  aneur 
ism  following  a  shot  wound  of  the  dorsum  of  the  foot.  In  Hauibrd's  case  (CASE  1211)  com 
plete  paralysis  of  the  lower  extremities  and  dry  gangrene  of  the  toes  of  the  left  limb  were 
the  results  of  a  shot  injury  of  the  neck  with  lesion  of  the  spine.  In  the  case  of  Strauss, 
phlebitis  and  dry  gangrene  ensued  after  a  shot  perforation  of  the  pelvis  with  injury  of  the 
urethra.  Gammel  (CASE  1210)  received  a  shell  wound  just  above  the. left  ankle;  the  leg 
was  amputated;  sloughing  of  the  flaps  and  bed-sores  followed,  and  thirty -five  days  after 
the  operation  dry  gangrene  appeared  in  the  toes  of  the  right  foot.  The  patient  died. 

In  five  of  the  nine  cases  of  dry  gangrene  here  cited,  amputation  was  performed  after 
the  appearance  of  the  affection;  four  recovered.  The  remaining  four  cases,  in  which  no 
operative  interference  was  resorted  to,  proved  fatal. 

TRAUMATIC   ERYSIPELAS. 

Less  frequent  than  the  instances  of  gangrene  were  the  cases  complicated  by  traumatic 
erysipelas.  Under  traumatic  erysipelas  have  here  been  considered  the  cases  in  which  inflam 
mation  of  the  skin,  originating  from  a  wound,  quickly  extended  over  the  surrounding  parts, 
ending  in  rapid  resorption,  while  the  progress  was  accompanied  by  an  exceedingly  high  fever. 
Cases  of  acute  suppuration  and  diffuse  inflammation,  or  of  diffuse  acute  osteomyelitis,  which 
have  sometimes  been  classed  with  erysipelas,  are  not  considered  in  this  group. 

The  total  number  of  cases  of  traumatic  erysipelas  was  one  thousand  and  ninety-seven 
(1,097),  or  only  0.4  per  thousand  of  the  two  hundred  and  forty-five  thousand  seven  hundred 
and  ninety  (245,790)  cases  of  shot  wounds  recorded  during  the  war.  With  regard  to  the 
various  regions  of  the  body,  the  cases  were  distributed  as  indicated  in  TABLE  CLIX,  on 
the  next  page. 

The  percentages  there  given,  viz:  14.0  per  cent,  for  the  head,  face,  and  neck,  5.2  for 
the  trunk,  41.7  for  the  upper  extremities,  and  39.1  for  the  lower  extremities,  only  indicate 
the  relative  percentage  of  the  frequency  of  the  disease  in  the  four  subdivisions  of  the  body 
in  regard  to  each  other.  The  liability  of  the  various  portions  of  the  body  to  this  infection 


852 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


TABLE  OLIX. 

Numerical  Statement  of  One  Thousand  and  Ninety-seven  Cases  of  Traumatic  Erysipelas. 


Q 

M 

g 

PM  M 

SEAT  OF  INJURY. 

<o 

1 

o 

J 

H 

i 

i 

2  w 

m 

o 

H 

C5  u 

•4 

M 

<j 

H 

O 

K 

pr. 

& 

* 

a  dNeck 

154 

107 

44 

3 

14.0 

57 

23 

33 

1 

5.2 

457 

259 

180 

18 

41.7 

429 

229 

193 

7 

39.1 

450 

1,097 

C18 

29 

is  shown  by  comparing  the  number  of  wounds  of  each  region  with  the  number  of  cases  of 
erysipelas  reported  therein.  In  twenty-six  thousand  four  hundred  (26,400)  cases  of  shot 
wounds  of  the  head,  face,  and  neck,  erysipelas  was  noted  in  one  hundred  and  fifty-four,  or 
in  5.8  per  one  thousand;  in  forty-five  thousand  one  hundred  and  eighty-four  (45,184) 
wounds  of  the  trunk,  in  fifty-seven,  or  in  1.2  per  one  thousand;  in  eighty-seven  thousand 
seven  hundred  and  ninety-three  (87,793)  wounds  of  the  upper  extremities,  four  hundred 
and  fifty-seven,  or  in  5.2  per  one  thousand;  and  in  eighty-six  thousand  four  hundred  and 
thirteen  (86,413)  wounds  of  the  lower  extremities,  in  four  hundred  and  twenty-nine,  or  in 
4.7  per  one  thousand.  It  would  seem,  therefore,  that  erysipelas  occurred  most  frequently 
in  wounds  of  the  head,  face,  and  neck,  next  in  wounds  of  the  upper  extremities,  then  in 
wounds  of  the  lower  extremities,  and  least  frequently  in  wounds  of  the  trunk.  The  pre 
vailing  opinion  that  erysipelas  is  most  frequently  found  after  wounds  of  the  head  and 
face  is  here  corroborated;  the  frequency  of  erysipelas  after  wounds  of  the  upper  extrem 
ities  has  also  been  noted  by  Socin,  who  was  unable  to  assign  any  plausible  cause  therefor. 

The  average  duration  of  the  disease  was  eleven  days;1  in  31.7  per  cent,  it  subsided 
in  from  one  to  five  days,  in  31.7  per  cent,  in  from  six  to  ten  days,  in  19.4  per  cent,  in  from 
eleven  to  fifteen  days,  and  in  17.2  per  cent,  the  duration  of  the  disease  exceeded  fifteen 
days,  as  in  the  following  case,  in  which  it  continued  for  about  four  weeks: 

CASK  1216.— Private  G.  Walker,  Co.  A,  9th  Louisiana,  was  wounded  at  Gettysburg,  July,  1863,  and  was  admitted  on 
July  18th  into  the  Louisiana  Hospital  at  Richmond;  a  mini6  ball  fractured  the  crest  of  the  left  ilium;  the  ball  remained  embed 
ded  in  the  bone  and  was  extracted.  On  admission  the  wound  had  a  healthy  appearance  and  the  general  condition  of  the  patient 
was  good.  On  the  22d  and  25th  of  July  several  loose  spiculae  were  extracted.  On  July  28th  erysipelas  appeared  around  the 
wound  and  gradually  spread  upward  and  downward  until  the  whole  abdomen,  back,  and  chest  were  invaded.  It  there  seemed 
to  limit  itself.  At  the  first  manifestation  of  the  disease  an  active  purgative  was  administered,  and  immediately  after  tincture  of 
iron  was  given,  twenty  drops  every  two  hours.  An  ointment  of  sulphate  of  iron,  a  drachm  to  an  ounce  of  lard,  was  used  morn 
ing  and  night  on  the  whole  surface  affected  with  erysipelas.  In  spite  of  this  treatment  the  disease,  which  seemed  to  have  stopped 
spreading,  extended  to  the  neck,  arms,  and  thighs.  The  fever  increased  considerably  and  was  accompanied  with  delirium 
and  great  restlessness,  soon  followed  by  coma  and  prostration  ;  there  was  also  some  diarrhoea;  two  blisters  were  applied  to  the 
inner  part  of  the  thighs;  carbonate  of  ammonia,  camphor,  and  bark,  with  astringent  enemata  prescribed  in  addition  to  the  tinc 
ture  of  iron.  In  order  to  check  the  progress  of  the  erysipelas,  which  threatened  to  invade  every  part  of  the  body,  a  bracelet  one 
and  a  half  inches  wide  was  made  by  cauterizing  with  nitrate  of  silver  around  the  forearms  and  upper  part  of  the  legs.  This 
treatment  seemed  to  check  the  disease.  August  25th :  The  erysipelas  did  not  spread  beyond  the  line  of  cauterization,  and  did  not 
invade  the  head.  Consciousness  returned;  the  bowels  became  more  regular,  and  the  patient,  after  having  been  in  a  very  critical 
condition,  and  although  now  (August  25th)  very  weak,  is  gradually  but  steadily  recovering;  the  wound  has  a  healthy  appear 
ance  and  discharges  but  moderately.2 

1  SOCIN  (A.)  (Kriegschirurgische  Erfnhrungen  gesammelt  in  Carlsruhe  1870  und  1871,  Leipzig,  1872,  p.  34)  found  that  the  average  duration  of  the 
cases  observed  at  Carlsruhe  in  1870-'71  was  10  days,  and  LOSKEX  (H.)  (Kriegschirurgische  Erfahrungm  aus  den  Barackenlazarethen  zu  Mannheim,  Hei 
delberg  und  Carlsruhe  1870  und  1871,  in  Deutsche  Zeitschriftfur  Chirurgir.,  Leipzig,  1872,  B.  I,  p.  544)  states  that  at  Mannheim  the  mean  average  was 


9  days 


2  FOKMEXTO  (F.,  jr.),  Notes  and  Observations  on  Army  Surgery,  New  Orleans,  1863,  p.  57. 


CHAP.  XII.]  TRAUMATIC    ERYSIPELAS.  853 

A  first  attack  of  erysipelas  by  no  means  secured  the  patient  against  a  second,  and  as 
a  rule  it  would  seem  that  the  later  attacks  were  the  more  virulent.  On  page  433  of  this 
volume  has  been  detailed  the  case  of  Private  $.  Prillaman  (CASE  674),  in  which  the 
patient  had  nine  separate  attacks  of  erysipelas,  and  in  the  two  following  cases  repeated 
attacks  of  the  disease  were  noted  : 

CASE  1217. — Private  H.  B.  Williams,  Co.  G,  2?th  Indiana,  received  a  shot  wound  of  the  left  wrist,  at  Antietam,  Septem 
ber  17,  1862.  He  was  admitted  on  the  next  day  into  hospital  at  Frederick.  Acting  Assistant  Surgeon  W.  S.  Adams  reported : 
"Wrist  joint  much  disorganized;  ball  passed  through  left  wrist,  comminuting  the  small  bones  ;  finger  readily  passes  through 
the  opening.  September  20th :  Extensive  erysipelas  from  elbow  to  fingers ;  made  a  free  incision  along  the  arm  to  the  wrist  and 
two  incisions  along  the  dorsum  of  the  hand.  Ordered  lead  and  opium  wash  to  be  freely  applied  and  to  take  fifteen  drops  of 
tincture  of  iron  every  three  hours,  two  ounces  of  brandy  every  two  hours,  and  three  grains  of  quinine  every  three  hours;  gen 
erous  diet.  In  the  course  of  three  or  four  days  the  patient  passed  into  other  hands,  and  I  saw  no  more  of  him  until  November 
19th,  when  he  again  came  under  my  care.  He  stated  that  he  had  had  a  second  attack  of  erysipelas  some  time  in  October.  At 
this  date,  November  19th,  there  is  felt  evidence  of  a  third  attack;  pulse  120,  feeble;  some  diarrhoea;  tongue  red  and  glassy. 
Iron,  quinine,  brandy,  and  generous  diet  ordered.  November  20th  :  Patient  worse ;  erysipelas  has  extended  to  face,  which  is 
much  swollen;  21st,  eyes  nearly  closed;  treatment  continued;  affected  parts  kept  continually  wet  with  opium  wash;  22d, 
swelling  diminishing  and  parts  assuming  a  darker  hue;  24th;  swelling  almost  entirely  gone;  appetite  improving;  brandy  and 
quinine  continued,  but  iron  omitted  on  account  of  diarrhoea;  26th,  diarrhoea  checked;  cod-liver  oil  ordered;  28th,  stomach 
tolerated  the  oil ;  appetite  improving  ;  pulse  120,  and  small.  December  2d  :  Erysipelas  has  again  set  in  on  the  arm  ;  lead  and 
opium  resumed ;  3d,  made  several  free  incisions  and  evacuated  considerable  pus ;  6th,  patient  has  several  unmanageable  bed 
sores,  and  was  to-day  placed  on  a  water-bed.  On  December  10th  diarrhoea  again  set  in  ;  he  gradually  failed,  and  died  Decem 
ber  27,  1862.  Post-mortem  :  On  opening  the  chest  the  right  lung  was  found  to  be  firmly  adherent  to  the  diaphragm  and  pleura 
costalis.  Its  middle  and  upper  portions  were  thickly  studded  with  miliary  tubercles,  and  the  upper  portion  of  the  middle  lobe 
was  in  a  state  of  diffused  suppuration.  But  few  tubercles  could  be  found  in  the  left  lung.  On  examining  the  arm  the  integu 
ment  over  the  external  condyle  was  found  to  have  sloughed  away  and  the  bone  was  in  a  state  of  necrosis ;  the  elbow  joint 
contained  pus;  the  inferior  extremity  of  the  ulna  had  ulcerated;  the  carpal  bones  were  comminuted  and  carious.  Carpal 
extremities  of  second,  third,  and  fourth  metacarpal  bones  near  joints  were  in  a  necrosed  condition  and  the  joints  opened.  The 
lower  extremity  of  the  radius  was  comminuted :  there  was  also  union  of  an  oblique  fracture  at  its  middle  third."  The  bones  of 
the  right  forearm  and  parts  of  the  carpus  and  metacarpus  were  sent  to  the  Army  Medical  Museum  by  Dr.  Adams,  and  form 
Specimen  3838  of  the  Surgical  Section. 

CASE  1218. — Lieutenant  N.  Austin,  Co.  E,  14th  South  Carolina,  aged  30  years,  was  wounded  at  Gettysburg,  July  3,  1863. 
Acting  Assistant  Surgeon  J.  T.  Laning  reported:  "Wounded  in  the  upper  part  of  the  right  thorax,  causing  a  fracture  in 
both  the  clavicle  and  scapula.  Admitted  into  the  Cavalry  Corps  hospital  on  July  14th.  On  the  evening  of  July  17th  the 
patient  was  taken  with  a  chill,  and  on  the  18th  erysipelas  developed  itself  on  the  right  arm.  Tincture  of  iron  was  applied  to  the 
part  and  given  internally.  By  July  23d  the  arm  was  much  swollen,  discolored,  and  ecchymosed.  On  the  24th  a  free  incis 
ion  was  made  in  the  middle  of  the  arm,  from  which  a  great  quantity  of  very  unhealthy  pus  was  discharged.  The  patient  was 
greatly  prostrated,  but  improved  quickly  under  tonics  and  generous  diet.  On  August  5th  erysipelatous  inflammation  set  in  over 
the  right  hip,  accompanied  with  great  swelling,  but  soon  disappeared.  On  August  12th  the  disease  appeared  in  the  forearm,  to 
which  wet  bandages  were  applied.  On  the  19th  erysipelas  manifested  itself  in  the  shoulder  above  the  incision,  and  was  com 
bated  with  tincture  of  iodine  and  wet  cloths  to  the  parts."  The  patient  was  transfeiTed  on  August  21,  1863,  and  paroled. 

Generally  the  disease  confined  itself  to  the  parts  first  infected,  and  thence  extended  in 
a  centrifugal  manner,  showing  that,  as  Socin  expresses  it,  "the  matter  causing  the  inflam 
mation  spread  itself  abroad  more  by  the  way  of  imbibition  than  in  the  direction  of  the 
larger  venous  and  lymphatic  vessels;"  however,  swelling  and  abscesses  in  the  axillary  and 
inguinal  regions  were  not  infrequent.  In  the  case  of  Pease  (CASE  263,  p.  114,  ante)  large 
inguinal  and  popliteal  abscesses  were  noted  after  the  attacks  of  the  disease. 

Sometimes  the  disease  spread  itself  over  the  neighboring  parts  and  affected  nearly  the 
whole  body.  Gases  are  on  file  in  which  the  erysipelas  made  its  appearance  in  the  head 
and  extended  down  the  neck  and  chest  to  the  pelvis,  or  in  which  the  disease  originated  in 
a  wound  of  the  hand  and  spread  over  the  arm  and  trunk  and  even  the  face;  or  where  it 

A 

first  showed  itself  in  the  toes  and  attacked  the  leg,  thigh,  and  lower  portion  of  the  trunk. 
In  the  case  of  Walker,  cited  on  the  opposite  page,  the  crest  of  the  left  ilium  was  fractured; 
the  disease  spread  from  the  wound  first  over  the  entire  trunk,  and  then  over  the  neck, 
thigh,  and  arms.  In  the  case  of  Williams,  27th  Indiana,  cited  above,  erysipelas  followed 
a  shot  wound  of  the  wrist  and  extended  to  the  face.  Erysipelas  in  the  upper  and  lower 
extremities  seems  to  have  been  equally  liable  to  attack  the  trunk. 


854 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


CASK  1219. — Private  Jesse  Massey,  Co.  A,  129th  Illinois,  received  a  shot  wound  of  the  left  hand,  at  Resaca,  Georgia,  May 
15,  1864.  The  index  finger  was  removed  at  the  field  hospital.  On  May  2lst  he  was  admitted  into  the  field  hospital  at  Bridge 
port,  Alabama.  Soon  after  admission  erysipelas  affected  the  hand,  the  whole  arm  and  trunk  in  succession.  Several  abscesses 
had  to  be  opened.  Iodine  was  applied  externally.  The  patient  recovered  and  was  furloughed  June  28,  1884,  at  which  date  the 
wound  had  healed;  there  was  some  contraction  of  the  fingers,  caused  by  erysipelas. 

CASE  1220.— Private  George  Lincoln,  9th  Illinois,  aged  27  years,  was  wounded  at  Fort  Donelson,  February  15,  1832. 
A  rifle  ball  passed  from  side  to  side  through  the  arch  of  his  foot,  comminuting  the  anterior  portion  of  the  tarsus  and  the  metatar- 
sal  bones.  The  patient  was  conveyed  to  the  Academy  Hospital  at  Nashville,  where  Dr.  T.  L.  Madden,  of  Nashville,  amputated 
the  foot,  after  the  method  of  Pirogotf,  on  February  2.~>th.  Erysipelas  appeared  upon  the  stump  on  March  2d,  and  extended  thence 
over  the  greater  portion  of  the  body,  causing  death  on  March  8,  1862.  The  case  is  reported  by  Surgeon  E.  Swift,  U.  S.  A. 

CASK  1221. — Assistant  Surgeon  A.  K.  Smith,  1st  Michigan  Cavalry,  remarks,  on  the  monthly  report  of  sick  and  wounded 
of  the  1st  Michigan  Cavalry,  near  Fort  Scott,  Virginia,  for  January.  1863:  "The  case  of  traumatic  erysipelas  supervened  on  a 
gunshot  wound  of  the  foot  received  on  January  9,  18b':5.  The  ball  entered  the  dorsal  surface  between  the  last  phalanges  of  the 
second  and  third  toes,  and  passed  out  on  the  plantar  surface  an  inch  posterior  to  the  commissure  of  the  toes.  The  last  phalanx 
of  the  second  toe  was  shattered  and  the  metatarso-phalangeal  articulation  opened.  The  case  was  not  seen  until  the  14th.  The 
wound  and  foot  were  then  considerably  inflamed,  tense,  and  painful.  Amputation  was  not  then  thought  advisable  in  the  then 
condition  of  the  parts.  Water  dressings  with  cold  irrigation  were  employed,  but  the  wound  did  not  assume  a  healthy  appearance. 
The  track  of  the  ball  did  not  slough;  healthy  suppuration  did  not  take  place,  and  there  was  no  granulation.  The  wound  con 
tinued  to  look  drv,  purple,  tumid,  and  the  slight  discharge  that  took  place  was  of  a  serous  or  semi-sanguinolent  character.  Tin- 
general  health,  however,  seemed  good.  On  January  20th  an  erysipelatous  blush  first  appeared  around  the  wound,  and  in  a  few 
hours  an  erysipelatous  inflammation  of  the  cellulo-cutaneous  variety  was  fully  established,  accompanied  with  febrile  symptoms  of 
an  irritative  type.  The  erysipelas  spread  rapidly  up  the  limb  until,  on  January  30th,  it  had  reached  the  body.  The  limb  was 
much  swollen,  tense,  of  a  dusky  red  color,  and  covered  in  patches  with  vesicles.  The  foot  was  greatly  swollen,  tense,  boggy  to 
the  touch,  of  a  purplish  hue,  and  covered  with  blebs.  The  wound  was  livid,  dusky,  emitting  a  sanious  offensive  secretion. 
Thus  matters  went  on  until  January  2oth,  when  there  seemed  to  be  great  danger  of  gangrene  of  the  wound  and  foot.  The 
erysipelas  was  still  spreading  upward  ;  the  constitutional  symptoms  were  becoming  serious ;  the  parts  contiguous  to  the  wound 
were  dark,  boggy,  almost  insensible,  and  the  discharges  from  the  wound  were  offensive.  Amputation  of  the  second  toe,  at  the 
metatarso-phalangeal  articulation  was  resolved  upon,  notwithstanding  the  condition  of  the  parts  and  the  general  symptoms. 
This  was  done  on  January  25th.  Two  reasons  led  to  this  course.  First,  it  was  thought  the  incisions  would  be  beneficial  by 
relieving  the  tension  of  the  parts  and  by  affording  a  free  outlet  for  the  secretions  of  the  wound  and  the  inflammatory  effusion ; 
and,  second,  it  would  remove  a  source  of  irritation  in  the  fractured  and  shattered  phalanx.  The  operation  did  not  aggravate 
any  of  the  symptoms  but  rather  mitigated  them.  They  remained  about  the  same  for  four  days,  when  a  general  amendment 
began,  which  lias  continued  up  to  this  time,  February  5th.  The  inflammation  of  the  leg  has  subsided,  desquamation  taking 
place.  The  swelling  of  the  foot,  though  still  considerable,  is  much  reduced;  the  wound  has  put  on  a  healthy  character  and  is 
now  secreting  healthy  pus  and  showing  healthy  granulations ;  the  febrile  symptoms  have  subsided  and  the  patient's  general 
condition  is  rapidly  improving.  He  is  convalescent.  The  treatment  has  been  isolation,  that  the  other  wounded  men  might  not 
be  endangered,  good  ventilation,  nutritious  animal  diet,  muriated  tincture  of  iron,  and  wine;  locally  a  solution  of  lead  wash  to 
the  limb  and  a  solution  of  chlorinated  soda  to  the  wound." 

Four  hundred  and  fifty  of  the  one  thousand  and  ninety-seven  cases  of  erysipelas  proved 
fatal,  a  mortality  rate  of  41.0  per  cent. 

TABLE  CLX. 

Numerical  Statement  of  One  Thousand  and  Ninety-seven   Cases  of  Traumatic  Erysipelas,  indicating 

the  Results  and  Causes  of  Death, 


H 

DEATHS  AND  CAUSES  OF. 

M 

D 

» 

& 

H 

6 

a 

REGION". 

8 

§ 

S| 

tt 

o 

i 

go 

O 

•< 

H 

O 

|S 

rt 

a 

p 
to 

§ 

n 

0 

0 

0 

t-t 

.2" 

o 

8 

n 

>.. 

« 

o 

H 

M 

PH 

O 

H 

H 

0 

ft 

W 

Shot  TVounds  of  Head  Face  Neck 

154 

107 

3   '' 

1 

1 

4\        8 

30 

Shot  AVounds  of  Trunk          

57 

23 

1 

3 

1 

4 

G 

19 

128 

56 

n 

n 

1 

1 

5 

11 

.  37 

81 

49 

G 

1 

2 

3 

4 

10 

(  Amputation  

248 

154 

7 

25           1 

5 

20 

17 

19 

200 

109 

7 

4  '        1 

1 

6 

48 

24 

25 

15 

2 

2 

2!        4 

204 

105 

14 

3 

4 

2 

22 

35 

19 

1,097 

618 

29 

GO 

8 

5 

12 

06 

131 

1G8 

CHAP,  xu.l  TRAUMATIC    ERYSIPELAS.  855 

In  sixty  cases  death  was  ascribed  to  pyaemia,  in  eight  to  gangrene,  in  five  to  tetanus, 
in  twelve  to  haemorrhage,  and  in  sixty-six  to  other  diseases.  In  one  hundred  and  sixty- 
eight  instances  only  was  the  fatal  issue  directly  attributed  to  erysipelas,  making  a  fatality  of 
15.3  per  cent,  in  the  one  thousand  and  ninety-seven  cases  attended  by  this  complication. 

Erysipelas  made  its  appearance  under  the  most  favorable  hygienic  conditions.  Surgeon 
D.  Morgan,  U.  S.  V.,  in  the  latter  part  of  April  and  in  May,  1862,  reports  from  hospital 
No.  3,  at  Evansville,  which  was  located  on  high  ground,  free  from  moisture,  and  with 
nothing  to  interfere  on  either  side  with  the  free  circulation  of  air,  that  he  had  "no  epidemic 
disease  unless  it  be  erysipelas  which  followed  some  of  the  wounds."  It  was  observed  that 
the  disease  prevailed  less  extensively  in  tents  than  in  hospital  buildings. 

Generally  the  disease  occurred  in  crowded  hospitals  with  illy- ventilated  rooms  and 
rapidly  spread  from  one  wounded  patient  to  another.  This  was  the  case  in  Louisville  in 
November  and  December,  1862,  where  the  progress  of  the  affection,  although  quite  virulent, 
was  successfully  checked  by  the  use  of  bromine.  In  their  reports  Surgeons  M.  Goldsmith 
and  B.  Woodward,  U.  S.  V.,  speak  enthusiastically  of  this  agent  as  a  prophylactic  against 
erysipelas.  Surgeon  Woodward  remarks  that  "since  the  use  of  bromine  in  vapor  not  one 
case  originated  in  the  crowded  wards  of  the  barracks  [Park  Barracks  Hospital,  Louisville], 
in  which,  before  its  use,  from  five  to  eight  cases  of  erysipelas  a  week  had  occurred."  In 
the  application  of  bromine  in  erysipelas  two  different  methods  were  employed:  first,  by 
the  action  of  the  vapor  of  bromine  on  the  affected  part;  second,  by  a  direct  application  to 
the  erysipelatous  surfaces  of  a  solution  of  bromine  of  varying  strength.  In  the  first  method, 
the  part  affected  was  enveloped  in  dry  lint;  a  cloth  saturated  with  pure  bromine  was  then 
applied 'Over  this,  and  the  whole  dressing  covered  with  a  piece  of  oiled  silk.  The  only 
objection  to  this  treatment  was  the  tendency  of  the  bromine  to  blister  the  skin  by  soaking 
through  the  intervening  layer  of  dry  lint.  The  other  mode  of  using  the  bromine  was  to  apply 
directly  to  the  inflamed  integument  a  solution  of  the  bromine  and  bromide  of  potassium  of 
the  strength  of  from  fifteen  to  forty  drops  of  the  former  to  the  ounce  of  water. 

The  treatment  of  erysipelas  with  bromine  was  principally  confined  to  the  hospitals  at 
Louisville,  under  the  supervision  of  Medical  Director  M.  Goldsmith.  At  other  hospitals 
the  patients  were  at  once  isolated,  or  sent  to  separate  wards,  where  disinfectants  were  freely 
used.  In  the  great  majority  of  cases  the  disease  yielded  readily  to  a  local  application  of 
tincture  of  iodine  and  cloths  saturated  with  a  solution  of  creasote,  the  former  to  the  wound 
and  inflamed  surface,  the  latter  a  little  more  extensively  to  the  neighboring  parts.  The 
internal  treatment  consisted  of  tincture  of  muriate  of  iron  in  small  doses,  often  repeated, 
with  quinine,  etc.,  and  good  diet.  In  severe  cases  evaporating  lotions  of  ether  were  applied 
to  the  worst  points  and  numerous  incisions  or  scarifications  made  to  relieve  the  tension,  as 
in  CASE  78,  page  37,  ante. 

Opinions  differ  greatly  as  to  the  origin  and  mode  of  infection  of  traumatic  erysipelas. 
Billroth,  in  1863, l  believed  that  it  might  "result  from  retention  of  the  secretion  of  a  wound, 
and  consequent  reabsorption  of  a  slight  amount  of  putrid  substance,  in  which  case  it  is  so 
much  like  lymphangitis  that  at  the  commencement  it  is  often  difficult  to  distinguish  the 
two  diseases.  In  many  sporadic  cases  no  definite  cause  can  be  found;  in  other  cases  epi 
demic  influences  seem  to  come  into  play,  for  at  the  same  time  a  large  number  of  wounded 
patients  are  attacked  by  the  disease.  Crowding  such  patients  in  badly-ventilated  places 

'BILLROTH  (T.),  General  Surgical  Pathology  and  Therapeutics,  translated  from  the  fourth  German  edition  by  CHARLES  E.  HACKLKY,  New  York, 
1671,  p.  313. 


856  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

also  develops  a  contagion,  concerning  which  we  are  doubtful  if  it  acts  only  on  wounds,  or, 
being  taken  in  by  the  lungs,  may  induce  erysipelas  in  the  wound;  the  latter  is  not  very 
probable."  Socin1  claims  that  the  originally  pure  local  inflammation  may  generate  sub 
stances  of  a  peculiar  nature,  which  have  the  faculty  of  spreading  very  rapidly  over  the 
neighboring  parts,  causing  similar  inflammation,  while  at  the  same  time  the  deleterious 
matter  passes  into  the  blood  and  produces  high  fever;  or  that  the  disease  may  be  caused 
by  the  import  of  a  specific  agent — virus,  if  you  wish  it — of  the  nature  of  which  we  know 
very  little;  but  it  may  be  stated  that  "it  must  be  of  a  very  perambulating  kind;  that  it 
does  not  necessarily  depend  on  the  presence  of  pus  or  infiltration;  that  it  is  by  no  means 
present  in  every  case  of  pus  or  infiltration;  that  it  maintains  itself  for  a  long  period  outside 
of  the  body  without  losing  its  efficacy,  and  finally  that  we  know  of  no  remedy  which  will 
thoroughly  exterminate  it."  After  his  experience  in  the  Franco-German  War,  1870-'71, 
Billroth  abandoned  the  idea  of  septic  infection  and  ascribed  the  disease  to  specific  con 
tagion:2  "Since  I  have  conducted  operations  with  disinfectants  and  the  utmost  cleanliness 
I  have  had  no  further  cases  of  septic  erysipelas,  none  but  cases  of  erysipelas  occasioned 
by  contagion,  and  nearly  all  were  observed  in  cases  of  wounds  with  healthy  granulations. 
I  now  believe  that  I  have  inoculated  the  disease,  in  the  patients  who  shortly  after  the 
operation  were  attacked  by  erysipelas,  by  sponges,  bandages,  etc.  Whenever  in  the  last 
few  years  cases  of  retention  of  decomposed  blood  or  secretion  occurred — a  matter  which  can 
not  be  always  avoided — I  noticed  no  erysipelas,  but  only  a  simple  form  of  inflammation  of 
the  areolar  texture.  Genuine  erysipelas  can  be  carried  into  the  wound  at  every  stage ;  it  has 
nothing  to  do  with  the  reparative  process  of  the  wound,  and  is  always  an  accident  intro 
duced  from  without.  *  *  *  That  among  the  one  hundred  and  thirty-two  wounded 
treated  by  me  at  Weissenburg  only  one,  and  at  Mannheim  only  a  few  isolated  cases  occurred, 
certainly  proves  that  retention  of  secretion  itself  does  not  produce  erysipelas.  *  *  * 
Immediate  isolation  of  the  cases,  as  well  as  thorough  ventilation  of  the  barracks,  prevents 
the  further  propagation  of  this  fatal  wound  complication." 

Very  recent  wounds  were  attacked  by  erysipelas,  and  again  the  disease  occurred  in 
wounds  with  perfectly  healthy  granulations,  or  which  were  well  advanced  in  cicatrization, 
as  in  the  following: 

CASE  1222. — Private  Arthur  Farey,  Co.  C,  183d  Pennsylvania,  aged  35  years,  was  wounded  at  Cold  Harbor,  Virginia, 
June  3,  1864.  He  was  admitted  into  the  hospital  of  the  First  Division,  Second  Corps,  and  on  June  llth  was  transferred  to 
Philadelphia  and  entered  South  Street  Hospital.  Acting  Assistant  Surgeon  J.  A.  McArthur  reported:  "Wounded  by  an  explo 
sive  ball,  which  entered  the  right  side  of  the  thorax  one  and  a  half  inches  from  the  acromion.  At  date  of  admission  the  wound 
of  entrance  had  entirely  healed.  The  right  arm  was  very  much  swollen  and  inflamed.  A  large  abscess  formed,  situated  imme 
diately  over  the  biceps  muscle;  general  condition  poor.  On  June  12th  I  opened  the  abscess  and  extracted  the  ball  and  ordered 
that  the  wound  caused  by  opening  the  abscess  be  freely  injected  three  times  a  day  with  a  solution  of  chlorate  of  soda;  painted 
the  whole  arm  and  forearm  with  tincture  of  iodine  and  applied  a  bandage.  Flaxseed  poultice,  mixed  with  lead-water,  to  be 
applied  to  the  wound.  Four  bottles  of  porter  were  given  daily,  and  a  mixture  composed  of  sulphate  of  quinine  one  drachm, 
tincture  of  muriate  of  iron  one  drachm,  water  six  ounces,  and  simple  syrup  two  ounces,  Avas  given  in  tablespoonful  doses  four 
times  a  day.  June  20th:  The  pain  and  swelling  of  the  arm  have  almost  disappeared;  wound  discharging  healthy  pus;  general 
health  good.  Injections  kept  up  and  poultice  and  iodine  discontinued.  July  18th :  From  the  last  date  the  patient  continued 
steadily  improving  till  the  present  time.  He  is  again  suffering  from  erysipelas  over  the  whole  of  the  right  arm.  The  wound 
over  the  biceps  is  very  unhealthy  and  discharging  a  large  quantity  of  sanious  pus.  Abdomen  tympanitic,  pulse  fluttering,  legs 
cedematous.  July  20th :  Gradually  sinking,  pupils  very  much  contracted;  semi-comatose;  able  to  pass  his  urine  and  faeces  prop 
erly.  Died  July  22,  1864,  at  3  p.  m.  Autopsy:  Brain  healthy;  heart  contained  two  clots  (fibrinous),  one  lying  loose  in  the  left 
ventricle  and  one  occupying  the  right  auricle  and  extending  into  the  pulmonary  artery.  There  was  about  six  ounces  of  effusion 
in  the  pericardium.  Stomach  and  small  intestines  healthy;  about  two  quarts  of  effusion  in  the  peritoneal  cavity,  and  large  deposi 
tions  of  lymph  on  various  parts  of  the  intestines.  Liver  cirrhosed.  Upon  laying  open  the  wound  made  by  the  ball  discovered 
that,  the  missile  had  passed  through  the  glenoid  cavity  of  the  scapula,  partially  fracturing  the  head  of  the  humerus,  and  passing 

1  SOCIN  (A.),  Kriegschirurgische  Erfahrungen  gcsammelt  in  Carlsruhe  1870  und  1871,  Leipzig,  1872,  p.  31. 

a  Dlu.nOTiI  (T.),  Chirurgischc  Brirfe  aits  den  Kreigs-Lazarrthen  in  Weissenburg  und  Mannheim.  1870,  Berlin,  1872,  p.  97. 


CHAP.  XII.]  PYAEMIA.  857 

around  the  bone  lodged  beneath  the  fascia  covering  the  biceps  muscle."  The  upper  half  of  the  rig-lit  humerus  was  forwarded  to 
the  Army  Medical  Museum  by  Dr.  McArthur  and  constitutes  Specimen  3669  of  the  Surgical  Section.  There  is  a  double  longitu 
dinal  partial  fracture  of  five  inches  on  the  inner  side  of  the  shaft.  The  head  is  carious,  and  necrosed  bone  borders  the  lines  of 
separation  in  the  shaft.  A  brief  abstract  of  this  case  was  given  among  the  alleged  instances  of  injuries  by  explosive  bullets  on 
page  702,  ante. 

CASE  1223. — Sergeant  M.  V.  B.  Carr,  Co.  K,  104th  New  York,  aged  25  years,  received  a  shot  wound  of  the  left  leg,  at 
Gettysburg,  July  1,  1863,  and  on  July  19th  entered  the  hospital  at  York,  Pennsylvania.  A  mini6  ball  entered  the  outer  aspect 
of  the  upper  third  of  the  left  leg,  passed  downward  and  backward,  and  emerged  on  the  posterior  part  three  inches  below  the 
popliteal  space.  On  admission  the  parts  were  swollen  and  the  discharge  of  pus  abundant.  Simple  dressings  applied.  On 
October  12th  the  wounds  were  still  open;  condition  good.  The  patient  was  furloughed  on  October  28th  and  readmitted  on 
December  6th.  The  wound  of  entrance  became  unhealthy,  and  on  January  15,  1864,  was  four  by  two  inches  in  extent;  granu 
lations  flabby,  not  disposed  to  cicatrize,  leg  swollen  but  not  painful.  The  parts  were  touched  with  solid  nitrate  of  silver  daily 
and  simple  cerate  applied.  By  March  1st  the  wound  was  nearly  closed  though  three  inches  deep.  April  1st:  Wound  closed; 
no  swelling  of  part,  nor  pain;  leg  lame.  April  10th:  Wound  of  entrance  reopened;  discharge  slight.  May  1st:  External 
part  of  leg  red,  painful,  and  swollen  for  several  days ;  abscess  discharged.  Wound  of  exit  reopened  May  19th ;  wound  of 
exit  nearly  closed;  leg  less  swollen  and  painful.  On  May  21st  the  patient  was  transferred  to  Ladies'  Home  Hospital,  New  York. 
Acting  Assistant  Surgeon  G.  M.  Smith  reported  that  "on  admission  the  wound  was  healed,  but  the  p'atient  was  quite  lame.  He 
was  soon  after  attacked  with  erysipelas  of  the  left  leg.  A  lotion  composed  of  three  ounces  of  spirit  of  mindererus,  one  of  alcohol, 
and  twelve  of  water  was  applied  to  the  limb,  and  muriated  tincture  of  iron  given  internally.  In  the  subsidence  of  the  erysipelas 
he  soon  regained  his  general  health.  He  was  discharged  from  service  July  23,  1864.  The  wound  in  the  left  leg  had  healed, 
but  the  limb  was  purple  and  cedematous  and  the  patient  quite  lame." 

Erysipelas  was  noted  in  four  hundred  and  fifty-two  cases  of  amputations  and  in  one 
hundred  and  six  cases  of  excisions.  Of  the  four  hundred  and  fifty-two  amputation  cases  the 
disease  occurred  in  one  hundred  and  fifty-one  instances  before,  and  in  three  hundred  and 
one  after  the  operation.  Of  the  one  hundred  and  six  cases  of  excisions  the  complication 
made  its  appearance  in  all  but  four  cases  after  the  operation,  and  here  again  the  liability  of 
this  operation  to  be  complicated  by  erysipelas  will  be  noted. 

Regarding  the  years  in  which  the  erysipelas  was  recorded,  it  can  only  be  stated  that 
the  disease  was  most  frequent  in  periods  in  which  the  number  of  wounded  under  treatment 
was  the  largest.  Five  cases  were  noted  in  1861 ,  one  hundred  and  forty-three  in  1862,  three 
hundred  and  one  in  1863,  four  hundred  and  forty-nine  in  1864,  one  hundred  and  thirty- 
two  in  1865,  and  in  sixty-seven  cases  the  year  was  not  stated.  The  same  may  be  said  of 
the  seasons  of  the  year,  although  it  was  generally  more  frequent  in  cold  and  damp  seasons 
and  at  times  when  it  was  necessary  to  keep  the  doors  and  windows  of  hospital  buildings 
closed.  Thirty-nine  cases  originated  during  January,  twenty-nine  in  February,  thirtv- 
eight  in  March,  seventy-seven  in  April,  one  hundred  and  thirty-one  in  May,  one  hundred 
and  twenty-four  in  June,  one  hundred  and  seven  in  July,  seventy  in  August,  fifty-nine  in 
September,  fifty-seven  in  October,  thirty- five  in  November,  thirty-six  in  December,  and  in 
two  hundred  and  ninety-five  cases  the  month  in  which  the  disease  manifested  itself  was 
not  recorded. 

The  wounded  among  the  colored  troops  seem  to  have  been  seldom  affected  by  this  dis 
ease,  as  only  eleven  were  attacked  by  it;  but  five  of  the  eleven  cases  proved  fatal — four  in 
consequence  of  erysipelas,  and  one  of  pleuritis  and  erysipelas. 

PY^MIA. 

The  terms  septsemia,  septicaemia,  ichorrhamiia,  pyaemia,  pyohsemia,  toxaemia,  etc., 
found  on  the  surgical  reports  of  the  war,  were  probably  used  by  the  surgeons  as  expressing, 
in  their  opinions,  certain  degrees  or  phases  of  blood  poisoning,  intelligible  to  themselves, 
but  which  the  descriptions  of  the  cases  fail  to  reveal,  and  which,  therefore,  have  not  been 
adhered  to  here.  Nor  have  the  many  careful  investigations  since  the  war  enabled  writers 
on  surgery  to  reconcile  the  differences  of  their  views.  Lidell1  believes  that  pyaemia  is  the 

'LlDELL  (J.  A.),  On  Pyscmia,  in  United  States  Sanitary  Commission  Memoirs,  New  York,  1870,  Surgical  Volume  I,  page  511. 

SUKG.  Ill— 108 


858  WOUNDS    AND    COMPLICATIONS.  fCHAP.  xu. 

"variety  of  septsemia  in  which  some  local  suppuration  constitutes  the  primary  focus  or 
source  of  infection.  In  the  other  varieties  of  septic  blood  poisoning  the  source  or  focus 
from  which  the  poison  proceeds,  and  the  symptoms,  or  secondary  disturbances  and  struct 
ural  lesions  induced  by  it  in  distant  organs,  are  of  quite  a  different  nature,  as,  for  example, 
we  may  see,  in  cases  of  dissection  wound,  gangrene  from  injury  of  blood-vessels,  senile  gan 
grene,  spreading  inflammatory  gangrene,  and  hospital  gangrene."  Hueter  declares  that  the 
"first  wound  fever  is  essentially  a  septicaemia  fever.  *  *  In  the  course  of  a  few  days 
the  wound  fever  gradually  loses  the  character  of  the  simple  septicsemic  fever,  and  with 
the  appearance  of  suppuration  changes  into  a  septico-pyaemic  fever;  and,  finally,  with  the 
extinction  of  the  putrescent  process  and  the  continuance  of  suppuration  into  a  simple  pyaemic 
fever."  Socin  claims  that  the  various  forms  of  the  primary  wound  fever  caused  by  the  recep 
tion  into  the  blood  of  putrid  fermentative  products  should  be  designated  as  septicfflmic 
fevers,  and  those  caused  by  the  resorption  of  certain  pyogenic  products  of  pus  as  pysemic 
fevers.2  Billroth  contends  that  septicaemia  most  frequently  appears  in  the  first  days  after 
severe  injuries,  at  a  time  when  pus  has  not  yet  formed  in  the  wound,  and  that  pyaemia  is 
found  after  local  suppuration  has  been  established,  and  adds:  "I  have  not  seen  a  single 
instance  of  this  disease  in  which  there  was  not  found,  either  on  the  living  subject  or  on  the 
cadaver,  a  deposit  of  pus  or  ichor,  from  which  it  had  originated."3  A  similar  fact  was 
noted  by  Lidell.  In  not  one  of  the  fifty-seven  cases  observed  by  him  at  the  Stanton  Hos 
pital  did  "pyaemia  make  its  appearance  previous  to  the  establishment  of  local  suppuration."4 
Arnold,  who  cites  detailed  accounts  of  numerous  post-mortem  examinations  in  cases  of 
traumatic  pyaemia,  discriminates  between  simple  septicaemia  and  septico-pysemia  accom 
panied  by  metastatic  abscesses,  which  latter  he  designates  as  pyaemia.5 

The  reports  of  the  cases  of  blood  poisoning  of  the  American  civil  war  are  not  suffi 
ciently  clear  and  indicative  to  follow  the  hypothetical  discriminations  pointed  out  by  the 
authors  cited,  and  the  entire  series  will  here  be  considered  under  pyaemia. 

The  total  number  of  cases  of  pyaemia  after  shot  wounds  was  two  thousand  eight  hun 
dred  and  eighteen  (2,818),  of  which  seventy-one  (71)  recovered,  and  two  thousand  seven 
hundred  and  forty-seven  (2,747)  terminated  in  death — a  mortality  rate  of  97.4  per  cent. 
In  twenty-one  (21)  only  of  the  two  thousand  seven  hundred  and  forty-seven  (2,747)  fatal 
cases  were  other  causes  than  pyaemia  mentioned  as  having  influenced  the  fatal  issue,  viz: 
haemorrhage  in  seven,  gangrene  in  six,  tetanus  in  two,  erysipelas  in  one,  peritonitis  in  one, 
and  typhoid  pneumonia  in  four.  In  the  remaining  two  thousand  seven  hundred  and  twenty- 
six  (2,726)  fatal  cases  death  was  ascribed  to  pyaemia. 

Whether  in  the  cases  attacked  by  pyaemia  the  wounds  were  in  the  head,  the  face,  the  neck, 
the  trunk,  or  the  extremities;  whether  the  injuries  were  only  flesh  wounds  or  accompanied 
by  fractures;  or  whether  they  were  treated  conservatively  or  by  operative  interference, 
seemed  to  be  immaterial;  all  were  alike  fatal,  as  shown  in  TABLE  CLXI,  on  the  opposite  page. 

Over  one-half  of  all  of  the  cases  of  pyaemia  were  found  after  wounds  of  the  lower 
extremities;  in  eighty-six  thousand  four  hundred  and  thirteen  (86,413)  injuries  of  this 
class,  one  thousand  five  hundred  and  sixty-four  (1,564,  or  18.1  per  thousand)  cases  of 

1  HUETER  (C.),  Die  chirurgische  Behandlung  der  Wundjleber  bet  Schusswunden ,  in  VOLKMAXX'S  fiammluny  Klinischer  Vorlrdye  in  Verbindung 
mil  Deutschen  KHnikern,  No.  22,  p.  101. 

2  SOCIN  (A.),  Kriegschirurgische  Erfahrungr.ngesammf.lt  in  Carlsruhe  1870  und  1871,  Leipzig,  1872,  p.  U7. 

SBILLKOTII  (T.),  Chirurgische  Briefe  aus  den  Kricgslazarelhen  in  Weissenburg  und  Mannheim  1870,  Berlin,  1872,  pp.  108,  109. 
4  LIDELL  (J.  A.),  On  Py&.mia,  in  United  States  Sanitary  Commission  Memoirs,  New  York,  1670,  Surgical  Volume  I,  p.  511. 

5AUN'OLr>  (J.),  Anatomische  Deitrdge  zu  der  Lfhre  von  den  Schusswunden,  gesammelt  wiihrend  der  Krieyxjahre  1870  und  '71   in  den  Reserve- 
laiarethen  zu  Heidelberg.  Heidelberg.  1873,  p.  194. 


CHAP.    KIT. 


PYAEMIA. 


859 


TABLE  GLXT. 

Summary  of  Two   Thousand   Eight  Hundred  and  Eighteen   Cases  of  Pycemia,  indicating  Location  of 

Injury  and  Resull, 


SEAT  OF  INJURY. 

i 

o 

RECOVERIES. 

DEATHS. 

DEATH  RATE. 

66 

3 

03 

95.4 

270 

g 

262 

97  0 

338 

8 

330 

97  6 

165 

3 

162 

98.2 

415 

9 

406 

97  8 

709 

24 

685 

96.6 

55 

<) 

53 

96.3 

800 

14 

786 

98.2 

2  818 

71 

2  747 

97.4 

pyaemia  being  reported.  Of  eighty-seven  thousand  seven  hundred  and  ninety-three  (87,793) 
injuries  of  the  upper  extremities,  nine  hundred  and  eighteen  (918,  or  10.4  per  thousand),  of 
forty-five  thousand  one  hundred  and  eighty-four  (45,184)  injuries  of  the  trunk,  two  hundred 
and  seventy  (270,  or  5.9  per  thousand),  and  of  twenty-six  thousand  four  hundred  (26,400) 
injuries  of  the  head,  face,  and  neck,  sixty-six  (66,  or  2.5  per  thousand),  were  followed  by 
this  complication. 

In  one  thousand  seven  hundred  and  twenty-one  (1,721)  cases  the  day  of  the  appear 
ance  of  the  pysemic  symptoms  after  the  injury  was  noted  as  follows:   On  the 


2d    day  iii  

5  cases. 

12th  day 
13th  day 

n  

50  cases. 

4th  day  iu     ... 

13  cases. 

14th  day 

n  

54  cases. 

5th  day  in  
Cth  day  in 

.  -  16  cases. 

15th  day 
16th  day 

n  

.  -   60  cases. 
76  cases. 

17th  day 

8th  day  iu. 

29  cases. 

18th  day 

n   ... 

70  cases. 

38  cases. 

19th  day 

66  cases. 

10th  day  in 

20th  day 

llth  day  in  

37  cases. 

21st  day 

n  

56  cases. 

22d  day  in 55  cases. 

23d  day  in  42  cases. 

24th  day  in  40  cases. 

25th  day  in  42  cases. 

26th  day  in 50  cases. 

27th  day  in  31  cases. 

2fth  day  in 36  cases. 

29th  day  in  31  cases. 

30th  day  in 20  cases. 

3 1st  to  35th  day  in 135  cases. 


35th  to  40th  day  in...  89  cases. 

41st  to  45th  day  in. ..  55  cases. 

46th  to  50th  day  in...  42  cases. 

51st  to  100th  day  in...  151  cases. 

101st  to  150th  day  in.. .  30  cases. 

151st  to  200th  day  in.  .  8  cases. 

201st  to  250th  day  in. .  9  cases. 

251st  to  300th  day  in ...  5  cases. 

Ahove  300th  day  in 4  cases. 


Total 1,721  cases. 


From  the  second  day  after  the  injury  the  number  "of  cases  increases  gradually  and 
almost  regularly  until  the  sixteenth  day,  on  which  the  highest  total,  viz,  seventy-six,  is 
recorded;  from  the  seventeenth  to  the  thirtieth  day  after  the  injury  the  number  decreases; 
after  that  period  the  disease  appeared  at  desultory  intervals,  in  some  instances  as  late  as  two 
hundred  and  three  hundred  days,  and,  in  one  case,  a  case  of  recovery,  the  pysemic  infection 
was  ascribed  to  the  wound  over  four  and  a  half  years  after  the  injury. 

In  the  above  statement  the  days  of  appearance  of  the  pyaemia  after  the  injury  are 
given;  but  frequently  the  disease  was  not  noted  until  excision  or  amputation  had  been  per 
formed,  and  it  is  safe  to  say  that  in  many,  perhaps  in  the  large  majority  of  these  cases,  the 
pyaemic  infection  was  induced  or  influenced  by  the  operative  interference.  In  TABLE  CLXII, 
on  page  860,  the  day  of  the  appearance  of  the  disease  is  indicated  in  the  conservatively 
treated  cases  from  the  day  of  the  injury- — this  includes  a  number  of  cases  in  which  pyaemia 
existed  at  the  time  operative  interference  was  decided  upon;  in  the  cases  of  excision  and 
amputation,  from  the  day  of  the  operation.  In  the  cases  treated  without  operative  inter 
ference  the  disease  most  frequently  appeared  from  the  tenth  to  the  twentieth  day,  while 
in  the  cases  of  excision  and  amputation  by  far  the  larger  number  occurred  from  the  first  to 
the  sixth  or  seventh  day. 


860 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


TABLE  OLXII. 
Indicating  day  of  Appearance  of  Pycemia  after  Injury  and  after  Operation. 


g 

9 

' 

g 

o 

> 

a 

z 

g 

•S 

* 

a 

•5 

"S 

1 

cfi 

a 

a 

a 

DAY  OK  APPEARANCE.         | 

'3 

k! 

B 

DAY  OK  APPEARANCE. 

V 

I 

Pi 
S 

DAY  OK  APPEARANCE. 

I 

0 

t») 

PI 

a 

a 

U 

") 

a 

W 

*4 

a 

W 

•4 

o 

(N 

0 

h 

b 

0 

H 

a 

M 

* 

1 

5 

1 

O 
a 

M 

1 

c 

1st     . 

7 

37 

13th  

28 

r 

18 

25th 

20 

12 

2d                                                   3 

10 

33 

14th  

27 

1 

35 

26th 

17 

10 

3d                      4 

11 

45 

15th 

30 

4 

18 

27th 

10 

16 

4th                                                 S 

12 

37 

16th 

34 

5 

28th 

11 

3 

5th    7 

8 

34 

17th         .                      .... 

30 

2 

28 

29th 

11 

5 

6th                                                 8 

7 

32 

18th 

34 

2 

20 

30th 

g 

9 

2 

7th    18 

5 

31 

19th  

33 

4 

19 

31st  to  35th 

67 

4 

94 

8th         18 

C 

21 

20th 

37 

5 

28 

36th  to  40th 

36 

17 

9th  19 

5 

27 

21st  

29 

3 

17 

41st  to  45th 

25 

9 

11 

10th    25 

26 

22d  

22 

1 

19 

46th  to  50th 

19 

4 

llth             21 

4 

23 

23d 

17 

3 

18 

51st  to  100th 

80 

1 

''0 

12th    24 

3 

32 

24th  

13 

3 

A 

Above  100th 

°8 

9 

The  duration  of  the  pyaemia  from  the  day  on  which  the  first  symptoms  were  observed 
to  the  day  of  death  was  reported  in  one  thousand  six  hundred  and  eighty-seven  cases. 
The  deaths  occurred  on  the — 


1st  day 
2d  day 
3d  day 
4th  day 
5th  day 
6th  day 
7th  dav 


it  71  cases.       8th  day  iu 123  cases.      15th  day  in 24  cases.  26th  to  30th  day  in 18  cases. 

n     96  cases.       9th  day  hi  92  cases.      16th  day  in 17  cases.  31st  to  35th  day  in 12  cases. 

u 172  cases.      10th  day  in 81  cases.      17th  day  in  21  cases.  30th  to  40th  day  in 11  cases. 

11  171  cases,      llth  day  in 64  cases.     18th  day  iu 14  cases.  41st  to  45th  day  in 3  cases. 

n     204  cases.      12th  day  in 50  cases      19th  day  in 12  cases.  46th  to  50th  day  in lease. 

11 161  cases.      13th  day  in 41  cases.     20th  day  in 15  cases.  Above  50th  day  iu 3  cases. 

u     148  cases      14th  day  in 29  cases.     21st  to  25th  day  in  33  cases. 


About  two-thirds  of  the  cases  died  within  the  first  seven  days;  the  largest  number  of 
deaths  was  recorded  on  the  fifth  day;  in  eighty-one  only  of  the  one  thousand  six  hundred 
and  eighty-seven  cases  did  the  patients  survive  the  twentieth  day  after  the  appearance  of 
the  disease. 

Traumatic  pyaemia  was  seldom  noticed  unless  the  bony  structure  was  injured.  Of  one 
hundred  and  sixty-five  thousand  eight  hundred  and  twenty-one  (165,821)  wounds  without 
lesion  of  the  bones,  only  five  hundred  and  sixty-four  (564),  or  3.4  per  thousand,  were  fol 
lowed  by  pyaemia,  while  of  the  seventy-nine  thousand  nine  hundred  and  sixty-nine  (79,969) 
shot  fractures,  two  thousand  two  hundred  and  fifty-four  (2,254),  or  28.1  per  thousand,  were 
followed  by  this  complication. 

Very  little  is  to  be  said  of  the  treatment  of  pyaemia;  tonics,  stimulants,  and  a  support 
ing  diet  were  given,  but,  as  has  already  been  seen,  with  very  little  effect,  as  97.4  per  cent, 
of  all  the  cases  proved  fatal.  In  the  early  stages  of  the  disease  sulphate  of  quinine  in  large 
doses  would  greatly  reduce  the  temperature;  but  the  improvement  seemed  to  be  only  tem 
porary  unless  the  .treatment  was  continued  for  some  time,  which,  frequently,  the  patients 
were  unable  to  bear.  The  disease  appears  to  have  been  controlled  in  this  manner  in  the 
following  case: 

CASE  1224. — Private  George  Leigh,  Co.  C,  3d  Artillery,  aged  19  years,  was  wounded  at  Robinson's  Ford,  September  23, 
1863,  by  a  shell  fragment  which  carried  away  a  portion  of  the  right  foot.  Amputation  at  the  ankle  joint  was  performed  on  the 
field  by  a  modification  of  Syme's  method.  The  heel  being  injured,  the  flap  was  taken  from  the  dorsum  of  the  foot.  On  Septem 
ber  25th  he  was  admitted  into  Stanton  Hospital,  Washington.  Surgeon  John  A.  Liclell,  U.  S.  V.,  reported:  "His  general  con 
dition  was  then  far  from  satisfactory,  as  he  was  pale  and  very  feeble.  He  was  put  upon  the  use  of  stimulants,  tonics,  and  a  good 
diet.  Simple  dressings  were  applied  to  the  stump  and  he  was  directed  to  take  an  anodyne  at  night.  September  29th :  Half  of 


CHAP.  X11.J  PYAEMIA.  861 

the  flap  sloughed  off;  granulations  pale;  discharge  thin  and  serous;  Labarraque's  solution,  diluted,  was  applied  to  the  stump. 
October  llth :  had  a  severe  chill  this  morning,  and  complains  of  a  good  deal  of  pain  in  the  right  knee ;  twenty  grains  of  sulphate 
of  quinine  and  an  ounce  of  whiskey  were  given  every  six  hours.  12th  :  had  another  severe  chill ;  knee  red,  hot,  and  very  much 
swollen,  pulse  frequent  and  weak,  tongue  dry  and  coated,  complexion  assuming  a  bronzed  hue ;  quinine  repeated,  and  five  grains 
of  citrate  of  iron  and  quinine,  in  pill,  ordered  to  be  given  night  and  morning.  A  lotion  of  acetate  of  lead  and  opium  was  applied 
to  the  knee  and  lime  water  to  the  stump.  13th:  had  another  chill  to-day,  but  it  was  not  so  severe  as  the  others;  temperature  of 
inflamed  knee  lessened;  had  slept  well  during  the  night;  no  change  in  the  treatment.  14th:  swelling  of  the  knee  much  less; 
treatment  unchanged.  15th :  had  a  slight  chill  about  noon,  but  his  general  appearance  is  much  better;  same  treatment  continued. 
18th:  had  vomiting,  produced  apparently  by  the  large  doses  of  sulphate  of  quinine,  which  were  discontinued;  but  the  other 
treatment  was  continued.  20th:  bowels  constipated;  five  grains  aloes  and  fifteen  of  rhubarb  were  ordered.  25th:  swelling  dis 
appearing  from  knee  rapidly;  stump  looks  much  better;  granulations  more  fluid  and  healthy;  discharge  more  laudable.  October 
30th  :  decided  daily  improvement;  continued  the  stimulants,  together  with  the  citrate  of  iron  and  quinine,  and  the  lead  and  opium 
lotion  to  the  knee  and  lime  water  to  the  stump.  The  knee  joint  remained  slightly  swollen,  hot,  and  tender  for  a  long  time; 
indeed,  the  symptoms  of  inflammatory  action  in  it  did  not  entirely  disappear  till  about  the  first  of  February,  1864.  February  20th : 
the  amount  of  mobility  at  the  knee  is  small  (false  anchylosis);  patella  now  adherent;  knee  natural  in  size  and  shape.  Stump 
sore  on  account  of  having  bruised  it  recently;  general  condition  excellent.  March  29th:  the  stump  has  refused  to  heal;  there  is 
an  indolent  excavated  ulcer  about  the  size  of  a  franc  piece  situated  at  the  posterior  part  of  the  face  of  the  stump.  The  stump  is 
otherwise  unserviceable  on  account  of  the  delicate  character  of  its  covering,  which  had  been  taken  from  the  dorsum  of  the  foot. 
There  being  now  no  prospect  that  it  would  ever  become  useful,  the  leg  was  reamputated  about  the  junction  of  the  middle  with 
the  inferior  third  by  the  double-flap  method,  the  anterior  flap  being  considerably  shorter  than  the  posterior  one.  The  tibia  was 
sawn  off  obliquely,  as  directed  by  Sanson ;  anaesthetic  sulphuric  ether.  April  18th :  patient's  general  condition  excellent."  This 
soldier  was  discharged  September  17, 1864,  and  pensioned;  he  died  September  13, 1871.  The  amputated  stump  was  contributed 
to  the  Army  Medical  Museum  by  Dr.  Lidell,  and  is  numbered  2165  of  the  Surgical  Section. 

In  the  well  established  cases  of  pyaemia  all  remedies  were  found  ineffective.  In  wounds 
of  the  extremities  amputation  has  been  recommended  for  the  removal  of  the  infection  when 
first  observed;  but  even  this  extreme  remedy  seemed  to  be  of  little  avail.  Three  or  four 
cases  are  reported  in  which  limbs  were  removed  while  the  patients  were  in  a  pysemic  con 
dition,  and  from  the  successful  issue  it  may  be  presumed  that  the  removal  of  the  infectious 
focus  had  a  beneficial  influence,  as  in  the  following  cases,  in  which  chills  had  occurred 
shortly  before  the  operation: 

CASE  1225. — Corporal  C.  Killan,  Co.  H,  2d  Michigan,  received  a  shot  wound  of  the  right  elbow  joint,  at  Fair  Oaks,  May 
31,  1862.  He  was  admitted  on  June  2d  into  hospital  at  Annapolis,  Maryland.  Surgeon  T.  A.  McParlin,  U.  S.  A.,  reported : 
"The  ball  entered  close  to  the  external  condyle  of  the  humerus,  fractured  the  olecranon  process  of  the  ulna,  and  passed  out  just 
below  the  internal  condyle  of  the  humerus.  On  admission  the  arm  was  much  tumefied;  intense  inflammation.  Constant  appli 
cation  of  iced  water  was  made  to  the  parts  for  two  days  by  means  of  a  syphon;  the  inflammation  having  somewhat  subsided,  an 
attempt  was  made  to  save  the  arm  by  making  a  crucial  incision  and  removing  the  olecranon  process  by  means  of  a  metacarpal 
saw.  All  splinters  were  removed  and  the  parts  brought  together  with  sutures  and  adhesive  straps.  The  joint  was  kept  from  the 
air  by  means  of  an  albumen  scab.  The  arm  was  kept  at  perfect  rest  by  a  splint,  and  water  dressings  used.  For  ten  days  the  arm 
did  well,  when  sudden  tumefaction  of  the  entire  limb  supervened,  with  intense  inflammation.  The  dressings  were  removed,  save 
such  as  were  required  to  keep  the  wound  from  the  air.  A  heavy  chill  with  evidences  of  pyaemia  came  on.  The  patient  was 
stimulated  and  supported  by  generous  diet,  but  the  evidences  of  inflammation  were  so  marked  thaf  the  arm  was  amputated  at  the 
lower  third."  Killan  was  discharged  August  15,  1862,  with  a  good  stump,  and  pensioned. 

Iii  a  case  of  shot  wound  of  the  knee  with  pyaemic  symptoms,  in  which  the  lymphatic 
glands  of  the  knee  were  greatly  enlarged,  amputation  at  the  junction  of  the  middle  and 
lower  thirds  of  the  femur  was  performed  and  the  patient  recovered  with  a  fine  stump: 

CASE  1226. — Private  Joseph  Jones,  Co.  K,  13th  Tennessee  Cavalry,  aged  26  years,  was  wounded  at  Morristown,  Tennes 
see,  November  13,  1864,  in  the  right  knee.  The  ball  entered  near  the  upper  edge  of  the  patella,  passed  upward  and  backward, 
grazing  the  patella,  and  emerged  two  inches  above  the  inner  condyle  of  the  femur.  He  was  admitted  on  the  same  day  into  Asy 
lum  Hospital,  Knoxville.  The  early  progress  of  the  case  is  not  recorded.  On  May  10,  1865,  a  condition  of  pyaamiu  existed  ; 
the  patient  was  scarcely  more  than  skin  and  bone.  The -lymphatic  glands  in  the  groin  were  greatly  enlarged;  appetite  nearly 
entirely  gone;  tongue  dry,  hard,  and  glassy;  pulse  about  120,  weak;  nausea  and  occasional  vomiting.  Knee  and  leg  very  much 
swollen;  discharge  very  profuse  and  extremely  offensive;  soft  structures  of  joint  nearly  entirely  destroyed,  articular  surfaces 
very  much  corroded,  and  pus  burrowing  extensively  about  and  below  the  knee.  Acting  Assistant  Surgeon  T.  W.  Baiigh  ampu 
tated  the  thigh,  at  the  junction  of  the  lower  and  middle  thirds,  by  the  circular  operation.  The  case  progressed  nicely;  a  drachm 
of  bisulphite  of  soda  was  given  each  day  for  the  first  five  days,  together  with  whiskey.  After  this  the  bisulphite  was  decreased 
to  a  half  drachm,  and  quinine,  iron,  and  whiskey  added.  The  patient  recovered  with  a  beautiful  stump.  He  was  discharged 
from  service  August  22,  1865.  The  case  is  reported  by  Surgeon  F.  Meacham,  U.  S.  V. 

From  the  numerous  autopsies  reported  in  cases  of  pyaBmia  the  following  have  been 
selected  as  indicating  the  conditions  of  the  different  organs  in  the  fatal  cases  of  this  disease: 


862 


WOUNDS    AND    COMPLICATIONS.  [CHAV.  xn. 

Condensed  Summary  of  Forty-eight  Post- 


No. 
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8 

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10 
11 

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16 

17 
18 

19 

20 
21 
22 

NAME,  INJURY,  ETC. 

LUNGS  AND  PLKURAL  CAVITY. 

LIVER. 

KIDNEYS. 

Pt.  J.  Brown,  H,  4th  Mich.,  age 
35.  Wounds  of  back  ami  hand. 

Pt.  G.   H.  Guernsey,  E,  17th 
Conn.,  age  33.    Flesh  wound 
elbow;  amputation. 

Pt.  X.  Young,  B,  108th  N.  Y. 
Fracture  knee  joint. 

Corp'l  D.  "Ward,  H,  13th  Vir 
ginia  ;  age  19.    Fract.  femur; 
amputation. 

Pt.  "W.  Fader,  A,  140th  New 
York,  age  20.    Fracture  sa 
crum. 

Pt.  G.  Shaumway,  C,  10th  New 
York  Heavy  Artillery.  Cent, 
wound  over  right  eye  ;  age  28. 

Corp'l  N.  M.  Hildreth,  B,  94th 
New  York,  age  21.    Fracture 
femur;  amputation. 

Capt.  W.  Bogardus,  G,  86th  Illi 
nois,  age   43.    Wound    over 
right  sacroiliac  symphysis. 

Pt.  E.  Satterfield,  F,  12th  West 
Virginia,   age  40.     Fracture 
elbow  joint;  amputation  arm. 

Pt.    M.    McColligau,   C,    Stith 
Mass.,  age  17.    Fract.  hum.  ; 
amp.  at  shoulder  joint. 

Pt.  A.  H.  Comiiis,  K,  34th  New 
York,    age  25.     Fract.   fib.; 
amp.  thigh  ;  lig.  femo.  art.  in 
cont. 

Pt.  E.  Gallagher,  F,  69th  New 
York,  age  37.    Fract.  ankle 
joint;  amputation  leg. 

Pt.  J.  Brown,  F,  5th  New  York 
Cavalry,    age   34.     Fracture 
wrist  joint;  amputation  fore 
arm;  reauip.  arm. 

Pt,  C.  T.  Munu,  G,  77th  New 
York,  age  22.    Fracture  sca 
pula. 

Corp'l  C.  Putnam,  E,  64th  New 
York,  age  27.    Fracture  left 
knee  joint;  amputat'n  thigh. 

Corp'l  J.  Crowley,  A,  7th  New 
York,  age  25.   Fracture  knee  ; 
amputation  thigh. 

Pt.  S.  Hackett,  F,  11  th  Penna. 
Kes.,  age  25.    Fracture  tars, 
bones;  Chopart's  amput'n. 
Pt,  A.  Hammond,  H,  lllthNew 
York,  nge  47.    Fracture  left 
knee  joint;  amput'n  thigh. 

Pt.  C.  Rhodes,  C,  2d  Massachu 
setts  Cavalry,  age  20.    Frtic- 
ture  right  ulna. 

Pt.   S.  H.   Stevenson,  E,  34th 
Ohio,  age  26.    Wound  of  r't 
second  finger. 
Capt.  G.  Reis,  C,  15th  Missouri, 
age  31.      Fracture  forearm  ; 
amputation  arm. 
Pt.  J.  Stuart,  C,  8th  Michigan, 
age  30.    Fracture  8th  rib. 

Blood  effused  in  tissue  of  lungs  in  spots;  no 
abscesses  ;  costal  pleura  strongly  injected. 

A  few  inflamed,  indurated,  suppurating  lob 
ules  in  lower  lobes  of  lungs. 

R't  lung  compressed;  upper  and  middle  lobes 
studded  with  abs.  ;  left  tilled  with  abs.  ;  cavity 
of  lymph  J  inch  thick  on  pleura. 

Lungs;  lower  lobe  left  carnified;  hypostatic 
congestion  in  right;  pleuritic  effusion  in  left 
sac. 

Lungs;  left,  inf.  lobe  congested,  both  lobes  in- 
filt.  with  serum  ;  masses  of  fib.  matter  in  up 
per  and  lower  lobes;  light,  same  condition. 
Left,  22  oz.,  right,  24  oz. 
Some  congestion  both  lungs;  small  nbscesses 
in  left;  old  pleuritic  adhesions.     Right,  22 
oz.,  left,  14  oz.;  eft'usiou. 

Metastatic  abscesses  iu  both  lungs.    Left  lung 
weighed  1  Ib.  12J  oz. 

Lungs  congested;  portion  lower  lobe  right  r.ol- 
lapsed  and  carnified  ;  metast.  deposits  in  low. 
and  masses  of  white  substance  in  up.  and  low. 
lobes  left  lung.     Weight,  left,  18  oz.  4  dr., 
right,  18  oz.  3  dr. 

Lunys  flaccid  nnd  speckled  ;  small  yellow  mass 
es  in  left.      Weight,  right,  2  Ibs.,  left,   1  Ib. 
10  oz. 

Both  lungs  collapsed  aiid  coutaiuiug  abscess 
es;  pleunil  adhesions. 

Lungs  dark  colored  posteriorly;  numerous  ab 
scesses   iu  diseolored  portions;    ribs  of  pig 
mentary  matter  iu  upper  lobe.     Weight,  r't, 
10J  oz.,'left,  9ioz. 

Right  lung  adherent  to  thorax  ;  low.  lobe  of  k-ft 
conges.,  red  col'd;  tatty  secretion  with  blood 
exuded  ;  upper  lobe  dull  slate  col'd  ;  copious 
frothy  dirty-white  secretion  exuded. 
Low.  lobe  right  lung  consolidated  and  partly 
hepatized  ;  hard  tubercles  in  apex  and  inferior 
portion  third  lobe;  second  lobe  left  lung  con 
solidated,  parenchyma  unhealthy.     Weight, 
right,  35J  oz.,  left,  25J  oz. 
Right   lung  adherent   between  lobes  and   to 
right  costal  pleura;  organ   somewhat  pueu- 
monic  and  infiltrated  with  pus;    left  lung 
healthy. 
Pya3mic  patch  in  posterior  lobe  of  left  lung; 
lungs  otherwise  healthy  |  no  pleuritic-  adhe 
sions. 

Lungs  adherent  to  pleura  and  diaphragm,  and 
interspersed  thickly  with  pysemic  abscesses. 

Metastatic  abs.   in  lungs;  large  excavations 
partially  occupier!  by  dead  tissue  above  right 
lung;  pleuritic  adhesions. 
Posterior  lobes  of  both  lungs  solidified  and 
collapsed. 

Lungs  filled  with    circumscribed   abscesses; 
pleura  covered  with   broken   down  lymph; 
effusion  in  left  pleural  cavity. 

Posterior  lobes  of  lungs  congested  ;  tubercles 
in    both,   abscess  in  left;    effusion  in  each 
pleurae. 
Both  lungs  gorged  with  dark  venous  blood  .  .  . 

Abscesses  in  lungs;  left  pneumonic  and  hepa 
tized;  old  pleuritic  adhesions  in  right;  effu 
sion  in  cavity. 

Flabby,  ochre  and  slate  col 
ored  'on  surface  ;  homoge 
neous  and  spot'd  on  sect'n. 
Large,  pale,  clay  colored, 
and  somewhat  fatty. 

Large  abs.  Sa  middle  lobe 
cont.   4  oz.  pus;  tissues 
around  indurated. 

Enlarged,  heavy,  light  col 
ored,  finely  granulated  in 
appearance    and    quite 
solid. 

Healthy  

Healthy 

Natural  in  size,   light  in 
color. 

Normal;  rather  pale.   Ri't, 
7  oz.,  left,  7  oz. 

Small  masses  white   sub 
stance  in  both.    Weight 
of  each,  6  oz. 

Light  colored,  flexible,  and 
easily  torn;  no  abnormal 
ity  observed.    Weight  of 
each,  7J  oz. 

Yellow   tinged.      Weitiht, 
left,  5  oz.  3  dr.,  right,  6 
oz.     Supra-renal  capsules 
distended   with    bloody 
fluid. 

Mottled,  flabby,  light  col 
ored  on  section.    Weight, 
right,  7  oz.,  k-ft,  8  oz. 

Healthy  ... 

No  apparent  disease;  gall 
perfectly  black.  Weight, 
27  oz. 

Abscess  in  right  lobe;  or 
gan   light   colored,   mot 
tled,  and  finely  congested 
on  surface.    W't,  5J  Ibs. 

Reddish  brown  externally, 
bile   tinted   on    section  ; 
friable    and   nutmeg«ed. 
Weight,  3  Ibs.  14  oz.  4  dr. 

Large,  mottled  externally, 
soft  and  congested;  un 
pleasant  odor.     Weight, 
7  Ibs.  1  oz. 

Normal  

Light  reddish  brown,  hard, 
and  full  of  blood.  Weight, 
78  J  oz. 

Upper  half  of  right   lobe 
studded   with    small   ab 
scesses. 

Thick,   firm,   acini  well 
marked;   imtmegged  ap 
pearance;  blackish  color 
externally;    no    gall    in 
bladder.     W't,  63  oz. 
Eularg'd,  yellowish  br'wu, 
soft,  flabby,  and  fatty. 

Normal  si/e,  .•yellow,  gran 
ular,  mid  brittle. 

Contained  several  indura 
ted  spots  supposed  to  be 
pyaemia. 

Large,    heavy,    and    mot 
tled;  rough  to  the  touch. 

Softened  ;  no  abscesses  ... 

Congested;   large  abscess 
in  superior  lobe  opening 
into  peritoneal  cavity. 

Much  enlarged  and  very 
soft. 

Enlarged  and  congested    .  . 

Enlarged,  soft,  and  yellow  ; 
fatty. 

Congested.    AVeiuht,  rig't, 
7  o'z.,  left,  6  oz. 

Reddish  buff  and  mottled 
on   surface;    flabby   and 
fatty. 

Healthy            ...         

Small  and  apparently  soft 
er  than  usual. 

A  little  pale  but  natural.  .  . 
Softened;  no  abscesses  

Natural  size  and  healthy.. 

Enlarged  ;  the  two  w'g'd  21J 
oz.  Mottled;  capsule  peel 
ed  readily  ;  cort  ical  port'n 
thickened;  pale  yellow. 

CHAP.  XII.]  PYJEMIA. 

mortem  Examinations  in  Cases  of  Pywmia. 


863 


No. 

SPLEEN. 

INTESTINES. 

JOISTS. 

BLOOD  VESSELS. 

REMARKS. 

1 
2 

3 
4 

5 
6 

7 
8 

9 

10 
11 

12 
13 

14 
15 
16 

17 
18 

19 

20 
21 
22 

Large,  7x4,  and  flab 
by- 
Healthy  

Healthy  

No    inflammation    of 
neighboring   veins 
observed. 
Axillary  veinthick'd  ; 
clot  partially  brok'u 
down  into  puruloid 
matter. 

Veins  of  pia  mater 
cov.  cerebral  filled 
with  blood;  white 
elas  ic  thromb.  2  in. 
long  in  ex.  fem.  vein. 

Heart  large  and  flabby.    Recent  pleuritis 
of    right    side;    thin    pseudo-membrane 
formed  on  lung,  not  adherent  to  costal 
pleura 
Heart  healthy  ;  wound  gangrenous. 

Cyst  on  right  side  containing  2  quarts  se 
rum,  one  on  left  containing  a  pint.    Heart 
normal. 

Fibr.  clot  in  vcntr.  of  heart  extend  ing  from 
auricle  adh.  to  valve;  clot  in  left  ventr. 
near  valve  ;  clot  "<  lines  long  in  femoral  ar 
tery;  brain,  slight  opacity  of  arachnoid; 
some    congestion.    Stomach  abnormally 
large. 
White  fibrinous  clots  in  heart.    Weight, 
11J  oz.    Pancreas  much  enlarged  and  red 
dened. 

Clots  in  heart  ;  blood  generally  fluid;  some 
conges,  of  brain  ;  abs.  between  left  supra 
renal  capsule  and  kidney;  pancreas  en 
larged.    W't,  4oz.    Congestion  of  fundus 
of  stomach. 
Clots  in  ventricles  and  auricles  of  heart. 
W't  of  organ,  7J  oz.    Brain,  clear  serum 
in  both  lateral  ventricles.  Weight,  3  Ibs. 
9  oz.;  pancreas  normal. 

Heart,  clots  in  both  auricles  and  ventricles. 
Weight,  9  oz.    Brain,  serum  in  arachnoid 
and  lateral  ventricles  ;   some  congestion. 
W't,  3  Ibs.  7  oz.    Gall  bladder  contained 
IJoz.  viscid  tenacious  bile;  pancreas  nor 
mal. 
Heart,  large,  flaccid,  and  containing  clots. 
Weight,  1  Ib.    Brain,  surface  exsanguine, 
organ  flabby.    Serum  in  lateral  ventricles. 
Weight,  3  Ibs.  2  oz.     Pancreas.    Weight, 
3  oz.    Stomach  large,  mottled  in  fundus. 

Large  abscess  in  parietes  of  abdomen  at  in 
sertion  of  rectus  muscle. 

Heait  surrounded  by  adipose  tissue;  5oz. 
fluid  in  pericardia!  sac.    On  opening  skull 
large  quantity  of  blood  escaped  ;  2  clots  ad 
herent  to  bone  internally  ;  inguinal  glands 
enlarged. 
Heart  5J  in.  wide,  ">£  in.  thick,  weighed  17J 
oz.    Brain  normal;  diaphragm  dull  slate 
colored,  with  spots  of  lobular  pneumonia 
arid  copious  frothy  secretions. 
Fibriiious  clot  in  both  sides  heart;   oeso 
phagus  pale  and  yellow  ;  trachea  purple 
and  yellow  ;  pancreas  moderately  soft  ; 
pale  white  color. 

Heart  large  and  flabby;  left  ventricle  di 
lated  ;  white  fibrinous  clot  in  right  ventri 
cle  and  pul.  art.   Several  abscesses  in  both 
upper  extfeinities. 
Heart;  large  clot  in  r't  ventricle,  extended 
into  auricle,  inf.  and  sup.  cavae,  and  pul 
monary  art.  and  branches;  clots  in  left 
ventricle;  bladder  contracted  to  size  of 
walnut;  abs.  in  thigh. 
On  section  of  right  femur  cavity  found 
nearly  filled  with  pus;    extensive  inter- 
muscular  abscess  in  thigh. 

Abscess    through    both    hemispheres    of 
brain;  inguinal  glands  greatly  swollen; 
deep  abscess  below  popliteal  space. 
Clots  in  right  side  ot  heart;  medulla  and 
cancellated  structure  of  left,  and  medulla 
of  r't  femur  red  and  disorganized  ;  no  ab 
scesses  in  viscera. 
Walls  of  heart  thin  and  flabby  ;  valves  like 
finest  tissue  paper;  2  oz.  yellow  serum  in 
Sericardium  ;   brain  soft;  serum  beneath 
ura  mater  and  pia  mater,  and  in  lateral 
sinuses;  absces-*  on  back  of  left  hand. 
Pericardium  distended  with  serum.     Fore 
arm  and  hand  infiltrated  with  pus;   gan 
grene  ;  abscess  on  dorsal  aspect  left  hand. 
Heart  flabby   and    pale;    right   ventricle 
filled  and  soaked  with  blood. 

Large  thrombi  in  right  ventricle  and  au 
ricle  of  heart  ;  small  thrombi  in  left  side 
of  organ. 

Sliirht  patches  of  in 

flammation  in  lower 
part  small  intestine. 

L'ge  abs.  comin.  with 
kneej't;  syn.memb. 
soft  and  brok'u  down 
by  ulceration. 

Dark  purple,  twice 
natural  size;   2  fib. 
masses  at  mid.  post, 
border;   pus  in  low. 
border. 

Discolored  interiorly, 
and  easily  pulpitied. 
Weight,  22  oz. 

Light    colored  along 
exterior    and    ante 
rior  border.    W't,  1 
Ib. 

Light    colored,    flexi 
ble,  and  speckled  on 
section.    Weight,  12 
oz. 

Dark   colored   exter 
nally  and  internally. 
Weight,  9  oz.  4  dr. 

Large,    flabby,    light 
colored,  and  soft. 

Abscesses    in    poste 
rior  superior  surface. 

Dark   colored,    solid, 
and    quite    full    of 
blood.    Weight,  Hi 
oz. 

Natural    

Several  meseuteric 
glands  rnlarged;  in 
testinal  canal  natu 
ral. 

Discolored;  odor  pu 
trefactive.    Weight, 
5£  Ibs. 

Portions  of  ileum  and 
large  intestine  con 
gested  ;  jejunum  dis 
colored. 

A  few  blood  spots  and 
some    thinning    of 
mucous  membrane; 
otherwise     natural. 
Weight,  4  Ibs. 
Large  intestine  gen 
erally   dark   colored 
and     containing 
patches    of   lymph; 
same  in  jejunum. 

Jejunum  tinted  gray, 
mottled,  speckled, 
and  hypersernic  ;  ile- 
uni  congested;  large 
intestine  dark  col'd 
and  hypersemic. 
Normal  

Clot  in  femoral  artery 
of  stump  ;  another 
in  femoral  vein. 

Axillary  vein  clotted  ; 
contained   pus    and 
oil  globules;  no  pus 
in  femoral  vein. 
Fem.  art.  and  vein  dis 
eased  and  eroded  be 
low  lig.;  vein  inflam 
ed  above  and  cont'd 
purulent  matter. 
Apparently  healthy. 

Omentum  extended  £ 
way  to  pubis.     In 
testines  weighed  49 
oz. 

Right  knee  joint  filled 
with  apparently 
healthy  synovia. 

P  yarthrosis  left  elb'  w 

Dark  mulberry  color, 
and  softened.     Wt, 
11J  oz. 

Large  and  flabby,  con 
taining  about  a  doz. 
small  puruloid  foci. 

About   the    normal 
size,  but  softened. 

Enlarged,  and  almost 
of  the  consistence  of 
pulp. 

Normal  in  appear'ce; 
attached  to  diaph'm 
and  containing  pus. 
Softened;  no  abscess 
es. 

Fairly  congested  
Soft  and  enlarged  .... 

Inflated  with  gas.  .  .  . 

Healthy 

joint  ;  pus  in  cavity  ; 
articular  surface 
partly  denuded  of 
cartilage. 

Veins  of  both  upper 
extremities  healthy. 

Pus  formations  in  r't 
hip  joist. 

Right  hip  joint  liter 
ally  filled  with  pus. 

Seemingly  healthy  -  -  - 

Veins  of  stump  near 
end  loaded  with  d'rk 
soft  clots  ;  higher  up 
fil  1  'd  with  pus  nearly 
to  Poupart's  lig. 

3  oz.  pus  in  right  hip 
joint. 

Right,  elbow  joint 
rilled  with  pus;  pus 
in  right  shoulder 
joint. 

Left  femoral  vein 
filled  with  clots  up 
to  ext.  iliac;  fem. 
art.  healthy. 



Congested;  someadh. 
of  transverse  and  as 
cending    colon,   and 
ulceration   of   small 
intestine. 
Normal  .... 

Veins   leading    from 
forearm    and     hand 
diseased. 
Pulmonary  veins  fill 
ed  with  tough  cord- 
like  clots  of  fibrin. 

Considerably  eularg'd 
but  without  structu 
ral  change. 
Enlarged  ;  more  than 
J  normal  size;  pale 
blue,  and  soft. 

Mucous  liu'g  of  intes- 
tin'lcau'l  d'k  venous 
col'd;  ecchymoses. 

864 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XUL 


No. 
23 
24 
25 
26 

27 
28 
29 

30 
31 

32 
33 
34 

35 

36 
37 
38 

39 
40 

41 

42 

43 
44 

45 

46 
47 

48 

NAME,  INJURY,  ETC. 

LUNGS  AND  PLEUKAL  CAVITY. 

LIVER. 

KIDNEYS. 

Pt.  P.  Ostre,  H,  72d  New  York, 
age  21.    Fracture  ankle;  am 
putation  at  knee. 
Pt.  J.  Davis,  L,  1st  Michigan 
Cavalry,   age   22.      Fracture 
tarsus;  resection. 
Serg't  W.  Norton,  I,  5th  Wis 
consin,  age  20.  Fracture  neck 
right  troch.  major  of  femur. 
Pt.  J.  Thompson,  D,  9th  Vir 
ginia,  age  21.    Flesh  wound 
left  thigh. 

Serg't  D.  A.  Lent,  A,  6th  New 
York  Heavy  Artillery,  age  24. 
Flesh  wound  right  leg. 
Pt.  J.  P.  Yocum,  A,  89th  Illi 
nois.     Fracture    left   thigh  ; 
excision. 
Pt.  J.  Wallace,  F,  21st  Georgia, 
age  38.     Fracture  femur;  ex 
cision. 

Corp'l  A.  W.  Davis,  F,  14th  N. 
C.,  age  24.    Fracture  tars,  and 
met.  ;  amputation  leg. 
Corp'l  H.   Darragh,  K,    106th 
Penna  ,  age  40.    Fracture  r't 
shoulder  joint;  excision. 

Pt.  J.  F.  Bowser,  B,  llth  Penn 
sylvania,  age  18.      Fracture 
right  knee  joint;  amputation 
thigh. 
Pt.  J.  D.  Crowter,  D,  4th  New 
York  Heavy  Artillery,  aee24. 
Fracture  right  ankle  joint; 
amputation  leg. 
Pt,  C.  Smith,  B,  7th  Maryland, 
age  21.    Fracture  left  fibula. 

Pt,  C.  W.  Allen,  C,  1st  Maine 
H.  A.,  age  23.    Fracture  left 
elbow;  amputation  arm. 

Pt.  J.  Files,  I,  1st  Nebraska, 
age  20.    Fracture  left  radius; 
amputation  arm. 
Pt.  F.  Guthberlet,  K,  27th  Mas 
sachusetts,  age  26.    Fracture 
right  elbow;  exc.  ;  amp.  arm. 
Pt.  P.  Scanlan,  G,  69th  New 
York,  age  34.    Fracture  knee 
joint;  amputation  thigh. 

Pt.  G.  Laforce,  E,  26th  New 
Yerk.  Wounds  arm  and  knee 
joint;  amputation  arm. 

Pt.  J.  Moore,  E,  8th  Pennsylva 
nia  Reserves,  age  20.    Frac 
ture  leg;  amputation. 

PtS.McCan.  F,  1st  U.S.  Cav 
alry,  age  23.    Fracture  right 
ulna. 
Pfc.  C.  Crealman,  H,  118th  Penn 
sylvania,   age  21.     Fracture 
right  humerns. 

Corp'l  J.  H.  Higley,   A,  96th 
Pennsylvania,  ago'  20.     Frac 
ture  upper  third  femur. 

Pt.J.  Morrow,  D,  12th  Massa 
chusetts,   ago  31.      Fracture 
knee  joint;  amputation  thigh. 

Pt.   J.   Somers,  E,  64th  New 
York,  age  21.    Fracture  knee 
joint;  amputation  thigh. 

Pt,  M.  Casey,  K,  7th  Veteran 
Reserve  Corps,  age  25.     Frac 
ture  right  carpus. 
Pt.  G.  McCoy,  E,  6'2d  Pennsyl 
vania,  age  32.    Fracture  foot  ; 
amputation  leg. 

I't.  W.    Rimsey,    H,   6th  Vir 
ginia,  age  19. 

Numerous  small  abscesses  and  patches  of  lobu- 
lar  pneumonia  in  both  lungs. 

Abscess  in  left  lung  filled  with  dark  fetid  pus; 
small  abscess  in  right  lung;  effusion  in  left 
pleural  cavity. 
Nearly  whole  of  left  lung  inflamed  

Several    abscesses    in   left  lung:    right  lung 
healthy  ;  12  pints  pus  in  left  plenral  cavity. 

Lungs  congested  ;  largo  abscess  in  upper  lobe 
right  lung  filled  with  thick  pus. 

Left   lung   hepatized  ;    6   oz.   pus  in  pleural 
cavity. 

Lungs    adherent  and  studded  with   pya3mic 
patches;  serous  effusion  in  left  pleural  sac; 
pleurocollesis  both  sides. 

Small  abscesses  in  lower  lobes  both,  and  upper 
lobe  right  lung.     Weight,  right,  13*  oz.,  left, 
lljoz. 
Right  lung  adherent  to  walls  of  thorax  and  dia 
phragm  ;  frothy  fluid  exuded  from  lobes  on  sec 
tion;  left  lung  healthy.     Weight,  right,  21  oz.; 
left,  11J. 
Lungs  adherent;  lower  lobe,  right,  pneumonic 
and  studded  with  hardened  pyannic  patches  ; 
patches  contained  no  pus;  slight  congestion 
left  lung;  effusion  in  right  side. 
Lungs;  lower  lobes  carnifled;  adherent  to  sur 
rounding  tissue;  large  pyyeinic  patch  in  up- 
perlobe.  left;  about  20  abscesses  in  lower  iobe, 
right;  effusion  in  each  side  of  cavity. 
Lungs;  lower  lobes  hepatized  and  dotted  with 
pyaemic    patches;    recent   adhesions    about 
right;  20  oz.  effusion. 

Lungs  slightly  adherent  to  thorax  ;  right  lung 
considerably  congested  and  containing  a  small 
abscess.     Weight,  right,  Hi  oz.,  left,  9J  oz. 

Lungs  ;  lower  lobes  studded  with  metastatic 
abscesses;  recent  deposit  of  lymph  on  both 
pleural  surfaces. 
Pyretnic  abscesses   in  lungs;    left  collapsed; 
both  congested  and  adherent  to  pleura. 

Lungs,  strongly  marked  carbonaceous  deposit 
on;  lower  aud'posterior  parts  engorged;  right 
congested  and   containing  abscesses;   pleu 
ritic  adhesions  on  left  side. 
Lungs  black,   mottled,  and  reticulated;  me- 
lanic  deposit. 

Lungs  slightly  congested  ;  melanic  matter  pre 
sent;   abscesses  in  both.    Weight,   left,  22J 
oz.,  right,  15J  oz. 

Lungs  congested  and  coated  with  broken  down 
lymph  ;  right  filled  with  small  abscesses  ;  effu 
sion  in  left  pleural  cavity  ;  each  weighed  25  oz. 
Lungs  contained   numerous   abscesses;    both 
partially   adherent    and   hepatized  ;    pleura 
broken  down  and  adherent  to  lungs  ;  effusion 
in  cavity.     Right  weighed  25J  oz.,  left  19  oz. 
Lungs  congested  ;  recent  indurations  as  large 
as  an  egg  in  middle  part  of  both  near  base  ; 
not  converted  into  pus. 

Two  abcesses,  size  grain  of  maize,  in  apex  left 
lung;  surroundings  of  abscesses  for  about  J 
inch  of  a  dark  pink  color  and  denser  than 
surrounding  tissue. 

Abscesses  in  both  lungs;  left  compressed,  ad 
herent,  nnd  carnified  ;  right  pneumonic;   co 
pious  effusion  in  pleural  cavities. 

Pyajmic  patchetfin  lower  lobes  of  lungs;  large 
abscess  in  posterior  lobe  of  right  ;  slight  ad 
hesions;  no  effusion  in  c.ivities. 

Enl'g'd.  pale,  yellow,  fatty, 
and  softened. 

No  abnormal  appearances. 

No  abscesses  ;  fatty  

No  abscesses  ;  fatty  

Abscesses  in  both  kidneys  ; 
pus  in  both  ureters. 

Small  abscess  in  cortical 
portion  of  each  ;   pus  in 
ureters. 

Healthy   but  somewhat 
soft. 

Normal      

Healthy  

Healthy.     Weight,   right, 
8Joz.,  left,  7|  oz. 

Small,  contracted,  mottled, 
and  convoluted  ;    resem 
bled    brain    more    than 
liver.    Weight,  51  oz. 
Soft  and  fatty  

Decidedly  fatty  

Enlarged  J  ;  in  a  state  of 
fatty  degeneration;    gall 
bladder  nearly  empty; 
stricture  near  middle. 

Apparently  healthy  

Somewhat  fatty      .  . 

Abscess  in  right  lobe  filled 
with  creamy  pus.     W't, 
59  oz. 

No  abscesses  in  liver  

Apparently  healthy  

No  abscesses  in  kidneys  .. 

Decomposed  abscess  in  left 
lobe  size  of  a  small  shot. 

Enlarged,  adherent  to  dia 
phragm,    stomach,  and 
trans  v'se  colon  ;  abs.  in  r't 
lobe  and  on  up.  and  r'tside. 
Large  and  finely  mottled.. 

Light  coffee  colored,  finely 
mottled,  and  large.    W't, 
82J  oz. 

Three   abscesses  in,    con 
taining   2  oz.   pus   each. 
Weight,  5  Ibs.  2  oz. 
Enormously  enlarged,  and 
containing  numerous  ab 
scesses. 

Nutmeg  appearance  on  sec 
tion  ;  no  abscesses  in. 

Healthy     

Enlarged,  pale,  and  indura 
ted. 

Large  and  pale  

Kidneys.     Right  weighed 
6  oz.,  left,  6J  oz.     Supra 
renal  capsules  much  en 
larged.     W't,  both,  J  oz. 

Congested.    Weighed  6oz. 

Both  contained  abscesses  ; 
cortical    substance    con 
gested  ;  left  enlarged; 
right  weighed  7$,  Ieft9oz. 
Contained  no  abscesses  — 

Pale,    firm;    cortical   sub- 
stanco  same  hue  as  py 
ramidal. 

Healthy                     

In  a  state  of  acute  hepa 
titis  and  quite  friable. 

Lunus  slightly  congested  at  posterior  lobes; 
small  pysemic  patch  in  right  inferior  lobe  of 
right. 

In  a  state  of  putrid  decom 
position. 

CHAP.  XII.] 


PYAEMIA. 


865 


'NO. 


SPI.KEX. 


INTESTINES. 


JOINTS. 


BLOOD  VESSELS. 


REMARKS. 


23 
24 
25 
26 

27 
28 
29 

30 
31 

32 
33 
34 

35 

36 
37 
38 

39 
40 

41 
42 

43 
44 

45 

46 
47 

48 

Not  enlarged;    paler 
than   natural,    and 
softened. 
Enlarged   and    soft 
ened. 

Not  enlarged  or  soft 
ened. 

Largo  abscess  in  ;  dis 
charging  pus   into 
abdomen  ;  organ  en 
larged. 
Normal  . 

Thrombus  of  superf. 
fern.,  profunda,  and 
external  iliac  veins. 
Femoral  vein  throm- 
bosed. 

Large  thrombus  in  right  ventricle  and  au 
ricle  of  heart;  small  ones  in  left.  Muscles 
of  thigh  infiltrated  with  pus. 
Clots  in  both  ventricles  of  heart:  cancel- 
lous  structure  of  calcaneum  gangrenous  ; 
osteomyelitis. 
No  chills  occurred  although  tho  disease 
lasted  42  days. 

Heart  healthy;  3  oz.    serum   in   priicar- 
dinm.    Abscesses  in  and  pus  at  points  of 
right  cerebrum.    Pus  burrowed  among  ; 
muscles  of  thigh  from  knee  to  hip. 
Heart;  right  ventricle  filled  wiih  a  semi 
organized  clot.  Pancreas  and  stomach  nor 
mal. 
Parotid  gland  enormously  enlarged   and 
distended  with  pus;  cartilaginous  but  no 
ossific  union  of  fracture. 
Heart  healthy;  brain,  large  amount  of  se 
rous  subarachnoid  effusion.     Lymphatic 
glands,  left  groin,  enlarged. 

Small  clot  in  right  side  heart.     W't,  OJoz.; 
tissues  of  stump  in  sloughing  condition; 
structures  of  bones  full  of  oil  globules. 
Heart  ;  fibrinous  clot  in  both  ventricles. 
W't,  9  oz.    Ann  and  wound  gangrenous. 

Marrow  of  femur  red  and  soft;  in  portion 
gangrenous,  and  entirely  gone  for  3  inches 
in  lower  end. 

Abscesses  between  muscles  of  stump;  2 
small  ones  near  bone. 

Large  fibrinous  clot  in  left  auricle  and 
ventricle,  and  long  thin  clot  in  right  au 
ricle  extending  into  pulmonary  artery. 

Large  fibrinous  clot  in  right  side  heart  ; 
extremity  of  median  nerve  bulbous;  small 
abscess  throughout  tissues  of  slump  to 
shoulder  joint. 
Fungous  mushroom  protrusion  of  medulla 
and  other  marks  of  osteomyelitis. 

Heart  normal;  stump  oedematous  and  filled 
with  serum  ;  bone  semi-purulent  through 
out. 
Heaitlivid  in  colorand  flabby  ;  clotsin  right 
and  left  ventricles;    dura  mater  tense; 
coats  of  stomach  pale,  soft,  and  injecied 
in  spots. 
Bronchial  glands  enlarged  and  as  black  as 
ink  ;  gall  bladder  light  colored. 

Brain  ;  effusion  of  serum  into  lateral  ventri 
cles;  large  abscess  with  black  walls  about 
middle  third  femur  ;  medulla  of  tibia  soft 
ened. 

Heart  healthy.    Weighed  7  oz. 

Clot  in  left,  and  abscesses  in  r't  ventricle  of 
heart;  trach.  and  bron.  tubes  congested; 
cardiac  orifice  of  stomach  congested;  pan 
creas  broken  down  and  softened. 
Abscess  below  knee  broke,  discharging 
offensive  matter. 

Medullary  subst.  yellowish,  ochre-colored, 
and  protruding  from  femur;  no  inflamma 
tion  in  thigh,  or  any  of  tho  organs  ;  muscles 
attached  to  femur  healthy  ;  periosteum 
firmly  adherent. 
Entire  exterior  of  femur  in  a  gangrenous 
condition. 

Soft  parts  of  forearm,  except  vessels,  thor 
oughly  disorganized. 

Pericardium  filled  with  serum  ;  2  oz.  serum 
in  lateral  ventricles  of  brain  ;  no  pus,  but 
an  unusual  amount  of  serum  in  all  the  se 
rous  cavities. 
Fibrinous  clot  in  right  ventricle  of  heart  ; 
pyramidal  bodies  becoming  invisible. 

Pus   in  ankle  joint; 
also  in  astragalo-sca- 
phoid  articulation. 
Hip  joint  and   parts 
infiltrated    with    a 
dark  thin  fetid  pus. 
Left  knee  and  wrist 
joints  examined  ;  no 
pus. 

Pus  in  right  knee  and 
wrist  joints;  none  in 
ankle. 

Veins  as  far  as  exam 
ined  healthy. 

Enlarged  but  not  soft 
ened. 

Soft  and  pulpy.   W't, 
12i  oz. 

Much  enlarged,  firm, 
not  pulpy.   Weight, 
9  oz. 

Healthy  

Old,  partially  disinte 
grated  blood  clots  in 
fern,  vein;  walls  of 
vein  thickened;  fe 
moral  art.  healthy. 

Crocuni  congested; 
otherwise  healthy. 

Contained  no  pus  

Knee  joint  not  in 
volved. 

Femoral  vein  inflam'd 
and  filled  with  dark 
clots  ;  art.  healthy. 

Pus   in  one  of  the 
veins;   clots  in  the 
others. 

Dark  clot  partly  tilled 
femoral  vein  ;  inside 
coat  of  vein  red  and 
inflamed;  post.  tib. 
art.  oblite'd  in  w'd. 
Arteries  and  veins  of 
stump  healthy. 

Closure  of  vein  about 
li  inches  from  ex 
tremity  of  bone. 
Ves'ls  of  arm  normal  ; 
firm  black  clot  filled 
axill'y  vein  ;  no  pus. 
Vessels  of  dura  mater 
congested. 

Considerably   soften 
ed,  and  dark  colored. 

Healthy  

Apparently  healthy.. 

Apparently    healthy. 
"Weight,  9  oz. 

No  abscesses  in  spleen 

A  grumous  dark  pur 
ple  mass  ;  very  soft  ; 
complet'ly  disorg'd. 
Enlarged,  softened, 
dark  purple,  and  ad 
herent  to  diaphragm 
and  peritoneum. 
Enlarged,   hard,   and 
very  light  colored. 

Weighed  4  J  oz 

Apparently  healthy  .  . 

Fluid  resembling  pus 
in  left  shoulder  joint. 

Normal 

Large    abscess    in 
shoulder  joint  ;  pus 
healthy. 

Transverse   and    de 
scending  colon  and 
rectum    reduced   in 
calibre. 
Full  of  gas  ;  colon  es 
pecially  distended 

Inflated,  mottled,  and 
streaked. 

Fibrinous,  flaky,  tena 
cious  pus  to  hip  j't; 
abscesses   extended 
to  knee  j't;  cartila 
ges  of  knee  j't  erod'd. 
Pus  in  left  knee  joint  ; 
synovial   membrane 
destroyed;  cartilage 
eroded:  pus  in  r'tsh. 
j't;  none  in  hip  j'ts. 
Carpus  filled  with  pus. 

Phlebitis  with   total 
disorganization     of 
fern,  vein;  bel.  knee 
vein    occupied    by 
tube  filled  with  pus. 

Much  congested. 
Weighed  10  oz. 

Soft,  and  of   dark 
brown  hue.    W'd  8 
oz. 

Many  small  abscesses 
in  spleen  ;  not  much 
enlargement. 

Dark    purple    color, 
faintly    granulated  ; 
not  very  firm. 

About  the  usual  size 
and  consistence. 

Healthv  

Small  intestines  some 
what  congested  ;  cae 
cum  sphacelous 
throughout. 

Vessels  of  fractured 
arm  healthy. 

Thrombi   in    smaller 
veins  from  side  near 
est  broken  bone  ex 
tend  into  fern.  vein. 
Femoral  vein  filled 
with  a  grayish  black 
clot  ;  artery  fi  1  1  e  d 
with    partially    de 
composed  clot. 
Femoral  vein  fi  1  1  e  d 
with  partially  soft 
ened  clots  nearly  to 
Ponpart's  ligament. 
No  rJots  discovered  .  . 

Suppurative     inflam 
mation  of   veins  of 
leg. 

Thick  creamy  pus 
from  face  of  stump 
toPoupart's  liga 
ment  in  fern.  vein. 

Healthy  

Normal  

Formation  of  pus  in 
left  shoulder  joint. 

No  pus  in  the  joints 

Decidedly  softened 

SURG.  111—109 


866  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xii. 

Abstracts  of  forty-eight '-post-mortem  examinations  are  recorded  in  the  preceding  table. 
Metastatie  abscesses  were  found  in  the  lungs  in  thirty-five,  in  the  liver  in  nine,  in  the  kidneys 
in  three,  in  the  spleen  in  four  instances,  and  in  sixteen  cases  pus  was  found  in  the  joints.  The 
lymphatic  glands  of  the  groin  wen-  swollen  in  three-  cases,  and  in  a  case  of  a  fracture  of  the 
femur  (No.  2S.  p.  8(>4),  the  parotid  gland  was  enormously  enlarged  and  distended  with  pus. 
Several  other  instances  of  swelling  of  the  parotid  glands  were  recorded  in  cases  in  which 
no  autopsies  were  made: 

CASK  1227. — Private  Henry  M.  .Smith.  Co.  G,  82d  Pennsylvania,  aged  2s  years,  received  ut  Amelia  Springs,  Virginia, 
•April  6,  18t>.~>,  a  compound  comminuted  fracture  of  the  right  knee.  His  right  thigh  was  amputated  in  the  middle  third,  by  lateral 
Haps,  April  tith.  He  \vas  admitted  to  division  No.  1,  Annapolis  General  Hospital,  April  15th,  from  City  Point.  When  first  seen, 
on  April  28th.  l>y  Surgeon  U.  A.  Vanderkieft,  V.  S.  V..  who  reports  the  case,  the  patient  was  in  a  state  of  great  debility,  with 
delirium  and  other  symptoms  of  py;vmia.  The  stump  wis  in  a  very  unhealthy  condition,  the  discharge  of  pus  sanious,  and  the 
end  of  the  femur  protruding  an  inch.  The  stump  was  kept  clean  by  the  use  of  soap  and  water,  and  oakum  dressings  were 
applied.  Tonics  and  stimulants  were  administered  internally.  On  May  2d  the  pysemic  symptoms  were  still  more-  fully  devel 
oped,  the  skin  having  assumed  a  yellow  hue.  The  right  parotid  gland  was  swollen,  and  its  external  appearance  indicated  that 
an  abscess  had  formed.  The  patient  now  lay  in  a  lethargic  state,  the  discharges  from  the  bowels  became  involuntary,  and  he 
gradually  sank.  He  died  May  7.  1865.  No  post-mortem  examination  was  made. 

CASE  1228. — Corporal  Hubert  A.  Whecdu-n,  Co.  K.  47th  North  Carolina,  aged  '24  years,  received  a  compound  comminuted 
fracture  of  the  right  thigh,  at  the  battle  of  Gettysburg.  July  3,  1863.  Amputation  was  performed  in  the  hospital  of  the  2d  divis 
ion,  First  Corps,  July  7th,  at  the  upper  third  of  the  thigh.  On  July  12th  secondary  haemorrhage  occurred,  supposed  to  proceed 
from  a  large  muscular  branch;  was  arrested,  after  about  four  ounces  of  blood  had  been  lost,  by  elevating  the  stump  and  making 
pressure  over  the  femoral  artery.  Pyaemia  was  recognized  July  16th.  An  abscess  developed  in  the  region  of  the  left  parotid 
gland,  which  was  incised  July  21st.  when  a  slight  discharge  of  pus  oozed  from  the  incision.  Quinine,  stimulants,  and  nourish 
ing  diet  were  employed.  The  patient  died  July  23.  186?.  No  post-mortem  examination  was  made.  The  case  is  reported  by 
Surgeon  W.  B.  Chambers,  97th  New  York. 

CASK  1229. — Private  John  Kreps,  Co.  C,  29th  Iowa,  aged  16  years,  received  on  April  30.  1864,  a  shot  wound  of  the  right 
thigh ;  the  femur  was  fractured  at  the  junction  of  the  lower  with  the  middle  thirds,  and  the  bone  was  splintered  to  the  knee  joint. 
He  was  admitted  to  hospital  at  Little  Rock.  Arkansas,  on  May  3d.  The  ends  of  the  bone  at  the  point  of  fracture  became  carious, 
and  on  July  9th  amputation  was  performed  at  the  junction  of  the  upper  and  middle  thirds  of  the  thigh  by  the  antero-posterior 
flap  method;  there  was  little  haemorrhage;  chloroform  was  used.  The  patient  did  well  till  the  20th  day,  when  abscesses  formed 
in  the  stump  and  in  the  parotid  gland.  The  patient  died  of  pyaemia  August  8,  1864.  No  autopsy  was  held.  The  case  is 
reported  by  Assistant  Surgeon  E.  A.  Clark,  U.  S.  V.,  who  performed  the  amputation. 

CASK  1230.— Private  J.  F.  Smith.  Co.  C.  61st  New  York,  aged  17  years,  received,  at  Burksvillo,  Virginia.  April  8,  186'), 
a  shot  fracture  of  the  right  knee.  On  the  following  day  (April  9th)  amputation  through  the  lower  third  of  the  thigh  was  per 
formed.  He  was  treated  in  field  hospital,  and  subsequently,  on  May  14th,  lie  was  admitted  to  Armory  Square  Hospital  at  Wash 
ington.  The  symptoms  of  the  case  are  briefly  noted  on  the  bed-card  by  Acting  Assistant  Surgeon  C.  H.  Urown :  Metastatic 
abscesses  of  surface;  swelling  of  joints;  icteric  tinge  of  skin  and  conjunctiva  of  eye:  swelling  of  submaxillary,  sublingual.  and 
parotid  glands;  joints  painful?  chills,  and  change  of  chill  to  that  of  burning  heat;  profuse  diarrhoea;  nausea,  headache,  and 
delirium.  Death  on  May  24,  1865,  of  pyaemia  and  exhaustion.  No  autopsy  was  made. 

CONCLUDING  OBSERVATIONS  ON  SHOT  WOUNDS. 

The  details  of  the  treatment  of  special  shot  injuries  and  of  the  most  serious  complica 
tions  have  been  fully  described  under  the  proper  headings  in  this  and  the  preceding  volumes, 
and  it  is,  therefore,  only  necessary  here  to  allude  briefly  to  the  immediate  care  of  the 
wounded  after  battles  and  engagements,  and  to  a  few  points  of  a  general  character  appli 
cable  to  shot  wounds. 

Slight  wounds  were  examined  and  dressed  at  the  primary  stations;  those  of  greater 
severity  received  such  care  as  their  condition  demanded,  and  we're  at  once  sent  by  the 
ambulance  wagons  to  the  field  hospitals.  The  importance  of  an  early  and  complete  exam 
ination  of  the  wounded  seems  to  have  been  fully  real i /eel  by  the  surgical  staff.  This 
examination  was  generally  conducted  under  the  influence  of  anaesthetics  for  the  purpose  of 
accurate  diagnosis;  in  its  course,  balls  and  foreign  bodies  were  extracted,  bleeding  vessels 
secured,  and'  splinters  of  bone  removed;  upon  its  conclusion  such  operations  were  performed 
as  in  the  judgment  of  the  surgeon  were  necessary.  In  determining  the  extent  of  injury  it- 
was  not  unusual  to  enlarge  the  wound  caused  by  the  missile,  especially  in  cases  where  the 


CHAP.  XII.]  CLIMATIC,    HYGIENIC,    AND    MORAL    INFLUENCES.  867 

advent  of  swelling  caused  difficulty  or  uncertainty  of  touch,  or  where  it  became  necessary 
to  remove  splinters  or  foreign  bodies.  In  the  examination  of  a  wound  experience  confirmed 
the  common  view  that  the  finger  is  the  surest  and  most  intelligent  probe.  With  regard  to 
the  removal  of  splintered  bone  and  foreign  bodies,  experience  seems  to  warrant  all  reason 
able  means  for  their  removal,  since  they  are  liable  to  become  sources  of  irritation  and 
danger.  The  ends  of  splinters  of  bone  still  attached  may  be  cut  off,  but  forcible  detach 
ment  must  be  avoided.  Missiles  should  be  extracted  if  they  can  be  readily  found  and  it 
can  be  done  without  risk  to  vital  parts;  but  it  should  also  be  borne  in  mind  that  they  may 
become  encysted,  giving  no  further  trouble. 

The  primary  dressing  of  wounds  and  operations  was  always  of  the  simplest  character; 
a  piece  of  lint  or  linen  held  in  place  by  the  turns  of  a  roller  bandage  and  kept  well  moist 
ened  with  water.  Instances  have  been  cited  of  great  inconvenience  and  even  of  serious 

o 

complications,  such  as  gangrene  and  tetanus,  being  caused  by  tight  bandaging.  The  pres 
ence  of  maggots  in  wounds,  in  the  field  and  camp  hospitals,  was  frequently  an  annoying 
complication.  After  protracted  battles,  such  as  the  fighting  on  the  Peninsula  in  June  and 
July,  1862,  and  after  the  Wilderness  and  Spottsylvania,  in  1864,  when  the  means  of  trans 
portation  were  not  sufficient  to  move  the  wounded  rapidly  to  permanent  hospitals,  and  when 
the  number  of  attendants  was  entirely  inadequate  to  the  demand,  maggots  were  found  in 
abundance  in  and  beneath  the  dressings  and  in  the  wounds.  Surgeon  D.  Prince,  U.  S.  V., 
cautions  "against  the  use  of  too  much  dressing,  as  the  impression  that  the  work  of  flies 
will  be  frustrated  thereby  is  erroneous.  While  the  dressings  are  wet  flies  will  deposit  their 
eggs  through  several  thicknesses  of  muslin,  and  also  along  the  border  of  the  dressings,  and 
once  hatched  the  little  ravenous  maggots  will  insinuate  themselves  among  all  the  layers  of 
dressings  and  under  them  into  the  wound  itself.  Nothing  but  frequent  dressing  will  keep 
them  from  developing  in  the  wound.  Oil  of  turpentine  and  infusions  of  tobacco  were  used 
to  kill  these  pests.  Petroleum  or  kerosene  oil  was  tried  in  some  cases  with  markedly  good 
effect,  but  the  most  effectual  remedy  was  a  thorough  examination  of  the  dressing  every 
two  or  three  hours."  In  well  established  general  hospitals  the  presence  of  maggots  was 
rarely  noted. 

Climatic,  Hygienic,  and  Moral  Influences. — Of  the  effects  of  climate  on  the  treatment 
and  result  of  wounds  the  reports  of  the  war  afford  but  little  information.  Casual  remarks 
were  occasionally  made  by  medical  officers  that  in  certain  climates  and  localities  wounds 
"did  well,"  or  otherwise;  but  so  vague  a  statement  proves  of  little  value,  as  it  is  more 
than  probable  that  insufficient  consideration  was  given  to  other  closely  related  conditions 
which  may  have  exerted  a  stronger  influence  than  climate  itself.  The  change  of  climatic 
conditions  experienced  by  our  armies  during  the  operations  of  the  war  in  a  sudden  tran 
sition  from  the  cool  and  more  healthy  regions  of  the  north  to  the  warm  semi-tropical  and 
malarious  climates  of  the  south  could  not  fail  to  make  itself  felt  on  the  general  organism, 
aside  from  any  of  the  concurrent  exposures,  hardships,  or  privations  incident  to  the  soldier's 
life.  To  what  extent  the  health,  vigor,  and  efficiency  of  the  troops  campaigning  in  the 
southern  regions  was  impaired  by  causes  due  to  climatic  origin  is  shown  in  the  medical 
portion  of  this  work.  Suffice  it  to  say  that  under  these  acquired  conditions  wounds  and 
surgical  diseases  suffered  a  corresponding  modification.  Laying  aside  the  consideration  of 
other  factors,  it  seems  that  continuous  dry  heat  is  not  unfavorable  to  the  satisfactory  pro 
gress  of  gunshot  wounds;  the  same  may  be  said  of  the  same  quality  of  cold — both  probably 


868  WOUNDS    AND    COMPLICATIONS.  [CHAP.  XTI. 

act  as  tonics  to  the  system  at  large.  Moist  climates  with  continuous  heat  are  relaxing  and 
weakening,  rendering  the  body  less  capable  of  resisting  the  onset  of  prevailing  diseases, 
and  cannot  be  considered  advantageous.  It  has  been  claimed,  however,  that  the  moist 
climate  of  parts  of  the  southern  seacoast  was  exceedingly  favorable  to  the  healing  process 
of  wounds;  it  may  be  that  the  especial  qualities  of  sea  air  afforded  a  desirable  element. 
The  pure  bracing  air  of  the  highlands  of  Virginia,  Tennessee,  and  Georgia  were,  without 
doubt,  especially  favorable  to  the  recovery  of  the  wounded.  The  successful  results  of 
wounds  and  operations  in  General  Sherman's  campaign  from  Atlanta  to  the  sea  was  espe 
cially  marked,  though  it  must  be  admitted  that  very  important  factors  other  than  that  of 
mild  equable  climate  had  their  full  influence  upon  the  men  of  that  command.  Sudden  and 
extreme  variations  of  temperature  and  humidity  were  decidedly  prejudicial  to  the  course  of 
wounds,  and  seem  especially  to  favor  the  access  of  tetanus.  Prolonged  cold  and  moisture 
were  generally  regarded  unfavorably  as  favoring  the  presence  of  surgical  complications,  as 
erysipelas  and  gangrene,  though  here  the  probable  explanation  is  that  these  diseases  were 
engendered  by  the  want  of  free  ventilation. 

The  subject  may  be  briefly  summed  up  in  the  statement  that  those  conditions  of  climate, 
wherever  found,  which  allow  the  fullest  and  freest  exposure  to  pure  fresh  air,  are  undoubt 
edly  those  most  favorable  to  the  rapid  and  uncomplicated  recovery  from  wounds,  while  such 
conditions  as  tend  to  prevent  a  free  out  of  door  life,  or  compel  the  exclusion  of  large  quan 
tities  of  free  air  from  the  wards  of  hospitals  and  from  barracks  and  tents,  or  such  as  favor 
the  rapid  decomposition  of  vegetable  and  animal  matter,  are  to  be  considered  as  more  or 
less  prejudicial  and  harmful  to  the  course  and  treatment  of  wounds. 

The  influences  of  hygienic  conditions,  food,  and  concurrent  diseases,  upon  the  results 
of  shot  injuries  in  time  of  war  are  similar  to  those  observed  in  cases  treated  in  time  of  peace 
in  civil  hospitals.  The  influence  of  the  mental  condition  on  the  results  of  wounds  is  undeni 
able.  All  reports  agree  that  the  wounded  of  victorious  troops,  elated  by  the  successes 
achieved  by  their  own  bravery  and  that  of  their  comrades,  did  better  than  those  of  defeated 
armies.  The  most  striking  example  of  this  influence  of  the  mental  condition  on  the  success 
ful  treatment  of  wounds  in  modern  times  is  the  fearful  mortality  among  the  French,  after 
shot  wounds  of  all  kinds,  in  the  war  of  1870-'71.  The  excessive  mortality  of  that  cam 
paign,  repeatedly  pointed  out  in  the  chapters  on  special  wounds,  was  undoubtedly  largely 
owing  to  the  mental  depression  caused  by  a  succession  of  reverses  rarely  met  with  in  the 
history  of  warfare. 

Multiple  Wounds. — There  is  no  doubt  that  in  a  large  proportion  of  the  killed  on  the 
battle-field  death  was  caused  by  several  wounds  simultaneously  received;  but  many  cases 
of  recovery  after  multiple  wounds  have  also  been  recorded.  It  is  impossible  to  give  even 
an  approximate  estimate  of  the  frequency  of  the  cases  in  which  several  wounds  were  found 
in  the  same  individual.  The  cases  were  classed  with  those  injuries  which  seemed  to  be  the 
gravest.  In  the  following  instance  there  were  no  less  than  twenty-six  wounds  of  entrance 
and  exit.  The  patient  died  twenty-eight  days  after  the  receipt  of  the  injuries: 

CASK  1231. — Private  Franz  Metzel,  Co.  A,  llth  Massachusetts,  aged  31  years,  was  wounded  at  Spottsylvania.  May  12, 
1864.  On  May  25th  he  was  admitted  into  Armory  Square  Hospital,  Washington.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  reported: 
"  This  soldier  accidentally  got  between  or  in  the  range  of  cross-firing  and  received  twenty-six  separate  wounds  of  entrance  and 
exit,  and  when  admitted  was  sufficiently  strong  to  converse  and  relate  his  sad  fate.  The  wounds  were  by  minid  balls,  as  fol 
lows:  1st  entered  just  anterior  to  external  malleolus  of  left  ankle  and  emerged  about  the  middle  of  the  sole  of  the  foot;  *2d 
entered  left  leg  just  above  external  malleolus,  passed  upward,  and  emerged  five  inches  above  the  heel;  3d  ball  entered  left  leg 
six  inches  jvbove  external  malleolus,  and  made  its  exit  on  the  inner  side  four  inches  below  the  knee  joint;  4th  entered  just  below 
the  head  of  the  left  fibula,  and  emerged  on  the  internal  aspect  nearly  opposite  point  of  entrance ;  5th  entered  left  thigh  exter- 


CHAP,  xn.]  CONSERVATION,    EXCISION,    AMPUTATION.  869 

nally.  three  inches  ahove  knee,  and  emerged  on  inner  side  opposite  point  of  entrance;  6th  entered  left  thigh  on  the  external  and 
middle  part,  passed  through,  and  emerged  opposite  point  of  entrance;  7th  entered  just  above  the  coccyx  and  remains  in  parts 
unknown;  8th  entered  the  back  three  inches  above  left  hip,  and  remains;  9th  entered  just  below  inferior  angle  of  left  scapula 
and  remains  in  parts  unknown  ;  10th,  left  arm,  two  wounds  below  and  three  above  the  elbow,  the  bones  above  and  below  being 
fractured:  llth  entered  right  leg  above  the  middle  and  made  its  exit  on  the  calf  opposite  point  of  entrance;  12th  entered  about 
three  inches  below  the  right  knee,  a  little  internal,  and  remains;  13th  entered  right  thigh  externally,  about  the  middle,  and 
made  its  exit  on  the  inner  side  opposite  point  of  entrance;  14th  entered  upper  third  of  right  thigh,  on  the  external  side,  and 
remains  in  parts  unknown.  He  died  May  30,  1864." 

In  the  following  case  the  patient  made  a  good  recovery  after  receiving  four  shot 
wounds,  three  of  which  were  of  a  serious  nature : 

CASE  1232. — Private  Charles  Sebring,  Co.  F,  48th  Indiana,  was  wounded  at  luka,  Mississippi,  September  19,  1862,  and 
admitted  into  hospital  at  Jackson,  Tennessee,  September  19th.  Assistant  Surgeon  J.  P.  Wright,  U.  S.  A.,  reported :  "  He  was 
first  disabled  by  a  musket  ball,  which  passed  through  the  hamstring  muscles  of  the  left  thigh;  and  in  this  helpless  condition, 
stricken  down  in  the  thickest  of  the  fight,  he  received  three  other  wounds  from  musket  balls— one  ball  impinging  upon  the  left 
parietal  bone  and  furrowing  the  scalp  without  causing  fracture;  another  passing  through  the  left  forearm,  in  its  lower  third,  fract 
uring  and  comminuting  both  bones;  and  a  third  passing  through  the  middle  third  of  the  right  arm  and  emerging  on  the  posterior 
and  inner  aspect,  causing  a  comminuted  fracture  of  the  humerus.  The  flesh  wound  in  the  thigh  healed  rapidly;  the  wound  in 
the  left  forearm  continued  to  discharge  for  four  months,  and,  after  the  removal  of  several  fragments  of  bone,  ultimately  healed 
with  loss  of  pronatiou  and  supination,  and  with  contraction  of  the  flexor  tendons;  it  seemed,  however,  to  cause  little  constitu 
tional  disturbance.  The  fracture  of  the  left  humerus  gave  to  the  case  its  peculiar  interest.  In  November,  1862,  when  the  case 
first  came  under  my  own  supervision,  the  arm  was  much  swelled  and  very  intolerant  of  manipulation ;  there  had  been  no  attempt 
at  bony  union,  and  the  exsanguineous  and  emaciated  condition  of  the  patient  augured  a  speedy  and  fatal  issue.  There  was  a  pro 
fuse  discharge  from  both  orifices  of  the  wound,  the  character  of  which,  however,  was  healthy ;  light  dressings  were  applied  and 
a  nourishing  diet  enjoined.  Two  weeks  later  the  limb  was  seized  with  phlegmonous  erysipelas;  the  pain  was  excessive  and  the 
swelling  so  great  that  the  tense  and  glistening  integument  threatened  to  burst.  Great  constitutional  disturbance  ensued;  the 
stomach  rejected  everything  that  was  offered,  colliquative  diarrhoea  supervened,  a  harassing  cough  racked  the  patient's  frame, 
already  reduced  to  a  skeleton  by  months  of  suffering  and  exhaustive  suppuration,  the  conjunctiva  became  icteroid,  and  profuse 
sweats  by  day  and  night  gave  additional  evidence  of  the  great  prostration  of  the  vital  powers.  No  pus  was  detected  in  the 
alvine  evacuations;  but  it  was  strongly  suspected  in  the  sputa,  and  indicated  by  every  test  attainable.  The  local  treatment 
adopted  was  scarification  of  the  affected  part,  followed  by  warm  fomentations  of  infusion  of  elm  and  laudanum,  in  which  the  whole 
limb  was  enveloped.  The  constitutional  treatment  was  mainly  supporting.  About  four  days  from  its  inception  the  erysipelatous 
action  showed  signs  of  abatement,  attended  with  marked  improvement  of  the  constitutional  symptoms.  This  favorable  change 
continued  for  about  three  weeks,  and  the  improved  appetite  and  cessation  of  diarrhosa  and  exhaustive  sweats  again  aftbrded 
encouragement.  But  the  condition  of  the  arm  was  not  promising;  the  discharge  had  become  very  fetid,  and  the  tissues,  to  the 
fingers'  ends,  infiltrated  with  serum.  With  the  limb  in  this  condition,  the  most  favorable  result  to  be  anticipated  from  a  second 
attack  of  erysipelas  would  be  gangrene  of  the  extremity;  and  yet,  although  about  this  period  the  morbid  action  returned, 
scarcely  less  threatening  in  character  than  before,  it  yielded  promptly  to  free  scarification  followed  by  warm  fermentations,  the 
only  inconvenience  resulting  therefrom  being  a  considerable  amount  of  sloughing  of  the  integument.  On  the  subsidence  of  this 
second  attack  the  utter  prostration  of  the  vital  powers  seemed  almost  to  preclude  the  hope  of  recovery.  A  stimulating  and  nour 
ishing  diet  was  enjoined,  ale  or  milk  punch,  according  to  the  patient's  wish,  being  administered  several  times  daily,  together 
with  compound  tincture  cinchona,  which  was  exhibited  continuously  for  many  weeks.  From  this  period  convalescence  began." 
Sebring  was  discharged  from  service  April  8,  1863,  and  pensioned.  In  May,  1863,  his  left  arm  was  amputated  near  the  shoulder,1 
at  his  home,  by  Drs.  Grimes  and  Badger.  He  was  last  paid  in  September,  1881. 

CONSERVATION,  EXCISION,  AMPUTATION. 

The  shot  wounds  of  the  extremities  number  one  hundred  and  seventy-four  thousand 
two  hundred  and  six  (174,206),  or  over  two-thirds  of  the  total  number  of  shot  injuries.  Of 
these,  one  hundred  and  forty  thousand  one  hundred  and  twenty-four  (140,124)  were  treated 
without  operative  interference,  four  thousand  six  hundred  and  fifty-six  (4,656)  were  followed 
by  excision,  and  twenty-nine  thousand  four  hundred  and  twenty-six  (29,426)  by  amputa 
tion.  To  the  cases  of  amputation  should  be  added  three  hundred  and  five  (305)  amputa 
tions  following  excisions,  and  two  hundred  and  forty-nine  (249)  re-amputations,2  making 
the  total  number  of  amputations  twenty-nine  thousand  nine  hundred  and  eighty  (29,980). 
The  tables  on  the  next  two' pages  contain  numerical  summaries  of  the  shot  fractures  of  the 

'See  TABLE  LXXXIV,  No.  104,  page  778,  Second  Surgical  Volume. 

2  In  the  Surgical  portion  of  this  work  the  extremities  have  been  subdivided  as  follows :  Upper  Extremities — hand,  wrist,  forearm,  elbow  joint,  shaft 
of  humerus,  and  shoulder  joint;  and  Lower  Extremities — foot,  ankle  joint,  leg,  knee  joint,  thigh,  and  hip  joint.  Under  re-amputations,  here  referred  to, 
are  understood  cases  in  which,  for  instance,  the  original  amputation  was  in  the  leg  and  the  subsequent  operation  at  the  knee  joint,  thigh,  or  hip  joint  It 
was  impossible  to  indicate  in  this  TABLE  the  cases  of  re-amputations  in  the  same  subdivisions;  as,  for  instance,  amputations  in  the  low*  third  of  the 
thigh,  with  re-amputatiou  in  the  middle  or  upper;  and  likewise  in  the  leg  and  arm  and  forearm,  although  a  great  number  of  such  instances  are  reported. 


870 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 

TABLE 
Tabular  Statement  of  Eighty-seven   Thousand  Seven   Hundred   and   Ninety-three   Cases  of  Shot 


1 

S 

£ 
i 

3 
4 
5 
6 

7 
8 

9 
10 
11 
12 
13 
14 
15 
16 
17 

18 

SEAT  OF  INJURY. 

CASKS. 

TUF.ATED  BY  CONSERVATION.       TREATED  HY  EXCISION. 

I 

Recovery. 

I 

Undeter. 

Percent, 
of  Fatal. 

g 

I 

Recovery. 

3 
£ 

Undeter. 

3 

o 
H 

Recovery. 

3 

<S 

pq 

Undeter. 

54,801 
11,  369 
1,509 
5,194 
2,816 
8,245 
1,579 
2,280 

53,  161 
9,644 
1,305 
4,636 
2,211 
6,249 
948 
1,936 

1,640 
316 
193 

482 
532 
1,639 
492 
314 

1,409 
11 
76 
73 
357 
139 
30 

2.9 
3.1 
12.9 
9.4 
19.4 
20.7 
34.2 
13.9 

54,719 
3,092 
716 
2,971 
938 
2,960 
541 
2,196 

53,  118 
2,781 
653 
2,740 
828 
2,385 
383 
1,876 

1,601 
59 
54 
191 
96 
444 
149 
295 

252 
9 
40 
14 
131 
9 
25 

116 
109 
1,019 
731 
947 
835 
84 

104 
94 
883 
518 
653 
432 
60 

10 
15 
114 

159 
264 

277 
19 

2 

22 
54 
30 
126 
5 

Contusions  and  Fractures  of  Wrist  
Contusions  .and  Fractures  of  Forearm  .  . 
Contusions  and  Fractures  of  Elbow  
Contusions  and  Fractures  of  Arm  
Contusions  and  Fract.  of  Shoulder  Joint 
Contusions  and  Fract.  of  Clav.  and  Scap. 

Total      

87,  793 
Hand 

80,  090 

5,608 

2,095 

6.5 

68,  133 

64,764 

2,889 

480 

3,841 

2,744 

858 

239 

Amputations  following  Excisions  of  the 
Amputations  following  Excisions  at  the 
Amputations  following  Excisions  in  the 
Amputations  following  Excisions  at  the 
Amputations  following  Excisions  in  the 
Re-amputations  following  Amputations 
Re-amputations  following  Amputations  z 
Re-amputations  following  Amputations  \ 

Wrist 

Forearm 
Elbow 

Arm  ....   - 

>f  Hand 
t  Wrist 
n  Foreai 

m       ... 

Total  Amputations  and  Re-amputa 

TABLE 
Tabular  Statement  of  Eighty -six  Thousand  Four  Hundred  and  Thirteen  Cases  of  Shot  Injuries 


Number. 

SEAT  OF  INJURY. 

CASES. 

TREATED  BY  CONSERVATION. 

TRE 

3 

o 
H 

ATED    BY    EX 
CISION. 

>> 

1            "1 

O                    0 

H             « 

2 

1       | 

Percent, 
of  Fatal. 

3 

o 
H 

o              "S 

0                     +5 

OJ                   rt 

w        f*-i 

Undeter. 

Recov'y. 

ej 

a 

Undeter. 

1 
2 
3 
4 
5 
6 
7 

- 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 

20 

59,  139     56,  219 
5,  859       4,  968 
1,  722       1,  247 
9,  171       6,  491 
3,  398       1,  566 
6,  738       3,  115 
386             59 

2,920    

451     440 
460       15 
2,  402     278 
1,819       13 
3,  434     189 
327    

4.9 
8.3 
26.9 
27.0 
53.7 
52.4 
84.7 

58,  938 
3,587 
525 
4,116 
901 
3,620 
304 

56,150  ;  2,788 
3,  137         136 
414           99 
3,  442         539 
360         532 
1,  800     1,  719 
55         249 

Contusions  and  Fractures  of  the  Foot    

314 

12 
135 
9 
101 

97 
33 
388 
56 
186 
55 

75 
22 
276 
9 
55 
2 

18 
9 
108 
44 
123 
53 

4 
2 
4 
3 

Contusions  and  Fractures  of  the  Leg 

Contusions  and  Fractures  of  the  Knee  Joint.  .  . 
Contusions  and  Fractures  of  the  Thigh  
Contusions  and  Fractures  of  the  Hip  Joint  

Total  ... 

86,  413     73,  665 

11,  813     935 

13.8 

71,991 

65,  358     6,  062 

571 

815 

439 

355 

21 

Amputations  followin<T  Excisions  of  the  Foot 

Amputations  following  Excisions  at  the  Ankle 
Amputations  followin"'  Excisions  in  the  Le01 

Amputations  following  Excisions  at  the  Knee 
Amputations  following  Excisions  in  the  Femur 
Re-amputatious  following  Amputations  of  Toes 
Re-amputations  following  Amputations  of  Foot 
Re-amputations  following  Amputations  at  Ank 
Re-amputatious  following  Amputations  in  Leg 
Re-amputatious  following  Amputations  at  Knee 
Re-amputatious  following  Amputations  in  Thig 

::.::::::::::.^t*3! 

A                 

(ij  V  ^  V  ^  ^L  ~ 

"  t  T  V  1 

*•*•*•»•• 

JlW' 

&SS#         .     .  .. 

>i^<up* 

^z**^-  

Total  Amputations  and  Re-amputations 

CHAP    xir.J  CONSERVATION.     KXOTRTON.    AMPUTATION. 

OLXIII. 

fnjnricH  of  Hie,  Upper  Extremities,  indicating  Seat  of  Injury,  Mode  of  Treatment,  and  Final  Result. 


871 


FOI.I.OWKII  11  Y  AMITTATIOX. 

^                       C'                        -~ 

<U      i                                           i                                                   w 

,0     '                              I"                   •                *~ 

a       1          S         s        •§ 

So                 i.                «               S 
fc   !      H             -             ^            p 

1              82              43            30 

AMPUTATIONS— 

Oi   HAND 
FINGER 

1      r- 

u            *- 

AND           AT  THE          IN  THE  FUKK- 
s.                WRIST.                  AitM. 

«            o    '  "3        •    li       fe            -2          » 

-3          :     o         2        "*      '         §               -2           ** 

11              3 

AT  TH 
ELROV 

8    3 

^        cs 

K     r  4 

Undeter. 

Recovery.  M 
<"  •* 

*s 
s 
Fatal. 

•3  t> 

-  -  '  K 
i  -S 

Undeter. 

AT  THF 

SHOULDF 

C 

o       5 
<~        a 

5         9 

jg 

;  !  Cndeter. 

2        8,161        (i,  759          247  ;   1,  155 
3  '         084            558          1"4              " 

6,  551 

198 

1,153 

38       4 
19       3 

!        151         28 
1          507         93 
772       101 

1 

1 
11 

19          17          1 
28           26  '  

4 
26 
5 

0 

4        1,204        1,013          177            14 
5        1,  147            805          277              5 
0       4,338        3,211          931          190 
7            20!            133            60             4 

8  '    .. 

2 

1 

213           72           2 

847         272  1        5 
2,777         780       175 

2         2    ... 
13         4    ... 
434     151      21 
133       66       4 

...|... 

! 

6,  551 

13 

9     15,  819      12,582  :   1,801      1,376 
10               9              72 

198 

1,  153      57       7 

1  ':,  1,441       225 
7           2 

35 

3 

1 

3,  911      1,  194       183 

587     234     25 

11              13               9             4 

6           2 

3             2    

12             70             50           25  ;          1 
13              04              39            25 

!         17           3 

33           22    

1 

i 

39           25    

14              04              37            27 

33           16    
15             7    

4       11 
2    

15              71              51            20 

3 

i         30         13 

1 

10  i          10             1°             4  ' 

2      

9             4    

1    

17             15             12             3      

11             3  i  

1    

;  eo     7 

3 

1 

25 

18     10,147     12,799     1,971      1,377 

1 

6,  551 

198 

1,153 

1  |    1,503       245 

13 

36 

4,  054     1,  273       183 

596     245 

i 

GLXIV. 

of  the  Lower  Extremities,  indicating  Seat  of  Injury,  Mode  of  Treatment,  and  Final  Result. 


Number. 

AMPUTATIONS— 

OF  TOES. 

OF  FOOT.       AT  ANKLE.  '•       IN  THE  LEG. 

KNEE  J'T. 

IN  THE  THIGH. 

HIP  J'T. 

>,                       1     *i     i         ti                     *• 

/^                      '     a/            ,"•                   a 

-               >             -       !    •£             P-          -       -g 
-2                0:51-2              S          £       -V 
O                  i<                AH               0)            a         a 

H           PH          &H      ,   p          W        PH     P     ' 

Recov'y. 

1 

Undeter. 

V       _• 

O           r" 

g       •£ 

53  '.',     ^ 

•s  I  1     i 

a  \     o          a 

Undeter. 

Recov'y. 

1 

Undeter. 

Recov'y. 

13 

"S 

Undeter. 

Recov'y. 

1 

1 

2 
3 
4 
5 
6 
7 

8 
9 
10 
11 
L2 
13 
!t 
15 
16 
37 
18 
L9 

20 

"! 

l>o)         o:)        132                    l 

i                              i 
30            33 

1  i      5 

:      1           3 

i     1       10 
43       64 
29       24 

1 
1 

37 
3 

347 
1,168 
1,  257 

94 
3 
22 
447 
1,219 
1,560 

2,175      1,750         297      122       1,093      29      105       221 
1    1(54         811          352          1                   !   ..   I.....I 

51      16 

104      37      1           334          174 
14        1      1           780          319 
9  f!S:t       1    544 



138 

4  6(57      '*  773      1   755      13') 

''41!      1    197      1   243          1                   ' 

2  93°      1   ''00      I   502        80 

80 

3     26 

2     25 

5     51 

13,007      7,808      5,390  !  343       1,094      29      105 

11              8             3  !                                    ' 

221 

51 

16       118      38 

2      3,  536     1,  770 
5             3 

138 

75     106 
1    

2 

2,  819 
1 

3,  351 

80 

4              3-1 

3              1 

50           •>!           23  ! 

15             6 

2 

3 

10 
1 
2 

.  14 
6 
4 

7                  1:6                             ... 

7             2             5 

1 

!                            !  i  

12             5             7  :          1                       ! 

1 

1 

2 

4             3 

1 

13           12             1 

1 

11              1 

28           21             7l...     •  ! 

21             6 

1 
30 
5 

73           42           31  '   . 

4 

1 

38 

7 

12              7              51 

9              0             3    ... 

6 

3 
55 

52 

16 

13,  833      8,  002      5,  488      343       1,  094      29      105 

223 

119     40 

2      3,  595     1,  790 

138 

82 

111 

2 

2,878 

3,411 

80 

11 

872  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

upper  and  lower  extremities,  indicating  the  seat  of  injury,  mode  of  treatment,  and  termina 
tions  of  cases. 

Eighty-seven  thousand  seven  hundred  and  ninety-three  (87,793),  with  eighty  thousand 
and  ninety  (80,090)  recoveries,  five  thousand  six  hundred  and  eight  (5,608)  deaths,  and 
two  thousand  and  ninety-five  (2,095)  unknown  results  (a  mortality  rate  of  6.5  per  cent.), 
were  shot  injuries  of  the  upper  extremities.  Of  these,  thirty-two  thousand  nine  hundred 
and  ninety-two  (32,992)  were  wounds  complicated  by  fracture,  and  fifty-four  thousand  eight 
hundred  and  one  (54,801)  were  flesh  wounds;  of  the  latter,  eighty-two  (82)  were  followed 
by  amputation.  Of  the  thirty-two  thousand  nine  hundred  and  ninety-two  (32,992)  shot 
fractures  of  the  upper  extremities,  three  thousand  eight  hundred  and  forty-one  (3,841),  or 
11.6  per  cent.,  were  followed  by  excision,  fifteen  thousand  seven  hundred  and  thirty-seven 
(15,737),  or  47.7  per  cent.,  by  amputation,  and  thirteen  thousand  four  hundred  and  four 
teen  (13,414),  or  40.7  per  cent.,  were  treated  without  operative  interference  beyond  the 
removal  of  bone  splinters,  of  missiles,  or  other  foreign  substances. 

Eighty-six  thousand  four  hundred  and  thirteen  (86,413)  were  shot  injuries  of  the  lower 
extremities;  the  results  were  not  ascertained  in  nine  hundred  and  thirty-five  (935)  cases; 
seventy-three  thousand  six  hundred  and  sixty-five  (73,665)  resulted  in  recovery,  and  eleven 
thousand  eight  hundred  and  thirteen  (11,813)  in  death — a  fatality  rate  of  13.8  per  cent. 
Fifty-nine  thousand  one  hundred  and  thirty-nine  (59,139)  were  flesh  wounds,  of  which  two 
hundred  and  one  (201)  were  followed  by  amputation.  Twenty-seven  thousand  two  hun 
dred  and  seventy-four  (27,274)  were  shot  injuries  involving  the  bones  of  the  lower  extrem 
ities;  of  these,  eight  hundred  and  fifteen  (815),  or  3.0  per  cent.,  were  treated  by  excision, 
thirteen  thousand  four  hundred  and  six  (13,406),  or  49.1  per  cent.,  by  amputation,  and 
thirteen  thousand  and  fifty-three  (13,053),  or  47.9  per  cent.,  without  operative  interference. 
In  reality  the  percentage  of  cases  treated  by  amputation  in  the  upper  as  well  as  in  the  lower 
extremities  was  somewhat  larger  than  here  stated,  as  in  three  hundred  and  five  (305) 
instances  (two  hundred  and  twenty-six  in  the  upper  extremities,  ninety-two  in  the  lower 
extremities)  the  excisions  were  subsequently  followed  by  amputations,  as  is  indicated  in  the 
tabular  statements  on  the  two  preceding  pages. 

In  the  upper  extremities  11.6  per  cent,  of  the  total  fractures  were  treated  by  excision; 
in  the  lower  extremities  only  3.0  per  cent.  There  is  little  difference  in  the  relative  per 
centage  of  amputation  in  the  upper  and  lower  extremities  (in  the  first  47.7,  in  the  second 
49.1  percent.);  the  proportion  of  cases  of  conservative  treatment  in  the  lower  extremities 
exceeded  that  in  the  upper  7.2  per  cent.,  being  47.9  in  the  former  and  40.7  per  cent,  in  the 
latter.  It  is  difficult  to  account  for  this  larger  percentage  in  the  attempts  at  conservation  in 
shot  fracture  of  the  lower  extremities,  unless  it  be  due  to  the  instructions  given  during  the 
progress  of  the  war  by  medical  directors  of  the  armies  that  amputations  in  the  thigh  should 
riot  be  performed  on  the  battle-field,  and  that  by  the  time  such  patients  reached  general 
hospitals  the  favorable  time  for  operative  interference  had  passed. 

It  is  a  curious  anomaly  that  in  the  upper  extremity  conservatism  was  more  extensively 
employed  in  the  part  most  distant  from  the  trunk,  while  in  the  lower  extremity  the  reverse 
was  the  case.  Of  eight  thousand  two  hundred  and  forty-five  (8,245)  shot  fractures  of  the 
humerus,  two  thousand  nine  hundred  and  sixty  (2,960),  or  35.9  per  cent.,  and  of  five  thou 
sand  one  hundred  and  ninety-four  (5,194)  shot  fractures  of  the  bones  of  the  forearm,  two 
thousand  nine  hundred  and  seventy-one  (2,971),  or  57.2  per  cent.,  were  treated  by  con 
servative  measures  throughout.  In  the  lower  extremities  the  percentage  of  cases  of  fracture 


CONSERVATION,    EXCISION,    AMPUTATION. 


873 


of  the  femur  treated  conservatively  exceeded  that  of  the  fractures  of  the  bones  of  the  leg; 
in  the  former  three  thousand  six  hundred  and  twenty  (3,620)  out  of  six  thousand  seven 
hundred  and  thirty-eight  (6,738),  or  53.7  per  cent.,  being  treated  without  operative  inter 
ference,  in  the  latter  four  thousand  one  hundred  and  sixteen  (4,116)  out  of  nine  thousand 
one  hundred  and  seventy-one  (9,171),  or  44.8  per  cent.1 

One  hundred  and  thirteen  thousand  nine  hundred  and  forty  (113,940)  shot  flesh 
wounds  of  the  extremities,  including  cases  of  injuries  of  arteries  and  nerves  in  which  no 
lesions  of  bone  were  reported,  gave  four  thousand  five  hundred  and  sixty  (4,560)  fatal 
results,  a  mortality  rate  of  4.0  per  cent.,  of  which  fifty-four  thousand  eight  hundred  and 
one  (54,801)  of  the  upper  extremities,  with  one  thousand  six  hundred  and  forty  (1,640) 
deaths,  gave  a  mortality  rate  of  2.9  per  cent.,  and  fifty-nine  thousand  one  hundred  and 
thirty-nine  (59,139)  of  the  lower  extremities,  with  two  thousand  nine  hundred  and  twenty 
(2,920)  deaths,  a  fatality  rate  of  4.9  per  cent.  Of  the  former  in  eighty-two  (82),  and  of 
the  latter  in  two  hundred  and  one  (201)  cases,  amputation  was  resorted  to,  generally  on 
account  of  haemorrhage,  aneurisms,  or  extended  sloughing  or  suppuration;  less  frequently 
on  account  of  pyaemia,  gangrene,  and  erysipelas,  and,  in  a  few  instances,  on  account  of 
lacerations  of  nerves. 

Sixty  thousand  two  hundred  and  sixty-six  (60,266)  of  the  one  hundred  and  seventy- 
four  thousand  two  hundred  and  six  (174,206)  shot  wounds  of  the  extremities  were  compli 
cated  by  injuries  of  the  bony  structure.  Forty-four  thousand  three  hundred  and  seventy- 
five  (44,375)  recovered,  twelve  thousand  eight  hundred  and  sixty-one  (12,861)  proved 
fatal,  and  the  result  in  three  thousand  and  thirty  (3.030)  cases  was  not  recorded,  a  mor 
tality  rate  of  22.4  per  cent.  Thirty-two  thousand  nine  hundred  and  ninety-two  (32,992) 
were  fractures  in  the  upper,  and  twenty-seven  thousand  two  hundred  and  seventy-four 
(27,274)  in  the  lower  extremities: 

TABLE  CLXV. 

Summary  of  Sixty  Thousand  Two  Hundred  and  Sixty-six  Shot  Fractures  of  the  Extremities,  showing 

Treatment  and  Results. 


MODE  OF  TREATMENT. 

O 

Recovery. 

i 

I 

Undetermined. 

Percentage  of 
Fatality. 

UPPER  EXTREMITIES. 

LOWER  EXTREMITIES. 

Recovery. 

"3 
1 

Undeter 
mined. 

Percent,  of 
Fatality. 

Recovery. 

i 

Undeter 
mined. 

Percent,  of 
Fatality. 

Conservation  .  .               .... 

26,  467 
4,656 
29,  143 

20,854 
3,183 
20,  338 

4,562 
1,213 
7,086 

1,051 

260 
1,719 

17.9 
27.5 
25.  8 

11,646 
2,744 
12,  539 

1,288 
858 
1,822 

480 
239 
1,376 

9.9 
23.8 
12.6 

9,208 
439 
7,799 

3,274 
355 
5,264 

571 
21 
343 

26.2 
44.7 
40.2 

Excision  ...                   

Amputation      

Aggregates  ...        .... 

60,  266 

44,  375 

12,  861 

3,030 

22.4 

26,  929 

3,968 

2,095 

12.8 

17,  446 

8,893 

935 

33.7 

1 

Twenty-six  thousand  four  hundred  and  sixty-seven  (26,467),  or  43.9  per  cent.,  were 
treated  conservatively;  four  thousand  six  hundred  and  fifty-six  (4,656),  or  7.7  per  cent., 
were  followed  by  excision;  and  twenty-nine  thousand  one  hundred  and  forty-three  (29,143), 
or  48.4  per  cent.,  were  followed  by  amputation.  Of  the  conservatively  treated  cases,  17.9 
per  cent,  proved  fatal;  of  those  followed  by  excision  27.5  per  cent.,  and  of  those  by  ampu- 

JIt  might  be  claimed,  in  a  comparison  of  this  nature,  that  the  cases  of  excision  would  be  more  fairly  classed  with  the  cases  treated  by  conservation 
in  contradistinction  to  the  cases  treated  by  amputation.  While  this  would  somewhat  change  the  relative  percentages  in  the  two  groups  of  the  upper  and 
lower  extremities,  the  conclusion  arrived  at  above  would  remain  the  same,  thus:  Fractures  of  humerus,  8,245;  treated  by  conservation  or  excision,  3,907, 
or  47.4  per  cent.;  fractures  of  bones  of  the  forearm,  5,194 ;  treated  by  conservation  or  excision,  3,956,  or  76.8  per  cent.;  in  the  lower  extremities,  fractures 
of  the  femur,  6,738;  treated  by  conservation  or  excision,  3,806,  or  56.4  per  cent.;  and  fractures  of  the  tibia  and  fibula.  9,171 ;  treated  by  conservation  or 
excision,  4,326,  or  49.1  per  cent. 
SfRG.  Ill— 110 


874  WOUNDS    AND    COMPLICATIONS.  [CHAP.  xn. 

tation  25.8  per  cent.,  showing  that  the  fatality  after  excision  exceeds  that  after  amputation 
in  the  whole  series  of  cases  1.7  per  cent.,  although  over  three-fourths  of  the  excisions  were 
operations  performed  in  the  upper  extremities,  where  the  results  of  operative  interference 
are  less  serious  than  in  the  lower  extremities. 

The  greatest  fatality  after  shot  injuries  of  the  extremities  with  lesion  of  bone  was 
observed  in  shot  injuries  of  the  hip  joint,  where  the  fatality  reached  84.7  per  cent.  Next 
came  the  injuries  of  the  knee  joint,  with  a  mortality  of  53.7  per  cent.;  then  those  of  the 
thigh,  of  which  52.4  per  cent,  perished.  Then  come  the  injuries  of  the  shoulder  joint  with 
34.2  per  cent,  mortality,  of  the  leg  with  27.0,  of  the  ankle  joint  with  26.9,  of  the  arm 
with  20.7,  elbow  with  19.4,  wrist  12.9,  forearm  9.4,  foot  8.3,  and  finally  the  shot  injuries 
of  the  bony  structure  of  the  hand  with  3.1  per  cent,  fatality. 

A  reference  to  TABLES  CLXIII  and  CLXIV,  ante,  shows  a  percentage  highly  flatter 
ing  to  the  efforts  of  conservation;  but  it  must  be  borne  in  mind  that  the  cases  reported  as 
treated  conservatively  were  cases  selected  as  specially  adapted  to  this  mode  of  treatment, 
and  probably  were  the  least  serious.  Moreover,  there  were  many  cases  in  which  conserva 
tive  treatment  was  abandoned  and  intermediary  or  secondary  excisions  and  amputations 
were  resorted  to — cases  which  helped  to  increase  the  mortality  rate  of  these  operations, 
but  which  should  properly  be  charged  to  the  attempts  at  conservation.  On  the  other  hand, 
many  operations  were  performed  in  the  field,  where  the  appliances  and  necessary  rest  of 
conservative  surgery  could  not  be  had,  and  where  frequent  transportation  for  considerable 
distances  was  unavoidable,  in  which  in  general  hospitals  an  attempt  might  have  been  made 
to  save  the  limb. 

The  disposition  towards  conservation  developed  itself  rapidly  as  medical  officers  became 
familiar  with  serious  cases  of  shot  injuries,  and  it  is  safe  to  say  that  in  the  later  stages  of 
the  war  many  limbs  were  saved  which  at  an  earlier  period  would  have  been  sacrificed. 
Especially  was  this  the  case  in  the  upper  extremities,  where  the  preservation  of  the  hand, 
or  even  of  portions  of  the  same,  was  considered  most  important  for  the  well  being  of  the 
individual.  An  examination  of  the  many  cases  thus  treated,  as  described  in  previous 
sections  of  the  history,  will  show  the  formidable  risks  taken  to  attain  this  end. 

There  was  a  decided  growth  in  the  disposition  to  save  in  shot  injuries  of  the  lower 
extremities,  especially  in  those  of  the  femur,  and  the  many  favorable  results  leave  beyond 
doubt  the  wisdom  of  the  course.  Still  there  was  a  wide  difference  of  opinion  on  this  point, 
particularly  between  field  surgeons  and  those  in  charge  of  general  hospitals  at  the  rear — a 
difference  that  can  only  be  reconciled  by  viewing  the  subject  from  the  standpoint  of  each. 

Probably  the  least  satisfactory  ultimate  results  of  conservative  treatment  were  those 
in  the  foot  and  ankle,  which,  while  successful  in  saving  life,  render  it  doubtful,  in  the  light 
of  their  ultimate  condition,  whether  conservation  was  the  wisest  course. 

EXCISIONS. — The  consideration  of  this  operation  at  this  point  is  restricted  to  the 
excisions  in  the  bones  of  the  extremities;  the  three  hundred  and  fifty  cases  of  excisions  in 
the  bones  of  the  head,  face,  and  trunk,  including  two  hundred  and  twenty  instances  of 
trephining,  have  been  considered  in  the  First  Surgical  Volume. 

Of  four  thousand  six  hundred  and  fifty-six  excisions,  three  thousand  eight  hundred 
and  forty-one,  or  over  four-fifths,  were  in  the  upper  extremities,  and  eight  hundred  and 
fifteen  in  the  lower  extremities. 

The  excisions  at  the  hip  joint  lead  with  the  largest  mortality,  90.9  per  cent.;  next 
come  the  excisions  at  the  knee  joint  with  81.4  per  cent.;  the  excisions  in  the  shaft  of  the 


EXCISIONS. 


87.r> 


femur  have  a  fatality  of  69.4  per  cent.;  the  excisions  at  the  shoulder  of  36.6  per  cent.:  at 
the  ankle  joint  of  29.0  per  cent.;  in  the  shaft  of  the  humerus  of  28.6  per  cent.;  in  the 
tibia  and  fibula  of  28.2  per  cent.;  in  the  bones  of  the  foot  of  19.3  per  cent.;  at  the  wrist 
joint  of  13.8  per  cent.;  in  the  bones  of  the  forearm  of  11.3  per  cent.;  and  in  the  bones  of 
the  hand  of  9.6  per  cent.  With  the  exception  of  the  elbow  the  excisions  in  the  joints  show 

TABLE  CLXVI. 
Numerical  Statement  of  Four  Thousand  Six  Hundred  and  Fifty-six  Excisions  in  tlie  Extremities. 


SEAT  OF  OPERATION. 

CASES. 

PRIMARY. 

INTERMEDIARY. 

SECONDARY. 

PERIOD  OF  OPERA 
TION  UNKNOWN. 

3 

o 
H 

Recoveries. 

Fatal. 
Unknown. 

Percentage  of 
Fatality. 

Recoveries. 

3 

Unknown. 

Percentage  of 
Fatality. 

Recoveries. 

3 
& 

a 
t 
o 
a 

,M 

P 
15 

Percentage  of 
Fatality. 

Recoveries. 

3 

1 

Unknown. 

Percentage  of 
Fatality. 

Recoveries. 

1 

Unknown. 

Percentage  of 
Fatality. 

Clavicle  and  Scapula  
Shoulder  Joint  

84 
1,086 
696 
764 
986 
109 
116 
66 
175 
57 
387 
33 
97 

4,656 

60 
603 
477 

856 
94 
103 
6 
51 
10 
275 
22 
75 

19       5 
348   135 

191      28 
165     48 
109     21 
15  .... 
11       2 
60  .... 
116       8 
44       3 
108       4 
9       2 
18j      4 

24.1 
36.6 
28.6 
23.0 
11.3 
13.8 
9.6 
90.9 
69.4 
81.4 
28.  2 
29.0 
19.3 

27 
376 
326 
288 
589 
55 
58 
1 
20 
4 
148 
8 
40 

9 
185 
145 
75 
71 
7 
6 
32 
65 
26 
67 
2 
11 

3 
91 
16 
33 

6 
2 

1 
2 

25.0 
32.9 
30.7 
20.6 
10.7 
11.2 
9.3 
96.9 
76.4 
86.6 
31.1 
20.0 
21.5 

12 
124 
64 
152 
120 
18 
15 
2 
9 
1 
58 
5 
15 

6 
113 
29 
74 
29 
6 
2 

20 
39 
12 
29 
3 
5 

33.3 
47.6 
31.1 
32.7 
19.4 
25.0 
11.7 
90.9 
81.2 
92,3 
33.3 
37.5 
25.0 

8 
69 
36 
57 
36 
15 
6 

0 

a 

15 
4 
42 
5 
16 

13 
34 
51 
54 
111 
6 
24 

4 
21 
12 

8 
5 

2 
25 
12 
10 
16 

23.5 
38.1 
19.0 
12.9 
4.3 

29       4 
5   .... 
8     .. 
4  ... 
2  .... 

29.5 
12.1 
12.3 
10.0 
11.7 

Elbow  Joint. 

Radius  and  Ulna  

Wrist  Joint 

Bones  of  Hand  

3 

2 

11.1 

Hip  Joint  

8 
3 
3 

8 
4 

1 

..     72.7 

Shaft  of  Femnr    

1      16.6 
j    42.  8 

....     16.0 
44  4 

7 
1 
27 
A 

9 
3 
4 

1     56.2 
1     75.0 
4     12.9 

Knee  Joint 

Tibia  and  Fibula.  . 

Ankle  Joint  

Bones  of  Foot  . 

5.8 

4 

1 

2     20.  0 

Aggregates 

3,183 

1,  213   260 

27.6 

1,940 
2 

701 
—  v  — 
800 

159 

» 

27.0 

595 

367 

~982~ 

20     38.  1 

' 

312 

V—  

75 

—  *v— 

392 

5 

—  _* 

19.3 

!336 

v 

70 

—  -v— 

482 

76     17.  2 

larger  mortality  rates  than  those  in  the  osseous  structures  immediately  above  the  joint; 
the  fatality  of  the  operations  in  the  knee  joint  exceeds  that  in  the  shaft  of  the  femur  12.0 
per  cent.;  in  the  ankle  joint  the  fatality  is  0.8  per  cent,  greater  than  in  the  leg,  and  in  the 
wrist  joint  2.5  per  cent,  greater  than  in  the  bones  of  the  forearm;  the  excisions  at  the 
elbow  joint,  on  the  contrary,  show  more  favorable  results  than  those  in  the  arm,  the  death- 
rate  being  5.6  per  cent,  less  in  the  former  than  in  the  latter. 

The  percentage  of  fatality  in  the  entire  series  of  excisions  in  the  extremities  is  dis 
appointing,  especially  when  it  is  considered  that  over  four-fifths  of  the  excisions  were 
performed  in  the  upper  extremities,  where  the  chances  for  success  must  be  considered  the 
brightest.  It  disproves  the  opinion  held  by  the  advocates  of  this  operation  that  excision 
involves  less  loss  of  life  than  amputation.  That  it  might  be  possible  to  obtain  better 
results  in  well-appointed  and  less  crowded  hospitals  is  not  denied;  and  the  many  excellent 
results  obtained  in  civil  practice  should  encourage  the  military  surgeon  to  persevere  in  his 
efforts  m  this  direction  in  suitable  cases  and  under  favorable  circumstances.  As  to  whether 
the  effort  made  to  secure,  a  useful  limb  by  excision  compensates  for  the  formidable  risk 
which  must  be  encountered  in  military  practice,  can  be  best  determined  by  the  reader  by 
an  examination  of  the  analyses  of  the  cases  in  the  various  sections  of  the  extremities,  as 
given  previously  under  their  appropriate  headings.  In  brief,  it  may  be  stated  that  the 
results  after  excisions  in  the  long  bones  and  in  the  knee  and  ankle  joints  were  little  less 
than  disastrous,  and  the  ultimate  conditions  of  many  of  these  cases,  although  considered 
successful  shortly  after  the  operation,  proved  to  be  deplorable. 


876 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


The  results  in  excisions  of  the  shoulder  and  elbow  joints  and,  to  some  extent,  in  the 
wrist  joint  have  been  more  encouraging,  as  useful  limbs  were  preserved  after  many  of  these 
operations.  In  the  excision  at  the  wrist  the  patient  generally  recovered  with  anchylosis 
and  extreme  deformity  of  the  hand  and  stiffness  of  the  fingers;  but  such  is  the  adaptability 
of  the  hand  to  all  pursuits  in  life,  that  even  with  these  disadvantages  it  remained  a  useful 
member  to  the  patient. 

In  three  hundred  and  five  cases  the  excision  was  followed  by  amputation  of  the  limb, 
in  two  hundred  and  twenty-six  in  the  upper,  in  seventy-nine  in  the  lower  extremities. 

The  operations  have  been  grouped  into  primary,  intermediary,  and  secondary.  The 
primary  operations  contain  the  excisions  performed  within  the  first  three  days;  the  inter 
mediary  those  from  the  fourth  to  the  thirtieth  day,  inclusive;  and  the  secondary  those 
performed  more  than  thirty  days  after  the  date  of  injury.  As  indicated  in  TABLE  CLXVI, 
the  ratio  of  fatality  after  primary  operations  was  27.0  per  cent.,  after  intermediary  38.1, 
and  after  secondary  19.3  per  cent.  The  results  of  the  secondary  operations  were  the  most 
favorable ;  but  it  must  always  be  remembered  that  this  group  embraces  the  cases  only  which 
had  successfully  resisted  the  attacks  of  the  inflammatory  period. 

It  will  be  noticed  in  the  detailed  histories  of  cases  of  excisions  that  the  period  of 
treatment  extended  over  a  long  time,  even  months  and  years,  and  that  these  cases  appeared 
to  be  particularly  prone  to  consecutive  haemorrhage,  gangrene,  and  pyaemia  (see  pages  808, 
810,  825,  and  857,  ante). 

Towards  the  latter  part  of  the  war  the  most  thoughtful  surgeons  found  it  necessary  to 
exercise  a  careful  discrimination  in  the  selection  of  cases  for  excision,  and  to  refuse  to 
operate  in  many  instances  in  which,  early  in  the  contest,  this  operation  would  have  been 
favored. 

A  table  indicating  the  different  months  in  which  the  operations  were  performed  is  here 
appended.  The  highest  rate  of  mortality  it  will  be  noticed  occurred  in  June,  the  lowest  in 
November;  but  as  regards  the  influence  of  season  on  the  operations  seemingly  no  points 
of  value  can  be  deduced  from  the  tabular  statement: 

TABLE  GLXVII. 
Tabular  Statement  of  Excisions,  indicating  the  Months  in  which  the  Operations  were  performed. 


SEAT  OF  INJURY. 

JAN. 

FEB. 

MAK. 

APRIL. 

MAY. 

JUNK. 

JULY. 

AUGUST. 

SEPT.         OCT. 

Nov.         DEC. 

Recoveries. 

1 

Recoveries. 

Fatal. 
Reaoveries. 

$ 
A 

Recoveries. 

1 

Recoveries, 

"3 
a 

* 

Recoveries. 

"a 
2 

Recoveries. 

1 

h 

Recoveries. 
Fatal. 

Recoveries. 

1 

Recoveries. 

3 

£ 

Recoveries. 

\ 

Recoveries. 

1 

a 
'ft. 

Shoulder  Joint  

10 
12 
12 
7 
2 
2 

5 
3 
3 

1 
1 
1 
2 

16 

8 
6 
12 
1 
5 

7 
2 
2 
2 

1 

2 

1 

11 
18 
17 
22 
4 
2 
1 
2 
1 
10 
1 

1 
3 
3 
5 

1 
4 
8 
2 

26 
20 
15 
30 
2 
3 

4 
1 
13 

2 
4 

126 

33. 

1 

21 
7 
9 
3 

6 
6 
2 

8 

1 

109 
113 

143 
195 
24 
32 

7 
2 
56 

14 

81 
43 
43 
31 

1 

1 
12 
28 
15 
22 

5 

94 
70 
74 
101 
12 
15 

73 
42 
37 
24 
5 
2 
5 

82 
66 
67 
114 
14 
5 

44 
34 
19 
10 
3 
2 
5 

46     22 
23     15 
33       5 
47       4 

:..:. 

.      10 

54 
47 
37 
37 
7 
.   10 
1 
2 

26 

1 
7 

25 
12 
13 

y 
1 

7 
9 
4 

1 

45 
27 
53 
43 

6 
5 

2 
3 
24 
2 
4 

20 
10 
17 

I 

1 

5 
8 
4 
3 

1 

43 
33 
25 

" 

1 

2 
3 

16 

14 
8 
3 
6 

1 
2 
2 
5 

32 
30 
26 
41 
6 
7 

4 
1 
16 
1 

14 
6 

1 
6 
6 
9 

Elbow  Joiiit  

Hand        

1 

5 

30 
4 

8 

21 

3 

" 

3 

9 

31 
3 

7 

11 
2 
11 
4 
o 

4       5 
....      1 
12       4 
1    .... 
3       2 

Knee  Joint  

10       6 

4 
1 

1 

Foot     

5 

^ 

10 

5 

3 

Aggregates    
Prr  ct.  of  Fatality. 

CO     23     56     18 

27.  7%      24.  3% 

89 

V  

28 

35 

2% 

63 
3% 

699     282 

28?7% 

473 

V  

•J4 

252     398 

v  •    <  

7%          27. 

153 

7%~" 

175  ;  69 

28.  20/0 

229 

25. 

79 

6% 

214 
25. 

72 

1°/T 

171 
19. 

41 
3% 

169 
24. 

55 

5% 

CHAP.  XII.] 


AMPUTATIONS. 


877 


AMPUTATIONS. — The  total  number  of  amputations  reported  on  the  records  in  this 
Office  is  twenty-nine  thousand  nine  hundred  and  eighty  (29,980);  but  the  whole  number  of 
amputations  performed  for  injuries  received  during  the  war  would  undoubtedly  exceed  that 
number.  During  the  first  eighteen  months  of  the  strife  few  or  no  reports  were  made  of  the 
wounded  in  the  various  engagements,  and  the  hospital  reports  for  this  period  were  found  to 
be  very  meagre.  Furthermore,  a  number  of  amputations  performed  on  officers  treated  in 
private  quarters,  and  sometimes  by  their  own  family  physicians,  is  unavoidably  omitted  in 
this  summary,  as  no  reports  of  these  operations  were  ever  sent  to  this  Office.  Another 
class  of  operations  only  partially  included  in  this  summary  are  late  amputations,  performed 
after  the  soldiers  were  discharged  from  service  for  wounds  received  during  the  war. 

Of  the  twenty-nine  thousand  nine  hundred  and  eighty  (29,980)  amputations  the 
results  were  ascertained  in  all  but  one  thousand  seven  hundred  and  nineteen  (1,719),  as 
shown  in  the  following  tabular  statement: 

TABLE  CLXVIII. 

Tabular  Statement  of  Twenty-nine  Thousand  Nine  Hundred  and  Eighty  Amputations,  indicating  Seat 

of  Operation  and  Results. 


AMPUTATIONS. 

CASES. 

Totals. 

Recoveries. 

Deaths. 

Results  Unknown. 

Percentage  of  Fa 
tality. 

Upper  Extremities  .  . 
Lower  Extremities... 

Amputations  of  the  Hand  or  Fingers  

7,902 
68 
1,761 
40 
5,  510 
86fi 
1,519 
161 
5,523 
195 
6,369 
66 

6,551 
CO 
1,503 
36 
4,054 
596 
1,317 
119 
3,595 
82 
2,878 
11 

198 

24:> 
3 
1,273 
245 
81 
40 
1,790 
111 
3,  411 
55 

1,133 
1 
13 
1 

183 

121 
2 
138 
2 

80 

2.9 
10.4 
14.0 
7.6 
23.8 
29.1 
5.7 
25.1 
33.2 
57.5 
54.2 
83.3 

Amputations  of  the  Wrist  Joint  ... 

Amputations  in  the  Forearm  

Amputations  at  the  Elbow  Joint.  ....                            . 

Amputations  in  the  Upper  Arm  

Amputations  at  the  Shoulder  Joint         -  -   . 

(  Amputations  of  the  Foot  or  Toes  

Amputations  in  the  Leg  

Amputations  at  the  Knee  Joint  

Amputations  in  the  Thigh  

Amputations  at  the  Hip  Joint  

Aggregates  

29,  980 

20,  802 

7,459       1,719 

26.3 

Of  the  one  thousand  seven  hundred  and  nineteen  (1,719)  undetermined  cases,  one 
thousand  one  hundred  and  fifty-three  (1,153)  were  amputations  of  the  hand  or  fingers, 
and  but  for  the  want  of  time  and  sufficient  clerical  assistance  the  results  in  nearly  all  these 
cases  could  have  been  ascertained.  As  it  is,  the  number  of  cases  in  which  the  ultimate 
results  are  known  is  sufficiently  large  to  determine  the  ratio  of  mortality  attending  the 
amputations  in  the  various  sections  of  the  extremities.  As  in  the  excisions  the  operations 
at  the  hip  gave  the  largest  ratio  of  mortality,  83.3  per  cent.;  next  come  the  amputations 
through  the  knee  joint  with  57.5  per  cent.,  those  of  the  thigh  with  54.2  per  cent.,  of  the 
leg  with  33.2  per  cent.,  of  the  shoulder  joint  with  29.1  per  cent.,  of  the  ankle  joint  with 
25.1  per  cent.,  of  the  arm  with  23.8  per  cent.,  of  the  forearm  with  14.0  per  cent.,  of  the 
wrist  with  10.4  per  cent.,  of  the  elbow  with  7.6  per  cent.,  of  the  foot  with  5.7  per  cent., 
and  of  the  hand  with  2.9  per  cent. 


878 


WOUNDS    AND    COMPLICATIONS. 


[CUM'.  XII. 


It  will  be  noted  that  with  the  exception  of  the  amputations  at  the  elbow  and  those  at 
the  knee  joint  the  ratio  of  mortality  in  the  upper  extremities  as  well  as  in  the  lower 
decreases  with  the  increasing  distance  of  the  point  of  ablation  from  the  trunk.  No  sufficient 
reason  can  be  assigned  for  the  exceptionally  favorable  results  in  amputations  at  the  elbow; 
while  the  gravity  of  injuries  as  well  as  of  operations  in  the  knee  has  been  repeatedly 
pointed  out  in  this  volume. 

Comparing  the  mortality  rate  after  amputations  with  that  of  excisions  in  the  same 
portion  of  the  extremities,  we  find  the  following  results : 

TAHLK  OLXIX. 
Table  indicating  the  Rate  of  Mortality  after  Amputations  and  Excisiom  in  the  Extremities. 


UPPER  EXTREMITIES—  SEAT  OF 
OPERATION. 

RATIO  OF  M< 
Amputation. 

)KT.   AFTER— 

Excision. 

2.9 
10.4 
14.0 
7.6 
23.8 
29.1 

9.6 
13.8 
11.3 
23.0 
28.6 
36.6 

Elbow     

Arm  

Shoulder     

RATIO  OF  MOUT.  AFTER— 


LOWER  EXTREMITIES—  SEAT  OF 


OPERATION. 

Amputation. 

Excis'.on. 

5.7 

19.3 

25.  1 

29  0 

Lea  .  . 

33.2 

28.2 

57.5 

81.4 

54.2 

69.4 

83.3 

90.9 

With  the  exception  of  the  operations  in  the  bones  of  the  forearm  and  those  in  the 
bones  of  the  leg,  the  excisions  are  uniformly  followed  by  larger  percentages  of  fatality 
than  the  amputations,  the  excisions  of  the  knee  joint  especially  showing  an  exceedingly 
large  excess  in  the  mortality  rate  over  the  amputations  at  the  knee.  The  favorable  results 
after  excisions  in  the  bones  of  the  forearm  and  leg  are  due  to  the  fact  that  in  many  of  these 
cases  only  portions  of  one  or  the  other  of  the  two  bones  comprising  them  were  excised, 
thus  lowering  considerably  the  percentage  of  fatality  of  the  operation.  For  instance,  as 
shown  on  page  445,  ante,  the  fatality  after  excisions  in  the  fibula  was  27.2,  after  those  in 
the  tibia  25.6,  and  after  those  in  both  bones  was  61.1  per  cent.,  while  the  average  fatality 
of  all  the  excisions  in  the  bones  of  the  leg  is  only  28.2  per  cent.  Similar  results  were 
obtained  in  the  excisions  of  the  bones  of  the  forearm,  the  mortality  after  excisions  of  both 
radius  and  ulna  exceeding  those  of  the  radius  or  ulna  alone. 

The  necessity  for  a  uniform  system  of  classification  of  the  amputations  in  order  that 
the  results  of  operations  performed  at  different  periods  could  be  compared  is  self  evident. 
All  operations  performed  within  forty-eight  hours  after  the  injury  have  here  been  grouped 
as  primary,  as  the  commencement  of  inflammatory  symptoms  rarely  falls  within  this  period. 
In  the  amputations  at  the  hip  joint  alone  the  primary  period  has  been  restricted  to  twenty- 
four  hours,  as  it  is  believed  that  in  those  cases  the  inflammatory  period  is  hastened  by  the 
gravity  of  the  injury.  In  the  second  or  intermediary  group  have  been  placed  the  cases  in 
which  the  operation  was  performed  in  the  interval  from  the  third  to  the  thirtieth  day 
(both  inclusive)  after  the  injury;  this  class  consists  mainly  of  the  operations  performed 
during  the  inflammatory  stage.  The  third  group  comprises  the  operations  performed  after 
the  thirtieth  day  from  the  date  of  the  injury,  or  at  a  period  when  the  inflammation  had 
abated  or  entirely  subsided. 

Of  the  twenty-nine  thousand  nine  hundred  and  eighty  (29,980)  amputations,  the  date 
after  the  injury  on  which  the  operations  were  performed  was  recorded  in  twenty-three  thou 
sand  nine  hundred  and  ninety-three  (23,993)  cases.  Of  these  the  results  were  not  ascer- 


AMPUTATIONS. 


879 


tained  in  two  hundred  and  thirty-one  (231),  leaving  twenty-three  thousand  seven  hundred 
and  sixty-two  (23,762)  cases  in  which  the  results  as  well  as  the  dates  of  operation  and 
injury  were  recorded. 

Sixteen  thousand  two  hundred  and  thirty-eight  (16,238)  amputations  belong  in  the 
group  of  primary  operations  performed  within  the  first  forty-eight  hours;  of  these,  three 
thousand  nine  hundred  and  ninety-two  (3,992),  or  23.9  per  cent.,  terminated  in  death;  five 
thousand  five  hundred  and  one  (5,501)  were  intermediary  operations;  of  these,  one  thousand 
nine  hundred  and  eighteen  (1,918),  or  34.8  per  cent.,  proved  fatal;  and  two  thousand  and 
twenty-three  (2,023)  were  secondary  operations,  performed  after  a  lapse  of  thirty  days  from 
the  date  of  injury,  of  which  five  hundred  and  eighty-four  (584),  or  28.8  per  cent.,  had  fatal 
terminations.  The  primary  operations  gave  the  best  chance  for  life.  The  operations  per 
formed  during  the  intermediary  or  inflammatory  period  were  the  most  unfavorable  in  their 
results: 

TABLE  GLXX. 

Summary  of  Twenty-three  Thousand  Seven  Hundred  and  Sixty-two  Amputations,  indicating  the  period 

of  the  Operation. 


SEAT. 

CASES. 

PRIMARY. 

INTERMEDIARY. 

SECONDARY. 

i 

o 
H 

Recoveries. 

3 

,* 

PH 

Recoveries. 

£ 

48 
5 
97 
1 
603 
117 
36 
23 
1,  032 
57 
1,951 
22 

Percentage  of 
Fatality. 

Recoveries. 

i 
& 

Percentage  of 
Fatality. 

Recoveries. 

a 

w 

Percentage  of 
Fatality. 

a 
2 

Si- 
£~ 
S 

p 

I 

wl- 

r 
^ 

Amputations  of  Hand  or  Fingers  

4,501 
07 
1,655 
35 
4,626 
722 
1,045 
153 
4,900 
189 
5,803 
66 

4,412 
60 
1,420 
33 
3,581 
505 
987 
115 
3,350 
79 
2,715 
11 

89 
7 
235 
2 
1,045 
217 
58 
38 
1,550 
110 
3,088 
55 

3,179 
50 
911 
27 
2,659 
369 
651 
78 
2,309 
50 
1,  960 
3 

1.4 
9.0 
10.6 
3.5 
18.4 
24.0 
5.2 
22.7 
30.8 
53.2 
49.8 
88.0 

1,059 

350 
5 
615 
86 
243 
25 
690 
16 
488 

41 
109 

3.7 

14.2 
23.7 

174 
159 

1 

307 
50 
93 
12 
351 
13 
267 
8 

Amputations  at  Wrist  Joint  

1 
29 
1 
122 
22 
2 
1 
136 
16 
244 
10 

584 

• 

23 

20.0 
15.4 
50.0 
28.4 
30.5 
2.1 
7.6 
27.9 
55.1 
47.7 
55.5 

Amputations  at  Elbow  

320 
78 
20 
14 
382 
37 
893 
23 

34.2 
47.5 
7.6 
35.8 
35.6 
69.8 
64.  6 
100.0 

Amputations  at  Shoulder  

Amputations  at  Ankle  Joint  

Amputations  at  Knee  Joint  .   . 

Amputations  in  Thigh  

Amputations  at  Hip  Joint  .        

Total    

23,  762 

17,  268 

6,494 

12,246     3,992 
16,  238 

23.9 

3,583 

1,918 

,  ' 
501 

34.8 

1,439 

'  .- 
2,  < 

28.8 

Primary  operations  were  the  rule,  over  two-thirds  of  all  the  amputations  belonging  to 
this  group.  Tn  the  field,  where  few  of  the  appliances  of  conservative  surgery  can  be  had, 
and  where,  moreover,  the  chances  of  properly  applying  them  are  uncertain,  where,  further 
more,  transportation  for  considerable  distances  is  unavoidable,  frequently  amputations  are 
necessary  where  at  least  an  attempt  at  conservation  might  be  made  in  a  general  hospital. 
Nearly  all  the  surgeons  of  the  war  agreed  that  the  decision  in  regard  to  amputation  should 
be  made  at  the  time  of  the  injury  and  should  be  followed  by  immediate  operation.  In  this 
connection  Surgeon  H.  S.  Hewit,  U.  S.  Y.,  observed  that  shock  to  the  extent  of  forbidding 
surgical  interference,  even  in  cas.es  of  considerable  gravity,  is  much  less  common  than 
generally  thought. 

The  experience  with  intermediary  operations  was  so  discouraging  that  when  the  time 
for  primary  operation  had  passed  the  operation,  if  possible,  was  deferred  until  the  inflam 
mation  had  subsided  and  the  lesions  had  become  local  and  analogous  to  chronic  disease. 


880 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  Xll. 


Of  the  different  modes  of  operation  each  method  had  its  advocates;  but  the  flap 
operations  were  more  frequently  used,  especially  in  amputations  in  and  near  the  joints.  Of 
eleven  thousand  and  fifty-three  (11,053)  cases  of  major  amputations  in  which  the  method 
is  specified,  six  thousand  two  hundred  and  forty  (6,240)  were  flaps,  and  four  thousand  eight 
hundred  and  thirteen  (4,813)  circular  operations.  A  multitude  of  varieties  of  the  flap 
operation  were  recorded;  instances  have  been  cited  of  the  use  of  the  anterior,  posterior, 
antero-posterior,  lateral,  bilateral,  external,  internal,  oval,  circular,  U-shaped,  rectangular, 
and  skin  or  muscular  flap.  In  regard  to  the  last  two  modifications  it  seems  to  have  made 
little  difference  whether  a  thick  covering  of  muscular  tissue  was  used  or  a  skin  flap,  for,  as 
a  rule,  the  stumps  became  conical  sooner  or  later;  short  stumps  sometimes  remained  well- 
rounded,  long  stumps  rarely;  but  when  they  remained  full  it  was  often  due  to  osteophytes, 
which  in  time  became  troublesome.  The  advocates  of  the  circular  operation  claimed 
for  this  mode  that  it  required  little  time  and  care  in  dressing,  was  easily  handled,  that  it 
seldom  sloughed,  that  its  discharges  were  less,  and  that  it  was  less  frequently  followed 
by  haemorrhage  than  the  flap  operation,  while  the  latter  mode  would  not  stand  transporta 
tion  unless  very  carefully  supported,  and  was  considered,  altogether,  too  nice  an  operation 
for  the  flurry  of  a  battle-field.  As  far  as  the  stumps  are  concerned,  handsome  rounded 
stumps  were  achieved  by  either  method,  as  has  been  illustrated  in  PLATE  LXXIII,  oppo 
site  page  356,  and  conical  stumps  were  noted  after  the  circular  as  well  as  after  the  flap 
operation. 

The  side  upon  which  the  operation  was  performed  was  recorded  in  eighteen  thousand 
seven  hundred  and  eighteen  (18,718)  cases.  The  amputations  on  the  left  side  exceeded 
those  on  the  right  by  3.4  per  cent. — the  operations  on  the  left  side  being  nine  thousand  six 
hundred  and  eighty-three  (9,683),  or  51.7  per  cent.,  on  the  right  nine  thousand  and  thirty- 
five  (9,035),  or  48.3  per  cent,  of  the  cases  in  which  this  point  was  recorded.  This  is  in 
accordance  with  the  facts  pointed  out  throughout  the  preceding  volumes,  that,  with  a  few 
exceptions,  the  shot  injuries  of  the  left  side  were  more  numerous  than  those  of  the  right. 

TABLE  CLXXI. 


EXTREMITY. 

Total  Cases. 

RIGHT  SIDE. 

LEFT  SIDE. 

1 
H 

Recoveries. 

Percentage  of 
Fatality. 

"3 
1 
H 

Recoveries. 

"3 
"8 

Percentage  of 
Fatality. 

Amputations  in  the  Upper  Extremities  

7,628 
11,090 

3,655 
5,380 

2,845  j        810 
3,  138       2,  242 

22.1 
41.6 

3,973 

5,710 

3,127 
3,  326 

846 
2,384 

21.2 

41.7 

Amputations  in  the  Lower  Extremities  ...        

Aggregates  

18,  718 

9,035 

5,983       3.052 

33.7 

9,683 

6,453 

3,230 

33.3 

Whether  the  seat  of  the  injury  was  on  the  right  or  the  left  side  seems  to  have  had  no 
influence  on  the  ratio  of  mortality.  In  the  upper  extremities  the  fatality  is  slightly  larger 
in  the  amputations  on  the  left  side;  in  the  lower,  in  those  of  the  right;  but  the  difference 
in  the  rate  of  mortality  of  the  two  sides  in  the  whole  number  is  only  0.4  per  cent. 

The  number  of  double  amputations  performed  on  account  of  shot  injuries  was  one 
hundred  and  seventy-two;  of  these,  both  upper  extremities  were  amputated  in  forty-seven, 
one  upper  and  one  lower  in  forty-three,  and  both  lower  in  eighty-two,  as  follows: 


CHAP.  XII.l  DOUBLE    AMPUTATIONS.  881 

TABLE  OLXXII. 
Numerical  Statement  of  One  Hundred  and  Seventy-two  Cases  of  Double  Amputations  for  Shot  Injuries. 


a 

< 

CO 

K 

'D 

H 

S 

O  ^ 

EXTREMITY. 

U 

a 

W 

B 
K 

gg 

|J 

J 

O 

8  H 

£H 

0 

E- 

M 

O 

H 

P4 

fc 

£ 

PH 

Both  Amputations  in  the  Upper  Extremities   

47 

31 

16 

34  0 

One  Amputation  in  Upper  one  in  Lower  Extremities  

43 

21 

21 

1 

50  0 

Both  Amputations  in  the  Lower  Extremities  

82 

31 

50 

1 

61  7 

172 

83 

87 

2 

51  1 

The  mortality  rate  of  the  cases  in  which  both  the  upper  members  were  removed  is 
34.0  per  cent.,  of  those  in  which  one  of  the  upper  and  one  of  the  lower  extremities  were 
amputated,  50.0  per  cent.,  and  of  those  in  which  the  two  operations  were  performed  in  the 
lower  members,  61.7  per  cent.  Brief  accounts  of  these  cases  will  be  found  in  the  following 
table : 

TABLE  CLXXIII. 
Condensed  Summary  of  One  Hundred  and  Seventy-two  Double  Amputations  after  Shot  Injury. 


No. 

NAME.  MILITARY  DESCRIP 
TION,  AND  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  THE  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

1 

Warner,  G.  W.,  Pt.,  B,  20th 

Jnly  3, 

Right  arm  severed  from  body 

Julv   3, 

Amputation  of  right  arm  at 

Discharged  October  7,  1863. 

Connecticut,  age  32. 

1863. 

4  inches  below  shoulder, 

1863. 

shoulder  and  left  arm  in 

and  left  forearm  fractured 

lower  third. 

and  lacerated  by  shell. 

2 

Fuller,  D.,  PL.G,  53dPenn- 

Sept.  17, 

Shell  wound,  botli  arm.s   .... 

Sept.  17, 

Amputation  at  right  shoul 

Discharged    Dec.  17,   1862; 

sylvania. 

1862. 

Oct.  5, 

der    joint   and    in    upper 

both  stumps  heajthy  and 

1862. 

third  of  left  forearm. 

healed. 

3 

Mark,  F.,  PL,  A,  2d  Mis 

Mav  26, 

Both  arms  torn  off  by  acci 

May  26, 

Amp.  at  left  shoulder  joint 

Discharged  August  12.  1861; 

souri  Light  Artillery,  age 

1861. 

dental  discharge  of  a  can 

1861. 

and  in  right  forearm  3  ins. 

stumps  in  good  condition. 

20. 

non. 

below  elbow.  Dr.  Schmidt. 

4 

Hodgdou,  J.  F.,  PL,  I,  1st 

June  14, 

Both  arms  torn  off  to  elbow 

June  14, 

Circular  amputation  of  both 

Discharged  August  5,  1863. 

Mass.  Heavy  Artillery. 

1863. 

and    burner!  fractured  in 

1*63. 

arms  in  upper  third.    Sur 

several  places  from  prema 

geons  M.  F.   Bowes,    12th 

ture  explosion  of  cannon; 

Pennsylvania  Cavalry,  and 

great  laceration. 

T.  C.  Smith,  116th  Ohio. 

5 

Sergeant,  W.,   PL,  E,  53d 

June,   1, 

Shot  fracture  of  both  arms 

June  1, 

Circular  amputation  left  arm 

Disch'd  November  19,  1864; 

Pennsylvania,  age  18. 

1802. 

and  wound  of  nose. 

July  —  , 

in  middle  and  right  arm  in 

sound  stump. 

1802. 

upper  thirds. 

6 

Stratton,  A.,  PL,  C   147th 

June  18, 

Solid-shot  fractures  of  both 

June  18, 

Flap  amputation  both  arras 

Discharged  October  3,  1864  ; 

New  York,  age  17. 

1864. 

elbow  joints;  laceration. 

1864. 

through   mi  idle.   Surgeon 

good   stump.    Died  June 

A.  S.  Coo,  147th  New  York. 

3,  1874;  consumption. 

7 

Bacon,  B.W.,  CapL,G,74tli 

June  27, 

Shot  fracture  of  right  radius 

July  14, 

Flap  amp.  middle  third  right 

Died  July  21,  1864,  of  pyae 

Illinois,  age  40. 

1864. 

and  ulna,  and  of  left  radius. 

19,  1864. 

arm.  Surg.  J.E.  llcrbst,  U. 

mia. 

S.V.  In  lower  third  I't  arm. 

A.  A.  Surgeon  J.  11.  Green. 

8 

Bawn,  W.,  PL,  G,  16th  Me., 

Dec.  13, 

Fracture  of  right    arm   by 

Dec.  14, 

Amputation  of  both  arras  at 

Died  February  22,  1863. 

age  26. 

1862. 

shell,  and  left  arm  by  con- 

1862. 

junction  of  upper  and  mid 

oidal  ball. 

dle  thirds. 

9 

Clarke,  R.,  PL,  E,  13th  Col 

Dec.  10, 

Shot  wounds  of  both  arms, 

Dec.  16, 

Right,  upper  third,  flap  ;  left, 

Died  December  19,  1864. 

ored  Troops,  age  18. 

1864. 

lower   thirds;     great    de 

1864. 

middle  third,  flap.     A.  A. 

struction. 

Surgeon  J.  S.  Giltner. 

10 

Haltzee,  F.,  Pt.,  F,  16th  N. 

Sept.  1, 

Both  forearms  carried  away 

Sept.   1, 

Amputation  in  middle  third 

Died    October  9,   1864;   ex 

Y.  H.  A.,  age  21. 

1S64. 

by  a  cannon  ball. 

1864. 

of  both  arms.    Surgeon  M. 
S.  Kittinger,  100th  N.  Y. 

haustion. 

11 

Lacbine,  L.,  Pt.,  1),  1st  N. 

June  18, 

Hands   blown   off,  eyes  de 

Juno  18, 

Amputation  of  both  arms  .  .  . 

Died  June  20,  1864. 

York  Artillery. 

1864. 

stroyed,  humerus  and  fore 

1864. 

arm  fractured  ;  premature 

discharge  of  cannon. 

12 

McHugh,  O.,  PL,  D,  37th 

Dec.  13, 

Shot  fracture  of  both  arms  .  . 

Dec.  13, 

Amputation  of  both  arms  .  .  . 

Died. 

New  Fork. 

1862. 

1802. 

13 

Ruth,  J.,  PL,  H,6th  Arkan 

Nov.  30, 

Shell  fracture  of  both  elbow 

Dec.    1, 

Right,  ant.  post,  flap,  lower 

Gangrene.    Died  March  26, 

sas. 

1864. 

joints. 

1864, 

third;      left,     ant  ero-  pos 

1865. 

Jan.    2, 

terior   flap,    upper    third. 

1865. 

Surgeon  Cooper.  C.  S.  A. 

14 

Savage,  G.,  PL,  A,  2d  Con 

Juno  1, 

Shot  fracture  of  both  arms 

On  field. 

Amputation  ol  both  arms    .  - 

Died  June  4,  1804. 

necticut  Artillery. 

1864. 

by  bullet. 

lo 

Tanner,  T.  B.,  PL,  B,  3d 

July  10, 

Wound  of  both  arms  by  pre 

Julv  10, 

Amputation  of  both  arms    . 

Aug.  5,  haemorrhage.   Died 

Rhode  Island  Artillerv. 

1863. 

mature  explosion. 

1863. 

August  9,  1863. 

16 

Vanatta,   J,.,    I't.,    A,    23d 

Jan.  11, 

Wound  of  both  arms 

Jan.  11, 

Amp.  of  both  arms.    Surg.  J. 

Die.  (March  0,1863. 

Wisconsin. 

1863. 

1863. 

W.  F.  Gerrish,  67th  Ind. 

SURG.  Ill— 111 


882 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

NAME,  MILITARY  DESCRIP 
TION,  ASD  AGE. 

DATE 

OF 

INJURY. 

NATURE  OF  THE  INJUUV. 

DATE 

OF 

OPERA 
TION'. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

17 

Benrry.  J.  H.,  Pt.,  K,  5th 

Julv   3, 

Right  forearm  and  left  arm 

July  3, 

Flap  amputation  of  left  arm 

Discharged     May  26,  1864; 

Art  illery. 

1803. 

atlowcrthird  carried  away 

1863. 

at  upper  third  and  right 

sound  stumps. 

by  premature  discharge  of 

forearm  nt  middle  third. 

cannon:  fracture  of  j.iw. 

18 

Conner,  J.,  Pt.,  F,  3d  Del 

Feb.    2,    Compound  fiacttire  of  right 

Feb.    2, 

Amputation  right  forearm; 

Disch'd  Xovember  12,  1863; 

aware,  age  15. 

le'63.           forearm,  wound  of  left  arm, 

May  20, 

dissecting  aneurism  of  left 

healthy  stumps. 

ami  \v<  muds  of  breast;  acci 

1803. 

brachial  artery;   amp.  left 

dental  discharge  of  gun. 

arm.  upper  third.    Surg.  E. 

| 

Wolfe  and  Asst.  Surg.  J. 

M.  Houston,  3d  Delaware. 

10 

Duey.    M.,    Pt.,    K,   97th 

Jan.  13,    Shell  fracture  of  riiiht  arm, 

Jan.  16, 

Cir.  amp.  of  right  arm,  upper 

Disch'd   October   21,    1865; 

Pennsylvania,  age  21. 

1805.           middle  third,  ;m<l  left  fore 

1865. 

third  ;  left  forearm  at.junct 

good  stumps. 

arm  by  conoidal  ball. 

upper  and  middle  thirds. 

20 

Hill,  W.,   Sergt,    A,    7Gth 

Apr.    4,    Fracture  of  right  elbow  and 

Apr.    4, 

Flap  amputation  right  arm, 

Discharged  July  22,  1865. 

Colored  Troops,  ago  20. 

1865. 

lett    forearm    by    a    shell 

1865. 

lower  third.     Surgeon   N. 

fragment. 

N.  Ilorton,  47th  C.  T.    Flap 

amputation    left  forearm, 

upper  Third.     Asst.  Surg. 

B.  F.  L.sford,  68th  C.  T. 

21 

Maher,  M.,  Corp'l,  Detach 
ment  of  Ordnance. 

Sept  19, 
1863. 

Injured    by  explosion  of  a 
shell. 

Sept,  19, 
1863. 

Amp.  right  arm,  upper  third  ; 
flap  at  middle  third  of  left 

Discharged     February     8, 
1864;  sound  stumps. 

forearm.     Surg.  E.  H.  Aba- 

die  and  Asst.  Surg.  H.  L. 

Sheldon,  IT.  S.  A. 

22 

Plunket,  T..  Serg't,  E,  21st 

Dec.  13, 

Shell  wounds  of  b;jth  arms  .  . 

Dec.  13, 

Flap  amputation  right  arm 

Discharged,  March  9,  1864. 

Massachusetts. 

1S62. 

1862. 

near  shoulder,  and  left  fore 

arm  in  middle  third. 

23 

Price,    I..  Corp'l,    F,   15th 

Oct.  13, 

Shell  fractures  of  both  arms 

Oct.   14, 

Amputation  of   right   arm, 

Discharged  June  9,  1865. 

West  Virginia,  age  34. 

1804. 

and  tlesh  wound  of  thigh. 

186  J. 

lower  third,  and  left  fore- 

a'ui,    upper   third.     Surg. 

W.  S.  Walsh,  15th  W.  Va. 

24 

SLippcn,  S.  C.,  Pt,  D,  3d 
Rhode  Island  Heavy  Ar 

July  10, 
1863. 

Both  arms  mangled  by  pre 
mature  discharge  of  gun  ; 

Julv  10,- 
1863. 

Amputation  right  arm  near 
shoulder,  and  lelt  forearm 

Discharged  October  19,  1863. 

tillery. 

loss  of  i  ight  eye. 

near  wrist.     Asst.  Surg.  11. 

S.  Lamson,  3d  R.  I.  Art. 

25 

Young,  A.  H.,  Pt.,  A,  6th 

Sept.  17, 

Shot  wounds  of  both  arms  .. 

Sept.  17, 

Amp.  in  upper  third  of  left 

Disch'd  November  16,  1863. 

Wisconsin. 

1862. 

1862. 

arm.  and  flap  am  p.  in  upper 

third  right  forearm.  Surg. 

J.  McXulty,  TJ.  S.  V. 

20 

Chatiield,   J.,    Pt.,  E,  6th 

June21, 

Shot  compound  fracture  of 

July  14, 

Amputation  at  lower  third 

Died  July  14,1863. 

Ohio  Cavalry,  age  32. 

1863. 

left  ratlins  and  right  car 

18B3. 

of  left  arm  and  lower  third 

pal  and  metaearpal  bones 

of  right  forearm. 

27 

Colwell,  A.  N.,  Pt.,  E,  1st 

Nov.    7, 

Fracture  of   both   forearms 

Nov.    7, 

Amp.  in  lower  third  left,  arm 

Died  :<"ovember  7,  1863. 

Rhode  Island  Artillei-y. 

1863. 

by  premature  discharge  of 

1863. 

and  upper  third  right  fore 

cannon. 

arm.     Asst.  Surgeon  H.  G. 

Taylor,  8th  N.  Jersey. 

28 

Ferris,  G.  W.,  Corp'l,  A, 

May  27, 

Shell   wounds  of   left    arm, 

May  27, 

Circular  amp.  left  arm,  mid 

Died  June  17,  1864,  of  pyae 

:itilh  Wisconsin,  age  34. 

1864. 

right  hand,  and  left  thigh. 

June.  12, 

dle  third;   circ.  amp.  right 

mia. 

1804. 

forearm,  upper  third.     A. 

A.  Surg.  W.B.Dick. 

20 

Walker.   P.,  Pt.,  I,   104th 

June  18, 

Shot  fracture  right  himierus 

June  18, 

Muse,  flap  ainp.  at  surg.  neck 

Died  July  9,  1864,  of  exhaus 

New  York,  age  40. 

1H64. 

and  left  forearm  by  cannon 

1864. 

right  huiueius,  and  circ.  of 

tion. 

ball. 

lelt  forearm  in  upper  third. 

30 

McDonald,  J.,  Pt.,  G,  85th 

July  29, 

Shell  wounds  of  right  arm 

July  29, 

Amp.  right  arm  near  shoul 

Discharged  March  7,   1864; 

Pennsylvania. 

1862. 

and  left  hand. 

1802. 

der,  and  amp.  at  left  wrist 

sound  stumps. 

joint.     Surg.  S.  A.  Green, 

34th  Mass. 

31 

Stanford.  V.  B.,  Pt,  A,  1st 

May  15, 

Mutilation  of  hands  by  pre 

May  15, 

Amp.  at  mid.  third  right  arm 

Died  June  4,  1864. 

Ohio  L.  A. 

18U4. 

mature  discharge  of  gun. 

1864. 

and  left  wiist  joint.    Surg. 

E.B.G  lick,  40th  Indiana. 

32 

Cassidy,  J.  E.,  Pt,  K,  4th 

Mar,  31, 

Left  hand  blown  off  ami  right 

Mar.  31, 

Ov;il  flap  amp.  light  forearm 

Discharged  July   21,    1865; 

Artillery,  age  33. 

1865. 

wrist  .joint  comm.  by  explo 

1865. 

at  mid.  th'd  and  left  forearm 

both      stumps      perfectly 

sion  of  camion;   fare  and 

in  upper  third.    Surg.  W.S. 

healed. 

breast  burned. 

Thompson,  U.  S.  V. 

33 

Decker,  S.  H.,  Pt,,   I,  4th 

Got     8. 

Wounds  of  both  forearms  by 

Oct.     8, 

Amputation   both    forearms 

Discharged  Nov.    3,    1862; 

Artillery. 

1862. 

premature  discharge  of  can 

1862. 

six  inches  from  elbow. 

good  stumps. 

non. 

34 

Latham,  E.  P.,  Pt,  9th  Bat 

June  19, 

IJoth  hands  blown  off  by  pre- 

June  19, 

Amp.  right  and  left  forearms 

Discharged  Nov.  20,    1862; 

tery  Ohio  Light  Artillery. 

1862. 

11  aturo  discharge    of   can 

1862. 

in  upper  third.    Surgs.  J.  C. 

left   stump    sound,    right 

non. 

McPheeteis,  33d  Ind  .  and 

withered. 

C.  W.  Millen,  2d  Tenu. 

35 

Lewis,  W.  H.,  Pt,  C,  5th 

June  7, 

Compound  fracture  both  fore-    June  7, 

Flap  amp.  upper  third  right 

Discharged  April   29,  1865; 

Artillery,  ago  22. 

lr:64. 

arms    by    explosion     of    a       1804. 

forearm  and  lowerthird  left 

stumps  healed. 

shell. 

forearm. 

36 

Minor,  E.,  I't,  F,Ind.  Oatt. 

Sept.  28, 

Injured  by  premature  explo-    Sept.  28, 

Ant.  post,  flap  amp.  low.  th'd 

Recovered.    Stumps  healed. 

Minnesota  Cavalry. 

1864. 

siou  of  a  cannon.                         1S04. 

both  forearms.      Drs.  Sow- 

art  and  Murphy. 

37 

Shelby,  T.,Pt.,E,  1st  Ohio 
Heavy  Artillery. 

A  pr.  10, 
1K65. 

Comminution  of  both    fore-    Apr.  10, 
arms,  premature  discharge       1865. 

Circ.  amp.  left,  aiid  flap  amp. 
right  forearm.  A.  A.  Surgs. 

Discharged  June  22,  1865. 

of  cannon. 

C.  F.  Thomas  and  W.  Tib- 

belts. 

38 

Tucker,    J.    B..  Serg't,  B, 

Julv    4, 

Severe  injury  both  forearms    July    4, 

Circ.  amp.  right  forearm  near 

July  11,  ream  p.  left  forearm 

Green  River  B-Ut'u  Hen- 

1865. 

and  hands  by  ramrod  from       1865. 

elbow  and  left  near  wrist. 

4  inches  below  el  bow.    Dis 

tacky  State  Militia. 

cannon. 

Asst,  Surg.  C.    !•.   Ulricli, 

charged  August,  23,  1865; 

:)0     \Vallace,    11..    Pt,,    F,  33d 

May  18, 

Shell  wounds  of  both  hands;     May  18, 

Kentucky  State  Militia 
Amp.  light  forearm  in   mid 

stumps  healed. 
Died  on  hospital  steamer. 

Missouri. 

1864. 

great  mutilation.                          1864. 

dle  and  left  in  lower  third. 

Asst.  Surg.  C.  H.  Andrus, 

128th  New  York. 

40 

Magoonaugh,  I!.,  Pt,  Ord 

May    4, 

Wounded  while  filing  a  sa-    May    4, 

Circ.  amp.  mid.  third  right    Duty  October  16,  1865. 

nance  Corps,  age-  23. 

1865. 

lute. 

1865. 

foreaiui,  and   flap  amp.  at 

left  wrist     A.  A.  Surgs.  E 

S.  Snow  and  D.  O.  Farrand. 

41 

Thompson.  T.  M.,  Pt  ,  1st 

Jan.  14, 

Left  hand  torn  off  above,  and    Jan.   14, 

A  mp.  left  forearm  3  inches  be 

Discharged   May   10,    1863; 

Maine  Battery. 

1863. 

right  below,  wrist;  prema-  !     ]863. 
ture  discharge  of  cannon. 

low  elbow  and  at  right  wrist 
joint.      Surg.  M.  D.  Bene 

stumps    partially   healed, 
but  painful. 

dict,  75th  N.  Y. 

CHAP.  XII.] 


DOUBLE    AMPUTATIONS. 


No. 

NAME,  MILITARY  DESCRIP 
TION",  AND  AGE. 

DATE 

OK 

IXJUllY. 

NATURE  OF  THE  INJURY. 

DATE 

OF 
OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

42 

Colvin,  R.  J.,  Pt,3d  Xcw 

Oct.     1, 

Compound  fracture  lower  end 

Oct.    2, 

Flap  amp.  lower  third  right 

Discharged  Feb.  20,  1805. 

York  lud.  Butt.,  ago  22. 

1804. 

right    forearm,     involving 

186  J. 

forearm  and   left,  little  lin 

wrist,  joint,  and  of  lifth  me- 

ger  with  part  of  mctacm  pill 

tatarsal  bone  left  hand. 

bone.    A  A.  Surg.  E.  Ohlcii- 

schlagcr. 

43 

Eil  ward  s,  M.,  Pt,  M,   3d 

July  13, 

Right  and  left  hands  hlown 

July  13, 

Flap  amp.  low  tl'ird  left  fore 

Discharged  Apiil  13,  1805. 

New  York  Art.,  ago  'JO. 

1804. 

off  at  wrist  joint  by  explo 

1804. 

arm  and  of  right  thumb,  in 

sion  of  shell;  flesh  wound 

dex  iiiid  mill,  lingers  with 

of  side. 

metacarpal  bones. 

44 

Harris,   M.,   Pt,   G,    32th 

Apr.  17, 

Shot  wounds  of  hoth  hands.  . 

Apr.  25, 

Oval  ani|).  right  3d  finger, 

Returned  to  duty  Dec.  17, 

New  York  Cavalry,  age 

1804. 

May    3, 

low.  third  met.  bone.    A.  A. 

1864. 

19. 

1864. 

Surg.  1'.  C.  Porter.    Circ. 

skin  (lap  amp.  up.  third  left 

forearm.     Surg.  C.  A.  Cow- 

gill,  U.S.  V. 

45 

"Warren,  M.  C.,  HUB.,  A, 

Mav    3, 

Injured  hy  the  bursting  of  a 

Mav    3, 

Amputation  of  both  hands 

Discharged  Jan.  20,  1865. 

20th  Maine. 

1863. 

musket  in  his  own  hands. 

1803. 

at  wrist  joints. 

4G 

Ciirrico,    A.,    Pt,  H,  39tli 

Apr.    5, 

Accidental  shot  wounds  of 

A  pr.    5, 

Amp.  right  and  left  index 

Discharged  Jan.    13,   1665; 

Ohio,  ase  31. 

18C4. 

hoth  hands. 

1804. 

fingers  with  met.  bones. 

healed. 

47 

Dnrdtnsrer,  J.  S.,  Pt,   A, 

Julvll, 

Both  hands  partially  hlown 

Amp.  index,  mid  ,  ring,  and 

Discharged  Nov.  26,  1803. 

llth  West  Virginia. 

1803. 

off  firing  a  salute. 

Jittlo  lingers  through  met. 

bones  and  port,  thumb  left 

hand,  and  r't  hand  through 

met.  bones  except  thumb. 

48 

'Rand,  W.  J.,  Pt.,  K,  45th 

Dec.  14, 

Left  arm  near  shoulder  and 

Dec.  14, 

Amp.  at  left  shoulder  j't  and 

Died  January  24,   1863,  of 

Massachusetts,  age  25. 

1862. 

lower   third    right    femur 

1862. 

mid.  third  r't  thigh      Surg. 

pyaemia. 

crushed  hy  solid  shot. 

I.  F.  Galloupe,  17th  Mass. 

40 

Marquis,  "W.  II.,  Pt.,  E,  83d 

Aug.  27, 

Shell     compound     fracture 

Aug.  27, 

Amputation  at  right  shoul 

Sept.  12.  ha;m.  from  brachial 

Pennsylvania,  age  20. 

1803. 

right  arm  and  left  leg. 

1863. 

der  joint  and  at  lower  third 

art.;  lig.  of  axillary.    Died 

left  'leg. 

Sept.  12,  1863. 

50 

Gallagher,  L.,Pt,  A,  09th 

Sept  1, 

Shot  fracture  left  humerus 

Sept.   1, 

Circ.  amp.  upper  third  left 

Discharged  March  2,  1866; 

Ohio,  age  18. 

1864. 

and  wound  right  forearm. 

1864. 

arm.    Surg.  L.  Slugger,  09th 

stump  perfectly  healed. 

Jan.  31, 

Wound  of  right  leg  by  rail 

Jan.  31, 

Ohio.    Flap  amp.  low.  third 

1865. 

road  accident. 

1805. 

right  thigh.    Surg.  C.  Mc- 

Dermott,  U.  S.  V. 

51 

Kircher,  H.,  Capt,  E,  12th 

Nov.  27, 

Shot  wound  left  leg  and  right 

Nov.  27, 

Flap  amp.  right  arm  at  mid. 

Mustered  out  Nov.  14,  1864. 

Missouri. 

1863. 

arm. 

1863. 

third  and  of  left  thigh  four 

inches  above  knee.    Surg. 

J.  Spiegel  halter,  12th  Mo. 

52 

Kreig,  P.,  Pt.,  C,  40th  New 

Auir.21, 

Compound     comminuted 

Aug.  21, 

Flap  amp.  left  arm,  up.  third, 

Discharged  April  27,  1865. 

York,  age  28. 

1804. 

shell    fractures    left   arm 

1864. 

and  left  thiirh  at  mid.  third. 

and  thigh. 

Surg.  W.  B.  Fox,  8th  Mich. 

53 

Lovely,  C.,  Pt,  I,  llth  Ver 

June  1, 

Shot  fractures  left  elbow  and 

June  1, 

Double  flap  amp.  at  mid.  th'd 

Union  of  both  stumps  by 

mont,  ago  38. 

1864. 

right  knee  joint. 

1864. 

left  humerus  and  mid.  third 

first    intention.      Disch'd 

right  thigh. 

Fob.  G,  1865. 

54 

Rose.  F.,  Pt,  D,  57th  New 

Oct.   14, 

Shell  compound  comminuted 

Oct.  14, 

Circ.  amp.  left  arm   1   inch 

Aug.  9,  18U4,  rem.  of  seques 

York,  age  20. 

1S63. 

fractures  left  humerus  and 

1863. 

from  shoulder  and  of  right 

trum.    Discharged  Oct.  13, 

right  knee  joint. 

thigh  at  lower  third.    Surg. 

1864.    Spec.  3104,  A.  M.  M. 

W.  H.  Potter,  57th  N.  Y. 

55 

Schmidt,  H.,  Pt,  G,  57th 

Oct.  3, 

Shot  wounds  right  leg  and 

Oct.  4, 

Amp.  in  upper  right   arm. 

Discharged    December  18, 

Illinois. 

1862. 

light  arm. 

28,  1862. 

Confed.  surg'n.    Flap  amp. 

1803. 

upper  right  thigh.      Surg. 

J.  R.  Zeariug,  57th  111. 

50 

2  Weeks,  J.  D.,  Pt,  G,  3d 

Nov.  14, 

Comminuted  fracture  left  fe 

Nov.  14, 

Ant-post  flap  amp.  middle 

Discharged  July  27,  1865. 

Colored  Troops,  age  20. 

1863. 

mur,  middle  third,  and  left 

1863. 

third  left  arm;  oblique  flap 

elbow  ;  lacerated  wound  of 

amp.  of  upper  left  thigh. 

side;  explosion  of  shell. 

Surg.  S.  W.  Gross,  U.  S.  V. 

57 

Wiun,  J.  J.,  Quartermas 

Apr.  22, 

Shell  wounds  left  arm  and 

Apr.  22, 

Amp.  left  arm,  upper  third, 

Discharged    November  17, 

ter,  U.  S.  S.  Oneida,  age 

1862. 

thigh. 

1862. 

and  left  thiizh  at  junction 

1862;     thigh    stump    un 

33. 

of  upper  and  middle  thirds. 

healthy. 

58 

Arms,  A.  J.,  Pt,  H,  71st 

July  2, 

Shot  fracture  right  arm  and 

July  2, 

Amputation    of    right   arm 

Died  July  3,  1803. 

Now  York. 

1863. 

middle  third  femur. 

1863. 

and  of  thigh. 

59 

Cramer,   S.,    Pt.,    B,   142d 

July  1, 

Shot  wounds  left  arm  and 

July  1, 

Amputation    left    arm   and 

Died  July  9,  1863. 

Pennsylvania. 

1863. 

thigh. 

1863. 

thigh. 

60 

Jackson',    II.,    Pt,   E,    4th 

Sept.  20, 

Shot  wounds  left  arm,  lower 

Sept,  20, 

Amputation  lower  third  left 

Died  October  11,  1864,  of  ex 

Colored  Troops,  age  23. 

1804. 

third,  and  left  thigh,  mid 

1864. 

arm  and  middle  third  left 

haustion. 

die  third. 

thigh. 

01 

Xickinson,  A..  Pt.,  G,  52d 

July   3, 

Comminuted  fracture  middle 

July  3, 

Amp.  arm  at  junction  upper 

Died  July  19,  1863. 

North  Carolina. 

1883. 

third  humerus  and  lower 

1863. 

and  middle  thirds;   thigh 

third  tibia  and  fibia;  con- 

at  lower  third.    Sure:.  C.  S. 

oidal  ball. 

Wood.  66th  New  York. 

62 

Reed,  F.,  Pt.,  A,  53d  111... 

July  12, 

Shot  injury  of  left  arm  and 

Amputation    left    arm    and 

Died  August  12,  1803. 

1803. 

knee  joint. 

thigh. 

03 

Thorn,  T.,  Lieut.,  D,  IGth 

July  3, 

Shot  wounds  of  right  thigh 

July  4, 

Amputation    of   right   arm 

Died   July  30,  1S63,  of  py- 

Norih  Carolina,  ago,  30. 

1803. 

and  light  arm. 

1863. 

and  right  thigh. 

scmia.     • 

64 

Wilson.  J.,  J't,  2IstN.  Y. 

Mar.  27, 

Shot  fracture  left  femur  and 

Primary. 

Amputation    left    arm    and 

Died  March  27,  1865. 

Battery. 

1805. 

left  humerus. 

left  thigh.  Surg.C.Winue, 

77th  Illinois. 

05 

Bierce,  P..  Pt.,  A.  1st  Ohio 

Nov.  13, 

Shell  wounds  left  elbow  joint 

Nov.  13, 

Flap  amputation  left  arm  at 

Discharged  August  29,  1864  ; 

Artillery,  age  20. 

1863. 

and  left  leg;  also  wounds 

1863. 

middle  third  and  left  log 

good  stump  in  1870. 

right  leg  and  left  thigh. 

at  upper  third.    Surg.  G. 

H.  Bane,  115th  Illinois. 

66 

Martin,    L.,    Pt,    E,    29th 

July  30, 

Shot  fractures  left  leg,  right 

July  31, 

Flap  amp.  at  upper  third  of 

Disch'd  December  C,  1865; 

Colored  Troops. 

1804. 

arm,    left    shoulder,    and 

1864. 

right  arm,  and  circ.  atlow'r 

sound  stumps. 

face,  by  conoidal  balls. 

third  of  left  lets.    Surg.  D. 

MacKay.  29th  ('.  T. 

07 

Part  tan,  J.,  Pt.,  D,  Philip's 

Mav  G, 

Shot  fracture  right  arm  and 

May  6, 

Amp.  middle  third  right  arm 

Recovered. 

Georgia  Legion. 

1804. 

right  leg. 

1804. 

and  lower  third  ri;;ht  log. 

68 

Smith,  II.,  Pt.,  E,  11  Ver 

Sept.  13, 

Shell  fracture  left  elbow  joint 

Sept.  13, 

Flap  amputation  loft  arm  at 

Sopt.  20,  secondary  haem.; 

mont,  age  19. 

1861. 

and  left  leg;    both  limbs 

1864. 

lower  third  and  left  log  at 

ant.  tib.  art.  lig.    Disch'd 

almost  shot  off. 

upper  third.     Surg.  C.  B. 

September  14,  1865;  good 

Park,  llth  Vermont. 

stumps. 

1  GALLOUPE  (T.  F.),  Army  Medical  Intelligence,  in  Boston  Medical  and  Surgical  Journal,  1803,  Volume  xviii,  p.  205. 
2GROss  (S.  W.),  Original  communications  in  American  Medical  Times,  1804,  Volume  VLU,  p.  122. 


884 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

NAME,  AGE,  AND  MILI 
TARY  DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 

OPERATION,  OPERATOR. 

RESULT  AND  REMARKS. 

TION. 

69 

Thornton,   J/.  L.,   Pt,,  E, 

Oct.  19, 

Shot  comminution  right  el 

Oct.  19, 

Amp.  at  middle  third  right 

Transferred  to  Provost  Mar 

31st  Georgia,  age  22. 

1804. 

bow  and  right  ankle  joints. 

1804. 

arm,   and  circular  amp.  at 

shal  April  8,  1865. 

lower  third  leg.     Surg.  G. 

G.  Button,  81st  Georgia. 

70 

Bryan,  M.W.,  Pt.,  «,  llth 

Aug.  7, 

Shot  fracture  right  foot  and 

Aug.  7, 

Amputation  of  right  leg  and 

Died  September  6,  1864. 

Michigan. 

1804. 

arm. 

1804. 

arm. 

71 

Crowuirigshu'lds.L.  C.,Pt., 

Dec.  25, 

Shot  fracture  left  arm  and 

On  field  . 

Amputation    left    arm    and 

Died  January  11,  1865. 

G,  142d  New  York. 

1804. 

i  ight  leg. 

right  leg. 

72 

Grossman,  W.,  Pt.,  C,  llth 

May  8, 

Shell  wounds  right  arm  and 

Primary. 

Amp.  right  arm  and  right  leg. 

Died  August  3,  1864. 

Pennsylvania,  ago  23. 

1804. 

right  leg. 

Surg.  W.  Lyons,  llth  Pa, 

Res.,  and  B'.  Rohrer,  10th 

Pa.  Res. 

73 

Jullivett,  N.,  Pt.,  D,  98th 

Sept.  29, 

Shell  wounds  left  arm  and 

Sept.  30, 

Amputation    left  arm  near 

Died  October  9,  1864,  of  ex 

New  York,  age  18. 

1804. 

right  leg. 

1804. 

shoulder  and  right  leg  in 

haustion. 

middle  third.     Asst.  Surg. 

J.  A.  Bigelow,  8th  Conn. 

74 

Piuney,  A.  N.,  Capt.,  II, 

July  30, 

Shot  fracture  of  right  hu- 

July  30, 

Circular  amputation  of  arm 

Died  August  8,  1864. 

27th  Colored  Troops. 

1804. 

morus  and  right  leg. 

1804. 

in   middle   third    and  leg. 

Surg.  G.  J.  Potts,  23d  C.T. 

75 

Pool,  J.,  Pt.,  B,  16th  Ga..  . 

July  —  , 

Shot  wounds  of  leg  find  arm 

Amputation  of  leg  and  arm. 

Died  Julv  6,  1803. 

1803. 

70 

Ray,    S..   Sergt  ,   D,   84th 

Sept.  2, 

Shot  fracture  leg  and  arm   . 

Sept.  2, 

Amp.  of  leg  and  arm.    Surg. 

Died  September  6,  1864. 

Illinois. 

1804. 

lf-04. 

T.  M.  Cook,  101st  Ohio. 

77 

Taylor,  S.  J.,  Pt.,  E,  30th 
Alabama,  age  22. 

Dec.  10, 
1804. 

Shot  fracture  right  humerus 
and  elbow  joint  and  left 

Dec,  17? 
1804, 

Ant.-post.  flap  amp.  at  lower 
th'd  of  arm.    A.  A.  Surg.  E. 

Died  April  8,  1865,  of  chronic 
diarrhoea. 

tarsus. 

Jan.  20, 

AVoodruff.      Circ.  amp.  at 

1865. 

lower  third  of  leg.     A.  A. 

Surg.  W.  M.  Hodman. 

78 

Brown,  P.  W.,  Pt.,  I,  15th 

Sept.—, 

Shot  wounds    left    leg  and 

Amputation  of  Irft  le<r  and 

Virginia. 

1802. 

arm. 

arm. 

79 

Schouc.-kles,    F.,  Pt.,   G, 

Dec.  13, 

Comminuted  fracture  upper 

Dec.  19, 

Amp.  in  upper  th'd  ri't  arm, 

Died. 

2d  Delaware. 

1802. 

third  light  humerus  and 

1862. 

and  Piroiroff's  amp.  at  ri't 

bones  right  foot  by  can 

ankle  joint.      Surgs.  C.  S. 

non  ball. 

AVood,  00th  New  York,  and 

C.  Gray,  7th  New  York. 

80 

Fuller,  II.  D.,  Pt.,  F,  28th 

Oct.  19, 

Shell  wounds  left  forearm, 

Oct.  20, 

Flap  amp.  at  lower  third  left 

Discharged    June,  21,    1805. 

Iowa,  ago  16. 

1864. 

upper  third  left  foot,  and 

1864. 

aim,   and   Chopart's  amp. 

Spec.  4226,  A.  M.  M. 

right  tibia,  middle  third. 

of  left  foot.    Surg.J.AV.  H. 

Vest,  28th  Iowa, 

81 

Wimpfler,  S.,  Pt.,  C,  9th 

Nov.  25, 

Shot   wounds   left    forearm 

Primary. 

Amp.  at  left  dhow  joint  and 

Died  December  9,  1863. 

Ohio. 

1863. 

and  left  foot, 

at  lower  third  of  left  let?. 

82 

Clark,  G.  W.,  Pt.,  E,  12th 

May  9, 

Fragment  of  shell   commi 

May  9. 

Amputation    in    right  fore 

Discharged  June  2,  1865. 

New  Hampshire,  age  25. 

1804. 

nuted    right  forearm   and 

1804. 

arm   and   in   middle   third 

lower  third  right  femur. 

of  right  thijjh. 

83 

Costdlo,   1'.,  Corp'l,  E,  83d 

June  10, 

Shot  wounds  right  thigh  and 

June  12, 

Amputation  right  forearm  1  J 

Mustered  out  Aug.  10,  1805. 

Indiana. 

1804. 

right  foreaim. 

1804. 

inch    above   wrist  and    of 

right  thigh  4  inches  above 

knee.  Confederate  surgeon. 

84 

Fay,    J.    S.,    Pt.,    F,    13th 
Massachusetts. 

Apr.  30, 
1803. 

Shell  fractures  i  ight  forearm 
and  right  knee. 

Apr.  30, 
1803. 

Amputation  mid.  th'd  right 
forearm  and  low.  th'd  ri-jht 

Disch'd  September  9,  1803; 
stumps  sound  in  1SGG. 

thigh.     Surg.  A.  W.  AVhit- 

ney,  13th  Massachusetts. 

85 

Kretzler,    A.,    Corp'l,    D, 

June  14, 

Sh  ell  fractures  righ  t  forearm  . 

June  14, 

Flap  amp.  low.  3d  light  fore 

Disch'd  Aug.  29,  1863.    Died 

162d  New  York. 

1803. 

right  knee,  and  lower  jaw. 

1803. 

arm  and  ant.  post,  flap  low. 

July  8,  1876.  of  phthisis. 

th'd  light  thigh.     Surg.  W. 

B.  Eager,  102d  New  York. 

86 

Lawrence,   C.,   Corp'l,   E, 

June  10, 

Shell  wounds,  fracture  left 

June  10, 

Circular  amp.  mid.  third  left 

Discharged  Nov.  21,  1803. 

9oth  New  York. 

18t3. 

ulna  and  fifth  metacarpal 

1803. 

forearm  and  lower  th'd  left 

bone  and  opening  left  knee 

thigh.      Surg.  E.    S.   Hoff 

joint. 

man,  90th  New  York. 

87 

Jecko,  P.,  Serg't,  D,  15th 

Nov.  29, 

Shot  fractures  right    wrist 

Nov.  29, 

Circ.  amp.  lower  third  right 

Discharged  July  31,  18G5. 

Missouri,  age  29. 

1804. 

joint  and  lower  third  right. 

1864. 

forearm,  and  flap  amp.  mid. 

• 

leg. 

third  r't  leg.     Surg.  Graves, 

Gth  Arkansas,  C.  S.  A. 

88 

Bendall,  B.  F.,  Pt.,  F,  53d 

July—, 

Shot  wounds  left  forearm  and 

Amputation  in  left  forearm 

Died  August  6,  18C3. 

Virginia 

1803. 

right,  leg. 

and  right  leg. 

89 

Price,  II.,  Pt..,  B,  1st  New 
Jersey  Artillery,  age  25. 

Julv  3, 
1803. 

Shot  fractures  nght  forearm 
and  right  leg. 

July  4, 
1803. 

Amputation  hi  upper  third 
right    forearm    and    lower 

Colliquat  i  ve  diarrhoea.  Died 
August  23,  1803,  of  exhaus 

third  right  leg. 

tion. 

90 

Kearney,  J.,  Serg't,  I,  70th 

July  2, 

Shell  shattered  lower  th'd  ri't 

July  2, 

Circular  amp.  June.  mid.  and 

September   25,   gangrene  in 

New  York,  age  30. 

1803. 

thigh  and  carried  away  r't 

1803. 

lower  thiid  r't  thigh  and  1st 

stum]).  Discharged  July  G, 

thumb,  fracturing  metacar 

metacarpal  bone  at  middle. 

1804.     Spec.  4366,  A.  M.'M. 

pal  bone. 

Surg.  G.  AV.  Metcalf,  76th 

New  York. 

91 

Waters,  W.,  Pt.,  K,  123d 
New  York. 

MavlS, 
1864. 

Large,  fragment  of  shell  car 
ried  away  left  thigh  and 

May  15, 
1804. 

Amputation  at.  left  hip  joint 
and  in  middle  third  right 

Survived  but  a  short  time. 
Died    May  15,  1804.     (See 

fractured  right  leg. 

leg.     Surgeon  J.  AV.  Brock, 

CASE  280,  p.  135,  ante.) 

CGth  Ohio. 

92 

Allen,  S..Pt,,G,  59th  Mas 

June  17, 

Conoidal    ball    comminuted 

June  17, 

Amputation  in  lower  third 

Flabby  granulation;  profuse 

sachusetts,  age  1!). 

1804. 

both  knee  joints. 

1804. 

both  thighs. 

suppu'n.    Died  June  27,  '64. 

93 

Baglry,  S.,  Pt.,  B.  5th  New 

Anr.  7, 

Conoidal   ball   comminuted 

Aprils, 

Circular  amp.  mid.  th'd  right 

Julv  5,  pus  burrowing  about 

Hampshire,  age  21. 

1865. 

both  condyles  right  femur 

June  3, 

thigh.    Sur.W.  O'Menglier, 

both  thighs     Died  July  10, 

and  head  left  tibia. 

1805. 

G9th  N.  Y.     Ant.-post.  tlap 

165,  of  exhaustion,    tipec. 

amp.  left,  thigh,  juuc.  lower 

4232,  A.  M.  M. 

and   middle   thirds.     Surg. 

O.  A.  Judsou,  U.  S.  V. 

94 

Dowd,   T.,    Serg't,   C,    2d 

Julv  30, 

Shot  wound  both  thighs. 

Julv  30, 

Amputation  mid.  third  both 

Died  July  3  1,1864. 

Michigan. 

1864. 

1864. 

thighs.     Surg.  AV.  B.  Fox, 

8th  Michigan. 

95 

Good  well,  S.,  Pt.,  G,  29th 

Mar.  30, 

Shot  fracture  both  thighs.  .  . 

Mar.  30, 

Amput'n  both  thighs.    Surg. 

Died  March  31,  1865. 

Illinois. 

1865. 

1865. 

W.  D.  Murray,  101st  N.  Y., 

and  J.  W.  Aiigel,  -Jlid  Wis. 

90 

Earner,  n.,  Pt,,  4th  Vir 

July—  , 

Wounds  of  both  thirrhs 

Amputation  of  both  thighs. 

Died  July  6,  1863. 

ginia. 

1863. 

97 

Michael,  U.  S.,  Pt,,  A,  105th 

July  3, 

Shot  wounds  of  both  legs  .. 

Julv  3, 

Amputation  in  lower  third 

Died  July  10,  1863. 

Pennsylvania. 

1863. 

1803. 

both  thighs. 

CHAP.  XII.] 


DOUBLE    AMPUTATIONS. 


885 


No. 

NAME,  AGE,  AND  MILITARY 
DESCRIPTION. 

DATE 

OF 

INJURY. 

NATURE  OF  INJURY. 

DATE 

OF 

OPERA 
TION. 

OPERATION,  OPERATOR. 

RESULT  AND  REMARKS. 

98 

Mills,  \V.  F.,  Pt.,  E,  8th 

June  16,  !  Shot  fracture  of  right  femur   June  16, 

Amp.    both    thighs,    lower 

Died  June  23,  1864. 

New  York  Heavy  Artil 

18G4.         and  left  knee  joint                  1864. 

third.     Surg.  S.  H.  Plumb, 

lery,  a<'o  42. 

Sid  N.  Y. 

99 

Moore,    J.,    Pt.,    E,    4Gth 

Aug.  9, 

Fract.  int.  condyle  right  fe 

Aug.  15,    Double  flap  amputation  low. 

August  26,  nervous  shock 

Pennsylvania. 

18U2. 

mur,  and  right  leg  below 

1862.         third   both  thighs.     Surg. 

from  fright.     Died  1  hour 

joint  •  also  wou'ds  1't  thi^h. 

J.  E.  Summers.  IT.  S.  A.                afterward.  August  2(i.  1S62. 

100 

Myer,  C.,  Pt.,  F,  30th  Mis 

June  4, 

Couoidal  ball  fractures  both    June  4,    Double  flap  amputation  both  !  Died  June  5,  18G3. 

souri. 

1803. 

thighs. 

18C3. 

thighs.    Surg.  M.  W.  Rob- 

bins,  4th  Iowa. 

101 

Nicholson,  D..  Pt.,  H,  22d 

May  10, 

Shot  wounds  of  both  thighs 

May  10, 

Ant.  post,  flap  amput'n  both 

Stumps  unhealthy,  tendency 

Massachusetts,  age  23. 

1864. 

by  conoidal  ball. 

1864. 

thighs  at  low.  third.    Surg. 

to  slough.    Died  May  28, 

J.  Thomas,  118th  Penn. 

1864.     Spec.  2966.  A.  M.  M. 

102 

Nuncngrr,  G.,  Pt.,  A,  58th 

Shot  fracture  both  thigh?  -  .  .  . 

Amputation  of  both  thighs.  . 

Died  August  17,  1862. 

103 

Virginia. 
Rabbitt,  E.  C.,  Serg't,  B, 
10th  Missouri. 

Nov.  24, 
1803. 

Shot  wounds  of  both  knee 
joints. 

Nov.  25, 
1863. 

Amputation  lower  third  both 
thighs.    Surg.  E.  J.  Buck, 

Died  December  26,  1863. 

18th  Wisconsin. 

104 

Stewart,  ,T.,    Pt.,   D,    77th 

Mar.  25, 

Shell  fracture  both  legs  Mar.  25, 

Amputation  in  lower  third 

Died  April,  1865;  pya3mic  in 

New  York,  age  38. 

18G5. 

1865. 

both  thighs. 

toxication. 

105 

Tieman,  H.,  Pt.,  C,  119th 

June  21, 

Shot  wounds  of  both  thighs.  .  June  21, 

Amputation  of  both  thisrhs. 

Died  July  3,  1864. 

New  York. 

1864. 

1864. 

Surgs.  G.  P.  Oliver,  lllth 

Penn.,  and  J.  V.  Kendall, 

149th  New  York. 

106 

Wallace,  D,  Pt,,  I,  5th  Ar 

July  1, 

Conoidal  ball  shattered  pa 

July  4, 

Circular   amputation   lower 

Died  August  2,  1863.    Specs. 

tillery. 

1863. 

tella  of  right  and  coudyles 

1863. 

third  both  thighs. 

1383,  1384,  A.  M.  M. 

of  left  knee  joint. 

107 

Whelpley,  J.,  Lieut.,  D,  1st 

Mar.  25,    Solid  shot  carried  off  both 

Mar.  25, 

Amputation  in  lower  third 

Died  March  25,  1865. 

AT'iiiio  * 

1865.     '     lotrs. 

1865. 

both  thighs. 

108 

Woodwortb,  J.  W.,  Corp'l, 

Nov.  7,  I  Shot  compound  fracture  mid. 

Nov.  7, 

Amputation  at  middle  third 

Died  November  8,  1863. 

H.  llth  Infantry. 

1863. 

third  both  thighs. 

1803. 

both  thighs. 

109 

Dunn,  M.,  Corp'l,  II,  4<ith 

May  25, 

Grape  shot  passed  through 

May  26, 

Amputation  both  thighs,  low. 

August,  1864,  re-amp,  right 

Pennsylvania,  ago  21. 

1864. 

both  legs  just  below  knee 

27,  1864. 

third.  A.  A.  Surg.  S.  Teats. 

thigh,  mid.  third.    Disch'd 

joint. 

Aug.  I',  18G5.    Died  Oct.  23, 

•  1877.     Spec.  3193,  A.  M.  M. 

110 

Parker.  J.A.,  Pt.,L  Cobb's 

June  24 

Shot  wounds  of  both  thighs 

Amputation  of  both  thighs  .  . 

Furloughed  August  2,  Ifc64. 

Georgia  Legion. 

1864T  ' 

1111 

Rush,  r.  G.,Pt.,G,  21  Geor 

Mar.  25, 

Shell  comminution  left  knee 

Mar.  25, 

Ant.  post,  flap  amp.  low.  th'd 

Released  Aug.  2,  1865.    Spec. 

gia,  ago  22. 

1865. 

joint  and  right  leg. 

1865. 

both  thighs.    Surg.  L.  W. 

3998,  A.  M.  M. 

Bliss;  51st  New  York. 

112 

Laphani,  C.  N.,  Corp'l,  K, 

Julv    8, 

Both  legs  carried  away  by 

July  10, 

Ant.  post,  flap  amp.  middle 

Discharged  August  25,  1864. 

1st  Vermont  Cav.,  age  23. 

18ti3. 

solid  shot;  extensive  com 

1863. 

third  right  thi'ih  and  at  left 

minution. 

knee  joint.    Surgeon  L.  P. 

Woods,  5th  New  York  Cav. 

113 

Barker,    J.,    Pt.,    I,    5Sth 

June  17, 

Conoidal  ball  wounded  right 

June  17, 

Oval  flap  amp.  lower  third 

Died  June  27,  1864. 

Massachusetts,  atre  42. 

18G4. 

knee-joint  and  left  leg. 

1864. 

rig't  thigh  and  1't  knee  j'nt. 

114 

Smith,  H.,  Pt.,  1,  14th  New 

June  7, 

Shot  wounds  right  thigh  and 

June  7, 

Flap  amputations  at   lower    Died  June  17,  1864. 

Jersey,  ago  24. 

1864. 

left  leg. 

1864. 

third  right  thigh  and  at  left 

B 

knee  joint. 

115 

Brown,  11..  Pt.,  K,22d  Col 

July  30, 

Shell  fracture  both  legs  .   .  . 

July  30, 

Amputation  right  leg  in  up-    Discharged  March  20,  1865. 

ored  Troops,  age  19. 

1864. 

1864, 

per  third  ;  double  flap  am 

Died  July  14,  1872. 

Mar.  19, 

putation  left  thigh,  lower 

•    1865. 

th'd    A.A.Surg.O.Shittler. 

116 

Housley,  H.,  Cook,  F,  33d 

Apr.   2, 

Shell    fracture   right    kaee 

Apr.  11, 

Amp.  right  thigh,  lower  th'd, 

Sent  home  July  23,    1865; 

Wisconsin,  ago  20. 

1865. 

joint  and  left  leg,  mid.  th'd. 

1865. 

and  left  leg  in  upper  third  ; 

not  a  pensioner. 

antero-post.  skin  flaps  and 

circ.  sect,  muse.    Surg.  F. 

E.  Piquette,  86th  C.  T. 

117 

Banks,  S.,  Pt.,  C,  43d  C.  T. 

July  30, 

Conoidal  ball  fractured  left 

Julv  30, 

Amp.  mid.  th'd  r't  thigh  and 

Died  July  31,  1864. 

1864.          leg  and  right  thigh. 

1864. 

of  left  lesr,  lower  th'd.  Surg. 

D.  MacKay,  29th  C.  T. 

118 

Bradley,  P.,  Serg't,  C,  IGth 

Aug.  21, 

Shell  fracture  left  knee  joint 

Aug.  21, 

Amp.  lower  third  left  thigh 

Died  September  16,  1864. 

Michigan. 

1864. 

and  right  leg. 

1864.         and  upper  third  right  leg. 

119 

Foss.  J.,  Serg't,  C,  50th  N. 

Sept.  17, 

Shot  wounds  both  legs  and    Sept.  17,    Amputation    of   thigh    and 

Died  September  21,  1862. 

York. 

18G2. 

left  arm. 

1862. 

leg. 

120 

Hess,    T.    W.,   Pt.,   K,  8th 

Sept.  30, 

Kluit    f  r:u't,iirr>s   lpfY,  Iprr  and 

Amputation  of  left  leg  and 

Died  October  7,  1864,  of  irri 

North  Carolina. 

1864.    '      right  thigh. 

of  right  thigh. 

tative  fever. 

121 

Johnson,  C.  L.,   Pt.,  B,  1st 

Au;r.  6,    Compound  shot  fracture  left 

Aug.   6, 

Amputation  in  low.  third  left 

Died  August  21,  1864. 

Tennessee. 

1861. 

leg,   inv.  knee  joint,    and 

1864.         thigh  and  upper  third  right 

riiiht  leg,  lower  third. 

leg. 

122 

Lamphere,  L.  O.,  Pt.,  G, 

June  30, 

Shell  comminution  lower  end 

June  30, 

Amp.  lower  third  left  thigh 

Died  July  22,  1864,of  tetanus. 

21st  Connecticut. 

1SG4. 

left  femur  and  right  foot 

1864. 

and  lower  third  right  leg. 

and  ankle. 

123 

Lewis,  J.  K.,  Pt.,  H,  53d 

Julv  —  , 

Shot  wound  left  knee  joint 

July  —  , 

Amp.  left  thigh,  lower  third  ; 

Died  July  10,  1863. 

Georgia,  age  32. 

18G3. 

and  fracture  right  leg. 

1863. 

ri't  leg  at  point  of  election. 

Surg.  J.  J.  Knott,  P.  A.  C.  S. 

|124 

Birmingham,  A.,   Lt.,    A, 

Dec.  13,    Shot  wounds  right  knee  and    Dec.  13, 

Amp.  right  thigh,  and  Piro- 

Died  December  17,  1862. 

69th  New  York.                        1862.          left  foot. 

1862. 

gotf's  amp.  left  ankle  joint. 

125 

Alexander,  J.   W.,  Corp'l, 

Dec.  11,    Shot  fracture  both  legs  

Dec.  11, 

Amputation  of    both  legs. 

Recovered. 

K,  13th  Mississippi. 

1862.                                                                  1862. 

Surgeon  Gilmore,  C.  S.  A. 

120 

Hartram,  W.  H.,  Pt.,  F,  1st 

Sept  17     Shot  fracture  both  legs          .  1 

Amputation  of  both  logs    .  . 

Furloucrhed  Sent.  23.  1864. 

North  Carolina. 

1862. 

127 

Fisher,  E.    II.,  Lieut..  A, 

Oct.  20,    Wound  of  both  legs  by  ex-     Oct.  20, 

Amp.  both  legs.     Surg.    E.  1  Discharged    November  20, 

21st  Indiana. 

lb'62.          plosion  of  a  shell                          1862.          Bead,  21st  Indiana.                       1863. 

19Q 
1JO 

Gordon,  J.,  Teamster,  Q. 

Aug.  30,    Shell  wounds  both  legs,  low.     Sept,  1,  :  Amp.  both  legs,  lower  third.     Recovered. 

M.  I)  ,  age  38. 

1862.          third.                                               18G2.      !     A.  A.  Surg.  M.  J.  Davis. 

129 

Higginbotham,  E.  U.,  1't., 

Mav  12, 

Shot  fracture  of  both  legs...  I  May  13,    Amp.  mid.  third,  both  legs. 

Recovered. 

F,'  38th  Georgia, 

1864. 

1864. 

Surgeon  Arrington,C.  S.  A. 

130 

Kopp,  E.,  Pt.,  K,  12th  New 

Mar.  25, 

Shot  fracture,  of  hoth  tibiae    Mar.  26, 

Flap  amp.   low.  third  right 

April  1G,  protruding  bones 

Jersey,  age  32. 

1865. 

and  left  ankle  joint,                   27,  1865. 

and  mid.  third  left  leg.  Sur 

removed     from      stumps. 

ge  on  s    A..    Sat  terth  wait  e, 

Discharged  Oct.  3,  1865. 

12th  N.  J.,  and  W.  J.  Burr. 

131 

lLorence,  J.,  Corp'l,  K,  9th 

Fob.    8, 

Shot  wounds  of  both  legs  by 

Feb.    8, 

Flap  amputation  both  legs, 

Discharged   September    30, 

Now  Jersey,  age  35. 

1862. 

cannon  ball.                                1862. 

up.  third.    Surgeons  J.  H. 

1862;  1875,    knee  joints 

Thompson,  U.  S.  V.,  and  II. 

without    motion,    stumps 

| 

! 

W.  Rivers,  4th  R.  I. 

very  tender. 

1  THOMPSON  (J.  II.),  Report  of  cases  occurring  at  the  battle  of  Roanoke  Island,  Va.;  in  Am.  Mcd.  Times,  1802,  Volume  IV,  p.  199. 


886 


WOUNDS    AND    COMPLICATIONS. 


[CHAP.  XII. 


No. 

NAME,   MILITARY 
DESCRIPTION,  AXD  AGE. 

DATE 

OF 

IXJUIIY. 

NATURE  OF  IKJUUY. 

DATE 

OF 

OPERA 
TION. 

OPERATION  AND  OPERATOR. 

RESULT  AND  REMARKS. 

132 

Lee,  D.,  Pt.,  G,  2d  N.Y. 

June  1C, 

Shell  injury  of  hoth  legs    .  . 

June  16, 

Circ.  amp.  lower  third,  both 

Disch'd  May  31,  1865  ;   died 

H.  A.,  aj;e  20. 

1804. 

18Ct. 

legs.     Ass't  Surgeon  0.  S. 

September  25,  1874. 

Paine,  2d  N.  Y.  Art. 

133 

Page,P.,Pt.1K,3ilMicb  .. 

Apr.  1C, 

Shell  wounds  of  hoth  legs. 

Apr.  1C, 

Circular  amp.  at  lower  third, 

Discharged  August  16,  1802. 

18G2. 

1802. 

both  legs. 

134 

Scott.  J.  G.,  Pt.,  D,  77th 

May    6, 

Shell  fracture  of  both  legs  .  .  . 

May    6. 

Flap  amp.  both  legs.     Snr. 

Disch'd  Nov.  3,  '64;  '79,  rig't 

New  York,  age  23. 

1H61. 

186.4. 

E.  B.  P.  Kelly,  95th  Pa. 

leg  ream  putated.  «Sp«c.  513. 

135 

Smith,  A.  A.,Pt,,  A,  3d  R. 

Apr.    8, 

Fracture  of  both  lesrs  by  ex 

Apr.    9, 

Flap  am  p.  upper  th'd  left  leg. 

Discharged  August  25,  1804. 

Island  Art.,  age  23. 

1S63. 

plosion  of  magazine  stmr. 

July  31, 

Surgeon  F.  L.   Dibble,  6th 

Spec.  1103,  A.  M.  M. 

G.  Washington. 

1863. 

Conn.      Circ.  of  right  leg. 

A.  A.  Surg.  J.  W.  dishing. 

136 

Snettings,  E.  A.,  Pt.,  Not- 

June22, 

Shot  fracture  both  le^s  ..... 

June  22 

Amp.  mid.  th'd  left,  and  low. 

Recovered. 

taway's  Artillery. 

1864. 

1864. 

th'd  right  leg.  Confed.surg. 

137 

Starin,  F.,Pt.,  C,  43d  Wis 

Nov.    5, 

Shell  wounds  mid.  th'd  right 

Nov.    5, 

Flap  amp.  upper  third  right 

Discharged  July  2,  1865. 

consin,  age  is*. 

18G4. 

and  low.  third  left  leg. 

1864. 

and  lower  th'd  left  leg. 

138 

Stewart,  T.  B.,  Pt.,  0,  2d 

Sept  19, 

Shell  wounds  both  feet,  com- 

Sept.  23, 

Circular   amputation   lower 

Discharged  August  17,  1865. 

Conn.  H.  A.,  age  31. 

1864. 

minut'gall  thetarsal  bones. 

24,  1864. 

th'd  both  lesis.    Ass't  Sursr. 

!.  G.  Thompson,  77th  N.  Y. 

139 

Tanner,  J.,  Corp'i,  C,  87th 

Ann.  30, 

Shell  wounds  both  legs  

Ausr.30, 

Flap  amputation  upper  th'd 

Discharged  Oct.  15,  1802. 

New  York,  age  18. 

1802. 

1802. 

both  legs. 

140 

Trim,    S.   H.,  Pt,,  B,  41st 

Mav  21, 

Both  legs  torn  off  near  ankle 

Mav  21, 

Circ.  amp.  both  lesrs.    Surg. 

July    13,  1864,   recovered  ; 

Alabama,  age  19. 

1861. 

by  explosion  of  shell. 

1864. 

D.  Jackson,  44th  Tenn. 

furloughed. 

141 

Troy,   B.  F.,  Pt.,  G,  10th 

May  1C, 

Shot  wounds  both  legs  

May  16, 

Amp.  right  leg  4  inches,  and 

Discharged  Sept.   3,     1803  ; 

Iowa. 

1803. 

1863. 

left  leg  8J  ins.  below  knee. 

sound  stumps  in  1870. 

142 

Willson,  S.  L.,  Pt,  D,  72(1 

July  2, 

Shot  fracture  both  legs,  lower 

July   3, 

Flap  amp.  up.  third  both  legs. 

Discharged  May  31,  1805. 

New  York,  age  18. 

1803. 

third,  by  conoidal  hall. 

180!. 

Surg.  C.  K.  It-win,  72d  N.  Y. 

143 

Albeit,  •  I.,  l't.,F,  91st  New- 

Oct.  12, 

Shot  wounds  of  lower  third 

Oct..  19, 

Amputation  in  upper  third 

Died  November  4,  1804,  of 

York,  age  19. 

1804. 

both  legs. 

1864. 

both  legs. 

pytemia. 

144 

Anderson,    D.,  Corp'i,  II, 

Au"-.21, 

Shell  wounds  both  le^s  

Aug.  21, 

Amp.  both  legs.  Surg.  W.  C. 

Died  October  1,  1804. 

7th  Maryland,  age  41. 

1804. 

1804. 

Shurlock,  51st  Penn. 

145 

Arkerson,  A.,  Pt.,  D,  llth 

June  17, 

Shot  fracture  both  legs  

June  18, 

A  mputation  of  both  legs  .  

Died  June  19,  1864. 

Infantry. 

1804. 

1M54. 

140 

BT  iukmann,  A.,  l't.,G,79th 

Aiisr.  11, 

Shot  fracture  both  le^s 

An".  11. 

Amputation  of  both  legs.  .  .  . 

Died  August  12,  1864. 

Pennsylvania. 

1804. 

1804. 

147 

Cookscy,  A.  J.,  Pt,  D,  3d 

Dec.  15, 

Shot  wounds  of  both  legs    .  . 

Dec.  16, 

Circular  amputation  in  mid 

Died  January  2,  1865,  from 

Mississippi,  age  35. 

1864. 

1864. 

dle  third  both  legs. 

exhaustion. 

148 

Daniel,   J.   P.,  Coip'l,  H, 

Shot  wounds  of  both  ankles. 

Second 

Amputation  of  both  le^s 

Died  September  30,  1803. 

llth  Virginia. 

ary. 

149 

Flciuming.  C.,  Pt.,  A,  35th 

Dec.  13, 

Shell  fracture  both  legs  

Dec'.  13, 

Amputation  of  both  legs     . 

Di:d  December  21,  1862. 

New  York. 

1802. 

1862. 

150 

Luallen,   J.,   Pt.,  D,  13th 

Jan.  15, 

Shot  fracture  of  both  legs.  .  . 

Jan.  15, 

Amp.  of  both  legs.    Surg.  L. 

Died  January  23,  1865. 

Indiana. 

1865. 

1865. 

Barnes,  Gth  C.  T.,  and  As 

sistant  Surg.  n.  C.  Merry- 

weather,  5th  C.  T. 

151 

MoCurdle,  J.,    Pt.,  E,    2d 

July  2 

Shell  injury  both  le^s 

July  2 

Amp.  left  leg  near  knee  and 

Died  July  3,  1864. 

Penn.  Artillery,  ago  23. 

1804. 

1804. 

light  leg  near  ankle. 

152 

Manson,  J.  P.,  Pt.,  A,  121st 

Dec.  13, 

Shot  fracture  of  both  legs  .  . 

Dec.  13, 

Flap  amputation   both  legs 

Died  December  25,  1862. 

Pennsylvania. 

180:?. 

1802. 

below  knee. 

153 

Nason,  ll.,Pt..C,  1st  Khode 

Nov.  30, 

Cannon  ball  took  off  both  legs 

Dec.   2, 

Circularamp.  lower  ri^ht  3d; 

Died  December  21,  1803,  of 

Island  Artillery,  ago  38. 

1803. 

just  above  ankles. 

1803. 

flap  at  middle  3d  left  leg. 

pyajtnia. 

154 

Nock,  P.,  Pt,,  E.  1st  La., 

Mav  27, 

Both   feet  carried  away  by 

May  27, 

Both  legs  amputated  

Died  May  27,  1803. 

att'ch'd  to  1st  Me.  Batt'v. 

1803. 

cannon  bull. 

1863. 

155 

Paine,  A.,   Pt.,  42d    New 

July   2, 

Fracture  of  both  feet  by  solid 

July   3, 

Amp.  low.  3d  both  legs.  S'g. 

Died  July  23,  1863. 

York. 

1863. 

shut. 

1863. 

H.  M.  Me  A  bee,  4th  Ohio. 

150 

Randell,   A.,    Pt.,  C,    35th 

Dee,.  13, 

Shell  fracture  both  legs  

Dec.  13, 

Amputation  of  both  legs  .  .  . 

Died  December  15,  1862. 

New  York. 

1802. 

1802. 

157 

Rath,    11.  A..   Pt.,   F,    52d 

Shot  wounds  both  le^s   ..... 

Amputation  of  hoth  logs.  .  .  . 

Died  January  8,  1803. 

North  Carolina. 

158 

S              B    Corp'i  3d  Md 

Shot  fracture  upper  third  left 

Feb.  10 

Amp.  throu(rh  middle  third 

Died  March  12,  1805. 

Battery,  age  37. 

femur;  mortification. 

1805.  ' 

of  both  legs. 

150 

Shearer',  F.,  Pt.,    A,  I!5th 

Dec.  15, 

Shot  fracture  both  legs  

Dec.  15, 

Amputation  of  both  legs  

Died  December  16,  1804. 

Indiana. 

1804. 

1861. 

100 

Smith,   1'.,  Serg't,  K,  GDth 

AiiL'.lC, 

Shot  wounds  of  both  feet  by 

Sept,  C, 

Circ.  amp.  both  leus,  lo'r  3d. 

Died  Oct.  11).  18(54,  of  exhaus 

New  York,  aste  30. 

1804. 

conoidal  ball. 

1864. 

A.A.Surg  J.  A.IIutchinson. 

tion.     Spec.  3li44,  A.  M.  M. 

101 

York.  M.,I't.,E,  12UthNew 

July   2, 

Cmiiiidal  ball  fractured  both 

Julv27, 

Amp.  both  legs.    A.  A.  Surg. 

Died  August  8,  1>-03.     Spec's 

York,  nj-e  20. 

1803. 

ankles. 

28,  1803. 

F.  llinklo. 

1005,1601),  A.M.  M. 

162 

Carpenter,   J'.   J..   Pt.,   D, 

Shot  wounds  both  legs  

Amputation  of  both  legs 

intli  Viruini  i. 

103 

Johnson,  J.  M  ,  Pt,,  C,  3d 

June  3, 

Shell  wounds  right  leg  and 

June  3, 

Amp.  mid.  th'd  right  leg,  and 

Discharged  Juno  8,  1805. 

Delaware,  age.  31. 

1801. 

left  foot. 

1804. 

Svine's  amp.  1  ft  ankle  i't. 

Surg.  D.  E.  Wolfe,  3.1  Del. 

104 

1  Unknown,  C.  S.  A  

Shot  wounds  of  both  legs  .  .  . 

Primary 

Lenoir's  am.  in  leg,  and  Piro- 

Flaps  of  ankle  joint;  stump 

goff  samp,  in.'therankle  j't. 

sloughed.     Died. 

Surg.  J.  'L1.  Gilmore.C.  S.'A. 

105 

Bums.ir.lnor,  S.,  Serg't,  F, 

Sept.  22, 

Shot  wounds  of  both  feet  .  .  . 

Sept.  23, 

Amp.  left  leg,  mill,  third,  and 

Disch'd  November  4,  1805; 

14l  h  \V.  Virginia,  r.ge  35. 

1804. 

1*04. 

r't  ft  by  Ch(ip:irt'smethod. 

tender  stumps. 

ICC 

Martin,.!.,  1't.,  L,  2d  N.  Y. 

June  10, 

Shell  wounds  right  leg  and 

June  16, 

('ire.  amp.  mid  3d  r't.  leg  and 

Disc-h'd  November  11,  1804. 

11.  A.,  age  21. 

1MJ4. 

left,  foot. 

1804. 

four  toes  of  left  foot. 

Mav,    1805,    reamputation 

right  leg. 

167 

Sadl'y,    A.  D,  Serg't,    G, 

Dec.  11, 

Shut  fracture  right  leg  and 

Dec.  11, 

Amp.  of  right   le<r   and  left 

Recovered. 

21st  Mississippi. 

1802. 

left  foot. 

1*02. 

foot.     Surg.  Hill.  C.  S  A. 

1G8 

Williams.  U.,  Pt  ,K.  198th 

Apr.   9, 

Shell   wounds    left  leg  and 

Apr.   9, 

Circ.  amp.  low.  third  left  leg, 

Discharged  October  G,  1805; 

Pennsylvania,  ago  2J. 

1805. 

right  foot. 

1805. 

and  List'ranc's  amp.  r't  foot. 

parts  entirely  healed. 

Surg.  II.  A.  Grim,  198th  Pa. 

109 

Hicks,  11.  F.,  Pt.,  A,  1st  R. 

Dee,  13, 

Shot  wounds  of  both  feet  .  .  . 

Dec.  14, 

S.vmo's  amp.  at  r't  and  Piro- 

Disch'd  September  24,  1803. 

Isl.ind  Artillery. 

ISO.'. 

1802. 

goff's  at  left  ankle  joint, 

170 

'Chirk,  II.  W..PL  n,  100th 

May  13, 

Solid    shot    fractured    both 

May  13, 

Syme's  amp.  left  ankle,  Cho- 

Disch'd  December  13,  1801. 

New  York,  age  3U. 

1804. 

feet. 

1804. 

part's  amp.  r't  font.    Surg. 

Sp«e.  2857,  A.M.  M. 

M.  S.  Kittinirer,  imith  X.  Y. 

171 

Carpenter.  J.  AV.,  Serg't,  I, 

June  3, 

Conoidal  hall  injured  both 

June  3, 

Hey's  amp.  left-  foot,  anil  1st 

Died  Juno  15,  1801. 

30th  Vcvmout. 

1X04. 

feet. 

1804. 

toe  and  met.  bone  r't  foot. 

172 

Rowland,  S  ,  Serg't,  A,  48th 

Mav   3, 

Shot  wounds  of  both  feet 

Amputation  of  both  leet 

Died  Juno  C,  1803. 

New  York. 

18C3. 

1  IIoi-LOWAY  (J.  M  ),  Comparative  Advantages  of  PlUOGOFF's,  SYME'S,  and  CIIOPAUT'S  Amputations,  etc.,  in  Am.  Jour.  Mcd.  ScL,  1805, 
Volume  LI,  pp.  85,  8(5. 

2Slimi  (S.),  Amputations  at  the  Ankle  Joint  in  llilitarg  Surgery,  in  TJ.  S.  San.  Com.  Memoirs,  1871,  Surg.  Vol.  II,  pp.  110, 140. 


CHAP,  xm.]  ANAESTHETICS.  887 


III. 


It  was  impracticable  to  determine  the  total  number  of  cases  in  which  anaesthetics  were 
employed  during  the  war,  but  as  near  as  can  be  ascertained  they  were  used  in  no  less  than 
eighty  thousand  (80,000)  instances.  Time  and  clerical  assistance  did  not  allow  of  the 
examination  of  this  enormous  number  of  cases  in  detail,  and  in  treating  of  this  subject  we 
must  confine  our  remarks  to  the  number  of  major  operations  in  which  the  agents  used  were 
definitely  ascertained.  Of  eight  thousand  nine  hundred  cases  chloroform  was  used  in  six 
thousand  seven  hundred  and  eighty-four,  or  76.2  per  cent.,  ether  in  one  thousand  three 
hundred  and  five,  or  14.7  per  cent.,  a  mixture  of  chloroform  and  ether  in  eight  hundred 
and  eleven,  or  9.1  per  cent.  These  percentages  differ  somewhat  from  the  percentages  given 
in  the  preliminary  report,1  where  it  was  stated  that  chloroform  was  used  in  60  per  cent., 
ether  in  30  per  cent.,  and  ether  and  chloroform  in  10  per  cent.;  but  at  that  time  the  per 
centage  of  the  different  agents  had  been  principally  derived  from  the  reports  of  general 
hospitals,  and  in  which  ether  was  frequently  used.  When,  afterwards,  the  operations 
performed  in  the  field  hospitals  were  examined,  where  chloroform  was  almost  uniformly 
used,  the  percentage  of  the  cases  in  which  the  latter  agent  was  employed  increased  to  76.2 
per  cent.,  as  above  indicated,  while  the  number  of  cases  in  which  ether  or  the  mixture  of 
ether  and  chloroform  was  used  was  proportionally  decreased. 

The  inestimable  value  of  the  use  of  anaesthetics  in  military  surgery  will  hardly  be 
denied  at  this  date,  although  it  has  been  claimed  that  the  effect  of  anaesthetics  in  the  treat 
ment  of  shot  injuries  are  deleterious,  inasmuch  as  they  add  to  the  depression  caused  by  the 
shock,  and  retard  union  by  first  intention,  and  predispose  to  haemorrhages  and  pyaemia.  It 
is  possible  that  in  two  hundred  and  fifty-four  cases  in  which  it  was  asserted  that  no  anaes 
thetic  was  given  the  surgeons  were  actuated  by  such  objections,  as  no  reasons  have  been 
assigned  why  anaesthetics  were  not  administered.  How  far  the  use  of  anaesthetics  has  con 
tributed  to  the  saving  of  life  during  the  late  war  it  is  impossible  to  say,  as  we  have  no 
statistics  to  make  this  comparison.  It  maybe  stated,  however,  that  their  use  has  undoubt 
edly  influenced  the  favorable  percentages  of  mortality  after  major  operations  pointed  out  in 
different  sections  of  this  and  the  preceding  volumes. 

From  the  rapidity  of  its  effects,  and  from  the  small  quantity  required — qualities  which 
can  only  be  appreciated  at  their  proper  values  by  the  field  surgeon  when  surrounded  by 
hundreds  of  wounded  anxiously  awaiting  speedy  relief — chloroform  was  preferred  by  nearly 

1  Circular  Xo.  (i,  War  Department,  Surgeon  Ot'iienil's  Oflico,  Washington,  November  1,  16Cd. 


ANAESTHETICS.  [CHAP,  xiii 

all  the  field  surgeons,  and  their  testimony  as  to  its  value  and  efficacy  is  almost  unanimous, 
although  all  recommend  the  greatest  care  in  its  administration.  It  is,  perhaps,  best  to  allow 
the  different  medical  officers  to  speak  for  themselves  on  this  subject:  Surgeon  G.  J.  Walton, 
21st  Kentucky,  administered  "chloroform  in  every  painful  operation,  but  did  not  keep  the 
patients  under  its  influence  longer  than  was  absolutely  necessary,  withdrawing  it  as  soon  as 
the  cutting  was  completed.  *  *  *  While  I  could  not  dispense  with  chloroform,  I  must 
protest  against  the  extravagant  and  indiscreet  use  of  it.  It  is  a  most  potent  agent,  and 
should  be  used  with  the  utmost  caution.  In  no  case  were  we  displeased  with  its  effect." 
Surgeon  B.  B.  Breed,  U.  S.  V.:  "Chloroform  was  almost  universally  employed  as  an  anaes 
thetic,  and  without  bad  effect  in  any  case.  Whenever  practicable,  I  employed  ether  in 
preference  to  chloroform,  preferring,  both  from  personal  experience  and  observation,  the 
delay  and  discomfort  in  its  administration  to  the  possible  danger  from  the  use  of  the  latter. 
On  the  field  of  battle,  however,  chloroform  is  the  safe  and  preferable  agent."  Assistant 
Surgeon  C.  Bacon,  jr.:  "The  anaesthetic  I  have  seen  used  has  invariably  been  chloroform. 
Among  the  great  number  of  cases  in  which  I  have  witnessed  its  administration  I  have  seen 
but  one  death  resulting  from  its  use.  I  have,  however,  frequently  seen  cases  in  which  its 
use  required  extreme  care,  and,  at  times,  have  been  obliged  to  desist  in  its  administration 
in  cases  of  great  exhaustion  consequent  upon  long-established  injuries.  I  have  frequently 
seen  the  use  of  chloroform  attended  with  bad  results  when  improperly  administered.  As 
an  anaesthetic  I  think  chloroform  should  be  given  in  prompt  and  efficient  dose.  The  desired 
effect  being  attained,  its  administration  should  be  discontinued;  in  this  mannerless  chloro 
form  is  required,  thereby  avoiding  to  a  great  extent  its  toxical  effect."  Surgeon  D.  P. 
Smith,  U.  S.  V.:  "I  have  in  every  instance  but  one,  in  the  army,  employed  chloroform, 
and  in  but  one  case  have  I  had  reason  to  believe  its  use  disastrous.  In  this  instance  it  was 
given  too  profusely  by  an  entirely  incompetent  person  (since  then  dismissed  from  the  medical 
corps)  while  I  was  amputating  at  the  knee  joint.  The  patient  never  reacted  from  the  shock, 
but  died  about  twelve  hours  subsequently."  Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.: 
"I  have  always  used  chloroform  as  an  anaesthetic,  have  given  it,  and  have  seen' it  given 
under  my  direction,  and  in  the  practice  of  other  surgeons  in  an  immense  number  of  cases, 
and  never  saw  a  death  from  it,  or,  in  army  practice,  even  an  alarming  symptom.  I  am 
inclined  to  believe  that  in  general  practice  the  chief  danger  of  choloform  is  that  in  its  admin 
istration  care  is  not  taken  to  let  the  patient  inhale  sufficient  air  with  it  (a  fact  often  due  to 
the  desire  to  be  economical  in  its  use),  and  the  patients  die,  not  from  the  chloroform,  but  from 
the  want  of  oxygen."  Surgeon  U.S.  Hewit,  U.  S.  V.:  "Chloroform  was  used  freely  with 
out  any  fatal  accident.  But  I  conceived  that  those  cases  did  not  finally  do  so  well  who 
were  kept  under  its  influence  for  a  length  of  time;  and  I  am  of  the  opinion  that  when  used 
the  patient  should  be  kept  under  its  influence  merely  long  enough  to  last  through  the  severest 
part  of  the  operation.  I  believe  that  when  a  patient  is  kept  under  its  influence  for  a  long 
time  his  chances  of  recovery  are  thereby  lessened."  The  serious  results  following  the  use 
of  chloroform,  when  "improperly"  or  "too  long"  administered,  or  when  administered  by 
"incompetent  persons,"  referred  to  by  several  of  the  operators,  will  hardly  be  charged  to 
the  agent  itself.  In  the  reports  of  the  surgeons  in  charge  of  base  hospitals,  sometimes  the 
use  of  ether,  sometimes  of  chloroform  alone,  or  a  mixture  of  both,  is  advocated. 

The  most  convenient  and  common  form  of  administering  anaesthetics  was  a  cloth  or 
paper  folded  in  the  shape  of  a  cone,  with  a  sponge  in  the  apex.     It  was  placed  at  some  distance 


CHAP.  XIII.]  ANESTHETICS.  889 

over  the  nose  and  mouth  of  tho  patient  to  allow  the  first  inhalations  to  become  diluted  with 
air,  and  then  gradually  advanced  to  the  nose  until  anaesthesia  was  produced,  when  the 
inhalation  was  suspended.  The  method  of  Marshall  Hall,  by  placing  a  double  fold  of  mus 
lin  over  the  mouth  and  nose  of  the  patient  and  simply  dropping  the  chloroform 
on  it  drop  by  drop,  was  found  to  be  tedious,  and  inoperative  in  the  open  air, 
where  many  of  the  operations  were  performed,  owing  to  rapid  evaporation.  In 
the  southern  armies,  where  chloroform  was  scarce,  Surgeon  J.  J.  Chisolm,  find 
ing  that  much  chloroform  was  wasted  by  these  methods,  employed  a  flattened 
cylinder  two  and  a  half  inches  long  and  one  inch  wide  in  its  broadest  diameter, 
having  in  one  of  its  broadest  surfaces  a  perforated  plate.  Attached  to  the  cover 
are  two  nose  pieces.  When  the  instrument  is  not  in  use  these  projections  can 
be  pressed  into  the  cylinder,  thus  diminishing  the  size  of  the  instrument.  In 
the  interior  of  the  cylinder  is  found  a  piece  of  sponge,  or  what  is  much  better,  a  FIG. 424.-cms. 
bent  wire,  over  which  is  folded  a  piece  of  cotton  cloth.  The  chloroform  when  spec. 4910. 
dropped  through  the  perforated  plate  is  received  upon  the  sponge  or  folded  cloth,  which  offers 
an  extended  surface  for  evaporation. 

In  reference  to  the  propriety  of  giving  alcoholic  stimulants  prior  to  the  administration 
of  ether  and  chloroform,  the  records  of  the  war  supply  little  definite  information.  They 
give  simply  the  number  of  cases  in  which  anaesthesia  was  induced,  and  frequently  not  even 
the  name  of  the  anaesthetic  employed.  In  cases  in  which  the  effect  of  the  anaesthetic  was 
believed  to  have  led  to  a  fatal  result  special  reports  were  made.  These  special  reports 
throw  little  light  on  the  question,  since  they  include,  in  almost  equal  proportion,  cases  in 
which  stimulants  had,  or  had  not,  been  administered  prior  to  the  inhalation  of  the  anaes 
thetic.  Some  surgeons  advise  the  use  of  stimulants  prior  to  anaesthesia  uniformly;  others 
deprecate  the  practice  except  in  rare  cases,  and  others  again  discard  it  altogether.  When 
there  is  extreme  depression,  alcoholic  stimuli  will  of  course  be  employed,  in  conjunction 
with  other  restoratives,  to  bring  about  reaction.  But  when  the  patient  is  in  a  fit  state  to 
undergo  a  major  operation,  a  stimulant  should  not  be  given  with  especial -reference  to  the 
anaesthesia  about  to  be  induced,  as  it  would  seem  that  in  the  practice  of  surgeons  who 
habitually  employed  the  stimulants  the  patients  were  less  readily  anaesthetized.  It  would 
be  better  to  reserve  the  stimulant  as  a  restorative  in  the  course  or  on  the  completion  of  the 
operation,  that  it  may  aid  in  reducing  reaction  instead  of  retarding  the  induction  of  anaes 
thesia. 

It  has  been  stated  that  the  nature  of  the  anaesthetic  employed  was  indicated  in  eight 
thousand  nine  hundred  cases,  viz:  chloroform  in  six  thousand  seven  hundred  and  eighty- 
lour,  ether  in  one  thousand  three  hundred  and  five,  and  chloroform  and  ether  in  eight  hun 
dred  and  eleven  cases.  Of  the  six  thousand  seven  hundred  and  eighty-four  cases  in  which 
chloroform  was  used,  death  was  ascribed  to  this  agent  in  thirty-seven,  or  5.4  per  thou 
sand; L  of  the  one  thousand  three  hundred  and  five  cases  in  which  the  anaesthesia  was  induced 
by  ether,  four  deaths,  or  3.0  per  thousand;  and  of  the  eight  hundred  and  eleven  cases  in 

'CmsOLM  (J.  J.),  (.1  Manual  of  Military  Surgery  for  the  use  of  Surgeons  in  the  Confederate  States  Army,  Columbia,  1864,  pp.  429-30):  ;'Of  the 
;  ny  thousand  instances  of  its  administration  since  the  war  between  the  Confederate  States  and  United  States  began,  but  two  fatal  cases  from  chloroform 
1  ahition  have  been  reported.  In  one,  the  patient  died  in  a  few  minutes  after  inhalation  was  commenced.  In  the  other,  the  patient  did  not  die  for  several 
i  irs.  The  case  was  that  of  a  healthy  young  soldier  who  had  a  mini§  ball  embedded  under  Hie  scapula,  and  who,  while  en  route  to  rejoin  his  command, 
c  ppud  at  a  hospital  and  desired  its  removal.  The  operation  was  very  tedious,  and  he  was  kept  under  the  influence  of  chloroform  for  one  and  a  half 

1  i  irs.     Although  he  regained  his  consciousness  when  the  administration  was  stopped,  his  pulse  never  reacted,  notwithstanding*  the  liberal  use  of  brandy. 

A  few  hours  after  the  operation  was  completed  there  appeared  an  increasing  disposition  to  sleep,  which  gradually  ended  in  coma,  the  pulse  becoming 

more  and  more  feeble.     lie  died  thirty-two  hours  after  the  inhalation.     As  the  operation  affected  no  vital  part,  and  us  the  health  of  the  patient  was  good, 

his  death  could  be  attributed  to  no  other  cause  than  the  inhalation  of  the  chloroform." 
SUKG.   Ill— 112 


890  ANESTHETICS.  [CHAP.  xm. 

which  a  mixture  of  chloroform  and  ether  had  been  employed,  two  deaths,  or  2.4  per  thou 
sand,  were  charged  to  the  anaesthetic.     Brief  abstracts  of  the  fatal  cases  are  given. 

Deaths  from  Chloroform. — Thirty-seven  cases  were  reported: 

CASE  1233.— Surgeon  M.  K.  Hogan,  U.  S.  V.,  reports  that  Private  Sylvester  Anninger,  Co.  F,  147th  New  York,  aged  27 
years,  received  u  shot  fracture  of  the  left  leg,  at  Spottsylvania,  May  12, 1834.  He  was  at  once  carried  to  the  field  hospital  of  the 
3d  division,  Ninth  Corps.  He  died  May  — ,  1864,  "under  chloroform." 

CASK  1234.— Corporal  -  -  Ballon,  Co.  E,  14th  Pennsylvania  Cavalry,  fracture  of  bones  of  right,  hand,  April,  1863. 
Operation  for  removal  of  fingers  October  12,  1863.  Chloroform  inhaled  without  unpleasant  symptoms ;  upon  removing  index 
finger  pain  was  evinced;  small  additional  portion  given  and  operation  recommenced,  when  patient  struggled  violently;  arterial 
haemorrhage  ceased  to  How;  tongue  found  to  not  have  fallen  back  upon  rima  glottidis;  usual  means  of  exciting  respiration 
applied;  good  current  of  fresh  air;  patient  rolled  from  side  to  side;  artificial  respiration  resorted  to;  spirit  of  ammonia  applied 
to  nostrils  and  cold  water  dashed  on  chest  and  face,  without  effect.  In  the  opinion  of  Surgeon  W.  B.  Wynne,  14th  Pennsyl 
vania  Cavalry,  the  operator,  the  patient  was  not  under  the  effects  of  the  anaesthetic  five  minutes  before  life  was  extinct.  At  the 
autopsy  the  lungs  were  found  to  be  perfectly  healthy;  the  heart  presented  some  appearance  of  slight  ossification. 

CASE  1235. — Private  J.  Bradley,  Co.  D,  25th  North  Carolina;  slight  wound  of  patella;  admitted  into  Chimborazo 
Hospital,  Richmond,  June  25th ;  necrosis  and  gangrene.  July  18th,  amputation  at  junction  of  upper  and  middle  thirds  of  thigh. 
There  was  but  little  blood  lost,  but  the  patient  sank  under  the  operation  and  expired  a  few  minutes  after  its  completion.  It  is 
remarked,  upon  an  unsigned  case-book,  that  "the  chloroform  may  have,  by  its  depressing  effect,  contributed  to  this  unfavorable 
result,  for  it  caused  him  to  vomit  freely,  and  he  was  unable  to  retain  any  stimulants  in  the  stomach." 

CASE  1238.— Private  G.  Budlinger,  76th  Ohio,  aged  30  years,  admitted  into  hospital  of  1st  division,  Fifteenth  Corps, 
with  a  shot  wound  of  hand;  placed  upon  operation  table  and  about  a  drachm  of  chloroform  sprinkled  upon  four  folds  of  patent 
lint  applied  to  face,  space  being  given  for  the  free  admission  of  air.  After  breathing  it  for  a  few  moments  quietly  without  any 
apparent  effect,  more  chloroform  was  added  and  reapplied  by  a  nurse  in  attendance  (the  surgeon  having  stepped  aside  for  a 
moment),  when,  after  six  or  seven  respirations,  the  patient  drew  up  his  legs  and  arms  convulsively,  and  heavy  stertorous 
breathing  came  on.  Chloroform  removed  immediately,  and  a  few  moments  given  him  to  resume  his  regular  breathing,  but  the 
difficulty  increased ;  frothy  exudation  from  mouth  not  caused  by  excess  of  saliva;  respiration  became  more  and  more  incomplete, 
pulse  small  and  imperceptible,  veins  of  neck  and  face  prominently  distended;  heart  action  ceased  before  respiration  had  entirely 
stopped.  Friction  to  extremities,  cold  water  dashed  in  face,  jugular  vein  opened,  artificial  respiration,  without  relief.  The 
surgeons  of  the  hospital  reported,  as  the  result  of  an  autopsy,  that  "being  unable  to  discover  any  other  abnormal  condition,  and 
in  the  absence  of  further  evidence,  it  may  be  proper  to  conclude  that  this  is  a  case  of  apoplexy  induced  by  chloroform." 

CASE  1237. — Private  J.  G.  Clarkson,  Co.  A,  35th  Massachusetts,  age  40  years,  is  reported  by  Surgeon  F.  M.  Lincoln, 
35th  Massachusetts,  to  have  died  in  hospital  at  Falmouth,  Virginia,  "from  the  inhalation  of  chloroform  administered  for  the 
performance  of  an  amputation,"  January  20,  1863. 

CASE  1238.— Private  J.  Conley,  Co.  A,  90th  Illinois,  aged  18  years;  shot  fracture  left  ankle  joint,  Mission  Ridge,  Novem 
ber  25,  1853 ;  ball  lodged ;  admitted  into  hospital  No.  1,  Nashville,  February  4, 1863.  Surgeon  R.  L.  Stanford,  U.  S.  V.,  reports 
that  the  patient  "died  from  the  effects  of  the  chloroform  at  the  time  of  the  operation  of  extraction  of  the  ball,"  and  forwarded 
the  specimen  of  the  lower  portions  of  the  left  leg,  the  astralagus,  and  calcaneum ;  they  constitute  Spec.  3360  of  the  Suryical  Section. 

CASK  1239. — Private  P.  Conlin,  Co.  G,  llth  New  Jersey;  shot  perforation  knee  joint,  popliteal  artery  cvit ;  Ream's  Station, 
September  17, 1884 ;  considerable  haemorrhage ;  patient  in  a  very  nervous  state  and  having  great  fears  of  the  result.  Stimulants 
were  given,  and  after  he  had  rallied  a  little  he  was  placed  upon  the  table  and  chloroform  administered.  Plenty  of  fresh  air  was 
allowed  during  the  administration  and  he  passed  through  the  usual  stages  necessary  to  insensibility,  but  died  before  the  contem 
plated  operation  was  commenced,  having  just  reached  the  point  of  insensibility.  The  only  observable  symptoms  which  were 
unusual  were  the  high  state  of  nervous  excitement  while  the  chloroform  was  being  administered  and  the  very  small  quantity 
required  to  render  him  insensible.  Methods  for  resuscitation  freely  used  for  half  an  hour  without  effect.  A  post-mortem  exam 
ination  revealed  nothing  abnormal  in  the  size  or  appearance  of  the  organs. 

CASE  1240.— Sergeant  S.  Crumlaler,  Co.  A,  35th  Virginia  Cavalry,  aged  44  years,  was  admitted  into  the  Confederate 
hospital  at  Charlottesville  in  May,  1864,  with  a  pistol  ball  perforation  of  the  head  of  the  humerus,  received  at  the  Wilderness, 
May  6th.  On  May  llth  chloroform  was  administered  and  the  head  of  the  humerus  was  excised.  He  is  reported  to  have  died 
May  16,  1884,  "from  the  effects  of  the  chloroform." 

CASE  1241.— Private  T.  Donaldson,  Co.  E,  13th  Ohio  Cavalry,  aged  19  years;  shot  injury  left  humerus,  Poplar  Springs, 
Virginia,  October  8,  1884  ;  admitted  into  hospital  at  Beverly,  New  Jersey.  Necrosis  of  humerus.  October  29,  1864,  amputa 
tion  of  left  arm  at  shoulder  by  antero-posterior  flaps  by  Acting  Assistant  Surgeon  J.  C.  Morton;  chloroform  used.  Patient 
"  died  from  the  effects  of  the  chloroform  and  nervous  shock  to  the  general  system."  The  upper  part  of  the  humerus  was  for 
warded  to  the  Museum  by  Assistant  Surgeon  C.  Wagner,  U.  S.  A.,  and  is  numbered  Specimen  3708  of  the  Sunjlcal  Section. 

CASK  1242.— Private  1").  Flynn,  Co.  A,  18th  Infantry,  admitted  into  hospital  No.  19,  Nashville,  January  5,  1863,  with  a 
compound  fracture  of  fingers  of  right  hand,  received  December  31,  1862.  January  8th,  chloroform  administered  with  a  due 
proportion  of  atmospheric  air;  patient  was  rather  troublesome,  struggled,  etc.  A  relaxation  of  the  muscles  testifying  to  anaes 
thesia,  the  chloroform  was  suspended  and  the  operation  commenced;  just  after  the  formation  of  the  anterior  flap  the  patient 
commenced  to  breathe  stertorously,  and  at  that  instant  the  brachial  pulse  suddenly  ceased;  there  was  an  up  and  down  movement 
of  the  thyroid  cartilage,  a  swelling  out  almost  to  bursting  of  the  external  jugular  veins,  blue  lips,  a  pupil  insensible  to  light,  and 
an  ashy  paleness.  Cold  water  dashed  in  face,  aqua  ammonia  to  nostrils  and  upon  thorax,  tongue  drawn  forward  with  tenaculum. 


CHAP.  XI;T  1  DEATHS    FROM    CHLOROFORM.  891 

artificial  respiration  kept  up,  and  the  principles  of  Marshall  Hall's  method  of  respiration  put  into  requisition,  but  without  effect; 
patient  expired  after  one  or  two  long-drawn  sighs.  Amount  of  chloroform  expended  was  about  two  drachms.  No  autopsy 
possible. 

CASE  1243. — Private  R.  Gormley,  Co.  I,  7th  New  York  Artillery,  admitted  into  McClellan  Hospital,  Philadelphia,  June 
13,  1864,  with  a  shot  wound  of  the  lower  third  of  the  right  leg;  ball  lodged.  On  November  29th  chloroform  was  administered 
with  a  view  of  removing  the  ball.  The  anaesthetic  was  given  with  great  caution,  and  inhaled  with  perfect  facility  until  the 
operation  was  nearly  completed.  Acting  Assistant  Surgeon  W.  E.  Ely  stated  that  "the  patient's  pulse  continued  good,  and 
nothing  of  unusual  interest  presented  itself  until  the  incision  had  been  made,  when  I  was  suddenly  deterred  from  proceeding  in 
search  of  the  ball  by  a  spasmodic  rigidity  of  the  muscles,  such  as  generally  occurs  immediately  before  the  point  of  complete 
anaesthesia  is  attained.  The  patient,  who  had  up  to  this  time  appeared  perfectly  sensible  of  external  objects,  suddenly  threw  his 
head  back  and  almost  immediately  expired.  Cold  water  was  dashed  into  his  face,  ammonia  was  applied  to  his  nostrils,  his  mouth 
was  kept  open,  and  his  tongue  drawn  forward,  while  Hall's  ready  method  of  artificial  respiration  was  kept  up  for  nearly  an 
hour,  but  only  with  the  effect  of  producing  three  or  four  long  inspiratory  efforts,  when  life  became  entirely  extinct."  Dr.  Ely 
was  assisted  by  Acting  Assistant  Surgeon  A.  S.  Uhler. 

CASE  1244. — Private  Thomas  Hamilton,  Co.  A,  1st  Maryland  Infantry,  aged  31  years,  admitted  into  Patterson  Park  Hos 
pital,  Baltimore,  June  25,  1864,  with  a  gunshot  wound  of  the  hand.  September  3,  1864,  patient  placed  on  table  to  undergo  an 
operation  for  necrosis  of  the  carpal  bones.  A  sponge  wet  with  chloroform  was  carefully  held  at  first  some  three  or  four  inches 
from  the  face,  and  at  no  time  less  than  two  or  three  inches.  The  patient  inhaled  for  about  five  minutes  and  still  remained  con 
scious,  frequently  making  some  remark.  He  soon,  however,  commenced  muscular  efforts,  such  as  are  quite  common  with 
patients  inhaling  chloroform,  except  that  the  muscular  contractions  were  more  violent  than  usual.  Before  the  contractions 
ceased  the  pulse  grew  feeble  and  the  chloroform  was  withdrawn  for  two  or  three  minutes;  the  breathing  continued  regular,  only 
that  the  patient  occasionally  took  a  deep  inspiration  and  expired  forcibly,  Ihen  the  muscles  became  relaxed;  the  operation  was 
commenced;  but  the  respiration  soon  commenced  to  fail  and  the  pulse  became  imperceptible;  the  operation  was  stopped.  All 
known  means  for  resuscitation  were  resorted  to,  but  life  had  fled.  The  friends  of  the  deceased  could  only  be  persuaded  to  allow 
an  examination  of  the  heart.  The  organ  was  found  of  normal  size  and  appearance;  both  auricles  were  distended  with  venous 
blood,  but  the  ventricles  were  empty.  A  clot  of  white  fibrin,  streaked  in  some  places  with  coagula  of  blood,  was  found  in  each 
auricle. 

CASE  1245. — Private  Robert  Harris,  Co.  G,  132d  New  York,  was  admitted  into  Ward  Hospital,  Newark,  New  Jersey, 
May  4,  18(54.  Surgeon  George  Taylor,  U.  S.  A.,  reported  that  the  patient  died  on  May  20,  1864,  while  under  the  influence  of 
chloroform  administered  for  the  purpose  of  amputating  the  leg. 

CASE  1246. — Private  John  Johnson,  Co.  B,  2d  Pennsylvania  Heavy  Artillery,  a  patient  in  Mower  General  Hospital, 
near  Philadelphia,  expired  suddenly  on  May  13,  1865,  while  inhaling  chloroform  preparatory  to  undergoing  a  surgical  operation. 
The  case  is  reported  by  Surgeon  J.  Hopkinson,  U.  S.  V. 

CASE  1247.— Private  John  Kroft,  Co.  D,  7th  New  York,  shot  fracture  leg,  Petersburg,  September  16,  1864.  Admitted 
into  hospital  at  Beverly,  New  Jersey,  September  28th.  Amputation  of  leg  October  8th.  On  November  16th  a  second  amputa 
tion  was  found  necessary;  at  the  previous  operation  sufficient  chloroform  was  administered  to  produce  complete  anaesthesia 
without  unpleasant  effect.  On  the  latter  date  chloroform  was  administered  on  a  sponge,  from  one  drachm  to  a  drachm  and  a 
half — in  all  not  over  an  ounce  was  given.  He  had  been  upon  the  table  about  fifteen  minutes  when  fatal  symptoms  were  mani 
fested,  and  he  died  in  from  five  to  six  minutes.  An  autopsy  revealed  no  pathological  lesions  sufficient  to  account  for  death. 
Assistant  Surgeon  C.  Wagner,  U.  S.  A.,  reported  the  case. 

CASE  1248. —  William  Laws,  Co.  E,  23d  North  Carolina,  aged  24  years,  shot  wound  of  groin,  fracturing  tuber  ischii; 
admitted  in*o  hospital  No.  1,  Frederick.  October  28th,  chloroform  was  administered  to  remove  the  fragments  of  the  ischium. 
The  chloroform  was  administered  on  a  pocket  handkerchief  which  was  pressed  firmly  against  the  mouth  of  the  bottle  which  was 
then  inverted.  Plenty  of  air  was  given,  and  the  handkerchief  was  wet  with  chloroform  but  once.  About  a  minute  after  the 
administration  was  begun  almost  complete  relaxation  was  produced,  and  two  stertorous  respirations  were  observed,  when  the 
handkerchief  was  immediately  removed.  The  pulse  up  to  this  time  was  undisturbed;  the  patient  then  took  some  ten  or  twelve 
deep  and  rather  rapid  inspirations,  with  quickened  pulse,  when  respiration  suddenly  ceased;  the  pulse  continued  for  six  or  eight 
beats,  which  were  slower  and  feeble,  and  then  suddenly  ceased.  Artificial  respiration  was  immediately  resorted  to  by  Marshall 
Hall's  ready  method,  which  produced  distinct  respiration,  but  no  pulsation.  Having  kept  it  up  for  about  twenty  minutes 
without  result,  the  case  was  given  up  as  hopeless.  An  account  of  the  post-mortem  appearances,  together  with  other  details  of 
the  case,  will  be  found  in  CASE  703,  page  242,  Second  Surgical  Volume. 

CASE  1249. — Colonel  McGilvray,  Chief  of  Artillery  of  the  Tenth  Corps,  was  slightly  wounded  in  the  forefinger  of  the 
left  hand,  at  Flussus  Mills,  August  17, 1864.  Excision  of  the  joint  was  advised,  and,  on  September  4th,  chloroform  was  admin 
istered;  about  a  drachm  of  the  anaesthetic  was  poured  on  a  sponge  enclosed  in  a  towel  folded  funnel-shaped.  The  patient  came 
very  kindly  under  its  influence,  about  two  drachms  of  chloroform  in  all  being  used.  The  period  of  excitement  did  not  last  over 
a  minute  and  a  half.  The  operation  was  commenced;  the  pulse  was  then  beating  steady  and  firm  at  about  65,  respiration  slow 
and  regular;  at  the  time  the  inhalation  of  the  chloroform  had  been  discontinued  for  at  least  two  minutes;  at  the  moment  of  the 
first  incision  the  pulse  and  respiration  at  the  same  moment  ceased  without  the  slightest  warning.  The  face  flushed  for  a  moment, 
and  then  became  pallid  ;  the  eyes  were  fixed  and  not  suffused.  About  half  a  minute  after  the  cessation  of  respiration  the  patient 
made  one  or  two  spasmodic  attempts  at  respiration  and  then  was  still.  Artificial  respiration  was  commenced  and  kept  up  for  an 
hour,  but  in  vain.  The  heart  and  lungs  were  examined  on  the  next  day,  but  did  not  indicate  the  cause  of  death.  The  particu 
lars  of  the  case  were  communicated  by  Surgeon  A.  M.  Clark,  U.  S.  V. 

CASK  1250.— Sergeant  George  S.  Moss,  Co.  C,  125th  New  York,  received  a  shell  wound  of  the  penis,  scrotum,  and  thigh, 
at  Gettysburg,  July  3,  1863;  the  missile  lodged  among  the  muscles  of  the  back  of  the  thigh.  The  patient  desired  to  have  the 


892  ANESTHETICS.  [CHAP.  xm. 

missile  removed,  but  positively  refused  to  be  touched  without  the  administration  of  chloroform.  On  August  8th  a  stimulant  was 
given  and  the  anaesthetic  was  administered;  in  one  minute  the  patient  came  under  its  influence,  the  shell  fragment  was  removed 
in  less  than  half  a  minute,  and  additional  stimulant  administered;  pulse  became  suddenly  weak,  and  the  patient  died  almost 
instantly.  It  was  the  opinion  of  surgeons  present  that  the  patient  died  from  valvular  affection  of  the  heart. 

CASE  1251. — Private  Patrick  Murphy,  Co.  13,  lllth  Pennsylvania,  aged  22  years,  admitted  into  hospital  at  Murfreesboro', 
Tennessee,  October  28,  1863,  with  shot  wounds  of  right  knee  joint  and  in  centre  of  forehead,  received  at  Brown's  Ferry,  Ten 
nessee,  on  the  same  day.  On  admission  patient  was  wild,  delirious,  and  unruly,  but  a  few  hours  afterwards  seemed  partially  to 
recover  his  senses.  On  October  30th  amputation  of  the  thigh  was  performed.  On  loosening  the  tourniquet  no  blood  escaped 
from  the  vessels,  and  the  patient  was  observed  to  be  in  a  state  of  collapse.  Stimulants  were  freely  given,  but  without  avail. 
He  died  on  the  table  soon  after  the  operation,  probably  from  the  effects  of  chloroform.  A  section  of  the  anterior  portion  of  the 
cranium,  showing  a  partial  fracture  and  depression  of  the  centre  of  the  frontal  bone,  was  forwarded  to  the  Museum  by  Assistant 
Surgeon  John  C.  Norton,  U.  S.  V.,  and  is  numbered  2139  of  the  Surgical  Section. 

CASK  1252. — Private  C.  M.  Odell,  Co.  I,  36th  Wisconsin,  received  a  shot  fracture  of  the  head  and  shaft  of  the  humerus, 
at  Cold  Harbor,  June  3,  1864.  Amputation  was  deemed  necessary;  his  pulse  was  good,  and  he  walked  to  the  operating  table 
unassisted.  Chloroform  was  given  until  complete  relaxation  of  the  voluntary  muscles  was  produced;  the  amputation  was  per 
formed,  the  arteries  ligated,  and  the  flaps  were  about  to  be  closed,  when  respiration  suddenly  and  quietly  ceased.  Artificial 
respiration  was  set  up,  but  without  success.  The  autopsy  showed  the  heart  much  enlarged,  without  thinning  of  the  walls,  and 
distended  on  both  sides  with  a  grumous  fluid  and  tough  grayish  clot,  which  extended  into  the  great  vessels. 

CASE  1253. — Surgeon  J.  F.  Patterson,  131st  New  York,  states  that  "on  June  11,  1803,  the  114th  New  York  was  ordered  to 
take  a  position  in  front  of  our  line,  and  while  advancing  to  execute  the  order  one  of  the  privates  shot  himself  in  the  foot  and  was 
carried  to  the  field  hospital  for  treatment.  An  ampliation  being  deemed  necessary,  chloroform  was  administered  by  the  assistant 
surgeon  of  the  1st  Louisiana  in  such  a  manner  that  death  almost  immediately  ensued.  The  surgeon  of  the  114th,  whose  name  I 
believe  was  Wagoner,  opened  the  chest  of  the  cadaver  about  fifteen  minutes  after  death,  and  finding  the  lungs  lying  on  the  back 
of  the  chest  announced  that  death  was  occasioned  by  collapse  of  the  lungs."  The  case  of  William  Eathbone,  Co.  K,  114th  New 
York,  who  received  a  gunshot  wound  of  toe  of  left  foot  at  Port  Hudson,  Louisiana,  and  who  died,  is  reported  by  Surgeon  L.  P, 
Wagner,  114th  New  York,  but  no  details  of  the  case  are  furnished. 

CASE  1254. — Surgeon  S.  A.  Eichardson,  13th  New  Hampshire,  in  a  special  report  of  the  surgical  operations  performed  at 
Flying  Hospital,  Twenty-fourth  Corps,  March  30th  to  April  9, 1865,  remarks :  "Manuel  Silver,  Private,  Co.  F,  10th  Connecticut, 
gunshot  comminuted  fracture  of  the  left  humerus  by  conoidal  ball.  Flap  amputation  left  arm  in  middle  third  by  Surgeon  H.  C. 
Levensaler,  8th  Maine,  April  2, 1865  (primary  operation).  Died  during  the  operation,  from  effects  of  chloroform  given  by  Sur 
geon  De  Landre,  158th  New  York.  Was  brought  under  the  influence  of  chloroform  with  difficulty." 

CASE  1255. — Sergeant  Major  Adolphus  Spaeth,  9th  Ohio,  was  admitted  into  Cumberland  Hospital,  Nashville,  September 
24,  1863,  with  a  shot  fracture  of  the  right  wrist.  The  ball  passed  upward  on  the  palmar  aspect  of  the  forearm  nearly  to  the 
bend  of  the  elbow,  but  so  deeply  embedded  as  not  to  be  found.  He  had  violent  erysipelas  of  arm  and  great  constitutional  dis 
turbance.  Three  orfour  days  afterwards  the  ball  was  removed  from  the  deep  layer  of  muscles  opposite  the  upper  third  of  the 
radius,  palmar  aspect.  His  general  condition  continued  bad.  On  October  17th  he  was  placed  upon  the  table  for  amputation  at 
the  middle  third  of  humerus.  During  the  administration  of  chloroform  death  took  place  with  scarcely  a  premonitory  symptom. 
The  post-mortem  exhibited  venous  congestion  of  both  lungs,  evidently  produced  by  the  chloroform,  the  lungs  being  otherwise 
perfectly  healthy.  The  quantity  of  chloroform  inhaled  did  not  exceed  two  drachms. 

CASE  1256. — Private  George  E.  Stannard,  Co.  G,  14th  Connecticut,  admitted  into  Finley  Hospital,  Washington,  with  a 
shot  fracture  of  left  ulna,  received  at  Fredericksburg  December  31,  1862.  Patient  was  a  perfectly  healthy,  robust  man,  of  lively 
temperament,  rather  pale  in  color.  On  January  28,  1863,  chloroform  was  administered  for  the  purpose  of  removing  the  loose 
pieces  of  bone.  About  two  drachms  of  the  anaesthetic  were  sprinkled  on  a  towel  and  placed  to  the  nose ;  in  about  five  or  six 
minutes  he  came  under  its  influence;  the  usual  struggle  came  on  just  preceding  complete  anaesthesia,  when  he  suddenly  ceased 
to  breathe  and  his  pulse  failed.  Every  effort  to  resuscitate  him  failed.  The  history  of  the  case,  together  with  the  specimen  of 
the  lower  extremity  of  the  left  ulna,  was  contributed  by  Surgeon  I.  Moses,  U.  S.  V.;  the  Specimen  is  numbered  859  of  the 
Suryical  Section  of  the  Museum. 

CASE  1257. — Corporal  C.  F.  Tarbell,  Co.  D,  21st  Maine,  aged  19  years,  shot  wound  of  left  thigh,  at  Port  Hudson,  May 
27,  18:5:5.  He  was  removed  to  the  regimental  hospital,  where  it  was  found  necessary  to  amputate  the  thigh  in  the  middle  third. 
Surgeon  G.  E.  Brickett,  21st  Maine,  reports  that  the  patient  died  May  27,  1803,  from  the  effects  of  the  chloroform. 

CASE  1258. — Private  G.  N.  Titus,  Co.  G,  8th  Vermont,  was  admitted  into  regimental  hospital  at  Algiers,  Louisiana,  August 
21,  1862,  with  a  wound  of  one  of  his  toes.  Chloroform  was  administered  by  Surgeon  II.  H.  Gillett  and  Assistant  Surgeon  S.  H. 
Currier,  8th  Vermont,  for  the  purpose  of  amputating  the  injured  toe.  The  patient  expired  suddenly,  before  the  operation  was 
commenced.  Assistant  Surgeon  L.  C.  Herrick,  4th  U.  S.  Colored  Cavalry,  reports  the  case. 

CASE  1259. — Surgeon  Edwin  Bentley,  U.  S.  V.,  reports  that  a  Confederate  soldier,  a  large,  robust,  muscular  Noi'th  Caro 
linian,  after  the  battle  of  Hanover  Court  House,  May  29,  1862,  underwent  amputation  of  the  thigh.  The  operation  was  per 
formed  in  the  open  air  and  very  little  blood  was  lost.  A  large  amount  of  chloroform  had  been  administered  without  the  patient 
becoming  at  all  unconscious,  when  the  surgeon  forced  him  to  large  and  free  inspirations  and  he  became  immediately  under  its 
influence.  Just  after  the  completion  of  the  operation  the  pulse  sank  rapidly,  and  he  appeared  to  cease  to  breathe  simultaneously 
with  the  effects  of  the  anaesthetic. 

CASE  1260. — Surgeon  John  A.  Lidell,  U.  S.  V.,  in  his  report  of  the  operations  of  the  medical  staff  of  General  Sedgwick's 
division  of  the  Second  Corps,  at  Fair  Oaks,  states:  "A  soldier  of  General  Eichardson's  division  was  placed  on  the  table  and 


CHAP.  xm.J  DEATHS  FROM  CHLOROFORM.  893 

chloroform  administered  for  the  purpose  of  amputation  of  the  thigh  for  gunshot  comminuted  fracture  of  the  femur  in  the  neigh 
borhood  of  the  knee  joint.  While  inhaling  the  chloroform  he  suddenly  became  pale,  pulseless,  and  ceased  to  breathe,  dying  on 
the  operating  table  while  the  amputation  was  going  on." 

CASE  1261.— Private  J.  W.  Whitlock,  Co.  K,  lllth  Illinois,  gunshot  wound  of  left  elbow  joint,  Dallas,  Ga.,  May  31,  1864. 
Admitted  into  hospital  of  2d  division,  Fifteenth  Corps,  same  day;  chloroform  administered  for  the  purpose  of  operating,  but  he 
died  from  its  effects.  An  autopsy  revealed  extensive  adhesions  of  the  pericardium  and  hepatization  of  the  right  lung.  The  case 
is  reported  by  Surgeon  J.  B.  Potter,  30th  Ohio. 

CASE  1262. — Unknown  soldier,  with  a  shot  injury  necessitating  amputation  at  the  knee  joint;  chloroform  was  admin 
istered,  and  the  patient  died  while  the  operation  was  being  performed.  Surgeon  D.  P.  Smith,  U.  S.  V.,  the  operating  surgeon, 
states  that  the  anaesthetic  was  administered  too  profusely  by  an  entirely  incompetent  person,  who  was  subsequently  dismissed 
from  the  service. 

CASE  1263. — Corporal  A.  Wilde,  Co.  H,  61st  New  York,  wounded  at  Deep  Bottom,  August  19,  1864 ;  distal  phalanx  of 
thumb  shattered;  admitted  into  hospital  of  1st  division,  Second  Corps.  Assistant  Surgeon  C.  Smart,  II.  S.  A.,  reports  that 
chloroform  was  given,  and  after  about  three  drachms  had  been  taken  the  patient  became  much  excited  and  passed  into  a  violent 
convulsion,  in  the  midst  of  which  he  died.  At  the  autopsy  the  heart  was  found  small  and  firmly  contracted,  its  walls  being  in 
contact  and  the  cavities  obliterated. 

CASE  1264. — Private  Lewis  Winters,  Co.  I,  llth  Michigan,  aged  40  years,  Atlanta,  August  7,  1864;  conoidal  ball  in 
upper  third  right  thigh.  Admitted  into  hospital  No.  8,  Nashville,  August  20th  ;  gangrene.  October  27th,  preparatory  to  cleaning 
and  burning  the  wound  Acting  Assistant  Surgeon  R.  W.  Forrest  commenced  to  administer  chloroform  from  a  sponge  surrounded 
with  a  napkin,  plenty  of  atmospheric  air  being  admitted.  Not  more  than  half  an  ounce  of  chloroform  was  poured  upon  the 
sponge.  His  pulse  was  good,  and  he  was  judged  to  be  a  healthy  man.  After  inhaling  the  chloroform  for  about  three  minutes  a 
very  severe  spasm  came  on;  his  head  was  thrown  violently  back,  his  body  arched,  resting  on  top  of  head  and  feet,  the  arms 
were  drawn  up,  and  the  hands  violently  clenched.  The  chloroform  was  withdrawn;  the  spasm  relaxed'in  a  few  seconds;  his 
head  and  face  became  very  much  congested.  Cold  water  was  instantly  dashed  over  his  face  and  chest  and  ammonia  applied  to 
the  nostrils,  and  every  means  that  could  be  devised  to  resuscitate  kept  up  for  more  than  an  hour  without  effect.  Autopsy:  Five 
points  of  cicatrization  from  scarification  for  cupping;  considerable  serous  effusion  under  arachnoid  and  filling  sulci;  vessels  on 
surface  of  brain  much  congested;  pleuritic  adhesions  very  firm  on  both  sides;  left  lung  deeply  engorged  with  dark  blood,  frothy 
serum  exuding  from  cut  surface,  and  numerous  small  chalk-like  deposits  found  near  the  surface;  heart  normal  in  size  and 
appearance. 

CASE  1265.— D.  ZebrisTce,  Co.  I,  12th  Alabama,  admitted  into  hospital  No.  5,  Frederick,  October  18,  1862,  with  a  shot  flesh 
wound  left  hip,  traversing  deep  portion  of  gluteal  muscles;  Antietam,  September  17, 1862;  ball  lodged.  October  19th,  chloroform 
administered  with  a  view  of  removing  missile.  No  unusual  symptom  was  observed;  but  while  the  operation  was  in  progress 
and  the  patient  not  in  the  act  of  inhaling  the  vapor,  it  was  discovered  that  he  had  ceased  to  breathe.  The  autopsy  threw  no 
light  on  the  cause  of  death.  The  subject  was  anaemic,  and  exhausted  by  hardship  and  depleted  by  suppuration.  The  report  of 
the  case  was  made  by  Surgeon  H.  S.  Hewit,  U.  S.  V. 

CASE  1266. — Private  G.  G.  Allison,  Co.  A,  6th  New  York  Artillery,  aged  43  years,  admitted  into  hospital  at  Beverly,  New 
Jersey,  July  7, 1864.  On  February  7,  1865,  he  was  placed  upon  the  table  to  be  operated  on  for  fistula  in  ano.  Chloroform  was 
administered  in  the  ordinary  manner;  room  was  well  ventilated  and  the  vapor  of  the  chloroform  freely  diluted  with  atmospheric 
air ;  full  anaesthesia  was  produced,  when  the  pulse  rapidly  failed,  and  in  a  very  brief  period  death  took  place.  The  quantity  of 
chloroform  inhaled  did  not  exceed  two  drachms.  Every  effort  was  made  to  restore  life  by  artificial  respiration,  ammonia,  stimu 
lants,  etc.  An  autopsy  was  made  twelve  hours  after  death;  the  brain,  thoracic  and  abdominal  viscera  were  very  carefully 
examined,  but  nothing  detected  sufficient  to  account  for  death;  the  brain  was  very  slightly  congested.  Assistant  Surgeon  C. 
Wagner,  U.  S.  A.,  reported  the  case. 

CASE  1267. — Private  Francis  Heward,  Co.  F,  1st  New  Jersey,  was  admitted  into  Fairfax  Seminary  Hospital,  April  5, 
1862,  with  a  dislocation  of  left  humerus  forward  and  inward  of  a  few  hours'  standing.  Surgeon  Henry  A.  Armstrong,  2d  New 
York  Artillery,  reduced  the  bone  without  assistance.  On  May  6th  Acting  Assistant  Surgeon  H.  W.  Ducachet  discovered  that 
the  bone  was  again  out  of  place  in  the  same  direction.  The  patient  was  chloroformed  and  reduction  attempted  with  the  heel  in 
the  axilla,  but  without  success.  On  the  9th  pulleys  and  counter-extending  bands  were  obtained  and  adjusted.  Chloroform  was 
again  administered,  a  drachm  being  poured  upon  a  piece  of  lint  about  two  inches  square  and  held  about  three  inches  from  his 
face,  a  towel  being  thrown  over  the  head  of  the  patient  and  hand  of  the  operator,  and  which  was  removed  from  time  to  time  to 
admit  air.  Some  time  elapsed  before  the  muscles  became  relaxed,  when  the  chloroform  was  removed.  There  was  no  stertorous 
breathing,  choking,  or  struggling,  nor  was  there  occasion  to  use  force  to  keep  him  down,  as  at  the  previous  administration. 
There  was,  as  there  always  is,  congestion  of  the  conjunctiva  and  vessels  of  the  neck,  but  not  as  much,  certainly  not  more,  than 
when  the  chloroform  was  administered  on  the  6th.  Reduction  was  being  attempted  when  symptoms  of  asphyxia  were  noticed; 
the  pulleys  were  instantly  relaxed,  the  tongue  drawn  forward,  and  artificial  respiration  resorted  to,  but  everything  failed. 
No  autopsy  was  made.  The  report  of  the  case  is  signed  by  Surgeon  H.  A.  Armstrong  and  Acting  Ass't  Surgeon  H.  W. 
Ducachet. 

CASE  1268. — T.  A.  Leaning,  Co.  H,  76th  New  York,  a  patient  in  Eckington  Hospital,  was  troubled  with  stricture  of  the 
urethra.  An  attempted  examination  by  the  catheter  was  so  painful  that  chloroform  was  administered  on  a  handkerchief,  pains 
being  taken  that  the  patient  had  plenty  of  air  by  holding  the  handkerchief  far  enough  away  from  the  face.  In  a  few  minutes 
the  rigidity  of  the  muscles  yielded,  but  only  partly,  and  two  or  three  stertorous  respirations  were  taken.  The  chloroform  was 
immediately  suspended  and  the  examination  by  the  catheter  commenced.  The  instrument  had  only  been  introduced  to  about 
the  membranous  urethra  when  an  involuntary  evacuation  of  both  bladder  and  bowels  took  place;  the  patient  at  that  moment 
ceased  to  breathe  and  his  face  grew  purplish.  The  action  of  the  heart  could  not  be  observed  at  this  time,  since  the  administrator 


894  ANESTHETICS.  [CHAP.  XIII. 

had  not  his  finger  on  the  pulse.  On  being  immediately  observed,  no  pulsation  could  be  felt  at  the  wrist  nor  observed  on  auscul 
tation  over  the  heart.  The  tongue  was  immediately  pulled  forward  with  a  tenaculum,  but  as  no  respiration  succeeded,  Marshall 
Hall's  ready  method  of  artificial  respiration  was  immediately  commenced.  The  temporal  artery  was  also  instantly  cut,  but  only 
a  few  drops  of  blood  escaped.  Eespiration  incomplete  and  obstructed  by  eructation;  passive  vomiting,  with  friction  of  the 
surface  by  the  hand  and  by  a  stiff  brush,  and  stimulating  injections  of  ammonia  and  turpentine  were  kept  up  for  over  two  hours 
with  no  favorable  result,  and  the  attempt  at  resuscitation  was  then  given  up.  Acting  Assistant  Surgeon  W.  W.  Keen,  jr.,  who 
reports  the  case,  remarks  of  the  autopsy  that  "almost  the  only  things  strictly  abnormal  were  the  enormous  congestion— probably 
passive — of  the  heart,  fluidity  of  the  blood,  and  the  absence  of  rigor  mortis." 

CASE  1269. — Surgeon  J.  R.  Weist,  1st  Colored  Troops,  reports:  "A  death  from  chloroform  occurred  in  hospital  No.  12, 
Nashville,  in  1882.  The  hospital  was  then  under  the  charge  of  Surgeon  Frederick  Seymour,  U.  S.  V.  I  supposed  that  he  had 
reported  the  case.  I  cannot  now  obtain  the  name  of  the  soldier,  but  there  can  be  no  mistake  about  it,  as  I  administered  the 
chloroform  myself.  The  patient  was  a  United  States  soldier  (Irish),  suffering  from  anal  fistula,  and  the  chloroform  was  carefully 
administered  from  a  towel  folded  in  the  shape  of  a  cone  preparatory  to  an  operation.  The  patient  was  in  a  well- ventilated  room. 
About  two  drachms  of  the  anaesthetic  had  been  used,  when  death  suddenly  occurred  without  any  warning.  Autopsy  revealed 
fatty  degeneration  of  the  heart.  Nothing  else  abnormal  found." 

Considering  the  great  number  of  eases  in  which  chloroform  was  applied,  principally 
during  and  after  the  exciting  circumstances  of  a  battle,  when  expedition  was  a  matter  of 
necessity,  it  is  remarkable  that  not  more  cases  of  death  from  this  agent  have  been  recorded. 
With  what  justice  the  fatal  issues  in  the  cases  here  cited  are  chargeable  to  the  anaesthetic 
the  reader  must  judge  for  himself. 

Deaths  from  Chloroform  and  Ether. — Two  cases  were  reported.  In  one  case,  although 
the  patient's  condition  would  appear  to  have  been  favorable,  no  efforts  at  resuscitation  seem 
to  have  been  made;  in  the  other  case  it  is  doubtful  whether  death  was  due  to  the  severity 
of  the  injury  or  the  anaesthetic: 

CASK  1270. — Private  Henry  Jefferson,  Co.  E,  19th  Colored  Troops,  aged  20  years ;  shot  fracture  of  femur  two  inches  below 
trochanter  major.  August  14,  1865;  doing  well  until  October  16th,  when  the  pus  became  rusty.  November  17th,  Acting  Assistant 
Surgeon  H.  Raphael,  at  the  post  hospital  at  Brownsville,  Texas,  administered  an  anaesthetic  of  two  parts  of  ether  and  one  part 
of  chloroform  with  the  intention  of  excising  the  ends  of  the  bone;  but  after  inhaling  two  minutes  the  patient  began  to  sink 
pulse  failed,  spasms  occurred,  the  head  was  drawn  back  and  hands  and  feet  were  in  a  tremor;  the  sponge  was  removed,  and  the 
patient  rallied;  but  upon  re-administration  spasms  immediately  returned,  the  pulse  stopped,  and  the  patient  was  dead. 

CASK  1271. — Lieutenant  Colonel  J.  C.  Hodges,  44th  Indiana,  was  injured  on  the  railroad,  September  27,  1864.  The  right 
femur  was  fractured  and  the  soft  parts  lacerated;  the  left  os  calcis  was  also  fractured;  considerable  haemorrhage.  At  the 
patient's  urgent  request  a  mixture  of  chloroform  and  ether  was  administered.  The  pulse  improved  slightly,  and  amputation  of 
the  thigh  was  decided  upon.  Five  minutes  before  the  conclusion  of  the  operation  the  breathing  was  noticed  to  be  stertorous  and 
soon  intermitting,  with  flagging  pulse.  Artificial  respiration  was  immediately  resorted  to  by  posture  and  by  compression  of 
chest  at  intervals,  while  the  tongue  was  drawn  forward  by  an  assistant.  This  procedure  gave  much  encouragement  for  a  long 
time — indeed,  for  two  hours  the  indications  of  returning  .vitality  and  consciousness  seemed  to  depend  entirely  upon  the  vigorous- 
ness  of  the  efforts  at  artificial  respiration,  but  every  effort  failed  to  restore  life. 

Deaths  from  Ether. — Four  cases  were  reported.  In  three  cases  death  was  probably  due 
to  the  shock  and  the  effects  of  the  ether  combined;  in  one  an  overdose  was  administered: 

CASE  1272.— Captain  John  Brennan,  Co.  A,  16th  Virginia,  shot  wound,  right  thigh,  lower  third,  Weldon  Railroad,  October 
27,  1864.  Admitted  into  Harewood  Hospital  October  3 1st.  The  condition  of  the  wound  was  good,  but  haemorrhage  occurred 
November  10th,  from  the  popliteal  artery,  by  which  ten  ounces  of  blood  were  lost.  The  artery  was  ligated  in  popliteal  space, 
and  the  patient  did  well  until  November  2lst,  when  the  limb  became  oedematous.  November  25th,  haemorrhage  recurred  to  th« 
amount  of  twelve  ounces;  it  could  not  be  controlled,  and  the  limb  was  amputated;  the  patient  died  on  the  operating  table  from 
the  shock  and  effects  of  ether.  At  the  post-mortem  no  abnormities  could  be  discovered,  with  the  exception  of  slight  venous  con- 
jestion  of  the  rijrht  lung  and  old  adhesions  of  the  left.  The  case  is  reported  by  Surgeon  R.  B.  Bontecou,  U.  S.  V. 

CASE  1273. — An  unknown  soldier  received,  in  1862,  a  shot  fracture  of  the  condyle  of  the  femur.  The  patient  was  stout 
and  exhibited  no  symptom  of  exhaustion  or  severe  shock;  his  heart  acted  with  uniformity  and  strength;  amputation  was  decided 
on  and  ether  was  administered,  which  produced  insensibility  in  about  ten  minutes.  As  soon  as  the  operation  was  begun  the 
patient  seemed  to  be  regaining  consciousness;  but  it  required  only  a  few  seconds  to  restore  complete  anaesthesia.  The  assistant 
then  removed  the  ether  from  the  patient's  face,  but  was  ordered  by  the  operating  surgeon  to  renew  the  application.  After  one 
or  two  inspirations  the  patient  ceased  to  breathe.  The  saw  had  not  been  applied  nor  the  use  of  the  knife  been  finished  when 
death  occurred.  The  case  is  reported  by  Dr.  Walter  Burnham.1 

CASE  1274. — Private  John  Maxwell,  Co.  E,  159th  New  York,  was  wounded  before  Port  Hudson,  May  27,  1863,  just  below 
the  knee,  implicating  the  joint.  He  lay  on  the  field  of  battle  until  midday  of  the  28th.  His  pulse  was  small  and  feeble  and  his 

1  BURNHAM  (W.),  (Death  from  the  Effectt  of  Sulphuric  fther  [in  an  overdose.— ED.],  in  The  Boston  Mt.d.  and  Surg.  Jour.,  1870,  Vol.  VI,  p.  377. 


CHAP.  XIII.  |  ANAESTHETICS.  895 

nervous  system  much  prostrated.  He  was  fed  on  beef  tea  and  stimulants.  He  was  brought  to  the  field  hospital,  and  three  hours 
later  ether  was  administered  to  him  with  a  view  of  amputating  the  wounded  leg.  After  being  partially  anaesthetized  he  was 
removed  from  where  he  had  been  lying  and  placed  upon  the  operating  table.  More  ether  was  then  administered,  and  as  soon  as 
the  patient  appeared  to  be  sufficiently  narcotized  a  circular  incision  was  made  just  above  the  knee  joint.  The  assistant  holding 
the  pulse  remarked  that  the  circulation  was  failing,  and  efforts  were  immediately  made  to  induce  restoration  of  the  vital  energies 
by  drawing  out  the  tongue,  throwing  back  the  head,  artificial  respiration,  and  dashing  of  cold  water.  All  was  in  vain,  and  the 
patient  died  May  23,  1833.  The  case  is  reported  by  Surgeon  C.  A.  Robertson,  159th  New  York. 

CASE  1275. — Private  Henry  S.  Ware,  Co.  K,  38th  New  York,  aged  23  years,  was  struck  by  a  shell  in  the  upper  part  of 
the  right  leg,  at  the  battle  of  Williamsburg,  May  5, 18G2,  for  which  injury  the  limb  was  removed  on  the  field,  at  the  middle  third 
of  the  thigh.  He  was  admitted  into  the  general  hospital  at  David's  Island,  New  York  Harbor,  on  June  loth,  and  came  under 
the  care  of  Acting  Assistant  Surgeon  E.  B.  Root  on  June  2Gth,  at  which  time  his  general  condition  was  bad.  He  was  suffering 
from  diarrhea  and  a  very  large  bed-sore.  The  wound  had  nearly  united  but  the  bone  was  denuded.  The  constant  discharge 
from  the  stump  necessitated  the  removal  of  the  necrosed  bone.  On  October  9th  the  patient  was  placed  under  the  influence  of 
ether  and  an  inch  of  bone  removed  with  the  chain  saw,  and  then  two  inches  of  the  bone  with  its  iuvolucrum.  During  the  opera 
tion  the  femoral  artery  was  divided,  but  not  much  blood  was  lost.  Although  it  was  found  that  more  of  the  shaft  was  involved, 
further  operative  interference  was  deemed  unnecessary.  The  patient  was  removed  to  his  bed,  when  severe  vomiting  commenced 
which  continued  to  the  time  of  his  death,  seventy-two  hours  subsequently.  The  post-mortem  examination  showed  all  the  viscera 
healthy.  Surgeon  S.  W.  Gross,  U.  S.  V.,  ascribes  the  death  to  th«  effects  of  the  ether  superadded  to  the  previous  exhausted 
condition  of  the  system.  The  constant  vomiting  and  retching  could  not  be  arrested. 

A  few  instances  are  recorded  in  which  suspended  animation  was  restored  by  energetic 
and  prompt  interference.  The  following  two  may  serve  as  examples: 

CASE  1276. — Private  A.  Boyd,  Co.  C.  38th  Georgia,  received  a  shot  fracture  of  the  right  elbow  joint,  at  Gettysburg,  July 
1,  1863,  and  was  admitted  to  hospital  at  Frederick  five  days  afterwards.  Water  dressings  were  applied  until  July  18th,  when 
considerable  oedema  of  the  limb  having  become  apparent,  with  redness  about  the  joint,  a  resection  of  the  injured  parts  was 
decided  upon.  The  patient  having  been  brought  to  the  operating  room,  ether  was  administered  by  a  Medical  Cadet  for  fifteen  or 
twenty  minutes  without  producing  anaesthesia,  when  from  one  and  a  half  to  two  drachms  of  chloroform  was  added  to  the  sponge 
and  closely  placed  over  the  patient's  mouth  and  nose.  In  the  course  of  thirty  or  forty  seconds  stertorous  breathing  was  pro 
duced,  whereupon  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  in  charge  of  the  hospital,  proceeded  to  operate  and  commenced  the 
incisions.  About  this  time,  however,  pulsation  in  the  brachial  artery  was  noticed  to  be  running  down  rapidly,  and  the  respira 
tory  movements  of  the  chest  and  abdomen  were  observed  to  have  ceased,  when  one  of  the  attending  surgeons  was  instructed  to 
examine  the  patient's  tongue,  and  finding  it  had  not  fallen  back,  "Marshall  Hall's"  ready  method  was  proposed  and  instantly 
applied.  After  this  had  been  kept  up  for  about  half  a  minute  and  no  respiratory  effort  had  been  observed,  the  operator  immedi 
ately  proceeded  to  open  the  larynx,  when,  after  artificial  respiration  by  means  of  compressing  and  relaxing  the  chest  and 
abdominal  walls  for  the  period  of  about  two  minutes,  natural  breathing  was  re-established  and  pulsation  of  the  radial  artery 
could  be  felt.  There  was  scarcely  any  haemorrhage  from  the  incision,  and  none,  perhaps,  entered  the  trachea.  The  edges  of  the 
wound  were  drawn  together  by  adhesive  straps.  It  not  being  thought  proper  to  proceed  with  the  operation  of  excision,  the 
patient  was  returned  to  his  ward  and  stimulants  ordered  to  be  given  freely,  also  generous  diet.  He  rested  fairly  and  took  broth 
very  freely  the  next  morning;  pulse  130  and  quite  feeble;  respiration  quite  easy.  During  the  next  night  and  for  several  days 
afterwards  the  patient  had  a  daily  chill,  and  there  was  considerable  cough,  with  well  marked  capillary  bronchitis  throughout 
the  whole  extent  of  the  left  lung;  tongue  coated  and  brown ;  wound  of  elbow  but  little  disposed  to  suppurate.  These  symptoms 
continued  to  grow  worse,  and  subsequently  there  were  several  slight  haemorrhages  from  the  incision  over  the  olecranon  process. 
During  the  last  few  days  the  patient's  swallowing  became  very  difficult,  and  beef  tea  and  whiskey  were  administered  by  means  of 
clysters.  Death  supervened  on  July  23,  1863.  The  post-mortem  examination  disclosed  a  small  abscess  on  each  side  of  the  sternum, 
just  beneath  the  pleura-costal  is  and  about  one  and  a  half  inches  below  the  clavicles,  and  confirmed  the  existence  of  capillary 
bronchitis.  The  history  of  the  case  was  furnished  by  Acting  Assistant  Surgeon  W.  S.  Adams.  The  lower  third  of  the  injured 
humerus  and  a  wet  preparation  of  the  upper  portion  of  the  trachea,  the  cricoid  cartilage,  and  larnyx.  showing  the  incision  made, 
were  contributed  to  the  Museum  by  the  operator,  and  constitute  Specimens  3901  and  4080,  respectively,  of  the  Surgical  Section. 

CASE  1277. — Private  S.  R.  Green,  Co.  A,  5th  New  Hampshire,  was  wounded  in  the  leg,  at  Gettysburg,  July  2,  1863,  by 
a  mini<5  ball,  which  fractured  the  tibia  and  fibula.  Amputation  at  the  middle  third  of  the  leg  was  performed  at  a  field  hospital 
by  Surgeon  C.  S.  Wood.  6Gth  New  York,  who  made  the  following  report :  ''  Out  of  the  hundreds  of  cases  in  which  I  have  admin 
istered  chloroform  this  is  the  only  one  accompanied  by  any  unpleasant  symptoms;  here  the  patient  sunk  under  its  use,  was 
apparently  dead,  and  respiration  and  circulation  both  ceased.  But  by  the  continual  use  for  some  ten  or  fifteen  minutes  of  Marshall 
Hall's  ready  method  he  was  restored  and  the  operation  was  proceeded  with.  The  cause  was  evidently  inattention  on  the  part  of 
the  administrator."  The  patient  subsequently  died  at  the  Seminary  Hospital  at  Gettysburg  on  July  30,  1863. 

The  reports  of  the  surgical  operations  of  the  war  are  very  deficient  in  regard  to  the 
quantities  of  the  anaesthetic  used,  the  manner  in  which  it  was  administered,  the  time  required 
to  produce  insensibility,  the  period  during  which  it  was  maintained,  or  the  unfavorable 
symptoms  following  its  application;  the  reports  of  the  medical  officers  of  the  army  after 
the  war  were  somewhat  fuller  on  these  points;  but  to  make  them  as  complete  as  possible, 
the  following  order  was  issued  in  1876  from  the  Surgeon  General's  Office: 


896 


ANESTHETICS. 


ICHAP.  xin. 


WAR  DEPARTMF.NT,  SURGEON  GENERAL'S  OFFICE, 
CIRCULAR  ORDERS.  No.  2.  WASHINGTON,  October  2,  18?<">. 

With  a  view  of  collecting  precise  data  relative  to  the  effects  of  chloroform  and  ether,  Medical  Officers  are  instructed  to 
record,  during  the  year  1877,  the  cases  in  which  recoui-se  is  had  to  anesthetics,  noting  the  following  particulars  :  Name  and  age 
of  subject;  nature  of  the  anaesthetic ;  the  quantity  used  in  maintaining  anaesthesia;  the  time  required  to  induce  complete  insensi 
bility;  the  time  the  anesthetic  influence  was  maintained;  the  mode  of  administration;  whether  vomiting,  excitement,  or  great 
prostration  was  observed  during  or  after  the  administration.  These  memoranda  will  be  transcribed  and  returned  on  the  Quarterly 
Reports  of  Wounded  for  March,  June,  September,  and  December,  1877. 

BY   ORDER   OF   THE   SURGEON   GENERAL:  C.    H.    CRANE, 

Assistant  Surgeon  General,  V.  S.  Army. 

As  the  number  of  cases  in  which  anaesthesia  was  employed  during  the  year  1877  was 
limited,  the  order  was  continued  in  force  by  the  following: 

WAR  DEPARTMENT,  SURGEON  GENERAL'S  OFFICE, 

WASHINGTON,  May  20,  1878. 
CIRCULAR  ORDKRS,  No.  1. 

Circular  Orders  No.  2,  of  October  2,  1876,  from  this  Office,  will  be  hereby  continued  in  force  until  further  orders.  Med 
ical  Officers  will  render  reports  accordingly. 

BY   ORDER   OF  THE   SURGEON   GENERAL:  C.    H.    CRANE, 

Assistant  Surgeon  General,  U.  S.  Army. 

The  information  thus  obtained  is  here  briefly  given :  The  total  number  of  cases  since 
the  close  of  the  war.  in  I860,  in  which  anaesthesia  was  produced,  is  one  thousand  two  hun 
dred  and  ten  (1,210).  Of  these  chloroform  was  used  in  three  hundred  and  fifty-five  (355), 
ether  in  five  hundred  and  eighty-seven  (587),  and  ether  and  chloroform  in  two  hundred  and 
sixty-eight  (268)  cases.  In  the  cases  reported  previous  to  the  issue  of  Circular  Orders  No. 
2,  Surgeon  General's  Office,  1876,  the  data  are,  like  those  of  the  war,  very  incomplete,  and 
we  will  therefore  confine  ourselves  to  the  consideration  of  the  cases  reported  since  the  issue 
of  that  order.  They  number  five  hundred  and  ninety-seven  (597);  in  one  hundred  and 
fifty-seven  (157),  or  26.3  per  cent,  of  these,  chloroform;  in  one  hundred  and  eight  (108), 
or  18.1  per  cent.,  chloroform  and  ether;  and  in  three  hundred  and  thirty-two  (332),  or  55. 6 
per  cent.,  ether  was  administered.  In  three  of  the  cases  death  was  ascribed  to  the  anaes 
thetic — to  chloroform  in  one,  to  chloroform  and  ether  in  one,  and  to  ether  in  the  third. 

The  smallest  quantity  of  chloroform  used  to  induce  anaesthesia  was  three-fourths  of  one 
drachm,  of  chloroform  and  ether  one  drachm,  and  of  ether  two  drachms;  the  largest  quan 
tity  of  chloroform  ninety-six  drachms,  of  chloroform  and  ether  one  hundred  and  thirty 
drachms,  and  of  ether  two  hundred  and  fifty-six  drachms;  the  average  amount  of  the  agents 
used  was  chloroform  eleven,  chloroform  and  ether  thirty-two,  and  ether  fifty-one  drachms. 
The  average  time  in  which  insensibility  was  induced  by  chloroform  was  nine  minutes,  by 
ether  and  chloroform  seventeen  minutes,  and  by  ether  sixteen  minutes,  as  shown  in  the 
following  table: 

TABLE  GLXXIV. 

Statement  of  Five  Hundred  and  Ninety-seven  Cases  of  the  Employment  of  Anaesthetics,  showing  Quantities 
used,  Time  to  induce  Ancestliesia,  and  Period  during  which  it  was  maintained. 


ANESTHETIC  AGENTS  EMPLOYED. 

CASES. 

QUANTITIES  USED. 

TIME  TO  INDUCE  ANESTHESIA. 

ANAESTHESIA  SUSTAINED. 

Small 
Qnant. 

Large 
Qtiiint. 

Average 
Quant. 

Drachm. 
11 

32 

51 

1 

Shortest 
Time. 

Longest 
Time. 

Minutes. 
35 

60 
55 

Average 
Time. 

Shortest 
Time. 

Longest 
Time. 

Average 
Time. 

157 
108 
332 

Drachm. 
J 
1 

2 

Drachm. 
96 

130 
256 

Minutes. 
1 

1 
1 

Minutes. 
U 

17 
16 

Minutes. 

1 
I 

1 

MinuU'S. 
180 

130 
235 

Minutes. 
22 

26 
26 

Chloroform  a  ad  Ether  ...   

Ether 

CHAP.  XIII.] 


ANESTHETICS. 


897 


The  rapidity  of  the  effects  and  the  saving  in  quantity  in  the  use  of  chloroform,  so 
important  to  the  field  surgeon,  especially  after  large  battles,  is  at  once  apparent.  There  is 
hardly  any  difference  in  the  average  time  required  to  produce"  anaesthesia  by  ether  or  by 
chloroform  and  ether. 

Vomiting  was  recorded  in  twenty-three  (23),  or  14.6  per  cent.,  of  the  one  hundred 
and  fifty-seven  (157)  cases  of  chloroform;  in  thirty-two  (32),  or  29.6  per  cent.,  of  the  one 
hundred  and  eight  (108)  cases  of  chloroform  and  ether;  and  in  ninety-eight  (98),  or  29.5 
per  cent.,  of  the  three  hundred  and  thirty-two  (332)  cases  of  ether, — the  relative  frequency 
being  nearly  the  same  in  the  cases  in  which  ether  or  ether  and  chloroform  was  used,  and 
less  in  the  cases  of  chloroform,  as  well  as  less  copious: 

TABLE  OLXXV. 

Statement  showing  the  Frequency  of  Vomiting,  Excitement,  and  Prostration  in  Five  Hundred  and  Ninety- 
seven  Cases  of  Ancesthesia. 


ANESTHETIC  AGENT  EMPLOYED. 

i 

o 

VOMITISO. 

EXCITEMENT. 

PKOSTEA.TION. 

1 

«i 

•a 
§ 

Copious. 

0 

a 

£ 

s 

to 
§ 

Marked. 

Violent. 

0 

§ 

fc 

1, 

7. 

Marked. 

Chloroform  ... 

157 
108 
332 

134 
70 
234 

20 
25 
83 

3 

7 
15 

113 
68 
202 

23 
24 
85 

9 
10 
31 

12 
C 

14 

136 
95 

295 

11 

11 

24 

10 
2 
13 

Chloroform  find  Ether  

Ether    

Excitement  was  likewise  reported  less  frequently  in  cases  in  which  chloroform  was 
administered  than  in  those  in  which  chloroform  and  ether  or  ether  was  used,  the  percentages 
being  28.0  in  chloroform,  37.0  in  chloroform  and  ether,  and  39.1  in  ether;  but,  as  the 
figures  in  the  table  indicate,  it  seems  to  have  been  somewhat  more  violent  in  the  cases  of 
chloroform  narcosis,  although  in  one  case  in  which  ether  was  employed  the  excitement  was 
so  intense  that  the  use  of  the  anesthetic  was  abandoned  and  the  operation  completed  with 
out  anaesthesia.  Prostration  was  reported  in  twenty-one,  or  13.3  per  cent.,  of  the  cases  of 
chloroform;  in  thirteen,  or  12.0  per  cent.,  of  the  cases  of  chloroform  and  ether;  and  in 
thirty-seven,  or  11.1  per  cent.,  of  the  cases  of  ether. 

In  four  of  the  one  hundred  and  fifty-seven  cases  in  which  chloroform  was  used  slight 
disturbance  of  respiration  was  noted,  and  in  two  cases  respiration  ceased  and  the  pulse 
stopped,  but  life  was  restored  after  prolonged  efforts.  Pulse  and  respiration  were  likewise 
suspended  in  two  instances  in  which  ether  and  chloroform,  and  in  one  in  which  ether  alone, 
had  been  used;  they  also  were  brought  back  to  consciousness.  In  three  cases  death  was 
ascribed  to  the  anaesthetic.  A  case  of  death  from  chloroform  is  reported  by  Assistant 
Surgeon  R.  Barrett,  U.  S.  A.: 

CASK  1278. — Private  A.  L.  Bruce,  Co.  G,  13th  Infantry,  aged  '26  years,  suffered  from  bleeding  internal  piles,  and  deriv 
ing  no  benefit  from  a  palliative  treatment  it  was  decided  to  relieve  him  by  operation.  After  abstaining  from  solid  food  for  six 
teen  hours  the  patient  was,  on  August  23,  1877,  placed  on  the  operating  table  and  the  administration  of  chloroform  was  com. 
menced.  The  inhaler  used  was  a  towel  folded  cone-shaped,  with  an  inch  aperture  at  the  apex.  Fearing  that  this  opening  \vns 
not  sufficiently  large  to  admit  of  the  free  access  of  atmospheric  air,  the  inhalation  was  discontinued  and  the  opening  enlarged  to 
twice  its  former  size.  The  inhalation  was  then  resumed,  the  patient  at  this  time  lying  on  the  table  and  quietly  observing  the 
operations  going  on  around  him.  I  am  thus  minute  as  I  wish  to  show  that  the  patient  was  perfectly  conscious  when  the  second 
inhalation  began.  He  took  the  anaesthetic  kindly  for  about  a  minute,  when  he  suddenly  sat  upright  and  asked  if  his  piles  wer*> 
out.  I  replied  "No,  lie  down;''  he  said  ''All  right  doctor,  I  have  the  utmost  confidence  in  you."  His  head  had  hardly  touched 
the  table  when  his  radial  pulse  ceased  and  his  face  became  intensely  congested ;  his  breathing  was  stertorous  and  a  large  quan 
tity  of  froth  appeared  on  his  lips.  I  directed  the  attendants  to  seize  his  heels  and  hold  him  up,  head  down,  at  the  same  tim<- 
SURG.  Ill— 113 


89S  ANAESTHETICS.  [CHAP.  xm. 

applying  aqua  ammonia  to  the  nostrils.  His  respiration  was  now  reduced  to  an  occasional  gasp,  and  finding  the  Nelaton  posi 
tion  of  no  benefit  I  had  him  laid  on  the  table,  and  drawing  forward  his  tongue  with  a  forceps  introduced  a  large  gum  catheter 
into  the  trachea  and  gently  blew  air  into  the  lungs;  this  was  repeated  several  times,  the  air  being  forced  out  after  each  infhlion 
by  pressing  on  the  thorax.  While  attempting  artificial  respiration  I  ordered  an  enema  of  whiskey,  which  was  retained,  but  v  as 
immediately  followed  by  a  copious  discharge  of  urine.  This  was  the  last  act  of  the  patient's  life,  for  he  was  now  dead,  an  1  I 
reluctantly  discontinued  my  efforts  to  revive  him.  I  have  estimated  the  quantity  of  chloroform  used  as  about  two  drachn  s. 
Death  no  doubt  occurred  from  paralysis  of  the  heart,  as  there  was  no  evidence  of  a  pulse  after  it  first  ceased  at  the  wrist.  Afti  r 
the  patient's  death  I  learned  that  he  had  stated  that  he  had  heart  disease  and  expected  to  die  under  the  operation. 

Assistant  Surgeon  0.  E.  Price  reports  a  case  of  death  from  the  administration  of  ether; 
the  case  was  hopeless  before  the  operation  was  begun : 

CASE  1279. — A.  J.  Moore,  aged  50  years,  suffered  for  about  six  years  from  the  results  of  a  contusion  of  the  knee.  The 
joint  became  swollen  and  painful,  and  an  examination  in  May,  1878,  showed  that  the  bone  had  become  diseased.  Amputation 
or  resection  was  advised,  but  the  patient  refused  to  be  operated  upon,  and  gradually  became  worse  until  July  llth,  when  he 
finally  consented  to  an  amputation.  He  was  then  put  on  a  generous  diet  with  stimulants.  However,  he  grew  rapidly  worse. 
The  urine  had  only  a  trace  of  albumen,  but  there  was  rodema  of  the  lungs  with  evidence  of  great  effusion  in  the  pleural  cavity. 
His  breath  began  to  be  labored,  and  there  were  large,  coarse,  moist  rales  in  both  lungs,  while  the  effusion  almost  destroyed  all 
movement  in  the  left  lung  and  impaired  that  of  the  right.  He  became  greatly  alarmed,  as  in  two  or  three  coughing  spells  he  was 
nearly  strangled  to  death.  He  now  begged  me  to  operate,  and  said  he  was  sure  to  die  very  soon  if  I  did  not.  When  I  explained 
the  dangers  of  the  operation  he  said  he  knew  it  all,  but  that  it  gave  him  a  possibility  of  life.  Having  no  assistant  of  any  kind,  I 
called  upon  Lieut.  Halloran,  12th  Infantry,  who  had  on  several  occasions  attended  to  the  administration  of  an  anaesthetic  for  me. 
I  read  to  Lieutenant  Halloran  and  gave  him  to  study  the  instructions  as  given  in  Ashhurst's  and  Erichseii's  Surgery,  MM! 
explained  to  him  the  importance  of  closely  watching  the  effects  of  the  anaesthetic.  I  had  but  six  ounces  of  ether  (Squibb's),  so  I 
took  the  bottle  of  chloroform  for  use  in  case  the  ether  should  prove  insufficient.  With  Lieutenant  Halloran  to  attend  to  the 
anaesthetic  and  two  soldiers  for  assistants  I  began.  At  first  I  attended  to  the  anaesthetic  myself.  After  a  few  breaths  of  the 
ether  I  said:  "Moore,  do  you  feel  it  ?"  He  said  :  "A  little."  A  few  more  breaths  and  he  said  :  "  Wait  a  minute  and  give  me 
a  rest;"  I  replied  "all  right,"  but  kept  along  with  the  ether.  After  a  few  moments  more  I  gave  the  sponge  to  Lieutenant  Hal 
loran  and  began  applying  an  Esmarch's  bandage.  I  had  wrapped  it  up  to  the  lower  part  of  the  swelling  about  the  knee  when  I 
looked  up  and  said  to  Lieutenant  Halloran  "take  away  the  sponge,"  and  noticed  that  his  breath  had  stopped.  Lieutenant 
Halloran  replied  :  "His  pulse  is  good,"  but  by  the  time  I  felt  it  it  had  disappeared.  I  instituted  artificial  respiration  at  once, 
applied  nitrite  of  amyl  to  his  nostril,  and  injected  ammonia  into  a  vein  of  the  arm.  I  kept  up  artificial  respiration  after  Sylves 
ter's  method  for  three-quarters  of  an  hour,  but  it  was  of  no  avail.  In  the  chest  a  large  effusion  was  found  in  the  pleural  cavity, 
with  stringy  pus  and  bands  of  adhesion  in  many  places.  The  upper  and  middle  portions  of  the  left  lung  were  thickly  filled  with 
points  of  caseous  deposit,  and  in  many  of  these  spots  were  deposits  which  were  as  hard  as  and  seemed  to  be  solid  limestones. 
The  right  side  of  the  heart  was  dilated  and  nearly  full  of  clotted  blood;  the  left  side  was  nearly  empty. 

The  details  of  a  case  in  which  first  ether  and  subsequently  chloroform  were  administered 
are  given  by  Assistant  Surgeon  P.  J.  A.  Gleary,  U.  S.  A.:1 

CASK  1280. — Private  H.  D.  Bradfield,  Co.  H,  19th  Infantry,  aged  about  33  years,  large  and  robust,  addicted  to  liquor, 
Avas  admitted  to  hospital  December  3,  1878,  suffering  with  an  injury  of  the  middle  finger,  right  hand,  resulting  in  gangrene  of 
the  seoond  and  third  phalanges,  and  in  consequence  it  was  decided  to  amputate  at  the  metacarpal  articulation.  For  this  purpose 
a  mixture  of  equal  parts  of  ether  fortior  and  chloroform  was  administered.  About  ten  minutes  previously  two  ounces  of  whiskey 
were  given.  I  examined  his  heart  and  found  it  normal  in  every  respect.  The  anaesthetic  was  administered  on  a  piece  of  lint, 
covered  with  a  small  towel,  held  square  in  contradistinction  to  cone-shaped.  I  personally  administered  the  mixture  while  the 
steward  observed  his  pulse.  The  cloth  was  held  so  as  to  allow  a  free  admixture  of  air.  He  inhaled  freely.  About  two  drachms 
were  first  poured  on  the  cloth,  but  had  no  apparent  effect.  Shortly  after  about  the  same  quantity  was  poured  on;  he  observed 
that  "he  did  not  feel  it."  After  a  time  about  the  same  quantity  was  again  poured  on,  and,  as  I  turned  to  look  at  some  instru 
ments,  ho  requested  me  not  to  begin  yet  to  cut  him.  A  further  quantity  was  now  poured  on  the  cloth,  when  he  began  to  laugh ; 
this  was  followed  by  attempts  to  articulate,  then,  as  is  common,  by  strong  gesticulations  of  his  arms,  to  stop  which  the  steward 
forcibly  pressed  down  one  arm,  holding  him  by  the  wrist,  while  an  attendant  did  likewise  with  the  other.  He  was  now  passing 
to  a  state  of  unconsciousness,  and  in  reply  to  my  inquiry  the  steward  said  he  could  not  feel  the  pulse,  but  added  that  his  arm 
was  somewhat  twisted,  which  prevented  his  perceiving  the  pulse.  I  therefore  felt  for  the  pulse  at  the  other  wrist,  but  could  not 
perceive  it.  Just  as  I  felt,  the  muscles  of  his  arm  and  neck,  which  had  been  strongly  in  action,  suddenly  relaxed;  his  breathing, 
however,  was  very  good  and  such  as  would  in  no  wise  have  attracted  attention.  At  once  I  removed  the  anaesthetic  and  dashed 
some  cold  water  in  his  face.  The  pulse  did  not  return.  He  continued  to  breathe  freely  for  a  little  time  longer,  then  his  breathing 
became  labored,  and  then  suddenly  stopped.  The  action  of  the  heart  had  previously  stopped,  and  the  man  was  dead.  I  will  add 
that  everything  I  ever  heard  of,  saw,  or  read,  appropriate  for  such  cases,  was  done,  but  to  no  effect.  The  mixture  consisted  of 
chloroform  and  ether  fortior;  amount  used  exactly  one  ounce;  time  in  using  it,  fifteen  minutes.  Cause  of  death,  paralysis  of  the 
heart.  Of  the  entire  amount  used  one-half  only  was  chloroform,  i.  e.,  half  an  ounce.  Of  this  amount  a  large  proportion  was 
wasted  over  the  cloth  and  which  lie  never  inhaled;  the  inhalation  of  the  remainder  occupied  fully  fifteen  minutes. 


1  The  case  has  been  reported  in  the  Philadelphia  Medical  Times,  1879,  Volume  IX,    age  280. 


CHAP.  XIV.]  THE    MEDICAL    STAFF    AND    MATERIA    CH1RURGICA. 


CHAPTER    XIV. 


THE  MEDICAL  STAFF  AND  MATERIA  CHIRURGICA. 


Previous  to  the  outbreak  of  the  rebellion  the  regular  army  numbered  one  thousand 
one  hundred  and  seventeen  (1,117)  commissioned  officers  and  eleven  thousand  nine  hun 
dred  and  seven  (11,907)  enlisted  men.  The  Medical  Department  was  composed  of  one 
Surgeon  General  with  the  rank  of  Colonel;  thirty  Surgeons  with  the  rank  of  Major,  and 
eighty-four  Assistant  Surgeons  holding  for  the  first  five  years  the  rank  of  1st  Lieutenant, 
and  subsequent  to  that  period,  until  promotion  to  Surgeon,  the  rank  of  Captain.  The  offi 
cers  of  the  Medical  Department  formed  a  portion  of  the  General  Staff  of  the  army ;  were 
not  permanently  attached  to  any  regiment  or  command,  but  were  subject  to  duty  wherever 
their  services  were  needed.  Experience  had  demonstrated  this  system  to  be  the  best  for 
the  necessities  of  an  army  widely  scattered  over  an  immense  area  of  territory,  serving  in 
commands  of  less  than  regimental  strength,  while  it  possessed  the  advantage  of  increasing 
the  efficiency  and  value  of  the  medical  force  in  a  professional  point  of  view. 

At  the  beginning  of  hostilities,  in  1861,  large  forces  of  State  troops,  or  militia,  responded 
to  the  several  proclamations  of  the  President  calling  for  aid  in  suppressing  the  rebellion. 
Each  regiment  was  provided  with  a  Surgeon  and  an  Assistant  Surgeon  commissioned  by  the 
States  in  which  the  troops  had  been  enlisted.  These  officers  were  borne  on  the  muster-rolls 
and  permanently  attached  to  the  regimental  organization,  being  seldom  detached  except 
for  urgent  reasons. 

During  the  early  military  operations  the  administrative  duties  pertaining  to  the  Med 
ical  Department  were  performed  by  officers  of  the  regular  medical  staff,  detailed  for  the 
purpose,  or  by  volunteer  Surgeons  appointed  as  Medical  Directors  of  Divisions,  as  allowed 
by  the  President's  proclamation  of  May  3,  1861. 

On  the  22d  of  July,  1861,  Congress  passed  an  act  authorizing  the  President  to  raise  a 
force  of  volunteers,  not  exceeding  500,000,  and  prescribing  the  organization  of  this  levy 
into  divisions  of  three  or  more  brigades,  and  that  "each  brigade  shall  be  composed  of  five 
or  more  regiments,  and  shall  have  one  Brigadier  General,  two  Aids-de-Camp,  one  Assistant 
Adjutant  General  with  the  rank  of  Captain;  one  Surgeon;  one  Assistant  Quartermaster,  and 
one  Commissary  of  Subsistence."  The  Surgeons  authorized  by  this  act  were  known  as 
Brigade  Surgeons,  and  were  borne  as  such  on  the  official  army  registers  of  September, 
1861,  and  January,  1862;  they  held  the  rank  of  Major. 

The  duties,  prerogatives,  and  responsibilities  of  Brigade  Surgeons  being  somewhat 
vaguely  defined,  the  following  bill  was  passed  by  Congress  on  July  2,  1862:  "From  and 
after  the  passage  of  this  act  Brigade  Surgeons  shall  be  known  and  designated  as  Surgeons 


900  THE    MEDICAL    STAFF    AND    MATEKIA    CHIRUEQICA.  [CHAP.  xiv. 

of  Volunteers,  and  shall  be  attached  to  the  general  medical  staff  under  the  direction  of  the 
Surgeon  General;  and  hereafter  such  appointments  for  the  medical  service  of  the  army  shall 
be  appointed  Surgeons  of  Volunteers." 

The  Brigade  Surgeons,  or  Surgeons  of  Volunteers  as  they  were  henceforth  called,  were 
assimilated  to  those  of  the  regular  staff,  holding  equal  rank  with  the  latter  under  commis 
sions  conferred  by  the  President  and  confirmed  by  the  Senate.  They  became  eligible  to 
all  the  duties  and  prerogatives  pertaining  to  the  medical  officers  of  the  army,  whether  in 
the  field  as  Directors  of  Armies,  Corps,  or  Departments,  or  in  charge  of  hospitals,  etc. 
From  time  to  time,  by  acts  of  Congress,  additions  were  made  to  the  regular  and  volunteer 
corps,  and  such  changes  effected  as  were  necessarily  demanded.  The  act  of  April  16,  1862, 
was  one  of  the  most  important  of  these  acts,  wherein  the  rank  of  Brigadier  General  was  con 
ferred  upon  the  Surgeon  General.  Provisions  were  also  made  in  this  act  for  an  Assistant 
Surgeon  General  and  a  Medical  Inspector  General,  both  with  the  rank,  pay,  and  emolu 
ments  of  Colonel  of  Cavalry,  and  for  eight  Medical  Inspectors  with  the  rank,  pay,  and 
emoluments  of  Lieutenant  Colonel  of  Cavalry,  also  for  Medical  Purveyors  and  Medical 
Cadets.  The  text  of  the  act  is  here  inserted : 

"AN  ACT  TO  REORGANIZE  AND  INCREASE  THE  EFFICIENCY  OF  THE  MEDICAL  DEPARTMENT  OF  THE  ARMY. 

"Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the  United  States  of  America  in 
Congress  assembled,  That  there  shall  be  added  to  the  present  medical  corps  of  the  army  ten  Sur- 
geous  and  ten  Assistant  Surgeons,  to  be  promoted  and  appointed  under  existing  laws;  twenty 
medical  cadets,  and  as  many  hospital  stewards  as  the"  Surgeon  General  may  consider  necessary 
for  the  public  service,  and  that  their  pay  and  that  of  all  hospital  stewards  in  the  volunteer,  as  well 
as  the  regular  service,  shall  be  thirty  dollars  per  month,  to  be  computed  from  the  passage  of  this 
act.  And  all  medical  cadets  in  the  service  shall,  in  addition  to  their  pay,  receive  one  ration  per 
day,  either  iii  kind  or  commutation. 

"SEC.  2.  And  be  it  further  enacted,  That  the  Surgeon  General  to  be  appointed  under  this 
act  shall  have  the  rank,  pay,  and  emoluments  of  a  Brigadier  General.  There  shall  be  one  Assistant 
Surgeon  General  and  one  Medical  Inspector  General  of  Hospitals,  each  with  the  rank,  pay,  and 
emoluments  of  a  Colonel  of  Cavalry,  and  the  Medical  Inspector  General  shall  have,  under  the 
direction  of  the  Surgeon  General,  the  supervision  of  all  that  relates  to  the  sanitary  condition  of 
the  army,  whether  in  transports,  quarters,  or  camps,  and  of  the  hygiene,  police,  discipline,  and 
efficiency  of  field  and  general  hospitals,  under  such  regulations  as  may  hereafter  be  established. 

"  SEC.  3.  And  be  it  further  enacted,  That  there  shall  be  eight  Medical  Inspectors,  with  the 
rank,  pay,  and  emoluments  each  of  a  Lieutenant  Colonel  of  Cavalry,  and  who  shall  be  charged 
with  the  duty  of  inspecting  the  sanitary  condition  of  transports,  quarters,  and  camps,  of  field  and 
general  hospitals,  aiid  who  shall  report  to  the  Medical  Inspector  General,  under  such  regulations 
as  may  be  hereafter  established,  all  circumstances  relating  to  the  sanitary  condition  and  wants  of 
troops  and  of  hospitals,  and  to  the  skill,  efficiency,  and  good  conduct  of  tho  officers  and  attendants 
connected  with  the  medical  department. 

"SEC.  4.  And  be  it  further  enacted,  That  the  Surgeon  General,  the  Assistant  Surgeon  General, 
Medical  Inspector  General,  and  medical  inspectors,  shall,  immediately  after  tho  passage  of  this  act, 
be  appointed  by  the  President,  by  and  with  the  advice  and  consent  of  the  Senate,  by  selection 
from  the  medical  corps  of  the  army,  or  from  the  surgeons  in  the  volunteer  service,  without  regard 
to  their  rank  when  so  selected,  but  with  sole  regard  to  qualifications. 

"SEC.  5.  And  be  it  further  enacted,  That  medical  purveyors  shall  be  charged,  under  the 
direction  of  the  Surgeon  General,  with  the  selection  and  purchase  of  all  medical  supplies,  including 
new  standard  preparations,  and  of  all  books,  instruments,  hospital  stores,  furniture,  and  other 
articles  required  for  the.  sick  and  wounded  of  the  army.  In  all  cases  of  emergency  they  may  pro 
vide  such  additional  accommodations  for  the  sick  and  wounded  of  the  army,  and  may  transport 
such  medical  supplies  as  circumstances  may  render  necessary,  under  such  regulations  as  may  here 
after  be  established,  and  shall  make  prompt  and  immediate  issues  upon  all  special  requisitions 


CHAP.  XIV.J  THE    MEDICAL    STAFF.  901 

made  upon  them  under  such  circumstances  by  medical  officers;  and  the  special  requisitions  shall 
consist  simply  of  a  list  of  the  articles  required,  the  qualities  required,  dated,  and  signed  by  the 
medical  officers  requiring  them. 

"SEC.  (>.  And  be  it  further  enacted,  That  whenever  the  .Inspector  General,  or  any  of  the  medi 
cal  inspectors,  shall  report  an  officer  of  the  medical  corps' as  disqualified,  by  age  or  otherwise,  for 
promotion  to  a  higher  grade,  or  unfitted  for  the  performance  of  his  professional  duties,  he  shall  be 
reported  by  the  Surgeon  General  for  examination,  to  a  medical  board,  as  provided  by  the  seven 
teenth  section  of  the  act  approved  August  third,  eighteen  hundred  and  sixty-one. 

USEC.  7.  And  be  it  further  enacted,  That  the  provisions  of  this  act  shall  continue  and  be  in 
force  during  the  existence  of  the  present  rebellion  and  no  longer:  Provided,  however,  that,  when 
this  act  shall  expire,  all  officers  who  shall  have  been  promoted  from  the  medical  staff  of  the  army 
under  this  act  shall  retain  their  respective  rank  in  the  army,  with  such  promotion  as  they  would 
have  been  entitled  to." 

Approved  April  16,  1862. 

Beside  the  medical  officers  of  the  regular  and  volunteer  staff,  and  the  medical  officers 
of  regiments,  there  was  a  class  designated  as  Acting  Assistant  Surgeons,  who  were  private 
physicians,  uncommissioned,  serving  under  contract  to  do  duty  with  the  forces  in  the  field 
or  in  general  hospitals.  This  class  was  very  large  and  embraced  in  its  number  some  of 
the  most  eminent  surgeons  and  physicians  of  the  country.  The  Medical  Cadets  were  gener 
ally  young  men,  students  of  medicine,  who  were  assigned  to  duty  in  general  hospitals  as 
dressers  and  assistants.  The  Medical  Department  was  still  further  increased  by  a  number 
of  Hospital  Stewards,  who  were  enlisted  as  needed,  and  who  performed  the  duties  of  druggists, 
clerks,  and  storekeepers. 

During  the  years  of  the  war  the  organization  of  the  Regular  Staff  had  been  increased 
so  as  to  number  one  Surgeon  General,  one  Assistant  Surgeon  General,  one  Medical  Inspector 
General,  sixteen  Medical  Inspectors,  and  one  hundred  and  seventy  Surgeons  and  Assistant 
Surgeons;  there  had  been  appointed  five  hundred  and  forty-seven  (547)  Surgeons  and 
Assistant  Surgeons  of  Volunteers ;  there  were  mustered  into  service  between  April,  1861, 
and  the  close  of  the  war,  two  thousand  one  hundred  and  nine  (2,109)  regimental  Surgeons, 
three  thousand  eight  hundred  and  eighty-two  (3,882)  regimental  Assistant  Surgeons.  Dur 
ing  the  same  period  there  were  employed  eighty-five  (85)  Acting  Staff  Surgeons  and  five 
thousand  five  hundred  and  thirty-two  Acting  Assistant  Surgeons.1 

To  the  fidelity  and  efficiency  of  this  vast  body  of  professional  men  the  Surgeon  Gen 
eral,  in  his  annual  report  of  1865,  bears  the  following  well-deserved  tribute:  "I  desire  to 
bear  testimony  to  the  ability,  courage,  and  zeal  manifested  throughout  the.  war  by  the 
officers  of  the  Medical  Department  under  all  circumstances  and  upon  all  occasions.  With 
hardly  an  exception  they  have  been  actuated  by  the  highest  motives  of  national  and  pro 
fessional  pride,  and  the  number  who  have  been  killed  or  wounded  bear  honorable  testimony 
to  their  devotion  and  duty  on  the  field  of  battle." 

The  following  record  of  casualties  of  the  Regular  and  Volunteer  Staff  during  the  war 
shows  well  for  the  honor  of  those  who  are  erroneously  supposed  to  escape  the  dangers  and 
chances  of  war:  "Thirty-two  (32)  were  killed  in  battle,  or  by  guerillas  or  partizans,  and 
nine  (9)  by  accidents;  eighty-three  (83)  were  wounded  in  action,  of  whom  ten  (10)  died; 
four  (4)  died  in  rebel  prisons,  seven  (7)  of  yellow  fever,  three  (3)  of  cholera,  and  two 
hundred  and  seventy-one  (271)  of  other  diseases,  most  of  which  were  incidental  to  camp 
life  or  the  result  of  exposure  in  the  field."2 

'Bnowx  (H.  E.),  The  Medical  Department  of  the  United  Statin  Army  f rum  1775  to  1873,  Washington,  Surgeon  General's  Office,  1873,  p.  245. 
*  BROWN  (II.  E.),  (toe.  cit.),  p.  040. 


902  THE    MEDICAL    STAFF    AND    MATERIA    CHIRURGICA.  [CHAP.  xtv. 

Of  the  amount  of  labor  performed  by  the  Medical  Staff  during  the  war  some  idea  may 
be  obtained  when  it  is  stated  that  5,825,480  cases  of  wounds  and  disease  occurred  among 
the  white  troops  and  629,354  cases  among  the  colored  troops.1 

"The  cost  of  maintaining  the  Medical  Department  formed  no  small  portion  of  the  total 
expenses  of  the  war,  and  it  is  a  matter  of  just  pride  that  it  can  be  said  that  the  medical 
disbursing  officers  performed  their  duties  faithfully  and  honestly,  and  that  the  immense 
quantities  of  medical  supplies  distributed  all  over  the  country  were  almost  without  excep 
tion  properly  accounted  for.  The  expenditures  on  behalf  of  the  Medical  Department  to  the 
close  of  each  fiscal  year,  on  the  30th  of  June,  from  1861  to  1866,  were  as  follows: 

1861 $194,126.77 

1862 2,371,113.19 

1863 '.... 11,594,650.35 

1864  11,025,791.33 

1865 19,328,499.23 

1866 2,837,801.37 

making  a  total  of  $47,351,982.24  expended  during  the  war  (exclusive  of  salaries  of  com 
missioned  officers)  for  the  benefit  of  the  sick  and  wounded  soldiers  of  the  nation."5 

After  the  organization  of  the  forces  raised  for  the  suppression  of  the  rebellion  was  per 
fected,  the  medical  service  in  the  field  was  based  upon  an  independent  hospital  and  ambu 
lance  establishment  for  each  division  of  three  brigades.  The  personnel  of  the  division 
hospital  consisted  of  a  Surgeon  in  charge,  with  an  Assistant  Surgeon  as  executive  officer 
and  a  second  Assistant  Surgeon  as  recorder,  an  operating  staff  of  three  Surgeons  aided  by 
three  Assistant  Surgeons,  and  the  requisite  number  of  nurses  and  attendants. 

The  division  ambulance  train  was  commanded  by  a  First,  Lieutenant  of  the  line, 
assisted  by  a  Second  Lieutenant  for  each  brigade.  The  enlisted  men  detailed  for  ambu 
lance  duty  were  a  sergeant  for  each  regiment,  three  privates  for  each  ambulance,  and  one 
private  for  each  wagon.  The  ambulance  train  consisted  of  from  one  to  three  ambulances 
for  each  regiment,  squadron,  or  battery,  a  medicine  wagon  for  each  brigade,  and  two  or  more 
supply  wagons.  The  hospital  and  ambulance  train  were  under  the  control  of  the  Surgeon-in- 
Chief  of  the  Division.  The  division  hospitals  were  usually  located  just  out  of  range  of 
artillery  fire.  Sometimes  three  or  more  division  hospitals  were  consolidated  under  the 
orders  of  a  Corps  Medical  Director,  who  was  assisted  by  his  Medical  Inspector,  Quarter 
master,  Commissary,  and  chief  ambulance  officer. 

The  medical  officers  not  employed  at  field  hospitals  accompanied  their  regiments  and 
established  temporary  depots  as  near  as  practicable  to  the  line  of  battle. 

As  soon  as  possible  after  every  engagement  the  wounded  were  transferred  from  the 
division  or  corps  hospitals  to  the  base  or  general  hospitals,  which  at  one  time  numbered 
205 ;  these  were  under  the  charge  and  command  of  the  Regular  or  Volunteer  Staff,  assisted 
by  Acting  Assistant  Surgeons,  Medical  Cadets,  and  officers  of  the  2d  Battalion  of  the 
Veteran  Reserve  Corps. 

The  following  extracts  of  reports  are  presented  to  show  the  system  of  the  medical 
organization  in  one  of  the  corps  of  the  Army  of  the  Potomac.  The  reports,  which  give  in 
detail  the  specific  duties  of  each  class  of  officers,  were  made  in  accordance  with  the  follow 
ing  circular  'letter  of  Surgeon  T.  A.  McParlin,  Medical  Director  of  the  Army  of  the  Potomac : 

1  BKOWN  (II.  E.),  The  Medical  Department  of  the  United  Stales  Army  from  177A  to  1873,  Washington,  Surgeon  General's  Office,  1873,  p.  246. 
'M5UOWN  (II.  F,.).   the.  cit.),  p.  24(i. 


CHAP.  xiv.|  THE    MEDICAL    STAFF.  903 

"HEADQUARTERS  ARMY  OF  THE  POTOMAC, 
"MEDICAL  DIRECTOR'S  OFFICE, 

"  September  28,  1864. 
"  Surgeon  J.  J.  MILHAU,  U.  S.  Army, 

"Medical  Director  Fifth  Army  Corps. 

" DOCTOR:  You  will  require  from  one  of  each  of  the  following  named  officers  a  detailed 
written  report  of  their  duties,  both  sedentary  and  active,  the  reports  they  make  and  receive,  their 
duties  and  positions  before  and  after  engagements  and  on  the  march: 

1.  Medical  Director  of  Corps. 

2.  Medical  Inspector  of  Corps. 

3.  Surgeou-iu-Chief  of  Division. 

4.  Surgeon-in-Chief  of  Brigade. 

5.  Surgeon  in  charge  of  Division  Hospital. 

6.  Recorder  of  Division  Hospital. 

7.  Attending  or  Prescribing  Surgeon  of  Division. 

8.  Operating  Surgeon. 

9.  Surgeon  of  Regiment. 

10.  Assistant  Surgeon  of  Regiment. 

11.  Division  Hospital  Commissary. 

12.  Chief  Ambulance  Officer  of  Corps. 

13.  Chief  Ambulance  Officer  of  Division. 

14.  Ambulance  Officer  of  Brigade,  who  will  also  specify  the  duties  of  the  non-commissioned 
officers  and  privates  under  him.    The  reports  when  rendered  you  will  forward  to  this  office. 

"Very  respectfully,  your  obedient  servant, 
(Signed)  "THOMAS  A.  McPARLIK, 

"  Surgeon  U.  S.  Army  and  Medical  Director  Army  of  Potomac." 

The  responses  to  this  circular  were  collected  by  Surgeon  J.  J.  Milhau,  U.  S.  A.,  and 
by  him  transmitted  to  the  Medical  Director,  T.  A.  McParlin.  Omitting;  the  official  verbiage 

J  o  o 

and  forms  the  substance  of  the  reports  is  here  given: 

"  Duties  of  the  Medical  Director  of  a  Corps:  The  Medical  Director  of  a  Corps  is  the  head  of  the 
Medical  and  Ambulance  Departments  of  the  corps,  and  he  is  held  responsible  by  the  Corps  Com 
mander  that  they  be  properly  and  effectively  managed  under  all  circumstances.  It  is  therefore 
impossible  to  specify  definitely  his  duties  in  every  case.  He  should  possess  the  confidence  of  his 
Commander  and  ask  for  instruction  in  all  cases  of  doubt.  He  should  have  an  office  and  at  least 
two  clerks,  of  whom  one  should  be  a  Hospital  Steward.  The  following  books  should  be  kept,  viz: 
1st,  a  Register  of  all  Medical  Officers  and  regular  Hospital  Stewards  belonging  to  the  Corps;  2d, 
an  Endorsement  Book ;  3d,  a  Record  of  Certificates  of  Death,  and  action  thereon  ;  4th,  a  Letter  and 
Order  Book  ;  5th,  a  Blotter,  in  which  are  checked  oft'  the  regular  requisitions  and  Monthly  Reports 
of  Sick  and  Wounded  as  received;  6th,  a  Manifold  Writer.  The  following  regular  reports  are 
received:  1st,  Daily  Report  of  the  Medical  Inspector  of  the  Corps ;  2d,  the  Weekly  Report  of  Sick 
and  Wounded ;  3d,  the  Weekly  Report  of  the  Ambulance  Corps  (in  duplicate) ;  4th,  the  Weekly 
Report  of  Brandy  and  Whiskey  received,  issued,  etc.,  from  each  Brigade  and  from  each  Hospital; 
5th,  the  Monthly  Returns  of  Medical  Officers  from  Divisions  and  Brigades;  6th,  the  Monthly 
Returns  of  Hospital  Stewards,  TJ.  S.  A.;  7th,  the  Monthly  Returns  of  Ambulance  Officers  (in  dupli 
cate)  ;  8th,  Statement  of  Hospital  Fund  from  each  Hospital.  After  engagements  are  to  be  trans 
mitted  to  the  Medical  Director  of  the  Army:  1st,  Nominal  Lists  of  Wounded,  for  transmittal;  2d, 
Classified  Returns  of  Injuries  and  Wounds  (in  duplicate);  3d,  Aggregate  Mean  Strength  of  Command 
(per  regiment);  a  Report  of  the  Operations  of  the  Ambulance  Corps.  The  following  Consolidated 
Reports  for  the  Corps  are  made  at  stated  periods  to  the  Medical  Director  of  the  Army :  1,  Weekly 
Report  of  Sick  and  Wounded;  2d,  Monthly  Return  of  Medical  Officers;  3d,  Monthly  Return  of  Hos 
pital  Stewards,  U.  S.  A.;  4th,  Statement  of  Balance  due  Hospital  Fund;  5th,  Record  of  Certificates 
of  Disability,  and  action  thereon.  All  other  reports  are  simply  transmitted  without  consolidation, 
including  certificates  of  death.  The  following  papers  are  referred,  by  order  of  the  Corps  Com- 


904  THE    MEDICAL    STAFF    ANT)    MATERIA    CHIRURGICA.  [CHAP.  xrv. 

mander,  to  the  Medical  Director  for  approval,  recommendation,  expression  of  opinion  or  disapproval, 
viz:  All  tenders  of  resignations  on  account  of  disability;  all  applications  for  leaves  of  absence; 
all  certificates  of  disability  for  discharge,  and  invalid  rolls  when  doubtful ;  all  recommendations  and 
complaints  referring  to  the  Medical  and  Ambulance  Departments  or  affecting  the  health  and  well 
being  of  the  troops ;  all  applications  for  leave  of  absence  or  resignation  of  Medical  or  Ambulance 
Officers — in  fact,  all  papers  relating  to  the  Medical  Department  are  referred  to  the  Medical  Director 
prior  to  the  action  of  the  General  Commanding.  The  following  papers  require  to  be  examined  and 
acted  upon  by  the  Medical  Director:  All  requisitions  for  Medical  and  Hospital  Supplies,  and  all 
requisitions  and  estimates  for  supplies  for  the  Ambulance  Corps.  Written  circulars  and  instruc 
tions  from  the  Medical  Director  of  the  Army  and  from  the  Surgeon  General  should  either  in  whole 
or  part  be  promptly  published  to  the  Surgeons-iu-Chief  of  Divisions  and  Surgeons-in-Chief  of  sep 
arate  commands.  The  health  and  welfare  of  the  troops,  as  well  as  the  comfort  and  proper  care  of 
the  sick  and  wounded,  should  receive  the  unceasing  attention  of  the  Medical  Director.  It  therefore 
becomes  his  duty  to  ascertain,  through  the  Medical  Inspector,  the  Surgeons-in-Chief  of  Divisions, 
and,  from  his  own  observation,  the  existence  of  irregularities  and  of  deficiencies  in  the  hospitals 
or  in  the  command,  and  he  must  issue  the  necessary  instructions  to  have  the  one  corrected  and  the 
other  supplied.  In  matters  of  defective  police,  bad  drainage,  unhealthy  camp  grounds,  insufficient 
shelter,  improper  or  damaged  food,  etc.,  etc.,  he  should  first  call  the  attention  of  the  Medical  Offi 
cers  to  the  fact  and  suggest  remedies;  but  if  these  suggestions  be  not  promptly  attended  to,  a 
written  report  with  recommendations  should  be  made  without  delay  to  the  Corps  Commander. 
Special  attention  must  be  given  to  the  keeping  up  of  supplies,  both  medical  and  hospital.  Circu 
lars  should  be  issued  from  time  to  time,  giving  information  to  the  medical  officers  as  to  what  articles 
can  be  obtained,  specifying  the  manner  of  obtaining  them.  The  Ambulance  Corps  being  under 
the  direction  of  the  Medical  Director,  the  ambulances  and  everything  connected  with  them  claim  a 
fall  share  of  his  attention.  In  conjunction  with  the  Chief  Ambulance  Officer  he  must  therefore  see 
that  nothing  is  neglected  to  render  them  efficient  in  every  respect  and  the  intention  of  the  law  be 
carried  out.  The  Surgeous-in-Cbief  of  Divisions  look  to  the  Medical  Director  for  orders,  instruc 
tions,  and  suggestions  in  reference  to  the  fitting  up  of  the  different  hospitals;  he  should  therefore 
instruct  them  as  to  the  number  of  tents  to  be  pitched,  and  as  to  whether  it  is  desirable  to  construct 
fire-places,  erect  bunks,  dig  wells,  etc.,  etc.  As  a  general  rule,  verbal  orders  will  be  sufficient.  When 
a  movement  is  ordered,  the  Medical  Director  should  ask  for  instructions  in  reference  to  the  sending 
off  of  sick  and  wounded,  the  breaking  up  of  the  hospitals,  the  number  of  ambulances  and  wagons 
allowed  to  march  with  the  troops,  and  the  number  to  be  sent  to  the  rear,  and  on  receiving  them  will 
give  the  necessary  orders  in  writing,  specifying  the  number  of  tents  and  flies  to  be  carried,  as  well 
as  the  amount  of  hospital  supplies,  medical  stores,  clothing,  and  rations,  and  directing  the  Sur- 
geous-in-Chief  of  Divisions  to  see  that  the  "hard  bread"  is  put  up  in  the  ambulance  boxes,  and  the 
field  companions  and  hospital  knapsacks  are  filled.  Orders  should  be  given  to  the  Chief  Ambulance 
Officer  in  reference  to  the  position  of  the  stretcher  bearers;  as  a  general  rule  they  should  all  march 
with  their  commands,  with  stretchers.  When  only  a  limited  number  of  ambulances  accompany  the 
troops,  all  the  stretchers  should  go  to  the  front  strapped  on  the  ambulances.  Orders  should  be  given 
to  have  the  water-kegs  filled.  On  the  march  the  Medical  Director  accompanies  the  Staff,  acquaint 
ing  himself  as  far  as  practicable  with  the  nature  of  the  country  passed  over,  the  general  direction 
and  condition  of  the  roads,  the  position  of  the  houses,  streams,  woods,  etc.,  etc.  This  knowledge 
will  materially  assist  him  in  the  selection  of  hospital  sites.  When  an  engagement  commences  the 
Medical  Director  should  ascertain  the  position  of  the  troops,  and  should  immediately  communicate 
with  the  Surgeons-in-Chief  of  Divisions,  directing  the  establishment  of  field  depots  for  the  wounded 
at  such  points  as  will  be  most  convenient  for  collecting  them  and  where  the  ambulances  can  come 
up.  In  locating  these  depots  special  care  must  be  taken  to  have  them  as  near  the  line  of  troops  as 
possible,  so  as  to  diminish  the  distance  of  stretcher  transportation.  Ravines  and  woods  should  be 
taken  advantage  of  as  a  protection  against  the  enemy's  fire;  if  necessary,  a  breastwork  can  be 
thrown  up  by  the  attendants.  An  occasional  bullet  or  an  occasional  shell  is  not  sufficient  to  war 
rant  Medical  Officers  in  leaving  their  posts.  If  practicable,  the  Medical  Director  should  himself 
visit  and  inspect  these  depots,  and  give  orders  that  will  insure  the  object  of  their  establishment ; 
he  should  also  consult  with  the  Chief  Ambulance  Officer  as  to  the  best  roads,  everything  considered, 
to  be  taken  by  the  ambulances.  Should  the  enemy  fall  back  these  depots  should  be  removed 


CHAP,  xiv.]  THE    MEDICAL    STAFF.  905 

farther  to  the  front;  should  our  own  troops  yield  the  ground,  the  depots  must  be  moved  farther  to 
the  rear.  The  moment  the  number  of  wounded  warrants  the  establishment  of  Division  Hospitals 
the  Corps  Commander  should  be  consulted  as  to  the  locality  of  these  hospitals,  in  a  military  point 
of  view.  The  Medical  Director  then  selects  the  site  himself,  or  designates  some  one  to  do  it  in  his 
name.  Orders  should  be  immediately  given  to  the  Surgeon s-iii-Chief  of  Divisions  and  to  the  Chief 
Ambulance  Officer,  designating  the  locality  chosen.  Should  a  lull  occur  in  the  firing  or  the  enemy 
be  driven  back,  orders  must  be  immediately  given  to  advance  the  field  depots  and  to  take  all  the 
available  ambulances  to.  the  front  to  pick  up  the  wounded  as  rapidly  as  possible,  and  to  convey 
them  to  the  hospitals.  During  an  engagement  the  duty  devolving  upon  the  Medical  Director  of 
a  Corps  to  select  a  site  for  the  different  hospitals  of  the  Corps  is  not  always  an  easy  one.  As  a  gen 
eral  rule  they  should  be  placed  near  the  most  practicable  roads,  in  rear  of  the  centre  of  the  troops, 
and  sufficiently  to  the  rear  to  be  out  of  the  ordinary  range  of  the  enemy's  guns;  suitable  ground, 
good  water,  and  plenty  of  fuel  must  of  course  decide  the  choice  of  locality.  During  the  action  the 
Medical  Director  must  keep  himself  thoroughly  acquainted  with  the  movements  of  the  troops  and 
act  accordingly.  The  Corps  may  take  up  a  new  position  with  a  different  front;  sometimes  a  part 
or  even  the  whole  of  a  Corps  may  meet  a  superior  force  and  be  repulsed;  under  such  circumstances 
the  Medical  Director  should  be  ready  to  act  promptly,  and  to  transfer  his  wounded  to  a  safer  locality. 
Should  the  Corps  Commander  be  present  he  will  advise  his  Medical  Director  of  the  state  of  affairs 
and  give  orders  in  reference  to  the  removal  of  the  hospitals.  There  are  times,  however,  in  which 
the  Director  is  called  upon  to  act  upon  his  own  responsibility.  Should  it  become  necessary  to 
leave  the  wounded  in  hospitals  in  the  hands  of  the  enemy,  the  Medical  Director  will  see  that  they 
are  properly  sheltered,  that  a  sufficient  number  of  Medical  Officers,  Hospital  Stewards,  and  attend 
ants  remain  with  them,  and  that  an  ample  supply  of  medical  and  hospital  stores,  dressings,  and 
provisions  be  left  for  their  comfort.  After  an  engagement,  the  Medical  Director  of  the  Army  should 
be  communicated  with  as  to  the  means  of  transportation  for  the  wounded  to  General  Hospital;  he 
should  be  informed  of  the  number  and  of  the  time  at  which  they  will  be  ready  for  such  transit;  on 
receiving  instructions  the  necessary  orders  are  given.  The  Medical  Inspector  generally  attends  to 
the  shipment  of  wounded.  During  action  the  duties  of  a  Medical  Director  require  his  preseuce  at 
Corps  Headquarters,  where  he  can  be  found,  and  where  he  can  obtain  the  earliest  information  and 
receive  orders  and  reports.  As  a  general  rule,  therefore,  he  cannot  stop  to  operate  during  an 
engagement;  he  should  remember  that  he  is  responsible  for  all  the  wounded,  and  that  there  are 
occasions  in  which  the  delay  of  half  an  hour  will  result  in  the  loss  of  his  hospitals.  The  Corps 
Commander  should  be  kept  informed  of  the  operations  of  the  Department  both  during  and  after 
engagements,  and  should  always  be  consulted  in  matters  of  importance.  As  it  is  necessary  for  the 
Medical  Director  to  visit  his  hospitals  and  field  depots  from  time  to  time,  he  should  always  leave  a 
competent  Medical  Officer  at  headquarters  to  represent  him.  When  practicable,  the  hospitals  of 
the  different  Divisions  should  be  located  near  together — each  one,  however,  to  be  kept  perfectly 
independent  and  distinct  in  its  management.  This  will  much  facilitate  the  operations  of  the  Ambu 
lance  and  Medical  Departments,  enabling  the  divisions  to  assist  each  other  in  taking  care  of  the 
wounded.  For  instance,  should  one  Division  suffer  more  than  another,  an  operating  staff,  or  more 
if  necessary,  with  the  Auteurieth  wagon,  can  be  ordered  to  the  suffering  Division ;  again,  should 
one  Division  be  deficient  in  shelter  or  supplies,  they  can  be  obtained  from  the  other  Divisions; 
another  advantage  is  the  facility  given  for  inspection,  and  for  giving  instruction,  and  in  distributing 
the  wounded  as  they  come  in;  for  instance,  all  available  ambulances  are  used  when  wanted,  with 
out  reference  to  their  Divisions.  An  ambulance  reaches  the  hospital  containing  wounded  of  different 
Divisions,  no  difficulty  is  experienced  in  distributing  them,  each  to  his  own  Division  Hospital, 
thus  enabling  them  to  be  treated  by  their  own  Medical  Officers  and  to  be  registered  in  their  own 
Divisions.  Again,  in  sending  off  the  wounded  to  General  Hospital,  the  loading  of  the  wagons  will 
be  much  facilitated  and  a  corps  train  readily  found.  When  avoidable,  the  wounded  should  not  be 
sent  off  from  the  field  Division  Hospital  until  they  have  been  operated  upon,  properly  dressed,  fed, 
and  have  obtained  some  rest,  and  have  somewhat  recovered  from  the  shock.  In  sending  sick  and 
wounded  off  to  General  Hospital  the  Corps  Director  gives  the  necessary  orders  to  have  the  wagons 
or  cars  properly  bedded  with  brush  or  hay,  specifies  the  number  of  rations  to  be  taken,  and  the 
number  of  Medical  Officers,  Stewards,  and  attendants  that  should  accompany  the  train,  giving  any 
instructions  that  he  may  deem  important  in  reference  to  the  roads,  camping,  etc.  When  the  troops 
SUKG.  Ill— 114 


906  THE    MEDICAL    STAFF    AND    MATEEIA    CHIRURGICA.  [CHAP.  xiv. 

remain  in  camp  some  time,  it  will  be  found  convenient  to  bave  near  each  Division  a  few  ambulances, 
with  horses  hitched  up  ready  to  convey  a  patient  to  the  hospital.  These  are  known  in  the  Corps 
as  picket  ambulances,  and  are  relieved  every  twelve  hours.  At  this  post  there  should  be  a  medi 
cine  wagon,  under  the  charge  of  a  Steward,  to  issue  medicines  to  the  regimental  Surgeons.  The 
post  should  be  marked  by  an  ambulance  guidon  ;  this  wagon  to  be  relieved  as  often  as  emptied.  As 
a  large  number  of  stretchers  and  lanterns  are  always  broken  or  lost  during  an  engagement,  orders 
should  be  given  after  an  action  to  have  the  deficiencies  supplied  as  early  as  possible. 

". Duties  of  the  Medical  Inspector  of  a  Corps:  A  Medical  Inspector  of  a  Corps  has  but  few  spe 
cific  duties  assigned  to  him,  and  these,  with  one  exception,  are  such  as  the  Medical  Director  may 
direct  to  facilitate  the  management  of  the  Medical  Department  and  keep  him  informed  of  the  defi 
ciencies  which  need  correcting  and  errors  that  should  be  rectified;  as  his  relative  position  to  the 
Medical  Director  is  analogous  to  that  occupied  by  an  Assistant  Adjutant  General  to  his  Command 
ing  General,  any  authority  he  may  exercise  in  the  discharge  of  duty  is  entirely  delegated  power. 
The  only  reports  made  to  him  are  the  daily  morning  reports  of  each  hospital  from  which  the  Corps 
report  is  made.  A  monthly  report  of  the  inspection  of  troops  has  been  used,  but  since  that  has 
been  abandoned  reports,  not  in  tabular  form,  have  been  made  of  the  condition  of  the  troops  only  to 
the  Medical  Director,  calling  his  attention  to  any  violation  of  sanitary  rules  that  may  have  been 
observed.  Previous  to  an  engagement,  or  march,  he  sees  that  the  direction  of  his  superior  officers 
relative  to  the  proper  disposition  of  the  flying  hospital  and  medicine  wagons  are  obeyed,  and  that 
they  are  in  readiness  to  accompany  the  troops.  The  principal  duty  devolved  upon  him  during  an 
engagement  has  been  to  represent  the  Medical  Director  at  the  hospitals,  to  see  that  the  men  are 
properly  provided  for,  and  when  instructed  to  send  wounded  to  the  rear  to  assist  the  Chief  Ambu 
lance  Officer  in  the  proper  apportioning  of  the  means  of  transportation,  to  make  the  detail  of  Medi 
cal  Officers  and  attendants  to  accompany  the  train,  and  ascertain  that  they  are  provided  with 
stimulants  and  other  essentials  to  render  the  patients  confided  to  them  as  comfortable  as  possible. 

" Duties  of  the  Surgeon-in- Chief  of  a  Division:  1.  The  Surgeon  in-Chief  of  a  Division  promul 
gates  to  Surgeons-in-Chief  of  Brigades  all  orders,  circulars,  and  communications  that  are  received 
from  the  Medical  Director  of  the  Corps,  also  all  orders,  circulars,  and  communications  pertaining 
to  the  Medical  Department  that  emanate  from  Division  Headquarters.  2.  He  receives  all  reports 
that  are  made  by  the  Surgeons-in-Chief  of  Brigades  and  consolidates  them  before  forwarding  them 
to  the  Medical  Director  of  the  Corps,  except  the  'Monthly  Keport  of  Sick  and  Wounded'  fur 
nished  by  the  regimental  Surgeons,  and  the  weekly  report  of  'Brandy  and  Whiskey'  furnished 
by  the  Surgeons-in-Chief  of  Brigades:  these  are  forwarded  without  any  action  from  him.  The  only 
reports  made  directly  by  him  are  the  '  Monthly  Return  of  Medical  Officers'  of  the  Division,  which  he 
forwards  to  the  Medical  Director  of  the  Corps,  and  the  Personal  Report  to  the  Surgeon  General  from 
the  post  at  which  he  is  serving.  3.  All  requisitions  for  medicines  and  hospital  supplies,  made  by 
the  Surgeons-in-Chief  of  Brigades,  are  received  by  him  and  forwarded  to  the  Medical  Director  of 
the  Corps,  without  any  action  from  him  except  'Special  Requisitions,'  which  are  either  approved  or 
disapproved  before  being  forwarded.  4.  All  applications  for  leave  of  absence  and  resignation  on 
Surgeon's  certificate,  and  all  Certificates  of  Disability  for  discharge  of  enlisted  men,  are  forwarded 
from  their  regiments  through  the  regular  military  channel  and  referred  to  the  Surgeon  in-Chief 
of  the  Division  by  the  Assistant  Adjutant  General  of  the  Division;  each  case  is  personally  exam 
ined  by  the  Surgeon-in-Chief  and  the  action  indorsed  on  the  official  paper.  Applications  for  leave 
of  absence  of  Medical  Officers  are  referred  to  the  Surgeon-in-Chief  by  the  Assistant  Adjutant  Gen 
eral  for  his  action.  5.  All  details  of  Medical  Officers  and  enlisted  men  for  duty  at  Division  Hos 
pitals  are  made  by  the  Assistant  Adjutant  General,  to  whom  the  names,  rank,  regiment,  and  com 
pany  are  furnished  by  the  Surgeon-in-Chief.  6.  The  Surgeon-in-Chief  of  a  Division  has  no  official 
relation  with  any  Staff  Officers  except  the  Assistant  Adjutant  General.  7.  A  detail  of  one  Medical 
Officer  as  'Officer  of  the  Day'  is  made  each  day  by  the  Surgeon-in-Chief,  with  instructions  to  visit 
each  regiment  of  the  Division  and  inspect  carefully  its  hygienic  and  sanitary  conditions,  also  to 
visit  the  Division  Hospital  and  see  that  proper  attention  is  given  to  cleanliness  and  to  the  comfort 
of  the  patients;  examine  the  cooking  and  whether  the  attendants  perform  their  duties  faithfully. 
A  written  report  to  be  furnished  of  these  investigations.  8.  Before  an  engagement  the  detail  for 
the  'Field  Hospital'  is  announced  by  the  Surgeon-in-Chief  of  the  Division:  the  Surgeon  in  charge 
of  the  Division  Hospital  remains  in  charge  and  has  control  of  all  the  shelter;  the  officer  detailed 


CHAP,  xiv.j  THE    MEDICAL    STAFF.  907 

as  Hospital  Commissary  provides  the  food;  the  records  are  kept  by  a  Hospital  Steward,  U.  S.  A. 
Three  (3)  Surgeons  are  detailed  as  operators,  and  three  (3)  Medical  Officers  are  assigned  to  each 
operator  as  Assistants.  One  Cook,  two  Nurses,  and  one  Hospital  Steward  are  taken  from  each 
regiment  for  the  'Field  Hospital.'  9.  The  Medical  Officers  who  remain  on  the  field  at  the  time  of 
and  after  an  engagement  are  instructed  to  form  their  depots  and  locate  them  by  Brigades,  and  are 
to  select  their  positions  in  compliance  with  instructions  of  'Circular'  from  Headquarters,  Army  of 
the  Potomac,  Medical  Director's  Office,  dated  October  30,  1862,  and  to  examine  each  man  before 
he  is  put  in  an  ambulance.  10.  The  position  of  a  Surgeon-iu-Chief  of  a  Division  during  an  engage 
ment  is,  first  to  locate  the  'Field  Hospital'  and  see  that  the  details  are  properly  filled,  then  to  visit 
the  front  and  confer  with  the  Ambulance  Officer  of  the  Division,  ascertain  that  the  depots  are 
properly  located  and  that  the  Ambulance  Sergeants  have  been  notified  of  their  positions,  then  to 
report  to  the  General  Commanding  and  receive  any  instructions  he  may  have;  afterwards  to  return 
to  the  hospital  and  assist  in  making  the  wounded  comfortable.  11.  On  the  march  the  Surgeou- 
in-Chief  of  a  Division  remains  with  the  General  Commanding. 

"  Duties  of  a  Surgeon-in-Chief  of  a  Brigade:  1.  The  Surgeou-in-Chief  of  a  Brigade  has  under 
his  charge  all  the  medical  supplies  allowed  to  his  command.  He  draws  once  a  month  from  the 
Medical  Purveyor  of  the  Army  all  needed  to  bring  what  he  has  on  hand  up  to  the  requirements 
of  the  supply  table,  and  in  case  of  emergency  can,  during  the  month,  make  special  requisitions 
for  necessary  articles.  He  issues  to  Medical  Officers  in  charge  of  regiments  only  what  they  want 
for  immediate  use.  By  this  excellent  arrangement  the  Army  has  been  relieved  from  the  encum 
brance  of  the  large  supplies  formerly  allowed  to  regiments  and  the  transportation  of  the  Medical 
Department  is  greatly  reduced.  Under  two  orders  from  Surgeon  Letterman,  Medical  Director  of 
the  Army  of  the  Potomac,  Brigade  Surgeons  were  forbidden,  for  more  than  a  year,  to  take  receipts 
from  regimental  Surgeons  for  supplies  issued  to  them,  and  the  Brigade  Surgeon  was  ordered  to 
expend  them  on  his  annual  returns.  This  proving  unsatisfactory  to  the  Treasury  Department,  a 
circular  from  the  Surgeon  General  directed  a  return  to  the  requirements  of  Army  Regulations  in 
the  transfer  of  all  property.  As  medicines  and  other  expendable  articles  are  issued  continuously, 
and  in  very  small  quantities,  it  is  unavoidable  for  the  Surgeon-in-Chief  of  a  Brigade  to  be  forced 
to  expend,  on  his  returns,  much  property  really  issued  to  regimental  Surgeons.  The  transporta 
tion  granted  to  each  Brigade  for  its  entire  medical  supplies,  including  the  desks  and  medicine 
chests  of  regimental  Surgeons,  consists  of  one  Army  and  one  Auteurieth  or  Perot  medicine 
wagon.  In  addition,  however,  to  the  articles  carried  in  the  wagons,  the  boxes  of  the  ambulances 
are  filled  with  the  material  necessary  to  establish  a  temporary  field  hospital  in  case  the  supply 
train  during  a  movement  is  inaccessible.  This  arrangement  is  one  of  the  greatest  advances  made 
during  the  past  two  years  in  providing  for  the  wounded — as  the  conveyances  bringing  them  in 
have  all  that  is  absolutely  required  to  feed  them,  and  the  hospital  tent  and  fly  generally  carried 
in  the  ambulance  gives  sufficient  shelter.  In  the  construction  of  new  ambulances  it  would  be 
desirable  to  increase  the  width  and  depth  of  the  box  so  that  larger  camp  kettles  could  be  carried, 
the  present  only  admitting  the  smallest  sized  kettle.  The  Surgeon-iu-Chief  of  a  Brigade  furnishes 
the  material  carried  in  the  ambulance  boxes,  and  assures  himself  by  weekly  inspections  of  them 
that  each  box  contains  all  required  by  the  supply  table  and  other  orders.  He  also  draws  from  the 
Medical  Purveyor  and  is  responsible  for  the  stretchers  carried  on  the  ambulances.  2.  The  Surgeou- 
in-Chief  of  a  Brigade  is  the  Medical  adviser  of  a  Brigade  Commander  in  all  professional  ques 
tions  affecting  the  command.  Applications  for  leave  of  absence,  discharge,  and  invalid  rolls, 
grounded  on  the  certificates  of  regimental  Surgeons,  are  submitted  to  him  for  his  opinion  of  their 
propriety,  to  be  based  on  an  examination  of  the  applicant.  It  is  the  duty  of  the  Surgeon-in-Chief 
of  a  Brigade  also  to  keep  careful  watch  over  the  health  of  the  Brigade,  pointing  out  and  endeavor 
ing  to  correct  all  infractions  of  hygienic  laws.  He  receives  every  Saturday,  from  each  Medical 
Officer  in  charge  of  the  regiments  constituting  the  Brigade,  a  weekly  Report  of  Sick  and  Wounded 
of  his  regiment  and  of  the  anti-scorbutics  issued  to  it.  Whenever  a  regimental  Medical  Officer 
leaves  or  returns  to  his  command  he  should  furnish  the  Surgeon-in-Chief  of  the  Brigade  with  a 
copy  of  the  order  under  which  he  acts.  The  Surgeou-in-Chief  consolidates  the  regimental  weekly 
reports  of  sick  and  wounded  and  of  anti-scorbutics,  and  forwards  them  to  the  Surgeon-in-Chief  of 
his  Division.  He  sends,  at  the  same  time,  a  report  of  the  liquors  drawn  and  issued  by  him  during 
the  week.  He  makes  also,  to  the  Surgeon-in-Chief  of  the  Division,  a  monthly  return  of  the  Medi- 


908  THE    MEDICAL    STAFF    AND    MATERIA    CHIRURGICA.  [CHAP.  xiv. 

cal  Officers  of  the  Brigade.  After  a  battle  he  sends  to  the  Surgeon-in-Chief  of  the  Division  a 
report  of  the  aggregate  strength  for  duty  and  names  of  Medical  Officers  present  for  duty,  and  the 
killed,  wounded,  and  missing  in  action,  according  to  the  reports  received  from  regimental  Surgeons. 
The  losses  in  skirmishing  in  the  intervals  between  the  battles  have  been  reported  weekly. 

"Duties  of  the  Surgeon-in-Charge  of  a  Division  Hospital:  The  duties  of  a  Surgeon-in-Charge 
of  a  Division  Hospital  arc  somewhat  varied,  depending  upon  the  season  of  the  year  and  the  state 
of  military  operations,  whether  the  Army  is  in  winter-quarters  or  engaged  in  an  active  campaign.  In 
one  case  more  permanent  arrangements  are  made  with  a  view  of  remaining  undisturbed  for  several 
mouths;  in  the  other  all  the  appliances  of  a  Division  Hospital  are  arranged  and  managed  to  meet 
certain  conditions,  definite  transportation,  general  mobility,  and  despatch  in  its  construction  and 
removal.  Procuring  all  the  necessary  supplies  for  the  sick  and  wounded,  superintending  the  care 
and  treatment  which  they  should  receive,  organizing  the  hospital  attendants,  keeping  the  necessary 
and  suitable  records,  causing  reports  to  be  made,  and  receiving  orders  from  his  superior  officers 
and  complying  with  them,  are  briefly  in  the  aggregate  the  duties  of  the  Surgeon-in-Charge  of  a 
Division  Hospital.  On  the  march  the  sick  and  wounded  on  hand  are  placed  in  ambulances,  and 
a  Medical  Officer  connected  with  the  hospital  is  assigned  the  duty  of  keeping  with  the  ambulance 
train  and  rendering  such  assistance  on  the  journey  as  the  wants  of  the  sick,  etc.,  may  demand. 
In  the  evening,  or  at  the  close  of  the  day's  march,  the  Surgeou-in -Charge  will  make  the  necessary 
arrangements  for  sheltering  and  furnishing  the  sick,  etc.,  present,  with  food  and  medical  attend 
ance.  This  is  often  accomplished  in  this  manner:  The  Medical  Director  of  the  Corps  indicates  to 
the  Ambulance  Officer  the  place  he  desires  the  ambulances  to  park.  The  Surgeon-iu-Cbarge  then 
proceeds  to  pitch  a  sufficient  number  of  tents,  directs  the  cooks  to  provide  beef  tea,  hot  coffee,  etc., 
orders  sinks  to  be  dug,  sees  that  the  sick  and  wounded  are  unloaded  and  taken  care  of,  thus  affording 
them  attentions  and  comfort  consistent  with  the  nature  of  circumstances.  On  the  following  morn 
ing,  after  food  has  been  served  to  all,  a  'Sick  Call'  is  held,  and  all  that  require  medicine  receive  it. 
Soon  after,  a  morn  ing  report  is  made,  signed  by  the  Surgeon-in-Charge,  and  sent  to  the  Surgeon-in- 
Chief  of  the  Division.  Thereafter,  if  it  is  intended  to  resume  the  inarch,  the  sick  and  wounded  are 
reloaded,  the  tents  are  struck,  and  everything  packed.  Thus  the  routine  continues  from  day  to  day 
as  long  as  the  march  may  last.  In  the  event  of  an  engagement,  the  Surgeon-in-Chief  of  the  Division 
indicates  to  the  Surgeon  in  charge  of  the  hospital  the  place  selected  for  the  location  of  the  Division 
Hospital.  The  latter  then  directs  the  pioneers  or  fatigue  party  to  police  the  ground  and  pitch  the 
tents,  establishes  the  kitchen,  appoints  a  chief  cook  and  a  cook  for  special  diet,  organizes  the 
nurses  and  other  attendants,  unloads  the  ambulances  of  the  sick,  provides  operating  tables  and 
all  necessary  appliances  for  surgical  operations,  such  as  chloroform,  stimulants,  dressings,  etc., 
orders  sinks  dug,  sees  that  a  sufficient  supply  of  water  is  near,  either  by  opening  springs  or  by 
digging  wells,  etc.  Thus  accommodations  are  made  for  the  sick  on  hand  as  well  as  for  the  wounded 
that  may  be  brought  in  from  the  battle-field.  The  Surgeon-in-Charge  selects  a  Medical  Officer  to 
superintend  unloading  and  disposing  of  the  wounded  as  they  come  in.  Such  as  require  operations 
are  taken  to  the  tables  and  receive  the  attention  of  the  Surgeons.  Very  often  comfortable  and 
convenient  beds  are  made  by  filling  sacks  with  hay  or  straw,  raising  them  from  the  ground  on 
crutches  or  cross-pieces.  The  Recorder's  attention  is  then  called  to  the  wounded,  and  he  takes 
down  their  names,  rank,  regiment,  and  character  of  injury,  and,  in  order  to  prevent  confusion,  often 
finds  it  necessary  to  attach  a  small  piece  of  bandage  to  the  button-hole  of  the'wouuded  man  that  he 
may  be  assured  afterwards  that  his  name,  etc.,  has  been  registered.  It  is  the  duty  of  the  Surgeon- 
in-Churge  to  see  that  the  records  are  at  the  amputating  tables  and  properly  kept,  specimens 
preserved  and  labelled,  etc.  He  selects  either  a  Medical  Officer  or  a  Hospital  Steward  to  have 
immediate  supervision  of  the  kitchen,  diet,  and  feeding  of  the  men.  He  sees  also  that  the  wounds 
of  all  the  wounded  men  are  examined  and  dressed,  and  in  order  to  secure  this  a  sufficient  number 
of  Medical  Officers  are  assigned  to  wards  as  dressers,  and  a  Medical  Officer,  Surgeon,  or  Assistant 
Surgeon  appointed  each  day  to  act  as  officer  of  the  day.  He  is  required  to  be  on  duty  at  night, 
also  to  attend  to  any  emergency  that  may  arise — sudden  hemorrhage,  prostration,  etc.  The  dead 
likewise  require  the  duties  of  the  Surgeou-in-Charge.  He  selects  a  suitable  location  for  a  cemetery 
and  here  inters  the  dead,  giving  them  a  Christian  burial  by  the  presence  of  a  Chaplain  to  officiate 
and  attend  to  the  funeral  obsequies.  The  graves  are  marked  by  a  head -board,  written  or  inscribed 
on  it  the  name,  rank,  company,  and  regiment  of  the  deceased.  His  effects  are  preserved  and  at  a 


CHAP.  XIV.]  THE    MEDICAL    STAFF.  909 

convenient  time  disposed  of  according  to  the  requirements  of  the  Army  Regulations.  His  duties 
consist,  likewise,  in  making  out  provision  returns  and  drawing  from  the  Commissary  of  Subsistence 
a  sufficient  number  of  rations  for  the  sick  and  wounded,  as  well  as  for  the  hospital  attendants 
present.  He  should  see  to  it  that  an  abundant  supply  of  chloroform,  stimulants,  beef-stock,  blankets, 
bed-sacks,  bandages,  dressings,  shirts,  drawers,  and  socks  is  on  hand  to  meet  almost  any  emer 
gency  that  may  occur.  When  the  sick  and  wounded  are  ordered  to  be  sent  to  the  'Depot  Hos 
pital'  a  list  of  them  will  be  made  out  complete,  which,  when  approved  by  the  Medical  Director  of 
the  Corps,  will  be  sent  with  the  Medical  Officer  who  accompanies  them.  A  proper  entry  of  the 
disposition  of  these  will  be  made  in  the  register.  The  supervision  of  the  Hospital  Fund  made 
from  the  savings  devolves  upon  the  Surgeon  in-Charge.  He  will  keep  a  correct  account  of  it,  and 
authorize  the  purchase  from  it  of  such  delicacies  as  are  needed  for  the  comfort  of  the  more  serious 
cases  in  the  hospital.  The  Surgeon  in  charge  of  the  hospital  is  immediately  subject  to  the  orders 
of  the  Surgeon-in-Chief  of  the  Division,  and  such  other  orders  as  may  come  through  him  from 
higher  authority — Medical  Director  of  Corps  and  Army.  His  reports  should  be  made  through  the 
same  channel,  also  the  requisitions  for  Medical  Supplies,  requests  for  details,  etc.,  and  in  fact  all 
official  communications  whatever,  except  property  returns,  which  go  directly  to  the  Department  of 
the  Surgeon-General.  The  following  is  a  list  of  reports,  requisitions,  etc.,  made  by  the  Surgeon  in 
charge  of  the  hospital:  A  Weekly  Report,  Monthly  Report,  Report  of  Sick  and  Wounded,  Cer 
tificates  of  Death,  Requisitions  for  Medical  and  Hospital  Stores,  Morning  Reports,  etc.  The  fol 
lowing  is  a  list  of  the  books  and  registers  kept  on  hand:  Morning  Report  Book,  Register,  Pre 
scription  Book,  Case  Book,  Letter  and  Order  Book. 

"Duties  of  the  Medical  Recorder  of  a  Division  Hospital:  1.  During  a  battle  the  names  of  all 
wounded  admitted  to  the  hospital  are  carefully  entered  in  the  prescribed  forms:  Lists  of  Wounded, 
giving  Rank,  Company,  Regiment,  and  Corps;  also  the  nature  of  the  missile  or  weapon  causing 
the  injury,  when  wounded,  its  nature  (slight  or  severe)  and  the  treatment  pursued  in  each  case. 
On  this  form  are  also  entered  all  amputations  and  operations  and  deaths.  After  the  engagement  is 
over  a  Classified  Return  of  Wounds  and  Injuries  is  prepared  from  this  list.  2.  At  the  operating 
table  an  assistant  prepares  all  specimens  of  interest  for  preservation  in  a  specimen  jar.  Here, 
likewise,  the  name  and  designation  of  the  patient  is  noted  down,  with  a  full  detail  of  the  injury  and 
the  operation  performed,  with  the  name  and  rank  of  the  operator.  When  the  specimen  is  ready  to 
be  deposited  in  the  jar  it  is  labelled  and  the  number  on  the  label  written  opposite  the  patient's 
name.  As  soon  as  possible  afterwards,  a  complete  list  is  made  of  all  the  operations  during  the 
engagement,  giving,  as  it  were,  a  history  of  each  case,  the  number  opposite  the  patient's  name  cor 
responding  with  the  number  of  the  specimen  in  the  jar.  After  a  battle  a  report  of  aggregate 
strength  of  men  and  names  of  Medical  Officers  present  for  duty  is  also  made  out. 

"Duties  of  the  Attending  or  Prescribing  Surf/eon  of  a  Division  Hospital:  1.  To  visit  his  ward 
regularly  twice  each  day,  or  as  often  as  the  condition  of  his  patients  may  require.  2.  To  examine 
and  make  proper  diagnosis  of  patients  as  they  may  be  reported  to  him,  either  for  wounds  or  disease; 
to  make  and  keep  a  correct  register  of  all  patients,  with  their  treatment,  and  daily  to  report  them  to 
the  Surgeon  in  charge  of  the  hospital.  3.  To  prescribe  suitable  remedies  and  to  see  that  they  are 
regularly  administered  by  the  attendants.  4.  To  inspect  the  diet  of  the  men  and  see  that  proper 
food  is  given  them.  5.  To  attend  strictly  to  the  sanitary  condition  of  his  ward  and  surroundings, 
and  compel  those  whose  duty  it  may  be  to  remove  everything  offensive  or  detrimental  to  health. 
G.  To  assist  in  all  surgical  operations,  or  operate,  as  he  may  be  required  by  the  Surgeon  assigned 
to  that  duty.  7.  To  see  that  the  men  under  his  care  are  as  comfortable  as  circumstances  will 
admit. 

"Duties  of  the  Operating  Surgeon:  1.  The  Operating  Surgeon  shall  select  steady  and  reliable 
attendants,  give  them  clear  and  explicit  instructions  relative  to  their  respective  duties,  and  assign 
to  each  his  proper  place.  2.  He  shall  see  that  all  the  necessary  appliances  be  at  hand  required  in 
performing  operative  surgery,  that  the  instruments  are  in  good  order  and  in  their  proper  places, 
and  that  a  good  and  sufficient  supply  of  lint,  bandages,  ligatures,  sponges,  plaster,  etc.,  be  con. 
venieutly  placed  and  ready  for  use.  3.  He  should  take  charge  of  all  patients  that  in  the  opinion 
of  the  Prescribing  Surgeon  require  surgical  attention,  make  a  minute  and  thorough  examination  of 
each  case  and  determine  whether  surgical  aid  is  necessary;  judge  of  the  best  manner  of  benefiting 
the  patient,  taking  into  consideration  the  relation  of  important  organs,  vessels,  and  nerves  in 


910  THE    MEDICAL    STAFF    AND    MATEEIA    CHIRUEGICA.  [CiiAl>.  xiv. 

proximity  to  the  wound,  what  bearing  they  may  have  in  the  preservation  or  loss  of  the  patient's  life, 
and  to  use  every  preservative  means  within  the  reach  of  surgical  science  to  save  the  life  of  the 
patient  with  as  little  impairment  of  all  his  functions  as  possible.  4.  An  operation  beiug  deter 
mined  upon,  he  should  have  the  patient  properly  placed  upon  the  table  and  should  judge  of  the 
practicability  of  administering  anaesthetics,  and  if  their  use  is  found  necessary  should  superintend 
the  administration.  5.  The  patient  being  etherized,  the  Surgeon  proceeds  with  the  operation  that 
the  case  requires  in  the  most  expeditious  and  scientific  manner  compatible  with  the  nature  of  the 
injury,  endeavoring  to  preserve  the  usefulness  of  the  parts  operated  upon  to  the  greatest  extent — 
in  operations  on  the  extremities  preserving  as  great  a  length  of  bone  as  possible  and  securing 
sufficient  integument  to  give  a  liberal  covering  to  the  stump. 

"Duties  of  the  Regimental  Surgeon:  The  first  duty  of  the  day  is  that  of  the  Morning  'Sick 
Call,'  when  the  sick  and  disabled,  as  well  as  those  who  are  neither  sick  nor  disabled,  present  them 
selves  for  treatment.  The  Surgeon  is  called  upon  to  exercise  his  judgment  in  determining  the 
character  and  gravity  of  their  ailments.  If  he  had  none  to  deal  with  but  those  who  were  really  sick, 
his  task  would  be  plain,  simple,  and  easy;  but,  unfortunately,  many  of  the  cases  are  feigned,  and 
he  is  required  to  discover  and  overcome  the  means  brought  into  requisition  by  a  skulker's  ingenuity 
to  carry  out  his  deception.  Presuming  that  the  Surgeon  is  fortified  by  skill  and  experience  suf 
ficient  to  detect  these,  and  has  a  just  sense  of  responsibility  to  the  United  States  Government  (for 
he  really  regulates  the  strength  of  the  command ),  his  examinations  will  be  made  without  partiality 
and  regardless  of  position  or  prejudice,  and  in  his  report  he  will  assign  to  duty  those  who  are  fit 
for  duty,  the  sick  to  quarters  for  treatment,  or  send  them  to  hospital,  and  recommend  the  perma 
nently  disabled  for  discharge  or  the  Veteran  Eeserve  Corps.  It  may  be  added  that  in  cases  having 
slight  symptoms  of  diseased  action,  insufficient  to  indicate  position  and  unmistakable  disease, 
humanity  would  dictate,  and  authority  sanctions,  that  they  be  placed  off  duty,  and  that  they  may 
have  the  benefit  of  the  doubt  and  time  for  development  of  disease.  Having  concluded  his  work 
thus  far,  the  Surgeon  will  see  that  a  copy  of  his  report  is  forwarded  to  the  Adjutant,  who  deducts 
all  excused  from  duty  from  the  mean  strength  present  in  the  regiment;  and  the  available  strength 
of  the  command  is  obtained,  which  forms  the  basis  for  all  details  and  assignments  that  may  be  made 
in  the  regiment.  Should  the  regiment  be  filled  up  by  conscripts,  substitutes,  or  enlisted  men,  .the 
Surgeon  is  required  to  examine  each  one  carefully  and  report  on  their  fitness  for  service,  rejecting 
all  those  who,  by  reason  of  infirmity,  are  unfit,  and  recommending  for  reception  such  as  he  thinks 
will  be  able  to  discharge  the  duties  of  a  soldier.  That  the  duties  imposed  upon  the  Surgeon  are 
important  is  obvious  to  any  one,  and  should  be  particular^  so  to  an  officer  who  has  recorded  his 
obligation  to  subserve  the  interest  of  the  United  States.  If  the  Surgeon  indulges  the  men  and 
reports  them  off  duty  when  they  are  not  sick,  he  imposes  additional  labor  on  the  faithful  men  who 
bear  the  heat  and  burden  of  the  day,  and  virtually  offers  a  reward  to  the  faithless;  or  in  examin 
ing  recruits  admits  any  who  are  physically  disqualified,  he  acts  in  bad  faith  to  all  and  in  the  end 
unwarrantably  weakens  the  command,  defrauds  the  Government,  and  may  be  the  cause  of  render 
ing  an  important  engagement  abortive.  If  he  conducts  his  examinations  carelessly,  the  men  will 
soon  avail  themselves  of  the  chance  to  escape  duty,  and  in  great  numbers  report  themselves  sick; 
the  Surgeon  loses  his  influence  for  good,  and  he  sinks  into  disrepute  and  merited  disgrace,  which 
does  not  terminate  with  his  service  in  the  Army,  but  will  follow  him  throughout  all  time.  After 
'Sick  Call'  the  Surgeon  should  visit  the  sick  in  quarters,  prescribe  for  them,  and  see  that  suitable 
food  is  provided  and  their  quarters  made  as  comfortable  as  possible,  inspect  the  camp  daily,  see 
that  it  is  well  drained  by  proper  ditching  through  which  all  superfluous  or  surface  water  may  be 
carried  off,  that  all  filth  or  anything  likely  to  produce  disease  is  removed  or  corrected,  that  the 
quarters  of  the  men  are  swept  and  aired  and  their  bedding  exposed  to  the  sun  whenever  practicable, 
that  the  sinks  are  covered  with  dirt  or  ashes  (the  latter  preferable),  that  the  food  of  the  men  is  of 
good  quality  and  sufficient  quantity  (reporting  any  error  in  either),  and  that  the  cooking  is  judi 
ciously  done.  These  duties  are  essential  and  should  receive  daily  attention,  as  the  neglect  thereof 
will  decidedly  increase  the  sickness  of  the  regiment  and  consequently  impair  its  efficiency.  Should 
a  soldier  die  in  camp  or  regimental  hospital,  the  Surgeon  should  notify  his  Commanding  Officer 
and  forward  to  him  an  inventory  of  his  effects,  with  the  disease  from  which  he  died  and  the  date 
of  death,  select  a  place  for  burial  and  see  that  he  is  decently  buried  and  his  grave  carefully  marked. 
The  duties  thus  far  pointed  out  are  obligatory,  and  no  excuse  can  be  made  for  their  uon-perform- 


C11A1-.  xiv.]  THE    MEDICAL    STAFF.  911 

ance  iu  camp.  There  are  many  other  acts  of  kindness,  more  correctly  denominated  '  favors,'  that 
can  be"  extended  by  a  Surgeon  without  detriment  to  himself,  that  will  have  a  good  effect  upon  the 
soldier  in  leading  him  to  believe  that  his  life  and  comfort  command  the  Surgeon's  consideration; 
these  being  done  willingly  will  have  the  effect  of  improving  the  morale  of  the  command  and  useful 
ness  of  the  Surgeon.  When  a  inarch  is  likely  to  be  made  the  Surgeon  is  directed  to  send  his  sick 
to  General  or  Division  Hospital.  Again  he  is  called  upon  to  make  a  careful  and  rigid  examination 
to  avoid  imposition ;  for  the  terrifying  effect  of  a  prospective  battle  will  cause  men  to  limp  who 
never  limped  before,  and  many  hitherto  good  soldiers  will  make  an  effort  to  escape  it.  The  Sur 
geon  completes  his  list  and  forwards  a  copy  by  name,  rank,  and  compau}',  regiment,  and  disease, 
with  descriptive  lists  of  each  man;  when  he  loads  his  men,  providing  sufficient  food  for  the  time 
required  to  reach  the  hospital.  Having  provided  the  requisite  quantity  of  medicines,  etc.,  to  fill 
the  'hospital  knapsack'  or  'field  companion,'  he  gives  them  to  his  hospital  attendants,  and  when 
the  regiment  moves  the  Surgeon,  Hospital  Steward,  and  attendants  take  their  position  in  the  rear. 
If  any  of  the  command  take  sick  or  are  wounded  on  the  march,  the  Surgeon  is  notified  and  is  pre 
pared  to  prescribe  medicines  or  suitable  dressings,  and  furnishes  a  pass  for  ambulance  transporta 
tion  (a  duplicate  of  which  he  retains),  or  directs  them  to  walk  leisurely  in  the  road,  being  governed 
by  the  severity  of  the  diseases  or  wounds,  and  being  careful  that  no  deception  is  practised  by  men 
that  are  not  sick,  recording  each  case  in  his  'Field  Register,'  with  character  of  disease  or  wound. 
Having  thus  carefully  discharged  his  duties  during  the  day,  and  though  the  march  has  been  a  long 
and  laborious  one,  he  should,  after  arriving  iu  camp,  visit  and  prescribe  for  the  sick,  and  endeavor 
to  make  them  as  comfortable  for  the  night  as  the  means  at  hand  will  permit,  before  his  day's  work 
is  done.  Again,  in  the  morning,  before  the  regiment  moves,  he  should  see  them  and  prescribe 
medicines  for  the  day,  select  such  cases  as  require  wagon  transportation,  see  that  they  are  loaded, 
and  those  able  to  march  started  before  he  leaves  the  carnp.  From  day  to  day  these  duties  should 
be  performed.  Although  trying  on  the  strength  of  the  Surgeon  he  should  not  fail  to  do  them, 
as,  sooner  or  later,  a  day  of  rest  will  come  and  he  will  be  able  to  recuperate.  During  an  engage 
ment  the  Surgeon,  if  not  detailed  on  the  operating  staff  at  the  hospital,  should  report  with  his 
assistants  and  attendants  to  a  point  selected  in  the  rear  of  his  command,  either  by  brigade  or 
regiment,  and  notify  the  sergeant  in  charge  of  the  stretcher  bearers  thereof,  that  the  wounded  may 
be  carried  to  said  point,  to  whom  he  should  give  such  medicines  and  apply  such  dressings  as  their 
wounds  may  require,  to  afford  comparatively  comfortable  transportation  to  the  hospital  of  their 
Division,  where  each  case  receives  minute  examination  and  further  attention.  Should  the  Surgeon 
be  placed  on  the  operating  staff,  his  duty,  in  connection  with  other  members,  is  to  examine  care 
fully  every  wounded  man  and  determine  the  extent  of  his  wound,  the  parts  involved,  and  the  neces 
sity  for  and  kind  of  operation  his  case  may  demand.  Should  he  be  selected  to  perform  the  operation 
he  should  endeavor  to  do  it  as  scientifically  and  with  as  much  despatch  as  the  nature  of  the  case 
and  safety  of  the  patient  will  admit,  and  in  all  cases  apply  appropriate  dressings  m  such  a  manner 
that  they  will  not  become  detached  in  transportation  to  General  Hospital.  He  may  be  thus 
employed  for  an  indefinite  length  of  time;  he  should  therefore  feel  it  incumbent  on  him  to  labor  as 
long  as  there  are  any  cases  requiring  attention,  until  all  have  had  the  advantage  of  primary  opera 
tions  and  are  relieved  from  the  excessive  pain  of  undressed  wounds  and  increased  mortality  attend 
ing  secondary  operations.  The  duties  of  the  Surgeon  in  every  position  may  be  summed  up  in 
one  sentence:  He  does  not  rest  until  everything  is  done  that  can  contribute  to  the  comfort  of 
the  wounded.  After  a  battle  the  Surgeon  will  report  to  his  regiment,  unless  otherwise  ordered, 
and  resume  the  charge  thereof,  and  will  perform  such  duties  as  are  mentioned  in  describing  those 
in  camp,  etc.,  previously  procuring  the  names  of  the  men  killed  in  the  action,  and  of  the  wounded, 
the  nature  of  their  wounds  and  character  of  the  missile  inflicting  them,  together  with  all  statistics 
required  in  reports  he  may  have  to  make.  The  reports  required  of  a  Surgeon  of  a  regiment  are 
the  'Morning  Report'  to  the  Adjutant,  the  'Weekly'  to  the  Surgeou-in-Chief  of  the  Brigade,  and 
the  'Monthly.'  It  is  altogether  necessary  that  a  medical  officer  should  so  conduct  his  depart 
ment  that  he  may  secure  the  confidence  of  the  officer  in  command  of  the  regiment  to  which  he  is 
attached,  that  said  officer  may  receive  his  reports  and  rely  on  their  correctness.  If  both  military 
and  medical  officers  are  sincerely  interested  in  the  health  of  the  regiment  and  act  in  concert,  much 
can  be  done  to  promote  order  and  discipline.  The  necessity  for  this  can  be  discovered  when  the 
opposite  is  experienced.  The  Surgeon  cannot  have  an  order  issued  or  carried  into  effect  without 


912  THE    MEDICAL    STAFF    AND    MATERIA    CHIRURGICA.  [CHAP.  xiv. 

great  difficulty,  and  if  the  variance  should  continue  the  intercourse  will  be  so  unpleasant  that  the 
command  eventually  suffers  in  consequence.  The  officers  are  mutually  responsible  and  should  be 
mutually  respectful. 

"Duties  of  the  Assistant  Regimental  Surgeon:  The  duties  of  an  Assistant  Surgeon  when  in 
charge  of  a  regiment  or  hospital  are  identical  with  those  of  a  Surgeon  in  the  same  position.  If  he 
be  acting  under  a  Surgeon  in  charge  he  will  perform  such  share  of  the  Surgeon's  duties  in  the  case 
of  the  sick  as  the  Surgeon  may  assign  to  him.  The  sick  in  the  ambulances  on  the  march  are 
usually  put  in  charge  of  an  Assistant  Surgeon,  one  or  more,  whose  duty  it  is  to  accompany  the 
ambulances  and  see  that  such  medicines  are  administered  as  the  patients  may  require;  usually  he 
both  prescribes  and  dispenses.  He  decides  also  what  patients  must  be  carried,  and  when  they  are 
well  enough  to  walk  or  to  rejoin  their  companies.  Beef  stock,  tea,  and  sugar  are  carried  in  each 
ambulance  for  the  use  of  the  sick,  subject  to  the  order  of  the  Assistant  Surgeon  in  charge,  and  to 
be  prepared  by  the  ambulance  meu  belonging  to  each  ambulance.  When  an  action  is  about  to 
take  place  the  Surgeons  with  the  regiments  are  usually  ordered  to  the  Division  Hospital,  while 
the  Assistant  Surgeons  are  left  to  establish  regimental  field  hospitals  or  depots,  where  the  wounded 
come  or  are  brought  by  the  stretcher  bearers  to  be  dressed.  Sometimes  a  Surgeon  is  left  in  charge 
of  the  Assistant  Surgeons  of  a  Division  with  orders  to  select  the  places  for  the  field  hospitals.  A 
depot  of  this  kind  should  be  in  some  comparatively  safe  place,  but  not  too  far  from  the  regiment, 
and  where  the  ambulances  can  have  a  good  chance  to  conic  without  being  in  great  danger  from  the 
enemy's  fire;  it  should  also  be  convenient  to  good  water,  which  will  be  needed  for  dressing  the 
wounded.  If  the  place  is  too  much  exposed  the  stretcher  men  will  not  be  likely  to  bring  the 
wounded,  nor  will  wounded  men  wish  to  be  left  where  they  may  get  more  wounds  while  being 
dressed  or  waiting  their  turn  to  be  attended  to;  but  will  prefer  to  go  farther  to  the  rear.  If  the 
ambulances  cannot  come  to  the  depots  where  the  men  are  brought  to  be  dressed,  a  sudden  change 
in  the  lines  may  cause  some  men  to  be  left  on  the  field  who  were  waiting  to  be  attended  to,  and  who 
might  have  been  carried  off  in  a  very  few  moments  if  necessary,  even  though  they  were  not 
dressed,  were  the  ambulances  there.  Still,  although  perfectly  safe  places  can  seldom  be  found 
near  where  the  fighting  is  going  on,  especially  where  the  ground  is  comparatively  even,  the  Assist 
ant  Surgeon  should  not  allow  his  fears  to  induce  him  to  remain  too  far  away  from  his  men.  and 
they  should  be  kept  advised  of  his  whereabouts;  hence,  when  a  regimental  field  hospital  has  been 
established  it  should  not  be  moved  unless  it  is  absolutely  necessary  to  do  so.  .  Assistant  Surgeons 
on  the  battle-field  should  be  furnished  with  the  ordinary  Surgeons'  dressing  case  of  instruments 
— operations  requiring  other  instruments  than  these  are  usually  of  too  severe  a  character  to  be 
attempted  on  the  field.  He  should  be  accompanied  by  one  or  two  nurses  with  plenty  of  lint, 
bandages,  isinglass  plaster,  water,  sponges,  and  a  few  of  the  most  frequently  required  medicines. 
After  dressing  the  men  the  Surgeon  should  see  that  they- are  properly  placed  in  the  ambulances, 
and  give  the  direction  for  their  care  until  they  reach  the  Division  Hospital— duties  often  of  great 
importance  to  the  patient.  When  it  can  be  done  conveniently  it  is  better  that  the  Assistant  Sur 
geons  of  several  regiments  or  of  a  Brigade  be  together  on  the  field,  as  they  will  often  be  enabled  to 
assist  and  advise  each  other.  An  Assistant  Surgeon  in  the  field  has  very  little  opportunity  for 
observing  severe  surgical  cases;  after  the  first  dressing  he  very  rarely  sees  or  hears  anything  of 
their  further  treatment  or  termination.  So  far  as  practicable  the  Assistant  Surgeon  in  the  field 
should  keep  a  memorandum  of  the  names  of  the  men  he  dresses,  their  companies  and  regiments, 
also  the  character  and  severity  of  their  wounds;  this  will  be  of  much  service  in  making  the 
required  reports  and  in  answering  the  inquiries  of  anxious  friends.  Of  the  relative  position  of  an 
Assistant  Surgeon  very  little  is  to  be  said.  He  seems  to  be  subject  to  the  orders  of  the  commander 
of  his  regiment,  brigade,  etc.,  whether  he  be  colonel  or  corporal,  and  to  those  of  the  Surgeon  of  his 
regiment,  brigade,  division,  etc.,  and  has  command  only  over  those  of  inferior  rank  in  his  own 
department.  So  far,  however,  observation  leads  to  the  belief  that  regimental  commanders  seldom 
interfere  with  the  duties  of  their  Assistant  Surgeons. 

"Duties  of  the  Commissary  of  Subsistence  of  a  Division  Hospital :  The  Division  Hospital  Com 
missary  is  under  the  immediate  direction  of  the  Surgeon  in  charge  of  the  hospital ;  he  makes 
reports  to  him  and  receives  his  orders.  His  duties  while  in  camp  are  to  draw  at  stated  intervals 
from  the  commissary  officer,  authorized  to  issue  to  the  hospital,  such  stores  as  are  required  for  the 
use  of  the  sick  and  wounded,  stewards,  and  authorized  attendants,  on  provision  returns  approved 


CHAP.  XIV.J  THE    MEDICAL    STAFF.  913 

by  the  Surgeon  in-Charge.  He  is  required  by  existing  orders  to  keep  on  band  at  least  one  thousand 
rations  of  bread,  sugar,  coffee,  tea,  pork,  and  from  six  to  ten  head  of  beef-cattle.  He  makes  a  daily 
inspection  of  the  stores  on  hand  in  order  to  keep  np  the  necessary  amount  of  supplies,  so  as  to  be 
ready  at  all  times  for  a  rapid  movement  or  an  engagement.  It  is  also  his  duty  to  make  out  the 
provision  returns,  having  them  agree  with  the  morning  report  of  sick  and  wounded ;  the  names  of 
all  the  hospital  attendants  to  be  written  on  the  back  of  each  return.  He  superintends  the  purchase 
of  such  articles  as  are  not  furnished  by  the  Government,  and  which  the  Surgeon-in-Charge  consid 
ers  necessary  for  the  use  of  the  sick  and  wounded.  He  also  keeps  an  account  of  the  savings  of  the 
hospital,  and  makes  a  monthly  report  of  the  state  of  the  hospital  fund  to  the  Surgeon-iu-Charge. 
He  has,  in  conjunction  with  a  medical  officer,  charge  of  the  cooking  and  preparation  of  the  food, 
seeing  that  there  is  no  unnecessary  waste,  and  that  the  place  in  which  the  stores  are  kept  and  food 
prepared  is  properly  policed  daily.  When  orders  to  move  are  received  he  attends  to  the  packing  of 
the  supplies  in  the  wagons  assigned  for  that  purpose.  He  also  sees  that  there  is  a  sufficient  number 
of  cooking  utensils  on  hand,  and  that  they  are  kept  clean  and  in  good  condition.  On  the  march 
he  is  required  to  keep  his  wagons  with  the  hospital  department,  or  wherever  they  may  be  ordered, 
also  to  have  the  beef-cattle  up  with  the  wagons,  so  that  if  necessary  they  can  be  slaughtered  and 
prepared  for  food  in  the  evening,  or  whenever  a  halt  is  ordered.  He  selects  a  proper  place  for  cook 
ing  purposes,  unloads  such  stores  as  are  required  for  the  occasion,  and,  if  within  reach  of  the  supply 
train,  gets  his  stock  replenished.  On  the  approach  of  an  engagement  it  is  his  duty  to  have  hot 
coffee,  tea,  beef-soup,  and  other  necessary  articles  of  diet  ready  for  the  wounded  as  soon  as  they 
may  be  brought  in  from  the  field.  When  the  wounded  are  being  sent  to  the  depot  hospital  he 
furnishes  each  man  with  sufficient  rations  to  last  him  until  he  reaches  his  place  of  destination. 
When  men  are  returned  to  duty  from  the  hospital  he  also  furnishes  them  with  rations. 

"  Duties  of  the  Chief  Ambulance  Officer  of  a  Corps:  In  addition  to  the  regular  monthly  returns 
of  Quartermaster's  property  the  Chief  Ambulance  Officer  of  the  Corps  receives  and  makes  the  fol 
lowing  reports:  1,  Daily  Wagon  and  Forage  Report;  2,  Weekly  Ambulance  Report;  3,  Monthly 
Report  of  Transportation ;  4,  Monthly  Report  of  Officers  in  Quartermaster's  Department  of  the 
Ambulance  Train  and  the  time  to  which  they  have  made  their  property  returns ;  5,  Monthly  Report 
of  all  Quartermaster's  property  received  and  issued  during  the  month;  G,  Monthly  Report  of  Offi 
cers  serving  in  the  Ambulance  Train.  When  not  on  the  march  the  Chief  Ambulance  Officer  of  the 
Corps  inspects  the  ambulance  train  every  Sunday  morning  with  the  object  of  correcting  all  abuses 
and  of  promoting  the  efficiency  of  the  train.  Before  a  move  he  should  give  timely  notice  to  the 
Division  Ambulance  Officers,  so  that  they  may  have  everything  packed  up  and  ready  to  start  at  the 
appointed  hour.  It  is  his  duty  to  regulate  the  order  of  march  of  his  train,  select  suitable  camping 
grounds,  and  see  that  his  train  is  at  all  times  ready  for  active  service.  Before  an  engagement  he 
informs  himself  as  well  as  possible  about  the  country,  roads,  etc.,  sees  that  his  train  is  well  up  and 
together,  so  that  as  soon  as  the  lines  of  battle  are  established  he  can  park  his  whole  train  in  some 
central  position  from  which  to  send  picket  ambulances  as  near  the  lines  of  each  Division  as  possible. 
An  officer  is  always  placed  in  charge  of  the  main  park  of  ambulances,  one  in  charge  of  the  picket 
ambulances  of  each  Division,  and  the  remainder  of  the  officers  are  instructed  to  take  charge  of  the 
stretchers,  men,  and  sergeants.  It  is  also  necessary  to  leave  an  officer  in  charge  of  the  hospital 
train  of  the  corps.  The  Chief  Ambulance  Officer  must  personally  superintend  the  working  of  his 
train  so  as  to  see  that  every  one  does  his  duty,  that  the  drivers  do  not  become  stampeded,  and  that 
the  wounded  are  transferred  to  the  hospital  as  quickly  and  easily  as  possible.  It  is  also  his  duty  to 
see  that  the  stretcher  men  do  not  carry  the  wounded  farther  than  is  necessary.  When  in  camp, 
and  it  is  necessary  to  send  off  sic-k  or  wounded,  the  chief  Ambulance  Officer  orders  the  proper  num 
ber  of  ambulances  and  details  an  officer  to  take  charge  of  the  train ;  one  ambulance  officer  from 
each  Division  superintends  the  loading  of  the  ambulances  at  his  Division  Hospital.  When  in 
camp,  the  stretcher  men  are  used  in  the  hospital  when  needed.  It  is  also  necessary  that  the  Chief 
Ambulance  Officer  should  see  that  the  ambulances  are  not  improperly  used.  It  being  desirable 
to  receive  orders  as  early  as  possible,  the  Chief  Ambulance  Officer  finds  it  best  to  have  his  quarters 
at  Corps  Headquarters. 

"Duties  of  the  Chief  Ambulance  Officer  of  a  Division:   He  should  be  the  receipting  officer  for 
all  Quartermaster's  property  belonging  to  his  Division,  and  be  responsible  for  all  deficiencies. 
He  should  make  all  necessary  returns  required  by  the  Quartermaster's  Department,  Commissary 
SURG.  Ill— 115 


914  THE    MEDICAL    STAFF    AND    MATERIA    CHIRURGTCA.  [CHAP.  xiv. 

Department,  and  Ordnance  Department,  viz:  Monthly  returns  of  property  to  the  Quartermaster's 
Department,  Quarterly  return  of  Ordnance,  usual  Ration  return  to  Commissary  Department,  also 
the  daily  Forage  Report,  the  Weekly  report  of  Ambulance  Department,  Monthly  report  to  Quar 
termaster's  Department,  and  Monthly  report  of  Officers.  When  on  the  march  he  should  attend  to 
the  running  of  his  train,  see  that  forage  is  drawn  from  the  nearest  post,  and  a  sufficient  quantity 
kept  constantly  on  hand;  properly  park  his  train  at  night  according  to  orders  from  the  Chief  Am 
bulance  Officer  of  the  Corps;  necessary  sentries  posted  so  that  horses  may  not  stray  away  or  be 
stolen,  and  be  ready  to  move  at  short  notice.  Before  an  engagement  it  is  his  duty  to  see  that  the 
Brigade  Officers  are  with  their  Brigades,  and  that  they  have  the  sergeants  and  stretcher  bearers 
well  up  with  their  regiments,  have  his  train  so  parked  that  it  will  be  easy  of  access,  and  so  near  that 
the  stretcher  men  will  not  have  any  farther  than  actually  necessary  to  carry  the  wounded,  and  at  the 
same  time  protect  his  horses  from  unnecessary  exposure;  and  after  an  engagement  to  assure  himself 
that  all  the  wounded  of  the  Division  have  been  removed  from  the  field;  also  to  assist  the  Surgeons 
when  a  train  of  sick  and  wounded  is  to  be  sent  to  Base  or  General  Hospital. 

^Duties  of  the  Chief  Ambulance  Officer  of  a  Brigade;  1.  While  in  camp  one  Brigade  Officer  of 
each  Division  train  is  constantly  with  the  troops,  and  in  case  of  any  movement  reports  the  fact  at 
once  to  the  Chief  Ambulance  Officer  of  his  Division.  He  should  see  that  the  drivers  and  stretcher 
men  are  at  the  established  posts,  and  that  all  orders  from  Surgeons  for  ambulances  or  stretchers 
for  the  transportation  of  sick  or  wounded  men  are  promptly  attended  to.  2.  When  not  on  duty 
with  the  troops  he  will  see  that  the  ambulances  are  properly  parked,  and  that  the  drivers  attend 
faithfully  to  the  feeding  and  grooming  of  their  horses,  the  cleaning  of  the  harness  and  ambulances, 
and  to  the  policing  of  the  stables  and  grounds  of  the  park;  also  that  the  kegs  are  kept  constantly 
filled  with  fresh  water.  Stretcher  men  will  assist  in  the  policing  when  not  on  duty  at  the  Division 
Hospital.  3.  A  suitable  non-commissioned  officer  will  be  selected  to  have  the  direct  supervision  of 
the  ambulances  of  the  Brigade,  and  another  of  the  stretcher  men.  The  rest  of  the  nou  commis 
sioned  officers  will  have  charge  of  the  stretcher  men  of  their  respective  regiments  under  the  one 
in  charge  of  the  stretcher  men  of  the  Brigade.  4.  On  the  march  (unless  otherwise  directed)  Bri 
gade  Officers  remain  with  the  headquarters  of  their  Brigades,  and  in  case  of  an  engagement  select 
a  spot  as  near  the  line  as  possible,  with  a  reasonable  degree  of  safety  to  the  horses,  and  as  central 
to  the  lines  of  the  Brigade  as  possible.  5.  The  Brigade  Officer  will  cause  a  small  number  of  ambu 
lances  to  be  brought  to  the  spot  selected,  and  others  to  be  sent  to  fill  their  places ;  and  as  fast  as 
they  are  filled  to  send  to  the  place  selected  for  the  hospital.  The  stretcher  men  will  be  informed 
of  the  position  of  the  ambulances,  and  will  bring  to  them  as  fast  as  possible  any  man  that  may  be 
wounded  and  unable  to  walk,  until  all  the  wounded  men  are  carried  fiom  the  field.  6.  The  Brigade 
Officer  should  inform  himself  of  the  shortest  and  best  roads  to  the  Division  Hospital,  and  see  that 
the  drivers  take  them,  driving  carefully,  and  avoiding  the  bad  places  as  much  as  possible  on  an 
uneven  road.  A  good  non-commissioned  officer  should  remain  constantly  with  the  advanced  ambu 
lances  to  see  that  the  wounded  men  are  loaded  carefully  and  speedily  and  the  drivers  do  not  get 
demoralized.  7.  No  written  reports  are  made  by  Brigade  Officers.  They  report  verbally  to  the 
Division  Officer  any  breach  of  discipline  or  neglect  of  duty  that  may  require  his  attention.  8.  He 
receives  only  such  orders  as  come  through  the  Chief  Ambulance  Officer  of  the  Corps  or  his  Division, 
or  some  medical  officer.'' 

It  is  only  necessary  to  point  to  the  manifold  functions  required  of  the  medical  officers 
in  the  foregoing  reports  to  see  that  their  duties  were  arduous  and  responsible,  calling,  aside 
from  professional  ability,  for  the  exercise  of  firmness  combined  with  tact  and  moderation 
to  do  justice  to  the  sick  and  wounded  entrusted  to  their  immediate  care,  and  at  the  same 
time  to  avoid  complications  with  clashino-  interests 

1  O 

MATERIA    CHIRUKGTCA. 

At  the  beginning  of  the  war  each  regimental  Surgeon  was  furnished  with  a  suitable 
equipment,  for  his  regiment  for  field  service,  consisting  of  medicines,  stores,  instruments, 
and  dressings,  in  quantities  regulated  by  the  Standard  Supply  Table.1  In  action  he  was 

1  See  Standard  Supply  Table  for  field  Service,  in  Jlm'frrl  Jlrgulatinnsfnr  the  Arm;/  of  tlir.  United  State*,  18(51,  p.  304. 


CHAP.   XIV.] 


MATKRIA    CHIRURGICA. 


915 


accompanied  by  a  hospital  orderly,  who  carried  a  knapsack  containing  a  limited  supply  of 
anaesthetics,  styptics,  stimulants,  and  anodynes,  and  material  for  primary  dressings.  This 
hospital  knapsack  had  been  recommended  for  adoption  by  an  army  board  in  1859;  it  was 
made  of  light  wood,  18  inches  in  height,  15  inches  wide,  and  7£  inches  deep,  but  subsequently 


FIG.  425. — Hospital  knapsack  of  wicker-work,  covered 
with  enamelled  cloth. 


FIG.  426.— Regulation  hospital  knapsack  of  1862. 


wicker-work,  covered  with  canvas  or  enamelled  cloth,  was  substituted  for  the  wood;  its 
weight  when  filled  was  18  pounds.  This  knapsack  (FiG.  425)  was  in  general  use  in  the  first 
year  of  the  war  and  served  an  excellent  purpose.  In  1862  it  was  changed  for  what  was 
known  as  the  new  regulation  knapsack,  in  which  the  arrangement  and  character  of  the  sup 
plies  were  modified.  The  new  pattern  was  16  inches  high,  12i  inches  wide,  and  6  inches 
deep;  the  contents  were  packed  in  drawers,  which  were  more  accessible  than  in  the  old  style 
and  less  liable  to  become  disarranged  or  broken.1  The  weight  when  packed  was  nearly  20 
pounds  (Fro.  426).  Notwithstanding  its  convenience  and  general  adaptability  it  was  too 
heavy  and  cumbrous  to  be  carried  by  the  Surgeon 
himself,  and,  when  entrusted  to  other  hands,  was 
liable,  in  the  vicissitudes  of  battle,  to  be  lost. 
In  the  early  part  of  1.S63  Medical  Inspector  R.  H. 
Coolidge,  U.  S.  A.,  arranged  a  field  case  or  com 
panion2  (FiG.  427)  to  take  the  place  of  the  knap 
sack.  It  was  something  after  the  plan  of  the  one 
used  in  the  British  service,  and  was  intended  to 
be  carried  by  the  Surgeon  himself,  if  necessary. 
The  "companion"  is  a  leather  case  13  inches  long,  6  inches  wide,  and  7£  inches  deep;  it  is 
supported  by  a  strap  passing  over  the  shoulder,  and  is  provided  with  a  waist  strap  to  steady 
it  when  carried. 

The  hospital  medicine  chest,  mess-chest,  and  bulky  hospital  supplies  were  transported 
in  wagons  of  the  supply  train  and  were  often  inaccessible  when  required.     To  obviate  this 

1  The  contents  of  the  knapsack  were  :  One  piece  of  white  wax,  8  oz.  simple  cerate,  12  oz.  chloroform,  5  yds.  adhesive  plaster,  2  yds.  isinglass  plas 
ter,  1  oz.  persulphate  of  iron,  100  compound  cathartic  pills,  150  blue  mass  pills,  ISO  opium  pills,  100  opium  and  camphor  pills,  150  quinine  pills,  8  oz. 
aromatic  spirit  of  ammonia,  Ifi  oz.  brandy,  4  oz.  laudanum,  10  bandages,  10  binder's  boards,  4  oz.  charpie,  2  medicine  glasses,  1  (spirit)  lamp,  12  oz.  lint,  1 
box  matches,  1  paper  of  pins,  1  spool  of  surgeons'  silk,  4  pieces  of  sponge,  4  (Dunton's)  field  tourniquets.  2  spiral  tourniquets,  1  piece  of  tape.  1  spool  of 
lead  wire.  1  spool  of  silver  wire,  and  1  spatula. 

2  The  contents  of  the  Surgeon's  Companion  were :  6J  oz.  chloroform,  2  oz.  fluid  extract  of  ipecacuanha.  0  oz.  fluid  extract  of  ginger,  2  oz.  solution  of 
persulphate  of  iron.  24  oz.  of  whiskey,  2  oz.  tincture  of  opium,  144  compound  cathartic  pills,  144  colocynth  and  ipecacuanha  pills,  144  sulphate  of  quinine 
pills,  144  opium  pills,  1  yard  isinglass  plaster,  a  medicine  cup,  scissors,  teaspoon,  pins,  thread,  4  oz.  lint,  a  towel,  2  doz.  bandages,  muslin,  and  corks. 


FIG.  427. — Surgeon's  Field  Companion. 


916 


THE    MEDICAL    STAFF    AND    MATEBJA    CHIRURGICA. 


[CHAP.  XIV. 


inconvenience  panniers  were  provided  containing  the  most  necessary  medicines,  dress 
ings,  and  appliances;  they  were  designed  to  be  carried  on  the  backs  of  pack-animals,  but 
were  found  to  be  inconveniently  heavy  to  be  transported  in  this  manner,  and  were  more 

generally  carried  in  one  of  the  ambulance 
wagons  and  filled  from  the  medicine  chest  as 
required.  FIGS.  428,  429  represent  the  pan 
nier  arranged  for  army  use  by  Dr.  Squibb,  of 
Brooklyn,  N.  Y.;  it  consists  of  a  wooden  box 
strongly  bound  with  iron,  2H  inches  in 
length,  lit  inches  in  breadth,  and  111  inches 
in  depth;  it  weighs,  when  filled,. 88  pounds. 
The  medicines  are  well  packed  in  japanned 
tin  bottles  and  boxes,  and  room  is  left  for 
an  adequate  supply  of  dressing  material. 
The  pannier  had  two  compartments.1 

In  the  early  part  of  the  war  medical  sup 
plies  and  instruments  had   been  carried  in 

FIG.  428.-Medicine  pannier,  heavy   army  wagons.     In    March,   1862,  a 

medicine  wagon  was  constructed  by  E.  Hayes  &  Co.,  of  Wheeling,  Virginia,  in  accordance 
with  plans  and  instructions  of  Surgeon  Jonathan  Letterman,  U.  S.  A.  Details  of  the  inter 
nal  arrangement  of  this  wagon  could  not  be 
obtained.  A  Board,  consisting  of  Brigade  Sur- 
u'oon  William  Hayes  and  Assistant  Surgeons 
Hammond  and  Dunster,  U.  S.  A.,  on  April  17, 
1862,  examined  the  wagon  and  reported  as  fol- 

.  429.— upper  tray  of  medicine  pannier.  lows :  "The  merits  of  this  dispensary  wagon  are 

so  apparent,  when  compared  with  the  old  method  of  packing  medicines  and  instruments  in 
unwieldy  boxes  and  transporting  them  in  the  heavy  army  wagons,  that  the  Board  unani 
mously  approves  of  the  same,  and  recommend  that  it  at  once  be  sent  into  the  field  where 
it  can  be  practically  tested.  The  adoption  of  a  vehicle  of  this  or  some  similar  construction 
for  the  transporting  of  medicines,  etc.,  in  the  field  would  be  an  actual  saving  in  transporta 
tion  over  the  present  plan,  as  a  three  months'  regimental  supply  can  be  carried  with  ease 
in  a  single  wagon  dispensary.  The  advantage  accruing  from  the  prevention  of  loss  by 
wastage,  and  breakage,  the  convenience  of  having  the  whole  together  and  unencumbered 
by  other  baggage,  and  the  readiness  of  access  to  medicines,  instruments,  and  dressings  in 
case  of  an  emergency,  are  so  palpable  that  it  is  only  a  matter  of  surprise  that  some  such 
plan  has  not  been  previously  adopted." 

In  November,  1862,  Mr.  J.  Dunton  proposed  a  medicine  wagon,  a  drawing  of  which 
is  shown  in  FIG.  430.  It  was  examined  by  Medical  Inspectors  T.  F.  Perley  and  J.  M. 
Cuyler  and  Surgeons  J.  Simpson  and  J.  H.  Brinton,  who  reported,  on  November  3,  1862, 
that  it  was  questionable  whether  it  would  answer  the  purpose  for  which  it  was  designed,  as 
it  was  faulty  in  construction,  and  its  capacity  insufficient  to  accommodate  the  entire  hos- 

'The  upper  compartment  contained  24  roller  bandages,  1  yd.  of  isinglass  plaster,  1  paper  of  pins,  2  yds.  bleached  muslin,  and  1  pair  of  scissors. 
In  the  lower  compartment  were  6J  oz.  purified  chloroform,  2  oz.  fluid  extract  of  ipecacuanha,  2  oz.  fluid  extract  of  ginger,  2  oz.  liquor  of  persulphate  of 
iron,  12  doz.  compound  cathartic  pills,  12  doz.  quinine  pills  (3  grs.  each),  12  doz.  opium  pills,  12  doz.  pills  of  compound  extract  colocynth  (3  grains)  and 
ipeononanha  (J  grain),  S4  oz.  whiskey,  2  oz.  tincture  of  opium,  i  Ib.  patent  lint,  1  medicine  glass,  1  tinned  iron  teaspoon,  1  small  piece  fine  sponge,  J  07. 
•ilk  for  ligatures,  1  towel,  and  G  corks. 


CHAP    XIV.  1 


MATERIA    CIIIRURGICA. 


917 


pital  supplies  for  a  regiment  for  three  months."     The  wagon  could  be  elongated  at  both  ends, 
or  closed,  as  was  desired,  and  was  arranged  so  as  to  be  opened  on  the  side.1 


FIG.  430. — DUNTON's  regimental  medicine  wagon. 

As  the  organization  of  the  medical  staff  was  perfected,  the  cumbrous  regimental  sup 
plies  were  curtailed  and  the  brigade  supplies  augmented.  Each  brigade  was  provided  with 
a  "medicine  wagon,"  which 
was  furnished  not  only  with 
drugs  but  with  ample  provis 
ion  of  stores,  dressings,  fur 
niture  and  appliances,  an  am 
putating  table,  and  a  limited 
amount  of  bedding.  The  con 
tents  of  the  medicine  wagon 

O 

were  constantly  replenished 
from  the  stores  of  the  medi 
cal  purveyors  who  accom 
panied  each  army.  FIGURE 
431  represents  the  medicine 
wagon  of  Perot .~'  While  the 

internal  fixtures  and  arrange- 
pro.  431. — PEROT'S  medicine  wagon. 

ments  tor  transporting  sup 
plies  in  this  wagon  were  excellent  and  convenient,  the  cost  of  furnishing  it  was  very  great, 
and  on  the  recommendation  of  a  Medical  Board  consisting  of  Surgeons  C.  H.  Crane,  R.  O. 

1  This  medicine  wagon  is  erroneously  designated  by  Professor  T.  LONGMOUE  (A  Treatise  on  the  Transport  of  Sick  and  Wounded  Troops,  London, 
IStiy,  page  38G>  as  a  United  States  Sick  Transport  Wagon  with  side  and  end  openings. 

*  CONTESTS  OF  PKKOT'S  MKDICIXE  WAGON. — Drawer  1  contained  an  oval  keg  for  6  galls,  of  whiskey,  with  a  cock  on  top  and  bottom,  on«  to  let 
in  air,  the  other  to  draw  from.  This  keg  is  on  a  skid  and  can  be  drawn  out  and  filled  at  the  bung.  Drawer  2 :  Stronger  ether  for  anaesthesia,  32  oz.;  sweet 
spirit  of  nitre,  32  oz.;  solution  of  ammonia,  32  oz.;  turpentine,  1  qt.;  castor  oil,  4  qts.;  brandy,  6  qts.;  olive  oil,  2  qts.;  purified  chloroform,  32  oz.i  copaiba, 
02  07..:  sulphate  of  quinia,  10  07.;  syrup  of  squill,  4  Ibs.  (part  in  Drawer  !>).  l»rawer  3  :  1  sponge-holder  for  throat,  12  probangs,  1  hinged  tongue  depres- 


918 


THE    MEDICAL    STAFF    AND    MATERIA    CHIRURGICA. 


[CHAP.  XIV. 


FIG.  432.— AUTENRIETH  medicine  wagon. 


Abbott,  and  Charles  Sutherland,  U.  S.  A.,  in  June,  1864,  the  Autenrieth  pattern1  (Fios. 

432,  433)  was  furnished  to  the  army.     An  improved  wagon,  recommended  by  the  Medical 

Department  and  constructed  at  the 
Government  shops,  was  adopted 
during  the  last  year  of  the  war. 

Surgical  instruments  were  fur 
nished  by  the  Government,  each 
medical  officer  making  requisition 
for  his  equipment,  receipting  for  it 
and  becoming  responsible  for  its 
condition  while  in  his  possession; 
no  transfers  were  allowed,  and  an 
annual  return  was  required  to  be 
made  to  the  Surgeon  General.  On 
leaving  the  service  it  was  turned 
in  to  the  nearest  medical  purveyor, 
who  receipted  for  the  same.  The 
instruments  intended  for  surgeons 

o 

and  assistant  surgeons  of  the  regu 
lar  and  volunteer  staff  were  com 
prised  in   three  cases — one  for  capital  operations,  containing  amputating,  trephining,  and 

nor,  4  single  trusses,  2  bottles  ink,  1  bottle  mucilage,  1  U.  S.  Dispensatory,  1  portfolio  (cap  size),  2  quarto  blank  books,  1  order  and  letter  book,  4  quires 
writing  paper,  1  register  of  patients,  1  Gray's  Anatomy,  1  Erichsen's  Surgery,  1  Packard's  Minor  Surgery,  1  Longmore  on  Gunshot  Wounds,  1  tooth- 
extracting  case  (army  pattern),  1  8-oz.  hard-rubber  syringe,  1  self-injecting  rubber  syringe,  2  thumb  lancets,  12  hair  pencils,  2  scarificators.  Drawer  4  : 
Closet  for  3  gall,  can  of  alcohol,  and  a  vacant  drawer  for  any  articles  desired.  Draiver  5:  1  set  splints  (6  forearm,  4  leg,  6  large  coaptation,  4  small 
coaptation),  2  papers  pill  boxes  (turned  wood),  1  pair  pliers,  1  gimlet,  1  tape  measure,  8  pieces  binder's  board  (4x17  inches),  8  pieces  binder's  board 
(2J  x  12  inches),  razor  strop  in  case,  1  file,  6  glass  penis  syringes,  1  corkscrew,  1  set  Aiken's  tool  pad,  8  oz  twine  (J  coarse),  1  hone,  1  razor.  Drawer  6' : 
2  quires  wrapping  paper  (white  and  blue),  2  oz.  ligature  silk,  1  oz.  linen  thread  (unbleached),  2  papers  pins,  4  pieces  cotton  tape,  case  containing  25 
needles,  1  spool  cotton  and  thimble,  1  yard  gray  silk  for  shades,  8  field  tourniquets,  2  screw  tourniquets  with  pad,  12  cupping  tins,  2  scissors  (large  and 
small),  1  pocket  case,  1  box  for  sundries,  100  printed  envelopes,  1  traveller's  inkstand,  24  steel  pens,  2  pen-holders,  6  lead-pencils  No.  2,  1  stick  sealing  wax, 
1  sheep-skin  (dressed).  Drawer  7,  Dispensing  Case:  1  Wedgewood  mortar,  2  doz.  vials  (6  6-oz.,  12  4-oz.,  3  2-oz.,  3  1-oz.),  1  pill  tile  (6x8  inches),  8  oz. 
fine  sponge  (small  pieces),  1  tin  funnel  (pint),  5  yds.  adhesive  plaster,  4  Ibs.  patent  lint,  pestle  for  mortar,  4  yds.  red  flannel  (all  wool),  2  medicine  measur 
ing  glasses,  2  yds.  gutta-percha  cloth,  5  yds.  isinglass  plaster,  8  doz.  assorted  corks,  1  glass  graduated  measure  (4  oz.),  1  minim  measure,  10  yds.  bleached 
muslin,  2  cotton  bats,  1  sheet  cotton  wadding,  1  set  prescription  scales  and  weights,  2  spatulas  (3  and  6-inch),  2  glass  urinals,  8  suspensory  bandages,  2  Ibs. 
scraped  or  picked  lint,  2J  yds.  oiled  silk,  2J  yds.  oiled  muslin,  16  doz.  roller  bandages,  assorted  (2  doz.  1  inch  by  1  yd.,  4  doz.  2  ins.  by  3  yds.,  4  doz.  2J 
ins.  by  3  yds..  2  doz.  3  ins.  by  4  yds.,  2  doz.  3i  ins.  by  5  yds.,  1  doz.  4  ins  by  C  yds.,  1  doz.  4  ins.  by  8  yds.),  10  Ibs.  pressed  tow,  1  doz.  towels,  aromatic 
sulphuric  acid,  tannic  acid,  spirit  of  nitrous  ether,  stronger  ether  (for  anaesthesia),  strong  alcohol,  alum,  aromatic  spirit  of  ammonia,  purified  chloroform, 
Dover's  powder,  sulphate  of  morphia,  olive  oil.  castor  oil,  laudanum,  paregoric,  acetate  of  lead,  bicarbonate  of  potassa,  creasote,  fluid  extract  of  colchi- 
cum  seed,  fluid  extract  of  aconite  root,  fluid  extract  of  ipecac,  fluid  extract  of  seneka,  tincture  of  chloride  of  iron,  solution  subsulphate  of  iron,  pure 
glycerin,  chlorate  of  potassa,  iodide  of  potassium,  bicarbonate  of  soda,  whiskey,  syrup  of  squill,  blue  mass,  citrine  ointment,  powdered  squill,  Hoffman's 
anodyne,  carbonate  of  ammonia,  solution  of  ammonia,  camphor,  collodion,  copaiba,  sulphate  of  copper,  alcoholic  extract  of  belladonna,  fluid  extract  cin 
chona  (aromatic),  fluid  extract  ginger,  mercury  with  chalk,  oil  of  turpentine,  croton  oil,  permanganate  of  potassa,  Fowler's  solution,  chlorinated  solution 
soda,  solution  chloride  zinc,  resin  cerate,  simple  cerate,  powdered  gum  arabic,  nitrate  of  silver  (crystals),  fused  nitrate  silver,  sulj.nate  cinchona,  citrate 
iron  and  quinia,  powdered  subsulphate  iron,  iodide  of  iron,  powdered  ipecac,  powdered  opium,  pills  of  camphor  (2  grains)  and  opium  (1  grain),  compound 
cathartic  pills,  opium  pills,  pills  of  sulphate  of  quinia  (3  grains),  sulphate  of  quinia,  powdered  Hochelle  salts,  sulphate  zinc,  blistering  cerate,  powdered 
compound  extract  colocynth.  Drawer  6 :  8  oz.  Fowler's  solution,  8  oz.  aromatic  sulphuric  acid,  8  oz.  fluid  extract  ipecac,  8  oz.  fluid  extract  seneka,  8  o/. 
tincture  chloride  of  iron,  8  oz.  pure  glycerin,  blue  mass,  empty  bottles,  8  Ibs.  sulphate  magnesia,  8  Ibs.  flaxseed  meal,  10  Ibs.  farina,  12  Ibs.  white  crushed 
sugar.  Drawer  9:  16  oz.  Hoffman's  anodyne,  16  oz.  fluid  extract  ginger,  10  oz.  laudanum,  16  oz.  paregoric,  16  oz.  chlorinated  solution  of  soda,  16  oz. 
solution  chloride  zinc,  4  Ibs.  syrup  of  squill  (part  in  Drawer  No.  2).  8  oz.  powdered  tartaric  acid,  16  oz.  subnitrate  bismuth,  8  oz.  ground  cayenne  pepper. 
16  oz.  powdered  Rochelle  salt,  8  oz.  alum,  8  oz.  mercury  with  chalk,  8  oz.  powdered  ipecac,  8  oz.  Dover's  powder,  8  oz.  acetate  lead,  8  oz.  bicarbonate 
potassa,  8  oz.  chlorate  potassa,  8  oz.  iodide  potassium,  8  oz.  bicarbonate  soda,  8  oz.  nutmegs,  8  oz.  powdered  gum  arabic,  8  oz.  carbonate  ammonia,  8  o/. 
camphor,  8  oz.  powdered  opium,  empty  bottles,  8  Ibs.  castile  soap.  Drawer  10:  2  tin  basins  (small,  for  dressers),  3  wash-hand  basins,  2  vacant  boxes  for 
sundries,  1  metal  bed-pan.  Drawer  31:3  Ibs.  simple  cerate,  24  oz.  sulphate  cinchona,  16  oz.  mercurial  ointment,  1  smoothing  plane,  1  saw,  1  hatchet, 

1  nutmeg  grater,  4  oz.  white  wax,  6  Ibs.  ground  black  mustard  seed,  5  Ibs.  black  tea,  1  box  for  sundries,  2  Ibs.  candles  (half  length).     Drawer  12 :  2  doz. 
planed  splints,  20  gray  blankets,  2  blanket  cases  (canvas),  8  gutta-percha  bed-covers,  15  bed  sacks,  15  pillow  cases  (white),  2  leather  buckets,  1  coffee 
mill.    The  wagon  also  contained  an  amputating  table,  3  box  lanterns,  and  2  camp  stools,  and  four  hand  litters  were  attached  outside. 

1  CONTENTS  OF  THE  A UTEXKIETH  MEDICINE  WAGON.— First  Case:  Tannic  acid,  1  oz.;  aromatic  sulphuric  acid,  8oz.;  powdered  gum  arabic,  6  o/.; 
stronger  ether,  2  Ibs.:  Hoffman's  anodyne,  1  lb.;  alcohol,  64  oz.;  alum,  8  oz.;  solution  of  ammonia,  32  oz.;  carbonate  of  ammonia,  8  oz.;  aromatic  spirit 
of  ammonia,  4  oz.;  tartar  emetic,  1  oz.;  nitrate  of  silver,  1  oz.;  fused  nitrate  of  silver,  1  oz.;  subcarbonate  of  bismuth,  4  oz.;  camphor,  8  oz.;  simple  cerate, 

2  Ibs.;  cerate  of  cantharides,  8  oz.;  resin  cerate,  1  lb.;  pure  chloroform,  32  oz.;  collodion,  4  oz.;  copaiba,  16  oz.;  creasote,  4  oz.;  sulphate  of  copper,  2  oz.; 
fluid  extract  of  aconite  root,  4  oz.;  extract  of  belladonna,  1  oz.;  fluid  extract  of  cinchona,  aromatic,  16  oz.;  fluid  extract  of  colchicum  seed,  4  oz.;  compound 
extract  of  colocynth,  8  oz.;  fluid  extract  of  ipecac,  8  oz.;  fluid  extract  of  ginger,  8  oz.;  tincture  of  chloride  of  iron,  8  oz.;  citrateof  iron  and  quinine,  2oz.; 
solution  of  persulphate  of  iron,  4  oz.;  powdered  subsulphate  of  iron,  2  oz.;  glycerin,  8  oz.;  calomel,  8  oz.;  blue  mass,  8  oz.;  mercurial  ointment,  16  oz.;  citrine 


CHAP,  xiv.] 


MATERIA    CHIRURGICA. 


919 


forceps, 
the  field 


FIG.  433. — AUTEXiUKTii  medicine  wagon — side  view. 


resecting  instruments;1  one  for  general  and  minor  operations,2  composed  of  knives, 
catheters,  etc.;  and  a  pocket  case.3  For  regimental  surgeons  and  assistant  surgeons 
case4  was  issued ;  this  con 
tained  mucli  the  same  as 
sortment  of  instruments 
as  those  already  mention 
ed,  but  were  somewhat 
more  closely  packed  and 
more  easily  transported. 
Teeth -extracting  instru 
ments  and  dissecting  cases 
were  also  furnished  to  reg 
imental  and  general  hos 
pitals.  Great  liberality 
was  shown  in  providing 
special  instruments  and 
appliances,  and  every  ef 
fort  was  made  to  render 
the  surgical  equipment  as 
perfect  as  possible. 

At  the  beginning  of  the  war  it  was  the  general  custom  to  secure  possession  of  buildings, 
such  as  churches,  mills,  and  dwelling  houses,  for  hospital  accommodations;  but  the  hygienic 
evils  growing  out  of  such  occupancy  soon  led  to  the  use  of  tent  hospitals  for  the  wounded, 
and  finally,  under  the  excellent  organization  of  the  field  hospitals,  tents  were  almost  uni 
versally  used  by  our  armies  in  campaigns  as  well  as  in  periods  of  inactivity.  The  prin 
cipal  tents  used  were  the  Hospital  and  the  Sibley  tent. 

ointment,  4  oz.;  Dover's  powder,  8  oz.;  flaxseed,  C  Ibs.;  flaxseed  meal,  12  Ibs.;  morphia,  J  oz.;  olive  oil,  2  qts.;  castor  oil,  4  qts.;  oil  of  turpentine,  1  qt.; 
croton  oil,  1  oz.;  powdered  opium,  8  oz.;  tincture  of  opium,  16  oz.;  paregoric,  16  oz.;  pills  of  camphor  (2gr.)  and  opium  (Igr.),  12  doz.;  compound  cathartic 
pills,  16  doz.;  pills  of  compound  extract  of  colocynth  (3  gr.)  and  ipecac  (£  gr.),  16  doz.;  opium  pills,  10  doz.;  sulphate  of  quinine  (3  gr.)  pills,  12  doz.; 
chlorate  of  potassa,  8  oz.;  acetate  of  lead,  8  oz.;  bicarbonate  of  potassa,  8  oz.;  permanganate  of  potassa,  32  oz.;  iodide  of  potassium,  8  oz.;  sulphate  of 
quinine,  8  oz.;  soap,  8  Ibs.;  syrup  of  squill,  3  Ibs.;  powdered  black  mustard,  9  Ibs.;  bicarbonate  of  soda,  8  oz.;  solution  of  chlorinate  of  soda,  32  oz.; 
Kochelle  salt,  16  oz.;  sweet  spirit  of  nitre,  2  Ibs.;  solution  of  chloride  of  zinc,  1  lb.;  sulphate  zinc,  1  oz.;  sulphate  cinchona,  2  oz.;  arrow  root,  10  Ibs.; 
extract  of  beef,  16  Ibs.;  brandy,  6  qts.;  farina,  10  Ibs.;  nutmegs,  4  oz.;  sugar  (white,  crushed),  15  Ibs.;  extract  of  coffee;  black  tea,  10  Ibs.:  whiskey,  6  qts.; 
patent  lint,  6  Ibs.;  scraped  lint,  2  Ibs.;  roller  bandages  (assorted),  32  doz.;  suspensory  bandages,  8.  The  wagon  also  contained  surgical  instruments, 
books,  and  stationery,  prescription  furniture  and  utensils,  bed-pans,  urinals,  tow,  coffee  mill,  rubber  buckets,  tin  basins,  wash-hand  basins,  blankets,  gutta 
percha  bed-covers,  lanterns,  and  a  hatchet.  The  medicines  were  arranged  in  slides ;  the  hospital  stores,  dressings,  furniture,  utensils,  etc.,  were  arranged 
in  drawers  or  on  shelves. 

1  The  Capital  Operating  Case  contained:  2  amputating  knives  (one  long,  one  medium),  2  catlings  (one  long,  one  medium),  4  scalpels,  1  cartilage 
knife,  1  capital  saw  (long,  bow,  two  blades),  1  metacarpal  saw,  1  chain  saw,  1  Hey's  saw,  1  trephine  (conical),  1  trephine  (small  crown),  1  bone  forceps 
(I.iston's  l»ng,  sharp,  spring  handle),  1  bone  forceps  (broad  edged,  slightly  curved,  spring  handle),  1  bone  forceps  (gnawing,  spring  handle),  1  bone  forceps 
(sequestrum,  spring  handle),  1  artery  forceps,  1  artery  needle,  1  artery  needle  key,  12  surgeon's  needles,  1  tourniquet  screw  with  pad,  1  tenaculum,  1 
scissors,  1  chisel,  1  gouge,  1  mallet,  4  drills  (with  one  handle),  2  retractors,  1  raspatory,  1  elevator,  1  brush,  12  yards  suture  wire  (iron),  J  oz.  ligature 
silk.  £  oz.  wax,  1  mahogany  case  (brass  bound,  slide  catch),  1  leather  pouch. 

2 The  Minor  Operating  Case  contained:  1  amputating  knife,  3  scalpels,  2  bistouries,  1  hernia  knife,  1  finger  knife,  1  artery  forceps,  1  ball  forceps,  1 
gullet  forceps,  1  dressing  forceps,  1  dissection  forceps,  1  artery  needle,  1  artery  needle  key,  12  surgeon's  needles,  1  tenaculum,  2  scissors,  1  trocar  and  canula. 
1  Belloc's  canula,  1  bullet  probe,  1  director,  1  cutting  pliers  (small),  6  steel  bougies  (silvered,  double  curve,  Nos.  1  and  2,  3  and  4,  5  and  6,  7  and  8,  9  and 
10,  11  and  12),  3  silver  catheters  (Nos.  3,  6,  and  9),  6  gum-elastic  catheters  (Nos.  1,  3,  5,  7,  9,  and  11),  24  suture  pins  (silvered),  6  yards  suture  wire  (iron), 
J  oz.  ligature  silk,  J  oz.  wax,  1  mahogany  case  (brass  bound,  slide  catch),  1  leather  pouch. 

3  The  rocket  Case  contained :  1  scalpel,  3  bistouries,  1  tenotome,  1  gum  lancet,  2  thumb  lancets,  1  razor  (small),  1  artery  forceps,  1  dressing  forceps, 
i  artery  needle,  6  surgeon's  needles,  1  exploring  needle.  1  tenaculum,  1  scissors,  1  director,  3  probes,  1  caustic  holder,  1  silver  catheter  (compound),  6  yards 
suture  wire  (iron),  J  oz.  ligature  silk,  J  oz.  wax,  1  liussiu  leather  case. 

4 The  Field  Case  contained:  2  amputating  knives  (one  long,  one  medium),  2  catlings  (one  long,  one  medium),  3  scalpels,  2  bistouries,  1  hernia 
knife,  1  finger  knife,  1  capital  saw  (long,  bow,  two  blades).  1  metacarpal  saw,  1  lley's  saw,  1  trephine  (conical),  1  bone  forceps  (broad  edged,  slightly 
curved,  spring  handle),  1  bone  forceps  (sequestrum,  spring  handle),  1  artery  forceps.  1  ball  forceps,  1  dressing  forceps,  1  dissection  forceps,  1  artery  needle, 
1  artery  needle  key,  12  surgeon's  needles,  1  tourniquet  screw  with  pad,  1  tenaculum,  2  scissors,  2  retractors,  1  trocar  and  canula,  1  raspatory,  1  elevator, 
1  brush,  1  bullet  probe,  1  director,  6  steel  bougies,  silvered,  double  curve  (Nos.  1  and  2,  3  and  4,  5  and  6,  7  and  8,  9  and  10, 11  nnd  12),  3  silver  catheters 
(Xos.  3,  6,  and  U),  6  gum-elastic  catheters  (Xos.  1,  3,  5,  7,  9,  11),  12  yards  suture  wire  (iron),  J  oz.  ligature  silk,  J  07.  wax,  1  mahogany  case  (brass  bound, 
slide  catch),  1  leather  pouch  ;  pocket  case  the  same  as  allowed  to  staff  surgeons. 


920 


THE    MEDICAL    STAFF    AND    MATERTA    OHIRURGICA. 


[CHAP.  XIV. 


FIG.  434. — Regulation  hospital  tent. 


The  hospital  tent1  in  use  previous  to  the  war  was  24  feet  in  length,  14  feet  6  inches  in 
breadth,  and  11  feet  6  inches  high;  it  was  bulky,  heavy,  and  difficult  to  pitch  in  windy 

weather.     By  the  action  of  an  army  board  in 
1860  its  size  was  reduced,  the  general  form 
being  retained.     Its  general  appearance  will 
be  seen  in  FIG.  434,  and  its  dimensions  were: 
length  14  feet,  breadth  ]  4  feet  6  inches,  height 
11   feet    (centre),   with   a  wall   4i    feet,  the 
whole  covered  with  a  "fly"  21  feet  6  inches 
by  14  feet.     The  weight  of  this  tent,  includ 
ing  its  poles  and  pins,  was  217  pounds.     Each 
tent  had  at  one  end  a  lapel  to  admit  of  two  or  more  tents  being  joined  and  thrown  into  one 
ward.     Each  hospital  tent  was  designed  to  accommodate  comfortably  eight  patients.     This 
tent  has  been  found  in  practice  to  answer  every  necessary  purpose.     By  the  Army  Regula 
tions  three  hospital  tents  were  assigned  to  each 
regiment,  also  one  Sibley  tent  and  one  common 
wedge  tent.     The  Sibley  tent  (PiG.  435)  is  con 
ical  in  shape,  18  feet  in  diameter  at  base  and  12 
feet  high,  with  an  opening  at  the  apex,  to  which 
is  fitted  a  hood  which  may  be  closely  fitted  or 
removed  at  pleasure.     The  absence  of  any  wall 
renders  it  inconvenient  and  illy  adopted  to  hos 
pital  purposes,  and  the  want  of  a  fly  renders  it 
almost  intolerable  on  account  of  heat  in  mid 
summer,  while  the  centre  pole  curtails  the  avail 
able  space  and   interferes  with   the   free  move 
ments  of  the  medical  officers  and  attendants.     It 
was  not  used  to  any  very  great  extent  for  hospital 
FIG.  435.-sit>iey  tent.  purposes.     The  wedge  tent  was  still  less  adapted 

to  hospital  purposes  though  found  convenient  as  an  adjunct  to  field  hospitals.  The  hospital 
tent  "fly"  alone  was  found  to  answer  an  admirable  purpose  in  sheltering  the  wounded  in 
mild  weather  or  when  it  was  inconvenient  or  impracticable  to  pitch  the  entire  tent. 

Surgeon  A.  P.  Meylert,  U.  S.  V.,  treated  about  eighteen  hundred  (1,800)  patients  in  a 
field  hospital  of  the  Army  of  the  Ohio  constructed  of  tarpauling,  such  as  was  used  by  the 
Quartermaster's  Department  for  covering  stores  and  forage,  and  remarks:  "The  chief  cause 
of  success  in  this  hospital,  I  believe,  was  in  the  mode  of  shelter  adopted.  The  difficulty  in 
obtaining  quarters  for  the  sick  and  wounded,  which  in  the  outset  I  regarded  as  the  greatest 
possible  calamity,  was  no  doubt  of  the  utmost  advantage,  since  it  led  to  the  adoption  of 
those  cool,  clean,  and  airy  wards,  in  which  I  am  satisfied  the  patients  improved  more  rapidly 
and  surely  than  in  either  wall  or  hospital  tent  or  in  ordinary  buildings.  Whenever  it  was 
practicable,  board  floors  were  placed  in  the  tents,  resting  on  sleepers  placed  directly  on  the 
ground.  A  trench  from  6  to  8  inches  in  depth,  dug  around  the  base,  and  loose  earth  thrown 
around  the  lower  edge  of  the  tent  wall  in  cold  weather,  completed  the  arrangement." 

1  In  October,  1809,  a  board  of  medical  officers,  consisting'  of  Surgeons  C.  A.  Finley,  R.  S.  Satterlee,  C.  S.  Tripler,  J.  M.  Cuyler,  and  Assistant  Sur 
geon  R.  H.  Coolidge,  had  recommended  for  the  army  the  following  allowance  of  tents  for  the  sick  and  wounded  and  their  attendants  :  For  one  company, 
1  Sibley  tent  and  1  common  tent ;  for  three  companies,  1  hospital  tent,  1  Sibley  tent,  and  1  common  tent ;  for  five  companies,  2  hospital  tents,  1  Sibley 
tent,  and  1  common  tent ;  for  ten  companies,  3  hospital  tents,  1  Sibley  tent,  and  1  common  tent. 


CHAP,  xiv.]  MATERIA    CHIRURGICA.  921 

The  bedsteads  used  in  the  hospital  tents  were  cots  of  a  light  frame-work  of  stout  wood, 
provided  with  four  folding  legs  and  furnished  with  a  jointed  support  near  the  head.  The 
whole  frame-work  was  covered  with  sacking,  and  throughout  the  war  proved  a  most  useful 
and  satisfactory  hospital  cot.  It  was  light,  strong,  easily  transported,  and  was  comfortable 
to  the  patient. 

Various  modes  were  employed  for  heating  hospital  tents  in  the  field.  Wood-burning 
stoves  were  largely  used,  their  chief  objection  being  the  difficulty  of  transportation.  The 
plan  which  was  most  generally  in  vogue,  particularly  in  the  Army  of  the  Potomac,  and 
which  gave  the  utmost  satisfaction,  was  that  known  as  the  California  plan.  A  pit  was  dug 
about  two-and-a-half  feet  deep  outside  the  door  of  the  hospital  tent;  from  this  a  trench 
passed  longitudinally  through  the  tent,  terminating  outside  its  farther  or  closed  extremity. 
At  this  point  a  chimney  was  formed  by  barrels  placed  one  upon  the  other,  or  by  some  other 
simple  plan.  The  joints  and  crevices  of  this  chimney  were  cemented  with  clay.  The  trench 
in  the  interior  of  the  tent  was  roofed  over  with  plates  of  sheet-iron  issued  for  that  purpose 
by  the  Quartermaster's  Department.  A  fire  was  built  in  the  pit,  and  the  resulting  heat, 
radiating  from  the  sheet-iron  plates,  kept  the  interior  of  the  tent  warm  and  comfortable 
even  in  the  coldest  weather.  In  the  western  armies,  in  the  trench  in  the  interior  of  the 
tent,  railroad  iron  was  placed  in  regular  layers  and  covered  with  iron  plates  when  possible 
to  procure  them,  or  with  stone  slabs.  Occasionally  funnel-shaped  stoves,  open  at  the  bottom, 
resting  upon  the  ground,  and  provided  with  a  short  pipe,  were  used.  These  were,  however, 
objectionable.  The  wood  fire  burned  out  rapidly,  and  although  an  intense  heat  was  cre 
ated  while  it  lasted,  after  its  extinguishment  the  atmosphere  soon  chilled,  exposing  the  men 
to  rapid  and  uncomfortable  changes  of  temperature. 

From  an  examination  of  the  records  and  reports  in  this  office  it  would  appear  that 
the  first  regular  tent  field  hospital  was  organized  during  the  battle  of  Shiloh,  April,  1862, 
by  Dr.  B.  J.  D.  Irwin,  U.  S.  A.,  Medical  Inspector  of  the  4th  Division,  Army  of  the  Ohio. 
His  interesting  description  is  here  given  :  "During  the  military  movements  of  troops  during 
the  battle  of  Shiloh,"  Dr.  Irwin  says,  "one  of  the  operating  hospitals  was  moved  forward 
to  a  deserted  farm-house  situated  on  an  open  level  piece  of  unbroken  ground.  The  presence 
of  a  spring  of  cool  potable  water  and  the  nearness  of  the  building  to  a  branch  of  the  creek 
were  advantages  that  were  promptly  recognized,  and  but  a  short  time  elapsed  ere  these  valu 
able  desiderata  were  utilized  in  providing  shelter  and  other  comforts  for  the  large  number  of 
wounded  of  our  own  division  and  those  disabled  on  that  part  of  the  field  in  the  preceding 
day's  conflict,  pertaining  to  both  of  the  contending  parties,  left  on  the  field  without  assistance 
some  twenty-four  to  thirty-six  hours.  The  proximity  of  this  field  hospital  to  the  recaptured 
camp  of  a  division  of  our  troops  defeated  and  made  prisoners  the  preceding  day,  suggested 
the  utilization  of  the  abandoned  tents  for  the  benefit  of  the  wounded;  and  as  soon  as  the  battle 
ceased  the  hospital  tents,  commissary  tents,  and  wall  tents  pertaining  thereto  were  accordingly 
taken  possession  of,  and  in  a  short  space  of  time  were  removed  to  and  pitched  in  regular 
order  on  the  level  ground  by  which  the  house  was  surrounded.  The  building  afforded  an 
operating  room,  dispensary,  office,  kitchen,  and  dining-room.  Long  into  the  night  the  ambu 
lances  continued  to  bring  in  the  wounded,  who,  after  receiving  the  necessary  professional 
attendance,  were  made  as  comfortable  as  possible  by  being  supplied  with  an  abundance  of 
warm  food,  good  bedding,  and  shelter  from  the  inclement  weather.  Next  day  the  hospital 
camp  was  enlarged  so  as  to  accommodate  some  300  patients,  and  the  tents  were  system 
atically  arranged;  all  bedsteads,  cots,  bedding,  cooking  and  messing  utensils,  hay  and 

SlTKG.    ill— 110 


922  THE    MEDICAL    STAFF    AND    MATERIA    CHIRURGICA.  [CHAP.  XIV. 

straw  found  in  the  abandoned  camp  were  taken  possession  of,  and  on  the  evening  of  the  8th 
the  Division  Medical  Purveyor  reached  us  with  our  medical  supplies  and  hospital  stores.  By 
this  time  the  hospital  had  assumed  the  proportions  and  discipline  of  a  well  regulated  army 
camp,  arranged  with  a  view  to  meet  the  special  wants  of  those  for  whom  it  had  been  estab 
lished.  Some  mattresses  were  secured,  and  the  bed-sacks,  filled  with  hay  and  straw,  were 
placed  on  cots,  bedsteads,  or  improvised  bunks,  so  that  almost  every  patient  was  provided 
with  comfortable  sleeping  accommodations.  A  suitable  number  of  attendants  of  each  class 
was  detailed  for  duty  in  the  establishment,  which  was  placed  under  the  charge  of  Surgeon 
Menzies,  1st  Kentucky  Volunteer  Infantry,  so  that  the  invalids  were  promptly  and  regu 
larly  supplied  with  abundance  of  properly  prepared  nutritious  food,  and  even  a  fair  supply 
of  extra  diet  and  delicacies  were  served  to  the  inmates  requiring  special  attention.  It  soon 
became  manifest  that  the  wounded  in  this  improvised  field  hospital  were  better  provided 
for  and  more  comfortable  in  every  way  than  those  who  were  moved  aboard  the  hospital 
transports.  *  *  *  In  illustration  of  how  the  efforts  made  to  ameliorate  the  condition 
of  the  wounded  were  appreciated  the  following  official  communication  was  published,  viz: 

"'HEADQUARTERS  FOURTEI  DIVISION,  ARMY  OF  THE  OHIO, 

FIELD  OF  SHILOH,  April  12,  1862. 
"  Col.  J.  B.  FRY, 

Assistant  Adjutant  General,  Chief  of  Staff. 

"'SiR:  I  desire  to  call  the  especial  attention  of  the  General  commanding  this  Army  to  the 
admirable  hospital  accommodations  adopted  by  Dr.  Irwin,  U.  S.  A.,  Medical  Inspector  of  the 
Division,  during  the  battle  of  the  7th  iiist.  They  will  be  found  as  nearly  perfect  as  the  circum 
stances  would  allow.  The  wounded  in  the  Division  did  not  suffer  from  the  inclement  weather ;  they 
were  all  promptly  sheltered  and  cared  for.  I  beg  to  recommend  Dr.  Irwin  to  the  favorable  con 
sideration  of  his  superiors. 

'"Very  respectfully, 
(Signed)  <"W.  NELSON", 

" ' Brigadier  General."1 

"Thus  was  established  ihe  first  tent  field  hospital  of  any  magnitude  for  the  reception  and 
treatment  of  the  wounded  on  the  field  of  battle.  In  the  movements  of  the  armv  following 

./  O 

Shiloh  and  culminating  in  the  siege  of  Corinth,  Miss.,  the  utility  of  large  field  hospitals  was 
recognized,  and  soon  developed  into  a  system  which  became  general  in  the  combined  armies 
engaged  in  the  investment  of  that  place.  *  *  :;:  Further  experience  in  the  treatment 
of  the  sick  and  wounded  under  canvas  demonstrated  the  many  great  advantages  possessed 
by  such  hospitals  over  those  established  in  churches,  houses,  and  other  structures  temporarily 
used  as  hospitals,  such  as  the  wooden  and  iron  huts  used  by  the  allied  armies  in  the  Crimea, 
or  those  established  in  large  buildings,  especially  when  not  constructed  in  accordance  with 
modern  sanitary  science.  Numerous  tent  hospitals  of  much  greater  capacity  were  estab 
lished  and  kept  in  successful  operation  during  the  last  two  years  of  the  war,  it  having  been 
satisfactorily  shown  that  the  wounded  who  were  treated  under  canvas  did  better  in  every 
way,  and  recovered  sooner  than  those  treated  in  the  large  permanent  hospitals." 

The  consideration  of  the  construction,  organization,  and  administration  of  permanent 
or  general  hospitals  is  deferred  to  thoT]nrd  JVfpdical  Volume  of  the  Medical  and  Surgical 
History  of  the  War. 

([UNIVERSITY)) 


CHAP.  XV.] 


TRANSPORTATION    OF    THE    WOUNDED. 


923 


CHAPTER    XV. 


TRANSPORTATION  OF  THE  WOUNDED. 


The  first  removal  of  the  wounded  from  the  battle-field  was  generally  effected  by  means 
of  hand  litters.  The  number  of  litters  issued  during  the  war  exceeded  fifty  thousand1 
(50,000).  From  the  Purveyor's  Office  at  New  York,  Brigadier  General  R.  S.  Satterlee 
reports  that  from  April  1,  1861,  to  August,  1865,  sixteen  thousand  eight  hundred  and  seven 
(16,807)  hand  litters  were  issued.  At  the  Medical  Purveyor's  Depot  at  Louisville,  from 
November,  1863,  to  August,  1865,  seven  thousand  and  ninety-eight  (7,098)  hand  stretchers 
were  issued,  and  Surgeon  D.  L.  Magruder,  U.  S.  A.,  estimated  that  four  thousand  seven 
hundred  and  thirty-two  (4,732)  had  been  given  out  before  November,  1863.  The  Medical 
Purveyor's  Office  at  Philadelphia  issued,  from  January,  1863,  to  August,  1865,  five  thousand 
five  hundred  and  forty-eight  (5,548),  and  the  Office  at  New  Orleans,  from  September,  1864, 
to  the  end  of  the  war,  eight  hundred  and  thirty-five  (835)  stretchers.2 

In  the  beginning  of  the  war  the  Satterlee,  or  U.  S.  Regulation  litter  (FlG.  436),  was  sup 
plied  to  the  regiments.  It  weighed  twenty  -four  and  one-half  pounds  and  was  twenty-seven 
inches  wide.  The  canvas 
consisted  of  two-pieces,  five 
feet  ten  inches  long,  sewed 
in  the  centre  with  a  flat 
seam,  and  with  a  hem  on 
either  side  seven  and  one- 
half  inches  wide,  through  which  the  poles  were  passed;  there  was  an  inch  and  a  half  hem 
on  each  end;  on  one  end  were  three  tarred  rope  loops  to  put  over  the  pins  on  the  cross-bar, 

'The  Records  of  the  Property  Division  of  the  Surgeon  -General's  Office  show  that  from  1861  to  1865  fifty-two  thousand  four  hundred 
and  eighty-nine  (52.489)  litters  of  various  manufacture  were  purchased  and  issued  to  the  troops. 

2  Extemporaneous  modes  of  conveying  wounded  from  the  field  of  battle  can  only  be  briefly  alluded  to.  Stout  sticks  or  muskets  may 
bo  passed  through  the  sleeves  of  a  coat,  or  rolled  into  the  edges  of  blankets  and  a  litter  thus  be  formed.  Hurdles,  gates,  or  ladders,  with 
blankets  or  straw  thrown  over  them,  have  made  useful  stretchers.  Poles  interlaced  with  ropes  or  telegraph  wire  have  been  found  to 
answer  the  purpose  of  a  litter.  The  editor  was  once  oblisred  to  transport  a  soldier,  wounded  in  the 
abdomen,  a  distance  of  twelve  miles  along  the  narrow  bed  of  a  creek  filled  with  boulders  and  obstruc 
tions  :  "I  was  fortunate  enough  to  find  two  ash  saplings  which,  with  a  blanket  stretched  across,  made, 
an  improvised  litter,  on  which  my  patient  was  borne  by  relays  of  men  with  comparative  ease  ami  com 
fort.  At  another  lime  a  man  belonging  to  a  small  detachment  sent  out  from  a  scouting  parly  was 
wounded  in  the  leg  by  the  accidental  discharge  of  a  musket.  Finding  it  impossible  to  place  the  man 
on  horseback,  and  unsafe  to  detach  a  small  paity  to  seek  the  main  command,  his  comrades  carried 
him  a  distance  of  about  three  miles  by  forming  a  scat  with  their  hands  and  arms  similar  to  the  chairs 
made  by  children  in  their  games  (Fig.  437).  During  the  late  war  I  saw  a  soldier  who  had  been  wounded 
nt  some  distance  from  his  command  conveyed  to  a  place  of  safety  by  laying  him  prone  across  a  saddle, 
the  stirrup  of  one  side  being  sufficiently  lengthened  to  afford  support  for'one  foot.  The  horse  with 
his  burden  was  then  led  quite  a  distance.  I  am  familiar  with  another  instance  where  a  man,  badly 
wounded,  was  conveyed  about  a  three-days'  journey  in  a  cot  or  hammock  formed  by  securing  a  blanket 
to  two  lariat  ropes  ;  the  ends  of  the  ropes  were  gathered  and  carried  by  his  comrades  on  horseback. 
All  military  surgeons  know  of  instances  where  wounded  men  have  been  carried  from  the  battle-field  on  muskets  with  an  overcoat  laid  upon 
them  for  a  bed.  Under  the  urgent  demands  of  necessity  the  fruits  of  ingenuity  are  snre  to  come  to  the  rescue."  (See  Circular  No.  9,  On  tJie 
Transport  of  Sick  and  Wounded  by  Pack-Animals,  Washington,  1877,  p.  27.) 


FIG.  436. — SATTEHLEE  or  Regulation  hand  litter. 


437  _  Seat  made  by  clasping  hands. 


924  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  XV. 

and  two  five-inch  drilling  loops  for  pulling  the  canvas  over  the  poles;  at  the  other  end  were 
three  eyelet-holes,  with  a  piece  of  rope  three  feet  long  and  spliced  into  one  of  the  holes  for 
fastening  the  canvas  to  the  pins  on  the  other  cross-bar.  The  poles  were  made  of  seasoned 
red  ash,  were  one  and  one-half  inches  in  diameter  and  eight  feet  nine  inches  long.  Sixteen 
inches  from  either  end  of  the  poles  were  wrought-iron  bands  three-sixteenths  of  an  inch  thick 
and  three-fourths  of  an  inch  wide,  and  riveted  to  the  poles  as  shoulders  for  the  cross-bars 
to  strike  against.  The  cross-bars  weighed  six  and  one-fourth  pounds;  they  were  made  of 
seasoned  white  ash,  one  and  one-half  inches  thick  by  twenty-four  inches  long.  A  piece  of 
wrought-iron,  six  feet  long  by  one  inch  wide  and  one-fourth  of  an  inch  thick,  was  so  curved 
as  to  form  the  legs1  and  sockets  on  either  end  of  the  wooden  cross-bar  for  the  poles  to  pass 
through,  and  was  fastened  by  two  rivets,  one  at  each  end;  the  pin  in  the  centre,  on  which  the 
canvas  was  looped,  was  used  as  a  third.  The  three  pins  in  each  cross-bar  were  made  of  half- 
inch  iron,  and  projected  one  inch,  with  heads  to  keep  the  loops  from  slipping  off.  The 
shoulder  straps  weighed  one  and  one-half  pounds,  were  made  of  leather  two  inches  wide, 
five  feet  eight  inches  long,  with  a  three  and  one-half  inches  loop  at  one  end  and  a  buckle  at 
the  other  end  for  adjustment  on  the  handles  of  the  stretcher.  One  objection  to  the  Satterlee 
litter  was  its  bulk,  which  seriously  interfered  with  its  conveyance  in  large  numbers. 

The  Halstead2  litter,  a  stretcher  of  lighter  and  more  compact  pattern  (FiG.  438),  soon 
superseded  the  Satterlee.    It  weighed  twenty-three  and  three-fourths  pounds  and  was  twenty  - 

^    three  and  one-half  inches  wide;  the 

length  of  the  canvas   (unbleached) 
was  five  feet  eleven  inches,  being 
M  ^  fastened  on  the  outer  side  of  the  rave 

FIG.  438,-HALSTEAu's  litter.  with   six-ounce   tacks.      The   poles 

were  made  of  seasoned  white  ash,  eight  feet  long  and  one  and  five-sixths  inches  square,  with 
thirteen  inches  at  one  end  and  twelve  inches  at  the  other,  extending  beyond  the  canvas,  and 
rounded  off  for  handles.  The  legs,  which  were  also  made  of  seasoned  white  ash,  were  four 
teen  and  one-half  inches  long,  one  inch  thick,  one  and  seven-eighths  inches  wide  at  the  top, 
and  tapering  to  one  and  three-eighths  inches  at  the  bottom.  They  were  fastened  to  the  poles 
with  screw  bolts,  washers  under  the  heads  of  the  bolts,  and  rivets  through  the  upper  end 
of  the  legs  to  prevent  them  from  splitting.  The  braces  to  hold  the  stretcher  open,  one  (on 
the  under  side)  at  either  end,  consisted  of  two  pieces  of  wrought-iron  one  inch  wide  by  three- 
eighths  of  an  inch  thick;  one  piece  was  fifteen  inches  and  the  other  twelve  inches  in  length, 
hinged  in  the  centre  of  the  stretcher,  the  longer  one  overlapping  the  shorter  three  and  one- 
half  inches,  and,  when  open,  shutting  on  a  bolt  or  pin,  forming  a  stiff  shoulder  for  the  hinge 
and  preventing  the  stretcher  from  accidentally  closing.  The  braces  were  fastened  on  with 
heavy  screws,  with  pieces  of  common  hoop  iron  underneath  the  brakes  to  prevent  them  from 
wearing  the  wood.  The  shoulder  straps  weighed  eight  ounces,  and  were  made  of  striped 
cotton  webbing  two  and  one-half  inches  wide  by  fifty  inches  long,  with  a  five-inch  loop  at 
one  end  and  a  leather  strap  twenty-two  and  one-half  inches  long  by  one  and  one-sixth 
inches  wide,  with  buckle,  at  the  other  end  to  loop  around  the  handles  of  the  stretcher  at 
any  length  desired.  A  hair  pillow  covered  with  canvas  accompanied  this  stretcher,  which 

1  Professor  LOXGMORK  in  his  Treatise  on  the  Transport  of  Sick  and  Wounded  Troops,  London,  1800,  p.  129,  has  probably  mistaken  the  iron  feet  for 
yoke  pieces,  as  he  speaks  of  the  absence  of  feet  in  the  litter. 

2  In  the  preliminary  report,  Circular  No.  6,  S.  O.  O.,  1805,  p.  81,  this  litter  is  erroneously  called  the  Smith  hand  litter ;  the  litter  there  designated  as 
the  Halstead  litter  was  a  stretcher  issued  by  the  Sanitary  Commission.     It  is  to  be  regretted  that  these  errors  have  misled  Professor  LOXOMOKE,  who  iu 
his  excellent  Treatise  on  the  Transport  of  Sick  and  Wounded  Troops,  p.  141,  reproduced  the  wood  cuts  from  Circular  No.  6. 


CHAP,  xv.] 


LITTEES. 


925 


Fio.  439. — Sanitary  Commission  litter. 


gave  great  satisfaction,  and  out  of  the  litters  (16,807)  issued  by  the  New  York  Purveying 
Depot  twelve  thousand  eight  hundred  and  sixty-seven  (12,867)  were  of  this  pattern 

Of  the  litter  shown  in  FIG.  439 
and  known  in  New  York  as  the  San 
itary  Commission  litter,  few  were 
issued ;  it  was  too  fragile  for  the  hard 
usage  of  actual  warfare. 

A  drawing  of  the  litter  used  in  the  Confederate  armies  is  shown  in  FIG.  440,  and  has 
been  copied  from  Chisolm.1     Its  construction  was  very  simple  and,  with  the  exception  of 
the  mode  of  securing  the  duck  cloth,  or  sacking,  to  the  frame,  needs  n'o  explanation:   "A 
groove  three-quarters  of  an  inch 
wide  and  five-eighths  of  an  inch 
deep  is  cut  out  in  the  length  of 
the  frame.    The  cloth  is  tacked 


FIG.  440.— Confederate  litter. 


FIG.  441.— SCHELL'B  litter. 


in   this  and  secured  by  a  lath 
which  fits  accurately  the  groove 
and  which  is  nailed  in,  covering 
the  cloth.      The  tension  upon  the  cloth  is  not  borne  by  the  tacks,  but  is  uniformly  sup 
ported  by  the  entire  lath,  and  therefore  never  rips  off." 

A  litter  to  be  used  as  a  bedstead  was  proposed  by  Assistant  Surgeon  Henry  S.  Schell, 
in  1862,  in  a  letter  to  Medical  Inspector  Vollurn,  U.  S.  A.:  "I  beg  leave  to  suggest  that 
the  hand  litter  at  present  in  use 
be  somewhat  modified,  so  that  it 
may  be  arranged  as  a  bedstead 
in  the  hospital  tent  when  it  is 
desirable  to  have  a  large  number 
of  beds  quickly  made  up.  It 
generally  takes  a  day,  perhaps  more,  to  prepare  bedsteads,  or  rather  to  build  them,  so 
that  they  may  be  elevated  from  the  damp  and  uneven  surface  of  the  ground.  The  present 
stretcher  cannot  be  used  to  make  two  rows  of  beds,  with  a  passage  from  door  to  door 
between  them  in  the  usual  manner,  because 
of  its  length.  The  litter  (FiGS.  441,  442) 
which  I  would  propose  is  constructed  of  two 
parallel  bars,  each  six  feet  two  inches  long, 
connected  by  a  strong  canvas,  and  separated 
by  a  jointed  iron  rod  about  six  or  eight  inches 
from  each  end,  somewhat  similar  to  those  on  the  litter  now  in  use.  To  the  ends  of  each  of 
the  parallel  wooden  bars  a  shorter  one,  ten  inches  long,  is  joined  by  a  strong  hinge  placed 
underneath.  This  latter  bar  constitutes  the  handle  when  used  as  a  stretcher,  or  the  leg 
when  used  as  a  camp  bedstead.  It  is  retained  in  the  upright  position  by  a  short  iron  stay, 
as  seen  in  the  figure.  I  have  long  felt  the  want  of  such  an  arrangement  when  arriving  in 
camp  and  wishing  to  pitch  the  hospital  tent  immediately.  The  hinge  will  be  found  to 
last  much  longer  than  the  canvas.  As  each  ambulance  carries  two  stretchers,  a  hospital 
may  be  improvised  from  these  very  readily." 

1  CHISOLM  ( J.  JULIAN1,  .1  Manual  of  Military  Surgery  for  the  Use  of  Surgeons  in  the  Confederate  States  Army,  Columbia,  18fv»,  :td  edition,  page 
530.  and  PLATK  1. 


FIG.  442. — SCHELL'8  litter  used  as  a  cot. 


926 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


Fir,.  443. — Hand-litter  carriage — scale  J  inch  to  the  foot. 


In  the  last  year  of  the  war  an  order  was  issued  for  the  construction  of  a  form  of  litter1 
on  wheels  (FiG.  443),  similar  to  one  used  advantageously  in  the  Danish  war  of  1864, 

but  there  are  no  reports 
/\  that  indicate  its  prac 

tical  utility. 

The  modes  of  carry 
ing  wounded   men    on 


horse  or  mule  litters 
during  the  war  have 
been  fully  described  in 
Circular  No.  9,  Surgeon 
General's  Office,  March 
1,  1877,  and  we  cannot 
do  better  than  to  repro 
duce,  with  a  few  addi 
tional  remarks,  the  ac 
count  given  there  by  the  author,  the  late  Surgeon  George  A.  Otis,  U.  S.  Army: 

"In  the  Revised  Regulations  for  the  Army  of  the  United  States  for  1861,  Paragraph 
1298  reads:  'Horse  litters  may  be  prepared  and  furnished  to  posts  whence  they  may  be 
required  for  service  on  ground  not  admitting  the  employment  of  two-wheeled  carriages;  said 
litters  to  be  composed  of  a  canvas  bed  similar  to  the  present  stretcher,  and  of  two  poles, 
each  sixteen  feet  long,  to  be  made  in  sections,  with  head  and  foot  pieces  constructed  to  act 
as  stretchers  to  keep  the  poles  apart.'  There  is  no  record  that  these  litters  were  used 
during  the  war.2 

"During  the  progress  of  the  late  war  in  this  country  a  number  of  persons,  actuated  by 

motives  of  patriotism, 
humanity,  or  interest, 
devised  and  brought  to 
the  notice  of  the  War 
Department  forms  of 

Flo.  444. — United  States  Army  regulation  two-horse  litter.     [From  a  sample  in  the  Army  Medical  Museum.]        nr\r\  veVanCC  for  tll6  sick 

and  wounded  in   localities   impracticable  for   wheeled   vehicles,  that  were  represented  as 
improvements  upon  existing  patterns.     Several  of  these  were  apparently  suggested  by  the 
descriptions  of  Delafield3  and  McClellan4  of  the  horse  litters  and  cacolets  they  had  observed 
in  the  Crimea.     In  October,  1861,  W.  C.  H.  Waddell  forwarded  to  Secretary  Cameron  a« 
proposal  to  construct  cacolets  and  litters  for  army  use,  accompanied  by  drawings  (FiGS. 

'GUULT  (E.),  Militdr-chirurgische  Fragmente,  Berlin,  18G4,  p.  G.     XEUDOKFER  (J.),  Handbuch  der  Kricgschirurgie,  etc.,  Leipzig,  18G4. 

2 Professor  T.  LOXGMOIIE,  in  his  excellent  Treatise  on  the  Transport  of  Sick  and  Wounded  Troops,  London,  1809,  p.  292,  thus  refers  to 
this  form  of  litter:  "It  is  necessary  to  notice  another  form  of  wick-transport  litter  issued  for  use  in  the  early  part  of  the  late  war  in  the 
United  States,  in  which,  instead  of  two  litters  being  suspended  across  one  horse  or  mule,  one  litter  was  suspended  between  two  horses. 
This  is  a  very  ancient  form  of  litter  in  Europe.  Frequent  notices  of  it  occur,  showing  its  common  use  on  occasions  of  state  and  ceremony, 
as  well  as  its  employment  for  the  carriage  of  sick  persons,  in  the  records  of  our  own  country  prior  to  the  introduction  of  coaches.  It  seems 
curious  that  its  use  should  have  been  revived  in  modern  times  in  America."  In  a  note  it  is  added:  "  This  form  of  litter  is  referred  to  as 
late  as  the  reign  of  Charles  II.  A  quotation  introduced  into  the  first  volume  of  Knight's  London,  pp.  24  and  25,  mentions  that  'Major 
General  Skipton,  coming  in  a  horse-litter  to  London  when  wounded,  as  he  passed  by  the  brew  house  near  St.  John  street,  a  fierce  mastiff 
flew  at  one  of  the  horses  and  held  him  so  fast  that  the  horse  grew  mad  as  a  mad  dog:  the  soldiers  were  so  amazed  that  none  had  the  wit  to 
shoot  the  mastiff;  but  the  horse-litter,  borne  between  the  two  horses,  tossed  the  major-general  like  a  dog  in  a  blanket.'  " 

3Rppprt  on  the  Art  of  War  in  Europe  in  1854,  1855,  and  1856,  by  Major  KlCHAKD  DELAFIEI.D,  Corps  of  Engineers,  from  his  Xotes  and  Observa 
tions  made  as  a  member  of  a  ''Military  Commission  to  the  Theatre  of  War  in  Europe,"  Washington,  I860. 

4  Report  of  the  Secretary  of  War,  communicating  the  Report  of  Captain  GEORGE  B.  McCr.K.l.LAN  ( First  Regiment  United  States  Cavalry),  one 
of  the  officers  sent  to  the  Seat  of  War  in  Europe  in  1855  and  1856,  AVashington,  1857. 


CHAP.  XV.)  CACOLKTS.  "  927 

446,  447)  copied  from  Delafield's  report,  and  suggested  some  trivial  modifications.  In 
November,  1861,  Mr.  G.  Kohler  offered  to  furnish  rnule  litters  and  chairs  of  patterns 
imitated  from  those  used  in  the  Crimea.  In  July,  1862,  three  hundred  of  these  litters  were 
purchased.  In  April,  1862,  Surgeon  Glover  Perin,  U.  S.  A.,  and  Assistant  Surgeon  Benja 
min  Howard,  U.  S.  A.,  reported  to  Surgeon  General  C.  A.  Finley  the  results  of  their 
inspection  of  cacolets  and  litters  devised  by  Mr.  Charles  Proal,  of  Louisville.1  News 
paper  descriptions,  almost  textually  quoted  from  Delafield's  report,  with  figures  of  these 
appliances,  were  transmitted.  -Mr.  Proal  claimed  to  have  improved  upon  the  French 
patterns  by  diminishing  the  weight  and  cost  of  construction.  Messrs.  Lawrence,  Bradley 
&  Pardee,  of  New  Haven,  Connecticut,  in  1861,  applied  for  a  patent  for  a  cacolet  of  cum 
brous  pattern,  weighing  131  pounds.  The  chairs 
could  not  be  detached  from  the  saddle.  A.  sample, 
figured  in  the  adjoining  wood-cut  (FiG.  445),  was 
sent,  in  1867,  to  the  Army  Medical  Museum,  and  is 
numbered  824  in  Section  VI.  It  combines,  in  an 
unusual  degree,  the  undesirable  qualities  of  weight, 
weakness,  and  inconvenience.  On  September  25, 

1862,  a  board   of   officers   of   the  Quartermaster's 
Department   examined    cacolets    submitted  by  Dr. 

1          .    1  VlC*.  44.~>. — Cacoiet   of  Lawrence,    Bradley  &  Pardee.     Spec. 

blade  Davis,  and  reported  ~  that,  as  compared  with  884,  SECT,  vi,  A.  M.  M. 

others  that  had  been  purchased  for  the  service,  the  only  advantage  of  this  form  of  cacolet  was 
its  lightness.  It  was  thought  that  those  already  on  hand  were  as  light  as  was  consistent 
with  the  requisite  degree  of  strength.  Mr.  E.  P.  Woodcock,3  of  New  York,  in  November, 

1863,  patented  a  pack-saddle  with  wooden  outriggers  from  the  pommel  and  can  tie  for  the 
suspension  of  litters.     By  securing  litters  to  the  -projecting  parts  by  straps,  and  protecting 
the  sides  of  the  animal  by  pads,  it  was  designed  to  carry  two  patients  in  the  recumbent 
position.     This  contrivance  was  exhibited  by  the  United  States  Sanitary  Commission  at  the 
Exposition  in  Paris  in  1867,  but  met  with  no  more  approval  abroad  than  at  home.     Mr.  J. 
Jones,4  of  New  York,  in  December,  1862,  proposed  to  the  Surgeon  General  of  the  Army  a 
mule  litter  for  carrying  two  persons  either  in  a  sitting  or  recumbent  position,  the  litters  being 
designed  to  serve  also  as  efficient  hand  stretchers  or  hospital-beds.     The  'exceeding  light 
ness,  strength,  and  simplicity'  of  these  conveyances  were  insisted  on.     The  saddle  with 

'Extract  from  a  communication  to  Surgeon  General  C.  A.  FIXLEV,  by  Surgeon  G-.  PEKIN  aud  Assistant  Surgeon  B.  HOWARD,  dated 
Louisville,  April  2,  1862:  "  Tl:e  undersigned  would  respectfully  state  that  Mr.  CHARLES  PROAL,  of  this  city,  has  submitted  to  our  inspection 
a  saddle  ambulance,  which  has  been  fairly  tested  by  us  in  the  open  field.  Its  chief  excellences,  compared  with  other  saddle  ambulances, 
^ire  that  it  is  lighter,  is  more  easily  adjusted,  and  combines  both  the  litter  and  the  chair,  both  of  which  can  be  packed  away  in  a  very  small 
compass  when  the  pack-saddle  to  which  they  belong  is  required  for  other  purposes.  The  weight  of  the  entire  ambulance,  with  saddle,  etc., 
is  about  seventy-four  pounds,  that  of  the  French  being  about  one  hundred  and  forty -two  pounds.  The  mode  of  adjustment  is  such  that  two 
litters,  two  chairs,  or  one,  chair  and  one  litter,  can  bo  used  at  the  same  time,  .at  discretion,  each  of  which  may  be  affixed  to  or  detached  from 
the  saddle,  while  the  patient  remains  undisturbed.  The  harness  appears  to  be  very  complete,  the  breeching  and  breast-band  preventing 
motion  backward  or  forward,  while  the  surcingle,  by  being  attached  to  the  bottom  of  each  chair  or  litter,  prevents  either  undue  oscillation 
or  shifting,  which  would  be  otherwise  consequent  upon  any  inequality  in  the  weight  of  the  two  patients  being  carried  .  .  .  The  price  of 
the  ambulance  and  appurtenances  completed  is  about  $50." 

2 A  board  of  officers,  consisting  of  Colonel  D.  H.  RUCKEK,  Quartermaster,  Captain  J.  J.  DAXA,  A.  Q.  M.,  and  Captain  E.  E.  CAMP, 
A.  Q.  M.,  was  convened  at  Washington,  September  25,  1862,  to  "examine  a  cacolet  to  be  presented  for  inspection  by  Dr.  SLADE  DAVIS,  and 
to  report  its  opinion  of  the  cacolet,  as  compared  with  other  patterns  which  have  been  purchased  for  the  service.  The  board  reported  that 
"  in  their  opinion  the  cacolet  presented  by  Dr.  SLADE  DAVIS  possessed  an  advantage  over  those  furnished  by  Mr.  KOIILEK  (three  hundred  in 
number,  all  of  which  are  now  on  hand)  in  lightness  only.  Those  made  by  Mr.  KOHLEU  are  constructed  in  a  strong  and  desirable  manner, 
and  are  as  light  as  is  consistent  with  the  requisite  degree  of  strength.  No  call  has  yet  been  made,  either  for  those  first  purchased  or  for 
those  furnished  by  Mr.  KoiiLEii,  which  cost  $21,000.  We  would  not  recommend  the  purchase  of  an  additional  number  from  any  source." 

3  Compare  LOXGMOUE  (Treatise  on  the  Transport  of  Sick  and  Wounded,  etc.,  op.  cit.,  p.  290) :  Subject-matter,  Index  of  Patents  for  Inven 
tions,  Washington,  1874,  Volume  1H,  p.  1232;  and  SfciamiER  (Conferences  Internationale  des  Societe*  avx  Rlesses  Militaires  des  Armeen  de 
Terre  et  de  Her,  tcnues  <i  Paris,  cu  1867,  T.  I,  p.  47). 

••Manuscript  Records  of  War  Department  for  1862. 


928' 


TRANSPOETATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


two  litters,  girths,  bridle,  and  other  appurtenances  weighed  only  62  pounds,  and  could,  prob 
ably,  be  reduced  to  60  pounds.  In  September,  1863,  a  board  of  medical  officers  \v;is  con 
vened  in  Washington  to  examine  into  the  merits  of  an  adjustable  ambulance  and  pack- 
saddle,  'submitted  by  Spencer,  Nichols  &  Co.'  Lightness,  strength,  simplicity,  efficiency, 
adjustability,  and  cheapness  were  the  merits  claimed  for  this  contrivance."1  Shortly  after 
ward  (December  1,  1863)  another  medical  board  assembled  in  Washington  to  inspect  and 
report  on  a  mule  litter  submitted  by  Messrs.  Pomeroy  &  Co.,  which  was  found  to  possess 
some  good  and  some  objectionable  features.2  In  addition  to  these  essays  in  invention, 
cacolets  and  litters  were  submitted  to  the  Quartermaster's  Department  that  purported  to 
be  constructed  simply  in  accordance  with  drawings  in  General  Delafield's  report.3  August 
20,1861,  Messrs.  Lutz  &  Bridget,  harness-makers,  furnished  twenty  such  sets,  with  pack- 
saddles  and  harness.  These  drawings,  which  are  copied,  of  a  reduced  size,  in  FIGS.  446 

and  447,  though  prepared  by 
so  distinguished  an  artist  as 
Professor  Weir,  do  not  accu 
rately  represent  the  mechanical 
details  of  either  the  French  or 
British  Crimean  litters  and  cac 
olets,  and  the  ambulance  equip 
ments  made  in  imitation  of 
them  did  not  prove  to  be  of 
utility.  Early  in  the  war,  how 
ever,  probably  as  early  as  May, 
1861,  the  Quartermaster's 
Department  had  purchased  a 
number  of  cacolets  and  mule 
litters  of  the  pattern  used  in  the  French  army,  and  in  July,  1861,  engaged  Tiffany  &  Co., 
of  New  York,  to  construct  others,  and  employed  a  French  agent  to  give  instruction  in  the 

1  The  board,  consisting  of  Surgeon  T.  H.  BACHE,  U.  S.  V.,  Surgeon  C.  ALLEN,  TJ.  S.  V.,  and  Assistant  Surgeon  W.  Moss,  U.  S.  V., 
reported,  September  16.  1863 :  1.  That  the  cacolets  weighed  55J  pounds,  and  the  saddle-girths  and  other  equipment  38  pounds  ;  2.  The  saddle 
tree  was  jointed  so  that  by  turning  screws  it  could  be  adapted  to  animals  of  different  sixes ;  3.  As  to  simplicity,  the  saddle  was  provided 
with  projecting  crane-like  supports  of  hickory,  covered  with  raw-hide,  which  were  connected  either  with  a  flat  framework  of  hickory  for 
packs,  or  with  litters  for  patients ;  4.  As  to  strength,  the  saddle  easily  sustained  two  barrels  of  flour;  but  when  two  soldiers,  one  of  them  a 
heavy  man,  mounted  on  the  litters  there  was  a  "slight  yielding ;  "  but  the  board  considered  the  litters  "strong  enough  to  bear  any  load  that 
a  horse  or  mule  could  carry."  Finally,  the  board  considered  the  pattern  submitted  as  "comfortable  as  such  a  conveyance  can  be  made." 

2 The  board  consisted  of  Medical  Inspector  J.  M.  CUYLEU,  U.  S.  A.,  Surgeon  O.  A.  JUDSON,  TJ.  S.  V.,  and  Assistant  Surgeon  C.  A. 
McCALL,  TJ.  S.  A.  The  report  is  unaccompanied  by  a  description  or  drawing  of  tbe  conveyance,  but  states  that  it  was  simple  in  construc 
tion,  with  unusual  capacity  for  providing  for  the  comfortable  carriage  of  two  wounded  men.  Some  modifications  were  suggested,  such  as 
strengthening  the  attachments  of  the  litters  by  substituting  chains  for  straps ;  of  supplying  means  for  rendering  their  framework  rigid,  so 
that  they  might  be  used  temporarily  as  stretchers ;  of  arranging  that  they  might  bo  detached  from  the  saddle  ;  of  having  rings  and  hooks 
for  attaching  necessary  articles  to  the  pack-saddle,  and  particularly  a  vessel  for  water.  The  board  was  unwilling  to  decisively  approve  of 
the  conveyance  until  these  alterations  had  been  effected  and  a  trial  in  actual  service  had  been  successfully  made. 

3  DELAKIELU  (R.)  (Report  on  the  Art  of  War  in  Europe,  4-to,  Washington,  1860,  p.  73)  makes  the  following  observations  on  mule  litters  and  cacolets : 
"The  requisites  for  an  ambulance  should  be  such  as  to  adapt  it  to  the  battle-field,  among  the  dead,  wounded,  and  dying;  in  plowed  fields,  on  hill-tops, 
mountain  slopes,  in  siege  batteries  and  trenches,  and  a  variety  of  places  inaccessible  to  wheel  carriages,  of  which  woods,  thick  brush,  and  rocky  ground  are 
frequently  the  localities  most  obstinately  defended,  and  where  most  soldiers  are  left  for  the  care  of  the  surgeons.  These  difficulties  were  felt  in  a  great 
degree  by  all  the  armies  allied  against  Russia  in  the  siege  of  Sebastopol,  and  the  consequence  was  that  the  English,  French,  and  Sardinian  armies  adopted 
finally,  in  part  or  altogether,  pacJc-mules  carrying  litters  or  chairs.  The  careful  and  sure-footed  mule  can  wind  its  way  over  any  road  or  trail,  among  the 
dead,  dying,  ijnd  wounded  on  any  battle-field,  as  well  as  in  the  trench  and  siege  battery.  It  required  but  suitable  arrangements  to  support  the  wounded 
from  the  mule's  or  horse's  back  to  attain  the  desired  object,  and  this  the  allied  armies  finally  accomplished  and  put  in  practice.  The  merit  of  the  plan 
renders  it  worthy  our  consideration,  particularly  so  in  our  Rocky  Mountain  and  other  distant  expeditions."  Further  on  he  remarks:  "...  I  witnessed 
the  transport  of  one  hundred  and  ninety-six  sick  and  wounded  French  soldiers,  with  their  arms,  accoutrements,  and  knapsacks,  on  the  route  from  the 
Tchernaya  to  Kamiesch  Bay,  cm  these  litters  and  chairs.  Fifty -two-of  them  were  on  twenty-six  mules  in  the  horizontal  litters,  and  one  hundred  and  forty- 
four  seated  in  chairs  on  seventy-two  other  mules.  A  driver  was  provided  for  every  two  mules  or  four  wounded  men.  The  appearances,  with  such  an 
examination  as  I  gave  the  whole  equipment,  were  so  favorable  as  to  recommend  it  for  trial  in  our  service.  To  make  the  system  better  understood  I  annex 
two  additional  figures  (Flos.  446  and  447),  showing  the  animal,  the  equipment,  and  position  of  the  soldier,  for  which  compilation  and  drawing  1  am  indebted 
to  Professor  WEIB." 


FIG.  446.— British  Crimean  mule  litter.     [After  WEIR.] 


CHAP.  XV. J 


MULE    LITTERS    AND    CAOOLETiS. 


929 


FIG.  4-17. — British  Crimean  cacolet.     [After  WEIR.) 


use  of  these  cacolets  and  litters,  and  purchased  animals  specially  adapted  for  their  transport. 

The  Quartermaster  General  has  remarked  that  these  horses  and  mules  were  gradually  appro 

priated  as  draft  animals,  and  that  the  litters  and  cacolets  were,  for  the  most  part,  con 

demned  as  unserviceable.     The  French  litters 

and  cacolets  were  what  is  known  as  the  old 

pattern,  such  as  the  French  used  in  Algeria 

and  the  Crimea.     They  are  figured  in  the  surg 

ical  report  in  Circular  6,   S.  G.  0.,  1865,  at 

page  82.    Surgeon  General  Longmore  correctly 

observes   (op.   cit.,    p.    291)    that   'the   same 

drawings  may  also  be  seen  in  Chapter  XX  of 

M.  Legouest's  Traite  de  Chirurgie  d  '  Armee, 

Paris,  1863,  pp.  968-9.'    I  ventured  to  copy 

the  drawings  because  they  well  represented 

the  identical  cacolets  and  litters  issued  in  our 

army,   and   through    an  inadvertence,   which 

must  be  conceded  to  be  unusual  in  me,  I  neg 

lected    to    acknowledge    my    indebtedness  to 

my  honored  friend  and  master.     I  trust  this 

explanation  will  convince  him  and  every  one  that  I  had  no  surreptitious  design  in  using  the 

cuts.     In  the  mule  litters  and  cacolets  now  issued  in  the  French  army  there  are  improve 

ments  providing  for  making  the  sections  of  the  litter  rigid,  so  that  it  can  be  used  temporarily 

as  a  hand-stretcher,  for  reduction  in  weight,  and  for  greater  compactness  in  packing.1     The 

mule  chairs  and  litters  now  issued  by  the  British  Royal  Carriage  Department  are  lighter 

and  more  convenient  than  those  used  in  the 

Crimea.     I   take   the  liberty  of  copying  Sur 

geon   General 

Longmore's 

drawings  o 

cacolet 
FIG.  448)  and 

littf-r   (FiG. 

449)  now  em 

ployed  m  the 

British     serv 

ice.2  The  only 

reference    I 

find  of  the  act- 


PIG.  448.—  British  mule  chair  orcaeolet,  open  for 
use  and  packed  for  traveling.     [After  LONGMOKK.] 


Pl<--  441).  —  British  army  mule  litter  attached  to  the  pack-saddle.     [After 
LoN(;MOKF-l 


ment  in  battle,  during  the  late  war  in  this  country,  of  horse  litters  or  cacolets.  is  made 
by  Professor  F.  H.  Hamilton.  He  mentions  that,  at  the  battle  of  Fair  Oaks,  May  31, 
1862,  when  he  was  Medical  Director  of  the  Fourth  Army  Corps,  eight  pack-saddles,  pro- 

1  M.  BOUDIN  states  (Systeme  d  'ambulances  des  armies  Fran$aise  et  Anglaise,  1855.  p.  H5)  that  the  cacolet  weighed  something  over  1!)  kilogrammes 
the  pair.     The  pair  in  the.  Army  Medical  Museum  weighs  40  pounds.     Including  the  pack-saddle.  Professor  LONGMORE  says  a  pair  weighed  in  the  Crimea 
was  found  to  be  89  pounds  and  12  ounces. 

2  The  weight  of  a  pair  of  English  litters  used  in  the  Crimea  was  138  pounds  12  ounces  without  the  pack-saddle.     The  present  pattern  weighs  84 
pounds  without  bedding  or  pack-saddle.     With  palliasses  and  pack-saddle  the  weight  is  107  pounds. 

SUKG.    Ill—  117 


930  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  XV. 

vided  with  a  litter  on  one  side  and  a  cacolet  on  the  other,  were  provided  as  a  part  of  the 
ambulance  outfit  of  that  corps,  and  were  used  only  on  the  first  day  of  the  battle,  proving 
utterly  unserviceable.1  Notes  are  found  in  the  War  Department  of  the  transmission,  August 
26,  1861,  of  twelve  of  the  mule  litters  and  cacolets  made  by  Tiffany  &  Co.,  to  the  army  in 
the  Shenandoah  Valley,  commanded  by  General  Banks.  A  supply  of  litters  and  cacolets 
was  provided  for  the  advance  of  the  Army  of  the  Potomac  from  Yorktown  toward  Rich 
mond,  in  May,  1862.  There  were  forty,  at  least,  in  store  at  White  House,2  but  there  were 
no  trained  animals  to  bear  them.  Moreover,  the  subordinate  quartermasters  and  medical 
officers  appear  generally  to  have  regarded  the  experiment  with  little  favor.  Medical  Director 
Tripler,  who,  in  1859,  in  a  report  on  the  needs  of  the  ambulance  service,  had  urged  the 
importance  of  supplying  horse  litters  to  troops  serving  in  regions  impracticable  for  wheeled 
carriages,  made  several  efforts  to  secure  suitable  equipment  and  proper  animals3  for  this 
purpose,  but  without  much  success.  His  successor  also,  Medical  Director  Letterman,  enter 
tained  similar  views,  in  correspondence  with  the  opinions  of  European  authorities;  and 
persevering,  though  ill-arranged,  efforts  were  made  to  give  the -system  a  fair  trial.  In  July, 
1862,  the  Surgeon  General  requested  the  Quartermaster's  Department  to  provide  three  hun 
dred  litters,  and  this  number  was  purchased  of  Mr.  G.  Kohler.4  Prior  to  the  battle  of  Antietam 
Medical  Director  Letterman  asked  for  a  supply  of  mules  equipped  with  cacolets  and  litters.5 
The  Quartermaster's  Department  had  an  ample  supply  of  the  French  patterns,  which  were 
beyond  all  question  the  best  that  had  been  devised  at  that  time.  But  there  were  no  trained 
animals  to  bear  them,  and  few,  if  any,  available  skilled  packers.  September  1,  18G2,  the 
Surgeon  General  requested  that  a  hundred  mule  litters  should  be  sent  to  Medical  Inspector 
R.  H.  Coolidge.  A  few  weeks  after  the  battle  of  Antietam  a  hundred  and  fifty  mules  were 
sent  to  the  Army  of  the  Potomac  for  ambulance  service,  but  they  were  so  unruly  that  it 
was  thought  unwise  to  pack  them  with  their  equipment,  and  the  litters  and  cacolets  were 
sent  along  in  wagons,  and,  as  far  as  can  be  learned,  never  found  their  way  to  the  backs  of 
the  mules.6  Little  could  be  anticipated  from  such  essays.  In  November,  1862,  the  Sur- 

1  HAMILTON  (F.  H.)  (.4  Treatise  on  Military  Surgery  and  Hygiene,  1865,  p.  162):   "Just  before  the  battle  of  Fair  Oaks,  eight  were  sent  to  us  for 
the  use  of  the  4th  corps.     They  were  only  employed,  however,  on  the  first  day  of  the  battle.     The  horses  were  found  to  be  impatient  and  restless  under 
them,  and  six  of  the  eight  were  soon  broken  and  rendered  unfit  for  use.     Mules  are  better  than  horses  for  this  purpose ;  they  are  not  so  high,  and  arc  less 
restive  under  the  pressure  of  heavy  weights  upon  their  backs;  but  even  mules  require  to  be  trained  especially  to  this  kind  of  service  before  they  can  be 
rendered  useful  or  safe." 

2  From  a  telegraphic  order  of  May  27,  1862,  recorded  on  the  files  of  the  War  Department,  and  addressed  from  the  Headquarters  of  the  Army  of  the 
Potomac,  by  Lieutenant  Colonel  J.  A.  HARDIE,  to  Colonel  S.  VAN  VLIET,  Quartermaster,  at  White  House  on  the  Parnunkey,  it  appears  that  a  certain  num 
ber  of  cacolets  were  at  that  depot  prior  to  the  battle  of  Fair  Oaks.     The  dispatch  reads :  "  The  Commanding  General  directs  that  you  furnish  the  forty 
cacolets  at  the  White  House,  belonging  to  the  Medical  Department,  with  horses,  and  report  to  the  Medical  Director  here  the  moment  they  are  ready." 
Doubtless  the  eight  cacolets  sent  to  the  Fourth  Corps  were  supplied  from  this  source. 

3March  13,  1862,  on  receiving  the  papers  regarding  Mr.  KOHLER's  request  for  an  examination  of  his  litters  and  cacolets,  Medical  Director  TuirLER 
makes  the  indorsement  that:  "  there  are  sufficient  horse  litters  for  this  army  in  the  possession  of  the  Quartermaster's  Department.  All  we  want  now  is 
horses  or  mules  properly  trained  to  carry  them.  On  April  25, 1862,  Dr.  TRIPLER  stated  that  there  were  some  200  or  more  cacolets  furnished  by  the  Quar 
termaster's  Department,  and  that  he  made  every  effort  to  have  horses  trained  to  carry  them  with  their  loads;  that  orders  to  that  effect  were  issued  by 
General  McClellan,  but  were  not  executed. 

4  June  17,  1862.  Colonel  RUCKER  advises  the  Quartermaster  General  that  he  has  advertised  for  proposals  for  mule  litters,  and  that  the  only  proposal 
received  is  from  Mr.  G.  KOHLER,  and  that  the  litter  he  proposes  to  furnish  seems  to  be  very  high  priced :  "  It  is  intricate  and  cumbersome  in  construction, 
and,  in  my  opinion,  inferior  to  those  now  in  Captain  DANA'S  store-house"  [the  French  cacolet  and  litidrel-  July  26,  1862,  Surgeon  General  HAMMOND 
states,  in  reply  to  a  letter  from  the  Quartermaster  General  concurring  in  Colonel  Rucker's  opinion  :  .  .  .  "The  litter  presented  by  Mr.  KOHLER  has 
been  examined  by  myself  and  a  board  of  officers,  who  agree  that  it  possesses  sufficient  merit  to  entitle  it  to  trial  in  the  field.  I.therefore  request  that  three 
hundred  of  the  mule  litters  presented  by  Mr.  KOHLER  be  purchased  for  the  use  of  the  army."  Quartermaster  General  MEIGS  replies,  July  29,  1862,  that 
"inasmuch  as  the  Surgeon  General  adopts  and  requests  that  these  litters  be  constructed,  though  in  the  opinion  of  the  Quartermaster's  Depart 
ment  they  are  not  as  good  as  those  already  on  hand,  they  will  be  contracted  for  under  the  proposal  of  Mr.  KOHLER.  The  price  bid  is  understood,  as  in 
other  cases,  to  include  the  whole  set,  namely:  head-stall,  harness,  saddle,  and  two  litters  for  each  mule."  As  early  as  December  9,  1861,  this  pattern  of 
mule  litter  had  been  reported  on  by  a  board  convened  by  General  McCLELLAX,  consisting  of  Colonel  D.  H.  UrcKEIt,  Surgeon  C.  H.  LAUIS,  and  Surgeon 
J.  R.  SMITH,  it  is  presumed  unfavorably,  as  further  action  was  not  had  at  the  time. 

6  The  records  of  the  Property  Division  of  the  Surgeon  General's  Office  show  that  during  the  period  from  1861  to  1865,  nine  hundred  and  eighteen 
horse  or  mule  litters  were  purchased  and  distributed  by  the  Medical  Department.  Of  these,  417  were  manufactured  in  the  depot  at  New  York,  and  the 
rest  were  purchased  from  Tiffany  &  Co.,  of  New  York,  Wyeth  &  Brother,  of  Philadelphia,  A.  F.  Coldeway,  Louisville,  Ky.,  and  Suire  &  Eckstein,  of 
Cincinnati,  Ohio. 

6 In  October,  1862,  the  Surgeon  General  again  made  requisition  on  the  Quartermaster's  Department  for  one  hundred  and  fifty  mules  provided  with 
mule  litters,  to  be  sent  to  Dr.  JONATHAN-  LETTEUMAN,  Medical  Director  of  the  Army  of  the  Potomac.  In  reference  to  delay  in  compliance  with  this 


AMBULANCE    CORPS. 


931 


geori  General  made  another  requisition  for  a  hundred  and  fifty  mules  with  drivers,  with  a 
view  of  having  them  drilled  with  cacolets  in  the  field  by  Dr.  Slade  Davis;  but  this,  liko 
previous  experiments  in  this  direction,  proved  abortive;  and  the  ambulance  material  for 
transport  by  pack-animals,  accumulated  at  no  inconsiderable 

cost,  was  never  really  tested 

in  the  field.1     There  seems 

to  have  been  a  widespread 

distrust  of  the  system  on 

the  part  of  officers  of  the 

Quartermaster's    and    the 

Medical  Departments. 
"In  a  letter  of  March 

20,  1863,  Surgeon  George 

Suckley,U.S.V.,  Medical 

Director  of  the  Eleventh 

Corps,  wrote  from  the  Army 


FIG.  450. — French  litifire  folded.     [After  LEGOUEST.J 


-  of  the  Potomac,  near  Fred- 


FIG.  451. — French  cacolet  unfolded.  [After 
LEGOUEBT.] 


ericksburg,  to  Surgeon  J. 
H.  Brinton,  U.  S.  V.,  at  Washington:  'There  are  no  cacolets  in  this  corps,  and  I  want 
none.  Three  hundred  and  fifty  pounds  weight  is  too  much  for  a  mule's  back  over  rough 
ground,  encumbered  by  bushes,  stones,  logs,  and  ditches.  Among  trees,  cacolets  will  not 
answer  at  all;  although  used  in  European  services  and  in  Algeria,  they  have  there  been 
employed  under  some  favorable  circumstances,  either  on  plains  or  on  open  rolling  country. 
Here  they  would  prove,  I  sincerely  believe,  only  a  troublesome  and  barbarous  encumbrance, 
cruel  alike  to  the  wounded  and  the  pack-animals." 

AMBULANCE  CORPS. 

The  necessity  for  a  drilled  and  instructed  corps  for  the  transportation  of  wounded  from 
the  field  is  apparent  to  every  one  who  will  consider  the  subject.  The  importance  of  having 
the  wounded  rapidly  removed  from  the  scene  of  strife  must  be  conceded,  not  only  on  the 
score  of  humanity,  but  also  as  a  military  necessity.  Without  a  detachment  whose  service 

requisition  Captain  J.  J.  DANA,  A.  Q.  M.,  reported  October  17,  1862,  as  follows:  "The  order  was  given  by  me  October  3d,  immediately  on  its  receipt,  for 
one  hundred  and  fifty  mules  and  litters  to  be  made  ready  for  service.  At  that  time  we  had  no  mules  sufficiently  well  broken  for  the  purpose.  I  directed 
fifty  of  the  best  to  be  taken  from  the  ambulance  train,  the  litters  to  be  fitted  upon  them,  and  the  mules  drilled  daily  until  they  were  fit  to  go  into  the  field. 
On  the  SHh  of  October  fifty  mules,  with  litters  upon  them,  were  started  for  Dr.  LKTTEHMAN.  Much  difficulty  was  experienced  in  getting  the  mules  fur- 
ward,  as  they  were,  many  of  them,  inclined  to  lie  down,  and  were  otherwise  unruly.  Among  a  lot  of  mules  received  oifthe  10th  instant  we  found  one 
hundred  which  were,  to  some  extent,  suitable  for  the  purpose,  and  were  sent  forward  on  the  llth  instant,  the  litters  being  sent  by  wagons  in  order  to 
expedite  the  matter."  October  3,  1862,  Quartermaster  General  MEIGS,  in  transmitting  this  report  to  Surgeon  General  HAMMOND,  stated:  "I  desire 
respectfully  to  call  your  attention  to  the  fact  mentioned  in  the  report:  that  there  are  a  large  number  of  cacolets  now  in  the  possession  of  the  Government 
which  appear  to  have  been  overlooked  by  the  officers  of  your  Department,  and  to  suggest  the  expediency  of  directing  their  availing  themselves  of  them 
as  occasion  may  arise.  General  McCl.ELLAX  issued  orders,  a  year  ago,  for  drill  and  practice  of  ambulance  men,  including,  as  I  understand,  the  use  of 
the  mule  litters,  of  which,  of  French  and  American  manufacture,  there  were  then  a  considerable  number  provided  by  the  Quartermaster's  Department. 
Those  lately  purchased  from  Mr.  KOHLER,  on  the  requisition  of  the  Surgeon  General,  cost  £21,OCO  and  are  still  in  store." 

1  "From  the  papers  laid  before  the  Quartermaster  General  to-day,  there  appears  an  expenditure  for  purchase  of  cacolets  and  litters  in  1861  and!8C2 
for  the  army,  partly  upon  requisitions  from  the  Surgeon  General,  partly  from  orders  originating  in  this  office,  of  over  120,000.  To  this,  if  the  cost  of 
animals  and  use  of  men,  of  forage,  etc.,  supplied  by  this  Department  for  the  experiment  of  introducing  these  litters  and  cacolets,  it  would  be  found  that 
not  less  than  §10(1.000,  and  probably  more,  has  been  expended  in  an  experiment  which  was,  so  far  as  information  in  this  office  goes,  entirely  unsuccessful. 
There  never  was,  to  the  knowledge  of  the  Quartermaster  General,  a  requisition  from  any  military  commander.  All  the  requisitions  came  from  the  Sur 
geon  General's  Office.  It  is  not  known  to  this  office  that  these  mule  litters  ever  were  used  in  service,  and  the  Quartermaster  General  believes  that  no 
wounded  man  was  ever  placed  upon  one  of  them.  While  the  wheeled  ambulances  and  hand  litters  provided  for  the  hospital  equipments  were  in  constant 
and  useful  use,  the  litters  burdened  the  trains,  and  the  mules  were,  by  the  ordinary  accidents  of  service,  taken  for  the  ambulances  and  wagons.  He 
believes  that  no  better  cacolets  or  mule  litter  will  be  constructed  than  the  French  cacolet  and  litter,  ordered  at  the  beginning  of  the  rebellion  ;  and  these, 
which  though  in  his  judgment  inferior,  were,  at  a  later  period,  bought  at  the  urgent  requisition  of  the  then  Surgeon  General.  He  is,  therefore,  of  opinion 
that  any  further  expenditure  by  this  Department  in  this  line  of  experiment  will  be  a  waste  of  public  money,  and  he  will  not.  therefore,  unless  under  order 
of  higher  authority,  expend  money  or  make  reports  upon  any  models  thus  far  submitted  to  him- — Mem.  of  QuAUTE-UMASTEll  GEXEUAL,  December  23, 18C3- 


932  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

it  is  to  attend  to  this  duty,  the  natural  impulse  of  sympathy  will  draw  men  from  the  ranks 
to  assist  their  fallen  comrades,  while  the  pretext  is  a  temptation  to  the  faint-hearted  to 
shirk  the  perils  of  their  position.  Moreover,  the  courage  of  troops  under  fire  would  be 
sustained  if  they  were  assured  that  reliable  men  would  be  ready  to  bear  them  rapidly  from 
the  vicissitudes  of  a  conflict  and  to  tender  them  early  assistance. 

No  organized  ambulance  corps1  existed  in  the  army  at  the  beginning  of  the  war,  but 
the  necessity  of  such  an  organization   under  the  control  of  the  Medical  Department  was 

1  Propositions  were  made  by  citizens  early  in  the  war  to  aid  in  the  establishment  of  an  ambulance  corps.  In  May,  1801,  Dr.  J.  O.  Buox- 
BON",  of  New  York,  urged  upon  General  Winfield  Scott  the  formation  of  an  organization  to  consist  of  a  surgeon-in-chief,  with  aids,  nurses, 
and  an  efficient  body  of  men  to  attend  upon  the  ambulance  and  litters.  The  letter  was  referred  by  General  Scott  to  the  Surgeon  General,  but 
no  further  action  seems  to  have  been  taken.  On  September  19,  1861,  the  Surgeon  General  of  Pennsylvania,  Dr.  H.  H.  SMITH,  wrote  to  Surg. 
C.  S.  TRIPLKR,  U.  S.  A.,  Medical  Director  of  the  Army  of  the  Potomac:  "I  shall  have  at  Camp  Curtin,  near  Harrisburg,  in  a  few  days,  fifteen 
of  your  ambulances,  thirty  of  those  of  Coolidge,  and  fifteen  transport  carts,  with  harness  complete,  ready  to  semi  to  the  Pennsylvania  Reserve 
Corps.  I  should  like  to  enlist,  if  authorized,  and  drill  for  one  week  at  this  camp,  teamsters  as  drivers,  with  non-commissioned  and  commis 
sioned  officers,  at  the  same  pay  as  similar  grades  in  the  Army.  The  corps  would  consist  as  follows:  One  driver  to  each  carriage — GO  drivers; 
one  corporal,  mounted,  to  fifteen  carriages — 4  corporals ;  one  sergeant,  mounted,  to  a  division  (20  carriages) — 3  sergeants ;  two  second  lieu 
tenants — 2  officers;  67  men.  This  company  would  have  its  motions  in  transportation  directed  by  the  lieutenants,  who  would  be  commanded 
by  the  surgeon  of  brigade,  etc.;  the  officers  and  drivers  dismounting  to  lift  wounded  men,  and,  whilst  carriages  went  to  a  hospital  and  back, 
could  ride  round  and  give  temporary  assistance  with  tourniquets,  canteens,  etc.  This  may  suffice  to  show  my  general  ideas,  which  can 
readily  be  made  to  conform  to  Army  Regulations  when  I  am  authorized  to  do  so.  Not  knowing  who  to  apply  to,  I  place  the  matter  in  your 
hands,  asking  a  prompt  reply,  that  no  time,  may  be  lost,  especially  if  wanted.  Such  a  corps  would  servo  to  drill  and  form  ethers.  When 
not  acting  with  ambulances  the  corps  could  attend  to  general  police  of  sinks,  stables,  water,  fuel,  etc.,  aided  by  guard-house  prisoners,  and 
relieving  guard  of  such  duties,  or  act  as  extra  nurses,  cooks,  wardmasters,  etc.,  of  regimental  hospitals.  Many  volunteer  regiments  are 
deficient  in  these  men — those  having  them  could  organize  an  ambulance  corps  readily."  Surgeon  TRIPI.EU  forwarded  this  letter  to  the  honor 
able  Secretary  of  War  with  the  following  endorsement:  "The  plan  suggested  by  Dr.  SMITH,  if  authorized  to  be  carried  out,  would  meet  a 
pressing  want — that  of  having  properly  instructed  men  to  handle  the  wounded.  The  only  difficulty  in  the  way  is  that  medical  officers  are 
not  now  authorized  to  command  lieutenants.  The  necessity  for  that  authority,  however,  becoming  daily  more  apparent,  it  is  hoped  it  may 
be  granted,  at  the  next  session  of  Congress,  to  the  same  extent  as  in  the  other  staff  departments.  The  whole  plan  of  Dr.  SMITH  is,  therefore 
earnestly  recommended  to  the  favorable  consideration  of  the  honorable  Secretary  of  War."  No  action  was  had  on  this  recommendation.  lu 
the  early  spring  of  1862  a  plan  was  submitted  to  the  Secretary  of  War  by  Mr.  CHAKLKS  PFIUSCIIIXG  :  "To  every  division  of  the  army  a  company 
shall  be  attached  which  will  follow  it  immediately  into  action  on  the  day  of  battle  for  the  purpose  of  taking  up  all  its  wounded  and  carrying 
them  back  to  the  ambulances,  or  to  the  points  where  the  regimental  surgeons  have  taken  position.  Each  man  of  this  company  should  be 
armed  and  equipped  in  the  following  manner:  Two  navy  revolvers,  carried  in  the  cartridge-box  belt;  a  hatchet,  carried  on  the  left  side  of 
the  cartridge-box  belt ;  a  cartridge-box  on  a  leather  belt ;  a  knapsack  half  filled  with  his  own  things,  while  the  other  half  is  appropriated  to 
a  stock  of  bandages,  linen,  lint,  etc.,  as  they  may  be  necessary  for  a  bandage  to  prevent  the  death  of  the  wounded  before  he  obtains  the 
assistance  of  the  surgeon.  Besides  some  prepared  sticking  plasters,  etc.,  and  some"  bottles  with  stimulating  essences  to  recall  the  spirits  of 
the  wounded,  or  to  enable  him  to  bear  the  pains  of  his  wound  and  of  the  transportation,  a  large  canteen  with  water,  to  which  some  vinegar 
or  pure  brandy  may  be  added  for  the  use  of  the  wounded ;  a  tin  tumbler  with  it ;  a  small  canteen  for  the  man's  own  use ;  a  small  box  on  the 
cartridge-box  belt,  with  lint,  bandages,  a  small  bottle  of  vinegar  for  immediate  use,  so  that  he  has  not  to  take  off  his  knapsack;  the  half 
of  a  litter  of  my  own  invention.  Two  men  of  this  company  always  keep  together,  and  by  means  of  their  two  halves  they  form  a  litter  on 
which  they  carry  the  wounded  from  the  battle-field  to  the  ambulances,  or  to  the  places  where  the  regimental  surgeons  have  established  them 
selves.  Every  man  has  a  broad  bandoleer  of  black  leather  from  the  left  shoulder  to  the  right  hip,  and  one  from  the  right  shoulder  to  the  loft 
hip,  with  a  sling  to  each  to  put  the  ends  of  the  litter  through,  so  that  the  weight  of  the  load  rests  on  it,  and  that  the  men  may  have  one  or 
both  hands  free  if  fhey  should  be  obliged  to  make  use  of  their  weapons.  Each  man  should  have  a  small  whistle  to  give  signals  to  other 
members  of  his  company.  Each  company  should  have  one  first  and  one  second  lieutenant,  and  as  many  non-commissioned  officers  as  there 
are  regiments  in  the  division.  If  brigades  or  regiments  should  be  detached  from  the  division,  a  corresponding  number  of  platoons  would  bo 
detached  from  the  ambulance  companies  with  them.  All  ambulance  companies  of  the  army  should  be  under  the  command  of  a  colonel.  The 
men  would  be  instructed  in  a  particular  drill  for  their  particular  duties x>n  the  battle-field.  The  two  or  four  wheeled  ambulances  would  then 
be  stationed  on  a  convenient  place  in  the  rear  of  the  different  regiments,  and  with  them  might  be  stationed  the  regimental  .surgeons  to  give 
the  wounded  the  first  regular  assistance  before  they  are  sent  farther  back.  By  this  arrangement  not  only  a  great  deal  of  pain  and  suffering 
might  be  spared  to  the  wounded,  but  a  great  many  lives  might  be  saved  also.  In  an  economical  point  of  view  a  saving  would  also  bo  made, 
for  the  ambulances  would  last  a  good  deal  longer  than  at  present.  All  the  confusion  with  the  wounded  at  present  on  the  battle-fields  would 
be  avoided ;  the  ranks  would  not  be  broken  by  men  who  want  to  assist  their  wounded  comrades,  or  who  use  this  excuse  to  cover  their  cow 
ardice.  The  men  of  the  ambulance  companies  would  be  detached  from  the  different  regiments  of  every  division,  say  one  man  from  every 
company.  I  am  willing  to  undertake  the  formation  and  instruction  of  these  companies,  and  to  take  the  command  of  them.  (Signed) 
CHAKLKS  PFIBSCHING."  The  Secretary  of  War  directed,  on  March  3,  1862,  Surgeon-General  C.  A.  FIXLEY  to  examine,  or  cause  to  be  examined, 
this  plan,  and  report.  Surgeon  General  FIXLEY  sent  the  paper  to  Surgeon  CHAULKS  S.  TUIPLER,  F.  S.  A.,  Medical  Director  of  the  Army  of  tho 
Potomac,  requesting  his  views  with  regard  to  its  adaptability  to  the  service  and  with  regard  to  the  question  whether  the  proper  organization 
of  the  bands  in  the  field  would  not  obviate  the  necessity  for  the  proposed  organization.  The  report  of  Surgeon  Tuil'i.EU  is  appended :  "Head 
quarters  Army  of  the  Potomac,  Medical  Director's  Office,  Washington,  March  6,  1862.  Sir:  I  have  the  honor  to  report  that,  in  obedience  to 
your  instructions,  I  have  examined  the  plan  of  organization  of  an  anbulance  corps  submitted  by  CHAKLES  Pi-'lRSCinxr,.  However  desirable  a 
regularly  organized  ambulance  corps  may  be  for  an  army,  it  is  too  late  now  to  raise,  drill,  and  equip  so  elaborate  an  establishment  as  this  for 
our  service.  There  is  nothing  new  in  this  plan,  nothing  that  has  not  been  thought  of  and  well  weighed  years  ago  in  connection  with  our  own 
organization,  unless  it  be  the  arsenal  of  pistols  and  hatchets  with  which  the  men  are  to  be  loaded.  As  wo  have  no  ambulance  corps  proper, 
an  attempt  has  been  made  to  instruct  a  certain  number  of  men  in  each  regiment  in  tho  duties  appertaining  to  such  a  corps.  An  order  pro 
viding  for  the  drilling  of  ten  men  and  the  band  of  each  regiment  to  the  ambulance  service  was  issued  from  these  headquarters  on  the  3d  of 
October,  1801.  This  has  been  generally  faithfully  done,  and  we  now  have  a  tolerably  well  instructed  body  of  men  for  this  duty.  Instruc 
tions  for  the  distribution  and  employment  of  these  men  during  an  action  have  been  prepared  by  me  and  even  submitted  to  General  Williams, 
Adjutant  General  of  the  Array  of  tho  Potomac,  for  the  action  of  General  McClellan,  some  ten  days  ago.  I  hope  they  will  soon  bo  printed 
and  circulated.  When  that  is  done  all  necessary  and  practicable  arrangements  for  the  transportation  of  our  wounded  will  have  been  made. 
I  am,  therefore,  of  opinion  that  the  plan  of  Mr.  PEIUSCHING  is  neither  needed  nor  available  for  our  service  at  tho  present  time.  Very  respect 
fully,  your  obedient  servant.  (Signed)  CHAS.  S.  TKIVLER,  Surgeon  and  Medical  Director,  Army  of  the  Potomac."  Tho  report  of  Surgeon 
TKIPLER  was  returned,  on  March  7th,  to  the  Secretary  of  War  by  the  Surgeon  General,  who  fully  endorsed  the  views  of  Surgeon  TKIPI.ER. 


CHAP.  XV.]  AMBULANCE    CORPS.  933 

early  recognized  by  the  medical  officers,  and  already  in  April,  1862,  Medical  Director  Tripler, 
of  the  Army  of  the  Potomac,  called  attention  to  the  absolute  necessity  of  having  an  experi 
enced  quartermaster  arid  assistant  commissary  of  subsistence  attached  to  the  command  of 
the  Chief  Medical  Officer  of  an  army  in  the  field:  "I  find  it  impossible  to  secure  either 
transportation  or  subsistence  for  the  men  thrown  upon  my  hands  without  tedious  delays 
and  much  unnecessary  suffering.  Time,  which  is  so  valuable  to  me  now,  is  taken  up  and 
wasted  in  endeavors,  too  often  unsuccessful,  to  get  together  ambulances  and  wagons1  to  have 
these  trains  properly  and  economically  conducted,  to  have  boats  prepared  and  in  position, 
to  procure  buildings  for  hospitals,  to  get  subsistence  for  the  sick  and  wounded,  and,  in  short, 
doing  the  duty  assigned  to  quartermasters  and  subsistence  officers.  It  seems  to  me  that  to 
bring  this  evil  to  the  notice  of  the  Secretary  of  War  will  be  sufficient  to  cause  its  instant 
remedy;  at  all  events,  I  protest  beforehand  against  the  Medical  Department  being  held 
responsible  for  evils  they  have  no  possible  means  of  obviating.  My  experience  in  this  cam 
paign  has  taught  me  that  without  an  executive  officer  of  these  two  important  departments 
under  my  command,  more  time  is  lost  in  negotiating  through  second  and  third  parties,  with 
an  even  chance  of  not  getting  at  all  what  is  wanted,  and  a  certainty  of  not  getting  it  in 
time,  than  would  be  required  in  procuring  what  is  necessary  and  having  it  in  the  right  place 
if  these  officers  were  placed  at  my  disposal." 

On  August  21,  1862,  Surgeon  General  W.  A.  Hammond,  U.  S.  Army,  in  a  letter  to 
the  Secretary  of  War,  urged  the  necessity  for  such  a  corps: 

"SURGEON  GENERAL'S  OFFICE, 

"WASHINGTON,  August  21,  1862. 
"Honorable  EDWIN  M.  STANTON, 

Secretary  of  War. 

"SiR:  In  accordance  with  your  verbal  permission,  I  have  the  honor  to  submit  to  you  the 
inclosed  project  for  an  Hospital  Corps,  and  to  ask  your  favorable  consideration  for  the  same.  The 
plan  is  merely  submitted  as  a  basis  on  which  the  corps  can  be  organized;  much  will  remain  to  be 
done  by  regulations,  and  I  propose,  should  you  approve  the  inclosed  outline,  to  ask  for  a  board  of 
medical  officers  to  perfect  the  organization.  I  have  not  considered  it  necessary  to  enter  into  details ; 
the  first  thing  essential  is  to  obtain  your  sanction  to  the  organization  of  such  a  corps.  The  need  for 
it  is  most  urgent.  In  no  battle  yet  have  the  wounded  been  properly  looked  after;  men  under  pre 
tence  of  carrying  them  off  the  field  leave  the  ranks  and  seldom  return  to  their  proper  duties.  The 
adoption  of  this  plan  would  do  away  with  the  necessity  of  taking  men  from  the  line  of  the  army  to 
perform  the  duties  of  nurses,  cooks,  and  attendants,  and  thus  return  sixteen  thousand  men  to  duty 
iii  the  ranks.  lu  view  of  these  facts,  and  many  others  which  could  be  adduced,  I  respectfully  ask 
your  approval  of  the  inclosed  project. 

*I  am,  sir,  very  respectfully, 

"Your  obedient  servant, 
(Signed)  "WILLIAM  A.  HAMMOND, 

"Surgeon  General." 
To  this  the  following  answer  was  received: 

"WAR  DEPARTMENT, 

"WASHINGTON  CITY,  D.  C.,  August  29,  1862. 

"SiB:  The  Secretary  of  War  directs  me  to  acknowledge  the  receipt  of  your  communication 
of  the  21st  instant,  submitting  a  project  for  a  Hospital  Corps,  and  to  inform  you  that  the  subject 
was  referred  to  the  General-in-Chief,  whose  views,  ad\7erse  to  the  project,  are  expressed  iu  the  fol 
lowing  words:    'Our  army  trains  are  already  much  too  large  and  very  seriously  impede  the  move 
ments  of  our  troops  in  the  field.     The  enemy  have  great  advantages  over  us  in  this  respect.     To 

1  It  will  be  shown  hereafter  that  the  importance  of  having  the  ambulance  wag-ons  under  the  control  of  the  Medical  Department  had,  before  the  war, 
been  pointed  out  by  a  board  of  medical  officers  consisting  of  Surgeons  U.  S.  SATTKUL.EK,  C.  M.  I.Al'B.  and  Assistant  Surgeon  C.  H.  CHANK,  V.  S.  A., 
who,  in  March,  1858,  had  been  appointed  a  board  to  examine  and  report  upon  the  Moses'  ambulance  wagon. 


9B4  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

organize  such  a  medical  force  as  is  here  proposed  would,  besides  involving  enormous  expenses, 
greatly  increase  this  evil.  Moreover,  the  presence  of  non-combatants  on,  or  near  the  field  of  bat 
tle,  is  always  detrimental,  as  most  panics  and  stampedes  originate  with  them.  Medical  soldiers 
would  not  obviate  the  necessity  of  sending  fighting  soldiers  from  their  ranks  with  their  wounded, 
for  the  former  would  seldom  be  near  enough  to  the  enemy  to  perform  that  duty.  The  soldier  can 
be  very  much  relieved  by  hiring  cooks,  nurses,  and  attendants  in  hospitals,  whenever  the  circum 
stances  will  permit;  but  I  can  see  no  advantage  in  having  them  enlisted  for  that  special  purpose. 
All  persons  so  employed  are,  by  law,  subject  to  Army  Regulations.  I  regard  this  project  as  one 
calculated  to  increase  the  expenses  and  immobility  of  our  army  by  adding  to  it  a  large  corps  of 
non-combatants,  without  any  corresponding  advantages.  I  therefore  report  against  its  adoption.' 

"Very  respectfully,  your  obedient  servant, 
"SURGEON  GENERAL,  (Signed)  "P.  H.  WATSON, 

Washington,  D.  C.r  "Assistant  Secretary  of  War. 

A  second  appeal  was  made  to  the  Secretary  of  War  on  September  7,  1862: 

"SURGEON  GENERAL'S  OFFICE, 

"WASHINGTON  CITY,  D.  C.,  September  7, 1862. 

"SiR:  I  have  the  honor  to  ask  your  attention  to  the  frightful  state  of  disorder  existing  in 
the  arrangements  for  removing  the  wounded  from  the  field  of  battle.  The  scarcity  of  ambulances, 
the  want  of  organization,  the  drunkenness  and  incompetency  of  the  drivers,  the  total  absence  of 
ambulance  attendants,  are  now  working  their  legitimate  results,  results  which  I  feel  I  have  no 
right  to  keep  from  the  knowledge  of  the  Department.  The  whole  system  should  be  under  the 
charge  of  the  Medical  Department;  an  ambulance  corps  should  be  organized  and  set  in  instant 
operation.  I  have  already  laid  before  you  a  plan  for  such  an  organization,  which  I  think  covers 
the  whole  ground,  b*ut  which  I  am  sorry  to  find  does  not  meet  with  the  approval  of  the  General-in- 
Chief.  I  am  not  wedded  to  it.  I  only  ask  that  some  system  may  be  adopted  by  which  the  removal 
of  the  sick  from  the  field  of  battle  may  be  speedily  accomplished,  and  the  suffering  to  which  they 
are  now  subjected  be,  in  future,  as  far  as  possible  avoided.  Tip  to  this  date  six  hundred  wounded 
still  remain  on  the  battle-field  in  consequence  of  an  insufficiency  of  ambulances  and  a  want  of  a 
proper  system  for  regulating  their  removal  in  the  Army  of  Virginia.  Many  have  died  of  starvation, 
many  more  will  die  in  consequence  of  exhaustion,  and  all  have  endured  torments  which  might  have 
been  avoided.  I  ask,  sir,  that  you  will  give  me  your  aid  in  this  matter;  that  you  will  interpose  to 
prevent  a  recurrence  of  such  consequences  as  have  followed  the  recent  battle,  consequences  which 
will  inevitably  ensue  on  the  next  important  engagement,  if  something  is  not  done  to  obviate  them. 

"I  am,  sir,  very  respectfully, 

"Your  obedient  servant, 
"Hon.  E.  M.  STANTON,  (Signed)  "WILLIAM  A.  HAMMOND, 

Secretary  of  War."  "Surgeon  General,  U.  8.  A. 

This  also  was  referred  to  the  General-in-Chief  and  returned  endorsed  as  follows: 

"HEADQUARTERS   OF   THE   ARMY, 

"WASHINGTON,  September  15,  1862. 

"  I  am  informed  by  the  Quartermaster  General  that  every  effort  is  being  made  to  supply  a 
large  number  of  ambulances.  It  is  proper  to  remark,  however,  that  the  enemy  have  provided  for 
their  wounded  on  every  battle-field  with  not  one-half  the  ambulances  and  other  facilities  provided 
for  our  armies.  I  do  not  perceive  how  the  drunkenness  and  incornpeteucy  of  drivers  are  likely  to 
be  prevented  any  more  by  putting  the  ambulances  exclusively  under  the  direction  of  the  Medical 
Department.  It  is  the  duty  of  all  officers  to  furnish  fatigue  parties,  properly  officered,  on  the  requisi 
tion  of  medical  officers,  for  the  care  and  removal  of  the  wounded,  and  it  is  the  duty  of  all  medical 
officers  to  make  such  requisitions,  and  if  not  filled,  to  report  the  neglect.  No  such  neglect  has 
been  reported  by  medical  officers  on  the  recent  battle-fields.  My  objection  to  the  proposed  organi 
zation  of  a  separate  non-combatant  corps  to  be  attached  to  the  Medical  Department  were  set  forth 
in  my  endorsement  upon  a  former  letter  of  the  Surgeon  General. 

(Signed)  "H.  W.  HALLECK, 

' '  Oeneral-in-  Chief? 


CHAP.  XV.]  AMBULANCE    CORPS.  935 

Owing  to  the  opposition  of  the  General-in-Chief,  no  further  steps  were  taken  in  this 
direction  at  this  time.  In  the  meantime  the  medical  officers  in  the  field  had  been  com 
pelled  to  devise  the  best  means  they  could  for  the  immediate  care  of  the  wounded  after 
battles.  At  the  suggestion  of  Medical  Director  Tripler,  the  following  order  was  issued  in 
the  Army  of  the  Potomac  on  October  3,  1861 : 

"HEADQUARTERS   ARMY   OF   THE   POTOMAC, 

"WASHINGTON,  October  3,  1861. 
"  GENERAL  ORDERS  No.  20. 

******** 
"VI. — The  hospital  attendants,  to  the  number  of  10  men  to  a  regiment,  and  the  regimental 
bands,  will  be  assembled  under  the  supervision  of  the  brigade  surgeons,  and  will  be  drilled  one 
hour  each  day,  except  Sunday,  by  the  regimental  medical  officers,  in  setting  up  and  dismantling 
the  hand-stretchers,  litters,  and  ambulances;  in  handling  men  carefully;  placing  them  upon  the 
litters  and  ambulance  beds ;  putting  them  into  the  ambulances,  taking  them  out,  etc.;  carrying 
men  upon  the  hand-stretchers  (observing  that  the  leading  bearer  steps  off  with  the  left  foot  and 
the  rear  bearer  with  the  right) ;  in  short,  in  everything  that  can  render  this  service  effective  and 
the  most  comfortable  for  the  wounded  who  are  to  be  transported. 

******** 

"BY   COMMAND   OF  MAJOR  GENERAL   McOLELLAN: 

(Signed)  "S.  WILLIAMS, 

"Assistant  Adjutant  General." 

Similar  plans  were  adopte.d  in  other  armies,  but  the  first  and  most  complete  ambu 
lance  system1  was  that  established  in  August,  1862,  at  the  instance  of  Surgeon  Jonathan 
Letterman,  U.  S.  A.,  Medical  Director  of  the  Army  of  the  Potomac.  The  plan  is  clearly 
set  forth  in  the  accompanying' order: 

"HEADQUARTERS  ARMY   OF   THE   POTOMAC, 

"CAMP  NEAR  HARRISON'S  LANDINGS,  VA.,  August  2, 1862. 
"  GENERAL  ORDERS  No.  147. 

"The  following  regulations  for  the  organization  of  the  Ambulance  Corps  and  the  manage 
ment  of  ambulance  trains  are  published  for  the  information  and  government  of  all  concerned. 
Commanders  of  Army  Corps  will  see  that  they  are  carried  into  effect  without  delay : 

"  1.  The  Ambulance  Corps  will  be  organized  on  the  basis  of  a  captain  to  each  Army  Corps  as 

'A  crude  draft  of  a  plan  for  the  establishment  of  an  ambulance  corps*  had,  on  July  15,  1862,  been  submitted  to  the  Surgeon  General  by 
Surgeon  B.  A.  VAXDEUKIEFT,  IT.  S.  V.,  as  follows:  "Each  division  shall  be  provided  with  a  special  corps  under  the  name  of  'Division 
Ambulance  Corps.'  This  corps  will  be  under  the  immediate  orders  of  the  Division  Medical  Director.  This  corps  will  be  composed  of  one 
hundred  private  soldiers  and  four  non-commissioned  officers,  under  the  orders  of  a  medical  officer  with  the  rank  of  surgeon,  who  will  be 
aided  in  his  duties  by  an  assistant  surgeon ;  both  being  detailed  from  respective  regiments,  and  being  exempt  from  all  duties  save  those 
connected  with  the  above  mentioned  corps.  The  non-commissioned  officers  attached  to  this  corps  will  have  the  rank  and  pay  of  hospital 
stewards,  and  the  privates  will  receive  the  additional  pay  of  hospital  attendants.  Among  the  privates  four  will  be  detailed  to  act  as  cooks. 
One  blacksmith  shall  be  attached  to  the  corps.  The  four  non-commissioned  officers  to  be  mounted.  The  men  composing  the  Division  Ambu 
lance  Corps  will  be  selected  from  the  different  regiments  forming  the  division ;  and  preference  will  be  given  to  hospital  attendants  recom 
mended  by  their  respective  surgeons  as  being  competent,  intelligent,  and  of  unimpaired  physique.  As  means  of  transportation  there  will 
be  required  :  12  four-wheeled  four-horse  ambulances ;  12  two-wheeled  one-horse  ambulances  for  transportation  of  sick  and  wounded ;  1  four- 
wheeled  two-horse  ambulance,  containing  the  medical  stores  on  hand  and  serving  as  an  ambulating  surgery ;  2  four-wheeled  four-horso 
transport  wagons,  for  transporting  medical  stores  and  provisions.  The  corps,  having  no  permanent  place  of  settlement,  should  always  bo 
provided  with  a  few  days'  rations  for  attendants  and  patients.  Rations  and  forage  should  bo  drawn  by  the  medical  officer  in  charge  from  the 
division  commissary.  Every  man  belonging  to  this  corps  shall  be  instructed,  if  possible,  four  hours  each  day  in  the  following  exercises: 
Transportation  of  sick  and  wounded ;  removing  sick  and  wounded  in  ambulances  from  the  field  of  battle ;  attendance  of  the  wounded  on 
the  field  before  the  arrival  of  the  surgeon,  such  as  applying  tourniquets  and  bandages  to  prevent  fatal  bleeding,  etc.  The  building  of 
provisional  hospitals  (abris),  where  no  other  means  offer,  and  the  construction  of  impromptu  bunks  and  litters  will  also  form  part  of  the 
instruction  of  attendants,  to  make  them  more  thoroughly  efficient  for  their  position.  Each  man  shall  be  provided  with  a  bag  containing  a 
tourniquet,  lint,  linen,  bandages,  and  a  few  haemostatic  and  stimulant  medicines,  the  use  of  each  having  been  explained.  During  and  after 
a  battle  or  engagement,  the  surgeon  in  charge  shall  always  superintend  the  transportation  of  the  wounded,  not  only  by  his  own  corps,  but 
even  by  the  different  regimental  ambulance  corps.  In  cases  where  it  may  be  absolutely  required,  operations  on  the  field  should  oven  be 
performed  by  the  surgeon  in  charge  or  his  assistant  surgeon,  but  only  in  the  absence  of  the  proper  regimental  surgeon,  such  privilege 
belonging  properly  to  him.  After  an  engagement  the  division  ambulances  shall  be  used  for  transporting  the  sick  and  wounded  to  the  central 
hospitals  ;  and  when  the  division  is  only  moving  they  shall  assist  the  different  regiments  in  the  transportation  of  the  sick,  thus  preventing 
the  numerous  stragglers  arising  from  insufficient  means  of  regimental  transportation.  When  the  corps  has  attained  a  certain  degree  of 
proficiency,  the  men  composing  it  may  be  gradually  returned  to  the  departments  from  which  they  have  been  taken,  and  new  ones  detailed 
who  shall  be  instructed  in  the  same  exercises.  The  division  ambulance  corps  is  thus  not  only  intended  for  the  transportation  of  sick  and 
wounded,  but  to  be  a  school  of  instruction  to  form  well-disciplined  hospital  attendants." 


936  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  XV. 

the  Commandant  of  the  Ambulance  Corps,  a  1st  lieutenant  for  a  Division,  2d  lieutenant  for  a 
brigade,  and  a  sergeant  for  each  regiment. 

"2.  The  allowance  of  ambulances  and  transport  carts  will  be:  One  transport  cart,  one4-horse 
and  two  2-horse  ambulances  for  a  regiment;  one  2-horse  ambulance  for  each  battery  of  artillery, 
and  two  2-horse  ambulances  for  the  Headquarters  of  each  Army  Corps.  Each  ambulance  will  be 
provided  with  two  stretchers. 

"3.  The  privates  of  the  Ambulance  Corps  will  consist  of  two  men  and  a  driver  to  each  ambu 
lance,  and  one  driver  to  each  transport  cart. 

"  4.  The  captain  is  the  commander  of  all  the  ambulances  and  transport  carts  in  the  Army 
Corps,  under  the  direction  of  the  Medical  Director.  He  will  pay  special  attention  to  the  condition 
of  the  ambulances,  horses,  harness,  etc.,  requiring  daily  inspections  to  be  made  by  the  commanders 
of  Division  ambulances,  and  reports  thereof  to  be  made  to  him  by  these  officers.  He  will  make  a 
personal  inspection  once  a  week  of  all  the  ambulances,  transport  carts,  horses,  harness,  etc.,  whether 
they  have  been  used  for  any  other  purpose  than  the  transportation  of  the  sick  or  wounded,  and  med 
ical  supplies;  reports  of  which  will  be  transmitted  through  the  Medical  Director  of  the  Army  Corps 
to  the  Medical  Director  of  the  Army  every  Sunday  morning.  He  will  institute  a  drill  in  his  corps, 
instructing  his  men  in  the  most  easy  and  expeditious  method  of  putting  men  in  and  taking  them 
out  of  the  ambulances,  taking  men  from  the  ground  and  placing  and  carrying  them  on  stretchers, 
observing  that  the  front  man  steps  off  with  the  left  foot  and  the  rear  man  with  the  right,  etc.  He 
will  be  especially  careful  that  the  ambulances  and  transport  carts  are  at  all  times  in  order,  provided 
with  attendants,  drivers,  horses,  etc.,  and  the  keg  daily  rinsed  and  filled  with  fresh  water,  that  he 
may  be  able  to  move  at  any  moment.  Previous  to  and  in  time  of  action  he  will  receive  from  the  Med 
ical  Director  of  the  Army  Corps  his  orders  for  the  distribution  of  the  ambulances  and  the  points  to 
which  he  will  carry  the  wounded,  using  the  light  two  horse-ambulances  for  bringing  men  from  the 
field,  and  the  four-horse  ones  for  carrying  those  already  attended  to  farther  to  the  rear,  if  the  Med 
ical  Director  considers  it  necessary.  He  will  give  his  personal  attention  to  the  removal  of  the  sick 
and  wounded  from  the  field  and  to  and  from  the  hospitals,  going  from  point  to  point  to  ascertain 
what  may  be  wanted,  and  to  see  that  his  subordinates  (for  whose  conduct  he  will  be  responsible) 
attend  to  their  duties  in  taking  care  of  the  wounded,  treating  them  with  gentleness  and  care,  and 
removing  them  as  quickly  as  possible  to  the  places  pointed  out;  and  that  the  ambulances  reach 
their  destination.  He  will  make  a  full  and  detailed  report  after  every  action  and  march  of  the 
operations  of  the  Ambulance  Corps. 

"5.  The  1st  lieutenant  assigned  to  the  Ambulance  Corps  of  a  Divisou  will  have  complete  con 
trol,  under  the  Commander  of  the  whole  Corps  and  the  Medical  Director,  of  all  the  ambulances, 
transport  carts,  ambulance  horses,  etc.,  in  the  Division.  He  will  be  the  Acting  Assistant  Quarter 
master  for  the  Division  Ambulance  Corps,  and  will  receipt  and  be  responsible  for  the  property 
belonging  to  it,  and  be  held  responsible  for  any  deficiencies  in  ambulances,  transport  carts,  horses, 
harness,  etc.,  pertaining  to  the  Ambulance  Corps  of  the  Division.  He  will  have  a  travelling  cav 
alry  forge,  a  blacksmith,  and  a  saddler,  who  will  be  under  his  orders,  to  enable  him  to  keep  his  train 
in  order.  He  will  receive  a  daily  inspection  report  of  all  the  ambulances,  horses,  etc.,  under  his 
charge  from  the  officer  in  charge  of  Brigade  Ambulance  Corps,  will  see  that  the  subordinates  attend 
strictly  to  their  duties  at  all  times,  and  will  inspect  the  corps  under  his  charge  once  a  week ;  a 
report  of  which  inspection  he  will  transmit  to  the  Commander  of  the  Ambulance  Corps. 

"6.  The  2d  lieutenant  in  command  of  the  ambulances  of  a  brigade  will  be  under  the  imme 
diate  orders  of  the  commander  of  the  Ambulance  Corps  for  the  Division,  and  have  superintend 
ence  of  the  Ambulance  Corps  for  the  brigade. 

"  7.  The  sergeant  in  charge  of  the  Ambulance  Corps  for  a  regiment  will  conduct  the  drills, 
inspections,  etc.,  under  the  orders  of  the  Commander  of  the  Brigade  Ambulance  Corps,  and  will  be 
particular  in  enforcing  rigidly  all  orders  he  may  receive  from  his  superior  officers.  The  officers  and 
non-commissioned  officers  of  this  corps  will  be  mounted. 

"8.  The  detail  for  this  corps  will  be  made  with  care  by  Commanders  of  Army  Corps,  and  no 
officer  or  man  will  be  selected  for  this  duty  except  those  known  to  be  active  and  efficient;  and 
no  man  will  be  relieved  except  by  orders  from  these  Headquarters.  Should  any  officer  or  man 
detailed  for  this  duty  be  found  not  fitted  for  it,  representations  of  the  fact  will  be  made  by  the 
Medical  Director  of  the  Army  Corps  to  the  Medical  Director  of  this  Army. 


CHAP,  xv  ]  AMBULANCE    CORPS.  937 

"9.  Two  medical  officers  from  the  reserve  corps  of  surgeons  of  each  Division,  and  a  hos 
pital  steward  who  will  be  with  the  medicine  wagon,  will  be  detailed  by  the  Medical  Director  of  the 
Army  Corps  to  accompany  the  ambulance  train  when  on  the  march,  the  train  of  each  Division  being 
kept  together,  and  will  see  that  the  sick  and  wounded  are  properly  attended  to.  A  medicine  wagon 
will  accompany  each  train. 

"  10.  The  officers  connected  with  the  corps  must  be  with  the  trains  on  the  march,  observing 
that  no  one  rides  in  the  ambulances  without  the  authority  of  the  medical  officers,  except  in  urgent 
cases ;  but  men  must  not  be  allowed  to  suffer,  and  the  officers  will,  when  the  medical  officers  cannot 
be  found,  use  a  sound  discretion  in  this  matter,  and  be  especially  careful  that  the  men  and  drivers 
are  in  their  proper  places.  The  place  for  the  ambulances  is  in  front  of  all  the  wagon  trains. 

"  11.  When  in  camp  the  ambulances,  transport  carts,  and  Ambulance  Corps  will  be  parked 
with  the  brigade,  under  the  supervision  of  the  commander  of  the  corps  for  the  brigade.  They  will 
be  used  on  the  requisition  of  the  regimental  medical  officers,  transmitted  to  the  Commander  of  the 
Brigade  Ambulance  Corps,  for  transporting  the  sick  to  various  points  and  procuring  medical  sup 
plies,  and/or  nothing  else.  The  non-commissioned  officer  in  charge  will  always  accompany  the  am 
bulances  or  transport  carts  when  on  this  or  any  other  duty,  and  he  will  be  held  responsible  that 
they  are  used  for  none  other  than  their  legitimate  purposes.  Should  any  officer  infringe  upon  this 
order  regarding  the  uses  of  ambulances,  etc.,  he  will  be  reported  by  the  officer  or  non-com  missioned 
officer  in  charge  to  the  commander  of  the  train,  all  the  particulars  being  given. 

"  12.  The  officer  in  charge  of  a  train  will  at  once  remove  anything  not  legitimate,  and  if  there 
be  not  room  for  it  in  the  baggage  wagons  of  the  regiment,  will  leave  it  on  the  road.  Any  attempt 
by  a  superior  officer  to  prevent  him  from  doing  his  duty  in  this  or  any  other  instance  he  will  promptly 
report  to  the  Medical  Director  of  the  Army  Corps,  who  will  lay  the  matter  before  the  commander 
of  that  corps.  The  latter  will,  at  the  earliest  possible  moment,  place  the  officer  offending  in  arrest 
for  trial  for  disobedience  of  orders. 

11 13.  Good,  serviceable  horses  will  be  used  for  the  ambulances  and  transport  carts,  and  will 
not  be  taken  for  any  other  purpose,  except  by  orders  from  these  Headquarters. 

"14.  The  uniform  of  this  corps  is:  For  privates,  a  green  baud  two  inches  broad  around  the 
cap,  a  green  half  chevron  two  inches  broad  on  each  arm  above  the  elbow,  and  to  be  armed  with 
revolvers.  Non-commissioned  officers  to  wear  the  same  band  around  the  cap  as  a  private,  chevrons 
two  inches  broad,  and  green,  with  the  point  toward  the  shoulder,  on  each  arm  above  the  elbow. 

"  15.  No  person  will  be  allowed  to  carry  from  the  field  any  wounded  or  sick,  except  this  corps. 

"16.  The  Commanders  of  the  Ambulance  Corps,  on  being  detailed,  will  report  without  delay  to 
the  Medical  Director  at  these  Headquarters  for  instructions.  All  Division,  Brigade,  or  Regimental 
Quartermasters  having  any  ambulances,  transport  carts,  ambulance  horses  or  harness,  etc.,  in  their 
possession,  will  turn  them  in  at  once  to  the  Commander  of  the  Division  Ambulance  Corps. 

"BY   COMMAND   OF   MAJOR  GENERAL   McCLELLAN: 

(Signed)  "S.WILLIAMS, 

"  Assistant  Adjutant-  General." 

The  advantages  accruing  from  this  organization  became  speedily  manifest.  At  the 
battle  of  Antietam,  in  September,  1862,  by  the  active  and  energetic  exertions  of  the  mem 
bers  of  this  corps  the  disabled  of  the  right  wing  of  the  army  (there  was  no  ambulance 
system  on  the  left)  were  rapidly  conveyed  from  the  scene  of  conflict  to  the  hospitals  in  the 
rear.  The  train  of  ambulances  plied  incessantly  between  the  battle-ground  and  the  field 
hospital.  During  the  night  of  the  battle  all  of  our  wounded  in  the  widely  extended  field 
were  removed  to  shelter  and  received  the  necessary  surgical  attention.  Different  members 
of  the  corps  behaved  with  the  utmost  gallantry,  passing  freely  under  fire  in  their  search 
of  the  fallen,  and  advancing  at  times  to  the  extreme  verge  of  the  enemy's  pickets.  All  of 
our  wounded  having  thus  been  collected  at  the  temporary  depots,  such  as  were  deemed  best 
able  to  undergo  further  transportation  were  carefully  selected.  These,  during  the  following 
two  or  three  days,  were  then  conveyed  by  the  ambulance  train  to  Frederick  City,  Md., — 
the  nearest  point  of  railway  connections.  At  the  first  battle  of  Fredericksburg  the  results 

SURG.   Ill— 118 


938  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

of  the  persevering  endeavors  of  the  Ambulance  Corps  were  not  less  happy.  During  the 
night  following  the  battle  all  of  the  wounded  remaining  on  the  ground  not  absolutely  in 
the  hands  of  the  enemy  were  safely  conveyed  to  the  city  of  Predericksburg  and  its  neigh 
borhood.  When  it  subsequently  became  necessary  to  evacuate  the  city  of  Fredericksburg 
for  military  reasons,  the  wounded  were  again  placed  upon  the  train  and  safely  reached  the 
opposite  bank  of  the  river.  These  fortunate  results  were,  however,  obtained  at  the  expense 
of  the  Ambulance  Corps,  which  experienced  a  loss  of  one  officer  and  several  privates  killed, 
besides  others  who  were  captured  during  their  humane  efforts  to  remove  their  fallen  coun 
trymen. 

In  the  Army  of  the  Tennessee,  with  the  exception  of  General  Sherman's  Corps,  no 
system  for  the  formation  of  an  ambulance  train,  for  confining  ambulances  to  their  proper 
use,  or  for  the  ready  removal  of  wounded  had  existed  prior  to  March,  1863,  when  Medical 
Inspector  E.  P.  Vollum,  U.  S.  A.,  urged  upon  General  Grant  the  necessity  of  establishing 
an  ambulance  corps.  The  proposition  was  cheerfully  entertained,  and  on  March  30,  1863, 
the  following  order  was  issued  from  the  Headquarters  of  the  Department  of  the  Tennessee : 

"HEADQUARTERS  DEPARTMENT  OF  THE  TENNESSEE, 

"YOUNG'S  POINT,  LOUISIANA,  March  30,  1803. 
"  GENERAL  ORDERS  No.  22. 

"  Ariny  Corps  Commanders  will  at  once  enforce  the  following  regulations : 

"  1.  All  ambulances  with  the  Army  in  the  field  will  be  turned  in  to  Division  Quartermasters, 
each  Division  retaining  all  the  ambulances  it  now  has. 

"  2.  Division  ambulance  trains  will  be  formed  in  charge  of  one  commissioned  officer  for  each 
Division,  one  non-commissioned  officer  for  each  brigade,  and  one  driver  and  two  enlisted  men  for 
each  ambulance,  to  be  detailed  for  that  purpose,  who  will  be  subject  to  the  direction  of  the  Chief 
Surgeon  of  the  Division. 

"3.  The  officers  in  charge  of  Division  ambulance  trains  will  have  direct  military  control  over 
all  the  non-commissioued  officers  and  privates  of  their  respective  trains,  and  will  see  that  the  am 
bulances  are  only  used  for  conveying  sick  or  wounded,  carrying  provisions  for  hospitals  when  neces 
sary,  and  other  purposes  connected  with  the  relief  of  sick  and  wounded. 

"4.  In  removing  sick  and  wounded  the  enlisted  men  detailed  to  attend  ambulances,  as  above 
directed,  will  nlone  be  permitted  to  accompany  them,  and  that  they  may  be  recognized  as  having 
been  appointed  for  this  purpose,  each  of  them  will  wear  a  white  badge  on  the  left  arm  above  the 
elbow,  the  same  to  be  provided  by  the  Medical  Department.- 

"5.  Division  Quartermasters  will  be  responsible  for  all  public  property  connected  with  said 
Division  ambulance  trains,  and  will  exercise  authority  over  all  matters  pertaining  to  the  parking 
and  preservation  of  the  same. 

"  G.  Army  Corps  commanders  and  Medical  Directors  of  Army  Corps  will  make  such  regula 
tions  for  the  removal  of  wounded  and  sick  as  will,  in  their  judgment,  best  secure  the  end  desired 
to  be  attained  under  this  order. 

"  By  order  of  Major-General  TJ.  S.  GRANT. 

(Signed)  "JNO.  A.  RAWLINS, 

11  Assistant  Adjutant  General" 

Actual  experience  in  the  field  suggested  various  changes  in  the  original  plan  adopted 
in  the  Army  of  the  Potomac,  and  on  August  22,  1863,  Surgeon  Letterman  laid  before  the 
General  Commanding  revised  regulations,  which  wore  published  in  General  Orders  No.  85, 
Headquarters  of  the  Army  of  the  Potomac,  August  24.  1863: 

"The  following  revised  regulations  for  the  organization  of  the  Ambulance  Corps  and  the 
management  of  the  ambulance  trains  are  published  in  lieu  of  Special  Orders  No.  147,  Headquarters 
Army  of  the  Potomac,  August  2,  18G2,  for  the  information  and  government  of  all  concerned.  Com 
manders  of  Army  Corps  will  see  that  they  are  carried  into  effect. 


CHAP,  xv.]  AMBULANCE    CORPS.  939 

"  1.  The  Army  Corps  is  the  unit  of  organization  for  the  Ambulance  Corps,  and  the  latter  will 
be  organized  upon  the  basis  of  Captain  as  the  Commandant  of  the  Corps,  one  1st  Lieutenant  for 
each  Division,  one  2d  Lieutenant  for  each  brigade,  one  sergeant  for  each  regiment. 

"2.  The  privates  of  this  corps  will  consist  of  two  men  and  one  driver  to  each  ambulance  and 
one  driver  to  each  medicine  wagon. 

"3.  The  two-horse  ambulances  only  will  be  used,  and  the  allowance  until  further  orders  to 
each  corps  will  be  upon  the  basis  of  three  to  each  regiment  of  infantry,  two  to  each  regiment  of 
cavalry,  one  to  each  battery  of  artillery,  to  which  it  will  be  permanently  attached,  and  two  to  the 
Headquarters  of  each  Army  Corps;  and  two  army  wagons  to  each  Division.  Each  ambulance  will 
be  provided  with  two  stretchers. 

U4.  The  captain  is  the  commander  of  all  the  ambulances,  medicine,  and  other  wagons  in  the 
corps,  under  the  immediate  direction  of  the  Medical  Director  of  the  Army  Corps  to  which  the 
Ambulance  Corps  belongs.  He  will  pay  special  attention  to  the  condition  of  the  ambulances, 
wagons,  horses,  harness,  etc.,  and  see  that  they  are  at  all  times  in  readiness  for  service,  that  the 
officers  and  men  are  properly  instructed  in  their  duties,  and  that  these  duties  are  performed,  and 
that  the  regulations  of  the  corps  are  strictly  adhered  to  by  those  under  his  command.  He  will  insti 
tute  a  drill  in  his  corps,  instructing  his  men  in  the  most  easy  and  expeditious  method  of  putting 
men  in  and  taking  them  out  of  the  ambulances,  lifting  them  from  the  ground,  and  placing  and  car 
rying  them  on  stretchers,  in  the  latter  case  observing  that  the  front  man  steps  oif  with  the  left  foot 
and  the  rear  man  with  the  right,  etc.;  that  in  all  cases  his  men  treat  the  sick  and  wounded  with  gen 
tleness  and  care;  that  the  ambulances  and  wagons  are  at  all  times  provided  with  attendants,  dri 
vers,  horses,  etc.;  that  the  vessels  for  carrying  water  are  constantly  kept  clean  and  filled  with  fresh 
water;  that  the  ambulances  are  not  used  for  any  other  purpose  than  that  for  which  they  are  designed 
and  ordered.  Previous  to  a  march  he  will  receive  from  the  Medical  Director  of  the  Army  Corps 
his  orders  for  the  distribution  of  the  ambulances  for  gathering  up  the  sick,  and  previous  to  and  in 
time  of  action  he  will  receive  orders  from  the  same  officer  where -to  send  his  ambulances,  and  to  what 
points  the  wounded  are  to  be  carried.  He  will  give  his  personal  attention  to  the  removal  of  the 
sick  and  wounded  from  the  field  in  time  of  action,  going  from  place  to  place  to  ascertain  what  may 
be  wanted,  to  see  that  his  subordinates  (for  whose  conduct  he  will  be  responsible)  attend  faithfully 
to  their  duties  in  taking  care  of  the  wounded  and  removing  them  as  quickly  as  may  be  found  con 
sistent  with  their  safety  to  the  field  hospitals,  and  see  that  the  ambulances  reach  their  destination. 
After  every  battle  he  will  make  a  report,  in  detail,  of  the  operations  of  his  corps  to  the  Medical  Di 
rector  of  the  Army  Corps  to  which  he  belongs,  who  will  transmit  a  copy  with  such  remarks  as  he 
may  deem  proper  to  the  Medical  Director  of  this  Army.  He  will  give  his  personal  attention  to  the 
removal  of  sick  when  they  are  required  to  be  sent  to  general  hospitals,  or  to  other  points  as  may 
be  ordered.  He  will  make  a  personal  inspection  at  least  once  a  month  of  everything  pertaining  to 
the  Ambulance  Corps,  a  report  of  which  will  be  made  to  the  Medical  Director  of  the  Corps,  who 
will  transmit  a  copy  to  the  Medical  Director  of  this  Army.  This  inspection  will  be  minute  and 
made  with  care,  and  will  not  supersede  the  constant  supervision  which  he  must  at  all  times  exercise 
over  his  corps.  He  will  also  make  a  weekly  report  according  to  the  prescribed  form  to  the  same 
officer,  who  will  forward  a  copy  to  the  Medical  Director  of  this  Army. 

"5.  The  1st  lieutenant  assigned  to  the  Ambulance  Corps  for  a  Division  will  have  complete 
control,  under  the  captain  of  his  corps  and  the  Medical  Director  of  the  Army  Corps,  of  all  the  am 
bulances,  medical  and  other  wagons,  horses,  etc.,  and  men  in  that  portion  of  the  Ambulance 
Corps.  He  will  be  the  Acting- Assistant  Quartermaster  for  that  portion  of  the  corps,  and  will 
receipt  for  and  be  responsible  for  all  the  property  belonging  to  it,  and  be  held  responsible  for  any 
deficiency  in  anything  appertaining  thereto.  He  will  have  a  travelling  cavalry  forge,  a  blacksmith, 
and  a  saddler,  who  will  be  under  his  orders,  to  enable  him  to  keep  his  train  in  order.  His  supplies 
will  be  drawn  from  the  Depot  Quartermaster  upon  requisitions  approved  by  the  captain  of  his  corps 
and  the  Commander  of  the  Army  Corps  to  which  he  is  attached.  He  will  exercise  a  constant 
supervision  over  his  train  in  every  particular,  and  keep  it  at  all  times  ready  for  service.  Especially 
before  a  battle  will  he  be  careful  that  everything  be  in  order.  The  responsible  duties  devolving 
upon  him  in  time  of  action  render  it  necessary  that  he  be  active  and  vigilant,  and  spare  no  labor 
in  their  execution.  He  will  make  reports  to  the  captain  of  the  corps  upon  the  form  prescribed 
every  Saturday  morning. 


940  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

"  G.  The  2d  lieutenant  will  have  command  of  the  portion  of  the  Ambulance  Corps  for  a  brig 
ade,  and  will  be  tinder  the  immediate  orders  of  the  commander  of  the  ambulances  for  a  Division, 
and  the  injunctions  in  regard  to  care  and  attention  and  supervision  prescribed  for  the  Commander 
of  the  Division  he  will  exercise  in  that  portion  under  his  command. 

"  7.  The  sergeant  will  conduct  the  drills,  inspections,  etc.,  under  the  orders  and  supervision  of 
the  commander  of  the  ambulances  for  a  brigade,  be  particular  in  enforcing  all  orders  he  may  receive 
from  his  superior  officers,  and  that  the  men  are  attentive  to  their  duties.  The  officers  and  non 
commissioned  officers  will  be  mounted.  The  non-commissioned  officers  will  be  armed  with  revolvers. 

"8.  Two  medical  officers  and  two  hospital  stewards  will  be  detailed  daily  by  roster  by  the  Sur- 
geon-in-Chief  of  the  Division,  to  accompany  the  ambulances  for  the  Division  when  on  the  march, 
whose  duties  will  be  to  attend  to  the  sick  and  wounded  with  the  ambulances  and  see  that  they  are 
properly  cared  for.  No  man  will  be  permitted  by  any  line  officer  to  fall  to  the  rear  to  ride  in  the 
ambulances  unless  he  has  written  permission  from  the  senior  medical  officer  of  his  regiment  to  do 
so.  These  passes  will  be  carefully  preserved,  and  at  the  close  of  inarch  be  transmitted  by  the  senior 
medical  officer  with  the  train,  with  such  remarks  as  he  may  deem  proper,  to  the  Surgeon-in-Chief 
of  his  Division.  A  man  who  is  sick  or  wounded,  who  requires  to  be  carried  in  an  ambulance,  will 
not  be  rejected;  should  he  not  have  the  permission  required,  the  Surgeon  of  the  regiment  who  has 
neglected  to  give  it  will  be  reported  at  the  close  of  the  march  by  the  senior  Surgeon  with  the  train, 
to  the  Surgeon-in-Chief  of  his  Division.  When  on  the  march,  one-half  the  privates  of  the  Ambu 
lance  Corps  will  accompany  on  foot  the  ambulances  to  which  they  belong,  to  render  such  assistance 
as  may  be  required.  The  remainder  will  march  in  the  rear  of  their  respective  commands  to  conduct, 
under  the  orders  of  the  medical  officers,  such  men  as  may  be  unable  to  proceed  to  the  ambulances, 
or  who  may  be  incapable  of  taking  proper  care  of  themselves,  until  the  ambulances  come  up. 
When  the  case  is  of  so  serious  a  nature  as  to  require  it,  the  Surgeon  of  the  regiment  or  his  assist 
ant  will  remain  and  deliver  the  man  to  one  of  the  medical  officers  with  the  ambulances.  At  all 
other  times  the  privates  will  be  with  their  respective  trains.  The  medicine  wagons  will  on  the  march 
be  in  their  proper  places  in  the  rear  of  the  ambulances  for  each  brigade.  Upon  ordinary  marches 
the  ambulances  and  wagons  belonging  to  the  train  will  follow  immediately  in  the  rear  of  the  Divis 
ion  to  which  it  is  attached.  Officers  connected  with  the  corps  must  be  with  the  trains  when  on 
the  march,  observing  that  no  one  rides  in  any  of  the  ambulances  except  by  authority  of  medical 
officers.  Every  necessary  facility  for  taking  care  of  the  sick  and  wounded  upon  the  march  will  be 
afforded  the  medical  officers  by  the  officers  of  the  Ambulance  Corps. 

"  9.  When  in  camp  the  ambulances  will  be  parked  by  division.  The  regular  roll-calls,  reveille, 
retreat,  and  tattoo  will  be  held,  at  which  at  least  one  commissioned  officer  will  be  present  and 
receive  the  reports.  Stable  duty  will  be  at  hours  fixed  by  the  captain  of  the  corps,  and  at  this 
time,  while  the  drivers  are  in  attendance  upon  their  animals,  the  privates  will  be  employed  in  keep 
ing  the  ambulances  to  which  they  belong  in  order,  keeping  the  vessels  for  carrying  water  filled  with 
fresh  water,  and  in  general  police  duties.  Should  it  become  necessary  for  a  regimental  medical 
officer  to  use  one  or  more  ambulances  for  transporting  sick  and  wounded,  he  will  make  a  requisition 
upon  the  Commander  of  the  Ambulances  for  a  Division,  who  will  comply  with  the  requisition.  In 
all  cases  when  ambulances  are  used  the  officers,  non-commissioned  officers,  and  men  belonging  to 
them  will  accompany  them;  should  one  ambulance  only  be  required,  a  non-comrnissioued  officer  as 
well  as  the  men  belonging  to  it  will  accompany  it.  The  officers  of  the  Ambulance  Corps  will  see 
that  ambulances  are  not  used  for  any  other  purpose  than  that  for  which  they  are  designed,  viz : 
the  transportation  of  sick  and  wounded,  and  in  urgent  cases  only,  of  medical  supplies.  All  officers 
are  expressly  forbidden  to  use  them,  or  to  require  for  them  to  be  used  for  any  other  purpose. 
When  ambulances  are  required  for  the  transportation  of  sick  or  wounded  at  Division  or  Brigade 
Headquarters  they  will  be  obtained  as  they  are  needed  for  this  purpose  from  the  Division  train, 
but  no  ambulances  belonging  to  this  corps  will  be  retained  at  such  headquarters. 

"  10.  Good,  serviceable  horses  will  be  used  for  the  ambulances  and  medicine  wagons,  and  will 
not  be  taken  for  any  other  purpose  except  by  orders  from  these  Headquarters. 

"11.  The  corps  will  be  designated,  for  sergeants,  by  a  green  band  1£  inches  broad  around 
the  cap,  and  chevrons  of  the  same  material,  with  the  point  toward  the  shoulder,  on  each  arm 
above  the  elbow.  For  privates,  by  a  band  the  same  as  for  sergeants  around  the  cap,  and  a  half 
chevron  of  the  same  material  on  each  arm  above  the  elbow. 


CHAP.  XV.]  AMBULANCE    CORPS.  941 

"12.  No  person  except  the  proper  medical  officers  or  the  officers  and  non-commissioned  officers 
and  privates  of  this  corps  will  be  permitted  to  take  or  accompany  sick  or  wounded  to  the  rear 
either  on  the  march  or  upon  the  field  of  battle. 

"  13.  No  officer  or  man  will  be  selected  for  this  service  except  those  who  are  active  and 
efficient,  and  they  will  be  detailed  and  relieved  by  Corps  Commanders  only. 

"14.  Corps  Commanders  will  see  that  the  foregoing  regulations  are  carried  into  effect. 

"BY   COMMAND   OF   MAJOR   GENERAL   M.EADE: 

(Signed)  "S.  WILLIAMS, 

"  Assistant  Adjutant  General? 

The  establishment  of  a.  uniform  system  of  ambulance  corps  in  the  armies  of  the  United 
States  was  not,  accomplished  until  the  spring  of  1864,  when  Congress1  passed  the  following 
act,  which  was  approved  by  the  President  on  March  11,  1864,  and  promulgated  by  the 
Secretary  of  War  in  General  Orders  ~No.  106,  War  Department,  A.  G.  0.,  Washington,  D.  C.. 
March  16,  1864: 

"Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the  United  States  of  America  in 
Congress  assembled,  That  the  medical  director,  or  chief  medical  officer  of  each  army  corps,  shall, 
under  the  control  of  the  medical  director  of  the  army  to  which  such  army  corps  belongs,  have  the 
direction  and  supervision  of  all  ambulances,  medicine  and  other  wagons,  horses,  mules,  harness, 
and  other  fixtures  appertaining  thereto,  and  of  all  officers  and  men  who  may  be  detailed  or  employed 
to  assist  him  in  the  management  thereof,  in  the  army  in  which  he  may  be  serving. 

"  SEC.  2.  And  be  it  further  enacted,  That  the  commanding  officer  of  each  army  corps  shall 
detail  officers  and  enlisted  men  for  service  in  the  ambulance  corps  of  such  army  corps,  upon  the 

1  A  copy  of  the  bill  as  originally  introduced  in  Congress  in  the  winter  of  18G3  to  3864,  was  submitted  by  the  Committee  on  Military  Affairs  of  the 
Senate  to  Surgeon  LETTEKMAN  fur  recommendations  and  suggestions,  and  was  returned  by  him  with  the  following  letter : 

"HEADQUARTERS  ARMY  OF  THE  POTOMAC, 

"MEDICAL  DIRKCTOH'S  OFFICE,  January*,  1864. 

';  DEAR  SIR:  As  desired  by  the  clerk  of  the  Committee  on  Military  Affairs  in  the  Senate,  from  whom,  since  I  took  the  liberty  of  addressing  you 
on  the  3Ist  nit.,  I  received  a  copy  of  the  bill  in  reference  to  an  Ambulance  System,  I  have  the  honor  to  submit  for  your  consideration  the  following  sug 
gestions,  viz:  In  SECTION  1,  line  2,  after  the  word  'shall'  insert  the  words  'under  the  control  of  the  Medical  Director  of  the  Army  to  which  such  Army 
Corps  belongs.'  This  suggestion  is  made  because  it  is  considered  necessary  that  there  should  be  one,  officer  who  shall  have  the  control  and  supervision  of 
the  Ambulance  Corps  throughout  an  army,  and  as  the  Medical  Director  of  an  army  is  held  responsible  for  the  care  (in  the  widest  meaning  of  the  word) 
of  the  wounded  and  sick  in  that  army,  it  is  necessary  that  he  should  control  the  subordinate  officers  in  his  department,  and  his  authority  be  commensurate 
with  his  responsibility.  SECTION  1,  line  4,  after  the  word  'medicine'  insert  the  words  'and  other.'  This  will  make  the  provisions  of  the  bill  harmonize. 
SECTION  2,  line  2.  after  the  word  '  detail '  insert  the  words  '  officers  and  enlisted  men.'  SECTION  2,  line  2,  after  the  words  '  Army  Corps '  insert  the  words 
'  upon  the  following  basis,  viz.'  These  alterations  will,  I  think,  clearly  show  that  the  officers  and  men  are  detached  from  their  regiments,  brigades,  etc  , 
and  the  Ambulance  Corps  in  each  Army  Corps  considered  a  unit,  and  as  belonging  not  to  any  particular  regiment,  brigade,  etc.,  but  to  the  Army  Corps 
at  large,  a  feature  very  essential  to  the  proper  working  of  the  system.  SECTION  3.  Strike  out  all  after  the  word  'furnished,'  in  line  1,  to  the  word  'and,' 
in  line  7,  and  insert  the  words  'to  each  Army  Corps  two-horse  ambulances  upon  the  following  basis,  viz:  three  to  each  Regiment  of  Infantry ;  two  to  each 
Regiment  of  Cavalry ;  one  to  each  Battery  of  Artillery;  to  which  it  shall  be  permanently  attached.'  The  ground-work  of  the  organization  is  to  take 
from  regiments  the  direct  control  of  the  ambulances  and  form  them  into  trains  under  proper  officers  and  men.  Unless  they  are  so  they  cannot  be  wielded 
with  facility,  kept  in  order,  or  be  properly  supervised  by  the  superior  medical  officers.  It  has  been  found  when  ambulances  are  attached  to  regiments  that 
they  are  of  very  little  use,  especially  upon  a  march  or  in  time  of  action — the  regimental  medical  officers  under  such  circumstances  cannot,  from  the  nature 
and  pressure  of  their  duties  at  such  time,  control  them.  The  proposed  alteration  will  harmonize  with  the  provisions  of  SECTION  8.  It  is  proposed  to 
attach  the  ambulance  to  each  battery,  as  the  latter  has  no  fixed  position  and  is  liable  to  constant  change.  I  regard  the  last  three  suggestions  as  of  vital 
importance  to  the  successful  working  of  the  system.  SECTION  3,  line  8,  after  the  word  'division'  insert  the  words  'train  of  ambulances.'  SECTION  5. 
Strike  out  all  after  the  words  'Army  Corps,'  in  line  15,  to  the  words  'and  it  shall,'  in  line  18,  and  insert  'previous  to  a  march,  and  previous  to  and  in 
time  of  action,  or  whenever  it  may  be  necessary  to  use  the  ambulances,  to  issue  the  proper  orders  to  the  captain  for  the  distribution  and  management  of 
the  same;  for  collecting  the  sick  and  wounded  and  conveying-  them  to  their  destination.'  SECTION  5,  line  21,  strike  out  all  after  the  words  'Surgeon 
General '  to  the  end  of  the  section,  and  insert  instead  'or  the  Medical  Director  of  the  Army;  and  all  reports  to  higher  authority  than  the  Commanding 
Officer  of  the  Army  Corps  shall  be  transmitted  through  the  Medical  Director  of  the  Army  to  which  such  Army  Corps  belongs.'  The  Medical  Director 
of  an  Army  having,  under  the  Commanding  General,  the  control  of  the  Ambulance  Corps  in  all  Army  Corps,  military  subordination  and  discipline  require 
all  correspondence  and  reports  to  pass  through  him.  The  words  that  are  proposed  to  be  stricken  out  are  not  necessary,  as  the  Commanding  Officer  of  an 
Army  Corps  has  all  in  his  Corps  under  his  supervision.  SECTION  6.  Strike  out  in  line  7  the  words  'of  their  respective  regiments'  and  insert  the  words 
'  under  his  orders.'  This  is  suggested  that  the  different  sections  may  be  in  harmony,  and  to  reject  the  idea  of  the  ambulances  being  attached  to  regiments. 
SECTION  8,  line  3,  strike  out  the  word  '  officers '  and  instead  of  it  insert  the  word  '  persons.'  I  have  made  the  above  suggestions  freely  and  without  reserve, 
as  I  believe  you  desire,  and  it  is  in  accordance  with  my  own  wishes  that  my  views  be  plainly  given  on  the  subject.  The  manner  in  which  the  ambulance 
trains  are  now  established  and  conducted  in  this  army  permits  the  formation  either  of  Corps,  Division,  or  Regimental  Hospitals,  or  the  change  from  one 
to  the  other  as  the  exigencies  of  the  service  may  require  at  any  time,  without  delay  or  inconvenience,  and  to  the  great  advantage  of  the  sick  and  wounded, 
and  I  am  fully  convinced  from  my  experience  that  when  properly  carried  into  effect  this  system  can  be  managed  without  trouble,  and  the  sick  and 
wounded,  by  their  own  officers,  be  promptly,  carefully,  and  efficiently  cared  for,  and  thus,  in  no  small  degree,  contributing  to  the  efficiency  of  the  army 
in  which  it  is  properly  administered. 

"I  am.  sir,  very  respectfully,  your  obedient  servant, 

(Signed)  "JONATHAN    LETTERMAX, 

"Hon.  HEXRY  WILSON,  "Medical  Director. 

"  I'.  S.  Senate.'' 

It  will  be  noted  that  the  suggestions  of  Dr.  LETTEKMAN  were  incorporated  in  the  bill. 


942  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

following  basis,  viz:  one  captain,  who  shall  be  commandant  of  said  ambulance  corps;  one  first 
lieutenant  for  each  division  in  such  army  corps ;  one  second  lieutenant  for  each  brigade  in  such 
army  corps;  one  sergeant  for  each  regiment  in  such  army  corps;  three  privates  for  each  ambu 
lance,  and  one  private  for  each  wagon;  and  the  officers  and  non-commissioned  officers  of  the  ambu 
lance  corps  shall  be  mounted:  Provided,  That  the  officers,  non-commissioned  officers,  and  privates 
so  detailed  for  each  army  corps  shall  be  examined  by  a  board  of  medical  officers  of  such  army  corps 
as  to  their  fitness  for  such  duty ;  and  that  such  as  are  found  to  be  not  qualified  shall  be  rejected, 
and  others  detailed  in  their  stead. 

USEC.  3.  And  be  it  further  enacted,  That  there  shall  be  allowed  and  furnished  to  each  army 
corps  two-horse  ambulances  upon  the  following  basis,  to  wit :  three  to  each  regiment  of  infantry 
of  five  hundred  men  or  more;  two  to  each  regiment  of  more  than  two  hundred  and  less  than  five 
hundred  men  or  more ;  and  one  to  each  regiment  of  infantry  of  less  than  two  hundred  men :  two 
to  each  regiment  of  cavalry  of  five  hundred  men  or  more;  and  one  to  each  regiment  of  cavalry 
of  less  than  five  hundred  men;  one  to  each  battery  of  artillery — to  which  battery  of  artillery  it 
shall  be  permanently  attached;  to  the  headquarters  of  each  army  corps  two  such  ambulances;  and 
to  each  division  train  of  ambulances  two  army  wagons;  and  ambulances  shall  be  allowed  and 
furnished  to  division  brigades  and  commands  not  attached  to  any  army  corps  upon  the  same  basis, 
and  each  ambulance  shall  be  provided  with  such  number  of  stretchers  and  other  appliances  as  shall  be 
prescribed  by  the  Surgeon  General :  Provided,  That  the  ambulances  and  wagons  herein  mentioned 
shall  be  furnished,  as  far  as  practicable,  from  the  ambulances  and  wagons  now  in  the  service. 

"  SEC.  4.  And  be  it  further  enacted,  That  horse  and  mule  litters  may  be  adopted  or  author 
ized  by  the  Secretary  of  War,  in  lieu  of  ambulances,  when  judged  necessary,  under  such  rules  and 
regulations  as  may  be  prescribed  by  the  medical  director  of  each  army  corps. 

"SEC.  5.  And  be  it  further  enacted,  That  the  captain  shall  be  the  commander  of  all  the  ambu 
lances,  medicine  and  other  wagons  in  the  corps,  under  the  immediate  direction  of  the  medical 
director,  or  chief  medical  officer,  of  the  army  corps  to  which  the  ambulance  corps  belongs.  He 
shall  pay  special  attention  to  the  condition  of  the  ambulances,  wagons,  horses,  mules,  harness,  and 
other  fixtures  appertaining  thereto,  and  see  that  they  are  at  all  times  in  readiness  for  service;  that 
the  officers  and  men  of  the  ambulance  corps  are  properly  instructed  in  their  duties,  and  that  their 
duties  are  performed,  and  that  the  regulations  which  may  be  prescribed  by  the  Secretary  of  War, 
or  the  Surgeon  General,  for  the  government  of  the  ambulance  corps  are  strictly  observed  by  those 
under  his  command.  It  shall  be  his  duty  to  institute  a  drill  in  his  corps,  instructing  his  men  in 
the  most  easy  and  expeditious  manner  of  moving  the  sick  and  wounded,  and  to  require  in  all  cases 
that  the  sick  and  wounded  shall  be  treated  with  gentleness  and  care,  and  that  the  ambulances  and 
wagons  are  at  all  times  provided  with  attendants,  drivers,  horses,  mules,  and  whatever  may  be 
necessary  for  their  efficiency;  and  it  shall  be  his  duty  also  to  see  that  the  ambulances  are  not  used 
for  any  other  purpose  than  that  for  which  they  are  designed  and  ordered.  It  shall  be  the  duty 
of  the  medical  director,  or  chief  medical  officer,  of  the  army  corps,  previous  to  a  march,  and  prev 
ious  to  and  in  time  of  action,  or  whenever  it  may  be  necessary  to  use  the  ambulances,  to  issue  the 
proper  orders  to  the  captain  for  the  distribution  and  management  of  the  same,  for  collecting  the 
sick  and  wounded  and  conveying  them  to  their  destination.  And  it  shall  be  the  duty  of  the  cap 
tain  faithfully  and  diligently  to  execute  such  orders.  And  the  officers  of  the  ambulance  corps, 
including  the  medical  director,  shall  make  such  reports,  from  time  to  time,  as  may  be  required  by 
the  Secretary  of  War,  the  Surgeon  General,  the  medical  director  of  the  army,  or  the  commanding 
officer  of  the  army  corps  in  which  they  may  be  serving;  and  all  reports  to  higher  authority  than 
the  commanding  officer  of  the  army  corps  shall  be  transmitted  through  the  medical  director  of  the, 
army  to  which  such  army  corps  belongs. 

"  SEC.  6.  And  be  it  further  enacted,  That  the  first  lieutenant  assigned  to  the  ambulance  corps 
for  a  division  shall  have  complete  control,  under  the  captain  of  his  corps  and  the  medical  director  of 
the  army  corps,  of  all  the  ambulances,  medicine  and  other  wagons,  horses,  mules,  and  men  in  that 
portion  of  the  ambulance  corps.  He  shall  be  the  acting  assistant  quartermaster  for  that  portion 
of  the  ambulance  corps,  and  will  receipt  for  and  be  responsible  for  all  the  property  belonging  to  it, 
and  be  held  responsible  for  any  deficiency  in  anything  appertaining  thereto.  He  shall  have  a 
travelling  cavalry  forge,  a  blacksmith,  and  a  saddler,  who  shall  be  under  his  orders,  to  enable  him 
to  keep  his  train  in  order.  He  shall  have  authority  to  draw  supplies  from  the  depot  quartermaster, 


CHAP.  xv.J  -AMBULANCE    CORPS.  943 

upon  requisitions  approved  by  the  captain  of  his  corps,  the  medical  director,  and  the  commander 
of  the  army  corps  to  which  he  is  attached.  It  shall  be  his  duty  to  exercise  a  constant  supervision 
over  his  train  in  every  particular,  and  keep  it  at  all  times  ready  for  service. 

"SEC.  7.  And  be  it  further  enacted,  That  the  2d  lieutenant  shall  have  command  of  the  por 
tion  of  the  ambulance  corps  for  a  brigade,  and  shall  be  under  the  immediate  orders  of  the  1st 
lieutenant,  and  he  shall  exercise  a  careful  supervision  over  the  sergeants  and  privates  assigned  to 
the  portion  of  the  ambulance  corps  for  his  brigade ;  and  it  shall  be  the  duty  of  the  sergeants  to 
conduct  the  drills  and  inspections  of  the  ambulances,  under  his  orders,  of  their  respective  regi 
ments. 

"SEC.  8.  And  be  it  further  enacted,  That  the  ambulances  in  the  armies  of  the  United  States 
shall  be  used  only  for  the  transportation  of  the  sick  and  wounded,  and,  in  urgent,  cases  only,  for 
medical  supplies,  and  all  persons  shall  be  prohibited  from  using  them,  or  requiring  them  to  be 
used,  for  any  other  purpose.  It  shall  be  the  duty  of  the  officers  of  the  ambulance  corps  to  report 
to  the  commander  of  the  army  corps  any  violation  of  the  provisions  of  this  section,  or  any  attempt 
to  violate  the  same.  And  any  officer  who  shall  use  an  ambulance,  or  require  it  to  be  used,  for  any 
other  purpose  than  as  provided  in  this  section,  shall,  for  the  first  offense,  be  publicly  reprimanded 
by  the  commander  of  the  army  corps  in  which  he  may  be  serving,  and  for  the  second  offense  shall 
be  dismissed  from  the  service. 

"SEC.  9.  And  be  it  further  enacted,  That  no  person  except  the  proper  medical  officers,  or 
the  officers,  non-commissioned  officers,  and  privates  of  the  ambulance  corps,  or  such  persons  as 
may  be  specially  assigned,  by  competent  military  authority,  to  duty  with  the  ambulance  corps  for 
the  occasion,  shall  be  permitted  to  take  or  accompany  sick  or  wounded  men  to  the  rear,  either  on 
the  march  or  upon  the  field  of  battle. 

"  SEC.  10.  And  be  it  further  enacted,  That  the  officers,  non-commissioned  officers,  and  pri 
vates  of  the  ambulance  corps  shall  be  designated  by  such  uniform  or  in  such  manner  as  the  Secre 
tary  of  War  shall  deem  proper.  Provided,  That  officers  and  men  may  be  relieved  from  service  in 
said  corps  and  others  detailed  to  the  same,  subject  to  the  examination  provided  in  the  second  sec 
tion  of  this  act,  in  the  discretion  of  the  commanders  of  the  armies  in  which  they  may  be  serving. 

"SEC.  11.  And  be  it  further  enacted,  That  it  shall  be  the  duty  of  the  commander  of  the  army 
corps  to  transmit  to  the  Adjutant  General  the  names  and  rank  of  all  officers  and  enlisted  men  de 
tailed  for  service  in  the  ambulance  corps  of  such  army  corps,  stating  the  organizations  from  which 
they  may  have  been  so  detailed;  and,  if  such  officers  and  men  belong  to  volunteer  organizations, 
the  Adjutant  General  shall  thereupon  notify  the  governors  of  the  several  States  in  which  such 
organizations  were  raised  of  their  detail  for  such  service;  and  it  shall  be  the  duty  of  the  com 
mander  of  the  army  corps  to  report  to  the  Adjutant  General  from  time  to  time  the  conduct  and 
behavior  of  the  officers  and  enlisted  men  of  the  ambulance  corps,  and  the  Adjutant  General  shall 
forward  copies  of  such  reports,  so  far  as  they  relate  to  officers  and  enlisted  men  of  volunteer  organ 
izations,  to  the  governors  of  the  States  in  which  such  organizations  were  raised. 

"  SEC.  12.  And  be  it  further  enacted,  That  nothing  in  this  act  shall  be  construed  to  diminish 
or  impair  the  rightful  authority  of  commanders  of  armies,  army  corps,  or  separate  detachments, 
over  the  medical  and  other  officers  and  the  non-commissioned  officers  and  privates  of  their  respect 
ive  commands. 

"Approved  March  11, 1864.r 

By  the  passage  of  tins  act  the  authority  of  the  Medical  Department  over  the  Ambu 
lance  Corps  was  fully  established.  How  effectually,  and  at  the  same  time  how  considerately, 
the  medical  officers  availed  themselves  of  the  power  thus  conferred  upon  them  is  strikingly 
shown  in  the  systematic  manner  with  which  the  immense  number  of  wounded  after  tire 
battles  of  the  Wilderness,  Spottsylvania  Court  House,  Cold  Harbor,  Petersburg,  and  of  the 
campaign  in  Georgia  and  the  Carolina^,  were  cared  for  on  the  battle-field,  were  removed  to 
field  and  base  hospitals,  and  were  finally  distributed  in  general  hospitals  throughout  all  parts 
of  the  United  States.  Notwithstanding  the  opinion  of  General  H.  W.  Hal  lock,  no  panics 
or  stampedes  were  reported  as  having  been  caused  by  the  presence  of  the  non-combatants 
of  the  ambulance  corps. 


944  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

AMBULANCE   WAGONS. 

Ambulance  wagons,  or  wagons  especially  designed  for  the  transport,  of  sick  and 
wounded,  had  not  been  in  use  in  the  armies  of  the  United  States  until  a  year  or  so  before 
the  outbreak  of  the  War  of  the  Eebellion.  Transport  carts,  army  wagons,  ox  teams,  in 
fact  anything  that  could  be  made  available  for  the  purpose,  had  been  employed.  In  the 
War  of  Independence,  in  April,  1777.  the  Congress  of  the  United  States  passed  a  bill 
"devising  ways  and  means  for  preserving  the  health  of  the  troops"  which  contained  the 
following  paragraph:1  "That  a  suitable  number  of  covered  and  other  wagons,  litters,  and 
other  necessaries  for  removing  the  sick  and  wounded,  shall  be  supplied  by  the  Quarter 
master  or  Deputy  Quartermaster  General ;  and  in  case  of  their  deficiency,  by  the  Director 
or  Deputy  Director  General."  There  is  no  record  that  such  vehicles  were  supplied.  During 
the  war  with  Great  Britain,  in  1812-'14,  there  were  evidently  no  ambulance  wagons  in  the 
United  States  army,  as  Surgeon  James  Mann,2  in  his  report  of  that  campaign,  is  found  to 
make  the  request  that,  "to  facilitate  the  movement  of  the  hospital  department  attached  to 
an  army,  it  should  be  furnished  with  a  number  of  wagons  and  teams,  so  as  not  to  be  imme 
diately  dependent  on  the  Quartermaster's  Department,  when  requisite  either  to  take  the 
wounded  from  the  field  of  battle,  or  transport  the  sick  in  case  of  a  retrograde  march,  or 
remove  invalids  after  having  recovered  from  wounds  to  a  remote  hospital.  The  flying 
machines  called  volantes,  drawn  by  horses  (an  improvement  of  Larrey,  Chief  Surgeon  of 
the  French  army),  are  useful  in  open  countries,  where  a  corps  is  assigned  to  accompany 
them  on  the  field  of  battle,  upon  Larrey 's  plan."  The  same  author  (loc.  cit.,  p.  126)  relates 
that  he  transported,  in  February,  1814,  four  hundred  and  fifty  sick  men  from  Malone  to 
Plattsburgh  and  Burlington,  a  distance  of  seventy  miles,  in  sleighs,  losing  six  patients  by 
death.  In  the  Florida  war,  in  1838,  ambulance  wagons  are  mentioned  by  Surgeon  R.  S. 
Satterlee,  U.  S.  A.,  Medical  Director  south  of  Withlacoochee,  in  a  report  from  Fort  Brooke, 
Tampa  Bay.  dated  January  5th:  "I  found  the  ambulances  very  serviceable,  but  as  some  of 
the  wounded  could  not  be  transported  in  them,  on  account  of  the  roughness  of  the  road, 
between  thirty  and  forty  of  them  were  brought  a  part  of  the  way  on  litters  between  two 
horses."  Surgeon  Satterlee  probably  had  reference  to  the  ordinary  transport  wagons  used 
on  this  occasion  for  conveying  sick  and  wounded. 

In  the  General  Regulations  for  the  Army  of  the  United  States,  Washington,  1847, 
page  123,  paragraph  704,  it  was  ordered  that:  "For  the  accommodation  of  the  sick  and 
disabled,  a  wagon  will  be  attached  to  the  rear  guard,  when  necessary  and  practicable,  and 
a  surgeon  will  attend  to  give  assistance,  and  to  see  that  no  improper  persons  are  suffered 
to  avail  themselves  of  the  accommodation."  No  ambulance  wagons  were  attached  to  t he- 
American  army  in  Mexico  in  1846— '48,  or  to  the  expeditions  in  Indian  territories  before 
the  outbreak  of  the  war. 

In  1858  an  ambulance  wagon  (Fios.  452,  453)  had  been  proposed  by  Dr.  I.  Moses,  of 
New  York,  and  on  March  2,  1858,  a  Board  of  Officers,  consisting  of  Surgeons  R.  S.  Satterlee, 
C.  H.  Laub,  and  Assistant  Surgeon  C.  H.  Crane,  had  been  appointed  to  examine  and  report 
on  its  merits.  The  report  of  the  Board  is  appended :  "The  ambulance  resembles  an  omnibus, 
is  entered  by  two  steps  in  the  rear,  contains  seats  for  eighteen  persons — fourteen  inside  and 
four  on  the  front  seat.  By  raising  the  flaps  of  the  inside  seats  and  supporting  them  by  the 

1  BROWN  (H.),  The  Medical  Department  of  the  United  State*  Army  from  1775  to  1873,  Washington,  1873,  page  36. 

2  MANN  (JAMES),  Medical  Sketches  of  the  Campaign*  of  1812-13-14,  Dedham,  1816,  page  250. 


CHAP.  XV.l 


AMBULANCE    WAGONS. 


945 


uprights  attached,  and  removing  the  cushions  from  the  backs  of  the  permanent  seats,  a  bed 
is  arranged  which  will  accommodate  one,  two,  or,  on  an  emergency,  three  men  lying  down. 
With  one  man  in  a  recumbent  position,  room  for  twelve  men  seated  remains;  with  two 
men  lying  down,  room  for  eight,  and  with  three  men  lying  down,  room  for  six  remains.  A 


FIG.  452. — The  "MOSES"  ambulance  wagon — front  view. 


FIG.  453. — The  "MOSES "  ambulance  wagon — rear  view. 


canvas,  stretched  and  suspended  by  cords  from  the  top,  will  accommodate  two  men  lying 
down  where  the  roads  are  rough.  A  close-stool  is  provided  in  the  vehicle.  Two  seats, 
separated  from  the  rest,  next  to  the  door,  are  provided  for  the  hospital  steward  and  attend 
ant.  Two  movable  chests  are  placed  under  these  seats  to  contain  what  may  be  required 
for  daily  use.  The  movable  door  closing  the  ambulance  may  become,  by  change  of  position, 
a  table  for  writing  or  dispensing  medicine.  The  interior  is  closed  entirely  by  curtains  of 
prepared  canvas,  or  partly  by  curtains  and  Venetian  blinds  for  free  ventilation — windows 
admitting  suffi 
cient  light  when 
entirely  closed. 
Under  the  front 
seat  are  placed 
two  store  chests. 
Underneath  the 
carriage,  on 
either  side  of  the 
door,  are  two 
five-gallon  kegs 
for  water.  Un- 

FlG.  454. — The  "MOSES    ambulance  wagon  and  tent. 

der  the  body  of 

the  vehicle  are  hooks  for  camp  kettles,  pails,  and  cooking  utensils.  Two  drawers  are 
arranged  on  each  side,  between  the  wheels  and  under  the  carriage,  which  may  be  used  as 
panniers  when  necessary.  On  the  hooks  surrounding  the  ambulance,  five  feet  from  the 
ground,  canvas  is  stretched,  extending  ten  feet  on  each  side  of  the  carriage,  the  front  and 
rear  being  protected  in  the  same  manner,  which  forms  a  comfortable  and  ample  tent  protec- 

SURG.  Ill— 119 


A 


\ 


946 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


tion  for  thirty  sick  men,  and  which  may  be  arranged  in  a  few  minutes  after  arriving  in  camp 
by  one  or  two  men.  In  more  permanent  encampments,  or  in  hot  weather,  this  canvas  may 
be  fastened  to  hooks  around  the  top  of  the  ambulance  wagon  (FiG.  454),  serving  a  better 
purpose  by  giving  more  space  and  freer  ventilation.  It  is  suggested  that  a  light  iron  rail 
ing,  about  four  inches  in  height,  should  surround  the  top  of  the  ambulance,  where,  by 
having  a  suitable  canvas  cover,  blankets  and  other  indispensable  articles  might  be  securely 
carried.  A  lantern  suspended  over  the  front  seat  may  be  removed  to  the  rear  of  the  car 
riage,  at  will.  It  will  admit  of  sufficient  accommodation  in  the  way  of  transportation  arid 
provide  tent  shelter  for  the  sick  of  a  regiment  on  marches.  The  dimensions  are:  extreme 
length,  thirteen  feet  eight  inches;  height  of  floor  from  ground,  three  feet  three  inches; 
height  of  top  from  ground,  eight  feet  four  inches;  height  of  inside,  five  feet;  width,  four 
feet  four  inches.  Weight,  two  thousand  one  hundred  and  fifteen  (2,115)  pounds.  When 
loaded  with  men,  medicines,  tent  canvas,  etc.,  it  can  be  readily  drawn  by  six  horses  or 
mules.  The  size  of  the  wheels  and  the  track  of  the  same  correspond  with  those  of  the 
government  wagons.  After  a  close  examination  of  the  ambulance,  the  Board  is  of  the. 
opinion  that  it  is  well  adapted  for  field  and  frontier  service,  and  for  the  comfortable  trans 
portation  of  sick  and  wounded -men  on  long  marches;  that  the  tent  arrangement  forms  a 
valuable,  useful,  and  comfortable  shelter  for  hospital  patients.  On  marches  it  does  away 
with  the  use  of  hospital  tents,  is  easily  arranged,  keeps  the  hospital  separate,  and  requires 
no  detail  of  pioneers  or  extra  duty  men  to  pitch  and  arrange  it.  In  submitting  this  opinion 
the  members  of  the  Board  must  also  express  their  views,  based  upon  their  own  individual 
experience,  that  to  be  made  thus  available  and  useful  for  the  comfort  and  well-being  of  the 
sick  the  ambulance  should  be  the  property  of  the  Medical  Department,  and  that  the  team, 
harness,  etc.,  should  be  under  the  exclusive  control  and  direction  of  the  medical  officers 
under  all  and  every  circumstance."  ~No  action  seems  to  have  followed  the  recommendations 
of  this  Board,  and  no  ambulances  were  built. 

In  October,  1859,  a  Board  of  Medical  Officers,  consisting  of  Surgeon  0.  A.  Finley,  R. 


FIG.  455. — The   "FINLEY"  two-wheeled  ambulance 
wagon — front  view. 


FIG.  456.— The  "FINLEY"  two- wheeled  ambulance  wagon — side  view. 


8.  Satterlee,  C.  S.  Tripler,  J.  M.  Ouyler,  and  Assistant  Surgeon  K  H.  Goolidge,  had  recom 
mended:  1st,  that  ambulance  transportation  ought  to  be  furnished  for  forty  men  per  thou 
sand — twenty  lying  extended  and  twenty  sitting;  2d,  that  both  two  and  four-wheeled 


CHAP.  XV.J 


AMBULANCE    WAGONS. 


947 


ambulance  wagons  are  necessary  for  the  hospital  service;  3d,  that  a  two-wheeled  ambulance 
wagon  is  the  best  for  the  conveyance  of  dangerously  sick  or  wounded  men  *  *  *;  that 
to  each  company  one  two-wheeled  ambulance  wagon,  to  a  battalion  of  five  companies  one 
four-wheeled  and  five  two-wheeled  ambulance  wagons,  arid  to  a  regiment  two  four-wheeled 
and  ten  two-wheeled  ambulance  wagons  be  allowed ; 
and  that  for  hospital  supplies  to  commands  of  less 
than  three  companies  one  two-wheeled  transport 
cart,  to  commands  of  more  than  three  or  less  than 
five,  or  five  companies,  two,  and  to  a  regiment  four 
two-wheeled  transport  carts  be  assigned ;  and  that 
the  transport  carts  be  made  after  the  models  of  the 
two-wheeled  ambulance  wagons  (their  interior  ar 
rangement  for  the  sick  excepted) .  The  same  Board 
selected,  from  a  number  of  the  most  approved  plans 
laid  before  them,  the  two-wheeled  wagons  designed  FIG<  457— The  "COOLIDGE"  ambulance  wagon, 

by  Surgeon  C.  A.  Finley  and  Assistant  Surgeon  R.  H.  Coolidge.  The  bottom  of  the  body 
of  the  Finley  pattern  (FiGS.  455,  456)  was  divided  into  two  compartments,  each  containing 
a  movable  mattress  frame  or  stretcher;  four  longitudinal  pieces  either  in  or  upon  the  frame 
work  were  grooved  on  their  upper  surfaces  so  as  to  receive  the  rollers  in  the  mattress  frame. 
The  body  of  the  wagon  rested  on  four  elliptical  springs  fastened  upon  the  shafts,  which 
extended  the  whole  length  of  the  body,  crossing,  and  connected  with  the  axle.  The  body 


Fm.  458. — The  "  TRIPLER"  ambulance  wagon — side  view. 


FIG.  459. — The  same— rear  view. 


of  the  Coolidge  cart  (FiG.  457)  was  hung  on  platform  springs.  The  body  was  seven  feet 
long,  four  feet  wide,  and  one  foot  and  eight  inches  deep,  covered  with  a  ribbed  frame-work 
five  and  a  half  inches  above  the  floor.  Upon  the  relative  merits  of  the  two  patterns  of  two- 
wheeled  ambulance  carts  the  Board  hesitated  to  express  an  opinion,  and  therefore  recom 
mended  "that  one  of  each  pattern  be  sent  to  the  respective  Military  Departments  of  Texas, 
New  Mexico,  Utah,  California,  and  Oregon,  and  two  of  each  pattern  to  Fort  Leavenworth, 
and  that  they  be  placed  in  service  at  the  scene  of  Indian  hostilities  and  on  marches  across 
the  plains,  in  order  that  their  practical  advantages  might  be  ascertained."  The  Board  con- 


948 


TRANSPOKTATION    OF    THE    WOUNDED. 


[CHAP.  XV 


FIG.  460.— The  "TRIPLER"  ambulance  wagon— longitudinal  section. 


sidered  the  two-wheeled  cart  as  the  most  convenient  for  the  conveyance  of  dangerously  sick 
and  dangerously  wounded  men.  A  number  of  these  two-wheeled  carts1  were  furnished  to 
__^_  the  troops  in  the  early 


part  of  the  war,  but  expe 
rience  soon  proved  them 
useless ;  their  motion  was 
intolerable  and  excru 
ciating;  wounded  men 
begged  to  be  taken  out, 
wounded  officers  insisted 
upon  leaving  them,  and 
they  were  supplanted  by 
four-wheeled  vehicles, 
the  earliest  of  which  was 
the  Tripler  ambulance 
wagon  recommended  by 
the  Medical  Board  of 
1 859  (Flos.  458-460). 
It  was  constructed  to  carry  ten  men,2  four  lying  at  length  and  six  seated,  and  required 
four  horses.  The  body  of  the  wagon  was  ten  feet  long,  four  feet  wide,  and  the  sides  three 

feet  high.  Upon 
the  floor  were 
permanently 
laid  four  parallel 
iron  rails  seven 
feet  long  and  one- 
fourth  of  an  inch 
wide  and  high, 
with  con  vex  faces. 
Two  spring  mat 
tresses  were  run  in 
upon  these  rails. 
Twenty-two  inch 
es  above  the  sur 
faces  of  these  mat 
tresses  another  set 
of  rails  was  fitted 
to  the  wagon ,  upon 

which  another  set  of  mattresses  was  run.  In  front  of  the  wagon  was  a  chest  intended  for 
instruments,  dressings,  etc.,  which,  when  closed,  formed  a  seat  for  three  persons.  At  the 
tail  of  the  carriage  was  another  seat  for  three  persons.  All  or  any  part  of  the  interior  of 

'On  May  20,  1861,  Acting  Surgeon  General  R.  C.  WOOD  wrote  to  the  Secretary  of  War:  "It  is  highly  important  that  provision  be  made  for  the 
safe  and  comfortable  transportation  of  the  sick  and  wounded,  and  in  conformity  with  the  recommendations  of  a  Board  of  Medical  Officers  convened  by 
the  Secretary  of  War,  and  their  report  approved  by  him  in  General  Orders  No.  1,  January  19,  I860,  I  have  to  recommend  that  .  .  .  two  hundred  of 
the  two-wheeled  ambulances  be  immediately  constructed  by  the  Quartermaster's  Department.  The  recommendation  was  approved  by  the  Secretary  of 
War  and  the  wagons  were  constructed  and  sent  to  the  troops." 

2LONOMORE  (T.)  (4  Treatise  on  the  Transport  of  Sick  and  Wounded  Troops,  London,  1801),  page  382)  erroneously  states  that  this  wagon  was 
constructed  to  carry  eight  men,  all  lying  down. 


FIG.  461.— The  "WHEELING"  or  "ROSECBANS"  ambulance  wagon. 


CHAP.  XV.] 


AMBULANCE    WAGONS. 


949 


the  wagon  was  arranged  so  that  it  could  be  removed  at  pleasure,  making  it  available  for  the 
transportation  of  hospital  supplies.  The  cover  of  the  wagon  was  of  heavy  duck  supported 
on  five  hoops.  The  carriage  was  hung  on  plat-  _ 

form  springs,  and  underneath  the  body  was  sus 
pended  a  water-butt  three  feet  six  inches  long  and 
fourteen  inches  in  diameter.  This  wagon  was 

O 

extensively  used  and  answered  the  purpose, 
although  it  was  cumbrous  and  very  heavy.1 

The  Wheeling  or  Rosecrans  ambulance  wagon 
(FiGS.  461,  462)  was  also  used  in  the  early  part 
of  the  war.  It  was  built  in  the  Government  work 
shops  after  a  design  of  General  W.  S.  Rosecrans, 
IT.  S.  A.  It  was  lighter  than  the  Tripler  or  the 
Coolidge,  could  be  readily  drawn  by  two  horses, 
and  would  accommodate  eleven  or  twelve  sitting 
or  two  recumbent  and  two  or  three  sitting  pa 
tients.  Two  cushioned  benches  were  attached  to 
the  two  sides  of  the  interior  of  the  wagon,  running  ^ 
along  its  whole  length.  From  the  edge  of  each  FIG.  462.—  -rue  same-rear  view. 

of  these  benches,  fastened  by  hinges,  depended  a  cushioned  seat  the  length  of  the  benches. 
These  seats  could  be  readily  brought  on  a  level  with  the  benches,  and  when  thus  elevated 
could  be  secure 
ly  fixed  by  iron 
feet,  folded  in 
the  suspended 
seat.  For  the 
ends  of  the  iron 
feet  receptacles 
were  fitted  in 
the  floor  of  the 
wagon.  When 
both  seats  were 
raised  they  met 
in  the  middle 
of  the  carriage 
and  made  one 
continuous  bed 
for  two  patients. 


ide  view. 


OIll  V  Ore  *'1G<  *^'  —  ^ew  COOLIDGE  ambulance  wagon- 

seat  was  raised  it  formed  a  bed  for  a  recumbent  patient,  while  the  other  bench,  with  its 
suspended  seat,  allowed  space  for  at  least  four  sitting  patients.  A  water-tank,  capable  of 
holding  five  gallons,  was  stored  away  under  the  seats  in  the  rear  end  of  the  ambulance 
wagon  ;  not  unfrequently  stretchers  took  the  place  of  one  of  the  water-tanks.  In  front  of 
the  benches  a  transverse  seat,  accommodating  the  driver  and  two  or  three  patients,  was 


1  1  ictailrd  specifications  |'..T  the  Tlill'l.KU  ambulance  wagon  will  be  found  in  a  Re/wl  <,f  a  Hoanl  of  O;/<«vrs  to  ilecitle  njxm  <i  /'attcru  uf  Ambulance 
\\'<ig<>» j'or  Arm;/  CV.  Washington,  1878.  page  50. 


950 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


FIG.  464. — New  COOLIDGE  ambulance  wagon  arranged  for  two  recumbent  patients — perpendicular  section. 


provided.  Under  the  seat  was  a  box  for  medicines  and  other  articles  for  field  use.  Accurate 
specifications  for  the  building  of  this  ambulance  will  be  found  on  page  59  of  the  Report  of  a 
Board  of  Officers  to  decide  upon  a  pattern  of  ambulance  wagon  above  referred  to.  The 

body  of  the 
wagon  rest 
ed  upon  four 
elliptical 
springs,  two 
placed  trans 
versely  (one 
on  the  front 
and  one  on 
rear  axle), 
and  two  on 
the  rear  axle 
running  lon 
gitudinally. 
A  frame  of 
light  wood, 
with  canvas 
cover,  pro 
tected  the  patients  against  the  inclemencies  of  the  weather,  and  on  the  sides  curtains  of 
canvas  could  be  closely  buttoned  to  the  top  and  the  body.  At  the  rear  of  the  wagon  was  a 
step  to  assist  patients  and  bearers  in  lifting  in  the  wounded.  The  weight  of  the  wagon  was 
between  seven  hundred  and  eight  hundred  pounds. 

A  four-wheeled  ambulance  wagon  (Fias.  463, 464) ,  designed  by  Assistant  Surgeon  R.  H. 

Coolidge,  was 
very  little  used. 
The  sills  of  the 
wagon  were 
ten  feet  four 
inches  long, 
and  the  body 
rested  between 
two  semi-ellip 
tical  springs 
seven  feet  nine 
and  three- 
quarter  inches 
in  length  (FiG. 
463).  It  was 
intended  to  ac 
commodate  two 
patients  in  re 
cumbent  and  four  in  sitting  postures,  two  with  the  driver  on  the  front  seat,  and  two  at  the 
end  of  the  wagon,  one  on  each  side  (see  FIG.  465).  The  beds  for  the  two  prone  patients 


FIG.  465. — New  "COOLIDGE"  ambulance  wagon  arranged  for  sitting  patients — perpendicular  section. 


CHAP.  XV.]  AMBULANCE    WAGONS. 

were  so  arranged  that  they  could  be  changed  into  seats,  as  shown  in  FIG.  465,  when  the 
wagon  would  accommodate  ten  patients  and  the  driver.  Detailed  specifications  of  this 
ambulance  wagon  will  be  found  on  page  61  of  the  Report  of  a  Board  of  Officers  to  decide 
upon  a  pattern  of  ambulance  wagon  already  referred  to. 

Other  plans  for  ambulance  wagons  were  proposed  during  the  war,  and  for  the  informa 
tion  of  those  interested  in  this  subject  we  will  here  refer  to  such  as  were  submitted  to 
boards  of  medical  officers  for  examination  and  report.  In  June,  1863,  A.  W.  Siis  (Subject- 
Matter  Index  of  Patents  for  Inventions  issued  by  the  United  States  Patent  Office,  Wash 
ington,  1874,  Vol.  I,  page  14,  No.  39,595)  exhibited  a  wagon  intended  to  carry  four  severely 
wounded  men  in  a  recumbent  position.  A  Medical  Board  (Medical  Inspectors  E.  P.  Vol- 
lurn  and  W.  H.  Mussey,  and  Surgeon  J.  H.  Brinton,  U.  S.  V.)  considered  an  "increase  in 
the  carrying  capacity  advantageous  and  feasible,"  but  was  not  prepared  to  endorse  the 
plan  of  Mr.  Siis  in  all  its  details.  The  Board  was  of  the  opinion  that  the  Wheeling  ambu 
lance  wagon,  then  largely  in  use  in  the  army,  could  readily  be  altered  to  carry  four  patients 
in  a  lying  position,  as  in  Mr.  Siis's  plan.  Mr.  Siis,  in  April,  1864,  offered  an  improved 
plan,  which  was,  by  order  of  Surgeon  R.  0.  Abbott,  Medical  Director,  Department  of  Wash 
ington,  inspected  by  Assistant  Surgeon  W.  E.  Waters,  U.  S.  Army,  who  reported,  on  June 
2,  1864:  "These  improvements  consist  in  adapting  the  ambulance  for  the  conveyance  of 
four  patients  lying  down,  instead  of  two,  as  with  the  present  arrangement,  while,  at  the 
same  time,  the  carrying  capacity  for  such  as  can  sit  up  is  not  at  all  interfered  with.  The 
improvement  is  effected  by  having 'the  seats  fastened  with  hooks  to  the  side  of  the  ambu 
lance  so  that  they  can  be  detached  and  put  upon  the  floor,  thus  forming  a  bed,  on  which 
the  patient  can  lie  with  full  as  much  comfort,  as  regards  position,  as  with  the  present 
arrano-ement,  while  they  are  made  more  comfortable  by  the  addition  of  elastic  springs 
within  the  cushion."  Surgeon  Waters'  report  was  approved  by  Medical  Director  Abbott, 
who  recommended  that  ten  or  twelve  ambulances  fitted  with  these  improvements  be  sent 
to  the  field  for  trial.  In  April,  1864,  G.  W.  Arnold  (Subject- Matter  Index  of  Patents,  etc., 
page  14,  No.  45,152)  brought  to  the  notice  of  the  Surgeon  General  an  ambulance  wagon  for 
which  he  claimed  advantages  over  the  Wheeling  ambulance  wagon  in  the  arrangements  of 
the  seats  or  beds.  The  Board  (Surgeon  0.  A.  Juclson  and  Assistant  Surgeon  W.  Thomson) 
to  whom  the  examination  of  the  vehicle  was  referred  reported,  on  April  5,  1864,  that  "the 
only  advantages  it  possessed  over  the  Wheeling  model  was  that  its  litters  could  be  removed 
from  the  wagon,  the  patient  placed  upon  them,  and  then  easily  returned;  but  that  the 
capacity  for  carrying  men  was  diminished,  and  that  the  litters  accompanying  the  wagon 
were  too  heavy,  weighing  about  seventy  pounds  each,  and  would  add,  with  their  apparatus 
for  suspension,  nearly  two  hundred  pounds  to  the  weight  of  the  ambulance  wagon."  On 
October  11,  1864,  E.  R.  McKean  patented  an  ambulance  wagon  (Subject- Matter  Index  of 
Patents,  etc.,  page  14,  No.  44.643)  with  litters  or  beds  suspended  by  rubber  rings.  Surgeons 
R.  0.  Abbott,  0.  Sutherland,  and  Assistant  Surgeon  William  Thomson  inspected  the  wagon 
and  reported,  on  March  25,  1865:  "The  principle  of  suspending  the  stretcher  upon  which  the 
patient  lies  by  rings  of  India  rubber,  in  lieu  of  the  springs  of  steel  usually  placed  beneath 
tho  body  of  the  wagon,  is  the  main  difference  between  this  and  the  ambulance  now  in  gen 
eral  use.  However  valuable  this  principle  may  be,  the  mechanical  contrivances  by  which 
it  is  obtained  in  the  wagon  submitted  are,  in  the  opinion  of  the  Board,  too  complicated, 
wanting  in  solidity  and  durability,  and  too  liable  to  the  loss  of  detached  pieces,  to  render 
this  ambulance  lit  for  the  severe  test  of  field  service."  In  September,  1865,  an  India  rub- 


952 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


ber  spring  ambulance  wagon,  by  Perot  &  Co.,  was  brought  to  the  attention  of  the  Surgeon 
General  by  Brigadier  General  C.  H.  Grossman,  U.  S.  Army.  Surgeons  C.  McDougall,  John 
Campbell,  and  A.  "K.  Smith,  and  Assistant  Surgeon  C.  H.  Alden.  appointed  a  Board  to 
examine  the  rubber  spring  wagon,  reported,  on  October  26, 1865 :  "The  Board  is  very  favor 
ably  impressed  with  the  plan  proposed,  and  as  its  peculiarities  are  best  shown  by  contrast, 
would  state  the  following  as  some  of  the  particulars  in  which  it  is  thought  the  India  rubber 
spring  is  superior  to  the  ordinary  steel  spring.  It  more  perfectly  controls  the  movements 
of  the  body  of  the  ambulance  in  every  direction,  either  upward,  downward,  or  laterally, 
rendering  the  motion  of  those  seated  or  lying  within  steadier  and  more  equable.  It  is  better 
adapted  to  carrying  weights  in  the  ambulance,  acting  with  nearly  the  same  effect  with  a 
light  or  heavy  load.  It  is  believed  to  be  more  durable.  An  ambulance  built  upon  this 
plan  was  shown  to  the  Board,  belonging  to  the  West  Philadelphia  Fire  Company,  which  had 
been  in  use  for  several  years,  and  which  showed  but  little  evidence  of  wear  in  the  springs. 
It  is  easily  repairable,  as  a  spare  spring  can  be  readily  carried  in  the  ambulance  wagon,  and 
can  be  substituted  for  a  broken  one  with  but  little  delay  and  trouble.  The  India  rubber 
springs  weigh  thirty-five  and  three-quarter  pounds,  which  at  seventy-five  cents  per  pound 
would  amount  to  $26.81.  Steel  springs  of  the  same  power  would  weigh  about  two  hundred 
pounds  and  cost  about  $50.00." 

The  most  serviceable  ambulance  wagon  used  during  the  latter  part  of  the  war  was  that 
designed  by  Brigadier  General  D.  H.  Rucker,  and  built  at  the  Government  repair  shops  at 

Washington.  It  accom 
modates  patients  either 
in  the  sitting  or  lying 
postures.  On  the  floor 
of  the  vehicle  are  two 
stretchers  suitable  for 
carrying  one  patient 
each,  and  each  divided 
by  a  longitudinal  hinge- 
joint.  These  stretchers 
have  the  usual  handles, 
and  run  on  elastic  rollers 
so  as  to  move  readily 
longitudinally  in  the 
bottom  of  the  wagon. 
When  required  as  seats, 
the  joints  of  the 


FlG.  4GC.-Tbe  "  RUOKEII"  ambulance  wagon. 

ers  are  bent,  and  the  two  parts  are  made  to  assume  (see  FIG.  469)  a  position  at  right  angles 
to  each  other,  the  half  which  has  the  horizontal  position  being  hooked  to  the  sides  of  the 
vehicle,  the  other  part  forming  the  support  or  leg  for  the  front  of  the  seat.  When  the  lower 
bed  or  stretcher  is  thus  bent  to  form  a  seat,  the  upper  beds  are  turned  down  to  make  backs 
for  the  lower  seats  (see  FIG.  469).  These  backs  are  only  joined  to  the  sides  of  the  wagon 
by  hinges  at  their  upper  edge,  and  the  lower  edge  can  be  raised  upward  and  inward,  toward 
the  middle  of  the  carriage.  When  thus  elevated  the  two  backs  meet  in  the  middle  of  the 
carriage  and  are  there  supported  by  iron  supports,  which,  being  hinged  to  their  under  sur 
faces,  can  be  readily  lowered  for  the  purpose.  In  the  floor  are  springs  for  the  reception  of 


CHAP.  XV.] 


AMBULANCE    WAGONS. 


953 


the  iron  supports.  A  platform  is  thus  built  on  which  two  patients,  on  stretchers,  can  be  laid 
(FiG.  468).  These  stretchers  ordinarily  are  suspended  from  the  roof  of  the  carriage,  each 
stretcher  being  slung  with  one  side  to  the  middle  of  the  roof  and  with  the  other  to  the  bend 
of  the  arched  roof  (see  FIG.  469).  The  space  be 
tween  the  upper  surface  of  the  lower  and  the  lower 
surface  of  the  upper  stretchers  was  about  twenty-one 
inches.  This  space  was  ventilated  by  lattice  open 
ings  on  each  side  of  the  body  of  the  ambulance 
wagon,  as  indicated  in  FIG.  466.  The  body  rested 
on  platform  springs,  and  the  fore  wheels  were  smaller 
than  the  hind  wheels.  The  water-cask  was  under 
the  driver's  seat,  and  the  spigot  projected  slightly 
through  the  side  of  the  body.  The  weight  was  about 
one  thousand  one  hundred  and  twenty  pounds,  exceed 
ing  that  of  the  Wheeling,  which  only  weighed  from 
seven  to  eight  hundred  pounds,  but  the  Rucker  wagon 
was  somewhat  longer  and  broader.  Detailed  specifi 
cations  of  this  ambulance  wagon  will  be  found  on 
page  48  of  the  Report  of  a  Board  of  Officers  to  decide 
upon  a  Pattern  of  Ambulance  Wagon  for  Army  Use, 
Washington,  1878. 

In  October,  1864,  Assistant  Surgeon  B.  Howard,  U.  S.  Army,  constructed  an  ambu 
lance  wagon  (FiGS.  470,  471)  for  which  he  claimed  many  advantages.  A  full  description, 
with  illustrations,  will  be  found  on  pages  981—994  of  The  Sanitary  Commission  Bulletin, 
Vol.  I,  1866;  an  extract,  omitting  some  of  the  minor  details,  is  here  reproduced:  "To  enable 

the  badly  wounded  to 
be  easily  loaded  and 
unloaded,  two  litters  or 
beds  are  provided, made 
of  wood,  like  an  ordi 
nary  shutter,  with  sli 
ding  handles  at  each 
corner.  Upon  this  the 
patientis  easily  shifted, 
and  without  any  dis 
turbance.  The  litter 
is  slid  into  the  ambu 
lance  wagon  on  rollers. 


FIG.  467. — The  same — rear  view. 


J    '  I 


In  the  same  way  the 


FIG.  408. — The  same — arranged  for  four  recumbent  •  FIG.  409. — The  body  of  the  ''RuCKEll"  ambulance 

patients.  patient  is    removed    On     waS°u  arranSed  for  ordinary  use. 

arrival  at  the  hospital,  and  without  being  disturbed  until  he  reaches  his  bed.  If  part,  or 
all  the  patients  are  able  to  sit  up,  one  or  both  of  the  litters  can  be  slid  into  a  compartment 
provided  for  that  purpose  under  the  floor  of  the  vehicle.  There  are  six  permanent  seats, 
each  situated  transversely,  and  each  a  corner  seat  with  back  and  cushioned  seats.  This 
gives  a  comfortable  purchase,  secures  the  patients  against  much  of  the  usual  jolting,  and 
prevents  them  being  driven  against  each  other  in  going  over  rough  roads.  The  sides  of  the 

SiriJG.  Ill— 1-,>0 


954 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


ambulance  wagon,  as  also  both  sides  of  the  back  of  the  driver's  seat,  and  the  inside  of  the 
upper  section  of  the  tail-board,  are  cushioned,  while  the  middle  seats  have  for  a  back  a 
leather  strap,  like  that  used  in  stage  coaches;  thus  each  seat  is  rendered  very  comfortable, 
and  being  transverse  instead  of  longitudinal  is  in  every  respect  easier  for  the  patient.  In 
order  to  diminish  the  motion  of  the  body  of  the  wagon  and  prevent  rolling  and  pitching,  so 
intolerable  in  the  ordinary  ambulance  wagon,  semi- 
elliptical  springs  have  been  substituted  for  the 
elliptical  ones..  In  order  that  the  limited  motion 


.  470. —  i  lie  IluWAKD  iiiubulaiioe  wagon. 


FIG.  471. — The  same — rear  view. 


thus  obtained  be  so  modified  as  to  give  least  jar  to  patients,  internal  counterpoise  springs  are 
used,  the  delicacy  of  which  may  be  modified  to  any  extent  desired.  The  platform  or  frame 
on  which  the  seats  and  beds  rest  is  as  long  but  not  so  wide  by  about  two  inches  as  the 
inside  of  the  body  of  the  wagon.  Between  the  inside  of  the  body  and  the  frame  of  the 
platform  is  an  interspace;  this  is  occupied  by  two  lateral  semi-elliptical  steel  springs  on 
either  side,  fastened  at  the  centre  of  their  arc  to  the  inside  of  the  body  of  the  vehicle, 

i  i        ^         I| ~i      ^ie  ^ee^  °^  wnicn  plav  upon  iron  plates  on  the  outside  of 

the  frame.  Opposite  the  centre  of  the  arc  on  the  frame 
is  fixe(]  a  b]oc],  Of  goft  rubber,  so  that  on  the  application  of 
much  force  it  should  be  received  by  the  rubber  blocks, 

which  thus  act  as  buffers.  The  platform  or  frame  on  which  the  seats  and  beds  rest  stands 
upon  four  iron  stanchions,  each  of  which  rests  on  springs  like  the  lateral  springs  described 
above,  but  much  stronger,  as  seen  at  FIG.  472,  the  iron  stanchions  resting  on  steel  springs, 
the  feet  of  which' play  upon  iron  plates  let  into  the  floor  of  the  ambulance  wagon.  The 
spring  is  restrained  in  its  motion  upward  by  an  iron  staple,  and  when,  by  an  unusual  weight, 
it  is  heavily  pressed  down,  the  force  is  received  by  a  block  of  soft  India  rubber  enclosed 
within  the  staple.  An  impulse  communicated  to  the  floor  of  the  wagon,  instead  of  being 
propagated  to  the  beds  or  seats,  causes  a  counteraction  downward  of  the  spring,  which,  if 
the  force  be  very  great,  spends  itself  upon  the  block  of  rubber.  In  this  way,  both  laterally 
and  perpendicularly,  a  constant  poise  is  preserved,  and  what  would  otherwise  be  a  very 
violent  jar  is  reduced  to  little  more  than  a  vibration.  The  steadiness  of  the  entire  vehicle 
is  preserved  by  the  stout  semi-elliptical  spring  beneath  the  body,  and  the  delicacy  regulated 
to  any  degree  by  the  internal  counterpoise  springs  within  the  body.  That  the  water  may 
be  carried  securely,  immobility  of  the  vessel  containing  it  during  transportation  is  neces- 


CHAP.  xv.  AMBULANCE    WAGONS.  955 

sary.  This  is  effected  by  substituting  for  the  casks  in  ordinary  use  a  tank,  which  slides  into 
a  grooved  bed  and  is  secured  by  an  ordinary  fastening.  In  a  military  point  of  view  it  pos 
sesses  a  great  advantage  in  this:  that  besides  the  prescribed  articles  which  may  be  carried 
in  the  driver's  box,  a  large  amount  of  medical  supplies  may  be  carried  in  the  body  of  the 
ambulance  wagon  without  interfering  with  the  comfort  of  badly  wounded  patients.  There 
being  but  four  stanchions,  and  these  being  close  up  to  the  side  of  the  vehicle,  the  entire 
body  beneath  the  platform  is  free  for  transportation  of  supplies.  There  is  an  arrangement 
for  suspension  of  fractures  of  the  lower  extremity,  which  is  very  grateful  to  the  patients. 
Two  parallel  iron  bars  are  attached  to  the  roof  of  the  ambulance  wagon  longitudinally  over 
each  bed,  between  which  runs  a  roller  with  a  dependent  hook.  The  fractured  limb  being 
placed  in  a  double-inclined  plane  or  other  splint,  a  bandage  is  passed  through  terrestra  of 
the  box  splint  and  then  carried  over  the  hook  from  which  the  limb  is  suspended.  In  this 
way,  instead  of  the  jolting  and  jarring  so  commonly  experienced,  simple  oscillation  is  sub 
stituted,  or,  if  desired,  guys  of  bandage  may  be  so  extended  to  the  uprights  of  the  ambulance 
as  to  render  the  limb  nearly  motionless  during  transportation." 

The  weight  of  the  Howard  ambulance  wagon  was  twelve  hundred  and  thirty-two 
pounds.  The  plan  of  this  wagon,  with  recommendations  of  some  twenty  officers  of  the 
Army  of  the  Potomac,  was  submitted  for  examination  by  Surgeon  T.  A.  McParlin,  -Medical 
Director  of  the  -Fifth  Army  Corps,  to  a  Board  of  Medical  Officers,  consisting  of  Surgeon  .1. 
J.  Milhau,  U.  S.  A.,  Surgeon  L.  W.  Read,  U.  S.  V.,  and  Assistant  Surgeon  George  A. 
Mc.Grill,  U.  S.  A.,  who  reported,  on  October  6,  1864,  that:  "the  ambulance  wagon  meets  the 
approbation  of  the  Board  as  one  presenting  some  decided  advantages  over  that  now  in  use. 
It  is  recommended  further  that  at  least  two  to  a  division  be  furnished,  so  that  a  fair  trial  can 
be  made  of  such  vehicles."  A  number  of  the  old  pattern  ambulance  wagons  were  there 
upon  altered  according  to  the  plans  submitted  by  Assistant  Surgeon  B.  Howard,  U.  S.  A., 
at  the  Government  repair  shops  at  Washington.  But  it  seems  that  after  nine  months' 
experience  in  the  field  these  ambulance  wagons  failed  to  meet  the  expected  advantages.  In 
a  letter  dated  Medical  Director's  Office,  Headquarters  Fifth  Corps,  June  29,  1865,  Surgeon 
Charles  Page,  U.  S.  A.,  remarks:  "There  have  been  two  of  the  ambulance  wagons  in  each 
division  train  of  the  corps,  and  for  ease  to  the  patient  the  report  is  universal  in  their  favor. 
They  are  apt  to  get  out  of  order,  and  being  heavy  cannot  be  carried  where  the  other  ambu 
lance  wagons  can  go.  For  marches  I  think  the  Howard  ambulance  wagon  is  superior;  but 
for  field  work,  in  time  of  action,  I  would  prefer  the  present  Rucker  pattern  of  ambulance 
wagon."  In  a  reply  to  a  note  of  enquiry  from  the  Surgeon  General  dated  June  29,  1865, 
Surgeon  T.  R.  Spencer,  U.  S.  V.,  from  Headquarters  of  the  Fifth  Army  Corps,  takes  a  sim 
ilar  view:  "So  far  as  I  can  learn  in  this  corps,  it  is  not  regarded  as  an  improvement  upon 
the  old  one.  It  is  so  heavy  as  to  require  four  horses,  else  it  rapidly  destroys  two.  It  is 
so  complicated  as  to  be  continually  getting  out  of  order.  As  now  constructed  the  ambu 
lance  wagon  does  not  ride  as  easy  over  all  roads  as  the  old  one.  The  only  advantage  it 
seems  to  possess  is  in  the  greater  convenience  of  loading  and  unloading;  this  soon  results 
in  the  loss  of  the  bed,  as  officers  will  not  consent  to  be  removed  from  the  bed  during  trans 
portation.  Once  lost,  or  taken  from  the  ambulance  wagon,  the  bed  is  never  returned,  and 
the  wagon  is  henceforth  useless." 

In  the  winter  of  1864— '65  an  ambulance  wagon,  proposed  by  Dr.  I.  Langer,  was  used 
at  the  Fifth  Army  Corps  Depot  Hospital  before  Petersburg.  It  was  arranged  to  accom 
modate  eight  persons,  four  in  sitting  and  four  in  recumbent  positions,  or  six  in  sitting 


956 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


and  two  in  recumbent,  or  all  eight  in  sitting  postures.  The  advantages  claimed  were, 
greater  seating  capacity,  greater  facilities  for  loading  and  unloading,  greater  comfort  to 
patients,  offering  easier  access  to  each  single  patient,  superior  ventilation,  and  that  it  had 
apparatus  for  suspending  two  patients  with  compound  fractures  of  the  thigh.  In  April, 
1865,  a  Board  was  convened,  consisting  of  Colonel  R.  0.  Abbott  and  Assistant  Surgeons 


Flu.  473.  —  Au  army  wagon  fitted  up  us  an  ambulance  wagon.     [After  LANU 

J.  J.  Woodward  and  William  Thomson,  U.S.A.,  to  examine  and  report  on  this  ambulance 
wagon.-  The  Board  considered  seriatim  the  advantages  claimed  by  Dr.  Langer,  basing  its 
opinions  on  comparisons  with  the  Wheeling  and  the  Rucker  patterns  then  most  generally 
in  use:  "The  model  examined  is  altered  from  a  Wheeling  ambulance  wagon;  the  changes 

O  O  o 

^-—  —  —  -—'--.--  „-,-«.,—  ^  -----  ,,        are   radical  and  the  additions  numerous.     So 

f^ 

ingeniously  complicated  are  the  appliances,  and 
so  multitudinous  the  objects  to  be  obtained,  that 
the  wagon  would  fail  to  meet  the  test  of  field 
service.  The  probable  loss  of  its  numerous 
detached  pieces  would  rob  it  of  all  its  special 
advantages,  and  leave  it  less  useful  than  the 
Wheeling  and  Rucker  wagons.  In  comparison 
with  the  former  it  hfis  some  advantages;  but  it 
fails  to  compete  in  practical  usefulness  with  the 
ambulance  wagon  devised  by  Brigadier  Gen- 

Rucker>"         With    reard    to    tlie    a 


Fic,.  474.-The  Confederate  field  ambulance  wagon.  [After  CHISOUJ.J 

for  the  purpose  of  transporting  two  thigh  fractures  the  Board  find:  "The  novelty  of  the 
method  and  the  uncertainty  of  its  practical  value  would  not  warrant  the  alteration  of  all  the 
ambulance  wagons  in  the  service  to  fit  them  for  transporting  in  this  manner  an  occasional 
fractured  femur."  The  Board  refused  to  recommend  the  introduction  of  the  Langer  ambu 
lance  wagon  into  the  service  in  preference  to  those  then  in  use.  At  the  same  time  Dr. 


CHAP.  XV.]  RAILWAY   TRANSPORTATION.  957 

Langer  submitted  to  the  Surgeon  General  for  inspection  an  army  wagon  (Fio.  473)  which 
had  been  fitted  up  with  twelve  beds  for  transporting  patients.  Dr.  Langer  claimed  "that 
this  change  of  the  army  wagon  would  not  interfere  with  its  design  of  conveying  forage  or 
other  articles  to  and  from  a  camp;  that  when  the  wagon  is  used  for  carrying  forage  the  twelve 
beds  are  packed  under  a  movable  bottom,  and  the  railing  supporting  them  is  stowed  away 
on  the  sides,  so  that  the  capacity  of  the  wagon  box  is  not  impaired;  that  in  ten  minutes 
after  the  wagon  is  unloaded  it  is  changed  into  an  ambulance  wagon  with  all  the  equipments 
for  transport — six  patients  in  a  sitting  posture',  six  in  a  lying,  two  of  which,  if  necessary, 
suspended  on  fracture  beds  of  Dr.  Langer's  pattern;  that  there  is  room  for  all  the  equip 
ments  of  the  patients,  for  a  water-keg,  and  for  boxes  with  provisions  and  bandages,  and 
that  the  wagon  can  be  loaded  from  the  front  as  well  as  the  rear."  As  far  as  can  be  ascer 
tained  the  experiment  was  tried  but  once.  A  drawing  of  the  Confederate  field  ambulance 
wagon  is  copied  from  Chisolm1  in  FIG.  474.  No  description  of  the  vehicle  could  be  obtained. 

RAILWAY  TRANSPORTATION. 

The  facilities  afforded  by  railroads  for  the  movement  of  troops  and  material  to  the 
theatre  of  warfare  have  formidably  augmented  the  destructive  power  of  armies;  but  they 
have  also  offered  useful  and  most  effective  means  of  saving  lives  and  alleviating  suffering 
by  the  speedy  removal  of  the  sick  and  wounded  from  the  scene  of  active  operations.  After 
the  battle  of  Gettysburg,  in  July,  1863,  for  instance,  twenty  thousand  three  hundred  and 
forty-two  wounded  came  under  the  care  of  the  medical  officers  of  the  Army  of  the  Potomac, 
and  in  two  weeks  fifteen  thousand  four  hundred  and  twenty-five  had  been  forwarded  to 
Baltimore,  York,  Harrisburg,  and  New  York  City.  Of  the  remainder  a  large  proportion 
was  unable  to  bear  the  fatigues  of  a  protracted  journey.  After  the  bloody  battles  of  the 
Wilderness  and  Spottsylvania  the  distribution  of  the  wounded  was  even  more  rapidly 
effected,  and,  with  a  few  exceptions,  the  fallen  were,  within  a  few  days,  comfortably  sheltered 
in  the  hospitals  at  Alexandria,  Washington,  Baltimore,  Philadelphia,  and  New  York. 

By  rapid  dispersion  of  the  disabled  the  fighting  force  is  less  diminished  than  by  any 
other  plan.  Fewer  combatants  are  withdrawn  from  their  proper  duties  to  attend  their  sick 
and  wounded  comrades.  With  proper  inspection  of  those  sent  to  the  rear,  and  such  enforce 
ment  of  discipline  in  the  base  hospitals  as  will  ensure  the  prompt  return  of  convalescents, 
the  number  of  sick  and  wounded  engaging  in  fresh  active  service  will  be  greater  than  by 
any  other  arrangement;  and  a  less- proportion  of  division,  brigade,  and  regimental  medical 
officers  and  hospital  attendants  need  be  detached  from  the  marching  columns,  which,  in 
the  exigencies  of  actual  battle,  are  rarely  adequately  supplied  with  surgical  assistance. 
Large  accumulations  of  medical  and  hospital  supplies  with  the  army  become  superfluous. 
The  depot  hospitals,  frequently  great  lurking  places  for  malingerers,  may  be  reduced  to  the 
smallest  compass.  If,  without  changes,  the  wounded  can  be  directly  placed  in  a  fixed  hospital 
not  too  distant,  many  primary  mutilations  may  be  justifiably  avoided,  with  a  view  of  employ 
ing  more  delicate  special  operations  when  the  patients  arrive  at  a  safe  place  of  rest.  Lastly, 
the  most  important  consideration  is  the  most  obvious,  the  distribution  of  the  sick  and 
wounded  prevents  the  generation  of  those  pestilences  that  are  the  greatest  scourge  of  armies. 
The  sick  and  wounded  avoid  infecting  each  other,  and  those  who  are  well  escape  contagion. 

In  a  report  published  from  this  office2  on  the  subject  of  transportation  of  wounded  by 

1  UfllSOLM  (J.  J.),  A  Manual  of  Military  Surgery,  Columbia,  1864.     PI.ATF.  I. 

2 OTIS  (GEOKGE  A.),  A  Report  on  a  Plan  for   transporting  Wounded  Soldiers  by  Railway  in  Kme  of  War,  Washington,  War  Department, 
JSurgeun  Ueucrul's  Oflice,  1875, 


958 


TRANSPORTATION    OF    THE    WOUNDED. 


(CHAP.  XV. 


Fir;.  475. — Interior  of  an  improvised  hospital  car. 


railway,  the  means  employed  have  been  considered  at  length,  and  as  there  is  very  little  to 
be  added  to  that  report,  it  is  deemed  best  to  reproduce  such  portions  of  the  report  as  refer 
to  railway  transportation  during  the  late  war: 

"After  the  action  at  Wilson's  Creek  and  minor  engagements  in  central  Missouri,  in  August, 
18C1,  the  severely  wounded  fell  into  the  hands  of  the  enemy.  They  were  soon  paroled  and  con 
centrated  at  Kolla,  the  southwestern  terminus  of  the  St.  Louis  railroad,  whither  two  hundred  less 
grievously  injured,  and  carried  oft'  by  the  retreating  army,  had  previously  been  sent.  Here,  the 
freight  cars  available  were  fitted  up  for  the  transportation  of  this  large  body  of  wounded  to  the 
hospitals  established  at  St.  Louis.  Various  expedients  were  employed  to  adapt  the  cars  to  the 
requirements  of  the  different  classes  of  patients.  *  *  *  Seasoned  tent-poles  were  shaved  down 
to  give  them  as  much  elasticity  as  was  compatible  with  requisite  strength,  and  secured  transversely 
near  the  roof,  passing  through  holes  in  the  side  studs  of  the  car.  Ropes  attached  to  these  poles 

and  also  to  the  floor  suspended  two  tiers  of  field  stretch 
ers,  on  which  pallets  were  laid.  With  this  plan  a  feeling 
of  insecurity  was  common  to  the  patients  and  attendants, 
and  additional  lashings  and  constant  inspections  were 
necessary  to  prevent  accidents.  Another  method  con 
sisted  in  placing  a  double  row  of  upright  stanchions,  which 
were  erected  on  either  side  of  the  car  (FiG-,475),  connecting 
the  floor  and  roof,  at  intervals  of  seven  feet  lengthwise. 
To  these  firm  posts  tiers  of  two  or  three  litters  were 
securely  lashed.  In  other  cars  rough  wooden  bunks  were 
built  along  the  sides  of  the  vehicle  and  filled  with  straw, 
and  made  more  comfortable  by  being  floored  by  narrow 
elastic  slats.  In  all  cases  large  window  spaces  were  sawn 
out  of  the  ends  and  sides  of  the  car  to  afford  ventilation. 
There  was  often  cause  to  remark  on  the  great  ingenuity  displayed,  on  this  and  other  similar  occa 
sions,  by  the  line  officers,  quartermaster's  men,  and  the  soldiers  themselves,  in  improvising  various 
contrivances  for  the  comfort  of  the  wounded  subjected  to  these  rough  modes  of  transportation. 
With  an  intelligent  adaptation  of  the  means  at  hand  it  was  found  practicable  to  make  the  con 
dition  of  the  wounded  on  freight  cars  very  tolerable  with  the  aid  of  articles  belonging  to  the  field 
equipment  alone.  *  *  * 

"After  the  Army  of  the  Potomac  left  the  vicinity  of  Washington  the  sick  and  wounded  were 
removed  mainly  by  the  hospital  transport  steamers  on  the  Potomac,  Ivappahannock,  York,  and 
James  rivers.  The  short  lines  from  Savage's  Station  to  White  House,  on  the  York,  and  from  Aqnia 
Creek  to  Fredericksburg,  were  largely  utilized,  however,  for  the  same  purpose;  and  when  the 
theatre  of  hostilities  was  transferred  to  Maryland  and  Pennsylvania  numerous  railway  lines 
became  available.  Medical  Director  J.  Letterrnan  recorded  the  transfer1  of  no  less  than  nine 
thousand  sick  and  wounded  over  the  Aquia  Creek  road  on  June  12th,  13th,  and  14th,  1863,  when 
the  army  moved  northward  after  the  disasters  of  Chancellors ville.  All  patients  that  would  be 
injured  by  sitting  up  were  carried  by  hand  to  the  railway  on  the  beds  they  occupied  in  hospital, 
the  beds  being  placed  on  hay-covered  floors  in  freight  cars. 

"The  following  year,  when  this  army  was  massed  before  the  entrenched  line  at  Petersburg, 
a  large  depot  hospital  was  erected  at  City  Point,  the  base  of  supplies,  at  the  junction  of  the  James 
and  Appomattox  rivers.  This  depot  was  connected  with  the  positions  of  the  several  army  corps 
by  a  railroad  with  branches,  and  the  sick  and  wounded  from  the  division  hospitals  were  brought 
to  the  depot  chiefly  in  the  box-cars  which  had  carried  forward  supplies  for  the  troops,  and  were 
transferred  to  hospital  steamers,  or  retained  at  City  Point  for  treatment,  at  the  discretion  of  the 
medical  director  for  transportation,  Surgeon  E.  B.  Dalton,  U.  S.  V.  There  were  at  first  two,  and, 
subsequently,  a  larger  number  of  passenger  cars  converted  into  hospital  cars  by  the  erection  of 
rows  of  stanchions,  to  which  litters  were  suspended  by  elastic  rubber  rings,  each  car  having 
accommodation  for  thirty  recumbent  patients.  The  box-cars,  with  door-ways  at  the  sides  5  feet 
in  width  and  an  interior  height  in  the  centre  of  0  feet  9  inches,  had  a  floor  space  of  25  feet  2 


'LKTFEKMAN  (J.),  Medical  Recollections  of  the  Army  of  the.  I'otomac,  New  York,  1866,  p.  150. 


CHAP.  xv.|  RAILWAY    TRANSPORTATION.  959 

inches  in  length  by  7  feet  8  inches  in  breadth,  or  about  192  square  feet.  They  afforded  comfortable 
accommodation  for  nine  recumbent  patients,  but  were  sometimes  packed  with  as  many  as  twenty. 
When  the  floors  were  covered  with  a  thick  bed  of  fresh  straw  or  hay,  on  which  well-filled  bed- 
sacks  or  mattresses  could  be  laid,  the  concussions  from  the  motion  of  these  rough  cars  were  so 
much  deadened  as  not  to  be  intolerable  even  to  severely  wounded  men.  There  was  a  great  advan 
tage  in  carrying  the  wounded  on  the  beds  or  litters  on  which  they  lay  through  the  wide  door 
ways  of  the  box-cars,  and  unloading  them,  in  like  manner,  at  the  depot  hospital  or  the  wharves  of 
the  transport  steamers  at  City  Point.  It  was,  however,  very  difficult  to  obtain  an  adequate  supply 
of  straw  or  hay  when,  after  a  general  engagement,  train  after  train  was  sent  in  rapid  succession, 
and  recourse  was  sometimes  had  to  bedding  of  dry  leaves  or  evergreen  boughs.  In  one  of  the 
reports  to  Medical  Director  T.  A.  McParlin1  it  is  stated  that  it  was  necessary  to  empty  the  bed- 
sacks  of  the  field  hospitals  of  a  corps  in  order  to  obtain  sufficient  bedding  for  the  box-cars  of  a 
train  of  wounded. 

"In  the  summer  and  autumn  of  1802,  and  during  the  two  succeeding  seasons,  four  large  bri 
gades  stationed  at  New  Berne  suffered  from  malarial  fever  to  that  extent  that  general  hospitals,  or 
rather  sanitaria,  of  great  capacity,  were  established  on  the  sea-coast  at  Carolina  City,  near  Fort 
Macou,  the  former  connected  with  New  Berne  by  a  railway  forty  miles  long.  The  patients  were 
conveyed  in  freight  cars,  for  there  were  no  others  available.  The  floors  of  the  cars  were  covered 
with  dry  'pine  tags'  supplemented  by  a  layer  of  loose  hay  or  straw  when  it  could  be  procured. 
The  patients  were  laid  upon  bed-sacks  on  this  substratum,  and  even  those  most  gravely  ill  were 
transported  with  comparative  comfort.  Medical  Inspector  E.  P.  Vollum,  U.  S.  A.,  has  recorded2 
that  after  the  battle  of  Gettysburg,  July  1-3,  1863,  over  fifteen  thousand  wounded  were  sent  from 
the  field  hospitals  prior  to  July  22d,  nearly  all  by  railway  to  Baltimore,  York,  Harrisburg,  and 
Philadelphia.  They  were  transported,  in  large  proportion,  in  the  box-cars  of  the  returning  supply 
trains.  'Each  car  was  supplied  with  a  sufficient  quantity  of  hay,  and,  on  the  longer  routes,  water- 
coolers,  tin  cups,  bed-pans,  and  urinals  were  placed  on  them.'  After  the  battle  of  Olustee,  Febru 
ary  20,  1804,  where  the  wounded  of  the  Union  side  numbered  over  eleven  hundred,  Assistant 
Surgeon  John  H.  Janeway,  U.  S.  A.,  states  that  the  grave  cases  of  compound  fracture  and  of 
penetrating  wounds  of  cavities,  and,  indeed,  all  the  more  seriously  wounded,  were  transported  on 
the  Mobile  Eailway  on  freight  cars  bedded  with  pine  boughs,  palmetto  leaves,  and  a  small  allow 
ance  of  straw,  covered  with  blankets.  The  trains  moved  slowly  from  Sanderson  to  Jacksonville, 
on  the  coast,  a  distance  of  nearly  fifty  miles,  and  patients  who  had  undergone  amputation,  and 
others  severely  wounded,  complained  but  little  of  the  rough  method  of  transit.  In  the  campaigns 
about  Chattanooga,  also,  Medical  Director  G.  E.  Cooper,  U.  S.  A.,  reported  that  in  emergencies, 
when  the  regular  hospital  trains  were  overcrowded,  recourse  was  often  had  to  transport  by  freight 
cars  bedded  with  dry  leaves. 

"In  a  letter  to  the  Surgeon  General,  dated  Philadelphia,  January  7, 1803,  Surgeon  A.  K.  Smith, 
U.  S.  A.,  describes  'a  car  recently  fitted  up  by  the  Philadelphia  Railroad  Company  for  the  better 
conveyance  of  the  worse  class  of  sick  and  wounded.  *  *  *  The  internal  arrangements  are 
similar  to  those  of  sleeping  cars,  with  the  exception  that  the  berths  slide  in  and  out,  and  two  men 
can  carry  each,  with  its  patient,  to  the  ambulance  wagon  or  the  nearest  hospital,  the  berths  being, 
in  fact,  comfortable  stretchers.  The  car  has  fifty-one  of  these  berths,  and  a  seat  at  each  end  for 
an  attendant.  It  is  provided  with  a  stove,  on  which  soups  can  be  cooked,  a  water-tank  and  locker, 
and  a  convenient  water-closet.  It  is  proposed  to  use  the  car  with  the  regular  passenger  trains, 
and  to  bring  to  Philadelphia  cases  of  a  more  serious  nature  than  can  be  selected  for  transfer  by 
the  ordinary  mode  of  travel.  This  arrangement  is  entered  into  with  great  zeal  by  Mr.  Felton, 
president  of  the  road,  the  plan  being  in  a  great  measure  due  to  the  efforts  of  Mr.  William  Welsh. 
If  proved  to  work  well,  I  am  satisfied  in  saying  that  more  cars  will  be  similarly  constructed  for 
the  purpose  of  bringing  the  seriously  sick  and  badly  wounded  from  Frederick  and  Harper's  Ferry.' 
This  proposition  was  warmly  seconded  at  Washington,  and  a  number  of  passenger  cars,  converted 
to  hospital  requirements,  and  hospital  cars  also  of  special  construction,  were  soon  in  operation  on 
the  railway  lines  connecting  the  theatre  of  hostilities  with  Baltimore,  Harrisburg,  Philadelphia, 
and  New  Yoik.  They  wore  not  fitted  up  on  a  uniform  plan,  but  under  the  auspices  of  different 

'A  Ueport  frmn  the  Fifth  <'<>rjw  headquarters  by  Assistant  Surgeon  (,'.  K.  WlXXE,  U.  S.  A. 

-Yoi.u  M  (E.  P.),  Report  <»i  the  Transportation  of  the  Wounded  after  the  Battle  of  Gettysburg;  in  Appendix  to  J'art  I,  Medical  and  Surgical 
Uistory  of  the  War  of  the  Rebellion,  Washington,  1870,  p.  143. 


960 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.   XV. 


benevolent  associations;  but  all  secured  a  comparatively  comfortable  mode  of  transport  for  recum 
bent  patients,  and  rendered  almost  inestimable  service  in  relieving  the  crowded  hospitals  near 
the  scene  of  hostilities.  The  hospital  cars  fitted  out  by  the  United  States  Sanitary  Commission 
are  understood  to  have  been  arranged  in  accordance  with  plans  furnished  by  Dr.  Elisha  Harris.1 
A  model  of  one  of  these  cars  was  exhibited  at  the  Paris  Exposition  of  1867  (see  FIG.  476).  These  cars 
were  about  fifty  feet  in  length.  A  passage-way  extended  through  the  middle  to  the  doors  at  either 


FIG.  476. — Longitudinal  section  of  a  passenger  car  fitted  up  as  a  hospital  car.     [After  EVANS.] 

end.  On  either  side  of  the  passage-way  were  eight  upright  wooden  posts,  three  inches  square,  con 
necting  the  floor  and  ceiling,  and  so  placed  that  the  distances  apart  should  correspond  with  the 
length  of  a  field  stretcher.  At  a  distance  somewhat  less  than  the  width  of  a  field  stretcher,  opposite 
each  pillar,  another  post  of  like  dimensions  was  placed  next  the  side  of  the  car;  thus  one  side-pole 
of  a  stretcher  was  attached  inside  the  wall-pillar  and  outside  the  pillar  next  the  passage-way,  and 
its  suspension  was  rendered  easier  than  if  it  was  confined  between  the  rigid  pillars.  Wooden  pegs 

inserted  in  the  posts  served  for  the  attach- 

:  ^fgjjy  Hy— 

— •  !  -•  •  -  - — 


ment  of  large  rubber  rings  (FiG.  477),  which 
received  and  sustained  the  ends  of  the 
stretcher  poles.  Thirty-two  litters  could  be 
suspended,  leaving  a  space  in  the  middle  for 
a  stove  and  seats  for  attendants  or  wounded 
who  could  travel  in  a  sitting  posture.  It  is 
stated2  that  some  of  the  india-rubber  rings 
that  had  been  in  use  in  these  cars  were 
exhibited  in  Paris  in  1867,  and  were  still  in 
perfect  order.  I  have  been  informed  that 
these  cars  had  doors  of  three  feet  in  width; 
but  even  this  space  would  be  insufficient,  if 
the  litters  were  as  wide  as  represented  by 
Dr.  Evans.  The  ordinary  field  stretchers 


No.  3 


FIG.  477. — Mode  of  suspension  of  litters  by  rubber  rings  in  the  "Harris  car." 
1.  Vertical  view;  ~.  Lateral  view ;  3.  Enlarged  view  of  one  of  the  rings.  [After 
EVAAB.) 


used  in  the  United  States  were  uniformly  24  inches  wide,  and  it  was  this  form  of  stretcher  that 
was  generally  employed  upon  the  hospital  trains.  Although  the  advantage  of  caoutchouc  rings 
for  the  suspension  of  litters  was  generally  conceded,  and  the  inventor  and  exhibitor  were  rewarded 
with  medals,  many  objections  were  raised  to  the  arrangements  of  the  car  exhibited  in  Paris.  Dr. 
Lreffler3  declared  that  the  inconveniences  attending  the  transport  of  wounded  iu  tiers  of  three 
superimposed  berths  were  so  considerable  that  the  project  must  be  abandoned.  Professor  Gurlt4 
referred  to  the  danger  of  'the  frequent  jolting  of  the  car,  striking  the  poles  of  the  stretchers  against 
the  posts  and  communicating  concussions  to  the  litters  and  the  patients,  which  may  have  the 
gravest  consequences  for  the  latter.'  Professor  Billroth5  objects  to  these  and  all  other  arrange 
ments  for  the  railway  transport  of  wounded  that  cannot  be  extemporized. 

"STILLE  (C.  J.),  History  of  the  U.  S.  Sanitary  Commission,  Philadelphia,  1866,  p.  161;  HAMILTON  (F.  H.),  A  Treatise  on  Military  Surgery  and 
Hygiene,  New  York,  1865,  p.  168;  and  EVA\S  (T.  W.),  La  Commission  Sanitaire  des  iStats- Unis,  Paris,  1865,  p.  133,  et  Planche  IV.  A  letter  on  file  in 
the  Office  of  the  Quartermaster  General  indicates  that  Dr.  HAUUIS  invited  General  MEIGS  to  inspect  one  of  these  hospital  cars  as  early  as  March  20,  1863. 

2LONGMORE  (T.),  A  Treatise  on  the  Transjiort  of  Sick  and  Wounded  Troops,  London,  1868,  p.  476. 

*LCEFFLEE  (F.),  Das  Preussische  Militar-Sanitdtswesen,  untl  seine  Reform  nach  der  Kriegserfahrung  von  1866,  Berlin,  18G9,  B.  II,  8.  251. 

4  GURLT  (E.),  Abbildungen  zur  Krankenpjlege  im  Felde,  u.  s.  w..  Berlin,  1868,  s.  5,  Taf.  II. 

*BILLUOTH  (TH-),  Chirurgisclte  Brief  e.  uus  dc.n  Krier/s  La:arctlicn,  u.  s.  w.,  Berlin,  1872,  B.  71. 


CHAP.  XV.] 


RA  ILWAY    TRANSPORTATION. 


961 


"When  the  Army  of  the  Potomac  advanced  to  the  line  of  the  Rapidan,  the  Medical  Director 
of  the  Department  of  Washington,  Surgeon  Robert  O.  Abbott,  U.  S.  A.,  recommended  that  an 
hospital  train  of  twelve  cars,  one  fitted  up  as  a  dispensary  and  store-room  for  supplies,  one  for  the 
surgeon  in  charge  and  attendants,  and  ten  for  the  sick  and  wounded,  should  be  constructed  on 
plans  and  specifications  prepared  by  the  Assistant  Superiutendaut  of  Military  Railroads,  J.  Me 
Crickett,1  remarking  that  ' during  the  past  year  two  or  three  cars  somewhat  similarly  fitted  up, 
provided  with  medical  officers,  nurses,  and  the  proper  medical  appliances,  have  been  running,  under 
my  direction,  between  this  city,  Philadelphia,  and  New  York,  and  I  make  this  request  upon  my 
experience  of  their  practical  working  and  the  satisfaction  they  have  given  to  patients,  their  friends, 
and  this  office.  At  present,  the  sick  and  wounded  are  transported  in  cars  illy  adapted  for  the 
purpose,  and  with  difficulty  spared  from  the  other  pressing  demands,  and  lives  are  lost  on  the 
route,  not  infrequently,  which  in  all  probability  might  be  saved 
by  a  more  comfortable  and  easy  method  of  transportation.  These 
considerations  and  the  extended  facilities  such  cars  will  give  for 
transportation  of  the  wounded  particularly,  will,  in  my  opinion, 
justify  the  expense  of  construction.'  It  was  designed  that  this 
hospital  train  should  ply  between  the  advance  of  the  army,  near 
Culpeper,  and  the  base  hospitals  at  Alexandria  and  Washing 
ton,  and  should  supplement  or  supersede  the  freight  cars  bedded 
with  straw  or  hay  that  had  been  hitherto  in  use.  The  Surgeon 
General  and  Quartermaster  General  cordially  endorsed  this  pro 
ject,  and  several  complete  hospital  trains  were  soon  in  operation 
on  this  line. 

"FIGURE  478  is  a  reduction  from  Mr.  McCriekett's  'end  ele 
vation  of  the  hospital  car,  showing  the  litters  in  place,  and  the 
mode  of  hanging  them.  The  bottoms  of  the  permanent  couches, 
two  and  a  half  feet  wide,  are  made  either  of  wooden  slats  or  of  canvas,  with  mattresses  laid  upon 
them.  For  the  second  and  third  tiers,  ordinary  field  stretchers  are  used.  The  inside  poles  of  the 
litters  are  suspended  by  a  leathern  strap  or  by  strong  webbing,  the  strap  secured  to  a  carling  of 
extra  strength;  the  outside  handles  of  the  litters  are  supported  by  hooks  of  spring  steel.  There 
should  be  some  space  between  the  inside  litter  handles  and  the  side  of  the  car  to  prevent  concussions ; 


FIG.  4T8. — Transverse  section  of  hospital  car 
on  the  Orange  and  Alexandria  railroad. 


I 

f*f\  ..•  Y^" 

:    1    " 

°   ; 

F  ^     '1          - 

f"          1 
«• 

li                J 

^-  A          jF 

I 

G 

fobt 

I*<X  ^^^-1  :| 

1 

%*„©,  \         (l        \\         ° 

Lvvisd  J 

FIG.  479.  —  Horizontal  section  of  hospital  car  on  the  Alexandria  railway. 
/\  —  Stoves.                              C  —  Wash  Basin.                            E  —  Chair.                          G  —  Tiers  of  couches.                  1  —  Wood  Box. 
B—  Water-cooler.                   D  —  Lounge  or  couch.                   F  —  Table.                         H  —  Water-closet.                       K  —  Surgeon's  office. 

the  hooks  so  constructed  as  to  act  as  springs.  The  litters  of  the  second  and  third  tiers,  when  not 
in  use,  can  be  taken  down  and  folded  under  the  permanent  couches.  The  straps  also  can  betaken 
down  or  rolled  up;  there  will  then  be  no  obstacles  in  the  way  when  loading  the  cars  with  patients. 
A  door  three  feet  and  a  half  wide,  at  one  end?  gives  ample  room  for  ingress  and  egress  of  loaded 
stretchers.  The  aisle  is  three  feet  and  a  half  wide  and  can  be  occupied  by  folding  chairs  for  those 
who  can  travel  in  a  sitting  posture,  the  chairs  being  stored  under  the  permanent  couches.  The 

'Mr.  J.  McCKICKKTT  estimated  that  the  twelve  cars  could  be  built  in  thirty  days,  at  an  expense  not  exceeding  $30.000,  if  the  task  of  construction 
was  divided  among  the  factories  at  Wilmington,  York,  Ilarrisburg,  Philadelphia,  and  Springfield,  Massachusetts.  He  thought  it  "much  better  in  many 
respects  to  have  the  cars  made  to  order  than  to  buy  them  at  second-hand  and  .have  them  altered,''  since  railroad  companies  ''can  ill  spare  any  of  their 
rolling  stock  at  this  season,  and  would  sell  only  worn-out  or  condemned  cars,  the  alteration  and  fitting  up  and  repairs  of  which,  added  to  the  prime  cost, 
would  demand  a  greater  sum  than  would  be  required  for  new  hospital  cars."  It  is  impracticable  to  ascertain  from  the  records  of  the  Bureau  of  Construc 
tion  of  Military  Railways  whether  a  full  train  was  built  in  accordance  with  the  plans  and  specifications  of  Mr.  McCuiCKETT,  prepared  in  consultation 
with  Surgeon  E.  BEXTLEV,  U.  S.  V.  It  is  known  that  the  construction  of  a  number  of  hospital  cars  was  authorized  about  this  time,  at  different  car-shops, 
and  that  several  hospital  trains  were  soon  in  operation  on  the  Orange  and  Alexandria  line  ;  but  they  were  not  of  uniform  patterns.  In  many  of  them,  tlm 
litters  wore  suspended  by  india-rubber  rings.  It  is  probable  that  the  cars  constructed  under  the  direction  of  the  Sanitary  Commission  and  those  built  by 
Government  order  would  often  be  connected  or  separated  on  the  different  lines  as  the  exigencies  of  the  service  required. 

2  At  the  other  end,  represented  in  the  elevation  (Fin.  478),  the  door  opening  into  flit-  attendant's  room  is  only  two  feet  wide. 
SURG.    111—121 


962 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.   XV 


FIG.  480. — Lateral  elevation  of  a  part  of  one  of  the  cars  on  the  Alexandria  line. 


capacity  of  the  car,  which  measures  inside  eight  aiid  a  half  feet  in  width,  forty-five  and  a  half  feet 
in  length,  and  six  feet  eight  inches  in  height,  permits  the  transportation  of  fifty  or  sixty  patients- 
thirty  in  couches  and  the  others  in  chairs.'  FIGURES  479  and  480  explain  themselves. 

"With  the  addition  of  special  cars  fitted  up  with  rooms  for  kitchens,  dispensaries,  store  closets, 
quarters  for  the  employe's  of  the  train,  offices  for  the  executive  officer,  etc.,  a  well-organized  railway 
ambulance  train  became  a  nearly  complete  movable  hospital  establishment,  with  every  reasonable 
appliance  for  the  sustenance,  dressing,  nursing,  and  medication  of  the  patients.  The  hospital  trains 
of  the  armies  in  the  East  traversed  railways  within  the  Union  lines,  and  were  seldom  molested. 

They  were  moved  generally  at 
a  low  rate  of  speed.  They  were 
distinguished  by  displaying 
the  yellow  hospital  flag  near 
the  engine,  and  by  the  inscrip 
tion  'U.  S.  Hospital  Train' 
painted  in  large  letters  on  the 
panels  of  the  cars. 

"The  hospital  cars  prepared 
under  the  supervision  of  the 
Government  officials  and  those 
arranged  under  the  direction  of  the  agents  of  the  Sanitary  Commission  were  usually  passenger 
cars  converted  to  hospital  use,  although  the  kitchen  and  executive  cars,  and  a  few  of  those  for  the 
conveyance  of  the  sick  and  wounded,  were  built  specially  for  the  purposes  they  were  designed  to 
subserve.  There  was  great  variety  in  the  details  of  the  internal  arrangements;  but  nearly  all  con 
formed  to  the  general  plan  of  securing  berths  in  tiers  to  rows  of  uprights.  The  cars  constructed 
by  different  builders  varied  in  dimensions.  The  longest  were  58  feet  in  length  including  the  plat 
forms.  The  usual  interior  length  was  45  to  50  feet,  which  afforded  space  for  five  or  six  sections  of 
stretchers  on  each  side,  and  space  for  stoves,  lavatories,  water-closets,  and  seats  for  attendants. 
The  height  at  the  sides  was  6J  feet,  the  roof  sloping  upward  to  7£  feet,  and  being  surmounted  by 
a  clear  story  of  2  feet  provided  with  windows  and  ventilators. 

"It  was  in  General  George  H.  Thomas's  Army  of  the  Cum 
berland,  of  which  Surgeon  George  E.  Cooper,  U.  S.  A.,  was 
]\ledical  Director,  its  long  line  of  communication  extending  hun 
dreds  of  miles  away  to  its  base  of  supplies,  that  the  utility  of 
railway  transport,  in  relieving  the  army  of  its  disabled  men,  was 
most  conspicuous.  Although  freight  cars  were  used  for  very 
severe  cases,  several  trains  of  hospital  cars  of  special  construc 
tion  were  prepared  at  the  Government  work-shops  for  the  con 
veyance  of  patients  in  the  recumbent  posture.  In  1864  there 
were  three  hospital  railway  trains,  each  consisting  of  ten  or 
twelve  cars,  with  several  freight  or  baggage  cars  attached  some 
times,  connecting  the  advance  of  the  army  with  Nashville  and 
Louisville;  one  train,  at  least,  daily  leaving  the  vicinity  of  the 
field  hospitals.  In  each  train  one  car  was  fitted  up  exclusively 
as  a  kitchen  and  store-room,  and  another  as  a  dispensary,  with 
accommodation  for  the  medical  officer  in  charge,  and  an  ample 
supply  of  medicines,  stores,  instruments,  and  appliances.  Sur 
geon  Cooper  reported  that  upon  his  arrival  in  the  Department 
a  train  of  passenger  cars  fitted  up  for  the  transport  of  sick  and 
wounded  by  Acting  Assistant  Surgeon  J.P.Baruum  was  already 
in  operation  on  the  line,  a  hundred  and  eighty-five  miles  in 
length,  between  Louisville  and  Nashville.  This  train  had  been  prepared  at  Nashville  under  the 
direction  of  the  Western  Sanitary  Commission.  Each  of  the  cars  accommodated  thirty-three  recum 
bent  patients.  The  pallets  were  placed  in  tiers  of  three,  supported  by  iron  brackets  attached  to  the 
sides  of  the  car,  and  swung  on  india-rubber  springs  (FiG.  481).  'The  bed-frames,'  Surgeon  Cooper 
remarks,  'resemble  stretchers  with  a  portion  of  the  handles  sawn  off.  This  style  of  car  is  objection- 


FIG.  481. — Transverse  section  of  n  passenger  car 
fitted  out  by  Acting  Assistant  Surgeon  J.  P.  Bar- 
num,  and  known  as  the  "IIAUUIS  Car." 


CHAP.  XV.] 


RAILWAY   TRANSPORTATION. 


963 


able  on  account  of  the  surgeon  being  unable  to  manipulate  the  wounds,  when  they  require  dressing, 
without  great  inconvenience  to  himself.  The  space  between  the  beds  is  too  contracted,  and  causes 
much  complaint  from  the  wounded.  There  is  too  much  motion  in  the  beds,  and  altogether  the  car 
is  not  a  good  one.'  Dr.  Barrium  states  that  during  his  connection  with  the  railway  hospital  service 
he  'supervised  the  transportation  of  20,472  patients  and  lost  but  one,  who,  despite  the  advice  of  his 
surgeons,  implored  that  he  might  be  taken  to  die  in  the  bosom  of  his  family.' * 

"The  cars  thus  arranged,  and  others  in  which  litters  were  suspended  by  india-rubber  rings 
from  pegs  inserted  in  upright  posts,  as  in  the  Eastern  hospital  trains,  were  alike  known  at  the  West, 
under  the  designation  of  the  'Harris  car.'  Dr.  F.  L.  Town,  U.  S.  A.,  in  a  report  to  Assistant  Sur 
geon  General  E.  C.  Wood,  refers  to  them  as  follows:  'Other  ways  of  securing  the  beds  have  been 
tried.  The  'Harris  car'  is  in  use,  with  beds  arranged  in  three  tiers,  each  bed  resting  on  stretchers, 
suspended  by  four  rubber  rings,  between  uprights.  Each  rubber  ring  encircles  a  pin  in  the  upright 


FIG.  482. — Reduced  plan  of  a  horizontal  section  of  one  of  the  cars  of  Dr.  Barnaul's  train,  showing  the  positions  of  thirty-three  litters,  the 
wash-room,  and  water-closet.     [  From  a  drawing  furnished  by  Medical  Director  COO1JEU.J 

and  holds  up  one  end  of  the  lateral  bar  of  the  stretcher.  This  arrangement  has  one  advantage — 
the  stretcher  can  be  unshipped,  and,  if  necessary,  the  occupant  can  be  borne  away  without  disturb 
ing  him.  A  ward  in  the  '  Harris  car'  contains  thirty-three  or  thirty-six  beds.  The  removal  of  one 
section  of  the  tiers,  that  is,  three 
litters,  affords  room  for  a  stove 
in  cold  weather.  The  '  Harris 
car'  has  not  worked  well  in  prac 
tice.  The  elasticity  of  the  rub 
ber  bands  keeps  the  bed  in  con 
stant  vibration  while  the  car  is 
in  motion,  to  the  great  annoy 
ance  of  the  patients,  who  com 
plain  of  reclining  on  what  they 
term 'a  capering  bed.'  Severe 
cases  are  now  conveyed  in  the 
cars  to  be  hereafter  described. 

"FIGURES  482  and  483  further  illustrate,  by  horizontal  and  lateral  views,  the  arrangement  of 
one  of  the  hospital  cars  of  Dr.  Barnum's  train.  They  are  reductions  from  drawings  prepared  for  Dr. 
Cooper  by  a  draughtsman  of  the  Nashville  Car  Manufactory.  Some  further  particulars  respecting 
the  method  of  suspending  litters  by  rubber  tugs  or  rings,  and.  the  means  of  obviating  the  excessive 
oscillation  often  complained  of  as  a  grave  objection  to  this  system,  will  be  noticed  further  on. 

"Medical  Director  George  E.  Cooper  preferred  the  arrangement  of  the  ordinary  first-class 
passenger  cars  on  the  plan  indicated  in  FIG.  484.  The  cars  of  this  class  were  usually  fifty-five  feet 
long  and  nine  feet  four  inches  wide,  with  a  doorway  twenty-two  inches  wide  at  either  end,  a  passage 
way  of  equal  width  through  the  middle,  and,  on  either  side,  a  row  of  fourteen  double  seats.  Dr. 
Cooper  describes-  the  arrangement  (  FIGS.  479,  480)  he  commends  as  follows :  '  The  cars  thus  prepared 
have  a  capacity  for  thirty-three  patients.  The  beds  are  made  by  removing  the  alternate  seats,  and 
connecting  the  remaining  seats  with  slats  of  ash  or  some  other  springy  wood.  Two  bed-sacks  are 
laid  on  the  slats.  The  wounded  are  carried  on  the  slats  covered  with  bed-sacks,  and  are  placed 

1  EVANS  (T.  W.),  La  Commission  Sanitaire  des  £tals  Unis,  Paris,  18(53,  p.  133.  Medical  Director  COOPER  doubts  Ihis  remarkable  immunity 
from  deaths  in  transit  on  the  hospital  trains  directed  by  Dr.  BAKXUM,  while  testifying  to  the  indefatigable  zeal  and  efficiency  of  the  latter  during  his 
protracted  service.  "Acting  Assistant  Surgeon  J.  P.  BAUXUM,"  remarks  Dr.  TOWN,  "had  charge  of  the  first  hospital  train  built  at  Nashville.  He 
studiously  labored  to  improve  and  systematize  its  working,  and  devised  many  expedients  looking  to  the  comfort  of  tue  patients  in  days  when  tho  theory 
of  hospital  trains  was  not  so  well  understood  as  now." 


Fio.  483. — Lateral  view  of  half  of  a  hospital  car  of  Dr.  Barnum's  train,  showing  the  arrangement 
of  the  litters  and  the  wide  side  door.     [  From  a  drawing  from  Dr.  COOPEE.J 


964 


TRANSPORTATION    OF    THE    WOUNDED. 


ICHAP.  xv. 


two  on  each  bed.  The  upper  beds  are  framed  as  stretchers,  and  are  hooked  to  the  side  and  ceiling 
of  the  car  and  covered  with  a  mattress.  On  this  upper  tier  the  less  gravely  wounded  are  carried. 
This  plan  was  found  to  be  the  best,  the  least  expensive,  and  the  most  comfortable  to  the  patients 
of  all  the  hospital  cars  in  use.  The  medical  attendants  could  dress  wounds  in  these  cars  without 
much  inconvenience.1  On  the  drawings  sent  with  this  description  Surgeon  Cooper  annotates :  '  This 
is  the  simplest  and  best  form.' 

"  Dr.  F.  L.  Town,  U.  S.  A.,  gives  the  following  description 
of  five  of  these  cars  which  he  inspected  :  'Each  ward  contains 
about  twenty-four  beds,  arranged  lengthwise  along  either  side  of 
the  car,  in  two  tiers ;  the  upper  bed  exactly  above  the  lower.  In 
the  lower  tiers  the  bed  is  fixed  firmly  upon  the  car-seats;  the 
backs  of  these  [and  an  intervening  seat]  are  removed.  Its  width 
is  that  of  the  car-seat  [about  forty-four  inches],  and  its  distance 
from  other  beds  is  the  space  between  adjacent  seats.  In  the 
upper  tier  the  beds  are  about  two-thirds  as  wide,  and  are  on 
stretcher-frames,  attached  firmly  on  the  outer  side  to  the  wall  of 
the  car,  and  suspended  on  the  inside  by  two  iron  bars  from  the 
roof.  Each  upper  bed  thus  stands  or  hangs  immovably  in  its 
place.  The  wide  beds  in  the  lower  tier  are  considered  double, 
and,  on  short  routes,  are  often  occupied  by  two  patients  regarded 
as  mild  cases.  The  American  railway  companies  appreciate 
economy  of  space  in  their  sleeping  cars,  and  the  plan  of  trans 
porting  two  persons  in  one  bed  is  not  claimed  as  original  in 
hospital  trains.  The  hospital  car  is  supported  on  trucks  with 
elliptical  steel  springs,  as  is  usual  in  passenger  cars,  and,  in 
addition,  india-rubber  springs  are  so  arranged  as  to  equalize  the 
motion  and  deaden  the  jarring  of  the  car.  This  is  a  very  valuable  improvement  and  adds  much  to 
the  comfort  Of  the  patients.  In  the  wards  above  described  the  patients  ride  with  much  ease  and 
every  possible  provision  for  their  comfort.'  FIG.  485  shows  the  horizontal  plan  of  one  of  these  cars. 
"These  cars  were  fitted  up  under  the  immediate  supervision  of  Medical  Director  Cooper  and 
of  Surgeon  O.  O.  Herrick,  34th  Illinois  Volunteers.  The  latter  was  at  one  time  in  charge  of  one 
of  the  trains,  and  is  officially  reported  as  having  rendered  signal  service  in  devising  expedients  for 


Fir,.  484. — Transverse  section  of  hospital  oar  of 
the  Army  of  the  Cumberland.  ^Pattern  of  l>rs. 
Cooper  and  Herrick. 


I 


!•'!<;.  -185. — Horizontal  plan  of  one  of  the  hospital  cars  of  the.  Army  of  the  Cumberland. 

facilitating  the  safe  transport  of  wounded  and  in  promoting  the  organization  and  administration 
of  the  system.  General  Thomas  accorded  the  fullest  authority  to  Medical  Director  Cooper  to 
select  for  the  hospital  trains  the  best  locomotives  and  cars  to  be  found  among  the  rolling  stock, 
and  to  have  new  cars  fitted  up  whenever  necessary,  and  caused  to  be  detailed  for  the  hospital  serv 
ice  the  most  experienced  conductors,  engineers,  and  other  employes  of  the  several  railway  lines. 
Medical  Director  Cooper  informs  the  reporter  that  the  smoke-pipes  of  the  locomotives  of  the  hos 
pital  trains  were  painted  of  a  brilliant  scarlet;  the  exterior  of  the  hood,  and  of  the  tender  car  with 
water  and  fuel,  were  of  the  same  conspicuous  color,  with  gilt  ornamentation.  At  night,  beneath 
the  head-light  of  the  engine,  three  red  lanterns  were  suspended  in  a  row.  These  distinguishing 
signals  were  recognized  by  the  Confederates,  and  the  trains  were  never  fired  upon  or  molested  in 
any  way.  Dr.  Cooper  'was  informed  by  wounded  Confederate  officers  in  Nashville,  who  were  cap 
tured  at  the  battle  near  that  place,  of  the  stringent  orders  given  his  troopers  by  General  N.  B. 
Forrest  for  the  non-interference  with  and  protection  of  the  U.  S.  A.  hospital  trains,'  by  giving 


C'HAP.  XV.  1 


RAILWAY    TRANSPORTATION. 


965 


L 


FIG.  486. — Side  elevation  of  one  of  the  hospital  cars  constructed  under  Dr.  Cooper's  supervision 


them  timely  warning  in  the  event  of  the  railway  being  obstructed  or  torn  up.  The  partisan  troops 
of  Colonel  John  Morgan's  command  had  similar  instructions.  It  is  related  that  on  one  occasion 
Colonel  Morgan's  scouts  stopped  the  train  directed  by  Dr.  Baruum,  and  having  switched  it  off 
upon  a  siding,  after  inquiring  if  there  were  sufficient  stores  on  the  train  for  the  sick  and  wounded, 
they  tore  up  the  main  track,  and  then  rifled  and  destroyed  five  supply  trains  that  successively 
arrived  at  the  point  where  the  line  was  interrupted. 

''Ventilation  without  exposure  to  drafts  was  well  provided  for  in  these  cars  by  windows  in 
the  elevated  part  of  the  ceiling  ______„__ 


and  by  valvular  openings  near 
the  roof  (FiG.  48C).  Dr.  Town 
comments  0:1  the  admirable 
manner  in  which  the  apparatus 
for  lighting  and  heating  were 
made  also  to  promote  ventila 
tion.  He  refers  to  many  other 
details,  which  there  is  not  space 
to  notice  here,  and  concludes 
that  '  the  conception  of  a  com 
plete  hospital,  with  all  its  ap 
pliances  and  means  of  comfort,  propelled  by  steam,  was  first  carried  into  practical  operation  in  the 
medical  department  of  the  West,  and  its  perfect  success  was  most  gratifying  to  all.  In  visiting 
these  hospital  trains,  the  air  is  found  sweet  and  pure,  the  wards  neat  and  inviting,  and  it  may 
unhesitatingly  be  said  that  men  on  hospital  trains  are  often  as  comfortable,  and  better  fed  and 
attended  than  in  many  permanent  hospitals.'  Besides 
Drs.  Baruum  and  Herrick,  Medical  Director  Cooper  men 
tions  Surgeon  L.  J.  Dixon,  1st  Wisconsin  Volunteers,  and 
Assistant  Surgeon  E.  J.  Darken,  U.  S.  A.,  as  having  super 
vised  hospital  trains  with  great  skill  and  devotedness. 
Of  the  Medical  Director  himself,  Dr.  Town  observes: 
'Colonel  George  E.  Cooper  has  made  the  study  of  hospital 
railway  trains  his  pride.  All  of  the  western  trains  have 
been  in  the  Department  in  which  he  directs  the  medical 
service,  and  many  of  the  cars  have  been  fitted  up  under 
his  supervision.  *  *  *  He  has  just  cause  to  be  proud 
of  his  hospital  trains.'  As  far  as  the  records  of  the  Assist 
ant  Surgeon  General's  Office  show,  the  first  official  step 
toward  organizing  hospital  cars  was  a  letter  written 
August  11,  1803,  from  that  Office  by  Surgeon  Joseph  P. 
Brown,  U.  S.  A.  (during  the  temporary  absence  of  the 
Assistant  Surgeon  General  on  other  duty),  directing  the 
Medical  Director  of  the  Army  of  the  Cumberland  'to  take 
immediate  measures  to  fit  up  a  special  train  for  hospital 
purposes,  with  every  possible  comfort,'  to  run  between 
Nashville  and  Louisville. 

"  When  General  Sherman's  army  was  before  Atlanta, 
until  the  lines  of  communication  were  destroyed  prepara 
tory  to  the  march  to  the  sea,  hospital  cars  ran  regularly  from  the  front  to  base  hospitals,  some  of 
which  were  four  hundred  and  seventy-two  miles  distant.1 

"The  difficulty  of  introducing  loaded  stretchers  or  litters  through  the  narrow  end  doors  of 
the  converted  passenger  cars  was  obviated,  in  the  train  prepared  under  the  supervision  of  Drs. 
Cooper  and  Herrick,  by  leaving  the  middle  section  on  one  side  free  from  beds,  removing  two  win 
dows  and  the  paneling  beneath,  and  introducing  a  sliding  door,  six  feet  in  width,  affording  an 
ample  space  for  the  ingress  and  egress  of  litters  with  the  most  severely  wounded  patients.  Descrip- 

'Surgeon  F.  L.  TOWN'S  report. 


Fir..  487. — Uprights  and  elastic  ring  couplings  for  suspend 
ing  litters  in  hospital  cars.  B.  The  upright  post  next  the 
passage-way:  C.  The  fellow-post  next  the  side  of  the  car; 
F.  Oblique  view  of  the  coupling  by  rubber  bands;  D.  Lat 
eral  view  of  the  coupling  by  rubber  bands.  [After  HAKKIS.] 


966 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


FIG.  488.— The  "free"  or  inside  method 
of  suspending  litters  by  rubber  rings. 
[After  HARRIS.] 


tions  of  the  kitchen,  office,  and  dispensary  cars,  which  added  greatly  to  the  efficiency  of  these 
trains,  are  omitted  here.  A  further  description  of  the  hospital  trains  of  the  Army  of  the  Cumber 
land  has  been  given  by  Dr.  Dallas  Bache,  U.  S.  A.1  In  addition  to  the  illustrations  that  were 
published  with  his  paper,  it  may  be  useful  to  add  diagrams  explaining  the  details  of  the  arrange 
ments  for  suspending  litters  from  upright  posts  in  adapting  cars  for  hospital  purposes  (FiGS.  487, 

488,  489)  that  were  planned  by  Dr.  Harris  in  December,  1802,  and 
successfully  put  in  practical  operation  in  the  Spring  of  1803.  It  has 
already  been  shown  that  the  adaptation  of  cars  to  hospital  pur 
poses  by  securing  field  stretchers  to  rows  of  stanchions  was  practised 
from  a  very  early  period  of  the  late  war;  but  the  merit  of  devising  a 
simple  and  effective  method  of  suspending  the  stretchers  by  rubber 
rings  was  exclusively  due  to  Dr.  Elisha  Harris,  who,  moreover,  pro 
moted  Avith  great  earnestness,  during  the  war,  the  establishment  and 
organization  of  railway  transport  for  the  sick  and  wounded.  A  brief 
and  somewhat  inaccurate  account  of  this  system  was  published  in 
1805  by  Professor  F.  H.  Hamilton.2  The  plan  was  cursorily  alluded 
to  the  same  year  in  a  surgical  report  from  this  Office,1'  and  more  fully  described  in  a  work  by 
Dr.  T.  W.  Evans,  of  Paris.4 

"Dr.  Harris  proposed  to  suspend  three  tiers  of  litters  from  upright  oaken  stanchions  4  inches 
wide  by  2  inches  thick,  extending  from,  the  floor  to  the  roof  of  the  car,  which  gave  a  length  of 
about  6  or  GJ  feet  (FiG.  487,  B  and  C).  The  stanchions  were  placed  in  pairs,  the  fellow  posts  22 
inches  apart,  and  6£  feet  distant  from  the  next  couple  (FiG.  492).  The  stanchions  at  the  end  of 
each  row  of  uprights  were  perforated  to  receive  on  the  broad  face  three  hickory 
pins  an  inch  in  diameter,  and  three  on  the  narrow  face;  the  other  stanchions, 
each  pair  contributing  to  the  support  of  two  tiers  of  litters,  were  provided  with 
twelve  pins  (FiG.  487,  B,  C),  six  termed  holder  or  loop-pins,  and  six  arresting- 
pins  or  stops  (FiG.  487,  F,  D),  designed  .to  prevent  the  undue  descent  of  the 
litter.  Around  the  pins  on  the  broad  face  of  the  pillars  were  placed  loops  or 
tugs  of  vulcanized  india-rubber  3  inches  broad,  J  inch  thick,  with  4  inches 
aperture,  and  weighing  9£  ounces  Troy.  The  handles  of  the  stretchers,  sawn 
off  at  7i  inches  from  the  margins  of  the  canvas,  were  inserted  in  the  rings, 
which  were  put  upon  the  stretch  by  the  weight  of  the  patient.  Too  great 
oscillation  was  prevented  by  the  stopping-pins  or  by  substituting  more  massive 
rubber  rings.  The  holder-pin  for  the  lower  stretcher  was  0£  inches  from  the 
floor,  the  stop-pin  three  inches.  The  space  between  the  upper  and  middle  and  the  middle  and 
lower  stretchers  was  about  19  inches.  The  inside  length  of  the  cars  fitted  up  varied  from  41  to  47 
feet,  and  would  accommodate  four  or  five  tiers  of  litters  on  either  side,  with  space  reserved  for 
seats,  closets,  and  offices  at  the  ends.  The  inside  width  of  the  cars  was  8  or  8£  feet,  and  as  the 
two  series  of  berths  occupied  but  2  feet  4  inches  on  either  side,  a  passage 
way  of  3  feet  4  or  10  inches  was  left  in  the  middle.  The  end  doors,  usually 
opening  2  feet,  were  widened  to  2i,  or,  in  the  best  models,  to  3  feet.  Hair 
pillows  (FiG.  489)  were  attached  to  head-boards  of  finch  light  wood,  and 
secured  by  straps  to  the  litter  poles.  Dr.  Harris  proposed  a  modification  of 
this  plan,  designed  to  afford  greater  elasticity  to  the  litters  for  the  transport 
of  severe  cases.  The  inner  edges  of  the  upright  stanchions  were  placed  26 
inches  apart,  and  the  handles  of  the  litter  were  hung  between  the  posts  (FiG. 
488,  M);  a  wooden  or  iron  traverse  was  substituted  for  the  stop-pins,  and 
the  mode  of  insertion  of  the  pins  in  the  uprights  was  altered  (FiG.  488,  E); 
larger  rubber  rings,  weighing  12  ounces,  were  used.  On  experiment  this 


Fir..  489.— Pillon-s  for 
stretchers.  [After  HAlt- 
KI8.J 


Fin.  <T)0.— Hospital  railway 
ear — rear  elevation. 


ers  arc  sn-i">nded  en  loops  mtulc  ot  gutta-percha."  n  singularly  unsuitable  material. 

1.  ().,  Washington.  I?fi5.  Rzportt  on  the.  Extent  and  Xatitrc.  of  /;„:  MihrMs  available,  for  the  reparation  of  a  Medical  and 
he  Rebellion,— Surgical  Report.  r.  81.     Diagrams  were  given  (Flos  88,  W.  !)0),  from  a  photograph  by  Gardner,  of  the  working  draw- 
first  hospital  car  exhibited  by  Dr.  HARMS  in  Washington  in  March.  18fi3.     I  found  the  photograph  on  file,  but,  at  that  time,  could  obtain  no 
precise  information  of  its  origin. 

*  EVANS  (T.  W.).  La  Commission  Sanitaire  des  £lats-Unis,  etc.,  Paris,  1805. 


CHAP.  XV.] 


RAILWAY    TRANSPORTATION. 


967 


plnn  was  found  inferior  to  the  first.  Most  of  the  cars  were  provided  at  one  end  with  a  wash-room 
and  water-closet  (FiG.  491),  and  at  the  other  end  with  a  couch  and  seats  for  attendants,  a  stove, 
and  a  small  closet  for  a  few  essential  medicines  and  dressings,  and  a  copper  boiler  with  an  alcohol 
lamp.  This  brief  statement  of  details  applies  to  many  of  the-  long  passenger  cars  fitted  up  for  hos 
pital  purposes  upon  specifications  supplied  by  Dr.  Harris.  This  original  design  of  Dr.  Harris  was 


Fin.  491. — U.  S.  Army  Hospital  railway  oar  used  at  the  East — side  elevation. 

not,  however,  limited  to  transforming  passenger  cars  to  hospital  use;1  and  the  adaptation  of  elastic 
rubber  rings2  to  the  suspension  of  litters,  though  valuable,  was  not  the  most  important  and  enduring 
part  of  his  system.  There  will  probably  be  many  changes  and  improvements  in  the  methods  of 
moving  wounded  men  by  railway,  but  the  idea  of  utilizing  the  ordinary  field  stretchers  for  railway 
transport,  keeping  the  patients  upon  them  until  they  reach  a  fixed  hospital,  will  not  soon  be  aban 
doned.  This  expedient  had  been  already  resorted  to  in  isolated  instances,  but  Dr.  Harris  proposed 
its  systematic  adoption  and  devised  a  feasible  method  for  its  accomplishment.  The  system  was 
much  commended  in  Europe.3 

u  At  the  close 
of  the  war  there 
w e re  in  u s e 
thirtj'-nine  cars 
that  had  been 
fitted  out  under 
the  supervision 
of  the  Sanitary 
Commission. 


_*J 

(             p.                      u                        u                      -r- 

)EO 

irr  .$• 

Jv«/ 

»       1 

ri*                        o                         i                          o                          o 

—  &                                n                                  n                                   n                                   n       l_ 

Fir,.  492. — Hospital  railway  car  used  at  the  East — ground  plan. 


Except  in  a  few  instances,  however,  the  Government  had  reimbursed  the  Commission  for  the 
original  cost  and  the  expenses  of  the  outfit." 

tn  the  fall  of  1863  and  winter  of  1864  the  chief  army  of  the  West  was  concentrated4 
principally  along  the  line  of  railroads  leading  from  Nashville,  Tennessee,  southwest  via 
Chattanooga.  Tennessee,  and  stretching  on  toward  Atlanta,  Georgia.  Heretofore  such  sick 

o  o 

and  wounded,  on  railroad  lines,  as  could  bear  transportation  were  taken  to  points  in  the 
rear  and  north  l>y  ordinary  passenger  cars.  Severe  cases  could  not  be  removed  at  all 
and  had  to  remain  in  the  nearest  hospital  depots.  Those  w  transitu  often  suffered  from 
being  delayed  on  the  route  by  accident,  or  by  the  immense  supply  trams  destined  tor  the 
army  constantly  passing  over  the  road.  Xot  unfrequently  the  delay  was  at  points  where 
no  rations  could  be  drawn,  and  if  they  were  to  be  had  no  means  were  at  hand  for  cooking 
them,  or  feeding  the  men,  or  of  making  them  comfortable.  Hence  the  idea  of  a  hospital 
train,  an  ambulating  hospital,  an  independent  hospital  organization,  which  could  furnish 


pencil-sketch;  the  details  of  a  complete  ambulance  car  were  arranged  the  last  week  in  December.  1862.  and  the  first  ear  fitted  up.  the  pioneer,  w  s  the 
favorite  old  51 -feet  ear  that  was  mutilated,  when  occupied  by  the  fith  Massachusetts  Volunteers,  in  the  Baltimore  riot  of  April.  18(>1 .'' 

'•'The  elasticity  of  the  rubber  rings  was  objected  to  by  some  surgeons.  Assistant  Surgeon  F.  L.  Tmvx.  I".  S.  A.,  remarks:  "The  Hnrris  ca  docs 
not  work  well  in  practice:  the  elasticity  of  the  rubber  rings  keeps  the  bed  in  constant  vibration  while  the  car  is  in  motion.  This  greatly  anno  s  the 
patient,  who  objects  to  riding  a  capering  bed."  MlAVKOWITZ  (H.  v.),  Das  tlilitarsanitiitsweien.  18f~.ti.  S.  87. 

4  For  the  account  of  the  management  of  the  hospital  trains  of  the  Department  of  the  Cumberland  alluded  to  here,  the  editor  is  largely  indebted  to 
a  manuscript  report  of  Assistant  Surgeon  F.  L.  TOWN,  I'.  S.  A. 


968 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


each  sick  and  wounded  patient  with  a  comfortable  bed,  feed  and  care  for  him  en  route,  the 
same  as  if  in  a  general  hospital,  without  regard  to  time  or  distance.  Such  hospital  trains 
were  in  successful  operation  during  the  last  eighteen  months  ot  the  war. 

A  hospital  train,  when  complete,  is  made  up  of  ten  cars,  and  accommodates  from  one 
hundred  and   seventy-five  to  two  hundred  patients  comfortably.     The  arrangement  of  the 

train  is  as  follows:  One 
box  car,  one  kitchen  car, 
an  ordinary  passenger  car 
with  seats,  five  cars  with 
beds,  i.  e.,  hospital  wards, 
an  office  car.  and  a  con 
ductor's  car.  The  forward 
box  car  is  fitted  up  as  a 
storeroom  and  carries  provisions,  hospital  stores,  bedding,  etc.  The  drawings  and  brief 
descriptions  of  this  as  well  as  of  kitchen  and  surgeon's  cars  of  the  Army  of  the  Cumberland 


Fir;.  493. — Baggage  and  commissary  car  of  the  Army  of  the  Cumberland — horizontal  plan. 


r 


FIG.  4i)4. — Baggage  and  commissary  car  of  the  Army  of  the  Cumberland — longitudinal  section.  FIG.  495. — The  same — transverse  section. 

were  furnished  by  its  Medical  Director,  Surgeon  George  E.  Cooper,  U.  S.  A.  The  baggage 
car  ( FIG.  493)  contained  three  closets  to  store  rations;  the  centre  open  space  was  intended 
to  carry  barrels  and  large  stores.  The  two  bunks  shown  in  the  transverse  section  (Fio.  495) 


k 

X 

i>    am 

.                 /• 

9 

d 

! 

B 

3 

A. 

c 

»~~~, 

a 

z> 

=,*,l=^== 

L\^=v*A=3ZZ> 

_f 

^^ 

;  

««_- 

=^=*W===m*!==*m- 

m—ZL. 

J=u 

FIR.  49C.— Kitchen  car  of  the  Army  of  the  Cumberland— horizontal  plan. 

were  for  the  attendants  belonging  to  the  car.  The  kitchen  car  (FiGS.  496.  497)  was  divided 
into  three  compartments,  the  dining-room,  storeroom,  and  kitchen  proper.  The  storeroom 
occupied  the  centre  portion  of  the  car,  leaving  a  passage-way  from  the  kitchen  to  the  dining- 
room.  The  kitchen  proper  was  furnished  with  a  small  range  with  boilers,  etc.,  complete. 
There  were  stands,  tables,  and  a  closet  for  kitchen  utensils  in  the  kitchen  proper.  The 
letters  indicate:  A,  kitchen,  a,  cooking  range;  b,  sink;  c,  cupboard;  d,  table  and  shelves. 
B,  store-room;  e,  ice-box;  /,  shelves  for  provision.  C,  dining-room;  g,  table,  surrounded  by 
benches,  This  apartment  contained  also  a  stove  and  wood-box.  The  car  answered  well  tin- 
purpose  required  and  gave  perfect  satisfaction. 

Tho  p-issongpr  car  with  seats  was  occupied  by  those  not  confined  wholly  to  their  beds, 


CHAP.   XV 


KATLWAY    TRANSPORTATION. 


969 


and  others,  men  furloughed  from  general  hospitals,  etc..  who  did  not  ordinarily  require  them 
at  all.     The  five  bed-cars  were  first-class  passenger  cars  transformed  into  hospital  wards. 

The  surgeon's  car  was  an  ordinary  passenger  car  with  the  seats  removed  and  with  par 
titions  and  fixtures  introduced  for  the  accommodation  of  the  surgeon  in  charge  of  the  train 
and  his  medical  assistant;  there  was  also  a  small  .dispensary  and  an  office  for  the  transac- 


Pio.  497. — Kitchen  car  of  the  Army  of  the  Cumberland— longitudinal  secti 


tion  of  business  (  FIGS.  498,  499).  The  letters  indicate:  A,  dispensary  and  steward's  quar 
ters:  a,  desk  and  book-case;  />,  shelves  for  medicines.  This  apartment  contained  also  a 
revolving  chair  at  the  desk  and  a  bed  for  the  steward.  B,  surgeon's  sitting-room ;  d,  lounge ; 


Fio.  498. — Surgeons'  car  of  the  Army  of  the  Cumberland — horizontal  plan. 


e,  water-closet;  /,  clothes  closet.     C,  surgeon's  bedroom;   c,  bed.      D,  office;  g,  lounge:   h, 
water-cooler;   /,  wood-box  and  stove.      E,  wash-room,  with  water  basin,  tank,  and  dressing 


FIG.  499. — Surgeons'  car  of  the  Army  of  the  Cumberland — longitudinal  section. 

locker.  F  F,  passage  through  car.  G,  water-closet.  The  conductor's  car  in  the  rear  was 
similar  to  the  car  so  called  attached  to  freight  trains  on  ordinary  railroads.  It  was  appro 
priated  to  the  use  of  the  conductor  and  the  citizen  employes  running  the  train.  The 
hospital  cars  were  warmed  and  lighted  in  the  winter  in  the  same  way  as  passenger  cars  on 
our  railroads.  The  same  means  were  adopted  in  some  cars  as  were  in  use  in  general  hos 
pitals,  combining  warming  and  ventilation.  The  hospital  wards  were  originally  those  cars 
in  which  the  central  portion  of  the  roof  was  raised  considerably  above  the  general  plane: 
>pening  the  windows  occupying  the  space  between  the  planes  very  perfect  ridge  ventila 


tion  was  obtained.      The  wards  had  also  such  other  means  of  ventilation  as  were  in  use  in 

Sl'RG.    Ill— l'J2 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


first-class  passenger  cars.  If  necessary,  except  in  the  coldest  weather  (and  the  seasons  were 
mild  in  this  climate),  the  car  doors  could  be  thrown  open  for  a  few  minutes,  at  intervals, 
which  rapidly  supplied  a  fresh  atmosphere. 

The  surgeon  in  charge  of  a  hospital  train  was  its  sole  head,  the  same  as  on  a  hospital 
transport  or  in  a  general  hospital.  He  had  a  citizen  conductor  and  engineers,  firemen,  and 
brakemen,  employed  by  the  Quartermaster's  Department,  who,  under  the  immediate  con 
trol  of  the  conductor,  moved  the  train  when  and  wherever  he  ordered  it.  Unlike  the  chief 
medical  officer  of  a  hospital  transport,  he  was  not  required  to  act  as  a  commissary  of  sub 
sistence  or  an  assistant  quartermaster.  He  drew  his  rations  from  time  to  time  as  in  a 
general  hospital.  One  medical  assistant  and  one  hospital  steward  was  ordinarily  all  that 
were  required  on  a  train.  Enlisted  men  were  detailed  as  cooks,  nurses,  and  hospital 
attendants.  Only  a  limited  number  of  the  latter  were  required,  and  those  not  on  duty 
occupied  beds,  if  necessary,  kept  vacant  in  one  of  the  wards.  The  needful  washing  of 
bedding,  etc.,  was  done  at  one  of  the  termini  of  the  route. 

In  the  spring  of  1864,  and  during  the  advance  of  General  Sherman's  army  on  Atlanta, 
Georgia,  and  while  that  place  was  occupied  by  General  Sherman  previous  to  his  cutting 
loose  from  all  communication  with  the  north  and  striking  across  the  country  to  Savannah, 
three  hospital  trains  ran  regularly  between  Louisville,  Kentucky,  and  Atlanta,  Georgia,  a 
distance  of  four  hundred  and  seventy-two  miles,  viz:  Train  No.  3,  from  Louisville.  Ken 


tucky,  to  Nashville,  Tennessee,  distance  one  hundred  and  eighty-five  miles;  train  No.  2, 
from  Chattanooga,  Tennessee,  to  Atlanta.  Georgia,  distance  one  hundred  and  thirty-six 
miles.  These  trains  passed  over  the  road  once  every  day — down  one  day  and  returning  the 

•it/  */  O 

next,     Train  No.  1  connected  with  No.  3  at  Nashville,  and  with  No.  2  at  Chattanooga,  on 


FIG.  501. — Kitchen  and  dispensary  car.  Army  of  the  Potomac — longitudinal  view. 


alternate  days.  A  time-table  was  prepared  by  which  the  running  of  the  hospital  trains  was 
regulated — which  was  adhered  to  for  some  time.  Sick  and  wounded  in  the  sanguinary 
engagements  of  this  eventful  campaign  were  taken  from  the  large  hospital  depots  at  Atlanta, 
Marietta,  Kingston,  and  Rome,  Georgia,  to  the  permanent  hospitals  at  Chattanooga  and 
Nashville,  Tennessee,  and  Louisville,  Kentucky.  Some  men  were  brought  directly  through 


CHAP.  XV.]  WATER   TRANSPORTATION.  971 

from  Atlanta,  Georgia,  to  Louisville,  Kentucky,  over  this  long  span  railway  line,  stretching 
south  four  hundred  and  seventy-two  miles  to  the  distant  army.  If  necessary,  a  ward  in  one 
train  was  uncoupled  and  attached  to  the  connecting  train  without  disturbing  the  patients. 
The  ordinary  modus  operandi  in  railroad  transportation  was  to  empty  the  hospitals  at  Nash 
ville  and  Chattanooga  of  men  partially  recovered,  and  who  would  not  be  injured  by  moving, 
and  take  them  up  to  Louisville.  The  beds  thus  vacated  at  these  points  were  filled  from 
below. 

In  the  Army  of  the  Potomac  the  complete  hospital  train  consisted  of  twelve  cars — one 
for  the  surgeon  in  charge,  one  for  the  kitchen  and  dispensary,  and  ten  for  the  sick  and 
wounded.  The  cars  fitted  up  for  the  carrying  of  patients  have  been  described  on  page  961. 
The  kitchen  and  dispensary  (FiGS.  500,  501)  car  was  built  according  to  plans  prepared  by 
the  Assistant  Superintendent  of  Military  Railroads,  J.  McCrickett.  The  car  was  divided 
into  two  compartments.  The  dispensary  contained  a  stove,  A;  a  water-closet,  B;  cases  for 
shelves,  C;  cases  of  drawers,  D;  wood-box,  E;  table  or  desk,  F;  couch,  G;  wash-basins,  H. 
In  the  kitchen,  P,  were:  C,  cases  of  shelves;  D,  cases  of  drawers;  I,  water-cooler;  J,  refrig 
erator;  K,  sink  for  washing  dishes;  L,  table;  M,  pantry;  N,  wood-box;  0,  cooking-stove. 

WATER  TRANSPORTATION. 

The  military  operations  in  the  western  departments  in  the  spring  of  1862  embraced 
a  large  extent  of  territory  and  necessitated  the  moving  of  large  bodies  of  men  from  point 
to  point.  As  a  result,  the  fresh  unacclimated  levies  fell  victims  to  malignant  fevers,  diar 
rhoea,  dysentery,  etc.  The  resources  of  the  Medical  Department  under  these  circumstances 
were  entirely  inadequate  to  the  pressing  necessities.  It  became  evident  that  to  disem 
barrass  the  medical  officers  and  to  have  them  in  readiness  for  the  exigencies  of  battles, 
which  all  knew  were  impending,  the  sick  must  be  removed  to  points  remote  from  the  scene 
of  operations.  For  this  purpose  the  large  rivers  of  the  Western  States,  especially  the 
Mississippi,  offered  the  best  facilities.  But  there  were  no  transports  at  the  disposition  of 
the  medical  officers.  In  order  to  send  a  single  sick  soldier  it  was  necessary  to  apply  to' the 
quartermaster  of  the  army,  who  naturally  gave  the  preference  to  his  immediate  duties, 
and  even  when,  after  much  circumlocution,  a  boat  was  secured  and  partly  filled  with 
patients,  it  was  frequently  delayed  until  the  demands  of  other  departments  were  complied 
with.  The  necessities  of  the  sick  and  wounded  were  of  a  secondary  consideration,  and  the 
surgeon  who  exerted  himself  in  the  interest  of  common  humanity  was  regarded  as  asking 
favors  for  himself.  The  fact  that  the  efforts  of  the  Medical  Department  were  thus  paralyzed 
was  brought  to  the  notice  of  the  General  Commanding  by  Surgeon  J.  Simons,  U.  S.  A., 
Medical  Director,  who  recommended  that  a  suitable  number  of  boats  be  taken  and  fitted 
up  comfortably  with  beds,  cooking  apparatus,  surgeons,  and  nurses,  etc.  The  appeal  was 
favorably  received,  and  several  steamers  were  chartered  and  placed  under  the  charge  of 
medical  officers.  We  will  quote  from  the  excellent  report  of  Surgeon  A.  H.  Hoff,  U.  S.  V., 
master  of  hospital  transportation  on  the  Mississippi,  made  in  September,  1863:  "The  City 
of  Memphis,  a  very  large  and  fine  steamer,  was  chartered,  and  Assistant  Surgeon  W.  D. 
Turner,  1st  Illinois  Light  Artillery,  placed  in  charge.  The  steamer  City  of  Louisiana  was 
also  chartered  and  fitted  up  under  the  control  of  Assistant  Surgeon  C.  Wagner,  U.  S.  A., 
and,  with  the  City  of  Memphis,  was  at  once  employed  in  the  carrying  of  sick  and  wounded. 
About  the  1st  of  April,  1862,  after  the  experiment  had  been  made  and  proved  successful, 


972  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

% 

Surgeon  Simons  requested  that  boats  be  purchased  and  fitted  up  as  floating  hospitals. 
On  his  report  and  the  co-operation  of  Mr.  Yeatman,  the  President  of  the  Western  Sanitary 
Commission,  the  steamer  D.  A.  January  was  purchased  and  placed  in  my  charge.  This 
boat,  on  account  of  her  light  draught  and  airy  cabin,  was  well  suited  for  the  purpose. 
There  was  no  time  to  make  more  than  temporary  arrangements,  and  she  was  not  recon 
structed  until  September,  1862,  when  she  was  fitted  up  with  every  convenience  as  a  hospital. 
These  boats  proving  inadequate  to  supply  the  amount  of  transportation  required,  two  of  the 
largest  steamers  on  the  river  were  chartered  (the  Empress  and  Imperial)  and  temporarily 
fitted  up,  and  Surgeons  T.  F.  Azpell  and  J.  H.  Grove,  U.  S.  V.,  were  placed  in  charge 
of  them.  The  transportation  still  being  insufficient,  the  steamers  Stephen  Decatur  and 
J.  S.  Pringle  were  added  to  the  list,  and  these,  together  with  the  several  boats  sent  by 
different  states,  made  quite  a  formidable  fleet;  yet  they  all  had  plenty  of  employment,  as 
sick  and  wounded  had  to  be  transferred  to  the  number  of  thousands.  These  boats,  as  they 
ceased  to  be  needed,  were  discharged,  leaving  the  D.  A.  January  alone.  As  the  hospital 
accommodations  at  Pittsburg  Landing  were  very  imperfect,  Medical  Director  Charles 
McDougall,  Surgeon,  U.  S.  A.,  requested  the  construction  of  a  floating  hospital,  which  could 
be  towed  from  point  to  point,  to  be  used  as  a  receiving  hospital,  from  which  the  transports 
could  load  and  in  which  the  sick  and  wounded  could  be  placed  and  made  comfortable 
in  the  absence  of  the  transports.  In  this  he  was  finally  successful,  and  the  hulk  of  the 
steamer  Nashville  was  purchased  and  fitted  up  so  that  she  would  be  able  to  receive  in  an 
emergency  one  thousand  men,  and  Surgeon  Strawbridge,  U.  S.  V.,  was  placed  in  charge. 
She  was  towed  to  Milliken's  Bend,  La.,  and  was  of  great  service,  as  the  submerged  condi 
tion  of  the  country  made  it  impossible  to  care  for  the  sick  on  shore.  Up  to  this  time, 
although  the  Assistant  Surgeon  General,  on  taking  charge  of  the  Western  Department  and 
visiting  the  scene  of  active  operations,  repeatedly  urged  the  purchase  of  more  steamers  for 
hospital  purposes,  for  some  reason,  unknown  to  him  as  well  as  to  others,  he  was  unsuccess 
ful;  but  the  unsuccessful  attack  on  Vicksburg,  in  December,  the  battle  of  Arkansas  Post, 
and  the  advance  of  the  whole  army  in  the  direction  of  Vicksburg  made  it  necessary  to 
again  resort  to  chartering  transports.  The  City  of  Memphis  and  City  of  Alton  were  again 
temporarily  fitted  up,  and  with  the  D.  A.  January  transferred  the  sick  and  wounded  from 
Milliken's  Bend,  Young's  Point,  and  Sherman's  Landing,  to  Memphis  and  St.  Louis.  In 
the  meantime,  however,  several  boats  had  been  taken — the  steamers  Von  Phul  and  J. 
C.  Swon,  in  fact  at  least  one-fourth  of  the  returning  transports — without  a  single  comfort 
for  the  sick  and  wounded  on  board,  were  made  use  of  to  transfer  them  to  the  general 
hospitals  North.  Under  such  circumstances  the  suffering  was  terrible  and  the  mortality 
frightful.  I  am  not  disposed  to  find  fault,  nor  do  I  wish  to  censure  any  one,  but  I  feel  it 
my  duty  to  remark  that  the  Medical  Department  did  everything  in  their  power  to  correct 
this  matter,  with  but  poor  success.  The  Assistant  Surgeon  General,  never  tiring  in  his 
determination  to  push  this  matter,  finally  succeeded  in  getting  the  City  of  Louisiana  pur 
chased  and  fitted  up  in  a  most  comfortable  manner,  with  good  accommodations  for  four 
hundred,  with  every  improvement  that  a  year's  experience  could  suggest.  During  this 
time  the  Navy  had  fitted  the  Red  Rover  in  a  most  elegant  and  substantial  manner;  the 
Marine  Brigade  also  fitted  the  Wooclford  as  a  hospital  with  every  comfort  that  could  be 
made  available.  The  U.  S.  Hospital  Steamer  D.  A.  January  having  run  for  a  year  and  a 
half  it  became  necessary  to  repair  her,  and  upon  examination  new  boilers  were  found  to  be 
necessary.  As  we  came  m  possession  of  more  of  the  Mississippi  additional  accommoda- 


CHAP.  xv.J  WATEE    TRANSPORTATION.  973 

tions  for  the  comfort  of  the  sick  and  wounded  were  required.  Under  these  circumstances 
the  January  was  reconstructed,  better  ventilation  secured,  better  and  more  convenient 
arrangements  for  cooking  were  made,  and  a  fan,  one  hundred  and  sixty  feet  long  and  pro 
pelled  by  machinery,  was  placed  in  the  main  ward  for  the  purpose  of  cooling  the  atmosphere 
and  as  a  means  of  ventilation.  It  answered  an  admirable  purpose  and  did  away  with  the 
necessity  of  covering  the  decks  with  an  awning,  which  was  not  only  difficult  but  a  verv 
expensive  matter.  After  her  reconstruction  her  name  was  changed  to  Charles  McDougall, 
in  honor  of  Surgeon  McDougall,  U.  S.  A.,  who  had  interested  himself  when  Medical  Director 
of  the  Department  in  securing  proper  transportation  for  the  sick  and  wounded,  and  by  whose 
request  she  was  finally  fitted  with  all  the  conveniences  for  a  hospital  transport. 

"It  would  be  impossible  for  me,  not  being  in  possession  of  records,  to  give  any  idea  of 
the  number  of  sick  and  wounded  transferred — nor  do  I  believe  it  would  be  possible,  from 
the  fact  that  emergencies  required  boat  after  boat  to  be  made  use  of  where  no  record  was 
kept  to  give  the  exact  figures — suffice  it  to  say  that  the  U.  S.  Hospital  Steamer  Charles 
McDougall  (D.  A.  January)  carried  from  April  5,  1862,  to  September  12,  1863,  twelve 
thousand  two  hundred  and  ninety-nine  sick  and  wounded  to  the  several  general  hospitals, 
she  being  constantly  employed.  A  fair  average  may  be  made  by  taking  into  calculation 
the  time  the  other  boats  were  employed,  most  of  them  probably  carrying  more  at  each  load. 
The  use  of  steamers  for  hospital  purposes  being  a  new  thing,  changes  in  the  arrangements 
were  required  as  the  necessities  became  apparent.  Orders  were  made  by  the  chiefs  of  the 
several  Departments  of  such  a  character  as  would  secure  prompt  attention  on  the  part  of 
all  their  subordinates  and  at  the  same  time  place  the  surgeons  in  charge  in  such  a  position 
that  the  least  possible  delay  should  occur.  Believing  it  to  be  of  interest  and  forming  a 
part  of  the  success  of  the  subject  to  which  this  history  relates,  I  will  append  these  orders 
as  they  were  made  from  time  to  time.  The  first  great  difficulty  to  be  overcome  was  to  do 
away  with  the  idea  that  as  these  boats  were  for  the  transportation  of  the  sick  and  wounded 
they  were  the  vehicles  for  carrying  not  only  all  the  friends  of  the  sick  and  wounded,  but 
every  man,  woman,  and  child  who  became  impressed  with  the  slightest  inkling  that  their 
hearts  contained  one  particle  of  sympathy  for  the  poor  soldier;  curiosity  seekers,  sanitarians, 
state  agents,  sutlers,  committees  from  various  associations,  one  and  all  concluded  they  had 
a  right  to  transportation  on  such  a  boat.  This  of  course  was  out  of  the  question,  as  it  pre 
vented  the  employe's  from  properly  cleaning  the  boat  and  took  up  room  required  for  patients. 
More  than  this,  it  used  up  the  subsistence  which  belonged  to  the  hospital  fund,  which  was 
used  to  buy  so  many  things  necessary  for  the  diet  of  the  sick.  It  was  annoying  to  the 
surgeons,  it  was  in  the  way  of  all  discipline,  and  in  fact  disagreeable  to  every  one.  Under 
these  circumstances  Major  General  Halleck  issued  the  following  order: 

1  HEADQUARTERS,  DEPARTMENT  OF  THE  MISSISSIPPI, 

PITTSBURG  LANDING,  TENNESSEE,  April  20,  1862. 

Surgeon  Simons  has  authority  to  prevent  persons  from  travelling  ou  hospital  boats. 
BY  ORDER  OF  MAJOR  GENERAL  HALLECK:  (Signed)  A.  C.  KEMPER, 

Assistant  Adjutant  General. 

No  person  will  hereafter  be  permitted  on  floating  hospitals  except  by  permission  of  the 
Surgeon  in  charge.  (Signed)  J.  SIMONS,  Surgeon  of  Army, 

Medical  Director.' 

'  This  left  the  Surgeon  in  charge  an  opportunity  of  using  his  discretion  in  reference  to 
who  should  travel  on  his  boat,  and,  I  think,  in  most  instances  it  has  been  confined  to  medical 
officers  who  could  assist  instead  of  being  in  the  way. 


974  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  XV. 

11  The  next  important  step  was  to  be  arranged  with  the  Subsistence  Department.  This 
was  surrounded  with  some  difficulties,  as  there  was  no  room  on  board  for  a  commissary. 
The  difficulty  was  soon  remedied  by  making  the  Surgeon  in  charge  an  Acting  Assistant 
Commissary  of  Subsistence,  thereby  enabling  him  to  receive  subsistence  from  any  com 
missary  by  invoice  and  receipt,  and  to  purchase  such  articles  as  the  sick  required. 

'  CAIRO,  ILLINOIS,  April  7,  1863. 

SIR  :  By  authority  from  Major  General  Halleck,  commanding  the  Department  of  the  Mis 
sissippi,  Surgeons  in  charge  of  hospital  boats  will  act  as  A.  A.  C.  S.,  so  far  as  receiving  and  issuing 
stores  for  the  hospital  under  their  charge  is  concerned. 

Respectfully  your  obed't  servant. 

B.  Du  BARRY, 

Capt.,  &c.,  C.  8.,  U.  S.  A, 
To  Surgeon  in  charge  of  hospital  boat  D.  A.  January.' 

"By  a  similar  order  the  surgeon  was  held  responsible  for  all  the  property  belonging  to 
the  Quartermaster's  Department  in  his  charge,  and  required  to  receipt  for  it.  This,  of  course, 
was  an  anomaly  in  departmental  matters,  but  one  that  was  required  for  the  proper  adminis 
tration  of  the  affairs  of  the  floating  hospitals ;  without  such  an  arrangement  the  unavoidable 
delays  would  have  destroyed  their  efficiency.  The  Medical  Department  is  much  indebted 
to  Major  Generals  Halleck  and  Grant  for  the  kindness  shown  and  interest  taken  by  them 
in  this  branch  of  the  service.  We  are  also  indebted  to  Quartermasters,  Brigadier  General 
Allen  and  Colonel  Myers,  and  to  Colonel  Parsons,  in  charge  of  the  river  transportation,  for 
their  uniform  kindness  and  assistance  in  the  purchase  and  reconstruction  of  the  boats; 
also  to  Colonel  Haines,  Chief  Commissary,  for  the  liberal  manner  in  which  the  boats  have 
been  supplied  with  subsistence,  and,  through  his  orders,  the  little  delay  occasioned  in 
receiving  supplies.  In  fact,  all  have  wished  us  a  'God  speed'  in  a  work  which  has  been 
the  means  of  relieving  so  much  distress  and  probably  of  saving  many  lives." 

/Steamer  City  of  Memphis. — The  first  boat  chartered  on  the  western  rivers  for  the 
transportation  of  wounded  was  the  steamer  City  of  Memphis,  which  was  taken  into  the 
service  as  a  hospital  boat  at  Fort  Henry  on  February  7,  1862,  by  order  of  Major  General 
U.  S.  Grant,  and  placed  under  the  charge  of  Assistant  Surgeon  W.  D.  Turner,  1st  Illinois 
Light  Artillery.  She  was  fitted  out  as  thoroughly  as  circumstances  permitted.  Spring 
mattresses  were  placed  on  the  floor  of  the  upper  deck  and  saloon;  the  state-room  was 
rearranged,  and  medicine  and  commissary  stores  supplied.  Her  length  was  three  hundred 
and  thirty  feet  and  her  beam  seventy  feet;  her  main  deck  was  large  and  roomy,  and  her 
saloon  of  great  length,  and  she  was  capable  of  carrying  comfortably  seven  hundred  and  fifty 
wounded  men.  From  February  7th  to  18th  she  was  used  as  a  receiving  boat,  conveying  a 
large  number  of  sick  and  wounded  from  Fort  Henry  and  transferring  them  to  other  boats. 
No  record  of  this  work  was  kept;  but  the  number  thus  transported  is  estimated  at  two 
thousand.  On  February  18th  she  left  Fort  Henry  with  four  hundred  and  seventy-five 
sick  and  wounded  for  Paducah,  Kentucky,  where  she  arrived  on  February  19th;  the 
patients  were  transferred  to  the  general  hospitals,  and  the  boat  left  for  Fort  Donelson  the 
same  day  and  arrived  there  on  February  21,  1862.  The  boat  was  discharged  from  the 
hospital  service  in  July,  1862,  by  Medical  Director  McDougall,  of  the  Army  of  the  Ten 
nessee,  but  re-engaged  and  employed  in  carrying  wounded  from  the  vicinity  of  Vicksburg 
during  Grant's  campaign.  No  record  of  the  number  transported  during  her  second  engage 
ment  is  found. 


CHAP.  XV.] 


WATER    TRANSPORTATION. 


975 


From  February  18th  to  July  19th,  1862,  the  boat  made  fourteen  trips  and  conveyed 
seven  thousand  two  hundred  and  twenty-one  sick  and  wounded  men,  as  follows: 

TABLE  CLXXVI. 
Tabular  Statement  of  Trips  made  by  the  Steamer  City  of  Memphis  from  February  18  to  July  19,  1862. 


Ko.  OF  TKIP. 

DATE  OF  DEPARTURE. 

PLACE  OF  DEPARTURE.         DATE  OF  ARRIVAL. 

PLACE  OF  ARRIVAL. 

Xo.  SICK  AND 
WOUNDED. 

1  
2  

February  18,  1862  
February  22,  1862  
March  6,  1862  

Fort  Henry,  Tenii  February  19.  1862  Paducah,  Ky  
Fort  Donelson,  Term  February  23,  1862  Mound  City,  111  
Fort  Donelson  Tenn              March  8  1862                    Mound  City  HI 

475 
600 
400 
410 
8GO 
1,093 
413 
520 
400 
400 
350 
400 
550 
350 

3  

4  

March  14,  1862  
April  6  1862 

Savannah,  Tenu    March  18  1869                  Snint  T.rmia  Mr. 

5  

Sliilnh    TATITI                                   :    Anrilfi    18R9 

Savannah,  Tenn  

Mnnnd  flifT   "HI 

6  

April  9,  1862  Pittshiirw  Landing  TMITI   !    Ar>ril  12    18fi2 

7  

April  15,  1862  
April  21,  1862  

Pittsburg  Landin"  Tenn  '  April  18  1862 

8  

New  Madrid,  Mo  April  23,  1862  
Pittshnrf  Trindimr    Tp.rm   '  "M"n,v  1    IRK1* 

9  

April  27,  1862  

10  

May  13,  1862  Pit,t,shnr<r  T.-iiulintr    Tpnn    '   ATnv  18    1Kfi9 

11 

June  2,  1862  
June  15,  1862  
July—,  1862  

Pittsburg  Landing,  Tenn     June  5,  1802  
Pittsburg  Landing,  Tenn  .    June  20,  1862  

Louisville,  Ky  

"PTpnknl^  Tnwa 

12  
13  

Paducah,  Ky  July  10  1862 

14  

July  16,  1862  

Helena,  Ark                            July  17  1862 

Memphis,  Tenn  

Total  

7,221 

Steamer  Louisiana,  afterwards  named  R.  C.  Wood. — The  fast  steamer  Louisiana  was 
chartered  on  March  12,  1862,  and  placed  under  the  charge  of  Assistant  Surgeon  C.  Wagner, 
U.  S.  A.,  who  mainly  furnished  the  data  here  adduced.  The  boat  was  immediately  sup 
plied  with  bedding  and  the  necessary  hospital  commissary  stores;  the  Western  Sanitary 
Commission  very  liberally  supplied  many  articles  not  procurable  at  the  time  from  the 
Medical  Purveyor.  The  boat  was-  divided  into  four  wards,  two  on  the  lower  deck  and  two 
on  the  upper  or  boiler  deck,  each  of  which  had  a  medical  officer,  a  wardmaster,  six  perma 
nently  detailed  male  nurses,  and  one  female  nurse.  The  nurses  were  relieved  from  duty 
every  six  hours,  day  and  night.  Upon  the  lower  deck  was  the  kitchen,  commissary,  store 
room,  bakery,  and  ice-house;  upon  the  upper  deck  the  captain's  office  was  converted  into 
the  office  of  the  Surgeon  in  charge,  and  the  bar-room  into  a  dispensary,  the  barber-shop 
and  wash-room  into  a  kitchen  for  low  and  half-diet  patients  under  the  supervision  of  a 
female  nurse.  The  bulkheads  between  the  state-rooms  were  removed,  improving  the  ven 
tilation  and  rendering  access  to  the  patients  more  easy.  Beds  were  also  placed  on  the 
guards  of  the  boat,  tarpaulins  being  stretched  to  protect  the  patients  from  the  inclement 
weather.  The  texas  upon  the  hurricane  deck  was  used  as  quarters  for  the  hospital  attend 
ants  and  the  boat's  crew.  An  oven  was  on  board  capable  of  baking  bread  for  a  thousand 
men  daily.  In  admitting  as  well  as  in  removing  the  patients  a  systematic  arrangement  was 
adopted.  A  medical  officer  was  stationed  at  the  gangway  to  receive  them,  one  on  the  boiler, 
and  another  on  the  lower  deck.  Each  wardmaster  remained  in  his  ward,  and  a  sufficient 
number  of  nurses  was  detailed  to  carry  the  patients  on  or  off  the  boat.  By  this  arrange 
ment  all  confusion  was  avoided;  no  one  was  admitted  as  a  patient  except  upon  a  written 
order  from  the  Medical  Director.  The  boat  at  this  time  had  accommodations  for  four  hun 
dred  patients.  She  carried,  in  less  than  four  months,  about  three  thousand  patients  from 
Pittsburg  Landing  and  other  points  on  the  western  rivers  to  northern  hospitals,  and  was 
released  from  service  during  the  summer  of  1862.  An  account  of  the  trips  is  taken  from 
the  report  of  Assistant  Surgeon  C.  Wagner,  U.  S.  Army: 


976 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV 


TABLE  OLXXVII. 
Tabular  Statement  of  Trips  made  by  the  Steamboat  Louisiana  from  March  33  to  June  14,  1862. 


No.  OF 
TRIP. 

DATE  OF  DEPARTURE. 

PLACE  OF  DEPARTURE. 

DATE  OF  ARRIVAL. 

PLACE  OF  ARRIVAL. 

No.  SICK  AND 
WOUNDED. 

35 

280 
310 
325 
306 
328 
340 
325 
350 
400 

1  

9 

Island  No  10  Teiin                                ) 

March  28,  1862  $ 

April  8,  1862  
April  14,  1862...  
April  24,  1862  
May  3,  1862  
May  9,  1862  
May  17,  1862  
June  2,  1862  
June  14,  1862  

Cairo,  111  

March  2r>  1862 

Mound  City,  111.,  and  Paducab,  Ky  -  ) 
Crump's  Landing,  Tenn  

Cincinnati,  Ohio  

3  
4  
5  
6 

April  6,  1862  

Saint  Louis,  Mo  
Saint  Louis,  Mo  

April  20,  1862  
May  1  1862            .     . 

Savannah,  Tenn  
Pittsburg  Landing,  Tenn  
Pittsburg  Landing,  Tenn  
Savannah,  Tenn  
Hamburg,  Tenn  
Hamburg  Tenn  

Cincinnati,  Ohio  
Saint  Louis,  Mo  
Saint  Louis,  Mo  

7.... 
8  
9 

May  7,  1862  
May  15,  1862  
May  Cl   1862   

Saint  Louis,  Mo  
Paducah,  Ky  

10  

June  13  186° 

Total                                                                                

2,999 

In  April,  1863,  the  boat  was  purchased  by  the  Government  and  remodelled  as  a  perma 
nent  hospital  boat,  with  beds  for  four  hundred  and  fifty  patients,  and  was  named  the  '  K.  C. 
Wood,'  in  honor  of  the  Assistant  Surgeon  General  of  the  United  States  Army,  to  whose 
wisdom,  humanity,  and  constant  foresight  many  of  the  improvements  in  the  hospital  arrange 
ments  were  due.  Surgeon  T.  F.  Azpell,  U.  S.  V.,  was  placed  in  charge.  Her  state-rooms 
were  removed,  the  whole  upper  deck  was  made  into  one  large  ward,  with  abundant  light 
and  excellent  means  of  ventilation,  with  ample  provisions  of  bath-rooms,  hot  and  cold  water, 
cooking  apartments,  nurses'  rooms,  dispensary,  laundry,  and  many  other  conveniences.1  Her 
length  was  two  hundred  and  fifty  feet,  beam  forty  feet,  hold  seven  feet.  From  April,  1863, 
to  April  11,  1865,  this  boat  made  thirty-three  trips,  travelled  thirty-four  thousand  eight  hun 
dred  and  five  miles,  and  carried  eleven  thousand  and  twenty-four  (11,024)  sick  and  wounded, 
as  follows: 

TABLE  OLXXVIII. 
Statement  of  Trips  made  by  the  Hospital  Steamboat  R.  C.  Wood  from  April  1,  1863,  to  April  11, 1865. 


No.  OF 
TRIP. 


DATE  OF  DEPARTURE. 


PLACE  OF  DEPARTURE. 


PLACE  OF  ARRIVAL. 


April  1,  1863 1  Milliken's  Bend 


May  26,  1863 

June  2,  1863 

June  8,  1863 

June  23,  1863 

July  4,  1863 


Saint  Louis 
Memphis  . . . 
Memphis . . . 
Memphis  . . . 
Memphis  . . . 


July  8,  1863 !  Memphis 


Saint  Louis 


July  25,  1863    

August  8,  1863 [  Saint  Louis 

August?,  1863 !  Memphis 

1  August  28,  1863  . .  Keokuk 

September  19,  1863 '  Saint  Louis 

October  2,  1863 Memphis 

October  24,  1863 Saint  Louis 

February  6,  1864 Saint  Louis 

February  28,  1864 Saint  Louis 

March  14,  1864 i  Memphis 

March  19,  1864 j  Nashville 

April  14,  1864 I  Louisville 

•  April  22,  1864 Louisville 


Saint  Louis 

Chickasaw  Bayou  and  Memphis  . 
Chickasaw  Bayou  and  Memphis  . 
Chickasaw  Bayou  and  Memphis  . 

Vicksburg  and  Memphis 

Helena  and  Memphis 

Vicksburg  and  Saint  Louis 

Vicksburg  and  Saint  Louis 

Vicksburg  and  Memphis 

Vicksburg  and  Keokuk 

Vicksburg  and  Saint  Louis 

Vicksburg  and  Memphis 

Saint  Louis 

Vicksburg  and  Saint  Louis 

Natchez  and  Saint  Louis 

Vicksburg  and  Memphis 

Nashville  . . . 


Louisville 

Cairo  and  Louisville 

Alexandria  and  New  Orleans 


Carried  forward. 


No.  SICK 

AXU 
WOUNDED. 

107 
425 
410 
459 
397 
360 
371 
389 
330 
412 
355 
418 
387 
178 
303 
349 
240 
120 

213 
fi,  2.'3 


1  See  Report  of  the  Western  Sanitary  Commission  f<jr  the  year  ending  June  1,  1863,  St.  Louis,  Mo.,  1863,  page  18. 


CHAP.  XV.] 


WATER    TRANSPORTATION. 


^Tim'1                 DATE  OF  DEPARTURE. 

PLACE  OF  DEPARTURE. 

No.  SICK 
PLACE  OF  ARRIVAL.                         AND 
WOUNDED. 

6  2''3 

•Jl   May  3    1864  

New  Orleans  

Louisville  292 

22             May  18   1864 

..    Lou  sville  

Evansville  and  Louisville  366 

^3             September  1    1864 

24             September  1°   1864 

Lon  sville  

Evansville  and  Louisville   114 

25             November  13   1864 

26             November  30   1864 

Lou  sville  

Mound  City  485 

Moi  ml  Citv 

Clarksville  and  Louisville  134 

28             December  13   1864 

Cairo  and  Louisville  610 

2!)             December  30  1864         

Lou  sville  

Nashville  and  Louisville  705 

30             March  1   1865 

Keokuk  and  Mound  City                                          333 

31             March  14   1865 

Moi  nd  Citv 

Saint  Louis  aud  Louisville    163 

3°             March  24   1865 

Vicksburg  and  Saint  Louis  459 

33             April  11   1865 

Vicksburg  and  Saint  Louis  370 

Total 

11,  024 

With  the  two  thousand  nine  hundred  and  ninety-nine  (2,999)  patients  carried  during 
her  first  engagement,  from  March  23d  to  June  14,  1862,  the  boat  altogether  conveyed  four 
teen  thousand  and  twenty-three  (14,023)  sick  and  wounded  from  the  scene  of  action  to 
northern  hospitals. 

Perhaps  the  most  perfect  of  the  western  hospital  boats  was  the  steamer  '  D.  A.  Jan 
She  was  purchased  on  April  1,  1862,  and  placed  under  the  orders  of  Assistant 
A.  H.  Hoff,  U.  S.  A.  She  had  been  built  at  Cincinnati  in  1857.  She  was  a  side- 


uar. 


no.  502.— U.  S.  Army  Hospital  Steamer  D.  A.  January. 

wheel  steamer  of  four  hundred  and  fifty  tons  burden,  two  hundred  and  thirty  feet  in  length, 
thirty-five  feet  beam,  and  sixty-five  feet  extreme  width.  She  had  two  high-pressure  engines, 
with  cylinder  twenty-two  inches  in  diameter  and  seven  feet  stroke.  As  a  precautionary 
measure  against  accident  bv  fire,  she  had  a  small  steam  fire  engine,  which  worked  hide- 

O  •/ 

pcndently.  and  was  supplied  with  sufficient  hose.  During  the  summer  of  1862  the  boat 
carried  patients  from  Pittsburg  Landing,  Paducah.  and  Helena,  to  St.  Louis,  Keokuk,  New 
Albany,  and  Cincinnati.  In  the  fall  of  1862  she  was  entirely  remodelled  under  the  super 
vision  of  Assistant  Surgeon  A.  II.  Hoff.  to  whom  the  department  is  indebted  for  many 
important,  suggestions,  especially  in  the  earlier  days  of  hospital  transportation.  On  the 

Ill— 123 


978 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


hurricane  deck  (FlG.  503).  the  roof  of  the  boat,  was  the   texas,  on  top  of  that  the  pilot 
house.      The  staterooms  were  taken  out  nnd  the  whole  cabin  deck  converted  into  one  spa- 


0D 


il 


f~ 

1  L 

L 

£,  \ 

A          ^ 

C      (        I 

K 

1          ^ 

v_ 

^ 

r 

|i  \ 

_> 

7f 


1 


Fir..  503.— Upper  deck,  or  texas,  of  U.  S.  Hospital  Steamer  D.  A.  January. 


A  A  Projections  of  lower  deck. 

B  Q  Hoof. 

C  C  Cabin  roof  above  skylights. 

D  D  Smoke-stacks. 


E  Water-closets. 

F  Wash-house. 

G  G  Wheels. 

H  H  H  Water-tanks. 


I  Captain's  room. 

J  Social  hall. 

K  Texas  dining-room. 

L  L  L  Rooms  for  steamboat  officers. 


cious  ward  (  FIG.  504).      Long  windows  were  placed  on  all  sides  of  this  ward,  attached  by 
'  butts  alori"-  the  centre  of  the  ward.     About  the  centre  of  this  deck,  on  one  side,  was 


A  A  Projections  of  lower  deck.  F  F 

D  Office.  G  G 

C  C  Private  rooms.  H  H 

D  Front  stairs.  I 

E  E  Texas  stairs.  J 


Fir,.  504. — Cabin  deck  of  I".  S.  Hospital  Steamer  D.  A.  January. 

Steamboat  chimneys.  K  K  Bath-rooms,  hot  and  cold. 

Stoves.  L  L  Steamboat's  wheels. 

Middle  ward  stairs.  M  M  Water-closets. 

Nurses'  dining-room.  N  Private  room. 

Kitchen.  O  Drug-store. 


P  Surgery. 

Q  Linen-room. 

R  Space  occupied  by  the  mirror. 

S  S  (.'old-water  pipes. 


a  nurses'  dining-room,  a  bath-room,  and  water-closet,  and  on  the  other  a  special  diet  kitchen. 
bath  and  wash-room,  and  water-closet.  Away  aft  there  was  on  one  side  a  drug-shop  and 
steward's  room,  on  the  opposite  side  a  linen-room,  in  the  centre  an  operating-room.  Drink 
ing-water  throughout  the  ward  was  drawn  from  faucets  placed  at  convenient  distances. 
The  bath-rooms  were  supplied  with  water  from  a  large  tank  on  the  hurricane  deck,  filled 


A  A  Lower  deck. 
B  B  B  Hatchways. 
C  Boilers. 


DDEE  Middle  deck. 
F  F          Space  fur  sick. 
G  G          Nurses'  quarters. 
H  H         Cold  water. 


Side  or  middle  deck. 
,  (  Stairs  to  lower  deck. 
)  Stairs  to  upper  deck. 


K  K   Water-closet-.. 

L        Nurses'  stairs  from  cabin  deck. 

M  M  Nurses'  stairs  to  lower  deck. 


with  water  by  steam-power.     The  drinking-water  arrangement  was  a  refrigerator  on  a  large 

*  L  O  O  O  O 

scale.     Pipes  ran  from  the  tank  on  the  hurricane  deck  into  two  large  ice-chests  in  the  hold 

1  O 

of  the  boat,  one  on  each  side.     In  these  chests  were  large  worms  through  which  the  water 

O  D 


CHAP.  XV.] 


WATKK    TRANSPORTATION. 


979 


passed  and  was  carried  through  the  different  wards,  furnishing  iced  water,  or  water  cool 
enough  for  all  purposes.  By  this  plan  a  large  amount  of  ice  was  saved,  as  the  chests  were 
seldom  opened. 

Between  the  main  and  the  boiler  decks,  on  the  middle  deck  (  FIG.  505).  where  the 
wood-racks  used  to  be,  two  wards,  one  on  each  side,  were  arranged,  containing  thirty  beds 
each,  with  water-closets,  wash-troughs,  and  faucet  for  drinking-water.  The  wards  were 
low.  but  the  bulkheading  was  composed  almost  entirely  of  windows,  so  that  plenty  of  air 
could  circulate.  On  the  lower  deck  (  FIG.  506)  there  was  a  comfortable  ward  for  one  hun- 


FIG.  50(5. — Lower  Boiler  Deck  of  the  U.  S.  Hospital  Steamer  D.  A.  January. 


A       Foot  of  stairs.  E 

B  B  Space  for  wood  and  coal.  F 

C       Boilers.  G 

D       Stores.  H 


Pastry  room. 
Kitchen. 

Carpenter's  shop. 
Blacksmith's  shop. 


I        Engines. 

J        Donkey  engine. 

K  K  Wheels. 

L       Washstancts 


M  M  Water-closets. 

N  N  Main  deck. 

O  Stoves. 

P  P  Cold  water. 


dred  beds,  water-closets,  and  wash-troughs;  a  large  kitchen  connected  with  the  wards  on  the 
upper  decks  by  a  dumb-waiter;  a  bakery  on  one  side,  a  blacksmith  shop,  carpenter  shop, 
and  commissary  room  on  the  other.  Through  the  whole  length  of  the  main  ward  ran  a  fan, 
worked  by  steam  from  below  (it  made  about  ninety  revolutions  a  minute),  and  as  the  tran 
som  windows  opened  just  above  it,  at  the  sides,  it  created  a  pleasant  current  of  air  and  kept 
out  all  flies  and  mosquitoes.  This  boat  carried  from  April,  1862,  to  August,  1865,  alto 
gether  twenty- three  thousand  seven  hundred  and  thirty-eight  patients,  as  follows: 

TABLE  GLXXIX. 
Trips  made  by  the  Hospital  titeamer  D.  A.  January  from  April,  186%,  to  August,  1865. 


NO.  OF 

Tiur. 


DATE  OF  DEPARTURE. 


April  11,  1862 
April  18,  1862 


PLACE  OF  DEPARTURE. 


DATE  OF  ARRIVAL. 


PLACE  OF  ARRIVAL. 


May  2.  1862 Pittsburg  Landing 


May  10,  1862    .  .  Pittsburg  Landing. . 

June  9,  1862  Pittsburg  Landing.. 

June  19,  1862  Pittsburg  Landing. . 

July  0,  1862 Paducah 


July  17,  1862 Helena 

July  25.  1862 |  Paducah 

August  4,  1862 ;  Paducah 

August  20,  18G2 Helena 

August  23,  1862 Paducah    

September  29,  1862 Helena 

October  7,  1^62     Helena 

October  12,  1862 \  Columbus 


Pittsburg  Landing April  14,  1862 Saint  Louis 

Pittsburg  Landing April  23,  1862 Keokuk 

May  4,  1862 New  Albany 

May  6,  1862 •  Cincinnati-. err— .-rA. . . 

May  14,  1862 !  Jefferson  Barracks  

June  12,  1862 Jefferson  Barracks 

June  20,  1862 Paducah 

June  22,  1862 Jefferson  Barracks 

June  23,  1862 Keokuk 

July  7,  1862 Evansville ^ 

July  8,  1862 Louisville $ 

July  21,  1862 Jefferson  Barracks 

July  27,  1862 Jefferson  Barracks 

August  6,  1862 Saint  Louis 

August  23,  1862 Mound  City 

August  23,  1862 Mound  City 

October  3,  1862 Saint  Louis 

October  10,  1862  St'r  T.  L.  McGill,  Columbus 

October  15,  1862 Saint  Louis 


"No.  SICK 
AND 

WOUNDED. 


431 
284 

300 

284 
375 


287 

317 
298 
-1U 
100 
30 


Carried  forward 


4,400 


980 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV 


TripF        DATE  OF  DEPARTURE. 

PLACE  OF  DEPARTURE.               DATE  OF  ARRIVAL. 

No.  SICK 
PLACE  OF  ARRIVAL.               ASU 
WOUNDED. 

B        btf          d 

j 

4,400 

16            October  °1    1802 

Columbus            October  23,  1862  

Mound  City  88 
Keokuk  378 

17            October  30  1862 

Columbus  November  4,  1862  
Columbus  November  21,  1862  
Columbus  November  30,  1862  
Helena                 December  16,  1862  

18  November  18,  1862  
19  November  28,  1862  
20            December  9  1862 

Jefferson  Barracks  ...         .                  435 

Saint  Louis  440 
Memphis    .                        .  .  > 

21     .  .     January  14,  1863  

\    January  18  1863 

Arkansas  Post     rftm,»rv  2*  1863 

>                 432 

f    March    1863                           1 

r    March,  1863  •) 

f             1,174 
Transferred  to  other  hos-j             1,460 
pital  steamers.                                    736 
1,195 
Saint  Louis  378 

1     ADril   1863 

Served   as  receiving   hos-       A  ^  18JJ3 

1    May  1863                               f 

pital  at  Milliken's  Bend,  -I 

1    June  1863                              J 

Louisiana. 
I    June,  1863  J 

23             August  11   1863 

Milliken's  Bend                           August  18,  18G3       

21             August  27   1863 

Vicksburg                                   August  31   1863 

Memphis  387 

25.           September  5,  1863  
26  September  15,  1863    
27  ....    September  29,  1863    
2S....     October  28,  1863  

29     ...    November  23,  1863             .... 

Vicksburg  i  September  8,  1863  
Vicksburg  September  18.  1863  
Vicksburg    October  7,  1863  
New  Orleans  Novernlx  r  2,  1863    
(  •  November  25  1863 

Memphis          377 

Memphis  244 
Memphis  78 
Cairo  100 
Cairo  .  .                                 .  ) 

Memphis 

345 

30  December  9,  1863  
31            February  11   1864                  < 

1  1  November  27  "8  1863 

Nashville  December  12,  1863  
New  Albany...                    .) 

Evansville  344 

'     February  15  1864 

32  March  18  19  1864 

Louisville     ...                      ^ 

Madison,  Ind  463 
Madison  382 
Memphis      ^ 

Louisville                                    March  19,  1864    

33  April  7,  1864     < 

Louisville                              ) 

New  Albany                           >    April  8  1864    

34  April  27,  1864  

Jeffersonville  ....               J 

Vicksburg                                   May  1,  2  1864 

35  Mayl,  1864     
36.           May  3,  1864  

Memphis                                   :  May  3   1864 

Cairo 

Cairo    '  May  8,  1864   

V                398 
Louisville  

37  May  3,  1864  

Mound  Citv                                 May  9  1864 

New  Albany  J 

38   May  14,  1864 

Mound  City                              '  May  17  1864 

39  May  22,  1864  
40  June  10,  1864     
41.   .       June  21,  1861  .. 
42.    ..     June  22,  1864  

Nashville  May  26,  1864  
Mound  City  .                             June  12  1861  ..               

New  Albany  239 
Jefferson  Barracks      120 

Louisville                                    June  22   1861 

Evansville 

Evansville                                   June  25  1864 

498 

43.    ..      August  10,  1864  
44....    August  22,  1864    
45  ....    September  2.  1864  
46  September  19,  1864  ... 
47  September  20,  1864  

Memphis   ...                             August  16  1864 

Jefferson  Barracks  345 

Memphis  .  .                                 August  27   1864 

Jefferson  Barracks          .                       309 

Helena  September  9,  1  864  

Helena  
.      September  24,  1864  
Memphis                                > 

Jefferson  Barracks  332 
Jefferson  Barracks  229 

Mound  City  4()7 
Jefferson  Barracks  
Cairo                     .          ....                  127 

48  October  12,  1864  

49  November  3,  1804  
50  November  10,  1864  

t     October  19,  20,  1864  .  . 
Duvall's  Bluff  .  . 

(    October  22,  1864  
Mouth  of  White  Iliver               November  G   1S64 

Mouth  of  White  River              November  14   1861 

Mound  Citv                                                 48 

51  November  25,  1864    
52  December  1,  1861  

53  December  19,  1864      ..   . 

Nashville  .           November  29  1864 

Nashville  December  5,  1864  
Louisville                               ) 

Jefferson  Barracks  416 

Cincinnati  >                545 

December  21,  1864  I 
Jeffersonville  ^ 

54  December  26,  1864  j 

Louisville                               )                                                    { 

>     December  27,  1864 

Jeffersonville   .                >                                                     ( 

Louisville  January  8,  1865  

Cairo   .  .                              .  .  ) 

55  January  5,  1865  • 
January  27,  to  —  >                  ( 

Jeffersonville  January  9   18G5 

426 

Eastport  February  5,  1865    

1    February  4,  1865  \                 \ 
57  February  12,  1865  

Waterloo    February  8,  1865  

Memphis  \ 

58.    ..      February  14,  1865     
59  ....'.    February  14,  1865  
60  February  16,  1865  

Waterloo    1 

}>    February  19  1805 

318 

Johnsouville  

61.    ..      March  12,  19,  18G5     
62     ..      April  Ki,  18G5    

63            April  17   18  18G5 

Chickasaw  March  23,  18S55 

New  Orleans  April  14,  1865    
\     April  21,  1865  

St'rE.  Carroll,  N.  Orleans. 
1C9 

I  !  April  25,  1S65 

C.irried  foi  war.i. 


21,  534 


CHAR  XV. 


WATER    TRANSPORTATION. 


981 


NO.  OF 

TRIP. 

DATE  OK  DKI-AUTUUE. 

PLACE  OK  DEL'AIU'UKK. 

DATE  OF  AUUIVAL. 

PLACE  OK  AUKIVAL. 

No.  SICK 

AND 

WOUNDED. 

Brought  forwr.rd  

21  534 

64 

May  6  1865 

65 

May  8  1865 

Mobile 

May  15  1865 

66  

May  9,  1865  

Fort  Games  .  .  -                •  •    I 

Mav  25   1865 

389 

67. 

May  18   1865 

i 

May  31,  1865  

New  Orleans     

08   .. 
09  .... 

Juno  2,  1865  
June  5,  1865  

New  Orleans  
VicUsburg  

June  8,  1865  
June  10   1865 

Memphis  .  . 
St'r  W.  Butler  at  Cairo      J 

560 

70. 

June  20,  1865  

June  28,  1865  

Cairo    ) 

72   ... 

Juno  23,  1865    

June  29,  1865  

Jefferson  Barracks  ) 

229 

73 

July  17   1865 

July  24   1865    .   ... 

74  

Julr  18,  1865  

328 

July  26  1865 

75 

July  24   1865 

76  ... 

August  3,  9,  1865  

August  16,  1865  

Cairo    ...          .                     ) 

77  

August  10,  1865    

Baton  Rouge           .     .            > 

439 

August  18,  1865  

Jefferson  Barracks  ) 

78  
79 

August  12,  1865  
August  26   1865 

Vicksburg  i 

Cairo                                       ) 

80     .. 

August  27   1865 

259 

September  4,  1865     

Jefferson  Barracks               ^ 

81  

August  28,  1865  

Vicksburg       j 

Total  

23  738 

Steamer  Empress. — The  steamer  'Empress'  was  chartered  on  April  10,  1862,  and 
placed  in  charge  of  Surgeon  Thomas  F.  Azpell,  U.  S.  V.  Being  built  expressly  for  a  cotton 
boat,  and  said  to  be  the  largest  engaged  in  that  trade,  she  was  found  to  be  admirably  adapted 
to  hospital  purposes.  Her  capacious  dimensions  and  the  unusually  large  area  on  each  deck, 
which, could  be  used  for  beds,  rendered  her  accommodations  for  the  sick  unsurpassed.  Her 
cabin  was  small,  containing  only  forty  state-rooms,  which  were  principally  used  by  the 
hospital  corps  in  consequence  of  their  imperfect  ventilation.  Canvas  flies  on  the  upper  and 
tarpaulins  on  the  lower  deck  completely  protected  the  guards  from  the  weather.  Her  length 
was  two  hundred  and  sixty-six  feet,  width  of  beam  forty-five  feet,  depth  of  hold  eight  feet 
three  inches.  Her  carrying  capacity  was  five  hundred  patients,  but  this  number  could  be 
largely  increased  in  mild  weather.  The  largest  number  she  carried  on  one  trip  was  eight 
hundred  and  seventeen.  The  'Empress'  made  six  trips,  but  her  draught  of  water  was  such 
as  to  render  her  unfit  for  the  navigation  of  the  Tennessee  and  Cumberland  rivers  during 
their  low  stage.  She  was  therefore  discontinued  as  a  floating  hospital  in  June,  1862. 

Steamer  Imperial. — On  April  10,  1862,  the  steamer  'Imperial,'  a  new  and  very  large 
boat,  was  fitted  up  as  a  transport  for  sick  arid  wounded  by  Surgeon  J.  H.  Grove,  U.  S.  V. 
She  made  four  trips,  carrying  one  thousand  seven  hundred  and  eighty-one  (1,781)  patients, 
but  her  services  were  discontinued  on  May  17,  1862,  as  her  draught  of  water  was  too 
great  for  the  low  state  of  the  Tennessee  River  during  the  summer  season. 

O  O 

Other  steamers  employed  on  the  western  waters  were  the  'City  of  Alton,'  the  'Baltic,' 
the  'Ginnie  Hopkins,'  the  'Mercury,'  'Woodford,'  'Decatur,'  'Pringle,'  'Nashville,'  etc. 
Space  will  not  permit  to  enter  in  detail  into  a  description  of  these  boats  or  the  nature 
of  their  service. 

In  the  eastern  armies,  although  many  boats  were  temporarily  employed  for  the  purpose 
of  conveying  sick  and  wounded,  few  were  fitted  up  as  regular  hospital  transports.  In  the 
early  summer  of  1862,  when  the  scene  of  active  operations  was  transferred  from  the  interior 
of  Virginia  to  the  eastern  seaboard  on  the  Peninsula,  it  became  evident  that  unusual  means 
would  be  required  to  remove  the  sick  and  wounded  as  fast  as  possible  from  these  malarial 


982 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


districts  to  healthier  localities.  The  boats  used  for  the  transport  of  troops  were  all  under 
the  immediate  direction  of  the  Quartermaster  General.  On  application  to  the  Secretary  of 
War  quite  a  number  were  turned  over  to  the  medical  authorities,  but  these  boats  were  desti 
tute  of  all  conveniences.  Perhaps  the  earliest  boat  thus  assigned  in  the  latter  part  of  April, 
1862,  was  the  'Daniel  Webster.'  She  was  entirely  without  mattresses,  bedding,  medicine, 
and  surgical  appliances,  but  was  hastily  fitted  up  by  the  Sanitary  Commission,  filled  with 
patients,  and,  on  May  1st,  left  the  York  River  for  New  York.  The  'Ocean  Queen,'  a 
large,  commodious  vessel,  capable  of  carrying  comfortably  one  thousand  patients,  was,  a  few 
days  later,  also  turned  over  to  the  Medical  Department  and  fitted  up  by  the  Sanitary 
Commission.  When  received  there  was  not  a  bunk  nor  an  article  of  food  on  board.  The 
'Ocean  Queen'  took  about  nine  hundred  patients  to  New  York,  but,  on  her  arrival  there, 
was  withdrawn  from  the  hospital  service  and  sent  with  troops  to  the  Gulf  of  Mexico. 

The  principal  boats  employed  in  the  eastern  waters,  besides  the  two  already  mentioned, 
were  the  'Connecticut,'  'State  of  Maine,'  'Western  Metropolis,'  'De  Molay,'  'Spaulding,' 
'Baltic,'  'Atlantic,'  'J.  K.  Barnes,'  'Commodore,'  'Cosmopolitan.'  'Knickerbocker/  'Elm 


Flo.  507. — U.  S.  Hospital  Steamship  '  J.  K.  Barnes.' 

City,'  etc.  The  capacity  of  the  'Connecticut'  was  four  hundred  patients.  She  made 
altogether  forty-seven  trips  and  conveyed  eighteen  thousand  nine  hundred  and  nineteen 
(18,919)  patients.  The  capacity  of  the  'State  of  Maine'  was  three  hundred  patients,  and 
she  carried  in  forty-eight  trips  fifteen  thousand  seven  hundred  and  eleven  (15,711)  patients. 
The  capacity  of  the  'Western  Metropolis'  was  four  hundred  and  fifty  patients,  of  the 
'De  Molay'  three  hundred,  of  the  'Baltic'  five  hundred,  and  of  the  'Atlantic'  five  hun 
dred  patients.  Some  of  these  boats  were  employed  on'  the  inland  waters,  others,  like  the 
'Western  Metropolis,'  'De  Molay,'  'Cosmopolitan,'  and  'Baltic,'  conveyed  the  wounded 
from  all  points  along  the  Middle  and  Southern  Atlantic;  coast  to  Philadelphia.  New  York, 
and  points  in  the  North  and  East.  Of  the  latter  class  was  the  'J.  K.  Barnes,'  fitted  up 


CHAP.   XV.] 


WATER    TRANSPORTATION. 


983 


in  New  York  city  during  the  latter  part  of  1864,  under  the  supervision  of  Assistant  Surgeon 
A.  H.  Hoff,  U.  B.  A.,  to  whose  large  experience  in  the  transport  of  the  sick  and  wounded 
iu  western  waters  we  have  had  occasion  to  allude.  The  '  J.  K.  Barnes'  was  two  hundred 


2  — 

y 

—  i 
-    i 

c 

— 

=U^T 

\     rf~~l^ 

9 

I 

k 

U 

n 

n 

i 

j 

r 

1  1  1 

. 

5 

c 

j 

Ji 

• 

3 

^J 

} 

v 

ar 

'! 

y 

nn- 

I     d      ij 

i  ' 

1 

1 

k 

I 

i 

n 

1 

Tl 

7 

i. 

^ 

FIG.  508. — Spar  deck  of  the  I'.  S.  Army  Hospital  Steamship  •  J.  K.  Barnes.' 


a  Forecastle.  </  Officers'  mess.  m  Saloon. 

b  Table.  h  Galley.  n  n  Wine-room  and  office. 

c  <:  Hatches.  i  Ice-house.  o  Table. 

d  d  d  Mess  tables  and  mess-room.  fcfcH'A-  Quarters  of  medical  officers,  qq  Heaters. 

ee  Pantries.  II  Linen-room.  r  Bath-room  and  water-closet. 


i  >t  Water-closets. 
t  <  Guard -rooms. 
Ward  A— 1,  2,  3—72  bunks. 


and  twenty-three  feet  in  length,  thirty-five  feet  two  inches  beam,  and  twenty-two  feet  nine 
inches  depth  of  hold.  In  fitting  her  up  an  orlop  deck  was  introduced  and  a  mess-room  was 
built  on  the  forward  deck  in  front  of  the  galley.  The  arrangement  of  the  bunks  is  shown 


FlG.  509.— Gun  deck  of  U.  S.  Army  Hospital  Steamship  'J.  K.  Barnes.' 


a      Commissary  storeroom. 
6       Engine. 
c  c    Hatches. 


ddddd  Ventilators, 
e  f  Wash-tables. 

f  f  Water-closets. 


til/  Closets.  Ward  C  (midships),  2, 2,  4, 4 — 42  bunks. 

li  h  h  h     Steam  heaters.  Ward  D  (aft),  1,  2, :? — (!:)  bunks. 
Ward       (forward),  1 .  2,  3,  4,  5,  6,  7— 
138  bunks. 


in  FIG.  509.  On  the  completion  of  the  'Barnes,'  Assistant  Surgeon  Thomas  McMillin, 
U.  S.  A.,  was  assigned  as  Surgeon-m-charge,  and,  on  December  23d,  was  ordered  to  report 
to  the.  Medical  Director  of  the  Department  of  the  South,  at  Hilton  Head,  Bouth  Carolina, 


Ull 

| 

Ward 

£ 

FIG.  !">10.— Orlop  deck  of  I*.  S.  Army  Hospital  Steamship  '.T.  K.  Banif 

a    Quarters  for  nurses.  c    Baggage-room. 

b     Knapsack-room.  d    Ventilator. 


Want  E.  1.  a,  :»— 48  bunks. 


where  she  took  her  first  load  of  sick  on  board  on  January  1.  1865.  Bhe  continued  on  this 
service  until  November,  1865,  during  which  time  she  carried  three  thousand  six  hundred 
and  fifty-five  (3,655)  patients,  as  follows: 


984 


TRANSPORTATION    OF    THE    WOUNDED. 


[CHAP.  XV. 


TABLE  CLXXX. 

Statement  of  Trips  made  by  the   U.  S.  Army  Hospital  Steamship  '  J.  K.  Barnes,'  from  January  1st  to 

November  2,  1865. 


I!i?\OF        DATE  OF  DEPARTURE.            PI.ACB  OF  DEPARTURE.               DATE  OF  ARRIVAL. 

A  RIP. 

PLACE  OF  ARRIVAL. 

No.  SICK 

AND 

WOUNDED. 

i  

2  

3  
4  

5  
6  

7.... 
8  

9  
10  .... 

11  
12  .... 
13  
14  

15 

Hilton  Head  and  Beaufort  .  . 
New  Orleans  

January  5,  6,  1865  

De  Camp  General  Hospital, 
David's  Island,  N.  Y. 
Grant  General  Hospital,  Wil- 
let's  Point,  N.  T. 
Beaufort,  S.  C  

368 
119 

Q 

68 

:i20 

439 
449 

385 
375 

217 
25 

845 

338 
198 

January  31,  1865  

February  25,  1865  
February  26,  1865  

March  14  1865 

February  9  1865   

February  26,  1S65  
February  27    1865 

Beaufort,  S.  C  
Beaufort,  S.  C  i 

St'r  Northern  Light,  Port 
Royal,  S.  C. 

MeDougall  General  Hospi 
tal,  Fort  Schuyler,  N.  T. 

De  Camp  General  Hospital, 
David's  Island,  N.  Y. 

De  Camp    G.  H.,  David's 
Island,  N.   Y.,  Grant  G. 
H.,  Willet's  Point,  N.  Y., 
McDougall    G.    H.,   Fort 
Schuyler,  N.  Y. 
Washington,  D.  C  

March  19   1865   

March  15,  1865  
April  5   1865 

Beaufort,  S.  C    [ 
Steamers    Spaulding    and  1 

April  11,  1865  

Wilmington  and  Morebead 
City,  N.  C. 

Beaufort,  New  Berne,  and 
Morehead  City,  N.  C. 

Hilton  Head  and  Beaufort, 
S.  C. 
Savannah,  Ga.,  and  Hilton 
Head,  S.  C. 
New  Orleans,  La  

April  24  25   1865 

Apiil28,  1865  ... 

May  11   1865 

May  19,  1865  

Juno  9,  1865  
July  8  ISCi 

Alexandria,  Va  

June  17,  1865  
July  16   1865         

Philadelphia  Pa  

New  York  City 

August  5  1865 

Key  West  Fla      ] 

Auo-ust23   1865           

De  Camp  General  Hospital, 
David's  Island,  N.  Y. 

De  Camp  General  Hospital, 
David's  Island,  X.  Y. 

De  Camp  General  Hospital, 
David's  Island,  N.  Y. 

August  10  1865 

Barrancas  aud  Fort  Pick- 
ens  Fla               

August  12  1865 

16  
17.... 
18... 
10  

20   .... 
21.... 
22  
23  
24  .... 
2V    .. 
1C     ... 
27  
28.   .. 

August  16,  1865  Beaufort,  S.  0  

August  17,  186">                      ...       TTiltnn  llpnd    S.  P, 

October  1   1865 

August  19,  1K65   
August  21,  1«T>  

September  19  1865 

Charleston,  S.  C  .  .  .  .   
Morehead  City  and  New 
Berne  N  C 

New  Oi  leans,  La     1 
Savannali,  Ga  > 
Hilton  Head,  S.  C  J 

September  26.  1865  
September  27  1865 

November  4   1865 

October  23   1865 

October  25,  1865  Pensao.ltt   Fla                       I 

October  27,  1865          .                 Key  West    Fla 

October  30,  1865  Savannah,  Ga  [ 
OctoberSl,  1865  Hilton  Head    S   P 

November  2,  1865 

Morehead  City,  N.  C  J 

Total  

3,655 

One  of  the  greatest  difficulties  that  the  Medical  Department  had  to  contend  with  in 
the  early  part  of  the  war  was  its  want  of  control  over  the  hospital  transports.  Many  boats 
were  assigned  for  the  conveyance  of  wounded,  but  no  sooner  had  they  been  fitted  up  and 
had  made  a  few  trips  than  they  would  be  claimed  by  the  Quartermaster's  Department,  by 
which  they  had  originally  been  chartered,  as  transports  for  troops.  When  they  were  finally 
returned  to  the  Medical  Department  they  had  been  stripped  of  all  the  appurtenances  for 
the  comfort  of  the  sick,  thus  necessitating  their  refitting  at  enormous  costs.  This  anom 
alous  condition  continued  until  November,  1863,  when  the  hospital  steamer 'Cosmopolitan,' 
which  had  been  used  in  transporting  sick  from  one  point  to  another  in  the  Department  of 
the  South,  was  taken  away  from  the  Medical  Department  and  turned  back  to  the  Quarter- 


CHAP.  XV. J  WATER    TRANSPORTATION.  985 

master's  Department  by  order  of  Major  General  Gilmore.  The  Acting  Surgeon  General 
requested  the  return  of  the  steamer  to  the  Medical  Department,  which  being  rei'erred  to 
General  Gilmore  for  remark,  he  replied  that  the  vessel  was  only  temporarily  loaned  to  the 
Medical  Department,  and  that  "as  commanding  officer  of  the  department  I  hold  myself 
responsible  for  the  administration  of  its  internal  affairs,  and  consequently  assume  the  right 
to  apply  its  resources  as  the  exigencies  of  the  service  may  seem  to  require."'  To  this 
endorsement  the  Acting  Surgeon  General  replied,  on  December  25th,  in  the  following  letter 
to  the  Secretary  of  War : 

"SURGEON  GENERAL'S  OFFICE, 

"December  25,  1863. 

"Sra:  I  have  the  honor  to  acknowledge  the  receipt  of  Major  General  Gilmore's  endorsement 
upon  my  application  for  the  restoration  of  the  steamer  Cosmopolitan  to  the  Medical  Director, 
stating  that  'the  steamer  Cosmopolitan  belongs  to  the  Quartermaster's  Department,  and  was  placed 
at  the  disposal  of  the  Medical  Director  for  temporary  purpose  by  orders  from  these  headquarters.' 

"  In  the  request  of  November  24th  no  question  was  made  of  the  power  of  the  general  com 
manding  the  department  to  dispose  of  the  steamer,  but  the  necessity  for  her  services  was  stated 
as  a  reason  for  her  restoration.  The  Cosmopolitan  was  selected  by  the  then  Medical  Director, 
under  orders  from  Major  General  Hunter,  and  by  his  orders  was  fitted  up  and  especially  assigned 
to  the  Medical  Department  as  a  hospital  steamer,  and  not  as  a  temporary  transport.  All  hospital 
steamers  are  owned  or  employed  by  the  Quartermaster's  Department,  but  their  outfits  and  move 
ments  are  under  charge  of  the  Medical  Department.  Upon  the  only  occasion  of  emergency  when 
Major  General  Hunter  used  the  Cosmopolitan  as  a  dispatch  boat  he  did  so  after  advisement  with 
his  Medical  Director  *  *  *  * 

a  Very  respectfully,  your  obedient  servant, 

(Signed)  "J.K.BARNES, 

"Acting  Surgeon  General." 

The  Secretary  of  War  directed  the  steamer  to  be  returned  to  the  Medical  Department, 
which  was  accordingly  done;  but  in  the  following  June  she  was  again  taken  from  it  by 

O    *i  O  cj  J 

General  Hatch,  and  much  suffering  to  the  sick  and  wounded  resulted.  A  similar  interfer 
ence  with  the  Medical  Department  in  the  case  of  the  hospital  steamer  'Spaulding'  was 
reported  to  the  Surgeon  General  by  Medical  Inspector  G.  H.  Lyrnan,  in  December,  1864. 
This  report  was  forwarded  to  the  Secretary  of  War  with  the  following  endorsement: 

"Respectfully  forwarded  to  the  Honorable  Secretary  of  War,  with  the  urgent  request  that 
orders  may  be  issued  prohibiting  interference  with  hospital  transports  by  other  departments. 

"The  hospital  transport  Spauldiug  has  just  been  fitted  up  at  great  expense,  and  was  dis 
patched  to  meet  General  Sherman's  army  upon  notification  of  its  arrival  at  Savannah.  To  divert  it 
to  other  purposes  entirely  cripples  this  Department  in  its  efforts  to  provide  properly  for  the  sick  and 
wounded,  and  subordinates  all  its  interests  to  the  caprice  or  whim  of  local  commanders. 

(Signed)  "  J.  K.  BARNES, 

"  Surgeon  General? 
"  S.  G.  O.,  January  3.  18U5." 

On  January  23,  1865,  the  Surgeon  General  addressed  a  further  letter  to  the  Secretary 
of  War  on  this  subject,  of  which  the  following  is  a  copy: 

"  SURGEON  GENERAL'S  OFFICE, 

"January  23,  1865. 

"  SIR  :  From  the  nature  of  the  service  upon  which  they  are  employed  it  is  absolutely  essential 
that  hospital  transports  and  hospital  boats  should  be  exclusively  under  the  control  of  the  Medical 
Department,  and  not,  under  any  circumstances,  diverted  from  their  special  purposes  by  orders  of 
local  commanders  or  officers  of  other  departments.  I  have,  therefore,  the  honor  to  request  that 

'BKOWN  (II.  E.),  Tlu  Medical  Department  of the  United  States  Armyfrom  1775  to  1873.  Washington,  D.  C.,  1 873,  page  243. 
SURG.  Ill— 124 


986  TRANSPORTATION    OF    THE    WOUNDED.  [CHAP.  xv. 

orders  to  this  effect  be  issued,  and  that  the  hospital  steamer  Cosmopolitan  be  restored  to  the 
Medical  Department  and  placed  under  the  immediate  control  of  the  Medical  Director,  Department 
of  the  South,  at  Hilton  Head,  South  Carolina,  to  be  used  as  a  hospital  tender  for  the  troops  opera 
ting  under  Major  General  Sherman  in  that  department. 
"Very  respectfully,  your  obedient  servant, 

(Signed)  "J.  K.  BARNES, 

"Surgeon  General." 

In  accordance  with  this  request  the  following  order  was  issued  on  February  8th: 

"WAR  DEPARTMENT,  ADJUTANT  GENERAL'S  OFFICE, 

"  WASHINGTON,  February  8,  1865. 
"  GENERAL  ORDERS  No.  18. 

"Hospital  transports  and  hospital  boats,  after  being  properly  assigned  as  such,  will  be  exclu 
sively  under  the  control  of  the  Medical  Department,  and  will  not  be  diverted  from  their  special 
purposes  by  orders  of  local  or  department  commanders,  or  of  officers  of  other  staff  departments. 

"  BY  ORDER  OF  THE  SECRETARY  OF  WAR. 

(Signed)  "E.  I).  TOWNSEND. 

"Assistant  Adjutant  General.'''' 

This  order  effectually  ended  the  interference  of  local  or  department  commanders  and 
vested  the  control  of  the  hospital  transport  steamers  where  it  properly  belonged- — i.  e.,  in 
the  Medical  Department. 


LIST    OF    PLATES. 


1.    PLATE  XXVIII,  facing  p.  18.     GANGRENE  FOLLOWING  A  SHOT  LACERATION  OF  THE  FEMORAL  ARTERY.    Case  of 
G.  "VV.  Gardner,  page  18.     (Chromolithograph.) 

'2.     PLATK  L  VI,  facing  p. '27.     DRY  TRAUMATIC  ARTHRITIS  OF  THE  RIGHT  Hi  P.     Specimen  5518.     Case  of  Albert  McGee, 
page  27.     (  Heliotype.) 

3.  PLATK  XXVII,  facing  p.  53.     EFFECTS  OF  HOSPITAL  GANGRENE.    Case  of  C.  II.  Dudley,  page  5:>.    (Chromolithograph.) 

4.  PLATE  LVII,  facing  p.  68.     GUNSHOT  FRACTURE  OF  THE  RIGHT  ACETABULUM  AND  THE  HEAD  OF  THE  FEMUR. 

Case  of  Jame>?  C.  Strong,  page  08.     (Lithograph.) 

5.  PLATE  XXXIII,  facing  p.  74.     CONSOLIDATED  GUNSHOT  FRACTURE  OF  THE  FEMUR.     Case  of  Philip  Sweeny,  page 

74.     (Lithograph.) 

0.     PLATE  LIX,  facing  p.  178.    CONSOLIDATED  GUNSHOT  FRACTURE  OF  THE  FEMUR.     Two  figures.    FIG.  1,  case  of  W. 
Rigney,  page  178.     FIG.  2,  case  of  T.  Crassley,  page  182.     (Lithograph.) 

7.  PLATE  LVIII,  facing  p.  180.    CONSOLIDATED  GUNSHOT  FRACTURES  OF  THE  FEMUR.    Two  figures.    FIG.  1,  case  of  D. 

Lewis,  page  179.     FlG.  2,  case  of  A.  F.  Dinsmore,  page  179.     (Lithograph.) 

8.  PLATE  LV,  lacing  p.  182.    Two  VIEWS  OF  A  UNITED  SHOT  FRACTURE  OF  THE  UPPER  EXTREMITY  OF  THE  RIGHT 

FEMUR  OVER  11  YEARS  AFTER  INJURY.    Case  of  E.  L.  Postley,  page  182.     Specimen  659b'.     (Lithograph.) 

9.  PLATE  XXV,  facing  p.  184.     SECONDARY  INFLAMMATION  OF  THE  KNEE  JOINT.     Case  of  William  Ziliox,  page  18f>. 

(Chromolithograph.) 

10.  PLATE  LX,  facing  p.  188.    CONSOLIDATED  GUNSHOT  FRACTURES  OF  THE  FEMUR.     Two  figures.    FIG.  1.  case  of  J. 

Buckley,  page  188.     FIG.  2,  case  of  J.  Hamilton,  page  188.     (Lithograph.) 

11.  PLATE  LXI,  facing  p.  190.     CONSOLIDATED  GUNSHOT  FRACTURES  OF  THE  FEMUR.     Two  figures.    FIG.  1,  case  of  A. 

Ryder,  page  188.     FIG.  2,  case  of  T.  Miller,  page  190.     (Lithograph.) 

12.  PLATE  LXI  I,  facing  p.  192.    CONSOLIDATED  GUNSHOT  FRACTURES  OF  THE  FEMUR.    Two  figures.    FIG.  1,  case  of  H. 

E.  Gumberts,  page  192.     FIG.  2,  case  of  H.  Shelter,  page  192.     (Lithograph.) 

13.  PLATE  XXIV,  facing  p   194.     OSTEOMYELITIS  IN  A  FRACTURED  FEMUR.     Case  of  Tobias  Sever,  page  193.     Specimen 

2167.     (Chromolithograph.) 

14.  PLATE  LXIII,  facing  p.  19,!.     CONSOLIDATED  GUNSHOT  FRACTURES  OF  THE  FEMUR.     Two  figures.    FIG.  1,  case  of 

J.  Durst,  page  194.     FIG.  2,  case  of  M.  Burns,  page  195.     (Lithograph.) 

15.  PLATE  LXIV,  facing  p.  198.     CONSOLIDATED  GUNSHOT  FRACTURES  OF  THE  FEMUR.     Two  figures.    FIG.  1,  case  of 

R.  Hanlon,  page  198.     FlG.  2.  case  of  J.  O'Connor,  page  190.     (Lithograph.) 
10.     PLATE  XXX,  facing  p.  204.     OBSTRUCTED  FEMORAL  VEIN.    Case  ut  Jonathan  Wallace,  page  204.    (Chromolithograph.) 

17.  PLATE  LXIX,  facing  p.  224.    TUBULAR  SEQUESTRA  FROM  AMPUTATIONS  OF  THE  FEMUR.    Four  figures.    FIG.  1,  case 

of  II.  H.  Ellis,  page  288,  Specimen  1853.     FlG.  2,  case  of  J.  Nash,  page  288,  Specimen  144.     FIG.  3,  case  of  J. 
Glassie,  page  288,  Specimen  3100.     FIG.  4,  case  of  J.  McMahon,  page  223,  Specimen  4281.     ( Lithograph.) 

18.  PLATE  XXXII,  facing  p.  226.    DISEASED  STUMP  OF  FEMUR.     Case  of  John  Sproul,  page  225.     (Chromolithograph.) 

19.  PLATE  XXXI,  facing  p.  228.     GANGRENE  OF  THE  MEDULLA.     Case  of  John  Sproul,  page  225.     (Chromolithograph.) 

20.  PLATE  LXX,  facing  p.  242.     INVOIUCRA  OF  THE  FEMUR.     Four  figures.     FlG.  1,  case  of  W.  Vannatta,  page  287,  Spec 

imen  2602.     FlG.  2,  case  of  J.  Miller,  page  241,  Specimen  1094.     FlG.  3,  case  of  J.  Wearing,  page  224,  Specimen 
4196.     FIG.  4,  case  of  L.  C.  Griffin,  page  293,  Specimen  3141.     (  Lithograph.) 

21.  PLATE  XXVI,  facing  p.  278.    OSTEOMYELITIS  OF  FEMUR.    Case  of  Clark  Chase,  page  279.    Specimen  6715.    (Chromo 

lithograph.) 

22.  PLATE  XLII,  facing  p.  280.    ROUND  MUSKET  BALL  IN  THE  MEDULLARY  CAVITY  OF  THE  FEMUR.    Case  of  E.  Kirby, 

page  280.     Specimen  1076.     (Lithograph.) 


II  LIST    OF    PLATES. 

23.  PLATE  XLIII,  facing  p.  290.     RESULTS  OF  OSTEOMYELITIS.     Five  figures.    FIGS.  1,  2,  and  3,  case  of  W.  Sailor,  page 

289.     FJUS.  4  and  5,  case  of  J.  X.  Saxtoii,  page  290.     (Chromolithograph.) 

24.  PLATE  XXI.  facing  p.  292.     GANGRENE  OF  A  THIGH  STUMP.     Case  of  ltr.  E.  Davis,  page  291.     (Chromolithograph.) 

25.  PLATE  XX,  facing  p.  294.     FEMORAL  ARTERY  AND  FEMORAL  VEIN  AFTER  AMPUTATION.      Two  figures.     Case  of 

D.  A.  Baruett,  page  292.     Specimens  3991  and  2246.     (Lithograph.) 

26.  PLATE  LXVI,  facing  p.  30o.     SHOT  FRACTURE  OF  THE  MIDDLE  THIRD  OF  THE  FEMUR.     Case  of  John  Pool,  page 

306.     Specimen  2229.     (Chromolithograph.) 

27.  PLATE  XXIII,  facing  p.  312.     SEPARATION  OF  PERIOSTEUM  IN  OSTEOMYELITIS.     Case  of  E.  W.  Cappt,  page  312. 

(Chromolithograph.) 

28.  PLATE  XLIX,  facing  p.  314.    MEDULLARY  ABSCESSES  OF  THE  FEMUR.     Case  of  E.  W.  Capps,  page  312.     (Chromo 

lithograph.) 

29.  PLATE  LXXII,  facing  p.  317.    INVOLUCRA  OF  BONKS  OF  THE  LEG.     Two  figures.    FIG.  1,  case  of  Oliver  Payne,  page 

528,  Specimen  4740.     FIG.  2,  case  of  W.  H.  Miller,  page  317,  Specimen  4172.     (Lithograph.) 

30.  PLATE  LXXIII,  facing  p.  35(>.     THIGH  STUMPS.     Six  figures.     Specimens  367,  417,  4317,  3022,  3513,  2306.     (Chromo 

lithograph.  ) 

31.  PLATE  LXVIII,  facing  p.  370.     RKSULTS  OF  SHOT  INJURIES  OF  THE  KNEE  JOINT.     Two  figures.    FIG.  1,  case  of 

T.  W.  Robertson,  page  378.     FIG.  2,  case  of  P.  Stuck,  page  370.     (Lithograph.) 

32.  PLATE  LXVII,  facing  p.  372.    BALI.  LODGED  IN  OUTER  CONDYLE  OF  LEFT  FEMUR  OVER  15  YEARS.    Case  of  E.  B. 

Blake,  page  372.     Specimen  6812.     (Lithograph.) 

33.  PLATE  LXV,  facing  p.  386.    SUCCESSFUL  EXCISIONS  OF  THE  KNEE  JOINT  AFTER  SHOT  INJURY.    Two  figures.    FIG. 

1,  case  of  C.  Knowlton,  page  391.     FIG.  2,  case  of  A.  Rider,  page  386.     ( Lithograph. ) 

34.  PLATE  LXXI,  facing  p.  428.     TUBULAR  SEQUESTRA  AND  PIECES  OF  NECROSFD  BONE  FROM  TIBIA.    Four  figures. 

FIG.  1,  case  of  H   Rail,  page  428.     FlG.  2,  case  of  J.  Walker,  page  435.     FIG.  3,  case  of  O.'M.  Armstrong,  page 

529.  FIG.  4,  case  of  G.  Cullom,  page  520.     (Lithograph.) 

35.  PLATE  LXXIV,  facing  p.  434.     UPPER  PORTION  OF  RIGHT  TIBIA  SAWN  LONGITUDINALLY.    Case  of  Colonel  W.  F. 

Lynch,  page  435.     Specimen  0734.     (Lithograph.) 

36.  PLATE  LXXVI,  facing  p.  478.     LACERATION*  OF  RIGHT  LEG  BY  SOLID  SHOT.    Case  of  D.  Jerman,  page  478.    (Chro 

molithograph.) 

37.  PLATE  LXXV,  facing  p.  596.    AMPUTATIONS  AT  THE  ANKLE  JOINT.    Four  figures.     FIG.  1,  case  of  W.  (J.  Weeks,  page 

597.     FIG.  2,  case  of  J.  E.  Avers,  page  59<>.     FIG.  3,  case  of  J.  H.  Short,  page  603.     FIG.  4,  case  of  A.  K.  Rus 
sell,  page  596.     (  Lithograph  ) 

38.  PLATE  LXXVIII,  facing  p.  710.     DISTORTED  BULLETS.     Figures  of  twenty  specimens  in  Army  Medical  Museum.     (Lith 

ograph.) 

39.  PLATE  XXXIX,  facing  p.  712.    EARLY  APPEARANCES  OF  ENTRANCE  AND  EXIT  SHOT  WOUNDS.    Tioenty-three  figures. 

(Chromolithograph.) 

40.  PLATE  XL,  facing  p.  714.     EARLY   APPEARANCES  OF  ENTRANCE   AND   EXIT   SHOT   WOUNDS.     Twenty-four  figures. 

(Chromolithograph.) 

41.  PLATE  XXXVIII,  facing  p.  741.     FACIAL  PARALYSIS  CONSEQUENT  ON  SHOT  INJURY.     Case  of  Dr.  R.  D.  Murray. 

42.  PLATE  LXXVII,  facing  p.  808.     TRAUMATIC  ANEURISM.     Case  of  Francis  M.  Denton,  page  809.     (Chromolithograph.) 

43.  PLATE  LXXIX,  facing  p.  818.    FIG.  1,  THE  LEFT  FEMORAL  VEIN  AFTER  DEATH  FROM  PYAEMIA;  caseot'W.  Sailor. 

page  289.    FIG.  2,  GANGRENE  OF  FOOT  AFTER  SHOT  WOUND  OF  LEG  (  UPPER  THIRD);   case  of  W.  Steel, 
page  850.     (Chromolithograph.) 

44.  PLATE  XXIX,  facing  p.  850.    DRY  GANGRENE  OF  THE  FEET.    Case  of  H.  Strauss,  see  page  850.    (Chromolithograph.) 


LIST  OF  OPERATORS  AND  REPORTERS. 


Page. 

ABADIE,  E.  H 882 

ABBOTT,  C 225 

ABBOTT,  N.  W 93 

AD AMS,  E 217 

ADAMS,  H.  N 526 

ADAMS,  0 483 

ADAMS,  O.  H 472 

ADAMS,  S 243, 464,  470, 474,  482,  489 

ADAMS,  W.  S 29,  37,  50,  244, 

245,  248, 257,  206,  276,  294,  298, 
434,  462,  465,  476,  544,  801 ,  853 

ADAMS,  Z.  B 361,  485 

ABLER,  J.  M 253 

ADOLPHUS,  P. .  .2(13, 286,  315,  664,  719,  723,  768 

AGNEW,  D.  H 148,149,156 

AIKEN,  J 48, 281, 286, 454, 471, 626, 790 

AINSWORTH,  F.  L 260 

ALBRIGHT,  F.  G 500, 527,  542 

ALDEN,  C.  H 106,627 

ALEXANDER,  C 212,234 

ALEXANDER,  C.  T 75, 

429,  548,  767, 774,  817,  822 

ALEXANDER,  J.  W 472,481 

ALLEMAN,  L.  J 581 

ALLEN,  A 793 

ALLEN,  A.  L 321 

ALLEN,  C.  G  222 

ALLEN,  C.  H 286,  469 

ALLEN,  C.  L 86, 183,  622, 634,  780 

ALLEN,  D.  B 477,502 

ALLEN,  G.  T 361 

ALLEN,  H 17,  47,  85, 109, 112, 185, 

283,  300,  312,  379, 406,  442,  456,  459,  546,  549, 
553,  633,  634,  66:3,  677,  714,  773,  777,  784,  850 

ALLEN,  J 6 

ALLEN,  S.  J 87,141 

ALLEN,  W.  J 501 

ALLEN,  W.  W 228 

ALLISON,  T.  H 549 

ALTMAN,  W 498 

AMEN,  M.  V .670,  672,  677 

ANAWALT,  J.  W 222,  262, 451, 469, 472 

ANDERSON,  H.  P 534 

ANDERSON,  W 519,549 

ANDREW,  A.  D 533 

ANDREWS,  A.  W.  K 276,  531 

ANDREWS,  E 314,  342, 595,  6C8 

ANDREWS,  J 678 

ANDRUS,  C.  II 227,234,236, 

238,  251,  260, 276,  450,  467,  623,  626, 754, 882 

ANGELL,  J.  W 269, 884 

ANSELL,  A 312,  316,  321,  534,  554,  779 

ANTISELL,  T 42, 170,  282,  382,  470, 788 

APPLEGATE,  J.  W 467,  605 

APPLET,  W 220 

ARMSBY,  ,T.  H 17,187,235, 

278, 295,  309,  429,  446,  529,  553,  791 

ARMSTRONG,  D.  II 495,  502 

ARMSTRONG,  J.  A 269, 371,  517 

ARMSTRONG,  O.  H 468,501 

A RNDT,  P.  S 468, 488,  489,  495 

ARNOLD,  A.  E 248 

ARNOLD,  J 352 

ARRINGTON,  W.  J 479,  484 

ARTAUD.  T 459 

ARTER,  J.  R 209,  388 


Page. 

ARTHUR,  C.  S  260 

ARTHUR,  J.  P 55,  57,  58,  526.  550 

ASH,  J 217,  248, 489,  727 

ASHHURST,  J.,  jr.  .23, 43, 126, 129, 173,  680,  779 

ATKINS,  F.  H 435 

ATKINSON,  A 315,  455,  536 

ATLEE,  W.  F 51,  52, 174, 783,  802,  803 

ATWOOD,  A.  A 471 

AUSTIN,  A.  S 675 

A  VENT,  B.  W 74 

AVENTS,  J 280 

AVERDICK,  II.  G 222 

AVERY,  G.  W ....  106,  112, 157, 216, 219,  232, 235 

A  VERY,  J 256 

AYERS,  J.  H 472 

AYRES,  D.  C 471,  484,  492,  495,  523 

AYRES,  S.  C 11, 55, 58,  234,  774 

AZPELL,  T.  F 36,773 

BABCOCK,  W.  A 489,497 

BACHE,  D 70,  66 1 

BACHE,  T.  H 37,443,536 

BACON,  C.,jr 322,455, 

473,  534,  554,  661,  668,  669,  675 

BACON,  F 106,  279,  286, 516,  541,  667,  676 

BADGER,  G 

BAGULEY,  D 469. 

BAILEY,  A.  W 

BAILEY,  E.  I 

BAILEY,  F.  K 712, 

BAILEY,  J.  C 

BAILEY,  J.  R 271, 

BAILEY,  J.  S 197, 

BAILEY,  T.  P 

BAILEY,  W.  W 

BAINE,  G.  H 

BAKER,  J.  W.  H... 


BAKER,  L.  H 

BALDWIN,  L.  K 374,739, 

BALDWIN,  M 

BALDWIN,  R.  F 48, 

BALDWIN,  R.  T 

BALDWIN,  W.  H 

BALEY,  G.  D 

BALL.  A 135,  296, 

BALL,  C.  E 78, 

BALLOU,  L.  T 

BALSER,  W 276,  2<J8,  527,  547,  662, 

BANCROFT,  F.  J 133, 138, 

BANE,  G.  II 

BANKS,  W.  A 

BANNISTER.  T.  O 47,181,196,299,392, 

BANTA,  J.  Q.  A 

BARBARIN,  F.  S 

BARBER,  J 

BARETTE,  B.  A 

BARKER,  T.  C 

BARLOW,  A.  C. .  .264,  390,  450,  472,  498,  500, 

BARNARD,  C.  F 

BARNES,  A.  S 

BARNES,  A.  T 483,  518, 

BARNES,  F 

BARNES,  F.  N 250, 

BARNES,  I.  N 231,450,  470,  482,. 626, 

BARNES,  L 253,  487,  510, 

B ARNES,  N.  R 245,  250,  502, 


55 
496 
386 
[39 

81 ; 
314 
V,  5 

.M  I? 

259 

883 
58 
S47 
776 
66] 
536 
53] 
585 
301 
1 16 
381 
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678 
01 

580 

54  ; 
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450 
619 
721 
632 
55 
357 
552 
298 
266 
780 
886 
632 


Page. 

BARNES,  N.  S 73,  243,  246,  481,  760 

BARNEY,  L 220 

BARR,  R 217,  389,  457 

BARRY,  W.  A 3:;,  234, 248, 

251,  254,  277,  297, 298,  3C2,  479, 480,  487,  499 

BARTHOLF,  J.  H 19,29,30,49,205. 

238,  274,  280,  301,  383,  446,  521, 
524,  527,  582,  651,  672,  785,  798 

BARTHOLOMEW,  J.  H 11 

BARTHOLOW,  R 70, 81, 117, 119, 

209,  210,  314,  321, 322, 448,  517,  523,  524, 541, 

543,  546,  548,  549,  554,  COS,  607,  658,  668,  790 

BARTLETT,  A.  T 235, 245, 

452,  475,  497,  508,  630,  631 

BARTON,  E 180 

BARTON,  M.  H 524 

BARTRAM,  T.  S 541 

BARUCH,  S 531 

BASCOM,  J.  B 179 

BATEMAN,  R.  T 139,144,296 

BATES,  C.  C 374 

BATES,  J.  A 284 

BATTEY,  R 247, 470,  541 

BAT  WELL,  E 48, 172,  203,  219,  209,  247, 

248,  281,  356,  449, 467, 482, 487, 488, 632, 797 

BAUDUY,  J.  K 6 

BAUER,  H 234 

B  A  U  E  R,  L 55, 56, 1 57 

BA  UGH,  T.  W 314,  668, 861 

BAUSCH,  C 519,  675 

BAXTER,  A.  J 370 

BAXTER,  J.  B 296 

BAXTER,  J.  B.  G 506,518,525,679 

BAXTER,  J.  H 207,321, 

522, 524,  532,  535,  552,  554,  676 

BAXTER,  M.  L 534,  535 

BAYLES,  G 139 

BAYLOR,  J.  C 773,788 

BAYLOR,  W.  L 87, 251,  253, 254,  300,  676,  789 

B  A  YNE,  J.  H 154 

BEACH,  J.  N 235,262,264 

BEAKS,  G.  M 251,266 

BEATTY,J.E 240 

BECK,  E.  W.  H 251,485,495 

BECK,  S.  L 643 

BECKET,  T 320 

BECKWITH,  E.  W..., 247 

BEEBE,  G.  D 232,340 

BEEBE,  O.  1 651 

BEECH,  G.  W 236 

BEECH,  J.  H 203, 232, 

235,  264,  265, 294, 467, 471, 520,  525,  630,  811 

BELDEN,  A.  P 429 

BELL,  D.  C 320 

BELL,  D.  H 297,  535 

BE  LL,  J 69,  375 

BELL,  J.  B 642 

BELLANGEE,  J.  B 286,581 

BELLOWS,  C.  J 228, 482,  496 

BELLOWS,  H.  M 23, 51,  224, 

551,  553,  673, 795,  804 

BELTON,  T.  F 299, 492 

BENEDICT,  A.  C 228 

BENEDICT,  M.  D 70, 230,  314,  388, 391,  882 

BENJAMIN,  M.  N 524,680 

BENNETT,  J 233, 253,  255,  257,  259, 484,  675 


[V 


LIST    OF    OPERATORS    AND    REPORTERS. 


Page. 

BENNETT,  J.  H 542 

BENNETT,  \V.  C.233,  242,  255, 270,  488,  501, 503 

BENSON,  J 69 

BENSON,  W.  K 230 

BENTLEY.E 8, 

48,  54,  55,  56,  58,  70,  78,  61,  84, 130, 144, 
145, 150, 151,  Kit,  162, 176, 180, 182, 183, 
191,  215, 222, 233,  245,  252,  2G5,  273,  275, 
277,  2SO,  281,  28-',  283,  284, 285,  286,  29C, 
297,  298,  299,  300,  302,  303,  313, 31 4,  315, 
316,  322, 323,  363,  381,  393, 394,  4C4,  405, 
406, 407, 441,  448,  455,  456, 465, 518,  522. 
524,  526,  527,  531,  532,  533, 534,  535,  549, 
550, 585,  589,  006, 626,  627,  634,  644,  666, 
669, 670,  675,  676, 768, 769,  779,  783, 784, 
787, 788,  789,  790,  792,  802,  803,  807,  811 

BERRY,  A.  J 68,672 

BERRY,  W 486 

BEUST,  B 375,532 

BIBB,  O.  K 542 

BIGELOW,  C.  P 299,  519,  781 

BIGELOW,  H.  J 297,  542,  668,  671 

BIG  ELO  VV,  J.  A 295,  302,  490,  884 

BIGELOW,  J.  K 115,  119,  218, 227 

BIGSBY,  G 553 

BILL,  J.  H 71,77,  104,  111 

BILLERT.  F.  W 624 

BILLINGS,  A.  J .     -177 

BILLINGS,  J.  S ..  94,105, 

108,  111,  112, 154,  203,  233,  281 ,  283,  297,  29!'. 
406,  488,  505,  523,  527,  54::,  585,  619,  658,  659 

B1R.  IIETS,  T.  C, ....     4:!3 

BISSELL.  E.  L...  .     517 

BLACK,  H ....523 

BLACK,  W  .     :,;!i 

BLACKMAN.  G.  C . . .  ...  97,  100, 

104,112,  114,  142,  144,  14i:,  151,  162,  314,  395 
BLACKWOOD,  S ...  ...50,210 

BLACKWOOD,  S.  \V          531 ,  777,  7*4,  799,  804 

BLACKWOOD,  W.  K.I)  229 

BLAIR,  W.  W   .  .     343 

BLANCIIARD,  C.  S . . .  .     486 

BLANCK,  O 525 

BLAND,  D.  W  496 

BLANDRY,  U.  H  . .  .300,  320 

BLANEY,  J.  B.  X   . .  30 

BLICKIIAHN,  G.  H   ..  .     482 

BLISS,  C .     157 

BLISS,  D.  W 8,  26,  31,  32,  47,  54,  58,  84. 

1 10,  112,  180, 190,  278, 280,  281, 282, 283, 
284,  285,  £86,  293,  294, 295, 296,  305,  308, 
31J,  313, 314,  315,  321,  353,  365,  390,  435, 
439,  518,  522.  523,  524,  525,  527,  529,  531, 
SK>,  534,  535,  54 1 ,  542,  543,  548,  549,  588, 
598,  605,  634,  650,  666,  768,  771,  851,  868 

BLISS,  E.L 626 

BLISS,  L.  W...  239,243, 

246, 254, 255,  260,  266,  484,  489,  510,  626,  885 

BLISS,  Z.  E 84. 

195,  282, 431,  438,  483,  516, 518, 527,  534, 
535,  541,  543,  548,  661,  667,  672,  676,  768 

BLOUNT,  J 515 

BLUNDELL,  W 469 

BLUNT,  X.  F 245,  495,  498 

BOARDMAN,  H 409 

BOBBS,  J.  S 115 

BOCKEE,  J 182, 281 

BODMAN,  L.  H '  756 

BOGUE,  R.  G : C6G 

BOISNOT,  J.  M 459,  505 

BOND,  B.  N 225, 250,251, 

259, 267, 269,  283, 452,  475,  499.  501,  508,  6:72 

BOND,  R.  C 282 

BONINE,  E.  J 181,219,250 

BONNER,  S.  P 227)  233 

245,  247,  249,  250,  253,  268,  534,  671 


Page. 

BONTECOU,  R.  B 14,27, 

31, 32, 36. 44, 47, 50, 51,  53, 54, 55, 56, 
58,  74,  75, 78, 118,  119, 133, 152, 171, 
173, 178,  182, 183, 188, 190, 193, 210, 
244,  253,  256,  283,  284,  285, 286,  289, 
295,  297,  298,  299,  300,  301,  302, 303, 
321,  322,  371,  374,  379,  386,  387,  392, 
393,  399, 406,  407,  40!),  430,  433, 434, 
438,  455, 456,  490,  493,  518,  531,  535, 
550,  551,  553,  554,  591,  594,  599,  602, 
603,  604,  605,  606,  608,  619,  651,  668, 
673,  677,  678,  C80,  721,  769,  771 ,  775, 
776, 780,  790,  792,  793,  795,  796,  801 

BOONE,  J 235 

BOONE,  J.  H 459 

BOOR,  W.  H 646 

BOOTH,  D.  S 281 

BORCK,  E : 459 

BOUCHER,  J.  H 143 

BOULWARE,  W.  P 373 

15OURNONVILLE,  A.  C 84, 186, 197,  394 

BOWDITCH,  II.  I £0 

DO  WEN,  C.  II 58,  318 

BO  WEN,  G.  W 466 

BOWEN,  J.  B 365,367,604 

BO  W  ER,  C 218,  220,  226,  232,  236, 

245,  254,  262, 470,  472,  484,  494,  626, 629,  631 

BOWES,  M.  F 84,281,881 

BOWIE.  A 496 

li<  >WLBY,  W.  W 252, 393 

BOWLES,  B.  F 276 

BOWMAN.  E.  H 517 

P.O W.MAN,  .1 710 

BOYD,  S.  S 308,519 

BUYER,  P.  C 513 

BOYLE,  C.  E   516,  553,  669,  674 

BRADFORD.  F.  G.  II 294,298, 

2H9, 304, 322,  456,  626,  771,  778,  822 

BRADLEY,  E 12, 72, 378 

BRADLEY,  O.  II 542 

BRADSHAW,  II.  N 648 

BRADT,  J.  G 218, 220,  466,  473,  483,  488 

BRADY,  J 253 

BRADY,  J.  W 401} 

BRAINARD,  D : 39,  44 

BRAINERD,  T.  C 224, 321,  428, 463, 550, 552 

BRAMLETTE.  W.  II 770 

BRANCH,  T.  W 55 

BRAUX,  L 466 

BRECK,  W.  G 543 

BREED.  B.  B 56,155,208,221, 

315,  321,  322,  526,  5-11,  551,  554,  586, 
623,  624,  626,  676,  769,  773, 779,  804 

BREXNAN,  G.  M 481 

BREXNEMAX.  E.  I)  195,226,785 

BRENT,  C.  P 231 

BRENTOX,  J.  L 220, 256,  271,  508,  631 

BREVARD,  E.  L 296,  298 

BREWER,  G.  ft 769 

BREWER,  J.  W 587 

BKEWSTER,  O.  E 581 

BRICKETT,  G.  E 58,  248, 

294,  320,  548,  635,  674,  675,  778 

BRIDGE,  W.  W 381,  523 

BUIGGS,  C.  E 470 

BRIGGS,  G.  W 489,  601 

BRIGGS,  L 542 

BRIGGS,  S.  W 51,802 

BRIXTOX,  D.  G 648 

BRINTOX,  J.  B 286,  315, 

394,  480,  518,  523,  533, 550,  797 

BRIXTOX.  J.  H   18,46,80, 

282,  291,  339,  347,  381,  402, 403, 405,  480,  491 , 
492,  495,  635,  710,  718,  787,  810,  830, 831,  836 

BRISTOL,  B.  J 319, 599 

BROCK,  C.  W.  P 321,  323,  633,  634 


Page. 

BROCK,  J.  W 135, 138,  222,  232,  246, 884 

BROCKWAY,  A.X 302 

BRODIE,  R.  L 96 

BRODXAX,  J.  G 549 

BRONSOX,  J.  R 315, 431 

BROOKE,  J 184 

BROOKS,  G.  W 518 

BROOKS,  N.  G 586 

BROWER,  D.  R 27,201,  301,  322 

BROWX,  B.  P 669,  820 

BRO  WX,  C.  H 866 

BROWX,  F.  H 301,527,531 

BROWX,  H 249 

BROWN,  H.  E 54,95,253,322 

BROWX,  H.  W 325 

B  RO  W  X,  J.  A 52, 652 

BROWX,  J.  B 78, 699 

BROWX,  J.  J 310 

BROWX,  J.  M 48,  293,  298 

BROWN,  J.  T 281,495 

BROWN,  L.  C 673 

BROWX,  R.  B 254 

BROWX,  R.  H 675 

BROWX,  W.  W 249 

BROWXE,  J.  M 795 

BROWXE,  R.  K 133,  376 

BROWXELL,  W.  R 254 

BRUBACKER,  H 370,  654 

BRUCE,  J.  S 247 

BRUCKER,  M 267,  482,  484, 660 

BRUMBAUGH,  A.  B 447 

BRUMLEY,  J.  D 514,  642,  789 

BRUNDAGE,  A.  H 246,247 

BRUXER,  J.  F 295,  297 

BKUXS,  J.  D 82 

BRYAN,  J ...  26, 636 

BRYAX,  S.  P ...516 

BRYAXT,  II 294,  296, 

297,  299,  300,  408,  531 ,  605, 674 

BRYANT,  W.  G 250,298,314,450,488 

BUCHANAN,  . I.  A 634 

BUCHANAN,  J.  G 801 

BUCHANAN,  W.  F..  121 

BUCK,  D 519 

BUCK.  E.  J 55,  229, 264,  267, 270,  885 

BUCK,  G 152, 158, 159,  408,  409,  607 

BUCK,  R.  H 671 

BUCK,  S.  S 511 

BUCK,  S.  T 632,  664,  669,  67(5 

BUCK,  W 470 

BUCKLEY,  B.  T 648 

BUCKLEY,  W.  B.   310 

BUCKMAN,  J.  II 250,  263, 482,  499 

BUCKMAN.  J.  W 246,482 

BUCKMASTER,  II 548 

BUFFIXGTOX,  A.  L 410 

B  UI S  T,  J.  R 135, 1 38,  302 

BULLARD,  G.  B 437 

BULLEX,  c.  F 298, 302, 535 

BUMSTEAD,  s.  J 684 

BURBECK,  C.  H 264 

BURDETT,  ft.  M 55,  263,405,  519 

BURDICK,  J.  T 154,  620, 748 

BURGESS,  W.  J 249 

BURKE,  F.  X 14,  211,  212,  046 

BURKE,  G.  W 210,  222, 234,  293,  321,  542 

BURKE,  W.  R 674 

BURKET,  G.  W 642 

BUUMEISTER,  F.  F . .  1 34,  266,  283, 301 ,  527,  529 

BURNS,  J.  B 54,631 

BURNS,  W.  W 69 

BURR,  ft 323,  716,  804 

BURR,  W.  J 206,250,261. 

283, 285, 318, 402,  451,  465,  466,  471 , 

473, 477, 485,  498,  510,  51 1,  780,  885 

BURR1TT,  H.  L.  W 54,  301, 379 


LIST    OF    OPEEATOES    AND    REPORTERS. 


Page. 

BURT,  J.  C 70 

BURT,  S.  S 378 

BURTON,  M 646 

BURTON,  W.  II 507 

BUSH,  J.  F 373 

BUSHEY.  F.  A 281,  619 

BUTCHER,  B.  F 32,  58,  273 

BUTCHER,  H.  B 543 

BUTLER,  J.  II 320 

BUTLER,  W.  H 469,  518 

BUTT,  II.  F 471 

BUTTERBAUGH,  J 458 

BUTTON,  G.  B 884 

BUTTON,  J.  I)..-  .  649 

BUZZELL,  A.  J.  H 256,601 

BYERS,  G 10,785 

BYINGTON.  W.  C 249 

BYRNE,  C.  C 26,301,302, 

405,  455,  51 7,  525,  532,  535,  587.  623,  661 , 723 

CABELL,  J.  G...  95 

CABOT,  S 320,  674 

CADWALLADER,  D.  W 428 

CADY,  C.  E 219 

CADY,  W.  F 258 

CAIN,  J.  S 485 

CAKE,  W.  M 387 

CALD  WELL,  D.  G 517,  634 

CALHOUN,  A.  W 548 

CALHOUN,  J.  T 24, 133, 232,  234, 

239, 250, 402,  475,  483,  536,  575,  654,  674,  675 

C ALLA WAY,  L.  H 676 

C AMAC,  W 22 

CAMERON,  C.  D 2C8 

CAMPBELL,  A 225,  239, 517 

CAMPBELL,  A.  B 647 

CAMPBELL,  C.  M 217,  251,  256 

CAMPBELL,  II.  F 506 

CAMPBELL,  J...  ....  498 

CAMPBELL,  W 268 

CAMPBELL,  W.  F  ..  35 

CANTWELL,  J.  Y 207,  247,  708 

CAPERS,  L.  G : 250, 472 

CAREY,  E.  R 308 

CAREY,  M.  T 95,99,221 

CAREY,  W.  B 266,675 

CARHART,  G.  L 231,  239,  248,  452,  480 

CARLE,  C 216,485,502 

CARLTON,  S.T 446 

C ARNOCHAN,  J.  M 134,  138, 162 

C AROTHERS,  A.  E 130, 282, 339,  627 

CARPENTER,  H.  W 252,  467, 499 

CARPENTER,  J.  T 27,74,666 

CARPENTER,  S.  D 607 

C  ARR,  A.  B 673 

CARR,  G.  W 206,  251,  401 

CARRIER,  C.W 315, 554 

CARRINGTON,  W.  A 542 

CARROLL,  J 282,557 

CARROLL,  R.  W.  W . .  286,  353, 456,  519,  523,  626 

CARROLL,  T 524,  531,  535 

CARROLL,  \V 253,  284,  285,  296 

CARSON,  W 14 

CARTER,  N.  M 228 

CARTER,  R.  K 157, 159 

C  ARVALLO,  C 106,  258, 

291, 298,  526,  584,  620, 717 

CASE,  M 229 

CASEY,  W.  B 58,  322 

CASS,  J 20,  82,  286,  301,  321,  519 

CASSELBERRY,  I 313,430 

CASWELL,  E.  T 300 

CH  ADDOCK,  G IPS,  228, 

260,  262, 264,  271 ,  450,  469,  474,  484,  496,  598 
CHAMBERLAIN,  C.  N 32, 195,  202,  255, 

257, 261,  435,  466,  492,  549,  550,  588,  591,  597 
CHAMBERLAIN,  D.  A  . . .  .73,  245,  248, 456,  501 


Page. 

CHAMBERLAIN,  W.  M 195,  598, 644 

CIIAMBERLIN,  D.  P 472 

CHAMBERS.S.R 532 

CHAMBERS,  W.  B 56, 228, 

250,  452,  483,  496,  524,  866 

CHAMBERS,  W.  M 589, 726 

CHAMBLISS,  J 39,  788 

CHANCELLOR,  J.  E 507 

CHANDLER,  C.  M 229 

CHAPEL,  A 69,  70, 75,  82, 297, 450 

CHAPIN,  A.  B 284 

CH  APIN,  J.  B 447 

CHAPIN,  S.  F 82,  84, 

262,  443, 470,  474,  546, 601,  632 
CHAPMAN,  J 218,  231, 

251, 256,  259, 449,  486, 498,  601 

CHASE,  E.  G 137, 138, 275, 482,  487, 503 

CHASE,  H.  M 70 

CHASE.J.B 746 

CHEANEY,  S.  L 506,  509 

CHEARS,  B  ..  506 

CHEEVER,  U.  W 516,  624,  627, 769 

CHERBONNIER,  A.  V. .  56,  71,  72,  212,  258,  280, 
318, 322,  458, 459,  527,  537,  540,  542, 543,  587 

CHESLEY,  G.  A 298,  608, 769 

CHILD,  W.  A... 194,491,497 

CHILD,  W 356 

CHISOLM,  J.  J 35,  341 

CHRIST,  T 238, 487 

CHRISTY,  G.  B 601 

CHRISTY,  II.  C 245 

CHRITZMAN,  H.  G...  .  401 

CHURCHILL,  A 234,239 

CHURCHMAN,  H.  J 285,  286,  339,  343, 349 

CLAIBORNE,  J.  H 408 

CLAPP,  W.  A 528 

CLARDY,  S.F 203 

CLARK,  A.  M 237, 249,  251,  467,  504,  516 

CLARK,  A.  P 95, 100, 

227,  253, 256,  402, 481,  495, 656 

CLARK,  C.  C 481 

CLARK,  C.  M 55, 95,  98,  99, 

100,  201, 203, 206,  218, 222, 228, 232, 233,  234, 
240,  246,  249,  252, 261,  494,  496,  502,  627,  630 

CLARK,  E.  A .- 285, 308,  504,  553,  675,  866 

CLARK,  E.  P 400 

CLARK,  H.  K 472 

CLARK,  R.  R 218,262,481,663 

CLARK,  W.  R.  S 308 

CLARKE,  D 742 

CLARKE,  W.  E 527 

CLAUDE,  A 673 

CLE AVELAND,  C.  H 809,  843 

CLEEMAN,  R.  A 542 

CLELLAND,  H.  A 181 

CLEMENTS,  B.  A .  .57, 106,110, 112, 282, 289,  300. 
462,  463, 479, 520,  526,  538,  596,  597,  607,  643 

CLEMMER,  W.  L 542 

CLEMONS,  P.  H 489 

CLENDENIN,  W 16,389 

CLEVELAND,  J.  F 487 

CLEVELAND,  W.  K 44,47, 

283, 284;  286,  316,  548, 792 

CLIPPINGER,  G.  W 115,  517 

CLOAK,  B 11,  323,  361, 538,  623,  624,  719 

CLYMER,  M 434,  536,  635 

COALE,  R.  W 18,  47, 

58,  301,  394,  518,  548,  549, 669, 775 

COCHRAN,  M.  B 485 

COCKRELL.  J.  J 299, 301 

COE,  A.  S 26,  238, 

247,  252,  261, 472, 480, 502,  528,  881 

COFFMAN,  V.  II 471 

COGGSWELL,  G.  B 219,  221, 

230, 248, 254, 326,  485, 486, 501,  771 
COGSWELL,  M.  F 36 


Page. 

COHEN,  J.  S 48,790 

COLBURN,  A.  W    458, 549 

COLHY,  G.  W 232 

COLE,  H.  B 47, 48, 793,  796 

COLEM AN,  R.  T 55 

COLGAN,  J.  P 233 

COLLAMORE,  G.  A 256,  340,  341,  474 

COLLINS,  G 553 

COLLINS,  J 76,650 

COLOOSDIAX,  S 284, 297,  519, 802 

COLTON,  C.  M 104, 137 

COLTON,  F.  II <J80,  »e5, 

294,  296, 298,  387,  518,  531 , 800 

COLTON,  W.  S ;J74 

COMBS,  D.  H 660,  C03 

COMFORT,  J.  J 232, 257,  270, 401, 501 

COMINGTON,  J.  A 251.,  482 

COMPTON,  W.  M 132, 134, 138,  ](!2 

CONNELL,  J.  O... 


635 

CONNER,  P.  S 58, 176, 284,  454 

CONNOR,  W.  A 47 

CONOVER,  W.  A 44,792 

CONSTANT,  W.  T 589 

COOK,  A.  P 278 

COOK,  C 227, 230,  480 

COOK,  G.  W 17, 73,  433 

COOK,  J.  C 549 

COOK,  T.M .'.259,261,266,511,884 

COOLE  Y,  F 373 

COOLIDGE,  A 308 

COOLIDGE,  R.  H 524,  773 

COONS,  I.  A 372 

COOPER,  G.  E .     135 

COOPER,  G.  F 507 

COOPER,  S 495 

COOPER,  W.  S 218,  228, 

230,  255, 288,  295, 450, 481,  487, 489,  662 

COOVER,  J.  H 50,  31 5,  354,  533,  769,  797 

COPELA  ND,  O.  S -. . . .  .219, 256,  449,  500 

CORD,  C 600 

COREY,  G.  W 313, 383 

CORNICK,  W.  F 59 

CORNISH,  T.  O 301 

CORSON,  T.  F 245 

COTES,.!.  R 228 

COUES,  E 652 

COULTER,  J.  P 313 

COVENTRY,  C.  B 188 

COVERTON,  W.  H 321 

COWAN,  L.  M 54 

COWEN,  J.  M 229 

COWGILL,  C.  A 7,  210,  260, 275, 301 , 

355,  453, 455,  504,  654,  669, 675, 795, 810, 883 

COWLES,  C 09 

COX,  A.  L 135,  257 

COX,  W.  S.  A 549 

CRAFT,  H 17, 56,  546,  550, 776 

CRAFTS,  A.  P 4C5.534 

CRAIG.  G.G 514 

CRAIG,  W.  H 75, 182 

GRAIN,  W.  B 296, 4CO,  586 

CRANDALL,  J.  B 51, 773, 803 

CRAXE,  C.  E 220,491 

CRARY,  C.  W 247 

CRAVEN,  J.  J 555 

CRAWFORD,  G.G 232 

CRAWFORD,  H.  M 470 

CRAWFORD,  J.  B 65. 

CRAWFORD.  J.  S 375 

CRA  WFORD,  S.  K 046,  452,  490 

CREHORE,  C.  F . . .  . .  498,  631 

CROMBIE,  J.  H 13 

CROMWELL,  J.  B.  M S5, 208 

CROOKER,  B.  T 302,677 

CROSBY,  A.  B 232,  412,  505 

CROSBY,  A.  H 55, 54a 


VI 


LIST    OF    OPERATORS    AND    REPORTERS. 


Page. 

CROSBY,  T.  R 47,  49,  208,  28-,',  301, 

30;!,  308,  366,  535,  554,  767,  779,  791,  794,  SCO 

CROSIER,  E.  S 621 

CROSS,  J.  A 549 

CROWE,  J.  E 54,  837 

CROWELL,  B.  M 482 

CRUMIT,  C.  K 39G 

CRUTHERS,  J.  H 2«5, 295 

CRYMES,  A.  C 143,144 

CULBERTSON,  H 114,  204, 

206,  235,  309, 314,  320,  354,  396,  458,  459,  492, 
550,  585,  621,  C51,  660,  663,  674,  682,  683,  787 

CULLEN.  J.  S.  D 97, 100 

CUMMINS,  D 670 

CUMMINS,  S.  A 673 

CUMM1NSKEY,  J 76,  437 

CUNDIFF,  W.H.H 295 

CURRIER,  C.  B 434 

CUNNINGHAM,  J.  L 481 

CURRAN,  R 253,  663 

CURREY,  J.  H 682 

CURTIS,  E ....  50,  322,  (i66, 783,  785,  786,  793,  8CC 

CURTIS,  J 133 

CURTIS,  L 674 

CUSH1XG,  J.  W .59, 543,  635,  lib3,  880 

CUTLER,  J.  H 635 

CUTTER,  J.  B 7,  39, 543,  553,  007,  674 

DA  COSTA,  J.  M 665 

DAGGETT,  J.  F .     643 

DALUYMPLE,  A.P 299 

DANIEL,  J.  M .     543 

DANIELS,  W.A .     632 

DANIELS,  W.  C 2^3 

DARBY,  C.  E.  C .     :,15 

DARE,  G.  H 275,  459,  517,  532 

DARGAN,  T.  A M2 

DARLING,  L 283, 299, 477,  J82 

DARRACH,  M og;3 

DARROW,  W.  H  .  * 246,  451 

DAVID,  \V.  G . . . : 514 

DA  VIES,  R .     382 

DAVIS,  C 475,  632 

DAVIS,  C.  W 135, 138 

DAVIS   H.  W 592 

DAVIS,  J.  B GOO 

DAVIS,  J.  D 55 

DAVIS,  M.  J 497,885  | 

DAVIS,  P.  C 281 ,  287,  295,  296,  339,  663  j 

DAVIS,  W.  G ]78 

DAY,  B.I 430 

DAY,  H.  B 10 

DAY,  J.  F 4^  5->4 

DAY.W.E 773 

DEAN,  H.  C 188 

DEAN,  H.  M 70i  17o 

284, 298,  299,  312,  516,  518,  523,  779, 801  ' 

DEARBORN,  T.  B GG8  ' 

DEARING.  T.  II 366,532 

DE  BENNEVILLE,  J.  S 297 

DE  BUULER,  J.  P 140  144 

DEEM Y,  E.  K 276,  297,'  532 

DE  LANDRK,  G 257  i 

DELANY,  A 50,  56,  277,  281, 298,  4CG, 

456,  516,  52G,  528,  533,  551,  552,  794,  799,  801 
DE  LONG,  1).  L  .  . .  .471^  471 

DEMENT,  J.  J ...92,99 

DEMING,  H.  H .   ~718 

DENHAM,  S.  N...  .     757 

DENIG.  C.  E .     eg, 

DENISE,  J.  C ...255,283,494 

DENNLER,  Z.  P 294,  300,  525,  %7 

DERBY,  G 250,254 

258,  296,  320,  321 , 482, 486,  525,  54l»,  774 

DEVAN,  S.  T.  T .     i;»7 

DE  WITT,  E 48, 196,  674,  675,  C7fi,  777 

DE  WITT,  W.  R.,jr ....&7,  171,  180 

DEXTER,  J.  E 55 


Page. 

DE  YOUNG,  H 380 

D1I5I5LE,  F.  L 133,  221),  473,  479,  68-': 

DICK,  W.  B 882 

DICKEY,  J.  L 55,  253 

DICKIE,  J.  W 12 

DICKINSON,  W 234,  281,  315 

DICKSON,  J 38,  516,  532,  626 

DIFFENBECHER,  P.  L 75 

DIGBY,  J.  W 283,  523, 535,  550 

DILTS,  G.  S 470 

DISBRO W,  R.  r, 450 

DIXON,  L.  I 232,  483 

DIXON,  W.  C 13,  276 

DODGE,  J.  L 468 

DODGE,  L.  C 298, 527,  596 

DODSON,  B.  E 669,676 

DODSON,  N.  M 71 

DODSON,  R.  A 247,469 

DOLSON,  J.  S 499 

DO  NNELLY,  E 313,  320,  322,  406, 006 

DORR,  J.  C 281, 295,  362, 404,  669 

DORRAN,  W.  M 35,  212, 285 

DORSE  Y,  F  482 

DORSE  Y,  L 580 

DOUGHERTY.  A.  N  . .  .49,  56, 240, 250,  258,  271, 
277,  283, 2!;5,  "02,  369, 429,  471,  492,  753,  779 

DOUGLAS,  F 450,  500 

DOUGLAS,  J.  A 267 

DOUGLAS,  J.  C 525 

DOWLING,  J.  P 478 

DOWNS,  J.  M 197,  453, 552 

DRANE,  H.  A 51, 58 

DRAPER,  J.  A 406,409 

DRAPER,  L.  J 285 

DREWRY,  E.  A 555 

DRURY,  W.  H 56,553,627 

DUBOIS,  H.  A 84,116, 

119, 150, 151, 276, 313, 505 

DUBOIS,  J.  C 148 

DUCACHET,  H.  W 47,  58, 

188,  280,  283,  '^96, 302, 453,  455,  534, 
586,  650, 718,  700,  780,  781,  794,  825 

DUDLEY,  F.  A 245,  246, 247, 254 

DUDLEY,  J.  G 47,  29G,  525,  532, 789 

DUER,  E.  L 552,  624,  627,  661,  776,  804 

DUFF,  H.  M 495, 498,  518 

DUFFELL,  C.  L 488 

DUFFIELD,  J.  T 265,  471,  484 

DUFF  Y,  C 507 

DUGAN,  J.  B 92 

DUNCAN,  T.  F 467 

DUNHAM,  R.  C 463,814 

DUNKLEY,  C.  L 313 

DUNN,  J 35 

DUNN,  J.  L . . .  249, 251,  252, 254, 267,  451 ,  476,  632 

DUNOTT,  T.  J 2U4,  298,  301,  354, 781, 799 

DUNTON,  W.  R 783 

DURANT,  II.  R.. 48G 

DURHAM,  B 264 

DUVAL,  —    141,238 

DWINELLE,  J 232,  237,  251,  25-',  295,  302 

DWYER.  J 295 

DYER,  J.  F 82,  86, 87,  203, 258, 435,  522 

DYER.  L 55,259,276,307,675 

DYER,  O.  G 708 

DYER,  R.  F 525,533 

EAGER,  W.  B 250, 884 

EAKIN,  T.  C 488,  623,  626 

EALY,  J.  H 255 

EAMES,  W.  M 446 

EARL,  C 301,457 

EAST.  W.  A 103 

EASTMAN,  G.  W 230, 471 

EASTMAN,  II 580 

EATON,  J.  L 7Bi 

EBERIIART,  C 297,  298,  783,  801 


Page. 

EBERSOLE,  J 227,  234,  236, 237,  240, 

253,  300, 401, 402, 406,  440,  473, 484,  488,  GOO 

ECHEVERRIO,  M.  G 740 

EDDY.W 526 

EDELEN,  J.  B 507,  531,  649,  767 

EDGAR.W.S 488 

EDMANSON,  J.  A 525 

EDSON,  P.  O'M 264 

EDSON,  W.  II 708 

EDWARDS,  G.  W 72, 284,  302, 534 

EDWARDS,  L.  A 538 

I  EDWARDS,  T.  O 25 

;  ELA,  C.  C 302,  772 

ELLINWOOD,  C.N 455 

ELLIOTT,  T.  H 12 

'  ELLIOTT,  W.N 219 

ELLIOTT,  W.  S.  G 785 

ELLSWORTH,  P.  W 280 

ELY,  W.  S, 53,  273,  298 

EMANUEL,  L.  M 472 

EMMERSON,  J.  S 470,  541 

EMMONS,  F.  A 73 

EMERY,  A.  G 480 

EMORY,  A.  W 55,320,516 

ENSEY,  J.  B 286,489 

ENSIGN,  W.  H 18, 23,  55,  205,  284,  298,  320, 

406, 456,  667,  673,  770, 780, 789, 792, 795,  818 

ERICKSON,  J.  P 282 

ETTER,  F 635 

EVANS,  D.  J 53,  282,  554 

EVANS,  E 282 

EVANS,  J 469,501,672,783 

EVANS,  O.  J 238, 483 

EVANS,  T.  A 232 

EVE,  P.  F 134, 135, 137,  531,  534,  605, 607 

EVERETT,  R.  A 209, 48G 

EVERHART,  J.  R 133, 231,  494 

EVERLETH,  F.  M. . .  .206, 261, 389,  471, 475,  483 

EVERTS,  O 30,  84, 

133, 225,  262,  279,  481,  589,  023 

E  WING,  A 496, 624,  717 

EWING,  J.  S 295 

FA1LOR,  B.  M 254 

FARLEY,  C.  F 492 

FARLEY,  J.  M 232,  280,  487,  502,  523 

FARNSWORTH,  P.  J 71 

FARRAND,  D.  O 30,  56, 

361,  459,  487,  628,  CG4,  667,  778, 882 

FARRLNGTON,  J.  M 538 

FAR  WELL,  E.  J 56 

FASSETT,  O.  F 457,  572 

F  ASS1TT,  L , 532,  708 

FAULKNER,  R 549,589 

FAULKNER,  W 277 

FAUNTLEROY,  A.  M 143, 152,  157, 162 

F AVILL,  J 310 

FAY,  G.  W 29G 

FE  ARN,  H 220,  497,  662 

FELAND,  W 634 

FELL,  E.  R 535,  679 

FELTON,  R.  A 143,144 

FENNER,  E.  T 533 

FERGUSON,  J.  F 72,  378 

FERGUSON,  N.  D 485,  626 

FERRIS,  O  256 

FEW,  S.  F 652 

FIFIELD,  A.  K 217,  218,  222, 257, 

44G,  447,  450,  451,  473,  485,  516,  783 

FILLMORE,  C.  W 295 

FINCH,  C.  M 215 

FINLEY,  J.  Y 409, 495,  542 

FINN,  W.  II 229,  473,  516 

FISH,  B.  M 553 

FISH ER,  C.  H 432,  548,  550,  553,  G23, 626 

FISHER,  G.  F 428 

FISHER,  H.  N 767, 769 

FISHER,  L 405,539,543 


LIST    OF    OPERATORS    AND    REPORTERS. 


VII 


Page. 

FITCH,  C 248 

FITCH,  E.  P 298,  315 

FITCH,  T.  D 313,481,523,549 

FLANDRAU,  T.  M 137,181, 

188,  229, 234, 236,  388,  488,  494 

FLEMING,  R 485 

FLINN,  \V.  D 208 

FLOOD,  P.  H 201,473,483,494 

FLOR EU,  T.  AV 284,  299,  468, 666,  710 

FLOWERS,  .T 473,635 

FLYNN,  A.  T 506 

FOLSOM,  N 216,222 

FOLSOM,  N.  L 078 

FOLWELL,  M.  B 68 

FONTAINE,  J.  B 2C8 

FOOTE,  H.  E 592 

FORBES,  S.  F 629,  631, 674 

FORBES,  W.  S 147, 151, 258, 542 

FORCE,  J.  F 021 

FORD,  C.  M 282,  517 

FORDYCE,  B 50, 238, 252,  501 

FOREMAN,  E.  K 239, 466 

FORMENTO,  F. 275, 632, 779 

FORREST,  R.  W 54 

FORWOOD,  AV.  H 155, 323 

FORWOOD,  J.  F.  M 545,547 

FOSDICK,  A.  C 501,647 

FOSSARD,  G.  H 181 

FOSTER,  F.  J 229 

FOSTER,  F.  P 46,  55,  661 

FOUTS,  L.  C 468 

FOWLER,  C.  N 206,251, 

467, 470, 488, 496,  588 

FOWLER,  H.  B 482 

FOX,  AV.  B 16,49,217,218,219,220,221, 

226,  228,  230, 231, 236,  238, 245, 248, 249,  256, 
257,  258,  200, 201,  202,  267, 449,  466, 469,  481, 
483,  485,  491,  495,  499,  500,  626,  754,  883, 884 

FOYE,  J.  AV 80 

FRANKLIN,  E.  C 237,262,276, 

281, 283,  284, 285, 286, 295, 296, 
298,  299,  300,  485,  486,  518,  681 

FRANKLIN,  G.  S 136 

FRANTZ,  J.  H 54,  56,  522,  523,  662 

FREEMAN,  J.  A 57, 227, 236,  256,  281 

FREEMAN,  J.  N 494 

FREEMAN,  O.  R 230 

FREEMAN,  S.  D 459 

FREIOT,  C 314 

FRENCH,  G.  F. .  .  .47,  366, 395,  522, 527, 716, 794 

FRENCH,  J.  O 294,300,664 

FRENCH,  J.  S- 220 

FRENCH,  J.  T 654 

FRENCH,  S.  S 231, 235, 237,  239,  240, 

255,  260, 265, 286,  402, 470, 474, 490,  503 

FRICK,  A.  P 284,  302 

FRINK,  C.  S 206,  218, 257,  263, 490,  524, 535 

FRITZ,  AV 54 

FROTHINGHAM,  W 468 

FRY,  C.  B 677 

FRY,  T.  W 140,  659 

FRYER,  B.  E 50,  55,  58,  527,  542,  045, 

075,  677,  684,  704,  787,  800,  811, 812 

FULKS,  J.  S 582 

FULLER,  C 170 

FULLER,  G.  E 395 

FULLER,  S.  E 54,276,321,323,515, 

518,  523, 550, 552, 666,  070, 774 

FULLER,  AV 96, 100 

FULTON,  J.  M 552 

FUNKHOUBER,  D 675 

GABRIEL,  J.  F 407 

GALE,  J.  S 675 

GALEN,  G.  E 57 

GALL,  A.  D 524 

GALLOUPE,  I.  F .  .54, 195, 232, 239, 249,  517,  883 

GARCELON,  A 236, 267, 297, 504,  516, 533 

GARDNER,  P 228, 246,  602,  031 

STJRG.  TIT— 125 


Page. 

GARDNER,  T.  S 218 

GARDNER,  AV.  H , 54,774 

GARLAND,  G.  W 597 

GARLAND,  J.  B 102 

GARNETT,  A.  Y.  P 275 

GARRETT,  H.  F 523 

GARRISON,  H.  D 38, 494 

GASTON,  J.  M 234 

GATCH,  J.  D 218, 245, 473 

GATES,  H.  E 446, 572 

GAUNTT,  C.  S 627 

GAY,  N. . .  .58,  220,  250, 295,  297,  497,  526, 606, 673 

GEMRIG,  J.  M 190 

GENTRY,  AV.  A 251,631 

GERRISH,  J.  W.  F 881 

GESNER,  B 153, 488, 495 

GETCHELL,  F.  H 57,253, 

297,  322,  533,  552,  554 

GIBBON,  R 467 

GIBBON,  AV.  H 247, 254,  532 

GIBBONS,  H.,  jr 279,  300, 370,  524 

GIBBONS,  J 627 

GIBBONS,  T.  B 377 

GIBSON,  C.  B 97, 98, 100, 101, 

104,  112, 116, 143,  218, 236,  246,  249, 251, 258, 
285,  298, 391, 402, 403,  404, 406, 452, 468, 469, 
474,  475,  501,  527,  536,  601,  605,  631,  632,  634 

GIBSON,  J.  R 122, 125, 399, 501 

GIBSON,  O.  W 387 

GIDD1NGS,  E 516 

GILBERT,  D 080 

GILBERT,  R.  H 316 

GILFILL AN,  W.  J 674 

GILL,  H.  Z 70,130,138,217, 

218,  219, 232, 254,  255, 256, 264 

GILL,  W.  G 656 

G1LLIAM,  F 507 

GILMAN,  J 55, 621 

OILMAN,  J.  H 54 

GILMORE,  J.  T 94, 100, 132, 137,138, 162, 

208,  488,  505,  506,  508, 512,  517,  602, 886 

GILROY,  P 275,  323 

GILTNER,  J.  S 239, 249,  257, 466, 471, 

476, 477,  481, 490,  491,  553, 676,  881 

GINKINGER,  W.  H.  H 281 

GIRARD,  J.B 120 

GIRVIN,  R.  M 654 

GL1CK,  E.  B 206,265, 

266,  451, 467, 476, 502,  670,  882 

GLOCKER,  T.  W 157,109 

GOBRECHT,  AV.  H 283 

GODDARD,  P.  B 22, 75,  320, 361,  680 

GOFF,  J.  N 524 

GOLDSBOROUGH,  C.  E 519 

GOLDSBOROUGH,  J 531 

GOLDSMITH,  M 34, 104, 105,  227,  357,  549, 

751,  823,  832, 834, 835, 836, 837,  842, 855 

GOLDSMITH,  W.  W 70 

GOOD,  D.  R 79,321 

GOOD,  S.  L 654 

GOODALL,  F.  W 443 

GOODBRAKE,  C 217 

GOODMAN,  H.  E 14,54,76,215, 

218, 232, 233, 236,  L'38, 245,  295, 

450,  470,  472,  487, 497,  525,  589 

GOODRICH,  B.F 399 

GOODAVIN,  D.  M 141, 144,  219,  230,  407, 498 

GOODAVIN,  R.  I.  P 54 

GOODAVIN,  AV.  C 525 

GOODAVIN,  AV.  F 532 

GORDON,  J 20 

GORDON,  S.  C 474 

GORE,  J.  R 496 

GORGAS,  A.C 130,138 

GOSLIN,  A 239,240,486,499 

GOSS,  S.N 314 

GOTT,  W.  A 

GOULD,  J.B 60 


GOULEY,  J.  W.  S 95, 100, 283, 

357,  425,  SCO,  513,  517, 596, 598, 
605, 007,  029,  658,  608,  756,  780 

GRAFF,  M.  B 531 

GRAHAM,  N.  F 2!),  55,  294, 

389, 480,  549, 663,  669, 768 

GRAHAM,  S 26,389 

GRAHAM,  AV 206, 478,  508 

GRANGE,  H 500 

GRANT,  G. .  . .  58,  229, 315,  320, 309, 658,  069, 802 

GRANT,  J 021, 783 

GRANT,  J.  F 93, 100, 137, 138 

GRANT,  J.  T 482 

GRAVES,  AV.  L 484 

GRAY,  A.  R 246, 294, 296, 298,  302,  535,  C75 

GRAY,  C 203,  218, 266,  488, 518,  605,  606 

GRAY,  C.  C 301,430,073 

GRAY,  E.  P 140, 144, 662 

GRAY,  J.  W 503 

GRAY,  W.  M 219, 234 

GREELEY,  G.  P 236, 450 

GREEN,  E 70 

GREEN,  J.  H 236, 238,  518,  552, 881 

GREEN,  J.  N 549,668 

GREEN,  J.  W 219,  230, 466 

GREEN,  S.  A 219,252, 

283, 474, 497,  523, 532, 882 

GREEN,  W 547 

GREEN,  AV.F 233 

GREEN,  W.  J 467 

GREENE,  A.  S 803,806 

GREENE,  D.C 374 

GREENE,  F 489 

GREENE,  F.C 768 

GREENE,  J.  B 219 

GREENE,  J.  M 132 

GREENE,  J.  McC 501 

GREENE,  M.  L 457 

GREENLEAF,  C.  R 545,  548,  625, 627, 665 

GREENLEAF,  D.C 470 

GREENLEAF.E.  G 485 

GREENLEAF,  AV.  R 456,  807 

GREENOUGH.F.  B 634 

GREGG,  P 514 

GREGG,  V.  H 270,473 

GREGORY,  E 516 

GREGORY,  F.  R 472,507 

GRIBR,  M.  J 364 

GRIFFIN.P 268 

GRIFFITH,  C.  G.  M 409 

GRIFFITH,  D.  J 302, 498,  068,  669, 769,  778 

GRIM,  H.  A 140,  632, 886 

GRIMES,  W 227, 232 

GRIMES,  AV.  S 517 

GRISWOLD,  C.  A 71 

GRISWOLD,  E 51, 142, 144. 

194,  284, 288, 297, 302, 485,  587, 804 

GROSS,  F.  H 108, 112, 245, 525,  773 

GROSS,  S.  D 25, 35, 142, 

315, 365,  542, 543,  548,  604, 774 
GROSS,  S.  W 16, 44,  66,  67, 70, 

219, 233,  264,  488,  500,  699, 883 

GROVE,  J.  H 271,360,773,777,780 

GROVER.H.C 254 

GRUMBEIN,  AV 634 

GUELICH,  E 219, 295,  4S7 

GUNKLE,  AV 524 

GUNN.M 

GUSTINE,  J.  AV -     252 

HABERSHAM,  S.  E 240 

HACHENBERG,  G.  P 550,025,627,683 

HAGEN,  C.  AV 293,485 

HAIGHT,  D.  L 295, 524, 532, 800 

HAILE.  G.  W 

HAINES,  A.  B -     484 

HAISE,  G.  A 629 

HALBERSTADT,  A.  H 553,601 


VIII 


LIST    OF    OPERATOKS    AND    REPORTERS. 


Page. 

HALDERMAN,  D 347,25), 

387,  449,  450,  452,  471 

HALL,  A.  D . . . . '. ...  58,  54:5,  814 

HALL,  E 194 

HALL,  F 321,390,533 

HALL,  J.  A.  431 ,550,  084 

HALL,  J.  0 .    -  .  '-47,  259,  482, 770 

HALL,  J.  W.  .004 

HALLER.J .-  2-17,  388,  484 

HALSEV,  C.  C...  ...     433 

HAM,  L.  J 233 

HAMILTON,  A.  A... 

HAMILTON,  C.  A ....  .     295 

HAMILTON,  F.  II. . .  .17,  39,  04,  (17,  134,  13(5, 152, 

154, 158,  228,  285,  301),  341, 412,  483,  5->6,  071 

HAMILTON,  J.  W 074 

HAMILTON,  R.  D 002 

HAMILTON,  W 217,  501 

HAMLIN,  N.  S 275 

HAMMER,  A 59,  308,  579,  002,  681,  082,  083 

HAMMOND,  E.  15 59 

HAMMOND,  F.  M 17,182,183,  195,583 

HAMMOND,  G.  B . .  .49, 791 

HAMMOND,  J.  F 370 

HAMMOND,  T.  H 283,  458 

HAMMOND,  W.  A 322 

HAMMOND,  W.  L 301,  702,  723 

H  ANA  WALT,  G.  P 297 

HAND,  D.  W 099  i 

HANSON,  Z.  P 250  j 

HAPPERSETT,  J.  C.  G 251,  302,  534,  780 

HARD,  A 230,230,314,471,477,480 

HARD,  C 195 

HARDING,  H.  W ....     524 

HARDING,  P.H 155,371 

HARDY,  J.  G 500 

HARLAN.  G.  C 321,469 

HARLO  W,  L.  D 247,  305,  458,  020 

HARPER,  C.  W 301 

HARPER,  T.  S 050,  740 

HARRINGTON,  J.  15 26 

HARRIS,  G.  F 70 

HARRIS,  J 39,  152,  170,  279,  451,  470,  028 

HARRIS,  J.  L 485 

HARRISON,  E 408,469 

HARRISON,  J 482,497 

HARRISON,  W.  15 •..     487 

HART,  A.  G 502,631 

HART,  D.  A 313 

HART,  S 340,486,673 

HARTM  A  N,  W.  B 254,  265,  299,  477 

HARTSHORN,  D.  W 212 

HARTSHORNK,  E 543 

HAUTSUFF,  A 28, 295, 

297,  300,  307,  308,  310,  535 

HART  WELL,  S.  C 513 

HARVEY,  II.  M 190 

HARVEY,  J.  G . . .  222,  003,  077 

HARVEY,  I' 259,  275,  294,  300,  301 ,  472,  778 

HARVEY,  T.  15  548 

HARVEY,  W.  A  ...  . .  50,  382,  405,  532 

HASSE,  H.  E...  ...217,403,472,477,489 

HASSENBEKG,  F 152,158, 

J59, 2:;e,  2(.i7, 550, 024, 004 

HASSON,  A.  15 542,581,774 

HASTINGS,  J.  W 257, 489,  499 

HATCHITT,  J.  G 20, 212,  249, 

309,  314,  323,  553,  554,  555,  674 

HAUSEN,  J 474 

HA  WES,  M 4&7 

HAWLEY,  S.  B . .  .231,  252,  520 

HAWTHORNE,  F 007 

HAYDEN,  F.  V 479 

HAYES,  C 53,  70,  75 

HAYES,  I.  1 10,  37, 153, 

304,  378,  408,  522,  538,  043,  053, 718,  771 
HAYES,  J.  A 206 


Page. 

HAYES,  J.  M -     <W2 

HAYES,  T.  R 70 

HAYNES,  C.  F -     533 

HAYNES,  T 008,  074 

HAYS,  D.  S 222,  225,  227,  234,  250,  409, 501 

HAYS,  W 54,82 

HAYS,  W.  L 554 

HAYS,  W.  W -     653 

HAY  WARD,  J.  M 253, 293,  001 

II  AY  WARD,  N 48, 206,  227, 

229, 231,  251,  203,  204,  390,  402,  403, 
435, 470,  473,  478,  481 , 495,  490,  499, 
504,  516,  523,  533,  598,  000,  001,  031 

HA  Y  WOOD,  E.  B 49,  517,  791 

IIAZLETT,  R.  W 231 

250,  254, 293,  408, 490,  031 

HEAD,  J.  F 399 

HEAD,  M.  H 203,  500 

HEARD,  L 42,  431 

HEATH,  D.  L 219,  239,  258,  205,  471,  503 

HEATH,  W.  II 450 

HEGER,  A 42,  47,  48,  55, 70, 184,  294,  353, 

3!  3,  400,  021,  779,  790,  793,  800,  803,  800 

HEILNER,  H.  C 284,294 

HEISE,  A.  W 229,  283,  339,  342 

HELM,  J.  C 726 

HELMER,  A.  M 481 

HELMER,  J.  II 10 

HELMS,  C 469,  473,  673 

HELSBY,  T.  H 514 

HELWIG,  T.  A 231,468 

HENDERSON,  C.  L 252 

HENDERSON,  D.  W 268,723 

HENDERSON,  F.  B 92 

HENDERSON,  F.  W 69 

HENDERSON,  J.  M 295 

HENDERSON,  P.  P 507 

HENDRICKS,  E.  F 261,  300,  534,  553,  810 

IIENDRICKS,  J.  G 70 

HENDR1CKSON,  S 769 

HENKLE,  C.  C 489,502 

HENNING,  T.  S 74,710,712 

HERBST,  J.  E 50,200, 

440,  535,  017,  670,  680,  684,  881 

HEREFORD,  F.  M 469 

HERMAN,  A.  F 500 

HERNDON,  C.  B 277 

HERNDON,  E.  S 518 

HERR,  A.  J 239 

IIERK,  M.  L 56, 212, 220,  259,  261,  308,  321, 

322,  431,  450, 456,  519,  542,  554,  632,  661,  682 

HERRICK,  H 275,  524 

HERSCHE,  C 593 

I1ERW1G,  E 676 

HESS,  J.  F 249,524 

HETZELL,  D.  G 078 

IIEUSER,  C.  F 607 

HEWETT,  J.  D 452,519 

HEWIT,  H.  S 55,  71,  72,  77,  94, 100, 140,  173, 

283,  285,  297,  308,  313,  318,  322,  340,  342,  392, 
393,  411,414,  420,  526,  527,  532,  533,  535,  537, 
540,  001,  609, 770,  775,  789,  794,  800,  811,  879 

HEWSON,  A 42,  543,  006,  607,  780,  788, 821 

HICKS,  R,  J 498,500,507 

HIGD AY,  T 675 

HIGG1NS,  G.  II 322,720 

HIGG1NS,  G.  Z 074 

HIGG1NS,  R.  T 405, 430 

HILDRETH,  J.  S 081,682,683 

HILDRET H,  T 19, 237, 238,  483 

HILL,  15.  F 483 

HILL,  E.  L 468 

HILL,  F.  H 288,  294 

HILL,  J.  S 54,  296, 301 

HILL,  L 484 

HILL,  R.  E 482 

HILL,  R.  J 236,258,269 


Page. 

HILL,  S.  V.  D 494,501 

HILL,  T.  C 481 ,  500 

HIMES,  I.  N 51,403,497,803 

HINDS,  VT.  H.  W 450 

H1NES,  ILL 484 

IIINES,  M 495 

HINES,  W.  M 308 

IIINRLE,  F.  .  .282,  314,  390,  519,  524,  535,  548,  549 

H1NKMO,  J.  B 494 

HINSEY,  J.  C 4&0 

H1NTON,  J.  II 083 

HIRSCHF1ELD,  H 629 

HITCHCOCK,  II.  O 52,181 

HOADLEY,  W.  J 305 

HOAG,  W.  H 475 

HOAGLAND,  C.  N 50,  470,  667,  669 

HOBBINS,  J 374 

HOBBS,  W 672 

HODGE,  H.  L 70,  591 

HODGEN,  J.  T  48,  283, 

339, 3 10,  345,  347,  357,  361 ,  390,  680,  773 

HODGES,  R.  M 66 

HOFF,  A.  H C8,  238,  245,  299,  339 

HOFF,  J.  V.  R 123, 124, 125, 126,  742 

HOFFMAN,  E.  S 182,  251,  258,  200, 499, 884 

HOGAN,  M.  K 72,187, 

205,  224,  374, 378, 400,  464,  514,  630 

HOGEBOOM,  G.  W 535,653 

HOGG,  A.  J 121 

HOKES,  D.  F 228 

HOLBROOK,  L 228,  235,  489,  497 

HOLBROOK,  W 248, 483 

HOLLEY,  P.  R 292,  296 

HOLLEY,  S.  J 257,  264,  295,  517,  525,  526,  527 

HOLLO  WAY,  J.  M 472,  577,  £94,  812 

HOLMES,  F.  S 488,  516 

HOLMES,  W.  J.  R 315,  320,  482,  027,  664 

HOLSTON,  J.  G,  F 222,  230,  234,  250,  271,  027 

HOLT,  A 497 

HOLT,  J.  F 48,790 

HOLT,  L 489, 496 

HOLT,  W.  A 69,486 

ROMANS,  J.,  jr 182,  210,  212,  227,  230, 

239,  251,  254,  283,  388,  517,  548,  024,  000,  667 

HOOD,  C.  II 497 

HOOD,  H.  H 074,  075 

HOOPER,  F 593 

HOOPER,  W 778 

HOOTON,  M.  M Ill,  230,  485 

HOOVER,  G.  W 389 

HOPE,  R.  II 10 

HOPKINS,  IX  S 228,  203,  438 

HOPKINS,  G.  H 29 

HOPKINS,  H.  R 08 

HOPKINS,  T 299,  534 

HOPKINSON,  J . .  .457,  463,  545,  589,  019, 005,  814 

HORN  OR,  C.  W 430,  437,  583,  025 

IIORTON,  N.  N 407,  020,  882 

HORTON,  S.  M 373,  718,  800 

HOSTETTER,  J.  ( J 048 

HOTALING,  J.  M 527 

HOUSTON,  D.  II 29,218,428 

HOUSTON,  J.  M 882 

HOUTS,  S.  B 520 

HOVEY,  B.  L 228, 247,  525,  822 

HOW,  J.  C 234,  230 

HOWARD,  B 00,137, 

138,  225,  233,  230,  239,  250,  275,  270,  277, 
280,  294,  296,  303,  304,  350,  :551 ,  402,  404, 
400,  507,  512,  510,  519,  520,  530,  772,  774 

HOWARD,  E.  L 494,  497 

HOWARD,  T.  H 543 

HO  WE,  J 239 

HOY,  A.  II 049,778 

HOYT,  C.  S 402 

HOYT,  O. 232,  248,  002,  072 

HOYT,  W.  D 71 


LIST    OF    OPERATORS    AND    REPORTERS. 


IX 


Page. 

HUBBARD,  G.  H 302,360 

HUBBARD.  H.  H 469,485,507 

HUBER,  J.  F 189,  526,  626,  655, 807 

HUBERICH,  H.  E 673 

HUBON,  P.  E 219, 221, 236, 

237,  239,  248, 250, 254,  260,  265,  2Cfi,  271, 
288,  450,  474, 477,  481, 489,  491,  500,  626 

HUDSON,  A.  T 227, 

230,  236,  238,  245,  247,  253,  254,  265, 
269,  277,  472,  477,  483,  486,  501,  509 

HUDSON,  D 11 

HUDSON,  E.  D 8,  59, 122, 131, 154, 162, 180, 

189, 202,  216,  224,  243, 263,  288,  305,  408,  446, 
447,  457,  479,  528,  545,  596,  603,  604,  613,  620 

HUDSON,  W.  M 518 

HUDSON,  W.  O 467, 498 

HUFF.S.W 266 

HUGER,  H 531 

HUGHES,  J.  C 552 

HUMPHREY,  O.M 662,679,774 

HUMPHREY,  W.  F 219, 

220,  256, 263,  265,  450, 467, 468,  500,  549 

HUMPHREYS,  G.  H 249, 268,  600,  601 

HUNT,  D.  W 447 

HUNT,  S.  B 59 

HUNT,  W 22,  47, 156, 197, 299,  792 

HUNTER,  W.  G 233, 251,  293, 494,  499 

HUPP,  J.  C 27,  71,  586 

HURD.Y.G 253 

HURSAM,  N.  A 219,258,489 

HURT,  L.  V 230, 249 

HUTCHINS,  C.  B 454, 469, 523 

HUTCHINSON,  E 235, 267, 494,  502 

HUTCHINSON,  J.  F 218,  233,  261, 498 

HUTCHINSON,  J.  H 230,  249, 

256,  266, 300,  522,  527, 717,  886 

HUTCHISON,  J.  H 503 

HUTTON,  G 703 

HYDE.F 548,674 

HYDE,  M.  J 485 

HYDE,  W.  C 25 

IDELER,  H... 471 

INGALLS,  W 230, 260 

INGRAM,  A 39,  51,  56, 58, 

109,  111,  141, 144, 276, 282, 294,  295,  300, 
308,  323,  447,  44<>,  591,  643,  669,  677,  803 

IRISH,  F 285,  676 

1RWINE,  C.  K 133,  248, 254, 462,  474,  524, 886 

ISHAM,  R.  N 31,  39,  69,  321,  667,  677,  786 

JACKSON,  D 886 

JACKSON,  E 261,483,484,632 

JACKSON,  G.  W 154, 248 

JACKSON,  J.  D 96,  461.',  474 

JACKSON,  J.  S 255 

JACKSON,  R.  D 506 

JACKSON,  R.  M.  S 57 

JACOBS,  W.  C 252, 256, 2u3, 264, 450,  498,  790 

JAMAR,  J.  II 323,  619,  665,  666,  776,  802,  804 

JAMES,  H.  H 56,  58 

JAMISON,  J.  S. 19,215,218,262,488,525 

JANES,  H.  .26,  42,  70,  75,  82,  87, 183, 187,  211,  255, 
437,  443,  457,  462, 494,  520,  525,  579,  581 ,  591 

JANE  WAY,  J.  H 27, 134 

JANVRIN,  J. 596,  616 

JARROTT,  M.  M 662 

JEARICON,  J.  A 619 

JEFFREY,  T.  R.  W 228 

JEMISON,  L 648 

JENNINGS,  E 482,  646 

JENNINGS,  II.  P 255 

JENNINGS,  R.  G 22 

JESSOP,  S.  S 18,51, 

235,  617,  620,  634,  659,  669,  678,  804 

JESSUP,  R.  B 49!» 

JEWELL,  W 619,  625 


Page. 

JEWETT,  C.  C 133, 138,  476,  486,  605 

JEWETT,  D.  L 266,  504 

JEWETT,  G 645 

JEWETT,  P.  A 50,314,478 

JOHNSON,  A.  F 675 

JOHNSON,  C.  M 216 

JOHNSON,  D   483 

JOHNSON,  G 71,  72 

JOHNSON,  G.  K 402 

JOHNSON,  H.  B 259, 296,  475,  675,  779 

JOHNSON,  J.  D 533,  627, 790 

JOHNSON,  J.  J 227 

JOHNSON,  P.  H 276 

JOHNSON,  R.  P 666,671 

JOHNSON,  T.  D 129, 130 

JOHNSON,  W 308 

JOHNSON,  W.  A. 554 

JOHNSON,  W.  E 246 

JOHNSON,  W.  L 52C 

JOHNSTON,  E.  M 543 

JOHNSTONE,  T.  S 10 

JONES,  C.  H.  .300,  301,  320,  321,  517,  522,  524,  526 

JONES,  C.  W 23,55,241,301,331,322,542 

JONES,  D.  C 785 

JONES,  E/L 524 

JONES,  G.  S... 740 

JONES,  H.  E 630 

JONES,  J 33,  35,  292, 322, 823 

JONES,  J.  A 671 

JONES,  J.  C 770 

JONES,  J.  W 471 

JONES,  N.  M 114 

JONES,  R.  C.  C 322 

JONES,  R.  K 379 

JONES,  T 232,  447, 450,  524 

JONES,  \Y 617 

JONES,  W.  B 437 

JONES,  W.  H 661 

JORDAN,  R.  H 498 

JOSLIN,  C.  C 294 

JUDKINS,  A 234 

JUDKINS,  D 411 

JUDSON,  A.  B 378 

JUDSON,  O.  A 86,  276, 283, 285,  295, 297, 

299,  300,  301,  315,  374,  454,  456,  464, 515,  519, 

520,  524, 531, 533,  543,  633,  659,  703, 774,  884 

JUMP,  1 544 

KEABLES,  B.  F 483,498 

KEARNEY,  T.  H 227, 253, 408, 409 

KEATING,  W.  V 42,  589,  606, 821 

REEFER,  H.  G 240 

KEEN,  W.  W.,jr 9,12,300,357,361, 

382,  383,  429,  525,  653,  654,  684,  769, 826,  837 

KEENEY,  C.  C 391 

KEENON,  J.  G 18, 47,  55,  56,  283, 285, 319, 

459,  592,  599,  620,  633,  634,  663,  667,  703,  794 

KEIR,  W.  G 260 

KELLER,  J.  M 141 

KELLOGG,  A.H 665 

KELLY,  A 206 

KELLY,  E.  B.  P 404,446,473,500,886 

KELLY,  F.  W : 207, 208, 771 

KELSEY,  C.  T -  488 

KELSEY,  D.  E -  -  .218, 467 

KEMBLE,  G.  S -  210 

KEMPSTER,  W 55, 297,  455 

KENDALL,  J.  V 203,  218, 

231, 237,  246, 251,  261,  500,  602,  626,  885 

KENDERDINE,  R.  S 321,  408,  409,  661,  676 

KENNEDY,  D 283,  643, 772,  774,  782 

KENNEDY,  J.  T 75, 778 

KENNEDY,  L.  W 260,  261, 263, 451,  516 

KENNEDY,  T 70 

KENNEDY,  V.  B 247,  264,  483, 487,  496 

KENNON.  J.  C.  W 47 

KERR,  J- 466,497,548 


Page. 

KERR,  J.  W 51, 804 

KERSEY,  S.  II 51,206, 

249,  265.  485,  490,  497,  626,  629,  804 

KESSLER,  A 30 

KETCHERS1N,  J.  1)  . .  .668 

KIBBEE,  A.  D «)7 

KILBOURNE,  H.  S 276 

KILB  Y,  J.  T . .  .263, 264, 285 

KIMBA  LL.  F.  IS. .  .230,  232,  238,  247,  472,  502,  672 

KIMBALL,  II.  H 727 

KIMBA  LL,  J.  H 249, 295,  626 

KIMBL  Y,  J.  T i>40,  489 

KING,  A.  F.  A 525,553 

KING,  C.  U 287,  458,  549 

KING,  D.  H '^86 

KING,  J.  E 375 

KING.  J.  W 671 

KING,  S.C 662 

KING,  W.N 534 

KINGER,  S.  O 516 

KINGSTON,  S.  T 383 

KINLOCH,  R.  A 142,144,375 

KINSMAN,  J.  H 297 

KIPP,  C.  J 436 

KIRBY,  H 257 

KIRK,  R.  M 662 

KIRKER,  J 542,661 

KITCHEN,  J.  M 190 

KITCHEN,  J.  T 219 

KITTINGER,  M.  S 220,  259,  390, 471,  476, 

483,  487,  495,  498,  523,  596,  600,  631,  881,  886 

KITTOE.  E.  D 249,  592 

KIZER,  G.W 661 

KNAUSS,  J 227 

KNEELAND,  B.  F 206,545 

KNEELAND,  S 158, 624 

KNICKERBOCKER,  B 663 

KNIGHT,  J.  H 483 

KNIGHT,  L.  M 516 

KNORR,  M.  K 591 

KNOTT,  J.  J 254,262, 

389,  473, 476,  602,  626, 630,  632,  885 

KNOWLES,  H.  B 527,  535, 552 

KNOWLSON,  J 229 

KNOX,  W.  A 646 

KOECHLING,  C.  W 243 

KOELER,  R 321 

KOERPER,  E.  A 115, 241 

KOERPER,  J.  F 650 

KRAMER,  E 663 

KREBS,  T.  D 674 

L ABAR,  F.  C 543, 550 

LADD,  C.  H 96,100, 

217, 267,  386, 463, 474, 476,  507 

LA  FORCE,  D.  A 470 

LAISY,  J 114 

LAMBERT,  A 20 

LAMBERT,  J 4?J 

LAMBERT,  W.  S 264 

LAMONT,  J.  C 314 

LAMPEN,  M 58, 550 

LAMSON,  H.  S b'82 

LANDIS,  A.H 440 

LANE,  S.  G 252 

LANEY,  T.  M 173 

LANGDON,  H.H 230 

LANGENBECKER,  C 84 

LANGER,  1 349 

LANNING,  J.  T 482,  853 

LANNING,  S 136, 138 

LARKIN,  J.  B 314 

LARRIMER,  B 672 

LATHAM,  II 550 

LAUB,  C.  H 95,121,154 

LAWRENCE,  C.  W 299,  320 

LAWRENCE,  G.  W.    . .  .     600 


LIST    OF    OPERATORS    AND    REPORTERS. 


Page. 

LAWSON,  II.M 282 

LAWSON,  J.  \V 240, 283, 466,  486,  518 

LA  WTON,  J.  W. .  230,  261, 451, 452, 477,  504,  550 

LAY,  B.  D 135, 138, 143, 144, 161,  466 

LEALE,  C.  A 182,  277,  439,  597 

LE  AMAN,  H 211, 212, 298,  315,  452,  456, 782 

LE  AVITT,  D.  F 227,  470 

LEAVITT,  P.  C 26 

LEAVITT,  T.  L 315 

LE  BLOND,  J.  B 486 

LECONTE,  J.  L 539 

LEE,  C.  C 313,  366,  400,  401, 407, 44 1 , 526,  677 

LEE.J.C 663,  664 

LEE,  J.  H 233, 261 

LEE,  J.  W 708 

LEET,  J.  M 473 

LEGLER,  H.  T 58,447, 

585, 533, 663,  668,  672,  779 

LEIDY,  P 236,  261, 401,  47J,  483,  518,  601 

LEIGHTON,  N.  W 231 

LEISENRING,  P.  8 436 

LEIT,  N.  Y 93, 100, 201, 232, 245,  255, 259, 475 

LE MOYNE,  F 32, 203, 218, 234 

LENCE,  \V.  C 70 

LEONARD,  A.  II 667,  673 

LEONARD,  W.  H 480, 513,  518,  523 

LEONARD,  W.  L 248 

LEVENSA  LER,  H.  C 217, 232,  248,  256, 517 

LEVIS,  R.  J 252, 

287, 317,  320,  321, 374, 464,  553, 773 

LEWIS,  E.H 437 

LEWIS,  G.  R 440, 466 

LEWIS,  J.  B 49,  5fi,  172, 

236, 302,  303,  315,  321,  322,  540.  768, 778,  796 

LEWIS,  J.  D 538,542 

LEWIS.  R.  A 281 ,  483 

LEWIS,  R.  8 35 

LIDELL,  J.  A 6,11,16,40,44,46,47,49, 

54,75, 83, 148, 173, 191, 193. 209,  276,  281,  287, 
289, 290,  301,  306, 308,  320,  369,  380,  438, 443, 
519,  521, 527, 530,  534,  539,  542,  543,  548,  553, 
554, 590, 715, 716,  752, 756,  761, 773, 820,  860 

LIEBOLD,  T 52,  283, 

298,  321,  393,  400,  773,  783,  786,  791,  802 

LILLY,  H.  M 7,  320,  793,  507,  674 

LINCOLN,  N.  S 152,153,159,321 

LINDSAY,  C.  A 519 

LINDSAY,  W.  D 324 

LINDSLE  Y,  C 57,  58 

LINK,  J.  E. . .  .220,  236, 309,  314, 302,  459,  667,  675 

LIPSCOMB,  W.  H 4C8 

LLOYD,  F 587 

LOGAN,  J 835 

LOGAN,  J.  E 499 

LOGAN,  J.  T G33 

LOGAN,  S 388,390 

LOMAX,  W 238,  248, 260, 452,  476, 494 

LONG,  J.  W 215 

LONGENECKER,  J.  H 440 

LONGSHORE,  W.  R 235 

LOOMIS,  II.  N 028 

LORD,  C.  H 215,217, 

220, 222, 258,  276, 322,  446, 45!),  453,  518 

LORD,  J 409 

LORD,  J.  J.  II 033 

LOUGHR  AN,  R 275,  403 

LOVE.  W.  S. .  .228, 230, 324, 48(5, 467, 554,  707^  7C8 

LOWE,  L.  W 040 

LOWELL,  A.L 115,198,579 

LUC  A  S,  G.  L 435, 481 , 497,  542,  705 

LUDINGTON,  H 465, 466,  470, 482,  630, 632 

LUDLOW.J.  R 220,260. 

203,  267, 285, 208, 308, 507,  606 

LULDON,  R.  J 075 

LUTZE,  J.  J 46 

LYFORD,  B.  F 256,882 

LYMAN,  J.  W. 87, 225, 2:58, 239, 292,  495 


Page. 

LYMAN,  W.  C 73 

LYNCH,  J.  E 286, 403, 481 

LYNDE,  R.  D 547 

LYNN,  J.  P 727 

LYON,  E.  B 245 

LYONS,  H.  M 475 

LYONS,  W.  B 239, 884 

LYSTER,  H.  F 220,  223, 

227, 233,  238, 247,  248, 251,  256,  257, 258. 

259, 261,  263,  469, 489,  497,  623,  626,  803 
LYTLE,  F.W 87,247 

[  MABIN,  H.  B 48,55,795 

MACDONALD,  J.  E 83,  445,  682,  683 

\  MACKAY,  D 235,255, 

476,  483,  490,  495,  498, 499,  502,  626, 883,  885 

MACKENZIE,  T.  G 295,297 

;  MADDIN,  T.  L 15,606,854 

1  M ADILL,  W.  A 501 

j  MAGEE,  T.  L 236,  238,  245 

1  MAGUIRE.S 474 

1  MALTBIE.C.  B 586 

MALLOCH.E.C 584 

|  MANFRED,  H 296 

j  MANGER.L 218 

1  MANOWN,  J.  H 231 

:  MANSFIELD,  T.  B 607 

!  MANSOX,  J.C 56 

i  MARION,  A 33 

MARKfE,  T.  M 46, 48,  676,  790 

;  MARKS,  J.J 219 

MARKS,  S 253, 254, 467, 501 

MARMION,  G.n 543,545,548 

MARSH,  A 666 

MARSH,  A.F 264,293 

!  MARSH,  E.  J 55, 298,  299,  387,  653 

:  MARSH,  F.E 553,554 

:  MARSH,  II 301 

MARSH,  M.  M 307 

!  MARSH,  N.  F 667 

MARSH,  W.  R  . .  .257, 260,  480,  483,  490, 508,  530 

MARSHALL,  D.M 86 

MARSHALL,  E 438,673 

MARSHALL,  S.  D 771 

MARSHALL,  S.W 240 

MARTIN,  C.  M 216 

MARTIN,  G 548 

MARTIN,  II.  A 172, 203,  255, 499 

MARTIN,  J.C 300 

MARTIN,  J.  S 218, 229 

MARTIN,  J.  W 435 

MARTIN,  N.F 316 

MARTIN,  O 313 

MARTINDALE,  F.E 527,672 

MASON,  E 409 

MASS,  A 314 

MASSER,  G.  M 69 

MASTIN,  C.  H 92, 140, 280, 281,  553 

MATCIIETT,  W.  H 206, 296 

M ATHERSON,  A 488 

MATLOCK,  W.  II 314,  501 

MATTISON,  W.  E 254 

MAUGHS,  G.  M.  B  . . .   339,  324 

MAULL,  D.  W 188, 217, 

202,  239, 251 , 252, 259, 450, 482, 483, 497,  542 

MAURY,  F.  F 246,  630,  666, 670, 803 

MAURY,  R.  B 553 

MAURY,  T.  F 71 

MAY,  J.  F 42 

MAY,  II.  C 56, 241,  247,  285, 

314, 456,  527, 535,  547,  550,  583,  584, 778, 794 

MAYER,  N 255 

MAXWELL,  D.  A 506 

MAXWELL,  J.  H 648 

McABEE,  II.  M 263,  264, 266, 

209,  286, 486,  494, 504,  509,  511, 512,  518, 886 
Me  ALPINE,  J 486 


Page. 
Me  ARTHUR,  J.  A 190,  543,  704, 779, 856 

MCBEAN,  A 435 

McCALL,  C.  A 25, 50,  54, 107, 112, 276,  286, 

303, 313, 441,  521,  528,  534,  552, 600,  674, 801 

MCC ALLA,  J.  M 456 

MCC  ANDLESS,  J.  N 264 

MCCANDL1SS,  R.  R 481 

McCANN,  J 485 

MCC  ARTIN,  H.  E 811 

MCCAUSLAND,  M.  B 253, 300, 673,  675 

McC  A  Y,  R.  B 376,  505 

MCCHESNEY,  W.  F 217 

McCLANAHAN,  J.  P 494 

MCCLEERY,  B.  N 285,  459 

McCLELLAN,  E 50,52, 

57, 80, 83,  98,  139, 216,  390,  429,  455,  555,  596 

MCCLELLAN,  j 228 

MCCLELLAN,  j.  H 625 

McCLELLAN,  S 295 

MCCLELLAN,  w 203 

McCLINTOCK,  E 506, 791 

MCCLURE,  J.  D 26 

MCCLURE,  R.  L 261, 262, 

284, 286,  502, 518,  525,  531,  534 

MCCLURE,  s.  M 295 

McCLURG,  J.  R 34,  54,  668,  670 

MCCOLLUM,  W 188 

MCCOOK,  G 25, 27 

McCORD,  D.  O 308,669 

MCCORMICK,  C 391 

McCORMICK,  J.  J 74 

MCCOY,  II.  W 15 

MCCUEN,  E 474 

McCULLEY,  W.  A 469 

McCULLOCH,  J 447 

McCULLOUGH,  W.  P 81,  365,  815 

MCCUNE,  G.  W 222,  263 

MCCURDY,  J 469 

McDERMONT,  C 153, 215, 548,  667,  684,  883 

MCDONALD,  G 48i 

MCDONALD,  w.  o 233, 235, 

252  254  257  296  378 

MCDONNELL,  E 350, 472, 506 

MCDOWELL,  G.M 526 

MCELDERR  Y,  H 317, 320, 410, 678 

MCFALLS,  D 227,250,481 

MCGAVRAN,  W.  B 476 

McGEE,  J.  W 268,467 

McGEE,  T.  L 516 

McGILL,  G.  M 56,  93, 173, 192, 

275,  286,  314,  316,  399,  401,  403,  478, 515, 531, 
532, 543,  547,  548,  603,  605, 634,  670,  673,  724 

McGIRR,  J.  E 325 

McGOORISK,  E.  J 270,482 

MCGO WAN,  R 409 

McGRATH,  J.  M 50,  683,  780,  783, 801 

McGRAW,  T.  A 320,  517, 

518, 525, 531,  533, 542, 543,  668, 674,  801 

MCGREW,  J.  S 252, 257 

McGUIRE,  II 27,  94,  !)7, 100, 134, 

138,  217,  228, 240,  240, 248, 320,  412, 501, 507 

McGUIRE,  J.  M.  G 249,  255,  303, 496 

MCHENCH,  W.  J 54,  627,  634 

MCIIENRY,  II 206,467,471 

McINTYRE,  J.  II 293,488,496 

MCKEE,  J.  C 26, 33,  39, 4<>,  50,  59,  79, 

147, 150,  151,  225, 243, 245, 263,  266,  285,  311, 
312,  314,  315, 318, 301,  379, 434,  518,  527,  546, 
548,  583,  596,  676, 773,  786,  787,  792,  801,  8C9 

MCKELVEY,  A.  J 3<il 

McKENNAN,  II 235,  230, 247, 269, 270,  472 

MCKIM,  W.J 281,308 

MCKINNEY,  D.  F 267, 296 

MCLANE,  II 252, 529,  531 

MCLAUGHLIN,  c.c 251 

MCLEAN,  c.  R 625 

MCLEAN,  D  ..  so.eoo 


LIST    OF    OPERATORS    AND    REPORTERS. 


XI 


MCLEAN,  L 133,138,549,071 

MCLETCHIE,  A 58,  315, 430,  071 

McMAHOX,  A 47, 82, 105, 108,  111,  112, 

11G,  119, 257,  301, 481,  7G7,  768,  775, 780, 791 

MCMASTERS,  J.M 053 

MCMILLAN,  c.  w 200, 239, 

25C,  259,  473, 495, 882 

MCMILLAN,  T 302, 523 

MCNAUY,  R.  B 498 

MCXEELY,  J.  s 440,  G44 

McNEILL,  D 408,  489 

MCNEILL  Y,  R . . .  .237, 302, 315, 520,  533, 541, 553 

MCXULT  Y,  J 98,  99, 100,  230,  753, 882 

McNULT  Y,  R 533 

MCPARLIN,  T.  A 53, 54, 349,  SGI 

MCPHEETERS,  J.  G esa 

MCPHERSON,  j.  B 533,  oca 

McREYNOLDS,  W.  H 480 

MCRUER,  D 282 

ME ACH AM,  F 120, 121, 125, 210, 861 

MEANS,  T.  A 549, 632 

MEARS,  G.  W 629, 72G 

MEEKER,  D 488 

MEEKS,  J.  A 296 

MEIGS,  J.  J 247, 293, 484 

MELCHER,  S.  H 517 

MENDEXHALL,  J G4G 

MENDENHALL,  W.  T 275 

MENZIES,  S.  G 93 

MERCER,  T.  II 835 

MERRI  AM,  J.  H 778 

MERRILL,  A.  W 4G4,  C73, 805 

MERRILL,  C.  S 518,531 

MERRILL,  G.  V.  R 501 

MERRILL,  H.  W 45G 

MERRILL,  J.  H 280 

MERRILL,  L 662 

MERUILLAT,  W.  C 072,  075 

MERRITT,  D 469, 496, 525, 526, 531,  805 

MERRITT,  J.K 463 

MERRON,  J.  M  . . . . 229, 487, 524,  596, 601 

MERRYWEATIIER,  H.  C 233,236, 

256, 4G9, 473, 474,  480, 48G,  510, 886 

MESSENGER,  A.  C 219, 220,  221, 

222,  228, 235,  237,  240,  251, 253, 
254,  256,  262,  265,  267,  272,  452 

METCALF,  G.  W 44, 230, 

234,  239,  246,  201,  477,  600,  884 

METCALF,  R.  L 255 

MEYER,  N 069, 075 

MEYERS,  L.  G 296 

MICHEL,  W.  M 391,  536 

MIDDLETON,  P 314,  317,  532 

MILES,  B.  B 67, 156, 

293, 295,  301,  303,  308,  314,  315,  320,  321, 
339,  523,  527,  53D,  534,  549,  550,  671, 703 

MILES,  J.  C 780 

MILHAU,  J.  J 104, 242,  597, 047 

MILLAR,  R 245, 253,  552 

MILLER,  A.  C 232 

MILLER,  A.  F 232 

MILLER,  A.  J 455,805 

MILLER,  B.  F 230,601 

MILLER,  C 508 

MILLER,  C.  H 601 

MILLER,  G.  L 245, 499, 524, 534 

MILLER,  G.  W 470, 548 

MILLER,  I.  V 532 

MILLER,  J.  G 549, 783 

MILLER,  J.  W 219 

MILLER,  L.  D 295 

MILLER,  M.  L 440 

MILLER,  S.  J.  F 727 

MILLER,  T.  W 283 

MILLIGAN,  F.  H 322,503 

MILLS,  A.  C 484 

MILLS,  C.  H 250,  496 


Page. 

MILLS,  W.  W 525 

MIXASSIAX,  8.G G69 

MIXER,  J.  F 08 

MINOR,  W.  C 303 

MINTZER,  ST.  J.  W 314,  400, 

472, 500,  579,  G75,  G77 

MITCHELL,  E.  D 703 

MITCHELL,  J.  B GC8 

MITCHELL,  J.  D 246, 475,  502, 533 

MITCHELL,  J.  W 219, 228, 

231, 236, 24G,  247, 275 

MITCHELL,  S.  B.  W 18, 29,  75, 205 

MITCHELL,  S.  W 9, 491 

MITCHELL,  T.  E 197,  29G,  526, 534 

MIX,  H.  A 218 

MOHR,  R.  J 253, 256, 480 

MOLA,  E.  L 353,523,526,791 

MONEYPENXY,  J 300, 516 

MONOHAX,  A.  B 217,  233,  248, 250, 252, 

260,  263, 265,  463,  468,  473, 480,  483,  486,  496 

MONROE,  A.  L 170 

MONTGOMERY,  H.  F 46 

MOODY,  G.  O 553 

MOODY,  S 282 

MOON,  W.  P 48,55, 

315,  353, 459,  534, 550,  079,  776,  780,  790,  814 

MOORE,  C.  D 230,236,255,449 

MOORE,  J 124, 413 

MOORE,  J.  M 700,768 

MOORE,  N.  K 542 

MOORE,  S 517 

MOREHOUSE,  G.  R 9 

MORGAN,  D 855 

MORGAN,  J.  C 206,207, 

220, 258, 284, 285,  300,  467, 531, 779 

MORGAN,  W.  P 434 

MOROXG,  E.  P 20,  407, 500 

MORRIS,  F.  D 440 

MORRIS,  J 47,  48, 

49,  54, 315, 550,  778,  781,  792,  794, 795, 797 

MORRIS,  X.  R 543 

MORRIS,  R '.237, 260, 451,  485, 48C 

MORRISON,  A.M 500 

MORRISON,  F.  W 475 

MORRISON,  T 233,  525 

MORRISOX,  W.  B 301, 523, 554 

MORSE,  S 661 

MORTOX,  C.  J 305,308, 

322,  548,  074,  773, 79G 

MORTOX,  J.  C 39, 49, 155, 172, 296,  321, 

378, 549,  670,  774, 788, 790, 791,  794, 797, 799 

MORTOX,  T 497 

MORTOX,  T.  G 59, 130, 147, 149, 152, 

156, 159, 100, 162, 104, 407, 409, 627, 079, 773 

MOSELEY,  E.  B 163 

MOSELEY,  N.  R 23, 36, 47, 205, 

208, 276,  284,  285,  288, 293,  294, 297, 
298, 299,  302, 314, 315, 321, 378, 392, 
453, 455, 519,  523,  525,  526, 531,  534, 
541, 543, 553,  554, 589,  597,  598,  022, 
634,  719, 768,  709,  773, 778, 779,  780, 
784, 786,  789, 792,  793,  797, 817, 818 

MOSES,  1 81,  210, 283, 

300,  309,  339,  381, 409,  413,  455,  473,  769, 815 

MOSHER,  M.  A 2GO 

MOSS,  S.  C 474, 497 

MOTT,  A.  B 12,28, 

152, 154, 158, 159, 162,  285,  304,  308,  315, 
459,  517,  519,  524,  526,  549, 7C8,  773, 787 

MOTT,  V 13 

MOULTOX,  A.  A  ....  ...  133, 134 

MUDGE,  C 488 

MULFORD,  J.  L 494,  499 

MULFORD,  W.  C 275, 286, 315,  321,  533 

MULLEX,  I.  V 

MULLER.  A •     C53 

MULLINS,  W.  H 249 


Page. 

MUXGER.M.  J 524 

MUXN,  C.  E 47 

MUNSON,  A.W 46C 

MUXSOX,  C 217, 283, 473, 485,  511 

MURDOCH,  R 768 

MURDOCK,  T.  F 55, 302 

MURPHY,  J 036 

MURPHY,  J.  A 371, 619 

MURPHY,  J.  B 58 

MURPHY,  J.  G 524, 535, 802 

MURPHY,  R.  R 507 

MURRAY,  J 077 

MURRAY,  J.  H 507 

MURRAY,  W.  D 239, 269, 473, 500,  525, 884 

MURSICK,  G.A 102,103, 

111,  209,  276, 289, 299, 301,  302, 406, 
531,  535, 717,  709, 776,  780, 781,  821 

HURT  A,  J.  E 247,294,435,487 

MUSCROFT,  C.  S 227, 245, 4G9,  486 

MUSGRAVE,  J.  F 239, 261, 451 

MUSSEY,  W.H 673 

MYERS,  J.  T 246, 260, 401, 626 

MYERS,  T.  N 142 

NAGLE,  J.  P 276 

NAPHEYS,  G.  H 370 

NASH,  A 227, 294, 488 

NASH,  W.  M 246 

NAUMAN.H 068 

NEFF,  H.  K 701 

NEFF,  J 276, 321, 519,  524, 554,  664, 670 

NEIL,  J 183 

NE1LL,  J 23, 24, 74, 199, 314,  374, 407,  635 

NELSON,  A.  W 20, 43 

NELSON,  J.  C  . . .  .293,  298, 518, 519,  634, 7C9, 770 

NEW,  G.  W 217, 219, 235, 255,  503 

XEWCOMBE,  J 49, 186, 276, 353, 793, 798 

NEWELL,  A.E 435 

NEWELL,  W.  D 501 

NEWLAND,  B.  J 253 

NEWMAN,  G.  W 806 

NEWTON,  M.  T 470 

NEWTON,  W.  S 232,469 

NICCOLLS,  R 71, 84, 354, 749 

NICHOLS,  C.  H 121,  651 

NICHOLS,  G 473 

NICHOLS,  J 16, 20, 303 

NICHOLS,  T.  B 199 

NICHOLS,  W.  T 371 

NIDET,  S.L 525 

KIMS,  E.  B 239,  285 

NOBLE,  H.  B 82 

NORDQUIST,  C.  J 216, 389,  515 

NORRIS,  B 221, 245, 265, 

280, 285, 295, 308, 313,  314, 321, 323, 482,  580 

NORRIS,  G.  P 669 

NORRIS.S.L 256 

NORRIS,  W.  F 47, 48,  54, 106, 112, 

152, 171, 204, 225, 279, 285, 297, 298, 
299, 300, 302, 435, 444, 526, 527,  535, 
583,  717, 722,  782, 792, 793,  796,  800 

NORTH,  A 40, 276, 308, 314,  319,  458 

NORTHRUP,  J C72 

NORTON,  J.  C 301,  472 

NORTON,  O.  D 54, 181, 241, 069 

NOSSIXGER,  F.  B 173, 266 

NOTSOX,  W.  M 28, 86, 285,  526 

XOTT,  G.  A 499, 549 

XOTT,  J.  C 409 

XOYES.G.H 4!)7 

NOYES.T.C G54 

NUGEXT,  W.  G 227 

OAKES,  T.  F 220, 221, 222, 

223, 232,  233,  247, 258, 2GO,  261, 262, 
285,  468,  472,  475, 476,  489,  495,  500 

OAKLEY,  L.  W . . .  103, 232, 313,  315,  321,  517,  525 


XII 


LIST    OF    OPERATORS    AND    REPORTERS. 


Page 

OATMAN,  I.  E 642 

O'CONNELL,  P.  A 10,  87, 13:!,  134, 226,  442 

O'CONNOR,  J 541 

ODIORNE,  G.  G 254 

O'DOHERTY,  F 96 

O'DONNELL,  J.  S 219,  254,  472 

O'HAGAN,  C.  J 96,  485 

OHLENSCHLAGER,  E 883 

OHR.C.H 299 

OKIE,  W.  T 549 

O'LEARY,  C 314,  341 

O'LEARY,  R 802 

OLIVER,  G.  P 220,  237,250, 256, 

271,  295,  29!>,  300.  302,  303,  450, 
477, 517,  518,  519,  523,  524,  885 

OLIVER,  J 92,  265,  283, 284,  532 

O'MEAGHER,  W 206,  229, 235,  236, 

293,  300,  466, 485,  500,  668,  751,  884 

O'REILLY,  J.  J 589 

ORSAY,  D 285,296 

ORTON,  J.  G 12,621,642 

ORTON,  S.  H 40,  58, 59, 293,  301,  3L6, 

320,  321,  513,  541,  542,  543,  646, 663 

OSBORNE,  B.  E 472 

OSBORNE,  C.  H 05, 299,  527,  530,  535 

OSBORNE,  H 240,  477,  800 

OSBORNE,  J.  D 230 

OSBORNE,  W.  F 227 

OTIS,  A 643 

OTIS,  G.  A 7, 8, 24,  25,  56,  68,  89, 152, 154, 

159, 162,  338, 247,  4C6,  482,  502,  503,  621 

OTTERSON,  W.  C 366,547,797 

OTTMAN,  R 302, 454,  515,  518, 526 

OULD,  E.  R 10 

OWEN,  D.  C 703 

OWENS,  H 074 

OWENS,  1 245 

OWENS,  J 247 

OWENS,  J.  R 247 

OWINGS,  H.  W 670,  677 

PACKARD,  J.  H 48,  152,155, 

159,  162,  262,  670,  708,  789 

PADDOCK,  J 523 

PAGE.  C 187,281,282,284,296, 

298,  :(00,  :!0l,  308,  524,  534,  541,  721 

PAGE,  C.  G 255,775 

PAGE,  J.  H 525 

PAGE,  J.  R 524 

PAGE,  W.  H 52 

PAINE,  C.  F 592 

PAINE,  O.  S 498,  686 

PAINE,  R.  T 252,  494 

PALMER,  A.  D 248,  £50,  255,  294 

PALMER,  B.  R 653 

PALMER,  C.  D 142 

PALMER.  G.  S £38,284, 

301,  454,  5;!0,  549,  603,  633 
PALMER,  H 48,74,208,211, 

294,  314,  543,  634,  635,  727,  769,  777 

PALMER,  J.  C 488 

PALMER,  J.  M 236,  542 

PANCOAST,  G.  L. . .  .21',  4P,  51,  58, 323,  362,  455, 

514,  517,  527,  077,  709,  770,  796, 804,  821 

PANCOAST,  J 156 

PANCOAST,  W.  II 680 

PARCHER,  G 155 

PARK,  C.  B.,  jr 217, 233,  250, 252,  253, 

467, 473,  4s'2,  489, 495, 497,  501,  883 

PARKS,  W.  H 249 

PARKER,  G.  B 258,  349,  553 

PARKER,  M.  P 673 

PARKER,  N 582 

PARKER,  O.  F 314 

PARKER,  W 315, 370,  378,  666 

PARKS,  G.  H 494 

PARMELEE,  S.  L     .  .     187 


Pnge. 

PATTERSON,  C 247 

PATTERSON,  1>.  C 466 

PATTERSON,  J.  C 548 

PATTERSON,  J.  E 283, 490,  532,  533 

PATZKI,  J.  H 410 

PAULLIN,  G.  M 56,79,185, 

235,  258,  297,  299,  468,  518 

PAYNE,  H.  R 219 

PAYNE,  O.  B 294 

PE ABODY,  A.  G 603 

PEABODY,  J.  H -.517.549 

PE  ABODY,  O 252 

PEACHY,  ST.  G 35,143,144,516 

PEARCE,  H 278,684,766,769 

PEARSON,  C.  B 453 

PEARSON,  I.  F 48,487 

PEASE,  P.  C 238 

PEASE,  R.  W.  .73,  206,  295,  296,  301,  302,  495,  666 

PECK,  W 48, 504,  534,  550,  606,  769,  785, 796 

PECK,  W.F 527,546 

PECK,  W.  L 494 

PEEBLES,  R.  S.  J 497 

PEETS,  G.  H 248,  268 

PEGG,  C.  H 255,  468,  488, 496,  535 

PEIRCE,  W.  P 217,  251,  254, 255, 

403,  450,  451,  473,  488,  496,  497,  632 

PELAZE,  C 674,682 

PEMBERTON,  O 54 

PEPPER,  W 149 

PERCIVAL,  G.  P 140 

1'ERIN,  G 82, 121,  447, 592 

PERKINS,  E.  T 481 

PERKINS,  J 80 

PERLEY,  T.  F 661 

PERRY,  D.  O 280 

PERRY,  J.  O 32 

PERRY,  M.  S 59, 409 

PERRY,  W.  G 59,70 

PETER,  P 314,321 

PETERS,  D.  C 73,  79,  202,  339,  340,  351, 

396,  523,  527,  529,  550,  634,  635,  703, 757 

PETERS,  G.  A 676 

PETICOLAS,  A.  E 35,143 

PETTIS,  C.  V 103 

PHELPS,  A.  J 339,  342, 355,  413,  609 

PHELPS,  B.  E 320 

PHELPS,  O.  J 352 

PHILLIPS,  E 249, 255,  293, 496 

PHILLIPS,  G.  W 233 

PHILLIPS,  J 191,283,284 

PHILLIPS,  J.  A 140, 276,  516 

PHILLIPS,  J.  H 42,  362,  525,  543,  671 

PHILLIPS,  M 254 

PHILLIPS,  W.  H 297 

PHILLIPS,  W.  W.  L 218,228,233,483 

PHILPOST,  W.  H 254 

PHILSON,  J.  R 232 

PHINNEY,  L 472 

PIERCE,  B.  G 489 

PIERCE,  J.  W 320 

PIERSON,  W 103 

PINEO.  P 48,  99, 100, 141, 144, 161,  518,  794 

PINKNEY,  H...  .     281 


PINKNEY,  N 227 

PIQUETTE,  F.  E 293, 294,  295,  296,  300, 

517,  531,  533,  534,  536,  541,  067,  674,  885 

PITKIN,  J 285, 299 

PLUMB,  II 229,  251, 

446,  450,  470,  482,  495,  496,  503 

PLUMB,  S.  II 206, 

231 ,  2:57,  250,  252,  258,  270, 468,  469,  472,  477, 
484,  491,  <1!!5,  496  504,  508,  511,  519,  602,  885 

PLUMMER,  S.  C 222,  490,  510 

POGUE,  J 220, 233, 

253,  ','58,  207,  401,  497,  503 

POLLOCK,  A.  M 851 

POMERE NE,  .1 . .    253,  254,  255.  056,  480,  485,  489 


Page. 

POMFRET,  J.  E 236, 249, 254, 

311,  458,  481,503,  541,  594,  603,  635,  678 

PORTER,  C.  II 75,182 

PORTER,  F.  G 263 

PORTER,  H.  P 133 

PORTER,  J.  B 67 

PORTER,  P.  C 285,  455,  521,  523,  883 

PORTNESS,  J 629 

PORTEOUS,  J.  G 472 

POST,  W.  H.  B 266,  527 

POTTER,  G.  L 154,  219,  221,  230, 234, 

237, 239,  240, 247,  248,  251, 255, 256, 257,  258, 
260, 261,  265, 403,  451,  452,  468,  475, 476,  477, 
47S,  481,  482, 484,  489,  497,  499,  542,  626,  884 

POTTER,  H.  S 295 

POTTER,  J.  B 238 

POTTER,  W.  H 883 

POTTER.  W.  W 70,  253, 646 

POTTS,  G.  J 248,481,501,511,884 

POTTS,  R 140,144 

POWELL,  A.  H 542 

POWELL,  E 173,  227,  323,  497 

POWELL.  W.  P 283 

POWERS,  C 265,  388,  489,  623 

POWERS,  E.  M 38,284,285,769 

PRATT,  F 467 

PRAY,  O.  M 212 

PRENTICE,  F 133,405 

PRESCOTT,  A.  B 629 

PRICE,  M.  F 57,280,297, 

480,  490,  527,  532,  533,  534 

PRICE,  R.  E 456 

PRICE,  W.  B 476 

PRIDE,  J.  S 588 

PRIESTLEY,  J 58, 316,  549 

PRIETO,  J 281,  284 

PRINCE,  D 276,  294,  366,  595,  632,  674,  867 

PRINCE,  J.  P 170,228, 

247,  253,  254,  283,  357,  445,  450,  451, 
482,  489,  495,  497,500,  501,  507,  794 

PROUT,  J.  S 354,448,480,797 

PROVOST,  W.  Y 261 

PRYER,  W.  C 276,785 

PUGH,  T.  C 468 

PUGSLEY,  E.  G 293 

PULLEN,  G.  W 25 

QUICK,  L H 

QUIDOR,  J.  E 518 

QUINAN,  P.  A 297 

QUINN,  J.  P 136 


RADCLIFFE,  S.  J 

RADZINSKY,  L.  D 

RAE,  R 

RATHER,  C.  A 

RAINE,  J.  R 

RAMSAY,  G.  M 208,230, 

RAMSAY,  J.  A 233,239, 

RAMSEY,  A.  H. . .   

RAMSEY,  J.  R 

RAMSEY,  J.  W 

RA.MSE Y,  W.  R 179, 210,  515, 

RANDALL,  15 

RANDALL,  P.  R 

RANDOLPH,  J.  F 308,  553,  593,  669,  703, 

RANDOLPH,  W.  H 283,322,501, 

RANKIX,  A.  C 

RANXELS,  D.  V 

RANNEY,  A.  B... 


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295 
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250 
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527 
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RANSOM.  .1 301,803 

RAPPOLD,  J.  C 248 

RAUCH.  J.  H 380,383 

RAVENOT,  P.  F 93 

RAWLINGS,  J.  W 496 

RAYMOND,  M.  II 253,  262 

READ,  E 462,  408 


LIST    OF    OPERATORS    AND    REPORTERS. 


XIII 


Page. 

READ,  J.  B 10J,  111,  116, 118,  ]  19,  391 

READ,  L.  W 37,  53, 192,  206, 

256,  351,  428,  447, 478,  484, 809 

REAGAN,  A.  W 200,  203, 246,  -181, 482,  534 

REAMER,  F.  C 96,100,471,501 

HE  AMY,  T.  A 69,191 

REAT,  J.  I, 252 

REBER.  C.  T 256,407,634 

RECK  ARD,  F.  A 435 

RECTANUS,  F 677 

REDDEN,  J.  W 15 

REDF1ELD,  J.  S 517 

REED,  C   R 25 

REED.  H.  (J 646 

REED,  J.  A.  E 20'J.  252,  448,  552, 468,  5:t3 

REED,  J.  W 257,258 

REED,  T.  B 176,  508,  580,  589,  594,  624 

REEDER,  G 501 

REESE,  J.  J 672 

REEVE,  J.  C 5:58, 542,  668 

REEVE,  J.  T 233,  498 

REEVES,  J.  S 227-,  229,  245, 266 

REGAN,  M.  F 255, 497,  602 

REILEY.  J   228,254,451, 

481 , 482,  496.  500, 504,  668 

REINHOLDT,  J.  K 26 

REX,  G.  P 218,231,674 

REYBURN.  R 212, 280,  298,  519 

REYNOLDS,  B.  O 275 

REYNOLDS,  F 217,228 

REYNOLDS.  H.  A '. .     480 

REYNOLDS,  L 486,523 

REYNOLDS,  W.  B 495,  768 

REZNEK,  W.  B 250 

RICE,  C.  D 284 

RICE,  D.  B 227 

RICE,  J.  B 258,  476 

RICE,  P.  L 58,313,  315 

RICE,  W.  H 2!  8, 232,  269, 494, 594 

RICH,  T.  C 76 

RICHARDS,  C.  B 221, 

223,  233,  234,  239,  254, 257,  260.  451, 
473,  474,  476,  477.  486.  490,  497,  499 

RICHARDS,  G.  R 230,  501 

RICHARDSON,  S.  A 31,591.594 

RICHARDSON,  T.  G 143, '218 

RICHARDSON,  W.  F 19.  97.  <:8, 104.  220, 

221. 230.  237,  276,  315.  353,  505,  530,  542, 768 

RICHMOND,  C.  H 523, 6CO 

RICHMOND,  L 620,071 

RITCHIE,  A.  J 280 

RITTER,  H.  P 269,  296 

RITTER,  J.  A 484 

RIVERS.  H.  W 206,  462, 470, 518,  885 

RIZER,  M 47,  220,  228, 

239,  245,  246, 250,  263, 264,  294,  323, 
402,  450,  466,  48!,  482,  500,  601,  602 

ROBARTS,  J 470,491 

ROBBINS,  H.  A 180, 187 

ROBBINS.  J 586 

ROBBINS,  L.  H 727 

ROBBINS,  M.  W 245,  270,  271.  489,  885 

ROBBINS,  N.  A 47,518,527,768,791 

ROBERTS,  D.  J 634 

ROBERTS,  H 645 

ROBERTS,  H.  C 58,  139,  144,518,519 

ROBERTS,  1 20 

ROBERTS,  W.  E 533 

ROBERTSON,  C.  A 23S,  255,  487, 512 

ROBERTSON,  W.  A 252,  507,  532 

ROBIE,  J.  W 447,  549 

ROBILLARD,  A 669 

ROBINSON,  G.  R.  B  ..  -  -  -48,  796 

ROBINSON,  J.  H 455 

ROBINSON,  P.  G .     481 

ROBINSON,  R.  H 206,  228,  250 

ROBINSON,  W.  C 453 


Page. 

ROBISON,  J.  D 389 

ROCHE,  E.  P 230,  245, 253,  263,  471,  501 

RODGERS,  J.  H 227,  251, 253,  254,  255 

RODMAN,  W.  M 554,884 

ROE,  J.  B 154,  5a%  553 

ROE,  J.  L 671 

ROGERS,  C 255,  400,  402 

ROGERS,  D.  L 377 

ROGERS,  E.  M 261,  270,  271,  471,  484,  503 

ROGERS,  S.  G 673 

ROHRER,  B 140, 144  236,  239,  450, 

452, 484,  487,  489,  490,  509,  884 

ROLER,  E.  0.  F 73,  253, 483,  579 

ROLLS,  A 235,477,  517 

ROMAYNE,  J.  A 535,  632 

RONALD,  G.  W 667 

ROOT.E.  B 673 

ROOT,  J.  P 232,  286 

ROOT,  0.  S 580 

ROOT,  W.  W 234,  254 

ROSE,  F.  M 232,  234,  249,  250,  255,  468,  516 

ROSS,  J.  C 249 

ROSS,  J.  S 228,  239,  240,  245, 

247, 259,  261 ,  263,  270,  511,  542 

ROWLAND,  C 182,360 

ROWLAND,  M.  C 281,466,507 

ROY,  G.  G 268 

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ROYAL,  W.  W 

ROYSTON,  R.  Y 

RUDER,  I.  H 

RULISON,  W.  H 227,  302,  389, 

RUMBOLD,  T.  F 

RUSH,  D.  G 139,  202,  393, 494,  504, 

RUSSELL,  C.  P 286, 

RUSSELL,  E 

RUSSELL,  W.  P... 


RUTHERFORD,  J.C. 
RUTHERFORD,  W.  W 
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SANDERS,  H 

SANDERS,  J.. I 

SANDS,  E.  H 

SANDS,  II.  B 

SANGER,  E.  F 

S  ANGER,  S.  C 

SARGENT,  G.  P 

SARGENT,  W 

SATCHEL,  S.  S 

SATTERLEE,  D 

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SAUNDERS,  D.  D 

SAUNDERS,  F.  W 

SAUNDERS,  L.  L 

SAWIN,  W.  J 

SAWYER,  J 

SAWYER,  S.  H 

SAYERS,  S.  R 

SAYRE,  L.  A 

SCARLOCK,  W 

SCHAFHIRT,  F 

SCHELL,  H.  S 209,  676,  680, 

SCHELDT,  O.  F 

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Page. 

SCHULTZ,  L 494,662,671 

SCOTT,  1 379, 463,  465,  494 

SCOTT,  M.  P 549 

SCOTT,  N.  B 482 

SEABROOK,  E.  M 26,73,268 

SEARLE,  I.  II 284,  526 

SEELEY,  E.M .     474 

SELDEN,  W 773 

SEMMES,  A.  J 71,487 

SEMPLE,  G.  W 235,  500 

SEMPLE,  J.  E 16, 219, 542,  545, 604,  615 

SEYFFARTH,  E 286,  459, 

527,  532,  5i1,  547, 549,  554,  672,  683 

SEYMOUR,  F 70,  314,  315,  542, 894 

SIIACKELFORD,  A.  P 5l(i 

SHANNON,  T.  J 667 

SHAPLEY,  W.  W 58 

SHARP,  J 05 

SHARP,  J.  N 322, 626, 773,  805 

SHARP,  S 136 

SHARPE,  R 171, 188,  496,  502,  528,  587,  634 

SHAW,  B.  S 320 

SHEFFIELD,  M 299 

SHEKELL,  A.  B 599 

SHELDON,  A.  F 207,210, 

275,  276,  283,  285, 286,  296,  2117,  298,  299,  302, 
315,  322,  354,  355,  390,  524,  525,  526,  527,  528, 
531,  533,  543,  548,  549,  551,  554,  633,  (r34,  773 

SHELDON,  II.  L 8ft,  882 

SHELTON,  C.  S 227 

SHELTON,  M.P 321,485 

SHENK,  O 498 

SHEPPARD,  D 285,  323,  673 

SHERMAN,  B.  F 429 

SHERMAN,  M.  G 28,  231,  413,  629 

SHERMAN,  S.  N 59,60,70, 

246,  248,  259,  516,  526,  5:53,  661,  668,  677,  776 

SHERWIN,  O.  W 188 

SHERWOOD,  J.  H 650 

SHIELDS,  J 54 

SHIMER,  J.  C 30, 44,  47. 

49,  259,  260, 276, 285,  301 ,  31 1 ,  494, 531, 798 

SHINDLE,  Y 180 

SHINDLE,  D.  W 457 

SH1PMAN,  A.  1! 308 

SHIPPEN,  E 131,136,138,140. 

144,  162,  220,  308,  403,  475,  589,  630,  632,  776 

SHITTLER,  O 58,  318,  320,  40!',  658,  684, 885 

SHOVE,  S 321 

SHOYER,  C.  C 541 

SHRADER,  J.  C 470 

SHRADY,  G.  F. . .  .216,  244,  462,  479,  520,  538,  773 

SHRADY.  J 83,  283,  302, 534 

SHULTZ,  S.  S 511 

SHURLOCK,  W.  C 223,  246,  253, 

256, 259, 271, 450,  451,  464,  472,  473, 474, 
482, 483,  486,  488, 495,  497,  498,  500, 886 

SICKLER,  P.  E 499 

SIDNEY,  R.  O : 297, 531,  634 

SIGLER,  W.  F 230 

SILL,  R.  T 282 

SIM.  T  . . . .  95, 242, 252, 254, 314,  321,  402,  525,  666 

SIMMONS,  F.  A 396 

SIMMONS.  J.  K 496,673 

SIMONS,  J 80, 179, 457, 598,  669, 973 

S1MONSON,  J.  C 255 

SIMPERS.  C.  T 254,499,635 

SIMPSON,  J 916 

SIMPSON,  S.  A 473 

SINCLAIR,  L 264, 452,  524, 534,  535,  676 

SINNETT,  E Ill,  112 

SKEER,  J.  D 672,  674 

SKILLERN,  S.  R 282,523 

SKINNER,  J.  O 246 

SKINNER,  S.  W  . .  232 

SLEEPER,  W.  W    582 

SLOAN,  A.  B 65J 


XIV 


LIST    OF    OPERATORS    AND    REPORTERS. 


Page. 

SLOAN,  J 294,  784 

SLOAN,  W.  J 647 

SLOANAKER,  L.  M 496 

SLOAT,  G.  E 246, 2-17, 252,  320,  481 

SLUSSER,  L 234, 249, 255,  543, 883 

SMALL,  H.  N 229,  238, 706 

SMART,  C 753,  893 

SMILEY,  T.  T 498,  503,  530,  534,  604,  605,  606 

SMITH,  A.  A 783,  784 

SMITH,  A.,H 300,  357,  51(5, 790 

SMITH,  A."  J 54,  527, 671 

SMITH,  A.  K 378,  854, 952,  959 

SMITH, C •     526 

SMITH,  D.  P 8, 55, 113, 

119, 140, 144,  299,  302,  308,  390, 404, 406, 
420,  443,  458,  523,  549,  589,  605,  617, 643, 
668,  683, 715,  719, 768,  779, 790, 888, 893 

SMITH,  E.  A 24, 211,  404, 650 

SMITH,  E.  P 540 

SMITH,  G.  C 147,250 

SMITH,  G.  K 106,110,112, 

179, 188,  189, 190,  194, 195, 196,  204,  439,  677 

SMITH,  G.  M 857 

SMITH,  H - 346, 532, 541 

SMITH,  II.  E 229, 450,  484,  488, 498,  602 

SMITH,  H.  H 61 

SMITH,  H.  M 589 

SMITH,  I.P 320 

SMITH,  J.  B 241 

SMITH,  J.  E 288,  294,  650,  778 

SMITH,  J.  F 508 

SMITH,  J.  J 232 

SMITH,  J.  R 469, 515,  524 

SMITH,  J.  S 263,  501,  599 

SMITH,  J.  T 25G,  499 

SMITH,  J.  V.  C 656 

SMITH,  J.  W 221, 238, 498 

SMITH,  N 497 

SMITH,  O 499 

SMITH,  S 57,  250,  607 

SMITH,  S.  M 191, 589 

SMITH,  S.  P 548,668 

SMITH,  T.  C . . . ' 258,  881 

SMITH,  T.  F 72,196,429 

SMITH,  W.  A 6 

SMITH,  W.  F 235,  249, 257, 470 

SMULL,  W.  G 179,478,482 

SM  YSER,  E.  M 115, 251, 261, 449 

SXELL1XG,  F.  G 220,281,510 

SXIVELY,  J.  N 321 

SXO W,  C.  E 378 

SNOW,  G.  W 93, 100, 

204,  234,  2°>(5,  261,  4G8, 484,  485,  499,  503 

SNOW,  N.  L 230,  252,  487 

SNYDER,  ILL 782 

SONN1CK,  P.  L 253 

SOURELL,  F 340 

SOUT11ALL,  R.  G 436 

SPARKS,  J 253 

SPARKS,  J.  B 250,602 

SPARROW,  W.  E 517 

SPAULD1NG,  A.  M 321 

SPEER,  A.  M 25,58,275 

SPENCE,  W.  A 471, 482 

SPENCER,  I    10 

SPENCER,  .1.  A 221,451,476,499 

SPENCEU,  T.  R 28,  87,  225, 1)55 

SPIEGELHALTER,  J £50,  256, 

483, 491,  5C8,  535, 883 

SPINZIG,  C 218, 488,  502 

SPOONER,  II.  K 58, 254,314,  494,  502 

SPRAGUE,  A.G 235 

SPRAGUE,  G 230 

SPRAGUE,  II.  M 47,54,259, 

262. 203.  296,  321, 498,  517,  520,  523,  526,  783 


Page. 

SQUIRE,  T.  H 6, 79, 218, 

221,  227, 228,  238,  246,  252,  254,  255, 256, 
259, 266,  2(58,  285,  299,  340,  411,  476,  513, 
532,  550, 608,  621,  681,  716, 750,  751,  776 

STAEHLY,  B.  F  . . .   234 

STANFORD,  R.  L 34,  320,  547,  553, 890 

STANTON,  D 371,  665,  667 

STANTON,  J.  O 301,  455, 456,  621, 780 

STAN  WAY,  T.  S 197 

ST.  CLAIR,  A.  K 227, 495,  597,  602 

ST.  CLAIR,  T 667 

STE ARXS,  H.  P 140,  263,  315,  524, 75fi 

STEARNS,  I.  H 468,  483, 503 

STEARNS,  J 783 

STEBB1NS,  R 315 

STEDM AN,  C.  E 55 

STEELE,  A 200 

STEELE,  A.  H 200 

STEELE,  J.  E 54,  321,  457,  459,  542 

STEGMAN,  G 663,  672 

STEIN,  C 229 

STEINER,  J.  M 163 

STEPHENS,  A.  H 49, 799 

STEPHENSON,  B.  F 206, 231, 255,  469,  486 

STERLING,  A 210,  212,  525,  526,  552,  777 

STERLING,  E    114, 1J9 

STERLING,  R.  H 516,  527,  532,  534 

STERNBERG,  G.  M 320,410,548 

STEVENS,  G.  T 222, 229,  230, 233, 235,  245, 

246,  247,  248, 251,  254,  257,  259, 2(50,  262,  265, 
266, 285,  286,  301,  449, 451,  466, 470, 471,  474, 
475,  481, 482,  484,  4S5,  487,  488,  489,  495,  497, 
499,  500,  504,  512,  518,  587,  628,  630,  631,  632 

STEWART,  A.  B 231 

STEWART,  J.  D 133,498 

STEWART,  J.  L 314 

STEWART,  J.  T 705 

STEWART,  W.  D 47,  57,  580,  582,  789 

STICKNEY,  H.  G 133 

STILLMAN,  W 322 

STILLWELL,  J.  A 397,  485,  486 

STILLWELL,  T.  H 672 

STIMMEL,  M.  M 480 

STIXSON,  C.  W 221,314,504,519 

STOCKER,  A.  A 247 

STOCKER,  A.  E 506 

STOCKYELL,  D.  L 517 

STONE,  A.  R 485 

STONE,  B 186, 276, 316,  409,  517 

STONE,  H 252 

STONE,  J.  C 447 

STONE,  L.  R 655 

STONE,  S.E 525 

STONE,  W 279, 282, 514 

STONEY,  R.  Q 470 

STORROW,  S.  A 12 

STORRS,  M 92,  99, 232,  250,  480, 517 

STOWE,  C.  H 533 

STRAITH,  J.  A 248 

STRATTOX,  B.  II 23 

STREETER,  B.  G 230,  249,  255, 261,  499 

STREETER,  II.  S 661,662,669 

STRICKLAND,  D.  II 515 

STRODE,  A 666 

STRONG,  II 254, 281 

STRONG,  II.  P 494 

STROTIIER,  C.  G 2G9 

STROW  BRIDGE,  J.  G.  F 634,  802 

STIIUBE,  F C81 

STUBBS,  G.  E 78,  532 

STUDY,  G.  M 18,  36, 234,  394,  477 

STULL,  T.  W 220,  253 

STURDEVANT,  S.  B 487 

STURGIS,  W 5E6 

SUCKLEY,  G 191,931 

SULLIVAN,  G.  R 203, 204, 206 

SULLIVAN,  J.  F...  .     672 


Page. 

SUMMERS,  J.  E 286, 296, 

297, 298, 300,  496,  515,  517,  649, 721, 723,  685 

SUTHERLAND,  C 918,  951 

SUTTON,  G.  L 182, 258 

SUTTON,  W.  T 487 

SWAIN,  D 282 

SWAN,  J 466 

SWANN,  C.  E 548 

SWASEY,  C.  E 84,  221, 

222,  245,  252,  300,  314, 504,  510,  663 

SWEENEY,  R.  L 428 

SWEET,  J 518,  532, 781,  802 

SWEET,  O.  P 47, 48,  454, 

456,  520,  525,  534,  633,  775,  790,  792,  805 

SWEETLAND,  W.  P 314,  319, 321,  673 

SWIFT,  D.  D 255 

SWIFT,  E . .  15,  28, 376, 470,  490,  642,  710,  760, 854 
SWINBURNE,  J.  .231,  281,  339, 347,  498,  523,  667 
SYMPSON,  J 218 

TADLOCK,  A.  B 623 

TALBOT,  D.  D 47,240,315,322,793 

T  ALLEY,  A 35 

TAPPAN,  B 667 

TAYLOR,  D.  W 431 

TAYLOR,  E.  F 184 

TAYLOR,  G 362,666,667,891 

TAYLOR,  G.  K 395 

TAYLOR,  II.  G 882 

TAYLOR,  J.  B. 532 

TAYLOR,  J.  II 36,228,318 

TAYLOR,  J.  S 218, 247,  258,  294,  524 

TAYLOR,  J.  W 321,  661 

TAYLOR,  J.  Y 220 

TAYLOR,  M.  K 69,233,646,671,681 

TAYLOR,  R.  H 555 

TAYLOR,  R.  K 602 

TAYLOR,  R.  R 230,  405,  406, 

493,  549,  550, 552,  554,  645,  649,  658,  780 

TAYLOR,  \V.  E 122, 125 

TE AL,  N 320, 755 

TEATS,  S 57,  243,  289, 403,  479,  714,  776, 885 

TELFAN,  R.  S 660 

TERRILL,  R.  M 250 

TERRY,  J.  W 219, 498 

TESSON,  L.  S 121 

THAYER,  W.  II 484 

TIIOM  AIN,  R 209, 210,  515,  523,  525 

THOMAS,  C.  F 882 

THOMAS,  II.  L 391,588 

THOMAS,  J 06,  228, 

231,  256,  264,  470,  471,  498,  532,  885 

THOMAS,  K.  G 251 

TIIOM  AS,  M.  S 506 

THOMAS,  M.  W 231,  260,  480 

THOMAS,  R.  J 718 

THOMAS,  R.  P 29, 186, 408 

THOMPSON,  E.  A 451,  510,  522 

THOMPSON,  G.  F 285 

THOMPSON,  H.  W 507 

THOMPSON,  J 319,  322,  518,  599,  675 

THOMPSON,  J.  F 56, 109, 

112,  283, 320,  406,  522, 591,  776 

THOMPSON,  J.  G 282,284,285, 

295,  297,  298,  480, 488,  501,  528,  723,  886 

THOMPSON,  J.  II 40,230,233, 

276, 280,  281 ,  284,  285,  295,  297,  299,  302, 308, 
301, 449, 402, 519,  527,  534,  553, 667,  788,  885 

THOMPSON,  J.  W 412, 449 

THOMPSON,  L.S 727 

THOMSON,  W 34,  44, 46, 48, 52, 

85,  87,  109,  111,  126, 152, 170, 183,  203,  206, 
276, 279,  280,  283,  280, 288,  291,  292, 295,  297, 
299,  300,  301, 302,  300,  350,  35:i,  365,  400,  434, 
430,  44 1 ,  444, 445,  516,  517,  527,  530, 535,  550, 
570,  584,  650,  659,  661,  671,  720,  727,  7U8,  770, 
780,  792,  795,  796,  802,  823, 837,  851, 951,  956 


LIST    OF    OPERATORS    ANt>    REPORTERS. 


XV 


Page. 

THOMPSON,  S.  \V 54,253,673 

THOMPSON,  W.  8 882 

THOMSON,  W.  II 307 

THORN,  E GG7 

THOKN,  S.  S ...     191 

THOHNDIKE,  W.  H 320 

THORNE,  J 203, 208,  394,  39G,  630 

THORNE,  W.  H 82,  362,  486 

THORNHILL,  G.  W 281 

THORNTON,  V.  B 283,720 

THORPE,  J.  C 215, 217, 

259,  320,  321,  322,  323, 455,  482,  504, 
510,  542,  543,  669,  674,  676, 719,  776 

THRALL,  W.  R 248 

THRECKELD,  W 26 

THURSTON,  A.  H 55, 104, 

112,  314,  543, 552,  673,  788 

THURSTON,  W.  T 275 

TIBBETT,  J.  C 188 

TIBBETTS,  W 882 

TILTON,  H.  U 313, 541, 806 

TINGLE,  J 663 

TIPTON,  R.  H 266 

TITUS,  A 481 

TODD,  C.  H 261,262, 

263,  476,  481, 489,  516, 631,  771 

TODD,  C.  W 785 

TODD,  G.  R.  C 217,601. 

TODD,  S.  S 654 

TOLMAN,  M.  C 140 

TOMPKINS,  II.  C 234,  246, 252,  642 

TOOKER,  R.  W 518 

TOPPING,  C.  W 668 

TORRE Y,  W 533 

TOWARD,  J.  W 375, 538 

TOWLE,  S.  K 516, 523 

TOWLE,  W.  C 482 

TOWLES,  C.  J 496 

TOWN,  F.  L 82,  352,  549,  963,  964 

TOWNSEND,  E.  P 79, 186, 436,  530 

TO WNSEND,  M.  M .' 54,  302,  533,  641 

TOWNSEND,  51.  W 675 

TOWNSEND,  T.  B 55,  322,  676 

TOWNSEND,  W.  E 20, 516 

TOZIER,  L.  L 12 

TRACY,  J.  W 474 

TRACY,  L.  E 11,58,517 

TRAPTON,  C.  L 231 

TRAIN,  H.  D 658 

TRANSUE,  A 528, 533,  548 

TRAU,  A 542,  548,  634,  635 

TRAUTMAN,  C.  F 285, 297, 322,  676 

TREGANOWAN,A 659 

TREMAINE,  W.  S 270, 435,  677 

TRENOR,  J.,  jr 595,  628 

TRIPLER,  C.  S .28,  459,  627,  946 

TRIPLET'!',  W.  H ' 554 

TRIPS,  J.  D 548 

TROWBRIDGE,  G.  M 233, 258,  265,  504 

TROWBRIDGE,  S.  T 482 

TRUE,  W.  H 246,488,535 

TRULL,  W.  B 11,  55, 

58,  236, 245,  260,  284, 296,  459,  535 

TRYON,  A.  W 526 

TRYON,  J.  R 529,  533,  647,  652 

TUCKER,  M 264 

T UNNICLIFFE,  J.  W 230, 234,  645 

TURNER,  C.  M 592 

TURNER,  T.  J 523 

TURNER,  W.  D 406,  456,  708,  773,  974 

TURNEY,  S.  D 284,  362,  605,  670,  676 

TUTHILL,  R.  K 232 

TUTTLE,  II.  B 254 

TWIFORD,  W.  H 206,208, 

232,  234, 264,  266,  355,  519 
TYSON,  J 275, 285,  550, 789 

SUKG.  Ill— 12(3 


Page. 

UHLER,  A.  S 891 

UHLER,  J.  R 264,  265,  295, 2'J9,  503 

ULRICH,  C.  F 882 

UMBERGER,  E.  R 466,  469,  497 

UNDERBILL,  G.  C 678 

UPHAM,  J.  B 14,550 

UPSHUR,  J.  N 27 

URQUHART,  G 435 

VALK,  W.  W 315,  518, 769 

VAN  BUREN,  W.  H 542 

VANCE,  S.  W 646 

VANCE,  W. 525 

VAN  CORTLANDT,  A 676 

VANDERKIEFT,  B.  A 26,47,53,70, 

192, 202, 210, 218,  253, 274,  300,  356,  357,  425, 
454, 456,  516,  526,  604,  605, 703,  781,  793,  866 

VAN  DEVERE,  A 221,265 

VAN  DUYN,  A.  C 55,677,779 

VAN  METER,  J.  N 261 

VAN  NORDEN,  T.  L 525 

VAN  NOSTRAND,  A.  H 235,  388,  516 

VANNUY,  S.  C 70 

VANS  ANT,  J 56, 117, 119, 297,  302,  627 

VANSLYCK,  D.  B 477 

VAN  SLYCK,  D.  C 298, 390 

VARIAN,  W 275,320,663,780 

VARNE Y,  R.  W 248 

VEST,  J.  W.  H 470,  631, 884 

VICKERY,  R.  S 16, 754 

VIGAL,  J.  A 229, 234,  481 

VOGEL,  E 56, 320 

VOLLUM,  E.  P 365,  959 

VON  HARLINGER,  R.  L 222,261,475 

VONTAGEN,  C.  H 627 

VOSBURGH,  H.  D 276,  781 

VOSBURGH,  W 247, 256,  269,  496,  584 

VOSE,  E.  H 378 

VOYLES,  D.  W 234,  275 

WADE,  C.  H 281, 302 

WADE,  J.  L 486 

WAFER,  F.  M 250 

WAGGONER,  J.  S 320,  518, 527 

WAGNER,  C 39, 42, 118, 

11 9, 137, 151 , 155,  270,  378, 409, 472,  526, 
541, 666,  772, 774, 890, 891, 893,  971,  975 

WAGNER,  F.  R 215 

WAGNER,  L.  P 182,  239, 

266,302,476,511,524,  892 

WAGONSELLER,  B.  F 673 

WALKER,  A.  C 672 

WALKER,  F.  A 502 

WALKER,  G.  S 217,248 

WALKER,  J 288, 806 

WALKER,  W.  II 354,  645, 749 

WALLACE,  J.  D 143 

WALLACE,  R 549 

WALLACE,  T.  C 450 

WALLACE,  W.  H 643 

WALLS,  I.  W 254,389,392 

WALSER,  J.  W 39 

WALSH,  J 18 

WALSH,  R.  S.  L 186 

WALSH,  W.  S 469, 882 

WALTON,  C.  J •     231, 

235, 237, 245,  246,  248,  253,  257, 260, 

261, 263,  265,  284,  296,  508,  519,  525 

WARD,  A.  J.  .190,  203, 294, 403,  480,  496,  632, 888 

WARD,  E.  F  •     500 

WARD,  J.  R -     501 

WARD,  S.  B 282,284,302,406, 

409, 456,  526,  531,  542,  549,  626 

WARD,  T.  B 496 

WARD,  W.  S 275,  321,  541,  662 

WARDNER,  II 231,  286,  316,  473, 

519,  527,  650,  660,  662,  665,  668,  678 


Page. 

WARNER,  A.  S 481 

WARNER,  C.  A 527 

WARNER,  J.  E 524 

WARNER,  O  49,  C65, 798,  802 

WARNER,  W.  II 302,  517 

WAEREN,  E 35,143,  144 

WARREN,  J.C 14 

WARREN,  J.  M 10, 26, 372 

WARREN,  L.  P 507 

WARREN,  W.  C 483 

WARWICK,  J.  B 233 

WASHBURN,  C.  E 254 

WASHBURN,  T.  D 593 

WASHINGTON,  B.  H 548,555 

WASSON,  J 475 

WATERMAN,  A 631 

WATERMAN,  L.  D 397,470 

WATERMAN,  W.  B 467 

WATERS,  E.  G 71,  156, 158,  209, 282,  294, 

295, 298,  301,  339,  375, 433,  550,  580, 778 

WATERS,  E.  M. . .   485 

WATERS,  W.  E 42, 315,  506,  553,  951 

WATKINS,  J 485 

WATSON,  A.  T 646 

WATSON,  R.  B 673 

WATSON,  W 254,  298, 503, 514, 

520,  525, 532,  533,  535,  553 

WATTS,  H.  H 659 

WATTS,  R 501 

WAY,  W.  R 240 

WEAVER,  J.  M 247 

WEBB.G.W 57 

WEBB,  N...  .     315 


WEBBER,  A.  C 626 

WEBER,  C.E 607 

WEBSTER,  J.  O 182 

WEBSTER,  W 87, 180, 184, 

189, 195, 202,  216,  297,  320,  361, 
457,  522,  533,  534,  535,  587,  770 

WEBSTER,  W.  S 549 

WEEDS,  J.  F 538,  542 

WEEKS,  G.  R 34,593,844 

WEEKS,  J.  F 231 

WEIDEXBACH,  A 248 

WEIDMAN,  W.  M 251,  266 

WEIR,  R.  F.  .28,  40,  41,  44, 73,  79, 84, 86, 148, 151, 
185, 244,  249,  251,  274,  276,  284,  285,  295, 308, 
315,  319,  357,  363,  462,  465,  493,  514, 517,  521, 
537,  540,  596,  606,  652,  670,  671,  768,  769,  895 

WEISEL,  D 186,303,516,519,531,535 

WEISSE,  F.  D 58 

WELBORN,  W.  P 483 

WELCH,  A 73 

WELCH,  J.  C 489,  503 

WELCH,  S.  A 524 

WELCH,  W.  B 139, 141, 144 

WELCH,  W.  M 241, 309,  436 

WELD,  F.  M 222, 267, 451,  477, 496, 503 

WELLES,  W.  L 280,  286, 

299, 314,  321, 535, 549,  776 

WELLING,  E.  L 235,  388 

WEST,  C.  P 542 

WEST,  D.  A 624 

WEST,  F 707 

WEST,  G.  S 97,99,496,501 

WEST,  W.  F 280,282,481 

WESTERLIXG,  R 55 

WESTFALL,  J 485 

WESTMORELAND,  W.  F 495,  525 

WESTON,  J.  C 840 

WEY,  W.  C 54, 676,  677 

WH ALEY,  S.  O C9 

WHARTON,  J.  T 222 

WHEELER,  J.  S 549 

WHELAN,  A.  F 227, 229, 234,  236, 276,  401, 

402,  403,  441,  452,  470,  477,  495,  496, 505,  632 
WHIMPER,  D.  W....  --.      75 


XVI 


LIST    OF    OPERATORS    AND    REPORTERS. 


Pace. 

WHISTON,  E.  A 133 

WHITAKER,  J.  L 208,  286, 549 

WHITBECK,  J.  F 468 

WHITCOMB,  J.  13 152, 157, 159, 229, 247 

WHITE,  A.  A 93,99,217,221,231,239, 

246,  248,  249,  250, 265,  390,  401,  402,  403, 
450, 477, 481, 501,  504,  527,  599,  632,  804 

WHITE,  C.  B 95 

WHITE,  E.  M 234,488 

WHITE,  H.  B 280,  283,  286, 296,  550,  555 

WHITE,  J.  A 654 

WHITE,  W.  H 218,281,676 

WHITE,  W.  J.  H 605 

WHITE,  W.  V 92,99,228,239,256, 

266, 267,  314,  485, 494,  495,  498,  504 

WHITEHEAD,  P.  F 282, 485, 

489,  507,  531,  532,  600 

WHITEHEAD,  W.  E 218,320,550 

WHITEHILL,  J.  C 592,  670 

WH1TFIELD,  G 485 

WHITFORD,  J.  H 263 

WHITING,  L 623 

WHITMAN,  F 467 

WH1TNEV,  A.  W 248,295, 

473,  474,  486, 630,  631, 884 

WHITNEY,  J.  J 238,257,448 

WH1TON,  II.  B. .  .217, 218, 235, 237, 238, 451,  503 

WHITTINGHAM,  E.  T 496 

WICKES,  S 103 

WIGHT,  C.  M 481 

WIGHTMAN.  J 518 

WILBU R,  J.  G 483 

WILBUR,  W.  II 472 

WILCOX,  T.  E 121 

WILD,  T 237 

WILDER,  A.  M 136,  222, 223,  236,  247,  249 

257,  466, 469,  470, 503, 504,  524, 802 

WILDER,  B.  G 576 

WILEY,  M 632 

WILKERSON,  W.  W 48 

WILKINSON,  T.  B 507 

WILKINSON,  W.  G 196 

WILLARD,  J 238,  276,  286,  527 

WILLIAMS,  B 57 

WILLIAMS,  J.  W 218,2:13,264,548,634 

WILLIAMS,  P.O 205 

WILLIAMS,  S.  T 48,295,462,667,795 

WILLIAMS,  T.  B 223,228, 

230,  251,  252,  474,  481,  484, 494 


Page. 

WILLIAMS.  W.  H 535 

WILSON,  A 232, 248, 253, 256 

WILSON,  A.  D 615 

WILSON,  B 58 

WILSON,  B  B. . . .  102, 178,  428, 474,  492,  551, 800 

WILSON,  C.I 217 

WILSON,  C.  L 218,230,524 

WILSON,  D.  C 395 

WILSON,  D.  G 672 

WILSON,  J  221,  464,  476 

WILSON,  J.  C 246 

WILSON,  J.  E 669 

WILSON,  J.  H 322 

WILSON,  P 58 

WILSON,  T.  H 643 

WILSON,  W.  R 484,  497 

WINDELL,  J 636 

WINNE,  C 253,  271,  322,  883 

WINNE,  C.  K 74 

WINSLOW,  G.  F 516 

WINSLOW,  J 286,  298 

WIRTH,  R 229, 255,  674 

WIRTZ,  H.  R 508 

WISE,  J 485 

WISHART,  J.  W 134, 

138,  217, 218, 220,  221,  222,  231,  232, 235,  236, 
237,  239,  240, 249,  252,  255,  256,  257,  202, 264, 
265,  266,  267,  271,  284,  300,  469,  470, 471,  472, 
473, 474,  475, 476,  484,  488, 490, 495,  496, 499, 
500,  502,  503,  597,  598,  600,  601,  602,  613,  631 

WITHAM,  J 520 

WITSELL,  C 315 

WITT,  W.  B 248,  282,  294 

WOLCOTT,  E.  B 310,  548,  635 

WOLF,  F 265, 469,  480, 483,  510,  523,  526 

WOLF,  H.  S 75 

\VOLFE,  D.  E 484,497,882,886 

WOLFE,  J.  A 26,232,233, 

249,  387,  452,  456, 466, 482, 589,  632 

WOLHAUPTER,  D.  P 783,  821 

WOLVERTON.  W.  D 459 

WOOD,  A 231,  486 

WOOD,  C.  S 55,  220,  221 , 222,  238, 

239,  248,  256,  262,  267, 273,  275, 276, 277, 
281 , 284,  297,  300, 388,  402,  466, 468,  470, 
472,  474,  477,  478,  481,  485,  487,  504,  515, 
525,  527,  532,  534,  557,  587,  588,  599,  601, 
602,  606,  613,  632,  722  821,  883,  884, 895 
WOOD,  E.  H 273 


Page. 

WOOD,  J.  G 679 

WOOD,  J.  R 439 

WOODBURY,  H.  E 535 

WOODHULL,  A.  A 377 

580 
500 


WOODHULL,  A.  W 103,394, 

WOODMAN,  L.  C 

WOODRUFF,  E 534, 

WOODS,  J.  T 82,227,339,350,: 

383, 401,  412,  415,  470,  477,  609, 

WOODS,  L.  P 224,248, 

WOODS,  P.  N 205,323, 

WOODS,  W.  S 195,  227,  255, 

WOODWARD,  B 206, 676,  766,  835, 837, 

WOODWARD,  J.  J 317, 830, 

WOODWARD,  W 

WOOD  WORTH,  J.  M 437,480, 

WOODWORTH,  M.  C 480, 

WOOLEN,  G.  V 237, 

WOOLEY,  D.F 

WOOLF,  M.  P 

WOOLSTON,  E.  B 301 ,  523,  605,  779, 

WOOSTER,  S.  R 

WORKMAN,  W.  G 

WRIG HT,  C.  B 

WRIGHT,  D.  F 47,  48,  034,  789, 

WRIGHT,  J 164, 

WRIGHT,  J.  P 

WRIGHT,  P 

WRIGHT,  P.  H 

WRIGHT,  R.  N 

WRIGHT,  T.  J 662,673, 

WRIGHT,  W.  M . .  183,  383, 482,  483,  510,  583, 

WYER,  J.  P 

W  YLIE,  F 

W  YNKOOP,  A 294, 

WYNNE,.!  J... 


WYNNE,  W.  B 219,484, 

YANDELL,  D.  W 135, 

YANDELL,  H 

YATES,  P.  C 

YORK,  I.  II 

YOUAL,  J.  M 603, 

YOUNG,  D.  S 229,  253,  255,  294,  485,  480, 

YOUNG,  H.  N 

YOUNG,  J.  A 

YOUNG,  S.J 

YOUNG,  W.  P 481,483,504, 

YOUNGLOVE,  J 265, 

ZEARING,  J.  R. . .  .84,  240, 245, 275,  484,  026, 


564, 
619 
885 
490 
588 
855 
956 
252 
552 
525 
309 

52 
631 
792 
218 
523 
519 
790 
665 
869 
778 
554 
582 
675 
672 
380 
501 
519 

92 
890 
138 

75 

sa3 

769 
667 
524 
501 
197 
281 
524 
606 
883 


SUBJECT-MATTER    INDEX 


OF  THE 


MEDICAL  AND  SURGICAL  HISTORY  OF  THE  WAR  OF  THE  REBELLION. 


Abdomen,  injuries  of,  II.  1-208;  III,  689.  Parietal  wounds,  II,  3;  punc 
tured  and  incised  wounds,  II,  302;  sabre  wounds,  II,  3,  8;  III,  686; 
rupture  and  protrusion  of  intestines  after  sabre  wound,  II,  3;  bayonet 
wounds,  II,  3,  8;  III,  686;  other  punctured  and  incised  wounds,  II, 
4,  8;  III,  653;  lacerated  and  contused  wounds,  II,  4,  8;  rupture  of 
muscles,  II,  5.  Shot  flesh  wounds,  II,  6 ;  III,  689 ;  mortality  rates  of, 
II,  7;  tabular  statement  of  injuries  of  parietes,  II,  8.  Complications 
of  parietal  wounds,  II,  8;  haemorrhage.  II,  8;  foreign  bodies,  II,  11; 
gangrene,  II,  8,  12;  hernia,  II,  13;  nervous  disorders,  II,  13;  tetanus, 

II,  14.     Shot  contusions,  III,  689.     Visceral  injuries  without  external 
wounds,  II,  15-28;  III,  689;  tabular  statement  of,  II,  26;    diagnosis 
and  treatment  of,  11,27-28;  ruptures  of  liver,  II,  ]6;  of  spleen,  II,  18; 
of  kidney,  II,  20;  of  stomach,  II,  22;  of  intestines,  II,  22;  of  omentum 
and  mesentery,  II,  23;  of  blood-vessels,  II,  24;  of  diaphragm,  II,  25. 
Penetrating  wounds.  II,  29;  111,689;  penetrations  without  visceral 
injury,  II,  29-40,  202;  by  bayonet,  II,  31-33,39;  by  arrow,  11,33; 
by  ramrod,  II,  33 ;  shot  wounds,  II,  34-39 ;  III,  689 ;  autopsies,  II,  32, 
36.     Diagram  of  subdivisions  of  abdominal  region,  II,  97.     Injuries 
of  abdomen  involving-stomach,  see  Stomach;  involving  intestines, 
see  Intestines;  involving  liver,  see  LJver;   involving  pancreas, 
see  Pancreas;  involving  spleon,  see  Spleen;  involving  kidneys, 
see  Kidneys;   involving  suprarenal  capsules,  see  Supra  Renal 
Capsules ;   involving  omentum,  mesentery,  and  blood-vessels,  see 
Omeiitum,  Mesentery,  and  Klood-vessels.     Complications  of 
penetrating  wounds  of  the  abdomen.  11,176;  haemorrhage,  II,  176; 
foreign  bodies,  II,  179;  visceral  protrusions,  II,  180;  hernia,  II,  184; 
abdominal  effusions,  II,  188;  air  or  gases,  II,  198;   traumatic  peri 
tonitis,  II,  199.    Frequency  of  wounds  of  abdomen,  II,  201 ;  mortal 
ity,  II,  202 ;  diagnosis  and  treatment,  II,  20C.-207. 

Abdominal  Effusions,  II,  188;  of  blood,  II,  189,  190;  of  bile,  II,  192; 
of  urine,  II,  193;  of  faeces,  II,  194;  of  pus,  II,  197. 

Abscess,  in  shot  wounds  of  head,  I,  127;  in  cerebrum,  I,  327  ;  air  passing 
through  opening  in  abscess  of  neck,  I,  360;  abscess  around  balls,  I, 
404  ;  metastatic  abscesses  of  lung,  I,  626,  628;  II,  841,  844,  920;  III, 
431,  455;  of  liver,  I,  443,  585;  II.  216,  772,  781,  843;  III,  431,  547; 
of  spleen,  II,  151,  813;  III,  547;  of  kidney,  II,  171. 

Acetabulum,  shot  fractures  of,  II,  179;  III,  05,  68,  78-79,  80,  81. 

Acromial  Thoracic,  aneurism  of,  III,  8C8;  haemorrhage  from,  II,  459; 

III,  704  ;  ligation  of  branch  of,  II,  632;  III,  765,  776.     . 
Actual  Cautery  in  haemorrhages,  II,  320,  456,  736;  III,  811. 
Acupressure,  III,  811. 

Air,  accumulation  of,  in  abdomen,  II,  19?. 

Air  Passages,  operations  on,  I,  415;  III,  684. 

Amaurosis  in  wounds  of  head,  I,  38,  116,  178,  208,  228,  232,  289;  pro 
duced  by  wind  of  shell,  I,  344. 

Ambulance  Corps,  III,  931-943;  officers  of,  III,  913,  914;  plans  for 
organization  of:  by  Dr.  H.  H.  SMITH,  III,  932;  Surgeon  B.  A.  VAN- 
DERKIKFT,  III,  935;  C.  PFIRSCH1XO,  111,932;  organization  and  man 
agement  of,  III,  935,  938,  939,  941 ;  act  of  Congress  establishing,  III, 
941,  943. 

Ambulance  Train,  III,  902. 


Ambulance  Wagons,  III,  944-957;  MOSES,  III,  945-946;  FIXLEY, 
two-wheeled,  III,  946;  COOLIDGE,  two-wheeled,  III.  947;  TniPl.EK, 
III,  947;  ROSECRANS,  III,  948;  COOLIDGK,  four-wheeled,  111,949; 
St)s,  111,951;  ARXOLU,  III,  951;  MCKEAX,  III,  952;  I'F.KOT  &  Co., 
111,952;  RUCKER,  III,  952;  HOWARD,  III,  953;  LAXGER,  III,  955; 
Confederate,  III,  956. 

Amputations,  analysis  of  total  number  of,  III,  877-886;  mortality  rates 
of,  III,  678 ;  primary  amputations,  III,  879 ;  intermediary,  III,  879 ; 
secondary,  III,  879;  methods  of.  III,  880;  double  amputations,  III, 
880.  See  Shoulder  Joint,  Arm,  Elbow  Joint,  Forearm, 
"Wrist  Joint,  Hand,  Fingers,  Hip  Joint,  Thigh,  Knee 
Joint,  Leg,  Ankle  Joint,  Foot,  Toes,  Penis. 

Anaesthetics,  III,  887-898;  number  of  cases  of,  III,  887;  agents  used, 
111,887;  mode  of  administering,  III.  889:  MARSHALL  HALL'S  mode, 
III,  889;  administered  by  CHISOLM's  inhaler,  III,  889;  deaths  from, 
III,  890-895;  restoration  of  animation  suspended  by  anaesthetics,  III, 
895;  cases  of  anesthetics  in  the  U.  S.  Army  since  the  war,  III.  896; 
chloroform,  III,  897;  ether,  III,  897;  chloroform  and  ether,  III,  897; 
prostration  following  anaesthesia,  III,  897:  excitement,  III,  897; 
vomiting,  III,  897. 

Anal  Fissure,  treated  by  incision  or  by  rupture  of  the  sphincter,  II,  321. 

Anal  Fistula,  number  of  instances  of.  II,  321 ;  treatment  of,  II,  321. 

Anaplasty,  cases  of,  II,  77,  79,  91 ;  unnecessary  and  ineffectual,  II,  111. 

Anastomotica  Magna  of  brachial,  wounds  of,  II,  457;  III,  764;  liga 
tion,  II,  454;  III,  765,  782;  of  femoral,  haemorrhages  from,  III,  764. 

Anchyloblepharon,  operation  for,  III,  683. 

Aneurism,  traumatic,  III,  808;  of  acromial  thoracic,  III,  808;  aorta.  II, 
189;  axillary,  11,468;  111,808;  brachial,  II,  4fi3,  468;  III,  680,808; 
carotid,  II,  499;  111,679,808;  circumflex,  111,808;  femoral,  III,  38, 
39.  40,  42,  45,  46,  808 ;  iliac,  III,  808 ;  innominata,  III,  808 ;  intercostal, 
11,597;  interosseous,  III,  808;  superior  mesenteric,  II,  2o;  peroneal, 
111,808;  popliteal,  III,  14,680,  808;  profunda,  III,  49, 808 ;  pudic,  II, 
252;  III,  808;  radial,  11,969.  1010;  111,808:  sciatic,  111,808;  sub- 
clavian,  II,  632, 634,  635 ;  III,  808 ;  suprascapular,  III,  808  ;  tibial.  Ill, 
55, 673,  808 ;  diffuse  traumaticaneurism,  1, 446, 555 ;  III,  755 :  following1 
bayonet  wounds,  II,  323,  335. 

Ankle  Joint,  wounds  and  operations  of,  III,  577-61G;  shot  injuries  of, 
111,577,  608-610;  periarticular  wounds  of,  III,  31,  690;  shot  con 
tusions  of,  III,  577,  690,  716;  shot  fractures  of.  III,  578,  690,  870; 
treated  by  conservation,  III,  579;  treated  by  excision,  III,  585,  610- 
612;  primary  excisions,  III,  586;  intermediary  excisions,  III,  588; 
secondary  excisions,  III,  591;  autopsy,  III,  590;  treated  by  amputa 
tion,  III,  595,  608,  612,  616;  primary  amputations,  III,  596,  598; 
intermediary  amputations,  III,  603;  secondary  amputations.  III,  606; 
SYME'8  operation,  cases  of,  III,  596-615;  PlROGOFF's  operation, 
cases  of,  III,  596-615;  BOXTECOU'S  modification  of  PntOGOKF,  cases 
of,  III,  604,  605,  606  ;  BAUDEX'S  operation,  cases  of,  III,  604  :  modifi 
cation  of  SYME,  cases  of,  III,  601 ;  amputations  following  excisions, 
III,  870;  re-amputations  following  amputations  at  ankle.  III,  870; 
miscellaneous  injuries  of  ankle  joint,  dislocations,  III,  648;  fractures, 
III,  652;  excisions  of,  III,  657-658,  659;  amputations  at,  III,  664. 

(XVTl) 


XVIII 


SUBJECT-MATTER    INDEX. 


Antiseptic  treatment  of  wounds  on  field  of  battle,  III,  418,  419. 

Anus,  abnormal,  II,  100;  instruments  for  destroying- septum:  DUPUYTEEX's 
enterotome,  BLASIUS*  intestine  pincers,  Gnoss'8,  REYBAKD'S  instru 
ments,  II,  110,  111 ;  DESAULT'S  operations  on  abnormal  anus,  II,  113; 
PAI.FYX'S  method,  II,  114,  280 ;  artificial  unus,  II,  109,  113 ;  operation 
to  produce  artificial  anus,  II,  84 ;  prolapsus  of,  II,  254. 

Aorta,  aneurism  of,  II,  189;  ball  encysted  between  aorta  and  vena  cava, 
II,  135 ;  wounds  of,  I,  519 ;  ecchymosis  of  arch  of,  I,  572;  exposed  to 
view  in  shot  wound  of  chest,  I,  487,  597;  haemorrhage  from  descend 
ing,  III,  7C4. 

Aphonia  in  shot  wounds  of  cranium,  I,  47,  108,  266,  283,  338,  382;  voice 
restored  after  hoemorrhage  from  fauces,  I,  46 ;  restored  during  vomit 
ing,  I,  635. 

Apparatus,  for  excisions  of  head  of  humerus,  II,  5G8,  5C3,  580,  594 ;  for 
excisions  in  shaft  of  humerus,  II,  075 ;  for  excisions  at  elbow,  II,  849, 
907,  9C8;  for  double  amputation  of  forearm,  II,  9C8;  for  dangle  wrist, 
II,  1015 ;  for  amputation  at  the  hip,  III,  131, 1C2 ;  for  excision  in  shaft 
of  femur,  III,  202;  for  amputation  of  both  thighs,  III,  224;  for  frac 
tures  of  femur,  III,  343-349. 

Arachnitis  after  bayonet  wound  of  cranium,  I,  32;  after  shot  wounds  of 
cranium,  I,  53,  113,  125,  298. 

Arm,  shot  injuries  of,  II,  807-815;  carried  away  by  missile,  II,  C20,  622, 
623,  625,  628,  629,  031,  632,  633,  034,  636 ;  amputation  of,  for  shot  flesh 
wounds,  II,  400,  470;  amputations  of,  for  shot  fractures,  II,  697;  pri 
mary  amputations  of,  11,697-750;  autopsies,  II,  717,  736,  748;  inter 
mediary,  II,  752-775;  autopsy,  II,  772;  secondary,  II,  775-792; 
autopsy,  II,  781  ;  mortality  of  amputations  of,  II,  805-807,  824  ;  large 
mortality  in  amputations  in  lower  third,  II,  824  ;  ages  of  patients  in 
amputations  of,  II,  806;  amputations  of  arm  in  eastern  and  western 
armies,  II,  807. 

Arnold's  ambulance  wagon,  III,  951. 

Arrow  Wounds,  of  cranium,  I,  34;  penetrating  abdomen,  II,  33;  of  blad 
der,  II,  276;  of  knee  joint,  III,  653. 

Arteries,  statistics  of  wounds  of,  III,  763;  frequency  of  hemorrhages 
from,  III,  763;  erysipelas,  gangrene,  pyaemia,  and  tetanus  in  injuries 
of,  III,  763;  primary  injuries  of,  II,  621, 622,  025,  026, 027;  III,  763-705; 
primary  haemorrhages  in  wounds  of,  III,  763,764,765;  enlargement 
of  arteries,  III,  007;  ossification  of,  III,  652;  torsion  of,  II,  842;  athe- 
roma  of,  III,  810;  ligation  of,  to  control  inflammation,  III,  377,  383; 
transportation  in  cases  of  wounded  arteries,  III,  810  ;  occlusion  of,  by 
impacted  ball,  III,  756 ;  ligations  of,  III,  765.  See  the  several  arteries, 
Aorta,  etc. 

Arteriotomy  in  concussion  of  brain,  I,  37. 

Arthritis,  traumatic,  I,  1 16 ;  II,  490,  493 ;  HI,  27,  28, 54,  287,  290,  552. 

Articular  Arteries  of  popliteal :  haemorrhages,  III,  764 ;  ligations,  III, 
765;  primary  injury  of,  III,  704. 

Artificial  pupil,  operations  for,  III,  681,  682. 

Ascites,  paracentesis  abdominis  in  cases  of,  II,  191 ;  in  wound  of  bladder, 
II,  273. 

Asphyxia,  in  wounds  of  face,  I,  350;  of  neck,  I,  417,418,419;  of  chest,  I, 
516;  of  spine,  I,  427, 452. 

Astragalus,  excisions  of,  III,  585,  587,  588,  591,  595,  624. 

Atheroma  of  arteries,  III,  810. 

Auricular  Artery,  hemorrhages  from,  I,  101,  224,  393;  III,  763;  liga 
tions  of,  I,  233  ;  III,  705,  771;  primary  injury  of,  III,  763;  primary 
haemorrhage  from,  III,  703. 

Axillary  Artery,  aneurisms,  I,  528,539,  541,  542,  543,  545;  II,  443,  455, 
468,  572,  650 ;  III,  808 ;  wounds  of,  I,  538, 539,  553 ;  II,  443,  454  ;  III, 
764;  primary  haemorrhages  of,  III,  704;  ligations  of,  I,  553,  556;  II, 
442,  444,  468,  042-644,  047,  780 ;  III,  511,  6U2,  679,  705;  summary  of 
cases,  III,  775;  limits  of,  II,  444;  days  intervening  between  injury 
and  haemorrhage,  II,  442. 

Axillary  Pad,  STROMEYEU'S,  II,  517. 

Axillary  Vein,  wounds  of,  I,  539, 542,  555;  II,  640;  ligations  of,  1, 539, 555. 

Back,  bayonet  wound  of,  I,  356;  II,  429;  III,  686;  incised  wound  of,  III, 
653;  punctured  wounds  of,  II,  429;  shot  flesh  wounds  of,  II,  427,  428, 
429-432;  III,  689;  gangrene  in  wounds  of,  II,  432. 

Balls,  varieties  of,  III,  697;  with  guiding  attachment,  III,  7CO;  balls 
lodged  in  brain,  I,  251,252,255,258;  in  face,  I,  316;  in  ilium,  II,  216, 
222;  in  bladder.  II,  271, 272, 273, 286;  innocuously  in  knee  joint  over 
fifteen  years,  III,  372;  between  innominata  and  vena  cava,  I,  534; 
against  innominata,  I,  521;  embedded  in  parotid  gland,  I,  305;  con 
cealed  under  petrous  bone,  I,  367;  held  in  folds  of  omentum,  II,  147; 


ball  encysted:  in  brain,  I,  204,302;  near  lung,  I,  587;  between  vena 
cava  and  aorta,  II,  135;  in  mesenterio  pouch,  II,  179;  in  thigh,  II, 
100,  425;  in  penis,  II,  345;  ball  pressing  on  nerve,  I,  410;  balls  ex 
tracted,  I,  309,  316;  II,  11, 12, 218, 235,  283;  by  trephine,  I,  366;  balls 
ejected  in  coughing,  I,  329,  342, 404,  4C5,  431,  596,  598,  629;  ball  ulcer 
ating  into  cavity  of  lung,  I,  493;  ball  inverting  in  wound,  I,  532;  II, 
619;  acting  as  plug  in  injured  bleed-vessels,  III,  750;  balls  voided  at 
stool,  I,  515,  584,  598;  II,  36,  37,  70,  <:9-101 ;  erratic  course  of,  II,  134, 
368,487;  brush  of,  III,  706,  707;  windage  of,  I,  344,  385;  III,  706, 
707;  ball  flattened  by  contact  with  bone,  III,  717;  balls  split:  on  cra 
nium,  I,  180-182;  on  bones  of  face,  I,  338;  on  bones  of  chest,  I,  503, 
570,  577,  593;  on  ilium,  II,  232;  on  tibia,  III,  717,  718.  See  Co- 
noidal  Balls,  Musket  Balls,  Explosive  Balls,  Missiles. 
Bandaging,  results  of  injudicious,  II,  513,  517;  III,  867.  SEUTIN'S  starch 
bandage,  III,  020. 

Battles  and  Engagements,  chronological  summary  of,  I,  xxiii-clv. 
Bayonet  "Wounds,  III,  085,  686,  687;  relative  percentage  of,  to  sabre  and 

shot  wounds,  III,  685,  687;  of  scalp,  I,  30,  31;  of  cranium,  I,  31-34; 

efface,  I,  323,  324;  of  neck,  I,  400;  of  chest,  I,  467,  470,  599;  of  heart, 

I,  468;  of  abdomen,  II,  3, 4,  31, 32,  323, 335;  of  flesh  wounds  of  lower 
extremities,  III,  5,6;  of  knee  joint,  III,  300;  of  foot,  III,  017. 

Bed-cards,  form  of,  I,  xviii. 

Bile,  extravasation  of,  II,  192, 193 ;  escape  of,  in  shot  wounds  of  liver,  II, 
142, 143. 

Bladder,  injuries  of,  II,  202-303;  ruptures  of,  II,  203;  punctured,  incised, 
and  lacerated  wounds  of,  II,  203;  arrow  wound  of,  II,  270;  concus 
sions  of,  II,  264;  shot  wounds  of,  II,  264;  frequency  and  fatality,  II, 
264;  III,  689;  diagnosis  and  treatment,  301,  302;  opium,  303;  autop 
sies,  II,  268,  291,  292,  293,  295, 296;  foreign  bodies  in,  II,  208;  autopsy, 

II,  425;  clothing  removed  from,  II,  280;  bone  removed  from,  II,  277, 
278,  279;   missiles  removed  from,  II,  270-281;  puncture  of,  II,  305, 
370,  381,  385.     See  Lithotomy. 

Bleeding  from  injured  artery  arrested  by  lodgement  of  ball,  III,  750;  pri 
mary,  III,  703, 764. 

Blepharoplasty,  I,  368. 

Blood,  extravasation  of:  in  contusions  of  cranium,  I,  03,  112;  in  fractures 
of  cranium,  I,  67;  in  brain,  I,  332;  in  abdomen,  II,  189,190,191;  in 
pelvic  cavity,  II,  220;  transfusion  of,  II,  042;  III,  811. 

Blood-vessels,  injuries  of,  by  round  ball,  III,  750;  by  conoidal  ball,  III, 
750;  by  fragments  of  shell,  III,  75(i;  by  spiculte  of  bone,  III,  755, 
756;  shot  contusions  of,  III,  755;  complete  division  of,  III,  752;  par 
tial  division  of,  III,  754;  retraction  after  injury  of,  III,  752,  754;  pri 
mary  injury  of,  III,  763,  764;  primary  bleedings  from,  III,  7ti3,  704; 
of  abdomen,  II,  24,  174,  175,  202;  III,  689;  of  chest,  I,  650;  ligation 
of,  I,  521, 525.  See  Arteries,  Veins, 

Bone,  early  removal  of  fragments  of,  I,  598;  II,  235;  III,  416,807;  union 
of,  III,  203, 208,  211,  212;  formation  of  new,  III,  182,  223;  wiring  of, 

II,  819, 820;  III,  212;  drilled  to  facilitate  formation  of  callus,  III, 
659;  osteitis  in  contusions  of,  II,  818;  fragments  of,  removed  from 
bladder,  II,  277, 278, 279. 

Bone  Forceps,  II,  256,  and  plate  opposite. 

Bougies,  II,  405. 

Brachial  Artery,  aneurisms  of,  II,  444,  463,  468,  470;  III,  080,  808;  in 
cised  wound  of,  III,  680;  punctured  wound  of,  II,  430;  shot  injuries 
of,  I,  553;  II,  445,455,027,  074;  III,  704;  primary  haemorrhages  from, 

III,  764,  765;  obliteration  of,  II,  407;  ligations  of,  I,  553;  II,  446,  650, 
700, 763,  764,  709, 773,  774,  785,  840,  843,  920,  955,  958,  959,  980,  1010; 
III,  663,  680;  summary  of  cases,  III,  705,777-782. 

Brachial  plexus  of  nerves,  wounds  of,  I,  409,  410,  401,  402. 

Brachial  Vein,  haemorrhages  from,  III,  810;  wounds  of,  II,  430;  liga 
tions  of,  II,  436,  446,  448. 

Brain,  shot  concussion  of,  I,  37,  65-67;  treatment  by  cannabis  indica,  109, 
113, 118, 121, 122, 125,  308;  compression  of,  after  shot  wounds,  I,  18,  21, 
38,  67, 126;  after  miscellaneous  injuries,  III,  640;  loss  of  substance  of, 
I,  208,210,  218,  235,  241,  242,  257,  260;  laceration  of,  I,  37,  39,  40,67; 
pus  in,  1, 126;  inflammation  of,  I,  111;  exposure  of,  I,  40, 133, 102, 170, 
199;  ball  encysted  in,  I,  204,  302.  See  Cerebral  Hernia. 

Bromine  in  cases  of  gangrene,  III,  292,  634. 

Buccal  Cavity,  shot  wounds  of,  I,  392. 

Buck  and  Ball,  III,  7CO;  injuries  by,  III,  710,714. 

Burns  and  Scalds,  III,  641. 

Bushe's  Compressor  for  haemorrhage  in  rectum,  n,  320. 

Buttocks,  flesh  wounds  of,  II,  428. 


SUBJECT-MATTEE    INDEX. 


XIX 


Cacolets,    III,    926-931;  caoolets  of:    KoHLEii;   PUOAL;  LAWRENCE, 

BRADLEY  &  PARDEK;  DAVIS;  WOODCOCK;  JOXE8;  SPENCER, 
NICHOLS  &  CO.,  and  POMEBOY  &  CO. 

Calcaneuin,  injuries  of,  see  Os  calcis. 

Calculi,  vesical,  II,  269-283;  around  foreign  bodies,  II,  298;  formed  on 
projectiles,  II,  27],  272, 273,  274,  275,  276;  on  hair,  II,  281 ;  passed  by 
urethra,  II,  376;  instruments  for  crushing,  II,  378-379;  renal,  III,  540. 

Canister-shot,  nature  of  injuries  by,  III,  696,706;  description  of,  111,697. 

Camiabis  Indica  in  cerebral  disturbances,  I,  58. 

Carditis  in  shot  wounds  of  chest,  I,  622. 

Caries  in  shot  contusions  cranial  bones,  I,  106, 128. 

Carotid  Artery,  aneurisms  of,  I,  355;  11,499,500;  111,679,808;  wounds 
of  common,  I,  350,  352,  353,  412,  416,  420,  421  ;  II,  500 ;  III,  679,  751 ; 
of  external,  I,  347,  421 ;  of  internal,  I,  432,  456 ;  occlusion  of  com 
mon,  by  impacted  ball,  III,  756;  rupture  of  common,  during  cough 
ing,  I,  350 ;  haemorrhages  from,  III,  763 ;  ligations  of  common,  I, 
421;  111,766,767-770;  disadvantages  of  AXEL'S  operation.  I,  423; 
ligation  of  external,  III,  765,  770. 

Casualties  among  army  surgeons,  I,  xxx-xxxii. 

Cataract,  traumatic,  I,  193,  340,  345;  operation  for,  III,  681. 

Catheters,  II,  380-384 ;  of  SQUIRE,  II,  302 ;  of  GAUJOT  and  SPILLMAX, 

II,  381;  catheter  found  at  Pompeii,  II,  382;  curved  gum-elastic,  II, 
382;  of  IIEISTER,  II,  382;  of  BOYER,  II,  386;  catheter  gouge,  II,  384; 
unsuccessful  attempts  to  introduce,  II,  352,  365,  370,  373 ;  broken  in 
dilating  stricture,  II,  376;  broken  in  wound,  II,  379;  use  of,  causing 
fistulas,  II,  3G3 ;  essential  in  wounds  of  urethra,  II,  351, 354;  in  wounds 
of  penis,  II,  348. 

Cerebral  Artery,  haemorrhage  from,  I,  269;  III,  764. 

Cerebral  Hernia,  after  sabre  fractures,  I,  27;  after  bayonet  fractures,  I, 
32:  after  miscellaneous  injuries,  1,44,  58,  60;  after  shot  contusions 
cranial  bones,  I,  123;  after  shot  fractures  cranium,  I,  206,  210,  211, 
212,  249,  260 ;  excisions  of,  I,  294-298,  302,  303 ;  summary  of  opera 
tions,  1,309,317,318. 

Cervical  Artery,  Superficial,  hemorrhage  from,  III,  764 ;  ligations, 

III,  765,  774. 

Cervical  plexus  of  nerves,  wound  of,  I,  405. 
Cheek,  shot  wounds  of,  I,  387. 
Cheiloplasty,  I,  374. 

Chest,  injuries  of,  465-650;  frequency  of,  I,  509,  600,  602,  603;  mortality  in, 
I,  604-611.  Miscellaneous  injuries  of,  I,  460  ;  punctured  wounds  of, 

I,  599 ;  incised  wounds  of,  I,  470,  471,  534,  599 ;  incised  wound  of  ster 
num,  I,  534.     Sabre  wounds  of,  I,  466,  471,  599;  III,  G86.      Bayonet 
wounds  of,  I,  467,  470,  599 ;  autopsy,  I,  468.     Contused  wounds  of,  I, 
471,599.     Shot  wounds  of,  I,  472-050;    III,  689;  shot  flesh  wounds 
of,  I,  470,  473,  599 ;  111,089;  shot  penetrations  of,  I,  599,  600,  606 ;  per 
forations  of,  I,  600;  fractures  without  penetrations  of,  I,  473,  474-476; 
autopsies,  I,  474,  475,  470;  internal  without  external  injuries  of,  I, 
470,  477;  penetrations  of,  without  fracture,  I,  478-482;  penetrations 
of,  with  fracture,  I,  482-495;  with  fracture  of  scapula,  I,  483,  484,  486, 
etc.;  of  ribs,  I,  482,  484,  485,  etc.;  of  clavicle,  I,  482,  484,  etc.;  of  ster 
num  I,  480,  488,  etc.;  penetrations  involving  lung,  I,  492-497,  634  ;  her- 
metical  sealing,  1,497-514;  involving  blood-vessels,  I,  519-528;  per 
icardium  and  heart,  I,  5J8-530;   mediastinum,  I,  486,  530,  535,  589; 
thoracic  duct,  I,  535;  lodgement  of  missiles  in,  I,  606,  617;  haemor 
rhage  in  wounds  of,  I,  Oil  ;  complications  in  wounds  of,  I,  472,  631, 
633,  634-638;  treatment  of  wounds  of,  I,  042;  operations  on,  537. 

Chisolm's  Inhaler,  III,  889. 

Chloroform,  percentage  of  surgical  operations  in  which  it  was  used.  Ill, 
887;  value  and  efficiency  of,  III,  888;  deaths  from,  III,  890-894; 
HALL'S  method  of  artificial  respiration,  II,  242  ;  quantities  required 
to  induce  anaesthesia,  III,  890;  period  during  which  it  was  main 
tained,  III,  8:J6;  vomiting,  excitement,  prostration  after  administra 
tion  of,  III,  897;  use  of  stimulants  prior  to  administration  of.  Ill,  889; 
larynx  opened  to  restore  life  after  administration  of,  II.  841. 

Chloroform  and  Ether,  III,  8S8;  deaths  from,  III,  8!)4  ;  time  to  induce 
anasstbcsia,  III,  800;  period  during  which  it  was  maintained,  III, 
890;  vomiting  and  excitement  after  administration  of,  III,  897. 

Circumcision  for  phiinosis,  II,  301,  374. 

Circumflex  Artery,  of  axillary,  aneurism  of,  III,  808 ;  incised  wound  of, 

II,  498  ;  shot  wound  of,  II,  557;  III,  704  ;  ligations  of,  I,  557  ;  II,  454, 
408,  498,  525,  551,  590,  605,  629,  649,  682;  III,  705,  777;- circumflex  of 
femoral,  haemorrhage  from,  III,  704  ;  circumflex  of  iliac,  II,  324  ;  III, 
764. 


Civiale's  Uthotrite,  II,  378. 

Clavicle,  sabre  fractures  of,  II,  474;  III,  G8G;  bayonet  fractures  of,  II, 
474  ;  III,  C6G ;  shot  fractures  of,  II,  474 ;  III,  690,  870 ;  autopgiei,  II, 
491 ;  excisions  in,  I.  557-562, 598;  II,  477,  489,  497-499;  III,  870;  sim 
ple  fracture  of,  from  fall,  I,  562. 

Climate,  effects  of,  on  treatment  of  wounds,  III,  867,  808. 

Coccyx,  shot  fractures  of,  II,  252;  treatment,  II,  253. 

Colica  Media  Artery,  haemorrhage  from,  III,  704 ;  wound  of,  II,  69. 

Colon,  punctured  wounds  of,  II,  70;  incised  wounds  of,  II,  76;  shot 
wounds  of,  II,  77-105,  155,  179,  288,  309,  318,  331. 

Compression,  for  hemorrhage,  II,  9, 10,  320,  922,  932 ;  III,  515,  537,  509, 
810;  in  wounds  of  abdominal  parietes,  II,  9,  10;  in  scalp  wounds,  I,  16. 

Compressor,  BL'SHK'S,  for  haemorrhage  in  rectum,  II,  320. 

Confederate  hospital  records.  I,  xx. 

Conoidal  Rails,  injuries  by,  III,  090 ;  effectiveness  of,  III,  709 ;  range 
of,  III,  709;  appearance  of  injuries  by,  III,  711;  varieties  of,  III, 
697;  power  of  penetration,  III,  757. 

Contre-Coup,  I,  214,  304,  305,  306. 

Contusions,  shot,  of  bone,  III,  716;  of  blood-vessels,  III,  755. 

Contusions  and  Sprains,  III,  642. 

Coxitis,  traumatic,  III,  9,  25,  26,  27. 

Cranium,  sabre  fractures  of,  I,  16-28;  of  frontal  bone,  I,  16, 18, 19,  20,  21, 
22;  of  occipital,  I,  17,  18,  20,  21,  23;  of  parietal,  I,  16,  17,  18,  19,  20, 
21,  22,  23;  of  temporal,  I,  21,  23;  of  sphenoid,  I,  33;  exfoliation  of 
cranial  bones  after  sabre  fractures  of,  I,  17,  20,  21,  24 ;  necrosis  of,  I, 
18,  21;  trephining  after  sabre  fractures  of,  I,  17,  22,  23,  24;  pyaemia 
after  sabre  fractures,  III,  687.  Bayonet  fractures  of,  I.  31-34,  308  ;  of 
frontal,  I,  32,  33;  of  parietal,  31,  32,  33;  treatment  of  bayonet  frac 
tures  of,  I,  34.  Sabre  and  bayonet  fractures  of,  III,  686,  687.  Miscel 
laneous  injuries  of:  railroad  accidents,  falls,  blows,  falling  trees, 
kicks,  I,  35-69,  305,  308;  fracture  external  table  only,  I,  54,  55,  68; 
bone  removed,  I,  55,  57,  09 ;  trephining  of  cranial  bones,  I,  57-60,  69  ; 
III,  657.  Shot  contusions:  frontal,  parietal,  temporal,  and  occipital 
bones,  I,  95-128,  308;  III,  088;  exfoliation  of,  after  shot  contusions, 
I,  102,  103-106,  114,  119,  122,  123,  127 ;  removal  of  exfoliation,  I,  103, 
104,  105,  114;  trephining  for  shot  contusions  of,  I,  122-126;  balls 
lodged  in,  I,  96,  101,  102,  103,  105,  109;  balls  removed  from,  I,  97, 
101,  102,  103,  105,  109.  Shot  fractures  of  external  table  alone,  I, 
128-H1,  307 ;  III,  688 ;  of  temporal  bone,  1, 131, 132,  130, 137 ;  frontal, 
I,  128-139;  of  occipital,  I,  134,  135,  138,  139;  of  parietal,  1,132,  133, 
134,  137, 138;  exfoliation  removed,  I,  132;  bone  removed,  I,  129,  130, 
134,  135;  ball  lodged  in,  I,  130,  131,  136  ;  ball  removed  from,  1, 130, 
131,  136.  Shot  fractures,  inner  table  alone,  I,  141-159,  307,  III,  688 ; 
trephining  for  shot  fractures  of  inner  table,  I,  148,  149.  Shot  frac 
tures  of  both  tables,  1, 159-214  ;  linear  or  capillary  fissure,  1, 159-160 ; 
autopsies,  I,  159-160;  III,  688.  Shot  fractures  of  both  tables,  with 
out  depression,  I,  101-167;  III,  688;  numerical  statement  of  cases  of, 
I,  307;  mortality  of,  I,  307.  Shot  fractures  of  both  tables,  with 
depression,  I,  167-190;  III,  688;  balls  splitting  on  the  cranial  bones, 
I,  180-182;  balls  lodged,  I,  169,  179,  180,  182,  184;  balls  removed 
from,  I.  168,  170,  175,  177,  178,  181,  383, 190;  numerical  statement,  I, 
307.  Shot  penetrating  fractures,  I,  190-206,  307;  III,  688;  balls 
lodged  within  the  cranial  cavity,  1, 191,  192,  193-196,  200,  201,  202, 
203,  204,  205,  206;  missiles  extracted  from  within  the  cranium,  I,  191, 
190-200,  201,  203;  exfoliations,  I,  192,  190.  Shot  perforations,  I, 
206-212,  307;  III,  688;  exfoliations  after  shot  perforations,  I,  208; 
ecrasemeut,  crash  or  smash.  I,  213-214,  307;  III,  688.  Removal  of 
fragments,  I,  215-261 ;  lodgement  of  foreign  bodies,  I,  230,  237,  251 ; 
exfoliations,  I,  215,  223,  227,  2C8,  231,  240.  Trephining  after  shot 
fractures,  I,  261-293,  299,  316,  317,  319,  320.  Contre-coup,  I,  304,306, 
307;  III,  688.  Tabular  statement  of  operations  on  cranium,  I,  309. 

Crural  Nerve,  shot  wounds  of,  I,  440  ;  II,  400;  III,  9,  74,  823. 

Cuboid  Bone,  excision  of,  III,  625.  626,  627. 

Cuneiform  Bone,  excision  of,  III,  623,  G2fi,  627. 

Cutaneous  Nerve,  external,  injurj  of,  II,  404,  470;  excision  of,  II,  470; 
internal,  wound  of,  II,  462,  463,  928;  excision  of,  II,  462. 

Cystitis,  II,  221,  238,  239,  267,  287,  309,  356,  370. 

Deglutition,  difficulty  of,  in  shot  wounds  of  nock.  T.  403.  405.  411,  413; 
in  shot  wounds  of  cranium,  I,  263. 

Dental  Artery,  haemorrhage  from,  I,  340,  353. 

Diaphragm,  bayonet  wounds  of,  I,  467,  409 ;  punctured  wound  of.  II,  76 ; 
shot  wounds,  I,  536,  606,  634  ;  ball  lodged  in,  I,  480;  rupture  of,  with 
out  external  wound,  II,  25;  hernia  of,  I,  515,  516. 


XX 


SUBJECT-MATTER    INDEX. 


Diastasis  of  crauial  bones,  J,  213. 

Digital  Arteries,  injuries  of,  II,  459;  III,  764;  ligationsof,  II,  454;  III, 

765,  785,  786. 
Dilatation,  in  strictures  of  urethra.  II,  368;  instruments  for,  by  PEKUEVE, 

II.  387;  by  SHEl'i'AUD,  II,  388;  by  WAKLKY,  II,  388;    by  MALLKZ, 

II,  389;  by  MlCHELEXA,  II,  389;  by  RIGAUO,  II,  389;  by  MATH1EU, 
11,389;  bySEGALAS,  II,  390;   by  HOLT,  II,  390;   by  VOILLEMIEli,  II, 
390;  by  GOULEY,  II,  390,  391;  by  DUCAMF,  II,  391;   by  TEEVAX,  II, 

391. 

Diphtheria,  operations  for,  I,  418. 
Dislocations,  following  shot  wounds :  at  the  hip,  III,  67,  68,  69, 70, 71,  76, 

83;  at  the  knee,  III,  373 ;  of  patella,  III,  273;  after  excisions  of  bones 

of  leg,  III,  446,  447  ;  for  miscellaneous  injuries,  III,  644. 
Division  Hospital,  personnel  of,  III,  t:02;  duties  of  recorder  of,  III,  909. 
Dorsalis  Carpi  Artery,  haemorrhage  from,  III,  764;  ligationsof,  III, 

765, 785, 786. 

Dorsalis  et  Kad.  Intl.  Artery,  III,  764  ;  ligatioiis  of,  III,  7U5,  785,  786. 
Dorsalis  Peclis  Artery,  haemorrhage  from,  III,  53, 7G4 ;  ligatious  of.  III. 

621,  765,  803. 

Double  Amputations  for  shot  wounds,  III,  880;  mortality,  III,  881. 
Drainage  Tubes,  in  cases  of  empyema,  I,  580;   SMITH'S  watch-spring 

dilator  for  sinuses,  I,  580. 
Drowning,  summary  of  cases  of,  III,  641. 
Dry  Gangrene,  II,  351;  III,  850,  851;  after  ligation  of  ulnar  artery,  II, 

436;  after  shot  wounds,  II,  351;  III,  310,  314,  542;   for  frostbite,  III, 

678;  due  to  impaired  circulation,  III,  850. 
Duodenum,  shot  wounds  of,  II,  67,  68,  134,  147. 

Dyspiicea,  in  wounds  of  chest,  I,  638;  in  wounds  of  spine,  I,  432,  434,  449, 
454. 

Ear,  wounds  of,  I.  384 ;  rupture  of  membrane  of,  by  explosion,  I,  385 ;  total 

loss  of,  I,  :587. 

Ecchymosis,  I>umbar,  as  a  sign  of  penetrating  wound  of  chest,  I,  575. 
Ectropion,  operation  for,  III,  683. 

Effusions,  SMITH'S  apparatus  for,  in  plural  cavity,  I,  627. 
Elbow  Joint,  wounds  and  injuries  of,  II,  827;  bayonet  wounds  of,  II,  827; 

III,  686 ;  sabre  wounds  of,  II,  827;  III,  686 ;  shot  wounds  of,  II,  828 ; 
III,  690;   shot  fractures  of,  in  Confederate  army,  III,  690;   shot  fract 
ures  of,  treafed  by  conservation,  II,  830,  915;  III,  870;  autopsies,  II, 
841,  843,  844;  excisions  at,  II,  845;   III,  870;   primary  excisions,  II, 
845;   intermediary  excisions,  II,  864;   secondary  excisions,  11,884; 
excisions  at,  followed  by  amputation,  III,  870,  871 ;   excisions  at,  for 
miscellaneous  injuries,  III,  657,  658;    excisions  at,  in   Confederate 
service,  II,  896,  897,  899,  900;   extent  of  bone  removed  in  excisions 
at,  II,  906;  mode  of  operation,  II,  906.     Splints  used  in  fractures  of: 
ESMAUCH'8,  II,  835,  888;  AHL'S,  II,  888;  BOXD'S,  II,  897;  HEATH'S,  j 
II,  905;  HODGEN'S  wire  suspension,  II,  904 ;  VOLKMAXX'S  wire  splint, 
11,904;  BAUKtt's,  II,  835.     Apparatus  for  excision  at:  HUDSON'S, 
11,907;  LAXCEXBECK'S,  II,  907;   Socix's,  II,  907;  amputations  at, 
11,909;  111,871;   primary  disarticulations  at,  II,  910;  intermediary, 
II,  912;  secondary,  II,  913;  mortality  of  amputations  at,  II,  909;  dis 
location  at,  II,  827,  837. 

Electricity  applied  to  wounded  nerves,  I,  387,  409;  II,  1020;  III,  9. 

Emphysema  in  wounds  of  the  neck,  I,  415;  of  the  chest,  I,  493,  579,  590, 
613-15;  II,  145,  160. 

Einpyema  in  wounds  of  the  chest,  I,  470,  472,  490,  529,  578,  627;   II,  290. 

Encephalitis,  in  shot  contusions  of  cranial  bones,  I,  111,  112;  in  fractures 
of  cranium,  I,  205,  257. 

Endocarditis,  I,  533. 

Enterorrhaphy,  II,  112,  124, 128;  methods  of,  PALFYX,  II,  114;  LAl'EY- 
KOXIE,  II,  115;  KKYHARD,  II,  115;  LEDKAX,  II,  115;  the  four  mas 
ters,  II,  116:  DEXAXS,  II,  116;  RAMDOIIU,  II,  117;  JOHEKT,  II,  118; 
LEMBERT,  II,  119;  GEF.Y,  II,  119;  EMMEUT,  II,  121 ;  BAUDF.XS,  II, 

122;  SrlLI-MANN,  II,  122;  VEZIEX,  II,  121;   BOUISSOX,  II,  122;  BEU- 

AXGEK-FeuAUi>,  II,  122;  advocated  by  LARKEY,  BAUUEXS,  PIKO-  ' 

GOFF,  LOHMEYEIi,  etc.,  II,   124-126;    opposed  by  F.  H.  HAMILTOX,  j 

etc.,  II,  124. 

Entrance  and  Exit  Wounds,  II,  258;  III,  711. 
Entropion,  operations  for,  III,  681 ,  682. 
Epididyniitis,  II,  248. 
Epigastric  Artery,  wounds  of,  II,  175;   h;emorrhage  from,  II,  9,  103, 

178;   III,  764;   ligation  of,  II,  186;   III,  40;   ligation  of  superficial 

epigastric,  III,  40. 


Epilepsy  in  shot  wounds  of  cranium,  I,  118,  119,  176,  177,  229. 

Erysipelas,  traumatic,  in  scalp  wounds,  I,  77,  78,  79,  82;  in  wounds 
of  the  face,  III,  852;  in  wounds  of  neck,  I,  402,  404,  408,  412,  413' 
in  shot  wounds  of  upper  extremities,  III,  852;  in  wounds  of  chest,  I, 
634;  of  the  back,  II,  432;  in  flesh  wounds  of  lower  extremities,  III, 
37;  in  fractures  of  thigh.  III,  352;  of  the  knee  joint,  III,  408,  416;  in 
shot  wounds  of  the  lower  extremities,  III,  852 ;  frequency  of,  III,  851, 
852;  fatality.  III,  854;  regional  frequency,  III,  852;  duration  of,  III, 
852;  repeated  attacks  of,  III,  853;  causes  of,  III,  855,  856;  treatment 
of,  III,  855;  following  excisions,  III,  857;  following  amputation,  III, 
857;  among  white  and  colored  troops,  III,  857;  idiopatln'c,  III,  676. 

Ether,  in  major  operations,  III,  887,  897:  deaths  from,  III,  894,  895; 
autopsies  in  cases  of  death  from,  III,  894,  895,  898. 

Excisions  of  the  bones  of  the  head,  see  Trephining;  of  the  bones  of  the 
face,  I,  383,  398 ;  of  portions  of  the  spine,  I,  463,  see  Vertebras ;  of 
the  bones  of  the  chest,  I,  557,  598,  616,  see  Clavicle,  Kibs,  Scap 
ula,  Sternum;  of  pelvic  bones,  II,  255;  in  the  extremities,  III, 
874-876;  for  specific  operations  see  parts  excised. 

Excitement  during  anaesthesia,  III,  897. 

Execution  of  Sentence,  III,  641. 

Explosive  Balls,  I.  494  ;  II,  923;  III,  24, 176;  injuries  by,  III,  696,  701, 
702-704. 

Extirpation  of  eye,  for  ihot  injury,  1, 199,  217,  330,  345;  for  miscellaneous 
injuries  or  diseases,  III,  681,  683. 

Extravasation  of  blood  in  shot  contusions  of  head,  I,  38,  63,  67, 110, 112, 
120,  125;  in  fractures  of  cranium,  I,  332;  in  wounds  of  abdomen  and 
pelvic,  cavity,  II,  176,  177,  194,  220;  of  fascal  matter,  in  wounds  of 
stomach,  II,  42,  48,  57;  of  bile,  II,  192.  193;  of  urine,  II,  193;  incis 
ions  for,  II,  206. 

Extremities,  shot  flesh  wound  of,  873;  shot  fractures  of ',  III,  873;  treated 
by  conservation,  III,  869-874 ;  by  excision,  III,  869,  870,  871,  872,  874- 
876;  by  amputation,  III,  869,  871,  872,  877-886;  by  excision  and  sub 
sequent  amputation,  III,  869,  870,  871 ;  by  amputation  and  re-amputa 
tion,  III,  869,  870,  871 ;  upper  extremities,  punctured  flesh  wounds  of, 
II,  435;  sabre  and  bayonet  wounds  of,  III,  086;  shot  flesh  wounds  of, 

II,  435;  III,  690,  870,  871 ;   mortality,  III,  690:   gangrene  in  wounds 
of,  III,  824;  erysipelas,  III,  852;  pyaemia,  III,  859;  tetanus,  III,  819; 
excisions  in,  III,  870,  871 ;  amputations  in,  III,  870,  871 ;  lower  extrem 
ities,  punctured  flesh  wounds  of,  III,  5 ;  sabre  and  bayonet  wounds  of, 

III.  686;  shot  flesh  wounds  of,  III,  690,  870,  871 ;  shot  fractures  of,  III, 
690;  fatality,  III,  690;   complications  in  shot  wounds  of:  gangrene, 
111,824;    erysipelas,  III,  852;    pyaemia,  III,  858;    tetanus,  III,  819; 
amputations  for  miscellaneous  injuries  in,  III,  664. 

Eye,  punctured  wound  of,  I,  386;  shot  wounds  of,  1,  325;  destruction  of  both. 
I,  325,  342,  343,  345;  destruction  of  one  eye,  I,  329,  343;  balls  lodged  in 
orbit.  I,  340,  342;  should  be  extracted,  I,  345,  385;  incisions  in  ophthal- 
mitis,  I,  345;  extirpation  of  eye,  I,  199,  217,  330,  345;  artificial  eyes,  I, 

345,  387;  operations  for  miscellaneous  injuries  and  diseases  of,  III,  681. 
Eyelid,  excision  of  tumor  of,  III,  682. 

Face,  injuries  of,  I,  321-398 ;  mortality,  I,  382:  miscellaneous  injuries  of,  I, 
324;  punctured  wounds  of,  I,  324;  incised  wounds  of,  I,  324;  lacerated 
wounds  of,  I,  324;  sabre  wounds  of,  I,  321-323;  III,  686;  bayonet 
wounds  of,  I,  323,  324;  III,  686;  shot  wounds  of,  I,  325-398;  III,  688; 
fatality  of  shot  wounds  of,  I,  325;  shot  flesh  wounds  of,  I,  383;  III, 
688;  shot  contusions  of,  III,  324;  shot  fractures  of,  I,  381;  III,  688; 
balls  extracted,  I,  383;  removal  of  fragments,  I,  383;  excisions  of 
bones  of,  I,  383,  398;  complications  in  shot  wounds  of:  gangrene,  III, 
824;  erysipelas,  III,  852;  pyaemia,  111,859;  tetanus,  111,819;  plastic 
operations  III,  369,  380-383. 

Facial  Artery,  shot  wounds  of,  I,  350,  353, 397,  420;  haemorrhage  from,  I, 

346,  348;   ligations  of,  I,  374,  422;    III,  765,  772;   ligation  of,  for  in 
cised  wound,  III,  656. 

Facial  Nerve,  wounds  of,  I,  387;  treatment  of,  by  electric  currents,  I,  387 

Fiecal  Fistula,  II,  24,  49,  113,  2"-2,  253,  277;  plastic  operation  for,  1  f,  7!), 
84,  85. 

Fieces,  extravasation  of,  II,  61,  77-97,  194,  195;  fa>ces  vomited  in  shot 
wounds  of  intestines,  II,  79,  184,  189;  involuntary  evacuation  of:  in 
fractures  of  cranium,  I,  19,45,124,146;  in  wounds  of  spine,  I,  431, 
432,  461, 462. 

Faradization,  II,  342;  III,  9. 

Femoral  Artery,  aneurisms  of,  III,  808;  bayonet  wound  of,  III,  6;  in 
cised  wound  of,  III,  197;  t-hot  wounds  of,  III,  135,  160,  764 ;  shot  perfo 
ration  of,  III,  755;  haemorrhages  of,  III.  764;  primary  bleedings  of, 
ITT,  764;  obliteration  of.  III.  45,56:  occlusion  of,  III,  13;  emboli  in, 
III,  14,191;  ligationsof,  III,  765,788,789,798. 


SUBJ ECT-M ATTKR    IN DEX . 


X  XI 


Femoral  Vein,  shot  injuries  of,  III,  43,  44;  partial  division  of,  111,754; 
hemorrhages  from,  HI,  757,810;  primary  bleedings  of,  111,762;  liga- 
tions  of,  111,44,47,48,40,56;  thrombi  in,  III,  79,  191,5!>0;  removal 
of  darning  needle  from  sheath  of,  III,  43. 

Femur,  shot  contusions  of,  III,  109,710;  amputations  in  eases  of,  III,  172; 
shot  fractures  of,  III,  174;  shot  fractures  treated  by  conservation,  III, 
170:  in  upper  third,  III,  177;  in  middle  third,  III,  187;  in  lower  third, 
III,  194;  partial  shot  fractures  of,  111,175;  perforations  of,  111,721;  sim 
ple  shot  fractures  of,  111,705;  pseudi'.rthrosis  after  fractures  of,  III,  174, 
175,  170',  198,  199;  extension  and  counter-extension  in  fractures  of,  III, 
343;  side  fractured,  III,  352;  complications  of  fractures  of:  pyaemia, 
III,  352;  tetanus,  III,  352;  gangrene,  III,  352;  erysipelas,  111,  352; 
haemorrhage,  III,  352;  lengthening  and  shortening  of,  III,  351 ;  ever- 
siou  of  foot  in  fractures  of,  III,  180, 195,  198, 199;  inversion  of  foot,  111, 
187;  treatment  of  fractures  of,  III,  338;  mortality  in  Union  and  Con 
federate  armies,  III,  355;  splints  and  apparatus  fur  fractured,  III,  342: 
DKSAULT'S,  III,  343;  SMITH'S  anterior,  III,  345,  346;  HODGKX'S,  III, 
346,347,348;  SWINIJURNE'S,  111,347;  PHVSICK'S,  III,  343;  GORDON 

BUCK'S,  III,  348;  L ANGER'S,  III,  349;  BKLL'S  double-inclined  plane, 
III,  345;  HUDSON'S,  III,  180;  HOWARD'S  wire  suture,  III,  350,  351; 
fracture  of,  treated  by  excision,  III,  199;  primary  excisions,  111,200; 
intermediary  excisions,  111,207;  secondary  excisions,  111,210;  results 
of  excisions  discouraging,  III,  199;  excisions  for  miscellaneous  inju 
ries,  III,  657;  amputations  in  femur,  see  Thigli. 

Fibula,  shot  fractures  of,  III,  432,564;  treated  by  conservation,  III,  437; 
excisions  of,  III,  445;  fractured  by  patient's  weight  after  excision  oi 
tibia,  III,  464,  480. 

Field  Companion,  surgeon's,  III,  915. 
Field  Hospitals,  III,  920-922. 
Field  Kegister,  form  of,  I,  xiv. 
Fingers,  amputations  of,  for  shot  injury,  II,  1019;  for  miscellaneous  inju 
ries,  III,  659. 
Fire-balls,  III,  701. 
Firearms,  rifled,  superiority  of,  over  smooth-bore,  III,  694;  firearms  used 

during  the  war,  III,  695-704. 
Fistula,  anal,  II,  321;  gastric,  II,  45-48;  case  of  Alexis  St.  Martin,  II,  55; 
thoracic,  I,  6:iO,  479,  480,  488,  490,  502,  577;  urethral,  II,  360-371;  non- 
truumatic  urinary.  II,  368,  387,  400;  traumatic  urinary,  II,  403;  recto- 
vesical,  II,  309,310,313;  lachrymal,  I,  329,358;  salivary,  I,  330,  368, 
387. 

Foot,  bayonet  wounds  of,  111,617;  shot  wounds  of,  III,  617;  shot  contu 
sions  of,  III,  617,  690,  716,  870;  shot  fractures  of,  III,  618,  690,870 
treated  by  expectation,  III,  (118;  treated  by  excision,  III,  622,  627,  637 
638;  primary,  III,  623:  intermediary,  III,  624;  secondary,  III,  025 
excisions  in  bones  of  foot  for  miscellaneous  injuries,  III,  657;  amputa 
tions  of,  111,027;  primary,  III,  028;  intermediary,  III,  633;  second 
ary,  III,  634;  Cuoi'AUT's  operation,  III,  039;  LiSFKANc's,  III,  039 
IlKY's,  III,  039. 

Forearm,  II,  917;  punctured  and  incised  wounds  of,  II,  918;  sabre  wounds 
of,  11,918;  III,  686;  shot  wounds  of,  11,919;  III,  690,  870;  shot  flesl 
wounds  of,  11.917;  amputations  following  shot  flesh  wounds  of,  II 
471;  shot  contusions  of,  II.  919;  III,  716;  partial  shot  fractures  of 
11,921;  shot  fractures  of,  treated  by  expectation,  II,  922;  III,  870 
mode  nf  treatment,  II,  092:  splints  for  shot  fractures  of:  IlEWlT's 
11,932;  .SWIFT'S,  II,  932;  VEUDlCK's,  II,  932;  carried  away  by  shot 

11,  (125,02(1,647;  crcisions  in,  for  shot  injury,  II,  <:33,  066;  III,  870 
primary,  II,  033;  intermediary,  II,  953;  secondary,  II,  961;  ampu 
tations  following  excisions  in,  III,  870,  b71 ;  amputations  for  shot  in 
juries   of,   II,  907,  993;  III,  871;  primary,  II.  007;  intermediary,  II 
980;  secondary,  II,  987;  re-amputations  in,  III,  870,  871;  amputation 
for  miscellaneous  injuries,  III,  650,  602;  apparatus  for  double  ampr 
tation  of  forearm,  II,  908. 

Foreign  Bodies,  lodged  in  chest,  I,  582,  584,  500,  5!'8,  017;  extracted froi 
chest,  I,  590-593,595,508;  removed  from  abdominal  parietes,  If,  11 

12,  89,  90,  93,  146,  148;  removed  from  flesh  wounds,  lower  extremities 
III,  21,22;  removed  from  stomach,  II,  52;  early  removal  of,  advisee 
111,807;  removed  from  bladder  by  lithotomy:  clothing.  II,  280;  hail 

II,  281;  arrow-head,  II,  270;  bone,  II,  277-L79;  portion  of  bayone 
scabbard  and  of  bayonet  extracted  by  incision  in  perin;eum,  II,  245 
lodgement  of  foreign  bodies,  III,  758. 

Fougasses,  III,  699. 

Fracture-bed,  LANGEU'S,  III,  349;  I'ETIT'S,  III,  508. 

Fractures,  simple  shot.  Ill,  704,  705;  of  humerus,  II,  815,  810;  of  femiu 

III,  705;  without  flssnring,  III,  719;  with  flssuring.  Ill,  720;  perfi 
rating,  III,  721. 


•"roiital  Artery,  haemorrhage  from,  I,  81;  III,  763. 
'rostbitc,  HI,  071;  amputations  for,  III,  671,  672,  673,  674, 675, 070,  077. 
tall-bladder,  shot  wounds  of,  II,  136,  137,140;  shot  rupture  of,  II,  19o 
<  a  Ivan  is  in  to  revive  patient  asphyxiated  by  ether,  II,  187. 
ungrene,  frequency  of,  III,  824;  fatality  and  causes  of  death,  III,  824; 
frequency  of,  after  excisions,  111,  825;  after  amputations,  III,  825; 
influence  of  season  on,  III,  825;  j-ears  in  which  the  disease  occurred, 
111,815;  at  Frederick,  111,826;  at  West  Philadelphia,  III,  820;  at 
Annapolis,  III,  830;  symptoms  of,  III,  827;  contagion  by,  III,  826, 
827,  848;  microscopical  appearance  of,  III,  830;  characteristics  of,  III, 
827,  828,  830,  840;  treatment  of,  III,  826-830;  treatment  by  bromine, 
III,  834-837;  following  strangulation  by  tourniquet,  III,  825;  caused 
by  tight  bandaging.  III,  825;  in  scalp  wounds,  I,  79,  80;  in  wounds 
of  the  face,  III,  824;  in  wounds  of  spine,  II,  109;  in  chest  wounds,  I, 
472,  034,  in  wounds  of  abdomen,  11,8, 10, 12;  in  wounds  of  back,  II, 
432;  in  wounds  of  upper  extremities,  III,  824;  in  wounds  of  lower 
extremities,  III,  352,  509,  824;  haemorrhage  in  cases  of,  III,  763, 764; 
senile,  III,  675.     See  Dry  Gangrene. 
rases  in  penetrating  wounds  of  stomach,  II,  198. 

lastric  Artery,  branches  of,  severed  in  shot  wound  of  pancreas,  II,  160. 
iastric  Fistula  in  shot  wounds  of  stomach,  II,  45-48,  50,  52,  53,  54,  56; 

case  of  Alexis  St.  Martin,  II,  55. 

Gastro-epiploic  Artery,  bayonet  wound  of  branch  of,  ligated,  II,  42. 
Gastroraphy,  II,  58,  59, 113. 
Genioplasty,  I,  375. 

Genital  Organs,  injuries  of,  II,  343;  shot  wounds  of,  III,  689;  opera 
tions  on,  for  miscellaneous  injuries,  III,  684.     See  1'enis,  Urethra, 
Testes,  Scrotum. 
Glands,  inflammation  of  prostate,  HI,  81 ;  enlargement  of  inguinal,  HI, 

225;  ball  embedded  in  parotid,  I,  305;  wound  of  parotid,  I,  406,  411. 
Glottis,  eedema  of,  I,  404,  417,  418. 

Gluteal  Artery,  wounds  of,  II,  328,  330,  331,  334;  cut  during  operation, 
III,  97;  haemorrhages  from,  II,  327,328,  329,330;  III,  764;  ligations 
of,  II,  329,  330,  332;  HI,  97,  765, 787. 
Gluteal  Vein,  injuries  of,  II,  338  ;  III,  816. 
Grape-shot,  description  of,  III,  697;  nature  of  injury  by,  III,  706;  parts 

injured  by,  III,  696. 
Greek  Fire,  III,  701. 

Haematemesis,  in  rupture  of  stomach  without  external  wound,  II.  22;  in 
wounds  of  stomach,  II,  41,  42,  47,  57  ;  in  wounds  of  intestines,  II,  67, 
88;  in  wounds  of  neck,  I,  403,  413;  of  spine.  I,  445. 
Hjematocele,  II,  364. 

Haematuria,  II,  167,  108,  169,  179,  284,  290,  294,  335. 
Haemoptysis,  not  a  certain  sign  of  wound  of  lung,  I,  636;  eases,  1,  482, 

507;  I,  145,  146. 

Haemorrhage,  arterial,  summary  of  cases  of.  Ill,  "i63;  fatality  of,  HI, 
705;  days  on  which  first  haemorrhage  occurred.  Ill,  805;  long  deferred, 
111,800;  recurrent,  III.  806 ;  warning  bleedings,  III,  807;  from  distal 
ends  of  arteries,  III,  807;  capillary,  III,  807;  parenchymatous.  III, 
193,  807;  medullary,  III,  808;  treated  by  compression  and  styptics, 
III,  810,811 ;  by  ligation,  III,  810;  by  ligation  and  subsequent  ampu 
tation,  III,  810;  acupressure  in,  III,  811;  actual  cautery  in,  Hi< 
811;  treated  by  application  of  ice  and  cold,  III,  813:  primary  haemor 
rhage,  III,  701,  703,  704;  after  complete  divisions  of  large  arteries, 
HI,  752;.  proportion  of  killed  in  battle  caused  by,  III,  761 :  from  shot 
wounds  of  head,  III,  703;  I,  127,  256;  of  face,  III,  763;  I,  390,  303, 
306,  397;  of  neck,  III,  763;  of  trunk,  III,  763;  I,  472,  519-528, 
611-613,  638,  642;  II,  89,  18.  57.  150.  154,  159,  170-170,  J90,  3-H); 
upper  extremities,  111,703;  II,  472,928,  932;  lower  extremities.  HI, 
763;  in  shot  flesh  wounds,  III,  37;  in  shot  fractures,  III,  410.  448; 
transportation  as  cause  of,  HI,  810;  treatment  of.  III.  810;  venous, 
see  Veins. 

Hsemorrhoidal  Artery,  haemorrhage  from,  HI,  704:  II.  316,  320. 
Haemorrhoids,  operations  for,  II,  322;  SMITH'S  clamp  in,  II,  32" 
Haemothorax,  I,  624-626;  II.  155,  173. 
Hall's  mode  of  administering  chloroform,  IIT,  889. 

Hand,  shot  fractures  and  contusions  of  bones  of.  Ill,  600,  870;  fractures  .. 
bones  of  hand  treated  by  expectation,  II.  1020;  III.  870;  by  excision. 
II.  1019:  III,  870;  by  excision  and  subsequent  amputation,  III,  870, 
K71  :  by  amputation,  II,  1021;  III,  871:  amputations  for  miscel 
laneous  injuries  of,  III,  659,  663,  664. 
Harelip,  operation  for,  III,  684. 


XXTT 


SUBJECT-MATTER    INDEX. 


Head,  wounds  and  injuries  of,  1, 1-320;  incised  nud  punctured  wounds  of,  I, 
1-34 ;  sabre  wounds  of,  1, 1-28;  other  incised  wounds  of,  I,  28-30;  bay 
onet  wounds  of,  I,  31-34  ;  miscellaneous  injuries  of:  railroad  accidents, 
falls,  blows,  falling  trees,  kicks,  I,  35-69;  gunshot  wounds  of,  1, 70-320; 
III,  C88 ;  complications  in  wounds  of:  gangrene,  III,  824  ;  traumatic 
erysipelas,  III,  852;  pyaemia,  III,  859;  tetanus,  III,  819.  See  Cra 
nium,  Scalp. 

Heart,  shot  wounds  of,  I,  530,  613,  C23 ;  II,  51;  incised  wounds  of,  571, 
534 ;  bayonet  wounds  of,  I,  468  ;  action  of,  visible  through  wound,  I, 
535,  597;  autopsies  in  shot  wounds  of,  I,  530,  531,  532;  cardiac  diseases 
from  wounds  of,  I,  533;  congenital  malposition  of,  III,  437. 

Hemiplegia,  I,  316 ;  II,  32. 

Hepatic  Duct,  wound  of  branch  of,  II,  139 ;  III,  764. 

Hepatitis,  seldom  induced  by  shot  wounds  of  liver,  II,  139 ;  case  of,  II, 
148. 

Hermetical  Sealing  in  shot  wounds  of  chest ;  HOWARD'S  method  of,  I, 
497-514 ;  II,  32 ;  autopsies  in  cases  of,  I,  503,  504,  505. 

Hernia,  abdominal,  following  bayonet  and  sabre  wounds,  II,  3,  4  ;  fol 
lowing  lacerated  wounds,  11,5;  following  incised  wounds,  II,  129; 
III,  654 ;  following  shot  wounds,  II,  46,  47,  184,  185 ;  operations  for 
radical  cure  of,  II,  186;  diaphragmatic,  I,  515,  516;  II,  185;  inguinal, 
I,  596 ;  II,  474,  852 ;  III,  650,  653 ;  double  inguinal,  II,  227 ;  of  lung, 

I,  514,  515,  517,  518,  617;  II,  J47;  phrenic,  II,  25;  scrotal,  II,  288, 
347,  368,  419  ;  ligation  of  hernia,  I.  516.    See  Cerebral  Hernia. 

Herniotomy,  II,  186,  187,  271. 

Hip  Joint,  periarticular  wounds  of.  III,  24,  690;  shot  fractures  of,  III, 
65,  690,  870 ;  treated  by  conservation,  III,  66 ;  excisions  of,  III,  89, 
870 ;  primary  excisions,  III,  92;  intermediary  excisions,  III,  101  ; 
secondary  excisions,  III,  113;  amputations  at,  III,  127,  871  ;  primary 
amputations,  III,  131 ;  intermediary  amputations,  III,  139;  secondary 
amputations,  III,  145 ;  amputations  at,  for  disease,  III,  665. 

Holston's  Chisel  for  removal  of  depressed  bone,  I,  320. 

Homicide,  cases  of,  during  war,  III,  641. 

Hospital,  special,  for  the  treatment  of  injuries  and  diseases  of  the  nerves, 
III,  729. 

Hospital  Cars,  improvised  from  railway  freight  cars,  III,  958 ;  from  rail 
way  passenger  cars,  III,  960;  HARHIS  cur,  III,  960;  McCRICKETT's 
car,  III,  961 ;  car  of  the  Army  of  the  Cumberland,  III,  965;  U.  S. 
Army  hospital  car,  III,  967. 

Hospital  Commissary,  duties  of.  III,  912. 

Hospital  Gangrene,  diagnosis  of,  III,  845;  conditions  favorable  to 
accession  of,  III,  849 ;  microscopical  appearance  of,  III.  830-833,  843 ; 
at  Nashville,  111,832;  at  Annapolis,  III,  830,  836;  at  West  Phila 
delphia,  III,  825;  at  Frederick,  III,  826;  at  Douglas  Hospital,  Wash 
ington,  III,  837;  at  Memphis,  III,  843;  in  shot  flesh  wounds  of  lower 
extremities,  III,  33,  35;  in  shot  fractures  of  knee  joint,  III,  416; 
treatment  of,  by  bromine,  III,  834-837,  842-848. 

Hospital  Knapsack,  description  and  contents  of,  III,  915. 

Hospital  Steamers,  or  floating  hospitals,  in  Western  waters,  III, 
972-981;  City  of  Memphis,  III,  974;  Louisiana,  III,  975;  R.  C. 
Wood,  II,  975;  D.  A.  January,  III,  977;  Empress,  III,  981  ;  in  East 
ern  waters,  III,  981;  Daniel  Webster,  III,  981;  Connecticut,  III, 
981 ;  State  of  Maine,  III,  982;  J.  K.  Barnes,  III,  982. 

Hospital  Tents,  III,  920 ;  mode  of  heating  of,  III,  921. 

Hospital  Trains,  of  the  Army  of  the  Potomac,  III,  961 ;  of  the  Army 
of  the  Cumberland,  III,  962  ;  commissary  car,  III,  968 ;  baggage  car, 
III,  968;  kitchen  car,  III,  968,  969,  970;  surgeon's  car,  III,  969. 

Howard's  wire  sutures  in  fractures  of  femur.  III,  350  ;  in  excisions  of  shaft 
ofhumerus,  11,820;  method  of  hermetioal  sealing,  I,  497;  bone  drill, 

II,  801 ;  ambulance  wagon,  III,  903. 

Humerus,  shot  contusions  of,  II,  607,  817 ;  III,  716 ;  partial  shot  fractures 
of,  II,  668;  simple  shot  fractures  of,  II,  815;  complete  shot  fractures 
of,  II,  669,  826 ;  111,690;  treatment  of,  II,  811;  by  splints  of;  WELCH, 
II,  811;  HAMILTON,  II,  811 ;  PIIYSICK,  II,  812;  ROSE,  II,  812; 
KIRK.BRIDE,  II,  812;  VEDDEF.,  II,  812;  SWINBURNE,  II,  812;  by 
CLAKK'S  method  of  extension,  II,  813;  by  LAWSOX'S  method  of 
extension,  11,825;  excisions  in  shaft  of,  II,  675,  819-822,  820;  primary 
excisions,  II,  C75;  intermediary  excisions,  II,  686;  metallic  sutures 
in  cases  of  excision  of,  II,  820;  excision  of,  for  miscellaneous  injuries 
and  diseases,  III,  658;  secondary  excisions,  II,  6!)0;  for  amputations 
in  shaft  of  humerus.  See  Arm. 

Hydrarthrus  of  knee  joint,  amputation  in  thigh  for,  II,  C67. 
Hydrocele,  II,  420,  421. 


Hydrothorax,  I,  472,  624 ;  III,  430. 

Hygienic  Influences,  effect  of,  on  the  treatment  of  wounds,  III,  867,  868. 
Hyoid  Bone,  fracture  of,  in  hanging,  I,  400. 
Hyperostosis  in  shot  contusions  of  cranial  bones,  I,  127. 
Hypospadia,  II,  387 ;  III,  73. 

Ileum,  rupture  of,  II,  22,  205 ;  shot  wounds  of,  II,  70,  71,  72,  109,  190 ; 
protrusion  of,  II,  62;  enterorrhaphia  in  shot  wounds  of,  II,  72. 

Iliac  Artery,  common,  aneurism  of.  III,  39;  wounds  of,  II,  333,  335,  336; 
shot  perforation  of,  11,754;  haemorrhage  from,  III,  764;  ligation  of, 
III,  765,  786;  II,  333,  335,  336;  III,  39:  external,  aneurism  of,  III, 
239;  haemorrhage  from,  II,  10;  III,  764  ;  ligations,  summary  of,  III, 
765,787;  cases,  II,  10,  333,  336;  III,  39,  77,  84;  internal,  bayonet 
wound  of.  II.  335 ;  shot  wounds  of,  II,  330,  331 ;  ligations  of,  III,  765, 
786. 

Iliac  Region,  penetrations  of,  mistaken  for  wounds  of  abdomen,  II,  213, 
214. 

Iliac  Vein,  internal,  injuries  of,  II,  190;  III,  111,  816;  external,  emboli 
in,  III,  191. 

Ilio-l,umbar  Artery,  haemorrhage  from,  II,  218,  327;  III,  764. 

Ilium,  shot  fractures  of,  II,  212-237 ;  liability  to  pyaemia  in,  II,  212 ;  danger 
of  purulent  infiltration  in,  II,  212;  shot  fractures  of  both  iliac  bones, 

II,  215,  216 ;  excisions  of  portions  of,  II,  230-233. 
Impalement,  II,  204. 

Incised  "Wounds  (not  sabre),  III,  640,  652;  of  head,  I,  28-30,  308;  of 
neck,  I,  400;  of  spine,  I,  424;  of  chest,  I,  470;  of  abdomen,  II,  4,  31, 
61,  76, 129  ;  of  pelvic  cavity,  263,  343;  of  lower  extremities,  III,  7,  361. 

Inflammation  controlled  by  ligation  of  femoral  artery,  III,  377,  383. 

Inhaler,  ClllSOLM's,  for  the  administration  of  chloroform,  III,  889. 

Innominate  Artery,  wound  of,  I,  521,  606;  aneurism  of,  I,  521 ;  II,  808; 
haemorrhage  from,  I,  520;  III,  763. 

Insanity,  in  fractures  of  cranium,  I,  237,  238;  in  amputation  of  thigh,  III, 
229;  in  amputations  of  leg,  III,  295,  486,  518. 

Instruments,  contents  of  pocket  case  of,  III,  919;  of  field  case  of,  III, 
919;  of  operating  case  of,  III,  919;  for  resection,  II,  256,  aid  plate 
opposite;  HEINE'S  osteotome,  MOLLET's  saw,  gnawing  bone  forceps, 
LEGOUEST's  curved  gouge  and  chisel,  U.  S.  A.  gouge  and  chisel, 
NELATOX's  bone  forceps,  II,  256. 

Intercostal  Artery,  aneurism  of,  II,  597;  wounds  of,  I,  525,  526,  606; 
ligations  of,  III,  765,  774 ;  I,  550,  551,  552. 

Interosseous  Artery,  of  forearm :  aneurism  of,  III,  808 ;  wounds  of,  II, 
456,  469,  911 ;  accidentally  wounded  during  operation,  II,  954  ;  haem 
orrhages  from,  III,  764;  ligations  of,  JJ,  454,  961,  988, 1004 ;  III,  765, 
785;  of  leg,  haemorrhage  from,  III,  528,  764;  ligation  of,  III,  518,  765, 
803. 

Intestines,  shot  wounds  of,  III,  (iS9 ;  large,  punctured  and  incised  wounds 
of,  II,  76;  shot  wounds  of,  II,  76;  small,  punctured  and  incised  wounds 
of,  II,  61 ;  shot  wounds  of,  II,  64  ;  of  duodenum,  II,  67 ;  of  jejunum,  II, 
68;  of  ileum,  II,  70;  rupture  of  intestines,  II,  3,  22,  26;  operations  on 
large  intestines,  II,  109;  anaplasty,  II,  111 ;  enterorrhaphia,  II,  112; 
protrusion  of,  II,  32,  34,  62,  72,  73,  75,  183,  260 ;  protruding  intestines 
returned,  II,  62,  73,  260;  worms  in  wounds  of,  II,  95. 

Involucra  of  bones  of  the  leg,  III,  478,  492,  539,  545;  of  the  femur.  III, 
189,  196,  198,  226,  241,  256,  293,  310,  317,  319. 

Iridectomy,  III,  681,  682,  683. 

Ischium,  contusion  of,  II,  254;  shot  fractures  of,  II,  241-245,255;  excisions 
of  portions  of,  II,  245. 

Jaundice,  in  shot  wounds  of  abdomen  and  pelvic  cavity,  IT,  1H8,  145,  160, 
291,  304. 

Jejunum,  rupture  of,  II,  22,  23;  bayonet  wound  of,  II.  42;  punctured 
wounds  of,  II,  61 ;  protruding  after  bayonet  puncture,  II,  61,  62;  shot 
wounds  of,  II,  6?,  69,  72. 

Jugular  Vein,  external,  injuries  of,  I,  407,  411,  412,  491;  III,  816;  inter 
nal,  injuries  of,  I,  383,  302,  397,  420;  III,  750,  816;  accidentally  cut 
during  operation,  I.  392,  397;  1-gation  of,  I,  383,  392,  397. 

Kidney,  shot  wounds  of,  II,  163-172,  202 ;  III,  689 ;  autopsies,  II,  168,  169, 
170;  rupture  of,  II,  20,  21,  26. 

Knapsack,  Hospital,  description  and  contents  of,  III,  915. 

Knee  Joint,  periarticular  wounds  of,  III,  24-32,  690;  bayonet  wounds  of, 

III,  360,  686;   punctured  and  incised  wounds  of,  III,  6,  359;   arrow 
wound  of.  III.  653:  miscellaneous  injuries  of.  Ill,  360:  incised  wounds 
of.  followed  by  amputation  of.  III.  362;  shot  contusions,  III,  364.  690, 


SUBJECT-MATTER    INDEX. 


XX  TIT 


Knee  Joint — [Continued. 

716,  870;  shot  contusions  of.  followed  by  amputation,  III,  363;  shot 
fractures  of,  Til,  367,  870;  sHot  fractures  of,  treated  by  conservation, 
III.  368,  384,  411,  417,418,  419,  870;  by  excision,  III,  384,419-422;  pri 
mary  excisions,  111,386;  intermediary  excisions,  III,  391 ;  secondary 
excisions,  111,394;  by  amputation,  111,397-407;  primary  amputations, 
III,  398 ;  intermediary  amputations,  III,  40-1 ;  secondary  amputations, 
III,  407;  amputations  following  excisions,  III,  870;  re-amputations  in 
amputations  at  knee  joint,  III,  871;  modes  of  amputation :  Hoix's, 
L,EVEII,LE'S,  N.  SMITH'S,  VELPEAU'S,  BAUDEXS',  Rossi's,  PAX- 
COAST'S,  SYME'S,  CARDK.X'S,  MEI.CHIORJ'S,  STOKES'  modification  of 
GRITTI'S,  III,  424-426;  shock  in  wounds  of,  III,  412;  perforation  of, 
without  lesion  of  bones,  III,  415,  416;  missile  lodged  in  knee  joint, 
III,  372,  416;  antiseptic  treatment  of  fractures  of,  on  field  of  battle, 
III,  418,  419;  GKITTI'S  osteoplastic  operation,  III,  263,  424. 

Lachrymal  Canal,  destruction  of,  I,  345.  368,  370. 

Lachrymal  Fistula,  I,  329,  358. 

Lachrymal  Sac,  operation  on,  for  chronic  inflammation,  III,  683. 

Lance  Wounds,  I,  34;  II,  34. 

Langer's  Ambulance  Wagon,  HI,  955,  956. 

Laryngotomy,  I,  415,  418;  III,  684. 

Larynx,  incised  wound  of,  I,  400;  shot  wounds  of,  I,  40G;  III,  688;  death 
caused  by  clot  of  blood  in,  I,  354 ;  opened  in  suspended  animation 
following  administration  of  chloroform,  II,  841. 

Leg,  punctured  flesh  wounds  of,  III,  6,  7;  shotjlesh  wounds  of,  III,  8 ;  shot 
contusion*  of  bones  if,  III,  427,  090,  716,  870;  shot  contusions  followed 
by  amputation,  III,  430 ;  shot  fractures  of  bones  of,  III,  432,  690,  870 ; 
treated  by  conservation,  III,  432, 564 ;  treated  by  PETIT's  fracture  box, 
III,  568;  by  splints,  III,  568;  treated  by  excision,  III,  444,  570,  870; 
primary  excisions,  III,  445;  intermediary  excisions,  III,  453;  second 
ary  excisions,  III,  456;  excisions  in  the  bones  of  the  leg  followed  by 
amputation,  III,  870;  amputations  in,  III,  460,  572,  871;  primary 
amputations,  III,  491 ;  intermediary  amputations,  III,  512 ;  secondary 
amputations,  III,  537;  re-amputations  after  amputations  in  leg,  III, 
870,  871;  protrusions  of  bone  after  amputations,  III,  576;  amputations 
for  miscellaneous  injuries  of,  III,  670;  excisions  for  miscellaneous 
injuries  of,  III,  657,  658,  659.  See  Fibula,  Tibia. 

Ligations  of  arteries  in  shot  wounds,  III,  765,  813;  percentage  of  fatality 
in,  III,  813;  ligations  in  continuity,  III,  814;  above  and  below  wound, 
III,  814;  in  wound,  III,  814;  ligations  in  stump.  HI,  814;  rarely 
required  on  field  of  battle.  Ill,  815;  of  veins  in  shot  wounds,  III,  816; 
ligations  for  miscellaneous  injuries,  III,  679;  ligations  in  wounds  of 
the  head,  I,  160,  225,  241,  244,  255,  269,  288,  298,  313,  315;  of  the/ace, 
I,  332,  339,  346,  347,  349,  350,  367,  396,  397;  of  the  neck,  I,  419;  of  the 
spine,  I,  455 ;  of  the  chest,  J,  537-556 ;  of  the  abdomen,  II,  191 ;  of  the 
pelvis,  II,  326,  327,  330,  333,  337 ;  of  the  upper  extremities,  II,  436, 
442-454;  of  the  lower  extremities,  III,  7,  38-52,  172,  353.  See  Aorta, 
etc. 

Lightning  Stroke,  III,  655. 

Lingual  Artery,  haemorrhages  from,  III,  763;  wounds  of,  1,351,  421; 
III,  763;  ligations  of,  I,  397,  421 ;  III,  765,  771. 

Lithotomy,  II,  269-299. 

Lithotrite,  CIVIALE'S,  II,  378. 

Litters,  III,  923;  SATTEULEE'S,  III,  923;  HALSTEAU'S,  III,  924;  SAXI- 
TARY  COMMISSION'S,  III,  925;  CONFEDERATE  STATES',  III,  925; 
SCHELL's,  III,  925;  litter  carriage,  III,  926;  mule  litter:  BRITISH, 
III,  928;  FRENCH,  III,  931 ;  two-horse,  III,  926;  litters  suspended  in 
hospital  cars,  III,  958. 

Liver,  ruptures  of,  II,  16 ;  bayonet  wound  of,  I,  46!) ;  punctured  and  incised 
wounds  of,  II,  129;  shot  wounds  of,  II,  131;  III,  689;  metastatic 
abscesses  of,  II,  133;  escape  of  bile  from,  II,  142,  143. 

Lumbar  Kcchymosis  as  a  sign  of  penetrating  wound  of  chest,  I,  575. 

Lumbar  Nerve,  shot  wound  of,  II,  330. 

Lumbar  Vertebrae,  miscellaneous  injuries  of,  I,  426;  shot  injuries  of,  I, 
441-449,  451,  458-462,  584 ;  II,  36,  48,  72,  155, 168,  170. 

Lumbrici,  escape  of,  in  wounds  of  abdomen,  II,  42,  64,  68,  71,  94,  195. 

Lung,  sabre  perforation  of,  I,  466,  467 ;  bayonet  wound  of.  I,  467,  468,  469, 
470 ;  knife  wounds  of,  I,  470.  471 ;  shot  wounds  of,  I,  491 ;  shot  wounds 
of  both,  I,  495,  634;  autopsies  in  wounds  of,  I,  492,  494,  497  ;  collapse 
of,  I,  631,  632;  balls  lodged  in,  I,  489,  505,  552,  585;  ball  removed 
from,  I,  32,  585 ;  foreign  bodies  lodged  in,  I,  493 ;  fragments  of  cloth 
ing  expectorated  after  wound  of,  I,  584. 

Maggots,  in  wounds,  III,  867;  precaution  against,  III,  867;  cases  of,  I, 
241,  348;  II,  754;  III,  20,  454,  530;  in  stump,  III,  269. 

SURG.   111—127 


Malar  Bone,  shot  fractures  of,  I,  345,  381 ;  excisions  of,  I,  383 ;  miscel 
laneous  injuries  of,  I,  324. 

Malleolar  Artery,  external,  wounds  and  haemorrhages  of,  III,  764. 

Malleolus,  external,  excisions  of,  III,  589,  593 ;  internal,  excisions  of.  Ill, 
586,  591. 

Mammary  Artery,  external,  shot  wounds  of,  I,  519,  523,  524  ;  on  ligation 
of,  I,  524;  internal,  shot  wounds  of,  I,  523,  524,  548;  III,  764:  on 
ligations  of,  1,  548 ;  II,  177 ;  III,  76:>,  774. 

Materia  Chirurgica,  III,  914  ;  hospital  knapsacks,  Id,  914  ;  field  com 
panion,  III,  915;  medicine  pannier,  III,  916;  medicine  wa^mis  of: 
E.  HAYES  &  Co.,  Ill,  916;  of  J.  DCXTOX,  III,  916;  of  PKitor,  III. 
917;  of  AUTEXRKITH,  III,  918.  Surgical  instruments:  capital  opera 
ting  case,  III,  919;  minor  operating  case,  III,  919  ;  pocket  ca»e,.IIT, 
919;  field  case,  111,919.  Tents:  hospital,  III  920;  Sim.EY,  III,  920. 

Maxilla,  upper,  miscellaneous  injuries  of,  I,  324  ;  shot  fractures  of,  I,  381; 
excision  of,  I,  348,  354,  383,  398;  lower,  miscellaneous  injuries  of,  I, 
324 ;  shot  fractures  of,  I,  381 ;  excisions  of,  I,  347,  351,  3(52,  383;  splints 
and  apparatus  in  treatment  of  shot  fractures  of  lower,  I,  391. 

Maxillary  Artery,  shot  wounds  of  internal,  I,  346,  351,  352,  360;  haem- 

orrhnges  from,  III.  763. 
Median  Nerve,  bayonet  wound  of,  II,  827;  III,  687  ;  shot  wounds  of,  I, 

479  ;  II,  447,  946,  1020 ;  excisions  of,  II,  461,  464,  470,  778. 
Mediastinum,  shot  wounds  of,  I,  486,  535,  589. 
Medical  Department,  expenditures  of,  during  the  war,  III,  902. 
Medical  Descriptive  List,  form  of,  I,  XVII. 
Medical  Director  of  corps,  duties  of,  III,  903-906. 
Medical  Inspector  of  corps,  duties  of,  III,  906. 
Medical  Staff,  III,  899;  casualties  among,  I,  XXX-XXXII;  III,  901. 
Medicine  Panniers,  III,  916. 
Medicine  Wagons,  III,  917;  PEROT'S,  III,  917;  DUXTOX'8,  111,917; 

AUTEXRIETH,  III,  918. 

Medio-tarsal  amputations,  III,  628. 

Medullary  Artery,  haemorrhage  from,  III,  224. 

Medullary  Canal,  of  femur,  ball  lodged  in,  III,  176;  gangrene  of,  III, 

225. 

Meloplasty,  I,  369. 
|  Meningeal  Artery,  ruptures  of,  II,  49,  54,  60,  125 ;  wounds  of,  I,  229  ; 

haemorrhage  from,  III,  763. 
Meningitis,  Spinal,  cases  of,  I,  439,  444. 
Mercurial  Poisoning,  I,  375. 
Mesenteric  Artery,  punctured  wound  of,  II,  62;  aneurism  of,  II,  25: 

shot  wound  of,  II,  155:   haemorrhage  from,  III,  764:   ligations  of 

branches  of,  II,  62. 
Mesentery,  ruptures  of,  II,  23,  24  ;  shot  wounds  of,  II,  174, 175 ;  III,  689 ; 

ball  lodged  iu,  II,  179. 

Metacarpal  Bones,  shot  fractures  of,  II,  1019. 
Metallic  Sutures,  iu  excisions  of  shaft  of  humerus,  II,  820. 
Metastatic  Abscesses,  in  lung,  I,  628,  and  plate  opposite;  in  liver, 

II,  133. 

Metatarsal  Bones,  bayonet  wound  of,  III,  617,  686;  shot  fractures  of 

III,  618;  excisions  of,  III,  622. 

Miscellaneous  Injuries,  III,  640 ;  operations  for,  III,  657. 
Missiles,  nature  and  seat  of  injury  of,  in  shot  wounds,  during  the  war,  III, 

696;  small  arm  missiles,  round  ball,  III,  697;  more  prone  to  lodge 
than  conoidal,  III.  757:  buck  and  ball,  III,  697  ;  rifle  balls,  III,  697; 
slugs,  III,  700  ;  from  fowling  pieces,  III,  700  :  SHAl.KR's  sectional 
bullet,  III,  700;  erratic  course  of  small  missiles,  III,  7H>;  effects  of 
small  missiles.  Ill,  709,  710;  distortions  of  small  missiles,  III,  710; 
large  missiles,  III,  697;  shrapnel  shots,  III,  697;  spherical  case  shot, 
III,  698:  bolts,  III,  698;  rifled  shot:  WHITWORTH,  I'ARROT,  III. 
698;  shells.  Ill,  699;  milroad  iron  as  missiles,  III,  697;  effects  of 
missiles  on  blood-vessels,  III,  750;  on  bony  structure.  III.  713; 
lodgement  of.  HI,  757  ;  early  extraction  of,  III,  867 ;  encygtinent  of, 
III,  867. 

Moral  Influences,  effects  of,  on  the  treatment  of  wounds,  III,  86" 

Mouth  and  Appendages,  operations  on,  for  miscellaneous  injuries  nn-J 
diseases,  III,  684. 

Mule  Litters,  III,  928. 

Multiple  Wounds,  case  of,  I,  334.  340  :  II,  017,  241,  408  ;  III,  37?,  409, 
868. 


XXIV 


SUBJECT-MATTEE    INDEX. 


Muscular  Tissue,  effects  of  gunshot  projectiles  on,  III,  712;  repair  of 
shot  wounds  of,  III,  714  ;  pyaemia  in  shot  lesions  of,  III,  713. 

Musculo-spiral  Nerve,  shot  wounds  of,  II,  464  (note),  673  (note),  861  ; 
rupture  of,  III,  644. 

Nasal  Bones,  shot  fractures  of,  I,  381 ;  miscellaneous  injuries  of,  I,  324. 

Neck,  sabre  and  bayonet  wounds  of,  I,  399,  400  ;  III,  68C  ;  miscellaneous 
injuries  of,  I,  400;  III.  653;  shot  injuries  of,  I,  401-424;  III,  688 ; 
wounds  of,  by  conoidal  balls,  I,  402;  lodgement  of  missiles  in,  I,  403; 
extraction  of  missiles  from,  1, 405 ;  torticollis  in  shot  wounds  of,  I,  405; 
wounds  of  the  larynx  and  trachea,  I,  40C ;  aphonia  in.  I,  407;  wounds 
of  the  pharynx  and  cesopha  jus,  I.  408 ;  paralysis  in,  I,  408  ;  complica 
tions  in  shot  wounds  of:  haemorrhage,  I,  411 ;  traumatic  erysipelas,  I, 
412;  111,852;  sloughing  and  gangrene,  I,  413;  111,824;  pysemia,  I, 
413;  III,  859;  tetanus,  III,  819;  operations  on  the,  I,  415. 

Nerves,  shot  wounds  of,  III,  725 ;  effects  of  missiles  and  projectiles  on, 
III,  725,  726,  730,  742;  paralysis  following  shot  wounds  of,  III,  726; 
wounds  of  nerves  of  special  sense,  III,  738  ;  concussion  6r  commotion 
of,  III,  741;  contusion  of,  III,  741;  cicatricial  pressure  on,  III,  741; 
tetanus  following  wounds  of,  III,  743;  immediate  deaths  from  injuries 
of,  III,  743;  altered  nutrition  following  injuries  of,  III,  743,  744; 
excessive  skin  secretion  following  injuries  of,  III,  746;  neuralgia  fol 
lowing  injuries  of,  III,  746;  motor  paralysis,  III,  748;  wounds  of 
nerves  of  the  neck,  I,  423;  of  the  chest,  I,  634;  of  the  pelvis,  II,  339, 
342,  423;  in  flesh  wounds  of  the  upper  extremities,  III,  461-468;  of 
the  lower  extremities,  III,  9;  ball  pressing  on,  I,  410;  involved  in 
cicatrix,  II,  736;  excisions  or  removals  of  portions  of  nerve,  II,  461, 
462,  618,  736,  747,  970,  !»73;  III,  11,  492,  495,  820;  electricity  in 
injuries  of,  I,  387,  409;  II,  461,  1020;  III,  9;  nerve  included  in  liga- 
tion  of  subclavian,  I,  540;  special  hospital  for  treatment  of  injuries 
and  diseases  of,  III,  729 ;  wounds  of:  axillary  plexus,  I,  410 ;  II,  461, 
492 ;  brachial plexus,  I,  409,  410,  478,  522,  560 ;  cervical  plexus,  1, 405; 
crural  nerve,  I,  446;  II,  339,  400;  III,  10,  74,  823;  cutaneous  nerve, 
II,  4t>2,  463,  464,  470,  928;  III,  9,  11;  excision  of  cutaneous  nerve, 
II,  462,  470;  dental  nerve,  I,  358,  362,  397,  398;  facial  nerve,  I,  117, 
302,  387;  lumbar  nerve,  II,  330;  median  nerve,  I,  479;  II,  447,  461, 
464,  469,  470,  778,  827,  946,  1020;  III,  687;  excision  of  median,  II, 
461;  musculo-spiral  nerve,  II,  461,  464,  673,  861;  III,  644;  optic 
nerve,  I,  326,  327,  335,  344;  peroneal  nerve,  III,  492,  495;  plantar 
nerve,' III,  617;  pneumogastric  nerve,  I,  357;  popliteal  nerve,  III,  9, 

II,  55,  ;">6.  95,  103,  173;  radial  nerve,  II,  452,  467,  925,  938;  sacral 
nerve,  I,  449:  II,  261 ;  sacral  plexus,  II,  232,  253,  254  ;  saphennus, 
long,  nerve,  III,  9,  10,  11 ;  sciatic  nerve,  II,  323,  327,  339,  340,  346, 
354,  366,  406;  III,  9,  10,  22,  56,  196,  311,  687.     Spinal  nerves,  I,  577, 
584;   II,  163,  340;   necrosis  involving  sympathetic  nerve,    II,  466; 
thoracic  nerve,  I,  536 ;  tibial,  II,  412  ;  anterior  tibial,  III,  7,  9,  11,  55; 
posterior  tibial,  III,  9,  11,  12,  20,  54,  56 ;  excision  of  posterior  tibial, 

III,  58;  ulnar,  II,  461,  465,  466,  469,  843,  861. 

Neuralgia,  traumatic,  I,  478;  probably  caused  by  lodgement  of  ball,  II, 
232 ;  relieved  by  removal  of  ball,  II,  236 ;  treatment  of,  II,  342. 

Nervous  Anxiety,  in  shot  wounds  of  chest,  I,  638. 

Neuroma,  II,  463,  465,  466,  623,  628,  699 ;  III,  624. 

Neurotomy,  II,  465,  623,  628,  699. 

Nose,  wounds  of,  I,  386 ;  protracted  discharge  from  wounds  of,  I,  387. 

Occipital  Artery,  wounds  of,  I.  80,  82,  83,  124,  132,  456;  haemorrhages 
from,  III,  763;  ligations  of  I,  456  ;  III,  765,  771. 

CEdema  of  Glottis,  I,  404,  417,  418. 

OEsophagus,  incised  wound  of,  I,  400 ;  shot  wounds  of,  I,  536,  606,  634 ; 
III,  618. 

Oinentum,  ruptures  of,  II,  23;  shot  wounds  of,  II,  36, 174;  III,  689  ;  ball 
held  in  folds  of,  II,  174;  protrusion  of,  I,  449;  II,  32,  33,  34,  169,  175, 
180,  182,  183;  removal  of  protruding,  II,  32,  77,  91,  181,  182;  slough 
ing  of,  I,  516. 

Ophthalmitis,  general,  incisions  in,  I,  345. 

Opium,  use  of,  in  injuries  of  abdomen,  II,  17,  27,  207. 

Optic  Nerve,  shot  wound  of,  I,  326,  327,  332,  335,  344. 

Orthopnooa,  in  chest  wounds,  I,  480,  505,  529;  in  wounds  of  the  abdomen, 
II,  135,  155. 

Os  Calcis,  shot  contusion  of,  III,  617;  shot  fractures  of,  III,  618,  619; 
excisions  of,  III,  624,  625,  626,  627. 

Osteoplasty,  in  wounds  of  the  testes,  II,  410,  416. 

Osteomyelitis,  following  injuries  of  the  upper  extremities,  II,  648,  715, 
754,  788;  of  the  lower  extremities,  III,  146,  148,  149,  152,  153,  156, 
157,  193,  223,  280,  281,  290,  297,  301,  312,  315,  442,  590;  resulting  from 
shot  contusions  of  femur;  simple,  111,716;  gangrenous,  III,  171,  717. 


Osteophytes,  in  shot,  contusions  of  cranial  bones,  I,  127;  in  injuries  of  the 

femur,  III,  31,  202,  225,  291. 

Osteo-sarcoma,  amputation  of  thigh  for,  III,  666. 
Palate  Bone,  shot  fractures  of,  I,  381. 
Palatine  Artery,  haemorrhage  from,  I,  346. 
Palmar  Arcli  Arteries,  incised  wound  of,  II,  437;  haemorrhage  from 

II,  437,  448,  449,  459;  III,  764;  ligations  of,  II,  454;  III,  765,  785. 
Pancreas,  shot  wounds  of,  II,  158.  159, 130. 161,  202;  III,  089;  ball  lodged 

in,  II,  159,  100;  protrusion  of,  II,  158;  excision  of,  II,  158. 

Paracentosis,  thoracis:  for  hydrothorax,  I,  573;  for  metastatic  abscesses 
and  empyema,  I,  573;  for  idtopathic  pleurisy,  I,  573;  for  effusions  fol 
lowing  perforations  of  the  chest,  I,  574 ;  abdominis,  for  ascites,  II,  191, 
192;  natnralis,  I,  576. 

Paralysis,  after  shot  fractures  of  cranium,  I,  226,  227,  228,  229,  230,  278, 
287;  after  wounds  of  neck,  I,  409,  410:  after  wounds  of  chest,  I,  478, 
479;  after  wounds  of  abdomen,  II,  14;  of  bladder  and  rectum,  II,  252, 
229,  247,  248 ;  relieved  by  removal  of  ball,  I,  424 ;  electricity  in,  I,  442. 

Parotid  Gland,  wounds  of,  I,  406,  411;  ball  embedded  in,  I,  305. 
Patella,  shot  fractures  of,  III,  367;  shot  perforations  of,  III,  371,  373,  380; 
percentage  of  fatality  of  shot  injuries  of.  Ill,  416;   shot  contusions  of, 

III,  364;  bayonet  wound  of,  III,  360;   miscellaneous  injuries  of,  III, 
651. 

Pelvis,  sabre  and  bayonet  wounds  of,  III,  686;  punctured  and  incised 
wounds  of,  II,  323,  326,  335,  336,  423;  shot  contusions  of,  III,  716: 
shot  fractures  of,  II,  211-254,  424-426;  III,  689;  excisions  of  pelvic 
bones,  II.  255.  See  Ilium,  Pubis,  Ischium,  Sacrum,  Coccyx, 
shot  injuries  of  parts  contained  in  pelvis,  II,  257-406. 

Penis,  incised  wounds  of,  II,  343,  344;  bayonet  wounds  of,  II,  344;  shot 
wounds  of,  II,  345-349;  laceration  of,  II,  374;  ball  encysted  in,  II, 
345;  ball  lodged  in,  II,  345,  346;  ball  extracted  from,  II,  345,  346; 
use  of  catheter  in  wounds  of,  II,  348;  amputation  of,  II,  347,  349. 

Perforating  Arteries,  haemorrhages  from,  III,  50,  239,  267,  764;  liga 
tions  of,  III,  50,  239,  267,  765,  799. 

Periarticular  Wounds,  of  the  shoulder  joint,  II,  502 ;  of  the  elbow  joint, 
II,  829;  rarity  of,  in  wounds  of  the  wrist,  II,  995;  of  the  hip  joint.  Ill, 
25;  of  the  knee  joint,  III,  28;  of  the  ankle  joint,  III,  31;  summaries 
of,  III,  690. 

Pericarditis,  in  wounds  of  the  chest,  I,  529,  530,  578,  587,  622. 

Pericardium,  wounds  of,  I,  528,  529,  606 ;  ball  lodged  in,  I,  528 ;  autop 
sies  in  wounds  of,  I,  528,  529. 

Perinaeum,  shot  wounds  of,  II,  243,  244,  399 ;  ball  extracted  from,  II,  399 ; 

lacerated  wound  of,  II,  402. 
Perineal  Fistula,  after  shot  wounds,  II,  365. 
Perineal  Section  (perineotomy),  ball  removed  by,  II,  260;   fragment  of 

bone  removed  by,  II,  399,  400;   portions  of  bayonet  scabbard  and  of 

bayonet  removed  by,  II,  245. 

Periostitis,  in  shot  contusions  of  cranial  bones,  I,  102,  127;  of  scapula,  I, 
564;  in  wounds  of  hip  joint,  III,  79;  in  fractures  of  bones  of  lower 
extremities,  III,  183,  310,  313,  314,  428,  455,  515,  518. 

Peritonitis,  traumatic,  in  wounds  of  spine,  I,  427,  444,  440, 449 ;  in  wounds 
of  chest,  I,  586;  in  wounds  of  abdomen,  II,  5,  7,  12;  general  observa 
tions  on,  II.  199,  200,  207,  208. 

Peroneal  Artery,  traumatic,  aneurism  of,  III,  808 ;  wounds  of,  III,  456 ; 
haemorrhage  from,  III,  515,  764 ;  ligations  of,  III,  51,  450,  456,  526, 
765,  805. 

Peroneal  Nerve,  excisions  of,  III,  492,  495. 

Phalangeal  Bones,  of  hand,  shot  fractures  of,  II,  1019;  of  foot,  shot 
fractures  of,  III,  618;  excisions  of,  III,  626. 

Pharyngitis,  in  wounds  of  the  neck,  I,  350,  416. 

Pharynx,  shot  wounds  of,  I,  414;  III,  688. 

Phlebotomy,  in  shot  wounds  of  chest,  I,  649. 

Phrenic  Artery,  haemorrhage  from,  II,  177;  III,  764. 

Phimosis,  operations  for,  II,  343,  361,  374 ;  non-traumatic,  II,  386. 

Plantar  Artery,  haemorrhage  from,  IIT,  764;  ligations  of,  III,  552,  673, 
678,  765,  804,  805. 

Plantar  Nerve,  shot  injury  of,  III,  617. 

Plastic  operations,  in  injuries  of  the  face,  I,  368-380;  for  fecal  fistula, 
II,  79. 

Pleural  Cavity,  incisions  into,  after  empyema,  I,  581 ;  apparatus  for  effu 
sions  in,  I,  627. 


SUBJECT-MATTER    INDEX. 


XXV 


Pleurisy,  traumatic,  in  penetrating  wounds  of  chest,  I,  617,  618:  cases  of,  ; 

470,  492,  574,  576. 

Pneumogastric  Nerve  involved  in  wound,  I,  337. 
Pneumonia,  traumatic,  in  penetrating  wounds  of  chest,  I,  619-622;  II, 

493,  486,  499,  500;  in  shot  wounds  of  the  back,  II,  432. 

Piieumotliorax,  in  shot  wounds  of  chest,  I,  633 ;  cases  of,  I,  493,  494,  520.  ! 
Poisoned  Wounds,  III,  640,  656,  663. 

Popliteal  Artery,  wounds  of,  III,  14,  17,  18,  47,  51,  56,  173,  226;  haem 
orrhages  from,  III,  764;  aneurisms  of,  III,  14,  54,  55,  58,  542,  080, 
808;  occlusion  of,  III,  14,  18,  388;  ligations  of,  III,  14,  50,  51,  54, 175, 
383,  404,  569,  765,  800. 

Popliteal  Nerve,  shot  injuries  of,  III,  9,  11,  55,  56,  173. 
Popliteal  Vein,  injuries  of,  III,  55;  haemorrhage  from,  III,  816 ;  ligations 

of,  III,  383. 

Priapism,  persistent,  1, 209 ;  11,303  (note):  111,81. 

Profunda  Artery,  of  arm :  injuries  of,  II,  448,  585,  049,  736 ;  haemorrhages 
from,  HI,  704 ;  aneurism  of,  111,808;  ligationof,  11,454,  681,736;  III, 
765,  782;  of  thigh:  injuries  of,  111,47,49,55,172;  haemorrhages  from 
III,  704;  aneurisms  of,  III,  49,  808;  ligations  of,  111,44-49,172,233, 
236,  765,  798,  799 ;  re-ligations  of,  III,  44-47,  48. 
Projectiles  used  during  the  war,  III,  695-704  ;  effects  of  large,  III,  704. 

See  Missiles,  Balls. 
Prostate,  shot  wounds  of,  II,  303,  304,  313,  423;  III,  689;  autopsy  in  shot 

wounds  of,  II,  304 ;  ball  lodged  in,  II,  304. 
Prostration  after  anaesthesia,  III,  897. 

Prothetic  Apparatus,  in  excisions  at  the  shoulder  joint,  II,  568,  573,  580, 
594  ;  in  excisions  in  shaft  of  humerus,  II,  675;  in  excisions  at  elbow 
joint,  II,  849,  907, 908 ;  in  amputations  in  forearm,  II,  968;  in  fractures 
or  excisions  at  wrist  or  ankle  joint,  II,  1015;  for  amputations  at  hip 
joint,  III,  131, 162 ;  in  amputations  in  the  thigh,  III,  224. 
Pseudartnrosis,  after  fractured  jaw,  1,361;  in  shot  fractures  of  the  hu 
merus,  II,  673,  676,  680,  682,  087 ;  frequency  of,  after  excisions  in  shaft 
of  humerus,  II,  696;  after  excisions  of  elbow,  II,  853,  854,  856,  858, 
877,  890 ;  after  excisions  in  forearm,  II,  934,  940, 945,  963,  964 ;  in  peri- 
articular  wounds  of  hip  joint,  III,  25  (note) ;   in  fractures  of  femur 
III,  186,  198, 199;  after  excisions  in  shaft  of  femur,  III,  202;  after  ex 
cisions  in  bones  of  leg,  III,  447,  450,  456,  457, 459,  460  566,  572. 
Pterygium,  operation  for,  III,  681,  682,  683. 
Ptosis,  in  shot  wounds  of  cranium,  I,  115,  186,  358. 
Pubic  Bones,  shot  fractures  of,  II,  237-240;  table  of  cases  of,  II,  255; 

autopsies  after  shot  fractures  of  pubic  bones,  II,  238,  239, 240. 
Pudic  Artery,  traumatic  aneurism  of,  III,  808 ;  wound  of,  II,  357 ;  haemor-  ] 
rhages  from,  III,  764  ;  external,  II,  326;  III,  764 ;  ligation  of,  II,  186,  I 
326;  III,  765,  798;  internal,  aneurism  of,  II,  252;  haemorrhage  from, 
II,  324,  327;  wound  of,  II,  304  ;  bayonet  wound  of  branch  of,  II,  323. 
Pulmonary  Artery,  thrombi  in,  II,  967 ;  haemorrhage  from,  III,  764. 
Punctured  Wounds,  number  of,  during  the  war,  III,  640 ;  of  scalp,  I, 
30;    of  cranium,   I,  31;  of  face,  I,  321,323,324;  of  neck,   I,  399;  of 
chest,  I,  460,  407,599;    of  abdominal  parietes,  II,  3;  of  abdominal 
cavity  without  visceral  injury,  II,  31,  202;  of  jejunum,  II,  42;  of 
stomach,  II,  42,43,44,57;  of  small  intestines,  II,  61  ;  of  mesenteric 
artery,   II,  62;   of  large  intestines,  11,76;  of  diaphragm,  II,  76;  of 
colon,  II,  76;  of  liver,  II,  129;  of  spleen,  II,  149;  of  kidney,  II,  162; 
of  bladder,  II,  203 ;  of  urethra,  III,  052 ;  of  blood-vessels  of  pelvis, 
II,  323;  of  pudic  artery,  II,  323;   of  iliac  artery,  II,  335;   of  penis, 
II,  344;  of  back,  II,  429;  of  upper  extremities,  II,  435;  of  brachial 
artery,  II,  430 ;  of  clavicle  or  scapula,  II,  473,  474 ;   of  elbow  joint, 
II,  827;  of  metatarsal  bones,  III,  017;   of  lower  extremities,  III,  5; 
of  femoral  artery,  III,  6;  of  knee  joint,  III,  359,  653;  of  leg,  III,  6. 
Pus,  extravasation  of,  in  shot  wounds  of  abdomen,  II,  197;  cases  of,  II,  24, 

67,  104,  135,  130. 

Pysemia,  tabular  statement  of  cases  of,  III,  858 ;  percentage  of  fatality 
in  cases  of,  III,  858;  complicated  with  other  diseases,  HI,  858;  time 
of  appearance  of,  after  injury,  III,  859,  800;  duration  of,  III,  800; 
after  shot  flesh  wounds,  HI,  800 ;  after  shot  fractures,  III,  800 ;  treat 
ment  of,  III,  860,  861;  in  shot  lesions  of  muscular  tissue,  III,  713; 
post  mortem  appearances  in  cases  of,  III,  802-866;  after  shot  fractures 
of  cranium,  I,  250 ;  of  the  face,  III,  859  ;  after  shot  wounds  of  the 
neck,  I,  412,  413;  III,  859 ;  after  shot  wounds  of  the  spine,  I,  454  ;  of 
chest,  I,  472;  after  shot  fractures  of  pelvis,  II,  212,231,239,  247;  in 
fractures  of  upper  extremities,  III,  859 ;  in  fractures  of  forearm,  II, 
932;  in  fractures  of  lower  extremities,  III,  838,  659;  in  flesh  wounds 
of  lower  extremities,  III,  32,  33;  in  fractures  of  femur,  III,  352;  in 
fractures  of  knee  joint,  III,  410;  in  fractures  of  leg,  III,  569. 


Pyohnemia,  III,  857. 

Radial  Artery,  incised  wound  of,  II,  436;  shot  wounds  of,  II,  452,  455, 
409,  840,  914;  haemorrhages  from,  II,  452,453;  III,  704;  aneurism* 
of,  II,  969, 1010 ;  III,  808 ;  ligations  of,  II,  430, 452, 453,  469 ;  III,  705, 
782;  summary  of  ligations  of,  III,  783;  shot  wound  of  radial  and 
uliuir,  HI,  704. 

Radial  Nerve,  shot  injuries  of,  II,  452, 467,  925,  93d. 
Radius,  shot  fractures  of,  11,922;  treated  by  expectation,  11,927-932: 

followed  by  excision,  II,  936. 
Radius  and  Ulna,  shot  fractures  of,  II,  923. 
Railway  Transportation  of  wounded,  III,  957-971. 
Ramrod,  abdominal  cavity  transfixed  by,  without  injury  to  viscera,  II, 

33;  missile  extracted  by,  II,  251. 
Re-amputations,  III,  870,871. 

Recto-vesical  Fistula,  after  shot  wounds,  II,  309,  310,  313. 
Rectum,  shot  wounds  of,  II,  305;  III,  689;  lesions  of,  without  injury  to 
other  organs  of  pelvis,  II,  423;  autopsies  in  shot  wounds  of,  II,  316. 
317,  318 ;  foreign  bodies  removed  from,  II,  322. 

Rectus  Muscles,  rupture  of,  in  lacerated  wound  of  abdomen,  II,  5. 
Reflex  Paralysis  in  shot  wounds,  III,  726, 729-738. 
Remote  Results  of  wounds  and  injuries,  sources  from  whence  obtained, 

I,  xir. 
Report  of  surgical  operations,  form  of,  I,  xvi;   of  wounded,  form  of,  I, 

xvi. 

Resections,  instruments  for,  see  plate  opposite  II,  256.     See  Kxclsions. 
Rliinoplasty,  I,  372. 

Ribs,  shot  fractures  of,  I,  488,560;  III,  689;  shot  fractures  of,  without  le 
sion  of  thoracic  cavity,  I,  446;  fractures  of,  not  shot,  I,  599;  excisions 
of,  portions  of,  I,  566, 570,  598. 

Rifle-balls,  of  Springfieldmusket,  III,  697;  of  Enfield  musket,  III,  697;  of 

Austrian  musket,  III,  697 ;  of  Burnside  rifle,  III,  097 ;  of  Spencer  rifle, 

111,697;  of  Sharp's  carbine,  III,  697;  .of  Green's  rifle,  III,  697;  of 

Colt'sarmy  pistol, III,  697;  superiority  of,  over  round  ball,  III,  094,  697. 

Rucker  ambulance  wagon,  III,  952,  953. 

Sabre  Wounds,  of  scalp,  I,  1,  308;  fracturing  cranium,  I,  16,  308;  of 
foce,  I,  321,  382;  of  neck,  I,  399,  400;  of  chest,  I,  466,  471 ;  of  ab 
dominal  parietes,  II,  3,  8;  penetrating  abdominal  cavity,  II,  32,  202; 
of  small  intestines,  II,  61;  of  large  intestines,  II,  76;  of  liver,  II,  129; 
of  urethra,  II,  374;  of  back,  II,  429;  of  upper  extremities,  II,  435, 
436;  of  scapula,  II,  473;  of  elbow  joint,  II,  828;  of  forearm,  II,  918; 
of  lower  extremities,  III,  5,  7;  summary  of  sabre  wounds,  III.  685, 
686 ;  mortality  of  sabre  wounds,  III,  686. 
Sacral  Nerves,  wounds  of,  I,  449;  II,  261 ;  wounds  of  plexus  of,  II,  232, 

253,  254,  341. 

Sacro-luinbsvr  Nerves,  shot  injury  of,  II,  340. 

Sacrum,  shot  fractures  of,  II,  246-251 ;  excisions  of  portions  of,  II,  251 ; 
portion  of,  removed  by  trephine,  II,  251;  lodgement  of  12-pound 
shell  in,  II,  248. 

Saliva,  profuse  escape  of,  in  shot  wounds  of  face,  I,  369,  370,  371,  372,  37, 
Salivary  Fistula,  cases  of,  I,  330,  368,  369 ;  treatment  of,  I,  380,  387. 
Saplienous  Nerve,  injury  of  long,  III,  9,  10, 11. 
Sarcocele,  II,  418. 

Scalds  and  Burns,  cases  of,  during  the  war,  III,  641. 
Scalping,  I,  315. 

Scalp,  injuries  of,  I,  1-10,  28-31,  35,  70-95,  308;  sabre  wounds  of,  1, 1-16; 
summary  of  cases  of,  I,  16, 3C8 ;  sutures  in  scalp  wounds,  I,  1-16,  25; 
adhesive  plaster  in,  I,  15,  16 ;  other  incised  wounds  of,  I,  28-30,  308 ; 
bayonet  wounds  of,  I,  30^,  31 ;  contusions  and  lacerations  of,  I,  35, 
38,  39-42,  43,  45,  47,  51 ;  FltIAU'8  balsam  in  scalp  wounds,  I,  04  ; 
edges  of  wound  approximated  by  tying  hair,  1, 64 ;  interrupted  sutures 
in  scalp  wounds,  I,  04  ;  sabre  nnd  bayonet  wounds  of.  Ill,  686;  shot 
wounds  of,  I,  70-95;  III,  688  ;  tabular  statement  of  shot  wounds  of, 

I,  70 ;  scalp  wounds  complicated  with  intcrcurrcnt  diseases,  I,  85-88 ; 
compression  of  brain  in  scalp  wounds,  I,  75,  76 ;  coma,  I,  75,  76  ;  ball 
extracted  from  scalp,  I,  92 ;   foreign  bodies  lodged  in,  I,  92 ;  seton 
wounds  of  scalp,  I,  90,  91,  95. 

Scapula,  sabre  wounds  of,  II,  473;  III,  C86;  punctured  fractures  of,  II, 
474 ;  shot  fractures  of,  II,  474-481 ;  III,  690,  870  ;  remarkable  fisstiring 
of,  II,  488  ;  exfoliations  of,  II,  482,  487;  autopsies  in  shot  fractures  of 

II,  488,  489,  490;  excisions  of  portions  (if,  I,  562,  566;  II,  49 

490,  497 ;  III,  657,  658 ;  excision  of  entire,  II,  49D  (note) ;  trephining 
of  portion  of,  II,  492. 


XXVI 


SUBJECT-MATTER    INDEX. 


Sciatic  Artery,  shot  wound  of,  II,  326  ;  haemorrhages  from,  II,  326,  327; 
III,  764  ;  aneurism  of,  III,  808 ;  ligations  of,  II,  326,  765,  787. 

Sciatic  Nerve,  bayonet  wounds  of,  II,  323;  III,  C87;  shot  wounds  of,  II, 
100,  179,  252,  339,  340,  3o5;  III,  9,  10,  22,  56,  CO,  139,  196,  311. 

Scrotum,  shot  wounds  of,  II,  419;  ball  extracted  from.  II,  419. 
Septicaemia,  II,  351 ;  III,  857,  858.    See  Pyreinia. 
Sequestra,  removal  of,  II,  715;  III,  212,  224,  439,  459,  520,  522. 

Seton  Wounds,  in  injuries  of  the  scalp,  I,  90,  91,  95 ;  in  injuries  of  the 
ilium,  II,  213,  227. 

Shells,  injuries  by,  III,  696;  appearance  of  injuries  by,  III,  711 ;  lodge 
ment  of,  III,  705.  706 ;  lodgement  of  12-pound  shell  in  sacrum,  II, 
248.  See  Missiles. 

Shock,  in  shot  wounds  of  chest,  I,  639 ;  in  shot  wounds  of  the  abdominal 
parietes,  II,  13;  in  penetrating  wounds  of  abdomen,  II,  30  ;  as  a  pri 
mary  symptom  of  shot  wounds,  III,  759;  death  from  shock  of  wound 
or  operation,  II,  490,541,  642,  644,  760,  979,  990 ;  III,  298,  299,  300,  301, 
302,  308,  315,  321,  322,  459,  661,  662,  669,  670,  676. 

Shot  Wounds,  number  of  cases  of,  treated  during  the  war,  III,  685,  688; 
regional  frequency  of,  III,  691,  692.-  relative  frequency  of,  III,  691, 
692;  definition  of,  III,  694;  primary  symptoms  of:  pain,  III,  760; 
shock,  III,  759;  haemorrhage,  III,  762;  entrance  and  exit  wounds, 
III,  711 ;  early  examination  of,  III,  867;  early  treatment  of,  III,  867 ; 
primary  dressing  of,  III,  867 ;  maggots  in,  III,  867  ;  multiple  wounds, 
III,  868,  869 ;  influence  of  hygienic  and  moral  conditions  on  treatment 
of,  III,  868 ;  effects  of  climate  ou  treatment  of,  III,  867.  See  shot 
wounds  of:  Head,  Face,  Neck,  Chest,  Spine,  Abdomen, 
Pelvis,  Back,  Upper  and  Lower  Extremities ;  fur  shot 
contusions,  see  Contusions ;  fur  shut  fractures,  see  Fractures. 

Shoulder  Joint,  shot  fractures  of,  II,  502;  III,  690,  8";0;  periarticular 
wounds  of,  II,  502 ;  III,  690  ;  shot  fractures  of,  treated  by  expecta 
tion,  II.  502-519,  656  ;  III,  870 ;  hemorrhage  in  shot  fractures  of,  II, 
513,  514;  autopsies  in  shot  fractures  of,  II,  510,  511,512,  513;  shot 
fractures  of,  treated  by  excision,  II,  519-613,  664 ;  III,  870 ;  treated 
by  amputation,  II,  613,  655 ;  III,  871. 

Sibley  Tents,  used  as  hospital  tents,  III,  920. 
Simple  Dressings  in  shot  wounds  of  chest,  I,  642. 
Simple   Shot  Fractures,  III,  704,  705;  of  the  humerus,  II,  815;  of 
the  radius,  II,  929  ;  of  the  tibia  and  fibula  by  cannon  ball,  III,  440. 

Skin  Grafting,  in  shot  wounds  of  back,  II,  430,  431. 

Small  Arms,  projectiles  from  and  seat  of  injury  in  wounds  by,  III,  696; 
effects  by  missiles  from,  III,  708,  709.  See  Missiles. 

Solid  Shot,  summary  of  injuries  by,  III,  696. 

Spermatic  Artery,  haemorrhage  from,  II,  337 ;  III,  764  ;  ligations  of,  II, 
337  ;  III,  684,  765,  788. 

Spermatic  Cord,  shot  wounds  of,  II,  417 ;  III,  689 ;  cases  of,  II,  339, 
413,  415. 

Sphincter,  division  of,  for  fistula,  II,  315,  321;  stricture  of,  after  shot 
wounds,  II,  312,  314,  315;  paralysis  of,  II,  310,  312. 

Spinal  Canal,  incised  wound  of,  I,  425;  shot  wounds  of,  II,  154,  155; 
balls  lodged  in,  I,  435,  436,  438,  439,  440,  443,  444,  447,  449,  452,  453, 
457 ;  perforation  of,  I,  444,  447 ;  ball  extracted  from,  I,  444. 

Spinal  Cord,  laceration  of,  I,  426,  427,  431,  433,  435,  436,  438,  440,  443, 
444,  447,  458;  perforation  of,  I,  437,  446,  452;  severed,  I,  439,  444; 
II,  339 ;  compressed,  I,  426,  438 ;  gangrene  of,  II,  169 ;  exposed,  II, 
229. 

Spine,  miscellaneous  injuries  of,  I,  426-429;  III,  643,  649;  incised  wounds 
of,  I,  425;  shot  wounds  of,  I,  430-460;  III  689;  concussion  of,  I,  427, 
427,  429,465;  III,  643;  foreign  bodies  in,  I,  437,438,  444;  excisions, 
trephining  of,  I,  4G3-465;  balls  lodged  in,  I,  430.  432, 435,  436, 437,  439, 
441,  447,  453,  459,  460;  balls  extracted  from,  I,  430,442,443,446,452, 
456,  460, 462;  absence  of  paralysis  after  shot  wounds  of,  I,  431,  442,  443, 
444,  446,  447,  449,  451 ;  tetanus,  dyspnoea,  pyaemia,  dysphagia,  costive- 
ness,  and  priapism  after  injuries  of  vertebrae,  I,  454.  See  Vertebrae, 
and  Cervical,  Dorsal,  and  Lumbar. 

Spleen,  ruptures  of,  I,  38,  II,  18, 19,  26;  punctured  wounds  of,  II,  149;  shot 
wounds  of,  II,  149-157,202;  111,689;  protrusion  of,  in  penetrating 
wound  of  abdomen,  II,  151;  extirpation  of,  II,  150. 

Splenic  Artery,  wound  of,  II,  159 ;  haemorrhage  from,  III,  764. 

Splenitis,  traumatic,  II,  19,  157. 

Splenotomy,  II.  149,  254. 


Splints,  AHL'S  felt,  II,  822,888;  BAUER'S,  II,  835;  BOND'S,  II,  897;  DE- 
SAULT'S,  III,  343;  ESMARCH'S,  II,  835,  888;  GURDON  BUCK'S,  III, 
348;  HODGEN'B,  II,  904;  III,  346,  347,  348;  HARLAN'S  bracketed,  II, 
509,  517,  562;  MARTIN'S,  II,  822;  PHYSICK'S,  III,  343;  SMITH'S  an 
terior,  III.  345,  346;  VOLKMANN's  wire,  II,  904;  HEATH'S,  II,  905; 
in  excisions  of  the  sho  aider  joint,  II,  509,  517;  in  excisions  of  the 
humerus,  II,  822  :  in  shot  fractures  of  the  elbow,  II,  835;  in  excisions 
at  the  elbow,  II,  888;  in  fractures  of  the  femur,  III,  343. 

Sprains  and  Contusions,  III,  642. 

Staphyloma,  operations  for,  III,  681-683. 

Staphylorraphy  in  wounds  of  upper  jaw,  I,  378. 

Sternum,  shot  fractures  of,  I,  486,  504,  525;  excisions  of  portions  of,  I,  571. 

Stimulants,  in  shot  wounds  of  the  chest,  I,  647;  prior  to  the  administra 
tion  of  anaesthetics.  Ill,  889. 

Stomach,  rupture  of,  without  external  wound,  II,  22 ;  punctured  and  in 
cised  wounds  of,  II,  42,  56;  treatment  of,  by  ligature,  II,  44;  shot 
wounds  of,  II,  45-60, 154,  160,  202;  III,  689;  autopsies  in  cases  of,  II, 
42,  48,  50,  51  ;  escape  of  lumbricoid  worms  in  wound  of,  II,  42. 

Stomatoplasty  in  shot  wounds  of  mouth,  I,  370. 

Strabotomy,  cases  of,  III,  681,  682,  683. 

Stricture,  Traumatic,  in  shot  wounds  of  urethra,  II,  351-358,  365,  368, 
372,  397 ;  after  laceration  of  urethra,  III,  652. 

Stromeyer's  Axillary  Pad  in  wounds  of  shoulder  joint,  II,  517. 

Stumps,  after  amputations  in  thigh,  by  the  anterior,  posterior,  antero-pos- 
terior,  lateral,  and  circular  methods,  III,  356,  and  plate  opposite. 

Styptics,  use  of,  in  hemorrhage,  III,  812;  in  wounds  of  scalp,  I,  64;  of  face, 

I,  346;  injected  into  wounds  of  chest  through  female  catheter,  I,  544; 
danger  of  their  falling  into  the  pleural  cavity  in  chest  wounds,  I,  550; 
discouraged  in  wounds  of  the  abdominal  parietes  and  abdomen,  II,  9, 
10,  177,  179;  no  reliance  to  be  placed  on  the  use  of,  II,  460. 

Subclavian  Artery,  shot  wounds  of,  I,  479,  521,  522,  5fiO;  haemorrhages 
from,  III,  764;  aneurism  of,  I,  4§4;  II,  621;  III,  808;  ligatious  of,  II, 
440,  449,  468,  632,  648,  716;  III,  662;  analysis  of  ligations  of,  111,772. 

Subclavian  Vein,  shot  wound  of,  I,  560;  haemorrhage  from,  III,  816; 
accidentally  opened  while  searching  for  artery,  I,  555;  rupture  of,  I, 
527. 

Sublingual  Artery,  wounds  of,  I,  347,  353,  394. 

Submental  Artery,  injury  of,  III,  763;  ligations  of,  III,  765,772. 

Subscapular  Artery,  injuries  of,  I,  351,  519,  596;  II,  484;  III,  764; 
ligations  of,  II,  443,  484,  585;  III,  765,  776. 

Subsultus  Tendinum,  in  shot  injuries  of  cranium,  I,  160,  162,  299. 

Suicides,  number  of  cases  of,  during  the  war,  III,  641. 

Sunstroke,  fatal  case  of,  III,  656. 

Supra-renal  Capsules,  shot  wounds  of,  II,  173,  202;  III,  689;  autopsy 
in  wound  of,  II,  173;  ball  encysted  in  II,  173. 

Suprascapular  Artery,  wounds  of,  II,  490,  642;  haemorrhages  from,  I, 
539;  II,  496;  III,  764;  aneurism  of,  III,  808;  ligations  of,  I,  538,  549; 
III,  765,  774. 

Surgeons,  duties  of,  as  surgeons  in  chief:  of  a  division,  III,  906;  of  a 
brigade,  III,  907;  in  charge  of  division  hospital,  III,  908;  as  attend 
ing  or  prescribing.  Ill,  909;  as  operating,  III,  909;  as  regimental,  III, 
910  ;  as  assistant  regimental,  III,  912. 

Surgeon's  Field  Companion,  III,  915. 

Sutures,  in  wounds  of  the  eyelids,  I,  388;  in  incised  wounds  of  the  abdom 
inal  parietes,  II,  4 ;  in  punctured  and  incised  wounds  of  the  stomach, 

II,  44;  in  shot  wounds  of  the  stomach:  JOHERT'S,  LEMBKRT'S,  II,  59; 
LEDRAX'S,  BERTRANLH'S,  11,44;  in  wounds  of  the  small  intestines,  II, 
72,  73,  76,  112, 124, 128;  PALFYN'S,  BELL'S,  II,  114;  LEDRAN'S,  BEK- 
TRANDI'S,  II,  115;  JOBERT'S,  II,  118;  LEMBERT'S,  GELY'S,  119;  EM- 
MERT's,  VEZIEN's,  II,  121;  the  continued,   the   Glover's,    IF,   122; 
BOSEMAN'S  button,  II,  183;  HOWARD'S  metallic,  in  excisions  of  the 
shaft  of  humerus,  II,  820. 

Symblepharon,  operation  for,  III,  683. 

Sympathetic  Nerve  involved  in  wound,  II,  466. 

Syndectomy,  III,  682. 

Talipes  Equinus,  resulting  from  shot  fractures  of  knee  joint,  II  f,  371, 

394,  395. 

Target  Area  of  different  portions  of  the  human  body,  III,  691. 
Tarsal  Bones,  shot  fractures  of,  III,  618;  excisions  of,  III,  622,  623;  nin- 

putation  through,  III,  628,  631,  632,  636. 
Tarso-metatarsal  Articulation,  shot  fractures  of,  III,  618;  exclsioni 

of,  III,  622. 


SUBJECT-MATTER    INDEX. 


XX  VII 


Temperature,  great  diminution  of,  in  shook   attending  wounds  of  the    Tourniquet,  distribution  to  each  soldier,  111,762;   use  of,  III,  811;   injn- 
abdomen,  II,  30;  in  traumatic  peritonitis,  II,  200.  dicious  use  of,  resulting  in  necrosis,  III,  676;   in  gangrene,  III,  625; 

Temporal  Artery,  wounds  of,  I,  188,  352;  division  of,  I,  160;  hsBmor-  LEE  and  LAMBERT'S,  II,  825;  MORBL'B,  II,  992;  PETIT'*,  II,  992. 

rhages  from,  I,  288,  338;   III,  763;   ligations  of,  I,  101,  215,  241,  244,  j  Trachea,  shot  wounds  of,  I,  414;  III,  688. 

Tracheotomy,  I,  415,  418. 
Transfusion  of  blood,  IT,  642;  III,  58,  811. 


256,  310;  III,  765;  analysis  of  cases  of,  III,  771. 
Tendons,  effects  of  projectiles  on,  III,  712. 
Tenotomy,  III,  59. 

Testes,  shot  wounds  of,  II,  405-418,  423;  III,  689;  excisions  of,  for  shot 
injury,  II,  409 ;  III,  154 ;  excisions  of  both,  II,  4 14  ;  suicidal  tendency 
after  loss  of,  II,  416;  traumatic  displacement  of,  II,  418  (note);  sutures 
in  removal  of,  II,  337,  410,  416;  miscellaneous  injuries  of,  I,  39;  III 
643,  684. 

Tetanus,  number  of  cases  of,  III,  818;   location  of  injury  in  cases  of,  III, 


Transportation  of  Wounded:  by  hand  litters,  III,  923;  by  wheel 
litters,  III,  926;  by  mule  litters  and  cacolets,  III,  926;  by  ambulance 
wagons,  HI,  944;  by  railway,  III,  957;  by  water,  III,  971. 

Trephining,  in  sabre  fractures  of  cranium,  I,  22,  23,  24;  for  miscellaneous 


injuries,  I,  57;  for  shot  fractures  of  cranium,  I,  261,  277,  317,  318,  319, 
320;  summary  of  cases  of,  I,  309;  in  injuries  of  spine,  I,  463;  missile 
extracted  by,  II,  251;  bone  extracted  by,  II,  251. 

Trichiasis  of  the  eyelid,  operation  for,  III,  682. 
818,  819;   preponderating  frequency  in  injuries  ot  lower  extremities,  | 

III,  8 18 ;  after  operations  in  the  extremities,  III,  819 ;  ratio  of  mortality  ]  Trocar,  FLURANT'S,  II,  385. 

in,  III,  819 ;  date  of  appearance  of,  after  injury,  III,  819;  causes  of,  III,  \  Tromatopnoea  in  wounds  of  chest,  I,  635;'  for  cases  see  I,  480,  484,  576  '< 
820;  duration  of,  III,  820;  treatment  of,  I,  454  ;  III,  820;  amputation  I  II,  53,  144. 

to  relieve,  III,  820;  tetanus  among  colored  and  white  troops,  III,  823;  j  Tubular  Sequestra  of  femur,  III,  224,  241. 

frequenay  of,  in  wounds  of  the  nerves,  III,  743 ;   in  lesions  of  muscu-  !     

Tympanitis,  after  rupture  of  abdominal  viscera,  II,  22,  26,  166,  200;  m 
lar  tissue,  III,  713;   in  contusions  of  cranial  bones,  I,  122;   in  injuries 

traumatic  peritonitis,  II,  200. 
of  the  face,  III,  819;   in  injuries  wf  the  neck,  III,  819;   in  injuries  ot  | 


the  chest,  I,  472,  635-   in  injuries  of  the  abdomen,  II,  14,  432,  464;  in     Tympanum,  destroyed  by  shot  wound,  I,  384;  rupture  of  membrane  of, 
injuries  of  the  upper  extremities,  II,  772,  932,  1020;    III,  819;    in  froln  propinquity  to  artillery  fire,  111,708. 

Ulna,  shot  contusions  of,  886;  shot  fractures  of,  II,  922;  shot  fractures  of, 
treated  by  conservation.  II,  925;  treated  by  excision  of  portions  of, 
II,  934  ;  excisions  of  entire,  II,  860 ;  excisions  of.  for  miscellaneous 
injuries,  III,  657. 


wounds  of  the  lower  extremities,  III,  35,  352,  380,  400;  416,  442,  569. 


Thigh,  amputations  of,  for  shot  contusions  of  femur,  III,  172;  for  shot 
fractures  of,  III,  213 ;  primary  amputations  of,  III,  214  ;  intermediary 
amputations  of,  III,  272 ;  secondary  amputations  of,  III,  304 ;  sum 


mary  of  amputations  in,  III,  870,  871 ;  amputations  in  the,  followed 
by  amputations  at  the  hip,  III,  870,  671 ;  amputations  in,  compared 
with  amputations  in  arm,  III,  331 ;  seat  of  original  injury  in  cases  of, 
III,  332 ;  percentage  of  fatality  in  amputations  in  upper,  middle,  and 


Ulnar  Artery,  incised  wound  of,  II,  436;  III,  663;  shot  wounds  of,  II, 
451,  453,  469,  470;  III,  764;  haemorrhages  from,  III,  764;  aneurism 
of,  II,  451 ;  III,  808;  ligations  of,  III,  765,  784. 

Ulnar  Nerve,  shot  wounds  of,  II,  466. 


lower  thirds  of,  III,  333;   amputations  in  both,  III,  333;   table  indi-     Urethra,  punctured  wounds  of,  III,  652;  other  injuries  of,  not  caused  by 


•siting  ages  of  patients  in  amputations  of,  III,  358;  influence  of  size 
of  limb  on  mortality  rate  in  amputations  of,  III,  357;  methods  of 
amputations  in,  III,  355;  periosteal  flap  operation,  III,  317  (note); 
OEITTI'S  method  of,  III,  357;  treatment  of  retracted  flaps  in  amputa 
tions  of,  III,  357;  amputations  of,  for  miscellaneous  injuries,  III,  664, 
666. 

Thoracentesis,  for  idiopathic  pleurisy,  I,  573 ;  for  hydrothorax,  I,  573 ; 
for  empyema  and  metastatic  abscesses  of  lung,  I,  573;  summary  of 
cases  of,  I,  598. 

Thoracic  Artery,  wounds  of,  II,  457 ;  haemorrhage  from,  III,  764 ;  supe- 


shot,  III,  375  :  sabre  wound  of,  II,  374  ;  shot  wounds  of,  II,  351,  380 
386,  404,  423;  III,  689;  incisions  in,  to  prevent  urinary  infiltration, 
II,  380.  385;  foreign  bodies  in,  II,  375;  instruments  for  removal  of 
foreign  bodies  from,  II,  375;  foreign  bodies  escaping  by,  II,  276,  279, 
280,  284,  285,  294,  379 ;  foreign  bodies  extracted  from,  II,  352,  379 ; 
incisions  in,  for  removal  of  foreign  bodies.  II,  378,  400;  use  of  catheter 
in  wounds  of,  II,  352  ;  strictures  of,  II,  386;  treatment  in  strictures  of, 
II,  386 ;  dilatation  of,  II,  368,  388 ;  instruments  for  dilatation  of,  II, 
388  ;  operations  on,  II,  376-404. 
Urethra!  Fistules,  causes  and  diagnosis  of,  II,  360  ;  cases  of,  II,  360,  :i69. 


rior  thoracic,  II,  817 ;  thoracica  longa,  ligation  of,  I,  556. 
Thoracic  Duct,  wounds  of,  I,  535,  634. 

Thoracic  Fistula  in  penetrating  wounds  of  the  chest,  I,  630. 
Thoracic  Nerves,  wounds  of,  I,  536. 
Thyroid  Artery,  shot  wounds  of,  I,  411 ;  thyroid  axis,  haemorrhage  from, 


Urethritis,  caused  by  frequent  catheterization,  II,  387. 

Urethroplasty,  11,401.  402. 

Urethrotomy,  II,  392 ;  internal,  II,  392 ;  instruments  for  internal,  II,  392, 

394,  395,  396 ;  external  perineal,  II,  396,  397,  398. 
Urinals,  for  urethral  fistules,  II,  403 ;  GARIEL'8,  II,  403. 

Ill,  764;   ligations  of,  765,  774;   superior  thyroid,  shot  wound  of,  I,  !  Urinary  Fistules,  II,  164,  386,  387,  400;  apparatus  for,  II.  403;  PEM- 
353 ;  haemorrhages  from,  III,  763 ;   ligations  of,  I,  383,  387 ;   III,  765,  BElJTOX's  canula  for,  II,  403;  foreign  bodies  escaping  through,  II,  265, 

771 ;  inferior  thyroid,  haemorrhages  from,  III,  764.  273,  285. 

Tibia,  shot  contusions  of,  III,  428;  shot  fractures  of,  III,  432;  shotperfora-  |  Urinary  Infiltration  as  cause  of  death  in  shot  wounds  of  bladder,  II, 


tion  of,  III,  722;  shot  fractures  of,  treated  by  conservation,  III,  438, 
563;  hypertrophy  of,  III,  436  ;  excisions  of  portions  of,  III,  445,  569, 
570 ;  excision  in,  a  useless  operation,  III,  572 ;  pseudarthrosis  in  excis 
ions  of,  III,  572. 

Tibial  Arteries,  wounds  of,  III,  764;  haemorrhages  from,  III,  764; 
anterior:  incised  wound  of,  III,  7;  shot  wounds  of,  III,  20,  48,  52,  55> 
400;  haemorrhages  from,  III,  366,  378;  ligatious  of,  III,  765,  801-803; 
posterior:  punctured  wound  of,  III,  7;  shot  wounds  of,  III,  20,  47,  50, 
51,  320;  aneurism  of,  III,  7,  673,  808;  ligations  of,  III,  765,  803-804; 
anterior  and  posterior  :  wounds  of,  III,  52;  aneurism  of,  III,  55,  808; 
ligations  of,  III,  52,  569,  621,  765. 

.Tibial  Nerve,  anterior:  incised  wound  of,  III,  7;  shot  wounds  of,  HI,  9, 


296. 

Urine,  extravasation  of,  as  cause  of  death  in  shot  wounds  of  bladder, 
II,  296;  absence  of  extravasation  in  wounds  of  kidney  or  ureter,  II, 
193  ;  treated  by  free  incisions,  II,  373;  escape  of.  through  wound,  II, 
304  ;  incontinence  of:  in  shot  wounds  of  cranium,  I,  31,  187,  252;  in 
wounds  of  the  bladder,  II,  267,  271,  272  ;  of  the  urethra,  II,  353,  354, 
355 ;  retention  of :  in  shot  fractures  of  cranium,  I,  37,  187,  300 ;  in 
injuries  of  the  spine,  I,  425,  426,  431,  432 ;  in  wounds  of  the  stomach, 
II,  42 ;  in  wounds  of  the  intestines,  II.  68. 

Valgus,  after  excision  of  bones  of  foot,  III,  623. 

Varicocele,  as  a  disability  for  military  service,  II,  422 ;  operations  for,  II, 
422. 


11,  55;  posterior:  shot  wounds  of,  III,  9,  11,  20,  54,  58;  excision  of    Varix,  aneurismal,  II,  336;  cases  of,  II,  TOO;  III,  69,  170,  196,  373;  fol- 


portions  of,  III,  11,  58. 


lowing  ligation  of  femoral  vein,  II,  354. 


Tonsils,  excisions  of,  for  disease,  I,  415,  419. 

Torpedoes,  nature  of  injuries  by,  III,  706;  McCALLUM's  bridge  torpedo. 

Ill,  699. 
Torsion  of  arteries,  HI,  811. 


I,  539,  555 ;  basilic,  wound  of,  II,  637 ;  brachial.  punctured  wound 
of,  II,  436;  haemorrhages  from,  III.  816;  ligations  of.  II,  436,  446, 
448;  cava,  bayonet  wounds  of,  I,  468;  shot  wounds  of,  I,  520,  606; 

II,  139:  hsemorrlmges  from,  III.  816 ;  femoral,  wounds  of,  II,  304, 


XXVIII 


SUBJECT-MATTER    INDEX. 


Veins-  [Continued. 

338,  339;  III,  13,  15,  43,  44,  47,  48;  haemorrhages  from,  III,  757; 
partial  division  of,  III,  754  ;  primary  bleeding  from.  III,  762;  ligation 
of,  III,  44,  47,  48,  49 ;  III,  54 ;  thrombi  in,  III,  79,  191,  590 ;  darning 
needle  removed  from  sheath  of,  III,  43;  varix  after  ligation  of,  III, 
354;  glutcal,  injury  of,  II,  338;  haemorrhages  from,  III,  816;  hsemor- 
rhoidal,  injury  of,  II,  338;  haemorrhages  from.  III,  816;  iliac,  external, 
injury  of,  III,  191 ;  thrombi  in,  III,  191 ;  internal,  injuries  of,  II,  190; 
III,  111;  haemorrhages  from,  III,  816 ;  intercostal,  haemorrhage  from, 
III,  8)6;  jugular,  external,  injuries  of,  I,  407,  408,  411,  412,  491; 
haemorrhages  from.  III,  816;  internal,  wound  of,  I,  421;  perforation 
of,  III,  750;  haemorrhages  from,  I,  420;  III,  816;  ligations  of,  for 
accidental  cutting  of.  during  operation,  I,  392,  397 ;  ligations  of,  for 
shot  injury,  I,  383;  lateral  sinus,  rupture  of,  I,  201;  longitudinal 
sinus,  wounds  of,  I,  176,  203,  275;  haemorrhages  from,  III,  816; 
median  cephalic,  wound  of,  II,  536;  haemorrhages  from,  III,  816; 
mesenteric,  haemorrhages  from,  III,  816 ;  omo-hymd,  shot  wound  of, 
I,  457;  parietal,  haemorrhages  from,  III,  816;  popliteal,  injuries  of, 
III,  55;  haemorrhages  from,  III,  816;  ligations  of,  III,  383;  profunda 
femoris,  haemorrhages  from,  III,  816;  saphennus  wounds  of,  III,  15, 
55;  haemorrhages  from,  III,  816;  ligation  of.  Ill,  52 ;  subclavian,  shot 
wound  of,  I,  560;  haemorrhages  from,  III,  816;  accidentally  opened 
while  searching  for  artery,  I,  555 ;  ruptured,  I,  527 ;  temporal,  haemor 
rhage  from,  111,816;  tibial,  punctured  wound  of.  III,  7;  shot  wounds 
of,  III,  54  ;  wounds  of  veins  of  the  pelvic  cavity,  II,  338. 

Vena  Cava,  bayonet  wounds  of,  1,468;  shot  wounds  of,  I,  520,  606 ;  II,  139; 
haemorrhages  from,  III,  816. 

Venesection,  in  penetrating  wounds  of  the  chest,  I,  643-645;  in  wounds 
of  the  abdomen,  I,  207;  cases  of,  I,  280,  483,  485;  II,  76, 138,  155. 


Vertebrae,  incised  wound  of,  I,  425 ;  contusions  and  miscellaneous  injuries 
of,  I,  426;  shot  fractures  of,  I,  430;  shot  fractures  of  cervical,  I,  430; 
of  dorsal,  I,  433;  of  lumbar,  I,  441  ;  summary  of  shot  fractures  of,  I, 
452 ;  III,  689.  See  Spine. 

Vertebral  Artery,  shot  wounds  of,  I,  417,  421;  coat  of,  injured  by  ball 
lodging  against  it,  I,  355;  haemorrhages  from,  III,  764. 

Visceral  Protrusions,  after  penetrating  wounds  of  abdomen,  II,  180, 182, 
183,  184;  excision  of,  II,  7li;  return  of,  II,  94. 

Volar  Arteries,  haemorrhages  from,  III,  764 ;  ligations  of.  III,  765,  785, 
786. 

Vomiting,  from  the  effects  of  anaesthetics,  III,  897. 

Wheel  Litters,  III,  926. 

Windage  of  Balls,  alleged  traumatic  effects  of,  III,  706,  707;  to  bo  dis 
missed  from  the  domain  of  surgery,  I,  344,  385;  II,  28. 

Wire  Sutures,  HOWARD'S,  after  excisions  in  shaft  of  humerus,  II,  819; 
in  shot  fractures  of  femur,  III,  350  (note),  351. 

Worms,  Liumbricoid,  escape  of,  in  wounds  of  abdomen,  II,  42,  64,  68, 
71,  94,  195. 

Wounds,  of  entrance  and  exit,  III,  711;  caused  by  weapons  of  war,  III, 
685;  complications  of,  III,  762;  effects  of  climate  on  the  treatment  of, 
III,  867.  868.  See  Incised,  Punctured,  Sabre,  Bayonet,  and 
Shot  Wounds. 

Wrist,  shot  fractures  of,  H,  995 ;  III,  690,  870,  871 ;  treated  by  conserva 
tion,  II,  996;  III,  870;  followed  by  excision,  II,  999;  III,  870;  ampu 
tations  following  excisions  at  the,  III,  870,  871 ;  amputation  at,  for 
shot  fracture,  II,  1017 ;  III,  871 ;  artificial  apparatus  in  fractures  of, 
II,  998;  after  excisions,  11,1012,  1014,  1015;  dislocations  after  shot 
fractures  of,  II,  1002,  1005. 


o  o  :R:R  i  G-  :m  nsr  D  .A. . 


Page     2,  fifteenth  line,  for  454,  read  434. 

Page     8,  forty-third  line,  for  farroughed,  read  furrowed. 

Puge    24,  sixth  line,  for  XI,  read  XII. 

Page    24,' ninth  and  tenth  lines  of  Note  1,  for  A.  G.  D.,  read  A.  J.  D. 

Page   24,  tenth  line  of  Note  1,  for  1862.  read  1861. 

Page    26,  first  line  of  Note  1,  for  shussverletzungen,  read  schiissrerJttzwnge.n. 

Page    27,  first  line  of  Note  2,  dele  comma  after  anatomie. 

Page    47,  transpose  Notes  2  and  3. 

Page   50,  TABLE  IV,  No.  15,  for  CASE  107,  read  CASE  110. 

Page   58,  TABLE  VIII,  No.  32,  for  amputation  left  thigh,  read  amp.  left  leg. 

Page    G2,  fifty-fourth  line  of  Note  1,  for  p.  16,  read  p.  316. 

Page    63,  eighth  nonpareil  line,  for  26,  read  36. 

Page    03,  ninth  nonpareil  line,  for  16,  read  26. 

Page    82,  thirty-ninth  lino,  for  meager,  read  meagre. 

Page    87,  fifty -fifth  line,  for  J.  F.  Smith,  read  H.  P.  Smith. 

Pago    88,  eighth  line,  dele  the  hyphen  between  the  words  forty  and  days. 

Page  102,  ninth  line,  for  87th  New  York,  read  Sth  New  Jersey. 

Page  104,  description  of  FIG.  55,  for  right,  read  left. 

Page  128,  sixty-ninth  line,  for  1848,  read  1851. 

Page  130,  fifty-sixth  line,  for  Dominico  Ludovess,  read  Boaiso  Dominica. 

Page  130,  first  line,  for  for  wounds,  were,  read  were  for  wounds,  and  dele  the 
comma  after  the  word  wounds. 

Page  142,  first  line  of  Note  3,  for  Kinlock,  read  Kiriloch. 

Page  151,  TABLE  XVII,  No.  9,  for  C.  Warner,  read  C.  Wagner. 

Page  152,  eighteenth  line  of  Note  1,  for  Coxe's,  read  Cox's. 

Page  153,  description  of  FIG.  Ill,  for  Spec.  5614,  read  Spec.  5684. 

Page  156,  first  line  of  Note  1,  for  p.  26,  read  p.  17. 

Page  103,  first  line,  dele  the  word  or  after  Williamson. 

Page  108,  thirty-ninth  line  of  Note  2,  for  rezection,  read  rejection. 

Page  171,  first  line  of  Note  3,  for  Case  340,  read  Case  338. 

Page  174,  first  line  of  Note  3,  for  siege,  read  siige. 

Page  179,  Case  363,  seventeenth  line,  for  W.  S.  Small,  read  W.  G.  Small. 

Page  181,  Case  368,  thirty-third  line,  for  O.  H.  Hitchcock,  read  H.  O.  Hitch 
cock. 

Page  186,  Case  379,  second  line,  for  B.  Brinton,  read  B.  Stone. 

Page  188,  eleventh  line,  for  McCollom,  read  McCollum. 

Page  190,  sixteenth  line,  for  J.  M.  Gemrig,  read  J.  H.  Geinrig.- 

Page  191,  thirty-eighth  line,  for  eighty-six,  rend  sixty-eight. 

Pago  192,  twenty-fifth  line,  insert  after  Lidell  a  reference  to  Note  1 . 

Page  194,  Case  397,  third  line,  for  W.  A.  Childs,  read  W.  A.  Child. 

Page  195,  Case  399,  fourth  line,  for  Brenneman,  read  Brencman. 

Page  208,  TABLE  XXV,  No.  7,  for  Mosely,  read  Moseley. 

Page  209,  seventh  line,  for  T.  Fitzgerald,  read  P.  Fitzgerald. 

Page  210,  TABLE  XXVI,  No.  35,  for  Thomaine,  read  Thomain. 

Page  214,  Note  2,  sixth  line,  for  L.  Johnson,  read  C.  L.  Johnson. 

Page  215,  second  line  of  Case  429,  for  Jameson,  read  Jamison. 

Page  220,  TABLE  XXX,  No.  295,  for  L.  Barney,     =d  L.  Barnes. 

Page  222,  TABLE  XXX,  No.  509,  for  N.  Falf;.n,  read  N.  Folsom. 

Page  228,  TABLE  XXXT,  No.  119,  for  J.  M.  Rizer,  read  if.  Rizer. 

Page  232,  TABLE  XXXI,  No.  437,  for  J.  F.  Galloupe,  read  /.  F.  Galloupe. 

Page  232,  TABLE  XXXI,  No.  407,  for  J.  H.  Beach,  read  J.  H.  Beech. 

Page  234,  TABLE  XXXI,  No.  564,  for  D.  S.  Hayes,  read  D.  S.  Hays. 

Page  235,  TABLE  XXXI,  No.  663,  for  J.  H.  Beach,  read  J.  H.  Beech. 

Page  235,  TABLE  XXXI,  No.  684,  for  G.  W.  Simple,  read  G.  W.  Semple. 

Page  235,  TABLE  XXXI,  No.  703,  for  Spec.  4332,  read  Spec.  4232. 


Page  236,  TABLE  XXXI,  No.  790,  for  W.  0.  Meagher,  read  W.  O'Meagher. 
Page  237,  TABLE  XXXI,  No.  854,  for  H.  C.  Messenger,  56th  Ohio,  read  A. 

C.  Messenger,  57th  Ohio. 
Page  239,  TABLE  XXXI,  No.  1049,  for  A.  Surg.  M.  Rizer,  read  Snrg.  M. 

Rizer. 
Page  240,  TABLE  XXXI,  Nos.  1116  and  1119,  for  Surg.  C.  M.  Clarke,  read 

Surg.  C.  M.  Clark. 
Page  240,  TABLE  XXXI,  No.  1121,  for  Snrg.  W.  R.  Wray,  read  Surg.  W. 

R.  Way. 
Page  240,  TABLE  XXXI,  No.  1122,  for  Surg.  A.  M.  Dougherty,  read  Surg- 

A.  JV.  Dougherty. 

Page  240,  TABLE  XXXI,  No.  1140,  for  J.  F.  Kimbly,  read  J.  T.  Kimbly. 
Page  243,  forty-fourth  line,  for  middle,  read  lower. 

Page  244,  descriptions  of  Figs.  186  and  187,  for  Spec.  1966,  read  Spec.  2966- 
Page  246,  TABLE  XXXII,  No.  140,  for  H.  Taylor,  read  J.  H.  Taylor. 
Page  247,  TABLE  XXXIT,  No.  173,  for  J.  Owens,  read  J.  Owen. 
Page  257,  TABLE  XXXII,  No.  1052,  for  Spec.  3882,  read  Spec.  3832. 
Page  276,  TABLE  XXXIV,  No.  95,  for  Spec.  3895,  read  Spec.  3875. 
Page  276,  TABLE  XXXIV,  No.  105,  for  Spec.  4280,  read  Spec.  4820. 
Page  277,  TABLE  XXXIV,  No.  142,  for  Left,  read  Bight. 
Page  281,  TABLE  XXXV,  Nos.  55,  56,  transpose  the  remarks  in  the  third 

column  opposite  these  numbers. 

Page  285,  TABLE  XXXV,  No.  390,  dele  comma  after  word  ./Zap*. 
Page  286,  TABLE  XXXV,  third  column  heading,  for  opeeators,  read  operators. 
Page  288,  Case  405,  line  thirty,  for  p.  63,  read  p.  53. 

Page  288,  Case  466,  second  line,  for  C.  W.  Chamberlain,  read  C.  N.  Cham 
berlain. 

Page  290,  Case  470,  first  line,  for  J.  JV.  Saxon,  read  J.  JV.  Saxton. 
Page  295,  TABLE  XXXVI,  No.  140,  for  Spec.  182,  read  Spec.  1882. 
Page  296,  TABLE  XXXVI,  No.  198,  for  Vannetta,  read  Vannatta. 
Page  296,  TABLE  XXXVI,  No.  236,  for  116th  Pennsylvania,  read  HCth 

Ittinoit. 

Page  298,  TABLE  XXXVI,  No.  364,  for  Right,  read  Left. 
Page  301,  TABLE  XXXVI,  No.  571,  for  Saxon,  read  Saxton. 
Page  309,  third  line  of  Case  484,  for  Hatcbett,  read  Hatchitt. 
Page  313,  TABLE  XXXIX,  No.  11,  for  Disch'd  April  12,  1865,  read  Disch'd 

August  12,  1865. 

Page  314,  TABLE  XXXIX,  No.  92,  for  Vanvourst,  read  Vanvorst. 
Page  318,  line  four  of  Case  492,  for  J.  M.  Burr,  read  W.  J.  Burr. 
Page  336,  TABLE  XLVIH,  7th  line,  for  1739,  read  1743. 
Page  337,  forty-ninth  nonpareil  line,  for  1876,  read  1871,  and  for  B.  XXIII, 

read  B.  XXIV. 

Page  348,  second  line  of  Note  1,  for  Schrady,  read  Shrady. 
Page  351,  second  line  of  Case  497,  for  L.  W.  Reed,  read  L.  W.  Read. 
Page  372,  descriptions  of  Figs.  223  and  224,  for  Schenk,  read  Schenck. 
Page  373,  thirteenth  line,  for  272,  read  372. 

Page  449,  TABLE  LXIII,  No.  1,  third  column,  strike  out  the  words  leg  useful. 
Page  45?,  first  line  of  Note  2,  for  middle,  read  upper. 
Page  459,  TABLE  LXV,  No.  47,  for  large  portion  of  tibia  and  fibula,  read 

small  portion  of  fibula  above  malleolus. 

Page  464,  sixth  line  of  Case  727,  for  Spec.  4081,  read  Spec.  4018. 
Page  477,  TABLE  LXVIII,  No.  999,  for  Walters,  read  Waters. 
Page  586,  for  Case  385,  read  Case  835. 
Page  658,  description  of  Fig.  368,  for  fibula,  read  tibia. 
Page  838,  sixteenth  line,  for  Feburary,  read  February. 


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